Occupation |
Frequency |
Percent |
Service holder |
5 |
1.9 |
Businesswomen |
20 |
19 |
Housewives |
77 |
62.9 |
Day labourer |
3 |
16.2 |
Total |
105 |
100 |
Table 1 shows distribution of the respondents by their occupation whereas out of 105 respondents maximum 62.9% were the housewives and only 1.9% were service holder. On the other hand, businesswomen and day laborer represent very close to each other those were subsquently19% and 16.2%.
Table 2. Distribution of the respondents by duration of using Smokeless Tobacco (SLT) with betel leaf (Sadapata, Zarda, Gul, Khaini)
n=31, 82, 19, 49
Characteristics |
Frequency |
Percent |
Sadapata (>10 years) |
15 |
48.4 |
Zarda (< 5 years) |
30 |
36.6 |
Gul (5 years) |
10 |
52.6 |
Khaini (5 years) |
19 |
38.8 |
Table 2 represent the distribution of the respondents by the duration of using Smokeless Tobacco (SLT) with betel leaf (Sadapata, Zarda, Gul, Khaini) where as 48.4% using sadapata, 36.6% using zarda, 52.6% using gul and 38.8% using khaini from respectively both more than 10 years and within 5 years.
Table 3. Distribution of the respondents by reasons behind using Smokeless Tobacco (SLT)
n=105
Reasons behind using Smokeless Tobacco (SLT) |
Frequency |
Percent |
For addiction or habituation |
39 |
37.1 |
For fun |
42 |
40 |
For relief from tiredness |
2 |
1.9 |
For relief from tension |
2 |
1.9 |
For relief from toothache |
20 |
19 |
Total |
105 |
100 |
Table 3 revealed that the reasons behind using smokeless tobacco was stated as fun by 40 % respondents, as addiction or habituation by 37.1% respondents, as relief from toothache by 19% and as relief from tiredness & relief from tension by 1.9%.
Table 4. Distribution of the respondent’s opinion cause of any harm in the oral cavity by Smokeless Tobacco (SLT) use
n=105
Opinion cause of any harm in the oral cavity by Smokeless Tobacco (SLT) use |
Frequency |
Percent |
Yes |
33 |
31.4 |
No |
72 |
68.6 |
Total |
105 |
100 |
Table 4 shows that out of 105 respondents, almost 68.6 % think smokeless tobacco do not cause any harm in the oral cavity while only 31.4 % stated smokeless tobacco cause harm in the oral cavity.
Table 5. Relationship between occupation and regular use of Smokeless Tobacco (SLT)
n=105
Occupation |
Regular use of smokeless tobacco |
Total |
|||
Yes |
No |
||||
Frequency |
Percent |
Frequency |
Percent |
||
Housewives |
45 |
66.2 |
21 |
31.8 |
66 |
Others (businesswomen, day laborer, service holder) |
33 |
84.6 |
6 |
15.4 |
39 |
Total |
78 |
74.3 |
27 |
25.7 |
105 |
c2 = 3.466; p < 0.05
Table 5 shows the distribution of the respondents by occupation and regular use of smokeless tobacco. Among the housewives 66.2 % uses Smokeless Tobacco (SLT) regularly and whereas in 84.6% of other groups (businesswomen, day laborer, and service holder) uses smokeless tobacco regularly. Study results show there was a significant association between occupation and regular use of Smokeless tobacco (SLT).
Discussion
This cross-sectional descriptive study was carried out to find out the impact of Smokeless Tobacco (SLT) use among the women’s health in the selected old town of Bangladesh. Total 105 respondents were interviewed and were selected purposively. As the old town in Bangladesh is a density populated and congested area and due to limited facilities, they do not give enough preference about their improvement on socio-economic status. By profession out of 105% respondent’s shows that 63% were housewives, 19%were businesswomen, 16.2 % were day laborer and only 1.9 % was service holder.
The finding is near about similar to the study conducted by Jalil MA. A study on prevalence of tobacco consumption habits among the rural people in a selected Thana of Gazipur district. Dissertation, NIPSOM 1997, showed that tobacco consumption habits were highly prevalent in low monthly family income group and most common among the housewives (40%) [11].
In this study found that out of 105 respondents, the reasons behind using smokeless tobacco were stated as fun by 40 % respondents, as addiction or habituation by 37.1% respondents, as relief from toothache by 19% and as relief from tiredness & relief from tension by1.9% Above finding is not similar to the study conducted by Jalil MA. Prevalence of tobacco consumption habits among the rural people in a selected Thana of Gazipur district, Dissertation, NIPSOM 1997 showed that about 49% respondents were motivated by friends to start tobacco consumption habits, 28.7% due to family influence and 20.5% of the respondents started due to curiosity [11]. My opinion is peoples living in old Dhaka are culturally and traditionally habituated to use smokeless tobacco while in other areas in Bangladesh peoples living in Gazipur district are not so. Above finding is near about like the study conducted by M Ahmed et al. Out of 719 students, 22% were current smokers and the rest 78% were non-smokers. Half of the students reportedly mentioned that they started smoking due to peer pressure followed by curiosity (34%) to avoid anxiety and tension (28%), feeling of maturity (14%), symbol of manliness (9%), unhappy family environment (8.2%), However 24.5% of the respondents mentioned that they started smoking without any reason [14]. In this study according to the type of smokeless tobacco use 45.3 % used Zarda, 10.5 % used gul, 17.1 % used SadaPata, and 27.2 % used Khaini. About 38.7% respondents were using SadaPata five times and above per day. About 48.4% respondents were using SadaPata for more than 10 years. The study conducted by Mahiuddin MA. A study on tobacco consumption habits among the workers of a bidi (bin) factory in Bangladesh revealed that out of 275 workers interviewed 74.55% were found to be as tobacco consumers. Among them 86.83% were smoked biri / Cigarette. 40% were chewed pan with tobacco and 12.20% used gul [12]. My opinion is in old Dhaka peoples uses smokeless tobacco as like as fun and entertainment to the others from the ancient period to till date mostly Zarda, Khaini, Gul, and SadaPata while the workers of a bidi (bin) factory in Bangladesh are not so. In this study about 68.6 % respondents think smokeless tobacco do not cause harm in the oral cavity while only 31.4 % stated smokeless tobacco cause harm in the oral cavity.
Among them one third (30.3%) answered ulcer occurs in them out due to smokeless tobacco use, 27.3% thought that it causes stain in the teeth, 12.1 % think that it causes loss of appetite and 27.3 % think that it causes stain in the teeth & loss of appetite. It was also found that nearly 79.9% of adult American men thought tobacco snuff increase the risk of cancer whereas 83.8% adult American men considered chewing tobacco increases cancer risk. Among those who chew tobacco leaves, 71.5% knew the risk associated with it as compared to those who did not chew tobacco [13, 14, 15]. The finding is near about same with this study. According to the relationship between occupation and regular use of smokeless tobacco, among the housewives 66.2 % uses smokeless tobacco regularly and whereas in 84.6% of others group (businesswomen, day laborer and service holder) uses smokeless tobacco regularly. There was significant association between occupation and regular use of smokeless tobacco (p < 0.05). Above finding is nearly similar to the study conducted by Jalil MA. Prevalence of tobacco consumption habits among the rural people in a selected Thana of Gazipur district, Dissertation, NIPSOM 1997 showed that the prevalence rate of tobacco consumption among the study population was 36.14%. Tobacco consumption habits were highly prevalent in low monthly family income group and most common among the housewives (40%) [11].
Though there were very limited study was conducted on Smokeless tobacco (SLT). For this reason, more and more research need to be performed in order to help the researcher to give more information as well as discussion needs to be addressed about this problem in the matter.
Conclusion
This Smokeless Tobacco (SLT) constitutes more than 50% of tobacco use among men and women in Bangladesh yet less received attention in tobacco control policies and action because of perceived less harmful effects than smoking and sociocultural aspect in Bangladesh. According to Tamak Birodhi Nari Jote -TABINAJ report on Anti-Tobacco Alliance report, 2016-Bangladesh has one of the highest rates of smokeless tobacco use in the world with 28 million users. It is mostly used among adults (27.2%). Rates among women (27.9%) are slightly higher than among men (26.4%).
Furthermore, Control of the use of Smokeless tobacco (SLT) products has not been focused enough as a priority at national and international level. On global scenario, there are about 300 million SLT users in 70 countries, among them 89% are in India. India and Bangladesh make up 80% of the smokeless tobacco users of the world. The Tobacco control movement is more concentrated on “smoke-Free” rather than ‘tobacco free’ which may include both smoke and smokeless products [16].
By observing this scenario Tabinaj (1st Women Allaiance againt Tobacco) launched 6th March, 2011 in Bangladesh was affiliated with UBINIG (Policy Research for Development Alternative), a research organization engaged in conducting intensive research on tobacco cultivation and its impact on food production since 2006 with support from International Development and Research Centre (IDRC), Canada.
Finally considering the harmful impact with its consequences smokeless tobacco (SLT) use which was unfortunately unknown and unaware by the general population mostly women. It was reflected in my research about 63% of users were housewives. So, it is necessary to implement a very strong comprehensive monitoring and evaluation system both national and international region to stop the use of smokeless tobacco by involving government, non-government policy makers immediately. Now it is the time to realize in a true sense by our local political personnel and government to make emergency step and making network system so that we can make slogan Banning of Smokeless Tobacco (SLT) at national and international level around the world.
Recommendation
Based on the findings of the present study, following recommendations were made for the prevention of smokeless tobacco consumption habits.
- Anti-smokeless tobacco health education should be regarded as part of general health education programme.
- To make laws prohibiting the sale of smokeless tobacco to children and adolescent.
- Mass media should be involved to address the injurious use of smokeless tobacco on oral health which though known but obscure to general population.
- Systematic community-oriented oral health promotion programmes are needed for better control of oral diseases and hazards smokeless tobacco to be taught in all educational institution, religious centers to increase health awareness.
- A prevention oriented oral health care policy, indeed, more advantageous than the curative approach. Health education related to oral health in the educational institutions may provide effective settings for oral health education programmes.
- Research should be continued into the factors which influences smokeless tobacco using behaviour to determine mere appropriate in health education.
DECLARATIONS
Research Ethical Approval
Ethical permission for carried out the study was taken from local ethical committee (ethical review committee of NIPSOM) in due time. Written informed consent was taken from positive respondent with maintaining their full autonomy. All relevant documents including questionnaires were preserved under control of investigator. No individual information was supplied.
Funding
This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.
Author’s contribution
Authors personally try to aware the respondent about the negative impact of Smokeless Tobacco (SLT) by representing different health educational methods and media after the interviewing procedure. In addition, he also provides PowerPoint presentations to the Sapporo Dental College & Hospital department faculty and the students about this research thoroughly.
Completing Interest
The author has an interest in future to do more research work on (Smokeless Tobacco) SLT.
Conflicts of Interest
The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
Acknowledgment
At first, my heartful gratitude to Almighty Allah whose invisible guidance helped me to complete this dissertation. It is a matter of great pleasure to express my deep sense of gratitude to Professor Dr. Saroj Kumar Majumder Director, NIPSOM, Dhaka, and other faculty members of the dissertation protocol Committee for their kind approval of this dissertation. My Profound regards and admiration to my respected guide Dr. Jahanara Begum, Assistant Professor & Head, Dept of Health Education, NIPSOM, Dhaka for his scholarly guidance, Valuable Suggestions, kind supervision, and affectionate help in the preparation and completion of my dissertation in time. I would like to acknowledge my respect and appreciation to the Principal of Sapporo Dental College Hospital and other Teachers and Dental Surgeons for their sincere support and co-operation. I am also grateful to Dr. Kazi Jahangir Hossain Ph.D. Assistant Professor and Dr. Shamsul Alam, Medical officer, Department of Health Education, National Institute of Preventive and Social Medicine (NIPSOM) Mohakhali, Dhaka for their additional suggestions and encouragement in my research work. I am indebted to them for helping me in carrying out some important tasks in this field. I would like to acknowledge my respect and appreciation to Dr. Nurul Amin, Professor & Head, Department of Oral & Maxillofacial Surgery, Sapporo Dental College who with his in-depth knowledge in this field helped me a lot. I would like to thank Dr. Muktadir, Dr. Bithee, MD Hasan, Mrs. Rahima, Dr. Md. Shahed Jahan, Dr. Farzana Karim, Dr.Saima Akter, and other friends of mine for their help and support. I should like to thank my parents, wife, son, brothers, sister, for their prayerful concern and patience during the completion of my research work and dissertation.
Lastly, I would like to thank all those respondents who helped me with their precious time with patience
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