<sec><title>BACKGROUND</title>Population-based surveys are crucial for understanding smoking and TB epidemiology.</sec><sec><title>METHODS</title>A sub-national cross-sectional survey was conducted among individuals aged ≥15 years in 180 clusters in Southern India.</sec><sec><title>RESULTS</title>Among 130,914 participants included for analysis, 117,091 were non-smokers, 5,410 were past smokers, and 8,413 were current smokers. Sixty-two (0.7%) participants in the current smoking group, 31 (0.6%) participants in the past smoking group, and 151 (0.1%) participants in the non-smoking group were diagnosed with microbiologically confirmed pulmonary TB (MCPTB). The crude prevalence ratio (cPR) of MCPTB in the smoking population was 4.33 (95% CI 3.30-5.68, P < 0.01). The adjusted PR (aPR) of MCPTB among the smoking population for the 31-45-years age group was 4.38 (95% CI 0.96-20.04); among those aged 46-60 years, this was 9.69 (95% CI 2.29-40.91); and among those aged >60 years, it was 11.59 (95% CI 2.74-49.05). The aPR among those with a body mass index of <16.50 kg/m², was 13.18 (95% CI 5.46-31.86). The aPR among those with alcohol use was 2.43 (95% CI 1.10-5.35), and 3.19 (95% CI 1.79-5.69) among those with a history of TB.</sec><sec><title>CONCLUSION</title>The prevalence of MCPTB in smokers is significantly higher than in non-smokers. Increasing age, undernutrition, alcohol use, and history of PTB were strongly associated with PTB among smoking participants.</sec>.