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The relative risk of all-cause mortality due to SLT use is also higher among women.[9] Several studies have shown that women have difficulty in quitting tobacco, tend to experience faster relapse due to stressful events or depression and fail to maintain long-term abstinence.[10,11,12] Evidence suggests that estrogen may enhance nicotine metabolism in women, which can affect their ability to quit tobacco successfully.[13] Since its introduction in the 17 th century in India, tobacco chewing was believed to have calming and stimulating qualities and was not only socially acceptable but also a part of its culture.[14] SLT use can be found in other South and Southeast Asian countries as well

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