Smokeless tobacco use among adult patients who visited family practice clinics in Karachi, Pakistan

Use of smokeless tobacco (SLT) is significantly associated with poor oral health and cancers. The objectives of this study were to estimate the proportion of use and the knowledge about SLT in relation to oral cancer and its differentials by socio-demographic and patient's diagnostic categories. This study also aimed to assess the SLT user's attitude and practices for its use. In a cross-sectional study, 502 adult patients (>= 15 years) were randomly interviewed in family practice clinics in Karachi, Pakistan. SLT use was considered as usage of any of the following: betel quid (paan) with tobacco, betel nuts with tobacco (gutkha), and snuff (naswar). Overall, 52.4% subjects had used SLT at least in one form. More males were using SLT than females (P = 0.03). Similarly, higher proportion of patients with gastro-intestinal diseases were using SLT compared with other diagnostic categories (P = 0.004). Knowledge about the oral carcinogenic effect of SLT was higher among men and those who had schooling of > 10 years (P < 0.001). This knowledge was also higher in patients with non-communicable and infectious diseases. Among SLT users, 31.3% tried to quit this habit but failed. The majority of users started using SLT before the age of 15 years; 40.2% and 30.8% started after being inspired by media advertisements and friends/peer pressure, respectively. In this study, over half of the patients were using SLT in various forms and had poor knowledge about its hazards. We suggest that there is a need for socially and culturally acceptable educational and behavioral interventions for control of SLT usage.