Exploring biocultural models of chewing tobacco andpaanamong reproductive‐aged women: Self‐medication, protection, or gender inequality?

Abstract

ObjectivesTobacco and areca nut are two of the most widely used psychoactive plant substances worldwide, yet the biocultural factors that account for variation in use patterns are not well understood. Here we attempt to understand the high prevalence of, and variation in, tobacco and areca nut use among reproductive‐aged women.MethodsResearch was carried out in Mysore, Karnataka, India. First, we conducted a qualitative investigation where participants engaged in semistructured interviews and focus group discussions to uncover cultural norms of women's tobacco use. Findings informed the second stage of research which quantitatively tested three models of tobacco and areca nut use (N = 74).ResultsThe qualitative study found that women were more likely to chew “natural” forms of tobacco and areca nut products (kaddipudi and paan). Quantitative tests of our hypotheses revealed that kaddipudi and combined tobacco use were best explained by the self‐medication model, with somatic and environmental stress as strong indicators of use. The presence of cotinine, our biological indicator of tobacco use, was best modeled by gender inequality. We also found that men and women reported approximately equal tobacco use, even though their preferred types of tobacco and areca nut products differed.ConclusionsFindings did not support the protection hypothesis as it relates to plant toxins. Instead, this study suggests that women might exploit neurotoxins such as nicotine and arecoline to offset the cognitive and energetic costs associated with iron deficiency in stressful environments.

The impact of information about tobacco-related reproductive vs. general health risks on South Indian women's tobacco use decisions

“…Cultural norms might exacerbate tobacco use when communities report benefits of tobacco use and lack models of its adverse impact on general and reproductive health ( R. Gupta et al, 2013 ). Jenu Kuruba women from Mysore, Karnataka, for example, rely on smokeless tobacco for energy while working in agricultural fields and did not report any costs to reproduction ( Placek et al, 2019 ).…”

“…Unfortunately, tobacco is not always viewed as harmful by women in LMICs, and is even thought to provide benefits, such as increasing energy ( Placek et al, 2019 ). Part of the problem is that tobacco control programmes typically emphasize health-related harms that occur late in life, yet evolutionary theory suggests that individuals should discount costs and benefits that will occur later in life, a phenomenon termed temporal discounting.…”

“…In India, one of the largest LMICs with a population of about 1.3 billion, women’s use of smokeless tobacco is increasing ( Sinha et al, 2015 ). In some regions of India, rates of smokeless tobacco use among women is as high as 49% ( P. C. Gupta & Ray, 2003 ; Placek et al, 2019 ), and women consume tobacco and paan (an areca nut preparation that often contains tobacco) during pregnancy and throughout their reproductive years ( P. C. Gupta & Ray, 2003 ; Krisshna, 1978 ; Placek et al, 2019 ). These alarming rates are probably due, in part, to local perceptions that smokeless tobacco is less harmful than cigarettes ( Sinha et al, 2015 ).…”

“…Although these interventions often emphasize both short- and long-term consequences of tobacco use, adolescents tend view the near-term harms of tobacco as being minimal and discount the long-term harms of use ( Mishra et al, 2005 ). Tobacco control efforts also tend to be gender-neutral even though Indian men and women differ in the types of tobacco products they prefer ( Amos, Greaves, Nichter, & Bloch, 2011 ; Nichter & Cartwright, 1991 ; Placek et al, 2019 ). Finally, the recent change in India from a symbolic warning label (a scorpion) to graphic warning labels (graphic images of cancer of the mouth, jaw or neck) was not associated with any improvement in health-related outcomes, such as awareness of the labels, thoughts about the harms of tobacco use or reduced tobacco use ( Gravely et al, 2016 ).…”

“…Jenu Kuruba women report learning to chew tobacco for its perceived positive benefits and because prominent members of the community are tobacco users (Placek et al, 2019).…”