Contextual challenges to smokeless tobacco cessation among vulnerable urban Indian women

This presentation describes a systemic approach to smokeless tobacco cessation among vulnerable women in India, a country with high production, use and morbidity/mortality associated with SLT. Women's tobacco use is under-researched and ranges from 18% to more than 65%, especially among poor women with limited education. Methods: A team of Indo-US researchers conducted a mixed methods study in a Mumbai slum. Qualitative/spatial data were collected on SLT accessibility, availability, promotion and social norms. Data on patterns of use, correlates of use, and quitting were collected through a survey of 408 users aged 18 - 40. Results: Tobacco products are accessible and available in 68 cheap brands. Social norms and cultural practices endorse use. Women used up to 4 types of tobacco, 98% daily. Women's use was associated with husband's use (R=.250, sig. 01) and use by close associates) (R=.127; sig. .01). 60% had tried to reduce use of any product in the past year but could not and 36% had tried unsuccessfully to quit SLT . 77% thought it difficult to quit and 1/3 of users said it was not possible to quit. 60% said husband or family member told them to quit but when asked about help for quitting, 99% said only self determination could help them. Discussion: Tobacco control efforts have not succeeded in reducing use among poor women. Besides lack of cessation support, globally there are no successful approaches to SLT cessation Changing availability accessibility, social norms and social influence are the current best approaches to prevention/cessation.