Smokeless Tobacco

Good..!
Let their focus
JARDA / KHAINI TOBACCO be only on
prevalence

52% adults
exposed to
passive smoking
at home
Ban
Smokeless
Plastic Tobacco
Ban

They are Ignoring
harm caused by
smoking.
Is it because we are
SWADESHI

Strong
Industry? in India
Legal
Health
Warning Cases

Jarda / Khaini
Tobacco Industry

Will you support this?

To increase sales of Videshi products,
If Swadeshi products are banned?

If you do not support this, then please read this booklet to understand
how Swadeshi Smokeless Tobacco Industry is being targeted for the
benefit of Videshi Smoking Industry

VIDESHI Cigarette Industry cheers
1
• High potential from women users and switch from non-cigarettes to cigarettes will aid cigarettes companies
2
• Government goes soft on statutory warnings for cigarette packs
• Rollback of blanket ban on depiction of smoking in films3

SWADESHI Chewing Tobacco Industry cries
4
• Health Ministry is formulating a smokeless tobacco specific policy
5
• Separate harsher pictorial warnings have been designed for smokeless tobacco products
6
• National Consultation for Smokeless Tobacco recommends ban on smokeless tobacco products
7
• Despite Food Safety and Standards Act (FSSA) excludes Tobacco from its purview ,
8
some states are trying to cover Jarda / Khaini under prohibitory order , thus imposing unjustified ban.

2

Brief Facts
Smokeless tobacco is tobacco consumed without burning. It is 989 to 99%10 safer than cigarettes. In India,
various types of smokeless tobacco products are used like Chewing tobacco, Jarda, Khaini, Spit Tobacco.
These are manufactured by Swadeshi Industry since centuries providing livelihood to millions. Unfortunately,
livelihood in this industry is in danger due to dual approach. Most harmful tobacco i.e. cigarettes are favoured
and least harmful tobacco like smokeless tobacco is treated harshly. In setting policies, all tobacco products
consumed without burning are combined into one category called 'Smokeless Tobacco'. Even products like
Gutkha / Pan Masala are wrongly perceived as Smokeless Tobacco products. Actually, these are
primarily an Areca Nut based products11 because their principal ingredient (> 80%) is Areca Nut.
The scientific basis of tobacco product regulation: report of a WHO study group clearly says -
'The differences in risks associated with use of different smokeless tobacco products mean
that it would be scientifically inappropriate to consider smokeless tobacco as a single
product for the purposes of estimating risk or setting policies12.
However, this aspect is completely ignored by policy makers.

13
Lie - Smokeless Tobacco contains 28 carcinogenic chemicals -
Advocates of Tobacco Control often say this giving reference of International
Agency for Research on Cancer (IARC). However, Table given by IARC
Monograph on Smokeless Tobacco clearly shows that there are only 11
chemical agents in Chewing Tobacco (not 28), for 6 chemicals there is
insufficient evidence available and for 5 chemicals, no evidence is available as
regards carcinogenicity in humans14. Reality - As per IARC itself, no chemical
agent present in chewing tobacco is found to be carcinogenic in humans.

Lie - Almost 2 in 5 deaths among adults in India are caused due to
smokeless tobacco15 -
News in a prominent daily said this giving reference of WHO Global Report
- Mortality Attributable to Tobacco. The said report however does not
mention this anywhere, and this news is completely misleading. 2 in 5 means
40%, whereas title of the news itself says 'Smokeless tobacco claims lives of
17% of 30 plus adults'. Further, even 17% is incorrect. Reality - Page 182 of
this report16 clearly says that proportion of deaths attributable to tobacco is
7%. Here tobacco means smoking as well as smokeless tobacco.
This booklet will explain further how smoking related deaths are more
than 95% of tobacco related deaths in India.

Lie - Deaths due to tobacco are equivalent to 10 packed jumbo jets
crashing every day or 10 Tsunamis hitting Indian shores every year17 -
Advocates of tobacco control describe tobacco related deaths in India as 20
jumbo jets crashing every day. This figure is derived assuming 10 lac deaths in
India due to tobacco and dividing 10 lac by 365 days. However GATS (Global
Adult Tobacco Survey India) report has mentioned that smoking causes 9.30
lac adult deaths in India18.
Reality - This means 93% of tobacco related deaths in India are due to
smoking. This booklet will explain further how smoking related deaths are
much more than 9.30 lacs.
3

Smokeless Tobacco is less harmful
Because it is not burnt
Extracts from 'ORAL AND MAXILLOFACIAL PATHOLOGY' written by - Dr. Robert E. Marx
19
(DDS) & Dr. Diane Stern (DDS) University of Miami, School of Medicine, Miami, Florida
"In order for electrophilic intermediates that damage DNA or become
bound to DNA to be generated from tobacco products, the tobacco must
be combusted (smoked). Thus, these epoxides of tobacco tars, not
nicotine, are the actual DNA-damaging agents (i.e. carcinogens)"

"Nicotine is the addictive agent and is not by itself carcinogenic.
Therefore, because these epoxides are not formed in "smokeless"
tobacco, such tobacco products are not significantly
carcinogenic and, despite the claims of several organizations, do not
produce a higher incidence of oral squamous cell carcinoma than that
which spontaneously occurs in the nonsmoking, nonusers of
smokeless tobacco population"

"However, 9% of all squamous cell carcinomas in our major cancer
center occurred in individuals with no direct tobacco history, indicating
that "smokeless tobacco" history is coincidental rather than
causative"

But based on high prevalence, smokeless tobacco is regulated...

Tobacco control policies in India are framed considering prevalence4 and ignoring which type of
tobacco is causing real harm. In their appeal, advocates of tobacco control mention combined harm
caused by all types of tobacco (smoking as well as smokeless). However their appeal is restricted to
20
ban on smokeless tobacco .

As per GATS India 2009-2010 report
18
9.30 lac Smoking related deaths in India
21
Smokeless tobacco is more prevalent than smoking in India

What should be banned?
More harmful smoking or
More prevalent smokeless

Is it not injustice to focus on prevalence instead of harm?

4

Prevalence of smokeless tobacco is more...
but can you ignore passive smoking ?
22
Second hand smoke is four times more toxic than mainstream cigarette smoke

50.00%
Percentage of Adults in India

40.00%

30.00%
Passive Smoking

Passive Smoking
20.00%

Passive Smoking
10.00%

Smoking
Passive

Smoking
Passive

Smoking
Passive
0.00%
Smokeless 24 Health
23 24 Public Public Restaurants Government
Tobacco Smokers Home Care
23 Places24 Transport 24
Buildings
24
24
users Facility
25.90% 14% 52.30% 29% 17.50% 11.30% 6.60% 5.40%

Exposed to second hand smoke at various places

Only 14% adults smoke in India23
but second hand smoke affects larger population24

Please refer page 7 for harmful effects of passive smoking

Unfortunately those affected include innocent children

5

Chronic Obstructive Pulmonary Disease (COPD) epidemic in India

Emphysema
25
COPD Currently, India has close to 2.40 crore ( 1 in 50 people) COPD cases
Chronic
Bronchitis Asthma

26
It is One of the main causes of death in India (more than 5.50 lakh p.a.)

27
Cigarette smoking is the most important risk factor for COPD

28
Passive smoking doubles kids' risk of developing COPD as adults

Lack of awareness on this disease in health care providers and policy
26
makers has led to the increase in prevalence rate of lung diseases

Not only COPD,
Leading site of cancer is Lung Cancer, not Mouth Cancer
As per Page 111 of National Health Profile 2010
29
[Published by Central Bureau of Health Intelligence - Government of India ]

Lung cancer is the leading cancer site among males in 7 Population Based Cancer Registries (PBCRs).
Mouth cancer is not leading site of cancer in any of the 16 PBCRs.

MALE FEMALE
At Rank 1 At Rank 2 At Rank 1 At Rank 2

29 29 29 29
7 PBCRs 4 PBCRs Lung Cancer 2 PBCRs 3 PBCRs

- 2 PBCRs
29 Mouth Cancer - -

6

Not only COPD & Cancer... Cigarettes are harmful in many ways!

30
- As per Report of U.S. Department of Health and Human Service

Harmful effects of
SMOKING

As per W.H.O.
40% of
Tuberculosis Burden
in India
is attributable to
31
smoking

Harmful effects of
PASSIVE SMOKING

52% adults in
India are
exposed to
passive smoking
32
at home

World over these harmful effects of cigarettes
are shown in Pictorial Warnings
7

33
Harsh Pictorial Warnings on cigarettes Worldwide
showing various harmful effects

Malaysia European Union Australia Brazil

Brunei America Malaysia European Union

Singapore Singapore Singapore

SMOKING CAUSES SMOKING CAUSES
92% of ORAL CANCERS NECK CANCER
QUIT: 1800-438-2000 QUIT 1800-438-200

Hong Kong New Zealand

8

USA has proposed 9 harsh pictorial warnings for cigarettes
34
but only 4 text warnings on smokeless tobacco products

TYPE 34 35
Cigarette Packages Smokeless Tobacco Products

Warning area 50% of front and rear panel 30% of 2 principal sides

Type 9 different Harsh & Gory Pictures Only 4 Text warnings
No pictures
Harmful Addiction, Harm to Children, Fatal Lung Disease Addiction, Mouth Cancer,
effects (Smokers as well as non smokers), Cancer, Strokes Gum disease and tooth loss
covered and Heart Disease, Harm to baby during pregnancy,
Death, Serious risk to health

Difference in Cigarettes cause cancer This product can cause
Wordings mouth cancer

USA has mild warnings for smokeless tobacco products
9

But in India, cigarettes are favoured

Mild Pictorial Warnings on cigarettes in India
3 similar and animated pictures, is this a "Find the difference" contest?
36

Pictorial Warnings on Cigarettes are not noticed because
In India 70% of sales are in Loose Sticks37
So 70% cigarette customers do not see the warning.
In many countries law does not allow such loose stick sale.
WHO Framework Convention on Tobacco Control (FCTC) also says
"Each party shall endeavour to prohibit the sale of cigarettes
38
individually or in small packets".

In India pictorial warnings on cigarettes show only lung and mouth cancer!
What about other harmful effects about which there is no awareness at all?

As explained in Lies Vs Reality on page no. 3, as per IARC itself,
no chemical agent present in chewing tobacco is found to be carcinogenic in humans.
Despite of this, only in India warnings on smokeless tobacco products are harsher than cigarettes.

Comparison of employment

Smokeless Tobacco
Industry
Smokeless tobacco industry (27.59 lacs)
75%
3 times more employment
39
than cigarette industry,
but favour is given to cigarettes Cigarette
Industry
(9.43 lacs)
25%

10

Smoking kills more than 10 lac adults every year
Smokeless
Tobacco &
Passive
Smoking
(1 lac) 40 No. of Deaths
9%

Smoking (10 lacs)41
91%

Ban smokeless tobacco - deaths will increase to 35.78 lacs
Dr. Brad Rodu, Prof. of Medicine, Tobacco Harm Reduction Research University of Louisville (U.S.A.) estimated
that if all 46 million smokers used smokeless tobacco, United States would see, at worst, 6,000 deaths from oral
42
cancer, versus current 419,000 deaths from smoking-related cancers, heart problems & lung disease.
Had Dr. Rodu seen situation in India, he would have suggested The Harm Reduction theory (THR) of switching
to smokeless tobacco from smoking. Unfortunately National Consultation on Smokeless Tobacco has
6
recommended ban on only smokeless tobacco products . This recommendation if accepted, then present
21
16.37 crore users of only smokeless tobacco may switch to smoking to satisfy crave for nicotine. In this
scenario present 11 lac tobacco related deaths40,41 will increase multi-fold to 35.78 lacs.43 If The Harm Reduction
theory (THR) as stated above is followed, then present 11 lac tobacco related deaths40,41 can be reduced to
57,000, if smoking is banned.44 (Assuming that present 6.89 crore21 users of only smoking switch to smokeless
tobacco)
35 lacs
DANGER AHEAD

30 lacs

National Consultation on
25 lacs Smokeless tobacco
recommended ban on
6
20 lacs smokeless tobacco products
which may lead to this scenario

15 lacs

10 lacs

5 lacs

A) Currently (10 Lac due to B) Ban on smokeless C) Ban on smoking tobacco
41
smoking & additional 1 Lac tobacco (35.78 lac deaths (57,000 deaths due to smokeless
45 43 44
(60,000 passive smoking + due to smoking) tobacco)
46
40,000 smokeless tobacco ).
11

Lowest deaths in India from tobacco
related cancers per 1 lac population
30.00

25.00

20.00

15.00

10.00

5.00

0.00
United United
New
Kingdom
Japan China Bhutan Australia Canada States of Bangladesh INDIA
Zealand
America

27.82 20.27 20.09 16.74 14.88 14.54 13.67 13.26 12.71 11.93

47
If we compare no. of estimated deaths for the year 2008 (As per report of WHO ) due
to Mouth, Oropharynx, Oesophagus and Bladder cancers (which are considered as
Tobacco Related Cancers apart from Lung Cancer), then India is the lowest, despite of
alleged prevalence of smokeless tobacco to be the highest. In Bhutan, such no. of deaths
are more despite of ban on tobacco.
Secondly while reporting tobacco related cancers, sites associated with the use of
48
tobacco are reported by Population Based Cancer Registries (PBCRs) , without verifying
whether these cancer patients are users of tobacco or not.
This means even cancer patients who do not use tobacco are counted in
reports of 'tobacco related cancer' (TRC) figures. Please ask age-wise break-up of
TRC to any PBCR and you will find some patients in the age group of 0-4 also.
Is it possible that an infant uses tobacco?
nd 49
India is 2 highest tobacco producing country in World
But TRCs (excl. lung cancer) deaths in India are lowest in these 10 countries
This must be because use of tobacco in smokeless 9 form than smoking
(which is 98% safer than smoking )

This is what The Harm Reduction Theory (THR) is advocating.
This theory says that, if it is not possible for a smoker to quit smoking, then
smoker should switch to less harmful products like smokeless tobacco.

12

American President Obama advised to
switch to smokeless tobacco
Jeff Stier of American Council on Science and Health (ACSH) advises US President
Obama how he can quit smoking by switching to smokeless. He says :-
"Surprisingly, the risk of oral cancer from smokeless tobacco is low--far lower than the
oral cancer risk from smoking cigarettes. And switching from cigarettes to snus
eliminates the risk of heart disease, lung cancer and50the other systemic diseases
related to smoking--not to mention secondhand smoke"
Dr. Gilbert Ross of American Council on Science and Health (ACSH)
"The simple truth, however, is that for those smokers who are trying to quit and have been
unsuccessful with current FDA-approved cessation methods-as is the case in the large majority- 51
smokeless tobacco is an excellent alternative and has a great track record, especially in Sweden"

What are the advocates of The Harm Reduction theory (THR) saying?
Some Extracts from Tobacco Harm Reduction 2010 - a yearbook of recent research and analysis
Edited by - Dr. Carl V. Phillips & Paul L. Bergen
52a

Cancer risk from a lifetime of smoking compared to a lifetime of smokeless tobacco use.

Best case:
Worst case:
Current case: If all smokers
If all tobacco users
(1,04,999) were smokeless
were smokers
tobacco users
(1,35,542)
(1,103)

Based on American estimates of 7 cancer mortalities for 35+ males (re Lee & Hamling, 2009)

v The evidence shows that the risk for any life-threatening disease from Smokeless Tobacco use is so low
52b
that it cannot be reliably measured or even definitively established.
v There is evidence of American men switching to ST as a method for quitting smoking (Dr.Rodu & Dr.Phillips
2008), and THR is increasingly being discussed in the scientific literature, and is gaining acceptance in the
medical community (Dr.Nitzkin & Dr.Rodu 2008) 52C
v In their response to the EU Green Paper Consultation on Public Smoking, the Swedish Ministry of Health
and Social Affairs drew attention to the need to take account of the Swedish experience with the use of snus
as an alternative to cigarettes. 52d
v Thus, discouraging a smoker, even one who would have quit entirely, from switching to a low-risk
52e
alternative is almost certainly more likely to kill him than it is to save him.
v I believe that FDA regulation of tobacco products will be effective and beneficial for public health if it
incorporates tobacco harm reduction, which involves the substitution of alternative sources of nicotine,
including smokeless tobacco products, for cigarettes by smokers who are unwilling or unable to abstain
altogether from nicotine and tobacco.52f

13

Smokers in USA have already started believing in
The Harm Reduction Theory (THR)….
53
FTC Reports Indicate Smokers Finally Getting The Right Message
Two encouraging reports released Saturday by the FTC may indicate that U.S. tobacco users are
getting the message that smokeless tobacco products are up to 99% safer than smoking.
According to the reports, smokeless tobacco consumption has increased 3.6% from 2006 to 2008 and
smokeless tobacco advertising spending increased 55% during the same period. Additionally, nationwide
cigarette advertising and promotional expenditures declined 20% from 2006 to 2008 and cigarette consumption
declined by 8%.
“For over a decade, smokers have been given the scientifically untrue message that smokeless
products are just as dangerous as smoking, because tobacco manufacturers are prohibited by law to tell the
whole truth,” said Elaine Keller, CASAA's vice president. “They are required to place warnings on their
packaging that the products 'are not a safe alternative to smoking.' While this is technically true, most people
would consider a less than 1% health risk as quite safe compared to the smoking risks.

Worldwide Cigarette companies are focusing more
on smokeless tobacco, but in India scenario is opposite

Tobacco companies are shifting their advertising dollars
from high-risk cigarettes to these low-risk smokeless alternatives53

14

Smokeless Tobacco is not so harmful...
19
As a explained on page no. 4, smokeless tobacco is not burnt and hence less harmful.
This is not just a theory but can be proven with following example....
Deaths from Tobacco Related Cancers
(excl. Lung Cancer)

POLAND Only 1% male & 20.83 per 1 lac
Less smokeless 0.1% females use population
47
54
but more cancers smokeless tobacco

INDIA 33% male & 11.93 per 1 lac
47
More smokeless 18% females use population
55
but less cancers smokeless tobacco

Definitely, it is not smokeless tobacco alone,
but other factors also responsible for these cancers.

Otherwise how is it possible that,
a country like Poland (very less prevalence of smokeless) has more cancers
than India (prevalence of smokeless tobacco 33 times more in males).

India - Lowest consumption of cigarettes, hence great potential for smoking.
Hence smoking tobacco companies trying to eliminate smokeless tobacco?

56
Number of cigarettes per adult per year
2500

2000

1500
Refer page 10
which shows
1000 danger ahead
(35.78 lac deaths
500 due to smoking
in India)

0
United New Bangla
Russia Japan China United Australia Canada Kingdom Zealand desh India
States

2319 2028 1648 1196 1130 897 790 565 172 99

15

Why blame chewing tobacco alone?

Main causes of oral cancer :
1. “According to the WHO, chewing supari leads to cancer of the mouth even if tobacco is
not added to it. In countries where betel nut is consumed extensively, there is a much higher
level of oral cancer. There is a dire need to initiate a drive against this sweet poison. To save
our oral and general health, children you need to be aware of the harmful effects of these
easily available packets of sweet supari and gutka”57

2. In countries around the world, smoking is public health's enemy No 1. But there are unique
and vexing problems everywhere. In Taiwan, for example, there's a major push to convince
people to eschew the addictive areca, or betel nut, because chewing it is a major cause of Hence Taiwan (Chinese Taipei)
is No.1 in Oral Cancer
cancer. The areca nut causes 90 per cent of oral cancers in Taiwan, the world's second
58
leading producer of the crop behind India.
3. Gutka is primarily an areca nut based product. It has been conclusively proven that OSF
Occurs because of areca nut consumption and is not associated with tobacco. 11
- Dr. Ajay Nayak, Yogesh Chhaparwal, Keerthilatha M.Pai (Manipal College of Dental
Sciences) in OOOOE Journal

4. A Report of the Surgeon General. Atlanta, GA: U.S. Department of Health and Human
Services, Centers for Disease Control and Prevention, Page 225
The 2004 Surgeon General's report, The Health Consequences of Smoking: A Report of the
Smoking Surgeon General (U.S. Department of Health and Human Services [USDHHS] 2004),
concluded that the evidence is sufficient to infer a causal relationship between smoking and
cancers of the lung, larynx, oral cavity, pharynx, esophagus, pancreas, bladder, kidney,
cervix, and stomach, and acute myeloid leukemia59.

5. An article published in “Journal of Cancer Research and Therapeutics” Apr-Jun 2009,
Volume 5, Issue 2. Article written by Dr. Pankaj Chaturvedi, Department of Head and
Neck, Tata Mem. Hospital, Mumbai
“There has been a rising international recognition of the role of HPV as an etiologic agent in
a subset of oral cancers. The HPV detection rate of 20%-50% in oral carcinomas is
among the highest of any extragenital human malignancy. Given this high rate of positivity
HPV may be recognized as a tumorigenic factor for development of head and neck
cancers.”60

6. “The evidence for carcinogenic effects of alcoholic beverage consumption on the risk for
cancers of the oral cavity and pharynx in humans was considered to be sufficient by a previous
IARC Working Group (IARC, 1988)”61

7. Oral cancer - Other Risk Factors 62
a. History of Oral Precancer Lesions
63
b. Family history of cancer
c. Age > 35 years, Chronic irritation of the mouth, Diet low in vegetables and fruits, Male
gender, Poor oral hygiene, Sun exposure64

It will be an injustice to blame chewing tobacco alone for oral cancers
Unfortunately only in India there are
Mild health warnings on smoking products
No awareness about HPV
No health warnings on alcohol & many areca nut products
But chewing tobacco products have strong health warnings
16

India is not the oral cancer capital of the world,
but Taiwan is with 20.9 incidences per 1 lac population
22 As per data from WHO Top 20 countries in crude rate of
20.9
Lip-oral cavity cancers per 1 lac population65
20

18
Incidence
Crude rate per 1 lac

16
14.9 India is not in Mortality
14
Top 20 list*
12.1 11.6
12 11.4

10 9.9 9.8 9.6 9.4 9.4 9.2 9.1 9 8.7 8.7 8.6 8.4 8.4
8.1 8.3 8
7.7 7.9
8

6 5.4 5.1
4.4 4.5
4 3.2 3.6
2.8 3 3.2 2.9 2.9 2.8
2.4 2.3
2 1.9 1.8
1

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*Crude Rate of incidence in India is 5.9 per 1 lac population (almost 1/4 of Taiwan)
Lip-Oral Cavity
Lung Cancers
What about health problems in India which are
55,540

more serious than mouth cancer?
30 lacs

25 lacs

20 lacs

15 lacs

10 lacs

5 lacs

0
Tuberculosis,
Mouth
Cardio- Respiratory Maternal & STDs Road
Other Diarrhoeal Digestive Diabetes and
vascular Infections & Perinetal & Traffic
reasons diseases Diseases mellitus oropharynx
diseases Respiratory Conditions HIV Accidents
Diseases cancers

If we compare various reasons of death from the data of World Health Foundation - Global Burden Disease Death
Estimates 200866, then it can be seen that there are other serious health problems than mouth cancer.
17

Curing of smoking tobacco causes destruction of Forests

As per a study by the Indian Institute of Forest Management, Bhopal, the use of
fuelwood between 1962 and 2002 for tobacco curing and production of cigarettes and other
smoking consumables has destroyed and degraded 680 sq. km of scrub forests, or nearly 868
67
million tonnes of wood, through successive extraction.
There is a global evidence of deforestation linked to tobacco production. An average of
68
7.8 kg of wood is needed to cure 1 kg of tobacco.
India - Second largest producer of tobacco in the world. Output of approx. 600 M.Kgs
69
(dry weight) of which Flue Cured Virginia (FCV) tobacco accounts for 185 M.Kgs.
70
This means 1443 million Kg of wood is needed to cure 185 M.Kgs. of FCV tobacco.
71
However, smokeless tobacco is Sun-Dried. It does not require wood for curing.
Thus it does not cause harm to the forests and environment.
72

Smoking causes deaths due to fire accidents...

Smoking causes deaths due to fire accidents. More people die in fires caused by smoking than in fires
73
caused by anything else. According to a report in 1998 due to fires caused by smoking, worldwide
there was a destruction of property to the tune of 2700 crore dollars 74 (1,21,500 crore rupees)

Smokers turned off detectors at AMRI hospital. The 93 persons who suffocated to death in the
blaze at Kolkata's AMRI hospital on Friday may well have been saved if insensitive smokers,
75
including doctors and staffers, had not turned off the smoke alarms before puffing away

18

Comparison at Glance

SMOKING TOBACCO SMOKELESS TOBACCO
21 HARM 21
No. of users 6.89 crores , no. of 100 No. of users 16.37 crores , no. of
deaths 10 Lacs41. Deaths due to deaths 40,00046. So no. of deaths

SMOKING
80

passive smoking 60,00045. So no. 60 per 1 lac user = 24.
of deaths per 1 lac user = 1538 40 This is 1.56% as compared to
64 times more harmful than 20 smoking, means 98% safe.
SMOKELESS
smokeless tobacco products. 0

As per WHO, 40% of Tuberculosis Not responsible for Tuberculosis
Burden in India is attributable to burden in India
31
smoking

Harms to non smokers due to Does no harm to non users
second hand and third hand smoke.
As per GATS India survey, more
than 52% adults are exposed to
32
passive smoking at home.

Cigarette filters are made from Plastic ban for Chewing tobacco
78
cellulose acetate and are resistant
76
products is being enforced . But
to degradation. Duration of the use of plastic by cigarette industry
degradation process is cited as is still continued in the form of filters
taking as little as 1 month to 76
77
3 (made of cellulose acetate ) and
76

years to as long as 10–15 years .
It is estimated that 4.5 trillion cigarette pack wrapped in
cigarette butts become litter every cellophane.
76
year (9 lac tonnes, worldwide)

Close to 4000 chemicals are Nearly 3000 chemicals identified in
79
present in tobacco smoke, many of smokeless tobacco .But tobacco must
79
them harmful. Among more than be burnt for these chemicals to be
4000 constituents of tobacco harmful19. As explained in Lies Vs
smoke, over 60 are known or Reality (page no. 3), as per IARC itself,
80 no chemical agent in chewing tobacco
suspected carcinogens is found to be carcinogenic in humans.
39
Dir./Indirect employment 9.42 lac Dir./Indirect employment 27.58 lac39
EMPLOYMENT
Profits taken away in foreign
countries through dividends &
royalties. Major harm to Indians & Profits are retained in India.
profits taken out of India ?

There will be lot of news in the media about
Smokeless Tobacco
(other than Gutkha / Pan masala).
We sincerely request you to
Analyze the truth before believing...

19

References
1. High potential from women users and switch from non-Cig to Cig will aid ITC (Cig account for 15% of total tobacco usage) as the
duplication is high in these categories which will enhance tobacco users' upgrade to cigarettes —As per post dated 21 August
2012 on equitybulls.com.
http://www.equitybulls.com/admin/news2006/news_det.asp?id=109615
2. Government has watered down the pictorial warnings to be printed on cigarette packets depicting the health risks of smoking -
News dated 31 May 2011 in Mumbai Mirror.
http://www.mumbaimirror.com/article/15/2011053120110531033122548ed6c363a/Govt-goes-soft-onstatutory-warnings-for-
cigarette-packs.html
3. The Union health ministry has rolled back its original call for a blanket ban on the depiction of smoking in films - News dated 10
August 2012 in The Times of India.
http://articles.timesofindia.indiatimes.com/2012-08-10/india/33136438_1_tobacco-use-occurrences-i-b-ministry-foreign-
films
4. Noting that 26 per cent of the total population is chewing cancer-causing tobacco, the Centre on Monday said it was formulating
a smokeless tobacco specific policy - News dated 17 January 2011 in Jagran Post.
http://post.jagran.com/centre-to-frame-smokeless-tobacco-specific-policy-azad-1295272976
5. For the first time that separate harsher pictorial warnings have been designated for smokeless tobacco - News dated 28 May
2011 in The Times of India
http://articles.timesofindia.indiatimes.com/2011-05-28/india/29594315_1_pictorial-warnings-smokeless-tobacco-tobacco-
products
6. A progressive ban on smokeless tobacco products in the country was one strong recommendation that delegates of a National
Consultation agreed upon and urged the Government to move in that direction. —Press Release published on 5 April 2011 by
Centre for Tobacco Control and Health Promotion.
http://www.ctchp.org/index.php?option=com_content&view=article&id=161:national-consultation-forsmokeless-tobacco-
ban-is-an-instrument-need-more-actions-under-12th-five-yearplan&catid=16&Itemid=112
7. According to the FSSAI CEO, Dr V N Gaur , ”At present, the Act clearly says tobacco is not a food item.” —News dated 26 March
2011 —FSSAI news archive.
http://fssai.gov.in/Daily_News_Archive/March.aspx
8. Chewable tobacco products such as gutkha and khaini may soon be banned in Delhi. —News dated 23 August 2012 in
Hindustan Times.
http://www.hindustantimes.com/India-news/NewDelhi/Chew-on-this-Delhi-set-to-ban-gutkha/Article1-917951.aspx
9. Use of smokeless tobacco is 98% safer than smoking.
http://www.smokersonly.org/
10. Smokeless tobacco products are up to 99% safer than smoking.
http://www.onlineprnews.com/news/158413-1312221121-ftc-reports-indicate-smokers-finally-getting-the-right-
message.html
11. http://www.ooooe.net/article/S1079-2104(10)00488-9/fulltext
12. Page 9 of 'The scientific basis of tobacco product regulation: second report of a WHO study group' (WHO technical report
series ; no. 951).
http://www.who.int/entity/tobacco/global_interaction/tobreg/publications/9789241209519.pdf
13. Union health minister Ghulam Nabi Azad had informed Lok Sabha on March 11, 2011 that there are more than 3,000 chemical
ingredients in chewing tobacco products. Out of these, 28 chemical ingredients are proven carcinogens.
http://www.downtoearth.org.in/content/kerala-becomes-second-state-ban-chewing-tobacco
14. Table 3. Chemical agents identified in smokeless tobacco products (IARC Monographs on the Evaluation of Carcinogenic
Risks to Humans - VOLUME 89 - Smokeless Tobacco and Some Tobacco-specific N-Nitrosamines)
http://monographs.iarc.fr/ENG/Monographs/vol89/mono89.pdf
15. News dated 16 February 2012 in The Times of India.
http://articles.timesofindia.indiatimes.com/2012-02-16/india/31066047_1_smokeless-tobacco-harsher-pictorial-warnings-
tobacco-report
16. Page 182 of WHO global report: mortality attributable to tobacco.
http://whqlibdoc.who.int/publications/2012/9789241564434_eng.pdf
17. Deaths due to tobacco are equivalent to 10 packed jumbo jets crashing every day or 10 Tsunamis hitting our shores every year -
News dated 27 July 2012 in kanglaonline.com.
http://kanglaonline.com/2012/07/manipur-has-the-highest-tobacco-consumption-in-india/
18. It has been estimated that in 2010 smoking will cause about 930,000 adult deaths in India; and about 70 percent of them will be
between the age 30—years : Page No. 5 of 'The Global Adult Tobacco Survey India, 2009-2010' (GATS Report)
http://www.searo.who.int/LinkFiles/Regional_Tobacco_Surveillance_System_GATS_India.pdf
19. Page 286, ORAL AND MAXILLOFACIAL PATHOLOGY' written by professors of , University of Miami, School of Medicine,
Miami, Florida —Dr. Robert E. Marx (DDS, Professor of Surgery and Chief Division of Oral and Maxillofacial Surgery) Dr. Diane
Stern (DDS, Clinical Professor of Surgery, Division of Oral and Maxillofacial Surgery)
20. Billboards in India: Ban Smokeless Tobacco (This billboard displayed in front of Hon'ble Supreme Court mentions 10 lac deaths
per year, but appeals to ban only smokeless tobacco. Surprisingly, it is displayed by 'World Lung Foundation' which should
speak more against smoking than smokeless tobacco.
http://worldlungfoundation.org/ht/d/ViewBloggerThread/i/15655
21. The estimated number of tobacco users in India is 274.9 million, with 163.7 million users of only smokeless tobacco, 68.9
million only smokers, and 42.3 million users of both smoking and smokeless tobacco. - Page xxxv of Global Adult Tobacco
Survey India 2009-2010 (GATS Report)

20

22. Philip Morris toxico logical experiments with fresh side stream smoke : more toxic than main stream smoke - S Schick, S Glants
http://tobaccocontrol.bmj.com/content/14/6/396
23. Table 4.36 (Smokeless tobacco) and Table 4.14(Smokers) : From Page 72 & Page 43 resp. from 'Global Adult Tobacco Survey
India 2009-10' (GATS Report)
24. Graph prepared on the basis of Page No. 129 & 133 of 'Global Adult Tobacco Survey India 2009-10' (GATS Report)
25. Currently, India has close to 24 million (1 in 50 people) COPD cases which are expected to increase by 34 per cent to 32 million
by 2020
http://health.india.com/news/1-out-of-50-indians-will-have-copd-by-2012/
26. Although COPD is one of the main causes of death in India — more than 5.50 lakh people every year — lack of awareness on
this disease in health care providers and policy makers has led to the increase in prevalence rate of lung diseases
http://www.dnaindia.com/health/report_never-smokers-more-vulnerable-to-copd_1467854
27. Cigarette smoking is the most important risk factor for COPD. It is estimated that 80% of COPD patients have significant
exposure to tobacco smoke
http://www.ijpbs.com/data/OCT-DEC2011/447-456.pdf
28. Exposure to passive smoking doubles kids' risk of developing chronic obstructive pulmonary disease (COPD) as adults
http://www.medindia.net/news/exposure-to-secondhand-smoke-raises-copd-risk-in-kids-99016-1.htm
29. Page 111 of National Health Profile 2010, Published by Central Bureau of Health Intelligence - Government of India
http://cbhidghs.nic.in/writereaddata/mainlinkFile/File1012.pdf
30. Figure 1.1 The health consequences causally linked to smoking and exposure to secondhand smoke —Page 4 of How
Tobacco Smoke Causes Disease: The Biology and Behavioral Basis for Smoking-Attributable Disease: A Report of the
Surgeon General. Dept. of Health and Human Services, Public Health Service, Office of Surgeon General, 2010.
http://www.surgeongeneral.gov/library/reports/tobaccosmoke/full_report.pdf
31. Page 1 of FACT SHEET ON TUBERCULOSIS AND TOBACCO (Sept. 2009) Published by World Health Organisation (WHO)
http://www.who.int/tobacco/resources/publications/factsheet_tub_tob.pdf
32. 52.3% adults exposed to second-hand smoke at home – Pg.129-'Global Adult Tobacco Survey India 2009-10' (GATS Report)
33. http://www.tobaccolabels.ca/healthwarningimages
34. http://www.fda.gov/downloads/TobaccoProducts/Labeling/UCM259401.pdf
On the top 50 percent of both the front and rear panels of each cigarette package.
http://www.fda.gov/TobaccoProducts/Labeling/ucm259214.htm#Placement_of_New_Warnings_on_Cigarette_Packages_a
nd_Advertisements
35. For smokeless tobacco packaging, the warning must be located on the two principal sides of the package and cover at least 30
percent of each side.
http://www.fda.gov/TobaccoProducts/Labeling/Labeling/SmokelessLabels/default.htm
36. http://www.tobaccolabels.ca/healthwarningimages/country/india
37. According to appellants 70% of sales by the retailers are in the form of loose sticks and only 30% of sales are in packages [1998
(104) E.L.T. 151 (Tribunal) I.T.C. Ltd. Versus C.C.E. Bangalore]
38. WHO Framework Convention on tobacco control (FCTC) - Article 16: Sales to and by minors - Each Party shall endeavour to
prohibit the sale of cigarettes individually or in small packets which increase the affordability of such products to minors.
http://www.who.int/tobacco/framework/final_text/en/index6.html
39. Impact of Anti-Tobacco Legislation (including a ban on advertising) on direct employment in the Tobacco Sector Report
prepared for Government of India (UNION MINISTRY OF LABOUR) : Dr. P. Pullarao.
40. In addition, there are excess deaths due to smokeless tobacco use, which is common among men as well as women
and also deaths due to exposure to second-hand smoke. These deaths have not been quantified, but it appears reasonable to
assume that these will add at least another 100,000 deaths.- Page 89 of Report on Tobacco Control in India - Published by
Ministry of Health and Family Welfare, Government of India.
http://mohfw.nic.in/WriteReadData/l892s/911379183TobaccocontroinIndia_10Dec04.pdf
41. Tobacco use has assumed the dimension of an epidemic resulting in enormous disability, disease and death with 17% of the
smokers of the world living in India. It is estimated that in 2010 smoking will cause about one million adult deaths in India,
annually. - Letter dt. 12 Feb 2010 written by 'Advocacy Forum for Tobacco Control' (AFTC) to Dr. Manmohan Singh, Honourable
Prime Minister of India. This letter is signed by 5 prominent personalities working in the field of tobacco control i.e. Dr. K. Srinath
Reddy, Dr. Prakash C. Gupta, Dr. Mira B. Aghi, Shri. Alok Mukhopadhyay, Ms. Monika Arora).
http://www.aftcindia.org/pdf/Letter%20to%20PM.pdf
42. Table 1 showing comparison of deaths in equal no. of smokers and smokeless tobacco users.
www.smokersonly.org/our_harm/scientific_rationale.html
43. Present 6.89 core users of smoking21 + 16.37 crore users of only smokeless tobacco21 may switch to smoking. Hence total
smokers will be 23.26 crore. Presently there are 10 lac deaths due to smoking41 and 60,000 deaths due to passive smoking 45.
Hence no. of deaths in 23.26 crore smokers will be 35.78 lacs (10.60 Lacs x 23.26 crore / 6.89 crore)
44. Present 6.89 core users of smoking21 + 16.37 crore users of only smokeless tobacco21 may switch to smokeless. Hence total
smokeless tobacco users will be 23.26 crore. Presently there are 40,000 deaths due to smokeless tobacco46. Hence no. of
deaths in 23.26 crore users of smokeless tobacco will be 57,000 (40,000 x 23.26 crore / 16.37 crore = 56,836 say 57,000)
45. As per http://www.smokersonly.org/our_harm/scientific_rationale.html there are 40,000 passive smoking deaths in America
due to 4.60 crore smokers. In India, as per page xxxv of Global Adult Tobacco Survey India 2009-2010, there are 6.89 crore only
smokers21. Hence, in India, passive smoking deaths are assumed at 60,000 (40000 x 6.89 / 4.60 = 59,913, say 60,000).
46. As per page 89 of Report on Tobacco Control in India - Published by Ministry of Health and Family Welfare, Government of
India, there are 1 lac deaths due to smokeless tobacco and passive smoking40. Hence if we deduct 60,000 passive smoking
deaths45 as calculated above, smokeless tobacco related deaths can be assumed at 40,000.
47. As per data from, World Health Organisation Burden Disease Death Estimates for the year 2008, estimated deaths from
mouth, oropharynx, oesophagus and bladder cancers (which are considered as Tobacco Related Cancers by Population

21

Based Cancer Registries in India) calculated per 1 lac population.

48. Table 3.2 on Page 61-62 of 'Three year Report of Population Based Cancer Registries 2006-2008' reports no. of tobacco
related cancers (TRCs) in different PBCRs & related sites. These sites of cancer considered in calculating TRCs are Lip,
Tongue, Mouth, Oropharynx, Hypopharynx, Pharynx Unsp., Oesophagus, Larynx, Lung & Bladder. If individual report of each
PBCR is verified, then these figures will exactly match with total no. for each such site. This means, sites associated with the
use of tobacco are considered in calculation of TRCs without verifying whether these patients are users of tobacco or not.
49. Tobacco is an extremely important commercial crop in India. It is the world's second largest producer of tobacco.
http://www.tobaccoasia.net/features/389-tobacco-consumption-in-india-an-overview.html
50. http://www.acsh.org/healthissues/newsID.1871/healthissue_detail.asp
51. http://www.acsh.org/factsfears/newsid.2875/news_detail.asp
52. Tobacco Harm Reduction 2010 - a yearbook of recent research and analysis edited by Carl V. Phillips & Paul L. Bergen
http://tobaccoharmreduction.org/thr2010yearbook.htm
a) Page 217 b) Page 17 c) Page 26 d) Page 46 e) Page 113 f) Page 150
53. http://www.onlineprnews.com/news/158413-1312221121-ftc-reports-indicate-smokers-finally-getting-the-right-
message.html
54. Prevalence of smokeless tobacco in Poland : World Health Organisation
http://www.who.int/entity/tobacco/surveillance/en_tfi_gats_poland_2010.pdf
55. The extent of use of smokeless tobacco products among males (33%) is higher than among females (18%) - As per page xxxv
of Global Adult Tobacco Survey India 2009-2010 (GATS Report)
56. Graph prepared for 10 countries from List of countries by cigarette consumption per capita
http://en.wikipedia.org/wiki/List_of_countries_by_cigarette_consumption_per_capita
57. http://www.dawn.com/2011/09/10/health-sweet-poison.html
58. http://www.canada.com/story_print.html?id=d1fb2308-1705-4342-8059-b2328a4b41bd&sponsor=
59. http://www.surgeongeneral.gov/library/tobaccosmoke/report/full_report.pdf
60. http://www.cancerjournal.net/temp/JCanResTher5271-3358555_091945.pdf
61. As per Page 237 of IARC Monographs on the Evaluation of Carcinogenic Risks to Humans - VOLUME 96 - Alcohol
Consumption and Ethyl Carbamate
http://monographs.iarc.fr/ENG/Monographs/vol96/mono96.pdf
62. http://sites.google.com/site/quitnut/arecapedia/arecancer/oral-cancer/risk-factors
63. http://my.clevelandclinic.org/disorders/oral_cancer/hic_oral_cancer.aspx
64. http://www.bettermedicine.com/article/oral-cancer-1/causes
65. Graph available on web site of IARC-Globocan
http://globocan.iarc.fr/bar_site.asp?selection=12010&title=Lip%2C+oral+cavity&sex=0&statistic=1&populations=5&window
=1&grid=1&info=1&orientation=1&color1=20&color1e=&color2=30&color2e=&submit=%A0Execute%A0
66. As per data from, World Health Organisation Burden Disease Death Estimates for the year 2008, estimated deaths are
calculated per 1 lac population for various reasons
http://www.who.int/entity/gho/mortality_burden_disease/global_burden_disease_death_estimates_sex_age_2008.xls
67. http://www.gobartimes.org/content/smoking-reality
68. http://articles.timesofindia.indiatimes.com/2012-03-29/india/31254073_1_tobacco-production-world-lung-foundation-
cigarette-production
69. http://commerce.nic.in/psft/fs_tobacco.htm
70. An average of 7.8 kg of wood is needed to cure 1 kg of tobacco. 3 Output of Flue Cured Virginia (FCV) tobacco accounts for 185
M.Kgs70. 4 Hence wood needed = 185 million kgs. X 7.8 = 1443 million kgs.
71. Khaini is made from sun-dried or fermented coarsely cut tobacco leaves. Page 51 - IARC MONOGRAPHS VOLUME 89
http://monographs.iarc.fr/ENG/Monographs/vol89/mono89-6A.pdf
72. http://theblacklisters.com/wp-content/themes/theblacklist/images/facts-deforestation-aboutit.jpg
73. http://www.direct.gov.uk/en/HomeAndCommunity/InYourHome/FireSafety/DG_071693
74. Smoking is a leading cause of fires and death from fires globally, resulting in an estimated cost of nearly $7 billion in the United
States and $27.2 billion worldwide in 1998.
http://www.sciencedaily.com/releases/2000/08/000807064005.htm
75. http://www.hindustantimes.com/India-news/Kolkata/Smokers-turned-off-detectors-at-AMRI-hospital/Article1-781134.aspx
76. http://en.wikipedia.org/wiki/Cigarette#Cigarette_litter
77. Our filter tips are biodegradable over a period of between a month and three years
http://www.bat.com/group/sites/UK__3MNFEN.nsf/vwPagesWebLive/4572237B0C2D456CC1257314004EF667
78. India bans plastic tobacco pouches
http://www.bbc.co.uk/news/world-south-asia-11939933
79. Page 76 of Report on Tobacco Control in India Published by Ministry of Health and Family Welfare, Government of India.
80. Page 290 of Report on Tobacco Control in India Published by Ministry of Health and Family Welfare, Government of India.

Disclaimer
External web site links are subject to change. Operation of these web sites is not in our control.

22

On screen smoking targets youth and women...
3
...but there is rollback of blanket ban on smoking in films

You do not censor on screen smoking...
6
...and least harmful tobacco (smokeless) is recommended complete ban?
23

Humble Appeal
1. Smokeless tobacco is tobacco consumed without burning. It is 98-99% safer than smoking.
2. As per WHO - It would be scientifically inappropriate to consider smokeless tobacco as a single
product for estimating risk or setting policies
3. As per IARC - No chemical agent present in chewing tobacco is found to be carcinogenic in humans
4. It is a complete lie to say that almost 2 in 5 adult deaths in India are caused due to smokeless
tobacco.
5. Smoking causes 1538 deaths in its one lac users whereas smokeless tobacco causes 24 deaths in
its one lac users. This means Smokeless tobacco is 98% safer than smoking.
6. Smoking kills 10 lac adult Indians every year. In addition, there are deaths due to passive smoking.
More than 52% adults in India are exposed to passive at home. Despite of this, pictorial warnings in
India are harsher on smokeless tobacco products than cigarettes.
7. If smokeless tobacco products are banned, people will switch to smoking & it will cause more than
35 lac deaths.
8. There are various reasons for oral cancer. Smokeless tobacco alone cannot be blamed for it.
9. As per National Health Profile – 2010, Lung cancer is the leading cancer site among males in 7
Population Based Cancer Registries (PBCRs). Mouth cancer is not leading site of cancer in any of
the 16 PBCRs.
10. India is not the oral cancer capital of the world as accused always. It is Taiwan (Chinese Taipei) with
20.9 incidences per 1 lac population. Crude incidence rate in India is 5.9 per 1 lac population.
There will be lot of news in the media about smokeless tobacco.
We sincerely request you to analyze the truth before believing.

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Shramik Sangha Maharashtra Chewing Tobacco Workers Federation
(Affiliated with Bhartiya Majdur Sangha) Lal Tara (Lal Bavta),
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