CDC. US: The
first-ever report on the global use and public health impact of
smokeless tobacco finds that more than 300 million people in at least 70
countries use these harmful products. The report, Smokeless Tobacco and Public Health: A Global Perspective,
is being released today by the CDC and the National Cancer Institute at
the National Conference on Smoking or Health in Mumbai, India.
Thirty-two leading experts from around the world contributed to the
report.The serious health effects of smokeless tobacco have been
documented. As the report explains, there is sufficient evidence to
conclude that smokeless tobacco causes oral cancer, esophageal cancer,
and pancreatic cancer in humans.
More than 30 carcinogens have been
identified in smokeless tobacco products. Smokeless tobacco use also
causes adverse oral health outcomes, including oral mucosal lesions,
leukoplakia, and periodontal disease. Additionally, smokeless tobacco
products contain nicotine, and users of these products demonstrate signs
of dependence similar to those of cigarette smokers, including
tolerance with repeated use and symptoms of withdrawal upon cessation of
use.
In addition to detailing the serious and well-documented
health effects of smokeless tobacco products, the report also examines
the distinct challenges and policy solutions in reducing the burden of
smokeless tobacco use.
For example, a wide range of smokeless tobacco
products with different characteristics are in use around the world, yet
limited data are available detailing the contents of these products,
how they’re used, and their prevalence within different population
groups.
Additionally, the ways in which smokeless tobacco products are
produced, sold, used, and regulated differ widely across counties and
regions.
“Making smokeless tobacco prevention and control a top
priority in South Asia is critical to saving lives from tobacco-related
death and disease,” said Samira Asma, D.D.S., M.P.H., chief of the
Global Tobacco Control Branch in CDC’s Office on Smoking and Health.
“Urgent action is needed in countries where smokeless tobacco use is
most prevalent. Reduction of smokeless tobacco use should be an integral
component of national tobacco prevention and control strategies.”
The
report finds the majority of smokeless tobacco users (89 percent) are
in Southeast Asia, which also has the highest oral cancer rates in the
world. Users in India and Bangladesh make up 80 percent of total
smokeless tobacco users in the world. Prevalence among men is high
across most of the region, varying between 25 percent and 51percent in
five countries. However, use by adult women is similar to or greater
than use by men in some low-and middle-income countries. Among youth
aged 13 to 15 years, prevalence is also high across the region,
equivalent to that of cigarettes.
“While the adverse health
effects of smokeless tobacco use are well documented, expanded research
and surveillance efforts are critically needed to support effective
action to reduce the burden of smokeless tobacco worldwide,” said Mark
Parascandola, Ph.D., M.P.H., epidemiologist in the Tobacco Control
Research Branch at the National Cancer Institute.
In countries
with the highest prevalence of smokeless tobacco use, smokeless tobacco
prices are lower, warning labels are weaker, surveillance is less
developed, fewer evidence-based cessation interventions are available,
and fewer resources are devoted to prevention and control programs, when
compared with cigarettes and other smoked tobacco products. Developing
and implementing effective strategies will require increased public
health capacity, particularly in low- and middle-income countries where
the smokeless tobacco burden is high.
Use of smokeless tobacco can
lead to nicotine addiction, which can make cessation more difficult. In
addition to causing cancer, smokeless tobacco products cause adverse
reproductive and developmental effects, including stillbirth, preterm
birth, and low birth weight. Some, but not all, smokeless tobacco
products are associated with increased risk of fatal ischemic heart
disease, type 2 diabetes, and fatal stroke.