LUNG CANCER IN NEPAL: THE ROLE OF TRADITIONAL TOBACCO PRODUCTS AND COMBUSTION RELATED HOUSEHOLD AIR POLLUTION

The burden of chronic diseases such as cancer is increasing in low and middle income countries around the globe. Nepal, one of the world’s poorest countries, is no exception to this trend, with lung cancer as the leading causes of cancer deaths. Despite this, limited data is available on the environmental and behavioral risk factors that contribute to the lung cancer etiology in Nepal. The objectives of this dissertation are to: 1) investigate the ethnic differences in consumption of local tobacco products and their role in lung cancer risk in Nepal; 2) evaluate urinary metabolite of 1,3-butadiene as a biomarker of exposure to combustion related household air pollution (CRHAP); 3) investigate the association between CRHAP exposure and lung cancer risk using urinary metabolite of 1,3-butadiene as a biomarker of exposure; 4) investigate the association between CRHAP exposure and lung cancer risk using questionnaire based measure of exposure. Lung cancer cases (n=606) and frequency matched controls (N=606) were recruited from B.P. Koirala Memorial Cancer Hospital. We obtained biological samples and information on lifestyles including cooking habits and type of fuels used. We used liquid chromatograph tandem mass spectrometer (LC-MS/MS) to quantify urinary metabolites of 1,3-butadiene in urine samples. We employed a combination of logistic and linear regression models to detect any exposure-disease associations while controlling for known confounding variables. Overall, we found that ethnic groups in Nepal use different tobacco products that have different differing cancer potency -we observed the highest odds ratios for the traditional tobacco products. The biomarker analysis showed strong evidence that monohydroxybutyl mercapturic acid is associated with biomass fuel use among participants. However, we did not find significant association between urinary MHMBA and lung cancer risk. When we used questionnaire based measure of exposure to household air pollution, we observed significant, dose-response associations between CRHAP exposure and lung cancer risk, particularly among never-smokers. Our results show that important role of local tobacco products in lung cancer risk in Nepal. Furthermore, we demonstrate that CRHAP exposure is a risk factor for lung cancer risk, independent of tobacco smoking.

A VOICE OF THEIR OWN: MUSIC AND SOCIAL COHESION IN TURKISH ALEVI LIFE

This dissertation examines the role that music has played in the expression of identity and revitalization of culture of the Alevis in Turkey, since the start of their sociocultural revival movement in the late 1980s. Music is central to Alevi claims of ethnic and religious difference—singing and playing the bağlama (Turkish folk lute) constitutes an expressive practice in worship and everyday life. Based on research conducted from 2012 to 2014, I investigate and present Alevi music through the lens of discourses on the construction of identity as a social and musical process. Alevi musicians perform a revived repertoire of the ritual music and folk songs of Anatolian bards and dervish-lodge poets that developed over several centuries. Contemporary media and performance contexts have blurred former distinctions between sacred and secular, yet have provided new avenues to build community in an urban setting. I compare music performances in the worship services of urban and small-town areas, and other community events such as devotional meetings, concerts, clubs, and broadcast and social media to illustrate the ways that participation—both performing and listening—reinforces identity and solidarity. I also examine the influence of these different contexts on performers’ musical choices, and the power of music to evoke a range of responses and emotional feelings in the participants. Through my investigation I argue that the Alevi music repertoire is not only a cultural practice but also a symbol of power and collective action in their struggle for human rights and self-determination. As Alevis have faced a redefined Turkish nationalism that incorporates Sunni Muslim piety, this music has gained even greater potency in their resistance to misrecognition as a folkloric, rather than a living, tradition.