In many parts of the world, including in the WHO Eastern Mediterranean Region, people use smokeless tobacco. The tobacco is usually chopped up and moistened, and is used by chewing it or holding it in the mouth between the gum and the cheek.
Chewing tobacco is sometimes mixed with other substances including herbs, spices, areca nut, betel leaf and slaked lime. Different forms include paan, naswar, chalia/supari and gutkha. Gutkha is a commercially-manufactured smokeless chewing tobacco that is a sweetened and flavoured dry mixture which is increasingly popular among young people and women in some countries.
Health risks of smokeless tobacco use
Smokeless tobacco use is highly addictive and damaging to health. The nicotine in smokeless tobacco is more easily absorbed than by smoking cigarettes enhancing its addictiveness. Smokeless tobacco contains many cancer-causing toxins and its use increases the risk of cancers of the head, neck, throat, oesophagus and oral cavity (including cancer of the mouth, tongue, lip and gums) as well as various dental diseases.
In Pakistan, where rates of smokeless tobacco use are high (and higher than cigarette use), oral cancer rates are among the highest in the world, and are significantly higher than other countries of the Region. Oral cancer is the second leading cancer there after breast cancer. Smokeless tobacco users have much higher rates of oral cancer than non-users.
Gutkha has been strongly implicated in an increase in oral submucous fibrosis, a very malignant and debilitating condition with no cure. This rise is being seen especially among young people, even after a short period of use.