title: Use of smokeless tobacco by Indian women aged 18-40 years during pregnancy and reproductive years.
abstract: OBJECTIVE
  This paper discusses patterns of daily smokeless tobacco (SLT) use and correlates of poly SLT use among married women aged 18-40 years in a Mumbai slum community with implications for tobacco control.
  
  
  METHODS
  Using a mixed methods approach, the study included a structured survey with 409 daily SLT users and in-depth interviews with 42 women. Participants for the survey were selected using a systematic sampling procedure (one woman in every fourth eligible household). Univariate and bivariate analysis, and multiple logistic regressions were conducted to identify demographic and social factors associated with women's use of poly SLT products. To illustrate survey results, in-depth interviews were analyzed using Atlas ti software.
  
  
  RESULTS
  Sixty-four percent of the women surveyed used only one type of SLT; of these, 30% used mishri, 32% used pan with tobacco and the rest used chewed tobacco (11%), gul (17%) or gutkha (10%). Thirty-six percent used more than one type of SLT. Poly SLT users chewed or rubbed 50% more tobacco as compared to single users (mean consumption of tobacco per day: 9.54 vs. 6.49 grams; p<0.001). Women were more likely to be poly SLT users if they were illiterate as compared to literate (adjusted odds ratio [AOR]=1.67; 95% confidence interval [CI]=1.07-2.71), if they had lived in Mumbai for 10 years or more, versus less than ten years (AOR=1.67, 95% CI=1.03-2.71); and if their husband was a poly SLT user as compared to a non SLT user (AOR=2.78, 95% CI=1.63-4.76). No differences were noted between pregnant and non-pregnant women in SLT consumption patterns.
  
  
  CONCLUSIONS
  Tobacco control policies and programs must focus specifically on both social context and use patterns to address SLT use among women of reproductive age with special attention to poly SLT users, an understudied and vulnerable population.
authors.affiliation: National Institute of Medical Statistics, New Delhi, India.
authors.forename: Saritha
authors.initials: S
authors.lastname: Nair
authors.affiliation: Institute for Community Research, Hartford, Connecticut, United States of America.
authors.forename: Jean J
authors.initials: JJ
authors.lastname: Schensul
authors.affiliation: National Institute for Research in Reproductive Health, Mumbai, India.
authors.forename: Shahina
authors.initials: S
authors.lastname: Begum
authors.affiliation: Healis Sekhsaria Institute for Public Health, Mumbai, India.
authors.forename: Mangesh S
authors.initials: MS
authors.lastname: Pednekar
authors.affiliation: University of Connecticut, Mansfield, Connecticut, United States of America.
authors.forename: Cheryl
authors.initials: C
authors.lastname: Oncken
authors.affiliation: National Institute for Research in Reproductive Health, Mumbai, India.
authors.forename: Sameena M
authors.initials: SM
authors.lastname: Bilgi
authors.affiliation: National Institute for Research in Reproductive Health, Mumbai, India.
authors.forename: Achhelal R
authors.initials: AR
authors.lastname: Pasi
authors.affiliation: National Institute for Research in Reproductive Health, Mumbai, India.
authors.forename: Balaiah
authors.initials: B
authors.lastname: Donta
mesh_terms: D000328:Adult; D002947:Cities; D003710:Demography; D005260:Female; D006801:Humans; D007194:India / Q000453:epidemiology; D007407:Interviews as Topic; D000067010:Literacy; D016015:Logistic Models; D016017:Odds Ratio; D011204:Poverty Areas; D011247:Pregnancy; D064424:Tobacco Use / Q000453:epidemiology*; D014030:Tobacco, Smokeless / Q000009:adverse effects*