A question about smoking alone misses a large share of tobacco use in India, where gutka, khaini, zarda and betel quid with tobacco are common, particularly among men and in rural and working populations. These products carry their own risks, including oral cancer and cardiovascular disease, and nicotine dependence from them is real.
Patients who answer no to smoking often do not volunteer chewing tobacco unless asked by name. Recording both, and asking about the specific products used locally, gives an accurate history and opens the door to treatment.
- Ask separately about smoking and chewing tobacco at every new admission or clinic visit.
- Name the local products, such as gutka, khaini or zarda, when asking.
- Examine the mouth for leukoplakia or other lesions in anyone using smokeless tobacco.
- Offer the same cessation support to smokeless tobacco users as to smokers.
Why it matters
A smoking-only history leaves a large group of tobacco users untreated.
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