Skip to main content

Age-specific prevalence and predictors of tobacco consumption among male adults in India: subnational inequality and associated risk factors



This study aimed to identify regional inequalities in the prevalence and comparison of the correlates of tobacco consumption among male Indian adults across age cohorts.


Associations between explanatory variables and the prevalence of tobacco consumption are determined using bivariate and multivariable binary logistic regression analyses. This study utilizes information from 112,122 male adults collected through the cross-sectional and population-based National Family Health Survey in India conducted in 2015–2016.


Tobacco consumption prevalence was higher among older men from the North-east region (72.6%, confidence interval [CI]: 70.4%–74.8%) and relatively lower among younger men from the South region (8.3%, CI: 7.5%–9.3%). A significant association between educational attainment and tobacco consumption was observed in middle-aged men. For the model fitted to the respondents of this age group, compared to more highly educated males, those with secondary, primary and no institutional education were 1.21 (odds ratio [OR]: 2.21; CI: 2.03–2.42), 3.01 (OR: 4.01; CI: 3.53–4.55) and 2.63 (OR: 3.63; CI: 3.16–4.17) times as likely to consume tobacco, respectively. Among respondents aged 15–19 years, those involved in physical labour were 3.31 (OR: 4.31; CI: 3.66–5.07) times as likely to consume tobacco as those not engaged in paid work.

Conclusions and policy implications

The research recommends designing dynamic interventional programmes to replace uniformly implemented tobacco control measures adopted in contemporary India. Special interventions are suggested for high-risk target groups, including for the North-east region, for those with lower levels of educational attainment, those from schedule caste background and younger males involved in physical paid work. Tobacco control measures in India are usually framed and implemented for the national population as a whole and without much focus on socio-economic inequalities and regional disparities. This study adds value to the growing body of literature through identifying the inequalities in the prevalence and correlates of tobacco consumption across the country’s geographically distributed regions and among the male respondents across the age cohorts.

This is a preview of subscription content, access via your institution.

Fig. 1
Fig. 2


  1. Abrams D, Villanti A, Warner K (2014) The Changing Landscape of Tobacco Control Current Status and Future Directions. In: The Health Consequences of Smoking-50 Years of Progress: A Report of the Surgeon General. US Department of Health and Human Services, Center for Disease Control and, pp 845–864

  2. Al-Sadat N, Misau A, Zarihah Z, Maznah D, Su TT (2010) Adolescent tobacco use and health in Southeast Asia. Asia Pacific J Public Health 22(3_suppl):175S–180S

    Article  Google Scholar 

  3. Asma SMJ, Song SY, Zhao L, Morton J, Palipudi KM et al (2015) The GATS atlas. CDC Foundation, Atlanta

    Google Scholar 

  4. Bhan N, Karan A, Srivastava S, Selvaraj S, Subramanian S, Millett C (2016) Have socioeconomic inequalities in tobacco use in India increased over time? Trends from the national sample surveys (2000–2012). Nicotine Tobacco Res 18(8):1711–1718

    Article  Google Scholar 

  5. Coakes SJ, Ong C (2013) SPSS 21.0 versions for windows analysis without anguish. John Wiley & Sons Ltd, Milton

    Google Scholar 

  6. Dandona R, Pandey A, Dandona L (2016) A review of national health surveys in India. Bull World Health Organization 94(4):286–296a.

    Article  Google Scholar 

  7. Ekpu V U, Brown AK (2015) The economic impact of smoking and of reducing smoking prevalence: review of evidence. Tobacco Use Insights 8:1–35.

  8. Forouzanfar MH, Afshin A, Alexander LT, Anderson HR, Bhutta ZA, Biryukov S, Brauer M, Burnett R, Cercy K, Charlson FJ (2016) Global, regional, and national comparative risk assessment of 79 behavioural, environmental and occupational, and metabolic risks or clusters of risks, 1990–2015: a systematic analysis for the global burden of disease study 2015. Lancet 388(10053):1659–1724

    Article  Google Scholar 

  9. Gajalakshmi V, Kanimozhi C (2010) A survey of 24,000 students aged 13–15 years in India: global youth tobacco survey 2006 and 2009. Tobacco Use Insights 3:1179173X1000300001

    Article  Google Scholar 

  10. Gajalakshmi V, Kanimozhi V (2015) Tobacco chewing and adult mortality: a case-control analysis of 22,000 cases and 429,000 controls, never smoking tobacco and never drinking alcohol, in South India. Asian Pacific J Cancer Prevention: APJCP 16(3):1201–1206

    Article  Google Scholar 

  11. Government of India (1936) The Gazette of India (Schedule Caste Order 1936). Government of India

  12. Hasan MM, Richardson A (2017) How sustainable household environment and knowledge of healthy practices relate to childhood morbidity in South Asia: analysis of survey data from Bangladesh, Nepal and Pakistan. BMJ Open 7(6):e015019 %@ 012044-016055

    Article  Google Scholar 

  13. Health UDo, Services H (2012) Preventing tobacco use among youth and young adults: a report of the surgeon general. US Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, Atlanta, p 3

    Google Scholar 

  14. IIPS, ICF (2017) National Family Health Survey (NFHS-4), 2015–16. IIPS, Mumbai

    Google Scholar 

  15. Jha P, Peto R (2014) Global effects of smoking, of quitting, and of taxing tobacco. New England J Med 370(1):60–68

    CAS  Article  Google Scholar 

  16. John RM, Mamudu HM, Liber AC (2012) Socioeconomic implications of tobacco use in Ghana. Nicotine Tob Res 14(10):1205–1212.

    Article  PubMed  Google Scholar 

  17. John RM, Rao RK, Rao MG, Moore J, Deshpande RS, Sengupta J, Selvaraj S, Chaloupka FJ, Jha P (2010) The economics of tobacco and tobacco taxation in India. International Union Against Tuberculosis and Lung Disease, Paris

    Google Scholar 

  18. Jose A (2019) India’s regional disparity and its policy responses. J Public Affairs 19(4):e1933.

  19. Kamal MM, Hasan MM, Davey R (2015) Determinants of childhood morbidity in Bangladesh: evidence from the demographic and health survey 2011. BMJ Open 5(10):e007538 %@ 002044–e007538 %@ 006055

    Article  Google Scholar 

  20. Kaur J, Jain D (2011) Tobacco control policies in India: implementation and challenges. Indian J Public Health 55(3):220–227.

    Article  PubMed  Google Scholar 

  21. Ladusingh L, Dhillon P, Narzary PK (2017) Why do the youths in Northeast India use tobacco? J Environ Public Health 2017

  22. Mahapatra S, Kamath R, Shetty BK, Binu VS (2015) Risk of oral cancer associated with gutka and other tobacco products: a hospital-based case-control study. J Cancer Res Ther 11(1):199–203.

    CAS  Article  PubMed  Google Scholar 

  23. McCambridge J, McAlaney J, Rowe R (2011) Adult consequences of late adolescent alcohol consumption: a systematic review of cohort studies. PLoS Med 8(2):e1000413

    Article  Google Scholar 

  24. Mini GK, Sarma PS, Thankappan KR (2014) Pattern of tobacco use and its correlates among older adults in India. Asian Pacific J Cancer Prevention : APJCP 15(15):6195–6198

    CAS  Article  Google Scholar 

  25. Mohan P, Lando HA, Panneer S (2018) Assessment of tobacco consumption and control in India. Indian J Clin Med 9:1179916118759289

    Article  Google Scholar 

  26. Murray CJ, Lopez AD (2013) Measuring the global burden of disease. N Engl J Med 369(5):448–457

    CAS  Article  Google Scholar 

  27. NHP (2017) The National Health Policy: Ministry of Health and Family Welfare Government of India

  28. Palipudi K, Rizwan S, Sinha D, Andes L, Amarchand R, Krishnan A, Asma S (2014) Prevalence and sociodemographic determinants of tobacco use in four countries of the World Health Organization: South-East Asia region: Findings from the Global Adult Tobacco Survey

  29. Rani M, Bonu S, Jha P, Nguyen S, Jamjoum L (2003) Tobacco use in India: prevalence and predictors of smoking and chewing in a national cross sectional household survey. Tob Control 12(4):e4–e4

    CAS  Article  Google Scholar 

  30. Rani M, Thamarangsi T, Agarwal N (2017) Youth tobacco use in South-East Asia: implications for tobacco epidemic and options for its control in the region. Indian J Public Health 61(5):12

    Article  Google Scholar 

  31. Reitsma MB, Fullman N, Ng M, Salama JS, Abajobir A, Abate KH, Abbafati C, Abera SF, Abraham B, Abyu GY (2017) Smoking prevalence and attributable disease burden in 195 countries and territories, 1990–2015: a systematic analysis from the global burden of disease study 2015. Lancet 389(10082):1885–1906

    Article  Google Scholar 

  32. Ruhil R (2018) India has reached on the descending limb of tobacco epidemic. Indian journal of community medicine: official publication of Indian Association of Preventive & social. Medicine 43(3):153

    Google Scholar 

  33. Sarkar A, Roy D, Nongpiur A (2019) A population-based study on tobacco consumption in urban slums: its prevalence, pattern, and determinants. J Family Med Primary Care 8(3):892

    Article  Google Scholar 

  34. Sarkar BK, Shahab L, Arora M, Ahluwalia JS, Reddy KS, West R (2016) The social gradient in tobacco use does not generalize to low-income urban communities in India: findings from a census survey. Nicotine Tob Res 19(12):1516–1520

    PubMed Central  Google Scholar 

  35. Sharma K, Junaid M, Diwakar MKP (2017) Economic implications of tobacco industry in India: an overview. Indian J Public Health 61(2):131

    PubMed  Google Scholar 

  36. Sharma S, Singh M, Lal P, Goel S (2015) Predictors of tobacco use among youth in India: GATS 2009-2010 survey. Asian Pacific J Cancer Prevention : APJCP 16(17):7535–7540

    Article  Google Scholar 

  37. Singh A, Ladusingh L (2014) Prevalence and determinants of tobacco use in India: evidence from recent global adult tobacco survey data. PLoS One 9(12):e114073.

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  38. Sreeramareddy CT, Ramakrishnareddy N, Kumar HH, Sathian B, Arokiasamy JT (2011) Prevalence, distribution and correlates of tobacco smoking and chewing in Nepal: a secondary data analysis of Nepal demographic and health Survey-2006. Substance Abuse Treatment Prevent Policy 6(1):33

    Article  Google Scholar 

  39. Sridharan G (2014) Epidemiology, control and prevention of tobacco induced oral mucosal lesions in India. Indian J Cancer 51(1):80–85.

    CAS  Article  PubMed  Google Scholar 

  40. Subramanian S, Nandy S, Kelly M, Gordon D, Smith GD (2004) Patterns and distribution of tobacco consumption in India: cross sectional multilevel evidence from the 1998-9 national family health survey. Bmj 328(7443):801–806

    CAS  Article  Google Scholar 

  41. Team RC (2017) R: a language and environment for statistical computing. 3.4.3 edn. R Foundation for Statistical Computing, Vienna

    Google Scholar 

  42. Thakur JS, Prinja S, Bhatnagar N, Rana S, Sinha DN (2013) Socioeconomic inequality in the prevalence of smoking and smokeless tobacco use in India. Asian Pacific J Cancer Prevention : APJCP 14(11):6965–6969

    Article  Google Scholar 

  43. Wang Q, Shen JJ, Sotero M, Li CA, Hou Z (2018) Income, occupation and education: are they related to smoking behaviors in China? PLoS One 13(2):e0192571

    Article  Google Scholar 

  44. WHO (2013) Updated revised draft global action plan for the prevention and control of noncommunicable diseases 2013–2020. 2013. Google Scholar

  45. WHO (2015) WHO report on the global tobacco epidemic 2015: raising taxes on tobacco. World Health Organization

  46. Zahiruddin QS, Gaidhane A, Bawankule S, Nazli K, Zodpey S (2011) Prevalence and pattern of tobacco use among tribal adolescents: are tobacco prevention messages reaching the tribal people in India? Ann Trop Med Public Health 4(2):74

    Article  Google Scholar 

Download references


Not applicable.

Author information




Md Masud Hasan: conceptualization, methodology, data analysis, visualization, draft preparation.

Ali Quazi: draft preparation, visualization.

Nivarthi Sarangapani: draft preparation, visualization.

Khorshed Alam: draft preparation, reviewing and editing.

Corresponding author

Correspondence to Khorshed Alam.

Ethics declarations

Ethical approval

Ethics approval is not required for the study as it used secondary data from the National Family Health Survey in India. There is no identifiable information of individuals in the data.

Informed consent

Not applicable.

Research involving human participants and/or animals

Not applicable.

Conflict of interest

The authors declare that they have no conflict of interest.

Additional information

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.



Fig. 3

Fig. 3

Region-wise tobacco consumption by different caste groups

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Hasan, M.M., Quazi, A., Sarangapani, N. et al. Age-specific prevalence and predictors of tobacco consumption among male adults in India: subnational inequality and associated risk factors. J Public Health (Berl.) (2021).

Download citation


  • India
  • Logistic regression
  • Prevalence and predictors
  • Regional inequality
  • Tobacco consumption