Editing Gutka

{{Short description|Tobacco preparation chewed in South Asia}}
{{EngvarB|date=May 2014}}
{{Use dmy dates|date=May 2014}}

[[File:Gutka vendor in India.jpg|right|thumb|250px|Gutka street vendor, India]]
'''Gutka''', ghutka, or guṭkha ({{IPAc-en|'|g|ʌ|t|k|ə}}) is a type of [[betel quid]] and [[chewing tobacco]] preparation made of crushed [[areca nut]] (also called betel nut), [[tobacco]], [[catechu]], [[paraffin wax]], [[Calcium hydroxide|slaked lime]] (calcium hydroxide) and sweet or savory flavourings, in India, Pakistan, other Asian countries, and North America.<ref name=cp>{{cite web|url=http://www.cpaaindia.org/activities/projects.htm#gutkha|title=CPAA: Quit Smoking Campaign, Anti Tobacco & Quit Smoking Campaign|access-date=30 May 2015|archive-url=https://web.archive.org/web/20150517015526/http://www.cpaaindia.org/activities/projects.htm#gutkha|archive-date=17 May 2015|url-status=dead}}</ref>

Using gutka is highly addictive and can cause various harmful effects such as [[head and neck cancer]],<ref name="NCI">{{cite web |date=22 November 2019 |title=Oropharyngeal Cancer Treatment (Adult) (PDQ®)–Patient Version |url=https://www.cancer.gov/types/head-and-neck/patient/adult/oropharyngeal-treatment-pdq |access-date=28 November 2019 |website=National Cancer Institute |language=en |archive-date=28 August 2021 |archive-url=https://web.archive.org/web/20210828102202/https://www.cancer.gov/types/head-and-neck/patient/adult/oropharyngeal-treatment-pdq |url-status=live }}</ref><ref name=":0">{{cite journal |vauthors=Jeng JH, Chang MC, Hahn LJ |date=September 2001 |title=Role of areca nut in betel quid-associated chemical carcinogenesis: current awareness and future perspectives |journal=Oral Oncology |volume=37 |issue=6 |pages=477–492 |doi=10.1016/S1368-8375(01)00003-3 |pmid=11435174}}</ref> [[Oral cancer|oral]] and [[oropharyngeal cancer]]s,<ref name=":6">{{Cite journal |last1=Gormley |first1=Mark |last2=Creaney |first2=Grant |last3=Schache |first3=Andrew |last4=Ingarfield |first4=Kate |last5=Conway |first5=David I. |date=2022-11-11 |title=Reviewing the epidemiology of head and neck cancer: definitions, trends and risk factors |journal=British Dental Journal |language=en |volume=233 |issue=9 |pages=780–786 |doi=10.1038/s41415-022-5166-x |issn=0007-0610 |pmc=9652141 |pmid=36369568}}</ref> [[Coronary artery disease|coronary heart disease]], as well as negative reproductive effects including [[stillbirth]], [[premature birth]] and [[low birth weight]].<ref name="VidyasagaranSiddiqi2016">{{cite journal |last1=Vidyasagaran |first1=A. L. |last2=Siddiqi |first2=K. |last3=Kanaan |first3=M. |year=2016 |title=Use of smokeless tobacco and risk of cardiovascular disease: A systematic review and meta-analysis |url=http://eprints.whiterose.ac.uk/101100/1/EJPC_D_16_00085_R1_2016.pdf |journal=European Journal of Preventive Cardiology |volume=23 |issue=18 |pages=1970–1981 |doi=10.1177/2047487316654026 |issn=2047-4873 |pmid=27256827 |s2cid=206820997 |access-date=2 June 2024 |archive-date=1 June 2024 |archive-url=https://web.archive.org/web/20240601025303/https://eprints.whiterose.ac.uk/101100/1/EJPC_D_16_00085_R1_2016.pdf |url-status=live }}</ref><ref name=":2">{{Cite journal |last1=Gupta |first1=Ruchika |last2=Gupta |first2=Sanjay |last3=Sharma |first3=Shashi |last4=Sinha |first4=Dhirendra N |last5=Mehrotra |first5=Ravi |date=2019-01-01 |title=Risk of Coronary Heart Disease Among Smokeless Tobacco Users: Results of Systematic Review and Meta-Analysis of Global Data |url=https://academic.oup.com/ntr/article/21/1/25/4793346 |journal=Nicotine & Tobacco Research |language=en |volume=21 |issue=1 |pages=25–31 |doi=10.1093/ntr/nty002 |issn=1469-994X |pmc=6941711 |pmid=29325111 |access-date=2 June 2024 |archive-date=31 May 2024 |archive-url=https://web.archive.org/web/20240531085312/https://academic.oup.com/ntr/article/21/1/25/4793346 |url-status=live }}</ref>

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.<ref name="Sage Journals">{{cite journal |last1=Mohan |first1=Priya |last2=Lando |first2=Harry A |last3=Panneer |first3=Sigamani |title=Assessment of Tobacco Consumption and Control in India |journal=Indian Journal of Clinical Medicine |volume=9 |publisher=Sage Journals |pages=1179916118759289 |language=en |doi=10.1177/1179916118759289 |date=1 January 2018|doi-access=free }}</ref> 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<ref name="Smoking and Tobacco Use">{{cite web|url=https://www.cdc.gov/tobacco/data_statistics/fact_sheets/smokeless/betel_quid/|title=CDC - Fact Sheet - Betel Quid with Tobacco (Gutka) - Smoking & Tobacco Use|work=Smoking and Tobacco Use|access-date=30 May 2015|archive-date=2 April 2015|archive-url=https://web.archive.org/web/20150402022539/http://www.cdc.gov/tobacco/data_statistics/fact_sheets/smokeless/betel_quid/|url-status=live}}</ref> that cost between 2 and 10 [[Indian rupee|rupees]] each.<ref name="who">{{cite web |last1=Shaukat |first1=Mohammed |title=Tobacco control in India - achievements and remaining challenges |url=http://www.searo.who.int/entity/noncommunicable_diseases/events/ncd-bengaluru-tobacco-control-india.pdf?ua=1 |website=WHO |publisher=Ministry of health and family welfare |access-date=5 October 2018 |archive-date=13 November 2017 |archive-url=https://web.archive.org/web/20171113074218/http://www.searo.who.int/entity/noncommunicable_diseases/events/ncd-bengaluru-tobacco-control-india.pdf?ua=1 |url-status=live }}</ref> 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.<ref name="Smoking and Tobacco Use" /> Due to containing [[Carcinogen|cancer-causing substances]], it is subjected in India to the same restrictions and warnings as [[cigarettes]].<ref name="cp" /><ref name="thankyou">{{cite news |last1=Ananth |first1=Venkar |date=1 April 2015 |title=Thank you for smoking: A brief history of tobacco warning labels |url=https://www.livemint.com/Politics/ZNFwGtWis70q2eYpUl9l1L/Thank-you-for-smoking-A-brief-history-of-tobacco-warning-la.html |access-date=5 October 2018 |newspaper=Live Mint |archive-date=5 October 2018 |archive-url=https://web.archive.org/web/20181005195139/https://www.livemint.com/Politics/ZNFwGtWis70q2eYpUl9l1L/Thank-you-for-smoking-A-brief-history-of-tobacco-warning-la.html |url-status=live }}</ref><ref>{{cite web |date=2 February 2011 |title=NCI Dictionary of Cancer Terms |url=https://www.cancer.gov/publications/dictionaries/cancer-terms/def/gutka |access-date=7 December 2019 |website=National Cancer Institute |publisher=National Institutes of Health |language=en}}</ref><ref>{{cite journal |last1=Niaz |first1=Kamal |last2=Maqbool |first2=Faheem |last3=Khan |first3=Fazlullah |last4=Bahadar |first4=Haji |last5=Ismail Hassan |first5=Fatima |last6=Abdollahi |first6=Mohammad |date=9 March 2017 |title=Smokeless tobacco (paan and gutkha) consumption, prevalence, and contribution to oral cancer |journal=Epidemiology and Health |publisher=Us National Library of Medicine, National Institutes of Health |volume=39 |pages=e2017009 |doi=10.4178/epih.e2017009 |pmc=5543298 |pmid=28292008}}</ref> Highly [[drug addiction|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.<ref name="Hindustan Times">{{cite web |date=4 April 2012 |title=MP becomes 1st state to ban Gutka products containing tobacco |url=http://www.hindustantimes.com/India-news/NewDelhi/MP-becomes-1st-state-to-ban-Gutka-products-containing-tobacco/Article1-834532.aspx |url-status=dead |archive-url=https://web.archive.org/web/20130905050300/http://www.hindustantimes.com/India-news/NewDelhi/MP-becomes-1st-state-to-ban-Gutka-products-containing-tobacco/Article1-834532.aspx |archive-date=5 September 2013 |access-date=16 August 2013 |work=Hindustan Times |df=dmy-all}}</ref>

== 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.<ref name="emro.who.int">{{cite web |title=The truth about smokeless tobacco use {{!}} Know the truth {{!}} TFI |url=http://www.emro.who.int/tfi/know-the-truth/smokeless-tobacco-use.html |website=www.emro.who.int |publisher=World Health Organization, Eastern Mediterranean Regional Office |access-date=7 December 2019 |archive-date=7 December 2019 |archive-url=https://web.archive.org/web/20191207223518/http://www.emro.who.int/tfi/know-the-truth/smokeless-tobacco-use.html |url-status=live }}</ref> The combinations of gutka ingredients vary according to local preferences. Spices may include [[Mustard plant|mustard]], [[turmeric]], [[anise|anise seeds]], [[cardamom]], [[saffron]] and [[cloves]].<ref name="Smoking and Tobacco Use"/>

In addition to [[areca nut]], [[nicotine]], [[slaked lime]], paraffin and [[catechu]], it can be laced with thousands of chemicals.<ref>{{cite web |last1=Banerji |first1=Annie |title=India "gutka" chewing tobacco habit a tough nut to crack |url=https://www.reuters.com/article/us-india-tobacco-idUSBRE88508420120906 |website=Reuters |publisher=Thomson Reuters |access-date=7 December 2019 |language=en |date=6 September 2012 |archive-date=6 December 2019 |archive-url=https://web.archive.org/web/20191206191631/https://www.reuters.com/article/us-india-tobacco-idUSBRE88508420120906 |url-status=live }}</ref> 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|date=March 2011}}

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.<ref>{{cite web |last1=Kolhatkar |first1=Sandip |date=12 April 2013 |title=Do not spit here, for god's sake! |url=https://www.mid-day.com/articles/do-not-spit-here--for-gods-sake/208490 |access-date=7 December 2019 |website=mid-day |language=en |archive-date=8 December 2019 |archive-url=https://web.archive.org/web/20191208040751/https://www.mid-day.com/articles/do-not-spit-here--for-gods-sake/208490 |url-status=live }}</ref><ref>{{cite news |last1=Bearak |first1=Max |title=Officials in India are really sick and tired of their country's tobacco habit |url=https://www.washingtonpost.com/news/worldviews/wp/2016/04/18/officials-in-india-are-really-sick-and-tired-of-their-countrys-tobacco-habit/ |access-date=7 December 2019 |newspaper=The Washington Post |language=en |archive-date=8 December 2019 |archive-url=https://web.archive.org/web/20191208040750/https://www.washingtonpost.com/news/worldviews/wp/2016/04/18/officials-in-india-are-really-sick-and-tired-of-their-countrys-tobacco-habit/ |url-status=live }}</ref><ref>{{cite news |last=Bhattasali |first=Amitabha |date=23 November 2011 |title=Scheme to save Calcutta's Howrah Bridge from spit |url=https://www.bbc.co.uk/news/world-asia-india-15837262 |access-date=16 August 2013 |work=BBC News |archive-date=24 July 2012 |archive-url=https://web.archive.org/web/20120724110742/http://www.bbc.co.uk/news/world-asia-india-15837262 |url-status=live }}</ref>

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."<ref name="Arecanut as an emerging etiology of">{{cite journal |last1=Shah |first1=Gunjan |last2=Chaturvedi |first2=Pankaj |last3=Vaishampayan |first3=Sagar |date=2012 |title=Arecanut as an emerging etiology of oral cancers in India |journal=Indian Journal of Medical and Paediatric Oncology |publisher=Indian Society of Medical and Paediatric Oncology : Official Journal of Indian Society of Medical & Paediatric Oncology |volume=33 |issue=2 |pages=71–79 |doi=10.4103/0971-5851.99726 |pmc=3439794 |pmid=22988348 |doi-access=free}}</ref>

== Health effects ==
Gutka is highly addictive, represents a major health risk, has no safe level use and is not a safe substitute for smoking.<ref name="WHO2017">{{cite web |year=2017 |title=Recommendation on smokeless tobacco products |url=http://apps.who.int/iris/bitstream/10665/42658/1/9241590556.pdf |publisher=[[World Health Organization]] |pages=1–9 |access-date=2 June 2024 |archive-date=8 August 2017 |archive-url=https://web.archive.org/web/20170808233908/http://apps.who.int/iris/bitstream/10665/42658/1/9241590556.pdf |url-status=live }}</ref><ref name="ACS015">{{cite web |date=13 November 2015 |title=Health Risks of Smokeless Tobacco |url=https://www.cancer.org/cancer/cancer-causes/tobacco-and-cancer/smokeless-tobacco.html |publisher=[[American Cancer Society]] |access-date=2 June 2024 |archive-date=6 July 2024 |archive-url=https://web.archive.org/web/20240706204005/https://www.cancer.org/cancer/risk-prevention/tobacco/health-risks-of-tobacco/smokeless-tobacco.html |url-status=live }}</ref><ref name="NCI2010">{{cite web |date=25 October 2010 |title=Smokeless Tobacco and Cancer |url=https://www.cancer.gov/about-cancer/causes-prevention/risk/tobacco/smokeless-fact-sheet |publisher=United States Department of Health and Human Services |agency=[[National Cancer Institute]] at the National Institutes of Health |access-date=2 June 2024 |archive-date=31 May 2024 |archive-url=https://web.archive.org/web/20240531183504/https://www.cancer.gov/about-cancer/causes-prevention/risk/tobacco/smokeless-fact-sheet |url-status=live }}{{PD-notice}}</ref><ref name="Group2002">{{cite book |author=Royal College of Physicians of London. Tobacco Advisory Group |url=https://books.google.com/books?id=fpUgCBGb5SwC&pg=PA5 |title=Protecting Smokers, Saving Lives: The Case for a Tobacco and Nicotine Regulatory Authority |publisher=Royal College of Physicians |year=2002 |isbn=978-1-86016-177-3 |pages=5– |access-date=2 June 2024 |archive-date=31 May 2024 |archive-url=https://web.archive.org/web/20240531183455/https://books.google.com/books?id=fpUgCBGb5SwC&pg=PA5 |url-status=live }}</ref> Globally smokeless tobacco products like gutka contribute to 650 000 deaths each year with a significant proportion of them in [[Southeast Asia]].<ref name="SinhaSuliankatchi2016">{{cite journal |last1=Sinha |first1=Dhirendra N |last2=Suliankatchi |first2=Rizwan A |last3=Gupta |first3=Prakash C |last4=Thamarangsi |first4=Thaksaphon |last5=Agarwal |first5=Naveen |last6=Parascandola |first6=Mark |last7=Mehrotra |first7=Ravi |year=2016 |title=Global burden of all-cause and cause-specific mortality due to smokeless tobacco use: systematic review and meta-analysis |journal=Tobacco Control |volume=27 |issue=1 |pages=tobaccocontrol–2016–053302 |doi=10.1136/tobaccocontrol-2016-053302 |issn=0964-4563 |pmid=27903956 |s2cid=10968200}}</ref><ref name=":3">{{Cite journal |last1=Chugh |first1=Aastha |last2=Arora |first2=Monika |last3=Jain |first3=Neha |last4=Vidyasagaran |first4=Aishwarya |last5=Readshaw |first5=Anne |last6=Sheikh |first6=Aziz |last7=Eckhardt |first7=Jappe |last8=Siddiqi |first8=Kamran |last9=Chopra |first9=Mansi |last10=Mishu |first10=Masuma Pervin |last11=Kanaan |first11=Mona |last12=Rahman |first12=Muhammad Aziz |last13=Mehrotra |first13=Ravi |last14=Huque |first14=Rumana |last15=Forberger |first15=Sarah |date=June 2023 |title=The global impact of tobacco control policies on smokeless tobacco use: a systematic review |url=https://linkinghub.elsevier.com/retrieve/pii/S2214109X2300205X |journal=The Lancet Global Health |language=en |volume=11 |issue=6 |pages=e953–e968 |doi=10.1016/S2214-109X(23)00205-X |pmid=37202029 |access-date=2 June 2024 |archive-date=3 June 2024 |archive-url=https://web.archive.org/web/20240603043722/https://linkinghub.elsevier.com/retrieve/pii/S2214109X2300205X |url-status=live |hdl=20.500.11820/e0442377-9f02-4360-8d09-292d86110e45 |hdl-access=free }}</ref>

Using gutka can cause a number of adverse health effects such as [[head and neck cancer]],<ref name="NCI" /><ref name=":0" /> [[oral cancer]],<ref name="Arecanut as an emerging etiology of" /> [[oral submucous fibrosis]],<ref name="emro.who.int" /> [[Esophageal cancer|oesophagus cancer]], and [[pancreatic cancer]], [[cardiovascular disease]], and [[asthma]].<ref name="NiazMaqbool2017">{{cite journal |last1=Niaz |first1=Kamal |last2=Maqbool |first2=Faheem |last3=Khan |first3=Fazlullah |last4=Bahadar |first4=Haji |last5=Ismail Hassan |first5=Fatima |last6=Abdollahi |first6=Mohammad |year=2017 |title=Smokeless tobacco (''paan'' and ''gutkha'') consumption, prevalence, and contribution to oral cancer |journal=Epidemiology and Health |volume=39 |pages=e2017009 |doi=10.4178/epih.e2017009 |issn=2092-7193 |pmc=5543298 |pmid=28292008}}{{CC-notice|cc=by4|url=https://www.e-epih.org/journal/view.php?doi=10.4178/epih.e2017009|author(s)=Kamal Niaz, Faheem Maqbool, Fazlullah Khan, Haji Bahadar, Fatima Ismail Hassan, Mohammad Abdollahi}}</ref> It also raises the risk of fatal [[coronary artery disease]], fatal [[stroke]] and non-fatal ischaemic heart disease<ref name="VidyasagaranSiddiqi2016"/><ref name=":2"/> When a person chews gutka, the mixture directly enters the system through the oral cavity, which absorbs 28 cancer-causing chemicals.<ref name="Smokeless tobacco paan and gutkha" />

Gutka can cause adverse reproductive effects including [[stillbirth]], [[Preterm birth|premature birth]], [[low birth weight]]. Nicotine in gutka that are used during pregnancy can affect how a baby's brain develops before birth.<ref name="VidyasagaranSiddiqi2016"/>

Gutka use causes the production of various reactive [[radical (chemistry)|free radicals]] that induce [[oxidative stress]], particularly in oral tissues.<ref name = Prajapati2024>{{cite journal |vauthors=Prajapati RK, Joshi J, Karthikeyan S, Inder MP |title=Comparative evaluation of salivary, serum and urinary 8-OHdG in gutka-associated oral submucous fibrosis |journal=J Oral Maxillofac Pathol |volume=28 |issue=1 |pages=37–41 |date=2024 |pmid=38800434 |pmc=11126255 |doi=10.4103/jomfp.jomfp_442_23 |doi-access=free |url=}}</ref>  Gutka exposure can lead to the oxidation of [[guanine]] bases in [[DNA]] to form [[8-Oxo-2'-deoxyguanosine|8-hydroxy-2’-deoxyguanosine]] (8-OHdG or its tautomer 8-oxo-dG) as a major byproduct.<ref name = Prajapati2024/> Exposure to Gutka tends to be highest in [[saliva]] and [[urine]] as evaluated by measuring 8-OHdG in DNA.

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.<ref name="Smokeless tobacco paan and gutkha">{{cite journal |last1=Niaz |first1=Kamal |last2=Maqbool |first2=Faheem |last3=Khan |first3=Fazlullah |last4=Bahadar |first4=Haji |last5=Ismail Hassan |first5=Fatima |last6=Abdollahi |first6=Mohammad |title=Smokeless tobacco (paan and gutkha) consumption, prevalence, and contribution to oral cancer |journal=Epidemiology and Health |volume=39 |pages=e2017009 |publisher=US National Library of Medicine, National Institutes of Health |doi=10.4178/epih.e2017009 |pmid=28292008 |pmc=5543298 |date=9 March 2017}}</ref> In fact 34.4% of smokers have switched to smokeless tobacco use as way to quit<ref name="Sage Journals" /> but there is no scientific evidence that using gutka can help a person quit smoking.<ref name="NCI2010"/><ref name=":1">{{Cite web |last=ERS |date=2019-05-29 |title=ERS Position Paper on Tobacco Harm Reduction |url=https://www.ersnet.org/news-and-features/news/ers-position-paper-on-tobacco-harm-reduction-2/ |access-date=2024-05-30 |website=ERS - European Respiratory Society |language=en-GB |archive-date=30 May 2024 |archive-url=https://web.archive.org/web/20240530093952/https://www.ersnet.org/news-and-features/news/ers-position-paper-on-tobacco-harm-reduction-2/ |url-status=live }}</ref> As of 2015 it was the fourth most common addictive product worldwide.<ref>{{cite journal |last1=Wu |first1=Fen |last2=Parvez |first2=Faruque |last3=Islam |first3=Tariqul |last4=Ahmed |first4=Alauddin |last5=Rakibuz-Zaman |first5=Muhammad |last6=Hasan |first6=Rabiul |last7=Argos |first7=Maria |last8=Levy |first8=Diane |last9=Sarwar |first9=Golam |last10=Ahsan |first10=Habibul |author10-link=Habibul Ahsan |last11=Chen |first11=Yu |date=25 June 2015 |title=Betel quid use and mortality in Bangladesh: a cohort study |journal=Bulletin of the World Health Organization |publisher=World Health Organization |volume=93 |issue=10 |pages=684–692 |doi=10.2471/blt.14.149484 |pmc=4645429 |pmid=26600610}}</ref><ref>{{cite journal |last1=Javed |first1=Fawad |last2=Chotai |first2=Milisha |last3=Mehmood |first3=Abid |last4=Almas |first4=Khalid |date=1 June 2010 |title=Oral mucosal disorders associated with habitual gutka usage: a review |journal=Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology, and Endodontology |publisher=Oral Surgery, Oral edicine, Oral Pathology, Oral Radiology, and Endodontology |volume=109 |issue=6 |pages=857–864 |doi=10.1016/j.tripleo.2009.12.038 |pmid=20382045}}</ref>

== Usage ==
[[File:Panmasala Gutkha stains on wall due to spitting.jpg|thumb|Red stains of Gutka on walls due to [[spitting]]]]
Use of gutka and other forms of tobacco are culturally ingrained and use can begin at a young age.<ref name="Sage Journals" /> Smokeless tobacco use is most common in India where oral cancer accounts for 30 to 40% of cancer cases.<ref>{{cite journal |last1=ALI |first1=SYED MUMTAZ |last2=QURESHI |first2=REHAN |last3=JAMAL |first3=SYED |s2cid=35257267 |journal=Pakistan Oral and Dental Journal }}</ref> 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.<ref>{{cite journal |last1=Niaz |first1=Kamal |last2=Maqbool |first2=Faheem |last3=Khan |first3=Fazlullah |last4=Bahadar |first4=Haji |last5=Ismail Hassan |first5=Fatima |last6=Abdollahi |first6=Mohammad |title=Smokeless tobacco (paan and gutkha) consumption, prevalence, and contribution to oral cancer |journal=Epidemiology and Health |volume=39 |pages=e2017009 |publisher=US National Library of Medicine, National Institute of Health |doi=10.4178/epih.e2017009 |pmid=28292008 |pmc=5543298 |date=9 March 2017}}</ref> Immigrants to the United States where spitting in public is not as socially acceptable, learn to be discreet.<ref>{{cite journal |last1=Banerjee |first1=Smita C. |last2=Ostroff |first2=Jamie S. |last3=Bari |first3=Sehrish |last4=D’Agostino |first4=Thomas A. |last5=Khera |first5=Mitali |last6=Acharya |first6=Sudha |last7=Gany |first7=Francesca |title=Gutka and Tambaku Paan Use Among South Asian Immigrants: A Focus Group Study |journal=Journal of Immigrant and Minority Health |date=12 April 2013 |volume=16 |issue=3 |pages=531–539 |doi=10.1007/s10903-013-9826-4 |pmid=23579964 |pmc=4097304 }}</ref> Those in the lower socioeconomic populations are especially at risk. It is here that access to education and treatment is limited.<ref>{{cite journal |last1=Coelho |first1=Ken Russell |title=Challenges of the Oral Cancer Burden in India |journal=Journal of Cancer Epidemiology |volume=2012 |pages=701932 |language=en |doi=10.1155/2012/701932 |pmid=23093961 |pmc=3471448 |date=2012|doi-access=free }}</ref> Easy access and extremely low cost lead to early addiction and the prevalence of gutka use.<ref name="auto">{{Cite journal |last1=Dsouza |first1=Vivek |last2=Kembhavi |first2=Pratiksha Mohan |last3=S |first3=Praveen Rao |last4=P |first4=Kumaran |last5=Hebbar |first5=Pragati B. |date=2023-03-27 |title=How does Indian news media report smokeless tobacco control? A content analysis of the gutka ban enforcement |journal=PLOS Global Public Health |language=en |volume=3 |issue=3 |pages=e0001724 |doi=10.1371/journal.pgph.0001724 |issn=2767-3375 |pmc=10042338 |pmid=36972290 |doi-access=free }}</ref><ref>{{cite journal |last1=Balappanavar |first1=Aswini |last2=Mohanty |first2=Vikrant Ranjan |last3=Hussain |first3=Abrar |title=Compliance with Tobacco Promotion and Sale Laws in School Neighbourhoods in India |volume=18 |issue=2 |journal=Asian Pacific Journal of Cancer Prevention |publisher=US National Library of Medicine, National Institutes of Health |pages=563–570 |doi=10.22034/APJCP.2017.18.2.563 |pmid=28345846 |pmc=5454759 |date=1 February 2017}}</ref><ref>{{cite news |last1=A.H.R. |title=The nut cracks: Half of all Indian states have banned gutka since April. More may follow |url=https://www.economist.com/banyan/2012/10/09/the-nut-cracks |newspaper=The Economist |access-date=7 December 2019 |archive-date=7 December 2019 |archive-url=https://web.archive.org/web/20191207222236/https://www.economist.com/banyan/2012/10/09/the-nut-cracks |url-status=live }}</ref> 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.<ref>{{cite web |last1=Waldman |first1=Amy |title=Sweet but Deadly Addiction Is Seizing the Young in India |url=https://www.nytimes.com/2002/08/13/world/sweet-but-deadly-addiction-is-seizing-the-young-in-india.html |website=The New York Times |access-date=8 December 2019 |date=13 August 2002 |archive-date=8 December 2019 |archive-url=https://web.archive.org/web/20191208005154/https://www.nytimes.com/2002/08/13/world/sweet-but-deadly-addiction-is-seizing-the-young-in-india.html |url-status=live }}</ref>

=== 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.<ref name="Sage Journals"/> Many Indian states have sought to curb the use and spread of gutka by taxing sales heavily or by banning it.<ref name="Hindustan Times"/>

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 Territory|union territories]].<ref>{{cite news |url=http://www.dnaindia.com/mumbai/report_cancer-centres-urge-pm-to-ban-gutka-across-india_1767377 |title=Cancer centres urge PM to ban gutka across India |newspaper=DNA India |date=21 November 2012 |access-date=16 August 2013 |archive-date=7 January 2019 |archive-url=https://web.archive.org/web/20190107054602/https://www.dnaindia.com/mumbai/report-cancer-centres-urge-pm-to-ban-gutka-across-india-1767377 |url-status=live }}</ref> 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.<ref>{{cite news|url=https://timesofindia.indiatimes.com/city/mumbai/Govt-to-file-caveat-in-HC-today-on-gutka-paan-masala-ban/articleshow/14858958.cms |archive-url=https://archive.today/20130126085134/http://articles.timesofindia.indiatimes.com/2012-07-13/mumbai/32662776_1_paan-masala-gutka-magnesium-carbonate |url-status=live |archive-date=26 January 2013 |title=Govt to file caveat in HC today on gutka, paan masala ban |date=13 July 2012 |work=[[The Times of India]] |access-date=16 August 2013}}</ref> Enforcement of the law is generally lax and many shops still sell gutka, although it may not be displayed.<ref>{{cite news|url=http://www.firstpost.com/india/why-the-gutka-ban-in-maharashtra-wont-work-376475.html|title=Why the gutka ban in Maharashtra won't work|date=13 July 2012|access-date=13 July 2012|archive-date=14 July 2012|archive-url=https://web.archive.org/web/20120714030058/http://www.firstpost.com/india/why-the-gutka-ban-in-maharashtra-wont-work-376475.html|url-status=live}}</ref><ref>{{cite news|url=http://www.thehindu.com/news/cities/Kochi/article3535702.ece|title=Sale of pan masala thriving|date=16 June 2012|location=Chennai, India|work=The Hindu|first=M. P.|last=Praveen|access-date=13 July 2012|archive-date=18 June 2012|archive-url=https://web.archive.org/web/20120618000904/http://www.thehindu.com/news/cities/Kochi/article3535702.ece|url-status=live}}</ref><ref>{{cite news|url=https://timesofindia.indiatimes.com/city/patna/What-ban-Gutka-still-sells/articleshow/14222559.cms|archive-url=https://archive.today/20130103144240/http://articles.timesofindia.indiatimes.com/2012-06-18/patna/32298406_1_paan-masala-gutka-tobacco-products|url-status=live|archive-date=3 January 2013|work=[[The Times of India]]|title=What ban? Gutka still sells|date=18 June 2012 }}</ref><ref>{{cite news|url=https://timesofindia.indiatimes.com/city/patna/Gutka-ban-not-satisfactory-admits-minister/articleshow/18095271.cms |archive-url=https://archive.today/20130411034453/http://articles.timesofindia.indiatimes.com/2013-01-20/patna/36445192_1_tobacco-control-voice-of-tobacco-victims-gutka-ban |url-status=live |archive-date=11 April 2013 |title=Gutka ban not satisfactory, admits minister |date=20 January 2013 |work=[[The Times of India]] |access-date=16 August 2013}}</ref><ref>{{cite news|url=https://timesofindia.indiatimes.com/city/bhubaneswar/Gutka-continues-to-rustle-undercover-despite-ban/articleshow/18231182.cms |archive-url=https://archive.today/20130411035609/http://articles.timesofindia.indiatimes.com/2013-01-29/bhubaneswar/36614819_1_ban-gutka-gutka-and-paan-masala-tobacco-products |url-status=live |archive-date=11 April 2013 |title=Gutka continues to rustle undercover despite ban |date=29 January 2013 |work=[[The Times of India]] |access-date=16 August 2013}}</ref> Enforcemnent is stricter in some regions like [[Mumbai]] and [[Delhi]], but illegal sale of gutka still occurs.<ref name="auto"/><ref>{{cite news |url=http://www.business-standard.com/india/news/indians-want-their-fixgutkhapan-masala-despite-ban/486544/ |title=Indians want their fix of gutkha & pan masala despite ban |work=Business Standard |date=16 September 2012 |access-date=16 August 2013 |archive-date=6 July 2024 |archive-url=https://web.archive.org/web/20240706204007/https://www.business-standard.com/search?q=news |url-status=live }}</ref>

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.<ref name="The Health">{{cite news | url=https://thehealth.today/fact-check-about-ban-on-smokeless-tobacco-products-in-india/ | title=Fact Check About Ban On Smokeless Tobacco Products In India | work=[[The Health]] | date=May 10, 2019 | access-date=September 8, 2019 | author=Siddharth | url-status=live | archive-date=25 August 2019 | archive-url=https://web.archive.org/web/20190825183531/https://thehealth.today/fact-check-about-ban-on-smokeless-tobacco-products-in-india/ }}</ref> Offenders can be fined or receive prison sentences.<ref>{{cite news|author=Masand, Pratibha |url=https://timesofindia.indiatimes.com/city/mumbai/Ban-implementation-may-take-few-weeks/articleshow/14858935.cms |archive-url=https://archive.today/20130126044336/http://articles.timesofindia.indiatimes.com/2012-07-13/mumbai/32663143_1_paan-masala-ban-implementation-fda-commissioner-mahesh-zagade |url-status=live |archive-date=26 January 2013 |title=Ban implementation may take few weeks |date=13 July 2012 |work=[[The Times of India]] |access-date=16 August 2013}}</ref> The law has provisions of imposing fines up to {{INRConvert|25000}} on the sale of products that are injurious to health.<ref>{{cite web |url=http://hillpost.in/2012/07/13/himachal-bans-sale-of-gutka-pan-masala-masheri-khaini/46753/latest-news/ravinder |title=Himachal bans sale of Gutka, Pan Masala, Masheri & Khaini |work=Hill Post |date=13 July 2012 |access-date=16 August 2013 |archive-date=24 November 2012 |archive-url=https://web.archive.org/web/20121124040710/http://hillpost.in/2012/07/13/himachal-bans-sale-of-gutka-pan-masala-masheri-khaini/46753/latest-news/ravinder |url-status=dead }}</ref>

{| class="wikitable sortable" style="text-align: center;"
|-
! State !! Date of ban !! Remarks
!Ref.
|- 
| [[Andaman and Nicobar]] || 1 November 2012 ||
|<ref>{{cite web |url=http://www.andamansheekha.com/2012/10/02/administration-imposes-complete-ban-on-gutka/ |title=Administration imposes complete ban on 'gutka' |publisher=Andaman Sheekha |date=1 November 2012 |access-date=16 August 2013 |archive-date=7 January 2019 |archive-url=https://web.archive.org/web/20190107054515/http://www.andamansheekha.com/2012/10/02/administration-imposes-complete-ban-on-gutka/ |url-status=live }}</ref>
|- 
| [[Andhra Pradesh]] || 9 January 2013 ||
|<ref>{{cite web |url=http://www.deccanchronicle.com/130110/news-current-affairs/article/andhra-pradesh-orders-ban-manufacture-sale-gutka |title=Andhra Pradesh orders ban on manufacture, sale of gutka |work=Deccan Chronicle |date=10 January 2013 |access-date=16 August 2013 |url-status=dead |archive-url=https://web.archive.org/web/20130114022421/http://www.deccanchronicle.com/130110/news-current-affairs/article/andhra-pradesh-orders-ban-manufacture-sale-gutka |archive-date=14 January 2013 |df=dmy-all }}</ref>
|- 
| [[Arunachal Pradesh]] ||  ||
|<ref name="The Times of India">{{cite news|url=http://articles.timesofindia.indiatimes.com/2013-04-23/india/38762557_1_pan-masala-tobacco-products-population-based-cancer-registry |archive-url=https://archive.today/20130629131243/http://articles.timesofindia.indiatimes.com/2013-04-23/india/38762557_1_pan-masala-tobacco-products-population-based-cancer-registry |url-status=dead |archive-date=2013-06-29 |work=[[The Times of India]] |title=Tripura, Meghalaya to ban gutka, Ruaab Pan Masala }}</ref>
|-
| [[Assam]] ||  ||
|<ref>{{cite news |author=Singh, Bikash |url=http://articles.economictimes.indiatimes.com/2013-03-08/news/37561579_1_pan-masala-tobacco-and-nicotine-gutka |title=Gutka, pan masala containing tobacco and nicotine banned in Assam |work=Economic Times |date=8 March 2013 |access-date=16 August 2013 |archive-date=5 April 2014 |archive-url=https://web.archive.org/web/20140405062437/http://articles.economictimes.indiatimes.com/2013-03-08/news/37561579_1_pan-masala-tobacco-and-nicotine-gutka |url-status=dead }}</ref><ref>{{cite web |url=http://www.indianexpress.com/news/assam-govt-imposes-ban-on-gutkha/1085431/ |title=Assam govt imposes ban on gutkha |work=Indian Express |date=9 March 2013 |access-date=16 August 2013 |archive-date=7 January 2019 |archive-url=https://web.archive.org/web/20190107054456/http://archive.indianexpress.com/static/sorry/ |url-status=live }}</ref>
|- 
| [[Bihar]] || 30 May 2012<ref>{{cite news|author=Bhatia, Banjot Kaur |url=https://timesofindia.indiatimes.com/city/patna/World-No-Tobacco-Day-Bihar-govt-bans-gutkha-pan-masala-for-1-year/articleshow/13679128.cms |archive-url=https://archive.today/20130103080551/http://articles.timesofindia.indiatimes.com/2012-05-31/patna/31920287_1_pan-masala-global-adult-tobacco-survey-world-no-tobacco-day |url-status=live |archive-date=3 January 2013 |title=World No Tobacco Day: Bihar govt bans gutkha, pan masala for 1 year |date=31 May 2012 |work=[[The Times of India]] |access-date=16 August 2013}}</ref> || The law was upheld by the [[Patna High Court]].
|<ref>{{Cite web | url=http://www.expressindia.com/latest-news/up-stand-on-gutkha-ban-contrary-to-earlier-assurance-hc/1001455/ | archive-url=https://archive.today/20130122154714/http://www.expressindia.com/latest-news/up-stand-on-gutkha-ban-contrary-to-earlier-assurance-hc/1001455/ | url-status=dead | archive-date=2013-01-22 |title = UP stand on gutkha ban contrary to earlier assurance: HC - Express In…}}</ref>
|-
| [[Chandigarh]] ||  ||
|<ref name="KT">{{cite web |url=http://www.kashmirtimes.com/newsdet.aspx?q=11857 |title=PIL seeks ban on tobacco, gutka in J&K |work=Kashmir Times |access-date=12 February 2013 |archive-date=7 January 2019 |archive-url=https://web.archive.org/web/20190107054445/http://www.kashmirtimes.com/newsdet.aspx?q=11857%20 |url-status=dead }}</ref>
|-
| [[Chhattisgarh]] || 24 July 2012 ||
|<ref>{{cite web |url=http://www.jagranjosh.com/current-affairs/the-government-of-chhattisgarh-banned-gutka-and-pan-masala-1343382702-1 |title=The Government of Chhattisgarh banned Gutka and Pan Masala |publisher=Jagran Josh |date=27 July 2012 |access-date=16 August 2013 |archive-date=7 January 2019 |archive-url=https://web.archive.org/web/20190107054459/https://www.jagranjosh.com/current-affairs/the-government-of-chhattisgarh-banned-gutka-and-pan-masala-1343382702-1%20 |url-status=live }}</ref>
|-
| [[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.
|<ref>{{cite news|url=https://timesofindia.indiatimes.com/city/delhi/HC-refuses-to-lift-gutka-ban/articleshow/16789367.cms |archive-url=https://archive.today/20130103100314/http://articles.timesofindia.indiatimes.com/2012-10-13/delhi/34430495_1_gutka-ban-gutka-products-delhi-high-court |url-status=live |archive-date=3 January 2013 |title=HC refuses to lift gutka ban |date=13 October 2012 |work=[[The Times of India]] |access-date=16 August 2013}}</ref><ref>{{cite news |author=Perappadan, Bindu Shajan |url=http://www.thehindu.com/news/cities/Delhi/article3884583.ece |title=Delhi decides to ban gutka |work=The Hindu |date=11 September 2012 |access-date=16 August 2013 |location=Chennai, India |archive-date=7 January 2019 |archive-url=https://web.archive.org/web/20190107054443/https://www.thehindu.com/news/cities/Delhi/article3884583.ece%20/ |url-status=live }}</ref><ref>{{cite web|url=http://ibnlive.in.com/news/delhi-bans-gutka-following-high-court-orders/290635-3-244.html |archive-url=https://web.archive.org/web/20120914025734/http://ibnlive.in.com/news/delhi-bans-gutka-following-high-court-orders/290635-3-244.html |url-status=dead |archive-date=14 September 2012 |title=Delhi bans gutka following High Court orders |publisher=IBN Live |date=11 September 2012 |access-date=16 August 2013}}</ref><ref>{{cite news|url=https://timesofindia.indiatimes.com/city/delhi/Delhi-government-slaps-ban-on-all-gutka-products/articleshow/16345567.cms |archive-url=https://web.archive.org/web/20121023013024/http://articles.timesofindia.indiatimes.com/2012-09-11/delhi/33762330_1_tobacco-products-gutka-products-sale-and-production |url-status=live |archive-date=23 October 2012 |title=Delhi government slaps ban on all gutka products |date=11 September 2012 |work=[[The Times of India]] |access-date=16 August 2013}}</ref>
|-
| [[Goa]] || 2 October 2005 ||
|<ref>{{cite news |url=http://articles.economictimes.indiatimes.com/2005-09-27/news/27502007_1_gutka-food-products-ban |title=Goa to ban gutka consumption |work=Economic Times |date=27 September 2005 |access-date=16 August 2013 |archive-date=15 January 2013 |archive-url=https://web.archive.org/web/20130115021119/http://articles.economictimes.indiatimes.com/2005-09-27/news/27502007_1_gutka-food-products-ban |url-status=dead }}</ref>
|-
| [[Gujarat]] || 11 September 2012<ref>{{cite web |url=http://www.indianexpress.com/news/gutka-to-be-banned-in-gujarat-from-september-11-narendra-modi/988726/ |title=Gutka to be banned in Gujarat from 11 September: Narendra Modi |work=Indian Express |date=15 August 2012 |access-date=16 August 2013 |archive-date=9 January 2019 |archive-url=https://web.archive.org/web/20190109233328/http://archive.indianexpress.com/static/sorry/ |url-status=live }}</ref><ref>{{cite news |url=http://www.thehindu.com/health/policy-and-issues/article3775436.ece |title=Gutka to be banned in Gujarat from 11 Sept.: Modi |work=The Hindu |date=15 August 2012 |access-date=16 August 2013 |location=Chennai, India |archive-date=7 January 2019 |archive-url=https://web.archive.org/web/20190107054502/https://www.thehindu.com/health/policy-and-issues/article3775436.ece%20/ |url-status=live }}</ref> || 100% export-oriented units are exempt from the ban.
|<ref>{{cite news |url=http://www.financialexpress.com/news/gutkha-ban-lone-unit-exempted/1009027/0 |title=Gutkha ban: Lone unit exempted |newspaper=Financial Express |date=28 September 2012 |access-date=16 August 2013 |url-status=dead |archive-url=https://web.archive.org/web/20140514060207/http://www.financialexpress.com/news/gutkha-ban-lone-unit-exempted/1009027/0 |archive-date=14 May 2014 |df=dmy-all }}</ref>
|-
| [[Himachal Pradesh]] || 13 July 2012 ||
|<ref>{{cite web |url=http://zeenews.india.com/news/himachal-pradesh/himachal-govt-bans-gutka-pan-masala-products_787358.html |title=Himachal govt bans Gutka, pan masala products |publisher=Zee News |date=13 July 2012 |access-date=16 August 2013 |archive-date=7 January 2019 |archive-url=https://web.archive.org/web/20190107054518/http://zeenews.india.com/news/himachal-pradesh/himachal-govt-bans-gutka-pan-masala-products_787358.html |url-status=live }}</ref>
|-
| [[Haryana]] || 15 August 2012 ||
|<ref>{{cite news|url=https://timesofindia.indiatimes.com/city/chandigarh/Haryana-to-ban-food-items-having-tobacco/articleshow/15467775.cms |archive-url=https://archive.today/20130103081233/http://articles.timesofindia.indiatimes.com/2012-08-13/chandigarh/33181467_1_ban-on-hookah-bars-hookah-and-tobacco-haryana-government |url-status=live |archive-date=3 January 2013 |title=Haryana to ban food items having tobacco |date=13 August 2012 |work=[[The Times of India]] |access-date=16 August 2013}}</ref>
|-
| [[Jharkhand]] || 24 July 2012 ||
|<ref>{{cite web |url=http://news.in.msn.com/national/article.aspx?cp-documentid=250390903 |title=Jharkhand bans production, sale of gutka/panmasala |publisher=MSN News |date=25 July 2012 |access-date=16 August 2013 |archive-url=https://web.archive.org/web/20140514031032/http://news.in.msn.com/national/article.aspx?cp-documentid=250390903 |archive-date=14 May 2014 |url-status=dead }}</ref><ref>{{cite web|url=http://www.firstpost.com/india/jharkhand-bans-sale-manufacturing-of-gutka-389468.html|title=Jharkhand bans sale, manufacturing of gutka|work=Firstpost|date=24 July 2012|access-date=30 May 2015|archive-date=7 January 2019|archive-url=https://web.archive.org/web/20190107054521/https://www.firstpost.com/india/jharkhand-bans-sale-manufacturing-of-gutka-389468.html|url-status=live}}</ref>
|-
| [[Kerala]] || 25 May 2012<ref>{{cite news |author=Mathew, Roy |url=http://www.thehindu.com/news/states/kerala/article3455962.ece |title=Kerala bans pan masala and its variants |work=The Hindu |date=25 May 2012 |access-date=16 August 2013 |location=Chennai, India |archive-date=7 January 2019 |archive-url=https://web.archive.org/web/20190107054624/https://www.thehindu.com/news/states/kerala/article3455962.ece%20/ |url-status=live }}</ref> || On 2 August 2012, Kerala High Court declined to stay the ban.
|<ref>{{cite news | url=http://zeenews.india.com/news/kerala/hc-refuses-to-stay-ban-on-pan-masala_791249.html | title=HC refuses to stay ban on pan masala | date=2 August 2012 | access-date=2 August 2012 | archive-date=7 January 2019 | archive-url=https://web.archive.org/web/20190107054527/http://zeenews.india.com/news/kerala/hc-refuses-to-stay-ban-on-pan-masala_791249.html | url-status=live }}</ref>
|- 
| [[Karnataka]] || 31 May 2013 ||
|<ref>{{cite news|url=https://timesofindia.indiatimes.com/city/bangalore/Karnataka-to-ban-gutka-on-World-No-Tobbaco-Day/articleshow/20353186.cms |archive-url=https://web.archive.org/web/20130618095533/http://articles.timesofindia.indiatimes.com/2013-05-30/bangalore/39628254_1_gutka-products-areca-growers-karnataka-government |url-status=live |archive-date=18 June 2013 |title=Karnataka to ban gutka on 'World No Tobacco Day' |date=30 May 2013 |work=[[The Times of India]] |access-date=16 August 2013}}</ref>
|-
| [[Madhya Pradesh]] || 1 April 2012<ref>{{cite web |url=http://www.downtoearth.org.in/content/madhya-pradesh-bans-gutkha-and-other-chewing-tobacco-products |title=Madhya Pradesh bans gutkha and other chewing tobacco products |publisher=Down To Earth |date=3 April 2012 |access-date=16 August 2013 |archive-date=7 January 2019 |archive-url=https://web.archive.org/web/20190107054545/https://www.downtoearth.org.in/content/madhya-pradesh-bans-gutkha-and-other-chewing-tobacco-products%20 |url-status=dead }}</ref> || The law was upheld by the [[Madhya Pradesh High Court]].
|<ref>{{cite news|author=Tripathi, Ashish |url=https://timesofindia.indiatimes.com/city/lucknow/Ban-gutka-or-we-will-High-court-tells-Akhilesh-Yadav-government/articleshow/16452676.cms |archive-url=https://archive.today/20130103171713/http://articles.timesofindia.indiatimes.com/2012-09-18/lucknow/33925119_1_ban-gutkha-justice-anurag-kumar-high-court |url-status=live |archive-date=3 January 2013 |title='Ban gutka or we will', High court tells Akhilesh Yadav government |date=18 September 2012 |work=[[The Times of India]] |access-date=16 August 2013}}</ref>
|-
| [[Maharashtra]] || 20 July 2012<ref>{{cite news|url=https://timesofindia.indiatimes.com/city/mumbai/Ban-Day-1-FDA-set-to-root-out-gutka/articleshow/15065743.cms |archive-url=https://archive.today/20130126150711/http://articles.timesofindia.indiatimes.com/2012-07-21/mumbai/32776326_1_gutka-and-pan-masala-magnesium-carbonate-fda-commissioner-mahesh-zagade |url-status=live |archive-date=26 January 2013 |title=Ban Day 1: FDA set to root out gutka |date=21 July 2012 |work=[[The Times of India]] |access-date=16 August 2013}}</ref> || 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.<ref>{{cite news|url=https://timesofindia.indiatimes.com/city/mumbai/Maharashtra-bans-gutka-paan-m/articleshow/14825412.cms |archive-url=https://archive.today/20130126081852/http://articles.timesofindia.indiatimes.com/2012-07-11/mumbai/32631865_1_gutka-and-paan-masala-ban-maharashtra-government-today |url-status=live |archive-date=26 January 2013 |title=Maharashtra bans gutka, paan m |date=11 July 2012 |work=[[The Times of India]] |access-date=16 August 2013}}</ref><ref>{{cite news|author=Deshpande, Swati |url=https://timesofindia.indiatimes.com/city/mumbai/Current-ban-on-stronger-footing-than-in-2002/articleshow/14870645.cms |archive-url=https://archive.today/20130126204343/http://articles.timesofindia.indiatimes.com/2012-07-14/mumbai/32674531_1_gutka-and-pan-masala-ban-sale-tobacco-and-nicotine |url-status=live |archive-date=26 January 2013 |title=Current ban on stronger footing than in 2002 |date=14 July 2012 |work=[[The Times of India]] |access-date=16 August 2013}}</ref> The most recent ban was upheld by the [[Bombay High Court]] on 15 September 2012.<ref>{{cite web |url=http://www.ndtv.com/article/india/bombay-high-court-upholds-ban-on-gutka-pan-masala-in-maharashtra-267896 |title=Bombay High Court upholds ban on gutka, pan masala in Maharashtra |publisher=NDTV.com |date=15 September 2012 |access-date=16 August 2013 |archive-date=7 January 2019 |archive-url=https://web.archive.org/web/20190107054507/https://www.ndtv.com/india-news/bombay-high-court-upholds-ban-on-gutka-pan-masala-in-maharashtra-499412 |url-status=live }}</ref>
|
|-
| [[Manipur]] || ||
|<ref name="The Times of India" /><ref>{{cite web|url=http://m.indiatoday.in/story/tripura-meghalaya-to-ban-gutka-and-pan-masala/1/267258.html|title=Tripura, Meghalaya take initiative to ban gutka and pan masala|date=23 April 2013|access-date=30 May 2015|archive-date=7 January 2019|archive-url=https://web.archive.org/web/20190107054559/https://www.indiatoday.in/india/northeast/story/tripura-meghalaya-to-ban-gutka-and-pan-masala-159758-2013-04-23|url-status=live}}</ref>
|-
| [[Mizoram]] || 18 October 2012 ||
|<ref>{{cite web |url=http://www.indianexpress.com/news/mizoram-bans-gutkha-products/1018691 |title=Mizoram bans gutkha products |work=Indian Express |date=18 October 2012 |access-date=16 August 2013 |archive-date=21 October 2012 |archive-url=https://web.archive.org/web/20121021141334/http://www.indianexpress.com/news/mizoram-bans-gutkha-products/1018691 |url-status=live }}</ref><ref>{{cite web |url=http://zeenews.india.com/news/health/health-news/mizoram-bans-gutkha-products_19272.html |title=Mizoram bans gutkha products |publisher=Zee News |date=18 October 2012 |access-date=16 August 2013 |archive-date=7 January 2019 |archive-url=https://web.archive.org/web/20190107054509/http://zeenews.india.com/news/health/health-news/mizoram-bans-gutkha-products_19272.html |url-status=live }}</ref><ref>{{cite news|url=http://www.business-standard.com/article/pti-stories/mizoram-bans-gutkha-products-112101800580_1.html|title=Mizoram bans gutkha products|author=Press Trust of India|date=18 October 2012|access-date=30 May 2015|newspaper=Business Standard India|archive-date=7 January 2019|archive-url=https://web.archive.org/web/20190107054606/https://www.business-standard.com/article/pti-stories/mizoram-bans-gutkha-products-112101800580_1.html|url-status=live}}</ref><ref>{{cite web |url=http://www.assamtribune.com/scripts/detailsnew.asp?id=sep0912/city07 |title=Call to replicate Mizoram ban in State |publisher=The Assam Tribune |date=9 September 2012 |access-date=16 August 2013 |url-status=dead |archive-url=https://web.archive.org/web/20140514035638/http://www.assamtribune.com/scripts/detailsnew.asp?id=sep0912%2Fcity07 |archive-date=14 May 2014 |df=dmy-all }}</ref>
|-
| [[Nagaland]] ||  ||
|<ref name="KT" />
|-
| [[Odisha]] || 1 January 2013||
|<ref>{{cite news |url= https://timesofindia.indiatimes.com/city/bhubaneswar/Odisha-rings-in-2013-with-gutka-ban/articleshow/17850350.cms |archive-url= https://web.archive.org/web/20130108002322/http://articles.timesofindia.indiatimes.com/2013-01-02/bhubaneswar/36110984_1_fssai-regulation-gutka-ban-tobacco-and-nicotine |url-status= live |archive-date= 8 January 2013 |title=Odisha rings in 2013 with gutka ban |year=2013|quote=The state government on Tuesday announced a ban on the sale and manufacture of gutka and paan masala. |work= [[The Times of India]] |access-date=2 January 2013}}</ref><ref>{{cite web |url=http://www.thehindubusinessline.com/news/states/odisha-bans-gutkha-tobacco-sale/article4262271.ece |title=Business Line : News / States : Odisha bans gutkha, tobacco sale |work=thehindubusinessline.com |year=2013 |quote=The Odisha Government on Tuesday announced a State-wide ban on the manufacture, sale and use of gutkha and chewing tobacco containing nicotine. |access-date=2 January 2013 |archive-date=7 January 2019 |archive-url=https://web.archive.org/web/20190107054613/https://www.thehindubusinessline.com/news/national/odisha-bans-gutkha-tobacco-sale/article4262271.ece%20/ |url-status=live }}</ref><ref>{{cite web |url=http://www.indianexpress.com/news/briefly-nation-orissa-bans-use-of-gutkha/1053040/ |title=Briefly Nation: Orissa bans use of gutkha - Indian Express |work=indianexpress.com |year=2013 |quote=Orissa government on Tuesday announced a state-wide ban on the manufacture, sale and use of gutkha and chewing tobacco containing nicotine. |access-date=2 January 2013 |archive-date=6 January 2013 |archive-url=https://web.archive.org/web/20130106010800/http://www.indianexpress.com/news/briefly-nation-orissa-bans-use-of-gutkha/1053040 |url-status=live }}</ref>
|-
| [[Punjab, India|Punjab]] || 26 August 2012 ||
|<ref>{{cite web |url=http://news.webindia123.com/news/Articles/India/20120827/2052048.html |title=Punjab bans sale of gutka, pan masala |publisher=News.webindia123.com |date=27 August 2012 |access-date=16 August 2013 |archive-date=7 January 2019 |archive-url=https://web.archive.org/web/20190107054547/http://news.webindia123.com/news/Articles/India/20120827/2052048.html%20 |url-status=dead }}</ref>
|-
| [[Rajasthan]] || 18 July 2012 ||
|<ref>{{cite web |url=http://zeenews.india.com/news/rajasthan/rajasthan-government-decides-to-ban-gutkha_788233.html |title=Rajasthan government decides to ban Gutkha |publisher=Zee News |date=18 July 2012 |access-date=16 August 2013 |archive-date=7 January 2019 |archive-url=https://web.archive.org/web/20190107054524/http://zeenews.india.com/news/rajasthan/rajasthan-government-decides-to-ban-gutkha_788233.html |url-status=live }}</ref><ref>{{cite web |url=http://www.indiatvnews.com/news/india/rajasthan-government-decides-to-ban-gutkha-17044.html |title=Rajasthan government decides to ban Gutkha |publisher=India TV News |date=18 July 2012 |access-date=16 August 2013 |archive-date=7 January 2019 |archive-url=https://web.archive.org/web/20190107054449/https://www.indiatvnews.com/news/india/rajasthan-government-decides-to-ban-gutkha-17044.html%20 |url-status=live }}</ref>
|-
| [[Sikkim]] || 17 September 2012 ||
|<ref>{{cite web |url=http://www.downtoearth.org.in/content/sikkim-bans-gutkha |title=Sikkim bans gutkha |work=DownToEarth |access-date=12 February 2013 |archive-date=7 January 2019 |archive-url=https://web.archive.org/web/20190107054621/https://www.downtoearth.org.in/content/sikkim-bans-gutkha%20 |url-status=dead }}</ref>
|-
| [[Tamil Nadu]] || 8 May 2013 ||
|<ref>{{cite web |url=http://www.thehindubusinessline.com/news/states/tn-bans-pan-masala-gutka/article4695155.ece |title=TN bans pan masala, gutka |work=The Hindu |date=8 May 2013 |access-date=16 August 2013 |archive-date=7 January 2019 |archive-url=https://web.archive.org/web/20190107054554/https://www.thehindubusinessline.com/news/national/tn-bans-pan-masala-gutka/article4695155.ece%20/ |url-status=live }}</ref>

|-
| [[Uttar Pradesh]] || 1 April 2013 ||
|<ref>{{cite news|url=https://timesofindia.indiatimes.com/city/lucknow/After-HC-order-UP-to-ban-gutka-from-April-1-next-year-2013/articleshow/16662953.cms |archive-url=https://web.archive.org/web/20130221011826/http://articles.timesofindia.indiatimes.com/2012-10-04/lucknow/34259483_1_ban-gutka-gutka-and-pan-masala-tobacco-and-nicotine |url-status=live |archive-date=21 February 2013 |title=After HC order, UP to ban gutka from April 1 next year, 2013 |date=4 October 2012 |work=[[The Times of India]] |access-date=16 August 2013}}</ref>
|-
| [[Uttarakhand]] || 1 January 2013 ||
|<ref>{{cite news |url=http://www.thehindu.com/todays-paper/tp-national/uttarakhand-gutka-ban-now-from-january-1/article4018117.ece |title=Uttarakhand gutka ban now from January 1 |work=The Hindu |date=21 October 2012 |access-date=16 August 2013 |location=Chennai, India |archive-date=7 January 2019 |archive-url=https://web.archive.org/web/20190107054533/https://www.thehindu.com/todays-paper/tp-national/uttarakhand-gutka-ban-now-from-january-1/article4018117.ece%20/ |url-status=live }}</ref>
|-
| [[West Bengal]] || 1 May 2013 ||
|<ref>{{cite news|url=https://timesofindia.indiatimes.com/city/kolkata/Finally-state-orders-ban-on-gutka/articleshow/19719114.cms |archive-url=https://web.archive.org/web/20130618040620/http://articles.timesofindia.indiatimes.com/2013-04-25/kolkata/38816134_1_pan-masala-gutka-10-tax-hike |url-status=live |archive-date=18 June 2013 |title=Finally, state orders ban on gutka |date=25 April 2013 |work=[[The Times of India]] |access-date=16 August 2013}}</ref><ref>{{cite web |title=Government of west bengal department of health and family welfare |url=http://www.wbhealth.gov.in/go/cfs146.pdf |archive-url=https://web.archive.org/web/20130702171010/http://www.wbhealth.gov.in/go/cfs146.pdf |archive-date=July 2, 2013 |url-status=dead}}</ref>
|}

Research firm [[Edelweiss Group|Edelweiss]] estimates the gutka ban will cause the industry {{INR|15-20 billion}} in losses.<ref>{{cite news|author=Chandramouli, Rajesh |url=https://timesofindia.indiatimes.com/city/chennai/Gutka-ban-loss-could-be-Rs-1500--Rs-2000-crores/articleshow/16398290.cms |archive-url=https://archive.today/20130103131948/http://articles.timesofindia.indiatimes.com/2012-09-14/chennai/33842950_1_gutka-ban-gutkha-tobacco |url-status=live |archive-date=3 January 2013 |title=Gutka ban loss could be Rs 1500 - Rs 2000 crores |date=14 September 2012 |work=[[The Times of India]] |access-date=16 August 2013}}</ref>

==== 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 [[surrogate advertising|skirt the ban on advertising tobacco products]]. Surrogate advertisements often use pan masala ads to promote gutka products with similar name and packaging.<ref>{{Cite news |date=20 June 2012 |title=Ban surrogate advertisements of tobacco products |url=http://www.deccanherald.com/content/258543/ban-surrogate-advertisements-tobacco-products.html |work=[[Deccan Herald]] |access-date=10 July 2012 |archive-date=17 October 2014 |archive-url=https://web.archive.org/web/20141017222628/http://www.deccanherald.com/content/258543/ban-surrogate-advertisements-tobacco-products.html |url-status=live }}</ref>

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 {{INRConvert|1000000|lk=on}}.<ref>{{cite news| url=https://timesofindia.indiatimes.com/city/bhubaneswar/No-relaxation-on-gutka-ban/articleshow/18041675.cms | archive-url=https://archive.today/20130411034610/http://articles.timesofindia.indiatimes.com/2013-01-16/bhubaneswar/36373255_1_gutka-and-paan-masala-sale-and-advertisement-anti-tobacco | url-status=live | archive-date=2013-04-11 | work=[[The Times of India]] | title=No relaxation on gutka ban}}</ref>

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.<ref>{{cite news | url=https://industrynewswire.us/what-are-the-key-challenges-to-india-pan-masala-market-growth/136971/ | work=Industry News Wire | title=Indian Pan Masala Market Share Analysis | access-date=20 February 2020 | archive-date=20 October 2020 | archive-url=https://web.archive.org/web/20201020140525/https://industrynewswire.us/what-are-the-key-challenges-to-india-pan-masala-market-growth/136971/ | url-status=live }}</ref>

==See also==
* [[Mukesh Harane]]

==Notes==
{{Reflist|30em}}

== 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 ==
* [https://www.nytimes.com/2002/08/13/international/asia/13INDI.html?todaysheadlines Sweet but Deadly Addiction is Seizing the Young in India], ''[[The New York Times]]'', 13 August 2002
* [http://news.bbc.co.uk/1/hi/health/398630.stm Chewing tobacco cancer warning], ''[[BBC News]]'', 26 July 1999
* [http://news.bbc.co.uk/2/hi/health/289976.stm Health: Children Buy Cancerous Sweets], ''[[BBC News]]'', 3 March 1999
* [https://web.archive.org/web/20150517015526/http://www.cpaaindia.org/activities/projects.htm#gutkha Anti Gutkha Campaign], Cancer Patients Aid Association
* [http://ruaab.in Ruaab Pan Masala], ''Gutka'', 16 July 2018

{{Social issues in India}}

[[Category:Chewing tobacco brands]]
[[Category:Tobacco in India]]
[[Category:Tobacco in Pakistan]]
[[Category:Herbal and fungal stimulants]]
[[Category:Desi culture]]
[[Category:Masticatories]]
[[Category:IARC Group 1 carcinogens]]
[[Category:Controversies in India]]