Global Tobacco Control Updates

New Report: Smokeless Tobacco Use is an Overlooked Global Scourge with a Huge Public Health Toll
15 Dec 2014
Press Release

WASHINGTON, DC — Smokeless tobacco use is an overlooked public health menace that is used by more than 300 million people in at least 70 countries, causing cancer and other serious medical conditions, according to a comprehensive report issued today.

The report highlights the need for policymakers, researchers and health advocates to better understand and address the burden of smokeless tobacco use. Policy makers should take strong action to reduce all tobacco use — including smokeless tobacco use — through proven strategies such as higher tobacco taxes; large, graphic health warnings; bans on tobacco advertising, promotion and sponsorship; and product regulation. This report reminds us that efforts to reduce the deadly consequences of tobacco use around the world must include smokeless tobacco.

The report, 2014 Smokeless Tobacco and Public Health: A Global Perspective, was released today by the U.S. Centers for Disease Control and Prevention and the U.S. National Cancer Institute at India’s National Conference on Tobacco or Health in Mumbai.

The report shows that while global efforts to reduce tobacco use have largely focused on cigarette smoking, smokeless tobacco is widely used in some parts of the world, particularly Southeast Asia. In India and Myanmar, smokeless tobacco use exceeds cigarette smoking among adults. Across the region, rates of smokeless tobacco use among youth aged 13 to 15 rival cigarette smoking. The impacts of smokeless tobacco are evident in all regions. According to the report, the scientific evidence shows that smokeless tobacco causes addiction; cancer of the oral cavity, esophagus, and pancreas; and reproductive and developmental effects such as stillbirth, preterm birth, and low birth-weight. Some types of smokeless tobacco are linked with heart disease, diabetes and stroke.

One of the challenges to understanding smokeless tobacco use is the tremendous diversity of products and how they are used around the world. Smokeless tobacco includes products that are chewed, sucked, dipped, held in the mouth, or inhaled, and many products are combined with other non-tobacco ingredients such as nuts, mushrooms and a wide variety of flavorings. Faced with increasing regulation on cigarettes, tobacco companies are creating appealing flavors of smokeless tobacco, such as mint and fruit, that could attract children.

Key findings of the study include:

  • Smokeless tobacco use is a global problem impacting all regions. Smokeless tobacco use adversely affects all countries and regions and increasing use and industry promotion presents an increasing threat to public health worldwide.
  • There is a divide between some high-income countries — with strong tobacco control and regulatory frameworks and falling rates of tobacco use — and low- and middle-income countries, where smokeless tobacco products have high levels of harmful ingredients, tobacco marketing is increasing, and a large, unorganized tobacco sector makes regulation very difficult.
  • Southeast Asia suffers from the greatest burden of smokeless tobacco use, with 89 percent of the world’s smokeless users. Three countries (India, Bangladesh and Myanmar) alone are home to 259 million users, 86 percent of the global total.
  • In Southeast Asia, smokeless tobacco use among women is generally more common than smoking, most notably in India and Bangladesh.
  • Africa has the highest smokeless tobacco use among children, with the highest use in Congo, Namibia, Lesotho, Djibouti and Botswana.

While there has been some progress in reducing smokeless tobacco use — for example, almost all states in India have now banned the sale of gutka, a deadly form of chewing tobacco — more needs to be done.

The harmful global impact of smokeless tobacco use is sure to grow as tobacco companies find new ways to market their deadly products and develop more appealing smokeless products. Policy makers must be equally aggressive in taking action to prevent and reduce use of all tobacco products, including smokeless tobacco. Parties to the World Health Organization Framework Convention on Tobacco Control should ensure that the policies they are obligated to implement under the treaty adequately address smokeless tobacco use.

Related Resources


bangladesh, gutka, heart disease, india, marketing, world health organization