Chewing/Smokeless Tobacco Better Than Smoking? Read This!

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Tobacco is one of the most common preventable risk factors of premature morbidity and mortality all over the world. Globally, it leads to more than 7.2 million premature deaths. India is the second largest consumer of tobacco[1]. The prevalence of tobacco use in men is 48% and women is 20% in India[2]. It is revealed that 28.6% of adults aged above 15 years of age use tobacco in smokeless forms such as chewing, applying, sucking, gargling, etc[3]. Smokeless tobacco (SLT) which is consumed either orally or nasally has been in use for as long as other forms of tobacco.

Chewing tobacco or spitting tobacco is one of the common types of smokeless tobacco. Tobacco chewing includes chewing or placing the tobacco between the cheek and gum or teeth or between the upper lip and gum. Some people consider these products as a safer option than cigarettes as the smoke is not inhaled like cigarettes. However, in reality, these products result in some of the same or even additional health risks as cigarettes[4]. Here’s more you need to know about the fatal effects of chewing tobacco on the health.

Health Effects of Chewing Tobacco 

Currently, 70 million women aged 15 years and older use SLT in India, which is attributed to the easy availability and low cost of SLT[5]. Chewing tobacco can lead to a number of health complications which include:

Pregnancy complications: The use of smokeless tobacco during pregnancy results in 70% higher risk of anaemia in pregnant women. Moreover, it also causes complications in the baby. There is a 2–3 times higher rate of low birthweight and 2–3 times higher rate of stillbirth in women using smokeless tobacco[5].

Mouth and tooth problems: Tobacco chewing stains the teeth and causes bad breath. Many studies have shown high rates of leukoplakia in the mouth where users place their chew or dip[6]. Leukoplakia is a condition which causes gray-white patches in the mouth that can become cancer. It can also irritate or destroy the gum tissue. The sugar and irritants in smokeless tobacco products can cause cavities, abrasion of teeth, bone loss around roots and tooth loss.

Heart disease: Some forms of smokeless tobacco can increase the heart rate and blood pressure. The use of smokeless tobacco in the long run can put pressure on the heart. This can increase the risk of cardiovascular diseases such as heart attack and stroke[7].

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Addiction: There is a common misconception that smokeless tobacco is safer as compared to smoking. And this could be one of the common reasons for initiation and persistence of the use of tobacco in smokeless form. Moreover, all forms of tobacco are addictive, as they contain nicotine which makes it addictive. Unlike smoked tobacco which is used periodically during the day, chewing tobacco often exposes in high dependency of nicotine consumption.

Some people also believe that smokeless tobacco can help people quit but. But SLT contains high amounts of nicotine and it stays in the bloodstream for a longer duration[3]. So this could be the reason for addiction and dependence which further prevents the users from quitting smoking. Moreover, there is no research evidence to prove that use of smokeless tobacco can help quit smoking.

Cancer: Just like smoking, tobacco chewing or chewing other smokeless tobacco increases the risk of oral cancer. Cancers of the oral cavity and pharynx are an important public health problem in India, with nearly 85,000 new cases among men and 34,000 among women in India each year[5]. At least 90% of these cancers are caused by tobacco use in some form, and more than half are caused by SLT use[5]. 

According to studies[3], more than 28 chemicals have been extracted from SLT which are carcinogens. Nicotine which is the key ingredient in tobacco is directly absorbed into the body through the mucous membranes in the mouth or nose. 

SLT can increase the risk of cancer of the mouth, gums, cheek, throat, tongue or lips. It also leads to cancer in the esophagus that is the swallowing tube that goes from the mouth to the stomach[8].. Many smokeless tobacco products contain cancer-causing chemicals. The most harmful chemicals are tobacco-specific nitrosamines, which are formed during the growing, curing, fermenting, and aging of tobacco. The amount of these chemicals varies depending upon the product[8].

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Bottomline: Smokeless tobacco are no different than cigarette smoking. What you need to know and remember is that there are no harmless tobacco products and there may be fatal effects of chewing tobacco. There are numerous treatments available for quitting tobacco.

Smoking cessation products are available for home use for people interested in quitting tobacco. Consult your doctor personally or opt for online consultation to know how to quit smoking. Write to us in the comments section if you need any specific help or information related to quit smoking. Stay informed, stay healthy! 

(The article is reviewed by Dr. Swati Mishra, Medical Editor)

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1. Ruhil R. India has Reached on the Descending Limb of Tobacco Epidemic. Indian J Community Med. 2018 Jul-Sep;43(3):153-156.

2. Mishra GA, Kulkarni SV, Gupta SD, Shastri SS. Smokeless tobacco use in Urban Indian women: Prevalence and predictors. Indian J Med Paediatr Oncol. 2015 Jul-Sep;36(3):176-82.

3. Thakur JS, Paika R. Determinants of smokeless tobacco use in India. Indian J Med Res. 2018 Jul;148(1):41-45.

4. Cullen JW, Blot W, Henningfield J, Boyd G, Mecklenburg R, Massey MM. Health consequences of using smokeless tobacco: summary of the Advisory Committee’s report to the Surgeon General. Public health reports. 1986 Jul;101(4):355.

5. Smokeless tobacco and public health in India. Executive Survey. Ministry of Health and Family Welfare. Government of India.

6. Health risks of smokeless tobacco. The American Cancer Society.

7. Asplund K. Smokeless tobacco and cardiovascular disease. Progress in Cardiovascular Diseases. 2003;45(5):383-394.

8. WHO International Agency for Research on Cancer. IARC monographs on the evaluation of carcinogenic risks to humans: volume 89. Smokeless tobacco and some tobacco-specific N-nitrosamines. Lyon, France: WHO International Agency for Research on Cancer. 2007.

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