- Volume 14 Issue 5
DOI QR Code
Global Adult Tobacco Survey (GATS): A Case for Change in Definition, Analysis and Interpretation of "Cigarettes" and "Cigarettes Per Day" in Completed and Future Surveys
- Jena, Pratap Kumar (Project STEPS, Public Health Foundation of India, New Delhi, India and Heath Systems Research India Initiative) ;
- Kishore, Jugal (Department of Community Medicine, Maulana Azad Medical College) ;
- Sarkar, Bidyut K. (Department of Epidemiology and Public Health, University College London (UCL), U.K. and Public Health Foundation of India (PHFI))
- 발행 : 2013.05.30
Background: The Global Adult Tobacco Survey has 15 key indicators, cigarettes smoked per day (CPD) among daily smokers being one of them. The first wave of GATS in 14 countries indicated that mean CPD use is higher in women than men in India only, which is contrary to the current understanding of tobacco use globally. This study was undertaken to understand the unusual findings for mean CPD use in the GATS-India survey. Materials and Methods: Items B06a and B06b of the GATS India survey questionnaire that collected information on daily consumption of manufactured and rolled cigarettes were analyzed using SPSS software. Exclusive users were identified from these items after excluding the concurrent users of other tobacco products. Cigarette type, exclusive use and gender stratified analyses were made. Consumption of different types of cigarettes among the mixed users of manufactured and rolled cigarettes were correlated. Results: Higher mean number of CPD use among male daily-smokers was observed than their female counterparts in product specific analysis. Mean CPD as per GATS cigarette definition was higher in males than females for exclusive users but a reverse trend was observed in case of non-exclusive users. Use of manufactured cigarettes increased with increase in use of rolled cigarette among the mixed users and around half of these users reported equal CPD frequency for the both types of cigarettes. Conclusions: The anomaly in mean CPD estimate in GATS-India data was due to inclusion of two heterogeneous products to define cigarettes, variation in cigarette product specific user proportions contributing to the average and non-exclusive concurrent use of other tobacco products. The consumption pattern of cigarettes among the mixed users highlights bias in CPD reporting. Definition, analysis and interpretation of 'cigarettes per day' in the GATS India survey need to be improved by redefining cigarettes and making product specific analyses.
Global Adult Tobacco Survey (GATS);India;cigarettes per day;nicotine dependence;rolled cigarettes
- Burns DM, Major JM, Shanks TG (2003). Changes in Number of Cigarettes Smoked per Day: Cross-Sectional and Birth Cohort Analyses Using NHIS. In: Marcus SE, ed., Smoking and Tobacco Control Monograph No. 15-Those Who Continue To Smoke: Is Achieving Abstinence Harder and Do We Need to Change Our Interventions. Bethesda, MD: National Institutes of Health, National Cancer Institute, USDHSS.
- Centers for Disease Control and Prevention (2010). How Tobacco Smoke Causes Disease: The Biology and Behavioral Basis for Smoking-Attributable Disease: A Report of the Surgeon General. Atlanta (GA): CDC, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health (US).
- Centers for Disease Control and Prevention (2012). Cigarette smoking among adults-United States, 2011. Morbidity and Mortality Weekly Report (MMWR), 61, 889-908.
- Dawe S, Loxton NJ, Hides L, Kavanagh DJ, Mattick RP (2002). Review of diagnostic screening instruments for alcohol and other drug use and other psychiatric disorders (2nd Ed). Australia: Commonwealth Department of Health and Ageing.
- Doll R, Peto R, Boreham J, Sutherland I (2004). Mortality in relation to smoking: 50 years' observations on male British doctors. BMJ, 328, 1519. https://doi.org/10.1136/bmj.38142.554479.AE
- Fagerstrom KO (2003). Time to ﬁ rst cigarette; the best single indicator of tobacco dependence? Monaldi Arch Chest Dis, 59, 91-4.
- Fagerstrom KO (2012b). Determinants of tobacco use and renaming the FTND to the fagerstrom test for cigarette dependence. Nicotine Tob Res, 14, 75-78. https://doi.org/10.1093/ntr/ntr137
- Fagerstrom KO, Eissenberg T (2012a). Dependence on tobacco and nicotine products: a case for product-specific assessment. Nicotine Tob Res, 14, 1382-90. https://doi.org/10.1093/ntr/nts007
- Fichtenberg CM, Glantz SA (2002). Effect of smoke-free workplaces on smoking behaviour: systematic review. BMJ, 325, 188. https://doi.org/10.1136/bmj.325.7357.188
- Foll BL, George TP (2007). Treatment of tobacco dependence: integrating recent progress into practice. CMAJ, 177, 1373-80. https://doi.org/10.1503/cmaj.070627
- Giovino GA, Gupta PC, Samet JM et al (2012b). Authors' reply to comments on ‘Tobacco use in 3 billion individuals from 16 countries: an analysis of nationally representative crosssectional household surveys'. Lancet, 380, 1906-07.
- Giovino GA, Mirza SA, Samet JM, et al (2012a). Tobacco use in 3 billion individuals from 16 countries: an analysis of nationally representative cross-sectional household surveys. Lancet, 380, 668-79. https://doi.org/10.1016/S0140-6736(12)61085-X
- Hatziandreu EJ, Pierce JP, Fiore MC et al (1989). The reliability of self-reported cigarette consumption in the United States. Am J Public Health, 79, 1020-23. https://doi.org/10.2105/AJPH.79.8.1020
- Hyland A, Li Q, Bauer JE, et al (2004). Predictors of cessation in a cohort of current and former smokers followed over 13 years. Nicotine Tob Res, 6, 363-69. https://doi.org/10.1080/14622200412331320761
- International Agency for Research on Cancer (IARC) Handbooks of Cancer Prevention (2008). Tobacco Control Vol. 12: Methods for Evaluating Tobacco Control Policies. Lyon, France: IARC, World Health Organization.
- Jena PK, Kishore J & Bandyopadhyay C (2012). Prevalence and patterns of tobacco use in Asia. Lancet, 380, 1906.
- Jena PK, Kishore J, Jahnavi G (2013). Correlates of Digit Bias in Self-reporting of Cigarette per Day (CPD) Frequency: Results from Global Adult Tobacco Survey (GATS), India and its Implication. Asian Pac J Cancer Prev, 2013, 5.
- Klesges RC, Debon M, Ray JW (1995). Are self-reports of smoking rate biased? Evidence from the second national health and nutrition examination survey. J Clin Epidemiol, 48, 1225-33. https://doi.org/10.1016/0895-4356(95)00020-5
- Koplan JP, Mackay J. Curtailing tobacco use: first we need to know the numbers. Lancet, 380, 629 -30.
- Manley M, Pierce JP, Gilpin EA et al (1997). Impact of the american stop smoking intervention study on cigarette consumption. Tobacco Control, 6, 12-16. https://doi.org/10.1136/tc.6.suppl_2.S12
- Means B, Habina K, Swan GE et al (1992). Cognitive research on response error in survey questions on smoking. Meryland, USA: National Center for Health Statistics, United States Department of Health and Human Services, 1-32
- National Institute of Medical Statistics (NIMS) (2009). IDSP Non-Communicable Disease Risk Factors Survey, Phase-I States of India (2007-08). New Delhi: NIMS, Indian Council of Medical Research, New Delhi, India.
- O'Brien CP (2003). Research advances in the understanding and treatment of addiction. Am J Addict, 12, 36-47. https://doi.org/10.1111/j.1521-0391.2003.tb00555.x
- US Department of Health and Human Services (USDHHS) (2004). The Health Consequences of Smoking: A Report of the Surgeon General. Rockville, MD: USDHHS, CDC, Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health (US).
- US Department of Health and Human Services (USDHHS) (2008). Clinical Practice Guideline - Treating Tobacco Use and Dependence: 2008 Update. Rockville, MD: US Dept of Health and Human Services, Public Health Service.
- Warner KE (1978). Possible increases in the underreporting of cigarette consumption. J Am Stat Assn, 73, 314-18. https://doi.org/10.1080/01621459.1978.10481575
- Warner KE (2006). Tobacco policy research: insights and contributions to public health policy. In: Warner KE, Isaacs SL, Knickman JR, editors. Tobacco control policy. Robert Wood Johnson Foundation Health Policy series. v. 3. San Francisco: Jossey-Bass Publishers.
- West R, McNeill A, Raw M (2000). Smoking cessation guidelines for health professionals: an update. Thorax, 55, 987-99. https://doi.org/10.1136/thorax.55.12.987
- Young D, Yong H, Borland R et al (2012). Trends in Roll-Your-Own Smoking: Findings from the ITC Four-Country Survey (2002–2008). J Environ Public Health, 2012, 406283
- Tobacco Use and Quit Behaviour Assessment in the Global Adult Tobacco Survey (GATS): Invalid Responses and Implications vol.14, pp.11, 2013, https://doi.org/10.7314/APJCP.2013.14.11.6563