• Safety and Health at Work
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• v.11 no.2
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• pp.143-151
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• 2020

Objective: Bidi is an inexpensive, low-processed, hand-rolled tobacco product. In Bangladesh, especially in Rangpur, tobacco farming and bidi processing are common. In this study, we aimed to evaluate the impact of bidi making on children working in bidi factories. Methods: This qualitative(walk-through survey) and quantitative(questionnaire-based survey and a urine cotinine level quantitation) study was conducted in Rangpur, Bangladesh in 2017. Study population included child-workers aged ≤14 years who were regularly employed as bidi makers. Findings: The results of the walk-through survey revealed hazardous working environments at bidi factories. For the quantitative survey, 171 child-workers were categorized into "less-working"(<5 hours/day) and "more-working"(≥5 hours/day) groups; additionally, "forced-working"(forced into work by parents) and "voluntary-working"(working voluntarily) groups were delineated within the same population. In the logistic regression analysis, odds ratios(ORs) of respiratory symptoms and unusual absence(absent ≥5 days/month) were higher in the "more-working" group than in the "less-working" group(unusual absence: OR, 2.91; 95% confidence interval[CI], 1.43-5.94), and this association became higher in the "forced-working" group with longer working hours(OR, 5.68, 95%CI 2.30-14.00). Conclusions: Cheap, hand-rolled tobacco(bidi) is harmful to the health of bidi-making child-workers. Children in poverty bow to the demands of cheap labor and poverty and jeopardize their health and future prospects by working in bidi factories. Tobacco control policies should consider the social effects of tobacco beyond its biological effects.

• Asian Pacific Journal of Cancer Prevention
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• v.14 no.10
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• pp.5657-5661
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• 2013

In India, among males, leukemia rates vary across the country. The present unmatched hospital-based case-control study conducted at Tata Memorial Hospital included subjects registered between the years 1997-99. There were 246 leukemia cases and 1,383 normal controls. Data on demographics, lifestyle, diet and occupation history were recorded. Cigarette (OR=2.1) and bidi smoking (OR=3.4) showed excess risk for leukemia. Odds ratios were 3.9 for fish-eaters, 0.40 for chilli eaters, 1.5 for milk drinkers and 0.60 for coffee drinkers, compared to non-drinkers/eaters. However, neither exposure to use of pesticides nor cotton dust showed any excess risk for leukemia.

• Asian Pacific Journal of Cancer Prevention
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• v.14 no.5
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• pp.3323-3329
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• 2013

Background: The Global Adult Tobacco Survey (GATS) was carried out for systematically monitoring tobacco use and for tracking key tobacco control indicators. Materials and Methods: A total of 70,802 households, including 42,647 in rural areas and 28,155 in urban areas, were covered with a three stage sampling design. Data were collected on sociodemographic characteristics, knowledge, attitude and practices of tobacco consumption.Results: GATS-India highlighted that total tobacco use among its residents is overall 34.6%, varying for males (47.9%) and females (20.7%). The rural areas of the country exhibit comparatively higher prevalence rates (38.4%) in comparison to urban areas (25.3%). Overall, Khaini, a smokeless tobacco product (12.0%), is the most popular form of tobacco use among males and females, followed by bidi smoking (9.0%). Conclusion: Results of GATS data can be used as baseline for evaluation of new tobacco control approaches in India integrating culturally acceptable and cost effective measures.

• Asian Pacific Journal of Cancer Prevention
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• v.16 no.14
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• pp.5721-5726
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• 2015

Lung cancer is the leading contributor to cancer deaths in the developing world. Within countries, significant variability exists in the prevalence of lung cancer risk, yet limited information is available whether some of the observed variability is associated with differences in the consumption pattern of local tobacco products with differing potency. We recruited 606 lung cancer cases and 606 controls from the B.P. Koirala Memorial Cancer Hospital in Nepal from 2009-2012. We estimated odds ratios (ORs) and 95% confidence intervals (CI) for lung cancer risk associated with different tobacco products, using unconditional logistic regression. Unfiltered cigarettes tended to be the most frequently used products across ethnic subgroup with about 53.7% of Brahmins, 60.1% of Chettris, and 52.3% of Rai/Limbu/Magar/others. In contrast, about 39.9% of Madishe/Tharu smokers reported using bidi compared with only 27.7% who smoked unfiltered cigarettes. Among those who only smoked one type of product, choor/kankat smokers had the highest lung cancer risk (OR 10.2; 95% CI 6.2-16.6), followed by bidi smokers (OR 5.6; 95% CI 3.6-8.7), unfiltered cigarettes (OR 4.9; 95% CI 3.4-7.2), and filtered cigarettes (OR 3.4; 95% CI 2.2-5.3). A clear dose-response relationship was observed between increased frequency of smoking and lung cancer risk across all ethnic subgroups. These results highlight the important role of traditional tobacco products on lung cancer risk in the low income countries.

• Asian Pacific Journal of Cancer Prevention
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• v.14 no.2
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• pp.775-780
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• 2013

Background: In the year 2010, it is estimated that nearly 0.36 million new cases and 0.19 million deaths with Non-Hodgkin lymphoma occurred. In India, among males, NHL incidence rates vary across the country which has encouraged us to conduct a case-control study to study risk factors. Materials and Methods: The present unmatched hospital-based case-control study conducted at Tata Memorial Hospital included subjects registered between the years 1997-99. There were 390 'lymphoma cases' and 1,383 'normal controls. Results: Data on age, tobacco habits, occupational history, dietary factors, tea, coffee were collected by the social investigators. Univariate and multivariate methods were applied for obtaining the odds ratios for risk factors. Conclusions: In the study, cigarette smoking (OR=2.0) and bidi smoking (OR=2.8), were associated with excess risk of lymphoma. Among the dietary items, only consumption of mutton showed 7.3-fold significant excess risk for lymphoma. Consumption of milk showed a 6-fold excess risk (OR=1.5); while coffee showed a 50% reduction in risk for lymphoma. Among occupational exposure, exposure to use of pesticides showed 3-fold excess risk for lymphoma.

• Asian Pacific Journal of Cancer Prevention
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• v.13 no.2
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• pp.539-543
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• 2012

Background: The results of the Global School Personnel Survey (GSPS) conducted in India in 2009 are compared with 2006 GSPS to assess any change in 2009 on tobacco use and knowledge and attitudes to tobacco use, training and availability of tobacco control teaching material in schools and the existence of school tobacco control policies. Methods: GSPS is a cross sectional survey conducted twice (2006 and 2009) in entire India. A total of 180 schools were surveyed each time. Results: Of the participating school personnel, 2660 in 2006 and 2575 in 2009, about 95% were teachers and the balance administrators. In 2009, compared to 2006 the prevalence of current smoking of cigarettes (19.6% in 2006 and 10.3% in 2009) and bidis (21.5% in 2006 and 13.9% in 2009) was found to be significantly lower; the percentage of teachers receiving training on preventing youth tobacco use has significantly reduced (16.7% in 2006 and 10.1% in 2009); access of teachers to educational materials on tobacco use and how to prevent its use among youth had not increased (34.6% in 2006 and 37.8% in 2009); there was no change in policy prohibiting tobacco use among students and school personnel; however, ever use of any tobacco on school premises was significantly lower (15.6% in 2006 and 9.6% in 2009). Conclusions: The prevalence of current smoking (cigarettes/bidis) among school personnel and use of any tobacco on school premises were significantly decreased in 2009 as compared to 2006. Necessary action should be planned to increase the number of teachers trained and the availability of teaching materials on preventing youth tobacco use in order to have effective prevention of tobacco use among students.

• Asian Pacific Journal of Cancer Prevention
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• v.13 no.6
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• pp.2663-2667
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• 2012

Objectives: An attempt was made to understand the nicotine dependence of smokers selected for an ongoing smoking cessation intervention programme in rural Kerala, India. Methods: Data were collected from resident males in the age group of 18 to 60 years from 4 randomly allocated community development blocks of rural Thiruvananthapuram district (2 intervention and 2 control groups). Trained accredited social health activist workers were utilised to collect data from all groups through face to face interview. Nicotine dependence among participants was assessed by means of the six-item Fagerstrom Test for Nicotine Dependence (FTND) translated into the local language. The internal consistency of FTND was computed using Cronbach's alpha coefficient. Criterion validity (concurrent) was assessed by correlations of nicotine dependence scores with age at initiation of smoking and cumulative smoking volume in pack-years. Results: Among the 928 smokers identified, 474 subjects were in the intervention area (mean age = 44.6 years, SD = 9.66 years) and 454 in the control area (mean age = 44.5 years, SD = 10.30 years). The overall FTND score among current daily smokers was 5.04 (SD: 5.05). FTND scores in the control and intervention areas were 4.75 (SD: 2.57) and 4.92 (SD: 2.51) respectively. The FTND scores increased with age and decreased with higher literacy and socioeconomic status. The average FTND score was high among smokers using both bidi and cigarettes (mean 6.10, SD 2.17). Internal consistency analysis yielded a Cronbach's alpha coefficient of 0.70 in a subsample of 150 subjects, a moderate result. The association of the scale was strongest, with the number of pack-years smoked (rho = 0.677, p < 0.001). Conclusion: A moderate level of nicotine dependence was observed among smokers in the current study. Tobacco cessation strategies could be made more cost effective and productive if a baseline assessment of nicotine dependence is completed before any intervention.

• Asian Pacific Journal of Cancer Prevention
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• v.14 no.11
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• pp.6797-6802
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• 2013

Background: Prevalence of tobacco use is higher in the rural than urban areas of India. Unlike tobacco cessation clinics located in urban areas, community-based smoking cessation intervention has the potential to reach a wider section of the community to assist in smoking cessation in the rural setting. The present study aimed to assess the effectiveness of a cessation intervention in rural Kerala state, India. Materials and Methods: Current daily smoking resident males in the age group 18-60 years from four community development blocks in rural Kerala were randomly allocated to intervention and control groups. The intervention group received multiple approaches in which priority was given to face-to-face interviews and telephone counselling. Initially educational materials on tobacco hazards were distributed. Further, four rounds of counselling sessions were conducted which included a group counselling with a medical camp as well as individual counselling by trained medical social workers. The control group received general awareness training on tobacco hazards along with an anti-tobacco leaflet. Self-reported smoking status was assessed after 6 and 12 months. Factors associated with tobacco cessation were estimated using binomial regression method. Results: Overall prevalence of smoking abstinence was 14.7% in the intervention and 6.8% in the control group (Relative risk: 1.85, 95% CI: 1.05, 3.25). A total of 41.3% subjects in the intervention area and 13.6% in the control area had reduced smoking by 50% or more at the end of 12 months. Lower number of cigarettes/ bidi used, low nicotine dependence and consultation with a doctor for a medical ailment were the statistically significant predictors for smoking cessation. Conclusions: Rigorous approaches for smoking cessation programmes can enhance quit rates in smoking in rural areas of India.