title: Socioeconomic Inequalities in Secondhand Smoke Exposure at Home and at Work in 15 Low- and Middle-Income Countries.
abstract: BACKGROUND
  In high-income countries, secondhand smoke (SHS) exposure is higher among disadvantaged groups. We examine socioeconomic inequalities in SHS exposure at home and at workplace in 15 low- and middle-income countries (LMICs).
  
  
  METHODS
  Secondary analyses of cross-sectional data from 15 LMICs participating in Global Adult Tobacco Survey (participants ≥ 15 years; 2008-2011) were used. Country-specific analyses using regression-based methods were used to estimate the magnitude of socioeconomic inequalities in SHS exposure: (1) Relative Index of Inequality and (2) Slope Index of Inequality.
  
  
  RESULTS
  SHS exposure at home ranged from 17.4% in Mexico to 73.1% in Vietnam; exposure at workplace ranged from 16.9% in Uruguay to 65.8% in Bangladesh. In India, Bangladesh, Thailand, Malaysia, Philippines, Vietnam, Uruguay, Poland, Turkey, Ukraine, and Egypt, SHS exposure at home reduced with increasing wealth (Relative Index of Inequality range: 1.13 [95% confidence interval [CI] 1.04-1.22] in Turkey to 3.31 [95% CI 2.91-3.77] in Thailand; Slope Index of Inequality range: 0.06 [95% CI 0.02-0.11] in Turkey to 0.43 [95% CI 0.38-0.48] in Philippines). In these 11 countries, and in China, SHS exposure at home reduced with increasing education. In India, Bangladesh, Thailand, and Philippines, SHS exposure at workplace reduced with increasing wealth. In India, Bangladesh, Thailand, Philippines, Vietnam, Poland, Russian Federation, Turkey, Ukraine, and Egypt, SHS exposure at workplace reduced with increasing education.
  
  
  CONCLUSIONS
  SHS exposure at homes is higher among the socioeconomically disadvantaged in the majority of LMICs studied; at workplaces, exposure is higher among the less educated. Pro-equity tobacco control interventions alongside targeted efforts in these groups are recommended to reduce inequalities in SHS exposure.
  
  
  CONCLUSIONS
  SHS exposure is higher among the socioeconomically disadvantaged groups in high-income countries. Comprehensive smoke-free policies are pro-equity for certain health outcomes that are strongly influenced by SHS exposure. Using nationally representative Global Adult Tobacco Survey (2008-2011) data from 15 LMICs, we studied socioeconomic inequalities in SHS exposure at homes and at workplaces. The study showed that in most LMICs, SHS exposure at homes is higher among the poor and the less educated. At workplaces, SHS exposure is higher among the less educated groups. Accelerating implementation of pro-equity tobacco control interventions and strengthening of efforts targeted at the socioeconomically disadvantaged groups are needed to reduce inequalities in SHS exposure in LMICs.
authors.affiliation: Health Promotion Division, Public Health Foundation of India, New Delhi, India; Department of Non-Communicable Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom; gaurang.nazar@ext.phfi.org.
authors.forename: Gaurang P
authors.initials: GP
authors.lastname: Nazar
authors.affiliation: School of Public Health, Faculty of Medicine, Imperial College London, London, United Kingdom; Saw Swee Hock School of Public Health, National University of Singapore, Singapore.
authors.forename: John Tayu
authors.initials: JT
authors.lastname: Lee
authors.affiliation: Health Promotion Division, Public Health Foundation of India, New Delhi, India;
authors.forename: Monika
authors.initials: M
authors.lastname: Arora
authors.affiliation: Health Promotion Division, Public Health Foundation of India, New Delhi, India; School of Public Health, Faculty of Medicine, Imperial College London, London, United Kingdom;
authors.forename: Christopher
authors.initials: C
authors.lastname: Millett
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001459:Bangladesh / Q000453:epidemiology; D002681:China / Q000453:epidemiology; D003430:Cross-Sectional Studies; D004534:Egypt / Q000453:epidemiology; D006801:Humans; D007194:India / Q000453:epidemiology; D008296:Malaysia / Q000453:epidemiology; D008297:Male; D008800:Mexico / Q000453:epidemiology; D008875:Middle Aged; D011044:Poland / Q000453:epidemiology; D011203:Poverty / Q000191:economics*; D012426:Russia / Q000453:epidemiology; D061845:Smoke-Free Policy / Q000191:economics; D012907:Smoking / Q000009:adverse effects / Q000191:economics* / Q000453:epidemiology*; D012959:Socioeconomic Factors; D011795:Surveys and Questionnaires; D013785:Thailand / Q000453:epidemiology; D014028:Tobacco Smoke Pollution / Q000009:adverse effects / Q000191:economics*; D014421:Turkey / Q000453:epidemiology; D014455:Ukraine / Q000453:epidemiology; D017132:Workplace / Q000191:economics*; D055815:Young Adult
chemical_list: D014028:Tobacco Smoke Pollution