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

Abstract

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.

Outcome of tobacco cessation in workplace and clinic settings: A comparative study

“…[2] The Global Adult Tobacco Survey (GATS) in 2010 revealed that 47.9% of males and 20.3% of females, constituting 34.6% of the adult population, used tobacco in one or the other form in India. [34] Social and cultural acceptance among youth is one of the reason for higher prevalence of tobacco consumption in India.…”

Changes in adult smoking behaviours in ten global adult tobacco survey (GATS) countries during 2008–2018 - a test of ‘hardening’ hypothesis’

“…Further information about number of cigarettes is likely to be under reported and inaccurate as smokers tend to round off to five,10 etc. (known as ‘heaping’) and do not report exact number of sticks smoked during the previous 24 h [ 34 ]. We examined a change in ten countries having data from at least five years intervals and the most recent survey done was during 2015 or later.…”

Changes in adult smoking behaviours in ten Global Adult Tobacco Survey (GATS) countries during 2008-2018 - a test of ‘hardening’ hypothesis

“…Further information about number of cigarettes is likely to be under reported and inaccurate as smokers tend to round off to five,10 etc. (known as 'heaping') and do not report exact number of sticks smoked during the previous 24 hours [33]. We examined a change in ten countries that had at least five years interval and most recent survey done was during 2015 or later.…”