Addiction perceptions among users of smokeless or combustible tobacco attending a tertiary care hospital in India

Introduction: Addiction plays a key role in continued tobacco use. The study assessed association of perceived personal addiction and the perceived addictiveness of different forms of tobacco with type of tobacco product used, demographic characteristics and socio-cultural factors. Methods: A cross-sectional survey of 607 adult tobacco users with age 18 years and above attending a general medicine out-patient department was conducted. Participants were asked questions on perceived personal addiction to tobacco use and perception of addiction on tobacco products. Logistic regression was applied to investigate the association between demographic characteristics, type of tobacco, socio-cultural factors and addiction perceptions. Results: The odds of perceived addiction (PA) were lower among smokeless tobacco (SLT) users [OR (95% CI): 0.57 (0.37, 0.89) P = 0.01]. An increase in the odds of PA was seen as age increased [OR (95% CI):1.02 (1.00, 1.03) P = 0.01] and participants with secondary education and above had higher odds of PA compared to participants with no formal education [OR (95% CI): 1.68 (1.09, 2.58) P = 0.02]. The odds of perceiving SLT products to be addictive was lower among SLT users [OR (95% CI): 0.48 (0.30, 0.75) P = 0.002)] compared to combustible tobacco users. The odds of perceiving SLT products to be addictive was lower [(OR (95% CI): 0.35 (0.18, 0.67) P = 0.002)] among females. Participants with secondary education and above had higher odds of perceiving combustible [OR (95% CI): 1.80 (1.17, 2.77) P = 0.008)] and SLT products [OR (95% CI): 1.98 (1.20, 3.30) P = 0.008)] to be addictive compared to no schooling. Discussion and Conclusions: There is a need to raise awareness in India of the addictiveness of tobacco, particularly for users of SLT, younger people and those with less education.