Health literacy and tobacco cessation among hypertensive individuals: A mixed method study

BACKGROUND: Hypertension and tobacco addiction are two major public health challenges in India that frequently coexist. About 30% of Indian adults have hypertension, while over one-fourth use some form of tobacco. So, the present study aimed to determine the prevalence and patterns of tobacco consumption and identify associated socio-demographic factors among hypertensive patients in urban India and also further explored patient perspectives regarding tobacco use through qualitative interviews. MATERIALS AND METHODS: This mixed-method study was conducted among 305 hypertensive adults recruited from an urban tertiary hospital using interviewer-administered questionnaires. Additionally, 15 tobacco-consuming patients were purposively sampled for in-depth interviews regarding perceptions and behaviors related to tobacco. Descriptive statistics and multi-variable logistic regression models were applied for quantitative analysis and thematic analysis for qualitative data. RESULTS: The prevalence of ever tobacco use among hypertensive patients was 21%. Smokeless tobacco was the predominant form used. Male gender, urban locality, illiteracy, and lack of knowledge about tobacco hazards had a higher likelihood of tobacco consumption. Qualitative interviews provided complementary insights into triggers like peer influences and stress, barriers to quitting including withdrawal effects and system gaps, and participant perspectives on facilitating cessation. CONCLUSION: Tobacco consumption among hypertensives is higher than national averages. Tailored educational, motivational, and policy-level interventions addressing gaps in knowledge, risk perceptions, addiction behaviors, and cessation support systems can enable the promotion of tobacco abstinence and hypertension control in this vulnerable sub-group. The multi-method data provide actionable inputs for planning targeted control and prevention strategies addressing this dual burden.