Chewing tobacco killed around a quarter of a million people in 2023, with use of the product remaining stubbornly high, according to research.

The smokeless tobacco, which is placed between the cheek and lower gum, is particularly popular in south Asia. It is flavoured and sometimes sweetened, and users often spit out unwanted juices while chewing. It is often viewed as safer than smoking but it is a major cause of stroke, as well as head and neck cancer.

Chewing tobacco is different to white snus or nicotine pouches, which contain no tobacco. These white pouches are also made up of flavourings and sometimes sweeteners, and deliver a hit of nicotine through the lining of the mouth.

Despite a successful fight against smoking over the last few decades, rates of chewing tobacco use have fallen little and it has often been overlooked in tobacco control efforts, researchers point out.…