Editor—The article by Subramanian et al on patterns and distribution of tobacco consumption in India is interesting and informative but raises issues.1
Figure 1.
Unadjusted prevalence of adults aged 18 and above who smoke or chew tobacco in 1998-9 by Indian state
The second national family health survey collected data from more than 90 000 ever married women aged 15-49 years in India, covering all states. The data on the consumption pattern of paan masala, tobacco, smoking, and alcohol among household members aged 15 years and above were collected. However, no direct interviews were conducted of the adult men in the household (the information was collected by the women interviewed). In view of the above, under-reporting is a strong possibility as the women interviewed might not be aware of the consumption of tobacco outside the household. Also, because of the social stigma attached with the consumption of tobacco women might be under-reporting to the interviewers.
Hence this study may not be a true reflection of current consumption of tobacco among the adult men in India. To our knowledge it is, however, the best data set available on the prevalence of consumption of paan masala, tobacco, smoking, and alcohol in the country.
Competing interests: None declared.
References
- 1.Subramanian SV, Nandy S, Kelly M, Gordon D, Davey Smith G. Patterns and distribution of tobacco consumption in India: cross sectional multilevel evidence from the 1998-9 national family health survey. BMJ 2004;328: 801-6. (3 April.) [DOI] [PMC free article] [PubMed] [Google Scholar]