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INDIA is at the intersection of local and global forces fueling a worldwide epidemic of smoking deaths. Approximately 1.25 billion people smoked worldwide in 1998 and, assuming no change in global prevalence, this number will increase to 1.7 billion by 2020. This smoking epidemic currently results in an estimated 4 million deaths annually, projected to rise to 10 million by 2030 (1). Seventy percent of those deaths will occur in developing countries. The smoking epidemic has spread from its initial focus, men in high-income countries, to women in high-income countries, and more recently to men in low-income countries (2). Now, the aggressive marketing of tobacco also threatens women in the developing world.
India's tobacco industry is one of the biggest in the world. India's acreage devoted to growing tobacco is the second largest in the world, exceeded only by China's. India's tobacco production is third, after China and the U.S. About 6 million Indian farmers are engaged in growing tobacco. Another 20 million people work on tobacco farms, and a large percentage of the population is employed in the retail trade (3). If the employees' families are counted, it can safely be said that the tobacco industry in India probably supports ioo million people. The industry also generates substantial revenues for the government-nearly 5 percent of the budget revenue (3). Given those facts, it is clear that the tobacco industry plays an important role in the Indian economy.
At the same time, the enormous health costs have made tobacco control a serious issue, prompting ongoing debates over the economics of tobacco control globally, as well as in India. In many parts of the world, tobacco consumption mostly takes the form of smoking cigarettes, but in South Asia, tobacco consumption takes many different forms. In addition to manufactured cigarettes, hand-rolled cigarettes called biais are more commonly used. Tobacco can also be chewed inside a paan or betel leaf, a practice also prevalent in South Asia. Effectively tackling tobacco consumption must involve measures to control the varying ways of using tobacco. While a significant literature exists on tobacco consumption and production in India, this paper takes a fresh look at trends in prevalence, using the 1995-96 National Sample Survey (NSS) data, as well as other secondary evidence....