Tobacco Use Among Tribal Communities in India: A Systematic Review and Meta-Analysis of Prevalence Studies

Tribal populations in India face multiple health challenges, including high tobacco use. However, national-level estimates specific to tribal communities are lacking. This systematic review and meta-analysis assessed the prevalence of tobacco use among tribal populations in India, disaggregated by gender and type of tobacco product. Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidelines, four databases, PubMed, Embase, Scopus, and Web of Science, were searched up to 31 January 2024. Studies reporting tobacco use among tribal populations in India were included. Meta-analysis was performed using a random-effects model. Subgroup analyses were conducted by gender and tobacco type. Heterogeneity was assessed using the I-squared (I²) statistic. Publication bias was assessed using the deviation from ordinary least squares (OLS) regression line (DOI) plots and the Luis Furuya-Kanamori (LFK) index. Thirty-nine studies involving 56,883 tribal individuals were included. The pooled prevalence of tobacco use was 60% (95% confidence interval (CI): 49%-70%; I² = 99.6%). Among male individuals, prevalence was 66% (95% CI: 42%-83%; I² = 99.2%), and among female individuals, it was 42% (95% CI: 22%-66%; I² = 99.6%). The prevalence of smokeless tobacco use was 45% (95% CI: 30%-62%) versus 20% for smoked tobacco (95% CI: 14%-27%). Nine studies lacked separate data on smoked and smokeless forms. The LFK index score of 0 indicated no asymmetry in the DOI plot, suggesting an absence of publication bias among the included studies. The majority of studies demonstrated a low risk of selection bias (78.5%), whereas fewer studies showed a low risk of information bias (57.1%) and reporting bias (53.5%). Tobacco use among tribal populations in India is alarmingly high, especially among men and for smokeless products. These findings warrant urgent, culturally appropriate public health interventions.