Socioeconomic determinants of smokeless tobacco use among Indian women: An analysis of global adult tobacco survey-2, India.

Introduction: The predominant form of tobacco consumption among women from many Asian countries, including India, is smokeless tobacco (SLT). The present study aimed to assess the prevalence and socioeconomic determinants of SLT use among Indian women. Methodology: The study used data from the Global Adult Tobacco Survey-2, India, conducted during 2016-2017, with a sample size of 40,265 women aged 15 years and above. Chi-square test and binary logistic regression were applied with the current use of SLT as the dependent variable to find the sociodemographic factors associated with it. Results: Overall, 12.8% (95% confidence interval [CI]; 12.4-13.1) of all women and 7.4% (CI: 6.0-8.8) of pregnant women reported SLT use. Its use was higher among women >50 years (23.1%, CI: 22.2-23.8), and those from northeast India (34.9%, CI: 33.8-36.0). Adjusted odds of using SLT were higher among older women (adjusted odds ratio [AOR]: 5.8, CI: 4.5-7.3), women from rural areas (AOR: 1.5, CI: 1.4-1.7), and women belonging to scheduled tribe (AOR: 2.4, CI: 2.2-2.7) as compared to their counterparts. In addition, poor (AOR: 2.6; 95% CI, 2.4-2.8) and middle class (AOR: 1.8; 95% CI, 1.7-2.0) women were more likely to use SLT compared to their rich counterparts. The use of SLT within 30 min of waking up in the morning was seen in 57.2 percent of women users. SLT prevalence was highest among Mizo-speaking women (46.1%, CI: 42.6-49.6), followed by Manipuri (38.9%, CI: 35.5-42.2), Odiya (34.4%), and Khasi (34%, CI: 29.8-38.2). Conclusions: There is an imperative need for women-centric schemes on SLT cessation, with special attention to older women, pregnant women, from rural areas, poor households, and the north-eastern region of India.

Trends in socioeconomic inequalities in smoking in Turkey from 2008 to 2016.

BACKGROUND: Smoking inequalities in Turkey were previously demonstrated in an early stage of the smoking epidemic model. This paper aimed to assess the trends for socioeconomic inequalities in smoking in Turkey over the years in the context of the smoking epidemic model using data from the Global Adult Tobacco Survey (GATS) Turkey 2008-2012-2016. METHODS: Cross-sectional data were analyzed to calculate the association of smoking with, wealth, education, occupation and place of residence using age-standardized prevalence rates, odds ratios, relative index of inequality (RII) and slope index of inequality (SII). The analysis was performed separately for age groups (younger: 20-39 years/older: 40 and above years) and sex. RESULTS: Younger women with higher wealth and older women with higher wealth and education smoked more. For both age groups, smoking was increased for working class and urban women. Relative wealth inequalities in smoking narrowed and then showed a reversal for younger women (RII2008 = 3.37; 95% CI:1.64-3.40; RII2012 = 2.19; 95% CI:1.48-3.24; RII2016 = 0.80; 95% CI:0.58-1.10, p-for trend < 0.0001). Relative educational inequalities in smoking for older women also showed a narrowing (RII2008 = 21.45; 95% CI:11.74-39.19; RII2012 = 15.25; 95% CI:9.10-25.55; and RII2016 = 5.48; 95% CI:3.86-7.78, p-for trend < 0.0001). For older women, a similar narrowing was observed for wealth (RII2008 = 3.94; 95% CI:2.38-6.53; RII2012 = 2.79; 95% CI:1.80-4.32; and RII2016 = 1.34; 95% CI:0.94-1.91, p-for trend = 0.0001). The only significant trend for absolute inequalities was for younger women by wealth. This trend showed a narrowing and then a reversal (SII2008 = 0.14; 95% CI:0.09-1.20; SII2012 = 0.12; 95% CI:0.06-0.18; and SII2016 = -0.05; 95% CI:-0.12-0.02, p-for trend = 0.0001). Unlike women, smoking in men showed inverse associations for wealth and education, although not statistically confirmed for all years. Smoking was increased in working classes and unemployed men in 2012 and 2016. Inequalities did not show a trend in relative and absolute terms for men. CONCLUSIONS: For smoking inequalities in Turkey, a transition to the next stage was observed, although the previously defined Southern European pattern also existed. Low socioeconomic women deserve special attention as well as stressors at work and drivers of smoking at urban settings.

Factors Affecting the Intention to Quit among Women Smokers in Turkey.

OBJECTIVES: Tobacco use is an important public health problem that affects adversely the quality of life. A person's attitude toward quitting tobacco use can be reflected by the desire or intention to quit smoking. The aim of this study was to determine risk factors affecting women's intention to quit tobacco in Turkey. METHODS: In this study, the data obtained from the Global Adult Tobacco Survey (GATS) were used. The GATS is a standard method used in countries to monitor and evaluate the frequency of tobacco use in adults and tobacco control practices. The data used in the study was obtained from the GATS carried out in Turkey in 2008 and 2012. The data related to 1248 women smoking tobacco were used in the analysis. The relationship between women's intention to quit tobacco use and socio-demographic and economic variables was examined. RESULTS: Men were excluded from the analysis because the focus of the study was women. It was determined that 732 of 1248 women using tobacco intend to quit smoking tobacco. 40.4% of women smoking tobacco are primary school graduates. Women, who were aware of anti-smoking messages and exposed to stimulants that promote smoking, were 36.4% and 27% more likely to intend to stop tobacco use after the next month, respectively. It was observed that women living in a house, where smoking is allowed, are less likely to quit smoking than others (ME = -0.522). This shows the importance of domestic restrictions. CONCLUSION: Intending to quit is an important preliminary step to quit. Understanding the factors associated with the intention to quit smoking can help tobacco users to stop using it and shape effective policies to increase the quit rates. 
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Exposure to second hand smoke and its correlates in Northern State of India.

BACKGROUND: Second-hand smoke (SHS) has enormous adverse health impacts with grave health implications for the next generation. Section 4 of Indian legislation, Cigarettes and Other Tobacco Products Act, prohibits smoking at public places, thus protecting people from SHS. OBJECTIVE: The objective of present study was to assess the exposure to SHS at home and working areas in Punjab, India. METHODS: The present cross-sectional study was conducted from December 2015 to March 2016. A three-stage sampling technique was used for collecting data from three randomly selected districts representing three major regions of Punjab, India. A sample size of 510 individuals was divided equally into an urban and rural area with proportionate sampling on the basis of subsets of age groups and gender. The questionnaire based on tobacco questions for the survey, a subset of key questions from global adult tobacco survey was used. RESULTS: At home, the odds of exposure to SHS exposure was higher (odds ratio [OR] = 2.2, 95% confidence interval [CI] = 0.6-7.3) in urban area, females, low educational status, and nongovernment employee as compared to their counterparts. At workplace, (OR = 3.9 and 95% CI = 1.11-14.3) SHS exposure was higher in rural area, among males, primary and middle education and nongovernment or self-employed occupation. CONCLUSION: SHS exposure was low in Punjab, India especially in females as compared to other states of the country. The socio-economic disadvantaged groups and people with low education were more likely to experience exposure to SHS at workplace, which should be targeted to reduce tobacco consumption.

Prevalence of tobacco use among adults in Egypt, 2009.

INTRODUCTION: We assessed the differences in overall use of tobacco and in the use of various tobacco products, by sex and by frequency of use across various demographic groups. METHODS: We used data from the Global Adult Tobacco Survey (GATS), conducted in 2009 in Egypt. The data consist of answers to GATS by 20,924 respondents from a nationally representative, multistage probability sample of adults aged 15 years or older from all regions of Egypt. Current tobacco use was defined as current smoking or use of smokeless tobacco products, either daily or occasionally. We analyzed the differences in current cigarette, shisha, and smokeless tobacco use by sex and frequency of use (daily or occasional); and by demographic characteristics that included age, region, education level and employment status. RESULTS: Overall, 19.7% of the Egyptian population currently use some form of tobacco. Men (38.1% [95% confidence interval (CI) 36.8-39.4]) are much more likely than women (0.6% [95% CI 0.4-0.9]) to use tobacco. Almost 96% of men who use tobacco, do so daily. Men are more likely to use manufactured cigarettes (31.8% [95% CI 30.6-33.1]) than shisha (6.2% [95% CI 5.6-6.9]) or smokeless tobacco (4.1% [95% CI 3.4-4.8]). Few women use tobacco (cigarettes (0.2%), shisha (0.3%) and smokeless tobacco (0.3%)); however, all women who currently smoke shisha, do so daily. Lower educational status, being between ages 25-64 and being employed predicted a higher use of tobacco. CONCLUSION: Egypt has implemented several initiatives to reduce tobacco use. The World Health Organization (WHO) MPOWER technical package, which aims to reverse the tobacco epidemic, is implemented at various levels throughout the country. Our findings show that there is significant variation in the prevalence of tobacco use and types of tobacco used by adult men and women in Egypt. GATS data can be used to better understand comparative patterns of tobacco use by adults, which in turn can be used to develop interventions.

Exposure to secondhand smoke among adults - Philippines, 2009.

INTRODUCTION: We assessed the differences in exposure to secondhand smoke (SHS) among adults at home, in indoor workplaces, and in various public places in the Philippines across various socio-demographic groups. METHODS: Data from the Global Adult Tobacco Survey conducted in 2009 in the Philippines were used. The data consist of survey answers from 9705 respondents from a nationally representative, multistage probability sample of adults aged 15 years or older. We considered that respondents were exposed to SHS if during the previous 30 days they reported that they lived in a home, worked in a building, or visited a public place where people smoked. The public places included in our analysis were indoor workplaces, public transportation vehicles, restaurants, government buildings or offices, and healthcare facilities. The differences in various socioeconomic and demographic groups' exposure to SHS in these places were also examined. RESULTS: Of respondents who reported working indoors, 36.8% were exposed to SHS. Men (43.3% [95% CI 39.7-46.9]) were more likely than women (28.8% [95% CI 25.4-32.4]) to be exposed to SHS (p < 0.001). Of those working in sites where smoking was not allowed, 13.9% were exposed to SHS, whereas 66.5% were exposed where smoking is allowed in some enclosed areas, and 90.7% were exposed where smoking is allowed everywhere. During the 30 days preceding the survey, more than 50% of those who took public transportation were exposed to SHS; exposure for those who visited public buildings was 33.6% in restaurants, 25.5% in government buildings or offices, and 7.6% in healthcare facilities. CONCLUSION: Despite a national law passed and several local government ordinances that have promulgated smoke-free workplaces, schools, government offices, and healthcare facilities, our findings show that a large proportion of adults were exposed to SHS at work and in public places, which offers opportunities to strengthen and improve enforcement of the smoke-free initiatives and ordinances in the Philippines.

Unravelling India's tobacco epidemic--priorities and recommendations for the second round of Global Adult Tobacco Survey (GATS).

The Global Adult Tobacco Survey, or GATS, has proved to be an invaluable tool for policymakers. In India, it highlighted the alarming rates of prevalence of use and risks both nationally and at state level. However, a rapid analysis of GATS-India shows that there are limitations in methods (sampling, questionnaire, measures undertaken to ensure data quality and management), which may impact the estimates of prevalence. This review discusses these potential weaknesses and recommends measures that can be adopted in the next round of surveys to overcome the limitations.