123 WHO South-East Asia Journal of Public Health | September 2016 | 5 (2) Access this article online Website: www.searo.who.int/ publications/journals/seajph Quick Response Code: Original research Social impacts on adult use of tobacco: fndings from the International Tobacco Control Project India, Wave 1 Survey Cecily S Ray 1 , MS Pednekar 1 , PC Gupta 1 , M Bansal-Travers 2 , ACK Quah 3 , GT Fong 3,4 ABSTRACT Background: Social impacts on tobacco use have been reported but not well quantifed. This study investigated how strongly the use of smoked and smokeless tobacco may be infuenced by other users who are close to the respondents. Methods: The International Tobacco Control Project (TCP), India, used stratifed multistage cluster sampling to survey individuals aged ≥15 years in four areas of India about their tobacco use and that of their close associates. The present study used logistic regression to calculate odds ratios (ORs) for tobacco use for each type of close associate. Results: Among the 9780 respondents, tobacco use was signifcantly associated with their close associates’ (father’s, mother’s, friends’, spouse’s) tobacco use in the same form. After adjusting for confounding variables, women smokers were nine times more likely to have a mother who ever smoked (OR: 9.0; 95% confdence interval [CI]: 3.3–24.7) and men smokers fve times more likely (OR: 5.4; 95% CI: 2.1–14.1) than non-smokers. Men smokers were seven times more likely to have close friends who smoked (OR: 7.2; 95% CI: 5.6–9.3). Users of smokeless tobacco (SLT) were fve times more likely to have friends who used SLT (OR: 5.3; 95% CI: 4.4–6.3 [men]; OR: 5.0; 95% CI: 4.3–5.9 [women]) and four times more likely to have a spouse who used SLT (OR: 4.1; 95% CI: 3.0–5.8 [men]; OR: 4.3; 95% CI: 3.6–5.3 [women]), than non-users. The ORs for the association of the individuals’ tobacco use, whether smoked or smokeless, increased with the number of close friends using it in the same form. Conclusion: The infuence of family members and friends on tobacco use needs to be appropriately addressed in tobacco-control interventions. Key words: India, smokeless tobacco, smoking, social environment, tobacco, tobacco use. 1 Healis Sekhsaria Institute for Public Health, Navi Mumbai, India, 2 Department of Health Behavior, Roswell Park Cancer Institute, Buffalo, New York, United States of America, 3 Department of Psychology, University of Waterloo, Waterloo, Ontario, Canada, 4 Ontario Institute for Cancer Research, Toronto, Ontario, Canada Address for correspondence: Ms Cecily S Ray, Healis Sekhsaria Institute for Public Health, 501 Technocity, Plot X-4/5 TTC Industrial Area, Mahape, Navi Mumbai 400701, India Email: raycs@healis.org BACKGRoUnD Tobacco use is a recognized public health problem worldwide and in India. It is implicated in cancer, cardiovascular disease, stroke, chronic lung diseases, adverse reproductive effects 1 and higher mortality, with half of users dying prematurely. 2 Therefore, it is important to understand the factors infuencing individuals’ use of tobacco. In India, the prevalence of smoking is 14.0% overall (24.3% of men; 2.9% of women) and 25.9% use smokeless tobacco (SLT; 32.9% of men; 18.4% of women), as shown by the Global Adult Tobacco Survey. 3 Tobacco use in India is higher in rural areas compared to urban areas, increases with age, and decreases with education 3 as well as income. 4 It is important to understand the social context of tobacco use, to develop interventions promoting its cessation. 5,6 Community surveys and interventions in India have shown that tobacco use is often learnt from parents, other elders and peers. 7,8 Studies at workplaces and in educational institutions have reported similar fndings. 9–12 The rationale for the present study was that the pattern of impact of close social contacts using tobacco on individuals’ tobacco use has not yet been well quantifed or studied by sex in India and that this information might be useful when designing effective interventions to control tobacco use. It was expected that the pattern of social impact on women’s use of tobacco, which is mainly SLT, 3 would differ from that for men. The purpose of this study was to quantify the associations of tobacco use with its use by close social contacts, according to sex, in a large general population across different states of India.