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Health behaviour

Did India’s tobacco epidemic peak and recede?

Shaikh R, Janssen F, Vogt T · BMC public health · 2022

Open access · cc by · source: Europe PMC

Across NFHS rounds, age-standardized tobacco use in Indian men rose 32% from 1998-99 to 2005-06 (27.90% to 36.81%) then fell 26% by 2015-16 (to 27.31%), while women’s use declined throughout—yet 2015-16 levels still looked like 1998-99, with huge state gaps.

Study at a glance

Design
Cross-sectional — Repeated nationally representative NFHS-2/3/4 household surveys (1998–2016) with age-standardized smoking and smokeless tobacco prevalence for ages 15–49 by sex and state
N
N=601509 · NFHS-4 interviewed 601,509 households (2015-16); NFHS-2 91,196; NFHS-3 109,041; analysis of men and women aged 15–49
Population
Indian men and women aged 15–49 in 27 states and two union territories covering 99% of the population
Outcome
Age-standardized prevalence of any tobacco, smoking, and smokeless tobacco, nationally and by state, 1998–2016

Structured fields used in claim comparison tables when every cited study has a complete layer.

Key findings

National use rose then fell for men, declined throughout for women. By 2015-16 male smoking was 12.20% and smokeless 15.12%; female smoking 0.40% and smokeless 2.87%. Male smoking ranged from 5.71% (Maharashtra) to 37.70% (Mizoram).

Methodology

Used NFHS-2/3/4 (91,196; 109,041; 601,509 households) to age-standardize smoking and smokeless prevalence for ages 15–49 in 27 states and 2 union territories covering 99% of India.

Limitations

Repeated cross-sections cannot prove which policies caused the drop; self-report undercounts, ages 15–49 miss older users, and 2015-16 prevalence remaining near 1998-99 warns against declaring the epidemic over.

How this study connects

Role on claims

Each row is a claim on a concept or method page where this paper supports, challenges, or qualifies the statement. Roles are hand-checked — not a model guess.

  • SupportsTobacco smoke exposureconcept

    India’s tobacco epidemic rose then fell for men while women declined, with huge state gaps and smokeless still common.

    NFHS rounds showed age-standardized male tobacco use rising 32% from 1998–99 to 2005–06 (27.90% to 36.81%) then falling 26% by 2015–16 (to 27.31%); women’s use declined throughout. By 2015–16 male smoking was 12.20% and smokeless 15.12%, with male smoking from 5.71% (Maharashtra) to 37.70% (Mizoram).

    Evidence for the claim as stated.

  • SupportsTobacco smoke exposureconcept

    National NFHS time trends, LASI occupational SLT prevalence, and smoked-tobacco CVD relative risks describe different products, ages, and outcomes.

    Evidence for the claim as stated.

Open questions

Tensions this paper is part of

From concept pages' “where studies disagree.” Disagreement means the same question; scope means different assays, populations, or outcomes.

History

When this study was placed

Dated entries from the concept change log — when this paper was added or removed as support, challenge, or qualifier on a claim.

  1. 2026-09-17

    Placed as supporting evidence on Tobacco smoke exposure

    NFHS rounds showed age-standardized male tobacco use rising 32% from 1998–99 to 2005–06 (27.90% to 36.81%) then falling 26% by 2015–16 (to 27.31%); women’s use declined throughout. By 2015–16 male smoking was 12.20% and smokeless 15.12%, with male smoking from 5.71% (Maharashtra) to 37.70% (Mizoram).

  2. 2026-09-17

    Placed as supporting evidence on Tobacco smoke exposure

    National NFHS time trends, LASI occupational SLT prevalence, and smoked-tobacco CVD relative risks describe different products, ages, and outcomes.

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