Impact of India's National Tobacco Control Programme on bidi and cigarette consumption: a difference-in-differences analysis
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Public Health Foundation of India, Health Promotion Division, India
London School of Hygiene & Tropical Medicine, Non-Communicable Disease Epidemiology, United Kingdom
Johns Hopkins Bloomberg School of Public Health, Department of International Health, United States of America
Imperial College London, Public Health Policy Evaluation Unit, School of Public Health, United Kingdom
Indian Institute of Public Health, India
Public Health Foundation of India, India
Publication date: 2018-03-01
Tob. Induc. Dis. 2018;16(Suppl 1):A295
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Notwithstanding the importance of decreasing tobacco use to achieve Sustainable Development Goals' mortality reduction targets, evaluations of tobacco control programmes in low- and middle-income settings are scarce. We studied the impact of India's National Tobacco Control Programme (NTCP) on household-reported consumption of bidis and cigarettes using a Difference-in-differences (DID) analysis, typically used in econometrics for programme impact evaluation.

Secondary analyses were conducted on three cross-sectional datasets from nationally representative Household Consumer Expenditure Surveys (CES) (1999-2000; 2004-05 and 2011-12). Their sample sizes varied between 100,000-125,000 households. The CES collected information on consumption and expenditure of 350 food and non-food items. Outcomes were: any bidi/cigarette consumption in the household during the past 30 days; and monthly consumption of bidi/cigarette sticks per person. DID two-part models were used to compare changes in outcomes over time and between districts with NTCP and without NTCP implemented, adjusting for socio-demographic characteristics and time-based heterogeneity.

There were no significant reductions in the proportion of households reporting bidi (adjusted odds ratio [AOR] 1∙04, 95% confidence interval [CI] 0∙84-1∙28) or cigarette consumption (AOR: 1∙01, 95% CI 0∙82-1∙26) in NTCP districts compared with non-NTCP districts. Among households that reported any bidi/cigarette consumption, we observed an overall reduction in the monthly per person consumption of bidi/cigarette sticks over time. However, these reductions were not significantly different between NTCP and non-NTCP districts (adjusted coefficients were: 0∙07 bidi sticks, 95% CI -0∙13-0∙28 bidi sticks; and -0∙002 cigarette sticks, 95% CI -0∙26-0∙26 cigarette sticks).

Although the consumption of bidis and cigarettes had reduced in India between 1999-2000 and 2011-12, these reductions were not significantly different between NTCP and non-NTCP districts. Strengthening implementation and enforcement of tobacco control policies is vitally important to reduce the future burden of tobacco use in the country.

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