A bidi is a cigarette made from flavourful tobacco citrates. After World War II, bidi industry became an important cottage industry in India. With the discovery of power looms in the 1960s, many of the leaders were left unemployed, and they took up bidi rolling jobs in Telangana region of Andhra Pradesh. By the mid-1970s, major tobacco industries were concentrated in Nizamabad, Kareemnagar and Warangal. Bidi workers are often the most vulnerable group in society, most of which depend on Bidi rolling in rural India. Bidi manufacturing in India is one of the biggest jobs for women in the age-old industry and unorganized secto [1]. Female bidi workers are unaware about the health hazards of bidi rolling. They ignore the health problems arising out of bidi rolling and never seek medical help for it due to fear of loss of daily wages. Most of these female bidi workers are in reproductive age group and exposed to the harmful effects of bidi tobacco. Bidi is made by using 0.2 to 0.5 grams of pulverized sun- cured (unfiltered) locally grown tobacco rolled in to a cylindrical shaped tendu or temburi leaf and secured with a thread. The tobacco rolled in bidis is different from that used in cigarettes and it is referred as bidi tobacco. Bidi rolling is a one of the major occupations for most of the women, who form the root of the industry. Mostly the people who are employed in this job are illiterates. They are engaged in the process of bidi rolling since a very young age and they roll approximately 500-1000 bidis everyday using 250-400gm of tobacco. These bidi rollers work in small factories or at household- base enterprises or at home in an environment laden with tobacco dust. Individuals working for 6 to 10 hr/day and inhale swallow, expose their skin and mucous surface to significant amounts of particulate tobacco. They are exposed to unfiltered tobacco dust and volatile compounds containing hazardous chemicals while making bidis as they do not use any protective wear [2]. Our objective of the study is to find out the health problems in female bidi rollers and suggest preventive strategies.

Setting and type of study: The present study was a community based cross sectional descriptive study. The study was undertaken in bidi rolling factories of Telangana state. In Telangana, the bidi sector is spread across 16 districts covering 45 constituencies.

Table-1: Age wise distribution of female bidi rollers (n = 400).

Association between socioeconomic status and literacy of female bidi rollers shows that 240 (60%) of bidi rollers belong to socio economic class IV followed by 160 (40%) class III. None of them belonged to class I, II and V. While 256(64%) bidi rollers were illiterate, 84 (21%) had primary education and 60 (15%) were educated upto secondary level. None of them had higher secondary education. There was statistically high significance of association found between socioeconomic status and literacy of female bidi rollers (p value <0.01) (Table 2).

Table No.-2: Association between socioeconomic status and literacy of female bidi rollers (n = 400).

chi square value = 23.5, degree of freedom = 2, p value <0.01, Statistically highly significant.

Association between literacy status and awareness about adverse effects of bidi rolling on health among female bidi rollers shows that 248(62%) of the females were aware about the adverse health effects of bidi rolling and 152 (38%) were unaware about it. Out of those aware about it,132 (33%) were illiterate, 64 (16%) had primary education and 52(13%) had secondary education. There was statistically high significance of association found between literacy status and awareness about adverse effects of bidi rolling on health among female bidi rollers (p value <0.01) (Table 3).

Table-3: Association between literacy status and awareness about adverse effects of bidi rolling on health among female bidi rollers (n = 400).

Bidi rolling is considered as serious occupation which leads to health hazards as these workers constantly expose themselves to tobacco dust and other dangerous chemicals. Due to poor socio-economic status and poor environmental conditions, the bidi workers are forced to work continuously for hours in improper working postures and beyond their normal working capacities which causes serious physiological manifestations [3]. As the bidi rolling is one of the main occupations of females of Telangana bidi factories, the present investigation attempted to understand the health problems in female bidi rollers. Out of total 400 participants in the present study, majority 272(68%) were in the age group of 15-45 years. Joshi K.P. et al in an epidemiological study of occupational health hazards among bidi workers of Amarchinta, Andhra Pradesh found that majority of the women bidi rollers (55%) were in the age group of 15-35 years. The mean age of the participants was 28.68 years [3]. In the present study it was found that 240 (60%) of bidi rollers belong to socio economic class IV followed by 160 (40%) class III and 256 (64%) bidi rollers were illiterate. Sable R.et al studied working condition and health hazards in bidi rollers residing in the urban slums of Mumbai and found that the mean age of bidi rollers was 45 years with SD of 12 years [4]. 42.31 and 25% belonged to socio-economic class IV and class III respectively. Around 42.31% of bidi workers were illiterate. The study findings are parallel to the present study. Poor socio-economic status, poor education and lack of awareness lead to various health problems to the bidi workers. During rolling of bidi, nicotine of tobacco powder comes into direct contact with the skin and becomes absorbed through the skin into the blood. The present study showed that 248 (62%) of the females were aware about the adverse health effects of bidi rolling and 152 (38%) were unaware about it. Palande P. et al has done a study of health problems of women bidi rollers in Ahmednagar district and found that, majority of the respondents (74.9%) were aware about the adverse or negative effects of bidi rolling work on their health while 25.1 of respondents were not aware about the negative or adverse effects of bidi rolling work [5]. It shows that, awareness about adverse effects of occupation is significantly high but still majority of women continue to work in the same occupation due to poverty and unavailability of other job opportunity.

A study done by Mukherji et al, in Murshidabad of West Bengal, has shown that most of the bidi workers or their family members suffered from diseases like tuberculosis (22.5%), oral diseases (36.7%), ulcers (24.2%). A majority (89.2%) of the respondents replied that they suffer from irregular menstruation followed by cough (76.7%), Hypertension (65.8%), throat ache (64.2%), fatigue (59.2%), callosities (56.70%), numbness in the hands (55.8%) and other respiratory diseases (52.50%). The study findings are comparable to the present study [8].

The survey of the study is confined to limited areas, therefore, the results of the study cannot be generalized to other bidi industries situated in the different districts of India.

In a nutshell, the present study concludes that poverty, illiteracy and ignorance are the main factors forcing female bidi rollers in this harmful occupation. It is observed that, majority of the female bidi rollers are having awareness about negative or adverse effects of bidi rolling work. They should be encouraged to use protective material like protective clothing, gloves or masks to avoid harmf ul exposure to tobacco causing severe health issues.

The present study found that awareness and health education about the tobacco health hazards is very much necessary for the bidi rollers. Therefore, the dimensions of the present study variables revealed that the health hazards existing in the bidi rolling work and experienced by the women beedi rollers is at dangerous level.

Appreciate the help of all bidi factory members including manager, staff and workers for carrying out smooth functioning of data collection without hampering their work.

Dr. Suchita N. Kawale: Concept, study design, manuscript preparation, Dr. Manjusha A. Shinde: