Oral Health Consequences of Use of Smokeless Tobacco in North India: A Cross-Sectional Survey

ABSTRACT Objective: To evaluate the effects of commonly used smokeless tobacco forms on oral health at habitual placement sites of smokeless tobacco compared to non-placement sites among the North Indian population. Material and Methods: This cross-sectional study was conducted among 542 individuals using smokeless tobacco recruited from the outpatient wing of the Dental College. Subjects completed a questionnaire and received an oral examination. Periodontal pocket depth, gingival index, plaque index, gingival recession, and oral mucosal changes were assessed. Kendal's Tau test, paired t-test, and chi-square test were carried out to compare different variables among placement and non-placement sites. Results: Most of the subjects were male, reporting an average of 11.26 years of SLT use. Clinical inflammation of gingiva was significantly greater (p=0.01) at placement-sites (1.64 ± 0.53) of SLT in comparison to non-placement-sites (1.40 ± 0.41). The difference in the GR and PPD at placement and non-placement-sites was also statistically significant with p=0.002 and p=0.001, respectively. Clinically, the majority of subjects had mucosal changes at the placement sites, and a statistically significant association (p=0.034) was observed between the duration of the use of smokeless tobacco and the mucosal changes. Conclusion: Smokeless tobacco use predisposes to increased risk of periodontal diseases and oral mucosal changes at the placement sites in an individual due to the local irritant effect.

The effect of Maras powder and smoking on the microRNA deregulation of oral mucosa

Abstract Objective This study aimed to investigate the effects of Maras powder (a type of smokeless tobacco obtained from Nicotiana rustica Linn and mixed with the ashes of wood, especially from oak, walnut or grapevine) on the microRNA (miRNA) deregulation of oral mucosa, and it compares these effects with those of smoking. Methodology Oral mucosal samples were collected from 74 patients, consisting of 16 nonusers, 26 smokers, and 32 Maras powder users. Genes associated with oral cancer were selected and 90 microRNAs targeting these genes were identified. MicroRNA were isolated and purified using the microRNA isolation kit. MicroRNA were expressed using Fluidigm RT-PCR. Results A positive correlation between the duration of Maras powder use with miR-31 expression levels, and a negative correlation between the Maras powder chewing time and miR-372 expression levels was found. In addition, there is a negative correlation between the amount of Maras powder consumed and expression levels of miR-375, miR-378a, miR-145, and miR-10b; moreover, another negative correlation is observed between the number of cigarettes consumed and the expression levels of miR-23a, miR-23b, miR-203a, miR-200b, and miR-375. However, miR-200b and miR-92a levels were downregulated significantly more in Maras powder users when compared with smokers and nonusers (p<0.05). Conclusion The results show both chewing Maras powder and smoking have an effect on deregulation of miR-200b and miR-92a expressions. This leads to the belief that assessing the expression of these two miRNAs is a promising noninvasive method of analysis, especially in mutagen exposures. Finally, large-scale and high-throughput studies may help to identify an extensive miRNA expression profile associated with tobacco use and improve the understanding of oral malignancies.

The double burden of malnutrition among adults in India: evidence from the National Family Health Survey-4 (2015-16) / 한국역학회지

OBJECTIVES: India still faces the burden of undernutrition and communicable diseases, and the prevalence of overweight/obesity is steadily increasing. The discourse regarding the dual burden of underweight and overweight/obesity has not yet been widely explored in both men and women. The present study assessed the determinants of underweight and overweight/obesity in India among adult men and women aged 15-49.METHODS: Population-based cross-sectional and nationally representative data from the National Family Health Survey-4 (2015-16), consisting of a sample of men and women, were analyzed. Stratified 2-stage sampling was used in the NFHS-4 study protocol. In the present study, bivariate and adjusted multinomial logistic regression analyses were performed to determine the correlates of underweight and overweight/obesity.RESULTS: The results suggested a persistently high prevalence of underweight coexisting with an increased prevalence of overweight/obesity in India. The risk of underweight was highest in the central and western regions and was also relatively high among those who used either smoking or smokeless tobacco. Overweight/obesity was more prevalent in urban areas, in the southern region, and among adults aged 35-49. Furthermore, level of education and wealth index were positively associated with overweight/obesity. More educated and wealthier adults were less likely to be underweight.CONCLUSIONS: In India, underweight has been prevalent, and the prevalence of overweight/obesity is increasing rapidly, particularly among men. The dual burden of underweight and overweight/obesity is alarming and needs to be considered; public health measures to address this situation must also be adopted through policy initiatives.

Prevalence of Neoplasms among Former Adolescent Psychiatric Inpatients

OBJECTIVE: To examine the association between psychiatric disorders and neoplasms. METHODS: A follow-up study of a population-based cohort of patients admitted for psychiatric care between the ages 13–17 years. The cases were patients with a follow-up diagnosis of neoplasm. The K-SADS-PL interview was used to assess DSM-IV based psychiatric diagnoses at adolescence. The treatment episodes due to neoplasms and related psychiatric disorders were extracted from the National Health Care Registers. RESULTS: Of the original cohort, 6.3% of subjects had a neoplasm diagnosis. Male cases were characterized as taking snuff and females as having a fear of becoming obese. 75% of cases had smoked regularly and 47% suffered from substance misuse disorder already in adolescence. At a mean age of 22 years, the diagnoses of skin or soft tissue neoplasms were prevailing, three being malignant neoplasms of the skin, mouth or colon. Non-psychotic disorders were comorbid both two years before (26%) and after (33%) the neoplasm diagnosis. CONCLUSION: Focus on psychiatric symptoms of patients with neoplasms may enhance their treatment outcome and quality of life.

Smokeless Tobacco: Insight on Prevalence of Oral Manifestation

Objective: To determine the prevalence of oral mucosal lesions among smokeless tobacco users of Pakistani Population. Material and Methods: A cross-sectional study was conducted for a period of six months (from July 2017 to January 2018) at Dental Outpatient department of Sindh, via aid of a validated custom-made questionnaire. Random sampling technique was adopted among patients attending dental Outpatient Departments, making use of OPEN API online software determining sample size as 289, with limitation included exclusion of pregnant women, edentulous individuals, children under age of 18 years and those having oral manifestations associated with any systemic disease. Statistical analysis included Logistic Regression and Chi-square for determining odds' ratio and possible associations. Results: Logistic regression model 71% predicted discoloration of buccal mucosa 206 times in absence of any predictor variable. Discoloration of oral tissues was prevalent among individuals who chewed tobacco at least 6 times or more in a day. Periodontal associated damage was also prevalent among 6 times/day and more tobacco chewers. Statistically significant values were for normal buccal mucosa 06-10 times (p=0.007), white patch on buccal mucosa 11-15 times (p=0.0043) and swelled buccal mucosa 11-15 times (p=0.002). Conclusion: This study has demonstrated specific smokeless tobacco associated oral lesions. Further studies nationwide, addressing attributes of socioeconomic status and ethnicity with respect to composition of smokeless tobacco will reveal more conclusive findings.

Various Forms of Fatal Nicotine Intoxications: Three Cases Report / 대한법의학회지

Recently, fatal nicotine intoxications with electronic cigarette liquid have increased in Korea, but various kinds of cigarettes and smoking cessation aids may also cause fatal poisoning. We report cases of fatal nicotine intoxications involving causes other than the use of liquid nicotine. A 29-year-old woman (case 1) found dead in a hotel room with about 70 patches (21 mg dose) of nicotine on her body. Blood nicotine levels were 7.68 mg/L (heart) and 3.25 mg/L (femoral). A toxic level of zolpidem was also detected. A 28-year-old Uzbekistan man (case 2) was found dead in his uncle's room with his face covered with chewing tobacco. Blood nicotine levels were 7.3 mg/L (heart) and 4.6 mg/L (femoral). Blood alcohol level was 0.139%. A 55-year-old man (case 3) bit his tongue. As he was taken to the hospital, his wife put tobacco powders in his mouth for hemostasis, and he died of cardiac arrest. Blood nicotine levels were 2.01 mg/L (heart) and 0.96 mg/L (femoral). Nicotine-related deaths can be caused by various types of administration including transdermal and transmucosal routes, and relatively small doses may cause death, so meticulous investigation should be taken when such deaths are suspected.

Distal Radial Approach through the Anatomical Snuff Box for Coronary Angiography and Percutaneous Coronary Intervention

No abstract available.

O Chimó, uma Preparação de Tabaco sem Fumaça, está Associado a uma Frequência mais Baixa de Hipertensão em Indivíduos com Diabetes Tipo 2 / Chimó, a Smokeless Tobacco Preparation, is Associated With a Lower Frequency of Hypertension in Subjects with Type 2 Diabetes

Fundamentos: O uso do tabaco e a hipertensão arterial sistêmica (HAS) são as principais causas preveníveis de morte a nível global. O tabaco é apresentado nas formas com ou sem fumaça (TSF). O uso do TSF tem sido relacionado à doença cardiovascular, diabetes tipo 2 (DM2) e câncer. Na Venezuela, o chimó é a preparação de TSF mais comum e a sua relação com a HAS é desconhecida. Objetivo: Avaliar a relação entre o uso de chimó e HAS em uma população com alta prevalência de uso de TSF na Venezuela. Métodos: Entre 2013-2014, um total de 1.938 indivíduos com 20 anos ou mais foram avaliados consecutivamente em um centro médico. Foram obtidas medidas antropométricas e de pressão arterial (PA), além de respostas a um questionário padrão. Resultados: Os participantes tinham uma média de idade de 49,2 anos, 59,5% eram do sexo feminino, 38,9% apresentavam HAS, 23,2% relataram uso de TSF e 11,6% relataram ter DM2. Um terço dos indivíduos com DM2 eram usuários de TSF, e este grupo mostrou valores mais baixos de frequência cardíaca, PA sistólica, índice de massa corporal (IMC) e frequência de HAS quando comparado a sujeitos com DM2 não usuários de TSF (p < 0,05). Em indivíduos com DM2 com 50 anos ou mais, o uso de TSF foi associado a uma frequência 69% mais baixa de HAS quando comparados a indivíduos que não usavam TSF. Em regressão logística ajustada pela frequência cardíaca, idade, ocorrência de DM2, sobrepeso/obesidade e história familiar de HAS, o uso de TSF esteve associado a uma frequência 30% mais baixa de HAS (razão de chances 0,70; intervalo de confiança de 95% 0,55 - 0,90). Conclusão: O chimó, um TSF frequentemente utilizado na região dos Andes na Venezuela, está associado a valores mais baixos de PA, frequência cardíaca, IMC e frequência mais baixa de HAS em indivíduos com DM2 com mais de 50 anos. Esta associação contraintuitiva negativa entre o chimó e alguns fatores de risco cardiometabólicos realça o caráter complexo destas relações e a necessidade de estudos adicionais

Background: Tobacco use and hypertension are leading preventable causes of death globally. Tobacco is presented as smoked or smokeless tobacco (ST). ST use has been related to cardiovascular disease, type 2 diabetes (T2D), and cancer. In Venezuela, chimó is the most common ST preparation, and its relationship with hypertension is unknown. Objective: To evaluate the relationship between chimó use and hypertension in a population with a high prevalence of ST use in Venezuela. Methods: From 2013-2014, a total of 1,938 consecutive subjects aged 20 years or older were evaluated in a medical center. Anthropometrics and blood pressure (BP) measurements, and responses to a standard questionnaire were obtained. Results: The participants had a mean age of 49.2 years, 59.5% were female, 38.9% had hypertension, 23.2% reported ST use, and 11.6% reported having T2D. One-third of the subjects with T2D were ST users, and this group showed lower heart rate, systolic BP, body mass index (BMI), and frequency of hypertension when compared with T2D subjects who were not ST users (p < 0.05). In subjects with T2D who were 50 years or older, ST use was associated with a 69% lower frequency of hypertension when compared with subjects without ST use. On logistic regression adjusted by heart rate, age, occurrence of T2D, overweight/obesity, and family history of hypertension, ST use was associated with a 30% lower frequency of hypertension (odds ratio 0.70; 95% confidence interval 0.55 ­ 0.90). Conclusion: Chimó, a ST frequently used in the Andes region of Venezuela, is associated with lower BP, heart rate, BMI, and frequency of hypertension in subjects with T2D older than 50 years. This counter-intuitive negative association of chimó with some cardiometabolic risk factors highlights the complex nature of these relationships and the need for further studies

Smokeless tobacco (paan and gutkha) consumption, prevalence, and contribution to oral cancer / 한국역학회지

Smokeless tobacco consumption, which is widespread throughout the world, leads to oral submucous fibrosis (OSMF), which is a long-lasting and devastating condition of the oral cavity with the potential for malignancy. In this review, we mainly focus on the consumption of smokeless tobacco, such as paan and gutkha, and the role of these substances in the induction of OSMF and ultimately oral cancer. The list of articles to be examined was established using citation discovery tools provided by PubMed, Scopus, and Google Scholar. The continuous chewing of paan and swallowing of gutkha trigger progressive fibrosis in submucosal tissue. Generally, OSMF occurs due to multiple risk factors, especially smokeless tobacco and its components, such as betel quid, areca nuts, and slaked lime, which are used in paan and gutkha. The incidence of oral cancer is higher in women than in men in South Asian countries. Human oral epithelium cells experience carcinogenic and genotoxic effects from the slaked lime present in the betel quid, with or without areca nut. Products such as 3-(methylnitrosamino)-proprionitrile, nitrosamines, and nicotine initiate the production of reactive oxygen species in smokeless tobacco, eventually leading to fibroblast, DNA, and RNA damage with carcinogenic effects in the mouth of tobacco consumers. The metabolic activation of nitrosamine in tobacco by cytochrome P450 enzymes may lead to the formation of N-nitrosonornicotine, a major carcinogen, and micronuclei, which are an indicator of genotoxicity. These effects lead to further DNA damage and, eventually, oral cancer.

Comparison of Mineral Contents in Three Different Tobacco Formulations / 生物医学与环境科学（英文）

We identified and quantified a variety of mineral elements in 18 tobacco samples purchased from a Tunisian market. In total, 25 mineral elements have been measured in cigarettes, water pipe tobacco, and smokeless tobacco using inductively coupled plasma-optical emission spectroscopy following microwave-assisted digestion. Statistical analyses were performed using SPSSTM, version 18.0. The lowest concentrations of all studied elements were observed in water pipe tobacco. Significantly higher concentrations of Al, Fe, Mg, Na, Ca, Cr, and Co were found in smokeless tobacco, while cigarettes brands contained the highest concentrations of K, Mn, Ni, Ba, and Sr. There was no significant difference between the mineral contents of local and foreign cigarettes and conventional and light cigarettes. Our findings demonstrated that local smokeless tobacco appears to be the most hazardous tobacco type. The concentration of minerals in light cigarettes was not significantly different from the concentration in conventional cigarettes.

Smokeless tobacco (paan and gutkha) consumption, prevalence, and contribution to oral cancer / 한국역학회지

Smokeless tobacco consumption, which is widespread throughout the world, leads to oral submucous fibrosis (OSMF), which is a long-lasting and devastating condition of the oral cavity with the potential for malignancy. In this review, we mainly focus on the consumption of smokeless tobacco, such as paan and gutkha, and the role of these substances in the induction of OSMF and ultimately oral cancer. The list of articles to be examined was established using citation discovery tools provided by PubMed, Scopus, and Google Scholar. The continuous chewing of paan and swallowing of gutkha trigger progressive fibrosis in submucosal tissue. Generally, OSMF occurs due to multiple risk factors, especially smokeless tobacco and its components, such as betel quid, areca nuts, and slaked lime, which are used in paan and gutkha. The incidence of oral cancer is higher in women than in men in South Asian countries. Human oral epithelium cells experience carcinogenic and genotoxic effects from the slaked lime present in the betel quid, with or without areca nut. Products such as 3-(methylnitrosamino)-proprionitrile, nitrosamines, and nicotine initiate the production of reactive oxygen species in smokeless tobacco, eventually leading to fibroblast, DNA, and RNA damage with carcinogenic effects in the mouth of tobacco consumers. The metabolic activation of nitrosamine in tobacco by cytochrome P450 enzymes may lead to the formation of N-nitrosonornicotine, a major carcinogen, and micronuclei, which are an indicator of genotoxicity. These effects lead to further DNA damage and, eventually, oral cancer.

A Variant Extensor Pollicis Brevis Crossing the Anatomical Snuff Box / 계명의대학술지

During an educational dissection, accessory tendon of the extensor pollicis brevis muscle was found on the left side in a Korean cadaver. The abductor pollicis longus, extensor pollicis brevis, and extensor pollicis longus muscles showed normal morphology and course: however, narrow muscle belly originated between the extensor pollicis brevis and extensor pollicis longus muscles. It crossed the anatomical snuff box and then inserted on the base of the distal phalanx of the thumb. The author describes this previously novel case report and discusses the clinical implications of such a variant.

Trastorno dual en población general de Itagüí, Colombia / Dual Pathology in General Population of Itagüí, Colombia

Objetivos: Estudiar la prevalencia de trastorno dual (concomitancia de un trastorno por uso de sustancias y un trastorno mental) en la población general de una pequeña ciudad del departamento de Antioquia en Colombia, mediante el análisis secundario de datos del estudio en salud mental realizado en esta población en el año 2011. Métodos: Se aplicó a una muestra de 415 sujetos la entrevista Composite International Diagnostic Interview (CIDI), versión CAPI de la Organización Mundial de la Salud, y el análisis estadístico se realizó mediante el programa SPSS v.21. Resultados: Las prevalencias de vida y trastorno dual, considerando como tal el diagnóstico de un trastorno mental y un trastorno por uso de sustancias distintas del tabaco, fue del 7,2%. Las sustancias con mayores prevalencias de consumo en la vida para los sujetos con trastorno dual resultaron ser el alcohol (96,7%), la marihuana (80,0%), la cocaína y derivados (33,3%), la heroína (23,3%) y los tranquilizantes no recetados (13,3%); se encontró asociación estadística entre consumo de drogas y trastorno dual. La depresión mayor (40%), el trastorno negativista desafiante (36,7%), el estrés postraumático (33,3%), la fobia específica y el déficit de atención (26,7%) son los trastornos más prevalentes en los sujetos con trastorno dual de esta muestra. Consumir alcohol o drogas y cumplir criterios diagnósticos de trastorno dual presentan una asociación estadística significativa para el consumo de drogas como marihuana, cocaína, heroína y medicamentos sin prescripción médica (p < 0,001), todas con razones de disparidad (RD) > 1,00, muy altas cuando la droga consumida es la heroína (RD = 38,754) o los medicamentos no recetados (RD = 29,462). Tener antecedentes familiares de enfermedad y consumo de drogas presenta una alta asociación estadística con el trastorno dual, que es aún mayor con los antecedentes de enfermedad mental (p < 0,001; RD = 3,677). Conclusiones: El estudio da cuenta de la prevalencia de sujetos con trastorno dual en una población colombiana. El alcohol, la marihuana, la cocaína y derivados y la heroína son las sustancias mayormente consumidas por estos pacientes, y los trastornos mentales más prevalentes son la depresión, el TOD y el estrés postraumático. Estos hallazgos motivarán a los clínicos a buscar de manera más activa la presencia de trastorno dual para orientar más adecuadamente los planes de tratamiento.

Objectives: To study the prevalence of dual diagnosis (presence of a substance use disorder and an associated mental disorder) in the general population of a small town in the department of Antioquia in Colombia, through secondary analysis of survey data on Mental Health held in this city in 2011. Methods: With a sample of 415 subjects, the interview Composite International Diagnostic Interview (CIDI), WHO CAPI version, was used and statistical analysis was performed using SPSS v.21. Results: The prevalence of dual diagnosis, considering that the presence of a diagnosis of mental disorder and a disorder snuff use of different substances was 7.2%. Substances with higher prevalence of use in life for individuals with dual diagnosis were alcohol (96.7%), marijuana (80.0%), cocaine and derivatives (33.3%), heroin (23.3%) and finally no prescription tranquilizers (13.3%), finding statistical association between drug use and dual diagnosis. Major depression (40%), oppositional defiant disorder (36.7%), posttraumatic stress (33.3%), specific phobia and attention deficit (26.7%) are the most prevalent disorders in individuals with dual diagnosis of this sample. Alcohol or drugs consumption and fulfilling diagnostic criteria for dual diagnosis have a significant statistical association for consumption of drugs like marijuana, cocaine, heroin and prescription medications (P< 0.001), all with disparity ratios of >1.00, very high when the drug is heroin consumed (RD = 38.754) or non-prescription medications (RD = 29.462). A family history of disease and drug use has a high statistical association with dual diagnosis, with a higher association with a history of mental illness (P<.001; RD = 3.677). Conclusions: The study reports on the prevalence of subjects with dual diagnosis in a Colombian population. Alcohol, marijuana, cocaine and heroin are derivatives and substances mostly consumed by these patients and the most prevalent mental disorders are depression, TOD and posttraumatic stress. These findings motivate clinicians to more actively seek the presence of dual diagnosis, directing a more appropriately treatment plans.

Study of Some Cardiovascular Risk Factors in Tobacco Chewers and Non Tobacco Chewers.

Tobacco chewing is known causative factor of cardiovascular disorders and cancer. In India tobacco and gutkha chewing is very common. In present study effect of tobacco chewing was studied on other cardiovascular risk factors. This is comparative study done to see the association of smokeless tobacco consumption with blood pressure, heart rate, BMI and serum cotinine in adult male tobacco chewers. Methods: In present study 175 apparently healthy males were selected. Out of these 80 were tobacco non chewers and 95 were tobacco chewers. Parameters such as BMI, B.P., heart rate and serum cotinine were measured in both the groups. Result: No significant difference were observed among tobacco chewers and controls for heart rate and BMI, however, significant increase was observed in systolic and diastolic blood pressure (p > 0.001) in tobacco chewers as compared to tobacco non chewers. Conclusion: Significantly increased values of systolic and diastolic blood pressure indicated that tobacco consumption in any form increases the risk for cardiovascular diseases.

Are dental access centers, the potential locations for primary prevention of oral cancer

The objectives of the study was to determine the proportion of patients attending dental access centers that are at risk of developing oral cancer because of lifestyle habits. Data were collected prospectively about the smoking and smokeless tobacco habits of patients attending a dental access centre at Karachi Medical and Dental College and Abbasi Shaheed Hospital in Karachi. It was a cross-sectional questionnaire survey. Results showed that more than 50% of patients attending the dental access centre were smokers, with almost 30% of the patients in high or very high tobacco use groups. The majority of attendees were under 45 years of age. It was concluded that significant numbers of patients attending the dental access centre have lifestyle habits that make them vulnerable to oral cancer. Dental access centres could usefully provide opportunistic health messages to patients about risk factors in the development of oral cancer and could create smoking cessation programmes

Prevalence of pan, gutka, betalnut, naswar and cigarette smoking in university students of Karachi

To evaluate prevalence of pan, gutka. betal nut, niswar and cigarette addiction among students of different universities and to be familiar with perception of people about addiction and smoking free public places. Cross-sectional study This study was carried out at three different universities of Karach, i.e. Karachi University, NED University and Sindh Medical University, Karachi from 10.08.2012 to 05.01.2013. A cross-sectional study conducted with a total of 537 students aged between 18-28 years from three different universities of Karachi. A questionnaire was given to them containing 28 close ended questions about addiction of pan, gutka, betel nut, naswar and tobacco. The data obtained was analysed by using SPSS version 17. The results showed 67.5% [361] were males and 32% [171] were females.The prevalence of addiction of pan, gutka, betal nut, Naswar and cigarette smoking is higher among males than in female university students. Addiction of betal nut is found 41.55% in males and 12.86% in females. There were 71.1% males and 72.5% females in complete favor of smoke free public places. The perception about addiction was 5.62% of the males and 0.585% of the females feel that it's good About 56.5% of the males and 84.79% of the females note that it's deleterious to health. Most popular addiction is of betal nut. Many people think that public places should be smoked free. Most of them are aware of the deleterious effect of addiction to health and tried to quit but failed. Hence, it is suggested that some awareness program about quitting modalities should be introduced

Awareness of risk factors among medical students of Peshawar for using oral snuff [NASWAR] in causing oral cancer

Introduction: Naswar [in Pashto, Snuff in English] is a known risk factor in causing oral cancer. Many domestic and international studies have shown it to be associated with increased risk of developing oral cancer. Naswar addiction in men and women of Southern and Northern districts of KPK is considered a risk factor in causing serious health problems. This study aimed to evaluate the awareness level among medical students of Peshawar about the association of naswar with oral cancer

Material and Methods: It was a cross-sectional study based on online administered questionnaire in which perceptions were taken. A total of 50 medical students from different medical colleges participated to complete the online survey, developed using Google Spreadsheet form. SPSS version 15 was used for data analysis

Result: Out of 50 students n=45 [90%] were aware about the oral cancer. 68% [n=34] of students believed that naswar caused oral cancer and majority of the students [76%] thought naswar as social. Tobacco leaves were considered the main ingredient used in naswar, also 66% [n=33] of the students believed that it is not safe to use tobacco in some other form

Conclusion: Majority of medical students were aware of oral cancer and health hazards of naswar and its association with oral cancer. However, lack of correct information was observed in both users and non-users of naswar. This has implication for raising the incidence of oral cancer and addiction rate among vulnerable population, especially children

Smokeless tobacco use: A meta-analysis of risk and attributable mortality estimates for India.

BACKGROUND: Use of smokeless tobacco (SLT) is widely prevalent in India and Indian subcontinent. Cohort and case–control studies in India and elsewhere report excess mortality due to its use. OBJECTIVE: The aim was to estimate the SLT use‑attributable deaths in males and females, aged 35 years and older, in India. MATERIALS AND METHODS: Prevalence of SLT use in persons aged 35 years and older was obtained from the Global Adult Tobacco Survey in India and population size and deaths in the relevant age‑sex groups were obtained from UN estimates (2010 revision) for 2008. A meta‑relative risk (RR) based population attributable fraction was used to estimate attributable deaths in persons aged 35 years and older. A random effects model was used in the meta‑analysis on all‑cause mortality from SLT use in India including four cohort and one case–control study. The studies included in the meta‑analysis were adjusted for smoking, age and education. RESULTS: The prevalence of SLT use in India was 25.2% for men and 24.5% for women aged 35 years and older. RRs for females and males were 1.34 (1.27–1.42) and 1.17 (1.05–1.42), respectively. The number of deaths attributable to SLT use in India is estimated to be 368127 (217,076 women and 151,051 men), with nearly three‑fifth (60%) of these deaths occurring among women. CON CLUSION: SLT use caused over 350,000 deaths in India in 2010, and nearly three‑fifth of SLT use‑attributable deaths were among women in India. This calls for targeted public health intervention focusing on SLT products especially among women.