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Rapid Responses: Rapid Responses published:
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commandable task
- Mahamood.S Basharuthulla (4 April 2004)
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Missing from the religious data - the Sikhs
- JK Anand (5 April 2004)
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Sikhs and Tobacco Use
- Kawaldip Singh Sehmi (5 April 2004)
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Tobacco consumption pattern in India: Cautious interpretation
- Preeti Singh, Umesh Kapil (8 April 2004)
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Increasing tobacco consumption among the lower socioeconomic classes in India
- Rajeev Gupta (19 April 2004)
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Mahamood.S Basharuthulla, Consultant Physician & Cardiologist Starr Hospital Bangalore 560034
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Dear sir, Dr Subramaian et al have done a great job in data collection,its analysis and publishing the conclusion on this article,which is a gigantic task in a vast country like India which is densely populated.We must congratulate the authers for their excellent work and effort in producing this paper. As it is pointed out ,our country needs basic education and preventive measures at the national level. The authers have done the job,it is now the turn of authorities to follow it. M.S.Basharuthulla MD,FACP,FRCP-Glasg,FRCP-Ire Ref.Patterns and distribution of tobacco consumption in India:cross sectional multilevel evidence from 1998-9,national family health survey, BMJ 2004.328 801-806 Competing interests: None declared |
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JK Anand, Retired Not applicable
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It is a little strange that this paper does not mention the followers of Sikh religion. Although some "Sehjdhari" Sikhs do smoke, no "Kesdhari" (those with long uncut hair worn under a turban) will smoke - at least not openly. Aggregating the data for Sikhs, Christians and Budhists is illogical. Dr JK Anand retired public health physician Competing interests: None declared |
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Kawaldip Singh Sehmi, Director of Health Ineqaulities 211 Old street London EC1V 9NR
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Professor S V Subramanian et al have confirmed in their BMJ study what we in the field suspected for a long time that tobacco consumption in the South Asian communities based in the UK reflect what is happing in their countries of origin. 1, 2 Smoking and tobacco chewing is still a matter of health inequalities and the strategy adopted by the UK Department of Health in tackling health inequalities has raised the profile of smoking cessation in addressing these health inequalities in the South Asian communities 3 South Asian communities have the highest smoking rates. 4 However, what the Professor and his colleagues have not looked at intensely is the issue around religion and tobacco use. In the 2001 census the UK census was the first one of its kind to ask about religion. We are now finding that Sikh Punjabi’s who had been included within the Indian category have the lowest tobacco consumption rates both in the UK and in India on account of a decree set on 13th April 1699 (vaishakahi) in the Sikh Commonwealth of North India that banned tobacco use through a baptism ceremony called the Amrit Ceremony. 5 On 13th April 2004 (next week) some 1million Sikhs will refresh their vows not to smoke in this year’s Vaishaki baptism. The Sikh leaders have taken a strong position against tobacco and have banned its sale around the Golden Temple Amiritsar. If the WHO Framework Convention on Tobacco Control Treaty and its application is handed to the many Indian religious groups like the BJP, Akali Dal and Shiv Sena then, like the Amrit Ceremony in Punjab, they could tackle tobacco sale and consumption far quicker than the state. Many states are still hooked on tobacco taxes to balance budgets and dare not put bans into place. 6 1) BMJ 2004;328:801-806 (3 April), doi:10.1136/bmj.328.7443.801 2) BMJ 2004;328:780 (3 April), doi:10.1136/bmj.328.7443.780 3) Tackling Health Inequalities: A program for action (2003) Department of Health 4) Health Survey of England-the health of minority ethnic groups (1999) DoH 5) McAuliffe, M. A. (1909) Sikh Religion: Its Gurus, Sacred Writings, and Authors, London, Oxford University Press 6)The World Bank, Washington DC (1999) Curbing the Epidemic: Governments and the Economic of Tobacco Control Competing interests: None declared |
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Preeti Singh, Research Scientist Human Nutrition Unit, All India Institute of Medical Sciences, New Delhi -110029, India, Umesh Kapil
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The article “Patterns and distribution of tobacco consumption in India: cross sectional multilevel evidence from the 1998-9 national family health survey” is interesting and informative however, we would like to raise certain issues. The National Family Health Survey (NFHS) - 2 collected data from more than 90,000 ever married women between the age group of 15 - 49 years in India covering all the states. The data on the consumption pattern of paan masala, tobacco, smoking and alcohol amongst household members aged 15 years and above was collected. However, no direct interviews were conducted of the adult male members in the household (the information was collected by the women interviewed). In view of the above, there is a strong possibility of under reporting on the actual scenario possible on pattern of tobacco consumption as the women interviewed might not be aware of the consumption of tobacco outside the household. Also due to the social stigma attached with the consumption of tobacco women might be under reporting to the interviewers. Hence, this may not be the true reflection of current scenario of the consumption of tobacco amongst the adult males in India. However, this is the best data set available on the prevalence of consumption of paan masala, tobacco, smoking and alcohol in the country. Competing interests: None declared |
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Rajeev Gupta, Consultant Physician and Professor of Medicine Monilek Hospital and Mahatma Gandhi National Institute od Medical Sciences, Jaipur 302004 India
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Subramanian et al (1) report that tobacco use in more prevalent among the lower socioeconomic classes in India. In the National Family Health Survey of India executed in 1998-1999 it is observed that households belonging to the lowest fifth of standard of living index were 2.54 times more likely to smoke or chew tobacco than those in the highest fifth. We studied socioeconomic differences in prevalence of coronary risk factors and used educational status as its marker. In an Indian rural population we reported that tobacco consumption (smoking and/or tobacco chewing) was more 1.59 times more common among the illiterate as compared to those with more than 10 years of formal education (2). In men (n= 1982), tobacco use was in 60% illiterate subjects, 51% in 1-5 years of education, 46% in 6-10 years of education and 35.5% in those with more than 10 years of education. Tobacco use was low in rural women (n=1166) and was 6% in illiterate as compared to 4% and 2% in other groups. Among urban subjects also a significant gradient was noted and in men (n=1415), tobacco use was in 44% illiterate, 52% in those with 1-10 years education, 30% in 11-15 years education and 18% in those with more than 15 years education (3). In urban women (n=797) tobacco use was confined to the lower socioeconomic classes only (illiterate 24.1%, 1-10 years education 22.9%). We performed a repeat survey among the urban subjects to evaluate changes in coronary risk factors (4). Although there was no change in overall age- adjusted prevalence of tobacco use in both men (39% vs. 41%) and women (19% vs. 20%), the use increased significantly among the lower socioeconomic strata. The tobacco use in illiterate increased from 44% to 54% while it increased from 24% to 28% in illiterate women. A high prevalence of smoking and other coronary risk factors has been reported from other parts of India as well (1,5). Clearly the focus of tobacco control has to be subjects in lower socioeconomic classes in India and other developing countries. Increasing the educational status of the population could be one simple approach. References: 1. Subramanian SV, Nandy S, Kelly M, Gordon D, Davey-Smith G. Patterns and distribution of tobacco consumption in India: cross sectional multilevel evidence from the 1998-9 national family health survey. BMJ. 2004; 328:801-806. 2. Gupta R, Gupta VP, Ahluwalia NS. Educational status, coronary heart disease and coronary risk factor prevalence in a rural population of India. BMJ. 1994; 309:1332-1336 3. Gupta R, Prakash H, Majumdar S, Sharma SC, Gupta VP. Prevalence of coronary heart disease and coronary risk factors in an urban population of Rajasthan. Indian Heart J. 1995; 47:331-338 4. Gupta R, Gupta VP, Sarna M, Prakash H, Rastogi S, Gupta KD. Serial epidemiological surveys in an urban Indian population demonstrate increasing coronary risk factor among the lower socioeconomic strata. J Assoc Physicians Ind. 2003; 55:470-477 5. Misra A, Sharma R, Pandey RM, Khanna N. Adverse profile of dietary nutrients, anthropometery and lipids in urban slum dwellers of northern India. Eur J Clin Nutr. 2001; 55:727-734 Competing interests: None declared |
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