Tobacco Awareness with Socioeconomic Status and Pictorial Warning in Tobacco Cessation: An Exploratory Institutional Survey in a Semi-urban Population

Abstract

To explore the impact of socioeconomic status (SES) and/on the awareness of ill effects of tobacco on oral and general health and to evaluate the effectiveness of pictorial warning on tobacco cessation in a semi-urban population of South Chennai. This cross-sectional survey for 1 week was conducted using a two-stage sampling design, with a sample size of 300. New op patients constitute the first sampling design, and patients with history of any form of tobacco constituted second sampling design for the second part of the study. Following an informed consent in patient's own language, and as per inclusion criteria's, new op patient was interviewed with questionnaire 1, which comprised 27 closed-ended questions to assess subject's general awareness on tobacco, awareness of ill effects of tobacco on oral and general health, and their SES. Sociodemographic information such as age, sex, marital status, occupation, address, educational level, and family income per month was also recorded. Response categories for each of the questions were "yes", "no", and "don't know". The Questionnaire-2 comprised 8 closed-ended questions that assessed the subject's willingness to quit and to evaluate the effectiveness of pictorial warning on tobacco cessation, which was subjected only to those patients who had a history of tobacco usage which was recorded after completing the Questionnaire-1. This group formed the secondary sampling unit. Questionnaire-2 also included an individual suggestion for the preference of type of warning sign on the tobacco packet/sachet in the end. Statistically, Cronbach's α coefficient, one-way analysis of variance, Tukey HSD post hoc tests, and Chi-square test were used. On the whole, this study reported good awareness about harmful effects of tobacco. In all, 33.2% of respondents could not change after noticing the warning ads, 90.3% of our respondents are not aware that a professional help is available to motivate quitting. Smokers were more aware than smokeless tobacco users, and tobacco users recommended a greater area to be covered for pictorial warnings and to increase the frequency to change the pictorial warning signs. Alarmingly high statistics and delayed presentation of oral and health hazards at the time of primary diagnosis underscores the need for an extensive awareness campaign on the issues related to ill effects of tobacco more focused on tobacco user's perspective and feedback. Health awareness programs related to awareness of ill effects of tobacco should be tailor-made to the targeted population and should be more focused on the control of specific risk factors. Health warnings on tobacco packages that combine text and pictures, along with the frequent role of impact of mass media and campaigns on mouth self-examination and improvement in quality of life can effectively increase the general public awareness of the serious and deleterious health risks of tobacco use and to reduce its consumption.