Smokeless Tobacco Product Use among South Asian Americans

Tobacco use is one of the central risk factors for many leading chronic conditions, including cardiovascular diseases, diabetes, lung and oral cancers, and stroke. Previous research has shown that, while South Asians living outside their countries of origin tend to have lower rates of smoking than the general population, they have higher rates of smokeless tobacco product use (paan, supari, tambaku, and gutka). Data were collected from a convenience sample of 344 South Asian adults in Southern California, representing five South Asian countries with substantial portions from lower socioeconomic backgrounds. Although the overall rate of current smoking (9%) was below observed rates in the general U.S. population, 28% reported current use of one or more smokeless tobacco products. The most commonly used products were: paan masala (22.9%), paan (14.4%), supari (11.5%), and paan parag (15.6%). Rates of paan masala use were significantly higher among Pakistanis (54.22%), whereas rates of paan (29.0%) and supari (23.2%) use were significantly higher among Bangladeshis compared to other South Asian groups.

Multivariate logistic regression results indicated that South Asian ethnicity, health status, and gender significantly predicted use of smokeless tobacco products after accounting for sociodemographic variables (years in US, age, income, and education). Multivariate results showed that Bangladeshis (OR=2.3; p=0.036) and those in poor health (OR=7.6; p=0.002) were significantly more likely to report smokeless tobacco product use. Women (OR=0.47; p=0.02) and Sri Lankans (OR=0.19; p=0.039) were significantly less likely to report use. These findings are informative for designing tobacco control services targeting South Asian Americans.