ArticleTobacco induced diseases2026
Socioeconomic inequality in any tobacco use versus current smoking across 66 DHS countries: Indirect implications for smokeless tobacco and oral cancer prevention.
Article in Tobacco induced diseases, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
0 citing papers in PubMed.
No citing paper in PubMed yet.
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
7 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
introductionSmokeless tobacco use is a major preventable risk factor for lip and oral cavity cancer, with a particularly heavy burden in South and Southeast Asia. We aimed to quantify, across countries, whether the socioeconomic gradient of any tobacco use is more pro-poor than that of smoked tobacco alone, thereby indirectly assessing the additional inequality attributable to smokeless tobacco.
methodsIn this secondary analysis of publicly available Demographic and Health Surveys (DHS) data (66 countries, survey years 1999-2024), supplemented by the WHO Global Health Observatory and World Bank indicators, we computed concentration indices (CIXs), the slope index of inequality (SII), and Wagstaff-normalized CIXs for smoking and any tobacco use across wealth, education level, and residence dimensions. Eligible observations were country-survey estimates stratified by wealth quintile, education level, or urban/rural residence, with complete data across all subgroups; national-total, age-, and region-only estimates were excluded. The core hypothesis was tested indirectly, via paired comparison of any-tobacco versus smoked-only CIXs (81 paired observations), because DHS smokeless indicators are available only as national aggregates. Wagstaff decomposition quantified the relative contributions of socioeconomic determinants.
resultsThe mean wealth-related CIX for smoking was -0.045 (SD=0.184), with 66% of estimates negative. The mean CIX for any tobacco use (-0.094) was significantly lower than for smoking alone (-0.060; paired ΔCIX= -0.033, 95% CI: -0.060 - -0.007, p=0.017), with 62% of pairs showing a more pro-poor gradient for any tobacco use. Education level and residence together accounted for >80% of explainable inequality in the decomposition analysis.
conclusionsThe socioeconomic gradient of any tobacco use is significantly more pro-poor than that of smoking alone, suggesting that smokeless tobacco amplifies tobacco-related health inequality. These ecological findings suggest that tobacco-control monitoring may benefit from integrating smokeless tobacco into inequality surveillance; individual-level studies are needed before specific populations are targeted.
Indexed as
Identifiers
What OpenQuestion holds
Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.