Did you know?
India has over 100 million adult smokers, the second highest number of smokers in the world after China.
There are already about 1 million adult deaths per year from smoking.
What are the new findings?
The age-standardised prevalence of smoking declined modestly among men aged 15–69 years, but the absolute number of male smokers at these ages grew from 79 million in 1998 to 108 million in 2015. This is due to population growth offsetting modest declines in prevalence.
Cigarettes are displacing bidis, especially among younger men and among illiterate men. This change might further increase the smoker: non smoker relative risks of disease.
Smoking cessation remains uncommon—only about 5% of men aged 45–59 years are ex-smokers. India has about 4 current male smokers for every quitter at these ages.
Female smoking at ages 15–69 years has not likely risen.
The trends studied:
Smoking of cigarettes or bidis (small, locally manufactured smoked tobacco) in India has likely changed over the last decade. Trends in smoking prevalence among Indians aged 15–69 years between 1998 and 2015 have been studied.
About 14 million residents from 2.5 million home were the participants under the study.
- The age-standardised prevalence of any smoking in men at ages 15–69 years fell from about 27% in 1998 to 24% in 2010, but rose at ages 15–29 years.
- During this period, cigarette smoking in men became about twofold more prevalent at ages 15–69 years and fourfold more prevalent at ages 15–29 years. By contrast, bidi smoking among men at ages 15–69 years fell modestly.
- The age-standardised prevalence of any smoking in women at these ages was 2.7% in 2010. The smoking prevalence in women born after 1960 was about half of the prevalence in women born before 1950.
- By contrast, the intergenerational changes in smoking prevalence in men were much smaller. The absolute numbers of men smoking any type of tobacco at ages 15–69 years rose by about 29 million or 36% in relative terms from 79 million in 1998 to 108 million in 2015. This represents an average increase of about 1.7 million male smokers every year.
- By 2015, there were roughly equal numbers of men smoking cigarettes or bidis. About 11 million women aged 15–69 smoked in 2015.
- Among illiterate men, the prevalence of smoking rose (most sharply for cigarettes) but fell modestly among men with grade 10 or more education.
- The ex-smoking prevalence in men at ages 45–59 years rose modestly but was low: only 5% nationally with about 4 current smokers for every former smoker.
The Indian government implemented the Cigarettes and Other Tobacco Products Act (COTPA) in 2003 and ratified the WHO’s Framework Convention on Tobacco Control in 2004, as well as the Cable Television Networks (Amendment) Act 2000 prohibiting tobacco advertising in all state-controlled electronic media and publications, including cable television. , Further, the Government has also included tobacco control in the priorities of the ongoing National Rural Health Mission. Despite these programmes, the major challenge to success is effective implementation of the provisions of COTPA, especially in enforcement of bans on smoking in public places (which are known to raise cessation rates). Most importantly, these trends in smoking reflect the lack of substantial increases in tobacco excise taxes, which have not kept up with the increased affordability of cigarettes and bidis. Hence, tobacco control in India urgently requires effective implementation of national policies.
Despite modest decreases in smoking prevalence, the absolute numbers of male smokers aged 15–69 years has increased substantially over the last 15 years. Cigarettes are displacing bidi smoking, most notably among young adult men and illiterate men. Tobacco control policies need to adapt to these changes, most notably with higher taxation on tobacco products, so as to raise the currently low levels of adult smoking cessation.
More effective tobacco control policy including higher tobacco taxation for cigarettes needs to be implemented as a short-term priority. India’s complicated tax structure has kept overall taxes on cigarettes low relative to other countries, with particularly low taxes on the less-expensive, short cigarettes that compete with the bidi market. Longer term policies need to raise taxes on bidis.
Intervention programmes to raise the currently low levels of tobacco cessation are needed.
Use of reliable, representative, large scale population surveys can help monitor the evolution of smoking and its consequences.