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Table of Contents
ORIGINAL ARTICLE
Year : 2020  |  Volume : 8  |  Issue : 1  |  Page : 41-45

Survey Study to assess the awareness and health impact of tobacco addiction in children of Zilla Panchayat Schools of Wardha


1 Department of Kaumarbhritya, Mahatma Gandhi Ayurveda College, Hospital and Research Centre, Datta Meghe Institute of Medical Sciences (DU), Wardha, Maharashtra, India
2 Department of Ras shastra-Bhaishajya Kalpana, Mahatma Gandhi Ayurveda College, Hospital and Research Centre, Datta Meghe Institute of Medical Sciences (DU), Wardha, Maharashtra, India

Date of Submission16-Mar-2020
Date of Decision28-Mar-2020
Date of Acceptance29-Mar-2020
Date of Web Publication2-Jul-2020

Correspondence Address:
Mr. Saurabh Ramesh Holani
Third Year BAMS Student, Mahatma Gandhi Ayurved College, Hospital and Research Centre, Datta Meghe Institute of Medical Sciences (DU), Wardha, Maharashtra.
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/JISM.JISM_11_20

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  Abstract 

Background: It is estimated that 5500 adolescents started using tobacco every day in India, joining the 4 million, younger than 15 years of age, who are regularly using tobacco. There is an urgent need for good, scientifically sound data about tobacco use pattern to design preventive strategies, and to create awareness about its hazards and deaddiction. Aims and Objectives: This survey was aimed to assess the physical–mental health impact and psychosocial behavior of tobacco users and to make the children aware about its harmful effects on body, mind, and social impact; also, to search the psychosocial reasons of accepting the addictions in early ages. Materials and Methods: The questionnaire-based survey study was conducted upon 100 children in the age-group 6–16 years of Zilla Parishad schools of Salod and Sawangi, Wardha, Maharashtra, India. An interview-based interaction was conducted with children consuming tobacco in any form. Observations and Results: Tobacco addiction is emerging as a big threat among children in developing countries. The early age of initiation emphasizes the urgent need to intervene and protect this vulnerable group from falling prey to this addiction. Of 300 students, one-third, that is, 33.33% were affected with addiction and this number may increase due to environment and peer pressure with easy availability and imitating/copying habit of children. Tobacco products mainly Masala Supari, Pan Masala, and tobacco with lime were prevalent in Zilla Parishad schools of Sawangi and Salod, Wardha, Maharashtra, India. As parents beaten and abuse to the addictive children and denied (them) to give money for tobacco purchase still they are so much addicted that they could not live without it. Conclusion: In this survey, tobacco addiction was affecting physical–mental health of 19% participants. No one had developed any major side effects due to addiction. Tobacco use awareness program was undertaken, and schoolchildren were educated regarding the bad effects on the body and mind, with sincere efforts to demotivate them against the addiction of tobacco products.

Keywords: Addiction, deaddiction, health impact, survey, tobacco, Zilla Parishad school


How to cite this article:
Holani SR, Rathi RB, Rathi B. Survey Study to assess the awareness and health impact of tobacco addiction in children of Zilla Panchayat Schools of Wardha. J Indian Sys Medicine 2020;8:41-5

How to cite this URL:
Holani SR, Rathi RB, Rathi B. Survey Study to assess the awareness and health impact of tobacco addiction in children of Zilla Panchayat Schools of Wardha. J Indian Sys Medicine [serial online] 2020 [cited 2020 Aug 4];8:41-5. Available from: http://www.joinsysmed.com/text.asp?2020/8/1/41/288803




  Introduction Top


The epidemic of tobacco use is shifting from developed to developing countries, including India. Smoking and tobacco use is a major public health issue in developing countries. The World Health Organization (WHO) estimates that 4.9 million deaths annually are attributable to tobacco addiction. This gives rise to 4 million deaths occurring in India.[1] Approximately 90% of the oral cancers in Southeast Asia are linked to tobacco chewing and tobacco smoking.[2] Currently in India, more than 8 lakh people die and 12 million become ill as a result of tobacco use each year. An estimated 186 million of the world population are schoolchildren of 13–15 years. Among them, approximately 34.8 million are current tobacco users.[3] Approximately 40% of the tobacco consumed in India is in the smokeless form (Pan, Pan Masala, Gutka, Zarda, Kharrha, Khaini, and Masala Supari).[4]

As per WHO, addiction means the fact or process of being addicted (dependent on as a habit; unable to do without a thing), especially the condition of taking a drug habitually and being unable to give it up without incurring adverse effects.[5] The prevention of tobacco use in young people appears as the single greatest opportunity for preventing noncommunicable diseases in the world today.[6] The main cause is bad peer group. Parents used to send their children to purchase tobacco products for them and consumed them in front of the children. These environmental factors compel them to try it once and later more often, which easily becomes an addiction. The need of the study was the tobacco addiction in children, which is very difficult to get rid of. In a recent study, it has been revealed that 86% of the world’s oral cancer cases occur in India. Approximately 24% of school-going children are addicted to tobacco chewing.[7] It is very difficult to deaddict from tobacco products due to their strong affinity with developing brain. Addiction was so strong that some theft money from home to purchase tobacco when parents denied to give money. So, effort has been made to choose it as a research study to counsel and educate them regarding its hazards on physical, mental, and social life too.[8] The prevention of tobacco use in young people appears as the single greatest opportunity for preventing noncommunicable diseases in the world today.[9] The use of tobacco products increases the risk of noncommunicable diseases to many folds. Tobacco product addiction is the most common leading causes of preventable morbidity and mortality.[10] Ayurveda has widely described Sadvritta (good conduct) and Satvavajay Chikitsa (Ayurveda psychotherapy)[11] with meditation and counseling, which can be applied in this context to detoxify the effects of tobacco and divert them from the habit. The aim and objectives of the study was to assess the physical–mental health impact of tobacco use and to make the children aware about the harmful effects on body, mind, and social life.


  Materials and Methods Top


The questionnaires-based survey study was conducted with a sample size of 100 (selected from 300 children screened), and children in the age-group 6–16 years, consuming tobacco, were interrogated. An interview-based interaction was conducted and their respective answers were evaluated. Survey was started after getting institutional ethics committee (IEC) approval (Sept 2019/8455).

Place of the Study

This study was conducted in Zilla Parishad (ZP) schools of Salod, Sawangi, Wardha, Maharashtra, India.

Study Design

This was an observational study.

Sample Size of the Study

Study was carried out in ZP schools of Sawangi and Salod, Wardha, Maharashtra, India, among 300 children; of which, 100 in the age-group 6–16 years were addicted to tobacco products. Study duration was 6 months.

Inclusion Criteria

  1. The children in ZP schools of Salod and Sawangi, Wardha, Maharashtra, India, in the age-group of 6–16 years, having habit of tobacco use in Gutka or other smokeless form, irrespective of their gender, socioeconomic status, caste, and religion


  2. Children, who gave assent, or teachers/parents willing to give consent for this survey study


Methods

This study was a survey undertaken among schoolchildren in ZP schools of Sawangi and Salod, Wardha, Maharashtra, India, with the objective of assessment of health impact in tobacco addictive children and the awareness to remain away from addiction and if addicted then for deaddiction. The study population comprised all students studying in class first to tenth. The survey was conducted using tobacco questionnaire validated and based on WHO guidelines.[12] The school authorities, class teachers, and students were given a brief introduction of the survey, the aim, and the method of giving response. Then students were informed regarding the side effects of tobacco chewing and suggestions were given. Data were collected from the survey by fill-up of questionnaire and were documented. As per the validated questionnaire, questions were asked related to tobacco addictions or tobacco use. The respondents were briefed that they should reply the answers on what they really do and what really happen with them. Thus, collected data were analyzed by using suitable diagrams and tables. They were educated with PowerPoint presentation and made aware about the harmful effects of tobacco products on the body and mind by showing images of oral cancer.


  Observations and Results Top


The total number of students that were studied in this survey was 100 of the total 300, who were consuming tobacco products. One third means 33.33% are affected with addiction and this number may increase due to environment and peer pressure with easy availability and imitation/copy habit of children. The detailed observations of them are as follows.

Of 100 participants, 88% of males and 12% of females were consuming tobacco in one or the other form. As far as age of tobacco consumers is concerned, students of the age-group 6–11 years were 32% and of the age-group 12–16 years were 68%. Regarding duration of addiction, it was observed that maximum students means 63% were addicted from past 2 months, 16% were from past 1 year. While 15% were habituated from last 2-3 years and 6% students were addicted since more than 3 years.

Religion of students was 72% Hindus, 18% Buddhists, and 10% Muslims. The occupation of fathers was 42% labors, 18% farmers, whereas 18% were doing service and 22% were self-employed. The occupation of mothers was 20% labors, 42% housewives, 29% farmers, and 19% self-employed by performing daily wages jobs. The type of family was nuclear (52%), whereas 48% belonged to joint family. 88% students had no impact on their routine activities whereas only 12% students agreed that their daily activities, such as sports, different competitions and other co-curricular events were decreased due to addiction. As they craved for it and need time to be apart from mob to consume it. It was observed that 19% students were affected with physical problems, whereas maximum 81% were having no sufferings as mentioned in [Figure 1].
Figure 1: Physical problems

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As far as physical problems are concerned, 18% participants were having complaints of cough, 1% complained of difficulty in breathing, whereas 81% participants did not have any complaint.

Even after having physical problems, 18 participants continued consuming tobacco, whereas 1 participant discontinued using tobacco due to illness as depicted in [Table 1]. Only one participant remembered the onset of first appearance of physical problem while 18 participants did not recall it as shown in [Table 2].
Table 1: Continuing tobacco after physical problems also

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,
Table 2: Time of problems appearing for first time

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About the recent appearance of physical problems, two participants had problem in the past month, eight had problems during the past 2–6 months, and eight had problems in the past 6–12 months.

Effect of Addiction on Anthropometry of Participants

When the weight of students was taken, 13 students fell under 30–40kg, 27 under 40–50kg, 32 were under 50–60kg, and 28 were above 60kg. It was noticed that 4% students were affected with moderately acute malnutrition, whereas 1% was with severely acute malnutrition, irrespective of other causes. Regarding the examination for anemia, it was found that 12% were pallor, whereas 88% were not pallor in nail and eye examination. No Bitot’s spots were observed in eyes, which are present in vitamin A deficiency, depicting the good implementation of national programs such as vitamin A and midday meal supplement. Regarding oral hygiene, teeth were examined, in which 28% participants were having stained, dirty teeth, whereas 72% participants were having normal teeth. Prakriti examination was done, 28% students were having Vata-Pittaj Prakriti, 37% were having Vata-Kaphaj Prakriti, and 35% were having Pitta-Kaphaj Prakriti.

Appetite

When interrogating regarding appetite, 72% were found to have good appetite and 28% poor appetite. While examining skin, it was found that 68% were having smooth skin and 32% were having dry skin texture. As far as sleep was concerned, 12% had disturbed sleep cycle, whereas 88% had sound sleep. The status of some general examination and points of Dashavidha Pariksha were as shown in [Figure 2].
Figure 2: Graphical details of some points of personal data and Dashvidha pariksha of students

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Heart Rate/Pulse

Pulse rate was examined, 11% had pulse rate of 60–70 per min, 52% had 70–80 per min, 17% had 80–90 per min, and 20% had above 90 per min. When temperature was taken, 6% were found to be mild febrile and 94% were afebrile. All observations of vitals were near normal as per different age variations.


  Discussion Top


Of 100 tobacco-consuming students, it was observed that a smaller number of females and more males were in the habit of tobacco consumption in regular basis. The male population was more exposed to tobacco-consuming environment, and thus, they were more influenced through friends and family. Similar findings were observed in another survey study carried out by Kumar et al.[13] In this survey, it was observed that teenage students (13–16 years) were more influenced with addiction as compared to 6–12 years children. As shown in [Table 3], maximum students were denied to share the start of addiction timings. As per religion is concerned, majority of Hindu students were found as compared to Buddhists and Muslims because the population of Salod and Sawangi is mostly following Hinduism, and so most of the students were Hindus.
Table 3: First time consumption of tobacco

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The participants who told that they were not having reduced physical activity as well as no physical problems due to tobacco were more because may be due to the less frequency of consumption or just started as 63% were started from past 2 months only. Somewhat similar findings regarding the activities were also seen in a study by Kishore et al.[14] carried out at Wardha. Thereafter, the physical problems observed were more of coughing, difficulty in breathing, whereas many students did not have any physical problems. Coughing is increased due to obstruction in airways, then there were many students who did not have any problem as they had started consumption a month ago. The participants were consuming tobacco products even after the physical problems because they were very much addicted to tobacco. Many participants did not know the time of first appearance of problems because they had ignored the problem. It was observed that less number of children was malnourished because they got the midday meal on a daily basis at their school, and thus, they were not malnourished. It was observed from nail, teeth, and eye examination that some of them were anemic as pallor was noted in some students, and this pallor may be due to chronic consumption of tobacco. In teeth examination, it was observed that the teeth of some participants were yellowish, stained, and some students had normal teeth because they might have started consuming tobacco recently. Similar observations of oral problems were found in a study by Basakhetre et al.[15] It was observed that few individuals were having poor appetite that might be due to Vata aggravation from Kashaya Rasa of tobacco products, whereas many were having good appetite, which might be because they started consuming tobacco recently. Skin of some participants was dry and it might be due to Vata aggravation from winter season. Many individuals were having Madhyam Saar (tissue excellence), Satmya (tolerance), Samhanan (compactness of body), and Vyayam Shakti (capacity to exercise or work). There was a change in the psychosocial behavior of students, and some students were weak in Maths and English. It may be possible that they were having difficulty in understanding these subjects due to frequent tobacco intake and less food intake. Therefore, it can be revealed that tobacco has a possibility to create a bad impact on cognitive domain also. Heart rate was high in some students, and it might be due to chronic consumption of tobacco that induced cough and breathlessness with mild fever. Tobacco products are astringent in nature and hence create choking feeling, and to clear the throat, body’s effort enhances in the form of cough. No one had lockjaw or difficulty in mouth opening, lymphadenopathy, or organomegaly, which may be due to recent start of addiction as shown in Table 4, no one was affected. Of 100 students, 4% were categorized under moderately acute malnutrition and 1% were under severely acute malnutrition of protein energy malnutrition classification as per the Indian Academy of Pediatrics because of successful implementation of midday meal program.


  Conclusion Top


In a nutshell, tobacco products mainly Masala Supari, Pan Masala, and tobacco with lime were prevalent in ZP schools of Sawangi and Salod, Wardha, Maharashtra, India. It was found that 19% students were affected with physical problems and the rest were normal, which might be due to the recent start of addiction. No one had developed any major changes such as lockjaw or difficulty in opening of mouth, organomegaly, or lymphadenopathy. They were unable to get rid of this habit in spite of trying many times due to strong urge, craving, and deep impact on their mind. Awareness program was undertaken and they were educated regarding the bad effects of tobacco products on body and mind.

Financial support and sponsorship

Datta Meghe Institute of Medical Sciences (DU).

Conflicts of interest

There are no conflicts of interest.



 
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