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Zhong H, Wang Z. Split household and smoking behaviour of rural migrants in China. Public Health 2024; 231:7-14. [PMID: 38588635 DOI: 10.1016/j.puhe.2024.02.005] [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: 07/18/2023] [Revised: 02/02/2024] [Accepted: 02/06/2024] [Indexed: 04/10/2024]
Abstract
OBJECTIVES This study aimed to address the direct impact of split households on smoking behaviour. Three types of spilt households (sole migration, couple migration, and family migration) were incorporated to explore the concise effect of different split household forms. This study also examined factors that contributed to the narrowing gap in smoking prevalence between 2008 and 2018. STUDY DESIGN Retrospective observational study. METHODS Data were obtained from the Rural Urban Migration (RUMiC-2009) and China Household Income Project (CHIP2018). Analyses were conducted using chi-squared tests/analysis of variance tests and multiple logit regression. The order probit model with sample selection was conducted to correct for selection bias. Fairlie decomposition was used to quantify the contribution of individual variables to the observed differences in smoking prevalence. RESULTS Smoking prevalence for all migrants decreased by 5.79% between 2008 and 2018. The results in 2008 reveal the positive and significant contribution of couple migration (coefficient = -0.4608; 95% CI = [-0.6453, -0.2762]) and family migration (coefficient = -0.3705; 95% CI = [-0.5959, -0.1452]) on the reduction of smoking; the finding for family migration remained robust in 2018. Measurable factors partially explain the decline in smoking disparity. The migration of families, working in the construction and manufacturing industries, and educational attainment were the largest contributing factors to the declining gap in smoking prevalence. CONCLUSIONS The increase in family migration and education, and decrease in the number of workers in the construction and manufacturing industries, contributed to a decrease in smoking prevalence. Public policies should target sole migrants, couple migrants, individuals with lower education levels, and those working in the construction and manufacturing industries.
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Affiliation(s)
- Huizhen Zhong
- School of Public Administration, Jinan University, China.
| | - Zicheng Wang
- School of Public Administration, Jinan University, China.
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2
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Sarode GS, Sarode SC, Anand R. Health Warnings on Loose Cigarettes: Lessons for Asian Countries. Nicotine Tob Res 2024; 26:790-791. [PMID: 38127654 DOI: 10.1093/ntr/ntad255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2023] [Indexed: 12/23/2023]
Affiliation(s)
- Gargi S Sarode
- Department of Oral Pathology and Microbiology, Dr. D.Y. Patil Dental College and Hospital, Dr. D.Y. Patil Vidyapeeth, Pune, Maharashtra, India
| | - Sachin C Sarode
- Department of Oral Pathology and Microbiology, Dr. D.Y. Patil Dental College and Hospital, Dr. D.Y. Patil Vidyapeeth, Pune, Maharashtra, India
- Dr. D.Y. Patil Unitech Society's Dr. D. Y. Patil Institute of Pharmaceutical Sciences and Research, Pune, Maharashtra, India
| | - Rahul Anand
- Department of Oral Pathology and Microbiology, Dr. D.Y. Patil Dental College and Hospital, Dr. D.Y. Patil Vidyapeeth, Pune, Maharashtra, India
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Bai R, Dong W, Chu M, Liu B, Li Y. Trends in mortality due to tracheal, bronchial, and lung cancer across the BRICS: An age-period-cohort analysis based on the Global Burden of Disease Study 1990-2019. Chin Med J (Engl) 2024:00029330-990000000-00948. [PMID: 38311810 DOI: 10.1097/cm9.0000000000002977] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Indexed: 02/06/2024] Open
Abstract
BACKGROUND Tracheal, bronchus, and lung cancer (TBL) is a major cause of mortality and top contributor to productivity loss in large emerging economies such as the BRICS (Brazil, Russia, India, China, and South Africa). We examined the time trends of TBL mortality across the BRICS to better understand the disease burden in these countries and inform public health and healthcare resource allocation. METHODS TBL mortality-related data between 1990 and 2019 were obtained from the Global Burden of Disease Study 2019 and analyzed using age-period-cohort models. Net drift (local drift) was used to describe the expected age-adjusted TBL mortality rate over time overall (each age group); the longitudinal age curve was used to reflect the age effect; the period rate ratios (RRs) were used to reflect the period effect; and the cohort RR was used to reflect the cohort effect. RESULTS In 2019, there were 958.3 thousand TBL deaths across the BRICS, representing 46.9% of the global TBL deaths. From 1990 to 2019, the age-standardized mortality rate (ASMR) of TBL decreased in Russia, Brazil, and South Africa while increased in China and India, with the largest reduction reported in Russia (-29.6%) and the largest increase in China (+22.4%). India showed an overall increase (+15.7%) in TBL mortality but the mortality risk decreased among individuals born after 1990 (men) and 1995 (women). Although South Africa and Brazil experienced an overall decline in TBL mortality, their recent birth cohorts, such as Brazilian individuals born after 1985 (men) and 1980 (women), and South African men born after 1995, had an increasing TBL mortality risk. China has experienced an overall increase in TBL mortality, with the mortality risk rising among individuals born after 1995 for both men and women. Russia, which had the highest TBL mortality among the BRICS countries in 1990, has demonstrated significant improvement over the past three decades. CONCLUSIONS Over the past 30 years, the BRICS accounted for an increasing proportion of global TBL mortality. TBL mortality increased in older women in all the BRICS countries except Russia. Among the recent birth cohort, the risk of TBL mortality increased in Brazil, China, and South Africa. More effective efforts are needed in the BRICS to reduce the burden of TBL and help achieve the United Nation's Sustainable Development Goals.
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Affiliation(s)
- Ruhai Bai
- Clinical medical Research Center, Children's Hospital of Nanjing Medical University, Nanjing, Jiangsu 210008, China
- School of Public Affairs, Nanjing University of Science and Technology, Nanjing, Jiangsu 210094, China
| | - Wanyue Dong
- School of Elderly Care Services and Management, Nanjing University of Chinese Medicine, Nanjing, Jiangsu 210023, China
| | - Meng Chu
- Infection Control Office, Department of Medicine, the First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi 710061, China
| | - Bian Liu
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Yan Li
- School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
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Vanapalli KR, Sharma HB, Anand S, Ranjan VP, Singh H, Dubey BK, Mohanty B. Cigarettes butt littering: The story of the world's most littered item from the perspective of pollution, remedial actions, and policy measures. JOURNAL OF HAZARDOUS MATERIALS 2023; 453:131387. [PMID: 37080035 DOI: 10.1016/j.jhazmat.2023.131387] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/02/2023] [Revised: 04/06/2023] [Accepted: 04/06/2023] [Indexed: 05/03/2023]
Abstract
Cigarettes butt (CB) is one of the most littered items on the planet. This paper critically analyzes the factors responsible for CB littering, and associated environmental ramifications, and reviews all the possible technical, behavioural, and policy-based solutions. Even while smoking has declined globally, middle-income nations have seen an increase in consumption, which may be related to increased affordability and a lack of public awareness. The smokers' individual beliefs and habits, environmental ignorance, covert littering as a result of social taboos associated with smoking, and behavioural gaps between intention and action might all be contributing factors to CBs' littering behaviour. The low biodegradability of cellulose acetate filters and toxic chemical leaching from CBs are the most important aspects of CB environmental toxicity. The small size and low economic value of CB contribute to the inefficiencies of current waste collection and management systems. The current research on CB valorisation includes fired-clay bricks, asphalt concrete, biofilms, sound absorber, cellulose pulp, pesticides, and insecticides as downstream mitigation strategies. This study highlights the urgent need for policymakers to enforce regulations enabling innovative cigarette designs, the creation of deposit-refund schemes, extended producer responsibility and stringent waste collection mechanisms. Adopting gentler marketing strategies and non-confrontational behavioural nudges could result in an overall reduction in CB pollution.
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Affiliation(s)
- Kumar Raja Vanapalli
- Department of Civil Engineering, National Institute of Technology, Mizoram, Aizawl, Mizoram 796012, India; School of Environmental Science and Engineering, Indian Institute of Technology, Kharagpur, West Bengal 721302, India
| | - Hari Bhakta Sharma
- Department of Civil Engineering, Sikkim Manipal Institute of Technology, Rangpo, Sikkim 737136, India; Department of Civil Engineering, Indian Institute of Technology, Kharagpur, West Bengal 721302, India.
| | - Shaivya Anand
- Department of Civil Engineering, Indian Institute of Technology, Kharagpur, West Bengal 721302, India
| | - Ved Prakash Ranjan
- Department of Civil Engineering, Indian Institute of Technology, Kharagpur, West Bengal 721302, India
| | - Hemant Singh
- School of Environmental Science and Engineering, Indian Institute of Technology, Kharagpur, West Bengal 721302, India
| | - Brajesh K Dubey
- School of Environmental Science and Engineering, Indian Institute of Technology, Kharagpur, West Bengal 721302, India; Department of Civil Engineering, Indian Institute of Technology, Kharagpur, West Bengal 721302, India.
| | - Bijayananda Mohanty
- Department of Civil Engineering, National Institute of Technology, Mizoram, Aizawl, Mizoram 796012, India
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5
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Tamoli SM, Harit MK, Mundhe N, Pande SP, Damle N, Chavan S, Kamde R, Pawar VA, Mahadik S. Nicotine Free Herbal Composition for Smoking De-Addiction - A Placebo Controlled, Double Blind, Randomized, Multicentric Clinical Study. JOURNAL OF PHARMACY AND BIOALLIED SCIENCES 2023; 15:88-94. [PMID: 37469645 PMCID: PMC10353661 DOI: 10.4103/jpbs.jpbs_647_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Revised: 01/21/2023] [Accepted: 01/21/2023] [Indexed: 07/21/2023] Open
Abstract
Background Smoking is a major predisposing factor for many health problems including cancers, vascular disorders, etc., To quit smoking is the only solution to prevent them. Various medicinal and non-medicinal methods are used worldwide for the same. The present study evaluates the effect of a nicotine free herbal formulation containing ingredients like Mucuna pruriens, Withania somnifera, Bacopa monnieri, etc., for cessation of smoking and its effects on other health parameters related to smoking. Materials and Methods The present study was a placebo controlled, double blind, randomized, and multi-centric clinical study conducted at three clinical sites in India. After ethical approval and informed consent, all participants were given Smotect Tablets or Placebo tablets in a dose of 2 tablets twice daily for 90 days. A total of 103 participants (52 in trial group and 51 in placebo group) completed the study. Evaluation of cessation of smoking was done along with other parameters like measurement of lung capacity, clinical assessment, and laboratory investigations before and after the study. Results A significant reduction in smoking as well as in the alveolar Carbon monoxide (p < 0.05) and Carboxyhemoglobin levels (p < 0.05) were observed with the use of Smotect tablets as compared to placebo over a period of 90 days. Significant improvement was also observed in quality of life, energy and stamina levels, and reduction of stress level. Smotect tablets were found to be safe without causing any adverse effects. Conclusion Smotect Tablets is an effective and safe remedy for cessation of smoking and reducing other effects related to smoking.
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Affiliation(s)
- Sanjay Motilal Tamoli
- Target Institute of Medical Education and Research, Jaswanti Allied Business Center, Malad West, Mumbai, Maharashtra, India
| | - Mahesh Kumar Harit
- Department of Maullik Siddhant, Dr. D.Y. Patil Ayurved College and Hospital, Nerul, Navi Mumbai, Maharashtra, India
| | | | - Shishir Purushottam Pande
- Department of Rasashastra and BK Ayurved Seva Sangh Ayurved Mahavidyalaya Nashik, Maharashtra, India
| | - Neena Damle
- D. Y. Patil School of Ayurveda, Nerul, Navi Mumbai, India
| | - Sheetal Chavan
- Ayurved Seva Sangh, Ayurveda Research Centre, Ganeshwadi, Panchvati, Nashik, Maharashtra, India
| | - Rahul Kamde
- KVTR College Hospital Boradi Shirpur, Maharashtra, India
| | | | - Swapnali Mahadik
- Target Institute of Medical Education and Research, Jaswanti Allied Business Center, Malad West, Mumbai, Maharashtra, India
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6
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Menon S, Singh S, Rathore BS. Socio-cultural determinants of tobacco consumption: a study of migrant and local workers in a district of Punjab, India. J Ethn Subst Abuse 2022:1-17. [PMID: 36271891 DOI: 10.1080/15332640.2022.2134954] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Although the use of tobacco in the state of Punjab is below the national statistics of India, according to Global Adult Tobacco Survey (GATS) 2016 Report, its consumption has increased. Also, what sets it apart from rest of the nation is the cultural as well as the religious taboo associated with tobacco use. The case of Punjab is also peculiar because of the socio demographic profile of the region which has changed since Green Revolution. Having said that, use of tobacco is a social phenomenon and it becomes important to place tobacco use in a social and cultural context. The aim of the study is to explore the socio -cultural determinants of tobacco use within local and migrant groups in a district of Punjab. The tobacco users in the district were divided into groups of local and migrant labourers and focus group discussion was carried out with them. There were various social correlates of tobacco use in the district which saw variations within and across these groups. The socio demographic factors of age, gender, religion and place of residence were related to the use of tobacco and presented similarities and variations across the groups. The study concluded that tobacco prevention and control policies should include cultural interventions to change current traditional practices and social determinants which influence the use of tobacco.
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Affiliation(s)
- Shaveta Menon
- Eternal University, Sirmaur, Himachal Pradesh, India
| | - Swapnil Singh
- Banaras Hindu University, Varanasi, Uttar Pradesh, India
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7
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Rehman E, Rehman S. Particulate air pollution and metabolic risk factors: Which are more prone to cardiac mortality. Front Public Health 2022; 10:995987. [PMID: 36339190 PMCID: PMC9631442 DOI: 10.3389/fpubh.2022.995987] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2022] [Accepted: 08/18/2022] [Indexed: 01/26/2023] Open
Abstract
This study explored multiplex, country-level connections between a wide range of cardiac risk factors and associated mortality within the South Asian Association for Regional Cooperation (SAARC) countries. The grey relational analysis (GRA) methodology is used to evaluate data from 2001 to 2018 to compute scores and rank countries based on cardiac mortality. Subsequently, we used the conservative (Min-Max) technique to determine which South Asian country contributes the most to cardiac mortality. The Hurwicz criterion is further applied for optimization by highlighting the risk factors with the highest impact on cardiac mortality. Empirical findings revealed that India and Nepal are the leading drivers of cardiovascular disease (CVD) mortality among all SAARC nations based on the results of the GRA methodology. Moreover, the outcomes based on the Hurwicz criterion and the conservative criterion indicated that CVD mortality is considerably impacted by household air pollution from the combustion of solid fuel, with India as a potential contributor in the SAARC region. The outcomes of this research may enable international organizations and public health policymakers to make better decisions and investments within the SAARC region to minimize the burden of CVD while also strengthening environmentally sustainable healthcare practices.
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Affiliation(s)
- Erum Rehman
- Department of Mathematics, Nazarbayev University, Nur-Sultan, Kazakhstan,School of Economics, Shandong University of Science and Economics, Jinan, China,Group of Energy, Economy and Systems Dynamics, University of Valladolid, Valladolid, Spain
| | - Shazia Rehman
- Department of Biomedical Sciences, Pak-Austria Fachhochschule: Institute of Applied Sciences and Technology, Haripur, Pakistan,*Correspondence: Shazia Rehman
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8
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Ke C, Narayan KMV, Chan JCN, Jha P, Shah BR. Pathophysiology, phenotypes and management of type 2 diabetes mellitus in Indian and Chinese populations. Nat Rev Endocrinol 2022; 18:413-432. [PMID: 35508700 PMCID: PMC9067000 DOI: 10.1038/s41574-022-00669-4] [Citation(s) in RCA: 71] [Impact Index Per Article: 35.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/24/2022] [Indexed: 02/08/2023]
Abstract
Nearly half of all adults with type 2 diabetes mellitus (T2DM) live in India and China. These populations have an underlying predisposition to deficient insulin secretion, which has a key role in the pathogenesis of T2DM. Indian and Chinese people might be more susceptible to hepatic or skeletal muscle insulin resistance, respectively, than other populations, resulting in specific forms of insulin deficiency. Cluster-based phenotypic analyses demonstrate a higher frequency of severe insulin-deficient diabetes mellitus and younger ages at diagnosis, lower β-cell function, lower insulin resistance and lower BMI among Indian and Chinese people compared with European people. Individuals diagnosed earliest in life have the most aggressive course of disease and the highest risk of complications. These characteristics might contribute to distinctive responses to glucose-lowering medications. Incretin-based agents are particularly effective for lowering glucose levels in these populations; they enhance incretin-augmented insulin secretion and suppress glucagon secretion. Sodium-glucose cotransporter 2 inhibitors might also lower blood levels of glucose especially effectively among Asian people, while α-glucosidase inhibitors are better tolerated in east Asian populations versus other populations. Further research is needed to better characterize and address the pathophysiology and phenotypes of T2DM in Indian and Chinese populations, and to further develop individualized treatment strategies.
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Affiliation(s)
- Calvin Ke
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada.
- Department of Medicine, Toronto General Hospital, University Health Network, Toronto, Ontario, Canada.
- Centre for Global Health Research, Unity Health Toronto, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.
- Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China.
- Asia Diabetes Foundation, Shatin, Hong Kong SAR, China.
| | - K M Venkat Narayan
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
- Nutrition and Health Sciences Program, Graduate Division of Biological and Biomedical Sciences, Laney Graduate School, Emory University, Atlanta, GA, USA
- Department of Medicine, School of Medicine, Emory University, Atlanta, GA, USA
| | - Juliana C N Chan
- Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China
- Asia Diabetes Foundation, Shatin, Hong Kong SAR, China
- Hong Kong Institute of Diabetes and Obesity, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China
- Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China
| | - Prabhat Jha
- Centre for Global Health Research, Unity Health Toronto, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Baiju R Shah
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
- Department of Medicine, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
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9
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Shi L, Mayorga M, Su D, Li Y, Martin E, Zhang D. Generation 1.5: Years in the United States and Other Factors Affecting Smoking Behaviors Among Asian Americans. Ethn Dis 2022; 32:75-80. [PMID: 35497393 DOI: 10.18865/ed.32.2.75] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Introduction Generation 1.5, immigrants who moved to a different country before adulthood, are hypothesized to have unique cognitive and behavioral patterns. We examined the possible differences in cigarette smoking between Asian subpopulations who arrived in the United States at different life stages. Methods Using the Asian subsample of the 2015 Tobacco Use Supplement to the Current Population Survey, we tested this Generation 1.5 hypothesis with their smoking behavior. This dataset was chosen because its large sample size allowed for a national-level analysis of the Asian subsamples by sex, while other national datasets might not have adequate sample sizes for analysis of these subpopulations. The outcome variable was defined as whether the survey respondent had ever smoked 100 cigarettes or more, with the key independent variable operationalized as whether the respondent was: 1) born in the United States; 2) entered the United States before 12; 3) entered between 12 and 19; and 4) entered after 19. Logistic regressions were run to examine the associations with covariates including the respondent's age, educational attainment, and household income. Results Asian men who entered before 12 were less likely to have ever smoked 100 cigarettes than those who immigrated after 19; for Asian women, three groups (born in the United States, entered before 12, entered between 12 and 19) were more likely to have smoked 100 cigarettes than those who immigrated after 19. Conclusions While Asian men who came to the United States before 12 were less at risk for cigarette smoking than those who immigrated in adulthood, the pattern was the opposite among Asian women. Those who spent their childhood in the United States were more likely to smoke than those who came to the United States in adulthood. These patterns might result from the cultural differences between US and Asian countries, and bear policy relevance for the tobacco control efforts among Asian Americans.
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Affiliation(s)
- Lu Shi
- Department of Public Health Sciences, Clemson University, Clemson, SC
| | - Maria Mayorga
- Department of Industrial Engineering, North Carolina State University, Raleigh, NC
| | - Dejun Su
- Department of Health Promotion, Social and Behavioral Health, College of Public Health, University of Nebraska Medical Center, Omaha, NB
| | - Yan Li
- Icahn School of Medicine, Mount Sinai Health System, New York, NY
| | - Emily Martin
- Department of Public Health Sciences, Clemson University, Clemson, SC
| | - Donglan Zhang
- New York University Long Island School of Medicine, Mineola, NY
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10
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Shaikh R, Janssen F, Vogt T. The progression of the tobacco epidemic in India on the national and regional level, 1998-2016. BMC Public Health 2022; 22:317. [PMID: 35168590 PMCID: PMC8845293 DOI: 10.1186/s12889-021-12261-y] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Accepted: 10/19/2021] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Evidence regarding the progression of the tobacco epidemic remains fragmented in low- and middle-income countries. In India, most of the studies that examined tobacco consumption focused on one time point, on the country as a whole, and on men. Despite important gender differences in tobacco consumption, vast economic and cultural differences exist within India. We, therefore, assessed the progression of the tobacco epidemic in India on both the national and the regional level, by gender. METHODS We use information on current tobacco use among Indians aged 15-49 from three rounds of the National Family Health Survey (NFHS) (1998-99, 2005-06, 2015-16) to estimate the age-standardized sex specific smoking and smokeless tobacco prevalence across India and its states. RESULTS Age-standardized tobacco use prevalence in India increased between 1998-1999 and 2005-2006, and declined from 2005-2006 to 2015-2016, simultaneously for men and women. There are substantial spatial differences in the progression of the tobacco epidemic in India. While tobacco use declined in the majority of states, we observe high and increasing use for men in the north-eastern states of Manipur, Mizoram and Nagaland, and for women in the western state of Gujarat and north-eastern state of Manipur. We observed even more states with a recent increasing prevalence in either tobacco smoking or smokeless tobacco. Throughout, prevalence of tobacco use has been higher among men than women for all Indian regions, and remained higher than the national average in the north-eastern states. CONCLUSIONS Our results suggest that India and the majority of its states experienced a 'compressed tobacco epidemic' in which the prevalence of tobacco consumption increased and decreased simultaneously for women and men over a comparatively short period of time. Despite the overall progress India made in reducing tobacco use, further lowering tobacco consumption remains a public health priority, as the prevalence of smoking and/or smokeless tobacco use remains high in a number of states. We therefore conclude that tobacco regulations should be expanded with the aim of reducing the overall health burden associated with tobacco consumption across India.
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Affiliation(s)
- Rufi Shaikh
- International Institute for Population Sciences (IIPS), Mumbai, India
| | - Fanny Janssen
- Netherlands Interdisciplinary Demographic Institute-KNAW/University of Groningen, Groningen, The Netherlands
- Population Research Centre, Faculty of Spatial Science, University of Groningen, Groningen, The Netherlands
| | - Tobias Vogt
- Population Research Centre, Faculty of Spatial Science, University of Groningen, Groningen, The Netherlands.
- Max Planck Institute for Demographic Research, Rostock, Germany.
- Prasanna School of Public Health, Manipal Academy of Higher Education, Manipal, India.
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11
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Vishwakarma G, Singh S, Marani SK, Arya A, Calabro K, Gupta G, Mehta A, Alexander V. Evaluation and Impact of ASPIRE: An Interactive Tobacco Prevention Curriculum among University Students in India. South Asian J Cancer 2021; 10:144-150. [PMID: 34938675 PMCID: PMC8687867 DOI: 10.1055/s-0041-1731900] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Online education approach provides innovative opportunities for engaging youths. Web-based, multimedia smoking prevention programs have been tested in high-income countries; however, efficacy of such programs is not well-investigated in low- and middle-income countries. The aim of this study was to evaluate the impact of A Smoking Prevention Interactive Experience (ASPIRE), an interactive tobacco prevention curriculum, among university students in India. A single-subject cohort study where each subject serves as their own control was conducted among university student participants engaged in ASPIRE, 60 minutes per week for five consecutive weeks during July to August of 2019. Assessments were conducted at baseline and immediately after exposure to ASPIRE. To evaluate the program, a structured instrument was specifically designed to measure the outcomes.
A total of 103 university students participated voluntarily. Average age of the participants was 18.3±0.9 ranging from 17 to 20 years. Eighteen percent of students were curious to know about the various smoking products. More males were more susceptible to cigarette smoking as compared to females. The majority of participants felt that ASPIRE was culturally appropriate for young adults in India, but a modified version targeted toward Indian youth would be more acceptable. Pre- to postintervention knowledge of tobacco-related hazards increased from 70 to 97% (
p
< 0.001).
ASPIRE, a multimedia interactive program, demonstrated its considerable potential to discourage smoking initiation among Indian youth.
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Affiliation(s)
| | - Sohini Singh
- Department of Biotechnology, Amity University, Noida, Uttar Pradesh, India
| | - Salma K Marani
- Youth and Family Cancer Prevention Program, University of Texas, M D Anderson Cancer Center, Houston, Texas, United States
| | - Ashish Arya
- Youth and Family Cancer Prevention Program, University of Texas, M D Anderson Cancer Center, Houston, Texas, United States
| | - Karen Calabro
- Department of Behavioral Sciences, University of Texas, M D Anderson Cancer Center, Houston, Texas, United States
| | - Garima Gupta
- Rajiv Gandhi Cancer Institute and Research Centre, New Delhi, India
| | - Anurag Mehta
- Rajiv Gandhi Cancer Institute and Research Centre, New Delhi, India
| | - V Alexander
- Youth and Family Cancer Prevention Program, University of Texas, MD Anderson Cancer Center, Houston, Texas, United States
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12
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Bedford R, Perkins E, Clements J, Hollings M. Recent advancements and application of in vitro models for predicting inhalation toxicity in humans. Toxicol In Vitro 2021; 79:105299. [PMID: 34920082 DOI: 10.1016/j.tiv.2021.105299] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Revised: 11/20/2021] [Accepted: 12/10/2021] [Indexed: 12/01/2022]
Abstract
Animals have been indispensable in testing chemicals that can pose a risk to human health, including those delivered by inhalation. In recent years, the combination of societal debate on the use of animals in research and testing, the drive to continually enhance testing methodologies, and technology advancements have prompted a range of initiatives to develop non-animal alternative approaches for toxicity testing. In this review, we discuss emerging in vitro techniques being developed for the testing of inhaled compounds. Advanced tissue models that are able to recreate the human response to toxic exposures alongside examples of their ability to complement in vivo techniques are described. Furthermore, technology being developed that can provide multi-organ toxicity assessments are discussed.
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Affiliation(s)
- R Bedford
- Labcorp Early Development Laboratories Limited, Harrogate, UK.
| | - E Perkins
- Labcorp Early Development Laboratories Limited, Harrogate, UK.
| | - J Clements
- Labcorp Early Development Laboratories Limited, Harrogate, UK.
| | - M Hollings
- Labcorp Early Development Laboratories Limited, Harrogate, UK.
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13
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Affiliation(s)
- Dharma Ram Poonia
- Department of Surgical Oncology, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | - Amit Sehrawat
- Department of Medical Oncology, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | - Manoj Kumar Gupta
- Department of Radiation Oncology, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
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14
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Kulkarni MM, Kamath VG, Kamath A, Lewis S, Bogdanovica I, Bains M, Cranwell J, Fogarty A, Arora M, Nazar GP, Ballal K, Bhagwath R, Britton J. Exposure to tobacco imagery in popular films and the risk of ever smoking among children in southern India. Tob Control 2021; 30:560-566. [PMID: 32900918 PMCID: PMC8394755 DOI: 10.1136/tobaccocontrol-2019-055353] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2019] [Revised: 06/09/2020] [Accepted: 06/10/2020] [Indexed: 11/24/2022]
Abstract
BACKGROUND Exposure to smoking in films is a recognised cause of smoking uptake among children. In India, in an attempt to protect children, films containing smoking are required to include tobacco control messaging including audiovisual disclaimers, on-screen health warnings when tobacco imagery is displayed and antitobacco 'health spots' before and during the film. We report a study of the association between ever smoking and exposure to tobacco imagery in locally popular films among children in Udupi district of Karnataka state in southern India. METHODS A cross-sectional questionnaire survey of all students in grades 6-8 in schools in the Udupi district ascertained smoking status and potential confounders of smoking uptake, and whether children had seen any of 27 locally popular films we had coded and found to contain imagery of actual or implied tobacco use. Ever-smoking status was defined as any reported smoking of cigarettes, beedis or other tobacco products currently or at any time in the past. Independent effects on ever-smoking status were estimated using multiple logistic regression. RESULTS Of 46 706 students enrolled in grades 6-8 in 914 participating schools, 39 282 (84.1%) provided questionnaire responses sufficiently complete for analysis. Ever smoking was reported by 914 (2.3%) participants and in a mutually adjusted model was significantly related to age, male sex, living in a home where smoking is allowed, having parents or siblings who smoke, low paternal education, low levels of family wealth, low self-esteem, rebelliousness and poor school performance. After allowing for these effects, the odds of ever smoking were not increased among students who had seen any of the listed films containing tobacco imagery when included in the analysis as a binary exposure (OR 0.9, 95% CI 0.4 to 2.0), and decreased in relation to level of exposure graded into tertiles of tobacco intervals seen. CONCLUSIONS In this cross-sectional study, children in southern India who had seen films containing tobacco imagery are no more likely to smoke than those who had not, indicating that the tobacco control messaging mandated by Indian law may be attenuating the effect of tobacco imagery in films on smoking uptake.
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Affiliation(s)
- Muralidhar M Kulkarni
- Community Medicine, Kasturba Medical College, Manipal Academy of Higher Education, Udupi, India
| | - Veena Ganesh Kamath
- Community Medicine, Kasturba Medical College, Manipal Academy of Higher Education, Udupi, India
| | - Asha Kamath
- Department of Data Science, Prasanna School of Public Health, Manipal Academy of Higher Education, Udupi, India
| | - Sarah Lewis
- Division of Epidemiology and Public Health, UK Centre for Tobacco and Alcohol Studies, University of Nottingham, Nottingham, UK
| | - Ilze Bogdanovica
- Division of Epidemiology and Public Health, UK Centre for Tobacco and Alcohol Studies, University of Nottingham, Nottingham, UK
| | - Manpreet Bains
- Division of Epidemiology and Public Health, UK Centre for Tobacco and Alcohol Studies, University of Nottingham, Nottingham, UK
| | - Jo Cranwell
- Department of Health, University of Bath, Bath, Somerset, UK
| | - Andrew Fogarty
- Division of Epidemiology and Public Health, UK Centre for Tobacco and Alcohol Studies, University of Nottingham, Nottingham, UK
| | - Monika Arora
- Health Related Information Dissemination Amongst Youth (HRIDAY), New Delhi, India
- Health Promotion, Public Health Foundation of India, New Delhi, India
| | - Gaurang P Nazar
- Health Related Information Dissemination Amongst Youth (HRIDAY), New Delhi, India
| | - Kirthinath Ballal
- Community Medicine, Kasturba Medical College, Manipal Academy of Higher Education, Udupi, India
| | - Rohith Bhagwath
- Community Medicine, Kasturba Medical College, Manipal Academy of Higher Education, Udupi, India
| | - John Britton
- Division of Epidemiology and Public Health, UK Centre for Tobacco and Alcohol Studies, University of Nottingham, Nottingham, UK
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15
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Ranganath R, Chu Q. Global trends in pancreas cancer among Asia-Pacific population. J Gastrointest Oncol 2021; 12:S374-S386. [PMID: 34422401 DOI: 10.21037/jgo-20-118] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Accepted: 08/26/2020] [Indexed: 12/12/2022] Open
Abstract
The incidence of pancreatic cancer is rising. Understanding trends of pancreatic cancer is crucial prior to putting policies and interventions in place. Countries with a high human development index (HDI) have a higher incidence, prevalence and mortality due to pancreatic cancer. This global trend is replicated in the Asia-Pacific countries with high HDI having higher incidence, prevalence and mortality due to pancreatic cancer. The incidence of pancreatic cancer is rising in the Asia-Pacific population as life expectancy increases with a rising HDI. Lack of good cancer registries has resulted in under reporting of pancreatic cancer in developing countries in the Asia-Pacific region. The mortality still remains high as in the Western world as most pancreatic cancers are diagnosed in an advanced stage of the disease due to non-availability of cost-effective screening tools with few patients receiving definitive care. Smoking, alcohol consumption, poor diet and obesity are significant modifiable risk factors contributing to the development of pancreatic cancer. Population based screening for pancreatic cancer is not cost-effective. Identification of hereditary and genetic factors in the Asia-Pacific population can help in targeted screening of high-risk individuals. Policies and interventions aimed at primary prevention have the greatest potential to be cost-effective yet impactful and reduce the disease burden.
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Affiliation(s)
- Rohit Ranganath
- Department of Surgery, Louisiana State University Health Sciences Center, Shreveport, LA, USA
| | - Quyen Chu
- Department of Surgery, Louisiana State University Health Sciences Center, Shreveport, LA, USA
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16
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Bhutia P, Sen S, Nath T, Shamshad MA. The effect of smoking on ocular surface and tear film based on clinical examination and optical coherence tomography. Indian J Ophthalmol 2021; 69:1693-1696. [PMID: 34146008 PMCID: PMC8374799 DOI: 10.4103/ijo.ijo_2840_20] [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] [Indexed: 12/12/2022] Open
Abstract
Purpose: Smoking is a global health problem with a high burden of smokers in India and the world as well. Smoking is a known eye irritant that may have a significant effect on the anterior ocular surface. Hence, the present study was aimed to investigate the effect of smoking on dry eye parameters, ocular surface, and central corneal thickness (CCT) and to compare the results with nonsmokers. Methods: In this cross-sectional study, 40 (80 eyes) smokers and 40 (80 eyes) age-matched nonsmokers were included. The severity of ocular surface disease symptoms was assessed by the Ocular Surface Disease Index (OSDI) tool. All participants underwent a series of measurements, that is, the Schirmer’s II test score and tear breakup time (TBUT). Tear meniscus height (TMH) and CCT were measured using anterior segment optical coherence tomography (OCT). Results: The mean value of all dry eye parameters was statistically different among the group of smokers and nonsmokers. The mean score of symptomatic assessment (OSDI) was observed to be significantly higher in smokers than in nonsmokers (P < 0.0001), and dry eye parameters, that is, Schirmer’s score (P = 0.0127), TMH (P < 0.0001), and TBUT (P < 0.0001) were significantly lower among smokers than nonsmokers. There was no significant difference in CCT between smokers and nonsmokers (P = 0.06). Conclusion: Cigarette smoking has deteriorating effects on the ocular surface. Exposure to smoking was found to be associated with dryness of the eye. Further studies are needed on a molecular basis.
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Affiliation(s)
- Pinkila Bhutia
- Department of Ophthalmology, Sarojini Naidu Medical College, Agra, Uttar Pradesh, India
| | - Snigdha Sen
- Department of Ophthalmology, Sarojini Naidu Medical College, Agra, Uttar Pradesh, India
| | - Tirupati Nath
- Department of Ophthalmology, Sarojini Naidu Medical College, Agra, Uttar Pradesh, India
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17
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Khandpur S, Bhardwaj M, Awasthi A, Newtonraj A, Purty AJ, Khanna T, Abraham G, Tiwari S. Association of kidney functions with a cascade of care for diabetes and hypertension in two geographically distinct Indian cohorts. Diabetes Res Clin Pract 2021; 176:108861. [PMID: 34022251 DOI: 10.1016/j.diabres.2021.108861] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Revised: 04/16/2021] [Accepted: 05/08/2021] [Indexed: 11/27/2022]
Abstract
AIM Type 2 diabetes (T2DM) and hypertension (HTN) are the main modifiable risk factors of chronic kidney disease (CKD), among the known traditional and non-traditional risk factors. METHODS We determined the prevalence and care-cascade of these modifiable CKD-risk factors and their association with socioeconomic status in adjoining Lucknow and Puducherry cities of India. RESULTS 439 participants reported no CKD were recruited. Serum analysis revealed an Estimated Glomerular Filtration Rate (eGFR) ≥ 90 ml/min/1.73 m2 in 60.36% of the population. Of them, 55.85% had HTN and/or T2DM as CKD-risk factors; however, less than half of this population was unaware of their CKD-risk status. Awareness and treatment were significantly higher in Puducherry and were associated with literacy, occupation, and residence place. Although the CKD-risk population was about two times higher in Puducherry than Lucknow, the populations with mild-low eGFR were comparable in the two regions. Moreover, in Lucknow, mild-low eGFR and low awareness were more prevalent among the younger participants (<30 years), relative to Puducherry. CONCLUSIONS Despite a higher prevalence of CKD-risk factors in Puducherry, populations with mild-low eGFR were comparable to Lucknow. More heightened awareness and better care cascade for CKD-risk factors in Puducherry may prevent or delay eGFR reduction.
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Affiliation(s)
- Sukhanshi Khandpur
- Department of Molecular Medicine & Biotechnology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow 226014, India
| | - Mansi Bhardwaj
- Department of Molecular Medicine & Biotechnology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow 226014, India
| | - Ashish Awasthi
- Centre for Chronic Conditions and Injuries, Public Health Foundation of India, Gurugram 122002, India
| | - Ariarathinam Newtonraj
- Department of Community Medicine, Pondicherry Institute of Medical Sciences (A Unit of Madras Medical Mission), Kalapet, Puducherry 605014, India
| | - Anil J Purty
- Department of Community Medicine, Pondicherry Institute of Medical Sciences (A Unit of Madras Medical Mission), Kalapet, Puducherry 605014, India
| | - Tripti Khanna
- Indian Council of Medical Research, Ramalingaswami Bhawan, New Delhi, India
| | - Georgi Abraham
- Department of Community Medicine, Pondicherry Institute of Medical Sciences (A Unit of Madras Medical Mission), Kalapet, Puducherry 605014, India
| | - Swasti Tiwari
- Department of Molecular Medicine & Biotechnology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow 226014, India.
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18
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Welding K, Iacobelli M, Saraf S, Smith KC, Puntambekar N, Gupta PC, Cohen JE. The Market for Bidis, Smokeless Tobacco, and Cigarettes in India: Evidence From Semi-Urban and Rural Areas in Five States. Int J Public Health 2021; 66:1604005. [PMID: 34335142 PMCID: PMC8284861 DOI: 10.3389/ijph.2021.1604005] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Accepted: 04/27/2021] [Indexed: 11/13/2022] Open
Abstract
Objectives: Compare the brand availability, pricing and presence of illicit products in semi-urban and rural areas in India across product types and states. Methods: In late 2017, 382 unique tobacco products were purchased from localities with populations under 50,000 in the states of Assam, Karnataka, Maharashtra, Rajasthan, and Uttar Pradesh. Brand, printed maximum retail price, price paid, tax, and health warning labels (HWLs) were used to compare the market for bidis, smokeless tobacco (SLT), and cigarettes. Results: Brand availability and pricing of SLT products was similar to cigarettes. Brand availability and pricing of bidis was consistent with having many small producers. Bidis and single serving SLT with spice mixtures were more affordable than cigarettes and SLT sold alone. 2% of SLT and 10% of cigarettes did not feature an India HWL. Conclusion: The elimination of single serving SLT packets and the removal of tax exemptions for small producers, often exploited by bidi producers, could reduce their respective affordability. State differences in illegal and illicit products could indicate a greater need for enforcement in some states.
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Affiliation(s)
- Kevin Welding
- Department of Health, Behavior and Society, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, United States.,Institute for Global Tobacco Control, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, United States
| | - Michael Iacobelli
- Institute for Global Tobacco Control, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, United States
| | - Sejal Saraf
- Institute for Global Tobacco Control, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, United States
| | - Katherine Clegg Smith
- Department of Health, Behavior and Society, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, United States.,Institute for Global Tobacco Control, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, United States
| | | | - Prakash C Gupta
- Healis Sekhsaria Institute for Public Health, Maharashtra, India
| | - Joanna E Cohen
- Department of Health, Behavior and Society, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, United States.,Institute for Global Tobacco Control, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, United States
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19
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Zhang Y, Wang L, Mutlu GM, Cai H. More to Explore: Further Definition of Risk Factors for COPD - Differential Gender Difference, Modest Elevation in PM 2. 5, and e-Cigarette Use. Front Physiol 2021; 12:669152. [PMID: 34025456 PMCID: PMC8131967 DOI: 10.3389/fphys.2021.669152] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Accepted: 03/11/2021] [Indexed: 11/29/2022] Open
Abstract
Chronic obstructive pulmonary disease (COPD) is a severe respiratory disease with high morbidity and mortality, representing the third leading cause of death worldwide. Traditional risk factors for COPD include aging, genetic predisposition, cigarette smoking, exposure to environmental pollutes, occupational exposure, and individual or parental respiratory disease history. In addition, latest studies have revealed novel and emerging risk factors. In this review, differential gender difference as a factor for COPD development at different territories is discussed for the first time. First, women seem to have more COPD, while more women die of COPD or have more severe COPD, in Western societies. This seems different from the impression that COPD dominants in men, which is true in Eastern societies. It might be related to higher rate of cigarette smoking in women in developed countries (i.e., 12.0% of women in United States smoke vs. 2.2% in China). Nonetheless, women in Eastern societies are exposed to more biomass usage. Second, modest elevation in PM2.5 levels at >∼21.4-32.7 μg/m3, previously considered "cleaner air," is associated with incidence of COPD, indicating that more stringent goals should be set for the reduction of PM2.5 levels to prevent COPD development. Last but not least, e-cigarette use, which has become an epidemic especially among adolescents as officially declared by the United States government, has severe adverse effects that may cause development of COPD early in life. Built upon an overview of the established risk factors for COPD primarily focusing on cigarette smoking and environmental pollutions, the present review further discusses novel concepts, mechanisms, and solutions evolved around the emerging risk factors for COPD discussed above, understanding of which would likely enable better intervention of this devastating disease.
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Affiliation(s)
- Yixuan Zhang
- Division of Molecular Medicine, Department of Anesthesiology, Division of Cardiology, Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, United States
| | - Lu Wang
- Department of Pulmonary and Critical Care Medicine, The First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, China
| | - Gökhan M. Mutlu
- Section of Pulmonary and Critical Care Medicine, Department of Medicine, University of Chicago, Chicago, IL, United States
| | - Hua Cai
- Division of Molecular Medicine, Department of Anesthesiology, Division of Cardiology, Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, United States
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20
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Vashistha V, Garg A, Iyer H, Jain D, Madan K, Hadda V, Guleria R, Mohan A. A comprehensive comparison between young and older-age non-small cell lung cancer patients at a public referral centre in Delhi, India. Ecancermedicalscience 2021; 15:1223. [PMID: 34158827 PMCID: PMC8183650 DOI: 10.3332/ecancer.2021.1223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Indexed: 12/02/2022] Open
Abstract
Purpose Given the increasing number of non-small cell lung cancer (NSCLC) patients in India, a comparative analysis between patients under 40 years and those of older age at a major public referral centre would provide insight into the phenotypic patterns of this group. Methods NSCLC patients who were accessioned within the lung cancer clinic database of the Pulmonary Medicine Department at the all India institute of medical sciences – Delhi between 2008 and 2019 were reviewed. Patients 40 years or younger and 60 years or older were selected and categorised as young and older patients, respectively. Baseline clinical characteristics, histologic profiles, treatments administered and survival outcomes were compared between both groups. Results Following the database review, 154 young and 1,058 older patients were selected for inclusion. Clinically, young patients were more often female (26.0% versus 14.5%, p < 0.001), retained a more independent performance status (64.1% versus 45.5%; p < 0.001) and never smoked (63.7 % versus 18.8%, p < 0.001). Regarding disease profiles, young patients were more frequently diagnosed with adenocarcinoma (p < 0.001) and 12 young patients had adenoid cystic carcinoma. Rates of stage IV disease at presentation were higher among young patients (78.0% versus 63.0%, p < 0.001). Regarding treatment, no differences in systemic therapies administered or survival were identified. Conclusion In India, young NSCLC patients are frequently non-smokers and diagnosed with advanced disease. Despite better performance status, young patients do not share better outcomes. Efforts should be directed towards optimising intensive treatment for young patients.
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Affiliation(s)
- Vishal Vashistha
- Raymond G. Murphy New Mexico Veterans Affairs Healthcare System, Section of Haematology and Oncology, 1501 San Pedro Dr SE, Albuquerque, NM 87108, USA.,Department of Pulmonary Medicine and Sleep Disorders, All India Institute of Medical Sciences, New Delhi 110608, India.,Fulbright-Nehru Fellowship Programme, United States-India Educational Foundation, Fulbright House, 12 Hailey Rd, New Delhi 110002, India
| | - Avneet Garg
- Department of Pulmonary Medicine and Sleep Disorders, All India Institute of Medical Sciences, New Delhi 110608, India.,Adesh Institute of Medical Sciences and Research, Department of Pulmonary Medicine, Barnala Bypass, Bathinda 151109, India
| | - Hariharan Iyer
- Department of Pulmonary Medicine and Sleep Disorders, All India Institute of Medical Sciences, New Delhi 110608, India
| | - Deepali Jain
- Department of Pathology, All India Institute of Medical Sciences, Sri Aurobindo Marg, Ansari Nagar, Ansari Nagar East, New Delhi 110029, India
| | - Karan Madan
- Department of Pulmonary Medicine and Sleep Disorders, All India Institute of Medical Sciences, New Delhi 110608, India
| | - Vijay Hadda
- Department of Pulmonary Medicine and Sleep Disorders, All India Institute of Medical Sciences, New Delhi 110608, India
| | - Randeep Guleria
- Department of Pulmonary Medicine and Sleep Disorders, All India Institute of Medical Sciences, New Delhi 110608, India
| | - Anant Mohan
- Department of Pulmonary Medicine and Sleep Disorders, All India Institute of Medical Sciences, New Delhi 110608, India
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21
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Hejjaji V, Khetan A, Hughes JW, Gupta P, Jones PG, Ahmed A, Mohan SKM, Josephson RA. A combined community health worker and text messagingbased intervention for smoking cessation in India: Project MUKTI - A mixed methods study. Tob Prev Cessat 2021; 7:23. [PMID: 33791445 PMCID: PMC8005919 DOI: 10.18332/tpc/132469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Revised: 12/26/2020] [Accepted: 01/15/2021] [Indexed: 11/24/2022]
Abstract
INTRODUCTION We sought to evaluate the effectiveness of a community health worker (CHW) led smoking cessation intervention, supplemented by text messages, and tailored to an individual’s readiness to quit. METHODS We conducted a cluster randomized controlled trial (April 2018–August 2019) in adult smokers residing in a semi-urban region of India. Participants in the intervention arm received CHW-led home visits and had the option of choosing to receive regular text messages. The dose and content of CHW counseling and text messages were tailored to the participant’s readiness to quit. The control group received brief education only. Primary outcome was biochemically verified smoking cessation at the end of 12 months. Both intention-to-treat and as-treated analyses were performed. RESULTS A total of 238 (mean age 43±12.3 years, male 96.2%) participants were enrolled; 151 (64%) in the intervention arm and 83 (35.4%) in the control arm. At 12 months, 31 (20.5%) participants in the intervention arm and 9 (10.8%) in the control arm quit smoking (absolute risk difference=9.7%; RR=1.69; 95% CI: 0.04–71.33, p=0.74). In the as-treated analysis, 17 (36.9%) of the 46 participants who received optimal dose of the intervention quit smoking. CONCLUSIONS CHW-led home-based counseling, supplemented by regular text messages, led to an increase in quit rates for smoking, especially among those exposed to a higher dose of the intervention. However, the difference in cessation rates was not statistically significant. Future studies should consider testing mobile application-based multimedia messaging with larger populations, as a supplement to CHW-based counseling.
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Affiliation(s)
- Vittal Hejjaji
- Department of Cardiovascular Medicine, Saint Luke's Mid America Heart Institute, University of Missouri Kansas City, Kansas, United States
| | - Aditya Khetan
- Department of Cardiovascular Medicine, McMaster University Medical Center, Hamilton, Canada
| | - Joel W Hughes
- Department of Psychology, Kent State University, Kent, United States
| | - Prashant Gupta
- Department of Psychology, All India Institute of Medical Sciences, New Delhi, India
| | - Philip G Jones
- Department of Cardiovascular Medicine, Saint Luke's Mid America Heart Institute, University of Missouri Kansas City, Kansas, United States
| | - Asma Ahmed
- Department of Surgery, Ramaiah Medical College, Bangalore, India
| | - Sri Krishna Madan Mohan
- Department of Cardiovascular Medicine, Harrington Heart and Vascular Institute, University Hospitals Cleveland Medical Center - Case Western Reserve University, Cleveland, United States
| | - Richard A Josephson
- Department of Cardiovascular Medicine, Harrington Heart and Vascular Institute, University Hospitals Cleveland Medical Center - Case Western Reserve University, Cleveland, United States
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22
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Lahoti S, Dixit P. Declining trend of smoking and smokeless tobacco in India: A decomposition analysis. PLoS One 2021; 16:e0247226. [PMID: 33630963 PMCID: PMC7906458 DOI: 10.1371/journal.pone.0247226] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Accepted: 02/03/2021] [Indexed: 11/19/2022] Open
Abstract
There has been a relative reduction of tobacco consumption between Global Adult Tobacco Survey-India (GATS-India) 2009–10 and GATS-India 2016–17. However, in terms of absolute numbers, India still has the highest number of tobacco consumers. Therefore, this paper aims to examine the socioeconomic correlates and delineate the factors contributing to a change in smoking and smokeless tobacco use from GATS (2009–10) to GATS (2016–17) in India. We used multivariable binary logistic regressions to examine the demographic and socioeconomic correlates of smoking and smokeless tobacco use for both the rounds of the survey. Further decomposition analysis has been applied to examine the specific contribution of factors in the decline of tobacco consumption over a period from 2009 to 2016. Results indicated that the propensity component was primarily responsible for major tobacco consumption decline (smoking- 41%, smokeless tobacco use- 81%). Most of the decrease in propensity to smoke has been explained by residential type and occupation of the respondent. Age of the respondent contribute significantly in reducing the prevalence of smokeless tobacco consumption during the seven-year period, regardless of change in the composition of population. To achieve the National Health Policy, 2017 aim of reducing tobacco use up to 15% by 2020 and up to 30% by 2025, targeted policies and interventions addressing the inequalities identified in this study, must be developed and implemented.
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Affiliation(s)
- Supriya Lahoti
- Master of Public Health (Health Policy, Economics and Finance), Tata Institute of Social Sciences, Mumbai, Maharashtra, India
| | - Priyanka Dixit
- Centre for Health and Social Sciences, School of Health Systems Studies, Tata Institute of Social Sciences, Mumbai, Maharashtra, India
- * E-mail:
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23
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Puri P, Kothavale A, Singh S, Pati S. Burden and determinants of multimorbidity among women in reproductive age group: a cross-sectional study based in India. Wellcome Open Res 2021; 5:275. [PMID: 34131591 PMCID: PMC8182697 DOI: 10.12688/wellcomeopenres.16398.2] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/21/2021] [Indexed: 01/07/2023] Open
Abstract
Background: India's government is currently running several programs with a sole focus on women's health during their child-bearing years. However, none of these programs incorporate the management of chronic health conditions during the reproductive span. This issue is an emerging public health concern; therefore, the present study aims to identify the patterns and correlates of multimorbidity among women in reproductive age groups in India. Methods: The study utilizes nationally-representative cross-sectional data from the Demographic and Health Survey on 661,811 women in the reproductive age group of 15-49 years. The study uses information on seven chronic morbidities, namely asthma, cancers, heart disease, diabetes, tuberculosis, hypertension, and thyroid disorder. Descriptive, bivariate, and multivariable techniques were utilized to accomplish the study objective. Results: The findings show that 17.4 and 3.5 per 100 women of reproductive age suffered from any one morbidity and multimorbidity, respectively. Hypertension, diabetes, and thyroid disorders were commonly occurring morbidities. The prevalence of having any one morbidity or multimorbidity increased with age. Variables like religion, wealth, parity, menopause, consumption of tobacco and alcohol, body mass index, and type of diet were found to be significantly related to the burden of multimorbidity. The prevalence of multimorbidity was found to be higher for women who belong to the Southern, Eastern, and North-Eastern regions of India. Conclusions: Findings suggest the importance of multimorbidity in the context of women of reproductive age. Inclusion of chronic disease management strategies with maternal and child health services needs to be taken into consideration by the program and policymakers. The annexation of social marketing approaches at the primary level of healthcare would assist policy-makers in educating women about the importance of leading a healthy lifestyle. Practicing dietary diversity can help in maintaining optimal estrogen levels, which would further help in decreasing multimorbidity rates among women in India.
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Affiliation(s)
- Parul Puri
- International Institute for Population Sciences, Govandi Station Road, Deonar, Mumbai, Maharashtra, 400088, India
| | - Ajinkya Kothavale
- International Institute for Population Sciences, Govandi Station Road, Deonar, Mumbai, Maharashtra, 400088, India
| | - S.K. Singh
- International Institute for Population Sciences, Govandi Station Road, Deonar, Mumbai, Maharashtra, 400088, India
| | - Sanghamitra Pati
- ICMR Regional Medical Research Centre, Indian Council of Medical Research, Department of Health Research, Bhubaneswar, Odisha, 751023, India
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24
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Disruptions in oral and nasal microbiota in biomass and tobacco smoke associated chronic obstructive pulmonary disease. Arch Microbiol 2021; 203:2087-2099. [PMID: 33598807 DOI: 10.1007/s00203-020-02155-9] [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: 04/24/2020] [Revised: 11/17/2020] [Accepted: 12/03/2020] [Indexed: 02/01/2023]
Abstract
Chronic exposures to tobacco and biomass smoke are the most prevalent risk factors for COPD development. Although microbial diversity in tobacco smoke-associated COPD (TSCOPD) has been investigated, microbiota in biomass smoke-associated COPD (BMSCOPD) is still unexplored. We aimed to compare the nasal and oral microbiota between healthy, TSCOPD, and BMSCOPD subjects from a rural population in India. Nasal swabs and oral washings were collected from healthy (n = 10), TSCOPD (n = 11), and BMSCOPD (n = 10) subjects. The downstream analysis was performed using QIIME pipeline (v1.9). In nasal and oral microbiota no overall differences were noted, but there were key taxa that had differential abundance in either Healthy vs COPD and/or TSCOPD vs. BMSCOPD. Genera such as Actinomyces, Actinobacillus, Megasphaera, Selenomonas, and Corynebacterium were significantly higher in COPD subjects. This study suggests that microbial community undergoes dysbiosis which may further contribute to the progression of disease. Thus, it is important to identify etiological agents for such a polymicrobial alterations which contribute highly to the disease manifestation.
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Haque M, Kumar S, Charan J, Bhatt R, Islam S, Dutta S, Abhayanand JP, Sharma Y, Sefah I, Kurdi A, Wale J, Godman B. Utilisation, Availability and Price Changes of Medicines and Protection Equipment for COVID-19 Among Selected Regions in India: Findings and Implications. Front Pharmacol 2021; 11:582154. [PMID: 33628172 PMCID: PMC7898674 DOI: 10.3389/fphar.2020.582154] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Accepted: 10/14/2020] [Indexed: 12/12/2022] Open
Abstract
Background: COVID-19 has already claimed a considerable number of lives worldwide. However, there are concerns with treatment recommendations given the extent of conflicting results with suggested treatments and misinformation, some of which has resulted in increased prices and shortages alongside increasing use and prices of personal protective equipment (PPE). This is a concern in countries such as India where there have been high patient co-payments and an appreciable number of families going into poverty when members become ill. However, balanced against pricing controls. Community pharmacists play a significant role in disease management in India, and this will remain. Consequently, there is a need to review prices and availability of pertinent medicines during the early stages of the COVID-19 pandemic in India to provide future direction. Objective: Assess current utilisation and price changes as well as shortages of pertinent medicines and equipment during the early stages of the pandemic. Our Approach: Multiple approach involving a review of treatments and ongoing activities across India to reduce the spread of the virus alongside questioning pharmacies in selected cities from early March to end May 2020. Our Activities: 111 pharmacies took part, giving a response rate of 80%. Encouragingly, no change in utilisation of antimalarial medicines in 45% of pharmacies despite endorsements and for antibiotics in 57.7% of pharmacies, helped by increasing need for a prescription for dispensing. In addition, increased purchasing of PPE (over 98%). No price increases were seen for antimalarials and antibiotics in 83.8 and 91.9% of pharmacies respectively although shortages were seen for antimalarials in 70.3% of pharmacies, lower for antibiotics (9.9% of pharmacies). However, price increases were typically seen for PPE (over 90% of stores) as well as for analgesics (over 50% of pharmacies). Shortages were also seen for PPE (88.3%). Conclusion: The pandemic has impacted on utilisation and prices of pertinent medicines and PPE in India but moderated by increased scrutiny. Key stakeholder groups can play a role with enhancing evidenced-based approaches and reducing inappropriate purchasing in the future.
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Affiliation(s)
- Mainul Haque
- Unit of Pharmacology, Faculty of Medicine and Defence Health, Universiti Pertahanan Nasional Malaysia (National Defence University of Malaysia), Kuala Lumpur, Malaysia
| | - Santosh Kumar
- Department of Periodontology and Implantology, Karnavati University, Gandhinagar, India
| | - Jaykaran Charan
- Department of Pharmacology, All India Institute of Medical Sciences, Jodhpur, India
| | - Rohan Bhatt
- Department of Pediatric Dentistry, Karnavati University, Gandhinagar, India
| | - Salequl Islam
- Department of Microbiology, Jahangirnagar University, Savar, Bangladesh
| | - Siddhartha Dutta
- Department of Periodontology and Implantology, Karnavati University, Gandhinagar, India
| | | | - Yesh Sharma
- Department of Conservative Dentistry and Endodontics, Rajasthan University of Health Sciences, Jaipur, India
| | - Israel Sefah
- Pharmacy Department, Ghana Health Service, Keta Municipal Hospital, Keta-Dzelukope, Ghana
- Pharmacy Practice Department, School of Pharmacy, University of Health and Allied Sciences, Volta Region, Ghana
| | - Amanj Kurdi
- Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow, United Kingdom
- Department of Pharmacology, College of Pharmacy, Hawler Medical University, Erbil, Iraq
| | - Janney Wale
- Independent Consumer Advocate, Brunswick, VIC, Australia
| | - Brian Godman
- Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow, United Kingdom
- Division of Clinical Pharmacology, Karolinska Institute, Karolinska University Hospital Huddinge, Stockholm, Sweden
- School of Pharmacy, Sefako Makgatho Health Sciences University, Ga-Rankuwa, South Africa
- School of Pharmaceutical Sciences, Universiti Sains Malaysia, Penang, Malaysia
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A review of tobacco abuse and its epidemiological consequences. JOURNAL OF PUBLIC HEALTH-HEIDELBERG 2021; 30:1485-1500. [PMID: 33425659 PMCID: PMC7786188 DOI: 10.1007/s10389-020-01443-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Accepted: 11/20/2020] [Indexed: 12/12/2022]
Abstract
Aim The economic burden caused by death and disease in the world is credited mainly to tobacco use—currently linked to approximately 8,000,000 deaths per year with approximately 80% of these faralities reported in low and middle income economies. The World Health Organization (WHO) estimates that nearly 7,000,000 deaths are attributed to direct tobacco use, while approximately 1,200,000 non-smokers exposed to second hand cigarette smoke die every year. Accordingly, tobacco use is a major threat to the public health infrastructure; therefore, proper cessation interventions must be put in place to curb tobacco abuse and ease economic and social burdens caused by the tobacco epidemic. Methods A systematic review was conducted to investigate how scientific efforts have been advanced towards harm reduction among smokers and non-smokers. Relevant articles published during the period 2010–2020 in PubMed, Crossref, Google scholar, and Web of Science were used in this study. The articles were selected based on health impacts of cigarette smoking, tobacco cessation and emerging diseases, including Covid−19. Various cessation strategies have been identified although their efficiency is yet to match the desired results. Results A series of carcinogenic chemicals are generated during cigarette smoking resulting in serious health complications such as cancer and mutagenesis. The precursors for tobacco induced diseases are toxic and carcinogenic chemicals of the nitrosamine type, aldehydes, polonium-210 and benzo[a]pyrene, which bio-accumulate in the body system during cigarette smoking to cause disease. Rehabilitation facilities, use of drugs to diminish the desire to smoke, heavy taxation of tobacco products and warning labels on cigarettes are some of the cessation strategies employed towards curbing tobacco abuse. Conclusion The need for further research to develop better methods and research based policies for safe cigarette smoking and workable cessation strategies must be a priority in order to deal with the tobacco epidemic. Campaigns to promote tobacco cessation and abstinence are recommended in this review as a sure measure to mitigate against the deleterious impacts caused by cigarette smoking and tobacco abuse.
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Khobragade B, Sharma V, Deshpande SN. Cognitive function in women with major mental illnesses who use tobacco. Psychiatry Res 2021; 295:113603. [PMID: 33278742 DOI: 10.1016/j.psychres.2020.113603] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Accepted: 11/25/2020] [Indexed: 10/22/2022]
Abstract
Cognitive effects of tobacco use among women with schizophrenia, bipolar disorder or depression have not been studied extensively as most studies focussed on men smokers. As part of a study on prevalence and cognitive effects of tobacco use, women with schizophrenia, bipolar disorder and depression were assessed for cognitive functioning using an information questionnaire derived from the Indian Post Graduate Institute Battery of Brain Dysfunction (PGIBBD) and the Trail Making Tests (TMT) A and B. The community dwelling women were clinically diagnosed and recruited from the outpatient department of a free tertiary care teaching hospital in India. The sample consisted of 321 women, 141 with schizophrenia (SZ), 80 with Bipolar Disorder (BD) and 100 with Recurrent Depressive Disorder (RDD). Tobacco users answered statistically significantly fewer questions on the PGIBBD Information Questionnaire. Users also took significantly more time to complete both TMT-A and TMT-B. Age, years of schooling and tobacco use were all significant co-variates for performance on cognitive tests. Tobacco users had lower motor speed and lesser visual scanning, poorer flexibility of thinking and working memory. Women with schizophrenia performed the worst. Tobacco use may exacerbate the cognitive dysfunction associated with major mental illnesses among women.
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Affiliation(s)
- Bhupendra Khobragade
- Dept. of Psychiatry, De-addiction Services & Resource Center for Tobacco Control, Centre of Excellence in Mental Health, ABVIMS - Dr Ram Manohar Lohia Hospital, Bangabandhu Sheikh Mujib Road, New Delhi, India 110001.
| | - Vikas Sharma
- Dept. of Psychiatry, De-addiction Services & Resource Center for Tobacco Control, Centre of Excellence in Mental Health, ABVIMS - Dr Ram Manohar Lohia Hospital, Bangabandhu Sheikh Mujib Road, New Delhi, India 110001.
| | - Smita N Deshpande
- Dept. of Psychiatry, De-addiction Services & Resource Center for Tobacco Control, Centre of Excellence in Mental Health, ABVIMS - Dr Ram Manohar Lohia Hospital, Bangabandhu Sheikh Mujib Road, New Delhi, India 110001.
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Nandi S, Mandal A, Chhebbi M. The prevalence and clinicopathological correlation of human papillomavirus in head and neck squamous cell carcinoma in India: A systematic review article. Cancer Treat Res Commun 2020; 26:100301. [PMID: 33401132 DOI: 10.1016/j.ctarc.2020.100301] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Revised: 12/23/2020] [Accepted: 12/30/2020] [Indexed: 06/12/2023]
Abstract
OBJECTIVE Head and neck squamous cell carcinoma (HNSCC) pose a great danger to society and now we have shreds of evidence for Human Papillomavirus (HPV) being one of the major causative agents for it. Though the prevalence of HPV varies throughout the world, it is gradually on the rise. The present systematic review aims to retrospect all the available studies on the prevalence of HPV in HNSCC in India and its clinicopathological aspect to study how it is different from HPV negative HNSCC. METHODS An objective electronic database search was conducted in PUBMED Central, MeSH, NLM Catalog, Bookshelf, and PUBMED published in 25 years period from 1994 till 2019. A total of 33 articles were shortlisted for the present review. RESULTS Studies conducted across India show the prevalence of HPV in Head and Neck Cancers ranging from 0-86.6%. Some studies reported that HPV positive HNSCC is more common in younger age, presents with advanced stage disease, and more commonly presents with nodal metastasis. As opposed to western literature HPV positive HNSCC in India is associated with a well-differentiated tumor grade. There is no difference in treatment outcome and survival among HPV positive and negative HNSCC. CONCLUSION Exact prevalence of HPV in HNSCC is still doubtful but now we have some insight into it. The prevalence of HPV in Indian HNSCC patients has risen gradually but treatment outcome and survival may be poorer compared to other countries. However definite conclusions cannot be drawn without proper prospective study.
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Affiliation(s)
- Sourabh Nandi
- Department of Surgical Oncology, All India Institute of Medical Sciences, India.
| | - Amitabha Mandal
- Department of Surgical Oncology, All India Institute of Medical Sciences, India.
| | - Madiwalesh Chhebbi
- Department of Surgical Oncology, All India Institute of Medical Sciences, India.
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Devaraj S, Patel PC. The Association Between Participation in Mahatma Gandhi National Rural Employment Guarantee Program and Smoking in India. Nicotine Tob Res 2020; 22:2246-2253. [PMID: 31504811 DOI: 10.1093/ntr/ntz166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2019] [Accepted: 08/28/2019] [Indexed: 11/14/2022]
Abstract
BACKGROUND This paper examines whether participating in Mahatma Gandhi National Rural Employment Guarantee Program (NREGA) is associated with the likelihood of smoking among program participants in India. METHODS We use two-stage residual inclusion (2SRI) estimation method and two waves of India Human Development Surveys completed before (2005) and after (2012) NREGA implementation. RESULTS The likelihood of smoking increased with NREGA participation. For every 10% increase in NREGA income, the likelihood of smoking bidis (but not cigarettes) increased by 0.88 percentage point. A bidi, a stick of unprocessed tobacco wrapped in temburini leaves, is a significantly cheaper alternative to cigarettes. Nonparticipants who had a comparable increase in income between the two India Human Development Survey waves did not show an increase in likelihood of smoking. The heterogeneity in NREGA treatment effect shows that smoking tendency is not influenced by caste/religion or literacy. CONCLUSIONS NREGA, as the largest workfare program, most certainly has had a significantly positive influence on the rural poor in India. The findings highlight its small but meaningful influence of a negative health behavior, greater likelihood of uptake of smoking bidis/hookah among program participants. IMPLICATIONS Existing studies have found mixed evidence of an exogenous increase in income among low-income adults and its impact on smoking. No studies to date have tested the influence of workfare programs in rural areas of developing countries, where unemployment rates are higher and a substantial share of population in those areas is poor. Based on participation in employment guarantee programs as a proxy for exogenous increase in guaranteed income among rural population in India, we find that participants in the program were more likely to smoke bidis/hookah but not cigarettes.
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Affiliation(s)
- Srikant Devaraj
- Center for Business and Economic Research, Miller College of Business, Ball State University, Muncie, IN
| | - Pankaj C Patel
- Villanova School of Business, Villanova University, Villanova, PA
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Puri P, Kothavale A, Singh S, Pati S. Burden and determinants of multimorbidity among women in reproductive age group: a cross-sectional study based in India. Wellcome Open Res 2020; 5:275. [PMID: 34131591 PMCID: PMC8182697 DOI: 10.12688/wellcomeopenres.16398.1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/05/2020] [Indexed: 08/23/2023] Open
Abstract
Background: India's government is currently running several programs with a sole focus on women's health during their child-bearing years. However, none of these programs incorporate the management of chronic health conditions during the reproductive span. This issue is an emerging public health concern; therefore, the present study aims to identify the patterns and correlates of multimorbidity among women in reproductive age groups in India. Methods: The study utilizes nationally-representative cross-sectional data from the Demographic and Health Survey on 661,811 women in the reproductive age group of 15-49 years. The study uses information on seven chronic morbidities, namely asthma, cancers, heart disease, diabetes, tuberculosis, hypertension, and thyroid disorder. Descriptive, bivariate, and multivariable techniques were utilized to accomplish the study objective. Results: The findings show that 17.4 and 3.5 per 100 women of reproductive age suffered from any one morbidity and multimorbidity, respectively. Hypertension, diabetes, and thyroid disorders were commonly occurring morbidities. The prevalence of having any one morbidity or multimorbidity increased with age. Variables like religion, wealth, parity, menopause, consumption of tobacco and alcohol, body mass index, and type of diet were found to be significantly related to the burden of multimorbidity. The prevalence of multimorbidity was found to be higher for women who belong to the Southern, Eastern, and North-Eastern regions of India. Conclusions: Findings suggest the importance of multimorbidity in the context of women of reproductive age. Inclusion of chronic disease management strategies with maternal and child health services needs to be taken into consideration by the program and policymakers. The annexation of social marketing approaches at the primary level of healthcare would assist policy-makers in educating women about the importance of leading a healthy lifestyle. Practicing dietary diversity can help in maintaining optimal estrogen levels, which would further help in decreasing multimorbidity rates among women in India.
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Affiliation(s)
- Parul Puri
- International Institute for Population Sciences, Govandi Station Road, Deonar, Mumbai, Maharashtra, 400088, India
| | - Ajinkya Kothavale
- International Institute for Population Sciences, Govandi Station Road, Deonar, Mumbai, Maharashtra, 400088, India
| | - S.K. Singh
- International Institute for Population Sciences, Govandi Station Road, Deonar, Mumbai, Maharashtra, 400088, India
| | - Sanghamitra Pati
- ICMR Regional Medical Research Centre, Indian Council of Medical Research, Department of Health Research, Bhubaneswar, Odisha, 751023, India
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Patel R, Kumar P, Srivastava S, Chauhan S. Change in socio-economic inequality of tobacco consumption among men in India: evidence from National Family Health Survey 2005-06 to 2015-16. JOURNAL OF SUBSTANCE USE 2020. [DOI: 10.1080/14659891.2020.1846217] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Affiliation(s)
- Ratna Patel
- Department of Public Health and Mortality Studies, International Institute for Population Sciences, Mumbai, India
| | - Pradeep Kumar
- Department of Mathematical Demography and Statistics, International Institute for Population Sciences, Mumbai, India
| | - Shobhit Srivastava
- Department of Mathematical Demography and Statistics, International Institute for Population Sciences, Mumbai, India
| | - Shekhar Chauhan
- Department of Population Policies and Programmes, International Institute for Population Sciences, Mumbai, India
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Sarkar S, Datta D, Debbarma S, Majumdar G, Mandal SS. Patterns of Cancer Incidence and Mortality in North- Eastern India: The First Report from the Population Based Cancer Registry of Tripura. Asian Pac J Cancer Prev 2020; 21:2493-2499. [PMID: 32986344 PMCID: PMC7779450 DOI: 10.31557/apjcp.2020.21.9.2493] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2019] [Accepted: 09/04/2020] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND There is, till date no population-based data regarding cancer patterns in North- Eastern India, dictating the need to understand the epidemiology of cancer in this population for its effective management. METHODS This is the first report of the Population Based Cancer Registry (PBCR) in Tripura (2010-2014). The protocol involves active collection of data on all cancer cases from Tripura through staff visit in more than 150 sources of incident and mortality registration, government and private hospitals, municipal corporation, etc. and scrutiny, corroboration with existing records. Data was analyzed statistically to understand cancer trends in terms of incidence and mortality across different sites, age groups affected and gender. RESULTS A total of 10,251 cases were registered during the period, with overall age-adjusted incidence rates of 75.7 and 54.9 per 100,000 males and females respectively. Crude Incidence Rate (CR) and Age- Adjusted Rate (AAR) was among the lowest reported in India, probably due to associated socio-economic factors. The most prevalent cancers were lung (18.1%), esophageal (8.3%) for men and cervix uteri (17.6%), breast (13.8%) for females. Gall bladder cancer in females was one of the highest in the country. Rate of cancer mortality in the population was quite high and significantly increased with time, probably accounting for dearth in early detection and feasible treatment alternatives. CONCLUSION The data suggests that high cancer incidence and mortality are prevalent in the population of Tripura, dictating the need of active tobacco control measures, early detection and awareness drives for effective cancer control.
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Affiliation(s)
- Shreya Sarkar
- Department of Epidemiology and Biostatistics, Chittaranjan National Cancer Institute, Kolkata, India.
- Dalhousie Medicine New Brunswick, Saint John, NB, Canada.
- New Brunswick Heart Centre, Saint John Regional Hospital, Saint John, NB, Canada.
| | | | | | | | - Syam Sundar Mandal
- Department of Epidemiology and Biostatistics, Chittaranjan National Cancer Institute, Kolkata, India.
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Khobragade B, Sharma V, Deshpande SN. A study on tobacco use in women with major mental illnesses- schizophrenia, bipolar disorder and recurrent depression. Psychiatry Res 2020; 290:113121. [PMID: 32505927 DOI: 10.1016/j.psychres.2020.113121] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Revised: 05/21/2020] [Accepted: 05/22/2020] [Indexed: 11/29/2022]
Abstract
About 14.2% of women in the general Indian population and 4.8% in Delhi use tobacco but its use among women with Major Mental Illness (MMI) in developing countries has not been adequately studied. We assessed tobacco use in women with MMI in a tertiary care psychiatry outpatient department through a cross-sectional, observational study, with sample size of at least n= 77 each for schizophrenia-SZ, bipolar disorder-BD and Recurrent Depressive Disorder-RDD. Fagerstrom Test for Nicotine Dependence (FTND) both for smoke and smokeless tobacco were applied along with a subset of questions from Global Adult Tobacco Survey 2016. After diagnosis and referral by the treating psychiatrist and written informed consent, in our total sample of 321 women participants, lifetime use of tobacco was reported by 14.64%. Of all those who had ever used tobacco, 12.14% used it currently as well. As for diagnosis, those with BD (16.25%) used tobacco most frequently followed by SZ (14.18%) and RDD (6%). The FTND score was higher for schizophrenia indicating greater dependence. Tobacco use among women with MMI was thrice as common as women in general population of Delhi State, with smoke and smokeless tobacco use being equally prevalent, a grave cause for concern and intervention.
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Affiliation(s)
- Bhupendra Khobragade
- Dept. of Psychiatry, De-addiction Services & Resource Center for Tobacco Control, Centre of Excellence in Mental Health, ABVIMS Dr. Ram Manohar Lohia Hospital, Bangabandhu Sheikh Mujib Road, New Delhi, India 110001
| | - Vikas Sharma
- Dept. of Psychiatry, De-addiction Services & Resource Center for Tobacco Control, Centre of Excellence in Mental Health, ABVIMS Dr. Ram Manohar Lohia Hospital, Bangabandhu Sheikh Mujib Road, New Delhi, India 110001
| | - Smita N Deshpande
- Dept. of Psychiatry, De-addiction Services & Resource Center for Tobacco Control, Centre of Excellence in Mental Health, ABVIMS Dr. Ram Manohar Lohia Hospital, Bangabandhu Sheikh Mujib Road, New Delhi, India 110001.
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Basu S, Yadav P, Banerjee B, Yadav A. The effect of a clinic-based behavioral intervention in promoting enrolment in a text-message tobacco cessation program at a rural primary health clinic in Delhi, India. Tob Prev Cessat 2020; 6:27. [PMID: 32760862 PMCID: PMC7398136 DOI: 10.18332/tpc/120382] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2020] [Revised: 03/16/2020] [Accepted: 04/08/2020] [Indexed: 11/24/2022]
Abstract
INTRODUCTION The mCessation is a text-message service for quitting tobacco in India, associated with high quit rates but low rates of enrolment. We determined if a brief behavioral intervention package (BBPMC) can promote the enrolment of male tobacco users in the mCessation program (MCP) METHODS We conducted a quasi-experimental study (single-arm) at a rural primary health clinic in Delhi, India, January–April 2019. We enrolled adult male current tobacco users after screening for eligibility. A trained medical physician administered the BBPMC explaining to patients the major health risks causally associated with tobacco use, along with information on the MCP and the way to register for the service. RESULTS We recruited a total of 159 tobacco users, mean age 44.5 years (SD=14.3) with median tobacco use duration of 15 years. After administration of the BBPMC, 50 (31.2%) participants registered with the MCP program on-site. On an adjusted analysis, tobacco users with a preexisting intention to quit were three times more likely to enroll in the MCP. CONCLUSIONS Physicians and other healthcare providers in Indian outpatient health settings should utilize BBPMC like interventions that are easily scalable, require no specialized training, and and allow them to fulfill their obligation to provide a readily accessible tobacco cessation service to their patients.
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Affiliation(s)
- Saurav Basu
- Department of Community Medicine, Maulana Azad Medical College, New Delhi, India
| | - Priyanka Yadav
- Department of Community Medicine, Maulana Azad Medical College, New Delhi, India
| | - Bratati Banerjee
- Department of Community Medicine, Maulana Azad Medical College, New Delhi, India
| | - Ankit Yadav
- Department of Community Medicine, Maulana Azad Medical College, New Delhi, India
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Mbulo L, Palipudi KM, Smith T, Yin S, Munish VG, Sinha DN, Gupta PC, Swasticharan L. Patterns and related factors of bidi smoking in India. Tob Prev Cessat 2020; 6:28. [PMID: 32760863 PMCID: PMC7398128 DOI: 10.18332/tpc/119053] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Revised: 02/29/2020] [Accepted: 03/16/2020] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Bidis are the most commonly smoked tobacco product in India. Understanding bidi smoking is important to reducing overall tobacco smoking and health-related consequences in India. We analyzed 2009–2010 and 2016–2017 Global Adult Tobacco Survey (GATS) India data to examine bidi smoking and its associated sociodemographic correlates and perceptions of dangers of smoking. METHODS GATS is a nationally representative household survey of adults aged ≥15 years, designed to measure tobacco use and tobacco control indicators. Current bidi smoking was defined as current smoking of one or more bidis during a usual week. We computed bidi smoking prevalence estimates and relative change during 2009–2010 and 2016–2017. Used pooled multilevel logistic regression to identify individual-level determinants of bidi smoking and neighborhood-level and state-level variations. RESULTS Overall, 9.2% and 7.7% of adults smoked bidis in India during 2009–2010 and 2016–2017, respectively, reflecting 16.4% significant relative decline. In pooled analysis, male, older age, rural residence, lower education level, lower wealth index, less knowledge about harms of smoking, and survey year were associated with increased odds of bidi smoking. Results also showed variance in odds of smoking bidis is associated with neighborhood (15.9%) and state (31.8%) level. CONCLUSIONS Higher odds of bidi smoking were found among males, older age groups, and among those with lower socioeconomic status. Accordingly, health education interventions designed for these groups across India and other population-level interventions, such as WHO recommendation on increasing price on tobacco products, could help reduce bidi smoking. In addition, state/neighborhood-specific interventions could also help address differential bidi smoking across India.
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Affiliation(s)
- Lazarous Mbulo
- Global Tobacco Control Branch, Office on Smoking and Health, Centers for Disease Control and Prevention, Atlanta, United States
| | - Krishna M Palipudi
- Global Tobacco Control Branch, Office on Smoking and Health, Centers for Disease Control and Prevention, Atlanta, United States
| | - Tenecia Smith
- Global Tobacco Control Branch, Office on Smoking and Health, Centers for Disease Control and Prevention, Atlanta, United States
| | - Shaoman Yin
- Global Tobacco Control Branch, Office on Smoking and Health, Centers for Disease Control and Prevention, Atlanta, United States
| | | | | | - Prakash C Gupta
- Healis-Sekhsaria Institute of Public Health, Navi Mumbai, India
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Li Y, Raftery AE. ESTIMATING AND FORECASTING THE SMOKING-ATTRIBUTABLE MORTALITY FRACTION FOR BOTH GENDERS JOINTLY IN OVER 60 COUNTRIES. Ann Appl Stat 2020; 14:381-408. [PMID: 32405333 PMCID: PMC7220047 DOI: 10.1214/19-aoas1306] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Smoking is one of the leading preventable threats to human health and a major risk factor for lung cancer, upper aero-digestive cancer, and chronic obstructive pulmonary disease. Estimating and forecasting the smoking attributable fraction (SAF) of mortality can yield insights into smoking epidemics and also provide a basis for more accurate mortality and life expectancy projection. Peto et al. (1992) proposed a method to estimate the SAF using the lung cancer mortality rate as an indicator of exposure to smoking in the population of interest. Here we use the same method to estimate the all-age SAF (ASAF) for both genders for over 60 countries. We document a strong and cross-nationally consistent pattern of the evolution of the SAF over time. We use this as the basis for a new Bayesian hierarchical model to project future male and female ASAF from over 60 countries simultaneously. This gives forecasts as well as predictive distributions that can be used to find uncertainty intervals for any quantity of interest. We assess the model using out-of-sample predictive validation, and find that it provides good forecasts and well calibrated forecast intervals, comparing favorably with other methods.
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Affiliation(s)
- Yicheng Li
- Department of Statistics, Box 354322, University of Washington, Seattle, Washington 98195-4322, USA
| | - Adrian E Raftery
- Department of Statistics, Box 354322, University of Washington, Seattle, Washington 98195-4322, USA
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Pandey A, Singh A, Singh S, Shahi H, Kumar A, Kumari A, Das A. Smoking Pattern among Rural Indian Cancer Patients: A Prospective Survey. Indian J Med Paediatr Oncol 2020. [DOI: 10.4103/ijmpo.ijmpo_56_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Abstract
Background: Smoking predisposes to cancer. Prevalence and pattern of smoking among rural Indian cancer patients is unknown. Aim: The aim of the study was to estimate the prevalence of smoking in cancer patients. Objective: The objective of the study was to estimate the type of smoking and pattern in cancer patients and correlate with clinical and demographic variables through a prospective survey. Materials and Methods: All consecutive individual adult (age >18 years) patients diagnosed with any cancer and registered in the medical oncology outpatient department were enrolled for questionnaire-based survey on smoking between July 2017 and October 2017. Demographic variables were also recorded including income, education, and occupation. Frequency distribution and cross tabulation were used for the statistical analysis using SPSS version 17. Results: Of 517 cancer patients enrolled, 456 (88%) were rural. The prevalence of smoking was 125/517 (0.24, 95% confidence interval – 0.20–0.27). Among them, 67 (54%) were bidi smokers, while 58 (46%) smoked cigarette. Majority had smoking history of more than 20 years (40%), while 20% were recent smokers, <5 years. Hundred out of one hundred twenty-five (80%) patients were male, while 24/25 (96%) women smoked bidi. More than 56% of the bidi smokers were illiterate, while the majority of cigarette smokers (50%) had completed high secondary schooling. The majority of bidi (63%) and cigarette smokers (62%) had monthly income <Rs. 10,000. Almost 98% of bidi smokers and 77% of cigarette smoking population were rural. Farmers and laborers had higher prevalence of smoking, 35/96 (53%) and 28/70 (40%), respectively, while 11% of housewives were bidi smokers. Nearly 40% of head-and-neck cancer and 48% of lung cancer patients had a smoking history, with 65% and 76% being bidi smokers among them, respectively. Conclusion: One in four cancer patients smoke. Most of the smokers are illiterate with low socioeconomic profile and predominantly laborers and farmers. Bidi is the predominant type of smoking.
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Affiliation(s)
- Avinash Pandey
- Department of Medical Oncology, State Cancer Institute, Indira Gandhi Institute of Medical Sciences, Patna, Bihar, India
| | - Anjana Singh
- Department of Medical Oncology, State Cancer Institute, Indira Gandhi Institute of Medical Sciences, Patna, Bihar, India
| | - Shivkant Singh
- Department of Medical Oncology, State Cancer Institute, Indira Gandhi Institute of Medical Sciences, Patna, Bihar, India
| | - Heena Shahi
- Department of Medical Oncology, State Cancer Institute, Indira Gandhi Institute of Medical Sciences, Patna, Bihar, India
| | - Amit Kumar
- Department of Medical Oncology, State Cancer Institute, Indira Gandhi Institute of Medical Sciences, Patna, Bihar, India
| | - Aishwarya Kumari
- Department of Medical Oncology, State Cancer Institute, Indira Gandhi Institute of Medical Sciences, Patna, Bihar, India
| | - Anshuman Das
- Department of Medical Oncology, State Cancer Institute, Indira Gandhi Institute of Medical Sciences, Patna, Bihar, India
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Tobacco use patterns and tobacco-related awareness in medical students of Delhi. CLINICAL EPIDEMIOLOGY AND GLOBAL HEALTH 2020. [DOI: 10.1016/j.cegh.2019.04.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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Kaur P, Ramachandra Rao S, Venkatachalam R, Kangusamy B, Radhakrishnan E, Kaliaperumal K, Thota V, Gupte MD. Risk factors for cardiovascular disease in rural South India: cohort study. BMJ Open 2019; 9:e029759. [PMID: 31662362 PMCID: PMC6830617 DOI: 10.1136/bmjopen-2019-029759] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Cardiovascular diseases (CVD) accounted for one-third of the deaths in India. We conducted a cohort study to estimate the incidence of CVD and the association of established risk factors with the incident CVD in a rural population in South India. DESIGN, SETTING AND PARTICIPANTS We conducted a community-based cohort study among 6026 adults aged 25-64 years in five villages in Tiruvallur, Tamil Nadu. We did baseline (2005-2007) and two follow-up surveys in 2008-2009 and 2013-2015. Risk factors studied were tobacco, alcohol, hypertension, self-reported diabetes and central obesity. OUTCOME MEASURES Outcome measures were fatal or non-fatal ischaemic heart disease or cerebrovascular event. We estimated HRs for the risk factors and population attributable fraction (PAF). RESULTS We followed up 5641 (94.4%) subjects, and follow-up duration was 33 371 person years. The overall incidence of cardiovascular event or death was 4.6 per 1000 person years. Current smoking (HR 1.6, 95% CI 1.1 to 2.6) and hypertension (HR 2.2, 95% CI 1.5 to 3.4) were the risk factors among men and accounted for 47% of the PAF. Among women, hypertension (HR 1.8, 95% CI 1.0 to 3.4), self-reported diabetes (HR 4.3, 95% CI 2.2 to 8.1) and central obesity (HR 2.2, 95% CI 1.2 to 4.0) were associated with CVD and accounted for more than half of the PAF. CONCLUSIONS We described the high burden of fatal CVD and identified the role of CVD risk factors such as hypertension, self-reported diabetes, smoking and central obesity. There is an urgent need to implement low-cost interventions such as smoking cessation and treat hypertension and diabetes in primary care settings.
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Affiliation(s)
- Prabhdeep Kaur
- Division of Noncommunicable Diseases, ICMR-National Institute of Epidemiology, Chennai, India
| | - Sudha Ramachandra Rao
- Division of Noncommunicable Diseases, ICMR-National Institute of Epidemiology, Chennai, India
| | | | - Boopathi Kangusamy
- Division of Heath Systems Research, ICMR-National Institute of Epidemiology, Chennai, India
| | - Ezhil Radhakrishnan
- Division of Noncommunicable Diseases, ICMR-National Institute of Epidemiology, Chennai, India
| | - Kanagasabai Kaliaperumal
- Division of Computing and Information Science, ICMR-National Institute of Epidemiology, Chennai, India
| | - Venkatarao Thota
- Division of Noncommunicable Diseases, ICMR-National Institute of Epidemiology, Chennai, India
| | - Mohan D Gupte
- Former Director, ICMR-National Institute of Epidemiology, Chennai, India
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Vashistha V, Choudhari C, Garg A, Gupta A, Parthasarathy G, Jain D, Madan K, Hadda V, Khilnani GC, Guleria R, Mohan A. The time required to diagnose and treat lung cancer in Delhi, India: an updated experience of a public referral center. ACTA ACUST UNITED AC 2019. [DOI: 10.1186/s41241-019-0080-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Abstract
Background
Delays that postpone the evaluation and management of malignancy may lead to considerable morbidity. The primary objective of this study was to assess the time required to diagnose and treat lung cancer at an Indian public referral center that predominantly serves lower-income patients.
Methods
A review of patients diagnosed with lung cancer between January 2008 and December 2016 was completed. We computed the median time intervals and inter-quartile ranges between symptom onset, definitive diagnostic investigation, confirmed histologic diagnosis, and chemotherapy initiation. Median intervals were correlated with baseline demographics and disease characteristics using Kruskal-Wallis test.
Results
One thousand, three hundred and-seventy patients were selected. A majority (94.5%) with non-small cell lung cancer were diagnosed with advanced disease. After developing symptoms, patients required 101 [56–168] days to undergo a definitive diagnostic study, 107 [60–173] days to confirm a diagnosis, and 126 [85–196.8] days to initiate treatment. Patients who were previously treated for tuberculosis required more time to receive chemotherapy compared to those who were not (187 [134–261.5] days vs. 113 [75–180] days, p < 0.0001). A specialty Lung Cancer Clinic was implemented in 2012, and the mean referrals per month increased nearly four-fold (p < 0.0001), but the time required to administer treatment was not shortened.
Conclusion
Among lower-income Indian patients, the most prominent delays occur prior to diagnosis. Efforts should be directed toward encouraging physicians to maintain a high index of clinical suspicion and educating patients to report concerning symptoms as early as possible.
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Shang C, Chaloupka FJ, Fong GT, Gupta PC, Pednekar MS. The Association Between State Value-Added Taxes and Tobacco Use in India-Evidence From GATS and TCP India Survey. Nicotine Tob Res 2019; 20:1344-1352. [PMID: 29059339 DOI: 10.1093/ntr/ntx184] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2017] [Accepted: 08/17/2017] [Indexed: 01/17/2023]
Abstract
Introduction State value-added taxes (VAT) on tobacco products have been increased significantly in recent years in India. Evidence on how these VATs were associated with smoking is highly needed. Methods State bidi and cigarette VAT rates were linked to Global Adult Tobacco Survey (GATS) India 2009-2010 and Tobacco Control Policy (TCP) India Survey waves 1 (2010-2011) and 2 (2012-2013), respectively. These linked data were used to analyze the associations between bidi VAT rates and bidi smoking, between cigarette VAT rates and cigarette smoking, and between the two VAT rates and dual use of bidis and cigarettes. Weighted logistic regressions were employed to examine GATS cross-sectional data, whereas generalized estimating equations (GEE) were employed to examine longitudinal TCP data. We further stratified the analyses by gender. Results A 10% increase in cigarette VAT rates was associated with a 6.5% (p < .001) decrease in dual use of cigarettes and bidis among adults and a 0.9% decrease (p < .05) in cigarette smoking among males in TCP; and with a 21.6% decrease (p < .05) in dual use among adults and a 17.2% decrease (p < .001) in cigarette smoking among males in GATS. TCP analyses controlling for state fixed effects are less likely to be biased and indicate a cigarette price elasticity of -0.44. As female smoking prevalence was extremely low, these associations were nonsignificant for females. Conclusions Higher state cigarette VAT rates in India were significantly associated with lower cigarette smoking and lower dual use of cigarettes and bidis. Increasing state VAT rates may significantly reduce smoking in India. Implications Both Global Adult Tobacco Survey and Tobacco Control Policy (TCP) India datasets suggest that higher state cigarette value-added tax rates were significantly associated with lower male cigarette smoking and lower dual use of cigarettes and bidis among all adults in India. TCP analyses indicate a cigarette price elasticity of -0.44. As shown in this study, state tobacco taxes in the current taxation system are likely effective in reducing smoking. Given this, a future central goods and service tax (GST) system could consider keeping states' authority in implementing local tobacco taxes or designing a GST system that is equally or more effective in reducing tobacco use.
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Affiliation(s)
- Ce Shang
- Health Policy Center, Institute for Health Research and Policy, University of Illinois at Chicago, Chicago, IL
| | - Frank J Chaloupka
- Health Policy Center, Institute for Health Research and Policy, University of Illinois at Chicago, Chicago, IL.,Division of Health Policy and Administration, School of Public Health, University of Illinois at Chicago, Chicago, IL
| | - Geoffrey T Fong
- Department of Psychology, University of Waterloo, Waterloo, Canada.,Ontario Institute for Cancer Research, Toronto, Canada
| | - Prakash C Gupta
- Healis Sekhsaria Institute for Public Health, Navi Mumbai, India
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Thomas BE, Thiruvengadam K, S. R, Kadam D, Ovung S, Sivakumar S, Bala Yogendra Shivakumar SV, Paradkar M, Gupte N, Suryavanshi N, Dolla CK, Gupte AN, Kohli R, Pradhan N, Sivaramakrishnan GN, Gaikwad S, Kagal A, Dhanasekaran K, Deluca A, Golub JE, Mave V, Chandrasekaran P, Gupta A. Smoking, alcohol use disorder and tuberculosis treatment outcomes: A dual co-morbidity burden that cannot be ignored. PLoS One 2019; 14:e0220507. [PMID: 31365583 PMCID: PMC6668833 DOI: 10.1371/journal.pone.0220507] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2019] [Accepted: 07/17/2019] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND More than 20% of tuberculosis (TB) disease worldwide may be attributable to smoking and alcohol abuse. India is the second largest consumer of tobacco products, a major consumer of alcohol particularly among males, and has the highest burden of TB globally. The impact of increasing tobacco dose, relevance of alcohol misuse and past versus current or never smoking status on TB treatment outcomes remain inadequately defined. METHODS We conducted a multi-centric prospective cohort study of newly diagnosed adult pulmonary TB patients initiated on TB treatment and followed for a minimum of 6 months to assess the impact of smoking status with or without alcohol abuse on treatment outcomes. Smokers were defined as never smokers, past smokers or current smokers. Alcohol Use Disorder Identification Test (AUDIT) scores were used to assess alcohol misuse. The association between smoking status and treatment outcomes was assessed in univariate and multivariate random effects poisson regression models. RESULTS Of 455 enrolled, 129 (28%) had a history of smoking with 94 (20%) current smokers and 35 (8%) past smokers. Unfavourable treatment outcomes were significantly higher among past and current smokers as compared to never smokers. Specifically, the risk of treatment failure was significantly higher among past smokers (aIRR = 2.66, 95% CI: 1.41-4.90, p = 0.002), recurrent TB among current smokers (aIRR = 2.94, 95% CI: 1.30-6.67, p = 0.010) and death among both past (2.63, 95% CI: 1.11-6.24, p = 0.028) and current (aIRR = 2.59, 95% CI: 1.29-5.18, p = 0.007) smokers. Furthermore, the combined effect of alcohol misuse and smoking on unfavorable treatment outcomes was significantly higher among past smokers (aIRR: 4.67, 95% CI: 2.17-10.02, p<0.001) and current smokers (aIRR: 3.58, 95% CI: 1.89-6.76, p<0.001). CONCLUSION Past and current smoking along with alcohol misuse have combined effects on increasing the risk of unfavourable TB treatment outcomes. Innovative interventions that can readily address both co-morbidities are urgently needed.
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Affiliation(s)
| | - Kannan Thiruvengadam
- National Institute for Research in Tuberculosis, ICMR, Chennai, Tamil Nadu, India
| | - Rani S.
- National Institute for Research in Tuberculosis, ICMR, Chennai, Tamil Nadu, India
| | - Dileep Kadam
- Byramjee Jeejeebhoy Government Medical College, Pune, Maharashtra, India
| | - Senthanro Ovung
- National Institute for Research in Tuberculosis, ICMR, Chennai, Tamil Nadu, India
| | - Shrutha Sivakumar
- National Institute for Research in Tuberculosis, ICMR, Chennai, Tamil Nadu, India
| | | | - Mandar Paradkar
- Byramjee Jeejeebhoy Government Medical College–Johns Hopkins University Clinical Research Site, Pune, Maharashtra, India
| | - Nikhil Gupte
- Byramjee Jeejeebhoy Government Medical College–Johns Hopkins University Clinical Research Site, Pune, Maharashtra, India
- Johns Hopkins School of Medicine, Baltimore, Maryland, United States of America
| | - Nishi Suryavanshi
- Byramjee Jeejeebhoy Government Medical College–Johns Hopkins University Clinical Research Site, Pune, Maharashtra, India
| | - C. K. Dolla
- National Institute for Research in Tuberculosis, ICMR, Chennai, Tamil Nadu, India
| | - Akshay N. Gupte
- Johns Hopkins School of Medicine, Baltimore, Maryland, United States of America
| | - Rewa Kohli
- Byramjee Jeejeebhoy Government Medical College–Johns Hopkins University Clinical Research Site, Pune, Maharashtra, India
| | - Neeta Pradhan
- Byramjee Jeejeebhoy Government Medical College–Johns Hopkins University Clinical Research Site, Pune, Maharashtra, India
| | | | - Sanjay Gaikwad
- Byramjee Jeejeebhoy Government Medical College, Pune, Maharashtra, India
| | - Anju Kagal
- Byramjee Jeejeebhoy Government Medical College, Pune, Maharashtra, India
| | - Kavitha Dhanasekaran
- National Institute for Research in Tuberculosis, ICMR, Chennai, Tamil Nadu, India
| | - Andrea Deluca
- Johns Hopkins School of Medicine, Baltimore, Maryland, United States of America
| | - Jonathan E. Golub
- Johns Hopkins School of Medicine, Baltimore, Maryland, United States of America
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Vidya Mave
- Byramjee Jeejeebhoy Government Medical College–Johns Hopkins University Clinical Research Site, Pune, Maharashtra, India
- Johns Hopkins School of Medicine, Baltimore, Maryland, United States of America
| | | | - Amita Gupta
- Johns Hopkins School of Medicine, Baltimore, Maryland, United States of America
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
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Kumar A, Shariff M. Atherosclerostic cardiovascular disease risk score: Are Indians underestimating the risk of cardiovascular disease? Indian Heart J 2019; 71:364-365. [PMID: 31779868 PMCID: PMC6890962 DOI: 10.1016/j.ihj.2019.08.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2019] [Revised: 04/20/2019] [Accepted: 08/13/2019] [Indexed: 12/21/2022] Open
Affiliation(s)
- Ashish Kumar
- Resident, Department of Critical Care Medicine, St John's Medical College Hospital, Bangalore, India.
| | - Mariam Shariff
- Resident, Department of Critical Care Medicine, St John's Medical College Hospital, Bangalore, India
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Chatterjee S, Ghosh Laskar S, Mehanna H, Nutting CM, Mallick I. Oropharyngeal Cancers in the East and the West - Implications of Aetiopathogenesis on Prognosis and Research. Clin Oncol (R Coll Radiol) 2019; 31:510-519. [PMID: 31196762 DOI: 10.1016/j.clon.2019.05.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2019] [Revised: 04/30/2019] [Accepted: 05/09/2019] [Indexed: 10/26/2022]
Abstract
There has been a surge in human papillomavirus (HPV)-positive oropharyngeal cancers (OPCs) in the West. Although the prognosis of HPV-positive OPC is good, de-escalation strategies have so far not been able to confirm comparable cancer control. We examine the strategies implemented across the globe to safely reduce toxicities in HPV-positive disease. HPV-negative OPC has a poorer prognosis and is more prevalent in Eastern countries. We outline the intensification strategies currently used in HPV-negative cancers, with an aim to better prognosis. With recent improvements in clinical trial frameworks in Eastern countries such as India, we discuss areas where joint collaborative research between Western and Eastern countries could further improve outcomes in OPC.
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Affiliation(s)
- S Chatterjee
- Department of Radiation Oncology, Tata Medical Center, Kolkata, India.
| | - S Ghosh Laskar
- Department of Radiation Oncology, Tata Memorial Hospital, Mumbai, India
| | - H Mehanna
- Institute of Head and Neck Studies and Education, Institute of Cancer and Genomic Sciences, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - C M Nutting
- Department of Clinical Oncology, Royal Marsden Hospital and Institute of Cancer Research, London, UK
| | - I Mallick
- Department of Radiation Oncology, Tata Medical Center, Kolkata, India
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Mummudi N, Agarwal JP, Chatterjee S, Mallick I, Ghosh-Laskar S. Oral Cavity Cancer in the Indian Subcontinent - Challenges and Opportunities. Clin Oncol (R Coll Radiol) 2019; 31:520-528. [PMID: 31174947 DOI: 10.1016/j.clon.2019.05.013] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Revised: 04/24/2019] [Accepted: 04/29/2019] [Indexed: 12/21/2022]
Abstract
Oral cavity cancer (OCC) poses a global challenge that plagues both the Orient and the Occident, accounting for an estimated 350 000 new cases and 177 000 deaths in 2018. OCC is a major public health problem in the Indian subcontinent, where it ranks among the top three cancer types in both incidence and mortality. Major risk factors are the use of tobacco, betel quid and alcohol consumption. OCC is a heterogeneous group of multiple histologies that affects multiple subsites. The oral cavity includes the lips, buccal mucosa, teeth, gingiva, anterior two-thirds of the tongue, floor of the mouth and hard palate. OCC is defined as cancer of lips, mouth and tongue as defined by the International Classification of Diseases coding scheme. The epidemiology, aetio-pathogenesis and treatment philosophy are similar within this group. Although salivary gland malignancies, sarcomas, mucosal melanomas and lymphomas can also arise within the oral cavity, this review will focus on squamous cell cancer, which is the predominant histology in OCC. We review and contrast data from developing and developed countries. We also highlight the unique regional challenges that countries in the East face; citing India as an example, we elaborate on the opportunities and scope for improvement in the management of OCC.
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Affiliation(s)
- N Mummudi
- Department of Radiation Oncology, Tata Memorial Hospital, Parel, Mumbai, India
| | - J P Agarwal
- Department of Radiation Oncology, Tata Memorial Hospital, Parel, Mumbai, India
| | - S Chatterjee
- Department of Radiation Oncology, Tata Medical Center, Kolkata, India
| | - I Mallick
- Department of Radiation Oncology, Tata Medical Center, Kolkata, India
| | - S Ghosh-Laskar
- Department of Radiation Oncology, Tata Memorial Hospital, Parel, Mumbai, India.
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Mehre SA, Dhara AK, Garg M, Kalra N, Khandelwal N, Mukhopadhyay S. Content-Based Image Retrieval System for Pulmonary Nodules Using Optimal Feature Sets and Class Membership-Based Retrieval. J Digit Imaging 2019; 32:362-385. [PMID: 30361935 PMCID: PMC6499853 DOI: 10.1007/s10278-018-0136-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
Abstract
Lung cancer manifests itself in the form of lung nodules, the diagnosis of which is essential to plan the treatment. Automated retrieval of nodule cases will assist the budding radiologists in self-learning and differential diagnosis. This paper presents a content-based image retrieval (CBIR) system for lung nodules using optimal feature sets and learning to enhance the performance of retrieval. The classifiers with more features suffer from the curse of dimensionality. Like classification schemes, we found that the optimal feature set selected using the minimal-redundancy-maximal-relevance (mRMR) feature selection technique improves the precision performance of simple distance-based retrieval (SDR). The performance of the classifier is always superior to SDR, which leans researchers towards conventional classifier-based retrieval (CCBR). While CCBR improves the average precision and provides 100% precision for correct classification, it fails for misclassification leading to zero retrieval precision. The class membership-based retrieval (CMR) is found to bridge this gap for texture-based retrieval. Here, CMR is proposed for nodule retrieval using shape-, margin-, and texture-based features. It is found again that optimal feature set is important for the classifier used in CMR as well as for the feature set used for retrieval, which may lead to different feature sets. The proposed system is evaluated using two independent databases from two continents: a public database LIDC/IDRI and a private database PGIMER-IITKGP, using three distance metrics, i.e., Canberra, City block, and Euclidean. The proposed CMR-based retrieval system with optimal feature sets performs better than CCBR and SDR with optimal features in terms of average precision. Apart from average precision and standard deviation of precision, the fraction of queries with zero precision retrieval is also measured.
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Affiliation(s)
- Shrikant A. Mehre
- Department of Electronics and Electrical Communication Engineering, Indian Institute of Technology Kharagpur, Kharagpur, India
| | - Ashis Kumar Dhara
- Department of Electronics and Electrical Communication Engineering, Indian Institute of Technology Kharagpur, Kharagpur, India
- Centre for Image Analysis, Uppsala University, Uppsala, Sweden
| | - Mandeep Garg
- Department of Radiodiagnosis and Imaging, Post-graduate Institute of Medical Education and Research, Chandigarh, India
| | - Naveen Kalra
- Department of Radiodiagnosis and Imaging, Post-graduate Institute of Medical Education and Research, Chandigarh, India
| | - Niranjan Khandelwal
- Department of Radiodiagnosis and Imaging, Post-graduate Institute of Medical Education and Research, Chandigarh, India
| | - Sudipta Mukhopadhyay
- Department of Electronics and Electrical Communication Engineering, Indian Institute of Technology Kharagpur, Kharagpur, India
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Sen N, Bathija P, Chakravarty T, Das D, Baghel NS, Khan TA. Caries risk assessment using Cariogram model among smokeless tobacco users in India. Med Pharm Rep 2019; 92:165-171. [PMID: 31086845 PMCID: PMC6510351 DOI: 10.15386/mpr-978] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2018] [Revised: 06/17/2018] [Accepted: 11/12/2018] [Indexed: 11/23/2022] Open
Abstract
Background Smokeless tobacco forms are known to have fermentable sugar compounds which may strengthen the development of cariogenic microbes. In addition, cervical abrasion of teeth occur at the site of tobacco pouch placement. These components may assume an essential role in caries advancement in smokeless tobacco users. Objective The objective of the study was to assess caries risk among smokeless tobacco users using Cariogram model. Methods A descriptive cross sectional study was conducted among 50 smokeless tobacco users of Udaipur for 3 months. Caries risk assessment was done by employing a proforma survey based on the Cariogram Model. Statistical analysis included descriptive statistics, Chi-square test and Stepwise multiple linear regression with 95% confidence interval and 5% significance level. Results The majority of the smokeless tobacco users (46%) were found to be in the “Moderate” Streptococcus mutans count category and portrayed “Moderate” plaque amount score (82%). Smokeless tobacco users (34%) depicted a higher caries risk profile than the control group (6%) utilizing the Cariogram model. Conclusion Cariogram model could be a useful tool to represent caries risk among smokeless tobacco users.
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Affiliation(s)
- Nandini Sen
- Public Health Dentistry Department, Pacific Dental College and Hospital, Udaipur, India
| | - Pratiksha Bathija
- Public Health Dentistry Department, Sri Aurobindo College of Dentistry & P.G. Institute, Indore, India
| | - Tulip Chakravarty
- Public Health Dentistry Department, Pacific Dental College and Hospital, Udaipur, India
| | - Diptajit Das
- Public Health Dentistry Department, Centre for Dental Education and Research, AIIMS, New Delhi, India
| | - Nidhi Singh Baghel
- Oral and Maxillo-Facial Surgery Department, Jaipur Dental College, Jaipur, India
| | - Tauseef Ahmad Khan
- Oral and Maxillo-Facial Surgery Department, Jaipur Dental College, Jaipur, India
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Affiliation(s)
- C H Shafneed
- All India Institute of Medical Sciences, New Delhi, India
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Agarwal D, Hanafi NS, Chippagiri S, Brakema EA, Pinnock H, Khoo EM, Sheikh A, Liew SM, Ng CW, Isaac R, Chinna K, Ping WL, Hussein NB, Juvekar S. Systematic scoping review protocol of methodologies of chronic respiratory disease surveys in low/middle-income countries. NPJ Prim Care Respir Med 2019; 29:17. [PMID: 31068586 PMCID: PMC6506487 DOI: 10.1038/s41533-019-0129-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2019] [Accepted: 04/12/2019] [Indexed: 11/09/2022] Open
Abstract
This protocol describes a systematic scoping review of chronic respiratory disease surveys in low/middle-income countries (LMICs) undertaken as part of the Four Country ChrOnic Respiratory Disease (4CCORD) study within the National Institute for Health Research Global Health Research Unit on Respiratory Health (RESPIRE). Understanding the prevalence and burden of chronic respiratory disease (CRD) underpins healthcare planning. We will systematically scope the literature to identify existing strategies (definitions/questionnaires/diagnostics/outcomes) used in surveys of CRDs in adults in low-resource settings. We will search MEDLINE, EMBASE, ISI WoS, Global Health and WHO Global Health Library [search terms: prevalence AND CRD (COPD, asthma) AND LMICs, from 1995], and two reviewers will independently extract data from selected studies onto a piloted customised data extraction form. We will convene a workshop of the multidisciplinary 4CCORD research team with representatives from the RESPIRE partners (Bangladesh, India, Malaysia, Pakistan and Edinburgh) at which the findings of the scoping review will be presented, discussed and interpreted. The findings will inform a future RESPIRE 4CCORD study, which will estimate CRD burden in adults in Asian LMICs.
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Affiliation(s)
- Dhiraj Agarwal
- Vadu Rural Health Program, KEM Hospital Research Centre, Pune, India
| | - Nik Sherina Hanafi
- Department of Primary Care Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | | | - Evelyn A Brakema
- Department of Public Health and Primary care, Leiden University Medical Centre, Leiden, The Netherlands
| | - Hilary Pinnock
- NIHR Global Health Research Unit on Respiratory Health (RESPIRE), Usher Institute of Population Health Sciences and Informatics, The University of Edinburgh, Edinburgh, UK
| | - Ee Ming Khoo
- Department of Primary Care Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Aziz Sheikh
- NIHR Global Health Research Unit on Respiratory Health (RESPIRE), Usher Institute of Population Health Sciences and Informatics, The University of Edinburgh, Edinburgh, UK
| | - Su-May Liew
- Department of Primary Care Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Chiu-Wan Ng
- Department of Primary Care Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Rita Isaac
- RUHSA Department, Christian Medical College, Vellore, India
| | - Karuthan Chinna
- Department of Primary Care Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Wong Li Ping
- Department of Primary Care Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Norita Binti Hussein
- Department of Primary Care Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Sanjay Juvekar
- Vadu Rural Health Program, KEM Hospital Research Centre, Pune, India.
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Jawad M, Al-Houqani M, Ali R, El Sayed Y, ElShahawy O, Weitzman M, Sherman SE. Prevalence, attitudes, behaviours and policy evaluation of midwakh smoking among young people in the United Arab Emirates: Cross-sectional analysis of the Global Youth Tobacco Survey. PLoS One 2019; 14:e0215899. [PMID: 31017949 PMCID: PMC6481845 DOI: 10.1371/journal.pone.0215899] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2018] [Accepted: 04/10/2019] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION Non-cigarette tobacco products are an increasing public health concern globally. Little is known about midwakh, a pipe indigenous to the United Arab Emirates (UAE). This study aimed to assess the prevalence, attitudes, behaviours and policy evaluation of midwakh smoking among 13 to 15 year olds in the UAE. METHODS We conducted secondary analyses of the 2013 UAE Global Youth Tobacco Survey. The main three outcomes were ever use, current use (past-30 days), and the number of midwakhs smoked per day. We assessed cessation, attitude, and policy measures. Regression models identified the association between each outcome measure and sex, school grade, nationality, weekly spending money, cigarette use, and parent and peer tobacco use. RESULTS The prevalence of ever and current midwakh use were 18.5% and 9.0%, respectively. Daily midwakh users smoked a median of 8.0 per day while non-daily users smoked 3.8 per month. Higher midwakh prevalence was reported among wealthier males, older age groups, concurrent cigarette users and among participants having peers or parents who use tobacco. There was also variation by nationality. Reduced harm perception was greater among midwakh users than non-users. About 39.6% reported being declined a midwakh purchase due to age, and 35.5% reported noticing health warnings on packages. CONCLUSIONS Midwakh use is prevalent among 13 to 15 year olds in the UAE, and burden lies mainly with daily users. Further needed research should not delay implementation and evaluation of policies known to curb tobacco use among youth, including taxation, media campaigns, and provision of cessation services.
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Affiliation(s)
- Mohammed Jawad
- Public Health Policy Evaluation Unit, Imperial College London, London, United Kingdom
- * E-mail:
| | - Mohammed Al-Houqani
- College of Medicine and Health Sciences, UAE University, Abu Dhabi, United Arab Emirates
| | - Raghib Ali
- Public Health Research Center, New York University Abu Dhabi, Abu Dhabi, United Arab Emirates
| | - Yehya El Sayed
- College of Arts and Sciences, American University of Sharjah, Sharjah, United Arab Emirates
| | - Omar ElShahawy
- Public Health Research Center, New York University Abu Dhabi, Abu Dhabi, United Arab Emirates
- Department of Population Health, New York University School of Medicine, New York, New York, United States of America
- College of Global Public Health, New York University, New York, New York, United States of America
- AHA Tobacco Regulation and Addiction Center, American Heart Association, Dallas, Texas, United States of America
| | - Michael Weitzman
- Public Health Research Center, New York University Abu Dhabi, Abu Dhabi, United Arab Emirates
- College of Global Public Health, New York University, New York, New York, United States of America
- Departments of Pediatrics and Environmental Medicine, New York University School of Medicine, New York, New York, United States of America
| | - Scott E. Sherman
- Public Health Research Center, New York University Abu Dhabi, Abu Dhabi, United Arab Emirates
- Department of Population Health, New York University School of Medicine, New York, New York, United States of America
- College of Global Public Health, New York University, New York, New York, United States of America
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