Tobacco use and nicotine dependence among patients with diabetes and hypertension in Ballabgarh, India
Tobacco use is one of the most important modifiable risk factors for cardiovascular mortality and has a synergistic effect with diabetes and hypertension. This study was conducted to estimate the prevalence of tobacco use and nicotine dependence among adult diabetic and/or hypertensive patients. We conducted a cross-sectional study among 419 consecutively enrolled patients from the non-communicable diseases (NCDs) outpatient clinic of a secondary level hospital in Ballabgarh, India between July 2018 and January 2019. We administered a pre-tested questionnaire to assess tobacco use and Fagerstrom Test for Nicotine Dependence (FTND) to assess nicotine dependence. Current tobacco users were defined as those who smoked in the past seven days. Nicotine dependence was classified as low, moderate or high for the FTND score of 0 -3, 4-6, and 7-10, respectively. Seventy-nine patients had diabetes, 226 had hypertension, and 114 had both. The prevalence of tobacco use was 20.8% (95% CI : 17.1 - 24.9); prevalence of smoking was 15% (95% CI: 11.9 â€“ 18.8) and smokeless tobacco use was 7.2% (95% CI: 5 - 10.1). Moderate to high nicotine dependence was found among 59.7% of tobacco users; 75.9% tobacco users attempted to quit tobacco in the past one month. One-fifth of attendees of a NCD clinic in a secondary level hospital used tobacco, most of whom had moderate-to-high nicotine dependence. High level of nicotine dependence and inability to quit despite making an attempt for it necessitates the inclusion of tobacco cessation services in the management of patients with non-communicable diseases.
World Health Organization. Noncommunicable diseases country profiles. 2018. Available from: https://apps.who.int/iris/handle/10665/274512
Kyu HH, Abate D, Abate KH, et al. Global, regional, and national disability-adjusted life-years (DALYs) for 359 diseases and injuries and healthy life expectancy (HALE) for 195 countries and territories, 1990–2017: a systematic analysis for the Global Burden of Disease Study 2017. Lancet 2018;392:1859–922. DOI: https://doi.org/10.1016/S0140-6736(18)32335-3
S Office of the Registrar General & Census Commissioner [Internet]. Causes of death in India 2010-2013. Accessed: 2019 Apr 30. Available from: http://www.censusindia.gov.in/vital_statistics/causesofdeath.html
Hackam DG, Anand SS. Emerging risk factors for atherosclerotic vascular disease: a critical review of the evidence. J Am Med Assoc 2003;290:932–40. DOI: https://doi.org/10.1001/jama.290.7.932
Fagard RH. Smoking amplifies cardiovascular risk in patients with hypertension and diabetes. Diabetes Care 2009;32:S429–31. DOI: https://doi.org/10.2337/dc09-S354
Vidyasagaran AL, Siddiqi K, Kanaan M. Use of smokeless tobacco and risk of cardiovascular disease: A systematic review and meta-analysis. Eur J Prev Cardiol 2016;23:1970–81. DOI: https://doi.org/10.1177/2047487316654026
Tan J, Zhang X, Wang W, et al. Smoking, blood pressure, and cardiovascular disease mortality in a large cohort of Chinese men with 15 Years follow-up. Int J Environ Res Public Health 2018;15:1–9. DOI: https://doi.org/10.3390/ijerph15051026
Jha P, Jacob B, Gajalakshmi V, et al. A nationally representative case–control study of smoking and death in India. N Engl J Med 2008;358:1137–47. DOI: https://doi.org/10.1056/NEJMsa0707719
World Health Organization. Global action plan for the prevention and control of NCDs 2013-2020. Accessed: 2019 Apr 20. Available from: http://www.who.int/nmh/events/ncd_action_plan/en/
Government of India, WHO. National action plan and monitoring framework for prevention and control of NCDs. 2012. Accessed: 2019 Jan 20. Available from: http://www.searo.who.int/india/topics/cardiovascular_diseases/National_Action_Plan_and_Monitoring_Framework_Prevention_NCDs.pdf
Ministry of Health and Family Welfare, World Health Organization, Tata Institute of Social Sciences. Global Adult Tobacco Survey (GATS2) second round, India, 2016-17.
World Health Organization. Global report on trends in prevalence of tobacco smoking 2000-2025. Available from: https://apps.who.int/iris/bitstream/handle/10665/272694/9789241514170-eng.pdf
Abdulkader RS, Sinha DN, Jeyashree K, et al. Trends in tobacco consumption in India 1987–2016: impact of the World Health Organization Framework Convention on Tobacco Control. Int J f Public Health 2019;64:841–51. DOI: https://doi.org/10.1007/s00038-019-01252-x
Wafeu GS, Tankeu AT, Endomba FTA, et al. Prevalence and associated factors of active smoking among individuals living with hypertension and/or diabetes in Africa: a systematic review and meta-analysis protocol. BMJ Open 2017;7:e015444. DOI: https://doi.org/10.1136/bmjopen-2016-015444
Sarkar A, Roy D, Chauhan M, et al. A study on the pattern of self-reported tobacco addiction in hypertensive patients in Gujarat, India. Addict Health 2019;11:35–41.
Thresia CU, Thankappan KR, Nichter M. Smoking cessation and diabetes control in Kerala, India: an urgent need for health education. Health Educ Res. 2009;24:839–45. DOI: https://doi.org/10.1093/her/cyp020
Kishore J, Gupta N, Kohli C, Kumar N. Prevalence of hypertension and determination of its risk factors in rural Delhi. Int J Hypertens 2016;2016:7962595. DOI: https://doi.org/10.1155/2016/7962595
Gupta A, Gupta R, Sharma KK, et al. Prevalence of diabetes and cardiovascular risk factors in middle-class urban participants in India. BMJ Open Diabet Res Care 2014;2: e000048. DOI: https://doi.org/10.1136/bmjdrc-2014-000048
Directorate General of Health Services, Ministry of Health and Family Welfare, Government of India [Internet]. National programme for prevention and control of cancer, diabetes, cardiovascular diseases and stroke. Accessed: 2020 Aug 30. Available from: https://dghs.gov.in/content/1363_3_NationalProgrammePreventionControl.aspx
Directorate General of Health Services, Ministry of Health and Family Welfare, Government of India [Internet]. National tobacco control programme. Accessed: 2020 Aug 30. Available from: https://dghs.gov.in/content/1356_3_NationalTobaccoControlProgramme.aspx
Cosci F, Pistelli F, Lazzarini N, Carrozzi L. Nicotine dependence and psychological distress: outcomes and clinical implications in smoking cessation. Psychol Res Behav Manag 2011;4:119–28. DOI: https://doi.org/10.2147/PRBM.S14243
Heatherton TF, Kozlowski LT, Frecker RC, Fagerstrom K-O. The Fagerström test for nicotine dependence: a revision of the Fagerstrom Tolerance Questionnaire. Br J Addict 1991;86:1119–27. DOI: https://doi.org/10.1111/j.1360-0443.1991.tb01879.x
Ebbert JO, Patten CA, Schroeder DR. The Fagerström test for nicotine dependence-smokeless tobacco (FTND-ST). Addict Behav 2006;31:1716–21. DOI: https://doi.org/10.1016/j.addbeh.2005.12.015
Mariappan VA, Sahu SK, Sarkar S, e al. Smoked and smokeless tobacco use among pulmonary tuberculosis patients under RNTCP in urban Puducherry, India. Indian J Tubercul 2016;63:158–66. DOI: https://doi.org/10.1016/j.ijtb.2016.08.004
Ruhil R. Sociodemographic determinants of tobacco use in India: Risks of risk factor—an analysis of global adult tobacco survey India 2016-2017. SAGE Open 2019;9:2158244019842447. DOI: https://doi.org/10.1177/2158244019842447
Morrow M, Barraclough S. Gender equity and tobacco control: bringing masculinity into focus. Global Health Promot 2010;17:2S1–8. DOI: https://doi.org/10.1177/1757975909358349
World Health Organization. Gender, women, and the tobacco epidemic. World Health Organization, Geneva; 2010.
Islam K, Datta AK, Seth S, et al. A study on the prevalence and correlates of nicotine dependence among adolescents of Burdwan Town, West Bengal. Indian J Psychiatry 2019;61:89–93.
Naik BN, Majella MG, Parthibane S, Kar SS. Level of tobacco dependence among tobacco users in an urban slum of Puducherry: A pilot study. J Family Med Prim Care 2017;6:336–9. DOI: https://doi.org/10.4103/2249-4863.220000
Pallavi P, Amith HV, Garima B, et al. Assessment of nicotine dependence among the tobacco users in outreach programs: A questionnaire based survey. Int J Oral Health Med Res 2015;2:34–8.
Aryal UR, Bhatta DN, Shrestha N, Gautam A. Assessment of nicotine dependence among smokers in Nepal: a community based cross-sectional study. Tob Induc Dis 2015;13:26–34. DOI: https://doi.org/10.1186/s12971-015-0053-8
Divinakumar KJ, Patra P, Prakash J, Daniel A. Prevalence and patterns of tobacco use and nicotine dependence among males industrial workers. Ind Psychiatry J 2017;26:19. DOI: https://doi.org/10.4103/ipj.ipj_14_17
Srivastava S, Malhotra S, Harries AD, et al. Correlates of tobacco quit attempts and cessation in the adult population of India: secondary analysis of the Global Adult Tobacco Survey, 2009–10. BMC Public Health 2013;13:263. DOI: https://doi.org/10.1186/1471-2458-13-263
Whelton PK, Carey RM, Aronow WS, et al. 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA guideline for the prevention, detection, evaluation, and management of high blood pressure in adults: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. J Am Coll Cardiol 2018;71:2199-269. DOI: https://doi.org/10.1161/HYP.0000000000000076
American Diabetes Association. 5. Facilitating behavior change and well-being to improve health outcomes: standards of medical care in diabetes - 2020. Diabetes Care 2020;43:S48–65. DOI: https://doi.org/10.2337/dc20-S005
Institute for Health Metrics and Evaluation [Internet]. Global burden of diseases. Country profile - India 2015. Accessed: 2020 Apr 16. Available from: http://www.healthdata.org/india
- Abstract views: 118
- PDF: 42
Copyright (c) 2021 The Author(s)
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
PAGEPress has chosen to apply the Creative Commons Attribution NonCommercial 4.0 International License (CC BY-NC 4.0) to all manuscripts to be published.