Prevalence and factors associated with tobacco use among men in India: findings from a nationally representative data

BACKGROUND: Tobacco consumption causes almost 638,000 premature deaths per year in India. This study sought to examine the prevalence and determinants of tobacco use among men in India. METHODS: We analyzed data from the fourth round of the National Family Health Survey in India. These nationally representative cross-sectional sample data were collected from January 20, 2015, to December 4, 2016. A total of 112,122 men aged 15-54 years were included in this study. Primary outcomes were tobacco use categorized into smoking, smokeless, any tobacco, and both smoked and smokeless tobacco use. Complex survey design and sampling weights were applied in both the descriptive analyses and logistic regression models. We present the findings using odds ratios. RESULTS: The prevalence of tobacco use among men in India for the studied period was 45.5% (95% CI 44.9-46.1), smoking was 24.6% (95% CI 24.1-25.1), smokeless tobacco use was 29.1% (95% CI 28.6-29.6), and both smoked and smokeless tobacco use was 8.4% (95% CI 8.1-8.7). The prevalence of tobacco use among men was higher among the elderly, separated/divorced/widowed individuals, those with lower education and wealth status, alcohol consumers, manual workers, and residents of the northeast region. Multivariate analysis showed that age, lower education, occupation, region, alcohol consumption, separated/divorced/widowed status, and economic status were substantially associated with tobacco use among Indian men. CONCLUSIONS: Innovative and cost-effective strategies targeting high-risk groups are crucial to curbing the tobacco epidemic in India. Anti-smoking campaigns should also focus on mitigating alcohol abuse. Reducing tobacco marketing and implementing formal education about the dangers of tobacco use, progressive taxing, packaging, and labeling of tobacco products and price strategies should be harmonized in legal provisions.