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.

Smokeless tobacco cessation in South Asian communities: a multi-centre prospective cohort study.

AIM: To evaluate smokeless tobacco cessation in communities of South Asian origin. DESIGN: Multi-centre prospective cohort study. SETTING: Three tobacco cessation services offering specialist smokeless tobacco cessation outreach clinic support to South Asians (Bangladeshi, Indian and Pakistani) resident in England. PARTICIPANTS: A total of 239 South Asian participants seeking to stop smokeless tobacco use between November 2010 and December 2011. MEASUREMENTS: Socio-demographics, tobacco use and dependence, self-reported abstinence at 4 weeks and satisfaction measures. FINDINGS: Participants' mean age was 45 [standard deviation (SD) = 13] years, were predominantly female (76%), of Bangladeshi origin (74%), either home carers (53%) or not working (29%). Sixty-three per cent were recruited from community locations, 21% through a clinical contact and 16% through friends and family. Mean daily number of smokeless tobacco intakes was 10 (SD = 7) and the mean dependence score was 4.5 (SD = 1.9). Sixty-three per cent of participants achieved continuous abstinence 4 weeks after quitting. Using nicotine replacement therapy (NRT) versus not using it [OR = 3.47, 95% confidence interval (CI): 1.25, 9.62] and below median (≤ 8) daily smokeless tobacco intakes (OR = 1.91, 95% CI: 1.07, 3.40) predicted successful abstinence. CONCLUSION: South Asian smokeless tobacco users resident in England accessing services to help them stop appear to have short-term success rates comparable with smokers attending stop-smoking services, with higher success rates being reported by those using nicotine replacement therapy.

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.

Predictors of successful short-term tobacco cessation in UK resident female Bangladeshi tobacco chewers.

AIM: To identify predictors of short-term smokeless tobacco cessation in Bangladeshi women resident in the United Kingdom. DESIGN: Prospective cohort study. SETTING: A tobacco cessation service offering culturally tailored smokeless tobacco cessation support. PARTICIPANTS: A total of 419 Bangladeshi women chewing paan with tobacco. MEASUREMENTS: Demographics, tobacco use and dependence and cessation attempt process and outcomes. FINDINGS: Client mean age was 48.92 [95% confidence interval (CI) 47.5, 50.34] years and the mean area social deprivation score was 3.65 (95% CI 3.33, 3.97). Mean daily smokeless tobacco intakes, as paan, was 9.96 (95% CI 9.22, 10.7); 69.8% were recruited from primary care, 78.8% received behavioural support and nicotine replacement therapy (NRT) and the remainder behavioural support alone. Self-reported 4-week continuous abstinence was 58.3%, predicted by NRT use [odds ratio (OR) = 4.93, 95% CI 2.02, 12.00], community recruitment (OR = 1.84, 95% CI 1.01, 3.35) and relatively lower social deprivation (IMD) score (OR = 1.98, 95% CI 1.18, 3.33). CONCLUSION: Bangladeshi women in the UK attending clinics to help cessation of paan with tobacco appear to be more likely to be successful in the short term if they use nicotine replacement therapy, are recruited via the community and have relatively lower levels of social deprivation.

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.