Patterns, Predictors, and Expenditure Associated with Tobacco Use among Rural Adults in Jharkhand: A Cross-Sectional Study

Abstract

Background: Jharkhand carries one of India's highest tobacco burdens, yet little is known about what rural users consume, what sustains their use and what it costs them.
Objectives: To describe the forms, frequency, age at initiation and duration of tobacco use, and to assess domain-based predictors and expenditure among current tobacco users.
Methods: A community-based cross-sectional study was conducted among 212 adults aged more than 15 years in the rural field practice area of the Rural Health Training Centre, RIMS, Ranchi. The current tobacco users were assessed for the mode, frequency and form of use, age at initiation, duration of use and expenditure; eight behavioural predictor domains were scored from 0 to 1.
Results: Of 212 participants, 94 (44.3%) were current tobacco users. Smokeless tobacco predominated: 85 (90.4%) used it daily, whereas 36 (38.3%) smoked, only 11 (11.7%) daily. Khaini was the commonest product, used daily by 50 (53.3%). Exclusive smokeless use (61.7%), dual use (28.7%) and exclusive smoking (9.6%) were the patterns observed. Mean age at initiation was 18.0 years for smoking and 22.4 years for smokeless tobacco, with mean durations of 7.6 and 25.8 years. Misinformation (0.893) and peer pressure (0.882) scored highest, followed by self-medication (0.615) and parental influence (0.516); social rewards (0.274) scored lowest. Mean expenditure was Rs. 12.87 daily and Rs. 2760.64 yearly.
Conclusion: Tobacco use was predominantly daily, smokeless, early-initiated and long-standing, sustained by peer networks, family modelling and beliefs that tobacco revitalises and relieves tension, at a recurring cost to modest household budgets.