INTRODUCTION

Teenagers and and young adults (between 15 to 25 years of age) are more prone to addiction of tobacco & alcohol due to peer pressure and psychological triggering factors (www.verywellmind.com).

Tobacco smoking is the biggest public health threat of the current era. Worldwide, smoking‑related diseases kill an estimated 4 million people every year. This number is predicted to rise to a staggering 10 million a year over the next two decades. There is an overwhelming body of evidence of Tobacco use is measured to be the most important modifiable risk factor for such chronic diseases and considered as the biggest public health threat of the current era. Worldwide, smoking‑related diseases kill an estimated 4 million people every year. This number is predicted to rise to a staggering 10 million a year over the next two decades (Thakur, D. et al., 2014). Beedi, cigarette, hookah (hubble are mainly use as smoked form of tobacco and in contrast with other smokeless or chewed form of tobacco are gutka, khaini, zarda. Applying form of tobacco is also there as gul, snuff & tobacco containing powder & paste available in various regions of the country (Singh, M. M., & Dhiman, V. 2018).

In developing countries like India, alcohol consumption also tends to be a major problem because of the various socio-cultural practices across the nation, different alcohol policies and practices across the various states, lack of awareness of alcohol-related problems among the community, false mass media propaganda about alcohol use, various alcohol drinking patterns among the alcohol consumers and the emergence of social drinking as a habit because of the widespread urbanisation across the country (Eashwar, V. A. et al., 2020). According to the WHO, there are three million deaths yearly anually due to alcohol consumption, which constitutes around 5.3% of total deaths globally and 5.1% of the global burden of disability-adjusted life years (DALYs) due to alcohol consumption. The consumption of alcohol leads to various digestive or cardiovascular diseases, including cancer (Sivapuram, M. S. et al., 2020).

Legislative efforts to control substance abuse don’t look very promising either, as we can see people smoking publically, wine shops selling alcohol to minors, smokeless tobacco products being sold even after ban. Most of the bars in Shimla city allow minors to drink and smoke keeping their monetary benefits above the law (himachalwatcher.com; & timesofindia.indiatimes.com).

Though not much scientific data on this problem is available still some studies has reported high level of alcohol and tobacco use among adolescent and youth in Shimla City (Thakur, D. et al., 2014; Sharma, P., & Thakur, A. 2014; & Kumar, D. et al., 2016).

A number of studies have done in different parts of the India to see the pattern of Tobacco and Alcohol consumption; such studies are limited in hilly areas of District Shimla. Thus the present study was developed to evaluate the pattern of Tobacco and Alcohol consumption among teenagers & young adult patients came to the OPD of Department of Oral Medicine and Radiology, Government dental college, Shimla.

OBJECTIVES OF THE STUDY

To evaluate the pattern of Smoking and Alcohol consumption among teenagers & young adult patients came to the OPD of Department of Oral Medicine and Radiology, Government Dental College, Shimla.

RESEARCH METHODOLOGY

• Research Approach -Descriptive

• Research Design- Cross-sectional survey design

• Study area: OPD of Department of Oral Medicine and Radiology, Government dental college, Shimla.

• Study duration- 15^th August 2019 to September 15^th 2019

• Study population- Teenagers & Young adults

• Sample size- 250 samples (130 male and 120 female) and age group was 15-25 years.

• Study tool: A self-designed, close ended questionnaires consisting of 20 questions regarding socio-demography and pattern of Tobacco and Alcohol consumption was created.

• Inclusive Criteria- who were willing to participate in the study.

• Exclusion Criteria: who were not willing to participate in the study

• Validity of tool - by the experts in this field

• Data collection- Data was collected under the guidance of supervisors. Responses were then recorded in a Google Excel spreadsheet, the information from which was used to generate graphical display.

• Data analysis- Data was collected and entered in Microsoft excel spread sheet, cleaned for errors and analysed with Epi Info V7 Software with appropriate statistical test in terms of frequencies, percentage, mean standard deviation etc..

• Ethical Considerations- Participants confidentiality and anonymity was maintained.

RESULTS

Present study is a hospital based cross sectional questionnaire based study being conducted between 15 th Aug. 2019 to September 15^th 2019 in Department of Oral Medicine and Radiology to evaluate the pattern of Tobacco and Alcohol consumption among teenagers & young adult patients came to the OPD of Department of Oral Medicine and Radiology, Government dental college, Shimla.

Out of total 318 patients in age group of 15-25 years present to the OPD, 250 people agreed to participate in the study. The study sample included 250 samples (130 male and 120 female) and age group was 15-25 years.

Among these 250 patients, maximum 131(52.4%) in the age group of 21-15 years, 130(52%) were males, 154(61.6%) were educated up to secondary level and 169(67.6%) were students. (Table-1)

Table-1: Socio-Demographic Pattern of Study Participants

Among the total participants, 151 presented with the complaint of pain in tooth/oral lesion, 22 with trauma/ fracture, 1 with oro mucosal lesion and 76 with other complaints. (Table-2)

Table Image is available in PDF File

Table-2: Reasons to Report to the Dental Hospital

Among the total participants, 56(22.4%) were smokers. Among these 56 smokers, 27(48.22%) were started smoking for <2 years and 39(69.66%) were smoking 8-10 times a day. Among these 56 smokers, 35(62.5%) initiating smoking due to the influence of their friends, 34(60.72%) were smoking cigrratte. Among these 56 smokers, 34(60.72%) tried to quit and among these 34 participants, loss of health was the reason for quit among 26(76.47%) participants. (Table-3)

Table-3: Tobacco Smoking Habits

Among the total participants, 17(6.8%) were Non-smoking Tobacco users. Among these 17 Non-smoking Tobacco users, 10(58.82%) were taking Jarda/Khaini, all 17 (100%) tried to quit and loss of health was the reason for quit among all 17 (100%) participants. (Table-4)

Table-4: Non-Smoking (Chewable) Tobacco Habits

Among the total participants, 71(28.4%) were alcoholic. Among these 71 alcoholics, 47(62.20%) were taking alcohol daily and 35(49.29%) started taking alcohol for < 2 years. Among these 71 alcoholics, 06 (8.45%) tried to quit and among these 6 participants, loss of health was the reason for quit among all 6(100%) participants. (Table-5)

Table-5: Alcohol Habits

DISCUSSION

Alcohol and tobacco are legal substances that are often abused in India and constitute major risk factors for various diseases, also increasing the burden of non-communicable diseases, especially when these substances are used by the general public (Sivapuram, M. S. et al., 2020a).

Substance abuse in various forms has always been culturally and socially acceptable particularly among adult in Himachal Pradesh. Angoori (a local grape wine from Kinnaur region), moori (local apple wine from upper region of Shimla Kullu Kinnaur), Aara (famous local drink from Lahual and spiti), Chhang and lugdi are some of the different forms of alcohol beverages that are freely brewed, distributed and consumed at home without any restriction. Tobacco use in different forms (bidi, hukkah, chilam) has been used for ages by the people of Himachal (Kumar, D. et al., 2016).

In the present study, among the 250 patients, maximum 131(52.4%) in the age group of 21-15 years, 130(52%) were males, 154(61.6%) were educated up to secondary level and 169(67.6%) were students. Among the total participants, 151 presented with the complaint of pain in tooth/oral lesion, 22 with trauma/ fracture, 1 with oro mucosal lesion and 76 with other complaints. Among the total participants, 56(22.4%) were smokers. Among these 56 smokers, 27(48.22%) were started smoking for <2 years, 39(69.66%) were smoking 8-10 times a day, 35(62.5%) initiating smoking due to the influence of their friends, 34(60.72%) were smoking cigrratte and 34(60.72%) tried to quit and among these 34 participants, loss of health was the reason for quit among 26(76.47%) participants. Among the total participants, 17(6.8%) were Non-smoking Tobacco users. Among these, 10(58.82%) were taking Jarda/Khaini, all 17 (100%) tried to quit and loss of health was the reason for quit among all 17 (100%) participants. In the NFHS-5 Survey in 2019-20 in District Shimla1.5% of females and 31.7% males were using any kind of tobacco (NFHS-5 Shimla, 2021).

In the present study, among the total participants, 71(28.4%) were alcoholic. Among these, 47(62.20%) were taking alcohol daily, 35(49.29%) started taking alcohol for < 2 years, 06 (8.45%) tried to quit and among these 6 participants, loss of health was the reason for quit among all 6(100%) participants. In the NFHS-5 Survey in 2019-20 in District Shimla 0.5% of females and 34.4% males were consuming alcohol (NFHS-5 Shimla, 2021).

Table-6: Pattern of Tobacco & Alcohol in District Shimla as Per NFHS-5

CONCLUSION

Both Tobacco & Alcohol consumption is emerging as a major public health problem in Shimla. To prevent the disease burden from legal substances abuse like alcohol & smoking, a cost-effective non-pharmacological approach is required. People must have to be educated about the consequences of chronic smoking & alcohol through sensitisation programmes and health education campaigns. Stringent policies are needed across the state to reduce smoking & alcohol consumption. Multi-centric scientific community-based research studies have to be conducted to understand these problems better and to develop a comprehensive program to combat the problem.

REFERENCES

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2. Thakur, D., Gupta, A., Thakur, A., Mazta, S. R., & Sharma, D. (2014). Prevalence of cigarette smoking and its predictors among school going adolescents of North India. South Asian journal of cancer, 3(04), 193-195.

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9. Kumar, D., Parashar, A., & Thakur, A. (2016). Tobacco use and its correlates among youth in a northern urban city of India. Int J Sci Res, 5(2), 1577-82.

10. Sivapuram, M. S., Nagarathna, R., Anand, A., Patil, S., Singh, A., & Nagendra, H. R. (2020). Prevalence of Alcohol and Tobacco Use in India and Implications for COVID-19-Niyantrita Madhumeha Bharata Study Projections. Journal of Medicine and Life, 13(4), 499-509.

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