title: Tobacco use among adults in Cambodia: evidence for a tobacco epidemic among women.
abstract: OBJECTIVE
  To identify the demographic characteristics of current tobacco users in Cambodia, particularly women, and to explore the reasons for current tobacco use in demographic subgroups of the Cambodian population.
  
  
  METHODS
  We used a stratified three-stage cluster sample of 13,988 adults aged 18 years and older from all provinces in 2005-2006. Participants completed an interviewer-administered survey that contained items on all forms of tobacco use and on health and lifestyle variables. Multivariable regression analysis was performed to identify demographic predictors of tobacco use.
  
  
  RESULTS
  Cigarette smoking occurred among 48.0% of men and 3.6% of women. We estimated that 560,482 women (95% confidence interval, CI: 504,783 to 616 180) currently chewed tobacco (typically as a component of betel quid) and that the prevalence more than doubles with each decade of adulthood up to the point that about half of all older women chew tobacco. Both men and women cited the influence of older relatives as their primary reason for starting to use tobacco. About one out of five rural women who used chewing tobacco started their habit for relief from morning sickness. The highest prevalence of chewing tobacco among women was seen among midwives (67.9%) and traditional healers (47.2%). High rates (66.8%) of cigarette and pipe tobacco use occurred among ethnic minorities who represent hill tribes found throughout south-east Asia.
  
  
  CONCLUSIONS
  The tobacco epidemic in Cambodia extends far beyond cigarette smoking in men. Tobacco control that focuses only on cigarettes will not address the health burden from smokeless tobacco use in women that may be an integral part of cultural, familial, and traditional medicine practices.
authors.affiliation: School of Public Health, Loma Linda University, 2005 Nichol Hall, Loma Linda, CA 92350, United States of America. psingh@llu.edu
authors.forename: Pramil N
authors.initials: PN
authors.lastname: Singh
authors.forename: Daravuth
authors.initials: D
authors.lastname: Yel
authors.forename: Sovann
authors.initials: S
authors.lastname: Sin
authors.forename: Sothy
authors.initials: S
authors.lastname: Khieng
authors.forename: Jaime
authors.initials: J
authors.lastname: Lopez
authors.forename: Jayakaran
authors.initials: J
authors.lastname: Job
authors.forename: Linda
authors.initials: L
authors.lastname: Ferry
authors.forename: Synnove
authors.initials: S
authors.lastname: Knutsen
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002160:Cambodia; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012907:Smoking / Q000453:epidemiology*; D011795:Surveys and Questionnaires; D014029:Tobacco Use Disorder / Q000453:epidemiology; D014030:Tobacco, Smokeless; D055815:Young Adult
references.citation: J Oral Pathol Med. 2002 Sep;31(8):468-72
references.pmid: 12220354
references.citation: Semin Oncol Nurs. 2003 Nov;19(4):233-43
references.pmid: 14702857
references.citation: West J Med. 1994 Apr;160(4):326-30
references.pmid: 8023480
references.citation: Bull World Health Organ. 2000;78(7):920-9
references.pmid: 10994266
references.citation: Nature. 1975 Dec 18;258(5536):627-8
references.pmid: 1207742
references.citation: Southeast Asian J Trop Med Public Health. 1998 Sep;29(3):643-8
references.pmid: 10437972
references.citation: Tob Control. 2000 Mar;9(1):3-8
references.pmid: 10691743
references.citation: J Oral Pathol Med. 1996 Aug;25(7):367-70
references.pmid: 8890050
references.citation: J Toxicol Environ Health A. 2001 Nov 23;64(6):465-72
references.pmid: 11732697
references.citation: Chin J Physiol. 2000 Mar 31;43(1):23-8
references.pmid: 10857465
references.citation: Southeast Asian J Trop Med Public Health. 1995 Jun;26(2):291-6
references.pmid: 8629063
references.citation: J Nerv Ment Dis. 1988 May;176(5):257-63
references.pmid: 3367140
references.citation: Addict Biol. 2002 Jan;7(1):77-83
references.pmid: 11900626
references.citation: Tob Control. 2006 Jun;15 Suppl 1:i42-7
references.pmid: 16723675
references.citation: Int J Tuberc Lung Dis. 2004 Sep;8(9):1045-57
references.pmid: 15455588
references.citation: Tob Control. 1999 Autumn;8(3):327-32
references.pmid: 10599579
references.citation: Ann Acad Med Singap. 2004 Jul;33(4 Suppl):31-6
references.pmid: 15389304
references.citation: Stud Fam Plann. 2002 Sep;33(3):269-73
references.pmid: 12385088
references.citation: Farmaco. 2001 May-Jul;56(5-7):383-5
references.pmid: 11482763
references.citation: Drug Alcohol Depend. 2008 May 1;95(1-2):134-9
references.pmid: 18282667