Use of Betel Quid in India from 2009 to 2017: An Epidemiological Analysis of the Global Adult Tobacco Survey (GATS)

Background:Betel quid chewing is a deep-rooted practice in India and neighboring countries, which has migrated to other parts of the world. Betel leaf acts as a carrier for areca nut and most often, smokeless tobacco, both of which are carcinogenic, making betel quid a harmful product.Objectives:The first objective was to compare the prevalence of "use of betel quid with tobacco" from GATS-1 to GATS-2. The second was to study the association of "use of betel quid with and without tobacco" with different socio-economic groups (wealth quintiles) according to select background characteristics.Methods:This study used data from the Global Adult Tobacco Surveys (GATS), 2009-10 and 2016-17. Logistic regression with adjustment of co-variates (age, gender, residence and education) was used to study association of use of betel quid with different socio-economic groups.Results:Highest reduction (40 percent) was seen in "use of betel quid with tobacco" among male youth (15-24 years) over the two rounds of GATS. No change was seen in this form of use among females. The odds of "use of betel quid with tobacco" had a positive gradient with decreasing wealth quintiles. "Use of betel quid without tobacco" showed highest odds among participants with moderate levels of education.Conclusion:Health promotion interventions around harmful effects of "betel quid with and without tobacco" are needed for all genders from poorer populations with low education. Stress needs to be laid on universal population-level public health awareness campaigns about the carcinogenic properties of areca nut in betel quid.