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Introduction Smokeless tobacco (SLT) companies produce different SLT brands and types that are used extensively throughout India. Methods Within this cross-sectional pack-collection study, available information on details, composition, and profiles of various SLT products and the pictorial warning labels were collected from available retail paan shops in Ananthapur town, Andhra Pradesh, India. Results SLT products are defined by specified names according to regional levels and the products of SLT have their own product constituents. The smokeless tobacco products like madhu chhap, hans chhap, and miraj were identified. The gutkha brands are in the form of khaleja and rebel, and are available in the Indian tobacco market. The brands of vimal, hira, rajnigandha, and RMD are panmasala products in the Ananthapur region. The health warning labels are present on the packets of most of the SLT products in the form of ‘Tobacco kills/Tobacco causes mouth cancer/ Chewing of tobacco is injurious to health/Chewing of panmasala may be injurious to health’. Conclusions This limited pack-collection study identified a plethora of SLT products on the Indian market with an array of ingredients and warning labels – including graphic warning labels. These findings suggest that the monitoring of pictorial health warnings on tobacco product packaging as prevention efforts/measures is warranted.

Nicotine dependence is a current indwelling and challenging health burden among smokeless tobacco users as it involves the compulsive use of a substance despite its known harmful effects. The evaluation of nicotine dependence is challenging as it involves physical and psychological dependence due to nicotine in smokeless tobacco., Aim and Objective: The primary aim is to assess the nicotine dependence in a group of smokeless tobacco by using a six-question Fagerstrom Test for Nicotine Dependence for Smokeless Tobacco (FTND-ST) and to assess the nicotine dependence among three groups, namely Group - 1, who were exclusively pan masala, gutka chewers, Group - 2, who were exclusively Hans users, and Group - 3, who were exclusively betel quid with smokeless tobacco chewers., Materials and Methods: Only those who use smokeless tobacco in the age groups between 21 to 70 years were randomly selected. The total sample size is 100 patients. The age groups were divided into 21-28, 29-35, 36-42, 43-49, 50-56, 57-63, and 64-70. Informed consent was obtained from the participants of the study., Results: The Hans chewers are predominantly females. Pan masala and gutka chewers are predominantly males., Conclusion: Smokeless tobacco chewers like pan masala were found to have high mean nicotine dependence Fagerstrom score than Hans and betel quid with smokeless tobacco chewers., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2023, Shaashi uday et al.)

O0 bjective: The main objective of the study was to understand the perceptions of the residents of rural part of Sriperambudur Taluk, regarding areca nut use. This article discusses the findings of in-depth interviews and focus group discussions at rural part of Sriperambudur Taluk. Materials and Methods: A community-based survey was conducted using qualitative methods. Out of 168 villages, 11 were randomly chosen. Fifteen in-depth interviews and five focus group discussions were conducted. Only those above 10 years of age and who used areca nut either in processed or un-processed form were included in the study. Results: Among different forms of areca nut products, the use of Hans, which is a commercial flavored product containing areca nut, tobacco and other ingredients is believed to be the most prevalent habit in all the age groups. Chewing areca nut is the initiating habit, leading to other habits such as smoking and consuming alcoholic beverages. Residents less than 30 years of age chew areca nut products for fun or because of peer pressure whereas the 30 to 50 year olds get habituated due to reasons such as boredom and family problems. Although there is awareness regarding the ill-effects of tobacco use, there is not much awareness regarding areca nut. According to the residents, the community has not given enough thought regarding areca nut products and therefore no action has been taken to mitigate this high-risk behavior. Conclusion: It is the perception of the community that there is an increasing trend in the use of areca nut especially the commercial forms such as Hans , in rural Tamilnadu. Habit gets initiated at a very young age; therefore age specific intervention programs should be implemented. Periodic research should be conducted to better understand the changing trends of chewing areca nut products.

Background: Tobacco consumption is the major risk factor for developing head and neck squamous cell cancer (SCC). The site of development of HNSCC may depend on the way the tobacco is consumed. While laryngeal cancers are more common among smokers, oral cancers are more common among tobacco chewers. Since the use of smokeless tobacco is increasing, it is important to know whether this difference is restricted only to site wise distribution or it has other clinical and pathological implications.Patients and Methods: We analyzed a prospectively collected dataset of HNSCC patients other than nasopharyngeal cancers attending our outpatient department at a single unit of the head and neck services at Tata Memorial Hospital, Mumbai, India, between January 2010 and September 2011. There were 747 eligible patients and were divided into three groups: Those with chewing as the only habit (chewers), those with smoking as the only habit (smokers), and those with no habits. Patients with regular use of alcohol were excluded from the study. The clinical and pathological parameters were analyzed.Results: Of the 747 patients, the tobacco chewers formed 69.3% followed by smokers (19.5%) and patients with no habits (11.1%). Majority of smokers were men (98%). Site distribution revealed patients with chewing as the only habit had oral cancers (most commonly gingivobuccal complex cancers) as the most common site and those with smoking as the only habit had larynx as the most common site. In patients with no habits, oral tongue was found to be the most common site. No statistically significant pathological differences were observed in between these groups in patients who underwent surgery (n = 366) at the initial modality of treatment.Conclusions: There is a direct relationship between the form of tobacco use and site of appearance of HNSCC. However, there are no differences in clinical or pathological parameters between HNSCC caused by tobacco chewing or tobacco smoking. [ABSTRACT FROM AUTHOR]

BACKGROUND: Smoking, drinking and chewing tobacco product, common habits in India have been positively associated with oral lesions. No study has been conducted in this part of Tamilnadu regarding the prevalence of oral lesions in relation to habits. METHODS: A hospital based cross-sectional study was carried out at Ragas Dental College, Chennai. Already existing data of two thousand and seventeen consecutive patients from sub-urban areas of Chennai, who attended the outpatient department, at Ragas Dental College, for dental complaints during a period of three months in 2004, who underwent oral examination and interviewer based questionnaire was used. RESULTS: Oral soft tissue lesions were found in 4.1% of the study subjects. The prevalence of leukoplakia, OSF and oral lichen planus was 0.59%, 0.55%, and 0.15% respectively. The prevalence of smoking, drinking alcoholic beverages and chewing was 15.02%, 8.78% and 6.99% respectively. Smoking and chewing were significant predictors of leukoplakia in this population. DISCUSSION: The prevalence of leukoplakia, OSF and oral lichen planus in our study population is similar to those found in other populations. The prevalence of consumption of alcoholic beverages in our study population was higher when compared to the Indian National Sample Survey study. However the prevalence of smoking and chewing was found to be lower. Smokers were more likely to develop smoker′s melanosis compared to other lesions. Among those who consumed alcoholic beverages alone, the prevalence of leukoplakia was higher compared to other lesions. OSF was the most prevalent lesion among those who chewed panmasala or gutkha or betel quid with or without tobacco.

The purpose of this study was to determine the prevalence of oral soft tissue lesions in patients who attended the outpatient department, at Bharati Vidyapeeth Deemed University Dental College during a period of 18 months in 2009-2010. About 24,422 subjects belonging to a semi-urban district of Sangli in Western Maharastra (India) were screened. Out of these about 623 cases showed soft tissue lesions. Statistical analysis was done using the SPSS software. 2.5% of the population studied had one or more oral lesions associated with prosthetic use, trauma and tobacco consumption etc. Six hundred and twenty-three patients were found to have significant mucosal lesions. 75 had leukoplakia, 152 had oral submucous fibrosis, 14 had both both leukoplakia and oral submucous fibrosis, 82 had oral squamous cell carcinoma, 35 had oral lichen planus, 195 had apthous ulcers, 23 had denture stomatitis, 28 had fibroma and 19 cases had pyogenic granuloma. The findings in the present study reveal a high prevalence of oral soft tissue lesions and a rampant misuse of variety of addictive substances in the community. Close follow up and systematic evaluation is required in this population. There is an urgent need for awareness programs involving the community health workers, dentists and allied medical professionals. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

Panmasala containing tobacco was introduced in the Indian market during the 1970s. Panmasala consists of areca nut (betel nut), catechu, lime, cardamom, spices, and unspecified flavoring agents, etc., with tobacco locally known as gutkha or without tobacco (Plain or sada), and consumed abundantly in India and also other parts of the world, predominantly in South East Asian countries. Available studies demonstrate that the habits of chewing panmasala gutkha or plain by students and adolesescents are on the increase, which may lead to deterioration of oral health and other organ systems. Based on the experimental as well as clinical studies available on panmasala as well as on different components of panmasala, this review suggests that it has the potential in causation of various oral diseases such as Oral Sub Mucosis Fibrosis (OSMF) and leucoplakia which may lead to oral cancer. Studies reviewed on these chewing mixtures also reveal that it is likely to be carcinogenic, as tobacco and areca nut have carcinogenic potential and both have encompassing addictive potential leading to dependence on chewing mixture containing areca nut and tobacco. These mixtures might not only lead to cancer but may also affect other organs of the body, including oral hard tissues in the form of dental attrition and sensitivity. There is a need to consider the potential health hazards associated with the habits of these products, especially oral cancer. More research is needed to find out early changes which could be reversible and also intervention measures through education to desist people in indulging in such habits. [ABSTRACT FROM AUTHOR]

An etiological and epidemiological study of oral submucous fibrosis (OSMF) has been done in Patna, Bihar. Total 157 cases of OSMF and 135 control subjects were selected for study in the period of 2002-2004. It was observed that Male:Female ratio was 2.7:1. The youngest case of OSMF was 11 year old and the oldest one was 54 years of age. Maximum number of cases were belonging to 21-40 years of age and they were belonging to low or middle socioeconomic class. Most of the OSMF cases used heavy spices and chillies, where as control mild spices and chillies. Gutkha was the most commonly used by the OSMF cases only 3 per cent did not use any gutkha or other areca nut product where as 80 per cent control did not have any chewing habit. The OSMF cases used gutkha and other products 2-10 pouches per day and kept in the mouth for 2-10 minutes and they were using since 2-4 years. Most of the OSMF cases kept gutkha in the buccal vestibule or they chewed and swallowed it, only a small number of patients chewed and spitted it out. It was also observed that OSMF developed on one side of the buccal vestibule where they kept the chew and other side was normal. [ABSTRACT FROM AUTHOR]