Exploring smokeless tobacco use in a multi ethnic society; a cross sectional study from Rawalpindi, Pakistan

Introduction: Smokeless tobacco (SLT) use is extremely common in South Asia. This is because of easy availability and lack of potent control measures. Its link with oral cancers is well established. One of the ways of decreasing its use is by educating the public about its adverse effects. The cities of Rawalpindi and Islamabad are strategically important with migrants of numerous ethnicities from all over Pakistan, providing a mixture of socio-cultural traditions, including increasing use of SLT. Objectives: To assess the knowledge, practice and attitude regarding various health outcomes of SLT use amongst users visiting tertiary care hospitals of Rawalpindi. Patients and Methods: Cross-sectional survey conducted at the outpatient departments of Holy Family Hospital, Benazir Bhutto Hospital and District Head Quarter Hospital Rawalpindi from October 2014 to January 2015. An interviewer administered questionnaire was used to interview 479 attendants of  patients. Users of SLT were identified and knowledge, attitude and practices were assessed. The data was analyzed with SPSS 17 and results reported in a descriptive format. Results:  Ninety (18.8%) users were identified. Seventy-eight percent users consumed SLT multiple times a day.  Seventy-eight percent users considered peer pressures as a cause for starting use while 56.7% users had a family member using it. Niswar was used by 82% of the users and the Punjabis (52%) and Pathans (20%) were the ethnic factions using it the most. Almost 19% users believed SLT was beneficial for health and only 5.6% appreciated its carcinogenic nature. Conclusion: SLT  use  is  common  amongst  younger,  less  educated  individuals  being  influenced  by regional  preference  and  persuasive  socio-cultural  factors.  Erroneous  perceptions  regarding  its carcinogenicity  were  identified.  Health  awareness  campaigns  and  oral  cancer  screening  will  be beneficial  in  this  region. Core tip Health  literacy  promotion,  screening  programs  for  oral  cancer  in  high  risk  groups  and  health regulatory measures are of cardinal importance is reducing the adverse health impacts of smokeless tobacco  use. Citation: Ul Abideen Z, Sabir SA, Sajjad Z, Abbasi A. Exploring smokeless tobacco use in a multi ethnic society; a cross sectional study from Rawalpindi, Pakistan. J Prev Epidemiol. 2018;3(1):e02. DOI: 10.15171/jpe.2018.02.