Smokeless Tobacco Warnings in Indian Mass Media: Intention and Attempts to Quit

Exposure to mass media chronic health campaign messages and the uptake of non-communicable disease screening in Ghana

The main goal of this study was to examine the relationship between exposure to mass media health campaign massages and the uptake of non-communicable diseases (NCDs) screening services in Ghana and whether this relationship differs by place of residence. Available evidence suggests a general low uptake of NCDs screening in developing country settings. Unfortunately, many NCDs evolve very slowly and are consequently difficult to detect early especially in situations where people do not screen regularly and in settings where awareness is low. In this study, we contribute to understanding the potential role of the media in scaling up NCDs screening in developing countries. We fitted multivariate logistic regression models to a sample of 1337 individual surveys which were collected at the neighborhood level in three Ghanaian cities. Overall, the results show that exposure to mass media chronic NCD health campaign messages was significantly associated with increased likelihood of screening for NCDs. The results further highlight neighborhood-level disparities in the uptake of NCDs screening services as residents of low-income and deprived neighborhoods were significantly less likely to report being screened for NCDs. Other factors including social capital, knowledge about the causes of NCDs and self-rated health predicted the likelihood of chronic NCDs screening. The results demonstrate mass media can be an important tool for scaling up NCDs screening services in Ghana and similar contexts where awareness might be low. However, place-based disparities need to be addressed.

Genetic and epigenetic instability induced by betel quid associated chemicals

Over the years, betel quid chewing and tobacco use have attracted considerable interest as they are implicated as the most likely causative risk factors of oral and esophageal cancers. Although areca nut use and betel quid chewing may lead to apoptosis, chronic exposure to areca nut and slaked lime may promote pre-malignant and malignant transformation of oral cells. The putative mutagenic and carcinogenic mechanisms may involve endogenous nitrosation of areca and tobacco alkaloids as well as the presence of direct alkylating agents in betel quid and smokeless tobacco. Metabolic activation of carcinogenic N-nitrosamines by phase-I enzymes is required not only to elicit the genotoxicity via the reactive intermediates but also to potentiate the mutagenicity with the sporadic alkylations of nucleotide bases, resulting in the formation of diverse DNA adducts. Persistent DNA adducts provides the impetus for genetic and epigenetic lesions. The genetic and epigenetic factors cumulatively influence the development and progression of disorders such as cancer. Accumulation of numerous genetic and epigenetic aberrations due to long-term betel quid (with or without tobacco) chewing and tobacco use culminates into the development of head and neck cancers. We review recent evidence that supports putative mechanisms for mutagenicity and carcinogenicity of betel quid chewing along with tobacco (smoking and smokeless) use. The detailed molecular mechanisms of the extent of accumulation and patterns of genetic alterations, indicative of the prior exposure to carcinogens and alkylating agents because of BQ chewing and tobacco use, have not yet been elucidated.