Systematic review of determinants and interventions of areca nut cessation: curbing a public health menace.

BACKGROUND: Areca nut (AN) is a proven human carcinogen and a global public health menace. There is yet no review providing comprehensive information on the determinants and interventions available for cessation of AN. This systematic review was aimed at summarizing the available literature on drivers and interventions for cessation of AN chewing habit and to highlight the research lacunae. METHODS: A systematic literature search (from 1990 till March 2021) was conducted for studies on AN cessation. Relevant data were extracted independently by two authors. RESULTS: A total of 16 studies were included, which highlighted the influence of socio-cultural factors, addictive nature of AN and withdrawal symptoms as barriers to quitting. However, the knowledge of ill-effects of AN use on health, absence of concurrent alcohol use or smoking and family pressure were associated with likelihood of AN cessation. The interventions utilized for AN cessation have been behavioural in majority of the studies except for one where antidepressants were used for this purpose. CONCLUSIONS: The current review emphasizes the imperative need of appropriate cessation strategies for AN chewing habit including enhancing awareness of the harmful effects and research into additional behavioural and pharmacologic cessation therapies to control this significant public health problem.

Advanced virtual mentoring of dentists in oral cancer screening and tobacco cessation - An interventional study.

Context: Oral cancer is the third common cancer in India. Its mortality can be reduced through early detection and tobacco cessation ideally by dentists owing to their forte of work. Aim: This study was conducted to discuss effectiveness of an advanced tele-mentoring programme in oral cancer screening and tobacco cessation for dentists across India. Settings and Design: Online, interventional study. Methods and Material: The 14-week long training programme with 52 participants/spokes from across India had weekly hour-long online sessions comprising of an expert-led didactic and case discussions by spokes. Online evaluation (pre- and post-training, post-session), weekly and post-one-year feedback were conducted. Successful spokes attended a hands-on workshop subsequently. Statistical Analysis Used: One and independent sample t-tests determined the significance of the evaluation scores of the participants. Findings on attitudes and practice-related questions are presented as simple percentages. Results: A notable increase in the overall and per-session mean knowledge score, and confidence in oral cancer screening was observed. Many participants started these services at their clinics, thereby reducing further referrals, and were also motivated to spread community awareness about the same. Conclusion: This tele-mentoring programme, based on the novel Extension for Community Healthcare Outcomes model, is the first oral cancer screening training programme for dentists. This model-comprising of expert didacts, case discussions, and significant spoke-expert interaction-is a promising best-practices tool for reducing the disparity in knowledge and skills regarding oral cancer prevention among dentists across different locations. This would enable these most appropriate healthcare providers to contribute toward the overall goal of oral cancer prevention.

Risk Reversal of Oral, Pharyngeal and Oesophageal Cancers after Cessation of Betel Quid Users: A Systematic Review and Meta-Analysis.

BACKGROUND: Areca nut (AN), the principal ingredient of betel quid (BQ) has been categorized as a human carcinogen associated with various cancers of upper aerodigestive tract. However, there has been no attempt at summarizing the risk reversal of oral and other cancers after cessation of BQ with or without tobacco (BQ+T/BQ-T). OBJECTIVE: To analyze the effect of cessation of betel quid without tobacco (BQ-T) and with tobacco (BQ+T) on reversal of the risk of oral, pharyngeal and oesophageal cancers. METHODS: A systematic literature search was conducted for publications evaluating risk of these three cancers among current and former users of BQ-T or BQ+T. The overall as well as subgroup meta-relative risks (meta-RR) were estimated using random-effect models. RESULTS: A total of 14 studies, seven each providing estimates for BQ-T and BQ+T, were identified. For BQ-T and oral cancer, a 28.9% risk reversal was observed among former users (meta-RR 5.61, 95% CI 2.24-14.04) compared to current users (meta-RR 7.89, 95% CI 3.90-15.98). A risk reversal of 48% was noted for pharyngeal cancer - former users (meta-RR 2.50, 95% CI 1.43-4.38), current users (meta-RR 4.81, 95% CI 2.05-11.30). For oesophageal cancer, no appreciable difference in risk was observed between current and former users.For BQ+T and oral cancer the overall meta-RR indicated a higher risk in former than in current users. However, sensitivity analysis including only better-quality studies showed a modestly lower cancer risk in former than in current users. Compared to current users, the risk in former users who quit less than 10 years ago (meta-RR 1.21, 95% CI 0.90-1.63) was increased, but decreased in former users who quit more than 10 years ago (meta-RR 0.72, 95% CI 0.48-1.07). CONCLUSION: Our analysis highlights for the first time the potential of risk reversal for oral and pharyngeal cancers following cessation of BQ-T and for oral cancer in long-term quitters (greater than 10 years) of BQ+T. The suggestive evidence from this systematic review further supports the imperative need of a strong policy to reduce the initiation of BQ use and inclusion of interventions for BQ cessation in cancer control efforts especially in geographic regions where BQ chewing is prevalent.

Tobacco use among urban slum dwellers attending a cancer screening clinic in the National Capital Region of India: a cross-sectional study.

BACKGROUND: Tobacco consumption in India varies based on the place of residence (urban/rural). Minimal, exclusive information exists regarding the same for 'urban slum' dwellers. The current study determines the tobacco use pattern among such individuals in Noida, Uttar Pradesh (India). METHODS: A cross-sectional study was conducted among the urban slum residents visiting the institutional clinic between December 2016 and June 2019. Apart from tobacco history, routine recording of the basic demographic details and oral visual examination was carried out for the participants. For categorical data, the percentage of different parameters was calculated and for quantitative data, descriptive statistics were calculated. Chi-square or Fisher's exact tests were employed to determine the association between the two categorical variables. To find the strength of association between tobacco use and the socio-demographic factors, univariate and multivariable binary logistic regression was used. RESULTS: Among 2,043 urban slum respondents (602 male, 1441 female), 15.0% (n = 308) currently consumed tobacco. The majority were smokeless tobacco (SLT) users (among both males and females). Among males, khaini (42.1%) and gutkha (32.5%) and among females gul (36.1%) were the most widely used tobacco products. CONCLUSION: The majority of the Noida urban slum population attending the screening clinic consumed SLT. Gender variation in the tobacco form and product-specific consumption patterns indicates that the undertaking of urban slums-specific surveys is essential. Tobacco control programmes must incorporate appropriate strategies addressing such subgroups of tobacco users.