A study of heart rate variability among khaini users: A form of smokeless tobacco in India

Background: Use of tobacco in cigarettes indeed represents a health concern of growing magnitude among cigarette smokers. As a consequence of its addictive qualities, the consumption of cigarettes often becomes a lifelong habit, with cumulative and deleterious effects on health. Smokeless tobacco has been advocated as a substitute for cigarette smoking. On the contrary, the use of smokeless tobacco is fraught with health risks and needs to be discouraged. Modernisation of life style has affected the population even in rural areas, leading to addiction. Smokeless tobacco is presumed to be less of an evil by the rural folk. Khaini addicts are likely to suffer from mental and physical exhaustion, leading to stress. Khaini is tobacco with slaked lime. This is important in view of the prevailing socio-economic as well as the healthcare system available in any developing country. Therefore, the present study is designed to measure the heart rate variability (HRV) among this special group of the population. Materials and Methods: Fifteen male subjects were enrolled from the rural farm labors′ population who regularly chew khaini. They were free from any type of physical and mental health issues and were non-smokers. A similar group of 15 male subjects anthropometrically matched, who did not chew khaini and did not use tobacco in any form, participated as controls. Each individual volunteer was subjected to an HRV analysis on three occasions: the first record was performed on the first day of their arrival in the hospital as subjects during the lean season. The second observation was recorded after 3 months. The final HRV analysis was performed after 6 months of the first recording. Two types of parameters were analyzed: time domain and frequency domain. Statistical analysis was performed using a paired t-test within the study group and the unpaired t-test between non-khaini chewing controls and subjects on Day 1 of the recording. Results: There was no statistically significant difference between the controls and the study group on Day 1 of recording. Both the HRV parameters - time and frequency domain, showed decreased values during the third month and sixth month recording as compared with the first week recording. The decrease is much more during the sixth month recording as compared with the third month recording. A statistically significant decrease is observed in the mean RR interval, heart rate, very large frequency and large frequency only when the first week recording is compared with the third month recording, but when the first week recording is compared with the sixth month recording, a significant decrease in the mean RR interval and heart rate is found. Conclusion: Subjects involved in taking khaini are likely to undergo a lot of physical and mental stress thus affecting their autonomic status. This adds up to the stress induced by their occupation. HRV analysis using short-term electrocardiogram recordings was used to detect changes consequent with this stress