state of smoking and health in india

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Smoking rate

4.6% (2022)

tobacco use rate

23.9% (2022)

Tobacco Use and Trends

In 2022, an estimated 253 million adults aged 15 years and older in India are tobacco product users. This positions India as the 2^nd globally and 1^st WHO South East Asia Region (SEAR) in terms of the number of tobacco users.
- Tobacco use is more prevalent for the older female age 65 years old and older group with 18.6% while in male, it is more prevalent for those age 50 and 64 age group (Figure 1)

Source: 2019/2021 National Family Health Survey

In 2016/17, approximately 200 million people ages 15 and older used smokeless tobacco.
Tobacco use is higher in rural areas, among those with a lower socioeconomic status, and among those with lower levels of education.
Manufactured white cigarettes are not as common as the other tobacco products in India. Despite this, the per capita cigarette consumption fell 34.1% from 4 packs in 2010 to 2.6 packs in 2020.

Nicotine Alternatives

India implemented a ban on all reduced-risk tobacco products in 2019, following the EVALI incidents in the USA.

Health and Economic Burden From Tobacco Use

Tobacco is the 4^th highest risk factor in 2019, driving the most death and disability combined in India.
Tobacco is estimated to account for more than 1.2 million deaths. Smoking accounts for 1 million deaths, second hand smoke for 240 thousand deaths, and chewing tobacco for 35 thousand deaths.
Ischemic heart disease (IHD), COPD, and Stroke are the top 3 causes of death in India where tobacco is responsible for 354.7 thousand or 20% of total IHD deaths, 424.7 thousand or 47% of all COPD deaths, and 98.5 thousand or 14% of all Stroke deaths in 2019.
Tobacco causes a substantial economic burden. Total economic costs attributable to all diseases and deaths in India in 2018-2019 for those above 35 years was USD 27.5 billion. Smoking contributed 74% and SLT use contributed 26% of the costs.

DOCTORS’ MISPERCEPTIONS ABOUT NICOTINE

Nearly 9 in 10 doctors in India mistakenly believe that nicotine causes lung cancer.
On average, 80% of physicians incorrectly believe nicotine causes COPD, birth defects, and a range of cancers.
While on average 94% of doctors in India at least moderately agree that helping patients quit smoking is a priority, lack of training and nicotine knowledge adversely impacts quitting and harm reduction advice.
Nearly half (48%) of doctors say they are not appropriately trained to help patients quit smoking.

The Doctors’ Survey, which was funded by a Foundation for a Smoke-Free World grant, was conducted in 2022 by Sermo who surveyed more than 15,000 physicians in 11 countries, including India. To learn more about the Doctor’s Survey findings in India, click here.

regulatory environment and economics

Public Health Commitment

India ratified the WHO Framework Convention on Tobacco Control (FCTC) in 2004, and WHO Illicit Trade Protocol in 2018.
Implemented Graphical Health Warnings (GHWs) on combustible cigarettes (CCs) in 2009.
In 2011, India banned food products containing nicotine (e.g., gutkha), however a substantial number of people continue to use such products.

Diverse Tobacco Market

Heated Tobacco Products HTPs and e-cigarettes irrespective of nicotine content are legally not allowed (e.g., production, sale, import, export assembly, distribution) in India.
- Possession of HTPs and e-cigarettes is considered a violation of the Prohibition of Electronic Cigarette Act (PECA).
- PECA does not prohibit individual use of HTPs and e-cigarettes outside smoke-free places.

Taxation Policy

In 2022, total tax rate on retail prices of a pack of cigarette was 57.6%.

Smoking and Advertising Bans

India enforces slightly less then comprehensive smoking and advertising bans with moderate compliance level as of 2022.

Age Restrictions

HTPs and e-cigarettes cannot be sold anybody irrespective of age in India.

Illicit Cigarette Trade

Estimated figures indicate that illicit cigarette trade has increased from 14.6% in 2008 to 27.6% in 2020, the slightly declined to 25.7% in 2022.

TOBACCO PRODUCTION AND DIVERSIFICATION

In addition to being a major consumer of tobacco, India is the second largest producer of tobacco in the world producing 761,335 tons, with the vast majority of tobacco production concentrated in three states and employing nearly 25 million across the production value chain.
The Indian Ministry of Agriculture, Cooperation, and Farmers Welfare implemented a Crop Diversification Scheme, part of the Rashtriya Krishi Vikas Yojna program, in states with high levels of tobacco production. The government reported in 2018 67,512 hectares or 8.7% of land in the designated area has been diversified away from tobacco since 2015-2016.
In 2022, India was a significant player in unmanufactured tobacco production, producing approximately 2 thousand tons. This accounts for about 13.4% of the global production of 5.78 million tons. In comparison to 2010, when India produced 690.0 thousand tons, there has been an increase of 11.9%.
Furthermore, India utilized an estimated 3 thousand hectares of land to harvest tobacco in 2022, which is 4.3% less than in 2010.

As research findings become available that are inclusive of additional gender identities, the Foundation will update the information presented.