Having nearly 275 million tobacco users, India ranks second globally and very close to China (approximately 301 million users). But unlike China, where nearly all are smokers and nearly 95 per cent smoke manufactured cigarettes, India accounts for more of smokeless tobacco users — 206 million, says a study published today (August 17) in The Lancet.

The study analysed the data from the Global Adult Tobacco Survey (GATS) conducted between October 2008 and March 2010. The data from 14 low and middle-income countries that “collectively contribute to most of the disease burden attributable to tobacco use” was compared with that of the U.K and the U.S. The number of people surveyed was different in the case of each country. India had the highest number surveyed, both of men and women.

Chewing tobacco accounted for almost all of the smokeless tobacco consumption in India. “Various forms of loose-leaf chewed tobacco are commonly consumed in the Indian subcontinent,” states the paper. “Smokeless tobacco use is particularly prevalent in India, Bangladesh, and in Thai women.”

In the case of India, 23 per cent of men were smokers during 2008-2010. This is comparable with the percentage seen in the U.S. and slightly higher than the U.K figure. Brazil was the only country that had lesser percentage of smokers. With more than 60 per cent, Russia has the highest number of smokers, and is closely followed by China at 53 per cent. With 6.1 mean cigarettes a day smoked, India has the lowest figure among the 16 countries.

But this is more than compensated by the number of men who chew tobacco. At nearly 33 per cent, India has the highest male smokeless tobacco users, just above Bangladesh (26.4 per cent). The other countries have it well below 5 per cent. “Approximately 52 per cent of oral cancers in India are attributable to the use of smokeless tobacco products,” the study underlines.

Once again it is clear that the percentage of men in India who smoke and also use smokeless tobacco products is as high as 9.3 per cent. The country ranks second in this category after Bangladesh (13 per cent).

For men, smoking of bidis is common in Bangladesh (21.4 per cent) and India (16.1 per cent). “Bidis produce risks for several diseases that are at least as high as those for manufactured cigarettes,” the study warns.

In the case of women in India, the percentage of current smokers is 2.9, thus figuring as the fourth from the bottom of the 16 countries analysed. But smokeless tobacco use among women is 18.4 per cent, second only to Bangladesh (28.7 per cent).

The prevalence of male smokers in the 15-19 age group in India is 5.4 per cent, much less than Russia’s 38 per cent.

“In both the crude and age standardised data, quit ratios were low in China, India, Egypt, Russia, and Bangladesh [less than 20 per cent overall], and substantially higher in the U.K., U.S.A., Brazil, and Uruguay [greater than 35 per cent],” states the study.