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BMC Public Health
Published in: BMC Public Health 1/2015

Open Access 01-12-2015 | Research article

A cross-sectional study of the prevalence and correlates of tobacco Use in Chennai, Delhi, and Karachi: data from the CARRS study

Authors: Carla J Berg, Vamadevan S. Ajay, Mohammed K. Ali, Dimple Kondal, Hassan M. Khan, Roopa Shivashankar, Rajendra Pradeepa, Deepa Mohan, Zafar Fatmi, Muhammad M. Kadir, Nikhil Tandon, Viswanathan Mohan, KM Venkat Narayan, Dorairaj Prabhakaran

Published in: BMC Public Health | Issue 1/2015

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Abstract

Background

Tobacco burdens in India and Pakistan require continued efforts to quantify tobacco use and its impacts. We examined the prevalence and sociodemographic and health-related correlates of tobacco use in Delhi, Chennai (India), and Karachi (Pakistan).

Methods

Analysis of representative surveys of 11,260 participants (selected through multistage cluster random sampling; stratified by gender and age) in 2011 measured socio-demographics, tobacco use history, comorbid health conditions, and salivary cotinine. We used bivariate and multivariate regression analyses to examine factors associated with tobacco use.

Results

Overall, 51.8 % were females, and 61.6 % were below the age of 45 years. Lifetime (ever) tobacco use prevalence (standardized for world population) was 45.0 %, 41.3 %, and 42.5 % among males, and 7.6 %, 8.5 %, and 19.7 % among females in Chennai, Delhi, and Karachi, respectively. Past 6 month tobacco use prevalence (standardized for world population) was 38.6 %, 36.1 %, and 39.1 % among males, and 7.3 %, 7.1 %, and 18.6 % among females in Chennai, Delhi, and Karachi, respectively. In multivariable regression analyses, residing in Delhi or Karachi versus Chennai; older age; lower education; earning less income; lower BMI; were each associated with tobacco use in both sexes. In addition, semi-skilled occupation versus not working and alcohol use were associated with tobacco use in males, and having newly diagnosed dyslipidemia was associated with lower odds of tobacco use among females. Mean salivary cotinine levels were higher among tobacco users versus nonusers (235.4; CI: 187.0-283.8 vs. 29.7; CI: 4.2, 55.2, respectively).

Conclusion

High prevalence of tobacco use in the South Asian region, particularly among men, highlights the urgency to address this serious public health problem. Our analyses suggest targeted prevention and cessation interventions focused on lower socioeconomic groups may be particularly important.
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Literature
1.
Mendez D, Alshanqeety O, Warner KE. The potential impact of smoking control policies on future global smoking trends. Tob Control. 2013;22(1):46–51.CrossRefPubMed
2.
Lozano R, Murray CJL, Lopez A. Global and regional mortality from 235 causes of death for 20 age groups in 1990 and 2010: a systematic analysis for the global burden of disease study 2010. Lancet. 2012;380(9859):2095–128.CrossRefPubMed
3.
Sempos CT, Durazo-Arvizu R, McGee DL, Cooper RS, Prewitt TE. The influence of cigarette smoking on the association between body weight and mortality. The Framingham heart study revisited. Ann Epidemiol. 1998;8(5):289–300.CrossRefPubMed
4.
U.S. Department of Health and Human Services. The Health Consequences of Smoking—50 Years of Progress: A Report of the Surgeon General. 2014, U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health: Atlanta, GA.
5.
Multiple Risk Factor Intervention Trial Research Group. Multiple risk factor intervention trial. Risk factor changes and mortality results. JAMA. 1982;248(12):1465–77.CrossRef
6.
Browner WS, Du Chene AG, Hulley SB. Effects of the multiple risk factor intervention trial smoking cessation program on pulmonary function. A randomized controlled trial. West J Med. 1992;157(5):534–8.PubMedPubMedCentral
7.
Ng M, Freeman MK, Fleming TD, Robinson M, Dwyer-Lindgren L, Thomson B, et al. Smoking prevalence and cigarette consumption in 187 countries, 1980-2012. JAMA. 2014;311(2):183–92.CrossRefPubMed
8.
World Health Organization. WHO Report on the Global Tobacco Epidemic, 2011. 2011, World Health Organization: Geneva, Switzerland
9.
Sreeramareddy CT, Pradhan PMS, Mir IA, Sin S. Smoking and smokeless tobacco use in nine south and southeast Asian countries: prevalence estimates and social determinants from demographic and health surveys. Popul Health Metr. 2014;12:22.CrossRefPubMedPubMedCentral
10.
Chockalingam K, Vedhachalam C, Rangasamy S, Sekar G, Adinarayanan S, Swaminathan S, et al. Prevalence of tobacco use in urban, semi urban and rural areas in and around Chennai city. India PLoS One. 2013;8(10), e76005.CrossRefPubMed
11.
National Institute of Population Studies (NIPS) [Pakistan] and ICF International. Pakistan Demographic and Health Survey 2012-2013. 2013, National Institute of Population Studies; ICF International: Islamabad, Pakistan; Calverton, Maryland, USA
12.
Asthma Epidemiology Study Group. Tobacco smoking in India: prevalence, quit-rates and respiratory morbidity. Indian J Chest Dis Allied Sci. 2006;48(1):37–42.
13.
Ahmad K, Jafary F, Jehan I, Hatcher J, Khan AQ, Chaturvedi N, et al. Prevalence and predictors of smoking in Pakistan: results of the National Health Survey of Pakistan. Eur J Cardiovasc Prev Rehabil. 2005;12(3):203–8.CrossRefPubMed
14.
Wilkinson P, Sayer J, Laji K, Grundy C, Marchant B, Kopelman P, et al. Comparison of case fatality in south Asian and white patients after acute myocardial infarction: observational study. BMJ. 1996;312(7042):1330–3.CrossRefPubMedPubMedCentral
15.
UK Prospective Diabetes Study Group. ethnicity and cardiovascular disease. The incidence of myocardial infarction in white, South Asian, and Afro-Caribbean patients with type II diabetes. Diabetes Care. 1998;21:1271–7.CrossRef
16.
Anand SS, Yusuf S, Vuksan V, Devanesen S, Teo KK, Montague PA, et al. Differences in risk factors, atherosclerosis and cardiovascular disease between ethnic groups in Canada: the study of health assessment and risk in ethnic groups (SHARE). Indian Heart J. 2000;52(7 Suppl):S35–43.PubMed
17.
Pais P, Pogue J, Gerstein H, Zachariah E, Savitha D, Jayprakash S, et al. Risk factors for acute myocardial infarction in Indians: a case-control study. Lancet. 1996;348(9024):358–63.CrossRefPubMed
18.
Nair M, Ali MK, Ajay VS, Shivashankar R, Mohan V, Pradeepa R, et al. CARRS surveillance study: design and methods to assess burdens from multiple perspectives. BMC Public Health. 2012;12:701.CrossRefPubMedPubMedCentral
19.
20.
21.
Population Division of the Department of Economic and Social Affairs of the United Nations Secretariat. World Population Prospects: The 2006 Revision and World Urbanization Prospects: The 2007 Revision. 2007, Population Division of the Department of Economic and Social Affairs of the United Nations Secretariat. Available from: http://​www.​un.​org/​en/​development/​desa/​population/​.
22.
Rizzo L, Brick J, Park I. A minimally intrusive method for sampling persons in Random Digit Dial surveys. Public Opin Q. 2004;68(2):267–74.CrossRef
23.
24.
Klesges RC, Meyers AW, Klesges LM, La Vasque ME. Smoking, body weight, and their effects on smoking behavior: a comprehensive review of the literature. Psychol Bull. 1989;106(2):204–30.CrossRefPubMed
25.
Munafo MR, Tilling K, Ben-Shlomo Y. Smoking status and body mass index: a longitudinal study. Nicotine Tob Res. 2009;11(6):765–71.CrossRefPubMed
26.
Bobo JK, Husten C. Sociocultural influences on smoking and drinking. Alcohol Res Health. 2000;24(4):225–32.PubMed
27.
Istvan J, Matarazzo JD. Tobacco, alcohol, and caffeine use: a review of their interrelationships. Psychol Bull. 1984;95(2):301–26.CrossRefPubMed
28.
Patra J, Jha P, Rehm J, Suraweera W. Tobacco smoking, alcohol drinking, diabetes, low body mass index and the risk of self-reported symptoms of active tuberculosis: individual participant data (IPD) meta-analyses of 72,684 individuals in 14 high tuberculosis burden countries. PLoS One. 2014;9(5), e96433.CrossRefPubMedPubMedCentral
29.
Binnie V, McHugh S, Macpherson L, Borland B, Moir K, Malik K. The validation of self-reported smoking status by analysing cotinine levels in stimulated and unstimulated saliva, serum and urine. Oral Dis. 2004;10(5):287–93.CrossRefPubMed
30.
Connor Gorber S, Schofield-Hurwitz S, Hardt J, Levasseur G, Tremblay M. The accuracy of self-reported smoking: a systematic review of the relationship between self-reported and cotinine-assessed smoking status. Nicotine Tob Res. 2009;11(1):12–24.CrossRefPubMed
31.
Alterman AI, Gariti P, Niedbala RS. Varying results for immunoassay screening kits for cotinine level. Psychol Addict Behav. 2002;16(3):256–9.CrossRefPubMed
32.
Lehtonen R, Pahkinen E. Practical Methods for Design and Analysis of Complex Surveys. 2nd ed. West Sussex, England: John Wiley & Sons, LTD.; 2003.CrossRef
33.
Gilani SI, Leon DA. Prevalence and sociodemographic determinants of tobacco use among adults in Pakistan: findings of a nationwide survey conducted in 2012. Popul Health Metr. 2013;11(1):16.CrossRefPubMedPubMedCentral
34.
International Institute for Population Sciences. Global Adult Tobacco Survey: Fact Sheet: India, 2009-2010. 2010, International Institute for Population Sciences: Mumbai, India.
35.
Giovino GA, Mirza SA, Samet JM, Gupta PC, Jarvis MJ, Bhala N, et al. Tobacco use in 3 billion individuals from 16 countries: an analysis of nationally representative cross-sectional household surveys. Lancet. 2012;380(9842):668–79.CrossRefPubMed
36.
Blecher E, van Walbeek C. An Analysis of Cigarette Affordability, in International Union Against Tuberculosis and Lung Disease. 2008: Paris, France.
37.
Pinsker EA, Berg CJ, Nehl EJ, Prokhorov AV, Buchanan TS, Ahluwalia JS. Intentions to quit smoking among daily smokers and native and converted nondaily college student smokers. Health Ed Res. 2013;28(2):313–25.CrossRef
38.
Sutfin EL, McCoy TP, Berg CJ, Champion H, Helme DW, O’Brien MC, et al. Tobacco use among college students: a comparison of daily and nondaily smokers. Am J Health Behav. 2012;36(2):218–29.CrossRefPubMedPubMedCentral
39.
40.
Pampel FC, Denney JT. Cross-national sources of health inequality: education and tobacco use in the world health survey. Demography. 2011;48(2):653–74.CrossRefPubMedPubMedCentral
41.
Sharma V, Kerr SH, Kawar Z, Kerr DJ. Challenges of cancer control in developing countries: current status and future perspective. Future Oncol. 2011;7(10):1213–22.CrossRefPubMed
42.
Etter JF, Vu Duc T, Perneger TV. Saliva cotinine levels in smokers and nonsmokers. Am J Epidemiol. 2000;151(3):251–8.CrossRefPubMed
43.
Wall MA, Johnson J, Jacob P, Benowitz NL. Cotinine in the serum, saliva, and urine of nonsmokers, passive smokers, and active smokers. Am J Public Health. 1988;78(6):699–701.CrossRefPubMedPubMedCentral
44.
National Institute of Population Studies (NIPS) [Pakistan] aMII. Pakistan Demographic and Health Survey 2006-07. 2008: Islamabad, Pakistan: National Institute of Population Studies and Macro International Inc.
Metadata
Title
A cross-sectional study of the prevalence and correlates of tobacco Use in Chennai, Delhi, and Karachi: data from the CARRS study
Authors
Carla J Berg
Vamadevan S. Ajay
Mohammed K. Ali
Dimple Kondal
Hassan M. Khan
Roopa Shivashankar
Rajendra Pradeepa
Deepa Mohan
Zafar Fatmi
Muhammad M. Kadir
Nikhil Tandon
Viswanathan Mohan
KM Venkat Narayan
Dorairaj Prabhakaran
Publication date
01-12-2015
Publisher
BioMed Central
Published in
BMC Public Health / Issue 1/2015
Electronic ISSN: 1471-2458
DOI
https://doi.org/10.1186/s12889-015-1817-z

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