Occupational exposure to bidi tobacco increases chromosomal aberrations in tobacco processors

Sexually dimorphic response to tobacco in the development of chronic kidney disease: a systematic review

INTRODUCTION

Chronic kidney disease (CKD) demonstrates a complex interaction with tobacco exposure and sex differences, where females and males may experience varying risks and outcomes. This study aims to investigate how sex differences mediate the relationship between tobacco exposure and CKD development, with a secondary focus on regional variability and social determinants of health.

STUDY SELECTION AND CRITERIA

Comprehensive searches on MEDLINE, EMBASE, clinicaltrials.gov, and MedRxiv until October 6, 2022, were conducted. Eligibility criteria involved any study that reported primary data on the prevalence of CKD, with information pertaining to both sex and tobacco exposure.

DATA EXTRACTION

Data retrieved include patient socio-demographic characteristics, general study information, diagnostic methods, social determinants of health, and the cause of CKD (e.g., tobacco-related or non-tobacco-related).

RESULTS

Studies were selected through a comprehensive search using key terms such as "chronic kidney disease," "smoking," and "sex differences," which identified 3,025 articles, of which 28 were selected for full texts after screening titles, abstracts. Among the 28 included studies, smoking was consistently identified as a significant risk factor for CKD, with notable disparities related to sex, socioeconomic status, race, and urban versus rural settings. Significant geographical variability in CKD prevalence was observed, ranging from 2.5% to 68.1%, with the highest prevalence in Asia. However, due to high heterogeneity and methodological limitations, a meta-analysis of CKD prevalence stratified by sex and tobacco exposure was not feasible.

CONCLUSIONS

The findings emphasize the need for further research to comprehend the intricate relationship between, tobacco exposure, sex, and CKD management, as well as the consideration of cultural, geographical, socioeconomic, political, and structural factors when understanding the pathophysiology and management of CKD.

Occupational health hazards of bidi workers and their families in India: a scoping review

BACKGROUND

Bidi workers and their families are exposed to harmful substances during bidi rolling, thereby jeopardising their health. We aimed to assess existing evidence on health conditions of bidi workers and their families in India.

METHODS

We searched nine databases and relevant websites, and conducted citation screening to identify primary studies assessing occupational health hazards of bidi workers and their families. Two authors independently conducted screening and data extraction. We synthesised the findings narratively in a structured fashion.

RESULTS

We found 3842 studies, out of which 95 studies met our eligibility criteria. High prevalence of disease conditions across all organ systems of the body was reported in bidi workers. Studies on female bidi workers showed decreased fertility (n=2), increased frequency of miscarriages (n=1) and higher risk of cervical cancer (n=1). Pregnant bidi workers were at an increased risk of anaemia and pregnancy-induced hypertension (n=2), higher frequency of neonatal deaths (n=1), stillbirths (n=1) and premature births (n=1) in comparison with non-bidi workers. Babies born to bidi workers reported low birth weight (n=5). Evidence from cohort studies suggests causal nature of the exposure to the disease condition.

CONCLUSION

Our review shows that bidi rolling leads to numerous occupational health hazards in bidi workers and their family members. It is essential to provide alternative livelihoods, and safe and protective working environment, and cover bidi workers under various social security provisions to alleviate the deleterious effect of bidi making at home. It is also important to shift bidi making away from home and strengthen existing regulations and promulgation of new provisions, including India's Occupational Safety, Health, and Working Conditions Code 2020.

Occupational exposure to unburnt tobacco and potential risk of toxic optic neuropathy: A cross-sectional study among beedi rollers in selected rural areas of coastal Karnataka, India

BACKGROUND

Beedi also known as poor man's cigarette is manufactured in almost all major states of India. Beedi workers are exposed to various health risks. There is an increased risk of systemic absorption of tobacco through skin and mucous membrane. The optic nerve is susceptible to damage from several toxic substances including tobacco. This group of disorders is known as toxic optic neuropathy (TON). The association of TON with occupational exposure to unburnt tobacco in beedi rollers has not been explored.

OBJECTIVES

Among the beedi rollers in Mangaluru and Bantwal talukas of Dakshina Kannada District, Karnataka, India: to assess the magnitude of potential TON utilizing colour vision and contrast sensitivity as screening tools and to identify the demographic, biological and occupational factors associated with potential TON.

METHODS

A community-based cross-sectional study was conducted from April-Sept 2016 in Mangaluru and Bantwal talukas, of Dakshina Kannada district, Karnataka. Beedi rollers from twelve villages (six from each taluka) were included. In each of the selected villages, the investigators identified beedi collection centres and all the eligible beedi rollers were included in the study till the required number of beedi rollers for that village was achieved. Participants were screened at the study site for visual acuity, colour vision and contrast sensitivity and those with abnormal colour and contrast sensitivity in the presence of good visual acuity were considered to have potential TON.

RESULTS

A total of 377 beedi rollers were approached; of which 365 consented to take part in the study (response rate: 96.81%). Women constituted the majority of the participants (n = 338, 92.6%). Based on the screening criteria, the prevalence of potential TON was 17.5% (n = 64, 95% CI: 13.5-21.9). On multiple logistic regression analysis, duration of beedi rolling (Adj OR: 1.061; 95% CI 1.015-1.109, p = 0.009), advancing age (Adj OR: 1.096; 95% CI 1.058-1.136, p<0.001) and presence of diabetes (Adj OR: 6.315; 95% CI 1.4572-27.376, p = 0.014) were independent correlates of potential TON.

CONCLUSION

In the present study, almost one out of six beedi rollers displayed clinical signs of potential TON. Increased duration of beedi rolling, advancing age and presence of diabetes were the independent correlates of potential TON. However, with this cross-sectional study it is not possible to conclude if these factors play a role individually or collectively or are a serendipitous association, for which large scale analytical studies are required.

Tobacco dust induced genotoxicity as an occupational hazard in workers of bidi making cottage industry of central India

CONTEXT

To explore genotoxicity in bidi rollers occupationally exposed to bidi tobacco dust.

AIMS

To assess the extent of genotoxicity of tobacco dust to bidi rollers of Jabalpur, Madhya Pradesh, India and cytotoxicity of bidi tobacco extract.

SETTINGS AND DESIGN

Blood samples from 31 bidi rollers and 30 controls taken after written informed consent were analyzed for chromosome aberrations (CA) and comet assay.

MATERIALS AND METHODS

Genotoxicity was studied by CA in cultured peripheral blood lymphocytes of bidi rollers and the deoxyribonucleic acid (DNA) damage studies were done by comet assay of their blood. The toxicity of bidi tobacco extract to normal human lymphocytes was studied by MMT (3-[4,5-dimethylthiazol-2-yl]-2,5 diphenyl tetrazolium bromide) assay as drop in viability.

STATISTICAL ANALYSIS USED

Student's t-test and DMRT.

RESULTS

There is a general trend of increase in CA% of both in exposed and control groups with age, but in every group the bidi rollers have a significantly higher CA% than the controls. The CA % is also directly related to exposure. The comet assay findings reveal that the mean comet length and tail length increases with exposure time. The toxicity of bidi tobacco extract (TE) to normal human lymphocytes was tested in vitro by 3-[4,5-dimethylthiazol-2-yl]-2,5 diphenyl tetrazolium bromide (MTT) assay at 2 h of incubation. The trend of drop in viability with increasing concentrations of TE was clearly evident from the data from four donors in spite of their individual differences in viability.

CONCLUSIONS

The results obtained in this investigation indicate that bidi rollers seem to be facing the occupational hazard of genotoxicity due to handling bidi tobacco and inhalation of tobacco dust. They should be advised to work under well-ventilated conditions.

Working condition and health hazards in beedi rollers residing in the urban slums of Mumbai

BACKGROUND

Beedi rollers are exposed to unburnt tobacco dust through cutaneous and pharyngeal route. They are not aware of their rights. Studies have been conducted on beedi workers but not many studies are carried out in urban areas. Thus, study was carried out to understand working condition and health hazards in beedi workers residing in the urban slums of Mumbai and to know whether beedi roller are in better condition in urban areas.

AIM

To study working condition and health hazard in beedi rollers in the urban slums.

MATERIALS AND METHODS

Descriptive, cross-sectional, community based study was carried in the urban slums of Mumbai with population of 8985 from April 2011 to June 2011. With snow balling sampling technique, 52 beedi workers were interviewed regarding their socio-economic status, working conditions and health problems after informed consent. Data entry and statistical analysis were performed using the SPSS windows version 14.0 software.

RESULTS

The mean age was 45 years with SD of 12 years. All were Hindu females. Around 42.31% were illiterate. Mean years of service were 30 years and they work on an average for eight hours. Children were not involved in beedi rolling. Most common morbidity was fatigue. None were aware of the benefits provided for them. Awareness regarding health hazard and safety measures was poor.

CONCLUSIONS

The working condition of beedi rollers in the urban areas is not favourable.

Genotoxic effects of tobacco chewing

Tobacco chewing is a widespread habit which leads to DNA damage. We are reporting a case of a tobacco chewer in which chromosomal aberrations, DNA breakage, buccal micronuclei and urinary thioether excretion level were studied. The study was carried out on a 28 year old male subject who is polio affected since his childhood. He has been chewing tobacco since the last 17 yrs @ 4 g, 08 times per day. The medical report of the subject indicates no abnormalities except post-polio paralysis in both lower limbs. He has no family history of any genetic disorder. He is not occupationally exposed to tobacco. The findings of the present investigation indicate increased incidence of chromosomal aberration % and micronuclei in buccal epithelial cells than the control values obtained from a subject of similar age and socioeconomic condition but not addicted to tobacco chewing. However, the urinary thioether values of the subject were lower than control values indicating a depression of the detoxification pathway.

Clinical, cytogenetic and CYP1A1 exon-1 gene mutation analysis of Beedi workers in Vellore region, Tamil Nadu

BACKGROUND

Beedi rollers are exposed to unburnt tobacco dust through cutaneous and pharyngeal route and it is extremely harmful to the body since it is carcinogenic in nature and can cause cancer during long exposure. This indicates that occupational exposure to tobacco imposes considerable genotoxicity among beedi workers.

MATERIALS AND METHODS

In the present study, 27 beedi workers and age and sex matched controls were enrolled for clinical, cytogenetics and molecular analysis. Clinical features were recorded. The workers were in the age group of 28-67 years and were workers exposure from 8-60 years. Blood samples were collected from workers and control subjects and lymphocyte cultures were carried out by using standard technique, slides were prepared and 50 metaphases were scored for each sample to find the chromosomal abnormalities. For molecular analysis the genomic DNA was extracted from peripheral blood, to screen the variations in gene, the exon 1 of CYP1A1 gene was amplified by polymerase chain reaction (PCR) and then screened with Single Strand Conformation Polymorphism (SSCP) analysis.

RESULTS

A statistically significant increase was observed in the frequencies of chromosomal aberrations in exposed groups when compared to the respective controls and variations observed in Exon 1 of CYP1A1(Cytochrome P450, family 1, subfamily A, polypeptide 1) gene.

CONCLUSIONS

This study shows that, the toxicants present in the beedi that enter into human body causes disturbance to normal state and behavior of the chromosomes which results in reshuffling of hereditary material causing chromosomal aberrations and genomic variations.

Association of tobacco habits, including bidi smoking, with overall and site-specific cancer incidence: results from the Mumbai cohort study

OBJECTIVE

Bidis are hand-rolled cigarettes commonly smoked in South Asia and are marketed to Western populations as a safer alternative to conventional cigarettes. This study examined the association between bidis and other forms of tobacco use and cancer incidence in an urban developing country population.

METHODS

Using data from the large, well-characterized Mumbai cohort study, adjusted hazard ratios (HRs) and 95% confidence intervals (CIs) were computed from Cox proportional hazards regression models in order to compare the relative effect of various forms of tobacco use on cancer incidence.

RESULTS

During 649,228 person-years of follow-up 1,267 incident cancers occurred in 87,222 male cohort members. Incident oral cancer in bidi smokers (HR = 3.55; 95% CI = 2.40,5.24) was 42% higher than in cigarette smokers (HR = 2.50;95% CI = 1.65,3.78). For all respiratory and intrathoracic organs combined, the increase was 69% (HR = 5.54; 95% CI = 3.46,8.87 vs. HR = 3.28; 95% CI = 1.99,5.39); for lung and larynx, the increases were 35 and 112%, respectively. Smokeless tobacco use was associated with cancers of the lip, oral cavity, pharynx, digestive, respiratory, and intrathoracic organs.

CONCLUSIONS

Despite marketing claims to the contrary, we found that smokeless tobacco use and bidi smoking are at least as harmful as cigarette smoking for all incident cancers and are associated with increased risk of oral and respiratory/intrathoracic cancers.

Occupational health hazards in women beedi rollers in Bihar, India

We studied the health problems of 197 female beedi rollers in Patna, Bihar, India to ascertain the effects of beedi rolling on health. The study found that more than 70% of the beedi rollers suffered from eye, gastrointestinal and nervous problems while more than 50% of the respondents suffered from respiratory problems, mostly throat burning and cough. More than 75% of the respondents faced osteological problems. Total RBC, WBC and platelet counts of the beedi rollers were significantly lower in comparison to the control subjects. Differential leucocyte count showed significantly risen lymphocytes and eosinophils and lowered neutrophils and monocytes in the beedi rollers as compared to the control group. Haemoglobin levels were lower among beedi rollers compared to the control group. SGPT (ALT) enzyme concentration, a parameter of liver dysfunction was significantly higher in the beedi rollers as compared to the control group. Thus, the study concluded that beedi rolling may cause significant health hazards.

Genotoxicity of tobacco smoke and tobacco smoke condensate: a review

This report reviews the literature on the genotoxicity of mainstream tobacco smoke and cigarette smoke condensate (CSC) published since 1985. CSC is genotoxic in nearly all systems in which it has been tested, with the base/neutral fractions being the most mutagenic. In rodents, cigarette smoke induces sister chromatid exchanges (SCEs) and micronuclei in bone marrow and lung cells. In humans, newborns of smoking mothers have elevated frequencies of HPRT mutants, translocations, and DNA strand breaks. Sperm of smokers have elevated frequencies of aneuploidy, DNA adducts, strand breaks, and oxidative damage. Smoking also produces mutagenic cervical mucus, micronuclei in cervical epithelial cells, and genotoxic amniotic fluid. These data suggest that tobacco smoke may be a human germ-cell mutagen. Tobacco smoke produces mutagenic urine, and it is a human somatic-cell mutagen, producing HPRT mutations, SCEs, microsatellite instability, and DNA damage in a variety of tissues. Of the 11 organ sites at which smoking causes cancer in humans, smoking-associated genotoxic effects have been found in all eight that have been examined thus far: oral/nasal, esophagus, pharynx/larynx, lung, pancreas, myeoloid organs, bladder/ureter, uterine cervix. Lung tumors of smokers contain a high frequency and unique spectrum of TP53 and KRAS mutations, reflective of the PAH (and possibly other) compounds in the smoke. Further studies are needed to clarify the modulation of the genotoxicity of tobacco smoke by various genetic polymorphisms. These data support a model of tobacco smoke carcinogenesis in which the components of tobacco smoke induce mutations that accumulate in a field of tissue that, through selection, drive the carcinogenic process. Most of the data reviewed here are from studies of human smokers. Thus, their relevance to humans cannot be denied, and their explanatory powers not easily dismissed. Tobacco smoke is now the most extreme example of a systemic human mutagen.

Cytogenetic effects in workers occupationally exposed to tobacco dust

Tobacco dust mainly contains nitrosamines, which are readily absorbed by the body tissues like skin, respiratory epithelium, and mucous membrane of mouth, nose and intestines. Exposure to tobacco dust is known to affect the respiratory tracts in humans. In the present study, cytogenetic effects of exposure to tobacco dust are evaluated in 154 male tobacco factory workers and 138 age and sex matched controls by analysing chromosomal aberrations in their peripheral blood lymphocytes. The workers were in the age group of 20-55 years and were employed in the tobacco processing factory for 1-32 years. Heparinised blood samples were collected from workers and control subjects and lymphocyte cultures were carried out by using standard technique. Slides were prepared and 150 metaphases were screened for each sample for various structural and numerical types of abnormalities. A statistically significant increase was observed in the frequencies of chromosomal aberrations in non-smoking and smoking exposed groups when compared to the respective controls. An increase in the frequencies of chromosomal aberrations was also observed with increase in years of service in the exposed subjects.

Concentrations of nine alkenylbenzenes, coumarin, piperonal and pulegone in Indian bidi cigarette tobacco

Indian-made bidi cigarettes sold in the United States are available in a variety of exotic (e.g. clove, mango) and candy-like (e.g. chocolate, raspberry) flavors. Because certain tobacco flavorings contain alkenylbenzenes and other toxic or carcinogenic chemicals, we measured the concentration of flavor-related compounds in bidi tobacco using a previously developed method. Twenty-three brands of bidis were sampled using automated headspace solid-phase microextraction and subsequently analyzed for 12 compounds by gas chromatography-mass spectrometry. Two alkenylbenzene compounds, trans-anethole and eugenol, were found in greater than 90% of the brands analyzed. Methyleugenol, pulegone and estragole were each detected in 30% or more of the brands, whereas safrole and elemicin were not detected in any of the brands. The flavor-related compounds with the highest tobacco concentrations were eugenol (12,000 microg/g tobacco) and trans-anethole (2200 microg/g tobacco). The highest eugenol and trans-anethole concentrations found in bidi tobacco were about 70,000 and 7500 times greater, respectively, than the highest levels previously found in US cigarette brands. Measurement of these compounds is crucial to evaluation of potential risks associated with inhaling highly concentrated flavor-related compounds from bidis or other tobacco products.

Effects of an aqueous extract of processed bidi tobacco on the growth of hamster tracheal epithelial cells

Inhalation of tobacco dust is responsible for elevated genotoxicity and pulmonary ailments in workers engaged in processing tobacco for the manufacture of bidis, the Indian version of cigarettes. Tracheal tissue being the major site of interaction with tobacco dust, the effects of different concentrations of an aqueous extract of bidi tobacco (ATE) on the growth of a hamster tracheal epithelial cell line (HTE) were investigated. Colony forming efficiency assay revealed that ATE was cytotoxic only at the highest concentration of 5.0 mg/ml. In cultures treated with 1.25 mg/ml ATE, the cell doubling time and growth rate were similar to that of the controls, while a significant increase in cell doubling time (29.4+/-0.3 h vs 14.0+/-3.75 h, P<0.001) was observed at 2.5 mg/ml ATE concentration. Exposure of HTE cells to the non-toxic ATE concentration of 2.5 mg/ml was found to stimulate ornithine decarboxylase (ODC) activity, incorporation of [3H] methyl thymidine into DNA and increase in the S phase fraction was seen by flow cytometry. However, a 56% reduction in the growth rate of cultures treated with 2.5 mg/ml ATE was related to the prolongation of the traverse of cells through S phase. ATE-induced growth suppression was reversed when cultures were grown in ATE-free medium or upon repeated exposure to ATE. The findings suggest that increased tracheal cell proliferation induced by chronic inhalation of tobacco dust may contribute to the development of pulmonary disorders and possibly neoplasia in exposed individuals.

Bidi Smoking among Massachusetts Teenagers

OBJECTIVES

This article presents the prevalence of bidi use among Massachusetts adolescents.

METHODS

Questions on bidi use were included in a statewide telephone survey of a population-based sample of youth 14 to 17 years of age (N = 733).

RESULTS

Past-month use rates were below 2.0% for all demographic subgroups. Minority respondents were more likely than white respondents to have ever smoked a bidi. Males and current cigarette smokers were more likely than their female and nonsmoking counterparts to have ever smoked a bidi or to have smoked one in the past year.

CONCLUSIONS

The demographic distributions of bidi smoking suggest the need for monitoring bidi use trends among adolescent subgroups.

Bidi smoking and health

Bidi, made of low-grade tobacco, is popular among rural folk and the urban poor, in the South Asian region. The objectives of this study were: (1) to assess the extent of bidi smoking in different countries; (2) to compare its smoke and health hazards with conventional cigarettes and; (3) to recommend preventive measures. English language articles were identified through a MEDLINE computerised search (1966-1998) using the term 'bidi', 'beedi', 'beedie', 'biri' and manually in order to collate all the available information and to present a descriptive epidemiological profile. The prevalence of bidi smoking was found to be 21-56% among men in South Asian countries with very little information available about women. Concentrations of nicotine, tar and other toxic agents in the smoke are higher for bidi than for other cigarettes. Bidi smoking is also considered to cause about 2-3 times greater nicotine and tar inhalation than do conventional cigarettes, due to the poor combustibility of the bidi wrapper and greater puff frequency needed to keep the bidi alight. It has also been shown to have greater odds ratios, although not statistically significant, for various cancerous and chronic conditions in comparison with other cigarettes. Since bidi is hand-rolled, workers employed in bidi factories are at risk of developing cancerous conditions due to exposure to tobacco dust and flakes. We suggest that anti-smoking campaigns should be directed to the bidi smokers of all South Asian countries. Most bidi smokers are illiterate and malnourished which makes them more vulnerable to smoking-related morbidity and mortality. At the same time, measures should be taken to make bidi less harmful and to produce bidi by machine to reduce exposure-related toxicity among bidi production workers.

Lymphocyte DNA damage in cigarette factory workers measured by the Comet assay

To investigate whether there were separate and combined effects of occupational exposure to tobacco dust and smoking on lymphocyte DNA damage, 148 workers from a cigarette manufacturing factory (107 occupationally exposed to tobacco dust from the production department and 41 unexposed controls who were managerial workers) were included in the study. The Tail Moment (TM) of Comet assay was used to measure DNA damage. The two groups had similar mean age, mean duration of work and smoking prevalence. The exposed workers had a larger TM than that of the controls (mean+/-S.D.: 43.43+/-13. 77 vs. 38.89+/-8.98, p<0.05). Smokers had significantly larger TM than non-smokers (47.25+/-14.02 vs. 38.90+/-10.75, p<0.001). Analysis of variance after adjustment for age and gender showed that occupational exposure and smoking had a significant and independent effect on Tail Moment (p=0.025 and p=0.002, respectively) and there was a significant positive two way interaction between the two factors (p=0.019). Age and gender had no significant effect on TM. The present study suggests that smoking and tobacco dust exposure can induce lymphocyte DNA damage and there is a synergistic effect of tobacco dust exposure and smoking on DNA damage.