Socioeconomic and Demographic Factors Patterning Smokeless Tobacco Use Behavior in Bangladesh: A Cross-Sectional Multilevel Analysis

Abstract

Background: Smokeless tobacco is also highly addictive and causes cancer of the head and neck, esophagus and pancreas, besides many oral diseases. Bangladesh is one of the most prevalent smokeless tobacco consumption countries in the world. This paper aimed to examine the socioeconomic and demographic factors patterning smokeless tobacco consumption among adults aged 15 years and above in Bangladesh using multilevel analysis. Materials and methods: A cross sectional, nationally representative sample of individuals from the Global Adult Tobacco Survey in Bangladesh (2010), which covered 9629 individuals aged 15 years and above using multi-stage stratified cluster sampling has been analyzed. Smokeless tobacco use daily was considered as outcome variable. Multilevel logistic regression analysis has been used with individuals nested within clusters. Measures of association (odds ratio) and measures of variance (intra-class correlation (ICC)) have been calculated, as well as the discriminatory accuracy by calculating the area under the ROC curve (AUC). Also the comparison between single and multilevel model has been done to investigate the necessity of multilevel effects. Results: According to the multilevel logistic regression model female use smokeless tobacco more than male (odds ratio (OR): 1.72, 95% CI: 1.39, 2.07). The use of smokeless tobacco by age was highest among older group (>46 years) than youngest group (≤24 years) (OR: 16.04, 95% CI: 12.60, 20.53). The smokeless tobacco use was highest among the least educated (no formal education) (OR=4.93, 95% CI: 3.28, 7.41) compared to highest educated (college/university completed or above) respondent. Respondents from the poorest wealth index were significantly more likely to consume smokeless tobacco (OR 1.67, 95%CI: 1.33, 2.09) compared to respondents of richest wealth index. Conclusions: There is an urgent need to curb the use of smokeless tobacco among female, less educated, older and of lowest wealth index. Tobacco control policies in Bangladesh should adopt a targeted, population-based approach to control and reduce tobacco consumption considering of socioeconomic and demographic factors to make it successful in the country. Citation: Begum M, Sultana P (2018) Socioeconomic and Demographic Factors Patterning Smokeless Tobacco Use Behavior in Bangladesh: A Cross-Sectional Multilevel Analysis. J Biom Biostat 9: 411. doi: 10.4172/2155-6180.1000411