1
|
Leite ICG, Koifman S. Revisão dos fatores de risco para o câncer de boca e faringe. REVISTA BRASILEIRA DE CANCEROLOGIA 2022. [DOI: 10.32635/2176-9745.rbc.1998v44n4.2827] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
O presente artigo realizou breve análise de perfil epidemiológico de tumores de boca e faringe no Brasil e no mundo, bem como uma revisão da literatura pertinente a seus fatores de risco. Sua incidência, geralmente, varia entre 2% a 30% do total dos novos casos de câncer no mundo, e é fortemente influenciada pela localização geográfica. No Brasil, é a sexta localização anatômica mais comum nos Registros de Base Populacional entre os homens, sendo que a localização envolvendo a língua corresponde a 40% do total de casos. Os principais fatores de risco são o tabaco, o álcool e a interação entre ambos, que exibem forte efeito multiplicativo sobre o risco. A quantidade consumida e o tempo de exposição a estes dois fatores exibem, comumente, gradiente crescente de risco para o câncer. Elementos da dieta são considerados fatores de proteção, especialmente oβ-caroteno, enquanto estados de carência nutricional são comumente percebidos entre os casos. Condições de precária saúde bucal são achados comuns entre os casos de câncer de boca e faringe. As recentes linhas de pesquisa em patogênese e prevenção do câncer de boca e faringe têm estudado a contribuição viral e genética. O comprometimento de grupos etários mais jovens e de mulheres provavelmente deve-se à universalização dos fatores de risco, levando a esta modificação do perfil epidemiológico.
Collapse
|
2
|
Ryman TK, Boyer BB, Hopkins SE, Philip J, Thompson B, Beresford SAA, Thummel KE, Austin MA. Association between iq'mik smokeless tobacco use and cardiometabolic risk profile among Yup'ik Alaska Native people. ETHNICITY & HEALTH 2018; 23:488-502. [PMID: 28116909 PMCID: PMC5796859 DOI: 10.1080/13557858.2017.1280136] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
OBJECTIVE The traditional lifestyle of Yup'ik Alaska Native people, including a diet abundant in marine-based foods and physical activity, may be cardio-protective. However, iq'mik, a traditional form of smokeless tobacco used by >50% of Yup'ik adults, could increase cardiometabolic (CM) risk. Our objective was to characterize the associations between iq'mik use and biomarkers of CM status (low-density lipoprotein cholesterol [LDL-C], high-density lipoprotein cholesterol [HDL-C], triglycerides [TG], systolic blood pressure [SBP] and diastolic blood pressure [DBP], glycated hemoglobin [HbA1c], fasting blood glucose [FBG], waist circumference [WC], and body mass index [BMI]). DESIGN We assessed these associations using data from a cross-sectional sample of Yup'ik adults (n = 874). Current iq'mik use, demographic, and lifestyle data were collected through interviews. Fasting blood samples were collected to measure LDL-C, HDL-C, TG, HbA1c, and FBG. SBP, DBP, WC, and BMI were obtained by physical examination. We characterized the association between current iq'mik use and continuous biomarkers of CM status using multiple approaches, including adjustment for measures of Yup'ik lifestyle and a propensity score. RESULTS Based on either adjustment method, current iq'mik use was significantly and positively associated with at least 5% higher HDL-C, and significantly associated but in an inverse direction with multiple biomarkers of CM status including 7% lower TG, 0.05% lower HbA1c, 2% lower FBG, 4% lower WC, and 4% lower BMI. Observed associations for LDL-C, SBP, and DBP varied by adjustment method. CONCLUSIONS This inverse association between iq'mik use and cardiometabolic risk status has not been previously reported. Additional research is needed to replicate these findings and explore physiological mechanisms and/or confounding factors.
Collapse
Affiliation(s)
- Tove K Ryman
- a Department of Epidemiology, School of Public Health , University of Washington , Seattle , WA , USA
| | - Bert B Boyer
- b Center for Alaska Native Health Research , University of Alaska Fairbanks , Fairbanks , AK , USA
| | - Scarlett E Hopkins
- b Center for Alaska Native Health Research , University of Alaska Fairbanks , Fairbanks , AK , USA
| | - Jacques Philip
- b Center for Alaska Native Health Research , University of Alaska Fairbanks , Fairbanks , AK , USA
| | - Beti Thompson
- c Department of Health Services , University of Washington , Seattle , WA , USA
| | - Shirley A A Beresford
- a Department of Epidemiology, School of Public Health , University of Washington , Seattle , WA , USA
| | - Kenneth E Thummel
- d Department of Pharmaceutics , University of Washington , Seattle , WA , USA
| | - Melissa A Austin
- a Department of Epidemiology, School of Public Health , University of Washington , Seattle , WA , USA
| |
Collapse
|
3
|
Severson HH, Danaher BG, Ebbert JO, van Meter N, Lichtenstein E, Widdop C, Crowley R, Akers L, Seeley JR. Randomized trial of nicotine lozenges and phone counseling for smokeless tobacco cessation. Nicotine Tob Res 2014; 17:309-15. [PMID: 25168034 DOI: 10.1093/ntr/ntu145] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
INTRODUCTION Relatively few treatment programs have been developed specifically for smokeless tobacco (ST) users who want to quit. Their results suggest that self-help materials, telephone counseling, and nicotine lozenges are efficacious. This study provides the first direct examination of the separate and combined effects of telephone counseling and lozenges. METHODS We recruited ST users online (N = 1067) and randomly assigned them to 1 of 3 conditions: (a) a lozenge group (n = 356), who were mailed 4-mg nicotine lozenges; (b) a coach calls group (n = 354), who were offered 3 coaching phone calls; or (c) a lozenge + coach calls group (N = 357), who received both lozenges and coaching calls. Additionally, all participants were mailed self-help materials. Self-reported tobacco abstinence was assessed at 3 and 6 months after randomization. RESULTS Complete-case and intention-to-treat (ITT) analyses for all tobacco abstinence were performed at 3 months, 6 months, and both 3 and 6 months (repeated point prevalence). ITT analyses revealed a highly similar result: the lozenge + coach calls condition was significantly more successful in encouraging tobacco abstinence than either the lozenge group or the coach calls group, which did not differ. CONCLUSIONS Combining nicotine lozenges and phone counseling significantly increased tobacco abstinence rates compared with either intervention alone, whereas coach calls and lozenges were equivalent. The study confirms the high tobacco abstinence rates for self-help ST cessation interventions and offers guidance to providing tobacco treatment to ST users.
Collapse
|
4
|
Abstract
This intentionally selective global review reflects the views and frustrations of a public health physician with 45 years of frontline experience in tobacco control. In particular, it focuses on the nexus between research and policy and the long periods between relevant discoveries and application as policy. Consideration is given to the relative neglect of the possibility of reducing the carcinogenicity and toxicity of the cigarette on the grounds that it is the preferred source of nicotine for the global majority of nicotine users. Although the outcome of such change is unquantifiable, there is much in cigarette smoke that can be changed to make it less carcinogenic and less toxic. It is difficult to think of excuses for accepting the status quo.
Collapse
Affiliation(s)
- Nigel J Gray
- Cancer Council Victoria, Carlton, Victoria, Australia
| |
Collapse
|
5
|
Hashemipour MA, Gholampour F, Fatah F, Bazregari S. Snus (nass) and oral cancer: A case series report. Dent Res J (Isfahan) 2013; 10:116-21. [PMID: 23878575 PMCID: PMC3714813 DOI: 10.4103/1735-3327.111813] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Snus (nass) is a form of snuff used in a similar manner to American dipping tobacco, but it does not typically result in a need for spitting. Possible hazards associated with this material include malignant and premalignant lesions in the oral cavity and gastrointestinal tract. The use of smokeless tobacco has increased in the Middle East in recent decades, particularly among teenagers and young adults. Therefore, practitioners must be able to recognize malignant and premalignant lesions. Although, an estimated 10-25% of the world's population uses smokeless tobacco, this practice is virtually unknown in Iran. The aim of this study is to report a series of cases of squamous cell carcinoma and verrucous carcinoma occurring in the users of snus, who referred to the Department of Oral Medicine in Kerman Dental School.
Collapse
Affiliation(s)
- Maryam Alsadat Hashemipour
- Kerman Oral and Dental Diseases Research Center, Kerman, Iran ; Department of Oral Medicine, Kerman University of Medical Sciences, Kerman, Iran
| | | | | | | |
Collapse
|
6
|
Willis D, Popovech M, Gany F, Zelikoff J. Toxicology of smokeless tobacco: implications for immune, reproductive, and cardiovascular systems. JOURNAL OF TOXICOLOGY AND ENVIRONMENTAL HEALTH. PART B, CRITICAL REVIEWS 2012; 15:317-331. [PMID: 22852812 DOI: 10.1080/10937404.2012.689553] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
The popularity of smokeless tobacco (ST), or noncombusted tobacco, usually placed within the mouth to be chewed, sucked, or swallowed, is growing rapidly and its prevalence of use is rising globally, due (in part) to greater convenience, as allowable cigarette smoking areas are rapidly decreasing, and increased social acceptability. Though data are limited, ST usage has been directly linked to a number of adverse health outcomes. The potential role that immune dysfunction, including dysregulation of immune cells and their components, may play in the progression of these adverse health outcomes is only just beginning to emerge. Evidence suggesting reproductive outcomes, such as perinatal mortality, preterm birth, and reduced sperm viability, also exists in conjunction with ST use. Cardiovascular health may also be impacted by ST use, resulting in increased blood pressure and endothelial dysfunction, both of which may potentially lead to cardiovascular diseases. This review describes the toxicological implications associated with ST use, with emphasis on immune, reproductive, and cardiovascular outcomes. Epidemiological studies are discussed with respect to experimental studies to help develop the relationship between ST and disease pathology. This review also summarizes the gaps in ST knowledge and potential future directions that are needed to more fully delineate the complex systems driving the adverse health outcomes associated with its use.
Collapse
Affiliation(s)
- Daniel Willis
- Department of Environmental Medicine, New York University School of Medicine, 57 Old Forge Rd., Tuxedo, NY 10987, USA.
| | | | | | | |
Collapse
|
7
|
Arnett MR, Baba NZ. Improving Tobacco Dependence Education Among the Loma Linda University School of Dentistry Faculty. J Dent Educ 2011. [DOI: 10.1002/j.0022-0337.2011.75.6.tb05112.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
| | - Nadim Z. Baba
- Department of Restorative Dentistry; School of Dentistry; Loma Linda University
| |
Collapse
|
8
|
Rudatsikira E, Muula AS, Siziya S. Current use of smokeless tobacco among adolescents in the Republic of Congo. BMC Public Health 2010; 10:16. [PMID: 20074362 PMCID: PMC2820474 DOI: 10.1186/1471-2458-10-16] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2009] [Accepted: 01/14/2010] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Tobacco use is a leading cause of global morbidity and mortality. Much of the epidemiologic research on tobacco focuses on smoking, especially cigarette smoking, but little attention on smokeless tobacco (SLT). METHODS Using data from the Republic of Congo Global Youth Tobacco Survey (GYTS) of 2006, we estimated the prevalence of SLT use among in-school adolescents. We also assessed the association between SLT use and cigarette smoking as well as the traditional factors which are associated with cigarette smoking among adolescents (e.g. age, sex, parental or peer smoking). Unadjusted odds ratios (OR) and adjusted odds ratios (AOR) together with their 95% confidence intervals (CI) were used to measure magnitudes of associations. RESULTS Of the 3,034 respondents, 18.0% (18.0% males and 18.1% females) reported having used smokeless tobacco (chewing tobacco, sniff or dip) in the last 30 days. In multivariate analysis, no significant associations were observed between age and sex on one hand and current smokeless tobacco use on the other. Cigarette smokers were more than six times likely to report current use of smokeless tobacco (AOR = 6.65; 95% CI [4.84, 9.14]). Having parents or friends smokers was positively associated with using smokeless tobacco (AOR = 1.98; 95% CI [1.51, 2.59] for parents who smoked cigarettes, AOR = 1.82; 95% CI [1.41, 2.69] for some friends who smoked cigarettes, and AOR = 2.02; 95% CI [1.49, 2.47] for most or all friends who smoked cigarettes). Respondents who reported have seen tobacco advertisement on TV, billboards and in newspapers/magazines were 1.95 times more likely to report current use of smokeless tobacco (AOR = 1.95; 95% CI [1.34, 3.08]). Perception that smoking was harmful to health was negatively associated with current use of smokeless tobacco (AOR = 0.60; 95% CI [0.46, 0.78]). CONCLUSIONS Prevention programs aimed to reduce teen [cigarette] smoking must also be designed to reduce other forms of tobacco use. The teenagers environment at home, at school and at leisure must also be factored in order to prevent their uptake or maintenance of tobacco use.
Collapse
Affiliation(s)
- Emmanuel Rudatsikira
- Division of Epidemiology and Biostatistics, San Diego State University, California, USA
| | | | | |
Collapse
|
9
|
Schwartz JL, Brunnemann KD, Adami AJ, Panda S, Gordon SC, Hoffmann D, Adami GR. Brand specific responses to smokeless tobacco in a rat lip canal model. J Oral Pathol Med 2010; 39:453-9. [DOI: 10.1111/j.1600-0714.2010.00892.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
|
10
|
GORDON JUDITHS, ALBERT DAVIDA, CREWS KARENM, FRIED JACQUELYN. Tobacco education in dentistry and dental hygiene. Drug Alcohol Rev 2009; 28:517-32. [DOI: 10.1111/j.1465-3362.2009.00108.x] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
|
11
|
Spangler J, Foley KL, Crandall S, Lane C, Walker K, MacRae M, Vaden K, Marion G. Implementing smokeless tobacco instruction into medical student education: addressing the gap. TEACHING AND LEARNING IN MEDICINE 2009; 21:33-7. [PMID: 19130384 PMCID: PMC4465384 DOI: 10.1080/10401330802573944] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
BACKGROUND Despite the unique health and epidemiological aspects of smokeless tobacco use, medical education regarding this topic is virtually lacking. DESCRIPTION The purpose of this study is to develop a comprehensive tobacco curriculum that includes smokeless tobacco education. A thorough review of the literature was carried out to develop includes 8 modules in basic and clinical sciences that are evaluated by pretest/posttest increases in knowledge as well as standardized patient encounters and process evaluation. EVALUATION Pretest/posttest data indicate that students increased knowledge on specific smokeless tobacco questions. Students also scored well on interactions with standardized patients using the Tobacco Intervention Risk Factor Interview Scale, a validated instrument to assess medical students' tobacco counseling skills. Process evaluation data indicate that modules were generally well received. CONCLUSIONS This Web-based, comprehensive curriculum-the only curriculum we are aware of treating the topic of smokeless tobacco use-appears to be effective and well received. Smokeless tobacco should be included in medical education.
Collapse
Affiliation(s)
- John Spangler
- Department of Family and Community Medicine, Wake Forest University School of Medicine, Winston-Salem, North Carolina 27157, USA.
| | | | | | | | | | | | | | | |
Collapse
|
12
|
Gartner CE, Hall WD, Chapman S, Freeman B. Should the health community promote smokeless tobacco (snus) as a harm reduction measure? PLoS Med 2007; 4:e185. [PMID: 17608560 PMCID: PMC1904463 DOI: 10.1371/journal.pmed.0040185] [Citation(s) in RCA: 79] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
The tobacco control community is divided on whether or not to inform the public that using oral, smokeless tobacco (Swedish snus) is less hazardous to health than smoking tobacco. Proponents of "harm reduction" point to the Swedish experience. Snus seems to be widely used as an alternative to cigarettes in Sweden, say these proponents, contributing to the low overall prevalence of smoking and smoking-related disease. Harm reduction proponents thus argue that the health community should actively inform inveterate cigarette smokers of the benefits of switching to snus. However, critics of harm reduction say that snus has its own risks, that no form of tobacco should ever be promoted, and that Sweden's experience is likely to be specific to that culture and not transferable to other settings. Critics also remain deeply suspicious that the tobacco industry will use snus marketing as a "gateway" to promote cigarettes. In the interests of promoting debate, the authors (who are collaborators on a research project on the future of tobacco control) have agreed to outline the strongest arguments for and against promoting Swedish snus as a form of harm reduction.
Collapse
Affiliation(s)
- Coral E Gartner
- School of Population Health, University of Queensland, Herston, Australia.
| | | | | | | |
Collapse
|
13
|
Vigneswaran N, Baucum DC, Wu J, Lou Y, Bouquot J, Muller S, Zacharias W. Repression of tumor necrosis factor-related apoptosis-inducing ligand (TRAIL) but not its receptors during oral cancer progression. BMC Cancer 2007; 7:108. [PMID: 17592646 PMCID: PMC1924860 DOI: 10.1186/1471-2407-7-108] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2007] [Accepted: 06/25/2007] [Indexed: 12/27/2022] Open
Abstract
Background TRAIL plays an important role in host immunosurveillance against tumor progression, as it induces apoptosis of tumor cells but not normal cells, and thus has great therapeutic potential for cancer treatment. TRAIL binds to two cell-death-inducing (DR4 and DR5) and two decoy (DcR1, and DcR2) receptors. Here, we compare the expression levels of TRAIL and its receptors in normal oral mucosa (NOM), oral premalignancies (OPM), and primary and metastatic oral squamous cell carcinomas (OSCC) in order to characterize the changes in their expression patterns during OSCC initiation and progression. Methods DNA microarray, immunoblotting and immunohistochemical analyses were used to examine the expression levels of TRAIL and its receptors in oral epithelial cell lines and in archival tissues of NOM, OPM, primary and metastatic OSCC. Apoptotic rates of tumor cells and tumor-infiltrating lymphocytes (TIL) in OSCC specimens were determined by cleaved caspase 3 immunohistochemistry. Results Normal oral epithelia constitutively expressed TRAIL, but expression was progressively lost in OPM and OSCC. Reduction in DcR2 expression levels was noted frequently in OPM and OSCC compared to respective patient-matched uninvolved oral mucosa. OSCC frequently expressed DR4, DR5 and DcR1 but less frequently DcR2. Expression levels of DR4, DR5 and DcR1 receptors were not significantly altered in OPM, primary OSCC and metastatic OSCC compared to patient-matched normal oral mucosa. Expression of proapoptotic TRAIL-receptors DR4 and DR5 in OSCC seemed to depend, at least in part, on whether or not these receptors were expressed in their parental oral epithelia. High DR5 expression in primary OSCC correlated significantly with larger tumor size. There was no significant association between TRAIL-R expression and OSSC histology grade, nodal status or apoptosis rates of tumor cells and TIL. Conclusion Loss of TRAIL expression is an early event during oral carcinogenesis and may be involved in dysregulation of apoptosis and contribute to the molecular carcinogenesis of OSCC. Differential expressions of TRAIL receptors in OSCC do not appear to play a crucial role in their apoptotic rate or metastatic progression.
Collapse
MESH Headings
- Adult
- Biopsy, Needle
- Carcinoma, Squamous Cell/genetics
- Carcinoma, Squamous Cell/physiopathology
- Case-Control Studies
- Cell Death/genetics
- Cell Death/physiology
- Cell Transformation, Neoplastic/genetics
- Cell Transformation, Neoplastic/pathology
- Disease Progression
- Down-Regulation
- Female
- Gene Expression Regulation, Neoplastic/genetics
- Gene Expression Regulation, Neoplastic/physiology
- Humans
- Immunohistochemistry
- Male
- Middle Aged
- Mouth Mucosa/metabolism
- Mouth Mucosa/pathology
- Mouth Neoplasms/genetics
- Mouth Neoplasms/pathology
- Mouth Neoplasms/physiopathology
- Prognosis
- Receptors, TNF-Related Apoptosis-Inducing Ligand/genetics
- Receptors, TNF-Related Apoptosis-Inducing Ligand/metabolism
- Reference Values
- Sensitivity and Specificity
- TNF-Related Apoptosis-Inducing Ligand/genetics
- TNF-Related Apoptosis-Inducing Ligand/metabolism
- Tumor Cells, Cultured
Collapse
Affiliation(s)
- Nadarajah Vigneswaran
- Department of Diagnostic Sciences, The University of Texas Health Science Center at Houston, Dental Branch, Houston, Texas 77030, USA
| | - Darryl C Baucum
- Department of Diagnostic Sciences, The University of Texas Health Science Center at Houston, Dental Branch, Houston, Texas 77030, USA
| | - Jean Wu
- Department of Diagnostic Sciences, The University of Texas Health Science Center at Houston, Dental Branch, Houston, Texas 77030, USA
| | - Yahuan Lou
- Department of Diagnostic Sciences, The University of Texas Health Science Center at Houston, Dental Branch, Houston, Texas 77030, USA
| | - Jerry Bouquot
- Department of Diagnostic Sciences, The University of Texas Health Science Center at Houston, Dental Branch, Houston, Texas 77030, USA
| | - Susan Muller
- Departments of Pathology and Otolaryngology–Head and Neck Surgery, Emory University School of Medicine, Atlanta, Georgia 30322, USA
| | - Wolfgang Zacharias
- Departments of Medicine, Pharmacology & Toxicology, James Graham Brown Cancer Center, University of Louisville, Louisville, Kentucky 40202, USA
| |
Collapse
|
14
|
Akers L, Gordon JS, Andrews JA, Barckley M, Lichtenstein E, Severson HH. Cost effectiveness of changing health professionals' behavior: training dental hygienists in brief interventions for smokeless tobacco cessation. Prev Med 2006; 43:482-7. [PMID: 16920184 DOI: 10.1016/j.ypmed.2006.07.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2005] [Revised: 07/05/2006] [Accepted: 07/10/2006] [Indexed: 11/19/2022]
Abstract
OBJECTIVE Disseminating effective interventions to health care professionals is a critical step in ensuring that patients receive needed advice and materials. This cost effectiveness analysis compared two methods of disseminating an effective protocol for smokeless tobacco cessation intervention. METHOD Interested dental hygienists (N = 1051) were recruited in 20 Western and Midwestern U.S. communities and randomized by community to receive workshop training, self-study with mailed materials, and delayed self-study training, in 1996-98. Hygienists were surveyed about their smokeless tobacco-related activities with patients at baseline and post-intervention. Data on intervention costs were collected, and incremental costs per unit of behavior change were calculated. RESULTS Self-study was more cost effective than workshop training under a wide range of assumptions: change in group versus individual behavior, hygienists' time and travel costs included or excluded, and hygienist wage rates at the national median or substantially lower. However, workshops may be as cost effective in producing behavior change among hygienists earning wages substantially higher than the national median. CONCLUSION Self-study may be a more cost effective method than workshops to achieve behavior change among motivated health professionals.
Collapse
Affiliation(s)
- Laura Akers
- Oregon Research Institute, Eugene, OR 94703, USA.
| | | | | | | | | | | |
Collapse
|
15
|
Gordon JS, Lichtenstein E, Severson HH, Andrews JA. Tobacco cessation in dental settings: research findings and future directions. Drug Alcohol Rev 2006; 25:27-37. [PMID: 16492575 DOI: 10.1080/09595230500459495] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
The hazards associated with cigarette smoking and smokeless tobacco use have been well documented. In addition to its association with many cancers and coronary conditions, tobacco plays a role in the aetiology of a number of oral morbidities. Dental care practitioners are a largely untapped resource for providing advice and brief counselling to tobacco-using patients, and there are good reasons to believe that they can be effective. Data from seven randomised trials indicate there is ample evidence for the efficacy of dental office-based interventions, but adoption of these tobacco cessation activities into practice has been slow. The limited research on dissemination of tobacco interventions is promising, but there is a need to develop and evaluate new methods for encouraging adoption, implementation and maintenance of tobacco interventions into routine dental care. Several studies currently under way may help to increase the effectiveness and dissemination of office-based tobacco cessation programmes into routine dental care. If dental practitioners provided cessation assistance routinely to their patients and achieved even modest success rates, the public health impact would be enormous. Researchers and clinicians must continue to work together towards universal adoption of effective tobacco cessation interventions at each clinical encounter.
Collapse
|
16
|
Savitz DA, Meyer RE, Tanzer JM, Mirvish SS, Lewin F. Public health implications of smokeless tobacco use as a harm reduction strategy. Am J Public Health 2006; 96:1934-9. [PMID: 17018821 PMCID: PMC1751814 DOI: 10.2105/ajph.2005.075499] [Citation(s) in RCA: 62] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Harm reduction strategies involve promoting a product that has adverse health consequences as a substitute for one that has more severe adverse health consequences. Smokeless tobacco low in nitrosamine content offers potential benefits in reducing smoking prevalence rates. Possible harm arises from the potential for such products to serve as a gateway to more harmful tobacco products, public misinterpretation of "less harmful" as "safe," distraction from the public health goal of tobacco elimination, and ethical issues involved in advising those marketing these harmful products. We offer a research agenda to provide a stronger basis for evaluating the risks and benefits of smokeless tobacco as a means of reducing the adverse health effects of tobacco.
Collapse
Affiliation(s)
- David A Savitz
- Department of Epidemiology, School of Public Health, University of North Carolina, Chapel Hill, USA.
| | | | | | | | | |
Collapse
|
17
|
McDowell JD. An Overview of Epidemiology and Common Risk Factors for Oral Squamous Cell Carcinoma. Otolaryngol Clin North Am 2006; 39:277-94. [PMID: 16580911 DOI: 10.1016/j.otc.2005.11.012] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Understanding the epidemiologic picture and the risk factors for oral cancer can help identify and treat patients at risk for oral cancers. Early diagnosis of an oral cancer continues to be important to achieving a favorable prognosis. Absent a diagnosis of oral/pharyngeal cancer, there clearly can-lot be an effective treatment plan. Discovering a potentially malignant or malignant lesion and through biopsy reaching a diagnosis for the lesion begins by performing an examination with the purpose of detecting oral/pharyngeal lesions. An oral cancer screening can be performed in less than five minutes without any expensive diagnostic aids. Despite the ease with which this exam can be performed and the noninvasive nature of the examination,most patients report that they have never had an oral cancer examination. Late stage diagnosis continues to be a common situation resulting in high rates of morbidity and mortality. Without early recognition it seems that the trend of late stage diagnosis will continue. Physicians, dentists, and other health care providers should be performing the oral cancer screening examination on a routine basis for all of their patients.Note: For the interested clinician, the author highly recommends an excellent comprehensive text on the subject of oral cancer. Sol Silverman's(with multiple contributors) The American Cancer Society's Atlas of Clinical Oncology Oral Cancer: Fifth Edition by BC Decker Publishers is an excellent overview of oral cancer covering in greater detail many of the subjects that could not be covered in this brief article. Additionally, there are excellent color photographs of the common presentations of oral malignancies that can be helpful in assessing oral/pharyngeal lesions.
Collapse
Affiliation(s)
- John D McDowell
- Department of Diagnostic and Biological Sciences, Division of Oral Diagnosis, Oral Medicine and Forensic Sciences, University of Colorado School of Dentistry, Mail Stop F844, PO Box 6508 Aurora, CO 80045 USA.
| |
Collapse
|
18
|
Abstract
Head and neck cancer comprises squamous cell carcinomas of the upper aerodigestive tract. There are similarities in their natural history, epidemiology and control. For these cancers premalignant changes can be identified. Smoking and drinking are the major risk factors. The geographical variations in incidence and mortality are indicative of differences in the prevalence of risk factors between countries. The dramatic increase in head and neck cancers is cause for great concern, particularly in Central-Eastern Europe. The great majority of these cancers could be prevented by reducing the prevalence of established risk factors. Screening could be used to detect both precancerous lesions and early invasive cancers; however, no study as yet has demonstrated a reduced incidence and mortality resulting from screening. When setting strategies for prevention, the socioeconomic differentials in incidence and mortality from head and neck cancers need to be taken into account.
Collapse
Affiliation(s)
- Lajos Döbrossy
- Hungarian Chief Medical Officer's Office, H-1097, Budapest, Gyáli ót 2-6, Hungary.
| |
Collapse
|
19
|
|
20
|
Boffetta P, Aagnes B, Weiderpass E, Andersen A. Smokeless tobacco use and risk of cancer of the pancreas and other organs. Int J Cancer 2005; 114:992-5. [PMID: 15645430 DOI: 10.1002/ijc.20811] [Citation(s) in RCA: 122] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Limited data are available on the carcinogenicity of smokeless tobacco products in organs other than the mouth. Snus is a smokeless tobacco product widely used in Norway. We studied 10,136 Norwegian men enrolled since 1966 in a prospective cohort study, 31.7% of whom were exposed to snus. The relative risk of pancreatic cancer for snus use was 1.67 (95% confidence interval [CI] = 1.12, 2.50); that of oral and pharyngeal cancer was 1.10 (95% CI = 0.50, 2.41), that of esophageal cancer was 1.40 (95% CI = 0.61, 3.24), and that of stomach cancer was 1.11 (95% CI = 0.83, 1.48). The relative risks of cancers of the lung (either all histological types or adenocarcinoma), urinary bladder and kidney were not increased among snus users. The increase in the relative risk of pancreatic cancer was similar in former and current snus users and was restricted to current tobacco smokers. Our study suggests that smokeless tobacco products may be carcinogenic on the pancreas. Tobacco-specific N-nitrosamines are plausible candidates for the carcinogenicity of smokeless tobacco products in the pancreas.
Collapse
Affiliation(s)
- Paolo Boffetta
- International Agency for Research on Cancer, 69008 Lyon, France.
| | | | | | | |
Collapse
|
21
|
Affiliation(s)
- Margaret M. Walsh
- Department of Preventive and Restorative Dental Sciences; University of California, San Francisco, School of Dentistry
| | - James A. Ellison
- Department of Preventive and Restorative Dental Sciences; University of California, San Francisco, School of Dentistry
| |
Collapse
|
22
|
Goldenberg D, Lee J, Koch WM, Kim MM, Trink B, Sidransky D, Moon CS. Habitual risk factors for head and neck cancer. Otolaryngol Head Neck Surg 2005; 131:986-93. [PMID: 15577802 DOI: 10.1016/j.otohns.2004.02.035] [Citation(s) in RCA: 79] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
UNLABELLED Chronic tobacco smoking and alcohol consumption are well-established risk factors for the development of squamous cell carcinoma (SCC) of the head and neck. There are, however, a variety of other habitual and culturally based activities that are less commonly seen in the Western world and that are also risks factors for the development of this type of cancer. In this era of globalization, many of these habits have now crossed borders and appear in various areas throughout the world. This article reviews habitual and social risk factors for cancer of the head and neck, excluding smoking and alcohol consumption. These factors include chewing tobacco and snuff, areca nut in its various forms, Khat leaves, and the drinking of Mate. EBM RATING D.
Collapse
Affiliation(s)
- David Goldenberg
- Department of Otolaryngology--Head and Neck Surgery, Johns Hopkins University, Baltimore, Maryland 21205, USA
| | | | | | | | | | | | | |
Collapse
|
23
|
Kaur J, Ralhan R. Establishment and characterization of a cell line from smokeless tobacco associated oral squamous cell carcinoma. Oral Oncol 2003; 39:806-20. [PMID: 13679204 DOI: 10.1016/s1368-8375(03)00084-8] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
A cell line, AMOS-III has been established from the surgically resected specimen of an untreated primary human oral squamous cell carcinoma of the floor of mouth from a chronic smokeless tobacco consumer. Immunocytochemical analysis showed epithelial specific antigen, cytokeratins 5, 10, 13 and 16 and integrin alpha(6) markers in AMOS-III cells, confirming the epithelial lineage of the cell line. Analyses of morphology, ultrastructure, karyotype, anchorage independent growth and immunocytochemical properties of the cell line demonstrated the transformed phenotype of epithelial cells. AMOS-III cells have doubling time of 42-44 h. Giemsa-banding patterns of chromosomes confirmed the human origin of the AMOS-III cells. Molecular analysis of cancer-related gene products, p53 and p21(cip1/waf1) showed the presence of wild type p21(cip1/waf1) and truncated p53 proteins. The molecular mechanism underlying the action of retinoids in preventing the occurrence of second primary tumors in oral cancer patients remain to be clearly defined. Treatment of AMOS-III cells with all-trans retinoic acid (ATRA) at 10(-4) microM resulted in 81% cell death. ATRA treatment resulted in enhanced expression of p21(cip1/waf1), nuclear translocation of retinoic acid receptors and apoptotic cell death. Thus, this cell line provides an in vitro model for elucidating the mechanism involving p53 inactivation and p21(cip1/waf1) overexpression in smokeless tobacco-induced oral cancer. Furthermore, the ATRA responsiveness of the cell line underscores its potential utility in identifying the retinoid responsive molecular targets in oral cancer cells.
Collapse
Affiliation(s)
- Jatinder Kaur
- Department of Biochemistry, All India Institute of Medical Sciences, Ansari Nagar, New Delhi 110029, India
| | | |
Collapse
|
24
|
Abstract
Although smoking cessation continues to get most of the attention from both researchers and practitioners, treatment for smokeless tobacco (SLT) dependence gets little consideration. The reasons are varied, but essentially smoking is more prevalent, has greater public health implications, and has been the subject of clean air laws and environmental issues that have focused the attention on a burned tobacco, thereby leaving SLT with scant public health attention. This is unfortunate, because the sales of SLT products, especially moist snuff, have increased consistently over the past decade; regular use of these products can result in oral cancer, other negative effects on oral health, and nicotine dependence or addiction. This article will review some unique issues of SLT use that affect cessation and the empirical research on interventions.
Collapse
|
25
|
Amarasena N, Ekanayaka ANI, Herath L, Miyazaki H. Association between smoking, betel chewing and gingival bleeding in rural Sri Lanka. J Clin Periodontol 2003; 30:403-8. [PMID: 12716331 DOI: 10.1034/j.1600-051x.2003.20010.x] [Citation(s) in RCA: 40] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To ascertain the association between tobacco use and gingival bleeding in a rural community in Sri Lanka. MATERIAL AND METHODS A cross-sectional field-based study was carried out in 2178 rural males aged 20-60 years, employing a multistage cluster sampling technique. The levels of plaque and gingivitis were recorded on four sites of all teeth present excluding third molars, using the plaque index (PLI) and gingival index (GI). Information pertaining to sociodemographic variables, oral hygiene practices and tobacco consumption habits was obtained from all subjects. RESULTS One-way anova combined with the Bonferroni test disclosed that betel chewers had a significantly higher mean number of sites with gingival bleeding (22.6+/-21.8) than smokers (10.8+/-11.2) and nontobacco users (8.7+/-6.8) (p<0.0001). A higher proportion of betel chewers (55.1%) showed > or =12 bleeding sites compared to smokers (27.6%). Logistic regression analysis revealed that the association between betel chewing and gingival bleeding was positive (OR=2.41; p<0.0001) whereas that of smoking and gingival bleeding was negative (OR=0.75; p<0.05). Oral hygiene had the strongest relationship with gingival bleeding (OR=18.11). CONCLUSION While confirming the masking effect of smoking on gingival bleeding, these findings indicate that betel chewing might significantly enhance gingival bleeding in the population studied.
Collapse
Affiliation(s)
- Najith Amarasena
- Division of Preventive Dentistry, Department of Oral Health Science, Graduate School of Medical and Dental Sciences, Niigata University, Japan.
| | | | | | | |
Collapse
|
26
|
Wetter DW, McClure JB, de Moor C, Cofta-Gunn L, Cummings S, Cinciripini PM, Gritz ER. Concomitant use of cigarettes and smokeless tobacco: prevalence, correlates, and predictors of tobacco cessation. Prev Med 2002; 34:638-48. [PMID: 12052025 DOI: 10.1006/pmed.2002.1032] [Citation(s) in RCA: 114] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
BACKGROUND This study examined the characteristics, tobacco use patterns over time, and predictors of tobacco cessation among concomitant users of cigarettes and smokeless tobacco. METHODS Participants were employed adults residing in the southeastern United States who participated in the Working Well cancer prevention trial. Participants were assessed at baseline and followed-up 4 years later. RESULTS AND CONCLUSIONS The study yielded several key findings: (a) the prevalence of concomitant smoking and smokeless tobacco use was high among males and nonexistent among females, (b) the characteristics of concomitant users were relatively distinct from those of both smokers and smokeless tobacco users, (c) concomitant users exhibited substantial variability in their tobacco use patterns and were less likely to stop using tobacco than were smokers or smokeless tobacco users, (d) indicators of nicotine dependence predicted tobacco cessation for both smokers and smokeless tobacco users, but were largely unrelated to tobacco cessation among concomitant users, and (e) demographics, environmental variables, and measures derived from the transtheoretical model were not consistent predictors of tobacco cessation after controlling for nicotine dependence.
Collapse
Affiliation(s)
- David W Wetter
- The University of Texas M.D. Anderson Cancer Center, Houston, Texas 77030, USA.
| | | | | | | | | | | | | |
Collapse
|
27
|
Spangler JG, Michielutte R, Bell RA, Knick S, Dignan MB, Summerson JH. Dual Tobacco use among Native American adults in southeastern North Carolina. Prev Med 2001; 32:521-8. [PMID: 11394956 DOI: 10.1006/pmed.2001.0835] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE While patterns of smokeless tobacco (ST) use and cigarette smoking are well documented, the epidemiology of simultaneous use of both tobacco products is less well studied, particularly among Native American populations. This study examines correlates of dual tobacco use among Lumbee Indian adults in southeastern North Carolina. METHODS A telephone survey among 400 adult Lumbee Indians in Pembroke, North Carolina, collected information on demographics, current tobacco use, amounts of tobacco used, and tobacco related attitudes. RESULTS Total of 241 (60.3%) individuals did not currently use tobacco, 104 (26%) currently smoked, 74 (18.5%) currently used ST, and 19 (4.8%) used both products. Thus, 19 of 104 (18.3%) current smokers and 19 of 74 (25.7%) current ST users reported dual tobacco use. Compared to exclusive users of either tobacco product, dual tobacco users were intermediate in age and frequency of church attendance, had lower levels of education, and were the highest proportion of subjects reporting no friends and few close relatives. There was no difference by gender or marital status by tobacco use categories. While exclusive cigarette smokers reported smoking more cigarettes per day than dual tobacco users, overall, dual tobacco users had higher estimated daily nicotine exposure levels. Logistic regression analysis showed that younger age and infrequent church attendance predicted exclusive cigarette smoking, while older age and less education predicted exclusive ST use. Dual tobacco use was predicted only by less education. CONCLUSIONS Simultaneous use of ST and cigarettes is comparatively more common among Lumbee Indian adults than the general population and has an epidemiology distinct from either exclusive cigarette smoking or ST use. These data are the first to explore social support as well as tobacco-related attitudes among dual tobacco users in a Native American population. Recognition of these patterns of dual tobacco use would be important in any future tobacco intervention among Lumbee Indian adults.
Collapse
Affiliation(s)
- J G Spangler
- Department of Family and Community Medicine, Wake Forest University School of Medicine, Medical Center Boulevard, Winston-Salem, North Carolina 27157, USA.
| | | | | | | | | | | |
Collapse
|
28
|
Abstract
Tobacco use continues to occur in epidemic proportions and with it, significant morbidity and mortality. One third of smokers will die prematurely of a smoking-related disease. This article reviews the adverse health effects of tobacco use so that clinicians can be aware of the benefits patients will reap when they stop using this lethal substance.
Collapse
Affiliation(s)
- B E Mitchell
- Resident, General Preventive Medicine Residency, Johns Hopkins University School of Hygiene and Public Health, Baltimore, Maryland 21205, USA
| | | | | |
Collapse
|
29
|
Abstract
Smokeless tobacco use is increasing in the United States, especially among young men, but there are few resources to assist users in quitting their use of moist snuff or chewing tobacco. This article reviews some unique aspects of smokeless tobacco use and provides a systematic four-step clinical plan for providing cessation. The authors provide clear suggestions, measures, and aids for getting the user ready to quit, planning their quit, quitting, and staying quit. The procedures and measures have been validated in randomized clinical trials and provide empirical support for the recommended cessation procedures. Finally, a review of brief cessation interventions in the context of health care is provided.
Collapse
Affiliation(s)
- H H Severson
- Senior Research Scientist, Oregon Research Institute, Eugene, Oregon 97403-1983, USA.
| | | |
Collapse
|
30
|
Abstract
The prevalence of smokeless tobacco is significant and reaches as high as 17% past month use in white males aged 18-25. Smokeless tobacco use is of concern because of the potential for addiction and the associated negative health consequences. This article reviews the basis for addiction to smokeless tobacco, examining the nicotine content in smokeless tobacco products, pharmacokinetics, psychoactive effects, tolerance, and withdrawal. It also explores the negative health consequences which include a number of oral pathologies and increased cardiovascular risk factors. Furthermore, it examines the factors associated with the initiation of smokeless tobacco use, and the current prevention programs that address these factors. Current smokeless tobacco treatment approaches are also discussed as well as predictors for abstinence. Finally, the future directions are discussed in light of the limited amount of research that has been conducted in the smokeless tobacco area, particularly related to prevention and treatment.
Collapse
Affiliation(s)
- D K Hatsukami
- Department of Psychiatry, University of Minnesota, Minneapolis 55455, USA.
| | | |
Collapse
|
31
|
Bouquot JE, Meckstroth RL. Oral cancer in a tobacco-chewing US population--no apparent increased incidence or mortality. ORAL SURGERY, ORAL MEDICINE, ORAL PATHOLOGY, ORAL RADIOLOGY, AND ENDODONTICS 1998; 86:697-706. [PMID: 9868728 DOI: 10.1016/s1079-2104(98)90207-4] [Citation(s) in RCA: 22] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
OBJECTIVE Smokeless tobacco use is an accepted risk factor for oral cancer in the United States, but the major proof of this is based largely on a single epidemiologic (case-control) comparison of women, whereas the chewing of tobacco is predominantly a habit of men. The present investigation sought to compare gender-specific oral cancer mortality and incidence rates in West Virginia, the state with the highest per capita consumption of smokeless tobacco, with rates from other states and with the US average rates. It was hypothesized that the cancer rates for West Virginia males would be significantly greater than the US average and greater than the rates for states with less smokeless tobacco consumption. STUDY DESIGN Data from the West Virginia Cancer Registry for the years 1993 through 1995 were compared with data from contemporary Surveillance and Epidemiology End Results for the US (with respect to incidence) and from the Center for Disease Control and Prevention's National Center for Health Statistics (with respect to mortality). RESULTS The average annual incidence rates (per 100,000 population) for oral/pharyngeal cancer in West Virginia males and females were 13.4 and 5.1, respectively; these compared with rates of 15.4 and 5.7 for the US. The average annual mortality rates (per 100,000 population) for the disease in West Virginia males and females were 4.2 and 1.6, respectively; these compared with 4.4 and 1.5 for the US. West Virginia oral/pharyngeal mortality rates for both genders were statistically significantly lower than US rates throughout the years 1950 through 1980. Among other potential oral cancer etiologic factors, the very low prevalence of alcohol abuse in West Virginia seemed to be relevant. CONCLUSIONS The hypothesis was not confirmed by data analysis. West Virginia is the state with the highest per capita consumption of smokeless tobacco, yet it has less oral/pharyngeal cancer than the US average. The authors strongly urge additional and improved epidemiologic evaluation of the oral cancer risk of smokeless tobacco use in US males.
Collapse
Affiliation(s)
- J E Bouquot
- Maxillofacial Center, Morgantown, WV 26508-8847, USA
| | | |
Collapse
|