Assessment of Willingness Towards Anti-Tobacco Counseling among Adults using Tobacco - A Retrospective Study

Keywords

Counselling; Harmful; Motivation; Smoking; Smokeless.

Introduction

The usage of tobacco products is one of the major and preventable causes of health issues and early deaths worldwide. Tobacco smoking consists of drawing into the mouth and usually the lungs, smoke from burning tobacco. It can also be consumed in the form of chewing, sniffing or being placed in the mouth [1].

Tobacco usage increases the chance of attaining a wide range of diseases which may be fatal. Stopping at any age is beneficial as compared to its continuation. Along with systemic diseases, there is a higher incidence of dental caries [2-7] and stains among smokers [8-14]. There are two forms of tobacco most consumed and they are: Smoking form and smokeless form [15]. Tobacco contains a biologically significant concentration of known carcinogens as well as many other toxic chemicals [16]. Nicotine sustains tobacco addiction that’s a major cause of disability and premature death. It is also the substance that causes or initiates addiction [17].

Tobacco dependence is a chronic condition that often requires repeated interventions [18]. Oral health care professionals play an important role in promoting tobacco free lifestyles [16, 19, 10]. Dentists can detect harmful effects of tobacco use which can be clinically apparent in the oral cavity at the early stages itself [18- 20]. They can influence children and youth to adapt a tobacco free lifestyle, by informing them regarding the dangers [12].

Tobacco cessation is essential to reduce the mortality and morbidity related to tobacco use. The methods can be classified into three: cognitive behavioural therapy, intensive therapy at smoking cessation centers and pharmacological means [12, 13, 21]. About 40% of current smokers attempt to quit each year and studies have shown that 4-6% are successful in doing so. Many professionals suggest abrupt cessation of the habit to be effective but it has been proved that a gradual reduction to be more effective. Main aspect is to maintain motivation and to make attempts [22, 23]. The national clinical guideline recommends an intervention for tobacco known as “5A’s” and they are: Ask, Advise, Assess, Assist, Arrange [24].

This study aims to study the willingness of patients to undergo anti-tobacco counseling and assess patients returning for review or second visit after first anti-tobacco counselling. It will aid in proper motivation and intervention, by providing a better idea regarding the general mind set of the patients who are undergoing anti-tobacco counselling.

Materials and Method

A retrospective study was conducted in an institutional setting. The ethical clearance was received from the institute’s ethical committee. (ethical approval number- SDC/ SIHEC/ 2020/ DIASDATA/ 0619-0320). The study involved all patients who had undergone anti-tobacco counselling within a given time frame of June 2019 to April 2020, in Saveetha Dental College and Hospital, Chennai.

Selection of subjects

All the patients who reported the habit of using tobacco and underwent anti-tobacco counselling were considered for the study. All age groups were taken into consideration. The time period of choice was from June 2019 to April 2020. There were three people involved in this study: the guide, reviewer and researcher. All the available data was collected and sorted. Further, the data was checked using DIAS (our patient management software) individually in case of any discrepancy.

Data collection

The detailed case sheets of each patient were reviewed and analyzed using parameters such as: gender,type of tobacco used, willingness for counselling, second review and fagerstrom scale value during primary counseling. Cross verification of the data was done by the second reviewer and when in doubt, the patient records with intra oral photographs were assessed regarding tobacco history. The data was manually retrieved and tabulated in Excel after sorting.

Inclusion criteria

Patients of all ages were considered for this study and any type of tobacco used were considered.

Exclusion criteria

Patient details that were incomplete and repeated were excluded from the study.

Statistical Analysis

The tabulated data was analysed using SPSS software (IBM SPSS statistics 26.0). The method of analysis that was used was “Chi square test”. Bivariate analysis was performed and the level of statistical significance set at 5%.

Results and Discussion

Gender, tobacco used, counselling and second review distribution in the study:

A total of 679 patients underwent anti-tobacco counselling as part of their first dental visit, out of which 660 patients (97.2%) were male patients and the remaining 19 patients (2.8%) were female patients. Male patients had a higher prevalence of tobacco use as compared to female patients who visited our dental institute. These results are shown in Figure 1.

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There were two types of tobacco products used: smoking tobacco and smokeless tobacco. 67.9% of the patients used smoking tobacco and the remaining 32.1% preferred smokeless tobacco. These results are shown in Table 1 and Figure 2.

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The willingness to undergo counselling for the cessation of the habit was divided into three categories: willing, somewhat willing and not willing. Majority of the patients (55.8%) were willing and 0.7% (5 patients) were not willing to undergo counselling. The results are shown in Table 2 and Figure 3. Only a very small number of the sample did not want the counseling. Out of the 679 patients who had undergone anti tobacco counselling, only 22.7% of them (154 patients) had returned for a second review. The remaining had not retired for review counseling. This is shown in Table 3 and Figure 4.

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Association of gender and second review

Out of the 660 patients who were male, 149 (21.89%) of them had returned for a second appointment and the remaining 511 (75.26%) did not. A total of 19 female patients who had undergone counselling and only 5 (0.74%) patients came for a second review. The p value was 0.704 (>0.05) and there was no significant difference statistically. These results are shown in Table 4 and Figure 5.

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Association of gender and type of tobacco

Out of 660 patients who were male, 459 (67.6%) patients preferred smoking forms of tobacco and 201 (29.6%) preferred smokeless forms of tobacco. Within the 19 female patients, it was seen that 2 (0.29%) patients preferred smoking tobacco and the remaining 17 (2.5%) preferred smokeless forms of tobacco. The p value was 0.00 (< 0.05), the results were statistically significant. These results are shown in Table 5 and Figure 6.

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The present study assesses the willingness of patients to undergo anti tobacco counseling and to return for second review. From the results we can see that use of tobacco was higher among men as compared to females. Tobacco in the smoking form was more preferred as compared to the smokeless. Majority of the patients were willing to receive anti tobacco counselling, but a handful returned for a second review. From the ones that had returned for the second review, most were male patients.

Tobacco usage is the leading cause of morbidity and mortality worldwide. Cessation of the habit significantly decreases the chances of diseases such as cancer, heart diseases, etc. dentists and health care workers need to consider it seriously and assist patients in its cessation. The process of cessation is prolonged and difficult [25].

The prevalence of tobacco used has been studied in various countries and the numbers differ from country to country. In the present study, there were more male patients who were having the habit of using tobacco as compared to female patients. A comparative study by DujrudeChinwong et al., [25, 26] stated that developing countries have similar percentages of male and females using tobacco products and in developed countries, there was a higher prevalence among females [25, 26]. In general, it is said that the prevalence of tobacco use is higher in males than in females, but it could differ from country to country.

Tobacco is smoked in forms of beedis and cigarettes or by using devices like hookah, chutta, etc. due to higher costs of these forms of usage, smoking is more common among the upper and middle socioeconomic classes than among poorer classes [27]. Smokeless forms of tobacco would include betel quid, gutta, pan masala, etc. these are less costly when compared to smoking tobacco and as a result have enormous use. In the present study, the majority of the patients preferred the smoking (cigarette/ beedi) type of tobacco when compared to the smokeless type. In a similar study conducted by Dina M Jones et al [28], it was stated that there were more individuals who preferred smoking tobacco instead of smokeless forms.

The willingness to quit using tobacco products should be selfinduced. Health care workers have the role of passing the information regarding the risks and also to motivate the individual. In the present study, it was seen that the majority of the patients were willing to receive the counselling from the dentists. Receiving counselling is one of the first steps in cessation of the habit. In a similar study conducted by Mahendra M et al [29], it was seen that 50.9% of the patients were ready to quit the habit. This was mostly seen in patients who were young and also those who had knowledge regarding the adverse effects.

In the present study, it was seen that the majority of the patients had not turned up for the second session of counselling. This could be due to the lack of motivation or proper counselling given. It could also be due to disinterest from the individuals side. A study done in 2013 by Radhakrishnan et al [30] stated that out of 928 patients that were involved in the study, 232 of them did not attempt to cease the habit nor turn up for review.

Appearing for the second review visit to the health care practitioner would state that the patient is willing to quit the habit of consuming tobacco. In the present study, more number of ale patients returned for counselling than female patients. This could be due to most female patients who use tobacco products in the area were older women who used smokeless forms. In the study by DhujdeeChinwong et al [31], it was seen that female individuals were more keen and interested in quitting the habit than male patients.

Study limitations

This study focused on a small area in South India and so it cannot be generalized to the entire population. The sample size was relatively smaller with an unequal number of male and female patients. Moreover, this is an institutional sample and anti tobacco counseling is provided irrespective of the individual's choice and we might overestimate the actual willingness towards anti tobacco counseling.

Future scope

In future studies, a larger population can be taken into consideration to have better results.

Conclusion

Within the limits of the study, it was seen that male patients were keen on using tobacco products than female patients. The more commonly used form of tobacco was in smoking form. Majority of the individuals were willing to receive counselling during the first visit but very few returned for the second visit.

Acknowledgement

The authors are thankful to Saveetha Dental College for providing a platform to express our knowledge.