Prevalence and Patterns of Polysubstance Use (Tobacco and Other Substances) and Associated Factors: A Cross-Sectional Analysis in a High-Risk Cohort for Oral Cancer in Varanasi, India, with a Special Focus on Young Emerging Adults

Introduction: The dearth of population-based data on polysubstance use, especially in young emerging adults, presents a critical gap in understanding public health challenges, particularly in rural India, where tobacco and oral cancer are prevalent. This study addresses this gap by investigating the prevalence and patterns of substance use, with a focus on young emerging adults (18-29 years) within a high-risk cohort for oral cancer in Varanasi, India.

Methods: The study involved a cross-sectional analysis of baseline data from 10,101 participants within a high-risk cohort in rural settings of the Varanasi district between December 2020-June 2023. This region has high rates of tobacco use and oral cancer. Polysubstance use was defined as the lifetime concurrent use of two or more substances for at least a year. The study examined the prevalence of any substance use, polysubstance use, and associated socio-demographic factors. Univariable and multivariable analyses were employed to identify significant predictors.

Results: The prevalence of any substance use in the study population was 55.7%. Tobacco use was most prevalent (94.3%), followed by areca nut (44.8%), alcohol (6.6%), and cannabis (0.8%). Among young emerging adult substance users, the prevalence of polysubstance use was 42.6%. Predictors of polysubstance use included age, male gender, employment status, and income.

Conclusion: This study offers vital insights into substance use among rural Indian communities, particularly among young adults who are at a critical juncture in their lives. The findings underscore the urgent need for evidence-based strategies to address this region's multifaceted public health challenge of polysubstance use.

Implications: Literature is scarce on population-based data for the prevalence and pattern of polysubstance (tobacco and other substances) use in India, both for the young and adult population. We studied the prevalence and pattern of substance use in a predominantly rural district of India, which reportedly has the second-highest burden of oral cancer among all Indian population-based cancer registries. We found that more than half (55.7%) of the study population used at least one substance; among them, nearly half (42.4%) used two or more substances. Tobacco use was the most prevalent form (94.3%), followed by areca nut use (44.8%), alcohol (6.6%) and cannabis (0.8%). Polysubstance use was prevalent among young emerging adult substance users. Age, male gender, employment, and income were predictors of polysubstance use. Distinct sociocultural factors shaping substance use in India necessitate research.