Youth can prevent the spread of COVID-19 by giving up Smokeless Tobacco

This World No-Tobacco Day: Do Your Bit!

Each year, 31st May is held as World No Tobacco Day to reiterate the World Health Organization’s (WHO) goal to spread awareness about the risks of tobacco use and how we can make the world tobacco free. This year the day is coming at the time of most challenging global health and social crises.

As per studies tobacco in any form is not only a threat to spread of the COVID-19 pandemic but also makes its consumers more prone to it. Through this article we are trying to bring to fore the negative impacts of smokeless tobacco.

“Smokeless tobacco is a significant part of the world’s tobacco problem1. Not only are its constituents such as tobacco-specific nitrosamines, cadmium, and nicotine etc. hazardous for health1,4,5,6,7; it is also considered potentially addictive. At present as compared to smoked tobacco, smokeless tobacco use is more common among the youth globally1,16. Youth are especially vulnerable to initiating smokeless tobacco use. And once they start using they often develop a pattern of regular daily use1,9. What aggravates the burden is the fact that tobacco manufacturers sell “starter” products that are milder or sweeter for initiating users1,14,15,” shared, Dr BC Goswami, Director, State Cancer Institute, GMCH, while talking about problem of smokeless tobacco amongst youth.

Further, smokeless tobacco products are usually cheaper than cigarettes leading to increased demand. As per WHO, people who experiment with smokeless tobacco, over time increase the quantity of tobacco consumption1,10, eventually leading to other addictions.

90% of smokeless tobacco chewers live in Asia1, 2, with maximum number of them residing in India and China. India has close to 27.5 crore tobacco users of which 16.4 crore use only smokeless tobacco and 4.3 crore use both forms of tobacco8.

As per Global Adult Tobacco Survey 2016-2017, 21.4% people in India consume smokeless tobacco in some form. While in the state of Assam consumption of smokeless tobacco is way higher with 41.7% adults consuming smokeless tobacco17.

With regards to high incidence of Smokeless tobacco in Assam, Dr Rajiv Pathni, Head of Operations, Assam Cancer Care Foundation, said, “Smokeless tobacco is a public health problem. Most oral tobacco users hold the quid in their mouths for a period of time and then spit out the tobacco juice along with their saliva. “Spitting” is most often done in open public places, rendering the rest of the community at risk of a range of communicable diseases13. To protect our communities, it is important to educate people and encourage a ‘Stop Spitting’ campaign.”

Smokeless tobacco could lead to spread of viral and bacterial diseases along with COVID-19. The WHO has advised that COVID-19 can spread through small droplets from the nose or mouth, which are dispersed when an infected person coughs or exhales. These droplets settle on objects and can survive for few hours or up to several days. Others can be infected by touching these objects or surfaces followed by touching their eyes, nose or mouth13.

“Smokeless tobacco consumers not only spread communicable diseases but are also are more susceptible to multiple problems including COVID-19. Tobacco use is known to cause immunosuppression affecting the adaptive and innate immune cells of the human body negatively. Once negatively affected, the cells make the tobacco user susceptible to numerous diseases. Tobacco users are more prone to cardiovascular, respiratory and autoimmune diseases, allergies, cancers and transplant rejection etc. In fact, all studies on COVID-19 to date have shown that the worst affected cohort of the pandemic has had at least one of these comorbid conditions,”added Dr Arundhati Deka, State Programme Officer, State Tobacco Control Cell, Assam.

As per WHO the use of tobacco products is of particular concern in view of the alarming COVID-19 pandemic. Smokeless tobacco use requires attention at every level to help stop the spread of the disease.

There is a pressing need to elucidate harmful effects of tobacco on individual, families and country at large and promote the cause of ‘No-Spitting’ in public places. In wake of COVID-19 pandemic tobacco consumers need to the harm they are causing to themselves and to society. Tobacco should not only be quit for self-good and a larger-good; youth must be stimulated to never to start tobacco consumption.

Help is available for those who want to quit. National Tobacco Control Programme (NTCP) offers a toll free quit-line 1800112356. For those seeking sms based quitting assistance, they need to give a missed call at 011-22901701 from their mobile number and register. Tobacco cessation centres are also available at district level.

Cognizant to the fact, the Government of India has banned the use of tobacco products and spitting in public places under disaster management act. Now is the turn of people of the nation to do their bit and what could be a better occasion than the World No Tobacco Day!

References and cross-references:
1. https://apps.who.int/iris/bitstream/handle/10665/42658/9241590556.pdf?sequence=1 (accessed on 15th May, 2020)
2. World Health Organization. Tobacco or Health, A Global Status Report. Geneva, WHO, 1997
3. Centers for Disease Control and Prevention, Office on Smoking and Health, Smokeless Tobacco Fact Sheets, 2002
4. (31) Hoffmann D, Adams JD, Lisk D, Fisenne I, Brunnemann KD. Toxic and carcinogenic agents in dry and moist snuff. Journal of the National Cancer Institute, 1987, 79(6): 1281-1286.
5. (32) Hoffmann D, MVD. Chemical composition and carcinogenicity of smokeless tobacco. Advances in Dental Research, 1997, 11: 322-329.
6. (33) Idris AM, Ibrahim SO, Vasstrand EN, Johannessen AC, Lillehaug JR, Magnusson B, et al. The Swedish snus and the Sudanese toombak: are they different? Oral Oncology, 1998, 34: 558-566.
7. (34) Zaridze DG, Safaev RD, Belitsky GA, Brunnemann KD, Hoffmann D. Carcinogenic substances in Soviet tobacco products. IARC Scientific Publications, 1991
8. GATS India Report 2009-2010. Available from http://mohfw.nic.in/WriteReadData/l892s/1455618937GATS%20India.pdf.
9. Henningfield JE, Fant RV, Tomar SL. Smokeless tobacco: an addicting drug. Advances in Dental Research, 1997, 11: 330-5.
10. Hatsukami DK, Severson HH. Oral spit tobacco: addiction, prevention and treatment. Nicotine andTobacco Research, 1999, 1: 21-44.
11. Tomar S. Snuff use and smoking in U.S. men. Implications for harm reduction(1). American Journal of Preventive Medicine, 2002, 23: 143.
12. Haddock CK, Weg MV, DeBon M, Klesges RC, Talcott GW, Lando H, et al. Evidence that smokeless tobacco use is a gateway for smoking initiation in young adult males. Preventive Medicine, 2001, 32: 262-267.
13. https://blogs.bmj.com/tc/2020/03/30/smokeless-tobacco-use-and-the-covid-19-pandemic/
14. Connolly G. The marketing of nicotine addiction by one oral snuff manufacturer. Tobacco Control, 1995, 4:73-79.
15. Andersson G, Axell T, Larsson A. Impact of consumption factors on soft tissue changes in Swedish moist snuff users: a histologic study. Journal of Oral Pathology and Medicine, 1990, 19: 453-458.
16. The Global Youth Tobacco Survey Collaborative Group. Tobacco use among youth: a cross country comparison. Tobacco Control, 2002, 11: 252-270.
17. https://www.who.int/tobacco/surveillance/survey/gats/GATS_India_2016-17_FactSheet.pdf

About Assam Cancer Care Foundation
ACCF (Assam Cancer Care Foundation) is a joint initiative of the Government of Assam and Tata Trusts, established to create a three-tier comprehensive distributed cancer care network to provide accessible and affordable care for the underserved.

ACCF has undertaken the challenging mission of setting up state-of-the-art cancer care facilities across the state of Assam. These facilities are strategically located to ensure everyone has access to quality treatment without having to travel more than three hours from their base.

The facilities will be digitally enabled by DiNC (Digital Nerve Centre) that has been set up within the premises of State Cancer Institute (SCI) in Guwahati. This centre will connect the three-tier hospital network in real time, for delivery of virtual care through effective and efficient communication.

ACCF is working towards strengthening the continuum of cancer care and preventive services through extensive research focusing on down staging by sensitizing masses through awareness, prevention, early detection, optimal treatment and palliative care.

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