Alternate Forms of
Tobacco Use Practices
Many kinds of tobacco are grown in the world, with a variety of uses.
In developed countries, cigarette smoking accounts for most of the
In South East Asian countries other forms of smoking and smokeless
tobacco is commonly used.
Types of Tobacco Products used in SEAR countries:
- Smoked Forms: Regular cigarettes, Kreteks, klobots, cherrots, beedis and
cigars, kakkad/chillum/sulfa/hookli (smoking in clay pipes), hukka (hubble-
bubble) and hand rolled tobacco.
- Smokeless Forms: Pan Masala with tobacco, gutkha, khaini, chewing tobacco
with areca nuts.
Tobacco Use in India: Practices and Prevalence
India has myriad varieties of
tobacco use (smoking, inhaling
and chewing forms).
Only about 14% of total tobacco
consumption is in the form of
cigarettes in India.
Beedis account for the largest
proportion of tobacco
consumption in India (about 40%).
Tobacco Toll in India
700, 000 deaths per year due to smoking
800, 000 to 900, 000 per year due to all forms of tobacco
Fastest trajectory of rise in tobacco related deaths
forecast for the next 20 years
Many of the deaths (>50%) occur below 70 years of age
Types of Tobacco
- Oral Use (through the mouth)
- Nasal Use (through the nose)
Alternative Forms of Smoking Tobacco
A cheroot is a roll made from tobacco leaves.
Indigenous cheroots containing tobacco, cloves and cocoa.
They contain a wide range of exotic flavourings which has an anaesthetising effect.
Kreteks are used commonly in Indonesia.
Chuttas are coarsely prepared cheroots.
Nearly 9% of the tobacco produced in India is used for making chuttas.
300 million pieces produced every year in India
Chutta smoking is widespread in the coastal areas of Andhra Pradesh, Tamil Nadu and Orissa.
REVERSE CHUTTA SMOKING
Term describes smoking while keeping the glowing end of the tobacco product inside the mouth.
Practiced extensively by women in rural areas of India like Vishakhapatnam and Srikakulam district of
Alternative Forms of Smoking Tobacco
Dhumti is a kind of a conical cigar made by rolling tobacco leaf in the leaf of another
It may be occasionally smoked with the lighted end inside the mouth (Reverse Dhumti
It is used in parts of India like Goa.
A beedi is an indigenous cigarette in which tobacco is wrapped in a tendu or temburini
leaf and tied with cotton thread at one end.
They are potent because they do not have a filter and are wrapped in nonporous leaves.
The tar and carbon monoxide content is higher than a regular cigarette
Popular in Bangladesh, Pakistan, Afghanistan, Sri Lanka, Cambodia and India because
of its low price as compared to cigarettes. Beedis are becoming popular outside of South
East Asia, where they have been marketed in a variety of flavours (cherry, chocolate etc.)
About 40% of the tobacco produced in India is used for making beedis.
Beedi smokers run the risk of developing oral cancers, lung cancers and other health
HUKKA (Hubble- Bubble)
It is a traditional Middle Eastern or Asian device for smoking and
considered smoother and more flavourful as compared to other methods
of smoking tobacco .
The tobacco is burnt directly by a piece of charcoal and the smoke
passes through the water before being inhaled through a long tube or
pipe attached to the bottle.
Hooklis are clay pipes commonly used in western India.
Chillum is a straight, conical pipe traditionally made from fired clay, 10-14
cm long and held vertically.
Chillum smoking is a very social form of smoking and is an exclusively
male practice. It is limited to the northern states of India, predominantly in
Chillum probably predates the introduction of tobacco to India and was
used for smoking opium and other narcotics.
Health Effects of Tobacco Smoking
Relative Risk for all-cause mortality for ever-smokers compared
to never-smokers was 1.6 in men and 1.3 in women.
Prevalence of Tuberculosis (TB) is about 3 times as great among
ever-smokers as among never smokers.
Gupta PC, et al. Cohort Studies, Cohort study for tobacco
attributable mortality in Mumbai, 2002.
Follow-up of a Mumbai cohort of 55000 people showed that all-
cause mortality relative risks for cigarettes use was 1.4 and 1.8
for beedi users.
Gupta P.C., World Health Organization Bulletin, 2000
Smokeless tobacco is used to describe tobacco that is consumed
without heating or burning at the time of use.
Smokeless tobacco can be used either orally or nasally.
In South East Asia, smokeless tobacco product are commonly
handmade but commercial products are also available and widely
marketed. The oral use of smokeless tobacco is widely prevalent in
Different methods of consumption include: chewing, sucking and
applying tobacco preparations to the teeth and gums.
Smokeless Tobacco Products
ORAL: CHEWING TOBACCO
Gutkha is a tobacco product industrially manufactured and
used mainly in India.
It is used by constantly chewing without letting the juice go in
and subsequently spitting the juice and contains sweeteners
PAN (Betel Quid) WITH TOBACCO
It is common and specific to India.
Consists of 4 main ingredients: betel leaf (Piper betle), areca
nut (Areca catechu), slaked lime [Ca(OH2)] and catechu
Smokeless Tobacco Products
PAN MASALA WITH TOBACCO
Pan masala is a commercial preparation containing
areca nut, slaked lime, catechu and condiments with or
without powdered tobacco
Pan masala is very popular in urban areas and is fast
becoming popular in rural areas
Tobacco water is used as a beverage and manufactured
by passing tobacco smoke through water.
Traditionally, tobacco water was offered to
guests/visitors both at family and social level and was
considered very rude to omit this greeting.
Smokeless Tobacco Products
KHAINI (Tobacco and Slaked Lime)
It is a mixture of sun-dried tobacco and slaked
lime and is widespread in Maharashtra and
several states of north India.
A small quantity of tobacco is taken in the palm
and a little slaked lime is added. The ingredients
are mixed vigorously with the thumb and placed
in the mouth.
Smokeless Tobacco Products
TOBACCO PRODUCTS FOR APPLICATION
In India, there is a widespread misconception that tobacco has beneficial effect on
Mishri is a roasted, powdered preparation made by baking tobacco on a hot metal plate until it is
This practice is common in India (prevalent in Goa and Maharastra)
Creamy snuff is a tobacco paste, consisting of tobacco, clove oil, glycerin, spearmint, menthol,
camphor and sold in a toothpaste tube.
They are advertised as possessing anti-bacterial property.
Gul is a pyrolysed tobacco product.
It is marketed under different brand names in small tin cans and used as a dentifrice in the eastern
part of India.
Popularly known as “Dant Manjan” made of tobacco and molasses.
It is available commercially but can be made by users themselves.
Commonly used in states of India like Bihar, Orissa, Uttar Pradesh and Uttaranchal.
Health Consequences of Tobacco Chewing
Relationship between oral cancer and tobacco use (chewing of pan with tobacco)
has been reported since the early twentieth century.
Case control studies conducted on tobacco and oral cancer in India have shown
that chewing of tobacco tended to have a higher risk for oral cancer than smoking.
In a study in the three centres of Bangalore, Chennai and Thiruvanthapuram
- women who chewed pan-tobacco, has a 46 times higher risk than those
women who had never chewed it (RR = 45.9)
- Men in this study had a 6 fold greater risk of oral cancer if they were pan-
tobacco users than never users (risk adjusted for smoking)
Balaram P, et al. International Journal of Cancer, 2002
Indian Tobacco Industry:
Employment & Policy Issues
Employment Structure: Indian Tobacco Industry
Production of beedis dominates employment opportunities within
the manufacturing sector of the domestic industry.
Vast majority of employment position are available either on a
part time or a seasonal basis.
Full time employment: Leaf processing, cigarette manufacturing,
distribution and retailing.
Beedi manufacturing employs about 72% of the total tobacco
industry employment as compared to cigarettes (1%)and other
Beedi Sector in India
Beedi making is a highly labour intensive activity, dominated by
home workers and involves much less sophisticated manufacturing
It is predominantly unorganized sector and involves 3 major
categories of workers:
- forest based tribal workers (who collect tendu leaves)
- tobacco growing farmers
- beedi rolling home based workers (women and girls)
Beedi Manufacturing: Largest tobacco industry in India.
- beedis sold (1998): 858 billion
- projection for 2007:1031 billion.
Beedi industry engages about 4.4 million workers. (two-thirds home
based women and 1 % children).
Exploitation in the Beedi Industry
India’s 1.5 million private sector beedi workers are among the
most exploited workers in India.
They belong to underprivileged sector of society, are illiterate and poor.
The beedi workers work under the control of the contractors.
They are subject to low wages and fraudulent exactions.
Beedi workers across India work in filthy, disease-causing conditions.
It is a health hazardous industry.
Children are introduced when they are 5-8 years of ages.
Federal Excise Revenue in India
Excise is imposed on the basis of a fixed amount per 1000 sticks for each
of the six categories with highest rate of excise applied to the longest
high quality filter tip cigarettes.
Excise structure for other tobacco products varies from zero excise on
cigars to a 50% excise duty on snuff and chewing tobacco through to a
300% excise duty on smoking tobacco.
Unorganized tobacco sector (beedis and chewing tobacco) receives a
preferential treatment through the imposition of lower excise.
Beedi manufacturing units producing less than 20 lakh beedis per annum
are relieved from paying taxes.
Legislations related to beedi in India
The government of India has enacted a number of legislative
measures to regulate the working and living conditions of workers
and their families involved in the beedi industry. The legislative
measures related to beedis can be categorized as:
Policies related to protection of consumer
Policies related to welfare of labour
Policies related to fiscal aspects
Policies Related to Protection of Consumers
The Cigarettes and other Tobacco Products (Prohibition of Advertisement
and Regulation of Trade and Commerce, Production, Supply and
Distribution) Act, 2003.
Advertising restrictions on beedis: Indian Tobacco Control Act, 2003
Consumer Protection Act, 1986.
The Standards of Weights and Measures ACT, 1976 and The Standards of
Weights and Measures (Packaged Commodities) Rules, 1977.
Indian Law- At a Glance
Key Provision of cigarettes and other tobacco product Act, 2003
Ban on smoking in public places
Ban on direct and indirect advertising of tobacco products
- Point-of-sale advertising is permitted
Ban on sales to minors
- Tobacco products cannot be sold to children <18 years
- Tobacco products cannot be sold within a radius of 100 yards of educational
Pictorial health warnings
English and one or more other Indian languages to be used for
health warnings on tobacco packs
Testing and Regulation: Ingredients to be declared on tobacco
product packages (Tar and Nicotine)
Proposed Indian Health Warning on Beedi Pack
Policies Related to Protection of Labour
Several legislations have been enacted to protect the beedi workers as they belong to
the vulnerable section of society and work in adverse work and health conditions
Bonded labour system (Abolition) Act, 1976: aims to abolish the bonded labour system to protect
children and other workers to become forced labour in case of inability to repay a loan.
The child labour (Prohibition and Regulation) Act, 1986: aims to stop the exploitation of children
involved in beedi rolling.
Minimum Wages Act, 1948: aims to fix minimum rates of wages in industry and trade where labour
organizations are non-existent or ineffective.
The beedi and cigar workers (Condition of Employment) Act, 1966: aims to regulate the
conditions of service of the beedi workers.
Beedi workers welfare fund Act, 1976: aims to provide for welfare schemes for the beedi workers
and their families, related to health, education, maternity benefits, group insurance, recreation,
housing assistance etc.
The beedi workers welfare cess (Amendment) Act, 1976: aims to improve living conditions and
provide welfare measures to beedi workers. This cess collected by way of excise duty on
manufactured beedis contributes to BWWF.
Policies Related to Fiscal Measures
Recently cess is levied on cigarettes, pan masala and tobacco
products to fund the health sector.
It increased the specific rate on cigarettes by 10% and imposed a
surcharge of 10% on ad valorem duties on other tobacco products
including gutkha, chewing tobacco, snuff and pan masala.
Beedis have been exempted from this levy.
Implementation : Barriers to be Overcome
Untrained and uncoordinated enforcement
Inadequately educated community
Lack of awareness of rules among relevant group
(e.g., restaurant managers)
Tobacco industry tactics
Other Measures that need to be Taken to
Strengthen Tobacco Control
Tax Net to be Uniform
- Current financial budget (2005-06) increased rate of excise tax on
cigarettes by about 10% and a surcharge of 10% ad valorem duties on
oral tobacco products (gutkha, chewing tobacco, snuff and pan masala).
- Beedis need to be brought under similar tax regime to avoid cost
influenced product choice by youth and poor.
Ban on Gutkha by Centre
- State governments requested the Centre to impose such a ban (as per
Supreme Court judgement). Under consideration of the Centre.
FCTC Implementation in India
The Indian Act enactment preceded the adoption and enforcement of the FCTC
Indian Legislation needs to be upscaled to comply with the provisions of FCTC
- Tax and price measures to be implemented to reduce tobacco consumption
- Duty free sales to be tackled by Ministry of Finance
- Prohibiting use of misleading terms to label tobacco products
- Mobilize stakeholders, engage civil society to promote and strengthen education,
communication, training and public awareness on tobacco control issues
- Promote effective measure for tobacco use cessation
- Elimination of all forms of illicit trade in tobacco products including smuggling, illicit
manufacturing and counterfeiting
- Sale to and by minors
- Curb cross-border advertising
- Promote economically viable alternatives for tobacco workers, growers and individual sellers (as