India leads a global study with WHO on the ill effects of Smokeless Tobacco products
In a first, a study has been undertaken by the World Health Organisation (WHO) to estimate the global death burden due to Smokeless Tobacco (SLT). Until now, the study was limited to 120 countries, mostly South Asian. Now 133 countries have been included to study the prevalence and ill-effects of SLT.
The study, which was conducted in 2015, was recently published in Tobacco Control journal. It reveals that over 6,52,000 people die every year due to the consumption of SLT across the world. In India, these would include products like gutkha, tambaku, mawa, paan masala, naas and maseri.
“SLT consumption causes over half a million deaths each year. Over 95 per cent users are from developing countries, particularly the South-East Asia. This is the first study to understand the consequences of SLT consumption across continents. Smokeless tobacco contains about 70-80 per cent tobacco content. Many, including women, take it to curb hunger,” said Dr Ravi Mehrotra, director, WHO-Framework Convention for Tobacco Control (FCTC) Global Hub. The project was conducted in collaboration with FCTC.
As per the study, the mortality rate of people consuming SLT is 37 times higher than those consuming other forms of tobacco. It also confirms that mortality rate due to SLT is the highest in cases of stroke.
“Earlier, it was assumed that SLT only leads to oral cancer and cancer of Upper Aerodigestive Tract (UADT). The study, however, confirms that the higher number of deaths due to SLT were because of stroke followed by UADT,” said Dr Dhirendra N Sinha, principal author of the study, and senior consultant at WHO-FCTC Global Hub.
SLT comprises a wide variety of products used globally (like snus, tobacco tooth powders, snuff, gutkha, khaini, tambaku, qiwam, dohra, kimam, tobacco powder, mawa and others). All these products were covered under the study.
Each region has its popular forms of SLT, arising from long standing traditions—Tawa, Neffa, Snuif and Toombak in the African region; khaini, gutkha, betel quid and zarda in the South-East Asia and Western Pacific region; Rapé and Chimó in the South Americas, dry snuff, dissolvable tobacco, Iqmik and moist snuff in the US, tombol, nas, shammah and zarda in the Eastern Mediterranean region, and as snus in the European region.
These products vary in toxicological profiles, and are consequently associated with varying risks of disease and mortality but none of them are safe to use.
“Increasing harmful effects due to consumption of SLT are being recognised from cancers, pre-cancers, cardiovascular effects, adverse pregnancy outcomes, respiratory infections, addiction and poor oral health to early mortality,” added Dr Sinha.
About 1,03,090 people have died of stroke due to the consumption of SLT in 2015 while 1,503 people have died from cancer of UADT. Death due to stroke is the highest as compared to other reasons like cervical cancer, stomach cancer etc.
Recently, the Supreme Court banned sale of all forms of chewable tobacco and nicotine, and directed authorities, including the Food Safety and Standards Authority of India (FSSAI) under Union Health Ministry, to strictly enforce its directions.
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