Over/under reporting of tobacco use by head of the household vs individual in a large-scale cross-sectional survey in India

Tobacco use is a significant public health challenge in India, contributing to considerable morbidity, mortality, and economic burden. Addressing discrepancies in reporting is essential for accurate assessment of health risks, improving knowledge on tobacco use, and providing effective cessation support and public health interventions. Using data from the National Family Health Survey-5 (2019-21), this study examined discrepancies in reporting tobacco use between household head and self-reporting of 101,608 (15–54 years) men and 724,009 (15–49 years) women. Bivariate analysis was used to assess tobacco use prevalence across geographic and socio-demographic factors, with reported disagreement tested using the McNemar test and the relative percentage of reporting discrepancies calculated to show the magnitude of the discrepancy. Household heads under-reported men’s tobacco use by 13.9% and over-reported women’s use by 39.7%. The most significant under-reporting among men was observed in the 15–24 age group (44%) and among unmarried men (43.4%), followed by those with higher education (24.8%) and urban residents (14.6%). Conversely, the most striking over-reporting of women’s tobacco use was found among Buddhist women (95.8%) and those from the wealthiest households (51%). Over-reporting was also high among highly educated women (54.1%) and urban women (45.5%). At the district level, the greatest under-reporting of men’s use was recorded in Sahibzada Ajit Singh (-50%) and Kasaragod (-42%), while women’s use was massively over-reported in districts like Latur (800%) and Rohtas (600%). This descriptive study highlights discrepancies in tobacco use reporting in India, emphasizing the need for better awareness and education. Addressing stigma and improving recognition of tobacco products, especially among household heads and women, is essential for accurate reporting and supporting cessation efforts. Involving healthcare workers in family discussions can foster a supportive environment for behavior change.