DISTRIBUTION OF TOBACCO USE IN POPULATIONS: A COMPARATIVE MULTILEVEL AND LONGITUDINAL ANALYSIS OF CANADA AND INDIA

Abstract

<p>Smoking/tobacco use is the leading preventable cause of death worldwide. Despite understanding the health consequences of smoking, less is known as to how and why the effects of smoking emerge differently between countries and within populations both over time and across socioeconomic groups and geographic locales. In this thesis, we examined socioeconomic status (SES) and geography as two potential causes of variability in current rates of tobacco use and cessation in Canada and India, countries at diverse levels of economic development and epidemiological transition. The major findings were: (i) low SES, defined by education, income, and occupation, was associated with increased risk of tobacco consumption in both Canada and India, although there was variability in the strength of this association by form of tobacco use in India; (ii) in a 60-year longitudinal study, rates of smoking have fallen over time in Canada but socioeconomic gaps have widened; (iii) smoking quit rates were higher in Canada than India; although in both countries there was a positive association between SES and quitting; (iv) geographic variation in tobacco use and quit rates remained after accounting for individual socioeconomic and demographic characteristics, suggesting the importance of place in shaping patterns of tobacco use in Canada and India. Taken together, these findings indicate that tobacco use in populations is strongly patterned along socioeconomic and geographic dimensions. Future prevention and cessation programs will need explicit consideration of socioeconomic and geographic aspects of the tobacco use distribution to effectively improve the situation across all areas and groups.</p>