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Naswar

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A pile of naswar

Naswār (Pashto: نسوار, Cyrillic script: насва́р, Hindi: नसवार), also called nās (ناس; на́с), nāsor (ناسور; насур) or nasvay (نسوای; насвай), is a moist, powdered tobacco dip consumed mostly in Afghanistan, and surrounding countries, including Pakistan, India and neighboring Central Asian republics.[1] Naswar is stuffed in the floor of the mouth under the lower lip, or inside the cheek, known as butt style stuffing, for extended periods of time, usually for 15 to 30 minutes. It is similar to dipping tobacco and snus. Swabi, Bannu, Dera Ismail Khan, Charsadda, Mohmand and Herat are renowned for their production of some of the highest quality Naswar.[2]

Using naswar can cause a various harmful effects such as dental disease, oral cancer, oesophagus cancer, and pancreas cancer, coronary heart disease, as well as negative reproductive effects including stillbirth, premature birth and low birth weight.[3][4] Naswar poses a lower health risk than traditional combusted products.[5] However it is not a healthy alternative to cigarette smoking.[6] The level of risk varies between different types of products and producing regions.[7][5] There is no safe level of naswar use.[6] Globally smokeless tobacco products contribute to 650 000 deaths each year.[8]

Types

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There are two forms of naswar; powder, and a paste cake style mixed with lime. It has a very pungent and powerful smell, resembling that of a fresh bale of coastal hay,[citation needed] and has a subtle flavor as it mixes with the saliva. The nicotine effect can occur within 5 minutes after intake, producing a slight burning sensation on the inner lip and tongue.

Nas: tobacco, ash, cotton or sesame oil, water, and sometimes gum.[9]

Naswar: tobacco, slaked lime, indigo, cardamom, oil, menthol, water.

Naswār is made from sun and heat-dried tobacco leaves. These are added to slaked lime, ash from tree bark, and flavoring and coloring agents are mixed together. Water is added and the mixture is rolled into balls.

Usage

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Packets of Naswar

South and Central Asia

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The green powder form is used most frequently. It is made by pouring water into a cement-lined cavity, to which slaked lime (calcium hydroxide) and air-cured, sun-dried, powdered tobacco is added. Indigo is added to the mixture to impart color,[10] and juniper ash may be added as flavoring.[citation needed]

Currently, the countries of the region freely sell naswar in the markets, usually on trays with cigarettes and sunflower seeds. The only exception is Turkmenistan, where in 2008 President Gurbanguly Berdimuhamedow signed a decree banning the production, sale, use, and import of naswar.[11]

In 2011, naswar was included in the list of narcotic and psychoactive substances to be controlled in Kazakhstan.[12]

In November 2006, an editorial in the newspaper Daily Times in Pakistan caused some controversy over its allegedly biased representations of Pashtun predilection for naswar.[13]

Eastern Europe and Russia

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In Russia, naswar is not a traditional product, but it has gained popularity especially among teenagers. It was sold in the markets of Moscow[14] and in other cities of the Urals, Volga, and other regions of the country. Its trade was usually conducted on trays with spices.[14] According to the association of tobacco distributors "Grandtabak", in the first half of 2004, Russia's import of naswar or "chewing tobacco" amounted to almost 67 tons (valued around 2 million US dollars), primarily from Kazakhstan, Kyrgyzstan, and Tajikistan.[15] On 23 February 2013, the Russian State Duma signed a federal law (N 15-ФЗ) which banned both wholesale and retail naswar from 1 June 2013 onward in Russia.[16]

Belarusian physicians have reported patients' medical information regarding naswar use to law enforcement agencies.[17] In Estonia, naswar is distributed to nightclubs.[18]

Health effects

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Even though it is less dangerous than smoking, naswar is addictive, represents a major health risk, has no safe level use and is not a safe substitute for smoking.[19][20][21][22] Globally it contributes to 650 000 deaths each year with a significant proportion of them in Southeast Asia.[23][24]

Using naswar can cause a number of adverse health effects such as dental disease, oral cancer, oesophagus cancer, and pancreatic cancer, cardiovascular disease, asthma, and deformities in the female reproductive system.[25] It also raises the risk of fatal coronary artery disease, fatal stroke and non-fatal ischaemic heart disease[26][27]

Quitting naswar use is as challenging as smoking cessation.[28] There is no scientific evidence that using naswar can help a person quit smoking.[29][30]

Cancer

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Naswar is a cause of oral cancer, oesophagus cancer, and pancreas cancer.[31] Increased risk of oral cancer caused by naswar is present in countries such as the United States but particularly prevalent in Southeast Asian countries where the use of smokeless tobacco is common.[32][33]

All tobacco products, including naswar, contain cancer-causing chemicals.[34][35] These carcinogenic compounds occurring in naswar vary widely, and depend upon the kind of product and how it was manufactured.[36] There are 28 known cancer-causing substances in smokeless tobacco products.[36]

Cardiovascular disease

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Using naswar increases the risk of fatal coronary heart disease and stroke.[37][38] In 2010 more than 200 000 people died from coronary heart disease due to smokeless tobacco use.[39] Use of naswar also seems to greatly raise the risk of non-fatal ischaemic heart disease among users in Asia, although not in Europe.[37]

Effects during pregnancy

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Naswar can cause adverse reproductive effects including stillbirth, premature birth, low birth weight.[37][40] Nicotine in naswar products that are used during pregnancy can affect how a baby's brain develops before birth.[40]

History

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Naswar was introduced into Western Europe by a Spanish monk named Ramon Pane after Columbus' second voyage to the Americas during 1493-1496.[41] In 1561, Jean Nicot, the French ambassador in Lisbon, Portugal, sent naswar to Catherine de' Medici to treat her son's persistent migraine.[42]

See also

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References

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  1. ^ Khan, Zohaib; Dreger, Steffen; Shah, Syed Majid Hussain; Pohlabeln, Hermann; Khan, Sheraz; Ullah, Zakir; Rehman, Basheer; Zeeb, Hajo (10 July 2017). "Oral cancer via the bargain bin: The risk of oral cancer associated with a smokeless tobacco product (Naswar)". PLOS ONE. 12 (7): e0180445. Bibcode:2017PLoSO..1280445K. doi:10.1371/journal.pone.0180445. PMC 5503251. PMID 28692704. Naswar use is often associated with the Pashtun tribes of Afghanistan and Pakistan but is also used in Central Asia, India, Bangladesh and by expat communities of these countries across the world.
  2. ^ "Naswar more injurious to health than smoking". The Express Tribune. 2010-11-22. Retrieved 2023-08-27.
  3. ^ Vidyasagaran, A. L.; Siddiqi, K.; Kanaan, M. (2016). "Use of smokeless tobacco and risk of cardiovascular disease: A systematic review and meta-analysis" (PDF). European Journal of Preventive Cardiology. 23 (18): 1970–1981. doi:10.1177/2047487316654026. ISSN 2047-4873. PMID 27256827. S2CID 206820997.
  4. ^ Gupta, Ruchika; Gupta, Sanjay; Sharma, Shashi; Sinha, Dhirendra N; Mehrotra, Ravi (2019-01-01). "Risk of Coronary Heart Disease Among Smokeless Tobacco Users: Results of Systematic Review and Meta-Analysis of Global Data". Nicotine & Tobacco Research. 21 (1): 25–31. doi:10.1093/ntr/nty002. ISSN 1469-994X. PMC 6941711. PMID 29325111.
  5. ^ a b Hajat, C.; Stein, E.; Ramstrom, L.; Shantikumar, S.; Polosa, R. (4 December 2021). "The health impact of smokeless tobacco products: a systematic review". Harm Reduction Journal. 18 (1): 123. doi:10.1186/s12954-021-00557-6. ISSN 1477-7517. PMC 8643012. PMID 34863207.
  6. ^ a b Lipari, R. N; Van Horn, S. L (31 May 2017). "Trends in Smokeless Tobacco Use and Initiation: 2002 to 2014". Substance Abuse and Mental Health Services Administration. PMID 28636307. {{cite journal}}: Cite journal requires |journal= (help)Public Domain This article incorporates text from this source, which is in the public domain.
  7. ^ Abrams, David B.; Glasser, Allison M.; Pearson, Jennifer L.; Villanti, Andrea C.; Collins, Lauren K.; Niaura, Raymond S. (2018). "Harm Minimization and Tobacco Control: Reframing Societal Views of Nicotine Use to Rapidly Save Lives". Annual Review of Public Health. 39 (1): 193–213. doi:10.1146/annurev-publhealth-040617-013849. ISSN 0163-7525. PMC 6942997. PMID 29323611. This article incorporates text by David B. Abrams, Allison M. Glasser, Jennifer L. Pearson, Andrea C. Villanti, Lauren K. Collins, and Raymond S. Niaura available under the CC BY 4.0 license.
  8. ^ Chugh, Aastha; Arora, Monika; Jain, Neha; Vidyasagaran, Aishwarya; Readshaw, Anne; Sheikh, Aziz; Eckhardt, Jappe; Siddiqi, Kamran; Chopra, Mansi; Mishu, Masuma Pervin; Kanaan, Mona; Rahman, Muhammad Aziz; Mehrotra, Ravi; Huque, Rumana; Forberger, Sarah (June 2023). "The global impact of tobacco control policies on smokeless tobacco use: a systematic review". The Lancet Global Health. 11 (6): e953–e968. doi:10.1016/S2214-109X(23)00205-X. PMID 37202029.
  9. ^ US Department of Health and Human Services. Health consequences of using smokeless tobacco: a report of the Advisory Committee to the Surgeon General. Bethesda, Maryland: US Department of Health and Human Services, Public Health Service, 1986.
  10. ^ Gupta, Prakash C.; Hamner, James E.; Murti, P. R. (1992). Control of Tobacco-related Cancers and Other Diseases: Proceedings of an International Symposium, January 15-19, 1990, TIFR, Bombay. Prakash C. Gupta. ISBN 9780195629613.
  11. ^ "В Туркмении запретили производить, продавать и жевать насвай - ЦентрАзия". Retrieved 30 May 2015.
  12. ^ "ИА КазахЗерно". Retrieved 30 May 2015.
  13. ^ "EDITORIAL: Hasba Bill beats the WP Bill hands down!". Daily Times. 15 November 2006. Archived from the original on 27 February 2007. Retrieved 16 October 2018.
  14. ^ a b "Унесённые пленом : Попавшие в плен военнослужащие считаются пропавшими без вести - FLB.ru - Агентство Федеральных Расследований". Retrieved 30 May 2015.
  15. ^ Гранд Табак. "Насвай - Словарь терминов - glossary - Гранд Табак". Retrieved 30 May 2015.
  16. ^ "Автоматизированная система обеспечения законодательной деятельности". Retrieved 30 May 2015.
  17. ^ Medvestnik Archived 2013-07-22 at the Wayback Machine / Газета «Медицинский вестник»
  18. ^ "Газета "Молодежь Эстонии" 10.09.99 Кухня наркоманов становится богаче Инесса КОЛЛОМ". Retrieved 30 May 2015.
  19. ^ "Recommendation on smokeless tobacco products" (PDF). World Health Organization. 2017. pp. 1–9.
  20. ^ "Health Risks of Smokeless Tobacco". American Cancer Society. 13 November 2015.
  21. ^ "Smokeless Tobacco and Cancer". United States Department of Health and Human Services. National Cancer Institute at the National Institutes of Health. 25 October 2010.Public Domain This article incorporates text from this source, which is in the public domain.
  22. ^ Royal College of Physicians of London. Tobacco Advisory Group (2002). Protecting Smokers, Saving Lives: The Case for a Tobacco and Nicotine Regulatory Authority. Royal College of Physicians. pp. 5–. ISBN 978-1-86016-177-3.
  23. ^ Sinha, Dhirendra N; Suliankatchi, Rizwan A; Gupta, Prakash C; Thamarangsi, Thaksaphon; Agarwal, Naveen; Parascandola, Mark; Mehrotra, Ravi (2016). "Global burden of all-cause and cause-specific mortality due to smokeless tobacco use: systematic review and meta-analysis". Tobacco Control. 27 (1): tobaccocontrol–2016–053302. doi:10.1136/tobaccocontrol-2016-053302. ISSN 0964-4563. PMID 27903956. S2CID 10968200.
  24. ^ Chugh, Aastha; Arora, Monika; Jain, Neha; Vidyasagaran, Aishwarya; Readshaw, Anne; Sheikh, Aziz; Eckhardt, Jappe; Siddiqi, Kamran; Chopra, Mansi; Mishu, Masuma Pervin; Kanaan, Mona; Rahman, Muhammad Aziz; Mehrotra, Ravi; Huque, Rumana; Forberger, Sarah (June 2023). "The global impact of tobacco control policies on smokeless tobacco use: a systematic review". The Lancet Global Health. 11 (6): e953–e968. doi:10.1016/S2214-109X(23)00205-X. PMID 37202029.
  25. ^ Niaz, Kamal; Maqbool, Faheem; Khan, Fazlullah; Bahadar, Haji; Ismail Hassan, Fatima; Abdollahi, Mohammad (2017). "Smokeless tobacco (paan and gutkha) consumption, prevalence, and contribution to oral cancer". Epidemiology and Health. 39: e2017009. doi:10.4178/epih.e2017009. ISSN 2092-7193. PMC 5543298. PMID 28292008. This article incorporates text by Kamal Niaz, Faheem Maqbool, Fazlullah Khan, Haji Bahadar, Fatima Ismail Hassan, Mohammad Abdollahi available under the CC BY 4.0 license.
  26. ^ Vidyasagaran, A. L.; Siddiqi, K.; Kanaan, M. (2016). "Use of smokeless tobacco and risk of cardiovascular disease: A systematic review and meta-analysis" (PDF). European Journal of Preventive Cardiology. 23 (18): 1970–1981. doi:10.1177/2047487316654026. ISSN 2047-4873. PMID 27256827. S2CID 206820997.
  27. ^ Gupta, Ruchika; Gupta, Sanjay; Sharma, Shashi; Sinha, Dhirendra N; Mehrotra, Ravi (2019-01-01). "Risk of Coronary Heart Disease Among Smokeless Tobacco Users: Results of Systematic Review and Meta-Analysis of Global Data". Nicotine & Tobacco Research. 21 (1): 25–31. doi:10.1093/ntr/nty002. ISSN 1469-994X. PMC 6941711. PMID 29325111.
  28. ^ Lipari, R. N; Van Horn, S. L (31 May 2017). "Trends in Smokeless Tobacco Use and Initiation: 2002 to 2014". Substance Abuse and Mental Health Services Administration. PMID 28636307. {{cite journal}}: Cite journal requires |journal= (help)Public Domain This article incorporates text from this source, which is in the public domain.
  29. ^ "Smokeless Tobacco and Cancer". United States Department of Health and Human Services. National Cancer Institute at the National Institutes of Health. 25 October 2010.Public Domain This article incorporates text from this source, which is in the public domain.
  30. ^ ERS (2019-05-29). "ERS Position Paper on Tobacco Harm Reduction". ERS - European Respiratory Society. Retrieved 2024-05-30.
  31. ^ Vidyasagaran, A. L.; Siddiqi, K.; Kanaan, M. (2016). "Use of smokeless tobacco and risk of cardiovascular disease: A systematic review and meta-analysis" (PDF). European Journal of Preventive Cardiology. 23 (18): 1970–1981. doi:10.1177/2047487316654026. ISSN 2047-4873. PMID 27256827. S2CID 206820997.
  32. ^ Aupérin A (May 2020). "Epidemiology of head and neck cancers: an update". Current Opinion in Oncology. 32 (3): 178–186. doi:10.1097/CCO.0000000000000629. PMID 32209823. S2CID 214644380.
  33. ^ Wyss AB, Hashibe M, Lee YA, Chuang SC, Muscat J, Chen C, et al. (November 2016). "Smokeless Tobacco Use and the Risk of Head and Neck Cancer: Pooled Analysis of US Studies in the INHANCE Consortium". American Journal of Epidemiology. 184 (10): 703–716. doi:10.1093/aje/kww075. PMC 5141945. PMID 27744388.
  34. ^ Lipari, R. N; Van Horn, S. L (31 May 2017). "Trends in Smokeless Tobacco Use and Initiation: 2002 to 2014". Substance Abuse and Mental Health Services Administration. PMID 28636307. {{cite journal}}: Cite journal requires |journal= (help)Public Domain This article incorporates text from this source, which is in the public domain.
  35. ^ Niaz, Kamal; Maqbool, Faheem; Khan, Fazlullah; Bahadar, Haji; Ismail Hassan, Fatima; Abdollahi, Mohammad (2017). "Smokeless tobacco (paan and gutkha) consumption, prevalence, and contribution to oral cancer". Epidemiology and Health. 39: e2017009. doi:10.4178/epih.e2017009. ISSN 2092-7193. PMC 5543298. PMID 28292008. This article incorporates text by Kamal Niaz, Faheem Maqbool, Fazlullah Khan, Haji Bahadar, Fatima Ismail Hassan, Mohammad Abdollahi available under the CC BY 4.0 license.
  36. ^ a b Drope, Jeffrey; Cahn, Zachary; Kennedy, Rosemary; Liber, Alex C.; Stoklosa, Michal; Henson, Rosemarie; Douglas, Clifford E.; Drope, Jacqui (2017). "Key issues surrounding the health impacts of electronic nicotine delivery systems (ENDS) and other sources of nicotine". CA: A Cancer Journal for Clinicians. 67 (6): 449–471. doi:10.3322/caac.21413. ISSN 0007-9235. PMID 28961314.
  37. ^ a b c Vidyasagaran, A. L.; Siddiqi, K.; Kanaan, M. (2016). "Use of smokeless tobacco and risk of cardiovascular disease: A systematic review and meta-analysis" (PDF). European Journal of Preventive Cardiology. 23 (18): 1970–1981. doi:10.1177/2047487316654026. ISSN 2047-4873. PMID 27256827. S2CID 206820997.
  38. ^ Gupta, Ruchika; Gupta, Sanjay; Sharma, Shashi; Sinha, Dhirendra N; Mehrotra, Ravi (2019-01-01). "Risk of Coronary Heart Disease Among Smokeless Tobacco Users: Results of Systematic Review and Meta-Analysis of Global Data". Nicotine & Tobacco Research. 21 (1): 25–31. doi:10.1093/ntr/nty002. ISSN 1469-994X. PMC 6941711. PMID 29325111.
  39. ^ Chugh, Aastha; Arora, Monika; Jain, Neha; Vidyasagaran, Aishwarya; Readshaw, Anne; Sheikh, Aziz; Eckhardt, Jappe; Siddiqi, Kamran; Chopra, Mansi; Mishu, Masuma Pervin; Kanaan, Mona; Rahman, Muhammad Aziz; Mehrotra, Ravi; Huque, Rumana; Forberger, Sarah (June 2023). "The global impact of tobacco control policies on smokeless tobacco use: a systematic review". The Lancet Global Health. 11 (6): e953–e968. doi:10.1016/S2214-109X(23)00205-X. PMID 37202029.
  40. ^ a b "Smokeless Tobacco: Health Effects". Centers for Disease Control and Prevention. 1 December 2016.Public Domain This article incorporates text from this source, which is in the public domain.
  41. ^ Bourne, G. E.: Columbus, Ramon Pane, and the Beginnings of American Anthropology (1906), Kessinger Publishing, 2003, page 5
  42. ^ McKenna, T.: Food of the Gods - The Search for the Original Tree of Knowledge - A Radical History of Plants, Drugs, and Human Evolution, Bantam Books, 1993, page 199
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