Tobacco Use in India: Key Epidemiological Trends and Statistics

India carries one of the heaviest tobacco burdens in the world. With hundreds of millions of users across genders, age groups, and geographies, tobacco use in India is not a fringe issue – it is a deeply embedded public health crisis. Understanding its epidemiology is essential for designing effective prevention and intervention strategies. The data from large-scale national and global surveys paint a clear – and sobering – picture.

Prevalence of tobacco use in India
Gender and regional differences
Common tobacco products in India
Smokeless tobacco products
Smoked tobacco products
Tobacco use among youth and professionals
Tobacco among school-going children: evidence from GYTS
Tobacco among health professional students: evidence from GHPSS
Why these trends matter

Prevalence of tobacco use in India

The Global Adult Tobacco Survey (GATS) is the gold standard for monitoring adult tobacco use worldwide. It is a standardized household survey covering persons aged 15 years and older, collecting data on smoking, smokeless tobacco, cessation behavior, secondhand smoke exposure, and more. India has completed two rounds – GATS-1 in 2009-10 and GATS-2 in 2016-17.

According to findings from GATS-1, overall tobacco use among Indian adults stood at approximately 34.6%, with significant variation by gender: 47.9% among males and 20.7% among females. Rural areas showed higher prevalence (38.4%) compared to urban areas (25.3%). These numbers placed India among the countries with the highest tobacco use globally.

By the time GATS-2 was conducted in 2016-17, some progress had been made. According to WHO India, nearly 267 million adults (29% of all adults aged 15 and above) were tobacco users. While this represented a decline from the earlier round, the absolute numbers remained staggering. Research analyzing GATS-2 data found that the overall prevalence of smoking tobacco use was about 10.38%, while smokeless tobacco use stood at 21.38% – confirming that smokeless tobacco remains the dominant form of consumption in India.

Gender and regional differences

The gender gap in tobacco use in India is pronounced. Males consistently report much higher usage rates than females across all tobacco forms. GATS-2 data shows that the burden of smoking-only tobacco use was higher among males, while smokeless tobacco use was more widespread among females compared to smoking. This pattern reflects deep-rooted social norms: smoking is often considered socially taboo for women in many parts of India, making smokeless tobacco a more “acceptable” alternative.

Regional disparities are equally significant. Studies based on GATS data show that tobacco use has increased in many Indian states over the years, with more than two-thirds of states reporting a rise in smokeless tobacco use among both males and females. States in the northeast and east – such as Mizoram, Jharkhand, and Odisha – consistently report the highest prevalence rates, far above the national average.

Common tobacco products in India

India’s tobacco landscape is unique. Unlike many Western countries where cigarettes dominate, India sees a wide array of products – both smoked and smokeless – reflecting its regional cultural diversity and economic stratification.

Smokeless tobacco products

Smokeless tobacco is the most prevalent form of tobacco use in India. WHO India identifies the most common smokeless products as khaini, gutkha, betel quid with tobacco, and zarda. Among these:

Khaini is a mixture of sun-dried tobacco and slaked lime. It is the single most popular tobacco product in India – used by approximately one in every nine adults (11.2%). It is especially prevalent among males, with khaini use among men running at 17.9% compared to 4.2% among women, per GATS-2 data.
Gutkha is a commercially manufactured mixture of tobacco, areca nut, lime, and flavoring agents. It is the third most commonly used tobacco product in India, with a prevalence of around 6.8% among adults. Despite being banned under the Food Safety and Standards Act in several Indian states, gutkha continues to be sold through illicit means. Its highest usage is concentrated in the 25-44 age group.
Betel quid with tobacco (paan with tobacco) ranks fourth, with about 5.8% prevalence, and is particularly common in northeastern states and Uttar Pradesh.
Other products include zarda, mawa, mishri, gul, and gudakhu – each more prevalent in specific regions or communities. India has over 40 identified types of smokeless tobacco products used through chewing, snuffing, and gum application.

A critical misconception that drives smokeless tobacco use is the belief that it is safer than smoking. Research clearly shows this is false – smokeless tobacco users who use a product 8-10 times daily may absorb nicotine equivalent to smoking 30-40 cigarettes per day, and the products are strongly linked to oral cancers, cardiovascular disease, and addiction.

Smoked tobacco products

Among smoking products, bidi and cigarette are the two dominant forms, with hookah being less common. Bidis – hand-rolled, unfiltered tobacco wrapped in tendu or temburni leaf – are far more economical than cigarettes and are especially widespread in rural areas. Their affordability and the cultural embeddedness of bidi rolling in rural livelihoods make them particularly difficult to regulate.

Cigarettes, while consumed at lower rates than bidis historically, are the predominant smoked product in urban areas. National Family Health Survey (NFHS) data spanning 22 years shows that while bidi and cigarette use among men has been declining modestly, smokeless tobacco use has remained stubbornly stable – signaling that India’s tobacco problem cannot be addressed through smoking cessation alone.

Tobacco use among youth and professionals

Perhaps the most alarming dimension of India’s tobacco epidemic is its reach into the youngest segments of the population – including children still in school and students training to become health professionals.

Tobacco among school-going children: evidence from GYTS

The Global Youth Tobacco Survey (GYTS) is a school-based cross-sectional survey targeting students aged 13-15 years. In India, four rounds of the GYTS have been conducted – in 2003, 2006, 2009, and 2019. It uses a standardized methodology to produce nationally representative estimates of youth tobacco use, covering both smoked and smokeless forms.

GYTS 2009 found that 14.6% of students aged 13-15 were current tobacco users. Among them, 8.1% smoked tobacco. Male students were disproportionately affected – 11% of all male students surveyed used smoking or smokeless tobacco, while 6% of female students used smokeless tobacco and 3.7% smoked. The data also revealed that more than half of current smokers had tried to quit but failed, underscoring the addictive grip tobacco has even on adolescents.

The fourth round (GYTS-4), conducted in 2019, found that nearly one-fifth of students aged 13-15 had tried some form of tobacco product in their lifetime – a deeply concerning statistic. The survey covered 97,302 students across 987 schools nationwide. Easy access was identified as a major enabling factor: a substantial proportion of underage students were able to purchase tobacco without being refused at shops, exposing gaps in enforcement of laws that prohibit tobacco sales to and near minors.

Tobacco among health professional students: evidence from GHPSS

The Global Health Professions Student Survey (GHPSS) focuses on third-year students in medicine, dentistry, nursing, and pharmacy programs. It is specifically designed to track tobacco use and cessation training among those who will become future health professionals – people whose habits and knowledge directly influence patient behavior.

The findings from India are troubling. A GHPSS-based study conducted among medical students in Chennai found that 10.9% had tried cigarette smoking – with the rate among male medical students reaching 23.5%. Additionally, 34.2% of students reported exposure to tobacco smoke at home, reflecting the extent to which tobacco culture permeates even educated households. Critically, only 23.6% of the medical students surveyed reported receiving any formal training in smoking cessation techniques – a significant gap given that healthcare providers play a frontline role in tobacco control.

This data points to a structural problem: if future doctors and nurses are themselves using tobacco or are untrained in how to help patients quit, the healthcare system loses one of its most powerful intervention channels. The problem is not just about individual choices – it reflects how tobacco norms are woven into the social fabric at every level.

Why these trends matter

India’s tobacco epidemic is not simply a matter of individual habit. WHO estimates that the total economic cost of tobacco-related diseases in India for 2017-18 was INR 177,341 crore (approximately USD 27.5 billion) – borne by patients, families, and the public health system. The burden falls hardest on the rural poor, who are more likely to use cheaper products like khaini and bidi, and who have less access to cessation support. Globally, India is the second-largest producer and consumer of tobacco after China, a distinction that creates both an economic dependency and a public health paradox.

While national data shows a gradual decline in some forms of tobacco use since GATS-1, progress has been uneven. Smokeless tobacco remains nearly constant across survey waves. Youth initiation persists. And health professionals remain undertrained in cessation counseling. Addressing this requires sustained policy enforcement, culturally sensitive public messaging, and robust curriculum integration in medical education.

What do you think? Given that smokeless tobacco is widely perceived as “safer” than smoking, what approaches do you think would most effectively challenge this misconception – especially in rural communities where khaini and gutkha are deeply normalized? And should tobacco cessation training be made a mandatory and assessed component of all health professional degree programs in India?

References

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Table of Contents

Prevalence of tobacco use in India 🔗

Gender and regional differences 🔗

Common tobacco products in India 🔗

Smokeless tobacco products 🔗

Smoked tobacco products 🔗

Tobacco use among youth and professionals 🔗

Tobacco among school-going children: evidence from GYTS 🔗

Tobacco among health professional students: evidence from GHPSS 🔗

Why these trends matter 🔗