Areca nut consumption with and without tobacco among the adult population: a nationally representative study from India.

Objective Areca nut is one of the most widely consumed substances globally, after nicotine, ethanol and caffeine and classified as carcinogenic to humans. This study examines the disparity and determinants of areca nut consumption with and without tobacco in India. Design Nationally representative cross-sectional study. Participants We used the nationally representative Global Adult Tobacco Survey 2016–2017. The analytical sample size was 74 037 individual’s aged 15 years and above with a response rate of 92.9%. Measures Current consumption of areca nut without tobacco and with tobacco. Method We examined determinants of areca nut consumption (without tobacco and with tobacco) using multinomial logistic regression, accounting for the survey design. Results About 23.9% (95% CI 23.1 to 24.8) of the adult population consume areca nut, that is, approximately 223.79 million people in India; majority of users (14.2%–95% CI 13.5 to 14.9) consumed areca nut with tobacco. When compared with women, men were more likely to consume areca nut (with tobacco relative risk (RR)=2.02; 95% CI 1.85 to 2.21 and without tobacco RR=1.13; 95% CI 1.07 to 1.20). Age, marital status, education, occupation, caste, religion and region were significantly associated with areca nut consumption. However, the direction and magnitude of association differ with respect to the areca nut consumption with and without tobacco. Conclusion The ongoing tobacco control efforts would not address the majority of areca nut users until greater attention to areca nut consumption with and without tobacco is reflected in health policies in India.