Search  

Vol.4 No.2 - May/June 2010
Pick an issue
 

Departments

Research

Jan/Feb 2009 — Vol. 3, Iss. 1

Tobacco Habits Among Dental Students in Northern India

Utkal Mohanty, MDS; Hari Parkash, MDS, FDS RCPS (Glas); Anil Kohli, MDS, DNBE (USA), FDS RCS (UK)

Abstract
Objectives: The aim of the study was to assess the knowledge, attitude, and practice regarding tobacco use among dental students. Material and Methods: A sample of 579 students was selected by random sampling method. Students were supplied with a questionnaire containing a set of 15 close-ended questions. The completed questionnaires were collected and subjected to analysis with SPSS 10. Results: Of 515 respondents, 94 (18.2%) were smokers, 31 (6.01%) were tobacco chewers, and 23 (4.4%) were both chewers and smokers. Approximately 40% of the tobacco users started using tobacco before joining the professional course and 60% started after joining. Peer pressure was found to be the most prevalent cause (36%) of tobacco use among the students. 77% of the students were of the opinion that tobacco products are very easily available near the college. 87% of the students believed that tobacco use increases the risk of heart disease. Conclusion: Tobacco products are very easily available near the college campus, which needs to be addressed to curb tobacco use among the students. Dental students need to be trained regarding anti-tobacco counselling.

Introduction
Oral cancer is an important public health issue. Cancer prevalence in India is estimated to be around 2.5 million, with over 800,000 new cases and 550,000 deaths occurring annually.12 The oral cavity is a common site for cancer for both men and women in India. Tobacco use is a fast growing behavior which is to be observed not only in the general population, but also among health professionals (medical and dental).

Therefore, there is a need to study the attitude regarding tobacco use among the health professionals, which can provide ideas regarding the cause of tobacco use and the prevailing knowledge among the newcomers to the dental profession. Because oral cancer is associated with tobacco use, many cases could probably be prevented with appropriate behavior modification among the dental students, which in turn will motivate the patients.

Material and Methods
A group of 579 dental students were selected, comprised of first year to final year students, and interns. A questionnaire consisting of 15 questions was provided to each of the selected students. The number of respondents was 515 out of 579. The completed questionnaires were subjected to analysis by using SPSS 10.

Results
A. Age distribution of the studentsin the sample

  • 18 years old: 124 students
  • 19 years old: 118 students
  • 20 years old: 80 students
  • 21 years old: 82 students
  • 22 years old: 78 students
  • 23 years old: 33 students

Sex-wise distribution of the students in the sample
Out of 515, 258 (50.10%) were males and 257 (49.90%) were females (Table 1 and Figure 1 View Figure).

B. Sex-wise distribution of the students according to tobacco use:
Of the 515 students, 94 (18.25%) smoked and 31 (6.02%) chewed tobacco. Of the smokers, 87 (92.55%) were men, 7 (7.45%) were women (Table 2 and Figure 2 View Figure). All the tobacco chewers were men. There were 23 (4.47%) students who both smoked and chewed tobacco.

C. Distribution according to start of using tobacco products in relation to academic year
Of 125 tobacco users, 51 (40.8%) students responded that they had begun using tobacco products before joining the professional course. The remaining 74 (59.2%) had begun using tobacco after joining the professional course. It was found that 6 students (8.11%) had begun using during first year, 14 (18.92%) had begun in second year, 22 (29.73%) during the third year, 24 (32.43%) during the final year, and 8 (10.81%) during the internship of their professional course (Table 3 and Figure 3 View Figure).

D. Causes of tobacco use among the students
Of 125 tobacco users, 15 (12%) started using due to curiosity, 27 (21.6%) had started due to pleasure, 45 (36%) had started out of peer pressure, 17 (13.6%) had started out of stress, and 3 (2.4%) did not know the cause of starting the use. About 3 (2.4%) had responded that both curiosity and pleasure were the cause of starting tobacco use. Another 3 (2.4%) responded that they did it out of curiosity, pleasure, and stress as well. 12 (9.6%) responded pleasure, peer pressure, and stress as the cause of starting tobacco use (Table 4 and Figure 4 View Figure).

For 37 students (29.6%), film actors were a source of inspiration for beginning tobacco use. 44 (35.2%) were inspired by friends, 33 (26.4%) were inspired by family members. 11 (8.8%) did not have any source of inspiration for starting tobacco use. Approximately 12 students (9.6%) felt fatigue after using tobacco products, 55 (44%) felt self-rewarding, 52 (41.6%) felt refreshed, and 6 (4.8%) did not feel anything after using tobacco.

Approximately 34 students (27.2%) spent less than Rs100 per month on tobacco products, 27 (21.6%) spent less than Rs200, 23 (18.4%) spent less than Rs300, and 41 (32.8%) spent more than Rs300.

397 (77.09%) responded that tobacco products were easily available near the college, but 103 (19.81%) responded that they were not available near the college. 16 (3.11%) did not respond to the question.

E. Exposure to secondhand smoke among the students
226 (43.88%) of the students have experienced secondhand smoke in some places as compared to 289 (56.12%) who responded that they have not experienced secondhand smoke. When the location of the secondhand smoke was analyzed, 17 (7.52%) occurred at home, 45 (19.91%) at a hostel, 154 (68.14%) at public places, and 10 (4.42%) at all the above mentioned places (Table 5 and Figure 5 View Figure).

436 students (84.66%) were of the opinion that using tobacco products in public places should be banned completely, whereas 79 (15.34%) were of the opinion not to ban it in public places.

F. Effect of tobacco use on general health
Among the 515 students, 448 (86.99%) were aware that using tobacco products is harmful to the health of an individual. but 67 (13.01%) did not have any awareness of this issue (Table 6 and Figure 6 View Figure).

221 (42.91%) responded positively to the question regarding smoking during pregnancy having adverse effect on the fetus, but 189 (36.7%) responded negatively to the same question. Of the sample, 105 (20.39%) failed to respond to the question.

G. Risk of developing cancer due to use of tobacco
When asked about the use of tobacco and risk of cancer, 415 (80.58%) responded positively, and 43 (8.35%) responded negatively. Of the group, 57 (11.07%) did not respond to the question (Table 7 and Figure 7 View Figure).

342 (66.4%) of the students had knowledge regarding the harmful effect of tobacco use on the heart, but 53 (10.3%) responded negatively to the question. 120 (23.3%) had no idea about the association between tobacco use and heart disease.

H. Risk of developing periodontal disease due to tobacco use
The response to the question about tobacco use and development of periodontal disease was affirmative by 315 (61.17%) students, and negative by 165 (32.04%) students. 35 students (6.8%) did not respond to the question (Table 8 and Figure 8 View Figure).

I. Role of dentist in tobacco cessation program
408 (79.22%) of the students responded positively regarding the role of the dentist in the cessation of the tobacco habit among the patients, but 88 (17.09%) did not feel that dentists have any role to play in this situation. 19 (3.69%) did not respond to the question (Table 9 and Figure 9 View Figure).

J. Interest of dental students regarding anti-tobacco counselling
Most of the students, ie 416 (80.78%), were interested in receiving training regarding anti-tobacco counselling, but 82 (15.92%) did not show any interest. Of the students, 17 (3.3%) did not respond to the question (Table 10 and Figure 10 View Figure).

189 (36.7%) of the students had knowledge regarding nicotine replacement therapy, but 309 (60%) did not have any knowledge regarding this therapy, and 17 (3.3%) did not respond to the question.

Discussion
In this study, of 515 students, 258 (50.09%) were male, 257 (49.91%) were female. Around 24.2% (18% smokers, 6% chewers) of the students were tobacco users in some form or another, as compared to 13.7% in the report published by Global Health Professional Survey (GHPS) of India 2005.12 This shows a slightly higher prevalence of tobacco use among dental students in the present study. In another study conducted in a Tokyo dental school, the smoking prevalence was found to be 19.4%.2

In the present study, among the smokers, 92.6% were male and 7.5% were female, but 100% of the chewers were male. The GHPS report also shows tobacco use to be a male prevalent condition.12 In a similar study by Furukawa et al, the male–female distribution was shown to be 91.3% and 8.7% respectively.2,4

Among all the tobacco users (n=125), 51 (40.8%) had begun before joining the professional course and 74 (59.2%) had started using after joining the professional course. The study conducted at Tokyo Dental School by Furukawa et al showed 43% of the current tobacco users started before entering the university.2,5,8

In the present study, an trend of increasing tobacco use was found from the first year to the final year. Similar findings were made by the Furukawa study conducted in the Tokyo Dental School.2

The current study shows 43.9% of the students have experienced secondhand smoke somewhere, which is less than 60% exposure as reported by GHPS in 2005.

79% of the students agreed to receive training regarding a tobacco cessation program in the current study, which is similar to the findings in a study conducted by Fried et al, in which at least 70% of students from health professions programs agreed that it was their professional responsibility to help smokers quit.13 Similar findings were made in a study conducted by Polychonopoulou et al6 in which more than 80% of the dental students considered tobacco cessation counselling a duty of every dentist.

About 85% students responded to ban the use of all kinds of tobacco products in public places, as compared to 90% response in the 2005 GHPS of dental students in India.12

In this study, 87% of the students had awareness regarding the harmful effects of tobacco on health, as compared to 92% reported by GHPS in dental students in India.12 However, dental students lack a certain knowledge about the harmful effect of tobacco on general health and well being of patients.

About 81% of the students were interested in receiving training regarding anti-tobacco counselling as compared to 70% in the study conducted by Fried et al.13

Conclusion
This study shows 24.2% (125 out of 515) dental students were tobacco users, of which more than 95% were male. Smoking is a more common form of tobacco use than chewing is. The trend of using tobacco products increases with the progression of academic years, which may be correlated to increasing stress due to the curriculum. Most of the dental students feel that it is their responsibility to promote tobacco cessation among patients and are interested in receiving the required training. Although the dental students have knowledge regarding harmful effects of tobacco, a significant percentage of students are habituated to it because of lack of motivation.

Recommendation
There is a necessity to train dental students regarding anti-tobacco counselling during their professional course, which will make them more confident in a tobacco cessation program.

Bibliography
1. Barker JG, Williams KB. Tobacco cessation activities in U.S. dental and dental hygiene students’ clinics. J Dent Educ. 1999;63(1):828-833.

2. Furukawa S, Tokunaga R, Abe S, Shinada K, Kawaguchi Y. Dental students’ smoking behavior and their attitude towards smoking. Kokubyo Gakkai Zasshi. 2005;72(3):201-208.

3. Victoroff KZ, Dankulich-Huryn T, Haque S. Attitudes of incoming dental students toward tobacco cessation promotion in the dental setting. J Dent Educ. 2004;68(5):563-568.

4. McCartan B, McCreary C, Healy C. Attitudes of Irish dental, dental hygiene and dental nursing students and newly qualified practitioners to tobacco use cessation: a national survey. Eur J Dent Educ. 2008;12(1):17-22.

5. Rikard-Bell G, Groenlund C, Ward J. Australian dental students’ views about smoking cessation counseling and their skills as counselors. J Public Health Dent. 2003;63(3):200-206.

6. Polychonopoulou A, Gatou T, Athanassouli T. Greek dental students’ attitudes toward tobacco control programmes. Int Dent J. 2004;54(3): 119-125.

7. Albert DA, Severson H, Gordon J, Ward A, Andrews J, Sadowsky D. Tobacco attitudes, practices, and behaviors: a survey of dentists participating in managed care. Nicotine Tob Res. 2005;7(Suppl 1):9-18.

8. Weaver RG, Whittaker L, Valachovic RW, Broom A. Tobacco control and prevention effort in dental education. J Dent Educ. 2002;66(3): 426-429.

9. Christen AG. Tobacco cessation, the dental profession, and the role of dental education. J Dent Educ. 2001;65(4):368-374.

10. Koerber A, Crawford J, O’Connell K. The effects of teaching dental students brief motivational interviewing for smoking-cessation counseling: a pilot study. J Dent Educ. 2003;67(4): 439-447.

11. Yip JK, Hay JL, Ostroff JS, Stewart RK, Cruz GD. Dental students’ attitudes toward smoking cessation guidelines. J Dent Educ. 2000; 64(9):641-650.

12. Shah M. Health professionals in tobacco control: evidence from Global Health Professional Survey (GHPS) of dental students in india. GHPS Fact Sheet. World Health Organization, 2005.

13. Fried JL, Reid BC, DeVore LE. A comparison of health professions student attitudes regarding tobacco curricula and interventionist roles. J Dent Educ. 2003;68(3):370 -377.

 
Table 1   Figure 1
     
 
Table 2   Figure 2
     
 
Table 3   Figure 3
     
 
Table 4   Figure 4
     
 
Table 5   Figure 5
     
 
Table 6   Figure 6
     
 
Table 7   Figure 7
     
 
Table 8   Figure 8
     
 
Table 9   Figure 9
     
 
Table 10   Figure 10