A major multicentre Indian study identifies three critical evidence-based implications for health professionals and tobacco control policymakers. First, bidi smoking as a standalone product is significantly associated with cancer risk across multiple anatomical sites, warranting clinical recognition and cessation counselling. Second, individuals combining bidis with other tobacco products face compounded cancer risk, suggesting that poly-tobacco assessment and intervention are essential clinical practices.
Third, existing regulatory and cessation frameworks inadequately address bidis despite robust epidemiological evidence of harm. This evidence-practice gap represents a critical public health vulnerability in South Asia, where bidis remain widely used yet overlooked in many tobacco control strategies.
Clinicians should incorporate bidi-specific screening into tobacco use histories, while policymakers should prioritise bidi-inclusive regulation and targeted cessation support to reduce cancer burden in this high-prevalence region.
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