{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,11]],"date-time":"2026-02-11T19:22:55Z","timestamp":1770837775421,"version":"3.50.1"},"reference-count":37,"publisher":"Public Library of Science (PLoS)","issue":"2","license":[{"start":{"date-parts":[[2026,2,11]],"date-time":"2026-02-11T00:00:00Z","timestamp":1770768000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS One"],"abstract":"<jats:sec id=\"sec001\">\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>India ranks second globally in tobacco consumption, with marked disparities across socially stratified caste groups. Despite tobacco control efforts, Scheduled Tribes (ST) and Scheduled Castes (SC)\u2014historically marginalized communities\u2014exhibit elevated tobacco use. This study examines caste-based disparities in smoked and smokeless tobacco (SLT) use and identifies factors contributing to these inequalities.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec002\">\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We analyzed nationally representative data from the Global Adult Tobacco Survey (GATS) 2016\u221217, comprising 74,037 adults aged \u226515 years. Social groups were classified as ST, SC, Other Backward Classes (OBC), and General categories. We estimated prevalence rates, used multivariable logistic regression to assess associations with\u00a0socio-demographic\u00a0factors, and employed multivariate decomposition analysis to quantify contributors to inter-group disparities.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec003\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Overall tobacco use prevalence was 28.6%, with substantial variation: ST (36.0%), SC (28.9%), OBC (29.1%), and General (23.1%). SLT use was particularly high among ST (27.7%) and SC (20.7%) compared to General (16.0%). Men had 16-fold higher odds of SLT use (AOR: 16.4; 95%CI:15.2-17.7) and 23-fold higher odds of smoking [Adjusted Odds Ratio (AOR): 23.1; 95%CI:20.8-25.6] compared to women, with similar patterns within each social group. Lower education, older age, disrupted marriage, rural residence, and poor wealth status were independently associated with higher tobacco use. Decomposition analyses revealed that sex (38%), education (24%), and region (18%) explained most between-group differences, with substantial tobacco use concentrated in Eastern, Central, and Northeastern states.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec004\">\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Pronounced caste-based tobacco use disparities persist in India, disproportionately affecting socioeconomically disadvantaged ST and SC populations, particularly older, less-educated in rural areas. Achieving Sustainable Development Goal 3.a requires targeted interventions addressing these structural inequalities through culturally appropriate cessation programs, enhanced health education, and region-specific tobacco control policies.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1371\/journal.pone.0341459","type":"journal-article","created":{"date-parts":[[2026,2,11]],"date-time":"2026-02-11T18:45:18Z","timestamp":1770835518000},"page":"e0341459","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":0,"title":["Caste and tobacco use: Decomposing inequalities using Global Adult Tobacco Survey, India"],"prefix":"10.1371","volume":"21","author":[{"given":"Lucky","family":"Singh","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1742-5534","authenticated-orcid":true,"given":"Prashant Kumar","family":"Singh","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2829-7446","authenticated-orcid":true,"given":"Shashi Kala","family":"Saroj","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7913-759X","authenticated-orcid":true,"given":"Ritam","family":"Dubey","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8271-1062","authenticated-orcid":true,"given":"Shalini","family":"Singh","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"340","published-online":{"date-parts":[[2026,2,11]]},"reference":[{"key":"pone.0341459.ref001","first-page":"150","volume-title":"Global report on trends in prevalence of tobacco use 2000 - 2025 fourth edition [Internet]","author":"World Health Organization (WHO)","year":"2021"},{"issue":"10292","key":"pone.0341459.ref002","doi-asserted-by":"crossref","first-page":"2337","DOI":"10.1016\/S0140-6736(21)01169-7","article-title":"Spatial, temporal, and demographic patterns in prevalence of smoking tobacco use and attributable disease burden in 204 countries and territories, 1990\u00e2\u20ac\u201c2019: a systematic analysis from the Global Burden of Disease Study 2019","volume":"397","author":"MB Reitsma","year":"2021","journal-title":"Lancet"},{"key":"pone.0341459.ref003","first-page":"1","author":"TISS-Ministry of Health & Family Welfare-Government of India","year":"2017"},{"issue":"6","key":"pone.0341459.ref004","doi-asserted-by":"crossref","DOI":"10.1136\/bmjopen-2019-033178","article-title":"Geographic variation in tobacco use in India: a population-based multilevel cross-sectional study","volume":"10","author":"A Singh","year":"2020","journal-title":"BMJ Open"},{"key":"pone.0341459.ref005","unstructured":"Census of India. Sample Registration System Statistical Report 2019. Off Regist Gen Census Com India Minist Home Aff Gov India [Internet]. 2019;11\u201328. Available from: http:\/\/www.censusindia.gov.in\/vital_statistics\/SRS_Report\/9Chap2-2011.pdf"},{"issue":"2","key":"pone.0341459.ref006","article-title":"Smokeless tobacco utilization among tribal communities in India: A population-based cross-sectional analysis of the Global Adult Tobacco Survey, 2016\u20132017","volume":"11","author":"R Agrawal","year":"2023","journal-title":"Front Public Heal"},{"issue":"1","key":"pone.0341459.ref007","doi-asserted-by":"crossref","first-page":"182","DOI":"10.1186\/s41043-024-00661-w","article-title":"Nested multilevel modelling study of smoking and smokeless tobacco consumption among middle aged and elderly Indian adults: distribution, determinants and socioeconomic disparities","volume":"43","author":"P Halder","year":"2024","journal-title":"J Health Popul Nutr"},{"key":"pone.0341459.ref008","doi-asserted-by":"crossref","first-page":"37","DOI":"10.18332\/tpc\/155190","article-title":"Prevalence and factors associated with tobacco use among beneficiaries attending the youth mental health promotion clinics (Yuvaspandana Kendra) in India: A case-record analysis","volume":"8","author":"GM Sukumar","year":"2022","journal-title":"Tob Prev Cessat"},{"key":"pone.0341459.ref009","first-page":"80","volume-title":"SDGs Report 2023 [Internet]. The Sustainable development Goals Report 2023: Special Edition","author":"UN DESA","year":"2023"},{"key":"pone.0341459.ref010","doi-asserted-by":"crossref","unstructured":"Global Tobacco Surveillance System (GTSS): Purpose, Production, and Potential. 2005;75(1):15\u201324.","DOI":"10.1111\/j.1746-1561.2005.tb00004.x"},{"key":"pone.0341459.ref011","unstructured":"Bhuria DS. REPORT OF THE SCHEDULED AREAS AND SCHEDULED TRIBES COMMISSIONS (Vol I & II). 2004;1426."},{"issue":"2","key":"pone.0341459.ref012","first-page":"27","article-title":"Tribal population in India: regional dimensions & imperatives","volume":"3","author":"T Paltasingh","year":"2014","journal-title":"J Reg Dev Plan"},{"key":"pone.0341459.ref013","volume-title":"An introduction to categorical data analysis","author":"MD Begg","year":"2007","edition":"2"},{"issue":"4","key":"pone.0341459.ref014","doi-asserted-by":"crossref","first-page":"556","DOI":"10.1177\/1536867X1201100404","article-title":"Mvdcmp: Multivariate Decomposition for Nonlinear Response Models","volume":"11","author":"DA Powers","year":"2011","journal-title":"The Stata Journal"},{"key":"pone.0341459.ref015","unstructured":"Powers DA, Pullum TW. Multivariate Decomposition for Nonlinear Models. Present Popul Assoc Am Annu Meet [Internet]. 2006:1\u201322. Available from: http:\/\/paa2006.princeton.edu\/papers\/60788"},{"key":"pone.0341459.ref016","unstructured":"StataCorp. Stata User Guide. 2021. p. 429."},{"key":"pone.0341459.ref017","doi-asserted-by":"crossref","unstructured":"Sarkar A, Roy D, Nongpiur A. Original Article A population \u2011 based study on tobacco consumption in urban slums: Its prevalence, pattern, and determinants. 2019;892\u20138.","DOI":"10.4103\/jfmpc.jfmpc_42_19"},{"key":"pone.0341459.ref018","doi-asserted-by":"crossref","first-page":"100053","DOI":"10.1016\/j.hpopen.2021.100053","article-title":"Tobacco control policies in India were unable to address inequities in Tobacco-related harm","volume":"2","author":"R Ruhil","year":"2021","journal-title":"Health Policy Open"},{"issue":"7","key":"pone.0341459.ref019","doi-asserted-by":"crossref","DOI":"10.1136\/bmjgh-2020-002367","article-title":"Smokeless tobacco control in India: policy review and lessons for high-burden countries","volume":"5","author":"A Yadav","year":"2020","journal-title":"BMJ Glob Health"},{"issue":"4","key":"pone.0341459.ref020","article-title":"Prevalence of tobacco consumption among the Northeast population of India: A systematic review and meta-analysis","volume":"8","author":"K Singal","year":"2023","journal-title":"Int J Noncommunicable Dis [Internet]"},{"issue":"1","key":"pone.0341459.ref021","first-page":"2020","article-title":"Why do the youths in northeast India use tobacco?","volume":"2017","author":"L Ladusingh","year":"2017","journal-title":"J Environ Public Health"},{"key":"pone.0341459.ref022","doi-asserted-by":"crossref","first-page":"48","DOI":"10.1016\/j.ypmed.2018.12.010","article-title":"Association between marital status and cigarette smoking: Variation by race and ethnicity","volume":"119","author":"MW Ramsey","year":"2019","journal-title":"Prev Med"},{"key":"pone.0341459.ref023","doi-asserted-by":"crossref","DOI":"10.1177\/1179916118759289","article-title":"Assessment of Tobacco Consumption and Control in India","volume":"9","author":"P Mohan","year":"2018","journal-title":"Indian Journal of Clinical Medicine"},{"issue":"1","key":"pone.0341459.ref024","doi-asserted-by":"crossref","first-page":"383","DOI":"10.1186\/s12889-021-10338-2","article-title":"Development of multifactor index for assessing quality of life of a tribal population of India: multilevel analysis approach","volume":"21","author":"M Bagavandas","year":"2021","journal-title":"BMC Public Health"},{"key":"pone.0341459.ref025","unstructured":"Bhadra A. Mass media usage and exposure of Sabar tribal community: A study abstract. 2023."},{"key":"pone.0341459.ref026","doi-asserted-by":"crossref","first-page":"390","DOI":"10.1186\/1471-2458-12-390","article-title":"\u201cHealth divide\u201d between indigenous and non-indigenous populations in Kerala, India: population based study","volume":"12","author":"S Haddad","year":"2012","journal-title":"BMC Public Health"},{"key":"pone.0341459.ref027","doi-asserted-by":"crossref","first-page":"89","DOI":"10.31557\/APJCP.2021.22.S2.89","article-title":"Tobacco Advertising, Promotion and Sponsorship in India and Indonesia: Present Regime and the Way Forward","volume":"22","author":"S Chandra","year":"2021","journal-title":"Asian Pac J Cancer Prev"},{"key":"pone.0341459.ref028","doi-asserted-by":"crossref","first-page":"101257","DOI":"10.1016\/j.ssmph.2022.101257","article-title":"Social desirability and under-reporting of smokeless tobacco use among reproductive age women: Evidence from National Family Health Survey","volume":"19","author":"PK Singh","year":"2022","journal-title":"SSM Popul Health"},{"issue":"2","key":"pone.0341459.ref029","doi-asserted-by":"crossref","first-page":"389","DOI":"10.31557\/APJCP.2022.23.2.389","article-title":"Smokeless Tobacco Use among Pregnant Women in India: The Tale of Two Nationally Representative Surveys","volume":"23","author":"PK Singh","year":"2022","journal-title":"Asian Pac J Cancer Prev"},{"issue":"1","key":"pone.0341459.ref030","first-page":"1","article-title":"Socioeconomic inequalities in tobacco cessation among Indians above 15 years of age from 2009 to 2017: evidence from the Global Adult Tobacco Survey (GATS","volume":"22","author":"R Shaikh","year":"2022","journal-title":"). BMC Public Health [Internet]"},{"issue":"10","key":"pone.0341459.ref031","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0308748","article-title":"Trend and determinants of tobacco use among Indian males over a 22-year period (1998-2021) using nationally representative data","volume":"19","author":"S Gupta","year":"2024","journal-title":"PLoS One"},{"issue":"1","key":"pone.0341459.ref032","doi-asserted-by":"crossref","first-page":"26","DOI":"10.1136\/tobaccocontrol-2016-053266","article-title":"Educational and wealth inequalities in tobacco use among men and women in 54 low-income and middle-income countries","volume":"27","author":"CT Sreeramareddy","year":"2018","journal-title":"Tob Control"},{"key":"pone.0341459.ref033","article-title":"Tobacco usage in India: A meta\u2010analysis of evidence drawn from regi","author":"P Pahari","year":"2023","journal-title":"Tropical Med Int Health"},{"issue":"3","key":"pone.0341459.ref034","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pgph.0002999","article-title":"Prevalence, regional patterns and socio-demographic factors associated with poly-tobacco use in India: A secondary data analysis","volume":"4","author":"P Bantwal","year":"2024","journal-title":"PLOS Glob Public Health"},{"key":"pone.0341459.ref035","doi-asserted-by":"crossref","first-page":"1358834","DOI":"10.3389\/fpubh.2024.1358834","article-title":"Is India on a path to reduce the tobacco industry\u2019s influence in tobacco control? Insights from the Global Tobacco Industry Interference Index (2019-2023)","volume":"12","author":"S Goel","year":"2024","journal-title":"Front Public Heal"},{"key":"pone.0341459.ref036","unstructured":"Ministry of Health and Family Welfare, Government of India. Guidelines for Tobacco Free Educational Institution (Revised). 2019;1\u201319. Available from: https:\/\/ntcp.mohfw.gov.in\/assets\/document\/TEFI-Guidelines.pdf"},{"key":"pone.0341459.ref037","unstructured":"national_tobacco_control_guideline.pdf"}],"container-title":["PLOS One"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0341459","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,2,11]],"date-time":"2026-02-11T18:45:24Z","timestamp":1770835524000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0341459"}},"subtitle":[],"editor":[{"given":"Rajesh","family":"Raushan","sequence":"first","affiliation":[],"role":[{"role":"editor","vocabulary":"crossref"}]}],"short-title":[],"issued":{"date-parts":[[2026,2,11]]},"references-count":37,"journal-issue":{"issue":"2","published-online":{"date-parts":[[2026,2,11]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pone.0341459","relation":{},"ISSN":["1932-6203"],"issn-type":[{"value":"1932-6203","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,2,11]]}}}