title: All in the name of flavour, fragrance & freshness: commonly used smokeless tobacco preparations in & around a tertiary hospital in India.
abstract: OBJECTIVE
  There is a general misconception that smokeless tobacco particularly sweetened and flavoured paan masala and gutkas are safe to use. The present study was undertaken with the objective of highlighting the deceptive and aggressive marketing techniques adopted by the manufacturers of smokeless tobacco preparations exploiting cultural, social and religious values. Another object was to highlight the lack of transparency in terms of content, weight, quality control and warning.
  
  
  METHODS
  All empty pouches of the used paan masalas, gutka, khaini or surti in and around a tertiary care hospital at east Delhi were collected. Their constituents were studied as per written declaration by the manufacturers on each packet. Information on net weight, cost, presence and type of warning, and quality assurance on each brand provided on side of the packets was noted.
  
  
  RESULTS
  A total of 1136 pouches of 33 brands/varieties were collected. Most of the gutka preparations contained tobacco, betel nut, unknown flavouring agents, undeclared spices and heavy metals. Warning regarding the harmful effect of tobacco was written in 90.9 per cent of brands with 81.8 per cent in English language only in minute font. Contents of the products were mentioned in 84.8 per cent of brands and only 27.3 per cent of those mentioned the net weight of the ingredients.
  
  
  CONCLUSIONS
  Seemingly 'innocuous' tobacco preparations in the form of paan masalas, gutka, khaini, surti or mouth fresheners contain various harmful substance like tobacco, betel nut, sugar coated fennel, saccharine, heavy metals like silver, unknown flavouring agents and undeclared spices in unknown quantities. Lack of transparency in terms of content, weight, quality control and warning is duping unsuspecting consumers.
authors.affiliation: Department of Medicine/Preventive Cardiology, University College of Medical Sciences,University of Delhi & GTB Hospital, Delhi, India. shridhar.dwivedi@gmail.com
authors.forename: Shridhar
authors.initials: S
authors.lastname: Dwivedi
authors.forename: Amitesh
authors.initials: A
authors.lastname: Aggarwal
authors.forename: Munish
authors.initials: M
authors.lastname: Dev
mesh_terms: D005421:Flavoring Agents; D007194:India; D062606:Tertiary Care Centers; D014030:Tobacco, Smokeless
chemical_list: D005421:Flavoring Agents