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Oguanobi NI, Chijioke CP, Ghasi SI, Nubila NI, Nwoke OC, Okolo CC. Impact of Smokeless Tobacco on Cardiovascular Disease Risk in a Nigerian Metropolitan City. Cardiovasc Toxicol 2024; 24:727-736. [PMID: 38709447 DOI: 10.1007/s12012-024-09862-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Accepted: 04/16/2024] [Indexed: 05/07/2024]
Abstract
The use of smokeless tobacco products (STP) as a substitute for tobacco smoking is driving increasing consumption of these products especially in developing countries. The study sought to make comparison of cardiovascular risk profile between chronic STP users and suitably matched tobacco-naïve controls. This is a preliminary report from the cross sectional part of a two-arm prospective study of Smokeless Tobacco Products Composition and Exposure Outcome in Enugu metropolis, Nigeria. Consecutively recruited current Smokeless tobacco users, who had no history of cigarette smoking, aged 18 years and above, residing in selected communities in Enugu metropolis, Nigeria were recruited for the study from October 2022 to July 2023. Age and sex matched non-tobacco users from same localities as the study subjects served as controls. Written informed consent to participate in the study was obtained from all study participants. All participants were screened by the investigators, using the study case report forms, to obtain data on medical history, demographic, clinical, laboratory, and electrocardiographic evaluation. Data from 54 STP-users and 54 non-STP-users (mean age 56.58 ± 8.15 years) were analyzed. Anthropometric parameters were similar in both groups. Smokeless tobacco users had higher erect and supine blood pressure indices as well as greater postural drop in systolic blood pressure. The occurrence of diabetes mellitus (20.37% versus 5.56%) and hypertension (25.93%; 11.11%) was significantly higher in the STP-users than in the non-user population, (p = 0.02192 and 0.04751 respectively). Electrocardiographic evaluation showed significantly increased QTc and dispersions of P-wave, QRS and QT intervals as well as reduced PR interval in STP users. Electrocardiographic abnormalities observed in STP users include left ventricular hypertrophy, left atrial enlargement, ST-segment elevation, short PR interval and long QTc. Use of smokeless tobacco products is associated with increased risk burden of diabetes mellitus and hypertensive heart disease. Electrocardiographic findings linked to STP-use in this study are features consistent with arrhythmia, ventricular repolarization abnormality, myocardial hypertrophy and ischaemia, suggesting that smokeless tobacco products are not safe substitutes for tobacco smoking.
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Affiliation(s)
- Nelson I Oguanobi
- Department of Pharmacology and Therapeutics, Faculty of Basic Clinical Sciences, College of Medicine, University of Nigeria, Enugu Campus, Nigeria.
- Department of Medicine, University of Nigeria Teaching Hospital, Enugu, Nigeria.
| | - Chioli P Chijioke
- Department of Pharmacology and Therapeutics, Faculty of Basic Clinical Sciences, College of Medicine, University of Nigeria, Enugu Campus, Nigeria
- Department of Medicine, University of Nigeria Teaching Hospital, Enugu, Nigeria
| | - Samuel I Ghasi
- Department of Pharmacology and Therapeutics, Faculty of Basic Clinical Sciences, College of Medicine, University of Nigeria, Enugu Campus, Nigeria
| | - Nkoyo I Nubila
- Department of Pharmacology and Therapeutics, Faculty of Basic Clinical Sciences, College of Medicine, University of Nigeria, Enugu Campus, Nigeria
| | - Obinna C Nwoke
- Department of Pharmacology and Therapeutics, Faculty of Basic Clinical Sciences, College of Medicine, University of Nigeria, Enugu Campus, Nigeria
| | - Caleb C Okolo
- Department of Pharmacology and Therapeutics, Faculty of Basic Clinical Sciences, College of Medicine, University of Nigeria, Enugu Campus, Nigeria
- Department of Medicine, University of Nigeria Teaching Hospital, Enugu, Nigeria
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Fakunle AG, Okekunle AP, Asowata OJ, Akpa O, Sarfo FS, Akpalu A, Wahab K, Obiako R, Komolafe M, Owolabi L, Osaigbovo GO, Adeoye AM, Tiwari HK, Uvere EO, Akinyemi J, Jenkins C, Arulogun O, Ibinaiye P, Appiah LT, Bello T, Singh A, Yaria J, Calys-Tagoe B, Ogbole G, Chukwuonye I, Melikam C, Adebayo P, Mensah Y, Adebayo O, Adeniyi S, Oguike W, Donna A, Akinyemi R, Ovbiagele B, Owolabi M. Non-cigarette Tobacco Use and Stroke Among West Africans: Evidence From the SIREN Study. Nicotine Tob Res 2024; 26:589-596. [PMID: 38015428 DOI: 10.1093/ntr/ntad239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Revised: 09/27/2023] [Accepted: 11/21/2023] [Indexed: 11/29/2023]
Abstract
INTRODUCTION Non-cigarette tobacco (NCT) represents a form of tobacco use with a misperceived significance in chronic disease events. Whether NCT use is sufficient to promote stroke events, especially among Africans, is yet to be understood. This study assessed the relationship between NCT use and stroke among indigenous Africans. METHODS A total of 7617 respondents (NCT users: 41 vs. non-NCT: 7576) from the Stroke Investigative Research and Educational Network (SIREN) study were included in the current analysis. NCT use was defined as self-reported use of smoked (cigars or piper) or smokeless (snuff or chewed) tobacco in the past year preceding stroke events. Stroke was defined based on clinical presentation and confirmed with a cranial computed tomography/magnetic resonance imaging. Multivariable-adjusted logistic regression was applied to estimate the odds ratio (OR) and 95% confidence interval (CI) for the relationship of NCT with stroke at a two-sided p < .05. RESULTS Out of the 41 (0.54%) who reported NCT use, 27 (65.9%) reported using smokeless NCT. NCT users were older than non-NCT users (62.8 ± 15.7 vs. 57.7 ± 14.8 years). Overall, NCT use was associated with first-ever stroke (OR: 2.08; 95% CI: 1.02, 4.23) in the entire sample. Notably, smokeless NCT use was independently associated with higher odds of stroke (OR: 2.74; 95% CI: 1.15, 6.54), but smoked NCT use (OR: 0.16; 95% CI: 0.02, 1.63) presented a statistically insignificant association after adjusting for hypertension and other covariates. CONCLUSIONS NCT use was associated with higher odds of stroke, and public health interventions targeting NCT use might be promising in reducing the burden of stroke among indigenous Africans. IMPLICATIONS A detailed understanding of the relationship between NCT use and stroke will likely inform well-articulated policy guidance and evidence-based recommendations for public health prevention and management of stroke on the African continent.
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Affiliation(s)
- Adekunle Gregory Fakunle
- Department of Medicine, College of Medicine, University of Ibadan, Ibadan, Nigeria
- Department of Public Health, Osun State University, Osogbo, Nigeria
| | - Akinkunmi Paul Okekunle
- Department of Medicine, College of Medicine, University of Ibadan, Ibadan, Nigeria
- Department of Food and Nutrition, Seoul National University, Seoul, Korea
| | - Osahon Jeffery Asowata
- Department of Epidemiology and Medical Statistics, University of Ibadan, Ibadan, Nigeria
| | - Onoja Akpa
- Department of Epidemiology and Medical Statistics, University of Ibadan, Ibadan, Nigeria
- Institute of Cardiovascular Diseases, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Fred S Sarfo
- Department of Medicine, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Albert Akpalu
- Department of Medicine, University of Ghana Medical School, Accra, Ghana
| | - Kolawole Wahab
- Department of Medicine, University of Ilorin Teaching Hospital, Ilorin, Nigeria
| | - Reginald Obiako
- Department of Radiology, Ahmadu Bello University, Zaria, Nigeria
| | - Morenikeji Komolafe
- Department of Medicine, Obafemi Awolowo University Teaching Hospital, Ile-Ife, Nigeria
| | - Lukman Owolabi
- Department of Medicine, Aminu Kano Teaching Hospital, Kano, Nigeria
| | | | - Abiodun M Adeoye
- Department of Medicine, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Hemant K Tiwari
- Department of Biostatistics, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Ezinne O Uvere
- Department of Medicine, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Joshua Akinyemi
- Department of Epidemiology and Medical Statistics, University of Ibadan, Ibadan, Nigeria
| | - Carolyn Jenkins
- Department of Nursing, Medical University of South Carolina, Charleston, SC, USA
| | - Oyedunni Arulogun
- Department of Health Promotion and Education, University of Ibadan, Ibadan, Nigeria
| | - Philip Ibinaiye
- Department of Radiology, Ahmadu Bello University, Zaria, Nigeria
| | - Lambert T Appiah
- Department of Medicine, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Temilade Bello
- Department of Public Health, Osun State University, Osogbo, Nigeria
| | - Arti Singh
- Department of Medicine, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Joseph Yaria
- Department of Medicine, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Benedict Calys-Tagoe
- Department of Community Health, University of Ghana Medical School, Accra, Ghana
| | - Godwin Ogbole
- Department of Radiology, University of Ibadan, Ibadan, Nigeria
| | | | - Chidinma Melikam
- Department of Radiology, Ahmadu Bello University, Zaria, Nigeria
| | - Philip Adebayo
- Department of Internal Medicine, Aga-Khan University, Dar es Salaam, Tanzania
| | - Yaw Mensah
- Department of Radiology, University of Ghana Medical School, Accra, Ghana
| | - Oladimeji Adebayo
- Department of Medicine, College of Medicine, University of Ibadan, Ibadan, Nigeria
- Institute of Cardiovascular Diseases, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Sunday Adeniyi
- Department of Medicine, University of Ilorin Teaching Hospital, Ilorin, Nigeria
| | - Wisdom Oguike
- Department of Radiology, Ahmadu Bello University, Zaria, Nigeria
| | - Arnett Donna
- College of Public Health, University of Kentucky, Lexington, KY, USA
| | - Rufus Akinyemi
- Department of Medicine, Federal Medical Centre, Abeokuta, Nigeria
- Neuroscience and Ageing Research Unit, Institute for Advanced Medical Research and Training, College of Medicine, University of Ibadan, Ibadan, Nigeria
- Center for Genomic and Precision Medicine, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Bruce Ovbiagele
- Weill Institute for Neurosciences, University of California San Francisco, San Francisco, CA, USA
| | - Mayowa Owolabi
- Department of Medicine, College of Medicine, University of Ibadan, Ibadan, Nigeria
- Center for Genomic and Precision Medicine, College of Medicine, University of Ibadan, Ibadan, Nigeria
- Lebanese American University, Beirut, Lebanon
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Gupta AK, Kanaan M, Siddiqi K, Sinha DN, Mehrotra R. Oral Cancer Risk Assessment for Different Types of Smokeless Tobacco Products Sold Worldwide: A Review of Reviews and Meta-analyses. Cancer Prev Res (Phila) 2022; 15:733-746. [PMID: 36095092 DOI: 10.1158/1940-6207.capr-21-0567] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Revised: 04/28/2022] [Accepted: 09/07/2022] [Indexed: 01/31/2023]
Abstract
Smokeless tobacco (SLT) use is a significant cause of lip and oral cavity cancers. Globally, oral cancer prevalence is strongly linked to the types of tobacco products used, their chemical composition, and their pattern of use. Except snus, all SLT products sold in different World Health Organization regions are strongly associated with oral cancer incidence. Shammah showed the highest association OR with 95% confidence intervals (CI; OR, 38.74; 95% CI, 19.50-76.96), followed by oral snuff (OR, 11.80; 95% CI, 8.45-16.49), gutkha (OR, 8.67; 95% CI, 3.59-20.93), tobacco with betel quid (OR, 7.74; 95% CI, 5.38-11.13), toombak (OR, 4.72; 95% CI, 2.88-7.73), and unspecified chewing tobacco (OR, 4.72; 95% CI, 3.13-7.11). Most SLT products containing high levels of carcinogenic tobacco-specific nitrosamines (TSNA) exhibit a high risk of oral cancer. There is an urgent need to frame and implement international policies for oral cancer prevention through legal control of the TSNA levels in all SLT product types. PREVENTION RELEVANCE Most smokeless tobacco products sold worldwide, mainly shammah, toombak, gutkha, betel quid with tobacco, and dry snuff, are associated with a high risk of oral cancer. A high concentration of tobacco-specific nitrosamines in smokeless tobacco products is the major causative factor for oral cancer development.
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Affiliation(s)
- Alpana K Gupta
- Independent Research Consultant, Noida, Gautam Budh Nagar, Uttar Pradesh, India
| | - Mona Kanaan
- Department of Health Sciences, University of York, Heslington, York, United Kingdom
| | - Kamran Siddiqi
- Department of Health Sciences, University of York, Heslington, York, United Kingdom
| | | | - Ravi Mehrotra
- Centre for Health, Innovation and Policy, Noida, Gautam Budh Nagar, Uttar Pradesh, India.,School of Health Sciences, University of York, Heslington, York, United Kingdom
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Zubair F, Husnain MIU, Zhao T, Ahmad H, Khanam R. A gender-specific assessment of tobacco use risk factors: evidence from the latest Pakistan demographic and health survey. BMC Public Health 2022; 22:1133. [PMID: 35668426 PMCID: PMC9172179 DOI: 10.1186/s12889-022-13574-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Accepted: 05/30/2022] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND The high prevalence of tobacco use in Pakistan poses a substantial health and economic burden to Pakistani individuals, families, and society. However, a comprehensive assessment of the key risk factors of tobacco use in Pakistan is very limited in the literature. A better understanding of the key risk factors of tobacco use is needed to identify and implement effective tobacco control measures. OBJECTIVES To investigate the key socioeconomic, demographic, and psychosocial determinants of tobacco smoking in a recent large nationally representative sample of Pakistani adults. METHODS N = 18,737 participants (15,057 females and 3680 males) from the 2017-18 Pakistan Demographic Health Survey, aged 15-49 years, with data on smoking use and related factors were included. Characteristics of male and female participants were compared using T-tests (for continuous variables) and χ2-tests (for categorical variables). Multivariable logistic regression models were used to identify gender-specific risk factors of tobacco use. The Receiver Operating Characteristic Curve test was used to evaluate the predictive power of models. RESULTS We found that the probability of smoking for both males and females is significantly associated with factors such as their age, province/region of usual residence, education level, wealth, and marital status. For instance, the odds of smoking increased with age (from 1.00 [for ages 15-19 years] to 3.01 and 5.78 respectively for females and males aged 45-49 years) and decreased with increasing education (from 1.00 [for no education] to 0.47 and 0.50 for females and males with higher education) and wealth (from 1.00 [poorest] to 0.43 and 0.47 for richest females and males). Whilst the odd ratio of smoking for rural males (0.67) was significantly lower than that of urban males (1.00), the odds did not differ significantly between rural and urban females. Finally, factors such as occupation type, media influence, and domestic violence were associated with the probability of smoking for Pakistani females only. CONCLUSIONS This study identified gender-specific factors contributing to the risk of tobacco usage in Pakistani adults, suggesting that policy interventions to curb tobacco consumption in Pakistan should be tailored to specific population sub-groups based on their sociodemographic and psychosocial features.
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Affiliation(s)
- Faiqa Zubair
- Department of Economics, COMSATS University, Islamabad, 45550 Pakistan
| | | | - Ting Zhao
- Menzies Institute for Medical Research, University of Tasmania, Hobart, 7000 Australia
| | - Hasnat Ahmad
- Menzies Institute for Medical Research, University of Tasmania, Hobart, 7000 Australia
| | - Rasheda Khanam
- School of Business, University of Southern Queensland, Toowoomba, QLD 4350 Australia
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