Non-compliant packaging and illicit smokeless tobacco in Bangladesh, India and Pakistan: findings of a pack analysis.

INTRODUCTION: Illicit smokeless tobacco (ST) trade has seldom been documented despite ST use in at least 127 countries across the world. Based on non-compliance with packaging regulations, we report the proportion of illicit ST products from samples on sale in Bangladesh, India and Pakistan where 85% of global ST users reside. METHODS: We purchased unique ST products from tobacco sellers in two purposively selected administrative areas (division/district) in each of the three countries. The criteria to determine illicit ST products were based on country-specific legal requirements for ST packaging and labelling. These requirements included: 'market retail price disclosure', 'sale statement disclosure', 'pictorial health warning (PHW) pertinence', 'appropriate textual health warning' and 'using misleading descriptors (MDs)'. Non-compliance with even one of the legal requirements was considered to render the ST product illicit. RESULTS: Almost all ST products bought in Bangladesh and India were non-compliant with the local packaging requirements and hence potentially illicit, all products in Pakistan lacked desirable features. The most common feature missing was health warnings: 84% packs in Bangladesh, 93% in India, and 100% in Pakistan either did not have PHW or their sizes were too small. In Bangladesh, 61% packs carried MDs. In India and Pakistan, the proportions of such packs were 32% and 42%, respectively. CONCLUSIONS: Weak and poorly enforced ST control policies may be slowing the progress of tobacco control in South Asia. Standardised regulations are required for packaging and labelling ST. Improving compliance and reducing sale of cheap illicit products may require business licensing and market surveillance.

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

INTRODUCTION: Smokeless tobacco (ST) is a significant South Asian public health problem. This paper reports a qualitative study of a sample of South Asian ST users. METHODS: Interviews, 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. RESULTS: Participants 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. CONCLUSIONS: Interventions 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. IMPLICATIONS: This 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.

Smokeless tobacco products, supply chain and retailers' practices in England: a multimethods study to inform policy.

BACKGROUND: In England, many people of South Asian origin consume smokeless tobacco (ST). ST use can lead to oral cancer, which is disproportionately high in South Asians. Our aims were to assess the compliance of ST product retailers with statutory regulations and to explore the supply chain of ST. METHODS: We undertook a multimethods study between August 2017 and July 2019 in five English boroughs with a high proportion of ethnic South Asians. We purchased ST products and conducted field surveys with ST retailers at point of sale. Qualitative interviews were conducted with ST retailers and suppliers. ST packs were assessed for regulatory compliance, while quantitative and qualitative data triangulated information on retailers' practices and the ST supply chain. RESULTS: We collected 41 unique ST products, which included dry snuff, naswar, gutka, chewing tobacco and zarda. ST products were not registered, and demonstrated low compliance with health warning (14.6%) and packaging (56.1%) requirements. ST availability in surveyed boroughs was high (38.2%-69.7%); dry snuff, naswar and zarda were most commonly available. ST retailers demonstrated limited knowledge of regulations, and one-third were found to advertise ST at point of sale. Qualitative insights revealed illicit supply and distribution networks, as well as ST production in discreet locations. CONCLUSION: ST products are widely available in England, yet non-compliant with statutory regulations. In order to safeguard consumers, in particular ethnic South Asians, stronger efforts are needed to regulate the supply chain of ST at both national and international levels.

Short-Term Smoking Cessation in English Resident Adults of Bangladeshi Origin: A Service Review.

INTRODUCTION: Cigarette smoking in English residents of Bangladeshi origin, particularly men, exceeds national estimates. Cessation outcomes and potential predictors of successful cigarette smoking cessation in this group await identification. METHODS: This service review reports cessation outcomes and predictors of success for 324 adult English resident Bangladeshi origin smokers recruited into a project providing a specialist tobacco cessation service. Interview measures included sociodemographics, tobacco use and dependence. Cessation data (self-reported and validated) at 4 weeks was also collected. Cessation rate and predictors of successful cessation, modeled using multiple logistic regressions, are reported. RESULTS: Clients' mean age was 45.59 (SD = 13.83) years. Thirty-three (10%) were females. Mean level of small area deprivation was 56.98 (SD = 5.37). Initial mean expired air carbon monoxide score was 11.66 parts per million (SD = 7.17). Thirty-eight per cent used combination nicotine replacement therapy (NRT) with behavioral support. Sixty-nine percent reported successful smoking cessation after 4 weeks, validated with carbon monoxide (mean =1.23 parts per million, SD = 1.32). Predictors of successful cessation were use of combined NRT with behavioral support (OR = 1.82, 95% CI = 1.07, 3.09), and community recruitment (OR = 1.85, 95% CI = 1.07, 3.22). CONCLUSIONS: English adult smokers of Bangladeshi origin resident in a highly disadvantaged locality, accessing community outreach services to help them quit and using NRT have validated short-term success rates greater than that locality's general population who access National Health Service Stop Smoking Services to quit.

Waterpipe tobacco dependence in U.K. male adult residents: a cross-sectional study.

INTRODUCTION: The prevalence of waterpipe tobacco smoking (WPTS) is increasing worldwide. The aims of this study were (a) to evaluate the psychometric properties of the Lebanon Waterpipe Dependence Scale (LWDS-11), and (b) to assess, estimate, and identify factors associated with waterpipe tobacco dependence symptoms among U.K. male adult resident waterpipe tobacco smokers. METHODS: A total of 180 waterpipe tobacco smokers were recruited during random visits to 7 outlets serving waterpipe tobacco. Data were collected via face-to-face interviews using the WPTS module of the Global Adult Tobacco Survey and the LWDS-11. Descriptive statistics, exploratory psychometric, univariate, and Poisson regression analysis were employed. RESULTS: Participants' M/SD age was 29.46/±9.41 years, Arabic ethnicity accounted for 58.3%, and 53.9% had completed more than secondary education. Psychometric analyses for the LWDS-10, after removing 1 item from the generic scale, revealed Cronbach's alpha coefficient = 0.74. About 47% of the sample demonstrated waterpipe tobacco dependence. Being Arab (p = .040, OR = 2.63, 95% CI = 1.05-6.62), smoking waterpipe daily in the past (p = .003, OR = 2.13, 95% CI = 1.30-3.49), and an increase in length in the last session of WPTS (p = .044, OR = 1.15, 95% CI = 1.00-1.32) were identified as risk factors for waterpipe tobacco dependence. CONCLUSIONS: This study demonstrated the potential of LWDS-11 and revealed 2 domains: positive and negative reinforcement and physiological dependence. Results indicated that waterpipe tobacco smokers in the United Kingdom demonstrated tobacco dependence symptoms, which were associated with socio-behavioral factors. Generalizability of these findings and their implications in public health are yet to be investigated.

Behavioural support and nicotine replacement therapy for smokeless tobacco cessation in Bangladesh, India and Pakistan: A pilot randomized controlled trial.

BACKGROUND AND AIMS: Smokeless tobacco (ST) use in South Asia is high, yet interventions to support its cessation are lacking. We tested the feasibility of delivering interventions for ST cessation in South Asia. DESIGN: We used a 2 × 2 factorial design, pilot randomized controlled trial with a duration of 26 weeks, including baseline and follow-up (6, 12 and 26 weeks) assessments. SETTING: Two primary health-care facilities each in Dhaka (Bangladesh) and Karachi (Pakistan) and a walk-in cancer screening clinic in Noida (India) took part. PARTICIPANTS: Adult daily ST users willing to make a quit attempt within 30 days. Of 392 screened, 264 participants [mean age: 35 years, standard deviation = 12.5, 140 (53%) male] were recruited between December 2020 and December 2021; 132 from Bangladesh, 44 from India and 88 from Pakistan. INTERVENTIONS: Participants were randomized to one of three treatment options [8-week support through nicotine replacement therapy (NRT, n = 66), a behavioural intervention for smokeless tobacco cessation in adults (BISCA, n = 66) or their combination (n = 66)] or the control condition of very brief advice (VBA) to quit (n = 66). MEASUREMENTS: Recruitment and retention, data completeness and feasibility of intervention delivery were evaluated. Biochemically verified abstinence from tobacco, using salivary cotinine, was measured at 26 weeks. FINDINGS: Retention rates were 94.7% at 6 weeks, dropping to 89.4% at 26 weeks. Attendance in BISCA pre-quit (100%) and quit sessions (86.3%) was high, but lower in post-quit sessions (65.9%), with variability among countries. Adherence to NRT also varied (45.5% Bangladesh, 90% India). Data completion for key variables exceeded 93% among time-points, except at 26 weeks for questions on nicotine dependence (90%), urges (89%) and saliva samples (62.7%). Among follow-up time-points, self-reported abstinence was generally higher among participants receiving BISCA and/or NRT. At 26 weeks, biochemically verified abstinence was observed among 16 (12.1%) participants receiving BISCA and 13 (9.8%) participants receiving NRT. CONCLUSIONS: This multi-country pilot randomized controlled trial of tobacco cessation among adult smokeless tobacco users in South Asia demonstrated the ability to recruit and retain participants and report abstinence, suggesting that a future definitive smokeless tobacco cessation trial is viable.

Oral pain before and after smokeless tobacco cessation in U.K.-resident Bangladeshi women: cross-sectional analyses.

INTRODUCTION: Paan quid with tobacco (PQT) use is common in South Asian populations. Oral pain following a PQT cessation attempt is commonly reported. Factors determining this await full exploration. METHODS: This prospective study of PQT chewers used a prepiloted interview and clinical examination. Oral pain, socioeconomic position, oral status, health service use, tobacco use and dependency, and psychological distress measures were collected from U.K.-resident Bangladeshi women before and after their quit attempts. Analysis included descriptive and analytic modeling of oral pain determinants, using multiple logistic regressions and a significance value p ≤ .05. RESULTS: A total of 150 females (mean age 51.2 [SD = 13.7, range = 24-84] years) completed the study. Baseline oral pain prevalence was 39% and 73% at follow-up. Completed education level predicted baseline oral pain (OR = 3.43, 95% CI [1.66, 7.11], p = .001). Follow-up oral pain was predicted by completed education level (OR = 3.74, 95% CI [1.43, 9.79], p = .007), anxiety (OR = 3.52, 95% CI [1.23, 10.07], p = .019), choosing behavioral support alone in the cessation attempt (OR = 3.12, 95% CI [1.26, 8.70], p = .015), failure to stop tobacco chewing during the cessation attempt (OR = 4.16, 95% CI [1.44, 12.04], p = .009), and tooth wear (attrition) (OR = 5.71, 95% CI [1.84, 17.79], p = .003). Lower dependency level (OR = 0.79, 95% CI [0.64, 0.97], p = .023) was protective. CONCLUSION: Dental care access, nicotine replacement therapy, and anxiety management should be incorporated into cessation service delivery protocols to manage oral pain onset and facilitate successful cessation.

Contents and price of vendor assembled paan quid with tobacco in five London localities: a cross-sectional study.

BACKGROUND: Little is known of paan quid with tobacco (PQT), a hand-made mixture of smokeless tobacco, areca nut, lime and flavourings in a betel leaf, despite its wide use in south Asian communities. This study has explored the price, tobacco types, brands and ingredient weights in vendor assembled PQT in London (England). METHODS: This cross-sectional study identified 31 commercial outlets selling PQT. Outlet staff were invited to assemble PQT for purchase. Individual ingredients were identified and weighed using a calibrated scale. Free nicotine availability was assessed in the laboratory. The data were analysed using frequencies, means, t test and Pearson correlations. Significance was set at p<0.05. RESULTS: 73 samples were assembled and purchased. Mean total PQT weight was 10.06 g (95% CI 9.26 to 10.86). Mean price was £1.43 (range £0.50-3.50), which varied by location (p=0.001). The most common smokeless tobacco type was zarda (64.4%). Mean tobacco weight was 0.65 g (95% CI 0.56 to 0.76) and the mean lime weight was 0.58 g (95% CI 0.41 to 0.75). While other ingredients did not vary, tobacco and lime mean weights varied by location (p=0.01). Tobacco and lime weights correlated positively (r=0.427, p=0.01). The pH of the tobacco and lime mix varied between 12.2 and 12.5, indicating 99% free nicotine availability. CONCLUSIONS: Vendor assembled PQT shares similar ingredients but varies by assembly locality, price and tobacco and lime weights. Tobacco and lime weights were balanced to ensure optimal free nicotine availability and dependency potential.

The impact of periodontal therapy on oral health-related quality of life in adults: a systematic review.

BACKGROUND: Periodontal disease negatively affects oral health-related quality of life (OHRQoL). While there is sufficient evidence for the clinical efficacy of periodontal therapy, data on patient-based outcomes are limited. OBJECTIVES: To systematically review the available evidence on the impact of periodontal therapy on OHRQoL in adults. MATERIAL & METHODS: MEDLINE, EMBASE, CENTRAL and LILACS were searched without language restrictions. Longitudinal observational and intervention studies assessing changes in OHRQoL using validated measures, in adults with periodontal disease undergoing non-surgical (NST) or surgical therapy (ST), were eligible for inclusion. Study quality was assessed using the Newcastle-Ottawa scale and CONSORT-checklist. No meta-analysis was performed. RESULTS: Eleven studies (seven prospective case-series', one controlled before-after study and three randomized controlled trials) of "medium" methodological quality were included in the review. All studies reported impaired OHRQoL before therapy. Nine studies reported a statistically significant improvement in OHRQoL after NST (follow-up = 1 week to 12 months, p < 0.05). The effect size for this improvement ranged from small (0.27) to large (0.8). No significant differences were reported between different forms of NST. Surgical therapy had a relatively lower impact on OHRQoL. A correlation between poor clinical response to therapy and poor OHRQoL outcomes was observed. CONCLUSION: Routine non-surgical therapy can moderately improve the OHRQoL in adults with periodontal disease.

Factors associated with dental and medical care attendance in UK resident Yemeni khat chewers: a cross sectional study.

BACKGROUND: The chewing of khat leaf with tobacco smoking amongst Yemenis, Somalis and Ethiopians is reported to impact oral and general health. The health status and particularly dental and medical care attendance of UK-khat chewers has not received attention. This study aimed to explore health status and dental and medical attendance and its associated factors in UK permanently resident Yemeni khat chewers. METHODS: A cross- sectional study with a purposively selected sample of 204 khat chewers was conducted. Data were collected through face to face interviews. Data analysis included descriptive, Chi-square tests and binary logistic regressions. RESULTS: The mean age for this study sample was 44.84 (SD = ±19.70) years and 35% were employed. Forty five percent reported symptomatic medical attendance for self reported health conditions in the last two weeks whilst 44% had symptomatic dental attendance. Higher khat chewing dependency levels associated positively with both symptomatic dental and medical attendance (p = 0.004, OR = 1.14, 95%CI = 1.04-1.25; p = 0.003; OR = 1.16, 95%CI = 1.05-1.29, respectively). Higher social participation levels associated negatively with symptomatic dental attendance (p = 0.034, OR = 0.98, 95%CI = 0.96-0.99) whilst increase in age and self-reported health conditions associated positively with symptomatic medical attendance (p = 0.030, OR = 1.03, 95%CI = 1.01-1.06; p = 0.001, OR = 4.51, 95%CI = 2.02-10.08, respectively). CONCLUSIONS: In this study of khat chewers, a significant proportion reported symptomatic dental and medical attendance. Demographic, psychosocial and self reported general health conditions were associated significantly with dental and medical attendance. Strategies to improve the dental and medical care attendance amongst this group should focus on these and other unexplored underlying factors.

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

BACKGROUND: Smokeless 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. METHODS: We 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. DISCUSSION: The 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 REGISTRATION: ISRCTN identifier 65109397.

Correlates of nicotine dependence in U.K. resident Yemeni khat chewers: a cross-sectional study.

INTRODUCTION: Khat chewing is often associated with tobacco use with impacts on health. This cross-sectional study aimed (a) to explore and validate aspects of self-reported tobacco smoking and whether objective measures of tobacco smoking differ in different situations among khat chewers who smoked and (b) to assess the social factors correlated with nicotine dependence among khat chewers who smoked regularly. METHODS: This study recruited a purposive sample of 204 U.K. resident Yemeni khat chewers during random visits to Khat sale outlets. Data were collected via a face-to-face scheduled interview. Data analyses included descriptive tests and a hierarchical linear multiple regression. RESULTS: Of 133 self-reported tobacco smokers, 68% were regular smokers with a mean (SD) carbon monoxide (CO) score (20.53 ± 12.12 ppm) and 32% were episodic smokers with a mean (SD) CO score (16 ± 15.66 ppm). Tobacco smoking as an enhancement of the impacts of khat chewing was reported by 65% and 69% of regular and episodic smokers, respectively. In both groups, higher CO scores were recorded during khat chewing. Hierarchical linear multiple regression modeling showed that increases in levels of severity of dependence on khat chewing were correlated positively with increase in levels of nicotine dependence (ß = .27, p = .006, 95% CI = 0.05, 0.29), whereas social participation was correlated inversely (ß = -.34, p = .001, 95% CI = -0.06, -0.02). CONCLUSIONS: In this study, smoking prevalence was high. Smoking increased during khat chewing. Nicotine dependence levels correlated positively with khat dependence levels, while higher social participation reduced nicotine dependence.

Male prisoner tobacco use and oral cancer knowledge: a case study of a local prison in India.

UNLABELLED: There is a high prevalence of tobacco consumption among prisoners. This study aimed to establish tobacco use, to explore and assess oral cancer awareness and to identify associations between oral cancer awareness and tobacco use in a sample of male prisoners in a local Indian prison. METHODOLOGY: A systematically selected random sample of male prisoners participated and a structured interview schedule was used, generated from two different sets of validated standardised questionnaires: the WHO STEPS instrument for NCD (Non Communicable Diseases) Risk Factors to assess tobacco consumption and the modified Humphris Oral Cancer Knowledge Scale to assess oral cancer knowledge. RESULTS: Participation rate was 100%. Prevalence of tobacco consumption, mainly smoked, amongst prisoners was 68.5% (95% CI 63, 73%) The mean oral cancer knowledge score amongst prisoners was 13.28 (95% CI 12.9, 13.6). Statistically significant associations (P < 0.05) were found between oral cancer knowledge and age of participants, years of education and starting age of tobacco use. No association was found between oral cancer knowledge and tobacco consumption. CONCLUSIONS: Tobacco use was high. Knowledge did not appear to impact on this behaviour, indicating the need for effective smoking interventions in this sample.

Validation of a dental pain screening questionnaire in a semi-urban hospital setting in South India.

AIMS: To assess the validity of modified DePaQ items in correctly classifying dental pain patients into three groups of common dental conditions when compared against clinically-determined classification; generate a model of classification equations from a sub-population of the sample; and assess the validity of the model in predicting group membership of new dental pain cases. METHODS: Consecutive adult hospital dental patients aged 18 years and older attending with a dental pain complaint were diagnosed by a dentist. Before treatment commenced a self-complete questionnaire was completed. The examining dentist was blinded to the questionnaire responses. The sample was randomly split into two groups (RS1 and RS2). Discriminant analysis was carried out on RS1 to develop a model for classifying new dental pain cases into three groups. This model was used to classify dental pain cases in RS2. RESULTS: Of the 311 questionnaires distributed, 306 (98.4%) were returned. Of the 205 Group 1 cases diagnosed clinically 186 (90.7%) were correctly predicted as belonging to that group by M-DePaQ. For 54 clinically diagnosed Group 2 cases 44 (81.5%) were correctly predicted, and for 32 Group 3 cases, 26 (81.3%) were correctly predicted. The model of classification equations derived from RS1 were capable of correctly classifying 85%, 82% and 79% of clinically-derived classification for Group 1, 2 and 3 respectively. CONCLUSIONS: This study has demonstrated that the M-DePaQ is valid in classifying dental pain patients into three groups of common dental conditions. Classification equations generated from a sub-group of the sample provided a valid statistical model for classifying dental pain cases from the same setting.

Bangladeshi dental students' knowledge, attitudes and behaviour regarding tobacco control and oral cancer.

Bangladesh's oral cancer incidence is high. Dentists can participate in tobacco control. The aim of this study is to explore tobacco use, tobacco control attitudes and oral cancer knowledge among Bangladeshi dental undergraduates. This cross-sectional study used the Global Health Professional Students Survey and the Humphris Oral Cancer Knowledge Scale. One hundred eighty six questionnaires were analysed, a 79% response rate. Tobacco use, oral cancer knowledge, attitudes towards tobacco control and the dentist's role in tobacco cessation varied significantly between colleges and by gender. Oral cancer knowledge and positive tobacco control attitudes did not influence tobacco use. There is a global problem in preparing dental students for a holistic, integrated approach to oral cancer prevention.

Activities related to the occurrence of traumatic dental injuries in 15- to 18-year-olds.

OBJECTIVE: To assess the activities related to the occurrence of traumatic dental injuries (TDI) in order to establish the relationship between gender, socio-economic status (SES) and major TDI related events, using classification and examination procedures suitable for epidemiological purposes, in a sample of 15- to 18-year-old students in Taiwan. METHODS: A random sample of 6312 15- to 18-year-old senior high school students in southern Taiwan was selected. Each was examined with standard clinical procedures and a questionnaire. RESULTS: The prevalence of TDI was 19.9%. The major TDI related events included sports and leisure activities (30.8%), eating (20.5%), falls (19.4%), traffic accidents (10.2%) and collisions (7.1%). Within TDI victims, sports and leisure related TDI were more prevalent among males (P = 0.001, OR = 1.640, 95% CI = 1.225, 2.195) and high SES adolescents (P = 0.014, OR = 1.991, 95% CI = 1.149, 3.449). The occurrence of non-accidental TDI was not related to age, gender and SES (P > or = 0.643). CONCLUSION: Traumatic dental injuries have become an important issue in public health and dentistry. Prevention and treatment of TDI should be emphasised to the public, the health professional and the policy maker. Future investigations into the relationship between TDI related events and their determinants are indicated.

Dental pain and care-seeking in 11-14-yr-old adolescents in a low-income country.

The purpose of this article was to document the 1-month dental pain prevalence in 11-14-yr-old subjects attending Grade Six of middle schools in Peshawar, Pakistan, and to explore the effect of dental pain and the impact on daily living on dental care-seeking. A self-completed questionnaire survey of all 13 middle schools in University Town, Peshawar, Pakistan, was carried out in April 2007. Questionnaire items on dental pain were adapted from the dental pain screening questionnaire (DePaQ) and items on the impact on daily living were adapted from the child-oral impact on daily performance (OIDP-Child) questionnaire. Regression analysis was carried out to determine the relative usefulness of predictors for care-seeking. The prevalence of dental pain was estimated to be 30.4%, and care-seeking in those reporting pain was estimated to be 64%. Care-seeking was associated with 'pain felt in one tooth', 'painful tooth felt loose', 'difficulties sleeping', and 'difficulties playing', which accounted for 35% of the explained variance. The findings substantiate dental pain as an important dental public health concern in Pakistan and support the hypothesis that assessment of dental pain characteristics can add to the accuracy of dental need estimation.

Impact of the curriculum on Chinese dental students' tobacco control attitudes and beliefs: a case study in Harbin, China.

UNLABELLED: Smoking is a major public health problem in China. Dentists can participate in tobacco control activity. AIM: To report the curriculum impact on dental students' tobacco control attitudes and beliefs in Harbin Dental School, Harbin, China. METHODS: A descriptive cross sectional study using the Global Health Professionals Survey self-complete questionnaire, assessing respondents': tobacco use prevalence, second-hand smoke exposure, knowledge and attitudes regarding tobacco control, smoking and cessation, and the content of the dental school's curriculum and training on tobacco effects and patient counselling. Third, 4th and 5th year undergraduates and postgraduate students participated in December 2005. RESULTS: The response rate was 96%. Current smoking prevalence was 4% whilst 74% reported exposure to second hand smoke in the previous week. There was variable recall of aspects of teaching, 12% reporting receiving formal smoking cessation training. Respondents were extremely positive in their professional behaviour beliefs but less about population based tobacco control. There was no relationship between curriculum recall and positive beliefs and attitudes about tobacco control. CONCLUSIONS: In this sample of Chinese dental students a low current smoking prevalence and high levels of exposure to second hand smoke were reported. Varying levels of recall of tobacco control aspects of the dental curriculum existed. Positive tobacco control attitudes and beliefs were reported, but this did not necessarily correlate with aspects of the curriculum content.

Emotional intelligence and perceived stress in dental undergraduates: a multinational survey.

This multinational survey investigated the relationship between emotional intelligence (EI) and perceived stress (PS) in seven countries. First-year dental undergraduates attending a dental school in England, Greece, Romania, South Africa, Australia, and the United States and three schools in Malaysia were invited to complete a set of questionnaires on age, gender, academic background, satisfaction with career choice, EI, and PS. Of 860 questionnaires distributed, 596 were fully completed--a response rate of 69.3 percent. Mean EI score was 123.8 (95 percent CI 122.7-124.9), and mean PS score was 19.1 (95 percent CI 18.6-19.7). Significant differences in EI and PS scores were detected between different countries. Females (p<0.05), younger students (p<0.001), those without a previous higher education qualification (p<0.001), and those not satisfied with their decision to study dentistry (p<0.001) were more likely to report PS when compared to their counterparts. A significant inverse relationship (coefficient=-0.29, p=0.001) between EI and PS was detected. Independent significant predictors of PS identified were gender (beta=0.22, t=5.71, p=0.001), previous higher education qualification (beta=-0.14, t=-2.42, p=0.010), satisfaction with decision to study dentistry (beta=-0.20, t=-5.11, p=0.001), and EI (beta=-0.24, t=-6.09, p=0.001), with the latter being relatively the most important predictor. In conclusion, the inverse relationship between EI and PS has been confirmed in this heterogeneous sample representing diverse sociocultural and academic contexts of dental undergraduates.