Northeast records some of India’s highest tobacco consumption rates, new study warns

Guwahati: A sharp rise in tobacco consumption across India over the past decade is ringing alarm bells for public health experts, with several Northeast states emerging among the highest-consuming regions in the country, according to a new analysis of national household consumption data.

The findings are part of a working paper titled “Rise in Tobacco Consumption and Policy Implications: An Analysis of Household Consumption Expenditure Survey 2011–12 and 2023–24,” authored by Dr Shamika Ravi, Member of the Economic Advisory Council to the Prime Minister, and Partha Protim Barman, a Young Professional at the council.

The study, based on the Household Consumption Expenditure Survey (HCES) 2023–24, found that tobacco use has increased dramatically nationwide, but the Northeast shows some of the most intense patterns of consumption in both rural and urban areas. Researchers noted that states in the Northeast region record tobacco consumption levels significantly higher than the national average.

Tripura, Arunachal Pradesh, Mizoram and Meghalaya were found to have some of the highest shares of households consuming tobacco in rural India. In Tripura, an estimated 96.4% of rural households reported consuming tobacco products, the highest in the country. This was followed by Arunachal Pradesh at 94.3%, Mizoram at 92.7% and Meghalaya at 89.8%, all significantly above the national rural average of 68.5%.

Urban areas show a similar pattern. Mizoram recorded the highest urban tobacco consumption at 91%, followed by Tripura at 89.8% and Arunachal Pradesh at 83%, again placing Northeast states among the top in the country.

The study shows tobacco consumption expanding rapidly across India over the past decade. In rural India, the number of households consuming tobacco rose from 9.9 crore in 2011–12 to 13.3 crore in 2023–24. In urban India, the number increased from 2.8 crore to 4.7 crore households, representing a 33% rise in rural areas and a staggering 59% increase in cities.

Researchers warn that tobacco use is no longer confined to traditional pockets and is increasingly spreading across regions and income groups. One of the most striking changes identified in the study is the rapid rise of packaged tobacco products such as gutkha and cigarettes, while traditional products like bidi are gradually declining.

The report notes that the Northeast region also shows a significant prevalence of gutkha consumption. The incidence of gutkha use in Tripura, Sikkim, Nagaland, Arunachal Pradesh and Assam is higher than the national average. However, the share has declined slightly in Meghalaya, from 8.8% to 7%, and in Mizoram from 5.1% to 1.2%.

At the national level, gutkha consumption in rural India rose sharply from 5.3% of households in 2011–12 to 30.4% in 2023–24, representing a more than six-fold increase. Cigarette use also increased from 4.8% to 11.2% of households during the same period. Urban areas recorded similar trends, with gutkha consumption rising from 3.07% to 16.8% of households, while cigarette consumption increased from 8.4% to 18%.

Experts say these changes indicate a shift away from traditional tobacco products towards commercially packaged and aggressively marketed alternatives.

The report also highlights distinct tobacco consumption patterns in the Northeast. Cigarette smoking is extremely high in Mizoram, where 85.9% of rural households reported cigarette use — the highest in the country. Meanwhile, leaf and chewing tobacco remain widely used in states such as Assam, where more than half of rural households reported consuming such products.

However, the study also points to some positive trends. In states such as Meghalaya and Mizoram, gutkha consumption has declined slightly over the decade, suggesting that targeted regulation and awareness campaigns may be having some effect.

Another worrying finding is that tobacco use remains highest among poorer households. Across India, more than 70% of rural households in the bottom 40% income group consume tobacco, compared with about 63% among the richest 20%.

Researchers say this means tobacco spending is diverting household resources away from essential needs such as nutrition, education and healthcare, particularly among low-income families.

The study further warns that rising tobacco consumption could worsen India’s growing burden of non-communicable diseases (NCDs). Tobacco is a major risk factor for cardiovascular disease, cancer, respiratory illness and hypertension. India already records around 1.3 million tobacco-related deaths every year, according to the report.

With publicly funded healthcare schemes expanding, the researchers caution that increasing tobacco use could place additional financial strain on government health systems.

They also call for stronger regulation and enforcement to curb the trend, pointing to widespread surrogate advertising of gutkha and pan masala, the “twin-product” strategy used by manufacturers to bypass bans, and the easy availability of smokeless tobacco products.

Without stronger intervention, the report warns, tobacco consumption could continue rising even as the country expands public healthcare coverage.

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