Ref: CHB/News Bulletin/007/2012

A UK advisory health board, The National Institute for Health and Clinical Excellence (NICE) has issued an advisory to stop chewing tobacco/using smokeless tobacco products like pan to all South Asians.

NICE says too often people using these products are unaware that they contain tobacco and can cause illnesses like cancer. And, unlike cigarettes, many smokeless products carry no warnings on packs.

For most people, tobacco use is automatically associated with smoking such as smoking cigarettes. Smoking, however, is not the only way that tobacco is used. Tobacco is often chewed also known as smokeless tobacco. Smokeless tobacco products include chewing tobacco like betel quid (sopari) and paan, sucked or "moist oral" tobacco as well as inhaled tobacco products like snuff.

st_1People often think that because the tobacco is only chewed or allowed to sit in one's mouth, it becomes safer than actually smoking it as they do cigarettes. Yet the same nicotine effect happens when they suck on the tobacco juices allowing nicotine to enter the bloodstream through the tissues in their mouth. There's no need to even swallow the tobacco since it already takes effect just by staying in one's mouth. The nicotine content in reality is more hence leading to the same if not more addictive phenomenon.

They may also contain other unhealthy ingredients such as areca nuts (sarautaa or sudi) - a mildly euphoric stimulant, known to be addictive and cancer-causing and slaked lime (chuno), a chemical used to make cement.

Smokeless tobacco products include:st_2

  • Tobacco with or without flavourants: misri India tobacco (powdered) and qwimam (kimam).
  • Tobacco with various alkaline modifiers: khaini, naswar (niswar, nass) and gul.
  • Tobacco with slaked lime as an alkaline modifier and areca nut: gutkha, zarda, mawa,

st3The effects of chewing tobacco range from the immediate, less scary ones to the long-term, more frightening conditions. Someone who has been chewing tobacco may soon enough develop discoloration of the teeth and persistent bad breath. Also, about 70% of those who chew tobacco suffer from mouth sores.

More serious effects are bleeding gums, falling out of teeth, elevated high blood pressure, increased risk of heart attack and stroke, and leukoplakia – a precursor to oral cancer. Oral cancer can affect the lips, the tongue, the floor of the mouth, the roof of the mouth, the cheeks, or the gums.

However, 'Meetha' (sweet) paan does not contain tobacco. Instead it is flavoured with coconut, fruit preserves, rose petal preserve, and candied fennel seeds wrapped in a betel leaf.


Compiled by: Neelam A. Ismail

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