|Year : 2021 | Volume
| Issue : 1 | Page : 59-62
Prevalence of tobacco use and associated factors among Injecting Drug Users and Men who have Sex with Men
Deepak Sharma1, Naveen Krishan Goel1, Munish Kumar Sharma1, Dinesh Kumar Walia1, Meenal Madhukar Thakare2, Vanita Gupta3, Sandeep Mittal3, Manish Sharma4
1 Department of Community Medicine, Government Medical College and Hospital, Chandigarh, India
2 Department of Community and Family Medicine, AIIMS, Bilaspur, Himachal Pradesh, India
3 State AIDS Control Society, Chandigarh, India
4 PGIMER, Chandigarh, India
|Date of Submission||29-Jul-2020|
|Date of Decision||21-Aug-2020|
|Date of Acceptance||11-May-2021|
|Date of Web Publication||29-Jun-2021|
Dr. Deepak Sharma
Department of Community Medicine, Government Medical College and Hospital, Chandigarh
Source of Support: None, Conflict of Interest: None
Introduction: Tobacco use is a leading cause of ill-health, disability, and death worldwide. The current study aimed at estimating the prevalence of tobacco use and identify factors associated with it among injecting drug users (IDUs) and men who have sex with men (MSM).
Materials and Methods: A cross-sectional study was conducted among 100 IDUs and 100 MSM each, recruited with the help of outreach workers and peer educators of Nongovernment Organizations working for them. Tobacco usage behavior was assessed using an interviewer-administered questionnaire. Epi Info software for windows (CDC Atlanta) was used to calculate proportions and evaluate the association between tobacco use and independent variables.
Results: The current tobacco use prevalence among IDUs was 91% (smokers 75%, smokeless tobacco users 45%). Similarly, the current tobacco use prevalence among MSM study participants was 48% (smokers 28%, smokeless tobacco users 32%). Around half of the current tobacco users had tried to quit tobacco in the past 12 months.
Conclusions: There is a high proportion of tobacco use among both IDUs and MSM. It is therefore of utmost importance to strengthen tobacco cessation efforts in these groups.
Keywords: Injecting drug user, men having sex with men, tobacco
|How to cite this article:|
Sharma D, Goel NK, Sharma MK, Walia DK, Thakare MM, Gupta V, Mittal S, Sharma M. Prevalence of tobacco use and associated factors among Injecting Drug Users and Men who have Sex with Men. Indian J Community Fam Med 2021;7:59-62
|How to cite this URL:|
Sharma D, Goel NK, Sharma MK, Walia DK, Thakare MM, Gupta V, Mittal S, Sharma M. Prevalence of tobacco use and associated factors among Injecting Drug Users and Men who have Sex with Men. Indian J Community Fam Med [serial online] 2021 [cited 2023 May 28];7:59-62. Available from: https://www.ijcfm.org/text.asp?2021/7/1/59/319964
| Introduction|| |
Tobacco use is a serious public health problem leading to considerable morbidity and mortality worldwide. Tobacco users are more likely than nonusers to develop noncommunicable diseases such as cardiovascular disease, stroke, and cancer. In addition, tobacco-related diseases strain the existing health-care delivery system by increasing inpatient admissions and more duration of hospital stay. To tackle this challenge, the Government of India has implemented tobacco control policies like implementing the Cigarettes and Other Tobacco Products Act, generating awareness of the dangerous effects of tobacco and helping those addicted to it in quitting.
Men who have sex with men (MSM) are more likely to face stigma and discrimination in the society due to their sexual identity;, which may be linked to the norms and prejudices. Similarly, injecting drug users (IDUs) because of their addiction behavior find it difficult to adjust in their family and society. The feeling of being marginalized and socially isolated predispose MSM and IDUs to psychological problems such as mood disorders, self-hatred, depression, and anxiety., Further existing literature shows that mental health problems can lead a person to adopt harmful behaviors like tobacco use., Loneliness and being socially isolated too have been reported to increase the chance of using tobacco.
The existing Indian studies on tobacco use have been conducted among different population groups such as adolescents,, adults, elderly, medical students, and females. However, to the best of our knowledge, no study on tobacco use in India has been specifically conducted among IDUs and MSM. This information if made available can help tobacco control policymakers in designing appropriate interventions tailored for this population group. In this backdrop, the present study aimed at estimating the prevalence of tobacco use and identify factors associated with it among IDUs and MSM.
| Materials and Methods|| |
This cross-sectional study was conducted among 100 IDUs and 100 MSM in Chandigarh city of North India. Sample size estimation for both these groups (IDU and MSM) was based on an assumed prevalence of tobacco consumption as 50%, 95% confidence interval, and precision of 10%. For enrolling this desired sample size, convenience sampling methodology was followed, wherein the study participants were recruited with the help of outreach workers and peer educators of Nongovernment Organizations (NGOs) working for them. The interviewers visited the drop-in centers of the selected NGOs to enroll the study participants. Apart from this, interviews were also held at some specific locations as deemed viable by NGO staff for enrolling study participants into the study.
A questionnaire was administered to the study participants after informing them about the objectives of the study and seeking their written informed consent. An “Injecting Drug User” was defined as one who had been injecting drugs for at least once in the past 3 months. The operational definition of “Men who have Sex with Men” was men who had sex (manual/oral/anal) with other men in the last 6 months. A “current tobacco user” was one who smoked or used smokeless tobacco, at least once in the last 30 days preceding the interview. Quit attempt was assessed by asking: “During the past 12 months have you tried to stop smoking/smokeless tobacco use?” The other studied variables included sociodemographic factors (age, education, occupation, and marital status) and awarness about harmful effects of tobacco. Data were analyzed using Epi Info software for windows version 7.2.4 (CDC Atlanta, USA). It was summarized as frequencies and proportions. Chi-square test and Fisher's exact test were conducted as appropriate to determine the association of independent variables with current tobacco use. The study was approved by the Research and Ethics Committee of Medical College. Prior to fieldwork, approval was obtained from the State AIDS Control Society.
| Results|| |
A total of 100 IDUs and 100 MSM each were interviewed. The mean age of IDUs and MSM was 31 ± 8.6 years and 26 ± 7.2 years, respectively. Most of the study participants were in the age group 18–30 years (IDUs = 58%; MSM = 73%), literate (IDU = 93%, MSM = 88%), and employed (IDU = 85%, MSM = 92%). Around half of them were unmarried (IDU = 50%, MSM = 60%). The mean age of initiation of smoking tobacco among IDUs and MSM was 17.9 ± 5 years and 17.5 ± 4.9 years, respectively. Similarly, for the smokeless tobacco, the mean age of initiation was 18.8 ± 5.8 years for IDUs and 19.3 ± 5.8 years for MSM.
The current tobacco use prevalence among IDUs was 91% (smokers 75%, smokeless tobacco users 45%). Only 8% of IDUs were past tobacco users and 1% never-user of tobacco. Among the 75 current smokers, 44 (58.6%) had tried to quit in the past 12 months. Similarly, out of 45 current smokeless tobacco users, 51.1% (23/45) had tried to quit in the past 12 months. The current tobacco use prevalence among MSM study participants was 48% (smokers: 28%, smokeless tobacco users: 32%). There were 8% past tobacco users and only 44% never-user of tobacco. Out of 28 MSM smokers, 17 (60.7%) had tried to quit in the past 12 months. Similarly, out of 32 MSM smokeless tobacco users, 18 (56.2%) had tried to quit in the past 12 months. Nearly all the study participants were aware that using tobacco in some form or the other can lead to illness (IDUs = 99%; MSM = 92%). The possible illnesses which may happen due to tobacco use as reported by study participants were cancer (IDUs = 69%; MSM = 61%), respiratory problems (IDUs = 44%; MSM = 24%), and oral ulcers (IDUs = 31%, MSM = 17%).
In the bivariate analysis, the current tobacco use among IDUs and MSM was not significantly related to sociodemographic factors namely age, education, occupation, or marital status [Table 1]. Among IDUs, significantly more proportion of unemployed smokeless tobacco users tried quitting tobacco (100%), as compared to the employed counterparts (45.0%; P = 0.049) [Table 2].
|Table 1: Factors associated with current tobacco use among the study participants|
Click here to view
|Table 2: Factors associated with quit attempt among the study participants|
Click here to view
| Discussion|| |
As far as we are aware, the present study is the first from India to document the prevalence of tobacco use among IDUs and MSM. The high tobacco usage found in our study confirms their vulnerability to the harmful effects of tobacco. This finding is consistent with previous studies conducted worldwide. Shin et al. in Mexico reported that 89.7% of the IDUs were current tobacco smokers. Similarly, Villanti et al. in a study among IDUs in Maryland reported that the prevalence of smoking was 92.1%. Duan et al. in China reported that 97.8% of the IDUs were smoking tobacco. In another study, Bowman et al. in Australia found that 84% IDUs were tobacco smokers. Storholm et al. studied young MSM and reported that 36.3% were currently smoking cigarettes. Berg et al. conducted a study among MSM in China and found that 65.9% were current smokers.
In the present study, around half of the study participants tried to quit tobacco in the past 1 year. This depicts the willingness of IDUs and MSM in quitting tobacco and thus needs focussed tobacco cessation services. Shin et al. in a study reported that 20.6% of the IDUs made a quit attempt in the past. Further, among IDUs more proportion of unemployed smokeless tobacco users tried quitting tobacco as compared to their counterparts. This finding may be attributed to the fact that unemployed people due to inadequate income may find it difficult to buy the tobacco product for consumption and thus abstain from its use. Similar to this finding, Nargis et al. studied the socioeconomic patterns of smoking cessation behavior using the Global Adult Tobacco Surveys and International Tobacco Control Surveys and reported that employed smokers were less likely to quit than their nonemployed counterparts.
The results of this study are generalizable to the studied groups. Further studies may be done across different study sites to have more information regarding tobacco use among IDUs and MSM. The limitation of the current study is its cross-sectional design; because of which the causality relationship between the independent variables and tobacco use cannot be established. Secondly, the information on tobacco usage and quit attempt could be subject to reporting or recall bias; thus leading to its under or over-reporting.
| Conclusion|| |
There was a high proportion of tobacco use among IDUs and MSM. Around half of them had tried to quit tobacco in the past 1 year. It is therefore recommended that IDUs and MSM should be viewed as a priority group for tobacco control efforts. Focused behaviour change interventions should be designed for them; so as to discourage tobacco initiation and encourage quit behaviour among those already using it.
The authors would like to thank the study participants for their contribution to this research. The authors would also like to thank the staff of NGOs working for IDUs and MSM in the study area for their cooperation and support.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Altman D, Aggleton P, Williams M, Kong T, Reddy V, Harrad D, et al
. Men who have sex with men: Stigma and discrimination. Lancet 2012;380:439-45.
Simmonds L, Coomber R. Injecting drug users: A stigmatised and stigmatising population. Int J Drug Policy 2009;20:121-30.
Soohinda GS, Jaggi PS, Sampath H, Dutta S. Depression and its correlates in men who have sex with men (MSM) in India. Indian J Soc Psychiatry 2018;34:239-44. [Full text]
Mackesy-Amiti ME, Donenberg GR, Ouellet LJ. Prevalence of psychiatric disorders among young injection drug users. Drug Alcohol Depend 2012;124:70-8.
Lawrence D, Mitrou F, Zubrick SR. Smoking and mental illness: Results from population surveys in Australia and the United States. BMC Public Health 2009;9:285.
Kalman D, Morissette SB, George TP. Co-morbidity of smoking in patients with psychiatric and substance use disorders. Am J Addict 2005;14:106-23.
Shankar A, McMunn A, Banks J, Steptoe A. Loneliness, social isolation, and behavioral and biological health indicators in older adults. Health Psychol 2011;30:377-85.
Thakur D, Gupta A, Thakur A, Mazta SR, Sharma D. Prevalence of cigarette smoking and its predictors among school going adolescents of North India. South Asian J Cancer 2014;3:193-5. [Full text]
Jaisoorya TS, Beena KV, Beena M, Jose DC, Ellangovan K, Thennarasu K, et al
. Prevalence and correlates of tobacco use among adolescents in Kerala, India. Indian J Med Res 2016;144:704-11.
] [Full text]
Koothati RK, Reddy GV, Ramlal G, Prasad LK, Kumar VJ, Pokala A. An epidemiological study of tobacco-related oral habits in Mahabubnagar district of Telangana, India. J Indian Acad Oral Med Radiol 2017;29:205-8. [Full text]
Goswami A, Reddaiah VP, Kapoor SK, Singh B, Dwivedi SN, Kumar G. Tobacco and alcohol use in rural elderly Indian population. Indian J Psychiatry 2005;47:192-7.
] [Full text]
Mony PK. Is tobacco use increasing among medical students of Bengaluru city, India? Evidence from two cross-sectional studies. Natl Med J India 2016;29:274-6.
] [Full text]
Mishra GA, Kulkarni SV, Gupta SD, Shastri SS. Smokeless tobacco use in Urban Indian women: Prevalence and predictors. Indian J Med Paediatr Oncol 2015;36:176-82.
] [Full text]
Shin SS, Moreno PG, Rao S, Garfein RS, Novotny TE, Strathdee SA. Cigarette smoking and quit attempts among injection drug users in Tijuana, Mexico. Nicotine Tob Res 2013;15:2060-8.
Villanti A, German D, Sifakis F, Flynn C, Holtgrave D. Smoking, HIV status, and HIV risk behaviors in a respondent-driven sample of injection drug users in Baltimore, Maryland: The besure study. AIDS Educ Prev 2012;24:132-47.
Duan S, Jin Z, Liu X, Yang Y, Ye R, Tang R, et al
. Tobacco and alcohol use among drug users receiving methadone maintenance treatment: A cross-sectional study in a rural prefecture of Yunnan Province, Southwest China. BMJ Open 2017;7:e014643.
Bowman J, Wiggers J, Colyvas K, Wye P, Walsh RA, Bartlem K. Smoking cessation among Australian methadone clients: Prevalence, characteristics and a need for action. Drug Alcohol Rev 2012;31:507-13.
Storholm ED, Halkitis PN, Siconolfi DE, Moeller RW. Cigarette smoking as part of a syndemic among young men who have sex with men ages 13-29 in New York City. J Urban Health 2011;88:663-76.
Berg CJ, Nehl EJ, Wong FY, He N, Huang ZJ, Ahluwalia JS, et al
. Prevalence and correlates of tobacco use among a sample of MSM in Shanghai, China. Nicotine Tob Res 2011;13:22-8.
Nargis N, Yong HH, Driezen P, Mbulo L, Zhao L, Fong GT, et al
. Socioeconomic patterns of smoking cessation behavior in low and middle-income countries: Emerging evidence from the Global Adult Tobacco Surveys and International Tobacco Control Surveys. PLoS One 2019;14:e0220223.
[Table 1], [Table 2]