title: Availability, accessibility and promotion of smokeless tobacco in a low-income area of Mumbai.
abstract: OBJECTIVE
  To examine the role of accessibility, product availability, promotions and social norms promotion, factors contributing to the use of smokeless tobacco (ST) products in a typical low-income community of Mumbai community using Geographic Information System (GIS), observational and interview methodologies and to assess implementation of Cigatettes and other Tobacco Products Act (COTPA) legislation.
  
  
  BACKGROUND
  In India, the third largest producer of tobacco in the world, smokeless tobacco products are used by men, women and children. New forms of highly addictive packaged smokeless tobacco products such as gutkha are inexpensive and rates of use are higher in low-income urban communities. These products are known to increase rates of oral cancer and to affect reproductive health and fetal development.
  
  
  METHODS
  The study used a mixed methods approach combining ethnographic and GIS mapping, observation and key informant interviews. Accessibility was defined as density, clustering and distance of residents and schools to tobacco outlets. Observation and interview data with shop owners and community residents produced an archive of products, information on shop histories and income and normative statements.
  
  
  RESULTS
  Spatial analysis showed high density of outlets with variations across subcommunities. All residents can reach tobacco outlets within 30-100 feet of their homes. Normative statements from 55 respondents indicate acceptance of men's, women's and children's use, and selling smokeless tobacco is reported to be an important form of income generation for some households. Multilevel tobacco control and prevention strategies including tobacco education, community norms change, licensing and surveillance and alternative income generation strategies are needed to reduce accessibility and availability of smokeless tobacco use.
authors.affiliation: Institute for Community Research, Hartford, Connecticut 06106, USA. jean.schensul@icrweb.org
authors.forename: Jean J
authors.initials: JJ
authors.lastname: Schensul
authors.forename: Saritha
authors.initials: S
authors.lastname: Nair
authors.forename: Sameena
authors.initials: S
authors.lastname: Bilgi
authors.forename: Ellen
authors.initials: E
authors.lastname: Cromley
authors.forename: Vaishali
authors.initials: V
authors.lastname: Kadam
authors.forename: Sunitha D
authors.initials: SD
authors.lastname: Mello
authors.forename: Balaiah
authors.initials: B
authors.lastname: Donta
mesh_terms: D000328:Adult; D002648:Child; D005260:Female; D062305:Geographic Mapping; D006801:Humans; D007182:Income; D007194:India; D007407:Interviews as Topic; D008297:Male; D040541:Marketing; D019370:Observation; D011203:Poverty; D012945:Social Values; D064424:Tobacco Use; D014030:Tobacco, Smokeless