Prevalence and Patterns of Tobacco Use in Bangladesh from 2009 to 2012: Evidence from International Tobacco Control (ITC) Study.
Prevalence and Patterns of Tobacco Use in Bangladesh from 2009 to 2012: Evidence from International Tobacco Control (ITC) Study.
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DOI：
10.1371/journal.pone.0141135
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发表时间：
2015
期刊：
影响因子：
3.7
通讯作者：
Abdullah AS
中科院分区：
文献类型：
--
作者：
Nargis N;Thompson ME;Fong GT;Driezen P;Hussain AK;Ruthbah UH;Quah AC;Abdullah AS
吸烟和被动吸烟是孟加拉国最大的可预防死亡原因，造成发病率、残疾、死亡率和社区成本等重大公共卫生负担。然而，现有的孟加拉国烟草使用研究不一定采用在全国范围内监测问题所需的具有全国代表性的样本。本文利用大型全国代表性可比调查研究了孟加拉国成年人烟草使用的流行率和模式以及随时间的变化。利用国际烟草控制 (ITC) 孟加拉国项目于 2009 年和 2012 年进行的两次调查的数据，根据社会经济决定因素和来自 30,000 多个家庭的 90,000 多人的样本类型，获得了所有烟草制品的流行率估计值。家庭水平样本权重用于获得具有全国代表性的患病率估计值和标准误差。对两个时间段之间估计值差异的统计检验基于逻辑回归模型，该模型考虑了复杂的抽样设计。使用多项 Logit 模型，可以确定烟草使用状况的时间趋势，以捕捉宏观层面决定因素的影响，包括烟草控制政策的变化。 2009 年至 2012 年间，总体烟草使用率从 42.4% 下降至 36.3%。无烟烟草使用量的下降比吸烟更为明显。只吸烟的比例从 7.2% 上升至 10.6%；只吸比迪烟的比例稳定在 2% 左右；同时吸香烟和比迪烟的比例从 4.6% 下降到 1.8%；纯无烟烟草使用率从 20.2% 下降至 16.9%；无烟烟草使用率和吸烟率均从 8.4% 下降至 5.1%。一般来说，男性的烟草使用率较高，从年轻群体到老年群体均呈上升趋势，贫困人群的吸烟率也较高。贫民窟人群吸烟率最高，其次是部落人群、民族人群和边境地区人群，表明弱势群体的烟草使用负担更大。烟草使用量的总体下降可以被视为孟加拉国烟草市场的结构性转变，从比迪烟和无烟烟草等低价值产品转向高价值卷烟，随着普通民众收入和购买力的增长，预计会出现这种转变。尽管总体烟草使用量有所减少，但孟加拉国男性吸烟率仍然高达 37%。世界男性平均每天吸烟率为 31.1%。 2005 年《烟草控制法》及其修正案尚未对遏制孟加拉国的烟草使用产生重大影响。本文的研究结果进一步表明，孟加拉国的烟草控制政策需要包括有针对性的干预措施，以限制特定人口和社会经济群体使用特定类型的烟草制品，例如男性吸烟，女性无烟烟草，以及生活在农村地区、社会经济地位低下以及部落和贫民窟人口的吸烟和无烟烟草。
Smoking and passive smoking are collectively the biggest preventable cause of death in Bangladesh, with major public health burden of morbidity, disability, mortality and community costs. The available studies of tobacco use in Bangladesh, however, do not necessarily employ nationally representative samples needed to monitor the problem at a national scale. This paper examines the prevalence and patterns of tobacco use among adults in Bangladesh and the changes over time using large nationally representative comparable surveys. Using data from two enumerations of the International Tobacco Control (ITC) Bangladesh Project conducted in 2009 and 2012, prevalence estimates are obtained for all tobacco products by socio-economic determinants and sample types of over 90,000 individuals drawn from over 30,000 households. Household level sample weights are used to obtain nationally representative prevalence estimates and standard errors. Statistical tests of difference in the estimates between two time periods are based on a logistic regression model that accounts for the complex sampling design. Using a multinomial logit model, the time trend in tobacco use status is identified to capture the effects of macro level determinants including changes in tobacco control policies. Between 2009 and 2012, overall tobacco use went down from 42.4% to 36.3%. The decline is more pronounced with respect to smokeless tobacco use than smoking. The prevalence of exclusive cigarette smoking went up from 7.2% to 10.6%; exclusive bidi smoking remained stable at around 2%; while smoking both cigarette and bidi went down from 4.6% to 1.8%; exclusive smokeless tobacco use went down from 20.2% to 16.9%; and both smokeless tobacco use and smoking went down from 8.4% to 5.1%. In general, the prevalence of tobacco use is higher among men, increases from younger to older age groups, and is higher among poorer people. Smoking prevalence is the highest among the slum population, followed by the tribal population, the national population and the border area population, suggesting greater burden of tobacco use among the disadvantaged groups. The overall decline in tobacco use can be viewed as a structural shift in the tobacco market in Bangladesh from low value products such as bidi and smokeless tobacco to high value cigarettes, which is expected with the growth in income and purchasing power of the general population. Despite the reduction in overall tobacco use, the male smoking prevalence in Bangladesh is still high at 37%. The world average of daily smoking among men is 31.1%. The Tobacco Control Act 2005 and the Amendment have yet to make a significant impact in curbing tobacco usage in Bangladesh. The findings in this paper further suggest that the tobacco control policies in Bangladesh need to include targeted interventions to restrain the use of particular types of tobacco products among specific demographic and socio-economic groups of the population, such as smoked tobacco among men, smokeless tobacco among women, and both smoked and smokeless tobacco among those living in rural areas, those in low socio-economic status and those belonging to the tribal and the slum population.