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Xie W, Mridha MK, Gupta A, Kusuma D, Butt AM, Hasan M, Brage S, Loh M, Khawaja KI, Pradeepa R, Jha V, Kasturiratne A, Katulanda P, Anjana RM, Chambers JC. Smokeless and combustible tobacco use among 148,944 South Asian adults: a cross-sectional study of South Asia Biobank. BMC Public Health 2023; 23:2465. [PMID: 38071311 PMCID: PMC10709928 DOI: 10.1186/s12889-023-17394-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Accepted: 12/02/2023] [Indexed: 12/18/2023] Open
Abstract
INTRODUCTION Tobacco use, in both smoking and smokeless forms, is highly prevalent among South Asian adults. The aims of the study were twofold: (1) describe patterns of SLT and combustible tobacco product use in four South Asian countries stratified by country and sex, and (2) assess the relationships between SLT and smoking intensity, smoking quit attempts, and smoking cessation among South Asian men. METHODS Data were obtained from South Asia Biobank Study, collected between 2018 and 2022 from 148,944 men and women aged 18 years and above, living in Bangladesh, India, Pakistan, or Sri Lanka. Mixed effects multivariable logistic and linear regression were used to quantify the associations of SLT use with quit attempt, cessation, and intensity. RESULTS Among the four South Asian countries, Bangladesh has the highest rates of current smoking (39.9% for male, 0.4% for female) and current SLT use (24.7% for male and 23.4% for female). Among male adults, ever SLT use was associated with a higher odds of smoking cessation in Bangladesh (OR, 2.88; 95% CI, 2.65, 3.13), India (OR, 2.02; 95% CI, 1.63, 2.50), and Sri Lanka (OR, 1.36; 95% CI, 1.14, 1.62). Ever SLT use and current SLT use was associated with lower smoking intensity in all countries. CONCLUSIONS In this large population-based study of South Asian adults, rates of smoking and SLT use vary widely by country and gender. Men who use SLT products are more likely to abstain from smoking compared with those who do not.
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Affiliation(s)
- Wubin Xie
- Population and Global Health, Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore.
| | - Malay Kanti Mridha
- Centre for Non-Communicable Diseases and Nutrition, BRAC James P Grant School of Public Health, Dhaka, Bangladesh
| | - Anaya Gupta
- Population and Global Health, Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, St Mary's Campus, Norfolk Place, London, UK
| | - Dian Kusuma
- School of Health & Psychological Sciences, City University of London, London, UK
| | | | - Mehedi Hasan
- Centre for Non-Communicable Diseases and Nutrition, BRAC James P Grant School of Public Health, Dhaka, Bangladesh
| | - Soren Brage
- MRC Epidemiology Unit, Institute of Metabolic Science, University of Cambridge, Cambridge Biomedical Campus, Cambridge, UK
| | - Marie Loh
- Population and Global Health, Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, St Mary's Campus, Norfolk Place, London, UK
| | | | - Rajendra Pradeepa
- The Madras Diabetes Research Foundation & Dr. Mohan's Diabetes Specialties Centre, Chennai, India
| | - Vinita Jha
- Max Helathcare Institute, Patparganj, Delhi, India
| | | | | | - Ranjit Mohan Anjana
- The Madras Diabetes Research Foundation & Dr. Mohan's Diabetes Specialties Centre, Chennai, India
| | - John C Chambers
- Population and Global Health, Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, St Mary's Campus, Norfolk Place, London, UK
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Hajat C, Stein E, Ramstrom L, Shantikumar S, Polosa R. The health impact of smokeless tobacco products: a systematic review. Harm Reduct J 2021; 18:123. [PMID: 34863207 PMCID: PMC8643012 DOI: 10.1186/s12954-021-00557-6] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Accepted: 10/12/2021] [Indexed: 12/23/2022] Open
Abstract
INTRODUCTION The objective was to systematically review studies on health outcomes from smokeless tobacco (SLT) products. METHODS We analysed published literature on the health outcomes from SLT use between 01/01/2015 to 01/02/2020, following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) protocol using PubMed, Embase, Scopus, and Google Scholar. RESULTS Of 53 studies included, six were global, 32 from Asia, Middle East and Africa (AMEA), nine from USA and six from Europe. 'Poor'-rated studies predominated (23;43%), in particular, for global (4;66%) and AMEA (16;50%). Health outcomes differed between SLT-products and regions; those in AMEA were associated with higher mortality (overall, cancer, Coronary heart disease (CHD), respiratory but not cardiovascular disease (CVD)), and morbidity (CVD, oral and head and neck cancers), with odds ratios up to 38.7. European studies showed no excess mortality (overall, CVD, from cancers) or morbidity (ischemic heart disease (IHD), stroke, oral, head and neck, pancreatic or colon cancers) from several meta-analyses; single studies reported elevated risk of rectal cancer and respiratory disorders. Pooled study data showed protection against developing Parkinson's disease. US studies showed mixed results for mortality (raised overall, CHD, cancer and smoking-related cancer mortality; no excess risk of respiratory or CVD mortality). Morbidity outcomes were also mixed, with some evidence of increased IHD, stroke and cancer risk (oral, head and neck). No studies reported on switching from cigarettes to SLT-products. CONCLUSION Our review demonstrates stark differences between different SLT-products in different regions, ranging from zero harm from European snus to greatly increased health risks in AMEA. The literature on the safety profile for SLT-products for harm reduction is incomplete and potentially misinforming policy and regulation.
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Affiliation(s)
- C Hajat
- Public Health Institute, UAE University, Abu Dhabi, 15551, UAE.
| | - E Stein
- Independent Researcher, New York, USA
| | - L Ramstrom
- Independent Researcher, Institute for Tobacco Studies, Stockholm, Sweden
| | - S Shantikumar
- Warwick Medical School, University of Warwick, Coventry, UK
| | - R Polosa
- Center of Excellence for the Acceleration of HArm Reduction (CoEHAR), University of Catania, Catania, Italy
- Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
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