ST Users Research Articles

Behavioural support and nicotine replacement therapy for smokeless tobacco cessation: protocol for a pilot randomised-controlled multi-country trial

BackgroundSmokeless tobacco (ST) is consumed globally by more than 350 million people, with approximately 85% of all users based in South and Southeast Asia. In this region, ST products are cheap and easily accessible. Evidence-based interventions to people quit ST use are lacking. This study aims to test the feasibility of conducting a future definitive trial of ST cessation, using a culturally adapted behavioural intervention, and/or nicotine replacement therapy (NRT) in three South Asian countries.MethodsWe will conduct a factorial design, randomised-controlled pilot trial in Bangladesh, India and Pakistan. Daily ST users will be recruited from primary health care settings in Dhaka, Noida and Karachi. Participants will be individually randomised to receive intervention A (4 or 6 mg NRT chewing gum for 8-weeks), intervention B (BISCA: face-to-face behavioural support for ST cessation), a combination of interventions A and B or usual care (Very Brief Advice - VBA). The participants will provide demographic and ST use related data at baseline, and at 6, 12 and 26 weeks of follow-up. Salivary cotinine samples will be collected at baseline and 26 weeks. The analyses will undertake an assessment of the feasibility of recruitment, randomisation, data collection and participant retention, as well as the feasibility of intervention delivery. We will also identify potential cessation outcomes to inform the main trial, understand the implementation, context and mechanisms of impact through a process evaluation and, thirdly, establish health resource use and impact on the quality of life through health economic data.DiscussionThe widespread and continued use of ST products in South Asia is consistent with a high rate of associated diseases and negative impact on the quality of life. The identification of feasible, effective and cost-effective interventions for ST is necessary to inform national and regional efforts to reduce ST use at the population level. The findings of this pilot trial will inform the development of larger trials for ST cessation among South Asian users, with relevance to wider regions and populations having high rates of ST use.Trial registrationISRCTN identifier 65109397

Fractal Dimension and Radiomorphometric analysis of Orthopanoramic radiographs in patients with tobacco and areca nut associated oral mucosal lesions: A pilot in-vivo study in a North Indian cohort

The aim of this study was to determine the fractal dimension (FD) and radiomorphometric indices (RMIs) in the mandible from orthopantomographic radiographs in patients with oral lesions associated with smokeless/smoking tobacco (SLT/ST) and areca nut habits in a North Indian cohort. A prospective, cross-sectional, observational pilot study was conducted of 120 subjects, including controls and 3 study groups of 30 patients each with oral submucous fibrosis, tobacco pouch keratosis, and oral leukoplakia (OL). Two observers calculated FD and the RMIs of mandibular cortical thickness (MCT), panoramic mandibular index (PMI), and mandibular cortical index (MCI). Mean FD was significantly reduced compared to controls with all oral lesions (P < .05) and with all habits in 3 of 4 regions of interest (P < .05). MCT was significantly reduced with OL (P < .005) and in ST users (P < .05). PMI did not differ regarding lesion status or habits. Compared to the controls, MCI C2 type was significantly more common in all oral lesions (P ≤ .005) and all types of habit (P < .005). Inter- and intraobserver agreement was strong to excellent. FD and RMI values were significantly altered compared to controls in oral lesions associated with tobacco and areca nut habits and in the dominant type of habit.

An eye-tracking based robotic scrub nurse: proof of concept

BackgroundWithin surgery, assistive robotic devices (ARD) have reported improved patient outcomes. ARD can offer the surgical team a “third hand” to perform wider tasks and more degrees of motion in comparison with conventional laparoscopy. We test an eye-tracking based robotic scrub nurse (RSN) in a simulated operating room based on a novel real-time framework for theatre-wide 3D gaze localization in a mobile fashion.MethodsSurgeons performed segmental resection of pig colon and handsewn end-to-end anastomosis while wearing eye-tracking glasses (ETG) assisted by distributed RGB-D motion sensors. To select instruments, surgeons (ST) fixed their gaze on a screen, initiating the RSN to pick up and transfer the item. Comparison was made between the task with the assistance of a human scrub nurse (HSNt) versus the task with the assistance of robotic and human scrub nurse (R&HSNt). Task load (NASA-TLX), technology acceptance (Van der Laan’s), metric data on performance and team communication were measured.ResultsOverall, 10 ST participated. NASA-TLX feedback for ST on HSNt vs R&HSNt usage revealed no significant difference in mental, physical or temporal demands and no change in task performance. ST reported significantly higher frustration score with R&HSNt. Van der Laan’s scores showed positive usefulness and satisfaction scores in using the RSN. No significant difference in operating time was observed.ConclusionsWe report initial findings of our eye-tracking based RSN. This enables mobile, unrestricted hands-free human–robot interaction intra-operatively. Importantly, this platform is deemed non-inferior to HSNt and accepted by ST and HSN test users.

Smokeless Tobacco Initiation, Use, and Cessation in South Asia: A Qualitative Assessment.

IntroductionSmokeless tobacco (ST) is a significant South Asian public health problem. This paper reports a qualitative study of a sample of South Asian ST users.MethodsInterviews, using a piloted topic guide, with 33 consenting, urban dwelling adult ST users explored their ST initiation, continued use, and cessation attempts. Framework data analysis was used to analyze country specific data before a thematic cross-country synthesis was completed.ResultsParticipants reported long-term ST use and high dependency. All reported strong cessation motivation and multiple failed attempts because of ease of purchasing ST, tobacco dependency, and lack of institutional support.ConclusionsInterventions to support cessation attempts among consumers of South Asian ST products should address the multiple challenges of developing an integrated ST policy, including cessation services.ImplicationsThis study provides detailed understanding of the barriers and drivers to ST initiation, use, and cessation for users in Bangladesh, India, and Pakistan. It is the first study to directly compare these three countries. The insight was then used to adapt an existing behavioral support intervention for ST cessation for testing in these countries.

Feasibility of a text-based reduction intervention in helping rural and underserved smokeless tobacco users quit

IntroductionSmokeless tobacco (ST) use significantly affects morbidity and mortality and remains disproportionally prevalent in rural and medically underserved communities. Few programs exist for rural smokeless tobacco users. Text-based interventions may increase the reach of cessation interventions; yet, none has tested them in ST users. We evaluated the feasibility, acceptability, and preliminary efficacy of a text-based Scheduled Gradual Reduction (SGR) intervention in rural and underserved ST users. MethodsST users were randomized in 2:1 fashion to the SGR group (N = 65), a text-based reduction program plus text-based support counseling messages or text-based support messages only group (N = 33). We surveyed participants at 30-days post intervention initiation to assess feasibility and acceptability and examined self-report 7-day point prevalence cessation at 30-days and 6-months post intervention initiation in the two arms. ResultsWe achieved benchmarks for feasibility and acceptability. Among the SGR participants 51% (n = 48) reported that intervention was useful in helping them quit, 83% (n = 48) indicated that they would recommend the intervention to a friend. Over 95% (n = 39) of SGR participants said that they read all alert texts. The SGR participants had a higher quit rate at 30-days compared to support messages alone (SGR = 21.5%, Control = 9.1%, p = 0.1627, Cohen’s d equivalent = 0.56, medium effect). However, the quit rate at 6-months was 21% (p = 0.9703) for both groups. ConclusionsA text-based intervention was feasible and acceptable among underserved ST users. SGR helped promote short-term cessation. The text-based interventions both had long-term efficacy. Given that text-based interventions have the potential to increase reach in underserved ST users, further testing is warranted.

ST product characteristics and relationships with perceptions and behaviors among rural adolescent males: a qualitative study.

Although smoking declines in the United States, the prevalence of male adolescent smokeless tobacco (ST; moist snuff and chewing tobacco) use remains unchanged. ST product characteristics, such as flavoring, packaging, and branding, could influence adolescents' ST initiation and continued use. This qualitative study examines the potential role of product characteristics in shaping ST-related perceptions and behaviors among rural adolescent males. Semi-structured individual interviews were conducted at three California rural high schools. ST users were asked about their experiences and perceptions related to product characteristics. Interviews were transcribed, coded, and analyzed using a general inductive approach. Participants associated flavored ST with appealing non-tobacco products, such as chewing gum and alcohol. Availability of different varieties and flavors stimulated interest and curiosity in sampling or switching between ST products. Time-limited promotional flavors and packaging also enhanced product appeal. Adolescent ST users preferred certain brands based on perceived brand features and perceived nicotine content, associating higher-strength brands as better suited for experienced ST users. Brand preferences frequently reflected perceived ST brand popularity within peer groups. Based on these observations, potential ST regulation and health education campaigns to address misconceptions about ST characteristics could influence adolescents' ST-related perceptions and reduce ST use among this vulnerable population.

Interrelations of Level of Urinary Cotinine and Score for Fagerstrom Test for Nicotine Dependence among Beedi Smokers, and Smokeless Tobacco Users in India.

Background:Tobacco related diseases is largely preventable and can stop pre-mature death. According to World Health Organization (WHO), the prevalence rate of smoking is 28.6% (40% among males and 18.2% among females).[1] Beedismoking and tobacco chewing are the commonest forms of tobacco habits in India, and strongly associated with oral cancer in India.[2] There are methods to estimation of severity of tobacco dependency, of them FTND is identified. The score for FTND is used for cigarette smoking, but we do not know the FTND score of ST users and Beedi smokers in India. Therefore, keeping the study in plan, we aim a systemic review with the following objective.Objectives:1. To pursue a review of published researches on interrelations between Beedi smoking and FTND score. 2. To pursue a review of published researches on interrelations between consumption of ST and FTND score.Materials and Methods:A systematic search of published papers were examined from three different electronic databases namely Pubmed, Cochrane library, and ProQuest. The inclusion criteria and exclusion criteria was set based on commonality of the studies which was looked through the objectives. Total of four papers of its category were found, and those met the criteria for inclusion factors.Results:Seventy-one articles were screened initially and forty-three articles were excluded and twenty-eight articles were screened, out of which twenty articles were excluded based on inclusion criteria. The abstracts of remaining eight articles were reviewed and four were removed because of duplication of the data. Finally, four articles were included for review after three stages of screening. Review results revealed that out of four selected reviews, one research study finding was interrelated with FTND score and Beedi and ST users. This study results also revealed that there is not a set of research carried out on FTND score for Beedi smokers and ST users.

Evaluating the role of smokeless tobacco use indices as brief measures of dependence

IntroductionThere is considerable interest in using brief measures of dependence for evaluation and treatment of tobacco dependence. The Heaviness of Smoking Index (HSI) is a validated measure of dependence among cigarette smokers. However, a similar index has not been studied among ST users. The aim of this study is to develop similar ST use indices and evaluate their utility as concise dependence measures. Time to first chew/dip of the day (TTFD), number of cans of ST used per week (CPW), and number of dips/chews per day (DPD) were used to create three ST use indices; heaviness of ST use index (HSTI), ST dependence index (STDI), and ST quantity frequency index (ST-QFI). MethodsThe study was based on data collected from a community based sample of exclusive ST users living in Oklahoma. Participants completed the self-administered survey which included dependence scales and questionnaires to measure sociodemographic factors and tobacco use characteristics. Saliva samples were obtained to measure cotinine concentration. Method of scoring for TTFD and DPD was similar to the scoring scheme employed for HSI items. DPD was transformed by a series of statistical tests into a three category scoring variable. Concurrent validity and reliability of the ST use indices were evaluated and overall accuracy of ST use indices was assessed. Level of agreement between the ST use indices and Fagerström Test for Nicotine Dependence for ST users (FTND-ST) was calculated to find the extent these indices were equivalent to FTND-ST in measuring dependence. ResultsST use indices were significantly correlated with FTND-ST. ST users who had higher HSTI or STDI scores were more likely to have Tobacco Dependence Screener (TDS) based dependence diagnosis (OR: 1.50, 95%CI: 1.12, 2.02 and OR: 1.53, 95%CI: 1.16, 2.02, respectively). Study findings showed that all ST use indices were predictors of cotinine concentration. The internal consistency assessed by Cronbach's alpha indicated that STDI had acceptable reliability. At the optimal cutoff scores, both HSTI and STDI had good level of agreement with FTND-ST (k=0.81, p<0.0001 and k=0.71, p≤0.0001, respectively). ConclusionsComponents of physical dependence are interrelated and each ST use item, TTFD, CPW, and DPD, explains a different dependence feature. Significant association of HSTI and STDI with other tobacco dependence measures and FTND-ST suggests that these indices are valuable brief measures of dependence among ST users and can be used as a substitute for FTND-ST, similar to HSI in smoking dependence studies. A concise dependence measure like HSTI or STDI has reduced response burden and is an effective tool in clinical and research setting.

C-MYC, HER2, and HER3 expression in localized prostate cancer (PC) treated with radical radiotherapy: Modulation by statins use and correlation with time to progression.

e16045 Background: There has been growing interest in the activity of statins (St) in PC patients receiving definitive radiation therapy. The oncogene Ras can be inhibited by HMG-CoA reductase inhibitors that in turn are also able to downregulate Myc. The aim of this study was to correlate St use and progression with the c-Myc, HER2 and HER3 expression in PC treated with radical radiotherapy (RT) with concurrent androgen deprivation. Methods: A total of 85 patients diagnosed with localised PC between 2000 and 2005 were selected for the study. Inmunohistochemical assay on core biopsy of each patient was performed using monoclonal antibodies for c-Myc, HER2 and HER3. The expression was evaluated using a semiquantitative method (Hscore scale: 0 to 300). Clinical and pathological variables were compared between St users and non-users and correlated with expression of c-Myc, HER2 and HER3. St users were defined as patients who had been taking St for at least 2 years before the diagnosis of PC and during follow up. Time to progression (TTP) was analyzed. Results: Mean age was 71 (56-82) years. Median follow-up was 75 months after RT. Twenty-five patients (29.4%) were using St. No statistical differences were found between treatment groups regarding median age, risk category, clinical T stage, Gleason score or median radiation dose. Median Hscore value of c-Myc was 40 (5-210) for St users vs. 72.5 (5-280) for non-users (p = 0.01). Only 8.6% of the cases showed HER2 expression and in those staining was mild intense and focal. Moderate expression of HER3 was observed in 36 cases (41.8%) and no correlation with St users nor with TTP was demonstrated (p=0.8). At the time of analysis, only 13 pts (15.3%) had biochemical relapse (1 low risk, 3 intermediate, and 9 high risk). St use (46.2%) was significantly associated with improved TTP (55 vs. 36.2 months, p = 0.022). Conclusions: Our work implicates a correlation of St use with a significant lower c-Myc expression and improvement in TTP in all groups, regardless the risk. No correlation was reported between HER2 or HER3, TTP and St use.

Measuring nicotine dependence among smokeless tobacco users

The objective of this study was to assess the concurrent validity of the FTQ-ST and the DIS-IV diagnosis of nicotine dependence among 68 adult ST users enrolled in a randomized, controlled clinical trial of bupropion SR. FTQ-ST scores were not found to differ between those with and without a current DIS-IV diagnosis of nicotine dependence (7.4 ± 2.1 vs. 6.8 ± 2.8, P = 0.325). For all possible FTQ-ST cutoff scores, the observed agreement between the FTQ-ST and the DIS-IV was not found to be different from that expected due to chance. FTQ-ST total scores were positively correlated with serum cotinine (Spearman's r = 0.40, P < 0.001), amount of tobacco used ( r = 0.51 and r = 0.41 for average dips/chews per day; average tins/pouches per week, respectively, P < 0.001), and a reduced likelihood of abstinence at 3 months (OR = 0.76, 95% C.I. 0.61–0.96; P = 0.019). Participants meeting DIS-IV criteria had lower cotinine concentrations than those without this diagnosis (411 ± 263 ng/ml vs. 493 ± 246 ng/ml; P = 0.042). Poor concordance was observed between the FTQ-ST and the DIS-IV in the assessment of nicotine dependence in ST users.

Treatments for spit tobacco use: a quantitative systematic review.

Spit tobacco use is prevalent in the United States and is associated with adverse health consequences. Health-care providers have neither evidence summaries nor evidence-based guidelines to assist them in treating patients who use spit tobacco. We completed a systematic review of the literature to determine the efficacy and safety of pharmacological and behavioral interventions for the treatment of spit tobacco use. We found six randomized controlled trials testing pharmacological interventions and eight testing behavioral interventions. Using random-effects meta-analyses,bupropion sustained-release (SR) increased point prevalence tobacco abstinence at 12 weeks [odds ratio (OR) 2.1; 95% confidence interval (CI), 1.0-4.2]. Nicotine replacement therapy with patch or gum increased point prevalence tobacco abstinence at 6 months (OR 1.3; 95% CI, 1.0-1.6). Behavioral interventions increased long-term (6 month)point prevalence tobacco abstinence (OR 1.7; 95% CI, 1.1-2.9). Studies including an oral examination followed by feedback to the patient had the highest treatment effect. Behavioral interventions for ST users are effective for increasing ST abstinence rates. Bupropion SR is probably effective and nicotine replacement therapy may be effective. This evidence from randomized controlled trials provides health-care professionals with information necessary to effectively treat spit tobacco use.

KISTI 과학기술정보 이용자의 원문수요와 관련된 정보환경 연구

이 연구의 목적은 KISTI의 과학기술정보 이용자들의 원문에 대한 요구와 충족에 관련된 정보환경을 분석하는 것이다. KIST떠 과학기술 문헌제공 서비스 통계, 일본의 NACSIS-ILL의 통계 및 2001년 9월에 수행된 KISTI 정보이용자 설문조사의 데이터에 근거하여, 원문 입수의 성공률, 국내 자급율, 소요기간과 비용 등의 요소를 비교 분석하였다. 주요한 발견은 일본과 비교할 때, 낮은 원문 수요, 비교적 낮은 원문의 입수 성공률과 국내 자급율, 해외 기관에 대한 높은 의존도, 신속, 적시적 및 비용 효과적인 원문 입수의 어려움 등을 포함하였다. 보다 효율적, 성공적인 고품질 정보자원의 확충과 공유, 문헌제공 서비스의 활성화로 국내 과학기술 정보이용자들의 정보환경을 개선할 정책마련이 시급한 것으로 나타났다. The purpose of this study is to describe the information environment of ST information users in Korea by examining their needs and satisfaction for documents. Comparison was made between the statistics of KISTI DDS and NACSIS-ILL document copy service, and data from the survey conducted for KISTI's ST information users in 2001 were analyzed. Findings include the low demand for documents delivery, low success rate in obtaining documents from domestic institutions, including KISTI, relatively high reliance on foreign DDS institutions, and difficulties in getting documents with speed, timeliness, and cost-effectiveness. It seems urgent to implement the strategic plans for more comprehensive and well-organized collection development and resource-sharing, and improvement of DDS.

Oral Leukoplakia Status Six Weeks After Cessation of Smokeless Tobacco Use

This study evaluated the prevalence and risk of developing oral leukoplakia in smokeless tobacco, or ST, users and the response of these leukoplakic lesions after six weeks of involuntary tobacco cessation. U.S. Air Force basic military training provided an environment of a mandatorily tobacco-free setting. The authors designed their investigation as a case control study with a nested cohort study. The principal investigator (G.C.M.) conducted oral examinations of 3,051 male U.S. Air Force basic military trainees. Using a questionnaire, he obtained detailed information concerning subjects' ST use patterns before basic training. Clinical photos were taken of all leukoplakic lesions identified in ST users at the initial examination and again six weeks later. Of the 3,051 male trainees examined (mean age = 19.5 years), 9.9 percent (302/3,051) were identified as current ST users. Among current ST users, 39.4 percent (119/302) had leukoplakia vs. 1.5 percent (42/2,749) of nonusers of ST (odds ratio = 41.9, 95 percent confidence interval = 28.1-62.6). At the end of the involuntary cessation of tobacco use, 97.5 percent of these leukoplakic lesions had complete clinical resolution. The type of ST used (snuff vs. chewing tobacco), amount used (cans or pouches per day), length of use (months), number of days since last use and brand of snuff used were significantly associated with the risk of developing leukoplakic lesions among ST users. The important new finding from this investigation is that if a young, otherwise healthy man with leukoplakic lesions stops using tobacco for six weeks, most of his leukoplakic lesions will resolve clinically. Use of ST, specifically snuff, is strongly associated with development of oral leukoplakia in young adult men. The clinician can use these findings in deciding when to perform biopsies on leukoplakic lesions associated with ST use. This information also should be used to assist ST users in quitting this addictive behavior.

Surveying Smokeless Tobacco Use, Oral Lesions and Cessation Among High School Boys

We surveyed 821 Iowa teenage boys to establish patterns of smokeless tobacco use, occurrence of oral lesions and the effect of lesions on attitudes about quitting, current use and plans for future use. Results suggest that young ST users who currently have a lesion or have experienced lesions may be particularly receptive to discussion of quitting options and other information about ST health effects. Dentists and other oral health professionals should initiate ST intervention when establishing a lesion history or on discovering a lesion at examination.