Smokeless Tobacco Consumption Research Articles

Prevalence and Determinants of Smoking and Smokeless Tobacco in the Rural Population of Karnataka, India

Background: Tobacco is known as a major cause of various preventable non-communicable diseases and kills half of all its users. With a greater prevalence in the rural community compared to the urban, this global health burden is substantially malignant. This study aimed to bridge the gap in the lack of adequate statistical information pertaining to prevalence and determinants of smoking and smokeless tobacco use in the rural population of Karnataka.Subjects and Method: This randomized community interventional study was conducted in primary health center areas of Karnataka, India. A total of 4,576 persons were interviewed (2,087 males and 2,489 females). Subjects ?30 years of age and residents for a minimum of six months were included. Mentally challenged, bedridden or differently abled subjects were excluded. The study employed a validated questionnaire adapted from the WHO STEPS questionnaire concerning demographical information, behavioral, physical, and biochemical measurements. Besides tobacco, informa-tion on use of beedis, cigarettes, and smokeless tobacco products (snuff, chewing tobacco) were also elicited. Data analysis of socio-demographic characteristics (age, educational/ marital/ occupational status) was carried out only for the participants with a current smoking habit. Data were analyzed using SPSS Version 18.0.Results: The overall prevalence rate of current smoking and smokeless tobacco habit in the study population was 54.8% (95%CI= 53.40 to 56.20) and the prevalence rate of ever/past users was 39.7% (95%CI= 38.26 to 41.10). Genderwise analysis predicted a higher prevalence of males currently smoking, and among them, most were 50 to 59 years of age (43.3%), illiterate (42.7%), widowed/ separated (39.8%), unskilled (44%), and semi-skilled workers (30%).Conclusion: Both genders participate in tobacco use, prevalence of smoking was higher among men and consumption of smokeless tobacco was higher among women. Subjects aged 50-59 years, illiterate, divorced/widowed/separated and, involved in unskilled or semi-skilled labor exhibited greater prevalence of tobacco habit compared to other determinants.Keywords: noncommunicable diseases, global health, tobacco use, tobacco smoking, smokeless tobacco. Correspondence: Dinesh Rajaram, Associate Professor. Department of Community Medicine, M.S. Ramaiah Medical college and Hospital, Bengaluru 560054, Karnataka, India. Email id.: dinesh.gayathri6@gmail.com. Mobile: +919980336893.

Influence of smokeless tobacco in development of oral submucous fibrosis among industrial workers: A cross-sectional study

Background: Tobacco usage in any form can contribute toward the development of various precancerous and cancerous lesions. Oral submucous fibrosis (OSMF) is a chronic precancerous lesion which has the highest rates of malignant transformation. Therefore, the present study was conducted among industrial workers to observe the effect of various forms of smokeless tobacco (SLT) usage and development of OSMF. Materials and Methods: The present cross-sectional study was conducted among 3998 industrial after obtaining approval from concerned authorities. A self-administered questionnaire approved by specialists was used to collect data from the study participants. The clinical diagnosis (the presence of fibrous bands and blanching) was performed by trained examiners who were calibrated in the department. Mouth opening was recorded by Vernier caliper. Statistical analysis was done using the Chi-square test and statistical significance was set at P ≤ 0.05. Results: The mean age of the study population was 38.341 ± 9.89 years. OSMF was reported in 50.2% (1149) of participants who were consuming one or other forms of SLT. Fibrous bands were seen in 59.6% of participants chewing areca nut, 56.8% of participants who consumed pan masala, and 50.6% of participants consuming khaini. 48.9% of participants who chewed gutkha developed blanching over their intraoral mucosa. Fibrous bands and blanching of the oral mucosa were observed in 89.4% and 88.3% of participants, respectively, who consumed all four types of SLT. Conclusion: Consumption of SLT has a strong correlation with the development of OSMF, especially with the use of gutkha, pan masala, and khaini. There is a need for public education programs among such vulnerable population groups.

Socio-economic Determinants of Smoking Prevalence and Intensity in Nepal

This study examines the socioeconomic determinants of smoking and smoking intensity in Nepal. Leveraging data from the nationally representative Nepal Multiple Indicator Cluster Survey 2019, a logistic regression is utilized to identify predictors of individual smoking while the study relies on Poisson estimation technique to examine the determinants of smoking quantity. Our results indicate that individual characteristics—particularly age, level of education, history of alcohol use, and consumption of smokeless tobacco—play a significant role in predicting the prevalence of smoking. On the other hand, household factors like wealth scores, household size, and house-specific attributes are only weakly associated with both smoking behavior and intensity. Our results also support that similar set of socio-economic variables influence the likelihood of smoking and the quantity of cigarettes consumed. These findings emphasize the need for demand-side interventions targeted to specific socioeconomic groups, and supplementing the existing supply-side policy and regulatory measures implemented by the Government of Nepal.

Taxonomic and functional profiling of Indian smokeless tobacco bacteriome uncovers several bacterial-derived risks to human health.

Smokeless tobacco (ST) consumption keeps human oral health at high risk which is one of the major reasons for oral tumorigenesis. The chemical constituents of the ST products have been well discussed; however, the inhabitant microbial diversity of the ST products is less explored especially from south Asian regions. Therefore, the present investigation discusses the bacteriome-based analysis of indigenous tobacco products. The study relies on 16S amplicon-based bacteriome analysis of Indian smokeless tobacco (ST) products using a metagenomic approach. A total of 59,15,143 high-quality reads were assigned to 34 phyla, 82 classes, 176 orders, 256 families, 356 genera, and 154 species using the SILVA database. Of the phyla (> 1%), Firmicutes dominate among the Indian smokeless tobacco followed by Proteobacteria, Bacteroidetes, and Actinobacteria (> 1%). Whereas, at the genera level (> 1%), Lysinibacillus, Dickeya, Terribacillus, and Bacillus dominate. The comparative analysis between the loose tobacco (LT) and commercial tobacco (CT) groups showed no significant difference at the phyla level, however, only three genera (Bacillus, Aerococcus, and Halomonas) were identified as significantly different between the groups. It indicates that CT and LT tobacco share similar bacterial diversity and poses equal health risks to human oral health. The phylogenetic investigation of communities by reconstruction of unobserved states (PICRUSt 2.0) based analysis uncovered several genes involved in nitrate/nitrite reduction, biofilm formation, and pro-inflammation that find roles in oral pathogenesis including oral cancer. The strong correlation analysis of these genes with several pathogenic bacteria suggests that tobacco products pose a high bacterial-derived riskto human health. The study paves the way to understand the bacterial diversity of Indian smokeless tobacco products and their putative functions with respect to human oral health. The study grabs attention to the bacterial diversity of the smokeless tobacco products from a country where tobacco consumers are rampantly prevalent however oral health is of least concern.

Smokeless tobacco consumption and its association with tobacco control factors in the Western Pacific Region: results from the Global Youth Tobacco Survey 2015-2019.

We estimated the prevalence of smokeless tobacco (ST) consumption and its associations with tobacco control factors among school-going youth in 18 Western Pacific Region (WPR) countries. We analyzed school-based Global Youth Tobacco Survey (2014-2019) microdata from 18 WPR countries and estimated weighted prevalence rates of ST consumption, cigarette smoking, and dual use. We used multilevel binary logistic regression to examine the associations of ST consumption and dual use with demographic variables, exposure to pro-tobacco and anti-tobacco factors, national income, and MPOWER indicators. Data from 58,263 school-going youth were analyzed. The prevalence of past 30-day ST consumption was highest in Kiribati (42.1%), the Marshall Islands (26.1%), Micronesia (21.3%), Palau (16.0%), and Papua New Guinea (15.2%). In adjusted multilevel models, ST consumption and dual use were significantly associated with sex, age, parental smoking, pro-tobacco factors, national income, and MPOWER score. For each unit increase in score for cessation programs, we observed approximately 1.4-fold increases in the odds of youth ST consumption (adjusted odds ratio [aOR], 1.38; 95% confidence interval [CI], 1.15 to 1.66) and dual use (aOR, 1.47; 95% CI, 1.16 to 1.86). Similarly, for each unit increase in score for health-related warnings, the odds of both ST consumption (aOR, 0.47; 95% CI, 0.42 to 0.53) and dual use (aOR, 0.35; 95% CI, 0.30 to 0.42) decreased by approximately 60%. The prevalence of youth ST consumption was substantial in the Pacific Islands, exceeding that of cigarette smoking in some countries. Implementing MPOWER measures for ST products could help reduce ST consumption.

Prevalence of chronic obstructive pulmonary disease (COPD) among rural population: A national survey in Bangladesh.

In Bangladesh, there is a scarcity of nationally representative data on the burden of chronic obstructive pulmonary disease (COPD). To estimate the COPD prevalence in rural settings, this cross-sectional, population-based study was conducted in all eight administrative divisions of Bangladesh, and involved adults aged 40 years and above. By using multi-stage random sampling, 2,458 individuals were enrolled. The Global Initiative for Chronic Obstructive Lung Disease (GOLD) guidelines were used to diagnose COPD based on post-bronchodilator lung function, while additional participant data was gathered through computer-assisted personal interviews. A 2% COPD prevalence (95% CI: 1.45, 2.55) was found in the study sample with a statistically significant difference between males (2.7%; 95% CI: 1.8, 3.6) and females (1.2%; 95% CI: 0.59, 1.81). Increasing age significantly inflated the odds of having COPD irrespective of sex (OR: 1.03; 95% CI: 1.00, 1.05; P value < 0.05). Furthermore, prevalence of COPD was higher among manual workers, cigarette smokers, and those that used the indoor kitchen and did not have a primary education. Sex-based analysis showed that smokeless tobacco consumption was significantly associated with COPD occurrence among males (OR: 2.14; 95% CI: 1.05, 4.37; P value < 0.05), but not females. Further, using an indoor kitchen increased the odds of developing COPD by 400% among female participants (OR: 4.39; 95% CI: 1.37, 14.10; P value < 0.05). This study provides a comprehensive sex-based estimation of COPD prevalence among rural population and imparts significant contribution to the growing database on COPD prevalence in Bangladesh.

Prevalence of tobacco consumption and the associated factors among the adults in an urban slum: Findings from the WHO STEPwise survey.

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. 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. 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). 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.

Smokeless tobacco industry's brand stretching through FM radio: A study from Delhi National Capital Region, India.

Smokeless tobacco (SLT) consumption is associated with multiple adverse health effects and mortality, with the highest burden in India. The WHO FCTC has banned tobacco advertisement, promotion and sponsorship via Article 13. Indian laws also prohibit any kind of direct or indirect advertisements in all forms of audio, visual, and print media; brand promotion; and sponsorship of tobacco products. However, the tobacco industry continues to find aggressive marketing ways to advertise their products. This study aims to assess the extent of surrogate advertisement of smokeless tobacco products through frequency modulation (FM) radio stations in the city of Delhi (National Capital Territory of India). In this study, the advertisements broadcasted over FM radio across different channels (private and government owned) in total 162 h were analyzed. The time duration was spread evenly over morning peak hours, off hours, and evening peak hours. It was found that multiple brands including Vimal, Kamla Pasand, and Rajshree have used surrogate advertising to market their brands that are commonly associated with smokeless tobacco products. However, no such advertisement was found to be aired on government-owned FM channels. The total surrogate advertisements broadcasted were over 286 times, where no significant difference was found in distribution among peak and non-peak hours. The study indicated that the tobacco industry is making its way to sell the products through indirect advertisements. The need of the hour is to not only enforce tobacco advertising ban laws in all forms of advertising media but also to strictly regulate smokeless tobacco products.

Breast Cancer Is Significantly Associated with Cancers in The First- and Second-Degree Relatives in Ethnic Mizo-Mongoloid Population, Northeast India

Background: High incidence of breast cancer among the endogamous Mizo-Mongoloid tribe stresses the need to explore the disease pertaining to the family history as well as other risk factors. This study investigates the association of risk factors and inherited diseases with breast cancer. Methodology: The study includes 426 unrelated breast cancer cases and 810 healthy controls of female Mizo ethnicity. Association between reproductive history, lifestyle/ dietary habits, tobacco and alcohol exposures, family history in relation to cancer and inheritable diseases was assessed by univariate logistic regression using Chi-square tests and multivariate analyses using Cox regression. Results: Age at diagnosis was highest between 41 to 50 years. Consumption of fermented pork fat, smoked food and Smoke-less tobacco, lower intake of vegetables/ water, having a first/ or second degree relative with cancers and inheritable diseases were found to be the major risk factors. Certain known factors were also acting as confounding factors. Conclusions: The present study reveals that Mizo women with first- and second-degree relatives of breast cancer, various other cancers and inheritable diseases have increased risk of breast cancer. This study also highlights the importance of analysing genetic factors which can aid in early detection of inherited risk factors.

Estimating the quantity of smokeless tobacco consumption among older adults in India

Problem consideredGlobally, smokeless tobacco (SLT) users are highest in India. Whilst, studies examined prevalence and determinants of SLT use, no evidence exists which examined the quantity of SLT consumed. MethodsStudy utilized national representative data from the Longitudinal Aging Study in India (LASI) which adopted a multistage stratified area probability cluster sampling design. First, we computed the average SLT consumption per day (in grams) from the LASI data. Consecutively, we further utilized the projected population approximations from the 26th round of the official United Nations population estimates and prevalence rate of current SLT use from the Global Adult Tobacco Survey (GATS-2) and LASI Survey, separately to estimate SLT use pattern for the entire Indian population aged 45 or above. ResultsThe prevalence of current SLT use among older adults was 17.2% wherein the SLT use is higher among men (20.8%). On average, an older adult consumes 1.01 g of SLT on a daily basis. The range of SLT quantity consumed by users’ according to the LASI and GATS-2 prevalence, varies from 65,000 kg to 85,000 kg per day whereas, annual consumption ranges from 23 million kilograms to 32 million kilograms, respectively. ConclusionThe development of SLT cessation services examining the quantitative aspects of SLT use would be beneficial in tackling the high SLT burden in India and improving the rates of intention to quit.

Smokeless tobacco consumption induces dysbiosis of oral mycobiome: a pilot study.

Smokeless tobacco (SLT) alters the oral microbiome of smokeless tobacco users. Dysbiosis of oral bacteriome has been determined; however, the mycobiome of SLT users has not been characterized. The oral mycobiome was assayed by amplification and sequencing of the fungal internal transcribed spacer (ITS1) region from oral swab samples of non-SLT users, SLT users (with or without oral lesions), and SLT with alcohol users. We observed that the richness and diversity of oral mycobiome were significantly decreased in SLT with oral lesions users than in non-users. The β-diversity analysis showed significant dissimilarity of oral mycobiome between non-users and SLT with oral lesions users. Linear discriminant analysis effect size and random forest analysis of oral mycobiome affirm that the genus Pichia was typical for SLT with oral lesions users. Prevalence of the fungal genus Pichia correlates positively with Starmerella, Mortierella, Fusarium, Calonectria, and Madurella, but is negatively correlated with Pyrenochaeta, Botryosporium, and Alternaria. Further, the determination of oral mycobiome functionality showed a high abundance of pathotroph-saprotroph-symbiotroph and animal pathogen-endophyte-epiphyte-undefined saprotroph at trophic and guild levels, respectively, indicating possibly major changes in normal growth repression of types of fungi. The oral mycobiome in SLT users was identified and comprehensively analyzed for the first time. SLT intake is associated with oral mycobiome dysbiosis and such alterations of the oral mycobiome may contribute to oral carcinogenesis in SLT users. This study will provide a basis for further large-scale investigations on the potential role of the mycobiome in SLT-induced oral cancer. KEY POINTS: • SLT induces dysbiosis of the oral microbiome that can contribute to oral cancer. • Oral mycobiome diversity is noticeably reduced in SLT users having oral lesions. • Occurrence of Pichia can be used as a biomarker for SLT users having oral lesions.

A study on the prevalence of hypertension and its associated risk factors in Gandhinagar urban PHC, Jaipur

Background: Hypertension is considered as an important public health issue around the world. It is associated with the development of more serious medical conditions like myocardial infarction, cardiac failure, stroke, renal disease, etc. According to the WHO, high blood pressure affects 1280 million adults aged 30 to 79 years worldwide and almost two-thirds of them come from low-middle-income countries. Methods: An OPD-based, observational study was conducted among individuals aged 30 years or above at Gandhinagar UPHC of Jaipur city in the state of Rajasthan. Prevalence of hypertension and prehypertension were analysed. The details regarding gender, age, family history of individuals and other behavioural characteristics like tobacco, smokeless tobacco and alcohol consumption, physical activity, and anthropometric measurements were collected. The Chi-square test was applied to analyze if a statistically significant association exist between hypertension and the above-mentioned factors.Results: This study estimated hypertension prevalence as 23.2%. The prevalence of prehypertension was estimated to be 33.2% and the prevalence of individuals with no-hypertension was 43.6%. This study also reports that obesity, consumption of alcohol, smoking and positive HTN family history were significant determinants for hypertension.Conclusions: Overall, the results of this study show that the HTN and pre-HTN prevalence was significant in the study population. In the absence of lifestyle changes, individuals referred to as prehypertensive are at high risk of developing HTN. Early detection and timely intervention will reduce the effect of high BP thus decreasing the risk of developing CVDs, stroke, and renal impairment.

Prevention of initiation of smokeless tobacco (SLT) consumption among rural children

Background: India Global Youth Tobacco Survey 2019 observed that 8.5% of the young age group (13-15 years) consume tobacco (9.6 % are boys and 7.4 % are girls). No interventional studies among adolescents were conducted before the initiation of the SLT use. Aims &amp; Objectives: To estimate the prevalence of consumption of tobacco and non-tobacco products and to provide school based interventions to bring behavioral changes. Materials and Methods: An interventional study was carried out in Primary Schools. For estimation of the prevalence of tobacco and non tobacco use all the students of 1st to 5th while for the interventions, 4th and 5th standard were selected. Baseline data and change in the behavior at the end of one year was collected. FGD with key informants were also conducted. Descriptive Statistics was conducted. Results: The prevalence of smokeless tobacco consumption and non-tobacco product was found to be 1.3% and 36.5% respectively. After intervention 40.5% students had quit non tobacco products. Findings of FGD suggested that children should not be sent to purchase tobacco products on behalf of their parents. Conclusion: School based intervention and sensitization of the field workers along with knowing their perceptions for the predictors of consumption could be useful.

Smokeless Tobacco: Pattern and Awareness in a Rural Area of Bangladesh

Background: Smokeless tobacco consumption has contributed nothing except diseases, disability and death. But assessment of awareness and knowledge regarding its use has less been studied to the extent as that of smoking. The study was undertaken to assess the pattern of use and awareness of smokeless tobacco among rural community.&#x0D; Materials and methods: This descriptive cross-sectional study was conducted among 310 respondents selected through systemic sampling method, aged 18 years, residing at least for 10 years in Noakhali district in Bangladesh. This study was conducted from May to November 2013. Data were collected with a pretested questionnaire through face-to-face interview. &#x0D; Results: Smokeless Tobacco (SLT) use was prevalent among 45.8% of respondents. Higher proportion of females than males used SLT. Zarda was the common form in more than half of the users. Among daily users, self-interest was the main factor for initiation and mean age of starting was 35 years. Per day frequency of SLT use for 1-8 times was in two-thirds of the daily users. Most of the respondents knew that SLT is injurious to health. About two-thirds of them mentioned SLT as addictive. More than one-thirds of the respondents had knowledge that smoking is more injurious than SLT. However, 30% of the respondents knew that both smoking and SLT were equally addictive. Excluding the former users, majority of the respondents knew that SLT might be quitted. &#x0D; Conclusion: Multistage effective behavioral change intervention programs are the preferable way to overcome this lifestyle-related health problem.&#x0D; JCMCTA 2022 ; 33 (1) : 166-172

Histological effects of the use of chewing tobacco during pregnancy on ovaries of the offspring of rats.

Introduction: Exposure to smokeless tobacco products (Nicotine) is associatedwith the generation of reactive oxygen species, modulation of inflammatory mediators, inhibition of collagen synthesis and impairment of DNA repair capacity whichin some way may cause harmful effects on the ovaries of the offspring.Objectives: To observe the effects of chewing tobacco on the gross morphologicaland histological alterations on the ovaries of offspring’s rats.Methodology: Twenty pregnant rats were divided in two groups: Group. A(Control) 10 pregnant rats received normal diet and water ad libitum. Group. B(Experimental) 10 pregnant rats received 5% tobacco mixed with normal feed andwater ad libitum. After 21 days, the female offspring of both control and experimental groups were sacrificed, ovaries removed and stained with H&amp;E stains formicroscopic examination.Results: The results clearly showed that smokeless tobacco consumption duringgestation reduces the weight and size of ovary along with the congested blood vessels, compact stroma and degenerative primordial follicles. Hence the practice ofchewing tobacco in mothers is directly related to the adverse effects in offspringhealth and ovaries.&#x0D; Key words: Chewing Tobacco, Offspring, Ovaries, Rats.

Effect of Chronic Consumption of Smokeless Tobacco (Snuff) on Liver Enzymes of Males in Maiduguri, Northeast Nigeria

Smokeless tobacco snuff consumption is as dangerous as cigarette smoking. It is now considered a significant source of morbidity and mortality owing to the effect of the numerous chemical constituents. Thus, this study was designed to investigate the effect of chronic consumption of Smokeless Tobacco (Snuff) on Liver Enzymes of males in Maiduguri and its environs, Northeast Nigeria. In this study we recruited 109 individuals who were smokeless tobacco snuffers and 97 healthy controls. It was a prospective case control study performed in adult males (30-50 years and 23 – 48 years for case and control respectively) with mean age of the case and control subjects of 37.12 ± 10.21and 33.64 ± 3.29 respectively. Serum Alanine amino transferase (ALT), Serum Aspartate amino transferase (AST) and serum Alkaline phosphatase (ALP) were estimated using kinetic methods by Cobas C311(Roche/Hitachi) chemistry auto analyzer. The estimated Serum AST, ALT, and ALP, levels were compared using un-paired student's t test between the two groups. Also, the liver enzyme levels were evaluated based on the duration of the smokeless tobacco consumption and correlation was determined. The age range of the study subjects was between 30 and 50 years and the mean age of the Case and control subjects were 37.12 ± 10.21and 33.64 ± 3.29 respectively. The mean(average) of the duration of tobacco snuff intake was 10.52 ± 7.02 years. The mean Serum level of AST, ALT, and ALP of tobacco snuffers were found to be higher (15.45 ± 3.32, 22.00 ± 5.10 and 22.00 ± 5.10 respectively) as compared to controls (10.42 ± 2.36, 8.88 ± 3.14 and 31.14 ± 4.60 for AST, ALT and ALP respectively) and the differences were statistically significant at p&lt; 0.05. Also, the serum levels of the liver enzymes (AST, ALT, and ALP) were evaluated according to duration of snuff intake and the liver enzymes were found to be higher in people who uses the tobacco snuff for 11-20 years. However, the duration of the snuff intake was correlated with the serum levels of the liver enzymes. There was strong correlation between duration of snuff intake and serum levels of AST and ALT (r=0.648 and r=0.741 respectively) and the relationship were statistically significant at p&lt;0.05. But the serum level of ALP was weekly correlated with the duration of snuff intake and the relationship was not statistically significant at p&gt;0.05. From the results of the current study and the literature reviewed it is evident that tobacco snuff may likely be one of the causes of several liver diseases. Therefore, our study might be helpful in creating awareness on the hazards of using smokeless tobacco products (Snuff), among our population who are using smokeless tobacco.

Expression of Sex Hormones in Oral Squamous Cell Carcinoma: A Systematic Review on Immunohistochemical Studies.

Oral squamous cell carcinoma (OSCC) is the most widespread oral malignancy. In the western world, smoking and alcohol remain the most common risk factors, whereas smokeless tobacco and areca nut consumption are the prevalent etiological factors in South Asia. Numerous markers were studied till date to identify the disease. However, the role of sex hormones in OSCC is poorly defined. Hormonal receptors play a role in breast cancer, prostate cancer, and human papillomavirus (HPV) driven oropharyngeal cancers. It is proven that the expression of estrogen receptor-α improved the overall survival of the patient with HPV-positive oropharyngeal cancer. Thus, this review article aims to determine the expression of sex hormones by immunohistochemistry in OSCC.This systematic review was performed with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) Statement Criteria 2020. Relevant articles were collected from the electronic database in PubMed and Cochrane till 2021. Immunohistochemical studies on sex hormones and their role in OSCC published in English literature were included. We excluded case reports, case series, and abstract-only articles. The sample size of the selected studies varied, and these studies measured the parameters such as sex hormones and OSCC. Furthermore, all the studies used different sex hormones and their association with oral cancer through the immunohistochemical process. Thus, this review summarizes that sex hormones influence the biopathology of oral cancer and have a prognostic significance in the tumor subgroups.

Smokeless tobacco consumption in South Asia: a review of the health programmes and interventions to reduce consumption

Over 290 million smokeless tobacco (SLT) users are located in South Asia (SA), accounting for 80% of the global burden of disease. Consequences of consumption include oral cancer, ischemic heart disease and still births, leading to an increased morbidity and mortality. The lack of a global mandate has led to less regulation and greater affordability of smokeless tobacco products, causing smokers to switch to these products. The need to identify effective interventions to reduce smokeless tobacco consumption is evident. This review will appraise the effectiveness of health programmes and interventions used to reduce SLT consumption in SA and identify areas for future research. Literature was found by searching Global Health, Medline, Web of Science, Google Scholar and Pubmed, using key terms. Literature was then systematically assessed using inclusion and exclusion criteria to yield 19 pieces of literature for this review. Four broad intervention categories were identified and appraised using different criteria for effectiveness. Each intervention had varying levels of effectiveness which depended on external factors. The lack of literature evaluating SLT interventions was noted and feasibility was estimated where necessary. Although interventions had a high effectiveness in some areas, many demonstrated low effectiveness due to their complex multi-sectoral nature. Further research is required to identify effective strategies and barriers precluding implementation.

Relationship between tobacco use, alcohol consumption and non-communicable diseases among women in India: evidence from National Family Health Survey-2015-16

BackgroundBased on an increased prevalence of diabetes, asthma and hypertension among women in reproductive age, understanding the risk factors of non-communicable diseases (NCDs) is crucial to inform policy and program interventions to address the problem. In this study, we empirically assessed the associations of behavioural factors such as alcohol consumption and tobacco use and a variety of socioeconomic characteristics with prevalence of NCDs in adult women.MethodsThe data were derived from the National Family Health Survey conducted in 2015–16. The effective sample size for the present paper was 699,686 women aged 15–49 years in India. Descriptive statistics along with bivariate analysis were conducted to find the preliminary results. Additionally, multivariable logistic regression analysis was conducted to find the relationship between NCDs and behavioural factors such as alcohol consumption and tobacco use. Moreover, population attributable risk was estimated in the present study.ResultsIt was revealed that 15.9% of women had any of the NCDs. A proportion of 0.8% of women smoked tobacco whereas 5.5% of women consumed smokeless tobacco. Also, a proportion of 1.2% of women consumed alcohol in the current study. The odds of having NCDs among women who smoked tobacco, consumed smokeless tobacco and consume alcohol were 16, 8 and 20% significantly higher than the odds of having NCDs among women who did not smoke tobacco, consume smokeless tobacco and consume alcohol respectively. The population attributable risk of having NCDs was 1.8% (p < 0.001) for women who smoked, 0.8% (p < 0.001) for women who consumed smokeless tobacco and 2.2% (p < 0.001) for women who consumed alcohol. Besides, the odds of having NCDs among overweight and obese women were 2.25 and 3.60 times greater than the odds of having NCDs among women who were underweight.ConclusionThe findings revealed that smoking and using smokeless tobacco and alcohol consumption were risk factors of NCDs in women. The findings also alarm the focus of maternal and child health programs on NCDs’ risk factors like maternal obesity, due to their adverse health consequences on their children too. Also, the coexistence of higher levels of tobacco use and alcohol consumption requires different strategies to address the vulnerability of women towards NCDs, including screening and early detection of NCDs especially among those who smoke or chew tobacco and consume alcohol.

Assessing the Effect of Smokeless Tobacco Consumption on Oral Microbiome in Healthy and Oral Cancer Patients.

Oral cancer is a globally widespread cancer that features among the three most prevalent cancers in India. The risk of oral cancer is elevated by factors such as tobacco consumption, betel-quid chewing, excessive alcohol consumption, unhygienic oral condition, sustained viral infections, and also due to dysbiosis in microbiome composition of the oral cavity. Here, we performed an oral microbiome study of healthy and oral cancer patients to decipher the microbial dysbiosis due to the consumption of smokeless-tobacco-based products and also revealed the tobacco-associated microbiome. The analysis of 196 oral microbiome samples from three different oral sites of 32 healthy and 34 oral squamous cell carcinoma (OSCC) patients indicated health status, site of sampling, and smokeless tobacco consumption as significant covariates associated with oral microbiome composition. Significant similarity in oral microbiome composition of smokeless-tobacco-consuming healthy samples and OSCC samples inferred the possible role of smokeless tobacco consumption in increasing inflammation-associated species in oral microbiome. Significantly higher abundance of Streptococcus was found to adequately discriminate smokeless-tobacco-non-consuming healthy samples from smokeless-tobacco-consuming healthy samples and contralateral healthy site of OSCC samples from the tumor site of OSCC samples. Comparative analysis of oral microbiome from another OSCC cohort also confirmed Streptococcus as a potential marker for healthy oral microbiome. Gram-negative microbial genera such as Prevotella, Capnocytophaga, and Fusobacterium were found to be differentially abundant in OSCC-associated microbiomes and can be considered as potential microbiome marker genera for oral cancer. Association with lipopolysaccharide (LPS) biosynthesis pathway further confirms the differential abundance of Gram-negative marker genera in OSCC microbiomes.