Urgent Need to Regulate Herbal and Nicotine-Based Tobacco Products in India

India is home to over 260 million tobacco users, making it the second-largest consumer base globally (1). In response to this public health burden, the country has implemented several key regulatory measures, including the Cigarettes and Other Tobacco Products Act (COTPA), the National Tobacco Control Programme (NTCP), and ban on electronic nicotine delivery systems (ENDS). Despite ongoing regulatory and educational efforts, the tobacco product landscape in India continues to evolve, with increasing concern over the growing popularity of herbal and nicotine-based alternatives such as herbal cigarettes, nicotine pouches, heated tobacco products (HTPs), and electronic nicotine delivery systems (ENDS). Although products like ENDS are explicitly prohibited under the Prohibition of Electronic Cigarettes Act (PECA), 2019, they are frequently marketed—often deceptively—as safer, natural, or even therapeutic alternatives, posing significant challenges to public health communication and regulatory enforcement. To better understand public perceptions of these products, we undertook a two-phase study combining quantitative and qualitative approaches in January 2025. In first phase, a cross-sectional online survey was conducted to quantify these perceptions using a pre validated and piloted questionnaire, comprised five sections: demographic information, knowledge of herbal and nicotine-based products, attitudes towards them, practices, and their exposure.