Money Gone Up in Smoke: The Tobacco Use and Malnutrition Nexus in Bangladesh

Abstract

BACKGROUND The tobacco epidemic in Bangladesh is pervasive. Expenditures on tobacco may reduce money available for food in a country with a high malnutrition rate. OBJECTIVES The aims of the study are to quantify the opportunity costs of tobacco expenditure in terms of nutrition (ie, food energy) forgone and the potential improvements in the household level food-energy status if the money spent on tobacco were diverted for food consumption. METHOD We analyzed data from the 2010 Bangladesh Household Income and Expenditure Survey, a nationally representative survey conducted among 12,240 households. We present 2 analytical scenarios: (1) the lower-bound gain scenario entailing money spent on tobacco partially diverted to acquiring food according to households’ food consumption share in total expenditures; and (2) the upper-bound gain scenario entailing money spent on tobacco diverted to acquiring food only. Age- and gender-based energy norms were used to identify food-energy deficient households. Data were analyzed by mutually exclusive smoking-only, smokeless-only, and dual-tobacco user households. FINDINGS On average, a smoking-only household could gain 269–497 kilocalories (kcal) daily under the lower-bound and upper-bound scenarios, respectively. The potential energy gains for smokeless-only and dual-tobacco user households ranged from 148–268 kcal and 508–924 kcal, respectively. Under these lower- and upper-bound estimates, the percentage of smoking-only user households that are malnourished declined significantly from the baseline rate of 38% to 33% and 29%, respectively. For the smokeless-only and dual-tobacco user households, there were 2–3 and 6–9 percentage point drops in the malnutrition prevalence rates. The tobacco expenditure shift could translate to an additional 4.6–7.7 million food-energy malnourished persons meeting their caloric requirements. CONCLUSIONS The findings suggest that tobacco use reduction could facilitate concomitant improvements in population-level nutrition status and may inform the development and refinement of tobacco prevention and control efforts in Bangladesh.

The crowding-out effect of tobacco expenditure on household spending patterns in Bangladesh

“…On average, a tobacco-user household spent nearly 392 Bangladesh Taka (BDT) per month in 2010, constituting 4.1% of the household budget. This expenditure share is much higher than many other food consumption items, including fruits, legumes and beans, oil and fat, milk, sugar, and eggs [ 20 ]. Husain et al [ 20 ] suggested that, in Bangladesh, the tobacco expenditure-shift could translate to an additional 4.6 to 7.7 million food-energy malnourished persons meeting their caloric requirements.…”

“…This expenditure share is much higher than many other food consumption items, including fruits, legumes and beans, oil and fat, milk, sugar, and eggs [ 20 ]. Husain et al [ 20 ] suggested that, in Bangladesh, the tobacco expenditure-shift could translate to an additional 4.6 to 7.7 million food-energy malnourished persons meeting their caloric requirements. Previously, Efroymson et al [ 8 ] asserted that, in Bangladesh, the average male cigarette smoker spends more than twice as much on cigarettes as compared to combined expenditures on clothing, housing, health and education; that a typical poor smoker could add over 500 calories to the diet of one or two children by eliminating daily tobacco expenditure; and that an estimated 10.5 million malnourished people could have an adequate diet if money on tobacco were spent on food instead.…”

“…This paper presents an analysis of household level tobacco use by different tobacco use types. Husain et al [ 20 ] analyzed smokeless tobacco use that showed the potential trade-offs between nutrition intake and tobacco use. To our knowledge, this is the first study that contributes to the tobacco use crowding-out literature by examining how the household expenditure patterns for smoking-, smokeless-, and dual- (both smoking and smokeless) user households differ from tobacco non-user households, from the recent data in Bangladesh.…”

Comparative analysis of diet and tobacco use among households in Bangladesh

“…Our results provide support for the conclusion that households that purchase tobacco may be diverting funds that would otherwise be spent on more costly food items, such as milk, and replacing those calories with inexpensive cereal grains 12 . A separate analysis of this dataset found that within food consumption categories, cereals constituted the largest share of expenditure (>40% of total food expenditure) among tobacco-use households 9 . Husain et al 18 recently (2018) reported that household consumption of tobacco competes with other household expenditures; while tobacco-use households spent more on food and medical items, compared with non-use households, they spent less on clothing, housing, education, transportation, and communication.…”

“…Less is known about the relationship between tobacco use, especially smokeless tobacco use, and dietary patterns among populations in developing countries. In a low-income setting, limited resources may result in money being diverted from basic necessities, including food, to tobacco purchasing thus reducing dietary quality and contributing to malnutrition 9 . Combating malnutrition in developing countries is a major global public health priority; expenditure on tobacco has been shown to exacerbate poverty and malnutrition by competing for the limited resources 10 - 12 .…”