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Impact of India’s National Tobacco Control Programme on bidi and cigarette consumption: a difference-in-differences analysis
  1. Gaurang P Nazar1,2,
  2. Kiara C-M Chang3,
  3. Swati Srivastava4,
  4. Neil Pearce2,
  5. Anup Karan5,
  6. Christopher Millett1,3,6
  1. 1 Health Promotion Division, Public Health Foundation of India, Gurugram, India
  2. 2 Department of Non-communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine (LSHTM), London, UK
  3. 3 Public Health Policy Evaluation Unit, School of Public Health, Imperial College London, London, UK
  4. 4 Department of International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, USA
  5. 5 Indian Institute of Public Health, Delhi (IIPHD), Public Health Foundation of India, Gurugram, India
  6. 6 Center for Epidemiological Studies in Health and Nutrition, University of São Paulo, São Paulo, Brazil
  1. Correspondence to Dr. Kiara C-M Chang, Public Health Policy Evaluation Unit, School of Public Health, Imperial College London, London W6 8RP, UK; chu-mei.chang{at}


Background Despite the importance of decreasing tobacco use to achieve mortality reduction targets of the Sustainable Development Goals in low-income and middle-income countries (LMICs), evaluations of tobacco control programmes in these settings are scarce. We assessed the impacts of India’s National Tobacco Control Programme (NTCP), as implemented in 42 districts during 2007–2009, on household-reported consumption of bidis and cigarettes.

Methods Secondary analysis of cross-sectional data from nationally representative Household Consumer Expenditure Surveys (1999–2000; 2004–2005 and 2011–2012). Outcomes were: any bidi/cigarette consumption in the household and monthly consumption of bidi/cigarette sticks per person. A difference-in-differences two-part model was used to compare changes in bidi/cigarette consumption between NTCP intervention and control districts, adjusting for sociodemographic characteristics and time-based heterogeneity.

Findings There was an overall decline in household-reported bidi and cigarette consumption between 1999–2000 and 2011–2012. However, compared with control districts, NTCP districts had no significantly different reductions in the proportions of households reporting bidi (adjusted OR (AOR): 1.03, 95% CI: 0.84 to 1.28) or cigarette (AOR: 1.01 to 95% CI: 0.82 to 1.26) consumption, or for the monthly per person consumption of bidi (adjusted coefficient: 0.07, 95% CI: −0.13 to 0.28) or cigarette (adjusted coefficient: −0.002, 95% CI: −0.26 to 0.26) sticks among bidi/cigarette consuming households.

Interpretation Our findings indicate that early implementation of the NTCP may not have produced reductions in tobacco use reflecting generally poor performance against the Framework Convention for Tobacco Control objectives in India. This study highlights the importance of strengthening the implementation and enforcement of tobacco control policies in LMICs to achieve national and international child health and premature NCD mortality reduction targets.

  • non-cigarette tobacco products
  • low/middle income country
  • cessation
  • public policy
  • harm reduction

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  • Contributors CM, AK, GPN and SS conceptualised the study. GPN contributed substantially to data analyses and interpretation of results under the guidance of CM and AK, and with technical inputs from KC-MC. SS acquired, extracted and merged the datasets under the guidance of AK and provided specific inputs on data-related issues. GPN drafted the manuscript and KC-MC, CM, AK and NP revised the manuscript critically for intellectual contents. All authors approved the final version of the manuscript. GPN has full access to all datasets used and takes responsibility for the integrity of data and the accuracy of the data analyses.

  • Funding CM and KC-MC are funded by a NIHR Research Professorship awarded to CM. This work is supported by a Wellcome Trust Capacity Strengthening Strategic Award to the Public Health Foundation of India and a consortium of UK universities.

  • Disclaimer The funding bodies had no role in the study design; in the collection, analysis and interpretation of data; in the writing of the report; and in the decision to submit the paper for publication.

  • Competing interests None declared.

  • Ethics approval Exemption from ethics review for using anonymised Consumer Expenditure Survey data for secondary analyses was obtained from the Research Ethics Committee at the London School of Hygiene and Tropical Medicine (Protocol: 9831) and the Institutional Ethics Committee at Public Health Foundation of India (TRC-IEC-255/15).

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement No additional data available. Household level Consumer Expenditure Survey data were obtained under licence and remain a property of the National Sample Survey Office. The datasets can be purchased from the Ministry of Statistics and Programme Implementation, Government of India.

  • Correction notice This article has been corrected since it was published Online First. The license has been updated to CC BY.

  • Patient consent for publication Not required.

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