Areca nut and tobacco use among school children in a village in South India - A cross sectional study

Background: Areca nut is the fourth most commonly used psychoactive substance in the world after caffeine, alcohol and nicotine. Its use is considered a benign and socially acceptable habit among most Indians. Like tobacco, chewing areca nut also leads to oral and oropharyngeal cancers. Chewing of these substances usually starts early in life leading to a multitude of problems in adulthood. This study was conducted among high school students to determine the prevalence and to assess awareness of health hazards associated with these substances. Method: This cross sectional study was carried out in Vantamuri village, South India. All consenting school children of 7 ^th, 8^th and 9^th class were interviewed individually using a pretested questionnaire about their chewing habits. This was followed by a thorough oral cavity examination for all. Results: Out of 392 participants 62.5% were boys. Mean age of all participants was 14.8 ± 1.13 years. The prevalence of areca nut usage among boys and girls was 27.3% and 6.1% while it was 2.4% for gutka (contains tobacco) amongst boys. Majority of students started chewing between 13 and 14 years. About 49% of users were chewing these substances regularly for more than a year. Addictive tendencies were seen in two users. 43% of users chewed the same product used by their family members (P<0.025). 13.4% of chewers were from divorced or separated parents (P<0.005). About 3/4^th of the participants were ignorant of associated health hazards or thought these substances to be harmless. Black staining of teeth was seen in 39.5% of areca nut users (P=0.001). One case of submucous fibrosis was identified among an arecanut chewer. Conclusion: Awareness level of health hazards was poor among the students. Health education against these substances at an early age may help in curbing this problem.