title: Effect of tobacco chewing, tobacco smoking and alcohol on all-cause and cancer mortality: a cohort study from Trivandrum, India.
abstract: OBJECTIVE
  To study the risk of all-cause, cancer and tobacco-related cancer mortality associated with tobacco chewing, tobacco smoking and alcohol use.
  
  
  METHODS
  Prospective community-based cohort study initiated in 1996.
  
  
  METHODS
  167343 adult subjects, aged 34 and older, living in 13 panchayaths (rural municipal administrative units) in South India, were regularly followed-up for a mean duration of 6.5 years.
  
  
  METHODS
  Mortality from all-causes, all cancer and tobacco-related cancer.
  
  
  RESULTS
  The mortality risks associated with chewing (and 95% confidence intervals), after adjusting for age, sex, socio-economic and dietary variables, and for other habits, were 0.90 (0.86-0.94) for all-cause, 1.07 (0.94-1.22) for cancer and 1.22 (1.04-1.44) for tobacco-related cancer; with smoking the respective mortality risks were 1.31 (1.24-1.39), 1.63 (1.37-1.94) and 1.68 (1.36-2.08); and with alcohol use the risks were 1.13 (1.06-1.20), 1.32 (1.11-1.57) and 1.47 (1.19-1.80), respectively. Reduced risk of all-cause mortality by chewing was observed only in the 60-84 years old group (0.90 (0.85-0.94)), and detrimental effects of chewing on cancer mortality were shown in the young and middle-age groups: 34-39 years old (1.33 (0.67-2.65)), and 40-59 years old (1.26 (1.03-1.55)).
  
  
  CONCLUSIONS
  Tobacco in any form and alcohol uses were harmful and a higher quality of life could be achieved by avoiding these habits. Given the demographic, epidemiological and economic transitions and changes in pattern of tobacco and alcohol use in India, the health loss from the tobacco and alcohol will grow even larger, unless effective interventions and policies to reduce these habits are implemented.
authors.affiliation: Division of Radiation Oncology, Regional Cancer Center, Medical College Campus, Trivandrum 695011, India.
authors.forename: Kunnambath
authors.initials: K
authors.lastname: Ramadas
authors.forename: Catherine
authors.initials: C
authors.lastname: Sauvaget
authors.forename: Gigi
authors.initials: G
authors.lastname: Thomas
authors.forename: Jean-Marie
authors.initials: JM
authors.lastname: Fayette
authors.forename: Somanathan
authors.initials: S
authors.lastname: Thara
authors.forename: Rengaswamy
authors.initials: R
authors.lastname: Sankaranarayanan
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000428:Alcohol Drinking / Q000009:adverse effects*; D002423:Cause of Death; D015331:Cohort Studies; D005260:Female; D006801:Humans; D015994:Incidence; D007194:India / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000209:etiology / Q000401:mortality*; D012042:Registries; D012307:Risk Factors; D012907:Smoking / Q000009:adverse effects*; D015996:Survival Rate; D014030:Tobacco, Smokeless / Q000009:adverse effects*