Background: Cost, social acceptability and non-stringent rules pertaining to smokeless tobacco (SLT) product sales have made people select and continue using SLT . If disaggregated data on smokeless forms and smoked forms of tobacco are reviewed, prevalence of smokeless tobacco remains static. There is a strong association of smokeless tobacco consumption with occurrence of adverse cardiovascular disease, particularly in the low socio-economic populations. Objectives: This study aims to investigate the use of smokeless tobacco among the low socio-economic populations around Dhaka city . Methodology: A cross-sectional study using both quantitative and qualitative approaches was used. 459 participants were interviewed after being selected through systematic random sampling technique, and four focus group discussions (FGDs) were conducted. Descriptive and inferential analyses were done including binary logistic regression to find out the factors influencing smokeless tobacco use. Findings: Almost half of the respondents initiated SLT usage at a very young age (15-24 years), and another 22 percent respondents were smoking and using SLT concurrently. Majority of the women respondents used SLT during their pregnancy. Nearly one-fourth of the respondents tried to quit SLT use and one-quarter had a plan to quit SLT in future. More than one-fifth of the respondents were suffering from dental decay. Significant association was found by gender (p<0.01), sufferings from SLT related disease (p<0.05). The logistic regression analysis suggested that, males were 2.7 times more knowledgeable than females (p<0.01) about the adverse health effects of SLT usage. The respondents suffering from SLT related diseases were 3.7 times more knowledgeable than the respondents without diseases (p<0.01). Regarding the knowledge on health effects of SLT use, one participant in the FGD session commented that “although mouth is the gateway to health, we infected our mouth by using Zarda and Gul”. Again, informants opined that peer, family, curiosity and hospitality culture are influencing factors for SLT initiation. Conclusion: Counseling on tobacco, including SLT, health hazards have to be emphasized through mass media and there is a need for development of relevant policies and communication messages to make people aware.

Md Shahjahan

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Use of Smokeless Tobacco by Low Socio-economic Populations and Risk Factors Associated with it