Bidi Smoking Research Articles

Women and tobacco: a cross sectional study from North India.

Tobacco is a leading risk factor for different types of diseases globally. Tobacco smoking by women is culturally unacceptable in India, but still women smoke tobacco at various times of their life. The aim was to estimate the prevalence and pattern of tobacco use among women and to study the associated sociodemographic factors. This cross-sectional study was conducted among women aged 30 years or over in an urban resettlement colony for the migrant population at Chandigarh, India. The study included women used tobacco products on one or more days within the past 30 days. Through systematic random sampling, 262 women were studied. As a part of the study 144 bidi smoking women were interviewed using detailed semi-structured questionnaire. Descriptive statistics and hypothesis testing with Chi-squared test and logistic regression were done using SPSS 16.0 version. Overall, the prevalence of tobacco use was 29.4% and that of bidi, zarda and hookah were 19.8%, 8.8%, and 2.7%, respectively. Around 6.2% women used tobacco during pregnancy. Teenage was the most common age of initiation of bidi smoking. Logistic regression analysis showed that the prevalence of tobacco use was high among Hindu unemployed women with no formal education belonged to scheduled caste, and those having grandchildren. This study highlighted high rates of tobacco use and explored both individual and family factors related to tobacco use among women. Affordable, culturally acceptable, sustainable and gender-sensitive individual and community-specific interventions will reduce the prevalence and effects of tobacco use.

Lifestyle Factors Including Diet and Leukemia Development: a Case-Control Study from Mumbai, India

In India, among males, leukemia rates vary across the country. The present unmatched hospital-based case- control study conducted at Tata Memorial Hospital included subjects registered between the years 1997-99. There were 246 leukemia cases and 1,383 normal controls. Data on demographics, lifestyle, diet and occupation history were recorded. Cigarette (OR=2.1) and bidi smoking (OR=3.4) showed excess risk for leukemia. Odds ratios were 3.9 for fish-eaters, 0.40 for chilli eaters, 1.5 for milk drinkers and 0.60 for coffee drinkers, compared to non-drinkers/eaters. However, neither exposure to use of pesticides nor cotton dust showed any excess risk for leukemia.

The Effect of Tobacco Control Measures during a Period of Rising Cardiovascular Disease Risk in India: A Mathematical Model of Myocardial Infarction and Stroke

We simulated tobacco control and pharmacological strategies for preventing cardiovascular deaths in India, the country that is expected to experience more cardiovascular deaths than any other over the next decade. A microsimulation model was developed to quantify the differential effects of various tobacco control measures and pharmacological therapies on myocardial infarction and stroke deaths stratified by age, gender, and urban/rural status for 2013 to 2022. The model incorporated population-representative data from India on multiple risk factors that affect myocardial infarction and stroke mortality, including hypertension, hyperlipidemia, diabetes, coronary heart disease, and cerebrovascular disease. We also included data from India on cigarette smoking, bidi smoking, chewing tobacco, and secondhand smoke. According to the model's results, smoke-free legislation and tobacco taxation would likely be the most effective strategy among a menu of tobacco control strategies (including, as well, brief cessation advice by health care providers, mass media campaigns, and an advertising ban) for reducing myocardial infarction and stroke deaths over the next decade, while cessation advice would be expected to be the least effective strategy at the population level. In combination, these tobacco control interventions could avert 25% of myocardial infarctions and strokes (95% CI: 17%-34%) if the effects of the interventions are additive. These effects are substantially larger than would be achieved through aspirin, antihypertensive, and statin therapy under most scenarios, because of limited treatment access and adherence; nevertheless, the impacts of tobacco control policies and pharmacological interventions appear to be markedly synergistic, averting up to one-third of deaths from myocardial infarction and stroke among 20- to 79-y-olds over the next 10 y. Pharmacological therapies could also be considerably more potent with further health system improvements. Smoke-free laws and substantially increased tobacco taxation appear to be markedly potent population measures to avert future cardiovascular deaths in India. Despite the rise in co-morbid cardiovascular disease risk factors like hyperlipidemia and hypertension in low- and middle-income countries, tobacco control is likely to remain a highly effective strategy to reduce cardiovascular deaths.

Tobacco use, smoking quit rates, and socioeconomic patterning among men and women: a cross-sectional survey in rural Andhra Pradesh, India

Tobacco use is common in India and a majority of users are in rural areas. We examine tobacco use and smoking quit rates along gender and socioeconomic dimensions in rural Andhra Pradesh. Data come from a cross-sectional survey. Markers of socioeconomic status (SES) were education, occupation, and income. Regression analyses were undertaken to examine determinants of current smoking, smoking quit rates, tobacco use by type (cigarettes, bidis, and chewing), and quantity consumed (number per day, pack-years). The weighted prevalence of current smoking and tobacco chewing was higher in men (50.3%, 95% confidence interval, CI, 48.1-52.6 and 5.0%, 95% CI 4.1-5.9, respectively) compared with women (4.8%, 95% CI 3.9-5.7 and 1.0%, 95% CI 0.6-1.4, respectively) and higher among older age groups. The quit rate was higher in women (45.5%, 95% CI 38.7-52.2) compared to men (18.8%, 95% CI 16.7-20.9). Illiterate individuals were more likely to be current smokers of any type compared to those with secondary/higher education (odds ratio, OR, 3.25, 95% CI 2.54-4.16), although cigarette smoking was higher in men of high SES. Smoking quit rates were positively associated with SES (OR 2.56, 95% CI 1.76-3.71) for secondary/higher education vs. illiterates. Level of consumption increased with SES and those with secondary/higher education smoked an additional 1.93 (95% CI 1.08-2.77) cigarettes or bidis per day and had an additional 1.87 (95% CI 0.57-3.17) pack-years vs. illiterates. The social gradients in cigarette smoking and level of consumption contrasted those for indigenous forms of tobacco (bidi smoking and chewing). International prevention and cessation initiatives designed at modifying Western-style cigarette usage will need to be tailored to the social context of rural Andhra Pradesh to effectively influence the use of cigarettes and equally harmful indigenous forms of tobacco.

Burden of Smoked and Smokeless Tobacco Consumption in India - Results from the Global adult Tobacco Survey India (GATS-India)- 2009-2010

The Global Adult Tobacco Survey (GATS) was carried out for systematically monitoring tobacco use and for tracking key tobacco control indicators. A total of 70,802 households, including 42,647 in rural areas and 28,155 in urban areas, were covered with a three stage sampling design. Data were collected on sociodemographic characteristics, knowledge, attitude and practices of tobacco consumption. GATS-India highlighted that total tobacco use among its residents is overall 34.6%, varying for males (47.9%) and females (20.7%). The rural areas of the country exhibit comparatively higher prevalence rates (38.4%) in comparison to urban areas (25.3%). Overall, Khaini, a smokeless tobacco product (12.0%), is the most popular form of tobacco use among males and females, followed by bidi smoking (9.0%). Results of GATS data can be used as baseline for evaluation of new tobacco control approaches in India integrating culturally acceptable and cost effective measures.

Case-control Study of Risk Factors for Non-Hodgkin Lymphoma in Mumbai, India

In the year 2010, it is estimated that nearly 0.36 million new cases and 0.19 million deaths with Non-Hodgkin lymphoma occurred. In India, among males, NHL incidence rates vary across the country which has encouraged us to conduct a case-control study to study risk factors. The present unmatched hospital-based case-control study conducted at Tata Memorial Hospital included subjects registered between the years 1997-99. There were 390 'lymphoma cases' and 1,383 'normal controls. Data on age, tobacco habits, occupational history, dietary factors, tea, coffee were collected by the social investigators. Univariate and multivariate methods were applied for obtaining the odds ratios for risk factors. In the study, cigarette smoking (OR=2.0) and bidi smoking (OR=2.8), were associated with excess risk of lymphoma. Among the dietary items, only consumption of mutton showed 7.3-fold significant excess risk for lymphoma. Consumption of milk showed a 6-fold excess risk (OR=1.5); while coffee showed a 50% reduction in risk for lymphoma. Among occupational exposure, exposure to use of pesticides showed 3-fold excess risk for lymphoma.

Chronic Smoking and Buerger’s Disease: A Hospital Based Study

Introduction: The role of tobacco smoking and Buerger's Disease has been examined in different countries. However, still there is need to understand the basic pathology and the conclusive important reasons of its causation because of differing observations among smokers of various socio-economic and geo- political settings. Hence, the study highlights the scenario, as observed in a developing country, for further designing and undertaking of the research in this regards. Purpose: To assess the prevalence of Buerger's Disease among various groups of traditionally used locally manufactured bidi smokers. Materials and methods: The use of pre-designed questionnaire in this hospital based study was followed by venography and arteriography in the affected patients. Results: Smoking was found highly associated with Bidi Smoking in terms of duration and frequency of smoking. The location of lesions and their commonality was also ascertained. Conclusion: Cessation of using unfiltered locally made Bidi smoking is required for minimizing the cases of Buerger's Disease.

Comparative study of lipid profiel on healthy smoker and non smokers

Background: Smoking is considered to cause heart disease, cancer, stroke and also have close relationship with gastric ulcer, periodontal disease, sudden infant death syndrome, and metabolic syndrome. Aims & Objective: (1) Study the effect of smoking on lipid profile of healthy smokers (2) To compare the lipid profile of both smokers and non-smokers (3)To study the effect of severity and duration of smoking on lipid profile. Material and Methods: The present study “Comparative study of lipid profile on healthy smoker and non-smokers” was carried out at Department of Physiology, Govt. Medical college, Bhavnagar on 100 healthy smokers and non-smokers. Results: The total serum cholesterol, LDL, VLDL and Triglyceride values were higher in smokers as compared to Non-smokers. These values increased with increase in number of Cigarette/bidis smoked. Serum levels of HDL are lower in smokers than the same in non-smokers. Serum HDL levels decrease with increase in number of Cigarette/bidis smoked. Association of HDL had inverse relationship with cigarettes/bidis smoked per day. Increase in duration of smoking adversely affects lipid profile. Bidi smoking has more adverse effects HDL than cigarette smoking although statistically significant results were not obtained. It shows that serum anti-atherogenic HDL-C level is significantly low in chronic smokers irrespective of the number of cigarettes smoked. The serum level of total cholesterol, LDL-C and VLDL-C and TG are significantly increased with the severity of smoking. The results shows that smoking influences the lipid profile adversely hence causing dyslipidaemia in smokers. Smoking results in increase in oxidized LDL-cholesterol level which plays a key role in the development of atherosclerosis, and also raising the cardiovascular disease risk. Conclusion: Tobacco smoking is associated with dyslipidaemia (Increase LDL-C and decrease HDL-C levels), which is atherogenic in nature. As tobacco smoking interacts with other risk factors, the tobacco smokers get additional benefit if these factors are diagnosed and managed adequately. These risk profiles may be helpful in developing preventive cardiovascular strategies for adolescents.

Compliance monitoring of prohibition of smoking (under section-4 of COTPA) at a tertiary health-care institution in a smoke-free city of India

Background:India enacted a comprehensive tobacco control law known as cigarettes and other tobacco products act (COTPA) in 2003. However, enforcement of the provisions under the law is still a matter of concern. Compliance survey is an effective tool to measure the status of implementation of the law at various public places. Smoke-free hospital campus demonstrates commitment to good health and sends a pro-healthy signal to the community.Objective:The objective of this study was to assess the compliance to the prohibition of smoking at public places (under section-4 of COTPA) in a tertiary health-care institution in a smoke-free city of India.Materials and Methods:An observational cross-sectional study was conducted at 40 different venues within a tertiary health-care institution in a smoke-free city of India. These places were observed for certain parameters of assessment by a structured checklist, which included evidence of active smoking, evidence of recent smoking, display of signages, presence of smoking aids, cigarette butts and bidi ends.Results:Overall compliance rate for section-4 of COTPA was found to be mere 23%. Evidence of active smoking was observed in 21 (52.5%) venues. Signages were seen at only 8 places (20%). Butt ends and other smoking aids were seen in 37 (92.5%) and 26 (65%) places respectively.Conclusion:These dismal findings suggest non-compliance to the provisions under COTPA, which calls for a sensitization workshop and advocacy for all the stakeholders.

Tobacco Consumption and Illegal Drug Use Among Bangladeshi Males

This article aimed to identify the determinants of tobacco consumption and illegal drug use (IDU) as well as to examine the association between these two variables using a representative sample of 3,771 Bangladeshi males aged 15 to 54 years. Data were collected through Bangladesh Demographic and Health Survey 2007. To identify the determinants, the patterns of tobacco consumption and IDU were analyzed by age, education and occupation, residence, mass media, premarital sex, wealth, and sexually transmitted infections (STIs). Prevalence of smoking cigarette and bidi was roughly 60%. However, the prevalence of IDU was 3.4%, and this proportion is statistically significant (Z = 11.32, p = .000). After bivariate analysis, almost all variables except STIs were significantly associated with tobacco consumption. Similarly, all variables except residence and mass media were associated with IDU. Based on multivariable adjusted logistic regression analysis, the likelihood of using IDU was approximately twofold (odds ratio [OR] = 1.8, 95% confidence interval [CI] = 1.23-2.53) among bidi smokers and fourfold (OR = 3.8, 95% CI = 2.62-5.56) among cigarette smokers as compared with nonsmokers.

Hookah smoking, nass chewing, and oesophageal squamous cell carcinoma in Kashmir, India

Background:Although cigarette smoking is an established risk factor for oesophageal squamous cell carcinoma (ESCC), there is little information about the association between other smoking and smokeless tobacco products, including hookah and nass, and ESCC risk. We conducted a case–control study in Kashmir Valley, India, where hookah smoking, nass chewing, and ESCC are common, to investigate the association of hookah smoking, nass use, and several other habits with ESCC.Methods:We recruited 702 histologically confirmed ESCC cases and 1663 hospital-based controls, individually matched to the cases for age, sex, and district of residence from September 2008 to January 2012. Conditional logistic regression models were used to calculate odds ratios (ORs) and 95% confidence intervals (95% CIs).Results:Ever-hookah smoking (OR=1.85; 95% CI, 1.41–2.44) and nass chewing (OR=2.88; 95% CI, 2.06–4.04) were associated with ESCC risk. These associations were consistent across different measures of use, including intensity, duration, and cumulative amount of use, and after excluding ever users of the other product and cigarette smokers. Our results also suggest an increased risk of ESCC associated with ever-gutka chewing and -bidi smoking. However, the latter associations were based on small number of participants.Conclusion:This study shows that hookah and nass use are associated with ESCC risk. As prevalence of hookah use seems to be increasing among young people worldwide, these results may have relevance not only for the regions in which hookah use has been a traditional habit, but also for other regions, including western countries.

Frequently used healthcare services in urban slums of Dhaka and adjacent rural areas and their determinants

To compare patterns of healthcare service user preference between urban slums in Dhaka and adjacent rural areas and to identify key determinants of those preferences. The data were collected through baseline surveys conducted in 2008 and 2009. A total of 3207 subjects aged 10-90 years were systematically selected from 12 big slums in Dhaka and 3 rural villages outside Dhaka. Two frequently used healthcare sources utilized in 1 month preceding the baseline survey were pharmacies (slum, 42.6%; rural, 30.1%) and government hospitals/clinics (GVHC; slum, 13.5%; rural, 8.9%). According to the multilevel logistic regression analysis adjusted for age, sex and marital status, the likelihood of using pharmacies and GVHC were higher for those subjects who used non-hygienic toilets, who reported food deficiency at a family level, who expressed dissatisfaction about family income and who stated poor health status. Some more factors namely overweight, living in permanently structured house, smoking bidis and less frequency of watching TV were associated with higher likelihood of using GVHC. Pharmacy was the most dominant healthcare service in both areas. As persons running pharmacies often provide poor quality of healthcare services, they need continuous training and back-up supports to improve their quality of services and to strengthen the overall healthcare system in Bangladesh.

The relevance of "Nonsmoking-associated lung cancer" in India: A single-centre experience

Lung cancer remains a major cause of morbidity and mortality worldwide, accounting for more deaths than any other cancer cause. The aim of this study was to analyze the clinical profile and the epidemiological trends in lung cancer patients from a single centre with an emphasis on the smoking practices. This is a retrospective analysis of prospectively collected data of 258 consecutive hospital in-patients with a proven diagnosis of lung cancer at a tertiary care oncology centre between 2003 and 2007. The median age of patients in our study was 56 years; the male to female ratio was approximately 3.5:1. Non-small-cell lung cancer (NSCLC) was the predominant histology in 224 patients; the histology in the remaining 34 patients was small-cell carcinoma. Within NSCLC, the most common histology was adenocarcinoma followed by squamous cell carcinoma. One hundred and two patients were never-smokers as compared to 156 patients who were ever-smokers. Among the smokers, the majority of them were found to be cigarette smokers compared to 28.2% bidi smokers. There was a very significant correlation found with adenocarcinoma among nonsmokers, and with squamous cell carcinoma among the smokers compared to non-smokers. Our study suggests that the epidemiology of lung cancer in India is possibly changing, with close to 40% of our lung cancer patients being nonsmokers. More importantly, our study reflects the global trend of rise in adenocarcinoma histology. These observations need to be substantiated in similar studies of larger magnitude, preferably population-based.

Risk for oral cancer associated to smoking, smokeless and oral dip products

Oral cancer is one of the most common life threatening diseases in India. Tobacco and alcohol are considered to be the most risk factors for oral cancer. This study was conducted to investigate the association of tobacco and poly-ingredient oral dip products with oral cancer. A case-control study of 350 cases and 350 controls, over a period of 19 months, between February 2005 and September 2006 was carried out in Pune, India. The self-reported information about the consumption of tobacco, poly-ingredient oral dip products, alcohol, dietary habits and demographic status were collected by a researcher made questionnaire. Univariate and multivariate analysis were used to identify the risk of substances abuse. The frequency of smoking, smokeless and oral dip products in cases were significantly higher than controls (P < 0.0001). Among smoking types, bidi (P < 0.0001, OR = 4.1 95% CI = 2.4 - 6.9), of smokeless types, chewing tobacco (P < 0.0001, OR = 8.3, 95% CI = 5.4 - 13.0) and mishiri (P < 0.0001, OR = 3.3, 95% CI =2.1 - 5.4), and of oral dip products, consumption of gutkha (P < 0.0001, OR = 12.8, 95% CI =7.0 - 23.7) and supari (P < 0.0001, OR = 6.6, 95% CI =3.0 - 14.8) indicated strong association with oral cancer upon adjustment. This study provides strong evidence that gutkha, supari -areca nut- chewing tobacco (tobacco flakes), bidi smoking and mishiri (tobacco powder, which applied as a tooth and gum cleaner) are independent risk for oral cancer.

Challenges in Global Improvement of Oral Cancer Outcomes: Findings from Rural Northern India

BackgroundIn India, 72% of the population resides in rural areas and 30-40% of cancers are found in the oral cavity. The majority of Haryana residents live in villages where inadequate medical facilities, no proper primary care infrastructure or cancer screening tools and high levels of illiteracy all contribute to poor oral cancer (OC) outcomes. In this challenging environment, the objective of this study was to assess the association between various risk factors for OC among referrals for suscipious lesions and to design and pilot test a collaborative community-based effort to identify suspicious lesions for OC.MethodsSetting: Community-based cross sectional OC screening.Participants: With help from the Department of Health (DOH), Haryana and the local communities, we visited three villages and recruited 761 participants of ages 45-95 years. Participants received a visual oral cancer examination and were interviewed about their dental/medical history and personal habits. Pregnant women, children and males/females below 45 years old with history of OC were excluded.Main outcome: Presence of a suspicious oral lesion.ResultsOut of 761 participants, 42 (5.5%) were referred to a local dentist for follow-up of suspicious lesions. Males were referred more than females. The referral group had more bidi and hookah smokers than non smokers as compared to non referral group. The logistic regression analysis revealed that smoking bidi and hookah (OR = 3.06 and 4.42) were statistically significant predictors for suspicious lesions.ConclusionsTobacco use of various forms in rural, northern India was found to be quite high and a main risk factor for suspicious lesions. The influence of both the DOH and community participation was crucial in motivating people to seek care for OC.

Socio-economic status of workers of building construction industry.

Background:Informal/unorganised sector covers 92% of the total work force in India. About 50% of the construction industrial workers belonged to informal/unorganised sector.Material and Methods:The present study was undertaken to know the socio-economic status of construction worker and availing of the social security measures by this working group.Results and Conclusion:The study covered 150 subjects with an average age of 32 years and mean duration of work was nine years. They were poorly paid with an average income of Rs. 4956/-per month. Though the literacy rate was high (79%) yet most of them were addicted to different habits like drinking alcohol, smoking bidi, tobacco chewing etc., Abusing the family members were noted in (30%) of the cases. Their regular intake of food, usually inadequate in quantity and was mainly consisted of rice, pulses, vegetables. Though most of the subjects (73%) were living in kacha houses yet the latrine facilities were available to 62% of total covered houses. Majority of them were unaware of the different social security schemes/measures. The details have been discussed here.

Tobacco exposure may enhance inflammation in prostate carcinoma patients: An explorative study in north Indian population

Prostate cancer is responsible for major deaths globally after lung cancer. However, etiology of prostate cancer is still unknown. Individual risk and incidence of prostate cancer may result from the interaction of genetic susceptibility with exposure to environmental factors such as infectious agents, tobacco, occupational exposure, dietary carcinogens, and/or hormonal imbalances leading to injury of the prostate and to the development of chronic inflammation. About 30% of all human cancers are caused by tobacco smoking and inhaled pollutants. Inflammation is now regarded as an important hallmark of cancer. The present study has been aimed to explore the pro-inflammatory levels in prostate carcinoma patients by examining the serum levels of novel cytokine interleukin-18 (IL-18) expression in tobacco exposed population. A total of 578 (n = 284 biopsy proven prostate cancer patients, n = 294 controls with and without tobacco exposed population) were recruited. Serum IL-18 (Interleukin-18) level was done by ELISA. The IL-18 levels between cancer patients and controls within same mode tobacco exposure as tobacco smoking (overall) showed significant difference (P < 0.0001) and further we compared within stratified group, it significantly differ (P < 0.0001) in bidi and cigarette smoking than control non users. Furthermore, IL-18 levels in tobacco chewers (overall) with gutkha and khaini chewers showed significant difference (P < 0.01) than controls non users. Moreover, the IL-18 levels between cancer patients and controls with in of combined mode chewers smokers and alcohol (CSA), smokers with alcohol showed significant difference (P < 0.01) than controls. The IL-18 levels also differed significantly (P < 0.05) with smokers and chewers in higher stages of III and IV, and showed non significant with in lower stages. Tobacco exposure enhance the inflammation in prostate carcinoma patients in stratified group as it have been represented as a risk factors in various cancers, but this study provide further its role that seems to influence inflammation especially in prostate carcinoma.

Estimating the Size of Tendu Leaf and Bidi Trade Using a Simple Back-of-the-Envelop Method

Since independence from the British in 1947, India has relied heavily on forest resources, including extraction of tendu leaves, to provide livelihood options for its marginalised tribal and forest-dependent communities. Tendu leaves are used to make bidis, an indigenous leaf-rolled cigarette made from coarse uncured tobacco, tied with a coloured string at one end. It is widely smoked in the Indian subcontinent and is gaining popularity globally, especially in USA, Germany, Middle East, Eastern Europe and Japan (Tobacco Board of India 2010). Bidis are harmful and pose a serious challenge to the health of youth globally and especially in the US where a health advisory warns of the potential harm (CDC http://www.cdc.gov/tobacco/data_statistics/fact_sheets/tobacco_industry/bidis_kreteks/). Curiously the use of tendu to make bidis is more recent, with the accidental discovery of tendu as the most suitable leaf to wrap tobacco and make bidis. The tendu tree (Diospyros melanoxylon or the black or east Indian ebony) grows in degraded deciduous forests of peninsular India, where once sal trees (Shorea robusta) were felled to make railway sleepers. Tendu leaves are available for plucking soon after the tobacco crop is ready and cured, when most other deciduous trees have shed their leaves in summer (April–June). Tendu leaves have all the characteristics of an excellent wrapper material—they are large and pliable, and do not crack on rolling when dry; their leathery texture is also more acceptable than the veins and rough textures of other leaves; and they match well with and augment the taste of tobacco, without interfering with the tobacco flavour. The first bidi factory was set up in 1911 in Jabalpur in erstwhile Central Provinces (now in the state of Madhya Pradesh), where tendu was most abundantly available. Bidis found wide consumer acceptance especially during the ‘Swadeshi andolan’ (a civil disobedience movement to boycott Imperial British goods during India’s struggle for independence) which was started by Mahatma Gandhi in 1920. This uplifted the prestige of the bidi that even educated Indians started smoking bidis instead of cigarettes. The two World Wars further spurred the use of bidis as they accompanied Indian soldiers to far-flung places (Lal 2009).

Tobacco consumption and the poor: An ethnographic analysis of hand-rolled cigarette (bidi) use in Bangladesh

Bidis, or hand-rolled, filterless tobacco cigarettes, are largely marketed to and consumed by the poor in Bangladesh. In exploring perceived rationales and the situational contexts of smoking, this study identifies the crucial connections between bidi smoking and the social and economic forces that influence choices and shape the contexts of individual suffering. Ethnographic research in Netrakona District revealed that inexpensive bidis were used to gain relief from physical ailments specific to the poor, such as hunger, indigestion and constipation. Bidis were found to be a socially accepted mood-altering drug that symbolizes relief from their everyday tensions, angers, perceived exploitations and disappointments. I argue that both cultural norms of reciprocity and hierarchy as well as the socio-economic structure of Bangladesh with its inequality, poverty and exploitation contribute to the tobacco consumption and related health problems of the poor.

P2-417 Nicotine dependence among daily cigarette smokers in 14 countries

IntroductionTobacco use is the leading preventable cause of death globally, causing more than five million deaths a year. There have been studies on nicotine dependence in developed countries. However, it...