Hardcore Smoking in Three South-East Asian Countries:Results from the Global Adult Tobacco Survey

Background: Hardcore smoking is represented by a subset of daily smokers with high nicotine dependence,inability to quit and unwillingness to quit. Estimating the related burden could help us in identifying a high riskpopulation prone to tobacco induced diseases and improve cessation planning for them. This study assessed theprevalence and associated factors of hardcore smoking in three South-East Asian countries and discussed itsimplication for smoking cessation intervention in this region. Materials and
Methods: Global Adult TobaccoSurvey (GATS) data of India, Bangladesh and Thailand were analyzed to quantify the hardcore smokingprevalence in the region. On the basis of review, an operational definition of hardcore smoking was adoptedthat includes (1) current daily smoker, (2) no quit attempt in the past 12 months of survey or last quit attemptof less than 24 hours duration, (3) no intention to quit in next 12 months or not interested in quitting, (4) time tofirst smoke within 30 minutes of waking up, and (5) knowledge of smoking hazards. Logistic regression analysiswas carried out using hardcore smoking status as response variable and gender, type of residence, occupation,education, wealth index and age-group as possible predictors.
Results: There were 31.3 million hardcore smokersin the three Asian countries. The adult prevalence of hardcore smoking in these countries ranges between3.1% in India to 6% in Thailand. These hardcore smokers constitute 18.3-29.7% of daily smokers. The logisticregression model indicated that age, gender, occupation and wealth index are the major predictors of hardcoresmoking with varied influence across countries.
Conclusions: Presence of a higher number of hardcore smokingpopulations in Asia is a major public health challenge for tobacco control and cancer prevention. There is needof intensive cessation interventions with due consideration of contextual predictors.