Socioeconomic Inequality in the Prevalence of Smoking and Smokeless Tobacco use in India

Background: Tobacco consumption has been identified as the single biggest cause of inequality in morbidityand mortality. Understanding pattern of socioeconomic equalities in tobacco consumption in India will help indesigning targeted public health control measures. Materials and
Methods: Nationally representative data fromthe India Global Adult Tobacco Survey (GATS) conducted in 2009-2010 was analyzed. The survey providedinformation on 69,030 respondents aged 15 years and above. Data were analyzed according to regions forestimating prevalence of current tobacco consumption (both smoking and smokeless) across wealth quintiles.Multiple logistic regression analysis predicted the impact of socioeconomic determinants on both forms of currenttobacco consumption adjusting for other socio-demographic variables.
Results: Trends of smoking and smokelesstobacco consumption across wealth quintiles were significant in different regions of India. Higher prevalenceof smoking and smokeless tobacco consumption was observed in the medium wealth quintiles. Risk of tobaccoconsumption among the poorest compared to the richest quintile was 1.6 times higher for smoking and 3.1 timeshigher for smokeless forms. Declining odds ratios of both forms of tobacco consumption with rising educationwere visible across regions. Poverty was a strong predictor in north and south Indian region for smoking and inall regions for smokeless tobacco use.
Conclusions: Poverty and poor education are strong risk factors for bothforms of tobacco consumption in India. Public health policies, therefore, need to be targeted towards the poorand uneducated.