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  • Title: Smoking, health, and survival: prospects in Bangladesh.
    Author: Cohen N.
    Journal: Lancet; 1981 May 16; 1(8229):1090-3. PubMed ID: 6112456.
    Abstract:
    Smoking is an increasingly prevalent habit in Bangladesh, particularly among men. In the past 10-15 years cigarette consumption has more than doubled. Over 100000 acres (405 Km2) of land that could produce food are planted with tobacco, and cereal imports making up for these production losses generally do not reach the below-subsistence cultivator and landless. Cancer of the lung is already the third commonest cancer among males, and annual deaths from this cause can be expected to increase by 12000 within 15 years. At present respiratory disease is the best-recognised direct health consequence of smoking. However, a more important health risk may be the reduction in nutritional status of young children which results from expenditure on smoking in households whose income for food purchase is already marginal. Smoking of only 5 cigarettes a day in poor household in Bangladesh might lead to a monthly dietary deficit of 8000 calories (33.5 MJ). The existence of young children in Bangladesh is already precarious owing to poor nutrition. If, as seems likely, expenditure on smoking means that they get even less food, then the survival of a large number of children is being seriously endangered. Cigarette production and consumption patterns in Bangladesh were examined and the health, nutritional, and economic consequences of these patterns was assessed. Consumption of cigarettes and biri, hand-made tobacco rolls, is increasing. Annual per capita consumption of cigarettes, taking into account all males and females over the age of 15, is 350 cigarettes. Previously conducted surveys of 2 villages indicated that 67% of the males and 1% of the females, over the age of 15, smoked 1 or more cigarettes or biri each day. Smoking is more prevalent among younger aged adults than among older aged adults. Cigarette smoking is promoted as a status symbol and is widely advertised. Most of the cigarettes and biri sold in Bangladesh are locally produced. Each month approximately 1500 million cigarettes and 3000 million biri are produced. 57% of all commercially produced cigarettes are manufactured by 1 company, which is affilated with the British American Tobacco interest group. Biri are generally produced in cottage industries. Cigarette production is expected to increase by 40% between 1980-1985. The cigarette industry is not labor intensive and it provides only a small number of jobs for the population. 123,000 acres of land are currently devoted to the production of tobacco. This constitutes a serious loss of land which might otherwise be used to raise needed rice. It is estimated that the annual rice production loss attributable to the use of land to raise tobacco is equal to 1/2 of the country's yearly food grain deficit. Food must be imported to make up this deficit, but the poor of Bangladesh cannot afford the cost of imported food. As a result cigarette production has a negative impact on the nutritional status of the poor. Furthermore, among the poor, who must spend the vast majority of their income on food, the purchase of cigarettes reduces the amount of money available for purchasing food. Despite the low life expectancy extant in Bangladesh, lung cancer is already the 3rd most common form of cancer among the male population. The rate of chronic and acute respiratory disease is high and smoking probably aggravates these conditions. Policies, aimed at altering the trend toward increased cigarette consumption, are clearly needed.
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