Introduction:
Smokeless tobacco (SLT) use is a major concern in the South East Asian region, especially India. Indian smokeless products have been reported to be more carcinogenic. The high prevalence of SLT use is generally attributed to ignorance of its detrimental effects on health, low cost and in some instances, religious practices. Hence, socio-demographic factors have a major influence on the use and awareness of dangers from SLT use.

Objectives:
To assess the influence of socio-demographic factors on smokeless tobacco use and its predictors in India.

Methods:
Data from the Global Adult Tobacco Survey-India (GATS-India) 2016–17 was used for the study. GATS is a nationally representative household survey using a standard core questionnaire, sample design, and data collection and management procedures. GATS India was conducted in 2017 using multistage stratified cluster sampling. The sample size was 84,047 selected households. Independent variables were gender, area of residence, education level, occupation, religion and marital status. Dependent variables were the prevalence and patterns, knowledge and perceptions of use of smokeless tobacco. Data was analysed using appropriate statistical tests using SPSS software.

Results:
A total of 74,037 completed individual interviews were obtained. Current use of SLT showed significant variation by gender (male > females), area of residence (rural > urban) and education (Illiterate > literate) [p<0.001]. Mean age of initiation of SLT was significantly higher among males, the urban population and illiterates [p<0.001]. Attempts at quitting using various methods was very low [0.4-4.7]. Other tobacco product use was comparatively higher among Christians and Muslims [p<0.001]. Knowledge regarding harmful effects of smokeless tobacco, especially oral cancer, also showed a socio-demographic gradient.

Conclusion(s):
A socio-demographic gradient exists with regard to SLT use and its predictors in India. Low quit attempts points to the poor acknowledgement of SLT as a health hazard. Tobacco control strategies need to be tailored to an understanding this gradient.