Youth Tobacco Use in India: Industry Strategies, Epidemiological Trends, and Policy Gaps

Abstract

Background: Youth tobacco and nicotine uptake in India persists despite strong legislation, as industry marketing adapts to entertainment media, digital channels, and surrogate promotion. Materials & Methods: This narrative review synthesises surveillance evidence and published reports on youth tobacco/nicotine use in India, alongside policy and implementation literature on tobacco control, industry tactics, and health consequences. Results: GYTS-4 India 2019 (report published 2021) reports that 8% of students aged 13–15 years currently use any tobacco product, and 3% have ever tried an e-cigarette. These figures represent a 42% decline in current use since 2009, indicating progress. However, exposure to tobacco advertisements and related imagery remains high across media platforms: television (44.5%), movies (37.3%), internet videos (33.5%), and online/internet (23.4%) in the past 30 days. The reviewed evidence indicates that flavoured products, surrogate branding, and influencer/digital promotion can sustain youth appeal despite statutory restrictions, while implementation gaps enable continued exposure and access. Early nicotine initiation is associated with dependence risk and adverse respiratory and psychosocial outcomes. Conclusions: India’s gains in reducing youth tobacco use will be sustained only if tobacco control implementation keeps pace with evolving marketing ecosystems, with stronger action on surrogate and digital promotion, media compliance monitoring, and youth-focused prevention and cessation support.