A Study to Assess the Oral Health Status and Knowledge on Oral Health Hazards among Tobacco Consuming Adults in Nanchiyampalayam, Dharapuram in view of Preparing a self Instructional Module

 

Shobiya D¹, Dr. Vijayarani Prince²

¹Asst Professor, Sree Abirami College of Nursing, Coimbatore

²Principal, Bishop’s College of Nursing, C.S.I Mission Compound, Dharapuram-638656.

 

ABSTRACT:

Health is a state of complete physical, mental and social and spiritual wellbeing and not merely the absence of disease or infirmity. Wellness is the condition in which an individual functions at optimum levels. Oral health is essential to general health and quality of life. It is a state of being free from mouth and facial pain, oral and throat cancer, oral infection and sores, periodontal (gum) disease, tooth decay, tooth loss, and other diseases and disorders that limit an individual’s capacity in biting, chewing, smiling, speaking, and psychosocial wellbeing. Dental problems can occur at every stage of life. But some problems happen at a particular stage and age. And particularly in the period of adults, some of the common dental problems faced by adults. They are tooth decay, teeth discoloration and gum diseases. Use of tobacco is a risk factor for oral cancer, oral mucosal lesions, periodontal disease and impaired healing after periodontal treatment, gingival recession, and coronal and root caries. Available evidence suggests that the risks of oral diseases increase with greater use of tobacco and that quitting smoking can result in decreased risk. The magnitude of the effect of tobacco on the occurrence of oral diseases especially oral cancer is high, with users having many times the risk of non-users. Tobacco use is generally perceived as an adult problem. The diseases widely caused by tobacco are mostly seen to afflict the older population, yet tobacco use most often starts in youth, vast majority start consuming tobacco before the age of 25 years.  Tobacco use has injurious effects on oral health. The oral health is an important aspect of community health. To plan important interventions it is necessary to find out the prevalence and factors associated with them.  This study was aimed to assess the oral health status and knowledge on oral health hazards among tobacco consuming adults in Nanchiyampalayam, Dharapuram in view of preparing a self instructional module. The research approach used for the study was descriptive approach. The Non-experimental descriptive research design was used for this study. The conceptual frame work of the study was based on The Health Belief Model (Rosen Stock 1974 And Becker And Maiman 1975)”. Non probability purposive sampling technique was used to select the 100 samples. The tool used for the study was the oral health assessment tool modified from Kayser-Jones et al. (1995) by Chalmers (2004) for assessing the oral health status and knowledge regarding oral health hazards was assessed by using a structured interview schedule. At the end of the data collection self instructional module regarding effects of tobacco use on oral health was distributed to the samples. Severe cases were instructed to go for further treatment. The collected data were analysed and tabulated by using descriptive and inferential statistics. The data analysis revealed that the mean and standard deviation scores of level of oral health status were 6(SD±3.12) and the mean and standard deviation scores of level of knowledge were 13(SD±5.16) respectively. The‘t’ value was 4.202 which was significant at P<0.05 level of significance.  There was a low positive correlation r=0.4 between the oral health status and the level of knowledge on oral health hazards among tobacco consuming adults. There was no significant association of the level of oral health status among tobacco consuming adults with their selected demographic variables except for the age of the adults (χ²=6.81). There was no significant association of the level of knowledge among tobacco consuming with their selected demographic variables except for the age of the adult (χ²=13.09), education (χ²=39.57), monthly income (χ²=16.25), frequency of consuming tobacco (χ²=12.66), and the duration of consuming tobacco (χ²=24.04).The study revealed that even though the adults had good knowledge on hazards of tobacco consumption on oral health they had poor oral health status. The findings of the study support the need for conducting educational programme to increase the knowledge of adults on tobacco consumption and its related problems. Educating the youth and adults with correct information regarding hazards of tobacco consumption can help them to avoid/stop the bad habits and develop a healthy life style.

 

 

INTRODUCTION:

Oral health is essential to general health and quality of life. It is a state of being free from mouth and facial pain, oral and throat cancer, oral infection and sores, periodontal (gum) disease, tooth decay, tooth loss, and other diseases and disorders that limit an individual’s capacity in biting, chewing, smiling, speaking, and psychosocial wellbeing¹. Adulthood is a period of challenges, rewards and crises. During this period they adopt the life style habits such as diet, smoking, stress, substance use, alcohol, and tobacco.  These habits increase the risk of future illness. Among these most of the adults are affected with the habit of taking tobacco products². Tobacco consumption can affect the lives of adolescents and other people the use of tobacco consumption begins in adolescents as an occasional trip from the friends, pressure from the friends, as a recreational use, experimental basis to have an experience out of curiosity about tobacco consumption, then it gradually progress to more intensive compulsive use and become victimization of tobacco consumption.  It is fashion in young stars and soon there is defective personality and causes of diseases^3.Many teenagers and adults think that there are no effects of smoking on their bodies until they reach middle age. Smoking-cause lung cancer, other cancers, heart disease, and stroke typically do not occur until years after a person's first cigarette. However, there are many serious harms from smoking that occur much sooner⁴.Tobacco products are products made entirely or partly of leaf tobacco as raw material, which are intended to be smoked, sucked, chewed or snuffed. All contain the highly addictive psychoactive ingredients, nicotine⁵ The survey of the awareness regarding the hazards of tobacco use revealed that 74.6% of the subjects knew about the link between oral cancer and tobacco⁶.

 

 

Globally tobacco use is one of the leading cause of death. The global tobacco epidemic kill nearly 6 million people each year, of which more than 600,000 are people exposed second-hand smoke. Unless we act, it will kill up to 8 million people by 2030, of which more than 80% will live in low and middle income countries⁷ In India 2010, tobacco use is a major preventable cause of death and disease and is responsible 1 in 10 deaths among adults worldwide. Approximately 5.5 million people die around the world every year - with India accounting for nearly a fifth of this. Compared with many countries around the world, India has been proactive in introducing tobacco control legislation since 2003⁸. According to the Hindu newspaper several students of schools run by the Chennai Corporation lined up outside the CAT (children against tobacco) stall at the Cancer Institute’s Youth Health Mela to participate in an hour-long session on tobacco control. CAT, an initiative launched by a non-government organisation. Through this, the students could become ambassadors against tobacco use and spread the information among their peers, family and community. The session covers a talk on tobacco control and health effects, documentary screening and story-telling on various aspects including second-hand smoking and chewable tobacco⁹.

 

STATEMENT OF THE PROBLEM:

A study to assess the oral health status and knowledge on oral health hazards among tobacco consuming adults in Nanchiyampalayam, Dharapuram in view of preparing a self instructional module.

 

METHODOLOGY:

RESEARCH APPROACH:

Descriptive  approach was used to conduct the study.

 

RESEARCH DESIGN:

Non-experimental descriptive design was used to conduct the study.

 

SETTING:

The study was conducted in Nanchiyampalayam urban area of Dharapuram.

 

 

POPULATION:

The population selected for the study was tobacco consuming adults.

 

SAMPLE :

The samples of the study were tobacco consuming adults who are residing in Nanchiyampalayam.

 

SAMPLE SIZE:

The sample size for the study was 100.

 

SAMPLING TECHNIQUE:

Non probability purposive sampling technique was used to select the sample.

 

CRITERIA FOR SAMPLE SELECTION:

INCLUSION CRITERIA:

1.     Adults in the age group of 25-55 years.

2.     Adults who are having the habit of tobacco consumption minimum 6 months.

3.     Both male and female adults

4.     Adults who are able to understand and speak Tamil

5.     Adults who are available at the time of data collection

 

EXCLUSION CRITERIA:

1.     Adults who are not willing to participate

2.     Adults who are sick at the time of data collection.

 

THE DESCRIPTION OF THE INSTRUMENT:

The instrument consists of 3 parts.

 

PART I:

It consists of demographic variables such as age, sex, religion, education, monthly income, marital status, occupation, frequency of consuming tobacco, type of tobacco consumption, duration of consuming tobacco, and source of information.

 

PART II:

It consists of Observational checklist for assessing the oral health status of tobacco consuming adults contains of 8 categories. Each category has scores of 0, 1 and 2

 

Scores will be interpreted by

0 = healthy

1 = changes

2 = unhealthy

 

PART III:

It consists of the structured interview schedule for assessing the knowledge regarding oral health hazards among tobacco consuming adults consists of 30 multiple choice questions. Each question has four options, among one option is the correct answer, other three are the distracters.

 

SCORING PROCEDURE:

PART II:

Observational checklist for assessing the oral health status of tobacco consuming adults Total score is 16. The final score is the sum of scores from the eight categories and can range from 0 (very healthy) to 16 (very unhealthy). While the cumulative score is important in assessing oral health, the score of each item should be considered individually.

 

PART III:

The structured interview schedule consists of 30 multiple choice questions the total score 30. For the right answer the score is 1 and for the wrong answer the score is 0.

 

Scores were interpreted by as follows

Level of knowledge	Scores	Percentage
Inadequate knowledge Moderately adequate knowledge Adequate knowledge	1-10 11-20 21-30	1-33% 34-66% 67-100%

 

VALIDITY:

The validity of the tool was obtained from 4 community health nursing experts and 1 medical expert.

 

RELIABILITY:

The reliability of the structured interview schedule was assessed by testing the stability and internal consistency. The stability was established by test retest method where Karl Pearson co efficient formula was used and r value was 0.9. The internal consistency was assessed by split half method where spearman’s brown prophecy formula was used and r value was 0.7. It found that the tool was reliable.

 

PROCEDURE FOR DATA COLLECTION:

The data was collected in Nanchiyampalayam at Dharapuram. Data collection was done for a period of 4 weeks. Written permission was obtained from the Counsellor of Nanchiyampalayam. Oral consent was obtained from the adults after explaining the purpose of the study. 100 samples were selected by using non probability purposive sampling technique. The data were collected from morning 9am to evening 5pm. Demographic data was collected and oral health status of the adult was assessed with the oral health assessment tool [modified from Kayser-Jones et al. (1995) by Chalmers (2004)]. Pen torch was used for checking the abnormalities. The knowledge regarding oral health hazards was assessed by using a structured interview schedule. 40-50 minutes were spent to each sample. 3-4samples were interviewed per day. At the end of the data collection self instructional module on oral health and ill effects of tobacco use was distributed to all the study samples. The collected data were analysed and tabulated by using descriptive and inferential statistical methods.

DATA ANALYSIS:

The data related to  assess the oral health status and knowledge on oral health hazards among tobacco consuming adults in Nanchiyampalayam, Dharapuram in view of preparing a self instructional module was analysed and tabulated by using descriptive and inferential statistical methods.

 

RESULTS:

Regarding age, majority 46(46%) of adults belonged to the age group of 46-55 years, 38(38%) belonged to the age group of 36-45 years and 16(16%) belonged to the age group of 25-35 years .Regarding to their sex, majority 61(61%) of adults were female and 39(39%) were male. Regarding religion, majority 96(96%) of adults were Hindus, 2(2%) were Christians and 2(2%) were Muslims. Regarding education, majority 56(56%) of adults had no formal education, 37(37%) had primary education, 6(6%) had secondary education and 1(1%) was graduate. Regarding monthly income, majority 32(32%) of adults had the income between Rs. 2001-3000, 27(27%) had the income between Rs. 3001-4000, 25(25%) had the income between Rs.4001-5000 and 16(16%) had the income between Rs. 5001 and above. Regarding marital status, majority 87(87%) of adults were married, 6(6%) were unmarried, 7(7%) were widow and none of them had divorce. Regarding occupation, majority 51(51%) of adults were Cooley, 19(19%) had self business, 16(16%) were un employees, 8(8%) were private employees and 6(6%) were government employees. Regarding frequency of consuming tobacco, majority 58(58%) of adults were consumed the tobacco for more than three times a day, 15(15%) were consumed for thrice in a day, 14(14%) were consumed for twice in a day and 13(13%) were consumed the tobacco for once in a day. Regarding type of tobacco consumption, majority 47(47%) of adults were consumed betelnut and tobacco, 23(23%) were consumed smoking only, 15(15%) were consumed betelnut only, 9(9%) were consumed smoking and paan masala, 4(4%) were consumed smoking and betel nut and 2(2%) were consumed smoking and tobacco. Regarding duration of consuming tobacco, majority 90(90%) of adults were consumed the tobacco for more than three years, 4(4%) were consumed for two years, 3(3%) were consumed for three years and 3(3%) were consumed for one year. Regarding source of information, majority 50(50%) of adults had got information by media, 33(33%) had got information by health personnel and 17(17%) had got information by family members.

 

SECTION B:

Table:1 Frequency and Percentage distribution of the level of oral health status among tobacco consuming adults.                        n=100

S. No	Level of oral health status	Frequency (F)	Percentage (P)
1. 2. 3.	Healthy(0) Changes(1-8) Unhealthy(9-16)	- 75 25	- 75 25

 

Regarding Frequency and Percentage distribution of the level of oral health status among tobacco consuming adults, that majority of 75 (75%) adults were had changes in their oral cavity, 25(25%) were unhealthy and none of them were having healthy oral status.

 

The findings are consistent with the findings of Barbara B et.al., (2012) Oral health status was assessed by adult’s self-assessment of the condition of his or her mouth and teeth. The result of this study was that both in males and females. Among adults aged 18–64, about three-quarters had very good or good oral health, 17% had fair oral health, and 7% had poor oral health.

 

SECTION C:

Table:2 Frequency and Percentage distribution of the level of knowledge regarding oral health hazards among tobacco consuming adults.                                                             n=100

S. No	Level of knowledge	Frequency (F)	Percentage (P)
1. 2. 3	Inadequate knowledge Moderately adequate knowledge Adequate knowledge	39 47 14	39 47 14

 

Regarding Frequency and Percentage distribution of the level of knowledge regarding oral health hazards among tobacco consuming adults. that the majority of 47(47%) adults had moderately adequate knowledge, 39(39%) had inadequate knowledge and 14(14%) had adequate knowledge regarding oral health hazards among tobacco consuming adults.

 

SECTION D:

Table:3 Correlations between the oral health status and knowledge on oral health hazards among tobacco consuming adults   n= 100

S. No	Variable	Mean	Standard deviation	Coefficient of correlation	Table value	t value	Inference
1. 2.	Level of oral health status Level of knowledge	6 13	3.12 5.16	r = 0.4	0.195	4.202	S

S- Significant                                                                       p<0.05   df= 98

 

Regarding Correlations between the oral health status and knowledge on oral health hazards among  tobacco consuming adults, depicts that the mean and standard deviation scores of the level of oral health status were 6(SD±3.12) and the mean and standard deviation scores of the level of knowledge were 13(SD±5.16). There was a low positive correlation (r=0.4) between the level of oral health status and the level of knowledge. It shows that there is a relationship between the level of oral health status and the level of knowledge in which there is a high mean value (13) on level of knowledge to be associated with low mean value (6) on level of oral health status.

 

The findings are consistent with the findings of Vinutha M D., (2005). Correlative research design was used. Data from 100 participants (n=50 tobacco smokers, n=50 tobacco chewers). A structured interview schedule on knowledge on hazards of tobacco consumption on oral health and mouth mirror, probe and observational checklist were used to assess the knowledge on tobacco consumption on oral health and oral health status. The results of this study showed that there was no significant difference between the knowledge score of tobacco smokers and tobacco chewers (t₉₈=0-7, p>0.05). There was no significant difference between oral health status of the tobacco smokers and tobacco chewers (t₉₈=1.85, p>0.05). There was no correlation between knowledge on hazards of tobacco consumption on oral health and oral health status of the smokers (r=0.0015, p>0.05).there was no correlation between knowledge on hazards of tobacco consumption on oral health and oral health status of the chewers (r=0.271, p>0.05).

 

SECTION-E:

The chi-square values were calculated to find the association of the oral health status among tobacco consuming adults with their selected demographic variables. The results revealed that there was no significant association of the level of oral health status among tobacco consuming adults with their selected demographic variables except for the age of the adults (χ²=6.81).

 

SECTION-F:

The chi-square values were calculated to find the association of the level of knowledge among tobacco consuming adults with their selected demographic variables. The results revealed that, there was no significant association of the level of knowledge among tobacco consuming with their selected demographic variables except for the age of the adult (χ²=13.09), education (χ²=39.57), monthly income (χ²=16.25), frequency of consuming tobacco (χ²=12.66), and the duration of consuming tobacco (χ²=24.04).

 

CONCLUSION:

The present study was conducted to assess the oral health status and knowledge on oral health hazards among tobacco consuming adults with a view to preparing a self instructional module. The study findings revealed that maximum of adults were moderately adequate knowledge (47%) and unhealthy oral status (75%). These findings insisted that there must be a need to improve oral health status of the tobacco consuming adults by increasing their knowledge regarding oral health status which turns to prevent further complications of tobacco consumption.

 

IMPLICATIONS:

The findings of the study have certain important implication for nursing service, nursing education, nursing administration, and nursing research.

 

Nursing Service:

·       The nurse must conduct oral examination tobacco consuming adults.

·       Nurse as the change agent, can introduce the various audio visual methods for the reduction of tobacco consumption among adults.

·       In the hospital, wall hangings, posters can display in outpatient department regarding ill effects of tobacco consumption.

 

Nursing Education:

·       The nurse educator can orient the students to conduct a health education programmes in reducing the tobacco consumption among adults

·        Nurse Educators should motivate the students to do mini projects on prevention of consumption of tobacco among adults in the community.

·       Nurse educators should conduct workshops/ seminars to update the knowledge of students on ill effects of tobacco consumption so that they can educate adults in the community.

 

Nursing Administration:

·       Nurse administrator can organize mass education programmes in the community regarding benefits of tobacco free life for the individual and the family.

·       Nurse administrator can prepare and distribute information booklets about tobacco cessation programmes in India.

 

Nursing Research:

·       The study findings can be a baseline for further studies to build upon for improving the body of knowledge in nursing.

·       The study findings can be effectively utilized by the emerging researchers to conduct further studies especially in India.

 

RECOMMENDATIONS:

Based on the findings the following recommendations are stated

·       Similar study can be replicated in a larger sample thereby findings can be generalized to a large population

·       Similar study can be conducted regarding knowledge, practise and attitude regarding prevention of tobacco consumption among tobacco consuming adults of different age groups.

·       Comparative study can also be done between the adults with tobacco consumption from rural and urban community.

·       Experimental study can also be done among tobacco consuming adults by using any nursing intervention.

·       Longitudinal study can be done to assess the effectiveness of planned teaching programme in reducing tobacco consumption.

 

LIMITATION:

It was difficult for the researcher to convince the samples to accept for oral health assessment.

 

REFERENCE:

1.      Barbara W et.al., (1997). Readings in Community Health Nursing. (5^th Ed). Philadelphia: Lippincott Publishers Pp: 394,181, 398-399.

2.      WHO., (2003). The Word Health Report: shaping the future. Geneva.

3.      Daniels R et. al., (2007). Contemporary Medical Surgical Nursing. India: Thomson Publishers. Pp: 1622.

4.      Sholtis L et.al., (1992). The Textbook of Adult Nursing. (6^th Ed). London: Chaplin Publishers. Pp: 490-495.

5.      Sundar R.K., (1984). An Introduction to Community Health Nursing. (4^th Ed). B.I. Publications. Pp: 669-675.

6.      Dwayne S., (2011). A framework for implementing sustainable oral health promotion interventions. Journal of Public Health Dentistry. Pp: 1-11.

7.      Gobalakrishnan K., (2008). Study of adolescents on risk factors related to oral cancer. Nightingale Nursing Times. Pp: 31-32.

8.      www.ineedce.com

9.      http://www. cdc.gov/nchs/nhis.htm

 

 

 

Received on 29.06.2018          Modified on 03.08.2018

Accepted on 06.09.2018     © A&V Publications all right reserved