90% of smokeless tobacco users live in South-East Asia
New Delhi, 11 September 2013: Approximately, 250 million adults consume smokeless tobacco in the 11 countries of the WHO South-East Asia Region, which constitutes 90% of global smokeless tobacco users. This figure is in addition to the 250 million smokers in the Region. Given the high number of users and the serious health consequences of tobacco use, countries in the Region have set a target for a 30% reduction in prevalence of current tobacco use in persons over 15 years of age.
A study of health care costs attributable to tobacco in India estimated that in 2004, the direct medical costs of treating smokeless tobacco-related diseases in India amounted to US$ 285 million. The indirect morbidity costs of smokeless tobacco use which includes the cost of caregivers and value of work loss due to illness amounted to US$ 104 million. Thus the total cost of diseases caused by smokeless tobacco use was US$ 389 million (about INR 17.9 billion) in 2004. .
Oral cancer is the most common cancer caused by smokeless tobacco. The Region carries the highest burden of oral cancer at over 95 000 oral cancer cases each year. According to the International Agency for Research on Cancer (IARC), over half of all oral cancers in Asia are caused by tobacco.
Oral cancer disproportionately affects the poor, who have a greater exposure to smokeless tobacco. This results in higher incidence, high mortality and worse outcomes of care and rehabilitation. Studies in Bangladesh, India, Indonesia, Sri Lanka and Thailand have revealed that both smoking and smokeless tobacco use are more prevalent among less educated and illiterate population.
Smokeless tobacco is associated with a 2 – 4 times increase in the risk for cardiovascular diseases. Asian studies indicate that the mortality risk for women who consume smokeless tobacco is higher than that for men. Use of smokeless tobacco in pregnancy is linked to stillbirths and a 2 – 3 times higher risk of low birth weight babies. Other health effects of smokeless tobacco use include caries of tooth, receding of gums, high blood pressure, a debilitating condition known as oral sub-mucous fibrosis (OSF), and cancers of the mouth and food pipe.
“The use of smokeless tobacco is rampant in South-East Asia. Lack of public awareness and incomplete knowledge about the harmful effects of smokeless tobacco are powerful obstacles in creating effective tobacco control policies.” said Dr Samlee Plianbangchang, WHO’s Regional Director for South-East Asia.
While many people are aware that tobacco is dangerous, the majority of users are not aware about the lethal connection between chewing tobacco and fatal diseases like cancers or that product like betel quid or mishri or gutka are dangerous.
Due to misinformation about chewing tobacco, many people use it to cleanse teeth, as a breath freshener, for toothache, to relieve gastric disturbances, to ease abdominal pain to relieve stress and even as an antidote for morning sickness.
This lack of awareness likely contributes to the low number of quit attempts for smokeless tobacco users in the Region. For example, the percentages of users who made a quit attempt in the past year was very low in Bangladesh (29%), India (35%) and Thailand (22%).
The WHO Framework Convention on Tobacco Control (FCTC) has been ratified by all countries in WHO’s South-East Asia Region except Indonesia. Some commendable legislative actions for tobacco control include the government’s decision to increase pictorial warning sizes to cover 85% of the front and back of the cigarette packets in Thailand and 45% in Sri Lanka. Revenue earned through increase taxes and pricing policies for tobacco products have been effectively used in many countries to help reduced tobacco consumption.
Figure 1. Prevalence of smokeless tobacco use among adults (current users) in the South-East Asia Region
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*WHO’s South-East Asia Region comprises the following 11 Member States: Bangladesh, Bhutan, Democratic People’s Republic of Korea, India, Indonesia, Maldives, Myanmar, Nepal, Sri Lanka, Thailand and Timor-Leste.
Ms Vismita Gupta-Smith, Public Information and Advocacy Officer
WHO Regional Office for South-East Asia.
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