Prevalence of smokeless tobacco use in India and its association with various occupations: A LASI study.

Background: More than two-thirds of deaths in developing countries are due to non-communicable diseases, and tobacco is a leading risk factor. There are numerous different socio-demographic factors that impact on the use of smokeless tobacco, of which occupation is one. The objectives of this study are to find out the overall prevalence of smokeless tobacco use (ever and current use), the pattern of association with various occupations and related variables (current and past workers), and the role of childhood adversity on initiation and use. Methods: This study used data from the Longitudinal Aging Study in India (LASI) wave 1, a nationally representative cross-sectional study collected in 2017-18. Current and previous users of smokeless tobacco are taken into consideration as the target population. For the data analysis, survey-weighted tools have been applied for descriptive statistics and multivariable logistic regression model. The weighted data analysis has been done using R studio with R version 4. Results and discussion: From the sample size of 65,561, 38% have used either smoking or smokeless tobacco. Among them, 40% use tobacco in smoke form, 51% use smokeless tobacco, and 9% take both. At the population level, 22.8 and 20.4% are previous and current users of smokeless tobacco, respectively. Type of occupation, type of employer, place of work, kind of business, and workload were found to be significantly associated with smokeless tobacco use. A deaddiction and tobacco quitting policy targeting rural male informal workers should be the focus of the Government.

Out-of-Pocket health expenditure and sources of financing for delivery, postpartum, and neonatal health in urban slums of Bhubaneswar, Odisha, India.

BACKGROUND: Out-of-pocket expenditure (OOPE) is an obstacle in the path of getting universal health coverage in India. OBJECTIVE: This study aimed to explore the OOPE, sources of funding, and experience of catastrophic expenditure (CE) for healthcare related to delivery, postpartum, and neonatal morbidity. METHODS: A community-based, cross-sectional survey was conducted among a sample of 240 recently delivered women from the slums of Bhubaneswar, Odisha. Information on background, details of delivery, expenditure on delivery and on morbidities, and sources of funding was collected using a structured interview schedule. RESULTS: Only 29.6% of the households incurred OOPE, and the others incurred either nil OOPE or had a net income because of benefits received from Janani Shishu Suraksha Karyakram (JSSK), Janani Suraksha Yojana (JSY), and "Mamata" schemes of the government. The median total OOPE was found to be 2100 INR (100-38,620). Multivariate analysis found parity, place of delivery, type of delivery, and presence of morbidity to be significantly associated with incurring any OOPE. Nearly 15% of the households incurred OOPE exceeding 40% of the reported monthly household income including 9%, whose OOPE was 100% or more of the reported household monthly income. CONCLUSION: While mechanisms such as JSSK, JSY, and Mamata had benefitted the vast majority, around half of those who did incur OOPE experienced CE. Additional insurance facility for cesarean section delivery might reduce the excessive financial burden on households.