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The Current Smokeless Tobacco Trend in Bangladesh
Ashek Elahi Noor
1Department of Dental Public Health, Sapporo Dental College and Hospital, Dhaka, Bangladesh .
Although many smokers believe that using smokeless tobacco is safer than smoking, numerous health hazards are associated with its use. Toxins are present in all cigarette products. Because these products are seen as a part of the cultural heritage, there is little enthusiasm for their regulation throughout South and South-East Asia, particularly in Bangladesh, India, Nepal, Pakistan, Sri Lanka, etc. Nearly 80% of users live in these areas, which could negatively impact their social, physical, and emotional health. According to several studies, quitting smoking may make people crave smokeless tobacco even more. However, they began using smokeless tobacco as a recreational activity but ultimately developed physical health conditions like gastritis, lung cancer, esophageal cancer, mouth cancer, and carcinoma of the liver. Additionally, they had medical and mental illnesses like melancholy, addiction, stress, mental anguish, and even suicidal thoughts, among others. Since it is harmful, smokeless tobacco should be handled with care. Unfortunately, our policy has not been upgraded or even had the legislation and regulation system applied. In order to alleviate this susceptible problem for the betterment of the country, it is now vital to take emergency steps to concentrate on & conduct preventive comprehensive action at every level from the government & local concern authorities.
Carcinoma; Nicotine replacement Treatment (NRTs); Nicotine Lozenges; Smokeless Tobacco Use (SLT)
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Introduction
In 1683, the first English-language discussion of powdered smokeless tobacco for inhaling appeared. It has been in use for over a thousand years. The cigarette industry has a foothold in the smokeless tobacco market. Smokeless tobacco is a type of tobacco used in activities other than smoking.They are consumed by chewing, inhaling, or sandwiching the material between the gums and cheeks.Smokeless tobacco products come in a variety of forms, including chewing tobacco, snuff, snus, and dissolvable tobacco products. Smokeless tobacco products frequently have more than 3,000 ingredients. Every smokeless tobacco product contains nicotine, making them all extremely addictive. Giving up smoking is challenging, but so is quitting smokeless tobacco. Smokeless tobacco is widely used all over the world. When they start using smokeless tobacco and are addicted to nicotine, many people, especially young people, start smoking cigarettes. Males were more likely than females to have smokeless tobacco in the past month. 1
Fragrances, artificial and natural flavors, perfumes, and chemicals like tobacco that make you look more appealing are some of the ingredients utilized in smokeless tobacco products to attract customers. carcinogens among the components.Non-tobacco plant components include papaya, herbs, Joyfal, jostimodhu, saffron2, molasses, cinnamon, menthol, glucose, glycerin, vegetable oil, Gum Arabic, and Mrigonavi (Musk).
Young people who use smokeless tobacco run the risk of developing a nicotine addiction, which increases the likelihood that they will also start smoking cigarettes. Young people are especially prone to beginning smokeless tobacco use. In the previous month, males were more likely than females to have used smokeless tobacco. In 2014, 8.7 million people (3.3 percent of those 12 and older) used smokeless tobacco.
Methods
The study on the current smokeless tobacco trends in Bangladesh employed a mixed-methods research design to comprehensively explore and analyze the various facets of smokeless tobacco use in the country. The research aimed to investigate prevalence rates, socio-demographic correlates, patterns of use, and associated factors among the population.
Study Design
The research design involved both quantitative and qualitative methods that would provide a holistic understanding of smokeless tobacco trends. A cross-sectional survey was conducted to collect quantitative data, while in-depth interviews and focus group discussions would be employed for qualitative insights.
Participants
The study would include a representative sample of participants from diverse socio-economic backgrounds and geographic regions in Bangladesh. A stratified random sampling technique would be utilized to ensure a balanced representation of different demographic groups.
Data Collection
Quantitative Data: A structured questionnaire would be administered to collect quantitative data on smokeless tobacco use prevalence, frequency, duration, and socio-demographic characteristics of the participants. The survey was conducted through face-to-face interviews and included both urban and rural settings.
Qualitative Data: In-depth interviews and focus group discussions would be conducted to gain a deeper understanding of the cultural, social, and behavioral aspects related to smokeless tobacco use. Participants were selected purposively to ensure diverse perspectives.
Measures
The survey instrument would include standardized questions that would be adapted from established tobacco use surveys, addressing smokeless tobacco initiation, current use patterns, cessation attempts, and perceptions about health risks associated with smokeless tobacco.
Data Analysis
Quantitative data would be analyzed using appropriate statistical techniques, including descriptive statistics, chi-square tests, and logistic regression analysis to identify associations between socio-demographic variables and smokeless tobacco use. Qualitative data were thematically analyzed to extract patterns and themes related to perceptions, cultural norms, and behavioral aspects associated with smokeless tobacco use.
Ethical Considerations
The study adhered to ethical guidelines, obtaining informed consent from all participants. Confidentiality and anonymity were maintained throughout the research process, and the study protocol would be approved by the relevant ethical review board.
Limitations
Possible limitations included recall bias in self-reported tobacco use and the cross-sectional nature of the study
Brief Communication
Globally, more than 300 million people use smokeless tobacco. Smokeless tobacco has historically been used in a number of countries, including North America, Pakistan, India, and other Asian nations. Many individuals, particularly young people, who use smokeless tobacco and get addicted to nicotine, also increase their cigarette smoking as a result. Cigarettes. The mid-2000s saw a rise in smokeless tobacco use among 12- to 17-year-olds, although the 2014 estimates were more in line with the lower levels observed in the early 2000s.An estimated 1.0 million adults aged 12 and older began using smokeless tobacco for the first time in 2014; this amounts to 0.5% of those who had never done so before. About 2 out of every 100 middle school pupils in the US reported using smokeless tobacco as of 2016 (2.2%). Nearly 6 out of every 100 high school students in the US reported using smokeless tobacco as of 2016 (5.8%).3 The 2017 Worldwide Adult Tobacco Survey A third of the population, or 37.8 million individuals, use tobacco. Of adults, 19.2 million, or 18%, smoke tobacco. Men smoke at a rate of 36.2% compared to 0.8% for women. Twenty-six million persons, or 26 percent, use smokeless tobacco; 18.7 million use betel quid and tobacco; 3.6% use gul. Women consume more smokeless tobacco than men: 24.8% of women and 16.2% of males 63.6% of those who use smokeless tobacco right now last bought tobacco from a retailer. Only 23.9% of adults observed anti-smokeless tobacco information on television or radio, compared to 46.2% of adults who noticed anti-smoking information, indicating that media projection of smokeless tobacco is lower. 82.0%, 82.5%, and 91.0% of people believed that smokeless tobacco causes stroke, heart attack, and oral/mouth cancer; respectively 3 based on their knowledge and perception of the health impacts of the product.
The majority of tobacco users combine smokeless tobacco with betel leaf, such as zarda, gul, and sadapata. Products made from smokeless tobacco are quite inexpensive, particularly zarda, sadapata, and gul.The BDT 2 to 5 pricing ranges that are the lowest. Sadapata costs BDT 6 per piece when bought individually, while Zarda weighs 10 grams and costs BDT 12. Small Gul packets exist between Tk 4 and Tk 8. People with lesser incomes can easily get it. 140 grams in weight and BDT 280 is the price of the priciest item at Zarda. 30 grams is the standard price for Zarda. For Forty BDT There are several names associated with the Zarda brand. 225 brands were the most popular in 2013, according to Tabinaj.Top ten brands include Hakimpuri, Shova, and Ratan. Other products are also offered in the neighborhood market, such Mama Akijzarda, Manik Vijapati, Jafrani Zarda, Dulal Shurovi Zarda, etc.These are listed indiscriminately and vary based on the state of the market. Except for Akij, the brand big renowned companies are not limited to Zarda's operations. Akij also makes a biri known as Akij Biri.3
All tobacco products, including smokeless tobacco products, are hazardous since they all contain carcinogens.In general, 28 carcinogens have been thoroughly identified across a variety of important smokeless tobacco products, largely from 3 types of compounds: nonvolatile, alkaloid-derived TSNAs (Tobacco-Specific Nitrosamines), N-nitrosoamino acids; and volatile N-nitrosamines. Researchers say that among these carcinogens, TSNAs are the most prevalent and cancer causing in smokeless tobacco. According to in vitro research, the levels of nicotine in saliva from using smokeless tobacco may be high enough to cause cytotoxicity.4
Cancer can also be brought on by other substances in tobacco. Among these is polonium-210, a radioactive substance discovered in tobacco fertilizer.Substances developed during the heating process of tobacco (also known as polycyclic aromatic hydrocarbons or polynuclear aromatic hydrocarbons). As the World Health Organization has classified smokeless tobacco products as containing human carcinogenic compounds, particularly tobacco-specific nitrosamines, which make up between 76 and 91% of the total burden of N-nitroso compounds (NOCs). Harmful metals (arsenic, beryllium, cadmium, chromium, cobalt, lead, nickel, and mercury) are also included in this classification. There are "a number of ethnically related smokeless tobacco types that contain areca nut, a Group 1 carcinogen," according to a 2014 assessment.5
Smokeless tobacco use during pregnancy raises the chance of premature delivery. Smokeless tobacco products include nicotine, which may have an impact on a baby's prenatal brain development. All tobacco products, including smokeless tobacco, which contains more than 2000 chemical components, including nicotine, are fundamentally dangerous. Smoking cessation products increases blood pressure quickly and contributes to chronic hypertension, both of which increase the risk of heart disease. There are apparently links between using smokeless tobacco and deadly myocardial infarction and stroke.6 In comparison to cigarette smokers, SLT users had very high levels of cotinine (380ng/ml [GSD:2]). SLT products are highly addictive and users need proper support to stop using them. This is indicated by the high cotinine concentration among SLT users and the rising prevalence of SLT use in Bangladesh. Although zarda and gul have negative effects on health,although sellers and users are aware of the negative effects of cigarettes and bidi.Additionally, because nicotine and other carcinogens are absorbed by the blood vessels in your gums and cheeks and delivered to your brain, smoking increases your risk of getting malignancies of the mouth, throat, and pancreas, to mention a few. Gum disease and tooth loss can cause irreversible facial deformities, facial paralysis, scarring, and myocardial infarction in addition to these conditions.7
Nevertheless, using varenicline and nicotine lozenges (marketed as Chantix and Champix; meant to assist individuals in quitting smoking) lessens the cravings and withdrawal symptoms associated with quitting.Valenicline is thought to be effective. While it shares similarities with cytisine in this sense, it differs from nicotinic antagonists such as bupropion and nicotine replacement therapies (NRTs) like nicotine patches and gum. Studies show that one in eleven smokers can successfully maintain their tobacco-free status after six months with the help of varenicline. While some behavioral therapies might be beneficial, it's important to understand their component pieces, according to a Cochrane analysis.The Bangladeshi government established a price of Tk 25 for 10 grams of Zarda and Gul in the National Budget for the 2018–19 fiscal year.3,7
Discussion
Studies may discuss the prevalence rates of smokeless tobacco use among different demographic groups in Bangladesh, such as age, gender, and socio-economic status.Patterns of use, including the types of smokeless tobacco products consumed, frequency of use, and initiation age, might be examined.Literature may delve into the socio-cultural factors that contribute to smokeless tobacco use. This could include traditional practices, cultural norms, and social acceptance of smokeless tobacco.Researchers may discuss the health implications of smokeless tobacco use in Bangladesh. This could encompass both short-term and long-term health effects, as well as the economic burden on the healthcare system.The literature may examine the effectiveness of existing tobacco control policies in Bangladesh and propose recommendations for improving them.Studies may also discuss the implementation of interventions aimed at reducing smokeless tobacco use, such as awareness campaigns and cessation programs.Some literature may explore the role of the tobacco industry in promoting smokeless tobacco products in Bangladesh. This could include marketing strategies and efforts to circumvent regulations.Discussions may revolve around public awareness regarding the health risks associated with smokeless tobacco. Studies might also investigate public perceptions and attitudes toward smokeless tobacco use.Longitudinal studies or analyses of trends over time may provide insights into how smokeless tobacco use has evolved in Bangladesh. This could include changes in prevalence rates and shifting patterns of consumption.Some studies might explore gender-specific trends, considering that tobacco use patterns can vary significantly between men and women. Understanding these differences can inform targeted interventions.Literature may discuss the challenges faced in addressing smokeless tobacco use in Bangladesh, such as limited resources, and propose potential opportunities for improvement.Researchers may explore how efforts to control smokeless tobacco use align with broader public health initiatives in Bangladesh, providing a holistic view of health promotion strategies.9
Significance of the finding
The findings of the study on the current smokeless tobacco trend in Bangladesh provide valuable insights into various aspects of smokeless tobacco use, shedding light on prevalence rates, socio-economic and cultural factors, health implications, and potential strategies for tobacco control.identify the prevalence rates of smokeless tobacco use in different regions, age groups, and socio-economic classes.Highlight any significant variations in prevalence across demographics.Uncover key socio-economic and cultural factors influencing smokeless tobacco consumption through interviews and focus group discussions.Identify common themes and patterns contributing to the acceptance and continuation of smokeless tobacco use.Examine the associations between smokeless tobacco use and health outcomes.Quantify the economic burden associated with health issues linked to smokeless tobacco.Integrate quantitative and qualitative findings to formulate evidence-based policy recommendations.Consider the perspectives of different stakeholders, including policymakers, healthcare professionals, and the community.Explore community perspectives on smokeless tobacco use, stigma, and perceived benefits.Understand community dynamics that either support or hinder tobacco control efforts.Acknowledge limitations such as sampling biases, data collection challenges, and potential biases in participant responses.Highlight areas where further research is needed to deepen understanding.Suggest potential research questions based on the current findings.9
Conclusion
In Bangladesh, adults use smokeless tobacco (SLT) at a high rate, however SLT was not included in the Tobacco Control Law until 2013. There is little data on SLT use among Bangladeshis to inform policy decisions and carry out efficient regulatory actions. Research indicates that SLTs in Bangladesh include manufactured goods such Khoinee, Zarda, Gul, and Sada Pata, as well as unprocessed goods. More than 27 percent of adult Bangladeshis who are 15 years of age or older use SLT in some capacity. Age, sex, financial position, and education are all related to SLT use.Roughly 320,000 disability-adjusted life years were lost in Bangladesh in 2010 as a result of SLT consumption, which has apparently been linked to an increase in the prevalence of heart disease, stroke, and oral cancer. For SLT users, there is no cessation service offered in public spaces. Bangladesh continues to tax SLT at a lower rate than it does cigarettes. The Tobacco Control Law was amended in 2013, requiring 50% of SLT
packaging to bear graphic health warnings, prohibiting the promotion of SLT goods, and limiting sales to minors. The law is not being applied well, though. Bangladeshi culture accepts the use of SLT, hence a culturally relevant public awareness campaign is needed to reduce SLT use in addition to higher taxes and help for quitting.8 Many non-cancerous oral health issues, such as nicotine addiction and dependency, psychological disorders, mental disease, and even a tendency toward suicidal behavior, may arise in the near future as a result of this secondary liver tumor addiction. It is now essential to take immediate action to focus on and carry out preventive comprehensive action at every level from the government & local concern authorities in order to alleviate this susceptible problem for the betterment of the nation.
Recommendation
Based on the findings of the study on the current smokeless tobacco trend in Bangladesh, several recommendations can be formulated to address the identified issues and contribute to effective tobacco control efforts. These recommendations should be tailored to the specific socio-economic, cultural, and health contexts revealed by the research. Here are some key recommendations:
Public Awareness and Education
Develop Comprehensive Educational Campaigns:Design culturally sensitive campaigns highlighting the health risks associated with smokeless tobacco use.Utilize various media channels, including television, radio, and social media, to reach diverse audiences.
Targeted Educational Programs:Develop targeted programs for schools, communities, and workplaces to raise awareness among different age groups and socio-economic classes.Incorporate information about the economic burden of smokeless tobacco-related health issues.
Regulatory Measures
Strengthen Enforcement of Existing Regulations:Improve monitoring and enforcement of regulations governing the production, sale, and advertising of smokeless tobacco products.Impose strict penalties for non-compliance with regulations.
Expand Regulations to Cover Emerging Products:Regularly update and expand regulations to include new and emerging smokeless tobacco products.Consider regulating ingredients, packaging, and advertising strategies.
Access and Affordability
Taxation Policies:Implement and periodically review taxation policies to increase the cost of smokeless tobacco products.Use tax revenue to fund tobacco control and cessation programs.
Reduce Availability:Restrict the availability of smokeless tobacco products in proximity to schools, playgrounds, and other areas frequented by youth.
Community Engagement
Community-Based Programs:Collaborate with local communities to design and implement tailored tobacco control programs.Leverage community leaders and influencers to advocate for smokeless tobacco-free environments.
Peer Education Programs:Establish peer education programs within communities, particularly targeting youth.Empower individuals to educate their peers about the risks of smokeless tobacco.
Healthcare Initiatives
Integrate Tobacco Cessation Services:Integrate tobacco cessation services into existing healthcare infrastructure.Train healthcare professionals to provide counseling and support for tobacco users.
Screening and Early Intervention:Implement routine screening for smokeless tobacco use during healthcare visits.Provide early intervention and counseling for individuals identified as users.
Research and Surveillance
Continued Surveillance:Establish a continuous surveillance system to monitor trends in smokeless tobacco use.Regularly update research on emerging products and consumption patterns.
Support Further Research:Allocate resources for ongoing research to address any remaining gaps identified in the current study.Encourage collaboration between researchers, government agencies, and non-governmental organizations.
Policy Advocacy
Engage with Policymakers:Collaborate with policymakers to advocate for evidence-based policies.Provide policymakers with regular updates on the effectiveness of implemented measures.
International Collaboration:Engage in international collaborations to share best practices and learn from successful tobacco control initiatives in other countries.
Evaluation and Feedback Mechanisms
Continuous Evaluation:Establish mechanisms for continuous evaluation of the effectiveness of implemented interventions.Use feedback to make adjustments and improvements.
Public Feedback:Encourage public participation and feedback on tobacco control efforts.Utilize public input to refine and enhance strategies.
Implementing these recommendations requires a coordinated effort involving government agencies, non-governmental organizations, healthcare providers, and the community. Regular evaluation and adaptation of strategies will be essential to ensure the long-term success of tobacco control efforts in Bangladesh.
In 1683, the first English-language discussion of powdered smokeless tobacco for inhaling appeared. It has been in use for over a thousand years. The cigarette industry has a foothold in the smokeless tobacco market. Smokeless tobacco is a type of tobacco used in activities other than smoking.They are consumed by chewing, inhaling, or sandwiching the material between the gums and cheeks.Smokeless tobacco products come in a variety of forms, including chewing tobacco, snuff, snus, and dissolvable tobacco products. Smokeless tobacco products frequently have more than 3,000 ingredients. Every smokeless tobacco product contains nicotine, making them all extremely addictive. Giving up smoking is challenging, but so is quitting smokeless tobacco. Smokeless tobacco is widely used all over the world. When they start using smokeless tobacco and are addicted to nicotine, many people, especially young people, start smoking cigarettes. Males were more likely than females to have smokeless tobacco in the past month. 1
Fragrances, artificial and natural flavors, perfumes, and chemicals like tobacco that make you look more appealing are some of the ingredients utilized in smokeless tobacco products to attract customers. carcinogens among the components.Non-tobacco plant components include papaya, herbs, Joyfal, jostimodhu, saffron2, molasses, cinnamon, menthol, glucose, glycerin, vegetable oil, Gum Arabic, and Mrigonavi (Musk).
Young people who use smokeless tobacco run the risk of developing a nicotine addiction, which increases the likelihood that they will also start smoking cigarettes. Young people are especially prone to beginning smokeless tobacco use. In the previous month, males were more likely than females to have used smokeless tobacco. In 2014, 8.7 million people (3.3 percent of those 12 and older) used smokeless tobacco.
Methods
The study on the current smokeless tobacco trends in Bangladesh employed a mixed-methods research design to comprehensively explore and analyze the various facets of smokeless tobacco use in the country. The research aimed to investigate prevalence rates, socio-demographic correlates, patterns of use, and associated factors among the population.
Study Design
The research design involved both quantitative and qualitative methods that would provide a holistic understanding of smokeless tobacco trends. A cross-sectional survey was conducted to collect quantitative data, while in-depth interviews and focus group discussions would be employed for qualitative insights.
Participants
The study would include a representative sample of participants from diverse socio-economic backgrounds and geographic regions in Bangladesh. A stratified random sampling technique would be utilized to ensure a balanced representation of different demographic groups.
Data Collection
Quantitative Data: A structured questionnaire would be administered to collect quantitative data on smokeless tobacco use prevalence, frequency, duration, and socio-demographic characteristics of the participants. The survey was conducted through face-to-face interviews and included both urban and rural settings.
Qualitative Data: In-depth interviews and focus group discussions would be conducted to gain a deeper understanding of the cultural, social, and behavioral aspects related to smokeless tobacco use. Participants were selected purposively to ensure diverse perspectives.
Measures
The survey instrument would include standardized questions that would be adapted from established tobacco use surveys, addressing smokeless tobacco initiation, current use patterns, cessation attempts, and perceptions about health risks associated with smokeless tobacco.
Data Analysis
Quantitative data would be analyzed using appropriate statistical techniques, including descriptive statistics, chi-square tests, and logistic regression analysis to identify associations between socio-demographic variables and smokeless tobacco use. Qualitative data were thematically analyzed to extract patterns and themes related to perceptions, cultural norms, and behavioral aspects associated with smokeless tobacco use.
Ethical Considerations
The study adhered to ethical guidelines, obtaining informed consent from all participants. Confidentiality and anonymity were maintained throughout the research process, and the study protocol would be approved by the relevant ethical review board.
Limitations
Possible limitations included recall bias in self-reported tobacco use and the cross-sectional nature of the study
Brief Communication
Globally, more than 300 million people use smokeless tobacco. Smokeless tobacco has historically been used in a number of countries, including North America, Pakistan, India, and other Asian nations. Many individuals, particularly young people, who use smokeless tobacco and get addicted to nicotine, also increase their cigarette smoking as a result. Cigarettes. The mid-2000s saw a rise in smokeless tobacco use among 12- to 17-year-olds, although the 2014 estimates were more in line with the lower levels observed in the early 2000s.An estimated 1.0 million adults aged 12 and older began using smokeless tobacco for the first time in 2014; this amounts to 0.5% of those who had never done so before. About 2 out of every 100 middle school pupils in the US reported using smokeless tobacco as of 2016 (2.2%). Nearly 6 out of every 100 high school students in the US reported using smokeless tobacco as of 2016 (5.8%).3 The 2017 Worldwide Adult Tobacco Survey A third of the population, or 37.8 million individuals, use tobacco. Of adults, 19.2 million, or 18%, smoke tobacco. Men smoke at a rate of 36.2% compared to 0.8% for women. Twenty-six million persons, or 26 percent, use smokeless tobacco; 18.7 million use betel quid and tobacco; 3.6% use gul. Women consume more smokeless tobacco than men: 24.8% of women and 16.2% of males 63.6% of those who use smokeless tobacco right now last bought tobacco from a retailer. Only 23.9% of adults observed anti-smokeless tobacco information on television or radio, compared to 46.2% of adults who noticed anti-smoking information, indicating that media projection of smokeless tobacco is lower. 82.0%, 82.5%, and 91.0% of people believed that smokeless tobacco causes stroke, heart attack, and oral/mouth cancer; respectively 3 based on their knowledge and perception of the health impacts of the product.
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Figure 1 Click here to view Figure |
The majority of tobacco users combine smokeless tobacco with betel leaf, such as zarda, gul, and sadapata. Products made from smokeless tobacco are quite inexpensive, particularly zarda, sadapata, and gul.The BDT 2 to 5 pricing ranges that are the lowest. Sadapata costs BDT 6 per piece when bought individually, while Zarda weighs 10 grams and costs BDT 12. Small Gul packets exist between Tk 4 and Tk 8. People with lesser incomes can easily get it. 140 grams in weight and BDT 280 is the price of the priciest item at Zarda. 30 grams is the standard price for Zarda. For Forty BDT There are several names associated with the Zarda brand. 225 brands were the most popular in 2013, according to Tabinaj.Top ten brands include Hakimpuri, Shova, and Ratan. Other products are also offered in the neighborhood market, such Mama Akijzarda, Manik Vijapati, Jafrani Zarda, Dulal Shurovi Zarda, etc.These are listed indiscriminately and vary based on the state of the market. Except for Akij, the brand big renowned companies are not limited to Zarda's operations. Akij also makes a biri known as Akij Biri.3
All tobacco products, including smokeless tobacco products, are hazardous since they all contain carcinogens.In general, 28 carcinogens have been thoroughly identified across a variety of important smokeless tobacco products, largely from 3 types of compounds: nonvolatile, alkaloid-derived TSNAs (Tobacco-Specific Nitrosamines), N-nitrosoamino acids; and volatile N-nitrosamines. Researchers say that among these carcinogens, TSNAs are the most prevalent and cancer causing in smokeless tobacco. According to in vitro research, the levels of nicotine in saliva from using smokeless tobacco may be high enough to cause cytotoxicity.4
Cancer can also be brought on by other substances in tobacco. Among these is polonium-210, a radioactive substance discovered in tobacco fertilizer.Substances developed during the heating process of tobacco (also known as polycyclic aromatic hydrocarbons or polynuclear aromatic hydrocarbons). As the World Health Organization has classified smokeless tobacco products as containing human carcinogenic compounds, particularly tobacco-specific nitrosamines, which make up between 76 and 91% of the total burden of N-nitroso compounds (NOCs). Harmful metals (arsenic, beryllium, cadmium, chromium, cobalt, lead, nickel, and mercury) are also included in this classification. There are "a number of ethnically related smokeless tobacco types that contain areca nut, a Group 1 carcinogen," according to a 2014 assessment.5
Smokeless tobacco use during pregnancy raises the chance of premature delivery. Smokeless tobacco products include nicotine, which may have an impact on a baby's prenatal brain development. All tobacco products, including smokeless tobacco, which contains more than 2000 chemical components, including nicotine, are fundamentally dangerous. Smoking cessation products increases blood pressure quickly and contributes to chronic hypertension, both of which increase the risk of heart disease. There are apparently links between using smokeless tobacco and deadly myocardial infarction and stroke.6 In comparison to cigarette smokers, SLT users had very high levels of cotinine (380ng/ml [GSD:2]). SLT products are highly addictive and users need proper support to stop using them. This is indicated by the high cotinine concentration among SLT users and the rising prevalence of SLT use in Bangladesh. Although zarda and gul have negative effects on health,although sellers and users are aware of the negative effects of cigarettes and bidi.Additionally, because nicotine and other carcinogens are absorbed by the blood vessels in your gums and cheeks and delivered to your brain, smoking increases your risk of getting malignancies of the mouth, throat, and pancreas, to mention a few. Gum disease and tooth loss can cause irreversible facial deformities, facial paralysis, scarring, and myocardial infarction in addition to these conditions.7
Nevertheless, using varenicline and nicotine lozenges (marketed as Chantix and Champix; meant to assist individuals in quitting smoking) lessens the cravings and withdrawal symptoms associated with quitting.Valenicline is thought to be effective. While it shares similarities with cytisine in this sense, it differs from nicotinic antagonists such as bupropion and nicotine replacement therapies (NRTs) like nicotine patches and gum. Studies show that one in eleven smokers can successfully maintain their tobacco-free status after six months with the help of varenicline. While some behavioral therapies might be beneficial, it's important to understand their component pieces, according to a Cochrane analysis.The Bangladeshi government established a price of Tk 25 for 10 grams of Zarda and Gul in the National Budget for the 2018–19 fiscal year.3,7
Discussion
Studies may discuss the prevalence rates of smokeless tobacco use among different demographic groups in Bangladesh, such as age, gender, and socio-economic status.Patterns of use, including the types of smokeless tobacco products consumed, frequency of use, and initiation age, might be examined.Literature may delve into the socio-cultural factors that contribute to smokeless tobacco use. This could include traditional practices, cultural norms, and social acceptance of smokeless tobacco.Researchers may discuss the health implications of smokeless tobacco use in Bangladesh. This could encompass both short-term and long-term health effects, as well as the economic burden on the healthcare system.The literature may examine the effectiveness of existing tobacco control policies in Bangladesh and propose recommendations for improving them.Studies may also discuss the implementation of interventions aimed at reducing smokeless tobacco use, such as awareness campaigns and cessation programs.Some literature may explore the role of the tobacco industry in promoting smokeless tobacco products in Bangladesh. This could include marketing strategies and efforts to circumvent regulations.Discussions may revolve around public awareness regarding the health risks associated with smokeless tobacco. Studies might also investigate public perceptions and attitudes toward smokeless tobacco use.Longitudinal studies or analyses of trends over time may provide insights into how smokeless tobacco use has evolved in Bangladesh. This could include changes in prevalence rates and shifting patterns of consumption.Some studies might explore gender-specific trends, considering that tobacco use patterns can vary significantly between men and women. Understanding these differences can inform targeted interventions.Literature may discuss the challenges faced in addressing smokeless tobacco use in Bangladesh, such as limited resources, and propose potential opportunities for improvement.Researchers may explore how efforts to control smokeless tobacco use align with broader public health initiatives in Bangladesh, providing a holistic view of health promotion strategies.9
Significance of the finding
The findings of the study on the current smokeless tobacco trend in Bangladesh provide valuable insights into various aspects of smokeless tobacco use, shedding light on prevalence rates, socio-economic and cultural factors, health implications, and potential strategies for tobacco control.identify the prevalence rates of smokeless tobacco use in different regions, age groups, and socio-economic classes.Highlight any significant variations in prevalence across demographics.Uncover key socio-economic and cultural factors influencing smokeless tobacco consumption through interviews and focus group discussions.Identify common themes and patterns contributing to the acceptance and continuation of smokeless tobacco use.Examine the associations between smokeless tobacco use and health outcomes.Quantify the economic burden associated with health issues linked to smokeless tobacco.Integrate quantitative and qualitative findings to formulate evidence-based policy recommendations.Consider the perspectives of different stakeholders, including policymakers, healthcare professionals, and the community.Explore community perspectives on smokeless tobacco use, stigma, and perceived benefits.Understand community dynamics that either support or hinder tobacco control efforts.Acknowledge limitations such as sampling biases, data collection challenges, and potential biases in participant responses.Highlight areas where further research is needed to deepen understanding.Suggest potential research questions based on the current findings.9
Conclusion
In Bangladesh, adults use smokeless tobacco (SLT) at a high rate, however SLT was not included in the Tobacco Control Law until 2013. There is little data on SLT use among Bangladeshis to inform policy decisions and carry out efficient regulatory actions. Research indicates that SLTs in Bangladesh include manufactured goods such Khoinee, Zarda, Gul, and Sada Pata, as well as unprocessed goods. More than 27 percent of adult Bangladeshis who are 15 years of age or older use SLT in some capacity. Age, sex, financial position, and education are all related to SLT use.Roughly 320,000 disability-adjusted life years were lost in Bangladesh in 2010 as a result of SLT consumption, which has apparently been linked to an increase in the prevalence of heart disease, stroke, and oral cancer. For SLT users, there is no cessation service offered in public spaces. Bangladesh continues to tax SLT at a lower rate than it does cigarettes. The Tobacco Control Law was amended in 2013, requiring 50% of SLT
packaging to bear graphic health warnings, prohibiting the promotion of SLT goods, and limiting sales to minors. The law is not being applied well, though. Bangladeshi culture accepts the use of SLT, hence a culturally relevant public awareness campaign is needed to reduce SLT use in addition to higher taxes and help for quitting.8 Many non-cancerous oral health issues, such as nicotine addiction and dependency, psychological disorders, mental disease, and even a tendency toward suicidal behavior, may arise in the near future as a result of this secondary liver tumor addiction. It is now essential to take immediate action to focus on and carry out preventive comprehensive action at every level from the government & local concern authorities in order to alleviate this susceptible problem for the betterment of the nation.
Recommendation
Based on the findings of the study on the current smokeless tobacco trend in Bangladesh, several recommendations can be formulated to address the identified issues and contribute to effective tobacco control efforts. These recommendations should be tailored to the specific socio-economic, cultural, and health contexts revealed by the research. Here are some key recommendations:
Public Awareness and Education
Develop Comprehensive Educational Campaigns:Design culturally sensitive campaigns highlighting the health risks associated with smokeless tobacco use.Utilize various media channels, including television, radio, and social media, to reach diverse audiences.
Targeted Educational Programs:Develop targeted programs for schools, communities, and workplaces to raise awareness among different age groups and socio-economic classes.Incorporate information about the economic burden of smokeless tobacco-related health issues.
Regulatory Measures
Strengthen Enforcement of Existing Regulations:Improve monitoring and enforcement of regulations governing the production, sale, and advertising of smokeless tobacco products.Impose strict penalties for non-compliance with regulations.
Expand Regulations to Cover Emerging Products:Regularly update and expand regulations to include new and emerging smokeless tobacco products.Consider regulating ingredients, packaging, and advertising strategies.
Access and Affordability
Taxation Policies:Implement and periodically review taxation policies to increase the cost of smokeless tobacco products.Use tax revenue to fund tobacco control and cessation programs.
Reduce Availability:Restrict the availability of smokeless tobacco products in proximity to schools, playgrounds, and other areas frequented by youth.
Community Engagement
Community-Based Programs:Collaborate with local communities to design and implement tailored tobacco control programs.Leverage community leaders and influencers to advocate for smokeless tobacco-free environments.
Peer Education Programs:Establish peer education programs within communities, particularly targeting youth.Empower individuals to educate their peers about the risks of smokeless tobacco.
Healthcare Initiatives
Integrate Tobacco Cessation Services:Integrate tobacco cessation services into existing healthcare infrastructure.Train healthcare professionals to provide counseling and support for tobacco users.
Screening and Early Intervention:Implement routine screening for smokeless tobacco use during healthcare visits.Provide early intervention and counseling for individuals identified as users.
Research and Surveillance
Continued Surveillance:Establish a continuous surveillance system to monitor trends in smokeless tobacco use.Regularly update research on emerging products and consumption patterns.
Support Further Research:Allocate resources for ongoing research to address any remaining gaps identified in the current study.Encourage collaboration between researchers, government agencies, and non-governmental organizations.
Policy Advocacy
Engage with Policymakers:Collaborate with policymakers to advocate for evidence-based policies.Provide policymakers with regular updates on the effectiveness of implemented measures.
International Collaboration:Engage in international collaborations to share best practices and learn from successful tobacco control initiatives in other countries.
Evaluation and Feedback Mechanisms
Continuous Evaluation:Establish mechanisms for continuous evaluation of the effectiveness of implemented interventions.Use feedback to make adjustments and improvements.
Public Feedback:Encourage public participation and feedback on tobacco control efforts.Utilize public input to refine and enhance strategies.
Implementing these recommendations requires a coordinated effort involving government agencies, non-governmental organizations, healthcare providers, and the community. Regular evaluation and adaptation of strategies will be essential to ensure the long-term success of tobacco control efforts in Bangladesh.
Acknowledgement
I would want to express my gratitude for my late father's support, who served as an inspiration and guiding force for me as I wrote the brief communication.
Conflicts of Interest
The authors declare no conflict of interest
Funding Sources
The research was not funded by the concern organization
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