By:- Dr. Prakash Swain (Consultant Radiation Oncology) HCG Cancer Hospital Cuttack
Smoking remains one of the most preventable causes of disease and premature deaths worldwide, yet its impact continues to strain public health systems and families alike. From cancers and heart disease to chronic respiratory illnesses, tobacco use silently contributes to a wide range of conditions that often go undetected until they are advanced. Despite decades of awareness campaigns, millions continue to initiate or sustain smoking habits, highlighting the need for stronger, more targeted public awareness and prevention strategies.
Every year, India loses over 1.35 million people to tobacco-related diseases and among them, 1,15mn deaths are directly attributable to smoking (Tobacco Atlas 2025). Each of these deaths is driven by gaps in awareness, policy enforcement, and access to support. Even when people want to quit, many find it hard to access help backed by facts.
At the heart of prevention lies education. Public awareness campaigns must go beyond generic warnings and clearly communicate the real-life consequences of smoking. Visual storytelling, survivor testimonies, and community-driven messaging can make risks more relatable and urgent. It is especially important to reach younger audiences before habits are formed. Schools, colleges, and digital platforms play a critical role in delivering age-appropriate, impactful information that discourages experimentation and counters the glamorization of tobacco use.
Awareness: The First Line of Defence
Through the tobacco control achievements, India has achieved so far are the result of sustained efforts. The National Tobacco Control Programme (NTCP), launched in 2007–08 and now active across all 36 states and union territories covering 612 districts, drove a measurable reduction in tobacco use. Pictorial health warnings, mass media campaigns, and school education programmes all contributed. That progress is now stalling.
The WHO's 2025 Global Tobacco Report shows adult smoking prevalence rising again, from 8.1% in 2020 to 9.3% in 2024. The Global Youth Tobacco Survey (GYTS, 2019) found that 8.4% of students aged 13–15 currently use tobacco. The Government's Tobacco Free Youth Campaign 3.0, launched in October 2025 across schools and colleges, was a direct response to this crisis.
Yet, the rise in cases tells us that campaigns without enforcement are mere noise. Awareness must move beyond data and platforms to reach the individual who believes a bidi is safer than a cigarette, the professional who considers occasional smoking harmless, and the family that does not recognize passive smoke as a health threat.
Meeting the Smoker Halfway
Only 7% of Indian smokers successfully quit without assistance (CDC). For the millions who want to stop, the system rarely meets them. India has over 2,000 Tobacco Cessation Centres (TCCs) in district hospitals, dental colleges, and medical institutions, alongside a National Tobacco Quitline (1800-11-2356) offering counselling in 16 languages and a Cessation programme via SMS. Unfortunately, they remain chronically underutilized, underfunded, and unknown to most users.
Quitting at any age, after any duration of use, delivers measurable health benefits. Within hours, blood pressure normalizes and circulation improves. Over years, the risk of tobacco-related cancers and cardiovascular disease declines substantially. For individuals already experiencing warning signs such as persistent cough, unexplained weight loss, blood in sputum, or mouth ulcers that do not heal, early clinical evaluation is not optional.
Clinicians are among the most trusted voices in the space for awareness. Even a brief conversation during a routine consultation, flagging risk, sharing cessation options can lead a patient to the Quitline. Abnormal findings in tobacco users, including oral lesions, respiratory symptoms, and irregular imaging, must trigger prompt investigation. Communities carry equal responsibility in creating a favorable environment.
Frameworks and the Gap Between Policy and Action
The Cigarettes and Other Tobacco Products Act (COTPA, 2003), still active. It prohibits smoking in public spaces, bans tobacco advertising, restricts sales near educational institutions, and mandates pictorial health warnings. India ratified the WHO Framework Convention on Tobacco Control (WHO-FCTC) in 2004, among the first countries to do so. The WHO's MPOWER framework remains the operational roadmap, monitoring use, protecting non-smokers, supporting cessation, warning the public, enforcing bans, and raising taxes.
The problem is not the frameworks. A 2025 study in Health Policy and Planning, evaluating two decades of COTPA and NTCP implementation, found compliance with smoke-free provisions inconsistent across states. Fines under COTPA have not been revised in over two decades, gutting their deterrent value. Tobacco continues to be sold near schools and colleges in many states. Implémentation of the law is uneven, under-resourced, and insufficiently monitored. Taxation, one of the most evidence-backed tools for reducing initiation, especially among the young, remains underutilized.
What are We Missing?
India has the frameworks, the clinical infrastructure, and the ecosystem. What has been missing is consistent, sustained action where campaigns are followed through, guidelines are enforced and awareness conversations happen at every consultation, not only when disease is advanced.
The number of deaths and increased cancer cases from smoking are a sign that awareness, political will, and clinical action can make a difference, if implemented without fail.
