Use of tobacco is on the rise in India both in men and women. Tobacco can be used in smoke form and smokeless form.

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Smokeless tobacco is tobacco that is not burned. It is also known as chewing tobacco, oral tobacco, spit or spitting tobacco, dip, chew, and snuff. Most people chew or suck (dip) the tobacco in their mouth and spit out the tobacco juices that build up, although “spitless” smokeless tobacco has also been developed. NICOTINEin the tobacco is absorbed through the lining of the mouth.

People in many regions and countries, including North America, northern Europe, India and other Asian countries, and parts of Africa, have a long history of using smokeless tobacco products.

What does smokeless tobacco do to your body?

Chewing and spitting tobacco can cause: cracking and bleeding lips and gums. receding gums, which can eventually make the teeth fall out. increased heart rate, high blood pressure, and irregular heartbeats, all leading to a greater risk of heart attacks and brain damage (from a stroke).

Are there harmful chemicals in smokeless tobacco?

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Yes.Smokeless tobacco causes oral cancer, esophageal cancer, and pancreatic cancer.Using smokeless tobacco may also cause heart disease, gum disease, and oral lesionsother than cancer, such as leukoplakia (precancerous white patches in the mouth)

There is no safe form of tobacco. At least 28 chemicals in smokeless tobacco have been found to cause cancer. The most harmful chemicals in smokeless tobacco are tobacco-specific nitrosamines, which are formed during the growing, curing, fermenting, and aging of tobacco. The level of tobacco-specific nitrosamines varies by product. Scientists have found that the nitrosamine level is directly related to the risk of cancer.

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Tobacco consumption is a huge public health issue in India and its impact is especially devastating among the poor.

In India, nearly 300 million people live in extreme poverty.About 28.6% of the population consume tobacco.Nationally representative surveys and community-based studies have shown that tobacco consumption among the poor has continued. The cyclical relationship between tobacco use among the poor and exacerbation of poverty due to tobacco-related diseases is also well-documented. 

One in four adults and one in ten school students (13-15 years) in India use SLT and are at grave risk due to their addiction. India bears the highest burden of oral cancer globally, due to high prevalence of smokeless tobacco use.

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India has 29 states and 7 union territories with wide cultural differences and habits; tobacco use is ingrained as a cultural practice and resultant addiction. In India, tobacco is used as smoked and smokeless forms. There are myriad forms; in this review, cigarettes, beedis, and smokeless tobacco (SLT) used orally are considered. Cigarettes are available in various types, filtered/unfiltered, length based, and flavoured. Beedi is an indigenous form of tobacco product, made with 0.2 to 0.3 g of tobacco wrapped in temburni leaf and tied with a small string. Beedis contain 3 times more nicotine and 5 times more amount of tar than the regular cigarette, and they are also available in flavours of strawberry, mango, and chocolate.

India is the second largest consumer of tobacco.GATS-2 reports that 28.6% of the population consume tobacco in any form, 10.7% smoke, and 21.4% use SLT.Khaini (a form of SLT) and beedis are the dominant forms of tobacco consumed in India, at 11% and 8%, respectively. Tobacco consumption annual growth rate is 2% to 3%.

Smoked form was consumed by 31% of the population. Beedis accounted for the largest proportion of smoked tobacco consumed in India, especially among the lower socio-economic group, they consume beedis 8 to 10 times more than cigarette smoking. Despite greater consumption and higher toxicology associated with beedis, they go unnoticed.

A study that assessed trends in beedi and cigarette smoking in India from 1998 to 2015 showed that cigarettes were displacing beedis among men due to rising income and increased affordability; this was also significantly noticed among the lower socio-economic status groups.

Smokeless tobacco use is documented in 120 countries. India has the largest number of SLT users in the world. Of the 346 million global consumers, India alone has 152.4 million men and 80.8 million SLT consumers, and there has been substantial increase in SLT across all age groups.

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A study analysed 2 nationally representative data in 2005 and 2009 and showed that SLT use continued to increase in the age group of 15 to 49 years.The prevalence of SLT use is higher among women (27%-37%) compared with men (10%-15%). Trends in age-specific standardised prevalence of SLT use in India showed that consumption of SLT increased with age for both the sexes. Moreover, SLT use is considered as a common smoking cessation method and a study showed that 34.4% of smokers switched to SLT use as a cessation method.

KEY POINTS

  • Smokeless tobacco (SLT) is tobacco that is not burned. It is also known as chewing tobacco, oral tobacco, spit or spitting tobacco, dip, chew, and snuff.
  • SLT causes oral cancer, esophageal cancer, and pancreatic cancer. It may also cause heart disease, gum disease, and oral lesions other than cancer, such as leukoplakia.
  • India bears the highest burden of oral cancer globally, due to high prevalence of smokeless tobacco use.
  • SLT use is higher among women (27%-37%) as compared with men (10%-15%).
  • Few states have judiciously banned all smokeless forms of tobacco.    

 

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