Smokeless tobacco and health in India and South Asia

Abstract

South Asia is a major producer and net exporter of tobacco. Over one-third of tobacco consumed regionally is smokeless. Traditional forms like betel quid, tobacco with lime and tobacco tooth powder are commonly used and the use of new products is increasing, not only among men but also among children, teenagers, women of reproductive age, medical and dental students and in the South Asian diaspora. Smokeless tobacco users studied prospectively in India had ageadjusted relative risks for premature mortality of 1.2-1.96 (men) and 1.3 (women). Current male chewers of betel quid with tobacco in case-control studies in India had relative risks of oral cancer varying between 1.8-5.8 and relative risks for oesophageal cancer of 2.1-3.2. Oral submucous fibrosis is increasing due to the use of processed areca nut products, many containing tobacco. Pregnant women in India who used smokeless tobacco have a threefold increased risk of stillbirth and a two-to threefold increased risk of having a low birthweight infant. In recent years, several states in India have banned the sale, manufacture and storage of gutka, a smokeless tobacco product containing areca nut. In May 2003 in India, the Tobacco Products Bill 2001 was enacted to regulate the promotion and sale of all tobacco products. In two large-scale educational interventions in India, sizable proportions of tobacco users quit during 5-10 years of follow-up and incidence rates of oral leukoplakia measured in one study fell in the intervention cohort. Tobacco education must be imparted through schools, existing government health programmes and hospital outreach programmes.

Pan masala habits and risk of oral precancer: A cross-sectional survey in 0.45 million people of North India

“…Another study in 1995 in 1110 residents of 2 states, 5-74 years, found that 72% males and 80% females chewed areca nut, 80% of whom incorporated tobacco in their quid. 18 In a house to house survey of 22,000 villagers, aged 15 and above in Bhavnagar district, Gujarat, 7 India 20.4% of males used mawa or betel quid. The popularity of areca nut mixtures, like mawa, pan masala, gutkha spawned an epidemic of SMF.…”

Tobacco‐specific nitrosamines in smokeless tobacco products marketed in India

“…The use of these products is strongly associated with oral cancer. [2][3][4] The levels of tobacco-specific nitrosamines in gutka were lower than those in many of the other products examined here, but were still considerably higher than nitrosamine levels in food and other common products, which are typically in the low ppb range. 11,24 Supari, which is similar to gutka but does not contain tobacco, did not have detectable levels of tobacco-specific nitrosamines.…”

“…Traditional forms of smokeless tobacco include betel quid containing tobacco, tobacco with lime and tobacco tooth powder but there are also new products with increasing popularity. 2 Chewing of betel quid containing tobacco is a well-established cause of oral cancer in India. [2][3][4] Oral leukoplakia and submucous fibrosis, likely precursor lesions to oral cancer, are also strongly linked to smokeless tobacco use.…”

“…2 Chewing of betel quid containing tobacco is a well-established cause of oral cancer in India. [2][3][4] Oral leukoplakia and submucous fibrosis, likely precursor lesions to oral cancer, are also strongly linked to smokeless tobacco use. In India and other parts of southern Asia, smokeless tobacco use is a major public health problem.…”

Perception and Practices of Physicians in Addressing the Smokeless Tobacco Epidemic: Findings from Two States in India

“…World Health Organization (2008) predicted that tobacco will lead to over 8 million deaths annually by 2030 with low and middle-income countries accounting for 70% of deaths. Smokeless tobacco use in South Asia is believed to be a significant contributor to morbidity and mortality (Gupta and Ray, 2003).…”