A comprehensive examination of alcohol and tobacco consumption in India, with attention to geographical variation and demographic factors that affect these patterns.

Background Male tobacco and alcohol use in India represents a substantially greater burden than in females, with consumption rates 4–5 times higher for tobacco and 15–25 times higher for alcohol nationally. These behavioural patterns drive the majority of substance-related cancer burden among Indian men, with significant regional and occupational variations that differ markedly from female-specific risk patterns [1]. Methods This study integrates nationally representative data from the National Family Health Survey-5 (2019–2021), Global Adult Tobacco Survey-2 (2016–2017), and cancer incidence estimates from the National Cancer Registry Programme and GLOBOCAN 2022. Male-specific projections for 2025 were derived by applying age-adjusted incidence rates to population estimates. Population-attributable fractions were calculated using relative risks from international meta-analyses, with gender-comparative analysis to elucidate sex-specific differences in risk drivers [2]. Results Approximately 712,176 new cancer cases are projected among Indian men in 2025, corresponding to a crude incidence rate of 95.6 per 100,000. Lung, oral cavity, and prostate cancers account for approximately 25% of male cancer cases [2]. Male tobacco uses prevalence ranges from 38% (NFHS-5) to 42.4% (GATS-2), dominated by smokeless forms at 27% but with smoking at 19.2%—substantially higher than female smoking rates [1, 3]. Male alcohol consumption ranges from 17.5% to 29.2% nationally, with pronounced regional variation and highest prevalence in northeastern states where consumption exceeds 45% in several districts [4]. An estimated 50–60% of projected male cancers are attributable to tobacco and alcohol exposure, substantially exceeding the 35% attributable fraction observed among females [2, 5]. The synergistic interaction between concurrent tobacco and alcohol use markedly amplifies cancer risk, accounting for approximately 62% of oral cancers among men [6]. Regional and occupational disparities reveal concentration of tobacco and alcohol use among manual labourers, agricultural workers, and in specific geographic zones of northeastern India, Tamil Nadu, and Telangana [5]. Conclusion Despite declining national prevalence of tobacco smoking, male tobacco and alcohol remain overwhelmingly dominant contributors to cancer burden in India, driven by smokeless tobacco persistence, occupational and social normalization of substance use, and regional concentration. Approximately 356,000–427,000 male cancer cases in 2025 are attributable to modifiable tobacco and alcohol exposure [2]. Gender-responsive prevention strategies specifically addressing male occupational contexts, masculinity norms, and regional disparities are essential to mitigate the projected male cancer burden, which exceeds that of females by two- to three-fold for tobacco- and alcohol-related malignancies [1].