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168 nations have signed a treaty produced by the World Health Organization that would regulate the sale, distribution, and marketing of cigarettes, but the United States has not ratified this treaty

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However, rise in consumption of smokeless forms (from 25.3% in GATS-1 to 20.4% in GATS-2) accounted for rise in overall tobacco usage in UP.Khaini (15.9%) topped the list of prevalence followed by gutka (11.5%), betel quid with tobacco (10.2%) and pan masala with tobacco (7.2%).Consumption was high across age groups studied and prevalence increased with age