Tobacco Use Remains Significantly Higher in Central and Eastern India, Raising Public Health Concerns
Regional disparities in tobacco consumption highlight the need for targeted anti-tobacco interventions as smokeless tobacco continues to drive addiction in several states.
Tobacco consumption continues to show stark regional differences across India, with central and eastern states recording substantially higher usage rates than many western and southern parts of the country. Public health experts say these patterns are driven by widespread use of smokeless tobacco products, socio-economic factors, and deeply rooted cultural practices.
According to national survey data, states such as Madhya Pradesh, Bihar, and parts of eastern India report significantly higher tobacco consumption than the national average. A recent policy paper also identified Madhya Pradesh as one of the large states with the highest overall tobacco consumption, followed by Uttar Pradesh, Bihar, and Rajasthan.
Eastern India, extending through West Bengal into the northeastern region, continues to face a particularly high burden of tobacco use. Researchers attribute this to the widespread availability of smokeless tobacco products such as khaini, gutkha, zarda, and betel quid with tobacco, which remain socially accepted in many communities.
Although the statement that tobacco use is “much higher in India’s central and eastern states” is broadly accurate, studies indicate that the highest prevalence overall is found in the northeastern states, including Tripura, Mizoram, Manipur, Meghalaya, and Nagaland. These states consistently record tobacco use rates well above the national average.
The World Health Organization estimates that nearly 267 million Indian adults use tobacco in some form, making India the world’s second-largest consumer of tobacco. Smokeless tobacco remains the dominant form of consumption and contributes significantly to oral cancers, cardiovascular disease, stroke, and other chronic illnesses.
Health experts warn that tobacco use is closely associated with poverty, lower educational attainment, and rural residence. Manual laborers and economically disadvantaged communities are disproportionately affected, underscoring the need for region-specific tobacco control policies rather than a one-size-fits-all national approach.
Despite overall declines in tobacco use over the past decade due to stricter regulations and awareness campaigns, progress has been uneven. Some regions continue to report persistent or rising smokeless tobacco consumption, particularly among vulnerable populations. Researchers recommend stronger enforcement of tobacco control laws, higher taxation, expanded cessation services, and culturally tailored public health campaigns to reduce the burden of tobacco-related disease.
