BACKGROUND: Tobacco use among young men (aged 15–24 years) is alarmingly high, with two-fifths of men consuming tobacco, and one-fifth of these being from this younger age group. While prior studies have focused on single-unit level variations in tobacco consumption, these fail to capture the complex within- and between-unit variations across different geographical levels. This study aims to analyze the extent of spatial heterogeneities at the community, district, and state levels in tobacco consumption among younger men.
METHODS: Data from 31070 young men (aged 15–24 years) sampled in the National Family Health Survey (NFHS-5, 2019–21) were analyzed. These individuals represent 25155 households, 8526 communities, and 707 districts across 36 states and Union Territories (UTs). Multi-level regression models were employed to estimate variations in the consumption of smoked and smokeless tobacco. Robustness checks were conducted by controlling for individual characteristics.
RESULTS: Overall, 22.5% of young men consumed some form of tobacco, with higher prevalence in rural areas (25.1%). Among these, 17.8% used smokeless tobacco. Adjusted models revealed that the largest variance partitioning coefficient (VPC) was attributed to community (57.5%) for any tobacco use, followed by states (26.5%) and districts (15.9%). For smoked tobacco, community accounted for 58.2% of the variation, states 30.2%, and districts 17.8%. In smokeless tobacco use, states exhibited the highest VPC (53.1%), followed by community (34.4%) and districts (12.5%). Similar patterns were observed among rural young men. State-specific analyses confirmed the predominance of community -level variation in most states.
CONCLUSIONS: Community exhibited the highest contribution to variation in overall tobacco consumption, with states playing a significant role in smokeless tobacco use. These findings emphasize the need for targeted interventions at the community level, particularly in rural areas, to address the factors driving tobacco consumption among young men.