Early Initiation of Tobacco Use and its Socio-Demographic Correlates in India: Evidence From the Global Adult Tobacco Survey (GATS-2)

Background: Tobacco use is a leading cause of preventable morbidity and mortality globally, with early initiation strongly linked to lifelong dependence and adverse health outcomes. In India, socio-cultural and economic heterogeneity complicates tobacco control, particularly among youth. Understanding early initiation patterns is essential for designing age-targeted interventions. Aim: The present study aims to use GATS-2 data to estimate the age of initiation of tobacco use in India, assess the prevalence of early initiation across population subgroups, and identify its key socio-demographic and economic correlates. Methods: We analyzed data from GATS-2 (2016-17), a nationally representative cross-sectional survey in India. The sample included 7647 ever-smokers and 12 772 ever-users of smokeless tobacco aged ≥15 years. Early initiation was defined as starting tobacco use at age ≤14. Weighted bivariate and multivariate logistic regression analyses were performed using STATA v17.0. Results: Early initiation occurred in 8.0% of smokers and 10.4% of smokeless users, with over half initiating between ages 15-24. Scheduled Tribes and Muslims had higher early use, while education showed a strong protective effect; postgraduates were 87% less likely to initiate early. Students (AOR = 5.31) and the unemployed (AOR = 2.14) faced greater risk. Rural residence lowered odds for early smoking (AOR = 0.22) but increased it for smokeless use (AOR = 1.16). Females had 36% higher odds for early smokeless tobacco use. High-burden states included Sikkim, Bihar, Odisha, and Arunachal Pradesh. Conclusions: Early tobacco initiation in India is prevalent among youth, marginalized groups, and certain regions. Strengthened education, policy enforcement, and culturally tailored interventions are vital to curb long-term dependence.