Bidi smoking and health.

Bidi, made of low-grade tobacco, is popular among rural folk and the urban poor, in the South Asian region. The objectives of this study were: (1) to assess the extent of bidi smoking in different countries; (2) to compare its smoke and health hazards with conventional cigarettes and; (3) to recommend preventive measures. English language articles were identified through a MEDLINE computerised search (1966-1998) using the term 'bidi', 'beedi', 'beedie', 'biri' and manually in order to collate all the available information and to present a descriptive epidemiological profile. The prevalence of bidi smoking was found to be 21-56% among men in South Asian countries with very little information available about women. Concentrations of nicotine, tar and other toxic agents in the smoke are higher for bidi than for other cigarettes. Bidi smoking is also considered to cause about 2-3 times greater nicotine and tar inhalation than do conventional cigarettes, due to the poor combustibility of the bidi wrapper and greater puff frequency needed to keep the bidi alight. It has also been shown to have greater odds ratios, although not statistically significant, for various cancerous and chronic conditions in comparison with other cigarettes. Since bidi is hand-rolled, workers employed in bidi factories are at risk of developing cancerous conditions due to exposure to tobacco dust and flakes. We suggest that anti-smoking campaigns should be directed to the bidi smokers of all South Asian countries. Most bidi smokers are illiterate and malnourished which makes them more vulnerable to smoking-related morbidity and mortality. At the same time, measures should be taken to make bidi less harmful and to produce bidi by machine to reduce exposure-related toxicity among bidi production workers.