Moving toward a true depiction of tobacco behavior among Asian Indians in California: Prevalence and factors associated with cultural smokeless tobacco product use

Abstract

BACKGROUND: Asian Indians (AIs) in the United States exhibit disproportionate burdens of oral cancer and cardiovascular disease, which are potentially linked to smokeless tobacco. However, little is known about the use of cultural smokeless tobacco (CST) products in this population. METHODS: California Asian Indian Tobacco Use Survey data from 2004 (n 5 1618) were used to investigate CST prevalence among California's AIs. CST products included paan, paan masala, and gutka. A multivariable logistic regression was conducted to examine factors (socioeconomic status, acculturation measures, and religious affiliation) associated with current CST use versus never use. RESULTS: The current CST prevalence was 13.0% (14.0% for men and 11.8% for women). In contrast, the prevalence of current cigarette use was 5.5% (8.7% for men and 1.9% for women), and the prevalence was lower for cultural smoked tobacco (0.1% for bidis and 0.5% for hookahs). Factors associated with CST use included the following: being male, being 50 years old or older, being an immigrant, speaking an AI language at home, having a higher level of education (adjusted odds ratio [AOR] for high school/some college, 2.6; 95% confidence interval [CI], 1.1-6.5; AOR for college degree or higher, 4.0; 95% CI, 1.7-9.5), having a higher income (AOR for $75,000-$100,000, 2.5; 95% CI, 1.3-4.7; AOR for $100,000, 2.6; 95% CI, 1.4-5.0), identifying as non-Sikh (AOR for Hinduism, 10.0; 95% CI, 6.0-16.5; AOR for other faiths, 10.2; 95% CI, 5.9-17.7), and disagreeing that spiritual beliefs are the foundation of life (AOR, 2.1; 95% CI, 1.2-3.5). CONCLUSIONS: The current CST prevalence is relatively high among California's AIs in comparison with the prevalence of smoking, with narrower differences between sexes. The association with a higher socioeconomic status is contrary to typical cigarette smoking patterns. Acculturation and religious affiliation are important factors associated with current use. Health care providers and policymakers should consider such determinants for targeted interventions. Cancer 2018;124:1607-13.

Knowledge, attitudes and practices of South Asian immigrants in developed countries regarding oral cancer: An integrative review

“…These practices were popular across almost all age groups and generations [21,22,27,45] with various patterns of practices in different religions [25,29,44]. Of concern was the supportive role of family and friends in the initiation of this kind of practices [22,26,27,42,43]. These findings complement the recent WHO report [57] regarding trends of tobacco product use in the South-East Asia region.…”

“…This is the first integrative review to assess current evidence regarding the knowledge, attitudes, and practices of South Asian immigrants in relation to oral cancer risk in developed countries. The majority of studies were conducted in the USA [21,22,40,42,43] and UK [25, 27-29, 41, 44, 45], and more recently in Italy [14] reflecting the changing migratory patterns of South Asians. It is also evident from the diversity of populations studied that irrespective of native countries, the oral cancer risk behaviours are widespread across a broader age range, gender, generations, and social class.…”

“…There were also notable age variations when the risk habits were initiated in their home countries ranging from 3-18 years [21,22,27,45]. Various reasons were cited behind the initiation of these practices such as social networks made up of South Asian friends or co-workers (45%-48.2%), passing of habit from one generation to the next (3.3%-81%), observation and encouragement within family members (27.5%-81%) [22,26,27,42,43]. These findings were also reflected in the qualitative studies [21,23,40] Despite legal restrictions in developed countries, the easy availability of guthka/customisable pan in Asian grocery stores, restaurants, specialised pan stalls, and supermarkets was highlighted as a factor responsible for the continuation of risk practices among respondents [21,23,43].…”

Knowledge, attitudes and practices of South Asian immigrants in developed countries regarding oral cancer: An integrative review

“…There were also notable age variations when the risk habits were initiated in their home countries ranging from 3-18 years [20,21,26,39]. Various reasons were cited behind the initiation of these practices such as social networks made up of South Asian friends or co-workers (45%-48.2%), passing of habit from one generation to the next (3.3%-81%), observation and encouragement within family members (27.5%-81%) [21,25,26,38,43]. These findings were also reflected in the qualitative studies [20,22,41] A pilot study [21] in the USA revealed that immigration can also influence the patterns of risk practices with participants switching habits from pan chewing to guthka use (nearly 54%) due to the social unacceptability of the former and ease of procurement /storage of the latter.…”

“…Supporting this notion is a study in the USA that found that people preferred smoking and sometimes swallowing the tobacco/pan instead of spitting it out because of society finding this inappropriate [20]. However, some studies found that betel quid usage along with tobacco chewing/smoking was an integral part of lifestyles, deeply rooted in the culture of south Asians and that these practices simply continued in new settlements as a habit or addiction [25,26,38,41,43].…”