Abstract
BackgroundHardcore smoking behaviours and test of hardening are seldom reported from low-and-middle-income countries (LMICs). We report country-wise changes in smoking behaviors between two sequential surveys and explored ecologically the relationship between MPOWER scores and smoking behaviors including hardcore smoking.MethodsWe analysed sequential Global Adult Tobacco Survey (GATS) data done at least at five years interval in 10 countries namely India, Bangladesh, China, Mexico, Philippines, Russia, Turkey, Ukraine, Uruguay, and Vietnam. We estimated weighted prevalence rates of smoking behaviors namely current smoking (both daily and non-daily), prevalence of hardcore smoking (HCS) among current smokers (HCSs%) and entire surveyed population (HCSp%), quit ratios (QR), and the number of cigarettes smoked per day (CPD). We calculated absolute and relative (%) change in rates between two surveys in each country. Using aggregate data, we correlated relative change in current smoking prevalence with relative change in HCSs% and HCSp% as well as explored the relationship of MPOWER score with relative change in smoking behaviors using Spearman’ rank correlation test.ResultsOverall daily smoking has declined in all ten countries lead by a 23% decline in Russia. In India, Bangladesh, and Philippines HCSs% decreased as the smoking rate decreased while HCSs% increased in Turkey (66%), Vietnam (33%) and Ukraine (15%). In most countries, CPD ranged from 15 to 20 sticks except in Mexico (7.8), and India (10.4) where CPD declined by 18 and 22% respectively. MPOWER scores were moderately correlated with HCSs% in both sexes (r = 0.644, p = 0.044) and HCSp% (r = 0.632, p = 0.05) and among women only HCSs% (r = 0.804, p = 0.005) was significantly correlated with MPOWER score.ConclusionWith declining smoking prevalence, HCS had also decreased and quit rates improved. Ecologically, a positive linear relationship between changes in smoking and HCS is a possible evidence against ‘hardening’. Continued monitoring of the changes in quitting and hardcore smoking behaviours is required to plan cessation services.
Highlights
Hardcore smoking behaviours and test of hardening are seldom reported from low-and-middle-income countries (LMICs)
If MPOWER score as a proxy indicator for tobacco control policy would explain the changes in the tobacco use behaviours and tested possible relationship between change in smoking rates and Hard-core smoking (HCS)% and HCSp%
Changes in smoking behaviours and constructs of HCS and MPOWER scores for each country are shown in the appendix
Summary
Hardcore smoking behaviours and test of hardening are seldom reported from low-and-middle-income countries (LMICs). Decreasing prevalence of tobacco smoking in many high-income countries leaves behind a subgroup of smokers who are unable to quit smoking as light smokers are more likely to quit than heavy (more dependent) smokers [1]. This has led to the concept of ‘hardening’, and that ‘hardened’ smokers would pose a greater challenge for further reduction of smoking prevalence [2]. Evidence from developed countries on hardening is inconclusive since very few studies have reported that ‘hardening’ was occurring, [6,7,8] while recent studies have reported that ‘hardening’ was not occurring [9,10,11]
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