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Rasool S, Holliday R, Khan Z, Dobbie F, Bauld L. Behavior Change Intervention for Smokeless Tobacco Cessation Delivered Through Dentists in Dental Settings: A Pragmatic Pilot Trial. Nicotine Tob Res 2024; 26:878-887. [PMID: 38079516 PMCID: PMC11190057 DOI: 10.1093/ntr/ntad243] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Revised: 11/16/2023] [Accepted: 11/27/2023] [Indexed: 06/22/2024]
Abstract
INTRODUCTION Evidence on smokeless tobacco (ST) cessation interventions is scarce. The South Asian (SA) region that shares more than 90% of the burden of ST use is grossly underrepresented in research on ST cessation. This study aimed to assess the feasibility of delivering and investigating a behavioral support intervention for ST cessation in dental settings in Pakistan. METHODS A multicenter, pilot, two-armed parallel-group, individually randomized control trial, with a 1:1 allocation ratio, was conducted at two dental hospitals. Eligibility criteria included being an ST user seeking dental treatment and not currently accessing cessation support. All participants were provided written self-help ST cessation material. The intervention group also received a dentist-delivered, bespoke behavioral support intervention for ST cessation developed for users of SA origin. Participants were followed up telephonically at 3 and 6 months. Self-reported 6-month abstinence was verified by salivary cotinine. Analysis was descriptive, with 95% confidence intervals presented where appropriate. RESULTS One hundred participants were successfully recruited from the selected hospitals. Of these, 78% continued to engage throughout the study duration and provided primary outcome data, whereas 63% completed all hospital visits. The outcome measures were successfully collected. Biochemically verified 6-month abstinence in the intervention and control groups was 10% and 4%. CONCLUSIONS It was feasible to deliver and evaluate a dentist-delivered behavioral support intervention for ST cessation in Pakistan. The data suggested that the intervention may improve ST quit rates. The findings of this study will be useful in informing the design of future definitive studies. IMPLICATIONS To our knowledge, this is the first pragmatic pilot trial on ST cessation in dental settings in Pakistan and the first trial on dentist-delivered structured behavioral support intervention for ST cessation. It adds to the scarce, trial evidence based on ST cessation interventions. The findings suggest behavioral support intervention for ST cessation may improve quit rates. The trial was conducted in a country with poor ST control measures, where ST products are not taxed, the products are sold openly to and by minors, and the users are offered negligible cessation support. The findings may, therefore, be generalizable to low-middle-income countries, particularly SA countries, with similar policy backgrounds.
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Affiliation(s)
- Shaista Rasool
- Usher Institute, The University of Edinburgh, Scotland, UK
- Insitute of Public Health, Khyber Medical University, Peshawar, Pakistan
| | - Richard Holliday
- School of Dental Sciences, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - Zohaib Khan
- Insitute of Public Health, Khyber Medical University, Peshawar, Pakistan
| | - Fiona Dobbie
- Usher Institute, The University of Edinburgh, Scotland, UK
| | - Linda Bauld
- Usher Institute, The University of Edinburgh, Scotland, UK
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Kaur J, Rinkoo AV, Richardson S. Trends in smokeless tobacco use and attributable mortality and morbidity in the South-East Asia Region: implications for policy. Tob Control 2024; 33:425-433. [PMID: 36596709 DOI: 10.1136/tc-2022-057669] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Accepted: 12/08/2022] [Indexed: 01/05/2023]
Abstract
OBJECTIVES To describe the prevalence of smokeless tobacco (SLT) use and number of users by year, in addition to trends in mortality and attributable disease burden in countries of the WHO South-East Asia Region (SEAR), to inform policies for SLT control in the Region. METHODS For each SEAR country, we obtained data from Global Adult Tobacco Surveys, WHO STEPwise Approach to NCD Risk Factor Surveillance surveys and Demographic and Health Surveys conducted since 2010 to estimate prevalence of SLT use by country, sex and year. Using data from the World Population Prospects database we estimated the number of users by country. Next, using the results of previous meta-analyses and prevalence results, we estimated the population attributable fractions and attributable mortality and morbidity in terms of annual deaths and disability-adjusted life years lost. We then characterised trends in attributable deaths and disease burden for countries with comparable data. RESULTS There were wide differences in SLT use prevalence by country. We estimated that, during 2015-2019, there were 165 803 900 SLT users across SEAR, with 479 466 attributable deaths annually of which India accounted for 79.9% with 383 248. Attributable annual deaths increased in some countries during 2015-2019. CONCLUSIONS Annual deaths and disease burden attributable to SLT remain high across SEAR and have only declined modestly in recent years. Effective implementation of all WHO Framework Convention on Tobacco Control measures, addressing both supply-side and demand-side issues, in relation to SLT and areca nut products must be prioritised to ensure reductions in mortality and disease burden are sustained and accelerated.
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Affiliation(s)
- Jagdish Kaur
- Tobacco Free Initiative, World Health Organization Regional Office for South-East Asia, New Delhi, Delhi, India
| | - Arvind Vashishta Rinkoo
- Tobacco Free Initiative, World Health Organization Regional Office for South-East Asia, New Delhi, Delhi, India
| | - Sol Richardson
- Vanke School of Public Health, Tsinghua University, Beijing, China
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3
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Hong S, Son Y, Lee H, Kim S, Kim HJ, Jo H, Park J, Lee K, Lee H, Dragioti E, Fond G, Boyer L, López Sánchez GF, Tully MA, Rahmati M, Smith L, Kim S, Woo S, Yon DK. Global association of secondhand smoke exposure locations and smoking behaviour among adolescents in 99 countries. Acta Paediatr 2024. [PMID: 38859709 DOI: 10.1111/apa.17319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2024] [Revised: 04/29/2024] [Accepted: 05/27/2024] [Indexed: 06/12/2024]
Abstract
AIM This study classified 99 countries into four income groups and then analysed the impact of secondhand smoke (SHS) exposure at home, in public places and at school, on current cigarette smoking prevalence. METHODS We utilised data from the WHO Global Youth Tobacco Survey and a meta-analysis was conducted to evaluate the prevalence and weighted odds ratios (wORs) of adolescent smoking behaviour and SHS exposure locations. RESULTS Both smoking behaviours increased with higher national income levels. Smoking behaviours in high and upper-middle-income countries (HICs and UMICs) exhibited an association with SHS exposure in public places (HIC: wOR, 3.50 [95% CI, 2.85-4.31]; UMIC: wOR, 2.90 [2.60-3.23]) compared to home. Low- and lower-middle-income countries (LICs and LMICs) showed an association with SHS exposure in the home (LIC: wOR, 5.33 [3.59-7.93]; LMIC: wOR, 2.71 [2.33-3.17]) than public places. The association between current cigarette smoking and SHS exposure at home increased with lower income levels, while anticipated future use of any form of tobacco with SHS exposure in public places rose in lower income countries. CONCLUSIONS Targeted interventions based on income levels are essential, emphasising home strategies in lower income countries and public place efforts in higher income countries.
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Affiliation(s)
- Seohyun Hong
- Department of Medicine, Kyung Hee University College of Medicine, Seoul, South Korea
| | - Yejun Son
- Center for Digital Health, Kyung Hee University College of Medicine, Seoul, South Korea
- Department of Precision Medicine, Kyung Hee University College of Medicine, Seoul, South Korea
| | - Hyeri Lee
- Center for Digital Health, Kyung Hee University College of Medicine, Seoul, South Korea
- Department of Regulatory Science, Kyung Hee University, Seoul, South Korea
| | - Soeun Kim
- Center for Digital Health, Kyung Hee University College of Medicine, Seoul, South Korea
- Department of Precision Medicine, Kyung Hee University College of Medicine, Seoul, South Korea
| | - Hyeon Jin Kim
- Center for Digital Health, Kyung Hee University College of Medicine, Seoul, South Korea
- Department of Regulatory Science, Kyung Hee University, Seoul, South Korea
| | - Hyesu Jo
- Center for Digital Health, Kyung Hee University College of Medicine, Seoul, South Korea
- Department of Regulatory Science, Kyung Hee University, Seoul, South Korea
| | - Jaeyu Park
- Center for Digital Health, Kyung Hee University College of Medicine, Seoul, South Korea
- Department of Regulatory Science, Kyung Hee University, Seoul, South Korea
| | - Kyeongmin Lee
- Center for Digital Health, Kyung Hee University College of Medicine, Seoul, South Korea
- Department of Regulatory Science, Kyung Hee University, Seoul, South Korea
| | - Hayeon Lee
- Center for Digital Health, Kyung Hee University College of Medicine, Seoul, South Korea
| | - Elena Dragioti
- Pain and Rehabilitation Centre, and Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
- Research Laboratory Psychology of Patients, Families, and Health Professionals, Department of Nursing, School of Health Sciences, University of Ioannina, Ioannina, Greece
| | - Guillaume Fond
- CEReSS-Health Service Research and Quality of Life Center, Assistance Publique-Hôpitaux de Marseille, Aix-Marseille University, Marseille, France
| | - Laurent Boyer
- CEReSS-Health Service Research and Quality of Life Center, Assistance Publique-Hôpitaux de Marseille, Aix-Marseille University, Marseille, France
| | - Guillermo F López Sánchez
- Division of Preventive Medicine and Public Health, Department of Public Health Sciences, School of Medicine, University of Murcia, Murcia, Spain
| | - Mark A Tully
- School of Medicine, Ulster University, Londonderry, UK
| | - Masoud Rahmati
- CEReSS-Health Service Research and Quality of Life Center, Assistance Publique-Hôpitaux de Marseille, Aix-Marseille University, Marseille, France
- Department of Physical Education and Sport Sciences, Faculty of Literature and Human Sciences, Lorestan University, Khoramabad, Iran
- Department of Physical Education and Sport Sciences, Faculty of Literature and Humanities, Vali-E-Asr University of Rafsanjan, Rafsanjan, Iran
| | - Lee Smith
- Centre for Health, Performance and Wellbeing, Anglia Ruskin University, Cambridge, UK
| | - Sunyoung Kim
- Department of Family Medicine, Kyung Hee University Medical Center, Kyung Hee University College of Medicine, Seoul, South Korea
| | - Selin Woo
- Center for Digital Health, Kyung Hee University College of Medicine, Seoul, South Korea
| | - Dong Keon Yon
- Department of Medicine, Kyung Hee University College of Medicine, Seoul, South Korea
- Center for Digital Health, Kyung Hee University College of Medicine, Seoul, South Korea
- Department of Precision Medicine, Kyung Hee University College of Medicine, Seoul, South Korea
- Department of Regulatory Science, Kyung Hee University, Seoul, South Korea
- Department of Pediatrics, Kyung Hee University Medical Center, Kyung Hee University College of Medicine, Seoul, South Korea
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Mankan AK, Shankar A, Limaye S, Ajaikumar BS, Nachane P, Singh N, Dawkhar S, Batra U, Bhosekar A, Ganguly S, Gawli P, Debnath K, Padalalu V, Reddy P, Sundaramoorthy S, Naveen KK, Bondarde S, Kumar P, Davis S, Ramkissoon SH, Chacko RT, Vidal L, Chico I, Hegedus A, Gupta S, Saini KS. Cancer Trials Ecosystem in India-Ready for Prime Time? JCO Glob Oncol 2024; 10:e2300405. [PMID: 38870438 DOI: 10.1200/go.23.00405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Accepted: 04/12/2024] [Indexed: 06/15/2024] Open
Abstract
Executing global clinical trials for cancer is a long, expensive, and complex undertaking. While selecting countries global studies, sponsors must consider several aspects including patient pool, quality of trained investigators, competing trials, availability of infrastructure, and financial investment versus returns. With a large, often treatment-naïve, and diverse patient pool, relatively low cost, good quality health care facilities in urban areas, and a robust and well-trained workforce, India offers several advantages for conducting oncology clinical trials. However, there remains challenges, including a shifting regulatory environment in recent decades. With the implementation of the New Drugs and Clinical Trial Rules in 2019, India's regulatory atmosphere seems to have stabilized. In this article, we present a review of the evolving clinical trial landscape in India, highlight the current regulatory scenario, and discuss the advantages and challenges of selecting India as a potential location for conducting global oncology clinical trials.
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Affiliation(s)
| | - Abhishek Shankar
- Department of Radiation Oncology, Dr BR Ambedkar Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, Delhi, India
| | | | | | | | - Navneet Singh
- PostGraduate Institute of Medical Education and Research, Chandigarh, India
| | | | - Ullas Batra
- Rajiv Gandhi Cancer Centre, New Delhi, India
| | | | | | | | | | | | | | | | | | | | | | - Sanish Davis
- Indian Society for Clinical Research, Mumbai, India
| | | | | | | | | | | | - Sudeep Gupta
- Tata Memorial Centre, Mumbai, India
- Homi Bhabha National Institute, Mumbai, India
| | - Kamal S Saini
- Fortrea Inc, Durham, NC
- Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
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5
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Quadri MFA, Kamel AM, Nayeem M, John T, Thacheril A, Tartaglia G, Tadakamadla S. Smokeless tobacco and periodontitis: A systematic review with meta-analysis. J Periodontal Res 2024. [PMID: 38757716 DOI: 10.1111/jre.13274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Revised: 04/04/2024] [Accepted: 04/10/2024] [Indexed: 05/18/2024]
Abstract
AIM The present systematic review with meta-analysis aimed to investigate the global association between smokeless tobacco (SLT) use and periodontitis, considering significant effect size variation based on the income levels of countries. METHODS We searched seven databases to identify studies that assessed the prevalence of periodontitis in adult SLT users compared to non-users. The quality of studies was evaluated using the 10-item risk-of-bias tool, and publication bias was addressed through the trim-and-fill method. Sensitivity analysis utilized the leave-one-out approach. Meta-analysis and meta-regression, stratified by country income, SLT type, and smoking status, employed robust variance estimation. RESULTS From an initial pool of 484 studies, 29 studies met the selection criteria and were subjected to qualitative synthesis. Subsequently, data from 19 studies were included in the meta-analysis. SLT users exhibited a nearly threefold greater likelihood of periodontitis compared to non-users (OR = 2.99; 95% CI: 2.10, 4.27; p < .01). The pooled estimate did not vary significantly based on the type of SLT used or concurrent smoking. However, the odds of periodontitis varied according to the economic level of the country; the pooled estimate was higher in high-income countries (OR = 1.69; 95% CI: 1.20, 2.37; p < .01) and even higher in lower-middle-income and lower-income countries (OR = 3.91; 95% CI: 2.66, 5.77; p < .01). CONCLUSIONS Smokeless tobacco users have a higher likelihood of developing periodontitis. This study underscores global disparities in the SLT-periodontitis relationship, highlighting the need for targeted interventions, particularly in economically challenged areas where SLT use is largely unregulated.
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Affiliation(s)
- Mir Faeq Ali Quadri
- Texas Tech University of El Paso, El Paso, Texas, USA
- Saveetha Dental College and Hospitals, Chennai, India
- University of Milan, Milan, Italy
| | | | | | - Tenny John
- Saveetha Dental College and Hospitals, Chennai, India
| | | | | | - Santosh Tadakamadla
- Dentistry and Oral Health, La Trobe University, Bendigo, Victoria, Australia
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6
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Guo B, Gan H, Xue M, Huang Z, Lin Z, Li S, Zheng P, Sun B. The Changing and Predicted Trends in Chronic Obstructive Pulmonary Disease Burden in China, the United States, and India from 1990 to 2030. Int J Chron Obstruct Pulmon Dis 2024; 19:695-706. [PMID: 38476123 PMCID: PMC10929568 DOI: 10.2147/copd.s448770] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Accepted: 03/01/2024] [Indexed: 03/14/2024] Open
Abstract
Background This study analyzed the burden of chronic obstructive pulmonary disease (COPD) in China, the United States, and India from 1990 to 2019 and projected the trends for the next decade. Methods This study utilized the GBD 2019 to compare the age-standardized incidence rate (ASIR), age-standardized mortality rate (ASMR), age-standardized disability-adjusted life years (DALYs) rate, and the proportion attributed to different risk factors in China, the United States, and India. Joinpoint models and autoregressive integrated moving average (ARIMA) models were employed to capture the changing trends in disease burden and forecast outcomes. Results From 1990 to 2019, China's age-standardized COPD incidence and mortality rates decreased by 29% and 70%, respectively. In the same period, India's rates decreased by 8% and 33%, while the United States saw an increase of 9% in COPD incidence and a 22% rise in mortality rates. Smoking and ambient particulate matter pollution are the two most significant risk factors for COPD, while household air pollution from solid fuels and low temperatures are the least impactful factors in the United States and India, respectively. The proportion of risk from household air pollution from solid fuels is higher in India than in China and the United States. Predictions for 2030 suggest that the age-standardized DALY rates, ASIR, and ASMR in the United States and India are expected to remain stable or decrease, while China's age-standardized incidence rate is projected to rise. Conclusion Over the past three decades, the incidence of COPD has been decreasing in China and India, while showing a slight increase in the United States. Smoking and ambient particulate matter pollution are the primary risk factors for men and women, respectively. The risk of household air pollution from solid fuels in India needs attention.
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Affiliation(s)
- Baojun Guo
- Department of Clinical Laboratory of the First Affiliated Hospital of Guangzhou Medical University, State Key Laboratory of Respiratory Disease, National Center for Respiratory Medicine, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, Guangzhou, 510120, People’s Republic of China
- School of Medicine, Henan University, Kaifeng, 475004, People’s Republic of China
| | - Hui Gan
- Department of Clinical Laboratory of the First Affiliated Hospital of Guangzhou Medical University, State Key Laboratory of Respiratory Disease, National Center for Respiratory Medicine, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, Guangzhou, 510120, People’s Republic of China
| | - Mingshan Xue
- Department of Clinical Laboratory of the First Affiliated Hospital of Guangzhou Medical University, State Key Laboratory of Respiratory Disease, National Center for Respiratory Medicine, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, Guangzhou, 510120, People’s Republic of China
- Guangzhou Eighth People’s Hospital, Guangzhou Medical University, Guangzhou, 510060, People’s Republic of China
| | - Zhifeng Huang
- Department of Clinical Laboratory of the First Affiliated Hospital of Guangzhou Medical University, State Key Laboratory of Respiratory Disease, National Center for Respiratory Medicine, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, Guangzhou, 510120, People’s Republic of China
| | - Zhiwei Lin
- Department of Clinical Laboratory of the First Affiliated Hospital of Guangzhou Medical University, State Key Laboratory of Respiratory Disease, National Center for Respiratory Medicine, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, Guangzhou, 510120, People’s Republic of China
| | - Shiyun Li
- Department of Clinical Laboratory of the First Affiliated Hospital of Guangzhou Medical University, State Key Laboratory of Respiratory Disease, National Center for Respiratory Medicine, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, Guangzhou, 510120, People’s Republic of China
| | - Peiyan Zheng
- Department of Clinical Laboratory of the First Affiliated Hospital of Guangzhou Medical University, State Key Laboratory of Respiratory Disease, National Center for Respiratory Medicine, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, Guangzhou, 510120, People’s Republic of China
| | - Baoqing Sun
- Department of Clinical Laboratory of the First Affiliated Hospital of Guangzhou Medical University, State Key Laboratory of Respiratory Disease, National Center for Respiratory Medicine, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, Guangzhou, 510120, People’s Republic of China
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7
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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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Fontes F, Suleman A, Silva-Matos C, Mate C, Amado C, Damasceno A, Lunet N. Tobacco consumption in Mozambique in 2005 and 2015. Drug Alcohol Rev 2024; 43:579-588. [PMID: 38133604 DOI: 10.1111/dar.13801] [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: 07/25/2023] [Accepted: 11/28/2023] [Indexed: 12/23/2023]
Abstract
INTRODUCTION The burden related to smoking exposure is growing in many low-income settings. We aimed to quantify the use of smoked and smokeless tobacco in Mozambique in 2014/2015, and to compare the estimates with those obtained in 2005. METHODS A cross sectional study was conducted in 2014/2015 on a representative sample of the Mozambican population aged 15 to 64 years, following the World Health Organization Stepwise Approach to Chronic Disease Risk Factor Surveillance (STEPS). Prevalence estimates with 95% confidence intervals were computed for different categories of tobacco consumption. The age-standardised prevalence in the age-group 25-64 years was compared with results from a STEPS survey conducted in 2005. RESULTS Between 2005 and 2014/2015, the prevalence of daily smoking decreased from 9.1% to 3.4% (p < 0.05) in women and from 33.6% to 27.3% (p < 0.05) in men. There was a significant decrease in the daily consumption of hand-rolled cigarettes among women (from 3.1% to 1.4%, p < 0.05). Among men, there was a decrease in the prevalence of daily consumption of smokeless tobacco (from 3.5% to 1.0%, p < 0.05). In 2014/2015, both manufactured and hand-rolled cigarette consumption were more prevalent among men, while the use of smokeless tobacco was more common among women; the consumption of both hand-rolled cigarettes and smokeless tobacco were more prevalent in rural settings. DISCUSSION AND CONCLUSIONS In Mozambique, there was a decrease in the prevalence of daily smokers in both genders and of daily consumption of smokeless tobacco among men between 2005 and 2014/2015. Efforts are needed to maintain the positive trends.
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Affiliation(s)
- Filipa Fontes
- Departamento de Ciências da Saúde Pública e Forenses e Educação Médica, Faculdade de Medicina da Universidade do Porto, Porto, Portugal
- EPIUnit-Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal
- Laboratório para a Investigação Integrativa e Translacional em Saúde Populacional, Universidade do Porto, Porto, Portugal
- Oncology Nursing Research Unit, IPO Porto Research Center, Portuguese Oncology Institute of Porto / Porto Comprehensive Cancer Centre & RISE at IPO Porto Research Center (Health Research Network), Porto, Portugal
| | - António Suleman
- Departamento de Psiquiatria e Saúde Mental, Hospital Psiquiátrico de Nampula, Nampula, Mozambique
| | - Carla Silva-Matos
- Unidade de Gestão do Fundo Global-Direção de Planificação e Cooperação, Ministério da Saúde, Maputo, Mozambique
| | - Celina Mate
- Direção Nacional de Saúde Publica - Secção das Doenças não Transmissíveis, Ministério da Saúde, Maputo, Mozambique
| | - Celeste Amado
- Direção Nacional de Saúde Publica - Secção das Doenças não Transmissíveis, Ministério da Saúde, Maputo, Mozambique
| | - Albertino Damasceno
- EPIUnit-Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal
- Laboratório para a Investigação Integrativa e Translacional em Saúde Populacional, Universidade do Porto, Porto, Portugal
- Departamento de Medicina, Faculdade de Medicina, Universidade Eduardo Mondlane, Maputo, Mozambique
| | - Nuno Lunet
- Departamento de Ciências da Saúde Pública e Forenses e Educação Médica, Faculdade de Medicina da Universidade do Porto, Porto, Portugal
- EPIUnit-Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal
- Laboratório para a Investigação Integrativa e Translacional em Saúde Populacional, Universidade do Porto, Porto, Portugal
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Kumari N, Manisha M, Paul S, Ram R. Socioeconomic inequality among smoking and smokeless tobacco uses among males in India: a decomposition analysis. Public Health 2024; 227:176-186. [PMID: 38232566 DOI: 10.1016/j.puhe.2023.12.006] [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: 10/10/2023] [Revised: 11/28/2023] [Accepted: 12/05/2023] [Indexed: 01/19/2024]
Abstract
OBJECTIVE India is the third-largest tobacco manufacturer and its use in India is characterised by a high prevalence of smoking and smokeless (sl) tobacco use. This results in 1 million deaths per year in the country. Given the high burden of tobacco use, this study examines the regional variations and socio-economic correlates of tobacco use in India. METHODS National Family Health Survey- 5 (2019-2020) have been analysed for the purpose of the study. A sample of 101,839 males aged 15-54 years was included in this study. Primary outcomes of tobacco use were categorised into smoking, smokeless and dual use of smoking and smokeless tobacco use. Bivariate analysis and decomposition analysis was done to study the socio-economic inequality. RESULTS The prevalence of tobacco use among males in India is around 41 percent. As indicated by the results of the logistics regression, age is positively related to smoking among males. Males aged 45-54 years are 2.5 (95 % concentration index [CI]:2.30-2.63) times probable to smoke, 1.4 (95% CI: 1.30-1.47) times probable of smokeless tobacco consumption and 2.2 (95% CI: 2.10-2.35) times more prone to using both types of substances compared to the younger age group. Males who are widower use smokeless 1.69 times (95% CI: 1.44-1.99) higher with reference to unmarried males. Males belonging to Scheduled tribes are 1.2 (95% CI: 1.13-1.25) times more likely to smoke, 1.3 (95% CI: 1.24-1.37) times more likely to use smokeless substances and 1.4 (95% CI: 1.33-1.47) times more likely to have dual use of tobacco than other social groups. Manual workers (both skilled are unskilled) are likely to smoke (odds ratio [OR] = 1.1, 95% CI: 1.02-1.11), use smokeless tobacco (OR = 1.3, 95% CI: 1.23-1.34) and have dual use of tobacco (OR = 1.29, 95% CI: 1.24-1.34) more than that of other categories. The decomposition of the concentration index shows a significant contribution from factors like a no education, ST/SC caste and wealth index. Among the states and union territories, the prevalence of tobacco is high in West Bengal, Tripura, Mizoram, Manipur, Meghalaya and Sikkim. CONCLUSION This study is useful for informing target-based prevention policies since it helps in highlighting regions, socio-economic and demographic groups especially vulnerable to tobacco addiction. In India, males from poorer and vulnerable socio-economic backgrounds are more likely to use tobacco. State wise, the eastern zone starting from West Bengal to the North-Eastern states have higher tobacco use than the rest of the country. There is an urgent need to frame policies for controlling the use of tobacco especially among high-risk groups.
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Affiliation(s)
- N Kumari
- Population Research Center, Udaipur, Rajasthan 313001, India.
| | - M Manisha
- Department of Migration and Urban Studies, International Institute for Population Science, Deonar, Mumbai 400088, India.
| | - S Paul
- Centre for the Study of Regional Development, School of Social Science, Jawaharlal Nehru University, New Delhi 110067, India.
| | - R Ram
- Department of Migration and Urban Studies, International Institute for Population Science, Deonar, Mumbai 400088, India.
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10
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Chen S, Dai S, Hou Y. Learn from tobacco to reduce betel nut use. Science 2023; 382:777-778. [PMID: 37972186 DOI: 10.1126/science.adk7903] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2023]
Affiliation(s)
- Shigao Chen
- Institute of Scientific and Technical Information, Chinese Academy of Tropical Agricultural Sciences, Haikou 571101, China
| | - Shengpei Dai
- College of Geography and Environmental Science, Hainan Normal University, Haikou 571158, China
| | - Yuanyuan Hou
- Institute of Scientific and Technical Information, Chinese Academy of Tropical Agricultural Sciences, Haikou 571101, China
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11
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Cunha ARD, Compton K, Xu R, Mishra R, Drangsholt MT, Antunes JLF, Kerr AR, Acheson AR, Lu D, Wallace LE, Kocarnik JM, Fu W, Dean FE, Pennini A, Henrikson HJ, Alam T, Ababneh E, Abd-Elsalam S, Abdoun M, Abidi H, Abubaker Ali H, Abu-Gharbieh E, Adane TD, Addo IY, Ahmad A, Ahmad S, Ahmed Rashid T, Akonde M, Al Hamad H, Alahdab F, Alimohamadi Y, Alipour V, Al-Maweri SA, Alsharif U, Ansari-Moghaddam A, Anwar SL, Anyasodor AE, Arabloo J, Aravkin AY, Aruleba RT, Asaad M, Ashraf T, Athari SS, Attia S, Azadnajafabad S, Azangou-Khyavy M, Badar M, Baghcheghi N, Banach M, Bardhan M, Barqawi HJ, Bashir NZ, Bashiri A, Benzian H, Bernabe E, Bhagat DS, Bhojaraja VS, Bjørge T, Bouaoud S, Braithwaite D, Briko NI, Calina D, Carreras G, Chakraborty PA, Chattu VK, Chaurasia A, Chen MX, Cho WCS, Chu DT, Chukwu IS, Chung E, Cruz-Martins N, Dadras O, Dai X, Dandona L, Dandona R, Daneshpajouhnejad P, Darvishi Cheshmeh Soltani R, Darwesh AM, Debela SA, Derbew Molla M, Dessalegn FN, Dianati-Nasab M, Digesa LE, Dixit SG, Dixit A, Djalalinia S, El Sayed I, El Tantawi M, Enyew DB, Erku DA, Ezzeddini R, Fagbamigbe AF, Falzone L, Fetensa G, Fukumoto T, Gaewkhiew P, Gallus S, Gebrehiwot M, Ghashghaee A, Gill PS, Golechha M, Goleij P, Gomez RS, Gorini G, Guimaraes ALS, Gupta B, Gupta S, Gupta VB, Gupta VK, Haj-Mirzaian A, Halboub ES, Halwani R, Hanif A, Hariyani N, Harorani M, Hasani H, Hassan AM, Hassanipour S, Hassen MB, Hay SI, Hayat K, Herrera-Serna BY, Holla R, Horita N, Hosseinzadeh M, Hussain S, Ilesanmi OS, Ilic IM, Ilic MD, Isola G, Jaiswal A, Jani CT, Javaheri T, Jayarajah U, Jayaram S, Joseph N, Kadashetti V, Kandaswamy E, Karanth SD, Karaye IM, Kauppila JH, Kaur H, Keykhaei M, Khader YS, Khajuria H, Khanali J, Khatib MN, Khayat Kashani HR, Khazeei Tabari MA, Kim MS, Kompani F, Koohestani HR, Kumar GA, Kurmi OP, La Vecchia C, Lal DK, Landires I, Lasrado S, Ledda C, Lee YH, Libra M, Lim SS, Listl S, Lopukhov PD, Mafi AR, Mahumud RA, Malik AA, Mathur MR, Maulud SQ, Meena JK, Mehrabi Nasab E, Mestrovic T, Mirfakhraie R, Misganaw A, Misra S, Mithra P, Mohammad Y, Mohammadi M, Mohammadi E, Mokdad AH, Moni MA, Moraga P, Morrison SD, Mozaffari HR, Mubarik S, Murray CJL, Nair TS, Narasimha Swamy S, Narayana AI, Nassereldine H, Natto ZS, Nayak BP, Negru SM, Nggada HA, Nouraei H, Nuñez-Samudio V, Oancea B, Olagunju AT, Omar Bali A, Padron-Monedero A, Padubidri JR, Pandey A, Pardhan S, Patel J, Pezzani R, Piracha ZZ, Rabiee N, Radhakrishnan V, Radhakrishnan RA, Rahmani AM, Rahmanian V, Rao CR, Rao SJ, Rath GK, Rawaf DL, Rawaf S, Rawassizadeh R, Razeghinia MS, Rezaei N, Rezaei N, Rezaei N, Rezapour A, Riad A, Roberts TJ, Romero-Rodríguez E, Roshandel G, S M, S N C, Saddik B, Saeb MR, Saeed U, Safaei M, Sahebazzamani M, Sahebkar A, Salek Farrokhi A, Samy AM, Santric-Milicevic MM, Sathian B, Satpathy M, Šekerija M, Senthilkumaran S, Seylani A, Shafaat O, Shahsavari HR, Shamsoddin E, Sharew MM, Sharifi-Rad J, Shetty JK, Shivakumar KM, Shobeiri P, Shorofi SA, Shrestha S, Siddappa Malleshappa SK, Singh P, Singh JA, Singh G, Sinha DN, Solomon Y, Suleman M, Suliankatchi Abdulkader R, Taheri Abkenar Y, Talaat IM, Tan KK, Tbakhi A, Thiyagarajan A, Tiyuri A, Tovani-Palone MR, Unnikrishnan B, Vo B, Volovat SR, Wang C, Westerman R, Wickramasinghe ND, Xiao H, Yu C, Yuce D, Yunusa I, Zadnik V, Zare I, Zhang ZJ, Zoladl M, Force LM, Hugo FN. The Global, Regional, and National Burden of Adult Lip, Oral, and Pharyngeal Cancer in 204 Countries and Territories: A Systematic Analysis for the Global Burden of Disease Study 2019. JAMA Oncol 2023; 9:1401-1416. [PMID: 37676656 PMCID: PMC10485745 DOI: 10.1001/jamaoncol.2023.2960] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Accepted: 05/04/2023] [Indexed: 09/08/2023]
Abstract
Importance Lip, oral, and pharyngeal cancers are important contributors to cancer burden worldwide, and a comprehensive evaluation of their burden globally, regionally, and nationally is crucial for effective policy planning. Objective To analyze the total and risk-attributable burden of lip and oral cavity cancer (LOC) and other pharyngeal cancer (OPC) for 204 countries and territories and by Socio-demographic Index (SDI) using 2019 Global Burden of Diseases, Injuries, and Risk Factors (GBD) Study estimates. Evidence Review The incidence, mortality, and disability-adjusted life years (DALYs) due to LOC and OPC from 1990 to 2019 were estimated using GBD 2019 methods. The GBD 2019 comparative risk assessment framework was used to estimate the proportion of deaths and DALYs for LOC and OPC attributable to smoking, tobacco, and alcohol consumption in 2019. Findings In 2019, 370 000 (95% uncertainty interval [UI], 338 000-401 000) cases and 199 000 (95% UI, 181 000-217 000) deaths for LOC and 167 000 (95% UI, 153 000-180 000) cases and 114 000 (95% UI, 103 000-126 000) deaths for OPC were estimated to occur globally, contributing 5.5 million (95% UI, 5.0-6.0 million) and 3.2 million (95% UI, 2.9-3.6 million) DALYs, respectively. From 1990 to 2019, low-middle and low SDI regions consistently showed the highest age-standardized mortality rates due to LOC and OPC, while the high SDI strata exhibited age-standardized incidence rates decreasing for LOC and increasing for OPC. Globally in 2019, smoking had the greatest contribution to risk-attributable OPC deaths for both sexes (55.8% [95% UI, 49.2%-62.0%] of all OPC deaths in male individuals and 17.4% [95% UI, 13.8%-21.2%] of all OPC deaths in female individuals). Smoking and alcohol both contributed to substantial LOC deaths globally among male individuals (42.3% [95% UI, 35.2%-48.6%] and 40.2% [95% UI, 33.3%-46.8%] of all risk-attributable cancer deaths, respectively), while chewing tobacco contributed to the greatest attributable LOC deaths among female individuals (27.6% [95% UI, 21.5%-33.8%]), driven by high risk-attributable burden in South and Southeast Asia. Conclusions and Relevance In this systematic analysis, disparities in LOC and OPC burden existed across the SDI spectrum, and a considerable percentage of burden was attributable to tobacco and alcohol use. These estimates can contribute to an understanding of the distribution and disparities in LOC and OPC burden globally and support cancer control planning efforts.
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Affiliation(s)
| | - Kelly Compton
- Institute for Health Metrics and Evaluation, University of Washington, Seattle
| | - Rixing Xu
- Institute for Health Metrics and Evaluation, University of Washington, Seattle
- Department of Data and Tooling, Sage Bionetworks, Seattle, Washington
| | - Rashmi Mishra
- Department of Oral Medicine, School of Dentistry, University of Washington, Seattle
| | - Mark Thomas Drangsholt
- Department of Oral Medicine, School of Dentistry, University of Washington, Seattle
- Oral Medicine Clinic, School of Dentistry, University of Washington, Seattle
| | | | - Alexander R Kerr
- Department of Oral and Maxillofacial Pathology, Radiology, and Medicine, College of Dentistry, New York University, New York, New York
| | - Alistair R Acheson
- Institute for Health Metrics and Evaluation, University of Washington, Seattle
| | - Dan Lu
- Institute for Health Metrics and Evaluation, University of Washington, Seattle
| | - Lindsey E Wallace
- Institute for Health Metrics and Evaluation, University of Washington, Seattle
| | - Jonathan M Kocarnik
- Institute for Health Metrics and Evaluation, University of Washington, Seattle
| | - Weijia Fu
- Institute for Health Metrics and Evaluation, University of Washington, Seattle
| | - Frances E Dean
- Institute for Health Metrics and Evaluation, University of Washington, Seattle
- Department of Mathematics, University of California, Berkeley
| | - Alyssa Pennini
- Institute for Health Metrics and Evaluation, University of Washington, Seattle
| | - Hannah Jacqueline Henrikson
- Institute for Health Metrics and Evaluation, University of Washington, Seattle
- Department of Global Health, School of Public Health, Boston University, Boston, Massachusetts
| | - Tahiya Alam
- Institute for Health Metrics and Evaluation, University of Washington, Seattle
| | - Emad Ababneh
- Pathology and Laboratory Medicine Institute, Cleveland Clinic, Cleveland, Ohio
| | - Sherief Abd-Elsalam
- Tropical Medicine Department, Faculty of Medicine, Tanta University, Tanta, Egypt
| | - Meriem Abdoun
- Department of Medicine, University of Setif Algeria, Setif, Algeria
| | - Hassan Abidi
- Laboratory Technology Sciences Department, Yasuj University of Medical Sciences, Yasuj, Iran
| | - Hiwa Abubaker Ali
- Department of Banking and Finance, University of Human Development, Sulaymaniyah, Iraq
| | - Eman Abu-Gharbieh
- Clinical Sciences Department, University of Sharjah, Sharjah, United Arab Emirates
| | - Tigist Demssew Adane
- Department of Clinical and Psychosocial Epidemiology, University of Groningen, Groningen, the Netherlands
| | - Isaac Yeboah Addo
- Centre for Social Research in Health, University of New South Wales, Sydney, New South Wales, Australia
- Quality and Systems Performance Unit, Cancer Institute NSW, Sydney, New South Wales, Australia
| | - Aqeel Ahmad
- Department of Medical Biochemistry, Shaqra University, Shaqra, Saudi Arabia
| | - Sajjad Ahmad
- Department of Health and Biological Sciences, Abasyn University, Peshawar, Pakistan
| | - Tarik Ahmed Rashid
- Department of Computer Science and Engineering, University of Kurdistan Hewler, Erbil, Iraq
| | - Maxwell Akonde
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia
| | - Hanadi Al Hamad
- Geriatric and Long Term Care Department, Hamad Medical Corporation, Doha, Qatar
- Rumailah Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Fares Alahdab
- Evidence-Based Practice Center Program, Mayo Clinic Foundation for Medical Education and Research, Rochester, Minnesota
| | - Yousef Alimohamadi
- Health Research Center, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - Vahid Alipour
- Health Management and Economics Research Center, Iran University of Medical Sciences, Tehran, Iran
- Department of Health Economics, Iran University of Medical Sciences, Tehran, Iran
| | | | | | - Alireza Ansari-Moghaddam
- Department of Epidemiology and Biostatistics, Zahedan University of Medical Sciences, Zahedan, Iran
| | - Sumadi Lukman Anwar
- Department of Surgery, Faculty of Medicine, Gadjah Mada University, Yogyakarta, Indonesia
| | | | - Jalal Arabloo
- Health Management and Economics Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Aleksandr Y Aravkin
- Institute for Health Metrics and Evaluation, University of Washington, Seattle
- Department of Applied Mathematics, College of Arts & Sciences, University of Washington, Seattle
- Department of Health Metrics Sciences, School of Medicine, University of Washington, Seattle
| | - Raphael Taiwo Aruleba
- Department of Molecular and Cell Biology, University of Cape Town, Cape Town, South Africa
| | - Malke Asaad
- Department of Plastic Surgery, University of Texas, Houston
| | - Tahira Ashraf
- University Institute of Radiological Sciences and Medical Imaging Technology, The University of Lahore, Lahore, Pakistan
| | | | - Sameh Attia
- Department of Oral and Maxillofacial Surgery, Justus Liebig University of Giessen, Giessen, Germany
| | - Sina Azadnajafabad
- Non-Communicable Diseases Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammadreza Azangou-Khyavy
- Non-Communicable Diseases Research Center, Tehran University of Medical Sciences, Tehran, Iran
- Social Determinants of Health Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Muhammad Badar
- Gomal Center of Biochemistry and Biotechnology, Gomal University, Dera Ismail Khan, Pakistan
| | - Nayereh Baghcheghi
- Department of Nursing, Saveh University of Medical Sciences, Saveh, Iran
| | - Maciej Banach
- Department of Hypertension, Medical University of Lodz, Lodz, Poland
- Polish Mothers' Memorial Hospital Research Institute, Lodz, Poland
| | - Mainak Bardhan
- Department of Molecular Microbiology and Bacteriology, National Institute of Cholera and Enteric Diseases, Kolkata, India
- Department of Molecular Microbiology, Indian Council of Medical Research, New Delhi, India
| | - Hiba Jawdat Barqawi
- Clinical Sciences Department, University of Sharjah, Sharjah, United Arab Emirates
| | - Nasir Z Bashir
- School of Oral and Dental Sciences, University of Bristol, Bristol, England, United Kingdom
| | - Azadeh Bashiri
- Health Information Management, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Habib Benzian
- Department of Epidemiology and Health Promotion, College of Dentistry, New York University, New York, New York
| | - Eduardo Bernabe
- Faculty of Dentistry, Oral & Craniofacial Sciences, King's College London, London, England, United Kingdom
| | - Devidas S Bhagat
- Department of Forensic Chemistry, Government Institute of Forensic Science, Aurangabad, India
| | - Vijayalakshmi S Bhojaraja
- Department of Anatomy, Royal College of Surgeons in Ireland Medical, University of Bahrain, Busaiteen, Bahrain
| | - Tone Bjørge
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
- Cancer Registry of Norway, Oslo, Norway
| | - Souad Bouaoud
- Department of Medicine, University Ferhat Abbas of Setif, Setif, Algeria
- Department of Epidemiology and Preventive Medicine, University Hospital Saadna Abdenour, Setif, Algeria
| | - Dejana Braithwaite
- Department of Epidemiology, College of Public Health and Health Professions and College of Medicine, University of Florida, Gainesville
- Cancer Control and Population Sciences Program, University of Florida Health Cancer Center, Gainesville
| | - Nikolay Ivanovich Briko
- Department of Epidemiology and Evidence-Based Medicine, I.M. Sechenov First Moscow State Medical University, Moscow, Russia
| | - Daniela Calina
- Department of Clinical Pharmacy, Faculty of Pharmacy, University of Medicine and Pharmacy of Craiova, Craiova, Romania
| | - Giulia Carreras
- Institute for Cancer Research, Prevention and Clinical Network, Florence, Italy
| | - Promit Ananyo Chakraborty
- School of Population and Public Health, Faculty of Medicine, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Vijay Kumar Chattu
- Department of Community Medicine, Datta Meghe Institute of Medical Sciences, Sawangi, India
- Saveetha Medical College and Hospitals, Saveetha Institute of Medical and Technical Sciences (SIMATS), Chennai, India
| | - Akhilanand Chaurasia
- Department of Oral Medicine and Radiology, King George's Medical University, Lucknow, India
| | - Meng Xuan Chen
- Department of Oral Biological and Medical Sciences, The University of British Columbia, Vancouver, British Columbia, Canada
| | - William C S Cho
- Department of Clinical Oncology, Queen Elizabeth Hospital, Hong Kong, China
| | - Dinh-Toi Chu
- Center for Biomedicine and Community Health, International School, Vietnam National University, Hanoi, Vietnam
| | | | - Eunice Chung
- Institute for Health Metrics and Evaluation, University of Washington, Seattle
| | - Natália Cruz-Martins
- Department of Therapeutic and Diagnostic Technologies, Polytechnic and University Higher Education Cooperative, Gandra, Portugal
- Institute for Research and Innovation in Health, University of Porto, Porto, Portugal
| | - Omid Dadras
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
- Section Global Health and Rehabilitation, Western Norway University of Applied Sciences, Bergen, Norway
| | - Xiaochen Dai
- Institute for Health Metrics and Evaluation, University of Washington, Seattle
- Department of Health Metrics Sciences, School of Medicine, University of Washington, Seattle
| | - Lalit Dandona
- Institute for Health Metrics and Evaluation, University of Washington, Seattle
- Public Health Foundation of India, Gurugram, India
- Indian Council of Medical Research, New Delhi, India
| | - Rakhi Dandona
- Institute for Health Metrics and Evaluation, University of Washington, Seattle
- Department of Health Metrics Sciences, School of Medicine, University of Washington, Seattle
- Public Health Foundation of India, Gurugram, India
| | - Parnaz Daneshpajouhnejad
- Department of Pathology, Johns Hopkins Medicine, Baltimore, Maryland
- Department of Pathology, Isfahan University of Medical Sciences, Isfahan, Iran
| | | | - Aso Mohammad Darwesh
- Department of Information Technology, University of Human Development, Sulaymaniyah, Iraq
| | | | | | - Fikadu Nugusu Dessalegn
- Department of Public Health, College of Medicine, Madda Walabu University, Bale Goba, Ethiopia
| | - Mostafa Dianati-Nasab
- Department of Epidemiology, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, the Netherlands
- Department of Epidemiology, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Lankamo Ena Digesa
- Department of Comprehensive Nursing, Arba Minch University, Arba Minch, Ethiopia
| | - Shilpi Gupta Dixit
- Department of Anatomy, All India Institute of Medical Sciences, Jodhpur, India
| | - Abhinav Dixit
- Department of Physiology, All India Institute of Medical Sciences, Jodhpur, India
| | - Shirin Djalalinia
- Development of Research and Technology Center, Ministry of Health and Medical Education, Tehran, Iran
| | - Iman El Sayed
- Department of Biomedical Informatics and Medical Statistics, Medical Research Institute, Alexandria University, Alexandria, Egypt
| | - Maha El Tantawi
- Department of Pediatric Dentistry and Dental Public Health, Faculty of Dentistry, Alexandria University, Alexandria, Egypt
| | | | - Daniel Asfaw Erku
- Centre for Applied Health Economics, Griffith University, Gold Coast, Queensland, Australia
| | - Rana Ezzeddini
- Department of Clinical Biochemistry, Tarbiat Modares University, Tehran, Iran
| | - Adeniyi Francis Fagbamigbe
- Department of Epidemiology and Medical Statistics, College of Medicine, University of Ibadan, Ibadan, Nigeria
- The Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, Scotland, United Kingdom
| | - Luca Falzone
- Epidemiology and Biostatistics Unit, National Cancer Institute IRCCS Fondazione G. Pascale, Naples, Italy
- Department of Biomedical and Biotechnological Sciences, University of Catania, Catania, Italy
| | - Getahun Fetensa
- Department of Nursing, College of Medical and Health Sciences, Wollega University, Nekemte, Ethiopia
| | | | - Piyada Gaewkhiew
- Department of Community Dentistry, Faculty of Dentistry, Mahidol University, Ratchathewi, Thailand
- Population and Patient Health Group, King's College London, London, England, United Kingdom
| | - Silvano Gallus
- Department of Environmental Health Sciences, Mario Negri Institute for Pharmacological Research, Milan, Italy
| | - Mesfin Gebrehiwot
- Department of Environmental Health, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
| | - Ahmad Ghashghaee
- School of Public Health, Qazvin University of Medical Sciences, Qazvin, Iran
| | - Paramjit Singh Gill
- Warwick Medical School, University of Warwick, Coventry, England, United Kingdom
| | - Mahaveer Golechha
- Department of Health Systems and Policy Research, Indian Institute of Public Health, Gandhinagar, India
| | - Pouya Goleij
- Department of Genetics, Sana Institute of Higher Education, Sari, Iran
| | - Ricardo Santiago Gomez
- Department of Oral Surgery and Pathology, School of Dentistry, Federal University of Minas Gerais, Belo Horizonte, Brazil
| | - Giuseppe Gorini
- Oncological Network, Institute for Cancer Research, Prevention and Clinical Network, Florence, Italy
| | | | - Bhawna Gupta
- Department of Public Health, Torrens University Australia, Melbourne, Victoria, Australia
| | - Sapna Gupta
- Toxicology Department, Shriram Institute for Industrial Research, Delhi, India
| | - Veer Bala Gupta
- School of Medicine, Deakin University, Geelong, Victoria, Australia
| | - Vivek Kumar Gupta
- Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, New South Wales, Australia
| | - Arvin Haj-Mirzaian
- Department of Pharmacology, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Obesity Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Esam S Halboub
- College of Dentistry, Jazan University, Jazan, Saudi Arabia
- School of Dentistry, Sana'a University, Sana'a, Yemen
| | - Rabih Halwani
- Clinical Sciences Department, University of Sharjah, Sharjah, United Arab Emirates
- College of Medicine, University of Sharjah, Sharjah, United Arab Emirates
| | - Asif Hanif
- University Institute of Public Health, The University of Lahore, Lahore, Pakistan
| | - Ninuk Hariyani
- Department of Dental Public Health, Airlangga University, Surabaya, Indonesia
- Australian Research Centre for Population Oral Health, University of Adelaide, Adelaide, South Australia, Australia
| | - Mehdi Harorani
- Department of Nursing, School of Nursing, Arak University of Medical Sciences, Arak, Iran
| | - Hamidreza Hasani
- Department of Ophthalmology, Iran University of Medical Sciences, Karaj, Iran
| | - Abbas M Hassan
- Department of Plastic Surgery, University of Texas, Houston
| | - Soheil Hassanipour
- Gastrointestinal and Liver Diseases Research Center, Guilan University of Medical Sciences, Rasht, Iran
- Caspian Digestive Disease Research Center, Guilan University of Medical Sciences, Rasht, Iran
| | - Mohammed Bheser Hassen
- Institute for Health Metrics and Evaluation, University of Washington, Seattle
- National Data Management Center for Health (NDMC), Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | - Simon I Hay
- Institute for Health Metrics and Evaluation, University of Washington, Seattle
- Department of Health Metrics Sciences, School of Medicine, University of Washington, Seattle
| | - Khezar Hayat
- Institute of Pharmaceutical Sciences, University of Veterinary and Animal Sciences, Lahore, Pakistan
- Department of Pharmacy Administration and Clinical Pharmacy, Xi'an Jiaotong University, Xi'an, China
| | | | - Ramesh Holla
- Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, Manipal, India
| | - Nobuyuki Horita
- Department of Pulmonology, Yokohama City University, Yokohama, Japan
- National Human Genome Research Institute (NHGRI), National Institutes of Health, Bethesda, Maryland
| | - Mehdi Hosseinzadeh
- Institute of Research and Development, Duy Tan University, Da Nang, Vietnam
- Department of Computer Science, University of Human Development, Sulaymaniyah, Iraq
| | - Salman Hussain
- Czech National Centre for Evidence-Based Healthcare and Knowledge Translation, Masaryk University, Brno, Czech Republic
- Institute of Biostatistics and Analyses, Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Olayinka Stephen Ilesanmi
- Department of Community Medicine, College of Medicine, University of Ibadan, Ibadan, Nigeria
- Department of Community Medicine, University College Hospital, Ibadan, Ibadan, Nigeria
| | - Irena M Ilic
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Milena D Ilic
- Department of Epidemiology, Faculty of Medical Sciences, University of Kragujevac, Kragujevac, Serbia
| | - Gaetano Isola
- Department of General Surgery and Surgical-Medical Specialties, University of Catania, Catania, Italy
| | - Abhishek Jaiswal
- Centre for Community Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Chinmay T Jani
- Department of Internal Medicine, Mount Auburn Hospital, Harvard University, Cambridge, Massachusetts
| | - Tahereh Javaheri
- Health Informatics Lab, Boston University, Boston, Massachusetts
| | - Umesh Jayarajah
- Postgraduate Institute of Medicine, University of Colombo, Colombo, Sri Lanka
- Department of Surgery, National Hospital of Sri Lanka, Colombo, Sri Lanka
| | - Shubha Jayaram
- Department of Biochemistry, Government Medical College, Mysuru, India
| | - Nitin Joseph
- Department of Community Medicine, Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, Mangalore, India
| | - Vidya Kadashetti
- Department of Oral and Maxillofacial Pathology, Krishna Vishwa Vidyapeeth (Deemed to be University), Karad, India
| | - Eswar Kandaswamy
- Department of Periodontics, School of Dentistry, Louisiana State University Health Sciences Center, New Orleans
| | | | - Ibraheem M Karaye
- School of Health Professions and Human Services, Hofstra University, Hempstead, New York
| | - Joonas H Kauppila
- Surgery Research Unit, University of Oulu, Oulu, Finland
- Department of Molecular Medicine and Surgery, Karolinska Institute, Stockholm, Sweden
| | | | - Mohammad Keykhaei
- Non-Communicable Diseases Research Center, Tehran University of Medical Sciences, Tehran, Iran
- Students' Scientific Research Center (SSRC), Tehran University of Medical Sciences, Tehran, Iran
| | - Yousef Saleh Khader
- Department of Public Health and Community Medicine, Jordan University of Science and Technology, Irbid, Jordan
| | - Himanshu Khajuria
- Amity Institute of Forensic Sciences, Amity University, Noida, India
| | - Javad Khanali
- Non-Communicable Diseases Research Center, Tehran University of Medical Sciences, Tehran, Iran
- Social Determinants of Health Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mahalaqua Nazli Khatib
- Global Consortium for Public Health Research, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, India
| | | | - Mohammad Amin Khazeei Tabari
- Department of Medicine, Mazandaran University of Medical Sciences, Sari, Iran
- MAZUMS Office, Universal Scientific Education and Research Network, Tehran, Iran
| | - Min Seo Kim
- Department of Genomics and Digital Health, Samsung Advanced Institute for Health Sciences & Technology (SAIHST), Seoul, South Korea
- Public Health Center, Ministry of Health and Welfare, Wando, South Korea
| | - Farzad Kompani
- Children's Medical Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Hamid Reza Koohestani
- Social Determinants of Health Research Center, Saveh University of Medical Sciences, Saveh, Iran
| | - G Anil Kumar
- Public Health Foundation of India, Gurugram, India
| | - Om P Kurmi
- Faculty of Health and Life Sciences, Coventry University, Coventry, England, United Kingdom
- Department of Medicine, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Carlo La Vecchia
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | | | - Iván Landires
- Unit of Genetics and Public Health, Institute of Medical Sciences, Las Tablas, Panama
- Ministry of Health, Herrera, Panama
| | - Savita Lasrado
- Department of Otorhinolaryngology, Father Muller Medical College, Mangalore, India
| | - Caterina Ledda
- Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
| | - Yo Han Lee
- Department of Preventive Medicine, College of Medicine, Korea University, Seoul, South Korea
| | - Massimo Libra
- Department of Biomedical and Biotechnological Sciences, University of Catania, Catania, Italy
| | - Stephen S Lim
- Institute for Health Metrics and Evaluation, University of Washington, Seattle
- Department of Health Metrics Sciences, School of Medicine, University of Washington, Seattle
| | - Stefan Listl
- Department of Dentistry, Radboud University, Nijmegen, the Netherlands
- Department of Translational Health Economics, Heidelberg University Hospital, Heidelberg, Germany
| | - Platon D Lopukhov
- Department of Epidemiology and Evidence-Based Medicine, I.M. Sechenov First Moscow State Medical University, Moscow, Russia
| | - Ahmad R Mafi
- Department of Clinical Oncology, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Rashidul Alam Mahumud
- NHMRC Clinical Trials Centre, University of Sydney, Sydney, New South Wales, Australia
| | - Ahmad Azam Malik
- University Institute of Public Health, The University of Lahore, Lahore, Pakistan
- Rabigh Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Manu Raj Mathur
- Department of Health Policy Research, Public Health Foundation of India, Gurugram, India
- Institute of Population Health Sciences, University of Liverpool, Liverpool, England, United Kingdom
| | - Sazan Qadir Maulud
- Department of Biology, College of Science, Salahaddin University, Erbil, Iraq
| | - Jitendra Kumar Meena
- Department of Preventive Oncology, All India Institute of Medical Sciences, New Delhi, India
| | | | - Tomislav Mestrovic
- Institute for Health Metrics and Evaluation, University of Washington, Seattle
- University Centre Varazdin, University North, Varazdin, Croatia
| | - Reza Mirfakhraie
- Department of Genetics, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Awoke Misganaw
- Department of Health Metrics Sciences, School of Medicine, University of Washington, Seattle
- National Data Management Center for Health, Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | - Sanjeev Misra
- Department of Surgical Oncology, All India Institute of Medical Sciences, Jodhpur, India
| | - Prasanna Mithra
- Department of Community Medicine, Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, Mangalore, India
| | - Yousef Mohammad
- Internal Medicine Department, King Saud University, Riyadh, Saudi Arabia
| | - Mokhtar Mohammadi
- Department of Information Technology, Lebanese French University, Erbil, Iraq
| | - Esmaeil Mohammadi
- Tehran University of Medical Sciences, Tehran, Iran
- Faculty of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Ali H Mokdad
- Institute for Health Metrics and Evaluation, University of Washington, Seattle
- Department of Health Metrics Sciences, School of Medicine, University of Washington, Seattle
| | - Mohammad Ali Moni
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Queensland, Australia
| | - Paula Moraga
- Computer, Electrical and Mathematical Sciences and Engineering Division, King Abdullah University of Science and Technology, Thuwal, Saudi Arabia
| | - Shane Douglas Morrison
- Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology-Head and Neck Surgery, University of Washington, Seattle
| | - Hamid Reza Mozaffari
- Department of Oral and Maxillofacial Medicine, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Sumaira Mubarik
- Department of Epidemiology and Biostatistics, School of Medicine, Wuhan University, Wuhan, China
| | - Christopher J L Murray
- Institute for Health Metrics and Evaluation, University of Washington, Seattle
- Department of Health Metrics Sciences, School of Medicine, University of Washington, Seattle
| | | | | | | | - Hasan Nassereldine
- Institute for Health Metrics and Evaluation, University of Washington, Seattle
| | - Zuhair S Natto
- Department of Dental Public Health, Faculty of Dentistry, King Abdulaziz University, Jeddah, Saudi Arabia
- Department of Oral Health Policy and Epidemiology, School of Dental Medicine, Harvard University, Boston, Massachusetts
| | | | - Serban Mircea Negru
- Department of Oncology, Victor Babes University of Medicine and Pharmacy, Timisoara, Romania
| | - Haruna Asura Nggada
- Department of Histopathology, University of Maiduguri Teaching Hospital, Maiduguri, Nigeria
- Department of Human Pathology, University of Maiduguri, Maiduguri, Nigeria
| | - Hasti Nouraei
- Department of Medical Mycology and Parasitology, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Virginia Nuñez-Samudio
- Unit of Microbiology and Public Health, Institute of Medical Sciences, Las Tablas, Panama
- Department of Public Health, Ministry of Health, Herrera, Panama
| | - Bogdan Oancea
- Department of Applied Economics and Quantitative Analysis, University of Bucharest, Bucharest, Romania
| | - Andrew T Olagunju
- Department of Psychiatry and Behavioural Neurosciences, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
- Department of Psychiatry, Faculty of Clinical Science, University of Lagos, Lagos, Nigeria
| | - Ahmed Omar Bali
- Diplomacy and Public Relations Department, University of Human Development, Sulaymaniyah, Iraq
| | | | - Jagadish Rao Padubidri
- Department of Forensic Medicine and Toxicology, Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, Mangalore, India
| | | | - Shahina Pardhan
- Vision and Eye Research Institute, Anglia Ruskin University, Cambridge, England, United Kingdom
| | - Jay Patel
- Global Health Governance Programme, University of Edinburgh, Edinburgh, Scotland, United Kingdom
- School of Dentistry, University of Leeds, Leeds, England, United Kingdom
| | - Raffaele Pezzani
- Endocrinology Unit, Department of Medicine, University of Padova, Padova, Italy
- Associazione Italiana Ricerca Oncologica di Base (AIROB), Padova, Italy
| | | | - Navid Rabiee
- School of Engineering, Macquarie University, Sydney, New South Wales, Australia
- Pohang University of Science and Technology, Pohang, South Korea
| | | | | | - Amir Masoud Rahmani
- Future Technology Research Center, National Yunlin University of Science and Technology, Yunlin, Taiwan
| | - Vahid Rahmanian
- Department of Public Health, Torbat Jam Faculty of Medical Sciences, Torbat Jam, Iran
| | - Chythra R Rao
- Department of Community Medicine, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, India
| | - Sowmya J Rao
- Department of Oral Pathology and Microbiology, Sharavathi Dental College and Hospital, Shimogga, India
| | - Goura Kishor Rath
- Department of Radiation Oncology, All India Institute of Medical Sciences, New Delhi, India
| | - David Laith Rawaf
- WHO Collaborating Centre for Public Health Education and Training, Imperial College London, London, England, United Kingdom
- Inovus Medical, St Helens, England, United Kingdom
| | - Salman Rawaf
- Department of Primary Care and Public Health, Faculty of Medicine, Imperial College London, London, England, United Kingdom
- Academic Public Health England, Public Health England, London, England, United Kingdom
| | - Reza Rawassizadeh
- Department of Computer Science, College of Arts & Sciences, Boston University, Boston, Massachusetts
| | - Mohammad Sadegh Razeghinia
- Department of Immunology and Laboratory Sciences, Sirjan School of Medical Sciences, Sirjan, Iran
- Department of Immunology, Kerman University of Medical Sciences, Kerman, Iran
| | - Nazila Rezaei
- Non-Communicable Diseases Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Negar Rezaei
- Non-Communicable Diseases Research Center, Tehran University of Medical Sciences, Tehran, Iran
- Endocrinology and Metabolism Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Nima Rezaei
- Research Center for Immunodeficiencies, Tehran University of Medical Sciences, Tehran, Iran
- Network of Immunity in Infection, Malignancy and Autoimmunity (NIIMA), Universal Scientific Education and Research Network (USERN), Tehran, Iran
| | - Aziz Rezapour
- Health Management and Economics Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Abanoub Riad
- Department of Public Health, Masaryk University, Brno, Czech Republic
- Czech National Centre for Evidence-based Healthcare and Knowledge Translation, Masaryk University, Brno, Czech Republic
| | - Thomas J Roberts
- Department of Medicine, Massachusetts General Hospital, Boston
- Harvard Medical School, Harvard University, Boston, Massachusetts
| | - Esperanza Romero-Rodríguez
- Clinical and Epidemiological Research in Primary Care (GICEAP), Maimonides Biomedical Research Institute of Cordoba (IMIBIC), Cordoba, Spain
| | - Gholamreza Roshandel
- Golestan Research Center of Gastroenterology and Hepatology, Golestan University of Medical Sciences, Gorgan, Iran
| | - Manjula S
- Department of Oral and Maxillofacial Surgery, JSS Academy of Higher Education and Research, Mysore, India
| | - Chandan S N
- Department of Oral and Maxillofacial Surgery, JSS Academy of Higher Education and Research, Mysore, India
| | - Basema Saddik
- Sharjah Institute for Medical Research, University of Sharjah, Sharjah, United Arab Emirates
| | - Mohammad Reza Saeb
- Department of Polymer Technology, Faculty of Chemistry, Gdańsk University of Technology, Gdańsk, Poland
| | - Umar Saeed
- International Center of Medical Sciences Research, Islamabad, Pakistan
- Multidisciplinary Laboratory Foundation University School of Health Sciences (FUSH), Foundation University, Islamabad, Pakistan
| | - Mohsen Safaei
- Advanced Dental Sciences Research Center, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Maryam Sahebazzamani
- Department of Medical Biochemistry, Rafsanjan University of Medical Sciences, Rafsanjan, Iran
- Medical Laboratory Sciences, Sirjan School of Medical Sciences, Sirjan, Iran
| | - Amirhossein Sahebkar
- Applied Biomedical Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
- Biotechnology Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | | | - Abdallah M Samy
- Department of Entomology, Faculty of Science, Ain Shams University, Cairo, Egypt
- Medical Ain Shams Research Institute (MARSI), Ain Shams University, Cairo, Egypt
| | - Milena M Santric-Milicevic
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia
- School of Public Health and Health Management, University of Belgrade, Belgrade, Serbia
| | - Brijesh Sathian
- Geriatric and Long Term Care Department, Hamad Medical Corporation, Doha, Qatar
- Faculty of Health and Social Sciences, Bournemouth University, Bournemouth, England, United Kingdom
| | - Maheswar Satpathy
- UGC Centre of Advanced Study in Psychology, Utkal University, Bhubaneswar, India
- Udyam-Global Association for Sustainable Development, Bhubaneswar, India
| | - Mario Šekerija
- Department of Medical Statistics, University of Zagreb, Zagreb, Croatia
- Department of Epidemiology and Prevention of Chronic Noncommunicable Diseases, Croatian Institute of Public Health, Zagreb, Croatia
| | | | - Allen Seylani
- National Heart, Lung, and Blood Institute, National Institutes of Health, Rockville, Maryland
| | - Omid Shafaat
- Department of Radiology and Radiological Science, Johns Hopkins Medicine, Baltimore, Maryland
- Department of Radiology and Interventional Neuroradiology, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Hamid R Shahsavari
- Department of Chemistry, Institute for Advanced Studies in Basic Sciences (IASBS), Zanjan, Iran
| | - Erfan Shamsoddin
- Department of Oral Health, Non-Communicable Diseases Research Center (NCDRC), Tehran, Iran
- Non-Communicable Diseases Committee, National Institute for Medical Research Development (NIMAD), Tehran, Iran
| | | | | | - Jeevan K Shetty
- Department of Biochemistry, Royal College of Surgeons in Ireland Medical University of Bahrain, Busaiteen, Bahrain
| | - K M Shivakumar
- Department of Public Health Dentistry, Krishna Vishwa Vidyapeeth (Deemed to be University), Karad, India
| | - Parnian Shobeiri
- Faculty of Medicine, Tehran University of Medical Sciences, Tehran, Iran
- Department of International Studies, Non-Communicable Diseases Research Center (NCDRC), Tehran, Iran
| | - Seyed Afshin Shorofi
- Department of Medical-Surgical Nursing, Nasibeh School of Nursing and Midwifery, Mazandaran University of Medical Sciences, Sari, Iran
- College of Nursing and Health Sciences, Flinders University, Adelaide, South Australia, Australia
| | - Sunil Shrestha
- School of Pharmacy, Monash University, Selangor Darul Ehsan, Malaysia
| | | | - Paramdeep Singh
- Department of Radiodiagnosis, All India Institute of Medical Sciences, Bathinda, India
| | - Jasvinder A Singh
- Heersink School of Medicine, University of Alabama at Birmingham, Birmingham
- Department of Medicine Service, US Department of Veterans Affairs, Birmingham, Alabama
| | - Garima Singh
- Department of Community Medicine, Lady Hardinge Medical College, New Delhi, India
- Department of Community Medicine, All India Institute of Medical Sciences, Jodhpur, India
| | - Dhirendra Narain Sinha
- Department of Epidemiology, School of Preventive Oncology, Patna, India
- Department of Epidemiology, Healis Sekhsaria Institute for Public Health, Mumbai, India
| | - Yonatan Solomon
- Department of Nursing, Dire Dawa University, Dire Dawa, Ethiopia
| | - Muhammad Suleman
- Center for Biotechnology and Microbiology, University of Swat, Mingora, Pakistan
- School of Life Sciences, Xiamen University, Xiamen, China
| | | | | | - Iman M Talaat
- Clinical Sciences Department, University of Sharjah, Sharjah, United Arab Emirates
- Pathology Department, Alexandria University, Alexandria, Egypt
| | - Ker-Kan Tan
- Department of Surgery, National University of Singapore, Singapore, Singapore
| | - Abdelghani Tbakhi
- Department of Cell Therapy and Applied Genomics, King Hussein Cancer Center, Amman, Jordan
| | - Arulmani Thiyagarajan
- Department of Clinical Epidemiology, Leibniz Institute for Prevention Research and Epidemiology, Bremen, Germany
| | - Amir Tiyuri
- Department of Epidemiology and Biostatistics, Birjand University of Medical Sciences, Birjand, Iran
- Department of Epidemiology and Biostatistics, Iran University of Medical Sciences, Tehran, Iran
| | - Marcos Roberto Tovani-Palone
- Saveetha Dental College and Hospitals, Saveetha Institute of Medical and Technical Sciences (SIMATS), Chennai, India
- Modestum LTD, Eastbourne, England, United Kingdom
| | - Bhaskaran Unnikrishnan
- Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, Mangalore, India
| | - Bay Vo
- Faculty of Information Technology, Ho Chi Minh City University of Technology (HUTECH), Ho Chi Minh City, Vietnam
| | - Simona Ruxandra Volovat
- Department of Medical Oncology, University of Medicine and Pharmacy "Grigore T Popa" Iaşi, Iaşi, Romania
- Department of Medical Oncology, Regional Institute of Oncology, Iaşi, Romania
| | - Cong Wang
- Department of Medicine, Vanderbilt University, Nashville, Tennessee
| | - Ronny Westerman
- Competence Center of Mortality-Follow-Up of the German National Cohort, Federal Institute for Population Research, Wiesbaden, Germany
| | - Nuwan Darshana Wickramasinghe
- Department of Community Medicine, Faculty of Medicine and Allied Sciences, Rajarata University of Sri Lanka, Anuradhapura, Sri Lanka
| | - Hong Xiao
- School of Public Health, Zhejiang University, Zhejiang, China
- Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Chuanhua Yu
- Department of Epidemiology and Biostatistics, School of Medicine, Wuhan University, Wuhan, China
| | - Deniz Yuce
- Hacettepe University Cancer Institute, Ankara, Turkey
| | - Ismaeel Yunusa
- Department of Clinical Pharmacy and Outcomes Sciences, College of Pharmacy, University of South Carolina, Columbia
| | - Vesna Zadnik
- Epidemiology and Cancer Registry Sector, Institute of Oncology Ljubljana, Ljubljana, Slovenia
| | - Iman Zare
- Research and Development Department, Sina Medical Biochemistry Technologies, Shiraz, Iran
| | - Zhi-Jiang Zhang
- School of Medicine, Faculty of Medical Sciences, Wuhan University, Wuhan, China
| | - Mohammad Zoladl
- Department of Nursing, Yasuj University of Medical Sciences, Yasuj, Iran
| | - Lisa M Force
- Institute for Health Metrics and Evaluation, University of Washington, Seattle
- Department of Health Metrics Sciences, School of Medicine, University of Washington, Seattle
- Division of Hematology-Oncology, Department of Pediatrics, University of Washington, Seattle
| | - Fernando N Hugo
- Department of Preventive and Social Dentistry, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
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Pedroso CM, Normando AGC, Siracusa CS, Lauby-Secretan B, Nethan ST, Tomasi RA, Lopes MA, Warnakulasuriya S, Santos-Silva AR. Pan-American prevalence of smokeless tobacco use and association with oral potentially malignant disorders and head and neck cancer: a systematic review and meta-analysis. Oral Surg Oral Med Oral Pathol Oral Radiol 2023; 136:322-332. [PMID: 37076380 DOI: 10.1016/j.oooo.2023.02.019] [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: 12/05/2022] [Revised: 02/26/2023] [Accepted: 02/28/2023] [Indexed: 03/11/2023]
Abstract
OBJECTIVES To determine the prevalence of smokeless tobacco (SLT) use and its association with oral potentially malignant disorders (OPMDs) and head and neck cancer (HNC) in the Pan-American Health Organization (PAHO) region. STUDY DESIGN A literature search was conducted across 9 databases and other sources. The eligibility criteria were pediatric (0-18 years old) and adult (19 years and older) populations consuming any type of SLT. Meta-analysis was performed to determine the prevalence of SLT and the association between its use and OPMDs/HNC in the PAHO region; the Grading of Recommendations Assessment, Development, and Evaluation tool was used to verify the certainty of evidence. RESULTS Fifty-nine studies from 6 PAHO countries were included, of which 51 were also subjected to quantitative analysis. The pooled SLT prevalence of use was 15% (95%CI: 11.93-18.69) overall, 17% (95%CI: 13.25-22.65) in adults, and 11% (95%CI: 8.54-14.78) in the pediatric population. The highest reported SLT prevalence of use was 33.4% (95%CI: 27.17-39.93) in Venezuela. HNC was positively associated with SLT use (OR = 1.98, 95%CI: 1.54-2.55), with a moderate certainty of evidence. Among OPMDs, only leukoplakia reported a positive association with SLT use (OR = 8.38; 95%CI: 1.05-67.25). However, the quality of the evidence was very low. CONCLUSION A high consumption of SLT use, chewing tobacco and snuff, is reported among the adult population residing in the PAHO region with a positive association with the development of oral leukoplakia and HNC.
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Affiliation(s)
- Caique Mariano Pedroso
- Oral Diagnosis Department, Piracicaba Dental School, University of Campinas (UNICAMP), Piracicaba, São Paulo, Brazil
| | - Ana Gabriela Costa Normando
- Oral Diagnosis Department, Piracicaba Dental School, University of Campinas (UNICAMP), Piracicaba, São Paulo, Brazil
| | - Cristina Saldivia Siracusa
- Oral Diagnosis Department, Piracicaba Dental School, University of Campinas (UNICAMP), Piracicaba, São Paulo, Brazil
| | - Béatrice Lauby-Secretan
- International Agency for Research on Cancer (IARC), World Health Organization (WHO), Lyon, France
| | - Suzanne Tanya Nethan
- International Agency for Research on Cancer (IARC), World Health Organization (WHO), Lyon, France
| | - Ramiro Alejandro Tomasi
- Department of Oral Pathology, Dental School, Universidad Nacional de Córdoba, Córdoba, Argentina
| | - Marcio Ajudarte Lopes
- Oral Diagnosis Department, Piracicaba Dental School, University of Campinas (UNICAMP), Piracicaba, São Paulo, Brazil
| | - Saman Warnakulasuriya
- The WHO Collaborating Centre for Oral Cancer, London, UK; Faculty of Dentistry, Oral and Craniofacial Sciences, King's College London, London, UK
| | - Alan Roger Santos-Silva
- Oral Diagnosis Department, Piracicaba Dental School, University of Campinas (UNICAMP), Piracicaba, São Paulo, Brazil.
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Mehrotra R, Yadav K, Siddiqi K. Tobacco Dependence in Adolescents: What Lies Ahead? Am J Public Health 2023; 113:859-860. [PMID: 37406268 PMCID: PMC10323837 DOI: 10.2105/ajph.2023.307342] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/07/2023]
Affiliation(s)
- Ravi Mehrotra
- Ravi Mehrotra is an adjunct professor at Emory University, Atlanta, GA. Kavita Yadav is a research fellow at George Institute for Global Health, New Delhi, India. Kamran Siddiqi is a professor in global public health, University of York, York, United Kingdom
| | - Kavita Yadav
- Ravi Mehrotra is an adjunct professor at Emory University, Atlanta, GA. Kavita Yadav is a research fellow at George Institute for Global Health, New Delhi, India. Kamran Siddiqi is a professor in global public health, University of York, York, United Kingdom
| | - Kamran Siddiqi
- Ravi Mehrotra is an adjunct professor at Emory University, Atlanta, GA. Kavita Yadav is a research fellow at George Institute for Global Health, New Delhi, India. Kamran Siddiqi is a professor in global public health, University of York, York, United Kingdom
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14
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Simba H, Menya D, Mmbaga BT, Dzamalala C, Finch P, Mlombe Y, Mremi A, Narh CT, Schüz J, McCormack V. The contribution of smoking and smokeless tobacco to oesophageal squamous cell carcinoma risk in the African oesophageal cancer corridor: Results from the ESCCAPE multicentre case-control studies. Int J Cancer 2023; 152:2269-2282. [PMID: 36733225 DOI: 10.1002/ijc.34458] [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: 10/12/2022] [Revised: 12/17/2022] [Accepted: 01/03/2023] [Indexed: 02/04/2023]
Abstract
Tobacco use is a well-established risk factor for oesophageal squamous cell carcinoma (ESCC) but the extent of its contribution to the disease burden in the African oesophageal cancer corridor has not been comprehensively elucidated, including by type of tobacco use. We investigated the contribution of tobacco use (smoking and smokeless) to ESCC in Tanzania, Malawi and Kenya. Hospital-based ESCC case-control studies were conducted in the three countries. Incident cases and controls were interviewed using a comprehensive questionnaire which included questions on tobacco smoking and smokeless tobacco use. Logistic regression models were used to estimate odds ratios (OR) and their 95% confidence intervals (CI) of ESCC associated with tobacco, adjusted for age, sex, alcohol use, religion, education and area of residence. One thousand two hundred seventy-nine cases and 1345 controls were recruited between August 5, 2013, and May 24, 2020. Ever-tobacco use was associated with increased ESCC risk in all countries: Tanzania (OR 3.09, 95%CI 1.83-5.23), and in Malawi (OR 2.45, 95%CI 1.80-3.33) and lesser in Kenya (OR 1.37, 95%CI 0.94-2.00). Exclusive smokeless tobacco use was positively associated with ESCC risk, in Tanzania, Malawi and Kenya combined (OR 1.92, 95%CI 1.26-2.92). ESCC risk increased with tobacco smoking intensity and duration of smoking. Tobacco use is an important risk factor of ESCC in Tanzania, Malawi and Kenya. Our study provides evidence that smoking and smokeless tobacco cessation are imperative in reducing ESCC risk.
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Affiliation(s)
- Hannah Simba
- Environment and Lifestyle Epidemiology Branch, International Agency for Research on Cancer (IARC/WHO), Lyon, France
| | - Diana Menya
- School of Public Heath, Moi University, Eldoret, Kenya
| | - Blandina T Mmbaga
- Kilimanjaro Clinical Research Institute, Kilimanjaro Christian Medical Centre and Kilimanjaro Christian Medical University College, Moshi, Tanzania
| | | | - Peter Finch
- Malawi College of Medicine, Blantyre, Malawi
| | - Yohannie Mlombe
- Department of Epidemiology and Biostatistics, Fred N. Binka School of Public Heath, University of Health and Allied Sciences, Hohoe, Ghana
| | - Alex Mremi
- Kilimanjaro Clinical Research Institute, Kilimanjaro Christian Medical Centre and Kilimanjaro Christian Medical University College, Moshi, Tanzania
| | - Clement T Narh
- Environment and Lifestyle Epidemiology Branch, International Agency for Research on Cancer (IARC/WHO), Lyon, France
- Department of Epidemiology and Biostatistics, Fred N. Binka School of Public Heath, University of Health and Allied Sciences, Hohoe, Ghana
| | - Joachim Schüz
- Environment and Lifestyle Epidemiology Branch, International Agency for Research on Cancer (IARC/WHO), Lyon, France
| | - Valerie McCormack
- Environment and Lifestyle Epidemiology Branch, International Agency for Research on Cancer (IARC/WHO), Lyon, France
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15
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Sharma P, Cheah NP, Kaur J, Sathiya Kumar S, Rao V, Morsed FA, Choo MYB, Murthy P. Physical and chemical characterization of smokeless tobacco products in India. Sci Rep 2023; 13:8901. [PMID: 37264008 PMCID: PMC10235085 DOI: 10.1038/s41598-023-35455-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Accepted: 05/18/2023] [Indexed: 06/03/2023] Open
Abstract
The rapid proliferation of smokeless tobacco (SLT) in India has occurred without adequate information on the possible dangers and toxicity of these products. Tobacco flavors as well as nicotine (both protonated and un-protonated) are responsible for health dangers and addiction. The study aimed to offer information on the physical characteristics of commonly used smokeless tobacco products (including microscopic analysis), along with nicotine content (both total and un-protonated), pH, moisture, and flavors. The Standard Operating Procedures (SOPs) validated by the World Health Organization (WHO) recognized Tobacco Testing Laboratory TobLabNet) were applied for the analysis of various constituents of the SLTs. The microscopic analysis indicated that some of the SLT products like khaini were finely processed and available in filter pouches for users' convenience and prolonged use leading to prolonged retention and addiction potential. Nicotine absorption and availability (both protonated and un-protonated) are affected by moisture and pH. Essences provide a pleasant aroma and flavor, with an increased risk of misuse and other health problems. Few chewing tobacco and Zarda had the lowest levels of un-protonated nicotine (0.10-0.52% and 0.15-0.21%, respectively), whereas Gul, Gudhaku, and Khaini had the highest levels, ranging from 95.33 to 99.12%. Moisture and pH ranged from 4.54 to 50.19% and 5.25-10.07 respectively. Menthol (630.74-9681.42 µg/g) was the most popular flavour, followed by Eucalyptol (118.16-247.77 µg/g) and camphor (148.67 and 219.317 µg/g). SLT's health concerns and addiction dangers are exacerbated by the high proportion of bioavailable nicotine coupled with flavors. The findings of this study have important implications for the regulation and use of SLT in countries where use of SLT is prevalent.
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Affiliation(s)
- Priyamvada Sharma
- Department of Clinical Psychopharmacology and Neurotoxicology and Department of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHNAS), Bangalore, India.
| | - Nuan Ping Cheah
- Director Cigarette Testing Laboratory, Applied Sciences Group, Health Sciences Authority, 11 Outram Road, Singapore, Singapore
| | - Jagdish Kaur
- Regional Adviser (Tobacco Free Initiative) Department of Healthier populations and Noncommunicable Diseases, WHO Regional Office for South-East Asia, World Health House, I.P. Estate, M.G. Road, New Delhi, India
| | - Sandhya Sathiya Kumar
- Toxicology Laboratory, Centre for Addiction Medicine, Department of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHNAS), Bangalore, India
| | - Vijayashree Rao
- Toxicology Laboratory, Centre for Addiction Medicine, Department of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHNAS), Bangalore, India
| | - Faridatul Akmam Morsed
- Cigarette Testing Laboratory, Pharmaceutical Division, Applied Science Group, Health Sciences Authority, 11 Outram Road, Singapore, 169078, Singapore
| | - Michelle Yong Bing Choo
- Cigarette Testing Laboratory, Pharmaceutical Division, Applied Science Group, Health Sciences Authority, 11 Outram Road, Singapore, 169078, Singapore
| | - Pratima Murthy
- Director and Senior Professor of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, 560029, 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: 0] [Impact Index Per Article: 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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Bakhtiari Aliabad M, Masoudi-Asl I, Abolhallaje M, Jafari M. Building a House on Sand: How Tobacco Use Is Devouring Resources. ADDICTION & HEALTH 2023; 15:128-135. [PMID: 37560397 PMCID: PMC10408758 DOI: 10.34172/ahj.2023.1375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/22/2022] [Accepted: 08/15/2022] [Indexed: 08/11/2023]
Abstract
BACKGROUND Tobacco is a major cause of preventable morbidity and mortality, with a considerable economic burden. The purpose of this systematic review was to summarize the evidence on the economic burden of tobacco use by searching national and international databases so as to generate useful information about the costs of tobacco use globally. METHODS A systematic search was conducted in Scopus, PubMed, EMBASE, ProQuest, and Web of Science (ISI) databases to identify relevant studies from 1990 to June 2021 using keywords like burden, productivity, indirect cost, direct cost, economic, monetary, expenditure, tobacco, smoking, and cigarettes. Cost estimates were converted into 2020 international dollars per adult. FINDINGS A total of 1,781 articles were identified, of which 361 were deemed to be eligible for inclusion. Eventually, 23 articles were found eligible. In most studies, cost estimates were provided using a prevalence-based approach. The highest total cost, as a percentage of gross domestic product (GDP), was reported for South Korea (1.19%). Noteworthy, in all studies, indirect costs accounted for the highest proportion of all costs. The mean total cost amounted to 5,866 million dollars. The direct costs ranged from 179 million dollars in South Korea to 8,156 million dollars in Israel. Meanwhile, the indirect costs ranged from 289 million dollars in Hong Kong to 9,808 million dollars in India. CONCLUSION The evidence demonstrated the considerable economic burden of tobacco use in various countries, ranging from 0.33 to 1.19% of the GDP of the investigated countries, indicating the necessity of taking immediate measures. Hence, policies are needed to address the economic burden of smoking.
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Affiliation(s)
- Mohammad Bakhtiari Aliabad
- Department of Health Services Management, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Iravan Masoudi-Asl
- Department of Health Services Management, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Masoud Abolhallaje
- Ministry of Health and Medical Education, National Center for Strategic Research in Medical Education, Tehran, Iran
| | - Mehdi Jafari
- Department of Health Services Management, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran
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18
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Siddiqi K, Arora M, Gupta PC. Common assumptions in tobacco control that may not hold true for South-East Asia. THE LANCET REGIONAL HEALTH. SOUTHEAST ASIA 2023; 8:100088. [PMID: 36644450 PMCID: PMC9831008 DOI: 10.1016/j.lansea.2022.100088] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Tobacco is a threat to public health in South-East Asia and its control should be a priority. However, many common assumptions about tobacco control may not hold true for the region and can misdirect policy. The substantial health risks associated with smokeless tobacco have been largely misunderstood and neglected. The syndemic association between tuberculosis and tobacco has also been overlooked. Similarly, less attention has been paid to address second-hand smoke exposure of pregnant women to indoor smoking (caused predominantly by men). On the other hand, our poor understanding of the diverse tobacco supply chain has been blocking progress in tobacco control. Finally, the rising popularity of electronic cigarettes has thrown new challenges; many governments, concerned for its youth, have banned such products. We argue for a nuanced approach to tobacco control in South-East Asia. We also encourage a wider debate in public health, where other established assumptions may be hampering progress.
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Affiliation(s)
- Kamran Siddiqi
- Department of Health Sciences, University of York and Hull York Medical School, Seebohm Rowntree building, University of York, York YO10 5DD, United Kingdom
| | - Monika Arora
- HRIDAY, New Delhi, and Public Health Foundation of India, New Delhi, India
| | - Prakash C Gupta
- Healis Sekhsaria Institute for Public Health, Thane, Maharashtra, India
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19
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Panda R, Lahoti S, Mishra A, Prabhu RR, Das S, Satapathy DM, Nazareth I. Designing a mobile health smokeless tobacco cessation intervention in Odisha, India: User and provider perspectives. Digit Health 2023; 9:20552076221150581. [PMID: 36655182 PMCID: PMC9841872 DOI: 10.1177/20552076221150581] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Accepted: 12/12/2022] [Indexed: 01/15/2023] Open
Abstract
Objective There is limited evidence on the development of mobile health (mHealth) interventions for smokeless tobacco (SLT) cessation, despite its widespread use in South Asia. This formative qualitative study explored the perceptions of tobacco users and healthcare providers (HCPs) regarding developing a mHealth intervention for SLT cessation. Methods This was a qualitative study using in-depth interviews (IDIs) with tobacco users (n = 26) and primary care physicians (PCPs) (n = 5) and focus group discussions (FGDs) with counsellors (n = 2) in four urban primary health centres (UPHCs) in Berhampur, Odisha from February to March 2020. The data were coded and analysed by two researchers using a framework analysis method. The discussion guides and initial codes were developed based on the Transtheoretical Model (TTM) of behaviour change. Results The results were elaborated under four themes: (1) Current scenario of SLT use; (2) Barriers and facilitators for quitting SLT; (3) Barriers and facilitators for mHealth counselling; and (4) Design and delivery of the proposed intervention. SLT use was prevalent in the community regardless of sociodemographic factors. Peer factors accounted for both tobacco consumption as well as considering cessation. Participants considered mobile message counselling helpful and acceptable. Not having a mobile phone and illiteracy were identified as barriers while ease of access and rising popularity of social media applications were considered facilitators to the use of mHealth for quitting tobacco. Participants preferred messages that were pictorial, short and simple, in the local language, and tailored to individual's needs. Conclusions This is the first study that provides evidence within the Indian context that the text messaging platform may be used for delivering an SLT cessation intervention. The integration of a theoretical basis and research findings from target users can guide future intervention development.
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Affiliation(s)
- Rajmohan Panda
- Research Division, Public Health Foundation of India, New Delhi, India
| | - Supriya Lahoti
- Research Division, Public Health Foundation of India, New Delhi, India
| | - Arti Mishra
- Project ECHO (Extension for Community Healthcare Outcomes), New Delhi, India
| | - Rajath R Prabhu
- Research Division, Public Health Foundation of India, New Delhi, India
| | - Sangeeta Das
- Research Division, Public Health Foundation of India, India
| | | | - Irwin Nazareth
- Department of Primary Care and Population Sciences, University College London, London, UK
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20
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Yang H, Ma C, Zhao M, Magnussen CG, Xi B. Prevalence and trend of smokeless tobacco use and its associated factors among adolescents aged 12-16 years in 138 countries/territories, 1999-2019. BMC Med 2022; 20:460. [PMID: 36434646 PMCID: PMC9700970 DOI: 10.1186/s12916-022-02662-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Accepted: 11/14/2022] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Smokeless tobacco use is popular in some regions worldwide, but it receives less attention compared to cigarette smoking. We aimed to estimate the recent prevalence of, and trends in, smokeless tobacco use and to examine its associated factors among adolescents aged 12-16 years in 138 countries/territories (hereafter "countries") from 1999 to 2019. METHODS Data from the Global Youth Tobacco Survey conducted in 138 countries in 2010-2019 and the National Youth Tobacco Survey conducted in the United States in 2019 were used to calculate the prevalence of current smokeless tobacco use and investigate its associated factors among adolescents aged 12-16 years. We also assessed the trend in the prevalence of smokeless tobacco use in 100 countries that had conducted more than one survey from 1999 to 2019. RESULTS The overall prevalence of current smokeless tobacco use was 4.4% (95% confidence interval [CI] 4.0-4.9), with 5.7% (5.1-6.3) for boys, 3.1% (2.6-3.5) for girls, 3.9% (3.5-4.4) for adolescents aged 12-14 years and 5.4% (4.8-5.9) for those aged 15-16 years. The prevalence was highest in the South-East Asian region (6.1%, 4.4-7.7) and lowest in the Western Pacific region (2.0%, 1.7-2.4). The prevalence of smokeless tobacco use decreased in 57 of 100 countries, increased in 32 countries, and remained unchanged in 11 countries. Current cigarette smoking (odds ratio [OR]=2.00, 95% CI=1.68-2.39), other tobacco product use (OR=6.03, 95% CI=4.92-7.40), tobacco advertisement exposure (OR=1.44, 95% CI=1.19-1.74), being offered free tobacco products (OR=2.01, 95% CI=1.66-2.42), and not being taught about dangers of smoking (OR=1.28, 95% CI=1.09-1.50) were all positively associated with current smokeless tobacco use. CONCLUSIONS Smokeless tobacco use among adolescents remains a public health concern worldwide. Although the prevalence among adolescents decreased in most countries, it remains high especially in the South-East Asian region. More strict and effective strategies and measures are needed to further curb the smokeless tobacco use among adolescents.
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Affiliation(s)
- Hui Yang
- Department of Epidemiology, School of Public Health, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Chuanwei Ma
- Department of Epidemiology, School of Public Health, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Min Zhao
- Department of Nutrition and Food Hygiene, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Costan G Magnussen
- Baker Heart and Diabetes Institute, Melbourne, VIC, Australia.,Research Centre of Applied and Preventive Cardiovascular Medicine, University of Turku, Turku, Finland.,Centre for Population Health Research, University of Turku and Turku University Hospital, Turku, Finland
| | - Bo Xi
- Department of Epidemiology, School of Public Health, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China.
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Bouvard V, Nethan ST, Singh D, Warnakulasuriya S, Mehrotra R, Chaturvedi AK, Chen THH, Ayo-Yusuf OA, Gupta PC, Kerr AR, Tilakaratne WM, Anantharaman D, Conway DI, Gillenwater A, Johnson NW, Kowalski LP, Leon ME, Mandrik O, Nagao T, Prasad VM, Ramadas K, Roitberg F, Saintigny P, Sankaranarayanan R, Santos-Silva AR, Sinha DN, Vatanasapt P, Zain RB, Lauby-Secretan B. IARC Perspective on Oral Cancer Prevention. N Engl J Med 2022; 387:1999-2005. [PMID: 36378601 DOI: 10.1056/nejmsr2210097] [Citation(s) in RCA: 28] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Affiliation(s)
- Véronique Bouvard
- From the International Agency for Research on Cancer (V.B., S.T.N., D.S., R.S., B.L.-S.), and INSERM 1052, Centre National de la Recherche Scientifique 5286, Centre de Recherche en Cancérologie de Lyon, Université Claude Bernard Lyon 1, and the Department of Medical Oncology, Centre Léon Bérard (P.S.) - all in Lyon, France; the Collaborating Centre for Oral Cancer of the World Health Organization (WHO) (S.W.) and the Faculty of Dentistry, Oral, and Craniofacial Sciences (N.W.J.), King's College London, London, the University of Sheffield School of Health and Related Research, Sheffield (O.M.), and the School of Medicine, Dentistry, and Nursing, University of Glasgow, Glasgow (D.I.C.) - all in the United Kingdom; Center for Health, Innovation, and Policy Foundation and Rollins School of Public Health, Emory University, Atlanta (R.M.); the Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, MD (A.K.C.); the Institute of Epidemiology and Preventive Medicine, National Taiwan University, Taipei (T.H.-H.C.); Sefako Makgatho Health Sciences University, Ga-Rankuwa, and the School of Health Systems and Public Health, University of Pretoria, Pretoria - both in South Africa (O.A.A.-Y.); Healis Sekhsaria Institute for Public Health (P.C.G.) and Preventive Oncology, Karkinos Healthcare (R.S.), Navi Mumbai, Rajiv Gandhi Centre for Biotechnology, Thiruvananthapuram (D.A.), Regional Cancer Centre, Trivandrum (K.R.), and the School of Preventive Oncology, Patna (D.N.S.) - all in India; New York University College of Dentistry, New York (A.R.K.); University of Peradeniya, Peradeniya, Sri Lanka (W.M.T.); the Faculty of Dentistry, University of Malaya, Kuala Lumpur (W.M.T., R.B.Z.), and MAHSA (Malaysian Allied Health Sciences Academy) University, Bandar Saujana Putra (R.B.Z.) - both in Malaysia; M.D. Anderson Cancer Center, Houston (A.G.); Griffith University Gold Coast, Southport, QLD, Australia (N.W.J.); University of São Paulo Medical School and A.C. Camargo Cancer Center (L.P.K.), São Paulo, and Piracicaba Dental School, University of Campinas, Campinas (A.R.S.-S.) - all in Brazil; the Department of Maxillofacial Surgery, School of Dentistry, Aichi Gakuin University, Nisshin, Japan (T.N.); WHO, Geneva (V.M.P., F.R.); and the Department of Otorhinolaryngology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand (P.V.)
| | - Suzanne T Nethan
- From the International Agency for Research on Cancer (V.B., S.T.N., D.S., R.S., B.L.-S.), and INSERM 1052, Centre National de la Recherche Scientifique 5286, Centre de Recherche en Cancérologie de Lyon, Université Claude Bernard Lyon 1, and the Department of Medical Oncology, Centre Léon Bérard (P.S.) - all in Lyon, France; the Collaborating Centre for Oral Cancer of the World Health Organization (WHO) (S.W.) and the Faculty of Dentistry, Oral, and Craniofacial Sciences (N.W.J.), King's College London, London, the University of Sheffield School of Health and Related Research, Sheffield (O.M.), and the School of Medicine, Dentistry, and Nursing, University of Glasgow, Glasgow (D.I.C.) - all in the United Kingdom; Center for Health, Innovation, and Policy Foundation and Rollins School of Public Health, Emory University, Atlanta (R.M.); the Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, MD (A.K.C.); the Institute of Epidemiology and Preventive Medicine, National Taiwan University, Taipei (T.H.-H.C.); Sefako Makgatho Health Sciences University, Ga-Rankuwa, and the School of Health Systems and Public Health, University of Pretoria, Pretoria - both in South Africa (O.A.A.-Y.); Healis Sekhsaria Institute for Public Health (P.C.G.) and Preventive Oncology, Karkinos Healthcare (R.S.), Navi Mumbai, Rajiv Gandhi Centre for Biotechnology, Thiruvananthapuram (D.A.), Regional Cancer Centre, Trivandrum (K.R.), and the School of Preventive Oncology, Patna (D.N.S.) - all in India; New York University College of Dentistry, New York (A.R.K.); University of Peradeniya, Peradeniya, Sri Lanka (W.M.T.); the Faculty of Dentistry, University of Malaya, Kuala Lumpur (W.M.T., R.B.Z.), and MAHSA (Malaysian Allied Health Sciences Academy) University, Bandar Saujana Putra (R.B.Z.) - both in Malaysia; M.D. Anderson Cancer Center, Houston (A.G.); Griffith University Gold Coast, Southport, QLD, Australia (N.W.J.); University of São Paulo Medical School and A.C. Camargo Cancer Center (L.P.K.), São Paulo, and Piracicaba Dental School, University of Campinas, Campinas (A.R.S.-S.) - all in Brazil; the Department of Maxillofacial Surgery, School of Dentistry, Aichi Gakuin University, Nisshin, Japan (T.N.); WHO, Geneva (V.M.P., F.R.); and the Department of Otorhinolaryngology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand (P.V.)
| | - Deependra Singh
- From the International Agency for Research on Cancer (V.B., S.T.N., D.S., R.S., B.L.-S.), and INSERM 1052, Centre National de la Recherche Scientifique 5286, Centre de Recherche en Cancérologie de Lyon, Université Claude Bernard Lyon 1, and the Department of Medical Oncology, Centre Léon Bérard (P.S.) - all in Lyon, France; the Collaborating Centre for Oral Cancer of the World Health Organization (WHO) (S.W.) and the Faculty of Dentistry, Oral, and Craniofacial Sciences (N.W.J.), King's College London, London, the University of Sheffield School of Health and Related Research, Sheffield (O.M.), and the School of Medicine, Dentistry, and Nursing, University of Glasgow, Glasgow (D.I.C.) - all in the United Kingdom; Center for Health, Innovation, and Policy Foundation and Rollins School of Public Health, Emory University, Atlanta (R.M.); the Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, MD (A.K.C.); the Institute of Epidemiology and Preventive Medicine, National Taiwan University, Taipei (T.H.-H.C.); Sefako Makgatho Health Sciences University, Ga-Rankuwa, and the School of Health Systems and Public Health, University of Pretoria, Pretoria - both in South Africa (O.A.A.-Y.); Healis Sekhsaria Institute for Public Health (P.C.G.) and Preventive Oncology, Karkinos Healthcare (R.S.), Navi Mumbai, Rajiv Gandhi Centre for Biotechnology, Thiruvananthapuram (D.A.), Regional Cancer Centre, Trivandrum (K.R.), and the School of Preventive Oncology, Patna (D.N.S.) - all in India; New York University College of Dentistry, New York (A.R.K.); University of Peradeniya, Peradeniya, Sri Lanka (W.M.T.); the Faculty of Dentistry, University of Malaya, Kuala Lumpur (W.M.T., R.B.Z.), and MAHSA (Malaysian Allied Health Sciences Academy) University, Bandar Saujana Putra (R.B.Z.) - both in Malaysia; M.D. Anderson Cancer Center, Houston (A.G.); Griffith University Gold Coast, Southport, QLD, Australia (N.W.J.); University of São Paulo Medical School and A.C. Camargo Cancer Center (L.P.K.), São Paulo, and Piracicaba Dental School, University of Campinas, Campinas (A.R.S.-S.) - all in Brazil; the Department of Maxillofacial Surgery, School of Dentistry, Aichi Gakuin University, Nisshin, Japan (T.N.); WHO, Geneva (V.M.P., F.R.); and the Department of Otorhinolaryngology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand (P.V.)
| | - Saman Warnakulasuriya
- From the International Agency for Research on Cancer (V.B., S.T.N., D.S., R.S., B.L.-S.), and INSERM 1052, Centre National de la Recherche Scientifique 5286, Centre de Recherche en Cancérologie de Lyon, Université Claude Bernard Lyon 1, and the Department of Medical Oncology, Centre Léon Bérard (P.S.) - all in Lyon, France; the Collaborating Centre for Oral Cancer of the World Health Organization (WHO) (S.W.) and the Faculty of Dentistry, Oral, and Craniofacial Sciences (N.W.J.), King's College London, London, the University of Sheffield School of Health and Related Research, Sheffield (O.M.), and the School of Medicine, Dentistry, and Nursing, University of Glasgow, Glasgow (D.I.C.) - all in the United Kingdom; Center for Health, Innovation, and Policy Foundation and Rollins School of Public Health, Emory University, Atlanta (R.M.); the Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, MD (A.K.C.); the Institute of Epidemiology and Preventive Medicine, National Taiwan University, Taipei (T.H.-H.C.); Sefako Makgatho Health Sciences University, Ga-Rankuwa, and the School of Health Systems and Public Health, University of Pretoria, Pretoria - both in South Africa (O.A.A.-Y.); Healis Sekhsaria Institute for Public Health (P.C.G.) and Preventive Oncology, Karkinos Healthcare (R.S.), Navi Mumbai, Rajiv Gandhi Centre for Biotechnology, Thiruvananthapuram (D.A.), Regional Cancer Centre, Trivandrum (K.R.), and the School of Preventive Oncology, Patna (D.N.S.) - all in India; New York University College of Dentistry, New York (A.R.K.); University of Peradeniya, Peradeniya, Sri Lanka (W.M.T.); the Faculty of Dentistry, University of Malaya, Kuala Lumpur (W.M.T., R.B.Z.), and MAHSA (Malaysian Allied Health Sciences Academy) University, Bandar Saujana Putra (R.B.Z.) - both in Malaysia; M.D. Anderson Cancer Center, Houston (A.G.); Griffith University Gold Coast, Southport, QLD, Australia (N.W.J.); University of São Paulo Medical School and A.C. Camargo Cancer Center (L.P.K.), São Paulo, and Piracicaba Dental School, University of Campinas, Campinas (A.R.S.-S.) - all in Brazil; the Department of Maxillofacial Surgery, School of Dentistry, Aichi Gakuin University, Nisshin, Japan (T.N.); WHO, Geneva (V.M.P., F.R.); and the Department of Otorhinolaryngology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand (P.V.)
| | - Ravi Mehrotra
- From the International Agency for Research on Cancer (V.B., S.T.N., D.S., R.S., B.L.-S.), and INSERM 1052, Centre National de la Recherche Scientifique 5286, Centre de Recherche en Cancérologie de Lyon, Université Claude Bernard Lyon 1, and the Department of Medical Oncology, Centre Léon Bérard (P.S.) - all in Lyon, France; the Collaborating Centre for Oral Cancer of the World Health Organization (WHO) (S.W.) and the Faculty of Dentistry, Oral, and Craniofacial Sciences (N.W.J.), King's College London, London, the University of Sheffield School of Health and Related Research, Sheffield (O.M.), and the School of Medicine, Dentistry, and Nursing, University of Glasgow, Glasgow (D.I.C.) - all in the United Kingdom; Center for Health, Innovation, and Policy Foundation and Rollins School of Public Health, Emory University, Atlanta (R.M.); the Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, MD (A.K.C.); the Institute of Epidemiology and Preventive Medicine, National Taiwan University, Taipei (T.H.-H.C.); Sefako Makgatho Health Sciences University, Ga-Rankuwa, and the School of Health Systems and Public Health, University of Pretoria, Pretoria - both in South Africa (O.A.A.-Y.); Healis Sekhsaria Institute for Public Health (P.C.G.) and Preventive Oncology, Karkinos Healthcare (R.S.), Navi Mumbai, Rajiv Gandhi Centre for Biotechnology, Thiruvananthapuram (D.A.), Regional Cancer Centre, Trivandrum (K.R.), and the School of Preventive Oncology, Patna (D.N.S.) - all in India; New York University College of Dentistry, New York (A.R.K.); University of Peradeniya, Peradeniya, Sri Lanka (W.M.T.); the Faculty of Dentistry, University of Malaya, Kuala Lumpur (W.M.T., R.B.Z.), and MAHSA (Malaysian Allied Health Sciences Academy) University, Bandar Saujana Putra (R.B.Z.) - both in Malaysia; M.D. Anderson Cancer Center, Houston (A.G.); Griffith University Gold Coast, Southport, QLD, Australia (N.W.J.); University of São Paulo Medical School and A.C. Camargo Cancer Center (L.P.K.), São Paulo, and Piracicaba Dental School, University of Campinas, Campinas (A.R.S.-S.) - all in Brazil; the Department of Maxillofacial Surgery, School of Dentistry, Aichi Gakuin University, Nisshin, Japan (T.N.); WHO, Geneva (V.M.P., F.R.); and the Department of Otorhinolaryngology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand (P.V.)
| | - Anil K Chaturvedi
- From the International Agency for Research on Cancer (V.B., S.T.N., D.S., R.S., B.L.-S.), and INSERM 1052, Centre National de la Recherche Scientifique 5286, Centre de Recherche en Cancérologie de Lyon, Université Claude Bernard Lyon 1, and the Department of Medical Oncology, Centre Léon Bérard (P.S.) - all in Lyon, France; the Collaborating Centre for Oral Cancer of the World Health Organization (WHO) (S.W.) and the Faculty of Dentistry, Oral, and Craniofacial Sciences (N.W.J.), King's College London, London, the University of Sheffield School of Health and Related Research, Sheffield (O.M.), and the School of Medicine, Dentistry, and Nursing, University of Glasgow, Glasgow (D.I.C.) - all in the United Kingdom; Center for Health, Innovation, and Policy Foundation and Rollins School of Public Health, Emory University, Atlanta (R.M.); the Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, MD (A.K.C.); the Institute of Epidemiology and Preventive Medicine, National Taiwan University, Taipei (T.H.-H.C.); Sefako Makgatho Health Sciences University, Ga-Rankuwa, and the School of Health Systems and Public Health, University of Pretoria, Pretoria - both in South Africa (O.A.A.-Y.); Healis Sekhsaria Institute for Public Health (P.C.G.) and Preventive Oncology, Karkinos Healthcare (R.S.), Navi Mumbai, Rajiv Gandhi Centre for Biotechnology, Thiruvananthapuram (D.A.), Regional Cancer Centre, Trivandrum (K.R.), and the School of Preventive Oncology, Patna (D.N.S.) - all in India; New York University College of Dentistry, New York (A.R.K.); University of Peradeniya, Peradeniya, Sri Lanka (W.M.T.); the Faculty of Dentistry, University of Malaya, Kuala Lumpur (W.M.T., R.B.Z.), and MAHSA (Malaysian Allied Health Sciences Academy) University, Bandar Saujana Putra (R.B.Z.) - both in Malaysia; M.D. Anderson Cancer Center, Houston (A.G.); Griffith University Gold Coast, Southport, QLD, Australia (N.W.J.); University of São Paulo Medical School and A.C. Camargo Cancer Center (L.P.K.), São Paulo, and Piracicaba Dental School, University of Campinas, Campinas (A.R.S.-S.) - all in Brazil; the Department of Maxillofacial Surgery, School of Dentistry, Aichi Gakuin University, Nisshin, Japan (T.N.); WHO, Geneva (V.M.P., F.R.); and the Department of Otorhinolaryngology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand (P.V.)
| | - Tony Hsiu-Hsi Chen
- From the International Agency for Research on Cancer (V.B., S.T.N., D.S., R.S., B.L.-S.), and INSERM 1052, Centre National de la Recherche Scientifique 5286, Centre de Recherche en Cancérologie de Lyon, Université Claude Bernard Lyon 1, and the Department of Medical Oncology, Centre Léon Bérard (P.S.) - all in Lyon, France; the Collaborating Centre for Oral Cancer of the World Health Organization (WHO) (S.W.) and the Faculty of Dentistry, Oral, and Craniofacial Sciences (N.W.J.), King's College London, London, the University of Sheffield School of Health and Related Research, Sheffield (O.M.), and the School of Medicine, Dentistry, and Nursing, University of Glasgow, Glasgow (D.I.C.) - all in the United Kingdom; Center for Health, Innovation, and Policy Foundation and Rollins School of Public Health, Emory University, Atlanta (R.M.); the Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, MD (A.K.C.); the Institute of Epidemiology and Preventive Medicine, National Taiwan University, Taipei (T.H.-H.C.); Sefako Makgatho Health Sciences University, Ga-Rankuwa, and the School of Health Systems and Public Health, University of Pretoria, Pretoria - both in South Africa (O.A.A.-Y.); Healis Sekhsaria Institute for Public Health (P.C.G.) and Preventive Oncology, Karkinos Healthcare (R.S.), Navi Mumbai, Rajiv Gandhi Centre for Biotechnology, Thiruvananthapuram (D.A.), Regional Cancer Centre, Trivandrum (K.R.), and the School of Preventive Oncology, Patna (D.N.S.) - all in India; New York University College of Dentistry, New York (A.R.K.); University of Peradeniya, Peradeniya, Sri Lanka (W.M.T.); the Faculty of Dentistry, University of Malaya, Kuala Lumpur (W.M.T., R.B.Z.), and MAHSA (Malaysian Allied Health Sciences Academy) University, Bandar Saujana Putra (R.B.Z.) - both in Malaysia; M.D. Anderson Cancer Center, Houston (A.G.); Griffith University Gold Coast, Southport, QLD, Australia (N.W.J.); University of São Paulo Medical School and A.C. Camargo Cancer Center (L.P.K.), São Paulo, and Piracicaba Dental School, University of Campinas, Campinas (A.R.S.-S.) - all in Brazil; the Department of Maxillofacial Surgery, School of Dentistry, Aichi Gakuin University, Nisshin, Japan (T.N.); WHO, Geneva (V.M.P., F.R.); and the Department of Otorhinolaryngology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand (P.V.)
| | - Olalekan A Ayo-Yusuf
- From the International Agency for Research on Cancer (V.B., S.T.N., D.S., R.S., B.L.-S.), and INSERM 1052, Centre National de la Recherche Scientifique 5286, Centre de Recherche en Cancérologie de Lyon, Université Claude Bernard Lyon 1, and the Department of Medical Oncology, Centre Léon Bérard (P.S.) - all in Lyon, France; the Collaborating Centre for Oral Cancer of the World Health Organization (WHO) (S.W.) and the Faculty of Dentistry, Oral, and Craniofacial Sciences (N.W.J.), King's College London, London, the University of Sheffield School of Health and Related Research, Sheffield (O.M.), and the School of Medicine, Dentistry, and Nursing, University of Glasgow, Glasgow (D.I.C.) - all in the United Kingdom; Center for Health, Innovation, and Policy Foundation and Rollins School of Public Health, Emory University, Atlanta (R.M.); the Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, MD (A.K.C.); the Institute of Epidemiology and Preventive Medicine, National Taiwan University, Taipei (T.H.-H.C.); Sefako Makgatho Health Sciences University, Ga-Rankuwa, and the School of Health Systems and Public Health, University of Pretoria, Pretoria - both in South Africa (O.A.A.-Y.); Healis Sekhsaria Institute for Public Health (P.C.G.) and Preventive Oncology, Karkinos Healthcare (R.S.), Navi Mumbai, Rajiv Gandhi Centre for Biotechnology, Thiruvananthapuram (D.A.), Regional Cancer Centre, Trivandrum (K.R.), and the School of Preventive Oncology, Patna (D.N.S.) - all in India; New York University College of Dentistry, New York (A.R.K.); University of Peradeniya, Peradeniya, Sri Lanka (W.M.T.); the Faculty of Dentistry, University of Malaya, Kuala Lumpur (W.M.T., R.B.Z.), and MAHSA (Malaysian Allied Health Sciences Academy) University, Bandar Saujana Putra (R.B.Z.) - both in Malaysia; M.D. Anderson Cancer Center, Houston (A.G.); Griffith University Gold Coast, Southport, QLD, Australia (N.W.J.); University of São Paulo Medical School and A.C. Camargo Cancer Center (L.P.K.), São Paulo, and Piracicaba Dental School, University of Campinas, Campinas (A.R.S.-S.) - all in Brazil; the Department of Maxillofacial Surgery, School of Dentistry, Aichi Gakuin University, Nisshin, Japan (T.N.); WHO, Geneva (V.M.P., F.R.); and the Department of Otorhinolaryngology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand (P.V.)
| | - Prakash C Gupta
- From the International Agency for Research on Cancer (V.B., S.T.N., D.S., R.S., B.L.-S.), and INSERM 1052, Centre National de la Recherche Scientifique 5286, Centre de Recherche en Cancérologie de Lyon, Université Claude Bernard Lyon 1, and the Department of Medical Oncology, Centre Léon Bérard (P.S.) - all in Lyon, France; the Collaborating Centre for Oral Cancer of the World Health Organization (WHO) (S.W.) and the Faculty of Dentistry, Oral, and Craniofacial Sciences (N.W.J.), King's College London, London, the University of Sheffield School of Health and Related Research, Sheffield (O.M.), and the School of Medicine, Dentistry, and Nursing, University of Glasgow, Glasgow (D.I.C.) - all in the United Kingdom; Center for Health, Innovation, and Policy Foundation and Rollins School of Public Health, Emory University, Atlanta (R.M.); the Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, MD (A.K.C.); the Institute of Epidemiology and Preventive Medicine, National Taiwan University, Taipei (T.H.-H.C.); Sefako Makgatho Health Sciences University, Ga-Rankuwa, and the School of Health Systems and Public Health, University of Pretoria, Pretoria - both in South Africa (O.A.A.-Y.); Healis Sekhsaria Institute for Public Health (P.C.G.) and Preventive Oncology, Karkinos Healthcare (R.S.), Navi Mumbai, Rajiv Gandhi Centre for Biotechnology, Thiruvananthapuram (D.A.), Regional Cancer Centre, Trivandrum (K.R.), and the School of Preventive Oncology, Patna (D.N.S.) - all in India; New York University College of Dentistry, New York (A.R.K.); University of Peradeniya, Peradeniya, Sri Lanka (W.M.T.); the Faculty of Dentistry, University of Malaya, Kuala Lumpur (W.M.T., R.B.Z.), and MAHSA (Malaysian Allied Health Sciences Academy) University, Bandar Saujana Putra (R.B.Z.) - both in Malaysia; M.D. Anderson Cancer Center, Houston (A.G.); Griffith University Gold Coast, Southport, QLD, Australia (N.W.J.); University of São Paulo Medical School and A.C. Camargo Cancer Center (L.P.K.), São Paulo, and Piracicaba Dental School, University of Campinas, Campinas (A.R.S.-S.) - all in Brazil; the Department of Maxillofacial Surgery, School of Dentistry, Aichi Gakuin University, Nisshin, Japan (T.N.); WHO, Geneva (V.M.P., F.R.); and the Department of Otorhinolaryngology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand (P.V.)
| | - Alexander R Kerr
- From the International Agency for Research on Cancer (V.B., S.T.N., D.S., R.S., B.L.-S.), and INSERM 1052, Centre National de la Recherche Scientifique 5286, Centre de Recherche en Cancérologie de Lyon, Université Claude Bernard Lyon 1, and the Department of Medical Oncology, Centre Léon Bérard (P.S.) - all in Lyon, France; the Collaborating Centre for Oral Cancer of the World Health Organization (WHO) (S.W.) and the Faculty of Dentistry, Oral, and Craniofacial Sciences (N.W.J.), King's College London, London, the University of Sheffield School of Health and Related Research, Sheffield (O.M.), and the School of Medicine, Dentistry, and Nursing, University of Glasgow, Glasgow (D.I.C.) - all in the United Kingdom; Center for Health, Innovation, and Policy Foundation and Rollins School of Public Health, Emory University, Atlanta (R.M.); the Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, MD (A.K.C.); the Institute of Epidemiology and Preventive Medicine, National Taiwan University, Taipei (T.H.-H.C.); Sefako Makgatho Health Sciences University, Ga-Rankuwa, and the School of Health Systems and Public Health, University of Pretoria, Pretoria - both in South Africa (O.A.A.-Y.); Healis Sekhsaria Institute for Public Health (P.C.G.) and Preventive Oncology, Karkinos Healthcare (R.S.), Navi Mumbai, Rajiv Gandhi Centre for Biotechnology, Thiruvananthapuram (D.A.), Regional Cancer Centre, Trivandrum (K.R.), and the School of Preventive Oncology, Patna (D.N.S.) - all in India; New York University College of Dentistry, New York (A.R.K.); University of Peradeniya, Peradeniya, Sri Lanka (W.M.T.); the Faculty of Dentistry, University of Malaya, Kuala Lumpur (W.M.T., R.B.Z.), and MAHSA (Malaysian Allied Health Sciences Academy) University, Bandar Saujana Putra (R.B.Z.) - both in Malaysia; M.D. Anderson Cancer Center, Houston (A.G.); Griffith University Gold Coast, Southport, QLD, Australia (N.W.J.); University of São Paulo Medical School and A.C. Camargo Cancer Center (L.P.K.), São Paulo, and Piracicaba Dental School, University of Campinas, Campinas (A.R.S.-S.) - all in Brazil; the Department of Maxillofacial Surgery, School of Dentistry, Aichi Gakuin University, Nisshin, Japan (T.N.); WHO, Geneva (V.M.P., F.R.); and the Department of Otorhinolaryngology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand (P.V.)
| | - Wanninayake M Tilakaratne
- From the International Agency for Research on Cancer (V.B., S.T.N., D.S., R.S., B.L.-S.), and INSERM 1052, Centre National de la Recherche Scientifique 5286, Centre de Recherche en Cancérologie de Lyon, Université Claude Bernard Lyon 1, and the Department of Medical Oncology, Centre Léon Bérard (P.S.) - all in Lyon, France; the Collaborating Centre for Oral Cancer of the World Health Organization (WHO) (S.W.) and the Faculty of Dentistry, Oral, and Craniofacial Sciences (N.W.J.), King's College London, London, the University of Sheffield School of Health and Related Research, Sheffield (O.M.), and the School of Medicine, Dentistry, and Nursing, University of Glasgow, Glasgow (D.I.C.) - all in the United Kingdom; Center for Health, Innovation, and Policy Foundation and Rollins School of Public Health, Emory University, Atlanta (R.M.); the Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, MD (A.K.C.); the Institute of Epidemiology and Preventive Medicine, National Taiwan University, Taipei (T.H.-H.C.); Sefako Makgatho Health Sciences University, Ga-Rankuwa, and the School of Health Systems and Public Health, University of Pretoria, Pretoria - both in South Africa (O.A.A.-Y.); Healis Sekhsaria Institute for Public Health (P.C.G.) and Preventive Oncology, Karkinos Healthcare (R.S.), Navi Mumbai, Rajiv Gandhi Centre for Biotechnology, Thiruvananthapuram (D.A.), Regional Cancer Centre, Trivandrum (K.R.), and the School of Preventive Oncology, Patna (D.N.S.) - all in India; New York University College of Dentistry, New York (A.R.K.); University of Peradeniya, Peradeniya, Sri Lanka (W.M.T.); the Faculty of Dentistry, University of Malaya, Kuala Lumpur (W.M.T., R.B.Z.), and MAHSA (Malaysian Allied Health Sciences Academy) University, Bandar Saujana Putra (R.B.Z.) - both in Malaysia; M.D. Anderson Cancer Center, Houston (A.G.); Griffith University Gold Coast, Southport, QLD, Australia (N.W.J.); University of São Paulo Medical School and A.C. Camargo Cancer Center (L.P.K.), São Paulo, and Piracicaba Dental School, University of Campinas, Campinas (A.R.S.-S.) - all in Brazil; the Department of Maxillofacial Surgery, School of Dentistry, Aichi Gakuin University, Nisshin, Japan (T.N.); WHO, Geneva (V.M.P., F.R.); and the Department of Otorhinolaryngology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand (P.V.)
| | - Devasena Anantharaman
- From the International Agency for Research on Cancer (V.B., S.T.N., D.S., R.S., B.L.-S.), and INSERM 1052, Centre National de la Recherche Scientifique 5286, Centre de Recherche en Cancérologie de Lyon, Université Claude Bernard Lyon 1, and the Department of Medical Oncology, Centre Léon Bérard (P.S.) - all in Lyon, France; the Collaborating Centre for Oral Cancer of the World Health Organization (WHO) (S.W.) and the Faculty of Dentistry, Oral, and Craniofacial Sciences (N.W.J.), King's College London, London, the University of Sheffield School of Health and Related Research, Sheffield (O.M.), and the School of Medicine, Dentistry, and Nursing, University of Glasgow, Glasgow (D.I.C.) - all in the United Kingdom; Center for Health, Innovation, and Policy Foundation and Rollins School of Public Health, Emory University, Atlanta (R.M.); the Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, MD (A.K.C.); the Institute of Epidemiology and Preventive Medicine, National Taiwan University, Taipei (T.H.-H.C.); Sefako Makgatho Health Sciences University, Ga-Rankuwa, and the School of Health Systems and Public Health, University of Pretoria, Pretoria - both in South Africa (O.A.A.-Y.); Healis Sekhsaria Institute for Public Health (P.C.G.) and Preventive Oncology, Karkinos Healthcare (R.S.), Navi Mumbai, Rajiv Gandhi Centre for Biotechnology, Thiruvananthapuram (D.A.), Regional Cancer Centre, Trivandrum (K.R.), and the School of Preventive Oncology, Patna (D.N.S.) - all in India; New York University College of Dentistry, New York (A.R.K.); University of Peradeniya, Peradeniya, Sri Lanka (W.M.T.); the Faculty of Dentistry, University of Malaya, Kuala Lumpur (W.M.T., R.B.Z.), and MAHSA (Malaysian Allied Health Sciences Academy) University, Bandar Saujana Putra (R.B.Z.) - both in Malaysia; M.D. Anderson Cancer Center, Houston (A.G.); Griffith University Gold Coast, Southport, QLD, Australia (N.W.J.); University of São Paulo Medical School and A.C. Camargo Cancer Center (L.P.K.), São Paulo, and Piracicaba Dental School, University of Campinas, Campinas (A.R.S.-S.) - all in Brazil; the Department of Maxillofacial Surgery, School of Dentistry, Aichi Gakuin University, Nisshin, Japan (T.N.); WHO, Geneva (V.M.P., F.R.); and the Department of Otorhinolaryngology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand (P.V.)
| | - David I Conway
- From the International Agency for Research on Cancer (V.B., S.T.N., D.S., R.S., B.L.-S.), and INSERM 1052, Centre National de la Recherche Scientifique 5286, Centre de Recherche en Cancérologie de Lyon, Université Claude Bernard Lyon 1, and the Department of Medical Oncology, Centre Léon Bérard (P.S.) - all in Lyon, France; the Collaborating Centre for Oral Cancer of the World Health Organization (WHO) (S.W.) and the Faculty of Dentistry, Oral, and Craniofacial Sciences (N.W.J.), King's College London, London, the University of Sheffield School of Health and Related Research, Sheffield (O.M.), and the School of Medicine, Dentistry, and Nursing, University of Glasgow, Glasgow (D.I.C.) - all in the United Kingdom; Center for Health, Innovation, and Policy Foundation and Rollins School of Public Health, Emory University, Atlanta (R.M.); the Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, MD (A.K.C.); the Institute of Epidemiology and Preventive Medicine, National Taiwan University, Taipei (T.H.-H.C.); Sefako Makgatho Health Sciences University, Ga-Rankuwa, and the School of Health Systems and Public Health, University of Pretoria, Pretoria - both in South Africa (O.A.A.-Y.); Healis Sekhsaria Institute for Public Health (P.C.G.) and Preventive Oncology, Karkinos Healthcare (R.S.), Navi Mumbai, Rajiv Gandhi Centre for Biotechnology, Thiruvananthapuram (D.A.), Regional Cancer Centre, Trivandrum (K.R.), and the School of Preventive Oncology, Patna (D.N.S.) - all in India; New York University College of Dentistry, New York (A.R.K.); University of Peradeniya, Peradeniya, Sri Lanka (W.M.T.); the Faculty of Dentistry, University of Malaya, Kuala Lumpur (W.M.T., R.B.Z.), and MAHSA (Malaysian Allied Health Sciences Academy) University, Bandar Saujana Putra (R.B.Z.) - both in Malaysia; M.D. Anderson Cancer Center, Houston (A.G.); Griffith University Gold Coast, Southport, QLD, Australia (N.W.J.); University of São Paulo Medical School and A.C. Camargo Cancer Center (L.P.K.), São Paulo, and Piracicaba Dental School, University of Campinas, Campinas (A.R.S.-S.) - all in Brazil; the Department of Maxillofacial Surgery, School of Dentistry, Aichi Gakuin University, Nisshin, Japan (T.N.); WHO, Geneva (V.M.P., F.R.); and the Department of Otorhinolaryngology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand (P.V.)
| | - Ann Gillenwater
- From the International Agency for Research on Cancer (V.B., S.T.N., D.S., R.S., B.L.-S.), and INSERM 1052, Centre National de la Recherche Scientifique 5286, Centre de Recherche en Cancérologie de Lyon, Université Claude Bernard Lyon 1, and the Department of Medical Oncology, Centre Léon Bérard (P.S.) - all in Lyon, France; the Collaborating Centre for Oral Cancer of the World Health Organization (WHO) (S.W.) and the Faculty of Dentistry, Oral, and Craniofacial Sciences (N.W.J.), King's College London, London, the University of Sheffield School of Health and Related Research, Sheffield (O.M.), and the School of Medicine, Dentistry, and Nursing, University of Glasgow, Glasgow (D.I.C.) - all in the United Kingdom; Center for Health, Innovation, and Policy Foundation and Rollins School of Public Health, Emory University, Atlanta (R.M.); the Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, MD (A.K.C.); the Institute of Epidemiology and Preventive Medicine, National Taiwan University, Taipei (T.H.-H.C.); Sefako Makgatho Health Sciences University, Ga-Rankuwa, and the School of Health Systems and Public Health, University of Pretoria, Pretoria - both in South Africa (O.A.A.-Y.); Healis Sekhsaria Institute for Public Health (P.C.G.) and Preventive Oncology, Karkinos Healthcare (R.S.), Navi Mumbai, Rajiv Gandhi Centre for Biotechnology, Thiruvananthapuram (D.A.), Regional Cancer Centre, Trivandrum (K.R.), and the School of Preventive Oncology, Patna (D.N.S.) - all in India; New York University College of Dentistry, New York (A.R.K.); University of Peradeniya, Peradeniya, Sri Lanka (W.M.T.); the Faculty of Dentistry, University of Malaya, Kuala Lumpur (W.M.T., R.B.Z.), and MAHSA (Malaysian Allied Health Sciences Academy) University, Bandar Saujana Putra (R.B.Z.) - both in Malaysia; M.D. Anderson Cancer Center, Houston (A.G.); Griffith University Gold Coast, Southport, QLD, Australia (N.W.J.); University of São Paulo Medical School and A.C. Camargo Cancer Center (L.P.K.), São Paulo, and Piracicaba Dental School, University of Campinas, Campinas (A.R.S.-S.) - all in Brazil; the Department of Maxillofacial Surgery, School of Dentistry, Aichi Gakuin University, Nisshin, Japan (T.N.); WHO, Geneva (V.M.P., F.R.); and the Department of Otorhinolaryngology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand (P.V.)
| | - Newell W Johnson
- From the International Agency for Research on Cancer (V.B., S.T.N., D.S., R.S., B.L.-S.), and INSERM 1052, Centre National de la Recherche Scientifique 5286, Centre de Recherche en Cancérologie de Lyon, Université Claude Bernard Lyon 1, and the Department of Medical Oncology, Centre Léon Bérard (P.S.) - all in Lyon, France; the Collaborating Centre for Oral Cancer of the World Health Organization (WHO) (S.W.) and the Faculty of Dentistry, Oral, and Craniofacial Sciences (N.W.J.), King's College London, London, the University of Sheffield School of Health and Related Research, Sheffield (O.M.), and the School of Medicine, Dentistry, and Nursing, University of Glasgow, Glasgow (D.I.C.) - all in the United Kingdom; Center for Health, Innovation, and Policy Foundation and Rollins School of Public Health, Emory University, Atlanta (R.M.); the Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, MD (A.K.C.); the Institute of Epidemiology and Preventive Medicine, National Taiwan University, Taipei (T.H.-H.C.); Sefako Makgatho Health Sciences University, Ga-Rankuwa, and the School of Health Systems and Public Health, University of Pretoria, Pretoria - both in South Africa (O.A.A.-Y.); Healis Sekhsaria Institute for Public Health (P.C.G.) and Preventive Oncology, Karkinos Healthcare (R.S.), Navi Mumbai, Rajiv Gandhi Centre for Biotechnology, Thiruvananthapuram (D.A.), Regional Cancer Centre, Trivandrum (K.R.), and the School of Preventive Oncology, Patna (D.N.S.) - all in India; New York University College of Dentistry, New York (A.R.K.); University of Peradeniya, Peradeniya, Sri Lanka (W.M.T.); the Faculty of Dentistry, University of Malaya, Kuala Lumpur (W.M.T., R.B.Z.), and MAHSA (Malaysian Allied Health Sciences Academy) University, Bandar Saujana Putra (R.B.Z.) - both in Malaysia; M.D. Anderson Cancer Center, Houston (A.G.); Griffith University Gold Coast, Southport, QLD, Australia (N.W.J.); University of São Paulo Medical School and A.C. Camargo Cancer Center (L.P.K.), São Paulo, and Piracicaba Dental School, University of Campinas, Campinas (A.R.S.-S.) - all in Brazil; the Department of Maxillofacial Surgery, School of Dentistry, Aichi Gakuin University, Nisshin, Japan (T.N.); WHO, Geneva (V.M.P., F.R.); and the Department of Otorhinolaryngology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand (P.V.)
| | - Luiz P Kowalski
- From the International Agency for Research on Cancer (V.B., S.T.N., D.S., R.S., B.L.-S.), and INSERM 1052, Centre National de la Recherche Scientifique 5286, Centre de Recherche en Cancérologie de Lyon, Université Claude Bernard Lyon 1, and the Department of Medical Oncology, Centre Léon Bérard (P.S.) - all in Lyon, France; the Collaborating Centre for Oral Cancer of the World Health Organization (WHO) (S.W.) and the Faculty of Dentistry, Oral, and Craniofacial Sciences (N.W.J.), King's College London, London, the University of Sheffield School of Health and Related Research, Sheffield (O.M.), and the School of Medicine, Dentistry, and Nursing, University of Glasgow, Glasgow (D.I.C.) - all in the United Kingdom; Center for Health, Innovation, and Policy Foundation and Rollins School of Public Health, Emory University, Atlanta (R.M.); the Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, MD (A.K.C.); the Institute of Epidemiology and Preventive Medicine, National Taiwan University, Taipei (T.H.-H.C.); Sefako Makgatho Health Sciences University, Ga-Rankuwa, and the School of Health Systems and Public Health, University of Pretoria, Pretoria - both in South Africa (O.A.A.-Y.); Healis Sekhsaria Institute for Public Health (P.C.G.) and Preventive Oncology, Karkinos Healthcare (R.S.), Navi Mumbai, Rajiv Gandhi Centre for Biotechnology, Thiruvananthapuram (D.A.), Regional Cancer Centre, Trivandrum (K.R.), and the School of Preventive Oncology, Patna (D.N.S.) - all in India; New York University College of Dentistry, New York (A.R.K.); University of Peradeniya, Peradeniya, Sri Lanka (W.M.T.); the Faculty of Dentistry, University of Malaya, Kuala Lumpur (W.M.T., R.B.Z.), and MAHSA (Malaysian Allied Health Sciences Academy) University, Bandar Saujana Putra (R.B.Z.) - both in Malaysia; M.D. Anderson Cancer Center, Houston (A.G.); Griffith University Gold Coast, Southport, QLD, Australia (N.W.J.); University of São Paulo Medical School and A.C. Camargo Cancer Center (L.P.K.), São Paulo, and Piracicaba Dental School, University of Campinas, Campinas (A.R.S.-S.) - all in Brazil; the Department of Maxillofacial Surgery, School of Dentistry, Aichi Gakuin University, Nisshin, Japan (T.N.); WHO, Geneva (V.M.P., F.R.); and the Department of Otorhinolaryngology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand (P.V.)
| | - Maria E Leon
- From the International Agency for Research on Cancer (V.B., S.T.N., D.S., R.S., B.L.-S.), and INSERM 1052, Centre National de la Recherche Scientifique 5286, Centre de Recherche en Cancérologie de Lyon, Université Claude Bernard Lyon 1, and the Department of Medical Oncology, Centre Léon Bérard (P.S.) - all in Lyon, France; the Collaborating Centre for Oral Cancer of the World Health Organization (WHO) (S.W.) and the Faculty of Dentistry, Oral, and Craniofacial Sciences (N.W.J.), King's College London, London, the University of Sheffield School of Health and Related Research, Sheffield (O.M.), and the School of Medicine, Dentistry, and Nursing, University of Glasgow, Glasgow (D.I.C.) - all in the United Kingdom; Center for Health, Innovation, and Policy Foundation and Rollins School of Public Health, Emory University, Atlanta (R.M.); the Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, MD (A.K.C.); the Institute of Epidemiology and Preventive Medicine, National Taiwan University, Taipei (T.H.-H.C.); Sefako Makgatho Health Sciences University, Ga-Rankuwa, and the School of Health Systems and Public Health, University of Pretoria, Pretoria - both in South Africa (O.A.A.-Y.); Healis Sekhsaria Institute for Public Health (P.C.G.) and Preventive Oncology, Karkinos Healthcare (R.S.), Navi Mumbai, Rajiv Gandhi Centre for Biotechnology, Thiruvananthapuram (D.A.), Regional Cancer Centre, Trivandrum (K.R.), and the School of Preventive Oncology, Patna (D.N.S.) - all in India; New York University College of Dentistry, New York (A.R.K.); University of Peradeniya, Peradeniya, Sri Lanka (W.M.T.); the Faculty of Dentistry, University of Malaya, Kuala Lumpur (W.M.T., R.B.Z.), and MAHSA (Malaysian Allied Health Sciences Academy) University, Bandar Saujana Putra (R.B.Z.) - both in Malaysia; M.D. Anderson Cancer Center, Houston (A.G.); Griffith University Gold Coast, Southport, QLD, Australia (N.W.J.); University of São Paulo Medical School and A.C. Camargo Cancer Center (L.P.K.), São Paulo, and Piracicaba Dental School, University of Campinas, Campinas (A.R.S.-S.) - all in Brazil; the Department of Maxillofacial Surgery, School of Dentistry, Aichi Gakuin University, Nisshin, Japan (T.N.); WHO, Geneva (V.M.P., F.R.); and the Department of Otorhinolaryngology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand (P.V.)
| | - Olena Mandrik
- From the International Agency for Research on Cancer (V.B., S.T.N., D.S., R.S., B.L.-S.), and INSERM 1052, Centre National de la Recherche Scientifique 5286, Centre de Recherche en Cancérologie de Lyon, Université Claude Bernard Lyon 1, and the Department of Medical Oncology, Centre Léon Bérard (P.S.) - all in Lyon, France; the Collaborating Centre for Oral Cancer of the World Health Organization (WHO) (S.W.) and the Faculty of Dentistry, Oral, and Craniofacial Sciences (N.W.J.), King's College London, London, the University of Sheffield School of Health and Related Research, Sheffield (O.M.), and the School of Medicine, Dentistry, and Nursing, University of Glasgow, Glasgow (D.I.C.) - all in the United Kingdom; Center for Health, Innovation, and Policy Foundation and Rollins School of Public Health, Emory University, Atlanta (R.M.); the Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, MD (A.K.C.); the Institute of Epidemiology and Preventive Medicine, National Taiwan University, Taipei (T.H.-H.C.); Sefako Makgatho Health Sciences University, Ga-Rankuwa, and the School of Health Systems and Public Health, University of Pretoria, Pretoria - both in South Africa (O.A.A.-Y.); Healis Sekhsaria Institute for Public Health (P.C.G.) and Preventive Oncology, Karkinos Healthcare (R.S.), Navi Mumbai, Rajiv Gandhi Centre for Biotechnology, Thiruvananthapuram (D.A.), Regional Cancer Centre, Trivandrum (K.R.), and the School of Preventive Oncology, Patna (D.N.S.) - all in India; New York University College of Dentistry, New York (A.R.K.); University of Peradeniya, Peradeniya, Sri Lanka (W.M.T.); the Faculty of Dentistry, University of Malaya, Kuala Lumpur (W.M.T., R.B.Z.), and MAHSA (Malaysian Allied Health Sciences Academy) University, Bandar Saujana Putra (R.B.Z.) - both in Malaysia; M.D. Anderson Cancer Center, Houston (A.G.); Griffith University Gold Coast, Southport, QLD, Australia (N.W.J.); University of São Paulo Medical School and A.C. Camargo Cancer Center (L.P.K.), São Paulo, and Piracicaba Dental School, University of Campinas, Campinas (A.R.S.-S.) - all in Brazil; the Department of Maxillofacial Surgery, School of Dentistry, Aichi Gakuin University, Nisshin, Japan (T.N.); WHO, Geneva (V.M.P., F.R.); and the Department of Otorhinolaryngology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand (P.V.)
| | - Toru Nagao
- From the International Agency for Research on Cancer (V.B., S.T.N., D.S., R.S., B.L.-S.), and INSERM 1052, Centre National de la Recherche Scientifique 5286, Centre de Recherche en Cancérologie de Lyon, Université Claude Bernard Lyon 1, and the Department of Medical Oncology, Centre Léon Bérard (P.S.) - all in Lyon, France; the Collaborating Centre for Oral Cancer of the World Health Organization (WHO) (S.W.) and the Faculty of Dentistry, Oral, and Craniofacial Sciences (N.W.J.), King's College London, London, the University of Sheffield School of Health and Related Research, Sheffield (O.M.), and the School of Medicine, Dentistry, and Nursing, University of Glasgow, Glasgow (D.I.C.) - all in the United Kingdom; Center for Health, Innovation, and Policy Foundation and Rollins School of Public Health, Emory University, Atlanta (R.M.); the Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, MD (A.K.C.); the Institute of Epidemiology and Preventive Medicine, National Taiwan University, Taipei (T.H.-H.C.); Sefako Makgatho Health Sciences University, Ga-Rankuwa, and the School of Health Systems and Public Health, University of Pretoria, Pretoria - both in South Africa (O.A.A.-Y.); Healis Sekhsaria Institute for Public Health (P.C.G.) and Preventive Oncology, Karkinos Healthcare (R.S.), Navi Mumbai, Rajiv Gandhi Centre for Biotechnology, Thiruvananthapuram (D.A.), Regional Cancer Centre, Trivandrum (K.R.), and the School of Preventive Oncology, Patna (D.N.S.) - all in India; New York University College of Dentistry, New York (A.R.K.); University of Peradeniya, Peradeniya, Sri Lanka (W.M.T.); the Faculty of Dentistry, University of Malaya, Kuala Lumpur (W.M.T., R.B.Z.), and MAHSA (Malaysian Allied Health Sciences Academy) University, Bandar Saujana Putra (R.B.Z.) - both in Malaysia; M.D. Anderson Cancer Center, Houston (A.G.); Griffith University Gold Coast, Southport, QLD, Australia (N.W.J.); University of São Paulo Medical School and A.C. Camargo Cancer Center (L.P.K.), São Paulo, and Piracicaba Dental School, University of Campinas, Campinas (A.R.S.-S.) - all in Brazil; the Department of Maxillofacial Surgery, School of Dentistry, Aichi Gakuin University, Nisshin, Japan (T.N.); WHO, Geneva (V.M.P., F.R.); and the Department of Otorhinolaryngology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand (P.V.)
| | - Vinayak M Prasad
- From the International Agency for Research on Cancer (V.B., S.T.N., D.S., R.S., B.L.-S.), and INSERM 1052, Centre National de la Recherche Scientifique 5286, Centre de Recherche en Cancérologie de Lyon, Université Claude Bernard Lyon 1, and the Department of Medical Oncology, Centre Léon Bérard (P.S.) - all in Lyon, France; the Collaborating Centre for Oral Cancer of the World Health Organization (WHO) (S.W.) and the Faculty of Dentistry, Oral, and Craniofacial Sciences (N.W.J.), King's College London, London, the University of Sheffield School of Health and Related Research, Sheffield (O.M.), and the School of Medicine, Dentistry, and Nursing, University of Glasgow, Glasgow (D.I.C.) - all in the United Kingdom; Center for Health, Innovation, and Policy Foundation and Rollins School of Public Health, Emory University, Atlanta (R.M.); the Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, MD (A.K.C.); the Institute of Epidemiology and Preventive Medicine, National Taiwan University, Taipei (T.H.-H.C.); Sefako Makgatho Health Sciences University, Ga-Rankuwa, and the School of Health Systems and Public Health, University of Pretoria, Pretoria - both in South Africa (O.A.A.-Y.); Healis Sekhsaria Institute for Public Health (P.C.G.) and Preventive Oncology, Karkinos Healthcare (R.S.), Navi Mumbai, Rajiv Gandhi Centre for Biotechnology, Thiruvananthapuram (D.A.), Regional Cancer Centre, Trivandrum (K.R.), and the School of Preventive Oncology, Patna (D.N.S.) - all in India; New York University College of Dentistry, New York (A.R.K.); University of Peradeniya, Peradeniya, Sri Lanka (W.M.T.); the Faculty of Dentistry, University of Malaya, Kuala Lumpur (W.M.T., R.B.Z.), and MAHSA (Malaysian Allied Health Sciences Academy) University, Bandar Saujana Putra (R.B.Z.) - both in Malaysia; M.D. Anderson Cancer Center, Houston (A.G.); Griffith University Gold Coast, Southport, QLD, Australia (N.W.J.); University of São Paulo Medical School and A.C. Camargo Cancer Center (L.P.K.), São Paulo, and Piracicaba Dental School, University of Campinas, Campinas (A.R.S.-S.) - all in Brazil; the Department of Maxillofacial Surgery, School of Dentistry, Aichi Gakuin University, Nisshin, Japan (T.N.); WHO, Geneva (V.M.P., F.R.); and the Department of Otorhinolaryngology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand (P.V.)
| | - Kunnambath Ramadas
- From the International Agency for Research on Cancer (V.B., S.T.N., D.S., R.S., B.L.-S.), and INSERM 1052, Centre National de la Recherche Scientifique 5286, Centre de Recherche en Cancérologie de Lyon, Université Claude Bernard Lyon 1, and the Department of Medical Oncology, Centre Léon Bérard (P.S.) - all in Lyon, France; the Collaborating Centre for Oral Cancer of the World Health Organization (WHO) (S.W.) and the Faculty of Dentistry, Oral, and Craniofacial Sciences (N.W.J.), King's College London, London, the University of Sheffield School of Health and Related Research, Sheffield (O.M.), and the School of Medicine, Dentistry, and Nursing, University of Glasgow, Glasgow (D.I.C.) - all in the United Kingdom; Center for Health, Innovation, and Policy Foundation and Rollins School of Public Health, Emory University, Atlanta (R.M.); the Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, MD (A.K.C.); the Institute of Epidemiology and Preventive Medicine, National Taiwan University, Taipei (T.H.-H.C.); Sefako Makgatho Health Sciences University, Ga-Rankuwa, and the School of Health Systems and Public Health, University of Pretoria, Pretoria - both in South Africa (O.A.A.-Y.); Healis Sekhsaria Institute for Public Health (P.C.G.) and Preventive Oncology, Karkinos Healthcare (R.S.), Navi Mumbai, Rajiv Gandhi Centre for Biotechnology, Thiruvananthapuram (D.A.), Regional Cancer Centre, Trivandrum (K.R.), and the School of Preventive Oncology, Patna (D.N.S.) - all in India; New York University College of Dentistry, New York (A.R.K.); University of Peradeniya, Peradeniya, Sri Lanka (W.M.T.); the Faculty of Dentistry, University of Malaya, Kuala Lumpur (W.M.T., R.B.Z.), and MAHSA (Malaysian Allied Health Sciences Academy) University, Bandar Saujana Putra (R.B.Z.) - both in Malaysia; M.D. Anderson Cancer Center, Houston (A.G.); Griffith University Gold Coast, Southport, QLD, Australia (N.W.J.); University of São Paulo Medical School and A.C. Camargo Cancer Center (L.P.K.), São Paulo, and Piracicaba Dental School, University of Campinas, Campinas (A.R.S.-S.) - all in Brazil; the Department of Maxillofacial Surgery, School of Dentistry, Aichi Gakuin University, Nisshin, Japan (T.N.); WHO, Geneva (V.M.P., F.R.); and the Department of Otorhinolaryngology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand (P.V.)
| | - Felipe Roitberg
- From the International Agency for Research on Cancer (V.B., S.T.N., D.S., R.S., B.L.-S.), and INSERM 1052, Centre National de la Recherche Scientifique 5286, Centre de Recherche en Cancérologie de Lyon, Université Claude Bernard Lyon 1, and the Department of Medical Oncology, Centre Léon Bérard (P.S.) - all in Lyon, France; the Collaborating Centre for Oral Cancer of the World Health Organization (WHO) (S.W.) and the Faculty of Dentistry, Oral, and Craniofacial Sciences (N.W.J.), King's College London, London, the University of Sheffield School of Health and Related Research, Sheffield (O.M.), and the School of Medicine, Dentistry, and Nursing, University of Glasgow, Glasgow (D.I.C.) - all in the United Kingdom; Center for Health, Innovation, and Policy Foundation and Rollins School of Public Health, Emory University, Atlanta (R.M.); the Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, MD (A.K.C.); the Institute of Epidemiology and Preventive Medicine, National Taiwan University, Taipei (T.H.-H.C.); Sefako Makgatho Health Sciences University, Ga-Rankuwa, and the School of Health Systems and Public Health, University of Pretoria, Pretoria - both in South Africa (O.A.A.-Y.); Healis Sekhsaria Institute for Public Health (P.C.G.) and Preventive Oncology, Karkinos Healthcare (R.S.), Navi Mumbai, Rajiv Gandhi Centre for Biotechnology, Thiruvananthapuram (D.A.), Regional Cancer Centre, Trivandrum (K.R.), and the School of Preventive Oncology, Patna (D.N.S.) - all in India; New York University College of Dentistry, New York (A.R.K.); University of Peradeniya, Peradeniya, Sri Lanka (W.M.T.); the Faculty of Dentistry, University of Malaya, Kuala Lumpur (W.M.T., R.B.Z.), and MAHSA (Malaysian Allied Health Sciences Academy) University, Bandar Saujana Putra (R.B.Z.) - both in Malaysia; M.D. Anderson Cancer Center, Houston (A.G.); Griffith University Gold Coast, Southport, QLD, Australia (N.W.J.); University of São Paulo Medical School and A.C. Camargo Cancer Center (L.P.K.), São Paulo, and Piracicaba Dental School, University of Campinas, Campinas (A.R.S.-S.) - all in Brazil; the Department of Maxillofacial Surgery, School of Dentistry, Aichi Gakuin University, Nisshin, Japan (T.N.); WHO, Geneva (V.M.P., F.R.); and the Department of Otorhinolaryngology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand (P.V.)
| | - Pierre Saintigny
- From the International Agency for Research on Cancer (V.B., S.T.N., D.S., R.S., B.L.-S.), and INSERM 1052, Centre National de la Recherche Scientifique 5286, Centre de Recherche en Cancérologie de Lyon, Université Claude Bernard Lyon 1, and the Department of Medical Oncology, Centre Léon Bérard (P.S.) - all in Lyon, France; the Collaborating Centre for Oral Cancer of the World Health Organization (WHO) (S.W.) and the Faculty of Dentistry, Oral, and Craniofacial Sciences (N.W.J.), King's College London, London, the University of Sheffield School of Health and Related Research, Sheffield (O.M.), and the School of Medicine, Dentistry, and Nursing, University of Glasgow, Glasgow (D.I.C.) - all in the United Kingdom; Center for Health, Innovation, and Policy Foundation and Rollins School of Public Health, Emory University, Atlanta (R.M.); the Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, MD (A.K.C.); the Institute of Epidemiology and Preventive Medicine, National Taiwan University, Taipei (T.H.-H.C.); Sefako Makgatho Health Sciences University, Ga-Rankuwa, and the School of Health Systems and Public Health, University of Pretoria, Pretoria - both in South Africa (O.A.A.-Y.); Healis Sekhsaria Institute for Public Health (P.C.G.) and Preventive Oncology, Karkinos Healthcare (R.S.), Navi Mumbai, Rajiv Gandhi Centre for Biotechnology, Thiruvananthapuram (D.A.), Regional Cancer Centre, Trivandrum (K.R.), and the School of Preventive Oncology, Patna (D.N.S.) - all in India; New York University College of Dentistry, New York (A.R.K.); University of Peradeniya, Peradeniya, Sri Lanka (W.M.T.); the Faculty of Dentistry, University of Malaya, Kuala Lumpur (W.M.T., R.B.Z.), and MAHSA (Malaysian Allied Health Sciences Academy) University, Bandar Saujana Putra (R.B.Z.) - both in Malaysia; M.D. Anderson Cancer Center, Houston (A.G.); Griffith University Gold Coast, Southport, QLD, Australia (N.W.J.); University of São Paulo Medical School and A.C. Camargo Cancer Center (L.P.K.), São Paulo, and Piracicaba Dental School, University of Campinas, Campinas (A.R.S.-S.) - all in Brazil; the Department of Maxillofacial Surgery, School of Dentistry, Aichi Gakuin University, Nisshin, Japan (T.N.); WHO, Geneva (V.M.P., F.R.); and the Department of Otorhinolaryngology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand (P.V.)
| | - Rengaswamy Sankaranarayanan
- From the International Agency for Research on Cancer (V.B., S.T.N., D.S., R.S., B.L.-S.), and INSERM 1052, Centre National de la Recherche Scientifique 5286, Centre de Recherche en Cancérologie de Lyon, Université Claude Bernard Lyon 1, and the Department of Medical Oncology, Centre Léon Bérard (P.S.) - all in Lyon, France; the Collaborating Centre for Oral Cancer of the World Health Organization (WHO) (S.W.) and the Faculty of Dentistry, Oral, and Craniofacial Sciences (N.W.J.), King's College London, London, the University of Sheffield School of Health and Related Research, Sheffield (O.M.), and the School of Medicine, Dentistry, and Nursing, University of Glasgow, Glasgow (D.I.C.) - all in the United Kingdom; Center for Health, Innovation, and Policy Foundation and Rollins School of Public Health, Emory University, Atlanta (R.M.); the Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, MD (A.K.C.); the Institute of Epidemiology and Preventive Medicine, National Taiwan University, Taipei (T.H.-H.C.); Sefako Makgatho Health Sciences University, Ga-Rankuwa, and the School of Health Systems and Public Health, University of Pretoria, Pretoria - both in South Africa (O.A.A.-Y.); Healis Sekhsaria Institute for Public Health (P.C.G.) and Preventive Oncology, Karkinos Healthcare (R.S.), Navi Mumbai, Rajiv Gandhi Centre for Biotechnology, Thiruvananthapuram (D.A.), Regional Cancer Centre, Trivandrum (K.R.), and the School of Preventive Oncology, Patna (D.N.S.) - all in India; New York University College of Dentistry, New York (A.R.K.); University of Peradeniya, Peradeniya, Sri Lanka (W.M.T.); the Faculty of Dentistry, University of Malaya, Kuala Lumpur (W.M.T., R.B.Z.), and MAHSA (Malaysian Allied Health Sciences Academy) University, Bandar Saujana Putra (R.B.Z.) - both in Malaysia; M.D. Anderson Cancer Center, Houston (A.G.); Griffith University Gold Coast, Southport, QLD, Australia (N.W.J.); University of São Paulo Medical School and A.C. Camargo Cancer Center (L.P.K.), São Paulo, and Piracicaba Dental School, University of Campinas, Campinas (A.R.S.-S.) - all in Brazil; the Department of Maxillofacial Surgery, School of Dentistry, Aichi Gakuin University, Nisshin, Japan (T.N.); WHO, Geneva (V.M.P., F.R.); and the Department of Otorhinolaryngology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand (P.V.)
| | - Alan R Santos-Silva
- From the International Agency for Research on Cancer (V.B., S.T.N., D.S., R.S., B.L.-S.), and INSERM 1052, Centre National de la Recherche Scientifique 5286, Centre de Recherche en Cancérologie de Lyon, Université Claude Bernard Lyon 1, and the Department of Medical Oncology, Centre Léon Bérard (P.S.) - all in Lyon, France; the Collaborating Centre for Oral Cancer of the World Health Organization (WHO) (S.W.) and the Faculty of Dentistry, Oral, and Craniofacial Sciences (N.W.J.), King's College London, London, the University of Sheffield School of Health and Related Research, Sheffield (O.M.), and the School of Medicine, Dentistry, and Nursing, University of Glasgow, Glasgow (D.I.C.) - all in the United Kingdom; Center for Health, Innovation, and Policy Foundation and Rollins School of Public Health, Emory University, Atlanta (R.M.); the Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, MD (A.K.C.); the Institute of Epidemiology and Preventive Medicine, National Taiwan University, Taipei (T.H.-H.C.); Sefako Makgatho Health Sciences University, Ga-Rankuwa, and the School of Health Systems and Public Health, University of Pretoria, Pretoria - both in South Africa (O.A.A.-Y.); Healis Sekhsaria Institute for Public Health (P.C.G.) and Preventive Oncology, Karkinos Healthcare (R.S.), Navi Mumbai, Rajiv Gandhi Centre for Biotechnology, Thiruvananthapuram (D.A.), Regional Cancer Centre, Trivandrum (K.R.), and the School of Preventive Oncology, Patna (D.N.S.) - all in India; New York University College of Dentistry, New York (A.R.K.); University of Peradeniya, Peradeniya, Sri Lanka (W.M.T.); the Faculty of Dentistry, University of Malaya, Kuala Lumpur (W.M.T., R.B.Z.), and MAHSA (Malaysian Allied Health Sciences Academy) University, Bandar Saujana Putra (R.B.Z.) - both in Malaysia; M.D. Anderson Cancer Center, Houston (A.G.); Griffith University Gold Coast, Southport, QLD, Australia (N.W.J.); University of São Paulo Medical School and A.C. Camargo Cancer Center (L.P.K.), São Paulo, and Piracicaba Dental School, University of Campinas, Campinas (A.R.S.-S.) - all in Brazil; the Department of Maxillofacial Surgery, School of Dentistry, Aichi Gakuin University, Nisshin, Japan (T.N.); WHO, Geneva (V.M.P., F.R.); and the Department of Otorhinolaryngology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand (P.V.)
| | - Dhirendra N Sinha
- From the International Agency for Research on Cancer (V.B., S.T.N., D.S., R.S., B.L.-S.), and INSERM 1052, Centre National de la Recherche Scientifique 5286, Centre de Recherche en Cancérologie de Lyon, Université Claude Bernard Lyon 1, and the Department of Medical Oncology, Centre Léon Bérard (P.S.) - all in Lyon, France; the Collaborating Centre for Oral Cancer of the World Health Organization (WHO) (S.W.) and the Faculty of Dentistry, Oral, and Craniofacial Sciences (N.W.J.), King's College London, London, the University of Sheffield School of Health and Related Research, Sheffield (O.M.), and the School of Medicine, Dentistry, and Nursing, University of Glasgow, Glasgow (D.I.C.) - all in the United Kingdom; Center for Health, Innovation, and Policy Foundation and Rollins School of Public Health, Emory University, Atlanta (R.M.); the Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, MD (A.K.C.); the Institute of Epidemiology and Preventive Medicine, National Taiwan University, Taipei (T.H.-H.C.); Sefako Makgatho Health Sciences University, Ga-Rankuwa, and the School of Health Systems and Public Health, University of Pretoria, Pretoria - both in South Africa (O.A.A.-Y.); Healis Sekhsaria Institute for Public Health (P.C.G.) and Preventive Oncology, Karkinos Healthcare (R.S.), Navi Mumbai, Rajiv Gandhi Centre for Biotechnology, Thiruvananthapuram (D.A.), Regional Cancer Centre, Trivandrum (K.R.), and the School of Preventive Oncology, Patna (D.N.S.) - all in India; New York University College of Dentistry, New York (A.R.K.); University of Peradeniya, Peradeniya, Sri Lanka (W.M.T.); the Faculty of Dentistry, University of Malaya, Kuala Lumpur (W.M.T., R.B.Z.), and MAHSA (Malaysian Allied Health Sciences Academy) University, Bandar Saujana Putra (R.B.Z.) - both in Malaysia; M.D. Anderson Cancer Center, Houston (A.G.); Griffith University Gold Coast, Southport, QLD, Australia (N.W.J.); University of São Paulo Medical School and A.C. Camargo Cancer Center (L.P.K.), São Paulo, and Piracicaba Dental School, University of Campinas, Campinas (A.R.S.-S.) - all in Brazil; the Department of Maxillofacial Surgery, School of Dentistry, Aichi Gakuin University, Nisshin, Japan (T.N.); WHO, Geneva (V.M.P., F.R.); and the Department of Otorhinolaryngology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand (P.V.)
| | - Patravoot Vatanasapt
- From the International Agency for Research on Cancer (V.B., S.T.N., D.S., R.S., B.L.-S.), and INSERM 1052, Centre National de la Recherche Scientifique 5286, Centre de Recherche en Cancérologie de Lyon, Université Claude Bernard Lyon 1, and the Department of Medical Oncology, Centre Léon Bérard (P.S.) - all in Lyon, France; the Collaborating Centre for Oral Cancer of the World Health Organization (WHO) (S.W.) and the Faculty of Dentistry, Oral, and Craniofacial Sciences (N.W.J.), King's College London, London, the University of Sheffield School of Health and Related Research, Sheffield (O.M.), and the School of Medicine, Dentistry, and Nursing, University of Glasgow, Glasgow (D.I.C.) - all in the United Kingdom; Center for Health, Innovation, and Policy Foundation and Rollins School of Public Health, Emory University, Atlanta (R.M.); the Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, MD (A.K.C.); the Institute of Epidemiology and Preventive Medicine, National Taiwan University, Taipei (T.H.-H.C.); Sefako Makgatho Health Sciences University, Ga-Rankuwa, and the School of Health Systems and Public Health, University of Pretoria, Pretoria - both in South Africa (O.A.A.-Y.); Healis Sekhsaria Institute for Public Health (P.C.G.) and Preventive Oncology, Karkinos Healthcare (R.S.), Navi Mumbai, Rajiv Gandhi Centre for Biotechnology, Thiruvananthapuram (D.A.), Regional Cancer Centre, Trivandrum (K.R.), and the School of Preventive Oncology, Patna (D.N.S.) - all in India; New York University College of Dentistry, New York (A.R.K.); University of Peradeniya, Peradeniya, Sri Lanka (W.M.T.); the Faculty of Dentistry, University of Malaya, Kuala Lumpur (W.M.T., R.B.Z.), and MAHSA (Malaysian Allied Health Sciences Academy) University, Bandar Saujana Putra (R.B.Z.) - both in Malaysia; M.D. Anderson Cancer Center, Houston (A.G.); Griffith University Gold Coast, Southport, QLD, Australia (N.W.J.); University of São Paulo Medical School and A.C. Camargo Cancer Center (L.P.K.), São Paulo, and Piracicaba Dental School, University of Campinas, Campinas (A.R.S.-S.) - all in Brazil; the Department of Maxillofacial Surgery, School of Dentistry, Aichi Gakuin University, Nisshin, Japan (T.N.); WHO, Geneva (V.M.P., F.R.); and the Department of Otorhinolaryngology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand (P.V.)
| | - Rosnah B Zain
- From the International Agency for Research on Cancer (V.B., S.T.N., D.S., R.S., B.L.-S.), and INSERM 1052, Centre National de la Recherche Scientifique 5286, Centre de Recherche en Cancérologie de Lyon, Université Claude Bernard Lyon 1, and the Department of Medical Oncology, Centre Léon Bérard (P.S.) - all in Lyon, France; the Collaborating Centre for Oral Cancer of the World Health Organization (WHO) (S.W.) and the Faculty of Dentistry, Oral, and Craniofacial Sciences (N.W.J.), King's College London, London, the University of Sheffield School of Health and Related Research, Sheffield (O.M.), and the School of Medicine, Dentistry, and Nursing, University of Glasgow, Glasgow (D.I.C.) - all in the United Kingdom; Center for Health, Innovation, and Policy Foundation and Rollins School of Public Health, Emory University, Atlanta (R.M.); the Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, MD (A.K.C.); the Institute of Epidemiology and Preventive Medicine, National Taiwan University, Taipei (T.H.-H.C.); Sefako Makgatho Health Sciences University, Ga-Rankuwa, and the School of Health Systems and Public Health, University of Pretoria, Pretoria - both in South Africa (O.A.A.-Y.); Healis Sekhsaria Institute for Public Health (P.C.G.) and Preventive Oncology, Karkinos Healthcare (R.S.), Navi Mumbai, Rajiv Gandhi Centre for Biotechnology, Thiruvananthapuram (D.A.), Regional Cancer Centre, Trivandrum (K.R.), and the School of Preventive Oncology, Patna (D.N.S.) - all in India; New York University College of Dentistry, New York (A.R.K.); University of Peradeniya, Peradeniya, Sri Lanka (W.M.T.); the Faculty of Dentistry, University of Malaya, Kuala Lumpur (W.M.T., R.B.Z.), and MAHSA (Malaysian Allied Health Sciences Academy) University, Bandar Saujana Putra (R.B.Z.) - both in Malaysia; M.D. Anderson Cancer Center, Houston (A.G.); Griffith University Gold Coast, Southport, QLD, Australia (N.W.J.); University of São Paulo Medical School and A.C. Camargo Cancer Center (L.P.K.), São Paulo, and Piracicaba Dental School, University of Campinas, Campinas (A.R.S.-S.) - all in Brazil; the Department of Maxillofacial Surgery, School of Dentistry, Aichi Gakuin University, Nisshin, Japan (T.N.); WHO, Geneva (V.M.P., F.R.); and the Department of Otorhinolaryngology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand (P.V.)
| | - Béatrice Lauby-Secretan
- From the International Agency for Research on Cancer (V.B., S.T.N., D.S., R.S., B.L.-S.), and INSERM 1052, Centre National de la Recherche Scientifique 5286, Centre de Recherche en Cancérologie de Lyon, Université Claude Bernard Lyon 1, and the Department of Medical Oncology, Centre Léon Bérard (P.S.) - all in Lyon, France; the Collaborating Centre for Oral Cancer of the World Health Organization (WHO) (S.W.) and the Faculty of Dentistry, Oral, and Craniofacial Sciences (N.W.J.), King's College London, London, the University of Sheffield School of Health and Related Research, Sheffield (O.M.), and the School of Medicine, Dentistry, and Nursing, University of Glasgow, Glasgow (D.I.C.) - all in the United Kingdom; Center for Health, Innovation, and Policy Foundation and Rollins School of Public Health, Emory University, Atlanta (R.M.); the Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, MD (A.K.C.); the Institute of Epidemiology and Preventive Medicine, National Taiwan University, Taipei (T.H.-H.C.); Sefako Makgatho Health Sciences University, Ga-Rankuwa, and the School of Health Systems and Public Health, University of Pretoria, Pretoria - both in South Africa (O.A.A.-Y.); Healis Sekhsaria Institute for Public Health (P.C.G.) and Preventive Oncology, Karkinos Healthcare (R.S.), Navi Mumbai, Rajiv Gandhi Centre for Biotechnology, Thiruvananthapuram (D.A.), Regional Cancer Centre, Trivandrum (K.R.), and the School of Preventive Oncology, Patna (D.N.S.) - all in India; New York University College of Dentistry, New York (A.R.K.); University of Peradeniya, Peradeniya, Sri Lanka (W.M.T.); the Faculty of Dentistry, University of Malaya, Kuala Lumpur (W.M.T., R.B.Z.), and MAHSA (Malaysian Allied Health Sciences Academy) University, Bandar Saujana Putra (R.B.Z.) - both in Malaysia; M.D. Anderson Cancer Center, Houston (A.G.); Griffith University Gold Coast, Southport, QLD, Australia (N.W.J.); University of São Paulo Medical School and A.C. Camargo Cancer Center (L.P.K.), São Paulo, and Piracicaba Dental School, University of Campinas, Campinas (A.R.S.-S.) - all in Brazil; the Department of Maxillofacial Surgery, School of Dentistry, Aichi Gakuin University, Nisshin, Japan (T.N.); WHO, Geneva (V.M.P., F.R.); and the Department of Otorhinolaryngology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand (P.V.)
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22
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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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Zhu S, Zhang F, Zhao G, Zhang X, Zhang X, Li T, Hu C, Zhu W, Li D. Trends in the global burden of oral cancer joint with attributable risk factors: Results from the global burden of disease study 2019. Oral Oncol 2022; 134:106189. [DOI: 10.1016/j.oraloncology.2022.106189] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2022] [Revised: 08/27/2022] [Accepted: 09/26/2022] [Indexed: 12/12/2022]
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Lund L, Bast LS, Rubæk M, Andersen S. Exploring factors associated with smokeless tobacco use among young people: A systematic scoping review. Drug Alcohol Depend 2022; 240:109627. [PMID: 36167002 DOI: 10.1016/j.drugalcdep.2022.109627] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Revised: 08/24/2022] [Accepted: 09/05/2022] [Indexed: 01/06/2023]
Abstract
PURPOSE While smoking is declining among young people, smokeless tobacco use is increasing. Identifying who is using smokeless tobacco and why is essential in preventing smokeless tobacco use. This study aimed to comprehensively explore the factors of young people's use of smokeless tobacco in western countries and identify research gaps. METHODS We conducted a systematic scoping review of studies that examined factors associated with smokeless tobacco use among young people (ages 13-29) from western countries published between January 2011 and September 2021. Searches were conducted in CINAHL, Medline, and Scopus. Studies on adults, total tobacco use (i.e., did not differentiate between tobacco product types), dual and multiple uses of tobacco, and studies on smokeless tobacco cessation programs were excluded. RESULTS A total of 160 studies were included in this scoping review. The studies were primarily undertaken in the US and the Scandinavian countries, and the majority explored smokeless tobacco use without distinguishing between the specific types. Smokeless tobacco users were more likely to be male, non-Hispanic white, engaging in physical activity, and using other substances, including cigarettes and alcohol. The role of friends and family were identified as critical factors that were related to the use of smokeless tobacco. CONCLUSIONS This scoping review suggests that preventative measures against smokeless tobacco use should focus on peer and family members' roles and that these measures may benefit from targeting males. Additional research, including systematic reviews on this area to validate the identified associated factors, would improve the understanding of smokeless tobacco use.
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Affiliation(s)
- Lisbeth Lund
- National Institute of Public Health, University of Southern Denmark, Studiestræde 6, 1455 Copenhagen, Denmark.
| | - Lotus Sofie Bast
- National Institute of Public Health, University of Southern Denmark, Studiestræde 6, 1455 Copenhagen, Denmark.
| | - Mette Rubæk
- National Institute of Public Health, University of Southern Denmark, Studiestræde 6, 1455 Copenhagen, Denmark.
| | - Susan Andersen
- National Institute of Public Health, University of Southern Denmark, Studiestræde 6, 1455 Copenhagen, Denmark.
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25
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Razzaq S, Nagi MLF, Athar U, Kazmi T, Alslamah T, Naz S, Abalkhail A. Prevalence of tobacco consumption and the associated factors among the adults in an urban slum: Findings from the WHO STEPwise survey. Tob Induc Dis 2022; 90:91. [PMID: 36381179 PMCID: PMC9619230 DOI: 10.18332/tid/154636] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Revised: 06/02/2022] [Accepted: 09/15/2022] [Indexed: 06/16/2023] Open
Abstract
INTRODUCTION Despite Pakistan's stringent tobacco control policy, its effective implementation has always been a challenge, leading to rising tobacco consumption. The aim of the study is to determine the prevalence of tobacco consumption and associated risk factors in the adult population of deprived urban areas. METHODS A community-based, cross-sectional survey was conducted from February to July 2019, comprising 607 adults residing in the urban squatter settlement of Lahore using a standardized questionnaire, the WHO STEPwise approach. The outcome was current use of tobacco and/or smokeless tobacco daily. Multivariable logistic regression was applied to determine factors associated with smoking and smokeless tobacco consumption. RESULTS Among 607 participants, about 64% were females, 49.3% were illiterate, 64.9% were currently unemployed, and 47.1% belonged to the low-income group. The prevalence of tobacco smoke was 10.5% (95% CI: 8.07-12.93), and smokeless tobacco consumption was 8.6% (95% CI: 6.38-10.82). Multivariable logistic regression found that smokeless tobacco was more likely among the aged 50-59 years (AOR=4.1; 95% CI: 1.1-13.8) and unemployed (AOR=3.6; 95% CI: 1.1-12.2). Whereas tobacco smoking was more likely among the aged 30-39 years (AOR=5.5; 95% CI: 1.8-16.7), Urdu ethnicity (AOR=2.9; 95% CI: 1.2-7.3), unemployed (AOR=6.6; 95% CI: 2.9-14.9), and never exposed to any media (AOR=3.2; 95% CI: 1.8-17.4). Participants exposed to health warnings were less likely to smoke (AOR=0.02; 95% CI: 0.01-0.05). CONCLUSIONS This study reports a high prevalence of tobacco consumption among adults and calls for effective policy implementation using a multi-pronged approach, including health professionals and media, to spread awareness about the harmful effects of tobacco and endorsement of health warnings on tobacco packaging.
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Affiliation(s)
- Shama Razzaq
- Division of Environment and Sustainability, The Hong Kong University of Science and Technology, Hong Kong, People's Republic of China
| | | | - Unsa Athar
- Department of Community Medicine, Shalamar Medical and Dental College, Lahore, Pakistan
| | - Tahseen Kazmi
- Department of Community Medicine, Central Park Medical College, Lahore, Pakistan
| | - Thamer Alslamah
- Department of Public Health, College of Public Health and Health Informatics, Qassim University, Al Bukairiyah, Saudi Arabia
| | - Sana Naz
- Department of Community Medicine, Shalamar Medical and Dental College, Lahore, Pakistan
| | - Adil Abalkhail
- Department of Public Health, College of Public Health and Health Informatics, Qassim University, Al Bukairiyah, Saudi Arabia
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26
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Singh PK, Jain R, Tyagi A, Yadav A, Singh S. Smokeless tobacco industry's brand stretching through FM radio: A study from Delhi National Capital Region, India. Front Public Health 2022; 10:999552. [PMID: 36311609 PMCID: PMC9616108 DOI: 10.3389/fpubh.2022.999552] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Accepted: 08/25/2022] [Indexed: 01/26/2023] Open
Abstract
Smokeless tobacco (SLT) consumption is associated with multiple adverse health effects and mortality, with the highest burden in India. The WHO FCTC has banned tobacco advertisement, promotion and sponsorship via Article 13. Indian laws also prohibit any kind of direct or indirect advertisements in all forms of audio, visual, and print media; brand promotion; and sponsorship of tobacco products. However, the tobacco industry continues to find aggressive marketing ways to advertise their products. This study aims to assess the extent of surrogate advertisement of smokeless tobacco products through frequency modulation (FM) radio stations in the city of Delhi (National Capital Territory of India). In this study, the advertisements broadcasted over FM radio across different channels (private and government owned) in total 162 h were analyzed. The time duration was spread evenly over morning peak hours, off hours, and evening peak hours. It was found that multiple brands including Vimal, Kamla Pasand, and Rajshree have used surrogate advertising to market their brands that are commonly associated with smokeless tobacco products. However, no such advertisement was found to be aired on government-owned FM channels. The total surrogate advertisements broadcasted were over 286 times, where no significant difference was found in distribution among peak and non-peak hours. The study indicated that the tobacco industry is making its way to sell the products through indirect advertisements. The need of the hour is to not only enforce tobacco advertising ban laws in all forms of advertising media but also to strictly regulate smokeless tobacco products.
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Affiliation(s)
- Prashant Kumar Singh
- Division of Preventive Oncology and Population Health, WHO FCTC Knowledge Hub on Smokeless Tobacco, ICMR-National Institute of Cancer Prevention and Research, Noida, Uttar Pradesh, India,*Correspondence: Prashant Kumar Singh
| | - Rupal Jain
- Division of Preventive Oncology and Population Health, WHO FCTC Knowledge Hub on Smokeless Tobacco, ICMR-National Institute of Cancer Prevention and Research, Noida, Uttar Pradesh, India
| | - Akansha Tyagi
- Guru Jambheshwar University of Science and Technology, Hisar, India
| | - Amit Yadav
- The International Union Against Tuberculosis and Lung Disease (The Union) South East Asia Office, New Delhi, India
| | - Shalini Singh
- Division of Preventive Oncology and Population Health, WHO FCTC Knowledge Hub on Smokeless Tobacco, ICMR-National Institute of Cancer Prevention and Research, Noida, Uttar Pradesh, India
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Miluna S, Melderis R, Briuka L, Skadins I, Broks R, Kroica J, Rostoka D. The Correlation of Swedish Snus, Nicotine Pouches and Other Tobacco Products with Oral Mucosal Health and Salivary Biomarkers. Dent J (Basel) 2022; 10:dj10080154. [PMID: 36005252 PMCID: PMC9406994 DOI: 10.3390/dj10080154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Revised: 08/09/2022] [Accepted: 08/11/2022] [Indexed: 11/26/2022] Open
Abstract
In society, tobacco products, such as e-cigarettes, and smokeless tobacco products, such as snus and nicotine pouches, are becoming more attractive. There is still a lack of information regarding the effects of these products on the oral mucosa and oral saliva biomarkers. The aim of this study is to evaluate oral mucosa and the presence of inflammatory biomarkers IL-6, IL-1, IL-8, TNF alpha and LRG-1 in saliva. Respondents were divided in four groups based on their tobacco product usage. Oral examination was carried out, saliva samples were taken, and the detection of IL-6, IL-8, IL-1, TNF alpha and LRG-1 levels in saliva was carried out. Out of the tobacco users, 30.8% were snus users, 48.7% were cigarette users and 20.5% were e-cigarette users. The control group was composed of respondents who did not use any tobacco products. E-cigarettes were used more by women, but snus was used more by men. Mucosal changes were seen in the group of snus users, and mucosal changes were only seen in men who had used 5–10 tobacco units per day for 5–10 years. Increased IL-6 levels in saliva were detected in respondents who also experienced mucosal changes. Mucosal changes were white, leathery and localized at the site where snus sachets were placed. Saliva, as an easily available biofluid, could be used as a first tool to detect potentially precancerous signs, but the LRG1 marker cannot be used as a prognostic marker.
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Affiliation(s)
- Sintija Miluna
- Department of Prosthetic Dentistry, Riga Stradins University, LV-1007 Riga, Latvia
- Department of Biology and Microbiology, Riga Stradins University, LV-1007 Riga, Latvia
- Correspondence:
| | - Ricards Melderis
- Emergency Department, Pauls Stradins Clinical University Hospital, LV-1002 Riga, Latvia
| | - Loreta Briuka
- Department of Medicine, Riga Stradins University, LV-1007 Riga, Latvia
| | - Ingus Skadins
- Department of Biology and Microbiology, Riga Stradins University, LV-1007 Riga, Latvia
| | - Renars Broks
- Department of Biology and Microbiology, Riga Stradins University, LV-1007 Riga, Latvia
| | - Juta Kroica
- Department of Biology and Microbiology, Riga Stradins University, LV-1007 Riga, Latvia
| | - Dagnija Rostoka
- Department of Biology and Microbiology, Riga Stradins University, LV-1007 Riga, Latvia
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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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Behaviour change intervention for smokeless tobacco (ST) cessation delivered through dentists within a dental setting: a feasibility study protocol. BDJ Open 2022; 8:12. [PMID: 35449103 PMCID: PMC9023496 DOI: 10.1038/s41405-022-00104-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Revised: 03/31/2022] [Accepted: 04/02/2022] [Indexed: 11/10/2022] Open
Abstract
Objectives/Aim To adapt a structured behavioural support intervention for smokeless tobacco (ST) cessation and to assess the feasibility and acceptability of delivering the intervention via dentists within dental settings in Pakistan. Material and methods The study will have 3 phases: (1) Adapt a previously developed intervention to make it suitable for delivery in a clinical/dental setting through qualitative interviews with dental patients and dentists; (2) A multi-centre, pilot randomised control trial in two teaching dental hospitals in Pakistan. Participants (dental patients) will be randomly assigned to intervention or control group in a 1:1 allocation ratio to receive either a structured behavioural support intervention involving face to face counselling or self-help material plus usual care. Each participant will be in the study for approximately 6 months and the overall study is expected to run for 12 months; (3) An embedded qualitative process evaluation. All trial participants will be followed up at 3 and 6 months to assess self-reported ST use. Outcome measures will include: rates of eligibility, recruitment and retention, randomisation group cross-over rates, the provision of data on ST use behaviour, fidelity to the intervention and qualitative assessment of acceptability and feasibility. Discussion Despite the high use of ST in Pakistan, users are offered negligible cessation support. The findings of this multi-centre, mixed-method feasibility study will inform the scope for a larger trial on ST cessation delivered through the existing dental health system.
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Kumbhalwar A, Hegde S, Kakodkar P, Mehta V, Gupte H, Jadhav S. Effectiveness of Behavioral Counseling in Smokeless Tobacco Cessation Among Adult Users Reporting to a Dental Hospital in Pune: A Randomized Controlled Trial. Cureus 2022; 14:e24041. [PMID: 35547431 PMCID: PMC9090216 DOI: 10.7759/cureus.24041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Accepted: 04/11/2022] [Indexed: 11/22/2022] Open
Abstract
Aim To assess the effectiveness of behavioral counseling for smokeless tobacco cessation among adult users in a dental hospital setting. Methods A total of 200 patients visiting a dental hospital who were exclusively using smokeless tobacco (SLT) were enrolled in the study. A randomized controlled trial with a concurrent parallel study design, which consisted of two arms, was conducted. Fagerstrom test for nicotine dependence level and the transtheoretical stage of change was assessed at the baseline. Behavioral cessation counseling and motivational interviewing were provided in the study arm and brief advice was given to those in the control arm. The counseling was provided at baseline and followed up till six months through telephone to assess the change in the frequency of use of SLT products and abstinence from SLT use. A biochemical validation with a urine cotinine test was done to confirm abstinence. Results At six months, there was a significant difference within and between the study and control groups, indicating the role played by behavioral tobacco cessation in reducing the frequency of consumption. About 24.4% of participants in the study group and 10% in the control group abstained from the habit at the sixth month, with an odd’s ratio (OR)=2.91 and with a loss to follow-up of 10% in each of the groups. The cotinine test, which was used for validation, revealed a significant difference between the study and the control group. The number needed to treat (NNT) shows that to motivate one additional person to give up the SLT habit, we need to intervene with about seven people. Conclusion Behavior intervention with motivational interviewing was considered an effective method in promoting smokeless tobacco cessation among adults. Transtheoretical stages of change have proven to be an effective model to assess the stage of behavior change of the population toward SLT use and was also helpful for changing the behavior.
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Noh JW, Kim MH, Lee Y, Kwon YD, Kim KB, Lee HJ, Yoo KB. Association between smokeless tobacco use and cigarette smoking amount by age. BMC Public Health 2022; 22:505. [PMID: 35292000 PMCID: PMC8922879 DOI: 10.1186/s12889-022-12929-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Accepted: 03/07/2022] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND The use of smokeless tobacco has increased worldwide among young people. This study aimed to investigate the association between smokeless tobacco use and cigarette smoking amount in adult smoker groups stratified by age. METHOD 2013-2015 National Health Interview Survey was used. A total of 19,635 subjects were included in our analysis. Propensity score matching was used to adjust for selection and any other bias. Generalized estimating equation was used to analyze the association between smokeless tobacco use and cigarette smoking amount by age. RESULTS All 580 smokeless tobacco users were matched to 2,900 non-smokeless tobacco users. Among those who were aged under 30, smokeless tobacco use was positively associated with the number of cigarettes used per day. Smokeless tobacco users who were aged under 30 and tried quitting smoking used more cigarettes than those who did non-smokeless tobacco users. CONCLUSIONS The present study revealed that among those who were aged under 30, smokeless tobacco use was positively associated with the number of cigarettes used per day. This study could contribute to understand the behaviors and tendencies of smoking in young adulthood and to establish effective smoking cessation methods for their age.
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Affiliation(s)
- Jin-Won Noh
- Division of Health Administration, College of Software and Digital Healthcare Convergence, Yonsei University, Wonju, 220710 Korea
| | - Min-Hee Kim
- Department of Physical Therapy, Eulji University, Seongnam, Republic of Korea
| | - Yejin Lee
- Department of Public Health, Graduate School, Korea University, Seoul, 02841 Republic of Korea
| | - Young Dae Kwon
- Department of Humanities and Social Medicine, College of Medicine and Catholic Institute for Healthcare Management, The Catholic University of Korea, Seoul, Republic of Korea
| | - Kyoung-Beom Kim
- Department of Health Administration, Dankook University, Yongin, Republic of Korea
| | - Hae-Jeung Lee
- Department of Food & Nutrition, Gachon University, Seongnam, Republic of Korea
| | - Ki-Bong Yoo
- Division of Health Administration, College of Software and Digital Healthcare Convergence, Yonsei University, Wonju, 220710 Korea
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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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Kumar RS, Mishra N, Kumar A. Characterization of Tobacco Microbiome by Metagenomics Approach. Methods Mol Biol 2022; 2413:229-244. [PMID: 35044669 DOI: 10.1007/978-1-0716-1896-7_22] [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] [Indexed: 10/19/2022]
Abstract
Chronic consumption of tobacco in all forms, either smoked/smokeless forms, causes major health hazards to humans that include cancer, cardiovascular, lung diseases, diabetes, fertility issues, etc. Among tobacco-mediated cancers, the prominent one being the oral cancers are caused due to chronic tobacco chewing. The biochemicals present in tobacco are involved in carcinogenesis, and their presence is partly mediated by the existence of microbes in tobacco products. The microbial characterization has been evolved from classical microscopical observation to the recent development of 16S rRNA sequencing by next-generation sequencing methods. The metagenomics approach using 16S rRNA-based next-generation sequencing methods enables the detection and characterization of the complete microbial community of tobacco, including both cultivable and non-cultivable microorganisms. Identification of microbes will help in devising strategies to limit the carcinogenic compounds present in tobacco.
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Affiliation(s)
- R Suresh Kumar
- Molecular Genetics Lab, Molecular Biology Group, National Institute of Cancer Prevention and Research (ICMR), Noida, Uttar Pradesh, India.
| | - Nivedita Mishra
- Molecular Genetics Lab, Molecular Biology Group, National Institute of Cancer Prevention and Research (ICMR), Noida, Uttar Pradesh, India
| | - Amit Kumar
- ICMR-AIIMS Computational Genomics Center, Division of Biomedical Informatics, Indian Council of Medical Research, New Delhi, India
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Wu H, Sun J, Xi B. Parental tobacco and indoor secondhand smoking exposure and the risk of offspring under-five mortality in low- and middle-income countries. INDOOR AIR 2021; 31:2188-2199. [PMID: 34181764 DOI: 10.1111/ina.12897] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Revised: 05/28/2021] [Accepted: 06/07/2021] [Indexed: 06/13/2023]
Abstract
Children are vulnerable to exposure of secondhand smoking (SHS) which is a major preventable cause of disease and death. This study aimed to investigate the association between parental tobacco use or SHS exposure, respectively, and under-five mortality. Data were obtained from the nationally representative and population-based Demographic and Health Surveys in low- and middle-income countries (LMICs) between 2000 and 2018. Cox proportional hazard regression models with complex survey design were conducted to examine the adjusted associations between parental smoking and SHS exposure and child under-five mortality. In the pooled analysis of parental smoking, 437 322 children were included. Compared with children whose parents are not smoking, those whose father or both parents smoked any form of tobacco had higher risks of mortality (hazard ratio [HR] = 1.08, 95% confidence interval [CI] = 1.03-1.13; HR = 1.18, 95% CI = 1.06-1.32, respectively). In addition, parental using smokeless tobacco, smoking tobacco, and using smokeless tobacco and smoking tobacco simultaneously was significantly associated with child under-five mortality (HR = 1.07, 95% CI = 1.01-1.12; HR = 1.12, 95%CI = 1.04-1.21; and HR = 1.17, 95%CI = 1.06-1.30, respectively). In the pooled analysis of SHS exposure, 605 442 children were included, and weekly and daily SHS exposure were significantly associated with child under-five mortality (HR = 1.11, 95% CI = 1.03-1.20, and HR = 1.10, 95% CI = 1.06-1.15, respectively). The results were robust in most stratification analyses and sensitivity analyses. Parental tobacco use and indoor SHS exposure were associated with increased risk of under-five mortality in LMICs. Comprehensive tobacco control programs should be considered by policymakers in LMICs to promote smoke-free environments for children.
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Affiliation(s)
- Han Wu
- Department of Epidemiology, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Jiahong Sun
- Department of Epidemiology, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Bo Xi
- Department of Epidemiology, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, China
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Huque R, Al Azdi Z, Sheikh A, Ahluwalia JS, Mishu MP, Mehrotra R, Ahmed N, Bauld L, Huq SM, Alam SM, Siddiqui F, Choudhury SR, Siddiqi K. Policy priorities for strengthening smokeless tobacco control in Bangladesh: A mixed-methods analysis. Tob Induc Dis 2021; 19:78. [PMID: 34707471 PMCID: PMC8500203 DOI: 10.18332/tid/140826] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2021] [Revised: 06/28/2021] [Accepted: 08/03/2021] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION Smokeless tobacco (ST) remains poorly regulated in Bangladesh. This study describes the prevalence and trends of ST use in Bangladesh, presents ST-related disease burden, identifies relevant policy gaps, and highlights key implications for future policy and practice for effective ST control in Bangladesh. METHODS We analyzed secondary data from the two rounds (2009 and 2017) of The Global Adult Tobacco Survey, estimated ST-related disease burden, and conducted a review to assess differences in combustible tobacco and ST policies. In addition, we gathered views in a workshop with key stakeholders in the country on gaps in existing tobacco control policies for ST control in Bangladesh and identified policy priorities using an online survey. RESULTS Smokeless tobacco use, constituting more than half of all tobacco use in Bangladesh, declined from 27.2% (25.9 million) in 2009 to 20.6% (22 million) in 2017. However, in 2017, at least 16947 lives and 403460 Disability-Adjusted Life Years (DALYs) were lost across Bangladesh due to ST use compared to 12511 deaths and 324020 DALYs lost in 2010. Policy priorities identified for ST control have included: introducing specific taxes and increasing the present ad valorem tax level, increasing the health development surcharge, designing and implementing a tax tracking and tracing system, standardizing ST packaging, integrating ST cessation within existing health systems, comprehensive media campaigns, and licensing of ST manufactures. CONCLUSIONS Our analysis shows that compared to combustible tobacco, there remain gaps in implementing and compliance with ST control policies in Bangladesh. Thus, contrary to the decline in ST use and the usual time lag between tobacco exposure and the development of cancers, the ST-related disease burden is still on the rise in Bangladesh. Strengthening ST control at this stage can accelerate this decline and reduce ST related morbidity and mortality.
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Affiliation(s)
- Rumana Huque
- Department of Economics, University of Dhaka, Dhaka, Bangladesh.,ARK Foundation, Dhaka, Bangladesh
| | | | - Aziz Sheikh
- Usher Institute, The University of Edinburgh, Edinburgh, United Kingdom
| | - Jasjit S Ahluwalia
- Department of Behavioral and Social Sciences, Alpert Medical School, Brown University School of Public Health, Providence, United States
| | - Masuma P Mishu
- Department of Health Sciences, Faculty of Sciences, University of York, Heslington, United Kingdom
| | - Ravi Mehrotra
- Centre for Health Economics, University of York, York, United Kingdom.,Department of Health Research, India Cancer Research Consortium, New Delhi, India
| | - Nasiruddin Ahmed
- 8 Institute of Governance and Development, BRAC University, Dhaka, Bangladesh
| | - Linda Bauld
- Usher Institute, The University of Edinburgh, Edinburgh, United Kingdom
| | | | | | - Faraz Siddiqui
- Department of Health Sciences, Faculty of Sciences, University of York, Heslington, United Kingdom
| | - Sohel R Choudhury
- Department of Epidemiology and Research, National Heart Foundation Hospital and Research Institute, Dhaka, Bangladesh
| | - Kamran Siddiqi
- Department of Health Sciences, Faculty of Sciences, University of York, Heslington, United Kingdom
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Gupta AK, Mehrotra R. Increasing use of flavoured tobacco products amongst youth. Indian J Tuberc 2021; 68S:S105-S107. [PMID: 34538383 DOI: 10.1016/j.ijtb.2021.07.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Accepted: 07/30/2021] [Indexed: 10/20/2022]
Abstract
Adolescence and early adulthood are the most susceptible phase of life for tobacco initiation and its use during this period can have profound public health implications. Anti-smoking campaigns have helped in reducing the social acceptability of smoking; however, newer nicotine products are becoming increasingly popular, globally. Evidence suggests that flavours play a key role in youth initiation of tobacco use. Flavoured Tobacco Products (FTP) are disproportionately used by the youth and young adults due to their high palatability and misperceptions regarding reduced ill effects of their constituents. Early use of a flavoured tobacco product puts youth and young adults at risk of continued tobacco use and other substance use. The prevalence of FTP use (72.7%) is much higher in young adults as compared to non-flavoured tobacco products.
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Affiliation(s)
| | - Ravi Mehrotra
- Addressing Smokeless Tobacco and Building Research Capacity in South Asia (ASTRA) Project, National Institute of Health Research, UK; School of Health Sciences, University of York, UK.
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Singh PK, Acharya S, Jain P, Singh S. COVID-19 as an opportunity for smokeless tobacco control and prohibiting spitting in public places. CLINICAL EPIDEMIOLOGY AND GLOBAL HEALTH 2021; 11:100794. [PMID: 36032560 PMCID: PMC9393231 DOI: 10.1016/j.cegh.2021.100794] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Revised: 04/29/2021] [Accepted: 05/19/2021] [Indexed: 11/26/2022] Open
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Kendrick PJ, Reitsma MB, Abbasi-Kangevari M, Abdoli A, Abdollahi M, Abedi A, Abhilash ES, Aboyans V, Adebayo OM, Advani SM, Ahinkorah BO, Ahmad S, Ahmadi K, Ahmed H, Aji B, Akalu Y, Akunna CJ, Alahdab F, Al-Aly Z, Alanezi FM, Alanzi TM, Alhabib KF, Ali T, Alif SM, Alipour V, Aljunid SM, Alomari MA, Amin TT, Amini S, Amu H, Ancuceanu R, Anderson JA, Andrei CL, Andrei T, Ansari-Moghaddam A, Antony B, Anvari D, Arabloo J, Arian ND, Arora M, Artanti KD, Asmare WN, Atnafu DD, Ausloos M, Awan AT, Ayano G, Aynalem GL, Azari S, B DB, Badiye AD, Baig AA, Banach M, Banerjee SK, Barker-Collo SL, Bärnighausen TW, Barqawi HJ, Basu S, Bayati M, Bazargan-Hejazi S, Bekuma TT, Bennett DA, Bensenor IM, Benzian H, Benziger CP, Berman AE, Bhagavathula AS, Bhala N, Bhardwaj N, Bhardwaj P, Bhattacharyya K, Bibi S, Bijani A, Biondi A, Braithwaite D, Brenner H, Brunoni AR, Burkart K, Burugina Nagaraja S, Butt ZA, Caetano dos Santos FL, Car J, Carreras G, Castaldelli-Maia JM, Cattaruzza MSS, Chang JC, Chaturvedi P, Chen S, Chido-Amajuoyi OG, Chu DT, Chung SC, Ciobanu LG, Costa VM, Couto RAS, Dagnew B, Dai X, Damasceno AAM, Damiani G, Dandona L, Dandona R, Daneshpajouhnejad P, Darega Gela J, Derbew Molla M, Desta AA, Dharmaratne SD, Dhimal M, Eagan AW, Ebrahimi Kalan M, Edvardsson K, Effiong A, El Tantawi M, Elbarazi I, Esmaeilnejad S, Fadhil I, Faraon EJA, Farwati M, Farzadfar F, Fazlzadeh M, Feigin VL, Feldman R, Filip I, Filippidis F, Fischer F, Flor LS, Foigt NA, Folayan MO, Foroutan M, Gad MM, Gallus S, Geberemariyam BS, Gebregiorgis BG, Getacher L, Getachew Obsa A, Ghafourifard M, Ghanei Gheshlagh R, Ghashghaee A, Ghith N, Gil GF, Gill PS, Ginawi IA, Goharinezhad S, Golechha M, Gopalani SV, Gorini G, Grivna M, Guha A, Guimarães RA, Guo Y, Gupta RD, Gupta R, Gupta T, Gupta V, Hafezi-Nejad N, Haider MR, Hamadeh RR, Hankey GJ, Hargono A, Hay SI, Heidari G, Herteliu C, Hezam K, Hird TR, Holla R, Hosseinzadeh M, Hostiuc M, Hostiuc S, Househ M, Hsiao T, Huang J, Ibeneme CU, Ibitoye SE, Ilic IM, Ilic MD, Inbaraj LR, Irvani SSN, Islam JY, Islam RM, Islam SMS, Islami F, Iso H, Itumalla R, Jaafari J, Jain V, Jakovljevic M, Jang SI, Jayaram S, Jeemon P, Jha RP, Jonas JB, Jürisson M, Kabir A, Kabir Z, Kalankesh LR, Kanchan T, Kandel H, Kapoor N, Karch A, Karimi SE, Kebede KM, Kelkay B, Kennedy RD, Khader YS, Khan EA, Khayamzadeh M, Kim GR, Kimokoti RW, Kivimäki M, Kosen S, Koulmane Laxminarayana SL, Koyanagi A, Krishan K, Kugbey N, Kumar GA, Kumar N, Kurmi OP, Kusuma D, Lacey B, Landires I, Lasrado S, Lauriola P, Lee DW, Lee YH, Leung J, Li S, Lin H, Liu W, Lugo A, Madhava Kunjathur S, Majeed A, Maleki A, Malekzadeh R, Malta DC, Mamun AA, Manjunatha N, Mansouri B, Mansournia MA, Martini S, Mathur MR, Mathur P, Mazidi M, McKee M, Medina-Solís CE, Mehata S, Mendoza W, Menezes RG, Miazgowski B, Michalek IM, Miller TR, Mini GK, Mirica A, Mirrakhimov EM, Mirzaei H, Misra S, Mohammad Y, Mohammadian-Hafshejani A, Mohammed S, Mokdad AH, Molokhia M, Monasta L, Moni MA, Moradzadeh R, Morrison SD, Mossie TB, Mubarik S, Mullany EC, Murray CJL, Nagaraju SP, Naghavi M, Naik N, Nalini M, Nangia V, Naqvi AA, Narasimha Swamy S, Naveed M, Nazari J, Nduaguba SO, Negoi RI, Neupane Kandel S, Nguyen HLT, Nigatu YT, Nixon MR, Nnaji CA, Noubiap JJ, Nowak C, Nuñez-Samudio V, Ogbo FA, Oguntade AS, Oh IH, Olagunju AT, Owolabi MO, P A M, Pakshir K, Pana A, Panagiotakos D, Panda-Jonas S, Pandey A, Parekh U, Park EC, Park EK, Pashazadeh Kan F, Pathak M, Pawar S, Pestell RG, Pham HQ, Pinheiro M, Pokhrel KN, Pourshams A, Prashant A, Radfar A, Rahimi-Movaghar V, Rahman MHU, Rahman MA, Rahmani AM, Ram P, Rana J, Ranabhat CL, Rathi P, Rawaf DL, Rawaf S, Rawassizadeh R, Renzaho AMN, Rezapour A, Riaz MA, Roever L, Ronfani L, Roshandel G, Roy A, Roy B, Saddik B, Sahebkar A, Salehi S, Salimzadeh H, Samy AM, Sanabria J, Santric-Milicevic MM, Sao Jose BP, Sathian B, Sawhney M, Saya GK, Schwendicke F, Seidu AA, Senthil Kumar N, Sepanlou SG, Shafaat O, Shah SM, Shaikh MA, Shannawaz M, Sharafi K, Sheikh A, Sheikhbahaei S, Shigematsu M, Shiri R, Shishani K, Shivakumar KM, Shivalli S, Shrestha R, Siabani S, Sidemo NB, Sigfusdottir ID, Sigurvinsdottir R, Silva JP, Singh A, Singh JA, Singh V, Sinha DN, Skryabin VY, Skryabina AA, Soroush A, Soyiri IN, Sreeramareddy CT, Stein DJ, Steiropoulos P, Stortecky S, Straif K, Suliankatchi Abdulkader R, Sulo G, Sundström J, Tabuchi T, Tadesse EG, Tamiru AT, Tareke M, Tareque MI, Tarigan IU, Thakur B, Thankappan KR, Thapar R, Tolani MA, Tovani-Palone MR, Tran BX, Tripathy JP, Tsegaye GW, Tymeson HD, Ullah S, Unim B, Updike RL, Uthman OA, Vacante M, Vardavas C, Venketasubramanian N, Verma M, Vidale S, Vo B, Vu GT, Waheed Y, Wang Y, Welding K, Werdecker A, Whisnant JL, Wickramasinghe ND, Wubishet BL, Yamagishi K, Yano Y, Yazdi-Feyzabadi V, Yeshaw Y, Yimmer MZ, Yonemoto N, Yousefi Z, Yu C, Yunusa I, Yusefzadeh H, Zaman MS, Zamani M, Zamanian M, Zastrozhin MS, Zastrozhina A, Zhang J, Zhang ZJ, Zhong C, Zuniga YMH, Gakidou E. Spatial, temporal, and demographic patterns in prevalence of chewing tobacco use in 204 countries and territories, 1990-2019: a systematic analysis from the Global Burden of Disease Study 2019. Lancet Public Health 2021; 6:e482-e499. [PMID: 34051920 PMCID: PMC8251505 DOI: 10.1016/s2468-2667(21)00065-7] [Citation(s) in RCA: 34] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Revised: 03/12/2021] [Accepted: 03/16/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND Chewing tobacco and other types of smokeless tobacco use have had less attention from the global health community than smoked tobacco use. However, the practice is popular in many parts of the world and has been linked to several adverse health outcomes. Understanding trends in prevalence with age, over time, and by location and sex is important for policy setting and in relation to monitoring and assessing commitment to the WHO Framework Convention on Tobacco Control. METHODS We estimated prevalence of chewing tobacco use as part of the Global Burden of Diseases, Injuries, and Risk Factors Study 2019 using a modelling strategy that used information on multiple types of smokeless tobacco products. We generated a time series of prevalence of chewing tobacco use among individuals aged 15 years and older from 1990 to 2019 in 204 countries and territories, including age-sex specific estimates. We also compared these trends to those of smoked tobacco over the same time period. FINDINGS In 2019, 273·9 million (95% uncertainty interval 258·5 to 290·9) people aged 15 years and older used chewing tobacco, and the global age-standardised prevalence of chewing tobacco use was 4·72% (4·46 to 5·01). 228·2 million (213·6 to 244·7; 83·29% [82·15 to 84·42]) chewing tobacco users lived in the south Asia region. Prevalence among young people aged 15-19 years was over 10% in seven locations in 2019. Although global age-standardised prevalence of smoking tobacco use decreased significantly between 1990 and 2019 (annualised rate of change: -1·21% [-1·26 to -1·16]), similar progress was not observed for chewing tobacco (0·46% [0·13 to 0·79]). Among the 12 highest prevalence countries (Bangladesh, Bhutan, Cambodia, India, Madagascar, Marshall Islands, Myanmar, Nepal, Pakistan, Palau, Sri Lanka, and Yemen), only Yemen had a significant decrease in the prevalence of chewing tobacco use, which was among males between 1990 and 2019 (-0·94% [-1·72 to -0·14]), compared with nine of 12 countries that had significant decreases in the prevalence of smoking tobacco. Among females, none of these 12 countries had significant decreases in prevalence of chewing tobacco use, whereas seven of 12 countries had a significant decrease in the prevalence of tobacco smoking use for the period. INTERPRETATION Chewing tobacco remains a substantial public health problem in several regions of the world, and predominantly in south Asia. We found little change in the prevalence of chewing tobacco use between 1990 and 2019, and that control efforts have had much larger effects on the prevalence of smoking tobacco use than on chewing tobacco use in some countries. Mitigating the health effects of chewing tobacco requires stronger regulations and policies that specifically target use of chewing tobacco, especially in countries with high prevalence. FUNDING Bloomberg Philanthropies and the Bill & Melinda Gates Foundation.
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Yadav A, Singh PK, Yadav N, Kaushik R, Chandan K, Chandra A, Singh S, Garg S, Gupta PC, Sinha DN, Mehrotra R. Smokeless tobacco control in India: policy review and lessons for high-burden countries. BMJ Glob Health 2021; 5:bmjgh-2020-002367. [PMID: 32665375 PMCID: PMC7365431 DOI: 10.1136/bmjgh-2020-002367] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Revised: 05/21/2020] [Accepted: 05/23/2020] [Indexed: 11/15/2022] Open
Abstract
We examined the magnitude of smokeless tobacco (SLT) use in India and identified policy gaps to ascertain the priorities for SLT control in India and other high SLT burden countries in the Southeast Asia region. We reviewed and analysed the legal and policy framework to identify policy gaps, options and priority areas to address the SLT burden in India and lessons thereof. In India, 21.4% adults, including 29.6% of men, 12.8% of women, use SLT while more than 0.35 million Indians die every year due to SLT use. SLT use remains a huge public health concern for other countries in the region as well. Priority areas for SLT control should include: constant monitoring, increasing taxes and price of SLT products, strengthening and strict enforcement of existing laws, integration of SLT cessation with all health and development programmes, banning of advertisement and promotion of SLT, increasing age of access to tobacco up to 21 years, introducing licensing for the sale of SLT, standardising of SLT packaging and preventing SLT industry interference in the implementation of SLT control policies besides a committed multistakeholder approach for effective policy formulation and enforcement. SLT control in India and the other high SLT burden countries, especially in the Southeast Asia region, should focus on strengthening and implementing the above policy priorities.
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Affiliation(s)
- Amit Yadav
- WHO FCTC Knowledge Hub on Smokeless Tobacco, 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
| | - Nisha Yadav
- Harlal School of Law, Greater Noida, Uttar Pradesh, India
| | - Ravi Kaushik
- Maulana Azad Medical College and Associated Hospitals, New Delhi, Delhi, India
| | - Kumar Chandan
- WHO FCTC Knowledge Hub on Smokeless Tobacco, ICMR-National Institute of Cancer Prevention and Research, Noida, Uttar Pradesh, India
| | - Anshika Chandra
- WHO FCTC Knowledge Hub on Smokeless Tobacco, ICMR-National Institute of Cancer Prevention and Research, Noida, Uttar Pradesh, India
| | - Shalini Singh
- ICMR-National Institute of Cancer Prevention and Research, Noida, Uttar Pradesh, India
| | - Suneela Garg
- Department of Community Medicine, Maulana Azad Medical College and Associated Hospitals, New Delhi, Delhi, India
| | - Prakash C Gupta
- Healis Sekhsaria Institute for Public Health, Navi Mumbai, Maharashtra, India
| | | | - Ravi Mehrotra
- India Cancer Research Consortium, New Delhi, Delhi, India
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Singh PK, Yadav A, Singh L, Mazumdar S, Sinha DN, Straif K, Singh S. Areca nut consumption with and without tobacco among the adult population: a nationally representative study from India. BMJ Open 2021; 11:e043987. [PMID: 34130957 PMCID: PMC8208015 DOI: 10.1136/bmjopen-2020-043987] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Accepted: 04/19/2021] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVE Areca nut is one of the most widely consumed substances globally, after nicotine, ethanol and caffeine and classified as carcinogenic to humans. This study examines the disparity and determinants of areca nut consumption with and without tobacco in India. DESIGN Nationally representative cross-sectional study. PARTICIPANTS We used the nationally representative Global Adult Tobacco Survey 2016-2017. The analytical sample size was 74 037 individual's aged 15 years and above with a response rate of 92.9%. MEASURES Current consumption of areca nut without tobacco and with tobacco. METHOD We examined determinants of areca nut consumption (without tobacco and with tobacco) using multinomial logistic regression, accounting for the survey design. RESULTS About 23.9% (95% CI 23.1 to 24.8) of the adult population consume areca nut, that is, approximately 223.79 million people in India; majority of users (14.2%-95% CI 13.5 to 14.9) consumed areca nut with tobacco. When compared with women, men were more likely to consume areca nut (with tobacco relative risk (RR)=2.02; 95% CI 1.85 to 2.21 and without tobacco RR=1.13; 95% CI 1.07 to 1.20). Age, marital status, education, occupation, caste, religion and region were significantly associated with areca nut consumption. However, the direction and magnitude of association differ with respect to the areca nut consumption with and without tobacco. CONCLUSION The ongoing tobacco control efforts would not address the majority of areca nut users until greater attention to areca nut consumption with and without tobacco is reflected in health policies in India.
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Affiliation(s)
- Prashant Kumar Singh
- Division of Preventive Oncology & Population Health, ICMR - National Institute of Cancer Prevention and Research, Noida, India
- WHO FCTC Global Knowledge Hub on Smokeless Tobacco, ICMR - National Institute of Cancer Prevention and Research, Noida, India
| | - Amit Yadav
- The International Union Against Tuberculosis and Lung Disease (The Union) South East Asia Office, New Delhi, India
| | - Lucky Singh
- ICMR - National Institute of Medical Statistics, New Delhi, India
| | - Sumit Mazumdar
- Centre for Health Economics, University of York, Heslington, York, UK
| | | | - Kurt Straif
- Boston College USA, Boston, Massachusetts, USA
- ISGlobal, Barcelona, Spain
| | - Shalini Singh
- WHO FCTC Global Knowledge Hub on Smokeless Tobacco, ICMR - National Institute of Cancer Prevention and Research, Noida, India
- ICMR - National Institute of Cancer Prevention and Research, Noida, India
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Wang Y, Bos JH, Schuiling-Veninga CCM, Boezen HM, van Boven JFM, Wilffert B, Hak E. Neuropsychiatric safety of varenicline in the general and COPD population with and without psychiatric disorders: a retrospective cohort study in a real-world setting. BMJ Open 2021; 11:e042417. [PMID: 34035088 PMCID: PMC8154988 DOI: 10.1136/bmjopen-2020-042417] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVES To evaluate the real-world association between varenicline and neuropsychiatric adverse events (NPAEs) in general and chronic obstructive pulmonary disease (COPD) population with and without psychiatric disorders compared with nicotine replacement therapy (NRT) to strengthen the knowledge of varenicline safety. DESIGN A retrospective cohort study. SETTING Prescription database IADB.nl, the Netherlands. PARTICIPANTS New users of varenicline or NRT among general (≥18 years) and COPD (≥40 years) population. Psychiatric subcohort was defined as people prescribed psychotropic medications (≥2) within 6 months before the index date. OUTCOME MEASURES The incidence of NPAEs including depression, anxiety and insomnia, defined by new or naive prescriptions of related medications in IADB.nl within 24 weeks after the first treatment initiation of varenicline or NRT. RESULTS For the general population in non-psychiatric cohort, the incidence of total NPAEs in varenicline (4480) and NRT (1970) groups was 10.5% and 12.6%, respectively (adjusted OR (aOR) 0.85, 95% CI 0.72 to 1.00). For the general population in psychiatric cohort, the incidence of total NPAEs was much higher, 75.3% and 78.5% for varenicline (1427) and NRT (1200) groups, respectively (aOR 0.82, 95% CI 0.68 to 0.99). For the COPD population (1598), there were no differences in the incidence of NPAEs between comparison groups in both the psychiatric cohort (aOR 0.97, 95% CI 0.66 to 1.44) and non-psychiatric cohort (aOR 0.81, 95% CI 0.54 to 1.20). Results from subgroup or sensitivity analyses also did not reveal increased risks of NPAEs but showed decreased risk of some subgroup NPAEs associated with varenicline. CONCLUSIONS In contrast to the concerns of a possible increased risk of NPAEs among varenicline users, we found a relative decreased risk of total NPAEs in varenicline users of the general population in psychiatric or non-psychiatric cohorts compared with NRT and no difference for NPAEs between varenicline and NRT users in smaller population with COPD.
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Affiliation(s)
- Yuanyuan Wang
- Department of PharmacoTherapy, -Epidemiology & -Economics, Groningen Research Institutte of Pharmacy, University of Groningen, Groningen, The Netherlands
| | - Jens H Bos
- Department of PharmacoTherapy, -Epidemiology & -Economics, Groningen Research Institutte of Pharmacy, University of Groningen, Groningen, The Netherlands
| | - Catharina C M Schuiling-Veninga
- Department of PharmacoTherapy, -Epidemiology & -Economics, Groningen Research Institutte of Pharmacy, University of Groningen, Groningen, The Netherlands
| | - H Marike Boezen
- Department of Epidemiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
- Groningen Research Institute for Asthma and COPD (GRIAC), University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Job F M van Boven
- Groningen Research Institute for Asthma and COPD (GRIAC), University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
- Department of Clinical Pharmacy & Pharmacology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Bob Wilffert
- Department of PharmacoTherapy, -Epidemiology & -Economics, Groningen Research Institutte of Pharmacy, University of Groningen, Groningen, The Netherlands
- Department of Clinical Pharmacy & Pharmacology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Eelko Hak
- Department of PharmacoTherapy, -Epidemiology & -Economics, Groningen Research Institutte of Pharmacy, University of Groningen, Groningen, The Netherlands
- Department of Epidemiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
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Mishu MP, Siddiqui F, Shukla R, Kanaan M, Dogar O, Siddiqi K. Predictors of Cigarette Smoking, Smokeless Tobacco Consumption, and Use of both forms in Adolescents in South Asia: A Secondary Analysis of the Global Youth Tobacco Surveys. Nicotine Tob Res 2021; 23:956-965. [PMID: 33022045 DOI: 10.1093/ntr/ntaa202] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Accepted: 09/29/2020] [Indexed: 11/14/2022]
Abstract
INTRODUCTION Tobacco uptake in adolescents is associated with a range of predictors. We examined the predictors of cigarette smoking, smokeless tobacco (ST) consumption, and use of both ST and cigarettes among adolescents in four South Asian countries. METHODS We analyzed the Global Youth Tobacco Surveys (GYTS) data for Bangladesh (2013), India (2009), Pakistan (2013), and Sri Lanka (2015), using multinomial regression to examine associations between several predictors and tobacco use. RESULTS Data from 23 681 adolescents were analyzed. Overall, 82.8% of the study population were between 13 and 15 years and 52.7% were girls, 2% were cigarette smokers, 6.5% were ST users, and 1.1% used both ST and cigarettes, in the past 30 days. Exposure to smoking in public places was associated with past 30-day smoking (relative risk ratio [RRR] 5.59, 95% confidence intervals [CI] 4.28-7.28), ST use (RRR 2.07, 95% CI 1.84-2.32), and use of both ST and cigarettes (RRR 11.42, 95% CI 7.44-17.54). Exposure to tobacco use in electronic media and being offered free tobacco products were associated with all forms of tobacco use. Shopkeepers' refusal to sell cigarettes protected adolescents from smoking (RRR 0.47, 95% CI 0.36-0.63) and ST use (RRR 0.65, 95% CI 0.45-0.95). However, exposure to antitobacco mass media messages was not protective for any form of tobacco use. Adolescents taught at school about harmful effects of tobacco were less likely to use ST; no evidence of this association was observed for smoking. CONCLUSION The associations between tobacco use and protobacco factors were strong, but the associations with antitobacco factors lacked strength and consistency in this study population. IMPLICATIONS The predictors of adolescents using different tobacco products, crucial to inform and evaluate tobacco control efforts, are poorly understood. We investigated the associations between several environmental-level factors and cigarette smoking, ST consumption, and use of both forms among adolescents, whereas most of the previous studies focused on individual-level factors. Our study found strong associations between tobacco use and protobacco factors and lack of strength and consistency in associations between antitobacco factors and tobacco use in the study population. Our results indicate that the current tobacco control policies need strengthening to curb the tobacco epidemic in these countries.
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Affiliation(s)
| | - Faraz Siddiqui
- Department of Health Science, University of York, York, UK
| | - Radha Shukla
- Department of Health Science, University of York, York, UK
| | - Mona Kanaan
- Department of Health Science, University of York, York, UK
| | - Omara Dogar
- Department of Health Science, University of York, York, UK
- Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Kamran Siddiqi
- Department of Health Science, University of York, York, UK
- Centre for Health and Population Sciences, Hull York Medical School, University of York, York, UK
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Mapping the triple burden of smoking, smokeless tobacco and alcohol consumption among adults in 28,521 communities across 640 districts of India: A sex-stratified multilevel cross-sectional study. Health Place 2021; 69:102565. [PMID: 33930730 DOI: 10.1016/j.healthplace.2021.102565] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Revised: 03/20/2021] [Accepted: 03/22/2021] [Indexed: 11/23/2022]
Abstract
National estimates on tobacco and alcohol consumption are insufficient to guide policy at the sub-national level. This study assessed the sex-stratified prevalence of different types of smoking and smokeless tobacco and alcohol consumption among adults aged 15-49 using the National Family Health Survey (2015-16) at sub-national administrative units. Three-level logistic regression models were applied to quantify the variation at district- and community-level in smoking and consumption of smokeless tobacco and alcohol. A higher prevalence of smoking, smokeless tobacco and alcohol consumption was observed among men. The study found that the considerable unexplained variations in two different forms of tobacco and alcohol consumption among men attributed to between-population differences at district-level and community-level. The between-population differences were even larger at the district- and community-level in tobacco and alcohol consumption among women. Continious assessment of tobacco and alcohol consumption at lower administrative units and the development of evidence-based localised cessation interventions must be integrated with health policy to reduce disease burden and preventable deaths.
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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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Solhi M, Fattahi E, Manzari ZS, Gupta PC, Kargar M, Kasmaei P, Barati H. The Reasons for Using Smokeless Tobacco: A Review. IRANIAN JOURNAL OF PUBLIC HEALTH 2021; 50:492-501. [PMID: 34178796 PMCID: PMC8214603 DOI: 10.18502/ijph.v50i3.5589] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Abstract
Background: Smokeless tobacco use is a public health problem in some parts of the world. The major objective of this study was to investigate the reasons and factors of consumption. Methods: A content analysis was conducted on articles for the past thirty years (1989–2019). We reviewed and selected 400 abstracts of original articles from PubMed databases by the search strategy, and reviewed one by one. Among these, 45 abstracts were selected, in which the patterns of use, the reasons for using, and the determinants and predictors were described. Eleven papers were selected based on the results and related to the research objectives. The results of these articles were evaluated precisely word by word and phrase by phrase with content analysis method and inductive approach. Results: The reasons for the use of smokeless tobacco fell in two main themes: socio-cultural structure; and, beliefs, each contained Sub-themes such as “culture and living conditions”, “laws”, “family and peer relationships”, “beliefs related to psychological” and “beliefs related to physical influences”, “beliefs”, “The role of harm perceptions “. Conclusion: There was a difference between beliefs, cultures and social conditions among the people about using of smokeless tobacco and the association of these factors is investigated in future studies. We also suggest for the prevention and control of smokeless tobacco use, cultural norms and beliefs will need to address adequately.
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Affiliation(s)
- Mahnaz Solhi
- Department of Education and Health Promotion, School of Health, Iran University of Medical Sciences, Tehran, Iran
| | - Esmaeil Fattahi
- Department of Education and Health Promotion, School of Health, Iran University of Medical Sciences, Tehran, Iran
| | - Zahra Sadat Manzari
- Department of Medical-Surgical Nursing, School of Nursing and Midwifery, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Prakash C Gupta
- Healis-Sekhsaria Institute for Public Health, Navi Mumbai, Maharashtra, India
| | - Mehdi Kargar
- Department of Health Education & Promotion, School of Health, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Parisa Kasmaei
- Health and Environment Research Center, Department of Health Education and Promotion, School of Health, Guilan University of Medical Sciences, Rasht, Iran
| | - Hadis Barati
- Department of Epidemiology, School of Public Health and Safety, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Siddiqi K, Islam Z, Khan Z, Siddiqui F, Mishu M, Dogar O, Shah V, Khan J, Pokhrel S, Iqbal R, Bauld L, Sheikh A, Grugel J. Identification of Policy Priorities to Address the Burden of Smokeless Tobacco in Pakistan: A Multimethod Analysis. Nicotine Tob Res 2021; 22:2262-2265. [PMID: 31570940 PMCID: PMC7733056 DOI: 10.1093/ntr/ntz163] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Accepted: 08/27/2019] [Indexed: 12/14/2022]
Abstract
Introduction We assessed the magnitude of smokeless tobacco (ST) use in Pakistan and identified policy gaps to help ascertain short-, medium-, and long-term priorities. We then elicited stakeholders’ views as to which of these identified priorities are most important. Methods In a multimethod study, we: analyzed Global Tobacco Surveillance System data sets to estimate ST consumption and disease burden; conducted a documentary review to identify gaps in policies to control ST in comparison with smoking; elicited stakeholders’ views in an interactive workshop to identify a set of policy options available to address ST burden in Pakistan; and ranked policy priorities using a postevent survey. Results Among all tobacco users in Pakistan (n = 24 million), one-third of men and two-thirds of women consume ST. In 2017, its use led to an estimated 18 711 deaths due to cancer and ischemic heart disease. Compared to smoking, policies to control ST lag behind significantly. Priority areas for ST policies included: banning ST sale to and by minors, advocacy campaigns, introduction of licensing, levying taxes on ST, and standardizing ST packaging. A clear commitment to close cooperation between state actors and stakeholder groups is needed to create a climate of support and information for effective policy making. Conclusions Smokeless tobacco control in Pakistan should focus on four key policy instruments: legislation, education, fiscal policies, and quit support. More research into the effectiveness of such policies is also needed. Implications A number of opportunities to improve ST regulation in Pakistan were identified. Among these, immediate priorities include banning ST sale to and by minors, mobilizing advocacy campaign, introduction of licensing through the 1958 Tobacco Vendors Act, levying taxes on ST, and standardizing ST packaging.
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Affiliation(s)
- Kamran Siddiqi
- Department of Health Sciences, University of York, York YO10 5DD, UK
| | - Ziauddin Islam
- Tobacco Control Cell, Ministry of National Health Services, Regulation and Coordination, Islamabad, Pakistan
| | - Zohaib Khan
- Office of Research Innovation and Commercialization, Khyber Medical University, Peshawar, Pakistan
| | - Faraz Siddiqui
- Department of Health Sciences, University of York, York YO10 5DD, UK
| | - Masuma Mishu
- Department of Health Sciences, University of York, York YO10 5DD, UK
| | - Omara Dogar
- Department of Health Sciences, University of York, York YO10 5DD, UK
| | - Vandana Shah
- Campaign for Tobacco Free Kids, Washington, DC 20005
| | - Javaid Khan
- Department of Medicine, Aga Khan University, Karachi, Pakistan
| | - Subhash Pokhrel
- Department of Clinical Sciences, Brunel University London, Uxbridge, Middlesex UB8 3PH, UK
| | - Romaina Iqbal
- Department of Community Health Sciences, Aga Khan University, Karachi, Pakistan
| | - Linda Bauld
- Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh EH8 9DX, UK
| | - Aziz Sheikh
- Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh EH8 9DX, UK
| | - Jean Grugel
- Department of Politics, University of York, York YO10 5DD, UK
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Siddiqui F, Khan T, Readshaw A, Croucher R, Dockrell M, Jackson C, Kanaan M, McCambridge J, McNeill A, Parrott S, Sheikh A, Siddiqi K. Smokeless tobacco products, supply chain and retailers' practices in England: a multimethods study to inform policy. Tob Control 2021; 30:e45-e49. [PMID: 33414267 DOI: 10.1136/tobaccocontrol-2020-055830] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Revised: 11/18/2020] [Accepted: 11/25/2020] [Indexed: 01/22/2023]
Abstract
BACKGROUND In England, many people of South Asian origin consume smokeless tobacco (ST). ST use can lead to oral cancer, which is disproportionately high in South Asians. Our aims were to assess the compliance of ST product retailers with statutory regulations and to explore the supply chain of ST. METHODS We undertook a multimethods study between August 2017 and July 2019 in five English boroughs with a high proportion of ethnic South Asians. We purchased ST products and conducted field surveys with ST retailers at point of sale. Qualitative interviews were conducted with ST retailers and suppliers. ST packs were assessed for regulatory compliance, while quantitative and qualitative data triangulated information on retailers' practices and the ST supply chain. RESULTS We collected 41 unique ST products, which included dry snuff, naswar, gutka, chewing tobacco and zarda. ST products were not registered, and demonstrated low compliance with health warning (14.6%) and packaging (56.1%) requirements. ST availability in surveyed boroughs was high (38.2%-69.7%); dry snuff, naswar and zarda were most commonly available. ST retailers demonstrated limited knowledge of regulations, and one-third were found to advertise ST at point of sale. Qualitative insights revealed illicit supply and distribution networks, as well as ST production in discreet locations. CONCLUSION ST products are widely available in England, yet non-compliant with statutory regulations. In order to safeguard consumers, in particular ethnic South Asians, stronger efforts are needed to regulate the supply chain of ST at both national and international levels.
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Affiliation(s)
- Faraz Siddiqui
- Department of Health Sciences, University of York, York, North Yorkshire, UK
| | - Talib Khan
- Interpretation and Translation services, National Health Service England, Leeds, Worcestershire, UK
| | - Anne Readshaw
- Department of Health Sciences, University of York, York, North Yorkshire, UK
| | - Ray Croucher
- Department of Health Sciences, University of York, York, North Yorkshire, UK
| | - Martin Dockrell
- Alcohol, Drugs and Tobacco, Public Health England, London, UK
| | - Cath Jackson
- Department of Health Sciences, University of York, York, North Yorkshire, UK
| | - Mona Kanaan
- Department of Health Sciences, University of York, York, North Yorkshire, UK
| | - Jim McCambridge
- Department of Health Sciences, University of York, York, North Yorkshire, UK
| | - Ann McNeill
- UK Centre for Tobacco Control Studies, National Addiction Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Steve Parrott
- Department of Health Sciences, University of York, York, North Yorkshire, UK
| | - Aziz Sheikh
- Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, UK
| | - Kamran Siddiqi
- Department of Health Sciences, University of York, York, North Yorkshire, UK
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Gupta AK, Nethan ST, Mehrotra R. Tobacco use as a well-recognized cause of severe COVID-19 manifestations. Respir Med 2021; 176:106233. [PMID: 33253975 PMCID: PMC7674071 DOI: 10.1016/j.rmed.2020.106233] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Revised: 11/07/2020] [Accepted: 11/09/2020] [Indexed: 02/08/2023]
Abstract
INTRODUCTION The Coronavirus disease (COVID-19) infection is caused by the novel Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2) primarily affecting the lungs. All tobacco-related illnesses including asthma, chronic obstructive pulmonary disease (COPD), and coronary artery disease are known to reduce the lung capacity and impair the immune system of the body and can greatly influence the ability to fight the novel coronavirus. The purpose of this state-of-the-art literature review is to summarize the evidence of the association of tobacco use with the severity of the COVID-19 manifestations. METHOD Articles describing the association of tobacco use with the severity of COVID-19 manifestations were searched on PubMed, MEDLINE, and Google. This review covers the relevant studies on the subject published from January 1, 2020 to September 10, 2020. RESULTS Tobacco use in all forms, whether smoking or chewing, is significantly associated with severe COVID-19 outcomes. Pre-existing comorbidities in tobacco users such as cardiovascular diseases, diabetes, respiratory diseases and hypertension were found to further aggravate the disease manifestations making the treatment of such COVID-19 patients more challenging due to their rapid clinical deterioration. CONCLUSIONS Current review indicates that nicotine exposure is linked to cardiopulmonary vulnerability to COVID-19 and tobacco use can be a potential risk factor for not only getting the viral infection but also its severe manifestations. The current pandemic provides a teachable moment to break the cycle of nicotine addiction and accelerate national tobacco control programs to achieve a tobacco-free world.
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Affiliation(s)
- Alpana Kumar Gupta
- Formerly Division of Preventive Oncology, ICMR-National Institute of Cancer Prevention and Research, Department of Health Research, Govt. of India, Noida, 201301, India
| | - Suzanne Tanya Nethan
- Division of Clinical Oncology, ICMR-National Institute of Cancer Prevention and Research, Department of Health Research, Govt. of India, Noida, 201301, India
| | - Ravi Mehrotra
- ICMR-India Cancer Research Consortium, Department of Health Research, New Delhi, 11000, India,ASTRA, Adjunct Professor of Global Health, University of York, York, Great Britain, UK,Corresponding author. ICMR-India Cancer Research Consortium, Department of Health Research, New Delhi, 11000, India
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Kumar N, Janmohamed K, Jiang J, Ainooson J, Billings A, Chen GQ, Chumo F, Cueto L, Niaura R, Zhang A. Tobacco cessation in low- to middle-income countries: A scoping review of randomized controlled trials. Addict Behav 2021; 112:106612. [PMID: 33002679 DOI: 10.1016/j.addbeh.2020.106612] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Revised: 07/24/2020] [Accepted: 08/15/2020] [Indexed: 12/24/2022]
Abstract
OBJECTIVE The growing prevalence of tobacco use in low "to middle" income countries (LMICs) and the hurdles of conducting tobacco cessation in that context necessitates a focus on the scope of randomized controlled trials (RCTs) in LMICs to guide tobacco cessation in this environment. We conducted a scoping review to identify LMIC tobacco cessation RCTs. METHODS Consistent with PRISMA-ScR guidelines and without language restrictions, we systematically searched peer-reviewed databases (MEDLINE, Embase, PsycINFO, articles published since inception, latest searches in March 2020) and gray literature (clinical trials registries, searches between September and December 2019). We searched for data on RCT type, outcome significance and intervention description. Inclusion: research conducted in LMICs; tobacco cessation; RCT. Exclusion: research conducted in high income countries; non-RCT; studies involving only those aged <18. Data was extracted from published reports. We generated narrative summaries of each LMIC's tobacco cessation RCT research environment. RESULTS Of 8404 articles screened, we identified 92 studies. Tobacco cessation RCTs were recorded in 16 of 138 countries/territories in LMICs. Evidence was weak in quality and severely limited. Most RCTs were psychosocial, with limited behavioral and pharmacological variants. CONCLUSIONS Tobacco control within LMICs is essential to reduce the tobacco mortality burden. Researchers should be cognizant that tobacco cessation in LMICs is still not an environment where best practice has been established. We suggest that developing solutions specific for LMICs is key to effective tobacco control in LMICs.
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