Analysis of the motivating factors for initiation and continuation of smokeless tobacco use in two Indian states: Gujarat and Andhra Pradesh
Background: The burden of smokeless tobacco (SLT) use still requires research attention as part of India's overall tobacco control and prevention efforts. This study gauges the demographic profile of smokeless tobacco users from Gujarat and Andhra Pradesh with an assessment of how this profile differs from the smokers in the sample. It then examines how the factors associated with the initiation and continuation of smokeless tobacco vary by age, gender and education. Methods: This study is based upon cross-sectional baseline survey data for the initiation and continuation factors of current smokeless tobacco users in the last twelve months in twelve districts of Gujarat and Andhra Pradesh. Chi-square analysis was used to make demographic comparisons between the demographic profiles of smokers and SLT users. Multivariable logistic regression analysis was used to obtain the odds ratios (ORs) of socio-demographic variables (age, gender, education) and tobacco user status (smoker/SLT). Results: SLT use was most common among 25-44 year olds and was more common in those with no education (50%) in AP than it was in Gujarat (34.36%). Gutkha, a form of SLT, was more commonly used in Gujarat (56.73%) than in Andhra Pradesh (20.71%). Khaini was more common in AP (41.88%) than in Gujarat (15.45%). Initiation: In the analysis, women were less likely than men to report "peer pressure" and "fashion statement" as factors (OR: 0.45 CI: 0.30-0.70; OR: 0.42 CI: 0.24-0.74) when gender, age and education were adjusted. They were more likely to report "stress/coping" (OR: 2.47, CI: 1.47-4.15). Older age groups had a lower probability of choosing "peer pressure" than those in the 15-24 year old category. All educational subgroups had a higher probability of reporting "fashion statement" than those with no education and were less likely to answer "peer pressure" and "smokers at home." Respondents with 11 or more years of education were more likely to report "stress/coping" than those with no education (OR: 2.82, CI: 1.06-7.48). Continuation: Women were less likely than men to choose "relaxation," and "distance from family" as continuation factors (OR: 0.50, CI:0.32-0.80; OR: 0.20, CI: 0.06-0.65). All age groups were less likely to choose "stimulation" as a factor than the youngest group. Those with 5-10 years of education were more likely to report "tension reduction" than those with none (OR: 2.13 CI: 1.22-3.75) and less likely to report "habit" (OR: 0.58 CI: 0.37-0.92). Conclusions: This study contributes to and expands upon a body of literature which analyzes motivating factors for beginning and continuing the use of SLT products. By doing so, it informs different levels of SLT prevention and cessation interventions.
Danawala, Saba, "Analysis of the motivating factors for initiation and continuation of smokeless tobacco use in two Indian states: Gujarat and Andhra Pradesh" (2013). Texas Medical Center Dissertations (via ProQuest). AAI1549826.