{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,20]],"date-time":"2026-02-20T18:47:56Z","timestamp":1771613276922,"version":"3.50.1"},"reference-count":17,"publisher":"BMJ","funder":[{"name":"Campaign for Tobacco-Free Kids","award":["n\/a"],"award-info":[{"award-number":["n\/a"]}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["Tob Control"],"accepted":{"date-parts":[[2025,6,18]]},"abstract":"<jats:sec><jats:title>Background<\/jats:title><jats:p>India\u2019s 2017 Goods and Services Tax (GST) reform standardised tax rates nationwide, replacing varying state-level value-added taxes (VAT) with a tiered GST structure that applied the highest 28% rate on tobacco products. This shift altered the overall tax burden on tobacco, with some states experiencing increases or decreases based on their pre-GST VAT rates.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>This study for the first time examines the impact of GST on tobacco use prevalence across Indian states, using state-level VAT rates from 2016 to 2017 and district-level tobacco use data from 2015 to 2016 and 2019 to 2021, covering 636 districts. Two econometric approaches\u2014pooled ordinary least squares and fixed effects panel regression models\u2014are used with a focus on the differential impact in states with high and low pre-GST VAT rates.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>The introduction of GST is associated with reductions in smokeless tobacco (SLT) and bidi use prevalence by 0.023 and 0.008\u2009percentage points, respectively, indicating a small but statistically significant effect, with no notable impact on cigarettes. Additionally, the GST reform had a relatively larger effect in reducing SLT and bidi prevalence in high-VAT states compared with low-VAT states.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>The study demonstrates that wherever the GST reform led to an increase in the tax burden, it resulted in a small but statistically significant reduction in tobacco use prevalence, emphasising the effectiveness of taxation as a tool to regulate tobacco consumption. It underscores the need for sustained public health-focused fiscal policies, including regular increases in excise duties, to further reduce tobacco use prevalence in India.<\/jats:p><\/jats:sec>","DOI":"10.1136\/tc-2024-059244","type":"journal-article","created":{"date-parts":[[2025,6,27]],"date-time":"2025-06-27T17:20:27Z","timestamp":1751044827000},"page":"tc-2024-059244","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":2,"title":["The impact of the GST reform on state-level tobacco use prevalence in India"],"prefix":"10.1136","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4525-6507","authenticated-orcid":false,"given":"Rijo M","family":"John","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5799-1915","authenticated-orcid":false,"given":"Hana","family":"Ross","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2025,6,27]]},"reference":[{"key":"2025062710201673000_tc-2024-059244v1.1","doi-asserted-by":"crossref","unstructured":"Rao RK , Mukherjee S . Evolution of goods and services tax in India. Cambridge University Press, 2019.","DOI":"10.1017\/9781108564120"},{"key":"2025062710201673000_tc-2024-059244v1.2","doi-asserted-by":"publisher","DOI":"10.1136\/tobaccocontrol-2018-054479"},{"key":"2025062710201673000_tc-2024-059244v1.3","doi-asserted-by":"publisher","DOI":"10.1136\/tobaccocontrol-2019-055525"},{"key":"2025062710201673000_tc-2024-059244v1.4","doi-asserted-by":"publisher","DOI":"10.1093\/ntr\/ntac230"},{"key":"2025062710201673000_tc-2024-059244v1.5","doi-asserted-by":"publisher","DOI":"10.4103\/jfmpc.jfmpc_1169_20"},{"key":"2025062710201673000_tc-2024-059244v1.6","doi-asserted-by":"publisher","DOI":"10.4103\/2224-3151.283001"},{"key":"2025062710201673000_tc-2024-059244v1.7","unstructured":"Government of India . Global adult tobacco survey (GATS India report) 2016-2017. Ministry of Health and Family Welfare, Government of India; Tata Institute of Social Sciences; 2017."},{"key":"2025062710201673000_tc-2024-059244v1.8","doi-asserted-by":"crossref","unstructured":"Kaur J , Rinkoo AV , Richardson S . Update on numbers of tobacco-attributable deaths by country in the South-East Asia region: implications for policy. Tob Control 2024. doi:10.1136\/tc-2024-058599","DOI":"10.1136\/tc-2024-058599"},{"key":"2025062710201673000_tc-2024-059244v1.9","doi-asserted-by":"publisher","DOI":"10.1093\/ntr\/ntaa154"},{"key":"2025062710201673000_tc-2024-059244v1.10","doi-asserted-by":"publisher","DOI":"10.1093\/ntr\/ntac048"},{"key":"2025062710201673000_tc-2024-059244v1.11","unstructured":"WHO . WHO technical manual on tobacco tax policy and administration. World Health Organization; 2021. Available: https:\/\/www.who.int\/publications\/i\/item\/9789240019188 [Accessed 14 Apr 2021]."},{"key":"2025062710201673000_tc-2024-059244v1.12","unstructured":"NCI & WHO . The economics of tobacco and tobacco control. U.S. Department of Health and Human Services, National Institutes of Health, National Cancer Institute; and Geneva, CH: World Health Organization; 2016. Available: https:\/\/cancercontrol.cancer.gov\/sites\/default\/files\/2020-06\/m21_complete.pdf [Accessed 19 Feb 2017]."},{"key":"2025062710201673000_tc-2024-059244v1.13","unstructured":"International Institute of Population Sciences (IIPS) . National Family Health Survey (NFHS-4), 2015-16. 2017. Available: http:\/\/rchiips.org\/NFHS\/NFHS-4Reports\/India.pdf"},{"key":"2025062710201673000_tc-2024-059244v1.14","unstructured":"International Institute for Population Sciences (IIPS) . National Family Health Survey (NFHS-5) INDIA report. 2022. Available: https:\/\/iipsindia.ac.in\/content\/national-family-health-survey-nfhs-5-india-report [Accessed 16 Jun 2023]."},{"key":"2025062710201673000_tc-2024-059244v1.15","doi-asserted-by":"publisher","DOI":"10.2307\/1913827"},{"key":"2025062710201673000_tc-2024-059244v1.16","unstructured":"Cameron AC , Trivedi PK . Microeconometrics using stata. Stata Press; 2010. Available: https:\/\/www.stata.com\/bookstore\/microeconometrics-stata\/ [Accessed 14 Oct 2018]."},{"key":"2025062710201673000_tc-2024-059244v1.17","doi-asserted-by":"publisher","DOI":"10.1007\/s11121-022-01360-w"}],"container-title":["Tobacco Control"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/tc-2024-059244","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,6,27]],"date-time":"2025-06-27T17:20:29Z","timestamp":1751044829000},"score":1,"resource":{"primary":{"URL":"https:\/\/tobaccocontrol.bmj.com\/lookup\/doi\/10.1136\/tc-2024-059244"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,6,27]]},"references-count":17,"alternative-id":["10.1136\/tc-2024-059244"],"URL":"https:\/\/doi.org\/10.1136\/tc-2024-059244","relation":{},"ISSN":["0964-4563","1468-3318"],"issn-type":[{"value":"0964-4563","type":"print"},{"value":"1468-3318","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,6,27]]}}}