From a smoker to a smokeless tobacco user: Study

Even as the state and the country is preparing for the next round of the Global Adult Tobacco Survey (GATS), a recent study based on the current edition of this globally followed survey has found that switching to equally harmful smokeless tobacco use is the most common smoking cessation method.

The study by Achutha Menon Centre for Health Science Studies of Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum shows that more than a third of the former smokers in India reported switching to smokeless tobacco for quitting smoking. The study has been published in a recent edition of the international peer-reviewed journal ‘Public Health’.

GATS 2009-10 posed a question to all 2035 successful quitters on the method they used for cessation. Among the options given to the respondents were smoking cessation clinic; nicotine replacement therapy; a quit line or a smoking telephone support line; and switching to smokeless tobacco. The majority 44.4 per cent of total successful quitters including 50.8 per cent men and 8.7 women reported switching to smokeless tobacco use. 

The GATS was conducted covering all the 29 states and two union territories in the country. This nationally representative household survey covered 69,296 individuals aged 15 years and above using a standardised methodology.

Highlighting the policy implications, Dr KR Thankappan, Prof and Head, Achutha Menon Centre and principal researcher of the study said, “Switching to smokeless tobacco is not a safer option as it is equally harmful as smoking. Coordinated measures including high levels of taxation on all tobacco products, strict enforcement of 85 per cent graphic warnings, and concerted awareness generation on harms of smokeless tobacco products is very important.”

Specifically for Kerala, he called for strict enforcement of the ban on pan masala and gutkha containing tobacco or nicotine, steps to combat smuggling of these products and targeted awareness building for the migrant population who are among the prime users of smokeless tobacco products.

Senior Project Fellow, Achutha Menon Centre and co-author of the study Dr GK Mini said, “Across the country, smokeless tobacco use surpasses smoking. If switching over is also added, the disease burden from smokeless tobacco use will be compounded. Studies have shown that smokeless tobacco users have a more than three-fold higher risk for cancer.”

As per GATS 2009-10, the number of adult current users of smokeless tobacco in India is 206.0 million, much higher than the number of current tobacco smokers of 111.2 million.

GATS is conducted once in five years; the next round is slated for 2016-17. In India, it is conducted under the coordination of the Union Ministry of Health & Family Welfare with technical assistance from the World Health Organisation.