Table 1.
Smokeless tobacco products consumed most commonly across the world
| 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 |