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Table 1 Smokeless tobacco products consumed most commonly across the world

From: Global burden of disease due to smokeless tobacco consumption in adults: analysis of data from 113 countries

Smokeless tobacco products Regions (WHO) Countries (highest consumption) Other ingredients Preparation and use pHa Nicotinea (mg/g) Total TSNAa (ng/g)
Snus (Swedish) Europe (Region A) Nordic countries (Denmark, Finland, Iceland, Norway, Sweden) Water, sodium carbonate, sodium chloride, moisturisers, flavouring A heat treatment process; placed between the gum and upper lip 6.6–7.2 7.8–15.2 601–723
Plug, Snuff (US), Snus (US) Americas (Region A and B) US, Canada, Mexico Sweeteners, liquorice Plug; air cured 4.7–7.8 3.9–40.1 313–76,500
Dry or moist snuff; finely ground and fire cured
Snus; steam cured
Snuff; kept between lip and gum, dry snuff can be inhaled too
Chimó Americas (Region B) Venezuela, Colombia Sodium bicarbonate, brown sugar, Mamo’n tree ashes Tobacco paste made from tobacco leaves; placed between the lip or cheek and gum and left there for some time 6.9–9.4 5.3–30.1 9390
Nass (Naswar) Europe (Region B) and Eastern Mediterranean (Region D) Uzbekistan, Kyrgyzstan, Tajikistan, Afghanistan, Pakistan, Iran Lime, ash, flavourings (cardamom), indigo Sundried and powdered; placed between lip or cheek and gum 8.4–9.1 8.9–14.2 478–1380
Tambook Eastern Mediterranean (Region D) and Africa (Region D) Sudan, Chad Mixed with moist sodium bicarbonate Fermented and grounded; placed and kept in mouth 7.3–10.1 9.6–28.2 302,000–992,000
Snuff (North and West African) Africa (Region D) Nigeria, Ghana, Algeria, Cameroon, Chad, Senegal Dried tobacco leaves mixed with potassium nitrate and other salts Dry snuff; finely ground and inhaled as a pinch 9.0–9.4 2.5–7.4 1520–2420
Moist snuff is placed in mouth
Snuff (South African) Africa (Region E) South Africa Dried tobacco leaves mixed with ash Dry snuff; finely ground and inhaled as a pinch 6.5–10.1 1.2–17.2 1710–20,500
Khaini South East Asia (Regions B and D) Western Pacific (Region B) Eastern Mediterranean (Region D) Europe (Region A) India, Bangladesh, Nepal, Bhutan Slaked lime, menthol, flavourings, areca nut Shredded; kept in mouth between lips and gum 9.6–9.8 2.5–4.8 21,600–23,900
Zarda Bangladesh, India, Pakistan, Myanmar, Thailand, Indonesia, Nepal, Maldives, Sri Lanka, UK Served wrapped in a betel leaf with lime, catechu, areca nuts Shredded tobacco leaves are boiled with lime and saffron; the mixture is dried then chewed and spat 5.2–6.5 9.5–30.4 5490–53,700
Gutkha India, Pakistan, Bangladesh, Nepal, Myanmar, Sri Lanka, UK Betel nut, catechu, flavourings, sweeteners Commercially manufactured; sucked, chewed, and spat 7.4–8.9 0.2–4.2 83–23,900
  1. WHO World Health Organization, TSNA tobacco-specific nitrosamines
  2. aFigures are adapted from Stanfill et al. [6], Lawler et al. [17], and NIH & CDC 2014 report on smokeless tobacco products [37]