Cross-Sectional Study to Estimate Dependence among Tobacco Smokers Attending a Tertiary Care Government Hospital in Bhavnagar, Western India

Authors

  • Bansi Jabakbhai Trivedi Government Medical College, Bhavnagar
  • Atul vishnubhai Trivedi Government Medical College, Bhavnagar
  • Mihir Prafulbhai Rupani Government Medical College, Bhavnagar

DOI:

https://doi.org/10.5455/njcm.20210529040045

Keywords:

Smoking, Dependence, Risk factors, Fagerstrom Test, Nicotine Dependence

Abstract

Background: India is one of the countries where addiction to tobacco smoking is rampant. The consumption of tobacco products is quite high in the Bhavnagar region in the western part of India.

Methods: We conducted a cross-sectional hospital-based study among 112 current tobacco smokers aged ≥18 years in April-May 2019 at Sir Takhtsinhji hospital in Bhavnagar. Fourteen smokers from each ward of the hospital were enrolled from eight randomly selected wards. Dependence was assessed using the Fagerstrom Test for Nicotine Dependence, with a score of ≥5 labelled as high dependence.

Results: Among the 112 current smokers, 79% (95% confidence interval 70%-85%) were dependent on tobacco smoking. One-fourth of the smokers belonged to the age group of 51-60 years.“Mawa” (a mixture of tobacco, betel nut and lime) was the most commonly consumed smokeless form of tobacco among the smokers. Mean expenditure on tobacco smoking was Indian Rupees 460. Those who had stress had 7 times higher odds (95% CI 3-23) of being dependent on tobacco smoking than their counterparts.

Conclusion: We conclude from the study that patients attending our hospital are highly dependent on tobacco smoking. Tobacco cessation activities in the form of provider-initiated counselling and treatment is warranted. Further research should focus on evaluating the implementation modalities and effectiveness of such provider-initiated activities.

References

Mendelsohn C. Nicotine dependence: why is it so hard to quit? MedicineToday. 2011 Oct;12(10):35–40.

Mackay j,Eriksen M. The Tobacco Atlas. Geneva: World Health Organization; 2002. Available from: . [Last accessed on 2016 Jan 16]. [Internet]. 1st ed. WHO; Available from: http://www. who.int/tobacco/resources/publications/ tobacco_atlas/en/

GATS2 (Global Adult Tobacco Survey) Fact Sheet, India, 2016-17. :4.

Kahar P, Misra R, Patel TG. Sociodemographic Correlates of Tobacco Consumption in Rural Gujarat, India. BioMed Res Int. :9.

National Family Health Survey (NFHS-4). Mumbai IIPS: Inter-national Institute for Population Sciences Deonar, Mumbai and ICF; 2015. 671 p.

Manimunda SP, Benegal V, Sugunan AP, Jeemon P, Balakrishna N, Thennarusu K, et al. Tobacco use and nicotine dependency in a cross-sectional representative sample of 18,018 individuals in Andaman and Nicobar Islands, India. BMC Public Health. 2012 Jul;12(515):11.

Chacko L, Chandanwale A, Jarali A. Assessment of nicotine dependency among adults at selected areas of Wagholi, Pune. Int J Curr Adv Res. 2018 May;7(5):12938–42.

Rushender CR, Ramraj B, Ganesan DK, Ashiq M. Prevalence of Nicotine Dependence among Men Aged 21–60 Years in the Ru-ral Field Practice Area of a Tertiary Care Hospital in Tamil Nadu, India. J Lifestyle Med [Internet]. 2018 Jul [cited 2019 Sep 6];8(2):105–9. Available from: https://www.ncbi.nlm.nih.gov/ pmc/articles/PMC6239139/

Cosci F, Pistelli F, Lazzarini N, Carrozzi L. Nicotine dependence and psychological distress: outcomes and clinical implications in smoking cessation. Psychol Res Behav Manag [Internet]. 2011 Sep 12 [cited 2020 Oct 28];4:119–28. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3218785/

Jayakrishnan R, Mathew A, Lekshmi K, Sebastian P, Uutela A. Assessment of Nicotine Dependence among Smokers in a Se-lected Rural Population in Kerala, India. Asian Pac J Cancer Prev. 13:2663–7.

Aryal UR, Bhatta, DN, Shrestha N, Gautam A. Assessment of nicotine dependence among smokers in Nepal: a community based cross-sectional study. Tob Induc Dis. 2015;13(1):1–8.

Pérez-Ríos M, Santiago-Pérez M, Alonso B, Malvar A, Hervada X, de Leon J. Fagerstrom test for nicotine dependence vs heavy smoking index in a general population survey. BMC Public Health. 2009;9:1–5.

Põld M, Pärna K. Nicotine Dependence and Factors Related to Smoking Cessation among Physicians in Estonia. Int J Env Res Public Health. 2020;17(9):1–10.

Grant BF, Hasin DS, Chou SP, Stinson FS, Dawson DA. Nicotine Dependence and Psychiatric Disorders in the United States. ARCH GEN PSYCHIATRY. 2004;61:9.

Chawla G, kansal A, Chopra V, kaur K, Kumar N. Nicotine de-pendence and readiness to quit smoking in the North Indian population. Eur Respir J. 2014 Dec 23;44(58):4173.

Sugavanesh P, Pushpanjali K. Nicotine Dependence, Its Risk Indicators, and Exhaled Carbon Monoxide Levels among the Smokers in Bengaluru, India. Indian J Community Med Off Publ Indian Assoc Prev Soc Med [Internet]. 2018 [cited 2019 Aug 29];43(3):220–3. Available from: https://www.ncbi.nlm.nih. gov/pmc/articles/PMC6166501/

International Institute for Population Sciences; Ministry of Health and Family Welfare; Government of India. Gujarat (In-dia) Factsheet: Global Adult Tobacco Survey 2009 2010. New Delhi: International Institute for Population Sciences; 2010.

Registrar General of India. Ministry of Home Affairs. Govern-ment of India., 2011. Census of India 2011 - District Census Handbook Bhavnagar: Primary Census Abstract. Government of India, New Delhi. [Internet]. [cited 2021 Apr 18]. Available from: https://censusindia.gov.in/2011census/dchb/2414_ PART_B_DCHB_BHAVNAGAR.

Duong M, Rangarajan S, Zhang X, Killian K, Mony P, Swamina-than S, et al. Effects of bidi smoking on all-cause mortality and cardiorespiratory outcomes in men from south Asia: an observational community-based substudy of the Prospective Urban Rural Epidemiology Study (PURE). Lancet Glob Health [Internet]. 2017 Feb 1 [cited 2019 Sep 5];5(2):e168–76. Available from: https://www.thelancet.com/journals/langlo/article/ PIIS2214-109X(17)30004-9/abstract

Heatherton TF, Kozlowski LT, Frecker RC, Fagerström KO. The Fagerström Test for Nicotine Dependence: a revision of the Fagerström Tolerance Questionnaire. Br J Addict. 1991 Sep;86(9):1119–27.

Patel P, Rupani M, Gajera A. Dependence on smokeless tobacco and willingness to quit among patients of a tertiary care hospital of Bhavnagar, Western India. Indian J Psychiatry [Internet]. 2019 [cited 2019 Oct 3];61(5):472–9. Available from: http://www.indianjpsychiatry.org/text.asp?2019/61/5/472/265893

Preeti S, D.K. R. Prevalence and Pattern of Tobacco Consump-tion in India. Int Res J Soc Sci [Internet]. 2012 Dec;1(4):36–43. Available from: www.isca.in

Sinha DN, Narain JP, Kyaing NN, Rinchen S. WHO Framework Convention on Tobacco Control and its Implementation in South-East Asia Region. Indian J Public Health. 2011; 55(3): 184–91.

The Cigarettes and other tobacco products (Prohibition of advertisement and regulation of trade and commerce, production, supply and distribution) ACT, 2003. :1–15.

Põld M, Parna K. Smoking prevalence and attitudes towards smoking among Estonian physicians: results from cross-sectional studies in 2002 and 2014. BMJ Open [Internet]. 7(11):1–8. Available from: (http:// dx. doi. org/ 10. 1136/ bmjopen- 2017- 017197).

Islam K, Datta AK, Seth S, Roy A, Das R. A study on the preva-lence and correlates of nicotine dependence among adoles-cents of Burdwan Town, West Bengal.Indian J Psychiatry. 2019;61(1):89–93.

Divinakumar KJ, Patra P, Prakash J, Daniel A. Prevalence and patterns of tobacco use and nicotine dependence among males industrial workers. Ind Psychiatry J. 2017;26(1):19–23.

Parashar M, Agarwalla R, Mallik P, Dwivedi S, Patvagekar B, Pathak R. Prevalence and correlates of nicotine dependence among construction site workers: A cross-sectional study in Delhi. Lung India. 2016;33(5):496-501.

Sharma M, Sharma P. Need for validation of Fagerstrom Test for Nicotine Dependence in Indian Context: Implications for Nicotine Replacement Therapy. Indian J PsyChol Med [Inter-net]. 2016 Apr; 38(2):105–8. Available from: https://www. ncbi.nlm.nih.gov/pmc/articles/PMC4820547/#

Saddichha S, Khess CRJ. Prevalence of Tobacco Use among Young Adult Males in India: A Community-Based Epidemiological Study. Am J Drug Alcohol Abuse. 2010;36:73–7.

Mony PK, Rose DP, Sreedaran P, D’Souza G, Srinivasan K. To-bacco cessation outcomes in a cohort of patients attending a chest medicine outpatient clinic in Bangalore city, southern India. Indian J Med Res. 2014;523–30.

Naik BN, Majella MG, Parthibane S, Kar SS. Level of tobacco dependence among tobacco users in an urban slum of Pudu-cherry: A pilot study. J Fam Med Prim Care. 2017;6(2): 336–9.

Sankaran A. A Study of Prevalence and Clinical Correlates of Nicotine Dependence among Patients with Bipolar Disorder. Int J Contemp Med Res. 2019;6(6):21–5.

Joshi U, Modi B, Yadav S. A Study on Prevalence of Chewing Form of Tobacco and Existing Quitting Patterns in Urban Pop-ulation of Jamnagar, Gujarat. Indian J Community Med. 2010;35(1):105–8.

Saha I, Islam K, Paul B, Som TK. Nicotine dependence and its correlates among the adult tobacco users in a slum of Burd-wan district, West Bengal, India. J Fam Med Prim Care. 2017;6(4):813–8.

Chinwong D, Mookmanee N, Chongpornchai J, Chinwong S. A Comparison of Gender Differences in Smoking Behaviors, In-tention to Quit, and Nicotine Dependence among Thai Univer-sity Students. J Addict [Internet]. 2018 [cited 2019 Nov 16];1–8. Available from: https://www.hindawi.com/journals/ jad/2018/8081670/

Islam K, Saha I, Saha R, Khan SAS, Thakur R, Shivam S. Predic-tors of quitting behaviour with special reference to nicotine dependence among adult tobacco-users in a slum of Burdwan district, West Bengal, India. INDIAN J MED RES. 2014;638–42.

Fagerström KO, Kunze M, Schoberberger R, Breslau N, Hughes JR, Hurt RD. Nicotine dependence versus smoking prevalence comparosons among countries and categories of smokers.Tobacco control 1996;5:52-56. Tob Control. 1996;52–6.

Saha I, Islam K, Paul B, Som TK. Tobacco related morbidity and nicotine dependence: An experience in an urban slum of Burdwan district, West Bengal, India. J Educ Health Promot. 2018;7:1–4.

Gupta N. Nicotine dependence among workers: Is it a time for smoke free workplaces. Lung India. 2016;33(5):477–8.

Gallus S, Pacifici R, Colombo P, La Vecchia C, Garattini S, Apo-lone G, et al. Tobacco dependence in the general population in Italy. Ann Oncol [Internet]. 2005 May 1 [cited 2019 Sep 5]; 16(5):703–6. Available from: http://academic.oup.com/ an-nonc/article/16/5/703/150269/Tobacco-dependence-in-the-general-population-in

Kumar R, Haokip HR, Beniwal K, Bahurupi Y. Nicotine Depen-dence, Readiness to Change Behavior among Tobacco Users Attending Tertiary Care Hospital’s De Addiction Clinic in Uttarakhand. :7.

Quraishi R, Jain R, Balhara YPS. Profile of Nicotine Use Among Alcohol Dependent Patients Visiting a Tertiary Care Center in North India. Indian J Psychol Med. 2014;36(2):5.

Mohamed Izham Mohamed Ibrahim , Nagmeldien Ahmed Mo-hammed Magzoub , Norlela Maarup . University-Based Smok-ing Cessation Program Through Pharmacist-Physician Initia-tive: An Economic Evaluation. Journal of Clinical and Diagnos-tic Research.2016;10(2): LC11-LC15

George D’Souza, Dorothy P. Rekha, Priya Sreedaran, K. Srinivasan, and Prem K. Mony. Clinico-epidemiological profile of tobacco users attending a tobacco cessation clinic in a teaching hospital in Bangalore city. Lung India. 2012 Apr-Jun; 29(2): 137–142

Carson KV, Brinn MP, Peters M, Veale A, Esterman AJ, Smith BJ. Interventions for smoking cessation in Indigenous populations. Cochrane Database of Systematic Reviews. 2012(1).

Downloads

Published

2021-06-30

How to Cite

1.
Trivedi BJ, Trivedi A vishnubhai, Rupani MP. Cross-Sectional Study to Estimate Dependence among Tobacco Smokers Attending a Tertiary Care Government Hospital in Bhavnagar, Western India. Natl J Community Med [Internet]. 2021 Jun. 30 [cited 2024 May 4];12(06):133-9. Available from: https://www.njcmindia.com/index.php/file/article/view/372

Issue

Section

Original Research Articles