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A significantly higher mean hemoglobin level in women smokers in comparison to nonsmokers with a generalized rightward shift of the hemoglobin distribution curve has been reported at the population level. Studies on pregnant women, however, have often associated smoking with decreased hemoglobin levels, although not consistently. We examined whether smokeless tobacco use during pregnancy influenced hemoglobin levels in a population-based cohort of 918 pregnant women in Mumbai, India. Mean hemoglobin levels (Hb) were significantly lower in users (10.00 g/dl) compared with nonusers (10.46 g/dl), p<.000. Anemia (Hb<10 g/dl) was significantly associated with smokeless tobacco in the univariate analysis (OR = 1.7, 95% CI 1.2-2.5). There was no change after adjusting odds ratios for potential confounders in multivariate analysis (OR = 1.7, 95% CI 1.2-2.5). The odds ratios for anemia were adjusted for age of mother, education, socioeconomic status, type of residence, lower body mass index, parity, vegetarian or nonvegetarian food habit, and hemodilution during pregnancy. The results suggest that smokeless tobacco use during pregnancy is associated with lower hemoglobin levels, as has often been observed with cigarette smoking. Smokeless tobacco use is widely prevalent among women in Southeast Asia and is gaining popularity across the world as a safe alternative to smoking. Further exploration and clarification of this association is therefore of considerable importance to public health. [ABSTRACT FROM AUTHOR]

Examines the mortality among the reverse chutta smokers in Srikakulam district in South India. Details on the components of chutta; Impact of smoking on the prevalence of oral disease; Comparison on mortality rate between chutta smokers and non-users of tobacco.

Background: Tobacco smoking and binge alcohol drinking are two of the leading risk factors for premature mortality worldwide. In India, studies have examined the geographic distributions of tobacco smoking and alcohol drinking only at the state-level; sub-state variations and the spatial association between the two consumptions are poorly understood. Methodology: We used data from the Special Fertility and Mortality Survey conducted in 1998 to examine the geographic distributions of tobacco smoking and alcohol drinking at the district and postal code levels. We used kriging interpolation to generate smoking and drinking distributions at the postal code level. We also examined spatial autocorrelations and identified spatial clusters of high and low prevalence of smoking and drinking. Finally, we used bivariate analyses to examine the spatial correlations between smoking and drinking, and between cigarette and bidi smoking. Results: There was a high prevalence of any smoking in the central and northeastern states, and a high prevalence of any drinking in Himachal Pradesh, Arunachal Pradesh, and eastern Madhya Pradesh. Spatial clusters of early smoking (started smoking before age 20) were identified in the central states. Cigarette and bidi smoking showed distinctly different geographic patterns, with high levels of cigarette smoking in the northeastern states and high levels of bidi smoking in the central states. The geographic pattern of bidi smoking was similar to early smoking. Cigarette smoking was spatially associated with any drinking. Smoking prevalences in 1998 were correlated with prevalences in 2004 at the district level and 2010 at the state level. Conclusion: These results along with earlier evidence on the complementarities between tobacco smoking and alcohol drinking suggest that local public health action on smoking might also help to reduce alcohol consumption, and vice versa. Surveys that properly represent tobacco and alcohol consumptions at the district level are recommended. [ABSTRACT FROM AUTHOR]

Tobacco use, and in particular smoking, is the largest cause of preventable death among adults in India, as it is globally. Bidi, an indigenous, leaf-rolled cigarette made from coarse sun-cured tobacco, tied with a coloured string at one end, is the dominant form among all smoked products. More than eight to ten bidis are consumed for every cigarette in India. We present mortality estimates from smoking cigarettes and bidis manufactured over the last 100 years in India. There are currently no estimates of mortality, over a period of time, in India that can be directly attributed to cigarettes/bidis manufactured in the country. The objective of this study is to estimate the number of premature deaths that can be attributable to cigarette and bidi manufactured and consumed over the last 100 years in India. Nearly 4.52 trillion cigarettes and 40.3 trillion bidis have been produced between 1910 and 2010, which are estimated to be responsible for nearly 100 million premature deaths (in which bidis contributed 77 million deaths) in adult men of =35 years. Some of these deaths will occur up to the middle of this century. These estimates are derived from the most conservative datasets and yet present alarming mortality estimates. This communication calls for greater emphasis on epidemiological research and a review of existing tobacco control measures in India, which together need to inform measures needed for reducing tobacco use and restricting the proliferation of the tobacco industry. [ABSTRACT FROM AUTHOR]

Background: Reduction in pulmonary function, as estimated by forced expiratory volume in 1 s (FEV(1)), has been found to predict all-cause mortality in developed-country populations. This study was designed to examine the association between FEV(1) and mortality in an urban developing-country population.Methods: Data from the large, well-characterized Mumbai Cohort Study (Maharashtra, India) were used to compute hazard ratios (HRs; deaths/100-ml FEV(1)) and 95% confidence intervals (CIs) from Cox proportional hazards regression models in which age, tobacco use, education, height and relative body weight were controlled.Results: A total of 13,261 deaths occurred in this cohort of 148,173 individuals. After controlling for important covariates, there was a 1.7% reduction in risk of overall death in women for each 100-ml increment in FEV(1) (HR = 0.983; 95% CI = 0.980-0.986) and a 1.5% reduction in men (HR = 0.985; 95% CI = 0.984-0.986). There was a 1.6% reduction in cancer deaths in women (HR = 0.984; 95% CI = 0.973-0.996) and a 0.8% reduction in men (HR = 0.992; 95% CI = 0.987-0.997). The largest reductions in women were observed in tuberculosis deaths (3.7%/100-ml increment in FEV(1)), and in men in respiratory system deaths (3.2%).Conclusions: In a densely populated urban Indian population, FEV(1) predicted overall and cancer mortality. Effects were larger in women and were not attenuated by exclusion of smokers or restricting analyses to subjects dying >2 years from recruitment. Because FEV(1) may be affected by air pollution, which is worsening in urban areas of most developing countries, further research is recommended to deepen understanding of these factors in relation to mortality. [ABSTRACT FROM AUTHOR]

Introduction: The dual use of smoked and smokeless tobacco (SLT) poses a serious challenge to tobacco control efforts. This article examines the trends and patterns of this usage in India during the period 2009-2010 and 2016-2017.Methods: Data from two rounds of nationally representative cross-sectional Global Adult Tobacco Survey (GATS) conducted in 2009-2010 and 2016-2017 have been used. Dual use was assessed based on current smokers and SLT users in both rounds.Results: Findings reveal that dual use in India has dropped from 5.3% during 2009-2010 to 3.4% during 2016-2017, a decline of nearly 10 million dual users. However, some states have added nearly 4.6 million new dual users during this period. While dual use continues to remain high in rural areas, there has been a manifold increase in urban areas. Findings revealed that intention to quit tobacco was lower among dual tobacco users as compared to single users with considerable difference between urban and rural areas.Conclusion: Easy availability and affordability of SLT products compared to smoking products and restrictions on smoking in public places may have pushed current smokers and dual users to take to or intensify their SLT consumption. Measures relating to awareness, pricing, taxation, and enforcement of tobacco control laws should focus on all forms of tobacco, especially targeting high dual burden in rural and urban settings.Implications: Dual form of tobacco users represent 12% of all tobacco users in the country. The study reveals that intention to quit tobacco among dual users is significantly lower than that among single tobacco product users. This requires improving public awareness about the morbidity and mortality that arises from the use of all forms of tobacco products. Efforts to restrict the availability of tobacco products should focus on licensing the sale of all tobacco products. Reduction in dual tobacco use will not only result in multiplied health benefits but also help in achieving the Non-Communicable Diseases targets under the United Nations Sustainable Development Goals. [ABSTRACT FROM AUTHOR]

Objectives: In India, a 2003 law ("COPTA") banned tobacco advertising with the exception of "point of sale" and "on-pack" advertising. Given substantial evidence regarding the impact of point of sale advertising (PoS), we analyzed the prevalence of encountering such advertising in Mumbai, India. Methods: A survey was conducted of 199 current and recent former tobacco users recruited at the Tata Memorial Hospital (Mumbai). Enrollees were queried regarding their exposure to tobacco advertising in the last 30 days through multiple media sources. Descriptive epidemiologic techniques were used to characterize the data. Results: Overall, 95% of participants were men and 5% were women (mean age=49 years). All were current tobacco users or quit using all forms of tobacco in the last 60 days. Participants' responses revealed that PoS tobacco advertising had been encountered in the last 30 days for cigarettes (61%), bidis (54%), and smokeless tobacco (59%). Other forms of tobacco advertising were virtually non-existent. Conclusions: PoS tobacco advertising remains prominent and highly visible to consumers in Mumbai, India, indicating corporate exploitation of a loophole in the COPTA legislation. Given the observed compliance with the currently imposed bans, revisions of COPTA to include all forms of tobacco promotion and advertising would be impactful. [ABSTRACT FROM AUTHOR]

Background India’s Cigarettes and Other Tobacco Products Act bans tobacco sales and advertisements within 100 yards of educational institutions. In schooladjacent neighbourhoods in Mumbai, we assessed adherence to these policies and whether tobacco vendor and advertisement densities were associated with students' tobacco use. Methods High school students' tobacco use was measured using a multistage cluster sampling survey (n=1533). Field geographic information systems data were obtained for all tobacco vendors and advertisements within 500 m of schools (n=26). Random-effects multilevel logistic regression was used to estimate associations of tobacco vendor and advertisement densities with ever tobacco use, current smokeless tobacco use and current tobacco use. Results There were 1741 tobacco vendors and 424 advertisements within 500 m of schools, with 221 vendors (13%) and 42 advertisements (10%) located within 100 m. School-adjacent tobacco vendor density within 100 m was not associated with the tobacco use outcomes, but tobacco advertisement density within 100 m was associated with all outcomes when comparing highest to lowest density tertiles: ever use (OR: 2.01; 95% CI 1.00 to 4.07), current use (2.23; 1.16, 4.28) and current smokeless tobacco use (2.01; 1.02, 3.98). Tobacco vendor density within 200, 300, 400 and 500 m of schools was associated with current tobacco use and current smokeless tobacco use, but not ever use. Conclusions The tobacco sales ban near educational institutions could be expanded beyond 100 m. Greater enforcement is needed regarding the current bans, particularly because advertisement density within 100 m of schools was associated with all students' tobacco use outcomes. [ABSTRACT FROM AUTHOR]

Background: Over 75% of the annual estimated 9.5 million deaths in India occur in the home, and the large majority of these do not have a certified cause. India and other developing countries urgently need reliable quantification of the causes of death. They also need better epidemiological evidence about the relevance of physical (such as blood pressure and obesity), behavioral (such as smoking, alcohol, HIV-1 risk taking, and immunization history), and biological (such as blood lipids and gene polymorphisms) measurements to the development of disease in individuals or disease rates in populations. We report here on the rationale, design, and implementation of the world's largest prospective study of the causes and correlates of mortality.Methods and Findings: We will monitor nearly 14 million people in 2.4 million nationally representative Indian households (6.3 million people in 1.1 million households in the 1998-2003 sample frame and 7.6 million people in 1.3 million households in the 2004-2014 sample frame) for vital status and, if dead, the causes of death through a well-validated verbal autopsy (VA) instrument. About 300,000 deaths from 1998-2003 and some 700,000 deaths from 2004-2014 are expected; of these about 850,000 will be coded by two physicians to provide causes of death by gender, age, socioeconomic status, and geographical region. Pilot studies will evaluate the addition of physical and biological measurements, specifically dried blood spots. Preliminary results from over 35,000 deaths suggest that VA can ascertain the leading causes of death, reduce the misclassification of causes, and derive the probable underlying cause of death when it has not been reported. VA yields broad classification of the underlying causes in about 90% of deaths before age 70. In old age, however, the proportion of classifiable deaths is lower. By tracking underlying demographic denominators, the study permits quantification of absolute mortality rates. Household case-control, proportional mortality, and nested case-control methods permit quantification of risk factors.Conclusions: This study will reliably document not only the underlying cause of child and adult deaths but also key risk factors (behavioral, physical, environmental, and eventually, genetic). It offers a globally replicable model for reliably estimating cause-specific mortality using VA and strengthens India's flagship mortality monitoring system. Despite the misclassification that is still expected, the new cause-of-death data will be substantially better than that available previously. [ABSTRACT FROM AUTHOR]

Background: Exposure to mass media may impact the use of tobacco, a major source of illness and death in India. The objective is to test the association of self-reported tobacco smoking and chewing with frequency of use of four types of mass media: newspapers, radio, television, and movies. Methodology/Principal Findings: We analyzed data from a sex-stratified nationally-representative cross-sectional survey of 123,768 women and 74,068 men in India. All models controlled for wealth, education, caste, occupation, urbanicity, religion, marital status, and age. In fully-adjusted models, monthly cinema attendance is associated with increased smoking among women (relative risk [RR]: 1?55; 95% confidence interval [CI]: 1·04-2·31) and men (RR: 1·17; 95% CI: 1·12-1·23) and increased tobacco chewing among men (RR: 1·15; 95% CI: 1·11-1·20). Daily television and radio use is associated with higher likelihood of tobacco chewing among men and women, while daily newspaper use is related to lower likelihood of tobacco chewing among women. Conclusion/Significance: In India, exposure to visual mass media may contribute to increased tobacco consumption in men and women, while newspaper use may suppress the use of tobacco chewing in women. Future studies should investigate the role that different types of media content and media play in influencing other health behaviors. [ABSTRACT FROM AUTHOR]

Background: In India, tobacco use during pregnancy is not routinely addressed during antenatal care. We measured the association between tobacco use and anemia in low-income pregnant women, and identified ways to integrate tobacco cessation into existing antenatal care at primary health centers. Methods: We conducted an observational study using structured interviews with antenatal care clinic patients (n = 100) about tobacco use, anemia, and risk factors such as consumption of iron rich foods and food insecurity. We performed blood tests for serum cotinine, hemoglobin and ferritin. We conducted in-depth interviews with physicians (n = 5) and auxiliary nurse midwives (n = 5), and focus groups with community health workers (n = 65) to better understand tobacco and anemia control services offered during antenatal care. Results: We found that 16% of patients used tobacco, 72% were anemic, 41% had iron deficiency anemia (IDA) and 29% were food insecure. Regression analysis showed that tobacco use (OR = 14.3; 95%CI = 2.6, 77.9) and consumption of green leafy vegetables (OR = 0.6; 95%CI = 0.4, 0.9) were independently associated with IDA, and tobacco use was not associated with consumption of iron-rich foods or household food insecurity. Clinics had a system for screening, treatment and follow-up care for anemic and iron-deficient antenatal patients, but not for tobacco use. Clinicians and community health workers were interested in integrating tobacco screening and cessation services with current maternal care services such as anemia control. Tobacco users wanted help to quit. Conclusion: It would be worthwhile to assess the feasibility of integrating antenatal tobacco screening and cessation services with antenatal care services for anemia control, such as screening and guidance during clinic visits and cessation support during home visits. [ABSTRACT FROM AUTHOR]