Distribution and disparities of healthy lifestyles and noncommunicable diseases risk factors between men and women aged 20-59 years in Bangladesh: Evidence from a nationwide survey

Background

Noncommunicable diseases (NCDs) are public health threats globally and recognized impediments to socioeconomic development. This study aimed to identify the prevalence and clustering of NCDs risk factors among Bangladeshi men and women aged 20-59 years using nationally representative data.

Methods

This study was conducted in 82 rural, nonslum urban, and slum clusters across all eight administrative divisions of Bangladesh using multistage cluster sampling. A total of 4917 men and 4905 women aged 20-59 years were included in the study. Descriptive analyses were performed to report the prevalence and distribution of behavioral and clinical risk factors. Multivariable binary logistic regression was performed to identify factors associated with the coexistence of three or more NCD risk factors.

Results

The prevalence of tobacco use (any form), insufficient physical activity, inadequate fruit and vegetable consumption, overweight and obesity, and central obesity were 38.3%, 13.6%, 87.1%, 42.3%, and 36.0%, respectively. Furthermore, 21.9% and 4.9% participants had hypertension and self-reported diabetes, respectively. Regarding the clustering of risk factors, 37.1% men and 50.8% women had at least three NCD risk factors. Only 3.0% men and 1.8% women reported no NCD risk factors. Age, place of residence, education, and wealth status were associated with the presence of at least three risk factors for both sexes.

Conclusion

Since a large proportion of Bangladeshi 20-59 years old population had multiple risk factors, population-based programs with multisectoral approaches are essential to reduce NCDs among Bangladeshi women and men.

Nested multilevel modelling study of smoking and smokeless tobacco consumption among middle aged and elderly Indian adults: distribution, determinants and socioeconomic disparities

INTRODUCTION

The Global Adult Tobacco Survey (GATS) shows a drop in tobacco use worldwide. Despite the drop, there still continues to be a significant number of tobacco users in India. Research on tobacco use among young persons is commonly prioritised in India, while studies on tobacco use among middle-aged (45-59 years) and elderly (≥ 60 years) adults are noticeably lacking. We have conducted this study with objective to estimate the distribution, determinants and socioeconomic inequalities of smoking (SM) and smokeless tobacco (SLT) consumption across Indian states and union territories.

METHODS

This study was based on 66,606 participants aged ≥ 45 years using Longitudinal Aging Study in India (LASI)-1 (2017-2018) data. Distribution of tobacco consumption (any form, smoking (SM), smokeless (SLT) and both) was documented as per Indian states and union territories with spatial distribution by Indian map. Demographic, socioeconomic, health related and behavioural determinants were established using nested multilevel regression modelling. Socioeconomic disparities were documented using concentration curve. P-value < 0.05 was considered as statistically significant.

RESULTS

Overall, 36.78% participants documented using any form of tobacco; with higher consumption of SLT (19.88%) than smoking/SM (13.92%). Only 2.98% consumed both. Mizoram had highest consumption of tobacco in any form (78.21%) and smoking (35.18%). Elderly participants had higher odds of consuming tobacco (any 1.23 (1.18-1.28), SM 1.99 (1.14-1.27), SLT 1.08 (1.03-1.14) and both 1.27 (1.14-1.40 times) than middle aged participants. Females, OBC (other backward castes), urban residence had lower odds in all the categories, while being widow/ separated/ divorced, belonging to Muslim community, having clerical and skilled occupation, poor self-rated health, comorbidity and multimorbidity had higher odds. With decrease in the wealth index, educational status and frequency of physical activity the odds of tobacco consumption increased. The odds of higher tobacco consumption were documented from northeast region (2.56 (2.37-2.76) higher than north). Alcohol consumption had the highest odds (4.94 (4.69-5.21)). Participants exposed to media had lower odds (11% lower) of consuming tobacco. The socioeconomic inequalities in tobacco consumption were significantly distributed more among the poorest (any -0.064 (-0.072 to -0.056) and SLT -0.069 (-0.072 to -0.056)).

CONCLUSION

Prioritising tobacco prevention and increasing availability and accessibility of cessation programmes that are suited with unique requirements and circumstances, even for elderly population, are essential focusing on the higher determinants across poorest section in the country.

Assessment of burden of prediabetes and diabetes with oral glucose tolerance test in community-based settings of Bengaluru rural district

Background and Objectives

Diabetes is a major public health concern in India. The majority of studies done in rural population lack systematic methodology in estimating the prevalence of diabetes mellitus. Objectives of this study were to estimate the burden of prediabetes, type 2 diabetes mellitus and its associated risk factors among adults (18-69) years in rural Bengaluru, Karnataka.

Methods

A cross-sectional study was conducted among adults aged 18-69 years in three villages of Devanahalli taluk of rural Bengaluru between May and October 2019. Behavioural and metabolic risk factors related to diabetes were assessed using WHO-STEPS instrument and IDSP-NCD risk factor tool. Fasting blood glucose and OGTT test were performed, and WHO diagnostic criteria were used to diagnose diabetes mellitus.

Results

Prevalence of prediabetes and type 2 diabetes (T2DM) in rural Bengaluru was found to be 6.3% and 10.9%, respectively. Behavioural risk factors related to diabetes measured in the study population were current tobacco use (32.7%), current alcohol use (9.9%), physical inactivity (46.8%) and unhealthy diet (82.3%). Metabolic risk factors measured were obesity (7.5%), central obesity (46.4%), prediabetes (6.3%) and hypertension (24.3%). More than one-thirds of diabetes and three-fourths of hypertension individuals were newly diagnosed by the population-based screening.

Conclusion

The burden of diabetes and its risk factors are high due to the health transition occurring in rural population of Bengaluru. Undiagnosed diabetes mellitus and hypertension in rural population as demonstrated by this study highlight the need to strengthen the population-based screening and diagnosis of T2DM and hypertension (HTN) under the national health programme.

Awareness and Attitude Towards Tobacco Products and Tobacco Industry and Perception about Government's Role in Tobacco Control among the Adult Rural Population: A Cross-sectional Study in the Indian State of Bihar

Background

Attitudes and impressions toward the tobacco industry and tobacco products among the general public are important determinants for curbing the menace of the tobacco epidemic. Accordingly, this study aimed to assess the knowledge and perceptions about the tobacco industry and tobacco products and analyze attitudes towards social denormalization (SD) of tobacco use and tobacco industry denormalization (TID) among the rural population of Bihar, India.

Methods

This community-based cross-sectional survey was conducted on 421 adults aged 18 to 65 years who were selected using multistage systematic random sampling in a rural area of Bihar State in India from January to March 2022. Results were presented as proportions and the factors associated with support for TID and SD were identified using the chi-square test and binary logistic regression.

Findings

Out of 421 participants, 342 (81.2%) did not consider smokeless tobacco to be very dangerous. Nearly half (192, 45.6%) of the individuals believed that tobacco companies never tell the truth about the ill effects of tobacco use on health. Maximum, 345 (89.5%) also believed that the tobacco industry is responsible for adverse health effects of tobacco use and that the government should sue them. The prevalence of favorable attitudes toward TID and SD was found to be 55.1% [95% CI: 50.3% - 59.8%] and 38.2% [95% CI: 33.7% - 42.9%], respectively.

Conclusion

One out of every two and one out of every three individuals showed favorable attitudes toward TID and SD, respectively. There is a need to inform and educate the public on the ill effects of tobacco and the deceptive strategies used by the tobacco industry to help them choose health over tobacco.

The crossroads of work and home: linkages between smoke-free policies at work and household environments

BACKGROUND

Tobacco use causes over eight million global deaths annually, with seven million directly attributed to tobacco use and 1.2 million to second hand smoke (SHS). Smoke-free environments are crucial to counter SHS. Although India banned smoking in public places in 2008, SHS exposure remains high. Studies have noted that limiting smoking in workplaces, restaurants, etc., helps to reduce overall smoking and reduce SHS exposure. Under this background, the study explores the linkages between smoke-free workplaces and living in smoke-free homes in India.

METHODS

The two rounds of the GATS India (2009-10 and 2016-17) have been used for the study. The study focuses on male tobacco smokers working indoors or outdoors or both indoors and outdoors. The sample for the study was 2,969 for GATS 1 and 2,801 for GATS 2. Dependent variables include living in a smoke-free home, while the independent variables were adherence to a smoke-free office policy and socio-demographic variables. The two rounds of the GATS data were pooled for analysis. Statistical analysis involves bivariate and multivariate analysis.

RESULTS

Findings reveal that 41% of respondents worked in smoke-free workplaces in GATS 2. Nationally, smoke-free homes increased from 35% in 2009-2010 to 44% in 2016-17. Individuals with smoke-free workplaces were more likely to have smoke-free homes. The Southern region consistently exhibited the highest proportion of smoke-free homes. Urban areas and higher education correlated with increased smoke-free homes. Logistic regression analysis confirmed that workplace smoke-free status is a significant predictor of smoke-free homes. In GATS 2, respondents aged 30 years and above were less likely to have smoke-free homes, while education and Southern region residence positively influenced smoke-free homes.

CONCLUSIONS

The correlation between smoke-free workplaces and smoke-free homes is linked to stringent workplace no-smoking policies, potentially deterring individuals from smoking at home. Opportunities exist for the expansion and stringent implementation of the smoke-free policies among Indian working adults, leveraging the workplace as a key setting for evidence-based tobacco control. The study highlights positive trends in India's smoke-free homes, crediting workplace policies. Effective policies, education, and regional strategies can advance smoke-free homes, stressing the pivotal role of workplace policies and advocating broader implementation.

Prevalence, regional patterns and socio-demographic factors associated with poly-tobacco use in India: A secondary data analysis

BACKGROUND

Tobacco use is associated with early, intermediate and long-term complications throughout the life course. With an influx of newer products containing nicotine, poly-tobacco use is slowly emerging as a public health concern, that is defined as existing tobacco users currently using two or more tobacco or nicotine products. While many studies have investigated single use tobacco, there is a paucity of research on regional patterns and socio-demographic factors associated with poly-tobacco use in India.

OBJECTIVES

To assess prevalence of poly-tobacco use and determine the socio-demographic factors associated with poly-tobacco use in India.

METHODS

Data from the Global Adult Tobacco Survey 2 (GATS, 2016-17) was analysed, which included information on tobacco use among people aged >15 years. The pattern of current tobacco status was described using descriptive statistics. Multiple logistic regression models were estimated to determine factors associated with poly-tobacco use.

RESULTS

The prevalence of poly-tobacco use in India was found to be 9.8%. Among the current tobacco users, the prevalence was 33%. Significant socio-demographic factors associated with poly-tobacco use included younger age, male gender, religion and backward caste. North-eastern region reported highest prevalence of poly-tobacco use in the country, followed by the central region.

CONCLUSION

The number of poly-tobacco users in India is considerably high and a matter of concern, more so in north east and central regions of the country. There is a need to create awareness about dangerous effects of all types of tobacco products and strengthen implementation of tobacco control policies with special focus on regions with high burden.

Prevalence of major non-communicable diseases and their associated risk factors in Afghanistan: a systematic review and meta-analysis

Background

Non-communicable diseases (NCDs) are the leading cause of mortality worldwide, and increasingly so in low- and middle-income countries. Afghanistan is dealing with a double burden of diseases, yet there has been no evidence synthesis on the prevalence of major NCDs and their risk factors.

Objective

This study aims to provide a comprehensive synthesis of the existing data on the prevalence of major NCDs and the common related risk factors in Afghanistan.

Method

We systematically reviewed scientific articles from 2000 to 2022 that reported the prevalence of diabetes, chronic respiratory diseases (CRDs), cardiovascular diseases (CVDs) or cancer, and their risk factors in Afghanistan. Four online databases (PubMed, Web of Science, Cochrane and Google Scholar) and two local journals in Afghanistan (not indexed online) were systematically searched and screened. Two reviewers independently screened and appraised the quality of the articles. Data extraction and synthesis were performed using tabulated sheets.

Results

Among 51 eligible articles, 10 (19.6%) focused on cancer, 10 (19.6%) on diabetes, 4 (7.8%) on CVDs, 4 (7.8%) on CRDs and 23 (45.1%) on risk factors as the primary outcome. Few articles addressed major NCD prevalence; no evidence of CVDs, cancer was 0.15%, asthma ranged between 0.3% and 17.3%, and diabetes was 12%. Pooled prevalence of hypertension and overweight were 31% and 35%, respectively. Central obesity was twice as prevalent in females (76% versus 40%). Similarly, gender differences were observed in smoking and snuff use with prevalence rates of 14% and 25% among males and 2% and 3% among females, respectively. A total of 14% of the population engaged in vigorous activity. Pooled prevalence for physical inactivity, general obesity, fruit and vegetable consumption, dyslipidaemia and alcohol consumption couldn't be calculated due to the heterogeneity of articles.

Conclusion

Only little evidence is available on the prevalence of major NCDs in Afghanistan; however, the NCD risk factors are prevalent across the country. The quality of the available data, especially those of the local resources, is poor; therefore, further research should generate reliable evidence in order to inform policymakers on prioritizing interventions for controlling and managing NCDs.

Enzyme ChE, cholinergic therapy and molecular docking: Significant considerations and future perspectives

Enzyme Che plays an essential role in cholinergic and non-cholinergic functions. It is present in the fertilized/unfertilized eggs and sperm of different species. Inclusion criteria for data collection from electronic databases NCBI and Google Scholar are enzyme AChE/BChE, cholinergic therapy, genomic organization and gene transcription, enzyme structure, biogenesis, transport, processing and localization, molecular signaling and biological function, polymorphism and influencing factors. Enzyme Che acts as a signaling receptor during hematopoiesis, protein adhesion, amyloid fiber formation, neurite outgrowth, bone development, and maturation, explaining the activity out of synaptic neurotransmission. Polymorphism in the Che genes correlates to various diseases and diverse drug responses. In particular, change accompanies cancer, neurodegenerative, and cardiovascular disease. Literature knowledge indicates the importance of Che inhibitors that influence biochemical and molecular pathways in disease treatment, genomic organization, gene transcription, structure, biogenesis, transport, processing, and localization of Che enzyme. Enzyme Che polymorphism changes indicate the possibility of efficient and new inhibitor drug target mechanisms in diverse research areas.

MPOWER Measures and Its Effect on Tobacco Control: A Cross-sectional Comparison of Global Adult Tobacco Surveys, India

OBJECTIVES

To study the MPOWER measures over time (GATS-1 vs GATS-2) and their effects on tobacco control indicators in India.

STUDY DESIGN AND METHODS

The study used a cross-sectional design to compare the common questions identified from GATS-1 and GATS-2. Odds ratios for various MPOWER measures were estimated using a multivariate logistic regression model.

RESULTS

Compared with GATS-1, the current any tobacco use was reduced by 32% in females and 17% in males in GATS-2 (M-measures). The P-measures have reduced across the survey periods. Under O-measures, compared with mixed users, only the male smokeless tobacco (SLT) users reported receiving more advice from a doctor to quit and reported trying more to stop SLT use. Compared with never users (W-measures), the health warnings were noticed on SLT products more by past users, smokers (males), and SLT users, while it was noticed on cigarette packages more by male past users and smokers. Promotion (E-measures) of cigarette and bidi was reported more by smokers (including mixed users), and promotion of SLT product was reported more by smokers (including mixed users) and male SLT users than by never users.

CONCLUSION

Overall, MPOWER measures have shown improvement, with most changes highly reported by the never users and past users than by the current tobacco users. Stringent methods for the enforcement of MPOWER measures to reach all forms of tobacco users and integration of the National Tobacco Control Programme with other national health programs are imperative for highest achievements. Also, specific targeted strategies for the effective control of SLT use are highly recommended to be included in the MPOWER package.

Social determinants of tobacco use among tribal communities in India: Evidence from the first wave of Longitudinal Ageing Study in India

BACKGROUND

Evidence on tobacco use among indigenous communities is scarce with available literature based either on a specific region or a particular tribe. Considering the large tribal population in India, it is pertinent to generate evidence on tobacco use among this community. Using nationally representative data, we aimed to estimate the prevalence of tobacco use and assess its determinants and regional variations among older tribal adults in India.

METHODS

We analysed data from Longitudinal Ageing Study in India (LASI), wave-1 conducted in 2017-18. A sample of 11,365 tribal individuals aged ≥ 45 years was included in this study. Descriptive statistics was used to assess the prevalence of smokeless tobacco (SLT), smoking, and any form of tobacco use. Separate multivariable regression models were executed to assess the association of various socio-demographic variables with different forms of tobacco use, reported as adjusted odds ratio (AOR) with 95% confidence interval.

RESULTS

The overall prevalence of tobacco use was around 46%, with 19% of smokers and nearly 32% smokeless tobacco (SLT) users. Participants from the lowest MPCE quintile group had a significantly higher risk of consuming (SLT) [AOR: 1.41 (95% CI: 1.04-1.92)]. Alcohol was found to be associated with both smoking [AOR: 2.09 (95% CI: 1.69-2.58)] and (SLT) [AOR: 3.05 (95% CI: 2.54-3.66)]. Relatively higher odds of consuming (SLT) were associated with the eastern region [AOR: 6.21 (95% CI: 3.91-9.88)].

CONCLUSION

This study highlights the high burden of tobacco use and its social determinants among the tribal population in India, which can help tailor anti-tobacco messages for this vulnerable population to make tobacco control programs more effective.

Smoke-free status of homes and workplaces among Indian people: Evidence from Global Adult Tobacco SurveyData-2016/2017

AIMS

This study aimed to determine the impact of correlates on tobacco control/smoke-free status of homes and workplace among Indian people. To assess the magnitude of the problem, the relationship between smoke-free status and secondhand smoke (SHS) exposure was also explored.

METHODS

Data was extracted from the Global Adult Tobacco Survey Data (GATS)-2017. It was a household survey that included people aged 15 years or older and covered all 30 states and 2 Union Territories (UTs) of India. A logistic regression model was used to determine the correlates of smoke-free status of homes and workplaces. Additionally, the Pearson correlation was used to explore the relationship between smoke-free status and the proportion of participants exposed to SHS both at homes and in the workplaces.

RESULTS

The overall prevalence of smoke-free status in the home and workplace was 62.8% and 51.7%, respectively. Results of multivariate analysis (Logistic regression) illustrated that indicators like tobacco smoking status, place of residence, region, education, occupation, wealth quintile, and knowledge status about children's illness were significantly associated with the respondent's intention to live in a completely smoke-free environment both at home and in the workplace in India. This study revealed that SHS exposure was significantly negatively associated with a smoke-free status.

CONCLUSION

This study will help the policymakers to promote efficient policies for improving smoke-free status and to ensure a better environment both at home and in the workplace in India.

Impact of Covid-19 on Caller Characteristics and Quit Rates: Experience of Regional Tobacco Quitline From India

BACKGROUND

The tobacco epidemic is a major health concern amplified by Covid-19. We aimed to study differences in caller profiles to the regional tobacco quitline services of South India during the Covid-19 pandemic in comparison with the prepandemic.

METHOD

Using a descriptive cross-sectional research design, we examined registered caller profiles to the quitline between March and July 2019 (Prepandemic N = 7845) and the same months in 2020 (Covid-19 pandemic phase N = 6447) phases.

RESULTS

The proportion of registered callers with an expressed intent to quit tobacco increased by 1.73 times during pandemic (16.7% versus 9.6%). Health concerns were cited as the major reason (93.25%) to quit tobacco in 2020 as compared to 2019 (88.02%). Cough (28.50%) and psychological difficulties (14.20%) were reported significantly more by RCs in 2020. Self-reported quit rates were significantly higher among RCs in 2020 as compared to 2019 on the quit day (2019-47.37% & 2020-77.54%, p = .001), at one week (2019-25.17% and 2020-56.06%, p = .001) as was one-month continuous abstinence (2019-11.88% and 2020-39.60%, p = .001).

CONCLUSION

The pandemic resulted in a greater intent to quit among registered callers to the quitline. However, awareness about the quitline services as well as other tobacco cessation services needs to be expanded to reach more tobacco users.

IMPLICATIONS

Pandemics offer an opportunity to change health risk behaviors. During the Covid-19 pandemic, callers to the tobacco quitline were more motivated to quit tobacco and attributed it to concerns about the health risks from tobacco use, particularly during the pandemic. Quit rates also increased significantly during the pandemic as compared to before. These gains in encouraging tobacco cessation need to be maintained beyond the pandemic by strengthening existing quitlines and other supports for tobacco cessation.

E-cigarettes: A continuing public health challenge in India despite comprehensive bans

India has introduced comprehensive e-cigarette bans focused on protecting youth from vaping-related harm. Despite these bans, educated young people appear to be a relatively high user group, although little is known about their usage patterns. The aims of the present study were to examine educated young adults' e-cigarette-related attitudes and behaviors and their support for various e-cigarette control policies. In total, 840 tertiary-educated young adults completed an online survey. Demographic characteristics, e-cigarette and tobacco use, beliefs about e-cigarettes, exposure to e-cigarette advertising, sources of access to e-cigarettes, numbers of family members and peers who vape, and support for a range of e-cigarette policies were assessed. One-third (33%) reported never having heard of e-cigarettes/vapes, 23% reported ever using e-cigarettes, 70% reported ever using tobacco, and 8% were dual users of both e-cigarettes and tobacco. Only 8% of e-cigarette users reported daily use. Vapers sourced e-cigarettes from retail outlets (vape shops, tobacconists) and their social networks (friends, siblings). Just under two-thirds of those who were aware of e-cigarettes believed them to be harmful and to contain chemicals. Among non-users, 31% were curious about using e-cigarettes and 23% intended to use in the following year, indicating high levels of susceptibility. The results suggest that despite a complete ban, young people are still able to access e-cigarettes in India. Greater education about harms associated with vaping and more intensive monitoring and enforcement could assist in reducing uptake in relatively high-prevalence groups such as educated young adults.

Profiles of tobacco product use and related consumer characteristics in the US and Israel: A multiple-group latent class analysis

Despite tobacco marketing diversification, limited research has examined use profiles across countries, particularly in relation to consumer values (e.g. appeal of innovation, conscientiousness). Using 2021 data, latent class analysis assessed past-month use of seven tobacco products (cigarettes, electronic cigarettes [e-cigarettes], heated tobacco products, cigars, hookah, pipe, smokeless) among adults reporting past-month use in the United States (US n = 382) and Israel (n = 561). Multivariable multinomial regression examined consumer values and sociodemographics in relation to country-specific class membership. US classes included: primarily cigarette 58.1%; e-cigarette-no cigarette 17.5%; primarily cigar 14.9%; and poly-product 9.9%. Higher innovation correlated with e-cigarette-no cigarette and poly-product (vs. primarily cigarette) use. Other correlates included being: younger with e-cigarette-no cigarette; male, Black, and more educated with primarily cigar; and Black and Asian (vs. White) with poly-product. Israel classes included: primarily cigarette 39.0%; moderate poly-product 40.3%; high poly-product 13.4%; and hookah 7.3%. Lower conscientiousness correlated with moderate poly-product (vs. primarily cigarette) use; higher innovation correlated with high poly-product; lower innovation correlated with hookah. Other correlates included being: younger, male, and more educated with moderate poly-product; male and sexual minority with high poly-product; and Arab with hookah. Tobacco consumer segments within and across countries likely reflect different consumer values and industry marketing targets.

Marital Disruption and Disparity in Tobacco Use in Reproductive-Aged Women: Evidence from India

Marital disruption defined as widowhood, divorce, or separation, has adverse consequences for women’s health and wellbeing. Extant evidence, however, is primarily available for older women or in developed country settings. Consequences of marital disruption for younger women in the developing countries is relatively less visited. The aim of this cross-sectional study is to assess whether maritally disrupted women of reproductive age (18–49 years) had differential risk of tobacco-use compared to their married counterparts. Using nationally representative data from India, we estimated multivariable logistic regressions to obtain the odds in favor of tobacco-use for maritally disrupted women. We found that compared to women remained in marriage, maritally disrupted women were 1.5 times (95% CI: 1.4–1.6) more likely to consume tobacco. The higher risk of tobacco-use of maritally disrupted women was evident in both younger (age 18–34) and older (age 35–49) cohorts. The results were robust across urban and rural areas, high- and low- education groups, and poor- and non-poor households. The higher odds of tobacco-use among maritally disrupted women persisted even after accounting for household fixed effects. The study findings thus, have implications for strengthening targeted tobacco control policies and health promotion among maritally disrupted women in low-and-middle income countries.

Gender dimensions of youth vulnerability toward access to cigarettes in South-East Asia: Evidence from global youth tobacco survey

Background

Youths are lured to smoking to make them tobacco customers. Limiting access to tobacco products by youths is a proven strategy to reduce youth tobacco use. This study aimed to examine the burden of cigarette smoking and access to tobacco by youth in South-East Asia (SEA).

Methods

The burden along with the physical (methods of obtaining cigarettes), financial (cigarette affordability by pocket money), and illegal (sale to minors) access to cigarettes among school-going boys and girls were examined by analyzing the Global Youth Tobacco Survey (GYTS) data (2013-2016) from seven SEA member countries. Descriptive statistics using country-specific GYTS sample weight was used to estimate parameters with 95% confidence intervals.

Results

The proportion of youths reporting cigarette smoking was highest in East Timor [boys: 55.57 % (51.93-59.21) and girls: 11.35% (9.12-13.59)] and lowest in Sri Lanka [boys: 2.96% (2.91-3.0) and girls: 0%]. Smoking prevalence was higher among boys than girls. Smoking among boys and girls was positively correlated (r = 0.849, p = 0.032). The most common method of obtaining cigarettes was "buying it from a store/kiosk/street hawker" and "other sources." Except in Indonesia, financial access was limited for most youths. Financial access had a positive but negligible influence on cigarette smoking. Despite legal restrictions on sales to minors, students could obtain cigarettes from vendors.

Conclusion

Contextual cigarette smoking and access to cigarettes by youths despite the legal ban and unaffordability is a concern. Country-specific socio-cultural-economic and legal dimensions need to be examined to limit cigarette use among youths.

Epidemiology and Economic Burden of Continuing Challenge of Infectious Diseases in India: Analysis of Socio-Demographic Differentials

Unlike other low- and middle-income countries, infectious diseases are still predominant, and non-communicable diseases (NCDs) are emerging without replacing the burden of infectious diseases in India, where it is imposing a double burden of diseases on households in the country. This study aimed to analyse the socio-economic and demographic differentials in the magnitude of economic burden and coping strategies associated with health expenditure on infectious diseases in India. National Sample Survey Organization (NSSO) data on “Key Indicators of Social Consumption in India: Health, (2017–18)” have been employed in this study. The findings of the study revealed that more than 33% of the individuals are still suffering from infectious diseases out of the total ailing population in India. Based on the various socio-economic and demographic covariates, infectious diseases are highly prevalent among individuals with marginalized characteristics, such as individuals residing in rural areas, females, 0–14 age groups, Muslims, illiterates, scheduled tribes (STs), and scheduled castes (SCs), large family households, and economically poor people in the country. The per capita out-of-pocket (OOP) expenditure on infectious diseases is INR 7.28 and INR 29.38 in inpatient and outpatient care, respectively. Whereas, monthly per patient OOP expenditure on infectious diseases by infection-affected populations is INR 881.56 and INR 1,156.34 in inpatient and outpatient care in India. The study found that people residing in rural areas, SCs followed by other backward classes (OBCs), illiterates, poor, and very poor are more dependent on borrowings, sale of assets, and other distressed sources of financing. However, under National Health Policy 2017, many initiatives, such as “Ayushman Bharat,” PM-JAY, and National Digital Health Mission (NDHM) in 2021, have been launched by the government of India in the recent years. These initiatives are holistically launched for ensuring better health facilities, but it is early to make any prediction regarding its outcomes; hopefully, the time will define it over the passing of a few more years. Finally, the study proposed the need for proper implementations of policy initiatives, awareness against unhygienic conditions and contamination of illnesses, immunisations/vaccination campaigns, subsidized medical facilities, and the country's expansion of quality primary health-care facilities.

Sociodemographic correlates of cervix, breast and oral cancer screening among Indian women

INTRODUCTION

Cervix, breast and oral cancers account for about one-third of all cancers in India which as a group is a major contributor to all non-communicable disease-related morbidity and mortality among women. Existing evidence suggests that early diagnosis plays a pivotal role in the prevention and intervention of these cancers, and many community-based early screening and awareness programs have been in place in developed countries. Currently, there is not enough research evidence regarding the sociodemographic correlates of cervix, breast and oral cancer screening among Indian women. In the present study, we aimed to assess the self-reported percentage and sociodemographic factors associated with the use of these three types of cancer screening services among Indian women aged 15-49 years.

METHODS

Data were collected from National Family Health Survey conducted during 2015-16. Sample population was 699,686 women aged 15-49 years. Associations between self-reported cervical, breast and oral cancer screening status and the associated sociodemographic factors were analyzed using multivariable logistic regression methods.

RESULTS

The percentage of screening for cervical (21%), breast (8.95%), and oral cancers (13.45%) varied significantly across the population sub-groups. Higher age, urban residence, higher education, having employment, health insurance, use of electronic media, higher household wealth quintile, having healthcare autonomy, showed a positive effect on taking screening services. Further analyses revealed that the strength of the associations varied considerably between urban and rural residents, denoting the need for region-specific intervention strategies. Sex of household head, age, watching TV, using radio, and having health insurance were the most significant contributors to the outcome effects.

CONCLUSIONS

The present study provides important insights regarding the current scenario of seeking cancer screening services among women in India. These findings could inform policy analysis and make an avenue for further in-depth analysis for future studies. Our findings conclude that cancer prevention policies should focus on leveraging the positive effects of better socioeconomic status, employment, health insurance ownership, exposure to electronic media, and better healthcare autonomy to improve the cancer screening service uptake among Indian women.

The association between the retail price of manufactured cigarettes and bidis on current smoking status in India

INTRODUCTION

In India, the retail prices of bidis and cigarettes varied between the two Global Adult Tobacco Surveys (GATS) conducted in 2009-2010 and 2016-2017. The relationship between the retail price of smoked tobacco products and their use is unclear for India. Our study thus aimed to use available datasets to investigate the association between the retail price and current smoking status of bidis and cigarettes in India.

METHODS

Current smoking status data for bidis and cigarettes were obtained from the two GATS rounds. The average state-level retail prices of bidis and cigarettes were obtained from India's Consumer Price Index- Industrial Workers database. Descriptive statistics were used to describe current smoking status patterns. Generalized Linear Mixed Models were used to investigate the association between the retail prices and current smoking status of bidis and cigarettes.

RESULTS

For cigarettes, an increase in the average retail price by one Indian Rupee was associated with a reduction in the odds of being a current smoker of 7% (OR=0.925; 95% CI: 0.918-0.932, p<0.001). For bidis, the association between the retail price and current smoking status was not statistically significant (OR=1.01; 95% CI: 1.00-1.02, p=0.082).

CONCLUSIONS

Current increases in the retail prices of tobacco products in India seem to have an impact on the use of cigarettes but not bidis. This highlights the need for tobacco product tax increases that result in sufficient retail prices increase to make all tobacco products less affordable and reduce their use.

Influence of Oral Dipping Tombak Smokeless Tobacco on Coagulation Profile and Platelet Counts

The goal of this paper is to investigate the influence of oral dipping of Tombak Smokeless Tobacco (SLT) on prothrombin time (PT), activated partial thromboplastin time (APTT), international normalized ratio(INR) values, and platelet counts (PLTs), in Sudanese Tombak users. An analytical cross-sectional study was conducted at Kosti health insurance hospital, Sudan, in 2019. According to the inclusion and exclusion criteria, 100 adult users of oral Tombak for three or more years were chosen randomly as a study group. Another 100 matched healthy individuals who never used Tombak were randomly selected as a comparative group. Venous blood specimens were collected in ethylene diamine tetra-acetic acid (EDTA) containers for the PLT counts using the automated haematology analyser (Sysmex, Tokyo, Japan XK-21SYSMEX) and in trisodium citrate anti-coagulant containers for coagulation tests using a co-agulometer machine analyser. Our findings show a significant decrease in PLT count mean values in the Tombak users group (212.1 × 103/mm3 ± 74.3 × 103/mm3) compared with the non-taking Tombak group mean values (243.2 × 103/mm3 ± 83.0 × 103/mm3), (p < 0.006). Both PT and APTT were significantly prolonged in Tombak users (16.03 ± 1.22 s vs. 14.44 ± 0.557 s), p < 0.001 for PT, and (41.62 ± 7.28 s vs. 34.99 ± 4.02 s), (p < 0.001) for APTT. INR mean values were significantly longer in Tombak users (1.11 ± 0.096) vs. (1.07 ± 0.66; p < 0.001). Multiple linear regression analysis findings show a significant impact of the four investigated variables, including duration of taking Tombak, age, and frequency of taking Tombak per day (p < 0.001). In conclusion, using Tombak a Smokeless Tobacco (SLT) for a long period significantly affect Platelet counts and coagulation profile.

Psychiatric morbidity and substance use in migrant workers: A population based study

BACKGROUND

The prevalence of mental health problems and substance abuse in the migrant population is higher than the general population.

AIMS AND OBJECTIVES

To assess the prevalence and pattern of mental health issues and substance use in the migrant population and highlight the association with the reverse migration of migrant workers.

METHODOLOGY

The field staff visited the shelter homes for migrant population in four cities of Northern India (Chandigarh (UT), Bhatinda (Punjab), Panchkula (Haryana) and Jaipur (Rajasthan). After maintaining the social distance and wearing masks by the staff and migrants, written informed consent was taken for participation in the study. The socio-demographic details of reverse migrants were noted down and Hindi version of Patient Health Questionnaire (PHQ-9) for mental health problems and screening tool for pattern of substance abuse was administered. Geographically matched undisplaced were also administered these tools.

RESULTS

A total of 275 reverse migrants and 276 undisplaced were included in the study. The prevalence of ever use for all the substances among reverse migrants was 44.4% (122/275) and among undisplaced, it was 45.3%. The prevalence of alcohol, tobacco and cannabis was higher than the general population. The prevalence of at least one diagnosis on PHQ-9 is 13.45% (reverse migrants 19.3% and undisplaced 7.6) and the prevalence of other depressive disorder is significantly higher in reverse migrants (17.1%) than undisplaced (4.0%).

CONCLUSION

The study concludes that prevalence of mental health issues and substance abuse in migrant population is significantly higher than the general population and the prevalence of at least one diagnosis and other depressive disorder is significantly higher in reverse migrants than undisplaced.

The Indian Chronic Kidney Disease (ICKD) study: baseline characteristics

Background

Chronic kidney disease (CKD) is an important cause of morbidity and mortality worldwide. There is a lack of information on epidemiology and progression of CKD in low–middle income countries. The Indian Chronic Kidney Disease (ICKD) study aims to identify factors that associate with CKD progression, and development of kidney failure and cardiovascular disease (CVD) in Indian patients with CKD.

Methods

ICKD study is prospective, multicentric cohort study enrolling patients with estimated glomerular filtration rate (eGFR) 15–60 mL/min/1.73 m², or >60 mL/min/1.73 m² with proteinuria. Clinical details and biological samples are collected at annual visits. We analysed the baseline characteristics including socio-demographic details, risk factors, disease characteristics and laboratory measurements. In addition, we compared characteristics between urban and rural participants.

Results

A total of 4056 patients have been enrolled up to 31 March 2020. The mean ± SD age was 50.3 ± 11.8 years, 67.2% were males, two-thirds of patients lived in rural areas and the median eGFR was 40 mL/min/1.73 m². About 87% were hypertensive, 37% had diabetes, 22% had CVD, 6.7% had past history of acute kidney injury and 23% reported prior use of alternative drugs. Diabetic kidney disease, chronic interstitial nephritis (CIN) and CKD-cause unknown (CKDu) were the leading causes. Rural participants had more occupational exposure and tobacco use but lower educational status and income. CIN and unknown categories were leading causes in rural participants.

Conclusions

The ICKD study is the only large cohort study of patients with mild-to-moderate CKD in a lower middle income country. Baseline characteristics of study population reveal differences as compared with other cohorts from high-income countries.

The association of long non-coding RNA in the prognosis of oral squamous cell carcinoma

BACKGROUND

Oral cancer is considered one of the most prevalent cancers in India. This is mainly because India suffers from high usage of tobacco, which is one of the main causative agents of oral cancer, and lacks proper health and sexual hygiene in rural areas.

DISCUSSION

Non-coding RNAs are reported to be involved in the various mechanism and causality of cancer. Numerous reports have identified viable prospects connecting non-coding RNA (ncRNA) with cancer. Specific ncRNAs like long non-coding RNA or lncRNAs are recently being prioritized as potential associations in the cause of cancer.

CONCLUSION

This review aims at presenting a concise perspective on the basics and the recent advancements of the lncRNA research pertaining specifically to oral cancer, its recurrence, and the future possibilities of knowledge it might possess.

A systematic review report on tobacco products and its health issues in India

India is the second country in tobacco production in the world. Smoking tobacco products included Hookah, Cohutta, Chillum, Chillum, ganja, Beedi, Mava, Cigarettes, and cigar etc. Various types of smokeless tobacco like betel quid, khaini, mishri, snuff, gutkha are used. Fifty percent of them are addicted to smokeless tobacco. Sixty eight smokeless tobacco products were available in 2010; most of them included the risk of cancer warning except for loose tobacco products. Women mostly prefer 8 out of 29 gutkha brands. Out of these 29 gutkha brands, 15 were loose tobacco packets. India is the second-largest tobacco consumer, comprises of 27.5 crore consumers which altogether greater than the population of Western Europe. From among these 27.5 crore consumers, 16.4 crore people are smokeless tobacco in takers, 6.9 crore people are exclusive smokers and 4.2 crore people are both tobacco in takers and exclusive smokers. If we take this data into consideration early mortality of 45 crore people is expected by 2050 worldwide. Female basically are prone to fewer cigarettes per day as compared to males. On the other hand, a cigarette that is consumed by females has lower nicotine content as compared to males. In developing countries, the female population has less prevalence of smoking because the level of employment is low, socio-cultural norms, and health and beauty concerns. According to the estimation by the South East Asia Region (SEAR) in the year 2000 basically from India, we encounter death of about 18% men and about 3% of women due to tobacco. Various policies have been set up to control the use of tobacco. So that threat to public health is reduced. Policies like tobacco control policy, pro-health policy are set up for this purpose. Talking about the effects on a longer-term usage of water pipe can add up to the risk of getting affected by cancers of lungs, mouth, bladders, atherosclerosis, cardiovascular and pulmonary diseases, tooth extraction, etc.

Epidemiologic Pattern of Cancer in Kathmandu Valley, Nepal: Findings of Population-Based Cancer Registry, 2018

PURPOSE

Although cancer is an important and growing public health issue in Nepal, the country lacked any population-based cancer registry (PBCR) until 2018. In this study, we describe the establishment of the PBCR for the first time in Nepal and use the registry data to understand incidence, mortality, and patterns of cancer in the Kathmandu Valley (consisting of Kathmandu, Lalitpur, and Bhaktapur districts), which comprises 10.5% of the estimated 29 million population of Nepal in 2018.

MATERIALS AND METHODS

The PBCR collects information from facilities and communities through the active process. The facilities include cancer or general hospitals, pathology laboratories, hospice, and Ayurvedic centers. In the communities, the field enumerators or female community health volunteers collected the data from the households. In addition, the Social Security and Nursing Division under the Department of Health Services, which provides subsidy for cancer treatment of underprivileged patients, was another major source of data. The collected data were verified for residence, accuracy, and completeness and then entered and analyzed using CanReg5 software.

RESULTS

In the Kathmandu Valley, the PBCR registered 2,156 new cancer cases with overall age-adjusted incidence rate for all cancers of 95.7 per 100,000 population (95.3 for males and 98.1 for females). The age-adjusted mortality rate for males was 36.3 (n = 365) and for females 27.0 (n = 305) per 100,000 population. We found that the commonest cancers in males were lung and stomach, whereas in females, they were breast and lung cancer. Gallbladder cancer was among the top five common cancers in both sex.

CONCLUSION

These findings provide a milestone to understand the cancer burden in the country for the first time using the PBCR and will be helpful to develop and prioritize cancer control strategies.

Tobacco Quitline toll-free number on tobacco packets in India: An analysis on outcome

On 1 September 2018, 2 year later the launch of National Tobacco Quitline Services (NTQLS), new health warnings on tobacco products packets consisting of NTQLS toll-free number came into effect in India. The present study aimed to measure the effects of printing tobacco Quitline number on tobacco packets on calls to NTQLS. All calls to the NTQLS were monitored over 1 year, six months before and after the tobacco Quitline number on tobacco packets came to effect. Call details such as tobacco user's demographic profile, tobacco use habit, follow-up and quitting status also extracted through Call Detail Record (CDR) files from the server of NTQLS for the purpose of this study. Calls hit on IVR (Interacted Voice Response) increased by 7.7 times, on an average 6064 calls daily hit on NTQLS's IVR after the new health warning consisting of toll-free number on tobacco packets came into effect. Tobacco user registration increased by 3.3 times (18039 vs 5469). Overall, 264.5% (4790) relative increment in tobacco quitters, as it were only 1314 quitters six months before the new health warning. 100% callers cited tobacco packets as the primary source of tobacco Quitline toll-free number. The helpline number of Quitline on tobacco packet showed a strong potential to aware the public about the tobacco Quitline. This has increased the number of callers calling to National Tobacco Quitline Services and registrations for tobacco cessation. Sharp increase in calls during the first three months of new health warning and latter diminishing rate of calls is the concern for further study.

Insights from a Pan India Sero-Epidemiological survey (Phenome-India Cohort) for SARS-CoV2

To understand the spread of SARS-CoV2, in August and September 2020, the Council of Scientific and Industrial Research (India) conducted a serosurvey across its constituent laboratories and centers across India. Of 10,427 volunteers, 1058 (10.14%) tested positive for SARS-CoV2 anti-nucleocapsid (anti-NC) antibodies, 95% of which had surrogate neutralization activity. Three-fourth of these recalled no symptoms. Repeat serology tests at 3 (n = 607) and 6 (n = 175) months showed stable anti-NC antibodies but declining neutralization activity. Local seropositivity was higher in densely populated cities and was inversely correlated with a 30-day change in regional test positivity rates (TPRs). Regional seropositivity above 10% was associated with declining TPR. Personal factors associated with higher odds of seropositivity were high-exposure work (odds ratio, 95% confidence interval, p value: 2.23, 1.92-2.59, <0.0001), use of public transport (1.79, 1.43-2.24, <0.0001), not smoking (1.52, 1.16-1.99, 0.0257), non-vegetarian diet (1.67, 1.41-1.99, <0.0001), and B blood group (1.36, 1.15-1.61, 0.001).

A combined community health worker and text messagingbased intervention for smoking cessation in India: Project MUKTI - A mixed methods study

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.

Declining trend of smoking and smokeless tobacco in India: A decomposition analysis

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.

Spatial Pattern and Determinants of Tobacco Use Among Females in India: Evidence From a Nationally Representative Survey

INTRODUCTION

Tobacco use has been steadily increasing among the females in developing countries. It has led to rise in tobacco-related morbidity and mortality among females. Knowing the geographic distribution of the habit is essential to identify high-priority areas and direct the healthcare intervention. Hence, this study was done to assess the spatial patterns and determinants of tobacco consumption among females in India.

AIMS AND METHODS

Univariate and bivariate Moran's I statistic and local indicators for spatial association maps were generated to determine the spatial clustering of tobacco consumption (smoked and smokeless form). Ordinary least-square regression, spatial-lag and spatial-error models were performed to assess the determinants. Poverty (belonging to poorest and poorer quintile of wealth index), illiteracy (no formal education), marital status, ST population, tobacco use by family members, and alcohol use were the explanatory variables.

RESULTS

Univariate Moran's I was .691 suggesting positive spatial autocorrelation. High-prevalence clustering (hotspots) was maximum in the central, eastern, and northeastern states such as Chhattisgarh, Madhya Pradesh, Odisha, Bihar, Manipur, Tripura, Meghalaya, Mizoram, and Assam. This pattern was similar for both smokeless and smoked form. Results of spatial-lag and spatial-error model suggested that alcohol use, scheduled tribes, illiteracy, poverty, marital status, and tobacco use by family members were significant determinants of female tobacco consumption. The coefficient of spatial association was maximum for alcohol use (β = .20, p < .001) followed by widowed/separated/divorced (β = .12, p < .001).

CONCLUSIONS

Tobacco consumption among females in India is spatially clustered. Multisectoral coordination and targeted interventions are required in the geographical hotspots of tobacco consumption.

IMPLICATIONS

This is the first study to explore the geospatial pattern of tobacco consumption among females in India. We found that the pattern of tobacco use among females is spatially clustered in India. Clustering was predominantly found in central, eastern, and northeastern regions of the country. Tribal population in these areas and complementarities between alcohol and tobacco use contributed significantly to the high-prevalence clustering. These findings will be helpful for policymakers and planners to devise specific intervention package targeting the high-risk regions.

Utilisation, Availability and Price Changes of Medicines and Protection Equipment for COVID-19 Among Selected Regions in India: Findings and Implications

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.

Tobacco imagery in entertainment media: evolution of tobacco-free movies and television programmes rules in India

INTRODUCTION

Tobacco imagery in films and television increased in India after it ended conventional tobacco advertising in 2004. The Ministry of Health and Family Welfare (MoHFW) introduced rules to eliminate this tobacco imagery in 2005 which took effect in amended form in 2012. This study presents the enablers and barriers in development and implementation of the regulations to curb tobacco imagery in films and television in India.

METHOD

We reviewed legislation, evolving regulations, parliamentary questions, judicial decisions, Bollywood trade publications and relevant news articles from 2003 to 2019 and interviewed key informants.

RESULTS

Based on the WHO reports and civil society demands, the MoHFW issued a complete ban on tobacco imagery in movies and television programmes in 2005. The Ministry of Information and Broadcasting (MoIB) joined the film industry in opposing the rules. A filmmaker challenged the rules in court, which ruled that they violated constitutional freedoms. On appeal by MoHFW, the Supreme Court allowed the rules to take effect. Continuing opposition by MoIB and the film industry weakened the rules and delayed implementation until 2012. As of 2020, rather than a ban, all films with tobacco imagery require strong editorial justification, 100 s of antitobacco messages produced by the MoHFW, and a static health warning at the bottom of screen during tobacco imagery display. In 2015, less than 48% of movies had tobacco imagery compared with 89% in 2005.

CONCLUSIONS

Although, not a ban, MoHFW, supported by local advocates and WHO, issued regulations that resulted in a substantial drop in on-screen tobacco imagery and increased exposure to antitobacco messages. India's experience informs WHO Framework Convention on Tobacco Control parties as they develop and implement policies to curb tobacco imagery in entertainment media.

Rapid Assessment of Price Instability and Paucity of Medicines and Protection for COVID-19 Across Asia: Findings and Public Health Implications for the Future

Background: Countries have introduced a variety of measures to prevent and treat COVID-19 with medicines and personal protective equipment (PPE), with some countries adopting preventative strategies earlier than others. However, there has been considerable controversy surrounding some treatments. This includes hydroxychloroquine where the initial hype and misinformation lead to shortages, price rises and suicides. Price rises and shortages have also been seen for PPE. Such activities can have catastrophic effects on patients where there are high co-payment levels and issues of affordability. Consequently, there is a need to investigate this further. Objective: Assess changes in the availability, utilization and prices of relevant medicines and PPE during the pandemic among a range of Asian countries. Our approach: Narrative literature review combined with interviews among community pharmacists to assess changes in consumption, prices and shortages of medicines and PPE from the beginning of March 2020 until end of May 2020. In addition, suggestions on ways to reduce misinformation. Results: 308 pharmacists took part from five Asian countries. There was an appreciable increase in the utilization of antimicrobials in Pakistan (in over 88% of pharmacies), with lower increases or no change in Bangladesh, India, Malaysia and Vietnam. Encouragingly, there was increased use of vitamins/immune boosters and PPE across the countries, as well as limited price rises for antimicrobials in India, Malaysia and Vietnam, although greater price rises seen for analgesics and vitamin C/immune boosters. Appreciable price increases were also seen for PPE across some countries. Conclusion: Encouraging to see increases in utilization of vitamins/immune boosters and PPE. However, increases in the utilization and prices of antimicrobials is a concern that needs addressing alongside misinformation and any unintended consequences from the pandemic. Community pharmacists can play a key role in providing evidence-based advice, helping to moderate prices, as well as helping address some of the unintended consequences of the pandemic.

Tobacco Use Among the Youth in India: Evidence From Global Adult Tobacco Survey-2 (2016-2017)

Background:

Worldwide, tobacco use is a serious public health concern affecting the youth. A vast majority of tobacco users start using tobacco well before the age of 18 years which has enormous psychosocial and health effects.

Objectives:

To estimate the prevalence of individual forms of tobacco usage among youth aged 15 to 24 years and to assess the association of sociodemographic factors with tobacco use.

Methods:

The source of data was a cross-sectional GATS-2 survey in India (analysed using SPSSv17.0) which used a multistage, geographically stratified cluster sampling method. Bivariate analysis was done for evaluation of the possible association of tobacco use with sociodemographic factors. Multivariable logistic regression analysis was conducted to determine the relative strength of association between those factors and tobacco use.

Results:

There were 13 329 respondents (44.9% males and 55.1% females) aged 15 to 24 years. Overall, 11.9% of respondents were using tobacco. The prevalence of smoke and smokeless tobacco usage was 5% and 10.9%, respectively, whereas 2% of respondents reported dual usage. The odds of using any form of tobacco were significantly higher among respondents aged 20 to 24 years (odds ratio [OR]: 2 [1.76-2.77]) who were primarily residing in rural areas (adjusted odds ratio [aOR]: 1.36 [1.2-1.54]) and were unmarried (aOR: 1.56 [1.37-1.88]). The odds of using any form of tobacco were significantly lower among females (aOR: 0.21 [0.19-0.24]), literate individuals (aOR: 0.33 [0.29-0.37]), and those who were unemployed/students/homemakers (aOR: 0.44 [0.39-0.50]).

Conclusions:

The overall tobacco usage of 11.9% among young people in the age group of 15 to 24 years is a matter of concern. The study identified several sociodemographic factors significantly associated with tobacco use, implying the need for designing interventions considering social vulnerabilities of youth.

Trends and patterns of second-hand smoke exposure amongst the non-smokers in India-A secondary data analysis from the Global Adult Tobacco Survey (GATS) I & II

Objectives

The primary objective of the present study was to compare the prevalence and patterns of second-hand smoke (SHS) exposure in the home, workplace, public places, and at all three places amongst the non-smoker respondents between the two rounds of Global Adult Tobacco Survey (GATS) in India. The secondary objectives were to assess the differences in various factors associated with SHS exposure among non-smokers.

Study design

This secondary data analysis incorporated data generated from the previous two rounds of the cross-sectional, nationally representative GATS India, which covered 69,296 and 74,037 individuals aged 15 years and above. Exposure to the SHS at home, workplace, and public places amongst the non-smokers were the primary outcome variables. Standard definitions of the surveys were used.

Results

The overall weighted prevalence of exposure to SHS amongst the non-smokers inside the home and public places reduced. In contrast, the prevalence in the workplace increased marginally in round II compared to I. The proportion of adults who were exposed to SHS at all three places did not change much in two rounds of surveys. A decrease in the knowledge of the respondents exposed to SHS at home and public places was observed about the harmful effects of smoking in round II. Age, gender, occupation, place, and region of respondents were found to be significant determinants of SHS exposure at all the three places on multinomial logistic regression analysis.

Conclusions

The study calls for focused interventions in India and stringent implementation of anti-tobacco legislation, especially in the workplaces for reducing the exposure to SHS amongst the non-smokers and to produce encouraging and motivating results by next round of the survey.

Improvement of oral cancer screening quality and reach: The promise of artificial intelligence

Oral cancer is easily detectable by physical (self) examination. However, many cases of oral cancer are detected late, which causes unnecessary morbidity and mortality. Screening of high-risk populations seems beneficial, but these populations are commonly located in regions with limited access to health care. The advent of information technology and its modern derivative artificial intelligence (AI) promises to improve oral cancer screening but to date, few efforts have been made to apply these techniques and relatively little research has been conducted to retrieve meaningful information from AI data. In this paper, we discuss the promise of AI to improve the quality and reach of oral cancer screening and its potential effect on improving mortality and unequal access to health care around the world.

Smokeless Tobacco and Its Adverse Effects on Hematological Parameters: A Cross-Sectional Study

Background

Smokeless tobacco (SLT) as a drug substance has been used throughout the world although it has dangerous effects on human health. Among the 28 known carcinogens in SLT, tobacco-specific nitrosamines are considered to be the most potent. This has challenged the metabolic condition leading to a rise in the inflammatory status, increased apoptosis, and red blood cell (RBC) membrane damage. Therefore, the present study was undertaken to evaluate the adverse effects of SLT on hematological parameters and establish a correlation between them.

Materials and Methods

A total of 100 subjects (50 SLT users and 50 nonusers) were selected for the study. Complete demographic data and history were taken and clinical examination was done to evaluate any oral mucosal changes. Venous blood samples were taken to analyze the hematological parameters.

Results

Significant changes were observed in the complete blood profile in SLT users when compared to nonusers. All the hematological parameters had a negative correlation with form of SLT except for total leucocyte count which had a positive correlation.

Conclusion

The current study confers an imperative role into SLT mediated effects on a complete hemogram and might be beneficial in spreading awareness against its usage. It also serves as a forewarning alarm among the population consuming SLT as an alternative to smoking tobacco.