Abstract In India, tobacco use is highly prevalent, yet evidence on nicotine dependence (ND) and its severity across the demographic groups are limited. This protocol outlines the approach to estimate the pooled prevalence and severity of ND among the tobacco users in India, stratified by age, gender, region, tobacco type, and rural–urban setting. This review was registered in PROSPERO (CRD420251133993) and follows Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols 2015 guidelines. We will do a literature search in the following database: PubMed, Cochrane Library, Embase, and Scopus, along with gray sources. Both community-based and hospital-based studies that assessed ND using any validated questionnaire, including but not limited to the Fagerström Test for Nicotine Dependence (FTND) or FTND-ST (Smokeless Tobacco) will be included. The study selection, data extraction, and risk-of-bias assessment (Newcastle–Ottawa Scale) will be done by two independent reviewers, and disagreements will be resolved through discussion or by a third reviewer. The pooled prevalence will be estimated using a random-effects model with 95% confidence interval. Planned subgroup and sensitivity analyses will be conducted. Publication bias will be assessed using deviation from expected inverse variance plots, quantified by the Luis Furuya–Kanamori index (±1 indicating no asymmetry and >±2 indicating major asymmetry). The certainty of evidence will be evaluated using the Grading of Recommendations, Assessment, Development, and Evaluation approach. This review may address a key evidence gap by generating pooled estimates of ND and its severity among tobacco users in India and also support policymakers, public health professionals in strengthening tobacco control measures, enhancing cessation services, and designing targeted interventions supporting Sustainable Development (SDG) Goals 3 and 3.a to reduce premature noncommunicable disease mortality.
Sivamani et al. (Thu,) studied this question.