Cross-sectional study on smokeless tobacco use, awareness and expenditure in an urban slum of Bhavnagar, western India.

Background: Data are sparse on smokeless tobacco (SLT) use in Bhavnagar. We assessed the prevalence and awareness of and expenditure on SLT use in Bhavnagar. Methods: We conducted a community-based, cross- sectional study in an urban slum of Bhavnagar on a sample of 260 SLT users for a period of three months in 2017. Results: The prevalence of SLT use in Bhavnagar was 27.3% (95% CI 25%-30%). Mawa, a preparation of tobacco flakes mixed with areca nut and lime, was the most commonly chewed form of tobacco; commonly kept in the buccal mucosa. The mean age ofstarting SLT use was 25 years; the mean number of years since chewing was 15 years; the mean time tobacco was kept in the mouth per consumption was 5 minutes and the mean number of packets of tobacco consumed per day was five. The mean expenditure on SLT use per month was ?536. All SLT users were aware that tobacco consumption led to oral cancer. Peer influence was the most common (75%) reason for starting SLT use, and addiction was the most common (74%) reason for its continued use. Among SLT users, 47% had made at least one attempt to quit; of them, 98% had tried self-control for quitting but did not succeed. The most common (72%) reason given by those not able to quit (n=119) was addiction to SLT use. Among the 260 study participants, 72% had read the warnings on packets of tobacco; 59% wished to chew tobacco even after reading the warnings and 62% opined on banning the sale and consumption of tobacco. Ninety-two per cent of SLT users were not comfortable with the idea that imitating them, their children too would start chewing tobacco. Conclusions: Every third person in the urban slum of Bhavnagar was a SLT user. Even though SLT users knew about the harmful effects of tobacco, only a handful were able to quit due to addiction to it. This burden on health services, in addition to the expenditure on purchase of tobacco, requires a comprehensive tobacco cessation programme at the community level.

Age at death and rectangularisation of the survival curve: trends in Switzerland, 1969-1994.

OBJECTIVE: To check if signs of rectangularisation of the survival curve appeared during recent decades in Switzerland--that is, if life expectancy is approaching a maximum with a clustering of age at death around an average value (the so called "compression of mortality"). METHODS: Descriptive analysis of age of death and its trends over 26 years, as characterised by the modal value, median, and various percentiles beyond the median. POPULATION: All deaths occurring after the 50th birthday in Switzerland between 1969 and 1994 (n = 1,390,362). MAIN RESULTS: Age at death is increasing at a sustained rate at all percentiles equal or greater than 50, without any slow down in the trend during this period. The increase is more marked among women. Rates of increase are diminishing as the percentiles of age at death are higher, suggesting some clustering of deaths beyond the median value. However, the maximum age at death, if any, seems to be far from the current median values, even for women who enjoy a relatively high median age at death.