Smokeless tobacco cessation

This guideline lays out advice for dealing with patients using smokeless tobacco (eg chewed). Its use is particularly prevalent in people of South Asian origin. They may not be aware that the product they are using contains tobacco and hence constitutes a health risk. NICE advises using local names and possible a picture (like the one above) to ask patients about its use as there may be language barriers.

Some products also contain areca nut, which is addictive and carcinogenic in its own right.

If use is identified, then encourage to stop and refer on as appropriate.


Local names include:

  • Misri Indian tobacco
  • Qimam
  • Khaini
  • Naswar (niswar / nas)
  • Gul
  • Gutka
  • Zarda
  • Mawa
  • Manipuri
  • Betel quid

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