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Lancet Oncol. 2019 Apr;20(4):e208-e217. doi: 10.1016/S1470-2045(19)30084-1.

Smokeless tobacco control in 180 countries across the globe: call to action for full implementation of WHO FCTC measures.

Author information

1
Division of Preventive Oncology and WHO-FCTC Global Knowledge Hub on Smokeless Tobacco, Indian Council of Medical Research National Institute of Cancer Prevention and Research, Noida, Uttar Pradesh, India. Electronic address: ravi.mehrotra@gov.in.
2
Division of Preventive Oncology and WHO-FCTC Global Knowledge Hub on Smokeless Tobacco, Indian Council of Medical Research National Institute of Cancer Prevention and Research, Noida, Uttar Pradesh, India.
3
School of Preventive Oncology, Patna, Bihar, India.
4
National Cancer Institute, Bethesda, MD, USA.
5
Centre for Public Policy Research, Kochi, Kerala, India.
6
Sefako Makgatho Health Sciences University, Pretoria North, South Africa.
7
American Cancer Society, Atlanta, GA, USA.
8
Department of Psychiatry, University of Minnesota, Minneapolis, MN, USA.
9
Department of Oral Medicine and Pathology and WHO Collaborating Centre for Oral Cancer, King's College London, London, UK.
10
International Agency for Research on Cancer, Lyon, France.
11
Department of Health Sciences, University of York, York, UK.
12
Healis-Sekhsaria Institute for Public Health, Navi Mumbai, Maharashtra, India.

Abstract

Smokeless tobacco is consumed by 356 million people globally and is a leading cause of head and neck cancers. However, global efforts to control smokeless tobacco use trail behind the progress made in curbing cigarette consumption. In this Policy Review, we describe the extent of the policy implementation gap in smokeless tobacco control, discuss key reasons on why it exists, and make recommendations on how to bridge this gap. Although 180 countries have agreed that the WHO Framework Convention on Tobacco Control is the best approach to control the demand and supply of smokeless tobacco, only 138 (77%) Parties define smokeless tobacco in their statutes. Only 34 (19%) Parties tax or report taxing smokeless tobacco products, six (3%) measure content and emissions of smokeless tobacco products, and 41 (23%) mandate pictorial health warnings on these products. Although awareness of the harms related to smokeless tobacco is growing in many parts of the world, few Parties collect or present data on smokeless tobacco use under global or national surveillance mechanisms (eg, Global Tobacco Surveillance System and WHO STEPwise). Only 16 (9%) Parties have implemented a comprehensive ban on smokeless tobacco advertisement, promotion, and sponsorships. Globally, a smaller proportion of smokeless tobacco users are advised to quit the use of smokeless tobacco products compared to tobacco users. Use of smokeless tobacco is becoming a global cause of concern, requiring a greater commitment on the full implementation of the WHO Framework Convention on Tobacco Control measures.

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