Journal of Radiation and Cancer Research

: 2019  |  Volume : 10  |  Issue : 1  |  Page : 72--76

A survey on urban adult addiction pattern

Shradha G Jaiswal1, Digpal Dharkar2, Rajeev Shrivastav3,  
1 Depatrment of Oral Pathology and Microbiology, Sri Aurobindo College of Dentistry; Department of Surgery, Indian Institute of Head and Neck Oncology, Indore Cancer Foundation, Rau, Indore, Madhya Pradesh, India
2 Depatrment of Oral Pathology and Microbiology, Sri Aurobindo College of Dentistry, Indore, Madhya Pradesh, India
3 Depatrment of Oral Pathology and Microbiology, Sri Aurobindo College of Dentistry; Department of Prosthodontics, Modern Dental College, Indore, Madhya Pradesh, India

Correspondence Address:
Dr. Shradha G Jaiswal
Depatrment of Oral Pathology and Microbiology, Sri Aurobindo College of Dentistry; Department of Surgery, Indian Institute of Head and Neck Oncology, Indore Cancer Foundation, Rau, Indore, Madhya Pradesh


Introduction: Oral cancer is a multifactorial disease, which is largely preventable. Awareness about cancer and its risk factors and symptoms can lead to prevention and early clinical diagnosis. Proper monitoring of the high-risk population along with periodic follow-up and deaddiction protocol can help reduce the incidence of oral cancer and lead to an early clinical diagnosis. Materials and Methods: A pretested questionnaire was the primary tool of the study. It had a total of 24 questions which were divided into three categories which would analyze the awareness, habits, and symptoms. Results: We found a statistically significant correlation between habits and symptoms and also between habit, age, and awareness. Conclusion: The study emphasizes the need for improving awareness and self-assessment of oral symptoms for early detection of precancerous lesions.

How to cite this article:
Jaiswal SG, Dharkar D, Shrivastav R. A survey on urban adult addiction pattern.J Radiat Cancer Res 2019;10:72-76

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Jaiswal SG, Dharkar D, Shrivastav R. A survey on urban adult addiction pattern. J Radiat Cancer Res [serial online] 2019 [cited 2019 Sep 17 ];10:72-76
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Oral cancer is a relatively common disease which can be prevented if the risk factors are controlled. This is a multifactorial disease; however, two major known risk factors for oral cancer are tobacco and alcohol. These factors have a synergistic effect, so people who both use tobacco and drink have a much higher risk of oral cancer than those using only tobacco and alcohol.[1] Other cofactors that have been implicated in the development and progression of oral cancer include poor nutrition, exposure to ultraviolet light, excessive spicy food, continuous irritation, and the human papillomavirus.[2] The risk for oral cancer is higher in the Indian subcontinent because of the production and usage of pan (a combination of betel leaf, lime, areca nut, and sun-cured tobacco) and smoking of cigarette and bidi (dried temburni leaf around approximately 0.2–0.3 g of sun-dried, oriental tobacco and securing the roll with a thread). Oral cancer has been found to be common in males and people of lower socioeconomic groups.[3] It has been found that a large percentage of Indian oral cancers are tobacco related and the possibility of developing a tobacco-related lesion is ten times higher if the habit is formed below the age of 14 years.[4]

Early diagnosis can be ensured by recognizing the early signs and symptoms in order to facilitate treatment in the early stages of the disease. A large number of patients in spite of symptoms do not consult a health-care professional either due to lack of knowledge and awareness or social stigma and responsibilities.[5] Among all these, lack of awareness has been found to be the primary cause for delay in seeking help for oral cancer.[6] This lack of awareness about oral cancer in the UK has been reported by Warnakulasuriya [7] who reported that the awareness of the early signs of the disease was found to be low (except for persistent ulcers).[8] A strong correlation has been found between low awareness and high risk.[9] Speight et al.[10] and Johnson et al.[11] have proposed that targeted opportunistic oral cancer screening of high-risk individuals may be the most effective method for oral cancer screening. This screening involves a simple and systematic examination of the oral cavity and associated structures.[12]

Visual inspection of the oral cavity is a simple, acceptable, and accurate screening technique for oral neoplasia. However, screening requires a large well-trained workforce, which may not always be possible. The second option for screening is self-assessment, using a questionnaire. This is a simple method of creating awareness which is actually the first step for preventing cancer.

Indore Cancer Foundation, a public charitable trust with the help of volunteers, and through its flagship project the Indian Institute of Head and neck Oncology, through its employees as well, is working on door-to-door survey on the prevalence of tobacco, focusing on the importance of early detection.

The present study aimed to identify high-risk population for oral cancer and also to improve the awareness about oral cancer and its risk factors using a pretested questionnaire.

 Materials and Methods


A pretested questionnaire comprising 24 questions which were divided into three categories was the primary tool. The questions were scored as No = 1 and Yes = 2. The total score for each section was separately calculated to determine the high- and low-risk groups (the questionnaire along with the scoring criteria is mentioned below):



Scoring for all questions Yes = 2 and No = 1Scoring in I Category (General knowledge and awareness) – 9 questions

Low awareness = 9–13High awareness = 14–18

Scoring in II Category (Habits) – 5 questions

Low risk = 5–7High risk = 8–10

III Category (Symptoms) – 10 questions

Low risk = 10–15High risk = 16–20.

The study was carried out on all the employees of the Madhya Pradesh Paschim Kshetra Vidyut Vitran Company Limited (MPPKVV). MPPKVV is a venture of the Government of Madhya Pradesh which was established on July 1, 2002, to undertake the activities of distribution and retail supply for and on behalf of Madhya Pradesh State Electricity Board in the areas covered by the commissionaires of Indore and Ujjain. Paschim Kshetra encompasses an area served by 77,021 km of high tension (HT) and 137,105 km of low tension (LT) distribution network.

A closed-ended questionnaire was developed which was administered to a pilot group. After validating the questionnaire and modifying it, an improvised version was created which was used as the primary tool for this study. The questionnaire was prepared in such a way that it was easy to understand and was constructed in the local language. The human resources heads were briefed about the questionnaire as they would be administering the questionnaire. This being a self-assessment questionnaire, no special training was required. All incompletely filled questionnaires were omitted from the study.


Descriptive statistics were used to describe the sample, their knowledge, and experiences. Inferential statistics were then used to check for relationships between outcome measures and risk factors (e.g., alcohol use and smoking status) and sociodemographic factors (gender, age, educational qualification, and socioeconomic classification). The Statistical Package for the IBM SPSS Statistics for Windows, Version 24.0 (IBM Corp., Armonk, NY, USA) was used for analyzing the data.


Response rate

The questionnaire was administered to a total of 8000 persons, who were employed with the MPPKVV. After omitting the incomplete questionnaires, a total of 6795 questionnaires were received for the analysis.

[Table 1] shows a summary of the sociodemographic characteristics of the participants.{Table 1}

Alcohol use

Nearly 7.80% of males and 1% of female respondents reported consuming alcoholic drinks.

Tobacco use

Nearly 9% of males and 1% of females had the habit of chewing tobacco, whereas 11.3% of males and 1% of females had the habit of smoking.


This survey sought to document if any relation existed between awareness, habits, and symptoms. Males constituted the majority of the population (95.5%), whereas females constituted 4.5%. Nearly 59.7% of the population were in the age range of 50–59 years because majority of the employees were permanent recruits working with the government organization and hence, as in a major government setup, the employees are permanently employed, thus resulting in a major population of elderly.

Majority of the population (53.55%) had only primary schooling as the educational qualifications; this finding could be attributed to the fact that majority of the employees were in the maintenance department, for which only basic education is required. Almost 7.4% of males had postgraduation, whereas 40.6% of females were postgraduates; this was primarily due to employment of women in the office and that of men in the field operations.

Nearly 34.4% of males and 19% of females had more than one habit, which can be directly correlated with the educational status, thereby further emphasizing the need for education. This is in accordance with that found by Zhu et al. in 1996 who found that, after 11 years of education, the likelihood of smoking decreased and that of smoking cessation increased with each successive year of education.[13],[14]

Nearly 10.7% of males and 1% of females had the habit of tobacco chewing, and 11.3% of males had the habit of smoking compared to 1% of women. This could be due to the social stigma associated with chewing and smoking of tobacco in women in India. Earlier studies have shown that smokeless tobacco consumption is the most common addiction. A logical explanation for this could be that it can be easily consumed at the place of work without creating a negative impact on the work profile, or any adverse reactions from colleagues or seniors.[15]

We found statistically significant difference between habits and symptoms [Table 2] and also between habits, age, and awareness.{Table 2}


It is worth mentioning the fact that the extent of ignorance about the link between tobacco and cancer was a surprising fact. Raising the question if other facts played a role here like denial is worthy of exploration as it may help plan more effective prevention and early detection strategies.

Even though anecdotal, our experience is that those addicted to tobacco do not necessarily stop using it even if exposed to cancer, highlighting the fact that tobacco addiction needs strategies similar to alcohol and drug addiction.

This cohort evaluated was belonging to the lower socio-economic status, uncertain work timings and a higher work pressure that might lead to the reason for a person to sccumb to the habit of tobacco consumption

Scope for further study

To carry out a survey keeping the baseline of gender and educational qualifications equalThe second stage of the study involves improving awareness using pamphlets and handouts. Deaddiction program for those with tobacco and alcohol abuse habits and clinical evaluation of persons in the high-risk habit groupRe-administration of the questionnaire after 6 months to the same population to evaluate the effect of awareness created by use of handouts and de—addiction programmes

Limitations of the study

Uneven gender distribution may lead to a gender biasThere was a difference in the educational qualification which could also have led to the above findings.


This oral cancer program was supported by Barbecue Nation, Bangluru, aimed at identifying high-risk habit and symptom population, so that awareness program can be initiated for educating those at risk of developing cancer.

We would also like to thank the friends of Indore Cancer Foundation Daly College, Indore, for helping in the validation process.

Financial support and sponsorship


Conflicts of interest

There are no conflicts of interest.


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