Age-specific prevalence and predictors of tobacco consumption among male adults in India: subnational inequality and associated risk factors

Objectives: This study aimed to identify regional inequalities in the prevalence and comparison of the correlates of tobacco consumption among male Indian adults across age cohorts. Methods: Associations between explanatory variables and the prevalence of tobacco consumption are determined using bivariate and multivariable binary logistic regression analyses. This study utilizes information from 112,122 male adults collected through the cross-sectional and population-based National Family Health Survey in India conducted in 2015–2016. Results: Tobacco consumption prevalence was higher among older men from the North-east region (72.6%, confidence interval [CI]: 70.4%–74.8%) and relatively lower among younger men from the South region (8.3%, CI: 7.5%–9.3%). A significant association between educational attainment and tobacco consumption was observed in middle-aged men. For the model fitted to the respondents of this age group, compared to more highly educated males, those with secondary, primary and no institutional education were 1.21 (odds ratio [OR]: 2.21; CI: 2.03–2.42), 3.01 (OR: 4.01; CI: 3.53–4.55) and 2.63 (OR: 3.63; CI: 3.16–4.17) times as likely to consume tobacco, respectively. Among respondents aged 15–19 years, those involved in physical labour were 3.31 (OR: 4.31; CI: 3.66–5.07) times as likely to consume tobacco as those not engaged in paid work. Conclusions and policy implications: The research recommends designing dynamic interventional programmes to replace uniformly implemented tobacco control measures adopted in contemporary India. Special interventions are suggested for high-risk target groups, including for the North-east region, for those with lower levels of educational attainment, those from schedule caste background and younger males involved in physical paid work. Tobacco control measures in India are usually framed and implemented for the national population as a whole and without much focus on socio-economic inequalities and regional disparities. This study adds value to the growing body of literature through identifying the inequalities in the prevalence and correlates of tobacco consumption across the country’s geographically distributed regions and among the male respondents across the age cohorts.