Comparative analysis of diet and tobacco use among households in Bangladesh
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US National Cancer Institute, Bethesda, United States
Centers for Disease Control and Prevention, Atlanta, United States
Mark Parascandola   

US National Cancer Institute, 9609 Medical Center Drive, Bethesda, MD 20892-9761, United States
Publish date: 2019-03-28
Submission date: 2018-10-29
Final revision date: 2018-12-10
Acceptance date: 2019-03-13
Tob. Prev. Cessation 2019;5(March):12
While studies from developed countries have reported dietary differences between tobacco users and non-users, less is known about the influence of tobacco on diet in developing countries where malnutrition is a major public health challenge.

In this study we used the nationally representative Household Income Expenditure Survey 2010 from Bangladesh. Detailed household-level food consumption data including both ethnic and region-specific foods were collected over 14 days, consisting of 7 visits each collecting two days of dietary recall information.

Out of 12240 households, 2061 consumed smoking tobacco only (16.8%), 3284 consumed smokeless tobacco only (26.8%), and 3348 consumed both (27.4%). Overall, 71% of the households reported expenditure on tobacco (smoking and/or smokeless) and were considered any-tobacco use households. Our results indicate that after controlling for household expenditure, household size, household child to adult ratio, place of residence (urban/rural), and region fixed effects, any-tobacco households consumed significantly lower amounts (g/ day) of milk and dairy products (β = -17.11, p<0.01) and oil/fat (β = -10.30, p<0.01) compared to tobacco non-use households (β: adjusted mean difference in food amount g/day/household). Conversely, consumption of cereal grains (β = 152.46, p<0.0001) and sugar (β = 8.16, p<0.0001) were significantly higher among any-tobacco households compared to non-tobacco households. We observed similar patterns for smoking-only, smokeless-only, and dual tobacco product households.

Evidence of dietary differences between tobacco-use and non-use households may play an important role in developing strategies to address poor diet and malnutrition among tobacco-use households in a developing country like Bangladesh. This study provides one of the first reports addressing diet in relation to tobacco use from a developing country, particularly using nationally representative data. The finding that tobacco-use households have poorer dietary consumption than non-use households suggests that it is important to address tobacco use in the context of nutrition and development programs in low-income environments.

The authors have completed and submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest and none was reported.
There was no source of funding for this research.
All authors participated in the development of the study plan and analysis, interpretation of results, and the writing of the paper.
Not commissioned; externally peer reviewed.
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