Patterns of tobacco use and tuberculosis prevalence among adults from states with the highest HIV prevalence in India

Background: Previous studies have demonstrated that tobacco use is an important contributor to fatal and non-fatal tuberculosis (TB). Smoking, which increases the incidence of clinical TB, is a cause of half the male TB deaths in India. TB is a raging infectious disease made more serious and widespread by the epidemic of HIV/AIDS. Our study therefore aimed to assess tobacco use prevalence among adults with self-reported TB from states with the highest HIV prevalence in India. Methods: Secondary data analysis from a population-based cross-sectional survey of men and women from Andhra Pradesh, Karnataka, Maharashtra, and Manipur (states with the highest HIV prevalence in India). The 4-states subsample is part of the data from the India's third National Family Health Survey (NFHS-3, 2005-2006). Results: The total sample population for the 4 states was 63,771, of whom 18,170 (28.5%) were tobacco users. Among those suffering from TB, 51.2% were current tobacco users (p<0.001). The prevalence of tobacco use was much higher in men compared to women who self-reported TB (67.1% vs. 28.4%), p<0.001. Among individuals self-reporting TB, 25.4% smoked tobacco and 60.9% used smokeless tobacco (overlapping use). Conclusions: If this population continues to use tobacco, the prevalence of TB is likely to continue to rise in a dramatic and devastating manner, especially if HIV risk is also considered. Understanding the characteristics of tobacco use among TB patients and the associated socio-cultural context in Andhra Pradesh, Karnataka, Maharashtra, and Manipur is critical for developing effective tobacco prevention and control programs.