[version 1; peer review: 2 not approved]
No competing interests were disclosed.
Pan is frequently taken with chewed smokeless tobacco products like Mishri and Pan masala (a chewable tobacco made with areca nuts). Smokeless tobacco use, particularly in the eastern, northern, and north-eastern regions of the country, is a socially accepted addiction. Most prior studies on the prevalence of tobacco use were either based on small-scale research surveys with an urban bias, small sample numbers, and poorly known sociodemographic correlates of tobacco use. Additionally, earlier prevalence estimations made in India are still extremely speculative and non-representative.
Transport employees who are under stress are more likely to abuse alcohol and other drugs, with cigarettes being the most popular. There has been research on a connection between smoking and job stress. It is often believed that a substantial percentage of bus drivers and other employees smoke cigarettes. The second leading cause of death worldwide and the leading contributor to morbidity and mortality that may be prevented is tobacco smoking. Oral malignancies and possibly malignant lesions, the degree and depth of periodontal disease, and poor wound healing are the most harmful impacts of tobacco use on the oral cavity.
India is a diverse nation that is home to numerous cultures, faiths, and languages in addition to various socioeconomic classes. Community health is a concern for all swaths of society, including the poor, the wealthy, children, adults, the elderly, men, and women. The Tobacco Control Team for the India Region works to reduce the burden of illness, mortality, and the financial costs associated with tobacco use and passive smoking. Tobacco use is currently the leading cause of death that may be prevented worldwide. Depending on the metastasis's location and features, other structures including the internal jugular vein, sternocleidomastoid muscle, or spinal auxiliary nerve may need to be sacrificed.
A significant portion of the nation's gross domestic product (GDP) and export earnings come from the production of tobacco, which is exported in 98 percent of cases. Typically, the crop accounts for roughly 10% of GDP, 30% of overall exports, and more than 50% of agricultural exports. The Tobacco Control team works to reduce the burden of illness, mortality, and the financial costs associated with tobacco use and exposure to passive smoking. Currently, smoking is the leading preventable cause of mortality in the world. For smokeless tobacco control, various strategies are required, including media campaigns and related programmes. Variable tobacco industry marketing tactics, lax enforcement of tobacco control laws, persistent affordability, and incomplete knowledge of the health hazards of tobacco use are all contributing reasons that are raising the use of smokeless tobacco.
To study the prevalence of oral tobacco usage amongst residents from an urban slum in central urban India
To study the pattern of oral tobacco usage amongst residents from an urban slum in central urban India. To assess the motivating and demotivating factors associated with usage of oral tobacco in our study settings.
A cross-sectional study will be conducted in Wardha district from June 2023 to Nov 2023.
The present study will be conducted in the urban slums of Wardha District.
Both male and female adult inhabitants of urban slums from the field practice area of the urban health training center of institute will be approached by door-to-door household surveying using the systematic random sampling method.
Inclusion criteria: Study participants (>18 years) who are willing to participate.
Exclusion criteria: Study participants (>18 years) who do not consent to take part in the research study.
Sampling method: The personal interview method will be used to visit the households to reach the sample size.
Oral tobacco use Types of oral tobacco used Motivating & demotivating factors
Information on the participants' knowledge, attitudes, and perceptions of tobacco use gathered used a questionnaire that modified from the Global Youth Tobacco Survey and the Global Adults Tobacco Survey (
| SN | Key study parameters | Variables | Data Sources | Data collection method |
|---|---|---|---|---|
| 1. | Socio-demographic profile |
Age Education Occupation Economic status |
Households from field practice area from Urban Health Training Centre, Wardha | Interview method using a Questionnaire |
| 2. | Assess the pattern of oral tobacco use |
Early initiation Oral tobacco duration First time chewing tobacco |
Households from field practice area from Urban Health Training Centre, Wardha | Interview method using a questionnaire |
| 3. | Assess the motivating and demotivating determinants | Ever thought of quitting tobacco
|
Participants who consume tobacco | Interview method using a questionnaire |
The data collected will be entered into a Microsoft Excel spreadsheet.
Descriptive statistics like mean, frequency and percentages of various parameters will calculated, the Open Epi version 3.01 Epi Info software (
Bias: There may be information bias and selection bias and social desirability bias in this study.
Selection bias will be addressed using systemic random sampling, and information and social disability bias will be minimizes as much as possible by building good rapport with study participants and making the beneficiaries understand the importance and objective of the study.
Study size: The average population is around 28,000. Using formula n= pq/L2 and precision 10% sample size comes to be around 384 using prevalence 51% as per previous studies.
Data analysis on the quantitative variables Descriptive Statistics like mean, frequency and percentages of various parameters will calculated, via the Open EPI Software and data will be presented using tables and graphs. Inferential statistics like chi square tests will be used. Different types of households in urban city areas use these tobacco products in different ways, so such households in field practice areas will be selected using systematic random sampling Statistical method: Data will be entered using Microsoft Excel. All the responses will be tabulated, and graphical representation will be made wherever necessary. Data will be analysed by using the Open Epi Info software which is freely available in the public domain.
Through our study we expect to assess the prevalence and pattern of oral tobacco use and its determinants in urban slum area and plan preventive strategies accordingly.
Ethical approval for this study (DMIHER (DU) IEC/2023/643) was provided by the Ethical committee of Data Meghe Institute of Higher Education and Research (Deemed to be University) on 11/02/2023.
Squamous cell carcinomas of the oral cavity (OSCC) make up a large percentage of cancer cases in India. The two most dangerous forms of oral cancer, with a higher incidence in India, are buccal mucosa and tongue OSCC.
The study will provide knowledge and awareness regarding the initiation of oral tobacco use amongst urban slum inhabitants in both male and female.
The information gathered in the study can further help decide what lifestyles and setting is responsible for oral tobacco problems in male and female. Moreover, the need to promote healthy lifestyle and proper assigning of lifestyles to avoid oral tobacco problems. Women with conditions where oral tobacco is contraindicated i.e., untreated active oral Cancer.
As the study is a cross sectional study being conducted at urban slums in catchment area of urban health training centre of a tertiary care hospital only so external validity of study shall be limited as prevalence and pattern and determinants of oral tobacco use may vary between geographical locations and prevailing socio-economic-cultural context.
As the study relies on participant’s response to oral tobacco use and perceptions, determinants there is chance of social desirability bias being introduced in the study.
In this study, the early initiation of oral tobacco use amongst urban slum inhabitants, exclusive tobacco consumption, determine the knowledge, attitude, and practice of oral tobacco use amongst urban slum inhabitants. Study explains the importance of early initiation of tobacco cessation as a public health priority and it is an important intervention strategy in reducing the oral disease, Avoidance of tobacco consumption and ensuring early initiation of tobacco cessation.
No data is associated with this article.
I would like to thank Statisticians and Members of the Research Guidance Unit, Research & Development Cell, DMIHER for their contribution in a part of sample size calculation to the completion of research manuscript.
It is universally agreed that tobacco in any form causes a myriad of health issues. In India, there is a notable shift of tobacco use from smoked forms to smokeless forms as revealed by several large scale studies. To formulate targeted or focussed policies – there is a sub-par data with for smokeless forms as compared to the smoked forms. It is widely recognized that bio-psycho-economic-social constructs play a crucial role in tobacco usage. Hence the need for this study is justified. My comments are as follows:
The sentence such as “Because everyone spits after using oral tobacco, there are more persons who spit in public due toits use” do not add meaningful contribution to the abstract or the protocol. Authors can remove such irrelevant, non-focussed sentence(s) to keep the focus of the article restricted to central theme. The abstract fails to justify the need for the study or the lacunae in the data to take policy based decisions.
The first paragraph of the introduction is not focused and misleading from the central theme of the protocol and most importantly, unreferenced. In the second paragraph, authors use the term
Authors need to be careful in choice of term as such studies may form evidence for future actions and policies. Involving specific group such as transport employees or citing job stress to smokeless tobacco use is misleading and unwarranted for such study as the focus of study in urban slum – hence such mis-construct may mislead and divert the intended goals of the study. Authors need to focus the words carefully. The introduction is superfluous and does not present a strong argument for the need of study, knowledge or data gap that exists. Authors claim the GTYS Indian data as – “India are still extremely speculative and non-representative” but fail to establish the why these were speculative and non-representative – hence their argument fails. Authors have preferred to write hundreds of words after stating primary goals of the study and that needs to be curtailed.
The rationale part fails to say how this study would increase the knowledge on the subject matter and how it would help to frame better polices for combating smokeless tobacco usage. Instead it focusses on what is already known in the domain.
For the methodology, operational definition of slum, tobacco (type/ frequency/ intensity/duration - pack years or equivalence), quantification of socio-economic factors, education etc., motivational and demotivational factors are missing. It is pertinent to note that authors prefer to use GYTS-GATS format, which they considered to be “extremely speculative and non-representative”.
Better inferential statistics have to be planned to draw meaningful conclusions. Mere descriptive statistics would not be helpful to make recommendations.
Is the study design appropriate for the research question?
No
Is the rationale for, and objectives of, the study clearly described?
No
Are sufficient details of the methods provided to allow replication by others?
Partly
Are the datasets clearly presented in a useable and accessible format?
No
Reviewer Expertise:
Oral and Maxillofacial Pathology, Smokeless tobacco, Areca nut and products, NCD and Oral Health, Cystogenesis
I confirm that I have read this submission and believe that I have an appropriate level of expertise to state that I do not consider it to be of an acceptable scientific standard, for reasons outlined above.
This cross-sectional study protocol intends to estimate the prevalence and patterns of oral tobacco use and assess the motivating and demotivating factors associated with it amongst urban slum inhabitants in India. Reporting of methodology is not up to standard and the writing of the manuscript needs to be substantially improved.
Please check this sentence and correct any errors: “Because everyone spits after using oral tobacco, there are more persons who spit in public due toits use”
Background is too long for an abstract. Please consider summarizing.
In abstract, include the sample size and country.
These two sentences seem to be out of place or too general, and not relevant to the topic addressed in the article. Consider deleting: “The United Nations’ World Health Organization (WHO) oversees global public health. The primary goal of the WHO, according to its constitution, is to ensure that everyone has the best possible level of health.”
There are no references for some statements. For example, “Smokeless tobacco usage patterns share significant parallels with patterns of use of other addictive drugs.” Please add them.
Again, these statements are too general. Instead, consider adding a reference for a WHO initiative (if any) that targeted smokeless tobacco. Consider deleting: “The mandate of the WHO calls for global collaboration to enhance health, uphold world peace and harmony, and assist the vulnerable. It encourages a billion more people to participate in monitoring public health risks, coordinating emergency medical response efforts, promoting health and wellness, and implementing universal health care.”
Please indicate the country in this sentence, because it hasn’t been mentioned anywhere earlier in the manuscript: “Smokeless tobacco use, particularly in the eastern, northern, and north-eastern regions of the country….”
What is Pan? “Pan is frequently taken with chewed smokeless tobacco products……”
Authors have not paid attention to the flow of information (poor transition from one point to another) and some sentences are out of place or irrelevant. For example, detailed description of tobacco processing is not necessary. I strongly suggest having this article edited by a professional English editor.
Please replace “Older folks” with words that are more suitable for a scientific journal.
Stay focused on smokeless tobacco and reduce information about tobacco in general and it’s health impacts.
Please do not use smokeless tobacco and oral tobacco interchangeable. Be consistent.
Correct this. The word “urban” is redundant: “…….urban slum in central urban India”
Provide more details about the study setting and sampling population.
Exclusion criteria are used for excluding ineligible participants (for example, based on a health condition) before they provide informed consent, and they are not invited to participate in the study. Therefore, not consenting to take part in the research study is not considered an exclusion criterion.
Sampling method indicates that the personal interview method was used but data sources section indicates that a questionnaire was used. Did you use an oral interview or a paper-based questionnaire? Please provide your instrument or rubric as a supplementary material.
Authors say that “……….. Selection bias will be addressed using systemic random sampling”. I’m curious if this is stratified random sampling, rather than systematic random sampling, and also, how you did it. Please provide more details of your sampling method.
Most of the information provided in discussion is not related to the topic and implications of the study.
This sentence needs to be corrected: “In this study, the early initiation of oral tobacco use amongst urban slum inhabitants, exclusive tobacco consumption, determine the knowledge, attitude, and practice of oral tobacco use amongst urban slum inhabitants.”
Additional major comment: Methodology is not adequately reported, and a lot of information is missing. Please follow the STROBE checklist for reporting of cross-sectional studies.
Is the study design appropriate for the research question?
Partly
Is the rationale for, and objectives of, the study clearly described?
Partly
Are sufficient details of the methods provided to allow replication by others?
No
Are the datasets clearly presented in a useable and accessible format?
No
Reviewer Expertise:
Substance use
I confirm that I have read this submission and believe that I have an appropriate level of expertise to state that I do not consider it to be of an acceptable scientific standard, for reasons outlined above.