Smoked out or chewed up: trends in tobacco consumption in India using National Family Health Survey data from 2015 to 2016 and 2019 to 2021

Objective To assess and compare the patterns of smoked and smokeless tobacco use in India and to identify demographic and socioeconomic factors associated with tobacco use through secondary data analysis of National Family Health Survey (NFHS-4) (2015–2016) and (NFHS-5) (2019–2021) datasets. Study design and setting A comparative weighted sample secondary data analysis was conducted using individual sampling weights in SPSS V.29.0, encompassing all 29 states and 7 union territories of India. Participants A total of 8 11 808 individuals from NFHS-4 (699 686 women aged 15–49 years and 1 12 122 men aged 15–54 years) and 825 954 individuals from NFHS-5 (724 115 women aged 15–49 years and 101 839 men aged 15–54 years), were included in the analysis. Main outcome measures Changes in smoked and smokeless tobacco use between the two survey rounds, stratified by age, gender, residency, socioeconomic status, and education. Methods Prevalence estimates were summarised as percentages with 95% CIs. Differences between NFHS-4 and NFHS-5 were assessed using the Z test for proportions, with significance at p<0.05. Results Bidi and cigarette use declined modestly among men, while gutkha/paan masala use showed the sharpest reduction among women. The overall prevalence of tobacco use declined from 45.5% to 40.8% among men (–4.7 points) and from 6.8% to 4.0% among women (–2.8 points). Bidi use showed the steepest reduction in the study. Among men, it was (14.9%–14.2%), while cigarette use declined modestly (13.7%–13.3%). Rare smoked forms such as pipe, hookah and cigar remained uncommon. Among women, the prevalence of smoked tobacco was negligible, whereas smokeless forms were more frequent but that too showed decline, with the largest reduction observed in gutkha/paan masala (2.2%–1.4%). Conclusions Tobacco use in India declined modestly between NFHS-4 and NFHS-5, with greater reductions in smoked than in smokeless forms. Nonetheless, smokeless tobacco remains more prevalent among women, and significant disparities persist across gender, rural–urban residence and socioeconomic strata.