title: Patterns of Use and Perceptions of Harm of Smokeless Tobacco in Navi Mumbai, India and Dhaka, Bangladesh.
abstract: BACKGROUND
  Globally, smokeless tobacco use is disproportionately concentrated in low-income and middle-income countries like India and Bangladesh.
  
  
  OBJECTIVE
  The current study examined comparative patterns of use and perceptions of harm for different smokeless tobacco products among adults and youth in Navi Mumbai, India, and Dhaka, Bangladesh.
  
  
  METHODS
  Face-to-face interviews were conducted on tablets with adult (19 years and older) smokeless tobacco users and youth (16-18 years) users and non-users in Navi Mumbai (n= 1002), and Dhaka (n= 1081).
  
  
  RESULTS
  A majority (88.9%) of smokeless tobacco users reported daily use. Approximately one-fifth (20.4%) of the sample were mixed-users (used both smoked and smokeless tobacco), of which about half (54.4%) reported that they primarily used smokeless over smoked forms like cigarettes or bidis. The proportion of users planning to quit was higher in India than in Bangladesh (75.7% vs. 49.8%,p< 0.001).Gutkhawas the most commonly used smokeless product in India, andpan masalain Bangladesh. Among users in Bangladesh, the most commonly reported reason for using their usual product was the belief that it was "less harmful" than other types. Perceptions of harm also differed with respect to a respondent's usual product. Bangladeshi respondents reported more negative attitudes toward smokeless tobacco compared to Indian respondents.
  
  
  CONCLUSIONS
  The findings highlight the high daily use of smokeless tobacco, and the high prevalence of false beliefs about its harms. This set of findings reinforces the need to implement effective tobacco control strategies in low and middle-income countries like India and Bangladesh.
authors.affiliation: School of Public Health and Health Systems, University of Waterloo, 200 University Avenue West, Waterloo, Ontario, N2L3G1 Canada.
authors.forename: Seema
authors.initials: S
authors.lastname: Mutti
authors.affiliation: Propel Centre for Population Health Impact, University of Waterloo, 200 University Avenue West, Waterloo, Ontario, N2L3G1 Canada.
authors.forename: Jessica L
authors.initials: JL
authors.lastname: Reid
authors.affiliation: Healis-Sekhsaria Institute for Public Health,501 Technocity, Plot X-4/5, MIDC, TTC Industrial Area, Mahape, Navi Mumbai 400701, India.
authors.forename: Prakash C
authors.initials: PC
authors.lastname: Gupta
authors.affiliation: Healis-Sekhsaria Institute for Public Health,501 Technocity, Plot X-4/5, MIDC, TTC Industrial Area, Mahape, Navi Mumbai 400701, India.
authors.forename: Mangesh S
authors.initials: MS
authors.lastname: Pednekar
authors.affiliation: Healis-Sekhsaria Institute for Public Health,501 Technocity, Plot X-4/5, MIDC, TTC Industrial Area, Mahape, Navi Mumbai 400701, India.
authors.forename: Gauri
authors.initials: G
authors.lastname: Dhumal
authors.affiliation: American Cancer Society, Washington DC, USA.
authors.forename: Nigar
authors.initials: N
authors.lastname: Nargis
authors.affiliation: Department of Economics, University of Dhaka, Nilkhet, Dhaka-1000, Bangladesh.
authors.forename: Akm Ghulam
authors.initials: AG
authors.lastname: Hussain
authors.affiliation: School of Public Health and Health Systems, University of Waterloo, 200 University Avenue West, Waterloo, Ontario, N2L3G1 Canada.
authors.forename: David
authors.initials: D
authors.lastname: Hammond
keywords: Bangladesh; India; Smokeless tobacco; attitudes and practice; health knowledge; perceptions of harm