Contextual correlates of intensity of smoking in northeast India

Exploring the Linkages Between Non-Communicable Disease Multimorbidity, Health Care Utilization and Expenditure Among Aboriginal Older Adult Population in India

Objective: The study investigates the magnitude and correlates of non-communicable disease multimorbidity and explores its linkages with health care utilization and out-of-pocket expenditure among aboriginal or tribal older adults.

Methods: The study employed data on 11,365 older adults from Scheduled Tribes from the Longitudinal Ageing Study in India, 2017-18. A disease score was computed integrating sixteen non-communicable diseases. Descriptive, bivariate, and multivariable analyses were performed to identify the magnitude and correlates of multimorbidity. The study further explored the linkages between selected diseases and multimorbidity with health care utilization and expenditure.

Results: The findings suggest that 27.1 and 14.5% of the aboriginal population lived with single or multiple disease, respectively. Hypertension and gastrointestinal disorders were frequent diseases. Higher age, Muslim religion, higher education, unemployment, and affluent background were the major correlates of multimorbidity. Health care utilization, mean expenditure on hospitalization, and outpatient visits increased significantly with multimorbidity.

Conclusion: Multimorbidity is emerging as a health care challenge among the aboriginal population. Measures need to be taken to assess the multimorbidity burden and reduce health care expenditure, ensuring health equity among country’s vulnerable population.

Does substance use by family members and community affect the substance use among adolescent boys? Evidence from UDAYA study, India

Background

Substance use among adolescents is risky behavior that had emerged as a concern in both developed and developing countries. Evidence revealed that substance use is more frequent among those adolescents whose immediate family members (parents, siblings and grandparents) also indulge in such consumption; however, scarce literature is present in the Indian context. Therefore, the present study examined whether substance use among family members and in the community is associated with the substance use behavior of adolescent boys in Uttar Pradesh and Bihar.

Method

We used the data for 5969 adolescent boys aged 10–19 years from the Understanding the Lives of Adolescents and Young Adults (UDAYA) survey conducted in 2016. A three-level random intercept logit model was utilized to understand the association of adolescent substance use behavior with familial and community context.

Results

We found that 16% of adolescent boys were using any substance (tobacco or alcohol or drug). The substance use was significantly higher among adolescent boys who were school dropouts (40%) than those who were currently in school. The prevalence of substance use is also high among those who were working (35%). Moreover, 19, 24 and 28% of the adolescents come from families where at least one of the family members consumed tobacco, alcohol and drugs, respectively. The odds of substance use were 2.13 times [CI:1.44–3.17] higher among those adolescent boys whose family members also indulged in substance use. Moreover, the likelihood of substance use was 1.24 times [CI:1.01–1.68] higher among the adolescent boys who come from a community with high substance use. Additionally, the risk of substance use is more likely among adolescent boys belonging to the same household of the same community.

Conclusion

It is evident that exposure to substance use in the family and community increases the likelihood of substance use among adolescent boys. There is a need for household- and community-level programmatic interventions to alleviate the risk of substance use among adolescents.

Why Do the Youths in Northeast India Use Tobacco?

This study is an assessment of the influence of parent's tobacco use on prospective tobacco use trajectories among young offspring. The study is based on unit level data from District Level Household and Facility Survey-4 (2012-2013) comprising 27,706 youths in 15–24 years' age group from northeastern states of India and used multilevel regression to identify the potential risk factors of tobacco consumption. The likelihood of using tobacco was found to be 3.4 and 1.14 times more, respectively, for the youths coresiding with mothers who use tobacco and fathers who use tobacco, in comparison to youths staying with parents not taking tobacco. The significant effect of peers on tobacco consumption among youths was also observed. School-going youths had significantly lower risk of tobacco use. The estimated likelihood of a young person from a household to use any tobacco, use smokeless tobacco, and smoke was found to be 28, 12, and 17 percent, respectively. There is an urgent need to extend National Tobacco Control Programme (NTCP) to the community level involving civil societies and young and adult generations for spreading awareness about the health hazards of tobacco use, providing support and facilitating quitting tobacco use.

Military service and smoking in a cohort of northern Vietnamese older adults

OBJECTIVES

Wide-ranging scholarship demonstrates war's impacts on US veterans' health. We ask whether, among Vietnamese men of a certain age, wartime experiences contributed to initiating smoking, and thus shaped one behavioral pathway linking war exposure and older adult health.

METHODS

We analyze the Vietnam Health and Aging Pilot Study (VHAPS), a survey of adults ages 55 and older (N = 405) conducted in one commune of northern Vietnam. We implement Cox discrete-time proportional hazards models to discern the effects of military service upon the initiation of smoking.

RESULTS

Military service results in a heightened risk of initiating smoking within this cohort (HR 2.13, [CI 1.36, 3.35]). Smoking initiation is also significantly gendered and age graded. Socioeconomic position and social capital variables in the models are statistically insignificant.

CONCLUSIONS

This study finds that, among older northern Vietnamese men whose early adulthood coincided with mass mobilization in the Vietnam War, involvement in formal military service significantly increased the risk of initiating smoking. Military-induced smoking emerges where tobacco products were not provided by the military institution, but where social availability of tobacco was widespread.