Background:
India ratified the framework convention on tobacco control (FCTC) in the year 2004. In order to understand the impact of the implementation of FCTC it is important to look at the trends in tobacco use. We studied the trends in tobacco use among Indian adults aged 15-49 years from 1998-99 to 2015-16.

Methods:
The data for the analysis were obtained from the three nationally representative population level cross-sectional surveys in India. We studied the National Family Health Survey-2 (NFHS-2) in 1998-99 (women:1,21,031; men:1,25,104), NFHS-3(women:1,24,385; men: 69,751) in 2005-06 and NFHS-4(women: 6,99,686; men: 1,03,525) in 2015-16 in India. All the NFHS surveys included men and women in the age group of 15-49 years.

Results:
Any tobacco use by men increased from 46.5% in NFHS-2 to 57% in NFHS-3 and decreased to 44.5% in NFHS-4. Any tobacco use by women reported consistent reduction in all the three NFHS surveys: 13.8% in NFHS-2, 10.8% in NFHS-3 and 6.8% in NFHS-4. Percentage reduction in tobacco use was higher in rural areas than in urban areas both among men (urban:50% to 39%; rural: 61% to 48%) and women (urban: 7% to 4%; rural: 13% to 8%) from NFHS-3 to NFHS-4. Except the four states of Meghalaya, Andhra Pradesh, Manipur and Telangana, all other Indian states reported a reduction of any form of tobacco use from NFHS-3 to NFHS-4.

Conclusions:
More efforts are required in the four states of Meghalaya, Andhra Pradesh, Manipur and Telangana to reduce tobacco use. In other states continued efforts are required to attain further reduction in tobacco use.