Tobacco use among adults in Cambodia: Evidence for a tobacco epidemic among women

Objective: To identify the demographic characteristics of current tobacco users in Cambodia, particularly women, and to explore the reasons for current tobacco use in demographic subgroups of the Cambodian population. Methods: We used a stratified three-stage cluster sample of 13 988 adults aged 18 years and older from all provinces in 2005-2006. Participants completed an interviewer-administered survey that contained items on all forms of tobacco use and on health and lifestyle variables. Multivariable regression analysis was performed to identify demographic predictors of tobacco use. Findings: Cigarette smoking occurred among 48.0% of men and 3.6% of women. We estimated that 560 482 women (95% confidence interval, CI: 504 783 to 616 180) currently chewed tobacco (typically as a component of betel quid) and that the prevalence more than doubles with each decade of adulthood up to the point that about half of all older women chew tobacco. Both men and women cited the influence of older relatives as their primary reason for starting to use tobacco. About one out of five rural women who used chewing tobacco started their habit for relief from morning sickness. The highest prevalence of chewing tobacco among women was seen among midwives (67.9%) and traditional healers (47.2%). High rates (66.8%) of cigarette and pipe tobacco use occurred among ethnic minorities who represent hill tribes found throughout south-east Asia. Conclusion: The tobacco epidemic in Cambodia extends far beyond cigarette smoking in men. Tobacco control that focuses only on cigarettes will not address the health burden from smokeless tobacco use in women that may be an integral part of cultural, familial, and traditional medicine practices.