- Title
- Epidemiology of smokeless tobacco consumption among South Asian people in Australia and rural women in Bangladesh
- Creator
- Hossain, Mohammad Shakhawat
- Relation
- University of Newcastle Research Higher Degree Thesis
- Resource Type
- thesis
- Date
- 2014
- Description
- Research Doctorate - Doctor of Philosophy (PhD)
- Description
- This thesis by publication is composed of a rationale, objectives, brief literature review, four papers, and a final chapter providing a conclusion and recommendations. At the time of submission, two papers have been published and a further two have been submitted to peer reviewed journals. Chapter 1 provides an overview of adverse pregnancy outcomes, stillbirth and smokeless tobacco consumption (STC), a brief literature review of the prevalence of STC, forms of smokeless tobacco products, reasons for STC, and health consequences of STC. It also describes the rationale for studying STC and stillbirth and for conducting this study in Australia and Bangladesh; and presents research questions, objectives, and a statement regarding ethical approval. Chapter 2 (Paper 1), reports an analytic cross-sectional study conducted among the South Asian ethnic population in Sydney, Australia. The title of the paper is “Smokeless tobacco consumption in the South Asian population of Sydney, Australia: prevalence, correlates and availability”, published in the Drug and Alcohol Review. The study showed that prevalence of ever consumption, more than 100 times consumption and current consumption were 72.1%, 65.9% and 17.1%. Over 96% of consumers reported buying smokeless tobacco products from ethnic shops in Sydney. Current consumption of smokeless tobacco products was associated with country of birth: Indians (odds ratio 5.7, 95% confidence interval 2.3-14.5) and Pakistanis (odds ratio 3.1, 95% confidence interval 1.5-6.5) were more likely to be current consumers than Bangladeshis after adjusting for socio-demographic variables. Chapter 3 (Paper 2), reports a large population-based analytic cross-sectional study conducted among married women in Madaripur, Bangladesh. The title of the paper is “Prevalence and Correlates of Smokeless Tobacco Consumption among Married Women in Rural Bangladesh”, published in PLoS ONE. The study showed that 31% of the cohort had never consumed smokeless tobacco, 44% were ever consumers but not current consumers, 25% were current consumers, and the mean age at first use was 31.5 years. After adjustment for demographic variables, current consumption was associated with being over 25 years of age (aOR=3.08, 95% CI: 2.26–4.20), being unemployed (aOR=7.00, 95% CI: 5.45–8.98), being Muslim, and being divorced or widowed (aOR=1.81, 95% CI: 1.42–2.29). Chapter 4 (Paper 3), “Health knowledge and smokeless tobacco quit attempts and intentions among married women in rural Bangladesh” has been submitted to Addiction. It reports that 45% of current consumers thought STC was good for their health and many ascribed medicinal values to it, e.g., 25% thought STC helped reduce stomach ache. Only 10% intended to quit while a quarter had previously tried to quit. Inaccurate knowledge of STC health consequences was associated with being older (aOR=2.65, 95% CI: 1.99–3.50), being less educated (aOR=2.04, 95% CI: 1.56–2.66), being Muslim (aOR=5.59, CI: 3.60–8.68), being unemployed (aOR=31.9, CI: 26.9–37.8), and being an income earner (aOR= 4.22, CI: 2.90–6.14). Having less education (aOR=2.52, CI: 0.98–6.45) and being unemployed (aOR=1.52, CI: 1.03–2.23) were associated with quitting intentions. Chapter 5 (Paper 4), reports a case-control study: “Smokeless tobacco consumption and stillbirth: Case-control study in Bangladesh”, finding an association between STC and stillbirth among married women in Madaripur, Bangladesh. This paper has been submitted to the British Journal of Obstetrics & Gynaecology. A 3.6 fold (95% CI: 1.90–6.90) increase in the odds of stillbirth was observed in women who consumed smokeless tobacco during their first pregnancy. Heavier users (>5 times daily) were at higher risk of having a stillbirth (aOR = 5.15, 95% CI: 1.67–15.8) than were less heavy users (1–5 times per day, aOR 1.67, CI: 0.67–4.17). Chapter 6 provides a conclusion and recommendations. The research reveals a high prevalence of STC in the South Asian population of Sydney and among women in rural Bangladesh. The case-control study revealed a dose-effect relationship between STC and stillbirth. The knowledge of women regarding the health risks of STC is poor and there are many myths circulating about supposed health benefits of STC. In Bangladesh, health awareness campaigns in mass media and school education should be used to improve knowledge of the harm of STC. Routine screening and cessation advice should be provided in primary healthcare settings, and consideration should be given to methods of regulating the smokeless tobacco market. In Australia, where mechanisms exist to control the supply of smokeless tobacco, enforcement of existing laws should be the priority.
- Subject
- smokeless tobacco; health knowledge; quit attempt; rural women; stillbirth
- Identifier
- http://hdl.handle.net/1959.13/1058803
- Identifier
- uon:16475
- Rights
- Copyright 2014 Mohammad Shakhawat Hossain
- Language
- eng
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