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The Social Gradient in Tobacco Use Does Not Generalize to Low-Income Urban Communities in India: Findings From a Census Survey
INTRODUCTION: The existence of a social gradient in tobacco use has been clearly established in a number of countries with people with lower socioeconomic status being more likely to use tobacco. It is not clear how far this gradient is evident within severely deprived communities. This study assess...
Autores principales: | , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
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Oxford University Press
2017
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Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5808735/ https://www.ncbi.nlm.nih.gov/pubmed/27613938 http://dx.doi.org/10.1093/ntr/ntw214 |
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author | Sarkar, Bidyut K Shahab, Lion Arora, Monika Ahluwalia, Jasjit S Reddy, K Srinath West, Robert |
author_facet | Sarkar, Bidyut K Shahab, Lion Arora, Monika Ahluwalia, Jasjit S Reddy, K Srinath West, Robert |
author_sort | Sarkar, Bidyut K |
collection | PubMed |
description | INTRODUCTION: The existence of a social gradient in tobacco use has been clearly established in a number of countries with people with lower socioeconomic status being more likely to use tobacco. It is not clear how far this gradient is evident within severely deprived communities. This study assessed the association between occupation as a marker of socioeconomic status and use of smoked and smokeless tobacco within “slum” areas of Delhi, India. METHODS: A census survey of 11 888 households, comprising 30 655 adults from 28 low-income communities (14 government-authorized and 14 unauthorized settlements called “Jhuggi-Jhopri/JJ” clusters) was conducted in 2012. The survey assessed age, sex, household size, occupational group, and current tobacco use. Independent associations with tobacco use were conducted using complex samples regression analysis, stratified by gender. RESULTS: A quarter of participants (24.3%, 95% confidence interval [CI] 21.5–27.5) used any tobacco. Slightly more people used smoked (14.6%, 95% CI 12.9–16.3) than smokeless (12.6%, 95% CI 10.7–14.8) tobacco, with a small minority being dual users (2.7%, 95% CI 2.1–3.5). Prevalence of any tobacco use was highest in unskilled (45.13%, 95% CI 42.4–47.9) and skilled (46.2%, 95% CI 41.1–51.4) manual occupations and lower in nonmanual (30.3%, 95% CI 26.2–34.7) occupations and those who were unemployed (29.0%, 95% CI 25.3–33.0). This was confirmed in adjusted analysis in men but associations were more complex in women. CONCLUSIONS: Use of smoked and smokeless tobacco in low-income urban communities in India has a complex association with occupational status with both nonmanual occupation and unemployment being associated with lower prevalence of smoked and smokeless tobacco in men. IMPLICATIONS: Tobacco use in high-income countries shows a strong inverse relationship with social grade, income, and deprivation such that use is much more common among those who can least afford it. This study is the first to look at this social gradient in the context of low-income communities in India, finding that both unemployment and nonmanual occupation were associated with lower rates of tobacco use in men. The data present a challenge to existing explanations of the social gradient, requiring further consideration of the conditions under which affordability may work to reduce health inequalities arising from tobacco use. |
format | Online Article Text |
id | pubmed-5808735 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2017 |
publisher | Oxford University Press |
record_format | MEDLINE/PubMed |
spelling | pubmed-58087352018-02-15 The Social Gradient in Tobacco Use Does Not Generalize to Low-Income Urban Communities in India: Findings From a Census Survey Sarkar, Bidyut K Shahab, Lion Arora, Monika Ahluwalia, Jasjit S Reddy, K Srinath West, Robert Nicotine Tob Res Brief Report INTRODUCTION: The existence of a social gradient in tobacco use has been clearly established in a number of countries with people with lower socioeconomic status being more likely to use tobacco. It is not clear how far this gradient is evident within severely deprived communities. This study assessed the association between occupation as a marker of socioeconomic status and use of smoked and smokeless tobacco within “slum” areas of Delhi, India. METHODS: A census survey of 11 888 households, comprising 30 655 adults from 28 low-income communities (14 government-authorized and 14 unauthorized settlements called “Jhuggi-Jhopri/JJ” clusters) was conducted in 2012. The survey assessed age, sex, household size, occupational group, and current tobacco use. Independent associations with tobacco use were conducted using complex samples regression analysis, stratified by gender. RESULTS: A quarter of participants (24.3%, 95% confidence interval [CI] 21.5–27.5) used any tobacco. Slightly more people used smoked (14.6%, 95% CI 12.9–16.3) than smokeless (12.6%, 95% CI 10.7–14.8) tobacco, with a small minority being dual users (2.7%, 95% CI 2.1–3.5). Prevalence of any tobacco use was highest in unskilled (45.13%, 95% CI 42.4–47.9) and skilled (46.2%, 95% CI 41.1–51.4) manual occupations and lower in nonmanual (30.3%, 95% CI 26.2–34.7) occupations and those who were unemployed (29.0%, 95% CI 25.3–33.0). This was confirmed in adjusted analysis in men but associations were more complex in women. CONCLUSIONS: Use of smoked and smokeless tobacco in low-income urban communities in India has a complex association with occupational status with both nonmanual occupation and unemployment being associated with lower prevalence of smoked and smokeless tobacco in men. IMPLICATIONS: Tobacco use in high-income countries shows a strong inverse relationship with social grade, income, and deprivation such that use is much more common among those who can least afford it. This study is the first to look at this social gradient in the context of low-income communities in India, finding that both unemployment and nonmanual occupation were associated with lower rates of tobacco use in men. The data present a challenge to existing explanations of the social gradient, requiring further consideration of the conditions under which affordability may work to reduce health inequalities arising from tobacco use. Oxford University Press 2017-11 2016-08-23 /pmc/articles/PMC5808735/ /pubmed/27613938 http://dx.doi.org/10.1093/ntr/ntw214 Text en © The Author 2016. Published by Oxford University Press on behalf of the Society for Research on Nicotine and Tobacco. http://creativecommons.org/licenses/by/4.0 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted reuse, distribution, and reproduction in any medium, provided the original work is properly cited. |
spellingShingle | Brief Report Sarkar, Bidyut K Shahab, Lion Arora, Monika Ahluwalia, Jasjit S Reddy, K Srinath West, Robert The Social Gradient in Tobacco Use Does Not Generalize to Low-Income Urban Communities in India: Findings From a Census Survey |
title | The Social Gradient in Tobacco Use Does Not Generalize to Low-Income Urban Communities in India: Findings From a Census Survey |
title_full | The Social Gradient in Tobacco Use Does Not Generalize to Low-Income Urban Communities in India: Findings From a Census Survey |
title_fullStr | The Social Gradient in Tobacco Use Does Not Generalize to Low-Income Urban Communities in India: Findings From a Census Survey |
title_full_unstemmed | The Social Gradient in Tobacco Use Does Not Generalize to Low-Income Urban Communities in India: Findings From a Census Survey |
title_short | The Social Gradient in Tobacco Use Does Not Generalize to Low-Income Urban Communities in India: Findings From a Census Survey |
title_sort | social gradient in tobacco use does not generalize to low-income urban communities in india: findings from a census survey |
topic | Brief Report |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5808735/ https://www.ncbi.nlm.nih.gov/pubmed/27613938 http://dx.doi.org/10.1093/ntr/ntw214 |
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