Cohort study of all-cause mortality among tobacco users in Mumbai, India

INTRODUCTION: Overall mortality rates are higher among cigarette smokers than non-smokers. However, very little is known about the health effects of other forms of tobacco use widely prevalent in India, such as bidi smoking and various forms of smokeless tobacco (e.g. chewing betel-quid). We therefore carried out a cohort study in the city of Mumbai, India, to estimate the relative risks for all-cause mortality among various kinds of tobacco users. METHODS: A baseline survey of all individuals aged > or = 35 years using voters' lists as a selection frame was conducted using a house-to-house approach and face-to-face interviews. RESULTS: Active follow-up of 52,568 individuals in the cohort was undertaken 5-6 years after the baseline study, and 97.6% were traced. A total of 4358 deaths were recorded among these individuals. The annual age-adjusted mortality rates were 18.4 per 1000 for men and 12.4 per 1000 for women. For men the mortality rates for smokers were higher than those of non-users of tobacco across all age groups, with the difference being greater for lower age groups (35-54 years). The relative risk was 1.39 for cigarette smokers and 1.78 for bidi smokers, with an apparent dose-response relationship for frequency of smoking. Women were basically smokeless tobacco users, with the relative risk among such users being 1.35 and a suggestion of a dose-response relationship. DISCUSSION: These findings establish bidi smoking as no less hazardous than cigarette smoking and indicate that smokeless tobacco use may also cause higher mortality. Further studies should be carried out to obtain cause-specific mortality rates and relative risks.     

Association of alcohol,alcohol and tobacco with mortality: findings from a prospective cohort study in Mumbai (Bombay), India

The aim of the present study was to examine the association between alcohol, alcohol and tobacco, and mortality in a large adult population in the city of Mumbai. A total of 35,102 men aged 45 years and older were surveyed about their alcohol drinking as part of a cohort study. These respondents were followed up over time, and all deaths were recorded. Compared with those who never drank alcohol, alcohol drinkers had 1.22 times higher risk of mortality, with the highest risk observed for liver disease (hazard ratio [HR] = 3.19). Among ever drinkers, risk of mortality varied according to types (country/desi), frequency (four or less times a week, HR = 1.39), and quantity of alcohol consumed (>100 mL) per day. In addition, country/desi drinkers (HR = 1.34) had the highest mortality risk compared with all other types of alcohol (HR = 0.97). Alcohol drinkers had increased risk of mortality for tuberculosis (HR = 2.53), cerebrovascular disease (HR = 1.83), and liver disease (HR = 3.19). Synergistic joint effect of tobacco and alcohol on mortality was also observed, with lowest risk in never tobacco user drinkers (HR = 1.02) and highest in mixed tobacco user drinkers (HR = 1.79). The results of this study show a direct association between greater consumption of alcohol and increased risk of mortality from alcohol-specific causes. In addition to individual effect, this study demonstrates the synergistic interaction between alcohol and tobacco use in various forms on mortality.     

Tobacco use among students in Bihar (India)

Determination of the prevalence and attitudes toward tobacco use was assessed among 13-15 years school students in Bihar (India). Settings and design: Schools having grade 8-10 in Bihar. A two stage cluster sample design was used. SUDAAN and the C-sample procedure in Epi-Info was used for statistical analysis. Of the 2636 respondents, 71.8% (76.5% boys, 57.2% girls) were ever tobacco users; of them 48.9% had used tobacco before 10 years of age. Current use was reported by 58.9% (Boys 61.4%, Girls 51.2%); smokeless tobacco by 55.6% (Boys 57.6%, Girls 49.2%); and smoking by 19.4% (23.0% boys, 7.8% girls). Nearly one third (29%) students were exposed to ETS inside their homes and nearly half (48%) outside their homes. Almost all students reported watching cigarette and gutka advertisements in almost all kinds of media and events. Tobacco use by parents and friends, knowledge on harmful effects of chewing tobacco, smoking and environmental smoke, and attitudes on tobacco use by others were strongly associated with student tobacco use. Current tobacco use was reported significantly more by students who received pocket money/or were earning than by students who did not receive any pocket money/or did not earn (p value for trend <0.0001). Over half of current users (56%) bought their tobacco products from stores; of these, over 3/4th (77.2%) of them despite their age, had no difficulty in procuring these products. Teaching in schools regarding harmful effects of tobacco use was non-existent (3%). This urgently requires a comprehensive prevention program in schools and the community especially targeted towards girls.     

Smoking and risk of all-cause mortality: the Jichi Medical School (JMS) Cohort Study

BACKGROUND: There have been comparatively few large-scale cohort studies analyzing all-cause mortality due to cigarette smoking. The goal of this analysis is to investigate the relationship between smoking status and all-cause mortality, and to evaluate the effect of smoking in the Japanese. METHODS: The baseline data were collected between 1992 and 1995. Ultimately, 10,873 Japanese (4,280 males and 6,593 females) aged 19 years or older from 12 rural communities located across Japan participated in the study. This analysis is based on the results, including the information on those who died and moved out of the communities, obtained by December 31, 2001. The Cox's proportional hazards model was used to calculate the hazard ratio (HR) of mortality for smoking with adjustment for age, systolic blood pressure, total cholesterol, body mass index, alcohol drinking habit and education. RESULTS: The mean follow-up period was 8.2 years, during which time, 284 males and 192 females died. The multivariate-adjusted HRs for total mortality among former and current smokers compared with never smokers were 1.09 (95% confidence interval [CI]: 0.73-1.61) and 1.65 (95% CI: 1.16-2.35) in males, and 0.98 (95% CI: 0.40-2.42) and 0.91 (95% CI: 0.42-1.95) in females, respectively. Those for the consumption of 1-14, 15-24, and 25+ cigarettes per day among male smokers were 1.62, 1.57, and 1.89, respectively. In females, there was no great difference in all-cause mortality between smokers and never smokers. CONCLUSIONS: The results of our study confirm an increased risk in males of premature death from all causes among Japanese with a smoking habit.     

Effects of a Tobacco Control Intervention for Teachers in India: Results of the Bihar School Teachers Study

Objectives. We assessed a school-based intervention designed to promote tobacco control among teachers in the Indian state of Bihar.Methods. We used a cluster-randomized design to test the intervention, which comprised educational efforts, tobacco control policies, and cessation support and was tailored to the local social context. In 2009 to 2011, we randomly selected 72 schools from participating school districts and randomly assigned them in blocks (rural or urban) to intervention or delayed-intervention control conditions.Results. Immediately after the intervention, the 30-day quit rate was 50% in the intervention and 15% in the control group (P = .001). At the 9-month postintervention survey, the adjusted 6-month quit rate was 19% in the intervention and 7% in the control group (P = .06). Among teachers employed for the entire academic year of the intervention, the adjusted 6-month abstinence rates were 20% and 5%, respectively, for the intervention and control groups (P = .04).Conclusions. These findings demonstrate the potent impact of an intervention that took advantage of social resources among teachers, who can serve as role models for tobacco control in their communities.The global burden of tobacco is rapidly shifting to the developing world. According to the World Health Organization, it is expected that by 2030 more than 8 million people globally will die from tobacco-related causes, 80% of them in low- and middle-income countries.1 As part of growing attention to this issue, the United Nations General Assembly included support for tobacco control in its initiative to reduce noncommunicable diseases.2,3 The World Health Organization created MPOWER as a resource for countries to implement tobacco control efforts4 and negotiated the Framework Convention on Tobacco Control, the first international treaty negotiated under the organization''s auspices.5 These efforts underscore the ongoing significant need for effective strategies that take into account the challenges of resource-poor situations.6India faces particular challenges because multiple forms of tobacco are in widespread use and limited resources are available for tobacco control.7 An estimated 1 million deaths in 2010 alone were attributable to tobacco-related causes in India, with increases projected in the future.8 The prevalence of tobacco use is 48% among men and 20% among women.7 Tobacco-related cancers constitute about half the total cancer incidence among men and about 20% among women.9,10 India also has the highest oral cancer rate in the world.11,12Although India was an early signatory to the Framework Convention on Tobacco Control, few resources are available in India to support tobacco use cessation,13–19 quitting tobacco use is not common practice, and few social norms support quitting.7 Indeed, little attention has been paid to studying, developing, and delivering effective interventions for cessation. Prevalence of former tobacco use is much lower in India than in the United States (3% vs 21%–25%).7,20–23Successful, evidence-based interventions with the potential for widespread implementation, beginning with opinion leaders who contribute to shaping social norms regarding tobacco use, are urgently needed.24 Teachers represent an important vanguard population for tobacco control efforts in India; they are role models for community norms generally and can be instrumental in school-based tobacco control efforts, which are often a community’s first step toward a broad-based control program.25–27We tested the efficacy of a school-based intervention designed to promote tobacco control among teachers in the Indian state of Bihar, where rates of tobacco use are among the highest in the country. In 2000, the Global School Personnel Survey found that 78% of teachers in Bihar used some form of tobacco.28 We randomly assigned schools to either an intervention or a delayed-intervention control condition. We tested the hypothesis that teachers in intervention schools who used tobacco would be more likely than teachers in control schools to (1) have quit for at least 30 days by immediately after the intervention and (2) have quit for 6 months or more by 9 months after the intervention.     

Cohort Profile Update: the China Metal-Exposed workers Cohort Study (Jinchang Cohort)

European Journal of Epidemiology - The Jinchang Cohort was an ongoing 20-year ambispective cohort with unique metal exposures to an occupational population. From January 2014 to December 2019, the...     

Metabolic syndrome mortality in a population-based cohort study: Jichi Medical School (JMS) Cohort Study

BACKGROUND: Metabolic syndrome is known to increase morbidity and mortality of cardiovascular disease. The National Cholesterol Education Program Adult Treatment Expert Panel III in 2001 (revised in 2005) and the Japanese definition of metabolic syndrome were launched in 2005. No study regarding the association between metabolic syndrome by Japanese definition and mortality has been performed. The aim of this study was to clarify the prevalence of metabolic syndrome and its effects to mortality in a population-based cohort study. METHODS: A total of 2,176 subjects who satisfied the necessary criteria for metabolic syndrome were examined between 1992 and 1995 as a part of Jichi Medical School Cohort Study by Japanese definition. Cox's proportional hazard models were used to analyze the association of metabolic syndrome with mortality. RESULTS: The prevalence of metabolic syndrome was 9.0% in males and 1.7% in females. There were 17 deaths (14 males), including 6 cardiovascular deaths (5 males), during a 12.5-year follow-up period among metabolic syndrome subjects. After adjusting for age, smoking status, and alcohol drinking status, the hazard ratio (95% confidence interval) for all-cause mortality was 1.13 (0.64-1.98) in males and 1.31 (0.41-4.18) in females, and HR for cardiovascular mortality was 1.84 (0.68-4.96) in males, and 1.31 (0.17-9.96) in females. CONCLUSION: No statistical significant relationship between metabolic syndrome by Japanese definition and all-cause mortality was observed in a population-based cohort study.     

Factors associated with prevalent human immunodeficiency virus (HIV) infection in the Multicenter AIDS Cohort Study

Interviews regarding medical history, life-style, specific drug taking and sexual activities, and physical examinations were administered to 4,955 homosexual men who volunteered for the Multicenter AIDS Cohort Study in Baltimore, Chicago, Los Angeles, and Pittsburgh. Overall, the prevalence of antibodies to human immunodeficiency virus (HIV) in these men was 38.0%. The factor most strongly associated with prevalent HIV infection according to a multiple logistic regression model was rectal trauma, a composite variable which included receptive anal fisting, enemas before sex, reporting of blood around the rectum, and the observation of scarring, fissures or fistulas on rectal examination. Receptive anal intercourse also was strongly associated with HIV infection in the model. The multivariate relative odds for HIV antibody positivity was 7.72 for the highest level of rectal trauma and 3.04 for receptive anal intercourse. Symptoms reported to occur in some persons who subsequently develop acquired immunodeficiency syndrome (AIDS) were frequent among HIV seropositive men (12.9%) but were reported in 8.4% of seronegative men as well. Generalized lymphadenopathy was observed significantly more often in seropositive men (48.8%) compared with seronegative men (11.4%). The prevalence of HIV antibodies was inversely related to the number of T-helper cells and directly related (to a lesser extent) to the number of T-suppressor cells. The results suggest that disruption of the rectal mucosa provides access by HIV to the blood stream and to specific immunologic cells. Since symptoms and generalized lymphadenopathy were often reported among seronegative men, they probably also occur among some seropositive men not currently progressing to AIDS.     

Increasing prevalence of HIV-2 and dual HIV-1-2 infections among patients attending various outdoor patient departments in Mumbai (Bombay)

Between 1993-96, a serological study was carried out for differentially identifying HIV-1 and HIV-2 infections among the high risk group persons attending the various outdoor patient departments of BYL Nair Municipal Hospital, Mumbai. This study indicates that although HIV-1 is still the predominant virus among the high risk HIV infected persons in Mumbai, dual HIV-1-2 infections are increasing especially among promiscuous heterosexuals and female commercial sex workers. Increases in HIV-2 infections were observed later than dual HIV-1-2 infections, indicating that it is the HIV-1 infected individuals who through continued high risk behavior got infected by HIV-2.