Smokeless tobacco consumption among public and heavy load drivers in Karachi, Pakistan: A cross-sectional study

Tobacco use remains a major cause of preventable morbidity and mortality worldwide. The World Health Organization states that 19.1% of the Pakistani population consumes smoked or smokeless tobacco (SLT). Although many population focused studies have focused on the use of SLT in Pakistan, but they have failed to address the use of SLT among laborers, especially the niche population of public and heavy load drivers (that is, transporters). This study aimed to estimate the prevalence of SLT consumption among this population and the relationship of this parameter with knowledge, attitudes, and practices regarding SLT use. From a sample size of 714 participants, 615 responses were obtained, generating an overall response rate of 86%. The prevalence of SLT consumption in the study population was 93.7%; here, gutka was the most frequently consumed preparation (60.2%), followed by naswar (35.8%), paan (32.4%), and Mawa (16.7%). A masticatory habit was the most commonly cited factor leading to dependence (87.8%), followed by the influence of friends and family (83.9%), peer pressure (80.7%), and increased alertness (52.8%). However, 61.3% of participants reported experiencing strong withdrawals upon ceasing SLT use and believed themselves to be addicted and unable to quit usage. These findings suggest that for transporters, a high-risk occupational group dependent on SLT consumption, specific, tailored tobacco-cessation programs and medical assistance are needed to reduce the burden of tobacco-related morbidity and mortality. Key words: Smokeless tobacco (SLT), tobacco use, gutka, heavy load and public drivers, transporters, Karachi.