Reducing adolescent smoking in India – Authors' reply
Authors: Bo Xi, Yajun Liang, Sreenivas P Veeranki
Journal: The Lancet Global Health (2017)

Historically, most of the smoked tobacco in India has been in the form of bidis, because they are cheap and locally manufactured. Evidence suggests that tobacco use rates are increasing in India, with a clear shift in consumption away from bidis to cigarettes among adults, particularly young adults aged 15–29 years.1Mishra S Joseph RA Gupta PC et al.Trends in bidi and cigarette smoking in India from 1998 to 2015, by age, gender and education.BMJ Glob Health. 2016; 1: e000005Crossref PubMed Google Scholar However, there is no such evidence for a consumption shift in adolescents aged 13–15 years despite high bidi smoking rates in this population. We appreciate Mrinal Barua and colleagues' interest in our paper,2Xi B Liang Y Liu Y et al.Tobacco use and second-hand smoke exposure in young adolescents aged 12–15 years: data from 68 low-income and middle-income countries.Lancet Glob Health. 2016; 4: e795-e805Summary Full Text Full Text PDF PubMed Scopus (121) Google Scholar and for proposing social class-specific strategies to reduce adolescent smoking in India. The existence of a social gradient in tobacco use has been clearly established in people with lower socioeconomic status, and it is also pronounced in Indian adults.3Bhan N Karan A Srivastava S et al.Have socioeconomic inequalities in tobacco use in India increased over time? Trends from the national sample Surveys (2000–2012).Nicotine Tob Res. 2016; 18: 1711-1718Crossref PubMed Scopus (34) Google Scholar To our knowledge, no evidence of this pattern exists in Indian adolescents and future studies are therefore warranted. India is the second largest consumer and third largest producer of tobacco in the world. The Indian Government has been significantly engaged in addressing the tobacco problem. A major policy, the Cigarettes and Other Tobacco Products Act (COTPA) was implemented in 2003, followed by WHO's Framework Convention on Tobacco Control (FCTC) ratification in 2004.4Kaur J Jain D C Tobacco control policies in India: Implementation and challenges.Indian J Public Health. 2011; 55: 220-227Crossref PubMed Scopus (95) Google Scholar The Indian Government also initiated the National Tobacco Control Programme, which is aimed at tobacco cessation efforts and capacity building at the state level.4Kaur J Jain D C Tobacco control policies in India: Implementation and challenges.Indian J Public Health. 2011; 55: 220-227Crossref PubMed Scopus (95) Google Scholar Despite these stringent efforts, cigarette and bidi consumption rates continue to increase with deceasing social class gradient.3Bhan N Karan A Srivastava S et al.Have socioeconomic inequalities in tobacco use in India increased over time? Trends from the national sample Surveys (2000–2012).Nicotine Tob Res. 2016; 18: 1711-1718Crossref PubMed Scopus (34) Google Scholar These trends reflect the lack of substantial increase in tobacco excise taxes to decrease affordability, as also highlighted by Barua and colleagues. Another suggestion of Barua and colleagues was the adoption of an alcohol retail sales model for tobacco products in India to reduce accessibility of tobacco products to adolescents—a provision already covered under the existing tobacco laws in India. This strategy would help reduce unorganised or unaccounted sale of tobacco products in India. Given the population dynamics in India, raising taxes to reduce adolescent smoking might work by decreasing affordability of tobacco products for adults thus indirectly reducing adolescents' access. But we have reservations about tobacco-specific regulated retail outlets—including the feasibilty of establishing such outlets— and simulation models are warranted in this direction. Comprehensive tobacco control programmes that aim to denormalise smoking behaviour to reduce initiation and increase parental and peer anti-smoking education, aggressive media campaigns, social norm changes, teen-specific smoking cessation programmes, and increasing tobacco prices or taxation could reduce adolescent smoking in India. We declare no competing interests. Reducing adolescent smoking in IndiaDavid P Thomas and Marita Hefler1 suggest ways to reduce adolescent smoking in low-income and middle-income countries, in response to the Article by Bo Xi and colleagues (November, 2016).2 We suggest some additional measures to reduce adolescent smoking in India. Full-Text PDF Open AccessTobacco use and second-hand smoke exposure in young adolescents aged 12–15 years: data from 68 low-income and middle-income countriesTobacco use and second-hand smoke exposure were frequent among young adolescents aged 12–15 years in low-income and middle-income countries. Parental tobacco use and second-hand smoke exposure were strongly associated with young adolescents' tobacco use. The data emphasise the need to strengthen tobacco control interventions and programmes in young adolescents from low-income and middle-income countries. Full-Text PDF Open Access