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Background: Text messaging health service is used to improve quality of life of people living with diabetes in Eastern Nepal. It has been projected that the number of diabetic patients has increased to 170% from 1995 to 2025 in developing countries and to 41% in developed world. The objectives of the study were to assess the quality of life of people living with diabetes, to prepare and provide health education, and to evaluate the effectiveness of health education program and mobile/telephone health services provided to the diabetes patients. Materials and Methods: The study was conducted among consecutive stable ambulatory patients, >18 years old, and 396 patients diagnosed with diabetes for at least 3 months were included in the study. The education intervention was continued for 6 months by the principal investigator and a trained nurse. Results: Most of the respondents (53.3%) were of the age group 40–60 years; female (59.34%); Hindus (97%); and of the Janjati ethnic group (52.5%). The majority (96.5%) were married and self-employed (70.7%). About 30% of the respondents belonged to the poor economic status group. Most of the respondents had type II diabetes mellitus; about 34% of the respondents had a family history of (sibling) diabetes. Most of them were non-vegetarians (88.9%). About 16% of the respondents were obese. Regarding habits, 14% had tobacco chewing, 5% had gutka chewing, 8% had smoking, and around 8% had alcohol consumption habits. Regarding treatment, about 84% were on oral hypoglycemic agent, 22% on insulin therapy, 68% on diet control therapy, 58% on weight control, and 4.5% on herbal therapy. It was found that the mean knowledge score before education intervention was 22.53 and after education intervention was 35.32. It was found that the difference in the mean score calculated using t-test between knowledge before and after education intervention program was significant (P < 0.01). Conclusion: It can be concluded that the education intervention program and SMS mobile service provided to diabetes patients were found to be very effective.

Background: Globally, there are over 7 million deaths resulting from tobacco consumption with 1 million deaths in India per year, and among middle-income countries listed as the second major consumer of tobacco products. The prevalence of tobacco consumption according to the recent studies already done is dissimilar among gender, different age categories, religion, urban and rural areas. The study purpose was to assess the prevalence of tobacco consumption among rural men. Methodology: Community-based cross-sectional study conducted from December 2018 to May 2019 in Amarpur village, Uttar Pradesh, India. There were 244 men in the age group of 15–54 years old, selected for the survey. Purposive sampling technique was used for taking sample and SPSS 16 software for statistics analysis. Results: The prevalence of smoked and smokeless tobacco was 36.1% and 42.6%. The most prevalent form of tobacco among smoked form was bidi and hookah, while among smokeless forms were gutka with paan. Among the smokers, 69.3% were willing to quit smoking on smokeless consumers and 78.8% were willing to stop tobacco consumption at some point. Age, marital status, education, and the number of children were associated with tobacco smoker and chewer. Tobacco was highest 38 (48%) among 25–34 years of age for tobacco smoker with P = 0.002, and tobacco chewer highest among 35–44 years which was 34 (61.8%) with P = 0.000. About one-third of the patients do not know that tobacco intake has ill effect on their health; the most common influencing factors for tobacco use were for enjoyment and stress. Conclusion: Prevalence of tobacco consumption was high in this community. Urgent awareness and increased literacy needed to improve knowledge on the effect of smoking in the rural area. Through the development of effective health education and multi-factorial quitting strategies to help those who are willing to quit tobacco.

Background: Tobacco exposure is the single greatest preventable cause of morbidity, disability, and mortality for chronic and debilitating diseases. In public health education, an important aspect is the treatment of tobacco use dependence. This experimental study is intended to deter the use of smokeless tobacco (ST) for the users who seek treatment and who do not seek treatment as well. Materials and Methods: The study was conducted using a pretest–posttest design on ST users (dental group = 40 and nondental group = 40) in a tertiary care setting. Educational video: A video film of 14 min was developed by a researcher that included contents related to the chemical properties of tobacco, its harmful health effects, the diseases caused by tobacco use, and the facilities available for treatment. Tools: The tools used were subject datasheet and attitude questionnaire. Results: The mean age of the participants in dental group was 39 years and in nondental group was 34 years. Most of the participants in dental group and nondental group were using gutka. Attitude scores of participants significantly increase from pretest (55.32 ± 7.0) to posttest (62.74 ± 4.2). There was a statistically significant difference between attitude scores of participants in dental group (60.3 ± 13.23) and nondental group (62.6 ± 4.19) at 1-month follow-up (P ≤ 0.05). Conclusion: The educational video film regarding the ill effects of tobacco use and its treatment was effective in enhancing positive attitude of both the equally useful.

Background: Despite increasing awareness of harmful effects of tobacco, its use in various forms continues to be significant health risk factors among children. Aim: To assess the prevalence, pattern, and age of initiation of tobacco consumption, various factors influencing the habit of tobacco consumption, correlation between the educational status of children and their habit of tobacco consumption, and evaluation of any tobacco-induced oral lesion among 8–14 years of school going children in Central Delhi zone. Methods and Materials: Total sample of 500 students aged 8–14 years from two schools in Central Delhi were studied using a structured, close ended, prevalidated questionnaire after taking prior permission and inform consent from the school authority. In the end, intraoral examination was done and health educational session was conducted to make students aware of health hazards of tobacco products. Results: Prevalence of tobacco consumption among students was 16.4%. Out of total 82 tobacco users, 89% were male, whereas 11% were female. Smokeless tobacco consumption was predominant with Gutka being most preferred. Mean age of initiation of smoking form of tobacco was 9.57 ± 1.13 year, whereas for smokeless form, it was 9.25 ± 1.16 years. Friends (78.04%) were most common influencing factors, followed by family member (12.2%) and media (9.7%). Conclusion: The rate of tobacco use was high, considering very young age group of this study. Consumption of tobacco among children is an emerging health problem in Central Delhi zone. Mandatory health education sessions against tobacco should be held regularly for students, teachers, and parents.

Background & objectives Beginning in 2012, all States in India eventually banned the sale of gutka. This study was conducted to investigate gutka vendors' knowledge on gutka ban, products covered under ban, penalties for non-compliance and action for enforcement by government agencies. Methods Twenty vendors were interviewed, 10 each in Mumbai (Maharashtra) and Indore (Madhya Pradesh) during May - June, 2013, one year after ban was imposed. Interviewers used a standardized questionnaire to assess vendors' knowledge of gutka ban, their attitude towards it and compliance to it in practice. Results All 20 vendors were aware that gutka sale was banned. However, despite ban, eight of the 10 vendors in Mumbai perceived sale of pan masala as legal. In Indore, all 10 vendors perceived sale of Indori Tambakoo, a local gutka variant, as legal. No vendor was sure about the quantum of fine applicable on being caught selling the banned product. Two vendors in Mumbai and nine in Indore admitted selling gutka. Five vendors in Mumbai and four in Indore supported an existing ban on gutka. Interpretation & conclusions All vendors were aware of the ban on gutka and reason for it. Many vendors supported the ban. However, awareness of other products covered under ban and on fines in case of non-compliance was low. Law enforcement system needs to be intensified to implement ban. Notification of ban needs to be further strengthened and made unambiguous to explicitly include all smokeless tobacco products.

Background: Cigarettes and other tobacco products act 2003 (COTPA) is the principal law governing tobacco control in India. However, enforcement of the provisions under the law is still a matter of concern. The desired impact and level of enforcement of the COTPA legislation and the gutka and pan masala ban in Himachal Pradesh need assessment. Objective: The objective of this study was to assess the knowledge and attitudes about the ill effects of tobacco use and COTPA among the adult male population of Shimla City. Materials and Methods: This study was a cross-sectional community-based survey carried out in Boileauganj, Shimla. Data were collected using a structured schedule by interviewing 100 participants. Proportions, percentages were calculated, and the Fischer's exact test was applied for the categorical variables. Results: About 58% had heard of ban on smoking in public places and 53% knew that Himachal Pradesh has been declared as a no smoke state. Only 50% of the participants had heard of COTPA. Conclusion: These dismal findings suggest average knowledge levels of male adults about COTPA, which calls for a sensitization workshop and advocacy for all the stakeholders.

Objective: To assess self‑perceived oral health and whole salivary immunoglobulin G (IgG) levels among habitual gutka‑chewers and nonchewers (controls).Materials and Methods: Fifty gutka‑chewers and fifty controls were included. Demographic data and self‑perceived oral health status (pain in teeth, pain on chewing, bleeding gums (BG), bad breath, loose teeth and daily oral hygiene protocols) were collected using a questionnaire. Unstimulated whole saliva (UWS) was collected and unstimulated whole salivary flow rate (UWSFR) was determined. Whole salivary IgG levels were determined using standard techniques. Odds ratios were calculated for oral symptoms and group differences in protein levels were compared using one‑way analysis of variance (α

Substance abuse is an important health problem throughout the world including India, but prevalence and pattern of abuse varies from country to country and in different types of population. Slums have their own social and economic problems so that substance abuse may be different in this population and might be related with these problems. The aim of the present study was to study the prevalence and pattern substances in slum population. Prakash Chandra Sethi Nagar slum area of Indore district was selected for the purpose of this study. In first phase of the study, first a camp was organized to sensitize local leaders, key persons, and local inhabitants about drug abuse at Chandra Prakash Sethi Nagar. After that basic information was gathered with the key persons in Chandra Prakash Sethi Nagar. In second phase by house-to-house survey, all members of the family were interviewed in detail and information was recorded on semi-structured proforma. We observed prevalence rate of 560/1000 populations, 78.2% were males, 28.2% were females, and two-third abusers were laborers (72%). In order of frequency, tobacco was the most common substance abused in 53.9% population followed by gutka (nontobacco pan masala). Other drugs in order of frequency were alcohol 46.5%, cannabis 8.9%, opiates 4.9%, sedative and hypnotic 2.0%, solvents 1.0%, and cocaine in 0.1%. Slum population has higher prevalence rates than general population.

Introduction: Dental health and oral health are used almost synonymously when stating the goals of oral health; such statements are only valid for dental health. This may lead to severe underestimation of the need of total oral health care. When planning measures of oral health care, the lack of data may lead to a risk of overlooking diseases of the soft tissue in, and adjacent to, the oral cavity. Prevalence data of oral mucosal lesions are available from many countries, but the information is usually restricted to very few lesions in each survey. Materials and Methods: The present study is an attempt to assess and compare the various deleterious habits and its associated oral mucosal lesions among patients visiting outpatient department of Jaipur Dental College, Jaipur, Rajasthan. Results: It was found that the prevalence of habits was 51.4% including both the sexes and prevalence of oral mucosal lesions were 9.9%. Discussion: The prevalence of habits and oral mucosal lesions is very high as compared with other studies. The habit of smoking was higher in males as compared to females.

Objectives: Oral submucous fibrosis (OSMF) is one of the most common premalignant conditions affecting the oral cavity of people consuming arecanut and gutka. According to the available literature, as the disease progresses the morphology of the soft palate changes. So, the objective of present study was to evaluate and compare the morphology of soft palate in individuals with and without OSMF, using digital lateral cephalogram. Materials and Methods: Sixty male individuals were selected and divided into three groups, Group I-20 individuals (habit group), Group II-20 individuals (OSMF group), and Group III-20 individuals (individuals with no habit and/or OSMF group). The morphology of soft palate was assessed using digital lateral cephalogram. Statistical analysis was carried out using Scheffe multiple comparison test. Results: The superoinferior dimension of soft palate was increased with statistically significant difference in the habit and OSMF groups. The anteroposterior dimension was reduced in the habit group as compared to normal individuals, with statistically significant difference in the OSMF group. The type of soft palate more common in normal individuals and habit group was type 1 and 2, while type 6 was seen more commonly in OSMF group. Conclusion: Cephalometry can be efficiently used to assess the morphology of soft palate and the morphology of soft palate is altered in individuals with the habit even before the development of OSMF. So, cephalometry can be beneficial in assessing fibrosis in individuals with the habit at an early stage, which can further help in prognosis.

Aims and Objectives: To determine the association between smoking, chewing tobacco (gutka), and age of individual on graying of hair. Materials and Methods: The present study was conducted on 120 patients attending the Outpatient Department of the DJ College of Dental Sciences and Research, Modinagar, UP. The individuals were classified into four groups (group I, II, III, IV) on the basis of the form of tobacco use (smoking or chewing). The Pearson correlation coefficient was utilized to find the correlation between the mean percentage of individuals with gray hair, risk multiplication factor (RMF), and age of the individual. Results: Mean percentage of individual with gray hair and RMF (r = 0.6487) are found to be positively associated. A significant and positive correlation was observed between the age of the individual and the frequency of individuals with gray hair. Conclusion: This study suggests that there is a significant association between tobacco use and aging on graying of hair.Keywords: Graying of hair, risk multiplication factor, smoking

Oral cancer is one of the most critical health problems faced by the mankind today. Cancer is a result of multiple genetic defects resulting from exposure to environmental and infectious agents. Most of the oral cancers are associated with tobacco use and some are attributed to inappropriate nutritional habits. Tobacco chewing is a unique habit of Indian, southeast Asian subcontinent and is consumed commonly in the form of pan, gutka, etc. Furthermore, cancer prevention strategies can be applied by upregulating the defense mechanism, inducing cancer cells to apoptosis and decreasing angiogenesis of cancer cells. Nutritional factors play a key role in cancer impediment by increasing the intake of vegetables and fruits. This paper is an effort to draw the attention towards the significant role of diet in cancer prevention and associated mechanisms with its carcinogenesis.

Objective: To estimate the nation-wide prevalence of chewable smokeless tobacco consumption among Indian females. Design: Secondary data taken from cross-sectional nationally representative population-based household survey. Subjects: 1,24,385 women aged 15-49 years who were sampled in the National Family Health Survey-3(2005-2006). Prevalence of chewable smokeless tobacco consumption was compared with socio-demographic characters. Materials and Methods: The prevalence of various smokeless tobacco current uses was used as outcome measures. Simple and two-way cross tabulations were the main analytical methods. Results: Of all the female participants, 13,309 (10.7%) used one or another chewing products; 3.3% used Panmasala, 1.8% used gutka and 6.6%used other chewable tobacco products. 12.8% of women used tobacco in some or the other form and 1.7% smokes tobacco. Smokeless tobacco consumption was more common in poor and less educated. The prevalence of tobacco consumption showed variation with types and varied widely between states and geographical location. This reflects a strong association with an individual's sociocultural characteristics. Conclusion : The findings of the study highlight that an agenda to improve the health outcomes among the poor in India must include effective interventions to control tobacco use. The higher use of chewable smokeless tobacco among Indian women is a cause of concern. There is a need for periodical surveys using more consistent definitions of tobacco use and eliciting information on different types of tobacco consumed. Such outcomes will help to frame policies that could curb the increasing use of tobacco in Indian Women.

The tobacco epidemic is an increasing threat to public health with the tobacco burden particularly high in WHO's South-East Asia Region (SEAR). The Region has many obstacles to tobacco control, but despite these challenges, significant progress has been made in many countries. Although much work still needs to be done, SEAR countries have nevertheless implemented strong and often innovative tobacco control measures that can be classified as "best practices," with some setting global precedents. The best practice measures implemented in SEAR include bans on gutka, reducing tobacco imagery in movies, and warning about the dangers of tobacco. In a time of scarce resources, countries in SEAR and elsewhere must ensure that the most effective and cost-efficient measures are implemented. It is hoped that countries can learn from these examples and as appropriate, adapt these measures to their own specific cultural, social and political realities.

Background: Smokeless tobacco is found to be as addictive and harmful as smoking but have not been explored into, especially among youth. Objectives: This study was conducted to find the prevalence of tobacco chewing among college students in Nepal and the factors that have influence over their use. Study design: A cross-sectional study with a self-administered questionnaire. Materials and Methods: Five colleges of different streams in Pokhara city were selected for the study. A total of 816 students participated. The study was conducted during the period of May 2006-February 2007, using a semi-structured, self-administered questionnaire. Results: Overall prevalence of ever tobacco chewing was 21.3% (males 30.2% and females 10.9%) among the youth with average age of initiation 15.7 years. Pan masala and gutka were used by 63.6% and frequency of use varied widely and only 5.7% said they were daily users. Reasons cited for chewing were most commonly ′just like it′ or ′friends chew′. Multiple logistic regression analysis showed age, ever smoking status, being ever alcoholic, and having friends or family members who chewed were significantly associated with students′ tobacco chewing. Almost one-tenth of the students believed they were addicted to chewing tobacco and 42.5% of them had tried to quit the habit. Conclusion: The study shows a high prevalence of tobacco chewing by Nepali youth. Important factors that influenced the habit were having chewer friends, their own smoking and alcohol status and having family members who chewed. It is pertinent to consider these when formulating cessation and prevention programs

Objectives: The objective of the study was to find the prevalence and pattern of tobacco use, exposure to tobacco prevention activity among adolescent from tribal area. Materials and Methods: A cross-sectional study was conducted in six tribal villages. Data was collected by interview from 240 adolescent by home visits. Results: Prevalence of tobacco use (all forms), smokeless tobacco use and smoking in tribal adolescents were 54.45%, 53.41%, and 23.14%, respectively. Prevalence of tobacco use in boys (66.25%; 95% Confidence Interval (CI) = 60.29-72.21) was more than girls (26%; 95% CI = 25.84-37.57). Prevalence of tobacco use was more in late adolescent period and earning adolescents. The average age of starting smokeless tobacco use and smoking was 13.75 years (SD 2.26) and 14.22 years (SD 2.54), respectively. Boys start smoking relatively earlier than girls (P = 0.04). Education shows significant protective effect on tobacco use. Bidi was commonly used for smoking, while pan masala and gutka were the preferred smokeless tobacco. Almost all smokers were also using smokeless tobacco. Around 69% adolescents from the tribal area have heard of the tobacco prevention message, but only three could interpret it correctly. Radio and television were the commonest modes of information. Conclusion: Considering the high prevalence of tobacco use among tribal adolescents, anti-tobacco activities need to scale up for tribal people, with more emphasis on behavior change through group or personal approach. School programs may have some limitation in tribal area due to high school dropout, and low enrolment. Prevention activities need more focus on smokeless tobacco use and bidi smoking.

Objective : To estimate the prevalence, the socioeconomic and demographic correlates of chewable smokeless tobacco consumption among males in India. Design : A cross-sectional, nationally representative population-based household survey. Subjects : 74,369 males aged 15-54 years who were sampled in the National Family Health Survey-3 (2005-2006). Data on tobacco consumption were elicited from male members in households selected for the study. Materials and Methods : The prevalence of various smokeless tobacco use currently was used as outcome measures. Simple and two-way cross tabulations and univariate logistic regression analysis were the main analytical methods. Results : Thirty-four percent of the study population (15 years or older) used chewable smokeless tobacco. Smokeless tobacco consumption was significantly higher in poor, less educated, scheduled castes, and scheduled tribe populations. The prevalence of tobacco consumption showed variation with types. The prevalence of chewing also varied widely between different states and had a strong association with an individual's sociocultural characteristics. Conclusion : The findings of the study highlight that an agenda to improve the health outcomes among the poor in India must include effective interventions to control tobacco use. Failure to do so would most probably result in doubling the burden of diseases-both communicable and noncommunicable-among India's teeming poor. There is a need for periodical surveys using more consistent definitions of tobacco use and eliciting information on different types of tobacco consumed.

Objectives: Is use of tobacco a major health problem among medical students? To find out the factors associated with the use of tobacco. Materials and Methods: A cross-sectional study was done on 250 undergraduate male medical students using a pre-designed, pre-tested questionnaire to study about the problem and various correlates of the tobacco use. Data was collected and analysed using Excel and SPSS software. Results: Among the tobacco users (28.8%), smoking was found in 87.5% and tobacco chewing in the form of gutka, khaini, gulmanjan (locally available forms of tobacco) in 37.5% as the predominant means of the use of tobacco. The mean age of our sample was 23.5 years. The residential background, i.e., rural or urban, and religion were not significantly associated with the use of tobacco in the present study. Hostellers were found to be more frequent tobacco users as compared to day-scholars. There was a familial aggregation of the use of tobacco. The factor initiating the use of tobacco was usually peer pressure. Conclusion: Tobacco use is a significant problem among the male medical students and we need to take steps to stop its use by them so as to prevent them from being exposed to its hazardous effects. This will also make their role in the advocacy of the smoking cessation activities more trustworthy.

BACKGROUND: Pan masala is a comparatively recent habit in India and is marketed with and without tobacco. Advertisements of tobacco products have been banned in India since 1st May 2004. The advertisements of plain pan masala, which continue in Indian media, have been suspected to be surrogate for tobacco products bearing the same name. The study was carried out to assess whether these advertisements were for the intended product, or for tobacco products with same brand name. MATERIALS AND METHODS: The programme of a popular television Hindi news channel was watched for a 24-h period. Programmes on the same channel and its English counterpart were watched on different days to assess whether the advertisements were repeated. The total duration of telecast of a popular brand of plain pan masala (Pan Parag) was multiplied by the rate charged by the channel to provide the cost of advertisement of this product. The total sale value of the company was multiplied by the proportion of usage of plain pan masala out of gutka plus pan masala habit as observed from a different study, to provide the annual sale value of plain pan masala product under reference. RESULTS: The annual sale value of plain Pan Parag was estimated to be Rs. 67.1 million. The annual cost of the advertisement of the same product on two television channels was estimated at Rs. 244.6 million. CONCLUSION: The advertisements of plain pan masala seen on Indian television are a surrogate for the tobacco products bearing the same name.