Socioeconomic Gradients in Different Types of Tobacco Use in India: Evidence from Global Adult Tobacco Survey 2009-10.

Dallas R English,Monika Arora,Manu R Mathur,Ankur Singh

doi:10.1155/2015/837804

Abstract

Socioeconomic differences in tobacco use have been reported, but there is a lack of evidence on how they vary according to types of tobacco use. This study explored socioeconomic differences associated with cigarette, bidi, smokeless tobacco (SLT), and dual use (smoking and smokeless tobacco use) in India and tested whether these differences vary by gender and residential area. Secondary analysis of Global Adult Tobacco Survey (GATS) 2009-10 (n = 69,296) was conducted. The primary outcomes were self-reported cigarette, bidi smoking, SLT, and dual use. The main explanatory variables were wealth, education, and occupation. Associations were assessed using multinomial logistic regressions. 69,030 adults participated in the study. Positive association was observed between wealth and prevalence of cigarette smoking while inverse associations were observed for bidi smoking, SLT, and dual use after adjustment for potential confounders. Inverse associations with education were observed for all four types after adjusting for confounders. Significant interactions were observed for gender and area in the association between cigarette, bidi, and smokeless tobacco use with wealth and education. The probability of cigarette smoking was higher for wealthier individuals while the probability of bidi smoking, smokeless tobacco use, and dual use was higher for those with lesser wealth and education.

Highlights

Mortality and morbidity due to active smoking and the resulting involuntary exposure of nonsmokers to tobacco smoke are well substantiated globally [1,2,3] and in India [4,5,6,7,8]
A study conducted by Thakur et al, 2013, revealed differences according to geographical regions in the association between socioeconomic attributes with smoking and smokeless tobacco use
A recent study conducted by Corsi and Subramanian (2014) assessed socioeconomic inequalities in smoking behavior amongst males in India and reported that while cigarette smoking was concentrated among people who were wealthier, more educated, and with higher occupational status, on the contrary bidi smoking was more concentrated among the disadvantaged [19]

Summary

Introduction

Mortality and morbidity due to active smoking and the resulting involuntary exposure of nonsmokers to tobacco smoke are well substantiated globally [1,2,3] and in India [4,5,6,7,8]. A study conducted by Thakur et al, 2013, revealed differences according to geographical regions in the association between socioeconomic attributes with smoking and smokeless tobacco use. Similar contrasting gradients have been reported from a regional study in India [23] This unusual variation in socioeconomic gradients in consumption of the two smoking products among Indian males raises both concerns and curiosity to assess how usage across the different types of tobacco products (SLT and cigarette, bidi) differs by socioeconomic profile.

Methods

Results

Conclusion