Decomposing the inequality of tobacco use between upper caste and scheduled caste/tribe men in India, 2005-06 to 2019-21

Tobacco use is significantly high among Indian men belonging to disadvantaged social groups, posing a major public health concern. This study measures inequality in tobacco consumption between Upper Caste (UC) males and socially disadvantaged men, specifically Scheduled Caste (SC) and Scheduled Tribe (ST) men, from 2005-2006 to 2019–2021 using data from the National Family Health Survey-3, 4, and 5. The study also quantifies the relative contributions of socio-demographic factors, household and community characteristics, and geographical space to this social disparity in tobacco consumption using Fairlie decomposition. Findings show a consistently higher tobacco consumption among SC and ST men, than among UC men; however, the disparity has declined considerably between 2005-2006 and 2019–2021. Key contributors to inequality in tobacco consumption include household wealth, education, occupation, and newspaper exposure. Community-oriented initiatives that address economic disadvantages, provide culturally relevant health education, and enhance addiction prevention, treatment, and cessation through media campaigns are crucial for reducing the burden of tobacco consumption and enhancing the overall well-being of socially marginalized populations.