Prevailing Familial, Social and Cultural Obstacles in Keeping Tobacco-Free Homes in Urban Areas of Bangladesh: A Mixed-Methods Study

Abstract

Background: Homes across the world are places where millions of children and others dangerously exposed to tobacco smoke and toxins. There is limited interest in laws and interventions controlling tobacco use in public places in Bangladesh, but no attention has been given to preventing tobacco use inside people's homes. This study examined familial, social and cultural obstacles in urban residential areas that traditionally prevent homes from being tobacco-free. Methods: An integrated mixed-methods design was adopted during March to October 2016. 24 In-Depth Interviews and a cross-sectional survey with 400 tobacco users were conducted across the Dhaka City, Bangladesh. Survey data were analysed using multivariate logistic regression with thematic contents used to analyse the qualitative data. Results: Multivariate logistic regression analysis identified that the familial and social factors were significantly associated with tobacco use at home: smoking habits of any family member (OR=3.562, 95% CI: 2.151-5.899; P<0.0001); no obstacle from family members for smoking (OR=1.436, 95% CI: 883-2.335); smoking as a sign of smartness (OR=1.197, 95% CI: 732-1.960), and smokeless tobacco sharing seen as a sign of intimacy at home (OR=1.378, 95% CI: 835-2.276). Qualitative data showed that societal fallacies, lack of religiosity, tobacco use of older members, and lack of familial control provided obstacles in enabling tobacco-free homes in urban homes. Interpretation: Use of tobacco at home is continuing as part of established familial and social norms. If tobacco use 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. Funding: Institute for Global Tobacco Control (IGTC) at the Johns Hopkins Bloomberg School of Public Health (JHSPH), USA. Declaration of Interests: The authors declared no competing interests. Ethics Approval Statement: The study protocol was reviewed and approved by the National Research Ethics Committee (NREC) of the Bangladesh Medical Research Council (BMRC).