The global tobacco pandemic continues to cause enormous health burden and fatality, especially in the low and middle-income countries (LMICs), in spite of continuing efforts under the umbrella of FCTC. India, representing a complex pattern of tobacco use, both in smoking and smokeless forms, remains the second largest tobacco-using country. This study was designed to understand the impact of COVID-19 pandemic and associated restrictive measures on all groups of tobacco users and the impact on the users of e-cigarettes (EC), as a result of imposition of ban. A well-designed, online or CATI interview-based survey was conducted in eight large metropolitan cities of India on 3005 samples (smoking tobacco [ST]: 1,193; smokeless tobacco [SLT]: 966; and EC: 846). The study finds all groups were affected albeit differently

The COVID-19 crisis affected all tobacco user segments positively as well as negatively. EC users, unless supported appropriately, were likely to revert to tobacco use after having quit it successfully.

Tobacco, smoking tobacco, smokeless tobacco, e-cigarette, COVID-19, EC ban, tobacco cessation, India

Action on Smoking and Health. (2019). Fact sheet: Tobacco and the developing world. https://ash.org.uk/uploads/Tobacco-Developing-World.pdf

Bhatnagar, A, Whitsel, L. P., Ribisl, K. M., Bullen, C., Chaloupka, F., Piano, M. R., Robertson, R. M., McAuley, T., Goff, D., Benowitz, N. American Heart Association Advocacy Coordinating Committee, Council on Cardiovascular and Stroke Nursing, Council on Clinical Cardiology, & Council on Quality of Care and Outcomes Research. (2014). Electronic cigarettes: A policy statement from the American Heart Association. Circulation, 130, 1418–1436. https://doi.org/10.1161/CIR.0000000000000107

Caponnetto, P., Inguscio, L., Saitta, C., Maglia, M., Benfatto, F., & Polosa, R. (2020). Smoking behavior and psychological dynamics during COVID-19 social distanc- ing and stay-at-home policies: A survey. Health Psychology Research, 8(1), 68–74. https://doi.org/10.4081/hpr.2020.9124

Chakma, K. J., Dhaliwal, R. S., & Mehrotra, R. (2019). White paper on electronic nicotine delivery system. Indian Council of Medical Research. https://doi.org/10.4103/ijmr. IJMR_957_19

Copeland, A. L., & Brandon, T. H. (2000). Testing the causal role of expectancies in smok- ing motivation and behavior. Addictive Behaviors, 25(3), 445–449. https://10.1016/ S0306-4603(99)00003-9

Das, S., Choudhury, Y., & Sharan, R. N. (2019). A systematic review and meta-analysis on the health and safety implications of Electronic Nicotine Delivery Systems. Indian Journal of Clinical Practice, 29(11), 1016–1026. https://ijcp.in/Pages/Post_Detail. aspx?wid=20305&A%20Systematic%20Review%20and%20Meta-analysis%20 on%20the%20Health%20and%20Safety%20Implications%20of%20ENDS

Farsalinos, Ks., Ambekar, A., & Polosa, R. (2019b). White Paper on electronic nicotine delivery systems by the Indian Council of Medical Research: A critical appraisal of the scientific evidence. Indian Journal of Clinical Practice, 30(3). https://ijcp.in/Admin/ CMS/PDF/03_Original%20Article_G02.pdf

Farsalinos, K., Russell, C., & Sharan, R. (2019). The prospects of e-cigarettes in India: Overview of evidence, opportunities and challenges based on experience in western countries. Indian Journal of Clinical Practice, 29(12), 1106–1120. https://ijcp.in/ Admin/CMS/PDF/Perspective.pdf

Framework Convention Alliance. (2020). Parties to the WHO FCTC (ratifications and accessions). https://www.fctc.org/parties-ratifications-and-accessions-latest/

Grana, R., Benowitz, N., & Glantz, S. A. (2014). E-cigarettes: A scientific review.

Circulation, 129(19). http://dx.doi.org/10.1161/CIRCULATIONAHA.114.007667 Hymowitz, N., Cummings, K. M., Hyland, A., Lynn, W. R., Pechacek, T. F., & Hartwell, T. D. (1997). Predictors of smoking cessation in a Cohort of adult smokers followed for five year. Tobacco Control, 6(Suppl. 2). https://doi.org/10.1136/tc.6.suppl_2.s57

International Chamber of Commerce. & ESOMAR. (2016). ICC/ESOMAR interna- tional code on market, opinion and social research and data analytics. International Chamber of Commerce. https://www.esomar.org/uploads/pdf/professional-standards/ ICCESOMAR_Code_English_.pdf

International Agency for Research on Cancer. (2004). Tobacco smoke and involuntary smoking (IARC Working Group on the Evaluation of Carcinogenic Risks to Humans). IARC Monographs on the Evaluation of Carcinogenic Risks to Humans (Vol. 83). IARC.

Jha, P., Ramasundarahettige, C., Landsman, V., Rostron, B., Thun, M., Anderson, R. N., McAfee, T. D., & Peto, R. (2013). 21st century hazards of smoking and benefits of cessation in the United States. New England Journal of Medicine, 368, 341–350. https://doi.org/10.1056/NEJMsa1211128

Lancet Editorial. (2018). Progress towards a tobacco-free world. Lancet, 392(10141), 1. https://doi.org/10.1016/S0140-6736(18)31482-X

Li, Q., Guan, X., Wu, P. et al. (2020). Early transmission dynamics in Wuhan, China, of novel coronavirus-infected pneumonia. New England Journal of Medicine, 382(13):1199–1207. doi:10.1056/NEJMoa2001316

Maddux, E. J., & &Rogers, W. R., (1983). Protection motivation and self-efficacy: A revised theory of fear appeals and attitude change. Journal of Experimental Social Psychology, 19(5), 469–479. https://doi.org10.1016/0022-1031(83)90023-9

McCaul, K. D., Hockemeyer, J. R., Johnson, R. J., Zetocha, K., Quinlan, K., & Glasgow, R. E. (2006). Motivation to quit using cigarettes: A review. Addictive Behaviors, 31(1), 42–56. https://doi.org/10.1016/j.addbeh.2005.04.004

Ministry of Health and Family Welfare. (2003). The Cigarettes and Other Tobacco Products (prohibition of advertisement and regulation of trade and commerce, pro- duction, supply and distribution) Act, 2003. An Act enacted by the Parliament of Republic of India by notification in the Official Gazette (Act 32 of 2003).

Ministry of Health and Family Welfare. (2018a). Global Adult Tobacco Survey GATS 2 India 2016–17. Tata Institute of Social Sciences and Ministry of Health and Family Welfare, Government of India.\

Ministry of Health and Family Welfare. (2018b). Report on Tobacco Control in India, 2004. Ministry of Health and Family Welfare, Government of India. http://www.who. int/fctc/reporting/Annex6_Report_on_Tobacco_Control_in_India_2004.pdf

Ministry of Health and Family Welfare. (2019). The Prohibition of Electronic Cigarettes (Production, Manufacture, Import, Export, Transport, Sale, Distribution, Storage and Advertisement) Bill, 2019. https://www.prsindia.org/billtrack/prohibition-electronic- cigarettes-production-manufacture-import-export-transport-sale-0

Ministry of Health and Family Welfare. (2020). COVID-19 INDIA. Ministry of Health and Family Welfare, Government of India. https://www.mohfw.gov.in/

Mishra, G. A., Pimple, S. A., & Shastri, S. S. (2012). An overview of the tobacco problem in India. Journal of Medical and Pediatric Oncology: Indian Journal of Medical and Pediatric Oncology, 33(3), 139–145. https://doi.org/10.4103/0971-5851.103139

Mohan, P., Lando, A. H., & Panneer, S. (2018) Assessment of tobacco consump- tion and control in India. Indian Journal of Clinical Medicine, 9, 1–8. https://doi. org/10.1177/1179916118759289

National Cancer Registry Programme. (2013). Consolidated Report of Hospital Based Cancer Registries 2007–2011. National Cancer Registry Programme, Indian Council of Medical Research.

National Cancer Registry Programme. (2020). Indian Council of Medical Research/ National Centre for Diseases Informatics and Research. https://ncdirindia.org/All_ Reports/Report_2020/Brf_2020/NCRPReport202_Brief_write_up.pdf

Nethan, S. T., Sinha, D. N., Chandan, K, Mehrotra, R. (2018). Smokeless tobacco cessa- tion interventions: A systematic review. Indian Journal of Medical Research, 148; 396–410. https://doi.org/10.4103/ijmr.IJMR_1983_17

Orleans, C. T., Jepson, C., Resch, N., & Rimer, K. B. (1994). Quitting motives and barriers among older smokers. The 1986 Adult use of tobacco survey revisited. Cancer, 74(7 Suppl.), 2055–2061. https://doi.org/10.1002/1097-0142(19941001)74:7+<2055:AID- CNCR2820741712>3.0.CO;2-Q

Pal, R., & Yadav, U. (2020). COVID-19 Pandemic in India: Present scenario and a steep climb ahead. Journal of Primary Care & Community Health, 11. https://doi. org/10.1177/2150132720939402

Pierce, J. P., Gilpin, E. A., Emery, S. L., White, M. M., Rosbrook, M., & Berry, C. (1998) Has the California tobacco control program reduced smoking? Journal of the American Medical Association, 280(10), 893–899.  https://doi.org/10.1001/jama.280.10.893

Public Health England. (2015). E-cigarettes around 95% less harmful than tobacco esti- mates landmark review. https://www.gov.uk/government/news/e-cigarettes-around- 95-less-harmful-than-tobacco-estimates-landmark-review

Rao, V., & Chaturvedi, P. (2010). Tobacco and health in India. Indian Journal of Cancer, 47(5), 3–8. http://www.indianjcancer.com/text.asp?2010/47/5/3/64373

Royal College of Physicians. (2016). Nicotine without smoke: tobacco harm reduction. RCP report on e-cigarettes. https://ukctas.net/rcp.html#:~:text=The%20Royal%20 College%20of%20Physicians,are%20muc

Romer, D., & Jamieson, P. (2001). The role of perceived risk in starting and stopping smoking. In P. Slovic (Ed.), Smoking: Risk, perception, & policy (pp. 64–80). SAGE Publications. https://doi.org/10.4135/9781452232652.n4

Roy, A., Rawal, I., Jabbour, S., & Prabhakaran, D. (2017). Tobacco and cardiovascular disease: A summary of evidence. In D. Prabhakaranj, S. Anand, T. A., Gaziano, J. C. Mbanya, Y. Wu & R. Nugemt (Eds), Cardiovascular, respiratory, and related disor- ders (Vol. 5, 3rd ed.). https://doi.org/10.1596/978-1-4648-0518-9

Sharan, R. N., Chanu, T. M., Chakrabarty, T. K., & Farsalinos, K. (2020). Patterns of tobacco and e-cigarette use status in India: A cross-sectional survey of 3000 vapers in eight Indian cities. Harm Reduction Journal, 17, 21. https://doi.org/10.1186/s12954- 020-00362-7

Shah, S., Dave, B., Shah, R., Mehta, T. R., & Dave, R. (2018). Socioeconomic and cul- tural impact of tobacco in India. Journal of Family Medicine and Primary Care, 7(6), 1173–1176. https://doi.org/10.4103/jfmpc.jfmpc_36_18

Singh, S., Jain, P., Singh, P. K., Reddy, K. S., & Bhargava, B. (2020). White paper on smokeless tobacco & women’s health in India. Indian Journal of Medical Research, 151, 513–521. https://doi.org/10.4103/ijmr.IJMR_537_20

Sinha, D. N., Palipudi, K. M., Gupta, P. C., Singhal, S., Ramasundarahettige, C., Jha, P., Indrayan, A., Asma, S., & Vendhan, G. (2014). Smokeless tobacco use: A meta-anal- ysis of risk and attributable mortality estimates for India. Indian Journal of Cancer, 51(Suppl. 1), S73–S77. https://doi.org/10.4103/0019-509X.147477

Thankappan, K. R. (2014). Tobacco cessation in India: A priority health intervention. The Indian Journal of Medical Research, 139(4), 484–486.

World Health Organization. (2015). Cardiovascular diseases: Fact sheet. https://www. world-heart-federation.org/wp-content/uploads/2018/05/Factsheet-Tobacco-and- CVD_Healthcare-professionals-v2.1.pdf

World Health Organization. (2018). Factsheet 2018 India. https://apps.who.int/iris/bit- stream/handle/10665/272672/wntd_2018_india_fs.pdf?sequence=1

World Health Organization. (2020). Coronavirus disease 2019 (COVID-19) (Situation Report-40). https://www.who.int/docs/default-source/coronaviruse/situation-reports/ 20200229-sitrep-40-covid-19.pdf?sfvrsn=849d0665_2

Wu, J. T., Leung, K., & Leung, G.M. (2020). Nowcasting and forecasting the potential domestic and international spread of the 2019-nCoV outbreak originating in Wuhan, China: Modelling study. Lancet, 395(10225), 689–697. https:doi.org/\:10.1016/ S0140-6736(20)30260-9

Yach, D. (2020, 9 September). Tobacco use patterns in five countries during the Covid-19 lockdown. Nicotine & Tobacco Research, 22, 1671–1672. https://doi.org/10.1093/ntr/ ntaa097