Abstract
South Asians are the third largest Asian group in the US and among the fastest growing racial groups in New Jersey. Tobacco consumption among South Asians is characterized by several smoked and smokeless tobacco products indigenous to the Indian subcontinent. However, there is a paucity of research on tobacco use behaviors among South Asians in the US. The goal of this study was to examine the awareness and use of South Asian tobacco products such as bidis, gutkha, paan, paan masala, and zarda as well as other potentially carcinogenic products such as supari, their context of use, and their cultural significance among South Asians living in the US. Eight focus groups were conducted with South Asian adults living in Central New Jersey. Overall, participants were aware of a wide variety of foreign and American tobacco products with older South Asians identifying a greater variety of indigenous products compared to younger South Asians. Hookah was consistently recognized as popular among the younger generation while products such as paan or paan masala were more commonly identified with elders. Use of tobacco-related products such as paan and supari were described as common at social gatherings or after meals. In addition, light or social users of South Asian tobacco products, including products not consistently defined as tobacco, may not report tobacco use on a survey. Better understanding of the use of these products among South Asians and how some may classify tobacco usage can inform future research and public health interventions in these communities.
Similar content being viewed by others
References
CDC Grand Rounds. (2014). Global Tobacco Control. MMWR, 63(13), 277–280. http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6313a1.htm.
World Health Organization (WHO). (2011). Warning about the dangers of tobacco. http://www.who.int/tobacco/global_report/2011/en/.
Siddiqi, K., Shah, S., Addas, S., et al. (2015). Global burden of disease due to smokeless tobacco consumption in adults: Analysis of data from 113 countries. BMC Medicine, 13(1), 194.
U.S. Census Bureau. (2002). The Asian population: 2000. Publication C2KBR/01-16. http://www.census.gov/prod/2002pubs/c2kbr01-16.pdf.
CDC. (2014). Tobacco product use among adults—United States, 2012–2013. MMWR, 63(13), 277–280. http://origin.glb.cdc.gov/Mmwr/preview/mmwrhtml/mm6325a3.htm?s_cid=mm6325a3w.
Mukherjea, A., Wackowski, O. A., Lee, Y. O., & Delnevo, C. D. (2014). Asian American, Native Hawaiian and Pacific Islander tobacco use patterns. American Journal of Health Behavior, 38(3), 362–369.
Gupta, P. C., & Ray, C. S. (2003). Smokeless tobacco and health in India and South Asia. Respirology, 8(4), 419–431.
Gandhi, R., Kaur, R., & Sharma, S. (2005). Chewing pan masala and/or betel quid—Fashionable attributes and/or cancer menaces? Journal of Human Ecology, 17(3), 161–166.
Mukherjea, A., & Modayil, M. V. (2013). Culturally specific tobacco use and South Asians in the United States: A review of the literature and promising strategies for intervention. Health Promotion Practice, 14(5 suppl), 48S–60S.
Mukherjea, A., Morgan, P. A., Snowden, L. R., Ling, P. M., & Ivey, S. L. (2012). Social and cultural influences on tobacco-related health disparities among South Asians in the USA. Tobacco Control., 21(4), 422–428.
Banerjee, S. C., Ostroff, J. S., Bari, S., D’Agostino, T. A., Khera, M., Acharya, S., & Gany, F. (2014). Gutka and tambaku paan use among south asian immigrants: A focus group study. Journal of Immigrant and Minority Health, 16(3), 531–539.
Delnevo, C. D., Steinberg, M. B., Hudson, S. V., Ulpe, R., & Dipaola, R. S. (2011). Epidemiology of cigarette and smokeless tobacco use among South Asian immigrants in the Northeastern United States. Journal of Oncology, 2011, 252675.
Malson, J. L., Sims, K., Murty, R., & Pickworth, W. B. (2001). Comparison of the nicotine content of tobacco used in ps and conventional cigarettes. Tobacco Control, 10(2), 181–183.
World Health Organization. (2004). Regional Office for South-East Asia. Report on oral tobacco use and its implications in South-East Asia. New Delhi: World Health Organization, Regional Office for South-East Asia. http://searo.who.int/entity/tobacco/topics/oral_tobacco_use.pdf. Accessed Nov 3, 2015.
WHO. (2007). Smokeless tobacco and some tobacco-specific N-nitrosamines (pp. 39–166). Lyon, France: International Agency for Research on Cancer Monographs on the Evaluation of Carcinogenic Risks to Humans.
American Lung Association. (2011). Hookah smoking: A growing threat to public health issue brief. [PDF–1.34 MB] Smokefree Communities Project. Accessed Nov 3, 2015. http://www.lung.org/assets/documents/tobacco/hookah-policy-brief-updated.pdf.
Akl, E. A., Gaddam, S., Gunukula, S. K., Honeine, R., Jaoude, P. A., & Irani, J. (2010). The effects of waterpipe tobacco smoking on health outcomes: A systematic review. International Journal of Epidemiology, 39, 834–857.
Cobb, C. O., Ward, K. D., Maziak, W., Shihadeh, A. L., & Eissenberg, T. (2010). Waterpipe tobacco smoking: An emerging health crisis in the United States. American Journal of Health Behavior, 34(3), 275–285.
Merchant, A., Husain, S. S., Hosain, M., Fikree, F. F., Pitiphat, W., Siddiqui, A. R., et al. (2000). Paan without tobacco: An independent risk factor for oral cancer. International Journal of Cancer, 86(1), 128–131.
Garg, A., Chaturvedi, P., & Gupta, P. C. (2014). A review of the systemic adverse effects of areca nut or betel nut. Indian Journal of Medical and Paediatric Oncology, 35(1), 3–9.
Alam, S. E. (1998). Prevalence and pattern of smoking in Pakistan. Journal of Pakistan Medical Association, 48(3), 64–66.
Banerjee, S. C., Ostroff, J. S., D’Agostino, T. A., Bari, S., Khera, M., Acharya, S., & Gany, F. (2014). Disengagement beliefs in South Asian immigrant smokeless tobacco users: A qualitative study. Addiction Research & Theory, 22(3), 229–238.
National Cancer Institute and Centers for Disease Control and Prevention. (2014). Smokeless tobacco and public health: A global perspective. Bethesda, MD: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention and National INSTITUTES of Health, National Cancer Institute. NIH Publication No. 14-7983.
Mukherjea, A., Modayil, M. V., & Tong, E. K. (2015). Paan (pan) and paan (pan) masala should be considered tobacco products. Tobacco Control, 24, e280–e284.
Acknowledgments
The authors gratefully acknowledge the assistance of John Capasso, Michelle Bover Manderski, Rajiv Ulpe, and Mia Hanos Zimmermann during the course of this study.
Funding
This study was supported by a grant from the National Cancer Institute and the Food and Drug Administration (R21CA164913). The work and conclusions of the paper are solely those of the authors and not the NCI or FDA.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
Dr. Steinberg received a $500 consulting fee from Arena Pharmaceuticals in March 2015 and is an ongoing consultant to Major League Baseball regarding tobacco treatment. There are no other conflicts of interest to declare.
Rights and permissions
About this article
Cite this article
Hrywna, M., Jane Lewis, M., Mukherjea, A. et al. Awareness and Use of South Asian Tobacco Products Among South Asians in New Jersey. J Community Health 41, 1122–1129 (2016). https://doi.org/10.1007/s10900-016-0208-4
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10900-016-0208-4