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Chewing tobacco may play a contributing role in complications during pregnancy as it contains various kinds of toxic metals such as lead (Pb), cadmium (Cd), cobalt (Co), manganese (Mn), chromium (Cr), and can cause alteration in serum metal concentration. Hence, the present study aimed to explore the effects of chewing tobacco consumption on serum metal contents in pregnant women. A total number of 200 chewing tobacco consumer pregnant women and 200 age-matched non-consumer pregnant women were selected for the study from the outpatient department of gynaecology at Rural Health Centre Tandojam, Pakistan. After obtaining the sociodemographic characteristics of all participants, 10 ml of venous blood was also drawn for serum metal analysis by atomic absorption spectroscopy. Different chewing tobacco samples consumed by consumer pregnant women were collected from local shops of Tandojam, Pakistan. Drinking water samples from the residential areas of consumer and non-consumer pregnant women were prepared and analysed for the same metal contents. In present study, serum Pb, Cd, K and Co were found significantly increased in CPW as compared to NCPW. Serum Pb was found significantly increased in gutkha consumers in comparison to mainpuri consumers. Serum Pb, Cd, and Co were present with significantly increased concentration in serum of CPW who were taking canal and well water for drinking purpose when compared with NCPW. Significant negative strong correlation of serum Pb with K and Cr of drinking water and Na of chewing tobacco samples were observed. Strong positive correlation of serum Cd and Cr with Co of drinking water had been observed. Whereas, serum maternal Co was strongly negatively correlated with Mn of chewing tobacco samples, and serum Cu of CPW had a strong positive correlation with K and Cr of drinking water and Na of chewing tobacco samples. In conclusion, consumption of chewing tobacco alters the serum metal contents in pregnant women at Tandojam and adjoining areas, Pakistan. [ABSTRACT FROM AUTHOR]

Abstract Smokeless tobacco (SLT) poses many negative health impacts. Despite its longstanding presence in societies across the world, the health implications of SLT have only been rigorously studied in recent decades. This systematic review and meta-analysis aimed to consolidate existing research to provide a comprehensive understanding of the global prevalence of SLT use among women of reproductive age. Relevant articles were extracted from databases such as PubMed, EMBASE, Web of Science, and Scopus from their inception until November 11, 2023. Observational studies reporting the number of SLT users among women of reproductive age were included. The quality of the studies was assessed using the Joanna Briggs Institute (JBI) tool. The meta-analysis used a random-effects model to determine SLT prevalence, supported by statistical tools like forest plots, I2 statistics, and sensitivity analyses to ensure the accuracy and comprehensiveness of the results. All statistical analyses were performed in R version 4.3. From 10 studies involving 2,053,667 participants, a pooled prevalence for SLT use among women of reproductive age was found to be 9.3% (95% CI: 0.038 to 0.21), with significant heterogeneity among studies (I2 = 100%). Publication bias was suspected among the studies. Sensitivity analysis and subgroup analysis couldn’t resolve the heterogeneity. Our analysis shows a significant prevalence of SLT use in women of reproductive age, especially in low socioeconomic and developing countries like India, Pakistan, and Nepal. For women of reproductive age, the use of smokeless tobacco (SLT) can lead to infertility, pregnancy complications, and adverse fetal outcomes, including low birth weight and preterm birth. The results highlight the necessity for specific public health measures and policy changes to decrease SLT consumption among reproductive-age women. Further studies are needed to investigate the reasons behind SLT usage in this group and to assess the impact of intervention strategies, to guide more effective public health initiatives and policies.

Smokeless tobacco (SLT) poses many negative health impacts. Despite its longstanding presence in societies across the world, the health implications of SLT have only been rigorously studied in recent decades. This systematic review and meta-analysis aimed to consolidate existing research to provide a comprehensive understanding of the global prevalence of SLT use among women of reproductive age. Relevant articles were extracted from databases such as PubMed, EMBASE, Web of Science, and Scopus from their inception until November 11, 2023. Observational studies reporting the number of SLT users among women of reproductive age were included. The quality of the studies was assessed using the Joanna Briggs Institute (JBI) tool. The meta-analysis used a random-effects model to determine SLT prevalence, supported by statistical tools like forest plots, I2 statistics, and sensitivity analyses to ensure the accuracy and comprehensiveness of the results. All statistical analyses were performed in R version 4.3. From 10 studies involving 2,053,667 participants, a pooled prevalence for SLT use among women of reproductive age was found to be 9.3% (95% CI: 0.038 to 0.21), with significant heterogeneity among studies (I2 = 100%). Publication bias was suspected among the studies. Sensitivity analysis and subgroup analysis couldn't resolve the heterogeneity. Our analysis shows a significant prevalence of SLT use in women of reproductive age, especially in low socioeconomic and developing countries like India, Pakistan, and Nepal. For women of reproductive age, the use of smokeless tobacco (SLT) can lead to infertility, pregnancy complications, and adverse fetal outcomes, including low birth weight and preterm birth. The results highlight the necessity for specific public health measures and policy changes to decrease SLT consumption among reproductive-age women. Further studies are needed to investigate the reasons behind SLT usage in this group and to assess the impact of intervention strategies, to guide more effective public health initiatives and policies. [ABSTRACT FROM AUTHOR]

AbstractObjectivesParticipantsMethodsResultsConclusionsTo examine knowledge, attitudes, beliefs, and behaviors about alternative tobacco products among American Indian tribal college students.One hundred and five tribal college students.Focus groups, one interview, and demographic surveys.Tobacco use varied across the sample with 35.2% of the participants being users of ENDS products and 29.5% were cigarette smokers. Overall, participants viewed electronic nicotine delivery systems and chewing tobacco as primary examples of alternative tobacco products and described a generational divide between alternative and conventional tobacco product use. Alternative tobacco products were not considered suitable for use in traditional contexts.Previously successful cessation programs in this population have relied on cultural tailoring related to traditional tobacco use in American Indian communities. Our findings suggest that this strategy may be less effective for addressing alternative tobacco use. Reliance on the importance of family relationships may prove more impactful in future programming. [ABSTRACT FROM AUTHOR]

Smokeless tobacco products are products that do not require a pyrolysis process and / or the production of tobacco aerosol (smoke) at the time of use. In the absence of data on the toxicological risks of smokeless tobacco, their consumption is potentially on the rise. The variety of non-smoking tobacco products creates certain problems in identifying chewing tobacco and sucking tobacco (banned for sale in the Russian Federation) as products that are identical in terms of physiological effects, method of consumption, and component composition. A methodology has been developed for a comprehensive assessment of non-smoking products, including the determination of consumer properties and technological indicators by instrumental methods, as well as the determination of the level of toxic components (nicotine, TSNA, B(a)P). The difference between the types of smokeless tobacco is mainly in the granulometric composition of the product: snus – finely ground tobacco, chewing tobacco – snatches of tobacco with a removed middle vein. Identification indicators have been determined: the presence of raw tobacco, the size of its particles and the number of large fragments in the finished product. The presence of raw tobacco can be determined by optical microscopy and/or luminescent analysis, and the quantitative content can be determined by sieve analysis. The quantitative content of the coarse fraction in chewing tobacco (not less than 15 %) is the main indicator of the product. The use of the fractionation method makes it possible to differentiate between sucking and chewing tobacco. A «Method for determining the fractional composition of non-smoking tobacco products for oral consumption by the method of sieve analysis» was developed (Certificate No. 022-01.00281-2013-2022). To certify the methodology, a set of studies was carried out, the data were obtained as a result of five parallel measurements by three performers for each sample. The technique is registered in the State Register of Measuring Instruments (FR.1.31.2022.43935 of 09/02/2022). Technological indicators of SLT samples were established: humidity (11,4-53,3) %, pH level 5,7-9,7, coarse fraction content (0,4-56,9) %, dust fraction content (0,2-76,3) %. The results of identification of commercial samples of a segmental product are presented.

India accounts for over 67% of chewing tobacco users globally and more than 50 million women in India chew tobacco. Chewing tobacco is documented to have negative effects on health of mother and foetus. This research was conducted to study the trends in chewing tobacco use among pregnant women in India, and identify factors associated with chewing tobacco use among pregnant women. We analyzed micro-data from two representative national surveys i.e., National Family Health Survey (NFHS)-4 (2015–16) & NFHS-5 (2019–21). A sample of 32,428 & 28,408 pregnant women were extracted from NFHS-4 & NFHS-5 respectively. Weighted prevalence and 95% confidence levels of chewing tobacco use were computed. State wide comparisons in chewing tobacco use were made. Employing binary logistic regression, adjusted odds ratios (AOR) were computed to identify factors associated with chewing tobacco use. From NFHS-4 to 5 the prevalence of chewing tobacco use among pregnant women decreased from 4.0%(95% CI = 3.9–4.0) to 2.3%(95% CI = 2.2–2.4) respectively indicating a relative reduction of 42.5%. The highest prevalence remains to be in north-eastern India at 13.0%. Belonging to north-eastern region AOR = 7.0(95 %CI = 6.2–7.9), no-education AOR = 13.2(95 %CI = 10.5–16.5), poorest wealth index AOR = 6.7(95 %CI = 5.6–8.0) and belonging to scheduled tribe AOR = 2.6(95 %CI = 2.4–2.9) was significantly associated with chewing tobacco use among pregnant women. From NFHS-4 to 5, chewing tobacco use during pregnancy has shifted more towards socio-economically vulnerable population. Targeted approaches with accessible and affordable tobacco cessation advice integrated to primary healthcare system are needed. [ABSTRACT FROM AUTHOR]

Nicotine-containing products, including combustible tobacco, smokeless tobacco, electronic cigarettes (e-cigarettes), and nicotine replacement therapies (NRT), are widely used and have significant implications in the perioperative setting for orthopedic surgery. Smoking has been linked to numerous surgical complications such as delayed wound healing, infection, cardiovascular and pulmonary complications and impaired bone healing. This narrative review aims to provide an overview of the different nicotine-containing products, their nicotine content, and the potential effects observed with their use in orthopedic surgery. A comprehensive literature search was conducted to identify studies reporting on dosage, health effects, and perioperative outcomes associated with various forms of tobacco and nicotine products. The findings reveal that combustible tobacco products contain varying levels of nicotine, ranging from 7.2 to 26.3 mg per gram of tobacco. Smokeless tobacco products have nicotine contents ranging from 7.1 to 23.1 mg per gram. Smokeless tobacco users exhibit better surgical outcomes in terms of bone healing compared to smokers. Nicotine content in e-cigarette liquids varies widely, from 0 to 134.7 mg per milliliter. Limited evidence exists regarding the effects of e-cigarettes on surgical outcomes, but animal studies suggest similar soft tissue healing rates compared to combustible cigarettes due to comparable nicotine levels. NRT, available as gum, nasal spray, lozenges, patches, and inhalers, aims to replace tobacco use and gradually reduce nicotine intake. Dosages range from 0.5 mg per spray to 42 mg in high-dose patches. Understanding the nicotine content, absorption, and route of administration of NRT products is crucial for perioperative management. In conclusion, different nicotine-containing products have varying nicotine levels and potential implications for surgical outcomes. Further research is needed to elucidate the specific effects of e-cigarettes and NRT on bone healing and to establish optimal perioperative management strategies for nicotine users undergoing orthopedic surgery. [ABSTRACT FROM AUTHOR]

INTRODUCTION This study aims to evaluate the association between oral malignant and oral potentially malignant disorders with smoking and chewing forms of tobacco. METHODS A search was conducted in Medline, Cochrane databases, Google Scholar, Scopus and Web of Science for studies up to December 2021. PRISMA guidelines were followed for the meta-analysis. Participants were adolescent children or adults with no age restrictions. Exposed to the risk factors were participants with a habit of tobacco chewing and/or smoking. Outcomes were oral malignancy or other potentially malignant oral disorders. Quality was evaluated using the Risk of Bias Assessment tool. Random effects model was used to assess and compare the association between smoking and chewing forms of tobacco with the outcome measure. Assessment of certainty of evidence was conducted using GRADE analysis. RESULTS A total of 30764 tobacco smokers and 36134 tobacco chewers with oral cancer were available for analysis. Similarly, 4135 tobacco smokers and 4033 tobacco chewers were available for analysis for oral potentially malignant disorders. Tobacco chewers were significantly associated with higher presence of oral potentially malignant disorders among patients with both mixed (OR=2.20; 95% CI: 1.25– 3.87, p=0.001; I²=93%) and no mixed usage (OR=2.63; 95% CI: 2.01–3.43, p=0.001; I² =44%) when compared with tobacco smokers with mixed and no mixed usage. Tobacco chewers were also significantly associated with higher presence of higher oral malignancy among patients with both mixed (OR=2.26; 95% CI: 1.19–4.28, p=0.01; I² =91%) and no mixed usage (OR=2.98; 95% CI: 1.62–5.46, p=0.001; I² =0%) when compared with tobacco smokers with mixed and no mixed usage. CONCLUSIONS This meta-analysis provides substantial evidence that consumption of chewing tobacco is significantly associated with higher oral malignancy and oral potentially malignant disorders compared to smoking tobacco. [ABSTRACT FROM AUTHOR]

Background: High school and college students as well as athletes have shown a rise in cigarette use. The aim of this study to evaluate the effects of Chewing Tobacco on Hematological Parameters. Material and methods: Fifty members of the department of General Medicine, LN Medical College and JK Hospital, Bhopalaged 20-50 participated in a pilot research. Individuals who were 20-50 years old, had a normal body mass index, and used smokeless tobacco exclusively for at least the previous five years were eligible for participation. Active and passive smokers, as well as people with preexisting conditions like lung disease, heart disease, cancer, chronic liver or kidney failure, diabetes mellitus, obesity, or a history of heavy alcohol consumption, were not allowed to participate. Results: In our study showed the mean value of Hb in chewing tobacco Hb(g/dl) 15.25±0.33, RBC(106/µL) 5.77±0.87, TLC(103/mm3) 6.57±0.67, Neutrophil (%) 66.02±2.21, Eosinophil (%) 1.91±0.61, Basophil (%)0.41±0.22, Lymphocyte (%) 30.15±2.54, Monocyte (%) 2.21±0.89, Platelets (103/mm3) 149.25±10.54. All three measures of haemoglobin, red blood cell count, and total leukocyte count are considerably greater in those who chew tobacco. Their blood also has a much greater neutrophil proportion, as seen by the differential count data. In addition, their blood has a noticeably reduced proportion of lymphocytes and monocytes. Chewing tobacco users also had considerably lower platelet counts. Conclusion: Chewing tobacco has been shown to have negative effects on a number of haematological parameters in the current investigation, including an increase in Hb level, RBC count, TLC, and neutrophil percentage and a drop in monocyte, lymphocyte, and platelet percentages. According to the results of the current research, care should be used when assessing haematological parameters or doing a screening for anaemia in those who regularly use chewing tobacco. [ABSTRACT FROM AUTHOR]

Mutations of p53 gene is one of the most common events in human cancers including oral squamous cell carcinoma (OSCC). However, its role in carcinogenesis and association with regard to prognosis is still under investigation and unclear. The aim was to study the expression of p53 in patients of OSCC and correlation with clinical presentation and prognosis. In this retrospective observational pilot study, we examined expression of p53 in 50 histologically diagnosed cases of OSCC and correlated it with initial clinical presentation and clinical events in follow up period. p53 expression was significantly negative (94%) in patients with history of only oral tobacco consumption while cases with additional history of smoking or alcohol were positive (p = 0.0001 and 0.011). On the other hand, aggressive course of the disease was found to be significant with p53 positivity in the form of lymph nodal extension (13 out of 17 cases) (p = 0.011) and recurrence (6 out of 10 cases) (p = 0.024). p53 was overexpressed (positive) in predisposing factors like smoking and alcohol but not in OSCC associated with chewing tobacco. p53 overexpression is also associated with advanced TNM stage. To the best of our knowledge, this is the first report where association of p53 overexpression and oral tobacco consumption associated OSCC was not observed and we recommend that carcinogenic events in chewing tobacco induced OSCC should be studied separately for its unique set of mutations. [ABSTRACT FROM AUTHOR]

This paper investigates the impact of cigarette prices on adults' smoking and smokeless tobacco (SLT) use initiation and cessation decisions in India from 1980 to 2017. We use individual-level data from the 2017 Global Adult Tobacco Survey (GATS) to recreate the smoking history of current or past adult tobacco users using self-reported data on the years of tobacco use, initiation, and cessation merged with historical data on cigarettes, bidis, and SLT product prices. To estimate the effect of price changes on smoking and SLT use transitions, we use a pooled linear model and propensity score matching (PSM) to construct an artificial treatment group where weights capture the likelihood of being an ever-smoker. We find that price increases are a statistically significant deterrent to smoking initiation, with price elasticity of initiation being on average -0.0236 (CI: -0.024 -0.023) and -0.000428 (0.0 – 0.0) for smoking and SLT, respectively. This implies, for example, that a 10% increase in prices results in a 0.24% smaller smoking initiation and 0.004% smaller SLT use initiation. We find that prices can also encourage quitting, but the effects are not always significant, with elasticities of 0.0218 (CI: 0.017 0.026) and 0.0026 (CI: 0.001 0.004) for smoking and SLT, respectively. This implies that a 10% increase in prices will result in a 0.22% increase in the probability of quitting smoking and a 0.03% increase in the probability of quitting SLT use. The elasticity varied by income group, gender, and between young and all adults, with larger effects among lower-income adults and especially among young females. Higher cigarette prices that can be achieved by tobacco tax increases can significantly reduce initiation and encourage cessation, thus improving public health, especially among the most vulnerable population subgroups. [ABSTRACT FROM AUTHOR]

INTRODUCTION Chewing tobacco and smoking among youth leads to poor health outcomes. Understanding the factors associated with chewing tobacco and smoking is thus important for interventions. METHODS A case-record analysis among 10340 youth (aged 15-35 years) attending a unique mental health promotion program, Yuva Spandana, across the state of Karnataka in southern India, was performed to assess prevalence of chewing tobacco and smoking. Multiple logistic regression was applied to determine the factors associated with their use. RESULTS Overall, the prevalence of chewing tobacco and smoking among beneficiaries was 3% and 2.1%, respectively. The risk of tobacco chewing and smoking increased with age and risk was higher among males, married individuals and among all occupational categories, other than students. Adjusted odds ratios of chewing tobacco were found to be highest among business/salaried beneficiaries (AOR=3.48; 95% CI: 2.27-5.34), followed by ever married beneficiaries (AOR=3.41; 95% CI: 1.27-9.17). Adjusted odds ratios of smoking tobacco were highest among males (AOR=12.89; 95% CI: 7.5-22.14), followed by emotional experience of feeling worthless (AOR=4.19; 95% CI: 2.78-6.32), beneficiaries with poor relationship with family members (AOR=3.79; 95% CI: 1.38-10.44), and business/salaried beneficiaries (AOR=2.90; 95% CI: 1.79-4.7). Strength of association of males with smoking was much higher (AOR=12.89; 95% CI: 7.5-22.14) than compared with chewing tobacco (AOR=2.49; 95% CI: 1.89-3.28). CONCLUSIONS Early identification of these factors associated with chewing tobacco and smoking will help in focusing on youth specific health promotion and interventions to improve their overall health and wellbeing. [ABSTRACT FROM AUTHOR]

Objective: The aim of this study was to compare the salivary proteomic profile of smokeless tobacco users with that of non-users and oral cancer patients using Liquid Chromatography-Mass Spectrometry/ Mass Spectrometry (LC-MS/MS)., Methods: Saliva samples from 65 participants were collected in three groups: control (25 participants), smokeless tobacco users (25 participants), and oral cancer (15 participants)., Results: The analysis revealed 343 protein groups with significantly altered abundance in the saliva samples (P < 0.05). Among these, 43 out of 51 dysregulated proteins in the smokeless tobacco group were also dysregulated in the oral cancer group. Notably, Apolipoprotein A1 (ApoA1) and Pon1 were found to be significantly increased in both smokeless tobacco users and oral cancer patients (p < 0.05). Furthermore, six out of the 20 most significantly altered proteins were mitochondrial proteins, and all of these were decreased relative to controls in both smokeless tobacco users and cancer samples., Conclusion: The proteomic profile of users of chewing (smokeless) tobacco (SLT) shows substantial overlap in the altered pathways and dysregulated proteins with those altered in oral cancer samples, suggesting that SLT use induces a shift toward an oncogenic state. Specifically indicated pathways included blood microparticles, platelet α-granules and protease inhibitors as well as indicators of oxidative stress and exogenous compound processing. What differentiates oral cancer samples from SLT users is enrichment of alterations related to cytoskeletal organisation and tissue remodelling., Clinical Significance: The findings emphasize the importance of salivary proteomic profiles because changes in certain proteins may be indicators for early oral cancer identification and risk assessment in smokeless tobacco users., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

Introduction: Since 2011, sale of commercially available smokeless tobacco products for chewing such as gutkha has been prohibited in many states in India. The current study attempts to understand the effectiveness and perception towards ban on gutkha sales in West Bengal and Kerala. Methods: Total six districts from both the states (three districts from each state). From each district, 1 Municipality and 2 Community Development Blocks were selected randomly, representing each cluster. From each cluster, line transect survey was used to identify Point of Sale (POS) of tobacco products. Tobacco consumers and vendors were interviewed from POS. Results: 865 tobacco users (West Bengal = 450, Kerala = 415) and 173 vendors (West Bengal = 90, Kerala = 83) were interviewed for the study. 16.1% of the total users from Kerala were using gutkha alone or in combination with other tobacco chewing products while in West Bengal the corresponding figure was 17.3%. Knowledge on ban was high among the consumers (95.7%) and vendors (100%) in Kerala while in West Bengal it was 64% and 62.2% respectively. Gutkha was available in 68% of the shops in West Bengal, while in Kerala no sale was reported in shops, though half of the vendors interviewed, admitted its sales in black market. Conclusion: The ban had little impact in West Bengal in the open market, while it had moderate impact in Kerala. However, the black market sales in Kerala are a matter of concern. Strict legislative measures are essential to cut the supply route for effective implementation of the ban.

An enrichment method was developed for the determination of inorganic mercury (Hg) in artificial saliva extracts (ASE) of frequently consuming chewing tobacco products (CTP). The artificial saliva extracts of the mainpuri and gutkha chewing tobacco were subjected to dispersive liquid-liquid micro-extraction (DLLµE) based on the ultrasound based back extraction of hydrophobic complex of inorganic mercury (iHg) separately by L-cysteine and hydrochloric acid. The total Hg, extractable Hg (EHg), and enriched inorganic mercury in artificial saliva extracts of chewing tobacco were determined by electrothermal atomic absorption spectrometry (ETAAS) and inductively coupled plasma – optical emission spectrometry (ICP-OES). The results obtained by these techniques were not significantly different (p > 0.05). Factors affecting the extraction efficiency of inorganic mercury such as concentration of the ligand, pH, disperser/extracting solvent, sonication time, and back extracting reagents were optimized by multivariate techniques. The precision and accuracy of total mercury (tHg) was confirmed by analyzing a tobacco certified reference material, while the validity of the proposed method (DLLµE) was ensured by spiking inorganic mercury in artificial saliva extracts of the chewing tobacco products. Using the optimized conditions for developed method, the limit of detection and enrichment factor for inorganic mercury were 0.17 μg/L and 96.2, respectively. The extractable Hg in artificial saliva extracts of chewing tobacco was from 35 to 48% of the total content. However, the concentration of inorganic mercury was between 68 and 80% of the total extractable concentration in artificial saliva extracts of the chewing tobacco. [ABSTRACT FROM AUTHOR]

Modern trends in the reduction of cigarette consumption have led to the spread of smokeless tobacco and non-tobacco nicotine-containing products [1]; their variety creates certain problems with the identification of products in this segment. Sucking tobacco (snus) has been banned in the Russian Federation for wholesale and retail trade since 2015, but it is a product similar to chew- ing tobacco in packaging, ingredient composition and physiological effects. Therefore, establishing the identification characteristics of chewing tobacco is an urgent task. The attitude towards chewing tobacco is controversial. The absence of the smoldering / burning process characteristic of cigarettes indicates a decrease in the harmful effect on the human body. At the same time, the physiological ef- fect on the consumer is based on the effect of nicotine extracted from tobacco through the oral mucosa. Consumer indicators of samples of smokeless tobacco / non-tobacco nicotine-containing products have been investigated: moisture content, fractional composition and nicotine content. The moisture content of samples of non-smoking products ranges from 19,0 % to 36,5 %. The nicotine content in the investigated tobacco / non-tobacco products is 0,3–2,4 % / 1,0–8,8 % respectively. To establish the identification signs of smokeless tobacco products the following methods have been used: product fractionation, optical microscopy, spectrophotometry, and liquid chromatography / tandem mass spectrometry (LCMS / MS). The main feature of the difference between smokeless tobacco products and non-tobacco nicotine-containing products has been determined – the presence of tobacco in the ingredient composition, confirmed by the structure of the product and the content of specific tobacco nitrosamines. As a result of the research, experimental data were obtained on the quantitative determination of the content of tobacco specific nitrosamines by the LCMS / MS method in smokeless tobacco products. The main identification feature of chewing tobacco has been established: the presence of raw tobacco in the ingredient composition with a coarse fraction content is at least 15 %.

Background and Objective: Using chewing tobacco is one of the most important health problems in ports of the southern coast of Iran. The prevention of this problem requires identifying the factors affecting this phenomenon. The aim of this study was to determine the prevalence of chewing tobacco and related factors among adolescents in South- East of Iran (2018). Methods: This descriptive-analytical study was conducted on 204 male high school students through multistage sampling in two the ports of Konarak and Chabahar located in south - east of Iran during March to June 2018. The data collection tool was a self-administered standardized questionnaire including items about knowledge, attitude and prevalence of chewing tobacco among participants, intimate friends and family members of the study population. Results: Prevalence of chewing tobacco in life time and current use (pervious 30 days) was 71.8% and 43.1%, respectively. Supari was the main chewing tobacco were used (80.8%) by participants. The negative attitudes about chewing tobacco was a protective factor (OR=0.41) and easy access (OR=6.88), using by family members (OR=2.28), and close friends (OR=3.28) were the most important risk factors. Conclusion: The prevalence of chewing tobacco was alarming in male high school students in south - east of Iran.

Previous studies on smokeless tobacco use and head and neck cancer (HNC) have found inconsistent and often imprecise estimates, with limited control for cigarette smoking. Using pooled data from 11 US case-control studies (1981-2006) of oral, pharyngeal, and laryngeal cancers (6,772 cases and 8,375 controls) in the International Head and Neck Cancer Epidemiology (INHANCE) Consortium, we applied hierarchical logistic regression to estimate odds ratios and 95% confidence intervals for ever use, frequency of use, and duration of use of snuff and chewing tobacco separately for never and ever cigarette smokers. Ever use (versus never use) of snuff was strongly associated with HNC among never cigarette smokers (odds ratio (OR) = 1.71, 95% confidence interval (CI): 1.08, 2.70), particularly for oral cavity cancers (OR = 3.01, 95% CI: 1.63, 5.55). Although ever (versus never) tobacco chewing was weakly associated with HNC among never cigarette smokers (OR = 1.20, 95% CI: 0.81, 1.77), analyses restricted to cancers of the oral cavity showed a stronger association (OR = 1.81, 95% CI: 1.04, 3.17). Few or no associations between each type of smokeless tobacco and HNC were observed among ever cigarette smokers, possibly reflecting residual confounding by smoking. Smokeless tobacco use appears to be associated with HNC, especially oral cancers, with snuff being more strongly associated than chewing tobacco.

With substance abuse, harm reduction refers to reducing or replacing use of a harmful product with a less risky agent. But many advertised "non-pharmaceutical" harm reduction alternatives for tobacco smoking are problematic. Studies have revealed inconclusive results using agents including chewing tobacco and e-cigarettes to quit smoking and have demonstrated continued use of these agents. Many smoking harm reduction agents pose other health risks not found in traditional tobacco smoking. Given these limitations, efforts should focus on promoting nicotine replacement therapy, and other pharmacologic agents with a better chance of producing sustained smoking cessation. To address the harmful nature of many tobacco replacement products, public health should focus on regulating these alternatives with the same stringency as tobacco, and social marketing efforts should target evidence-based and safer pharmaceutical grade or behavioural alternatives. [ABSTRACT FROM AUTHOR]

The consumer market for tobacco products is highly segmented by type of product, assortment, taste preferences of consumers and cost: these are traditional cigarettes, cigars, cigarillos, pipe and smoking tobacco, as well as innovative products – various types of nonsmoking products – oral tobacco (sucking, chewing) and nasal (snuff).Traditional types of tobacco products are well studied, have clearly defined requirements formulated in government documents.Recently appeared in a large assortment of non-smoking tobacco products are positioned by manufacturers as a less toxic alternative to smoking tobacco and the possibility of painless smoking cessation.In this situation there is a need to reduce toxicity and to produce high quality products.Identification issues step forward, i.e. attribution of products to one form or another.In particular, the identification of non-smoking oral tobacco tobaccos, which have similar methods of consumption, component composition and differ only in individual technological methods, is very serious.The article deals with important and relevant issues of identification of non-smoking tobacco products and methods for determining technological indicators.As a result of the studies, the identification features of chewing tobacco have been established and draft methods for determining the fractional composition and humidity of chewing tobacco developed.

Background: There is a well-established link between the use of smokeless tobacco (ST) and the development of oral cancer. This study was conducted to evaluate the impact of tobacco use, quid use, and other adverse habits related to smoking and alcohol consumption on ST-induced localized lesions., Objectives: The aim of the study was to examine the demographic data, frequency and contact duration of ST on the lesion, as well as to conduct a clinical evaluation of these parameters., Material and Methods: A total of 13,442 patients who had been experiencing oral and dental symptoms for a period of at least 6 months were screened. Of these, 334 patients were diagnosed with STor quid-induced localized lesions and had a positive history of ST or quid use. A structured questionnaire was employed to conduct interviews with participants regarding their use of ST and other adverse habits, including smoking and alcohol consumption. Other information related to the use of ST or quid and clinical findings were also recorded, along with the patients' demographic details. A statistical analysis was carried out using the χ2 test and the regression analysis., Results: The overall prevalence of ST-induced localized lesions was found to be 2.48%. In the study population, the majority of participants (58.7%) reported a habit of using khaini, while 26.8% reported using gutkha. The study found significant differences in the severity of ST-induced localized lesions and contact duration, frequency of the habit, and the presence of additional habits such as smoking and/or alcohol consumption. Based on this study, we proposed a modified Greer and Poulson's classification of ST-induced lesions, dividing them into 4 clinical types., Conclusions: Smokeless tobacco-induced localized lesions frequently remain asymptomatic, with patients unaware of their presence. Other adverse habits, including smoking and alcohol consumption, as well as increased ST contact duration were associated with the development of more severe ST-induced localized lesions.