Widespread inequalities in smoking & smokeless tobacco consumption across wealth quintiles in States of India: Need for targeted interventions.

Background & objectives: India is a large country with each state having distinct social, cultural and economic characteristics. Tobacco epidemic is not uniform across the country. There are wide variations in tobacco consumption across age, sex, regions and socio-economic classes. This study was conducted to understand the wide inequalities in patterns of smoking and smokeless tobacco consumption across various states of India. Methods: Analysis was conducted on Global Adult Tobacco Survey, India (2009-2010) data. Prevalence of both forms of tobacco use and its association with socio-economic determinants was assessed across states and Union Territories of India. Wealth indices were calculated using socio-economic data of the survey. Concentration index of inequality and one way ANOVA assessed economic inequality in tobacco consumption and variation of tobacco consumption across quintiles. Multiple logistic regression was done for tobacco consumption and wealth index adjusting for age, sex, area, education and occupation. Results: Overall prevalence of smoking and smokeless tobacco consumption was 13.9 per cent (14.6, 13.3) and 25.8 per cent (26.6, 25.0), respectively. Prevalence of current smoking varied from 1.6 per cent (richest quintile in Odisha) to 42.2 per cent (poorest quintile in Meghalaya). Prevalence of current smokeless tobacco consumption varied from 1.7 per cent (richest quintile in Jammu and Kashmir) to 59.4 per cent (poorest quintile in Mizoram). Decreasing odds of tobacco consumption with increasing wealth was observed in most of the states. Reverse trend of tobacco consumption was observed in Nagaland. Significant difference in odds of smoking and smokeless tobacco consumption with wealth quintiles was observed. Concentration index of inequality was significant for smoking tobacco -0.7 (-0.62 to-0.78) and not significant for smokeless tobacco consumption -0.15 (0.01to-0.33) Interpretation & conclusions: The findings of our analysis indicate that tobacco control policy and public health interventions need to consider widespread socio-economic inequities in tobacco consumption across the states in India.

Tobacco use among students and school personnel in India.

BACKGROUND: Tobacco usage is addictive and causative for several diseases and premature death. Concerted efforts by the individual and society are needed for control and for surveillance. The habit is initiated during early youth and this age group requires constant monitoring and timely appropriate action to curtail usage. The WHO FCTC has recommended actions to monitor and limit the tobacco use in young age groups. One of the actions is to examine the prevalence of tobacco habits in school children 13-15 years of age and of personnel employed in schools. METHODS: WHO & CDC designed the study systems for Global Youth Tobacco Survey (GYTS) and Global School Personnel Survey (GSPS). In 2006 we conducted GYTS and GSPS in several parts of the country. The schools were chosen by strict sampling procedure and a well structured, self-administered questionnaire was used to obtain information on tobacco usage from 13 to 15 year old students of chosen schools and personnel of these schools. RESULTS: Current use of any tobacco product was 14.1% among students (17.3% boys, 9.8% girls) and among school personnel it was 29.2%(35.0% males and 13.7% females). The prevalence was highest among male students in North East (34%) and the lowest was 4.9% among female students of western states. Cigarettes and Bidi smoking were more prevalent among boys. Smokeless tobacco use prevalence rate varied between 20% and 4.5% among boys and between 21.5% and 1.6% among girl students. Among male school personnel, the prevalence varied from 57.9% in NE to 25.7% in South. Among females 26.5% were tobacco users in the NE and in Western region it was 6.6%. CONCLUSION: It is essential to adopt forceful strategies, which are area specific, in order to undo the harm inflicted by tobacco use upon the individuals &society. Periodic surveys for surveillance of trends are essential to evaluate the outcome of programmes among students and school personnels.

Linking Global Youth Tobacco Survey (GYTS) data to the WHO framework convention on tobacco control: the case for India.

India ratified the WHO Framework Convention on Tobacco Control (WHO FCTC) on February 27, 2005. The WHO FCTC is the world's first public health treaty that aims to promote and protect public health and reduce the devastating health and economic impacts of tobacco. Post ratification, each member state as part of general obligation has agreed to develop, implement, periodically update and review comprehensive multisectoral national tobacco control strategies, plans and programmes in accordance with this Convention and the protocols to which it is a Party. The Global Youth Tobacco Survey (GYTS) was developed to track tobacco use among young people across countries and the GYTS surveillance system intends to enhance the capacity of countries to design, implement, and evaluate tobacco control and prevention programs. The South-East Asia Region of WHO has developed the "Regional Strategy for Utilization of the GYTS" to meet this need for countries in the Region. In 2003, India has passed its national tobacco control legislation (India Tobacco Control Act [ITCA]), which includes provisions designed to reduce tobacco consumption and protect citizens from exposure to second hand smoke. Data in the GYTS (India) report can be used as a baseline measure for future evaluation of the tobacco control programs implemented by the Ministry of Health and Family Welfare, Government of India. India has to upscale some provisions of its National Law to accommodate all of the requirements of FCTC. Using determinants measured by GYTS in India, the government can monitor the impact of enforcing various provisions of the ITCA and the progress made in achieving the goals of the WHO FCTC and the Regional Strategies. Effective enforcement of the provisions of ITCA will show in the receding numbers of tobacco use prevalence figures and reduction in the expenditures associated with tobacco use in India.