Tobacco use, exposure to second-hand smoke, and cessation training among the third-year medical and dental students in selected Member States of South-East Asia region: A trend analysis on data from the Global Health Professions Student Survey, 2005-2011.

Background: The Medical and Dental Global Health Professions Student Surveys (GHPSS) are surveys based in schools that collect self-administered data from students on the prevalence of tobacco use, exposure to second-hand smoke, and tobacco cessation training, among the third-year medical and dental students. Materials and Methods: Two rounds of medical and dental GHPSS have been conducted in Bangladesh, India, Myanmar, Nepal, Sri Lanka, and Thailand, among the third-year medical and dental students, between 2005 and 2006 and 2009 and 2011. Results: The prevalence of any tobacco use among third-year male and female medical students did not change in Bangladesh, India, and Nepal between 2005 and 2006 and 2009 and 2011; however, it reduced significantly among females in Myanmar (3.3% in 2006 to 1.8% in 2009) and in Sri Lanka (2.5% in 2006 to 0.6% in 2011). The prevalence of any tobacco use among third-year male dental students did not change in Bangladesh, India, Nepal, and Thailand between 2005 and 2006 and 2009 and 2011; however, in Myanmar, the prevalence increased significantly (35.6% in 2006 to 49.5% in 2009). Among the third-year female students, a significant increase in prevalence was noticed in Bangladesh (4.0% in 2005 to 22.2% in 2009) and Thailand (0.7% in 2006 to 2.1% in 2011). It remained unchanged in the other three countries. Prevalence of exposure to second-hand smoke (SHS) both at home and in public places, among medical students, decreased significantly in Myanmar and Sri Lanka between 2006 and 2009 and in 2011. Among dental students, the prevalence of SHS exposure at home reduced significantly in Bangladesh, India, and Myanmar, and in public places in India. However, there was an increase of SHS exposure among dental students in Nepal, both at home and in public places, between 2005 and 2011. Medical students in Myanmar, Nepal, and Sri Lanka reported a declining trend in schools, with a smoking ban policy in place, between 2005 and 2006 and 2009 and 2011, while proportions of dental students reported that schools with a smoking ban policy have increased significantly in Bangladesh and Myanmar. Ever receiving cessation training increased significantly among medical students in Sri Lanka only, whereas, among dental students, it increased in India, Nepal, and Thailand. Conclusion: Trends of tobacco use and exposure to SHS among medical and dental students in most countries of the South-East Asia Region had changed only relatively between the two rounds of GHPSS (2005-2006 and 2009-2011). No significant improvement was observed in the trend in schools with a policy banning smoking in school buildings and clinics. Almost all countries in the SEA Region that participated in GHPSS showed no significant change in ever having received formal training on tobacco cessation among medical and dental students.

Prevalence of smokeless tobacco use among adults in WHO South-East Asia.

Smokeless tobacco (SLT) use is an understudied problem in South-East Asia. Information on SLT use among the adult population was collected from various available sources. SLT use prevalence varies among countries in the region. The prevalence of SLT use is known for all countries at national level in the region with the exception of Bhutan and DPR Korea. For Bhutan, data pertains to Thimphu only. There is no available data on SLT use for DPR Korea. Using all available data from Bhutan, India, Myanmar, Nepal, and Sri Lanka, SLT use was found to be higher among males as compared to females; however, in Bangladesh, Indonesia, and Thailand, SLT use was higher among females as compared to males. Among males, prevalence of SLT use varied from 51.4% in Myanmar to 1.1% in Thailand. Among females, the prevalence of SLT use varied from 27.9% in Bangladesh to 1.9% in Timor-Leste. The prevalence also varies in different parts of countries. For instance, the prevalence of current use of SLT in India ranges from 48.7% in Bihar to 4.5% in Himachal Pradesh. In Thailand, prevalence of current use of tobacco use varies from 0.8% in Bangkok to over 4% in the northern (4.1%) and northeastern (4.7%) region. Among all SLT products, betel quid was the most commonly used product in most countries including Bangladesh (24.3%) and Thailand (1.8%). However, Khaini (11.6%) chewing was practiced most commonly in India. Nearly 5% of the adult population used tobacco as dentifrice in Bangladesh and India. SLT is more commonly used in rural areas and among disadvantaged groups. Questions from standard "Tobacco Questions for Surveys (TQS)" need to be integrated in routine health system surveys in respective countries to obtain standardized tobacco use data at regular intervals that will help in providing trends of SLT use in countries.

Special features of coronary heart disease in people of the Indian sub-continent.

Contrary to the popular belief, coronary heart disease (CHD) is indeed common in the Indian sub-continent. Expatriate Indians in their newly adopted countries have 3 to 5 times more chance of developing CHD than the native population or the other immigrant groups. The well-known risk factors such as hypercholesterolemia, hypertension and smoking do not appear to play a major role, while the syndrome of insulin resistance seems to be an important risk factor for CHD in people of this sub-continent. Abdominal obesity, hypertriglyceridemia, and low plasma HDL cholesterol are the markers of this syndrome. Increased plasma insulin levels or even better, the C-peptide measurement may help in identifying the abnormality early. As CHD among Indians has been found to be severe and more diffuse with serious complications and increased mortality at a younger age, preventive measures need to be instituted early. Low fat and complex carbohydrate diet along with regular aerobic exercise may help reduce abdominal obesity, improve insulin sensitivity and HDL cholesterol levels. Hypertriglyceridemia uncontrolled by above measures may require pharmacotherapy with agents such as gemfibrozil. Smoking must be stopped to help reduce insulin resistance and improve HDL levels and endothelial function. Those with hypertension should be considered for therapy with ACE inhibitors, which may improve insulin sensitivity. In patients with insulin resistance, therapy with metformin or troglitazone may be helpful.