While India's age-standardised exposure prevalence declined from 43.2% to 30.6% over the last three decades, the absolute number of people exposed rose from 375 million in 1990 to 444 million in 2023, an increase of 18.4%. The health toll also rose sharply, with deaths attributable to second-hand smoke climbing from 217,700 to 325,600 during the same period.