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Background and aims: Smokeless tobacco (ST) use in South Asia is high, yet interventions to support its cessation are lacking. We tested the feasibility of delivering interventions for ST cessation in South Asia. Design: We used a 2 × 2 factorial design, pilot randomized controlled trial with a duration of 26 weeks, including baseline and follow‐up (6, 12 and 26 weeks) assessments. Setting: Two primary health‐care facilities each in Dhaka (Bangladesh) and Karachi (Pakistan) and a walk‐in cancer screening clinic in Noida (India) took part. Participants: Adult daily ST users willing to make a quit attempt within 30 days. Of 392 screened, 264 participants [mean age: 35 years, standard deviation = 12.5, 140 (53%) male] were recruited between December 2020 and December 2021; 132 from Bangladesh, 44 from India and 88 from Pakistan. Interventions: Participants were randomized to one of three treatment options [8‐week support through nicotine replacement therapy (NRT, n = 66), a behavioural intervention for smokeless tobacco cessation in adults (BISCA, n = 66) or their combination (n = 66)] or the control condition of very brief advice (VBA) to quit (n = 66). Measurements Recruitment and retention, data completeness and feasibility of intervention delivery were evaluated. Biochemically verified abstinence from tobacco, using salivary cotinine, was measured at 26 weeks. Findings Retention rates were 94.7% at 6 weeks, dropping to 89.4% at 26 weeks. Attendance in BISCA pre‐quit (100%) and quit sessions (86.3%) was high, but lower in post‐quit sessions (65.9%), with variability among countries. Adherence to NRT also varied (45.5% Bangladesh, 90% India). Data completion for key variables exceeded 93% among time‐points, except at 26 weeks for questions on nicotine dependence (90%), urges (89%) and saliva samples (62.7%). Among follow‐up time‐points, self‐reported abstinence was generally higher among participants receiving BISCA and/or NRT. At 26 weeks, biochemically verified abstinence was observed among 16 (12.1%) participants receiving BISCA and 13 (9.8%) participants receiving NRT. Conclusions: This multi‐country pilot randomized controlled trial of tobacco cessation among adult smokeless tobacco users in South Asia demonstrated the ability to recruit and retain participants and report abstinence, suggesting that a future definitive smokeless tobacco cessation trial is viable. [ABSTRACT FROM AUTHOR]

Introduction: Smokeless tobacco (ST) is a significant South Asian public health problem. This paper reports a qualitative study of a sample of South Asian ST users.Methods: Interviews, using a piloted topic guide, with 33 consenting, urban dwelling adult ST users explored their ST initiation, continued use, and cessation attempts. Framework data analysis was used to analyze country specific data before a thematic cross-country synthesis was completed.Results: Participants reported long-term ST use and high dependency. All reported strong cessation motivation and multiple failed attempts because of ease of purchasing ST, tobacco dependency, and lack of institutional support.Conclusions: Interventions to support cessation attempts among consumers of South Asian ST products should address the multiple challenges of developing an integrated ST policy, including cessation services.Implications: This study provides detailed understanding of the barriers and drivers to ST initiation, use, and cessation for users in Bangladesh, India, and Pakistan. It is the first study to directly compare these three countries. The insight was then used to adapt an existing behavioral support intervention for ST cessation for testing in these countries. [ABSTRACT FROM AUTHOR]

Abstract: Ethnopharmacological relevance: Khat is a natural psychostimulant that has pharmacological effects similar to that of amphetamine. The behaviour of khat chewing is embedded within a cultural context. Meanwhile khat chewing is associated with psychological and physiologically burden, as a ‘dependence producing'' substance. Aims of the study: To assess the applicability of the construct of substance dependence syndrome (DSM-IV, 1994) to khat chewing and to examine psychosocial and behavioural correlates of this syndrome including tobacco use. Materials and methods: A sample of 204 khat chewers was recruited during random visits to khat sale outlets. A face to face interview that assessed socio-demographic, psychosocial dependence, substance dependence syndrome and behavioural characteristics was conducted. Descriptive, exploratory psychometric and multivariate analyses were employed. Results: Approximately a third (31%) of khat chewers reported symptoms consistent with dependence syndrome including increased khat chewing (13%) and cessation attempts (19%) while 17% reported withdrawal symptoms including depression (61%), increase in appetite (74%) and interrupted sleep (58%). Thirty-eight percent reported continued khat chewing despite impacts on their health. Psychometric assessment of the DSM-IV criteria for khat chewing dependence identified two factors; factor 1 consisted of bio-behavioural items and factor 2 withdrawal items, accounting for 67% of the variance and Cronbach''s alpha coefficient at 0.78. In multivariate logistic regression modelling, there was an association between intensity of psychological khat dependence (SDS-Khat) and nicotine dependence with the likelihood of exhibiting khat chewing dependence syndrome (p=0.0005, OR=1.51, 95%CI=1.33–1.71; p=0.043, OR=2.87, 95%CI=1.03–7.98, respectively). Conclusions: The substance dependence syndrome criteria are applicable to khat chewing and associated with increased intensity of nicotine and psychological khat dependence. The applicability of khat dependence syndrome and exploration of its dimensions and associated factors should be extended in future research. Concurrent validation of these findings using specific objective measures for self-report khat chewing is also recommended. [Copyright &y& Elsevier]

Background: The chewing of khat leaf with tobacco smoking amongst Yemenis, Somalis and Ethiopians is reported to impact oral and general health. The health status and particularly dental and medical care attendance of UK-khat chewers has not received attention. This study aimed to explore health status and dental and medical attendance and its associated factors in UK permanently resident Yemeni khat chewers. Methods: A cross- sectional study with a purposively selected sample of 204 khat chewers was conducted. Data were collected through face to face interviews. Data analysis included descriptive, Chi-square tests and binary logistic regressions. Results: The mean age for this study sample was 44.84 (SD = ±19.70) years and 35% were employed. Forty five percent reported symptomatic medical attendance for self reported health conditions in the last two weeks whilst 44% had symptomatic dental attendance. Higher khat chewing dependency levels associated positively with both symptomatic dental and medical attendance (p = 0.004, OR = 1.14, 95%CI = 1.04-1.25; p = 0.003; OR = 1.16, 95% CI = 1.05-1.29, respectively). Higher social participation levels associated negatively with symptomatic dental attendance (p = 0.034, OR = 0.98, 95%CI = 0.96-0.99) whilst increase in age and self-reported health conditions associated positively with symptomatic medical attendance (p = 0.030, OR = 1.03, 95%CI = 1.01-1.06; p = 0.001, OR = 4.51, 95%CI = 2.02-10.08, respectively). Conclusions: In this study of khat chewers, a significant proportion reported symptomatic dental and medical attendance. Demographic, psychosocial and self reported general health conditions were associated significantly with dental and medical attendance. Strategies to improve the dental and medical care attendance amongst this group should focus on these and other unexplored underlying factors. [ABSTRACT FROM AUTHOR]

Objectives: The purpose of this study is to explore tobacco control-related education of health profession students and demonstrate variations according to course of study. Methods: This was a cross-sectional survey of 154 of third year nursing, pharmacy, medical and dental students in a tertiary institution in Lagos, Nigeria. The validated Global Health Professional Students survey questionnaire was used to collect data on recall of tobacco-related training, attitudes to tobacco control and beliefs about the role of health professionals in tobacco control. This was voluntary and anonymous. Descriptive and univariate analysis were conducted. Results: Only 11.8% (n=18) of all respondents recalled being trained on all possible items of formal tobacco-related training. Pharmacy students had significantly low levels of training recall (X2(3)=9.88; p=0.02). Nursing students were reported to have the most positive attitudes to tobacco control with the highest mean score of 4.27 (95%CI= 3.88-4.66). However, there was no significant difference in attitudes to tobacco control. Compared to other students, Nursing students were significantly less likely to believe that as health professionals they had a role in tobacco-control (X2(3) = 8.06; p=0.045). Conclusions: Many respondents believed they have a role in providing cessation interventions and that specific training should be part of the education they receive. However, fewer respondents report receiving such training. The education and training of these samples of health profession students needs to place more emphasis on their role in tobacco control if they are to effectively function as health promoting health professionals in preventing tobacco-related diseases. [ABSTRACT FROM AUTHOR]

Objective. To reflect on recent proposed tobacco control initiatives in the socio-cultural context of the smoking behaviours of UK resident Bangladeshi men. Design. Cross-sectional study using focus groups and one-to-one interviews conducted in English and Sylheti. Eighty-one men, aged 18-64 years, were recruited from the Bangladeshi community of Tower Hamlets, London, during 2002. Participants were purposively selected to reflect their age, place of birth and tobacco-use status. The discussions were tape-recorded and subsequently transcribed. The transcripts were analysed using 'framework' principles. Three of the current themes for tobacco control - smoke-free workplace environments, access to alternative sources of tobacco, and use and availability of nicotine replacement therapy - were used to organise the data. Results. Smoking initiation and use was confirmed as linked to gender, age, religion and tradition. Continued smoking was supported by anxieties about harassment in younger respondents, the migration experience of older respondents, and the unskilled employment opportunities available in the restaurant trade. These employment opportunities, whilst providing social support, did not support smoking regulations, in contrast to the practices observed in the general employment market. Levels of knowledge about the health risks of smoking varied by age. Three cheaper alternative tobacco types were readily accessible for use: contraband, roll-ups and traditional chewing tobacco in paan (chewing tobacco mixed with areca nut rolled in a betel leaf). Despite the latter's associations with use by women, younger respondents described the transition to chewing tobacco in paan as a smoking cessation aid instead of nicotine replacement therapy. There was confusion about the purpose, availability and efficacy of nicotine replacement therapy. Respondents reported isolation and marginalisation from current tobacco control initiatives, including much NHS Stop Smoking Service provision. Conclusion. The socio-cultural context of the smoking behaviours of this group of Bangladeshi men was linked to a reported isolation and exclusion from current tobacco control initiatives. These initiatives should be inclusive and address the reported needs of this community. The findings have implications for service development. Addressing these findings will help to inform the implementation of relevant public health policy initiatives for tobacco control to meet the needs of this community. [ABSTRACT FROM AUTHOR]

This multinational survey investigated the relationship between emotional intelligence (EI) and perceived stress (PS) in seven countries. First-year dental undergraduates attending a dental school in England, Greece, Romania, South Africa, Australia, and the United States and three schools in Malaysia were invited to complete a set of questionnaires on age, gender, academic background, satisfaction with career choice, EI, and PS. Of 860 questionnaires distributed, 596 were fully completed--a response rate of 69.3 percent. Mean EI score was 123.8 (95 percent CI 122.7-124.9), and mean PS score was 19.1 (95 percent CI 18.6-19.7). Significant differences in EI and PS scores were detected between different countries. Females (p<0.05), younger students (p<0.001), those without a previous higher education qualification (p<0.001), and those not satisfied with their decision to study dentistry (p<0.001) were more likely to report PS when compared to their counterparts. A significant inverse relationship (coefficient=-0.29, p=0.001) between EI and PS was detected. Independent significant predictors of PS identified were gender (beta=0.22, t=5.71, p=0.001), previous higher education qualification (beta=-0.14, t=-2.42, p=0.010), satisfaction with decision to study dentistry (beta=-0.20, t=-5.11, p=0.001), and EI (beta=-0.24, t=-6.09, p=0.001), with the latter being relatively the most important predictor. In conclusion, the inverse relationship between EI and PS has been confirmed in this heterogeneous sample representing diverse sociocultural and academic contexts of dental undergraduates. [ABSTRACT FROM AUTHOR]

Objectives: The study objectives were to assess the oral health status of a sample of UK resident Bangladeshi women tobacco-in-paan users and its relationship to participant age and number of daily paan, to determine the prevalence of oral pain at baseline and at the one-week postcessation follow-up, and to explore the relationship between oral health status and changes in self-reported oral pain at baseline and at the one-week postcessation follow-up.Methods: Interviews were conducted in Sylheti using fully structured questionnaires and an oral examination was carried out. A quit date was set and nicotine replacement therapy patches (Nicorette 15 mg, Pfizer) were supplied. Age, number of daily paan, and oral pain characteristics, including intensity, frequency, any provoking factors, and associated symptoms were recorded. Oral mucosal lesions (OMLs) and numbers of teeth decayed, missing, filled, and those with recession, abrasion, loss of attachment (LOA), and tooth wear were charted.Results: Fifty-two women took part. The mean age was 42.8 years and number of daily paan with tobacco was 13. Compared to those aged 18-39 years, those aged 40 years and older had poorer oral health. Older adults were significantly more likely to have higher numbers of teeth with recession, abrasion, and LOA greater than 3.5 mm. They were significantly more likely to have an OML at baseline. The prevalence of self-reported oral pain was 26.9 percent at baseline and 51.9 percent at one-week follow-up. Presence of an OML at baseline was a significant predictor of reports of oral pain at the one-week follow-up. Results of stepwise multiple regression analysis confirmed this finding (OR = 3.66; 95% CI = 1.06, 12.621; P = .04).Conclusions: Reports of oral pain at follow-up during a tobacco cessation program correlate with the presence of OMLs at baseline. Further investigation of this relationship is needed. Access to appropriate dental care, as an aid to successful tobacco cessation, is indicated. [ABSTRACT FROM AUTHOR]

This study investigated the relationship between emotional intelligence (EI) and perceived stress (PS) in dental undergraduates. All dental undergraduates attending a UK dental school were invited to complete a questionnaire on age, gender, year of study, EI, and PS. Two hundred and thirteen students (48 percent male) participated, a response rate of 70 percent. The mean score for EI was 117.54 (S.D. 14.90) and PS was 17.73 (S.D. 6.49). Factor analysis confirmed four factors previously identified in the literature as comprising emotional intelligence: optimism/mood regulation, utilization of emotions, appraisal of emotions, and social skills. T-tests indicated that females had significantly higher EI scores than males. Mean PS scores were significantly higher for students aged over twenty-one years compared with those aged twenty-one years or less (p < 0.001), female compared to male students (p < 0.05), and those in higher years compared to those in lower years of study (p < 0.001). Correlational analysis showed an inverse relationship between EI and PS. Multiple regression analysis identified year of study, optimism/mood regulation, and gender as independent, significant predictors of PS. In conclusion, low EI scorers report more PS. Future research should investigate the relationships of EI and PS with impact on lifestyle behaviors, academic and clinical performance, and health outcomes. [ABSTRACT FROM AUTHOR]

A controlled evaluation of a 3-week teacher mediated dental health education curriculum package was undertaken in 35 English secondary schools in three Area Health Authorities. 4500 13-14-year-old adolescents were involved. The package emphasized self-care potential and combined a scientifically accurate message with educational and behavioural science concepts. Evaluation was at the levels of process and outcome using changes in oral hygiene recorded on a random sample (n =1491) by two trained examiners; self-complete pre/posttest questionnaires, pupil worksheets and home experiment diaries. Behavioural, cognitive and affective outcomes are reported. Significant improvements in oral hygiene status were recorded at the conclusion of the programme along with large gains in knowledge and positive changes in attitude. Long term follow-up oral hygiene examinations in six schools (n =145) conducted in conjunction with a reinforcement programme, indicated a maintenance of the initial improvements in five schools. Further significant improvements were measured after the reinforcement programme. [ABSTRACT FROM AUTHOR]

Interviews investigating factors influencing dental visiting were held with a nationally drawn (England + Wales) random sample of 690 16-20-year-olds. The results presented relate specifically to the last reported dental visit, the balance of self and professional dental care, knowledge and acceptability of charges for dental treatment, factors in choosing a dentist, feelings about visiting the dentist and whether information relating to treatment or prevention is either asked of or given by the dentist. The results were found to vary by age, sex, social class and region. The implications of these findings for the training of dentists and dental health education messages are discussed. [ABSTRACT FROM AUTHOR]

Objectives: To explore the self-reported oral health and health behaviours of a sample of Inner London Chinese elders and the impact of their self-reported oral health on their social functioning and eating ability.Design: Cross sectional.Setting: Luncheon clubs in Central and East London, UK.Subjects: 54 Chinese elders aged 54-81 years.Intervention: A structured questionnaire, administered by two interviewers in Cantonese.Main Outcome Measures: Knowledge and beliefs about the causes and prevention of tooth decay and gum disease, the oral conditions experienced in the previous twelve months and the impact of these conditions.Results: Overall health was rated more positively than oral health, although those who reported below average oral health were more likely to report below average overall health. Whilst over half thought that sugar and sweet food could cause tooth decay, only 19% thought that poor oral hygiene could cause gum disease. Over half thought that "hot air" caused gum disease. Three quarters brushed their teeth at least twice a day. Two thirds had experienced at least one oral condition in the previous twelve months, with the more elderly being more likely to report this. Social impacts affected 41% of the sample whilst 44% suffered at least one dietary impact.Conclusions: The burden of oral conditions is substantial, especially on the more elderly members, impacting on the performance of social functions. These burdens indicate a need for oral health services. Beliefs in the traditional Chinese explanation of "hot air" as a cause of gum disease were common. Health promotion effort should consider these when developing health messages. [ABSTRACT FROM AUTHOR]

This investigation aimed to audit patient satisfaction with care at a dedicated dental clinic, using previously developed standards and criteria. A self-complete questionnaire was administered to a group of 161 patients assessing the dimensions of care availability, affective behaviour and technical competence. Comparisons with baseline showed a high but slightly decreased level of satisfaction with technical competence, a significantly higher level of satisfaction with the affective behaviour of the clinic staff but a continuing level of dissatisfaction with the availability of care. Respondents with AIDS reported higher levels of satisfaction for all 3 dimensions. Women were less satisfied with the availability of care. The results indicate the inter-related nature of the dimensions of technical competence and care availability. Satisfaction with care availability will only improve if initiatives beyond the clinic are introduced to increase the overall supply of dental services available to this population. [ABSTRACT FROM AUTHOR]

This paper investigates whether eight specific life-events were related to self-reported chronic (persistent trouble over the last 12 months) and acute (trouble in the last 14 days) oral symptoms in a sample of 3861 civil servants aged 35-44 years. The results of a logistic regression analysis taking age, social class and gender into account showed that a range of life-events—marital or family problems other than divorce, death of a relative, personal serious illness, serious illness of a close relative, major financial difficulty and mugging and robbery—were significantly associated with either acute or chronic oral symptoms. Further analysis showed that marital or family problems other than divorce was found to be the most important life event studied. The results support the argument that marital dissatisfaction leads to poorer physical and psychological health. [ABSTRACT FROM PUBLISHER]

Khat, an "amphetamine-like green leaf," may influence the consumption of tobacco. This study reviews the epidemiology of tobacco use among khat users. Electronic database searches using appropriate keywords/terms were conducted to identify observational studies of khat use. Assessment of quality and risk of bias of all included studies was conducted, and the results were synthesised descriptively. Nine eligible cross-sectional studies were identified. All assessed self-reported tobacco among khat users and were carried out in Africa and the Middle East. Eight reported cigarettes and one reported waterpipes as the mode of use. Methods of tobacco use prevalence assessment varied. Prevalence of "current" tobacco use among students and university teachers ranged from 29 to 37%; "lifetime" tobacco use in university teachers was 58% and "undefined" tobacco use in nonspecific adults and students ranged from 17 to 78%. Daily tobacco use among adults was reported as 17% whilst simultaneous tobacco and khat use was reported as between 14 and 30% in students. In conclusion, tobacco prevalence among khat users appears significant. Findings should be interpreted cautiously due to self-reported tobacco use, diversity in questions assessing tobacco use, and type of tobacco consumption. Future research should address the methodological shortcomings identified in this review before appropriate policy interventions can be developed. [ABSTRACT FROM AUTHOR]

Aim To explore the impact of dental anxiety on daily living. Method Twenty people attending a dental sedation clinic completed the Modified Dental Anxiety Scale, and were interviewed privately using a reflexive, in-depth technique. All interviews were audiotape recorded and transcribed. The transcripts were analysed to identify the impact of dental anxiety upon the participants' daily lives. Twenty-five per cent of the qualitative data was reviewed by an independent researcher to ensure the reliability of the analysis. Results The mean age of participants was 41 years (range 23 to 60). The mean MDAS score was 21.5 (range 14 to 25). Five main impacts of dental anxiety were identified: physiological; cognitive; behavioural; health; and social. Subsumed under these broad categories were: the fright response; a vast array of negative thoughts, feelings and fears; avoidance behaviour and behaviours related to eating, oral hygiene, and self-medication; and other manifestations of anxiety in the dental environment including muscular tension, crying and aggression were all identified. Dental anxiety was also found to disturb sleep and to have a profound affect socially, interfering with work and personal relationships. Conclusion The impact that dental anxiety can have on people's lives is wide-ranging and dynamic. [ABSTRACT FROM AUTHOR]

Abstract: Ethnopharmacological relevance: Khat chewing amongst the UK communities originating from Yemen and the East African coast is suggested to create dependency through its main stimulant components (cathinone, norephedrine and norpseudoephedrine) on the central nervous system. Aims of the study: To validate self-reported khat chewing behaviours by measuring levels of cathinone, norephedrine and norpseudoephedrine in saliva and to explore their associations with self-reported khat chewing dependency. Materials and methods: Face-to-face interviews were conducted amongst 30 male UK-resident khat chewers. Saliva samples were collected from each participant and high-performance liquid chromatography (HPLC) employed to extract and quantify the levels of the biomarkers. Results: The mean (SD) for cathinone and the composite norephedrine and norpseudoephedrine levels were 33.93 (±39.20) and 29.28 (±26.32)μg/mL respectively. These biomarkers were significantly associated (p ≤0.05) with khat chewing dependency. Conclusions: Validation of self-reported khat chewing is possible. Khat chewing dependency correlates significantly with biomarker levels in saliva. Replication is required. [Copyright &y& Elsevier]