Health risks of smokeless tobacco

Dr. Partha Pratim Kalita

(The writer can be contacted to 7399737796)

Smokeless tobacco (SLT) is a tobacco product that is used by means other than smoking. The use of smokeless tobacco involves chewing, sniffing or placing the product between gum and cheek or lip. Smokeless tobacco products are produced in various forms, such as chewing tobacco, snuff, snus, and dissolvable tobacco products. All smokeless tobacco products contain nicotine and are highly addictive. The smokeless tobacco differs depending on the type of product, the types of tobacco used, and the amount of each tobacco type used within a product. Each variable results in different level of nicotine.

According to a study by ICMR – National Institute of Cancer Prevention and Research (NICPR), Indian smokeless tobacco products are the most lethal. People who dip or chew get about the same amount of nicotine as regular smokers. They also get at least 30 chemicals that are known to cause cancer. The most harmful cancer-causing substances in smokeless tobacco are tobacco-specific nitrosamines (TSNAs). TSNA levels vary by product, but the higher the level the greater the cancer risk.

The SLT is available in India as paan, paan masala, khaini, zarda and gutka. The prevalent misconception related with SLT is that it is considered as safer over smoking which could be on the grounds of its usage in terms of initiation and persistence. More than 28 chemicals have been extracted from SLT which are found to be carcinogens. In case of SLT, nicotine is directly absorbed into the body through the mucous membranes in the mouth or nose. Also, the levels of nicotine in blood are similar in case of SLT users as well as smokers, and it remains in the bloodstream for a longer duration. According to GATS 2 report, around 48.2 per cent of all adults in Assam, of whom 62.9 per cent are men and 32.9 per cent women, either smoke tobacco or use smokeless tobacco. As per GATS 2 report, 42.6 per cent of men and 28.7 per cent of women are daily smokeless tobacco users. The use of smokeless tobacco is still prevailing in the society and 50.5% of men and 32.5% of women and 41.7% of all adults currently use smokeless tobacco. About 28.6 per cent of adults aged 15 and above use any kind of tobacco that means every 5th adult uses smokeless tobacco (SLT) and 75 per cent of these adults resides in rural areas.

Cancers linked to the use of smokeless tobacco include:

* Mouth, tongue, cheek, and gum cancer

* Cancer in the esophagus (the swallowing tube that goes from your mouth to your stomach)

* Pancreatic cancer

* Tooth decay, Tooth loss and the formation of white or gray patches inside the mouth called leukoplakia that can lead to cancer.

* Smokeless tobacco use during pregnancy increases the risk for early delivery and stillbirth.

Other harmful health effects of smokeless tobacco include:

* Heart disease and high blood pressure

* Increased risk of heart attack and stroke

Smokeless tobacco use also has short term effects on health. These include:

* bad breath

* teeth staining

* tooth decay

* receding gums

* mouth sores.

Data available for India through National Family Health Survey (NFHS) and GATS reveal that SLT consumption is mostly found in the females, while that is distributed among the all kinds of uses amongst the males. This depicts the equal vulnerability of the adult females as that of males, and increased risk of using SLT, particularly in the high age groups. With increase in age, the odds of tobacco use increase significantly. There is less knowledge and awareness among the uneducated people which leads to higher usage of tobacco. Low socio-economic status was found to be significantly associated with increased use of SLT among males and use of SLT and dual use of tobacco among females in India. Also, the increase in taxation in SLT products is less than the per capita income growth which ultimately indicated the increased affordability.

The Delhi government has extended the ban on manufacture, storage, sale or distribution of gutka, pan masala and any other tobacco products for one year in the national capital. Other states like Andhra Pradesh, Andaman and Nicobar, Mizoram, Odisha, Rajasthan, Chhattisgarh, Uttar Pradesh, Uttarakhand, West Bengal, Sikkim, Himachal Pradesh, Goa, Karnataka, Jharkhand too have banned manufacture, storage, sale or distribution of gutka, pan masala and other tobacco products.

Although the Government of Assam, under Health & Family Welfare Department has banned sale on gutka, pan masala etc containing nicotine under regulation 2.3.4 of Food Safety and Standards (Prohibition and Restrictions on Sales) Regulation, 2011 read with clause (a) of Sub – Section 2 of Section 30 of Food Safety and Standards Act, 2006, for one year, to properly stop the manufacture, storage, transportation, display, distribution, etc. all other enforcing authorities should put forward their help and cooperation in it.