Betel quid with tobacco, also known as gutka, is a form of chewing tobacco primarily used in the Indian subcontinent (India, Pakistan, and Bangladesh). It is a dry preparation that consists of tobacco, areca nut, catechu, and slaked lime (calcium hydroxide) wrapped in betel leaf. Spices- such as cardamom, saffron, cloves, anise seeds, turmeric, and mustard- and sweeteners are also added as flavorants. It is used by placing a pinch of the mixture in the mouth between the gum and cheek and sucking or chewing it. The excess saliva produced by chewing may be swallowed or spit out.

Betel quid without tobacco is widely used in Southeast Asian countries, including Taiwan, Myanmar, Thailand, China, Papua New Guinea, and Guam. Prepared betel quid, either with or without tobacco, in the Indian subcontinent is know as pan.

Health Effects of Betel Quid

Studies examining the health effects of gutka have found it to be carcinogenic or able to cause cancer in humans. The following cancers and conditions have been associated with using betel quid: oral precancerous lesions; lesions that result in inability to open the mouth; oral cancers of the lip, mouth, tongue, and pharynx; and esophageal cancer.

Betel quid use can also have adverse effects on reproductive health in women. Studies have found that pregnant women in India had a threefold increased risk of having a low birth weight infant with regular betel quid use.

Current Estimates of Betel Quid Use in the U.S.

Betel quid use in not currently monitored in the United States.

Source: Centers for Disease Control and Prevention, Smoking and Tobacco Use. "Fact Sheet: Betel Quid with Tobacco (Gutka)," February 2007.