Smokeless Tobacco Use among Women in Kasama District-Zambia

Background: Smokeless tobacco is defined as a product that contains tobacco, is not smoked or burned at the time of use, and commonly consumed orally or nasally. These products can be placed in the mouth, cheek or the lip and are sucked or chewed. The Zambian government, in the 2019 country report, gave an estimated figure of 4.5% of females aged 15 years and above in 2017 used smokeless tobacco and by 31st December, 2018, there was an increase of smokeless tobacco users to 6.8% women of the same age group. This study aimed to explore the extent of smokeless tobacco use among women in Kasama district-Zambia. Methodology: An analytical cross-sectional quantitative study design was used to collect data using the modified structured interview schedule, adopted from Medicine for Global Health. Simple random sampling method using rotary technique was used to select 430 respondents after meeting the inclusion criteria. Informed consent to participate in the study was obtained. Data was analysed using version 26.0 of the Statistical Package for Social Sciences. Appropriate parametric or non-parametric statistical tests (Chi-squared or Fisher’s exact test) were adopted in testing for associations between variables. Univariable and multivariable binary logistic regression analysis were employed in identifying smokeless tobacco use among women using an investigator-led stepwise approach, guided by various fit statistics and the likelihood ratio test. All statistical analyses adopted a 5% significance level at 95% confidence interval. Results: The results showed that most of the respondents were aged between 18 and 25 years (45.6%), (53.7%) lived in urban settlements and the majority (80%) were unemployed. The majority of respondents (83.5%) had a friend/relative who used smokeless tobacco and over half (53.5%) thought smokeless tobacco was beneficial to them. The commonly mentioned benefits of smokeless tobacco included body warmth (13.6%) and vaginal tightening (7.9%). The results revealed that most of the respondents attained a secondary level of education (38.4%). According to the study, smokeless tobacco use among women of Kasama-Zambia was significantly associated with the following;age (p Conclusion: Based on these findings, the study recommends that efforts should be channeled towards the dissemination of information on the impacts of smokeless tobacco use in order to overcome cultural beliefs attached to smokeless tobacco use.

The effects of oral smokeless tobacco administration on endurance performance

Background： Smokeless tobacco is widely used by athletes to enhance performance. Nicotine is a central nervous system stimulant and acts on cardiocirculatory and metabolic systems, involving tissue blood flow and circulatory vasoreactivity. The aim of this study was to investigate the effects of the oral smokeless tobacco （Swedish snus （SS）） on the perception of fatigue and time to exhaustion （TTE） during moderate-intensity aerobic exercise. Methods： Fourteen healthy non-tobacco male users were recruited for a double-blind, controlled crossover design （SS vs. snus placebo （SP））. Subjects were tested for 3 sessions： experimental session 1 （Exp 1） consisted of an incremental test to determine the maximal aerobic power out-put （Wmax）, whereas Exp2 and Exp3 consisted of exercising at 65%Wmax until exhaustion in SS or SP conditions. During Exp2 and Exp3, muscle and cerebral oxygenation was assessed by means of near-infrared spectroscopy, and the rating of perceived exertion （RPE） was recorded. Results： Comparing SS with SP tests, significant differences （p 〈 0.05） were found in the values of cerebral （-3%） and muscular tissues oxygenation （-4%） in the first 30 min of exercise. The RPE values were not significantly different between the 2 conditions （SS vs. SP）. No significant difference was found in TTE （SS： 54.25 ± 21.84 min; SP： 50.01 ± 17.03 min）. Conclusion： This study showed that muscular and cerebral oxygenation increased significantly with snus administration during an endurance exercise until exhaustion, but this did not affect fatigue perception and TTE. The results showed that snus could not be considered an ergogenic substance in non-tobacco users.2018 Published by Elsevier B.V. on behalf of Shanghai University of Sport. This is an open access article under the CC BY-NC-ND license. （http：//creativecommons.org/licenses/by-nc-nd/4.0/）.

Histological Features of Parotid Gland of Albino Rats Exposed to. Smokeless Tobacco

Smokeless tobacco is very common personal habit of people living in various areas of Asia which is an alarming sign for the development of different oral diseases in such people. The aim of present study was to investigate effects of smokeless tobacco on parofid glands of the Aalbano rats by using various percentages of the smokeless tobacco. The rats were divided into three different groups, control group （A） no smokeless tobacco, experimental group （B） 5% smokeless tobacco and experimental group （C） 10% of smokeless tobacco with different feeds required according parameters. Weekly weight gain and partid gland were analyzed through student P test and histological structures were recorded through HE stain and Retculin stain. The results showed that as compared to control group body, weight of the rats was decreased in groups B and C having smokeless tobacco percentage in the diet. Weight of parotid gland as compared to control group was decreased in groups B and C with diet of smokeless tobacco. Further, histological observation under HE stain showed that parofid gland of group B showed mild narrowing of ductal lumen, collapse of vessels and stromal was also increased, in group C parenchyrnal tissues with loss of acini found damaged and glandular dystrop and lymphatic infiltration were determined moderate to severe. Meanwhile, reticulin stain showed that vascular collapses were shown because of increasing in stromal glandular atrophy in group C as compared to control group. In conclusion, this study showed that smokeless tobacco caused serious injuries in the tissue level in parotid gland with high percentage of smokeless tobacco which highlight health hazards on its consumption.

Gene Expression Changes and Signal Transduction Pathway Alterations in Primary Human Oral Epithelial Cells Exposed to Smokeless Tobacco Extracts

Smokeless tobacco (ST), an alternative to smoking, has gained wide popularity among tobacco users. This study is conducted to determine the time course of gene expression associated with specific signaling pathways in human oral epithelial cells after exposure to smokeless tobacco extract (STE). A differentiated layer of epithelial cell is created as a way to mimic reasonably similar physiological atmosphere. A dose and time dependent response is observed for cell viability and cell proliferation assays indicating that this model system is responsive to the treatment. Expressions of 84 genes representing 18 different signal transduction pathways are quantitated. This is accomplished by using real-time polymerase chain reaction arrays at 1 h, 3 h, 6 h and 24 h time points following exposure to STE. Changes in gene expression are observed on many cellular processes including cell cycle regulation, cell adhesion, inflammation, apoptosis, and DNA breaks-down including Akt pathway activation. Short time exposure (1 h) leads more genes to down regulate whereas longer incubation time results in more genes up regulation. Most notable differences in the expression of genes during the course of treatment are BCL2A1, BIRC3, CCL20, CDK2, EGR1, FOXA2, HOXA1, IGFBP3, IL1A, IL-8, MMP10, NOS2, NRIP1, PTGS2, SELPLG and TNF-a. This study provides an insight on gene expression on oral epithelial cells as a result of STE exposure. This may also postulate greater understanding on biological effects and the mechanism of action of STE particularly at the transcriptional level.

Pregnancy Outcomes in Smokeless Tobacco Users Cohort Study in a Tertiary Care Hospital

There is a dearth of literature regarding the pregnancy outcomes in antenatal women using smokeless tobacco products (STP). Objective: To compare maternal and neonatal pregnancy outcomes in antenatal women using smokeless tobacco products with those not using tobacco products. Method: Pregnant women attending antenatal clinic at Guru Teg Bahadur hospital, Delhi received brief information about smokeless tobacco products. Antenatal women using STP and matched controls, 92 in each group (total 184) were recruited for the study. After obtaining consent, the urinary cotinine level was measured in both groups at first contact. Antenatal, labour and postpartum events were recorded in both groups. Urinary cotinine levels were again measured at 6 months in the user group. Results: Average age of antenatal women under study was 24.8 yrs and 25.21 yrs in user and non-user groups respectively. More women in the user group were illiterate (P ? 20.39 μg/ml and 24.37 +/? 20.14 μg/ml respectively (p < 0.0001). Women using STPs for more than 5 yrs recorded higher urinary cotinine levels. There was no significant difference in urinary cotinine levels with the type of tobacco product consumed. Pregnancy outcomes of 39 women are known. There was no significant difference in antenatal, intra-natal and postpartum complications in the two groups. Neonatal weight difference was 20 gms.Conclusion: Smokeless tobacco products are the most common forms used by women in low and middle income countries. Larger studies are required to understand their effects on pregnancy outcomes.

Review with meta-analysis relating North American,European and Japanese snus or smokeless tobacco use to major smoking-related diseases

BACKGROUND While extensive information exists relating cigarette smoking to the risk of lung cancer,chronic obstructive pulmonary disease(COPD),ischaemic heart disease(IHD)or acute myocardial infarction(AMI),and stroke,far less information is available on risks from moist snuff(“snus”)or smokeless tobacco(ST)in United States/Canada,Europe or Japan.AIM To summarize data from the selected countries on risks of the four diseases associated with current ST or snus use.METHODS Publications in English in 1990-2020 were considered that,based on epidemiological studies in North America,Europe or Japan,estimated risks of lung cancer,COPD,IHD/AMI,or stroke according to use of ST or snus.The studies should involve at least 100 cases of the disease considered,and not be restricted to those with specific other diseases.Medline literature searches were conducted,selecting papers initially from examination of titles and abstracts,and then from full texts.Further papers were sought from reference lists in selected papers,reviews and meta-analyses.For each disease,relative risk estimates adjusted at least for age were extracted relating ST or snus use to risk,and combined using random-effects meta-analysis.The estimates were mainly for current vs.never or non-current use,but results for ever vs never use were also considered.RESULTS Seven publications reported results for ST use from six United States studies.The most useful results came from four studies which provided results for current vs.never use.Random-effects meta-analyses of these results showed an increased risk for each disease,clearest for lung cancer(relative risk 1.59,95%confidence interval 1.06-2.39,based on 4 estimates)and COPD(1.57,1.09-2.26,n=3),but also significant(at P<0.05)for IHD(1.26,1.10-1.45,n=4)and stroke(1.27,1.03-1.57,n=4).Also including results for ever vs.never use from two other studies increased the lung cancer estimate to 1.80(1.23-2.64,n=6),but had little effect on the other estimates.For snus,16 publications described results from 12 studies,one in Norway and the rest in Sweden.There were no results for COPD,and only three for lung cancer,with these reporting a relative risk of 0.80(0.40-1.30)for current vs never use.More extensive data were available for IHD/AMI and stroke.Using the latest results from each study,combined estimates for current vs.never use were 1.00(0.91-1.11,n=5)for IHD/AMI and 1.05(0.95-1.17,n=2)for stroke,while for current vs.non-current use they were 1.10(0.92-1.33,n=9)for IHD/AMI and 1.12(0.86-1.45,n=9)for stroke.Meta-analyses including earlier results from some studies also showed no significant association between snus use and IHD/AMI or stroke.No relevant results were found for Japan.CONCLUSION Risks of smoking-related diseases from snus use in Scandinavia are not demonstrated,while those from ST use in the United States are less than from smoking.

An Overview and Comparative Evaluation of Head and Neck Cancer Risk Factors in India and Australia

Aim: An overview and comparative evaluation of head and neck cancer risk factors in India and Australia. Method: In this review we included articles with information on head and neck cancer risk factors and its association based on: smoking tobacco, alcohol, smokeless tobacco, betel nut and areca nut chewing, viral infection like HPV, dental hygiene, diet, family history, socioeconomic status, other heavy metals and systemic conditions. Articles with clinical features, diagnosis, treatment and prognosis were excluded. Results: Head and neck cancer in India has different demographic, risk factors, dietary habits, personal and family history. Oral cancer is more common amongst all head and neck squamous cell cancers in males. This is mainly attributed with consumption of a variety of smokeless tobacco, smoking, alcohol, poverty, illiteracy, cultural, advanced stage at presentation;lack of good treatment infrastructure creates main challenge to India as compared to Australia. Conclusion: The knowledge about risk factors for HNC in public health education for general population supports health promotion and tobacco prevention, which is the main aim of the programs started by the government, as head and neck cancers are potentially preventable.

Optical investigation on polyoxymethylene dimethyl ethers spray flame at different oxygen levels in a constant volume vessel

In this paper,high-speed imaging and spectrometry diagnostics were used to study the spray flame structures and emission spectra of polyoxymethylene dimethyl ethers(PODE)in an optical constant volume vessel.The effects of oxygen volume fraction(15%to 80%)on some typical combustion characteristics such as spatially integrated natural intensity,flame propagation speed,lift-off length and the distribution of flame emission spectra were investigated.The results show that the PODE spray flame mainly exhibits blue chemiluminescence,which is different from the diesel yellow diffusion flame dominated by soot radiation.As the oxygen concentration increases,the flame natural luminosity and propagation speed increases,the position of lift-off region and flame tip move towards the injector nozzle,and the flame width becomes narrower.According to the spectral results,the blue chemiluminescence generated by carbon monoxide oxidation dominates the PODE flame luminescence,suggesting that no soot is formed.The increase in oxygen concentration leads to enlarged intensity and gradient of PODE flame radiation.In summary,the combination of PODE and oxygen-enriched combustion shows no soot formation and promotes the oxidation of carbon monoxide and unburned hydrocarbon.This study can provide more insights into PODE spray combustion,and offer guidelines for achieving efficient and clean combustion.

Fighting a Smokeless War

China still faces formidable challenges while endeavoring to keep its commitments under the World Health Organization Framework Convention on Tobacco Control On