Prevalence and correlates of nicotine dependence among adult tobacco users in India: evidence from global adult tobacco survey in India

Tobacco use is a significant public health concern in India, with nicotine dependence contributing to the persistence of tobacco consumption. This study offers national evidence on nicotine dependence among adult tobacco users in India and identifies regional and socio-demographic patterns relevant for targeted policies and interventions. This cross-sectional study analyzed data from 20,369 individuals aged 15 years and above using the Global Adult Tobacco Survey (GATS) India 2016–17, a nationally representative household survey covering all Indian states and Union Territories. Nicotine dependence was measured using the Heaviness of Smoking Index (HSI) for smokers and the Smokeless Tobacco Dependence Index (STDI) for smokeless tobacco users. Logistic regression models were employed to identify correlates of high dependence, adjusting for socio-demographic and behavioral variables. Overall, 18% of smokers and 4% of smokeless tobacco users exhibited high nicotine dependence. Dependence was significantly higher among males, older adults, Muslims, and residents of the North-Eastern and Central regions. Early initiation of tobacco use (before age 18 years) markedly increased the likelihood of high dependence, while higher education and smoke-free home environments were associated with lower dependence. Findings align with global patterns while highlighting India’s unique tobacco use profile and regional variation in nicotine dependence. They support region-specific, gender-sensitive, and education-based tobacco control strategies, strengthened MoHFW leadership, integrating cessation into primary care, and reinforcing TOFEI guidelines and the national quitline to reduce nicotine dependence and advance control goals.