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The Oral Fixation Problem: Muh Ko Kuch Chahiye There is another angle that gets completely ignored in most "how to quit gutkha" advice, and it is the oral fixation component

We found in current smokers a positive association between smoking pack-years and cigarettes per day with SBP in both genders, but not with DBP, and only for cigarettes per day with hypertension prevalence in both men and women

Much of this seems dependent upon dosage and current levels of nicotine in the blood

For heavy smokers who regularly light up 20 or more cigarettes, the health impact gets less polite and more assertive

All of these stack up