Tobacco in its various forms, is the most common substance of abuse worldwide. Introduced in India first in the 17th century, the practice of smoking tobacco merged with the age-old habit of smoking cannabis. The traditional ‘dhumapana’ (‘drinking smoke’) came to denote smoking cigarettes rather than the chillum or hookah originally used. Tobacco in the form of cigars, cigarettes, beedis, grounded betel nut (chewable), khaini and snuff form the bulk of its usage in India. Despite adding to the country's revenue, its health hazards are well-established and despite increasing legislation over the years, the implementation of anti-tobacco measures are sadly still in their adolescence.
The World Health Organisation (WHO) estimates around 125 million smokers in India and around 72% of all males have used tobacco in any form at least once in their lifetime. The National Mental Health Survey (NMHS) conducted in 2015-16 showed 21% of the entire Indian population using tobacco with the male: female ratio being 4:1. Around 1 million deaths are attributable each year to tobacco usage, that contributes to 9.5% of the total mortality. The concerning fact is that second-hand tobacco smoke affects even more people and the young economically-productive population are among the most affected. The Indian Heart Association (IHA) in its 2015 report states that India contributes to 75% of the world’s cardiac deaths even though it consists of only 20% of the world population. Besides one of the major direct contributors of this cardiac burden is tobacco use.