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Driezen-WCTOH2015-ITC-BD-Vulnerability-AQ.pptx

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Driezen-WCTOH2015-ITC-BD-Vulnerability-AQ.pptx

  1. 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

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