(MENAFN- Live Mint)

New Delhi: In what has sounded warning bells among Indian public policy makers, the Union government has been getting reports of children in some states starting to use tobacco as early as seven years of age, according to a senior government official and documents reviewed by Mint.

This comes in the backdrop of Gujarat, Karnataka, Maharashtra, Rajasthan, and Tamil Nadu having reported the highest number of violations. The development assumes significance given that tobacco remains a leading cause of death in India, killing 1.35 million people annually.

Based on the Global Youth Tobacco Survey (GYTS) 2019, children in India start tobacco use with both smoked and smokeless forms, a finding highlighted in a 2024 World Health Organization report. Smokeless Tobacco (SLT) products, such as gutkha, khaini, or zarda, are a major form of early initiation, with 24% of surveyed children aged 13-15 beginning their use before their seventh birthday. Smoked tobacco also contributes significantly to this early trend: Bidi smoking is initiated by 17.2%, and cigarette smoking by 11.4% of children before the age of seven.

Given the crisis, the Centre is launching a major enforcement drive to tackle tobacco use to strictly enforce the Cigarettes and Other Tobacco Products Act (Cotpa) and the ban on e-cigarettes (Prohibition of Electronic Cigarettes Act (Peca), 2019); with district-level teams under the National Tobacco Control Programme being tasked to step up raids. State drug controllers have also been tasked to monitor nicotine-containing products in the market.

There were 12,001 violations reported under the minor sales ban and 203 breaches of the e-cigarette ban in FY 2025-26 alone.

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In a letter issued to the States/UTs reviewed by Mint, Union health secretary Punya Salila Srivastava said that tobacco use remains one of the leading causes of preventable diseases and deaths in India, resulting in 13.5 lakh deaths annually.“Alarmingly, tobacco use is reported to begin at an early age, with the age of initiation of tobacco use reported as low as seven years in some States, which is very concerning," Srivastava said.

To combat this crisis, the government has institutionalized the annual Tobacco Free Youth Campaign (TFYC) since 2023, to educate and empower young Indians to resist or quit tobacco.

The tobacco use crisis among Indian children is driven by multiple interconnected factors, as detailed in various medical journals like PubMed and ResearchGate. Family influence is important, as the habit is often initiated due to tobacco use by parents or elder siblings, or when children are asked to purchase tobacco products.

Peer pressure and social factors, including experimentation and the influence of friends, act as major drivers. Furthermore, aggressive marketing and easy availability of nicotine products, particularly from companies targeting adolescents in developing countries, contribute significantly to the problem. Socio-economic predictors, such as lower family income and low parental education levels, increase the risk, compounded by awareness gaps regarding the specific, severe health hazards of tobacco.

The severe problem of early age tobacco initiation in India is documented by WHO GATS surveys. The Global Youth Tobacco Survey 2019 confirmed this trend, showing that a large number of adolescents (aged 13-15) who had used tobacco began the habit before the age of 10.

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Enforcement drive

This year's strategies include enhancing compliance with tobacco-free educational institutions (ToFEI) guidelines, ensuring tobacco-free villages, and strengthening enforcement of the Cigarettes and Other Tobacco Products Act, 2003, and the Prohibition of Electronic Cigarettes Act, 2019.

Queries sent to the health ministry spokesperson on Saturday remained unanswered.

“The government has directed the states/UTs for the rigorous implementation of the ToFEI guidelines. This involves several steps to create tobacco-free learning environments: every educational institution must administer a "No Tobacco Pledge", designate a teacher, staff member, or student as a "Tobacco Monitor", and ensure the campus and the surrounding area are clearly demarcated as tobacco-free zones. This demarcation includes painting a "Yellow Line" to mark the perimeter, making the 100-yard zone around schools and universities a target for enforcement drives," the official cited above said.

Furthermore, states have been directed to conduct intensive enforcement drives to implement tobacco control laws, with the support of specialised enforcement squads, the official added.

Tobacco kills half its users prematurely. In India, nearly 3,600 people die every day due to tobacco use. Mortality from tobacco in India is estimated at upwards of 1.3 million, with one million deaths attributed to smoking and the rest to smokeless tobacco use. According to the Indian Council of Medical Research (ICMR), tobacco use increases the risk of stroke by 78%, ischemic heart disease by 85.2%, and raises the chances of contracting tuberculosis and acute myocardial infarction. It is also responsible for 43% of oesophageal cancer, apart from increasing the probability of having oral and lung cancer.

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• Children in Gujarat, Karnataka, Maharashtra, Rajasthan, and Tamil Nadu are starting tobacco use as early as seven years old, prompting urgent government action.
• The Union government is launching a significant push to strictly enforce the Cigarettes and Other Tobacco Products Act and the Prohibition of Electronic Cigarettes Act.
• In FY 2025-26 alone, there were 12,001 reported violations of the minor sales ban and 203 breaches of the e-cigarette ban, underscoring major compliance issues.
• Enforcement strategy includes rigorous implementation of 'Tobacco Free Educational Institutions' guidelines.
• Experts stress that strict law enforcement must be combined with crucial interventions like sustained school-based education, parental awareness, and curbs on surrogate advertising to achieve long-term success.

Compliance efforts

Malavika Kaura Saxena, chief marketing officer at Rusan Pharma, welcomed the intensified efforts, noting that the reported early tobacco initiation is a "deeply concerning public health issue" and that stricter enforcement of laws like Cotpa and Peca is a "critical step forward." She highlighted that the increasing demand for scientifically backed nicotine replacement therapies (NRT) indicates India's readiness to shift "from addiction to cessation".

The demand for Nicotine Replacement Therapy in India is experiencing significant growth, driven by key market and policy shifts. The NRT market was valued at approximately $33 million in 2023 and is projected to reach $108 million by 2033, growing at a CAGR of about 12.5%. Nicotine gums dominate the revenue share (84% in 2023) as per Grand View Research.

This surge is due to increased public awareness of tobacco's detrimental health effects, and government support, notably the inclusion of NRT in the National List of Essential Medicines in September 2022. This step, along with services like the National Tobacco Quit Line, enhances accessibility and supports over half of Indian adult smokers who intend to quit, with NRT potentially increasing their success rate by 50-60%.

Dr. Shivaraj Ajji, head of pulmonology medicine at SPARSH Hospital, Bengaluru, said that the nationwide crackdown is a "much-needed step to protect India's youth from a lifetime of addiction and disease." He emphasized that the problem highlights significant gaps in enforcement and awareness. He concluded that while strict implementation of laws is essential, it must be combined with sustained school-based education, parental awareness, and curbs on surrogate advertising to make tobacco use socially unacceptable.

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