The public health community generally views them as a harm reduction tool for adults who specifically smoke cigarettes
Moreover, the measures to assess symptoms are clinical measures commonly used in research and clinical settings today with sound psychometric properties, high validity and reliability 33,34
The father-of-two, whose swollen cheek hints at his disease, is aged just 35.His brother Datta travelled with him from their village in rural Maharashtra state, where he says children start munching on colourful sachets of gutka, each priced at only one rupee (two US cents), at the age of just 11 or 12."I'm not sure if the government can ban it or not, but they should," Datta said.Maharashtra, of which Mumbai is the capital, on Wednesday became the fourth state this year to outlaw gutka, which campaigning doctors say is targeted at children -- even though Indian law prohibits tobacco sales to those under 18.They point the finger primarily at gutka for India's 75,000 to 80,000 new cases of oral cancer a year, the highest rate in the world, according to the US-based Campaign for Tobacco-Free Kids.Madhya Pradesh, Kerala and Bihar states have already banned gutka this year, following the earlier example of Goa, while others including Uttar Pradesh, India's most populous state, are considering similar action.But they face a struggle -- not only to enforce the law on the streets, but to overcome the powerful lobby of the billion-dollar gutka industry, which is disputing the bans on the grounds they are unlawful.Leading the anti-gutka fight in Mumbai is Kanade's surgeon, Pankaj Chaturvedi, a head and neck cancer specialist.He says half of his mouth cancer patients die within 12 months of diagnosis, while the rest are left severely disabled.While tobacco has been chewed across the subcontinent for centuries, often in a concoction known as "paan", Chaturvedi said gutka took over in recent decades as a more convenient, ready-made version for modern life."It comes in a pouch, it doesn't make your tongue and mouth red and it doesn't make an urge for spitting," he said, listing substances found in gutka including lead, arsenic, copper, chromium and nickel.The youngest addict he has treated was a 13-year-old boy, who died of an advanced form of mouth cancer."Gutka captured both economic strata, the poorest and the richest
The first thing that happens is your real friends emerge
Tobacco Control, 10, 6 [DOI] [PMC free article] [PubMed] [Google Scholar] Raisamo S
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