Gutka use often begins at a very young age. The product contains large amounts of sweeteners to conceal the bitterness of the tobacco, and children often consider it as a type of candy. Symptoms of cancer often appear by high school or college age. Social custom does not permit children in India to smoke cigarettes, so gutka use, being all but invisible to others, is the method of choice.
Maharashtra State[?] has placed a five year ban on all use of gutka (as a potentially hazardous foodstuff), but an active black market persists.
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