Tobacco Control Issue: Original Article
Women and tobacco: A cross sectional study from North India Kathirvel S, Thakur JS, Sharma S Department of Community Medicine, School of Public Health, Postgraduate Institute of Medical Education and Research, Chandigarh, India Correspondence to: Dr. J S Thakur, E‑mail: [email protected]
Abstract
BACKGROUND: Tobacco is a leading risk factor for different types of diseases globally. Tobacco smoking by women is culturally unacceptable in India, but still women smoke tobacco at various times of their life. AIMS: The aim was to estimate the prevalence and pattern of tobacco use among women and to study the associated sociodemographic factors. SETTINGS AND DESIGN: This cross‑sectional study was conducted among women aged 30 years or over in an urban resettlement colony for the migrant population at Chandigarh, India. METHODOLOGY: The study
included women used tobacco products on one or more days within the past 30 days. Through systematic random sampling, 262 women were studied. As a part of the study 144 bidi smoking women were interviewed using detailed semi‑structured questionnaire. STATISTICAL ANALYSIS: Descriptive statistics and hypothesis testing with Chi‑squared test and logistic regression were done using SPSS 16.0 version. RESULTS: Overall, the prevalence of tobacco use was 29.4% and that of bidi, zarda and hookah were 19.8%, 8.8%, and 2.7%, respectively. Around 6.2% women used tobacco during pregnancy. Teenage was the most common age of initiation of bidi smoking. Logistic regression analysis showed that the prevalence of tobacco use was high among Hindu unemployed women with no formal education belonged to scheduled caste, and those having grandchildren. CONCLUSIONS: This study highlighted high rates of tobacco use and explored both individual and family factors related to tobacco use among women. Affordable, culturally acceptable, sustainable and gender‑sensitive individual and community‑specific interventions will reduce the prevalence and effects of tobacco use. Key Words: Prevalence, tobacco, women
Introduction Globally 20% of smokers are women; tobacco causes 1.5 million deaths in women. Among them, more than 75% live in low‑ and middle‑income countries.[1,2] Global modeled age‑standardized prevalence of daily tobacco smoking estimate for 2012 among women ≥15 years of age is 6.2%, and the same for Indian women is 3.2%. [3] Tobacco use among women is getting more attention currently. There is scarcely available data on tobacco use in women from low‑ and middle‑income countries. These countries record low smoking prevalence among women, which can be due to under‑reporting.[4] Different cultural, psychosocial and socioeconomic factors can be the reasons for tobacco use. Use of traditional tobacco products like bidi smoking, khaini, chutki, betel quid use by women in India is poorly understood and studied. The traditional practices of tobacco use vary according to the region in India due to the difference in social norms, family life and cultural influence on behavior. This study estimated (i) the prevalence and pattern or type of tobacco use among women above 30 years of age in an urban resettlement colony of Chandigarh, the smoke free city of India, and (ii) explored the different cultural, psychosocial, socioeconomic and demographic factors associated with tobacco use. Methodology Study design and area
This is a cross‑sectional study conducted in an urban resettlement colony of Chandigarh, with a population of nearly 27,000 in 5,699 households consisting mainly of migrants from Uttar Pradesh (UP), Punjab, Haryana, Himachal Pradesh (HP), Uttarakhand and Bihar in Access this article online Quick Response Code:
Website: www.indianjcancer.com DOI: 10.4103/0019-509X.147478 PMID: *******
S78
descending order. Unskilled labors working in vegetable market is their main occupation. Study population
According to the recent annual survey (March, 2014), the study area has 6,522 women in this age group.[5] Women aged 30 years and above and residing in the study area for the past six months or more were enlisted for the study. Sampling and sample size
Sample size to estimate the prevalence of any tobacco product use among the study population was calculated assuming 12% prevalence (four times the national average) with the design effect of 1.5 at 5% precision. Systematic random sampling was done in which every twentieth household was sampled. Written informed consent was obtained from all participants. All women aged 30 and above from each sampled household were asked questions from the pretested semi‑structured questionnaire (Pearson correlation coefficient 0.721, P 100,001
Use of any tobacco products in women 1 (%)
Total (%)
Yes
No
16 (6.1) 23 (8.8) 23 (8.8) 11 (4.2) 4 (1.5)
66 (25.2) 60 (22.9) 34 (13) 16 (6.1) 9 (3.5)
82 (31.3) 83 (31.7) 57 (21.8) 27 (10.3) 13 (5.0)
50 (19.1) 2 (0.8) 0 0
174 (66.4) 30 (8.5) 5 (1.9) 1 (0.4)
224 (85.5) 32 (12.2) 5 (1.9) 1 (0.4)
4 (1.5) 12 (4.6) 36 (13.7)
53 (20.2) 91 (34.7) 66 (25.2)
57 (21.8) 103 (39.3) 102 (38.9)
5 (2) 50 (19.7) 15 (5.9) 5 (2.0)
25 (9.8) 114 (44.9) 25 (9.8) 15 (5.9)
30 (11.8) 164 (64.6) 40 (15.7) 20 (7.9)
65 (24.8) 12 (4.6)
167 (63.7) 18 (6.9)
232 (88.5) 30 (11.5)
72 (27.5) 4 (1.5) 1 (0.4) 0 0
103 (39.3) 35 (13.4) 24 (9.2) 21 (8.0) 2 (0.8)
175 (66.8) 39 (14.9) 25 (9.5) 21 (8.0) 2 (0.8)
42 (16) 3 (1.1) 7 (2.7) 24 (9.2) 1 (0.4)
152 (58) 4 (1.5) 11 (4.2) 15 (5.7) 3 (1.2)
194 (74) 7 (2.7) 18 (6.9) 39 (14.9) 4 (1.6)
1 (1.5) 15 (22.1) 11 (16.2) 5 (7.4)
2 (2.9) 11 (16.2) 6 (8.8) 9 (13.2)
3 (4.4) 26 (38.2) 17 (25) 14 (20.6)
4 (5.9)
4 (5.9)
8 (11.8)
OBC=Other backward class; SC=Scheduled class
ratio [OR]‑14.6), belonged to scheduled caste (OR‑5.6), Hindu religion (OR‑3), had any grandchild (OR‑3.2), unemployed (OR‑2.8), and Uttar Pradesh (OR-1.35) as their native place compared with other groups. Relaxation (74%) was the main reason for initiation of bidi smoking. Other reasons included are for Fun (50%), to cope up frustration (29%), relief from diseases (26%), reduce anger (21%), to maintain the social image (12%), unemployment (5%) and to show the power or S79
Kathirvel, et al.: Women and tobacco
Table 2: Tobacco use prevalence estimates among study population Characteristics
Tobacco prevalence study group (%)
Any tobacco product Bidi Cigarette Hookah Zardha Khaini Pan/chutki Alcohol use Prevalence of tobacco use in any family member Prevalence of tobacco and or alcohol use in any family member Tobacco use during pregnancy
Mean age since bidi use Age since bidi use (years) 1-10 11-20 21-30 31-40 41-50 Mean number of years‑bidi use Year since using bidi (years) 1-10 11-20 21-30 31-40 41-50 >50 Mean number of bidi use per day Number of bidi use per day 1-6 7-12 13-24 >24 Average money spent for any tobacco product use per day (in INR) Source of money for any tobacco product use Self Husband Family members Friends and neighbors
Male (n=158)
3 (8.6) 3 (8.6) 0 0 1 (2.9) 0 1 (2.9) 0
115 (72.8) 98 (62) 24 (15.2) 3 (1.9) 23 (14.6) 20 (12.7) 0 22 (13.9)
because of prevailing culture of not smoking in front of elders (W1) and dominance by others (W1).
6 (4.4) 70 (39.7) 29 (21.4) 22 (16.2) 9 (6.3) 23.3 (20.2-26.4)
Nearly, all women contemplated thoughts and also tried to quit smoking because of non-acceptance by the family members, fear of cancer, doctors’ advice, sickness in her and others, fear of respiratory diseases and due to financial problems. Since they tried and failed with cardamom, toffee/sweet and tea/coffee as a replacement to bidi they now feel that self‑control alone or in combination with medications work better. They were also aware of ill‑health effects of smoking bidi such as cancer, respiratory, cardiac and reproductive tract problems.
53 (36.8) 21 (14.6) 15 (10.4) 25 (17.4) 20 (13.9) 10 (6.9) 12 (10-14)
Diseases such as tuberculosis, bronchial asthma, chronic obstructive lung diseases (chronic obstructive pulmonary disease), and hypertension were reported more in bidi smokers than non-smokers (
Women and tobacco: A cross sectional study from North India Kathirvel S, Thakur JS, Sharma S Department of Community Medicine, School of Public Health, Postgraduate Institute of Medical Education and Research, Chandigarh, India Correspondence to: Dr. J S Thakur, E‑mail: [email protected]
Abstract
BACKGROUND: Tobacco is a leading risk factor for different types of diseases globally. Tobacco smoking by women is culturally unacceptable in India, but still women smoke tobacco at various times of their life. AIMS: The aim was to estimate the prevalence and pattern of tobacco use among women and to study the associated sociodemographic factors. SETTINGS AND DESIGN: This cross‑sectional study was conducted among women aged 30 years or over in an urban resettlement colony for the migrant population at Chandigarh, India. METHODOLOGY: The study
included women used tobacco products on one or more days within the past 30 days. Through systematic random sampling, 262 women were studied. As a part of the study 144 bidi smoking women were interviewed using detailed semi‑structured questionnaire. STATISTICAL ANALYSIS: Descriptive statistics and hypothesis testing with Chi‑squared test and logistic regression were done using SPSS 16.0 version. RESULTS: Overall, the prevalence of tobacco use was 29.4% and that of bidi, zarda and hookah were 19.8%, 8.8%, and 2.7%, respectively. Around 6.2% women used tobacco during pregnancy. Teenage was the most common age of initiation of bidi smoking. Logistic regression analysis showed that the prevalence of tobacco use was high among Hindu unemployed women with no formal education belonged to scheduled caste, and those having grandchildren. CONCLUSIONS: This study highlighted high rates of tobacco use and explored both individual and family factors related to tobacco use among women. Affordable, culturally acceptable, sustainable and gender‑sensitive individual and community‑specific interventions will reduce the prevalence and effects of tobacco use. Key Words: Prevalence, tobacco, women
Introduction Globally 20% of smokers are women; tobacco causes 1.5 million deaths in women. Among them, more than 75% live in low‑ and middle‑income countries.[1,2] Global modeled age‑standardized prevalence of daily tobacco smoking estimate for 2012 among women ≥15 years of age is 6.2%, and the same for Indian women is 3.2%. [3] Tobacco use among women is getting more attention currently. There is scarcely available data on tobacco use in women from low‑ and middle‑income countries. These countries record low smoking prevalence among women, which can be due to under‑reporting.[4] Different cultural, psychosocial and socioeconomic factors can be the reasons for tobacco use. Use of traditional tobacco products like bidi smoking, khaini, chutki, betel quid use by women in India is poorly understood and studied. The traditional practices of tobacco use vary according to the region in India due to the difference in social norms, family life and cultural influence on behavior. This study estimated (i) the prevalence and pattern or type of tobacco use among women above 30 years of age in an urban resettlement colony of Chandigarh, the smoke free city of India, and (ii) explored the different cultural, psychosocial, socioeconomic and demographic factors associated with tobacco use. Methodology Study design and area
This is a cross‑sectional study conducted in an urban resettlement colony of Chandigarh, with a population of nearly 27,000 in 5,699 households consisting mainly of migrants from Uttar Pradesh (UP), Punjab, Haryana, Himachal Pradesh (HP), Uttarakhand and Bihar in Access this article online Quick Response Code:
Website: www.indianjcancer.com DOI: 10.4103/0019-509X.147478 PMID: *******
S78
descending order. Unskilled labors working in vegetable market is their main occupation. Study population
According to the recent annual survey (March, 2014), the study area has 6,522 women in this age group.[5] Women aged 30 years and above and residing in the study area for the past six months or more were enlisted for the study. Sampling and sample size
Sample size to estimate the prevalence of any tobacco product use among the study population was calculated assuming 12% prevalence (four times the national average) with the design effect of 1.5 at 5% precision. Systematic random sampling was done in which every twentieth household was sampled. Written informed consent was obtained from all participants. All women aged 30 and above from each sampled household were asked questions from the pretested semi‑structured questionnaire (Pearson correlation coefficient 0.721, P 100,001
Use of any tobacco products in women 1 (%)
Total (%)
Yes
No
16 (6.1) 23 (8.8) 23 (8.8) 11 (4.2) 4 (1.5)
66 (25.2) 60 (22.9) 34 (13) 16 (6.1) 9 (3.5)
82 (31.3) 83 (31.7) 57 (21.8) 27 (10.3) 13 (5.0)
50 (19.1) 2 (0.8) 0 0
174 (66.4) 30 (8.5) 5 (1.9) 1 (0.4)
224 (85.5) 32 (12.2) 5 (1.9) 1 (0.4)
4 (1.5) 12 (4.6) 36 (13.7)
53 (20.2) 91 (34.7) 66 (25.2)
57 (21.8) 103 (39.3) 102 (38.9)
5 (2) 50 (19.7) 15 (5.9) 5 (2.0)
25 (9.8) 114 (44.9) 25 (9.8) 15 (5.9)
30 (11.8) 164 (64.6) 40 (15.7) 20 (7.9)
65 (24.8) 12 (4.6)
167 (63.7) 18 (6.9)
232 (88.5) 30 (11.5)
72 (27.5) 4 (1.5) 1 (0.4) 0 0
103 (39.3) 35 (13.4) 24 (9.2) 21 (8.0) 2 (0.8)
175 (66.8) 39 (14.9) 25 (9.5) 21 (8.0) 2 (0.8)
42 (16) 3 (1.1) 7 (2.7) 24 (9.2) 1 (0.4)
152 (58) 4 (1.5) 11 (4.2) 15 (5.7) 3 (1.2)
194 (74) 7 (2.7) 18 (6.9) 39 (14.9) 4 (1.6)
1 (1.5) 15 (22.1) 11 (16.2) 5 (7.4)
2 (2.9) 11 (16.2) 6 (8.8) 9 (13.2)
3 (4.4) 26 (38.2) 17 (25) 14 (20.6)
4 (5.9)
4 (5.9)
8 (11.8)
OBC=Other backward class; SC=Scheduled class
ratio [OR]‑14.6), belonged to scheduled caste (OR‑5.6), Hindu religion (OR‑3), had any grandchild (OR‑3.2), unemployed (OR‑2.8), and Uttar Pradesh (OR-1.35) as their native place compared with other groups. Relaxation (74%) was the main reason for initiation of bidi smoking. Other reasons included are for Fun (50%), to cope up frustration (29%), relief from diseases (26%), reduce anger (21%), to maintain the social image (12%), unemployment (5%) and to show the power or S79
Kathirvel, et al.: Women and tobacco
Table 2: Tobacco use prevalence estimates among study population Characteristics
Tobacco prevalence study group (%)
Any tobacco product Bidi Cigarette Hookah Zardha Khaini Pan/chutki Alcohol use Prevalence of tobacco use in any family member Prevalence of tobacco and or alcohol use in any family member Tobacco use during pregnancy
Mean age since bidi use Age since bidi use (years) 1-10 11-20 21-30 31-40 41-50 Mean number of years‑bidi use Year since using bidi (years) 1-10 11-20 21-30 31-40 41-50 >50 Mean number of bidi use per day Number of bidi use per day 1-6 7-12 13-24 >24 Average money spent for any tobacco product use per day (in INR) Source of money for any tobacco product use Self Husband Family members Friends and neighbors
Male (n=158)
3 (8.6) 3 (8.6) 0 0 1 (2.9) 0 1 (2.9) 0
115 (72.8) 98 (62) 24 (15.2) 3 (1.9) 23 (14.6) 20 (12.7) 0 22 (13.9)
because of prevailing culture of not smoking in front of elders (W1) and dominance by others (W1).
6 (4.4) 70 (39.7) 29 (21.4) 22 (16.2) 9 (6.3) 23.3 (20.2-26.4)
Nearly, all women contemplated thoughts and also tried to quit smoking because of non-acceptance by the family members, fear of cancer, doctors’ advice, sickness in her and others, fear of respiratory diseases and due to financial problems. Since they tried and failed with cardamom, toffee/sweet and tea/coffee as a replacement to bidi they now feel that self‑control alone or in combination with medications work better. They were also aware of ill‑health effects of smoking bidi such as cancer, respiratory, cardiac and reproductive tract problems.
53 (36.8) 21 (14.6) 15 (10.4) 25 (17.4) 20 (13.9) 10 (6.9) 12 (10-14)
Diseases such as tuberculosis, bronchial asthma, chronic obstructive lung diseases (chronic obstructive pulmonary disease), and hypertension were reported more in bidi smokers than non-smokers (
