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Indian J Community Med. 2016 Oct-Dec;41(4):280-287.

Patterns of Use and Perceptions of Harm of Smokeless Tobacco in Navi Mumbai, India and Dhaka, Bangladesh.

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School of Public Health and Health Systems, University of Waterloo, 200 University Avenue West, Waterloo, Ontario, N2L3G1 Canada.
Propel Centre for Population Health Impact, University of Waterloo, 200 University Avenue West, Waterloo, Ontario, N2L3G1 Canada.
Healis-Sekhsaria Institute for Public Health,501 Technocity, Plot X-4/5, MIDC, TTC Industrial Area, Mahape, Navi Mumbai 400701, India.
American Cancer Society, Washington DC, USA.
Department of Economics, University of Dhaka, Nilkhet, Dhaka-1000, Bangladesh.



Globally, smokeless tobacco use is disproportionately concentrated in low-income and middle-income countries like India and Bangladesh.


The current study examined comparative patterns of use and perceptions of harm for different smokeless tobacco products among adults and youth in Navi Mumbai, India, and Dhaka, Bangladesh.


Face-to-face interviews were conducted on tablets with adult (19 years and older) smokeless tobacco users and youth (16-18 years) users and non-users in Navi Mumbai (n = 1002), and Dhaka (n = 1081).


A majority (88.9%) of smokeless tobacco users reported daily use. Approximately one-fifth (20.4%) of the sample were mixed-users (used both smoked and smokeless tobacco), of which about half (54.4%) reported that they primarily used smokeless over smoked forms like cigarettes or bidis. The proportion of users planning to quit was higher in India than in Bangladesh (75.7% vs. 49.8%, p < 0.001). Gutkha was the most commonly used smokeless product in India, and pan masala in Bangladesh. Among users in Bangladesh, the most commonly reported reason for using their usual product was the belief that it was "less harmful" than other types. Perceptions of harm also differed with respect to a respondent's usual product. Bangladeshi respondents reported more negative attitudes toward smokeless tobacco compared to Indian respondents.


The findings highlight the high daily use of smokeless tobacco, and the high prevalence of false beliefs about its harms. This set of findings reinforces the need to implement effective tobacco control strategies in low and middle-income countries like India and Bangladesh.


Bangladesh; India; Smokeless tobacco; attitudes and practice; health knowledge; perceptions of harm

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