Smokeless Tobacco use kills - India Against Cancer

Tobacco use in any form or any amount is harmful for Health.

Smokeless tobacco use in a major preventable cause of premature death and disease in India.

Prevalence and Pattern of Smokeless Tobacco Use:

According to the 2^nd round of Global Adult Tobacco Survey (GATS-2) – 2016-17, on average, more than one in every five Indian has been using SLT product which amounts to nearly 20 crore adult population.
A little over 14 crore men and almost 6 crore women use SLT in the country (GATS-2).
Prevalence among men was higher, with more than one in every three using SLT in some form.

Source: Global Adult Tobacco Survey 2 (2016-17)

Current Use of Any Tobacco by State/UTs amongst youth (Age: 13 to 15 years)

Source: Global Youth Tobacco Survey Fact Sheet India 2019

Source: Global Youth Tobacco Survey 4 Fact Sheet India 2019

Types of SLT products used in India:

by 10,40,81,000 Indians, i.e. near about the population of the Philippines.
Gutka or tobacco lime, areca nut mixture is used by 6,35,83,000 Indians i.e. nearly the population of France.
Betel quid with tobacco is used by 5,40,97,000 which is more than the population of Myanmar.
Tobacco for oral application is used by 3,57,04,000 which is almost equal to the population of Canada.
Paan masala with tobacco is used by 2,65,37,000, that is more than the population of Australia.
Snuff is used by 58,38,000 Indians, i.e. almost about two third of the population of Sweden.

Commonly used Smokeless Tobacco Product

SLT use among reproductive-age women (Based on both GATS 2 & NFHS data) (Singh et al 2020):

GATS 2 (2016-17) approximately 12.8% of women aged 15 years and above consume any form of SLT in India which corresponds to nearly 58.2 million women consumers of any form of SLT in India.
National Family Health Survey [NFHS – 3 (2005-2006)] & [NFHS 4 (2015-2016)] suggest that approximately 4.0 and 7.4 percent of women, respectively, consume any form of SLT while pregnant.
National Family Health Survey [NFHS 4 (2015-2016)] also suggests that approximately 5 % of lactating women in India consume any form of SLT which directly contribute to the neonatal health and nutrition.

Age of Initiation:

The mean age of initiation of SLT has increased about one year, from 17.9 years in GATS-1 to 18.8 years in GATS-2.
In GATS-1, 20.1% reported to start using SLT before 18 years of age, this has slightly decreased to 18.1% in GATS-2.
However, nearly 40% users continue to report having started tobacco use before the age of 20 years in both the surveys.
In GYTS 2019 reported 52% of smokeless tobacco users in india initiated the use before the age of 10 years.

Cessation:

Number of SLT users planning to quit within next month has decreased from GATS-1 (14.6%) to GATS-2 (7.8%).
Pharmacotherapy with nicotine replacement therapy and prescription medications has been reported to be used by 3.2% respondents in GATS-2. Almost similar percentage of respondents reported to use counseling services in both the surveys.
There is decrease in the traditional medicines and other products from GATS-1 (21.9%) to GATS-2 (5.2%).
Three fourth (75%) of the individuals prefer tobacco cessation without any assistance (GATS-2); this option was not given to respondents in GATS-1.
In GYTS 4 (2019), the quit percentage is 27% among the current smokeless tobacco users who tried to quit using in past 12 months and another 25% wanted to quit immediately.

Economic Aspect:

The source of last purchase of SLT were from store, street vendor, kiosk and others including vending machine, military store, duty free shop, outside country purchase, from another person or any other place.
There is an increase in the store purchase of SLT products from GATS-1 to GATS-2, which is in contrast to the purchases made from street vendor, kiosk and other vendors.
In both GATS-1 and 2, compared to men women showed more preference to purchase SLT from vending machine, military store, duty free shop, outside country purchase, from other person or any other place.
There is a marked increase in the SLT expenditure in the last purchase (in INR) of 6.0 in GATS-1 to 42.6 in GATS-2.

Advertising & Promotion

There is a sharp decline in those who noticed any advertisements or promotion of SLT from 54.7% in GATS-1 to 20.5% GATS-2.
There is 4% decline current users who have noticed any anti-tobacco information during the last 30 days at any location.
However, there is a two-fold increase in SLT users who thought of quitting because of warning label on SLT package from 33.8% in GATS-1 to 67.4 in GATS-2.

Knowledge, Attitudes & Perception:

There is significant increase in the knowledge about the serious illness caused due to the SLT use from GATS-1 (88.8%) to GATS-2 (95.6%).
In GATS-2, most of the adults believed that the use of SLT causes serious illness (96.1%), oral cancer (95%), dental diseases (91.2%) and could harm the foetus during pregnancy (89.1%).
However, surprisingly only 35.1% SLT users reported to know or believed that SLT has harmed their body.