Tob Control 22:324-330 doi:10.1136/tobaccocontrol-2011-050148
  • Research paper

Availability, accessibility and promotion of smokeless tobacco in a low-income area of Mumbai

  1. Balaiah Donta2
  1. 1Institute for Community Research, Hartford, Connecticut, USA
  2. 2National Institute for Research in Reproductive Health, Mumbai, India
  3. 3Consultant
  1. Correspondence to Dr Jean J Schensul, Institute for Community Research, 2 Hartford Square West, Ste. 100, Hartford, CT 06106, USA; jean.schensul{at}
  1. Contributors All authors made contributions in conceptualising as well as collecting and analysing data for the paper. JJS, SN, SB and EC were directly involved in authoring and editing all aspects of the paper. As senior members of the field team, SDM and VK were involved in all aspects of data collection including mapping, critiquing digitisation and conceptualisation of results. BD reviewed all manuscripts and added critical comments.

  • Received 18 July 2011
  • Accepted 28 January 2012
  • Published Online First 2 March 2012


Objective To examine the role of accessibility, product availability, promotions and social norms promotion, factors contributing to the use of smokeless tobacco (ST) products in a typical low-income community of Mumbai community using Geographic Information System (GIS), observational and interview methodologies and to assess implementation of Cigatettes and other Tobacco Products Act (COTPA) legislation.

Rationale In India, the third largest producer of tobacco in the world, smokeless tobacco products are used by men, women and children. New forms of highly addictive packaged smokeless tobacco products such as gutkha are inexpensive and rates of use are higher in low-income urban communities. These products are known to increase rates of oral cancer and to affect reproductive health and fetal development.

Methods The study used a mixed methods approach combining ethnographic and GIS mapping, observation and key informant interviews. Accessibility was defined as density, clustering and distance of residents and schools to tobacco outlets. Observation and interview data with shop owners and community residents produced an archive of products, information on shop histories and income and normative statements.

Results Spatial analysis showed high density of outlets with variations across subcommunities. All residents can reach tobacco outlets within 30–100 feet of their homes. Normative statements from 55 respondents indicate acceptance of men's, women's and children's use, and selling smokeless tobacco is reported to be an important form of income generation for some households. Multilevel tobacco control and prevention strategies including tobacco education, community norms change, licensing and surveillance and alternative income generation strategies are needed to reduce accessibility and availability of smokeless tobacco use.


  • Funding 1R03TW008350-01 entitled: Smokeless Tobacco Use and Reproductive Health Among Married Women in a Low-income area of Mumbai, India, National Institutes of Health, USA, Fogarty Center/NCI.

  • Competing interests None.

  • Ethics approval Institute for Community Research; National Institute for Research on Reproductive Health; Indian Medical Research Council.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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