Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States
Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States.
BMJ Open. 2020 Jun 30;10(6):e037202. doi: 10.1136/bmjopen-2020-037202.
Having the world's second-largest tobacco-consuming population, tobacco control is a priority agenda of the Indian Government. Yet, there is no evidence of how peer influence and nature of social relationships-defined as social capital-affect tobacco use. This study aimed to explore the role of social capital and peer influence on tobacco consumption among household heads in rural Uttar Pradesh (UP), India.
This study was embedded within the baseline evaluation of Project Samuday. A cross-sectional multistage cluster survey was implemented in six census blocks of Hardoi and Sitapur districts of UP from June to August 2017. Self-reported tobacco consumption status of randomly selected 6218 household heads (≥18 years; men vs women=5312 vs 906) was assessed from 346 rural communities. Peer influence of tobacco use was measured by the non-self cluster proportion of tobacco consumption among respondents. Community engagement, social support, trust and social cohesion were separately measured as unique facets of social capital both at individual and community levels using the Shortened Adapted Social Capital Assessment Tool in India (SASCAT-I). The explanatory power of covariates was assessed using gender-stratified generalised estimating equations (GEE) with robust-variance estimator.
Tobacco consumption patterns were starkly different for men and women (71% vs 14%). The peer influence only affected men (adjusted odds ratio (AOR)=1.10, 95% CI: 1.05 to 1.16, p<0.01), whereas women were more likely to consume tobacco if they were more engaged with community organisations (AOR=1.33, 95% CI=1.07 to 1.66, p<0.01).
Gender alters the way social engagement affects tobacco use in rural India. Countering peer influence on Indian men should be prioritised as a tobacco control strategy. Moreover, as gender mainstreaming is a critical egalitarian agenda in India, further research is needed to understand how social engagement affects tobacco consumption behaviours among women.
印度拥有世界上第二大烟草消费人群，因此控烟是印度政府的首要任务。然而，目前尚无证据表明同伴影响和社会关系的性质（即社会资本）如何影响烟草使用。本研究旨在探讨社会资本和同伴影响在印度北方邦（UP）农村家庭户主烟草消费中的作用。
本研究嵌入在 Samuday 项目的基线评估中。2017 年 6 月至 8 月，在 UP 的 Hardoi 和 Sitapur 区的六个普查块内实施了一项横断面多阶段聚类调查。从 346 个农村社区中随机选择了 6218 名（≥18 岁；男性与女性比例为 5312 比 906）家庭户主，评估其烟草消费状况。烟草使用的同伴影响通过受访者中非自我集群的烟草消费比例来衡量。使用印度简化适应社会资本评估工具（SASCAT-I），分别在个人和社区层面上，将社区参与度、社会支持、信任和社会凝聚力作为社会资本的独特方面进行单独测量。使用性别分层广义估计方程（GEE）和稳健方差估计器评估协变量的解释力。
男性和女性的烟草消费模式差异很大（71%比 14%）。同伴影响仅影响男性（调整后的优势比（AOR）=1.10，95%置信区间：1.05 至 1.16，p<0.01），而如果女性更多地参与社区组织，她们更有可能吸烟（AOR=1.33，95%置信区间=1.07 至 1.66，p<0.01）。
性别改变了社会参与影响印度农村烟草使用的方式。遏制印度男性的同伴影响应作为控烟策略的重点。此外，由于性别主流化是印度的一个关键平等议程，因此需要进一步研究了解社会参与如何影响女性的烟草消费行为。
