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Objectives: Gutka is industrially manufactured in India and some Indian states have instituted bans on the sale of manufactured gutka as a public health initiative. We explored whether gutka was still available for purchase after the ban and also sought to observe methods of ban circumvention. Methods: We visited 5 different markets at different locations separated by at least 15-20 km around the Mumbai Metropolitan Region (MMR) area, consisting of Mumbai and its satellite towns in Maharashtra, India during August- September, 2019. In each location, purveyors were queried as to the availability of gutka. Results: Tobacco purchases were made in 5 locations/sections of MMR. At all markets, banned gutka was not displayed, and could only be purchased after requesting from the shopkeeper. Three methods of ban circumvention were observed: (1) packages marked 'export only'; (2) use of twin packaging in which pan masala and tobacco are sold together for immediate mixing to create gutka; and, (3) non-descript packaging without mention of 'gutka'. Conclusions: Although not readily displayed in shops, gutka is readily available in MMR, despite a statewide ban in Maharashtra. Marketers have used multiple methods to circumvent the statewide gutka ban. [ABSTRACT FROM AUTHOR]

Background: In response to India's growing tobacco epidemic, strategies are needed to decrease tobacco use among Indian youth, particularly among those who are economically disadvantaged. The objective of this study was to assess the effectiveness of a school-based life-skills tobacco control program for youth of low socio-economic status in Mumbai and the surrounding state of Maharashtra. We hypothesized that compared to youth in control schools, youth exposed to the program would have greater knowledge of effects of tobacco use; be more likely to take action to prevent others from using tobacco; demonstrate more positive life skills and attitudes; and be less likely to report tobacco use. Methods/Findings: Using a quasi-experimental design, we assessed program effectiveness by comparing 8th and 9th grade students in intervention schools to 8th grade students in comparable schools that did not receive the program. Across all schools, 1851 students completed a survey that assessed core program components in early 2010. The program consisted of activities focused on building awareness about the hazards of tobacco, developing life skills, and advocacy development. The primary outcome measure was self-reported tobacco use in the last 30 days. Findings indicate that 4.1% of 8th grade intervention students (OR = 0.51) and 3.6% of 9th grade intervention students (OR = 0.33) reported using tobacco at least once in the last 30 days, compared to 8.7% of students in the control schools. Intervention group students were also significantly more knowledgeable about tobacco and related legislation, reported more efforts to prevent tobacco use among others, and reported stronger life skills and self-efficacy than students in control schools. Limitations to the study include schools not being randomly assigned to condition and tobacco use being measured by self-report. Conclusions: This program represents an effective model of school-based tobacco use prevention that low-income schools in India and other low- and middle-income countries can replicate. [ABSTRACT FROM AUTHOR]

Background: Reduction in pulmonary function, as estimated by forced expiratory volume in 1 s (FEV(1)), has been found to predict all-cause mortality in developed-country populations. This study was designed to examine the association between FEV(1) and mortality in an urban developing-country population.Methods: Data from the large, well-characterized Mumbai Cohort Study (Maharashtra, India) were used to compute hazard ratios (HRs; deaths/100-ml FEV(1)) and 95% confidence intervals (CIs) from Cox proportional hazards regression models in which age, tobacco use, education, height and relative body weight were controlled.Results: A total of 13,261 deaths occurred in this cohort of 148,173 individuals. After controlling for important covariates, there was a 1.7% reduction in risk of overall death in women for each 100-ml increment in FEV(1) (HR = 0.983; 95% CI = 0.980-0.986) and a 1.5% reduction in men (HR = 0.985; 95% CI = 0.984-0.986). There was a 1.6% reduction in cancer deaths in women (HR = 0.984; 95% CI = 0.973-0.996) and a 0.8% reduction in men (HR = 0.992; 95% CI = 0.987-0.997). The largest reductions in women were observed in tuberculosis deaths (3.7%/100-ml increment in FEV(1)), and in men in respiratory system deaths (3.2%).Conclusions: In a densely populated urban Indian population, FEV(1) predicted overall and cancer mortality. Effects were larger in women and were not attenuated by exclusion of smokers or restricting analyses to subjects dying >2 years from recruitment. Because FEV(1) may be affected by air pollution, which is worsening in urban areas of most developing countries, further research is recommended to deepen understanding of these factors in relation to mortality. [ABSTRACT FROM AUTHOR]

A significantly higher mean hemoglobin level in women smokers in comparison to nonsmokers with a generalized rightward shift of the hemoglobin distribution curve has been reported at the population level. Studies on pregnant women, however, have often associated smoking with decreased hemoglobin levels, although not consistently. We examined whether smokeless tobacco use during pregnancy influenced hemoglobin levels in a population-based cohort of 918 pregnant women in Mumbai, India. Mean hemoglobin levels (Hb) were significantly lower in users (10.00 g/dl) compared with nonusers (10.46 g/dl), p<.000. Anemia (Hb<10 g/dl) was significantly associated with smokeless tobacco in the univariate analysis (OR = 1.7, 95% CI 1.2-2.5). There was no change after adjusting odds ratios for potential confounders in multivariate analysis (OR = 1.7, 95% CI 1.2-2.5). The odds ratios for anemia were adjusted for age of mother, education, socioeconomic status, type of residence, lower body mass index, parity, vegetarian or nonvegetarian food habit, and hemodilution during pregnancy. The results suggest that smokeless tobacco use during pregnancy is associated with lower hemoglobin levels, as has often been observed with cigarette smoking. Smokeless tobacco use is widely prevalent among women in Southeast Asia and is gaining popularity across the world as a safe alternative to smoking. Further exploration and clarification of this association is therefore of considerable importance to public health. [ABSTRACT FROM AUTHOR]

Aims: To assess the prevalence and pattern of alcohol use in a middle-aged and elderly population in Mumbai, India. Methods: 50 220 men aged ≥45 years from the lower and lower-middle section of the general population were interviewed. Results: 18.8% were currently consuming alcoholic beverages, of whom 32.8% drank on at least 6 days per week. The most popular beverage was locally distilled products of fruits and grain (country liquor). Seventy-five per cent of the consumers of country liquor would consume over 53 g of ethanol on a day when they drank, with 46.6% of these doing so on at least 6 days per week. Conclusions: Abstinence, and also heavy and frequent use of alcohol, are common in this population and the latter is likely to have significant public health implications. [ABSTRACT FROM AUTHOR]

Abstract: The aim of the present study was to examine the association between alcohol, alcohol and tobacco, and mortality in a large adult population in the city of Mumbai. A total of 35,102 men aged 45 years and older were surveyed about their alcohol drinking as part of a cohort study. These respondents were followed up over time, and all deaths were recorded. Compared with those who never drank alcohol, alcohol drinkers had 1.22 times higher risk of mortality, with the highest risk observed for liver disease (hazard ratio [HR]=3.19). Among ever drinkers, risk of mortality varied according to types (country/desi), frequency (four or less times a week, HR=1.39), and quantity of alcohol consumed (>100mL) per day. In addition, country/desi drinkers (HR=1.34) had the highest mortality risk compared with all other types of alcohol (HR=0.97). Alcohol drinkers had increased risk of mortality for tuberculosis (HR=2.53), cerebrovascular disease (HR=1.83), and liver disease (HR=3.19). Synergistic joint effect of tobacco and alcohol on mortality was also observed, with lowest risk in never tobacco user drinkers (HR=1.02) and highest in mixed tobacco user drinkers (HR=1.79). The results of this study show a direct association between greater consumption of alcohol and increased risk of mortality from alcohol-specific causes. In addition to individual effect, this study demonstrates the synergistic interaction between alcohol and tobacco use in various forms on mortality. [Copyright &y& Elsevier]

Abstract: Background: Tobacco use and body mass are major risk factors for many cancers. Despite this, very little is known about their combined effect on cancer mortality. These relationships are virtually unexplored in populations having patterns of both tobacco use and body habitus atypical of those typically enrolled in epidemiologic studies. Methods: A prospective cohort study of 148,173 men and women aged ≥35 years was conducted in Mumbai, India. Subjects were recruited during 1991–1997, measured for a variety of risk factors, including tobacco use and anthropometry, and then followed for approximately 5–6 years. Results: During 774,129 person-years of follow up, a total of 796 cancer deaths were observed. Tobacco use, especially smoking in men, was associated with particularly high risk of death in extreme categories of body mass. At highest risk were underweight smoking males [hazard ratio (HR)=9.45, 5.87, and 5.75 for those smokers who were extremely thin (<16.0kg/m2), very thin (16.0 to <17.0kg/m2), or thin (17.0 to <18.5), respectively]. Significant effects of underweight among never and smokeless tobacco users disappeared with exclusion of individuals with ≤2 years of follow up. Extremely thin (<16.0kg/m2) women smokeless tobacco users had an elevation in risk, HR=2.95, that actually appeared to increase (to 3.21) with exclusion of individuals who were diagnosed within 2 years of follow up. Conclusion: Tobacco use and undernutrition are known to be serious problems in developing countries. The current study underlines the strikingly elevated risk of cancer when they occur together. [Copyright &y& Elsevier]