Smokeless tobacco use among women in northeastern states, India: A study of spatial clustering and its determinants using National Family Health Survey-4 data

Abstract

Background: Use of tobacco, especially smokeless tobacco have characterised as highly prevalent among women, and also the mode of using smokeless tobacco varies based on geographic location, ingredient availability, cultural/societal norms, and personal preferences. Therefore, this study examines the prevalence and social determinants of use of smokeless tobacco among women in NE India. Further, it also identifies the cluster and district hotspots of smokeless tobacco prevalence. Methods: We analysed a nationally representative data of NFHS-4, covering 93,409 eligible women aged 15-49 years from a survey of representative households from NE states, India. Descriptive statistics, chi-square, binary logistic and log-binomial regression were employed to analyse the data by using STATA software 13.1. Spatial clustering analysis and hotspot analysis were carried out using R-library. Findings: The prevalence of SLT use among women in NE states, India is 23%. Mizoram (47.8 ± 1.2) shows the highest prevalence of SLT use, followed by Manipur (46.1 ± 0.7). It increases concomitantly with age among women. Social determinants like marital status (divorced/widowed), low educational level and residence (urban) were observed to be associated with smokeless tobacco use. Out of the 4032 clusters used in the analysis, 949 clusters were showed as hotspots. Conclusion:The existing implementation of tobacco control programs and policies in the NE states needs to be evaluated. Owing to the geographical barriers and cultural differences, there is a need to explore the influences unique to these regions, which can further strengthen tobacco control measures. Targeted and tailored intervention within the identified hotspots can be beneficial.

Prevalence, regional patterns and socio-demographic factors associated with poly-tobacco use in India: A secondary data analysis

“…Our results are supported by data on state wise prevalence of tobacco use in India, which indicates high prevalence of tobacco in states from these regions, that is much greater than the national average [50][51][52]. Studies have also reported greater use among students, women and tribal population in this region [53][54][55][56]. There have been studies that have highlighted that wealth quintile is an important factor that affects tobacco use [57,58].…”

Predictors of smokeless tobacco use among the adult population of north-east India during 2009-2017: A decomposition analysis

“…Despite the deleterious effects of SLT products on women’s health, an increase in use is observed across all age groups of women in Assam, Arunachal Pradesh, Manipur, Tripura and Nagaland. Cultural practices and norms 10 , 15 , higher prevalence of any form of tobacco in the region 16 and unregulated market particularly for unpackaged tobacco 17 could be the reasons for increased prevalence of use among women in these States. While an effective NTCP may have contributed to the overall reductions in the use of SLT 1 , findings necessitate deliberate inclusion of gender-sensitive tobacco control messages and campaigns in the NE States’ tobacco control programmes for prevention of tobacco use among women 6 , 18 , 19 .…”

Genetic and epigenetic instability induced by betel quid associated chemicals

“…In India, the world’s second-largest tobacco consumer, where predominantly STPs are used extensively by > 200 million people and STPs act as a putative causative factor of various cancers [80] , [81] . Some states of NEI have the highest prevalence of STPs use such as Mizoram has the highest prevalence of STPs use (47.8 ± 1.2) followed by Manipur among females (46.1 ± 0.7) (by National Family Health Survey-4, NFHS-4) [82] . Most popular STPs include khaini, gutkha, zarda, paan or BQ with tobacco, loose tobacco leaf or sadapata, tuibur or hidakphu [81] .…”