A study of factors impacting on the tobacco use patterns and tobacco-related behavior among the lower middle and lower classes in a resettlement colony of Delhi, India

Objectives: To study the factors impacting on the tobacco use patterns and tobacco related behavior among lower middle and lower classes in a resettlement colony in Delhi. Materials and Methods: The study was conducted in the year 2011, between the months of March and October. It was done as a community based, cross sectional, house to house survey in a resettlement colony in South Delhi, involving interviews with present tobacco users as per a structured interview guide wherein majority of the questions were closed ended and a few open ended questions. Results: Study enrolled 1698 subjects in all with males constituting 90.8% of the sample while women constituted 8.7%. Median age of the study subjects was 37 years while the mean age was 40 yrs. 87 percent of the respondents were educated to less than or equal to higher secondary level. Some of the other salient findings of the study are as under. Overall, both smoked and smokeless forms of tobacco were found to be almost equally used in the community. While 14% of the males consumed both the smoked and non-smoked forms of tobacco, similar percentage among women was only 1%. Age seemed to be an important determinant of the form of tobacco used. After controlling for literacy levels, it was found that variation in the consumption of different forms of smoked tobacco was statistically significant (P = .001) across different age categories. While cigarette smoking was commoner among the younger age groups, beedis were more popular among the older respondents. However, smokeless tobacco was the most commonly used form of tobacco among the youth. Age and income levels came out as two important determinants of the intensity of smoking. While there was a statistically significant increase in the intensity of smoking with increasing age (P = .001); there was statistically significant decline in the intensity of smoking (P = .001) with rise in income levels. However, there was no statistically significant relationship between intensity of smoking and income sufficiency or stability, or indebtedness status. There was a statistically significant decline in tobacco expenditure with rise in income levels and decline in tobacco consumption among the friend circle. Peer pressure and easy availability were among the two commonest reasons for people to get hooked on the tobacco use. After meals, while resting and when in a happy mood were the three commonest occasions in that order, when people indulged in tobacco usage. Implications of these findings have been discussed in detail.