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District-level epidemiology, hot spots and sociodemographic determinants of tobacco use in Indian men and women: analysis of national family health survey-4 (2015–16)
Authors: B. Karuppusamy, W. Paulson, S. Chellappan, S. K. Behera, and P. Balabaskaran Nina
Source: Public Health, Volume 194; DOI:
Topic(s): Adult health
Men's health
Tobacco use
Women's health
Country: Asia
Published: MAY 2021
Abstract: Objectives To map district-level tobacco hot spots and understand the Sociodemographic Indices (SDI) influencing tobacco consumption in Indian men and women. Study design Cross-sectional study. Methods Tobacco use data from 640 districts of India were extracted from National Family Health Survey-4, carried out from 2015 to 2016 with a sample size of 103,411 men and 699,686 women. Geographic Information System was used to map the tobacco prevalence, and hot spots were identified by spatial statistics (Getis-OrdGi*). SDI were studied by bivariate analyses and binary logistic regression. Results India has two major tobacco hot spots; one comprising the districts of North-Eastern states, excluding Sikkim, and the second cluster is formed by the districts of Central-Eastern states. These hot spots coincide well with demographic determinants: North-East (adjusted odds ratio [aOR] men, 5.74; aOR women, 13.54) and Central India (aOR men, 4.5; aOR women, 3.5) have higher odds of Tobacco consumption. In men, respondents with no education (aOR 2.52; 95% confidence interval [CI]: 2.26–2.81) and Muslims (aOR 3.53; 95% CI: 2.93–4.26) have higher odds of tobacco consumption. The poorest (men aOR, 2.06; 95% CI: 1.87–2.27; women aOR, 3.36: 95% CI: 2.69–4.19) and ST women (aOR 1.89; 95% CI: 1.68–2.13) have higher odds of tobacco consumption. Conclusions We have identified tobacco hot spots and detailed the SDI affecting tobacco use separately in men and women to guide public health policies for targeted intervention of tobacco consumption.