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There is a high prevalence of cigarette smoking and smoke exposure in the South Asian population. This identifies the great need to implement smoking prevention and cessation efforts. Tobacco-related deaths are highest in India, where 80% of the world’s tobacco users reside. One million deaths annually are linked to some form of tobacco use. Approximately one-third of the population in India aged ≥15 years uses tobacco products. In India, 5500 youths initiate tobacco use every day. Current tobacco use has been documented in 14.6% of school-going youths aged 13 to 15 years.37

Tobacco use in people living in low socioeconomic areas is high. In India, approximately 75% of children live in slums and low-resource settings. In these communities, evidence suggests that tobacco use starts in children as young as 6 years of age. Children in these environments lack the knowledge and skills to resist tobacco use and give in to social influences, including peer pressure, to use tobacco in a tobacco-friendly environment.37

Tobacco use is a modifiable risk factor that is relevant to the global burden of chronic diseases. The duration of tobacco use is an additional factor that needs to be considered. Some people go through start-quit-restart cycles; therefore, total exposure to tobacco use must be taken into consideration as a risk factor for chronic diseases.38

Smokeless tobacco and bidis are commonly used in India and Bangladesh; however, manufactured cigarettes are preferred by most tobacco users.39

The highest prevalence of smoking in India is in adolescent boys and men aged 15 to 29 years. Education levels and literacy are related to tobacco use; individuals with higher levels of education use less tobacco than individuals with lower education levels. The absolute number of adolescent boys and men aged 15 to 69 years has increased significantly in India over the past 15 years.40


A large body of literature demonstrates that, in ethnic minorities, chronic stress and disease exposure are linked to increased ASCVD.41,42 The belief that acquiring diseases such as diabetes or ASCVD is not under an individual’s control is prevalent among South Asians.8 This can be explained by the large spiritual foundation within the South Asian culture and the belief that much of life is in a higher power’s control and cannot be modified by the individual.


The South Asian population has many genetic risk factors for ASCVD and needs to be monitored, screened, and treated appropriately to prevent ASCVD. Education also needs to be provided to encourage healthy diets and physical activity. This population is at higher risk for cardiovascular incidents at much younger ages. It is essential that providers be aware of the increased cardiovascular risk factors among this population. Providers need to be diligent to appropriately treat this population to prevent cardiovascular incidents. The advanced practice clinician is particularly well positioned to proactively screen and treat the South Asian population for ASCVD.


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