Smokeless tobacco (ST) refers to tobacco products that are consumed without being burnt to make smoke. Smokeless tobacco products include ‘chewing tobacco’ (e.g. paan, gutkha or zarda), as well as various other types of oral and nasal tobacco (like naswar). Such products are particularly popular in South Asia, where they are socially acceptable, even when cigarettes aren’t. The products and their recipes are diverse and they may be commercially manufactured or home-made. Very often, the tobacco is mixed with other ingredients, such as betel nuts (areca), herbs and spices. These make the products look appealing and taste delicious, although some of the additives may themselves be harmful to health. Sometimes manufacturers (falsely) claim that their ST products freshen the breath, clean the teeth or have other health benefits.
Smokeless tobacco products have historically been assumed to be less harmful than cigarettes. Therefore, not very much research has been done on smokeless tobacco. However, ST is highly addictive and is known to cause cancers of the mouth, pharynx and oesophagus, as well as cardiovascular disease and pregnancy problems. Over 300 million people around the world use ST, making ST consumption a global public health issue, causing at least 650,000 deaths per year. 80% of ST users live in South Asia, hence our focus on Bangladesh, India and Pakistan.
Policies that are designed to reduce the harm caused by tobacco products are already in place in many countries, but these have been found to be applied less stringently to ST than to smoked forms of tobacco.