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Siddiqi K, Arora M, Gupta PC. Common assumptions in tobacco control that may not hold true for South-East Asia. THE LANCET REGIONAL HEALTH. SOUTHEAST ASIA 2023; 8:100088. [PMID: 36644450 PMCID: PMC9831008 DOI: 10.1016/j.lansea.2022.100088] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Tobacco is a threat to public health in South-East Asia and its control should be a priority. However, many common assumptions about tobacco control may not hold true for the region and can misdirect policy. The substantial health risks associated with smokeless tobacco have been largely misunderstood and neglected. The syndemic association between tuberculosis and tobacco has also been overlooked. Similarly, less attention has been paid to address second-hand smoke exposure of pregnant women to indoor smoking (caused predominantly by men). On the other hand, our poor understanding of the diverse tobacco supply chain has been blocking progress in tobacco control. Finally, the rising popularity of electronic cigarettes has thrown new challenges; many governments, concerned for its youth, have banned such products. We argue for a nuanced approach to tobacco control in South-East Asia. We also encourage a wider debate in public health, where other established assumptions may be hampering progress.
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Affiliation(s)
- Kamran Siddiqi
- Department of Health Sciences, University of York and Hull York Medical School, Seebohm Rowntree building, University of York, York YO10 5DD, United Kingdom
| | - Monika Arora
- HRIDAY, New Delhi, and Public Health Foundation of India, New Delhi, India
| | - Prakash C Gupta
- Healis Sekhsaria Institute for Public Health, Thane, Maharashtra, India
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Singhavi HR, Singh A, Chaturvedi P. Smokeless Tobacco and Its Ill-Effects: Recent Literature Update. Indian J Med Paediatr Oncol 2021. [DOI: 10.1055/s-0041-1735598] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
AbstractAccording to the Global Adult Tobacco Survey part 2 (GATS-2), approximately 200 million adult Indians consume smokeless tobacco (SLT). Circumvention of SLT product ban has been observed. We conducted a review of the literature to summarize the ill effects of tobacco for the articles published from 2019 to 2020. A systematic search of the databases PubMed (2019 onward) and Web of Science (2019 onward), through February 2021 was done. Search yielded 1,061 articles and after excluding articles based on the inclusion criteria, 37 articles were taken in to consideration. The review shows that differential SLT product has specific odds of oral carcinogenesis. Review also indicates the emerging data of cardiovascular risk due to higher use of SLT products along with its known cause of oral cancer. It also cautions about the adverse consequences of pregnancy associated with SLT use.
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Affiliation(s)
- Hitesh R. Singhavi
- Department of Surgical Oncology, Fortis Hospital, Mulund, Mumbai, Maharashtra, India
| | - Arjun Singh
- Department of Head and Neck Services, Tata Memorial Hospital, Tata Memorial Centre, Mumbai, Maharashtra, India
- Department of Surgical Oncology, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Pankaj Chaturvedi
- Department of Head and Neck Services, Tata Memorial Hospital, Tata Memorial Centre, Mumbai, Maharashtra, India
- Department of Surgical Oncology, Homi Bhabha National Institute, Mumbai, Maharashtra, India
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Effect of bidi smoking on nasal mucociliary clearance: a comparative study. The Journal of Laryngology & Otology 2018; 132:1077-1082. [PMID: 30457082 DOI: 10.1017/s0022215118002049] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE To compare nasal mucociliary clearance in adult non-smokers, cigarette smokers and bidi smokers using the methylene blue dye test. METHODS The study sample consisted of 20 non-smokers, 20 cigarette smokers and 20 bidi smokers (age range, 20-40 years). A single drop of the methylene blue dye was placed at the anterior end of the inferior turbinate of the participants' nasal cavity. The distance travelled by the methylene blue in 15 minutes inside the nasal cavity was measured. Nasal mucociliary clearance of the three groups was compared using the Kruskal Wallis test. RESULTS Nasal mucociliary clearance was significantly decreased in bidi smokers as compared to cigarette smokers and non-smokers (p < 0.05). Multivariate analysis revealed a significant association between nasal mucociliary clearance and bidi smoking, number of cigarettes or bidis smoked per day, and pack-years (all p < 0.05). CONCLUSION Nasal mucociliary clearance measurement is a simple and useful index for assessing the effect of smoking on the mucociliary activity of nasal mucosa.
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Abstract
Non-communicable diseases (NCDs) contributes to more than 50 per cent disability adjusted life years (DALYs) in India; and tobacco contributes to 7·4 per cent of DALYs which is next to diet and high blood pressure. According to Global Burden of Disease (GBD) 2015, tobacco use contributed to 5.9 per cent out of total DALYs in India. Smokeless tobacco (SLT) consumption is a multifactorial process influenced by varied range of contextual factors i.e., social, environmental, psychological and the genetic factors which are linked to the tobacco use. The determinants associated with the SLT use are gender, educational level, wealth index (inverse association), urban-rural residence, socio-economic status and low tax. Taking the view from tobacco control programmes, there is a need to address determinants of SLT use with State level monitoring and socio-economic inequalities, progress and review of the taxation of the SLT use in India.
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Affiliation(s)
- J.S. Thakur
- Department of Community Medicine, School of Public Health, Postgraduate Institute of Medical Education & Research, Chandigarh, India
| | - Ronika Paika
- Department of Community Medicine, School of Public Health, Postgraduate Institute of Medical Education & Research, Chandigarh, India
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Sinha DN, Suliankatchi RA, Amarchand R, Krishnan A. Prevalence and Sociodemographic Determinants of Any Tobacco Use and Dual Use in Six Countries of the WHO South-East Asia Region: Findings From the Demographic and Health Surveys. Nicotine Tob Res 2016; 18:750-6. [PMID: 26729735 DOI: 10.1093/ntr/ntv286] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2015] [Accepted: 12/23/2015] [Indexed: 11/14/2022]
Abstract
BACKGROUND Tobacco control is an important strategy to reduce the disease burden caused by several noncommunicable diseases. An in-depth understanding of the sociodemographic variations in tobacco use is an important step in achieving effective tobacco control. AIMS We aimed to estimate the age-standardized prevalence of any tobacco use and dual tobacco use and determine their association with sociodemographic variables in six countries (Bangladesh, Indonesia, India, Maldives, Nepal, and Timor Leste) of the WHO South-East Asia Region. METHODS The main outcome variables "any tobacco use" and "current dual use" were created from the latest available Demographic and Health Surveys data for each country. The prevalence estimates were weighted using sample weights and age standardized using the WHO standard population. Associations between the sociodemographic variables and tobacco use were calculated by performing multivariable logistic regression analysis. Analyses were performed in Stata 12 using "svyset" and "svy" commands. RESULTS The highest prevalence of any tobacco use among men was in Indonesia (76.4%) and among women in Nepal (15.7%). Also, Nepal had the highest prevalence of dual tobacco use in both men (17.9%) and women (1.5%). With regard to sociodemographic determinants, despite the inter-country variations, any and dual tobacco use were significantly associated with age, higher education, greater wealth, rural residence, and ever-married marital status. The poor and uneducated had a higher odds ratio for these practices. CONCLUSION Prevalence of dual tobacco use and its underlying socioeconomic disparities should be taken into account for the planning of tobacco control activities in the region. IMPLICATIONS The dual tobacco use phenomenon is being increasingly recognized as a distinct entity in the fight against tobacco addiction. When compared with single product users, dual users have a greater risk of developing tobacco related diseases and are less likely to quit their habits. However, this phenomenon has not been studied adequately in the South-East Asia region. In this context, this study has provided a detailed and comprehensive view of dual tobacco use and its sociodemographic determinants in six countries of the region. This study recommends that tobacco control interventions should be targeted specifically at the disadvantaged sections of the society, such as the poor and the uneducated, who are more likely to engage in "dual" as well as "any" tobacco use. This study could prove as an important reference and tool for policy making in the South-East Asia region.
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Affiliation(s)
- Dhirendra N Sinha
- Tobacco Free Initiative Unit, World Health Organization, Regional Office for South-East Asia, New Delhi, India;
| | - Rizwan A Suliankatchi
- Department of Community Medicine, Velammal Medical College Hospital and Research Institute, Madurai, India
| | - Ritvik Amarchand
- Centre for Community Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Anand Krishnan
- Centre for Community Medicine, All India Institute of Medical Sciences, New Delhi, India
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Stepanov I, Gupta PC, Dhumal G, Yershova K, Toscano W, Hatsukami D, Parascandola M. High levels of tobacco-specific N-nitrosamines and nicotine in Chaini Khaini, a product marketed as snus. Tob Control 2015; 24:e271-4. [PMID: 25217658 PMCID: PMC4929854 DOI: 10.1136/tobaccocontrol-2014-051744] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2014] [Accepted: 08/26/2014] [Indexed: 02/04/2023]
Abstract
INTRODUCTION Recently, a tobacco product, Chaini Khaini, identified as snus appeared in India. The product marketing emphasises its discreet nature and explicitly claims safety by referring to the existing evidence on Swedish snus. We analysed tobacco-specific nitrosamines and nicotine in 12 samples of Chaini Khaini purchased in 2013 at open markets in India. METHODS Samples were purchased twice: in March 2013 from Mumbai and in November 2013 from Mumbai and Ahmedabad. Chemical constituents were measured by our routine validated methods. RESULTS Levels of carcinogenic nitrosamines NNN, NNK and NNAL averaged 22.9 (±4.9), 2.6 (±1.0) and 3.1 (±1.5) µg/g tobacco (wet weight), respectively. The levels of NAB, which is normally present in trace levels in tobacco products, ranged from 3.9 to 12.9 µg/g tobacco. Total nicotine levels in all samples averaged 10.0 mg/g tobacco and unprotonated nicotine accounted for an average 95.4% of the total nicotine content. CONCLUSIONS Chaini Khaini, which is labelled as snus and is marketed as a safe alternative to other tobacco products contains very high levels of carcinogenic nitrosamines and biologically available nicotine. Interventions are urgently needed to educate current and potential consumers of this product.
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Affiliation(s)
- Irina Stepanov
- Masonic Cancer Center, University of Minnesota, Minneapolis, Minnesota, USA Division of Environmental Health Sciences, University of Minnesota, Minneapolis, Minnesota, USA
| | - Prakash C Gupta
- Healis-Sekhsaria Institute for Public Health, Mumbai, Maharashtra, India
| | - Gauri Dhumal
- Healis-Sekhsaria Institute for Public Health, Mumbai, Maharashtra, India
| | - Katrina Yershova
- Masonic Cancer Center, University of Minnesota, Minneapolis, Minnesota, USA
| | - William Toscano
- Division of Environmental Health Sciences, University of Minnesota, Minneapolis, Minnesota, USA
| | - Dorothy Hatsukami
- Masonic Cancer Center, University of Minnesota, Minneapolis, Minnesota, USA
| | - Mark Parascandola
- Tobacco Control Research Branch, National Cancer Institute, Bethesda, Maryland, USA
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Singh A, Arora M, English DR, Mathur MR. Socioeconomic Gradients in Different Types of Tobacco Use in India: Evidence from Global Adult Tobacco Survey 2009-10. BIOMED RESEARCH INTERNATIONAL 2015; 2015:837804. [PMID: 26273649 PMCID: PMC4529916 DOI: 10.1155/2015/837804] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/26/2014] [Accepted: 04/10/2015] [Indexed: 02/06/2023]
Abstract
Socioeconomic differences in tobacco use have been reported, but there is a lack of evidence on how they vary according to types of tobacco use. This study explored socioeconomic differences associated with cigarette, bidi, smokeless tobacco (SLT), and dual use (smoking and smokeless tobacco use) in India and tested whether these differences vary by gender and residential area. Secondary analysis of Global Adult Tobacco Survey (GATS) 2009-10 (n = 69,296) was conducted. The primary outcomes were self-reported cigarette, bidi smoking, SLT, and dual use. The main explanatory variables were wealth, education, and occupation. Associations were assessed using multinomial logistic regressions. 69,030 adults participated in the study. Positive association was observed between wealth and prevalence of cigarette smoking while inverse associations were observed for bidi smoking, SLT, and dual use after adjustment for potential confounders. Inverse associations with education were observed for all four types after adjusting for confounders. Significant interactions were observed for gender and area in the association between cigarette, bidi, and smokeless tobacco use with wealth and education. The probability of cigarette smoking was higher for wealthier individuals while the probability of bidi smoking, smokeless tobacco use, and dual use was higher for those with lesser wealth and education.
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Affiliation(s)
- Ankur Singh
- Department of Health Promotion, Public Health Foundation of India, Gurgaon, Haryana, India
- Australian Research Center for Population Oral Health (ARCPOH), University of Adelaide, Adelaide, SA 5000, Australia
| | - Monika Arora
- Department of Health Promotion, Public Health Foundation of India, Gurgaon, Haryana, India
| | - Dallas R. English
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC 3010, Australia
| | - Manu R. Mathur
- Department of Health Promotion, Public Health Foundation of India, Gurgaon, Haryana, India
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Javed F, Al-Kheraif AA, Al Amri MD, Mikami T, Vohra F, Warnakulasuriya S, Romanos GE. Periodontal Parameters and Whole Salivary Cytokine Profiles Among Habitual Gutka Chewers and Non-Chewers. J Periodontol 2015; 86:689-95. [DOI: 10.1902/jop.2015.140556] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Nair S, Schensul JJ, Begum S, Pednekar MS, Oncken C, Bilgi SM, Pasi AR, Donta B. Use of smokeless tobacco by Indian women aged 18-40 years during pregnancy and reproductive years. PLoS One 2015; 10:e0119814. [PMID: 25786247 PMCID: PMC4364978 DOI: 10.1371/journal.pone.0119814] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2014] [Accepted: 02/01/2015] [Indexed: 01/29/2023] Open
Abstract
Objectives This paper discusses patterns of daily smokeless tobacco (SLT) use and correlates of poly SLT use among married women aged 18–40 years in a Mumbai slum community with implications for tobacco control. Methods Using a mixed methods approach, the study included a structured survey with 409 daily SLT users and in-depth interviews with 42 women. Participants for the survey were selected using a systematic sampling procedure (one woman in every fourth eligible household). Univariate and bivariate analysis, and multiple logistic regressions were conducted to identify demographic and social factors associated with women’s use of poly SLT products. To illustrate survey results, in-depth interviews were analyzed using Atlas ti software. Results Sixty-four percent of the women surveyed used only one type of SLT; of these, 30% used mishri, 32% used pan with tobacco and the rest used chewed tobacco (11%), gul (17%) or gutkha (10%). Thirty-six percent used more than one type of SLT. Poly SLT users chewed or rubbed 50% more tobacco as compared to single users (mean consumption of tobacco per day: 9.54 vs. 6.49 grams; p<0.001). Women were more likely to be poly SLT users if they were illiterate as compared to literate (adjusted odds ratio [AOR]=1.67; 95% confidence interval [CI]=1.07-2.71), if they had lived in Mumbai for 10 years or more, versus less than ten years (AOR=1.67, 95% CI=1.03-2.71); and if their husband was a poly SLT user as compared to a non SLT user (AOR=2.78, 95% CI=1.63-4.76). No differences were noted between pregnant and non-pregnant women in SLT consumption patterns. Conclusions Tobacco control policies and programs must focus specifically on both social context and use patterns to address SLT use among women of reproductive age with special attention to poly SLT users, an understudied and vulnerable population.
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Affiliation(s)
| | - Jean J. Schensul
- Institute for Community Research, Hartford, Connecticut, United States of America
| | - Shahina Begum
- National Institute for Research in Reproductive Health, Mumbai, India
| | | | - Cheryl Oncken
- University of Connecticut, Mansfield, Connecticut, United States of America
| | - Sameena M. Bilgi
- National Institute for Research in Reproductive Health, Mumbai, India
| | - Achhelal R. Pasi
- National Institute for Research in Reproductive Health, Mumbai, India
| | - Balaiah Donta
- National Institute for Research in Reproductive Health, Mumbai, India
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Ladusingh L, Singh A. Contextual correlates of intensity of smoking in northeast India. Int J Public Health 2015; 60:317-26. [PMID: 25603984 DOI: 10.1007/s00038-015-0652-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2014] [Revised: 12/29/2014] [Accepted: 01/05/2015] [Indexed: 01/12/2023] Open
Abstract
OBJECTIVES This study assessed the significance of socio-demographic and contextual factors on the number of daily cigarette and bidi smoking in northeast India. METHODS This study is based on the data from the Global Adult Tobacco Survey-India (2009-2010). Community asset is measured as the totality of all households' durables and community affinity to smoking as the proportion of households which allowed smoking in the house. RESULTS High daily cigarette and bidi smokers constitute 20 and 30 % of the respective smokers and they smoke 35.8 cigarettes and 14.6 bidis daily, respectively, on the average. The higher is the community affinity to smoking, the higher is the intensity of smoking among the high daily cigarette smokers. Advancing age and educational attainment have significant deterrent effect on the intensity of cigarette and bidi smoking. CONCLUSIONS Contextual factors are found to be important for regional tobacco control programmes. The need for reaching out to communities and the importance of promotion of public-private partnership under the provision of corporate social responsibility for effectiveness of tobacco control programme is recommended.
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Affiliation(s)
- Laishram Ladusingh
- International Institute for Population Sciences, Govandi Station Road, Deonar, Mumbai, 400088, India,
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Zaman MM, Bhuiyan MR, Huq SM, Rahman MM, Sinha DN, Fernando T. Dual use of tobacco among Bangladeshi men. Indian J Cancer 2014; 51 Suppl 1:S46-9. [PMID: 25526248 PMCID: PMC6349137 DOI: 10.4103/0019-509x.147481] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
INTRODUCTION Dual use of tobacco (using smoking and smokeless forms) in Bangladesh is uncommon in women but common in men. Dual users are at additional risk of cancers and heart diseases compared with a single form of tobacco use. Knowledge about their socioeconomic background is necessary for planning appropriate interventions. We report here socioeconomic background of the dual users of tobacco from a nationally representative survey. METHODS The study adopted a probability proportionate to size sampling technic of divisional population stratified into urban and rural areas to recruit men aged 25 years or older from their households. A total of 4312 men were recruited. Variables included questions on 20 household assets, tobacco use and other behavioral risk factors, and measurement of body weight and height. RESULTS The average age of dual users was 46.7 years old compared to 43.4 and 52.3 years for smokers and smokeless tobacco users. Prevalence of "smoking only," "smokeless only" and "dual use" of tobacco was 40.6%, 15.2%, and 14.2%, respectively. Among all tobacco users, dual users constituted 20%. These dual users had lower educational achievement, rural residence, lower intake of fruit, and higher intake of alcohol. They were more undernourished as indicated by a thin body mass index compared to nonusers and smokers. Dual users were of socioeconomically deprived as measured by wealth quartiles constructed out of household assets. CONCLUSION Dual use of tobacco is common in Bangladesh, and it is intimately linked with socioeconomic deprivation. Poverty reduction strategy and campaigns should address tobacco control not only tobacco in general, but its dual use in particular.
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Affiliation(s)
- M M Zaman
- World Health Organization, Dhaka, Bangladesh
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Prevalence of tobacco use in urban, semi urban and rural areas in and around Chennai City, India. PLoS One 2013; 8:e76005. [PMID: 24098418 PMCID: PMC3788037 DOI: 10.1371/journal.pone.0076005] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2013] [Accepted: 08/19/2013] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Tobacco use leads to many health complications and is a risk factor for the occurrence of cardio vascular diseases, lung and oral cancers, chronic bronchitis etc. Almost 6 million people die from tobacco-related causes every year. This study was conducted to measure the prevalence of tobacco use in three different areas around Chennai city, south India. METHODS A survey of 7510 individuals aged > = 15 years was undertaken covering Chennai city (urban), Ambattur (semi-urban) and Sriperumbudur (rural) taluk. Details on tobacco use were collected using a questionnaire adapted from both Global Youth Tobacco Survey and Global Adults Tobacco Survey. RESULTS The overall prevalence of tobacco use was significantly higher in the rural (23.7%) compared to semi-urban (20.9%) and urban (19.4%) areas (P value <0.001) Tobacco smoking prevalence was 14.3%, 13.9% and 12.4% in rural, semi-urban and urban areas respectively. The corresponding values for smokeless tobacco use were 9.5%, 7.0% and 7.0% respectively. Logistic regression analysis showed that the odds of using tobacco (with smoke or smokeless forms) was significantly higher among males, older individuals, alcoholics, in rural areas and slum localities. Behavioural pattern analysis of current tobacco users led to three groups (1) those who were not reached by family or friends to advice on harmful effects (2) those who were well aware of harmful effects of tobacco and even want to quit and (3) those are exposed to second hand/passive smoking at home and outside. CONCLUSIONS Tobacco use prevalence was significantly higher in rural areas, slum dwellers, males and older age groups in this region of south India. Women used mainly smokeless tobacco. Tobacco control programmes need to develop strategies to address the different subgroups among tobacco users. Public health facilities need to expand smoking cessation counseling services as well as provide pharmacotherapy where necessary.
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