Use Of Smokeless Tobacco Products Research Articles

Impact of Smokeless Tobacco on Cardiovascular Disease Risk in a Nigerian Metropolitan City.

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 18years 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 ± 8.15years) were analyzed. Anthropometric parameters were similar in both groups. Smokeless tobacco users had higher erect and supine blood pressure indices as well asgreater 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.

In vitro permeation of nicotine and tobacco specific nitrosamines from smokeless tobacco product extracts in a 3D buccal tissue model

Tobacco product use is a risk factor in the development of oral cancer, although epidemiology studies show this risk is far less with smokeless tobacco product use than cigarette smoking. While smokeless tobacco contains harmful and potentially harmful constituents (HPHCs), the oral permeation of HPHCs in oral tobacco products is not completely understood. To improve the understanding, three different extract concentrations of the CORESTA reference products (CRP) for snus (CRP1.1) and moist snuff (CRP2.1) were applied to cellular tissue derived from two donors of EpiOral™ model, a 3D human buccal model, and permeation of nicotine and tobacco-specific nitrosamines (TSNAs) were measured over two hours. Permeation of 0.15% caffeine in complete artificial saliva and cell viability were also measured. Results showed that a consistent and concentration dependent cumulative permeation of nicotine and TSNAs was observed with high percent recovery in all conditions. A high degree of sensitivity was seen for all analytes, with minimal cytotoxicity for both CRPs. The data presented here show the EpiOral™ model is fit-for-purpose to evaluate the permeation of nicotine and TSNAs in nicotine-containing snus and moist snuff oral tobacco.

Smoked tobacco dependence and its correlates among participants attending life skills training and counselling services programme across Karnataka (2017-2022).

Indian National Mental Health Survey reports an alarming prevalence of 20.9% for tobacco dependence in India. Dependence on smoked tobacco can be prevented by thorough knowledge of the risk factors associated with it. To estimate the prevalence and identify the factors associated with smoked tobacco dependence among participants attending the life skills training and counselling services programme (LSTCSP) across Karnataka from 2017 to 2022. Pretraining data of 3104 participants from training programmes between 2017 and 2022 were utilised. Univariate and multivariable logistic regression analysis was performed based on a conceptual framework with various hypothesised exposure variables and smoked tobacco dependence as outcome. The overall prevalence of smoked tobacco dependence among LSTCSP participants who used smoked tobacco products was 59.4%. Ever use of smokeless tobacco products (Adjusted odds ratio (AOR) =2.05, 95% CI: 1.11-3.78) and screening positive for symptoms of generalised anxiety (AOR = 2.53, 95% CI: 1.32-4.84) significantly increased the odds of smoked tobacco dependence, whereas making decisions collectively in the family (AOR = 0.35, 95% CI: 0.18-0.66) and individuals with increased score for neurotic personality traits (AOR = 0.64, 95% CI: 0.44-0.93) were the factors associated with reduced odds of smoked tobacco dependence. The identified risk factors associated with smoked tobacco dependence are important to develop tobacco control programmes as well as in preventing its onset. With the risk factors for smoked tobacco dependence identified, the results of this study have implications for health promotion and prevention programmes as well as cessation programmes related to smoked tobacco dependence, within India and similar countries.

Tobacco use and outcomes of pregnancy: A community-based cross-sectional study among the women in the reproductive age group in the rural area of Belgaum District, Karnataka, South India

Exposure to tobacco smoke affects all stages of human reproduction. Smoking is not rare among Indian women, but research over the past decade has shown that Indian women’s use of smokeless tobacco products is substantial and increasing, with negative consequences for both oral morbidity and perinatal health, including premature delivery, low birth weight, and birth length. This study was done to know the prevalence of tobacco consumption among rural women in the reproductive age group and its association with the outcomes of pregnancy A community-based cross-sectional study, was conducted from January 2011 to December 2011 among 1200 rural women aged between 15 years to 49 years residing in Primary Health Centre (PHC) Vantmuri area, Belgaum, Karnataka, India. Statistical analysis was done using rates, ratios, and chi-square tests. The prevalence of tobacco consumption was 9.7%. In this study, we found that except for the first pregnancy outcomes, and all the subsequent outcomes of the pregnancies, the differences are statistically significant indicating an association between tobacco consumption and the outcome of pregnancy. Also, a significant association was found between tobacco consumption and low birth weight. Women under the reproductive age group constitute an important cohort of the population. A significant association was found between tobacco consumption and the outcomes of pregnancy. It has become the need of the hour to provide enough evidence on the correlates of tobacco use in the community and to put increasing effort against the expansion of tobacco companies in developing countries, which are often aimed at women.

Survival Outcomes and Patterns of Failure in Maxillary Alveolus Squamous Cell Carcinoma.

Introduction Squamous cell carcinoma (SCC) of the maxillary alveolus is a relatively rare disease. There is lack of data on this subsite as compared with other sites. The factors that affect survival in cases of maxillary alveolar SCC are tumor stage, local and cervical metastases, histological grading, and the margin status. Objectives To evaluate the overall survival (OS), the disease free survival (DFS), and the complex interaction and effects of margin status, histological differentiation, habits (such as smoking and the use of smokeless tobacco products), and cervical and distant metastases based on clinicopathological data. Methods We examined the electronic database at our hospital from 2003 to 2017. We included all cases with a histopathological diagnosis of SCC of the maxillary alveolus. Tumors originating primarily from the maxillary alveolus were included, while those originating from adjacent subsites, like the hard palate, the buccal mucosa or the maxillary sinus were excluded. We also excluded all the patients who were not operated on with a curative intent. Results More than half of the patients had stage-IV tumors at the time of presentation, while only one fourth of them had nodal metastasis. The rate of recurrence increased in cases of primary tumors in advanced stages and the degree of histological differentiation. The 2-year and 5-year OS rates were of 54.5% (18 patients) and 30.3% (10 patients) respectively. Conclusion Primary tumors in advanced stages, histological grade, and presence of nodal metastasis are poor prognostic markers in terms of long-term survival.

A Cross-Sectional Survey on Prevalence and Behaviour of Smokeless Tobacco Use Among Tobacco Users in China

Summary Increasing tobacco control and public health awareness have increased smokers’ attempts to quit smoking. However, some smokers also seek alternative products claimed to pose less risks. The use of smokeless tobacco (ST) products may thus increase in some countries which are not traditionally ST markets. To provide a cross-sectional picture on ST usage in China, a survey was conducted from December 2019 to March 2020 in representative metropolitan cities (divided into three tiers by their populations and gross domestic product (GDP) sizes), from which 3,000 tobacco users and 801 ST users were randomly recruited to provide a snapshot of ST usage behaviour and other pertinent factors for Chinese tobacco users. The study included questionnaires designed to probe potential reasons behind ST use, usage habits, and nicotine dependence attributes. These questions were devised to cover the type of tobacco products used, users’ age, gender, city of residence, residence time, household monthly income, etc., and was supported by some verification questions. Mann-Whitney-analysis was used for significance analysis between different groups. The results showed that ST prevalence for Chinese tobacco users was around 2.1%. The proportion of exclusively ST use was about 8.99%, and the mean conversion time to habitual ST use was about three months. Demographic information such as the city tiers where ST users lived, their age, gender, educational and income levels appeared to correlate with ST use habits although more studies are needed to verify the observations. The fact that a small but measurable population of Chinese ST users exists has important implications for tobacco control. This study provides the first large-scale, single-time-point survey on Chinese ST user profiles, which may help the future research on tobacco control policy regarding ST products in China.

Characterization of Ad Libitum Use Behavior of On! Nicotine Pouches.

Objectives: Actual use of nicotine pouch products is not well studied. The objectives of this study were to characterize on ® nicotine pouch (Test Products (TP)) use behavior, including association with cigarette and smokeless tobacco (ST) product use. Methods: Adults who smoke cigarettes (AS) and/or adults who use ST (ASTU) (N=1147) that were not planning to quit and had expressed interest in trying and using TP after a 5-day trial were offered ad libitum use of TPs (7 flavors at 5 nicotine levels) for 6 weeks. Results: Participants used a median of ~5-6 pouches/day of a variety of flavors and nicotine levels. In the final week of the study, 27% of AS and 71% of ASTU reported no use of cigarettes or ST respectively, while reporting continued use of TPs. Additionally, 39% of AS and 14% of ASTU reduced consumption of cigarettes or ST products respectively by 50%-99%, compared to reported use at screening. We found a statistically significant inverse relationship between TP flavor varieties and number of cigarettes/ST. Conclusions: These data suggest that TPs can be potential substitutes for cigarettes/ST products, and complete switching may offer harm reduction potential for AS and ASTU not interested in quitting.

Deciphering the Link Between Chewing Habits and Microrna 21 Dysregulation in Oral Squamous Cell Carcinoma: A Potential Cancerous Blend

MicroRNA-21, an oncomiR, plays a pivotal role in carcinogenesis and is upregulated in many cancers including oral squamous cell carcinoma (OSCC). Use of smokeless tobacco (ST) products and cigarettes smoking in causation of OSCC is well established. This study sought to reconnoiter miR-21 expression in relation to smoking and chewing habits among subjects with oral cancer. Methods After gaining approval from IRB of Ziauddin University, analysis of miR-21 expression was conducted in 100 biopsy proven OSCC cases and 100 controls. All participants gave informed written consent after which venous blood sample was collected. qRT-PCR (Quantitative real-time Polymerase chain reaction) was performed to check miR-21 expression. SPSS Version 24 was used for analyzing the data. Results Consumption of ST was reported by 85 % and 63% were smoking cigarettes. miR-21 expression was significantly higher among smokers and those addicted to ST products, p<0.001. Subjects addicted to gutka chewing and those using more than one chewable product showed significant upregulation of miR-21, p<0.05. Amount of ST product use and smoking cigarettes was found to be positively correlated with miR-21expression. Conclusion Our study provides the evidence that use of ST products and cigarette smoking trigger miR-21 which in turn potentiate carcinogenesis in OSCC.

Smokeless tobacco: a ticking time bomb for Pakistan

Oral cancers are one of the most prevalent cancers worldwide with almost 300,000 cases reported annually1. In Pakistan, it is the leading type of cancer in men and women after breast cancer. Each year around 16,000 new cases of oral cancers are documented with 5500 cases resulting in death2. There are multiple etiological factors for oral cancers among which the use of smokeless tobacco (SLT) is at the top of the list. SLT is available in different consumable forms such as chewable tobacco, betel leaf, snuff (naswar), Betelnut, etc., which contain a number of carcinogenic substances3. Studies have revealed that naswar is the most common etiological factor of oral cancers among the Pakistani population as compared to the other forms of SLT3. The basic constituents of naswar are slaked lime, powdered tobacco, and indigo which contain more potent carcinogens such as unionized nicotine and tobacco-specific N-nitrosamines, that are specifically harmful to the oral cavity4. It can be used through different routes either inhaled nasally or by placing inside the mouth under the tongue. The nicotine is absorbed into the oral mucosa which is further aided by the increased pH of the mouth by slaked lime5. It has been observed historically that the use of SLT products is very commonly acceptable in Pakistani culture3. The sale and production of naswar are not well regulated and it is being sold by different vendors at cheaper prices and in different package sizes with no such instructions and health warnings written on it1,2. Moreover, some scientific data implicates it as replacement therapy for tobacco smoke cessation as it is a cheaper nicotine substitute1. In 2005, Pakistan formalized the WHO “Framework Convention on Tobacco Control (FCTC),” which addresses the details of the regulation and control of tobacco and SLT products by regulating its price, taxation, packaging, labeling, advertisement, promotion, and sponsorship5. In the last few years, Pakistan has made significant progress in smoking cessation policies but regulation of STL production and taxing is still lagging5,6. A case-control study, conducted in Khyber Pakhtunkhwa, Pakistan, revealed that 68% (men) and 38% (women) of oral cancer patients in Pakistan are due to naswar use. It was also shown that those who used naswar ever in their lifetime have 20 times more risk to develop oral cancers compared with the nonusers of naswar1. Thus, the increasing incidence of oral cancers with the relative use of naswar sets a ground basis for the implementation of strict policies regarding the manufacture and sales of SLT. Studies have provided shreds of evidence that there is a marked decrease in tobacco product use among young people by applying a ban on their promotion and advertisement. Health warnings and relevant constituents written on packages can also be an important tool for minimizing SLT use6. Sticking firmly to the FCTC protocols of smokeless tobacco use is the dire need of time. Furthermore, awareness regarding the harmful effects of STL use should prevail on urban and rural levels as there is a great lack of knowledge among the local population. Ethical approval None. Sources of funding None. Author contribution S.F., O.A.S., G.S., and A.K.: wrote the manuscript. O.A.S. and S.A.: review editing, formatting, and referencing. Conflict of interest disclosure The authors declare that they have no financial conflict of interest with regard to the content of this report. Research registration unique identifying number (UIN) N/A. Guarantor Omer Ahmed Shaikh. Financial Disclosure The author(s) received no financial support for the research, authorship, and/or publication of this article.

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. Journal of Epidemiology and Public Health (2023), 08(01): 15-24 https://doi.org/10.26911/jepublichealth.2023.08.01.02.

Undiagnosed status and associated factors of hypertension among adults living in rural of central, Ethiopia, 2020: Uncovering the hidden magnitude of hypertension.

Hypertension is a major risk factor for cardiovascular (CVD) disease related deaths worldwide. It affects more than 20% of adults in Ethiopia, making it a major public health concern. Although it is important to uncover the hidden extent of hypertension, there is limited information on the proportion of undiagnosed hypertension in rural areas of the country. This study aimed to determine the magnitude of undiagnosed hypertension and associated factors among adults living in the rural Dano district, Central Ethiopia 2020. A quantitative, community-based cross-sectional study conducted from May to July 2020. A three-stage sampling technique was used to select a total of 605 study participants. A Validated tool was used to assess the participant's behavioral characteristics. Blood pressure was measured using digital blood pressure apparatus. The mean of three blood measurements was used to classify hypertension after intra-class correlation was tested. Standardized instruments were used to assess participants' health-seeking behavior and knowledge of the hypertensive disease. The proportion of undiagnosed hypertension was determined among patients with hypertension. The regression analyses were done to determine factors associated with undiagnosed hypertension. The adjusted odds ratio with 95% CI was estimated to measure the strength of the association. The level of statistical significance was set at a p-value < 0.05. The prevalence of undiagnosed hypertension was 21.32% (CI: 19.95%, 25.8%). Living in a household with the low wealth index [(AOR: 3.5,95%CI: (1.6,6.4)], far distance to health facility, [(AOR: 0.155,95%CI: (0.11.0.67)], underweight, [AOR = 2.2.1,95%CI:(2.00,4.22)], use of smokeless tobacco products, [AOR = 3.2,95%Cl:(1.88,4.75)], and participants' knowledge of hypertension were independently associated with undiagnosed hypertension. This study shows that undiagnosed hypertension is a major public health problem in the study area. Living in a household with a low wealth index, being far from a health facility, being underweight, using smokeless tobacco products, and having little knowledge about hypertension increase the likelihood of having undiagnosed Hypertension. Hypertension health information, particularly to smokes tobacco users, could improve the perceived susceptibility to hypertensive disease, and reduce the hidden extent of hypertension.

Use of Traditional Smokeless, Snus, and Dissolvable Tobacco Among U.S. Youth

Snus, dissolvable, and traditional smokeless tobacco product use is often amalgamated in youth epidemiologic research despite differences across these products. Prevalence, trends, and correlates of U.S. youth use across different classes of oral tobacco products are unknown. Using 2011-2020 National Youth Tobacco Survey (N=193,933) data, the authors tested for cross-year linear and quadratic trends in the weighted prevalence of ever and current use of traditional smokeless tobacco, snus, and dissolvable tobacco. Multivariable logistic regressions estimated the demographic and tobacco use factors associated with the use of different oral tobacco products in 2020. Analyses were conducted in 2022. During 2011-2020, there were declines in the prevalence of ever use of traditional smokeless tobacco (11.0% to 5.6%; linear trend, p<0.0001) and snus (5.2% to 2.4%; p<0.0001) but no change in ever dissolvable tobacco use (0.8%-1.2%). In 2020, an estimated 1,546,000 U.S. youth ever used traditional smokeless tobacco (7.7% high school, 3.0% middle school), 662,000 ever used snus (high school: 3.5%, middle school: 1.0%), and 326,000 ever used dissolvables (high school: 1.5%, middle school: 0.8%). In 2020, females and non-Hispanic Blacks and Hispanics had lower smokeless or snus ever use odds than males and non-Hispanic Whites, respectively, whereas sexual minorities (than heterosexuals) or those speaking a language other than English at home were more likely to report ever use of dissolvable tobacco. Flavored tobacco use was common, particularly for dissolvable current users (72.8% used any flavor). Differences in the epidemiology of oral tobacco use across product types among U.S. youth suggest that oral tobacco products should be disaggregated in future research and policy strategies.

Correlates and transitions between smoking and smokeless tobacco product use among adults in Bangladesh: Longitudinal findings from the ITC Bangladesh Surveys

Correlates and transitions between smoking and smokeless tobacco product use among adults in Bangladesh: Longitudinal findings from the ITC Bangladesh Surveys

Effectiveness of Behavioral Counseling in Smokeless Tobacco Cessation Among Adult Users Reporting to a Dental Hospital in Pune: A Randomized Controlled Trial.

AimTo assess the effectiveness of behavioral counseling for smokeless tobacco cessation among adult users in a dental hospital setting.MethodsA total of 200 patients visiting a dental hospital who were exclusively using smokeless tobacco (SLT) were enrolled in the study. A randomized controlled trial with a concurrent parallel study design, which consisted of two arms, was conducted. Fagerstrom test for nicotine dependence level and the transtheoretical stage of change was assessed at the baseline. Behavioral cessation counseling and motivational interviewing were provided in the study arm and brief advice was given to those in the control arm. The counseling was provided at baseline and followed up till six months through telephone to assess the change in the frequency of use of SLT products and abstinence from SLT use. A biochemical validation with a urine cotinine test was done to confirm abstinence.ResultsAt six months, there was a significant difference within and between the study and control groups, indicating the role played by behavioral tobacco cessation in reducing the frequency of consumption. About 24.4% of participants in the study group and 10% in the control group abstained from the habit at the sixth month, with an odd’s ratio (OR)=2.91 and with a loss to follow-up of 10% in each of the groups. The cotinine test, which was used for validation, revealed a significant difference between the study and the control group. The number needed to treat (NNT) shows that to motivate one additional person to give up the SLT habit, we need to intervene with about seven people.ConclusionBehavior intervention with motivational interviewing was considered an effective method in promoting smokeless tobacco cessation among adults. Transtheoretical stages of change have proven to be an effective model to assess the stage of behavior change of the population toward SLT use and was also helpful for changing the behavior.

Anti-fibrotic activity of licorice extract in comparison with colchicine on areca nut-induced fibroblasts: An in vitro study.

Objective:Oral submucous fibrosis (OSMF) is a debilitating chronic disease of the oral cavity with a high potential for malignant transformation. The main etiological agent attributed to the development of OSMF is the use of smokeless tobacco products like areca nut. There is no known cure for the disease. Current modalities of treatment do not provide a complete cure and often prove invasive for the patient. Herbal preparations using natural compounds and medicinal plant extracts have long since been used in India, as an acceptable, noninvasive and cost-effective method in the treatment of various diseases. Hence, the present study aims to assess the anti-fibrotic effect of licorice in comparison with colchicine on areca nut-induced fibroblasts.Materials and Methods:Extracts of areca nut, licorice and colchicine were prepared in accordance with established protocols. Human fibroblast cell lines were procured from ATCC®(PSC-201-018). Fibroblast cultures were established, and upon reaching confluence the cells were subjected to the 25 μg/ml areca nut extract for 24 h to induce fibrosis, with CCl4 used as control fibrosing agent. The areca nut and CCl4 induced cells were then subjected to varying concentration of the test antifibrotic agent, licorice extract for the periods of 24 and 48 h, with colchicine used as positive control. Total collagen quantification was done using spectrophotometry.Results:Collagen accumulation decreased with increase in the concentration of licorice extract with maximum reduction seen at 200 μg/ml. Kruskal–Wallis test was done to analyze the difference in collagen accumulation. Analysis revealed that the P < 0.05 for both periods in both the areca and CCl4 induced cell lines following the addition of licorice extract. The data were found to be statistically significant.Conclusion:The current study proves the antifibrotic efficacy of licorice in areca nut induced cell lines and hence, this agent can be used for the therapeutic management of OSMF.

Role of clinical pharmacist in tobacco cessation

Habitual to tobacco usage is a major contributor to morbidity and mortality. World health organization predicted that more than 500 million people alive today would killed by 2030 and tobacco consumption will become the single leading cause of death. According to a report from the Indian Council of Medical Research, there are 184 million tobacco users in India, which include 40 million cigarette smokers, 80 million beedi smokers and 60 million using chewable forms of tobacco. In India, tobacco use among the male and female population had estimated to be around 23.2% and 4% in urban and 33.6% and 8.8% in rural areas, respectively. In India, cigarette smoking comprises a small part of the tobacco-smoking problem, the major is beedi smoking, and a large part of the overall tobacco problem is the oral use of smokeless tobacco products. The first step towards a tobacco-free society includes anti-tobacco education and medical help for those willing to quit. Smokers who quit before they are aged 35 yrs. can expect a life expectancy similar to those who have never smoked. Pharmacists are effective providers of tobacco cessation program ultimately helping more patients to become tobacco free and live healthier lifestyles.

The pH of Smokeless Tobacco Determines Nicotine Buccal Absorption: Results of a Randomized Crossover Trial.

Nicotine absorption rate influences tobacco products' addictiveness. For smokeless tobacco, nicotine buccal absorption is associated with its free-base form; the pH of smokeless tobacco defines the proportion of free-base (i.e., unprotonated) vs. protonated nicotine. This was the first study to compare nicotine pharmacokinetics (PK) and pharmacodynamics (PD) after the use of commercial smokeless tobacco products that were experimentally manipulated to differ only in pH and percent free-base nicotine. Moist snuff users (N=40) completed four crossover visits and used a single 2g portion of Copenhagen Original Long Cut amended to 4 pH levels: 5.0, 7.7, 8.2, and 8.6 (free-base nicotine 0.1, 32, 60, and 79%) for 30minutes. Nicotine PK and PD were assessed for 4hours post-use. Nicotine PK substantially depends on its free-base proportion, with more than 4-fold increases in mean plasma nicotine maximum concentration and area under the curve over 240minutes (3.9 to 16.7ng/mL; 385 to 1810ngmin/mL, respectively, both P<0.001) from pH 5.0 to 8.6. The autonomic cardiovascular effects of smokeless tobacco use reflected percent free-base nicotine, with small (albeit significant) systematic increases in heart rate and blood pressure associated with free-base nicotine. Smokeless tobacco product pH and percent free-base nicotine play a major role in the rate and extent of nicotine absorption, determining product PD effects and abuse potential. Research and regulation of smokeless tobacco products should consider both total nicotine content and product pH. Further research may address the impact of modifying pH on the addictiveness of smokeless tobacco and associated use behaviors.

Contribution of Family History of Head and Neck Cancer and Associated Risk Factors: Analysis of an Internet Based Risk Assessment Tool

Common risk factors for head and neck cancer (HNC) include tobacco and alcohol use, HPV and EBV infection, and certain occupational exposures, including radiation. Genetics also play a role, though these effects are multifactorial and are likely not well appreciated in the lay population. We sought to understand the association between family history (FH) of HNC and other personal risk factors for cancer and hypothesized that those with a FH of HNC would be more likely to use tobacco and alcohol.Reduce My Risk is an online tool available on OncoLink.org. Voluntary participants input information related to demographics, FH, risk-factors, and risk-associated behavior and then receive personalized information regarding their cancer risk. Use of collected data was IRB approved. Differences between respondents with vs without FH of HNC were analyzed using chi-square test and adjusted via logistic regression.25179 responses were analyzed; 580 (2.3%) reported FH of HNC. Of these, median age was 30 (Range 18 - 72), 66.7% were female, 79.5% from North America, 83.1% White, 78.4% had at least some college, and 68.0% household income > $45,000. Comparing those with FH of HNC to those without, there were no significant differences in education, household income, or home setting. Those with FH of HNC were more likely to be "light" drinkers (1-7 per week), obese, and to have significant secondhand smoke exposure (Table). There were no significant differences in cigarette, marijuana, or "exotic" smoking, or use of smokeless tobacco products. (Table). There were also no differences in UV, radiation, or occupational exposures, except for hydrocarbons (OR 1.7, CI 0.99-2.74, P = 0.041).Those with a FH of HNC were more likely to have secondhand smoke exposure but were not more likely to use tobacco products themselves, suggesting differences in inter-generational behavior. Those with FH also reported increased non-modifiable risks. Limitations of this work include a convenience sample frame that is disproportionately white and high income, and results may not be applicable to a more diverse population. Future work should explore targeted intervention for those with a FH of HNC to educate on risk of external exposures and promote preventive behaviors.

Smokeless Tobacco and Its Ill-Effects: Recent Literature Update

AbstractAccording to the Global Adult Tobacco Survey part 2 (GATS-2), approximately 200 million adult Indians consume smokeless tobacco (SLT). Circumvention of SLT product ban has been observed. We conducted a review of the literature to summarize the ill effects of tobacco for the articles published from 2019 to 2020. A systematic search of the databases PubMed (2019 onward) and Web of Science (2019 onward), through February 2021 was done. Search yielded 1,061 articles and after excluding articles based on the inclusion criteria, 37 articles were taken in to consideration. The review shows that differential SLT product has specific odds of oral carcinogenesis. Review also indicates the emerging data of cardiovascular risk due to higher use of SLT products along with its known cause of oral cancer. It also cautions about the adverse consequences of pregnancy associated with SLT use.

Stopping Smokeless Tobacco Use: A Call to Action

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.