Abstract
More than 7 million cancer-related deaths worldwide are associated with tobacco, of which India is the second largest producer and consumer. The current study tests a model based on the hypothesis that poor implementation of tobacco control measures and poor basic education affect the frequency and duration of tobacco use, creating substantial nicotine dependency and thereby preventing smokers from quitting tobacco consumption.
Data from six randomly selected states in India was collected via face-to-face interviews for this cross-sectional study. Participants were interviewed with a questionnaire tested for its face and content validity and asked about their exposure to tobacco control policies by acknowledging potential violations of the existing laws. The model included two exogenous (MPOWER-based tobacco control measures and level of education) and four endogenous (tobacco dependency, duration, and frequency of smoking, and intention to quit smoking) variables. Structural equation modelling was done using RStudio (version 3.6.3) to test the model fit and to explore the association.
1962 participants were interviewed. Tambakoo was the most common type of tobacco used (by 1132 [57·7%] of 1962 interviewees). 857 (43·7%) of respondents reported to want to quit tobacco immediately. Many reported that tobacco was sold by a certified company, was taxed, and noted that the tax was high. However, 1352 (68·9%) said that minors (ie, individuals younger than 18 years) could buy tobacco illegally. Application of tobacco control measures directly affected the intention to quit (standardised path coefficient value [B]=0·181; p<0·0001), and this effect was partly mediated by frequency of tobacco consumption (B=0·06; p=0·041). Better education was associated with a higher intention to quit tobacco (B=0·122; p<0·0001). Responders from rural areas reported a lower intention to quit in comparison with respondents from urban and semi-urban areas. Neither duration nor dependency mediated an effect on the intention to quit.
These findings suggest that implementation of tobacco control measures and better education positively affects the intention to quit tobacco. Although India is moving towards universal health coverage, tobacco users with lower educational attainment and those from rural areas are less likely to avail themselves of health-care opportunities. These individuals might also have lower financial and psychological support, which in turn can prevent them from making healthy life choices, including quitting tobacco. The current study presents a validated model and the information is gathered directly from tobacco users to provide a ground-level observation of implemented policies. However, because of the cross-sectional design, no cause and effect relationship between various factors and intention to quit tobacco can be assumed. This study relied on perceived responses and the data collected might be affected by recall bias and social desirability.
None.