Fewer Indians used tobacco in 2015-16 than a decade ago, but only China consumes and produces more tobacco, keeping cancer rates high, according to the latest national health data.
Tobacco consumption in India is the highest in the six northeastern states of Mizoram, Meghalaya, Manipur, Nagaland, Tripura and Assam: On average, 70.7 percent men here use tobacco in some form or the other, according to data from the National Family Health Survey 2015-16 (NFHS-4). This figure is 26 percentage points higher than the national average.
Mizoram tops the northeast list, with 80.4 percent men and 59.2 percent women between 15 and 49 years consuming tobacco. When ranked for men using tobacco, it is followed by Meghalaya (72.2 percent), Manipur (70.6 percent), Nagaland (69.4 percent), Tripura (67.8 percent) and Assam (63.9 percent).
At 37.7 percent, the female average for tobacco users in Manipur, Tripura, Meghalaya and Nagaland was way above the national average of 6.8 percent.
The northeastern states also report a higher risk for cancer-112 men and 60 women of 1,000 die of cancer here while the national average is 47 for men and 44 for women, according to the 2012 Million Death Study published in The Lancet.
Tobacco use is one of the main risk factors for a number of chronic diseases, including cancer, lung diseases and cardiovascular diseases. And not just in the northeast, elsewhere too millions of Indians continue to be vulnerable to these diseases.
The latest national average for tobacco consumption, according to NFHS-4 - 44.5 percent men and 6.8 percent women-is lower than 2005-06 figures. Tobacco use has fallen in India-by 12.5 percentage points for men and four percentage points for women-over a decade.
But India is still the second-highest producer and consumer of tobacco, according to National Tobacco Control Program.
In 2011, the total cost of dealing with diseases related to tobacco use among the 35-69 age group amounted to Rs 1.05 lakh crore ($22.4 billion). This is 1.16 percent of GDP and 12 percent more than the combined state and central government expenditure on healthcare in 2011.
The survey also shows that 29.3 percent female and 30.6 percent male tobacco users in the 15-49 age group tried to wean themselves off tobacco in the 12 months preceding the survey. In Mizoram, tobacco use has fallen by 1.6 percentage points and three percentage points for women and men, respectively, since 2005-06.
Punjab and Puducherry with 19.2 percent and 14.4 percent, respectively, recorded the lowest use of tobacco among men. Fewer than one percent women in the 15-49 age group use any kind of tobacco in Himachal Pradesh, Daman & Diu, Kerala, Chandigarh and Puducherry.
Both men and women (between 15 and 49 years of age) use more tobacco in India's villages than its cities. Among urban women, 4.4 percent use it compared to the 8.1 percent women in villages. For men in villages, the figure is 48 percent and in cities, 38.9 percent.
Even on the question of trying to go off tobacco, more urban women users (33 percent) make an effort than women users in villages (28.2 percent). But the trend is reversed for men: 31.2 percent male tobacco users in villages and 29.6 percent in cities tried to wean themselves off tobacco.
Not a single state has more than 50 percent of male and female tobacco consumers (in the 15-49 age group) attempting to quit consumption of tobacco in any form in 12 months preceding the survey.
The number of those using smokeless tobacco (25.9 percent) is almost double that of those who smoke (14 percent), according to Global Adult Tobacco Survey 2009-10.
"Tobacco is responsible for nearly 50 percent cancers in India and 90 percent of mouth cancers. Half of the mouth cancer patients die within 12 months of diagnosis," said Pankaj Chaturvedi, professor and surgeon at the Tata Memorial Hospital in Mumbai.
Tobacco caused 42 percent of all cancers in men and 18 percent of all cancers in women, according to the Million Death Study. In all, tobacco caused 120,000 cancers with twice as many oral cancers as lung cancer. This highlights the high prevalence of tobacco chewing in India.
"Raising taxes on tobacco products is an evidence-based tool to reduce tobacco use. We appeal to the government to levy highest Goods and Services Tax on all tobacco products, including beedi," said Michelle Reyes, an expert with the International Union Against TB and Lung Disease, in a statement released on the eve of the International Tobacco Day.