Identifying socioeconomic and health related determinants of tobacco use among Indian women using the fifth National family health survey

Abstract Background Tobacco use among women in India remains under-researched despite its growing public health burden and strong sociocultural influences. Understanding its determinants is essential for designing gender-sensitive interventions. Methods This study analysed data from 724,115 women aged 15–49 years from the National Family Health Survey (NFHS-5, 2019–2021). A binary logistic regression model estimated the marginal effects of demographic, socioeconomic, and health-related predictors of tobacco consumption (smoked or smokeless). Results Overall, 6.28% of women reported current tobacco use. Prevalence increased sharply with age, peaking among women aged 45–49 years (+8.14 percentage points relative to those aged 15–19 years). Tobacco use was substantially higher among women with no formal education (+10.91 percentage points), those in the poorest wealth quintile (+11.79 percentage points), and residents of select Northeastern states, where prevalence exceeded 50%. In contrast, higher educational attainment and greater household wealth were associated with lower tobacco use. Women covered by health insurance (+2.04 percentage points) and those reporting chronic health conditions (+1.38 percentage points) exhibited higher tobacco use, suggesting possible behavioural risk compensation and stress-related coping mechanisms. After adjustment for socioeconomic and educational factors, rural residence was associated with a modest reduction in tobacco use. All estimated associations were statistically significant at the 1% level (p < 0.01). Conclusions Female tobacco use in India is shaped by intersecting demographic, economic, and health vulnerabilities, with novel evidence of higher use among insured and chronically ill women. Policy implications Targeted cessation efforts for older, less-educated, and low-income women, integration of tobacco screening into primary care and chronic disease management, and insurance-linked cessation incentives are recommended to address these disparities.