title: Association between concurrent alcohol and tobacco use and poverty.
abstract: OBJECTIVE
  The harm from alcohol and tobacco use in low- and middle-income countries includes substantial economic cost to the individual. Our aim was to describe the expenditure on concurrent alcohol and tobacco use in relation to family income in two districts in Sri Lanka.
  
  
  METHODS
  A community-based cross-sectional study was carried out in two districts in Sri Lanka. We sampled 2684 men over 18 years of age using multistage cluster sampling. Cost of alcohol and cigarettes was calculated using the retail price for each brand and multiplying by the amount consumed.
  
  
  RESULTS
  Among current alcohol users 63.1% were also smokers. Among current smokers 61.9% were also using alcohol. Prevalence of concurrent alcohol and tobacco use in urban areas was 20.1% and in rural areas 14%. The two lowest income categories (<$US76 per month) spent more than 40% of their income on concurrent use while the next category ($US76-143 per month) spent 34.8% of their income on concurrent use.
  
  
  CONCLUSIONS
  The poor spent less than those with higher income on alcohol and tobacco, but the expenditure constituted a much larger slice of their income thus compromising their ability to meet basic needs. In low-income countries, damaging economic consequences start at lower levels of alcohol and tobacco consumption and affect a significant proportion of the population. Defining risk levels and guidelines on safe limits based purely on individual health harm has, at best, little meaning in such settings.
authors.affiliation: Department of Psychological Medicine, Faculty of Medicine, Colombo, Sri Lanka. varunidesilva2@yahoo.co.uk
authors.forename: Varuni
authors.initials: V
authors.lastname: de Silva
authors.forename: Diyanath
authors.initials: D
authors.lastname: Samarasinghe
authors.forename: Raveen
authors.initials: R
authors.lastname: Hanwella
mesh_terms: D000428:Alcohol Drinking / Q000191:economics* / Q000453:epidemiology*; D003430:Cross-Sectional Studies; D000431:Ethanol / Q000191:economics; D006801:Humans; D007182:Income; D008297:Male; D011203:Poverty; D012309:Risk-Taking; D012907:Smoking / Q000191:economics* / Q000453:epidemiology*; D013188:Sri Lanka / Q000453:epidemiology; D062789:Tobacco Products
chemical_list: D000431:Ethanol