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 following four population-based surveys, on average, more than one in every five Indian has been using SLT product. Currently nearly 20 crore adult Indians use SLT (GATS-2).
- Prevalence among men was higher, with more than one in every three using SLT in some form.
- A little over 14 crore men and almost 6 crore women use SLT in the country (GATS-2).
- NFHS-4 data shows an overall high prevalence of 35.6% in males and GATS-1 shows an overall high prevalence of 18.4% among females.
Smokeless Tobacco Use over the years in India
Prevalence of SLT use among adults States & UTs
| Sl# |
States |
Men |
Women |
Total |
| 1 |
Tripura |
40.8 |
56.5 |
48.5 |
| 2 |
Manipur |
50.2 |
45.2 |
47.7 |
| 3 |
Odisha |
52.1 |
33.6 |
42.9 |
| 4 |
Assam |
50.5 |
32.5 |
41.7 |
| 5 |
Arunachal Pradesh |
50.1 |
27.7 |
39.3 |
| 6 |
Nagaland |
46 |
31.5 |
39 |
| 7 |
Chattisgarh |
47.7 |
24.5 |
36 |
| 8 |
Jharkhand |
54.1 |
15.7 |
35.4 |
| 9 |
Mizoram |
21.3 |
46 |
33.5 |
| 10 |
Uttar Pradesh |
42.6 |
15.2 |
29.4 |
| 11 |
Madhya Pradesh |
38.7 |
16.8 |
28.1 |
| 12 |
Maharashtra |
31.7 |
16.6 |
24.4 |
| 13 |
Bihar |
41.9 |
3.6 |
23.5 |
| |
India |
29.6 |
12.8 |
21.4 |
| 14 |
Meghalaya |
11.6 |
29.1 |
20.3 |
| 15 |
West Bengal |
22.8 |
17.2 |
20.1 |
| 16 |
Gujarat |
27.6 |
10 |
19.2 |
| 17 |
Karnataka |
22.2 |
10.3 |
16.3 |
| 18 |
Rajasthan |
22 |
5.8 |
14.1 |
| 19 |
Uttrakhand |
21.2 |
3.4 |
12.4 |
| 20 |
Tamil Nadu |
11.9 |
9.3 |
10.6 |
| 21 |
Telangana |
11.3 |
9 |
10.1 |
| 22 |
Sikkim |
13.8 |
5.1 |
9.7 |
| 23 |
Delhi |
13.7 |
3.2 |
8.8 |
| 24 |
Punjab |
15 |
0.3 |
8 |
| 25 |
Andhra Pradesh |
7.6 |
6.6 |
7.1 |
| 26 |
Goa |
9.2 |
3.6 |
6.5 |
| 27 |
Haryana |
10 |
2.2 |
6.3 |
| 28 |
Chandigarh |
10.4 |
0.8 |
6.1 |
| 29 |
Kerala |
7.4 |
3.6 |
5.4 |
| 30 |
Puducherry |
4.5 |
4.9 |
4.7 |
| 31 |
Jammu & Kashmir |
6.8 |
1.5 |
4.3 |
| 32 |
Himachal Pradesh |
6.1 |
0.1 |
3.1 |
Source: Global Adult Tobacco Survey India Report – 2016-17.
Types of SLT products used in India: In spite of the decline the absolute number of SLT user for different products are colossally high.
- Khaini or tobacco lime mixture is used 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
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.
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.
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 other 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 a 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.
