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.: Smoking Tobacco Products

Smoking Tobacco Products
 Ingredients Major Disease Consequences Main users

 Cigarettes

 One end is ignited and  allowed to smoulder;  smoke is inhaled through  the cigarette tube into  the mouth and lungs.
 The inhaled smoke  rapidly delivers nicotine,  an addictive drug, to the  brain.

 

 Cured, shredded and reprocessed tobacco is packed  In a white paper tube (about 0.7 to 1.1 gram  tobacco per cigarette).
 Tobacco types used: Cigarette tobacco is mostly  flue cured ‘Virginia’ (‘Bright’) tobacco. It is typically  blended with smaller amounts of White Burley and  Oriental tobacco (All three are varieties of Nicotiana  tabacum). These are tobaccos mild in taste  (‘American blend’). 1
 Modern cigarettes generally contain additives, many  of which are harmful. Some have the function of  making the taste sweeter or the smoke milder on  the throat, and reduce the odor and visibility of the  smoke. The harmfulness of the smoke remains  undiminished by these masking techniques. 2
 Reductions in tar and  nicotine have not had the  desired effect of reducing  disease appreciably. 3

 

Addiction, cancer of the lung, larynx, oral cavity, pharynx, oesophagus, stomach, pancreas, liver, kidney, urinary bladder and cervix and myeloid leukaemia 4,5

Also heart disease, clogged arteries, stroke, chronic obstructive lung disease, and adverse reproductive effects as well as periodontitis (gum disease) 4

 

 Teenagers, men, young  women, business  persons, media persons  and professionals. 6, 7  According to National  Sample Survey    data 8,  3.7% of  rural and 9.6%  of urban  households  consume  cigarettes. 9

 Bidis

 A hand-made commercial  smoking product  requiring frequent  puffing. Due to their  non-porous wrapper,  bidis deliver more  nicotine and tar to the  user per unit time than  cigarettes do despite  containing much less  tobacco: bidis typically  contain 0.15-0.25 g of  tobacco. 10

 

 Flakes of sun-cured tobacco (Nicotiana tabacum) are  rolled in a hand-rolled dried leaf of a tree (tendu,  temburni, etc). 11, 12
 Bidis contain tobaccos from different cultivars  blended for flavour and to remain lit longer. 13
 Bidis  made for export are often flavoured with fruit  or  chocolate flavours. They tend to be attractive to  teenagers. 14

 

Addiction, cancer of the lung, larynx, oral cavity, pharynx, oesophagus, stomach, pancreas, liver, kidney, urinary bladder and cervix and myeloid leukaemia. 4,5

Also heart disease and clogged arteries, stroke, chronic obstructive lung disease, tuberculosis15 and adverse reproductive effects 4

 

 Men and a few women,  mainly from middle and  lower socioeconomic  classes.
 Very popular all over  India and wherever  Indians emigrate: As per  NSSO data, 37% of rural  and 20% of urban  households consume  bidis in India 9

 Hookah – Indian  waterpipe

 Originated among Moghul  rulers. Mostly smoked in  North India. Tobacco is  slowly burned over  smouldering charcoal in a  covered bowl and the  smoke is made to pass  through water before  being inhaled.11

 Other names for the  waterpipe include hubble  bubble, narghile, and  sheesha

 


 Hookah tobacco, stronger than cigarette or bidi  tobacco, is mixed, in the proportion of 30% tobacco  with 70% molasses/honey and fruit pulp. Around 20  grams of this tobacco mixture is smoked at each  sitting and shared among users. The water filter is  not very effective in removing tar, nicotine or carbon  monoxide. 16

 While hookah smoking has declined from at least
 the 1950s in favour of bidis and cigarettes 17  recently hookah bars and restaurants are  coming  up, mainly attracting affluent young adults.  Due to  the fruit flavour of the smoke and the water  filter,  many users, who are not otherwise regular  smokers, may underestimate the harm and the  potential for addiction to tobacco. Hookah smoke  contains much more carbon monoxide than cigarette  or bidi smoke due to the use of charcoal, which may  result in headaches or even death (carbon
 monoxide poisoning). Depending on the number of  times the  person smokes the hookah during a  session (e.g. 45  minutes), it is possible to inhale  many times more  nicotine and other harmful  tobacco smoke  constituents than from one  cigarette, which can  have immediate effects on the  heart.16 

 

Addiction, cancer of the lung, larynx, oral cavity, pharynx, oesophagus, stomach, pancreas, liver, kidney, urinary bladder and cervix and myeloid leukaemia  4 , 5 Also heart disease and clogged arteries, stroke, chronic obstructive lung disease and adverse reproductive effects.4 Also carbon monoxide poisoning and transmission of tuberculosis, herpes and hepatitis 16


 Men, women, especially  in rural areas of Northern  and Eastern India and  now Young patrons at  specialized restaurants  and bars in urban areas  having water pipes.  According to NSSO data,  2.6% of rural and 0.4%  of urban households  consume hookah tobacco.   9

The hookah is often shared by a group.

 Other pipes

 Chilum (straight conical  clay pipe) – requires  deep pulmonary effort. 11

 Hookli (hook -shaped clay  pipe, often with a  wooden stem) 11

 

 Pipe tobacco tends to be darker and stronger than  cigarette tobaccos in general. About 15 grams of  tobacco may be smoked daily. 12

 

Addiction, cancer of the lung, larynx, oral cavity, pharynx, oesophagus, stomach, pancreas, liver, kidney, urinary bladder and cervix and myeloid leukaemia, 4,5  Also heart disease, clogged arteries, stroke, chronic obstructive lung disease and adverse reproductive effects.4

 

 Men, mainly in rural North  India, e.g., Gujarat, Uttar  Pradesh. Sometimes  shared by a group.12 a practice which could spread tuberculosis.

Chutta

 Hand –made smoking  product from small scale  and cottage  manufacture. Women  typically smoke chuttas in  reverse. 11

 

 Coarsely prepared small cigars, made by rolling a  tobacco leaf into a cylindrical shape and tying it at  one end. 12

 

Addiction, cancer of the lung, larynx, oral cavity, pharynx, oesophagus, stomach, pancreas, liver, kidney, urinary bladder and cervix, myeloid leukaemia.4,5and cancer of the palate (in reverse smokers).18  Also heart disease and clogged arteries, stroke, chronic obstructive lung disease and adverse reproductive effects. 4

 

 Rural men and women in  Andhra Pradesh, Tamil  Nadu and Orissa 11

 Dhumti

 Home-made smoking  product. 11

 

 A user-made conical roll of tobacco in a leaf, usually  of jackfruit. Some people smoke a dhumti in reverse.  11

 

Addiction, cancer of the lung, larynx, oral cavity, pharynx, oesophagus, stomach, pancreas, liver, kidney, urinary bladder and cervix and myeloid leukaemia. 4 , 5 and cancer of the palate in reverse smokers.19 Also heart disease, clogged arteries, stroke, chronic obstructive lung disease and adverse reproductive effects. 4

 

 Rural men and women  almost exclusively in Goa  12

 Cheroot

 A manufactured smoking  product made in Tamil  Nadu.

 

 A cheroot is a commercially made roll of heavy  bodied tobacco held together with a binder,  fermented and clipped at both ends. Similar to a  cigar.

  

Addiction, cancer of the lung, larynx, oral cavity, pharynx, oesophagus, stomach, pancreas, liver, kidney, urinary bladder and cervix and myeloid leukaemia. 4,5  Also heart disease, clogged arteries, stroke, chronic obstructive lung disease and adverse reproductive effects4

 

 Urban and rural men and  women (1.0% rural and  0.6% urban households  consume cheroots in  India. 9  While not commonly smoked in  India, they are exported,  e.g., to Europe.

 Cigar

 A factory made smoking  product. 11

 Cigar smokers tend not  to inhale the smoke.

 

 A cigar contains air-cured fermented tobacco filler,  held together by a processed tobacco binder,  covered with a tobacco-leaf spiral wrapper, and  tapered ends.

  

Addiction, cancer of the lung, larynx, oral cavity, pharynx, oesophagus, stomach, pancreas, liver, kidney, urinary bladder and cervix and myeloid leukaemia. 4,5 Also heart disease, clogged arteries, stroke, chronic obstructive lung disease, and adverse reproductive effects 4

 

 Affluent urban men and  women.

 Electronic Nicotine Delivery Devices (ENDD), also known as Electronic Cigarettes

 

 Nicotine typically dissolved in propylene glycol and glycerine, sometimes with flavourings, is held in a small cartridge. When turned on, the device heats the liquid using battery power, to create an aerosol for inhalation.

  

Long term effects are as yet unknown.

 

 Adolescents, young adults, others.

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.: Smoking Tobacco Products

Smokless Tobacco Products
 Ingredients Major Disease Consequences Main users

 Smokeless Tobacco

 Chewed, held in the mouth or applied to gums and teeth. 11

 

 

 
 With areca nut or without it Additives: Sugar, saccharine Spices: clove (lavang), anise (saunf), cardamom (elaichi), nutmeg (jaifal). Scents used in many of the above smokeless products mask the odour of tobacco and appeal to the user. They include camphor, sandalwood, musk, rose, kewra and other attars (oil based perfumes), or musk. Magnesium and calcium carbonate, regulated food additives, are ostensibly used to keep the smokeless products free flowing, however they may have other functions for the palatability or addictive-ness of the products. Other additives may also be used.

 


 The International Agency for Research on Cancer has established that smokeless tobacco causes addiction, cancers of the oral cavity and oesophagus.5,20Smokeless tobacco use also causes acute increases in blood pressure and heart rate, cardiovascular disease, and adverse reproductive outcomes. Any smokeless tobacco product may also cause periodontitis (gum disease).20The International Agency for Research on Cancer has established that areca nut, often used with smokeless tobacco, causes oral cancer.5

 


All ages use these products: men women, children. Used in both urban and rural areas.

 Plain chewing  Tobacco

 It goes by several  names Pattiwala  (Sun-dried flaked  tobacco used in  Uttar Pradesh),  Hogesappu (leaf  tobacco used in  Karnataka)  Kaddipudi (a  powdered tobacco  used in Kerala).   Usually used with  slaked lime.11

 

 

 
 Tobacco. Users may mix lime  (aqueous calcium  hydroxide)  with the tobacco before  chewing it.

 

 


 Addiction, oral cancer, cavity , oesophagus5 acute increases in blood pressure and heart rate, cardiovascular disease, and adverse reproductive outcomes 20

 


 Men and women in  North India.  Probably the most  popular form of  smokeless tobacco  used in India, as  according to NSSO  data, 19.4% and  7.4% of households  in India consume  leaf tobacco 9

 Khaini

 Chewed and held in  the mouth

 

 Sun dried tobacco and slaked  lime. Commercial khaini is  flavoured with cardamom,  menthol and other flavourings.

 

 Addiction, oral cancer, cavity , oesophagus5 acute increases in blood pressure and heart rate, cardiovascular disease, and adverse reproductive outcomes 20

 

 Men and women of  North India, also  including Bihar,  Gujarat and  Maharastra  11

 Zarda

 Chewed and held in  the mouth. Very  popular.

 

 Zarda - a scented chewing  tobacco product 12 spices  and  musk, and often containing  saffron. Traditional zarda is  brown in color. Contemporary  commercial zarda has a  white/beige powdery  appearance. It has been  promoted along with supari  mix for simultaneous use,  especially while some states  had banned gutka sales.

 

 Addiction, oral cancer, cavity , oesophagus5 acute increases in blood pressure and heart rate, cardiovascular disease, and adverse reproductive outcomes 20
 

 

 Men and women in  North India 12

 Kiwam

 Chewed and held in  the mouth.

  

 Tobacco paste, or granules  pellets of the paste, flavoured  with spices and musk. 12

 

 Addiction, oral cancer, cavity , oesophagus5 acute increases in blood pressure and heart rate, cardiovascular disease, and adverse reproductive outcomes 20

 

 Men and women in  North India 12

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Product
 Ingredients Major Disease Consequences Main users

 Bajjar/Tapkheer
 (Dry Snuff)

 Applied on gums  and teeth,11  especially by  women in Gujarat.  

 

 
 Powdered tobacco

 

 


 Addiction, oral cancer, cavity , oesophagus5 acute increases in blood pressure and heart rate, cardiovascular disease, and adverse reproductive outcomes 20

 


 Mostly women,  especially in Gujarat 12

 Masheri
 (or Mishri)

 Masheri (mishri) is  mainly used in  Maharashtra. Users  typically apply it to  teeth and gums  several times a day,  due to nicotine  addiction. 11

 


 Masheri (misheri or mishri) -  This is roasted or burnt and  powdered tobacco. Users  typically apply it to teeth and  gums several times a day, due  to nicotine addiction. (Another  meaning of mishri is  crystallized sugar.) Commonly  used in Maharashtra.. Masheri  is carcinogenic. Masheri use  during pregnancy leads to low  birthweight babies.

 


 Addiction, oral cancer, cavity , oesophagus5 acute increases in blood pressure and heart rate, cardiovascular disease, and adverse reproductive outcomes 20

 


 Women, men,  children mainly used in Maharashtra 12

 Gul

 Applied for use as a  dentifrice in  North- Eastern  India. 11

 

 A pyrolised tobacco product.

 

 Addiction, oral cancer, cavity , oesophagus5 acute increases in blood pressure and heart rate, cardiovascular disease, and adverse reproductive outcomes 20

 

 Women, men,  children especially in Northern, Eastern and Northeastern India 12

 Gudhaku

 Applied to teeth  and gums for  cleaning teeth.11

 

 Gudhaku is a paste of tobacco  powder and molasses. 11 ,12

 

 Addiction, oral cancer,5 and possibly other diseases, depending on the amount used 20

 

 Mainly women;  some men  Used in Bihar and  other parts of  eastern India .11 ,12

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Product
 Ingredients Major Disease Consequences Main users

 Tobacco  Toothpaste

 Applied with a  toothbrush. Users  may apply it several  times a day due to  nicotine addiction.11

 

 
 Creamy Snuff and Dentobac  are commercial tobacco  toothpaste containing scent. Tobacco in any dentifrice is banned by law 21

 


  Addiction, cancer the oral cavity and oesophagus acute increases in blood pressure and heart rate, cardiovascular disease, and adverse reproductive outcomes20

 


 Women, men, children has been documented as popular among children in Goa11,12

 Tobacco water

 Known as tuibur in  Mizoram and  hidakphu in  Manipur. 5 to 10 ml  tobacco water22 is  held in the mouth  for 5-10 minutes  and then spat out.  Offerred to guests.  Also used for  cleaning  teeth 23

 

 Tobacco water is made by  passing tobacco smoke  through water. The brownish  water is collected for use and  sale.

 

 Addiction, cancer the oral cavity and oesophagus5 acute increases in blood pressure and heart rate, cardiovascular disease, and adverse reproductive outcomes20 Tuibur may also cause stomach cancer 5,20

 

 Men and women in  Northeastern India 23

Products containing tobacco and areca nut:

Product
 Ingredients Major Disease Consequences Main users

 Paan with tobacco

 Chewed and held in  the mouth paan with tobacco is used in many Asian countries.24

 

 Betel Quid: areca nut, betel  leaf, lime and catechu. Other  ingredients are for flavour, like  spices and condiments. Any  form of smokeless tobacco is  incorporated in paan 11

 

 Addiction, oral submucous  fibrosis, oral cancer,  pharyngeal cancer,  esophageal cancer5  pancreatic cancer, worsening  of asthma, increased blood  pressure and heart rate, heart  attacks, reduced male fertility  and adverse reproductive  outcomes.20 And type II diabetes25,26

 

 Men and women.  Paan with tobacco  is a very common  mode of consuming  smokeless tobacco  in India. 11

 Gutka

 Chewed and held in  the mouth.

 

 A sweetened scented  commercial mixture of supari,  tobacco, catechu, lime,  flavourings (typically menthol,  saffron) and spices (typically  cardamom, clove or eugenol,  which is oil of cloves). 12  Gutka generally has a  white/beige  powdery appearance.

 

 Addiction, oral submucous fibrosis, oral cancer, pharyngeal cancer, oesophageal cancer5 worsening of asthma, increased blood pressure and heart rate, cardiovascular disease, adverse reproductive outcomes20 And and type II diabetes25,26 Gutka is probably the most hazardous smokeless tobacco product sold in India.

 

 Men, women,  children.
 Very popular in  India and wherever  Indians emigrate. Use of gutka and other commercial mixtures of tobacco and areca nut have been increasing generally in India 24and rising among school children in rural areas27

 Mawa

 Chewed and held in  the mouth.

 

 A scented and flavoured  mixture of shredded areca  nuts, lime and tobacco. 11 The packaged version of this product is virtually the same a gutka and has a white/beige powdery appearance. The name may have been adopted on commercial preparations to evade bans on gutka.

 

 Addiction, oral submucous fibrosis and oral cancer, pharyngeal and oesophageal cancer 5 worsening of asthma, increased blood pressure and heart rate, heart attacks, adverse reproductive outcomes 20 And and type II diabetes25,26

 

 Men, women,  children

 Mainpuri Tobacco

 Chewed and held in  the mouth.

 

 Tobacco and slaked lime, finely  cut betel nut, powdered cloves  or camphor. 11

 

 Addiction, oral submucous fibrosis and oral cancer, pharyngeal and oesophageal cancer 5 increased blood pressure and heart rate, heart attacks, adverse reproductive outcomes 20 And and type II diabetes25,26

 

 Men, women in  Uttar Pradesh 11,12

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Products containing areca nut but not tobacco:

Product
 Ingredients Major Disease Consequences Main users

 Areca nut  products used  orally

 Note: Areca nut  (also known as  betel nut or supari)  has addictive  properties but is  less addictive than  tobacco.

 

 

 With or without areca nut.  Some are simple mouth  fresheners without areca nut.
 Many have the same additives  as smokeless tobacco  products

 

 

 Addiction, oral submucous  fibrosis, increased risk of  oral cancer, oesophageal  cancer 5, altered  blood  pressure ,  worsening of asthma, type II  diabetes25   & coronary artery   disease26

 

 

 Men, women,  children

 Paan without  tobacco

 Chewed all over  India

 


 Betel Quid: areca nut, betel  leaf, lime and catechu. Other  ingredients are for flavour, like  spices and condiments.

 

 Addiction, oral submucous  fibrosis, increased risk of  oral cancer, oesophageal  cancer 5, altered  blood  pressure ,  worsening of asthma, type II  diabetes25   & coronary artery   disease26

 

 Men and women all over India, especially those who use pan occasionally 11,12

 Pan Masala

 Chewed and held in  the mouth

 

 A sweetened, sometimes  scented, commercial mixture of  areca nut (supari), flavourings  (e.g., menthol and saffron),  and spices. Pan masala has a  white/beige powdery  appearance. Generally,  nowadays, pan masala is  understood as a non- tobacco  product, but in the past, some  brands of pan masala  contained tobacco.

 

 Addiction, oral submucous  fibrosis, increased risk of  oral cancer, oesophageal  cancer 5, altered  blood  pressure ,  worsening of asthma, type II  diabetes25   & coronary artery   disease26

 

 Children, women,men

 Supari

 Typically chewed as  a digestive after  meals or for any  time for freshening  the breath or as a  mild stimulant.(Reddy,Gupta 2003)11  Supari is also an  ingredient of pan  masala and gutka  as well as some  mouth fresheners  (mukhwas).

 From the  association of  supari with betel  leaves (of the  creeper Piper  betle), the term  ‘betelnut’ was  coined for supari.  Tukda and Chalia  are other names for  supari in parts of  South Asia. Tamol is  a fermented form of  areca nut chewed  in Assam. 11

 

 a. Supari is Areca nut, the      seed of the Areca palm,      broken into pieces and      chewed by itself, or with      betel leaves, lime (aqueous      Calcium hydroxide) and      catechu, as paan. Paan is      technically known as betel      quid.

 b. Supari also denotes a      commercially prepared      sweetened mixture (sugar      and saccharine) of pieces of      processed areca nut      (usually reddish brown),      spices (e.g. saunf) and      flavourings (e.g menthol).      Such a mixture may be      labelled as scented supari,      a mouth freshener or an      "after mint".

 

 Addiction, oral submucous  fibrosis, oral cancer,  oesophageal cancer5, altered  blood pressure, worsening of  asthma & incresed the risk of   type II diebetes. 25,26

 

 Men, women,  children

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