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January 27, 2023
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Smokeless Tobacco a Seamless Problem

There is a wide range of cancer-causing tobacco products in Pakistan that are untaxed, unregulated, and whose health risks are going unnoticed.Unlike cigarettes, smokeless or chewing tobacco products such as paan (betel leaf), naswaar (powdered tobacco snuff), and gutka (a mix of tobacco and areca nut) carry no health warnings on their packaging leading to many users failing to appreciate the health consequences of consuming these addictive products. While lots of emphasis is given to cigarettes, some 85 percent of the world’s 300 million users of chewing tobacco live in countries in South Asia such as Pakistan, India, and Bangladesh.Long-term use of smokeless tobacco increases the risk of dying of heart diseases and stroke, dental diseases. The sugar and irritants in smokeless tobacco products can cause cavities, abrasion of teeth, teeth staining, bad breath, gum disease, receding gums, bone loss around roots, and tooth loss.

Approximately 6 million people die every year due to the use of both smoked and smokeless tobacco while smokeless tobacco (SLT) use causes about 12% of adult deaths globally. It was predicted that deaths due to SLT consumption might increase to 10 million/annum and around a billion deaths in this century.The consumption of SLT is a primary reason for preventable death worldwide. According to statistics fromthe World Health Organization (WHO), almost 90% of SLT users reside within South East Asia and the use of SLT in South East Asia had acquired the form of an epidemic. Almost one-third of the tobacco used in this region is consumed in the form of smokeless tobacco.A reason behind this high prevalence may be that the use of SLT is considered socially acceptable, unlike smoking and alcohol use.Paan is a commonly used form of SLT in Pakistan and is frequently servedon public occasions as a cultural dish, in this region. Another reason for extensive use can be easy availability and low prices, as South Asia is a noteworthy maker and a net exporter of tobacco.

Smokeless tobacco denotes tobacco-containing products that are consumed without combustion by different methods like inhaling through the nose, sucking, or chewing. It has been estimated that there are 17 million smokeless tobacco users in Pakistan and the most frequently used forms of smokeless tobacco are Paan, Naswar, and Gutka. Naswar accounts for 60% of the total tobacco consumed in Peshawar, the capital city of Khyber Pakhtunkhwa. The levels of carcinogenic tobacco-specific nitrosamines in Naswar are higher than in several smokeless tobacco products in the world. Evidence indicates that both globally and in Pakistan, smokeless tobacco control has almost always remained a neglected area compared to smoking control.

SLT products are widely available and consumed in the country even though these products pose serious health hazards for users. It is a point of great concern that the Pakistani public mainly perceives that chewing tobacco is not harmful and it is socially acceptable to use SLT.

Despite being signatories to the World Health Organization (WHO) Framework Convention for Tobacco Control (FCTC), there is a substantial disparity in policy development and implementation between smoking and SLT products.As a consequence, progress to curb SLT consumption is falling behind that of smoking. In Pakistan—a high tobacco burden country—SLT products are popular, cheap, and easily available. Unlike cigarettes, ST consumption is also common and socially acceptable among women and young people.

By: Qamar Naseem

The authoris a human rights activist and tweets @QamarNaseemPak

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