Background Tobacco use is a leading cause of preventable morbidity and mortality globally, with early initiation strongly linked to lifelong dependence and adverse health outcomes. In India, socio-cultural and economic heterogeneity complicates tobacco control, particularly among youth. Understanding early initiation patterns is essential for designing age-targeted interventions. Aim The present study aims to use GATS-2 data to estimate the age of initiation of tobacco use in India, assess the prevalence of early initiation across population subgroups, and identify its key socio-demographic and economic correlates. Methods We analyzed data from GATS-2 (2016-17), a nationally representative cross-sectional survey in India. The sample included 7647 ever-smokers and 12 772 ever-users of smokeless tobacco aged ≥15 years. Early initiation was defined as starting tobacco use at age ≤14. Weighted bivariate and multivariate logistic regression analyses were performed using STATA v17.0. Results Early initiation occurred in 8.0% of smokers and 10.4% of smokeless users, with over half initiating between ages 15-24. Scheduled Tribes and Muslims had higher early use, while education showed a strong protective effect; postgraduates were 87% less likely to initiate early. Students (AOR = 5.31) and the unemployed (AOR = 2.14) faced greater risk. Rural residence lowered odds for early smoking (AOR = 0.22) but increased it for smokeless use (AOR = 1.16). Females had 36% higher odds for early smokeless tobacco use. High-burden states included Sikkim, Bihar, Odisha, and Arunachal Pradesh. Conclusions Early tobacco initiation in India is prevalent among youth, marginalized groups, and certain regions. Strengthened education, policy enforcement, and culturally tailored interventions are vital to curb long-term dependence.
Mehta et al. (Thu,) studied this question.
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