Tobacco control policies in India were unable to address inequities in Tobacco-related harm

Introduction

The Global Adult Tobacco Survey (GATS) India 2016–17 has shown that increased regulations over time impacted tobacco use culture, which opened the doors for further regulation, making it an iterative process. But do the ‘tobacco control policies’ reach till most deprived sections of society? This paper tries to answer this question.

Methods

In this paper, the relative reduction in tobacco use prevalence is seen (from 2009 to 10 to 2016–17) across different levels of material deprivation and educational attainment. The relative reduction in prevalence/ use of various forms of smoking and smokeless tobacco products was also studied.

Material Deprivation as a new index was computed, where the weightage was given to various variables related to household ownership of various material things as available in data sets of GATS Survey. The recoded variables were then added and further categorised into six levels of material deprivation where Level 1 corresponds to least deprived and Level 6 corresponds to most deprived.

The relative reduction in the prevalence of tobacco use was calculated with the formula [(P1-P2)/P1]*100, where P1 is the prevalence of tobacco use (smoking or smokeless) during GATS1 (2009–10), and P2 is the prevalence of tobacco use (smoking or smokeless) during GATS2 (2016–17).

Results

It has been shown that the higher the level of material deprivation, the lesser the relative reduction in the prevalence of tobacco use. The relative reduction in tobacco use was more for higher levels of educational attainment. It has been found that relative reduction is more for smoking products as compared to smokeless tobacco (SLT) products. Khaini and Bidis are emerging as popular products, which are least regulated by existing tobacco control policies.

Conclusion

The reduction in the prevalence of tobacco use from GATS1 to GATS2 is inequitous across levels of material deprivation and levels of educational attainment by individuals. Also, there is a tendency for product substitution among tobacco users.