Disparities persist in tobacco use across India and the U.S. despite overall declines, driven by social, rural, and demographic inequalities. Despite an overall decline in tobacco consumption, disadvantaged and rural populations in India and the US continue to be disproportionately affected, according to a comparative analysis presented. NFHS-6 data points to declining numbers, yet recent economic reports and medical studies highlight rising household purchases and oral cancer risks linked to smokeless tobacco.