Gender differences in risk factors for smokeless tobacco use: Insights from the latest nationally representative cross-sectional demographic and health survey (2019–2021) and their potential implications for smokeless tobacco control in the WHO South-East Asia region

Abstract

Introduction: The global prevalence of Smokeless Tobacco (SLT) use is estimated to be 4.72%, concentrated in South East Asia. Despite declining smoking rates, SLT usage remains high, resulting in 2.5 million DALYs and 90,791 deaths in 2017 due to cancers and heart diseases, with India contributing 70% of DALYs. This study examines risk factors for SLT use in Indian males and females aged 15–49 using 2019–2021 demographic and health survey data, also exploring gender differences. Methods: The study analyzed a substantial sample of 724,115 females and 93,267 males utilizing data from a nationally representative cross-sectional demographic and health survey conducted between 2019 and 2021. Gender-specific multivariable logistic regression analyses were performed to identify risk factors influencing SLT use. Results: The findings reveal gender-specific variations in SLT use risk factors. Among males, older age groups (35–49) were less likely to use SLT compared to those aged 30–34. In contrast, among females, SLT use increased with age, with the highest rates in the 40–44 and 45–49 age groups. Marital status played a significant role, with widowed, divorced, and separated females having higher odds of SLT use compared to currently married females. Tribe ethnicity was associated with increased odds of SLT use in females but not in males. Christian females had higher odds of SLT use than Hindu females, while Christian males had lower odds compared to Hindu males. Conclusion: These findings provide valuable insights for policymakers, healthcare professionals, and public health advocates in developing targeted interventions to combat SLT use in South-East Asia. By addressing gender-specific risk factors and tailoring strategies to different populations, progress can be made in reducing the burden of SLT use and improving public health outcomes in the region.