Say NO to Tobacco: The Challenge of Tobacco Consumption in India

Tobacco Consumption in India and Globally

It is estimated that there are 300 million consumers of smokeless tobacco while 600 million people use areca-nut globally, South-East Asia and Central Asia being among the main consumers. ¹ Tobacco consumption in India affects nearly 250 million people, making it a significant public health concern.² 28.6% of Indian people used some type of tobacco, which makes India the second largest consumer in the world.³

Forms of Tobacco Usage

• Tobacco Smoking : Includes bidis, cigarettes and other products in which tobacco is used by burning it.
• Smokeless tobacco: Chewing, inhalation, sucking, local application or complete ingestion are common ways to use tobacco without burning, that is smokeless tobacco ² 

In India, people consume tobacco more in the smokeless form, which is unlike other countries where smoking is the main pattern of tobacco use.³

Areca nut, the seed of a plant called areca-palm, can be used alone or with smokeless tobacco with betel quid. ¹

Tobacco and Oral Health 

Tobacco consumption in any form drastically increases the risk of disease and death. This has led to a call for action by the WHO and ICMR to reduce tobacco consumption. Tobacco consumption is a public health problem that needs serious attention because it  causes a number of diseases, and  cancer of various organs of the body, including Oral Cancer.² 

Dr. Nirali, a Dental Surgeon practising in a private clinic at Vadodara, Gujarat, with over 10 years of experience in the field of Oral Care, warns about the impact of tobacco on Oral health

“In my practice, I regularly come across patients with gum diseases and oral pre-cancerous patches, all occurring due to the use of smokeless tobacco and areca-nut.”

A recent study has found that areca nut and tobacco are the main causes of oral cancer in India. Additionally, smokeless tobacco in the form of gutka, khaini, etc, plays a major role in causing oral cancer. Importantly, areca nut has been found to play a major role in oral cancer apart from smokeless tobacco products. ¹

Hence it is evident that by merely preventing areca nut and smokeless tobacco consumption, one third of all oral cancers can be prevented. ¹

She adds, “ Some patients argue that they consume tobacco and/or areca-nut just once or twice a day. What is important to understand is that even if the quantity is less, keeping these products in the mouth for longer times (as they usually do) is equally dangerous, as this causes the harmful chemicals to be in contact with the oral tissues for an extended time interval.”

Policies to Reduce Tobacco Consumption in India

The Government has passed several laws and acts to address the issue of tobacco consumption in India , which include

• Not to smoke in public places
• Prohibition of using tobacco as an ingredient in any food product.
• Vendors should strictly avoid selling tobacco products to children.
• All tobacco products packets must include a clear warning message regarding ill effects of tobacco like “TOBACCO KILLS”
• Prohibition of the use of electronic cigarettes
• Anti-tobacco health warning messages should be shown in any content that shows the use of tobacco or related products.⁸

Dr Nirali further talks about the role of dental surgeons

“As dentists, we are in a unique position to show the real impact of tobacco use on oral health. A single initiative or a short counselling during the visit can make patients think about how their life is being affected by these products. It is a win even if a single patient quits the habit.”

Why is tobacco being used in spite of all the preventive measures?

• Uneven implementation of the ban:

Gutka,zarda, khaini, and chewing tobacco are some of the important smokeless tobacco products available in India.^3,4  India has imposed a ban on the most consumed and popular smokeless tobacco product, gutka. However, this product can be recreated manually by mixing 2 separate packets containing chewing tobacco and spices. And hence though there is a ban in India, and shopkeepers know about it, gutka is still being sold in the form of separate packets that can be easily mixed and consumed.^5,6,7

• Marketing strategies by companies:

Apart from this, tobacco companies constantly try to make their product look more attractive and appealing, especially targeting the most vulnerable population- the youth. The teens are easily influenced by the appealing taste and smell of the products, which are in true sense used just for the sake of masking the harshness of tobacco.⁹

Their marketing tactics includes:

• The tobacco products are packaged in colorful packets  with  beautiful designs, and nice flavors.
• Their products are designed to mimic routine eatables like sweets, candies, with designs of some cartoon characters, which make them look harmless. 
• Substances with cooling effects that make the product more palatable are also added, to make quitting harder.⁹

People need to understand about mindful eating habits, and that these are marketing tactics used by the companies, which increase their sales and profits. But to a common person these are the very attractions that cause teens to start tobacco consumption early in their life. When started early, it can also imply a difficulty in quitting and  a life-long addiction with adverse health outcomes.⁹

WHO Theme for World No Tobacco Day 2025

Keeping in mind the aforementioned tactics of Tobacco manufacturers, this year WHO has announced the theme for the 2025 World No Tobacco Day (WNTD) campaign: “Unmasking the Appeal: Exposing Industry Tactics on Tobacco and Nicotine Products.” ⁹

The Aim of 2025 Campaign

This campaign aims to reveal the marketing tactics tobacco companies use to make their harmful products seem attractive

• Raise awareness: To make the people aware about the  industry methods which make the tobacco products look more attractive.
• Appeal for policy change: To make the companies stop the addition of flavored additives to tobacco products, and to resort to plainer packaging, to decrease the visual appeal and attractiveness of these products. Moreover, the campaign appeals to entirely ban promotions, sponsorships and advertisements of tobacco on all platforms.
• Reduce demand: The ultimate aim of exposing these tactics is to make people, especially the younger generation, aware about it, thereby decreasing the demand.⁹

Conclusion

There have been numerous attempts to decrease tobacco use. We, as a society, need to understand the economic, emotional, and societal burden of tobacco usage. It is by understanding the industrial tactics and bringing them to the limelight, that we can educate the youth thereby curbing the demand and use of tobacco and tobacco products, and aim for a healthier generation. Although WHO and the Indian government have made some successful efforts, we have yet to win the battle against tobacco.,

References:

1. Rumgay H, Nethan ST, Shah R, Vignat J, Ayo-Yusuf O, Chaturvedi P, et al. Global burden of oral cancer in 2022 attributable to smokeless tobacco and areca nut consumption: a population attributable fraction analysis. The Lancet Oncology [Internet]. 2024 Nov [cited 2025 May 31];25(11):1413–23. Available from: https://linkinghub.elsevier.com/retrieve/pii/S1470204524004583
2. Indian Council of Medical Research, Government of India https://www.icmr.gov.in/icmrobject/custom_data/1720339657_1720339631_tobacco_monograph
3. Global Adult Tobacco Survey GATS 2 India 2016–17 . Tata Institute of Social Sciences (TISS), Mumbai and Ministry of Health and Family Welfare, Government of India. http://www.who.int/tobacco/surveillance/survey/gats/GATS_India_2016-17_FactSheet.pdf
4. Welding K, Saraf S, Iacobelli M, Smith KC, Puntambekar N, Gupta PC, et al. Beyond Gutka: Evidence of Illegal Smokeless Tobacco in Rural and Semi-urban Areas in India. Nicotine & Tobacco Research [Internet]. 2022 Apr 28 [cited 2025 May 31];24(6):929–32. Available from: https://academic.oup.com/ntr/article/24/6/929/6453474
5. Kumar G, Pednekar MS, Narake S, Dhumal G, Gupta PC. Feedback from vendors on gutka ban in two States of India. Indian J Med Res. 2018 Jul;148(1):98–102.
6. Vidhubala E, Pisinger C, Basumallik B, Prabhakar DS. The ban on smokeless tobacco products is systematically violated in Chennai, India. Indian J Cancer. 2016;53(2):325–30.
7. Adhikari K, Pednekar MS, Stepanov I, Singh A, Nikam S, Singhavi H, et al. Observed Circumvention of the Gutka Smokeless Tobacco Ban in Mumbai, India. Tob Regul Sci [Internet]. 2020 Sep [cited 2025 May 31];6(5):331–5. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8528234/
8. National Tobacco Control Programme [Internet]. [cited 2025 May 31]. Available from: https://ntcp.mohfw.gov.in/
9. World No Tobacco Day: Unmasking the appeal: https://www.who.int/news/item/11-11-2024-no-tobacco-day-2025–unmasking-the-appeal

Written By: Dr. Priyanka H. Bhanushali

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