Consequences of tobacco consumption on health.

1. BACKGROUND
Core support provided
by the U.S. National
Cancer Institute
(P01 CA138389)
Core support provided
by the Canadian
Institutes of Health
Research (MOP-115016)
OBJECTIVES
RESULTS
Poster presented at the 16th World Conference
on Tobacco OR Health (WCTOH) 2015,
Abu Dhabi, March 17-21, 2015
Awareness of Tobacco Related Harms among Vulnerable Populations in
Bangladesh: Findings from the International Tobacco Control (ITC) Bangladesh
Survey
Pete Driezen1, Nigar Nargis2,3, Abu S. Abdullah4, Ghulam Hussain2,
Geoffrey T. Fong1,5, Mary E Thompson1, Anne C. K. Quah1, Steve Xu1.
1University of Waterloo, Ontario, Canada; 2University of Dhaka, Bangladesh; 3World Health Organization, Geneva, Switzerland;
4Boston Medical Center, Massachusetts, United States, 5Ontario Institute for Cancer Research, Ontario, Canada.
CONCLUSIONS
• Chronic disease risk factors tend to be more prevalent in vulnerable
populations, increasing their susceptibility to poor health outcomes.
• Social determinants of health identifying vulnerable populations include
economic factors, living conditions, gender and low education.
• Tobacco use is more prevalent among vulnerable groups who tend to
be less knowledgeable of its dangers.
• Decreased awareness of the harms of tobacco use may inhibit users’
motivation to quit.
• To assess awareness of tobacco harms among vulnerable
Bangladeshis using nationally representative survey data.
METHODS & MEASURES
• In 2011-2012, 5,288 tobacco users and non-users aged 15+
participated in Wave 3 of the ITC Bangladesh Survey. Respondents
were sampled using a multi-stage sampling design from the 6 districts
of Bangladesh (n = 4,223) and Dhaka’s urban slums (n = 1,055).
• Vulnerability was assessed using residence (urban, rural, slum), gender
and education (9+ years, 1-8 years, illiterate).
• Outcome measures: knowledge of the health harms of cigarette
smoking (smoking causes stroke, impotence, chronic obstructive
pulmonary disease (COPD), heart disease, mouth cancer & lung
cancer) and smokeless tobacco use (mouth cancer, throat cancer, heart
disease, gum disease). Respondents were also asked whether tobacco
packaging should contain more health information.
• The percentage of knowledgeable respondents (% responding “Yes” to
each outcome) was estimated for each vulnerability indicator.
Differences between groups were tested using logistic regression
accounting for the complex sampling design.
• Results were weighted to represent the Bangladeshi population.
• Deficits in awareness of tobacco harms among vulnerable
Bangladeshis signal a need for increased education. Warning labels
provide an immediate avenue to educate vulnerable groups about these
harms. Slum residents seem to want that information.
• Empowering women and providing equitable education opportunities,
aims consistent with the UN Sustainable Development Goals, should
increase knowledge among vulnerable groups. Development goals can
therefore augment the goals of the WHO FCTC.
• Knowledge of tobacco harms was significantly lower in vulnerable
groups, even after controlling for age and tobacco use (Figure 1).
• Fewer slum vs. urban non-slum residents knew that cigarette causes
stroke (70% vs 88%), impotence (56% vs 77%), heart disease (50% vs
86%) and COPD (45% vs 74%) and that smokeless tobacco causes
heart disease (48% vs 81%) and gum disease (74% vs 86%).
• Similar trends were observed among women and illiterate Bangladeshis
• Knowledge among the illiterate was consistently lower for all outcomes
compared to more educated populations.
• Using a combined indicator of vulnerability (0 = urban residents with
9+ years of education; 4 = illiterate slum residents), logistic regression
analysis estimated a 1 point increase in vulnerability significantly
decreased the odds of health harm knowledge (Table 1).
• Beliefs about the design of tobacco packaging also varied by
vulnerability: 82% of slum residents thought tobacco packaging should
contain more health information compared to only 66% of urban
residents (p < 0.001).
Table 1
(c) Harms caused by cigarette smoking; (s) Harms caused by smokeless tobacco
Cigarettes OR (95% CI) Smokeless OR (95% CI)
Stroke 0.64 (0.50 -0.80) Mouth cancer 0.58 (0.45 -0.76)
Impotence 0.65 (0.52 -0.81) Throat cancer 0.57 (0.43 -0.77)
Mouth cancer 0.58 (0.43 -0.79) Heart disease 0.72 (0.59 -0.86)
Lung cancer 0.50 (0.35 -0.71) Gum disease 0.66 (0.52 -0.84)
CHD 0.63 (0.52 -0.75)
COPD 0.68 (0.53 -0.88)
Figure 1