Trends in bidi and cigarette smoking in India from 1998 to 2015, by age, gender and education.

OBJECTIVES: Smoking of cigarettes or bidis (small, locally manufactured smoked tobacco) in India has likely changed over the last decade. We sought to document trends in smoking prevalence among Indians aged 15-69 years between 1998 and 2015. DESIGN: Comparison of 3 nationally representative surveys representing 99% of India's population; the Special Fertility and Mortality Survey (1998), the Sample Registration System Baseline Survey (2004) and the Global Adult Tobacco Survey (2010). SETTING: India. PARTICIPANTS: About 14 million residents from 2.5 million homes, representative of India. MAIN OUTCOME MEASURES: Age-standardised smoking prevalence and projected absolute numbers of smokers in 2015. Trends were stratified by type of tobacco smoked, age, gender and education level. FINDINGS: 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. CONCLUSIONS: 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.

The influence of prices on youth tobacco use in India.

INTRODUCTION: The tobacco epidemic has been rapidly spreading in many of the poorer nations of the world, including India. Although studies assessing the impact of prices on youth smoking in countries such as the United States are abundant, comparable research on Indian youth has been largely unavailable due to lack of data at the national level. This study aims to bridge this disparity in tobacco research. METHODS: We used data from the Global Youth Tobacco Survey, a national survey among 73,356 youth of age 13-15 years in India, to estimate the price elasticity of tobacco use among Indian youth for three tobacco products: cigarettes, bidi, and gutka. RESULTS: Higher prices can be an effective deterrent to youth tobacco use, irrespective of the form of tobacco. Among the products considered, bidis have the highest price elasticity of participation (-2.70), followed by gutka (0.58) and cigarettes (-0.40). In gender-specific analyses, girls have significantly higher participation price elasticities than boys. CONCLUSION: The results of this study indicate that fiscal measures to increase the price of tobacco products would be effective in curbing the tobacco epidemic in India.