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\title{Smokeless Tobacco use among Male and Female in Northeast State, India}
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             \author[1]{Kh. Jitenkumar  Singh}

             \author[2]{Neeru  Singh}

             \affil[1]{  National Institute of Medical Statistics}

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\date{\small \em Received: 15 December 2015 Accepted: 31 December 2015 Published: 15 January 2016}

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\begin{abstract}
        


Smokeless tobacco has been found as harmful as smoke tobacco. Smokeless tobacco associated with the various oral diseases including mouth cancer and adverse reproductive outcome. Objective of this study is to examine the prevalence of smokeless tobacco consumption in Northeast state, India and to study the socioeconomic, demographic correlates of tobacco use in the form of smokeless tobacco only. We used the cross sectional survey DLHS-4 (2012-2013) data of northeast state, India. All men and women living in the study area, aged 15 years and above were included. Information on socio demographic characteristics and smokeless tobacco consumption was administered. Smokeless tobacco consumption was categorized as ?Current consumers? and ?non consumers?. Associations between smokeless tobacco consumption and the explanatory variables were examine using bivariate and multivariate statistical technique. 67,930 individual men and 75,799 individual women were the unit of analysis in the study. The prevalence of ?Current consumption? among men 65% and women 51% respectively. Current consumption was associated with level of education, religion, caste, occupation, residence, marital status, and age.

\end{abstract}


\keywords{cross sectional study, men, women, smokeless tobacco and Northeast state.}

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\let\tabcellsep& 	 	 		 
\section[{I. Introduction and Review of Literatures}]{I. Introduction and Review of Literatures}\par
onsumption of tobacco kills approx six million people each year moreover, it is the measure threat of disease and death \hyperref[b0]{[1,}\hyperref[b1]{2]}. Tobacco is the most important oral cavity and pharyngeal cancer risk factors. Approximately 90\% of people with mouth cancer are tobacco users. Some 7.5\% of the world's (53.9 million) deaths were attributable to tobacco use in 1998 and if same smoking patterns continue, that number will Author ? ?: National Institute of Medical Statistics, Indian Council of Medical Research, Medical Enclave, Ansari Nagar, New Delhi, India. e-mails: jitensinghkh@gmail.com, neeru.singh.stats@gmail.com rise to 10 million deaths annually by 2030 \hyperref[b2]{[3]}. Tobacco can be consumed both in smoke and smokeless form.\par
Smokeless tobacco is tobacco that is not burned; it is also known as chewing tobacco, oral tobacco, spit or spitting tobacco, dip, chew, and snuff. Harmful health effects of smokeless tobacco include: mouth, tongue, cheek, gum, and throat cancer. Smokeless tobacco also causes nicotine addiction. South Asian people consume smokeless tobacco the most. More than one third of total tobacco consumption in this region is in the form of smokeless tobacco \hyperref[b3]{[4]}\hyperref[b4]{[5]}\hyperref[b5]{[6]}. Smokeless tobacco consumption in south Asia is a major public health threat, in India (prevalence: 18.4\%), Bangladesh (32.6\%), Sri Lanka (6.9\%) and Nepal (6\%) by the estimation of WHO \hyperref[b6]{[7]}.\par
India is the second most populous country and one of the world's largest producers and consumers of tobacco. Here, tobacco is available in a variety of different types and brands e.g. bidi, gutkka, khaini, pan masala, hookah, cigarettes etc \hyperref[b2]{[3]} and also the form of consumption varies from place to place like smoke cheroot in Odisha and Andhra Pradesh, dry snuff in western part, while creamy snuff in northeast part of India. Mostly the tobacco is consumed in smokeless form in northeast states. The prevalence of tobacco consumption in India, either smoked or smokeless tobacco, in the population aged 15 year and above was 47 per cent among men and 14 per cent among women while overall prevalence was 37 percent \hyperref[b7]{[8,}\hyperref[b8]{9]}. Consumption of smokeless tobacco products in India is increasing rapidly \hyperref[b9]{[10,}\hyperref[b10]{11]}, which is showing a negative effects for both male and female. As smokeless tobacco is quite famous among women, affecting their oral morbidity and perinatal health, including premature delivery, low birth weight and shortened length \hyperref[b11]{[12]}\hyperref[b12]{[13]}\hyperref[b13]{[14]}\hyperref[b14]{[15]}\hyperref[b15]{[16]}\hyperref[b16]{[17]} In northeast states of the India, smokeless tobacco is a part of the socio cultural \hyperref[b17]{[18]}. They have different customs, food habits, life-style, diverse ethnic groups, type and pattern of tobacco consumption as compared to the rest of the country. Research have shown that in northeast states, betel quid (55.4\%), is the most popular smokeless tobacco followed by tuibur (13.1\%), gul (12.0\%) and khaini (9.1\%), Gul and tubur are primarily used by women and recent study shows that the prevalence of smokeless tobacco in northern, eastern and northeast states is 8.4\%, 31.8\% and 23.8\% \hyperref[b17]{[18]}\hyperref[b18]{[19]}\hyperref[b19]{[20]}. Betel quid is a combination of betel leaf, areca nut, and slaked lime. Like other smokeless tobacco products, betel quid and gutka are known to cause Esophageal cancer, Lip cancer, Mouth cancer, Pharynx cancer, Tongue cancer. The most harmful cancercausing substances in smokeless tobacco are tobacco-specific nitrosamines (TSNAs). TSNA levels vary by product, but the higher the level the greater the cancer risk. 
\section[{Table 1 : Prevalence of smokeless tobacco use in northeast States India by sex}]{Table 1 : Prevalence of smokeless tobacco use in northeast States India by sex}\par
Table  {\ref 1} shows the prevalence of smokeless tobacco, Meghalaya, Tripura and Mizoram was higher in women while in Arunachal Pradesh, Manipur, Nagaland and Sikkim males are consuming more smokeless tobacco in GATS (2009-2010), while in DLHS (2012-2013) Meghalaya, Manipur and Tripura have the highest prevalence of smokeless tobacco among both male and female in DLHS (2012-2013). Hence, the objective of this study is to examine the prevalence of smokeless tobacco consumption among male and female in northeast state, India and to study the socioeconomic demographic characteristics correlates with tobacco use in the form of smokeless tobacco only. 
\section[{II. Data and Methods}]{II. Data and Methods}\par
characteristics (result not shown). For computation of age-adjusted prevalence rate, we use 2011 census data, RGI, Govt. of India as the standard population structure. We computed the standard age proportion by dividing the age-specific census population by the total census population number and standardizing proportion sum to 1. Then, age-adjusted factors for 6 (six) age grouping (10 year intervals each) were used for computation of age-adjusted prevalence. Binary logistic regression was applied to measure the association and to check the net effect of factors on the current consumers for males and females. Variance inflation factor (VIF) of all the variables were computed to check collinearity prior to inclusion in multivariate logistic regression problem of collinearity among independent variables not found (highest VIF, 2.36). The results of logistic regression, are presented in the form of estimated odds-ratios with 95\% CI. The whole analysis was performed using STATA version 13.0 with survey commands and R software. Ethical statement: This study is based on data available in public domain, therefore no ethical issue is involved. Data for this study was taken from the fourth round of the District Level Household Survey (DLHS-4) conducted during 2012-13. DLHS-4 adopted a multistage stratified systematic sampling design. Detailed information about sampling employed in this survey can be obtained from the DLHS-4 report. All seven states, namely, Arunachal Pradesh, Manipur, Meghalaya, Mizoram, Nagaland, Tripura and Sikkim separate CAB (Clinical Anthropometric and Biochemical) data files (excluding Assam) were merged together for this study. The outcome variable included in the analysis is "personal habit of age 15 and above using smokeless tobacco". Where the response was further divided into two categories like "Current Consumption" and "No Consumption" the household members was considered current consumers if they had responded that they were consuming (smokeless tobacco) and they coded as 1, while the never consumers, ex-consumers and don't know (0.3\%) are coded as 0. To measure level of prevalence and association of smokeless tobacco with factors, this study used both bivariate and multivariate analyses. Chi-square test is used to check the association of the current users with selected characteristics like age, literacy, occupation etc Table 2 presents the unweighted count of sampled respondents and population estimates classified by selected socio demographic and occupational background. The estimated population of person age 15 year and above in northeast state in DLHS (2012-2013) was 143,729 where 67,930 were male and 75,799 were female respondent were taken as unit of analysis. 
\section[{III. Results and Discussion}]{III. Results and Discussion} 
\section[{a) Differentials in current smokeless tobacco consumption}]{a) Differentials in current smokeless tobacco consumption}\par
(70.1\%) having the highest adjusted prevalence than female (55.8\%). We have also found that the wide variation in adjusted and unadjusted age prevalence especially non working male and unmarried male, female. Among states, Meghalaya have the highest prevalence followed by Mizoram. 
\section[{b) Factors associated with smokeless tobacco consumption}]{b) Factors associated with smokeless tobacco consumption}\par
Table \hyperref[tab_3]{4} presents odds ratio among male and female after performing logistic regression models which examine the effect of individuals household and     The prevalence of smokeless tobacco consumption among male and female in our study is 69.6\% and 50.8\%. Present study reveals that education is significantly associated with smokeless tobacco consumption. This is consistent with observations that those with lower level of education are more likely to consume smokeless tobacco \hyperref[b22]{[23,}\hyperref[b23]{24]}. In this study, the age wise prevalence of smokeless tobacco consumption is higher as the age advanced and the highest rate is found in the age group of 20-34 and 35-59 years and then declined after 60 years in both the sexes, similar finding was also reported \hyperref[b22]{[23,}\hyperref[b24]{25]}. Those who are married have a higher rate of smokeless tobacco consumption as compared to the unmarried respondents. This may be due to influences of the spouses consuming smokeless tobacco. Similar association between smokeless tobacco consumption and marital status was also reported \hyperref[b24]{[25]}. 
\section[{IV. Conclusion}]{IV. Conclusion}\par
In northeast states, India smokeless tobacco consumption is strongly associated with the level of education, religion, caste, marital status, occupation and place of residence. A comprehensive ban on tobacco advertising, promotion and sponsorship needs to be implemented according to the standard outlined in 'Article 13' in the WHO Framework Convention on Tobacco Control. Display and visibility of smokeless tobacco products at points of sale constitutes advertising and promotion and should therefore be banned \hyperref[b21]{[22]}. In addition to proper enforcement of the new law, there is a need for a nationwide campaign educating people in both rural and urban areas about the law and health risks of smokeless tobacco. 
\section[{V. Acknowledgments}]{V. Acknowledgments}\par
The authors gratefully acknowledge members of the study field team including who were involved in mapping/listing and main survey team during data collection in northeast states. The authors also acknowledge all the respondent for their active participation in this study. \begin{figure}[htbp]
\noindent\textbf{511}\includegraphics[]{image-2.png}
\caption{\label{fig_0}5 )Figure 1 . 1 :}\end{figure}
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\noindent\textbf{1}\includegraphics[]{image-3.png}
\caption{\label{fig_1}Figure 1 .}\end{figure}
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\noindent\textbf{} \par 
\begin{longtable}{P{0.5620967741935483\textwidth}P{0.04112903225806452\textwidth}P{0.04112903225806452\textwidth}P{0.04112903225806452\textwidth}P{0.04112903225806452\textwidth}P{0.04112903225806452\textwidth}P{0.04112903225806452\textwidth}P{0.04112903225806452\textwidth}}
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Smokeless tobacco, GATS( 2009-2010)\tabcellsep \tabcellsep \tabcellsep \tabcellsep \tabcellsep \tabcellsep \tabcellsep \\
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Female\tabcellsep 27.7\tabcellsep 37.0\tabcellsep 35.9\tabcellsep 43.5\tabcellsep 36.6\tabcellsep 23.3\tabcellsep 49.1\\
Smokeless tobacco, DLHS-4 (2012-2013)\tabcellsep \tabcellsep \tabcellsep \tabcellsep \tabcellsep \tabcellsep \tabcellsep \\
Male\tabcellsep 56.8\tabcellsep 65.6\tabcellsep 86.7\tabcellsep 66.6\tabcellsep 64.2\tabcellsep 39.3\tabcellsep 79.3\\
Female\tabcellsep 33.7\tabcellsep 51.4\tabcellsep 87.2\tabcellsep 65.8\tabcellsep 34.5\tabcellsep 23.6\tabcellsep 77.4\\
Source: GATS 2009-2010 and DLHS 2012-2013\tabcellsep \tabcellsep \tabcellsep \tabcellsep \tabcellsep \tabcellsep \tabcellsep \\
\multicolumn{8}{l}{AR : Arunachal Pradesh, MN: Manipur, MG: Meghalaya, TR: Tripura, NG: Nagaland, SK: Sikkim, MZ:}\\
Mizoram\tabcellsep \tabcellsep \tabcellsep \tabcellsep \tabcellsep \tabcellsep \tabcellsep \\
D D D D ) K\tabcellsep \tabcellsep \tabcellsep \tabcellsep \tabcellsep \tabcellsep \tabcellsep \\
(\tabcellsep \tabcellsep \tabcellsep \tabcellsep \tabcellsep \tabcellsep \tabcellsep \end{longtable} \par
 
\caption{\label{tab_0}}\end{figure}
 \begin{figure}[htbp]
\noindent\textbf{2} \par 
\begin{longtable}{P{0.21321229050279328\textwidth}P{0.0650558659217877\textwidth}P{0.07740223463687151\textwidth}P{0.3029608938547486\textwidth}P{0.07692737430167598\textwidth}P{0.08832402234636871\textwidth}P{0.026117318435754187\textwidth}}
\multicolumn{6}{l}{Smokeless Tobacco use among Male and Female in Northeast State, India}\tabcellsep \\
\tabcellsep \tabcellsep \tabcellsep \multicolumn{3}{l}{community characteristics on current smokeless}\tabcellsep \\
\tabcellsep \tabcellsep \tabcellsep \multicolumn{3}{l}{tobacco consumption in northeast states, India. The}\tabcellsep \\
\tabcellsep \tabcellsep \tabcellsep \multicolumn{3}{l}{results show that age group, social group, sex and}\tabcellsep \\
\tabcellsep \tabcellsep \tabcellsep \multicolumn{3}{l}{education are significantly associated with current}\tabcellsep \\
\tabcellsep \tabcellsep \tabcellsep \multicolumn{3}{l}{smokeless tobacco consumptions in both sexes. In}\tabcellsep \\
\tabcellsep \tabcellsep \tabcellsep \multicolumn{3}{l}{table 4 the male in age group (20-34 and 35-59) are 3}\tabcellsep \\
\tabcellsep \tabcellsep \tabcellsep \multicolumn{3}{l}{times more consuming smokeless tobacco than the}\tabcellsep \\
\tabcellsep \tabcellsep \tabcellsep \multicolumn{3}{l}{males in age group (15-19). Non ST, non Christian and}\tabcellsep \\
\tabcellsep \tabcellsep \tabcellsep \multicolumn{3}{l}{the males who are unmarried are consuming less}\tabcellsep \\
\tabcellsep \tabcellsep \tabcellsep \multicolumn{3}{l}{smokeless tobacco than ST, Christian and married}\tabcellsep \\
\tabcellsep \tabcellsep \tabcellsep males.\tabcellsep \tabcellsep \tabcellsep \\
Background\tabcellsep \multicolumn{2}{l}{Male (n=67,930)}\tabcellsep \multicolumn{2}{l}{Female (n=75,799)}\tabcellsep Total\tabcellsep Year 2016\\
characteristics\tabcellsep Percent\tabcellsep Sample size\tabcellsep Percent\tabcellsep Sample size\tabcellsep (N=143,729)\tabcellsep \\
Age\tabcellsep \tabcellsep \tabcellsep \tabcellsep \tabcellsep \tabcellsep \\
15-19\tabcellsep 47.6\tabcellsep 7,512\tabcellsep 52.4\tabcellsep 8,263\tabcellsep 15,775\tabcellsep \\
20-34\tabcellsep 42.9\tabcellsep 21,552\tabcellsep 57.1\tabcellsep 28,628\tabcellsep 50,180\tabcellsep \\
35-59\tabcellsep 48.1\tabcellsep 28,578\tabcellsep 51.9\tabcellsep 30,860\tabcellsep 59,438\tabcellsep \\
60+\tabcellsep 56.1\tabcellsep 10,288\tabcellsep 43.9\tabcellsep 8,048\tabcellsep 18,336\tabcellsep \\
Level of education\tabcellsep \tabcellsep \tabcellsep \tabcellsep \tabcellsep \tabcellsep \\
Illiterate\tabcellsep 35.0\tabcellsep 11,196\tabcellsep 65.0\tabcellsep 20,753\tabcellsep 31,949\tabcellsep \\
Below Middle\tabcellsep 46.8\tabcellsep 16,066\tabcellsep 53.2\tabcellsep 18,229\tabcellsep 34,295\tabcellsep \\
Middle\tabcellsep 50.2\tabcellsep 16,636\tabcellsep 49.8\tabcellsep 16,473\tabcellsep 33,109\tabcellsep \\
Secondary\tabcellsep 54.2\tabcellsep 24,049\tabcellsep 45.8\tabcellsep 20,359\tabcellsep 44,408\tabcellsep \\
Religion\tabcellsep \tabcellsep \tabcellsep \tabcellsep \tabcellsep \tabcellsep \\
Christian\tabcellsep 47.1\tabcellsep 39667\tabcellsep 52.9\tabcellsep 44520\tabcellsep 84,187\tabcellsep \\
Non Christian\tabcellsep 47.5\tabcellsep 28280\tabcellsep 52.5\tabcellsep 31294\tabcellsep 59,574\tabcellsep \\
Caste\tabcellsep \tabcellsep \tabcellsep \tabcellsep \tabcellsep \tabcellsep \\
Scheduled tribe\tabcellsep 47.2\tabcellsep 51243\tabcellsep 52.8\tabcellsep 57390\tabcellsep 108,633\tabcellsep \\
Nonscheduled tribe\tabcellsep 47.6\tabcellsep 16704\tabcellsep 52.4\tabcellsep 18424\tabcellsep 35,128\tabcellsep \\
Occupation Working\tabcellsep 69.5\tabcellsep 41,633\tabcellsep 30.5\tabcellsep 18,302\tabcellsep 59,935\tabcellsep ( D D D D ) K\\
Not working Marital status Unmarried Married Place of residence Urban Rural States\tabcellsep 31.4 51.4 45.9 46.4 47.6\tabcellsep 26,314 18,634 49,311 16,832 51,115\tabcellsep 68.6 48.6 54.1 53.6 52.4\tabcellsep 57,512 17,653 58,159 19,442 56,372\tabcellsep 83,826 36,287 107,470 36,274 107,487\tabcellsep Medical Research\\
Arunachal Pradesh Manipur Meghalaya Mizoram Nagaland Tripura Sikkim Total\tabcellsep 47.8 46.1 39.2 48.8 50.0 48.3 46.8 47.2\tabcellsep 17643 10678 5429 11720 14456 3260 4761 67,930\tabcellsep 52.2 53.9 60.8 51.2 50.0 51.7 53.2 52.8\tabcellsep 19272 12473 8407 12309 14460 3486 5407 75,799\tabcellsep 36,915 23,151 13,836 24,029 28,916 6,746 10,168 143,729\tabcellsep Global Journal of\\
\multicolumn{2}{l}{Source: Based on authors' computation.}\tabcellsep \tabcellsep \tabcellsep \tabcellsep \tabcellsep \end{longtable} \par
  {\small\itshape [Note: 3 Volume XVI Issue III Version I © 2016 Global Journals Inc. (US)]} 
\caption{\label{tab_1}Table 2 :}\end{figure}
 \begin{figure}[htbp]
\noindent\textbf{3} \par 
\begin{longtable}{P{0.20480314960629922\textwidth}P{0.1673228346456693\textwidth}P{0.16062992125984252\textwidth}P{0.16196850393700787\textwidth}P{0.1552755905511811\textwidth}}
Background\tabcellsep \multicolumn{2}{l}{Male (n=67,930)}\tabcellsep \multicolumn{2}{l}{Female (n=75,799)}\\
characteristics\tabcellsep Crude\tabcellsep Age adjusted\tabcellsep Crude\tabcellsep Age adjusted\\
Level of education\tabcellsep \tabcellsep \tabcellsep \tabcellsep \\
Illiterate\tabcellsep 65.2 (0.4)\tabcellsep 66.7 (1.0)\tabcellsep 47.2 (0.7)\tabcellsep 46.9 (0.8)\\
Below Middle\tabcellsep 68.1 (0.7)\tabcellsep 66.9 (0.7)\tabcellsep 54.5 (0.7)\tabcellsep 52.7 (0.7)\\
Middle\tabcellsep 65.4 (0.7)\tabcellsep 64.6 (0.7)\tabcellsep 52.6 (0.7)\tabcellsep 51.9 (0.7)\\
Secondary\tabcellsep 63.8 (0.7)\tabcellsep 62.6 (0.4)\tabcellsep 49.7 (0.7)\tabcellsep 50.4 (0.8)\\
Religion\tabcellsep \tabcellsep \tabcellsep \tabcellsep \\
Hindu\tabcellsep 61.7 (0.7)\tabcellsep 59.2 (0.6)\tabcellsep 48.6 (0.9)\tabcellsep 46.9 (0.9)\\
Christian\tabcellsep 69.8 (0.6)\tabcellsep 70.1 (0.6)\tabcellsep 56.0 (0.7)\tabcellsep 55.8 (0.7)\\
Others\tabcellsep 56.3 (0.7)\tabcellsep 54.7 (0.7)\tabcellsep 37.0 (0.8)\tabcellsep 36.2 (0.9)\\
Caste\tabcellsep \tabcellsep \tabcellsep \tabcellsep \\
Scheduled tribe\tabcellsep 66.9 (0.5)\tabcellsep 66.4 (0.5)\tabcellsep 51.9 (0.6)\tabcellsep 51.3 (0.6)\\
Scheduled caste\tabcellsep 62.8 (1.6)\tabcellsep 60.3 (1.4)\tabcellsep 48.7 (1.9)\tabcellsep 47.2 (1.2)\\
OBC\tabcellsep 55.1 (1.2)\tabcellsep 53.5 (1.2)\tabcellsep 42.4 (1.1)\tabcellsep 41.3 (1.1)\\
Others\tabcellsep 63.1 (0.9)\tabcellsep 60.7 (0.9)\tabcellsep 49.7 (1.1)\tabcellsep 47.5 (1.1)\\
Occupation\tabcellsep \tabcellsep \tabcellsep \tabcellsep \\
Working status\tabcellsep 71.7 (0.4)\tabcellsep 71.3 (0.5)\tabcellsep 57.5 (0.7)\tabcellsep 56.2 (0.7)\\
Not working\tabcellsep 55.7 (0.5)\tabcellsep 61.2 (0.5)\tabcellsep 48.7 (0.6)\tabcellsep 48.6 (0.6)\\
Marital status\tabcellsep \tabcellsep \tabcellsep \tabcellsep \\
Unmarried\tabcellsep 54.5 (0.6)\tabcellsep 61.4 (0.9)\tabcellsep 43.0 (0.7)\tabcellsep 51.4 (0.7)\\
Married\tabcellsep 69.6 (0.4)\tabcellsep 70.7 (0.5)\tabcellsep 53.3 (0.6)\tabcellsep 52.8 (0.6)\\
Place of residence\tabcellsep \tabcellsep \tabcellsep \tabcellsep \\
Urban\tabcellsep 65.7 (0.7)\tabcellsep 65.0 (0.7)\tabcellsep 53.9 (1.3)\tabcellsep 52.9 (1.2)\\
Rural\tabcellsep 65.3 (0.5)\tabcellsep 64.1 (0.5)\tabcellsep 49.3 (0.5)\tabcellsep 48.5 (0.5)\\
States\tabcellsep \tabcellsep \tabcellsep \tabcellsep \\
Arunachal Pradesh\tabcellsep 57.0 (0.7)\tabcellsep 55.4 (0.6)\tabcellsep 33.8 (0.8)\tabcellsep 33.4 (0.7)\\
Manipur\tabcellsep 65.4 (1.2)\tabcellsep 64.1 (1.2)\tabcellsep 51.9 (1.2)\tabcellsep 50.5 (1.1)\\
Meghalaya\tabcellsep 86.8 (1.2)\tabcellsep 86.9 (1.2)\tabcellsep 87.2 (1.1)\tabcellsep 86.3 (1.1)\\
Mizoram\tabcellsep 79.4 (0.6)\tabcellsep 78.7 (0.6)\tabcellsep 77.4 (0.6)\tabcellsep 76.5 (0.6)\\
Nagaland\tabcellsep 64.3 (1.1)\tabcellsep 65.9 (1.2)\tabcellsep 34.5 (0.9)\tabcellsep 36.1 (0.9)\\
Tripura\tabcellsep 66.6 (1.8)\tabcellsep 64.4 (1.\tabcellsep \tabcellsep \end{longtable} \par
 
\caption{\label{tab_2}Table 3 :}\end{figure}
 \begin{figure}[htbp]
\noindent\textbf{4} \par 
\begin{longtable}{P{0.48428571428571426\textwidth}P{0.10857142857142855\textwidth}P{0.07428571428571427\textwidth}P{0.11\textwidth}P{0.07285714285714286\textwidth}}
Background\tabcellsep \multicolumn{2}{l}{Male (n=67,930)}\tabcellsep \multicolumn{2}{l}{Female (n=75,799)}\\
characteristics\tabcellsep Odds Ratio\tabcellsep p value\tabcellsep Odds Ratio\tabcellsep p value\\
Age\tabcellsep \tabcellsep \tabcellsep \tabcellsep \\
15-19 \#\tabcellsep 1\tabcellsep \tabcellsep 1\tabcellsep \\
20-34\tabcellsep 3.18\tabcellsep 0.00\tabcellsep 2.56\tabcellsep 0.00\\
35-59\tabcellsep 3.05\tabcellsep 0.00\tabcellsep 2.64\tabcellsep 0.00\\
60+\tabcellsep 1.19\tabcellsep 0.00\tabcellsep 1.50\tabcellsep 0.00\\
Level of education\tabcellsep \tabcellsep \tabcellsep \tabcellsep \\
Illiterate\tabcellsep 1.24\tabcellsep 0.00\tabcellsep 0.97\tabcellsep 0.56\\
Below Middle\tabcellsep 1.28\tabcellsep 0.00\tabcellsep 1.14\tabcellsep 0.00\\
Middle\tabcellsep 1.16\tabcellsep 0.00\tabcellsep 1.15\tabcellsep 0.00\\
Secondary \#\tabcellsep 1\tabcellsep \tabcellsep 1\tabcellsep \\
Religion\tabcellsep \tabcellsep \tabcellsep \tabcellsep \\
Non Christian \#\tabcellsep 1\tabcellsep \tabcellsep 1\tabcellsep \\
Christian\tabcellsep 1.78\tabcellsep 0.00\tabcellsep 1.87\tabcellsep 0.00\\
Caste\tabcellsep \tabcellsep \tabcellsep \tabcellsep \\
Non Scheduled tribe \#\tabcellsep 1\tabcellsep \tabcellsep 1\tabcellsep \\
Scheduled tribe\tabcellsep 0.92\tabcellsep 0.08\tabcellsep 0.81\tabcellsep 0.00\\
Occupation\tabcellsep \tabcellsep \tabcellsep \tabcellsep \\
Working \#\tabcellsep 1\tabcellsep \tabcellsep 1\tabcellsep \\
Not working\tabcellsep 2.45\tabcellsep 0.00\tabcellsep 2.3\tabcellsep 0.00\\
Marital status\tabcellsep \tabcellsep \tabcellsep \tabcellsep \\
Unmarried \#\tabcellsep 1\tabcellsep \tabcellsep 1\tabcellsep \\
Married\tabcellsep 1.50\tabcellsep 0.00\tabcellsep 1.17\tabcellsep 0.00\\
Place of residence\tabcellsep \tabcellsep \tabcellsep \tabcellsep \\
Rural \#\tabcellsep 1\tabcellsep \tabcellsep 1\tabcellsep \\
Urban\tabcellsep 1.07\tabcellsep 0.103\tabcellsep 1.20\tabcellsep 0.00\\
\multicolumn{3}{l}{Source: Based on authors' computation. \# : reference category}\tabcellsep \tabcellsep \end{longtable} \par
 
\caption{\label{tab_3}Table 4 :}\end{figure}
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\end{document}
