Health effects associated with chewing tobacco: a Burden of Proof study

Chewing tobacco use poses serious health risks; yet it has not received as much attention as other tobacco-related products. This study synthesizes existing evidence regarding the health impacts of chewing tobacco while accounting for various sources of uncertainty. We conducted a systematic review...

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Bibliographic Details
Published in:Nature communications 2024-02, Vol.15 (1), p.1082-17, Article 1082
Main Authors: Gil, Gabriela F., Anderson, Jason A., Aravkin, Aleksandr, Bhangdia, Kayleigh, Carr, Sinclair, Dai, Xiaochen, Flor, Luisa S., Hay, Simon I., Malloy, Matthew J., McLaughlin, Susan A., Mullany, Erin C., Murray, Christopher J. L., O’Connell, Erin M., Okereke, Chukwuma, Sorensen, Reed J. D., Whisnant, Joanna, Zheng, Peng, Gakidou, Emmanuela
Format: Article
Language:English
Subjects:
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Cancer
Cardiovascular diseases
Head & neck cancer
Health risks
Heart diseases
Humanities and Social Sciences
Ischemia
Laryngeal cancer
Meta-analysis
multidisciplinary
Nasopharynx
Oral carcinoma
Oral cavity
Pharynx
Risk factors
Science
Science (multidisciplinary)
Tobacco
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Summary:Chewing tobacco use poses serious health risks; yet it has not received as much attention as other tobacco-related products. This study synthesizes existing evidence regarding the health impacts of chewing tobacco while accounting for various sources of uncertainty. We conducted a systematic review and meta-analysis of chewing tobacco and seven health outcomes, drawing on 103 studies published from 1970 to 2023. We use a Burden of Proof meta-analysis to generate conservative risk estimates and find weak-to-moderate evidence that tobacco chewers have an increased risk of stroke, lip and oral cavity cancer, esophageal cancer, nasopharynx cancer, other pharynx cancer, and laryngeal cancer. We additionally find insufficient evidence of an association between chewing tobacco and ischemic heart disease. Our findings highlight a need for policy makers, researchers, and communities at risk to devote greater attention to chewing tobacco by both advancing tobacco control efforts and investing in strengthening the existing evidence base. While the number of chewing tobacco users is increasing in many countries, it is often under-emphasized in tobacco control. Here, the authors show that chewing tobacco is a risk factor for major causes of disease burden, including stroke and various cancers, meriting future research and policy attention.
ISSN:2041-1723
2041-1723
DOI:10.1038/s41467-024-45074-9