• Nida Liaquat Health Services Academy, Islamabad
  • Abdul Majeed Jaffar Health Services Academy, Islamabad
  • Muhammad Zeeshan Haroon Health Services Academy, Islamabad
  • Muhammad Bilal Khan Health Services Academy, Islamabad
  • Hammad Habib Health Services Academy, Islamabad


Background: According to World Health Organization (WHO), six million deaths are attributable to tobacco use globally, of which nearly 1.2 million occur in South‑East Asia. Use of smokeless tobacco is highly prevalent in subcontinent and is home to over 250 million smokeless tobacco (ST) users. ST is a major public health problem. It cause localized oral lesions and poses risk for developing oral cancers owing to it containing more than 30 cancer causing substances, in addition to nicotine which is a highly addictive. This study was conducted to assess the overall knowledge and compare knowledge, attitude and perceptions of ST users presenting to private and public health care facilities. Methods: This cross sectional comparative study was carried out from April to July 2011 to establish the details of underlying factors and perceptions of areca/ST users presenting in public and private health care facilities of Karachi. Through systematic random sampling, 464 male and female users (≥14 years) were interviewed. The data was analysed in SPSS-16. Results: Mean age of the users of Private Clinic (PC) was 25±7.183 years while that of Public hospitals (PH) respondents was 34±11.3 years. The respondents present in PC (94%) had comparatively more knowledge than the users in PH (75%). About 78% of the study population in PH wanted to quit this habit of chewing whereas 88% in PC have the same attitude (p-0.01).  About 68% in Public and 89% in Private clinics ever tried to quit but failed; (p-0.000). Conclusion: Although respondents have substantial knowledge about the harmful effects of smokeless tobacco but due to their perceived psychological and emotional dependency, they remain addicted.


World Health Organization. WHO report on the global tobacco epidemic, 2011: warning about the dangers of tobacco. Geneva: World Health Organization; 2011.

Pandey A, Patni N, Sarangi S, Singh M, Sharma K, Vellimana AK, et al. Association of exclusive smokeless tobacco consumption with hypertension in an adult male rural population of India. Tob Induc Dis 2009;5:15.

Somatunga LC, Sinha DN, Sumanasekera P, Galapatti K, Rinchen S, Kahandaliyanage A, et al. Smokeless tobacco use in Sri Lanka. Indian J Ccancer 2012;49(4):357–63.

Kyaing NN, Sein T, Sein AA, Htike MT, Tun A, Shein NN. Smokeless tobacco use in Myanmar. Indian J Cancer 2012;49(4):347–51.

Rozi S, Akhtar S. Prevalence and predictors of smokeless tobacco use among high-school males in Karachi, Pakistan. East Mediterr Health J 2007;13(4):916–24.

Gupta PC, Ray CS. Smokeless tobacco and health in India and South Asia. Respirology 2003;8(4):419–31.

Smokeless tobacco major source of oral cancer. DAWN. [Internet]. 2011 [cited 2013 Nov 19]. Available from:

Iqbal MP, Yakub M. Smokeless tobacco use: a risk factor for hyperhomocysteinemia in a Pakistani population. PloS One 2013;8(12):e83826.

Gupta PC, Sinha DN. Tobacco research in India. Indian J Public Health 2004;48(3):103–4.

Creath CJ, Wright JT, Wisniewski JF. Characteristics of smokeless tobacco use among high school football players as related to type of smokeless tobacco and period of use. J Drug Educ 1992;22(1):69–85.

Lisnerski DD, McClary CL, Brown TL, Martin JP, Jones DR. Demographic and predictive correlates of smokeless tobacco use in elementary school children. Am J Health Promot 1991;5(6):426–31.

Khawaja MR, Mazahir S, Majeed A, Malik F, Merchant KA, Maqsood M, et al. Chewing of betel, areca and tobacco: perceptions and knowledge regarding their role in head and neck cancers in an urban squatter settlement in Pakistan. Asian Pac J Cancer Prev 2006;7(1):95–100.

Shah S, Qureshi R, Syed IA. Is Chaalia/Pan Masala harmful for health? practices and knowledge of children of schools in Mahmoodabad and Chanesar Goth, Karachi. J Pak Med Assoc 2009;59(8):550–4.

Mazahir S, Malik R, Maqsood M, Merchant KA, Malik F, Majeed A, et al. Socio-demographic correlates of betel, areca and smokeless tobacco use as a high risk behavior for head and neck cancers in a squatter settlement of Karachi, Pakistan. Subst Abuse Treat Prev Policy 2006;1:10.

Khuwaja AK, Kadir MM. Smoking among adult males in an urban community of Karachi, Pakistan. Southeast Asian J Trop Med Public Health 2004;35(4):999–1004.

Rozi S, Akhtar S. Smoking among high school adolescents in Karachi, Pakistan. Int J Epidemiol 2004;33(3):613–4.

Hussain SF, Moid I, Khan JA. Attitudes of Asian medical students towards smoking. Thorax 1995;50(9):996–7.



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