Among those who use smoked tobacco products 15m (14 pct) use cigarette and 5.3 m (5 pct) use bidi and 20m (18.7 pct) smokeless users used betel quid with tobacco
while 3.9 m (3.6 pct) use gul, it added.
Betel quid with tobacco showed higher risk of developing oral cancer compared to those who chewed betel quid without tobacco.
 In a study among people with chewing habits, those who chewed betel quid with tobacco showed an OR 3.19, 95% CI: 0.48-2.13 and tobacco alone (OR 2.89) showed a greater risk than controls.
Besides, 228(48.3%) patients used betel quid with tobacco, 108(22.9%) consumed areca nut only, 55(11.7%) chewed betel quid without tobacco, 36(7.6%) used naswar, while 45(9.5%) had no chewing habits (Table)
They exhibited an increased consumption of betel quid with tobacco and its associated locally available variants.
For men the OR for chewing betel quid with tobacco ranged from 1.5 [0.75-3.02]  to 10.9 ; among women the OR ranged between 6.5  and 45.8 [25-84.1] .
Users of betel quid with tobacco have a sevenfold higher risk for developing oral cancer as compared to nonchewers, OR 7.1 [4.5-11.1].
A large majority of these tobacco users prefer smokeless tobacco products like betel quid with tobacco
, gutkha, paan masala, khaini, mishri, gul, over smoking tobacco.
[paragraph] In Bangladesh, these included betel quid with tobacco, sada pata, gul, khoinee zarda, and pan masala.
([paragraph]) In Bangladesh, these include betel quid with tobacco, sada pata, gul, khoinee zarda, and pan masala.
Traditionally, chewing betel quid with tobacco
was more common among the Kerala population irrespective of social class and caste.