Abstract
Tobacco consumption has been identified as the single biggest cause of inequality in morbidity and mortality. Understanding pattern of socioeconomic equalities in tobacco consumption in India will help in designing targeted public health control measures. Nationally representative data from the India Global Adult Tobacco Survey (GATS) conducted in 2009-2010 was analyzed. The survey provided information on 69,030 respondents aged 15 years and above. Data were analyzed according to regions for estimating prevalence of current tobacco consumption (both smoking and smokeless) across wealth quintiles. Multiple logistic regression analysis predicted the impact of socioeconomic determinants on both forms of current tobacco consumption adjusting for other socio-demographic variables. Trends of smoking and smokeless tobacco consumption across wealth quintiles were significant in different regions of India. Higher prevalence of smoking and smokeless tobacco consumption was observed in the medium wealth quintiles. Risk of tobacco consumption among the poorest compared to the richest quintile was 1.6 times higher for smoking and 3.1 times higher for smokeless forms. Declining odds ratios of both forms of tobacco consumption with rising education were visible across regions. Poverty was a strong predictor in north and south Indian region for smoking and in all regions for smokeless tobacco use. Poverty and poor education are strong risk factors for both forms of tobacco consumption in India. Public health policies, therefore, need to be targeted towards the poor and uneducated.
Highlights
Inequalities in the health sector have been widely documented in the developing world in regard to reproductive health, child health, communicable diseases and until recently, in non-communicable diseases (Blas et al, 2011)
The trend of smoking and smokeless tobacco consumption across wealth quintiles was significant across all regions of India
Higher prevalence of smoking and smokeless tobacco consumption was observed in the medium wealth quintiles at national level and across all regions except East and West region for smoking and North and North East region for smokeless tobacco consumption respectively
Summary
Inequalities in the health sector have been widely documented in the developing world in regard to reproductive health, child health, communicable diseases and until recently, in non-communicable diseases (Blas et al, 2011). More often studies in the past have combined both forms of tobacco use for analysis (Harper and Kinnon, 2012; Palipudi et al, 2012) or have measured the smoking tobacco consumption only (Eik et al, 2010; Hosseinpoor et al, 2012; Nagelhout et al, 2012) They need to be analyzed separately as smokeless tobacco consumption is a major problem in India. This paper provides information from the analysis utilizing the GATS data on socio-economic inequity associated with smoking and smokeless tobacco consumption across different regions comprising 29 states and two Union Territories in India (Center for Disease Control, 2009). Data were analyzed according to regions for estimating prevalence of current tobacco consumption (both smoking and smokeless) across wealth quintiles. Public health policies need to be targeted towards the poor and uneducated
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