Consumption of chewing tobacco alters the serum metal contents in pregnant women at Tandojam and adjoining areas.

Chewing tobacco may play a contributing role in complications during pregnancy as it contains various kinds of toxic metals such as lead (Pb), cadmium (Cd), cobalt (Co), manganese (Mn), chromium (Cr), and can cause alteration in serum metal concentration. Hence, the present study aimed to explore the effects of chewing tobacco consumption on serum metal contents in pregnant women. A total number of 200 chewing tobacco consumer pregnant women and 200 age-matched non-consumer pregnant women were selected for the study from the outpatient department of gynaecology at Rural Health Centre Tandojam, Pakistan. After obtaining the sociodemographic characteristics of all participants, 10 ml of venous blood was also drawn for serum metal analysis by atomic absorption spectroscopy. Different chewing tobacco samples consumed by consumer pregnant women were collected from local shops of Tandojam, Pakistan. Drinking water samples from the residential areas of consumer and non-consumer pregnant women were prepared and analysed for the same metal contents. In present study, serum Pb, Cd, K and Co were found significantly increased in CPW as compared to NCPW. Serum Pb was found significantly increased in gutkha consumers in comparison to mainpuri consumers. Serum Pb, Cd, and Co were present with significantly increased concentration in serum of CPW who were taking canal and well water for drinking purpose when compared with NCPW. Significant negative strong correlation of serum Pb with K and Cr of drinking water and Na of chewing tobacco samples were observed. Strong positive correlation of serum Cd and Cr with Co of drinking water had been observed. Whereas, serum maternal Co was strongly negatively correlated with Mn of chewing tobacco samples, and serum Cu of CPW had a strong positive correlation with K and Cr of drinking water and Na of chewing tobacco samples. In conclusion, consumption of chewing tobacco alters the serum metal contents in pregnant women at Tandojam and adjoining areas, Pakistan.

Smokeless tobacco consumption among women of reproductive age: a systematic review and meta-analysis.

Smokeless tobacco (SLT) poses many negative health impacts. Despite its longstanding presence in societies across the world, the health implications of SLT have only been rigorously studied in recent decades. This systematic review and meta-analysis aimed to consolidate existing research to provide a comprehensive understanding of the global prevalence of SLT use among women of reproductive age. Relevant articles were extracted from databases such as PubMed, EMBASE, Web of Science, and Scopus from their inception until November 11, 2023. Observational studies reporting the number of SLT users among women of reproductive age were included. The quality of the studies was assessed using the Joanna Briggs Institute (JBI) tool. The meta-analysis used a random-effects model to determine SLT prevalence, supported by statistical tools like forest plots, I2 statistics, and sensitivity analyses to ensure the accuracy and comprehensiveness of the results. All statistical analyses were performed in R version 4.3. From 10 studies involving 2,053,667 participants, a pooled prevalence for SLT use among women of reproductive age was found to be 9.3% (95% CI: 0.038 to 0.21), with significant heterogeneity among studies (I2 = 100%). Publication bias was suspected among the studies. Sensitivity analysis and subgroup analysis couldn't resolve the heterogeneity. Our analysis shows a significant prevalence of SLT use in women of reproductive age, especially in low socioeconomic and developing countries like India, Pakistan, and Nepal. For women of reproductive age, the use of smokeless tobacco (SLT) can lead to infertility, pregnancy complications, and adverse fetal outcomes, including low birth weight and preterm birth. The results highlight the necessity for specific public health measures and policy changes to decrease SLT consumption among reproductive-age women. Further studies are needed to investigate the reasons behind SLT usage in this group and to assess the impact of intervention strategies, to guide more effective public health initiatives and policies.

The Effect of Price and Tax Policies on the Decision to Smoke or Use Smokeless Tobacco in India.

This paper investigates the impact of cigarette prices on adults' smoking and smokeless tobacco (SLT) use initiation and cessation decisions in India from 1980 to 2017. We use individual-level data from the 2017 Global Adult Tobacco Survey (GATS) to recreate the smoking history of current or past adult tobacco users using self-reported data on the years of tobacco use, initiation, and cessation merged with historical data on cigarettes, bidis, and SLT product prices. To estimate the effect of price changes on smoking and SLT use transitions, we use a pooled linear model and propensity score matching (PSM) to construct an artificial treatment group where weights capture the likelihood of being an ever-smoker. We find that price increases are a statistically significant deterrent to smoking initiation, with price elasticity of initiation being on average -0.0236 (CI: -0.024 -0.023) and -0.000428 (0.0 - 0.0) for smoking and SLT, respectively. This implies, for example, that a 10% increase in prices results in a 0.24% smaller smoking initiation and 0.004% smaller SLT use initiation. We find that prices can also encourage quitting, but the effects are not always significant, with elasticities of 0.0218 (CI: 0.017 0.026) and 0.0026 (CI: 0.001 0.004) for smoking and SLT, respectively. This implies that a 10% increase in prices will result in a 0.22% increase in the probability of quitting smoking and a 0.03% increase in the probability of quitting SLT use. The elasticity varied by income group, gender, and between young and all adults, with larger effects among lower-income adults and especially among young females. Higher cigarette prices that can be achieved by tobacco tax increases can significantly reduce initiation and encourage cessation, thus improving public health, especially among the most vulnerable population subgroups.

Exposure to chewing tobacco promotes primary oral squamous cell carcinoma and regional lymph node metastasis by alterations of SDF1α/CXCR4 axis.

A high incidence of oral squamous cell carcinoma (OSCC) is observed in South-East Asian countries due to addictions such as chewing tobacco. Local invasion and distant metastases are primary causes of poor prognosis in OSCC. This study aimed to understand the alterations in metastasis biomarkers, such as stromal cell-derived factor-1α (SDF-1 or SDF1α) and its receptor C-X-C chemokine receptor type 4 (CXCR4), in OSCC patient samples that were stratified based on the history of addiction to chewing tobacco. Targeted immunohistochemical staining and Western blotting were performed on primary tumour and metastatic lymph node (LN) tissues in parallel. Overexpression of hepatocyte growth factor (HGF), activated form of its cognate receptor tyrosine kinase, c-Met (p-Met), GRB2-associated-binding protein 1 (Gab1), phospho-protein kinase B (pAkt), nuclear factor kappa B (NF-κB) and cyclooxygenase-2 (COX-2) were observed in primary tumour and metastatic lymph nodes in both chewer and non-chewer cohorts. Variance analysis showed significant positive correlation between them (P < .0001) indicating upregulation of these biomarkers upon ligand-induced activation of c-Met in both tobacco chewers and non-chewers. Significantly higher expressions of SDF1α and CXCR4 were observed in both primary tumours and metastatic lymph nodes of tobacco chewers (P < .0001) and coincided with overexpressed HGF. In contrast, no significant correlation was observed between expression of HGF and that of SDF1α and CXCR4 in non-chewers. Together, our findings provide important insights into the association of HGF/c-Met and the SDF1α/CXCR4 axis in lymph node metastasis and to an aetiological link with the habit of chewing tobacco.

Tobacco Smoking and Smokeless Tobacco Use among Domestic and International Medical Students in Hungary.

BACKGROUND: Medical students as future physicians will have an important role in tobacco control; therefore, their tobacco use behavior is of particular interest. Consumption of combustible tobacco (cigarettes, waterpipes, cigars, and pipes) is prevalent throughout Europe, whereas smokeless tobacco use is common mainly in the Nordic countries. Objectives: Aim of our study is to assess tobacco use among medical students from different countries studying in Hungary with special focus on students from Norway where smokeless tobacco is widely used. A self-administered questionnaire survey was carried out to measure current tobacco use. Results: The survey included 1337 students from Hungary, Norway, Germany, and from other countries (Multinational group). The lowest prevalence of cigarette smoking was found among students from Norway (13.0%) when compared with students from Hungary (21.5%), Germany (34.2%), or with students in the Multinational group (29.5%). Conversely, prevalence of smokeless tobacco use was the highest among students from Norway (40.9%) when compared with students from Hungary (1.4%), Germany (2.6%), or with students in the Multinational group (6.2%). Waterpipes, cigars, and pipes were rarely used, mostly only 1-3 times a month in all groups. More than half of Norwegian students used some form of tobacco (smokeless and/or combustible tobacco). Conclusions: Considering the impending role of medical students in tobacco control, faculties of medicine should sensitize their students on the topic of possible health risks associated with combustible and smokeless tobacco products. Culturally tailored tobacco cessation programs need to be offered to medical students coming from different cultural backgrounds.

Potential effects of using non-combustible tobacco and nicotine products during pregnancy: a systematic review.

BACKGROUND: The range of risk reduced alternatives to smoking tobacco is increasing and so is use among pregnant women. The substantial harms of smoking during pregnancy are well established and there is reason to believe that nicotine alone is somewhat harmful. Differences in the exposure chemistry strongly suggest that the effects of using smoke-free nicotine products (including pharmaceutical nicotine products, smokeless tobacco, and electronic cigarettes containing nicotine) fall somewhere in the range between zero risk to the risk from smoking. How much lower risk these consumption choices are in terms of pregnancy outcomes, however, remains uncertain. METHODS: We reviewed the literature on smoke-free nicotine and tobacco product exposure and birth-outcome endpoints. Studies were included if they compared outcomes to either no nicotine use or smoking. We searched Google Scholar using broad search terms and additional articles were snowballed from citations. We report what could be learned from each study, given its methods. RESULTS: Of the 21 studies reviewed, 12 reported on the use of nicotine replacement therapies, 7 on Swedish snus, 1 on Alaskan iq'mik, and 1 on e-cigarettes. The range of results tends to support the prediction that smoke-free product use during pregnancy probably increases the risk of some negative birth outcomes, but that any effect is less than that from smoking. However, the limitations of epidemiology are such that no more-precise a conclusion is possible. DISCUSSION: The available epidemiology does not change our prior beliefs, based on other evidence and knowledge, that the risks from smoke-free nicotine and tobacco are lower than those for smoking, though it suggests they are non-zero. However, it also demonstrates that the epidemiology is unlikely to provide precise quantitative estimates. This is not just a matter of lack of studies; given the inherent limitation of these studies, doubling or tripling the corpus of available studies would add little precision. For the foreseeable future, decisions about using these products will need to be made based on rough estimates, based on a variety of forms of evidence, and qualitative comparisons.

An Overview on Betel Quid and Areca Nut Practice and Control in Selected Asian and South East Asian Countries.

Background: Areca nut (AN) and betel quid (BQ) chewing are ancient practices followed by an extensive proportion of the world's population. These practices are endemic in larger parts of South and Southeast Asia and selected Western Pacific countries. The prevalence of these habits varies across regions, age, gender, cultural practice, and socioeconomic status groups. Considerable variations exist between countries with respect to prevention/intervention programs, and policy guidelines of BQ usage. Objectives: (1) To provide an overview of the BQ chewing prevalence, practices, preventive interventions and policies in selected Asian and Western Pacific countries. (2) To explore the different terminologies associated with BQ use. Method: A narrative review of the current literature related to BQ, AN, and oral cancer was conducted by searching PUBMED, CINAHL, and GOOGLE databases. Results: The literature review revealed that the prevalence of BQ was found to be highest in Papua New Guinea, followed by Bangladesh, India, Pakistan, Myanmar and Sri Lanka. While, Cambodia, Malaysia, Indonesia and Taiwan had comparatively lower prevalence. Smokeless tobacco, BQ with tobacco, BQ without tobacco, AN were some of the terminologies used for BQ in various studies. Conclusions: The prevalence, and the interventional policies related to BQ and AN chewing habits varies widely among the selected countries. With the increasing awareness and association of BQ with oral cancer, there is a need to have better awareness, prevention and interventional strategies in place. We also found considerable variation in the use of terminologies associated with BQ.

Tobacco Awareness with Socioeconomic Status and Pictorial Warning in Tobacco Cessation: An Exploratory Institutional Survey in a Semi-urban Population.

AIM: To explore the impact of socioeconomic status (SES) and/on the awareness of ill effects of tobacco on oral and general health and to evaluate the effectiveness of pictorial warning on tobacco cessation in a semi-urban population of South Chennai. MATERIALS AND METHODS: This cross-sectional survey for 1 week was conducted using a two-stage sampling design, with a sample size of 300. New op patients constitute the first sampling design, and patients with history of any form of tobacco constituted second sampling design for the second part of the study. Following an informed consent in patient's own language, and as per inclusion criteria's, new op patient was interviewed with questionnaire 1, which comprised 27 closed-ended questions to assess subject's general awareness on tobacco, awareness of ill effects of tobacco on oral and general health, and their SES. Sociodemographic information such as age, sex, marital status, occupation, address, educational level, and family income per month was also recorded. Response categories for each of the questions were "yes", "no", and "don't know". The Questionnaire-2 comprised 8 closed-ended questions that assessed the subject's willingness to quit and to evaluate the effectiveness of pictorial warning on tobacco cessation, which was subjected only to those patients who had a history of tobacco usage which was recorded after completing the Questionnaire-1. This group formed the secondary sampling unit. Questionnaire-2 also included an individual suggestion for the preference of type of warning sign on the tobacco packet/sachet in the end. Statistically, Cronbach's α coefficient, one-way analysis of variance, Tukey HSD post hoc tests, and Chi-square test were used. RESULTS: On the whole, this study reported good awareness about harmful effects of tobacco. In all, 33.2% of respondents could not change after noticing the warning ads, 90.3% of our respondents are not aware that a professional help is available to motivate quitting. Smokers were more aware than smokeless tobacco users, and tobacco users recommended a greater area to be covered for pictorial warnings and to increase the frequency to change the pictorial warning signs. CONCLUSION: Alarmingly high statistics and delayed presentation of oral and health hazards at the time of primary diagnosis underscores the need for an extensive awareness campaign on the issues related to ill effects of tobacco more focused on tobacco user's perspective and feedback. CLINICAL SIGNIFICANCE: Health awareness programs related to awareness of ill effects of tobacco should be tailor-made to the targeted population and should be more focused on the control of specific risk factors. Health warnings on tobacco packages that combine text and pictures, along with the frequent role of impact of mass media and campaigns on mouth self-examination and improvement in quality of life can effectively increase the general public awareness of the serious and deleterious health risks of tobacco use and to reduce its consumption.

Oral health consequences of smokeless tobacco use.

Smokeless tobacco (SLT) use has many oral effects including oral cancer, leukoplakia and erythroplakia, oral submucous fibrosis (if mixed with areca nut), loss of periodontal support (recession) and staining of teeth and composite restorations. This review was aimed to provide information to identify oral lesions that occur due to the use of smokeless tobacco so that effective interventions can be undertaken to reduce morbidity and mortality from the use of SLT.

Smokeless tobacco taxation: Lessons from Southeast Asia.

Southeast Asia accounts for nearly 86 per cent of the smokeless tobacco (SLT) consumers in the world. The heterogeneous nature of SLT is a major impediment to using taxation as a tool to regulate SLT. This study was aimed to review issues around fiscal policies on SLT with the objective of providing clarity on the use of taxation as an effective policy instrument to regulate SLT use. Descriptive statistics and graphical representations were used to analyze published data from different sources. An analysis of prices and tax between smoke and SLT products was done to understand the impact of tax policies on SLT consumption. India, Bangladesh and Myanmar together account for 71 per cent of the world SLT users. The retail prices (PPP$) and tax were lower for SLT in low- and lower-middle-income countries and higher in high-income countries, on an average, suggesting a direct relationship between the two. Evidence from India and Bangladesh suggested that taxation had significantly reduced SLT use among adults. The compounded levy scheme used in India to tax SLT was found effective after incorporating speed of packing machines into the assessment of deemed production and tax on SLT products. The current analysis shows that taxation can be an effective instrument to regulate SLT consumption if tax rates are harmonized across SLT products and in a manner not to encourage substitution with other tobacco products. It is also imperative to set a minimum floor price on all tobacco products including SLT.

Exposure and response to current text-only smokeless tobacco health warnings among smokeless tobacco users aged ≥18years, United States, 2012-2013.

INTRODUCTION: We assessed US adult smokeless tobacco (SLT) users' exposure and response to SLT health warnings, which are currently in text-only format, covering 30% of the two primary surfaces of SLT containers and 20% of advertisements. METHODS: Data were from the 2012-2013 National Adult Tobacco Survey. Past 30-day exposure to SLT health warnings among past 30-day SLT users (n=1626) was a self-report of seeing warnings on SLT packages: "Very often," "Often," or "Sometimes" (versus "Rarely" or "Never"). We measured the association between SLT health warning exposure and perceptions of SLT harmfulness and addictiveness using logistic regression. RESULTS: Of past 30-day SLT users, 77.5% reported exposure to SLT health warnings, with lower prevalence reported among females and users of novel SLT products (snus/dissolvable tobacco). Furthermore, exposure reduced linearly with reducing education and annual household income (p<0.01). Among exposed past 30-day SLT users, 73.9% reported thinking about the health risks of SLT, while 17.1% reported stopping SLT use on ≥1 occasion within the past 30days. Exposure to SLT warnings was associated with perceived SLT harmfulness (AOR=2.16; 95% CI=1.15-4.04), but not with perceived SLT addictiveness. CONCLUSION: Socioeconomic disparities found in exposure and response to SLT health warnings can be addressed through implementation of large pictorial warnings.

The Effects of Chewing Betel Nut with Tobacco and Pre-pregnancy Obesity on Adverse Birth Outcomes Among Palauan Women.

The small Pacific Island nation of Palau has alarmingly high rates of betel nut with tobacco use and obesity among the entire population including pregnant women. This study aimed to determine the effects of betel nut with tobacco use and pre-pregnancy obesity on adverse birth outcomes. This study used retrospective cohort data on 1171 Palauan women who gave birth in Belau National Hospital in Meyuns, Republic of Palau between 2007 and 2013. The exposures of interest were pre-pregnancy obesity and reported betel nut with tobacco use during pregnancy. The primary outcomes measured were preterm birth and low birth weight among full-term infants. A significantly increased risk for low birth weight among full-term infants was demonstrated among those women who chewed betel nut with tobacco during pregnancy when other known risk factors were controlled for. Additionally, pre-pregnancy obesity was associated with a significantly increased risk for preterm birth when other known risk factors were controlled for. Both betel nut with tobacco use and pre-pregnancy obesity were associated with higher risks for adverse birth outcomes. These findings should be used to drive public health efforts in Palau, as well as in other Pacific Island nations where these studies are currently lacking.

The impact of inter-survey differences in the definition of current smokeless tobacco use on comparability of US national and state-specific prevalence estimates, 2009-2011.

BACKGROUND: We assessed how varying definitions of adult current smokeless tobacco (SLT) use affected overall prevalence estimates. METHODS: National prevalence estimates were from five surveys: 2009-2010 National Health and Nutrition Examination Survey (NHANES), 2009-2010 National Adult Tobacco Survey (NATS), 2010-2011 Tobacco Use Supplement of the Current Population Survey (TUS-CPS), 2010 National Survey on Drug Use and Health (NSDUH), and 2010 National Health Information Survey (NHIS). State-specific prevalence estimates were from three surveys: 2009-2010 NATS, 2010-2011 TUS-CPS, and 2010 Behavioral Risk Factor Surveillance System (BRFSS). Current SLT use definitions were as follows: past 5-day use (NHANES), past 30-day use (NATS and NSDUH), and "every day" or "some days" use (TUS-CPS, NHIS, and BRFSS). Inter-survey variations further existed in number and types of SLT products assessed. RESULTS: National prevalence estimates of current SLT use were as follows: NATS (3.9%), NSDUH (3.6%), NHIS (2.8%), NHANES (2.3%), and TUS-CPS (1.6%). State-specific prevalence estimates of SLT use were generally lower for TUS-CPS (median=2.1%, range: 0.5% in California and New York, to 7.2% in Wyoming) compared to either BRFSS (median=4.0%: range: 0.9% in Washington D.C., to 8.2% in Wyoming) or NATS (median=4.7%; range: 1.3% in New Jersey, to 9.8% in Wyoming). CONCLUSION: Concerted efforts are needed among interagency groups to harmonize SLT definition within different surveys.

Understanding American Indian tribal college student knowledge, attitudes, beliefs, and behaviors surrounding alternative tobacco products.

OBJECTIVES: To examine knowledge, attitudes, beliefs, and behaviors about alternative tobacco products among American Indian tribal college students. PARTICIPANTS: One hundred and five tribal college students. METHODS: Focus groups, one interview, and demographic surveys. RESULTS: Tobacco use varied across the sample with 35.2% of the participants being users of ENDS products and 29.5% were cigarette smokers. Overall, participants viewed electronic nicotine delivery systems and chewing tobacco as primary examples of alternative tobacco products and described a generational divide between alternative and conventional tobacco product use. Alternative tobacco products were not considered suitable for use in traditional contexts. CONCLUSIONS: Previously successful cessation programs in this population have relied on cultural tailoring related to traditional tobacco use in American Indian communities. Our findings suggest that this strategy may be less effective for addressing alternative tobacco use. Reliance on the importance of family relationships may prove more impactful in future programming.

Chewing tobacco use among pregnant women in India: Analysis of national family health surveys.

BACKGROUND: India accounts for over 67% of chewing tobacco users globally and more than 50 million women in India chew tobacco. Chewing tobacco is documented to have negative effects on health of mother and foetus. This research was conducted to study the trends in chewing tobacco use among pregnant women in India, and identify factors associated with chewing tobacco use among pregnant women. METHODS: We analyzed micro-data from two representative national surveys i.e., National Family Health Survey (NFHS)-4 (2015-16) & NFHS-5 (2019-21). A sample of 32,428 & 28,408 pregnant women were extracted from NFHS-4 & NFHS-5 respectively. Weighted prevalence and 95% confidence levels of chewing tobacco use were computed. State wide comparisons in chewing tobacco use were made. Employing binary logistic regression, adjusted odds ratios (AOR) were computed to identify factors associated with chewing tobacco use. RESULTS: From NFHS-4 to 5 the prevalence of chewing tobacco use among pregnant women decreased from 4.0%(95% CI = 3.9-4.0) to 2.3%(95% CI = 2.2-2.4) respectively indicating a relative reduction of 42.5%. The highest prevalence remains to be in north-eastern India at 13.0%. Belonging to north-eastern region AOR = 7.0(95 %CI = 6.2-7.9), no-education AOR = 13.2(95 %CI = 10.5-16.5), poorest wealth index AOR = 6.7(95 %CI = 5.6-8.0) and belonging to scheduled tribe AOR = 2.6(95 %CI = 2.4-2.9) was significantly associated with chewing tobacco use among pregnant women. CONCLUSION: From NFHS-4 to 5, chewing tobacco use during pregnancy has shifted more towards socio-economically vulnerable population. Targeted approaches with accessible and affordable tobacco cessation advice integrated to primary healthcare system are needed.

The Association Between Smokeless Tobacco and a Lung Mass in a Healthy Young Male.

Smokeless tobacco is widely used in the United States. Many commonly used forms of smokeless tobacco may contain microorganisms that can change the oral flora of tobacco users. Here we present a case of a previously healthy 21-year-old male who presented with six weeks of worsening cough productive of yellow sputum as well as pleuritic left-sided chest and back pain. Computed tomography (CT) of the chest showed a large 3.9 x 5.5 x 6.3 cm mass-like lesion. He was extensively worked up for potential causes of this mass, including autoimmune, HIV testing, sputum staining for acid-fast bacilli, and fungal serologies. He was empirically treated with antibiotics and antifungals. He ultimately underwent a CT-guided biopsy which was negative for malignancy and tuberculosis. The culture from the biopsy revealed 5,000 colony forming units of Streptococcus intermedius. Based on the sensitivities of the culture, he was switched to intravenous ceftriaxone and discharged to complete a course of intravenous antibiotics.  This case showcases a healthy 21-year-old male with no prior history who had an extensive workup for the possible causes and risk factors predisposing to a lung abscess. This workup was negative, and his only risk factor was the use of smokeless chewing tobacco. Smokeless tobacco may be associated with increased risk of lower respiratory tract infections and can increase the risk of lung abscess in an immunocompetent adult. More research is required to understand this association.

Occurrence of Oral Premalignant Lesions Among Tobacco Users in a Tribal Population: A Systematic Review and Meta-Analysis.

This review aimed to comprehensively assess the association between tobacco use and oral health outcomes, specifically the presence of premalignant lesions (PMLs), through a synthesis of multiple assessments conducted in diverse populations. A systematic search of relevant literature was performed, and studies meeting the inclusion criteria were selected using appropriate Medical Subject Headings (MeSH) words and Boolean operators. Data from these studies was pooled and analysed using Review Manager 5.4 (The Cochrane Collaboration, The Nordic Cochrane Centre, Copenhagen). The Newcastle-Ottawa scale was used to assess the methodological quality of the studies included. The pooled analysis of the five selected papers revealed a significant correlation between tobacco use and an increased prevalence of PMLs among tobacco users. Tobacco users had an odds ratio of 15.22 (95% CI: 10.01-23.15) as compared to non-user cohorts, significant at p 0.0001. This comprehensive synthesis of assessments underscores the detrimental impact of tobacco use on oral health, particularly in terms of potentially malignant lesions. The findings emphasise the urgency of targeted public health interventions to address tobacco consumption and promote oral health awareness, especially in populations with high tobacco consumption rates. Standardisation of methodologies and representation of diverse populations in future research would strengthen the evidence base and facilitate more effective strategies to improve oral health outcomes globally.

Prevalence and factors associated with tobacco use among beneficiaries attending the youth mental health promotion clinics (Yuvaspandana Kendra) in India: A case-record analysis.

INTRODUCTION: Chewing tobacco and smoking among youth leads to poor health outcomes. Understanding the factors associated with chewing tobacco and smoking is thus important for interventions. METHODS: A case-record analysis among 10340 youth (aged 15-35 years) attending a unique mental health promotion program, Yuva Spandana, across the state of Karnataka in southern India, was performed to assess prevalence of chewing tobacco and smoking. Multiple logistic regression was applied to determine the factors associated with their use. RESULTS: Overall, the prevalence of chewing tobacco and smoking among beneficiaries was 3% and 2.1%, respectively. The risk of tobacco chewing and smoking increased with age and risk was higher among males, married individuals and among all occupational categories, other than students. Adjusted odds ratios of chewing tobacco were found to be highest among business/salaried beneficiaries (AOR=3.48; 95% CI: 2.27-5.34), followed by ever married beneficiaries (AOR=3.41; 95% CI: 1.27-9.17). Adjusted odds ratios of smoking tobacco were highest among males (AOR=12.89; 95% CI: 7.5-22.14), followed by emotional experience of feeling worthless (AOR=4.19; 95% CI: 2.78-6.32), beneficiaries with poor relationship with family members (AOR=3.79; 95% CI: 1.38-10.44), and business/salaried beneficiaries (AOR=2.90; 95% CI: 1.79-4.7). Strength of association of males with smoking was much higher (AOR=12.89; 95% CI: 7.5-22.14) than compared with chewing tobacco (AOR=2.49; 95% CI: 1.89-3.28). CONCLUSIONS: Early identification of these factors associated with chewing tobacco and smoking will help in focusing on youth specific health promotion and interventions to improve their overall health and wellbeing.

Harm reduction in tobacco control: where do we draw the line?

With substance abuse, harm reduction refers to reducing or replacing use of a harmful product with a less risky agent. But many advertised "non-pharmaceutical" harm reduction alternatives for tobacco smoking are problematic. Studies have revealed inconclusive results using agents including chewing tobacco and e-cigarettes to quit smoking and have demonstrated continued use of these agents. Many smoking harm reduction agents pose other health risks not found in traditional tobacco smoking. Given these limitations, efforts should focus on promoting nicotine replacement therapy, and other pharmacologic agents with a better chance of producing sustained smoking cessation. To address the harmful nature of many tobacco replacement products, public health should focus on regulating these alternatives with the same stringency as tobacco, and social marketing efforts should target evidence-based and safer pharmaceutical grade or behavioural alternatives.

Analysis of constituents present in smokeless tobacco (Nicotiana tabacum)using spectroscopic techniques.

Laser-Induced Breakdown Spectroscopy (LIBS) is an analytical technique used to identify and quantify the elements present in any type of material present in any phase (solid, liquid, gas, and aerosol). In the present work, our objective is to find the presence of toxic and other elements in chewing tobacco (Nicotiana tabacum) using LIBS. Spectral signatures of elements like C, Fe, Si, Mg, Mn, Ca, Ti, Na, H, N, K, O, along with some toxic elements Al, Sr, Li, Cu, Sb, and Cr are observed in the LIBS spectra of these tobacco samples. The spectral intensity ratio is measured for quantitative analysis of elements present in the samples. Further, Atomic Absorption Spectroscopy is used for determining absolute concentration in these samples. A relation between the AAS result and the relative intensity of spectral lines measured in the LIBS is obtained using regression analysis. The multivariate technique, Principal Component Analysis (PCA), discriminates all the samples based on their toxicity and other constituents. Molecular study (Photoacoustic spectroscopy (PAS), UV-Visible (UV-vis), and FT-IR) of tobacco samples were performed to analyze the molecules present in the tobacco samples.