Occupational tobacco exposure and multisystem morbidity among beedi rollers: biomarker-validated evidence from a multi-state study in India

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Purpose Beedi rolling, employing nearly five million predominantly female home-based workers across India, remains one of the less formally organized occupational sectors. This study aimed to evaluate the working conditions and health hazards of beedi rollers across five Indian states. Methods A multi-centric cross-sectional study conducted in five states enrolled 1,800 adults; 900 beedi rollers and 900 controls. Data were obtained through structured interviews, clinical examinations, spirometry, and biochemical analyses of blood and urine samples. A multivariable binary logistic regression model was used to quantify the adjusted associations between occupational status (beedi rollers vs. non-beedi workers) and various morbidities, accounting for sociodemographic confounders. Results Beedi rollers had significantly higher odds of musculoskeletal and exposure-related conditions. Adjusted odds ratios for neck pain, back and leg pain, and lower back pain were 5.77, 3.14, and 1.71, respectively. Respiratory and ocular symptoms were more prevalent, with sneezing (AOR 3.13) and ocular redness (AOR 2.19) markedly elevated. Mean urinary cotinine levels were substantially higher among exposed workers (76.97 ng/ml) compared to controls (15.81 ng/ml; p < 0.001), corresponding to an AOR of 4.61 for elevated cotinine. Beedi rollers also exhibited higher diastolic blood pressure and HbA1c, alongside reduced Serum Glutamic-Oxaloacetic Transaminase (SGOT) levels. Conclusion This multi-state analysis underscores the profound occupational health burden among beedi rollers, driven by ergonomic strain and chronic tobacco exposure. Despite being a large informal workforce, these workers have yet to be fully integrated into occupational health services, highlighting opportunities to strengthen India's progress toward Universal Health Coverage. Addressing these gaps calls for strengthening workplace design, reinforcing occupational safety standards, and implementing targeted policy interventions.

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