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Introduction: Limited data exist on factors associated with concurrent use patterns of electronic nicotine delivery systems (ENDS) and cigarettes. We examined longitudinally perceptions and experiences with ENDS in relationship to concurrent use patterns among established, recent smokers who recently initiated ENDS., Methods: Participant recruitment took place using paid digital advertisements on social media. Between December 2020 and October 2021, 303 adults aged ≥21 years from across the US who currently or recently smoked and had initiated ENDS use within the past 30 days or reinitiated ENDS use after more than one year of non-use were surveyed. Multinomial logistic regressions were conducted to analyze association between the outcome of current use pattern at follow-up at 1 month [rejectors (discontinued ENDS, continued smoking), primary smokers (concurrent users, mostly smoke), dual user (similar smoking and ENDS use), primary vapers (concurrent users, mostly vape), and switchers (discontinued smoking, continued using ENDS) or quitters (discontinued both smoking and ENDS] and perceptions of and experiences with ENDS predictors at baseline., Results: At follow-up at 1 to 2 months after initiating ENDS, 20% were rejectors, 31% were primary smokers, 13% were dual users, 19% were primary vapers, and 17% were switchers/quitters. Perceiving ENDS as less harmful than smoking or being uncertain and as equally or more enjoyable smoking, experiencing a lot or complete reduction in cravings to smoking and in irritability with ENDS use, liking the taste of ENDS, and being satisfied with vaping were associated with higher odds of quitting smoking compared to rejecting ENDS or mostly smoking at follow-up at 1 month., Conclusions: Findings highlight the importance of initial ENDS perceptions and experiences when examining tobacco outcomes and potentially for developing policies and interventions targeting smoking cessation. ENDS initiators are differentiating into distinct use patterns based on these factors within a short period of time., Competing Interests: The authors have completed and submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest. The authors declare that they have no competing interests, financial or otherwise, related to the current work. M. Mavreles Ogrodnick, N.G. Kute, K. Henderson, C.A. Spears, T.F. Pechacek and S.R. Weaver report that since the initial planning of the work, they have received support from the National Cancer Institute of the National Institutes of Health (NIH) and U.S. Food and Drug Administration (FDA) Center for Tobacco Products (CTP) under Award Number R01CA235719. M. Mavreles Ogrodnick reports that Georgia State University received the grant funds from NIH/FDA which supported this work. N.G. Kute reports Georgia State University received the grant funds from NIH/ FDA which supported her travel and attendance to SRNT 2023 annual meeting to present the poster of this work. K. Henderson reports that Georgia State University received the grant funds from NIH/FDA which supported this work via a salary. C.A. Spears reports that in the past 36 months she has received grants or contracts from the National Cancer Institute, National Institute of Mental Health, Georgia Center for Oncology Research & Education, National Center for Complementary & Integrative Health, Fogarty International Center. She has also received consulting fees from the Stephenson Cancer Center at the University of Oklahoma Health Sciences Center, and has participated on Data and Safety Monitoring Boards for NIH-funded studies (National Center for Complementary & Integrative Health and National Institute on Drug Abuse), and is a Member of Community Advisory Board for the Center for Urban Research, Development, Sustainability, and Evaluation Initiative, DeKalb County Board of Health. Additionally, she has been a Fellow of the Society of Behavioral Medicine. T.F. Pechacek reports providing advice on legal cases involving electronic cigarettes as a paid expert, in the past 36 months. S.R. Weaver reports that in the past 36 months he has received grants or contracts from the National Cancer Institute, National Institute of Drug Abuse, Food & Drug Administration, Centers for Disease Control & Prevention (CDC), CDC Foundation, Georgia Family Connection Partnership, National Institute of Dental and Craniofacial Research (via Underwriters Laboratory), Robert Wood Johnson Foundation, Fulton County Board of Health. Additionally, he declares receiving payment from the Centers for Disease Control & Prevention (US) and New York City Department of Health and Mental Hygiene for teaching, scientific writing, and workshops., (© 2024 Mavreles Ogrodnick M. et al.)

Background: The sale of loose cigarettes or bidis can undermine the purpose of requiring health warning labels (HWLs) on cigarette packs and bidi bundles by diminishing their visibility and legibility., Objective: This mixed-methods study aims to examine the association between purchase behavior (loose vs pack or bundle), HWL exposure, and responses to HWLs among Indian adults who smoke., Methods: Data were analyzed from the 2018-2019 India Tobacco Control Policy Survey and from 28 in-depth interviews conducted with Indian adults who smoked in 2022. The Tobacco Control Policy Survey sample included tobacco users who bought cigarettes (n=643) or bidis (n=730), either loose or in packs or bundles at their last purchase. Ordinal regression models were fit separately for cigarettes and bidis, whereby HWL variables (noticing HWLs, reading and looking closely at HWLs, forgoing a cigarette or bidi because of HWLs, thinking about health risks of smoking, and thinking about quitting smoking cigarettes or bidis because of HWLs) were regressed on last purchase (loose vs packs or bundles). In-depth interviews with participants from Delhi and Mumbai who purchased loose cigarettes in the last month were conducted, and thematic analysis was used to analyze the interview data., Results: Survey findings indicated that about 74.3% (478/643) of cigarette users and 11.8% (86/730) of bidi users reported having bought loose sticks at their last purchase. Those who purchased loose cigarettes (vs packs) noticed HWLs less often (estimate -0.830, 95% CI -1.197 to -0.463, P<.001), whereas those who purchased loose bidis (vs bundles) read and looked closely at HWLs (estimate 0.646, 95% CI 0.013-1.279, P=.046), thought about the harms of bidi smoking (estimate 1.200, 95% CI 0.597-1.802, P<.001), and thought about quitting bidi smoking (estimate 0.871, 95% CI 0.282-1.461, P=.004) more often. Interview findings indicated lower exposure to HWLs among those who purchased loose cigarettes, primarily due to vendors distributing loose cigarettes without showing the original cigarette pack, storing them in separate containers, and consumers' preference for foreign-made cigarette brands, which often lack HWLs. While participants were generally aware of the contents of HWLs, many deliberately avoided them when purchasing loose cigarettes. In addition, they believed that loose cigarette purchases reduced the HWLs' potential to deliver consistent reminders about the harmful effects of cigarette smoking due to reduced exposure, an effect more common among those who purchased packs. Participants also noted that vendors, especially small ones, did not display statutory health warnings at their point of sale, further limiting exposure to warning messages., Conclusions: Survey and interview findings indicated that those who purchased loose cigarettes noticed HWLs less often. Loose purchases likely decrease the frequency of exposure to HWLs' reminders about the harmful effects of smoking, potentially reducing the effectiveness of HWLs., (©Mayank Sakhuja, Daniela B Friedman, Mark M Macauda, James R Hebert, Mangesh S Pednekar, Prakash C Gupta, Geoffrey T Fong, James F Thrasher. Originally published in JMIR Public Health and Surveillance (https://publichealth.jmir.org), 25.09.2024.)

Background: Tobacco is the major cause of preventable death globally, which kills one person prematurely every six seconds. In India, around 46.9% of men and women aged 15 years and above use any kind of tobacco, according to NFHS-5. Tobacco use for longer duration with increased frequency is often addictive. Nicotine in tobacco is often associated with dependence, which is recognized as a public health menace and the single most significant factor for premature death. Hence, assessment of nicotine dependence among tobacco users is essential to implement tobacco control measures effectively. To estimate the prevalence of nicotine dependence among tobacco users and to study the factors associated with nicotine dependence among those tobacco users in a rural area of Kancheepuram district, Tamil Nadu., Material and Methods: A community-based descriptive cross-sectional study was conducted among 375 tobacco users aged 18 years and above residing permanently in the rural field practice area of the Rural Health and Training Centre (RHTC) attached to a Tertiary Care Hospital in Tamil Nadu. The study has been conducted for 6 months. A systematic random sampling technique was used to recruit the study participants. Data was collected by conducting personal interviews using a pre-tested semi-structured questionnaire. The data obtained was subjected to statistical analysis using SPSS version 23., Result: About 48.7% of the study participants had high dependence, 25% had moderate dependence, and 26.3% had low physical dependence on nicotine. The duration of tobacco use ( P < 0.0000) and age of initiation of tobacco use (mean age was 28 ± 7.1 years) ( P < 0.0001) was found as a significant risk indicator for nicotine dependence., Conclusion: The high nicotine dependence (48.7%) among the study participants is quite alarming and warrants more visible and aggressive anti-tobacco campaigns and targeted preventive strategies., Competing Interests: There are no conflicts of interest., (Copyright: © 2024 Indian Journal of Community Medicine.)

Objective: The cross-sectional study was intended to evaluate the oral health and nicotine dependence among tobacco users., Material & Methods: Fagerstorm Test for Nicotine Dependence estimated nicotine dependence and clinically oral examination was performed in recording the dentition status, oral hygiene, gingivitis and periodontal health. Descriptive statistics was computed using mean, percentage and standard deviation. Association was estimated using Independent T Test. Binary logistic regression and multiple regression analysis was used in inferential statistics., Results: In general, 55.3% had dental caries, followed by 92.6% having gingivitis and 7.4% had clinical attachment loss. Mean DMF was 2.60 (± 3.88) and the subjects mean oral hygiene score was 3.49 (± 1.11). The mean DMF score of tobacco users worsened with increasing age. Current smokers were 1.07 times more predisposed to get dental caries than former smokers and smokeless tobacco chewers had higher odds of 1.060 times to fall susceptible to dental caries than those smoking tobacco. Dependence on tobacco substantially worsened oral hygiene., Conclusions: Tobacco cessation practices shall be effectively enforced to minimize the burden of nicotine dependence., (©2023 Pacini Editore SRL, Pisa, Italy.)

Background: Smokeless and smoking tobacco use results in increased oxidative stress and lipid peroxidation, which play a major role in the causation of cancer in tobacco habituates. Malondialdehyde (MDA) is a product of lipid peroxidation, and glutathione peroxidase (GPx) and superoxide dismutase (SOD), the main enzymes in the antioxidant defense system, are assessed among tobacco users. This study gave insight into the relationship between tobacco use, oxidative stress, and antioxidant enzyme activity., Aims and Objectives: This study aimed to estimate the levels of lipid peroxidation product MDA and antioxidant enzymes SOD and GPx among tobacco users and compare them with controls., Method: A case-control study comprising 30 smokeless tobacco users, 30 smokers, and 30 controls was enrolled for the study. Serum MDA was assayed by the thiobarbituric acid method; serum SOD and GPx were assayed using Ransel antioxidant kits. The results were statistically analyzed using descriptive and inferential statistical analysis., Results: Serum MDA levels, which indicate oxidative stress, were increased among all tobacco users and significantly increased among smokeless tobacco users as compared to smokers. Serum SOD and GPx levels were decreased among both forms of tobacco users compared with controls. With an increase in duration and frequency of tobacco use, there was a significant increase in serum MDA levels among both smokers and chewers and a decrease in serum SOD and GPx levels., Conclusion: In the present day, the tobacco epidemic has attained enormous proportions with the tobacco habit starting as early as 13-14 years and leading to serious conditions with high morbidity and mortality. These biochemical parameters such as MDA, SOD, and GPx, which act as marker of oxidant and antioxidant system, can constitute important tools for evidence-based medicine for educating patients and motivating interventions in tobacco cessation therapy., Competing Interests: There are no conflicts of interest., (Copyright: © 2023 National Journal of Maxillofacial Surgery.)

Introduction: Non-communicable diseases such as ischemic heart disease, cancer, diabetes, and chronic respiratory diseases are the leading causes of death worldwide, and are associated with tobacco use. The ultimate goal of health professionals and researchers working to combat smoking's extremely harmful health effects is to prevent smoking initiation. Nearly 5500 new smokers are added each day, for a total of almost 2 million new smokers each year. The COM-B model's primary goal is to determine what needs to be done for a behaviour change to occur. Behaviour modification requires an understanding of the factors that drive behaviour., Aim: The current qualitative study intends to explore the factors affecting tobacco use initiation (TUI) using the COM-B model, given the relevance of investigating the factors affecting TUI and the model., Methods: The present qualitative study has used a directed content analysis approach. Seventeen participants who reported having started any kind of tobacco in the last six months were recruited in the study using a purposive sampling method to understand the factors affecting TUI. The data was collected through interviews, and all of the participants were from the Hyderabad-Karnataka region of Karnataka, India (a state which has been reported as having the highest prevalence of cigarette smoking in India)., Results: Directed content analysis revealed six categories: psychological capabilities affecting TUI (lack of knowledge about adverse health effects of tobacco, behavioural control, and poor academic performance), physical capabilities affecting TUI (lack of better physical resilience), physical opportunities favouring TUI (tobacco advertisements, easy access of tobacco products, and favourite star smoke on screen), social opportunities favouring TUI (peer influence, tobacco use by parents, tradition of hospitality, tobacco use as a normal behaviour, and toxic masculinity), automatic motivation causal factors of TUI (affect regulation, risk taking behaviours and tobacco use for pleasure) and reflective motivation causal factors of TUI (perceived benefits of tobacco, risk perception, perceived stress, and compensatory health beliefs)., Conclusion: Identifying the factors that influence TUI may help to limit or prevent people from smoking their first cigarette. Given the importance of preventing TUI, the findings of this study indicated the factors that influence TUI, which can be valuable in improving behaviour change processes., Competing Interests: The authors have no conflicts of interest relevant to this article to disclose., (© 2023 The Authors.)

Background: Tobacco use is responsible for numerous adverse pregnancy outcomes for females and their infants. The aim of this study was to explore the adverse outcome of tobacco use among pregnant females., Method:  A cross-sectional study was conducted on 1250 females in the third trimester of pregnancy from April to June 2022, which were exposed to tobacco use in the form of gudaku, tobacco chewing, gutka, or smoking. Complications and outcomes during and after pregnancy were recorded based on self-administered questionnaires. Statistical analysis was performed using the Statistical Package for Social Sciences (SPSS) (IBM SPSS Statistics, Armonk, NY) software version 20.0 for categorical data, frequencies (n) and percentages (%) were calculated, and the chi-square test was used for determining intergroup differences., Results:  Out of 1250 females, tobacco exposure was present among 429 (34.3%), and 821 (65.7%) had no tobacco exposure. Of 429, 36.10% of females complained about complications such as abortion (1.60%), antepartum hemorrhage (0.90%), congenital anomaly (0.20%), infertility (1.20%), intrauterine fetal death (IUFD) (0.50%), intrauterine growth restriction (IUGR) (0.90%), oligohydramnios (OLIGO) (3.30%), preterm labor (18.40%), premature rupture of membrane (6.30%), and anemia (2.80%), which were slightly higher than the females with no tobacco exposure. In tobacco users, obstructive complications were found to be significant with a p value of 0.0036., Conclusion: Our study concluded that tobacco use could have an adverse effect on their fetus and infants, as well as the pregnant females themselves. Policymakers need to ensure effective strategies that pregnant females, their partners, and close relatives need to have enough knowledge to avoid potential risks., Competing Interests: The authors have declared financial relationships, which are detailed in the next section., (Copyright © 2022, Nagaria et al.)

Background: The world witnessed a highly contagious and deadly disease, COVID-19, toward the end of 2019. India is one of the worst affected countries. We aimed to assess anxiety and depression levels among adult tobacco users and people who recently quit tobacco during COVID-19 lockdown in India., Materials and Methods: The study was conducted across two Indian cities, Delhi and Chennai (July-August, 2020) among adult tobacco users ( n = 801). Telephonic interviews were conducted using validated mental health tools (Patient Health Questionnaire-PHQ-9 and Generalized Anxiety Disorder-GAD-7) to assess the anxiety and depression levels of the participants. Descriptive analysis and multiple logistic regression were used to study the prevalence and correlates of depression and anxiety., Results: We found that 20.6% of tobacco users had depression symptoms (3.9% moderate to severe); 20.7% had anxiety symptoms (3.8% moderate to severe). Risk factors associated with depression and anxiety included food, housing, and financial insecurity., Conclusion: During COVID-19 lockdown, mental health of tobacco users (primarily women) was associated with food, housing and financial insecurity. The Indian Government rightly initiated several health, social and economic measures to shield the most vulnerable from COVID-19, including a ban on the sale of tobacco products. It is also necessary to prioritize universal health coverage, expanded social security net, tobacco cessation and mental health services to such vulnerable populations during pandemic situations., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2022 Bassi, Nazar, Joshi, Sharma, Pandian, Deepa, Mohan, Patel, Ali, McNeill, Tandon, Mohan, Prabhakaran and Arora.)

Increased aggression and impulsivity represent a key component of several psychiatric disorders, including substance use disorder, which is often associated with deficient prefrontal brain activation. Thus, innovative tools to increase cognitive control are highly warranted. The current study investigates the potential of transcranial direct current stimulation (tDCS), a tool to modulate cortical activation and to increase cognitive control in individuals with a high potential for impulsive and aggressive behavior. In a double-blind, sham-controlled study, we applied anodal tDCS over the right dorsolateral prefrontal cortex in an all-male sample of alcohol-dependent patients (AD), tobacco users (TU) and healthy controls (HC), who completed the Taylor Aggression Paradigm and Stop Signal Reaction Time Task twice. While there were no observable effects of tDCS in controls, the results revealed altered aggressive behavior in AD following active stimulation. Specifically, these individuals did not show the standard increase in aggression over time seen in the other groups. Furthermore, improved response inhibition was found in AD and TU following active but not sham stimulation. Our study demonstrates that prefrontal tDCS improves our laboratory measure of impulse control in at-risk groups, illustrating the importance of sample characteristics such as nicotine intake and personality traits for understanding the effects of brain stimulation., (© The Author(s) 2020. Published by Oxford University Press.)

Aims: The aim of the study was to assess factors that determine tobacco habit initialization and cessation and oral cancer awareness among the general population of Vikarabad district, Telangana., Materials and Methods: The current study was a cross-sectional study conducted among the general population of the Vikarabad district. All tobacco users satisfying inclusion criteria of age 18-40 years and at least 1 year of tobacco usage were included in the study. Multistage random sampling was followed to select tobacco users and structured, pretested questionnaires were distributed. The populations mean age was 30 years with majority being rural residents and men contributing the majority of the study population., Results: The mean age at which a person begins to smoke was 20.4 ± 5.7 years among the general population. Peer influence (77%) was reported as one of the major reasons, and habit formation was found to be the major factor (55.6%) for continuing tobacco and also work stress (17%) and relaxation (17%). The primary reason for quitting was fear or awareness of the adverse effects of tobacco. Self-abstinence was reported as a predominant method that they followed to quit tobacco habit during the past year, while 16.3% reported that they did not give it a try. About 58.6% of participants were advised by a health-care provider to quit tobacco, respectively. A major proportion of tobacco users (71%) knew that tobacco causes oral cancer. Half of the study population is unaware of oral cancer's early symptoms, noncontagious progression, lifestyle modification, and early treatment have a good prognosis., Conclusion: Findings of the study highlight the factors to be considered in framing effective antitobacco policies applicable to the rural population., Competing Interests: There are no conflicts of interest., (Copyright: © 2021 Journal of Pharmacy and Bioallied Sciences.)

Background: Implementing effective tobacco cessation programmes requires an understanding of the factors that influence quit attempts in a given context. In this study, we explored these factors among current tobacco users attending the outpatient department (OPD) of Dr Yusuf Dadoo Hospital, South Africa., Methods: In a cross-sectional study involving 275 tobacco users, a researcher-administered questionnaire collected socio-demographic, clinical, tobacco use and quit attempt information. Outcomes of data analysis included the proportion of participants who made quit attempts, the motivations and barriers, and the factors significantly associated with quit attempts., Results: The mean age of the participants was 46.5 years. Most of them were black (61.8%), male (65.8%), and had at least one chronic disease (52.7%) - of which 55.2% had a cardiovascular disease. About 87% of participants smoked cigarettes while 10% used snuff. Most participants made a quit attempt in the past year (74%), perceived it important to quit (92.0%) and felt confident to do so (75.0%). Health concern was the most common motivation for making a quit attempt, while advice from a healthcare provider was the least. Stress and cravings were the top two barriers to make a quit attempt. In regression analysis, being married was the only factor independently associated with making a quit attempt (odds ratio [OR]: 2.13; confidence interval [CI]: 1.17-3.86, p = 0.01)., Conclusion: Most participants showed readiness to quit. However, healthcare professionals failed to leverage on participants' motivations about their health to scale up the provision of quit advice to promote smoking cessation.

To evaluate the proportions of current cigarette smokers (CCS) and current narghile smokers (CNS) as well as previous cigarette smokers (PCS) and previous narghile smokers (PNS) and to assess smoking knowledge and attitudes toward supporting smoking ban or cessation among previous compared with current smokers. This cross-sectional study took place between May and December 2018, and enrolled a sample of 1598 exclusive cigarette smokers (ECS) and 2091 exclusive narghile smokers (ENS), representative of all Lebanese governorates. A questionnaire designed specifically for this study was used to collect data. Among ECS, 45.2% were CCS and 54.8% were PCS. Among ENS, 83.5% were CNS and 16.5% were PNS. Higher age (adjusted odds ratio (aOR) (95% confidence interval (CI)) = 1.02 (1.01; 1.03)), higher knowledge (1.05 (1.02; 1.08)), and attitude scores (1.11(1.09; 1.13)) were significantly associated with higher odds of being PCS. Higher age (1.02 (1.01; 1.03)), being employed (1.32 (1.004; 1.72)), higher knowledge (1.04 (1.02; 1.07)), and attitude scores (1.09 (1.07; 1.12)) were significantly associated with higher odds of being PNS. Previous smokers have higher knowledge and better attitude toward supporting smoking cessation compared with current smokers. A better knowledge along with effective interventions, might lead to a positive attitude toward supporting smoking ban or smoking cessation among the general population.

Background: India being major consumer of tobacco faces various problems involved for its cessation. Over the time enormous methods have been evolved which may aid in tobacco cessation., Materials and Methods: The present study was conducted among 100 adult tobacco users attending tobacco cessation clinic. The individuals where randomized into 2 counselling groups: Group A - Basic health education (BHE) and Group B Cognitive Behavioral Therapy (CBT). Baseline evaluation of demographic parameters, smoking/smokeless behavior was recorded and Fagerstrom's test for Nicotine Dependence (FTND) was utilized to assess subjects' nicotine addiction levels. Follow up was done at intervals of 2 weeks and 4 weeks to assess the reduction in the mean FTND score. Appropriate statistical test was utilized to evaluate the results., Results: The majority of individuals in the study were male in age group of 41-60 years. The reduction in mean FTND score was found in both Group A and B on follow-up. But when both groups were compared, reductions in mean Fagerstrom scores were found to be more in CBT group than in BHE group at all time intervals., Conclusion: Individuals in both the group have quit the tobacco use by both the interventions followed by proper schematic follow up., Competing Interests: There are no conflicts of interest., (Copyright: © Journal of Family Medicine and Primary Care.)

Background: Tobacco kills half of its users, with smoking and smokeless tobacco killing nearly 6 million people worldwide - one death every 6 s in each year. Use of tobacco over time causes a physical and psychological addiction due to the presence of nicotine. To find out the level of nicotine dependence among adult (18 years and above) tobacco users and the factors responsible for it., Materials and Methods: A cross-sectional community-based study was conducted among 128 current tobacco users in an urban slum of Burdwan District, West Bengal, India. Study tools comprised of predesigned, pretested, semi-structured schedule, containing Fagerström test for nicotine dependence (FTND) questionnaire. Data were collected by interview after getting consent from the participants. Chi-square test, unpaired student t -test, ANOVA, correlation coefficient, and linear regression was calculated. SPSS software (Statistical Package for the Social Sciences Inc, Chicago, IL, USA). was used for analysis., Results: High level of nicotine dependence was maximally seen among increased in age group, prolonged duration of use and daily users. Age, duration of tobacco use and habit of tobacco use had a significant positive correlation with FTND score while starting age of tobacco had a significant negative correlation. Then in multivariable linear regression, starting age of tobacco use, habit of tobacco use and duration of tobacco use emerged as a significant predictor of FTND score and could explain 27.3% of total variation in FTND score., Conclusions: Suitable plan for quitting may be developed based on the FTND score of an individual, the most important determinant of quitting., Competing Interests: There are no conflicts of interest.

Background: There is general lack of knowledge concerning the sings, symptoms, and risk factors of oral cancer in the general population, particularly among tobacco users. A challenging measure for the health care professions is to improve patients' knowledge about the causes and signs of oral cancer and, more importantly, to modify their health behaviors. The most frequent approach used to achieve this is production of leaflet. The aim of this study was to outline and carry out the steps involved in the production of information leaflet for tobacco users and its evaluation., Materials and Methods: The existing materials on tobacco and its ill effects were reviewed. Leaflets were prepared based on the European Commission Guidelines for patient information leaflet and information packages. Subject experts reviewed the content of leaflet. Content validity was checked using Lawshe method. Reliability was checked using Flesch formula., Results: Content Validity Ratio (CVR) value was 0.99, which was acceptable. The reliability of the final wording of the leaflet was 80, which was classified as "fairly ease.", Conclusion: The leaflet could be used as a health education aid to motivate tobacco users to quit tobacco use.

Aim: To Quantify the DNA single-stranded breaks in the peripheral blood leukocytes (PBLs) of tobacco-habituated individuals with clinically normal mucosa and patients with oral carcinoma., Objectives: To evaluate DNA damage levels in PBLs of tobacco-habituated individuals with clinically normal mucosa and patients with oral carcinoma and compare with a control group of healthy volunteers. To evaluate the extent of DNA damage in PBLs using Single Cell Gel Electrophoresis (SCGE) in the above groups., Materials and Methods: Patients who were attending the outpatient department were enrolled in this study. A control group of 30 healthy volunteers included in Group I were selected from various age groups who are not tobacco users in any form. Thirty patients with tobacco habituation but with clinically normal mucosa were included in Group II, while 30 tobacco-habituated patients with oral squamous carcinoma were included in Group III. A biopsy was taken from the representative area and confirmed histologically. Intravenous blood samples were collected from all the groups for evaluation of the extent of DNA damage using ethidium bromide-stained slides under fluorescent microscope. The DNA tail length was calculated by subtracting the diameter from the total length. Twenty-five randomly selected cells per slide were analyzed and mean calculated., Results: The mean DNA damage levels in patients with tobacco habits were compared with that of the control group and the results were found to be statistically significant. The mean DNA damage level in PBLs between tobacco-habituated patients with normal mucosa and oral cancer patients was found to be statistically significant. The DNA damage in cancer patients was compared with the control group and the results were found to be statistically significant., Conclusion: DNA damage evaluation in PBLs by SCGE technique is a sensitive and reliable indicator of tobacco insult.

Background: Tobacco addiction is an important public health issue. It is important for health professional to counsel the tobacco users for cessation., Aim: To enhance communication skills of MBBS (Bachelor of Medicine and Bachelor of Surgery) students in counseling of tobacco users by using interactive teaching methods and examine it by using OSCE., Materials and Methods: It was a before and after comparison study. Communication skills of students were examined by standardized patients (investigators) by objective structured clinical examination (OSCE) method before and after intervention. All the students were trained to enhance the communication skills by role play, interactive session, anecdotes. Statistical analysis was done by using Paired t-test., Results: The difference in scores at all the 3 stations before and after the intervention and also global scores before and after the intervention was statistically highly significant (P = 0.0001)., Conclusion and Recommendation: Communication skills of students in counseling tobacco users improved after they were given role play, interactive session, anecdotes. Similar model can be used to improve the communication/counseling skills in other important health hazards.