Smoking Pattern among Rural Indian Cancer Patients: A Prospective Survey

Abstract

Background: Smoking predisposes to cancer. Prevalence and pattern of smoking among rural Indian cancer patients is unknown. Aim: The aim of the study was to estimate the prevalence of smoking in cancer patients. Objective: The objective of the study was to estimate the type of smoking and pattern in cancer patients and correlate with clinical and demographic variables through a prospective survey. Materials and Methods: All consecutive individual adult (age >18 years) patients diagnosed with any cancer and registered in the medical oncology outpatient department were enrolled for questionnaire-based survey on smoking between July 2017 and October 2017. Demographic variables were also recorded including income, education, and occupation. Frequency distribution and cross tabulation were used for the statistical analysis using SPSS version 17. Results: Of 517 cancer patients enrolled, 456 (88%) were rural. The prevalence of smoking was 125/517 (0.24, 95% confidence interval – 0.20–0.27). Among them, 67 (54%) were bidi smokers, while 58 (46%) smoked cigarette. Majority had smoking history of more than 20 years (40%), while 20% were recent smokers, <5 years. Hundred out of one hundred twenty-five (80%) patients were male, while 24/25 (96%) women smoked bidi. More than 56% of the bidi smokers were illiterate, while the majority of cigarette smokers (50%) had completed high secondary schooling. The majority of bidi (63%) and cigarette smokers (62%) had monthly income <Rs. 10,000. Almost 98% of bidi smokers and 77% of cigarette smoking population were rural. Farmers and laborers had higher prevalence of smoking, 35/96 (53%) and 28/70 (40%), respectively, while 11% of housewives were bidi smokers. Nearly 40% of head-and-neck cancer and 48% of lung cancer patients had a smoking history, with 65% and 76% being bidi smokers among them, respectively. Conclusion: One in four cancer patients smoke. Most of the smokers are illiterate with low socioeconomic profile and predominantly laborers and farmers. Bidi is the predominant type of smoking.

Keywords

Bidi - cancer - rural - smoking

• References

• 1 US Department of Health and Human Services. Smoking and Health. Report of the Advisory Committee to the Surgeon General of the Public Health Service. Department of Health, Education, and Welfare, Public Health Service, Centers for Disease Control. PHS Publication; 1964
• 2 Newcomb PA, Carbone PP. The health consequences of smoking. Cancer. Med Clin North Am 1992; 76: 305-31
• 3 Gandini S, Botteri E, Iodice S, Boniol M, Lowenfels AB, Maisonneuve P. et al. Tobacco smoking and cancer: A meta-analysis. Int J Cancer 2008; 122: 155-64
• 4 Sasco AJ, Secretan MB, Straif K. Tobacco smoking and cancer: A brief review of recent epidemiological evidence. Lung Cancer 2004; 45 Suppl (02) S3-9
• 5 Rahman M, Fukui T. Bidi smoking and health. Public Health 2000; 114: 123-7
• 6 Rahman M, Sakamoto J, Fukui T. Bidi smoking and oral cancer: A meta-analysis. Int J Cancer 2003; 106: 600-4
• 7 Rani M, Bonu S, Jha P, Nguyen SN, Jamjoum L. Tobacco use in India: Prevalence and predictors of smoking and chewing in a national cross sectional household survey. Tob Control 2003; 12: e4
• 8 Jha P, Jacob B, Gajalakshmi V, Gupta PC, Dhingra N, Kumar R. et al. A nationally representative case-control study of smoking and death in India. N Engl J Med 2008; 358: 1137-47
• 9 Shah PB, Pednekar MS, Gupta PC, Sinha DN. The relationship between tobacco advertisements and smoking status of youth in India. Asian Pac J Cancer Prev 2008; 9: 637-42
• 10 Muwonge R, Ramadas K, Sankila R, Thara S, Thomas G, Vinoda J. et al. Role of tobacco smoking, chewing and alcohol drinking in the risk of oral cancer in Trivandrum, India: A nested case-control design using incident cancer cases. Oral Oncol 2008; 44: 446-54
• 11 Gajalakshmi V, Hung RJ, Mathew A, Varghese C, Brennan P, Boffetta P. Tobacco smoking and chewing, alcohol drinking and lung cancer risk among men in Southern India. Int J Cancer 2003; 107: 441-7
• 12 Mishra S, Joseph RA, Gupta PC, Pezzack B, Ram F, Sinha DN. et al. Trends in bidi and cigarette smoking in India from 1998 to 2015, by age, gender and education. BMJ Glob Health 2016; 1: e000005
• 13 Jindal SK, Aggarwal AN, Chaudhry K, Chhabra SK, D’Souza GA, Gupta D. et al. Tobacco smoking in India: Prevalence, quit-rates and respiratory morbidity. Indian J Chest Dis Allied Sci 2006; 48: 37-42
• 14 Gupta R. Smoking, educational status and health inequity in India. Indian J Med Res 2006; 124: 15-22
• 15 Jayalekshmy PA, Akiba S, Nair MK, Gangadharan P, Rajan B, Nair RK. et al. Bidi smoking and lung cancer incidence among males in Karunagappally cohort in Kerala, India. Int J Cancer 2008; 123: 1390-7
• 16 Sinha DN, Gupta PC, Pednekar MS. Tobacco use in a rural area of Bihar India. Indian J Community Med 2003; 28: 167-70
• 17 Noronha V, Dikshit R, Raut N, Joshi A, Pramesh CS, George K. et al. Epidemiology of lung cancer in India: Focus on the differences between non-smokers and smokers: A single-centre experience. Indian J Cancer 2012; 49: 74-81
• 18 Pandey A, Desai A, Ostwal V, Patil V, Kulkarni A, Kulkarni R. et al. Outcome of operable oral cavity cancer and impact of maintenance metronomic chemotherapy: A retrospective study from rural India. South Asian J Cancer 2016; 5: 52-5