Socio-economic patterning of tobacco use in Indian states

BACKGROUND: Studies in India have identified marked variations in overall tobacco use between socio-economic groups. We examined whether associations between socio-economic status (SES) and tobacco use varied across individual Indian states by tobacco type. METHODS: Cross-sectional survey of 100855 households in 24 Indian states and Union Territories conducted in 2009-2010. Outcome measures were household tobacco consumption by type. Logistic and linear regression models were used to examine associations at the household level between education, income and use and volume of tobacco consumed. RESULTS: Overall, 52% of households used any form of tobacco product; the predominant form was smokeless tobacco (22%), followed by bidi (17%) and cigarettes (4%). Increasing household income and higher education level were associated with a higher likelihood of cigarette use but a lower likelihood of bidi and smokeless tobacco use in some Indian states. Increasing household income was associated with higher volumes of cigarette and bidi use among consuming households; however, association between educational level and volume of tobacco consumption was inconsistent. CONCLUSION: SES has a varying impact on different types of tobacco use in Indian states. Policy makers should consider socio-economic patterning of tobacco use when designing, implementing and evaluating tobacco control interventions in different states of India.