predictors of tobacco smoking and chewing are poorly understood. The existing studies on the prevalence of tobacco use are based on non-representative sample surveys or have been conducted in localised—mostly urban—geographical areas as reviewed. WHO estimated a prevalence of tobacco consumption of all forms at 65% and 33%, respectively, among men and women, based on small scale studies conducted in the past. [2,3] Smokeless tobacco users appear to have more gingival recession at facial sites than non-users, this finding corresponds to the location in the mouth where the smokeless tobacco lesions occurred and to where the tobacco was placed. Studies suggest that recession increased within one year in smokeless tobacco users. Oral cancer includes all cancers of the lips, tongue, gingiva, and all of the oral mucosa and oropharynx.[4]_. According to the world health organization (WHO), During nearly the past two decades, overall global tobacco use has fallen, from 1.397 billion in 2000 to 1.337 billion in 2018, or by approximately 60 million people, according to the WHO global report on trends in the prevalence of tobacco use 2000-2025 third edition. This has been largely driven by reductions in the number using these products (346 million in 2000 down to 244 million in 2018, or a fall over around 100 million). Over the same period, male tobacco use had risen by around 40 million, from 1.050 billion in 2000 to 1.093 billion in 2018 (or 82% of the world’s current 1.337 billion tobacco users). By 2020, WHO projects there will be 10 million fewer tobacco users, male and female, compared to 2018, and another 27 million less by 2025, amounting to 1.299 billion. Some 60% of countries have been experiencing a decline in tobacco use since 2010.[5] NICPR-ICMR report-2018, The use of SLT products, which include pan masala, gutkha and khaini, is a serious public health issue in India and the region. Globally there are nearly 36 crore SLT users. It said that around 80 per cent of these live in South-East Asia and 66 per cent in India and according to the latest Global Adult Tobacco Survey India Report nearly 20 crore Indians use SLTs. A 2010 study estimated that more than 36,8000 deaths were attributable to smokeless tobacco use in the country.[6].

the result was 0.78 and the reliability of attitude scale was analysed by using Cronbach alfa method it was 0.82.

Scoring Criteria

Section B

• The maximum score is 32
• Each Correct response gets 1
• Each Incorrect response gets a zero

Table 1: Scoring criteria for knowledge score.

Section C 

Table 2: Scoring criteria of attitude score.

Association of the level of attitude with selected demographic variables among people in early adulthood

The Chi-square test was carried out to determine the association between the Attitude score with selected demographic variables such as age, religion, education, monthly income, type of family and any one of the family members who are having the habit of using tobacco.

There is no significant association between the attitude of people in early adulthood and demographic variables such as age in years (χ2=10.00), religion (χ2=3.88) and educational status (χ2=4.17) are not significant at a 0.05 level of significance. Hence hypothesis H0₂ is rejected and null hypothesis H₂is accepted.

There is a significant association between the attitude of people in early adulthood and demographic variables such as monthly income (χ2= 20.36), type of family (χ2=24.41), and family members using tobacco (χ2= 16.38), at 0.05 level of significance. Hence hypothesis H₂ is accepted and null hypothesis H₀₂ is rejected.

Finding related to Correlation between knowledge and attitude of people of early adulthood.

DF- Degree of freedom =58

Level of significance=0.05

It evidenced that for the correlation between knowledge and attitude calculated value of Karl Pearson's correlation coefficient is 0.17 and the tabulated value of the correlation coefficient is 0.250 for df 58 at a 0.05 level of significance.

So the researcher accepts the null hypothesis and rejects the research hypothesis.

Dikshit M et al (2012) did a study under the title, Risk for oral cancer associated with smoking, smokeless and oral dip products. In a case-control study of 350 cases and 350 control, the frequency of smoking, smokeless and oral dip products in cases were significantly higher than in controls (P < 0.0001). Among smoking types, bidi (P < 0.0001, OR = 4.1 95% CI = 2.4-6.9), or smokeless types, chewing tobacco (P < 0.0001, OR = 8.3, 95% CI = 5.4-13.0) and oral dip products, consumption  of  gutkha  (P  <  0.0001,  OR  =  12.8,  95%  CI  =  7.0-23.7)  indicated  strong association with oral cancer.[12].

Sardana S (2011) conducted the study under the title Age of initiation & prevalence of tobacco use among school children. Data on tobacco use were collected from 4786 students of classes 7 to 12 (age: 11-19 years) studying in different private and government schools. Any kind of tobacco use was found in 537 (11.2%) students; 419 (8.8%) were ‘ever smokers’ 219 (4.6%) were tobacco chewers, 179 (3.7%) were ‘exclusive smokers’ and 118 (2.5%) were ‘exclusive tobacco chewers’. Around 12.4 years more than 50% of tobacco chewers reported use of khaini at least once.[13].

Mirza SS et al (2011) Pakistan did his study on Areca nut chewing and dependency syndrome:  is the dependence comparable to smoking?  We carried out a final analysis on  851  individuals,  of which  36.8% (n=314)  were areca nut users,  28.4%(n=242) were the chewers of areca with tobacco additives and 34.7%(n=295) were regular cigarette smokers. Dependency syndrome (OR = 2.17, 95%CI 1.39-3.40) while cigarette smokers were eight times more likely to have dependency syndrome as compared to areca nut only users.[14].

Sarawat N et al (2020) have conducted a study on the objective of this integrative review is to synthesize existing evidence regarding oral cancer-related knowledge, attitudes and practices of GPs in developed countries.” A total of 21 studies involving 3409 GPs were reviewed. Most studies revealed limited knowledge of GPs about emerging risk factors, such as betel nut chewing (0.8-50%). Significant variation (7-70%) was evident in routine oral examination practices of GPs. Most GPs felt unsure about diagnosing oral cancer and many (38-94%) raised the need for further education. No study explored the specific relevance of GPs' practices concerning South Asian immigrants.[15].

packets among patients attending the outpatient department. It was a cross-sectional study conducted among 419 patients through convenience sampling, using a structured close-ended questionnaire containing 35 questions. Out of a total of 419 participants, 62.8% were tobacco users. About 40.6% of the participants had average knowledge and only 22.9% had a positive attitude regarding the pictorial warnings. Nearly 77.9% of tobacco users had previously attempted decreasing the frequency of tobacco use and 63.7% had tried quitting the habit. The difference was statistically significant (P < 0.05 Chi-square test and ANOVA).[19].

Shetty K V (1999) conducted his study to assess the knowledge, attitudes and beliefs of South Asian adults (n = 367) regarding the risk factors and signs for oral cancer. Tobacco use was the only risk factor correctly identified by most adults (82%). A significant difference (P < 0.001) was seen in the betel-quid chewing habit among the age groups with 42.2% of adults in the 50-80 year age group practising this habit as compared to only 5.3% in the 16-29 year age group. Another finding was that the traditional method of betel-quid chewing is being replaced with readily available processed areca nut and tobacco products.[20].

Jayant K et al (1991) did a study of knowledge, attitude and practice concerning tobacco usage in school children. A study was conducted on 1278 boys and 353 girls studying in the final year in various schools. The proportion of boys given to one or the other form of tobacco usage (including experimenters/triers) was significantly higher in private English medium schools (22.5%) compared to private Indian language schools (6.9%) or municipal Indian language schools (13.8%). There was also a significant difference between the two types of Indian schools. Girls from only Indian language schools were entered into the study and the proportion of tobacco users in them was very low (1.1%).[21].