India's battle against tobacco remains far from over, with more than one in three men continuing to use tobacco products, according to the latest National Family Health Survey (NFHS-6). At the same time, the survey suggests a modest decline in alcohol consumption, particularly among men, offering a mixed picture of the country's progress in tackling lifestyle-related health risks.
The findings, part of the NFHS-6 (2023-24) report, come amid growing concerns over non-communicable diseases such as cancer, heart disease, stroke and chronic respiratory illnesses, many of which are closely linked to tobacco and alcohol use.
According to the survey, 36.3 per cent of men aged 15 years and above use some form of tobacco, whether smoked or smokeless. While this represents a slight decline from 38.0 per cent in NFHS-5 (2019-21), the prevalence remains alarmingly high.
Among women, tobacco use is significantly lower but still noteworthy. 8.4 per cent of women aged 15 years and above reported using any kind of tobacco, compared with 8.9 per cent in the previous survey.
The data also reveals a sharp urban-rural divide. Among men, tobacco use stands at 26.2 per cent in urban areas but rises dramatically to 41.1 per cent in rural India. Among women, the prevalence is 4.6 per cent in urban areas and 10.0 per cent in rural areas.
The findings underscore the enduring popularity of smokeless tobacco products such as gutka, khaini and chewing tobacco, particularly in rural regions where awareness campaigns have limited reach.
Tobacco use, say experts, reflects a long-standing public health challenge. While smoking receives greater public attention, smokeless tobacco remains deeply embedded in social and cultural practices across many states. This is also because, unlike cigarettes, smokeless tobacco products are often inexpensive and readily available, contributing to their widespread use among lower-income and rural populations.
Public health advocates and doctors warn that the health consequences are severe as tobacco use is a major risk factor for oral cancer, lung cancer, chronic obstructive pulmonary disease (COPD), cardiovascular disease and stroke.
"Many people believe tobacco-related lung damage develops only after decades of smoking, but the harmful effects begin much earlier. By the time symptoms become noticeable, significant and often irreversible lung damage may have already occurred," says Dr Jayachandra, senior consultant, interventional pulmonology, CARE Hospitals, Hyderabad.
"Products such as e-cigarettes, nicotine pouches, and flavoured vaping devices are often marketed as safer alternatives. In reality, nicotine addiction, airway inflammation, and long-term lung damage remain serious concerns. These products are specifically designed to attract and retain younger users," added Dr Jayachandra.
The NFHS-6 findings are somewhat more encouraging when it comes to alcohol consumption.
Among men aged 15 years and above, 18.9 per cent reported consuming alcohol, down from 18.7 per cent in NFHS-5, essentially remaining stable at the national level. However, the urban-rural split reveals significant differences.
While 15.5 per cent of urban men reported consuming alcohol, the figure rose to 20.6 per cent among rural men.
Among women, alcohol consumption remains relatively uncommon. Just 1.1 per cent of women aged 15 years and above reported consuming alcohol, down slightly from 1.3 per cent in the previous survey. The prevalence was 0.5 per cent in urban areas and 1.4 per cent in rural areas.
Although alcohol use is far lower than tobacco use, health experts note that even moderate consumption can increase the risk of liver disease, certain cancers, hypertension and mental health problems, particularly when combined with poor diet and sedentary lifestyles.
Despite years of anti-tobacco campaigns, higher taxation and stricter packaging regulations, tobacco continues to pose one of the largest preventable health risks in the country.
The World Health Organisation estimates that tobacco use kills more than a million Indians every year. Beyond the human cost, tobacco-related diseases place a substantial burden on the healthcare system and the economy through lost productivity and treatment expenses.
The NFHS-6 data indicate that while some progress has been made in reducing tobacco use, particularly among men, the pace of decline remains slow. The persistence of high tobacco consumption in rural India suggests that public health interventions may need to become more targeted and locally tailored.
The latest survey offers a reminder that India's health challenges are increasingly shaped by lifestyle and behavioural factors. While the country has successfully expanded immunisation, institutional deliveries and maternal healthcare, reducing tobacco and harmful alcohol use remains critical to preventing the next wave of chronic illnesses.
"What is concerning is that tobacco use is occurring alongside rising obesity, diabetes and hypertension. This combination significantly increases the risk of cardiovascular disease, cancer and premature mortality. While the slight decline in tobacco use is encouraging, we need sustained public health action," says Kamayani Mahabal, activist with Jan Swasthya Abhiyaan.
