It is not often that you hear of the phrase smokeless tobacco let alone the crisis it continues to incubate, even though these products have been around for a long time. There are scores of Kenyans using smokeless tobacco products believing that they are less harmful. What they do not know is that the so-called smokeless tobacco can cause cancer. A recent event by Harm Reduction Exchange highlighted this concern.
According to Dr Vivian Manyeki, a researcher and medic working at the Kenyatta National Hospital (KNH), harm reduction is a method of reducing and eventually ending tobacco smoking, which kills 8 million people per year according to the World Health Organization (WHO).
You may be wondering, what is smokeless tobacco? It is any product tobacco product that is chewed, sucked or sniffed, rather than smoked. The chemical that makes tobacco addictive, called nicotine, is absorbed through the tissues of the mouth or nose. Sometimes nicotine is swallowed.
“Harm reduction plays a crucial role in safeguarding health by promoting safer alternatives to traditional smoking. Rather than insisting on immediate and complete abstinence, harm reduction recognizes that many individuals may not be ready or able to stop using substances,” says Dr Manyeki. It is aimed at minimizing the negative consequences associated with substance use, including combustible tobacco addiction.
“Harm reduction plays a crucial role in safeguarding health by promoting safer alternatives to traditional smoking. Rather than insisting on immediate and complete abstinence, harm reduction recognizes that many individuals may not be ready or able to stop using substances,” says Dr Manyeki.
How it works
The medic says the method enables healthcare providers to meet the smokers at their point of need, reduce the incidence of smoking-related diseases, support individuals in their journey toward better health outcomes and prevent needless deaths.
“It focuses on providing practical strategies and support to enhance the health and well-being of users. This can include safer use practices, access to health services, and education about the risks involved, ultimately empowering individuals to make informed choices,” Dr Manyeki says.
In Kenya, smokeless tobacco and nicotine products, including items like chewing tobacco, snuff, areca nut derivatives such as pan (Khuber), gutkha, and khat (miraa), are viewed as alternatives to smoking. Dr Kariuki notes that the production processes in many of these products are unregulated and, thus, could be unsafe for use.
The products are also widely available, making it easy for users—especially minors—to access them without understanding the health risks involved, which can include cancers of the mouth and throat. “In my research and practice, I have seen cases of users as young as 8 years old,” added the medic.
”The majority of the smokeless tobacco products are locally made, often under conditions that lack quality control, which raises concerns about toxic substances entering the hands of young people” He warned that products containing areca nut are classified as Group 1 carcinogens or cancer-causing substances by the International Agency for Research on Cancer (IARC). While Kenya’s oral cancer rate is lower than in countries like India and the U.S., he cautioned that this might not reflect reality due to underreporting linked to limited cancer registry coverage.
Patterns of Usage
According to the 2014 Global Adult Tobacco Survey, usage patterns among SPP users in Kenya show that older populations are more likely to use these products, with a peak usage of 8.9% among those aged 60-69. There are also geographic and gender disparities: chewing tobacco is more common in urban areas (1.8%), while nasal snuff is more prevalent in rural regions (3.7%). Men tend to use these products more than women, with 3.9% of men using nasal snuff compared to just 1.7% of women.
The Need for Regulation and Harm Reduction
One major concern is the difficulty in regulating these products. Dr Kariuki said research evidence suggests that some local SPPs might be mixed with illegal drugs like heroin and cocaine, which adds to the health risks. He called for thorough toxicological studies and effective regulatory frameworks.
A Call to Action
Dr Kariuki emphasized the need for change: “It is vital to conduct comprehensive studies to evaluate the toxicant levels in both locally produced and imported SPPs. Sufficient prevention and caution should also be exercised to prevent minors from accessing these products” He urged all stakeholders to come together for a healthier future by developing relevant regulatory frameworks and public education campaigns about lower-risk alternatives like MONPs.
As countries continue to explore new ways to address public health challenges related to tobacco use, embracing harm reduction strategies could lead to a healthier continent free from the burdens of unregulated smokeless tobacco and nicotine products.
