Effects Of Smokeless Tobacco Research Articles

The effect of smokeless tobacco (SLT) excise taxes on SLT use among youth

BackgroundSmokeless Tobacco (SLT) use prevalence among youth in the United States (US) is comparable to youth prevalence of cigarette smoking. However, it is in general understudied compared to cigarettes and draws less attention nowadays compared to e-cigarettes (ECs). AimWe estimate the own- and cross-tax elasticities of SLT use among US youth and explicitly test how SLT use changes in response to taxes on SLT, cigarettes, ECs, and beer. MethodsWe standardized SLT taxes for chewing tobacco, moist snuff, dry snuff, and snus, and computed average SLT taxes. We implemented a logit regression model within the state- and year-fixed effects framework. ResultsA 10 % increase in SLT excise taxes reduced youth SLT use by 4 % (p < 0.01). This result is primarily driven by males, Whites, multiple non-Hispanic races, other races, and individuals living in non-Appalachian states. In addition, a 10 % increase in cigarette taxes increases youth SLT use by 8 % (p < 0.05), suggesting substitutional effects. A 10 % increase in EC and beer taxes reduce SLT use by 0.5 % and 2.4 % (p < 0.01), respectively, suggesting complementary effects. ConclusionRaising excise taxes on SLT products can effectively curtail their usage among the youth population. Furthermore, increasing EC and beer taxes reduces youth SLT use. However, an increase in cigarette taxes leads to an unintended consequence of promoting SLT use among youth. In addition, increasing SLT taxes does not appear to significantly impact the disparities in youth SLT use by whether living in Appalachian states. Future research is needed to assess whether SLT taxes reduce disparities in use by rural/urban divisions.

Effects of Smokeless Tobacco on Oral Health: A Cross-Sectional Study.

Smokeless tobacco (SLT) consumption poses a significant global public health challenge because of its adverse effects on oral health. Although the detrimental impact of SLT on oral tissues is well-documented, understanding its multifaceted effects is essential for effective prevention and intervention strategies. This study aimed to comprehensively assess the impact of SLT on oral health, focusing on various clinical parameters and their differences between placement and non-placement sites of SLT. A cross-sectional study involving 528 habitual users of SLT was conducted. Clinical parameters included the plaque index (PI), gingival index (GI), gingival bleeding index (GBI), gingival recession (GR), and probing depth (PD). Oral mucosal changes at SLT placement sites have also been reported. Statistical analysis was performed to compare parameters between the placement and non-placement sites. The study involved 528 subjects, mostly male (82%) and aged 21-40 years (mean±SD=31.14±9.10), habitual users of SLT. Prevalent SLT types included tobacco with betel nuts/masala/gutkha (59.9%) and tobacco with lime (54.5%). Significant differences were observed between SLT placement and non-placement sites: higher gingival inflammation (GI) at placement sites (1.54±0.61 vs. 1.45±0.54, p=0.01), lower GBI at placement sites (40.0% vs. 84.3%, p=0.001), and more prevalent GR (65.7% vs. 34.3%, p=0.03) at placement sites. Probing depths ≥ 3 mm were also less frequent at placement sites (2.67±0.72) than non-placement sites (3.37±1.03, p=0.001). These results highlight the detrimental impact of SLT on periodontal health, emphasizing the need for targeted interventions among SLT users. SLT use is associated with adverse effects on oral health, including GI, plaque accumulation, gingival bleeding, GR, and changes in the oral mucosa. Targeted interventions and public health policies are needed to address these issues effectively.

The Effect of Smokeless Tobacco on the Histopathology of Thyroid Gland in Albino Rats

Objective: To investigate the effect of smokeless tobacco on the histopathology of the thyroid gland in albino rats. Methodology: The experimental study was conducted at the Animal House of Sindh Agriculture University over a three-month duration from June to August 2018. Thirty healthy, non-pregnant female albino rats, aged 8-10 weeks and weighing 200-230 grams, were divided into three groups. The Control group received a standard diet, Experimental Group A was exposed to 5% smokeless tobacco, and Group B to 10%. Rats were housed under hygienic conditions. After the experiment, the rats were weighed, euthanized via cervical dislocation, and their thyroid glands were removed for detailed dissection. Tissues were preserved in 10% formaldehyde, processed for microscopic examination through paraffin embedding and sectioning (2-5 µm thick), and finally stained with Hematoxylin and Eosin (H&amp;E) and trichrome stain. Results: Significantly reduced weight was observed in albino rats from Group 2 and 3 compared to controls (p-value &lt; 0.0001). In the control group (Group I), histological examination revealed a normal structure of thyroid follicles. In Group 2, stroma exhibited mild infiltration of chronic inflammatory cells, whereas Group 3 showed benign lesions with mild fibrosis. Conclusion: In summary, smokeless tobacco has adverse effects on the weight of albino rats and may alter the normal histology of the thyroid gland. Further investigation into the effects on thyroid hormone levels and a study of the dose-dependent effects of various chemicals in smokeless tobacco on the thyroid gland are recommended.

Effects of Smokeless Tobacco on Color Stability and Surface Roughness of 3D-Printed, CAD/CAM-Milled, and Conventional Denture Base Materials: An In Vitro Study

Tobacco consumption in its different forms can affect the optical and surface properties of dental materials that are used in the oral cavity. Thus, the present study was conducted to evaluate the effects of two commercially available smokeless tobacco products on the color stability and surface roughness of denture base resins that were fabricated using three different techniques (CAD/CAM milling, 3D printing, and conventional heat polymerization). A total of 126 denture base resin specimens were fabricated using the three different manufacturing techniques (n = 42 each). Specimens from each group were further subdivided into three subgroups (n = 14 each) and immersed in three different immersion media (a khaini suspension, a tabbaq suspension, and artificial saliva). The differences in color and surface roughness were assessed according to data that were collected and statistically analyzed using SPSS version 24.0. The tabbaq smokeless tobacco was found to cause greatest changes in color and surface roughness; the effect was observed to be highest in the 3D-printed specimens followed by the conventional heat-polymerized and CAD/CAM milled specimens. The mean changes in color and surface roughness were the highest for the tabbaq smokeless tobacco followed by the khaini smokeless tobacco and the artificial saliva. Statistically significant (p-value < 0.05) differences were observed among all techniques and suspensions. We concluded that the mean changes in color and surface roughness were significantly higher for the 3D-printed dentures compared to the conventional heat-polymerized and CAD/CAM-milled dentures. Thus, the results of the present study strengthened the concept that tobacco in any form can lead to changes in the color and surface roughness of denture base materials.

Effect of Smokeless Tobacco (Mishri) Application on Periodontal Health and Correlation to the Duration of Use

Mishri is a form of smokeless tobacco used as a dentifrice in rural areas of central India. Mishri is applied to teeth and gums to clean the oral cavity. Mishri use has ill effects on oral health and periodontal tissues. T he present study assessed the ill effect of mishri application periodontal tissues, and its correlation to the duration of use. A total of 300 subjects who used mishri as a dentifrice were considered. The enrolled subjects were categorized into three subgroups depending on the

Effects of Smokeless Tobacco on the Histology and Functioning of Proximal Convoluted Tubules of the Kidneys of Female Albino Rats

Aims: The consumption of oral form of smokeless tobacco has increased rapidly. Its use is associated with increased risk of chronic diseases like diabetes, myocardial infarction, liver disorders, cerebrovascular accidents and many other health issues. Use of tobacco in any form either smoked or chewed form leads to the absorption of nicotine which spontaneously moves into the bloodstream where it is circulated throughout the body system. Hence through this study an effort is being made to evaluate the effects produced by the locally available brand of smokeless tobacco on the histology and functioning of proximal convoluted tubules of the kidneys of the female Swiss albino rats.&#x0D; Place and Duration of Study: The study was conducted in Sindh Agricultural University, Tandojam and further lab work was carried out in Isra University Hyderabad.&#x0D; Methodology: 30 adult female Swiss albino rats were randomly selected. They were divided into three groups (n=10). Group A were taken as control. Group B&amp;C comprised of rats which were given 5 %&amp; 10% of smokeless tobacco respectively along with their chow diet. The feed and water were given ad libitum. Animals were sacrificed on 31st day and their kidneys were removed and weighed. The specimens were processed routinely for examination under light microscope. The sections were stained using H &amp; E stains and examined under light microscope. Blood samples for analysis of creatinine and urea were collected.&#x0D; Results: A significant decrease in the weight of the kidneys, an increase in the levels of creatinine and urea were observed (P value = 0.001). Kidneys of both B &amp; C groups showed edema, congestion and presence of cast cells when compared with the kidneys of the control group.&#x0D; Conclusion: From these observations, it can be inferred that the exposure of female Swiss albino rats to the smokeless form of Tobacco is associated with structural and functional damage of the kidneys.

Effects of smokeless tobacco on cell viability, reactive oxygen species, apoptosis, and inflammatory cytokines in human umbilical vein endothelial cells

Smokeless tobacco products provide an alternative to cigarettes; however, smokeless tobacco is carcinogenic and harmful to human health. This study evaluated the toxicological effects of snus extracts and cigarette smoke total particulate matter (TPM) on human umbilical vein endothelial cells (HUVECs). Treated cells were examined for cell viability, reactive oxygen species (ROS), apoptosis, and inflammatory cytokines. Moreover, we explored the mechanism of programmed cell death induced by snus. The results showed that snus extracts significantly inhibited cell viability in a dose-dependent manner. ROS was significantly increased in treatment groups, and anti-oxidant treatment could not prevent snus extract-induced cell death. Snus extracts induced apoptosis, DNA damage, activation and cleavage of caspase-3 and caspase-8, pathway-related gene change, and interleukin (IL)-6 and IL-8 release in HUVECs. Snus extracts exposure may induce cytotoxicity, ROS generation, inflammatory cytokines release, and apoptosis or DNA damage through intrinsic and extrinsic pathways in HUVECs.

Evaluation of systemic inflammatory and thrombotic markers of cardiovascular risk among young Indian oral tobacco users

BackgroundWhile the pro-inflammatory and pro-coagulant effects of cigarette smoking have been well described, the effect of smokeless tobacco (ST) on inflammatory and coagulation markers is still not clear. The study aimed to evaluate impact of smokeless tobacco use on systemic markers of inflammation [(TLC), neutrophil-lymphocyte ratio (NLR) (ESR), interleukin (IL) IL-1β, IL-6 and tumor necrosis factor alpha (TNFα)] and hypercoagulable state [fibrinogen and d-dimer] leading to increased cardiovascular risk in ST users as compared to non-users. Methods150 healthy young adults using oral tobacco products for at least 1 year were included in the case group and 50 age-matched non-consumers as controls. Subjects with any known chronic illness or comorbidity were excluded from the study. Blood samples were tested for TLC, NLR, ESR, IL-1β, IL-6, TNFα, fibrinogen and d-dimer. Statistical analysis was done using SPSS 17.0 software. ResultsThe baseline clinical and cardio-metabolic characteristics were comparable between the two groups. ST users had significantly elevated serum IL-6 [59.29 ± 124.69 pg/mL (n = 149) vs 8.21 ± 27.27 pg/mL (n = 47), p-value = 0.005], TNFα [77.18 ± 236.10 pg/mL (n = 149) vs 8.32 ± 9.36 pg/mL (n = 47), p-value = 0.041], fibrinogen [310.53 ± 129.05 mg/dL (n = 143) vs 282.82 ± 65.23 mg/dL (n = 42), p-value = 0.045] and d-dimer [0.28 ± 0.42 mg/L (n = 144) vs 0.17 ± 0.09 mg/L (n = 45), p-value = 0.043] levels as compared to non-users. Serum TLC, NLR, ESR and IL-1β remained unchanged in ST users and were similar to that of controls. ConclusionsChronic use of ST is associated with systemic inflammation and coagulation, which may increase the risk of athero-thrombotic cardiovascular events among ST users.

Smokeless tobacco induces toxicity and apoptosis in neuronal cells: a mechanistic evaluation

Smokeless tobacco (SLT) or chewing tobacco has been a highly addictive practice in India across ages, posing major threat to the systemic health and possibly neurodegeneration. Earlier studies showed components of SLT could be harmful to neuronal health. However, mechanism of SLT in neurodegeneration remained unexplored. This study investigated the detrimental role of SLT on differentiated neuronal cell lines, PC12 and SH-SY5Y by using graded doses of water soluble lyophilised SLT. Reduced cell viability, compromised mitochondrial structure and functions were observed when neuronal cell lines were treated with SLT (6 mg/mL) for 24 h. There was reduction of oxidative phosphorylation and aerobic glycolysis as determined by diminution of ATP production (2.5X) and basal respiration (1.9X). Mitochondrial membrane potential was dropped by 3.5 times. Bid, a pro-apoptotic Bcl-2 family protein, has imperative role in regulating mitochondrial outer membrane permeabilization and subsequent cytochrome c release leading to apoptosis. This article for the first time indicated the involvement of Bid in SLT mediated neurotoxicity and possibly neurodegeneration. SLT treatment enhanced expression of cleaved-Bid in time dependent manner. The involvement of Bid was further confirmed by using Bid specific shRNA which reversed the effects of SLT and conferred significant protection from apoptosis up to 72 h. Thus, our results clearly indicated that SLT induced neuronal cell death occurred via production of ROS, alteration of mitochondrial morphology, membrane potential and oxidative phosphorylation, inactivation of survival pathway and activation of apoptotic markers mediated by Bid. Therefore, Bid could be a potential future therapeutic target for SLT induced neurodegeneration.

Conscious Abstinence from Smokeless Tobacco Evokes Higher Withdrawal Response and Impairs Cognitive Performance Independent of Sympathetic Response.

Introduction: High consumption of smokeless tobacco in adult Indian population increases the risk of developing oral cancers leading to high morbidity and mortality. Though the influence of abstinence from smoking on cognitive performance has been widely studied, the effect of smokeless tobacco on cognitive performance and its association with withdrawal symptoms is less understood. This study comparatively investigates the effect of short-term conscious abstinence and distraction during abstinence from smokeless tobacco consumption on the craving, withdrawal symptoms, sympathetic response, and cognitive performance in tobacco addicts.Methods: Age, sex, education and socioeconomic status matched control (N = 15) and smokeless tobacco addicts (N = 60) were recruited from residential areas in Bhubaneswar for the study. Following randomization of the addicts, conscious abstinence (N = 30) was induced by informed abstinence from tobacco consumption for 8 hours, while distracted cessation (N = 30) was induced by involving the participants in a cognitively engaging task for 8 hours during uninformed tobacco abstinence.Results: The results of the study show higher withdrawal symptoms and reduced cognitive performance in volunteers with conscious abstinence which was positively correlated. The decreased cognitive performance in conscious cessation was independent of tobacco-induced increase in the LF:HF ratio and cotinine concentration in saliva.Conclusion: While conscious abstinence results in higher withdrawal symptoms, distraction during abstinence lowers these symptoms. Inclusion of distraction sessions during cessation can, therefore, be a new element in tobacco control strategies.

A Study on Effect of Smokeless Tobacco on Pulmonary Function Tests in Class IV Workers of USM-KLE (Universiti Sains Malaysia-Karnataka Lingayat Education Society) International Medical Programme, Belagavi

A Study on Effect of Smokeless Tobacco on Pulmonary Function Tests in Class IV Workers of USM-KLE (Universiti Sains Malaysia-Karnataka Lingayat Education Society) International Medical Programme, Belagavi

Effect of smokeless tobacco on vascular changes following flap surgery - a doppler study

Effect of smokeless tobacco on vascular changes following flap surgery - a doppler study

A study on the effect of smokeless tobacco on oral cancer done in a Tertiary Care Hospital in Southern India

Background: Oral cancer is a major problem in India. The incidence is 10.1 cases per lac for males and 4.3 per lac in females. The risk factors for the development of oral cancers include smokeless tobacco. Objectives: The objectives of this study were to find the association between smokeless tobacco and oral cancer. Materials and Methods: A case–control study done at a tertiary care hospital, Bengaluru, India. Study subjects included new cases of oral cancer attending the hospital during the study period and equal number controls. Data collection was done by interview method. Results: Tobacco chewing with an odds ratio (OR) of 2.3 was significantly associated with the risk of oral cancer. Paan chewing with tobacco showed greater risk than paan chewing without tobacco. Chewers who started the habit before the age of 25 years showed an higher risk with OR of 4.5. An increasing trend in oral cancer risk with increase in the frequency and duration of paan chewing was found. The risk was 30 times higher for those with quid retention as compared to never chewers. Duration of quid retention for ≤5 h showed 29.6 times higher risk and for more than 5 h showed 33.3 times higher risk, as compared to those without quid retention. Conclusion: Smokeless tobacco shows higher risk for oral cancer. There is a great need to augment tobacco control measures and educate the public about harmful effects of smokeless tobacco.

Between Traditions and Health: Beliefs and Perceptions of Health Effects of Smokeless Tobacco Among Selected Users in Nigeria

ABSTRACTObjectives: Snuffing or licking of smokeless tobacco (SLT) is one of the oldest traditional practices among the African population. This study aims to investigate the beliefs and practices related to SLT use among users in Nigeria. We also assess the awareness of the health consequences of SLT among users. Methods: A qualitative technique involving an in-depth interview was employed to collect data from SLT users from selected indigenous Nigerian populations in their traditional settings (Saki, Ile-Ife, Ibadan, and Abuja). The locations were purposively selected based on the researchers' knowledge of the prevalent use of SLT in those areas. A snowball sampling technique was employed to select the respondents. The data were imported into the ATLAS.ti computer software for analysis. The data were analyzed using inductive coding, and the results were presented thematically using network diagrams. Results: The findings revealed that the majority of SLT users believed that the practice had the following health benefits, among others: clearing of eyes and nose, aiding in sleep and rest, protecting against colds and nose bleeds and curing headaches. The users believed that SLT helped them ‘feel high’ or bold when afraid. The SLT users also believed that it protected them from evil spirit(s) and dangerous reptiles. The users believed that SLT had no negative health consequences, and SLT was generally preferred to smoking cigarettes. Conclusion: The study concludes that there is a need to focus on the control of SLT because this product is a major alternative to tobacco smoking among indigenous African populations.

Use of moist oral snuff (snus) and pancreatic cancer: Pooled analysis of nine prospective observational studies.

While smoking is a well-established risk factor for pancreatic cancer, the effect of smokeless tobacco is less well understood. We used pooled individual data from the Swedish Collaboration on Health Effects of Snus Use to assess the association between Swedish snus use and the risk of pancreatic cancer. A total of 424,152 male participants from nine cohort studies were followed up for risk of pancreatic cancer through linkage to health registers. We used shared frailty models with random effects at the study level, to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) adjusted for confounding factors. During 9,276,054 person-years of observation, 1,447 men developed pancreatic cancer. Compared to never-snus use, current snus use was not associated with risk of pancreatic cancer (HR 0.96, 95% CI 0.83-1.11) after adjustment for smoking. Swedish snus use does not appear to be implicated in the development of pancreatic cancer in men. Tobacco smoke constituents other than nicotine or its metabolites may account for the relationship between smoking and pancreatic cancer.

Effect of Smokeless Tobacco (Madgha) on Spirometry

Effect of Smokeless Tobacco (Madgha) on Spirometry

An in vitro analysis to ascertain whether smokeless tobacco has any detrimental effect on the diagnostic efficacy of salivary lactate dehydrogenase

Background: Salivary diagnostics promise an easily accessible, non-invasive approach for analyzing and monitoring various oral diseases including cancer. Objectives: This study was undertaken to establish the baseline salivary lactate dehydrogenase (LDH) levels in healthy controls and to discern the effect of smokeless tobacco (SLT) on the diagnostic efficacy of salivary LDH. Materials and Methods: Thirty-seven systemically and periodontally healthy individuals in the age group of 19-27 years without any deleterious habit and oral lesion participated in this study. After explaining the procedure to the participants, unstimulated whole saliva was collected by spit method under sterile conditions. Baseline LDH activity was measured spectrophotometrically. After evaluating baseline activity, 1 ml of saliva was mixed with 1 g of SLT and incubated at 37°C. LDH activity was measured at different time intervals. Results: The median value of baseline LDH levels at rest was 338 IU/L. The gender-based variation in LDH activity was found to be non-significant. Exposure of whole saliva to SLT resulted in an initial increase followed by reduction in the LDH activity. Conclusion: This study provides additional rationale for the use of salivary LDH as a biomarker to investigate the aggressiveness and biological nature of oral pathological conditions. Interpretation of changes in salivary LDH activity should be done with caution in individuals habituated to tobacco use.

Aqueous Extract of Smokeless Tobacco (gutkha) Deregulates Tumor Suppressor and DNA Repair Response in a Murine Model of Smokeless Tobacco Use.

The effect of smokeless tobacco (gutkha) was investigated by treating male and female Swiss Albino mice with an aqueous extract of smokeless tobacco (AEST). AEST was administered at a dose of 25 mg kg-1 body weight per day for different time periods (6, 12, 16, and 24 weeks), and control animals were provided only drinking water without AEST for the same period. Control and AEST-treated mice were observed for different oxidative stress parameters, nitric oxide (NO) release, and myeloperoxidase (MPO) release, and they were evaluated for alterations in tumor suppressor and DNA repair responses in the liver and spleen. Both male and female mice treated with AEST showed significant increase in lipid peroxidation, protein carbonylation, and NO and MPO release in the liver and spleen compared to age- and gender-matched controls. The significant decline in tumor suppressor p53 protein levels, likely mediated by concomitantly upregulated levels of Mdm2, was observed. We also observed a significant decline in the levels of DNA repair proteins Brca2 and Ape-1 compared to the respective controls. Thus, AEST induces oxidative stress, inflammation, and significantly lowers tumor suppressor and DNA repair responses. These factors may work in conjunction to increase the risk for certain diseases, including cancer.

Evaluation of inflammatory and genotoxic effects of smokeless tobacco using an organotypic model of human oral epithelium

Evaluation of inflammatory and genotoxic effects of smokeless tobacco using an organotypic model of human oral epithelium

Dietary adequacy in tobacco-user and non-user households in Bangladesh

8 www.thelancet.com/lancetgh Published Online April 8, 2016 Health Behaviors Research Branch, National Cancer Institute, National Institutes of Health, Rockville, MD, USA (M K Virk-Baker PhD); Tobacco Control Research Branch, Behavioral Research Program, National Cancer Institute, National Institutes of Health, Rockville, MD, USA (M Parascandola PhD) Correspondence to: Mandeep Virk-Baker, National Cancer Institute, 9609 Medical Center Drive 3E632, Rockville, MD 20892, USA mandeep.virk-baker@nih.gov Dietary adequacy in tobacco-user and non-user households in Bangladesh Mandeep K Virk-Baker, Mark Parascandola Abstract Background Researchers have found dietary diff erences between people who smoke tobacco and those who do not, with lower intakes of fi sh, fruits, and vegetables in smokers. However, most of these studies are from developed countries, and less is known about the eff ects of tobacco on diet in developing countries where malnutrition is an important public-health challenge. Furthermore, the eff ect of smokeless tobacco on diet are not known. In this study, we aim to evaluate the eff ect of tobacco use on diet in a developing country.Background Researchers have found dietary diff erences between people who smoke tobacco and those who do not, with lower intakes of fi sh, fruits, and vegetables in smokers. However, most of these studies are from developed countries, and less is known about the eff ects of tobacco on diet in developing countries where malnutrition is an important public-health challenge. Furthermore, the eff ect of smokeless tobacco on diet are not known. In this study, we aim to evaluate the eff ect of tobacco use on diet in a developing country. Methods We used data from the nationally representative Household Income Expenditure Survey (HIES-2010) from Bangladesh.The HIES 2010 included data from 12 240 households (7840 rural and 4400 urban). The consumption module of the HIES survey recorded household food consumption quantities and money spent on those for 14 days. The data for 14 days’ food expenditure was collected in 7 visits with 2 days’ recall, and included both ethnic and region-specifi c foods. Data on tobacco and tobacco products, including cigarettes, tobacco leaf, bidies, gul, and betel leaf were recorded in the consumption section of the questionnaire. Findings Overall, 8693 (71·02 %) households reported positive expenditure on tobacco (smoking, smokeless, or both), and were classifi ed as any-tobacco users. Of these 8693 households, 2061 (16·8%) used smoking tobacco only, 3284 (26·8%) used smokeless tobacco only, and 3348 (27·4%) used both. After controlling for household expenditure, household size, place of residence, and education, any-tobacco users consumed signifi cantly lower amounts of vegetables per household (β=–18·35 g/day; p<0·0001), milk and dairy (–12·83 g/day; p<0·0001), fi sh (–11·19 g/day; p<0·0001), meat (–7·60 g/day; p<0·0001), legumes (–3·31g/day; p<0·0001), eggs (–1·60 g/day; p<0·0001) compared with tobacco non-user households. However, mean daily intake of cereal products (β=24·744 g/day; p<0·0001) was signifi cantly higher in any-tobacco users than in non-user households. We observed similar signifi cant associations for users of smokeless tobacco versus non-users. Interpretation The project provides evidence to support policy recommendations for addressing poor dietary intakes and the malnutrition burden in tobacco-user households in developing countries such as Bangladesh. Addressing tobacco use in relation to malnutrition would make tobacco control a higher priority for developing countries and for meeting the post-2015 development agenda of eradicating extreme poverty and hunger.