Use of smokeless tobacco by patients with drug-sensitive pulmonary tuberculosis: The need for strengthening tuberculosis–tobacco collaborative in India

Background A joint tuberculosis-tobacco collaborative was launched in India in 2017 to reduce the addictive habit of tobacco use among patients with tuberculosis (TB). We aimed to estimate the prevalence and predictors of smokeless tobacco use and its awareness among patients with pulmonary TB in Bhavnagar city, Gujarat, India. Methods We did a cross-sectional study among 258 randomly selected drug-sensitive pulmonary TB patients registered at the District TB Centre in Bhavnagar from April to October 2019. The Global Adult Tobacco Survey questionnaire was used for data collection. Multivariable logistic regression was used to determine the predictors of smokeless tobacco use. Results Among the 258 patients, 73% were male, 66% were married, 40% traveled for their occupation, 62% had a nuclear family, and 46% were illiterate. More than half (52%) the patients used smokeless tobacco: 44% were daily users and 8% were occasional users. On multivariable logistic regression, male gender (adjusted odds ratio [aOR]: 5 [95% confidence interval (CI) 2-11]), occupation requiring travel (aOR: 4 [95% CI: 2-7]), monthly income of ₹3001-6000 (aOR: 0.2 [95% CI: 0.1-0.6]), ₹9000-12 000 (aOR: 0.3 [95% CI: 0.1-0.9]) and above ₹12 000 (aOR: 0.3 [95% CI: 0.1-0.8]) were significant predictors of smokeless tobacco use. Almost all (98%) of the participants were aware of the harmful effects of smokeless tobacco on health. Conclusion More than half the patients with pulmonary TB used smokeless tobacco. The TB-tobacco collaborative framework needs to be strengthened with brief counselling interventions for patients with TB using smokeless tobacco for collateral benefits in the control of TB in India.