Researchers in Pakistan studied 283 children ages 6-12 to see if chewing smokeless tobacco products affects their blood health. They found that children who used smokeless tobacco had slightly lower iron levels in their blood compared to children who didn’t use it. However, the difference was small and not strong enough to be completely certain. The study is important because it shows that smokeless tobacco use among young children in rural areas is a real problem, with some kids starting as early as age 6. This research highlights a public health concern that needs more attention and prevention efforts.

The Quick Take

  • What they studied: Whether chewing smokeless tobacco products affects the amount of iron-carrying protein (hemoglobin) in children’s blood
  • Who participated: 283 school children ages 6-12 from four rural schools in Matiari, Pakistan. About 53% were boys, and the average age was 8 years old. About 12% of the children reported using smokeless tobacco
  • Key finding: Children who chewed smokeless tobacco had blood iron levels that were 0.4 points lower on average compared to children who didn’t use it. However, this difference was small and researchers couldn’t be completely certain it was real rather than just chance
  • What it means for you: If you have children in areas where smokeless tobacco use is common, this research suggests it may affect their blood health. However, more research is needed to confirm this connection. Prevention of tobacco use in children remains important for overall health

The Research Details

This was a cross-sectional study, which means researchers took a snapshot in time by collecting information from children all at once rather than following them over months or years. The study took place over 40 days in August and September 2024 in four schools in rural Pakistan. Researchers used a systematic approach to select students, making sure to include at least 14 students from each class and 70 from each school to get a fair sample.

The researchers asked children and their parents questions about smokeless tobacco use, eating habits, and health history using a computer-based survey. They measured each child’s blood iron levels using a special device called HemoCue, and they also measured height and weight. Smokeless tobacco use was defined as using any smokeless tobacco product (like chewing tobacco or snuff) for at least 5 minutes per day during the past month.

The study excluded children who had blood disorders, serious nutritional problems, or intestinal worm infections, since these conditions would affect blood iron levels independently of tobacco use.

This research approach is important because it looks at real children in their actual communities rather than in a lab setting. By comparing tobacco users to non-users at the same time, researchers can spot patterns and associations. However, this type of study can’t prove that tobacco causes lower iron levels—it can only show they happen together. Understanding these patterns helps public health officials identify problems that need more investigation

The study has several strengths: it used a systematic method to select participants, measured blood iron levels with a reliable device, and collected detailed information about tobacco use. However, there are limitations to consider. The study was done in only one rural area of Pakistan, so results may not apply to other regions or countries. The sample size of 283 children is moderate, and only 34 children used tobacco, which is a small number for drawing strong conclusions. The study couldn’t prove cause-and-effect, only that the two factors occurred together

What the Results Show

Among the 283 children studied, 34 (about 12%) reported using smokeless tobacco. The median blood iron level for tobacco users was 10.8 g/dL compared to 11.2 g/dL for non-users—a difference of 0.4 points. While tobacco users had lower levels, this difference was not statistically significant, meaning researchers couldn’t be confident it wasn’t just due to chance (p-value = 0.17).

When researchers adjusted their analysis to account for other factors that might affect blood iron levels, they found that smokeless tobacco use was associated with a 0.4 g/dL decrease in hemoglobin. However, the confidence interval (a range showing uncertainty) included zero, meaning the true effect could be anywhere from a decrease of 0.97 to an increase of 0.17. This wide range indicates considerable uncertainty about the true effect.

Most children who used smokeless tobacco (79%) used it only 1-3 days in the past month, suggesting occasional rather than daily use. This is important because occasional use might have different effects than regular use. The study also found that most tobacco-using children started before age 6 or between ages 7-8, which is concerning given their young age.

The overall group of children studied had lower blood iron levels than recommended for healthy children. This suggests that iron deficiency may be a broader problem in this rural Pakistani population beyond just tobacco use. The researchers noted that smokeless tobacco may interfere with how the body absorbs iron from food, which could explain why users had lower levels. The study also highlighted that tobacco use among very young children (starting before age 6) is a significant public health concern that deserves attention

Previous research has suggested that smokeless tobacco can interfere with iron absorption and nutritional status, particularly in developing countries. This study adds to that evidence by showing a pattern in children, though the effect was smaller than some previous studies suggested. The finding that children start using tobacco at very young ages (before age 6) is consistent with reports from other low- and middle-income countries where smokeless tobacco use is culturally common

The study has several important limitations. First, it was conducted in only one rural area of Pakistan, so the findings may not apply to urban areas or other countries. Second, the small number of tobacco users (34 children) makes it harder to find a clear effect. Third, the study only looked at one point in time, so researchers couldn’t determine whether tobacco use caused the lower iron levels or if children with lower iron levels were more likely to use tobacco. Fourth, the study relied on children and parents reporting their tobacco use, which might not be completely accurate. Finally, the researchers couldn’t account for all possible factors that might affect blood iron levels, such as specific dietary iron intake or parasitic infections

The Bottom Line

Based on this research, public health efforts should focus on preventing smokeless tobacco use in children, particularly in rural areas where it’s more common. Parents and educators should be educated about the potential health risks of smokeless tobacco, especially for young children. Healthcare providers should screen children for tobacco use and provide counseling. However, because this study shows only a weak association and can’t prove cause-and-effect, these recommendations should be part of broader tobacco prevention efforts rather than based solely on this research. Confidence level: Moderate—more research is needed to confirm these findings

Parents and caregivers in areas where smokeless tobacco use is common should pay attention to this research. Healthcare providers working with children in low- and middle-income countries should be aware of tobacco use as a potential factor affecting children’s nutrition and blood health. Public health officials and policymakers should consider these findings when developing tobacco prevention programs for children. Teachers and school administrators should also be aware of this issue. However, this research is most relevant to rural areas in South Asia where smokeless tobacco use is culturally common; it may be less relevant to areas where such use is rare

If smokeless tobacco use is stopped, improvements in blood iron levels would likely take weeks to months, depending on the child’s overall diet and iron stores. The body needs time to absorb iron from food and rebuild iron reserves. However, the most important benefit of stopping tobacco use would be preventing ongoing damage to nutrition and health

Want to Apply This Research?

  • Track tobacco use frequency (days per week or month) and blood iron levels (hemoglobin) at regular intervals (every 3 months). Users can log when they or their children use smokeless tobacco products and note any symptoms like tiredness or paleness
  • Set a goal to reduce smokeless tobacco use frequency by 50% over the next month, with a target of complete cessation. Use the app to log tobacco-free days and receive encouragement notifications. Track energy levels and appetite as potential improvements
  • Establish a baseline of current tobacco use and blood iron levels (if available from a health provider). Set monthly check-ins to review progress toward reducing use. If possible, arrange periodic blood tests to monitor hemoglobin levels over 3-6 months. Track related health markers like energy, appetite, and overall well-being

This research suggests an association between smokeless tobacco use and lower blood iron levels in children, but cannot prove that tobacco directly causes this effect. The findings are based on a single study in rural Pakistan and may not apply to all populations. If you’re concerned about a child’s blood iron levels or tobacco use, consult with a healthcare provider for proper evaluation and personalized advice. This information is for educational purposes and should not replace professional medical guidance. Parents should seek medical attention if their child shows signs of anemia, such as unusual tiredness, paleness, or shortness of breath.