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

Kh Jitenkumar Singh,Nirendra Haobijam,Saritha Nair,Aheibam Sharmila Devi,Sagolsem Roshan Singh,Meena Hijam,Nongzaimayum Tawfeeq Alee,Saurabh Sharma,Vijit Deepani,Lucky Singh,M Vishnu V Rao

doi:10.1016/j.cegh.2021.100840

Kh Jitenkumar Singh, Nirendra Haobijam + Show 9 more

Open Access

https://doi.org/10.1016/j.cegh.2021.100840

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Abstract

BackgroundUse 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. MethodsWe 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. FindingsThe 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. ConclusionThe 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.

Highlights

Among adults, males generally have higher rates of smokeless to bacco use than females, in some countries, such as Bangladesh, Thailand, Cambodia, Malaysia, Vietnam, South Africa, Mauritania, Si erra Leone, and Barbados, use among women is similar to, or higher than use among men.[1]
The present study reported that prevalence of smokeless tobacco (SLT) use was higher in higher age group, 40–49 yrs and three times more likely to use SLT compared to the younger age group (15–19 yrs)
NFHS-4 report[9] showed that there is continual decrease in SLT use with increasing wealth quintiles, this study reveals that women from wealthy households as measured by wealth quintile have a lower risk of SLT use as compared to their peers in lower wealth quintile, finding is consistent.[25]

Summary

Introduction

Males generally have higher rates of smokeless to bacco use than females, in some countries, such as Bangladesh, Thailand, Cambodia, Malaysia, Vietnam, South Africa, Mauritania, Si erra Leone, and Barbados, use among women is similar to, or higher than use among men.[1]. This study examines the prevalence and social determinants of use of smokeless tobacco among women in NE India. It 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. 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. Targeted and tailored inter vention within the identified hotspots can be beneficial

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