Incidence of Tobacco Use High in Rural Kerala, Study Report

“The study conducted in rural areas of Thiruvananthapuram district brings out that while 21.1 percent of young men (15-24 years) are prone to the smoking habit, 22.2 percent of men between the ages of 55 and 64 gravitated towards smokeless tobacco products over seven years.” 

TechnoparkToday.com>>  August 31 – The first-ever study on the incidence of tobacco use in India, even while signalling caution and determined action, has recommended effective implementation of Cigarettes and Other Tobacco Products Act (COTPA), 2003 to tackle the worrisome incidence of tobacco use.

The findings of the study have been summarised in an article titled ‘Incidence of Tobacco Use Among Adults (15-64 years) in Rural Kerala’ published in a recent edition of Asia-Pacific Journal of Public Health. Dr T Sathish, Dr Srinivasan Kannan, Dr P Sankara Sarma and Dr KR Thankappan of the Sree Chitra Tirunal Institute for Medical Sciences and Technology here are behind the study.

The cohort study evaluated the incidence of current smoking and current smokeless tobacco use over a seven-year period in a sample of 452 males and females aged 15 to 64 years using the World Health Organisation’s STEPS approach. The STEPS approach is an instrument of chronic disease risk factor surveillance and has three steps, viz., questionnaire, physical measurements and biochemical measurements.

At the start of the study in 2003, of the total of 452 persons, 385 were current nonsmokers and 402 were current nonusers of smokeless tobacco. A follow-up conducted in 2010 showed that 14.3 percent and 14.2 percent men became current smokers and current smokeless tobacco users respectively.

Current smokers and current smokeless tobacco users are defined as those who had used any of these products in the last 30 days. Smoking products include cigarettes and bidis while smokeless tobacco products included in the study are snuff, betel quid with tobacco, gutkha or khaini.

Incidence of smoking or the measure of risk of acquiring the habit has been obtained by dividing the number of new current smokers at follow-up by the number of current nonsmokers during baseline. A similar process was followed to understand the incidence of smokeless tobacco use. Incidence of current smoking and current smokeless tobacco use is of initiation and/or relapse.

The study also throws up the trend of smokeless tobacco use among women; 9.7 per cent of older women (55-64 years) became current smokeless tobacco users.

While there is seen a shift of preference from smoking to smokeless tobacco among men; it does not however translate itself to total abstinence from smoking. A high 45.5 per cent continued smoking even when they took up smokeless tobacco use. Again, none of the new smokeless tobacco users quit its use when they took up smoking.

Principal author Dr Sathish said, “COTPA is quite a unique legislation. Besides comprehensively listing the dos and don’ts for effective tobacco control, COTPA can be a very powerful tool for prevention of lifestyle diseases. Painfully, Kerala is leading in various non-communicable and lifestyle diseases and tobacco control through rigorous enforcement of COTPA will heavily contribute in bringing down this preventable burden. The state was chosen for the study as the epidemiological transition is more advanced here than other states of India.”

COTPA has well-thought-after provisions to not just prevent initiation of tobacco use by prohibiting sale of tobacco products to and by minors, but also to quell any enticements to tobacco use by prohibiting advertisements and displays.

“Alongside strict enforcement of the tobacco control legislation, a uniform taxation structure across all forms of tobacco will also help deter use,” added Dr Sathish who is doing his PhD at the School of Public Health and Preventive Medicine, Monash University, Australia.