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Faeq DT, Ahmed DR, Aziz IA, Yıldırım M. Perceptions and usage of traditional cigarettes, electronic cigarettes, and waterpipes among young and middle-aged adults in Iraq: A descriptive study. J Ethn Subst Abuse 2024:1-12. [PMID: 38949647 DOI: 10.1080/15332640.2024.2366982] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/02/2024]
Abstract
Tobacco use poses significant public health concerns, linked to various mental and physical health outcomes. Iraq has a high prevalence of smoking, predominantly with traditional cigarettes, but there is also growing popularity of electronic cigarettes and waterpipes among younger and middle-aged adults. This study aims to explore the perceptions and usage of traditional cigarettes, electronic cigarettes, and waterpipes among this population in Iraq. A descriptive study was conducted among 402 young and middle-aged adults (50.25% females), aged between 18 and 45 years, with a mean age of 25.88 (SD = 7.27). For the data collection, an online questionnaire was developed utilizing distribution channels on common social networking platforms. The results showed that 41.79% of respondents have used traditional cigarettes, while 31.1% of participants reported that they use electronic cigarettes. Ninety-four per cent of respondents acknowledged that they use waterpipes. The results also indicated that a significant proportion believe that using electronic cigarettes is either much more harmful or more harmful than traditional cigarettes. Participants commonly perceived all three types of tobacco products as highly harmful, including secondhand smoke, addictive qualities, and popularity among peers. Additionally, significant differences in perceptions emerged between smokers and nonsmokers regarding electronic cigarettes and traditional cigarettes, although no such differences were observed for waterpipes. These findings contribute to understanding the attitudes toward different forms of tobacco use among respondents, highlighting the need for targeted interventions to address the perceived harm associated with tobacco products.
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Affiliation(s)
| | | | | | - Murat Yıldırım
- Agri Ibrahim Cecen University, Ağrı, Turkey
- Lebanese American University, Beirut, Lebanon
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Kaur J, Rinkoo AV, Richardson S. Trends in smokeless tobacco use and attributable mortality and morbidity in the South-East Asia Region: implications for policy. Tob Control 2024; 33:425-433. [PMID: 36596709 DOI: 10.1136/tc-2022-057669] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Accepted: 12/08/2022] [Indexed: 01/05/2023]
Abstract
OBJECTIVES To describe the prevalence of smokeless tobacco (SLT) use and number of users by year, in addition to trends in mortality and attributable disease burden in countries of the WHO South-East Asia Region (SEAR), to inform policies for SLT control in the Region. METHODS For each SEAR country, we obtained data from Global Adult Tobacco Surveys, WHO STEPwise Approach to NCD Risk Factor Surveillance surveys and Demographic and Health Surveys conducted since 2010 to estimate prevalence of SLT use by country, sex and year. Using data from the World Population Prospects database we estimated the number of users by country. Next, using the results of previous meta-analyses and prevalence results, we estimated the population attributable fractions and attributable mortality and morbidity in terms of annual deaths and disability-adjusted life years lost. We then characterised trends in attributable deaths and disease burden for countries with comparable data. RESULTS There were wide differences in SLT use prevalence by country. We estimated that, during 2015-2019, there were 165 803 900 SLT users across SEAR, with 479 466 attributable deaths annually of which India accounted for 79.9% with 383 248. Attributable annual deaths increased in some countries during 2015-2019. CONCLUSIONS Annual deaths and disease burden attributable to SLT remain high across SEAR and have only declined modestly in recent years. Effective implementation of all WHO Framework Convention on Tobacco Control measures, addressing both supply-side and demand-side issues, in relation to SLT and areca nut products must be prioritised to ensure reductions in mortality and disease burden are sustained and accelerated.
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Affiliation(s)
- Jagdish Kaur
- Tobacco Free Initiative, World Health Organization Regional Office for South-East Asia, New Delhi, Delhi, India
| | - Arvind Vashishta Rinkoo
- Tobacco Free Initiative, World Health Organization Regional Office for South-East Asia, New Delhi, Delhi, India
| | - Sol Richardson
- Vanke School of Public Health, Tsinghua University, Beijing, China
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Tamil Selvan S, Yeo XX, van der Eijk Y. Which countries are ready for a tobacco endgame? A scoping review and cluster analysis. Lancet Glob Health 2024; 12:e1049-e1058. [PMID: 38762285 DOI: 10.1016/s2214-109x(24)00085-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Revised: 02/05/2024] [Accepted: 02/16/2024] [Indexed: 05/20/2024]
Abstract
Various countries have set tobacco endgame targets to eliminate tobacco use by a certain year. Tobacco endgames are generally considered more feasible in countries with advanced tobacco control measures and a smoking prevalence of 15% or less. We conducted a scoping review of 563 articles sourced from news, academic literature, and grey literature to examine global tobacco endgame progress, and grouped 153 countries into clusters based on their tobacco policy implementation score and smoking prevalence to systematically identify countries that might be well positioned to succeed in a tobacco endgame. The EU, Pacific Islands, and 18 other individual countries have set tobacco endgame targets, with another seven countries described as well positioned for an endgame. These were mostly high-income countries with higher smoking prevalence. We identified 28 endgame-ready countries with advanced tobacco policies and a low smoking prevalence. Of these, only five were part of tobacco endgame movements; the remaining 23 were all low-income or middle-income countries in Africa, Latin America, or Asia. Therefore, the global tobacco endgame movement should focus more on low-income and middle-income countries with low smoking rates and advanced tobacco policies, particularly in Africa, Latin America, and Asia.
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Affiliation(s)
- Sahaana Tamil Selvan
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore
| | - Xue Xin Yeo
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore
| | - Yvette van der Eijk
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore.
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Naznin E, George J, Driezen P, Palazzi K, Wynne O, Nargis N, Fong GT, Bonevski B. Trend over time on knowledge of the health effects of cigarette smoking and smokeless tobacco use in Bangladesh: Findings from the International Tobacco Control Policy Evaluation Bangladesh Surveys. Drug Alcohol Rev 2023; 42:1838-1849. [PMID: 37565295 PMCID: PMC11031133 DOI: 10.1111/dar.13735] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Revised: 07/04/2023] [Accepted: 07/26/2023] [Indexed: 08/12/2023]
Abstract
INTRODUCTION Cigarette smoking and smokeless tobacco (ST) use are prevalent in Bangladesh. This longitudinal study examined how knowledge of the health effects of smoking and ST use in Bangladesh has changed overtime with the country's acceleration of tobacco control efforts. METHODS Data were analysed from the International Tobacco Control Survey, a nationally representative longitudinal study of users and non-users of tobacco (aged 15 and older) in Bangladesh, across four waves conducted in 2009 (n = 4378), 2010 (n = 4359), 2012 (n = 4223) and 2015 (n = 4242). Generalised estimating equations assessed the level of knowledge about harms of tobacco use across four waves. Multivariable logistic regressions assessed whether knowledge of health effects from cigarette smoking and ST use in 2015 differed by user group. RESULTS In 2015 survey, most tobacco users were aware that cigarette smoking causes stroke (92%), lung cancer (97%), pulmonary tuberculosis (97%) and ST use causes mouth cancer (97%) and difficulty in opening mouth (80%). There were significant increases in the total knowledge score of smoking related health harm from 2010 to 2012 (mean difference = 0.640; 95% confidence interval [CI] 0.537, 0.742) and 2012 to 2015 (mean difference = 0.555; 95% CI 0.465, 0.645). Participants had greater odds of awareness for ST health effects from 2010 to 2015. DISCUSSION AND CONCLUSIONS The results suggest that increasing efforts of awareness policy interventions is having a positive effect on tobacco-related knowledge in Bangladesh. These policy initiatives should be continued to identify optimal methods to facilitate behaviour change and improve cessation of smoking and ST use.
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Affiliation(s)
- Eva Naznin
- Research higher degree, School of Medicine and Public Health, The University of Newcastle, University Drive Callaghan, NSW 2308, Australia
| | - Johnson George
- Senior lecturer, Centre for Medicine Use and Safety, Monash University, 381 Royal Parade, Parkville, Victoria 3052, Australia
| | - Pete Driezen
- Research Assistant Professor, Department of Psychology, University of Waterloo, 200 University Avenue West, Waterloo, Ontario N2L 3G1, Canada
| | - Kerrin Palazzi
- Senior Statistician, Hunter Medical Research Institute (HMRI), Lot 1, Kookaburra Circuit, New Lambton Heights, NSW 2305, Australia
| | - Olivia Wynne
- Health Research Economist, Hunter Medical Research Institute (HMRI), Lot 1, Kookaburra Circuit, New Lambton Heights, NSW 2305, Australia
| | - Nigar Nargis
- Senior Scientific Director, Surveillance and Healthy Equity Science. American Cancer Society, 555 11th Street NW suite 300, Washington DC, 20004
| | - Geoffrey T. Fong
- Professor, School of Public Health Sciences, University of Waterloo, 200 University Avenue West, Waterloo, Ontario N2L 3G1, Canada
| | - Billie Bonevski
- Professor and Lead of Public Health, Flinders Health and Medical Research Institute, College of Medicine and Public Health, Flinders University, Sturt Road, Bedford Park, Adelaide 5042, Australia
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Sani AI, Rubab Z, Usman S, Ahmed SZ, Arif S. Costimulatory Molecules OX40 and OX40L Upregulation in Oral Squamous Cell Carcinoma: A Blood-Based Study. Eur J Dent 2023; 17:1194-1200. [PMID: 36652956 PMCID: PMC10756792 DOI: 10.1055/s-0042-1760375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
OBJECTIVES This research aimed to determine OX40 and OX40L mRNA expression in blood samples of naive oral squamous cell carcinoma (OSCC) patients in different histological grades and clinical stages. The in silico analysis was performed using the STRING database for functional association and a better understanding of the interactions of OX40 and its ligand with other proteins. MATERIALS AND METHODS In this study, we recruited 141 newly diagnosed patients of OSCC. Levels of OX40 and OX40L mRNA expression were explored using real-time quantitative polymerase chain reaction. An in silico tool was also utilized to evaluate the OX40/OX40L interactome. RESULTS The results showed higher OX40 expressional levels in the late stage (23-fold) compared with the early stage (8.5-fold) (p = < 0.001). A similar trend was seen in OX40L mRNA expression, revealing a fold change of 5.8 in the early stage in comparison to 9.9-fold change in the late stage (p = < 0.001). Overexpression of OX40 and OX40L was found in different histological grades (p = 0.005 and p = < 0.001, respectively). Overexpression of OX40 and OX40L was detected in habits such as smoking and paan intake, whereas statistically significant upregulation was observed in the cheek, lip, and alveolus tumors. However, there was no substantial difference in OX40 and OX40L expression based on age or gender. The functional interactions, that is, interactomes of OX40 and OX40L with other proteins have been determined by in silico analysis. CONCLUSION Based on current study findings, despite OX40 and OX40L upregulation in newly diagnosed OSCC patients, it is speculated that the physiological function of these molecules is altered due to immune system exhaustion.
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Affiliation(s)
| | - Zila Rubab
- Department of Biochemistry, Ziauddin University, Karachi, Pakistan
| | - Shumaila Usman
- Department of Molecular Medicine, Ziauddin University, Karachi, Pakistan
| | | | - Sadia Arif
- Department of Pathology, Ziauddin University, Karachi, Pakistan
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Sharma AD, Garg S, Singh MM, Deshmukh C, Mishra A, Singh V, Sharma R. Pattern of Smokeless Tobacco Initiation and Use among School Going Adolescents in Delhi, India: A Mixed Method Study. Asian Pac J Cancer Prev 2023; 24:3187-3193. [PMID: 37774071 PMCID: PMC10762772 DOI: 10.31557/apjcp.2023.24.9.3187] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Accepted: 09/10/2023] [Indexed: 10/01/2023] Open
Abstract
INTRODUCTION With growing trends in tobacco consumption, it has been observed that the age of initiation is gradually decreasing. To combat the deep-rooted problem of the Society, we need to target the adolescents at the time of their first consumption of tobacco forms. Hence, this study was conducted to assess the pattern of smokeless tobacco use among school going adolescents in senior secondary schools with the assessment of the sociodemographic factors responsible for initiation of smokeless tobacco use by adolescents. METHODS A cross-sectional survey of total sample of 714 students across 9-11 standards in 3 schools of Delhi was done using a self-administered questionnaire after obtaining approval from Institutional Ethics Committee and School Health Scheme, Delhi. RESULT Consumption of tobacco was found to be 27.9% at a frequency of 6-9 days in a period of one month and a majority of 31 (39.2%) students initiated the use in the age group of 10-11 years. Among the different SLT products, pan masala combined with zarda with 56 (70.8%) users, was found to be the most commonly consumed SLT product. Grocery shops were preferred POS among the students as (67%) of students obtained the SLT product from this POS. 56 (70.8%) of the students wanted to quit the habit of SLT use whereas 49 (62%) students tried to quit the habit and 43 (54.4%) students sought help in order to quit the habit. DISCUSSION Such alarming results in terms of low age of initiation in Delhi is an emerging health problem. Adequate cessation programmes and schemes must be developed and strict implementation of laws and policies to achieve a tobacco free youth is the need of hour.
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Affiliation(s)
- Akash Deep Sharma
- Maulana Azad Medical College, Department of Community Medicine, New Delhi, India.
| | - Suneela Garg
- National Institute of Health & Family Welfare, Program Advisory Committee, New Delhi, India.
| | | | - Chetana Deshmukh
- Maulana Azad Medical College, Department of Community Medicine, New Delhi, India.
| | - Anshita Mishra
- Maulana Azad Medical College, Department of Community Medicine, New Delhi, India.
| | - Varun Singh
- Maulana Azad Medical College, Department of Community Medicine, New Delhi, India.
| | - Ragini Sharma
- Maulana Azad Medical College, Department of Community Medicine, New Delhi, India.
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Loh SM, Moloantoa T, Yende N, Variava E, Niaura R, Golub JE, Martinson N, Elf JL. A cross-sectional study of attitudes and behaviors of snuff use and cessation among people with and without HIV in South Africa. Tob Use Insights 2023; 16:1179173X231193890. [PMID: 37577008 PMCID: PMC10422901 DOI: 10.1177/1179173x231193890] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Accepted: 07/25/2023] [Indexed: 08/15/2023] Open
Abstract
Background Despite a high (48%) prevalence of snuff use among women with HIV in South Africa, little is known of the attitudes and behaviors of use, strategies for cessation, and potential health risks. Methods In a cross-sectional study, a questionnaire was administered to adults (≥18 years) with (HIV+) and without HIV (HIV-) who self-reported current snuff use to collect information on demographics, snuff use and cessation attempts, preferred strategies for cessation, other substance use, history of respiratory illness, and mental health. Results 150 (74 HIV+, 76 HIV-) participants were enrolled; 115 (77%) were daily snuff users, 6 (4%) were current smokers, and 17 (11%) former smokers. Top reasons for current snuff use included improving health (n = 48, 32%), reducing stress (n = 26, 16%), and "being a habit" (n = 38, 25%). Participants believed snuff use to have mostly positive (n = 68, 46%) or no (n = 54, 36%) health impacts, and 57 (38%) participants believed snuff cures headaches. 103 (69%) participants reported a previous quit attempt, and 110 (73%) indicated high interest in quitting snuff. Although 105 (70%) participants indicated that advice from a healthcare provider would aid them in quitting snuff, only 30 (20%) reported ever receiving that advice. A majority of participants (n = 141, 94%) suffer from moderate to high levels of perceived stress, and overall few differences were seen by HIV status. Conclusions Education on negative impacts of snuff, advice to quit from healthcare providers, and nicotine replacement therapy should be considered in the development of a snuff cessation program.
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Affiliation(s)
- Samantha M. Loh
- Department of Environmental and Radiological Health Sciences, Colorado State University, Fort Collins, CO, USA
| | | | | | - Ebrahim Variava
- Department of Internal Medicine, Klerksdorp Tshepong Hospital Complex, Matlosana, South Africa
| | - Raymond Niaura
- Department of Epidemiology; Department of Social and Behavioral Sciences, New York University, New York, NY, USA
| | - Jonathan E. Golub
- Department of Infectious Diseases, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | | | - Jessica L. Elf
- Department of Environmental and Radiological Health Sciences, Colorado State University, Fort Collins, CO, USA
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Sehgal A, Tayade M, Kunkulol R. Effectiveness of brief counseling (5As): Antenatal tobacco cessation support program among pregnant women availing antenatal care. J Family Med Prim Care 2023; 12:768-771. [PMID: 37312787 PMCID: PMC10259542 DOI: 10.4103/jfmpc.jfmpc_1650_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Revised: 01/18/2023] [Accepted: 01/27/2023] [Indexed: 06/15/2023] Open
Abstract
Introduction It is likely that a pregnant woman is more motivated and receptive to accepting healthy habits and practices if talked about the benefits to the fetus. When explained about the harmful effects of tobacco on the health of the baby, the mother can be encouraged to modify her tobacco consumption habits and work toward quitting tobacco. Aim Our aim was to study the effectiveness of brief counseling (5As)-Antenatal Tobacco Cessation Support Program among pregnant women availing antenatal care (ANC). Methodology A quasi-randomized study design was used to conduct the study. The participants were identified by screening during ANC visits, and women consuming tobacco were subjected to detailed history taking and very brief counseling with the help of 5A's framework. Results We found that Mishri was the commonest form of tobacco consumed by these women. Around 93.33% of the women consume Mishri, followed by 6.66% of women consuming chewing tobacco. The method of brief counseling made an impact in the cessation of tobacco consumption in 13.37% of the study subjects. Conclusion We conclude that the use of brief counseling and motivational interviewing is feasible in most settings without inhibiting the other important aspects of ANC or disrupting the patient flow.
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Affiliation(s)
- Akansha Sehgal
- TRCC Department, Intern Student, Dr. Balasaheb Vikhe Patil Rural Medical College, Pravara Institute of Medical Sciences (DU), Loni, Maharashtra, India
| | - Motilal Tayade
- Department of Physiology, Dr. Balasaheb Vikhe Patil Rural Medical College, Pravara Institute of Medical Sciences (DU), Loni, Maharashtra, India
| | - Rahul Kunkulol
- Department of Pharmacology, Dr. Balasaheb Vikhe Patil Rural Medical College, Pravara Institute of Medical Sciences (DU), Loni, Maharashtra, India
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Alhazmi HA. Determination of nicotine content in locally produced smokeless tobacco ( Shammah) samples from Jazan region of Saudi Arabia using a convenient HPLC-MS/MS method. OPEN CHEM 2023. [DOI: 10.1515/chem-2022-0300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/19/2023] Open
Abstract
Abstract
Shammah is one of the forms of smokeless tobacco (SLT) prepared by mixing tobacco powder with other ingredients to increase its acceptability. Nicotine (NT) is the main alkaloid present in tobacco and is a precursor for carcinogenic metabolites including tobacco specific nitrosamines (TSNAs). In this study, eight varieties of Shammah samples, collected from Jazan region of Saudi Arabia, were analyzed for NT content by a validated high performance liquid chromatography-mass spectrometry/mass spectrometry method. Electrospray ionization was used with the multiple reaction monitoring in the positive mode for data acquisition. The method was fast and short retention times (RT) of 1.4 and 3.1 min were observed for NT and lapatinib used as internal standard (IS), respectively. The inter- and intra-day accuracy and precision results met the acceptance criteria of United States Food and Drug Administration and International Council for Harmonisation validation guidelines. The developed method was successfully applied for the detection of NT contents in various Shammah samples. NT concentration was found to be in the range of 6.94 ± 0.16 to 31.69 ± 0.79% with the maximum level detected in special Shammah from Ahad Al Masarihah and the lowest level in Khadrah Shammah from Samtah city. The results of this investigation have warranted further research to determine the minor Shammah contents including additive materials and assessment of associated health effects.
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Affiliation(s)
- Hassan A. Alhazmi
- Department of Pharmaceutical Chemistry and Pharmacognosy, College of Pharmacy, Jazan University , Post Code 45142 , Jazan , Saudi Arabia
- Substance Abuse and Toxicology Research Centre, Jazan University , Post Code 45142 , Jazan , Saudi Arabia
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Stefil M, Bell J, Calvert P, Lip GY. Heightened risks of cardiovascular disease in South Asian populations: causes and consequences. Expert Rev Cardiovasc Ther 2023; 21:281-291. [PMID: 36866613 DOI: 10.1080/14779072.2023.2187780] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/04/2023]
Abstract
INTRODUCTION South Asian individuals comprise almost a quarter of the world's population and have an excess risk of atherosclerotic cardiovascular disease (ASCVD) compared to other ethnicities. In part, this can be explained by higher prevalence, earlier onset, and suboptimal control of traditional cardiovascular risk factors, such as insulin resistance, metabolic syndrome, and dyslipidaemia. However, there remains a significant residual excess risk associated with South Asian ethnicity after controlling for traditional risk factors. AREAS COVERED In this review, we describe the epidemiology of ASCVD in both native and diaspora South Asian populations. We explore how traditional cardiovascular risk factors, novel cardiovascular risk factors, and social determinants of health may contribute to the excess ASCVD risk seen in South Asian populations. EXPERT OPINION There should be increased awareness of the relative importance of South Asian ethnicity and related social determinants of health, as risk factors for ASCVD. Systematic screening processes should be tailored to this population, and modifiable risk factors should be treated aggressively. Further research is required to quantify determinants of the excess ASCVD risk seen in South Asian populations and to develop targeted interventions to address these factors.
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Affiliation(s)
- Maria Stefil
- Liverpool Centre for Cardiovascular Science at University of Liverpool, Liverpool John Moores University and Liverpool Heart & Chest Hospital, Liverpool, UK
| | - Jack Bell
- Liverpool Centre for Cardiovascular Science at University of Liverpool, Liverpool John Moores University and Liverpool Heart & Chest Hospital, Liverpool, UK
| | - Peter Calvert
- Liverpool Centre for Cardiovascular Science at University of Liverpool, Liverpool John Moores University and Liverpool Heart & Chest Hospital, Liverpool, UK.,Department of Cardiology, Liverpool Heart & Chest Hospital, Liverpool, UK
| | - Gregory Yh Lip
- Liverpool Centre for Cardiovascular Science at University of Liverpool, Liverpool John Moores University and Liverpool Heart & Chest Hospital, Liverpool, UK.,Department of Cardiology, Liverpool Heart & Chest Hospital, Liverpool, UK.,Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
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Ahmad F, Khan Z, Siddiqi K, Khan MN, Kibria Z, Forberger S, Bauld L, Kanaan M, Zeeb H. Awareness, perceptions of and compliance with tobacco control policies among naswar vendors in Khyber Pakhtunkhwa Pakistan. Tob Control 2022; 31:e111-e117. [PMID: 34226260 DOI: 10.1136/tobaccocontrol-2020-056377] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Accepted: 05/03/2021] [Indexed: 11/04/2022]
Abstract
INTRODUCTION Regulatory compliance in the retail environment is integral to the success of tobacco control. We assessed compliance among naswar (smokeless tobacco product widely used in South Asia) vendors with tobacco control laws. We also assessed their awareness of tobacco-related harms and policies and perceived effect of policies on their sales. METHODS We surveyed 286 naswar vendors in three districts of the Khyber Pakhtunkhwa province of Pakistan. We recruited general and specialty vendors from urban and rural areas through multistage cluster sampling. Compliance was measured for promotion, sale to/by minors and tax paid on naswar. We used logistic regression analyses for assessing the association between the outcome variables (awareness of tobacco harms and laws, perceptions about the effect of policies on business and compliance with laws) and their predictors. RESULTS Most vendors (70%) were aware of tobacco-related harms of naswar. Although educated vendors were more aware of tobacco control policies, the greatest awareness was for a ban on sales to/by minors (21% overall). The majority of vendors (76%) violated this policy (measured by self-report), and violations were more common among rural than urban vendors (OR 2.27, 95% CI 1.05 to 4.96). Most vendors (71%) violated a ban on promotion of naswar. Vendors perceived tax increases and sales ban to/by minors as most detrimental for business. CONCLUSIONS There was poor awareness and compliance among naswar vendors in Pakistan with tobacco control laws. This study finds potential areas for policy interventions that can reduce urban/rural disparities in implementation of and compliance with tobacco control laws.
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Affiliation(s)
- Fayaz Ahmad
- Institute of Public Health and Social Sciences, Khyber Medical University, Peshawar, Pakistan
- Office of Research, Innovation and Commercialization, Khyber Medical University, Peshawar, Pakistan
| | - Zohaib Khan
- Office of Research, Innovation and Commercialization, Khyber Medical University, Peshawar, Pakistan
| | - Kamran Siddiqi
- Institute of Health Sciences, University of York, UK, York, UK
| | - Muhammad Naseem Khan
- Institute of Public Health and Social Sciences, Khyber Medical University, Peshawar, Pakistan
| | - Zeeshan Kibria
- Institute of Public Health and Social Sciences, Khyber Medical University, Peshawar, Pakistan
- Office of Research, Innovation and Commercialization, Khyber Medical University, Peshawar, Pakistan
| | - Sarah Forberger
- Leibniz Institute for Prevention Research and Epidemiology, Bremen, Germany
| | - Linda Bauld
- Usher Institute and UK Centre for Tobacco and Alcohol Studies, College of Medicine and Veterinary Medicine, University of Edinburgh, Edinburgh, UK
| | - Mona Kanaan
- Health Sciences, University of York, York, UK
| | - Hajo Zeeb
- Prevention and Evaluation, Leibniz-Institute for Prevention Research and Epidemiology, Bremen, Germany
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Dhanapriyanka M, Kanthi RDFC, Jayasekara P, Ha DH. Tobacco chewing and associated factors among a vulnerable youth population in Sri Lanka. BMC Public Health 2022; 22:2209. [PMID: 36443802 PMCID: PMC9706888 DOI: 10.1186/s12889-022-14704-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Accepted: 11/22/2022] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Tobacco in any form kills millions of people every year. Tobacco addiction among youth shows an increasing trend while smokeless type is becoming more common. This study aimed to describe the lifestyle of chewing smokeless tobacco among a group of high-risk youth population in Sri Lanka. METHODS A descriptive cross-sectional study was conducted among a sample of 1431 youths aged between 15 to 24 years residing in urban slums in Colombo Sri Lanka, using a cluster sampling technique combined with probability proportionate to size technique. Data were collected using an interviewer-administered questionnaire. Chewing smokeless tobacco was assessed using betel quid chewing and commercially prepared tobacco and areca nut packet chewing. Current chewer was defined as who had the practice of chewing during past 30 days. RESULTS The mean age of the study sample was 17.53 (95% CI: 17.40-17.65). Of the 1431 respondents, 57% were males and 43% were females. The prevalence of current smokeless tobacco chewers was 44.9% and among them 90.8% were males and 9.8% were females. Around 31.3% did not have smokeless tobacco chewing practice (Male-5.9%, Female-64.9%). Among the current smokeless tobacco chewers 21.5% chew both types of smokeless tobacco products and all of them were males. Male gender (OR 17.9; 11.4 -27.9) and ever smoking lifestyle (OR 4.4; 2.9-6.6) were significant determinants of current smokeless tobacco chewing lifestyle. CONCLUSION AND RECOMMENDATIONS The study shows a high prevalence of smokeless tobacco use by youth aged between 15 to 24 years who were residing in urban slum areas in the district of Colombo, in Sri Lanka, highlighting this target group for early intervention to reduce the uptake and promote the quitting of this practice.
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Affiliation(s)
| | | | | | - Diep Hong Ha
- School of Dentistry, Faculty of Health and Behavioural Sciences, University of Queensland, Brisbane, Australia
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Mukherjee N, Jayakrishnan R, Bhattacharya P, Sarkar R, John D, Mitra A, Pal B, Lal P. Impact of ban on commercial smokeless tobacco products among users and vendors in West Bengal and Kerala states, India. CLINICAL EPIDEMIOLOGY AND GLOBAL HEALTH 2022. [DOI: 10.1016/j.cegh.2022.101160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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14
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Razzaq S, Nagi MLF, Athar U, Kazmi T, Alslamah T, Naz S, Abalkhail A. Prevalence of tobacco consumption and the associated factors among the adults in an urban slum: Findings from the WHO STEPwise survey. Tob Induc Dis 2022; 90:91. [PMID: 36381179 PMCID: PMC9619230 DOI: 10.18332/tid/154636] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Revised: 06/02/2022] [Accepted: 09/15/2022] [Indexed: 06/16/2023] Open
Abstract
INTRODUCTION Despite Pakistan's stringent tobacco control policy, its effective implementation has always been a challenge, leading to rising tobacco consumption. The aim of the study is to determine the prevalence of tobacco consumption and associated risk factors in the adult population of deprived urban areas. METHODS A community-based, cross-sectional survey was conducted from February to July 2019, comprising 607 adults residing in the urban squatter settlement of Lahore using a standardized questionnaire, the WHO STEPwise approach. The outcome was current use of tobacco and/or smokeless tobacco daily. Multivariable logistic regression was applied to determine factors associated with smoking and smokeless tobacco consumption. RESULTS Among 607 participants, about 64% were females, 49.3% were illiterate, 64.9% were currently unemployed, and 47.1% belonged to the low-income group. The prevalence of tobacco smoke was 10.5% (95% CI: 8.07-12.93), and smokeless tobacco consumption was 8.6% (95% CI: 6.38-10.82). Multivariable logistic regression found that smokeless tobacco was more likely among the aged 50-59 years (AOR=4.1; 95% CI: 1.1-13.8) and unemployed (AOR=3.6; 95% CI: 1.1-12.2). Whereas tobacco smoking was more likely among the aged 30-39 years (AOR=5.5; 95% CI: 1.8-16.7), Urdu ethnicity (AOR=2.9; 95% CI: 1.2-7.3), unemployed (AOR=6.6; 95% CI: 2.9-14.9), and never exposed to any media (AOR=3.2; 95% CI: 1.8-17.4). Participants exposed to health warnings were less likely to smoke (AOR=0.02; 95% CI: 0.01-0.05). CONCLUSIONS This study reports a high prevalence of tobacco consumption among adults and calls for effective policy implementation using a multi-pronged approach, including health professionals and media, to spread awareness about the harmful effects of tobacco and endorsement of health warnings on tobacco packaging.
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Affiliation(s)
- Shama Razzaq
- Division of Environment and Sustainability, The Hong Kong University of Science and Technology, Hong Kong, People's Republic of China
| | | | - Unsa Athar
- Department of Community Medicine, Shalamar Medical and Dental College, Lahore, Pakistan
| | - Tahseen Kazmi
- Department of Community Medicine, Central Park Medical College, Lahore, Pakistan
| | - Thamer Alslamah
- Department of Public Health, College of Public Health and Health Informatics, Qassim University, Al Bukairiyah, Saudi Arabia
| | - Sana Naz
- Department of Community Medicine, Shalamar Medical and Dental College, Lahore, Pakistan
| | - Adil Abalkhail
- Department of Public Health, College of Public Health and Health Informatics, Qassim University, Al Bukairiyah, Saudi Arabia
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15
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A set of common buccal CpGs that predict epigenetic age and associate with lifespan-regulating genes. iScience 2022; 25:105304. [PMID: 36304118 PMCID: PMC9593711 DOI: 10.1016/j.isci.2022.105304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Revised: 08/11/2022] [Accepted: 10/02/2022] [Indexed: 11/23/2022] Open
Abstract
Epigenetic aging clocks are computational models that use DNA methylation sites to predict age. Since cheek swabs are non-invasive and painless, collecting DNA from buccal tissue is highly desirable. Here, we review 11 existing clocks that have been applied to buccal tissue. Two of these were exclusively trained on adults and, while moderately accurate, have not been used to capture health-relevant differences in epigenetic age. Using 130 common CpGs utilized by two or more existing buccal clocks, we generate a proof-of-concept predictor in an adult methylomic dataset. In addition to accurately estimating age (r = 0.95 and mean absolute error = 3.88 years), this clock predicted that Down syndrome subjects were significantly older relative to controls. A literature and database review of CpG-associated genes identified numerous genes (e.g., CLOCK, ELOVL2, and VGF) and molecules (e.g., alpha-linolenic acid, glycine, and spermidine) reported to influence lifespan and/or age-related disease in model organisms. 130 CpGs have been used by two or more aging clocks applied to human buccal tissue Common CpG genes are linked to the adaptive immune system and telomere maintenance Common CpGs can be used to build a novel, proof-of-concept epigenetic aging clock Several compounds associated with common CpG genes regulate lifespan in animals
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16
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Combining Phenotypes of Nucleotide Excision Repair Pathway to Predict the Risk of Head and Neck Squamous Cell Carcinomas in a Chinese Population. DISEASE MARKERS 2022; 2022:4959737. [PMID: 36118674 PMCID: PMC9476247 DOI: 10.1155/2022/4959737] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Revised: 07/17/2022] [Accepted: 08/01/2022] [Indexed: 11/28/2022]
Abstract
Background Nucleotide excision repair (NER) is pivotal in the development of smoking-related malignancies. Nine core genes (XPA, XPB, XPC, XPD, XPF, XPG, ERCC1, DDB1, and DDB2) are highly involved in the NER process. We combined two phenotypes of NER pathway (NER protein and NER gene mRNA expression) and evaluated their associations with the risks of the head and neck squamous cell carcinomas (HNSCCs) in a Chinese population. Methods We conducted a case-control study of 337 HNSCC patients and 285 cancer-free controls by measuring the expression levels of nine core NER proteins and NER gene mRNA in cultured peripheral lymphocytes. Results Compared with the controls, cases had statistically significantly lower protein expression levels of XPA (P < 0.001) and lower mRNA expression levels of XPA and XPB (P = 0.005 and 0.001, respectively). After dividing the subjects by controls' medians of expression levels, we found an association between increased risks of HNSCCs and low XPA protein level (Ptrend = 0.031), as well as low mRNA levels of XPA and XPB (Ptrend = 0.024 and 0.001, respectively). Subsequently, we correlated the two phenotypes and found associations between the NER mRNA and protein levels. Finally, the sensitivity of the expanded model with protein and mRNA expression levels, in addition to demographic variables, on HNSCCs risk was significantly improved. Conclusions Combining two phenotypes of NER pathway may be more effective than the model only including one single phenotype for the assessment of risks of HNSCCs.
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17
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Ali A, Manzoor MF, Ahmad N, Aadil RM, Qin H, Siddique R, Riaz S, Ahmad A, Korma SA, Khalid W, Aizhong L. The Burden of Cancer, Government Strategic Policies, and Challenges in Pakistan: A Comprehensive Review. Front Nutr 2022; 9:940514. [PMID: 35938114 PMCID: PMC9355152 DOI: 10.3389/fnut.2022.940514] [Citation(s) in RCA: 25] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Accepted: 06/23/2022] [Indexed: 01/09/2023] Open
Abstract
Cancer is a severe condition characterized by uncontrolled cell division and increasing reported mortality and diagnostic cases. In 2040, an estimated 28.4 million cancer cases are expected to happen globally. In 2020, an estimated 19.3 million new cancer cases (18.1 million excluding non-melanoma skin cancer) had been diagnosed worldwide, with around 10.0 million cancer deaths. Breast cancer cases have increased by 2.26 million, lung cancer by 2.21 million, stomach by 1.089 million, liver by 0.96 million, and colon cancer by 1.93 million. Cancer is becoming more prevalent in Pakistan, with 19 million new cancer cases recorded in 2020. Food adulteration, gutkha, paan, and nutritional deficiencies are major cancer risk factors that interplay with cancer pathogenesis in this country. Government policies and legislation, cancer treatment challenges, and prevention must be revised seriously. This review presents the current cancer epidemiology in Pakistan to better understand cancer basis. It summarizes current cancer risk factors, causes, and the strategies and policies of the country against cancer.
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Affiliation(s)
- Anwar Ali
- Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, Changsha, China
- Hunan Provincial Key Laboratory of Clinical Epidemiology, Xiangya School of Public Health, Central South University, Changsha, China
- Food and Nutrition Society, Gilgit Baltistan, Pakistan
| | | | - Nazir Ahmad
- Department of Nutritional Science, Government College University Faisalabad, Faisalabad, Pakistan
| | - Rana Muhammad Aadil
- National Institute of Food Science and Technology, University of Agriculture, Faisalabad, Pakistan
| | - Hong Qin
- School of Nutrition and Food Hygiene, Xiangya School of Public Health, Central South University, Changsha, China
| | - Rabia Siddique
- Department of Chemistry, Government College University Faisalabad, Faisalabad, Pakistan
| | - Sakhawat Riaz
- Department of Home Economics, Government College University Faisalabad, Faisalabad, Pakistan
| | - Arslan Ahmad
- Department of Home Economics, Government College University Faisalabad, Faisalabad, Pakistan
| | - Sameh A. Korma
- Department of Food Science, Faculty of Agriculture, Zagazig, Egypt
| | - Waseem Khalid
- Department of Food Sciences, Government College University, Faisalabad, Pakistan
| | - Liu Aizhong
- Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, Changsha, China
- Hunan Provincial Key Laboratory of Clinical Epidemiology, Xiangya School of Public Health, Central South University, Changsha, China
- *Correspondence: Liu Aizhong
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18
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Keyser BM. Cytotoxicity, oxidative stress, and inflammatory response of smokeless tobacco extracts and cytotoxicity of combustible cigarette whole smoke in a 3D oral organotypic buccal cell model. Toxicol Mech Methods 2022; 32:352-361. [PMID: 34923904 DOI: 10.1080/15376516.2021.2009949] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Revised: 11/18/2021] [Accepted: 11/18/2021] [Indexed: 10/19/2022]
Abstract
Oral disease is frequently associated with viral and environmental exposures and oral hygiene. The use of tobacco is a risk factor in the development of oral disease. Cytotoxicity, inflammatory response, and oxidative stress have been reported to have a role in the development of oral disease. These three endpoints were evaluated in a 3D human oral buccal model, EpiOral™, following exposure to CORESTA reference smokeless tobacco products (CRPs) and cigarette whole smoke. CRPs for Swedish style snus (CRP1), moist snuff (CRP2), and dry snuff (CRP3) were each extracted in complete artificial saliva (CAS) with a ratio of 300 mg CRP to 1 mL of CAS. Each of the CRP extracts (15-300 mg/ml) were applied to the apical side of a 3D organotypic buccal cell model for 24 or 48 h continuously, then cytotoxicity (LDH), oxidative stress (8-isoprostane), and inflammatory response (IP10, IL-1α, and IL-8) were measured. Experiments with 3R4F cigarettes were conducted by exposing the buccal tissues to whole smoke for a maximum of 2.5 h. Cytotoxicity (MTT) was measured 24 h post-exposure. Exposure of buccal tissues to whole smoke from a cigarette induced a dose-dependent cytotoxic response. In contrast, the CRP extracts elicited minimal cytotoxicity (<15%) when compared to CAS (vehicle control), but time- and dose-dependent effects on oxidative stress and inflammatory response were observed. Collectively, these data demonstrate that a 3D organotypic buccal human model may be used to assess biological mechanisms (MOAs) involved in the development of oral disease following exposure to smokeless tobacco products and may be applicable for differentiation between tobacco product categories.
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Affiliation(s)
- Brian M Keyser
- Scientific & Regulatory Affairs, RAI Services Company, Winston-Salem, NC, USA
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19
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Warner KE. From Perth to Wellington: a 30-year journey. Tob Control 2022; 31:123-124. [PMID: 35241575 DOI: 10.1136/tobaccocontrol-2021-057234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2021] [Accepted: 12/21/2021] [Indexed: 11/03/2022]
Affiliation(s)
- Kenneth E Warner
- Health Management and Policy, University of Michigan School of Public Health, Ann Arbor, Michigan, USA
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20
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Chauhan R, Trivedi V, Rani R, Singh U. A Study of Head and Neck Cancer Patients with Reference to Tobacco Use, Gender, and Subsite Distribution. South Asian J Cancer 2022; 11:46-51. [PMID: 35833037 PMCID: PMC9273320 DOI: 10.1055/s-0041-1740601] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Context
Head and neck cancer (HNC) is very common in India, constituting 30% of all the cancers because of the widespread use of tobacco across India. The prevalence and pattern of tobacco use vary in different regions and states of the country. Although predominantly seen in males, studies have reported that the male-to-female ratio varies worldwide and also by anatomical subsite.
Aims
This study was done with an aim to determine the difference in pattern and prevalence of tobacco use in male and female patients with HNCs and compare them with different subsites' involvement in our region.
Methods and Materials
This is a retrospective analysis of 500 consecutive biopsy-proven HNC patients from a large comprehensive cancer hospital from Bihar during the period of January 2019 to June 2019. Data collected for the study included age, gender, site of the disease, and use of tobacco. The categorical data were analyzed by a chi-square test using SPSS (version 16).
Results
Our study showed a male-to-female ratio of 8.43:1 with tobacco addiction in 84.40% patients. Smokeless tobacco was used by 52.20%, combustible form by 12.80%, and both by 19.40% of the patients. Tobacco use was seen in 87.25% of male patients as compared with only 60.38% of female patients (
p
-value = 0.0001). Oral cavity cancer was seen in 60.85% of male patients and 37.74% of female patients (
p
-value = 0.0012), whereas oropharyngeal cancer was seen in only 11.63% of male patients as compared with 25.83% of female patients (
p
-value = 0.0008). The subsite analysis showed that in patients with oral cavity cancers, no addiction was found in only 10.29% of male patients as compared with 30% of the female patients (
p
-value = 0.008).
Conclusions
Our study confirms a high prevalence of tobacco use among HNC patients. So, we need to continue our efforts to create awareness against tobacco use. Besides, there is also a need for more studies to look into other etiological factors among nontobacco users.
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Affiliation(s)
- Richa Chauhan
- Department of Radiotherapy, Mahavir Cancer Sansthan, Patna, Bihar, India
| | - Vinita Trivedi
- Department of Radiotherapy, Mahavir Cancer Sansthan, Patna, Bihar, India
| | - Rita Rani
- Department of Radiotherapy, Mahavir Cancer Sansthan, Patna, Bihar, India
| | - Usha Singh
- Department of Radiotherapy, Mahavir Cancer Sansthan, Patna, Bihar, India
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21
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Bhatt G, Goel S, Gupta R, Grover S, Medhi B. Evaluating the impact of culturally specific patient-centric behavioral intervention package versus usual care for tobacco cessation among patients attending noncommunicable disease clinics in North India: A single-blind trial pilot study protocol. Tob Use Insights 2022; 14:1179173X211056622. [PMID: 34987297 PMCID: PMC8721367 DOI: 10.1177/1179173x211056622] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2020] [Accepted: 10/08/2020] [Indexed: 11/30/2022] Open
Abstract
Background In a low and middle-income country (LMIC) like India, non—communicable diseases (NCDs) contribute a major proportion (61.8%) of all causes of death. Out of this, 48% of cardiovascular diseases , 23% of Chronic Respiratory Diseases , and 10% of Cancer deaths are attributable to tobacco use. Tobacco use is a major risk factor for NCDs and thus, the tobacco cessation approach is a high priority intervention to combat complications and death among NCD patients. While several interventions are available for tobacco cessation, in resource constraint countries like India, the effectiveness of low-cost, culturally specific patient-centric tobacco cessation behavioral intervention holds a potential that needs to be evaluated. A newly developed evidence-based tobacco cessation intervention package will be compared with the existing/usual care provided under the National Programme for Prevention and Control of Cancers, Diabetes, Cardiovascular Diseases, and Stroke (NPCDCS) at NCD clinics. Methods and design 2 arm, parallel-group randomized controlled trial. Participants Patients aged ≥30 years suffering from NCD, currently using tobacco, and attending NCD clinics in 2 districts of Punjab, India. Sample size A total of 200 participants meeting the selection criteria will be recruited. They will be allocated either to the intervention arm or control (usual care) arm (100 each) using block randomization. Intervention For the participants, there will be 4 face-to-face disease-specific cessation counseling sessions, disease-specific pamphlets, short text messages in vernacular language, that is, Punjabi. Follow-ups will be done at the third, sixth, ninth, and 12th months. Primary outcome Seven-day abstinence, biochemically verified by plasma cotinine levels. Secondary outcome Quit attempts, number of sticks/number of times of smokeless tobacco usage in a day, and stage of behavior change in tobacco users. Discussion This multicomponent culturally specific-patient-centric behavioral intervention package for tobacco cessation at NCD clinic settings focusing on the individual, family, and social environment could increase the outreach of cessation services using existing resources, thereby strengthening health systems and enhancing the quality of life of NCD patients. Trial registration The protocol for the study has been registered with the Clinical Trials Registry in India under the registration number CTRI/2018/01/011643.
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Affiliation(s)
- Garima Bhatt
- Department of Community Medicine and School of Public Health, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Sonu Goel
- Department of Community Medicine and School of Public Health, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Rakesh Gupta
- Honorary Consultant, Tobacco Cessation, Department of Deaddiction, Santokba Durlabhji Memorial Hospital and Medical Research Institution, Jaipur, India
| | - Sandeep Grover
- Department of Psychiatry, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Bikash Medhi
- Department of Pharmacology, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
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22
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Pachuau L, Zami Z, Nunga T, Zodingliana R, Zoramthari R, Lalnuntluanga R, Sangi Z, Rinmawii L, Kumar NS, Lalhruaitluanga H. First-degree family history of cancer can be a potential risk factor among head and neck cancer patients in an isolated Mizo tribal population, northeast India. CLINICAL EPIDEMIOLOGY AND GLOBAL HEALTH 2022. [DOI: 10.1016/j.cegh.2021.100954] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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23
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Siddiqi K, Keding A, Marshall AM, Dogar O, Li J, Huque R, Fatima R, Khan A, Elsey H, Gabe R, Kotz D, Sheikh A. Effect of quitting smoking on health outcomes during treatment for tuberculosis: secondary analysis of the TB & Tobacco Trial. Thorax 2022; 77:74-78. [PMID: 34272336 DOI: 10.1136/thoraxjnl-2020-215926] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2020] [Accepted: 06/24/2021] [Indexed: 01/10/2023]
Abstract
BACKGROUND Despite treatment, patients with tuberculosis (TB) who smoke have poorer outcomes compared with non-smokers. It is unknown, however, if quitting smoking during the 6 months of TB treatment improves TB outcomes. METHODS The TB & Tobacco Trial was a double-blind, placebo-controlled randomised trial of cytisine for smoking cessation in 2472 patients with pulmonary TB in Bangladesh and Pakistan. In a secondary analysis, we investigated the hypothesis that smoking cessation improves health outcomes in patients during the TB treatment course. The outcomes included an eight-point TB clinical score, sputum conversion rates, chest X-ray grades, quality of life (EQ-5D-5L), TB cure plus treatment completion rates and relapse rates. These were compared between those who stopped smoking and those who did not, using regression analysis. RESULTS We analysed the data of 2273 (92%) trial participants. Overall, 25% (577/2273) of participants stopped smoking. Compared with non-quitters, those who quit had better TB cure plus treatment completion rates (91% vs 80%, p<0.001) and lower TB relapse rates (6% vs 14%, p<0.001). Among quitters, a higher sputum conversion rate at week 9 (91% vs 87%, p=0.036), lower mean TB clinical scores (-0.20 points, 95% CI -0.31 to -0.08, p=0.001) and slightly better quality of life (mean EQ-5D-5L 0.86 vs 0.85, p=0.015) at 6 months were also observed. These differences, except quality of life, remained statistically significant after adjusting for baseline values, trial arm and TB treatment adherence rates. CONCLUSION Patients with TB who stop smoking may have better outcomes than those who don't. Health professionals should support patients in stopping smoking.
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Affiliation(s)
- Kamran Siddiqi
- Health Sciences, University of York, York, UK
- Hull York Medical School, York, UK
| | - Ada Keding
- Health Sciences, University of York, York, UK
| | | | - Omara Dogar
- Health Sciences, University of York, York, UK
| | - Jinshuo Li
- Health Sciences, University of York, York, UK
| | - Rumana Huque
- Economics, Dhaka University, Dhaka, Bangladesh
- Research and Development, ARK Foundation, Dhaka, Bangladesh
| | - Razia Fatima
- Common Unit (HIV,TB,Malaria), Pakistan Ministry of National Health Services, Regulation and Coordination, Islamabad, Pakistan
| | - Amina Khan
- Research, The Initiative, Islamabad, Pakistan
| | - Helen Elsey
- Health Sciences, University of York, York, UK
- Hull York Medical School, York, UK
| | - Rhian Gabe
- Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Queen Mary University of London, London, UK
| | - Daniel Kotz
- Institute of General Practice, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Aziz Sheikh
- Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, UK
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Hajat C, Stein E, Ramstrom L, Shantikumar S, Polosa R. The health impact of smokeless tobacco products: a systematic review. Harm Reduct J 2021; 18:123. [PMID: 34863207 PMCID: PMC8643012 DOI: 10.1186/s12954-021-00557-6] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Accepted: 10/12/2021] [Indexed: 12/23/2022] Open
Abstract
INTRODUCTION The objective was to systematically review studies on health outcomes from smokeless tobacco (SLT) products. METHODS We analysed published literature on the health outcomes from SLT use between 01/01/2015 to 01/02/2020, following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) protocol using PubMed, Embase, Scopus, and Google Scholar. RESULTS Of 53 studies included, six were global, 32 from Asia, Middle East and Africa (AMEA), nine from USA and six from Europe. 'Poor'-rated studies predominated (23;43%), in particular, for global (4;66%) and AMEA (16;50%). Health outcomes differed between SLT-products and regions; those in AMEA were associated with higher mortality (overall, cancer, Coronary heart disease (CHD), respiratory but not cardiovascular disease (CVD)), and morbidity (CVD, oral and head and neck cancers), with odds ratios up to 38.7. European studies showed no excess mortality (overall, CVD, from cancers) or morbidity (ischemic heart disease (IHD), stroke, oral, head and neck, pancreatic or colon cancers) from several meta-analyses; single studies reported elevated risk of rectal cancer and respiratory disorders. Pooled study data showed protection against developing Parkinson's disease. US studies showed mixed results for mortality (raised overall, CHD, cancer and smoking-related cancer mortality; no excess risk of respiratory or CVD mortality). Morbidity outcomes were also mixed, with some evidence of increased IHD, stroke and cancer risk (oral, head and neck). No studies reported on switching from cigarettes to SLT-products. CONCLUSION Our review demonstrates stark differences between different SLT-products in different regions, ranging from zero harm from European snus to greatly increased health risks in AMEA. The literature on the safety profile for SLT-products for harm reduction is incomplete and potentially misinforming policy and regulation.
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Affiliation(s)
- C Hajat
- Public Health Institute, UAE University, Abu Dhabi, 15551, UAE.
| | - E Stein
- Independent Researcher, New York, USA
| | - L Ramstrom
- Independent Researcher, Institute for Tobacco Studies, Stockholm, Sweden
| | - S Shantikumar
- Warwick Medical School, University of Warwick, Coventry, UK
| | - R Polosa
- Center of Excellence for the Acceleration of HArm Reduction (CoEHAR), University of Catania, Catania, Italy
- Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
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25
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Binmadi N, Harere L, Mattar A, Aljohani S, Alhindi N, Ali S, Almazrooa S. Oral lesions associated with smokeless tobacco users in Saudi Arabia: Single center cross-sectional study. Saudi Dent J 2021; 34:114-120. [PMID: 35241900 PMCID: PMC8864373 DOI: 10.1016/j.sdentj.2021.12.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Revised: 11/18/2021] [Accepted: 12/01/2021] [Indexed: 01/29/2023] Open
Abstract
Introduction Smokeless tobacco (SLT) causes significant harm to the oral cavity and is considered a risk factor for oral cancer. Various forms, products, and patterns of SLT are used across different populations. Many products, such as nicotine and betel nut, have addictive and carcinogenic properties. SLT use is associated with benign, premalignant, or malignant lesions. This study aimed to identify the characteristics of these oral lesions and their association with SLT exposure. Materials and methods This cross-sectional study, performed at our institution’s Faculty of Dentistry, included all the patients with a history of using SLT within a 5-year period at the oral medicine clinic. The patients’ demographic details were collected, and information regarding habit, duration, frequency, site of placement, and history of habit discontinuity were recorded. If a biopsy was performed, the diagnoses were also reported. Results Of the 59 patients included, 89.8% were male and 10.2% were female. SLT lesions in the oral cavity were usually focal lesions (76.3%). The most preferred placement site by SLT users was the mandibular posterior vestibule. Follow-up of SLT patients after quitting or clinical changes in the placement site showed a 92.8% regression or complete healing of the lesions. Of the 59 patients who underwent SLT, 18.6% were diagnosed with oral squamous cell carcinoma. Conclusion This study demonstrated a high percentage of remarkable regression or complete healing of SLT lesions related to early diagnosis and habit change. In contrast, 18.6% of the lesions progressed to SCC.
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Affiliation(s)
- Nada Binmadi
- Department of Oral and Diagnostic Sciences, King Abdulaziz University, Faculty of Dentistry, Jeddah, Saudi Arabia
- Corresponding author at: Oral Diagnostic Sciences Department, Faculty of Dentistry, King Abdulaziz University, Jeddah, Saudi Arabia.
| | - Louae Harere
- King Abdulaziz University, Faculty of Dentistry, Jeddah, Saudi Arabia
| | - Ajwad Mattar
- King Abdulaziz University, Faculty of Dentistry, Jeddah, Saudi Arabia
| | - Suad Aljohani
- Department of Oral and Diagnostic Sciences, King Abdulaziz University, Faculty of Dentistry, Jeddah, Saudi Arabia
| | - Nada Alhindi
- Department of Oral and Diagnostic Sciences, King Abdulaziz University, Faculty of Dentistry, Jeddah, Saudi Arabia
| | - Sarah Ali
- Department of Oral and Diagnostic Sciences, King Abdulaziz University, Faculty of Dentistry, Jeddah, Saudi Arabia
| | - Soulafa Almazrooa
- Department of Oral and Diagnostic Sciences, King Abdulaziz University, Faculty of Dentistry, Jeddah, Saudi Arabia
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Jadgal MS, Alizadeh S, Alizadeh -Siuki H, Sadeghi S, Salehian T, Zareipour M. The effect of theory - Based educational intervention on consumption of smokeless tobacco products by merchants' guilds. JOURNAL OF EDUCATION AND HEALTH PROMOTION 2021; 10:428. [PMID: 35071634 PMCID: PMC8719556 DOI: 10.4103/jehp.jehp_86_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Accepted: 04/17/2021] [Indexed: 06/14/2023]
Abstract
BACKGROUND Smokeless tobacco (SLT) products are highly addictive and contain at least 28 carcinogenic chemicals. The purpose of this study was to determine the effect of theory-based on the Transtheoretical Model of Behavior Change on consumption of SLT products by Merchants' Guilds in 2018. MATERIALS AND METHODS The present quasi-experimental research was conducted over one intervention group. The research population consisted of all consumers of the SLT products among the merchants' guilds in Chabahar City, Iran in 2018. Data were gathered from 320 individuals by simple random sampling using a valid and reliable researcher-made questionnaire. The intervention program was designed based on the Transtheoretical Model of Behavior Change cognitive processes and lasted 6 months. After the intervention, the same questionnaires were administered among the participants. The data were analyzed by SPSS version 20 using the descriptive and analytical tests. RESULTS In the preintervention phase, the participants' mean scores of the cognitive processes at the precontemplation, contemplation, and preparation stages were 29.16 ± 4.63, 25.07 ± 3.84, and 12.12 ± 1.63, respectively. At the postintervention phase, mean scores of the precontemplation, contemplation, and preparation stages reached to 40.5 ± 5.96, 38.8 ± 5.03, and 35.5 ± 4.23, respectively. Furthermore, the participants' mean sores at the action and maintenance stages were 36.4 ± 4.57 and 43.3 ± 3.29, respectively. According to the ANOVA, a significant relationship was found between cognitive processes at the preintervention phase and stages of change (P < 0.001). CONCLUSIONS Individuals can improve from the precontemplation, contemplation, and preparation phases to the action and maintenance stages by attending based on Transtheoretical Model of Behavior Change educational interventions. It is suggested that the structure of this model be used to reduce high-risk behaviors in other occupations.
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Affiliation(s)
- Mohammad Saeed Jadgal
- Department of Public Health, School of Nursing and Midwifery, Iranshahr University of Medical Sciences, Chabahar, Iran
| | - Somayeh Alizadeh
- Department of Health Education and Promotion, Faculty of Public Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Hadi Alizadeh -Siuki
- Department of Public Health, School of Health, Torbat Heydariyeh University of Medical Sciences, Torbat Heydariyeh, Iran
| | - Saeedeh Sadeghi
- Department of Health Education and Promotion, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Tahmineh Salehian
- Department of Nursing and Midwifery, Iranshahr University of Medical Sciences, Chabahar, Iran
| | - Moradali Zareipour
- Department of Public Health, School of Health, Khoy University of Medical Sciences, Khoy, Iran
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Shukla R, Kanaan M, Siddiqi K. Tobacco Use Among 1 310 716 Women of Reproductive age (15-49 Years) in 42 Low- and Middle-Income Countries: Secondary Data Analysis From the 2010-2016 Demographic and Health Surveys. Nicotine Tob Res 2021; 23:2019-2027. [PMID: 34291296 PMCID: PMC8849114 DOI: 10.1093/ntr/ntab131] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2021] [Accepted: 06/17/2021] [Indexed: 12/30/2022]
Abstract
INTRODUCTION Tobacco use among women, especially during pregnancy is a public health concern. There is a need to understand the diverse nature of their tobacco consumption across the globe. METHODS We used Demographic and Health Surveys (DHS) data collected between 2010 and 2016 from 42 low- and middle-income countries (LMICs) to estimate the prevalence of smoking, smokeless tobacco, and dual use among pregnant and non-pregnant women of reproductive age (15-49 y). We compared tobacco use between both groups adjusted for age, type of residence, education and combined wealth index, and a subgroup analysis for the South-East Asia Region (SEAR) as the tobacco use in SEAR among women is far more diverse than in other regions primarily due to the popularity of smokeless tobacco use in this region. RESULTS Based on the data of 1 310 716 women in 42 LMICs, the prevalence of smoking was 0.69%(95%CI: 0.51-0.90) among pregnant women and 1.09%(95%CI: 0.81-1.42) among non-pregnant women. The prevalence of smokeless tobacco use was 0.56%(95%CI: 0.33-0.84) among pregnant women and 0.78%(95%CI: 0.35-1.37) among non-pregnant women. The relative risk ratios(RRR) for smoking (0.85; 95%CI: 0.67-1.09) and smokeless tobacco use (0.81; 95%CI:0.67-1.00) were not-significantly lower among pregnant women than non-pregnant women and education and wealth index had an inverse relationship with both forms of tobacco. In SEAR, among pregnant women, the prevalence of smoking and smokeless tobacco use was 1.81% and 0.45%, respectively. However, pregnant women were 7%(RRR 1.07; 95%CI:1.02-1.12) more likely to use smokeless tobacco than non-pregnant women. CONCLUSION Despite the added risk of foetal harm during pregnancy, there is no evidence that the tobacco consumption between pregnant and non-pregnant women differ in 42 LMICs. A significantly higher use of smokeless tobacco among pregnant women in SEAR is of particular concern and warrants further investigation. IMPLICATIONS Tobacco use among women in low- and middle-income countries (LMICs) is lower than high-income countries (HICs), but this may be because LMICs are earlier in the epidemiological transition of tobacco use. If ignored as a public health issue and the tobacco industry continues to market its products to women, the level of tobacco use may rise as it did in HICs. Also, despite low prevalence rates and with no evidence that these differ among pregnant and non-pregnant women, is concerning as tobacco consumption in any form during pregnancy is associated with poor birth outcomes. This suggests a need for raising awareness about the harms of tobacco use among women in LMICs, especially during pregnancy. There is a need to develop preventive and cessation interventions to decrease tobacco use (smoking and smokeless) among women who are from low socio-economic status and less educated, as they bear the greatest burden of tobacco use.
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Affiliation(s)
- Radha Shukla
- Department of Health Sciences, University of York, Heslington, York,UK
| | - Mona Kanaan
- Department of Health Sciences, University of York, Heslington, York,UK
| | - Kamran Siddiqi
- Department of Health Sciences, University of York, Heslington, York,UK
- Hull York Medical School, University of York, York,UK
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Huque R, Al Azdi Z, Sheikh A, Ahluwalia JS, Mishu MP, Mehrotra R, Ahmed N, Bauld L, Huq SM, Alam SM, Siddiqui F, Choudhury SR, Siddiqi K. Policy priorities for strengthening smokeless tobacco control in Bangladesh: A mixed-methods analysis. Tob Induc Dis 2021; 19:78. [PMID: 34707471 PMCID: PMC8500203 DOI: 10.18332/tid/140826] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2021] [Revised: 06/28/2021] [Accepted: 08/03/2021] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION Smokeless tobacco (ST) remains poorly regulated in Bangladesh. This study describes the prevalence and trends of ST use in Bangladesh, presents ST-related disease burden, identifies relevant policy gaps, and highlights key implications for future policy and practice for effective ST control in Bangladesh. METHODS We analyzed secondary data from the two rounds (2009 and 2017) of The Global Adult Tobacco Survey, estimated ST-related disease burden, and conducted a review to assess differences in combustible tobacco and ST policies. In addition, we gathered views in a workshop with key stakeholders in the country on gaps in existing tobacco control policies for ST control in Bangladesh and identified policy priorities using an online survey. RESULTS Smokeless tobacco use, constituting more than half of all tobacco use in Bangladesh, declined from 27.2% (25.9 million) in 2009 to 20.6% (22 million) in 2017. However, in 2017, at least 16947 lives and 403460 Disability-Adjusted Life Years (DALYs) were lost across Bangladesh due to ST use compared to 12511 deaths and 324020 DALYs lost in 2010. Policy priorities identified for ST control have included: introducing specific taxes and increasing the present ad valorem tax level, increasing the health development surcharge, designing and implementing a tax tracking and tracing system, standardizing ST packaging, integrating ST cessation within existing health systems, comprehensive media campaigns, and licensing of ST manufactures. CONCLUSIONS Our analysis shows that compared to combustible tobacco, there remain gaps in implementing and compliance with ST control policies in Bangladesh. Thus, contrary to the decline in ST use and the usual time lag between tobacco exposure and the development of cancers, the ST-related disease burden is still on the rise in Bangladesh. Strengthening ST control at this stage can accelerate this decline and reduce ST related morbidity and mortality.
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Affiliation(s)
- Rumana Huque
- Department of Economics, University of Dhaka, Dhaka, Bangladesh.,ARK Foundation, Dhaka, Bangladesh
| | | | - Aziz Sheikh
- Usher Institute, The University of Edinburgh, Edinburgh, United Kingdom
| | - Jasjit S Ahluwalia
- Department of Behavioral and Social Sciences, Alpert Medical School, Brown University School of Public Health, Providence, United States
| | - Masuma P Mishu
- Department of Health Sciences, Faculty of Sciences, University of York, Heslington, United Kingdom
| | - Ravi Mehrotra
- Centre for Health Economics, University of York, York, United Kingdom.,Department of Health Research, India Cancer Research Consortium, New Delhi, India
| | - Nasiruddin Ahmed
- 8 Institute of Governance and Development, BRAC University, Dhaka, Bangladesh
| | - Linda Bauld
- Usher Institute, The University of Edinburgh, Edinburgh, United Kingdom
| | | | | | - Faraz Siddiqui
- Department of Health Sciences, Faculty of Sciences, University of York, Heslington, United Kingdom
| | - Sohel R Choudhury
- Department of Epidemiology and Research, National Heart Foundation Hospital and Research Institute, Dhaka, Bangladesh
| | - Kamran Siddiqi
- Department of Health Sciences, Faculty of Sciences, University of York, Heslington, United Kingdom
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Kyriakos CN, Ahmad A, Chang K, Filippidis FT. Price differentials of tobacco products: A cross-sectional analysis of 79 countries from the six WHO regions. Tob Induc Dis 2021; 19:80. [PMID: 34720795 PMCID: PMC8519342 DOI: 10.18332/tid/142550] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Revised: 09/23/2021] [Accepted: 09/23/2021] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION Increased taxation is one of the most effective tobacco control measures. Price differentials across tobacco product types may undermine the effectiveness of taxation policies by providing the option to switch to cheaper products rather than to quit. The aim of this study was to use commercial data to compare prices and price differentials of both cigarette and non-cigarette products across countries from all geographical regions. METHODS We analyzed 6920 price data points (i.e. product brands) from Euromonitor Passport 2016 for 12 types of tobacco products across 79 countries from the six WHO regions: Africa (n=5), Eastern Mediterranean (n=6), Europe (n=39), the Americas (n=15), South-East Asia (n=3), and Western Pacific (n=12). For each product and country, a price differential was computed as the percentage of minimum price to the median. RESULTS Median cigarette prices (US$) were highest in Western Pacific countries (4.00; range: 0.80-16.20) and European countries (3.80; range: 0.80-14.00), but lowest in African countries (2.00; range: 0.80-2.20). The medians of cigarette price differentials were largest in the Eastern Mediterranean (48.33%) and African regions (50.00%), but smallest in Europe (82.35%). Pipe tobacco and fine-cut tobacco were generally less expensive than cigarettes while cigars were the most expensive. However, there were wide variations in prices and price differentials across regions and tobacco products. CONCLUSIONS We found substantial variations in prices and price differentials between countries and world regions across tobacco products, likely reflecting differences in taxation policies and structures. Findings identify types of tobacco products in specific geographical regions where price differentials are highest, thereby highlighting areas where taxation policies need improvement, for example through implementing specific excise taxes.
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Affiliation(s)
- Christina N. Kyriakos
- Public Health Policy Evaluation Unit, School of Public Health, Imperial College London, London, United Kingdom
| | - Aulia Ahmad
- Public Health Policy Evaluation Unit, School of Public Health, Imperial College London, London, United Kingdom
| | - Kiara Chang
- Public Health Policy Evaluation Unit, School of Public Health, Imperial College London, London, United Kingdom
| | - Filippos T. Filippidis
- Public Health Policy Evaluation Unit, School of Public Health, Imperial College London, London, United Kingdom
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Tasnim R, Sujan MSH, Islam MS, Ferdous MZ, Hasan MM, Koly KN, Potenza MN. Depression and anxiety among individuals with medical conditions during the COVID-19 pandemic: Findings from a nationwide survey in Bangladesh. Acta Psychol (Amst) 2021; 220:103426. [PMID: 34619554 PMCID: PMC8486640 DOI: 10.1016/j.actpsy.2021.103426] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Revised: 09/30/2021] [Accepted: 09/30/2021] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Coronavirus disease 2019 (COVID-19) disproportionately impacts individuals with medical conditions, including with respect to their mental health. The present study investigated depression and anxiety and their correlates among individuals with medical conditions in Bangladesh. METHODS Subjects were recruited to participate in an internet-based survey. Data were collected from November 2020 to January 2021 using convenience sampling by a semi-structured questionnaire through online platforms. Multiple regression analyses were performed to determine associations applying Bonferroni correction (p < 0.004). The Patient Health Questionnaire (PHQ-9) and Generalized Anxiety Disorder (GAD-7) measured depression and anxiety, respectively. RESULTS Nine-hundred-and-seventy-one participants (50.1% male; mean age = 42.29 ± 15.86 years; age range = 18-80 years) with medical conditions were included in final analyses. The most frequently reported conditions were diabetes, hypertension, obesity, heart disease, asthma, and anemia. Estimates of moderate to severe depression and anxiety were 38.9% and 35.2%, respectively. The mean depression and anxiety scores were significantly higher among participants who reported having hypertension, obesity, heart disease, asthma, anemia, cancer and chronic obstructive pulmonary disease (COPD). Using Bonferroni correction (p < 0.004), depression was associated with being female and a student, having poorer quality of life, poorer health status and greater numbers of co-morbidities, not engaging in physical exercise and tobacco smoking. Anxiety was associated with being female and a student, having lower socioeconomic status, poorer quality of life, poorer health status and greater numbers of co-morbidities, less sleep and tobacco smoking. CONCLUSIONS Depression and anxiety are prevalent among individuals with medical conditions and correlate with sociodemographic, quality-of-life and smoking measures. Interventions targeting vulnerable groups should be employed and investigated.
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Affiliation(s)
- Rafia Tasnim
- Department of Public Health and Informatics, Jahangirnagar University, Savar, Dhaka 1342, Bangladesh; Centre for Advanced Research Excellence in Public Health, Savar, Dhaka 1342, Bangladesh.
| | - Md Safaet Hossain Sujan
- Department of Public Health and Informatics, Jahangirnagar University, Savar, Dhaka 1342, Bangladesh; Centre for Advanced Research Excellence in Public Health, Savar, Dhaka 1342, Bangladesh.
| | - Md Saiful Islam
- Department of Public Health and Informatics, Jahangirnagar University, Savar, Dhaka 1342, Bangladesh; Centre for Advanced Research Excellence in Public Health, Savar, Dhaka 1342, Bangladesh.
| | - Most Zannatul Ferdous
- Department of Public Health and Informatics, Jahangirnagar University, Savar, Dhaka 1342, Bangladesh.
| | | | - Kamrun Nahar Koly
- Health System and Population Studies Division, icddr,b, Mohakhali, Dhaka 1212, Bangladesh.
| | - Marc N Potenza
- Department of Psychiatry and Child Study Center, Yale School of Medicine, New Haven, CT, USA; Connecticut Mental Health Center, New Haven, CT, USA; Connecticut Council on Problem Gambling, Wethersfield, CT, USA; Department of Neuroscience, Yale University, New Haven, CT, USA.
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Ahmad F, Boeckmann M, Khan Z, Zeeb H, Khan MN, Ullah S, Dreger S, Haq ZU, Forberger S. Implementing smokeless tobacco control policy in Pakistan: a qualitative study among Naswar supply chain actors. Tob Control 2021; 30:548-552. [PMID: 32817262 PMCID: PMC8394737 DOI: 10.1136/tobaccocontrol-2020-055748] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Revised: 06/11/2020] [Accepted: 06/16/2020] [Indexed: 01/14/2023]
Abstract
OBJECTIVE To obtain insights into the perceptions of barriers and facilitators to implementation of the WHO Framework Convention on Tobacco Control (FCTC) among smokeless tobacco (SLT) supply chain actors in the Khyber Pakhtunkhwa province of Pakistan. METHODS We conducted a qualitative study to investigate the perceptions about SLT control policy formulation and implementation among exclusive Naswar sellers and point of sale vendors. We conducted five focus group discussions in three districts of Khyber Pakhtunkhwa using combined deductive-inductive thematic analyses. RESULTS We identified three central themes that potentially impact policy formulation, its implementation and application. The first theme examines the role of children in the Naswar business: as potential customers, and as potential heirs to a Naswar-selling business. A second theme targets the 'business of Naswar', which includes a specific identity of Naswar sellers, its potential to generate profits and the special case of Naswar regulation as a socially accepted and culturally rooted product. The third theme addresses the unusual ingredients of Naswar and its production process, making Naswar a health risk for consumers and producers. We also report conflicting views regarding SLT control among the supply chain actors. CONCLUSIONS This study provides insights into the perceptions of important SLT supply-side stakeholders regarding various SLT control policy options based on the FCTC. While there is some opposition to policy approaches like taxation and switching of business, implementing a ban on selling SLT to minors may be a viable option for policymakers in the short term.
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Affiliation(s)
- Fayaz Ahmad
- Institute of Public Health and Social Sciences, Khyber Medical University, Peshawar, Khyber Pakhtunkhwa, Pakistan
- School of Public Health, University of Bielefeld, Bielefeld, Germany
| | - Melanie Boeckmann
- School of Public Health, University of Bielefeld, Bielefeld, Germany
| | - Zohaib Khan
- Khyber Medical University, Peshawar, Khyber Pakhtunkhwa, Pakistan
| | - Hajo Zeeb
- Prevention and Evaluation, Leibniz Institute for Prevention Research and Epidemiology, Bremen, Germany
| | - Muhammad Naseem Khan
- Institute of Public Health and Social Sciences, Khyber Medical University, Peshawar, Khyber Pakhtunkhwa, Pakistan
| | - Safat Ullah
- Khyber Medical University, Peshawar, Khyber Pakhtunkhwa, Pakistan
| | - Steffen Dreger
- Prevention and Evaluation, Leibniz Institute for Prevention Research and Epidemiology, Bremen, Germany
| | - Zia Ul Haq
- Khyber Medical University, Peshawar, Khyber Pakhtunkhwa, Pakistan
| | - Sarah Forberger
- Leibniz Institute for Prevention Research and Epidemiology, Bremen, Germany
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Aziz Ali S, Khan U, Abrejo F, Vollmer B, Saleem S, Hambidge KM, Krebs NF, Westcott JE, Goldenberg RL, McClure EM, Pasha O. Use of Smokeless Tobacco Before Conception and Its Relationship With Maternal and Fetal Outcomes of Pregnancy in Thatta, Pakistan: Findings From Women First Study. Nicotine Tob Res 2021; 23:1291-1299. [PMID: 33084903 PMCID: PMC8360631 DOI: 10.1093/ntr/ntaa215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Accepted: 10/15/2020] [Indexed: 11/13/2022]
Abstract
INTRODUCTION Smokeless tobacco (SLT) consumption during pregnancy has adverse consequences for the mother and fetus. We aimed to investigate the effects of maternal pre-pregnancy SLT consumption on maternal and fetal outcomes in the district of Thatta, Pakistan. AIMS AND METHODS We conducted a secondary data analysis of an individual randomized controlled trial of preconception maternal nutrition. Study participants were women of reproductive age (WRA) residing in the district of Thatta, Pakistan. Participants were asked questions regarding the usage of commonly consumed SLT known as gutka (exposure variable). Study outcomes included maternal anemia, miscarriage, preterm births, stillbirths, and low birth weight. We performed a cox-regression analysis by controlling for confounders such as maternal age, education, parity, working status, body mass index, and geographic clusters. RESULTS The study revealed that 71.5% of the women reported using gutka, with a higher proportion residing in rural areas as compared with urban areas in the district of Thatta, Pakistan. In the multivariable analysis, we did not find a statistically significant association between gutka usage and anemia [(relative risk, RR: 1.04, 95% confidence interval, CI (0.92 to 1.16)], miscarriage [(RR: 1.08, 95% CI (0.75 to 1.54)], preterm birth [(RR: 1.37, 95% CI (0.64 to 2.93)], stillbirth [(RR: 1.02, 95% CI (0.39 to 2.61)], and low birth weight [(RR: 0.96, 95% CI (0.72 to 1.28)]. CONCLUSIONS The study did not find an association between gutka usage before pregnancy and adverse maternal and fetal outcomes. In the future, robust epidemiological studies are required to detect true differences with a dose-response relationship between gutka usage both before and during pregnancy and adverse fetomaternal outcomes. IMPLICATIONS While most epidemiological studies conducted in Pakistan have focused on smoking and its adverse outcomes among males, none of the studies have measured the burden of SLT among WRA and its associated adverse outcomes. In addition, previously conducted studies have primarily assessed the effect of SLT usage during pregnancy rather than before pregnancy on adverse fetal and maternal outcomes. The current study is unique because it provides an insight into the usage of SLT among WRA before pregnancy and investigates the association between pre-pregnancy SLT usage and its adverse fetomaternal outcomes in rural Pakistan.
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Affiliation(s)
- Sumera Aziz Ali
- Department of Epidemiology, Columbia University New York, NY, USA
| | - Umber Khan
- Department of Community Health Sciences, Aga Khan University, Karachi, Pakistan
| | - Farina Abrejo
- Department of Community Health Sciences, Aga Khan University, Karachi, Pakistan
| | - Brandi Vollmer
- Department of Epidemiology, Columbia University New York, NY, USA
| | - Sarah Saleem
- Department of Community Health Sciences, Aga Khan University, Karachi, Pakistan
| | - K Michael Hambidge
- Department of Pediatrics, Section of Nutrition, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Nancy F Krebs
- Department of Pediatrics, Section of Nutrition, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Jamie E Westcott
- Department of Pediatrics, Section of Nutrition, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Robert L Goldenberg
- Department of Obstetrics and Gynecology, Columbia University, New York, NY, USA
| | | | - Omrana Pasha
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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Zahid N, Zahid W, Khalid W, Azam I, Ikram M, Hassan A, Iftikar H, Bhamani SS, Jabbar AA, Akhtar S, Siddiqui MI, Awan MS, Asad N, Ahmad K. Resilience and its associated factors in head and neck cancer patients in Pakistan: an analytical cross-sectional study. BMC Cancer 2021; 21:888. [PMID: 34344346 PMCID: PMC8330007 DOI: 10.1186/s12885-021-08624-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Accepted: 07/05/2021] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION The study aimed to assess resilience and its associated factors in head and neck cancer patients, post-treatment in a low middle income country (LMIC) such as Pakistan. METHODS An analytical cross-sectional study was conducted from November 2019 to May 2020 among head and neck cancer patients aged at least 18 years at the largest private tertiary care hospital, in Karachi, Pakistan. Information regarding their resilience scores was collected through Wagnild and Young's Resilience scale that comprises of 14 items (RS-14). Moreover, depression and anxiety were also assessed via Hospital Anxiety and Depression Scale (HADS) and social support was assessed by Enriched Social Support Instrument (ESSI). RESULTS The data was analyzed by linear regression modeling. Unadjusted and adjusted beta coefficients with 95% CI were reported. A total of 250 head and neck cancer patients were recruited, 79% of them were males. Mean age of the patients was 51.59 years with 93% having high social support and only 8% having severe depression and 3% having severe anxiety. After adjusting for the covariates in multivariable analysis resilience was associated with severe depression (- 17[- 20.98,-12.93]) or borderline depression (- 4[- 8.41,-0.39]), severe anxiety (- 11 [- 17.88,-4.18]), low social support (- 6[- 9.62,-1.71]), having family members of > 6 in the household (- 2[- 4.31,-0.29), smokeless tobacco users post- treatment (10[5.79, 14.45]), and those who underwent tracheotomy (- 4[- 7.67,-0.21]). There was a significant interaction between education and role in the family (decision maker). CONCLUSION In Pakistan, a South Asian LMIC, collectivist culture prevails, family ties are greatly promoted thus resilience and social support is highly prevalent in head and neck cancer patients resulting in lower prevalence of depression and anxiety. Our study highlights that higher resilience is prevalent among small families less than six members, as the welfare of the individual is prioritized over multiple needs of the family. Formal Education and role in household/decision making power are effect modifiers in our study, demonstrating its protective effect on the mental health of head and neck cancer patients. High resilience scores were reported among current smokeless tobacco users as compared to quitters post treatment. Resilience-building interventions should be formulated to aid head and neck cancer patients to cope with the disease and its sequel.
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Affiliation(s)
- Nida Zahid
- Department of Surgery, Aga Khan University Hospital, Stadium Road, Karachi, 74800, Pakistan
| | - Wajeeha Zahid
- Department of Community Health Sciences, Aga Khan University Hospital, Stadium Road, Karachi, 74800, Pakistan.
| | - Wardah Khalid
- Department of Surgery, Aga Khan University Hospital, Stadium Road, Karachi, 74800, Pakistan
| | - Iqbal Azam
- Department of Community Health Sciences, Aga Khan University Hospital, Stadium Road, Karachi, 74800, Pakistan
| | - Mubasher Ikram
- Department of Surgery, Aga Khan University Hospital, Stadium Road, Karachi, 74800, Pakistan
| | - Aneesa Hassan
- Department of Surgery, Aga Khan University Hospital, Stadium Road, Karachi, 74800, Pakistan
| | - Haissan Iftikar
- Department of Surgery, Aga Khan University Hospital, Stadium Road, Karachi, 74800, Pakistan
| | - Shireen Shehzad Bhamani
- School of Nursing and Midwifery, Aga Khan University Hospital, Stadium Road, Karachi, 74800, Pakistan
| | - Adnan Abdul Jabbar
- Department of Oncology, Aga Khan University Hospital, Stadium Road, Karachi, 74800, Pakistan
| | - Shabbir Akhtar
- Department of Surgery, Aga Khan University Hospital, Stadium Road, Karachi, 74800, Pakistan
| | | | - Mohammad Sohail Awan
- Department of Surgery, Aga Khan University Hospital, Stadium Road, Karachi, 74800, Pakistan
| | - Nargis Asad
- Department of Psychiatry, Aga Khan University Hospital, Stadium Road, Karachi, 74800, Pakistan
| | - Khabir Ahmad
- Department of Surgery, Aga Khan University Hospital, Stadium Road, Karachi, 74800, Pakistan
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Panda R, Persai D, Mahapatra S, Mohanty I. Does behavioral intervention affect intention to quit? : A quasi-experimental study from primary healthcare settings in India. Tob Prev Cessat 2021; 7:56. [PMID: 34395953 PMCID: PMC8330841 DOI: 10.18332/tpc/138951] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2020] [Revised: 05/30/2021] [Accepted: 06/14/2021] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Tobacco is the leading cause of death and disease in India. This study examines the effect of training intervention in behavioral counseling on intention to quit tobacco in primary healthcare settings in India. The intervention included training to improve behavioral counseling practices of primary care physicians (PCPs) based on the 5As approach to increase patients' motivation to quit tobacco. METHODS A quasi-experimental design was used for the study. The intervention consists of training of primary care physicians in the behavioral intervention in tobacco cessation. The intervention was conducted in twelve districts of two states in India (Rajasthan and Odisha) in 2016-2017. Four districts were randomly sampled for the study. A total of 1314 participants (intervention and control) were recruited for the study in the baseline and end-line surveys, respectively. Intention to quit in 30 days was the primary outcome measure. Difference-in-difference (DiD) logistic regression models were used separately for smokers and smokeless tobacco users to estimate the odds of intention to quit. Analysis was done in STATA Version 14. RESULTS The intervention and time variable had a significantly positive influence on the intention to quit tobacco among smokers. Smokers in the intervention districts had higher odds of intention to quit (OR=9.82; 95% CI: 1.67-57.72) compared to smokers in the control districts. Smokeless tobacco (SLT) users had higher odds of intention to quit (OR=3.06; 95% CI: 1.35-6.98) in the end-line survey compared to baseline survey. CONCLUSIONS Our findings indicate that building capacity in behavioral intervention in primary care settings can help increase the intention to quit among smokers. The observed difference in intention to quit between smokers and SLT users suggests the need of tailored counseling interventions for SLT users. There is a need for further research to design and evaluate training and behavioral interventions for SLT and dual (smoking and SLT) users in primary care settings in low- and middle-income countries.
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Affiliation(s)
| | - Divya Persai
- Public Health Foundation of India, Gurugram, India
| | | | - Itismita Mohanty
- Health Research Institute, University of Canberra, Canberra, Australia
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Garcia de Quevedo I, Arrazola RA, Yadav R, Soura BD, Ahluwalia IB. Implementation of the Uttarakhand Tobacco Free Initiative in Schools, India, 2016. Prev Chronic Dis 2021; 18:E74. [PMID: 34324415 PMCID: PMC8388200 DOI: 10.5888/pcd18.200650] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
PURPOSE AND OBJECTIVES A process evaluation, the Uttarakhand Tobacco Free Initiative (UTFI), was conducted in 49 public high schools and colleges in the state of Uttarakhand, India, to measure program implementation, provide feedback to school administrators, and identify barriers to tobacco control. INTERVENTION APPROACH UTFI aims to 1) raise awareness and provide education and tools for teachers and school administrators about the dangers of tobacco use and secondhand smoke, 2) encourage participation in student-led activities to promote tobacco-free initiatives, and 3) enforce tobacco-free school policies in the state of Uttarakhand. EVALUATION METHODS We used the CDC evaluation framework to document key components and lessons learned from the UTFI. We distributed questionnaires to 71 teachers and principals in December 2016, to assess awareness of school activities and policies related to the initiative. Descriptive statistics were computed for quantitative data, and a thematic content analysis was used for qualitative data. RESULTS Of the 71 participants, 66 (92.9%) were aware of tobacco use policies in schools, and 63 (88.7%) agreed policies were enforced. Sixty-six participants (93.0%) said that they taught tobacco prevention-related topics, and 41 of 70 respondents (58.6%) reported that a student-led group helped to enforce tobacco-free policies in their schools. Of 69 respondents, almost all (n = 66) reported satisfaction with UTFI implementation. Challenges identified were related to tobacco products being readily accessible near school premises, lack of tobacco prevention materials, and tobacco use by school staff. IMPLICATIONS FOR PUBLIC HEALTH Successes of UTFI were documented by measuring different components of the process, including implementation of program activities and teacher and principal satisfaction. Results might help enhance key processes for the initiative and highlight some barriers to implementation, such as enforcing tobacco control policy off school premises. Continued efforts are needed to prevent tobacco use among young people.
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Affiliation(s)
- Isabel Garcia de Quevedo
- CDC Foundation, Office on Smoking and Health, Centers for Disease Control and Prevention, 4770 Buford Highway NE, Atlanta, GA 30341-3717 MS-F79.
| | - Rene A Arrazola
- Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Rajesh Yadav
- Centers for Disease Control and Prevention, New Delhi, India
| | - Biesse D Soura
- Centers for Disease Control and Prevention, Atlanta, Georgia
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Naznin E, Wynne O, George J, Denham AMJ, Hoque ME, Milton AH, Bonevski B, Stewart K. Smokeless tobacco policy in Bangladesh: A stakeholder study of compatibility with the World Health Organization's Framework Convention on Tobacco Control. Drug Alcohol Rev 2021; 40:856-863. [PMID: 33470003 DOI: 10.1111/dar.13243] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Revised: 11/04/2020] [Accepted: 12/15/2020] [Indexed: 12/23/2022]
Abstract
INTRODUCTION Smokeless tobacco (ST) is the predominant form of tobacco used in Bangladesh and is associated with adverse health outcomes. Bangladesh ratified the World Health Organization's Framework Convention on Tobacco Control (FCTC) in 2004. There are concerns that FCTC legislation and implementation of ST control policy is insufficient in Bangladesh. The aim of this study was to investigate the achievements and challenges of ST policy in Bangladesh and its alignment with the FCTC. METHODS We conducted semi-structured key informant interviews with 20 stakeholders from government and non-government offices and international funding agencies, including tobacco control advocates, policy makers and non-governmental organisation workers. We used NVivo software to create key themes and the framework method for thematic analysis. RESULTS Our findings revealed a lack of national policy in terms of disclosure of harmful contents, illicit trade and standardised packaging of ST. Legislation remains ineffective in relation to graphical health warnings and tax measures. Challenges to ST control identified included inadequate law enforcement; paucity of research, surveillance, and evidence generation; and supply chain control. We identified lack of congruence of ST policies with FCTC due to slow progress in implementation of FCTC measures, lack of a country-specific policy and industry interference. To comply with FCTC, participants recommended strong leadership and political commitment, co-ordination between public and private sectors and proper use of tobacco control resources. DISCUSSION AND CONCLUSIONS Bangladesh has adopted several important FCTC measures, but further strengthening of ST policy is needed to enable full implementation of FCTC.
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Affiliation(s)
- Eva Naznin
- School of Medicine and Public Health, The University of Newcastle, Newcastle, Australia
| | - Olivia Wynne
- School of Medicine and Public Health, The University of Newcastle, Newcastle, Australia
| | - Johnson George
- Centre for Medicine Use and Safety, Monash University, Melbourne, Australia
| | - Alexandra M J Denham
- School of Medicine and Public Health, The University of Newcastle, Newcastle, Australia
- Priority Research Centre for Stroke and Brain Injury, Hunter Medical Research Institute, Newcastle, Australia
| | - Mohammad E Hoque
- Institute For Social Science Research, The University of Queensland, Brisbane, Australia
| | - Abul H Milton
- Department of Public Health, Northern University, Dhaka, Bangladesh
| | - Billie Bonevski
- School of Medicine and Public Health, The University of Newcastle, Newcastle, Australia
| | - Kay Stewart
- Centre for Medicine Use and Safety, Monash University, Melbourne, Australia
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Kankaria A, Sahoo SS, Verma M. Awareness regarding the adverse effect of tobacco among adults in India: findings from secondary data analysis of Global Adult Tobacco Survey. BMJ Open 2021; 11:e044209. [PMID: 34183338 PMCID: PMC8240568 DOI: 10.1136/bmjopen-2020-044209] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Accepted: 06/17/2021] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE To quantify the extent of awareness regarding the harmful effects of tobacco among the users (both smoked and smokeless) and non-users in India, and explore the determinants of comprehensive knowledge among the participants of the Global Adult Tobacco Survey (GATS), India. DESIGN Cross-sectional study. SETTING AND PARTICIPANTS The nationally representative GATS I (2009-2010) included 69 296 participants using a multistage sampling method, while GATS II (2015-2016) interviewed 74 037 respondents aged >15 years using a similar sampling method from all the states and union territories in India. PRIMARY AND SECONDARY OUTCOME MEASURES Comprehensive score were derived from nine items that explored awareness regarding the adverse effects of tobacco use among both users and non-users of tobacco in GATS II. Secondary outcome included predictors of awareness regarding adverse effects of tobacco and changes in the awareness compared with the previous round of the survey. RESULTS About 60.2%, 57.5% and 66.5% of the smokers, smokeless tobacco (SLT) users and non-users were aware of the adverse effects of tobacco, respectively. The awareness depicted significant age, gender, marital status, education status, urban-rural, wealth and regional disparities (p<0.05). Intention to quit tobacco use also varied significantly with awareness. Among smokers, awareness was high in those residing in eastern India and the poorest participants. Among SLT users, awareness was more among male participants, those who were poorest and lived in western India. Among non-users, awareness was more among middle-aged, more educated, rich participants of west India. Compared with GATS I, an increase in awareness was observed in GATS II across gender, age groups, residential areas and geographical regions in India. CONCLUSIONS Comprehensive awareness of tobacco's harmful effects is far from desirable among Indian users. We recommend further customised health promotion campaigns to counter the regional disparities, adopt a gender-neutral approach and target adolescents.
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Affiliation(s)
- Ankita Kankaria
- Department of Community & Family Medicine, All India Institute of Medical Sciences Bathinda, Bathinda, Punjab, India
| | - Soumya Swaroop Sahoo
- Department of Community & Family Medicine, All India Institute of Medical Sciences Bathinda, Bathinda, Punjab, India
| | - Madhur Verma
- Department of Community & Family Medicine, All India Institute of Medical Sciences Bathinda, Bathinda, Punjab, India
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Yadav A, Singh PK, Yadav N, Kaushik R, Chandan K, Chandra A, Singh S, Garg S, Gupta PC, Sinha DN, Mehrotra R. Smokeless tobacco control in India: policy review and lessons for high-burden countries. BMJ Glob Health 2021; 5:bmjgh-2020-002367. [PMID: 32665375 PMCID: PMC7365431 DOI: 10.1136/bmjgh-2020-002367] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Revised: 05/21/2020] [Accepted: 05/23/2020] [Indexed: 11/15/2022] Open
Abstract
We examined the magnitude of smokeless tobacco (SLT) use in India and identified policy gaps to ascertain the priorities for SLT control in India and other high SLT burden countries in the Southeast Asia region. We reviewed and analysed the legal and policy framework to identify policy gaps, options and priority areas to address the SLT burden in India and lessons thereof. In India, 21.4% adults, including 29.6% of men, 12.8% of women, use SLT while more than 0.35 million Indians die every year due to SLT use. SLT use remains a huge public health concern for other countries in the region as well. Priority areas for SLT control should include: constant monitoring, increasing taxes and price of SLT products, strengthening and strict enforcement of existing laws, integration of SLT cessation with all health and development programmes, banning of advertisement and promotion of SLT, increasing age of access to tobacco up to 21 years, introducing licensing for the sale of SLT, standardising of SLT packaging and preventing SLT industry interference in the implementation of SLT control policies besides a committed multistakeholder approach for effective policy formulation and enforcement. SLT control in India and the other high SLT burden countries, especially in the Southeast Asia region, should focus on strengthening and implementing the above policy priorities.
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Affiliation(s)
- Amit Yadav
- WHO FCTC Knowledge Hub on Smokeless Tobacco, ICMR-National Institute of Cancer Prevention and Research, Noida, Uttar Pradesh, India
| | - Prashant Kumar Singh
- Division of Preventive Oncology, ICMR-National Institute of Cancer Prevention and Research, Noida, Uttar Pradesh, India
| | - Nisha Yadav
- Harlal School of Law, Greater Noida, Uttar Pradesh, India
| | - Ravi Kaushik
- Maulana Azad Medical College and Associated Hospitals, New Delhi, Delhi, India
| | - Kumar Chandan
- WHO FCTC Knowledge Hub on Smokeless Tobacco, ICMR-National Institute of Cancer Prevention and Research, Noida, Uttar Pradesh, India
| | - Anshika Chandra
- WHO FCTC Knowledge Hub on Smokeless Tobacco, ICMR-National Institute of Cancer Prevention and Research, Noida, Uttar Pradesh, India
| | - Shalini Singh
- ICMR-National Institute of Cancer Prevention and Research, Noida, Uttar Pradesh, India
| | - Suneela Garg
- Department of Community Medicine, Maulana Azad Medical College and Associated Hospitals, New Delhi, Delhi, India
| | - Prakash C Gupta
- Healis Sekhsaria Institute for Public Health, Navi Mumbai, Maharashtra, India
| | | | - Ravi Mehrotra
- India Cancer Research Consortium, New Delhi, Delhi, India
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Fagbule O, Adebiyi A. FOCUS ON TOBACCO PREVENTION AMONG NON-SMOKING ADOLESCENTS IN AFRICA; A CALL TO TOBACCO CONTROL EXPERTS. Ann Ib Postgrad Med 2021; 19:5-7. [PMID: 35330895 PMCID: PMC8935679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Affiliation(s)
- O.F. Fagbule
- Department of Periodontology and Community Dentistry, College of Medicine, University of Ibadan, Nigeria., Department of Periodontology and Community Dentistry, University College Hospital, Ibadan, Nigeria
| | - A.O. Adebiyi
- Department of Community Medicine, College of Medicine, University of Ibadan, Nigeria., Department of Community Medicine, University College Hospital, Ibadan
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Reed D, Bowen E, Fint-Clark B, Clark B, Cobb N, Danberry KM, Hutson Z, Lusk S, Rine J, Robinson N. Stopping Smokeless Tobacco Use: A Call to Action. Front Public Health 2021; 9:601890. [PMID: 34123982 PMCID: PMC8193497 DOI: 10.3389/fpubh.2021.601890] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Accepted: 05/06/2021] [Indexed: 11/15/2022] Open
Abstract
In the United States, single smokeless tobacco use continues to increase in conjunction with the dual use of smokeless tobacco and other nicotine products. Problematically, much of the tobacco prevention literature and funding inundates tobacco users with smoking tobacco information while neglecting to provide them any information about smokeless tobacco. Meanwhile, American tobacco companies continually market new and dissolvable tobacco products targeted at non-smokers. New data suggests that smokeless tobacco use is, also, increasing in West Virginia and, in order to address this increased use, the West Virginia Extension Service recently partnered with the Division of Tobacco Prevention in the West Virginia Department of Health and Human Resources to develop a comprehensive spit tobacco curriculum for West Virginia students between third and sixth grade. This article details the development and assessment of the spit tobacco prevention curriculum and the resulting report from the initial pilot of the program. The curriculum was piloted across six counties with the participation of schools, after-school programs and 4-H clubs. After implementation, survey results demonstrate that youth have increased awareness of the health effects of smokeless tobacco. Throughout the article, we explore West Virginia's Cooperative Extension Service's response to this emerging public health issue and release a call to action for the National Cooperative Extension Services to join us in spit tobacco prevention.
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Affiliation(s)
- Donald Reed
- McDowell County Commission on Aging, Liberty University, Lynchburg, VA, United States
| | - Elaine Bowen
- Extension Service, West Virginia University, Morgantown, WV, United States
| | - Becca Fint-Clark
- Extension Service, West Virginia University, Morgantown, WV, United States
| | - Brent Clark
- Extension Service, West Virginia University, Morgantown, WV, United States
| | - Nila Cobb
- Extension Service, West Virginia University, Morgantown, WV, United States
| | - Kathy M Danberry
- West Virginia (WV) Division of Tobacco Prevention, Charleston, WV, United States
| | - Zona Hutson
- Extension Service, West Virginia University, Morgantown, WV, United States
| | - Stephanie Lusk
- Extension Service, West Virginia University, Morgantown, WV, United States
| | - Jason Rine
- Extension Service, West Virginia University, Morgantown, WV, United States
| | - Natasha Robinson
- Athletic Academic Support, Central State University, Wilberforce, OH, United States
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Ludwig DC, Morrison SD, Dillon JK. The Burden of Head and Neck Cancer in the United States, 1990 - 2017. J Oral Maxillofac Surg 2021; 79:2162-2170. [PMID: 34153257 DOI: 10.1016/j.joms.2021.04.031] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2021] [Accepted: 04/29/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE Head and neck cancers (HNC) are among the most common malignancies in the United States and are a significant cause of morbidity and mortality. Traditional risk factors for HNC include tobacco, alcohol, and Human Papilloma Virus (HPV) infection. Geographic location has also been shown to play a role, whether directly or indirectly. The purpose of this study was to describe the incidence, mortality and geographic variability of HNC within the United States between 1990 and 2017. MATERIALS AND METHODS The Global Burden of Diseases Study 2017, which models incidence and mortality, was used to obtain incidence and mortality data for "lip and oral cavity cancer", "nasopharynx cancer", "other pharynx cancer" (tonsil, oropharynx, and hypopharynx) and "larynx cancer" for the United States between 1990 and 2017. RESULTS The overall incidence rate of HNC increased (annual percent change (APC) = 0.23. 95% CI: 0.1-0.3) from 1990 through 2017 while overall mortality decreased (APC = -0.37. 95% CI: -0.4 to -0.3). The anatomic sub-site which saw the largest increase in incidence was "other pharynx" (APC=1.07. 95% CI: 0.9-1.2). In 2017, those in the West had the lowest incidence while those in the South had the highest (15.7 and 20.8 per 100,000 individuals, respectively). CONCLUSIONS The incidence of HNC in the United States increased between 1990 and 2017. This was driven by larger increases in those sites more prone to HPV-related HNC. While there exists geographic variability in the burden of this disease, additional studies are needed to further understand the impact of patient-specific factors.
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Affiliation(s)
- David C Ludwig
- Resident, Department of Oral and Maxillofacial Surgery, University of Washington, Seattle, WA
| | - Shane D Morrison
- Fellow, Section of Plastic Surgery, University of Michigan, Ann Arbor, MI
| | - Jasjit K Dillon
- Clinical Associate Professor, Program Director, Chief of Oral and Maxillofacial Surgery, Department of Oral and Maxillofacial Surgery, University of Washington, Harborview Medical Center, Seattle, WA.
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Kumar Singh P, Singh N, Jain P, Shukla SK, Singh L, Singh S. Slum and non-slum differences in tobacco and alcohol use among the adult population: a sex-stratified study from eight megacities of India. JOURNAL OF SUBSTANCE USE 2021. [DOI: 10.1080/14659891.2021.1916849] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- Prashant Kumar Singh
- Division of Preventive Oncology & Population Health, ICMR-National Institute of Cancer Prevention and Research, Noida, India
- WHO FCTC Global Knowledge Hub on Smokeless Tobacco, ICMR-National Institute of Cancer Prevention and Research, Noida, India
| | - Nishikant Singh
- Division of Preventive Oncology & Population Health, ICMR-National Institute of Cancer Prevention and Research, Noida, India
| | - Pankhuri Jain
- Division of Preventive Oncology & Population Health, ICMR-National Institute of Cancer Prevention and Research, Noida, India
| | - Sudheer Kumar Shukla
- Centre for the Study of Regional Development, School of Social Sciences, Jawaharlal Nehru University, New Delhi, India
| | - Lucky Singh
- ICMR-National Institute of Medical Statistics, New Delhi, India
| | - Shalini Singh
- Division of Preventive Oncology & Population Health, ICMR-National Institute of Cancer Prevention and Research, Noida, India
- WHO FCTC Global Knowledge Hub on Smokeless Tobacco, ICMR-National Institute of Cancer Prevention and Research, Noida, India
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Xie J, Zhong R, Wang W, Chen O, Zou Y. COVID-19 and Smoking: What Evidence Needs Our Attention? Front Physiol 2021; 12:603850. [PMID: 33815131 PMCID: PMC8012895 DOI: 10.3389/fphys.2021.603850] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Accepted: 02/26/2021] [Indexed: 12/21/2022] Open
Abstract
The current COVID-19 pandemic has caused severe morbidity and mortality worldwide. Although relevant studies show that the smoking rate of COVID-19 patients is relatively low, the current smoking status of people with COVID-19 cannot be accurately measured for reasons. Thus, it is difficult to assess the relationship between smoking and COVID-19. Smoking can increase the risk of severe COVID-19 symptoms and aggravate the condition of patients with COVID-19. Nicotine upregulates the expression of ACE2, which can also increase susceptibility to COVID-19, aggravatiing the disease. Although nicotine has certain anti-inflammatory effects, there is no evidence that it is related to COVID-19 treatment; therefore, smoking cannot be considered a preventative measure. Furthermore, smokers gathering and sharing tobacco may promote the spread of viruses. Despite the COVID-19 epidemic, the findings suggested that COVID-19 has not encouraged smokers to quit. Additionally, there is evidence that isolation at home has contributed to increased smoking behavior and increased quantities. Therefore, it is recommended that governments increase smoking cessation messaging as part of public health measures to contain the COVID-19 pandemic. This review analyzes the existing research on smoking's impact on COVID-19 so that governments and medical institutions can develop evidence-based smoking-related prevention and control measures for COVID-19.
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Affiliation(s)
- Jianghua Xie
- School of Nursing, Hunan University of Chinese Medicine, Changsha, China
| | - Rui Zhong
- Hunan Cancer Hospital, The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, China
| | - Wei Wang
- Hunan Cancer Hospital, The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, China
| | - Ouying Chen
- School of Nursing, Hunan University of Chinese Medicine, Changsha, China
| | - Yanhui Zou
- Hunan Cancer Hospital, The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, China
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Siddiqi K, Islam Z, Khan Z, Siddiqui F, Mishu M, Dogar O, Shah V, Khan J, Pokhrel S, Iqbal R, Bauld L, Sheikh A, Grugel J. Identification of Policy Priorities to Address the Burden of Smokeless Tobacco in Pakistan: A Multimethod Analysis. Nicotine Tob Res 2021; 22:2262-2265. [PMID: 31570940 PMCID: PMC7733056 DOI: 10.1093/ntr/ntz163] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Accepted: 08/27/2019] [Indexed: 12/14/2022]
Abstract
Introduction We assessed the magnitude of smokeless tobacco (ST) use in Pakistan and identified policy gaps to help ascertain short-, medium-, and long-term priorities. We then elicited stakeholders’ views as to which of these identified priorities are most important. Methods In a multimethod study, we: analyzed Global Tobacco Surveillance System data sets to estimate ST consumption and disease burden; conducted a documentary review to identify gaps in policies to control ST in comparison with smoking; elicited stakeholders’ views in an interactive workshop to identify a set of policy options available to address ST burden in Pakistan; and ranked policy priorities using a postevent survey. Results Among all tobacco users in Pakistan (n = 24 million), one-third of men and two-thirds of women consume ST. In 2017, its use led to an estimated 18 711 deaths due to cancer and ischemic heart disease. Compared to smoking, policies to control ST lag behind significantly. Priority areas for ST policies included: banning ST sale to and by minors, advocacy campaigns, introduction of licensing, levying taxes on ST, and standardizing ST packaging. A clear commitment to close cooperation between state actors and stakeholder groups is needed to create a climate of support and information for effective policy making. Conclusions Smokeless tobacco control in Pakistan should focus on four key policy instruments: legislation, education, fiscal policies, and quit support. More research into the effectiveness of such policies is also needed. Implications A number of opportunities to improve ST regulation in Pakistan were identified. Among these, immediate priorities include banning ST sale to and by minors, mobilizing advocacy campaign, introduction of licensing through the 1958 Tobacco Vendors Act, levying taxes on ST, and standardizing ST packaging.
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Affiliation(s)
- Kamran Siddiqi
- Department of Health Sciences, University of York, York YO10 5DD, UK
| | - Ziauddin Islam
- Tobacco Control Cell, Ministry of National Health Services, Regulation and Coordination, Islamabad, Pakistan
| | - Zohaib Khan
- Office of Research Innovation and Commercialization, Khyber Medical University, Peshawar, Pakistan
| | - Faraz Siddiqui
- Department of Health Sciences, University of York, York YO10 5DD, UK
| | - Masuma Mishu
- Department of Health Sciences, University of York, York YO10 5DD, UK
| | - Omara Dogar
- Department of Health Sciences, University of York, York YO10 5DD, UK
| | - Vandana Shah
- Campaign for Tobacco Free Kids, Washington, DC 20005
| | - Javaid Khan
- Department of Medicine, Aga Khan University, Karachi, Pakistan
| | - Subhash Pokhrel
- Department of Clinical Sciences, Brunel University London, Uxbridge, Middlesex UB8 3PH, UK
| | - Romaina Iqbal
- Department of Community Health Sciences, Aga Khan University, Karachi, Pakistan
| | - Linda Bauld
- Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh EH8 9DX, UK
| | - Aziz Sheikh
- Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh EH8 9DX, UK
| | - Jean Grugel
- Department of Politics, University of York, York YO10 5DD, UK
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Kadam S, Vandana M, Patwardhan S, Kaushik KS. Looking beyond the smokescreen: can the oral microbiome be a tool or target in the management of tobacco-associated oral cancer? Ecancermedicalscience 2021; 15:1179. [PMID: 33777172 PMCID: PMC7987485 DOI: 10.3332/ecancer.2021.1179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2020] [Indexed: 11/07/2022] Open
Abstract
A wide range of microbes inhabit the oral cavity, and bacterial and fungal communities most often exist as structured communities or biofilms. The use of tobacco alters the structure of the oral microbiome, including that of potentially malignant lesions, and the altered oral microbiome influences key microenvironmental changes such as chronic inflammation, secretion of carcinogenic toxins, cellular and tissue remodelling and suppression of apoptosis. Given this, it is clear that the bacterial and fungal biofilms in potentially malignant states are likely not passive entities, but could play a critical role in shaping potential malignant and carcinogenic conditions. This holds potential towards leveraging the oral microbiome for the management of tobacco-associated potentially malignant lesions and oral cancer. Here, we explore this line of investigation by reviewing the effects of tobacco in shaping the oral microbiome, and analyse the available evidence in the light of the microbiome of oral potentially malignant and cancerous lesions, and the role of dysbiosis in carcinogenesis. Finally, we discuss possible interventions and approaches using which the oral microbiome could be leveraged towards precision-based oral cancer therapeutics.
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Affiliation(s)
- Snehal Kadam
- Human-Relevant Infection Biology Group, Institute of Bioinformatics and Biotechnology, Savitribai Phule Pune University, Pune 411007, India
| | - Madhusoodhanan Vandana
- Human-Relevant Infection Biology Group, Institute of Bioinformatics and Biotechnology, Savitribai Phule Pune University, Pune 411007, India
| | - Sudhanshu Patwardhan
- Centre for Health Research and Education, University of Southampton Science Park, Chilworth, Hampshire SO16 7NP, UK
| | - Karishma S Kaushik
- Human-Relevant Infection Biology Group, Institute of Bioinformatics and Biotechnology, Savitribai Phule Pune University, Pune 411007, India
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Alemi Q, Stempel C, Montgomery S. Prevalence and social determinants of tobacco use in Afghanistan. Int Health 2021; 13:3-12. [PMID: 32304214 PMCID: PMC7807235 DOI: 10.1093/inthealth/ihaa010] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Revised: 02/04/2020] [Accepted: 02/15/2020] [Indexed: 11/21/2022] Open
Abstract
Background Limited evidence exists on the prevalence and social determinants of tobacco use in Afghanistan—a fragile post-war context where the tobacco epidemic is on the rise. This study aimed to estimate the prevalence and social determinants of tobacco use in Afghan men and women. Methods Data from the 2015 Afghanistan Demographic and Health Survey of 10 760 men and 29 461 women were used to generate weighted prevalence estimates for smoking, smokeless tobacco (SLT) products including chew and snuff tobacco, ‘any tobacco use’ and ‘dual tobacco use’. We also modelled associations with tobacco outcomes using binary logistic regressions. Results We found that for men, smoking cigarettes was the most prevalent form of tobacco use (21.9% [95% confidence interval {CI} 21.2–22.7]). Prevalence rates were far lower for women, with cigarette/pipe smoking at 3.4% (95% CI 3.2–3.7). For both sexes, tobacco use was inversely associated with education and positively associated with agricultural and skilled and unskilled manual labour occupations. Wealth increased the odds of smoking for men but decreased the odds for women. Media exposure had little influence on tobacco use among women; however, the effects were more varied for men. Conclusions Our results demonstrate social inequalities in tobacco use among Afghan men and women, which calls for stronger tobacco control measures and continued monitoring of this growing epidemic.
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Affiliation(s)
- Qais Alemi
- Department of Social Work and Social Ecology, School of Behavioral Health, Loma Linda University, Loma Linda, CA, USA
| | - Carl Stempel
- Department of Sociology and Social Services, California State University, East Bay, Hayward, CA, USA
| | - Susanne Montgomery
- Behavioral Health Institute, School of Behavioral Health, Loma Linda University, Loma Linda, CA, USA
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Gupta AK, Nethan ST, Mehrotra R. Tobacco use as a well-recognized cause of severe COVID-19 manifestations. Respir Med 2021; 176:106233. [PMID: 33253975 PMCID: PMC7674071 DOI: 10.1016/j.rmed.2020.106233] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Revised: 11/07/2020] [Accepted: 11/09/2020] [Indexed: 02/08/2023]
Abstract
INTRODUCTION The Coronavirus disease (COVID-19) infection is caused by the novel Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2) primarily affecting the lungs. All tobacco-related illnesses including asthma, chronic obstructive pulmonary disease (COPD), and coronary artery disease are known to reduce the lung capacity and impair the immune system of the body and can greatly influence the ability to fight the novel coronavirus. The purpose of this state-of-the-art literature review is to summarize the evidence of the association of tobacco use with the severity of the COVID-19 manifestations. METHOD Articles describing the association of tobacco use with the severity of COVID-19 manifestations were searched on PubMed, MEDLINE, and Google. This review covers the relevant studies on the subject published from January 1, 2020 to September 10, 2020. RESULTS Tobacco use in all forms, whether smoking or chewing, is significantly associated with severe COVID-19 outcomes. Pre-existing comorbidities in tobacco users such as cardiovascular diseases, diabetes, respiratory diseases and hypertension were found to further aggravate the disease manifestations making the treatment of such COVID-19 patients more challenging due to their rapid clinical deterioration. CONCLUSIONS Current review indicates that nicotine exposure is linked to cardiopulmonary vulnerability to COVID-19 and tobacco use can be a potential risk factor for not only getting the viral infection but also its severe manifestations. The current pandemic provides a teachable moment to break the cycle of nicotine addiction and accelerate national tobacco control programs to achieve a tobacco-free world.
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Affiliation(s)
- Alpana Kumar Gupta
- Formerly Division of Preventive Oncology, ICMR-National Institute of Cancer Prevention and Research, Department of Health Research, Govt. of India, Noida, 201301, India
| | - Suzanne Tanya Nethan
- Division of Clinical Oncology, ICMR-National Institute of Cancer Prevention and Research, Department of Health Research, Govt. of India, Noida, 201301, India
| | - Ravi Mehrotra
- ICMR-India Cancer Research Consortium, Department of Health Research, New Delhi, 11000, India,ASTRA, Adjunct Professor of Global Health, University of York, York, Great Britain, UK,Corresponding author. ICMR-India Cancer Research Consortium, Department of Health Research, New Delhi, 11000, India
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Arora M, Chugh A, Jain N, Mishu M, Boeckmann M, Dahanayake S, Eckhardt J, Forberger S, Huque R, Kanaan M, Khan Z, Mehrotra R, Rahman MA, Readshaw A, Sheikh A, Siddiqi K, Vidyasagaran A, Dogar O. Global impact of tobacco control policies on smokeless tobacco use: a systematic review protocol. BMJ Open 2020; 10:e042860. [PMID: 33361080 PMCID: PMC7768955 DOI: 10.1136/bmjopen-2020-042860] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Revised: 10/15/2020] [Accepted: 12/02/2020] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Smokeless tobacco (ST) was consumed by 356 million people globally in 2017. Recent evidence shows that ST consumption is responsible for an estimated 652 494 all-cause deaths across the globe annually. The WHO Framework Convention on Tobacco Control (FCTC) was negotiated in 2003 and ratified in 2005 to implement effective tobacco control measures. While the policy measures enacted through various tobacco control laws have been effective in reducing the incidence and prevalence of smoking, the impact of ST-related policies (within WHO FCTC and beyond) on ST use is under-researched and not collated. METHODS AND ANALYSIS A systematic review will be conducted to collate all available ST-related policies implemented across various countries and assess their impact on ST use. The following databases will be searched: Medline, EMBASE, PsycINFO, Cumulative Index to Nursing and Allied Health Literature, Scopus, EconLit, ISI Web of Science, Cochrane Library (CENTRAL), African Index Medicus, LILACS, Scientific Electronic Library Online, Index Medicus for the Eastern Mediterranean Region, Index Medicus for South-East Asia Region, Western Pacific Region Index Medicus and WHO Library Database, as well as Google search engine and country-specific government websites. All ST-related policy documents (FCTC and non-FCTC) will be included. Results will be limited to literature published since 2005 in English and regional languages (Bengali, Hindi and Urdu). Two reviewers will independently employ two-stage screening to determine inclusion. The Effective Public Health Practice Project's 'Quality Assessment Tool for Quantitative Studies' will be used to record ratings of quality and risk of bias among studies selected for inclusion. Data will be extracted using a standardised form. Meta-analysis and narrative synthesis will be used. ETHICS AND DISSEMINATION Permission for ethics exemption of the review was obtained from the Centre for Chronic Disease Control's Institutional Ethics Committee, India (CCDC_IEC_06_2020; dated 16 April 2020). The results will be disseminated through publications in a peer-reviewed journal and will be presented in national and international conferences. PROSPERO REGISTRATION NUMBER CRD42020191946.
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Affiliation(s)
- Monika Arora
- HRIDAY, New Delhi, India
- Health Promotion Division, Public Health Foundation of India, Gurugram, Haryana, India
| | | | - Neha Jain
- Health Promotion Division, Public Health Foundation of India, Gurugram, Haryana, India
| | - Masuma Mishu
- Department of Health Sciences, University of York, York, UK
| | | | - Suranji Dahanayake
- Department of Health Sciences, University of York, York, UK
- Ministry of Health, Nutrition and Indigenous Medicine, Colombo, Sri Lanka
| | | | - Sarah Forberger
- Leibniz Institute for Prevention Research and Epidemiology, Bremen, Germany
| | | | - Mona Kanaan
- Department of Health Sciences, University of York, York, UK
| | - Zohaib Khan
- Khyber Medical University, Peshawar, Pakistan
| | - Ravi Mehrotra
- Indian Council of Medical Research, India Cancer Research Consortium, New Delhi, India
| | - Muhammad Aziz Rahman
- School of Health, Federation University Australia, Berwick, Victoria, Australia
- La Trobe University, Melbourne, Victoria, Australia
| | - Anne Readshaw
- Department of Health Sciences, University of York, York, UK
| | - Aziz Sheikh
- Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Kamran Siddiqi
- Department of Health Sciences, University of York, York, UK
| | | | - Omara Dogar
- Department of Health Sciences, University of York, York, UK
- Usher Institute, University of Edinburgh, Edinburgh, UK
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Gupte HA, D'Costa M, Ramanadhan S, Viswanath K. Factors Influencing Implementation of a Workplace Tobacco Cessation Intervention in India: A Qualitative Exploration. Workplace Health Saf 2020; 69:56-67. [PMID: 33308086 DOI: 10.1177/2165079920952761] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Tobacco use is projected to cause more than 8 million deaths annually worldwide by 2030 and is currently linked to 1 million annual deaths in India. Very few workplaces provide tobacco cessation as a part of occupational health in India. In this study, we examined promoters and barriers to implementing an evidence-based tobacco cessation program in a workplace setting in India. METHODS In-depth interviews were conducted with all facilitators (two program coordinators and four counselors) of a workplace tobacco cessation intervention covering implementation efforts in five organizations, including three manufacturing units and two corporate settings. FINDINGS The identified promoters for implementation of the program were as follows: (a) workplaces that provided access to many individuals, (b) high prevalence of tobacco use that made the intervention relevant, (c) core components (awareness sessions, face-to-face counseling and 6-months follow-up) that were adaptable, (d) engagement of the management in planning and execution of the intervention, (e) employees' support to each other to quit tobacco, (f) training the medical unit within the workplace to provide limited advice, and (g) efforts to advocate tobacco-free policies within the setting. Barriers centered around (a) lack of ownership from the workplace management, (b) schedules of counselors not matching with employees, (c) nonavailability of employees because of workload, and (d) lack of privacy for counseling. CONCLUSION/IMPLICATIONS FOR PRACTICE This study provided practical insights into the aspects of planning, engaging, executing and the process of implementation of a tobacco cessation intervention in a workplace setting. It provided guidance for an intervention within occupational health units in similar settings.
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Pandey V, Pandey KC, Pant NK, Verma LP. Relevance of Combined Electron and Photon Beams in Radiotherapy of Head and Neck Cancers in the Era of Intensity-Modulated Radiotherapy. ASIAN JOURNAL OF ONCOLOGY 2020. [DOI: 10.1055/s-0040-1718636] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Abstract
Abstract
Introduction External beam radiotherapy (EBRT) for head and neck (H&N) cancers continues to be delivered using varied technologies, ranging from the old two-dimensional conventional radiotherapy (2DRT) techniques to the modern three-dimensional conformal radiotherapy (3DCRT), intensity-modulated radiotherapy (IMRT), and volumetric modulated arc therapy (VMAT) in different centers in India. Due to limitations of spinal cord tolerance, electron and photon beams are combined in 2DRT and 3DCRT techniques for treating nodal volume of the H&N cases. However, many centers having modern technology practice IMRT/VMAT in place of electron beams. The purpose of this study is to analyze the role of combined electron and photon beams in radiotherapy of H&N cancers and its relevance in the modern era of IMRT/VMAT.
Materials and Methods Data were collected through a survey conducted on cancer centers in India where radiotherapy is being given by 2DRT, 3DCRT, and IMR/VMAT for the treatment of head and neck cancers.
Results The mean percentage of H&N (H&N) cases among all cases were 39.2% (standard deviation [SD]: 14.22), out of which 16.63% (SD: 20.83) were treated with a combination of photon and electron beams and 49.73% (SD: 37.41) were treated with IMRT/VMAT. The average percentage of H&N cases of government institutes was 38.39% (SD: 14.11) and that of private institutes was 40.14% (SD: 14.11). Patients treated with photon and electron combination and IMRT/VMAT were 22.19% (SD: 11.24) and 24.05% (SD: 23.99), respectively, in government institutes, and 10.29% (SD: 11.24) and 79.09% (SD: 26.75) in private institutes.
Conclusion As per this study, we conclude that despite the availability of IMRT/VMAT, a combination of electron and photon beams is still relevant in India. Since a large proportion of the patients are still treated with the electron and photon combination, it is imperative that further studies on field–junction dosimetry should be conducted to ensure accurate dose delivery.
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Affiliation(s)
- Vinod Pandey
- Department of Radiotherapy, Swami Ram Cancer Hospital & Research Institute, Haldwani, Uttarakhand, India
| | - K. C. Pandey
- Department of Radiotherapy, Swami Ram Cancer Hospital & Research Institute, Haldwani, Uttarakhand, India
| | - N. K. Pant
- Department of Radiotherapy, Swami Ram Cancer Hospital & Research Institute, Haldwani, Uttarakhand, India
| | - L. P. Verma
- Department of Physics, Govt. P.G. College, Berinag,Uttarakhand, India
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