Tobacco Usage in Uttarakhand: A Dangerous Combination of High Prevalence, Widespread Ignorance, and Resistance to Quitting.
BACKGROUND
Nearly one-third of adults in India use tobacco, resulting in 1.2 million deaths. However, little is known about knowledge, attitudes, and practices (KAP) related to smoking in the impoverished state of Uttarakhand.


METHODS
A cross-sectional epidemiological prevalence survey was undertaken. Multistage cluster sampling selected 20 villages and 50 households to survey from which 1853 people were interviewed. Tobacco prevalence and KAP were analyzed by income level, occupation, age, and sex. 95% confidence intervals were calculated using standard formulas and incorporating assumptions in relation to the clustering effect.


RESULTS
The overall prevalence of tobacco usage, defined using WHO criteria, was 38.9%. 93% of smokers and 86% of tobacco chewers were male. Prevalence of tobacco use, controlling for other factors, was associated with lower education, older age, and male sex. 97.6% of users and 98.1% of nonusers wanted less tobacco. Except for lung cancer (89% awareness), awareness of diseases caused by tobacco usage was low (cardiac: 67%; infertility: 32.5%; stroke: 40.5%).


CONCLUSIONS
A dangerous combination of high tobacco usage prevalence, ignorance about its dangers, and few quit attempts being made suggests the need to develop effective and evidence based interventions to prevent a health and development disaster in Uttarakhand.
The Nossal Institute for Global Health, University of Melbourne, Vic 3010, Australia.
Nathan John
NJ
Grills
GCDWS, Chamba Hospital, Uttarakhand, India.
Rajesh
R
Singh
GCDWS, Chamba Hospital, Uttarakhand, India.
Rajkumari
R
Singh
The Nossal Institute for Global Health, University of Melbourne, Vic 3010, Australia.
Bradley C
BC
Martin
D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D004522:Educational Status; D004651:Employment / Q000706:statistics & numerical data; D005260:Female; D015438:Health Behavior; D007722:Health Knowledge, Attitudes, Practice; D057220:Health Literacy / Q000706:statistics & numerical data; D006801:Humans; D007182:Income; D007194:India / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D012307:Risk Factors; D017678:Sex Distribution; D062789:Tobacco Products / Q000706:statistics & numerical data*; D064424:Tobacco Use / Q000453:epidemiology* / Q000517:prevention & control*; D020340:Tobacco Use Cessation / Q000706:statistics & numerical data*; D061485:Tobacco Use Cessation Devices / Q000706:statistics & numerical data*; D055815:Young Adult