GATS India Report 2009-2010 Ministry of Health and Family Welfare Government of India GLOBAL ADULT TOBACCO SURVEY GATS INDIA 2009-2010 GATS India Report 2009-2010 © Ministry of Health and Family Welfare, Government of India, New Delhi. All rights reserved. The contents in this publication may be reproduced or translated free of charge after taking prior permission of the National Tobacco Control Programme, Ministry of Health & Family Welfare, Government of India, New Delhi – 110 011. However, short excerpts may be reproduced without authorization, on condition that the source is indicated and duly acknowledged. The material has to be reproduced accurately and not to be used in a derogatory manner or in a misleading context. The permission to reproduce this material shall not extend to any material which is identified as being copyright of a third party. The authorization to reproduce such material must be obtained from the departments/copyright holders concerned. This publication is also available on the website www.iipsindia.org, www.mohfw.nic.in. The Global Adult Tobacco Survey (GATS) India, 2009-2010 has been conducted by the International Institute for Population Sciences, Mumbai as per the standard protocol under Global Tobacco Surveillance System (GTSS). All reasonable precautions have been taken by the Ministry of Health & Family Welfare to verify the information contained in this publication. However, the published material is being distributed without warranty of any kind, either expressed or implied. Inquiries if any may be addressed to International Institute for Population Sciences, Govandi Station Road, Deonar, Mumbai-400 088 or email [email protected], [email protected]. The copy of this report may be obtained from International Institute for Population Sciences, Deonar, Mumbai – 400 088, as per the existing policy. Printed in India, 2010 GATS India Report 2009-2010 iiiii GATS India Report 2009-2010 v GATS India Report 2009-2010 viivii GATS India Report 2009-2010 ixix GATS India Report 2009-2010 xi GATS India Report 2009-2010 ACKNOWLEDGEMENT The 2009-2010 Global Adult Tobacco Survey (GATS) in India was successfully completed with the committed efforts and support of different organizations and individuals at various stages of the survey. At the outset we acknowledge our sincere gratitude to the Ministry of Health and Family Welfare (MoHFW), Government of India, for granting responsibility of conducting the Global Adult Tobacco Survey (GATS) in India to IIPS, Mumbai, and funding this project. We express our thanks to Miss. K. Sujatha Rao, Secretary to the Government of India, MoHFW; Dr. R. K. Srivastava, Director General of Health Services (DGHS); Shri Keshav Desiraju, Additional Secretary (H); Dr. Dinesh Bhatnagar, Additional Director General, Ms. Madhubala, ADG (Stats); Shri. S.K. Das, Former Additional Director General (Stats); Sh. B.K. Prasad, Joint Secretary, and Dr. D.C. Jain, DDG (NCD); for providing overall guidance and support during the tenure of the project. We wish to put on record the contributions of Late Prof. P. N. Mari Bhat, the former Director & Sr. Professor (2005 -2007) of the IIPS, Mumbai, who was instrumental in undertaking the GATS-India project at the initial stage. We gratefully acknowledge valuable suggestions and contributions by Ms. Anuradha Vemuri, Director, MoHFW; Dr. Rattan Chand, Chief Director (Stats); Dr. Jagdish Kaur, Chief Medical Officer and Dr. Vinayak Prasad, former Director (PH) at various stages of the survey. We extend our appreciation to all collaborative partner organizations viz., World Health Organization (WHO) Country office for India, WHO SEARO; Centers for Disease Control and Prevention (CDC); CDC Foundation, Atlanta; Research Triangle Institute (RTI) International and Johns Hopkins Bloomberg School of Public Health (JHSPH) for providing technical support in successfully conducting the GATS in India. We gratefully acknowledge the immense help and guidance received time to time from Dr. Samira Asma, Associate Director, CDC-Atlanta and Dr. Krishna Mohan Palipudi, Senior Survey Statistician, CDC- Atlanta for their constant involvement and support at various stages of the project. We sincerely acknowledge the WHO’s contribution to the project with special thanks to Dr. D. N. Sinha, Regional Surveillance Officer, WHO-SEARO and Ms. Vineet Gill Munish, National Professional Officer (TFI), WHO, India. Our special thanks to all the members of Technical Advisory Committee and Technical Review Committee in particular Dr. K. Srinath Reddy, President, Public Health Foundation of India (PHFI), New Delhi and Dr. P. C. Gupta, Director, Healis-Sekhsaria Institute for Public Health, Mumbai. This acknowledgement cannot be concluded without expressing appreciation for the efforts and hard work put in by the field investigators and supervisors in collecting data and all data managers for timely transferring data to IIPS. Last but not the least, credit goes to all respondents who participated in GATS-India project. L. Ladu Singh F. Ram B. Paswan S. Lahiri S. K. Singh Sulabha Parasuraman K. C. Das xiii GATS India Report 2009-2010 CONTRIBUTORS Prof. F. Ram Prof. S. Lahiri Prof. Sulabha Parasuraman Prof. L. Ladu Singh Prof. B. Paswan Dr. S. K. Singh Dr. K. C. Das xv GATS India Report 2009-2010 TECHNICAL ADVISORY COMMITTEE Chairman: Additional Secretary/ Joint Secretary in-charge of Tobacco Control Programme, MoHFW, GOI Co-Chairman: Additional DG (Stats.), Dte.GHS, MoHFW Members: Shri Keshav Desiraju, Additional Secretary (H), MoHFW Shri V. Venkatachalam, Additional Secretary, MoHFW Shri Prabir Krishan, Joint Secretary, MoHFW Shri B.K. Prasad, Joint Secretary MoHFW Dr. Amarjit Singh, Former Joint Secretary, MoHFW Dr. Dinesh Bhatnagar, Addl DG (DB), Dte.GHS, MoHFW Shri. S. K. Das, Former ADG (Stats.), MoHFW Dr. Rattan Chand, Chief Director (Stats.), MoHFW Ms. Anuradha Vemuri, Director, MoHFW Dr. Jagdish Kaur, Chief Medical Officer, Dte.GHS, MoHFW Dr. Vinayak M. Prasad, Former Director (PH), MoHFW Prof. F. Ram, Director, IIPS Prof. S. Lahiri, IIPS Prof. Sulabha Parasuraman, IIPS Prof. L. Ladu Singh, IIPS Prof. B. Paswan, IIPS Dr. S. K. Singh,Associate Professor, IIPS Dr. K. C. Das, Associate Professor, IIPS Dr. K. Srinath Reddy, President, Public Health Foundation of India, Delhi Dr. P. C. Gupta, Director, Healis-Sekhsaria Institute of Public Health, Mumbai Dr. D. N. Sinha, Technical Officer- TFI, WHO-SEARO Ms. Vineet Gill Munish, NPO-Tobacco Free Initiative, WHO India Dr. Samira Asma,Associate Director, CDC, Atlanta Dr. Krishna Mohan Palipudi, Senior Survey Statistician,CDC, Atlanta xvi GATS India Report 2009-2010 TECHNICAL REVIEWERS Dr. P. C. Gupta, Director, Healis-Sekhsaria Institute of Public Health, Mumbai Dr. K. Srinath Reddy, President, Public Health Foundation of India, Delhi Ms. Monika Arora, PHFI Ms. Anuradha Vemuri, Director, MoHFW Dr. Jagdish Kaur, Chief Medical Officer, Dte.GHS, MoHFW Dr. D. N. Sinha, Technical Officer- TFI, WHO-SEARO Dr. Samira Asma, Associate Director, CDC, Atlanta Dr. Krishna Mohan Palipudi, Senior Survey Statistician,CDC, Atlanta Ms. Vineet Gill Munish, NPO-Tobacco Free Initiative, WHO India Dr. Vinayak Prasad, Former Director (PH), MoHFW Edited by: Smt. Rita Vohra Editorial Assistant: Ms. Pooja Gupta Mr.Anand Kumar Panjiyar xvii GATS India Report 2009-2010 CONTENTS Page No. TABLES……………………………………….………………………………..…...........xv FIGURES………………………………….………………………….………............. xxiv MAPS……………………………………………………….………...………………. xxvii EXECUTIVE SUMMARY………………………..……………………………........xxviii CHAPTER 1 INTRODUCTION.………………………………………………………………………1 1.1 Tobacco Control Policies in India…………………………………….................................2 1.2 Tobacco Use in India……………………………………………………….………...…….3 1.3 Survey Objectives…………………………………………………………………….........7 CHAPTER 2 METHODOLOGY…………………………………………………………….................9 2.1 Study Population………………………………………………………………..…….....…9 2.2 Sampling Design…………………………………………………………………….…..…9 2.3 Questionnaire……………………………………………………………………..............11 2.4 Questionnaire Programming and Preparation of Handheld Computers……….………....12 2.5 Recruitment, Training and Fieldwork……………………………………………….........13 2.6 Data Processing and Aggregation………………………..……………………...………..16 2.7 Statistical Analysis…………………………………………………………………......…17 CHAPTER 3 SAMPLE AND POPULATION CHARACTERISTICS…………..……….…………19 3.1 Sample Coverage, Household and Person-Level Response Rates………..………...….…19 3.2 Characteristics of Sampled Respondents……………………………………………..…...23 3.3 States and Regional Population Distribution………………………………………..….....24 CHAPTER 4 TOBACCO USE………………………………………………………….………..........25 4.1 Tobacco Use…………………………………………………………………..………..…25 4.2 Tobacco Smoking…………………………………………………………………...….....43 4.3 Use of Smokeless Tobacco …..…………………………………………………….….….72 CHAPTER 5 TOBACCO CESSATION…………………………………………………....…...….…97 5.1 Cessation Attempts, Health Care Seeking Behaviour of Tobacco Users and Advice by Health Care Providers……………………………………..……………...…..97 5.2 Cessation Method.………………………………………………………………......…...105 5.3 Interest in Quitting Tobacco………………………………………………………..........110 5.4 Duration of Stopping Tobacco Use………………………………………………...……116 xix GATS India Report 2009-2010 CHAPTER 6 SECOND-HAND SMOKE…………………………………………...…………….….123 6.1 Exposure to Second-Hand Smoke (SHS) in Indoor Workplaces…………...………...…123 6.2 Exposure to Second-Hand Smoke at Home……………………………….………….…127 6.3 Exposure to Second-Hand Smoke at Various Public Places……………………….…....131 6.4 Designated Non-Smoking Area and Smoking in Designated