title: Prevalence and Sociodemographic Determinants of Any Tobacco Use and Dual Use in Six Countries of the WHO South-East Asia Region: Findings From the Demographic and Health Surveys.
abstract: BACKGROUND
  Tobacco control is an important strategy to reduce the disease burden caused by several noncommunicable diseases. An in-depth understanding of the sociodemographic variations in tobacco use is an important step in achieving effective tobacco control.
  
  
  OBJECTIVE
  We aimed to estimate the age-standardized prevalence of any tobacco use and dual tobacco use and determine their association with sociodemographic variables in six countries (Bangladesh, Indonesia, India, Maldives, Nepal, and Timor Leste) of the WHO South-East Asia Region.
  
  
  METHODS
  The main outcome variables "any tobacco use" and "current dual use" were created from the latest available Demographic and Health Surveys data for each country. The prevalence estimates were weighted using sample weights and age standardized using the WHO standard population. Associations between the sociodemographic variables and tobacco use were calculated by performing multivariable logistic regression analysis. Analyses were performed in Stata 12 using "svyset" and "svy" commands.
  
  
  RESULTS
  The highest prevalence of any tobacco use among men was in Indonesia (76.4%) and among women in Nepal (15.7%). Also, Nepal had the highest prevalence of dual tobacco use in both men (17.9%) and women (1.5%). With regard to sociodemographic determinants, despite the inter-country variations, any and dual tobacco use were significantly associated with age, higher education, greater wealth, rural residence, and ever-married marital status. The poor and uneducated had a higher odds ratio for these practices.
  
  
  CONCLUSIONS
  Prevalence of dual tobacco use and its underlying socioeconomic disparities should be taken into account for the planning of tobacco control activities in the region.
  
  
  CONCLUSIONS
  The dual tobacco use phenomenon is being increasingly recognized as a distinct entity in the fight against tobacco addiction. When compared with single product users, dual users have a greater risk of developing tobacco related diseases and are less likely to quit their habits. However, this phenomenon has not been studied adequately in the South-East Asia region. In this context, this study has provided a detailed and comprehensive view of dual tobacco use and its sociodemographic determinants in six countries of the region. This study recommends that tobacco control interventions should be targeted specifically at the disadvantaged sections of the society, such as the poor and the uneducated, who are more likely to engage in "dual" as well as "any" tobacco use. This study could prove as an important reference and tool for policy making in the South-East Asia region.
authors.affiliation: Tobacco Free Initiative Unit, World Health Organization, Regional Office for South-East Asia, New Delhi, India; sinhad@who.int.
authors.forename: Dhirendra N
authors.initials: DN
authors.lastname: Sinha
authors.affiliation: Department of Community Medicine, Velammal Medical College Hospital and Research Institute, Madurai, India;
authors.forename: Rizwan A
authors.initials: RA
authors.lastname: Suliankatchi
authors.affiliation: Centre for Community Medicine, All India Institute of Medical Sciences, New Delhi, India.
authors.forename: Ritvik
authors.initials: R
authors.lastname: Amarchand
authors.affiliation: Centre for Community Medicine, All India Institute of Medical Sciences, New Delhi, India.
authors.forename: Anand
authors.initials: A
authors.lastname: Krishnan
mesh_terms: D000293:Adolescent; D000328:Adult; D001210:Asia, Southeastern / Q000453:epidemiology; D001459:Bangladesh / Q000453:epidemiology; D005260:Female; D006306:Health Surveys / Q000379:methods; D006801:Humans; D007194:India / Q000453:epidemiology; D007195:Indian Ocean Islands / Q000453:epidemiology; D007214:Indonesia / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D009390:Nepal / Q000453:epidemiology; D015995:Prevalence; D012424:Rural Population; D012907:Smoking / Q000191:economics* / Q000453:epidemiology; D000074606:Smoking Prevention; D012923:Social Class; D049648:Timor-Leste / Q000453:epidemiology; D064424:Tobacco Use / Q000191:economics* / Q000453:epidemiology / Q000517:prevention & control; D014029:Tobacco Use Disorder / Q000191:economics / Q000453:epidemiology / Q000517:prevention & control; D014030:Tobacco, Smokeless / Q000706:statistics & numerical data; D014944:World Health Organization / Q000191:economics*; D055815:Young Adult