Tobacco use and COVID 19 related preventive behaviors treatment patterns and clinical characteristics among non-critical patients in urban Bangladesh

Tobacco use poses significant global public health risks, especially during infectious disease outbreaks. While tobacco use is typically examined as a predictor of COVID-19 outcomes, limited research has assessed how tobacco users differ in their preventive behaviors and treatment experiences, particularly in low- and middle-income countries. This study explored the associations between tobacco use and COVID-19 severity, treatment experiences, and preventive health behaviors in an urban LMIC context. Using multi-stage simple random sampling, a cross-sectional study was conducted among 659 COVID-19-positive patients who did and did not use tobacco products. Tobacco use was defined as current use of smoked or smokeless tobacco within the past 30 days prior to COVID-19 diagnosis. Data were collected through face-to-face interviews. Tobacco use was treated as a focal health behavior examined alongside sociodemographic, clinical, and COVID-19 preventive characteristics, including mask-wearing, respiratory hygiene, and avoiding large gatherings as co-occurring preventive health behaviors. Pearson’s Chi-square or Fisher’s exact test assessed the association between tobacco use and sociodemographic and clinical variables. Bivariate and multivariable logistic regression models estimated adjusted associations, adjusted logistic regression models were used to estimate associations between tobacco use, preventive behaviors, and treatment patterns. Patients requiring immediate ICU admission or invasive ventilation were excluded due to recruitment limitations. In our sample, 14% of participants reported tobacco use. Bivariate analysis showed significant associations between tobacco use and socio-demographic variables, including age, gender, housing type, and education level (all p < 0.01). After adjustment, tobacco use was less likely among females and among those who consistently wore masks or practiced respiratory hygiene. Patients who reported avoiding large gatherings showed higher odds of tobacco use. Comorbid conditions were found to be more likely among tobacco users across both home-based and hospital-based care settings. In home settings, tobacco users relied on alternative medicine and were more likely to report the use of Ivermectin. In hospitals, tobacco users received more intensive interventions, including Tocilizumab, plasma therapy, and multivitamin supplementation. Tobacco use among COVID-19 patients in urban Bangladesh was linked with distinct demographic profiles, preventive practices, and treatment choices. These findings highlight the need for tailored public health interventions to address tobacco-related vulnerabilities in pandemic contexts, especially in low-resource urban settings.