The project will aim to strengthen and expand India's Sample Registration System (SRS) to obtain reliable estimates of cause-specific mortality from tobacco smoking and chewing in various parts of India by age, gender and socioeconomic group. The SRS is the primary system for collection of Indian mortality data. It is a large demographic survey to provide annual estimates of birth, death and other fertility and mortality indicators at the national and state level. The SRS consists of 6,671 sample units (4,436 rural and 2,235 urban) covering 1.1 million households and a population of about six million. Sample units are selected from the preceding census frame to be representative of the population. The SRS sampling frame will be soon expanded to over 8,000 units, covering over seven million people. Specific goals of the project are: implementing a validated verbal autopsy instrument in the SRS so as to obtain reliable information on the cause of death (for tobacco as well as numerous other causes); determining past tobacco use for adult deaths and current use from living controls within the dead person's household (so as to provide retrospective case-control data annually); specific addition of questions to the baseline questionnaire of the SRS on tobacco and other risk factors, so as to turn the SRS into a uniquely large, reliable and representative prospective study; and follow-up of deaths by cause of a 1998 Special Fertility and Mortality Survey that obtained data on smoking from about two million adults within the current SRS sampling frame (including one million males of whom 40% would smoke). Pilot studies would begin in Andhra Pradesh, Karnataka, and Tamil Nadu, home to 191 million people and about one in six of the SRS units. The project will build sustained capacity within India's flagship mortality surveillance system to monitor a heterogeneous and growing tobacco epidemic, evaluate the effectiveness of control policies and create reliable information for individuals and policy makers. Specific steps will be taken to translate the research findings for state and national policy makers.
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