Correlates of nicotine dependence among patients visiting a tobacco cessation centre in India: A retrospective analysis.

Background We did a retrospective secondary analysis of 1-year data of a tobacco cessation clinic (TCC) to assess correlates of nicotine dependence among tobacco users visiting the TCC at a tertiary care dental hospital. Methods Secondary data were obtained from the records of patients who had visited the TCC from January to December 2019. Of the 1436 records, 1144 were found to contain all the information needed for the study. Patient records were obtained from a pre-validated standard TCC patient assessment sheet (PAS), which included various sections: Sociodemo-graphic items, tobacco use profile items, nicotine dependence status, strategy used for cessation and follow-up details. Results Of the 1144 proformas, 97.1% (n=1111) were of men and 2.9% (n=33) were of women. Around 48.5% had medium nicotine dependence followed by high nicotine dependence (29.7%) and low nicotine dependence (21.8%). The mean (SD) age of initiation of tobacco use was 26.1 (9.44) years and a significantly lower age of initiation was observed in patients with high nicotine dependence. Greater number of years of tobacco use was significantly associated with high nicotine dependence. About 47% of patients had attempted to quit tobacco in the past and the quitting attempts were found to be significantly higher in patients with high dependence. Conclusion We explored crucial determinants of nicotine dependence among tobacco users reporting to the TCC. These factors may be incorporated in routine assessment of the tobacco use status and may be used in tailored cessation counselling strategies.

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.

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.

Applicability of Data Mining and Predictive Analysis for Tobacco Cessation: An Exploratory Study.

Objectives: Predictive analysis can be used to evaluate the enormous data generated by the healthcare industry to extract information and establish relationships amongst the variables. It uses artificial intelligence to reveal associations not suspected by the healthcare professionals. Tobacco cessation is clearly beneficial; however, many tobacco users respond differently as it is based on multitude of factors. Our objectives were to assess the data mining techniques using the WEKA tool, evaluate its role in predictive analysis, and to predict the quit status of patients using prediction algorithms in tobacco cessation. Materials and Methods: WEKA, a data mining tool, was used to classify the data and evaluate them using 10-fold cross-validations. The various algorithms used in this tool are Naïve Bayes, SMO, Random Forest, J-48, and Decision Stump to further analyze its role in determining the quit status of patients. For this, secondary data of 655 patients from a tobacco cessation clinic were utilized and described using 20 different attributes for prediction of quit status. Results: The Decision Stump and SMO were found to be having the best prediction and accuracy for prediction of the quit status. Out of 20 attributes, previous quitting attempt, type of intervention, and number of years since the habit was initiated were found to be associated with early quitting rate. Conclusion: This study concluded that data mining and predictive analytical models like WEKA tool will not only improve patient outcomes but identify variables or a combination of variables for effective interventions in tobacco cessation.

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.

Oral health-related quality of life among elderly patients visiting special clinics in public hospitals in Delhi, India: A cross-sectional study.

BACKGROUND: Oral health is recognized as an integral component of general health, and poor oral health is reflected in general health and quality of life (QoL). India has seen a profound shift in the elderly population and is currently home to 103.9 million elders. General Oral Health Assessment Index (GOHAI) is a self-reported oral health assessment index used in elderly population and has been tested in multiple countries. OBJECTIVE: The study aimed to assess the oral health-related QoL (OHRQoL) using GOHAI and various factors affecting it, among elderly patients visiting special Sunday geriatric clinics at Delhi public hospitals. METHODS: A cross-sectional study was conducted among four purposively selected special geriatric public clinics in Delhi, India, and a convenience sample of 145 elderly patients was obtained. OHRQoL was measured using a prevalidated instrument (GOHAI) along with other variables (sociodemographic factors, self-perceived oral health, utilization of medical/dental services, dental problems in the past 12 months, and prosthetic status/need). Statistical analysis was done using Statistical Package for the Social Sciences software version 21, and descriptive results were obtained. RESULTS: The sample consisted of 66 males (45.5%) and 79 females (55.5%), and around 58% (n = 84) of the participants were illiterate. Around 39% (n = 57) of the elderly had never visited a dentist and 48% (n = 69) were financially dependent (no income) on others. The mean GOHAI score for the population was 26.69 + 4.44 (median = 25, interquartile range = 23-27). GOHAI score was compared for age, oral hygiene practices, dental problems in the past 12 months, self-reported oral health, and prosthetic need, and a statistically significant difference was observed. CONCLUSIONS: The current study assessed GOHAI score and highlighted important determinants of OHRQoL in elderly population visiting the special clinics in Delhi. Thus, OHRQoL should be considered as a surrogate measure to clinical oral examination.

Communicating Risk: Assessing Compliance of Tobacco Products to Cigarettes and other Tobacco Products Act (Packaging and Labelling) Amendment Rules 2015 in Delhi, India.

BACKGROUND: Tobacco is a public health problem with both health and economic consequences. Pictorial health warning (PHW) under cigarettes and other tobacco products Act, May 2003 (COTPA), offers advantages of being more universally available, low cost, and high exposure. The current study aims to assess compliance of smoking and smokeless tobacco products to Section 7, 8, and 9 of COTPA Amendment Rules 2015. MATERIALS AND METHODS: This cross-sectional study was conducted in the city of New Delhi during November-December. 2017. All nine districts were included in the study and in each districts, three public places, a Metro station, a hospital, and a public park, were randomly chosen for tobacco products collection. A standardized protocol was implemented for acquiring tobacco products from these 27 diverse points. Data collected were entered into MS Excel to make digital spreadsheets and were analyzed using SPSS version 21. RESULTS: Among 98 tobacco products, 57 (58%) and 41 (42%) were smoke form and smokeless form, respectively. Foreign Cigarette Brands and Beedi showed the least compliance followed by khaini and Gutkha. PHW was absent on 12 products (8 foreign brands of smoking type and 4 smokeless type). 42.8% (n = 42) of packaging was found to contain promotional inserts, while just 20.4% (n = 20) of the total sample size contained the presence of legislative information. CONCLUSIONS: Foreign brands and locally manufactured products (Beedi and Khaini) showed low compliance to new amendments of COTPA. Along with this, the presence of promotional inserts on tobacco packaging might be another issue to be dealt with in the future.

Designing and validation of text messages for m-Health intervention for tobacco cessation and management.

BACKGROUND: Tobacco is a growing epidemic and tobacco-related death results in health consequences and lost economic opportunities. Tobacco cessation efforts mandate the use of multiple strategies to bring about behaviour change. AIM: To develop and validate health promotive text messages using transtheoretical model and prospect theory for behaviour change. SETTINGS AND DESIGN: The present observational study was conducted in a tertiary care hospital, Delhi among patients reporting at Tobacco Cessation Centre (TCC). METHODS: The study was divided into two phases: first involved development of text messages in local language (Hindi) using a sound theoretical basis (TTM and prospect theory) and second phase dealt with validation of the developed text messages by patients and experts in the field of tobacco cessation. STATISTICAL ANALYSIS: Descriptive statistics was obtained using the SPSS version 17. RESULTS: The sample comprised 20 males and 6 females. Average appeal score ranged from 6.1 to 9.6 (54 messages). Forty two messages out of a total of 54 messages were found to be appropriate after validation by the experts. Mean words of the final messages (42 messages) was 24.5 ± 1.3. Two hundred ninety one (90%) out of a total of 324 questionnaires showed adequate understanding of message as assessed by the reviewers. CONCLUSIONS: The current effort developed and validated health promotive text messages package to aid in tobacco cessation. The preventive text messages were grounded in evidence and sound theoretical basis and followed a standard validating procedure leading to satisfactory understanding and appeal in all domains.

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.

Electronic Nicotine Delivery Systems (ENDS): Mapping the Indian Online Retail Market.

INTRODUCTION: Motivating tobacco consumers to change their behavior, and harm reduction strategies, are the predominant traditional approaches to tobacco cessation. Recent trends worldwide have shown the emergence of Electronic Nicotine Delivery Systems (ENDS), such as electronic cigarettes (e-cigarettes), as a purported harm reduction strategy to traditional cigarettes. Considering the global rise in the popularity of ENDS, our study aims to survey the online retail market for ENDS in India. METHODS: The current study was conducted in September-October, 2015 and 4 keywords were used to search Google India to identify online retail websites marketing ENDS. Each website was searched using the same keywords and all specific website pages displaying ENDS models were considered. Thus, data was obtained for various measures of ENDS present on the model descriptions. RESULTS: A total of 6 retail shopping websites were searched which revealed 65 different models of ENDS (34 brands). Forty-five models (69%) were flavored and 21 models (33%) mentioned about nicotine strengths. Seventeen models (26%) provided health warnings in their product descriptions. "No tar no tobacco" was most common claim accounting to 34 models (51%). CONCLUSIONS: This article provide insight into the current status of evident online sales of ENDS in India. There is urgent need to implement regulations on online sales of these products and protect the future from such approaches of tobacco control which still have divided opinions. IMPLICATIONS: The study permits the use of web search engine to explore market availability of ENDS at various online retail websites. Recommendations from the study can be used to guide policy makers in developing strategies tailored to regulate availability and online sales of ENDS in India.

Serum lipid profile in oral cancer and leukoplakia: correlation with tobacco abuse and histological grading.

INTRODUCTION: Role of alterations in serum lipid profile in oral cancer remains controversial. The present study aimed to evaluate the implications of altered serum lipid profile in patients with oral cancer (OC), oral leukoplakia (OLP), and tobacco habits. MATERIALS AND METHODS: Thirty patients with OC, 30 with OLP, 30 tobacco abusers (TAs), and 30 age and sex matched healthy controls were included in the study. Serum lipid profile including total cholesterol (TC), high density lipoprotein (HDL), low density lipoprotein (LDL), Very low density lipoprotein (VLDL), and triglycerides (Tg) were evaluated using a fully automatic Biochemistry analyzer. Difference in lipid profile in various types of TA, that is, smokeless tobacco (SLT), smoking tobacco (ST), and a combination (Comb) usage of both forms were also analyzed. RESULTS: TC, HDL, and LDL were much lower in the OC group compared with control. Although these parameters were low in the OPC group compared with controls, the difference was not significant. On histological analysis, TC and HDL were found to decrease marginally with loss of tumor differentiation in OC. No correlation was found between the mean serum lipid profiles and degree of dysplasia in OLP. TC and HDL were significantly lesser in all forms of TA when compared with control. CONCLUSIONS: There may be an inverse relationship between serum lipid profile and OC. No significant reduction in lipid profile was observed in the OLP group. This may indicate that hypolipidemia is a late change occurring during carcinogenesis or is an effect rather than the cause of cancer.