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Table of Contents
ORIGINAL ARTICLE
Year : 2019  |  Volume : 16  |  Issue : 1  |  Page : 31-34

Comparison of attitude of smokeless tobacco users taking dental treatment versus not seeking dental treatment toward cessation of smokeless tobacco use


1 Nursing Officer, AIIMS, New Delhi, India
2 Faculty, Department of Mental Health Nursing, AIIMS, New Delhi, India
3 Professor, Department of Psychiatry and NDDTC, AIIMS, New Delhi, India
4 Professor, Centre for Dental Education and Research, AIIMS, New Delhi, India

Date of Web Publication14-Oct-2019

Correspondence Address:
Dr. Sandhya Gupta
Department of Mental Health Nursing, AIIMS, New Delhi
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/IOPN.IOPN_13_19

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  Abstract 


Background: Tobacco exposure is the single greatest preventable cause of morbidity, disability, and mortality for chronic and debilitating diseases. In public health education, an important aspect is the treatment of tobacco use dependence. This experimental study is intended to deter the use of smokeless tobacco (ST) for the users who seek treatment and who do not seek treatment as well. Materials and Methods: The study was conducted using a pretest–posttest design on ST users (dental group = 40 and nondental group = 40) in a tertiary care setting. Educational video: A video film of 14 min was developed by a researcher that included contents related to the chemical properties of tobacco, its harmful health effects, the diseases caused by tobacco use, and the facilities available for treatment. Tools: The tools used were subject datasheet and attitude questionnaire. Results: The mean age of the participants in dental group was 39 years and in nondental group was 34 years. Most of the participants in dental group and nondental group were using gutka. Attitude scores of participants significantly increase from pretest (55.32 ± 7.0) to posttest (62.74 ± 4.2). There was a statistically significant difference between attitude scores of participants in dental group (60.3 ± 13.23) and nondental group (62.6 ± 4.19) at 1-month follow-up (P ≤ 0.05). Conclusion: The educational video film regarding the ill effects of tobacco use and its treatment was effective in enhancing positive attitude of both the equally useful.

Keywords: Tobacco, attitude regarding smokeless tobacco use, smokeless tobacco user


How to cite this article:
Linda P, Gupta S, Jhanjee S, Mathur VP. Comparison of attitude of smokeless tobacco users taking dental treatment versus not seeking dental treatment toward cessation of smokeless tobacco use. Indian J Psy Nsg 2019;16:31-4

How to cite this URL:
Linda P, Gupta S, Jhanjee S, Mathur VP. Comparison of attitude of smokeless tobacco users taking dental treatment versus not seeking dental treatment toward cessation of smokeless tobacco use. Indian J Psy Nsg [serial online] 2019 [cited 2019 Nov 22];16:31-4. Available from: http://www.ijpn.in/text.asp?2019/16/1/31/269156




  Introduction Top


Tobacco is a highly addictive substance. Tobacco use is among the most preventable causes of disease and premature death worldwide.[1] The Global Adult Tobacco Survey India 2009–2010 revealed that more than one-third (35%) of adults in India use tobacco in some form, 21% use smokeless tobacco (ST), 9% smoke, and 5% are mixed users.[2] The World Health Organization predicts that tobacco deaths in India may exceed 1.5 million annually by 2020.[3] ST use is a significant part of the overall world tobacco problem. The prevalence of use is relatively high in many countries, especially in South Asia, there is strong evidence that ST use leads to oral mucosal lesions, including oral precancerous lesions and gingival recession.[4] Substantial evidence indicates that tobacco cessation not only reduces the prevalence of a range of diseases but also limits their progression and improves treatment outcomes.[5] Patients who visit dental clinic routinely have little interaction with health-care professionals about tobacco use and related hazardous effects and so do the persons who accompany the patient to the dental clinic. To minimize the gap, improvement of education and counseling in tobacco cessation should be considered. As a first step, data have been collected from patients who seek dental treatment and who do not seek dental treatment about attitude of tobacco use and cessation.

The objective of the study

The main objective is to compare the attitude of ST users taking dental treatment versus not seeking dental treatment.

Research hypothesis

H1- ST users who are seeking dental treatment, who receive educational video will show enhanced attitude scores toward cessation as measured by the attitude scale significant at P < 0.05 as against those who are not seeking dental treatment.


  Materials and Methods Top


This includes a quantitative, experimental approach, preexperimental design, one group pretest–posttest, time-series design [Table 1].
Table 1: Diagrammatic representation of research design

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Treatment

Treatment includes educational video regarding the ill effects of tobacco use and its treatment.

Outcome was tested on the attitude of ST users toward quitting.

Population and sample

Persons currently using ST were chosen from a tertiary care hospital of New Delhi. Participants using smoking tobacco along with ST were excluded from the study. A total of 80 patients were enrolled for the study, 40 in each group. Seventeen participants did not come for the follow-up on posttest 1. A total of 62 participants, 32 in Subgroup 1 (seeking dental treatment) and 30 in Subgroup 2 (not seeking dental treatment) completed the study, by convenient sampling method.

Tools

Subject datasheet

Demographic data form: It has 13 items eliciting the demographic details. Demographic data include age, sex, marital status, educational status, occupation, monthly family income, and area of residence. Tobacco-related characteristics include type of tobacco, use per day, age of initiation, age started chewing regularly, and interest in quitting.

Tool 1: Fagerstrom test for nicotine dependence-smokeless tobacco

A standardized tool developed by Ebbert Jo, Patten CA, and Schoeder DR to assess the severity of nicotine dependence. It consists of six items. Total score ranges from 0 to 10, in which 0–2 = very low dependence, 3–4 = low dependence, 5 = medium dependence, 6–7 = high dependence, and 8–10 = very high dependence. Internal consistency reliability coefficient was 0.47.

Tool 2: Attitude questionnaire

Attitude questionnaire was developed for assessing the attitude of ST users regarding tobacco use. Content validity of attitude questionnaire was obtained by three experts in the field. Reliability was established by test–retest method. Attitude questionnaire was found to be reliable (Cronbach's alpha: 0.82). It was a five-point Likert scale consisting of 15 items. The positive worded items were scored from 5 to 1 and negative worded items were worded from 1 to 5. Minimum score was 15 and maximum score was 75.

Intervention (educational video film) regarding ill effects of tobacco use and its treatment

It was a 14 min long educational video regarding the ill effects of tobacco use and its treatment was validated by four experts in the field. The educational video includes, description of tobacco and tobacco products, effects and complications of tobacco use, complications of tobacco use on oral cavity, strategies available for cessation of tobacco use, and resources available for cessation of tobacco use.

Ethical clearance was obtained from the ethics committee of the institute, informed written consent was obtained from the study participants and their confidentiality and anonymity was maintained.


  Results Top


Description of the subjects

The mean age of the participants in dental group was 39 years (standard deviation [SD] ±11.2) and in nondental group was 34 years (SD ± 6.23). Most of the participants were male, 95.5% in dental group and 95% in nondental group. Most of the participants were married, 72.5% in dental group and 95% in nondental group. Educational status of 35% of participants in dental group was of primary level and 52.5% of nondental group was of secondary level. More than half of the participants were employed, 60% in the dental group and 62.5% in the nondental group. Most of the participants had monthly income of Rs. 5001–10,000, 45% in dental group and 50% in nondental group. Most of the participants were from urban area, 57.5% in dental group and 62.5% in nondental group.

Seventy-three percent of participants in dental group and 42.55% in nondental group were using gutka. The mean number of ST pouch used per day was five (SD ± 1.08) in participants of dental group and three (SD ± 1.9) in nondental group. The mean number of ST pouches chewed per day was two (SD ± 1.6) in participants of dental group and three (SD ± 2.0) in nondental group. The mean age of initiation of tobacco was at 23 years (SD ± 6.13) in participants of dental group and at 22 years (SD ± 5.77) in nondental group. The age of the participants for initiating chewing regularly was 24 years (SD ± 7.08) in participants of dental group and at 22 years (SD ± 5.61) in nondental group. Most of the participants (>50%) were “very interested in quitting of tobacco use” in dental group as compared to nondental group before the intervention.

As shown in [Table 2], attitude mean scores increased from pretest (55.32 ± 7.0) to posttest (62.74 ± 4.2) and was statistically significant at P < 0.05.
Table 2: Comparison of pre- and post-test attitude scores of smokeless tobacco users

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There was a significant increase in the positive attitude of ST users after 1-month follow-up of the intervention.

As shown in [Table 3], mean attitude scores for dental group and nondental group in pretest, were 54.3 ± 5.8 and 54.3 ± 10.9, respectively. Both groups were comparable in the pretest. Whereas mean attitude scores of participants increased from pretest (55.32 ± 7.0) to posttest (62.74 ± 4.2) which was statistically significant, P < 0.05 (mean difference = 6.42) in attitude scores in nondental group as compared to dental group after one month of educational package intervention.
Table 3: Comparison of pre- and post-test attitude scores between Subgroup 1 and Subgroup 2

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  Discussion Top


This study is the first one to document the attitude regarding tobacco use cessation simultaneously among ST users who seek dental treatment and who were not seeking dental treatment.

In the present study, mean attitude scores of participants increased from pretest (55.32 ± 7.0) to posttest (62.74 ± 4.2) which was statistically significant, P < 0.05 (mean difference = 6.42). Hence, there was significantly increased attitude scores of ST users for leaving ST use after 1-month follow-up of the intervention.

In the present study, the baseline attitude mean score was 55.32 ± 7.0 which is in contradictory to the findings of Horn et al.[6] (West Virginia), where it was reported that the baseline attitude score was 25.86 ± 5.38.

The authors found that, there was a statistically significant difference between the attitude scores of subjects in the dental group (60.3 ± 13.23) and nondental group (62.6 ± 4.19) at 1 month follow up, P < 0.05. Therefore, Research hypothesis: H1 Smokeless Tobacco users who are seeking dental treatment, who receive educational video will show enhanced attitude scores toward cessation as measured by attitude scale significant at P < 0.05 as against those who are not seeking dental treatment is rejected.

Hence, it implies that participants in nondental group have more positive attitude as compared to the dental group after 1 month follow up of the intervention [Table 3]. This surprising finding could be attributed to higher educational qualifications of nondental group as compared to the dental group.


  Conclusion Top


The educational video film regarding the ill effects of tobacco use, and its treatment was effective in enhancing the positive attitude toward cessation of ST use. Hence, video film regarding the ill effects of tobacco use and its treatment is found equally useful for both potential and current ST users, those having dental/oral cavity complications as well as those who are not yet seeking for dental/oral cavity treatment.

Implications

  • General public: The educational video regarding the ill effects of tobacco use and its treatment should be shown in schools/colleges to motivate the students to deter them from tobacco use, should be included in schools curriculum and be made available in public libraries to motivate the public to quit tobacco use
  • Nursing practice: Nursing educators should conduct training programs for in service nurses and preservice nurses for learning the ill effects of tobacco use and its treatment, early identification of tobacco users, brief intervention, and motivational counseling to leave tobacco use. Useful video film, should be made available in OPD, wards, various specialty clinic so that not only the patients but the general public also can be delivered educational information and motivational messages in ways that are engaging and deterring the use of tobacco.


Strength and limitations

Time series design was used and postintervention discussion was benefitted by ST users. The attrition rate was 20%.

Recommendations

Similar study can be done on a larger sample size, community-based study can be done and can be replicated to different regional languages.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
USDHHS. Healthy People 2010, ed. US Department of Health & Human Services, National Centre for Chronic Diseases Prevention & Health Promotion. Office of Smoking and Health. Atlanta, GA. https://www.cdc.gov/nchs/data/hpdata2010/hp2010_final_review.pdf.  Back to cited text no. 1
    
2.
Dhumal GG, Pednekar MS, Gupta PC, Sansone GC, Quah AC, Bansal-Travers M, et al. Quit history, intentions to quit, and reasons for considering quitting among tobacco users in India: Findings from the tobacco control policy evaluation India wave 1 survey. Indian J Cancer 2014;51 Suppl 1:S39-45.  Back to cited text no. 2
    
3.
Murray CJ, Lopez AD. The Global Burden of Disease: A Comprehensive Assessment of Mortality and Disability from Diseases, Injuries and Risk Factors in 1990 and Projected to 2020. Cambridge, Massachusetts: Harvard School of Public Health; 1996.  Back to cited text no. 3
    
4.
Recommendation on Smokeless Tobacco Products - Scientific Advisory Committee on Tobacco Products Regulation. https://www.who.int/tobacco/sactob/recommendations/en/smokeless_en.pdf  Back to cited text no. 4
    
5.
Preshaw PM, Heasman L, Stacey F, Steen N, McCracken GI, Heasman PA, et al. The effect of quitting smoking on chronic periodontitis. J Clin Periodontol 2005;32:869-79.  Back to cited text no. 5
    
6.
Horn KA, Gao X, Dino GA, Kamal-Bahl S. Determinants of youth tobacco use in West Virginia: A comparison of smoking and smokeless tobacco use. Am J Drug Alcohol Abuse 2000;26:125-38.  Back to cited text no. 6
    



 
 
    Tables

  [Table 1], [Table 2], [Table 3]



 

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Introduction
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