Gender differences in tobacco habits among rural Kadazans and Bajaus in Sabah. (Research Notes).

Introduction

Cigarettes became the dominant form of tobacco use in the twentieth century with the introduction of machine-manufactured cigarettes in 1881. European powers changed the agricultural patterns of their colonies in many parts of the world; these countries were encouraged to grow tobacco and even when they achieved independence, they continued to grow tobacco for its earnings (Chollat-Traquet 1992). In Sabab, the British started trial planting of tobacco in the Sandakan area in the early 1880s. When the first Sabah leaf sold in Amsterdam was considered to be among the finest in the world, tobacco cultivation, after 1885, was intensified. Tobacco development schemes generated revenue and tobacco growing became very important. By 1890, Dutch, German, and British planters had large estates, tobacco became a major export, and the wealth of the territory was at that time dependent on tobacco, timber, and land sales. The industry started to decline after 1902, but had a minor revival after the Great Depression in 192 9 (Gudgeon 1981). With a history of tobacco being an industry in Sabah, it is not surprising that the indigenous people have continued to plant tobacco on their own farms and that tobacco habits are widespread.

This article highlights gender differences in tobacco habits of rural Sabahans who have easy access to local tobacco. Its intent is to add to the information presented in a previous paper on medicinal and other uses of tobacco among rural Kadazans and Bajaus (Gan 1998). Gender differences in tobacco habits require control strategies that target each sex. Health messages must be focused and appropriate for each gender if they are to be effective. The findings in this article constitute part of a larger study aimed at documenting the prevalence, practice, and implications of tobacco use among the indigenous peoples of Sabah. The overall intention of this larger study is to focus attention on tobacco use in Sabah so that public health measures may be initiated.

Study area and study population

Kadazans in Tambunan District and Bajaus in Kota Belud District were surveyed. More than 90% of the population of Tambunan district is Kadazan, and 95% of the working population is engaged in agricultural activities: growing rice, coffee, vegetables, and tobacco (Buku Taklimat Daerah Tambunan 1988). Kadazans in Tambunan are invariably Roman Catholic. Slightly more than 30% of the population of Kota Belud is Bajau and the main occupations are farming (rice, cocoa, and vegetables) and fishing. The Bajaus are invariably Muslims. In both districts, the main occupation of men and women is farming.

Materials and Methods

Prevalence data were collected through two cross-sectional surveys using an interview questionnaire and were conducted in the Tambunan and Kota Belud districts respectively. The software program Epi Info 5 was used to estimate sample size for population cross-sectional surveys. After multi-stage sampling, 23 villages from Tambunan and 14 villages from Kota Belud were included in the survey. All adults 18 years of age or over were requested through the village headman to participate, and interviews were conducted mainly in the village community hall.

Information was also gathered through tape recorded interviews of Kadazan and Bajau informants in the two districts. The purpose of the study was made known to informants and participation was voluntary. An interview guide with issues for the informant to focus on was used. While there was a general plan of inquiry, the main questions were open-ended and there was no particular order or wording for the questions. A total of 50 female and 19 male informants participated and interviews were conducted in small groups or individually. Those interviewed were either those identified by local residents as informative or those who were randomly approached in public places. There were more women as women were more eager to participate. The interviews were conducted in Malay by the investigator and two trained interviewers. For older informants, a local health staff member assisted as interpreter. All surveys were completed by 1995.

Findings

A total of 877 Kadazans (405 males and 472 females) and 845 Bajaus (414 males and 431 females) were interviewed. Of both Kadazan and Bajau respondents, more than half were farmers.

Both communities have two major tobacco habits: smoking and the use of tobacco as an ingredient in betel chewing (smokeless tobacco use). Two types of cigarettes are smoked: kirai (handrolled cigarettes) and manufactured cigarettes. The kirai is more popular and is handrolled using shredded locally grown tobacco and wrappers made from the dried leaves of the palm Nipa fruticans or from the sago palm Metroxylon sagus (Burkill 1966). Various brands of manufactured cigarettes are also smoked, but less frequently because they are more costly. The kirai has its own aroma and this is another reason for it being the more popular choice. In Kota Belud, some Bajaus smoke big kirai, six inches to a foot long, resembling an elongated cone, which take a longer time to smoke.

In the ritual of betel chewing, a number of ingredients in various combinations are used. Commonly, betel leaf (from the vine Piper betle L), areca nut (the fruit of Areca catechu L), lime (from seashells), gambir (a preparation from the leaves and twigs of the shrub Uncaria gambir), and shredded tobacco are included. Depending on the individual's liking, various ingredients placed on a piece of betel leaf are usually chewed first to produce a quid and the initial juice is spat out. For those who like tobacco, a small amount of tobacco is then added which, imbibed with the betel juice, produces a pleasing flavor. The combination of ingredients used and sequence of ingredient added depends on individual preference. Some women smear minyak (bee's wax mixed with coconut oil) on their lips so that the quid, when placed between the lips, will not feel so hot.

A large proportion of Kadazan and Bajau men smoke, but very few use smokeless tobacco. Only a few men had both tobacco habits. Table 1 shows that the prevalence of smoking among Kadazan and Bajau men is high, while smokeless use among them is very low.

A total of 328 (69.5%) of Kadazan women have a chewing habit, but only 281 (59.5%) include tobacco as an ingredient. A total of 346 (80.3%) Bajau women have a chewing habit, but only 332 (77%) use tobacco as an ingredient. In both communities the prevalence of smoking is low among the women. The prevalence of female tobacco users is shown in Table 2.

Interviews with informants of both sexes revealed that men smoke because it is thought to be a normal male habit. Men smoke at social functions and during leisure time. Several male informants said: ""omen chew while we men smoke." Although it is thought that smoking is a male habit, there are no objections to women smoking. There are also no objections to men chewing betel quid. The few males who chew betel report that they do so because they like the taste and they fell totally at ease to do so in public.

Chewing betel with or without tobacco is considered a female habit. Women follow the examples of their practice during social events. Women are considered proud if they do not participate in chewing socially. During leisure time, it is a norm for women to gather together for chewing and chatting sessions. Women also feel that they can endure hardship better if they chew. They fell less tired, less sleepy, and can withstand hunger, thirst or cold after chewing. In Kota Belud, another reason why women have the habit is because they have to treat their children's ailments. Juice from betel quid is used to remedy abdominal colic, tobacco juice is rubbed on the abdomen for deworming, and tobacco imbibed with betel juice is placed on a newborn's umbilical cord stump in order to produce a beautiful navel. Older women also think that the chewing habit strengthens their teeth and that the juice, which reddens their lips, makes them more attractive. A woman is happy to carry a bag which holds chewing ingredients in dif ferent containers when she works in the field, travels, or when she visits her friends.

The informants also revealed a new trend in tobacco use among young women, teenagers, and schoolgirls. A small wad of shredded tobacco smeared with lime is placed between the gums and cheek and the juice is swallowed. The tobacco is spat out when it becomes tasteless. This subtle use of smokeless tobacco in preference to betel chewing is popular with schoolgirls and working women. It is less likely to be detected by teachers or bosses. Younger women also prefer lipstick to the red stain of betel juice. A small amount of shredded tobacco and lime is more compact and easily concealed compared to a bag of betel chewing ingredients. Young men do not have this habit; rather, they smoke.

The habits of smoking and smokeless tobacco use are easily sustained because the ingredients used are cheap and easily available. Farmers grow tobacco in the Tambunan, Ranau, and Keningau districts as a cash crop or for their own consumption. Both women and men grow and sell tobacco. Purchased from the tamu (weekly market), a bag of local shredded tobacco (sigup) and a bunch of kirai wrappers each cost one Malaysian ringgit. For a person who smokes 6 kirais a day, this purchase will last a week. Depending on the brand, manufactured cigarettes are 3 or 4 times more costly.

Ten betel leaves, a small block of gambir, a small container of lime, and five areca nuts cost 50 cents (Malaysian) for each type of ingredient. These ingredients together with 50 cents of sigup can last a week for the average smokeless tobacco user. All ingredients are easily available in the tamu or in little village stalls.

Discussion

The tradition of betel quid chewing had been practiced for more than 2000 years in Southeast Asia, while tobacco is thought to be a modern addition to the quid to enhance the flavor (Rooney 1993). In Thailand, Burma, Cambodia, Vietnam, the Philippines, Indonesia, Malaysia, and South China this history is evidenced by ancient betel chewing containers. Betel chewing is common among women. In Sabah, it is passed on from female ancestors.

The belief that tobacco and betel quid have medicinal value, particularly for children, has helped to entrench the smokeless tobacco habit among women. In rural societies where entertainment is limited, chatting and chewing sessions provide opportunity for female bonding and leisure. A smokeless tobacco habit is not only accepted, but expected. That smokeless tobacco use has stimulating effects is another reason why women continue the habit. Women (unlike men) do not find it cumbersome to carry a bag of ingredients among the many things that they are accustomed to carry as mothers.

In Western society, smoking had been very much a male habit until the 1920s when women started to smoke in public as a sign of equality. As women participated in war activities in the Second World War, smoking became associated with working women, independence, and emancipation. Smoking rates among women, which had been low in the early part of the twentieth century, rose as social restrictions relaxed and peaked later than it did for men (Chollat-Traquet 1992). A review of gender differences in tobacco use in Africa, Asia, the Pacific, and Latin America by Waldren et al. (Waidren et al. 1988) reveals that, in general, because men have greater social power than women, social prohibitions against women smoking have been a major cause of gender differences in tobacco use. However, variations in the social significance and benefits attributed to particular types of tobacco use in different cultures also result in gender differences in tobacco habits. Both these factors help to explain gender differences in tobac co habits in Sabah: smokeless tobacco use is both socially encouraged and useful for women. The exposure of these indigenous people to European societies in the late nineteenth century may have enhanced the perception that smoking was a male habit.

A study of gender differences in tobacco use in Kenya (Kaplan, Carrilker and Waldren 1990) showed that among the younger generation, there were social prohibitions against women smoking, resulting in more male smokers. The absence of restrictions on men's smoking was related to men's greater social power. Among the Lahanans living in Central Borneo (Alexander and Alexander 1994), it was reported that adult women who control the production and distribution of tobacco were more likely than men to smoke and were also heavier smokers. The study suggested that gender differences in tobacco use are probably inconsequential in societies where tobacco is grown for home consumption, but becomes increasingly substantial as manufactured cigarettes replace local tobacco products. In Sabah, tobacco and all ingredients for smokeless tobacco use are home grown, cheap, and easily available. Both women and men grow and sell tobacco. While it is acknowledged that this study did not examine differences in social power between t he sexes, there appears to be no apparent prohibition against women smoking nor is there any taboo against men using smokeless tobacco. It was traditionally thought, however, that smoking is a male habit and betel quid chewing a female one.

That only young women and not young men follow the new trend of sucking tobacco with lime confirms that smoking and not the use of smokeless tobacco is associated with men.

The findings reveal that while women are mainly smokeless tobacco users, they are not discouraged from smoking. While health authorities should strongly campaign against smokeless tobacco use among women, anti-smoking messages should be also be included for women. The problem of sucking tobacco with lime among young females should be addressed and discouraged. Campaigns against smoking should highlight that smoking kirai or manufactured cigarettes is harmful. Smoking is the main problem for men particularly when it is identified with being male.

Table 1

Tobacco habits of men

                              Kadazans                Bajaus

Tobacco habits *            No. %  (n=405)      No. %  (n=414)

Smoke                         247       61        308     74.4
Smokeless tobacco use           3      0.7         18      4.3
Smoke and smokeless             1      0.2         10      2.4
tobacco use

* The habits stated are not mutually exclusive
Table 2

Tobacco habits of women

                              Kadazans                Bajaus

Tobacco habits *            No. %  (n=472)      No. %  (n=431)

Smokeless tobacco use         281     59.5        332       77
Smoke                          51     10.8         14      3.3
Smoke and smokeless            23      4.9          7      1.6
tobacco use

* The habits stated are not mutually exclusive

Acknowledgements

The China Medical Board funded this project. The writer is grateful to the Director of the Medical and Health Department of Sabah and his staff for their assistance and cooperation. Ms M.F. Chen, Ms S.C. Woon, Mr Rajah Isaiah, Mrs C.S. Lee and Ms Siti Zaleha from the Department of Social and Preventive Medicine, University of Malaya, are thanked for assisting in the fieldwork. Special thanks are given to Professor Tan Chee Beng, now with the Department of Anthropology, the Chinese University of Hong Kong, for his advice.

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