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Gil GF, Anderson JA, Aravkin A, Bhangdia K, Carr S, Dai X, Flor LS, Hay SI, Malloy MJ, McLaughlin SA, Mullany EC, Murray CJL, O'Connell EM, Okereke C, Sorensen RJD, Whisnant J, Zheng P, Gakidou E. Health effects associated with chewing tobacco: a Burden of Proof study. Nat Commun 2024; 15:1082. [PMID: 38316758 PMCID: PMC10844244 DOI: 10.1038/s41467-024-45074-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Accepted: 01/15/2024] [Indexed: 02/07/2024] Open
Abstract
Chewing tobacco use poses serious health risks; yet it has not received as much attention as other tobacco-related products. This study synthesizes existing evidence regarding the health impacts of chewing tobacco while accounting for various sources of uncertainty. We conducted a systematic review and meta-analysis of chewing tobacco and seven health outcomes, drawing on 103 studies published from 1970 to 2023. We use a Burden of Proof meta-analysis to generate conservative risk estimates and find weak-to-moderate evidence that tobacco chewers have an increased risk of stroke, lip and oral cavity cancer, esophageal cancer, nasopharynx cancer, other pharynx cancer, and laryngeal cancer. We additionally find insufficient evidence of an association between chewing tobacco and ischemic heart disease. Our findings highlight a need for policy makers, researchers, and communities at risk to devote greater attention to chewing tobacco by both advancing tobacco control efforts and investing in strengthening the existing evidence base.
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Affiliation(s)
- Gabriela F Gil
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Jason A Anderson
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Aleksandr Aravkin
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
- Department of Health Metrics Sciences, School of Medicine, University of Washington, Seattle, WA, USA
- Department of Applied Mathematics, University of Washington, Seattle, WA, USA
| | - Kayleigh Bhangdia
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Sinclair Carr
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Xiaochen Dai
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
- Department of Health Metrics Sciences, School of Medicine, University of Washington, Seattle, WA, USA
| | - Luisa S Flor
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
- Department of Health Metrics Sciences, School of Medicine, University of Washington, Seattle, WA, USA
| | - Simon I Hay
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
- Department of Health Metrics Sciences, School of Medicine, University of Washington, Seattle, WA, USA
| | - Matthew J Malloy
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Susan A McLaughlin
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Erin C Mullany
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Christopher J L Murray
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
- Department of Health Metrics Sciences, School of Medicine, University of Washington, Seattle, WA, USA
| | - Erin M O'Connell
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Chukwuma Okereke
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Reed J D Sorensen
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Joanna Whisnant
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Peng Zheng
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
- Department of Health Metrics Sciences, School of Medicine, University of Washington, Seattle, WA, USA
| | - Emmanuela Gakidou
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA.
- Department of Health Metrics Sciences, School of Medicine, University of Washington, Seattle, WA, USA.
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Paul B, Jean Simon D, Kondo Tokpovi VC, Kiragu A, Balthazard-Accou K, Emmanuel E. Tobacco use in Haiti: findings from demographic and health survey. BMC Public Health 2023; 23:2504. [PMID: 38097954 PMCID: PMC10720190 DOI: 10.1186/s12889-023-17409-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2023] [Accepted: 12/05/2023] [Indexed: 12/18/2023] Open
Abstract
INTRODUCTION Although tobacco has harmful effects on the physical and mental health of individuals, its use remains significant, according to the World Health Organization. To understand this phenomenon, studies have been carried out in many countries around the world, while in Haiti where more than 5,000 people die each year due to tobacco use, little is known about the use of this substance. The aim of this study was to examine the prevalence and the factors associated with tobacco use in Haiti. METHODS We used data from the 2016/17 Haitian Demographic Health Survey. Both descriptive and multivariate analyses were conducted using STATA 16.0 software to assess the prevalence and identify factors associated with tobacco use. Results were reported as adjusted odds ratios with 95% confidence intervals. Statistical significance was declared at p < 0.05. RESULTS The prevalence of tobacco use was estimated at 9.8% (95% CI: 9.2-10.4) among men and 1.7% (95% CI: 1.5-1.9) among women. Although the prevalence of tobacco use was low among young people, it increased with age. Respondents aged 35 and above, with no formal education, non-Christians, divorced/separated/widowed, from poorest households, rural areas, "Aire Métropolitaine de Port-au-Prince" region, with high media exposure had a higher likelihood of tobacco use. CONCLUSION The low prevalence of tobacco use among Haitian women and youth represents a public policy opportunity to prevent these vulnerable groups from starting smoking. Adult male smokers should also be targeted by appropriate policy to reduce the different health burdens associated with tobacco, both for the smokers and other people they may expose to passive smoking. Government and health sector stakeholders, along with community leaders, should create and enforce awareness strategies and rules to control advertisements that encourage irresponsible and health-risky consumption behaviors.
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Affiliation(s)
- Bénédique Paul
- Department of Agro-socio-economics, Chibas, Université Quisqueya, Port-au-Prince, Haiti.
- Groupe d'Etude sur les Sciences de la Durabilité, Université Quisqueya, Port-au-Prince, Haiti.
| | - David Jean Simon
- Bureau d'Etudes et de Recherche en Statistiques Appliquées, Suivi et Evaluation (BERSA-SE), Port-au-Prince, Haiti
| | | | - Ann Kiragu
- Department of Law and Political and Social Sciences, University of Sorbonne Paris Nord, Paris, France
| | - Ketty Balthazard-Accou
- Groupe d'Etude sur les Sciences de la Durabilité, Université Quisqueya, Port-au-Prince, Haiti
- Espace universitaire One Health, Université Quisqueya, Port-au-Prince, Haiti
| | - Evens Emmanuel
- Espace universitaire One Health, Université Quisqueya, Port-au-Prince, Haiti
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Sarode GS, Sarode SC, Anand R. Impact of smokeless tobacco policies. Lancet Glob Health 2023; 11:e1337. [PMID: 37591577 DOI: 10.1016/s2214-109x(23)00309-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Accepted: 06/23/2023] [Indexed: 08/19/2023]
Affiliation(s)
- Gargi S Sarode
- Department of Oral Pathology and Microbiology, Dr D Y Patil Dental College and Hospital, Sant-Tukaram Nagar, Pimpri, Pune, Maharashtra 411018, India
| | - Sachin C Sarode
- Department of Oral Pathology and Microbiology, Dr D Y Patil Dental College and Hospital, Sant-Tukaram Nagar, Pimpri, Pune, Maharashtra 411018, India.
| | - Rahul Anand
- Department of Oral Pathology and Microbiology, Dr D Y Patil Dental College and Hospital, Sant-Tukaram Nagar, Pimpri, Pune, Maharashtra 411018, India
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Chugh A, Arora M, Jain N, Vidyasagaran A, Readshaw A, Sheikh A, Eckhardt J, Siddiqi K, Chopra M, Mishu MP, Kanaan M, Rahman MA, Mehrotra R, Huque R, Forberger S, Dahanayake S, Khan Z, Boeckmann M, Dogar O. The global impact of tobacco control policies on smokeless tobacco use: a systematic review. Lancet Glob Health 2023; 11:e953-e968. [PMID: 37202029 DOI: 10.1016/s2214-109x(23)00205-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Revised: 03/22/2023] [Accepted: 04/18/2023] [Indexed: 05/20/2023]
Abstract
BACKGROUND Smokeless tobacco, used by more than 300 million people globally, results in substantial morbidity and mortality. For smokeless tobacco control, many countries have adopted policies beyond the WHO Framework Convention on Tobacco Control, which has been instrumental in reducing smoking prevalence. The impact of these policies (within and outside the Framework Convention on Tobacco Control) on smokeless tobacco use remains unclear. We aimed to systematically review policies that are relevant to smokeless tobacco and its context and investigate their impact on smokeless tobacco use. METHODS In this systematic review, we searched 11 electronic databases and grey literature between Jan 1, 2005, and Sept 20, 2021, in English and key south Asian languages, to summarise smokeless tobacco policies and their impact. Inclusion criteria were all types of studies on smokeless tobacco users that mentioned any smokeless tobacco relevant policies since 2005, except systematic reviews. Policies issued by organisations or private institutions were excluded as well as studies on e-cigarettes and Electronic Nicotine Delivery System except where harm reduction or switching were evaluated as a tobacco cessation strategy. Two reviewers independently screened articles, and data were extracted after standardisation. Quality of studies was appraised using the Effective Public Health Practice Project's Quality Assessment Tool. Outcomes for impact assessment included smokeless tobacco prevalence, uptake, cessation, and health effects. Due to substantial heterogeneity in the descriptions of policies and outcomes, data were descriptively and narratively synthesised. This systematic review was registered in PROSPERO (CRD42020191946). FINDINGS 14 317 records were identified, of which 252 eligible studies were included as describing smokeless tobacco policies. 57 countries had policies targeting smokeless tobacco, of which 17 had policies outside the Framework Convention on Tobacco Control for smokeless tobacco (eg, spitting bans). 18 studies evaluated the impact, which were of variable quality (six strong, seven moderate, and five weak) and reported mainly on prevalence of smokeless tobacco use. The body of work evaluating policy initiatives based on the Framework Convention on Tobacco Control found that these initiatives were associated with reductions in smokeless tobacco prevalence of between 4·4% and 30·3% for taxation and 22·2% and 70·9% for multifaceted policies. Two studies evaluating the non-Framework policy of sales bans reported significant reductions in smokeless tobacco sale (6·4%) and use (combined sex 17·6%); one study, however, reported an increased trend in smokeless tobacco use in the youth after a total sales ban, likely due to cross-border smuggling. The one study reporting on cessation found a 13·3% increase in quit attempts in individuals exposed (47·5%) to Framework Convention on Tobacco Control policy: education, communication, training, and public awareness, compared with non-exposed (34·2%). INTERPRETATION Many countries have implemented smokeless tobacco control policies, including those that extend beyond the Framework Convention on Tobacco Control. The available evidence suggests that taxation and multifaceted policy initiatives are associated with meaningful reductions in smokeless tobacco use. FUNDING UK National Institute for Health Research.
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Affiliation(s)
| | - Monika Arora
- HRIDAY, New Delhi, India; Health Promotion Division, Public Health Foundation of India, Gurugram, India.
| | - Neha Jain
- Health Promotion Division, Public Health Foundation of India, Gurugram, India
| | | | - Anne Readshaw
- Department of Health Sciences, University of York, York, UK
| | - Aziz Sheikh
- Usher Institute, University of Edinburgh, Edinburgh, UK
| | | | - Kamran Siddiqi
- Department of Health Sciences, University of York, York, UK
| | | | | | - Mona Kanaan
- Department of Health Sciences, University of York, York, UK
| | - Muhammad Aziz Rahman
- Institute of Health and Wellbeing, Federation University Australia, Berwick, VIC, Australia
| | - Ravi Mehrotra
- Indian Council of Medical Research, India Cancer Research Consortium, New Delhi, India
| | | | - Sarah Forberger
- Leibniz Institute for Prevention Research and Epidemiology, Bremen, Germany
| | - Suranji Dahanayake
- Department of Health Sciences, University of York, York, UK; Ministry of Health, Nutrition and Indigenous Medicine, Colombo, Sri Lanka
| | - Zohaib Khan
- Khyber Medical University, Peshawar, Pakistan
| | - Melanie Boeckmann
- Faculty of Human and Health Sciences, University of Bremen, Breman, Germany
| | - Omara Dogar
- Department of Health Sciences, University of York, York, UK; Usher Institute, University of Edinburgh, Edinburgh, UK
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Sreeramareddy CT, Manoharan A. Smokeless tobacco consumption and its association with tobacco control factors in the Western Pacific Region: results from the Global Youth Tobacco Survey 2015-2019. Epidemiol Health 2022; 44:e2022103. [PMID: 36397245 PMCID: PMC10185971 DOI: 10.4178/epih.e2022103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Accepted: 11/08/2022] [Indexed: 11/11/2022] Open
Abstract
OBJECTIVES We estimated the prevalence of smokeless tobacco (ST) consumption and its associations with tobacco control factors among school-going youth in 18 Western Pacific Region (WPR) countries. METHODS We analyzed school-based Global Youth Tobacco Survey (2014-2019) microdata from 18 WPR countries and estimated weighted prevalence rates of ST consumption, cigarette smoking, and dual use. We used multilevel binary logistic regression to examine the associations of ST consumption and dual use with demographic variables, exposure to pro-tobacco and anti-tobacco factors, national income, and MPOWER indicators. RESULTS Data from 58,263 school-going youth were analyzed. The prevalence of past 30-day ST consumption was highest in Kiribati (42.1%), the Marshall Islands (26.1%), Micronesia (21.3%), Palau (16.0%), and Papua New Guinea (15.2%). In adjusted multilevel models, ST consumption and dual use were significantly associated with sex, age, parental smoking, pro-tobacco factors, national income, and MPOWER score. For each unit increase in score for cessation programs, we observed approximately 1.4-fold increases in the odds of youth ST consumption (adjusted odds ratio [aOR], 1.38; 95% confidence interval [CI], 1.15 to 1.66) and dual use (aOR, 1.47; 95% CI, 1.16 to 1.86). Similarly, for each unit increase in score for health-related warnings, the odds of both ST consumption (aOR, 0.47; 95% CI, 0.42 to 0.53) and dual use (aOR, 0.35; 95% CI, 0.30 to 0.42) decreased by approximately 60%. CONCLUSIONS The prevalence of youth ST consumption was substantial in the Pacific Islands, exceeding that of cigarette smoking in some countries. Implementing MPOWER measures for ST products could help reduce ST consumption.
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Forberger S, Khan Z, Ahmad F, Ahmed F, Frense J, Kampfmann T, Ullah S, Dogar O, Siddiqi K, Zeeb H. Scoping Review of Existing Evaluations of Smokeless Tobacco Control Policies: What Is Known About Countries Covered, Level of Jurisdictions, Target Groups Studied, and Instruments Evaluated? Nicotine Tob Res 2022; 24:1344-1354. [PMID: 35428887 DOI: 10.1093/ntr/ntac102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Revised: 03/17/2022] [Accepted: 04/12/2022] [Indexed: 11/13/2022]
Abstract
OBJECTIVE The implementation of smokeless tobacco control policies lags behind those for smoking. This scoping review summarizes the studies that evaluated public policies on smokeless tobacco regulation (SLT) and provides an overview of the jurisdictional level, target groups, and policy instruments. METHODS Seven databases were systematically searched for studies reporting on public policies regulating SLT. Two reviewers independently screened all studies. Data extraction was performed using a predefined extraction form. Extraction was replicated for 10% of the identified studies for quality assurance. A narrative synthesis of the included studies was used to analyze and interpret the data. The protocol was published beforehand with the Open Science Foundation (OSF). RESULTS Fourty articles comprising 41 studies were included. Most of the studies reported in the articles were conducted in the United States (n = 17) or India (n = 14). Most studies reported outcomes for students (n = 8), retailers/sellers (n = 8), and users/former users (n = 5). The impact of public policies on smokeless tobacco use, in general, was most frequently assessed (n = 9), followed by the impact of taxes (n = 7), product bans (n = 6), sales/advertising bans near educational institutions (n = 4), and health warnings (n = 3) on consumer behavior. CONCLUSIONS There are significant gaps in the evaluation of smokeless tobacco regulation studies that need to be filled by further research to understand the observed outcomes. WHO reporting on Framework Convention on Tobacco Control (FCTC) implementation should be linked to studies evaluating smokeless tobacco control measures at all levels of jurisdictions and in countries not members of the WHO FCTC or do not provide data. IMPLICATION Large gaps in the evaluation of SLT control policies exist. For some countries, WHO FCTC evaluations are available for different levels of jurisdictions. In countries with a strong federal structure, there is a lack of data beyond the national level to provide a more detailed look at compliance, indirect effects, or implementation gaps. More research is needed at all levels of jurisdictions, which add to the work of the WHO to understand what works for which target group, how the different levels of jurisdiction interact, how the real-world context can be incorporated, and what indirect effects may occur.
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Affiliation(s)
- Sarah Forberger
- Department Prevention and Evaluation, Leibniz Institute for Prevention Research and Epidemiology - BIPS, Achterstrasse 30, 28359 Bremen, Germany
| | - Z Khan
- Office of Research, Innovation, and Commercialization (ORIC), Khyber Medical University, Phase 5 Hayatabad, Peshawar, Khyber Pakhtunkhwa, Pakistan
| | - F Ahmad
- Faculty Institute of Public Health & Social Sciences, Khyber Medical University, F1 Phase-6 Rd, Phase 5 Hayatabad, Peshawar, Khyber Pakhtunkhwa 25100, Pakistan
| | - F Ahmed
- Department Prevention and Evaluation, Leibniz Institute for Prevention Research and Epidemiology - BIPS, Achterstrasse 30, 28359 Bremen, Germany
| | - J Frense
- Department Prevention and Evaluation, Leibniz Institute for Prevention Research and Epidemiology - BIPS, Achterstrasse 30, 28359 Bremen, Germany
| | - T Kampfmann
- Institute for Ethics and Transdisciplinary Sustainability Research, Leuphana University Universitätsallee 1, 21335 Lüneburg, Germany
| | - S Ullah
- Office of Research Innovation and Commercialization, Khyber Medical University Peshawar; Phase 5 Hayatabad, Peshawar, Khyber Pakhtunkhwa, Pakistan
| | - O Dogar
- Department of Health Sciences, University of York, Heslington, York YO10 5DD, UK
- Usher Institute, The University of Edinburgh, Old College, South Bridge, Edinburgh EH8 9YLUK
| | - K Siddiqi
- Department of Health Sciences, University of York, Heslington, York YO10 5DD, UK
- Hull York Medical School, John Hughlings Jackson Building, University Rd, Heslington, York YO10 5DD, UK
| | - H Zeeb
- Department Prevention and Evaluation, Leibniz Institute for Prevention Research and Epidemiology - BIPS, Achterstrasse 30, 28359 Bremen, Germany
- Health Sciences Bremen, University of Bremen, 28359 Bremen, Germany
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Welding K, Saraf S, Iacobelli M, Smith KC, Puntambekar N, Gupta PC, Cohen JE. Beyond Gutka: Evidence of Illegal Smokeless Tobacco in Rural and Semi-urban Areas in India. Nicotine Tob Res 2022; 24:929-932. [PMID: 34893893 PMCID: PMC9048865 DOI: 10.1093/ntr/ntab251] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2021] [Revised: 10/04/2021] [Accepted: 12/03/2021] [Indexed: 11/13/2022]
Abstract
INTRODUCTION Gutka, a popular smokeless tobacco (SLT) product combining chewing tobacco, areca nut, and spices, was banned by states in India beginning in 2012. Gutka can be recreated by the user mixing twin packets of tobacco and spice mixtures. We examine the availability of premixed gutka, the sale of twin packets (chewing tobacco and spice mixture sold together but in separate packets) and whether SLT was sold without legally mandated health warning labels (HWLs), without the printed maximum retail price (MRP), and above the MRP. AIMS AND METHODS In October/November of 2017, unique SLT packets were purchased using a systematic protocol in 25 localities with populations under 50 000 across five Indian states. Purchase information (location, twin packets, price paid) and packaging information (SLT type, printed MRP, type of HWL) were used to assess legality. RESULTS Of the 240 purchases of unique SLT packets, three were premade gutka. Twin packets were half of the sample, sold in every state, and illegally sold in Maharashtra where they were banned. Over half (62%) of single packets and 27% of twin packets did not feature a legal HWL. While only 5% of packets did not have a printed MRP, 29% of single packets, and 38% of twin packets were sold illegally for more than the MRP. CONCLUSIONS SLT without the proper HWL or sold above the MRP were common. Twin packets were widely available. India should consider a country-wide restriction to ban single serving tobacco packets that would decrease affordability. IMPLICATIONS This study is the earliest and that first outside of Mumbai that we are aware of to present evidence of tobacco products being sold above the MRP in India. While finding little evidence of premade gutka being sold, we found twin packets (chewing tobacco and spice mixture packets sold together) are widely available even in Maharashtra, which has a policy in place to ban twin packets. This study also finds evidence of SLT products sold without the correct HWL and without a MRP listed which shows that implementation and enforcement of regulations are as important as passing regulations.
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Affiliation(s)
- Kevin Welding
- Institute for Global Tobacco Control, Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Sejal Saraf
- Institute for Global Tobacco Control, Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Michael Iacobelli
- Institute for Global Tobacco Control, Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Katherine Clegg Smith
- Institute for Global Tobacco Control, Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | | | - Prakash C Gupta
- Healis-Sekhsaria Institute for Public Health, Mahape, Navi Mumbai, India
| | - Joanna E Cohen
- Institute for Global Tobacco Control, Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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Toxic effects of smokeless tobacco on female reproductive health: A review. Curr Res Toxicol 2022; 3:100066. [PMID: 35310558 PMCID: PMC8927787 DOI: 10.1016/j.crtox.2022.100066] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Revised: 02/11/2022] [Accepted: 03/03/2022] [Indexed: 12/04/2022] Open
Abstract
Smokeless tobacco use can lead to impairments of ovarian function, morphology, oocyte quality and hormonal regulation. Use of smokeless tobacco during pregnancy has adverse health effects on both the mother and fetus. Exposure to smokeless tobacco in utero has long term health consequences on offspring.
The habitual consumption of tobacco in its various form is widespread and a serious public health issue globally. In particular, the use of smokeless tobacco has increased substantially due to its easy availability and misconception that it is relatively harmless compared to smoking. Tobacco use has been well established from numerous studies as a causative agent of devastating illnesses such as cancer, insulin resistance, hypertension, acute respiratory disease, osteoporosis, etc. Limited but growing evidence have also suggested its role in adversely affecting reproductive capabilities and outcomes in women of reproductive age and during pregnancy. This paper provides an updated review on available literature regarding the negative effects of smokeless tobacco use on female reproductive health, during pregnancy and its adverse consequences on the offspring. Existing data suggests the association between chronic smokeless tobacco use and impairment of ovarian morphology and function, oocyte quality, hormonal perturbations, fetal development and long-term health effects on the fetus. Improved understanding of these issues can contribute to better awareness of the dangers of smokeless tobacco products.
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Mishu MP, Siddiqi K, McNeill A, Kanaan M, Jackson C, Huque R, Kanan S, Abdullah S, Fieroze F, Garg S, Singh MM, Borle AL, Deshmukh C, Akhter Z, Mazhar L, Khan Z, Rehman K, Ullah S, Han L, Readshaw A, Iqbal R. Protocol for a feasibility study of longitudinal surveys to assess the impact of policies on tobacco use among school-going adolescents in South Asia. F1000Res 2022; 9:1123. [PMID: 35903244 PMCID: PMC9274015 DOI: 10.12688/f1000research.25796.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/23/2022] [Indexed: 11/21/2022] Open
Abstract
Background: Smokeless tobacco (ST) use is common among youth in South Asia where 85% of the world’s 300 million ST users live and use the most lethal ST forms. Little is known about the impact of tobacco control policies on the youth ST uptake in those countries. We planned to conduct longitudinal surveys among school going adolescents to evaluate existing tobacco control policies on tobacco uptake and use, and a feasibility study for that prospective, observational cohort study. Study objectives: (1) To demonstrate the feasibility of selection, recruitment and retention of schools and of study participants; (2) To assess the feasibility and acceptability of the study procedure and study tool (questionnaire); (3) To evaluate if the questionnaire can assess tobacco uptake and use, and their potential predictors. Methods and analysis: The feasibility study will be conducted in two administrative areas within each of three South Asian countries: Bangladesh, India and Pakistan. We will use both quantitative and qualitative data collection methods. Eight eligible schools will be randomly selected within purposively selected sub-districts from each country. We plan to conduct one baseline and one follow up survey among students of grade 6-8, one year apart. At each time point, data on tobacco uptake and potential predictors will be collected from students via self-administered questionnaires that were designed for the longitudinal study. The qualitative component will be embedded into the study with each round of data collection to assess the acceptability of the study instrument (questionnaire) and data collection methods, via focus group discussions with students and semi-structured interviews with schoolteachers. Recruitment and retention rates, completeness of the questionnaires, frequencies and associations of tobacco use and explanatory variables will be reported. Data gathered from the focus group and interviews will be analysed using the framework approach.
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Affiliation(s)
- Masuma Pervin Mishu
- Department of Health Sciences, The University of York, Heslington, Yorkshire, YO10 5DD, UK
| | - Kamran Siddiqi
- Department of Health Sciences, The University of York, Heslington, Yorkshire, YO10 5DD, UK
| | - Ann McNeill
- National Addiction Centre, Institute of Psychiatry, Psychology & Neuroscience (IoPPN), King’s College London, London, SE5 8BB, UK
| | - Mona Kanaan
- Department of Health Sciences, The University of York, Heslington, Yorkshire, YO10 5DD, UK
| | - Cath Jackson
- Department of Health Sciences, The University of York, Heslington, Yorkshire, YO10 5DD, UK
| | - Rumana Huque
- ARK Foundation, Gulshan - 2, Dhaka, 1212, Bangladesh
- Department of Economics, University of Dhaka, Dhaka, 1000, Bangladesh
| | - Sushama Kanan
- ARK Foundation, Gulshan - 2, Dhaka, 1212, Bangladesh
| | - S.M. Abdullah
- ARK Foundation, Gulshan - 2, Dhaka, 1212, Bangladesh
- Department of Economics, University of Dhaka, Dhaka, 1000, Bangladesh
| | | | - Suneela Garg
- Department of Community Medicine, Maulana Azad Medical College, New Delhi, 110002, India
| | - M. Meghachandra Singh
- Department of Community Medicine, Maulana Azad Medical College, New Delhi, 110002, India
| | - Amod L. Borle
- Department of Community Medicine, Maulana Azad Medical College, New Delhi, 110002, India
| | - Chetana Deshmukh
- Department of Community Medicine, Maulana Azad Medical College, New Delhi, 110002, India
| | - Zohaib Akhter
- Departments of Community Health Sciences and Medicine, Aga Khan University, Karachi, 74800, Pakistan
| | - Laraib Mazhar
- Departments of Community Health Sciences and Medicine, Aga Khan University, Karachi, 74800, Pakistan
| | - Zohaib Khan
- Institute of Public Health & Social Sciences, Khyber Medical University, Peshawar, Khyber Pakhtunkhwa, 25100, Pakistan
| | - Khalid Rehman
- Institute of Public Health & Social Sciences, Khyber Medical University, Peshawar, Khyber Pakhtunkhwa, 25100, Pakistan
| | - Safat Ullah
- Institute of Public Health & Social Sciences, Khyber Medical University, Peshawar, Khyber Pakhtunkhwa, 25100, Pakistan
| | - Lu Han
- Department of Health Sciences, The University of York, Heslington, Yorkshire, YO10 5DD, UK
| | - Anne Readshaw
- Department of Health Sciences, The University of York, Heslington, Yorkshire, YO10 5DD, UK
| | - Romaina Iqbal
- Departments of Community Health Sciences and Medicine, Aga Khan University, Karachi, 74800, Pakistan
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10
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Chen DTH, Girvalaki C, Mechili EA, Millett C, Filippidis FT. Global Patterns and Prevalence of Dual and Poly-Tobacco Use: A Systematic Review. Nicotine Tob Res 2021; 23:1816-1820. [PMID: 34009377 PMCID: PMC8825763 DOI: 10.1093/ntr/ntab084] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Accepted: 04/27/2021] [Indexed: 11/21/2022]
Abstract
INTRODUCTION Improving understanding of the epidemiology of dual and poly-tobacco product use is essential for tobacco control policy and practice. The present study aimed to systematically review existing epidemiologic evidence on current dual and poly-tobacco use among adults globally. METHODS We systematically searched online databases for studies published up to June 30, 2020. We included quantitative studies with measures of nationally representative prevalence of current dual or poly-tobacco use among adults. Prevalence estimates for each country were extracted manually and stratified by WHO regions and World Bank income classifications. RESULTS Twenty studies with nationally representative prevalence data on current dual or poly-tobacco use in the adult population across 48 countries were included. Definitions of dual and poly-tobacco use varied widely. Prevalence of dual and poly-tobacco use was higher in low- and lower-middle-income countries compared to other higher-income countries. Current dual use of smoked and smokeless tobacco products among males ranged from 0.2% in Ukraine (2010) and Mexico (2009) to 17.9% in Nepal (2011). Poly-tobacco use among males ranged from 0.8% in Mexico (2009) and 0.9% in Argentina (2010) to 11.4% in the United Kingdom and 11.9% in Denmark in 2012. Dual tobacco use was generally higher in South-East Asia; poly-tobacco use was prevalent in Europe as well as in South-East Asia. CONCLUSIONS This is the first systematic review of the prevalence estimates of dual and poly-tobacco use among adults globally. The results of the current study could significantly help health policy makers to implement effective tobacco control policies. IMPLICATIONS This study demonstrates that dual/poly-tobacco use is common in many countries of the world, and highlights the need for in-depth exploration of this field in future studies, especially in high prevalence regions such as South-East Asian and European countries. In light of this, the global tobacco control community and health authorities should also agree upon a consistent operational definition of dual and poly-tobacco use to propel research and improve surveillance of dual/poly-use in health surveys for better communication and understanding of these phenomena.
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Affiliation(s)
- Daniel Tzu-Hsuan Chen
- Public Health Policy Evaluation Unit, School of Public Health, Imperial College London, London, UK
| | - Charis Girvalaki
- Clinic of Social and Family Medicine, School of Medicine, University of Crete, Heraklion, Greece
| | - Enkeleint A Mechili
- Clinic of Social and Family Medicine, School of Medicine, University of Crete, Heraklion, Greece
- Department of Healthcare, Faculty of Public Health, University of Vlora, Vlorë, Albania
| | - Christopher Millett
- Public Health Policy Evaluation Unit, School of Public Health, Imperial College London, London, UK
| | - Filippos T Filippidis
- Public Health Policy Evaluation Unit, School of Public Health, Imperial College London, London, UK
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11
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Sami A, Elimairi I, Patangia D, Watkins C, Ryan CA, Ross RP, Stanton C. The ultra-structural, metabolomic and metagenomic characterisation of the sudanese smokeless tobacco 'Toombak'. Toxicol Rep 2021; 8:1498-1512. [PMID: 34401360 PMCID: PMC8355839 DOI: 10.1016/j.toxrep.2021.07.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 06/08/2021] [Accepted: 07/07/2021] [Indexed: 12/04/2022] Open
Abstract
Toombak, a form of moist smokeless tobacco from Sudan is placed as a dip in the oral cavity most commonly used by males. The microbiome of Toombak predominantly consists of the phyla, Firmicutes and Actinobacteria while abundant species include Corynebacterium casei, Atopostipes suicloacalis and Oceanobacillus chironomi. High concentrations of iron, volatile aldehydes and tobacco specific nitrosamines were found in Toombak and can lead to toxicity. Toombak has a non-homogenous abrasive surface with a high sodium level in the ready to buy form that can damage the oral mucosa. New measures must be taken in Sudan to limit harmful compounds in Toombak.
Toombak is a smokeless tobacco produced from the Nicotiana rustica tobacco plant from Sudan. Pre-prepared and ready to buy Toombak samples were analysed using mass spectrometry (heavy metals), gas and liquid chromatography (metabolomics), 16S rRNA metagenomic sequencing (microbiome) and Phylogenetic Investigation of Communities by Reconstruction of Unobserved States (PICRUSt), scanning electron microscopy with energy dispersive X-ray spectroscopy (SEM-EDX) and pH analysis. Chromium, cobalt, and copper were high in the pre-prepared form of Toombak while iron, tobacco specific nitrosamines (TSNAs), formaldehyde and acetaldehyde were high in both types. Firmicutes and Actinobacteria dominated Toombak. Samples of ready to buy Toombak showed inter-variational differences depending on place of purchase. We found Virgibacillus were increased in the pre-prepared form while Corynebacterium casei, Atopococus tabaci, Atopostipes suicloacalis, Oceanobacillus chironomi and Staphylococcus gallinarum were the most abundant species in the ready to buy forms. PICRUSt analysis highlighted increased activity of metal transport systems in the ready to buy samples as well as an antibiotic transport system. SEM-EDX highlighted large non-homogenous, irregular particles with increased sodium, while pH of samples was in the alkaline range. The final composition of Toombak is affected by its method of preparation and the end product has the potential to impart many negative consequences on the health of its users. TSNA levels observed in Toombak were some of the highest in the world while the micro-environment of Toombak supports a distinct microbiota profile.
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Affiliation(s)
- Amel Sami
- APC Microbiome Institute, University College Cork, Cork, T12 YN60, Ireland.,Department of Oral and Maxillofacial Surgery and Oral Medicine, Faculty of Dentistry, National Ribat University, Nile Street, Khartoum, 1111, Sudan
| | - Imad Elimairi
- Department of Oral and Maxillofacial Surgery and Oral Medicine, Faculty of Dentistry, National Ribat University, Nile Street, Khartoum, 1111, Sudan
| | - Dhrati Patangia
- APC Microbiome Institute, University College Cork, Cork, T12 YN60, Ireland
| | - Claire Watkins
- APC Microbiome Institute, University College Cork, Cork, T12 YN60, Ireland
| | - C Anthony Ryan
- Department of Paediatrics and Child Health, University College Cork, Cork, T12 DFK4, Ireland
| | - R Paul Ross
- APC Microbiome Institute, University College Cork, Cork, T12 YN60, Ireland
| | - Catherine Stanton
- APC Microbiome Institute, University College Cork, Cork, T12 YN60, Ireland.,Teagasc Food Research Centre, Moorepark, Fermoy, Cork, P61 C996, Ireland
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12
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Welding K, Iacobelli M, Saraf S, Smith KC, Puntambekar N, Gupta PC, Cohen JE. The Market for Bidis, Smokeless Tobacco, and Cigarettes in India: Evidence From Semi-Urban and Rural Areas in Five States. Int J Public Health 2021; 66:1604005. [PMID: 34335142 PMCID: PMC8284861 DOI: 10.3389/ijph.2021.1604005] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Accepted: 04/27/2021] [Indexed: 11/13/2022] Open
Abstract
Objectives: Compare the brand availability, pricing and presence of illicit products in semi-urban and rural areas in India across product types and states. Methods: In late 2017, 382 unique tobacco products were purchased from localities with populations under 50,000 in the states of Assam, Karnataka, Maharashtra, Rajasthan, and Uttar Pradesh. Brand, printed maximum retail price, price paid, tax, and health warning labels (HWLs) were used to compare the market for bidis, smokeless tobacco (SLT), and cigarettes. Results: Brand availability and pricing of SLT products was similar to cigarettes. Brand availability and pricing of bidis was consistent with having many small producers. Bidis and single serving SLT with spice mixtures were more affordable than cigarettes and SLT sold alone. 2% of SLT and 10% of cigarettes did not feature an India HWL. Conclusion: The elimination of single serving SLT packets and the removal of tax exemptions for small producers, often exploited by bidi producers, could reduce their respective affordability. State differences in illegal and illicit products could indicate a greater need for enforcement in some states.
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Affiliation(s)
- Kevin Welding
- Department of Health, Behavior and Society, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, United States.,Institute for Global Tobacco Control, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, United States
| | - Michael Iacobelli
- Institute for Global Tobacco Control, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, United States
| | - Sejal Saraf
- Institute for Global Tobacco Control, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, United States
| | - Katherine Clegg Smith
- Department of Health, Behavior and Society, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, United States.,Institute for Global Tobacco Control, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, United States
| | | | - Prakash C Gupta
- Healis Sekhsaria Institute for Public Health, Maharashtra, India
| | - Joanna E Cohen
- Department of Health, Behavior and Society, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, United States.,Institute for Global Tobacco Control, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, United States
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13
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Siddiqui F, Croucher R, Ahmad F, Ahmed Z, Babu R, Bauld L, Fieroze F, Huque R, Kellar I, Kumar A, Lina S, Mubashir M, Nethan ST, Rizvi N, Siddiqi K, Kumar Singh P, Thomson H, Jackson C. Smokeless Tobacco Initiation, Use, and Cessation in South Asia: A Qualitative Assessment. Nicotine Tob Res 2021; 23:1801-1804. [PMID: 33844008 PMCID: PMC8521714 DOI: 10.1093/ntr/ntab065] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Accepted: 04/10/2021] [Indexed: 11/28/2022]
Abstract
Introduction Smokeless tobacco (ST) is a significant South Asian public health problem.
This paper reports a qualitative study of a sample of South Asian ST
users. Methods Interviews, using a piloted topic guide, with 33 consenting, urban dwelling
adult ST users explored their ST initiation, continued use, and cessation
attempts. Framework data analysis was used to analyze country specific data
before a thematic cross-country synthesis was completed. Results Participants reported long-term ST use and high dependency. All reported
strong cessation motivation and multiple failed attempts because of ease of
purchasing ST, tobacco dependency, and lack of institutional support. Conclusions Interventions to support cessation attempts among consumers of South Asian ST
products should address the multiple challenges of developing an integrated
ST policy, including cessation services. Implications This study provides detailed understanding of the barriers and drivers to ST
initiation, use, and cessation for users in Bangladesh, India, and Pakistan.
It is the first study to directly compare these three countries. The insight
was then used to adapt an existing behavioral support intervention for ST
cessation for testing in these countries.
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Affiliation(s)
- Faraz Siddiqui
- Department of Health Sciences, University of York, Heslington, York, UK
| | - Ray Croucher
- Department of Health Sciences, University of York, Heslington, York, UK
| | - Fayaz Ahmad
- IPH&SS Khyber Medical University, Peshawar, Pakistan
| | - Zarak Ahmed
- Department of Community Health Sciences, Aga Khan University, Karachi, Pakistan
| | - Roshani Babu
- Indian Council of Medical Research-National Institute of Cancer Prevention and Research, Noida, Uttar Pradesh, India
| | - Linda Bauld
- Usher Institute, Old Medical School, University of Edinburgh, Edinburgh, UK
| | | | | | - Ian Kellar
- School of Psychology, Lifton Place, University of Leeds, Leeds, West Yorkshire, UK
| | - Anuj Kumar
- Indian Council of Medical Research-National Institute of Cancer Prevention and Research, Noida, Uttar Pradesh, India
| | - Silwa Lina
- ARK Foundation, Gulshan-2, Dhaka, Bangladesh
| | - Maira Mubashir
- Department of Community Health Sciences, Aga Khan University, Karachi, Pakistan
| | - Suzanne Tanya Nethan
- Indian Council of Medical Research-National Institute of Cancer Prevention and Research, Noida, Uttar Pradesh, India
| | - Narjis Rizvi
- Department of Community Health Sciences, Aga Khan University, Karachi, Pakistan
| | - Kamran Siddiqi
- Department of Health Sciences and Hull York Medial School, University of York, Heslington, York, UK
| | - Prashant Kumar Singh
- Indian Council of Medical Research-National Institute of Cancer Prevention and Research, Noida, Uttar Pradesh, India
| | - Heather Thomson
- Adults and Health Directorate, Leeds City Council, Leeds, UK
| | - Cath Jackson
- Valid Research Ltd, Sandown House, West Yorkshire, UK
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14
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Singh S, Jain P, Singh PK, Reddy KS, Bhargava B. White paper on smokeless tobacco & women's health in India. Indian J Med Res 2021; 151:513-521. [PMID: 32719223 PMCID: PMC7602932 DOI: 10.4103/ijmr.ijmr_537_20] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Smokeless tobacco (SLT) use is widespread across many nations and populations, and India shares more than three-quarters of the global burden of SLT consumption. Tobacco use in India has been largely viewed as a male-dominant behaviour. However, evidence from medical, social and behavioural sciences show significant SLT use among women and young girls. This paper highlights key dimensions of SLT use among women in India including prevalence and determinants, the health effects arising from SLT use and cessation behaviours. The paper concludes by providing recommendations with the aim of setting research priorities and policy agenda to achieve a tobacco-free society. The focus on women and girls is essential to achieve the national targets for tobacco control under the National Health Policy, 2017, and Sustainable Development Goals 3 of ensuring healthy lives and promote well-being for all.
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Affiliation(s)
- Shalini Singh
- ICMR-National Institute of Cancer Prevention and Research, Noida, Uttar Pradesh, India
| | - Pankhuri Jain
- Division of Preventive Oncology, ICMR-National Institute of Cancer Prevention and Research, Noida, Uttar Pradesh, India
| | - Prashant Kumar Singh
- Division of Preventive Oncology, ICMR-National Institute of Cancer Prevention and Research, Noida, Uttar Pradesh, India
| | | | - Balram Bhargava
- Department of Health Research (ICMR), Ministry of Health and Family Welfare, New Delhi, India
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15
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Chen DTH, Millett C, Filippidis FT. Prevalence and determinants of dual and poly-tobacco use among males in 19 low-and middle-income countries: Implications for a comprehensive tobacco control regulation. Prev Med 2021; 142:106377. [PMID: 33346037 DOI: 10.1016/j.ypmed.2020.106377] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Revised: 10/14/2020] [Accepted: 12/15/2020] [Indexed: 11/25/2022]
Abstract
Despite their implications for tobacco control, data on concurrent dual (using two tobacco products) and poly-tobacco use (using more than two products) are relatively scarce globally. This study aimed to estimate the prevalence of dual and poly-tobacco use among men in 19 low-and middle-income countries (LMICs) and assess potential associations with individual and country level factors. Data from 19 LMICs were obtained from the most recent wave of the Demographic and Health Survey (DHS), collected between 2015 and 2016 comprising 235,975 men aged 15-49 years. The prevalence of current single, dual and poly-tobacco use were estimated using available sample weights. Mixed-effect multilevel models were used to estimate associations of individual and country level factors with tobacco use. Results showed that the prevalence of dual or poly-tobacco use among men was highest in Timor Leste (27.1%), Nepal (18.3%), Lesotho (13.2%) and India (9.3%). Factors associated with dual and poly-tobacco use were older age, low academic achievement, low income status, being divorced, living in urban areas and high frequency of media use. Among country-level characteristics, national wealth was not associated with dual and poly-tobacco use. Implementation of MPOWER measures was inversely associated with single tobacco use; this was not the case for dual and poly-tobacco use. Findings suggest that dual and poly-tobacco use are common among men especially in South-East Asian countries. This study highlights the need for MPOWER measures to be expanded and strengthened to address all tobacco products and explicitly consider dual and poly use.
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Affiliation(s)
- Daniel Tzu-Hsuan Chen
- Public Health Policy Evaluation Unit, School of Public Health, Imperial College London, United Kingdom.
| | - Christopher Millett
- Public Health Policy Evaluation Unit, School of Public Health, Imperial College London, United Kingdom.
| | - Filippos T Filippidis
- Public Health Policy Evaluation Unit, School of Public Health, Imperial College London, United Kingdom.
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16
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Arora M, Chugh A, Jain N, Mishu M, Boeckmann M, Dahanayake S, Eckhardt J, Forberger S, Huque R, Kanaan M, Khan Z, Mehrotra R, Rahman MA, Readshaw A, Sheikh A, Siddiqi K, Vidyasagaran A, Dogar O. Global impact of tobacco control policies on smokeless tobacco use: a systematic review protocol. BMJ Open 2020; 10:e042860. [PMID: 33361080 PMCID: PMC7768955 DOI: 10.1136/bmjopen-2020-042860] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Revised: 10/15/2020] [Accepted: 12/02/2020] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Smokeless tobacco (ST) was consumed by 356 million people globally in 2017. Recent evidence shows that ST consumption is responsible for an estimated 652 494 all-cause deaths across the globe annually. The WHO Framework Convention on Tobacco Control (FCTC) was negotiated in 2003 and ratified in 2005 to implement effective tobacco control measures. While the policy measures enacted through various tobacco control laws have been effective in reducing the incidence and prevalence of smoking, the impact of ST-related policies (within WHO FCTC and beyond) on ST use is under-researched and not collated. METHODS AND ANALYSIS A systematic review will be conducted to collate all available ST-related policies implemented across various countries and assess their impact on ST use. The following databases will be searched: Medline, EMBASE, PsycINFO, Cumulative Index to Nursing and Allied Health Literature, Scopus, EconLit, ISI Web of Science, Cochrane Library (CENTRAL), African Index Medicus, LILACS, Scientific Electronic Library Online, Index Medicus for the Eastern Mediterranean Region, Index Medicus for South-East Asia Region, Western Pacific Region Index Medicus and WHO Library Database, as well as Google search engine and country-specific government websites. All ST-related policy documents (FCTC and non-FCTC) will be included. Results will be limited to literature published since 2005 in English and regional languages (Bengali, Hindi and Urdu). Two reviewers will independently employ two-stage screening to determine inclusion. The Effective Public Health Practice Project's 'Quality Assessment Tool for Quantitative Studies' will be used to record ratings of quality and risk of bias among studies selected for inclusion. Data will be extracted using a standardised form. Meta-analysis and narrative synthesis will be used. ETHICS AND DISSEMINATION Permission for ethics exemption of the review was obtained from the Centre for Chronic Disease Control's Institutional Ethics Committee, India (CCDC_IEC_06_2020; dated 16 April 2020). The results will be disseminated through publications in a peer-reviewed journal and will be presented in national and international conferences. PROSPERO REGISTRATION NUMBER CRD42020191946.
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Affiliation(s)
- Monika Arora
- HRIDAY, New Delhi, India
- Health Promotion Division, Public Health Foundation of India, Gurugram, Haryana, India
| | | | - Neha Jain
- Health Promotion Division, Public Health Foundation of India, Gurugram, Haryana, India
| | - Masuma Mishu
- Department of Health Sciences, University of York, York, UK
| | | | - Suranji Dahanayake
- Department of Health Sciences, University of York, York, UK
- Ministry of Health, Nutrition and Indigenous Medicine, Colombo, Sri Lanka
| | | | - Sarah Forberger
- Leibniz Institute for Prevention Research and Epidemiology, Bremen, Germany
| | | | - Mona Kanaan
- Department of Health Sciences, University of York, York, UK
| | - Zohaib Khan
- Khyber Medical University, Peshawar, Pakistan
| | - Ravi Mehrotra
- Indian Council of Medical Research, India Cancer Research Consortium, New Delhi, India
| | - Muhammad Aziz Rahman
- School of Health, Federation University Australia, Berwick, Victoria, Australia
- La Trobe University, Melbourne, Victoria, Australia
| | - Anne Readshaw
- Department of Health Sciences, University of York, York, UK
| | - Aziz Sheikh
- Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Kamran Siddiqi
- Department of Health Sciences, University of York, York, UK
| | | | - Omara Dogar
- Department of Health Sciences, University of York, York, UK
- Usher Institute, University of Edinburgh, Edinburgh, UK
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17
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Abstract
Tobacco menace is responsible for significant mortality and morbidity worldwide.
Smokeless tobacco (SLT) is consumed in more than 140 countries, thus is emerging
as a global problem. Several adverse health outcomes like oropharyngeal,
oesophageal, and pancreatic cancers; oral potentially malignant lesions;
diabetes mellitus; cardiovascular diseases; mental illness; osteopenia; low
birth weight; preterm births; small for gestation age babies; and stillbirths
are attributed to SLT usage. Smokeless tobacco products vary greatly in types,
constituents, packaging, forms, addiction, and harm potential, and thus are
challenging to study and control. Involvement of both formal and informal sector
in SLT production and sales further add to the complexities. The problem of SLT
is usually understated and less researched upon. This paper summarizes the
existing knowledge and provides evidence to strengthen the case against the SLT,
stressing on the need to enhance the SLT control across the globe.
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Affiliation(s)
- Ravi Mehrotra
- Indian Council of Medical Research-Indian Cancer Research Consortium, New Delhi, Delhi, India
| | | | - Ravi Kaushik
- Maulana Azad Medical College and Associated Hospitals, New Delhi, Delhi, India
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18
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Readshaw A, Mehrotra R, Mishu M, Khan Z, Siddiqui F, Coyle K, Siddiqi K. Addressing smokeless tobacco use and building research capacity in South Asia (ASTRA). J Glob Health 2020; 10:010327. [PMID: 32257149 PMCID: PMC7101025 DOI: 10.7189/jogh.10.010327] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Anne Readshaw
- Department of Health Sciences, University of York, York, UK
| | - Ravi Mehrotra
- India Cancer Research Consortium, Indian Council of Medical Research - Department of Health Research, New Delhi, India
| | - Masuma Mishu
- Department of Health Sciences, University of York, York, UK
| | - Zohaib Khan
- Office of Research, Innovation and Commercialization, Khyber Medical University, Peshawar, Pakistan
| | - Faraz Siddiqui
- Department of Health Sciences, University of York, York, UK
| | - Kathryn Coyle
- Department of Clinical Sciences, Brunel University, London, UK
| | - Kamran Siddiqi
- Department of Health Sciences, University of York, York, UK
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19
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Zaatari GS, Bazzi A. Impact of the WHO FCTC on non-cigarette tobacco products. Tob Control 2019; 28:s104-s112. [PMID: 30065075 PMCID: PMC6589465 DOI: 10.1136/tobaccocontrol-2018-054346] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2018] [Revised: 07/04/2018] [Accepted: 07/07/2018] [Indexed: 11/17/2022]
Abstract
INTRODUCTION This paper investigates to what extent Framework Convention on Tobacco Control (FCTC) parties have successfully implemented regulatory measures against non-cigarette tobacco product (NCTP) use, considers the challenges and peculiarities in applying such regulations and proposes effective means. DATA AND METHODS This review was based on many sources mainly: International Legal Consortium, International Tobacco Control, Campaign for Tobacco-Free Kids, FCTC, expert group visits and published literature. FINDINGS AND CONCLUSION The FCTC provided a framework that applies to all forms of tobacco and this encouraged some parties to adopt control measures against NCTP and to incorporate them into their national tobacco control plans. Although a number of countries have adopted measures specifically targeted towards smokeless and waterpipe tobacco, greater global progress is needed. The strongest achievements have been in protection from exposure to tobacco smoke; controlling advertising, promotion and sponsorship; controlling sales to and by minors; education, communication and public awareness; and packaging and labelling of NCTP. Countries which adopted broad definitions of tobacco products have demonstrated encouraging trends in curbing their use. Future work should address the deep-rooted social acceptance of NCTP, the laxity in their control, their exclusion from regulations in some countries and the failure to subject them to increased taxation. Control measures should also specifically target the initiation risk to youth and adolescents and all factors that contribute to that such as banning flavourings and promotions through social media. Stronger global surveillance of NCTP use, tracking of policy implementation and evaluation of policy impact will provide important evidence to assist parties in fully implementing the FCTC to control their use.
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Affiliation(s)
- Ghazi S Zaatari
- Pathology & Laboratory Medicine, American University of Beirut, Beirut, Lebanon
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20
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Gupta AK, Tulsyan S, Bharadwaj M, Mehrotra R. Grass roots approach to control levels of carcinogenic nitrosamines, NNN and NNK in smokeless tobacco products. Food Chem Toxicol 2019; 124:359-366. [DOI: 10.1016/j.fct.2018.12.011] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2018] [Revised: 09/06/2018] [Accepted: 12/08/2018] [Indexed: 12/16/2022]
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21
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Gulati HK, Kumar A, Dhama AS, Gupta R, Sharma AK, Singh H, Sinha DN, Mehrotra R. Setting research priorities in smokeless tobacco control: A retrospective review. Indian J Med Res 2018; 148:103-109. [PMID: 30264759 PMCID: PMC6172912 DOI: 10.4103/ijmr.ijmr_80_18] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Background & objectives Smokeless tobacco (SLT) has become a global menace; India being one of the high-burden countries contributes about 67 per cent of its users. Although research is ongoing on various aspects of SLT use and its effects, there is a need to identify the still under-researched areas in this field. This study was aimed at delineating the quantum of research on various topics of SLT, with intent to delineate research gaps for guiding future research priorities. Methods Data about research in SLT were collected from PubMed database using 'smokeless tobacco' as a keyword and applying Medical Subject Headings (MeSH) terms filter. Data were extracted in XML (Extensible Markup Language) format and parsed into database to extract necessary fields such as PubMed IDs, authors' names, affiliations and MeSH terms. Quantum of research in various aspects of SLT was identified for individual MeSH terms and compared for global and Indian data. Results Data analysis of 2857 records revealed that maximum number of articles was devoted to adverse effects (35.6%) followed by epidemiology (32.4%). In comparison, India contributed only 11.7 per cent of records with maximum number of articles on the topics of epidemiology (26%) and adverse effects (45.8%). Higher proportion of research was published on epidemiology, aetiology and prevention and control at global level, while adverse effects of SLT were researched more in Indian studies as compared to global data. Interpretation & conclusions The present analysis highlighted the paucity of research studies on important topics such as economics and alternative strategies of SLT control, both on the global and regional levels.
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Affiliation(s)
- Harleen Kaur Gulati
- WHO FCTC Global Knowledge Hub for Smokeless Tobacco, ICMR-National Institute of Cancer Prevention & Research, Noida, India
| | - Amit Kumar
- Data Management Laboratory, ICMR-National Institute of Cancer Prevention & Research, Noida, India
| | - Ajay Singh Dhama
- Division of Informatics, Systems Research and Management, Indian Council of Medical Research, New Delhi, India
| | - Ruchika Gupta
- Division of Cytopathology, ICMR-National Institute of Cancer Prevention & Research, Noida, India
| | - Amitesh Kumar Sharma
- Division of Informatics, Systems Research and Management, Indian Council of Medical Research, New Delhi, India
| | - Harpreet Singh
- Division of Informatics, Systems Research and Management, Indian Council of Medical Research, New Delhi, India
| | | | - Ravi Mehrotra
- WHO FCTC Global Knowledge Hub for Smokeless Tobacco, ICMR-National Institute of Cancer Prevention & Research, Noida, India
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