Prevalence of Smokeless Tobacco among Low Socioeconomic Populations: A Cross-Sectional Analysis.
BACKGROUND
Cost, social acceptability and non-stringent regulations pertaining to smokeless tobacco (SLT) product sales have made people choose and continue using SLT. If disaggregated data on smokeless forms and smoked practices of tobacco are reviewed, the incidence of SLT remains static. There is a strong positive correlation of SLT intake with the occurrence of adverse cardiovascular disease, particularly in the low socioeconomic populations.


OBJECTIVE
To investigate the prevalence of smokeless tobacco, its initiation influence and risk factors associated with the practice among lower socioeconomic populations of Bangladesh. In this study, we explore the utilization of SLT among lower socioeconomic populations in industrialized zone of Bangladesh.


METHODS
A cross-sectional analysis using both quantitative and categorical approaches was employed. Using systematic random sampling method, four focus group discussions (FGDs) were conducted and 459 participants were interviewed. Multiple logistic regression model was applied to distinguish the significant factors among the SLT users.


RESULTS
Almost fifty percent of the respondents initiated SLT usage at the age of 15-24 years and another 22 percent respondents were smoking and using SLT concurrently. The bulk of the women respondents used SLT during their pregnancy. Nearly twenty five percent of the respondents tried to quit the practice of SLT and one-quarter had a plan to quit SLT in the future. More than twenty percent respondents were suffering from dental decay. A noteworthy correlation was found by gender (p<0.01), sufferings from SLT related disease (p<0.05). The multiple logistic regression analysis suggested that, males were 2.7 times more knowledgeable than that of females (p<0.01) about the adversative health condition of SLT usage. The respondents suffering from SLT related diseases were 3.7 times as more knowledgeable about the effect of the practice of SLT than the respondents without diseases (p<0.01). Regarding the knowledge about the health consequences of the practice of SLT, one participant in the FGD session commented that "although the mouth is the gateway to health, we infected our mouth by using Zarda and Gul". Again, informants opined that peer, family, curiosity and hospitality, culture are influencing factors for SLT initiation.


CONCLUSIONS
counselling on tobacco, including SLT, health hazards have to be emphasized through mass media and it is essential for development of relevant policies and communication messages to make people aware of serious health consequences of SLT usages.
King Saud University, Riyadh, Kingdom of Saudi Arabia.|Daffodil International University, Dhaka, Bangladesh.
Mohammad Nurul
MN
Azam
Department of Public Health, Daffodil International University, Dhaka, Bangladesh.
Mohammad
M
Shahjahan
EKRA Institute, Melbourne, Victoria, Australia.
Mahbuba
M
Yeasmin
Department of Epidemiology, Florida International University, Miami, United States of America.
Nasar U
NU
Ahmed
D000293:Adolescent; D000328:Adult; D000368:Aged; D001459:Bangladesh / Q000453:epidemiology; D003430:Cross-Sectional Studies; D003731:Dental Caries / Q000453:epidemiology / Q000209:etiology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D012959:Socioeconomic Factors; D064424:Tobacco Use / Q000009:adverse effects / Q000453:epidemiology; D014030:Tobacco, Smokeless / Q000009:adverse effects*