By Soe Moe
WHEN the topic of cigarettes and many other tobacco products is presented as a subject for serious discussion, the foremost question that arises is why their use has become universally widespread. The consensus is that smoking after initiation ultimately progresses to addiction, by which it is next to impossible to quit and rid oneself of this unhealthy habit. When the reason for the inability of users to easily stop using them is looked for, it is identified that the nicotine contained in the tobacco is the culprit.
Nicotine is an alkaloid compound that occurs naturally in the tobacco plant. It stimulates the central nervous system of the users by promoting the production of dopamine, which in turn creates a feeling of pleasure, a euphoric sensation. Although the feeling of well-being and calm caused by nicotine is merely an artificial sensation, the body, with nicotine entering the bloodstream, experiences muscle relaxation and the disappearance of anxiety and worry, resulting in feelings of satisfaction and well-being. However, nicotine is an addictive chemical substance. The body becomes dependent on and addicted to this substance, and if the nicotine supply is cut off, withdrawal symptoms occur.
Nicotine is the content that really matters in getting users hooked to tobacco products, and it is usually found in large quantities in cigars, cheroots, various types of cigarettes and betel quid.
Smokeless tobacco, electronic cigarettes where nicotine is still an ingredient (apart from their other ingredients having their own health hazards), heated tobacco products, electronic vapourizers (vapes), and water pipes (hookah, shisha) also cause users to face the same problem of nicotine addiction and trying to quit, which will bring about the adverse effects and painful symptoms of nicotine withdrawal. They are thus not the answer to quitting the habit of smoking as advertised and claimed by the industry to hoodwink people.
Of no less importance is secondhand smoke. For smokers, their having to pay for their indulgence is fair, but for those living and sharing the same supply of air with them, to suffer the adverse effects and impact of diseases similar to those afflicting smokers, is not fair at all.
For the tobacco products mentioned above, whether they are burned or heated electronically, to begin using them by simply pressing a button activates a microprocessor to work with the tobacco-containing liquid(e-liquid) and additives to produce varying amounts of vapour/smoke for the user to inhale. As for smokeless tobacco products, although they are used without the production of vapour, there is absorption of nicotine into the system, and as such are still harmful to human health.
Since awareness of smokeless tobacco products, apart from the betel quid, is still insufficient among the public, the following information is presented regarding these products, their types, methods of use, health impacts, and potential adverse effects in the hope of improving the situation and helping motivate the initiation of their control.
1) CHEWING TOBACCO
Chewing Tobacco is one type of smokeless tobacco. It is consumed by placing it between the cheek and gum. Unlike cigarettes or other smoked tobacco, it does not require combustion to produce smoke, and there is no inhalation of poisonous smoke/ vapour. However, the nicotine and other chemicals harmful to human health present in the tobacco still enter the body either through absorption by the mouth lining smokeless tobacco product. Chewing tobacco typically contains tobacco leaf, nicotine, sweetening agents, flavouring agents, and other chemical additives. Notably, it contains tobacco-specific nitrosamines (TSNAs), which are primarily responsible for causing various oral cancers and other cancers.
Adverse health effects are various oral cancers, gum disease, tooth decay, development of white patches inside the mouth (Leukoplakia), nicotine addiction and increased risk of cardiovascular disease. Although this smokeless tobacco does not produce smoke, it is as harmful as smoking tobacco.
2. BETEL QUID
Betel quid is a prepared substance chewed for its stimulating effects, often rooted in tradition. It is most commonly consumed by people in Asia and the Pacific region. Typically, the areca nut (betel nut) is sliced, combined with slaked lime (calcium hydroxide), and wrapped in a betel leaf (Piper betel) for chewing. Based on regional variations, additional ingredients like Ninety-Two, Forty-Five (flavoured tobacco products) and pickled tobacco-based liquid may also be used. Betel quid chewing is a commonly observed tradition in Myanmar, India, Bangladesh, Thailand, Indonesia, Malaysia, the Taiwan Province of China, and Pacific Island nations. Myanmar ranks top among these countries in the world for the highest rates of betel quid use. Offering betel quid to guests is a traditional practice and a symbol of respect and hospitality. By tradition, it remains a customary item offered in religious ceremonies, initiation into monkhood, weddings, and other social events.
The chemical arecoline found in the areca nut not only stimulates alertness, increasing energy, readiness, and heart rate, but also significantly increases saliva production. A betel quid thus renders not only the effect of the areca nut but also that of tobacco contained in the preparation. There is also a high probability of developing oral cancer, submucous fibrosis (a precancerous condition in the oral cavity), gum disease, dental caries, and oesophageal cancer.
(3) DISSOLVABLE TOBACCO
Dissolvable tobacco is also a type of smokeless tobacco product, designed to dissolve inside the mouth. Using this dissolvable tobacco, it dissolves in the mouth, releasing nicotine. It does not require spitting out like betel quid chewing, nor does it produce smoke like cigarettes or other smoked tobacco. These products are often advertised and marketed as alternatives to traditional tobacco products.
Dissolvable tobacco products are manufactured in various forms, such as lozenges, strips and pellets.
Lozenges: compressed pieces of tobacco formed into small tablets, resembling lozenges. They are held in the mouth and allowed to dissolve slowly.
Strips: thin, paper-like sheets that can be placed on the tongue for use.
Pellets: made into the form of small pellets that dissolve slowly in the mouth.
All forms of dissolvable tobacco contain powdered tobacco, nicotine, flavourings, sweeteners, and binding agents such as starches. Like other tobacco products, they contain chemicals harmful to the human body, with tobacco-specific nitrosamines (TSNAs) being the most dangerous. Although they do not produce smoke, dissolvable tobacco products are harmful to human health. Those can cause nicotine addiction, increased risk of oral health problems, high risk of oral cancer and oesophageal cancer and possible raised heart rates and blood pressures.
Dependence on and nicotine addiction are unavoidable consequences of these products. Furthermore, once addiction is established, an attempt to discontinue will invite withdrawal symptoms. It is a mistake to believe that using these new products is safe and does not pose increased health risks. Special attention must be paid to the marketing strategies, advertising, and the practice of adding flavours and fragrances designed to attract new users, especially adolescents and youth.
Dissolvable tobacco, due to its nicotine content, is a harmful product. Addressing its misuse requires public education and regulatory control.
As is only to be expected, the tobacco industry keeps on introducing novel products to continue making profits, and the latest that they have come up with are tobacco pouches.
(4) SNUS
Snus is typically made from ground tobacco mixed with salt and water and may include flavourings such as mint, moist and soft. To use it, one takes a portion with their fingers (pinch) and places it behind the upper lip. Although Snus is referred to as a less harmful alternative to smoking tobacco, it still poses risks to the human body and has addictive properties inherent to tobacco. This product originated in Sweden as early as the 18th Century.
Types of Snus are as follows.
(a) Loose Snus: This product is made from ground tobacco. This moist, soft substance can be shaped by hand and placed behind the upper lip, in front of the upper gums, for use.
(b) Portion Snus: This is ground tobacco pre-packaged in small sachets, similar to coffee grounds or tea leaf powder.
(c) White Portion Snus: This is a type of Snus with a dry surface.
(d) All White Nicotine Pouches: These are small sachets containing nicotine but do not contain tobacco leaves.
As Snus is a smokeless nicotine product containing nicotine, it has a significant effect on the brain and central nervous system, leading to strong addiction. Immediate health impacts caused by Snus are suppression of appetite, increased heart rate, elevated blood pressure, dizziness and headache for new users, irritation of the gum, and development of nicotine dependence, occurrence of oral lesions and increased risk of pancreatic cancer, according to research in the long term and also can harm brain development in younger people. Compared to smoking, the risk of lung cancer is significantly lower, as there is no inhalation of tar and smoke.
Cessation of use leads to nicotine withdrawal symptoms. Chemical Substances Found in Snus are nicotine, tobacco-specific nitrosamines (TSNAs), heavy metals, formaldehyde, acetaldehyde and polycyclic aromatic hydrocarbons (PAHs).
(4) Nicotine Pouches
Nicotine pouches are also a new product category resulting from the interference of the tobacco industry. These pouches contain nicotine powder or nicotine salts and come in the form of small, white, pillow-shaped sachets. They primarily contain highly addictive nicotine, various flavourings, sweeteners, and plant-based fibres. By placing these small pouches between the gum and the upper lip, nicotine is absorbed through the oral mucosa into the bloodstream, delivering the effects of nicotine.
The nicotine powder used in these pouches is mainly derived from tobacco. Over 90 per cent of these products are manufactured using nicotine extracted from tobacco leaf, while the remaining small percentage is made with synthetic nicotine produced in laboratories. As a highly profitable global tobacco industry, manufacturers constantly seek loopholes in laws, regulations, and bans, regardless of where or how they are enacted, to pursue their interests. In response to growing international concerns over health risks and dangers, regulations have been tightened on the production, use, import, possession, storage, sale, distribution, and advertising of cigarettes, electronic smoking devices, heated tobacco products, and electronic shisha. As a result, nicotine pouches, which are made from non-tobacco-derived nicotine, are now being aggressively advertised, imported, and marketed. Policymakers should pay close attention to this development.
Nicotine pouches can lead to addiction comparable to that caused by cigarettes and electronic smoking devices. They can impair brain development in young people, contribute to high blood pressure and cardiovascular diseases, and, since most contain tobacco-specific nitrosamines, are certain to increase the risk of various cancers.
In conclusion, the tobacco and tobacco product industry, driven by enormous profit margins, continuously exploits loopholes and weaknesses in laws, prohibitions, and regulations enacted by countries worldwide, regardless of regional contexts. They persistently strive to expand their markets and increase consumer bases to maximize profits. Therefore, state administrators, legislators, relevant authorities, and responsible citizens must remain vigilant against the tactics of the tobacco industry. With a focus on safeguarding the future and health of the public, especially young people, concerted efforts must be made through all available means to protect against the dangers of smokeless tobacco products. This is a matter of serious urgency.
References:
§ News from the Internet.
§ News and articles of SCAN In Focus Bulletin.
§ Documents & Literatures form WHO FCTC.
§ Literatures form Campaign for Tobacco Free Kids.
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