1. Tobacco Knowledge, Attitude and Practices among Adults attending Outpatient Department of Public Hospitals in Bangladesh
Palash Chandra Banik
Senior Lecturer
Department of Noncommunicable Diseases
Bangladesh University of Health Sciences (BUHS)
January 19, 2016

2. Background
Tobacco smoking is a major cause of preventable morbidities and mortality
Tobacco use results in the deaths of nearly 6 million people per year
If current trends continue, by 2030 tobacco will kill more than 8 million people per year
Tobacco smoking rates have decreased in many developed countries in the last 20 years, they remain high in developing nations

3. Background... (cont’d)
Hospitals are no smoking zones in Bangladesh but sometimes this law is broken by the peoples
Adults attending a hospital outpatient department can be directly or indirectly affected by tobacco related harms
The knowledge, attitudes and practices among the adults attending a hospital has not yet been assessed

4. Objectives General objective
To assess the tobacco knowledge, attitude and practices among adults attending Outpatient Department (OPD) of public hospitals in Bangladesh
Specific Objectives
To identify the practice regarding tobacco use among the study subjects
To assess the knowledge of tobacco consumption among the study subjects
To assess the attitude towards tobacco use among the study subjects
To find out the relationship between the knowledge and practice with selected socio-demographic variables

5. Methodology Study design: A cross-sectional study
Study areas: Outpatient departments of 07 government hospitals:
Sher-e-Bangla Medical College Hospital, Barisal
Chittagong Medical College Hospital, Chittagong
Dhaka Medical College Hospital, Dhaka
Khulna Medical College Hospital, Khulna
Rajshahi Medical College Hospital, Rajshahi
Rangpur Medical College Hospital, Rangpur
Sylhet MAG Osmani Medical College Hospital, Sylhet
Study period: March to November 2015
Study population: Adults aged 15 to 65 years

6. Methodology… (cont’d)
Sample Size: By using the software Power Analysis and Sample Size System (PASS), a total of 1140 sample was calculated
Sampling technique:
Hospitals were selected by purposive sampling
Samples (patients and their relatives) were selected through convenient sampling technique
Data Collection tools and technique:
Semi-structured pretested questionnaire
Face-to-face interview was conducted for data collection

7. Methodology… (cont’d)
Data analysis:
Univariate analysis: number, percentage, mean, median, standard deviation
Bivariate analysis: Chi-square test
Multivariate analysis: Binary logistic regression has also been done as multivariate analysis
Ethical consideration:
Informed consent was taken before interview session
Ethical clearance was obtained from Ethical Review Committee (ERC) of Bangladesh University of Health Sciences (BUHS)

8. Results

9. Socio-demographic characteristics
Table 1: Socio-demographic characteristics of the study subjects (n=1200)
Variables
Number (n)
Percentage (%)
Sex
Male
682
59.8
Female
458
40.2
Age (years)
15-24
328
28.8
25-44
574
50.4
45-64
230
20.2
65 and above 8
0.7
Mean ±SD
33.0 ±12.1
Education
Illiterate
146
12.8
Less than primary
122
10.7
Primary complete
331
29.0
SSC completed
195
17.1
HSC completed
217
19.0
Graduation and above
129
11.3

10. Socio-demographic characteristics ...(cont’d)
Table 1: Socio-demographic characteristics of the study subjects… (cont’d)
Variables
Number (n)
Percentage (%)
Occupational status
Employed
198
17.4
Unemployed 61
5.4
Business
138
12.1
Farmer 78
6.8
Laborer 76
6.7
Students
212
18.6
Homemaker
343
30.1
Others 34
3.0
Area of residence
Urban
535
46.9
Semi urban 75
6.6
Rural
530
46.5
Monthly Income (BDT)
Median
15000

11. Use of tobacco consumption
Table 2: Prevalence of tobacco consumption (n=1140)
Tobacco use
Number (n)
Percentage (%)
Current users
400
35.1
Former users 75
6.6
Never users
665
58.3

12. Use of tobacco consumption...(cont’d)
Figure 1: Types of tobacco product used by the tobacco users

13. Figure 2: Type of smoking tobacco (n=228)
Use of smoking tobacco
Figure 2: Type of smoking tobacco (n=228)

14. Use of smoking tobacco (cont’d)
Figure 3: Frequency of cigarette/ bidi smoke (n=228)

15. Use of smoking tobacco (cont’d)
Table 3: Number of sticks, age of initiation, money spent for smoking (n=228)
Variables
Number (n)
Percentage (%)
Number of sticks/per day
<10
175
76.8
10-20 21
9.2
>20 32
14.0
Mean ±SD
9.3±8.5
Age of first initiation (years)
<20
160
70.2 68
29.8
19.5±4.5
Money spent/day (TK.)
<100
180
79.2
13.7 13
5.8
>300 3
1.3
70±79.8

16. Use of smoking tobacco (cont’d)
Table 5: Reason(s) of smoking among the respondents
Reasons of smoking
Percent (%) of Cases
Helps me to feel stress free
43.9
Keep me away from family problem
7.4
Keep me away from personal problem
18.0
It is easily accessible to me
4.2
Peer pressure
36.0
Other
40.7
Base
190.0
Multiple responses

17. Use of smokeless tobacco
Figure 4: Type of smokeless tobacco used by the users (n=172)

18. Figure 5: Frequency of SLT consumption
Use of smokeless tobacco (cont’d)
Figure 5: Frequency of SLT consumption

19. Use of smokeless tobacco (cont’d)
Table 6: Age of initiation, money spends by the respondents for SLT
Variables
Number (n)
Percentage (%)
Age of first tried SLT (years)
<26
129
61.4
>26 81
38.6
Mean ±SD
26.0±9.7
Money spend /day for SLT
<100
182
86.7 17
8.1 8
3.8
>300 3
1.4
56.1±77.5

20. Knowledge about tobacco related health hazard
Figure 6: Respondent’s knowledge of tobacco related health hazard

21. Knowledge of tobacco related health hazard (cont’d)
Table 7: Knowledge on types of health hazard caused by tobacco consumption
Types of health hazard
Percent (%) of Cases
Respiratory problems
85.8
Heart Disease
26.9
Stroke
17.4
Cancer
79.2
Causes harm to fetus
2.8
Others*
31.9
Base
1106
Multiple responses

22. Knowledge of tobacco related health hazard (cont’d)
Table 8: Others knowledge about tobacco consumption
Variables
Number
Percent (%)
Tobacco cause addiction (n=1140) No
128
11.2
Yes
1012
88.8
Which one is more addictive (n=1012)
Smoking tobacco
482
47.6
Smokeless tobacco
149
14.7
Both
286
28.3
Don’t know 95
9.4
Which one is more injurious to health?
Smoking
500
43.9
172
15.1
398
34.9 70
6.1
Danger of smoking increases with dose 45
3.9
1095
96.1

23. Attitude towards tobacco use (cont’d)
Table 9: General Attitude towards tobacco use (n=1140)
Statements
Disagree (%)
Neutral (%)
Agree (%)
Smokers have more friends than non-smokers
12.8
5.2
82.0
Tobacco consumption is less harmful than illegal drug use
33.0
17.5
49.6
Smoking is a waste of money
0.9
0.7
98.4
Smoking helps to feel stress free
51.6
12.5
35.9
Smokers seems to be smarter
78.3
8.3
13.3
Smoking helps to be creative or think diversely
68.7
16.5
13.8
Sales of cigarettes should be outlawed
91.6
2.0
6.4

24. Sociodemographic variables Use of tobacco products
Results... (cont’d)
Table 11: Relationship between tobacco consumption with Socio-demographic variables
Sociodemographic variables
Use of tobacco products
Chi square (χ2)
p-value
No n(%)
Yes n(%)
Sex
Male
386 (56.6)
296 (43.4)
51.5
0.001*
Female
354 (77.3)
104 (22.7)
Age group
15-24 years
265 (80.8)
63 (19.2)
71.2
25-44 years
362 (63.1)
212 (36.9)
45-64 years
110 (47.8)
120 (52.2)
65+ years
3 (37.5)
5 (62.5)
Education level
Illiterate
66 (45.2)
80(54.8)
28.551
Literate
674 (67.8)
320 (32.2)
p<0.05 is considered as a level of significance, *=significant

25. Sociodemographic variables Knowledge on tobacco related health hazard
Results... (cont’d)
Table 11: Relationship between knowledge on health hazard with Socio demographic variables
Sociodemographic variables
Knowledge on tobacco related health hazard
Chi square (χ2)
p-value
No n(%)
Yes n(%)
Age group a
15-24 years
3 (0.9)
325 (99.1)
16.695
0.001*
25-44 years
17 (3.0)
577 (97.0)
45-64 years
12 (5.2)
218 (94.8)
65+ years
2 (25.0)
5 (75.0)
Education level
Illiterate
13 (8.9)
133 (91.1)
20.29
Literate
21 (2.1)
973(97.9)
Occupational status
Unemployed
5 (8.2)
56 (91.8)
6.056
0.014*
Employed
29 (2.7)
1050 (97.3)
a Fisher’s Exact test
p<0.05 is considered as a level of significance, *=significant

26. Results... (cont’d)
Table 12: Binary logistic model applied for uses of tobacco with socio demographic variables
Variables B
p-value OR
95% CI for OR
Lower
Upper
Sex
Male
Ref.
Female
-1.250
0.001*
0.286
0.213
0.385
Age group
15-24 years
25-44 years
0.688
1.990
1.392
2.846
45-64 years
1.044
2.840
1.839
4.386
Educational level
Illiterate
SSC completed
-1.084
0.338
0.203
0.563
HSC completed
-1.538
0.215
0.124
0.371
Graduation and Above
-1.524
0.218
0.123
Monthly Income (BDT)
0.000
0.003*
1.000
Constant
-0.188
0.483
0.828
p<0.05 is considered as a level of significance, *=significant

27. Conclusions
Almost all the respondents had very good knowledge on health hazards related to tobacco consumption irrespective of gender but they were not that much motivated which is reflected in their practices
Mixed types of attitudes has been followed about tobacco consumption among the respondents

28. Recommendations
Awareness program should be launched in all government and private hospitals and hospitals should be tobacco free
This types of study should be conducted on different groups of population to know the actual situation which might be helpful to any intervention

29. Policy implications
This study findings can be used by the policy makers for effectiveness of the anti-smoking policies for adults, like higher excise taxes and VATs on cigarettes, and import restrictions.

30. THANK YOU ALL