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Ravi P, Muralidhar K, Madhivanan P, Wilson AM, von Hippel FA, Salamova A, Moya E, Gerald LB. Occupational exposures among women beedi workers in Mysore District, India: A mixed-methods study protocol. PLoS One 2024; 19:e0297638. [PMID: 38573933 PMCID: PMC10994336 DOI: 10.1371/journal.pone.0297638] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2023] [Accepted: 01/05/2024] [Indexed: 04/06/2024] Open
Abstract
Beedi is the most common smoking form of tobacco used in India. The rolling of beedis is performed primarily by women in settings that lack occupational safeguards. The aims of this protocol are to establish methods for the study of occupational exposures among women beedi workers and their experiences and challenges working with unburnt tobacco. This protocol employs a convergent parallel mixed-methods approach. Qualitatively, we plan to explore the experiences and challenges faced by women beedi workers using photovoice, a community based participatory method. Occupational exposures to pesticides will be assessed through the use of silicone wristbands worn for seven days by workers, and exposure to toxic metals and metalloids will be assessed in dust samples collected in the homes of workers. The outcomes will be analyzed to form policy recommendations to improve the occupational health of women beedi workers.
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Affiliation(s)
- Priyanka Ravi
- Department of Health Promotion Sciences, Mel & Enid Zuckerman College of Public Health, University of Arizona, Tucson, Arizona, United States of America
| | - Kiranmayee Muralidhar
- Public Health Research Institute of India, Mysore, India
- JSS Academy of Higher Education and Research, Mysore, India
| | - Purnima Madhivanan
- Department of Health Promotion Sciences, Mel & Enid Zuckerman College of Public Health, University of Arizona, Tucson, Arizona, United States of America
- Public Health Research Institute of India, Mysore, India
| | - Amanda M. Wilson
- Department of Community, Environment & Policy, Mel & Enid Zuckerman College of Public Health, University of Arizona, Tucson, Arizona, United States of America
| | - Frank A. von Hippel
- Department of Community, Environment & Policy, Mel & Enid Zuckerman College of Public Health, University of Arizona, Tucson, Arizona, United States of America
| | - Amina Salamova
- Rollins School of Public Health, Emory University, Atlanta, Georgia, United States of America
| | - Eva Moya
- Border Biomedical Research Center, The University of Texas, El Paso, Texas, United States of America
| | - Lynn B. Gerald
- Population Health Sciences Program, University of Illinois, Chicago, Illinois, United States of America
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Tyagi J, Beri D, Ingale S, Sinha P, Bhaumik S. Occupational health hazards of bidi workers and their families in India: a scoping review. BMJ Glob Health 2023; 8:e012413. [PMID: 37918876 PMCID: PMC10626877 DOI: 10.1136/bmjgh-2023-012413] [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: 03/27/2023] [Accepted: 08/29/2023] [Indexed: 11/04/2023] Open
Abstract
BACKGROUND Bidi workers and their families are exposed to harmful substances during bidi rolling, thereby jeopardising their health. We aimed to assess existing evidence on health conditions of bidi workers and their families in India. METHODS We searched nine databases and relevant websites, and conducted citation screening to identify primary studies assessing occupational health hazards of bidi workers and their families. Two authors independently conducted screening and data extraction. We synthesised the findings narratively in a structured fashion. RESULTS We found 3842 studies, out of which 95 studies met our eligibility criteria. High prevalence of disease conditions across all organ systems of the body was reported in bidi workers. Studies on female bidi workers showed decreased fertility (n=2), increased frequency of miscarriages (n=1) and higher risk of cervical cancer (n=1). Pregnant bidi workers were at an increased risk of anaemia and pregnancy-induced hypertension (n=2), higher frequency of neonatal deaths (n=1), stillbirths (n=1) and premature births (n=1) in comparison with non-bidi workers. Babies born to bidi workers reported low birth weight (n=5). Evidence from cohort studies suggests causal nature of the exposure to the disease condition. CONCLUSION Our review shows that bidi rolling leads to numerous occupational health hazards in bidi workers and their family members. It is essential to provide alternative livelihoods, and safe and protective working environment, and cover bidi workers under various social security provisions to alleviate the deleterious effect of bidi making at home. It is also important to shift bidi making away from home and strengthen existing regulations and promulgation of new provisions, including India's Occupational Safety, Health, and Working Conditions Code 2020.
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Affiliation(s)
- Jyoti Tyagi
- Meta-Research and Evidence Synthesis, The George Institute for Global Health, New Delhi, Delhi, India
| | - Deepti Beri
- Injury Division, The George Institute for Global Health, New Delhi, Delhi, India
| | - Samiksha Ingale
- Meta-Research and Evidence Synthesis, The George Institute for Global Health, New Delhi, Delhi, India
| | - Praveen Sinha
- Non-Communicale Disease Division, WHO Country Office for India, New Delhi, Delhi, India
| | - Soumyadeep Bhaumik
- Meta-Research and Evidence Synthesis, The George Institute for Global Health, New Delhi, Delhi, India
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Russell A, Chandra P, Robson M, Narayanan P, Joseph S, Mukherjee P, Aghi M, Otañez M, Dutta M, Bhojani U, Pathak P, John S. Implementing FCTC Article 17 Through Participatory Research With Bidi Workers in Tamil Nadu, India. Nicotine Tob Res 2022; 24:1714-1719. [PMID: 35349705 PMCID: PMC9597000 DOI: 10.1093/ntr/ntac075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2021] [Revised: 02/22/2022] [Accepted: 04/05/2022] [Indexed: 11/24/2022]
Abstract
INTRODUCTION The exploitation, poor conditions, and precarity in the bidi (hand-rolled leaf cigarette) industry in India make it ripe for the application of the FCTC's Article 17, "Provision of support for economically viable alternative activities". "Bottom-up", participatory approaches give scope to explore bidi rollers' own circumstances, experiences, and aspirations. METHODS A team of six community health volunteers using a participatory research orientation developed a questionnaire-based semi-structured interview tool. Forty-six bidi rolling women were interviewed by pairs of volunteers in two northern Tamil Nadu cities. Two follow-up focus groups were also held. A panel of 11 bidi rollers attended a workshop at which the findings from the interviews and focus groups were presented, further significant points were made and possible alternatives to bidi rolling were discussed. RESULTS Bidi workers are aware of the adverse impact of their occupation on them and their families, as well as the major risks posed by the product itself for the health of consumers. However, they need alternative livelihoods that offer equivalent remuneration, convenience, and (in some cases) dignity. Alternative livelihoods, and campaigns for better rights for bidi workers while they remain in the industry, serve to undercut industry arguments against tobacco control. Responses need to be diverse and specific to local situations, i.e. "bottom-up" as much as "top-down", which can make the issue of scaling up problematic. CONCLUSION Participatory approaches involving bidi workers themselves in discussions about their circumstances and aspirations have opened up new possibilities for alternative livelihoods to tobacco. IMPLICATIONS Progress with the FCTC's Article 17 has generally been slow and has focussed on tobacco cultivation rather than later stages in the production process. The bidi industry in India is ripe for the application of an alternative livelihoods approach. This study is one of the first to use participatory methods to investigate the circumstances, experiences, and aspirations of bidi workers themselves.
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Affiliation(s)
- Andrew Russell
- Department of Anthropology, Durham University, Durham, UK
| | - P Chandra
- D Arul Selvi Rehabilitation Trust, Tirupattur, India
| | - Mary Robson
- Institute for Medical Humanities, Durham University, Durham, UK
| | | | - Stanley Joseph
- Praxis Institute for Participatory Practices, New Delhi, India
| | | | - Mira Aghi
- Healis Sekhsaria Institute for Public Health, Mumbai, India
| | - Marty Otañez
- Anthropology Department, University of Colorado, Denver, CO, USA
| | - Madhumita Dutta
- Department of Geography, Ohio State University, Columbus, OH, USA
| | | | | | - Sushil John
- Low Cost Effective Care Unit, CMC Vellore, Vellore, India
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Gogoi N, Sumesh SS. The Political Economy of Public Health Inequalities and Inequities in India: Complexities, Challenges, and Strategies for Inclusive Public Health Care Policy. INTERNATIONAL JOURNAL OF HEALTH SERVICES 2022; 52:225-235. [PMID: 35084231 DOI: 10.1177/00207314211066748] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This article examines the political economy of health inequalities and inequities in the public health care system in India and identifies potential areas for interventions to promote equal and equitable health care for marginalized people. Drawing on the Political Economy of Health Model of Research, this article reiterates the inadequacy of policy frameworks and programs in ensuring accessible, affordable, and quality public health care services to all. We argue that for policies to be successful, policymakers should consider the diverse social registries of class, caste, religion, gender, region, ethnicity, and age, as well as their intersections. We also argue that health care policies and programs need to be: (a) dynamic and flexible, (b) intersectional and backed up by sufficient grassroots research, and (c) equitable at every stage of policy formulation, implementation, and evaluation.
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Affiliation(s)
| | - S S Sumesh
- 28688Tezpur University, Sonitpur, Assam, India
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Ancy RJ, Shenoy RP, Jodalli PS, Sonde L, Mohammed IP. Comparative Evaluation of Salivary Sialic Acid Levels Among Beedi Rollers and Tobacco Users in Mangalore, South India. Cureus 2021; 13:e16651. [PMID: 34462684 PMCID: PMC8387602 DOI: 10.7759/cureus.16651] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/26/2021] [Indexed: 11/25/2022] Open
Abstract
Introduction: According to World Health Organization, the global cancer burden is estimated to have risen to 18.1 million new cases and 9.6 million deaths in 2018. Tobacco use is a leading cause of cancer and of death from cancer. Beedis are the most popular smoking form of tobacco in India. Thirty-four percent of the tobacco produced in India is used for making beedis. The beedi sector is agroforestry-based and the second largest industry in India with approximately 4.4 million full-time beedi workers in India. Toxic constituents present in tobacco are released into the ambient air during the processing of beedis. Methods: A descriptive cross-sectional study was conducted to assess and compare salivary sialic acid levels among beedi rollers, tobacco smokers, smokeless tobacco users and individuals with no tobacco exposure. The study sample comprised of 140 individuals who were 30 to 60 years old, who attended dental screening and treatment camps in rural and urban areas in Mangalore, conducted by the Department of Public Health Dentistry, Yenepoya Dental College and patients who visited the Department of Oral Medicine and Radiology of Yenepoya Dental College. Saliva was collected by passive drool method into a sterile container. Biochemical analysis of salivary sialic acid was done using the acidic ninhydrin method. Continuous variables are expressed in terms of mean and standard deviation. Categorical variables are expressed in terms of frequencies and percentages. To compare salivary sialic acid levels between the groups ANOVA was used. The Chi-square test was used to compare categorical variables between the groups. Results: A total of 140 participants, 35 beedi rollers, 35 smokers, 35 smokeless tobacco users and 35 individuals with no tobacco exposure participated in the study. Among the 140 participants, 90 participants were males and 50 participants were females. There was a statistically significant difference in the mean salivary sialic acid level between the different groups (p<0.001) with smokeless tobacco users having the highest (10.60 mg/dL) mean salivary sialic acid level. It was found that the mean salivary sialic acid level reduced as the age progressed, even though there was no statistically significant difference. There was a statistically significant difference in the mean salivary sialic acid level between the different groups (p=0.010) with participants with 11 to 20 years of exposure to tobacco having the highest (8.67 mg/dL) mean salivary sialic acid level and participants with no tobacco exposure having least (3.06 mg/dL) mean salivary sialic acid level. Conclusion: The salivary sialic acid level was more in beedi rollers than individuals with no tobacco exposure, even though the difference was not statistically significant. The results showed elevated levels of salivary sialic acid in smokeless tobacco users followed by tobacco smokers. This may be an indication that smokeless tobacco use has harmful effects similar to or more than tobacco smoking since salivary sialic acid levels in smokeless tobacco users were higher than those in smokers.
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Affiliation(s)
- R J Ancy
- Public Health Dentistry, Century International Institute of Dental Science and Research Centre, Kasaragod, IND
| | - Rekha P Shenoy
- Public Health Dentistry, Yenepoya Dental College and Hospital, Mangalore, IND
| | - Praveen S Jodalli
- Public Health Dentistry, Yenepoya Dental College and Hospital, Mangalore, IND
| | - Laxminarayan Sonde
- Public Health Dentistry, Yenepoya Dental College and Hospital, Mangalore, IND
| | - Imran P Mohammed
- Public Health Dentistry, Yenepoya Dental College and Hospital, Mangalore, IND
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Abstract
Purpose
This paper aims to provide a gendered analysis of the WHO Framework Convention on Tobacco Control (FCTC) benchmarked upon the global commitments to women’s health and well-being in the UN Convention on the Elimination of All Forms of Discrimination against Women (CEDAW) and the Beijing Declaration and Platform for Action. It reviews evidence of the global consequences of neglecting women’s tobacco use and health, as well as analyzes persistent issues related to sex and gender that compromise the efficacy of tobacco control and science. Actionable recommendations are made to the Conference of the Parties to the FCTC and other key stakeholders.
Design/methodology/approach
This paper draws upon empirical studies, literature reviews and global health data at the varying intersections of gender, sex, tobacco and global health.
Findings
The global tobacco control framework and its implementation by state governments have been largely gender blind to date with dire health and economic consequences, including inequitable positive outcomes for men compared to women, and an increase in women’s smoking with associated morbidity and mortality. Gender equitable progress in combatting the tobacco epidemic will not be possible without resolving the gender bias, stigmatization, sexism and lack of intersectionality that plague tobacco control policy, research and interventions for cessation and harm reduction.
Originality/value
This paper provides an updated global overview of current trends in women’s tobacco use and comprehensively details the persistent structural barriers in tobacco control and science that limit their capacity to effectively analyze and address tobacco use and its impact on women.
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