title: Social determinants of health and tobacco use in thirteen low and middle income countries: evidence from Global Adult Tobacco Survey.
abstract: BACKGROUND
  Tobacco use has been identified as the single biggest cause of inequality in morbidity. The objective of this study is to examine the role of social determinants on current tobacco use in thirteen low-and-middle income countries.
  
  
  RESULTS
  We used nationally representative data from the Global Adult Tobacco Survey (GATS) conducted during 2008-2010 in 13 low-and-middle income countries: Bangladesh, China, Egypt, India, Mexico, Philippines, Poland, Russian Federation, Thailand, Turkey, Ukraine, Uruguay, and Viet Nam. These surveys provided information on 209,027 respondent's aged 15 years and above and the country datasets were analyzed individually for estimating current tobacco use across various socio-demographic factors (gender, age, place of residence, education, wealth index, and knowledge on harmful effects of smoking). Multiple logistic regression analysis was used to predict the impact of these determinants on current tobacco use status. Current tobacco use was defined as current smoking or use of smokeless tobacco, either daily or occasionally. Former smokers were excluded from the analysis. Adjusted odds ratios for current tobacco use after controlling other cofactors, was significantly higher for males across all countries and for urban areas in eight of the 13 countries. For educational level, the trend was significant in Bangladesh, Egypt, India, Philippines and Thailand demonstrating decreasing prevalence of tobacco use with increasing levels of education. For wealth index, the trend of decreasing prevalence of tobacco use with increasing wealth was significant for Bangladesh, India, Philippines, Thailand, Turkey, Ukraine, Uruguay and Viet Nam. The trend of decreasing prevalence with increasing levels of knowledge on harmful effects of smoking was significant in China, India, Philippines, Poland, Russian Federation, Thailand, Ukraine and Viet Nam.
  
  
  CONCLUSIONS
  These findings demonstrate a significant but varied role of social determinants on current tobacco use within and across countries.
authors.affiliation: Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America. kpalipudi@cdc.gov
authors.forename: Krishna M
authors.initials: KM
authors.lastname: Palipudi
authors.forename: Prakash C
authors.initials: PC
authors.lastname: Gupta
authors.forename: Dhirendra N
authors.initials: DN
authors.lastname: Sinha
authors.forename: Linda J
authors.initials: LJ
authors.lastname: Andes
authors.forename: Samira
authors.initials: S
authors.lastname: Asma
authors.forename: Tim
authors.initials: T
authors.lastname: McAfee
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D003625:Data Collection; D019049:Developed Countries; D003906:Developing Countries; D004522:Educational Status; D005260:Female; D006304:Health Status; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D012907:Smoking / Q000453:epidemiology*; D012959:Socioeconomic Factors; D014030:Tobacco, Smokeless; D055815:Young Adult