Smokeless tobacco kills more than a quarter of a million people each year, say British scientists. The lives of millions of others are shortened by bad health due to their chewing habit.

Researchers from the University of Edinburgh and Imperial College London say their study is the first to assess the global impact of smokeless tobacco on adults, and that governments and public health groups need to consider regulating smokeless tobacco.

"It is possible that these figures are underestimated and future studies may reveal that the impact is even bigger," said Dr. Kamran Siddiqi of Hull York Medical School. "We need a global effort to try and address and control smokeless tobacco."

The study used data from 113 countries and found that in 2010, smokeless tobacco caused more than 200,000 deaths from heart disease, and 62,000 deaths due to cancers of the mouth, pharynx and esophagus.

Siddiqi said that smokeless tobacco was especially prevalent in South-East Asia, but that it was also a problem in some areas of England.

"We have got no international policy on how to regulate the production, composition, sale, labeling, packaging and marketing of smokeless tobacco products," Siddiqi said.

"The international framework to control tobacco doesn't seem to work to control smokeless tobacco. It doesn't get the same regulation as cigarettes.

"There is a need to build on the insights obtained from efforts to reduce cigarette smoking and to investigate strategies to reduce the use of smokeless tobacco," Siddiqi said.