Dual Burden of Smoked and Smokeless Tobacco Use in India, 2009–2017: A Repeated Cross-Sectional Analysis Based on Global Adult Tobacco Survey

Abstract

Introduction The dual use of smoked and smokeless tobacco (SLT) poses a serious challenge to tobacco control efforts. This article examines the trends and patterns of this usage in India during the period 2009–2010 and 2016–2017. Methods Data from two rounds of nationally representative cross-sectional Global Adult Tobacco Survey (GATS) conducted in 2009–2010 and 2016–2017 have been used. Dual use was assessed based on current smokers and SLT users in both rounds. Results Findings reveal that dual use in India has dropped from 5.3% during 2009–2010 to 3.4% during 2016–2017, a decline of nearly 10 million dual users. However, some states have added nearly 4.6 million new dual users during this period. While dual use continues to remain high in rural areas, there has been a manifold increase in urban areas. Findings revealed that intention to quit tobacco was lower among dual tobacco users as compared to single users with considerable difference between urban and rural areas. Conclusion Easy availability and affordability of SLT products compared to smoking products and restrictions on smoking in public places may have pushed current smokers and dual users to take to or intensify their SLT consumption. Measures relating to awareness, pricing, taxation, and enforcement of tobacco control laws should focus on all forms of tobacco, especially targeting high dual burden in rural and urban settings. Implications Dual form of tobacco users represent 12% of all tobacco users in the country. The study reveals that intention to quit tobacco among dual users is significantly lower than that among single tobacco product users. This requires improving public awareness about the morbidity and mortality that arises from the use of all forms of tobacco products. Efforts to restrict the availability of tobacco products should focus on licensing the sale of all tobacco products. Reduction in dual tobacco use will not only result in multiplied health benefits but also help in achieving the Non-Communicable Diseases targets under the United Nations Sustainable Development Goals.

Spatial, temporal, and demographic patterns in prevalence of chewing tobacco use in 204 countries and territories, 1990–2019: a systematic analysis from the Global Burden of Disease Study 2019

“…First, we did not quantify dual use of chewing tobacco and smoking, which is important to understand for both policy setting and burden implications. 31 Tracking and understanding dual use might be important to uncover potential issues with targeted advertising, differential cessation success, or particularly problematic adolescent use. 31 , 32 Second, our study relies on self-reported data and reporting biases might be present that vary across age groups, sexes, geographical regions, and socioeconomic statuses.…”

“… 31 Tracking and understanding dual use might be important to uncover potential issues with targeted advertising, differential cessation success, or particularly problematic adolescent use. 31 , 32 Second, our study relies on self-reported data and reporting biases might be present that vary across age groups, sexes, geographical regions, and socioeconomic statuses. The nature of these biases is not yet known, and previous studies indicate mixed scale and scope.…”

Global burden of disease due to smokeless tobacco consumption in adults: an updated analysis of data from 127 countries

“…If ST prevalence has been declining in a country over the last few decades, the disease burden obtained by applying more recent prevalence figures may underestimate attributable disease burden. This may well be the case in India where ST use has declined by 17% between the 2009 and 2017 GATS surveys [92]. On the other hand, if ST use is on the rise (e.g.…”

Areca nut consumption with and without tobacco among the adult population: a nationally representative study from India

“…India, with a population of over 1.30 billion, exhibits one of the highest socioeconomic and demographic heterogeneities ever experienced anywhere in the world at the regional level. 14 There is considerable evidence of marked regional inequities in tobacco use, 15 health and healthcare 16 and mortality outcomes 17 in India. These differences are primarily the outcomes of differences in community-level development, population composition, state health expenditure, poverty levels, status of women and availability, accessibility and affordability of maternal and child healthcare services and their utilisation.…”