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Objective
To investigate the prevalence of under-reported use of tobacco among Bangladeshi women and the characteristics of this group.
Design
Cross-sectional surveys.
Setting
Private households in England.
Participants
996 Bangladeshi women aged 16 years and above, 302 with a valid saliva sample and 694 without, in the 1999 and 2004 Health Surveys for England.
Main Outcome Measure
Prevalence of under-reported tobacco use (estimated using self-reported tobacco use and cotinine level from a saliva sample). Predictors of tobacco use status: self-reported user; cotinine-validated non-user; or under-reporting user.
Results
15% of Bangladeshi women with a saliva sample under-reported their personal tobacco use. Under-reporting users were similar to self-reported users in terms of socio-demographic, socio-economic, and tobacco-related variables, except for being much more likely to report chewing paan (a mixture of betel leaf, lime and areca nut) without tobacco (47% vs. 9%, p<0.001). Under-reporters differed significantly from cotinine-validated non-users in most respects, including age, birth country, education level, level of spoken English, language of the interview, chewing paan without tobacco, and presence of relatives in the interview. Regression analyses confirmed that under-reporters did not differ significantly from self-reported users regarding age, education level, or exposure to passive smoking. Under-reporters were generally older and less likely to be educated above O level compared with cotinine-validated non-users. Both self-reported users (odds ratio 0.11, 95% CI 0.04 to 0.30) and cotinine-validated non-users (odds ratio 0.42, 95% CI 0.20 to 0.89) were far less likely to report chewing paan without tobacco compared with under-reporters.
Conclusion
Contrary to our a priori hypothesis, under-reporters were not British-born, English-speaking young women likely to be concealing smoking but resembled self-reported tobacco users except for being much more likely to report chewing paan without tobacco. Further investigation is needed to discover whether the under-reporting was concealment or a lack of awareness that the paan they chewed contained tobacco.