A Systematic Review of the Risk and Protective Factors of Tobacco Use among South Indian Adults

Abstract

Background: India is facing a crucial health burden with the incremental rise in tobacco use prevalence and associated diseases. Tobacco use behaviour is largely influenced by socio-cultural factors. Hence, documenting the risk and protective factors associated with tobacco use among the South Indian population helps in developing context-based interventions and policies to reduce tobacco-related issues. Objective: This systematic review aims to synthesise the available literature evidence on the risk factors contributing to the use of tobacco and the protective factors which safeguard against this health risk behaviour among South Indian adults. Methods: The primary author conducted a PRISMA-compliant systematic search using five databases: PubMed, Scopus, Web of Science, Wiley Online Library, and Science Direct from the inception to June 23, 2021. To find pertinent publications, a manual search was also done in Google Scholar. 13 articles that met the review's inclusion criteria were selected from the 5063 articles that were initially found after a thorough screening process and suitable quality assessment. According to the socio-ecological model, the risk and protective factors discovered during the review were divided into five levels: intrapersonal, interpersonal, organisational, community, and public. Resultts: From the included studies the major risk factors found were stress, low perceived health effect, low income, peer influence, nature of the occupation, lack of awareness about health effects due to community marginalization, community misconception of positive aspects of tobacco use and ease of availability in the market. The major protective factors identified were: awareness, perceived harm to social image, familial support, community-based health education, exposure to tobacco warning labels and government initiatives of tobacco control. Conclusion: The multi-level factors identified from the current review findings reveal the need for population and context-specific interventions and tobacco control policies to be developed in the near future. Interventions tailored to address the risk factors and strengthen the protective factors identified would benefit the South Indian community in tackling this health burden.