Disengagement beliefs in South Asian immigrant smokeless tobacco users: A qualitative study.

Gutka and tambaku paan (smokeless tobacco products used by South Asian immigrants) are carcinogenic to humans (and perceived as such), yet, one-fourth of South Asian immigrants report current use. This study examined disengagement beliefs that perpetuate gutka/tambaku paan use among South Asians despite awareness of health risks. Six focus groups were conducted with immigrant South Asian adult gutka/tambaku paan users, in Gujarati, Bengali and Urdu languages in New York, USA. Participants included 39 South Asian adults residing in the New York City Metropolitan area, current (a minimum of weekly gutka or tambaku paan use in the last 12 months) or former (regular use prior to past 12 months) gutka or tambaku paan users and self-reported spoken fluency in Gujarati, Urdu or Bengali languages. Participants identified many health risks associated with gutka/tambaku paan use including locked jaw, high blood pressure and cancer. Five themes of disengagement beliefs emerged: (a) skepticism about the gutka/tambaku paan-cancer link, (b) perceived invulnerability to harm, (c) compensatory beliefs, (d) faith-based rationalization and (e) acknowledgment of addiction. To promote smokeless tobacco cessation among South Asians, interventions to counter disengagement beliefs and heighten the discomfort between the dissonant cognitions represent a promising area warranting further attention.

Social Determinants and the Prevalence of Paan Masala Use among Adults in India: Results from Global Adult Tobacco Survey, 2016-17.

BACKGROUND: Gutkha or Paan masala with tobacco is commonly used smokeless tobacco product in India. Given the restrictions on advertisement and promotion of Gutkha and the necessity of warning labels on tobacco products, the tobacco industry has popularised paan masala without tobacco as a surrogate product. Paan masala itself is harmful for health but remains beyond scope of current tobacco control policies. It was important to understand prevalence and determinants of its use (with or without tobacco). METHODS: Data from the Global Adult Tobacco Survey (GATS)-2, India was used to estimate prevalence of paan masala use (with or without tobacco) in India. Multi-nominal regression and logistic regression were used to calculate risk ratios and odds ratios. RESULTS: The prevalence of any form of paan masala was 12.1% among adults in India. Prevalence was higher among males (17.8%) than females (6.0%), aged 25-44 years (14.5%) than those aged 65 years or above (9.0%). Relative risk ratio (RRR) for Paan masala with tobacco was significantly high among those with no formal schooling (RRR:2.00) and among those in poorest wealth quintiles (RRR:1.26). While, RRR were lower for Paan masala use without tobacco among those with no formal schooling (RRR:0.95) and among poorest wealth quintiles (RRR:0.78). Region-wise AOR were highest for North-East (AOR:4.80) and Central regions (AOR:4.76) compared to South India. CONCLUSION: The prevalence of paan masala use is high in India. Persons belonging to lower socioeconomic status or having no formal schooling have higher risk of consuming paan masala with tobacco. However, persons from higher wealth quintiles or having formal schooling had higher risk of use of paan masala without tobacco. These findings need careful attention of policy makers and law enforcers as it indicates different marketing strategies might have adopted by industry to target these two mutually exclusive population groups.

Prevalence of the Usage of Smokeless Tobacco in Patients Presenting With Stroke in a Tertiary Care Hospital.

Background Stroke is one of the leading causes of disability, long-term morbidity, and mortality. The key modifiable risk factors for stroke are largely driven by demographic changes and various social adaptations. Smokeless tobacco consumption is high in developing countries with less awareness of its potential health risks. Aim This study was designed to determine the prevalence of usage of smokeless tobacco in patients presenting with stroke in a tertiary care hospital in Karachi. Methods This is a cross-sectional study conducted at the Department of Neurology of Dr. Ruth K. M. Pfau Civil Hospital in Karachi. A total of 192 patients were enrolled during the study period of six months, from September 2018 to March 2019. All consenting patients were recruited who presented with stroke and fulfilled the inclusion criteria. All patients were assessed by a trained neurologist. Results A total of 192 patients with stroke were included. There were 146 (76%) males and 46 (24%) females with a mean age of 53 ± 6.1 years. The highest percentage (39%) of cases was illiterate. A majority (64%) of patients presented belonged to a lower socioeconomic background. Out of 192 stroke patients, 131 (68.2%) consumed smokeless tobacco.  Conclusion The frequency of smokeless tobacco consumption was found to be high in stroke patients who require the attention of the physician on modifiable risk factors.

Host Long Noncoding RNA lncRNA-PAAN Regulates the Replication of Influenza A Virus.

The productive infection of influenza A virus (IAV) depends on host factors. However, the involvement of long non-coding RNAs (lncRNAs) in IAV infection remains largely uninvestigated. In this work, we have discovered a human lncRNA, named lncRNA-PAAN (PA-associated noncoding RNA) that enhances IAV replication. The level of lncRNA-PAAN increases upon infection of IAV, but not other viruses, nor interferon treatment, suggesting specific up-regulation of lncRNA-PAAN expression by IAV. Silencing lncRNA-PAAN significantly decreases IAV replication through impairing the activity of viral RNA-dependent RNA polymerase (RdRp). This function of lncRNA-PAAN is a result of its association with viral PA protein, a key component of IAV RNA polymerase complex. Consequently, depletion of lncRNA-PAAN prevents the formation of functional RdRp. Together, these results suggest that lncRNA-PAAN promotes the assembly of viral RNA polymerase, thus warranting efficient viral RNA synthesis. Elucidating the functions of lncRNAs in IAV infection is expected to advance our understanding of IAV pathogenesis and open new avenues to the development of novel anti-IAV therapeutics.

Smokeless tobacco and oral potentially malignant disorders in South Asia: a protocol for a systematic review.

INTRODUCTION: Oral potentially malignant disorders (OPMDs) are chronic lesions or conditions characterized by a potential for malignant transformation. Apart from being possible pre-cursors to oral cancer, OPMDs themselves are usually painful and debilitating conditions having an influence on the quality of life, both in terms of pain and social disability. Smokeless tobacco (SLT) use is considered a major risk factor for OPMDs. SLT use is a culturally and socially acceptable habit in South Asia. According to a recent report, 90 % of the SLT burden of the whole world lies in the South Asian countries of Pakistan, India, Sri Lanka, Bangladesh, Bhutan, Nepal, Afghanistan, and Maldives. This review aims to assess the association between the use of various SLT products in South Asia and risk of OPMDs. METHODS: This review will focus on epidemiological studies on the use of SLT and risk modification for OPMDs, which have been carried out in the human population of South Asian countries. Articles reporting estimates of relative risk, e.g., odds ratio (OR) or relative risk (RR) with their 95 % confidence intervals (CI) for SLT users versus non-users. Articles reporting data from which these effect estimates can be computed will be included in the review. We will search MEDLINE, the Science Citation Index (SCI), Scopus, and the Cumulative Index to Nursing and Allied Health Literature (CINAHL) databases for relevant literature using a combination of keywords and MeSH terms, where applicable. Appropriate sources of gray literature will also be included in the search. The electronic searches will be supplemented by a hand search of the bibliographies of the included articles. The included studies will be assessed for their quality using an established quality assessment tool. All relevant data from the included articles will be recorded in an MS Excel spread sheet and then transferred to Rev Man 5.3 to carry out a meta-analysis. Heterogeneity among the estimates will be assessed through the I (2) statistic. Sensitivity and subgroup analysis will be carried out to see the effects of individual or group of studies on the pooled effect estimate. Results of the review will be reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. DISCUSSION: This review may have a potential limitation with regard to the designs of the studies included as we expect that most of the included studies will be of the observational types. We will however try to address this issue by conducting sensitivity and subgroup analysis of similar quality studies. SYSTEMATIC REVIEW REGISTRATION: PROSPERO CRD42015029705 .

Various terminologies associated with areca nut and tobacco chewing: A review.

Globally, arecanut and tobacco are among the most common addictions. Tobacco and arecanut alone or in combination are practiced in different regions in various forms. Subsequently, oral mucosal lesions also show marked variations in their clinical as well as histopathological appearance. However, it has been found that there is no uniformity and awareness while reporting these habits. Various terminologies used by investigators like 'betel chewing','betel quid chewing','betel nut chewing','betel nut habit','tobacco chewing'and 'paan chewing' clearly indicate that there is lack of knowledge and lots of confusion about the exact terminology and content of the habit. If the health promotion initiatives are to be considered, a thorough knowledge of composition and way of practicing the habit is essential. In this article we reviewed composition and various terminologies associated with areca nut and tobacco habits in an effort to clearly delineate various habits.

Tobacco: Its historical, cultural, oral, and periodontal health association.

This article provides information on the origin of tobacco and its subsequent spread throughout the world. In the era of the migration of communities, tobacco use gradually gained access and subsequently migrated along with the migrants, establishing in different locations. Probably at that time people were unaware of the health hazards and were using tobacco in treating certain ailments. Much has been known and written about tobacco in the context of oral and general health hazards but little has been explored and is known to many about where from and how this plant, which is now used in various forms, and speading widely. In what form, where, and how it had been served in religious rituals and considered for treatment or remedy of certain ailments in those days could not certainly be known. In the 21(st) century, people are considering hazardous tobacco as beneficial for their teeth, good for concentration of mind, and something which keeps them engaged. Even many professionals, though knowing the deleterious effects, are still using tobacco and gutkha in one or the other form. This article has been designed to revive the awareness for health hazards of tobacco and similar products. A pilot project questionnaire survey comprising this subject involving the educated mass has already been started and will be produced after analysis of data in part II of this paper.

Influence of smokeless tobacco on periodontal health status in local population of north India: A cross-sectional study.

BACKGROUND: Limited studies have been published so far, which revealed the association of different types of smokeless tobacco on various periodontal health indicators, including mobility and furcation, on North Indian population. The present study has been undertaken to evaluate the effects of commonly used smokeless tobacco forms on periodontal health in Lucknow, North India. METHODS: This cross-sectional study investigated the effect of commonly used smokeless tobacco on periodontal health in local population of Lucknow, for which 2045 individuals were evaluated. Amongst them, 1069 individuals were found to be using some kind of tobacco; amongst the tobacco users, n=122 were smokers, n=657 were only using only smokeless tobacco and n=290 were using both smokeless tobacco as well as tobacco in smoking form. After completing the questionnaire, all the participants underwent clinical examination for the various clinical parameters. RESULTS: The impact of smokeless form of tobacco use was significantly higher on all the periodontal health indicators, viz., plaque index, gingival index, calculus, clinical attachment loss, gingival recession, mobility, furcation, lesion, and probing pocket depth. Both duration and frequency of smokeless tobacco use significantly affected the periodontal health. CONCLUSION: The periodontal health of the general population in the region required immediate attention as majority of subjects irrespective of their habit status had onset of clinical attachment loss and gingival recession, more so amongst the smokeless tobacco users than smoking form of tobacco as well as than from non-tobacco users.