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Table of Contents   
EPIDEMIOLOGICAL WORK  
Year : 2014  |  Volume : 25  |  Issue : 5  |  Page : 653-656
Socioeconomic mobility and tobacco consumption patterns in fish industry workers in Udupi District of coastal Karnataka


1 Department of Public Health Dentistry, Manipal University, Manipal College of Dental Sciences, Manipal, Karnataka, India
2 Department of Oral Medicine and Radiology, Manipal University, Manipal College of Dental Sciences, Manipal, Karnataka, India

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Date of Submission03-Jan-2014
Date of Decision19-Feb-2014
Date of Acceptance03-Jul-2014
Date of Web Publication16-Dec-2014
 

   Abstract 

Aim: The aim of this study was to understand the tobacco consumption patterns and their relationship with life course socioeconomic mobility among fish industry workers as this could provide important information in dealing with the tobacco problem in this very vulnerable population.
Materials and Methods: Socioeconomic life course data and information about tobacco habits was collected from 102 fish industry workers. A subject was considered to be upwardly mobile if the family head's educational attainment and the number of earning members increased and the number of children and dependents decreased since childhood in his or her household. Oral examination was also done for malignant/premalignant lesions.
Results: Of the 102 subjects, 64 regularly consumed tobacco either in smoking or smokeless forms and the common reasons for the habit were the co-workers' influence and to keep awake at work. Fourteen subjects had premalignant lesions in the oral cavity and all them were in the buccal mucosa. The prevalence of the tobacco habit was much lesser (25%) among the upwardly mobile group when compared to the minimal or no improvement group (75%). A majority of those free from the habit (73.7%) were belonging to the group, which showed improved educational attainment. Among those with good social mobility, the percentage of workers with high frequency of tobacco consumption and those with a longer duration of the tobacco habit was low when compared to the minimal social mobility group.
Conclusion: A holistic approach consisting of efforts to improve the overall socioeconomic conditions can be more effective than piecemeal solutions in dealing with the tobacco menace.

Keywords: Oral health, social mobility, tobacco

How to cite this article:
Acharya S, Pentapati KC, Acharya S. Socioeconomic mobility and tobacco consumption patterns in fish industry workers in Udupi District of coastal Karnataka. Indian J Dent Res 2014;25:653-6

How to cite this URL:
Acharya S, Pentapati KC, Acharya S. Socioeconomic mobility and tobacco consumption patterns in fish industry workers in Udupi District of coastal Karnataka. Indian J Dent Res [serial online] 2014 [cited 2019 Jul 17];25:653-6. Available from: http://www.ijdr.in/text.asp?2014/25/5/653/147116
Tobacco use is a leading cause of premature death and disability. Every year between 5 and 6 million deaths worldwide are attributed to tobacco use and exposure to second-hand smoke. [1],[2] Tobacco use in low-income and middle-income countries is predicted to contribute to an increasing share of the global burden of disease in future decades. Addressing this growing public health problem requires attention to increasing social disparities in patterns of tobacco use. It is important to examine indicators of socioeconomic position simultaneously if one is to understand their combined impact and thereby provide more complete descriptions of social inequalities in tobacco use. A similar socioeconomic gradient has been observed for the use of smokeless tobacco, including chewing tobacco, snuff, burnt tobacco, powder, and paste. [3],[4],[5] The "social mobility hypothesis" purports that intra and intergenerational social mobility, may affect health and health-related behaviors such as tobacco smoking later in life. [6]

However, there are very few studies that have considered the role of social mobility as a potential determinant of health-related behaviors. Studies by Karvonen et al. [7] and Lindstrφm et al. [8] showed that health damaging behaviors like smoking were more frequent among downwardly mobile and less frequent among upwardly mobile population. A literature search revealed no studies are seeking to test the social mobility hypothesis in relation to the tobacco habit in an Indian population.

Smokeless tobacco use in India raises various concerns. It is commonly used and increasingly so, especially as new forms of smokeless tobacco have been emerging over the last few decades, enticing new consumers. [9] In India, per capita smokeless tobacco consumption has increased among the poor between 1961 and 2000 in both rural and urban areas. [10]

The high levels of tobacco consumption among disadvantaged population groups may lead to a doubling of the disease burden in these social groups from chronic illnesses-related to tobacco consumption as well as from communicable and nutrition-related diseases, which still account for a large share of total disease burden in the disadvantaged social groups in India.

The fish processing industry is a major source of livelihood to a large number of people in the coastal areas of India. The people employed in this industry often belong to the lowest socioeconomic strata of the society. Tobacco consumption which is very high in this population has strong underpinnings to the prevailing social, economic as well as the regulatory scenario of the country. Unlike some other industries, the fish processing industry operates on a nearly 24 h basis resulting in heavy workloads on the workers. A combination of heavy workload, working at odd hours, low pay, and monotonous nature of work, low educational attainment and peer group pressures cause them to pick up the tobacco habit.

Tobacco control is still in its infancy in India. The Indian constitution mandates that among other things, health is a state subject, that is, outside the jurisdiction of the federal government. Framing of tobacco control laws is thus uneven across India with only a few states taking concrete steps to ban smoking in public places. Even this has been very difficult to implement in many states. There was a need to understand the socioeconomic underpinnings of the tobacco habit amongst a very disadvantaged section of the population and hence the aim of this study was to understand the tobacco consumption patterns and their relationship with life course socioeconomic mobility among fish industry workers as this could provide important information in dealing with the tobacco problem in this very vulnerable population.


   Materials and methods Top


This study was carried out among a sample of workers in the fish processing industry of Udupi District in the coastal region of South India. Of the 26 factories operating in the district, two were randomly selected for the exploratory study. There were a total of 117 workers employed in the two factories. After discounting those who were absent (13 workers) on the day of the study and those (two workers) who did not give consent, a total of 102 workers constituted the study population. Permission for the project was taken from the relevant industry associations, the factory managements and the government. Ethical approval was obtained prior to the study. Socioeconomic life course data and information about tobacco habits was collected from the 102 fish industry workers. Daily frequency of tobacco consumption and the duration of the tobacco habit in terms of years as well as the reasons for taking up the habit were recorded. Median split method was used to dichotomize the population for habit frequency and habit duration. Oral examination was also done for malignant/premalignant lesions. Clinical examination was done by a single examiner. Calibration of the examiner was conducted by an expert in oral health survey methodology in the Department of Public Health Dentistry. A sub-sample of 20 fish industry workers were reexamined after a week to test the intra-examiner variability using the kappa coefficient.

The educational status was classified as primary, middle, and high school level. The life course data consisted of educational attainment of family head, number of children and dependent members and the number of earning members in the household during the respondents' childhood and the present. A subject was considered to be upwardly mobile if the family head's educational attainment and the number of earning members increased and the number of children and dependents decreased since childhood in his or her household. A composite variable was created, which included the improvement in the family head's educational qualification, less number of siblings and dependents and increase in the number of earning members. All the participants had improvement in more than one variable. An improvement in more than two parameters was considered minimal improvement and more than three parameters were considered good or favorable improvement. The Kuppuswamy scale [11] was used to measure socioeconomic status (SES). Chi-square test was used to compare frequencies, and all statistical analysis was performed using the SPSS version 16 software (SPSS Inc., Chicago, IL, USA).


   Results Top


Of the 102 subjects, 64 (62.7%) regularly consumed chewing tobacco and the common reasons for the habit were the co-workers' influence and to keep awake at work. Most of the workers were male (84.3%). Half of the workers (54.9%) had studied only up to primary school or middle school level, and all belonged to the lower socioeconomic strata. The kappa coefficient was calculated to be 0.96. Fourteen subjects had premalignant lesions in the oral cavity and all them were in the buccal mucosa. Oral sub mucous fibrosis was the most common premalignant lesion (n = 6). Of the 64 workers who consumed tobacco, half (n = 32) consumed it <4 times a day and the other half (n = 32) consumed it ≥4 times day. Among those with the tobacco habit, the majority of them (59.6%) reported duration of ≥5 years. The remaining (49.6%) reported duration of <5 years [Table 1].
Table 1: Descriptive data of the sample population


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The effect of social mobility on the prevalence of the habit was assessed. Of the 102 workers surveyed, the prevalence of the tobacco habit was much lesser (25%) among those whose SES improved (upwardly mobile) as compared to those who had minimal or no improvement (75%). Furthermore, a majority of those free from the habit (73.7%) belonged to the group which had seen improved educational attainment when compared to those who showed less improvement (26.3%) [Table 2].
Table 2: Relationship between improvement in socioeconomic indicators and prevalence of the tobacco habit among the sample population


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When improvement statuses in each of the four criteria were independently compared against the habit frequency and duration, a statistically significant difference in "duration" was observed for "earning members in household." Among those with a shorter duration of the tobacco habit (<5 years), majority of them (80.8%) belonged to a group where the number of earning members of the family increased when compared with their childhood days [Table 3].

Among those with the tobacco habit (n = 64), 16 workers were considered as upwardly mobile. Among those with good social mobility, the percentage of workers with high frequency of tobacco consumption was 12.7% when compared to the minimal social mobility group where the percentage of workers with high frequency of the habit was 87.3%. These differences were statistically significant (P = 0.021) Similarly, among those with good social mobility, the percentage of workers with a longer duration of the tobacco habit was 15.8% as compared to the minimal social mobility group where the percentage of workers with a longer duration of the tobacco habit was 84.2%. These differences too were statistically significant (P = 0.04) [Table 4].
Table 3: Relationship between improvement in SES indicators and tobacco habit's frequency and duration among the tobacco users


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Table 4: Relationship between social mobility and tobacco habit frequency and duration


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   Discussion Top


We found socioeconomic mobility to be an important factor in determining tobacco consumption patterns. Those who showed an upward socioeconomic trajectory had lower levels of tobacco consumption as compared to those whose condition showed little or no improvement.

Most of the previous research has focused on the socioeconomic determinants of smoking and not on chewing tobacco. Current socioeconomic position has been shown to have a powerful effect on smoking status. [12],[13],[14],[15] Childhood effects have also been found, both for smoking [12],[13] and quitting. [12],[13],[14],[15] While previous research has shown that the upwardly mobile are less likely to smoke than those they leave behind, the overall effects of social mobility on smoking status are modest. [16],[17] We found that upwardly mobile people had a lower prevalence of the habit, consumed tobacco less frequently and had shorter duration of the habit, which was in agreement with previous studies. [7],[8]

Conceptually, the socioeconomic life course is usually represented as a person's journey from the socioeconomic environment of the natal family (typically indexed by father's occupation), through the education system (years/level of education) to adulthood (own occupation). While this system may hold good for industrialized countries, it may not be suitable for developing countries where accurate data is rare, and there are other factors like the joint family system and multiple members of a family being employed at the same time. Our method, in addition to assessing the educational attainment of the family head, also assessed the number of children, earning and nonearning members to determine the family SES. Occupation was not considered as the study population consisted of a homogenous community of workers employed in the fish processing industry. This method of assessing the socioeconomic life course mobility may be a more feasible in giving a true picture of the SES in disadvantaged populations than the conventional methods.


   Conclusion Top


The results of this study showed that a downward intergenerational socioeconomic trajectory was associated with increased frequency and duration of tobacco consumption among the study population. The results of this study also pointed to the need of a holistic approach consisting of efforts to improve the overall socioeconomic conditions, which could be more effective than piecemeal solutions in dealing with the tobacco menace.

 
   References Top

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World Health Organization. The Global Burden of Disease: 2004 Update. Geneva: World Health Organization; 2008. p. 146.  Back to cited text no. 1
    
2.
Ezzati M, Lopez AD. Estimates of global mortality attributable to smoking in 2000. Lancet 2003;362:847-52.  Back to cited text no. 2
    
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Gajalakshmi CK, Jha P, Ranson K, Nguyen S. Global patterns of smoking and smoking-attributable mortality. In: Jha P, Chaloupka FJ, editors. Tobacco Control in Developing Countries. New York: Oxford University Press Inc.; 2000. p. 11-39.  Back to cited text no. 3
    
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Gupta PC. A Database on Tobacco in the South-East Asia Region. New Delhi, India: World Health Organization; 2003.  Back to cited text no. 4
    
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Lynch JW, Kaplan GA, Cohen RD, Kauhanen J, Wilson TW, Smith NL, et al. Childhood and adult socioeconomic status as predictors of mortality in Finland. Lancet 1994;343:524-7.  Back to cited text no. 6
    
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Karvonen S, Rimpelä AH, Rimpelä MK. Social mobility and health related behaviours in young people. J Epidemiol Community Health 1999;53:211-7.  Back to cited text no. 7
    
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Lindström M, Modén B, Rosvall M. A life-course perspective on economic stress and tobacco smoking: A population-based study. Addiction 2013;108:1305-14.  Back to cited text no. 8
    
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Gupta PC. Smokeless tobacco use in India. In: Smokeless Tobacco or Health - An International Perspective. Smoking and Tobacco Control Monograph 2. NIH Publication No. 92-3461. USA: NIH; 1992. p. 19-25.  Back to cited text no. 9
    
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National Sample Survey Organization. NSS Report Government of India, New Delhi Nos. 184 and 461 (55/1.0/4). Reports Covering 1961-62 and 1999-2000.  Back to cited text no. 10
    
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Schooling M, Kuh D. A life course perspective on women's health behaviours. In: Kuh D, Hardy R, editors. A Life Course Approach to Women's Health. Oxford: Oxford University Press; 2002. p. 279-302.  Back to cited text no. 12
    
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Brunner E, Shipley MJ, Blane D, Smith GD, Marmot MG. When does cardiovascular risk start? Past and present socioeconomic circumstances and risk factors in adulthood. J Epidemiol Community Health 1999;53:757-64.  Back to cited text no. 13
    
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Graham H, Der G. Influences on women's smoking status: The contribution of socio-economic status in adolescence and adulthood. Eur J Public Health 1999;9:137-41.  Back to cited text no. 14
    
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Power C, Graham H, Due P, Hallqvist J, Joung I, Kuh D, et al. The contribution of childhood and adult socioeconomic position to adult obesity and smoking behaviour: An international comparison. Int J Epidemiol 2005;34:335-44.  Back to cited text no. 15
    
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Jefferis BJ, Power C, Graham H, Manor O. Changing social gradients in cigarette smoking and cessation over two decades of adult follow-up in a British birth cohort. J Public Health (Oxf) 2004;26:13-8.  Back to cited text no. 16
    
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Paavola M, Vartiainen E, Haukkala A. Smoking from adolescence to adulthood: The effects of parental and own socioeconomic status. Eur J Public Health 2004;14:417-21.  Back to cited text no. 17
    

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Correspondence Address:
Shashidhar Acharya
Department of Public Health Dentistry, Manipal University, Manipal College of Dental Sciences, Manipal, Karnataka
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0970-9290.147116

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