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Aim: This paper examines the pattern, growth and determinants of household health spending in India and compares the growth of per capita household health spending and per capita consumption expenditure over the last two decades. Subject and methods: The unit data of various rounds of the National Sample Survey (consumption expenditure surveys 1993-1994, 2004-2005 and 2011-2012 and morbidity and health care surveys 1995-1996 and 2004) along with data from other secondary sources are used in the analyses. The patterns and growth of health spending are analyzed by demographic, social and economic attributes and economic well-being is measured using per capita consumption expenditure. Household health spending is subdivided into age structure, population growth, real cost of medical care and increased hospitalization. Descriptive statistics, fixed effect models and simple decomposition methods are used in the analyses. Results: Results suggest that during 1993-2012, the annual growth rate of real per capita household health spending was twice (6.14 %) the real per capita consumption expenditure (2.60 %). On average, per capita household health spending among the richest consumption quintile was at least eight times higher than that of the poorest consumption quintile, linking household health spending to ability to pay. Household health spending was income inelastic. Though medicine accounts for a larger share of household health spending, household spending on medical tests is growing fast. We found a strong and positive gradient of age on per capita household health spending after controlling for income and other confounders. During 1995-2004, the age structure, hospitalization and real cost of hospitalization accounted for a 14, 42 and 26 % increase in the cost of hospitalization respectively. Conclusion: Household health spending is growing faster than the consumption expenditure (economic well being) of household and changing age structure is significantly affecting health spending in India. Increased public spending on health, upgrading the public health system and increasing access to health insurance can reduce the household health spending in India. [ABSTRACT FROM AUTHOR]

This paper examines the role of observed contextual factors like topography, development and literacy on severe malnutrition among social groups in rural Maharashtra based on the Reproductive and Child Health District Level Household Survey (RCH-DLHS) Round II (2002-04) data. Multilevel modelling techniques were applied in order to examine the district-wise variations in severe malnutrition associated with the characteristics of the places (contextual effects), as the relationships with the type of people (compositional effects) have already been well established. The results show that developmental aspects such as road connectivity, community literacy, toilet facilities and household standard of living contribute positively to the status of severe malnutrition. Also, the scheduled tribe, aboriginal underprivileged group are more at risk of severe malnourishment due to a lack of proper development, poor awareness about maintaining and enhancing the nutritional value of food and lack of hygiene and sanitation as compared with the scheduled castes, another aboriginal group. [ABSTRACT FROM AUTHOR]

Background: Type 2 diabetes mellitus (T2DM) is a prevalent metabolic disorder characterized by hyperglycemia and insulin resistance. Its incidence is increasing globally, with a significant impact on public health. Smokeless tobacco (SLT) is a form of tobacco consumption that has been associated with various health risks, including potential effects on glucose homeostasis. This case-control study aimed to investigate the association between SLT use and T2DM. Additionally, the study aimed to assess the relationship of age, gender, socioeconomic status (SES), body mass index (BMI), family history of diabetes, physical activity, and periodontal status with T2DM participants., Methods: The study was conducted over 24 months and included 82 T2DM cases and 164 non-diabetic controls. Demographic data, tobacco use, medical history, oral hygiene habits, BMI, and periodontal status were collected through a self-administered questionnaire and interviews. Statistical analyses were performed using Statistical Package for Social Sciences (SPSS) for Windows 26.0 (SPSS, Inc. Chicago, Illinois)., Results: The majority of T2DM cases were in the age group of 31-50 years, and there was a significant association between gender and T2DM, with more males being diabetic. There was no significant association between SES and diabetes. Obesity was found to be a significant risk factor for T2DM. Among SLT users, gutkha was the most commonly used product. SLT use was significantly associated with T2DM. Family history of diabetes and physical inactivity were also significantly associated with diabetes., Conclusion: The study suggests that SLT use is a risk factor for T2DM and may be associated with increased diabetes risk. Further research is warranted to understand the underlying mechanisms and potential interventions to reduce the impact of SLT on diabetes risk.

Introduction: Interdental aids such as dental floss and water flossers have been found to be effective in removing interdental plaque. This systematic review aimed to compare the available data on the efficacy of dental floss and water flossers in plaque removal among adults., Materials and Methods: Five databases: PubMed, Scopus, Cochrane, ScienceDirect, Lilac, and Google Scholar were searched from January 1, 2002, to October 31, 2022, to obtain the relevant articles. Based on the search strategy, the titles of the studies were screened independently by two reviewers. Randomized controlled trials were included in the review, in which the study participants were given either dental floss or water flosser. Reduction in plaque scores was the outcome that was assessed. Seven articles met the eligibility criteria and were further processed for qualitative analysis., Results: The majority of the studies favored water flossers over dental floss in plaque reduction. Water flosser was also found to be effective in removing plaque from inaccessible interproximal areas of the tooth surfaces as compared to dental floss., Conclusion: Based on the scope of this review, results suggest that water flossers can be used as an effective alternative to dental floss in patients with manual dexterity, patients undergoing orthodontic treatment, and patients with dental prostheses., Competing Interests: There are no conflicts of interest., (Copyright: © 2024 Indian Society of Periodontology.)

Background: Establishment of Tobacco Cessation Centres across all dental institutions has been made mandatory by the Dental Council of India. To make it a success, adequate knowledge and training, positive attitude and practices are expected by the dental health care professionals. Our study aims to assess the knowledge, attitude and practices of dentists towards Tobacco Cessation Counselling (TCC) and Nicotine Replacement Therapy (NRT)., Materials and Methods: 200 participants (60 faculty members, 20 postgraduate students and 120 interns) participated in this cross-sectional study. A self-designed questionnaire of 27 questions was used to assess the knowledge, attitude and practices of the participants regarding TCC and NRT. A descriptive analysis of the data was done. Frequency and percentage were calculated for each variable. The data were processed and analysed using SPSS software version 19-SPSS Inc. Chicago, IL, USA., Results: 22% candidates were trained for TCC as opposed to 78% candidates who didn't have an idea about it. 65% participants knew about various agents which are used for NRT but many did not know how to prescribe them. 83.5% were not willing to spare time for tobacco cessation in their private practice. Only 12% were currently practising TCC or NRT at workplace., Conclusion: Inclusion of TCC in the undergraduate curriculum, training and updating of dental faculty and students regarding TCC and NRT will help in serving the noble cause., Competing Interests: There are no conflicts of interest., (Copyright: © 2023 Journal of Family Medicine and Primary Care.)

Background: Dental education is considered a challenging and taxing program as on successful completion one is required to attain unique and diverse competencies. There is an established perception that students do not enjoy their experiences in the dental institution and they always demand for certain amendments. Therefore, a dental education perceptions and metacognition assessment tool (DEPMAT) was developed for Indian undergraduate and postgraduate dental students for assessing their learning in Deemed University versus Maharashtra University of Health Sciences in Pune, Maharashtra., Materials and Methods: This cross-sectional study was conducted among students of four dental colleges of two types of universities in Pune, India, using a 31-item DEPMAT based on Dundee Ready Education Environment Measure and metacognition awareness inventory using five subscales. Psychometric properties were also tested for this new tool. Data were analyzed using the SPSS software., Results: Of 512 participants, 498 (96.88%) students had duly returned the questionnaire. Cronbach's alpha coefficient value for reliability was found to be 0.87 which indicated good internal consistency and test-retest reliability was found to be k w = 0.76, which indicated substantial agreement. Significant difference was found among undergraduates in domains regarding their perception toward academics, infrastructure and learning environment, and health and stress., Conclusion: This study suggested that the general perception toward learning among final year postgraduate students was positive in both the universities. However, the perception of final year undergraduates toward learning was negative and students have suggested certain amendments in both the universities. This study also suggested the new tool was effective in assessing the attitude of practice of both undergraduate and postgraduate students., Competing Interests: There are no conflicts of interest., (Copyright: © 2022 Journal of Education and Health Promotion.)

Objectives: The present study was conducted to assess the clinical efficacy (against plaque and gingivitis) and antimicrobial efficacy (against gram negative, gram positive and S. mutans counts) of T. cordifolia (Guduchi)., Methodology: A nonrandomized before and after trial for 21 days of intervention was performed involving 17 participants. Plaque index, gingival index were recorded and saliva samples were collected at baseline, 13 th day and 22 nd day. Repeated measures ANOVA test was performed to compare the before and after results of the clinical parameters, i.e. score of plaque index and gingival index. Freidman's test was applied for comparison between the three intervals (for microbiological evaluation of colony counts)., Results: There was statistically significant reduction inplaque score, gingival score, and colony forming units of gram negative organisms and S. mutans from baseline to 22 nd day (P = 0.001). There was no significant reduction with gram positive organisms., Conclusion: This clinico-microbiological study concluded that twice rinsing of T.cordifolia decoction as mouth rinse in adjunct to scaling and routine brushing of teeth for 21 days shows anti-plaque, anti-gingivitis, and antimicrobial action against gram negative organisms and S. mutans., Competing Interests: None

Background: This study examines associations between sex composition of older siblings and infant mortality by sex, to guide efforts to address excess female infant mortality in India., Methods: We conducted a retrospective cross-sectional study of infant mortality in India using four waves of data from the nationally-representative National Family Health Survey, collected between 1992 and 2016 (unweighted N = 338,504 for children aged 1-5). We used sex-stratified multivariable logistic regression models to assess the associations between sex composition of older siblings and risk of infant mortality., Findings: Male infants with two living older sisters and no living older brothers had lower odds of infant mortality relative to those with one living older brother (e.g., 2015-16 AOR 0.62, 95% CI 0.50-0.76); this effect was significant for boys across all waves of data but was not seen for girls in any wave. Exploratory models focused on third order births found that boys were less likely than girls to die in infancy if born subsequent to two older sisters (2015-16 AOR 0.48, 95% CI 0.31-0.74); analysis of crude prevalence data indicated that this converts into a 64% greater risk for infant mortality for girls relative to boys in this third-order group., Interpretation: Higher birth order males with older sisters have greater protection against infant mortality, a finding that has persisted for over 25 years. To address ongoing gender inequities in infant survival in India, greater focus is needed to support higher birth order girls and social norm movements against son preference., (© 2019 Published by Elsevier Ltd.)

Introduction: There is an evidence of increasing inpatient expenditure for decedents. Estimates used to assess the economic burden of out-of-pocket (OOP) healthcare expenditure provide an underestimation for inpatient decedent cases. The aims of this paper are to study the trend and pattern of inpatient decedent expenditure and decipher the reasons behind the increasing cost in India., Methods: Using three rounds of national level National Sample Survey (NSS) data on morbidity & healthcare conducted during 1995-2015 in India, total and component-wise cost of dying was estimated by the socio-demographic characteristics and types of diseases. Generalised linear model was employed to find the changing effect of inpatient decedents on inpatient expenditure on three-time points., Results: More than half among inpatient decedents were elderly. Mean inpatient expenditure for neoplasm, circulatory system-related diseases and external causes of mortality and morbidity increased substantially during these two decades. Mean decedent inpatient expenditure become double, diagnostic and bed charges increased by 243%, 323% respectively during 2004-05 to 2014-15. During 2014-15 average decedents aged 15-59 years spent ₹53599 in last twelve month of their life. Controlling all other potential factors, the inpatient expenditure among decedents increased substantially between 1995-96 and 2014-15., Discussion: Out-of-pocket inpatient health expenditure widened between survivor and decedents in between 1995-2014. Increase in the proportion of elderly, proportion of non-communicable and lifestyle-related diseases, expenses on drugs, diagnostics, bed charges largely private sector expenses were the leading reasons for increasing inpatient decedent expenditure. Age-based risk adjustment and modification of end-of-life care are strongly required, future social insurance based on the health-based value of out-of-pocket expenditure rather than their pure consumption value need to be designed to tackle the burden., Competing Interests: The authors have declared that no competing interests exist.

Introduction: Tobacco epidemic is one of the biggest public health threats the world has ever faced. Tobacco use is a significant public health problem worldwide and the single-most preventable risk of human health. Mass media anti-tobacco advertisements can reach large sections of the society and increase awareness about the harms of tobacco use and increase quit attempts., Methodology: This cross-sectional study was conducted to find out the awareness of anti-tobacco advertisements and to assess the influence of anti-tobacco advertisements among 16 to 18-year-old students in Belgaum city. A self-structured, close-ended, 26-item questionnaire was distributed to 600 preuniversity students. The questionnaire consisted of sociodemographic data, tobacco usage status, questions related to awareness about anti-tobacco advertisements, and influence of anti-tobacco advertisements on attitude toward tobacco use. Frequency distributions and percentages were examined for each item and Chi-square test was used., Results: Majority of the study participants (89.4% males and 86.7% females) were aware of the anti-tobacco advertisements. Television and movie theaters were considered as the most effective means for anti-tobacco advertisements. Nearly 90.8% had noticed the statutory warning which is shown during tobacco products' usage on television/movies. Almost 78.35% of males and 90.6% of females had a positive change in attitude toward tobacco use due to influence of anti-tobacco advertisements., Conclusion: There is an increased awareness on anti-tobacco and this has been proved to be effective in motivating them to quit tobacco as well as stop them from initiating tobacco use., Competing Interests: There are no conflicts of interest.

Aim: Women, unlike men, are subjected to triple burden of disease, namely, non-communicable and communicable diseases and reproductive health related diseases. To assess prevalence of triple burden of disease of currently married women and to contrast out of pocket maternal care expenditure of these diseases in India., Subject and Methods: This study uses nationally representative unit level data from the 71st round (2014) of the National Sample Survey Organisation. Descriptive statistics and bivariate analysis are employed to assess triple burden of diseases by background of currently married women. Mean out of pocket (OOP) expenditure for healthcare care by demographic and household characteristics of women are also compared by type of diseases. Two parts model is adopted for assessment of determents of out of pocket healthcare expenditure of women., Results: Overall medical and non-medical expenses of non-communicable disease are much higher than those of other disease and disability, reproductive health related and communicable diseases. OOP expenditure for treatment of non-communicable diseases, reproductive health and related diseases and other disease and disability are significantly higher than the inpatient treatment of communicable diseases and the differences are statistically significant., Conclusion: Out of pocket expenditure for treatment of non-communicable diseases is the highest, followed by that of other diseases & disability, then reproductive health related diseases and the least is for communicable diseases. OOP expenditures for maternal healthcare in private health facilities are much higher than in public health facilities regardless of types of disease. Women from households having insurance of any member spent less than that of women from households not having health insurance. There is an urgent need to expand the outreach of the public health system in India to rural areas.

This study is an assessment of the influence of parent's tobacco use on prospective tobacco use trajectories among young offspring. The study is based on unit level data from District Level Household and Facility Survey-4 (2012-2013) comprising 27,706 youths in 15-24 years' age group from northeastern states of India and used multilevel regression to identify the potential risk factors of tobacco consumption. The likelihood of using tobacco was found to be 3.4 and 1.14 times more, respectively, for the youths coresiding with mothers who use tobacco and fathers who use tobacco, in comparison to youths staying with parents not taking tobacco. The significant effect of peers on tobacco consumption among youths was also observed. School-going youths had significantly lower risk of tobacco use. The estimated likelihood of a young person from a household to use any tobacco, use smokeless tobacco, and smoke was found to be 28, 12, and 17 percent, respectively. There is an urgent need to extend National Tobacco Control Programme (NTCP) to the community level involving civil societies and young and adult generations for spreading awareness about the health hazards of tobacco use, providing support and facilitating quitting tobacco use.

Background: Visually impaired people encounter numerous challenges in their daily life which makes it a cumbersome task to pay special attention to oral health needs. Furthermore, there is little knowledge about oral health practices among caretakers and visually impaired individuals, due to which oral health is often neglected when compared to the general health. Hence, there was a need to educate visually challenged individuals about oral hygiene practices in a customized format so that the comprehension of brushing techniques could be conveyed at its best., Materials and Methods: The present study was a randomized control trial of sixty visually impaired adolescents who were divided into three groups of 20 each. In Group 1, Braille was used, whereas in Group 2, audio-tactile performance (ATP) technique and in Group 3, a combination of both the methods were used to teach tooth brushing as a part of oral health education. Pre- and post-plaque index score using Silness and Loe (1967) after health education were calculated and tabulated for statistical analysis., Results: The postintervention mean plaque index score increased in Group 1 from 29.45 to 42.98, whereas the mean plaque score decreased in Groups 2 and 3 from 30.83-29.9 to 30.23-18.73, respectively. Intergroup comparison of postplaque index score using Kruskal-Wallis and ANOVA analysis showed significant difference among all three study groups., Conclusion: The combination of Braille and ATP technique of health education served as the most effective medium to teach oral hygiene methods to visually impaired adolescents., Competing Interests: There are no conflicts of interest.

Early life disparity - defined as the average life years lost due to death by the age of 60 years - can be used to assess more systematically the effect of savings from death at a young age. In addition, it can give valuable insight into the consequences of death in the early stages of life. Early life disparity can further be categorized into child life disparity (0-14 years) and adult life disparity (15-60 years). This study estimated early life disparity using complete life tables for the period 1970-1975 to 2006-2010, which were constructed from abridged life tables and death rates provided by the Sample Registration System (SRS) in India. The contribution of premature deaths to the difference in life disparity was estimated using a replacement algorithm. The findings clearly indicated an overall declining trend in early life disparity in India, with a notable reduction in child life disparity, and a deceleration of adult life disparity during the period 1970-1975 to 2006-2010. Interstate variations in early life disparity were seen to converge with time. Decomposition analysis suggested that these variations could be minimized further by averting death during childhood.

Objectives: This goal of this study was to shed light on the ecological context as a potential determinant of the infant mortality rate in nine high-focus states in India., Methods: Data from the Annual Health Survey (2010-2011), the Census of India (2011), and the District Level Household and Facility Survey 3 (2007-08) were used in this study. In multiple regression analysis explanatory variable such as underdevelopment is measured by the non-working population, and income inequality, quantified as the proportion of households in the bottom wealth quintile. While, the trickle-down effect of education is measured by female literacy, and investment in health, as reflected by neonatal care facilities in primary health centres., Results: A high spatial autocorrelation of district infant mortality rates was observed, and ecological factors were found to have a significant impact on district infant mortality rates. The result also revealed that non-working population and income inequality were found to have a negative effect on the district infant mortality rate. Additionally, female literacy and new-born care facilities were found to have an inverse association with the infant mortality rate., Conclusions: Interventions at the community level can reduce district infant mortality rates.

This study proposes a well-being index of older adults which integrates five domains, namely, activities of daily living, health status, psychological strength, life accomplishment and social ties, and examines potential socio-demographic, living arrangement, lifestyle and religiosity determinants of well-being. The present study uses micro data of 1255 older adults from the recent pilot survey for the Longitudinal Aging Study in India (LASI) conducted in 2010. The results suggest that normal activities of daily life, health, and social ties decline with advancing age, while life accomplishment remains stable over age. However, when all domains are integrated, well-being tends to fade out with advancing age. While smoking has a deterrent effect on well-being, better economic status, literacy, living in a joint family with spouse, religiosity, and regular physical exercise have a statistically significant positive effect on the well-being of older adults in India.

This study aims to examine the inter-district and inter-village variation of utilization of health services for institutional births in EAG states in presence of rural health program and availability of infrastructures. District Level Household Survey-III (2007-08) data on delivery care and facility information was used for the purpose. Bivariate results examined the utilization pattern by states in presence of correlates of women related while a three-level hierarchical multilevel model illustrates the effect of accessibility, availability of health facility and community health program variables on the utilization of health services for institutional births. The study found a satisfactory improvement in state Rajasthan, Madhya Pradesh and Orissa, importantly, in Bihar and Uttaranchal. The study showed that increasing distance from health facility discouraged institutional births and there was a rapid decline of more than 50% for institutional delivery as the distance to public health facility exceeded 10 km. Additionally, skilled female health worker (ANM) and observed improved public health facility led to significantly increase the probability of utilization as compared to non-skilled ANM and not-improved health centers. Adequacy of essential equipment/laboratory services required for maternal care significantly encouraged deliveries at public health facility. District/village variables neighborhood poverty was negatively related to institutional delivery while higher education levels in the village and women's residing in more urbanized districts increased the utilization. "Inter-district" variation was 14 percent whereas "between-villages" variation for the utilization was 11 percent variation once controlled for all the three-level variables in the model. This study suggests that the mere availability of health facilities is necessary but not sufficient condition to promote utilization until the quality of service is inadequate and inaccessible considering the inter-districts variation for the program implementation.

Assessment of the health status of the older adults can go a long way in controlling the disease burden and monitoring the path to healthy aging in India. In the absence of a population-based clinical survey to collect data on morbidities and other health conditions through biomarkers, self-rated health by nationally representative older population is used for understanding factors contributing to the gender differential in health status. Socioeconomic status is the most important factor explaining 59% of the gender gap in self-assessed health among older adults. The vulnerability of older women in terms of educational attainment, occupational status, and economic dependency is responsible for the higher level of poor self-assessed health. The gender gap in self-assessed poor health among older Indian adults, which perpetuates over the life course resulting in severe health disadvantages at old age can be reduced considerably through social empowerment and gender sensitive public policies., (© The Author(s) 2013.)

Context: Facial measurements serve as a valuable tool in the treatment planning of maxillofacial rehabilitation, orthodontic treatment, and orthognathic surgeries. The esthetic guidelines of face are still based on neoclassical canons, which were used in the ancient art. These canons are considered to be highly subjective, and there is ample evidence in the literature, which raises such questions as whether or not these canons can be applied for the modern population., Aims: This study was carried out to analyze the facial features of Indian and Malaysian women by using three-dimensional (3D) scanner and thus determine the prevalence of neoclassical facial esthetic canons in both the groups., Subjects and Methods: The study was carried out on 60 women in the age range of 18-25 years, out of whom 30 were Indian and 30 Malaysian. As many as 16 facial measurements were taken by using a noncontact 3D scanner., Statistical Analysis Used: Unpaired t-test was used for comparison of facial measurements between Indian and Malaysian females. Two-tailed Fisher exact test was used to determine the prevalence of neoclassical canons., Results: Orbital Canon was prevalent in 80% of Malaysian women; the same was found only in 16% of Indian women (P = 0.00013). About 43% of Malaysian women exhibited orbitonasal canon (P = 0.0470) whereas nasoaural canon was prevalent in 73% of Malaysian and 33% of Indian women (P = 0.0068)., Conclusions: Orbital, orbitonasal, and nasoaural canon were more prevalent in Malaysian women. Facial profile canon, nasooral, and nasofacial canons were not seen in either group. Though some canons provide guidelines in esthetic analyses of face, complete reliance on these canons is not justifiable.

Household risk factors affecting child health, particularly malnutrition, are mainly basic amenities like drinking water, toilet facility, housing and fuel used for cooking. This paper considered the collective impact of basic amenities measured by an index specially constructed as the contextual factor of child malnutrition. The contextual factor operates at both the macro and micro levels namely the state level and the household level. The importance of local contextual factors is especially important when studying the nutritional status of children of indigenous people living in remote and inaccessible regions. This study has shown the contextual factors as potential factors of malnutrition among children in northeast India, which is home to the largest number of tribes in the country. In terms of macro level contextual factor it has been found that 8.9 per cent, 3.7 per cent and 3.6 per cent of children in high, medium and low risk households respectively, are severely wasted. Lower micro level household health risks, literate household heads, and scheduled tribe households have a negating effect on child malnutrition. Children who received colostrum feeding at the time of birth and those who were vaccinated against measles are also less subject to wasting compared to other children, and these differences are statistically significant.

Objectives: To access knowledge and practices related to the oral health of geriatrics among the health care providers practicing in urban and rural areas., Background: Older adults have identified a number of barriers that contribute to lack of dental service use. However, barriers that clinicians encounter in providing dental treatment to older adults are not as clear-cut., Materials and Methods: 236 health professionals (of allopathy, ayurveda, and homeopathy) from urban and rural areas were assessed by means of structured questionnaire related to oral health practices and beliefs., Results: Doctors practicing in urban areas assessed dental care needs more frequently (P = 0.038) and performed greater practices related to oral health of geriatrics (P = 0.043) than the doctors practicing in primary health care (PHC) centers (rural) (P = 0.038)., Conclusion: Owing to the relative lack of knowledge among rural practitioners, there is a need to integrate primary health care with oral care in rural areas.

Objectives: This study assessed the significance of socio-demographic and contextual factors on the number of daily cigarette and bidi smoking in northeast India., Methods: This study is based on the data from the Global Adult Tobacco Survey-India (2009-2010). Community asset is measured as the totality of all households' durables and community affinity to smoking as the proportion of households which allowed smoking in the house., Results: High daily cigarette and bidi smokers constitute 20 and 30 % of the respective smokers and they smoke 35.8 cigarettes and 14.6 bidis daily, respectively, on the average. The higher is the community affinity to smoking, the higher is the intensity of smoking among the high daily cigarette smokers. Advancing age and educational attainment have significant deterrent effect on the intensity of cigarette and bidi smoking., Conclusions: Contextual factors are found to be important for regional tobacco control programmes. The need for reaching out to communities and the importance of promotion of public-private partnership under the provision of corporate social responsibility for effectiveness of tobacco control programme is recommended.

Background: Tobacco use in India is characterized by a high prevalence of smoking and smokeless tobacco use, with dual use also contributing a noticeable proportion. In the context of such a high burden of tobacco use, this study examines the regional variations, and socioeconomic, demographic and other correlates of smoking, smokeless tobacco and dual use of tobacco in India., Methods and Findings: We analyzed a cross sectional, nationally representative sample of individuals from the Global Adult Tobacco Survey in India (2009-10), which covered 69,296 individuals aged 15 years and above. The current tobacco use in three forms, namely, smoking only, smokeless tobacco use only, and both smoking and smokeless tobacco use were considered as outcomes in this study. Descriptive statistics, cross tabulations and multinomial logistic regression analysis were adopted as analytical tools. Smokeless tobacco use was the major form of tobacco use in India followed by smoking and dual tobacco use. Tobacco use was higher among males, the less educated, the poor, and the rural population in India. Respondents lacking knowledge of health hazards of tobacco had higher prevalence of tobacco use in each form. The prevalence of different forms of tobacco use varies significantly by states. The prevalence of tobacco use increases concomitantly with age among females. Middle-aged adult males had higher prevalence of tobacco use. Age, education and region were found to be significant determinants of all forms of tobacco use. Adults from the poor household had significantly higher risk of consuming smokeless tobacco. Lack of awareness about the selected hazards of tobacco significantly affects tobacco use., Conclusions: There is an urgent need to curb the use of tobacco among the sub-groups of population with higher prevalence. Tobacco control policies in India should adopt a targeted, population-based approach to control and reduce tobacco consumption in the country.

Length of stay (LOS) in hospital for inpatient treatment is a measure of crucial recovery time. Using nationwide data on inpatient healthcare in India, a three-component finite mixture negative binomial model was found to provide a reasonable fit to the heterogeneous LOS distribution. Associated risk factors for short-stay, medium-stay and long-stay subgroups were identified from the respective negative binomial components. In addition, significant heterogeneities within each group were also found.

Improving household use of healthcare facilities is a vital public health strategy to reduce burden of disease in India. Our study set out to understand the importance of the interplay of household characteristics and state-level public health covariates in accessing inpatient healthcare services. The study is based on morbidity and healthcare data from the 60th round of the Indian National Sample Survey Organisation, 2004. We used multilevel logistic regression to disentangle dependence among the observations. We observed that the education level of household heads and the household's economic well-being had a significant positive influence on accessing inpatient healthcare services. Distance from the household to the health facility showed a significant inverse association with use of health facilities for inpatient treatment. Further, we found a significant variation across the states. Variability in accessing inpatient services at the household and state levels are 1.7% and 21% respectively.

Objectives: The present study was attempted to study the in-patient health care behaviour, particularly choice of health care providers and their determinants., Methods: An analysis for treatment seeking behavior of 5989 inpatients which implied to 6726 hospitalized cases due to five ailments namely, heart, diarrhea, tuberculosis, urinary and gynecology diseases in India during the last 365 days prior to survey date has been revealed in this paper using data from the 60th round of National Sample Survey, 2004. Multivariate logistic regression model has been adopted to understand the correlates of being inpatients and of opting private hospitals., Results: It is evident that crowded household, being female, having higher educational level, living in lower income households, and living in urban residents have lower chances of being hospitalized compared to their respective counterparts. Maximum people opted for expensive private health sector which accounts for around 59 per cent. This study also reveals that many people had some form of treatment before being an inpatient where 59 per cent had past treatment., Conclusions: Patients from the highest quintile of MPCE have higher chances of being hospitalized and also of choosing costly private health care sector. Significant differences were found within age, sex, education, residence and monthly per capita consumption expenditure for hospitalization. Older age groups, highly educated and urban patients have higher instances of choosing a private sector.