Gupta P C, Ray Cecily S
Healis-Sekhsaria Institute for Public Health, Navi Mumbai, India.
Indian J Med Res. 2007 Oct;126(4):289-99.
The incontrovertible scientific evidence about tobacco use causing serious health consequences is now accepted even by the tobacco industry. Research continues to enlarge the spectrum of diseases caused by tobacco use among users as well as among nonusers exposed to secondhand tobacco smoke. This review attempts to illustrate the greater risk to adverse health outcomes among the less educated due to a greater prevalence of tobacco use among them. Numerous surveys worldwide and in India show a greater prevalence of tobacco use among the less educated and illiterate. In a large population based study in Mumbai, the odds ratios for any kind of tobacco use among the illiterate as compared to the college educated were 7.4 for males and 20.3 for females after adjusting for age and occupation. School-dropouts are more likely to take up tobacco use in childhood and adolescence. Student youth taught about the dangers of tobacco use in school are less likely to initiate tobacco use. High tobacco use among the less educated and under privileged affects them in multiple ways: (i) Tobacco users in such households, because of their nicotine addiction, prefer spending a disproportionate amount of their meager income on tobacco products, often curtailing essential expenditures for food, healthcare and education for the family. (ii) Because of high tobacco use and other factors of disadvantage connected with low educational status, they suffer more from the diseases and other health impacts caused by tobacco. This higher morbidity results in high health care expenditures, which impoverish the family further. (iii) Premature death caused by tobacco use in this under- privileged section often takes away the major wage earner in the family, plunging it into even more hardship. Tobacco use is a terrible scourge particularly of the less educated, globally and in India. Tobacco use, education and health in a human population are inter-related in ways that make sufferings and deaths caused by tobacco use even more tragic than normally realized. Tobacco use works against social and economic development and should be appropriately addressed through health education and tobacco cessation services particularly in the underprivileged, illiterate population.
关于烟草使用会导致严重健康后果的科学证据确凿，如今就连烟草行业也予以承认。研究不断拓展烟草使用在使用者以及接触二手烟的非使用者中所引发疾病的范围。本综述旨在说明，由于受教育程度较低者中烟草使用率更高，他们面临更严重健康不良后果的风险也更大。全球范围内以及印度的众多调查显示，受教育程度较低者和文盲中烟草使用率更高。在孟买一项基于大量人群的研究中，在调整年龄和职业因素后，文盲男性与受过大学教育男性相比，任何形式烟草使用的比值比为7.4，女性则为20.3。辍学者在童年和青少年时期更有可能开始使用烟草。在学校接受过烟草使用危害教育的学生青年开始使用烟草的可能性较小。受教育程度较低和贫困人群中烟草使用率高，在多方面对他们产生影响：（i）此类家庭中的烟草使用者，由于对尼古丁上瘾，往往将微薄收入中不成比例的部分用于烟草产品，常常削减家庭在食品、医疗保健和教育方面的必要开支。（ii）由于烟草使用率高以及与低教育水平相关的其他不利因素，他们更容易遭受烟草引发的疾病及其他健康影响。这种较高的发病率导致高额医疗费用，使家庭进一步陷入贫困。（iii）这一贫困群体中因烟草使用导致的过早死亡，往往使家庭失去主要收入者，使其陷入更深的困境。烟草使用是一场可怕的灾难，在全球和印度尤其对受教育程度较低者而言。在人群中，烟草使用、教育和健康相互关联，这使得烟草使用造成的痛苦和死亡比通常意识到的更加悲惨。烟草使用不利于社会和经济发展，应通过健康教育和戒烟服务加以妥善解决，特别是针对贫困、文盲人群。
