Health, economic, occupational effects and readiness for alternative livelihood among beedi rolling women in Tamil Nadu: A cross-sectional study

Background: The global tobacco epidemic causes over 8 million deaths annually, with beedi smoking contributing substantially in India. Beedi rolling, primarily done by economically disadvantaged women in Tamil Nadu, poses serious health and occupational risks. Objectives: The primary objective was to examine the health, economic, and occupational impacts of beedi rolling among women beedi workers in Tamil Nadu. The secondary objectives included assessing their willingness to shift to alternative livelihoods and identifying factors that influence this readiness. Materials and Methods: A descriptive cross-sectional household survey was conducted among 1000 beedi workers. Structured interviews captured data on sociodemographics, work conditions, health issues, financial challenges, and interest in alternative livelihoods. Chi-square tests were used to explore associations, and binary logistic regression identified predictors of willingness to transition. Results: Among respondents, 925 (92.5%) were women, and 637 (63.7%) were aged 18-40. Health problems were reported by 691 (69.1%), mostly musculoskeletal disorders (364, 52.7%). A total of 436 (43.6%) expressed willingness to shift to alternatives like tailoring, handicrafts, or agriculture. Key predictors included younger age, health problems, Tirunelveli residence, education, and prior exposure to other occupations. However, 203 (31.8%) lacked awareness of viable options. Conclusion: Many women beedi workers face health issues and are open to transitioning to alternative livelihoods. Readiness is influenced by age, health, education, and work exposure. Limited awareness remains a major barrier. Targeted health education and skill-building are essential to enable sustainable livelihood shifts, supporting WHO Framework Convention on Tobacco Control (FCTC) Article 17.