Association between concurrent alcohol and tobacco use and poverty.

INTRODUCTION AND AIMS: The harm from alcohol and tobacco use in low- and middle-income countries includes substantial economic cost to the individual. Our aim was to describe the expenditure on concurrent alcohol and tobacco use in relation to family income in two districts in Sri Lanka. DESIGN AND METHODS: A community-based cross-sectional study was carried out in two districts in Sri Lanka. We sampled 2684 men over 18 years of age using multistage cluster sampling. Cost of alcohol and cigarettes was calculated using the retail price for each brand and multiplying by the amount consumed. RESULTS: Among current alcohol users 63.1% were also smokers. Among current smokers 61.9% were also using alcohol. Prevalence of concurrent alcohol and tobacco use in urban areas was 20.1% and in rural areas 14%. The two lowest income categories (<$US76 per month) spent more than 40% of their income on concurrent use while the next category ($US76-143 per month) spent 34.8% of their income on concurrent use. DISCUSSION AND CONCLUSIONS: The poor spent less than those with higher income on alcohol and tobacco, but the expenditure constituted a much larger slice of their income thus compromising their ability to meet basic needs. In low-income countries, damaging economic consequences start at lower levels of alcohol and tobacco consumption and affect a significant proportion of the population. Defining risk levels and guidelines on safe limits based purely on individual health harm has, at best, little meaning in such settings.

Disaster management: lessons from immediate responses to the tsunami.

There are many lessons learnt from the immediate reactions of people in the aftermath of the vast destruction from the giant waves that hit Sri Lanka. Reactions of victims fell between extremes of resilience and helplessness. Responses of those not directly harmed illustrated the two extremes--selflessness and depravity. These responses offer insight into how we live and how we react to situations, and also to an extent how we should be reacting. Among these is that helpers should respect and involve, from the inception, the resources within the group or community affected by the disaster. Control of the relief effort to the maximum feasible extent, should be in the hands of those at whom it is directed.