Gurung Mongal Singh, Pelzom Dorji, Dorji Tandin, Drukpa Wangchuk, Wangdi Chador, Chinnakali Palanivel, Goel Sonu
Ministry of Health, Thimphu, Bhutan.
Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India.
Popul Health Metr. 2016 Aug 8;14:28. doi: 10.1186/s12963-016-0098-9. eCollection 2016.
Despite a comprehensive ban on cultivation, manufacture, distribution, and sale of tobacco products since 2004, two nationwide surveys conducted in 2012 and 2013 reported high tobacco use in Bhutan. National Health Survey 2012 reported that 4 % of the population aged 15-75 years used smoked tobacco and about 48 % used smokeless tobacco. Similarly, Global Youth Tobacco Survey (GYTS) of Bhutan reported tobacco use prevalence of 30.3 % in 2013. However, factors associated with this high tobacco use were not systematically studied. Hence, we assessed the prevalence of tobacco use and its associated sociodemographic, behavioral, and environmental factors.
This cross-sectional analytical study used secondary data collected in a nationally representative Non-communicable Disease Risk Factors Surveillance STEPS Survey 2014 conducted among Bhutanese adults (18-69 years). The survey included a total of 2820 adults; selected using multistage stratified cluster sampling. Weighted analysis was done to calculate the prevalence of tobacco use. Unadjusted and adjusted prevalence ratios were calculated using log binomial regression.
The prevalence of current overall tobacco use was 24.8 % (95 % CI: 21.4-28.3) and that of smoked, smokeless, and dual forms (smoked and smokeless forms) were 7.4 % (95 % CI: 5.8-9.0), 19.7 % (95 % CI: 16.5-22.9), and 2.3 % (95 % CI: 1.8-2.9), respectively. Significantly higher prevalence of tobacco use in all forms was found among males, younger age groups, and alcohol users. The prevalence of smoked form was higher in urban areas compared to rural areas (11 % vs 6 %; aPR 1.8, 95 % CI: 1.5-2.0). Among individuals who reported having a non-communicable disease, the prevalence of smoked tobacco use was significantly lower than those who did not have disease (3.5 % vs. 8.3 %; aPR 0.5, 95 % CI: 0.3-0.9). Exposure to health warnings was protective for current tobacco use and smokeless tobacco use, while exposure to tobacco warnings through the media was helpful among smokers and overall tobacco users.
Despite a comprehensive ban on tobacco, tobacco use was high in Bhutan, especially the smokeless form. Males, younger age groups, and alcohol users should be targeted with behavioral interventions along the stricter implementation of tobacco control measures.
尽管自2004年起全面禁止烟草制品的种植、制造、分销和销售，但2012年和2013年进行的两项全国性调查显示，不丹的烟草使用率很高。2012年全国健康调查显示，15 - 75岁的人口中有4%使用吸烟烟草，约48%使用无烟烟草。同样，不丹的全球青少年烟草调查（GYTS）报告称2013年烟草使用率为30.3%。然而，与这种高烟草使用率相关的因素尚未得到系统研究。因此，我们评估了烟草使用的患病率及其相关的社会人口学、行为和环境因素。
这项横断面分析研究使用了2014年在不丹成年人（18 - 69岁）中进行的具有全国代表性的非传染性疾病风险因素监测STEPS调查中收集的二手数据。该调查共纳入2820名成年人；采用多阶段分层整群抽样进行选择。进行加权分析以计算烟草使用的患病率。使用对数二项回归计算未调整和调整后的患病率比。
当前总体烟草使用率为24.8%（95%置信区间：21.4 - 28.3），吸烟、无烟和双重形式（吸烟和无烟形式）的使用率分别为7.4%（95%置信区间：5.8 - 9.0）、19.7%（95%置信区间：16.5 - 22.9）和2.3%（95%置信区间：1.8 - 2.9）。在男性、较年轻年龄组和饮酒者中，发现所有形式的烟草使用率显著更高。城市地区吸烟形式的使用率高于农村地区（11%对6%；调整后的患病率比为1.8，95%置信区间：1.5 - 2.0）。在报告患有非传染性疾病的个体中，吸烟烟草的使用率显著低于未患疾病的个体（3.5%对8.3%；调整后的患病率比为0.5，95%置信区间：0.3 - 0.9）。接触健康警示对当前烟草使用和无烟烟草使用具有保护作用，而通过媒体接触烟草警示对吸烟者和总体烟草使用者有帮助。
尽管全面禁止烟草，但不丹的烟草使用率仍然很高，尤其是无烟形式。应针对男性（5）、较年轻年龄组和饮酒者采取行为干预措施，并更严格地实施烟草控制措施。 （原文中此处“5”疑似错误，根据前文推测可能是“男性”，译文按推测翻译）
