EC Clinical and Medical Case Reports

All Health Care Professionals (HCPs) encounter patients with tobacco/nicotine addiction on a routine basis. According to the latest reports, 22.3% of the global population and 29% of the Indian population (37% males and 8% females), are involved in this practice. India is the second largest consumer of tobacco products, mostly used in smokeless forms rather than smoked ones. A recent trend of early initiation of tobacco consumption is seen among Indian youth, according to GATS-2 (2016-17) and GYTS-4 (2019) surveys, with more than 55% of youth beginning this habit before 20 years of age [1,2]. India is now the world capital of oral cancers. More than 8 million deaths yearly have been linked to tobacco, directly or indirectly [3,4]. So, it forms a major public health challenge, creating social, developmental and economic risks.

Varied kinds of tobacco products are used in the Indian sub-continent, making the situation more complex. The widely used forms of smoked tobacco comprise bidi and cigarettes, while hookah and E-cigarettes are also becoming prevalent now. The smokeless tobacco is available as a chew, snuff, dip, powder or liquid form applied for tooth cleaning, consumed with or without betel nut, slaked lime, catechu or other flavouring agents. The consumption of these products is usually initiated for perceived beneficial effects, such as mouth freshening, digestive and astringent effects, mood elevation, relieving tension and toothache, hunger and sleep reduction and oral cleaning [5,6]. India prohibited E-cigarettes under the Prohibition of E-Cigarettes Act (PECA)-2019, but due to sub-optimal enforcement of the law, these emerging nicotine products are still widely available, especially on e-commerce sites. Nicotine addiction due to the use of e-cigarettes is an issue in many other countries as well [7].

1. GATS-2. Global Adult Tobacco Survey-2 Factsheet India (2016-17) (2020).
2. GYTS-4. Global Youth Tobacco Survey-4 National Factsheet (2019).
3. World Health Organization IARC Working Group on the Evaluation of Carcinogenic Risks to Humans. Smokeless tobacco and some tobacco-specific N-nitrosamines. In IARC monographs on the evaluation of carcinogenic risks to humans Lyon, France: WHO International Agency for Research on Cancer 89 (2007).
4. WHO Tobacco Factsheets (2020).
5. Gupta PC and Ray CS. “Smokeless tobacco and health in India and South Asia”. Respirology 8 (2003): 419-431.
6. Niaz K., et al. “Smokeless tobacco (paan and gutkha) consumption, prevalence, and contribution to oral cancer”. Epidemiology and Health 39 (2017): e2017009.
7. About Electronic Cigarettes (E-Cigarettes) (2022).
8. Giraldi G. “Environmental tobacco smoke: health policy and focus on Italian legislation”. Clinical Therapeutics5 (2013): e429-e435.
9. Benowitz NL. “Nicotine Addiction”. The New England Journal of Medicine 24 (2010): 2295-2303.
10. Smoking Cessation: A Report of The Surgeon General - The 2020 Surgeon General’s Report Overview (2020).
11. Benowitz NL. “Pharmacology of nicotine: addiction, smoking-induced disease, and therapeutics”. Annual Review of Pharmacology and Toxicology 49 (2009): 57-71.
12. Jiloha RC. “Biological basis of tobacco addiction: Implications for smoking-cessation treatment”. Indian Journal of Psychiatry 4 (2010): 301-307.