Tobacco Use Characteristics and Transition Patterns in Bangladesh

Sociodemographic characteristicsSociodemographic characteristics examined were sex, age group (15–17, 18–24, 25–39, 40–54, and ≥55 years), residence (urban, rural), marital status (married, single or living alone), and education level (illiterate, 1–8 years or ≥9 years), and the CASHPOR housing index as a proxy of socioeconomic status (SES) (low, intermediate, high). The CASHPOR index of housing conditions was originally constructed by the ITC researchers and used as the basis for stratification of the population by socioeconomic status²¹ .
Current tobacco useIn the current study, respondents were considered as current tobacco users if they reported current use of cigarettes, bidis or smokeless (SLT) products on a daily, weekly, or less than weekly basis (e.g. monthly), in the surveys. For users of smoking products, the question was: ‘Do you currently smoke cigarettes/bidis?’. Those who answered ‘yes’ (Wave 1) or ‘daily/weekly/less than weekly’ (Waves 2, 3, and 4) were categorized as current users. For the identification of SLT users, the relevant question asked in Waves 1 and 2 was: ‘In the past 6 months, have you used any smokeless products?’ (yes/no); and a response to the statement ‘I generally use SLT at least weekly.’ (yes/no). Those who responded ‘yes’ to both, were classified as current SLT users. In Waves 3 and 4, the question was asked: ‘Do you currently use SLT?’, with response options ‘daily’, ‘weekly’, or ‘less than weekly’ indicating current use. However, those who responded ‘no’ to all of the above, were classified as non-users or quitters.
Perceptions and reasons for quitting and transitionsA set of questions around perceptions and reasons why exclusive cigarette, bidis, and SLT users in Wave 1 transitioned to other tobacco products (either exclusively or as dual/poly users of other products) in subsequent waves, were assessed. Current tobacco users were asked a series of questions about why they started smoking cigarettes (Waves 2 to 4), bidis (Waves 2 to 4), or using SLT (Waves 3 to 4). Potential answers to the questions include the influence of friends/family; people on media (cigarettes and bidis); curiosity; to occupy time; the calming effects (cigarettes and bidis); sign of sophistication (cigarettes); the packaging (bidis and SLT); to reduce stress (SLT); to help quit tobacco (SLT); the taste (bidis and SLT); and considered to be less harmful (bidis and SLT). Respondents were asked to respond ‘yes’, ‘no’, and ‘don’t know’ to the series of questions in the relevant waves. Reasons for quitting in the following waves were assessed by a number of questions asking cigarette (Waves 2 to 3) and bidi (Waves 2 to 4) smokers, or SLT (Waves 3 to 4) users, whether any of the following reasons led them to think about quitting: concerns for health; concerns for others; fewer places to smoke; workplace restrictions (SLT); set an example for children; doctor’s advice; price; warning labels; friends/family disapprove; and society disapproves (SLT). The responses to these questions were ‘yes’, ‘no’, and ‘don’t know’.
It is worth noting that some questions were asked only in certain waves. Therefore, data were analyzed only among the waves for which data were available. Supplementary file Table 1 shows a list of all the full questions asked above in relation to perceptions and reasons for transitions/quitting in the ITC Bangladesh Survey.