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.

Background: Smokeless tobacco (SLT) use among women is widely prevalent in Manipur state accounting for 45% users as per Global Adult Tobacco Survey (GATS)-2 India. Studies from India and elsewhere indicate changes in the way people used SLT during COVID-19 lockdown. This study explores individual and economic influences on SLT consumption and cessation attempts by tribal women in Manipur during the first COVID-19 lockdown (March-June, 2020) in India. Methods: Twenty in-depth interviews, both in-person and telephonically, were conducted among tribal women from Imphal west, Manipur, India, who used any SLT, from April to September 2020. Objective of the study was to understand the use, factors associated with consumption, purchasing behaviors, and cessation attempts of SLT during the lockdown. Thematic content analysis was used to identify core themes and codes. Results: Study participants reported of changes in current SLT use during restrictions imposed to contain COVID-19 pandemic in India. Majority reported of reduction or quit attempts in SLT use. Reasons included inaccessibility due to travel restrictions, limited availability and price rise of SLT products, fear of COVID-19, and disposable income for purchase of SLT products. However, a few women reported of increased consumption due to bulk purchasing, or switching to other SLT products as a result of unavailability or price rise of preferred products or to cope up with social isolation caused by the lockdown. Conclusion: Study findings on factors influencing quit attempts and strategies used for reducing SLT use by tribal women in Imphal, Manipur provide valuable insights for development of appropriate intervention for prevention of SLT use among women.

COVID-19 pandemic has caused disruptions in carrying out research activities in the field. The established methods of data collection for both qualitative and quantitative research could not be implemented. Researchers worldwide adopted contactless data collection methods, including the use of mobile phones for research purposes. This paper presents the experiences of conducting interviews among tribal population using mobile phones in three villages of Manipur during the pandemic. The interviews proved to be successful and effective. Minor technical glitches were a challenge but were not significant to affect the quality of the data. During unprecedented times such as the current pandemic, conducting interviews via mobile phones could be a viable alternative to face-to-face interviews for collecting qualitative data from the communities.

Background & objectives: Contrary to overall declining trend in smokeless tobacco (SLT) use in India, an increase is observed in north-east (NE) India. This study examined the predictors of daily SLT use by gender and assessed the demographic and socio-economic characteristics that contribute to gender differences in SLT use in NE India. Methods: Data collected from 15,259 and 13,574 adults in the two rounds of Global Tobacco Adult Survey 1 and 2 for NE India during 2009-2010 and 2016-2017 were analyzed. Relative change, multivariable binary logistic regression and Blinder-Oaxaca decomposition analysis were used for analysis. Results: The findings suggest that among women in NE India, the daily SLT use significantly increased by 58 per cent between 2009-2010 to 2016-2017. Women residing in Nagaland, Manipur, Mizoram and Tripura were 3.5 and 2.5 times, respectively more likely to be daily SLT users compared to those in Assam. While age, education and wealth were the significant predictors of SLT use in both women and men, increased odds of SLT use were observed with women’s type of occupation and the State of residence. The majority of the gender differences in daily SLT use was explained by differences in work status (44%), age (26%), education (14%) and wealth status (9%) between men and women. Interpretation & conclusions: Increasing prevalence of SLT use amongst women in the NE States necessitates integration of gender-specific messages on harmful effects of SLT in the ongoing tobacco control programmes and development of culturally appropriate community-based interventions for cessation of SLT use.