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If you thought the global anti-tobacco campaign—observed as World No Tobacco Day on 31 May each year—was only about smoking cigarettes, cigars, pipes or bidi, think again. The leaves of the tobacco plant are not only smoked; they are widely used in chewable products or even inhaled in the form of snuff.

Tobacco is a plant which, although local to the American continents, is now grown all over the world and is a major industry. Tobacco leaves contain the highly addictive substance called nicotine as well as many hydrocarbons and chemicals responsible for many types of cancer, heart disease and respiratory diseases, among other illnesses.

The Global Adult Tobacco Survey of 2016-17 conducted in India found that 29.6% men, 12.8% women and 21.4% of all adults—amounting to 199.4 million people—were consuming smokeless tobacco products in the country alone. Various health agencies and the government have been trying to deter the use of such products through advertising and anti-tobacco campaigns. But there is a long way to go before the dependency on tobacco is significantly reduced.

  1. Types of chewing tobacco
  2. Side effects of chewing tobacco and related products
  3. Diseases linked to chewing tobacco and related products
  4. Benefits of quitting chewing tobacco and related products
  5. Takeaways

Chewing tobacco is available in several forms and is commonly known as smokeless tobacco (SLT) made with a mixture of different products. Some of the common types used in urban as well as rural parts of India include:

  • Tambakoo or plain chewing tobacco: A common form of smokeless tobacco, chewing tobacco is sometimes also known as spitting tobacco. It is either made from loose tobacco leaves or in the form of snuff, both of which are kept between the gum and the cheek, and the juices that come out of chewing it are then spat out.
  • Gutka: Another form of chewing tobacco, gutka is made of crushed betel nut, tobacco, paraffin wax, catechu slaked lime as well as other artificial flavourings and comes in small pouches available across South Asia and North America.
  • Khaini: Tobacco leaves are dried or fermented and mixed with slaked lime to make khaini, which is also kept in the mouth between the gums and cheeks and the juices consumed slowly over time.
  • Paan leaf mixed with tobacco: Paan (betel or areca) leaves (also spelt as pan) are commonly available throughout South Asia, and used as an after-meal mouth freshener. Also known as betel quid, tobacco paan is made on a large betel leaf, filled with betel nuts, slaked lime, kattha paste and other artificial flavours.
  • Paan masala: A dried derivative of paan, paan masala is a mixture of betel nuts, slaked lime, catechu and other artificial flavourings. 
  • Kattha: Commonly known as catechu, kattha (also spelt katha) is an extract of the acacia tree that is used commonly in cooking and known by several names across the world. It is commonly used in paan in India for chewing purposes and produces a distinct red coloured spit when combined with lime.
  • Zarda: Zarda (also spelt as jarda) is another form of chewing tobacco common in several parts of rural India, and is a mixture of lime and tobacco. It is kept between the lip and the gum and is considered to be more harmful than even chewing tobacco.
  • Lime (chuna): Slaked lime (chuna), scientifically known as calcium hydroxide is a white, powdery substance which is consumed as it is or mixed in a paan leaf.

Whether it is smoked or chewed, the consumption of tobacco has several adverse effects—not only on the health of the person consuming it but also for those around them. For example, through passive smoking. (Read more: Disadvantages of smoking and benefits of quitting smoking)

Tobacco in chewed form also harms the body in several different ways, some of which include:

  • Betel or areca nut is a proven carcinogen—it causes cancer. And products like paan masala contain several toxic materials like residual pesticides, lead, cadmium and nickel.
  • Chewing tobacco products contain nicotine and other cancer-causing substances (carcinogens), and one can consume more nicotine while chewing tobacco than by smoking.
  • Chewing tobacco products are also related to loss of appetite and changes in sleep patterns. (Read more: Sleep disorders)
  • Chewing tobacco-derived products can cause various oral health problems such as gum disease and tooth decay, besides tooth loss in some cases.
  • Chewing tobacco and other products increases the risk of oral cancers.
  • Chewing tobacco also heightens the risk of gastrointestinal problems.
  • Chewing tobacco products is also linked to low testosterone and estrogen levels, as well as impotence. (Read more: Testosterone deficiency)
  • On experimental animals, tobacco products have been known to cause lesions in the lungs, liver and stomach.

As mentioned earlier, habitually chewing on various forms of tobacco has been linked to several diseases, such as:

  • Mouth cancer: Users of tobacco and tobacco-based products that can be consumed orally become exposed to different kinds of cancers, primarily oral cancers of the cheeks, gums, lips, tongue or the roof or floor of the mouth.
  • Other types of cancer: Some studies have also linked chewing tobacco with other forms of cancers such as stomach cancer, oesophagal cancer and pancreatic cancer.
  • Oral problems: Diseases of the mouth, including gum disease, gingival recession, bruxism, leukoplakia, stained teeth, dental plaque and tooth decay as well as the loss of teeth.
  • Heart problems: Increased risk of heart disease such as heart attack, although cardiovascular problems are higher among smokers.
  • Overall health: Habitual use of chewing tobacco has also been linked with high blood pressure, blurred vision and dizziness.
  • Addiction: Nicotine and other substances in tobacco are also well-known stimulants for the brain, and giving up such products have been linked to mental health issues such as irritability, anxiety, depression and other problems.
  • Pregnancy complications: Chewing tobacco during pregnancy can lead to complications as well, as the baby may be born underweight or with other issues linked to the habit.

While it may not be easy to give up nicotine-based products such as chewing tobacco, there are definite benefits of kicking the habit, some of which can be immediate, while others may take some time to become noticeable:

  • Improved breath: Chewing of tobacco and other products can leave a strong smell, which can be unpleasant for those around you. Kicking the habit is bound to improve your breath and overall oral hygiene.
  • A heightened sense of taste and smell: Chewing tobacco also dulls the sense of smell and taste, which can be reversed by quitting the habit.
  • Reduced health risk: Quitting the habit also reduces the risk of several diseases, including cancer.
  • Prevent tooth decay: The side-effects of chewing tobacco on oral health can also be mitigated, as the teeth can be saved from corrosion or decay, as well as discolouration.
  • Social aspects: Chewing tobacco as a habit is also frowned upon; many people are not comfortable around those who chew tobacco, or do not like to be in their company.
    Further, chewing paan masala, gutkha, khaini and kattha produces a red-coloured liquid that has to be spat out, which leaves stains on walls, streets and pavements everywhere, and is considered ill-mannered.
  • Save money: Although less expensive than smoking cigarettes, one can still save all the money that is used to purchase the products.

The long-term effects of chewing tobacco can be debilitating. There is a huge dependence on chewing tobacco products in several countries of the world. This is also true in India, where nearly 200 million people consume these products habitually.

Chewing tobacco and related products continue to be hugely popular here, despite programmes by governments and non-government organisations to discourage their use. Indeed, in many parts of India, pan masala is seen as a mouth freshener—ignoring the fact that habit-forming tobacco could be among its long list of ingredients. Many schoolchildren pick up the habit early—it does not help that the products are available in small, therefore cheap, packages.

Some of the diseases linked to the use of chewing tobacco and related products include hypertension, gum diseases, heart problems and mouth cancers which account for a large chunk of all cancer cases in the country.

Quitting tobacco has never been easy. But the tobacco-derived products increase the risk of certain diseases manifold should be seen as a good enough reason to quit.

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References

  1. Sinha DN et al. Prevalence of smokeless tobacco use among adults in WHO South-East Asia. Indian Journal of Cancer. 2012 Feb; 49(4): 342-346.
  2. Thakur JS and Paika R. Determinants of smokeless tobacco use in India. Indian Journal of Medical Research. 2018 Jul; 148(1): PMC6172920. PMID: 30264753.
  3. Rani M et al. Tobacco use in India: prevalence and predictors of smoking and chewing in a national cross sectional household survey. Tobacco Control. 2003 Dec; 12: e4.
  4. World Health Organization [Internet]. Geneva (SUI): World Health Organization; Global Adult Tobacco Survey.
  5. Ruhili R. India has reached on the descending limb of tobacco epidemic. Indian Journal of Community Medicine. 2018 Sep; 43(3): 153-156.
  6. Mohan P et al. Assessment of Tobacco Consumption and Control in India. Indian Journal of Clinical Medicine. 2018 Mar; 9: 1-8.
  7. Nanda PK and Sharma MM. Immediate Effect of Tobacco Chewing in the Form of 'Paan' on Certain Cardio-Respiratory Parameters. Indian J Physiol Pharmacol. Apr-Jun 1988; 32(2):105-13.
  8. Garg A et al. A review on harmful effects of pan masala. Indian Journal of Cancer. 2015 Jun; 52(4): 663-666.
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