Publications

To explore the subjective perceptions of women from rural and urban communities in Bangalore, India, regarding their perspectives about addictive substance use (ASU), and the interventions/support they need to quit use. Based on the data collected, the goal of this study was to develop an intervention that would address the women's needs. Mixed methods were used as follows: (a) door-to-door survey of women (N = 2044) regarding their use of addictive substances, and (b) focus group discussions with the women to explore their perceptions. Interviews were transcribed verbatim, themes and sub-themes identified. More than one-third (32.7%) reported past 3-month ASU, with majority reporting smokeless tobacco products (82.6%). Alcohol use was reported by 17.4%. Four major themes (with sub-themes) were identified from the focus group discussions: (1) Patterns of use (oral tobacco products-kaddipudi, thambaku; alcohol), (2) Reasons for use (to relieve stress and forget problems, tobacco use as a way of life, for postnatal benefits, due to easy availability, to reduce fatigue and pain, indigestion, hunger), (3) Low risk perception related to ASU ("We know how to use tobacco safely", "No real harm from tobacco"), and (4) Issues related to quitting ASU and help-seeking (unwillingness to quit, methods of intervention- "videos, or tablets/injections to help us quit ASU"). The findings highlight challenges involved in the development of effective interventions for women. Additionally, there is a clear need for broader community agencies to address psychological, cultural, and social dimensions.

Global consumption of smokeless tobacco (SLT) reached 300 million users worldwide majorly from middle-income countries. More than 4000 chemical compounds represent it as one of the noxious consumable products by humans. Besides toxicants/carcinogens, the heavy microbial load on smokeless tobacco further keeps human health at higher risk. Several of these inhabitant microbes participate in biofilm formation and secrete endotoxin/mycotoxins and proinflammatory-like molecules, leading to several oral diseases. Tobacco-associated bacteria exhibit their role in tobacco-specific nitrosamines (TSNAs) formation and acetaldehyde production; both are well-documented carcinogens. Moreover, tobacco exhibits the potential to alter the oral microbiome and induce dysbiotic conditions that lead to the onset of several oral and systemic diseases. Traditional cultivation approaches of microbiology provide partial information of microbial communities of a habitat; therefore, microbiomics has now been employed to study the metagenomes of entire microbial communities. In the past 5 years, few NGS-based investigations have revealed that SLT harbors four dominant phyla (Firmicutes, Proteobacteria, Actinobacteria, and Bacteroidetes) dominating Bacillus spp. and/or Pseudomonas spp. However, functional characterization of their genetic elements will be a more informative attribute to understand the correlation between inhabitant microbial diversity and their relatedness concerning abundance and diseases. This review provides an update on the microbial diversity of SLT and its associated attributes in human health. KEY POINTS: • Heavy microbial load on smokeless tobacco alarms for poor oral hygiene. • Inhabitant microorganisms of SLT participate in TSNA and biofilm formation. • SLTs alter the oral microbiome and causes oral dysbiosis.

A persistent challenge is characterizing patterns of tobacco use in terms of product combinations and frequency. Using Wave 4 (2016-17) Population Assessment of Tobacco and Health Study adult data, we conducted latent class analyses (LCA) of past 30-day frequency of use for 9 tobacco products. One-step LCA with joint multinomial logistic regression models compared sociodemographic factors between users (n = 13,716) and non-users (n = 17,457), and between latent classes of users. We accounted for survey design and weights. Our analyses identified 6 classes: in addition to non-users (C0: 75.7%), we found 5 distinct latent classes of users: daily exclusive cigarette users (C1: 15.5%); occasional cigarette and polytobacco users (C2: 3.8%); frequent e-product and occasional cigarette users (C3: 2.2%); daily smokeless tobacco (SLT) and infrequent cigarette users (C4: 2.0%); and occasional cigar users (C5: 0.8%). Compared to C1: C2 and C3 had higher odds of being male (versus female), younger (especially 18-24 versus 55 years), and having higher education; C2 had higher, while C3 and C4 had lower, odds of being a racial/ethnic minority (versus Non-Hispanic White); C4 and C5 had much higher odds of being male (versus female) and heterosexual (versus sexual minority) and having higher income; and C5 had higher odds of college or more education. We identified three classes of daily or frequent users of a primary product (cigarettes, SLT or e-products) and two classes of occasional users (cigarettes, cigars and polytobacco). Sociodemographic differences in class membership may influence tobacco-related health disparities associated with specific patterns of use.

Smokeless Tobacco (SLT) contains 9 times more nicotine than Smoked Tobacco (SMT). The carcinogenic effect of nicotine is intensified by converting nicotine-to-nicotine-derived Nitrosamines (NDNs).

Smokeless tobacco products possess a complex community of microorganisms. The microbial community ferment compounds present in the smokeless tobacco products and convert them into carcinogens like tobacco-associated nitrosamines. However, the potential of smokeless tobacco products associated bacteriome to manipulate systemic inflammation and other signaling pathways involved in the etiology of oral cancer will be a risk factor for oral cancer. Further, damage to oral epithelial cells causes a leaky oral layer that leads to increased infiltration of bacterial components like lipopolysaccharide, flagellin, and toxins, etc. The consumption of smokeless tobacco products can cause damage to the oral layer and dysbiosis of oral microbiota. Hence, the enrichment of harmful microbes due to dysbiosis in the oral cavity can produce high levels of bacterial metabolites and provoke inflammation as well as carcinogenesis. Understanding the complex and dynamic interrelation between the smokeless tobacco-linked bacteriome and host oral microbiome may help to unravel the mechanism of oral carcinogenesis stimulated by smokeless tobacco products. This review provides an insight into smokeless tobacco product-associated bacteriome and their potential in the progression of oral cancer. In the future, this will guide in the evolution of prevention and treatment strategies against smokeless tobacco products-induced oral cancer. Besides, it will assist the government organizations for better management and cessation policy building for the worldwide problem of smokeless tobacco addiction.

To understand how food laws are used, contested and interpreted to ban certain forms of chewing tobacco in India.

Smoked, and especially smokeless, tobacco are major causes of oral cancer globally. Here, we examine the oral bacteriome of smokers and of smokeless tobacco users, in comparison to healthy controls, using 16S rRNA gene sequencing.

It was observed that adult users start tobacco use in childhood or adolescence. The influence of digital and print media, social acceptance among peers, and in order to mimic role models from films attracts youth towards tobacco. Hence this study was conducted to assess the prevalence of smokeless tobacco (SLT) use among school-going adolescents with the assessment of the influencing factors such as exposure at school, home, and public places along with the role of various media in SLT use by adolescents.

The impact of smokeless tobacco (SLT) use on the risk of oral cavity cancer (OCC) has been confirmed; however, the sex-based difference in this association remains inconclusive. Therefore, this study aimed to estimate the association between SLT use and OCC risk in women and compared it to that in men.

 Tobacco use is one of the most important modifiable risk factors for cardiovascular mortality and has a synergistic effect with diabetes and hypertension. This study was conducted to estimate the prevalence of tobacco use and nicotine dependence among adult diabetic and/or hypertensive patients. We conducted a cross-sectional study among 419 consecutively enrolled patients from the non-communicable diseases (NCDs) outpatient clinic of a secondary level hospital in Ballabgarh, India between July 2018 and January 2019. We administered a pre-tested questionnaire to assess tobacco use and Fagerstrom Test for Nicotine Dependence (FTND) to assess nicotine dependence. Current tobacco users were defined as those who smoked in the past seven days. Nicotine dependence was classified as low, moderate or high for the FTND score of 0 -3, 4-6, and 7-10, respectively. Seventy-nine patients had diabetes, 226 had hypertension, and 114 had both. The prevalence of tobacco use was 20.8% (95% CI : 17.1 - 24.9); prevalence of smoking was 15% (95% CI: 11.9 â€" 18.8) and smokeless tobacco use was 7.2% (95% CI: 5 - 10.1). Moderate to high nicotine dependence was found among 59.7% of tobacco users; 75.9% tobacco users attempted to quit tobacco in the past one month. One-fifth of attendees of a NCD clinic in a secondary level hospital used tobacco, most of whom had moderate-to-high nicotine dependence.  High level of nicotine dependence and inability to quit despite making an attempt for it necessitates the inclusion of tobacco cessation services in the management of patients with non-communicable diseases.

Cessation of all forms of tobacco is necessary for controlling mortality associated with coronary artery diseases (CADs). In India, smokeless tobacco (SLT) is the most used form of tobacco. With around 60% of the world's smokeless tobacco users living in India, the task of tobacco cessation has become daunting and complicated for Indian researchers and policy makers.

Chewing tobacco and other types of smokeless tobacco use have had less attention from the global health community than smoked tobacco use. However, the practice is popular in many parts of the world and has been linked to several adverse health outcomes. Understanding trends in prevalence with age, over time, and by location and sex is important for policy setting and in relation to monitoring and assessing commitment to the WHO Framework Convention on Tobacco Control.

According to World Health Organization, the global cancer burden is estimated to have risen to 18.1 million new cases and 9.6 million deaths in 2018. Tobacco use is a leading cause of cancer and of death from cancer. Beedis are the most popular smoking form of tobacco in India. Thirty-four percent of the tobacco produced in India is used for making beedis. The beedi sector is agroforestry-based and the second largest industry in India with approximately 4.4 million full-time beedi workers in India. Toxic constituents present in tobacco are released into the ambient air during the processing of beedis.

Oral squamous cell carcinomas (OSCC) are caused by chronic tobacco abuse. In this regard, the carcinogenic potential of smoking and smokeless forms of tobacco, including chewing tobacco and moist/dry snuff, has been widely documented. However, the effects of tobacco-containing products such as creamy snuff on oral health have not been widely reported. Here, we report on the clinical presentation of a patient with OSCC induced by concurrent chewing tobacco and creamy snuff use. The development and progression of mucosal carcinogenesis in the context of mixed tobacco use habits is discussed. With the increased availability of newer tobacco-containing products, it is important for clinicians to be aware of these products in the marketplace, including dentifrices and nicotine pouches, and counsel their patients regarding their health risks.

Smokeless tobacco (SLT) consumption during pregnancy is a well-recognized health risk that causes placental damage including hypoxia and oxidative damage. Although consumption of SLT by women varies from region to region, majority of tea leave pluckers consume SLT for relieving stress and pain. Still, the effects of SLT consumption have not been evaluated in tea garden workers (TGW). While previous studies have attempted to report effects of cigarette smoke using in vitro model, hypoxia-inducible factor (HIF)-1α expression in human placentae from pregnant women exposed to SLT has not been previously studied. This study was aimed to explore the effects of SLT consumption on placental structure, expression of HIF-1α and oxidative DNA damage in sample population of TGW.

Squamous cell carcinoma is the most frequent head-and-neck malignancy and chiefly encompasses malignancies of the upper aerodigestive tract, including the oral cavity, nasal cavity, paranasal sinuses, nasopharynx, oropharynx, hypopharynx, pharynx, and larynx.

Findings of studies testing the association between smokeless tobacco (SLT) use and periodontal health have shown varying results in different populations. Considering the high prevalence of SLT use in India, the present study was conducted to understand the pattern of periodontal destruction within different areas of the dentition among SLT users.

To quantify the extent of awareness regarding the harmful effects of tobacco among the users (both smoked and smokeless) and non-users in India, and explore the determinants of comprehensive knowledge among the participants of the Global Adult Tobacco Survey (GATS), India.

Tobacco is one of the main reasons behind the occurrence of oral cancer. Oral cancer, even though being the tenth most common cancer in the world, gets diagnosed at an advanced stage and ends up with poor prognosis. So early diagnosis is the need of the hour. Our study aimed to evaluate the genotoxic changes in patients with different tobacco habits using buccal exfoliated cells.

Smokeless tobacco (SLT) consumption is presumed to be one of the major causes of high incidence of oral cancer in India. The present study aimed to document various types of SLT products consumed and their potential impact on the genome instability on the population from Assam state in Northeast India. A cross-sectional study (n = 5000) showed that 60.56 % of the study population consumed at least one of the three forms (sadagura, zarda and khaini) of SLT of which 52.0 % were only sadagura users. Genotoxicity assessment using buccal cytome assay in 240 age and sex matched volunteers revealed that except for zarda, other forms of SLT induced significantly higher incidence micronuclei in the buccal epithelial cells compared to the control individuals. Similar effects were also observed in other cytome parameters related to cell proliferation, cytokinesis defects and cell death. Significantly higher incidence of micronucleus was observed among sadagura and khaini users in lymphocyte cytokinesis-blocked micronucleus assay. The addition of lime in sadagura increased the pH and anion levels which possibly result in higher absorption and may lead to the development of cellular anomalies.

This study aims to examine how e-cigarette prices and advertising, key determinants of e-cigarette demand, are associated with the demand for smokeless tobacco (SLT) products in the US. Market-level sales and price data by year (2010-2017), quarter, and type of retail store were compiled from Nielsen retail store scanner database. E-cigarette TV advertising ratings data were compiled from Kantar Media. Four-way (market, year, quarter, store type) fixed-effect models were used to estimate the associations between e-cigarette price and TV advertising and sales of SLT products (chewing loose leaf, moist snuff, and snus). Our results showed that a 1% rise in own price was associated with a reduction in sales by 1.8% for chewing loose leaf, 1.6% for moist snuff, and 2.2% for snus, respectively. In addition, a 1% rise in disposable e-cigarette price was associated with 0.3% and 0.6% increased sales for moist snuff and snus, respectively. The association between e-cigarette TV advertising and SLT product sales was not significant. Our results suggest that disposable e-cigarettes and certain SLT products (moist snuff and snus) are potential substitutes. Policies aiming to regulate e-cigarette use and sales need to consider their potential link with the demand for SLT products.

Areca nut is one of the most widely consumed substances globally, after nicotine, ethanol and caffeine and classified as carcinogenic to humans. This study examines the disparity and determinants of areca nut consumption with and without tobacco in India.

Shammah is a smokeless tobacco product often mixed with lime, ash, black pepper and flavorings. Exposure to shammah has been linked with dental diseases and oral squamous cell carcinoma. There is limited literature on the prevalence of shammah and its role in pathobiology of oral cancer. In this study, we developed a cellular model to understand the effect of chronic shammah exposure on oral keratinocytes. Chronic exposure to shammah resulted in increased proliferation and invasiveness of non-transformed oral keratinocytes. Quantitative proteomics of shammah treated cells compared to untreated cells led to quantification of 4712 proteins of which 402 were found to be significantly altered. In addition, phosphoproteomics analysis of shammah treated cells compared to untreated revealed hyperphosphorylation of 36 proteins and hypophosphorylation of 83 proteins (twofold, p-value ≤ 0.05). Bioinformatics analysis of significantly altered proteins showed enrichment of proteins involved in extracellular matrix interactions, necroptosis and peroxisome mediated fatty acid oxidation. Kinase-Substrate Enrichment Analysis showed significant increase in activity of kinases such as ROCK1, RAF1, PRKCE and HIPK2 in shammah treated cells. These results provide better understanding of how shammah transforms non-neoplastic cells and warrants additional studies that may assist in improved early diagnosis and treatment of shammah induced oral cancer.

p16 is overexpressed in oral squamous cell carcinoma patients who are positive for human papilloma virus. The p53 tumor suppressor gene is commonly mutated in human cancer. The aim is to correlate clinical and pathological features with p16 and p53 expression. This is a prospective, observational study of 50 consecutive cases (43 males and 7 females) who underwent surgery for oral cancer. p16 and p53 were determined by immunohistological staining. The results were obtained and analyzed using chi-square test (Statistical Software SPSS 21.0 version); value ≤ 0.05 was considered significant. Of the 50 cases, p16 and p53 were overexpressed in 30% and 54% of patients, respectively. Overexpression of p16 was not significantly associated with age, subsites of oral cavity, or degree of differentiation. However, smokeless tobacco was significantly associated with p16 expression ( = 0.012). Similarly, overexpression of p53 was not correlated with age, subsites of oral cavity, or degree of differentiation. Seventy-five percent of poorly differentiated cancers had overexpression of p53 though this did not reach statistical significance ( = 0.279). p53 was overexpressed in smokers (80.95%) and those consuming alcohol (60%).

Countries globally are evaluating the concept of herd immunity and its critical role in the control of pandemic. The current paper attempts to conduct a critical interpretative synthesis (CIS) on the role of herd immunity in current COVID-19 pandemic.

Consumption of tobacco leads to a myriad of ill effects among the smokers as well as those in their proximity. The study related to tobacco consumption was conducted among individuals over 15 years of age, residing in urban slums.

Smokeless tobacco use is a public health problem in some parts of the world. The major objective of this study was to investigate the reasons and factors of consumption.

Tobacco consumed as smoke and smokeless forms is an important preventable public health issue projected to be the single largest cause of mortality worldwide. The aim of the study was to qualitatively assess the attitudes towards smoking, quitting and tobacco control policies among current smokers of different socio-economic status.

The Narikuravars or "gypsy" are a semi vagrant groups distributed across borders, but primarily live in Tamil Nadu, India. They are notorious to face discrimination that interprets into low education level, low socio-economic status and lack of pertinent access to health care. The focus of the present study is to determine the prevalence and dependency with tobacco use among tribal gypsies in Thoothukudi district.

Globally, the sixth most common malignancy is oral cancer, which is predominantly due to consumption of potent, proven carcinogens which includes smoking and smokeless form of tobacco and areca nut. Habits associated oral malignancies are mostly preceded by clinically asymptomatic oral lesions collectively referred under the umbrella term as oral potentially malignant disorders (OPMDs). There is a delayed presentation of oral pre cancer and oral cancer in India, as approximately 50% of patients are diagnosed at last stage since the asymptomatic pre cancer lesions are missed by oral physicians/dentists either due to lack of timely communication and habit counseling, lack of knowledge, or inappropriate attitude, putting all in a nut shell --- sheer lack of empathy and commitment towards patient care and society. Early diagnosis greatly increases patient's chances of survival. Patient awareness is much spoken in literature; however, the flip side of the coin lies within the attitude of the primary care physician. They play a pivotal role in effective communication and timely counseling of patients with OPMDs and should prevent malignant transformation to improve quality of life of patients. Poor compliance to attend for oral cancer screening links to the attitude and ignorance of the primary care physician. Palliative care concepts should be integrated to dentistry especially to oral medicine speciality.

Cardiovascular disease (CVD), the leading cause of death worldwide is responsible for over 17 million deaths globally, of which 10 per cent deaths have been expected due to consumption of tobacco. The association between CVD and chewing of tobacco is limited and remains arguable. The aim of this study was to find out the correlation between urinary cotinine level and cardiovascular autonomic function tests of tobacco chewers.

To evaluate and correlate the salivary urea and creatinine levels to the serum levels in smokeless tobacco (SLT) chewers.

Construction workers are one of the important neglected occupation groups. The study aimed to assess the prevalence and health risk score of tobacco and alcohol use and its association with sociodemographic factors and self-reported morbidities among construction workers.

While firefighters currently have low smoking rates, rates of smokeless tobacco (SLT) use among this population are remarkably high and substantially greater than similar occupational groups, and the general population. This study explored determinants associated with SLT use, barriers to cessation, and motivators for SLT cessation in the fire service. Key informant interviews were conducted in 23 career firefighters who were current (n = 14) and former (n = 9) SLT users from across the U.S. Discussions were recorded and independently coded according to questions and themes. Major themes that developed among firefighters regarding SLT use determinants included positive perceptions of SLT products, social influences from their peers and family members, acceptability of SLT use in the fire service, and a coping resource for job stress. Firefighters discussed several barriers to SLT cessation, including intrapersonal barriers such as SLT use habits and its dependency, concerns about withdrawal symptoms; and social-environmental barriers including lack of support from health and other services providers, and lack of enforcement of existing tobacco policies regarding SLT use. Firefighters also mentioned both internal and external motivators for cessation. Internal motivators included self-motivation and their health concerns while external motivators included friends and family support, incentives or rewards, and price of SLT products. Findings provide unique perspectives from firefighters on factors that influence SLT use and barriers and motivators to SLT cessation. These are insufficiently assessed and considered by the fire service organizations and their health care providers. Thus, the organizations must understand these issues in order to mitigate barriers and motivate the personnel to quit using SLT. Information gained from firefighters who were current and former SLT users can be used to develop an effective, culturally-tailored intervention that is acceptable to fire service personnel.

An individual's risk towards development of cancer depends not only on environmental factors or extrinsic exposure to carcinogens but also on individual's genetic susceptibility.

No study among Indian population has proposed modification of existing cardiovascular disease (CVD) risk scores or novel risk scores as risk estimation using conventional risk calculators can't be generalized because of epidemiological differences.

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).

In today's world, the mass media plays an important role, and it can provide a unified platform for all public health communication, comprehensive healthcare education, and guidelines. As a result, we investigated the various types of general health and oral health messages and advertisements broadcast through various forms of mass media.

Compare the brand availability, pricing and presence of illicit products in semi-urban and rural areas in India across product types and states. In late 2017, 382 unique tobacco products were purchased from localities with populations under 50,000 in the states of Assam, Karnataka, Maharashtra, Rajasthan, and Uttar Pradesh. Brand, printed maximum retail price, price paid, tax, and health warning labels (HWLs) were used to compare the market for bidis, smokeless tobacco (SLT), and cigarettes. Brand availability and pricing of SLT products was similar to cigarettes. Brand availability and pricing of bidis was consistent with having many small producers. Bidis and single serving SLT with spice mixtures were more affordable than cigarettes and SLT sold alone. 2% of SLT and 10% of cigarettes did not feature an India HWL. The elimination of single serving SLT packets and the removal of tax exemptions for small producers, often exploited by bidi producers, could reduce their respective affordability. State differences in illegal and illicit products could indicate a greater need for enforcement in some states.

This study aimed to evaluate and compare changes in the mandibular trabecular bone pattern using the fractal dimension (FD) and lacunarity analysis in tobacco users with healthy controls. This study was carried out on digital panoramic radiographs of 225 subjects divided into three groups: smokeless tobacco users (SLTs), smokers, and control (n=75). ImageJ program with FracLac plugin was used to assess the FD and lacunarity of mandibular trabecular bone on the digital panoramic radiographs. The differences in the mean FD values of the study and control groups were statistically significant ( < 0.001). Mean FD was lower in the case groups than the control group, with SLTs having the least FD value. A significant difference in lacunarity was noted between SLTs and controls ( < 0.001). On the contrary, there was no significant difference in lacunarity between smokers and controls. FD values were lower in tobacco users, suggesting that tobacco users have a less complex trabecular bone pattern than healthy controls. Higher lacunarity values in SLTs indicated a more heterogeneous bone pattern. These findings signify that FD and lacunarity analysis on digital panoramic radiographs can serve as promising predictive tools to assess bone quality for osteoporotic changes in tobacco users, thereby facilitating prompt referral for further management.

The metabolic syndrome has become one of the major public-health challenges worldwide which include diabetes, prediabetes (raised blood glucose level), abdominal obesity, high cholesterol level, and high blood pressure. Periodontitis is described as a multi-factorial irreversible and cumulative condition and, is also the sixth complication of diabetes. Areca nut chewing has already been linked with the development of various cancers, and more recently with metabolic syndrome. Therefore, the purpose of the study is to investigate the association of periodontal inflammatory conditions among gutka chewing with and without prediabetes patients.

Tobacco is the leading cause of death and disease in India. This study examines the effect of training intervention in behavioral counseling on intention to quit tobacco in primary healthcare settings in India. The intervention included training to improve behavioral counseling practices of primary care physicians (PCPs) based on the 5As approach to increase patients' motivation to quit tobacco.

The use of tobacco, especially smokeless variety, is common and culturally accepted among Indian women. Hence, oral cavity cancers rank as the fourth most common cancers among Indian women.

Verrucous carcinoma or Ackermann's tumor is considered a low-grade variant of squamous cell carcinoma frequently presenting at the oral mucosa and skin. Oral verrucous carcinoma clinically presents as a proliferative or cauliflower-like lesion or as ulceroproliferative lesion on the buccal mucosa followed by other sites such as the gingiva, tongue, and hard palate. Tobacco in both smoking and smokeless form, alcohol, and opportunist viral infections are the most associated etiologies in most of the reported literature cases. Here, in this paper, we discuss a rare case scenario of a 52-year-old female diagnosed with verrucous carcinoma of the left buccal mucosa with constant traumatic irritation caused by tooth as etiology for the occurrence of lesion, though verrucous carcinoma is described as a benign lesion with minimum aggressive potential but long-standing cases have shown transformation into squamous cell carcinoma. Therefore, early diagnosis and surgical excision of the lesion are the most appropriate treatment modality of verrucous carcinoma.