4 min readPuneApr 21, 2026 07:24 AM IST
First published on: Apr 21, 2026 at 07:24 AM IST
Over 20.49 million households — 10.6% of all households in the country — could rise to a higher economic class just by stopping spending on tobacco and redirecting that money to other needs, as per a new study published in BMJ Global Health. The study led by researchers at ICMR National Institute of Cancer Prevention and Research (ICMR-NICPR), Noida, and Tata Institute of Social Sciences (TISS), Mumbai, is the first to quantify at national scale the households using tobacco in different forms.
The poorest households, the study finds, spend 6.4% of their entire monthly income on tobacco, the study found. “Tobacco is not just a health burden — it is a poverty trap. We have now shown, with the most rigorous national data available, that 20 million households could move up an economic class simply by quitting. For a rural family already spending nearly 7% of all its income on tobacco, this is not an abstraction — this is the difference between poverty and dignity. Tobacco cessation must be treated as a poverty alleviation strategy, not merely a health message,” Dr Prashant Kumar Singh, Senior Scientist, ICMR-NICPR, Noida, and corresponding author told The Indian Express.
India carries one of the world’s largest tobacco burdens. With over 267 million tobacco users, which is nearly a quarter of the adult population, tobacco is the single largest preventable cause of death and disease in the country, responsible for over a million deaths every year. Its established links to cancers of the mouth, throat, lung, and oesophagus as well as to heart disease and stroke, have long made it a central concern of public health policy.
Drawing on 2,61,746 nationally representative households from the 2022-23 survey on Household Consumption Expenditure, the study found that the poorest families are paying the highest price. According to the study (The economics of quitting: estimating the uplift potential of Indian households through tobacco cessation), a family in the lowest income group spends 6.4% of its entire monthly income on tobacco. A family at the top spends just 2%. Among the poorest households, 5.62 million (12.4%) could escape their income class entirely through cessation, the study suggests.
ExplainedTobacco Tally & Toll
India is the second largest consumer and producer of tobacco globally. Tobacco products account for nearly 1.35 million deaths every year (3,700 deaths every single day). India also accounts for 70% of the global burden of smokeless tobacco, and 27% of all cancers in India are attributable to tobacco use. Nearly 9 out of 10 adults who use tobacco started before age 18 when the brain is still developing, making young people far more susceptible to nicotine dependence. Among adolescents specifically, tobacco prevalence among those aged 13-15 was 8.5% in 2019 according to the Global Youth Tobacco Survey. In India, 9.6% of boys and 7.4% of girls use tobacco, it said.
According to the researchers, 17 million rural households could move up an economic class through tobacco cessation, compared to 3.5 million urban households. Rural families spend a larger share of income on tobacco (6.6% vs 5.6% in cities) and have far fewer financial safety nets. The rural uplift rate is 60% higher than in urban areas. Also 7.12 million lower-middle-income households (16.8%) could advance to a higher income bracket through cessation.
“This study reframes the conversation on tobacco. It is no longer sufficient to speak of lives saved, we must speak of livelihoods transformed. When a family quits tobacco, they do not just reduce their cancer risk, they reclaim the income to feed their children, pay school fees, and seek timely medical care. Our findings demand that tobacco control be placed at the centre of poverty and development agenda,” said Dr Shalini Singh, Director, ICMR–National Institute of Cancer Prevention and Research (ICMR-NICPR), Noida.
According to Dr Montu Bose, School of Health Systems Studies, TISS Mumbai, the household expenditure data tells a story that tobacco is actively blocking economic mobility for millions of Indian families. “This study contributes evidence that bridges public health and social equity in such a direct, policy-relevant way,” Dr Bose said.
Study authors have pointed out that no new government schemes or additional cash transfer are required. “The resources are already there … What is vital is to integrate tobacco control into flagship poverty programmes and other nutrition and livelihood schemes. International development organisations should likewise incorporate cessation into their poverty reduction frameworks for low- and middle-income countries,” they said.
The poorest households, the study finds, spend 6.4% of their entire monthly income on tobacco, the study found. (File photo) 
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