Socioeconomic inequalities in tobacco cessation among Indians above 15 years of age from 2009 to 2017: evidence from the Global Adult Tobacco Survey (GATS).

BACKGROUND: Tobacco is strongly associated with socioeconomic status (SES), however evidence on differences in tobacco cessation by socio-economic attributes remains fragmented, especially in developing countries. The present study aims to estimate socioeconomic inequalities in tobacco cessation among Indian men and women above 15 years of age. METHODS: Two rounds of the Global Adult Tobacco Survey (2009-2010 and 2016-2017), India was used to estimate the association between socioeconomic indicators (wealth index and educational attainment) with tobacco cessation using a multinomial modeling approach. RESULTS: After adjusting for SES and demographic variables, we found significantly lower odds in tobacco cessation rates among respondents of GATS-2 (2016-2017) compared to GATS-1 (2009-2010). Additionally, huge regional variations in smoking and smokeless tobacco cessation rates were observed. Population belonging to the low wealth-asset score had higher odds of cessation compared to the high asset index. While greater educational attainment was seen to have a positive effect on cessation, the results were insignificant. Individuals belonging to the northeastern geographic region were seen to have the lowest odds of cessation. Though awareness about the health hazards of tobacco increased, cessation declined for both men and women. Quitting smokeless tobacco among men and women was observed to be lower than smoking. CONCLUSION: This study is the first to provide national-level evidence on the association between tobacco cessation and socioeconomic attributes among Indians above 15 years of age. Findings suggest the need to scale up tobacco cessation services separately for men and women, and also for smoking and smokeless tobacco forms.

The progression of the tobacco epidemic in India on the national and regional level, 1998-2016.

BACKGROUND: Evidence regarding the progression of the tobacco epidemic remains fragmented in low- and middle-income countries. In India, most of the studies that examined tobacco consumption focused on one time point, on the country as a whole, and on men. Despite important gender differences in tobacco consumption, vast economic and cultural differences exist within India. We, therefore, assessed the progression of the tobacco epidemic in India on both the national and the regional level, by gender. METHODS: We use information on current tobacco use among Indians aged 15-49 from three rounds of the National Family Health Survey (NFHS) (1998-99, 2005-06, 2015-16) to estimate the age-standardized sex specific smoking and smokeless tobacco prevalence across India and its states. RESULTS: Age-standardized tobacco use prevalence in India increased between 1998-1999 and 2005-2006, and declined from 2005-2006 to 2015-2016, simultaneously for men and women. There are substantial spatial differences in the progression of the tobacco epidemic in India. While tobacco use declined in the majority of states, we observe high and increasing use for men in the north-eastern states of Manipur, Mizoram and Nagaland, and for women in the western state of Gujarat and north-eastern state of Manipur. We observed even more states with a recent increasing prevalence in either tobacco smoking or smokeless tobacco. Throughout, prevalence of tobacco use has been higher among men than women for all Indian regions, and remained higher than the national average in the north-eastern states. CONCLUSIONS: Our results suggest that India and the majority of its states experienced a 'compressed tobacco epidemic' in which the prevalence of tobacco consumption increased and decreased simultaneously for women and men over a comparatively short period of time. Despite the overall progress India made in reducing tobacco use, further lowering tobacco consumption remains a public health priority, as the prevalence of smoking and/or smokeless tobacco use remains high in a number of states. We therefore conclude that tobacco regulations should be expanded with the aim of reducing the overall health burden associated with tobacco consumption across India.

Clustering of lifestyle risk factors among adult population in India: A cross-sectional analysis from 2005 to 2016.

INTRODUCTION: Individual's early life style and health behaviors are directly linked to chronic non-communicable diseases. Considering the increased burden of NCDs during the last two decades, the aim of this study is to assess co-occurrence/clustering of lifestyle risk factors and its association with different socio-demographic and economic characteristics among adult men and women in India from 2005-2016. METHODS: This study utilized the data from the National Family Health Survey 2005-06 and 2015-16 survey rounds. Multinomial logistic regression is employed to evaluate co-occurrence of multiple risk factors among adult men and women of different socio-economic and demographic characteristics to identify the subgroups with elevated risk of clustering of multiple unhealthy lifestyle risk factors. RESULTS: More adult men in India tend to exhibit clustering of multiple non-communicable disease risk factors than females. Individuals between 30-49 years of age, residing in urban areas, the population with no education, separated couples and those from poor economic strata are the specific population subgroups show higher prevalence of co-occurrence of multiple risk factors. The regional pattern of clustering of risk factors shows that the prevalence of co-occurrence of multiple risk factors is higher among men and women from the North-Eastern part of India compared to the other regions of the country. CONCLUSION: The prevalence of clustering of multiple risk factors associated with chronic NCDs is substantially high and has increased between 2005-06 to 2015-16. India may therefore experience a significant increase in the burden of chronic non-communicable diseases in the coming years. We therefore conclude that appropriate strategies should be implemented by policy makers and the government to reduce the overall health burden of NCDs due to lifestyle habits.

Gender and regional pattern of alcohol use and projection of problematic drinking in India, 1998-2016.

PURPOSE OF THE STUDY: Alcohol use is the third leading risk factor for premature mortality. India is one of the largest markets for alcoholic beverages. Existing research in India is localized to specific settings lacking national generalizability. The present study aims to estimate the trends in alcohol use in India by gender and regions and to estimate the current projected number of the population involved in problematic drinking. METHODS: The National Family Health Survey (NFHS) is used to estimate the age-standardized alcohol prevalence by gender and region. World Bank, 2019 population estimates are used to estimate the total population currently involved in problematic drinking, using the recent alcohol prevalence estimates. FINDINGS: Nationally, the age-standardized prevalence of alcohol use increased between 1998-1999 and 2005-2006 and declined thereafter, being higher among men than women. Exceptions to the declines after 2005 are seen in some regions where alcohol use still increased. A 43.6% increase and 8.5% decrease in the age-standardized prevalence of problematic drinking is observed among men and women, respectively, between 2005-2006 and 2015-2016. However, problematic drinking increased in some regions for both men and women. 103.62 million men and 3.34 million women in India were involved in problematic drinking during 2019, with the highest incidences being among men aged 40-44 years and among women aged 45-49 years. CONCLUSION: Despite the overall progress India has made in reducing its alcohol prevalence, lowering it further remains a public health priority. There was a substantial rise in the prevalence of problematic drinking among the population, which warrants immediate action. Spreading knowledge and awareness about the negative health effects of problematic drinking among the adult population seems necessary. Strict implementation of policies would therefore not only aid in reducing the prevalence of alcohol use and problematic drinking, but, in turn, would also help to reduce the burden of alcohol-related morbidity and associated mortality in India.