Singh et al Table 5 Tobacco consumption among decedents in relation to cause of death Tobacco intakes Circulatory Malignant Smoking & chewing (n = 623) Smoking (n = 277) Chewing (n = 465) Women n (%) n = 240 n = 54 Smoking & chewing (n = 125) 66 (27.5)* 41 (75.9)* Smoking (n = 40) 21 (8.8)* 15 (27.8)* Chewing (n = 83) 40 (16.7)* 23 (42.6)* Note: *P < 0.001; P values obtained by Chi square test;Values are numbers (%). n = 406 248 (61.1)* 150 (36.9)* 212 (52.2)* n = 610 Men n (%) n = 77 59 (76.6)* 55 (71.4)* 50 (64.9)* n = 164 Chronic bronchitis and asthma n = 97 66 (68.0)* 56 (57.7)* 52 (53.6)* n = 174 n = 65 16 (24.6)* 3 ( 4.6)* 16 (24.6)* Others n = 805 250 (31.1) 16 (2.0) 151 (18.8) n = 417 n = 470 2 (0.42) 1 (0.21) 4 (0.85) rural area residence were important factors associated with beedi smoking. Smoking was signiﬁcantly less common among urban compared with rural men (22.1 vs 36.1% in men and 3.8 vs 0.7% in women). Chronic obstructive lung disease was diagnosed in 4.1% of 35,295 subjects, with a male to female ratio of 1.56:1 and smoker to nonsmoker ratio 2.65:1. Prevalence rates among beedi and cigarette smokers were 8.2% and 5.9%, respectively (Jindal 2006b). Studies on the association of tobacco consumption with deaths due to noncommunicable diseases are rare from India (Gupta et al 1984; Singh et al 1997c). The adverse effects of smoking may be because of nicotine, carbon monoxide, and other chemicals, which may enhance carcinogens and free radical generation (Gupta et al 1980, 1984; Kesteloot 2003; Peto et al 1994; Foley et al 2002; Puska et al 2003; Schiaffino et al 2003; Schoenborn et al 2003). Tobacco consumption also dam- ages the taste buds in the oral cavity, which may be a factor in the observed decreases in intake of fruits and vegetables resulting in poor vitamin C and beta-carotine status among tobacco users (Gupta et al 1984).These effects are known to predispose to cardiovascular diseases and cancer (Gupta et al 1980, 1984; Singh et al 1997c; Foley et al 2002; Puska et al 2003; Schiaffino et al 2003; Schoenborn et al 2003). In the United States between 1975 and 2000 about 11%–15% of the population lived below the poverty level (Kesteloot 2003; Schoenborn et al 2003). This level was about 13% during the period 1997–1998, with 25% for blacks and 10% for whites. Differences in smoking behavior among the races could inﬂuence the overall results (Berger and Wynder 1994; Cavelaars et al 1997; Foley et al 2002; Puska et al 2003; Schiafﬁno et al 2003; Schoenborn et al 182 2003). White men smoke less than black men (26.3% vs 30.4%) and the reverse holds true for white compared with black women (24.1% vs 21.6%). In Spain the higher educated men started smoking later and had lower smoking rates than the lower educated, especially in the periods 1978–1982 and 1988–1992. However, higher educated women started smoking earlier (period 1958–1962) than lower educated women. In the period 1988–1992 the smoking rates and initiation ages of higher educated women were very similar to those of men of the same educational level. Lower educated women smoked more and started smoking earlier than the higher educated women (Schiafﬁno et al 2003). In the period 1994–1998, representative national surveys were performed in Estonia, Finland, and Lithuania. Higher educated men had signiﬁcantly (p < 0.01) lower smoking rates than lower educated men (OR 0.57, 0.43, 0.56, respectively). The same is true for women, with the exception of Lithuania (OR 0.62, 0.38, 1.29 [nonsigniﬁcant], respectively). Lithuanian women had the lowest smoking rates of the 3 countries considered (Puska et al 2003). While CVD is a global killer, since the mid 1960s deaths from myocardial infarction have declined by more than 50% in many industrialized countries, and similar declines have occurred for stroke (Yusuf et al 2001a, 2001b; WHO 2002; Sachs 2004). In 1980, heart attack was the leading cause of death in the United States in the age cohort 45–64 and malignancy was second (Gupta et al 1980). Age-speciﬁc data from 2000 indicate that malignancy is now the leading cause of death from age 35 through 74, albeit with a reduction in numbers of cases by 7.4%, compared with 1980. Heart disease, now in second place in this age group, has fallen by 265% since 1980, and is now only the major cause of death after age 75. For heart disease, the age-adjusted death rate International Journal of COPD 2007:2(2)