A Comparative Analysis of Tobacco and Alcohol Consumption Patterns Underlying Hypertension Prevalence Across Indian Women: Evidence from NFHS-5

doi:10.21203/rs.3.rs-4372899/v1

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A Comparative Analysis of Tobacco and Alcohol Consumption Patterns Underlying Hypertension Prevalence Across Indian Women: Evidence from NFHS-5

https://doi.org/10.21203/rs.3.rs-4372899/v1

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Background

The rise of hypertension among women aged 15–49 in India poses a significant public health challenge. To gain a better understanding of this issue, this study explores the prevalence of hypertension and its potential correlation with tobacco and alcohol use among women in the reproductive age group. By utilizing data from India's National Family Health Survey 5 (NFHS-5), the study aims to test the hypothesis that there is a link between hypertension and alcohol and tobacco consumption.

Methodology:

This study employs a descriptive approach and utilizes a stratified two-stage sample from NFHS 5 rural and urban, with a total of 724,115 women included in the analysis. Using binomial logistic regression, was used to examine the association between hypertension and individual, household, and behavioral factors.

Results

Overall, 4.6% of women are affected by hypertension. The study also revealed that 6.2%, 1.9%, and 7.7% of women respectively, reported using tobacco, alcohol, and both substances simultaneously. Further analysis showed that those who used tobacco (4.9%) and alcohol (6.0%) had a higher prevalence of hypertension compared to non-users (4.6%). The highest occurrence of hypertension was observed among those who used both substances (5.1%). This aligns with the results of adjusted logistic regression, which confirmed that tobacco use (OR 1.073), alcohol use (OR 1.325), and dual-use (OR 1.129) were all significantly linked to a higher likelihood of developing hypertension.

Conclusion

In India, there is a concerning link between hypertension and the consumption of tobacco and alcohol, particularly when used together, among young women. This highlights the need for immediate and widespread action to reduce the uptake of these substances. Policies that limit the advertising and availability of tobacco and alcohol should be implemented, alongside educational initiatives that address the dangers of hypertension. Additionally, improving access to health services for screening and treatment is crucial in addressing this issue.

hypertension

tobacco consumption

alcohol consumption

women's health

National Family Health Survey 5

India

Hypertension (HTN), most commonly referred to as high blood pressure, is a significant global health concern, and India is no exception to this growing issue. It is a chronic condition characterized by elevated blood pressure levels, potentially leading to severe health complications if not properly managed. HTN, often referred to as the “silent killer” because it may show no symptoms, wreaks havoc on the cardiovascular system, underscoring the urgency of understanding and addressing its underlying causes.

As per the World Health Organization (WHO), approximately 1.3 billion people worldwide had hypertension in 2019, suggesting a significant impact on Global public health. Factors such as age, family history, lifestyle choices, sedentary habits, an unhealthy diet, excessive alcohol consumption, and use of tobacco provide to the development of hypertension, affecting both mortality rates and healthcare costs on a global scale. [1]

In the Indian context, the Global Burden of Disease (GBD) Study emphasized hypertension as the leading cause of disease burden in 2015, resulting in millions of disability-adjusted life years and a considerable number of deaths. [2]

The Indian Council of Medical Research-India Diabetes (ICMR-INDIAB) further emphasized a higher prevalence of high blood pressure among women, ranging from 23–36% across different regions. [3]

In the last 25 years, hypertension has become a health challenge for women in India during their reproductive years (15–49 years), affecting 1 in 4 individuals i.e., 25% of the population. This change in health patterns calls for a closer look at the factors responsible for the surge among young women, who were previously believed to be less susceptible to high blood pressure. [4]

Multiple factors lead to this surge, including changing eating habits and the emergence of substance consumption, reflecting evolving lifestyles. However, knowledge gaps continue to exist regarding specific risk factors and their correlations concerning hypertension diagnosis, leaving room for further understanding and research. Untreated Hypertension affects not only personal health but also has consequences on inter-generational health which may include increased risk of pre-eclampsia and low birth weight in infants.

Global usage of tobacco encompassing both smoking and smokeless forms is widespread. Approximately 29% of the Indian population partake in tobacco consumption with a higher prevalence of smokeless tobacco. India holds a preeminent position in both the production and consumption of tobacco underlining the need to address the associated health risks preferably hypertension in women. [5]

Consumption of Alcohol in India is a major public health concern leading to millions of fatalities every year Globally. The global disease burden is significantly increased by the detrimental impact of alcohol use. With the emergence of a growing drinking culture in India, there is an escalation in alcohol consumption, reflecting the evolution of lifestyles. [6]

The purpose of this study is to give an analysis of alcohol and cigarette smoking and their link with hypertension in women in India. This study uses data from the National Family Health Survey (NFHS 5) to shed light on the complex interaction of sociodemographic factors leading to the rising prevalence of hypertension among Indian women. Understanding these complexities is crucial for developing targeted interventions and public health programs in response to rising hypertension incidence.

LITERATURE REVIEW

Barik et al. (2015) conducted a cross-sectional study to determine the socioeconomic factors associated with tobacco consumption using data from Birbhum Population Project (BIRPOP), West Bengal. The study, which included 29,783 people over the age of 15, showed gender trends in tobacco use, with smokeless tobacco being more popular among women. The study also identified education, employment status and wealth as factors that influence tobacco consumption. [7]

In a cross-sectional study, Yadav et al. (2018) explored the relationship between sociodemographic factors, smoking, and the prevalence of hypertension in urban and rural adults. With a sample of 5,000 participants, the study identified a significant association between age, education level, occupation and hypertension. Smoking has emerged as a modifiable risk factor influencing hypertension, highlighting the importance of tailoring interventions based on demographic characteristics. [8]

Rani et al. (2020) conducted a longitudinal study on the impact of alcohol consumption on blood pressure trends in middle-aged women in India. Using a group of 2,500 women over a five-year period, the study found a positive correlation between alcohol consumption and the development of hypertension. These findings demonstrate the need for targeted public health initiatives to address the risks of alcohol-related hypertension in this demographic. [9]

Verma et al. (2016), Verma and colleagues (2016) implemented a community-based intervention to reduce tobacco and alcohol use among rural Indian adolescents. The study demonstrated significant reductions in initiation rates, demonstrating the effectiveness of community-based strategies to reduce substance use in target populations. Patel et al. (2018) conducted a survey on the prevalence of dual consumption of tobacco and alcohol and its impact on hypertension in India. The study identified a higher risk of hypertension in people who used both substances, highlighting the importance of comprehensive interventions to counteract the synergistic effects of tobacco and alcohol. [10]

Mishra (2022) studied the interaction between smoking, alcohol consumption and non-communicable diseases (NCDs) in Indian women, using NFHS 4 data. The study found a significant contribution of tobacco and alcohol on NCD incidence, emphasizing the need for targeted interventions. Socio- demographic factors such as education, marital status, hormonal changes and socioeconomic conditions also play a role in the development of non-communicable diseases in women. [11]

Conducting a cross-sectional study among university students in Fiji, Kumar and Batra (2022) investigated knowledge and awareness of non-communicable diseases (NCDs) and risk factors their relevance. The study showed higher awareness among female students and identified teachers as the main source of information. Differences in cognitive levels across years of study were observed, with second- and third-year students' awareness being higher than that of first-year students.[12]

Jain and colleagues (2017) conducted a qualitative study exploring the social and cultural factors that influence tobacco and alcohol use among Indian women. These findings highlight the need for culturally sensitive interventions to address substance use that recognize the nuanced factors that shape women's smoking and drinking habits. [13]

Arora et al. (2019) studied the role of urbanization in changing tobacco and alcohol consumption habits of young people in urban cities. Research shows higher prevalence in urban areas, suggesting contextual influence on substance use. Understanding the impact of urbanization can guide appropriate interventions in urban areas. [14]

Pimenta (2012) predicted an increase in the global prevalence of hypertension, especially in women, using data from the National Health and Nutrition Examination Survey (NHANES).Research has found many different factors contribute to high blood pressure and cardiovascular disorders in women, including the use of birth control pills, hormone replacement therapy, pregnancy and menopause.[15]

Ramakrishan et al. (2019) conducted a national survey across 24 states and union territories of India to determine the prevalence of hypertension in adults. The study including 180,335 participants found an overall prevalence of hypertension of 30.7%, with notable differences between genders. The study also highlights the need to improve awareness, treatment and control of hypertension, noting disparities between rural and urban areas. [16]

Singh et al. (2017) conducted a community-based cross-sectional study in urban Varanasi to assess the prevalence of hypertension and associated factors among people aged 25–64 years. With a sample size of 640 people, the study showed gender disparities, noting a higher rate of isolated systolic and diastolic hypertension in men. Factors such as age, marital status, occupation, education level, smoking, physical activity and BMI contribute significantly to hypertension, with a higher prevalence observed in the urban population compared to rural areas. [17]

Gupta et al. (2012) conducted a demographic study with women between 35 and 70 years old in urban and rural areas. Research has identified predictors of hypertension including urban location, higher literacy levels, high-fat diet, low fiber intake, obesity, and trunk obesity. Research highlights the importance of awareness, therapy and control, with rural areas struggling to achieve these goals.[18]

In a systematic review and meta-analysis, Anchala et al. (2014) assessed the prevalence, awareness and control of hypertension in India. The study using data from Medline, Scopus and Web of Science found an overall prevalence of hypertension of 29.8%. Disparities between rural and urban areas have been observed, with higher disease prevalence, treatment, and control in urban populations. The study highlights the urgent need for targeted interventions to increase awareness and control of hypertension in urban and rural areas. [19]

Datasource

The data for this study were derived from the National Family Health Survey 5, the Indian version of the Demographic Health Survey (DHS) conducted in 2019-20. NFHS 5 provided information on various population parameters, health indicators and nutrition from 28 states, 8 union territories, and 707 districts. NFHS 5 is the nationwide community-based survey in India to provide estimates on selected biomarkers such as blood pressure and blood sugar level. BP was measured for eligible women aged 15–49 and (in the state module subsample of households only), using an Omron BP Monitor to determine the prevalence of hypertension. BP measurements for each respondent were taken three times with an interval of 5 minutes between two consecutive readings.

This is an exploratory study that will analyse the prevalence of hypertension and its association with tobacco and alcohol consumption among women in the reproductive age group 15–49 years based on the hypothesis that there is no association between hypertension and alcohol and tobacco consumption. An alternate hypothesis will be there is an association between hypertension and alcohol and tobacco consumption.

Sampling technique and Study population

The NFHS 5 sample was a stratified two-stage sample, with primary sampling units (PSUs) selected from villages in rural areas and Census Enumeration Blocks (CEBs) in urban areas. The sample size was determined based on the need to produce indicators at the district, state/union territory, and national levels. NFHS survey employed computer-assisted personal interviewing (CAPI) to collect data.

All women between the age group 15–49 years who stayed over the night before the survey in the selected households were included for data collection. As per NFHS-5, there were 747,176 eligible women aged 15–49 were identified for individual women’s interviews. Interviews were completed with 724,115 women, for a response rate of 97 percent. A total of 724,115 women were included in this study for analysis.

Outcome Variable:

The outcome variable in this study was the presence of hypertension among women in the reproductive age group 15–49 years. An individual is classified as having hypertension if the systolic blood pressure level ≥ 140 mmHg, or diastolic blood pressure ≥ 90 mmHg. In NFHS-5 blood pressure (both diastolic and systolic) of respondents was measured three times following a 5-minute gap for the second and third reading and has considered the average of the last two readings as suggested in the literature which helps in avoiding upward bias due to anxiety or nervousness while taking the very first reading. In this study the variable for hypertension was generated using a question “Currently have hypertension”? If the female respondent has blood pressure ≥ 140/90, this was coded as yes, otherwise no.

Explanatory variable:

The information related to socio-demographic variables including the age of the participants, education status, marital status, BMI, working status, wealth status, religion, place of residence, and other variables like consuming tobacco, alcohol consumption, and both alcohol and tobacco consumption. Data were extracted from the Demography Health Survey (DHS) conducted in 2019-20.

Individual Characteristics:

Individual characteristics that included age were grouped into 15–24 years, 25–34 years, and 35–49 years. Educational status was categorized as not educated, primary, secondary, and higher. Marital status coded as never married, currently married and others (divorced, separated and widowed), Body mass index (BMI)was recoded as underweight (less than 18.5), normal (18.5–24.9), overweight (25–29.9) and obese (30 and above). Working status coded as No and Yes.

Household Characteristics:

It includes variable wealth status that recoded as poorest, poorer, middle, richer, and richest based on the wealth index. Households were assigned scores under the wealth index based on the quantity and kind of things they own, from a television to a bicycle or car, and household characteristics like flooring material, toilet facilities, and sources of drinking water. In NFHS 5, Principal component analysis is used to calculate these scores. To produce the national wealth quintiles, each normal (de jure) household member is given a household score. Each household member is then ranked according to their score, and the distribution is then split into five equal categories, each comprising 20% of the population.

Religion was recoded as Hindu, Muslim, Christian, Sikh and Buddhist, Jain etc were categories as others. Caste was recoded as schedule Caste, schedule tribe, Other backward class, “Don’t know”. The place of residence was coded as urban and rural.

Behavioral Characteristics

Cigarettes, bidis, cigars, hookah, gutkha/paan masala, paan, and khaini are tobacco products commonly consumed in India. The variable 'smoke tobacco' was generated using the question “Do you currently smoke or use tobacco in any other form?” All the responses were recoded as no and yes. And if the female respondents smoked any of these products, they were coded as yes and otherwise no. In this study, passive smoking, type and duration of smoking are not considered.

Women who consume alcohol were coded as no and yes. The variable ‘consume alcohol’ was generated using the question "Do you currently drink alcohol?" the response was coded as no and yes. In this study duration and quantity of alcohol consumption are not considered.

Statistical analysis:

Secondary data from the Demographic Health Survey (DHS) were used for analysis. The data were processed through SPSS version 23. The analysis was done concerning the objective of the study. Descriptive statistical measures for different variables such as age, education, religion, residence, wealth index, and behavioral characteristics, etc have been computed. Cross-tabulation was used to analyze the percentage of tobacco and alcohol consumption. The Chi-square test was used to find the significant level at 95% Confidence Interval, to estimate the prevalence of hypertension among women by background characteristics. Additionally, binary logistic regression was used for modeling the association between dichotomous variable hypertension and individual, household and behavioral factors using the following using,

Link function: Log [P (Y)/1-P (Y)] = β₀ + β₁X₁ + β₂X_2……β_nX_n

where P (Y) is the likelihood of an individual being hypertensive, β0 is the log odds of the intercept, and β1, …, β_n are the coefficient for their corresponding predictor variables (X1, …, X_n).

Odds ratio with 95% confidence interval were calculated. A p-value ≤ 0.05 is considered statistically significant and will reject the Null hypothesis and lead to acceptance of the Alternative hypothesis. The overall results of this study have been presented in tabular form under different headings.

Table 1

Socio-demographic profile of women aged 15–49 years in India, NFHS 5
Background Characteristics	Frequency	Percentage
Individual Characteristics
Age(in years)
15–24	241104	33.3
25–34	219443	30.3
35–49	263483	36.4
Educational Status
Not Educated	167304	23.1
Primary	84983	11.7
Secondary	370012	51.1
Higher	101816	14.1
Marital Status
Never Married	181285	25.0
Currently Married	512408	70.8
Others	30422	4.2
BMI
Underweight	119713	16.5
Normal	416711	57.5
Overweight	115538	16.0
Obese	38178	5.3
Working Status
No	80443	11.1
Yes	28342	3.9
Household Characteristics
Wealth Status
Poorest	149844	20.7
Poorer	160340	22.1
Middle	151505	20.9
Richer	139607	19.3
Richest	122819	17.0
Religion
Hindu	546007	75.4
Muslim	90729	12.5
Sikh	16200	2.2
Christians	52146	7.2
Others	10389	1.4
Caste
Scheduled Caste	583167	80.5
Scheduled Tribe	101914	14.1
Other Backward Class	34661	4.8
Don’t Know	4373	0.6
Place of Residence
Urban	179535	24.8
Rural	544580	75.2
Behavioral Characteristics
Consume tobacco
No	678949	93.8
Yes	45166	6.2
Alcohol Consumption
No	710587	98.1
Yes	13528	1.9
Both Alcohol & and tobacco
No*	666882	92.1
Yes	55772	7.9
*Neither alcohol nor tobacco

Table 1 shows the sociodemographic characteristics of respondents. The study findings show that the largest percentage of women (36.4%) fall within the 35–49 age range. Additionally, the majority of participants (51.1%) have completed secondary education, and 70.8% are currently married. A significant portion (57.5%) also have a normal BMI. It is worth noting that only a small fraction (3.9%) of the respondents are employed, and among them, 22.1% belong to the poorer wealth status. Furthermore, a large majority (75.2%) of the participants reside in rural areas. In terms of lifestyle, a small proportion (6.2%) reported tobacco use, while 1.9% consume alcohol, and 7.7% consume both tobacco and alcohol.

Table 2

Prevalence of tobacco and alcohol consumption in each socio-demographic group of women 15–49 years in India, NFHS 5
Background Characteristics	Tobacco (%)	Alcohol (%)	Both (Tobacco & Alcohol %)
Individual Characteristics
Age(in years)
15–24	5414 (2.2)	1735 (0.7)	7049 (2.9)
25–34	26878 (12.2)	4092 (1.9)	28954 (13.2)
35–49	12874 (4.9)	7700 (2.9)	19768 (7.5)
Educational Status
Not Educated	11374 (6.8)	6392 (3.8)	16852 (10.1)
Primary	5938 (7.0)	1756 (2.1)	7272 (8.6)
Secondary	21657 (5.9)	4334 (1.2)	24753 (6.7)
Higher	6197 (6.1)	1046 (1.0)	6895 (6.8)
Marital Status
Never Married	3986 (2.2)	3112 (1.7)	6822 (3.8)
Currently Married	36971 (7.2)	9649 (1.9)	44314 (8.6)
Others	4209 (13.8)	767 (2.5)	4636 (15.2)
BMI
Underweight	7791 (6.5)	2452 (2.0)	9805 (8.2)
Normal	27840 (6.7)	7709 (1.8)	33673 (8.1)
Overweight	6536 (5.7)	2095 (1.8)	8207 (7.1)
Obese	1639 (4.3)	705 (1.8)	2244 (5.9)
Working Status
No	4374 (5.4)	1454 (1.8)	5512 (6.9)
Yes	2825 (10.0)	654 (2.3)	3297 (11.6)
Household Characteristics
Wealth Status
Poorest	11028 (7.4)	6048 (4.0)	16022 (10.7)
Poorer	10751 (6.7)	3333 (2.1)	13308 (8.3)
Middle	9378 (6.2)	2184 (1.4)	10956 (7.2)
Richer	7930 (5.7)	1202 (0.9)	8822 (6.3)
Richest	6079 (4.9)	761 (0.6)	6664 (5.4)
Religion
Hindu	30876 (5.7)	8997 (1.6)	38352 (7.0)
Muslim	5379 (5.9)	79 (0.1)	5456 (6.0)
Sikh	801 (4.9)	2074 (4.0)	821 (5.1)
Christians	6045 (11.6)	22 (0.1)	7457 (14.3)
Others	1058 (10.2)	945 (9.1)	1695 (16.3)
Caste
Scheduled Caste	24712 (4.2)	10253 (1.8)	33559 (5.8)
Scheduled Tribe	17190 (16.9)	2245 (2.2)	18101 (17.8)
Other Backward Class	2859 (8.2)	924 (2.7)	3617 (10.4)
Don’t Know	4051 (9.3)	106 (2.4)	495 (11.3)
Place of Residence
Urban	10267 (5.7)	1654 (0.9)	11499 (6.4)
Rural	34899 (6.4)	11874 (2.2)	44273 (8.1)

Table 2 shows the prevalence of tobacco and alcohol consumption according to various socio- demographic characteristics. Notably, among women aged 25–34, the prevalence of tobacco use is higher at 12.2%, while those aged 35–49 are more likely to engage in alcohol consumption at 2.9%. Interestingly, primary education appears to be associated with a higher use of both tobacco (7.0%) and alcohol (2.1%). Furthermore, the data shows that working women have a higher likelihood of consuming both alcohol (10.0%) and tobacco (2.3%), as well as those living in rural areas, with corresponding rates of 6.4% and 2.2%. Interestingly, wealth status also plays a role, as the richest quintile displays a lower prevalence of both tobacco and alcohol use. Finally, when examining religious affiliation, it is evident that Christians have a higher prevalence of tobacco use at 11.6% compared to Hindus with 1.6%.

Table 3

Prevalence of Hypertension in each socio-demographic group of women 15–49 years in India, NFHS 5
Background Characteristics	Hypertension (%)	Chi-square	P value
Individual Characteristics
Age(in years)
15–24	3261 (1.4)	14472.13	0.000
25–34	8061 (3.7)
35–49	21817 (8.4)
Educational Status
Not Educated	9398 (5.7)	1525.309	0.000
Primary	5233 (6.2)
Secondary	15227 (4.1)
Higher	3290 (3.2)
Marital Status
Never Married	7950 (4.4)	34.928	0.000
Currently Married	23656 (4.7)
Others	1542 (5.1)
BMI
Underweight	5950 (5.0)	52.968	0.000
Normal	18650 (4.5)
Overweight	5229 (4.6)
Obese	1765 (4.7)
Working Status
No	3475 (4.5)	25.547	0.000
Yes	1429 (5.1)
Household Characteristics
Wealth Status
Poorest	4771 (3.2)	1517.008	0.000
Poorer	6511 (4.1)
Middle	6993 (4.7)
Richer	7415 (5.3)
Richest	7458 (6.1)
Religion
Hindu	23752 (4.1)	2099.198	0.000
Muslim	4456 (4.9)
Sikh	2170 (4.3)
Christians	1928 (12.0)
Others	496 (4.9)
Caste
Scheduled Caste	25865 (4.5)	273.022	0.000
Scheduled Tribe	5661 (5.6)
Other Backward Class	1422 (4.1)
Don’t Know	200 (4.6)
Place of Residence
Urban	9463 (5.3)	254.154	0.000
Rural	23685 (4.4)
Behavioural Characteristics
Tobacco Consumption
No	30954 (4.6)	9.570	0.002
Yes	2194 (4.9)
Alcohol Consumption
No	32352 (4.6)	58.101	0.000
Yes	796 (6.0)
Both tobacco and alcohol^a
No	30243 (4.6)	40.464	0.000
Yes	2820 (5.1)
a. Estimation low, missing value

Table 3 shows the prevalence of hypertension in each socio-demographic group. The prevalence of hypertension increases with advancing age, 35–49 years (8.4%). A higher proportion of women with the richest wealth index (6.1%) were hypertensive. Also Christian women have the highest proportion of hypertension (12.0%) among all other group. A higher proportion of working women (5.1%) and from urban residence (5.3%) were hypertension.

Figure 1 showing the prevalence of hypertension on the basis of behavioral characteristics. According to the study, consuming tobacco has a strong link to developing hypertension. The occurrence of hypertension is found to be 4.6% among non-users, while slightly higher at 4.9% among tobacco users (with a p-value of 0.002). Furthermore, individuals who drink alcohol have a prevalence rate of 6.0%, whereas it is only 4.6% for non-consumers (with a p-value of less than 0.001). Interestingly, individuals who indulge in both tobacco and alcohol have a significantly higher prevalence of 5.1% (with a p-value of less than 0.001) compared to those who abstain from both substances, whose prevalence remains at 4.6%.

Table 4

Binary Logistic Regression
Background Characteristics	OR	Cl (95%)	P value
Individual Characteristics
Age(in years)	2.511	2.471–2.552	0.001
Educational Status	0.825	0.816–0.833	0.000
Marital Status	1.054	1.036–1.072	0.000
BMI	0.970	0.955–0.985	0.000
Working Status	1.177	1.105–1.253	0.000
Household Characteristics
Wealth Status	1.171	1.162–1.181	0.000
Religion	1.157	1.144–1.171	0.000
Caste	1.038	1.023–1.052	0.000
Place of residence	0.820	0.800–0.840	0.000
Behavioural Charactertics
Consume tobacco	1.073	1.026–1.121	0.002
Consume alcohol	1.325	1.232–1.424	0.001
Both tobacco and alcohol	1.129	1.087–1.172	0.000

Table 4 presents the Binary Logistic Regression for women having hypertension through background characteristics. In individual characteristics, Age shows a positive association with hypertension (OR = 2.511, 95% CI: 2.471–2.552, p = 0.001). Educational status exhibits a negative association, indicating lower odds of hypertension with higher education (OR = 0.825, 95% CI: 0.816–0.833, p < 0.001). Marital status and working status also show significant positive associations with hypertension (p < 0.001). In household characteristics Wealth status, religion, caste, and place of residence display statistically significant associations with hypertension (p < 0.001).

In Behavioral Characteristics, Tobacco consumption is positively associated with hypertension (OR = 1.073, 95% CI: 1.026–1.121, p = 0.002). Also, Alcohol consumption is strongly associated with hypertension (OR = 1.325, 95% CI: 1.232–1.424, p = 0.001). Concurrent tobacco and alcohol consumption also exhibit a significant positive association with hypertension (OR = 1.129, 95% CI: 1.087–1.172, p < 0.001).

The prevalence of hypertension was found to be 4.6%, and there were significant links between hypertension and older age, higher wealth status, tobacco use, alcohol use, and the combination of both habits.

In this study, we aimed to examine the relationship between hypertension and the use of alcohol and tobacco among women aged 15–49 in India, using data from the National Family Health Survey (NFHS-5). Our key findings suggest that the consumption of tobacco, alcohol, or both at the same time is significantly linked to a higher likelihood of hypertension among Indian women.

The findings reveal that among women, the occurrence of hypertension was 4.9% in those who use tobacco, as opposed to 4.6% in non-users. Similarly, the prevalence of hypertension was 6.0% in those who consume alcohol, compared to 4.6% in non-drinkers. Notably, individuals who indulged in both tobacco and alcohol had a hypertension rate of 5.1%, while those who abstained from both substances reported a lower rate of 4.6%. Further analysis taking into account influencing factors revealed a significant positive correlation between tobacco use (OR 1.073), alcohol consumption (OR 1.325), and dual use (OR 1.129) with the likelihood of developing hypertension.

The negative association between education level and likelihood of hypertension (OR 0.825) may be attributed to greater awareness of healthy behaviors among more educated women. Higher education equips individuals with knowledge about preventative actions like healthy diets, exercise and avoiding tobacco and alcohol - all protective against high BP (Lee et al. 2011). Additionally, education enables access to better socioeconomic status, income, jobs and healthcare facilities for early screening and control of hypertension (Gupta et al. 2012). [18, 21]

The heightened odds of developing hypertension with tobacco use (OR 1.073), alcohol consumption (OR 1.325) and dual use (OR 1.129) underscores the cardiovascular damage inflicted by these substances. Both tobacco smoke and alcohol mediate oxidative stress, inflammation, insulin resistance and atherogenesis - impacting blood pressure regulation (Virdis et al. 2010). Moreover, concurrent usage has a synergistic adverse effect that compounds the hypertension risk significantly (Patel et al. 2018). [20, 22]

The positive associations between hypertension and age, marital status and working status of women likely stems from hormonal changes, pregnancy complications, caregiving stress and work-life balance challenges that amplify risk as women advance in age and familial/occupational responsibilities (Pimenta 2012; Jain et al. 2017). [13, 15]

Urban residence displayed lower likelihood of hypertension compared to rural areas, despite urban populations tending to lead more sedentary, stressful lifestyles with higher rates of obesity and substance use - known risk factors for hypertension. This disconnect is likely attributable to the substantially higher access to healthcare facilities for screening and treating high BP in cities versus rural parts with more deprived, disconnected health infrastructure (Anchala et al. 2014).

These results support previous research indicating the harmful impact of tobacco and alcohol on cardiovascular health. Revealing insight from a longitudinal study conducted by Rani et al. (2020) suggests a link between alcohol consumption and the development of hypertension among middle-aged Indian women. Additionally, studies by Mishra (2019) and Yadav et al. (2018) have also identified tobacco use as a contributing factor for hypertension in Indian adults. This analysis further reveals the combined danger of using both tobacco and alcohol, highlighting consistent findings in previous evidence from Patel et al. (2018). [8, 9, 11]

The alarming correlation between substance use and hypertension risk among young women in India is concerning in light of increasing rates of tobacco and alcohol usage in this demographic. As highlighted by Arora et al. (2019), the rapidly changing lifestyles and urbanization in India have led to shifts in consumption habits. The heightened likelihood of developing hypertension as a result of tobacco and alcohol consumption emphasizes the pressing need to address this controllable health concern. [14]

To combat the alarming rise of hypertension among women, it is crucial to implement nationwide campaigns that educate and raise awareness about the risks associated with tobacco and alcohol use. These campaigns must reach both urban and rural areas, as both demographics are affected. To support this effort, community health workers should be empowered to actively screen and provide counsel for young women in their communities. This will not only aid in early detection and management of hypertension, but also in promoting healthier lifestyle choices. In addition to community-based initiatives, it is imperative for effective laws to be enacted and enforced to restrict the marketing and availability of tobacco and alcohol. This includes comprehensive bans on advertising, mandatory pictorial health warnings on packaging, and increased taxation. Research has shown that such population-level interventions can significantly reduce consumption rates (Verma et al., 2016) [10]

Moreover, it is essential to expand screening and affordable treatment options for hypertension under India's National Programme for Prevention and Control of Cancer, Diabetes, Cardiovascular Disease, and Stroke. Encourage the adoption of healthier eating habits and increased physical activity as key preventative measures against the growing problem of overweight/obesity and its connection to hypertension. This can be achieved through regulating the production and distribution of unhealthy food options, increasing access to nutritious foods in low socioeconomic groups, and creating safe and supportive environments for physical activity. In order to develop specific interventions for young Indian women, it is important to gather ongoing data on the patterns and factors contributing to substance use among this population, as highlighted by Jain et al. (2017). Additionally, monitoring the prevalence of hypertension in different geographic areas can help to guide the allocation of resources effectively in addressing this issue.[13]

This study showed that tobacco and alcohol consumption were the major risk factors for hypertension in women. Women who consumed alcohol or tobacco had a higher likelihood of developing hypertension compared to those who did not engage in such behaviors. Research encourages to conduct of comprehensive health education campaigns targeting females to raise awareness about the risks associated with alcohol and tobacco consumption and maintaining healthy blood pressure levels. There is a need to implement and enforce strict tobacco and alcohol control policies, including restrictions on advertising, increased taxation, and banning smoking in public places. Access to healthcare services should be improved to facilitate early detection and management of hypertension. By implementing these preventive measures, we can effectively reduce the burden of hypertension and improve the overall health and well-being of women in India.

NCD

Non Communicable Diseases

Odds Ratio

Confidence Interval

NFHS

National Family Health Survey

HTN

Hypertension

GBD

Global Burden of Disease

WHO

World Health Organisation

NHANES

National Health & Nutrition Examination Survey

BIRPOP

Birham Population Project

DHS

Demographic Health Survey

CEB

Census Enumeration Block

PSU

Priamry Sampling Units

CAPI

Computer Assisted Personal Interview

Acknowledgement

We want to acknowledge Dr Samik Chowdhury for reviewing this paper and providing his valuable feedback

Author Information

Authors and Affiliations

¹Department of Public Health, School of Global Affairs, Ambedkar University, Delhi, India

Dr Shanvi Yadav

²Department of Public Health, School of Global Affairs, Ambedkar University, Delhi, India

Aamir Siddiqui

Email ID: [email protected]

Corresponding Author

Correspondence to Aamir Siddiqui

Contribution

S.Y. conceptualized the idea of the study, developed the methodology, performed data analysis, interpreted the data, prepared tables and figures, and wrote the results section. A.S. designed the study, wrote the abstract, conducted the literature review, discussed the findings, drew conclusions, and handled referencing. Both authors reviewed and approved the final manuscript.

Funding

None

Ethical approval and consent to participants

This study carried out using secondary data source which is available at DHS website. No ethical approval and consent is needed

Consent for publication

Not applicable

Competing interests

The authors declare no competing interest.

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No competing interests reported.

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A Comparative Analysis of Tobacco and Alcohol Consumption Patterns Underlying Hypertension Prevalence Across Indian Women: Evidence from NFHS-5

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INTRODUCTION

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RESULT

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