Public health research underscores the profound impact of unhealthy behaviors on morbidity and mortality (WHO, 2013; WHO, 2014). Most diseases are linked to health behaviors (WHO, 2008; Lloyd-Jones et al., 2010). Therefore, defining and measuring health behaviors are critical for effective policy development (Conner & Norman, 2017). Disparities in health behaviors and dietary patterns significantly contribute to social variations in health outcomes (Stringhini et al., 2010), affecting premature mortality and recovery from illness. Despite their importance, understanding these behaviors and their clustering remains limited, complicating intervention strategies (Spring et al., 2012).
Interestingly, health behaviors vary across social classes, socioeconomic status, gender, race, and geography, influencing key risk factors for chronic diseases such as harmful alcohol use, smoking, sedentary lifestyles, and poor dietary practices (Borrell et al., 2000; Braveman et al., 2010; Pampel et al., 2010; Ding et al., 2015; Malta et al., 2015). Lynch et al. (1997) established that socioeconomic status inversely affects behavioral and psychosocial characteristics, which are crucial in determining health risks. Gender differences in smoking, diet, and access to health care contribute to divergent mortality patterns between men and women (Gjonça, 1999). Given the dynamic nature of health and mortality trends, understanding these gender disparities is crucial (Charmaz, 1995). Gender identities influence illness experiences and health outcomes, underscoring the importance of examining gender in epidemiological studies (Vlassoff, 2007). Gender differences in health behaviors are essential for addressing health disparities and informing policy, planning, and health services. A more systematic approach to gender-focused research is needed.
In India, gender disparities in mortality have been documented extensively (Saikia, 2019; Bora & Saikia, 2015; Canudas-Romo, Saikia, & Diamond-Smith, 2015, Dhakad & Saikia, 2023). In the Indian context, gender differences in health behaviors reflect sociocultural norms shaped by patriarchal structures (Sen, 1992; Dasgupta, 2003). Compared with men, women's restricted access to alcohol and tobacco is influenced by sociocultural factors, limiting their usage (Wilsnak et al., 2005; Pathania, 2011; Hitchman & Fong, 2011). Despite Indian women having greater life expectancies, they report poorer health and lower healthcare expenditures than men do (Saikia et al., 2016; Bora & Saikia, 2015; Canudas-Romo et al., 2015). However, studies on gender disparities in health behaviors among Indian adults are rare (Patel & Chauhan, 2020; Singh & Chattopadhyay, 2023; Marla & Padmaja, 2023). A limited number of studies have assessed gender differences in health behaviors, which may explain the gender gap in life expectancy and overall health outcomes.
Given the above context, to fill the research gaps, we analyzed National Family Health Survey (NFHS 5- 2019-2021) data to explore gender differentials in smoking, alcohol consumption, and dietary habits. Understanding these behaviors is crucial, as they are significant risk factors for chronic diseases and mortality (WHO, 2009). The analysis uncovered how gender influences these health behaviors among Indian adults, hypothesizing variations in both positive and negative health practices by gender.
Conceptual Framework
Gender relations in society are dynamic and evolving and are influenced by societal progress and changing norms. As women increasingly occupy roles historically dominated by men, there is a growing need for a nuanced examination of gender dynamics. However, traditional gender roles still intersect with social, economic, and cultural factors, creating diverse patterns of exposure to health risks and differential access to health information, services, and care. These disparities significantly impact health outcomes (WHO, 2002). Despite sporadic recognition, gender has not been fully integrated as a critical determinant in health promotion efforts (Gelb et al., 2012). Gender interacts with socioeconomic and contextual variables to shape health and behavioral outcomes differently for men and women (Vlassoff, 2007). To comprehensively understand these dynamics, it is essential to consider the complexity and intersectionality of social, cultural, and economic contexts alongside demographic and epidemiological indicators.
This study adopts a gendered perspective to explore how inherent and contextual factors influence individual behaviors, particularly in the Indian context, where gender-specific behaviors are pronounced. The framework posits that the interaction of gender with various background factors contributes to distinct health behaviors across genders. By examining these interactions, the study aims to elucidate the nuanced pathways through which gender influences health behaviors, thereby informing targeted interventions and policies aimed at promoting health equity.
From the understanding developed from the available literature, this study conceptualizes the framework below in Fig. 1.
Data and methods
Data Source
The NFHS-5 (2019–21) data were used to examine health behaviors by gender. Data were analyzed via Stata software, with a focus on individuals aged 15–49 years, categorized by urban and rural residence.
The NFHS, initiated in the early 1990s, is a comprehensive survey that provides critical data on population, health, and nutrition across India and its states. NFHS-5 (2019-21) (IIPS, 2022) is the fifth round of this survey, followed by NFHS-1 (1992-93), NFHS-2 (1998-99), NFHS-3 (2005-06) and NFHS-4 (2015-16) (IIPS, 2018). These surveys offer essential indicators of family welfare, maternal and child health, nutrition, and health behaviors.
The NFHS-5 adhered to the DHS (Demographic and Health Survey) via standardized questionnaires, sample strategies, and field methodology. A two-stage sampling design was adopted in the NFHS-5 (IIPS, 2022). The NFHS-5 (2019-21) includes 724,115 women and 93,144 men in the 15–49 years age group. The focus was on individual-level socioeconomic information relevant to health behaviors such as tobacco use, alcohol consumption, and diet, ensuring a comprehensive gender comparison.
Ethics statement
The present study is based on publicly available NFHS 5 datasets with no identifiable information on the survey participants; hence, there is no requirement of ethics statement.