Tuibur: tobacco in a bottle—commercial production of tobacco smoke‐saturated aqueous concentrate

Certain forms of tobacco that are relatively unknown in the scientific community have been used widely for centuries. One such form is tuibur 1, 2, a tobacco smoke-saturated aqueous concentrate prevalent in north-eastern India 3. The highest prevalence of tobacco consumption in India occurs in the northeastern province of Mizoram 4, 5, where the Aizawl District also leads the incidence rates of all tobacco-related cancers in the country 6. Yet references to tuibur use are rare and restricted mainly to local publications 3, 7-12. This commentary aims to raise awareness and stimulate research on this tobacco product about which little is known. We describe its production and distribution with the support of photographs to contextualize this knowledge for readers. Historically, women smoked tobacco in waterpipes made of bamboo (Fig. 1), and would offer the leftover tobacco-infused water from the pipe reservoir to their husband 10. Users keep a small amount (5–10 ml) of liquid in the mouth for many minutes several times throughout the day; some may also swallow a portion of the liquid 13. Increased demand for the product moved production from households to makeshift sheds located near natural water sources (Fig. 2). Indeed, concern over its environmental and health impact may help to explain why tuibur is produced in small batches in artisanal facilities 14-16. The production of a fresh batch of tuibur starts early in the morning. First, water is alkalized by being filtered through tobacco ash from the previous batch (Supporting information, Fig. S1). Alkaline pH maintains an unprotonated form of nicotine that is absorbed easily through the oral mucosa 1. This solution is then poured into the lower chamber of a device (Fig. 3) with a rudimentary water educator (aspirator). A pipe is inserted into this chamber with one end just below the water level, and sealed with mud (Fig. 3). The upper half of the device, the combustion chamber, is connected to the lower chamber through a filtered opening at the bottom. Dried tobacco stalk is placed in the combustion chamber and set to smoulder (Supporting information, Fig. S2). Subsequently, this chamber is sealed with wet tobacco ash. The pressure from a stream of water creates a suction in the smaller pipes, which ensures that tobacco smoke bubbles through the alkaline solution. The process is complete when the tobacco stalk has burned completely, which takes anywhere from 12 hours to 3 days, depending upon the amount of tobacco stalk used. ‘Crude’ tuibur from the lower chamber is then pipetted out and filtered again through tobacco ash (Supporting information, Figure S3). This ‘commercial’ grade tuibur is sold in bulk to distributors, who bottle and sell it in local markets with a statutory pictorial warning. Tuibur consumption is highly addictive, and deeply entrenched in the culture of the region. In addition, the rudimentary character of tuibur production has potential environmental consequences, which may compound health impacts. At a time when tobacco control is a global priority, we argue that this deleterious habit merits more research attention. None. We are grateful to the producers of Tuibur who welcomed our visit to their production site. We also thank Drs G. Castonguay and A. Levine for providing helpful comments on the manuscript. B. Nicolau holds a Canada Research Chair in Life Course Oral Epidemiology and received a Shastri Scholar Travel Subsidy Grant to support her visit to University of Mizoram. Figure S1 Preparation of feedstock for tuibur. S1a: Filtering water through tobacco ash to make it alkaline; S1b: filling the alkaline feedstock to lower compartment; S1c: inlet pipe for tobacco smoke to lower chamber. Figure S2 S2a and S2b: Dried tobacco stalk loaded into the upper chamber; S2c: burning of tobacco stalk in the upper chamber. Figure S3 S3a: Pipetting out of tuibur from lower chamber; S3b: filling containers with tuibur for transportation; S3c: tuibur sold in local market. Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article.

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