75 pc of smokeless tobacco users are Indians

Seventy-five percent of the world’s smokeless tobacco users are Indians (220 million individuals), who are at risk from several diseases ranging from cancer and heart attacks, a new public health report has suggested.

Smokeless tobacco is the predominant form of tobacco used in India, exceeding cigarette smoking among both men and women. Some of the commonest ways to consume it are chewing tobacco with lime (khaini), gutka and betel quid, which is typically freshly prepared by the user or a vendor.

Pan masala and gutka have become increasingly popular as alternatives to traditional betel quid as they are manufactured on an industrial scale and sold in dried form.

Nicotine in smokeless tobacco products leads to addiction, and quit rates are very low in India. A 2009 study found that only 7.9 per cent of smokeless tobacco users successfully quit, says the report, prepared by the Centre for Disease Control, Atlanta and National Cancer Institutes, USA. Almost a quarter of Indians use smokeless tobacco. The practice is more common in the countryside.

“India has the highest prevalence of oral cancer globally, with 75,000 to 80,000 new cases of oral cancers in a year. There are more than 3,000 chemical ingredients in smokeless tobacco products, out of these, 28 chemical ingredients are proven carcinogens,” said Bhavna Mukhopadhyay, executive director, Voluntary Health Association of India.

Smokeless tobacco use increases steadily with age, rising from 16.2 per cent for the 15−24 age group to 33.7 per cent for people aged 65 and older. Almost nine per cent of youth (13 to 15) use smokeless tobacco.

Region-wise, the prevalence was the highest in the east (38 per cent) and lowest in the north (7 per cent) India. Among the states, the use ranges from 49 per cent in Bihar to 5 per cent in Goa.

“Despite being a big public health threat, smokeless tobacco does not get much attention from the government. It is extremely difficult to quit,” Prakash Gupta, director of Healis-Sekhsaria Institute for Public health, Mumbai and one of the coauthors of the report told Deccan Herald.

Smokeless tobacco products cause addiction; precancerous oral lesions; cancer of the oral cavity, esophagus, and pancreas; and adverse reproductive and developmental effects including stillbirth, preterm birth, and low birth weight, says the report.

Some, but not all, smokeless products are associated with increased risk of fatal ischemic heart disease, type 2 diabetes and fatal stroke, it adds.