As India confronts a rising tide of tobacco use, smokeless tobacco products like chewing tobacco, snuff, snus, and gutkha are gaining attention for their widespread use, particularly in South Asia. Marketed as “safer” alternatives to cigarettes, these products are far from harmless, carrying significant health risks that impact millions.

With over 300 million users globally, many in low- and middle-income countries like India, the negative consequences of smokeless tobacco demand urgent scrutiny.

Smokeless tobacco, often chewed, sucked, or sniffed, delivers nicotine through the mouth or nose without burning. Products like paan, gutkha, and betel quid are deeply ingrained in Indian culture, especially in rural areas and among younger populations. Despite their popularity, these products contain nicotine and at least 28 cancer-causing chemicals, including tobacco-specific nitrosamines (TSNAs), which pose severe risks to users’ health.

The most alarming impact is the link to multiple cancers. Smokeless tobacco is a known cause of oral, esophageal, and pancreatic cancers, with users facing significantly higher risks than non-users. In India, where oral cancer accounts for a substantial portion of cancer cases, smokeless tobacco is a leading driver.

The American Cancer Society notes that leukoplakia—gray-white patches in the mouth often found in users—can progress to cancer if untreated. These patches, common among long-term users, are frequently painless, masking their danger until advanced stages.

Beyond cancer, smokeless tobacco wreaks havoc on oral health. Users often experience gum disease, tooth decay, and tooth loss due to the abrasive and chemical effects of these products. Receding or swollen gums and stained teeth are common, alongside bad breath that impacts quality of life. In severe cases, chronic use leads to bone loss around teeth, exacerbating periodontal issues.

Cardiovascular health is also at risk. Studies, including a 2018 meta-analysis, show that smokeless tobacco users in the U.S. face a 17% higher risk of heart disease and a 28% higher risk of stroke compared to non-users. While some argue that products like Swedish snus may pose lower cardiovascular risks due to stricter quality controls, the presence of nicotine and other toxicants like arsenic and cadmium still elevates circulatory disease risks globally.

Reproductive and pregnancy outcomes are another concern. Women using smokeless tobacco during pregnancy face increased risks of early delivery, stillbirth, and low birth weight, as nicotine and other chemicals harm fetal development. Men are not spared, with evidence linking smokeless tobacco to erectile dysfunction and reduced fertility due to impaired sperm health.

The addictive nature of smokeless tobacco compounds these risks. Nicotine, absorbed through the mouth or nose, reaches the brain rapidly, fostering dependency comparable to cigarette smoking. This makes quitting challenging, with many users transitioning to dual use with cigarettes or e-cigarettes, amplifying health harms. A 2024 report from the American Lung Association highlights that 9.6% of U.S. high school students use multiple tobacco products, including smokeless varieties, increasing their exposure to toxicants.

Social media platform X reflects growing concern. One user in Kenya shared a stark example, noting that smokeless tobacco caused chronic nausea and painful intestinal ulcers in a user named Japheth Korir, illustrating its severe digestive impact. Such anecdotes underscore the real-world toll, particularly in communities where smokeless tobacco is culturally normalized.

Public health efforts in India are ramping up to address this crisis. The National Health Mission promotes awareness campaigns, while bans on products like gutkha in several states aim to curb use. However, enforcement remains uneven, and tobacco companies spend heavily—$759 million in the U.S. alone in 2016—on marketing, often targeting youth with flavored or “spit-free” products that resemble candy.

The misconception that smokeless tobacco is a safe alternative to smoking persists, fueled by aggressive marketing. Yet, as the Centers for Disease Control and Prevention (CDC) emphasizes, no tobacco product is safe. Quitting remains the best defense, with counseling and nicotine replacement therapies doubling success rates, according to the World Health Organization. In India, community programs and cessation support are expanding, but cultural acceptance and easy access continue to hinder progress.

As smokeless tobacco use grows, its health, economic, and social costs cannot be ignored. From cancer to cardiovascular disease to reproductive harm, the risks are profound.

Public health advocates urge stronger regulations, better education, and increased access to cessation resources to combat this insidious threat. For now, the message is clear: avoiding or quitting smokeless tobacco is a critical step toward a healthier future.