Awareness regarding the adverse effect of tobacco among adults in India: findings from secondary data analysis of Global Adult Tobacco Survey

OBJECTIVE: To quantify the extent of awareness regarding the harmful effects of tobacco among the users (both smoked and smokeless) and non-users in India, and explore the determinants of comprehensive knowledge among the participants of the Global Adult Tobacco Survey (GATS), India. DESIGN: Cross-sectional study. SETTING AND PARTICIPANTS: The nationally representative GATS I (2009–2010) included 69 296 participants using a multistage sampling method, while GATS II (2015–2016) interviewed 74 037 respondents aged >15 years using a similar sampling method from all the states and union territories in India. PRIMARY AND SECONDARY OUTCOME MEASURES: Comprehensive score were derived from nine items that explored awareness regarding the adverse effects of tobacco use among both users and non-users of tobacco in GATS II. Secondary outcome included predictors of awareness regarding adverse effects of tobacco and changes in the awareness compared with the previous round of the survey. RESULTS: About 60.2%, 57.5% and 66.5% of the smokers, smokeless tobacco (SLT) users and non-users were aware of the adverse effects of tobacco, respectively. The awareness depicted significant age, gender, marital status, education status, urban–rural, wealth and regional disparities (p<0.05). Intention to quit tobacco use also varied significantly with awareness. Among smokers, awareness was high in those residing in eastern India and the poorest participants. Among SLT users, awareness was more among male participants, those who were poorest and lived in western India. Among non-users, awareness was more among middle-aged, more educated, rich participants of west India. Compared with GATS I, an increase in awareness was observed in GATS II across gender, age groups, residential areas and geographical regions in India. CONCLUSIONS: Comprehensive awareness of tobacco’s harmful effects is far from desirable among Indian users. We recommend further customised health promotion campaigns to counter the regional disparities, adopt a gender-neutral approach and target adolescents.