Pattern and Predictors of Tobacco Use in India: Evidence from National Family Health Survey (2015-2016)

Tobacco use continues to be of research interest due to the significant amount of tobacco-attributable non-communicable diseases and deaths in India. This study examines the pattern and predictors of smoking, chewing, and any tobacco use among adults of age 15-49 years in India. This study used secondary data from the fourth round of the National Family and Health Survey (NFHS, 2015-2016) which collected information on tobacco use from men and women in the age group 15-49 (n = 803097). Bivariate and multivariate analyses were conducted to understand the socio-economic and demographic predictors. GIS maps have been used to show inter-state variation in smoking, chewing, and any tobacco use by gender. About one out of every ten adults aged 15-49 use any tobacco, predominantly in chewing forms. Women are significantly less likely to smoke (odds ratio [OR]: 0.05, confidence interval [CI]: 0.04-0.05), chew (OR: 0.25, CI: 0.24-0.25), and use any tobacco (OR: 0.14, CI: 0.13-0.14) compared with men. Tobacco usage was found more common among the uneducated and economically weak people. There is considerable inter-state heterogeneity in the prevalence and type of tobacco use, and adults in the north-east region are among the most vulnerable population subgroups. Tobacco use continues to be a significant burden due to its magnitude and different forms of use in India. The higher use among males, illiterates, economically weak, socially backward and alcohol users suggest the need for targeted efforts to improve their knowledge and awareness about the harmful effects of tobacco use and stronger enforcement of tobacco control policies.