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Itumalla R, Khatib MN, Gaidhane S, Zahiruddin QS, Gaidhane AM, Neyazi A, Hassam AF, Satapathy P, Rustagi S, Kukreti N, Padhi BK. Smokeless tobacco consumption among women of reproductive age: a systematic review and meta-analysis. BMC Public Health 2024; 24:1361. [PMID: 38769491 PMCID: PMC11106917 DOI: 10.1186/s12889-024-18840-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2023] [Accepted: 05/13/2024] [Indexed: 05/22/2024] Open
Abstract
Smokeless tobacco (SLT) poses many negative health impacts. Despite its longstanding presence in societies across the world, the health implications of SLT have only been rigorously studied in recent decades. This systematic review and meta-analysis aimed to consolidate existing research to provide a comprehensive understanding of the global prevalence of SLT use among women of reproductive age. Relevant articles were extracted from databases such as PubMed, EMBASE, Web of Science, and Scopus from their inception until November 11, 2023. Observational studies reporting the number of SLT users among women of reproductive age were included. The quality of the studies was assessed using the Joanna Briggs Institute (JBI) tool. The meta-analysis used a random-effects model to determine SLT prevalence, supported by statistical tools like forest plots, I2 statistics, and sensitivity analyses to ensure the accuracy and comprehensiveness of the results. All statistical analyses were performed in R version 4.3. From 10 studies involving 2,053,667 participants, a pooled prevalence for SLT use among women of reproductive age was found to be 9.3% (95% CI: 0.038 to 0.21), with significant heterogeneity among studies (I2 = 100%). Publication bias was suspected among the studies. Sensitivity analysis and subgroup analysis couldn't resolve the heterogeneity. Our analysis shows a significant prevalence of SLT use in women of reproductive age, especially in low socioeconomic and developing countries like India, Pakistan, and Nepal. For women of reproductive age, the use of smokeless tobacco (SLT) can lead to infertility, pregnancy complications, and adverse fetal outcomes, including low birth weight and preterm birth. The results highlight the necessity for specific public health measures and policy changes to decrease SLT consumption among reproductive-age women. Further studies are needed to investigate the reasons behind SLT usage in this group and to assess the impact of intervention strategies, to guide more effective public health initiatives and policies.
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Affiliation(s)
- Ramaiah Itumalla
- School of Management, The Apollo University, Chittoor, 517127, Andhra Pradesh, India
| | - Mahalaqua Nazli Khatib
- Division of Evidence Synthesis, Global Consortium of Public Health and Research, Datta Meghe Institute of Higher Education, Wardha, India
| | - Shilpa Gaidhane
- One Health Centre (COHERD), Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education, Wardha, India
| | - Quazi Syed Zahiruddin
- South Asia Infant Feeding Research Network (SAIFRN), Division of Evidence Synthesis, Global Consortium of Public Health and Research, Datta Meghe Institute of Higher Education, Wardha, India
| | - Abhay M Gaidhane
- Jawaharlal Nehru Medical College, and Global Health Academy, School of Epidemiology and Public Health, Datta Meghe Institute of Higher Education, Wardha, India
| | - Ahmad Neyazi
- Afghanistan Center for Epidemiological Studies, Herat, Afghanistan.
- Scientific Affairs, Herat Regional Hospital, Herat, Afghanistan.
| | | | - Prakasini Satapathy
- Center for Global Health Research, Saveetha Institute of Medical and Technical Sciences, Saveetha Medical College and Hospital, Saveetha University, Chennai, India
- Medical Laboratories Techniques Department, AL-Mustaqbal University, Hillah, Babil, 51001, Iraq
| | - Sarvesh Rustagi
- School of Applied and Life Sciences, Uttaranchal University, Dehradun, Uttarakhand, India
| | - Neelima Kukreti
- School of Pharmacy, Graphic Era Hill University, Dehradun, India
| | - Bijaya Kumar Padhi
- Department of Community Medicine, School of Public Health, Postgraduate Institute of Medical Education and Research, Chandigarh, 160012, India
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Czaplicki L, Saraf S, Kroart L, Rasheduzzaman ABM, Islam MS, Cohen JE. Standard smokeless tobacco packaging: potential impact on perceived attractiveness, warning label visibility and harm perceptions among adults in Bangladesh. Tob Control 2024; 33:353-359. [PMID: 36316153 DOI: 10.1136/tc-2022-057597] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Accepted: 10/07/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND In Bangladesh, smokeless tobacco (SLT) is available in a variety of pack shapes and sizes. Lack of standard packaging could limit compliance with pictorial health warning label (HWL) requirements. We explored Bangladeshi SLT users' and non-users' perceptions of a proposed standard pack shape for gul (tobacco powder) and zordha (chewing tobacco), including the role that HWL placement plays on harm perceptions. METHODS We conducted 28 focus groups across three regions of Bangladesh: Dhaka, Sylhet and Khulna. Groups were stratified equally by urban/rural residence, gender and SLT use. Trained facilitators used a standardised guide to discuss perceived attractiveness, noticeability of HWLs and perceived harm of current versus standard packs. RESULTS Most groups found bright colours, 'brand owner' portrait imagery, and strong, sturdy pack material of current packs attractive. Many of the same features increased perceived attractiveness of the standard packs. Pictorial HWLs on the standard packs appeared larger and increased the visibility and noticeability of HWLs compared with current packs. Lack of HWLs or limited visibility of HWL due to discolouration contributed to lower levels of perceived harm of the current packs. In contrast, HWL prominence and placement on both sides of the standard pack increased perceived harm of standard packs. CONCLUSION The findings suggest a standard shape and size for SLT sold in Bangladesh, coupled with proper implementation of HWLs per the law, could improve HWL noticeability and increase harm perceptions. Additional plain packaging policies that also standardise pack colour may be required to reduce attractive colours and branding.
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Affiliation(s)
- Lauren Czaplicki
- Institute for Global Tobacco Control, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Sejal Saraf
- Institute for Global Tobacco Control, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Laura Kroart
- Department of Health, Behavior and Society, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | | | | | - Joanna E Cohen
- Institute for Global Tobacco Control, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
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Banu B, Khan MMH, Ali L, Barnighausen T, Sauerborn R, Souares A. Pattern and predictors of non-adherence to diabetes self-management recommendations among patients in peripheral district of Bangladesh. Trop Med Int Health 2024; 29:233-242. [PMID: 38221661 DOI: 10.1111/tmi.13966] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2024]
Abstract
OBJECTIVES This study was designed to determine the extent of non-adherence to the different dimensions of diabetes self-management and to identify the factors influencing non-adherence among peripheral patients in Bangladesh. METHODS A cross-sectional study was conducted among 990 adult diabetic patients residing in Thakurgaon district, Bangladesh. Data were collected through face-to-face interviews including socio-demographic information, disease and therapeutic, health services, knowledge and adherence to self-management components. RESULTS The proportion of non-adherence to drug prescription was 66.7%, dietary regimen (68.9%), physical exercise (58.0%), follow-up visit/blood glucose test (88.2%), stopping tobacco (50.6%), and regular foot care (93.9%). Significant predictors for non-adherence to drug were poorest socio-economic status (OR = 2.47), absence of diabetic complications (OR = 1.43), using non-clinical therapy (OR = 5.61), and moderate level of knowledge (OR = 1.87). Non-adherence to dietary recommendations was higher for women (OR = 1.72), poorest socio-economic status (OR = 3.17), and poor technical knowledge (OR = 4.68). Non-adherence to physical exercise was lower for women (OR = 0.62), combined family (OR = 0.63), middle socio-economic status (OR = 0.54), and moderate knowledge on physical exercise (OR = 0.55). Non-adherence to follow-up visits/blood glucose test was higher among patients who did not have diabetic complications (OR = 1.81) and with own transport (OR = 2.57), and respondents from high-income group (OR = 0.23) were less likely to be non-adherent. Non-adherence to stopping tobacco was higher for older individuals (OR = 1.86); but lower for women (OR = 0.48), individuals with higher education level (OR = 0.17) and patients sick for a longer time (OR = 0.52). Non-adherence to foot care was higher for patients who needed longer time to go to hospital (OR = 4.07) and had poor basic knowledge on diabetes (OR = 17.80). CONCLUSION An alarmingly high proportion of diabetic patients did not adhere to diabetes self-management. Major predictors for non-adherence were related to patient's demographic characteristics and their experience with disease, treatment and health care services.
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Affiliation(s)
- Bilkis Banu
- Heidelberg Institute of Global Health, Heidelberg University Hospital, Heidelberg, Germany
- Department of Public Health, Northern University Bangladesh, Dhaka, Bangladesh
| | | | - Liaquat Ali
- Pothikrit Institute of Health Studies, Dhaka, Bangladesh
| | - Till Barnighausen
- Heidelberg Institute of Global Health, Heidelberg University Hospital, Heidelberg, Germany
| | - Rainer Sauerborn
- Heidelberg Institute of Global Health, Heidelberg University Hospital, Heidelberg, Germany
| | - Aurélia Souares
- Heidelberg Institute of Global Health, Heidelberg University Hospital, Heidelberg, Germany
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Naznin E, George J, Driezen P, Palazzi K, Wynne O, Nargis N, Fong GT, Bonevski B. Trend over time on knowledge of the health effects of cigarette smoking and smokeless tobacco use in Bangladesh: Findings from the International Tobacco Control Policy Evaluation Bangladesh Surveys. Drug Alcohol Rev 2023; 42:1838-1849. [PMID: 37565295 PMCID: PMC11031133 DOI: 10.1111/dar.13735] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Revised: 07/04/2023] [Accepted: 07/26/2023] [Indexed: 08/12/2023]
Abstract
INTRODUCTION Cigarette smoking and smokeless tobacco (ST) use are prevalent in Bangladesh. This longitudinal study examined how knowledge of the health effects of smoking and ST use in Bangladesh has changed overtime with the country's acceleration of tobacco control efforts. METHODS Data were analysed from the International Tobacco Control Survey, a nationally representative longitudinal study of users and non-users of tobacco (aged 15 and older) in Bangladesh, across four waves conducted in 2009 (n = 4378), 2010 (n = 4359), 2012 (n = 4223) and 2015 (n = 4242). Generalised estimating equations assessed the level of knowledge about harms of tobacco use across four waves. Multivariable logistic regressions assessed whether knowledge of health effects from cigarette smoking and ST use in 2015 differed by user group. RESULTS In 2015 survey, most tobacco users were aware that cigarette smoking causes stroke (92%), lung cancer (97%), pulmonary tuberculosis (97%) and ST use causes mouth cancer (97%) and difficulty in opening mouth (80%). There were significant increases in the total knowledge score of smoking related health harm from 2010 to 2012 (mean difference = 0.640; 95% confidence interval [CI] 0.537, 0.742) and 2012 to 2015 (mean difference = 0.555; 95% CI 0.465, 0.645). Participants had greater odds of awareness for ST health effects from 2010 to 2015. DISCUSSION AND CONCLUSIONS The results suggest that increasing efforts of awareness policy interventions is having a positive effect on tobacco-related knowledge in Bangladesh. These policy initiatives should be continued to identify optimal methods to facilitate behaviour change and improve cessation of smoking and ST use.
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Affiliation(s)
- Eva Naznin
- Research higher degree, School of Medicine and Public Health, The University of Newcastle, University Drive Callaghan, NSW 2308, Australia
| | - Johnson George
- Senior lecturer, Centre for Medicine Use and Safety, Monash University, 381 Royal Parade, Parkville, Victoria 3052, Australia
| | - Pete Driezen
- Research Assistant Professor, Department of Psychology, University of Waterloo, 200 University Avenue West, Waterloo, Ontario N2L 3G1, Canada
| | - Kerrin Palazzi
- Senior Statistician, Hunter Medical Research Institute (HMRI), Lot 1, Kookaburra Circuit, New Lambton Heights, NSW 2305, Australia
| | - Olivia Wynne
- Health Research Economist, Hunter Medical Research Institute (HMRI), Lot 1, Kookaburra Circuit, New Lambton Heights, NSW 2305, Australia
| | - Nigar Nargis
- Senior Scientific Director, Surveillance and Healthy Equity Science. American Cancer Society, 555 11th Street NW suite 300, Washington DC, 20004
| | - Geoffrey T. Fong
- Professor, School of Public Health Sciences, University of Waterloo, 200 University Avenue West, Waterloo, Ontario N2L 3G1, Canada
| | - Billie Bonevski
- Professor and Lead of Public Health, Flinders Health and Medical Research Institute, College of Medicine and Public Health, Flinders University, Sturt Road, Bedford Park, Adelaide 5042, Australia
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Sarker MHR, Moriyama M, Sujon H, Rahman MM, Banu S, Chisti MJ, Ahmed T, Faruque ASG. Smokeless tobacco consumption and its association with risk factors of chronic kidney disease in rural and peri-urban Bangladesh. Tob Induc Dis 2023; 21:138. [PMID: 37869615 PMCID: PMC10588374 DOI: 10.18332/tid/171358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Revised: 08/07/2023] [Accepted: 08/17/2023] [Indexed: 10/24/2023] Open
Abstract
INTRODUCTION Compared to smoking, which has major consequences in chronic kidney disease (CKD) initiation and progression, smokeless tobacco (SLT) consumption is considered to have fewer health consequences. We investigated the prevalence of SLT consumption and its association with risk factors of CKD in a rural and peri-urban Bangladeshi population. METHODS Using random sampling we recruited 872 adults in 2020, from the Mirzapur Demographic Surveillance System of Bangladesh, who had resided in the area for at least five years. Interviews using a semi-structured questionnaire, physical examination and anthropometric measurements were done, followed by blood and urine testing. The blood and urine tests were repeated in selected participants after three months as per the CKD Epidemiology Collaboration equation. RESULTS The prevalence of SLT consumption was 29%. Being aged ≥46 years (OR=7.10; 95% CI: 4.79-10.94), female (OR=1.64; 95% CI: 1.21-2.22), housewife (OR=1.82; 95% CI: 1.35-2.45), farmer (OR=1.71; 95% CI: 1.06-2.76), widow (OR=3.40; 95% CI: 2.24-5.17), and having no formal schooling (OR=4.91; 95% CI: 3.59-6.72), family income of <$100/month (OR=1.66; 95% CI: 1.13-2.43), sleeping duration <7 hours per day (OR=2.33; 95% CI: 1.70-3.19), were associated with a significantly higher odds of SLT consumption. However, being aged 31-45 years (OR=0.25; 95% CI: 0.16-0.38) had significantly lower odds of being an SLT consumer. Among the diseases investigated, undernutrition (OR=1.63; 95% CI: 1.15-2.33), hypertension (OR=1.52; 95% CI: 1.13-2.05), anemia (OR=1.94; 95% CI: 1.39-2.71) and CKD (OR=1.62; 95% CI: 1.15-2.27) were significantly associated with SLT consumption. In the multivariable analysis, being aged 31-45 years (AOR=3.06; 95% CI: 1.91-4.90), ≥46 years (AOR=15.69; 95% CI: 4.64-53.09) and having no formal schooling (AOR=2.47; 95% CI: 1.72-3.55) were found to have a significant association with being an SLT consumer. CONCLUSIONS SLT consumption is associated with most of the established risk factors of CKD within the studied population.
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Affiliation(s)
- Mohammad H R Sarker
- Technical Training Unit, International Centre for Diarrheal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - Michiko Moriyama
- Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Hasnat Sujon
- Technical Training Unit, International Centre for Diarrheal Disease Research, Bangladesh, Dhaka, Bangladesh
- Directorate General of Health Services, Ministry of Health and Family Welfare, Dhaka, Bangladesh
| | - Md M Rahman
- Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Shakila Banu
- Technical Training Unit, International Centre for Diarrheal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - Mohammod J Chisti
- Nutrition and Clinical Services Division, International Centre for Diarrheal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - Tahmeed Ahmed
- Nutrition and Clinical Services Division, International Centre for Diarrheal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - Abu S G Faruque
- Nutrition and Clinical Services Division, International Centre for Diarrheal Disease Research, Bangladesh, Dhaka, Bangladesh
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Islam MM. Hardcore use of smoked and smokeless tobacco products among men and women in Bangladesh: data from two rounds of the global adult tobacco survey. J Ethn Subst Abuse 2022:1-13. [PMID: 36409782 DOI: 10.1080/15332640.2022.2148150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
This study examines the prevalence of and factors associated with "hardcore" use of smoked and smokeless tobacco (SLT) products in Bangladesh and the variation in the ages people started using them daily. Data from the 2009 and 2017 rounds of the Global Adult Tobacco Survey for Bangladesh were analyzed using multilevel logistic regression. The prevalence of "hardcore" use of smoked tobacco among current smokers decreased from 15.5% in 2009 to 13.1% in 2017. Almost all hardcore smokers were male in both rounds. Among the current users of SLT, 7.0% were "hardcore" users in 2009, with a higher proportion of females (8.9%) than males (4.8%) and these percentages remained similar in 2017. The current smokers in the age-group 25-64 and the current SLT users in the age-group 45-65+ were more likely than their counterparts to be "hardcore" users. The earlier the participants started using daily, the more likely they were to become "hardcore" users. There was regional variation in the prevalence of "hardcore" use. Coordinated preventive interventions and comprehensive treatment programmes and their equitable geographical distribution are needed.
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Affiliation(s)
- M Mofizul Islam
- Department of Public Health, La Trobe University, Melbourne, Australia
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Islam MM. Comparison between Smokers and Smokeless Tobacco Users in Their Past Attempts and Intentions to Quit: Analysis of Two Rounds of a National Survey. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:13662. [PMID: 36294241 PMCID: PMC9603089 DOI: 10.3390/ijerph192013662] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Revised: 10/20/2022] [Accepted: 10/20/2022] [Indexed: 06/16/2023]
Abstract
This study compares current tobacco smokers and smokeless tobacco (SLT) users in terms of their past quitting attempts and intentions to quit in the future, and identifies approaches used in their recent quitting attempts. Data (n = 14,498) of current tobacco users from two rounds of the Global Adult Tobacco Survey Bangladesh were analysed. Poisson regressions with robust variance were used to examine associations between the study factor and the two outcome variables. About half of smokers and a quarter of SLT users tried to quit during the 12 months before the survey. About two-thirds of smokers and half of SLT users intended to quit in the future. Smokers were more likely (adjusted prevalence ratio (aPR): 1.38, 95%CI: 1.24-1.53) than SLT users to have attempted to quit during the 12 months before the survey and to intend to quit in the future (aPR: 1.09, 95%CI: 1.02-1.16). The corresponding aPRs were even higher for dual users (smoked tobacco and used SLT). Future intention to quit for both smokers (aPR: 1.45, 95%CI: 1.38-1.53) and SLT users (aPR: 1.87, 95%CI: 1.76-1.98) was significantly associated with their past quitting attempts. Most of those who had attempted to quit did not receive any treatment. Proactive and tailored interventions to promote quitting and expansion of tobacco cessation methods are recommended.
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Affiliation(s)
- M Mofizul Islam
- Department of Public Health, Room 410, Health Sciences Building 2, La Trobe University, Bundoora, VIC 3086, Australia
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Shukla R, Kanaan M, Siddiqi K. Tobacco Use Among 1 310 716 Women of Reproductive age (15-49 Years) in 42 Low- and Middle-Income Countries: Secondary Data Analysis From the 2010-2016 Demographic and Health Surveys. Nicotine Tob Res 2021; 23:2019-2027. [PMID: 34291296 PMCID: PMC8849114 DOI: 10.1093/ntr/ntab131] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2021] [Accepted: 06/17/2021] [Indexed: 12/30/2022]
Abstract
INTRODUCTION Tobacco use among women, especially during pregnancy is a public health concern. There is a need to understand the diverse nature of their tobacco consumption across the globe. METHODS We used Demographic and Health Surveys (DHS) data collected between 2010 and 2016 from 42 low- and middle-income countries (LMICs) to estimate the prevalence of smoking, smokeless tobacco, and dual use among pregnant and non-pregnant women of reproductive age (15-49 y). We compared tobacco use between both groups adjusted for age, type of residence, education and combined wealth index, and a subgroup analysis for the South-East Asia Region (SEAR) as the tobacco use in SEAR among women is far more diverse than in other regions primarily due to the popularity of smokeless tobacco use in this region. RESULTS Based on the data of 1 310 716 women in 42 LMICs, the prevalence of smoking was 0.69%(95%CI: 0.51-0.90) among pregnant women and 1.09%(95%CI: 0.81-1.42) among non-pregnant women. The prevalence of smokeless tobacco use was 0.56%(95%CI: 0.33-0.84) among pregnant women and 0.78%(95%CI: 0.35-1.37) among non-pregnant women. The relative risk ratios(RRR) for smoking (0.85; 95%CI: 0.67-1.09) and smokeless tobacco use (0.81; 95%CI:0.67-1.00) were not-significantly lower among pregnant women than non-pregnant women and education and wealth index had an inverse relationship with both forms of tobacco. In SEAR, among pregnant women, the prevalence of smoking and smokeless tobacco use was 1.81% and 0.45%, respectively. However, pregnant women were 7%(RRR 1.07; 95%CI:1.02-1.12) more likely to use smokeless tobacco than non-pregnant women. CONCLUSION Despite the added risk of foetal harm during pregnancy, there is no evidence that the tobacco consumption between pregnant and non-pregnant women differ in 42 LMICs. A significantly higher use of smokeless tobacco among pregnant women in SEAR is of particular concern and warrants further investigation. IMPLICATIONS Tobacco use among women in low- and middle-income countries (LMICs) is lower than high-income countries (HICs), but this may be because LMICs are earlier in the epidemiological transition of tobacco use. If ignored as a public health issue and the tobacco industry continues to market its products to women, the level of tobacco use may rise as it did in HICs. Also, despite low prevalence rates and with no evidence that these differ among pregnant and non-pregnant women, is concerning as tobacco consumption in any form during pregnancy is associated with poor birth outcomes. This suggests a need for raising awareness about the harms of tobacco use among women in LMICs, especially during pregnancy. There is a need to develop preventive and cessation interventions to decrease tobacco use (smoking and smokeless) among women who are from low socio-economic status and less educated, as they bear the greatest burden of tobacco use.
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Affiliation(s)
- Radha Shukla
- Department of Health Sciences, University of York, Heslington, York,UK
| | - Mona Kanaan
- Department of Health Sciences, University of York, Heslington, York,UK
| | - Kamran Siddiqi
- Department of Health Sciences, University of York, Heslington, York,UK
- Hull York Medical School, University of York, York,UK
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Huque R, Al Azdi Z, Sheikh A, Ahluwalia JS, Mishu MP, Mehrotra R, Ahmed N, Bauld L, Huq SM, Alam SM, Siddiqui F, Choudhury SR, Siddiqi K. Policy priorities for strengthening smokeless tobacco control in Bangladesh: A mixed-methods analysis. Tob Induc Dis 2021; 19:78. [PMID: 34707471 PMCID: PMC8500203 DOI: 10.18332/tid/140826] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2021] [Revised: 06/28/2021] [Accepted: 08/03/2021] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION Smokeless tobacco (ST) remains poorly regulated in Bangladesh. This study describes the prevalence and trends of ST use in Bangladesh, presents ST-related disease burden, identifies relevant policy gaps, and highlights key implications for future policy and practice for effective ST control in Bangladesh. METHODS We analyzed secondary data from the two rounds (2009 and 2017) of The Global Adult Tobacco Survey, estimated ST-related disease burden, and conducted a review to assess differences in combustible tobacco and ST policies. In addition, we gathered views in a workshop with key stakeholders in the country on gaps in existing tobacco control policies for ST control in Bangladesh and identified policy priorities using an online survey. RESULTS Smokeless tobacco use, constituting more than half of all tobacco use in Bangladesh, declined from 27.2% (25.9 million) in 2009 to 20.6% (22 million) in 2017. However, in 2017, at least 16947 lives and 403460 Disability-Adjusted Life Years (DALYs) were lost across Bangladesh due to ST use compared to 12511 deaths and 324020 DALYs lost in 2010. Policy priorities identified for ST control have included: introducing specific taxes and increasing the present ad valorem tax level, increasing the health development surcharge, designing and implementing a tax tracking and tracing system, standardizing ST packaging, integrating ST cessation within existing health systems, comprehensive media campaigns, and licensing of ST manufactures. CONCLUSIONS Our analysis shows that compared to combustible tobacco, there remain gaps in implementing and compliance with ST control policies in Bangladesh. Thus, contrary to the decline in ST use and the usual time lag between tobacco exposure and the development of cancers, the ST-related disease burden is still on the rise in Bangladesh. Strengthening ST control at this stage can accelerate this decline and reduce ST related morbidity and mortality.
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Affiliation(s)
- Rumana Huque
- Department of Economics, University of Dhaka, Dhaka, Bangladesh.,ARK Foundation, Dhaka, Bangladesh
| | | | - Aziz Sheikh
- Usher Institute, The University of Edinburgh, Edinburgh, United Kingdom
| | - Jasjit S Ahluwalia
- Department of Behavioral and Social Sciences, Alpert Medical School, Brown University School of Public Health, Providence, United States
| | - Masuma P Mishu
- Department of Health Sciences, Faculty of Sciences, University of York, Heslington, United Kingdom
| | - Ravi Mehrotra
- Centre for Health Economics, University of York, York, United Kingdom.,Department of Health Research, India Cancer Research Consortium, New Delhi, India
| | - Nasiruddin Ahmed
- 8 Institute of Governance and Development, BRAC University, Dhaka, Bangladesh
| | - Linda Bauld
- Usher Institute, The University of Edinburgh, Edinburgh, United Kingdom
| | | | | | - Faraz Siddiqui
- Department of Health Sciences, Faculty of Sciences, University of York, Heslington, United Kingdom
| | - Sohel R Choudhury
- Department of Epidemiology and Research, National Heart Foundation Hospital and Research Institute, Dhaka, Bangladesh
| | - Kamran Siddiqi
- Department of Health Sciences, Faculty of Sciences, University of York, Heslington, United Kingdom
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Afolalu EF, Spies E, Bacso A, Clerc E, Abetz-Webb L, Gallot S, Chrea C. Impact of tobacco and/or nicotine products on health and functioning: a scoping review and findings from the preparatory phase of the development of a new self-report measure. Harm Reduct J 2021; 18:79. [PMID: 34330294 PMCID: PMC8325199 DOI: 10.1186/s12954-021-00526-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Accepted: 07/21/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Measuring self-reported experience of health and functioning is important for understanding the changes in the health status of individuals switching from cigarettes to less harmful tobacco and/or nicotine products (TNP) or reduced-risk products (RRP) and for supporting tobacco harm reduction strategies. METHODS This paper presents insights from three research activities from the preparatory phase of the development of a new self-report health and functioning measure. A scoping literature review was conducted to identify the positive and negative impact of TNP use on health and functioning. Focus groups (n = 29) on risk perception and individual interviews (n = 40) on perceived dependence in people who use TNPs were reanalyzed in the context of health and functioning, and expert opinion was gathered from five key opinion leaders and five technical consultants. RESULTS Triangulating the findings of the review of 97 articles, qualitative input from people who use TNPs, and expert feedback helped generate a preliminary conceptual framework including health and functioning and conceptually-related domains impacted by TNP use. Domains related to the future health and functioning measurement model include physical health signs and symptoms, general physical appearance, functioning (physical, sexual, cognitive, emotional, and social), and general health perceptions. CONCLUSIONS This preliminary conceptual framework can inform future research on development and validation of new measures for assessment of overall health and functioning impact of TNPs from the consumers' perspective.
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Affiliation(s)
- Esther F Afolalu
- PMI R&D, Philip Morris Product S.A., Quai Jeanrenaud 5, 2000, Neuchâtel, Switzerland.
| | - Erica Spies
- PMI R&D, Philip Morris Product S.A., Quai Jeanrenaud 5, 2000, Neuchâtel, Switzerland
| | - Agnes Bacso
- PMI R&D, Philip Morris Product S.A., Quai Jeanrenaud 5, 2000, Neuchâtel, Switzerland
| | - Emilie Clerc
- PMI R&D, Philip Morris Product S.A., Quai Jeanrenaud 5, 2000, Neuchâtel, Switzerland
| | - Linda Abetz-Webb
- Patient-Centered Outcomes Assessments Ltd., 1 Springbank, Bollington, Macclesfield, Cheshire, SK10 5LQ, UK
| | - Sophie Gallot
- PMI R&D, Philip Morris Product S.A., Quai Jeanrenaud 5, 2000, Neuchâtel, Switzerland
| | - Christelle Chrea
- PMI R&D, Philip Morris Product S.A., Quai Jeanrenaud 5, 2000, Neuchâtel, Switzerland
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Naznin E, Wynne O, George J, Denham AMJ, Hoque ME, Milton AH, Bonevski B, Stewart K. Smokeless tobacco policy in Bangladesh: A stakeholder study of compatibility with the World Health Organization's Framework Convention on Tobacco Control. Drug Alcohol Rev 2021; 40:856-863. [PMID: 33470003 DOI: 10.1111/dar.13243] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Revised: 11/04/2020] [Accepted: 12/15/2020] [Indexed: 12/23/2022]
Abstract
INTRODUCTION Smokeless tobacco (ST) is the predominant form of tobacco used in Bangladesh and is associated with adverse health outcomes. Bangladesh ratified the World Health Organization's Framework Convention on Tobacco Control (FCTC) in 2004. There are concerns that FCTC legislation and implementation of ST control policy is insufficient in Bangladesh. The aim of this study was to investigate the achievements and challenges of ST policy in Bangladesh and its alignment with the FCTC. METHODS We conducted semi-structured key informant interviews with 20 stakeholders from government and non-government offices and international funding agencies, including tobacco control advocates, policy makers and non-governmental organisation workers. We used NVivo software to create key themes and the framework method for thematic analysis. RESULTS Our findings revealed a lack of national policy in terms of disclosure of harmful contents, illicit trade and standardised packaging of ST. Legislation remains ineffective in relation to graphical health warnings and tax measures. Challenges to ST control identified included inadequate law enforcement; paucity of research, surveillance, and evidence generation; and supply chain control. We identified lack of congruence of ST policies with FCTC due to slow progress in implementation of FCTC measures, lack of a country-specific policy and industry interference. To comply with FCTC, participants recommended strong leadership and political commitment, co-ordination between public and private sectors and proper use of tobacco control resources. DISCUSSION AND CONCLUSIONS Bangladesh has adopted several important FCTC measures, but further strengthening of ST policy is needed to enable full implementation of FCTC.
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Affiliation(s)
- Eva Naznin
- School of Medicine and Public Health, The University of Newcastle, Newcastle, Australia
| | - Olivia Wynne
- School of Medicine and Public Health, The University of Newcastle, Newcastle, Australia
| | - Johnson George
- Centre for Medicine Use and Safety, Monash University, Melbourne, Australia
| | - Alexandra M J Denham
- School of Medicine and Public Health, The University of Newcastle, Newcastle, Australia
- Priority Research Centre for Stroke and Brain Injury, Hunter Medical Research Institute, Newcastle, Australia
| | - Mohammad E Hoque
- Institute For Social Science Research, The University of Queensland, Brisbane, Australia
| | - Abul H Milton
- Department of Public Health, Northern University, Dhaka, Bangladesh
| | - Billie Bonevski
- School of Medicine and Public Health, The University of Newcastle, Newcastle, Australia
| | - Kay Stewart
- Centre for Medicine Use and Safety, Monash University, Melbourne, Australia
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Solhi M, Fattahi E, Manzari ZS, Gupta PC, Kargar M, Kasmaei P, Barati H. The Reasons for Using Smokeless Tobacco: A Review. IRANIAN JOURNAL OF PUBLIC HEALTH 2021; 50:492-501. [PMID: 34178796 PMCID: PMC8214603 DOI: 10.18502/ijph.v50i3.5589] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Abstract
Background: Smokeless tobacco use is a public health problem in some parts of the world. The major objective of this study was to investigate the reasons and factors of consumption. Methods: A content analysis was conducted on articles for the past thirty years (1989–2019). We reviewed and selected 400 abstracts of original articles from PubMed databases by the search strategy, and reviewed one by one. Among these, 45 abstracts were selected, in which the patterns of use, the reasons for using, and the determinants and predictors were described. Eleven papers were selected based on the results and related to the research objectives. The results of these articles were evaluated precisely word by word and phrase by phrase with content analysis method and inductive approach. Results: The reasons for the use of smokeless tobacco fell in two main themes: socio-cultural structure; and, beliefs, each contained Sub-themes such as “culture and living conditions”, “laws”, “family and peer relationships”, “beliefs related to psychological” and “beliefs related to physical influences”, “beliefs”, “The role of harm perceptions “. Conclusion: There was a difference between beliefs, cultures and social conditions among the people about using of smokeless tobacco and the association of these factors is investigated in future studies. We also suggest for the prevention and control of smokeless tobacco use, cultural norms and beliefs will need to address adequately.
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Affiliation(s)
- Mahnaz Solhi
- Department of Education and Health Promotion, School of Health, Iran University of Medical Sciences, Tehran, Iran
| | - Esmaeil Fattahi
- Department of Education and Health Promotion, School of Health, Iran University of Medical Sciences, Tehran, Iran
| | - Zahra Sadat Manzari
- Department of Medical-Surgical Nursing, School of Nursing and Midwifery, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Prakash C Gupta
- Healis-Sekhsaria Institute for Public Health, Navi Mumbai, Maharashtra, India
| | - Mehdi Kargar
- Department of Health Education & Promotion, School of Health, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Parisa Kasmaei
- Health and Environment Research Center, Department of Health Education and Promotion, School of Health, Guilan University of Medical Sciences, Rasht, Iran
| | - Hadis Barati
- Department of Epidemiology, School of Public Health and Safety, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Haque MI, Zafar Ullah AN, Akter T, Chowdhury AA, Mamun AA, Tamanna TI, Hossain MK, Khan HT, Harun MGD. Familial and socio-cultural barriers in maintaining tobacco-free homes in Bangladesh: a comparative cross-sectional study. BMJ Open 2020; 10:e039787. [PMID: 33334831 PMCID: PMC7747576 DOI: 10.1136/bmjopen-2020-039787] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Revised: 10/19/2020] [Accepted: 10/20/2020] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVES Children, pregnant women and the elderly at a global level are all being dangerously exposed to tobacco use in the household (HH). However, there is no understanding of the familial and socio-cultural factors that provide barriers to ensuring tobacco-free homes in Bangladesh either in urban or rural areas (U&RAs). This study therefore investigates those barriers to help enable a move towards tobacco-free homes in Bangladesh. DESIGN Comparative cross-sectional study. SETTINGS Data were collected from both urban and rural settings in Bangladesh. PARTICIPANTS A probability proportional sampling procedure was used to select 808 participants in U&RAs out of a total of 3715 tobacco users. Semi-structured interviews through the use of a questionnaire were conducted with the participants followed by a multivariate logistic regression analysis of the data in order to explore the familial and socio-cultural factors associated with tobacco use at home. RESULTS The prevalence of tobacco use at home was 25.7% in urban areas and 47.6% in rural areas. In urban areas: marital status (adjusted OR (AOR)=3.23, 95% CI 1.37 to 6.61), education (AOR=2.14, 95% CI 1.15 to 3.99), the smoking habits of elderly family members (AOR=1.81, 95% CI 0.91 to 2.89), offering tobacco as a traditional form of leisure activity at home (AOR=1.85, 95% CI 0.94 to 2.95) and lack of religious practices (AOR=2.39, 95% CI 1.27 to 4.54) were identified as significant socio-cultural predictors associated with tobacco use at home. In rural areas: age (AOR=5.11, 95% CI 2.03 to 12.83), extended family (AOR=3.08, 95% CI 1.28 to 7.38), lack of religious practices (AOR=4.23, 95% CI 2.32 to 7.72), using children to buy or carry tobacco (AOR=3.33, 95% CI 1.11 to 9.99), lack of family guidance (AOR=4.27, 95% CI 2.45 to 7.42) and offering tobacco as a traditional form of leisure activity at home (AOR=3.81, 95% CI 2.23 to 6.47) were identified as significant determinants for tobacco use at home. CONCLUSION This study concludes that socio-cultural traditions and familial norms in Bangladesh provide significant barriers for enabling tobacco-free homes. The identification of these barriers can aid policymakers and programme planners in Bangladesh in devising appropriate measures to mitigate the deadly consequences of tobacco use in the home. The consequences also include the dangers involved in family members being exposed to secondhand smoke.
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Affiliation(s)
- Md Imdadul Haque
- Department of Public Health, Faculty of Allied Health Sciences, Daffodil International University, Dhaka, Bangladesh
| | - Abu Naser Zafar Ullah
- Department of Public Health, Faculty of Allied Health Sciences, Daffodil International University, Dhaka, Bangladesh
- KIT Royal Tropical Institute, Amsterdam, The Netherlands
| | - Tasnim Akter
- Department of Public Health, Faculty of Allied Health Sciences, Daffodil International University, Dhaka, Bangladesh
- SQUARE College of Nursing, Dhaka, Bangladesh
| | - Abm Alauddin Chowdhury
- Department of Public Health, Faculty of Allied Health Sciences, Daffodil International University, Dhaka, Bangladesh
| | - Abdullah Al Mamun
- Department of Public Health, Faculty of Allied Health Sciences, Daffodil International University, Dhaka, Bangladesh
| | - Tabassum Islam Tamanna
- Department of Public Health, Faculty of Allied Health Sciences, Daffodil International University, Dhaka, Bangladesh
- Jessore Medical College and Hospital, Jessore, Bangladesh
| | - Md Kamrul Hossain
- Department of General Educational Development, Faculty of Science and Information Technology, Daffodil International University, Dhaka, Bangladesh
| | - Hafiz Ta Khan
- Health Promotion and Public Health, College of Nursing, Midwifery and Healthcare, University of West London, Paragon House, Brentford, UK
| | - Md Golam Dostogir Harun
- Department of Public Health, Faculty of Allied Health Sciences, Daffodil International University, Dhaka, Bangladesh
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Solhi M, Fattahi E, Barati H, Mohammadi M, Kasmaei P, Rastaghi S. Smokeless Tobacco Use in Iran: A Systematic Review. ADDICTION & HEALTH 2020; 12:225-234. [PMID: 33244399 PMCID: PMC7679486 DOI: 10.22122/ahj.v12i3.274] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Background Smokeless tobacco (ST) use is one of the most important public health problems in Southeast Asia. The use of these substances increases the incidence of some cancers and other diseases. The purpose of this review study was to investigate on ST use in Iran. Methods A literature search was conducted on PubMed, Google Scholar, and three national databases [Scientific Information Database (SID), IranMedex, and IranDoc] based on the standard search strategy. Findings Most consumer people lived in Sistan and Baluchestan Province (Zahedan and Chabahar Cities) and Golestan Province, Iran. ST use rates ranged from 11.0% to 45.7% among college students in Sistan and Baluchestan (Zahedan and Chabahar) and Golestan. There are various types of ST consumed in Iran that have been mentioned in various articles, including Pan, Gutka, Nass, Naswar, Biti, and Supari. Conclusion Most studies on ST have been conducted in Sistan and Baluchestan and Golestan Provinces and we need more research for other provinces. Consumption by women is a warning and a threat to women's health in the future. Further studies will be needed to find out more precisely the prevalence of consumption in Iran.
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Affiliation(s)
- Mahnaz Solhi
- Department of Education and Health Promotion, School of Health, Iran University of Medical Sciences, Tehran, Iran
| | - Esmaeil Fattahi
- Department of Education and Health Promotion, School of Health, Iran University of Medical Sciences, Tehran, Iran
| | - Hadis Barati
- Student Research Committee AND Department of Epidemiology, School of Public Health and Safety, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Masoud Mohammadi
- Department of Nursing, School of Nursing and Midwifery, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Parisa Kasmaei
- Department of Health Education and Promotion, School of Health AND Research Center of Health and Environment, Guilan University of Medical Sciences, Rasht, Iran
| | - Sedighe Rastaghi
- Student Research Committee AND Department of Biostatistics, School of Health, Mashhad University of Medical Sciences, Mashhad, Iran
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15
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Yasmin F, Nahar N, Banu B, Ali L, Sauerborn R, Souares A. The influence of mobile phone-based health reminders on patient adherence to medications and healthy lifestyle recommendations for effective management of diabetes type 2: a randomized control trial in Dhaka, Bangladesh. BMC Health Serv Res 2020; 20:520. [PMID: 32513164 PMCID: PMC7282058 DOI: 10.1186/s12913-020-05387-z] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2019] [Accepted: 06/01/2020] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND In 2017, 80% of 425 million adults with diabetes worldwide were living in low and middle-income countries. Diabetes affected 6.9 million adults in Bangladesh and accounted for 3% of the country's total mortality. Proper management of diabetes is the key to positive health outcomes. This study investigated how mobile phone-based health intervention could increase patient adherence and thereby improve the disease outcomes for diabetes type 2 in Bangladesh. METHODS A mobile phone-based health project (including mobile phone reminders and 24/7 call center) was implemented in Dhaka District, Bangladesh from January to December 2014. A randomized control trial was carried out, recruiting randomly in intervention and control groups among the patients receiving treatment for type 2 diabetes at the Bangladesh Institute of Health Sciences Hospital, Dhaka, Bangladesh. A total of 320 patients from both groups at baseline and 273 at endline were interviewed. RESULTS A significant improvement in patient adherence to diet, physical exercise, the cessation of use of tobacco and betel nut, and blood glycaemic control was found in the intervention group, whereas no such significant improvement was found in the control group. Cost and other co-morbidities were found to be the main reasons for non-adherence. CONCLUSION A mobile-health intervention should be considered as an additional option for non-communicable disease programs.
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Affiliation(s)
- Farzana Yasmin
- Heidelberg Institute of Global Health (HIGH), Heidelberg University Hospital, Heidelberg, Germany.
- Friede Springer Endowed Professorship for Global Child Health, Faculty of Health/Department of Human Medicine, University of Witten/Herdecke, Alfred-Herrhausen-Str. 50, 58448, Witten, Germany.
| | | | - Bilkis Banu
- Heidelberg Institute of Global Health (HIGH), Heidelberg University Hospital, Heidelberg, Germany
| | - Liaquat Ali
- Pothikrit Institute of Health Studies, Dhaka, Bangladesh
| | - Rainer Sauerborn
- Heidelberg Institute of Global Health (HIGH), Heidelberg University Hospital, Heidelberg, Germany
| | - Aurélia Souares
- Heidelberg Institute of Global Health (HIGH), Heidelberg University Hospital, Heidelberg, Germany
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Prevalence and Correlates of Cultural Smokeless Tobacco Products among South Asian Americans in New York City. J Community Health 2020; 44:479-486. [PMID: 30874956 DOI: 10.1007/s10900-019-00649-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Despite the high prevalence of smokeless tobacco (SLT) use in South Asia, little is known about the use of cultural smokeless tobacco among South Asians in the United States (US). This study examines the prevalence and correlates of SLT products among South Asians living in New York City (NYC). A total of 602 South Asians living in NYC completed a community health needs and resource assessment and answered questions about the use of SLT. Multivariable logistic regression models were run to examine predictors of SLT use (ever and current use). A total of 28.2% South Asian individuals reported ever use of SLT (35.9% among men and 21.5% among women) and a total of 12.9% reported current use of SLT (16.5% among men and 9.7% among women). Logistic regression models were stratified by sex. Among men, factors associated with ever or current use included: Bangladeshi and Himalayan ethnic subgroup, speaking English very well, attending a religious service a few times a year (ever use only), and current or former cigarette smoking. Among women, factors associated with ever use included: Bangladeshi ethnic subgroup, self-reporting condition of mouth and teeth as fair/poor, and at risk for depression. No factors were significant among women for current use. Overall, prevalence of current and ever use of SLT is high, and important differences exist by sex. Future studies are needed to better understand SLT use patterns in South Asian communities in the US and to inform culturally relevant interventions aiming to decrease overall tobacco use.
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Naznin E, Wynne O, George J, Hoque ME, Milton AH, Bonevski B. Systematic review and meta-analysis of the prevalence of smokeless tobacco consumption among adults in Bangladesh, India and Myanmar. Trop Med Int Health 2020; 25:774-789. [PMID: 32358906 DOI: 10.1111/tmi.13410] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To estimate the pooled prevalence of smokeless tobacco consumption (STC) by gender and location in Bangladesh, India and Myanmar and to identify periodic changes in STC prevalence using data extracted from published studies. METHODS We searched for a combination of keywords in electronic databases and used a standard form to extract data from each article. We undertook a meta-analysis to estimate pooled prevalence and confidence intervals within these countries. To compare periodic changes in STC prevalence, we grouped studies into five-year periods (2000-2004, 2005-2009, 2010-2014 and 2015-2019). RESULTS The pooled estimates of STC prevalence were 25% (95% CI: 22-28%), 22% (95% CI: 15-28%) and 21% (95% CI: 14-28%) for Bangladesh, India and Myanmar, respectively. In pooled estimates across these countries, we found higher STC prevalence for men (30%; 95% CI: 24-35%) than women (16%; 95% CI: 10-23%) and for rural dwellings (24%; 95% CI: 18-31%) than urban dwellings (17%; 95% CI: 10-24%). We found significant decrease in STC in Bangladesh and India in the period 2010-2014 and 2015-2019, respectively. In Myanmar, STC prevalence increased significantly and substantially in 2010-2014, to levels higher than in Bangladesh and India. CONCLUSIONS The prevalence of STC in Bangladesh, India and Myanmar is highest in rural areas and among men. Public health prevention strategies are needed to maintain decrease in STC in Bangladesh and India, and to reverse the increased use in Myanmar.
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Affiliation(s)
- Eva Naznin
- School of Medicine and Public Health, The University of Newcastle, Callaghan, NSW, Australia
| | - Olivia Wynne
- School of Medicine and Public Health, The University of Newcastle, Callaghan, NSW, Australia
| | - Johnson George
- Centre for Medicine Use and Safety, Monash University, Parkville, Vic, Australia
| | - Mohammad Enamul Hoque
- Agency for Clinical Innovation, New South Wales Ministry of Health, Chatswood, NSW, Australia
| | | | - Billie Bonevski
- School of Medicine and Public Health, The University of Newcastle, Callaghan, NSW, Australia
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18
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Haque MI, Chowdhury ABMA, Hassan MS, Khan HTA, Harun MGD. Prevailing familial, social and cultural obstacles in keeping tobacco-free homes in urban areas of Bangladesh: A mixed-method study. PLoS One 2019; 14:e0220777. [PMID: 31404115 PMCID: PMC6690649 DOI: 10.1371/journal.pone.0220777] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2018] [Accepted: 07/23/2019] [Indexed: 11/02/2022] Open
Abstract
BACKGROUND Millions of children and others across the world are being dangerously exposed to tobacco smoke and toxins in their own homes. Whilst there is limited interest in laws and interventions controlling tobacco use in public places in Bangladesh, no attention has been given to preventing tobacco-use inside homes. This study explores the familial and socio-cultural factors that provide obstacles for ensuring tobacco-free homes in Bangladesh. MATERIALS AND METHODS A mixed-method design was adopted and from among the 1,436 tobacco users identified in a population of 11,853, 400 (tobacco users) were selected for cross-sectional survey. This survey involved a probability proportional sampling procedure, and 24 In-Depth Interviews. Multivariate logistic regression was performed to explore the association of familial and socio-cultural factors with tobacco-use at home adjusted by other demographic characteristics. Thematic content analysis was done on the qualitative data, and then inferences were drawn out collectively. RESULTS This study revealed that the prevalence of tobacco-use in the home was 25.7% in urban residential areas in Bangladesh. Multivariate logistic regression analysis identified that familial and socio-cultural factors were significantly associated with tobacco-use at home: marital status (OR 3.23, 95% CI: 1.37-6.61), education (OR 2.14, 95% CI: 1.15-3.99), smoking habits of older family members (OR 1.81 95% CI: 0.91-2.89), tobacco being offered as hospitality and for entertainment (OR 1.85, 95% CI: .94-2.95) and lack of religiosity practice (OR 2.39, 95% CI: 1.27-4.54). Qualitative findings indicated that social customs, lack of religious practice, tobacco-use of older family members, and lack of family guidance were key obstacles for enabling tobacco-free homes in urban areas. CONCLUSION Use of tobacco at home is continuing as part of established familial and socio-cultural traditions. If tobacco-use at home is not addressed seriously by the authorities then the emerging threat of second-hand smoke exposure and harmful consequences of tobacco- use will be exacerbated.
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Affiliation(s)
- Md. Imdadul Haque
- Department of Public Health, Faculty of Allied Health Sciences, Daffodil International University, Dhanmondi, Dhaka, Bangladesh
- * E-mail:
| | - ABM Alauddin Chowdhury
- Department of Public Health, Faculty of Allied Health Sciences, Daffodil International University, Dhanmondi, Dhaka, Bangladesh
| | - Muhammad Shaikh Hassan
- Center of Excellence for Health Systems and Universal Health Coverage, BRAC James P Grant School of Public Health, BRAC University, Dhaka, Bangladesh
| | - Hafiz T. A. Khan
- The Graduate School, University of West London, London, United Kingdom
| | - Md. Golam Dostogir Harun
- Department of Public Health, Faculty of Allied Health Sciences, Daffodil International University, Dhanmondi, Dhaka, Bangladesh
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19
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Huque R, Zaman MM, Huq SM, Sinha DN. Smokeless tobacco and public health in Bangladesh. Indian J Public Health 2019; 61:S18-S24. [PMID: 28928314 PMCID: PMC6349136 DOI: 10.4103/ijph.ijph_233_17] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Despite the high prevalence of smokeless tobacco (SLT) use among adults in Bangladesh, SLT was not included in the Tobacco Control Law till 2013. Information on SLT use among Bangladeshi people is inadequate for policymaking and implementing effective control measures. With the aim to identify the prevalence and trends of different SLT products, health and economic impacts, manufacture, and sale of and policies related to SLT in Bangladesh, we carried out a literature review, which involved literature search, data extraction, and synthesis. Evidence suggests that in Bangladesh, SLTs range from unprocessed to processed or manufactured products including Sada Pata, Zarda, Gul, and Khoinee. Over 27% of Bangladeshi adults aged 15 years and older use SLT in one form or other. SLT use is associated with age, sex, education, and socioeconomic status. SLT consumption has reportedly been associated with increased prevalence of heart diseases, stroke, and oral cancer and led to around 320,000 disability adjusted life years lost in Bangladesh in 2010. No cessation service is available for SLT users in public facilities. Compared to cigarettes, taxation on SLT remains low in Bangladesh. The amendment made in Tobacco Control Law in 2013 requires graphic health warnings to cover 50% of SLT packaging, ban on advertisement of SLT products, and restriction to sale to minors. However, implementation of the law is weak. As the use of SLT is culturally accepted in Bangladesh, culturally appropriate public awareness program is required to curb SLT use along with increased tax and cessation services.
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Affiliation(s)
- Rumana Huque
- Professor, Department of Economics, University of Dhaka, Dhaka, Bangladesh
| | - M Mostafa Zaman
- Adviser, Research and Publication Unit, World Health Organization, Dhaka, Bangladesh
| | - Syed Mahfuzul Huq
- National Professional Officer (Tobacco Control), World Health Organization, Dhaka, Bangladesh
| | - Dhirendra N Sinha
- Director, Department of Tobacco Control, School of Preventive Oncology, Patna, Bihar, India
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20
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Madewell ZJ, Kolaja CA. Smokeless Tobacco Warnings in Indian Mass Media: Intention and Attempts to Quit. Indian J Med Paediatr Oncol 2019. [DOI: 10.4103/ijmpo.ijmpo_135_19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Abstract
Introduction: In India, over 200 million people use smokeless tobacco (SLT), which increases the risk of cancers. Studies have demonstrated mass media campaigns effectively reduce smoking tobacco prevalence, but few have assessed their impact on SLT cessation. Objectives: This study used data from the Global Adult Tobacco Surveys (GATS) in 2009–2010 and 2016–2017 to examine associations between SLT health warnings in mass media, and intention and attempts to quit using SLT. We also compared the proportion of SLT users who noticed mass media warnings between 2009–2010 and 2016–2017. Materials and Methods: Over 16,000 and 15,000 current SLT users from the GATS-1 and GATS-2, respectively, were used for analysis. Weighted logistic regression models were used to analyze associations between noticed health warnings on SLT packages, newspapers/magazines, television, radio, billboards, cinemas, internet, vehicles, and walls, and intention and attempts to quit SLT. Results: In final models, the odds of intention and attempts to quit were highest among those who noticed warnings in newspapers/magazines (adjusted odds ratio [AOR]: 1.50; 95% confidence interval [CI]: 1.30–1.74) and the internet (AOR: 1.60; 95% CI: 1.12–2.29), respectively. Warnings on SLT packages, television, billboards, radio, vehicles, and walls were also associated with increased cessation behavior. More noticed warnings on SLT packages, television, billboards, and newspapers/magazines in GATS-2 than GATS-1, but fewer heard radio warnings. Conclusions: Among Indian SLT users, we found evidence that SLT warnings in mass media may promote cessation behavior. Health warnings in mass media could play an important role in the overall strategy to reduce the morbidity and mortality associated with SLT use.
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Affiliation(s)
- Zachary J. Madewell
- University of California, San Diego/San Diego State University, PhD Program in Public Health (Epidemiology), Department of Family Medicine and Public Health, La Jolla, CA 92093, USA
| | - Claire A. Kolaja
- University of California, San Diego/San Diego State University, PhD Program in Public Health (Epidemiology), Department of Family Medicine and Public Health, San Diego, CA 92107, USA
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Al-Shoaibi AAA, Matsuyama A, Khalequzzaman M, Haseen F, Choudhury SR, Hoque BA, Chiang C, Hirakawa Y, Yatsuya H, Aoyama A. Perceptions and behavior related to noncommunicable diseases among slum dwellers in a rapidly urbanizing city, Dhaka, Bangladesh: a qualitative study. NAGOYA JOURNAL OF MEDICAL SCIENCE 2018; 80:559-569. [PMID: 30587870 PMCID: PMC6295424 DOI: 10.18999/nagjms.80.4.559] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/30/2018] [Accepted: 05/23/2018] [Indexed: 02/03/2023]
Abstract
The increasing burden of noncommunicable diseases (NCDs) in Bangladesh can be attributable to rapid urbanization and coinciding changes in lifestyle accompanied by nutrition transition. The objective of this study is to explore respondents' lived experiences and perceptions relating to NCDs and nutrition change in an urban slum community in Dhaka. Qualitative methods were employed to explore a general understanding of behavior related to NCDs among residents of the slum community. We conducted key informant interviews of six men and seven women of various backgrounds and five focus group discussions to focus salient topics emerged from the interviews. The transcriptions of the audio-recordings were thematically analyzed, using the constant comparison method. Four major themes emerged: (1) financial hardship influencing health; (2) urbanized lifestyle affecting diet; (3) tobacco and sweetened tea as cornerstones of social life; and (4) health-seeking behavior utilizing local resources. One notable finding was that even with general economic improvement, respondents perceived poverty to be one of the major causes of NCDs. A promising finding for potentially curbing NCDs was the current trend for women to walk for exercise contrary to the commonly held notion that urban dwellers generally lead sedentary lifestyles. This study described how urban slum dwellers in Dhaka, experiencing a transition from a traditional to urbanized lifestyle, perceived their daily practices in relation to NCDs and nutrition. Our research revealed both adverse and encouraging elements of perceptions and behavior related to NCDs, which may contribute to the optimal design of NCD prevention and health promotion programs.
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Affiliation(s)
| | - Akiko Matsuyama
- Department of Public Health and Health Systems, Nagoya University School of Medicine, Nagoya, Japan
| | - Md Khalequzzaman
- Department of Public Health and Informatics, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh
| | - Fariha Haseen
- Department of Public Health and Informatics, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh
| | - Sohel Reza Choudhury
- Department of Epidemiology and Research, National Heart Foundation Hospital and Research Institute, Dhaka, Bangladesh
| | | | - Chifa Chiang
- Department of Public Health and Health Systems, Nagoya University School of Medicine, Nagoya, Japan
| | - Yoshihisa Hirakawa
- Department of Public Health and Health Systems, Nagoya University School of Medicine, Nagoya, Japan
| | - Hiroshi Yatsuya
- Department of Public Health and Health Systems, Nagoya University School of Medicine, Nagoya, Japan
- Department of Public Health, Fujita Health University School of Medicine, Toyoake, Japan
| | - Atsuko Aoyama
- Department of Public Health and Health Systems, Nagoya University School of Medicine, Nagoya, Japan
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Gupta R, Gupta S, Sharma S, Sinha DN, Mehrotra R. A systematic review on association between smokeless tobacco & cardiovascular diseases. Indian J Med Res 2018; 148:77-89. [PMID: 30264756 PMCID: PMC6172910 DOI: 10.4103/ijmr.ijmr_2020_17] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2017] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND & OBJECTIVES The association of smokeless tobacco (SLT) with cardiovascular diseases has remained controversial due to conflicting reports from various countries. Earlier meta-analyses have shown significantly higher risk of fatal myocardial infarction and stroke in SLT users. However, the risk of hypertension (HTN) with SLT products has not been reviewed earlier. This systematic review was undertaken to summarize the evidence available from global literature on the association of SLT with cardiovascular outcomes - heart disease, stroke and HTN. METHODS A systematic literature search was performed in PubMed and Google Scholar since their inception till October 2017 using pre-decided search terms and inclusion/exclusion criteria. Data were extracted from studies included independently by two authors and reviewed. RESULTS The review included 50 studies - 23 on heart disease, 14 on stroke and 14 on HTN. Majority of the studies evaluating heart disease or stroke were conducted in the European Region and most of these did not find a significant association between SLT use and either of these outcomes. On the other hand, 70 per cent of the studies on HTN were reported from South-East Asian Region and about half of the studies found a higher risk of HTN in SLT users. INTERPRETATION & CONCLUSIONS Current available evidence is insufficient to conclusively support the association of cardiovascular diseases with SLT use due to variability in results and methodological constraints in most of the studies. Region and product-specific well-designed studies are required to provide this evidence to the policymakers. However, advice on cessation of SLT products should be offered to patients presenting with cardiovascular diseases.
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Affiliation(s)
- Ruchika Gupta
- Division of Cytopathology, ICMR-National Institute of Cancer Prevention & Research, Noida, India
| | - Sanjay Gupta
- Division of Cytopathology, ICMR-National Institute of Cancer Prevention & Research, Noida, India
| | - Shashi Sharma
- Division of Epidemiology & Biostatistics, ICMR-National Institute of Cancer Prevention & Research, Noida, India
| | | | - Ravi Mehrotra
- WHO FCTC Global Knowledge Hub for Smokeless Tobacco, ICMR-National Institute of Cancer Prevention & Research, Noida, India
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The role of negative affect and message credibility in perceived effectiveness of smokeless tobacco health warning labels in Navi Mumbai, India and Dhaka, Bangladesh: A moderated-mediation analysis. Addict Behav 2017; 73:22-29. [PMID: 28441573 DOI: 10.1016/j.addbeh.2017.04.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2016] [Revised: 03/29/2017] [Accepted: 04/01/2017] [Indexed: 10/19/2022]
Abstract
OBJECTIVE There is strong evidence showing that pictorial health warnings are more effective than text-only warnings. However, much of this evidence comes from high-income countries and is limited to cigarette packaging. Moreover, few studies have identified mechanisms that might explain the impact of warnings. METHODS The current study examined the potential mediating role of negative affect and the moderating influence of message credibility in perceived effectiveness of smokeless tobacco warnings in two low- and middle-income countries (LMICs). Field interviews were conducted in India and Bangladesh, with adult (19+ years) smokeless tobacco users (n=1053), and youth (16-18years) users (n=304) and non-users (n=687). Respondents were randomly assigned to view warnings in one of four conditions: (1) Text-only, (2) pictorial with symbolic imagery, (3) pictorial with graphic images of health effects, or (4) pictorial with personalized graphic images plus a personal testimonial. RESULTS The findings provide support for the mediating influence of negative affect in perceived effectiveness, for adult and youth smokeless tobacco users who viewed pictorial warnings (vs. text-only), and graphic health warnings (vs. personal testimonials). Among adults, message credibility moderated the indirect effect; the association was stronger when credibility was high and weaker when it was low. Among youth users and non-users, message credibility did not moderate the indirect effect. CONCLUSIONS Consistent with research from high-income countries, these findings highlight the importance of selecting imagery that will elicit negative emotional reactions and be perceived as credible. Differential effects among adults and youth highlight the importance of pre-testing images.
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Shekhawat KS, Chauhan A, Sakthidevi S, Goyal P, Bhattacharjee S. Smokeless Tobacco: Profiling Sachets and Pattern of Use among Low Socioeconomic Population of Puducherry. Contemp Clin Dent 2017; 8:225-230. [PMID: 28839407 PMCID: PMC5551326 DOI: 10.4103/ccd.ccd_154_17] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND Tobacco consumption is highest among labor classes and low socioeconomic status (SES), with inclination toward smokeless tobacco (SLT). AIM The aim of the study was to determine the prevalence and pattern of SLT consumption with secondary objective to profile various sachets of SLT most commonly sold in the study setting. SETTING AND DESIGN A cross-sectional questionnaire study conducted in rural Puducherry. MATERIALS AND METHODS A self-interviewed structured questionnaire was administered to 150 participants from two villages. Data on education, occupation, and income were collected with details in the form of tobacco consumed, duration of habit, daily consumption, and brand of SLT among other things. Profiling of sachets was done with manufacturing date, date of expiry, presence and absence of warning signs, and name of the manufacturer as parameter. STATISTICAL ANALYSIS Descriptive analysis was done for frequency distribution and Chi-square test for proportions. RESULTS The overall prevalence of SLT was 44% with women consuming more than males. 41-50-year-old were highest users of SLT. More than 50% of the participants were unaware of the "pictorial warnings" and 65% did not know about the presence of "contents" on sachets. Pan masala with tobacco was the most preferred form. Only 5 of the 23 commercial brands of sachets had both "pictorial and readable warnings" printed. CONCLUSION The prevalence of STC was high when compared to the general population. Steps need to be taken to address the adverse effects printed on sachets for low SES populations. The printed warnings need to be inspected regularly. Dual tobacco use is a new addition to the existing list of challenges.
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Affiliation(s)
- Kuldeep Singh Shekhawat
- Department of Public Health Dentistry, Srinivas Institute of Dental Sciences, Mangalore, Karnataka, India
| | - Arunima Chauhan
- Department of Oral Biology, Faculty of Dentistry, Melaka-Manipal Medical College, Manipal University, Manipal, Karnataka, India
| | - S Sakthidevi
- Department of Periodontics, Indira Gandhi Institute of Dental Sciences, Puducherry, India
| | - Prasoon Goyal
- Triveni Institute of Dental Sciences and Research Center, Raipur, Chattisgarh, India
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Hossain MS, Kypri K, Rahman B, Milton AH. Smokeless tobacco consumption and stillbirth: Population-based case-control study in rural Bangladesh. Drug Alcohol Rev 2017; 37:414-420. [PMID: 28543690 DOI: 10.1111/dar.12566] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2016] [Revised: 03/31/2017] [Accepted: 04/06/2017] [Indexed: 11/28/2022]
Abstract
INTRODUCTION AND AIMS To investigate the association between smokeless tobacco consumption (STC) during pregnancy and risk of stillbirth. DESIGN AND METHODS We conducted a population-based case-control study of 253 cases and 759 randomly selected control women in Madaripur, Bangladesh. We conducted a survey of two rural local government areas, including 8082 women, and identified cases based on self-report of a stillbirth outcome of each participant's first pregnancy. All were asked about STC during their first pregnancy and a range of risk markers and known confounders. Demographic and maternal variables associated either with stillbirth or STC were included in logistic regression models. RESULTS Of the 241 cases and 757 controls with complete exposure data, 32 cases (13.2%) and 18 controls (2.4%) reported STC during pregnancy [odds ratio 6.28; 95% confidence interval (CI) 3.45, 11.4]. After adjustment for education, household income, age at first pregnancy, vaccination during pregnancy, complications, exposure to arsenic in drinking water, place of delivery and antenatal care, excess risk was attenuated but remained significant [adjusted odds ratio (aOR) 2.87; 95% CI 1.36, 6.08]. There was a dose-effect association, with women who used smokeless tobacco >5 times daily during their first pregnancy at greater risk of having a stillbirth (aOR 5.89; 95% CI 1.70, 20.3) than less frequent users (aOR 1.67; 95% CI 0.65, 4.29). Estimates were robust to extreme assumptions about missing exposure data. DISCUSSION AND CONCLUSIONS STC during pregnancy was associated with an increased risk of stillbirth. This finding adds to the urgency of need for smokeless tobacco control strategies to be implemented in South Asia. [Hossain MS, Kypri K, Rahman B,Milton AH. Smokeless tobacco consumption and stillbirth: Population-based case-control study in rural Bangladesh.
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Affiliation(s)
| | - Kypros Kypri
- Centre for Clinical Epidemiology and Biostatistics, School of Medicine and Public Health, University of Newcastle, Newcastle, Australia
| | - Bayzidur Rahman
- School of Public Health and Community Medicine, University of New South Wales, Sydney, Australia
| | - Abul Hasnat Milton
- Centre for Clinical Epidemiology and Biostatistics, School of Medicine and Public Health, University of Newcastle, Newcastle, Australia
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Azam MN, Shahjahan M, Yeasmin M, Ahmed NU. Prevalence of Smokeless Tobacco among Low Socioeconomic Populations: A Cross-Sectional Analysis. PLoS One 2016; 11:e0156887. [PMID: 27275870 PMCID: PMC4898710 DOI: 10.1371/journal.pone.0156887] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2016] [Accepted: 05/21/2016] [Indexed: 11/28/2022] Open
Abstract
Background Cost, social acceptability and non-stringent regulations pertaining to smokeless tobacco (SLT) product sales have made people choose and continue using SLT. If disaggregated data on smokeless forms and smoked practices of tobacco are reviewed, the incidence of SLT remains static. There is a strong positive correlation of SLT intake with the occurrence of adverse cardiovascular disease, particularly in the low socioeconomic populations. Aims To investigate the prevalence of smokeless tobacco, its initiation influence and risk factors associated with the practice among lower socioeconomic populations of Bangladesh. In this study, we explore the utilization of SLT among lower socioeconomic populations in industrialized zone of Bangladesh. Methods A cross-sectional analysis using both quantitative and categorical approaches was employed. Using systematic random sampling method, four focus group discussions (FGDs) were conducted and 459 participants were interviewed. Multiple logistic regression model was applied to distinguish the significant factors among the SLT users. Results Almost fifty percent of the respondents initiated SLT usage at the age of 15–24 years and another 22 percent respondents were smoking and using SLT concurrently. The bulk of the women respondents used SLT during their pregnancy. Nearly twenty five percent of the respondents tried to quit the practice of SLT and one-quarter had a plan to quit SLT in the future. More than twenty percent respondents were suffering from dental decay. A noteworthy correlation was found by gender (p<0.01), sufferings from SLT related disease (p<0.05). The multiple logistic regression analysis suggested that, males were 2.7 times more knowledgeable than that of females (p<0.01) about the adversative health condition of SLT usage. The respondents suffering from SLT related diseases were 3.7 times as more knowledgeable about the effect of the practice of SLT than the respondents without diseases (p<0.01). Regarding the knowledge about the health consequences of the practice of SLT, one participant in the FGD session commented that “although the mouth is the gateway to health, we infected our mouth by using Zarda and Gul”. Again, informants opined that peer, family, curiosity and hospitality, culture are influencing factors for SLT initiation. Conclusion counselling on tobacco, including SLT, health hazards have to be emphasized through mass media and it is essential for development of relevant policies and communication messages to make people aware of serious health consequences of SLT usages.
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Affiliation(s)
- Mohammad Nurul Azam
- King Saud University, Riyadh, Kingdom of Saudi Arabia
- Daffodil International University, Dhaka, Bangladesh
- * E-mail: ;
| | - Mohammad Shahjahan
- Department of Public Health, Daffodil International University, Dhaka, Bangladesh
| | | | - Nasar U. Ahmed
- Department of Epidemiology, Florida International University, Miami, United States of America
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Mutti S, Reid JL, Gupta PC, Pednekar MS, Dhumal G, Nargis N, Hussain AG, Hammond D. Patterns of Use and Perceptions of Harm of Smokeless Tobacco in Navi Mumbai, India and Dhaka, Bangladesh. Indian J Community Med 2016; 41:280-287. [PMID: 27890978 PMCID: PMC5112969 DOI: 10.4103/0970-0218.193337] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Background: Globally, smokeless tobacco use is disproportionately concentrated in low-income and middle-income countries like India and Bangladesh. Objectives: The current study examined comparative patterns of use and perceptions of harm for different smokeless tobacco products among adults and youth in Navi Mumbai, India, and Dhaka, Bangladesh. Methods: Face-to-face interviews were conducted on tablets with adult (19 years and older) smokeless tobacco users and youth (16–18 years) users and non-users in Navi Mumbai (n = 1002), and Dhaka (n = 1081). Results: A majority (88.9%) of smokeless tobacco users reported daily use. Approximately one-fifth (20.4%) of the sample were mixed-users (used both smoked and smokeless tobacco), of which about half (54.4%) reported that they primarily used smokeless over smoked forms like cigarettes or bidis. The proportion of users planning to quit was higher in India than in Bangladesh (75.7% vs. 49.8%, p < 0.001). Gutkha was the most commonly used smokeless product in India, and pan masala in Bangladesh. Among users in Bangladesh, the most commonly reported reason for using their usual product was the belief that it was “less harmful” than other types. Perceptions of harm also differed with respect to a respondent's usual product. Bangladeshi respondents reported more negative attitudes toward smokeless tobacco compared to Indian respondents. Conclusions: The findings highlight the high daily use of smokeless tobacco, and the high prevalence of false beliefs about its harms. This set of findings reinforces the need to implement effective tobacco control strategies in low and middle-income countries like India and Bangladesh.
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Affiliation(s)
- Seema Mutti
- School of Public Health and Health Systems, University of Waterloo, 200 University Avenue West, Waterloo, Ontario, N2L3G1 Canada
| | - Jessica L Reid
- Propel Centre for Population Health Impact, University of Waterloo, 200 University Avenue West, Waterloo, Ontario, N2L3G1 Canada
| | - Prakash C Gupta
- Healis-Sekhsaria Institute for Public Health,501 Technocity, Plot X-4/5, MIDC, TTC Industrial Area, Mahape, Navi Mumbai 400701, India
| | - Mangesh S Pednekar
- Healis-Sekhsaria Institute for Public Health,501 Technocity, Plot X-4/5, MIDC, TTC Industrial Area, Mahape, Navi Mumbai 400701, India
| | - Gauri Dhumal
- Healis-Sekhsaria Institute for Public Health,501 Technocity, Plot X-4/5, MIDC, TTC Industrial Area, Mahape, Navi Mumbai 400701, India
| | | | - Akm Ghulam Hussain
- Department of Economics, University of Dhaka, Nilkhet, Dhaka-1000, Bangladesh
| | - David Hammond
- School of Public Health and Health Systems, University of Waterloo, 200 University Avenue West, Waterloo, Ontario, N2L3G1 Canada
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Mutti S, Reid JL, Gupta PC, Pednekar MS, Dhumal G, Nargis N, Hussain AKMG, Hammond D. Perceived effectiveness of text and pictorial health warnings for smokeless tobacco packages in Navi Mumbai, India, and Dhaka, Bangladesh: findings from an experimental study. Tob Control 2015. [DOI: 10.1136/tobaccocontrol-2015-052315] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Abdullah AS, Driezen P, Ruthbah UH, Nargis N, Quah ACK, Fong GT. Patterns and predictors of smokeless tobacco use among adults in Bangladesh: findings from the International Tobacco Control (ITC) Bangladesh survey. PLoS One 2014; 9:e101934. [PMID: 25007266 PMCID: PMC4090160 DOI: 10.1371/journal.pone.0101934] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2013] [Accepted: 06/13/2014] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Although smokeless tobacco (SLT) use is prevalent in South Asian countries including Bangladesh, information about the pattern and correlates of SLT use is scarce. This study described the pattern and predictors of SLT use among Bangladeshi adults. METHODS The data for this study were derived from the International Tobacco Control Policy Evaluation Bangladesh (ITC BD) Survey, a prospective cohort survey of a nationally representative sample of smokers and non-smokers, conducted during November 2011 and May 2012. The study included 5522 adults aged 15 or above. We used multiple logistic regression models to identify predictors of SLT use. RESULTS Of the respondents (N = 5522), 20% were SLT users. In general, SLT use was significantly higher among women, the illiterate and residents of the Dhaka slums or non-tribal/non-border areas outside Dhaka; SLT use increased with age. Several attitudinal factors were also associated with SLT use. Multivariable logistic regression analyses revealed several predictors of SLT use: being female (OR = 1.96, 95% confidence interval, CI: 1.18-3.24), an increasing age, being a resident of a Dhaka slum (OR = 5.86; 95% CI: 3.73-9.21) or non-tribal/non-border areas outside Dhaka (OR = 3.42; 95% CI: 1.94-6.03), being illiterate (OR = 3.37; 95% CI: 1.99-5.71), holding positive opinion towards societal approval of SLT use (OR = 5.84; 95% CI: 3.38-10.09), holding positive opinion towards SLT use by women (OR = 2.63; 95% CI: 1.53-4.54), believing that SLT is addictive (OR = 2.96; 95% CI: 1.51-5.81), and believing SLT is less harmful than bidi (OR = 2.22; 95% CI: 1.36-3.62). CONCLUSION The findings suggest that coordinated efforts of governmental and non-governmental organizations, targeting both smoked tobacco and SLT use reduction and cessation, could be modified to reach each level of population including those who are marginalized, female, less educated and elderly. As most tobacco control programs in Bangladesh target mainly cigarette or bidi smoking, coordinated programs are needed that will also include SLT use within the tobacco control policy and prevention strategies.
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Affiliation(s)
- Abu S. Abdullah
- Boston University School of Medicine, Boston Medical Center, Boston, Massachusetts, United States of America
- School of Public Health, Guangxi Medical University, Nanning, China
- * E-mail:
| | - Pete Driezen
- Propel Centre for Population Health Impact, University of Waterloo, Waterloo, Ontario, Canada
| | | | - Nigar Nargis
- Department of Economics, University of Dhaka, Dhaka, Bangladesh
- World Health Organization, Geneva, Switzerland
| | - Anne C. K. Quah
- Department of Psychology, University of Waterloo, Waterloo, Ontario, Canada
| | - Geoffrey T. Fong
- Department of Psychology, University of Waterloo, Waterloo, Ontario, Canada
- Ontario Institute for Cancer Research, Toronto, Ontario, Canada
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Hossain MS, Kypri K, Rahman B, Arslan I, Akter S, Milton AH. Prevalence and correlates of smokeless tobacco consumption among married women in rural Bangladesh. PLoS One 2014; 9:e84470. [PMID: 24416234 PMCID: PMC3885568 DOI: 10.1371/journal.pone.0084470] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2013] [Accepted: 11/20/2013] [Indexed: 11/24/2022] Open
Abstract
Objective To estimate the prevalence and identify correlates of smokeless tobacco consumption among married rural women with a history of at least one pregnancy in Madaripur, Bangladesh. Materials and Methods We conducted a cross-sectional survey using an interviewer administered, pre-tested, semi-structured questionnaire. All women living in the study area, aged 18 years and above with at least one pregnancy in their lifetime, who were on the electoral roll and agreed to participate were included in the study. Information on socio-demographic characteristics and smokeless tobacco consumption was collected. Smokeless tobacco consumption was categorized as ‘Current’, ‘Ever but not current’ and ‘Never’. Associations between smokeless tobacco consumption and the explanatory variables were estimated using simple and multiple binary logistic regression. Results 8074 women participated (response rate 99.9%). The prevalence of ‘Current consumption’, ‘Ever consumption but not current’, and ‘Never consumption’ was 25%, 44% and 31%, respectively. The mean age at first use was 31.5 years. 87% of current consumers reported using either Shadapata or Hakimpuree Jarda. Current consumption was associated with age, level of education, religion, occupation, being an income earner, marital status, and age at first use of smokeless tobacco. After adjustment for demographic variables, current consumption was associated with being over 25 years of age, a lower level of education, being an income earner, being Muslim, and being divorced, separated or widowed. Conclusion The prevalence of smokeless tobacco consumption is high among rural women in Bangladesh and the age of onset is considerably older than that for smoking. Smokeless tobacco consumption is likely to be producing a considerable burden of non-communicable disease in Bangladesh. Smokeless tobacco control strategies should be implemented.
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Affiliation(s)
- Mohammad Shakhawat Hossain
- School of Medicine and Public Health, Faculty of Health, The University of Newcastle, New Lambton Heights, New South Wales, Australia
| | - Kypros Kypri
- School of Medicine and Public Health, Faculty of Health, The University of Newcastle, New Lambton Heights, New South Wales, Australia
| | - Bayzidur Rahman
- School of Public Health and Community Medicine, The University of New South Wales, Sydney, New South Wales, Australia
| | - Iqbal Arslan
- Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh
| | - Shahnaz Akter
- Directorate General of Health Services, Dhaka, Bangladesh
| | - Abul Hasnat Milton
- School of Medicine and Public Health, Faculty of Health, The University of Newcastle, New Lambton Heights, New South Wales, Australia
- * E-mail:
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Tobacco use patterns. JOURNAL OF ENVIRONMENTAL AND PUBLIC HEALTH 2012; 2012:564390. [PMID: 23326279 PMCID: PMC3541557 DOI: 10.1155/2012/564390] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/11/2012] [Accepted: 10/11/2012] [Indexed: 11/18/2022]
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