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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]

Background and aims Design Setting Participants Interventions Measurements Findings Conclusions 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.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.Two primary health‐care facilities each in Dhaka (Bangladesh) and Karachi (Pakistan) and a walk‐in cancer screening clinic in Noida (India) took part.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.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).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.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.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: Paan quid with tobacco (PQT) use is common in South Asian populations. Oral pain following a PQT cessation attempt is commonly reported. Factors determining this await full exploration. Methods: This prospective study of PQT chewers used a prepiloted interview and clinical examination. Oral pain, socioeconomic position, oral status, health service use, tobacco use and dependency, and psychological distress measures were collected from U.K.-resident Bangladeshi women before and after their quit attempts. Analysis included descriptive and analytic modeling of oral pain determinants, using multiple logistic regressions and a significance value p ≤ .05. Results: A total of 150 females (mean age 51.2 [SD = 13.7, range = 24–84] years) completed the study. Baseline oral pain prevalence was 39% and 73% at follow-up. Completed education level predicted baseline oral pain (OR = 3.43, 95% CI [1.66, 7.11], p = .001). Follow-up oral pain was predicted by completed education level (OR = 3.74, 95% CI [1.43, 9.79], p = .007), anxiety (OR = 3.52, 95% CI [1.23, 10.07], p = .019), choosing behavioral support alone in the cessation attempt (OR = 3.12, 95% CI [1.26, 8.70], p = .015), failure to stop tobacco chewing during the cessation attempt (OR = 4.16, 95% CI [1.44, 12.04], p = .009), and tooth wear (attrition) (OR = 5.71, 95% CI [1.84, 17.79], p = .003). Lower dependency level (OR = 0.79, 95% CI [0.64, 0.97], p = .023) was protective. Conclusion: Dental care access, nicotine replacement therapy, and anxiety management should be incorporated into cessation service delivery protocols to manage oral pain onset and facilitate successful cessation. [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]

Aim To evaluate smokeless tobacco cessation in communities of South Asian origin. Design Multi-centre prospective cohort study. Setting Three tobacco cessation services offering specialist smokeless tobacco cessation outreach clinic support to South Asians ( Bangladeshi, Indian and Pakistani) resident in England. Participants A total of 239 South Asian participants seeking to stop smokeless tobacco use between November 2010 and December 2011. Measurements Socio-demographics, tobacco use and dependence, self-reported abstinence at 4 weeks and satisfaction measures. Findings Participants' mean age was 45 [standard deviation ( SD) = 13] years, were predominantly female (76%), of Bangladeshi origin (74%), either home carers (53%) or not working (29%). Sixty-three per cent were recruited from community locations, 21% through a clinical contact and 16% through friends and family. Mean daily number of smokeless tobacco intakes was 10 ( SD = 7) and the mean dependence score was 4.5 ( SD = 1.9). Sixty-three per cent of participants achieved continuous abstinence 4 weeks after quitting. Using nicotine replacement therapy ( NRT) versus not using it [ OR = 3.47, 95% confidence interval ( CI): 1.25, 9.62] and below median (≤8) daily smokeless tobacco intakes ( OR = 1.91, 95% CI: 1.07, 3.40) predicted successful abstinence. Conclusion South Asian smokeless tobacco users resident in England accessing services to help them stop appear to have short-term success rates comparable with smokers attending stop-smoking services, with higher success rates being reported by those using nicotine replacement therapy. [ABSTRACT FROM AUTHOR]

ABSTRACT Aim To identify predictors of short-term smokeless tobacco cessation in Bangladeshi women resident in the United Kingdom. Design Prospective cohort study. Setting A tobacco cessation service offering culturally tailored smokeless tobacco cessation support. Participants A total of 419 Bangladeshi women chewing paan with tobacco. Measurements Demographics, tobacco use and dependence and cessation attempt process and outcomes. Findings Client mean age was 48.92 [95% confidence interval (CI) 47.5, 50.34] years and the mean area social deprivation score was 3.65 (95% CI 3.33, 3.97). Mean daily smokeless tobacco intakes, as paan, was 9.96 (95% CI 9.22, 10.7); 69.8% were recruited from primary care, 78.8% received behavioural support and nicotine replacement therapy (NRT) and the remainder behavioural support alone. Self-reported 4-week continuous abstinence was 58.3%, predicted by NRT use [odds ratio (OR) = 4.93, 95% CI 2.02, 12.00], community recruitment (OR = 1.84, 95% CI 1.01, 3.35) and relatively lower social deprivation (IMD) score (OR = 1.98, 95% CI 1.18, 3.33). Conclusion Bangladeshi women in the UK attending clinics to help cessation of paan with tobacco appear to be more likely to be successful in the short term if they use nicotine replacement therapy, are recruited via the community and have relatively lower levels of social deprivation. [ABSTRACT FROM AUTHOR]

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]

Objectives: To describe the perceived inability to cope (PIC) and impact on quality of life (QOL) in dental pain patients, and investigate their effect on perceived need for pain medication. Methods: Fully structured self-complete questionnaire survey of a sample of patients with current experience of dental pain/discomfort and sensitivity. Subjects were recruited from a dental teaching hospital’s emergency and restorative clinics. Questions were asked on pain intensity, PIC, impact on QOL and perceived need for pain medication. Results: Of 318 subjects approached, 199 (63%) completed usable questionnaires. In expressing PIC, 48.2% of the sample reported that they felt dependent on somebody else doing something about the pain, whereas 69.3% reported feeling helpless in their effort to try and do something about the pain. The prevalence of impact on QOL ranged from 55.8% reporting feeling like isolating oneself from other people to 77.9% for feeling grumpy, irritable, bad-tempered or miserable. Logistic regression analysis identified impact on QOL (OR = 1.17, 95% CI = 1.06–1.30), PIC (OR = 1.10, 95% CI = 1.01–1.21) and pain intensity (OR = 1.26, 95% CI = 1.05–1.50) as independent significant predictors of perceived need for pain medication. Conclusions: Pain intensity and PIC can enhance the ability of QOL measures in differentiating population groups into those who perceive the need for pain medication and those who do not. [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]

Abstract: Dental pain, estimated to affect 12–40% of community-dwelling adults, is a symptom of a wide range of clinical conditions. A population screening instrument is needed to study their prevalence. This project aimed to develop a questionnaire for classifying a sample of dental pain patients into three groups of common dental pain conditions, i.e. Group 1 (Acute periapical periodontitis and Irreversible pulpitis), Group 2 (Reversible pulpitis and Dentine hypersensitivity) and Group 3 (Pericoronitis). Initial items were generated through a literature review, individual unstructured patient interviews and consultation with experts. Items generated were administered to a sample of dental pain patients for self-completion. Responses were subjected to a series of factor and discriminant analyses to identify questions capable of differentiating the sample into three groups, originally categorized by clinical diagnosis, with high classification rates. The selected items were administered to a further sample of dental pain patients to test for its sensitivity and specificity in classifying the sample into three groups against the gold standard of clinical diagnosis. The final 16-item Dental Pain Questionnaire (DePaQ) was capable of correctly classifying 89.7% of dental pain cases initially categorized by clinical diagnoses. The sensitivity of the questionnaire was 0.80—Group1, 0.85—Group2 and 0.59—Group3. Specificity was 0.83—Group1, 0.89—Group2 and 0.90—Group3. The DePaQ, which can easily be administered by non-clinical personnel, may be used to collect epidemiological data on common dental pain conditions, assess dental needs for a specified population, and triage of patients seeking treatment for dental pain. [Copyright &y& Elsevier]

Aim: The aim of this study was to test whether dental injuries are related to problem behaviour. In addition, it aimed to confirm the relationship between dental injuries and size of overjet and type of lip coverage. Methods: A hospital-based matched (age and sex) case-control design was adopted. Data were collected through clinical examinations and interviews. The informant-rated version of the Strengths and Difficulties Questionnaire (SDQ) was used to identify problem behaviour. One parent of the child, most often the mother, was interviewed. Hierarchical modelling using conditional logistic regression was used to test the relationship between the five problem behaviours and traumatic dental injuries. Results: The Odds ratio of having a dental injury increased 3.14 times if children have peer relationship problems (P = 0.032), whilst a prosocial behaviour showed a tendency to have a protective effect (OR = 0.25; P = 0.064). Emotional symptoms, conduct disorder and hyperactivity behaviours were not related to dental injury (P > 0.75). Results were adjusted by father's level of education, size of overjet and type of lip coverage, and these variables were significantly related to dental injury (P < 0.05). Conclusion: Problem behaviour may play an important role in the occurrence of traumatic dental injury. [ABSTRACT FROM AUTHOR]

The objective of this study was to establish the prevalence of paan chewing with tobacco by UK-resident Bangladeshi women and the extent to which they manifest nicotine dependence. The cross-sectional study was conducted at two local authority housing estates in Tower Hamlets, London. Participants were 242 Bangladeshi women, selected at random from the current electoral register, who supplied a saliva sample for cotinine and an expired air sample for carbon monoxide analysis. They also participated in a structured interview assessing knowledge, attitudes and behavior with respect to tobacco use. Main outcome measures were data on tobacco use and nicotine dependence, assessed by questionnaire and intake measures. The population prevalence of chewing paan quid with tobacco was 48.5% (95% confidence interval, CI 42.01-54.98%), while 4% (95% CI 2.05-7.41%) smoked cigarettes. Higher mean salivary cotinine scores were associated with greater consumption frequency and use of leaf tobacco in the quid. Above-average nicotine dependence was associated with chewing paan quid with tobacco within 1 h of waking (OR = 4.02, p = 0.03, 95% CI 1.08-14.94) and the use of leaf rather than processed tobacco (OR = 3.91, p = 0.025, 95% CI 1.19-12.81). Smoking prevalence is low, but the prevalence of paan quid with tobacco chewing is high in this sample of Bangladeshi women. Cotinine concentration appears to be a reliable indicator of levels of nicotine dependence among paan quid with tobacco chewers. Questionnaire-derived items can be used to identify those with above-average levels of nicotine dependence. [ABSTRACT FROM AUTHOR]

Background: Smokeless tobacco (ST) is consumed globally by more than 350 million people, with approximately 85% of all users based in South and Southeast Asia. In this region, ST products are cheap and easily accessible. Evidence-based interventions to people quit ST use are lacking. This study aims to test the feasibility of conducting a future definitive trial of ST cessation, using a culturally adapted behavioural intervention, and/or nicotine replacement therapy (NRT) in three South Asian countries. Methods: We will conduct a factorial design, randomised-controlled pilot trial in Bangladesh, India and Pakistan. Daily ST users will be recruited from primary health care settings in Dhaka, Noida and Karachi. Participants will be individually randomised to receive intervention A (4 or 6 mg NRT chewing gum for 8-weeks), intervention B (BISCA: face-to-face behavioural support for ST cessation), a combination of interventions A and B or usual care (Very Brief Advice - VBA). The participants will provide demographic and ST use related data at baseline, and at 6, 12 and 26 weeks of follow-up. Salivary cotinine samples will be collected at baseline and 26 weeks. The analyses will undertake an assessment of the feasibility of recruitment, randomisation, data collection and participant retention, as well as the feasibility of intervention delivery. We will also identify potential cessation outcomes to inform the main trial, understand the implementation, context and mechanisms of impact through a process evaluation and, thirdly, establish health resource use and impact on the quality of life through health economic data. Discussion: The widespread and continued use of ST products in South Asia is consistent with a high rate of associated diseases and negative impact on the quality of life. The identification of feasible, effective and cost-effective interventions for ST is necessary to inform national and regional efforts to reduce ST use at the population level. The findings of this pilot trial will inform the development of larger trials for ST cessation among South Asian users, with relevance to wider regions and populations having high rates of ST use. Trial registration: ISRCTN identifier 65109397 [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]

This case-control study (n = 100 dental patients, matched for age and sex) investigated the rôle of life-events in periodontitis. Data collected included life events, tobacco use, oral health behaviours and socio-demographics. The results of conditional simple logistic regression analysis showed that periodontitis was associated with the negative impact of life-events (p<0.01), the number of negative life-events (p<0.05), high levels of dental plaque (p<0.01), tobacco smoking (p<0.01) and being unemployed (p<0.05). These associations remained statistically significant after adjusting for oral health behaviour and socio-demographic variables, but not tobacco smoking (p>0.05). Marital status became statistically significant after adjusting for the other variables (p<0.05). A model is suggested to explain pathways through which life events may affect periodontal health. It was concluded that psychosocial factors and oral health risk behaviours cluster together as important determinants of periodontitis. [ABSTRACT FROM AUTHOR]

BackgroundLittle is known of paan quid with tobacco (PQT), a hand-made mixture of smokeless tobacco, areca nut, lime and flavourings in a betel leaf, despite its wide use in south Asian communities. This study has explored the price, tobacco types, brands and ingredient weights in vendor assembled PQT in London (England).MethodsThis cross-sectional study identified 31 commercial outlets selling PQT. Outlet staff were invited to assemble PQT for purchase. Individual ingredients were identified and weighed using a calibrated scale. Free nicotine availability was assessed in the laboratory. The data were analysed using frequencies, means, t test and Pearson correlations. Significance was set at p<0.05.Results73 samples were assembled and purchased. Mean total PQT weight was 10.06 g (95% CI 9.26 to 10.86). Mean price was £1.43 (range £0.50–3.50), which varied by location (p=0.001). The most common smokeless tobacco type was zarda (64.4%). Mean tobacco weight was 0.65 g (95% CI 0.56 to 0.76) and the mean lime weight was 0.58 g (95% CI 0.41 to 0.75). While other ingredients did not vary, tobacco and lime mean weights varied by location (p=0.01). Tobacco and lime weights correlated positively (r=0.427, p=0.01). The pH of the tobacco and lime mix varied between 12.2 and 12.5, indicating 99% free nicotine availability.ConclusionsVendor assembled PQT shares similar ingredients but varies by assembly locality, price and tobacco and lime weights. Tobacco and lime weights were balanced to ensure optimal free nicotine availability and dependency potential. [ABSTRACT FROM AUTHOR]

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]

ObjectiveTo follow up calls made to NHS Direct and South Cheshire Dental Helpline concerning getting access to an NHS dentist in South Cheshire.DesignContact details of callers who had consented to a follow up call were passed by helpline staff to a researcher at regular intervals. In a structured interview, callers were asked why they had telephoned the helpline and whether they had subsequently obtained NHS dental care. Follow up calls continued until a total of 200 replies had been gathered, either by telephone or post (for those where telephone contact could not be made). Follow up calls were made between September 2001 and March 2002ResultsDuring the study period only three callers from South Cheshire contacted NHS Direct with a dental access query and consented to a follow up call, compared with 219 callers to South Cheshire Dental Helpline. Only 10% were not contacted either by telephone or post. A comparison with figures for calls made to South Cheshire Dental Helpline between April 2000 and March 2001 suggests that during the study period a year later the access problem has improved. However, there were still a few areas in South Cheshire where significant numbers of dental access queries were being received. Twenty five per cent of unregistered and 22% of registered callers still felt that they had problems getting access to NHS dental care after using information from the helplines.ConclusionA small but significant number of people in South Cheshire have problems accessing NHS dental care. [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]

Introduction: Cigarette smoking in English residents of Bangladeshi origin, particularly men, exceeds national estimates. Cessation outcomes and potential predictors of successful cigarette smoking cessation in this group await identification.Methods: This service review reports cessation outcomes and predictors of success for 324 adult English resident Bangladeshi origin smokers recruited into a project providing a specialist tobacco cessation service. Interview measures included sociodemographics, tobacco use and dependence. Cessation data (self-reported and validated) at 4 weeks was also collected. Cessation rate and predictors of successful cessation, modeled using multiple logistic regressions, are reported.Results: Clients' mean age was 45.59 (SD = 13.83) years. Thirty-three (10%) were females. Mean level of small area deprivation was 56.98 (SD = 5.37). Initial mean expired air carbon monoxide score was 11.66 parts per million (SD = 7.17). Thirty-eight per cent used combination nicotine replacement therapy (NRT) with behavioral support. Sixty-nine percent reported successful smoking cessation after 4 weeks, validated with carbon monoxide (mean =1.23 parts per million, SD = 1.32). Predictors of successful cessation were use of combined NRT with behavioral support (OR = 1.82, 95% CI = 1.07, 3.09), and community recruitment (OR = 1.85, 95% CI = 1.07, 3.22).Conclusions: English adult smokers of Bangladeshi origin resident in a highly disadvantaged locality, accessing community outreach services to help them quit and using NRT have validated short-term success rates greater than that locality's general population who access National Health Service Stop Smoking Services to quit. [ABSTRACT FROM AUTHOR]

Background Periodontal disease negatively affects oral health-related quality of life ( OHRQoL). While there is sufficient evidence for the clinical efficacy of periodontal therapy, data on patient-based outcomes are limited. Objectives To systematically review the available evidence on the impact of periodontal therapy on OHRQoL in adults. Material & Methods MEDLINE, EMBASE, CENTRAL and LILACS were searched without language restrictions. Longitudinal observational and intervention studies assessing changes in OHRQoL using validated measures, in adults with periodontal disease undergoing non-surgical ( NST) or surgical therapy ( ST), were eligible for inclusion. Study quality was assessed using the Newcastle- Ottawa scale and CONSORT-checklist. No meta-analysis was performed. Results Eleven studies (seven prospective case-series', one controlled before-after study and three randomized controlled trials) of 'medium' methodological quality were included in the review. All studies reported impaired OHRQoL before therapy. Nine studies reported a statistically significant improvement in OHRQoL after NST (follow-up = 1 week to 12 months, p < 0.05). The effect size for this improvement ranged from small (0.27) to large (0.8). No significant differences were reported between different forms of NST. Surgical therapy had a relatively lower impact on OHRQoL. A correlation between poor clinical response to therapy and poor OHRQoL outcomes was observed. Conclusion Routine non-surgical therapy can moderately improve the OHRQoL in adults with periodontal disease. [ABSTRACT FROM AUTHOR]

Introduction: Khat chewing is often associated with tobacco use with impacts on health. This cross-sectional study aimed (a) to explore and validate aspects of self-reported tobacco smoking and whether objective measures of tobacco smoking differ in different situations among khat chewers who smoked and (b) to assess the social factors correlated with nicotine dependence among khat chewers who smoked regularly. Methods: This study recruited a purposive sample of 204 U.K. resident Yemeni khat chewers during random visits to Khat sale outlets. Data were collected via a face-to-face scheduled interview. Data analyses included descriptive tests and a hierarchical linear multiple regression. Results: Of 133 self-reported tobacco smokers, 68% were regular smokers with a mean (SD) carbon monoxide (CO) score (20.53 ± 12.12 ppm) and 32% were episodic smokers with a mean (SD) CO score (16 ± 15.66 ppm). Tobacco smoking as an enhancement of the impacts of khat chewing was reported by 65% and 69% of regular and episodic smokers, respectively. In both groups, higher CO scores were recorded during khat chewing. Hierarchical linear multiple regression modeling showed that increases in levels of severity of dependence on khat chewing were correlated positively with increase in levels of nicotine dependence (β = .27, p = .006, 95% CI = 0.05, 0.29), whereas social participation was correlated inversely (β = -.34, p = .001, 95% CI = -0.06, -0.02). Conclusions: In this study, smoking prevalence was high. Smoking increased during khat chewing. Nicotine dependence levels correlated positively with khat dependence levels, while higher social participation reduced nicotine dependence. [ABSTRACT FROM AUTHOR]

Aims of the study: (1) To assess psychological khat dependence and (2) to assess the validity and reliability of the Severity Dependence Scale () amended for khat use (SDS-khat), in a sample of UK-resident male adult Yemeni khat chewers. Materials and methods: A cross-sectional study using a face to face structured interview schedule was conducted amongst purposively sampled UK-resident adult Yemeni male khat chewers, aged 18 years and above, selected during random visits to places of khat sale. A factor analysis with principal components extraction was conducted to explore the construct validity of the proposed SDS-khat. Reliability of the proposed scale was assessed using test–retest and internal reliability tests. The concurrent validity of the proposed SDS-khat was assessed in relation to individual measures and a composite index of khat chewing behaviours using univariate analyses. Results: Two hundred and four Yemeni male adult khat chewers were interviewed. The mean score of the proposed SDS-khat was 5.52 (SD ±4.03). Forty nine percent of respondents (95% CI=43–55%) with ≤5 scores were more likely not psychologically dependent. A single factor, uni-dimensional solution identifying the five items making up the scale accounted for 52.33% of variance. The internal reliability was good (Cronbach's alpha coefficient=0.76) and the test retest intraclass correlation coefficient (ICC) was 0.93 (95% CI=0.80–0.97). Many individual aspects of the khat chewing were significantly related to the scale. Assessment of the proposed SDS-khat's's concurrent validity with individual items of khat chewing identified several significant relationships (p ≤0.05) whilst the composite index of khat behaviour also identified a significant relationship (OR=14.40, 95% CI=6.71–30.89). The proposed SDS-khat also correlated with self-reported reasons for khat chewing (p ≤0.001, OR=3.54; 95% CI=1.80–6.96). Conclusions: In this sample of Yemeni khat chewers the SDS-khat is recommended as a valid and reliable research tool for measuring psychological dependence upon khat. Further validation in other samples is indicated. [Copyright &y& Elsevier]

Objective: To assess the activities related to the occurrence of traumatic dental injuries (TDI) in order to establish the relationship between gender, socio-economic status (SES) and major TDI related events, using classification and examination procedures suitable for epidemiological purposes, in a sample of 15- to 18-year-old students in Taiwan. Methods: A random sample of 6312 15- to 18-year-old senior high school students in southern Taiwan was selected. Each was examined with standard clinical procedures and a questionnaire. Results: The prevalence of TDI was 19.9%. The major TDI related events included sports and leisure activities (30.8%), eating (20.5%), falls (19.4%), traffic accidents (10.2%) and collisions (7.1%). Within TDI victims, sports and leisure related TDI were more prevalent among males ( P = 0.001, OR = 1.640, 95% CI = 1.225, 2.195) and high SES adolescents ( P = 0.014, OR = 1.991, 95% CI = 1.149, 3.449). The occurrence of non-accidental TDI was not related to age, gender and SES ( P ≥ 0.643). Conclusion: Traumatic dental injuries have become an important issue in public health and dentistry. Prevention and treatment of TDI should be emphasised to the public, the health professional and the policy maker. Future investigations into the relationship between TDI related events and their determinants are indicated. [ABSTRACT FROM AUTHOR]

Investigates the associations between social deprivation, income inequality and social cohesion and dental caries levels in school children of the Distrito Federal, Brazil. Socio-economic factors that determine differences in health between societies; Relation between dental health and social class; Effects of relative levels of income in determining the onset of caries.

Examines the relationship between levels of flexibility of working time schedule and the pattern and performance of tooth cleaning. Frequency of tooth cleaning; Use of oral hygiene aids; Level of dental plaque.

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]

Introduction: The prevalence of waterpipe tobacco smoking (WPTS) is increasing worldwide. The aims of this study were (a) to evaluate the psychometric properties of the Lebanon Waterpipe Dependence Scale (LWDS-11), and (b) to assess, estimate, and identify factors associated with waterpipe tobacco dependence symptoms among U.K. male adult resident waterpipe tobacco smokers. Methods: A total of 180 waterpipe tobacco smokers were recruited during random visits to 7 outlets serving waterpipe tobacco. Data were collected via face-to-face interviews using the WPTS module of the Global Adult Tobacco Survey and the LWDS-11. Descriptive statistics, exploratory psychometric, univariate, and Poisson regression analysis were employed. Results: Participants’ M/SD age was 29.46/±9.41 years, Arabic ethnicity accounted for 58.3%, and 53.9% had completed more than secondary education. Psychometric analyses for the LWDS-10, after removing 1 item from the generic scale, revealed Cronbach’s alpha coefficient = 0.74. About 47% of the sample demonstrated waterpipe tobacco dependence. Being Arab (p = .040, OR = 2.63, 95% CI = 1.05–6.62), smoking waterpipe daily in the past (p = .003, OR = 2.13, 95% CI = 1.30–3.49), and an increase in length in the last session of WPTS (p = .044, OR = 1.15, 95% CI = 1.00–1.32) were identified as risk factors for waterpipe tobacco dependence. Conclusions: This study demonstrated the potential of LWDS-11 and revealed 2 domains: positive and negative reinforcement and physiological dependence. Results indicated that waterpipe tobacco smokers in the United Kingdom demonstrated tobacco dependence symptoms, which were associated with socio-behavioral factors. Generalizability of these findings and their implications in public health are yet to be investigated. [ABSTRACT FROM PUBLISHER]

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]

The purpose of this article was to document the 1-month dental pain prevalence in 11–14-yr-old subjects attending Grade Six of middle schools in Peshawar, Pakistan, and to explore the effect of dental pain and the impact on daily living on dental care-seeking. A self-completed questionnaire survey of all 13 middle schools in University Town, Peshawar, Pakistan, was carried out in April 2007. Questionnaire items on dental pain were adapted from the dental pain screening questionnaire (DePaQ) and items on the impact on daily living were adapted from the child-oral impact on daily performance (OIDP-Child) questionnaire. Regression analysis was carried out to determine the relative usefulness of predictors for care-seeking. The prevalence of dental pain was estimated to be 30.4%, and care-seeking in those reporting pain was estimated to be 64%. Care-seeking was associated with ‘pain felt in one tooth’, ‘painful tooth felt loose’, ‘difficulties sleeping’, and ‘difficulties playing’, which accounted for 35% of the explained variance. The findings substantiate dental pain as an important dental public health concern in Pakistan and support the hypothesis that assessment of dental pain characteristics can add to the accuracy of dental need estimation. [ABSTRACT FROM AUTHOR]