Increased taxes and regulation of Indian cigarillos (bidi) industry: Effects on revenue and years of life lost.

INTRODUCTION: Indian cigarillos (bidi) are low-cost alternatives to cigarettes with only 22% imposed taxes, and turnover of upto INR 4 million per annum exempted from taxation. This paper estimates revenue implications and potential loss of life years (YLLs) averted, if bidi industry is subjected to increased regulations and taxation. METHODS: Revenue estimated at 10% increased regulation and 100% regulation were calculated, followed by estimates at taxes equivalent to cigarettes and World Health Organization - Framework Convention on Tobacco Control (WHO-FCTC) recommendation. Price elasticity was considered to assess demand. Price change in separate fractions (previously regulated and unregulated) were calculated to obtain potential YLLs averted. RESULTS: Current revenue of USD 59.25 million is projected to increase to USD 179.25 million with 695,159 averted YLLs at cigarette equivalent taxes and 10% increased regulation; USD 639.38 million with 4,527,597 averted YLLs with 100% regulation; USD 54.75 million, at WHO recommended taxes with 2,233,740 YLLs averted at 10% increased regulation, and 10,486,192 YLLs at 100% regulation. CONCLUSION: Proposed estimates are inline with WHO recommendations as they consider price elasticity and suggest substantial increase in revenue, while averting YLLs. A national action is needed to drive the policy decisions towards increased regulation and taxation and revision of India's tobacco control legislation. IMPLICATIONS: Our study presented empirical evidence of how the currently underutilized tool of taxation, as proposed in the WHO-FCTC, can be utilized to decrease bidi smoking prevalence and save measurable life years while generating government revenue simultaneously. While the revenue statistics counter the misleading tobacco industry narratives, the projected reduction in mortality will be seen as an irrefutable driving force for policy reforms, targeted at strategic increase in regulation and taxation of the traditional Indian cigarillos industry.

Estimating the weight of consumed tobacco product waste in various Indian states: a novel method to assess the potential burden of tobacco product waste.

INTRODUCTION: The direct morbidity and mortality caused by tobacco are well documented, but such products also contribute to a range of environmental pollutants resulting from tobacco product waste. No previous studies have yet quantified tobacco product waste in a low-income and middle-income country (LMIC). This study estimates the potential annual waste generated due to consumption of smoked and smokeless tobacco products in India and its states. METHODOLOGY: We systematically collected samples of smoked and smokeless tobacco products from 33 districts of 17 Indian states/union territories. Stratified weights of plastic, paper, foil and filter packaging components, and gross empty package weights were recorded. Prevalence of smoking and smokeless tobacco use at national and state-level estimates was derived from the Global Adult Tobacco Survey (2016-2017) to quantify waste potentially generated by tobacco products. RESULTS: We included 222 brands of tobacco products (70 cigarette, 94 bidi and 58 smokeless tobacco brands) in the final analysis. A total of 170 331 (±29 332) tonnes of waste was estimated to be generated annually, out of which 43.2% was plastic, 3.6% was foil and 0.8% was filter. Two-thirds of the overall waste was contributed by smokeless products alone. Maximum waste was generated in Uttar Pradesh (20.9%; 35 723.7±6151.6 tonnes), Maharashtra (8.9%; 15 116.84±2603.12 tonnes) and West Bengal (8.6%; 14 636.32±2520.37 tonnes). CONCLUSION: This study provides first of its kind national-level evidence on the types (plastic, paper, foil and filter) and quantity of waste potentially generated by use of tobacco products in India. Similar studies from other LMICs can serve to raise consciousness about many negative environmental impacts of tobacco products and need for policies to address them.

Complementary and Alternative Medicine/Therapy for Tobacco Cessation in India: A Secondary Analysis of GATS-1 and 2.

Background: India has nearly 267 million adult tobacco users, with a slowly improving quitting rate. Among the many approaches to quitting the habit, such as counseling, nicotine replacement therapy, nicotine patch or gum, and prescribed allopathic medicines. Complementary and alternative medicine/therapy (CAM), a thousand-year-old practice in India, may also prove to be a potential method in tobacco cessation; however, there is scarce literature on the extent of use of CAM among tobacco users who attempt to quit the habit. Therefore, this study attempts to examine the potential of CAM as a strategy for tobacco control in India. Material and Methods: We undertook a secondary analysis of the data from both rounds of the Global Adult Tobacco Survey (GATS 2009 and 2016). The dependent variable included in the analysis was the use of traditional medicine as a method for quitting tobacco in three types of users-smokers, smokeless tobacco users, and dual users. The prevalence of CAM use was reported, and Chi-square test was applied to find the factors significantly associated with the use of CAM among tobacco users considering a P value of 0.05 to be statistically significant. Results: The overall prevalence of traditional medicine use for GATS-1 was observed to be more among dual users (4%), while for GATS-2, it was highest among smokers (3%). For both rounds of the GATS survey, the use of traditional medicine was found to be higher among males, rural residents, users with no education or less than primary education, and the eastern region. Conclusions: CAM has a promising potential for supporting tobacco cessation provided a concerted effort is undertaken to standardize pharmacopeia and establish robust clinical evidence. In addition, there is a need to create awareness, build the capacity of healthcare providers, and foster academic-industrial research in indigenous Ayurveda, Yoga, Naturopathy, Unani, Siddha, and Homeopathy (AYUSH) systems.

Feasibility of the novel 'Tobacco-Free Hospital' model and its compliance assessment at a tertiary care hospital of New Delhi, India.

BACKGROUND: Tobacco is one of the biggest threats to the public health. Tobacco harms not only human health but also the environment. The Cigarette and Other Tobacco Products Act (COTPA) was implemented in India in 2003. Compliance of these laws in public places is mandatory. This study presents an innovative model to make hospitals tobacco-free. The aim is to assess the effectiveness of implementation of tobacco-free hospitals among security guards, tobacco users, and key observers visiting a tertiary care dental hospital through a comprehensive strategy. MATERIALS AND METHODS: An exploratory study was conducted in three phases. Structured training was organized for all security guards (n = 25) along with pre- and post-assessment using a validated questionnaire. All the patients and attendants entering the hospital were screened for tobacco products by security guards. Those patients who were carrying tobacco products to the hospital (n = 107) were interviewed using a validated questionnaire. Opinions of key observers (n = 223) who witnessed the event were also recorded. Descriptive statistics (means, frequency distribution) and inferential statistics (Chi-square test) were calculated. RESULTS: At the baseline, only 20% security guards were aware about tobacco legislations, whereas after 1 month, more than 80% security guards were aware about the laws. Around two-third of study participants of both the groups were aware of COTPA Section 4. Approximately 33.6% of tobacco users and 58.4% of key observers were aware of COTPA Section 6b. Forty tobacco users in the study availed tobacco cessation services of the hospital. CONCLUSION: Every staff should be a torch bearer of tobacco control. The study highlights a comprehensive approach of integrating hospital staff and linking vital cessation services by implementing Sections of COTPA.

Raising the legal age for purchase and use of tobacco to 21 years: A step towards tobacco endgame in India.

BACKGROUND: Globally, policies to counter targeting of young people by the tobacco industry have proven to be effective and a key determinant of reducing the magnitude of tobacco epidemic. This paper presents a case for increasing the minimum legal age to access tobacco to 21 years in India. METHOD: We analysed the two rounds of nationally representative Global Adult Tobacco Survey (GATS) data: GATS-1 (2009-10) and GATS-2 (2016-17). We segregated data for two categories of tobacco consumption (smokers and smokeless tobacco users) at the age of initiation (<18, 18-21 and >21 years) and analysed for their consumption patterns found during the time of the survey (current daily, current less than daily, former and ever users) from GATS-2 (2016-17). Further, we compared the projections from the sub-national level analysis for youth initiating tobacco use before 21 years and change in the prevalence of overall underage tobacco users between the two survey rounds. RESULT: Nearly 77% of smokers and 75% smokeless tobacco users in India initiate tobacco use before or until the age of 21 years. Many large, most populous and high tobacco prevalence states had higher than national mean (14.1%) of youth initiating into tobacco use before 21 years. Overall, as compared to GATS-1, there is a perceptible increase in the prevalence of underage tobacco use in most states. CONCLUSION: Global best practices and the significant number of young tobacco users in India call for increasing the age of access to tobacco from the current 18 years to 21 years. This will help in reducing the overall adult tobacco use prevalence in the longer run in India.

Indirect tobacco advertising, promotion and sponsorships in the Indian Premier League 2020: Tobacco Industry's continuous presence in Indian cricket.

BACKGROUND: Indian Premier League (IPL) cricket tournament - a shorter version of the sport which is played between assorted company-owned or individual owner teams - has grown immensely popular over the last decade. There is long history of tobacco advertisement, promotion and sponsorship (TAPS) in cricket. While direct and indirect TAPS is completely prohibited under the Cigarettes and Other Tobacco Products Act (COTPA), 2003 the nexus between tobacco industry and cricket in India continues. We monitored any tobacco product and allied brand or surrogate advertisement, promotion, sponsorship (TAPS) or placement during every match played in the IPL-13 season in the year 2020. METHODS: Using an investigative approach, 60 match highlights during IPL-13 (during September 19 to November 10, 2020) were monitored for TAPS (both on-site i.e. sportswear and/or in stadia) shown on the official website (www.iplt20.com). All sponsors and advertisers were validated using brand names or logos from their respective official website. RESULTS: Two IPL teams (Rajasthan Royals and Royal Challengers Bangalore) were sponsored by major tobacco industry owned brands. Violations by a major smokeless tobacco company promoting their brand extension product i.e. Vimal Elaichi, on the official telecast websites (www.espncricinfo.com and www.cricbuzz.com) and television channels (www.Zeenews.india.com/Gujarati) was observed. Tobacco companies i.e. Kamla Pasand and ITC Limited were also listed as associate sponsors for the 2020 championship. CONCLUSION: Despite comprehensive ban under India's tobacco control law (COTPA, 2003), sponsorship by tobacco industry was found widespread in IPL-13. Advertisement and logos of tobacco companies are persistent during the telecast and promotion of the IPL events, in clear violation of India's tobacco control legislation and Article 13 of WHO's Framework Convention on Tobacco Control (WHO-FCTC) and its guidelines. Given that India and South Asia comprise the largest audience for televised cricket, strong exclusion criteria is needed by the international cricket authority and national cricket associations to ensure compliance with the national law and global good practice, making the cricketing world truly tobacco free.

Banning Loose Cigarettes and Other Tobacco Products in India: A Policy Analysis.

BACKGROUND: Sale of single cigarettes (also known as singles or loosies) is a key driver for early initiation of smoking and is a leading contributor to the smoking epidemic in India. Sale of singles additionally deter implementation of tobacco control strategies of pictorial health warnings including plain packaging and defeat effective taxation and promote illicit trade. We review India's tobacco control policy responses towards banning singles and other products sold as loose tobacco and identify opportunities for future policy intervention especially in the context of the ongoing COVID-19 pandemic. METHODS: Existing national and sub-national policy documents were analyzed for their content since the inception of the tobacco control laws in the country. RESULTS: There are no effective provisions at national level to ban loose tobacco products in India. However, the implementation of multiple legislative and regulatory measures (Acts/circulars/letters/notifications/orders/court judgements) in 16 Indian states and jurisdictions provide sufficient legal framework to substantiate its complete ban pan India. While the majority of state governments have adopted state level measures, Rajasthan had issued specific directive to all the 33 districts banning loose cigarettes and other tobacco products. Himachal Pradesh introduced the most unique and comprehensive legislation, for banning the sale of cigarettes and beedis (Dated November 7, 2016). The most recent notification in the state of Maharashtra (September 24, 2020) is the first to leverage powers using a mix of national and state legislations including the legislation addressing the rapidly emerging challenge of managing COVID-19. CONCLUSION: A robust national policy which supports strong provision to deter tobacco companies, their distribution network and vendors from selling singles or loose tobacco products is urgently needed. Such policy should be backed by cautionary messaging for consumers as well. Eliminating singles and loose tobacco sale will help in blunting tobacco use prevalence besides curbing spread of infectious diseases like COVID-19 pandemic.

Stakeholder perspectives on the integration of oral health into national health schemes: A mixed-method study research design in Delhi, India.

AIM AND OBJECTIVES: To assess the factors and perception of various stakeholders on the integration of oral health into the national health schemes using a mixed-method research design. MATERIALS AND METHOD: A mixed-method study was carried out in 2018 in two phases. In the first phase of the study, a pretested and prevalidated self-designed close-ended questionnaire was used to assess the knowledge, attitude, perception, barriers, myths, and feasibility of the integration of oral health in national health schemes. This questionnaire was administered to 96 stakeholders consisting of a medical officer (MO), accredited social health activists (ASHA), auxiliary nurse midwifery (ANM), and dental surgeon in nine Delhi Government dispensaries. The questionnaire consisted of 42 close-ended questions and four open-ended questions. The domains and themes were identified along with the challenges and opportunities of integration for focus group discussion (FGD) after analyzing the results of the first phase. The FGD consisted of seven members representing each of the above stakeholders along with one moderator and one recorder. RESULTS: 88.3% of the ASHA workers and 85.7% of the ANM accepted that oral screening should be incorporated in their routine practice. The major barrier to the incorporation of oral health in general health was the lack of training and insufficient provision of monetary incentives. Job burnout, work situation, inadequate pay, opportunities, workload, and limited carrier development were the demotivators, whereas respect, goodwill, and recognition from the general public were the inducers. CONCLUSION: There was a strong agreement for National Oral Health schemes to be given space and priority in India. The majority agreed that they can be used as a medium for imparting oral health education. The majority of the stakeholders believed that oral health should be a part of general health and they are open to any scheme or program which would add an oral health component.

E-cigarette retailer storefront availability following a nationwide prohibition of e-cigarettes in India: A multicentric compliance assessment.

INTRODUCTION: This study aimed to assess the availability of retailer storefronts that continued to sell electronic nicotine/non-nicotine delivery systems (ENDS/ENNDS) in India, and characterise such retailers following the promulgation of 2019 Indian Ordinance and Act (Ordinance/Act) that prohibit ENDS/ENNDS nationwide. METHODS: Discreet observations were conducted of retailer storefronts across different socioeconomic zones in nine major cities of India (Bengaluru, Chandigarh, Dehradun, Delhi, Indore, Kolkata, Ludhiana, Raipur, and Ranchi) from 28 November 2019 to 22 January 2020 to identify the availability of ENDS/ENNDS (i.e. electronic cigarettes, e-cigarette liquid, e-cigarette accessories, heated tobacco products (HTPs), and HTPs accessories). We report the number and proportion (%) of retailers that sold ENDS/ENNDS. Other characteristics of the retailers are also described, including indirect evaluation of the retailer's awareness of the Ordinance/Act. RESULTS: Of the 199 retailer storefronts visited, 37 (18.6%) sold ENDS/ENNDS and, therefore, did not comply with the Ordinance/Act. The highest availability of non-compliant retailers was in Kolkata (n=26; 83.9%). The majority of the non-compliant retailers were tobacco retailers (n=35; 94.6%), sold e-cigarettes (n=22; 59.5%), and e-cigarette accessories (n=24; 64.9%). Although many of the non-compliant retailers displayed their ENDS/ENNDS products (n=33; 89.2%) and did not feature health warnings related to ENDS/ENNDS (n=32; 86.5%) in the stores, nearly 90% (n=33) were aware of the Ordinance/Act. CONCLUSIONS: Despite a nationwide ban, ENDS/ENNDS are still available in major cities in India, and concentrated in a particular city. Indian authorities should focus on law enforcement to ensure that the prohibition is effectively implemented.

Bacterial contamination of packaged smokeless tobacco sold in India.

INTRODUCTION: About 21.4% of India's population uses smokeless tobacco products (SLT), yet limited data are available on their microbial contamination. To understand the potential microbiological risks associated with SLT use, the present study aims to investigate bacterial contamination of tobacco and the types of microbes that could be cultured from SLT products. METHODS: Twenty-two brands of SLT products, including paan masala, khaini, gutka and tobacco-containing dentifrices were examined and cultured by using appropriate selective and differential media including MacConkey agar and CLED agar. This was followed by a sequence of further identification by biochemical tests. RESULTS: All 22 types of SLT products showed growth of aerobic bacteria. The most common bacteria isolated were Pseudomonas aeruginosa followed by Streptococcus faecalis. Other bacteria that were isolated from products, in traces, included Klebsiella spp., E. coli, and Bacillus subtilus. CONCLUSIONS: This study raises and addresses the issue of bacterial contamination of packaged SLT products. SLT users might be subjected to a significant health hazard, especially those who are immunocompromised.

Online sales compliance with the electronic cigarettes ban in India: a content analysis.

OBJECTIVES: To investigate the availability of and to characterise the internet electronic cigarette (e-cigarette) vendors (IEVs) that continued to sell vaping devices in an Indian city despite the promulgation of an Indian Ordinance on 18th September 2019 that prohibits e-cigarettes nation-wide. METHODS: A structured internet search engine queries to identify IEVs. Subsequently, a content analysis to all identified IEVs was performed to check if they delivered vaping products to a New Delhi address (non-compliant with Indian Ordinance). Those non-compliant IEVs were then described according to some characteristics of interest. RESULTS: Sixteen out of 45 identified IEVs (35.6%) were not compliant with the Indian Ordinance. Amongst them, half were general e-commerce, 75.0% did not apply any age verification methods, and 56.3% did not feature health or safety warnings on their websites. Many of these IEVs employed a wide range of promotional strategies, such as price discounts, health benefits claims, and social networks utilisation. CONCLUSIONS: E-cigarettes were still highly available and accessible in an Indian capital city through online sales following a bold step taken by the country to totally ban vaping products.

Cross-cultural Adaptation and Validation of Hindi Version of Child Oral Impacts on Daily Performance Index.

INTRODUCTION: Oral diseases may have an impact on quality of life (QoL) and the oral health-related quality of life (OHRQoL). As compared to clinical measures which are unable to provide a complete picture, OHRQoL indices quantify the oral health impact on overall health. Worldwide indices have been developed to measure the OHRQoL in children but none can be applicable in Indian context. AIM: The aim of the study was cross-cultural adaptation and psychometric analysis of Hindi version of child oral impacts on daily performance (C-OIDP) index. MATERIALS AND METHODS: Translation and back translation were done for index using prescribed guidelines for cross-cultural adaptation. A pilot study was conducted in 32 children and required modifications were done. The final Hindi version was tested for reliability and validity on a convenience sample of 64 children aged 11-14 years selected from public schools in Delhi. The psychometric properties of the Hindi version were tested for face, content, construct validity along with internal consistency, and test-retest reliability. RESULTS: The mean age of the final sample (n = 64) was 13.02 ± 0.93 years with boys (51.6%) and girls (48.4%). The mean C-OIDP score was 8.8 ± 7.8. Significant association was obtained when C-OIDP was compared with self-perceived oral health. Interitem correlation ranged from -0.008 to 0.45. Kappa for categories of child OIDP ranged from 0.711 to 1.00 and intraclass correlation coefficient was 0.91. CONCLUSION: The Hindi version of C-OIDP is a valid and reliable tool to measure OHRQoL in Hindi-speaking children in India. HOW TO CITE THIS ARTICLE: Chahar P, Mohanty V, Balappanavar AY, et al. Cross-cultural Adaptation and Validation of Hindi Version of Child Oral Impacts on Daily Performance Index. Int J Clin Pediatr Dent 2020;13(2):124-129.

Afghan Frontier: Understanding Tobacco Practices among Migrant Population in India.

BACKGROUND: According to the World Refugee Survey by US Committee for Refugees and Immigrants, migrants from Afghanistan constitute the 4th largest group of migrants to India. No previous study has been conducted to assess the tobacco consumption status and pattern among this marginalised migrant population. AIM: To get an insight of the tobacco usage pattern, accessibility and attitude towards tobacco cessation among the migrant population from Afghanistan. METHODOLOGY: A cross-sectional study was conducted among a convenience sample of Afghan tobacco users residing in Delhi, India in the month of June 2017. A close-ended self-administered validated questionnaire in Persian language was distributed at local cafés and restaurants. STATISTICAL ANALYSIS: Data was entered in MS Excel Spreadsheet and descriptive statistics using SPSS version 21 were carried out. RESULTS: A total of 127 male Afghan tobacco users with mean age of 33.49± 11.97 years completed the questionnaire. Better work opportunities were the most common reason for migration. Most of them (69%) smoked tobacco and 15.5% used only Naswar. Half (52%) of the respondents continue to use tobacco products manufactured in Afghanistan with 62% procuring the product through social means (friends/family). On assessing barriers to tobacco use, majority (85%) found higher cost of tobacco products to be a deterrent while19% agreed lack of availability to be a barrier. 50% felt that law enforcement and tobacco use regulation in India curbed their tobacco use. Tobacco usage was a stress buster for 64% of the respondents. Although 72% were interested in quitting tobacco, 58% feared losing friends if they quit. Strikingly, 93% were unaware about the availability of cessation services. CONCLUSION: Even as Afghans migrate from their homeland, they carry their cultural and social practices with them, including tobacco products, patterns and practices.

Prevalence, patterns and sociocultural factors associated with use of tobacco-based dentifrices (Gul) in India.

BACKGROUND: India poses a novel tobacco problem with majority of the tobacco users consuming smokeless form of tobacco (21.4%). Gul is one such Smokeless Tobacco (ST) product that is manufactured commercially as a dentifrice to be applied to the teeth and then to gums many times during the day, making it a cheap and easy tobacco source. Hence, the aim of the present study was to estimate the usage of Gul and its social determinants among adults in the capital city of India, Delhi. METHODS: The cross-sectional study was conducted among 1300 adults across 27 Delhi government dispensaries across 3 districts of Delhi through multistage stratified random sampling. A structured, close-ended, validated questionnaire inquiring about the tobacco practices was used for all the participants and a specially constructed, structured, close-ended, validated proforma was used for Gul users to assess practice and pattern of use. RESULTS: The overall prevalence of Gul users was found to be 4.9% with a mean usage duration of 6.28 ± 6.75 years. The usage was found to be more among males (67.7%) and unskilled workers (45.2%). 74.9% started using Gul to treat dental pain with 93.47% of them reporting pain relief. CONCLUSION: Gul usage is an emerging menace in Delhi. Awareness programs and initiatives are the need of the hour to bring this tobacco product under the tobacco control policy radar and at the same time educate people about the actual contents and ill effects of Gul usage.

Effectiveness of different parenting interventions on oral hygiene of cerebral palsy children: A randomized controlled trial.

AIM: To assess the effectiveness of different parenting interventions for improving oral hygiene of cerebral palsy (CP) children aged 4-12 years. METHODOLOGY AND RESULTS: A randomized controlled trial was done among 60 CP children and parents visiting a tertiary care center in New Delhi. The study population was randomly assigned to experimental or control group (30 in each group). Parents/caregivers in the experimental group (Group 1) received video-based dental health education (DHE) and the control group (Group 2) received conventional DHE. Each group also received two telephonic reinforcements at fourth and eighth week after the first intervention at baseline. The groups were assessed for sociodemographic, familial factors, medical history, oral hygiene practices, and oral hygiene status. At 3-month follow-up, the mean reduction in simplified oral hygiene index (OHI-S), plaque index (PI), and gingival index (GI) scores was 0.27, 0.17, and 0.09, respectively, in Group 1 (P-value < .05). The mean reductions seen in Group 2 were 0.03 in OHI-S, 0.14 in PI, and 0.04 in GI index (P-value < .05, except for GI score: P-value = .6). CONCLUSION: Video-based DHE is effective and brings about significant improvement in oral hygiene status and oral health among CP children.

Effectiveness of dental health education on oral hygiene among hearing impaired adolescents in India: A randomized control trial.

AIM: To assess the effectiveness of two different methods of dental health education (DHE) for improving oral hygiene among hearing impaired adolescents in school aged 11-20 years. METHODOLOGY AND RESULTS: A randomized double blind controlled parallel time series trial was done among 178 hearing impaired adolescents. Considering existing literature, the required sample size was found to be 82 per group, at 95% confidence interval, design effect = 1, type I error = 5%, power of study = 80%, and 20% attrition rate. Two out of five schools were randomly selected. Different methods of DHE were used, schools were coded as School A (DHE using sign language by the investigator) and School B (DHE by conventional visual method, using only posters). The mean reduction in Simplified Oral Hygiene Index (OHI-S), Plaque Index (PI), and Gingival Index (GI) scores was 1.13 ± 0.81, 0.66 ± 0.31, and 0.58 ± 0.32, respectively, in school A. The mean reductions seen in school B was 0.52 ± 0.89 in OHI-S, 0.44 ± 0.44 in PI, and 0.34 ± 0.32 in GI index (P-value < 0.05). CONCLUSION: Basic training of dental professionals in sign language is both effective and feasible, and brings about greater improvement in oral hygiene status and gingival health as compared to the conventional methods of health education.

Hookah products and online retail marketing strategies in India: A content analysis.

INTRODUCTION: Hookah smoking is becoming increasingly popular among the youth. Evidence shows that exposure to marketing of the unhealthy products through social media platforms may impact adolescent health behaviors. The aim of the study was to perform a content analysis of online portals selling hookah products. MATERIALS AND METHODS: A content analysis of online retail market was conducted on Google India using three keywords hookah, hookah products, and shisha. Retail websites popular in India that were selling hookah products were randomly selected and explored. A total of 15 themes were developed and used to describe various promotional strategies for hookah products. RESULTS: In all, 41 (19.2%) products claimed to be tobacco/nicotine-free and only 14 products (6.5%) displayed age/health-specific warnings. About 86% of products were available at discounted rates; glamorizing words for describing products in form of superior, premium, and legendary were found on 189 (88.3%) products. Phrases such as "ultimate way to celebrate," "perfect excuse to chill with your friends," and "now enjoy the world of smoking without any doubt of harm" are commonly used to promote hookah products. CONCLUSION: Easy availability of newer forms of smoking at online markets could play a role in promoting the use of hookah among the youth. Most products are being sold without any warnings and there is no means to control the selling of the products to minors. There is a need to raise the issue of hookah products in the same tune as done for other forms of tobacco.

Practice Perspectives of Left-Handed Clinical Dental Students in India.

INTRODUCTION: Handedness becomes important for students during their training period. Limited literature is available regarding the same. AIM: The purpose of this study was to assess the dental practice perspectives and determine the hand preference and discomfort level among the Left-Handed (LH) clinical dental students. MATERIALS AND METHODS: A 30-item survey tool was used to conduct a cross-sectional survey among four successive LH cohorts (third and final year undergraduates, dental interns and postgraduates) in all the dental colleges of Bengaluru, Karnataka, India, during the year 2014. RESULTS: A total of 84 students completed the survey, response rate being 100%. About one-third (37%) reported that their institution was not properly equipped to accommodate LH students. Majority felt that LH dentists were at a higher risk of developing musculoskeletal complications. Mouth mirror handling showed equal distribution for handedness as compared to the other dental activities, whereas discomfort levels were negligible ("without any difficulty"). Dental practice perspective scores significantly correlated with the difficulty levels (r=-0.333, p<0.001). CONCLUSION: Overall, the left-handers had a right dental practice perspective and their responses indicate a need to address their issues empathetically.