Knowledge, apptitude and practice: smoking and gutka habits in a lower socio-economic cohort


  • Aazmeer Mohammad Khan Student, PAF Chapter, Karachi, Pakistan
  • Saera Suhail Kidwai Department of Medicine, United Medical and Dental College, Karachi, Pakistan
  • Saima Akhtar Department of Public Administration, University of Karachi, Karachi, Pakistan
  • Jamal Ara Department of Medicine, United Medical and Dental College, Karachi, Pakistan



Attitude, Gutka, Knowledge, Practice, Smoking


Background: Smoking and smokeless tobacco use is the major cause of death and disease in South Asia, the use of gutka has surpassed that of smoking in this region thus, acting as a major contributor to oral and esophageal cancer especially in the younger population. Authors have designed this study to explore the knowledge, apptitude and practice regarding smoking and gutka use in a lower socio-economic cohort and observe the impact of education, income and type of profession on the users.

Methods: This cross sectional descriptive survey is conducted in Creek General Hospital, Korangi, Karachi. The study design is non-probability convenience. A questionnaire is used to quantify the frequency of smoking-related knowledge-attitude-practice, knowledge and attitude about tobacco-related disease and, smoking cessation-related thoughts and practice. Data is analysed in SPSS 16.

Results: A total of 250 subjects participated in this descriptive study, 133 subjects (22% females and 62.6% males) were found addicted to smoking or smokeless tobacco product with stress, seeking pleasure and peer pressure being the most convincing factor to initiate their habit.90% of the users want to stop using the substance of abuse and 80 have at least once tried to quit the habit.

Conclusions: This study shows a direct relationship between level of education and socioeconomic status with use of addictive substance. It also resulted in identifying the desire to quit in our cohort and need for formulating a plan specifically for the target population to focus not only to remove the cause, but also to empower them to take responsibility for their own well being. 


Secretan B, Straif K, Baan R, Grosse Y, El Ghissassi F, Bouvard V, et al. WHO International Agency for Research on Cancer Monograph Working Group A review of human carcinogens--Part E: tobacco, areca nut, alcohol, coal smoke, and salted fish. Lancet Oncol. 2009;(11):1033-4.

Murray CJ, Lopez AD. Alternative projections of mortality and disability by cause 1990-2020: Global burden of disease study. Lancet: 1997;349:1498-504.

Mathers CD. Loncar D. Projections of global mortality and burden of disease from 2002 to 2030. Public Libr. Sci. Med. 2006;

Hammond D, Fong GT, McNeill A, Borland R, Cummings KM. Effectiveness of cigarette warning labels in informing smokers about the risks of smoking: Findings from the International Tobacco Control (ITC) four country survey. Tob. Control. 2006;15:S19-25.

National Center for Chronic Disease Prevention and Health Promotion, U.S. Office on Smoking and Health. The Health Consequences of Smoking- 50 Years of Progress: A Report of the Surgeon General; Centers for Disease Control and Prevention: Washington, DC, USA; 2014:944.

Gharaibeh H, Haddad L, Alzyoud S, El-Shahawy O, Baker A, Umlauf M. Knowledge, Attitudes, and Behavior in Avoiding Second hand Smoke Exposure Among Non-Smoking Employed Women with Higher Education in Jordan. Int. J. Environ. Res. Public Health. 2011;8:4207-19.

Boffetta P, Hecht S, Gray N, Gupta P, Straif K. Smokeless tobacco and cancer. Lancet Oncol. 2008;9(7):667-75.

Gupta PC, Subramoney S. Smokeless tobacco use, birth weight, and gestational age: population based prospective cohort study of 1217 women in Mumbai, India. BMJ. 2004; 328(7455):1538.

Nair U, Bartsch H, Nair J. Alert for an epidemic of oral cancer due to use of the betel quid substitute’s gutkha and pan masala: a review of agents and causative mechanisms. Mutagenesis. 2004;19(4):251-62.

Pakistan Details. Tobacco Control Laws. 2018. Available at: legislation/country/Pakistan.

National Institute of Population Survey. Pakistan Demographic and Health Survey 2014/15. 2015.

Demaio AR, Nehme J, Otgontuya D, Meyrowitsch DW, Enkhtuya P. Tobacco smoking in Mongolia: Findings of a national knowledge, attitudes and practices study. BMC Public Health. 2014;14:213,

Benson FE, Stronks K, Willemsen MC, Bogaerts NMM, Nierkens V. Wanting to attend isn’t just wanting to quit: Why some disadvantaged smokers regularly attend smoking cessation behavioral therapy while others do not: A qualitative study. BMC Public Health. 2014;14:695.

Giskes K, Kunst AE, Benach J, Borrell C, Costa G, Dahl E, et al. Trends in smoking behavior between 1985 and 2000 in nine European countries by education. J. Epidemiol. Community Health. 2005;59:395-401.

Margolis R. Educational differences in healthy behavior changes and adherence among middle-aged Americans. J. Health Soc. Behav. 2013;54:353-68.

Usman G, Kumar S, Irfan MA, Agha S, Taj A. Prevalence of Pan, Gutka, Betalnut, Naswar and Cigarette Smoking in University Students of Karachi. Med Forum. 2015;26(1):41-4.

Banerjee CS, Ostroff SJ, Bari S, D’Agostino AT, Khera M, Acharya S, et al. Use Among South Asian Immigrants: A Focus Group Study Immigrant Minority Health. 2014;(16):531-9.




How to Cite

Khan, A. M., Kidwai, S. S., Akhtar, S., & Ara, J. (2018). Knowledge, apptitude and practice: smoking and gutka habits in a lower socio-economic cohort. International Journal of Research in Medical Sciences, 6(5), 1643–1648.



Original Research Articles