Regular use of alcohol and tobacco in India and its association with age, gender, and poverty
Introduction
Regular use of tobacco and alcohol is clearly associated with the development of significant disease and disability (Murray and Lopez, 1996, Ezzati and Lopez, 2003, Ezzati et al., 2002). For example, numerous studies have documented a myriad of seriously debilitating and often deadly health effects of regular tobacco use (Doll and Hill, 1956, Doll and Peto, 1981, Doll et al., 1994; United States Department of Health and Human Services (USDHHS, 1983, USDHHS, 1986, USDHHS, 1988) and misuse of alcohol (Eckhardt and Ryback, 1981, Hardwood et al., 1984, Williams et al., 1988, Shultz et al., 1990, Rice et al., 1990, Andreasson and Brandt, 1997, Makela et al., 1997, Rehm et al., 2003). These associations have motivated considerable interest in the epidemiology of tobacco and alcohol use in the world's population.
Despite the growing global interest in the problem, considerably less is known about the prevalence of tobacco and alcohol use in many developing countries, when compared with developed nations. One of the largest developing countries in the world is India: with a population exceeding one billion people, India already bears a large proportion of the world's disease burden (over 20% of all disability adjusted life years lost) and additional information on the prevalence of tobacco and alcohol use in this country has both national and global importance (Peters et al., 2002).
Recent studies have suggested that India has similar patterns of health risks associated with regular use of these substances as reported in other countries (Gajalakshmi et al., 2003a, Gajalakshmi et al., 2003b, Znaor et al., 2003, Gupta and Mehta, 2000). For example, a survey from Chennai (Madras), India (Gajalakshmi et al., 2003b) estimated that death rates from medical problems among people aged 25–69 years were twice as great among ever-smokers as among non-smokers. A 1999 World Health Organization (WHO) report stated that 10% of all smoking-related deaths and lost productivity in the world are estimated to come from India (WHO, 1999). Other small studies have suggested that regular users of alcohol have higher risks of liver disease and cancer (Narawane et al., 1998, Znaor et al., 2003). These findings underscore the importance of obtaining broader and more representative prevalence data in India on the regular use of both substances.
Risk factors associated with regular tobacco use in developed nations suggest that social disadvantage, age, and sex are associated with increased prevalence of use of tobacco (USDHHS, 1988, USDHHS, 2003, Jha et al., 2002) and heavy use of alcohol (USDHHS, 2003, Wardle et al., 1999). It has also been suggested that as national incomes rise, smoking rates increase, and that early in the smoking epidemic, the affluent are more likely to smoke than the poor, and that the age of uptake of smoking is in the teens and twenties (World Bank, 1999). The roles of these risk factors for tobacco and alcohol use are not well documented in India.
This study presents age- and sex-specific rates of regular tobacco and alcohol use in the general population of India. Data are also presented on the associations of regular tobacco and alcohol use with age, gender, social exclusion, poverty, residence, and education.
Section snippets
Study sample
This study presents data from the 52nd round of the National Sample Survey (NSS), a national household survey conducted in India from June 1995 to June 1996 across all of India (National Sample Survey Organization (NSSO), NSSO, 1995, NSSO, 1998). The NSS followed a stratified two-stage design: the first-stage units were census villages in the rural areas and sampling frame blocks in urban areas; the second-stage units were households. Each of the 35 states and union territories of India was
Prevalence of regular use for total national sample
The total sample revealed prevalence estimates of regular smoking of tobacco products of 16.2% (95% confidence interval (CI): 16.1–16.3) for the population of individuals 10 years and older and regular use of chewing tobacco of 14.0% (95% CI: 13.9–14.1). The prevalence of regular alcohol use was 4.5% (95% CI: 4.5–4.6).
Gender- and age-specific prevalence estimates
Significant differences were observed between men and women in the reporting of regular use of both substances (Table 1). The most frequently used substance in men was tobacco,
Regular use of tobacco and alcohol
These are among the first published nationwide estimates of the prevalence of regular use of tobacco and the first reported national estimates of regular use of alcohol in India. The high (41%) rate of tobacco use in Indian households is consistent with 1995 estimates of tobacco use reported in studies of men and women from the South Asia region (Jha et al., 2002, Gajalakshmi et al., 2000) though higher than the 30% reported current use rates in the National Family Health Survey 2 (NFHS-2) (
Acknowledgement
The authors acknowledge the support and guidance of Dr. Davinder Mohan, Ex-Professor and Head, Department of Psychiatry, All India Institute of Medical Sciences. No external funds were used to support this research.
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