Tobacco dependence in a UK Bangladeshi female population: a cross-sectional study

The objective of this study was to establish the prevalence of paan chewing with tobacco by UK-resident Bangladeshi women and the extent to which they manifest nicotine dependence. The cross-sectional study was conducted at two local authority housing estates in Tower Hamlets, London. Participants were 242 Bangladeshi women, selected at random from the current electoral register, who supplied a saliva sample for cotinine and an expired air sample for carbon monoxide analysis. They also participated in a structured interview assessing knowledge, attitudes and behavior with respect to tobacco use. Main outcome measures were data on tobacco use and nicotine dependence, assessed by questionnaire and intake measures. The population prevalence of chewing paan quid with tobacco was 48.5% (95% confidence interval, CI 42.01-54.98%), while 4% (95% CI 2.05-7.41%) smoked cigarettes. Higher mean salivary cotinine scores were associated with greater consumption frequency and use of leaf tobacco in the quid. Above-average nicotine dependence was associated with chewing paan quid with tobacco within 1 h of waking (OR = 4.02, p = 0.03, 95% CI 1.08-14.94) and the use of leaf rather than processed tobacco (OR = 3.91, p = 0.025, 95% CI 1.19-12.81). Smoking prevalence is low, but the prevalence of paan quid with tobacco chewing is high in this sample of Bangladeshi women. Cotinine concentration appears to be a reliable indicator of levels of nicotine dependence among paan quid with tobacco chewers. Questionnaire-derived items can be used to identify those with above-average levels of nicotine dependence.