title: A cross-sectional study of the prevalence and correlates of tobacco use in Chennai, Delhi, and Karachi: data from the CARRS study.
abstract: BACKGROUND
  Tobacco burdens in India and Pakistan require continued efforts to quantify tobacco use and its impacts. We examined the prevalence and sociodemographic and health-related correlates of tobacco use in Delhi, Chennai (India), and Karachi (Pakistan).
  
  
  METHODS
  Analysis of representative surveys of 11,260 participants (selected through multistage cluster random sampling; stratified by gender and age) in 2011 measured socio-demographics, tobacco use history, comorbid health conditions, and salivary cotinine. We used bivariate and multivariate regression analyses to examine factors associated with tobacco use.
  
  
  RESULTS
  Overall, 51.8 % were females, and 61.6 % were below the age of 45 years. Lifetime (ever) tobacco use prevalence (standardized for world population) was 45.0 %, 41.3 %, and 42.5 % among males, and 7.6 %, 8.5 %, and 19.7 % among females in Chennai, Delhi, and Karachi, respectively. Past 6 month tobacco use prevalence (standardized for world population) was 38.6 %, 36.1 %, and 39.1 % among males, and 7.3 %, 7.1 %, and 18.6 % among females in Chennai, Delhi, and Karachi, respectively. In multivariable regression analyses, residing in Delhi or Karachi versus Chennai; older age; lower education; earning less income; lower BMI; were each associated with tobacco use in both sexes. In addition, semi-skilled occupation versus not working and alcohol use were associated with tobacco use in males, and having newly diagnosed dyslipidemia was associated with lower odds of tobacco use among females. Mean salivary cotinine levels were higher among tobacco users versus nonusers (235.4; CI: 187.0-283.8 vs. 29.7; CI: 4.2, 55.2, respectively).
  
  
  CONCLUSIONS
  High prevalence of tobacco use in the South Asian region, particularly among men, highlights the urgency to address this serious public health problem. Our analyses suggest targeted prevention and cessation interventions focused on lower socioeconomic groups may be particularly important.
authors.affiliation: Department of Behavioral Sciences and Health Education, Emory University Rollins School of Public Health, 1518 Clifton Rd NE, 30322, Atlanta, Georgia, USA. cjberg@emory.edu.
authors.forename: Carla J
authors.initials: CJ
authors.lastname: Berg
authors.affiliation: Public Health Foundation of India, Plot No 47, Sector 44, 122002, Gurgaon, Haryana, India. ajay@ccdcindia.org.|Centre for Chronic Disease Control, Plot No 47, Sector 44, 122002, Gurgaon, Haryana, India. ajay@ccdcindia.org.
authors.forename: Vamadevan S
authors.initials: VS
authors.lastname: Ajay
authors.affiliation: Hubert Department of Global Health, Emory University Rollins School of Public Health, 1518 Clifton Rd NE, 30322, Atlanta, Georgia, USA. mkali@emory.edu.
authors.forename: Mohammed K
authors.initials: MK
authors.lastname: Ali
authors.affiliation: Public Health Foundation of India, Plot No 47, Sector 44, 122002, Gurgaon, Haryana, India. dimple@ccdcindia.org.|Centre for Chronic Disease Control, Plot No 47, Sector 44, 122002, Gurgaon, Haryana, India. dimple@ccdcindia.org.
authors.forename: Dimple
authors.initials: D
authors.lastname: Kondal
authors.affiliation: Aga Khan University, Stadium Road, P.O. Box 3500, 74800, Karachi, Pakistan. hassan.khan@giz.de.
authors.forename: Hassan M
authors.initials: HM
authors.lastname: Khan
authors.affiliation: Public Health Foundation of India, Plot No 47, Sector 44, 122002, Gurgaon, Haryana, India. roopa@ccdcindia.org.|Centre for Chronic Disease Control, Plot No 47, Sector 44, 122002, Gurgaon, Haryana, India. roopa@ccdcindia.org.
authors.forename: Roopa
authors.initials: R
authors.lastname: Shivashankar
authors.affiliation: Madras Diabetes Research Foundation, No 4, Conran Smith Road, Gopalapuram, 600 086, Chennai, India. guhapradeepa@gmail.com.
authors.forename: Rajendra
authors.initials: R
authors.lastname: Pradeepa
authors.affiliation: Madras Diabetes Research Foundation, No 4, Conran Smith Road, Gopalapuram, 600 086, Chennai, India. deepa.mohan1@gmail.com.
authors.forename: Deepa
authors.initials: D
authors.lastname: Mohan
authors.affiliation: Aga Khan University, Stadium Road, P.O. Box 3500, 74800, Karachi, Pakistan. zafar.fatmi@aku.edu.
authors.forename: Zafar
authors.initials: Z
authors.lastname: Fatmi
authors.affiliation: Aga Khan University, Stadium Road, P.O. Box 3500, 74800, Karachi, Pakistan. masood.kadir@aku.edu.
authors.forename: Muhammad M
authors.initials: MM
authors.lastname: Kadir
authors.affiliation: Department of Endocrinology & Metabolism, All India Institute of Medical Sciences (AIIMS), Ansari, New, Nagar, 110029, Delhi, India. nikhil_tandon@hotmail.com.
authors.forename: Nikhil
authors.initials: N
authors.lastname: Tandon
authors.affiliation: Madras Diabetes Research Foundation, No 4, Conran Smith Road, Gopalapuram, 600 086, Chennai, India. drmohans@diabetes.ind.in.
authors.forename: Viswanathan
authors.initials: V
authors.lastname: Mohan
authors.affiliation: Hubert Department of Global Health, Emory University Rollins School of Public Health, 1518 Clifton Rd NE, 30322, Atlanta, Georgia, USA. knaraya@emory.edu.
authors.forename: K M Venkat
authors.initials: KM
authors.lastname: Narayan
authors.affiliation: Public Health Foundation of India, Plot No 47, Sector 44, 122002, Gurgaon, Haryana, India. dprabhakaran@ccdcindia.org.|Centre for Chronic Disease Control, Plot No 47, Sector 44, 122002, Gurgaon, Haryana, India. dprabhakaran@ccdcindia.org.
authors.forename: Dorairaj
authors.initials: D
authors.lastname: Prabhakaran
mesh_terms: D000293:Adolescent; D000328:Adult; D000428:Alcohol Drinking / Q000453:epidemiology; D015897:Comorbidity; D003430:Cross-Sectional Studies; D005260:Female; D006304:Health Status; D006801:Humans; D007194:India / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D010154:Pakistan / Q000453:epidemiology; D011203:Poverty / Q000706:statistics & numerical data; D015995:Prevalence; D017678:Sex Distribution; D064424:Tobacco Use / Q000453:epidemiology* / Q000517:prevention & control; D014029:Tobacco Use Disorder / Q000453:epidemiology* / Q000517:prevention & control