Gender-based tobacco policies in Bangladesh and India: A prerequisite to counter the smokeless tobacco epidemic

Predictors of smokeless tobacco use among the adult population of north-east India during 2009-2017: A decomposition analysis

Background & objectives

Contrary to overall declining trend in smokeless tobacco (SLT) use in India, an increase is observed in north-east (NE) India. This study examined the predictors of daily SLT use by gender and assessed the demographic and socio-economic characteristics that contribute to gender differences in SLT use in NE India.

Methods

Data collected from 15,259 and 13,574 adults in the two rounds of Global Tobacco Adult Survey 1 and 2 for NE India during 2009-2010 and 2016-2017 were analyzed. Relative change, multivariable binary logistic regression and Blinder-Oaxaca decomposition analysis were used for analysis.

Results

The findings suggest that among women in NE India, the daily SLT use significantly increased by 58 per cent between 2009-2010 to 2016-2017. Women residing in Nagaland, Manipur, Mizoram and Tripura were 3.5 and 2.5 times, respectively more likely to be daily SLT users compared to those in Assam. While age, education and wealth were the significant predictors of SLT use in both women and men, increased odds of SLT use were observed with women's type of occupation and the State of residence. The majority of the gender differences in daily SLT use was explained by differences in work status (44%), age (26%), education (14%) and wealth status (9%) between men and women.

Interpretation & conclusions

Increasing prevalence of SLT use amongst women in the NE States necessitates integration of gender-specific messages on harmful effects of SLT in the ongoing tobacco control programmes and development of culturally appropriate community-based interventions for cessation of SLT use.

"So what if I use tobacco or alcohol? It won't hurt me!" How women perceive substance use: insights from a community study in India

To explore the subjective perceptions of women from rural and urban communities in Bangalore, India, regarding their perspectives about addictive substance use (ASU), and the interventions/support they need to quit use. Based on the data collected, the goal of this study was to develop an intervention that would address the women's needs. Mixed methods were used as follows: (a) door-to-door survey of women (N = 2044) regarding their use of addictive substances, and (b) focus group discussions with the women to explore their perceptions. Interviews were transcribed verbatim, themes and sub-themes identified. More than one-third (32.7%) reported past 3-month ASU, with majority reporting smokeless tobacco products (82.6%). Alcohol use was reported by 17.4%. Four major themes (with sub-themes) were identified from the focus group discussions: (1) Patterns of use (oral tobacco products-kaddipudi, thambaku; alcohol), (2) Reasons for use (to relieve stress and forget problems, tobacco use as a way of life, for postnatal benefits, due to easy availability, to reduce fatigue and pain, indigestion, hunger), (3) Low risk perception related to ASU ("We know how to use tobacco safely", "No real harm from tobacco"), and (4) Issues related to quitting ASU and help-seeking (unwillingness to quit, methods of intervention- "videos, or tablets/injections to help us quit ASU"). The findings highlight challenges involved in the development of effective interventions for women. Additionally, there is a clear need for broader community agencies to address psychological, cultural, and social dimensions.

Declining trends in smokeless tobacco use among Indian women: findings from global adult tobacco survey I and II

BACKGROUND

Smokeless Tobacco (SLT) use is culturally rooted and more acceptable among women in India. SLT is a significant risk for oral cancers and has other adverse health outcomes on women's general as well as reproductive health. This study aimed to estimate and compare the prevalence and correlates of SLT among adult females in India using Global Adult Tobacco Survey (GATS), 2009-2010 (GATS 1) and 2016-2017 (GATS 2).

METHODS

Data from a nationally representative cross-sectional study GATS 1 (n = 35,529) and GATS 2 (n = 40,265) were analysed for adult female smokeless tobacco users. Correlates of SLT exposure were assessed separately using binary logistic regression. Multivariable logistic regression analysis was done for the variables which computed p < 0.1. The association was expressed as Adjusted Odds ratio with 95% confidence intervals.

RESULTS

There was a reduction in prevalence of SLT use among women in India between GATS 1 (18.4%) and GATS 2 (12.8%). SLT use was highest among the North-Eastern women in both rounds [AOR: 4.567 (3.942-5.292) during GATS-1 and 9.149 (7.722-10.839) during GATS-2]. Odisha had highest prevalence of 56.53% while Himachal Pradesh had lowest 0.14% during the recent GATS 2 survey. 33.3% vs. 34.80% of the participants were willing to quit tobacco in Central region across both rounds of survey.

CONCLUSIONS

Although, smokeless tobacco prevalence among females has reduced between 2009 and 2016 in India, yet tobacco control strategies need further pace. Hence, more focused gender-based tobacco control programs and policies are the need of time.

Snus users had high levels of nicotine, cotinine and 3-hydroxycotinine in their breastmilk, and the clearance was slower than in smoking mothers

AIM

Using snus, an oral moist tobacco, has increased among pregnant women in Sweden, the only European Union country where sales are legal. This study evaluated whether snus generated similar concentrations of nicotine and its metabolites in breastmilk to cigarette smoking.

METHODS

We analysed 49 breastmilk samples from 33 nursing mother - 13 snus users, six cigarette smokers and 14 controls - for concentrations of nicotine, cotinine and 3-hydroxycotinine. The mothers were recruited at antenatal clinics in Sweden from 2007 to 2012.

RESULTS

The median nicotine concentration in breastmilk of the snus users was 38.7 ng/mL (0-137) versus 24.0 ng/mL (0-56) in smokers, with median cotinine levels of 327.6 ng/mL (37-958) versus 164.4 ng/mL and median 3-hydroxycotinine levels of 202.7 ng/mL (28-452) versus 112.4 (0-231), respectively. Nicotine was still detected in the breastmilk of eight of the 13 snus users after abstaining from tobacco for a median duration of 11 hours (0.6-12.5), while the breastmilk of the smokers was nicotine-free after four hours' abstinence.

CONCLUSION

Snus users had high levels of nicotine and metabolites in their breastmilk and nicotine was found even after 12.5 hours of abstinence.