Abstract
Aim:
The aim of the current cross-sectional study was to assess the prevalence of tobacco consumption among psychiatric jail patients residing in Central Jail, Bhopal, Madhya Pradesh, India.
Materials and Methods:
The study subjects consisted of prediagnosed psychiatric patients residing in Central Jail, Bhopal, Madhya Pradesh, India. A matched control consisting of cross-section of the population, that is, jail inmates residing in the same Central Jail locality was also assessed to compare the psychiatric subjects. An 18 item questionnaire was used to assess the prevalence of tobacco consumption among study subjects.
Results:
The total number of subjects examined was 244, which comprised of 122 psychiatric inmates and 122 nonpsychiatric inmates. Among all psychiatric inmates, about 57.4% of inmates had a diagnosis of depression, 14.8% had psychotic disorders (such as schizophrenia), and 12.3% had anxiety disorder. A total of 77% study inmates, which comprised of 87.7% psychiatrics and 66.4% nonpsychiatrics had a habit of tobacco consumption (smokeless or smoking).
Conclusion:
The information presented in this study adds to our understanding of the common tobacco related practices among psychiatric inmate population. Efforts to increase patient awareness of the hazards of tobacco consumption and to eliminate the habit are needed to improve oral and general health of the prison population.
Keywords: Jail inmates, psychiatric illness, psychiatrics, tobacco related habits
Tobacco is a highly addictive substance. It is estimated that 1.9 billion people worldwide currently smoke. Nearly, two-thirds of world's tobacco users live in just 10 countries and >40% live in just two countries, that is, China and India. India bears around 10% share of total tobacco users in the world.[1]
According to the WHO, tobacco is the second leading cause of death in developed and developing countries. Tobacco is the second leading risk factor except high blood pressure, for premature deaths.[2] It is estimated that, assuming the current smoking patterns continue, it will cause some 10 million deaths each year by 2020.[1]
There is increasing evidence for the association between substance use and criminality, including a high prevalence of substance use disorders in prison populations.[3,4,5] It has been estimated that around 64-88% of the prisoners smoke.[6] Prevalence rates of smoking in prison are at least doubled or even tripled compared to the general population,[6,7] and tobacco use is commonly accepted as part of prison life.[5]
Various studies[8,9,10] have also demonstrated the need for the enhancement of mental health services to cope with the high number of mentally ill prison inmates, including those with tobacco related problems. These mental or behavioral disorders are especially prevalent among prison populations.[8,11]
In India, the accessibility to healthcare facilities for the psychiatric jail inmates is nearly nonexistent. There is every possible chance that this neglected group of the population may have heavy stress and indulge in alcoholism, gutkha-pan chewing, and other pernicious habits. These factors may cause many oral and general health-related problems which can make their lives worse.[12]
To the best of our knowledge, there is no data available on the tobacco related status of this special community. Hence, the current cross-sectional study was conducted to assess the prevalence and pattern of tobacco consumption among psychiatric inmates residing in Central Jail, Bhopal, Madhya Pradesh, India.
MATERIALS AND METHODS
A descriptive, cross-sectional survey was conducted among the psychiatric inmates residing in Central Jail, Bhopal, Madhya Pradesh, India.
The study subjects consisted of prediagnosed psychiatric patients residing in Central Jail, Bhopal, Madhya Pradesh, India. A matched control consisting of cross-section of the population, that is, jail inmates residing in the same Central Jail locality was also surveyed to compare the psychiatric inmates.
Eligibility criteria
All the available prediagnosed psychiatric inmates who are approved by psychiatric professional and who are willing to participate in the survey with their consent were considered for the study.
Exclusion criteria
Subjects with serious mental illness, intellectual disability, and aggressive and uncooperative subjects, were excluded from the study due to their limited ability to cooperate. Similarly, subjects who fail to give consent were also excluded from the study.
Sample size
A total of 244 subjects comprised of 122 psychiatric inmates and 122 nonpsychiatric inmates residing in Central Jail were included in the study.
Method of collection of data
Ethical approval for the survey was taken from ethical committee, People's Dental Academy. Permission to conduct the survey was obtained from the medical in-charge of Psychiatric Department of Central Jail, Bhopal, Madhya Pradesh, India.
Survey scheduling
The survey procedure was systematically scheduled and was carried out for a period of 2 weeks in the month of September 2013.
Details of the survey
All the psychiatric patients with symptoms of mental disorder, and who are approved by the psychiatrist based on criteria specified in the Diagnostic and Statistical Manual of Mental Disorders, fourth edition, were surveyed for tobacco related habits. Prior to survey a written consent was taken from each participant. The cross-section of the eligible subjects residing in Central Jail was also matched to make valid comparisons.
Assessment of tobacco related habits
An 18 item, predesigned, structured questionnaire was used to obtain information on age, sex, education, type of psychiatric disorder, medication used for illness, duration spent in the jail, along with tobacco related habits, and extent of knowledge about the risk factors of oral cancer.
Statistical analysis
All the obtained data were entered into a personal computer on Microsoft Excel sheet and analyzed by using software, Statistical Package for Social Science (SPSS, IBM, IL, USA) version 20. Data comparison was done by applying Chi-square test and t-test. The statistically significant level was fixed at P < 0.05 with a confidence interval of 95%.
RESULTS
A total of 244 inmates (all males) were equally distributed into two groups that is, 122 (50%) psychiatric inmates and 122 (50%) nonpsychiatric inmates. Highest number of inmates, that is, 96 (39.3%) were in the age group of <34 years while; lowest of 31 (12.7%) inmates belonged to age group above 55 years. The difference was not statistically significant (P = 0.310) [Figure 1].
Figure 1.
Distribution of inmates according to age
Among 122 psychiatric inmates, about 70 (57.4%) of inmates had a diagnosis of depression, 18 (14.8%) had psychotic disorders (such as schizophrenia), and 15 (12.3%) had anxiety disorder. However, the majority of psychiatric inmates, 73 (59.8%) were receiving antidepressants [Table 1].
Table 1.
Distribution of psychiatric inmates according to psychiatric disorder and type of medication
A total of 188 (77%) study inmates which comprised of 107 (87.7%) psychiatrics and 81 (66.4%) nonpsychiatrics had a habit of tobacco consumption (smokeless or smoking). The difference in tobacco consumption among inmates was statistically significant (P = 0.000). Similarly, the frequency of tobacco consumption many times a day was highest among 93 (76.2%) psychiatric inmates followed by 71 (58.2%) nonpsychiatric inmates. The difference in frequency of tobacco consumption among inmates was statistically significant (P = 0.001) [Table 2].
Table 2.
Distribution of inmates according to tobacco related habits and frequency of tobacco use
DISCUSSION
Very few studies have been carried out on the tobacco related habits of prisoners across the globe. In this study, a very first of its kind, pioneering attempt has been made to assess the prevalence of tobacco consumption among psychiatric jail inmates residing in Central Jail, Bhopal, Madhya Pradesh, India.
This study had two limitations; first all the inmates recruited were male subjects. The second was a lack of literature on the subject at both country and international level for comparison and discussion purposes. Nevertheless, a sincere attempt has been made to compare our data with studies conducted among psychiatric patients and general population.
Among psychiatric inmates, about 57.4% of inmates had a diagnosis of depression (affective mood disorder). The next psychiatric condition, which was prevalent were psychotic disorder such as schizophrenia (14.8%) followed by anxiety disorder (9.8%) and bipolar disorder (2.5%). These findings are similar to study on psychiatric patients conducted in Copenhagen by Hede.[13] Furthermore, a study in Virginia by Barnes et al.[14] showed that majority (38%) were diagnosed with affective mood disorder and second large proportion were diagnosed to be having schizophrenia.
The majority of psychiatric inmates, 59.8% were receiving antidepressants followed by 17.2% antipsychotics and 18% anxiolytic drugs. These findings are similar to a study conducted by Kebede et al.[15] where, 65.8% patients were receiving antidepressants, and 17.5% antipsychotics.
In our study, marked rise in consumption of tobacco (smoked and smokeless) and associated products (gutkha, paan masala, khaini, areca nut, etc.) was observed among psychiatric (87.7%) and nonpsychiatric inmates (66.4%). The higher usage of tobacco among the study population can be correlated with stressful conditions of prison along with depression. Inmates may probably felt that use of these products reduces stress, tiredness and brought in excitement in the body.[16] Similarly, depression has been consistently associated with smoking,[17] in this study, the mentally ill group smoked more and for longer duration than the healthy individuals.
The findings of the present study revealed that tobacco use among psychiatric inmates of Central Jail, Bhopal is an issue of significant concern, which may have a serious impact on their health status. Working toward the mitigation of factors affecting tobacco menace at the individual level as well as at the institutionalized level should be implemented as a part of a long term commitment to safeguard public health. Anti-tobacco initiatives are thus warranted.
Further comparative studies with a larger sample size and with the addition of more number of similar institutionalized settings are recommended to focus on a broader assessment of tobacco related habits of psychiatric inmates and correlating it with possible associating factors.
CONCLUSION
The information presented in this study adds to our understanding of the common tobacco related habits among psychiatric inmate population. Efforts to increase the patient awareness of hazards of tobacco use and to eliminate the habit are needed to improve oral and general health of the prison population. Special attention to the psychiatric inmates should be provided by including the periodic monitoring of their tobacco related habits. The greater coordination between dentists and psychiatrists may better serve the needs of this underprivileged population.
Footnotes
Source of Support: Nil
Conflict of Interest: None declared.
REFERENCES
- 1.Geneva: World Health Organization; 2008. WHO. Report on the Global Tobacco Epidemic, 2008 – The MPOWER Package. [Google Scholar]
- 2.Sen U. Lifeline. Vol. 8. New Delhi, India: WHO, SEARO; 2002. Tobacco Use in Kolkata; pp. 7–9. [Google Scholar]
- 3.Greenfield LA. Washington, DC: US Department of Justice; 1998. Alcohol and Crime: An Analysis of National Data on the Prevalence of Alcohol Involvement in Crime. Ncj-168632. [Google Scholar]
- 4.Greenfield TK, Weisner C. Drinking problems and self-reported criminal behavior, arrests and convictions: 1990 US alcohol and 1989 county surveys. Addiction. 1995;90:361–73. doi: 10.1046/j.1360-0443.1995.9033616.x. [DOI] [PubMed] [Google Scholar]
- 5.Awofeso N, Testaz R, Wyper S, Morris S. Smoking prevalence in New South Wales correctional facilities, 2000. Tob Control. 2001;10:84–5. doi: 10.1136/tc.10.1.84a. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 6.Belcher JM, Butler T, Richmond RL, Wodak AD, Wilhelm K. Smoking and its correlates in an Australian prisoner population. Drug Alcohol Rev. 2006;25:343–8. doi: 10.1080/09595230600741198. [DOI] [PubMed] [Google Scholar]
- 7.Baker A, Ivers RG, Bowman J, Butler T, Kay-Lambkin FJ, Wye P, et al. Where there's smoke, there's fire: High prevalence of smoking among some sub-populations and recommendations for intervention. Drug Alcohol Rev. 2006;25:85–96. doi: 10.1080/09595230500459552. [DOI] [PubMed] [Google Scholar]
- 8.Brinded PM, Simpson AI, Laidlaw TM, Fairley N, Malcolm F. Prevalence of psychiatric disorders in New Zealand prisons: A national study. Aust N Z J Psychiatry. 2001;35:166–73. doi: 10.1046/j.1440-1614.2001.00885.x. [DOI] [PubMed] [Google Scholar]
- 9.Fazel S, Danesh J. Serious mental disorder in 23000 prisoners: A systematic review of 62 surveys. Lancet. 2002;359:545–50. doi: 10.1016/S0140-6736(02)07740-1. [DOI] [PubMed] [Google Scholar]
- 10.Lo CC, Stephens RC. Drugs and prisoners: Treatment needs on entering prison. Am J Drug Alcohol Abuse. 2000;26:229–45. doi: 10.1081/ada-100100602. [DOI] [PubMed] [Google Scholar]
- 11.Brugha T, Singleton N, Meltzer H, Bebbington P, Farrell M, Jenkins R, et al. Psychosis in the community and in prisons: A report from the British National Survey of psychiatric morbidity. Am J Psychiatry. 2005;162:774–80. doi: 10.1176/appi.ajp.162.4.774. [DOI] [PubMed] [Google Scholar]
- 12.Walsh T, Tickle M, Milsom K, Buchanan K, Zoitopoulos L. An investigation of the nature of research into dental health in prisons: A systematic review. Br Dent J. 2008;204:683–9. doi: 10.1038/sj.bdj.2008.525. [DOI] [PubMed] [Google Scholar]
- 13.Hede B. Oral health in Danish hospitalized psychiatric patients. Community Dent Oral Epidemiol. 1995;23:44–8. doi: 10.1111/j.1600-0528.1995.tb00196.x. [DOI] [PubMed] [Google Scholar]
- 14.Barnes GP, Allen EH, Parker WA, Lyon TC, Armentrout W, Cole JS. Dental treatment needs among hospitalized adult mental patients. Spec Care Dentist. 1988;8:173–7. doi: 10.1111/j.1754-4505.1988.tb00726.x. [DOI] [PubMed] [Google Scholar]
- 15.Kebede B, Kemal T, Abera S. Oral health status of patients with mental disorders in southwest Ethiopia. PLoS One. 2012;7:e39142. doi: 10.1371/journal.pone.0039142. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 16.Kasat V, Joshi M, Somasundaram KV, Viragi P, Dhore P, Sahuji S. Tobacco use, its influences, triggers, and associated oral lesions among the patients attending a dental institution in rural Maharashtra, India. J Int Soc Prev Community Dent. 2012;2:25–30. doi: 10.4103/2231-0762.103454. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 17.Hall SM, Muñoz RF, Reus VI, Sees KL. Nicotine, negative affect, and depression. J Consult Clin Psychol. 1993;61:761–7. doi: 10.1037//0022-006x.61.5.761. [DOI] [PubMed] [Google Scholar]