Social determinants of dual tobacco use in India: An analysis based on the two rounds of global adult tobacco survey.

This study examines the socioeconomic determinants of dual use of smoked and smokeless tobacco (SLT) in India between 2009-10 and 2016-17. Data from two rounds of the nationally representative cross-sectional Global Adult Tobacco Survey (GATS) conducted in 2009-10 and 2016-17 was used. Complete sample size from both rounds of survey covering 143,333 individuals (GATS I: 69,296 and GATS II: 74,037) from 153,239 households (GATS I: 76,069 and GATS II: 77,170) included in the study. Dual use was assessed based on current smoked and SLT users in both rounds. Bivariate analysis was applied to assess differences in dual tobacco use by socioeconomic status (SES) and across regions, whereas, pooled sampled analysis was conducted to examine the determinants of dual use applying multinomial logistic regression model. Findings reveal that dual use has declined in India from nearly 5% in 2009-10 to 3.4% in 2016-17. Considerable regional and SES differences in dual use are evident. Multivariate results indicate, while age is positively associated with dual use, education and household wealth was negatively associated. Dual use of tobacco was found to be considerably higher among men as compared to women (RRR: 15.66, 95%CI 14.20-17.27). Awareness about the adverse health consequences of tobacco was also negatively associated with dual tobacco use (RRR: 0.56, 95%CI 0.50-0.64). Future awareness and enforcement efforts should focus on all forms of tobacco, especially targeting vulnerable SE groups.