Officials warn that tradition could be an enemy in the fight to change attitudes towards chewing tobacco, a popular activity among Cambodian women

Photo by: Cat Barton

An ethnic minority woman in Ratanakkiri province displays the hallmark bad teeth that come from a lifetime of chewing tobacco, as she puts another wad into her mouth.

WHILE the government prepares to tighten its control over cigarettes through new laws on their promotion and labeling, tradition appears to be winning the battle to discourage a different type of tobacco addiction.

"I have never heard that chewing tobacco causes mouth cancer," said Oum Touch, 87, a nun who lives at Wat Lanka who picked up the habit of chewing tobacco from her mother.

Roughly 600,000 women in Cambodia, most middle-aged or older, chew tobacco, while the majority of men prefer to smoke it, according to Dr Yel Daravuth, national officer for the World Health Organisation's Tobacco Free Initiative.

But while most women are aware that smoking is unhealthy, knowledge about the adverse effects of chewing tobacco is still thinly spread.

"Research by the WHO shows that chewing tobacco can cause women to develop lung and mouth cancer," Yel Daravuth  said during a workshop earlier this month, calling on the government to initiate education campaigns that warn against the habit.

 "Tobacco control that focuses only on cigarettes will not necessarily address the health risks from other forms of tobacco that are in widespread use among women and ethnic minorities and that are part of long-standing cultural, familial and traditional medicine practices," he said.

Dr Lim Thaipheang, director of the National Center for Health Promotion (NCHP), told the Post that while chewing tobacco does not cause harm to others, "chewing and smoking have the same bad effects".

...I have never heard that chewing tobacco causes mouth cancer. 

He said that because only a small number of women smoke and chew - and due to limited financial resources - the government has not yet started to focus its campaigns on women.

As party to the WHO Framework Convention on Tobacco Control, Cambodia has been working on a draft law on tobacco control that is currently awaiting approval. The law includes a ban on tobacco advertising, promotion and sponsorship, the addition of warnings labels on packaging and the creation of smoke-free areas, but it does not refer to tobacco chewing.

But it is the potential risks of chewing tobacco, alongside other traditional habits, that needs promotion.

Wat Lanka nun Oum Touch said she knows nothing about the risks of chewing tobacco but "would never smoke cigarettes because they go straight into our bodies and affect the health of others around us", she said.

 The areca nut, better known as the betel nut, is another stimulant that enjoys widespread popularity among older Cambodians and is considered to be carcinogenic. As with tobacco, knowledge of its health effects among Cambodians is often shrouded in folklore.

"I do not know if [it] affects our health, but betel leaf and areca are important in curing typhoid", said Neth Thos, 63, who has run a betel nut shop at Boeung Keng Kang market since 1993. "They are Cambodian traditional medicine."

Lim Thai Pheang said the NCHP had not yet studied the health effects of betel nut.