Socio-demographic Characteristics of the Participants (Qualitative Study)
All the 30 participants from the selected regions were included in the analysis giving a response rate of 100%. The findings of the study shows that most (36.7%; n=11) of the respondents were between the age category of 30-39, 63.7% (n=19) were females, 70.0 % (n=20) attended tertiary education and 36.7% (n=11) were Nurses by occupation. Eighty-three percent of them (n=24) were married, 93.3% (n=28) were Muslims by religion and 40% (n=12) belonged to the Mandinka tribe.
Factors promoting genital tobacco powder use (Qualitative study)
Several sociocultural factors were perceived to be associated with the use of genital tobacco powder among women in The Gambia and the themes developed based on the findings of the qualitative data are presented below:
Perceived Benefits (Physical Factors)
Sexual Enhancement
Sexual enhancement was highly mentioned as a reason why women use genital tobacco powder. Genital tobacco powder like other sexual enhancement products was perceived by respondents to give women sexual pleasure. A male midwife stated that “according to the findings I got from a small research I conducted, most of the women explained to me that they have a pleasure when they apply vaginal tobacco powder during night time” (Nurse 002, age 48). A gender activist also mentions in a FGD that “Most women use it for sexual satisfaction” (FGD 001, 63 years).
Vaginal Tightening
Some participants stated that older women (multiparous) use genital tobacco powder for vaginal tightening to make them feel younger and provide enough sexual satisfaction to their husbands. This was attributed to the perception that women who have given birth many times have a loss of elasticity in their vaginal walls, making sex less pleasurable. This is said to lead to women using substances that constrict their vagina to please their husbands. A male OPD nurse disclosed that, “The reason that I heard why women use ‘Tabaa’ is to be able to satisfy their husbands during sex. According to them, it makes the sex sweeter, and also it constricts the vagina so that the man can enjoy himself” (Nurse 004, age 29). A participant in a FGD stated, “Some use it to tighten their vagina because some people believed that the more tied a woman's vagina is the more she enjoys sex that's why many women are using ‘Tabaa’” (FGD 003, 33 years).
Satisfy sexual desire without physical sexual intercourse
It was reported that girls or women who want to satisfy their sexual urge but do not want to have affair with men use genital tobacco powder as alternative. A participant said, “Even some students use ‘Tabaa’ now, because they want to satisfy their sexual urge without having sex with men and they believe that using ‘Tabaa’ is safer than having sex with men” (FGD 006, 35 years).
It is an Energizer
Some individuals think that genital tobacco powder contains stimulant that causes users to become extremely active and energized, allowing them to work for extended periods of time. A male participant stated, “Some said it's an energizer, it enables them to work the whole day” (MIDI 003, 30 years).
Perceived Benefits (Medical Factors)
It is a medicine
Some respondents perceived that genital tobacco powder is a good medicine for genital infections (STIs and UTIs), infertility and other conditions.
A woman disclosed, “I was feeling some abnormalities in my body but since I started using “tabaa” the abnormalities disappeared” (UIDI 003, 32 years)
Treatment for genital infections
Some women are believed to use genital tobacco powder to treat STIs such as candidiasis, genital warts, and other genital infections, and recommend it to other women. Healthcare professionals and gender activists on the other hand refute this claim, although it remains a strong belief among some women. A woman stated, “my aunty told me that ‘tabaa’ is very effective against candidiasis that was when I started using it” (UIDI 002, 24 years). Another woman stated that, “I used to feel certain abnormalities in my body which I couldn’t understand, and then I was told by a friend to test ‘tabaa’ and see hence I have tried different medicines and they couldn’t cure it. She mentioned to me that ‘tabaa’ has cured many people and advised me to try it to see if it’ll resolve my health issue. Since I have started using ‘tabaa’, those problems disappeared; however, I can’t guarantee that what ‘tabaa’ does to me will be applied to other people hence our bodies react differently to substances” (UIDI 001, 30 years).
Treatment for Infertility
Woman stated, “I know a woman who sat for many years without having a child but she started having children after using ‘tabaa’” (FGD 008, 28 years).
Fasten the duration of labour
The findings suggested that pregnant women when in labour, apply genital tobacco powder with the belief that it helps to fasting the duration of labour. A female midwife sated, “I once assessed a woman at the labor ward and realized that she applied ‘tabaa’, when asked why she did it she told me that a woman told her that ‘tabaa’ fasting labour that is why she applied it” (Nurse 001, 26 years).
Treatment for Bedwetting
It was expressed by participants that some parents apply genital tobacco powder for their kids in order to prevent bed wetting. A women group leader said, “Even children are on ‘tabaa’ now. Some parents belief that ‘tabaa’ is good for bed wetting; they use it on their children (FGD 001, 63 years).
Weight control
It was perceived that some women use genital tobacco powder to their control weight / reduce belly fats. A participant said, “my friend also told me that ‘Tabaa’ would help to reduce the size of my belly” (UIDI 004, 27 years).
Marital Factors
Long Distance Marriage
Long distance relationship was greatly viewed as a factor associated genital tobacco powder use among women. Women whose husbands live abroad for a long period without physical intimacies are at higher risk of using genital tobacco powder, according to the findings. It was stated that such women would want to satisfy their sexual urge without being engaged in extramarital affairs with other men, so the only option they will have is to use genital tobacco powder to gain sexual pleasure. A participant said, “my husband went to America few months after our marriage, and it has been 2 years now I have not set my eyes on him. I have really struggled to maintain myself because I do not want to have any affair outside my marriage. A friend of mine introduced ‘Tabaa’ to me that was when I started using it (UIDI 004, 27 years).
Another woman stated, “I know a lady whose husband lives abroad, she use to insert candle to satisfy herself but she was later introduced to ‘Tabaa’ and she claims that ‘Tabaa’ is more satisfactory than a man (FGD 001, 63 years).
Polygamy
The theme ‘polygamy’ came up as a factor since it is thought that many Gambian women in polygamous marriages compete with one another to impress their husbands. Given that genital tobacco powder has a vaginal tightening effect; it has been proposed that women in polygamous marriages use it to satisfy their husbands during sex. A male nurse said, “Some women want to become the best in the eyes of their husband than the other wives and they apply ‘Tabaa’ to make themselves feel young when having sex with their husband” (Nurse 009, 29 years).
Others, on the other hand, asserted that when a woman in polygamous marriage experiences problems with her husband and feel ignored, she might use genital tobacco powder to enhance her sexual arousal while her husband is with his other wives. A woman stated, “I am used to ‘tabaa’ now, that is why sometimes when my husband is with his other wife I use ‘tabaa’ to satisfy myself” (UIDI 003, 36 years).
Sociocultural Factors
False beliefs
The findings suggested that many women use genital tobacco powder as a result of false claims that the product has medicinal benefits. A participant, “and the false beliefs that it can cure vaginal candidiasis is causing women all this trouble” (nurse 004, 29 years).
Religious belief
In The Gambia where majority are Muslims, it is considered to be highly sinful for a woman to have sex outside marriage. Therefore, unmarried women or those in long distance relationships would prefer using genital tobacco powder for sexual enhancement than having unlawful sex. A women group leader said, “because they believe having sex with men they’re not married to is sinful, ‘Tabaa’ becomes their secret husbands” (FGD 001, 63 years).
A religious leader in a focus group discussion narrated, “you know fornication is sinful, that is why some women use ‘tabaa’ to satisfy themselves, but ‘tabaa’ use is also sinful because it is a drug and it allows women to play with their private parts” (FGD 005, 68 years).
Female genital mutilation (FGM)
Evidences suggest that painful sexual intercourse is one of the long term effects of FGM. This was reflected in the study as some respondents believed that the painful sexual intercourse experienced by women who underwent FGM prevent them from attaining libido when they’re with their husbands, thus they use genital tobacco powder to gain sexual pleasure. A male midwife sated, “my observation is that many women who have under gone FGM especially type 3 experience painful sexual intercourse which could be a reason why they use ‘Tabaa’ to gain sexual pleasure (Nurse 003, 36 years).
Lack of knowledge of effects
Lack of knowledge was highly rated as a factor that contributed to the use of genital tobacco powder. Majority of women who use genital tobacco powder are unaware of its negative consequences, according to the findings. A midwife stated, “Another factor could also be knowledge deficit because many women who apply tobacco don’t know the effects” (midwife 004, 48 years).
Peer influence
The findings suggested that friends and family members persuaded the majority of women who use genital tobacco powder to use it. A woman disclosed, “I had never heard of ‘Tabaa’ but it was recommended to me by a friend before I began to use it” (UIDI 003, 32 years). A community health nurse said, “Some of them are due to peer influence, because some of them will tell their friends that if you use ‘Tabaa’ it makes you very active when having sex with your husband (Nurse 010, 30 years).
Economic Factors
Economic factor emerged as a theme as participants expressed that genital tobacco powder use is rampant because the sellers are generating money from it, and they deceive women to buy the product. A gender activist mentioned, “women who sell ‘Tabaa’ are very wise. They will use different kinds of sweet words to other women only because they gain a lot of money from it” (FGD 004, 38 years).
Summary of the Participants’ Socio-demographic Characteristics (n=400) (Quantitative Study)
The Findings of the study showed that all the 400 participants from the selected regions were included in the analysis giving a response rate of 100%. All of them were women. The findings of the study shows that most (33.7%; n=15) of the respondents were between the age category of 30-39, 53.8% (n=215) were from the urban area, 37.3% (n=149) belong to the Mandinka tribe and were Muslims. About forty-two percent (n=167) of the participants attended non-formal education and most (45.5%; n = 182) of them were housewives. Sixty-six percent of them (n = 264) were married out of which 54.8% (n = 219) were in monogamous marriages, 55% (n=220) stayed with their husbands / partner and 8.5% (n=34) stated that their husbands stays away for 12 months or more when they travelled. Only 45.3% (n= 181) of the women did not undergo FGM/C out of the 400 participants.
Table 1: Information on Genital Tobacco Powder use (n=400) (Quantitative Study)
Variable
|
N
|
%
|
Ever of heard of genital tobacco powder
|
|
|
Yes
|
287
|
71.8
|
No
|
113
|
28.2
|
Source of information
|
|
|
Family
|
143
|
35.8
|
Friends
|
99
|
24.8
|
Media
|
40
|
10.0
|
Others
|
5
|
1.3
|
Did not have information
|
113
|
28.2
|
Table 1 showed that majority (71.8%; n=287) of the participants received information on genital tobacco powder use out of which 35.8% (n=143) heard it from family members while only 10% (n=40) heard it from different source of media outlets. However, 28.2% (n=113) of the participants were not aware of the practice of genital tobacco powder use among women.
Prevalence of Genital Tobacco Powder use
Table 2: Distribution of Participants’ Genital Tobacco Powder use (Quantitative Study)
Variable
|
n
|
%
|
Ever use of genital tobacco powder (n=400)
|
|
|
Yes
|
68
|
17.0
|
No
|
332
|
83.0
|
Last time used genial tobacco powder (n=68)
|
|
|
< 1 week
|
43
|
63.2
|
< 1 month
|
1
|
1.5
|
< 6 months
|
2
|
2.9
|
< 12 months
|
5
|
7.4
|
> 12 months
|
17
|
25
|
Current use of genital tobacco powder
|
|
|
Yes
|
43
|
63.2
|
No
|
25
|
36.8
|
Average number times used genital tobacco per day
|
|
|
Once
|
64
|
94.1
|
Twice
|
4
|
5.9
|
>Twice
|
0
|
|
Average number times used genital tobacco per week
|
|
|
Once
|
26
|
38.2
|
2 – 4 times
|
33
|
48.5
|
5 times or more
|
9
|
13.2
|
Duration of using of genital tobacco powder
|
|
|
< 6 months
|
22
|
32.4
|
6- 12 months
|
8
|
11.8
|
> 12 months
|
31
|
45.6
|
Used only once in a lifetime
|
7
|
10.3
|
Table 2 revealed that out of the 400 women interviewed, 17% (n= 68) had ever used genital tobacco powder. Out of the 68 participants who had ever used genital tobacco powder, most of them (63.2%; n=43) used it within the week of interview while 36.8% (n=25) reported that they had stopped using it. Most (94.1%; n=64) of the genital tobacco powder users said that they use it once in a day, few (13.2%; n=9) of them use it 5 times or more per week and 45.6% (n=31) used it for more than 12 months.
Table 3: Reasons for Genital Tobacco Powder use (ever used; n=68)
Variable
|
Yes
n (%)
|
No
n (%)
|
Used it for sexual enhancement / Vaginal tightening
|
25 (36.8)
|
43 (63.2)
|
Used for weight control
|
6 (8.8)
|
62 (91.2)
|
Used it as an energizer
|
9 (13.2)
|
59 (86.8)
|
Experimentation
|
3 (4.4)
|
65 (95.5)
|
Used it for treatment of genital infections (STIs, candidiasis, genital warts)
|
63 (92.6)
|
5 (7.4)
|
Used it treat bedwetting
|
4 (5.9)
|
64 (94.1)
|
Used to fasten labour
|
8 (11.8)
|
60 (88.2)
|
Used it due to peer influence
|
19 (27.9)
|
49 (72.1)
|
Used it due to addiction
|
21 (30.9)
|
47 (69.1)
|
Used it to treat fertility
|
17 (25.0)
|
51 (75.0)
|
Note: Most of the participants gave more than one reason for using tobacco
Table 3 showed that majority (92.6%; n=63) of the 68 participants who had ever used genital tobacco powder claimed that it was done so to treat genital infections (STIs, candidiasis, and genital warts). The second highest most frequently cited reason for using genital tobacco was for vaginal tightening and/or sexual enhancement (36.8%; n=25). The other reasons for using it include weight control (8.8%, n=6), energizer (13.4%, n=9), peer influence (27.9%, n=19), experimentation (4.4%; n=3), addiction (30.9%; n = 21), treatment for bedwetting (5.9%; n = 4), fasten labour (11.8%; n = 18) and infertility treatment (17%; n = 25). These finding further confirm the findings of the qualitative aspect of this study.
The results presented in figure 1 shows that 35.5% (n=142) of the participants perceived that genital tobacco powder use was a bad practice while only (14.8%; n=59) of them said that it was a good practice. Most of them did not know whether it was a good or bad practice.
The study reported that the most (16.5%; n = 66) perceived benefits of genital tobacco powder use was to treat genital infections while the lowest (5.8%; n=23) was to be used for weight control. This collaborate the findings of qualitative part of this study. However, majority (30.5%; n=122) of the participants stated that it has no benefits (Figure 2).
Factors Associated with Genital Tobacco Powder use (Quantitative Study)
Table 4: Association between Participants’ Demographic variables and Genital Tobacco Powder use
Variable
|
Genital tobacco powder use
|
ꭓ2
|
p – value
|
Yes
n (%)
|
No
n (%)
|
Age in Years
|
|
|
24.094a
|
0.001**
|
< 20
|
0 (0.0)
|
25 (100.0)
|
|
|
20 – 29
|
16 (12.2)
|
115 (87.8)
|
|
|
30 – 39
|
18 (13.3)
|
117 (86.7)
|
|
|
40 years or more
|
34 (31.2)
|
75 (68.8)
|
|
|
Area of residence
|
|
|
5.210a
|
0.022*
|
Rural
|
40 (21.6)
|
145 (78.4)
|
|
|
Urban
|
28 (13.0)
|
187 (87.0)
|
|
|
Tribe
|
|
|
2.576a
|
0.462
|
Mandinka
|
26 (17.4)
|
123 (82.6)
|
|
|
Wollof
|
14 (14.7)
|
81 (85.3)
|
|
|
Fula
|
19 (21.8)
|
68 (78.2)
|
|
|
Others
|
9 (13.0)
|
60 (87.0)
|
|
|
Religion
|
|
|
3.414a
|
0.065
|
Islam
|
68 (17.7)
|
316 (82.3)
|
|
|
Christianity
|
0 (0.0)
|
16 (100.0)
|
|
|
Education Level
|
|
|
15.358a
|
0.004*
|
Primary
|
6 (10.9)
|
49 (89.1)
|
|
|
Secondary
|
13 (11.8)
|
97 (88.2)
|
|
|
Tertiary
|
8 (11.9)
|
59 (88.1)
|
|
|
Non-formal education
|
40 (24.0)
|
127 (76.0)
|
|
|
Illiterate
|
1 (100.0)
|
0 (0.0)
|
|
|
Occupation
|
|
|
5.674a
|
0.339
|
Civil servant
|
15 (20.5)
|
58 (79.5)
|
|
|
Business
|
9 (15.8)
|
48 (84.2)
|
|
|
Skilled work
|
1(5.0)
|
19 (95.0)
|
|
|
Student
|
3 (8.1)
|
34 (91.9)
|
|
|
House wife
|
33 (18.1)
|
149 (81.9)
|
|
|
Unemployed
|
7 (22.6)
|
24 (77.4)
|
|
|
Marital status
|
|
|
14.559
|
0.002*
|
Married
|
46 (17.4)
|
218 (82.6)
|
|
|
Single
|
10 (9.5)
|
95 (90.5)
|
|
|
Divorce
|
3 (37.5)
|
5 (62.5)
|
|
|
Widow
|
9 (39.1)
|
14 (60.9)
|
|
|
Marriage type
|
|
|
16.292
|
0.001**
|
Monogamy
|
28 (12.8)
|
191 (87.2)
|
|
|
Polygamy
|
18 (36.7)
|
31 (63.3)
|
|
|
Not Married
|
22 (16.7)
|
110 (83.3)
|
|
|
Stay with husband / partner
|
|
|
34.076
|
0.001**
|
Yes
|
24 (10.9)
|
196 (89.1)
|
|
|
No
|
22 (45.8)
|
26 (54.2)
|
|
|
Not Married
|
22 (16.7)
|
110 (83.3)
|
|
|
Duration husband stays away
|
|
|
29.051
|
0.001**
|
< 1 week
|
8 (9.3)
|
79 (90.7)
|
|
|
< 1 month
|
4 (25.0)
|
12 (75.0)
|
|
|
< 6 months
|
7 (33.3)
|
14 (66.7)
|
|
|
12 months or more
|
15 (44.1)
|
19 (55.9)
|
|
|
Always around
|
12 (10.8)
|
99 (89.2)
|
|
|
Not Married
|
22 (16.7)
|
110 (83.3)
|
|
|
Undergone FGM
|
|
|
0.004
|
0.951
|
Yes
|
37 (16.9)
|
182 (83.1)
|
|
|
No
|
31 (17.1)
|
150 (82.9)
|
|
|
*p < 0.05 ** p < 0.001
Table 4 shows that most of those who ever use genital powder tobacco were within the age range of 40 years and above (34%; n=31.2) and the association between age of the participants and genital tobacco powder use was statistically significant (p<0.001). Place of Residence was statistically significantly associated with the use of genital tobacco powder use (p = 0.022), thus women from the rural area, that is Farafenni (40%; n =21.6) are more likely to use it than those from the capital Banjul (n = 28; 13%). In addition, women’s level of education (p = 0.04), marital status (p =0.002), marriage type (p<0.001), staying with husband / partner (p < 0.001) and duration husband travelled away (p < 0.001) were statistically significantly associated the use of genital tobacco powder. However, the women’s tribes, occupation and FGM/C status were not significantly associated with genital tobacco powder use.
Table 5: Multiple Logistic Regression Results on Demographic Variables Predicting Genital Tobacco Use Among Participants (N = 400)
Demographic variable
|
Odds ratio
|
Standard error
|
t
|
(P value)
|
95% confidence interval
|
Age in years
|
|
|
|
|
|
20 – 39
|
1.01
|
0.47
|
0.03
|
0.98
|
0.41 - 2.50
|
40 – above
|
2.88
|
1.51
|
2.02
|
0.04*
|
1.03 – 8.05
|
Ref. <20
|
|
|
|
|
|
Residence
|
|
|
|
|
|
Farafenni
|
2.01
|
0.69
|
2.01
|
0.04*
|
1.02 – 3.96
|
Ref: Banjul
|
|
|
|
|
|
Education
|
|
|
|
|
|
Primary
|
2.07
|
1.63
|
0.92
|
0.36
|
0.44 – 9.77
|
Secondary
|
1.85
|
1.14
|
0.99
|
0.32
|
0.54 -11.25
|
Non-formal
|
3.09
|
2.04
|
1.71
|
0.02*
|
0.85 – 11.26
|
Ref: tertiary
|
|
|
|
|
|
Occupation
|
|
|
|
|
|
Business
|
0.27
|
0.17
|
-2.05
|
0.04*
|
0.08 – 0.94
|
Student
|
0.68
|
0.60
|
-0.43
|
0.67
|
0.12 – 3.82
|
Civil Servant
|
0.40
|
0.23
|
-1.58
|
0.11
|
0.13 – 1.24
|
Ref: unemployed
|
|
|
|
|
|
Marital Status
|
|
|
|
|
|
Married
|
2.86
|
4.63
|
0.65
|
0.52
|
0.12 – 8.44
|
Divorce
|
2.79
|
2.75
|
1.04
|
0.27
|
0.41 – 19.25
|
Widow
|
3.18
|
2.76
|
1.34
|
0.81
|
0.58 – 17.37
|
Ref: Single
|
|
|
|
|
|
Duration husband travelled
|
|
|
|
|
|
< 1 week
|
1.04
|
0.54
|
0.08
|
0.94
|
0.38 – 2.88
|
< 1 month
|
2.49
|
1.87
|
1.22
|
0.22
|
0.57 – 10.86
|
6 months
|
6.67
|
4.63
|
2.73
|
0.006*
|
1.71 – 26.01
|
12 months or more
|
9.64
|
5.44
|
4.01
|
<0.001**
|
3.19 – 29.18
|
Ref: Always around
|
|
|
|
|
|
*p < 0.05 ** p < 0.001
The results of the multiple logistic regression in Table 5 show that women who were within the age group 40 years and above (OR = 2.88; 95% CI = 1.03–8.05; p = 0.04), from Farafenni and satellite villages (OR = 2.01; 95% CI = 1.02-3.96; p = 0.04), had non-formal education (OR = 3.09; 95% CI 0.85–11.26; p = 0.02) and had husbands who traveled for 6 (OR = 6.67; 95% CI = 1.71–26.01; p= 0.006) or 12 or more months (OR = 9.64; 95% CI 3.19-29.18; p<0.001) had increased odds of using genital tobacco. The business women had 73% (OR = 0.27; 95% CI = 0.08–0.94; p = 0.04) less of using genital tobacco compared to the non-working women. Marital status was not a significant predictor of genital tobacco use among the women respondents.
Table 6: Association between Genital Tobacco Powder Use and (source of information, perception, and peer influence)
Variable
|
Genital tobacco powder use
|
ꭓ2
|
p – value
|
Yes
n (%)
|
No
n (%)
|
Source of information
|
|
|
55.256a
|
0.001**
|
Family
|
44 (30.8)
|
99 (69.2)
|
|
|
Friends
|
24 (24.2)
|
75 (75.8)
|
|
|
Media
|
0 (0.00)
|
40 (100.0)
|
|
|
Others
|
0 (0.00)
|
5 (100.0)
|
|
|
Perception on genital tobacco powder
|
|
|
171.371a
|
0.001**
|
Good practice
|
43 (72.9)
|
16 (27.1)
|
|
|
Bad practice
|
25 (17.6)
|
117 (82.4)
|
|
|
I don’t know
|
0 (0.0)
|
199 (100)
|
|
|
Good for sexual enhancement
|
|
|
117.303a
|
0.001**
|
Yes
|
26 (65.0)
|
14 (35.0)
|
|
|
No
|
41 (27.3)
|
109 (72.7)
|
|
|
Don’t know benefits
|
1 (0.5)
|
209 (99.5)
|
|
|
Can be used to treat genital infections
|
|
|
149.575a
|
0.001**
|
Yes
|
43 (65.2)
|
23 (34.8)
|
|
|
No
|
24 (19.4)
|
100 (80.6)
|
|
|
Don’t know benefits
|
1 (0.5)
|
209 (99.5)
|
|
|
Yes
|
23 (31.9)
|
49 (68.1)
|
|
|
No
|
45 (30.8)
|
101 (69.2)
|
|
|
Never used it
|
0 (0.0)
|
182 (100)
|
|
|
Peer influence
|
|
|
400.000a
|
0.001**
|
Yes
|
19 (27.9)
|
0 (0.0)
|
|
|
No
|
49 (72.1)
|
0 (0.0)
|
|
|
*p < 0.05 ** p < 0.001
Table 6 reveals that the source of information was statistically significant (p<0.001) in relation to the use of genital tobacco powder, with those who received it from family members (30.8%; n=44) being more likely to use it.
In addition, the perception of women was statistically significant (p<0.001) with genital tobacco powder use, with 43.0% (n=72.9) of those who perceived that it is a good practice were using it. Moreover, perceived benefits such as sexual enhancement (p<0.001) and treatment for genital infections (p<0.001) were statistically significantly associated with genital tobacco powder use. Peer influence (p<0.001) was also statistically significantly associated with genital tobacco powder use.