Background and challenges to implementation:
Limited regulations on bidis has multifaceted role in exacerbating the poverty and is a major barrier in the Tobacco control and achievement of SDGs 1 & 3 in India. Moreover bidis used domestically are expanding internationally, increasing global consumer base and threatening the tobacco control efforts undertaken via FCTC, WHO. This systematic review assesses the economic and disease burden imposed by poor regulations, and their surrogate role in preventing tobacco control targets of National Health Policy 2017, India.

Intervention or response:
Systematic review of literature was carried out by Digital search of published data using key words with inclusion and exclusion criteria.

Results and lessons learnt:
In India, 53% of the smokers consumed bidi. Low cost has influenced consumption among the poor and students. Carbon monoxide and nicotine are 3 times and tar is 5 times higher than cigarettes. Apart from NCDs was associated with Tuberculosis, Nutritional disorders and Candidiasis were. Bidis are manufactured as home based instead of mechanized to elude the rights of bidi workers and also evade taxes. Also promotes child labour and early initiation of tobacco consumption. Workers develop dual burden of tobacco associated diseases and occupational hazards. Tobacco exports have increased, especially to developed countries in the disguise of natural herbal product and being less hazardous.

Conclusions and key recommendations:
Contrary to smoking trends elsewhere, bidi is the highest form of smoked tobacco among the poor. Absolute number of smokers between15-24 is increasing. Being least expensive students are driven for early initiation and continuation. Further increase in taxation on cigarettes in 2017, possibility of reversal of consumption pattern and relative boost to bidi industry. Uniformity in policies, more specifically taxation, on all tobacco products, will aid in effective tobacco control, prevent product switching and realize the goals of poverty alleviation and good health via tobacco control.