Analysis of Motivating Factors for Smokeless Tobacco Use in Two Indian States

  • Danawala, Saba Ashraf (Center for Disease Dynamics, Economics & Policy) ;
  • Arora, Monika (Public Health Foundation of India) ;
  • Stigler, Melissa Harrell (University of Texas Health Science Center at Houston)
  • Published : 2014.08.30


Background: This study was conducted to gauge how the demographic profile of smokeless tobacco (SLT) users from Gujarat and Andhra Pradesh, India, differs from that of smokers. It also addresses how factors associated with the initiation and continuation of smokeless tobacco vary by age, gender, and education. Materials and Methods: We analyzed 2011 cross-sectional survey data collected from 4,759 respondents (smokers/SLT users/non-users) in both states. Chi-square analysis was used to make comparisons between the demographic profiles of smokers and SLT users. Multivariable logistic regression analysis was used to obtain the odds ratios (ORs) for initiation and continuation factors regressed on socio-demographic variables (age, gender, education). Results: Initiation-women were less likely than men to report "peer pressure", "fashion statement", and "stress/coping" as relevant factors for SLT use (OR: 0.45 CI: 0.30-0.70; OR: 0.42 CI: 0.24-0.74; OR: 2.47, CI: 1.47-4.15). Older age groups had lower odds of choosing "peer pressure" than the 15-24 year olds. Respondents with 11 or more years of education were more likely to report "stress/coping" than those with no education (OR: 2.82, CI: 1.06-7.48). Continuation-women were less likely than men to choose "relaxation", and "distance from family" as important continuation factors (OR: 0.50, CI:0.32-0.80; OR: 0.20, CI: 0.06-0.65). All age groups were less likely to choose "stimulation" as a factor than the youngest group. Conclusions: Along with confirming and expanding upon previous literature, the findings of this study should encourage further SLT research in women and younger age groups (15-24 and 24-44). They also confirm the need for SLT prevention and cessation interventions in India in other community-based settings, besides schools.


Smokeless tobacco;tobacco control India;COTPA;logistic regression;oral cancer


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