chewing tobacco

Last edited 06/2021 and last reviewed 12/2021

Tobacco manufacturers can sell smokeless tobacco products that are sweeter or flavoured and aimed at new users, and these products are usually cheaper than
cigarettes

• a wide array of products is available in the market, but data on smokeless tobacco use are often not collected by specific products or subtypes, further complicating monitoring and regulation
• all smokeless tobacco products are consumed through the mouth or nose without burning, the wide variety of products are used in different ways and are associated with varying degrees and types of harm
• many studies have found strong evidence for the increased risk of oral cancer due to chewing tobacco

Epidemiology (1):

• in 2019, 273.9 million (95% uncertainty interval 258.5 to 290.9) people aged 15 years and older used chewing tobacco, and the global age-standardised prevalence of chewing tobacco use was 4.72% (4.46 to 5.01)
• 228.2 million (213.6 to 244.7; 83.29% [82.15 to 84.42]) chewing tobacco users lived in the south Asia region
• prevalence among young people aged 15--19 years was over 10% in seven locations in 2019
• although global age standardised prevalence of smoking tobacco use decreased significantly between 1990 and 2019 (annualised rate of change: -1.21% [-1.26 to -1.16]), similar progress was not observed for chewing tobacco (0.46% [0.13 to 0.79])
• among the 12 highest prevalence countries (Bangladesh, Bhutan, Cambodia, India, Madagascar, Marshall Islands, Myanmar, Nepal, Pakistan, Palau, Sri Lanka, and Yemen), only Yemen had a significant decrease in the prevalence of chewing tobacco use, which was among males between 1990 and 2019 (-0.94% [-1.72 to -0.14]), compared with nine of 12 countries that had significant decreases in the prevalence of smoking tobacco
• among females, none of these 12 countries had significant decreases in prevalence of chewing tobacco use, whereas seven of 12 countries had a significant decrease in the prevalence of tobacco smoking use for the period

Smokeless tobacco and cancer risk (2)

• causative linkages of smokeless tobacco (SLT) use with oral potentially malignant disorders and cancers of oral cavity, oesophagus and pancreas have been reported
• a systemic review showed a significant positive association of SLT use with various cancers (2):
  • majority of the studies from South-East Asian Region (SEAR) and Eastern Mediterranean Region (EMR) showed associations with
• with oral cancer [odds ratio (OR) ranging from 1.48 to 27.4]
• oesophageal cancers (OR between 2.06 and 12.8)
• studies from European Region (EUR) reported a positive association with pancreatic cancer (OR between 1.6 and 2.1)
• review emphasizes on the significantly positive association of SLT use with oral and oesophageal cancers in SEAR and EMR and pancreatic cancer in EUR

Reference:

1. GBD 2019 Chewing Tobacco Collaborators. Spatial, temporal, and demographic patterns in prevalence of chewing tobacco use in 204 countries and territories, 1990-2019: a systematic analysis from the Global Burden of Disease Study 2019.Lancet Public Health 2021 (May 27, 2021)
2. Gupta S, Gupta R, Sinha DN, Mehrotra R. Relationship between type of smokeless tobacco & risk of cancer: A systematic review. Indian J Med Res. 2018 Jul;148(1):56-76