RESEARCH PAPER
Patterns and related factors of bidi smoking in India
 
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1
Global Tobacco Control Branch, Office on Smoking and Health, Centers for Disease Control and Prevention, Atlanta, United States
2
World Health Organization Country Office, New Delhi, India
3
School of Preventive Oncology, Patna Medical College, Patna, India
4
Healis–Sekhsaria Institute of Public Health, Navi Mumbai, India
5
Ministry of Health and Family Welfare, Government of India, New Delhi, India
CORRESPONDING AUTHOR
Lazarous Mbulo   

Global Tobacco Control Branch, Office on Smoking and Health, Centers for Disease Control and Prevention, 4770 Buford Hwy NE, MS F-79, Atlanta, GA 30341, United States
Publication date: 2020-05-04
Submission date: 2019-12-18
Final revision date: 2020-02-29
Acceptance date: 2020-03-16
 
Tob. Prev. Cessation 2020;6(May):28
KEYWORDS
TOPICS
ABSTRACT
Introduction:
Bidis are the most commonly smoked tobacco product in India. Understanding bidi smoking is important to reducing overall tobacco smoking and health-related consequences in India. We analyzed 2009–2010 and 2016– 2017 Global Adult Tobacco Survey (GATS) India data to examine bidi smoking and its associated sociodemographic correlates and perceptions of dangers of smoking.

Methods:
GATS is a nationally representative household survey of adults aged ≥15 years, designed to measure tobacco use and tobacco control indicators. Current bidi smoking was defined as current smoking of one or more bidis during a usual week. We computed bidi smoking prevalence estimates and relative change during 2009–2010 and 2016–2017. Used pooled multilevel logistic regression to identify individual-level determinants of bidi smoking and neighborhood-level and state-level variations.

Results:
Overall, 9.2% and 7.7% of adults smoked bidis in India during 2009–2010 and 2016–2017, respectively, reflecting 16.4% significant relative decline. In pooled analysis, male, older age, rural residence, lower education level, lower wealth index, less knowledge about harms of smoking, and survey year were associated with increased odds of bidi smoking. Results also showed variance in odds of smoking bidis is associated with neighborhood (15.9%) and state (31.8%) level.

Conclusions:
Higher odds of bidi smoking were found among males, older age groups, and among those with lower socioeconomic status. Accordingly, health education interventions designed for these groups across India and other population-level interventions, such as WHO recommendation on increasing price on tobacco products, could help reduce bidi smoking. In addition, state/ neighborhood-specific interventions could also help address differential bidi smoking across India.

CONFLICTS OF INTEREST
The authors have completed and submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest and none was reported.
FUNDING
There was no source of funding for this research.
PROVENANCE AND PEER REVIEW
Not commissioned; externally peer reviewed.
 
REFERENCES (41)
1.
World Health Organization. Global Adult Tobacco Survey fact sheet: India 2016-17. New Delhi, India: Ministry of Health and Family Welfare; 2018.
 
2.
Shafey O, Eriksen M, Ross H, et al. The Tobacco Atlas. 3rd ed. Atlanta, GA: American Cancer Society, 2009.
 
3.
Gupta PC, Asma S. Bidi smoking and public health. New Delhi, India: Ministry of Health and Family Welfare, 2008.
 
4.
Nandi A, Ashok A, Guindon GE, et al. Estimates of the economic contributions of the bidi manufacturing industry in India. Tob Control. 2015;24(4):369-375. doi:10.1136/tobaccocontrol-2013-051404
 
5.
Lal P. Bidi - A short history. Current Science. 2009;96(10):1337-1337. http://www.indiaenvironmentpor.... Accessed February 29, 2020.
 
6.
Duong M, Rangarajan S, Zhang X, Killian K. et al. Effects of bidi smoking on all-cause mortality and cardiorespiratory outcomes in men from south Asia: an observational community-based sub-study of the Prospective Urban Rural Epidemiology Study (PURE). Lancet Glob Health. 2017;5(2):e168-e176. doi:10.1016/S2214-109X(17)30004-9
 
7.
Rahman M, Sakamoto J, Fukui T. Bidi smoking and oral cancer: a meta-analysis. Int J Cancer. 2003;10:106(4):600-604. doi:10.1002/ijc.11265
 
8.
Wu W, Siqing S, Ashley DL, Watson CH. Assessment of tobacco-specific nitrosamines in the tobacco and mainstream smoke of bidi cigarettes. Carcinogenesis. 2004;25(2):283-287. doi:10.1093/carcin/bgh004
 
9.
Malson JL, Sims K, MurtyR, Pickworth WB. Comparison of the nicotine content of tobacco used in bidis and conventional cigarettes. Tob Control. 2001;10(2):181-183. doi:10.1136/tc.10.2.181
 
10.
Watson CH, Polzin GM, Calafat AM, Ashley DL. Determination of tar, nicotine and carbon monoxide yields in the smoke of bidi cigarettes. Nicotine Tob Res. 2003;5(5):747-753. doi:10.1080/1462220031000158591
 
11.
John RM. Economic costs of diseases and deaths attributable to bidi smoking in India, 2017. Tob Control. 2019;28(5):513-518. doi:10.1136/tobaccocontrol-2018-054493
 
12.
John RM. Price Elasticity Estimates for Tobacco Products in India. Health Policy and Planning. 2008;23(3):200-209. doi:10.1093/heapol/czn007
 
13.
Krieger N, Williams DR, Moss NE. Measuring social class in US public health research: concepts, methodologies, and guidelines. Annu Rev Public Health. 1997;18(1):341-378. doi:10.1146/annurev.publhealth.18.1.341
 
14.
Lynch J, Kaplan G. Socioeconomic position. In Berkman LF, Kawachi I. Social Epidemiology. 1st ed. Oxford: Oxford University Press; 2000.
 
15.
Bhan N, Karan A, Srivastava S, Selvaraj S, Subramanian SV, Millett C. Have Socioeconomic Inequalities in Tobacco Use in India Increased Over Time? Trends From the National Sample Surveys (2000–2012). Nicotine Tob Res. 2016;18(8):1711-1718. doi:10.1093/ntr/ntw092
 
16.
Public Health Foundation of India. Bidi Industry in India: Employment and Wages. New Delhi, India: World Health Organization Country Office; 2017.
 
17.
Kaur J, Jain D C. Tobacco Control Policies in India: Implementation and Challenges. Indian J Public Health. 2011;55(3):220-227. doi:10.4103/0019-557x.89941
 
18.
Golechha, M. Health Promotion Methods for Smoking Prevention and Cessation: A Comprehensive Review of Effectiveness and the Way Forward. Int J Prev Med. 2016;7(1):7. doi:10.4103/2008-7802.173797
 
19.
Mishra S, Joseph RA, Gupta PC, et al. Trends in bidi and cigarette smoking in India from 1998 to 2015, by age, gender and education. BMJ Glob Health. 2016;1(1):e000005. doi:10.1136/bmjgh-2015-000005
 
20.
Mini GK, Thankappan KR. Pattern, correlates and implications of non-communicable disease multimorbidity among older adults in selected Indian states: a cross-sectional study. BMJ Open. 2017;7(3):e013529. doi:10.1136/bmjopen-2016-013529
 
21.
Kahar P, Misra R, Patel TG . Sociodemographic Correlates of Tobacco Consumption in Rural Gujarat, India. BioMed Res Int. 2016;2016:1-9. doi:10.1155/2016/5856740
 
22.
Global Adult Tobacco Survey Collaborative Group. Global Adult Tobacco Survey (GATS): Analysis and Reporting Package, Version 2.0. Atlanta, GA: Centers for Disease Control and Prevention; 2011.
 
23.
Chiosi JJ, Andes L, Asma S, et al. Warning about the harms of tobacco use in 22 countries: findings from a cross-sectional household survey. Tob Control. 2016;25(4):393-401. doi:10.1136/tobaccocontrol-2014-052047
 
24.
Palipudi KM, Gupta PC, Sinha DN, et al. Social determinants of health and tobacco use in thirteen low- and middle-income countries: evidence from Global Adult Tobacco Survey. PLoS One. 2012;7(3):e33466. doi:10.1371/journal.pone.0033466
 
25.
Asparouhov T. General Multilevel modeling with sampling weights. Communications in statistics. Theory and Methods. 2006;35(3):439-460. doi:10.1080/03610920500476598
 
26.
Goldstein H. Multilevel models in educational and social research. London, United Kingdom: Oxford University Press; 1987.
 
27.
Subramanian SV, Nandy S, Kelly M, Gordon D, Smith GD. Patterns and distribution of tobacco consumption in India: cross sectional multilevel evidence from the 1998-9 national family health survey. BMJ. 2004;328(7443):801-806. doi:10.1136/bmj.328.7443.801
 
28.
Jindal S, Agarwal A, Chaudhry K, et al. Tobacco smoking in India: Prevalence, quit-rates and respiratory morbidity. Indian J Chest Dis Allied Sci. 2006;48(1):37-42. PMID:16482950.
 
29.
Rani M, Bonu S, Jha P, Nguyen SN, Jamjoum L. Tobacco use in India: prevalence and predictors of smoking and chewing in a national cross sectional household survey. Tob Control. 2003;12(4):e4. doi:10.1136/tc.12.4.e4
 
30.
International Institute for Population Science and Ministry of Health and Family Welfare. Global Adult Tobacco Survey India 2009-2010. New Delhi, India: Ministry of Health and Family Welfare; 2010.
 
31.
Agrawal S, Karan A, Selvaraj S, Bhan N, Subramanian SV, Millett C. Socio-economic patterning of tobacco use in Indian states. Int J Tuberc Lung Dis. 2013;17(8):1110-1117. doi:10.5588/ijtld.12.0916
 
32.
Siahpush M, McNeill A, Hammond D, Fong GT. Socioeconomic and country variations in knowledge of health risks of tobacco smoking and toxic constituents of smoke: results from the 2002 International Tobacco Control (ITC) Four Country Survey. Tob Control. 2006;15(Suppl 3):iii65–iii70. doi:10.1136/tc.2005.013276
 
33.
Chow CK, Corsi DJ, Gilmore AB, et al. Tobacco control environment: cross-sectional survey of policy implementation, social unacceptability, knowledge of tobacco health harms and relationship to quit ratio in 17 low-income, middle-income and high-income countries. BMJ Open. 2017;7(3):e013817. doi:10.1136/bmjopen-2016-013817
 
34.
World Health Organization. Technical Manual on Tobacco Tax Administration. Geneva, Switzerland: World Health Organization; 2010.
 
35.
Jha P, Gupta PC, Guindon E, Mishra S. Experts find that the tobacco tax increase in India’s Union budget 2017 is insufficient to improve public health. Toronto, Canada: University of Toronto, Centre for Global Health Research; 2017. http://www.cghr.org/wordpress/.... Accessed April 30, 3019.
 
36.
Brener ND, Billy JO, Grady WR. Assessment of factors affecting the validity of self-reported health-risk behavior among adolescents: evidence from the sci-entific literature. J Adolesc Health. 2003;33(6):436-457. doi:10.1016/s1054-139x(03)00052-1
 
37.
Patrick DL, Cheadle A, Thompson DC, Diehr P, Koepsell T, Kinne S. The validity of self-reported smoking: a review and meta-analysis. Am J Public Health. 1994;84(7):1086-1093. doi:10.2105/ajph.84.7.1086
 
38.
Rutstein SO, Johnson K. The DHS Wealth Index: DHS Comparative Reports No. 6. Calverton, Maryland: ORC Macro; 2004.
 
39.
Howe, LD. The wealth index as a measure of socio-economic position. London, United Kingdom: London School of Hygiene & Tropical Medicine; 2009. doi:10.17037/PUBS.00768490
 
40.
Pawar PS, Pednekar MS, Gupta PC, Shang C, Quah AC, Fong GT. The relation between price and daily consumption of cigarettes and bidis: findings from the Tobacco Control Policy Evaluation Wave 1 Survey. Indian J Cancer. 2014;51(1):S83-S87. doi:10.4103/0019-509X.147479
 
41.
International Agency for Research on Cancer. IARC Handbooks of Cancer Prevention: Tobacco Control. Effectiveness of Price and Tax Policies for Control of Tobacco, Vol. 14. Lyon, France: International Agency for Research on Cancer; 2011.
 
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