Abstract
Smokeless tobacco (SLT) has long been realized as an important component of the fight for global tobacco control. It still remains a major problem in countries like India, Bangladesh and Nepal. The objective of this study was to estimate the trends of SLT use in three countries of the SEARO WHO office. We used data from national surveys in three countries (Bangladesh, India and Nepal) to estimate trends in prevalence of current SLT use. All available nationally representative data sources were used. Estimates were weighted, age standardized and given along with 95% confidence intervals. Significance of linear trend in prevalence over time was tested using the Cochrane-Armitage test for trend. A p value of less than 0.05 was considered statistically significant. We identified three surveys for Bangladesh, three for India and four for Nepal that met the selection criteria (such as Demographic and Health Surveys, WHO-STEPwise approach to Surveillance and Global Adult Tobacco Surveys). A significantly increasing trend was noticed in the prevalence of current SLT use among Bangladeshi men (20.2% to 23%, p=0.03). In India, a similar significantly increasing trend was seen among men (27.1% to 33.4%, p<0.001) and women (10.1% to 15.7%, p<0.001). In Nepal, there was a no significant trend among both men (39.1% to 31.6%, p=0.11) and women (5.6% to 4.7%, p=0.49). In the study countries SLT use has remained at alarmingly high levels. Usage trends do not show any signs of decline in spite of control efforts. Tobacco control measures should focus more on controlling SLT use.
Highlights
It has been predicted that if the current trends of tobacco use are unchecked the number of tobacco related deaths will reach eight million by 2030, with approximately 70% of these deaths occurring in developing countries. (WHO, 2008) Smokeless Tobacco (SLT) use affects nearly 300 million people worldwide and about 90% of the world’s users reside in the South-East Asia Region (SEAR) of the World Health Organization (WHO). (NCI, 2014) SLT use is so prevalent in this region that in certain countries like India it exceeds the prevalence of smoking
SLT has been recognized as an important component of the tobacco control efforts there has been no palpable decline in the South-East Asian countries. (WHO, 2011; Ansara et al, 2013; Bhawna, 2013) Similar to tobacco smoking, SLT use has been known to cause several health problems, mainly upper aero-digestive tract cancer, pancreatic cancer, lung cancer, ischemic heart disease, stroke, adverse reproductive outcomes, addiction and others. (USDHHS, 1986; International Agency for Research on Cancer (IARC), 2007; European Commission (EC), 2008; Piano et al, 2010; (Ng et al, 2014) examined trends in smoking prevalence for 187 countries between 1980 and 2012 and found that the age-standardized prevalence of daily tobacco smoking declined by 25% globally with an initial rapid decline followed by a much slower decline after 2006
Based on the pre-specified selection criteria a number of surveys were identified for trend analysis. (Table 1) For Bangladesh we identified six surveys that were conducted between 2004 and 2013
Summary
It has been predicted that if the current trends of tobacco use are unchecked the number of tobacco related deaths will reach eight million by 2030, with approximately 70% of these deaths occurring in developing countries. (WHO, 2008) Smokeless Tobacco (SLT) use affects nearly 300 million people worldwide and about 90% of the world’s users reside in the South-East Asia Region (SEAR) of the WHO. (NCI, 2014) SLT use is so prevalent in this region that in certain countries like India it exceeds the prevalence of smoking. SLT has been recognized as an important component of the tobacco control efforts there has been no palpable decline in the South-East Asian countries. (WHO, 2011; Ansara et al, 2013; Bhawna, 2013) Similar to tobacco smoking, SLT use has been known to cause several health problems, mainly upper aero-digestive tract cancer, pancreatic cancer, lung cancer, ischemic heart disease, stroke, adverse reproductive outcomes, addiction and others. (USDHHS, 1986; IARC, 2007; EC, 2008; Piano et al, 2010; (Ng et al, 2014) examined trends in smoking prevalence for 187 countries between 1980 and 2012 and found that the age-standardized prevalence of daily tobacco smoking declined by 25% globally with an initial rapid decline followed by a much slower decline after 2006. (USDHHS, 1986; IARC, 2007; EC, 2008; Piano et al, 2010; (Ng et al, 2014) examined trends in smoking prevalence for 187 countries between 1980 and 2012 and found that the age-standardized prevalence of daily tobacco smoking declined by 25% globally with an initial rapid decline followed by a much slower decline after 2006. Smokeless tobacco (SLT) has long been realized as an important component of the fight for global tobacco control It still remains a major problem in countries like India, Bangladesh and Nepal. Materials and Methods: We used data from national surveys in three countries (Bangladesh, India and Nepal) to estimate trends in prevalence of current SLT use. Tobacco control measures should focus more on controlling SLT use
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