Social disparities in tobacco use in Mumbai, India: the roles of occupation, education, and gender.

OBJECTIVES We assessed social disparities in the prevalence of overall tobacco use, smoking, and smokeless tobacco use in Mumbai, India, by examining occupation-, education-, and gender-specific patterns. METHODS Data were derived from a cross-sectional survey conducted between 1992 and 1994 as the baseline for the Mumbai Cohort Study (n=81837). RESULTS Odds ratios (ORs) for overall tobacco use according to education level (after adjustment for age and occupation) showed a strong gradient; risks were higher among illiterate participants (male OR = 7.38, female OR = 20.95) than among college educated participants. After age and education had been controlled, odds of tobacco use were also significant according to occupation; unskilled male workers (OR = 1.66), male service workers (OR = 1.32), and unemployed individuals (male OR = 1.84, female OR = 1.95) were more at risk than professionals. The steepest education- and occupation-specific gradients were observed among male bidi smokers and female smokeless tobacco users. CONCLUSIONS The results of this study indicate that education and occupation have important simultaneous and independent relationships with tobacco use that require attention from policymakers and researchers alike.