Community environment and its relationship with tobacco use in selected North Indian communities

Abstract

Background: Community environmental factors can influence tobacco use and their modification could be one of the ways for reduction of tobacco use. This study measured community environmental determinants of tobacco use in urban and rural Haryana and relates them to tobacco use. Materials and Methods: Community audit was done in ten rural and urban communities of Ballabgarh, Haryana, to characterize the community, map establishments selling tobacco, and tobacco advertisements. Individual establishments were assessed for their compliance to national law. Fifteen men and 15 women were sampled from each community and interviewed for tobacco use, exposure to tobacco promotion, knowledge of tobacco laws, and attitude toward tobacco. Multilevel mixed-effects logistic regression was conducted to measure community-level determinants' contribution to tobacco use. Results: Overall, 218 establishments and 552 participants were assessed in these 20 communities. The median density of tobacco-selling stores expressed in terms of per square kilometer area of the community was 82.9 (75.5- 110.8) for rural area and lower in urban area 34.6 (9.0- 91.0). Nearly 18.5% of participants were currently using tobacco. Multilevel modeling shows that 35% of the differences in the tobacco use in the community were explained by community-level differences. Conclusion: The higher dependency of tobacco consumption on the community environment needs to be further explored.

Keywords

• Community environment
• multilevel modeling
• North India
• tobacco use