Trends and correlates of smokeless tobacco use among Indian women: Evidence from three rounds of the National Family Health Survey 2005–2021

BACKGROUND: Tobacco use is one of the major threats to public health on a global scale. Smokeless Tobacco (SLT) poses a significant risk for oral cancer and has other adverse health outcomes in women. This study aimed to compare the trends of smokeless tobacco use among women of reproductive age in India as well as to identify the factors associated with SLT use. METHODOLOGY: Only women aged 15-49 years of three rounds of the National Family Health Survey (NFHS), NFHS 3 (2005-2006) (n = 1,24,385), NFHS 4 (2015-2016) (n = 6,99,686) and NFHS 5 (2019-2021) (n = 7,24,115) were analysed separately. Correlates of SLT exposure were assessed separately using Multivariable logistic regression analysis. RESULTS: The prevalence of SLT use among women in India declined from 8.4% in NFHS 3 to 5.6% in NFHS 4 and 3.8% in NFHS 5. Gutkha/ Paan masala was the most commonly used SLT among women in NFHS 4 (2.2%) and NFHS 5 (1.3%). In the recent NFHS 5, Mizoram had the highest (45%) prevalence of SLT use. Across the surveys lower education, older age, caste and region were found to be associated with the SLT use. Interestingly, the exposure to smoking in the house evolved as a strong predictor of SLT use in NFHS 4 [AOR 1.82(1.68-1.98)] and NFHS 5 [AOR 1.85(1.70-2.02)]. CONCLUSION: Educational status, age, caste and exposure to household smoking were associated with SLT use. Geographical variations for SLT usage were noted among women. There is an urgent need to strengthen efforts in the high prevalent regions to prevent the initiation of smokeless tobacco (SLT) use and to support its cessation. Since India hosts the majority of the world's SLT users, these measures could significantly impact global morbidity and mortality associated with SLT use.