Tobacco has been used in India for centuries. Early forms of tobacco were limited to chewing tobacco leaves or smoking tobacco. Today, several products made of, or containing tobacco, are available in the market.More than 4,000 different chemicals have been found in tobacco and tobacco smoke. More than 60 of these chemicals are known to cause cancer (carcinogens). Nicotine is a drug found in tobacco. It is highly addictive – as addictive as heroin or cocaine. Over time, a person becomes physically and emotionally addicted to, or dependent on, nicotine. Almost 30 percent of the Indian population older than age 15 uses some form of tobacco. Men use more smoked tobacco than smokeless tobacco. Women are more likely to use smokeless (chewed) tobacco.
Types of tobacco addiction
Smoked tobacco in India
Beedis: Crushed and dried tobacco is wrapped in tendu leaves and rolled into a beedi. Beedis are smaller in size than the regular company-made cigarettes so more beedis are smoked to achieve the desired feeling caused by nicotine. Beedi smokers are at least at an equal risk of developing cancers as cigarette smokers due to use of smoked tobacco. Beedi making is a source of livelihood for many families. In some families, everyone – including children – helps make beedis. The frequent inhalation of tobacco flakes has similar effects as the actual use of the tobacco product. Therefore, these families havean increased risk of lung diseases and cancers of the digestive tract. And, addiction is common among these families.
Cigarettes and cigars: A cigar is a roll of tobacco wrapped in leaf tobacco, and a cigarette is a roll of tobacco wrapped in paper. Cigarettes may come with filters, as thins, low-tar, menthol, and flavored – to entice more users, including women and youth and also to suggest the cigarettes have a lower health risk, which they do not. Many people view cigar smoking as less dangerous than cigarette smoking. Yet one large cigar can contain as much tobacco as an entire pack of cigarettes. Cigarette smoking is more common in the urban areas of India, and cigar use is seen in the big cities. Cigarette smoking in on the rise and is now also seen among teenage girls and young women.
Chillum: This involves smoking tobacco in a clay pipe. Chillum smoking increases chances of oral cancer and lung cancer. A chillum is shared by a group of individuals, so in addition to increasing their risk of cancer, people who share a chillum increase their chances of spreading colds, flu, and other lung illnesses. A chillum is also used for smoking narcotics like opium.
Hookah: Hookah smoking involves a device that heats the tobacco and passes it through water before it is inhaled. It is not a safer way to use tobacco. The use of hookah was once on the decline, but it has increased in recent years. Hookah is thought to be a sign of royalty and prestige and is available in highpriced coffee shops in flavors like apple, strawberry, and chocolate. It is marketed as a "safe" recreational activity, but it is not safe and is finding increasing use among college students of both sexes. Use of tobacco in this form can result in tobacco addiction.
Chutta smoking and reverse chutta smoking: Chuttas are coarse tobacco cigars that are smoked in the coastal areas of India. Reverse chutta smoking involves keeping the burning end of the chutta in the mouth and inhaling it. This practice increases the chance of oral cancer.
Smokeless tobacco use
Smokeless tobacco is very common in India. Tobacco or tobacco-containing products are chewed or sucked as a quid, or applied to gums, or inhaled.
Khaini: This is one of the most common methods of chewing tobacco. Dried tobacco leaves are crushed and mixed with slaked lime and chewed as a quid. The practice of keeping the quid in the mouth between the cheeks and gums causes most cancers of the gums – the most common mouth cancer in India.
Gutkha: This is rapidly becoming the most popularform of chewed tobacco in India. It is very popular among teenagers and children because it is available in small packets (convenient for a single use), uses flavoring agents and scents, and is inexpensive (as low as Re 1/- equivalent to 2 cents). Gutkha consists of areca nut (betel nut) pieces coated with powdered tobacco, flavoring agents, and other “secret” ingredients that increase the addiction potential. Gutkha use is responsible for increased cases of oral cancers and other disorders of the mouth and teeth in young adults.
Paan with tobacco: The main ingredients of paan are the betel leaf, areca nut (supari), slaked lime (chuna), and catechu (katha). Sweets and other condiments can also be added. The varieties of paan are named for the different strengths of tobacco in it. Some people think that chewing paan without tobacco is harmless, but this is not true. The International Agency for Research on Cancer (IARC) has established that people who chew both the betel leaf and the areca nut have a higher risk of damaging their gums and having cancers of the mouth, pharynx, esophagus, and stomach.
Paan masala: Paan masala is a commercial preparation containing the areca nut, slaked lime, catechu, and condiments, with or without powdered tobacco. It comes in attractive sachets and tins, which are easy to carry and store. The tobacco powder and areca nut are responsible for oral cancers in those who use these products a lot.
Mawa: This is a combination of areca nut pieces, scented tobacco, and slaked lime that is mixed on the spot and chewed as a quid. The popularity of mawa and its ability to cause cancer matches that of gutkha. Its use is rising among teenagers and young adults in India.
Mishri, gudakhu and toothpastes: These preparations are popular because people believe – incorrectly – that tobacco in the product is a germicidal chemical that helps in cleaning teeth. Mishri is roasted tobacco powder that is applied as a toothpowder. Mishri users often become addicted and start applying it as pastime. Gudakhu is a paste of tobacco and sugar molasses. These preparations are commonly used by women and involve direct application of tobacco to the gums, thus increasing the risk of cancer of the gums.
Tobacco-containing toothpastes, which are promoted as antibacterial pastes, are popular among children. This habit often becomes an addiction, and the children graduate to other forms of tobacco, thus increasing their chance for cancers.
Dry snuff: This is a mixture of dried tobacco powder and some scented chemicals. It is inhaled and is common in the elderly population of India. Snuff is responsible for cancers of the nose and jaw.
Problems due to tobacco-
Because of Smoking
- Mood stimulation
- Anxiety and irritability
- Unhealthy teeths
- Poor vision
- Early menopause
- Constricted blood vessel
- Lung cancer
- Heart diesese
- High cholesterol
- Blood clotting
- Problems with pregnancy
Because of chewing
Users of snuff and chewing tobacco are at an increased risk for certain types of cancer, most notably cancer of the oral cavity including cancers of the:
- floor and roof of the mouth.
Some studies have suggested a link between the use of chewing tobacco and the development of:
Those who use chewing tobacco have an increased risk of: