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ORIGINAL RESEARCH Table of Contents   
Year : 2007  |  Volume : 18  |  Issue : 1  |  Page : 11-14
Areca nut use among rural residents of Sriperambudur Taluk: A qualitative study


1 Medical Director, Chennai Dental Research Foundation, 56, Dr. Radhakrishnan Salai, Mylapore, Chennai - 4, India
2 Social Scientist, Chennai Dental Research Foundation, 56, Dr. Radhakrishnan Salai, Mylapore, Chennai - 4, India
3 Epidemiologist, Chennai Dental Research Foundation, 56, Dr. Radhakrishnan Salai, Mylapore, Chennai - 4, India
4 Dept. of Epidemiology, The Tamilnadu Dr. MGR Medical University, Guindy, Chennai - 32, India

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Date of Submission10-Apr-2006
Date of Decision30-Aug-2006
Date of Acceptance06-Sep-2006
 

   Abstract 

O0 bjective: The main objective of the study was to understand the perceptions of the residents of rural part of Sriperambudur Taluk, regarding areca nut use. This article discusses the findings of in-depth interviews and focus group discussions at rural part of Sriperambudur Taluk. Materials and Methods: A community-based survey was conducted using qualitative methods. Out of 168 villages, 11 were randomly chosen. Fifteen in-depth interviews and five focus group discussions were conducted. Only those above 10 years of age and who used areca nut either in processed or un-processed form were included in the study. Results: Among different forms of areca nut products, the use of Hans, which is a commercial flavored product containing areca nut, tobacco and other ingredients is believed to be the most prevalent habit in all the age groups. Chewing areca nut is the initiating habit, leading to other habits such as smoking and consuming alcoholic beverages. Residents less than 30 years of age chew areca nut products for fun or because of peer pressure whereas the 30 to 50 year olds get habituated due to reasons such as boredom and family problems. Although there is awareness regarding the ill-effects of tobacco use, there is not much awareness regarding areca nut. According to the residents, the community has not given enough thought regarding areca nut products and therefore no action has been taken to mitigate this high-risk behavior. Conclusion: It is the perception of the community that there is an increasing trend in the use of areca nut especially the commercial forms such as Hans , in rural Tamilnadu. Habit gets initiated at a very young age; therefore age specific intervention programs should be implemented. Periodic research should be conducted to better understand the changing trends of chewing areca nut products.

Keywords: Areca nut, awareness , betel quid, gutka, panmasala, Sriperambudur

How to cite this article:
Gunaseelan R, Shanthi S, Sowmya R, Datta M. Areca nut use among rural residents of Sriperambudur Taluk: A qualitative study. Indian J Dent Res 2007;18:11-4

How to cite this URL:
Gunaseelan R, Shanthi S, Sowmya R, Datta M. Areca nut use among rural residents of Sriperambudur Taluk: A qualitative study. Indian J Dent Res [serial online] 2007 [cited 2020 Aug 13];18:11-4. Available from: http://www.ijdr.in/text.asp?2007/18/1/11/30915

   Introduction Top


Areca nut is an important commercial crop in India. Areca nut is the seed of the areca nut palm. It plays an integral part of religious, social and cultural functions. Areca nut is a psychoactive substance used by several hundred million persons worldwide, predominantly in southern Asia.[1] Areca nut is available in processed and unprocessed forms. The processed areca nut products are available in a variety of commercial forms with and without tobacco such as plain arecanut (without tobacco) and Gutkha (with tobacco). Areca nut is taken as it is or wrapped in a betel leaf along with slaked lime and several condiments according to taste referred to as betel quid. The method of areca nut use varies by region.

Worldwide 600 million persons chew areca nut.[2] Recently the pan masala form of areca nut is becoming an increasingly popular form of areca nut chewing in India.[3],[4] It is the growing high- risk behavior among the youth of the country.[5] Several small surveys conducted in schools and colleges in several states of India have reported that 13-50% of students chew pan masala and gutka on a regular basis.[6]

Chewing betel quid (with or without tobacco) which has areca nut as one of its component has been positively associated with oral lesions such as oral submucous fibrosis (OSF) and leukoplakia, which has the potential for malignant transformation.[3],[7],[8],[9],[10],[11],[12] Several studies have reported relative risks of from 29 to 154 for developing OSF due to chewing of areca nut.[9],[13],[14],[15]

There is a need to decrease prevalence of areca nut use with or without tobacco, in the community. To implement effective interventions, it is important to understand the local forms of the habits. Understanding of how knowledge, attitude and behavior of a person influence his or her exposure to a pollutant is essential to improve the health of the community. Interviewing the individuals in the community helps in gathering information from the people in their natural setting and thus helps us to understand the experiences of the community regarding habits. Therefore, we conducted a cross-sectional survey using qualitative methods in the rural part of Sriperambudur Taluk during a period of two months from September 2005 to October 2005.


   Materials and Methods Top


Persons who were residents of the rural part of Sriperambudur Taluk, above 10 years of age, were included to be part of the study. Out of 168 villages, 11 villages were selected randomly. 15 in-depth interviews (one to one basis interview) and five focus group discussions were conducted. The focus group consisted of seven to eight persons each. The focus group discussions lasted for about 60 to 90 minutes and the one to one interview lasted for about 45 to 60 minutes. Only residents of those selected villages and those who used areca nut products were chosen for the study. Before including anybody into the study, oral consent was obtained. Focus groups and in-depth interviews were conducted from the age groups of above10 years to above 50 years old separately, to get an age-wise perspectives of the habit. Individuals were interviewed in five different age groups (10-20 years, 21-30 years, 31-40 years, 41-50 years and above 50 years). Four focus group discussions were conducted among men of different age groups separately (from age group of 10 years to 50 years). The older population, above 50 years refused to discuss. One focus group discussion was conducted among females above 50 years of age. We were unable to find enough number of women for other age groups for focus group discussion. Ten one-to-one interviews were conducted among the men population and five were conducted among the female population. Each interview was tape recorded after obtaining oral consent of the participant. The recorded interviews were then translated verbatim (word to word), translated to regional language and translated back to English to get the same information without changing its meaning.


   Results Top


General information

Majority of the community is involved in agriculture. The middle-aged and those persons above 60 years are involved in farming whereas the younger generation is employed in the organized sector as they get more remuneration. Some are involved in embroidery work. Most persons are educated only up to 10th standard and few study up to college. Persons employed in organized sector get higher remuneration

(Rs. 3000 - 5000 per month) as compared to those involved in agriculture/ construction work and embroidery work, who earn about Rs. 1000 to 1500 per month and Rs. 80 to 100 per day respectively. Residents who are involved in embroidery jobs do not have a consistent monthly income, as it depends on the number of days they get work.

Chewing habit in the community

Chewing areca nut is the initiating habit in the community. Residents chew areca nut primarily in the form of Gutkha (example: Hans). Some ladies of the community chew areca nut along with tobacco wrapped in a betel leaf.

Overall the use of Hans seemed to be the most prevalent habit. The residents believe that more than 60% of the male residents of the community would have the habit. The health workers of the community said, " Among those who are above 15 yrs of age, it will be difficult to point out a boy or a man who would not chew areca nut".

Friends coax the people into getting habituated to chewing areca nut. Initially friends provide areca nut products free and gradually they get habituated. Those in the age group of 30 to 50 years gave several reasons for getting addicted to the habit such as fights in the family, frustration and boredom. Some of them interviewed mentioned it as 'time pass', whereas residents above 50 years of age did not give any specific reasons for getting habituated.

Young boys who are employed were under the impression provided by their counterparts that chewing areca nut products would give them relaxation and thus would help them forget their problems. The community believes that the age at initiation of chewing habit is approximately between 13 to 15 years of age. Minors do not find it difficult to buy areca nut products with tobacco, as the shopkeepers do not refrain from selling it to them. Children who go to school do not develop the habit, but those who are employed at a young age develop the habit. Adolescents would sometimes go to the extremes of stealing money from their parents once they get habituated to areca nut products. Adults sometimes use their savings to pursue their habit.

The residents of the community chew areca nut products more when they are at work. Two of the participants said " we sometimes get up at night to chew gutkha. We get that urge". Those who occasionally practice the habit, do it due to peer pressure, during occasions such as death ceremonies, wedding and other festivities.

Family acceptance of the habits among youngsters

Youngsters, who are employed, feel too independent and parents do not have much control over them. When the parents confront them and pressurize them to quit chewing areca nut products, the children threaten to either quit work or commit suicide. Thus ultimately the parents feel helpless. The community members also expressed that, if the family has principles, standards or qualities considered worthwhile or desirable (good value system), their children would not indulge in such habit. The older people consider habits to be part of their life and are not alarmed by the fact that young kids indulge in high-risk behavior.

Action taken in the village or by the villagers

Unanimously everybody expressed that the village heads do not bother too much about the prevailing habit. Since chewing areca nut products is considered a personal habit, the community does not think that any action could be taken at village level and only self-realization could decrease the prevalence in the community. They felt that it might not be possible to ban areca nut products with tobacco from the community. The middle-aged expressed that the adolescents would turn violent with the shopkeepers if they did not stock gutkha whereas the adolescents viewed that if areca nut products were made unavailable in the local markets, the prevalence of the habit would decrease. Some of those habituated to chewing areca nut products, reported to have tried to quit the habit several times, by substituting with chocolates or sweets (Kal Kandu). One person said " I tried using bubble gum to quit chewing habit, but elders in the community said that if you swallow it, it will get stuck in the gut and will have problems, so I am scared to use it".

Awareness regarding the health effects

Awareness regarding the effects of chewing areca nut is minimal. The older generation believes that the use of areca nut products could cause no harm as they themselves have been pursuing the habit for a long time without any health problems. One old man said" I don't have any problem because of the habit, so there is nothing wrong". Some believe that those who chew Panmasala/ Gutkha are not able to eat well or speak loudly. They were aware of the fact that tobacco use could lead to cancer, but not much understanding regarding areca nut use. Some of the participants expressed that chewing gutkha could lead to oral cancer, as an effect of the tobacco content and not as an effect of the areca nut part of gutkha. No advertisements on the ill-effects of chewing areca nut products were found, nor were there any health warning in the communities that we visited.

Suggestions given by the community

The community suggested some ways, which they think, would help in mitigating the habit, such as conducting awareness camps on the ill-effects of chewing areca nut and suggesting a harmless substitute habit to the community. They also viewed that if the government bans the products and keeps a check on the distribution of the products, the prevalence could decrease. The youth of the community said " We feel only banning the product would work. People of our age would not listen to anybody. No advice would work". One adult said, " The effect of the awareness camps would be temporary. They would listen for a week. Then they would resume their habits". Some of the middle aged participants opinioned that if the local (women welfare association) takes active part it would be easier to ban these products from the community.


   Discussion Top


Areca nut products are easily available in remote villages. The most susceptible age for initiating areca nut use with tobacco in this community was as early as 15 years old. This is the vulnerable age when there is intense peer pressure and thus forces them to get involved in high-risk behavior. It is generally believed that when the adolescents of the community go outside the community for employment, they indulge in chewing areca nut products. Thus interventions should be targeted to motivate kids of this age group to keep away from chewing habit.

Areca nut use by the parents or friends, lack of knowledge on the harmful effects of areca nut products and elders being indifferent towards this habit, affects the younger generation's perception towards high-risk behavior. Although chewing of areca nut may be a practice of great antiquity, it cannot be regarded as a safe habit. To change the views of the people regarding high-risk behavior, all sectors of the community should get involved. Health effect awareness should be included in the school curriculum. Community-wide programs involving families, peers and village leaders should be conducted. It should be brought to the attention of policy makers that not much of awareness exists on the ill effects of areca nut use. There is lot of potential for interventional programs in Sriperambudur Taluk. A multi-pronged approach should be taken so as to target the social and behavioral factors, which influence high-risk behavior among the residents of the community.


   Acknowledgement Top


We thank The Kidney Help Trust and Tulsi Trust for allowing us to execute our study at Sriperambudur Taluk. We are grateful to the health workers of The Kidney Help Trust and Tulsi Trust for giving necessary help at the field. We also thank Ms. Amrita Duraiswamy and Ms. G. Subbulakshmi, research assistants, Chennai Dental Research Foundation, for their contribution to the study.

 
   References Top

1.International Agency for Research on Cancer: IARC Monographs on the evaluation of the carcinogenic risk of chemicals to humans. Tobacco habits other than smoking; Betel-quid and areca Nut chewing; and some related nitrosamines. International Agency for Research on Cancer: Lyon; 1984. p. 37.  Back to cited text no. 1    
2.Nelson BS, Heischober B. Betel nut: A common drug used by naturalized citizens from India, far East Asia and the South Pacific Islands. Ann Emerg Med 1999;34:238-43.  Back to cited text no. 2  [PUBMED]  
3.Gupta PC, Mehta FS, Daftary DK, Pindborg JJ, Bhonsle RB, Jalna walla PN, et al . Incidence rates of oral cancer and natural history in a 10-year follow up study of Indian villages. Commun Dent Oral Epidemiol 1980;8:287-333.  Back to cited text no. 3    
4.Gupta PC, Pindborg JJ, Mehta FS. Comparison of carcinogenicity of betel quid with and without tobacco: An epidemiological review. Ecol Dis 1982;1:213-9.  Back to cited text no. 4  [PUBMED]  
5.Reddy KS, Arora M. Tobacco use among children in India: A burgeoning epidemic. Indian Pediatr 2005;42:757-61.  Back to cited text no. 5  [PUBMED]  [FULLTEXT]
6.Gupta PC, Ray CS. Smokeless tobacco and health in India and South Asia. Respirology 2003;8:419-31.  Back to cited text no. 6  [PUBMED]  [FULLTEXT]
7.Gangadhran P, Paymaster JC. Leukoplakia - An epidemologic study of 1504 cases observed at the Tata Memorial Hospital, Bombay, India. Br J Cancer 1971;25:657-68.  Back to cited text no. 7    
8.Maher R, Lee AJ, Warnakulasuriya KA, Lewis JA, Johnson NW. Role of areca nut in the causation of oral submucous fibrosis: A case-control study in Pakistan. J Oral Pathol Med 1994;23:65-9.  Back to cited text no. 8  [PUBMED]  
9.Gupta PC, Bhonsle RB, Murti PR, Daftary DK, Mehta FS, Pindborg JJ. An epidemiologic assessment of cancer risk in oral precancerous lesions in India with special reference to nodular leukoplakia. Cancer 1989;63:2247-52.   Back to cited text no. 9  [PUBMED]  
10.WHO: Control of oral cancer in developing countries. A WHO meeting. World Health Org: Bull; 1984;62:817-30.  Back to cited text no. 10    
11.Sankaranarayanan R, Mathew B, Varghese C, Sudhakaran PR, Menon V, Jayadeep A, et al . Chemoprevention of oral leukoplakia with vitamin A and beta carotene: An assessment. Oral Oncol 1997;33:231-6.  Back to cited text no. 11  [PUBMED]  
12.Murti PR, Bhonsle RB, Gupta PC, Daftary DK, Pindborg JJ, Mehta FS. Etiology of oral submucous fibrosis with special reference to the role of areca nut chewing. J Oral Pathol Med 1995;24:145-52.  Back to cited text no. 12  [PUBMED]  
13.Sinor PN, Gupta PC, Murti PR, Bhonsle RB, Daftary DK, Mehta FS, et al . A case control study of oral submucous fibrosis with special reference to the etiologic role of areca nut. J Oral Pathol Med 1990;19:94-8.  Back to cited text no. 13  [PUBMED]  
14.Gupta PC, Sinor PN, Bhonsle RB, Pawar VS, Mehta HC. Oral submucous fibrosis in India: A new epidemic? Natl Med J India 1998;11:113-6.  Back to cited text no. 14  [PUBMED]  
15.Hazare VK, Goel RR, Gupta PC. Oral submucous fibrosis, areca nut and pan masala use: A case-control study. Natl Med J India 1998;11:299.  Back to cited text no. 15    

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Correspondence Address:
R Gunaseelan
Medical Director, Chennai Dental Research Foundation, 56, Dr. Radhakrishnan Salai, Mylapore, Chennai - 4
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0970-9290.30915

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    Abstract
    Introduction
    Materials and Me...
    Results
    Discussion
    Acknowledgement
    References

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