Individual, social and environmental determinants of smokeless tobacco and betel quid use amongst adolescents of Karachi: a school-based cross-sectional survey

Abstract

BackgroundWith 600 million people using betel quid (BQ) globally, and smokeless tobacco (SLT) use being more wide-spread; the duo is an uphill public health concern in South Asian countries. SLT and/or BQ use increases the risk for morbidity and mortality from oral cancer. Because SLT and/or BQ use is initiated during adolescence, it renders this group more vulnerable; and particular attention is needed to curb SLT and/or BQ use to reduce related disease burden. We aimed to observe the differential individual, social and environmental features amongst SLT and/or BQ users to determine the key influencers of its use in adolescents.MethodsThis study was a cross-sectional survey of 2140 adolescents from secondary schools of Karachi, Pakistan. The main outcome measure was SLT and/or BQ use based on their consumption in the past 30 days. Univariate and multivariate regression binary logistic analyses were employed while reporting results in both crude form and adjusted odds ratio (after adjusting for all remaining individual, social and environmental level variables) with 95% confidence level. A p-value of < .05 was considered significant for all analyses.ResultsThe overall prevalence of SLT and/or BQ use was 42.6% (n = 912) of the total sample. The SLT and/or BQ consumer group had more males than females. A significant proportion of user (n = 558, 61.2%) was found in co-education schools. Students whose peers (OR = 6.79, 95% CI 4.67–9.87, p-value <0.001) and/or either of the parents (OR = 2.16, 95% CI 1.73–2.65, p-value <0.001) used SLT and/or BQ, alongside, adolescents who had not attended knowledge based sessions in schools regarding harmful effects of SLT and/or BQ were more likely to consume it. It’s availability with outside school hawkers increased the odds of its use by 6 times, as indicated by both univariate and multivariate models after adjusting for the remaining variables.ConclusionIn conclusion, students studying in co-education, parents and peers use, lack of knowledge based sessions on harmful health effects of SLT and/or BQ, and easy availability of the product from hawkers outside school all contribute towards enhanced risk of SLT and/or BQ use in adolescents.

Betel Quid Health Risks of Insulin Resistance Diseases in Poor Young South Asian Native and Immigrant Populations

“…Low socioeconomic status was correlated with addiction potential and the use of areca nut products containing tobacco [ 23 ]. In another cross-sectional survey of 2140 high school students in Karachi, Pakistan, betel quid usage was 42.6%, and higher rates of use correlated with easy accessibility outside school, parental education, and peer pressure [ 69 ]. Similar trends in areca nut chewing were identified in a stratified cluster random sample of 2442 junior high school students in Changhua, Taiwan [ 70 ], and the trends were higher in vocational and agricultural students compared with that among general school students [ 71 ].…”

Looking Beyond a Rare Presentation of Betel Nut Use in a North American Patient- an Opportunity for Lessons and Intervention in Global Health and Gender Equity

“…Importantly, women often bear a higher proportion of BN-related disease not only due to limited means of healthcare access but also due to cultural norms that often discourage women from smoking tobacco and instead encourage BN use. [3] Here, standard tobacco and cancer screening missed a silent but significant driver of poor health which highlights the importance of a sagacious approach to migrant patients who may have a history of exposure to imported substances and cultural habits of clinical importance, particularly where women may be inadvertently neglected. This case demonstrates a need for awareness of BN availability and its effects in the North American context.…”

School health education program in Pakistan (SHEPP)—a threefold health education feasibility trial in schoolchildren from a lower-middle-income country

“…Prevalence of smoking was reported to be 14% in adolescents aged 5-15 years from Pakistan [11,12]. Additionally, the overall prevalence of smokeless tobacco and/or betel quid use is 42.6% in a study conducted on secondary school adolescents (n = 2140) [13].…”