Background: Tobacco is the leading cause of mortality globally and in India. The magnitude and the pattern of tobacco consumption are likely to be influenced by the geographical setting and with rapid urbanization in India there is a need to study this differential pattern.

Aim: The aim was to study the rural, urban, and urban-slum differences in patterns of tobacco use.

Settings: The study was conducted in Ballabgarh block, Faridabad district, Haryana, and was a community-based cross-sectional study.

Materials and Methods: The study was conducted in years 2003-2004 using the WHO STEPS approach with 7891 participants, approximately equal number of males and females, selected using multistage sampling from urban, urban-slum, and rural strata.

Statistical Analysis: The analysis was done using the SPSS 12.0 statistical package (SPSS Inc., Chicago, IL, USA). Direct standardization to the WHO world standard population was done to and chi-square and ANOVA tests were used for comparison across three study settings.

Results: Self-reported tobacco use among males was as follows: urban 35.2%; urban-slums 48.3%; and rural 52.6% (P value <0.05). Self-reported tobacco use among females was as follows: Urban 3.5%; urban-slums 11.9%; and rural 17.7% (P value <0.05). More males reported daily bidi (tobacco wrapped in temburini leaf) smoking (urban 17.8%, urban-slums 36.7%, rural 44.6%) than cigarette use (urban 9.6%, urban-slums 6.3%, rural 2.9%). Females using smoked tobacco were almost exclusively using bidis (urban 1.7%, 7.9%, 11% in rural). Daily chewed tobacco use had urban, urban-slum, and rural gradients of 12%, 10.5%, and 6.8% in males respectively. Its use was low in females.

Conclusion: The antitobacco policies of India need to focus on bidis in antitobacco campaigns. The program activities must find ways to reach the rural and urban-slum populations.