The "National Family Health Survey-5 India Report" is a wake-up call for governments, civil society, and policymakers in the northeast on tobacco control policies and campaigns. The report has brought to the fore the bitter truth of states in the northeast region figuring among the states in the red zone with 40% of men aged 15 years and above using any tobacco such as cigar, pipe, hookah, gutkha/ paan masala with tobacco, khaini, paan with tobacco, other chewing tobacco and snuff. The alarming picture of teens smoking, chewing tobacco and inhaling snuff in the region calls for an urgent review of anti-tobacco campaigns to adopt effective strategies to help them quit and intensify anti-tobacco campaigns among school children. Reaching out to out-of-school children apart from other sections of society is critical to stop the ticking health time bomb in tobacco-related cancer and other diseases. Madhya Pradesh, Uttar Pradesh, Odisha, Jharkhand, West Bengal, Bihar, Chhattisgarh, the northern part of Maharashtra, western Gujarat, and southern Rajasthan are also included in this red zone which depicts a worrying situation of tobacco use in the country. About 10 lakh people die every year in the country of non-communicable diseases attributable to tobacco use. Tobacco use among men in this group is the highest in Mizoram (73%), followed by Andaman & Nicobar Islands (59%) and Manipur (58%). Tobacco use among women is also the highest in Mizoram (62%), followed by Tripura (51%), and Manipur (43%). Reconciling these data reveal a mismatch between tobacco control strategy and the cancer profile of the region. The "Profile of Cancer and Related Health Indicators in the North East Region of India" prepared jointly by the Indian Council of Medical Research (ICMR) and National Centre for Disease Informatics and Research (NCDIR), Bengaluru reveals that nearly half (49.3%) of cancers in males and close to one-fourth (22.8 %) in females in the Northeast are tobacco use related sites- oesophagus (13.6% in males; 7.0% in females) followed by lung (10.9% in males; 6.8% in females). The NFHS report also brings to light that a higher proportion (40% and above) of alcohol consumption among men aged 15 years and over is found in Telangana, Arunachal Pradesh, the upper Brahmaputra region of Assam, a few districts in Jharkhand and Bastar region of Chhattisgarh, and the Chhota Nagpur region of Jharkhand and Odisha. In Manipur, Meghalaya and Tripura alcohol consumption in this age group is 30-40% which calls for a massive awareness drive before it is too late. Data contained in the national report presents an alarming picture of tobacco use in the country and reveals that 38% of men and 9% of women aged 15 years and over currently use any tobacco products. Among men as well as women, the use of tobacco is higher in rural areas (43% for men and 11% for women) than in urban areas (29% for men and 6% for women). Nearly three-fifths of men (58%) and 15 per cent of women with no schooling or less than 5 years of schooling use tobacco and increasing levels of education among both men and women tobacco use show a steady and substantial decrease which highlights the importance of formal education in the anti-tobacco campaign. A targeted approach to reaching out to the most vulnerable groups to make them aware of the health hazards of tobacco can produce desired results. The report, however, brings out a bitter truth of 18 men with 12 or more years of schooling using tobacco. There is an equally clear and continual decrease in tobacco use with increasing wealth quintiles. "Over one-fifth of men (21%) in the highest wealth quintile use tobacco, in comparison with 58 per cent of men in the lowest wealth quintile. Seventeen per cent of women in the lowest wealth quintile use tobacco. Women (19%) and men (51%) belonging to scheduled tribes are more likely to use tobacco than those from any other caste/tribe groups," states the report. Augmenting household income will improve their access to education and motivate them to quit tobacco use lending support to awareness drive as volunteers. State Governments, autonomous councils, and urban and rural bodies in the region identifying the reason behind the failure to strictly enforce the ban on the sale of tobacco products to minors and within a radius of 100 yards from educational institutions has become an urgent necessity. Accountabilities need to be fixed on those entrusted responsibilities of enforcement. The rising economic burden of tobacco-related cancer and other diseases is perturbing. Official data show that the average annual revenue collection including GST and excise duty from products in the country is about Rs 53,000 crore while the economic cost attributable to the treatment of tobacco use related diseases is more than double this revenue. Raising taxes and excise duty to make tobacco products unaffordable to more people can be an effective means of curbing its use in the Northeast and elsewhere.