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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: an updated analysis of data from 127 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 (regions A and B)

The USA, 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

Toombak

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

295,000–992,000

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), and 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

Afzal

Eastern Mediterranean (region B)

Oman

Dried tobacco mixed with various additives

Fermented; kept in mouth between lips and gums, users suck the juice, and spit out the rest

10.4

48.7

3573

Iq’mik

Americas (region A)

The USA

Tobacco combined with fungus or plant ash

Involves a burning process to make fungus ash; chewed

11.0

35.0–43.0

15–4910

Rapé

Americas (region B)

Brazil

Tobacco mixed with finely ground plant materials (tonka bean, cinnamon, clove buds, etc.) or alkaline ashes

Nasal snuff; air cured or heated, then pulverised, finely sifted, and mixed

5.2–10.2

6.3–47.6

88–24,200

Pituri/Mingkulpa

Western Pacific (region B)

Australia

Tobacco mixed with wood ash

Chewed as quid, kept in mouth and/or held against skin

5.47–11.6

4.8

15,280

  1. WHO World Health Organization, TSNA tobacco-specific nitrosamines
  2. aFigures are adapted from [1, 2, 18,19,20,21,22,23]