Women in India Reporting Abuse Show Higher Tobacco Use

Boston, MA -- Using a large population survey in India, a new study from Harvard School of Public Health (HSPH) researchers has found an association between domestic violence and adult smoking. The study appears in the December 11, 2007 issue of the journal Tobacco Control.

Smoking and chewing tobacco contribute to some 800,000 deaths in India every year. The smoking rate for Indian men is around 29%, for women, approximately 3%. The rate of tobacco chewing is around 29% for men, 12% for women. Although rates of tobacco use are low among women, early indications are that these levels are on the rise. While the harmful effects of tobacco use are well-documented, there has been little research looking at the stressors associated with tobacco use among Indians.

One of those stressors, or risk factors, is domestic violence, a serious problem in India. Some 40% of Indian women report being slapped, kicked, hit or beaten during their marriages. Smaller studies in the U.S. have also found an association between domestic violence and smoking. Researchers hypothesize that smoking may act as a "stress reliever" in households that experience domestic violence. In fact, Indians who smoke or chew tobacco cite stress relief as one of the reasons they begin using and continue to use tobacco.

To see if there was a link between domestic violence and tobacco use in India, the researchers, led by lead author Leland Ackerson, a research fellow, and senior author S. V. Subramanian, associate professor in the Department of Society, Human Development and Health, used data from the National Family Health Survey, a representative cross-sectional survey administered in India during 1998-1999. The samples included 89,092 women and 278,977 family members aged 15 and older.

The researchers found that, for women who had ever been married, 19% reported incidents of abuse; 85% of abused women reported abuse by their husbands. The study found that women who reported past and current abuse had 20%-40% increased odds of tobacco use compared with women reporting no abuse, even after controlling for factors such as income and education level. Another finding was that smoking risk increased for any adult in households where domestic violence was prevalent, regardless of whether they were personally a victim, a perpetrator or neither.

"This is the first study to show a link between domestic violence and tobacco use in a developing country.  It is a powerful piece of evidence that we found this same relationship in a place where poverty is endemic that had previously been shown only in wealthy nations," said Ackerson.

The study highlights yet another negative outcome of the social problem of domestic violence. "This research is important in terms of both tobacco control and the campaign against domestic violence," added Subramanian. "It reinforces the notion that addressing the psychological and social context is key in the fight against tobacco. Additionally, our findings provide further proof of the negative effects of domestic violence, evidence which will hopefully aid those working to address this problem."

Other HSPH co-authors of the study included Ichiro Kawachi and Elizabeth Barbeau.

"Exposure to Domestic Violence Associated With Adult Smoking In India: a Population-Based Study," Leland K. Ackerson, Ichiro Kawachi, Elizabeth M. Barbeau, S. V. Subramanian, Tobacco Control, December 11, 2007, 12: 378-383.