Trends and correlates of hardcore smoking in India: findings from the Global Adult Tobacco Surveys 1 & 2

Background: Data on the prevalence of hardcore smoking (HCS) among different socioeconomic status (SES) groups in low- and middle-income countries are limited. We looked at the prevalence and pattern of HCS in India with the following objectives: 1) to analyse the association between SES and HCS, 2) to find trends in HCS in different SES groups and 3) to find state-wide variations in hardcore smoking. Methods: Data of individuals aged ≥25 years from the Global Adult Tobacco Survey (GATS) India 2009-10 (N= 9223) and 2016-17 (N= 7647) were used for this study. If an individual met all the following criteria: (1) current smoker, (2) smokes 10 or more cigarettes/day, (3) smokes first puff within 30 minutes after waking up, (4) no quit attempt in the last 12 months, and (5) no intention to quit at all or in the next 12 months, s/he was identified as a hardcore smoker. Multiple regression analysis was done to find the factors associated with HCS. Results: Prevalence of HCS decreased from 3% in GATS 1 to 2.1% in GATS 2: males from 5.6% to 3.9% and females from 0.3% to 0.2%. Compared to the richest group the poorest, poor and those who belonged to the middle-income group were more likely to report HCS in GATS 1 and 2. However, only in the poorest SES group, there was an increase in the proportion of hardcore smokers in GATS 2 compared to GATS 1. Other factors that were significantly associated with HCS in both surveys were male gender, working adults, those with lower education, and households without any rules for smoking inside the home. Conclusions: Tobacco control and cessation efforts need to focus on individuals of poor SES groups, particularly in the high prevalence Indian states.