Spatial Pattern and Determinants of Tobacco Use Among Females in India: Evidence From a Nationally Representative Survey

Abstract

Introduction Tobacco use has been steadily increasing among the females in developing countries. It has led to rise in tobacco-related morbidity and mortality among females. Knowing the geographic distribution of the habit is essential to identify high priority areas and direct the healthcare intervention. Hence, this study was done to assess the spatial patterns and determinants of tobacco consumption among females in India. Methods Univariate and Bivariate Moran’s I statistic and local indicators for spatial association (LISA) maps were generated to determine the spatial clustering of tobacco consumption (smoked and smokeless form). Ordinary least-square regression, spatial-lag and spatial-error models were performed to assess the determinants. Poverty (belonging to poorest and poorer quintile of wealth index), illiteracy (no formal education), marital status, ST population, tobacco use by family members and alcohol use were the explanatory variables. Results Univariate Moran’s I was 0.691 suggesting positive spatial autocorrelation. High-prevalence clustering (hot-spots) was maximum in the Central, Eastern and North-Eastern states such as Chhattisgarh, Madhya Pradesh, Odisha, Bihar, Manipur, Tripura, Meghalaya, Mizoram and Assam. This pattern was similar for both smokeless and smoked form. Results of spatial-lag and spatial-error model suggested that alcohol use, scheduled tribes, illiteracy, poverty, marital status and tobacco use by family members were significant determinants of female tobacco consumption. The coefficient of spatial association was maximum for alcohol use (β=0.20, p<0.001) followed by widowed/separated/divorced (β=0.12, p<0.001). Conclusion Tobacco consumption among females in India is spatially clustered. Multisectoral coordination and targeted interventions are required in the geographical hotspots of tobacco consumption. Implications This is the first study to explore the geospatial pattern of tobacco consumption among females in India. We found that the pattern of tobacco use among females is spatially clustered in India. Clustering was predominantly found in Central, Eastern and North-Eastern regions of the country. Tribal population in these areas and complementarities between alcohol and tobacco use contributed significantly to the high prevalence clustering. These findings will be helpful for policymakers and planners to devise specific intervention package targeting the high-risk regions.

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

“…Much of the previous research on the prevalence of chewing tobacco use has focused on a particular country, 18 , 19 , 20 region, 3 , 4 , 21 source, 3 , 18 , 19 , 20 , 21 time period, 11 , 20 , 21 or age group, 5 , 22 making formation of a comprehensive global picture of where chewing tobacco is used most, among which age groups and sexes, and how these trends have changed over time very difficult. Our study is a step towards understanding this full picture so that policy makers, public health officials, and advocacy organisations have access to a full set of comparable estimates for use in addressing this harmful substance.…”

“…In this context, we aimed to provide an improved understanding of chewing tobacco use, which is essential for targeted policy, assessment of the effectiveness of these policies, and, ultimately, mitigation of the associated harms. 1 Studies have been done previously that estimated prevalence for a particular country, 18 , 19 , 20 region, 3 , 4 , 21 or source, 3 , 18 , 19 , 20 , 21 or a restricted time period 11 , 20 , 21 or age group, 5 , 22 but to our knowledge no attempt has been made to synthesise multiple data sources to understand these trends globally over time and across age groups. For the first time, as part of the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019, we comprehensively estimated the prevalence of chewing tobacco use using all available data sources to estimate age-sex-specific prevalence of chewing tobacco use from 1990 to 2019 in 204 countries and territories.…”

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

“…A study on spatial analysis has shown that clustering of tobacco use among females was also predominant in North-eastern states such as Assam, Manipur, Tripura and Meghalaya. 18 Another recent study also identified some districts of the North-eastern states of India (except Sikkim) as major tobacco hot spots. 19 Hence, the region of North east India can be considered a high priority area in terms of tobacco use.…”

Practice and awareness of migrant pregnant women living in urban slums towards tobacco consumption

“…Researchers have argued that alcohol consumption, illiteracy and tobacco use by any other family member is a predisposing factor of tobacco use (Krishnamoorthy and Ganesh, 2020).…”