Bulletin of the World Health Organization

India should ban chewing tobacco as well as smoking

Article: In brief: 2004;82:473

The number of adult and adolescent males chewing tobacco is rising (in particular, a commercially produced branded sachet-tobacco, which is the cause of a rising rate of oral submuscous fibrosis (OSMF) and a variety of Leukoplakia and pre-cancerous oral lesions which can develop into oral cancer. Historically, 'Paan' was formulated to an individual's wishes but now readymade packets of these products are available as a mixture known as 'Paan masala' or 'Gutkha' and is even available in certain parts of Europe and America.

Banning smoking alone does not solve the problem. In our experience, many tobacco smokers are becoming chewers, and a significant proportion of these are developing oral pre-cancerous lesion and oral cancer. They have little information on the ill-effects of chewing tobacco, which can be as injurious for health as smoking. Many people think that chewing tobacco is safer than smoking. However, chewing tobacco is not only highly carcinogenic, it may cause periodontal destruction and other systemic disorders like smoking-induced ailments (5).

Controlling tobacco use in India can only work if the campaigns include the ill effects of chewing tobacco as well as smoking.

I think it would be an effective measure if India's health care providers, policymakers, and law protecting agencies came forward to implement legislation banning both smoking and chewing tobacco.


  • Indian cabinet approves ban on tobacco advertising. Interactive Investor International, 2003. (http://www.tobacco.org/news/146158.html)
  • The WHO Framework Convention on Tobacco Control. (http://www.tobacco.org/articles/org/fctc/)
  • USDA Tobacco Yearbook (C) 1994-99. Washington DC, United States Department of Agriculture. M2 Presswire-23 December 1999. (http://www.highbeam.com/library/)
  • Mehrotra R, Singh M, Kumar D, Pandey AN, Gupta RK, Sinha US . Age specific incidence rate and pathological spectrum of oral cancer in Allahabad. Indian Journal of Medical Sciences, 2003;57:400-4.
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Prof. Chitta Ranjan Choudhury. Coordinator, International Programme for Tropical Oral Health, Poole Hospital NHS Department of MF Surgery, & IHCS, Bournemouth University, Longfleet Road, Poole, Dorset BH15 2JB, England, UK. Professor & Director, Centre for Oral Disease Prevention & Control, Department of Oral Biology, AB Shetty Memorial Institute of Dental Sciences, Deralakatte, Mangalore 574 160, India. (email: Chitta_choudhury@yahoo.com)