Gutka

Short description: Tobacco preparation chewed in South Asia

Gutka street vendor, India

Gutka, ghutka, guṭkha or betel quid is a chewing tobacco preparation made of crushed areca nut (also called betel nut), tobacco, catechu, paraffin wax, slaked lime (Calcium hydroxide) and sweet or savory flavourings, in India, Pakistan, other Asian countries, and North America.[1]

It contains carcinogens, is considered responsible for oral cancer and other severe negative health effects and hence is subjected in India to the same restrictions and warnings as cigarettes.[1][2][3][4] Highly addictive and a known carcinogen, gutkha is the subject of much controversy in India. Many states have sought to curb its immense popularity by taxing sales of gutkha heavily or by banning it.[5] Gutka is manufactured in the sub-continent and exported to a few other countries, often marketed under the guise of a "safer" product than cigarettes and tobacco.[6] Reported to have both stimulant and relaxation effects, it is sold throughout South Asia and some Pacific regions in small, individual-sized foil packets/sachets and tins[7] that cost between 2 and 10 rupees each.[8] It is widely consumed in India , Pakistan and the Madhesh region of Nepal. Gutka is consumed by placing a pinch of it between the gum and cheek and gently sucking and chewing, similar to chewing tobacco.[7]

## Contents

* 1 Characteristics
* 2 Effects
* 3 Usage
* 4 India
* 4.1 Advertising
* 5 Notes
* 6 References
* 7 External links

## Characteristics

Gutka is a commercially produced form of smokeless tobacco. Manufacturers add sweet or savory flavors, making it more appealing to women and young people in some locations.[9] The combinations of gutka ingredients vary according to local preferences. Spices may include mustard, turmeric, anise seeds, cardamom, saffron and cloves.[7]

In addition to areca nut, nicotine, slaked lime, paraffin and catechu, it can be laced with thousands of chemicals.[10] It is a powdery, granular, light brownish to white substance. Within moments of chewing mixing with saliva, the gutkha begins to dissolve and turn deep red in colour. It may impart upon its user a "buzz" somewhat more intense than that of tobacco chewing, snuffing and smoking. [citation needed]

## Effects

Red stains of Gutka on walls due to spitting

Creative advertising by tobacco companies and lack of accessible information for the public leads to many gutka users being unaware of the dangers it can bring. Often users believe that gutka can act as a digestion aid, kill germs, and generally give a sense of well being.[11] In fact 34.4% of smokers have switched to smokeless tobacco use as way to quit.[6]

In addition to cancer of the head, mouth, neck, throat, oesophagus, other aerodigestive tract cancers, and dental disease, areca nut, the main ingredient in gutka, is known to cause severe oral mucosal disorders.[12] Oral submucous fibrosis, one such disorder, is a malignant condition that is severely debilitating and has no cure.[9] Metabolic syndrome, hypertension, diabetes and obesity have also been linked to its use. Use by pregnant women increases the risk of low birth rates in newborns.[7] As of 2015 it was the fourth most common addictive product worldwide.[13][14] Areca nut "quid chewing has claimed to produce a sense of well being, euphoria, warm sensations of the body, sweating, salivation, palpitation and heightened alertness, tolerance to hunger, and increased capacity and stamina to work."[12]

When a person chews gutka, the mixture directly enters the system through the oral cavity, which absorbs about 28 carcinogenic chemicals including nicotine.[11]

"Smokeless tobacco use is highly addictive. The nicotine in smokeless tobacco is more easily absorbed than by smoking cigarettes enhancing its addictiveness."[9]

Gutka turns saliva bright red, and when it is chewed long and often enough it will stain a user's teeth bright red too. Saliva is generally spat onto a wall or at the ground, causing a red stain that is quite resistant to the elements. Some building owners have taken to combating this by painting murals of gods on their walls, with the idea that gutkha chewers would not spit on a god.[15][16][17]

## Usage

Use of gutka and other forms of tobacco are culturally ingrained and use can begin at a young age.[6] Smokeless tobacco use is most common in India where oral cancer accounts for 30 to 40% of cancer cases.[18] Its use has been reported in Thailand, Sri Lanka, Bangladesh, Pakistan, Malaysia, Cambodia, China, Indonesia and New Guinea. Immigrants to the United Kingdom, parts of Africa, Australia, North America have brought their habits with them. Gutka is readily available in these locations, especially in neighborhood Asian markets in highly populated areas.[19] Immigrants to the United States where spitting in public is not as socially acceptable, learn to be discreet.[20] Those in the lower socioeconomic populations are especially at risk. It is here that access to education and treatment is limited.[21] Easy access and extremely low cost lead to early addiction and the prevalence of gutka use.[22][23][24] Precancerous lesions have been observed in young children and symptoms of cancer often appear by high school or college age. Smoking is not allowed in many places, and when done by children, is disapproved of. In contrast gutka use, being all but invisible to others, is the method of choice. A New York Times article reported in 2002 that sales of gutka and the tobaccoless version, paan masala, reached $1 billion a year.[25]

## India

Over 25% of India's population use tobacco products including cigarettes and multiple forms of smokeless tobacco. India has the largest number of smokeless tobacco users in the world. The poorest populations are greatly affected due to the detrimental effects of its use and the subsequent costs of medical care.[6] Many Indian states have sought to curb the use and spread of gutka by taxing sales heavily or by banning it.[5]

They have banned the sale, manufacture, distribution and storage of gutka and all its variants. As of May 2013, gutka is banned in 24 states and 3 union territories.[26] The federal Food Safety and Regulation (Prohibition) Act 2011 allows harmful products such as gutka to be banned for a year. This can be renewed annually, resulting in a permanent ban. The ban is enforced by the state public health ministry, the state Food and Drug Administration, and the local police.[27] Enforcement of the law is generally lax and many shops still sell gutka, although it may not be displayed.[28][29][30][31][32] Enforcemnent is stricter in some regions like Mumbai and Delhi, but illegal sale of gutka still occurs.[33][34]

In 2019, the Delhi government extended the ban for one more year on Gutka, Pan Masala, Flavoured/Scented Tobacco, Kharra and similar products containing tobacco. In September 2012, State of Delhi banned Gutka and Pan Masala containing tobacco and/or nicotine. After the notification, Gutka manufacturers separated the components like tobacco from Gutka and Pan Masala. Since the term ‘Gutka and Pan Masala Containing Tobacco’ was used in the notification. The components like tobacco were manufactured and sold in separate pouches after the ban. The notification was revised in March 2015 to make it more strict and banned all smokeless tobacco (SLT) products including twin-pack.[35] Offenders can be fined or receive prison sentences.[36] The law has provisions of imposing fines up to 25,000 Indian rupees on the sale of products that are injurious to health.[37]

State | Date of ban | Remarks  | Ref.

|
|
|

Andaman and Nicobar | 1 November 2012 |  | [38]
Andhra Pradesh | 9 January 2013 |  | [39]
Arunachal Pradesh |  |  | [40]
Assam |  |  | [41][42]
Bihar | 30 May 2012[43] | The law was upheld by the Patna High Court.  | [44]
Chandigarh |  |  | [45]
Chhattisgarh | 24 July 2012 |  | [46]
Delhi | 11 September 2012 | On 12 October 2012, the Delhi High Court refused to lift ban in response to a plea by a city-based gutka manufacturer.  | [47][48][49][50]
Goa | 2 October 2005 |  | [51]
Gujarat | 11 September 2012[52][53] | 100% export-oriented units are exempt from the ban.  | [54]
Himachal Pradesh | 13 July 2012 |  | [55]
Haryana | 15 August 2012 |  | [56]
Jharkhand | 24 July 2012 |  | [57][58]
Kerala | 25 May 2012[59] | On 2 August 2012, Kerala High Court declined to stay the ban.  | [60]
Karnataka | 31 May 2013 |  | [61]
Madhya Pradesh | 1 April 2012[62] | The law was upheld by the Madhya Pradesh High Court.  | [63]
Maharashtra | 20 July 2012[64] | Previous bans on gutka on 1 August 2002 and again in 2008 were overturned by the Supreme Court on the grounds of unfair trade practice.[65][66] The most recent ban was upheld by the Bombay High Court on 15 September 2012.[67] |
Manipur |  |  | [40][68]
Mizoram | 18 October 2012 |  | [69][70][71][72]
Nagaland |  |  | [45]
Odisha | 1 January 2013 |  | [73][74][75]
Punjab | 26 August 2012 |  | [76]
Rajasthan | 18 July 2012 |  | [77][78]
Sikkim | 17 September 2012 |  | [79]
Tamil Nadu | 8 May 2013 |  | [80]
Uttar Pradesh | 1 April 2013 |  | [81]
Uttarakhand | 1 January 2013 |  | [82]
West Bengal | 1 May 2013 |  | [83][84]

Research firm Edelweiss estimates the gutka ban will cause the industry 15-20 billion rupees in losses.[85]

### Advertising

Like alcohol and tobacco products, there is a ban on advertisement of gutka. Often tobacco companies advertise gutka as pan masala in order to skirt the ban on advertising tobacco products. Surrogate advertisements often use pan masala ads to promote gutka products with similar name and packaging.[86]

According to the Food Safety and Standards (Prohibition and Restriction on Sales) Regulations, 2011 of the Food Safety and Standards Authority of India, misleading advertisement of such products invites a fine of 1,000,000 rupees.[87]

According to StraitsResearch, The India pan masala market is expected to reach USD 10,365 million by 2026 at the CAGR of 10.4% during the forecast period 2019–2026. The India pan masala market is driven by significant switching of consumers from tobacco products to pan masala, aggressive advertising and convenient packaging, and Maharashtra State’s revocation of the ban over pan masala products.[88]

## Notes

1. ↑ 1.0 1.1 "CPAA: Quit Smoking Campaign, Anti Tobacco & Quit Smoking Campaign". http://www.cpaaindia.org/activities/projects.htm#gutkha.
2. ↑ Ananth, Venkar (1 April 2015). "Thank you for smoking: A brief history of tobacco warning labels". Live Mint. https://www.livemint.com/Politics/ZNFwGtWis70q2eYpUl9l1L/Thank-you-for-smoking-A-brief-history-of-tobacco-warning-la.html.
3. ↑ "NCI Dictionary of Cancer Terms" (in en). National Institutes of Health. 2 February 2011. https://www.cancer.gov/publications/dictionaries/cancer-terms/def/gutka.
4. ↑ Niaz, Kamal; Maqbool, Faheem; Khan, Fazlullah; Bahadar, Haji; Ismail Hassan, Fatima; Abdollahi, Mohammad (9 March 2017). "Smokeless tobacco (paan and gutkha) consumption, prevalence, and contribution to oral cancer". Epidemiology and Health (Us National Library of Medicine, National Institutes of Health) 39: e2017009. doi:10.4178/epih.e2017009. PMID 28292008.
5. ↑ 5.0 5.1 "MP becomes 1st state to ban Gutka products containing tobacco". Hindustan Times. 4 April 2012. http://www.hindustantimes.com/India-news/NewDelhi/MP-becomes-1st-state-to-ban-Gutka-products-containing-tobacco/Article1-834532.aspx.
6. ↑ 6.0 6.1 6.2 6.3 Mohan, Priya; Lando, Harry A; Panneer, Sigamani (1 January 2018). "Assessment of Tobacco Consumption and Control in India" (in en). Indian Journal of Clinical Medicine (Sage Journals) 9: 1179916118759289. doi:10.1177/1179916118759289.
7. ↑ 7.0 7.1 7.2 7.3 "CDC - Fact Sheet - Betel Quid with Tobacco (Gutka) - Smoking & Tobacco Use". Smoking and Tobacco Use. https://www.cdc.gov/tobacco/data_statistics/fact_sheets/smokeless/betel_quid/.
8. ↑ Shaukat, Mohammed. "Tobacco control in India - achievements and remaining challenges". Ministry of health and family welfare. http://www.searo.who.int/entity/noncommunicable_diseases/events/ncd-bengaluru-tobacco-control-india.pdf?ua=1.
9. ↑ 9.0 9.1 9.2 "The truth about smokeless tobacco use | Know the truth | TFI". World Health Organization, Eastern Mediterranean Regional Office. http://www.emro.who.int/tfi/know-the-truth/smokeless-tobacco-use.html.
10. ↑ Banerji, Annie (6 September 2012). "India "gutka" chewing tobacco habit a tough nut to crack" (in en). Thomson Reuters. https://www.reuters.com/article/us-india-tobacco-idUSBRE88508420120906.
11. ↑ 11.0 11.1 Niaz, Kamal; Maqbool, Faheem; Khan, Fazlullah; Bahadar, Haji; Ismail Hassan, Fatima; Abdollahi, Mohammad (9 March 2017). "Smokeless tobacco (paan and gutkha) consumption, prevalence, and contribution to oral cancer". Epidemiology and Health (US National Library of Medicine, National Institutes of Health) 39: e2017009. doi:10.4178/epih.e2017009. PMID 28292008.
12. ↑ 12.0 12.1 Shah, Gunjan; Chaturvedi, Pankaj; Vaishampayan, Sagar (2012). "Arecanut as an emerging etiology of oral cancers in India". Indian Journal of Medical and Paediatric Oncology (Indian Society of Medical and Paediatric Oncology : Official Journal of Indian Society of Medical & Paediatric Oncology) 33 (2): 71–79. doi:10.4103/0971-5851.99726. PMID 22988348.
13. ↑ Wu, Fen; Parvez, Faruque; Islam, Tariqul; Ahmed, Alauddin; Rakibuz-Zaman, Muhammad; Hasan, Rabiul; Argos, Maria; Levy, Diane et al. (25 June 2015). "Betel quid use and mortality in Bangladesh: a cohort study". Bulletin of the World Health Organization (World Health Organization) 93 (10): 684–692. doi:10.2471/blt.14.149484. PMID 26600610.
14. ↑ Javed, Fawad; Chotai, Milisha; Mehmood, Abid; Almas, Khalid (1 June 2010). "Oral mucosal disorders associated with habitual gutka usage: a review". Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology, and Endodontology (Oral Surgery, Oral edicine, Oral Pathology, Oral Radiology, and Endodontology) 109 (6): 857–864. doi:10.1016/j.tripleo.2009.12.038. PMID 20382045.
15. ↑ Kolhatkar, Sandip (12 April 2013). "Do not spit here, for god's sake!" (in en). https://www.mid-day.com/articles/do-not-spit-here--for-gods-sake/208490.
16. ↑ Bearak, Max. "Officials in India are really sick and tired of their country's tobacco habit" (in en). The Washington Post. https://www.washingtonpost.com/news/worldviews/wp/2016/04/18/officials-in-india-are-really-sick-and-tired-of-their-countrys-tobacco-habit/.
17. ↑ Bhattasali, Amitabha (23 November 2011). "Scheme to save Calcutta's Howrah Bridge from spit". BBC News. https://www.bbc.co.uk/news/world-asia-india-15837262.
18. ↑ ALI, SYED MUMTAZ; QURESHI, REHAN; JAMAL, SYED. Pakistan Oral and Dental Journal.
19. ↑ Niaz, Kamal; Maqbool, Faheem; Khan, Fazlullah; Bahadar, Haji; Ismail Hassan, Fatima; Abdollahi, Mohammad (9 March 2017). "Smokeless tobacco (paan and gutkha) consumption, prevalence, and contribution to oral cancer". Epidemiology and Health (US National Library of Medicine, National Institute of Health) 39: e2017009. doi:10.4178/epih.e2017009. PMID 28292008.
20. ↑ Banerjee, Smita C.; Ostroff, Jamie S.; Bari, Sehrish; D’Agostino, Thomas A.; Khera, Mitali; Acharya, Sudha; Gany, Francesca (12 April 2013). "Gutka and Tambaku Paan Use Among South Asian Immigrants: A Focus Group Study". Journal of Immigrant and Minority Health 16 (3): 531–539. doi:10.1007/s10903-013-9826-4. PMID 23579964.
21. ↑ Coelho, Ken Russell (2012). "Challenges of the Oral Cancer Burden in India" (in en). Journal of Cancer Epidemiology 2012: 701932. doi:10.1155/2012/701932. PMID 23093961.
22. ↑ Dsouza, Vivek; Kembhavi, Pratiksha Mohan; S, Praveen Rao; P, Kumaran; Hebbar, Pragati B. (2023-03-27). "How does Indian news media report smokeless tobacco control? A content analysis of the gutka ban enforcement" (in en). PLOS Global Public Health 3 (3): e0001724. doi:10.1371/journal.pgph.0001724. ISSN 2767-3375. PMID 36972290.
23. ↑ Balappanavar, Aswini; Mohanty, Vikrant Ranjan; Hussain, Abrar (1 February 2017). "Compliance with Tobacco Promotion and Sale Laws in School Neighbourhoods in India". Asian Pacific Journal of Cancer Prevention (US National Library of Medicine, National Institutes of Health) 18 (2): 563–570. doi:10.22034/APJCP.2017.18.2.563. PMID 28345846.
24. ↑ A.H.R.. "The nut cracks: Half of all Indian states have banned gutka since April. More may follow". The Economist. https://www.economist.com/banyan/2012/10/09/the-nut-cracks.
25. ↑ Waldman, Amy (13 August 2002). "Sweet but Deadly Addiction Is Seizing the Young in India". https://www.nytimes.com/2002/08/13/world/sweet-but-deadly-addiction-is-seizing-the-young-in-india.html.
26. ↑ "Cancer centres urge PM to ban gutka across India". DNA India. 21 November 2012. http://www.dnaindia.com/mumbai/report_cancer-centres-urge-pm-to-ban-gutka-across-india_1767377.
27. ↑ "Govt to file caveat in HC today on gutka, paan masala ban". The Times of India. 13 July 2012. http://articles.timesofindia.indiatimes.com/2012-07-13/mumbai/32662776_1_paan-masala-gutka-magnesium-carbonate.
28. ↑ "Why the gutka ban in Maharashtra won't work". 13 July 2012. http://www.firstpost.com/india/why-the-gutka-ban-in-maharashtra-wont-work-376475.html.
29. ↑ Praveen, M. P. (16 June 2012). "Sale of pan masala thriving". The Hindu (Chennai, India). http://www.thehindu.com/news/cities/Kochi/article3535702.ece.
30. ↑ "What ban? Gutka still sells". The Times of India. 18 June 2012. http://articles.timesofindia.indiatimes.com/2012-06-18/patna/32298406_1_paan-masala-gutka-tobacco-products.
31. ↑ "Gutka ban not satisfactory, admits minister". The Times of India. 20 January 2013. http://articles.timesofindia.indiatimes.com/2013-01-20/patna/36445192_1_tobacco-control-voice-of-tobacco-victims-gutka-ban.
32. ↑ "Gutka continues to rustle undercover despite ban". The Times of India. 29 January 2013. http://articles.timesofindia.indiatimes.com/2013-01-29/bhubaneswar/36614819_1_ban-gutka-gutka-and-paan-masala-tobacco-products.
33. ↑ Dsouza, Vivek; Kembhavi, Pratiksha Mohan; S, Praveen Rao; P, Kumaran; Hebbar, Pragati B. (2023-03-27). "How does Indian news media report smokeless tobacco control? A content analysis of the gutka ban enforcement" (in en). PLOS Global Public Health 3 (3): e0001724. doi:10.1371/journal.pgph.0001724. ISSN 2767-3375. PMID 36972290.
34. ↑ "Indians want their fix of gutkha & pan masala despite ban". Business Standard. 16 September 2012. http://www.business-standard.com/india/news/indians-want-their-fixgutkhapan-masala-despite-ban/486544/.
35. ↑ Siddharth (May 10, 2019). "Fact Check About Ban On Smokeless Tobacco Products In India". The Health. https://thehealth.today/fact-check-about-ban-on-smokeless-tobacco-products-in-india/.
36. ↑ Masand, Pratibha (13 July 2012). "Ban implementation may take few weeks". The Times of India. http://articles.timesofindia.indiatimes.com/2012-07-13/mumbai/32663143_1_paan-masala-ban-implementation-fda-commissioner-mahesh-zagade.
37. ↑ "Himachal bans sale of Gutka, Pan Masala, Masheri & Khaini". Hill Post. 13 July 2012. http://hillpost.in/2012/07/13/himachal-bans-sale-of-gutka-pan-masala-masheri-khaini/46753/latest-news/ravinder.
38. ↑ "Administration imposes complete ban on 'gutka'". Andaman Sheekha. 1 November 2012. http://www.andamansheekha.com/2012/10/02/administration-imposes-complete-ban-on-gutka/.
39. ↑ "Andhra Pradesh orders ban on manufacture, sale of gutka". Deccan Chronicle. 10 January 2013. http://www.deccanchronicle.com/130110/news-current-affairs/article/andhra-pradesh-orders-ban-manufacture-sale-gutka.
40. ↑ 40.0 40.1 "Tripura, Meghalaya to ban gutka, Ruaab Pan Masala". The Times of India. http://articles.timesofindia.indiatimes.com/2013-04-23/india/38762557_1_pan-masala-tobacco-products-population-based-cancer-registry.
41. ↑ Singh, Bikash (8 March 2013). "Gutka, pan masala containing tobacco and nicotine banned in Assam". Economic Times. http://articles.economictimes.indiatimes.com/2013-03-08/news/37561579_1_pan-masala-tobacco-and-nicotine-gutka.
42. ↑ "Assam govt imposes ban on gutkha". Indian Express. 9 March 2013. http://www.indianexpress.com/news/assam-govt-imposes-ban-on-gutkha/1085431/.
43. ↑ Bhatia, Banjot Kaur (31 May 2012). "World No Tobacco Day: Bihar govt bans gutkha, pan masala for 1 year". The Times of India. http://articles.timesofindia.indiatimes.com/2012-05-31/patna/31920287_1_pan-masala-global-adult-tobacco-survey-world-no-tobacco-day.
44. ↑ "UP stand on gutkha ban contrary to earlier assurance: HC - Express In…". http://www.expressindia.com/latest-news/up-stand-on-gutkha-ban-contrary-to-earlier-assurance-hc/1001455/.
45. ↑ 45.0 45.1 "PIL seeks ban on tobacco, gutka in J&K". Kashmir Times. http://www.kashmirtimes.com/newsdet.aspx?q=11857.
46. ↑ "The Government of Chhattisgarh banned Gutka and Pan Masala". Jagran Josh. 27 July 2012. http://www.jagranjosh.com/current-affairs/the-government-of-chhattisgarh-banned-gutka-and-pan-masala-1343382702-1.
47. ↑ "HC refuses to lift gutka ban". The Times of India. 13 October 2012. http://articles.timesofindia.indiatimes.com/2012-10-13/delhi/34430495_1_gutka-ban-gutka-products-delhi-high-court.
48. ↑ Perappadan, Bindu Shajan (11 September 2012). "Delhi decides to ban gutka". The Hindu (Chennai, India). http://www.thehindu.com/news/cities/Delhi/article3884583.ece.
49. ↑ "Delhi bans gutka following High Court orders". IBN Live. 11 September 2012. http://ibnlive.in.com/news/delhi-bans-gutka-following-high-court-orders/290635-3-244.html.
50. ↑ "Delhi government slaps ban on all gutka products". The Times of India. 11 September 2012. http://articles.timesofindia.indiatimes.com/2012-09-11/delhi/33762330_1_tobacco-products-gutka-products-sale-and-production.
51. ↑ "Goa to ban gutka consumption". Economic Times. 27 September 2005. http://articles.economictimes.indiatimes.com/2005-09-27/news/27502007_1_gutka-food-products-ban.
52. ↑ "Gutka to be banned in Gujarat from 11 September: Narendra Modi". Indian Express. 15 August 2012. http://www.indianexpress.com/news/gutka-to-be-banned-in-gujarat-from-september-11-narendra-modi/988726/.
53. ↑ "Gutka to be banned in Gujarat from 11 Sept.: Modi". The Hindu (Chennai, India). 15 August 2012. http://www.thehindu.com/health/policy-and-issues/article3775436.ece.
54. ↑ "Gutkha ban: Lone unit exempted". Financial Express. 28 September 2012. http://www.financialexpress.com/news/gutkha-ban-lone-unit-exempted/1009027/0.
55. ↑ "Himachal govt bans Gutka, pan masala products". Zee News. 13 July 2012. http://zeenews.india.com/news/himachal-pradesh/himachal-govt-bans-gutka-pan-masala-products_787358.html.
56. ↑ "Haryana to ban food items having tobacco". The Times of India. 13 August 2012. http://articles.timesofindia.indiatimes.com/2012-08-13/chandigarh/33181467_1_ban-on-hookah-bars-hookah-and-tobacco-haryana-government.
57. ↑ "Jharkhand bans production, sale of gutka/panmasala". MSN News. 25 July 2012. http://news.in.msn.com/national/article.aspx?cp-documentid=250390903.
58. ↑ "Jharkhand bans sale, manufacturing of gutka". Firstpost. 24 July 2012. http://www.firstpost.com/india/jharkhand-bans-sale-manufacturing-of-gutka-389468.html.
59. ↑ Mathew, Roy (25 May 2012). "Kerala bans pan masala and its variants". The Hindu (Chennai, India). http://www.thehindu.com/news/states/kerala/article3455962.ece.
60. ↑ "HC refuses to stay ban on pan masala". 2 August 2012. http://zeenews.india.com/news/kerala/hc-refuses-to-stay-ban-on-pan-masala_791249.html.
61. ↑ "Karnataka to ban gutka on 'World No Tobacco Day'". The Times of India. 30 May 2013. http://articles.timesofindia.indiatimes.com/2013-05-30/bangalore/39628254_1_gutka-products-areca-growers-karnataka-government.
62. ↑ "Madhya Pradesh bans gutkha and other chewing tobacco products". Down To Earth. 3 April 2012. http://www.downtoearth.org.in/content/madhya-pradesh-bans-gutkha-and-other-chewing-tobacco-products.
63. ↑ Tripathi, Ashish (18 September 2012). "'Ban gutka or we will', High court tells Akhilesh Yadav government". The Times of India. http://articles.timesofindia.indiatimes.com/2012-09-18/lucknow/33925119_1_ban-gutkha-justice-anurag-kumar-high-court.
64. ↑ "Ban Day 1: FDA set to root out gutka". The Times of India. 21 July 2012. http://articles.timesofindia.indiatimes.com/2012-07-21/mumbai/32776326_1_gutka-and-pan-masala-magnesium-carbonate-fda-commissioner-mahesh-zagade.
65. ↑ "Maharashtra bans gutka, paan m". The Times of India. 11 July 2012. http://articles.timesofindia.indiatimes.com/2012-07-11/mumbai/32631865_1_gutka-and-paan-masala-ban-maharashtra-government-today.
66. ↑ Deshpande, Swati (14 July 2012). "Current ban on stronger footing than in 2002". The Times of India. http://articles.timesofindia.indiatimes.com/2012-07-14/mumbai/32674531_1_gutka-and-pan-masala-ban-sale-tobacco-and-nicotine.
67. ↑ "Bombay High Court upholds ban on gutka, pan masala in Maharashtra". NDTV.com. 15 September 2012. http://www.ndtv.com/article/india/bombay-high-court-upholds-ban-on-gutka-pan-masala-in-maharashtra-267896.
68. ↑ "Tripura, Meghalaya take initiative to ban gutka and pan masala". http://m.indiatoday.in/story/tripura-meghalaya-to-ban-gutka-and-pan-masala/1/267258.html.
69. ↑ "Mizoram bans gutkha products". Indian Express. 18 October 2012. http://www.indianexpress.com/news/mizoram-bans-gutkha-products/1018691.
70. ↑ "Mizoram bans gutkha products". Zee News. 18 October 2012. http://zeenews.india.com/news/health/health-news/mizoram-bans-gutkha-products_19272.html.
71. ↑ Press Trust of India (18 October 2012). "Mizoram bans gutkha products". Business Standard India. http://www.business-standard.com/article/pti-stories/mizoram-bans-gutkha-products-112101800580_1.html.
72. ↑ "Call to replicate Mizoram ban in State". The Assam Tribune. 9 September 2012. http://www.assamtribune.com/scripts/detailsnew.asp?id=sep0912/city07.
73. ↑ "Odisha rings in 2013 with gutka ban". The Times of India. 2013. http://articles.timesofindia.indiatimes.com/2013-01-02/bhubaneswar/36110984_1_fssai-regulation-gutka-ban-tobacco-and-nicotine. "The state government on Tuesday announced a ban on the sale and manufacture of gutka and paan masala."
74. ↑ "Business Line : News / States : Odisha bans gutkha, tobacco sale". thehindubusinessline.com. 2013. http://www.thehindubusinessline.com/news/states/odisha-bans-gutkha-tobacco-sale/article4262271.ece. "The Odisha Government on Tuesday announced a State-wide ban on the manufacture, sale and use of gutkha and chewing tobacco containing nicotine."
75. ↑ "Briefly Nation: Orissa bans use of gutkha - Indian Express". indianexpress.com. 2013. http://www.indianexpress.com/news/briefly-nation-orissa-bans-use-of-gutkha/1053040/. "Orissa government on Tuesday announced a state-wide ban on the manufacture, sale and use of gutkha and chewing tobacco containing nicotine."
76. ↑ "Punjab bans sale of gutka, pan masala". News.webindia123.com. 27 August 2012. http://news.webindia123.com/news/Articles/India/20120827/2052048.html.
77. ↑ "Rajasthan government decides to ban Gutkha". Zee News. 18 July 2012. http://zeenews.india.com/news/rajasthan/rajasthan-government-decides-to-ban-gutkha_788233.html.
78. ↑ "Rajasthan government decides to ban Gutkha". India TV News. 18 July 2012. http://www.indiatvnews.com/news/india/rajasthan-government-decides-to-ban-gutkha-17044.html.
79. ↑ "Sikkim bans gutkha". DownToEarth. http://www.downtoearth.org.in/content/sikkim-bans-gutkha.
80. ↑ "TN bans pan masala, gutka". The Hindu. 8 May 2013. http://www.thehindubusinessline.com/news/states/tn-bans-pan-masala-gutka/article4695155.ece.
81. ↑ "After HC order, UP to ban gutka from April 1 next year, 2013". The Times of India. 4 October 2012. http://articles.timesofindia.indiatimes.com/2012-10-04/lucknow/34259483_1_ban-gutka-gutka-and-pan-masala-tobacco-and-nicotine.
82. ↑ "Uttarakhand gutka ban now from January 1". The Hindu (Chennai, India). 21 October 2012. http://www.thehindu.com/todays-paper/tp-national/uttarakhand-gutka-ban-now-from-january-1/article4018117.ece.
83. ↑ "Finally, state orders ban on gutka". The Times of India. 25 April 2013. http://articles.timesofindia.indiatimes.com/2013-04-25/kolkata/38816134_1_pan-masala-gutka-10-tax-hike.
84. ↑ http://www.wbhealth.gov.in/go/cfs146.pdf [bare URL PDF]
85. ↑ Chandramouli, Rajesh (14 September 2012). "Gutka ban loss could be Rs 1500 - Rs 2000 crores". The Times of India. http://articles.timesofindia.indiatimes.com/2012-09-14/chennai/33842950_1_gutka-ban-gutkha-tobacco.
86. ↑ "Ban surrogate advertisements of tobacco products". 20 June 2012. http://www.deccanherald.com/content/258543/ban-surrogate-advertisements-tobacco-products.html.
87. ↑ "No relaxation on gutka ban". The Times of India. http://articles.timesofindia.indiatimes.com/2013-01-16/bhubaneswar/36373255_1_gutka-and-paan-masala-sale-and-advertisement-anti-tobacco.
88. ↑ "Indian Pan Masala Market Share Analysis". Industry News Wire. https://industrynewswire.us/what-are-the-key-challenges-to-india-pan-masala-market-growth/136971/.

## References

* Javed F, Altamash M, Klinge B, Engström PE. (2008). Periodontal conditions and oral symptoms in gutka-chewers with and without type 2 diabetes. Acta Odontol Scand; 66(5):268-73.
* Javed F, Chotai M, Mehmood A, Almas K. Oral mucosal disorders associated with habitual gutka usage. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2010;109:857-64.
* Javed F, Bello Correa FO, Chotai M, Tappuni AR, Almas K. Systemic conditions associated with areca nut usage: A literature review. Scand J Public Health 2010; 38: 838–44.

## External links

* Sweet but Deadly Addiction is Seizing the Young in India, The New York Times , 13 August 2002
* Chewing tobacco cancer warning, BBC News, 26 July 1999
* Health: Children Buy Cancerous Sweets, BBC News, 3 March 1999
* Anti Gutkha Campaign, Cancer Patients Aid Association
* Ruaab Pan Masala, Gutka, 16 July 2018

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