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Variations of toxic and carcinogenic constituents in nasvai: call for systematic research and regulation
  1. Irina Stepanov1,
  2. Joshua Abrams2,
  3. Vipin Jain3,
  4. Karoline Walter2,
  5. Deirdre Lawrence Kittner2
  1. 1Division of Environmental Health Sciences, Masonic Cancer Center, University of Minnesota, Minneapolis, Minnesota, USA
  2. 2Campaign for Tobacco-Free Kids, Washington DC, USA
  3. 3Masonic Cancer Center, University of Minnesota, Minneapolis, Minnesota, USA
  1. Correspondence to Dr Irina Stepanov, Masonic Cancer Center, University of Minnesota, Cancer and Cardiovascular Research Building, 2231 6th Street SE—Room 2-140, Minneapolis, MN 55455, USA; stepa011{at}

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Nasvai (sometimes referred to as naswar or nass) is a smokeless tobacco product used in central Asian countries such as Uzbekistan, Tajikistan, Kyrgyzstan, Turkmenistan and Kazakhstan. It is prepared by mixing locally grown tobacco with slaked lime or alkaline tree ash, and adding various combinations of flavouring and colouring ingredients. Nasvai can be produced in cottage industry settings or be custom made, and is sold either prepackaged in small containers or in bulk. While data on the prevalence of nasvai use in central Asian countries are scarce, the existing reports indicate that it may exceed that of smoking: 22.3% of adult men in Uzbekistan and 40% of rural adult men in Tajikistan reported using nasvai, while smoking prevalence estimates in the same populations were 19.6% and 8.7%, respectively.1 ,2 The largely unregulated production and accessibility of nasvai suggest that actual consumption may be even greater.

Consistent with the evidence that certain types of smokeless tobacco increase risk of oral cancer, including tobacco with lime in South Asia, the few published studies suggest that the use of nasvai may increase the risk of precancerous oral lesions and oral cancer.3–5 Analysis of toxic and …

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