Dataset Information

Social determinants of health and tobacco use in thirteen low and middle income countries: evidence from Global Adult Tobacco Survey.

ABSTRACT:

Background

Tobacco use has been identified as the single biggest cause of inequality in morbidity. The objective of this study is to examine the role of social determinants on current tobacco use in thirteen low-and-middle income countries.

Methodology/principal findings

We used nationally representative data from the Global Adult Tobacco Survey (GATS) conducted during 2008-2010 in 13 low-and-middle income countries: Bangladesh, China, Egypt, India, Mexico, Philippines, Poland, Russian Federation, Thailand, Turkey, Ukraine, Uruguay, and Viet Nam. These surveys provided information on 209,027 respondent's aged 15 years and above and the country datasets were analyzed individually for estimating current tobacco use across various socio-demographic factors (gender, age, place of residence, education, wealth index, and knowledge on harmful effects of smoking). Multiple logistic regression analysis was used to predict the impact of these determinants on current tobacco use status. Current tobacco use was defined as current smoking or use of smokeless tobacco, either daily or occasionally. Former smokers were excluded from the analysis. Adjusted odds ratios for current tobacco use after controlling other cofactors, was significantly higher for males across all countries and for urban areas in eight of the 13 countries. For educational level, the trend was significant in Bangladesh, Egypt, India, Philippines and Thailand demonstrating decreasing prevalence of tobacco use with increasing levels of education. For wealth index, the trend of decreasing prevalence of tobacco use with increasing wealth was significant for Bangladesh, India, Philippines, Thailand, Turkey, Ukraine, Uruguay and Viet Nam. The trend of decreasing prevalence with increasing levels of knowledge on harmful effects of smoking was significant in China, India, Philippines, Poland, Russian Federation, Thailand, Ukraine and Viet Nam.

Conclusions/significance

These findings demonstrate a significant but varied role of social determinants on current tobacco use within and across countries.

SUBMITTER: Palipudi KM

PROVIDER: S-EPMC3306395 | biostudies-literature | 2012

REPOSITORIES: biostudies-literature

ACCESS DATA

Publications

Social determinants of health and tobacco use in thirteen low and middle income countries: evidence from Global Adult Tobacco Survey.

Palipudi Krishna M KM Gupta Prakash C PC Sinha Dhirendra N DN Andes Linda J LJ Asma Samira S McAfee Tim T

PloS one 20120316 3

<h4>Background</h4>Tobacco use has been identified as the single biggest cause of inequality in morbidity. The objective of this study is to examine the role of social determinants on current tobacco use in thirteen low-and-middle income countries.<h4>Methodology/principal findings</h4>We used nationally representative data from the Global Adult Tobacco Survey (GATS) conducted during 2008-2010 in 13 low-and-middle income countries: Bangladesh, China, Egypt, India, Mexico, Philippines, Poland, Ru ...[more]

PMID: 22438937

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Project description:INTRODUCTION:Tobacco smoking is often more prevalent among those with lower socio-economic status (SES) in high-income countries, which can be driven by the inequalities in initiation and cessation of smoking. Smoking is a leading contributor to socio-economic disparities in health. To date, the evidence for any socio-economic inequality in smoking cessation is lacking, especially in low- and middle-income countries (LMICs). This study examined the association between cessation behaviours and SES of smokers from eight LMICs. METHODS:Data among former and current adult smokers aged 18 and older came from contemporaneous Global Adult Tobacco Surveys (2008-2011) and the International Tobacco Control Surveys (2009-2013) conducted in eight LMICs (Bangladesh, Brazil, China, India, Mexico, Malaysia, Thailand and Uruguay). Adjusted odds ratios (AORs) of successful quitting in the past year by SES indicators (household income/wealth, education, employment status, and rural-urban residence) were estimated using multivariable logistic regression controlling for socio-demographics and average tobacco product prices. A random effects meta-analysis was used to combine the estimates of AORs pooled across countries and two concurrent surveys for each country. RESULTS:Estimated quit rates among smokers (both daily and occasional) varied widely across countries. Meta-analysis of pooled AORs across countries and data sources indicated that there was no clear evidence of an association between SES indicators and successful quitting. The only exception was employed smokers, who were less likely to quit than their non-employed counterparts, which included students, homemakers, retirees, and the unemployed (pooled AOR?0.8, p<0.10). CONCLUSION:Lack of clear evidence of the impact of lower SES on adult cessation behaviour in LMICs suggests that lower-SES smokers are not less successful in their attempts to quit than their higher-SES counterparts. Specifically, lack of employment, which is indicative of younger age and lower nicotine dependence for students, or lower personal disposable income and lower affordability for the unemployed and the retirees, may be associated with quitting. Raising taxes and prices of tobacco products that lowers affordability of tobacco products might be a key strategy for inducing cessation behaviour among current smokers and reducing overall tobacco consumption. Because low-SES smokers are more sensitive to price increases, tobacco taxation policy can induce disproportionately larger decreases in tobacco consumption among them and help reduce socio-economic disparities in smoking and consequent health outcomes.

Project description:ObjectivesTo determine the prevalence and frequency of using any tobacco product and each of a detailed set of tobacco products, how tobacco use and frequency of use vary across countries, world regions, and World Bank country income groups, and the socioeconomic and demographic gradients of tobacco use and frequency of use within countries.DesignSecondary analysis of nationally representative, cross-sectional, household survey data from 82 low and middle income countries collected between 1 January 2015 and 31 December 2020.SettingPopulation based survey data.Participants1 231 068 individuals aged 15 years and older.Main outcome measuresSelf-reported current smoking, current daily smoking, current smokeless tobacco use, current daily smokeless tobacco use, pack years, and current use and use frequencies of each tobacco product. Products were any type of cigarette, manufactured cigarette, hand rolled cigarette, water pipe, cigar, oral snuff, nasal snuff, chewing tobacco, and betel nut (with and without tobacco).ResultsThe smoking prevalence in the study sample was 16.5% (95% confidence interval 16.1% to 16.9%) and ranged from 1.1% (0.9% to 1.3%) in Ghana to 50.6% (45.2% to 56.1%) in Kiribati. The user prevalence of smokeless tobacco was 7.7% (7.5% to 8.0%) and prevalence was highest in Papua New Guinea (daily user prevalence of 65.4% (63.3% to 67.5%)). Although variation was wide between countries and by tobacco product, for many low and middle income countries, the highest prevalence and cigarette smoking frequency was reported in men, those with lower education, less household wealth, living in rural areas, and higher age.ConclusionsBoth smoked and smokeless tobacco use and frequency of use vary widely across tobacco products in low and middle income countries. This study can inform the design and targeting of efforts to reduce tobacco use in low and middle income countries and serve as a benchmark for monitoring progress towards national and international goals.

Project description:ObjectivesTo describe the prevalence of school-based tobacco prevention programme exposure among adolescents in low-income and middle-income countries (LMICs) and its association with psychosocial predictors of smoking.DesignAnalysis of pooled cross-sectional data.SettingGlobal Youth Tobacco Survey (GYTS), conducted in 38 LMICs.ParticipantsThis was a pooled analysis of data involving a total of 132 755 adolescent respondents to GYTS in 38 LMICs across Africa, Europe and Central/South America between 2014 and 2017.Exposure and outcome measuresThe primary independent variable for this study was self-reported exposure to school-based tobacco prevention programmes in the past year. Five psychosocial determinants of smoking were explored as outcomes: perceived addictiveness of nicotine, perceived harm of secondhand smoke exposure, support for restricting cigarette smoking at public indoor locations, support for restricting cigarette smoking at public outdoor areas and self-reported prediction of enjoying cigarette smoking. Multivariable logistic regression models were used to examine the relationship between exposure to school-based tobacco prevention programmes and study outcomes, controlling for sociodemographic and smoking-related characteristics of respondents.ResultsOverall, 59.1% of adolescents in LMICs self-reported exposure to school-based tobacco prevention programmes. The country-specific prevalence of adolescent exposure to school-based tobacco interventions ranged from 24.9% in the Comoros to 99.3% in Turkmenistan. Exposure to school-based tobacco interventions was significantly associated with greater secondhand smoke harm perceptions (adjusted OR (AOR): 1.69; 95% CI: 1.69 to 1.70), perceptions of addictiveness (AOR: 1.37; 95% CI: 1.36 to 1.37) and supporting tobacco use restrictions indoors (AOR: 1.70; 95% CI: 1.69 to 1.70) and outdoors (AOR: 1.59; 95% CI: 1.59 to 1.60). Exposure to school-based tobacco interventions was associated with lower odds of anticipating enjoying cigarette smoking (AOR: 0.76; 95% CI: 0.76 to 0.76).ConclusionExposure to tobacco prevention programmes in schools is suboptimal in LMICs. Given the protective associations described in this study from school-based tobacco prevention programme exposure, it is imperative that national governments implement school-based programmes into ongoing tobacco control measures.

Project description:ObjectivesEarly initiation of tobacco use can lead to lifelong addiction and increases tobacco-attributable morbidity and mortality. This study assesses trends in tobacco use initiation and factors associated with tobacco use initiation using disaggregated data from two rounds of the Global Adult Tobacco Survey India (GATS; 2009-2010 (GATS 1) and 2016-2017 (GATS 2)).DesignSecondary analysis of repeated cross-sectional studies.Settings and participantsThe study involved data from 69 296 individuals and 76 069 households in GATS 1 and 74 037 individuals and 77 170 households in GATS 2, two rounds of a nationally representative survey in India.Outcome measuresMean age of initiation (as recalled by the participants) of smoked and smokeless tobacco (SLT) use (dependent variable) was compared and analysed across different sociodemographic variables (independent factors). We assessed change in mean age of initiation of tobacco usage on a daily basis between GATS 1 and GATS 2, and investigated the factors associated with early tobacco use initiation in the GATS 2 dataset (reported using adjusted ORs (aORs) with 95% CIs).ResultsThe mean age of initiation of smoked tobacco and SLT in GATS 2 was 20.9±8.5 and 22.3±10.6 years, compared with 18.5±9.7 and 19.7±12.0 years in GATS 1. The mean age of initiation increased with age and among those who were better aware of the adverse effects of tobacco. As per GATS 2, males initiated smoked tobacco and SLT use earlier (20.6±7.4 and 21.7±9.1) than females (23.3±14.2 and 23.2±12.6 years). Younger participants (15-24 years) reported earlier initiation of SLT (15.5±4.2 years) compared with others. Binary logistic regression depicted variables associated with early initiation of tobacco. Awareness about the harms caused by tobacco affected the odds of SLT (aOR 1.4, 95% CI 1.3 to 1.7) and dual usage initiation (1.8, 1.6 to 2.0), but not of initiation of smoked tobacco products (1.1, 0.9 to 1.2).ConclusionsMore robust health advocacy campaigns that communicate the harmful effects of tobacco on health could be useful to delay tobacco initiation, along with reducing the ease of access and affordability of tobacco products among vulnerable groups.

Dataset Information

Social determinants of health and tobacco use in thirteen low and middle income countries: evidence from Global Adult Tobacco Survey.

Background

Methodology/principal findings

Conclusions/significance

Publications

Social determinants of health and tobacco use in thirteen low and middle income countries: evidence from Global Adult Tobacco Survey.

Similar Datasets

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