The NMJI

ABSTRACT
    Background. Tuibur and hidakphu are watery tobacco products made by passing tobacco smoke through water. These have neither been described in the health literature nor are there any reports of epidemiological studies on these products. We collected information on the use of these products in Mizoram and Manipur.
    Methods. We conducted two surveys. In the first, we spoke to personnel involved in tobacco water manufacturing, marketing and sale. In the second, we carried out a house to house survey of adults on the attitude and behaviour towards the use of tobacco products in 25 randomly selected villages each in Aizawl district of Mizoram and Churchandpur district of Manipur.
    Results. About 7% of persons surveyed in Aizawl (872 of 12 185) and Churchandpur (139 of 2137) used tobacco water, which is stored and sold in bottles. It is sipped and retained in the mouth for 5–10 minutes and then spat out. Among tobacco water users, about 90% of users in Churchandpur and about 40% in Aizawl sipped tobacco water more than 5 times a day. The use of other tobacco products in both districts was also high.
    Conclusion. The use of tobacco water has been a part of the culture of some communities in Mizoram and Manipur for a long time. These communities also have a very high incidence of tobacco use. To discourage the use of such tobacco products, these communities should be educated about the harmful effects of tobacco use on a priority.

Natl Med J India 2004;17:245–7

INTRODUCTION
Tobacco is used in many forms. The most common of these is as a cigarette. However, in India, a wide range of smokeless tobacco products are also used.

While conducting the Global Youth Tobacco Survey

in the states of Mizoram and Manipur in the northeastern region of India, we came across the use of a hitherto undescribed tobacco product called tuibur in Mizoram and hidakphu in Manipur—a form of tobacco water. A literature review revealed that hookah (hubble bubble) is smoked in Mizoram and Manipur as in other parts of India but we did not come across the use of tuibur or hidakphu. In this, water impregnated with the use of tuibur or hidakphu. In this, water impregnated with tobacco smoke in a water receptacle is poured out through the mouthpiece of a pipe into a tobacco water flask and preserved for personal use. Usually, in one sip, 5–10 ml of tobacco water is kept in the mouth for 5–10 minutes and then spat out. It is either sipped directly from the bottle or through cotton soaked with tobacco water. People initially use tobacco water to clean their teeth or protect themselves from insect bites, but soon start sipping it several times a day and get addicted.

Tobacco water (tuibur) has been in use since the nineteenth century. A definite record of its use is available since 1907. Men and women alike sip tobacco water. In the past, it was predominantly used by women

and was offered to guests or visitors. It was a form of greeting and it was considered rude not to offer it. It was an essential item at parties in rural areas. A family generally owned three tobacco water flasks—one carried by the husband, one by the wife and a spare one kept in the house. No adult went around without a flask. This was a common feature among the Lakhers (a tribal community in Mizoram) in the urban and rural areas. During the process of courting, a girl would offer tobacco water to the boy. If the boy refused the tobacco water, it was presumed that he had no interest in the girl.
No epidemiological studies of this form of tobacco use have been reported in the literature. We, therefore, collected information about this product and the frequency of its use in different communities.

METHODS
Trained investigators (both men and women) collected information from different parts of Mizoram and Manipur. We obtained information about the different types and cost of tobacco water from 42 personnel involved in its manufacture, marketing and sale. We also conducted an attitude and behaviour survey among the population during September–December 2001.
A village-wise population list was obtained from the district offices in Aizawl district in Mizoram and Churchandpur district in Manipur. These districts had 358 and 107 villages, respectively. A random sample of 25 villages from each district was selected. All adults (>15 years of age) were eligible to participate in the survey. A house to house survey was conducted using a structured interview format by trained investigators. The survey was repeated on a sample of 5% of the surveyed population. The results were analysed with SPSS.