Smokeless Tobacco:

Challenges and
Threats for India Hemant Goswami

Indians always had a penchant for the "imported" As one would logically conclude, all this has now
tag on all products. I feel that it would have been proved to be one of the biggest mistakes in Indian
better if this fad for the foreign stuff dominated the tobacco control scenario. Some realisation has now
Indian mentality in case of tobacco too. If it was dawned-upon about the health effects and death
so, then we wouldn't have been having the massive toll due to consumption of other forms of tobacco;
challenge we are now facing on account of our own which has been exponentially rising, even though still
home grown 'Bidi' and "Smokeless' tobacco products. little attention is being paid to the issue. Among all
While the common man didn't get infatuated forms, the rise of the smokeless form of tobacco is
exclusively by the foreign version of tobacco; the particularly alarming.
policy makers, all these years, looked only towards
the west for controlling tobacco. Unfortunately the What is smokeless tobacco?
section of Indian policy makers who should not have For most parts of the west, smokeless tobacco is a
imported their understanding about the problem-in- new thing; atleast as a commercial product marketed
hand actually found it easy to import the 'statistics' with competitive marketing strategies. However in
on tobacco usage and problem. As a result; all our India, we have all possible variants of tobacco. Any
tobacco control efforts got concentrated around the tobacco product which is consumed without it being
'White Cigarettes' (which are around 15% of the burnt and inhaled comes in the category of smokeless
total consumption) and we ignored the challenges tobacco product. Some of the more popular and
posed by the domestic brown cigarettes, popularly commercially marketed forms are;
known as 'Bidi' and also the varied forms of
'Smokeless' tobacco. It is indeed shameful that the • Chewing tobacco
government does not even have complete statistics - raw - Chewing
on these products. Little is clearly known about tobacco consists of
the consumption patterns, use of tobacco other small pieces of raw
than cigarettes, health effects of other forms of finely cut tobacco.
tobacco, etc. Most of the statistics quoted by the Most of the times it
government bodies either come from the industry is unlabelled coming
itself, or majority of statistical understanding and from small cottage
data comes from foreign papers or funded research industries but there
(mostly focussing on cigarettes) or from small sample are a lot of small time commercial brands too
surveys about 'self-declared tobacco use' conducted available.
by WHO and some other such bodies. As a result, • Paan Masala - Tobacco
organisations and policy makers grope in dark and Paan Masala is a
have to work only with the best available guess commercial concoction
estimates. Not a good scenario for a country which containing areca nut,
has to deal with over a million tobacco related slaked lime, catechu,
deaths every year. condiments along with

II 9
 powdered tobacco. Paan MasaLa contains aLmost added and the mixture may
aLLthe ingredients that go into the making of a also be rolled into balls. It is
paan, but are dehydrated so that the finaL product heLd in the mouth for 10 to
is not perishabLe. Paan MasaLa is more popuLar 15 minutes. If it is chewed
in urban areas. The market for Paan Masala has it produces a bad taste in
grown many folds over the last 10 years. the mouth. People who are
addicted may consume it
• Gutka - It is a preparation
of crushed beteL nut, on an hourLy basis. Besides
tobacco, catechu, Lime India (among peopLe tracing
and sweet or a Little savory their origin to Pashtun ethnic groups) it is more
flavourings. It is mostly commonly used in Central Asia, Iran, Afghanistan,
soLd across smaLL sachets Pakistan, Tajikistan, etc.
at a highly economical • Snus - .Snus is a moist
price of Rs. 1 to 8. It is powder tobacco product
chewing tobacco. originated from a variant
of dry snuff, in the early
• Paan (Betel Quid) with
Tobacco - Paan with 19th century in Sweden,
tobacco consists of; consumed by pLacing it
• under the lip for extended
betel leaf, areca nut,
slaked Lime, catechu periods of time. It is
and tobacco. Betel availabLe in teabag Like
leaves contain voLatile pouches. Snus has its
oi~ such as eugenoL uniqueness in the fact that it is steam-cured rather
and terpenes, nitrates than fire-cured. It is said to be not fermented
and small quantities of containing no added sugar, unlike many chewing
sugar, starch, tannin and tobacco variants available in India.
several other substances. • Snuff - Snuff is ground
Many Condiments and sweetening agents may aLso or puLverized tobacco,
be added as per regional practices and individual which is generally
preferences. Each Paan is tailor made and insufflated or "snuffed"
specific ingredients are added along with tobacco through the nose. There
according to the instructions of the chewer. One are several types of
can find Paan shops in even the smaLLest viLLages snuff, but traditionally
of India. it means nasal snuff. It
is also often flavoured
• Khaini and Zarda
Another variant of and typical flavors are floral, mentholated, fruit,
chewing tobacco which and spice, either pure or in bLends. "Snuff" can
consists of raw tobacco also refer to dipping tobacco, which is appLied to
mixed with fragrances the gums rather than inhaled. Another common
and spices for achieving variant of this is 'Bajjar' in India. Bajjar is dry
desired flavors. While snuff (aka Tapkeer) applied commonly by women
Zarda represents tobacco in Gujarat on the teeth and gums.
that is Later mixed with • Other forms - Besides the above mentioned, there
lime by the user, Khaini is a considered a step are numerous other variants of liquid, chewing
ahead and provides the final mixture in a single and nasal tobacco like Tuibur, Mishri, Mawa, GuL,
package. Khaini is widely used for its wider range Gudhaku, Plug, etc., in use in many regions and
of fragrances and flavours and is a little costlier parts of India.
than Zarda because of its user-friendly nature.
Promotion Strategy of the Industry
• Naswar - Naswar is sun and heat-dried tobacco
leaves mixed with slaked lime and ash from tree To attract new users and highlight the features of
bark, flavoring and coLoring agents. Water is its smokeLess tobacco, the website of one of smokeless

I • 10
lIIIIIIIIIIiIIi_F_eb_ru_a~ __-_Ma_rC_h_a_nd_A_p_ril_-_Ma_~~2_0_10 ~=- ~==~_=~ _
tobacco manufacturers spells the advantages of its
products as reproduced hereunder;
• Less harmfuL than cigarettes.
• No externaL effects such as those from passive
smoking.
• Can be used in "No-Smoking" areas Like airports,
air pLanes & other pubLic pLaces.
• UnLike cigarettes, hands remain free since there is
no need to hoLd the product during consumption.
• As easy to use as chewing gum with a Use & Throw
method Like that of chewing gum
• It is an extremeLy Low-priced product
The manufactures promotionaL statement above
highLights the exact strategic approach of the
smokeLess tobacco industry. From the above, it is
clear that the tobacco industry is trying to buiLd upon
the restrictions on smoking and take advantage of
the tobacco controL momentum. The industry is aLso
strategising to gain from the cessation efforts of a
Large number of peopLe trying to quit smoking. One of
the most dangerous faLse statements made above are
claims stating, "Less harmfuL than cigarettes." Similar
misconception and faLse notions about safety are aLso
being pushed by Swedish 'Snus.
Health Effects
SmokeLess tobacco is no Less harmfuL than its
smoked variant Like cigarettes. In many cases it is
even more harmfuL with a smaller gestation period
for the onset of heaLth effects and the consequentiaL
fataLity. However many myths about the false concept
about its safety are being spread by the tobacco
industry to confuse the pubLic and even governments
Tobacco
causes
mouth
cancer
around the worLd. In some cases it is also being
wrongLy pushed as a repLacement to cigarettes or even
deceitfully pushed as an aLternate form of nicotine
usefuL in quitting tobacco. ALLsuch claims are not onLy
faLse and incorrect but rather have the potentiaL to
cause further miseries and compLicate and aggravate
the heaLth condition of existing smokers. The entry of
big pLayers has resuLted in these giants pressurising
the governments and heaLth authorities to declare
that smokeLess tobacco is Less harmfuL and LikeLyto
offer heaLth benefits. This is done soLeLyto give a faLse
notion of safety to peopLe.
Smokeless tobacco is aLso a 'class K carcinogen
and contains over 25 cancer causing agents. It is
weLL known that oraL and spit tobacco increases
the risk for leukoplakia. a precursor to oraL cancer.
Chewing tobacco has been known to cause cancer,
particuLarLy of the pancreatic, oesophagus, mouth and
throat. There is now clear evidence that increasing
trend of 'qutka consumption is causing an epidemic
of 'oral submucous fibrosis' and is Leading to an
increased incidence of oraL cancer even among young
persons.
SmokeLess tobacco use, which has now become
more common among women in India, has been found
to cause adverse reproductive outcomes in the form of
Lowbirth weight (Lower by an average of 105 g), Lower
gestation period ( an average of 6 days) and higher
stillbirth rates. One of the Latest studies by Prakash
Gupta (in Ahmedabad) shows that how there is an
exponentiaL growth of cases in mouth cancer with
increase in consumption patterns of chewing tobacco,
especially Gutka. The study shows that between 1985
and 2006, the incidents of mouth cancer have become
nearLy 300 percent more prevaLent among youngsters
in the age group of 35 to 44 years of age and has seen
over four foLd increase among the 25-34 age group
(see Fig. 1). This is indeed aLarming.
Fig. 1
50.0
India, Ahmedabad (Mouth Cancer) MaLe
46.1
45.0
40.0
35.0
30.0
-1985
-1995
32.3
25.0
20.0
15.0
-2006
10.0
o
5.0L~IIIIiiii~~D:=-~
0.5
15-24 24-34 35-44 45-54 55-64
_
65-74
• 11
The growth of smokeless tobacco
All evils grow the best in dark, away from any
attention. Smokeless tobacco is no different. Due to
lack of focus on smokeless tobacco by health workers,
government and policy makers; smokeless tobacco had
a very healthy growth in the last couple of decades.
The evil of smokeless tobacco found its way to schools
and now the average age of initiation of smokeless
tobacco among the first time users has come down to
8 to 10 years old children.
A mere perusal of various snap-shots of some
sample surveys show how the usage is increasing over
the years. The NSSO data of 1993-94 reported that
9.9 % male and 4.3 % females (age>10 yrs) in urban
areas consumed smokeless tobacco. The NFHS 1998-
99 data showed that the consumption of smokeless
tobacco was 20.8 % in males and 8.8% among
females. However NFHS-2 data of 2000 mentions
that over 35.4% of the males and 18.2 % females
consumed smokeless tobacco. The reported figures
show a possible trend on the growing menace. Latest
estimates put this figure to above 50% with alarming
increased rates of consumption among females. The
2003 survey showed that 10.7% females in Tamil
Nadu, 18% in Maharashtra, 14.4 % in Madhya Pradesh
and 60.7% females in Mizoram are already consuming
smokeless tobacco.
The industry has found that chewing tobacco is
a good way to get around the traditional taboo on
female smoking. Chewing of tobacco is not perceived
as such a bad thing as smoking among females. Since
it does not smell and on the contrary it is scented, so
female acceptance of chewing tobacco is higher. For
the industry, lack of appropriate legislation dealing
with the issues posed by the smokeless tobacco has
also been very helpful for its growth. The growth is
so good that the Economic Survey for 2008-09 reads
that, "the beverage and tobacco group recorded the
highest growth (15.6%) among all two digit industrial
groups during 2008-09; thai too on top of a strong
base. Among the industries subsumed under this product
group, cigarette production marginally declined during
2008-09." The increase reported mostly indicates the
growth of smokeless tobacco.
The growing market of smokeless tobacco has made
the big players in the market take note and enter the
market. Most big tobacco multinationals have already
entered the smokeless tobacco market and are all set
to consolidate the market and grab the lion's share
from small unorganised units, who till now were
playing in an open unchallenged market. Big MNC'sare
I!'lI 12
HEALTH FOR THE MILLIONS February - March and April- May, 2010
also seeing this as a new lifecyde of another tobacco
variant as the replacement of the dead cigarette
consumers (6 million oftheir consumers die each year)
and low induction rates of new cigarette users among
educated and in developed countries.
Legal provisions and the tax
structure
Though the addictive nature of tobacco in itself
is enough; the low entry cost, lax tax regime and
virtually no restriction market has further made
smokeless tobacco a very lucrative business. While a
single stick of cigarette may cost 3 to 15 Rupees, a
sachet of Gutka costs just Rs 1/. Even the premium
brands of smokeless are priced at highly affordable
Rs. 5/ a pouch. While a lot of attention is paid to
taxation on cigarettes, smokeless has escaped all
attention. It is well known that cigarettes in India
are not sufficiently taxed; however smokeless tobacco
is virtually not taxed at all. Most of the smokeless
tobacco is prepared from raw tobacco leaves and
requires no registration or license. There is no taxation
on tobacco at the entry stage and only two rupees per
kilogram as service charge and one paisa per kilogram
'tobacco cess' is charged at the time of auction sale
of tobacco. According to the Tobacco Board Report,
about one million rupees were collected by way of
cess by selling tobacco at the auction on an average
price of around 47 rupees (1 US$) a Kg.
Quite interestingly the taxation on chewing
tobacco is imposed by the government on tobacco
packed through mechanised machines. In this case
too the tax is imposed on the basis of number of
machines used for packaging and not on the finished
product. A rough estimate of the assumed capacity of
machine and the average suggested sale-price of the
finished product is used as a guideline for collection
of tax as suggested under "Chewing Tobacco and Un-
manufactured Tobacco Packing Machines (Capacity
Determination and Collection of Duty) Rules, 2010."
The structure of taxation is such that there is an
incentive for the manufacture to sell the product at a
lower cost. Such kind of taxation harms the poor more
than the rich. This encourages consumption of cheaply
priced tobacco and defeats the public health policies
on tobacco control.
Despite smokeless tobacco being a big challenge
for India, the tobacco control legislation in India,
namely the "Cigarettes and Other Tobacco Products
(Prohibition of Advertisement and Regulation of Trade
and Commerce, Production, Supply and Distribution)
Act, 2003" does not address the problem. Except for
some restrictions on advertisement and promotion of
tobacco, there are no other provisions to deal with
the challenges of smokeless tobacco. The smokeless
companies have found innovations to get around these
lame and unenforced restrictions too. The Government
still has to wake from its deep slumber.
Challenges and the next step
Framework Convention on Tobacco Control (FCTC)
is a wonderful initiative on tobacco control but it too
is centred around the assumption that the biggest
challenge is smoked form of tobacco and its emissions.
For the affluent world, chewing tobacco was not such a
big challenge as the consumption was always low. For
example per capita consumption of chewing tobacco
in Canada is around 1% only. However the situation
is not likely to remain like this for long. According to
2007 figures, in USA around 3% people use chewing
tobacco. The 2007 CDC survey points-out that more
than 13% of male high school students and more than
2% offemale high school students were using smokeless
tobacco among which even 4% of the boys and 1% of
the girls in middle school reported using smokeless
tobacco. So the menace is now reaching other parts of
the world too. Snus is also being pushed aggressively
by the industry and has started invading the global
market with a strategic misleading campaign about its
safety compared to cigarettes. India's own export of
chewing tobacco increased by 40% in quantity term
and 27% in value term in 2008 and is continuously
increasing since then. UAEremains one of the largest
importers with over 5000 tonnes every year.
There are countries which have realised the harmful
effects of smokeless tobacco and banned the entry of
such products in their country. Among such countries
are Iran and Tanzania who last year completely banned
smokeless tobacco import into the country. But with
the entry of the big companies' one can again see the
age-old arm-twisting of the smaller countries in WTO
and such like forums to open up their markets.
For us in India we are face-to-face with the next
big fight. If not controlled urgently and immediately,
smokeless tobacco will become one of the biggest
problems for us. Chewing tobacco has already reached
the primary schools. With every passing day more and
more children will become new tobacco addict and
in another ten years we will see the face of biggest
tobacco epidemic. Considering our slow paced, inertia
ridden government and the ultra-lax enforcement
machinery, even if we initiate action today, it will take
at-least five years to put them in shape.
As a priority, we must push for replacement of the
current tobacco control legislation, not only to plug
loop-holes in the current legislation but also to have
sufficient provisions to deal with all smokeless variants
and bring them within the scope of law under a new
comprehensive and well thought out legislation. There
is also an urgent need of unified action by various
arms and ministries of the Government, like Ministry
of Health, Commerce, Finance, Agriculture, etc.
This growing menace has to be stopped completely
by imposing complete prohibition on all forms of
smokeless tobacco products.
Hemant Goswami is a social activist. He is member of
the Indian Tobacco Control Steering Committee as well as
Chandigarh Tobacco Control Cell. He also heads the civil
society group, Tobacco Free India Coalition,' among others.
 Feb.-Mar. 2010, Vol. 35 No.6 & Apr.-May 2010, Vol. 36 N

Tobacco Control:
Gaining Momentum
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