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Aims Previously reported research suggests a dependence syndrome for areca nut use, though well-designed studies are virtually non-existent. The goal of this study was to examine evidence of areca dependence in a sample of areca-only (i.e. no tobacco) chewers using modified measurement scales. Design A purposive sample of chewers, identified via local informants and advertisements, was surveyed from January to March of 2005. Setting Six villages in Dakshina Kannada District, Karnataka State, India. Participants Fifty-nine daily areca chewers who do not also currently use any form of tobacco. Measurements Questionnaires included modified versions of the Fagerström Tolerance Questionnaire, Cigarette Dependence Scale (CDS-5) and the Smokeless Tobacco Dependence Scale (STDS). Additional questions assessed demographic characteristics and patterns of use. Findings Approximately half of respondents reported 1–3 chews/day (mean = 1.9; SD = 0.98). The average number of chewing episodes/day was 4.4 (SD = 3.4) and the average number of nuts/day was 1.2 (SD = 1.1). Users’ typical chew lasts up to 20 minutes and includes spitting out the juices and rinsing the mouth with water. Overall, the levels of reported dependence symptoms were quite low, but approximately 44% of chewers endorsed at least one of the following items: continued use despite illness or mouth wounds, difficulty refraining from chewing in forbidden places, or craving during periods of abstinence. Approximately 15.4% of chewers reported at least one intentional quit attempt and a subset had summary scores indicative of dependence (13.6% had scores >16 on the CDS-5 and 5.3% had scores >11 on the STDS). Dependence scores were positively correlated with frequency of chews/day. Conclusions The symptoms of dependence observed in a subset of areca-only chewers warrant further investigation. Next steps should include well-controlled laboratory evaluation of dependence features. [ABSTRACT FROM AUTHOR]

Tobacco use is a leading cause of death and of poor pregnancy outcome in many countries. While tobacco use is decreasing in many high-income countries, it is increasing in many low- and middle-income countries (LMICs), where by the year 2030, 80% of deaths caused by tobacco use are expected to occur. In many LMICs, few women smoke tobacco, but strong evidence indicates this is changing; increased tobacco smoking by pregnant women will worsen pregnancy outcomes, especially in resource-poor settings, and threatens to undermine or reverse hard-won gains in maternal and child health. To date, little research has focused on preventing pregnant women's tobacco use and secondhand smoke (SHS) exposure in LMICs. Research on social and cultural influences on pregnant women's tobacco use will greatly facilitate the design and implementation of effective prevention programs and policies, including the adaptation of successful strategies used in high-income countries. This paper describes pregnant women's tobacco use and SHS exposure and the social and cultural influences on pregnant women's tobacco exposure; it also presents a research agenda put forward by an international workgroup convened to make recommendations in this area. [ABSTRACT FROM AUTHOR]

Little research has focused on women's exposure to secondhand smoke (SHS) in LMICs, local perceptions of SHS risk to women and children, and women's attempts to limit exposure to tobacco smoke in their households. This paper describes a community based survey in Indonesia that investigated these issues as one step in a movement to initiate community wide household smoking bans. The survey found high levels of exposure to SHS, high levels of awareness among both women and men that SHS placed women and children at risk for illness, a very low percentage of households having indoor smoking rules, great interest on the part of women to participate in a communitywide ban, and a promising level of male smoker agreement to comply with such a ban. Women expressed a low sense of self efficacy in individually getting their husbands to quit smoking in their homes, but a strong sense of collective efficacy that husbands might agree to a well-publicized and agreed-upon community household smoking ban. Men and women expressed concern about the social risk of asking guests not to smoke in their homes without a communitywide ban and visible displays communicating their participation in this movement. The smoke free initiative described requires the participation of doctors in community education programs, and is attempting to introduce household smoking bans as a way of turning tobacco control into a family health and not just a smokers' health issue. [ABSTRACT FROM AUTHOR]

Background: The benefits of breastfeeding for infants and mothers have been well established, yet rates of breastfeeding remain well below national recommendations in the United States and even lower for women who smoke during pregnancy. Primary goals of this study were to explore contextual factors that contribute to breastfeeding intentions and behavior and to examine how smoking status affected women’s decision making about breastfeeding. Methods: This paper is based on a longitudinal qualitative study of smoking, pregnancy, and breastfeeding among 44 low-income women in the southwest U.S. who smoked during pregnancy. Each woman was interviewed 9 times; 6 times during pregnancy and 3 times postpartum using semistructured questionnaires. Interviews lasted 1 to 3 hours and were tape-recorded, transcribed, and analyzed. Results: Despite 36 (82%) respondents stating that they intended to breastfeed for an average duration of 8 months, rates of breastfeeding initiation and duration were much lower than intentions. By 6 months postpartum, only two women were breastfeeding exclusively. Conclusions: Women perceived that a strong risk of harming the baby was posed by smoking while breastfeeding and received little encouragement to continue breastfeeding despite an inability to stop smoking. The perceptions of the toxic, addictive, and harmful effects of smoking on breastmilk constitution and quantity factored into reasons why women weaned their infants from breastfeeding much earlier than the recommended 6 months. The results indicate a need for more consistency and routine in educating women on the relationship between smoking and breastfeeding and in promoting breastfeeding in spite of smoking postpartum. (BIRTH 35:3 September 2008) [ABSTRACT FROM AUTHOR]

Many studies have reported that adolescent girls and young women smoke to control their weight. The majority of these studies are cross-sectional and report on correlational data from quantitative surveys. This article presents data from ethnographic interviews with 60 smokers, interviewed in high school and in follow-up interviews at age 21. Contrary to previous research, this study found little evidence for the sustained use of smoking as a weight-control strategy. In high school, smokers were no more likely than nonsmokers to be trying to lose weight. In the follow-up study, 85 percent of informants replied that they had never smoked as a way to control their weight. One-half of informants at age 21 believed that smoking as a weight-control strategy would be ineffective, while the other one-half had no idea whether it would work or not. Researchers need to exert caution in propagating the idea that smoking is commonly used as a conscious and sustained weight-control strategy among adolescent females and young women. [ABSTRACT FROM AUTHOR]