A Systematic Review of the Risk and Protective Factors of Tobacco Use among South Indian Adults

Monica Daniel1, *
, Eslavath Rajkumar1
, Allen Joshua George2
, Romate John1

1 Department of Psychology, Central University of Karnataka, Kalaburagi, India
2 Indian Institute of Management, Pundag, Ranchi, Jharkhand, India

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Creative Commons License
© 2022 Daniel et al.

open-access license: This is an open access article distributed under the terms of the Creative Commons Attribution 4.0 International Public License (CC-BY 4.0), a copy of which is available at: This license permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

* Address correspondence to this author at the Department of Psychology, School of Social and Behavioural Sciences, Central University of Karnataka, Kalaburagi, Karnataka, India; E-mail:



India is facing a crucial health burden due to the incremental rise in the prevalence of tobacco use and associated diseases. Sociocultural factors largely influence tobacco use behaviour. Hence, documenting the risk and protective factors associated with tobacco use among the South Indian population helps develop context-based interventions and policies to reduce tobacco-related issues.


This systematic review aims to synthesise the available literature evidence on the risk factors contributing to tobacco use and the protective factors safeguarding against this health risk behaviour among South Indian adults.


The primary author conducted a PRISMA-compliant systematic search using five databases: PubMed, Scopus, Web of Science, Wiley Online Library, and Science Direct from the inception to June 23, 2021. A manual search was also done in Google Scholar to find pertinent publications. 13 articles that met the review's inclusion criteria were selected from the 5063 articles that were initially found after a thorough screening process and suitable quality assessment. According to the socio-ecological model, the risk and protective factors identified were divided into five levels: intrapersonal, interpersonal, organisational, community, and public.


From the included studies, the major risk factors found were stress, low perceived health effect, low income, peer influence, nature of the occupation, lack of awareness about health effects due to community marginalization, community misconception of positive aspects of tobacco use and ease of availability in the market. The major protective factors identified were awareness, perceived harm to social image, familial support, community-based health education, exposure to tobacco warning labels and government initiatives of tobacco control.


The multi-level factors identified from the current review findings reveal the need for population and context-specific interventions as well as the tobacco control policies to be developed in the near future. Interventions tailored to address the risk factors and incorporate the protective factors identified would benefit the South Indian community in tackling this health burden.

Keywords: Tobacco use, Risk factors, Protective factors, Socio-Ecological framework, Health effect, Stress.