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Smokeless tobacco control in India: policy review and lessons for high-burden countries
  1. Amit Yadav1,
  2. Prashant Kumar Singh2,
  3. Nisha Yadav3,
  4. Ravi Kaushik4,
  5. Kumar Chandan1,
  6. Anshika Chandra1,
  7. Shalini Singh5,
  8. Suneela Garg6,
  9. Prakash C Gupta7,
  10. Dhirendra N Sinha8,
  11. Ravi Mehrotra9
  1. 1WHO FCTC Knowledge Hub on Smokeless Tobacco, ICMR-National Institute of Cancer Prevention and Research, Noida, Uttar Pradesh, India
  2. 2Division of Preventive Oncology, ICMR-National Institute of Cancer Prevention and Research, Noida, Uttar Pradesh, India
  3. 3Harlal School of Law, Greater Noida, Uttar Pradesh, India
  4. 4Maulana Azad Medical College and Associated Hospitals, New Delhi, Delhi, India
  5. 5ICMR-National Institute of Cancer Prevention and Research, Noida, Uttar Pradesh, India
  6. 6Department of Community Medicine, Maulana Azad Medical College and Associated Hospitals, New Delhi, Delhi, India
  7. 7Healis Sekhsaria Institute for Public Health, Navi Mumbai, Maharashtra, India
  8. 8School of Preventive Oncology, New Delhi, Delhi, India
  9. 9India Cancer Research Consortium, New Delhi, Delhi, India
  1. Correspondence to Dr Amit Yadav; advocateamit{at}


We examined the magnitude of smokeless tobacco (SLT) use in India and identified policy gaps to ascertain the priorities for SLT control in India and other high SLT burden countries in the Southeast Asia region. We reviewed and analysed the legal and policy framework to identify policy gaps, options and priority areas to address the SLT burden in India and lessons thereof. In India, 21.4% adults, including 29.6% of men, 12.8% of women, use SLT while more than 0.35 million Indians die every year due to SLT use. SLT use remains a huge public health concern for other countries in the region as well. Priority areas for SLT control should include: constant monitoring, increasing taxes and price of SLT products, strengthening and strict enforcement of existing laws, integration of SLT cessation with all health and development programmes, banning of advertisement and promotion of SLT, increasing age of access to tobacco up to 21 years, introducing licensing for the sale of SLT, standardising of SLT packaging and preventing SLT industry interference in the implementation of SLT control policies besides a committed multistakeholder approach for effective policy formulation and enforcement. SLT control in India and the other high SLT burden countries, especially in the Southeast Asia region, should focus on strengthening and implementing the above policy priorities.

  • health policy
  • prevention strategies
  • public health

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  • Handling editor Eduardo Gómez

  • Twitter @ayadav24

  • Contributors This paper was conceptualised by AY, PKS and RM. AY, PKS and NY prepared the first draft of the paper. NY, RK, AC and KC contributed to data collection and analysis. SS, SG, PCG and DNS contributed to the idea and critically reviewed different versions of the manuscript. All authors contributed to the revision and final manuscript in its present form.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement All data are available from sources cited in the text or Supplemental File.

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