INTRODUCTION Tobacco use is detrimental at any time. However, it is proving to be more dangerous during the COVID-19 pandemic. Tobacco use may increase the risk of being infected, increases the chances of complications, and also increases the probability of its spread. We assessed the awareness about this association and the impact of the lockdown on tobacco use among tobacco users registered before the lockdown for LifeFirst, a tobacco dependence treatment program. METHODS 1016 tobacco users were under active follow-up in their course of the 6-month counselling program. From 14 to 28 May 2020, 650 (64%) of these registered users were contacted by counsellors for follow-up sessions over the telephone. Semi-structured questionnaires were filled in during the calls. RESULTS Two-thirds (67%) of tobacco users were unaware of the association between tobacco and COVID-19. Only 30% of the users felt that the current situation had affected their tobacco use, the commonest impacts being unavailability and increased prices of tobacco products. While this was seen as an opportunity to quit by some users, some reported increased tobacco use due to increased stress. Of the 219 (34%) tobacco users who quit tobacco during the lockdown, 51% quit because of the lockdown and their concern over COVID-19. Abstinence among those who were aware of the association between the coronavirus and tobacco was twice that among those who were not aware. CONCLUSIONS Awareness activities about the harmful effects of tobacco during the coronavirus pandemic have to be strengthened. Measures to motivate and support tobacco users to quit have to be provided through cessation services.
Introduction Areca nut, commonly known as supari, is widely used in India. In addition to tobacco and alcohol, it has been identified as one of the contributory factors for high rates of oral cancer in the country. Methods This qualitative study explored perceptions and practices around the use of areca nut by conducting in-depth interviews and focus group discussions with 61 school-going adolescents in the city of Mumbai, India. Results Respondents used low-priced sachets of sweetened, flavored areca nut called supari. They perceived supari as harmless because it was sweet, it had a fresh after-taste as compared to bitter-tasting smokeless tobacco products. How can something sweet be harmful was a common argument offered by respondents. Respondents invariably compared and contrasted areca nut to more harmful and addictive tobacco products; perceiving supari to have milder or inconsequential health effects. Supari use was initiated with friends, a sibling or cousin. It was almost always used with friends. Respondents also reported difficulty in refusal to use when offered supari by friends. Parental response to finding out about the child’s supari use was often muted in comparison to extreme reactions associated with child’s tobacco use. Conclusions Perceptions of low risk or relative harmlessness of the product, social influence and the features of the product itself influence adolescents’ use of areca nut. Although more research on perceptions of risk, with larger samples, is required, these findings are useful for school-based tobacco prevention and cessation programs and health policy-makers. Implications The study findings have implications for prevention and cessation programs, and policy makers. School-based health education programs should allocate special sessions on areca nut use. Focused mass media communication campaigns describing its harms and association with oral cancer are required for the larger community. As was done for tobacco, Indian policy-makers will have to evaluate the marketing, commerce, and distribution of areca nut and create appropriate laws. More research, with larger nationwide samples, is required to examine perceptions of areca nut.
Objective: Areca nut use, along with tobacco, is a contributor to India's high rates of oral cancer. Areca nut use is culturally accepted, often initiated early in adolescence, and said to lead to later tobacco use. Unlike tobacco prevention, there are scarce prevention or harm-reduction programmes or campaigns specifically targeted at areca nut. Methods: A participative ranking method was used to understand adolescents' assessment of risks of areca nut. Five focus group discussions were conducted with 31 adolescents, 19 fe-male and 12 male, non-users and users of chewing tobacco, water-pipe (hookah) and areca nut. Participants categorized and ranked the risk of 16 activities, including the use of areca nut and various tobacco-products, and discussed reasons for these risk-rankings. Results: Despite differences between groups on the assessment of risks associated with the 16 different activities, all the groups, user and non-user, rated cigarette smoking as having the highest risk, chewing fennel and using mouth fresheners as no risk, and areca nut as low risk. The other activities were ranked differently by each group. Adolescents' perceptions of smoking or online games as risky was influenced by greater exposure to messaging on harmful consequences of the activity through multiple channels such as mass media, interpersonal networks including parents, and classroom health-education sessions. Inadequate knowledge about the harmful consequences of areca nut use, greater social and cultural acceptability, and the sweet taste of commercially packaged areca nut influenced low-risk perceptions. Conclusion: Perceptions of risk from an activity often determines preventive behaviors. Presently, adolescents do not perceive areca use as risky. In comparison to smoking they con-sider it less harmful. More research is required to better understand areca nut use and its cul-tural determinants. However, targeted health communication messages and prevention poli-cies and programmes have to be initiated to reduce areca nut use and associated burden of oral cancer.
Introduction: Areca nut, initiated in adolescence, is considered a gateway for tobacco use and an important cause of oral cancers in India. This study examined differences in sociodemographic factors, attitudes and beliefs, and tobacco use between current (last 30 days) areca nut users and past users, who have ever used areca but not in the last 30 days. Material and Methods: A cross-sectional survey with school students attending grades 7, 8, 9 provided data to compare differences in age, gender, beliefs, attitudes, and concurrent tobacco use among self-reported areca users. Of 1909 participants surveyed, 641 (33.57%) reported use of areca nut; of which 355 (55.38%) current users had consumed it in the last 30 days. Results: A logistic regression model revealed that male gender, using tobacco concurrently, inability to refuse a friend’s request to use, and intention to use areca nuts in the next 12 months were significant predictors of current areca use. Conclusion: More research is needed to understand adolescent areca-nut use, including different types of users such as experimenters and those with established habits. This will help design targeted areca-nut prevention and cessation programs.
INTRODUCTION This study aimed to test whether school-going adolescents who self-report tobacco and/or supari use are more likely to quit if a school-based psychosocial cessation intervention is added to an existing life-skills and tobaccoprevention program. METHODS A quasi-experimental trial with pre-test and post-test 20 weeks after the intervention was conducted with students from low-income families in 12 schools in Mumbai; six schools were randomly assigned to the intervention and the remaining to the comparison condition. Participants were students from grades 7, 8 and 9 who self-reported tobacco and/or supari use. Intervention schools received six sessions of LifeFirst, a psychosocial group-based tobacco cessation intervention program, in addition to SuperArmy, a school-wide lifeskills and tobacco-prevention program. Trained counselors facilitated the cessation intervention, which spanned five months. All students in comparison schools received only SuperArmy. The outcome measures were self-reported use of tobacco-only, supari-only, and tobacco plus supari in the past 30 days. RESULTS The number of all users decreased by 19.1% in the intervention and 18.7% in the comparison schools at post-test. Although this reduction was significant (p<0.001) within each group, the difference between intervention and comparison schools was not significant. Further segregation by type of product used showed that for tobacco-only users there was a non-significant increase of 1.7% in intervention schools, and a significant 26.2% increase (p<0.001) in the comparison group. Tobacco plus supari use declined in both groups; however, supari-only use fell by 14.8% in the intervention and 32.7% in the comparison schools (p<0.01). CONCLUSIONS The combination of a cessation intervention along with the life-skills and tobacco-prevention program appear to have halted tobacco-only use in the intervention group. Future research needs to determine whether students are substituting supari for tobacco and to understand the psychological mechanisms underlying the cessation intervention and the interaction between cessation and prevention-only interventions.
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