A qualitative study of gutka and paan masala use among Bhutanese and Burmese migrants in Georgia

The city of Clarkston (Georgia) is home to many refugees and immigrants, including Bhutanese and Burmese populations. Use of gutka and paan masala is common in these populations. While gutka and paan masala contain toxic ingredients including carcinogens, little research has examined general use, perceptions of risk, cultural norms, and access to these products among Bhutanese and Burmese populations in the southern U.S. This study uses focus groups and key informant interviews to develop an understanding of gutka and paan masala use among Bhutanese and Burmese refugee populations residing in Clarkston, focusing in particular on knowledge and perceptions of harm, patterns of and reasons for use, access to gutka and paan masala, and resources for cessation and prevention of gutka and paan masala use. We conducted 21 focus groups with Bhutanese and Burmese youths and adults and 11 key informant interviews. We analyzed data using MAXQDA and a grounded theory approach. Emerging themes included mixed understandings of ingredients and harms associated with gutka and paan masala use. The continued use of paan masala was perceived to be due to cultural traditions. Youths, particularly Bhutanese, were perceived as a rising group of users of gutka and paan masala. Widespread availability and accessibility in Clarkston made it easy for both adults and youths to acquire and use gutka and paan masala. Few participants knew about prevention efforts or resources in their communities. In conclusion, culturally-relevant awareness and education programs as well as health promotion materials regarding gutka and paan masala are much needed in Bhutanese and Burmese communities. More regulatory actions are needed, such as better warning signs in businesses to inform customers of ingredients in these products and their health risks, age restrictions on gutka and paan masala purchase, and compliance checks.