This year’s World No Tobacco Day (WNTD) theme, “Unmasking the appeal: countering nicotine and tobacco addiction,” highlights a significant public health issue. This theme indicates a crucial shift towards addressing nicotine, which has long been exploited by the tobacco industry while overshadowing the harmful tobacco combustion products. In India, where approximately 267 million individuals use tobacco, this call for action is particularly urgent.

Tobacco-related deaths in India exceed 1.3 million annually, with cardiovascular diseases (CVDs) being the most prevalent cause. Reports indicate that close to 6.5 lakhs of these deaths originate from CVDs linked to nicotine. This fact underlines nicotine’s role in heightening health risks, including hypertension and atherosclerosis, affecting both smokers and the numerous users of smokeless tobacco.

The tobacco market in India is highly diverse and complex, featuring cigarettes, bidis, gutkha, and more. This diversity, however, shares a common factor—nicotine, which serves as the primary substance that fosters addiction. Understanding nicotine’s central role is essential for addressing the ongoing public health crisis effectively.

Legislative Framework and Challenges

India has one of the most progressive tobacco control legislations globally, with the Prohibition of Electronic Cigarettes Act and the Cigarettes and Other Tobacco Products Act among the key policies. These regulations provide the necessary framework to combat tobacco use and support public health initiatives, despite inconsistent enforcement posing challenges to their effectiveness.

Recent findings from a systematic review point to an alarming prevalence of vaping in India, reported at 14 per cent, even following the imposition of a ban in 2019. Ineffective enforcement has been identified as a significant factor contributing to the rising trend, highlighting the need for comprehensive application of existing laws.

Furthermore, certain Indian celebrities inadvertently contribute to the popularity of nicotine through indirect promotions in media and film. Legal provisions are already in place to classify nicotine as a drug and restrict its distribution. Strengthening the enforcement of these regulations through collaboration with various stakeholders may assist in curbing the rising trend in tobacco and nicotine use among the youth.

Future Directions for Tobacco Control in India

The call for comprehensive nicotine cessation strategies is pressing, especially given the low quit ratios among former tobacco users, as noted in the Global Adult Tobacco Survey. An approach focusing on effective non-nicotine pharmacological therapies, such as cytisine, could offer promising alternatives and empower more users to quit.

Moreover, revisiting Nicotine Replacement Therapy (NRT) poses an ethical dilemma in treating nicotine addiction with nicotine itself. Greater emphasis should be placed on non-nicotine options to aid in tobacco cessation, which may help in mitigating potential conflicts of interest arising from the tobacco industry’s involvement in the cessation market.

As India approaches WNTD 2026, there is a pressing need to highlight nicotine’s role in contributing to public health issues and to implement laws that encompass emerging products like synthetic nicotine. The nation’s objectives for a tobacco-free generation by 2047 rely on the successful execution of comprehensive and effective nicotine control measures.

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