BlessWorld Foundation International

Affecting the World Through Health
A Global Health Initiative

Global Health and Smokeless Tobacco



The Center for Disease Control and Prevention (CDC) describes smokeless tobacco and it’s products as nicotine-containing substances that can be consumed without burning. These products are consumed in various ways other than smoking, including chewing, sucking, dipping, sniffing, placing the product between the teeth and gum and application to the skin. There are numerous smokeless tobacco products around the world and they vary in composition, preparation and consumption methods and potential health risks. Smokeless tobacco is highly addictive since it still contains nicotine, and stopping it’s use can be as challenging as quitting smoking.

South and South-East Asia are locations with the highest prevalence of smokeless tobacco use. In these regions, smokeless tobacco is often served at social occasions and may contain slaked lime, areca nut, flavourings, and aromatic substances. Other areas where the consumption of smokeless tobacco is also evident include Nordic countries and North America, Venezuela, Uzbekistan, Kyrgyzstan, Sudan, Chad, Nigeria, Ghana and South Africa. In these parts of world, common products include Snus, Chimó, Nass, Tambook, Snuff and soluble tobacco such as tobacco lozenges, orbs, pellets, breath strips and toothpick-sized sticks. Some tobacco products are made like candy, containing contain sweeteners and flavors, however, they all have nicotine. Given the widespread international use and potential risks of smokeless tobacco, it is important to extensively assess its impact on health.

A 2010 study by Siddiqi et al. showed adult smokeless tobacco consumption data and estimated disease burden of over 100 countries. The estimates showed that the use of smokeless tobacco resulted in about 1.7 million DALYs lost and 62,283 deaths. The majority of the death were due to mouth, pharynx and oesophagus cancer. As expected, South-East, where the use of smokeless tobacco products is most prevalent, had the highest burden of death and disease. Furthermore, several studies have shown increased rates of leukoplakia in the areas of the mouth where tobacco is chewed or dipped. Leukoplakia is a cancerous painless grayish white patch, spot or sore in the mouth which usually clears when tobacco use is terminated. The likelihood of having leukoplakia increases with increase in the length of time oral tobacco is used. Additionally, tobacco use may cause teeth stains or decays, cavities, receding gums, bad breath and gum tissue irritation and disease, bone loss around the teeth and tooth loss. Given the above facts, it is quite obvious that all tobacco products are harmful, irrespective of their form, composition and method of consumption. Therefore, “smokeless” doesn’t translate to harmless as misconceived by a lot of people.

The use of smokeless tobacco results in significant but preventable global morbidity and mortality, especially from cancer. Consequently, health regulatory organizations such as CDC and World Health Organization need to consider the establishment of  smokeless tobacco regulations as part of tobacco control initiatives. Currently, WHO recommends that consumers must be informed on probable negative health effects by ensuring that health warnings and labelling are shown on smokeless tobacco products. In addition, further research should be conducted to assess nicotine and risks to individuals, as well as to identify health effects of changing patterns of smokeless tobacco use in populations.

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