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

Ravi Mehrotra, Amit Yadav, Dhirendra N. Sinha, Mark Parascandola, Rijo M. John, Olalekan Ayo-Yusuf, Nigar Nargis, Dorothy K. Hatsukami, Saman Warnakulasuriya, Kurt Straif, Kamran Siddiqi, Prakash C. Gupta

Research output: Contribution to journalReview articlepeer-review

21 Scopus citations


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.

Original languageEnglish (US)
Pages (from-to)e208-e217
JournalThe Lancet Oncology
Issue number4
StatePublished - Apr 2019

Bibliographical note

Funding Information:
We acknowledge financial support from the WHO FCTC Global Knowledge Hub on Smokeless Tobacco (DCI-SANTE/2011/261–053). The authors are also thankful to Anshika Chandra (Project Officer, WHO FCTC) and Amit Kumar (Scientist-B, ICMR-NICPR) for help in the compilation of the appendix and technical editing of the manuscript.

Publisher Copyright:
© 2019 International Agency for Research in Cancer. Published by Elsevier Ltd. All rights reserved


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