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 Table of Contents  
Year : 2017  |  Volume : 6  |  Issue : 4  |  Page : 210-214

Tobacco use behavior among construction site workers of Delhi, India

1 Department of Community Medicine, Hamdard Institute of Medical Sciences and Research, New Delhi, India
2 Department of Medicine and Preventive Cardiology, National Heart Institute, New Delhi, India
3 Department of Community Medicine, ESIC Medical College and Hospital, Faridabad, Haryana, India
4 Department of Cardiology, Max Smart Hospital, New Delhi, India

Date of Web Publication12-Dec-2017

Correspondence Address:
Mitasha Singh
Department of Community Medicine, ESIC Medical College and Hospital, Faridabad, Haryana
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/ijhas.IJHAS_65_17

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BACKGROUND: Despite various initiatives, menace of tobacco problem still remains a cause of concern globally. Job of construction site workers is primarily monotonous which predisposes to tobacco habit.
OBJECTIVE: Assessing behavior regarding tobacco consumption among construction site workers of Delhi.
METHODOLOGY: A cross-sectional study was carried out among all construction site workers of Hamdard Institute of Medical Sciences and Research and associated HAH centenary hospital, New Delhi. Study included 172 workers for a period of 6 months.
RESULTS: Majority (91%) were tobacco users, and out of these, 49% were using smokeless tobacco, 29% were consuming bidi/cigarette, and 22% were consuming both. Tobacco as cause of cancer was named by 55.8%, while other diseases named were cough (39.5%), tuberculosis (17.4%), and other diseases (25.6%). Warning labels lead to the thought of quitting tobacco in 62.8%. Most common place (97.4%) for tobacco consumption was workplace.
CONCLUSION: Hence the views of workers are of great importance before implementing any anti-tobacco measures at workplace.

Keywords: Behavior, construction site worker, tobacco use

How to cite this article:
Parashar M, Dwivedi S, Singh M, Patavegar B, Bhardwaj M. Tobacco use behavior among construction site workers of Delhi, India. Int J Health Allied Sci 2017;6:210-4

How to cite this URL:
Parashar M, Dwivedi S, Singh M, Patavegar B, Bhardwaj M. Tobacco use behavior among construction site workers of Delhi, India. Int J Health Allied Sci [serial online] 2017 [cited 2023 Oct 4];6:210-4. Available from: https://www.ijhas.in/text.asp?2017/6/4/210/220526

  Introduction Top

Tobacco is a risk factor for six of the eight leading causes of death.[1] It is estimated that 80% of these premature deaths will occur among people living in low- and middle-income countries.[2] Although initiatives for all forms of tobacco cessation have increased with time, the menace of tobacco problem still remains a cause of concern globally. According to World Health Organization (WHO), awareness of the harmful effects of tobacco is very low in South East Asia due to which many people use it in various forms for various purposes.[3] If the current trends continue, by the year 2030, tobacco use is likely to kill more than eight million people worldwide each year.

India accounts for approximately a sixth of the world's tobacco-related deaths. As per the WHO Global Report on “Tobacco Attributable Mortality” 2012, 7% of all deaths (for ages 30 and over) in India are attributable to tobacco.[4] In India, nearly two-thirds of the contribution to the net domestic product is by the unorganized sector.[5] Also known as informal labor which is defined as those not governed either by state regulations or by collective agreements between workers and employers. Notable differences in smoking rates are seen across occupational groups, and significantly, higher tobacco consumption rates have been found among construction site workers.[6] Migration from rural areas necessitates alterations in social status and living conditions that result in behavioral adaptations to urban life.[7]

Understanding the tobacco-use knowledge, attitudes, and behaviors among workers is of significance in the provision of behavioral therapy for smoking cessation.[8]

Thus, their views and attitudes are of great importance to be determined before implementing any anti-tobacco measures. Although there are several studies to investigate the tobacco behaviors among migrants and other population,[9] there is a scarcity of literature focusing individually on the population of construction site in Delhi. The objective of our study was to investigate behavior regarding tobacco consumption among construction site workers of Delhi.

  Methodology Top

Study Setting: A cross-sectional study was conducted using a predesigned and pretested structured pro forma. The study was conducted among all construction site workers aged 18 years and above in campus of Hamdard Institute of Medical Sciences and Research and associated HAH centenary hospital, New Delhi. This study is part of a project which included 172 workers for a period of 6 months (September 2014 through June 2015). The project recruited the workers, and along with the present interview nicotine dependence,[10] intention to quit[11] and cardiovascular with biochemical assessments[12] were also conducted.

Inclusion criteria

All adult males and females (age above 18 years) in a payroll of construction site and willing to participate were included.

Exclusion criteria

Workers who were unable to respond to the questions (due to hearing problem or any other reason) were excluded.

Ethical consideration

Necessary permission to conduct the study was obtained from the concerned authority of the construction site. Written informed consent was obtained from the workers after explaining the nature and objectives of the study in their local language. The study was approved by the Institutional Review Board and Institutional Ethical Committee of Jamia Hamdard, New Delhi.

Study variables

Outcome variables: knowledge, attitude, and practice of workers about smoked tobacco/smokeless tobacco (SLT).

Predictor variables

Education, occupation, age, socioeconomic status, and migration.

Method of data collection

Data were collected by face-to-face interview method using predesigned, pretested WHO adopted Questionnaire[13] on tobacco use. First, we contacted contactor at construction units for permission to conduct the survey in their premises. On receipt of this permission, we then contacted recognized group “leaders” who mobilized and encouraged their coworkers to participate in the study. The study purpose was explained to all eligible participants, and informed consent was obtained from all who elected to participate. All surveys were administered by local medical professionals, who were trained in research survey methods. The recruitment and data collection of participants lasted for 3 months. Each week, around 15 workers were worked up by the interviewers and medical professionals. Questionnaires were checked by investigators for completeness. Following completion, all participants were given a token of appreciation (free medicines if required) and counseling in tobacco cessation clinic. They were referred to appropriate department if any health problem was identified.

Operational definition and statistical analysis

Data were stored in Microsoft Excel and subsequently analyzed by using SPSS version 16.0 software package (SPSS Inc. Released 2007. SPSS for Windows, Version 16.0. Chicago, SPSS Inc.). Exploration of the data was performed before analysis to determine missing values and the distribution (normality) of the variables. Both descriptive and inferential statistics were applied wherever appropriate. Descriptive statistics was used to describe patients' demographic information, knowledge, attitudes, and tobacco-use behaviors. Knowledge on tobacco use was evaluated using total score for each participant, with one point for each correct answer and zero points for each wrong answer. The possible score in knowledge domain for each individual ranged from zero to five. Student's t-test and ANOVA test were applied to determine demographic differences in knowledge.

  Results Top

Demographic characteristic and knowledge scores among workers

Of the 250 workers enrolled, 172 (68.8%) male workers agreed to participate in the tobacco-use survey. Mean age of construction site workers was 32.1 (standard deviation, 11.6) years. Among the study participants, less than half (44.2%) were illiterate, and one third (33.7%) completed primary education. Majorities (72.1%) of the study population were laborers and 27.9% were involved in skilled and other types of work. Most of them (94.1%) were migrants from Uttar Pradesh, Bihar, and West Bengal. Majority of the participants were tobacco users (90%), of which 49% were SLT users, 29% smoked bidi/cigarette, and 22% were dual users. [Table 1] shows the proportion of the respondents who answered correctly each item of tobacco-use knowledge. More than half (55.8%) of the population had knowledge about harmful effects of smoking while it was 46.5% for SLT. Only 23.3% were aware that second-hand smoke could also be harmful. Most of workers (90.7%) had received tobacco-related information through media. Tobacco is related to cancer was named by 55.8% while others named tuberculosis (17.4%), cough (39.5%), and other diseases (25.6%). Significant association was found between literacy, occupation, marital status, migrants, and tobacco-related knowledge [Table 2].
Table 1: Correct knowledge among construction site workers regarding tobacco use

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Table 2: The influence of participants' characteristics on tobacco-use knowledge

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Attitudes regarding tobacco use

Less than half of the participants believed that tobacco use is a fun (47.4%) while others believed that it makes them free from all stresses of life (14.7%) and relieves constipation (8.9%). Around 64% noticed health warnings on tobacco product packages. Among them, warning labels lead to the thought of quitting tobacco in 62.8% users.

Behavior regarding tobacco use

It was found that a higher proportion of the workers started smoking cigarettes at younger age (mean age 9.6 years) when compared with SLT use (mean age 14.4 years). Nearly one-third of smokers smoked more than ten cigarettes/bidis per day. Average frequency of SLT use per day was 4.7. Most of them (80%) spent five hundred rupees on tobacco per month. The most common place (97.4%) for tobacco consumption was workplace. More than half (56.4%) of the tobacco users had some family member who smoked/chewed tobacco, suggesting that the tobacco use is common in families with tobacco habit [Table 3].
Table 3: Tobacco-related behavior among current tobacco users

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  Discussion Top

The present study investigates the tobacco habit of construction site workers in Delhi. Mean age of workers was 32.1 ± 11.6 years. In another study, mean age of workers was 26.3 ± 8.5 years which is lower than that reported in this study.[14] Nearly half of the tobacco users in our study were aware that tobacco was harmful; however, majority were having little knowledge about the harmful effect of passive smoking. Mishra et al.[15] reported that all tobacco users were aware about its harmful effects and most (97%) of them identified passive smoking as being dangerous for health. In rural Kerala, 96.6% of the individuals knew that tobacco use is harmful for health; however, only 22.5% knew that it causes cardiovascular diseases.[16] Differences in knowledge may be attributed to the different study location, sampling frames, and demographic characteristics of the individuals enrolled. The majority were only aware that tobacco caused cancer and media was the common source of information similar to findings in another studies.[16],[17] Higher education, income, and type of family were associated with higher awareness in the same line with other studies.[16],[18],[19] Participants from our study regarded smoking as a fun and this finding was also observed by a study conducted in Malaysia.[20] Study done by Akram et al. in Mangalore among industrial workers found prevalence of tobacco use as 53.7% and prevalence of smoking and tobacco chewing was found to be 11.9% and 41.8%, respectively.[21] The mean age at initiation of cigarette smoking and chewing tobacco was lower in our study than as reported in other studies.[22] The average monthly expenditure on tobacco use in the current study's participants is <500 INR. Employees using smoked form of tobacco spent significantly higher amounts of money as compared to the employees using smokeless forms. In a study from Nepal, the average daily expenditure on tobacco was 20 Nepalese rupees (~0.3 USD).[22] In the present study, most of the worker smoked and chewed tobacco at workplace. Literature suggest[14],[23],[24] that rates of tobacco use are especially elevated among workers, particularly those employed at construction site. These workers are employed in settings generally less supportive of nonsmoking. For example, studies from across the world[14],[23],[24] reported a lower prevalence of restrictive smoking policies in worksites where they are employed and less assistance in quitting smoking from employer compared with the assistance reported by other workers.


Though the study provides useful information, it may have some limitations. The survey was done on workers from a construction site in Delhi; hence, the results can only be generalized to the sampled population. Our survey was cross sectional, and smoking/chewing status was by self-reporting. Therefore, some participants may have not reported or overreported their smoking/chewing habit. In spite of these limitations, we believe that our findings have not been significantly affected.

  Conclusion and Recommendations Top

Our findings indicate a need for tobacco control among this subpopulation. Despite good knowledge regarding health hazards, tobacco-use prevalence was very high among construction site workers. Effective behavior change communication package is required to elaborate the scope of warning labels on tobacco packs with focus on other potential hazards of smoking such as heart disease, hypertension, chronic lung disease, and infertility as well rather than just focusing on cancer. Most of workers smoked/chewed tobacco at workplace. Reconsideration of current tobacco-free legislation as it applies to the construction site is also required. Special efforts should be taken to educate workers on the effective strategies in managing stress due to workplace as they thought that tobacco should be used as a coping strategy to face such a stress.

Financial support and sponsorship


Conflicts of interest

There are no conflicts of interest.

  References Top

Ministry of Health and Family Welfare, Tobacco Control Legislation and National Tobacco Control Programme. Annual Report (2011-2012). MOHFW, Government of India; 2012. p. 162-5.  Back to cited text no. 1
John RM, Rao RK, Rao MG, Moore J, Deshpande RS, Sengupta J, et al. The Economics of Tobacco and Tobacco Taxation in India. Paris: International Union Against Tuberculosis and Lung Disease; 2010. p. 1-49.  Back to cited text no. 2
World Health Organization. South East Asia Regional Office (WHO SEARO). Tobacco Cessation Services in South East Asia Region Newsletter: WHO SEARO; 2013. Available from: http://www.searo.who.int/mediacentre/releases/2013/pr1563/en./ [Last accessed on 2017 Apr 30].  Back to cited text no. 3
World Health Organization. Global Status Report on Non-Communicable Diseases 2010. Geneva: World Health Organization; 2011.  Back to cited text no. 4
Labour.nic.in. Informal Sector in India: Approaches for Social Security. Available from: http://www.labour.nic.in/ss/Informalsector/In/India/Approaches/for/Social/Security/pdf. [Last accessed on 2017 Apr 30].  Back to cited text no. 5
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Liu Y, Song H, Wang T, Wang T, Yang H, Gong J, et al. Determinants of tobacco smoking among rural-to-urban migrant workers: A cross-sectional survey in Shanghai. BMC Public Health 2015;15:131.  Back to cited text no. 7
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  [Table 1], [Table 2], [Table 3]


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