Centre for Tobacco Control and Health Promotion, Public Health Foundation of India, New Delhi, India.
Department of Epidemiology and Public Health, University College London, London, UK.
Nicotine Tob Res. 2017 Nov 7;19(12):1516-1520. doi: 10.1093/ntr/ntw214.
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.
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.
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.
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.
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.
在许多国家，使用烟草的社会阶层差异明显，社会经济地位较低的人更有可能使用烟草。目前尚不清楚在极度贫困的社区中，这种阶层差异有多明显。本研究评估了职业（社会经济地位的标志）与印度德里“贫民窟”地区使用吸烟和无烟烟草之间的关联。
2012 年对 28 个低收入社区（14 个政府授权和 14 个非授权定居点，称为“Jhuggi-Jhopri/JJ”集群）的 11888 户家庭进行了普查，共涉及 30655 名成年人。该调查评估了年龄、性别、家庭规模、职业群体和当前的烟草使用情况。使用复杂样本回归分析，按性别分层，对与烟草使用相关的独立因素进行了分析。
四分之一的参与者（24.3%，95%置信区间[CI]21.5-27.5）使用任何烟草。使用吸烟（14.6%，95%CI12.9-16.3）的人略多于使用无烟烟草（12.6%，95%CI10.7-14.8）的人，而少数人同时使用两种烟草（2.7%，95%CI2.1-3.5）。任何烟草使用的患病率在非熟练（45.13%，95%CI42.4-47.9）和熟练（46.2%，95%CI41.1-51.4）体力劳动者中最高，在非体力劳动者（30.3%，95%CI26.2-34.7）和失业者（29.0%，95%CI25.3-33.0）中最低。这在男性的调整分析中得到了证实，但在女性中，关联更为复杂。
在印度低收入城市社区中，吸烟和无烟烟草的使用与职业状况密切相关，非体力劳动职业和失业都与男性吸烟和无烟烟草使用的低流行率有关。
高收入国家的烟草使用与社会阶层、收入和贫困程度呈强烈负相关，因此，那些最负担不起烟草的人使用烟草的情况更为普遍。本研究首次在印度低收入社区的背景下研究了这种社会阶层差异，发现非体力劳动职业和失业都与男性烟草使用率较低有关。这些数据对现有的社会阶层差异解释提出了挑战，需要进一步考虑在何种条件下，负担能力可能有助于减少因使用烟草而产生的健康不平等。
