India tops global list in use of chewing tobacco, oral cancer

Some 80 per cent of more than 300 million consumers of smokeless tobacco in a survey of 70 countries were found to be in India and Bangladesh, a report on the global use of smokeless tobacco says.

And 75 per cent 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.

The study was not, of course, talking of the new-fangled electronic cigarettes, which are out of reach of most Indians, let alone Bangladeshis. Rather, it referred to the various forms of chewing tobacco most widely used in the sub-continent.

The report 'Smokeless Tobacco and Public Health: A Global Perspective' says that the majority of smokeless tobacco users (89 per cent) are in Southeast Asia, which also has the highest oral cancer rates in the world.

As many as 32 leading experts from around the world contributed to the research.

Smokeless tobacco is the predominant form of tobacco used in India, exceeding cigarette smoking among both men and women. Some of the commonest forms are chewing tobacco with lime (khaini), the ubiquitous but hazaedous 'gutka' and rolling the stuff in a betel quid, which is typically freshly prepared by the user or a vendor.

'Paan masala' and gutka have become increasingly popular as alternatives to traditional betel leaf stuffed with areca nut and spices, as these are manufactured on an industrial scale and sold in dried form.

Nicotine in these 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.