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Asia-Pacific also hosts 81% of the worlds smokeless tobacco users, with India, Bangladesh, and Nepal leading consumption of gutkha, khaini, and other forms, reinforcing strong revenue streams in the smokeless tobacco market

Moreover, SMG secretory cells produce a MUC5B -dominated mucus that requires less post-translational processing and glycosylation than surface epithelial mucus production, consistent with recent studies finding that mucus produced from the SMGs has distinct physical properties from that of surface epithelia 36,37

Across the studies examined, health risks associated with these alternative products remain incompletely defined, particularly in younger populations

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Competing interests The study notes that the authors have no connection to the tobacco industry