Number of male smokers in India rise by 36%

The number of men smoking tobacco in India rose by more than one-third to 108 million between 1998 and 2015, according to a new study published today in the journal BMJ Global Health.

The study also found that cigarettes were replacing the traditional bidi, a small, inexpensive Indian cigarette, possibly due to substantially higher income in India and population growth.

That finding led study author Dr. Prabhat Jha to urge the Indian government to increase tobacco taxes in its Feb. 29 budget. Previous research by Dr. Jha, director of the Centre for Global Health Research of St. Michael's Hospital, has shown that raising the tax on tobacco is the single most effective intervention to lower smoking rates and to deter future smokers.

China is the only country in the world with more smokers than India. In both countries, tobacco taxes have not kept pace with the increased affordability of cigarettes. In 2010 smoking caused about 1 million deaths or 10 per cent of all deaths in India, with about 70 per cent of those deaths occurring between the ages of 30 and 69, what should be the prime of their lives, said Dr. Jha, a professor in the Dalla Lana School of Public Health at the University of Toronto.

The study found the number of men smoking any type of tobacco at ages 15-69 years rose by about 29 million, or 36 per cent, from 79 million in 1998 to 108 million in 2015, representing an average annual increase of about 1.7 million male smokers.

The overall age adjusted smoking prevalence at ages 15-69 years declined modestly from 27 per cent in 1998 to 24 per cent in 2010 but total numbers rose due to population growth.

Cigarettes are steadily displacing traditional bidis. By 2015 there were roughly equal numbers of men ages 15-69 years smoking cigarettes or bidis: approximately 61 million Indian adult men smoked cigarettes (40 million exclusively) and 69 million smoked bidis (48 million exclusively).

Smoking cessation is uncommon in India. In 2015, at ages 45-59 years, there are roughly four current smokers for every quitter. By contrast, in North America, where smoking cessation is now common, there are more quitters than current smokers at these ages.

The study also found:

• The sharpest increase in male smoking occurred at ages 15-29 years.
• The highest prevalence of any smoking in men aged 15-69 years was in illiterate men in both 1998 and 2010. Among illiterate men, the prevalence of cigarette smoking rose most sharply, by about 3.6 times. By contrast, among men with Grade 10 or more education, the prevalence of bidi or any smoking fell, but still rose modestly for cigarettes.
• The number of smokers rose about 68 per cent from 19 to 31 million in urban India and about 26 per cent from 61 to 77 million in rural India.
• At the ages 15-69 years, there were about 11 million women who smoked (about one-tenth of the total of male smokers). The smoking prevalence in women born after 1960 was about half of the prevalence in women born before 1950, suggesting that there is no increase in young women smoking. By contrast, there are few intergenerational changes in smoking prevalence in men at these ages.