Lifestyle Health and Wellbeing 27 Feb 2020 Smokeless tobacco&md ...

Smokeless tobacco—a serial killer on the prowl

Published Feb 27, 2020, 1:22 pm IST
Updated Feb 27, 2020, 2:07 pm IST
In India alone, almost 200 million use Smokeless Tobacco, resulting in over 3,50,000 deaths every year
Representational image (PTI file)
 Representational image (PTI file)

While smoking Tobacco is detrimental to one’s health, leading to ghastly consequences like death and long term chronic conditions , Smokeless Tobacco (SLT) is like a serial killer on the prowl.

Dressed up in an illusion of being less harmful and mercilessly murdering anything in its wake. While we have always been overtly aware of how injurious to health Smoking Tobacco is, what we tend to underplay is how much more harmful the usage of Smokeless Tobacco is. Smokeless


Tobacco is a global health epidemic available in over 40 forms, preying on over 360 million people across 140 countries, resulting in over 650,000 deaths globally.

In India itself, almost 200 million use Smokeless Tobacco, resulting in over 3,50,000 deaths every year. Commonly consumed Smokeless Tobacco products include Paan, Paan Masala, Khaini, Zarda and Gutka, which are is taken in the various forms and commonly as chewing, snuffing, application to teeth and gums.

This consumption is based on the misconception that Smokeless Tobacco is considered as a safer option as compared to smoking.  Smokeless Tobacco products are both widely used by men and women in India. It has been observed that the more common forms consumed by men are Khaini and Gutka whereas women prefer to use Betel Quid with Tobacco followed by oral application of Tobacco and khaini

The side effects of consuming smokeless tobacco products studied to date include head to neck cancers, oral diseases (dental caries, gingival recession, tooth attrition, oral mucosal lesions), cardiovascular risk factors, diabetes, reproductive health effects, and overall mortality. Most smokeless tobacco products have harmful and potentially harmful constituents that are known to be hazardous, such as tobacco-specific nitrosamines, cadmium, and aromatic hydrocarbons.

Absorption of toxic and carcinogenic chemicals in tobacco and other ingredients added to various products are causally associated with several non-communicable diseases including cancer, especially oral cancer, which is the leading form of cancer among men, and the third most common cancer among women in India.

The chewing form of smokeless tobacco also contains nicotine, the factor responsible for tobacco addiction. Some chewing tobacco products contain microscopic abrasives which increase the rate of absorption of nicotine and carcinogens into  cell membranes.

Another factor is the disparities found in the tobacco market due to socio-demographic neighborhood. Lower-income societies often become victims of tobacco marketing. The adults are often induced to start using harmful substances through innovative marketing strategies or through cultural influence. Apparently, women use their children to purchase tobacco for them, thus exposing children at a very young age resulting in early initiation and addiction.

Due to less knowledge and awareness in such communities the usage of smokeless tobacco products is higher. In addition to this, low socio-economic groups also lack the resources required to combat the ill effects or morbidities associated with tobacco consumption making it a clear case of an “addiction crisis”.

Hence, we are in an alarming state where there is a need to generate robust, credible data that will not only fill the current gap in research, but also spur interest across the community to become proactive in setting up testing infrastructure, improve the innovation for cost effective safer alternatives and help initiate research to reduce some of the highest oral cancer death rates and tobacco related disability rates. The ability of the person to succeed in quitting substances completely depends on the balance between the individual's motivation to quit substance use and his level of dependence on the substances.

Through optimised harm reduction strategy, we have to empower people to assist them to quit or switch to a healthier alternative. For any harm reduction intervention to be effective, the motivation of the substance user is indispensable.

Training & awareness campaigns through social workers, NGOs and health professionals on cessation techniques and tools can help users understand adapt or switch to Reduced Risk Products like Swedish Snus. SLT cessation intervention-based research needs to be encouraged, especially in the low-income group which have weak tobacco cessation support.

Organizations like Harm Reduction Research & Innovation center are actually working towards tobacco cessation and adopt an evidence-based approach to support the policymakers, social planners and product developers to deliver innovative harm reduction techniques and further reduce individual drug-related harm.

By Nilesh Jain

The author is the co-founder of CliniVantage Healthcare Technologies Inc