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Smokeless tobacco use among online app-based cab drivers in Pune city and recommended measures for tobacco cessation from the literature

 Department of Research, Dr. D Y Patil Vidyapeeth, Pune, Maharashtra, India

Date of Submission22-Jan-2020
Date of Decision05-Mar-2020
Date of Acceptance24-Jun-2020

Correspondence Address:
Pradnya V Kakodkar,
Dr. D Y Patil Vidyapeeth, Pimpri, Pune, Maharashtra
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/mjdrdypu.mjdrdypu_25_20


Objective: The objective of this study is to assess the smokeless tobacco (SLT) use among online-app based cab drivers in Pune city and recommended measures for tobacco cessation from the literature. Materials and Methods: A descriptive, cross-sectional survey was conducted during February 2019 to October 2019 among the morning shift cab drivers in Pune city. A total of 360 drivers using SLT were recruited for the study. A standard checklist was used to collect the information such as the time of use of SLT, reasons for the use of SLT, and reason for the cessation of the habit. Approval was obtained from the Scientific and Institutional Ethics committee before starting. Results: Majority 62.8% (n = 226) of the drivers used SLT while driving, followed by 14.4% (n = 52) who preferred it only before driving and 8.9% (n = 32) used anytime during the day. Among the major reasons for the use of SLT, 80.3% (n = 289) reported it helps to improve concentration, whereas 67.5% (n = 243) used it under peer pressure. Participants (n = 90) declared that they have attempted to quit the habit and the main reason for quitting of the habit was burning sensation in the mouth among 64.4% (n = 58) followed 26.7% (n = 24) by self-motivation. Conclusion: This study serves as an evidence to plan and execute the cessation programs for the driver cohort by its company. It is proposed that the successful tobacco cessation measures from the literature can be implemented and evaluated for its effectiveness in the future studies.

Keywords: Drivers, health education, smokeless tobacco, tobacco cessation

How to cite this URL:
Kakodkar PV. Smokeless tobacco use among online app-based cab drivers in Pune city and recommended measures for tobacco cessation from the literature. Med J DY Patil Vidyapeeth [Epub ahead of print] [cited 2021 Nov 30]. Available from: https://www.mjdrdypv.org/preprintarticle.asp?id=321276

  Introduction Top

Online-app based cab service that makes hiring on demand private driver to pick you up and drop you to your destination with the tap of a button on any smartphone device is very popular service among commuters in Pune city. The cab drivers are provided with exceptional pay and even incentives on completing “X” number of rides in a week. It has been observed that the drivers sometimes need to slough out throughout the day and the night too, to earn that incentive.

Continuous driving can lead to boredom and stress. The driver profession exposes them to physical illness, mental illness, and addictions of habit-forming substances, especially tobacco.[1] Smokeless tobacco (SLT) is the cheapest, least taxed, and most commonly used tobacco product.[2] Auto rickshaw drivers and cab drivers are consistently seen to keep tobacco quid (“Mawa”) in their mouths to suppress their appetite and to have better concentration on the road while driving.[3] The continuous process of chewing tobacco elevates the mood and gives temporary relief from stress and anxiety which leads the person to use it frequently.[2] Further, they are found to use gutkha to cope with irregular meals.[4]

SLT products are a form of tobacco consumption without combustion or burning and are as addictive as cigarettes and can cause the same type of dependence which makes quitting SLT difficult.[2] Currently, about 5 million deaths per year are attributable to tobacco which is expected to rise to more than 8 million deaths a year by the year 2030.[5] Tobacco use is the largest preventable cause of death and disease. Literature reports beneficial outcome of the different interventions available for SLT cessation.[6]

A study by Shetty et al. among 450 cab drivers in Bengaluru city reported that 70.88% of cab drivers consumed tobacco; many taxi drivers opted to drive for longer hours and even during nighttime to achieve their target for incentives, and hence, this was one of the reasons for consuming tobacco; further, family members consuming tobacco was a significant factor for tobacco use and 48 drivers were also detected to have oral precancerous lesions.[7]

Rathi et al. in a cross-sectional study among 134 professional cab drivers from New Delhi reported that 32.8% drivers smoked tobacco and 27.6% used chewable tobacco.[1] This study gave more importance to mental health and also reported that small sample size was the limitation of their study.

A study by Arora et al.[8] reported the high usage of tobacco among auto rickshaw drivers. Since they comprise a subset of the population that have no organized health-care services targeted to them, on this basis, they recommended that auto drivers' union can form a platform to provide them with health education and tobacco cessation services. Based on this idea, the present study is undertaken, wherein the online app cab drivers who form a cohort and are controlled by the company can be helped to have a control of the tobacco use, monitor them regularly, and provide cessation services to them. Since they are connected by app, the mHealth tobacco control services can be provided to them.

As against this background, a study was conducted to assess the tobacco use among Uber car drivers in Pune City and recommend measures for tobacco cessation.

  Materials and Methods Top

A descriptive cross-sectional study was conducted in Pune city from February 2019 to October 2019. The study protocol was approved from the Scientific Committee and Institutional Ethics Committee (DYPDCH/IEC/1262/52/19). The author of the study used online app-based cab for commuting to the office. Hence, a cab was booked by the investigator from a specific location of Pune and it was taken to the desired destination. Those drivers who had the habit of using SLT were recruited for the survey. Informed consent of cab driver was obtained, and they were interviewed with the help of the reference questionnaire.[9] The interview was approximately for 5–7 min. This survey was conducted among the morning shift drivers. The data were compiled, and descriptive statistics in the form of number and percentage were calculated.

  Results Top

A total of 360 cab drivers having the habit of consuming SLT were interviewed. The age of the drivers ranged from 24 to 55 years. [Table 1] reports the number and percentage of participants with regard to the time of use of SLT, reasons for the use of SLT, and reason for cessation of the habit. The time of use of SLT indicates that the majority of the drivers used it while driving (62.77%), followed by only before driving (14.4%) and anytime during the day (8.8%). Among the major reasons for the use of SLT, majority (80.3%) reported it helps to improve concentration and also it was for the reason of peer pressure (67.5%). Ninety participants declared that they have attempted to quit the habit and the main reason for quitting the habit was burning sensation in the mouth (64.44%) followed by self-motivation (26.7%).
Table 1: Smokeless tobacco use among the cab drivers of Pune city in the year 2019 (n=360)

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  Discussion Top

Dependence on various addictive substances is rampant in this fast-paced world to cope with the day-to-day pressures of life, and SLT is one of the most prevalent addictions in India due to its easy availability.[3]

The present study was conducted among the morning shift drivers. However, the prevalence was not calculated. Four studies reported in the literature on the use of SLT among cab drivers indicate varying the prevalence of 27.6%,[1] 64%,[10] 70.88%,[4] and 85.57%,[11] respectively, and those with the higher prevalence indicate they were night shift drivers. As, it is reported that the night shift drivers account higher use of tobacco to improve concentration and to reduce sleepiness.[1]

A systematic review[6] on the SLT tobacco cessation interventions showed that behavioral intervention has maximum benefit (8%–58%). It includes Quitlines, personalized telephone call (motivational interviewing) and oral examination, telephone support, mHealth services, minimal advise, peer led sessions, self-help manual, and self-help videos. Further, behavior intervention with nonnicotine therapy showed 10%–15% quit rate and behavioral intervention with nicotine replacement therapy showed quit rate of 7%–53%. Interventions at the worksite and in the community are the powerful ways to modify the risk profiles of populations. The use of support groups or peer groups at work along with health promotion by higher management may be useful in curbing smoking habits of people.[12]

Community activity for tobacco cessation among the cab drivers is minuscule. There is only one report which details tobacco cessation program for the cab drivers. Here, 400 cab drivers in Mumbai were enrolled in a program and offered health education, oral cancer screening, and tobacco cessation assistance at regular intervals over a year. Surprisingly, 32% of cab drivers had quit tobacco by the end of 9 months and 36% cab drivers had reduced their tobacco consumption.[10] The study results indicate that if the drivers are given health education and motivation, they are likely to quit the habit.

Similarly, a study[5] among bus drivers and conductors in Western Uttar Pradesh where the prevalence of tobacco use was found to be 77.9% revealed that, addiction level for tobacco is very high, and they want to quit this habit but unable to quit in the absence of any guidance and counselling. It was recommended that repeated awareness programs should be conducted to make them aware about the ill effects.

Against this background, it becomes imperative that it is time the SLT habit among the cab drivers needs to be given special attention. The following recommendations can be considered as taken from the literature review: To set minimum working hours for the cab drivers, to develop tobacco cessation centers, especially for the cab drivers to initiate collaboration with few dentist in the city and earmark them for providing tobacco cessation services to the cab drivers. Just as the policy of car inspection, the driver should also undergo medical fitness and oral examination every year; “Tobacco free cab:” The driver should be informed not to use tobacco while driving, health educating the cab drivers about the quit lines and motivating them to use it and daily message service to the drivers on their mobiles to motivate them to quit the habit.

This study may have a few limitations. This is a preliminary study and may not add any new information to the literature. However, with no reported data on cab drivers, this study serves as an evidence to plan and execute cessation programs for the driver cohort by the company. The results of this study are limited to the app driven morning shift cab drivers of Pune city only.

  Conclusion Top

There is very little literature about cab drivers and their tobacco habit in general and tobacco cessation activities in particular. The results of the present study indicate that the main reason for SLT use is the concentration followed by peer pressure. It is also reported that the drivers use SLT while driving. Further, it is proposed that the study results should be considered as a baseline data and recommendations from the literature can be implemented and evaluated for its effectiveness in the future studies.

Financial support and sponsorship


Conflicts of interest

There are no conflicts of interest.

  References Top

Rathi A, Kumar V, Singh A, Lal P. A cross-sectional study of prevalence of depression, anxiety and stress among professional cab drivers in New Delhi. Indian J Occup Environ Med 2019;23:48-53.  Back to cited text no. 1
[PUBMED]  [Full text]  
ENVIS – NIOH. Available from: http://niohenvis.nic.in/newsletters/vol4_no2_Smokeless_tobacco.pdf. [Last accessed on 2019 Nov19].  Back to cited text no. 2
Patel PM, Rupani MP, Gajera AN. Dependence on smokeless tobacco and willingness to quit among patients of a tertiary care hospital of Bhavnagar, Western India. Indian J Psychiatry 2019;61:472-9.  Back to cited text no. 3
[PUBMED]  [Full text]  
Ankola AV, Angade PS, Hebbal MI, Ansingh PM. Behavioural assessment of Gutkha chewers amongst adolescent and young working male Population of Belgaum City, Karnataka State, India. EC Dent Sci 2018;17:2136-44.  Back to cited text no. 4
Parashari A, Ahmad S, Asthana S, Saxena S. Tobacco use among drivers and conductors in Western Uttar Pradesh, India. Indian J Comm Health 2017;29:301-7.  Back to cited text no. 5
Nethan ST, Sinha DN, Chandan K, Mehrotra R. Smokeless tobacco cessation interventions: A systematic review. Indian J Med Res 2018;148:396-410.  Back to cited text no. 6
[PUBMED]  [Full text]  
Shetty P, Khargekar NC, Debnath A, Khargekar NR, Srivastava BK, Hakeen NE. Determinants of tobacco use and prevalence of oral precancerous lesions in cab drivers in Bengaluru City, India. Int J Prev Med 2017;8:100.  Back to cited text no. 7
[PUBMED]  [Full text]  
Arora P, Kaur G, Khokar A, Jindal AK. Prevalence and pattern of tobacco use among auto rickshaw drivers of South Delhi: A cross-sectional study. Int J Community Med Public Health 2018:5:3464-8.  Back to cited text no. 8
Selvananthan S, Sivaganesh S, Vairavanathan S, Surenthirakumaran R, Balakumar S. Betel chewing among bus drivers in Jaffna district. Ceylon Med J 2018;63:68-71.  Back to cited text no. 9
Mishra GA, Pimple SA, Majmudar P, Kulkarni VV. Smoke free cabs: Assessment of impact on cab drivers and commuters; and tobacco cessation for cab drivers. Occup Environ Med 2018;75:A310-1.  Back to cited text no. 10
Baluja A, Ghosh A, Pal R, Menon GR, Bhoi S, Galwankar SC, et al. Occupational profile of taxi drivers from three metropolitan cities in India. Int J Acad Med 2018;4:119-23.  Back to cited text no. 11
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Mishra GA, Kulkarni SV, Majmudar PV, Gupta SD, Shastri SS. Community-based tobacco cessation program among women in Mumbai, India. Indian J Cancer 2014;51 Suppl 1:S54-9.  Back to cited text no. 12


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