Tobacco dependence in a UK Bangladeshi female population: a cross-sectional study

Abstract

The objective of this study was to establish the prevalence of paan chewing with tobacco by UK-resident Bangladeshi women and the extent to which they manifest nicotine dependence. The cross-sectional study was conducted at two local authority housing estates in Tower Hamlets, London. Participants were 242 Bangladeshi women, selected at random from the current electoral register, who supplied a saliva sample for cotinine and an expired air sample for carbon monoxide analysis. They also participated in a structured interview assessing knowledge, attitudes and behavior with respect to tobacco use. Main outcome measures were data on tobacco use and nicotine dependence, assessed by questionnaire and intake measures. The population prevalence of chewing paan quid with tobacco was 48.5% (95% confidence interval, CI 42.01-54.98%), while 4% (95% CI 2.05-7.41%) smoked cigarettes. Higher mean salivary cotinine scores were associated with greater consumption frequency and use of leaf tobacco in the quid. Above-average nicotine dependence was associated with chewing paan quid with tobacco within 1 h of waking (OR = 4.02, p = 0.03, 95% CI 1.08-14.94) and the use of leaf rather than processed tobacco (OR = 3.91, p = 0.025, 95% CI 1.19-12.81). Smoking prevalence is low, but the prevalence of paan quid with tobacco chewing is high in this sample of Bangladeshi women. Cotinine concentration appears to be a reliable indicator of levels of nicotine dependence among paan quid with tobacco chewers. Questionnaire-derived items can be used to identify those with above-average levels of nicotine dependence.

Tobacco initiation, cessation, and change: evidence from Vietnam

“…Although the health effects of rustic tobacco use have not been studied nearly as extensively as those of cigarette smoking, the available epidemiological evidence suggests that the use of rustic (chewing and smoking) tobacco is associated with elevated risks of lung, oropharyngeal, and oral cavity cancers and cardio-respiratory illness [8][9][10][11][12][13]. There is compelling evidence from recent largescale trials conducted in south India by Peto and colleagues that shows a greater than two-fold increase in the risk of tuberculosis among bidi smokers compared to non-smokers.…”

Dependence measures for non-cigarette tobacco products within the context of the global epidemic: a systematic review

“…Given that moist snuff and chew are the smokeless tobacco products used primarily in a Western context, only one study was identified that measured dependence on a tobacco product (paan) used more widely in a LMIC context 58. Croucher et al 58 found that paan consumers (Bangladeshi women in East London) who had above-average salivary cotinine levels, were four times more likely to have their first paan quid within the first hour of waking (‘time to first use’) compared with those with below-average cotinine levels.…”

Smokeless tobacco cessation guidelines for health professionals in England

“…4,12 For example, the largest grouping of the Bangladeshi community is resident in East London and Croucher and colleagues, using the same methodology as the Health Survey of England, have established a prevalence of tobacco/paan chewing of 49% among Bangladeshi women from a large random sample. 13 Paan chewing is very much a part of the Bangladeshi culture; for example research has shown that is a custom to offer a tray of paan to visiting guests and family members after tea or meals. Surveys have shown that some believe that chewing paan may have medicinal properties such as analgesic effects.…”

“…38 Using questions generated from the FTND, variations in levels of dependence, beliefs, knowledge and attitudes were observed between women chewing tobacco in paan and those chewing paan alone. 13 It may be noted however, that assessing level of dependence based on frequency of usage can be problematic. For example, paan can be prepared or chewed to suit an individual's need for the nicotine.…”