Knowledge of Health Effects and Intentions to Quit among Smokeless Tobacco Users in India: Findings from the International Tobacco Control Policy Evaluation (ITC) India Pilot Survey

Introduction and background: The prevalence of smokeless tobacco use in India is the highest in the world,with 26% of adults reporting being users of smokeless tobacco only. But to date, there are few studies of beliefs,knowledge, and other psychosocial measures relating to smokeless tobacco use in India. The aim of the presentstudy was to use data from the ITC India Pilot Study conducted in 2006 to examine beliefs about the harms ofsmokeless tobacco use, knowledge of health effects, and intentions to quit among current smokeless tobaccousers in two states, Maharashtra and Bihar.
Methods: Data from the ITC India Pilot Study, a face-to-face crosssectionalsurvey of 248 adults reporting exclusive current use of smokeless tobacco in Maharashtra and Bihar,were analyzed with respect to the knowledge of health effects, beliefs about harmfulness, and intentions to quitsmokeless tobacco use.
Results: Around three quarters (36%) of smokeless tobacco users from Maharashtra andtwo thirds (62%) from Bihar had a ‘bad’ opinion about smokeless tobacco use. About 77% believed that smokelesstobacco use causes mouth cancer, followed by gum disease (66%) and difficulty in opening the mouth (56%).Significant differences were found in health knowledge between urban and rural smokeless tobacco users in bothstates. Only 38% of smokeless tobacco users reported having intentions to quit, and only 11% had intentions toquit within the next 6 months. Smokeless tobacco users who reported higher knowledge of the specific healtheffects from smokeless tobacco use were more likely to have intentions to quit.
Conclusion: Despite the fairlyhigh levels of awareness of health effects from smokeless tobacco use in Maharashtra and Bihar, the majorityof smokeless users had no intentions to quit. Increased educational efforts about the detrimental health effectsfrom smokeless tobacco use may result in higher levels of knowledge about the harms of smokeless tobacco andthis in turn could increase quit intentions and subsequent quitting among users.