Confusion continues over risks of chewing and smokeless tobacco

New research undertaken with people of South East Asian origin indicates that nearly 80 per cent are unsure or underestimating the harmful effects of using smokeless or chewing tobacco. Smokeless tobacco is used widely in South East Asian communities, especially by women.

The research found that over one in six (17 per cent) people of Asian ethnic origin used smokeless tobacco. Smoking of normal tobacco was only slightly higher at 22 per cent. Approaching a third of respondents (29 per cent) considered smokeless tobacco to be less harmful than normal tobacco and just under half (49 per cent) did not know. In reality, smokeless tobacco is more dangerous and the incidence of mouth cancer is significantly greater among South Asian women.

The types of smokeless tobacco products most used in the UK often contain a mix of ingredients including slaked lime, spices, flavourings and sweeteners. Areca nut – a known carcinogen – is also sometimes added.

Unlike normal tobacco they are not burnt, but can used in a variety of ways including sucking, chewing, inhaling through the nose or rubbed onto gums. Gutka, Khaini, Pan Masala are just some of the many varieties of smokeless tobacco used in the UK.

Despite the higher risk of mouth cancer in South Asian communities, less than ten per cent of respondents said they had ever asked their dentist to check for mouth cancer.

The British Dental Health Foundation conducted the survey in the run up to Mouth Cancer Action Month, which begins on 1 November 2011 and is supported by Denplan. Smokeless tobacco, along with smoking, drinking alcohol to excess, poor diet and some sexually transmitted infections (Human Papilloma Virus or HPV) are all known risk factors for mouth cancer which is likely to affect 60,000 people in the UK over the next decade.

Chief Executive of the British Dental Health Foundation, Dr Nigel Carter, said: “More work needs to be done to improve our knowledge about the usage of smokeless tobacco and the best ways of communicating clear messages to remove the on-going confusion about the risk of smokeless tobacco. Education is key and we hope Mouth Cancer Action Month will provide an opportunity for everyone living and working in South East Asian communities to raise awareness.

“It is really important that everyone knows the warning signs for mouth cancer. They include ulcers which do not heal within three weeks, red and white patches in the mouth and unusual lumps or swellings in the mouth. Our message to everyone is ‘If in doubt, get checked out.'”


Editor’s notes

1. Smokeless tobacco is normally defined as any tobacco product that is placed in the mouth or nose and not burned. Although some people believe this type of tobacco is safer than smoking, the reality is that it is much more dangerous. The types of smokeless tobacco products most used in the UK often contain a mix of ingredients including slaked lime, areca nut (in itself an independent carcinogen), spices, flavourings and sweeteners. The terminology for smokeless tobacco varies, but the main types used in the UK include:

• Gutka, Khaini, Pan Masala (betel quid), Shammah and Maras powder (these are sucked or chewed);
• Zarda, Qiwam, or Mawa (chewed);
• Lal dantmanjan, Gadakhu, Gul, Mishri, or Creamy Snuff (dental products which are used as toothpaste or rubbed on gums);
• Nass (can be used nasally, sucked or chewed).

Smokeless tobacco is used particularly by South Asian Communities, especially women. The incidence of mouth cancer is significantly greater among South Asian women. Other parts of South Asian communities are also more at risk from the effects of smokeless tobacco including: people of Bangladeshi origin; those in older age groups; and people from lower socioeconomic groups.

2. Research findings

The Foundation surveyed 802 respondents in September 2011, including 103 people of South East Asian Origin. The findings included:

• 17% say they have used smokeless tobacco.
• 22% of respondents also smoke.
• 24% say other members of their family use smokeless tobacco.
• 41% say they would buy smokeless tobacco from local shops; 9% online.
• 29% think smokeless tobacco is less harmful; 49% don’t know.
• 85% have not received any educational information.
• 16% have had their mouths checked for mouth cancer.
• 91% have never asked their dentists to check for mouth cancer.