smoking

Smokeless Tobacco Kills More Than a Quarter Million Annually

More than a quarter million people die globally each year due to smokeless tobacco use and millions more suffer substantial morbidity that cuts their lives short, according to new findings.

“It is possible that these figures are underestimated, and future studies may reveal that the impact is even bigger,” says lead study author Kamran Siddiqi, MBBS, MRCP, MPH, PhD, clinical senior lecturer in epidemiology and public health in the Department of Health Sciences at the University of York in the UK.
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“This is the first study to estimate the overall burden of smokeless tobacco disease around the world, and I hope it might stimulate policymakers to take this threat seriously and address it through targeted policies,” he says.

Siddiqi and his colleagues arrived at these figures using data from 113 countries, which was extracted from the 2010 Global Burden of Disease Study and surveys such as the Global Adult Tobacco Survey.

According to their estimates, in 2010 alone, smokeless tobacco resulted in more than 62,000 deaths due to cancers of the mouth, pharynx, and esophagus and accounted for more than 200,000 deaths from heart disease. More than 85% of this burden was in Southeast Asia, where the market is largely unregulated.

“While my research looked at the full range of smokeless tobacco products, it concluded that smokeless tobacco products very commonly used in Southeast Asia have high levels of toxic substances leading to cancers and heart disease, accounting for this high burden,” Siddiqi says.  “In conclusion, those living in this region and/or using products sold in this region are particularly vulnerable.”

He notes that Southeastern Asians living in the UK are also a vulnerable population, as they tend to use smokeless tobacco imported from India and Bangladesh. He also emphasizes that it is possible to regulate the production of smokeless tobacco to minimize the levels of harmful substances it contains, as is the case with the production of snus in Sweden.

Siddiqi believes that policymakers should raise taxes on raw tobacco and smokeless tobacco products and regulate the production, sale, and marketing of such products, as well as funding effective health awareness campaigns and offering cessation services to those already addicted to smokeless tobacco.

“Practitioners should focus on raising awareness of the harms of smokeless tobacco use and the benefits of quitting, boosting patients’ motivation and self efficacy, and managing their triggers, withdrawal symptoms, and relapse,” Siddiqi says.

The team suggests more research is needed in countries with high levels of consumption but where figures for the relative risk of acquiring smoking-related cancers are not available. They are working on gaining a better understanding of dependence upon smokeless tobacco and measures to control its use.

—Colleen Mullarkey

Reference

Siddiqi K, Shah S, Abbas SM, Vidyasagaran A, Jawad M, Dogar O, et al. Global burden of disease due to smokeless tobacco consumption in adults: analysis of data from 113 countries. BMC Med. 2015 Aug 17;13:194. doi: 10.1186/s12916-015-0424-2.