Trends of smokeless tobacco in India- Narrative review

South Asia, primarily India, is the major producer and exporter of various forms of tobacco products worldwide. All forms of tobacco (smoke and smokeless/chewable/inhaled) such as cigarettes, pipes, cigars, beedis, paan and snuff have been implicated in the development of oral cancer. Almost 13% of the population of India chews tobacco in the form of pan or gutkha. People in India consume various forms of tobacco such as khaini, mishri, zarda, gutkha, mawa and naas. Areca nut chewing is also widely practised in India. Males have been found more likely to develop oral or esophageal cancer because of tobacco consumption. Children, teenagers and pregnant women are also found using products for pleasure, stress relieving, in social situations etc. Epidemiological studies also suggest tobacco consumption is more prevalent in lower socioeconomic strata. Oral cancer also called squamous cell carcinoma, oral submucous fibrosis (OSMF), leukoplakia, erosive lichen planus, asthma, chronic obstructive pulmonary disease (COPD) and hypertension are a few major manifestations of tobacco consumption. Smokeless tobacco users studies show mortality of 1.2–1.96 (men) and 1.3 (women). Educational intervention, mass media intervention in the form of television ads, public posters, newspaper articles, folk dramas and the most recent cessation camps have been implied to spread awareness about the misbeliefs of consuming tobacco and demonstrating health hazards associated with it.