Background:
Age of tobacco initiation is an important determinant leading to future tobacco dependence. The present study attempted to summarize the age of initiation of tobacco among users and its importance in formulating tobacco control measures.

Methods:
A cross-sectional study was conducted among 1360 respondents visiting 22 primary care facilities in two high tobacco burden states of India in 2016. The health facilities and patients were chosen using systematic random sampling. We summarized the age of initiation of the tobacco users and its implications to health. We considered the variable "number of visits to physicians in the last 12 months" as a proxy for the health condition of the respondents.

Results:
The average age of initiation of the respondents was 19 years. More than 65% respondents reported to have started using some form of tobacco (smoking and/or smokeless) between the ages of 16 to 25 years. Majority of these respondents reported to have visited a physician at least 3 to 5 times in past 12 months. Further the findings showed a decreasing trend in tobacco initiation after 25 years.

Conclusions:
The study suggests that initiation of tobacco products uptake starts around the age of 16 years and has adverse health implications. Hence, the efforts to prevent initiation of tobacco should not only focus on adults, but also on older youth and young adults. So far the tobacco programs and interventions in India have focused on the adults who are already users. We also need to intervene before tobacco use is taken up as a habit, stressing on not only preventive but also primordial care. Consistent and inescapable interventions should be devised to cater this group to reduce the uptake of tobacco.