Prevalence and Dependency of Tobacco Use in an Indigenous Populationof Kerala, India

Background: Kerala has a large number of tribal communities where the prevalence of tobacco related oral mucosal lesions is alarmingly high. This coupled with ignorance regarding harmful effects of tobacco use is an emerging public health problem. Purpose: To find out dependency of tobacco use in an indigenous population of Wayanad, India. Methods: A cross- sectional study was designed in the tribal colonies of Kalpetta, Kerala. A multi-stage cluster sampling design was adopted to select the indigenous people living in colonies. A structured close-ended interview was conducted using a 27-item questionnaire, modified and adapted from the National Institute for Mental Health and Neurosciences, India (NIMHANS). The questionnaire consisted of five domains. To assess the dependency of tobacco habit, Fagerstrom Nicotine Dependency Scale for both smoking and smokeless forms of tobacco were used. Results: Of the 103 responses obtained, 41.7% were males. Participants were in the age group of 14-70 years with a mean age of 43 years. Almost half of the respondents cleaned their teeth twice daily. About 53% of people cleaned their teeth using fingers. Toothpowder and rice husks were the commonly used materials for cleaning teeth (64%) followed by toothpaste (35.9%). It was observed that the prevalence of tobacco use in this population was 73.8%. Majority of the respondents (92%) used smokeless forms of tobacco. The mean scores of nicotine dependency for smoked tobacco was 3.85 (± 2.7) and that for smokeless form was 4.61 (± 2.17). Both these scores denote moderate dependency of tobacco use. The average age of onset of tobacco use was 16.41 years for smoked and 17.53 years for smokeless forms. Conclusions: The prevalence of tobacco consumption was found to be high among both males and females in the tribal population. Majority of them consumed different forms of smokeless tobacco