Understanding smokeless tobacco use among adults in rural areas

What is shaping tobacco

Tobacco research sits at the meeting point of regulation, public health and farm livelihoods. Every study we take on in this sector follows strict ethical guidelines and focuses on compliance, awareness, livelihoods and cessation.

• Point-of-sale and packaging rules are tightly regulated
• Public-health programmes track awareness and cessation
• Farm households weigh alternative crops and livelihoods

A public-health research consortium, working in Bihar, Uttar Pradesh & Odisha. Client identity is withheld to protect confidentiality.

Organisation

A public-health research consortium

Sector

Tobacco

Team engaged

Market Research

Services

Quantitative research, Offline data collection (CAPI), Qualitative research

Smokeless tobacco use was widespread, but the consortium lacked recent data on usage patterns, awareness of health risks and interest in quitting, to design a community programme.

• Deliver on the brief: understanding smokeless tobacco use among adults in rural areas.
• Measure how widespread each pattern is, and explain the reasons behind it.
• Give the client evidence it can act on within 12 weeks.

Scope: 4,000 adults, 40 interviews.

Audiences we typically reach in tobacco

Retailers and point-of-sale ownersTobacco farmersPublic-health programme teamsAdults trying to quitRegulators and enforcement officials

Coverage: Bihar, Uttar Pradesh & Odisha. Market: India.

• India

A mixed-method design: structured research measured how widespread each pattern was, and qualitative conversations explained why.

1. 1Brief
2. 2Household survey
3. 3In-depth interviews
4. 4Insight

We conducted interviews in private settings with careful consent procedures, using sensitive question design and same-gender interviewers where appropriate. In-depth interviews explored social norms and attempts to quit.

Quantitative researchOffline data collection (CAPI)Qualitative research

• Respondents were selected across Bihar, Uttar Pradesh & Odisha using quotas set in advance for each location and respondent type, so no single area or group dominated.
• Qualitative participants were recruited purposively to cover the full range of experiences that mattered, rather than for statistical representation.

adults

4,000

interviews

40

• Trained local-language interviewers conducted interviews in person on tablets (CAPI), with time and location recorded for every interview.
• Interviews and discussions were led by experienced moderators using a guide agreed with the client.

• Back-checks on a share of completed interviews
• Time and location checks on field interviews
• Supervisor accompaniment in the field
• Recordings and transcripts for every session
• Re-screening of qualitative recruits
• Logic and range checks on the final data
• Work carried out under our ISO 20252 quality procedures

• Cross-tabulation by key groups and locations
• Significance testing on the differences that mattered
• Thematic coding of interviews and discussions
• Journey and decision mapping

• Awareness of oral cancer risks was moderate, but few users knew where to get help quitting.

Privacy and trusted interviewers are critical for honest answers on stigmatised behaviours.

• Build on the core insight: privacy and trusted interviewers are critical for honest answers on stigmatised behaviours.
• Focus effort where the evidence was strongest: awareness of oral cancer risks was moderate, but few users knew where to get help quitting.
• Re-measure after the changes to confirm the effect.

• The consortium focused its programme on community health workers and quit support at primary health centres.

What changed in the business as a result of the work. Impact is described qualitatively.

• Insight report and management presentation
• Cleaned data file and data tables
• Interview summaries and key verbatims

• Repeat the measure after changes are in place to track progress.
• A natural follow-on question: how aware are people of health warnings?