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Background: Men's tobacco usage may be a contributing factor in up to 12% of cases of infertility in couples due to decreased semen parameters. It is the reality that Sudan is home to the greatest number of nicotine snuffers (toombaks) worldwide. Unlike snuff, the detrimental effects of cigarette smoking on sperm parameters are well-documented, even though they apply to other smokeless nicotine products. Aim: to research the influence on semen variables related to toombak snuffing. Methods: A comparative study analysed 120 subjects, out of which 50 were toombak snuffers (cases), (mean age = 33.9±6.4 years), and 70 were non-snuffers (control), (mean age= 33.5±6.9 years) attended Hawa Fertility Centre in the period from November 2021 to November 2022. Data regarding demographics, duration of tobacco snuffing, frequency of snuffing per day, diagnosis, and seminal analysis parameters were compared between groups. Results: Among patients in the snuffer group, the majority of them had snuffing duration from 10-20 years (n = 20; 40%) and had snuffing frequency >20 times per day (n = 27; 54%). Compared to the control group, snuffing was a significant predictor of low count. (oligiospermia and azoospermia) (OR = 3.8; 95% CI: 1.6-9.1; P = 0.002), low motility <42% (OR = 3.6; 95% CI: 1.7-7.9; P = 0.001), low progressive motility <30% (OR = 2.0; 95%CI: 1.3-4.2; P = 0.018) and normal morphs <4% (OR = 2.7; 95%CI: 1.2-5.7; P = 0.009). The snuffing duration above 20 years was a significant risk factor for a low count. (oligiospermia and azoospermia) (OR = 16.8; 95% CI: 2.6-46.3; P = 0.003), low motility <42% (OR = 11.0; 95% CI: 2.0-60.0; P = 0.006), low progressive motility <30% (OR = 10.8; 95%CI: 1.9-59.8; P = 0.007) and normal morphs <4% (OR = 10.6; 95%CI: 2.1-60.0; P= 0.007). The snuffing frequency above 20 times per day was a significant risk factor for low count (oligiospermia and azoospermia) (OR = 7.9; 95% CI: 1.8-34.5; P = 0.008), low motility <42% (OR = 3.4; 95% CI: 1.7-12.1; P = 0.041), low progressive motility <30% (OR = 4.1; 95% CI: 1.1-14.9; P = 0.033), but not normal morphs <4% (P = 0.083). Conclusion: Toombak snuffing had a major detrimental impact on spermatogenesis, which in turn affected sperm motility, measure, and shape. Furthermore, longer duration (>20 years) and intensive toombak snuffing use (>20 times per day) were significantly correlated with low motility, shape, and quantity of sperm. [ABSTRACT FROM AUTHOR]

Background: Regardless of how tobacco products are consumed, they increase the risk of morbidity and mortality for users. This study aims to determine the motivations for using snuff, assess awareness of tips to quit, and determine readiness to quit snuff use in patients at a clinic in a Pretoria township, in South Africa. Methods: A descriptive cross-sectional survey using a piloted, structured, and self-administered questionnaire was given to patients at Ramotse clinic. Results: The mean age of the 402 participants was 49.0 years, with a range of 18–104 years. The majority (83.8%) of the participants were females. Of the participants, 26.6% were 60 years of age or older, 59.7% were unemployed, 57.5% were married, and 41.5% had finished primary school. Socio-cultural practices and behaviour were mentioned by 38.1% as the main reason for snuff usage, while 77.2% were uninformed about tips for quitting snuff, and 63.25% were unwilling to give up snuff. Conclusion: The study found that unemployed, married, mostly female, 40 years of age or older, and had a basic education match with the profile of participants. Socio-cultural practices and behaviour and health benefits influenced the habit. Most participants were unaware of tips to quit habits and unprepared to do so. Contribution: Healthcare professionals need to be aware of the health hazards that their patients may face, make sure they are equipped to address them and offer community-saving tips for improvement.

Diabetes mellitus (DM) affects millions of people worldwide, with associated morbidity and premature mortality exacerbated by all forms of smoking. The effects of smokeless tobacco, such as snuff and chewing tobacco, have not been well researched. The use of these products is on the increase and is an important public health issue. The objective is to assess the difference between snuff tobacco use and non-tobacco use with regard to all-cause mortality, diabetic nephropathy (DN), and diabetic retinopathy (DR) over a nine-year period. The records of 1 241 patients were assessed at the diabetic clinic at Kalafong Provincial Tertiary Hospital. Patient data extracted from the database included demographic information, clinical observations, and laboratory data. All data regarding changes in tobacco use were extracted. Survival analyses were done using Kaplan–Meier analysis with log-rank tests to assess the relationship between snuff use and time to the development of diabetes complications and mortality. To adjust for confounders such as diabetic control and duration, as well as systolic hypertension, Cox proportional hazards modelling was done with the same outcome measures. Of the 1 241, 120 patients died, representing a natural all-cause mortality of 9.7%. There was no statistically significant difference between snuff users and non-snuff users with regard to all-cause mortality after adjustment for age, smoking, and diastolic blood pressure. The HR for snuff use was 1.116 (CI = 0.603–2.064) (p = 0.726) after adjustment for age (HR 1.042, CI 1.026–1.058, p < 0.001), smoking (HR 1.66, CI = 1.126–2.447, p = 0.01), and diastolic blood pressure (HR 1.014, CI 1.004–1.025, p = 0.007). This study could not demonstrate any additional risk to all-cause mortality, diabetic nephropathy, or diabetic retinopathy due to the use of snuff in diabetic patients. [ABSTRACT FROM AUTHOR]

The identification of volatile organic components in snuff was accomplished using GC–MS analysis in this study. The findings of the GC–MS analysis revealed the presence of nicotine, its derivatives, and several other toxic chemicals that are hazardous to human health. Furthermore, the content of 34 elements in four brands of snuff consumed in Neyshabur City was determined by ICP-OES analysis (with five repetitions). The health hazards of measured heavy elements were examined from two perspectives: carcinogenic (7 heavy elements were checked) and non-carcinogenic (4 heavy elements were checked). The investigation of non-carcinogenic hazards from inhalation was based on the computation of the hazard quotient (HQ) factor, and the results indicated that inhaling five heavy metals, Cu, Pb, Ni, Zn, and Cd, does not represent a substantial health risk ((HQ < 1). In contrast, the computed HQ factors for Cr and As were relatively high (1 < HQ < 10), indicating a substantial health risk from breathing these two elements. The carcinogenic factor (CR value) results revealed that the degree of carcinogenic risk for Cd was very low (CR value less than 1 × 10−6) and did not pose a concern to the consumer population. However, the risk of As, Cr, and Ni exposure is considerable in the carcinogenic risk range (CR values between 1 × 10−6 and 1 × 10−4). [ABSTRACT FROM AUTHOR]

Objectives: The objective of the study was to investigate the constituents of the most commonly consumed naswar brands from Khyber Pakhtunkhwa, Pakistan. Methods: A total of 14 most-sold brands of naswar, two from each division in KP were collected and analyzed by gas chromatography-mass spectrometry and inductively coupled plasma mass spectrometry to determine their organic and elemental composition respectively. In addition, pH, ash content, and aflatoxin assessment were also performed. Results: The average pH and ash content of all the test samples were 8.61 ± 0.271 and 18.94 ± 7.79 % respectively. Overall, the presence and concentration of the different constituents vary across the different naswar brands. GC–MS analysis identified 85 different organic compounds, the commonest being nicotine followed by glycerol tricaprylate and Di-n-octyl phthalate. Metal ions present in the highest concentration were iron (1146.84 ± 1050.31 mg/kg), tungsten (306.59 ± 494.82 mg/kg), and copper (288.95 ± 77.16 mg/kg). Aflatoxin B1 and B2 were the most common aflatoxins identified in naswar samples. Conclusions: Overall, naswar contains an array of organic, inorganic, toxic, and heavy metals and aflatoxin constituents with proven toxic and carcinogenic potential. Furthermore, high pH and nicotine contents make it highly addictive. There is an urgent need to enact and implement ST control policies to curb naswar use in Pakistan.

Abstract Background Clear evidence of an increased risk for SARS-CoV-2 infection among smokers has not been established. We aimed to investigate associations between cigarette smoking or use of snus (snuff) and other nicotine-containing products and a positive SARS-CoV-2 test, taking test behavior into account. Methods Current tobacco use and testing behavior during the pandemic were recorded by adult participants from the Norwegian Mother, Father and Child Cohort Study and The Norwegian Influenza Pregnancy Cohort. SARS-CoV-2 infection status was obtained from The Norwegian Surveillance System for Communicable Diseases (MSIS) in May 2021 (n = 78,860) and antibody measurements (n = 5581). We used logistic regression models stratified by gender and adjusted for age, education, region, number of household members, and work situation. Results Snus use was more common among men (26%) than women (9%) and more prevalent than cigarette smoking. We found no clear associations between cigarette smoking or snus and a COVID-19 diagnosis among men. Associations among women were conflicting, indicating that cigarette smoke was negatively associated with a diagnosis (OR 0.51, 95% CI 0.35, 0.75), while no association was found for snus use (OR 1.07, 95% CI 0.86, 1.34). Compared with non-users of tobacco, both cigarette smokers and snus users had increased odds of being tested for SARS-CoV-2. Conclusions Cigarette smoking, but not snus use, was negatively associated with SARS-CoV-2 infection in women. The lack of an association between snus use and SARS-CoV-2 infection in this population with prevalent snus use does not support the hypothesis of a protective effect of nicotine.

Background: Despite a high (48%) prevalence of snuff use among women with HIV in South Africa, little is known of the attitudes and behaviors of use, strategies for cessation, and potential health risks. Methods: In a cross-sectional study, a questionnaire was administered to adults (≥18 years) with (HIV+) and without HIV (HIV−) who self-reported current snuff use to collect information on demographics, snuff use and cessation attempts, preferred strategies for cessation, other substance use, history of respiratory illness, and mental health. Results: 150 (74 HIV+, 76 HIV−) participants were enrolled; 115 (77%) were daily snuff users, 6 (4%) were current smokers, and 17 (11%) former smokers. Top reasons for current snuff use included improving health (n = 48, 32%), reducing stress (n = 26, 16%), and "being a habit" (n = 38, 25%). Participants believed snuff use to have mostly positive (n = 68, 46%) or no (n = 54, 36%) health impacts, and 57 (38%) participants believed snuff cures headaches. 103 (69%) participants reported a previous quit attempt, and 110 (73%) indicated high interest in quitting snuff. Although 105 (70%) participants indicated that advice from a healthcare provider would aid them in quitting snuff, only 30 (20%) reported ever receiving that advice. A majority of participants (n = 141, 94%) suffer from moderate to high levels of perceived stress, and overall few differences were seen by HIV status. Conclusions: Education on negative impacts of snuff, advice to quit from healthcare providers, and nicotine replacement therapy should be considered in the development of a snuff cessation program. [ABSTRACT FROM AUTHOR]

Naswar is a smokeless tobacco product, commonly consumed in Pashtun population of Pakistan and Afghanistan. Despite being an established risk factor for oral cancer, not much is known about microbiological constituents of Naswar. Objectives: The objective of the study was to explore bacterial diversity in Naswar using shotgun metagenomic sequencing. Methodology: DNA was extracted from twelve (n = 12) famous brands of Naswar samples using an enzymatic and mechanical lysis method followed by next generation sequencing on Illumina Miseq platform. Results: Naswar samples exhibits differential abundance profile at all taxonomic levels with Khamar brand having the highest species richness and diversity indices. Of the total 22 phyla identified, phylum Proteobacteria was the most abundant (88.4%) followed by Bacteroidetes (4.71%) and Firmicutes (3.73%). At genus level, 234 genera (range: 32 - 132) were identified. Metagenomic sequencing also revealed presence of 455 (range: 44 - 210) different bacterial species in Naswar samples. The most common species were Pesudomonas aurgenosa, Yersinia enterocolitica, Salmonella enterica, Xanthomonas campestris, and E. coli. Some of the species are of concern due their ability to cause infections in humans. Conclusions: Naswar products harbor diverse bacterial microbiota with differential abundance at phylum, genus and species level. These findings may have several implications in terms of further research to explore microbiological associated health risks and provide scientific evidence to inform potential regulations regarding manufacturing and testing of Naswar in Pakistan. [ABSTRACT FROM AUTHOR]

Background: Clear evidence of an increased risk for SARS-CoV-2 infection among smokers has not been established. We aimed to investigate associations between cigarette smoking or use of snus (snuff) and other nicotine-containing products and a positive SARS-CoV-2 test, taking test behavior into account. Methods: Current tobacco use and testing behavior during the pandemic were recorded by adult participants from the Norwegian Mother, Father and Child Cohort Study and The Norwegian Influenza Pregnancy Cohort. SARS-CoV-2 infection status was obtained from The Norwegian Surveillance System for Communicable Diseases (MSIS) in May 2021 (n = 78,860) and antibody measurements (n = 5581). We used logistic regression models stratified by gender and adjusted for age, education, region, number of household members, and work situation. Results: Snus use was more common among men (26%) than women (9%) and more prevalent than cigarette smoking. We found no clear associations between cigarette smoking or snus and a COVID-19 diagnosis among men. Associations among women were conflicting, indicating that cigarette smoke was negatively associated with a diagnosis (OR 0.51, 95% CI 0.35, 0.75), while no association was found for snus use (OR 1.07, 95% CI 0.86, 1.34). Compared with non-users of tobacco, both cigarette smokers and snus users had increased odds of being tested for SARS-CoV-2. Conclusions: Cigarette smoking, but not snus use, was negatively associated with SARS-CoV-2 infection in women. The lack of an association between snus use and SARS-CoV-2 infection in this population with prevalent snus use does not support the hypothesis of a protective effect of nicotine. [ABSTRACT FROM AUTHOR]

BackgroundUse of smokeless tobacco (ST, moist snuff and chewing tobacco) is elevated among male rural youth, particularly participants in certain sports, including baseball.ObjectivesThis study aimed to assess factors associated with adolescent male athletes' ST-related behaviors over time, including: baseline use, initiation, and progression in use intensity in a school-based longitudinal cohort.MethodsBaseline and one-year follow-up questionnaires assessed sociodemographic characteristics, environmental factors, and tobacco-related perceptions and behaviors among 9- to12th-grade interscholastic baseball players in 36 rural California schools. Population characteristics were compared among ST use categories (never, experimental, and experienced users). Multivariable models using generalized estimating equations were estimated for outcomes among baseline ST never-users (ST susceptibility and future initiation) and experimenters (ST expectations and progression in ST use).ResultsOf 594 participants, over half (57%) had ever tried a tobacco product and the most common products tried were ST (36%) and electronic cigarettes (36%). Being older, perceiving less ST harm, being Non-Hispanic White, using alcohol or other tobacco products, having family or friends who use ST, and being receptive to advertising were associated with greater baseline ST use. Baseline alcohol consumption, lower perceived ST harm, peer use, and susceptibility and expectations were predictive of ST initiation and/or progression at one-year follow-up. Conclusion/Importance: Certain environmental, socio-demographic, cognitive, and behavioral factors predict ST susceptibility and later initiation and progression in use. Interventions addressing these factors have potential to prevent ST uptake and continued use within this high-risk adolescent population.

Introduction: It is unclear whether tobacco in early pregnancy and alcohol use preceding pregnancy are associated with spontaneous abortion. The purpose was to investigate if use of tobacco and/or alcohol is associated with spontaneous abortion among women attending antenatal care, and if age and body mass index (BMI) attenuate the risk. Material and Methods: A population‐based cohort study based on data from the Swedish Pregnancy Register. All pregnant women having had the first antenatal visit from January 2014 to July 2018 were included (n = 525 604). The register had information about smoking and use of snuff before and in early pregnancy, as well as data on alcohol habits before pregnancy, measured by the Alcohol Use Disorders Identification Test (AUDIT), a validated questionnaire. Logistic regression analysis was used to estimate the association between lifestyle factors and spontaneous abortion, and multiple imputation was used to impute missing data. Results: In total, 34 867 (6.6%) pregnancies ended in a spontaneous abortion after the first visit to maternal health care. At the first maternal healthcare visit, daily smoking was reported by 24 214 (5.1%), and 6403 (1.2%) used snuff. For 19 837 (4.2%) women, a high alcohol score was reported for the year preceding pregnancy. After adjusting for potential confounders and multiple imputation, use of tobacco was associated with spontaneous abortion; smoking 1–9 cigarettes/day (adjusted odds ratio [aOR] 1.11, 95% confidence interval [CI] 1.04–1.18), smoking 10 or more cigarettes/day (aOR 1.12, 95% CI 1.–1.26), and use of snuff (aOR 1.20, 95% CI 1.06–1.37). Higher AUDIT scores were not significantly associated with spontaneous abortion (AUDIT 6–9: aOR 1.03, 95% CI 0.97–1.10 and AUDIT 10 or more: aOR 1.07, 95% CI 0.94–1.22). Increasing maternal age showed the highest risk of spontaneous abortion from the age of 35, and BMI of 30 kg/m2 or more increased the risk. There were interactions between different lifestyle factors associated with spontaneous abortion that could either increase or decrease the risk of spontaneous abortion. Conclusions: Smoking and use of snuff were associated with an increased risk of spontaneous abortion. The AUDIT scores preceding pregnancy were not associated with an increased risk of spontaneous abortion, which contradicts the results from previous studies. [ABSTRACT FROM AUTHOR]

This essay explores the relationship between emotions and material culture in relation to one specific artefact, the snuffbox. Small in scale, capable of activating multiple senses and hugely fashionable, the snuffbox became an enormously popular accessory that was extensively used by both sexes in eighteenth-century society. Its scale, and intimate relationship to the body, made it an ideal gift between lovers or courting couples, and it could be personalised to carry affective inscriptions, imagery or even portraits. Often made of ornate or expensive materials, or studded with jewels, its materiality became part of its seductive charm. Its emotional potency extended to its role in the performance of public identities through the display and manipulation of the box in polite society, while its secret compartments facilitated the retention of mementos or the private display of explicitly pornographic imagery. [ABSTRACT FROM AUTHOR]

Abstract Introduction The objective was to systematically review studies on health outcomes from smokeless tobacco (SLT) products. Methods We analysed published literature on the health outcomes from SLT use between 01/01/2015 to 01/02/2020, following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) protocol using PubMed, Embase, Scopus, and Google Scholar. Results Of 53 studies included, six were global, 32 from Asia, Middle East and Africa (AMEA), nine from USA and six from Europe. ‘Poor’-rated studies predominated (23;43%), in particular, for global (4;66%) and AMEA (16;50%). Health outcomes differed between SLT-products and regions; those in AMEA were associated with higher mortality (overall, cancer, Coronary heart disease (CHD), respiratory but not cardiovascular disease (CVD)), and morbidity (CVD, oral and head and neck cancers), with odds ratios up to 38.7. European studies showed no excess mortality (overall, CVD, from cancers) or morbidity (ischemic heart disease (IHD), stroke, oral, head and neck, pancreatic or colon cancers) from several meta-analyses; single studies reported elevated risk of rectal cancer and respiratory disorders. Pooled study data showed protection against developing Parkinson’s disease. US studies showed mixed results for mortality (raised overall, CHD, cancer and smoking-related cancer mortality; no excess risk of respiratory or CVD mortality). Morbidity outcomes were also mixed, with some evidence of increased IHD, stroke and cancer risk (oral, head and neck). No studies reported on switching from cigarettes to SLT-products. Conclusion Our review demonstrates stark differences between different SLT-products in different regions, ranging from zero harm from European snus to greatly increased health risks in AMEA. The literature on the safety profile for SLT-products for harm reduction is incomplete and potentially misinforming policy and regulation.

Background: Smoke‐free tobacco via moist oral snuff (snus) is used daily in more than 20% of Swedish men. Negative effects of cigarette smoking on sperm parameters are well documented, unlike for snuff, despite relevance also for other smoke‐free nicotine products. Objectives: We wanted to investigate whether reproductive parameters differed between users and non‐users of snuff, and whether the amount of snuff and nicotine exposure mattered. Materials and methods: Men (n = 613) from the general population, recruited 2000–2010, were physically examined, answered questions on smoking and snuff use, and delivered urine, blood and semen samples. Sperm concentration, total sperm count, semen volume, percent morphologically normal and progressively motile sperm, and DNA fragmentation index (by the Sperm Chromatin Structure Assay) and reproductive hormones were analysed. Nicotine exposure was measured through urinary levels of cotinine. We used general linear models, with adjustments including cigarette smoking, and for semen parameters also abstinence time. Results: After adjustments, total sperm count was 24% lower (P = 0.03) and testosterone 14% higher (P < 0.001) in 109 users of snuff than in non‐users, whereas cotinine was positively associated with testosterone and oestradiol (P < 0.001). Numbers of boxes of snuff used per week were associated with testosterone and FSH (P < 0.001). Discussion: Applied to the general population, the consumption of smoke‐free tobacco by the use of snuff was associated with a lower sperm count and a higher testosterone, for which the extent seemed to play a role. Conclusions: Independent of smoking, consumption of snuff was associated with lower total sperm count and different hormone levels. Applying these results to a reported association between sperm count and the chance of pregnancy, men who used snuff would have about a 10% lower chance of fathering a child. [ABSTRACT FROM AUTHOR]

Background: Smokeless tobacco (SLT) is a tobacco-based product consumed without burning or smoking. Snuff, commonly known as naswar, is a widely used SLT product in Pakistan. This study is designed to investigate the concentrations of lead (Pb) and cadmium (Cd) in snuff and their associated health risks to consumers., Methods: Blood samples from snuff consumers and non-consumers were analyzed for Pb and Cd concentrations. Additionally, samples of drinking water and wheat flour were also analyzed for Pb and Cd. Health risk assessments were calculated using hazard quotient (HQ) and incremental lifetime cancer risk (ILCR) for Pb and Cd., Results: Snuff consumers had significantly higher blood-Pb and blood-Cd levels compared to non-consumers. Approximately 38.5 % of snuff consumers were found to exceed blood-Pb levels from the safe limits (10 µg dL⁻¹) of the World Health Organization (WHO), while 48.9 % of snuff consumers were found to exceed blood-Cd levels from the WHO safe range of 0.03-0.12 µg dL⁻¹. Snuff samples contained Pb and Cd concentrations ranging from 5.3 to 22.4 µg g⁻¹ and 0.5-2.2 µg g⁻¹, respectively. Drinking water and wheat flour samples were found within the safe limits for Pb and Cd concentration, suggesting snuff as the primary source of exposure. Health risk assessments indicated elevated HQ values, for Pb (38.9 %) and Cd (14.3 %) detected in snuff, surpassing the safe HQ threshold of 1. Concerning ILCR from snuff, values for Pb were within the acceptable range, but alarmingly 100 % of samples for Cd exceeded the safe limits of USEPA (1.0×10⁻⁴), indicating a significant cancer risk in snuff users., Conclusion: This study highlights the exceeded Pb and Cd concentrations in snuff as well as also reporting significant carcinogenic and non-carcinogenic health risks to consumers. These findings emphasized the urgent need for regulatory bodies to ensure the safety of snuff before selling in the market. Public Health Professionals should also initiate educational campaigns to raise awareness among consumers and manufacturers about various health risks associated with the snuff., Competing Interests: Declaration of Competing Interest I, being the Corresponding author, declared that there is no conflict of interest among the authors. I clearly disclosed no relationship with such a people and organization that could inappropriately influence our submitted work., (Copyright © 2024. Published by Elsevier GmbH.)

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.

Abstract Background Cigarette smoking is a well-known risk factor for cardiovascular disease (CVD), but whether smokeless tobacco such as snuff is associated with the risk of CVD is still unclear. We investigated the association of the use of Swedish oral moist snuff (snus) with a broad range of CVDs and CVD mortality. Methods We used data from a population-based cohort of 41,162 Swedish adults with a mean baseline age of 70 (56–94) years who completed questionnaires regarding snus use and other lifestyle habits and health characteristics. Participants were followed up for incident cardiovascular outcomes and death over 8 years through linkage to the Swedish National Patient and Death Registers. Hazard ratios (HR) were estimated by Cox proportional hazards regression. We conducted analyses among all subjects as well as among never smokers to reduce residual confounding from smoking. Results After adjustment for smoking and other confounders, snus use was not associated with myocardial infarction, heart failure, atrial fibrillation, aortic valve stenosis, abdominal aortic aneurysm, stroke, or CVD mortality. However, in never smokers, snus use was associated with a statistically significant increased risk of total and ischemic stroke (HRs [95% confidence intervals] = 1.52 [1.01–2.30] and 1.63 [1.05–2.54], respectively) and non-significantly positively associated with some other CVDs. Conclusions In this middle-aged and elderly Swedish population, current Swedish snus use was not associated with the risk of major heart and valvular diseases, abdominal aortic aneurysm, or CVD mortality in the entire study population, but was linked to an increased risk of stroke in never smokers.

Snuff, like porn, has been challenged by feminist and other political debates around representations focused on the body, exaggerated performance, claims of 'realness' and concerns about representing and/or encouraging violence against women. Thus, it is not surprising that simulated snuff horror, as a subgenre, is heavily influenced by the same technological changes that have also affected the porn industry: the content of the videos, how the videos are produced and how they are consumed. I argue that the decontextualized digital context of media production and consumption has especially lent itself to the subgenre of horror I refer to as 'simulated snuff films' and aids in the longevity of snuff mythology. I use the terminology simulated snuff films to differentiate these fictional, from authentic snuff. Building on Steve Jones' work, I explore the consumption of simulated snuff films that are scary real – fictional content that purposefully attempts to approximate the imagined look of a real snuff film – and films that are real scary – authentic depictions of extreme sexual violence and death – which may not give the appearance of being real or may be read by audiences as being faked. Further, using Jean Baudrillard's theories of Simulation and Simulacra (1981), I argue that the case of Luka Magnotta, and his now infamous internet videos, exemplifies the hyperreality of snuff films in the post-9/11 context. To put it another way, simulated snuff films now appear more real than authentic recordings of murder in the digital sphere. [ABSTRACT FROM AUTHOR]

Introduction. Oil lamp snuff divination practices used to be widespread enough in Tibet, Mongolia, Kalmykia, and other regions. Goals. The paper introduces into scientific discourse texts thereof in Chinese, Tibetan, and Mongolian. The analysis of the practices reveals values, logic, symbols, and structural patterns inherent to traditional societies. Materials. The article examines a number of sources, namely: 1) a Chinese text published in Hohhot (Inner Mongolia, PRC), 2) a Tibetan text posted on the website of Buddhist Digital Resource Center, 3) a Beijing xylograph of one Mongolian text stored at the Institute of Oriental Manuscripts of the RAS (St. Petersburg, Russia). The latter was checked against another copy of the Beijing xylograph submitted by Demberel Sükhee, a lecturer at the National University of Mongolia (Department of Philosophy and Religious Studies). Results. The article analyzes the traditional oil lamp snuff divination method and provides a comparative study of texts in three different languages, translating and transliterating the employed sources

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.

ObjectiveRestricting tobacco marketing is a key element in the US Food and Drug Administration's (FDA) public health framework for regulating tobacco. Given the dearth of empirical data on direct marketing, the objective of this study was to assess the reach and impact of promotions on sales through snuff websites.MethodsNine brands of snuff, representing more than 90% of market share, were monitored for content of coupons, sweepstakes, contests, and other promotions on their respective websites. Monthly sales data and website traffic for the 9 brands, corresponding to the 48-month period of January 2011 through December 2014, were obtained from proprietary sources. A time-series analysis, based on the autoregressive, integrated, moving average (ARIMA) method, was employed for testing the relationships among sales, website visits, and promotions.ResultsWebsite traffic increased substantially during the promotion periods for most brands. Time-series analyses, however, revealed that promotion periods for 5 of 7 brands did not significantly correlate with monthly snuff sales.ConclusionsThe success in attracting tobacco consumers to website promotions demonstrates the marketing reach of snuff manufacturers. This form of direct marketing should be monitored by the FDA given evidence of adolescents' exposure to cigarette brand websites.

The aim of this paper is to review the use of nasal stimulants in interpersonal communication. The literature survey was performed from PubMed, ProQuest Central database of Anadolu University, and Google Scholar. Throughout history, various materials have been used as nasal stimulants to communicate and socialize intensively. Snuff is tobacco inhaled into the nostrils. It goes through the nasal mucosa into the blood and affects the neural system. Maras Powder is also a smokeless tobacco type common in the southeast of Turkey, especially in Gaziantep and Maras, which gave its name to the product. Cocaine is made from the coca plant, and it can be in the form of powder and rock. The rock one is also known as crack. It passes through the nostrils and is absorbed in the blood, causing paranoias, sleeplessness, extreme energy, and more confidence. When oxytocin is said, some positive words come to mind, such as socializing, relationships, feeling of trust, and understanding. It is a hormone and neurotransmitter. Increasing interpersonal communication in the shortest time is an important issue today. Online meetings, the ability of different people to work on the same file simultaneously over the computer, cause individuals to distance themselves from each other and decrease communication among them. Despite being in the same social environment, friends often communicate with others with their smartphones instead of having face-to-face relations. To increase interpersonal communication experience, events involving alcohol take is the mostly commonly used one. Nasal snuff, cocaine, crack, and oxytocin abolish self-control which affects interpersonal communication negatively at the end of the day. [ABSTRACT FROM AUTHOR]

Introduction: The objective was to systematically review studies on health outcomes from smokeless tobacco (SLT) products. Methods: We analysed published literature on the health outcomes from SLT use between 01/01/2015 to 01/02/2020, following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) protocol using PubMed, Embase, Scopus, and Google Scholar. Results: Of 53 studies included, six were global, 32 from Asia, Middle East and Africa (AMEA), nine from USA and six from Europe. 'Poor'-rated studies predominated (23;43%), in particular, for global (4;66%) and AMEA (16;50%). Health outcomes differed between SLT-products and regions; those in AMEA were associated with higher mortality (overall, cancer, Coronary heart disease (CHD), respiratory but not cardiovascular disease (CVD)), and morbidity (CVD, oral and head and neck cancers), with odds ratios up to 38.7. European studies showed no excess mortality (overall, CVD, from cancers) or morbidity (ischemic heart disease (IHD), stroke, oral, head and neck, pancreatic or colon cancers) from several meta-analyses; single studies reported elevated risk of rectal cancer and respiratory disorders. Pooled study data showed protection against developing Parkinson's disease. US studies showed mixed results for mortality (raised overall, CHD, cancer and smoking-related cancer mortality; no excess risk of respiratory or CVD mortality). Morbidity outcomes were also mixed, with some evidence of increased IHD, stroke and cancer risk (oral, head and neck). No studies reported on switching from cigarettes to SLT-products. Conclusion: Our review demonstrates stark differences between different SLT-products in different regions, ranging from zero harm from European snus to greatly increased health risks in AMEA. The literature on the safety profile for SLT-products for harm reduction is incomplete and potentially misinforming policy and regulation. [ABSTRACT FROM AUTHOR]

The elite sport environment is one where athletes strive to find a competitive edge, through improved recovery modalities, cognitive performance or physical capacity. Due to this, non-scientifically evidenced and/or pseudo-scientific alternative remedies are ever popular. Snus (an oral tobacco based product containing the highly addictive compound nicotine) is one alternative 'physical and psychological performance enhancer', purported to act as a 'mental and physical booster', 'relaxative' and even as an 'appetite suppressor'. Despite snus having serious adverse health effects, along with no proven benefit to physical or mental performance, observations by the authors working in professional sport, along with several reports in the mainstream media, would suggest that the use of snus in elite sport appears to be increasing. Perhaps most worrying, the use of snus has been reported to be prevalent within younger athletes. It is crucial that athletes are fully educated with regards to the health implications of snus and other oral tobacco-based products, whilst practitioners should be aware of its growing prevalence in sport with strategies in place to discourage its use. [ABSTRACT FROM AUTHOR]

Abstract Background Several studies have investigated the role of snus as an aid to become smoke-free, but few have focused on who use snus, how they perceive snus use, why and how they quit, and their perception of being non-snus users. The purpose of this paper is to describe snus cessation patterns. Methods Respondents are part of a 7-year follow-up of former smokers in Sweden. Initially, 1400 respondents were contacted regarding participation and 705 answered a web-based survey (response rate 50%). Out of them, 118 had used snus. The analyses include percentage distributions, as well as factor analyses of inventories, and configural frequency analysis in order to examine configurations of snus-related patterns. Results Over 80% found snus of great importance to succeed with smoking cessation and half of them continued to use snus on a long term. Those who experienced both physical and psychological effects of switching to snus were the ones who continued and vice versa; those who did not experience such effects quit using snus. None made use of professional help but had their own strategies (60%), and most respondents who quit obtained psychological benefits (68%). Conclusions The distinction between the concepts smoke-free, tobacco-free, and nicotine-free contributes to nuances in the debate on snus as harm reduction. Continued snus use does not mean that snus is not an effective aid to become smoke-free. Snus cessation is mostly mentioned in relation to advices on how to succeed, but the cessation process has rarely been described; therefore, this study expands the knowledge on this quite neglected topic and contributes to a more nuanced picture of snus cessation.

Abstract Background Worldwide, tobacco use has caused over 100 million deaths in the twentieth century and is projected to cause death in up to one billion people in the twenty-first century. It is a leading cause of early death and disability in over 100 countries and accounts for over 11% of global deaths, disproportionately affecting low- and middle-income countries. The purpose of the study was to examine a variety of social determinants of tobacco use in the Democratic Republic of the Congo, including region, sex, ethnicity, education, literacy, wealth index and place of residence, to gain insights with regard to tobacco use among sub-national groups. Methods This project was a secondary data analysis of the 2013–2014 Demographics and Health Survey (DHS) for the Democratic Republic of the Congo. Logistic regressions predicting smoking, use of snuff and smoking cigars or natural tobacco as dichotomous variables were conducted. Independent variables included age, educational level, religion, rurality, literacy, wealth index, occupation and ethnicity. Results Tobacco use is highest among those with less education and low literacy. It was also highest among the working poor. Older age and living in larger cities were predictive of smoking, although the relationship between age and smoking was not linear. There was a strong linear effect for wealth. Being in a professional, technical or managerial position was highly protective against smoking while being engaged in services, skilled and unskilled manual labor, and the army had significantly greater odds of smoking. Conclusions Data indicate that tobacco use in the DRC, as is common in the developing world, is heavily concentrated in the working poor with lower educational status. Higher educational status is consistently predictive of avoiding tobacco use. Additionally, examining only national-level data to ascertain tobacco use levels and patterns may lead to mistaken conclusions that can lead to inefficient and ineffective allocation of resources aimed at controlling tobacco use.

Abstract Background The range of risk reduced alternatives to smoking tobacco is increasing and so is use among pregnant women. The substantial harms of smoking during pregnancy are well established and there is reason to believe that nicotine alone is somewhat harmful. Differences in the exposure chemistry strongly suggest that the effects of using smoke-free nicotine products (including pharmaceutical nicotine products, smokeless tobacco, and electronic cigarettes containing nicotine) fall somewhere in the range between zero risk to the risk from smoking. How much lower risk these consumption choices are in terms of pregnancy outcomes, however, remains uncertain. Methods We reviewed the literature on smoke-free nicotine and tobacco product exposure and birth-outcome endpoints. Studies were included if they compared outcomes to either no nicotine use or smoking. We searched Google Scholar using broad search terms and additional articles were snowballed from citations. We report what could be learned from each study, given its methods. Results Of the 21 studies reviewed, 12 reported on the use of nicotine replacement therapies, 7 on Swedish snus, 1 on Alaskan iq’mik, and 1 on e-cigarettes. The range of results tends to support the prediction that smoke-free product use during pregnancy probably increases the risk of some negative birth outcomes, but that any effect is less than that from smoking. However, the limitations of epidemiology are such that no more-precise a conclusion is possible. Discussion The available epidemiology does not change our prior beliefs, based on other evidence and knowledge, that the risks from smoke-free nicotine and tobacco are lower than those for smoking, though it suggests they are non-zero. However, it also demonstrates that the epidemiology is unlikely to provide precise quantitative estimates. This is not just a matter of lack of studies; given the inherent limitation of these studies, doubling or tripling the corpus of available studies would add little precision. For the foreseeable future, decisions about using these products will need to be made based on rough estimates, based on a variety of forms of evidence, and qualitative comparisons.

Background: Oral squamous cell carcinoma (OSCC) may arise from premalignant oral lesions (PMOL) in most cases. Minichromosome maintenance 3 (MCM3) is a proliferative marker that has been investigated as a potential diagnostic biomarker in the diagnosis of oral cancer. Objectives: To evaluate the association of MCM3 expression, its clinicopathologic parameters and to identify snuff (also called naswar) as a potential risk factor for changes in MCM3 expression in PMOL and OSCC. Methodology: Immunohistochemistry (IHC) of MCM3 was performed on 32 PMOL, 32 OSCC and 16 normal controls after optimization of IHC methodology. Histoscore (0–300) was used as a scoring system and seven different cut-offs were identified for analyses. Data were analyzed using various statistical tests. Results: Among the seven cutoffs, 40% strong positive cells were found to be a better cut-off as they were associated with many pathological variables (Broder’s grade, Aneroth’s grade, and mitotic activity). The differential MCM3 expression in oral lesions (PMOL and OSCC) was statistically significant (p = 0.03). Moreover, MCM3 expression is raised with increased duration and frequency of snuff use. Conclusion: High MCM3 expression is associated with disease progression and is a potential indicator of malignant transformations from PMOL to OSCC. Moreover, the use of snuff is associated with MCM3 over-expression.

[Display omitted] The objective of the study was to investigate the constituents of the most commonly consumed naswar brands from Khyber Pakhtunkhwa, Pakistan. A total of 14 most-sold brands of naswar, two from each division in KP were collected and analyzed by gas chromatography-mass spectrometry and inductively coupled plasma mass spectrometry to determine their organic and elemental composition respectively. In addition, pH, ash content, and aflatoxin assessment were also performed. The average pH and ash content of all the test samples were 8.61 ± 0.271 and 18.94 ± 7.79 % respectively. Overall, the presence and concentration of the different constituents vary across the different naswar brands. GC–MS analysis identified 85 different organic compounds, the commonest being nicotine followed by glycerol tricaprylate and Di-n-octyl phthalate. Metal ions present in the highest concentration were iron (1146.84 ± 1050.31 mg/kg), tungsten (306.59 ± 494.82 mg/kg), and copper (288.95 ± 77.16 mg/kg). Aflatoxin B1 and B2 were the most common aflatoxins identified in naswar samples. Overall, naswar contains an array of organic, inorganic, toxic, and heavy metals and aflatoxin constituents with proven toxic and carcinogenic potential. Furthermore, high pH and nicotine contents make it highly addictive. There is an urgent need to enact and implement ST control policies to curb naswar use in Pakistan. [ABSTRACT FROM AUTHOR]

Abstract The major components of 70 brands of smokeless tobacco products (STPs) from Sweden and the US were determined to provide greater understanding of the general chemical composition of these products. Various styles of STPs were examined: loose and portion snus from Sweden, and chewing tobacco, dry snuff, moist snuff, hard pellet, soft pellet and plug from the US. The components analysed were major STP components such as water, nicotine, sugars, humectants, sodium ions, chloride ions and ash. The relative quantities of the components varied significantly between different styles of STP. The major component of moist snuff and Swedish loose snus is water. With Swedish portion snus water and pouch material comprise more than half of the product mass; with chewing tobaccos water and sugars comprise around 60% of the products. With these STPs, tobacco was a minor component (30–35%) of the product mass. By way of contrast, tobacco comprised the majority (around 70–90%) of the product mass with dry snuff, hard pellet and soft pellet products. Additives such as sugars, propylene glycol, glycerol, and sodium chloride comprised up to around 12% of the STPs, except for plug and chewing tobaccos where sugars comprised 15–30% by mass of the STP on average. Significant disagreements were found amongst alternative methods of determining water/moisture content for STPs. In particular the oven method, commonly used to determine moisture in tobacco, gave significantly higher values than the Karl Fischer water method when propylene glycol was present. Smaller but similar differences were found using the Near-Infrared method. Choice of measurement technique has important consequences for accuracy of toxicant levels when reporting on a dry-weight basis, a commonly used parameter in smokeless tobacco research and emerging regulatory standards. Conversion to a DWB was also found to produce a preferential bias between and within different STP categories in favour of drier products. These data provide greater understanding of differences in the compositions of contemporary smokeless tobacco products, and demonstrate challenges associated with conversion of actual product contents to dry weight basis values.

Abstract Differences in health risks between different styles of smokeless tobacco products (STPs) have prompted interest in their relative levels of toxic chemicals. We report here the development of methods for the analysis of STPs for coumarin and for α-angelica lactone (α-AL), both of which have been included in various published lists of tobacco toxicants. We have also determined the concentrations of these lactones in commercial STPs from the US and Sweden, representing 80–90% of the 2010 market share for all the major STP categories in these two countries: 65 products (plus two reference products) for coumarin and 66 commercial products for α-AL. For coumarin, methanol extracts of the STPs were analysed by HPLC/MS/MS. The lower limit of quantification (LOQ) and limit of detection (LOD) were, respectively, 100 and 30 ng coumarin/g of STP on a wet weight basis (WWB). Alpha-AL was determined via direct headspace GC/MS. The LOQ and LOD were 65 and 30 ng/g WWB respectively. Coumarin was detected In 3/33 Swedish snus, 5/13 US chewing tobaccos, 16/16 moist snuffs and 5/6 dry snuffs. Concentrations in those samples with quantifiable coumarin contents ranged from 186 to 1656 ng/g WWB. Concentrations of coumarin measured in this study were consistent with levels naturally found in tobacco. None of the STPs analysed would significantly contribute to coumarin exposure in consumers compared with dietary sources, and estimated exposure levels were 1000× lower than the European Food Safety Authority Tolerable Daily Intake. Hence the relevance of coumarin to the toxicity of STPs and its inclusion in the FDA’s list of harmful and potentially harmful compounds list is questionable. Measurements of α-AL in these STPs found that the majority did not have quantifiable contents, however, for three STPs concentrations of α-AL were above the LOQ (116–140 ng/g WWB) and for four other STPs concentrations of α-AL could be estimated between the LOD and LOQ. Beta-angelica lactone was tentatively identified in three of the STPs but the levels could not be reliably quantified. The levels of α-AL in tobacco products are reported here for the first time, but the relevance of α-AL to the toxicity of STPs is also highly questionable given that it has GRAS status as a permitted food additive.

Background: Cigarette smoking is a well-known risk factor for cardiovascular disease (CVD), but whether smokeless tobacco such as snuff is associated with the risk of CVD is still unclear. We investigated the association of the use of Swedish oral moist snuff (snus) with a broad range of CVDs and CVD mortality.Methods: We used data from a population-based cohort of 41,162 Swedish adults with a mean baseline age of 70 (56-94) years who completed questionnaires regarding snus use and other lifestyle habits and health characteristics. Participants were followed up for incident cardiovascular outcomes and death over 8 years through linkage to the Swedish National Patient and Death Registers. Hazard ratios (HR) were estimated by Cox proportional hazards regression. We conducted analyses among all subjects as well as among never smokers to reduce residual confounding from smoking.Results: After adjustment for smoking and other confounders, snus use was not associated with myocardial infarction, heart failure, atrial fibrillation, aortic valve stenosis, abdominal aortic aneurysm, stroke, or CVD mortality. However, in never smokers, snus use was associated with a statistically significant increased risk of total and ischemic stroke (HRs [95% confidence intervals] = 1.52 [1.01-2.30] and 1.63 [1.05-2.54], respectively) and non-significantly positively associated with some other CVDs.Conclusions: In this middle-aged and elderly Swedish population, current Swedish snus use was not associated with the risk of major heart and valvular diseases, abdominal aortic aneurysm, or CVD mortality in the entire study population, but was linked to an increased risk of stroke in never smokers. [ABSTRACT FROM AUTHOR]

Background and aim: Smoking rates are decreasing in Norway while the use of snus has increased. We aimed to investigate the co-occurrence of, and the socio-demographics, personality and substance use characteristics associated with, student smoking and snus use. Methods: Survey data were collected among students in higher education in Bergen, Norway in 2015 (N = 11,236, response rate 39.4%). Multinomial regression analyses comparing snus users and smokers to non-users and non-smokers, respectively, on demographic, personality and substance use variables were conducted. Regression analyses comparing current dual users to current smokers and current snus users and comparing daily smokers to daily snus users, on demographic, personality and substance use variables were also conducted. Results: In total 67.9% of ever snus users identified themselves as non-smokers (past and current). Several demographic, personality and substance use characteristics associated with smoking and snus use were identified (all = p <. 05), some of which were common for both (e.g., use of cannabis) and some which were exclusively associated with either smoking (e.g., neuroticism) or snus use (e.g., extroversion). Conclusion: The current study contributes with several novel findings regarding traits associated with smoking and snus use. Though limited by a cross-sectional design, the current findings may suggest that the group of students using snus consists of a combination of previous smokers, students who would have smoked if snus was not available and a new segment who may not have used nicotine if snus was not available. [ABSTRACT FROM AUTHOR]

Abstract Background We are interested in comparing the levels of harmful or potentially harmful constituents in Swedish and American smokeless tobacco products (STPs). We report here the concentrations of the IARC Group 2 A (probable human) carcinogen ethyl carbamate (EC) in seventy commercial STPs from the US and Sweden, representing 80–90% of the market share of the major STP categories in these countries. We also examine the effects of various additives, processing and storage conditions on EC concentrations in experimental snus samples. Results EC was determined from aqueous extracts of the STPs using ultra performance liquid chromatography tandem mass spectrometry (UPLC/MS/MS). EC was undetectable (

As a result of the conducted studies the dependence of the quality indicators of consumer tobacco on duration and storage conditions was determined.

In India and the South Asian part of the world use of tobacco is seen for a longtime. If we go back decades back tobacco is used as a gift to treat the guests and also it was encouraged to use in past times. Sooner when the malicious side effects of tobacco were noticed people tried to avoid the consumption of tobacco. The psychological mindset of the youth is quite impressionable, seeing the things that the adults do would easily encourage them to do the same. Thus, this article reviews various forms of tobacco used in our Indian society and how the government of India is taking action to curb the tobacco abuse. [ABSTRACT FROM AUTHOR]

Background: Worldwide, tobacco use has caused over 100 million deaths in the twentieth century and is projected to cause death in up to one billion people in the twenty-first century. It is a leading cause of early death and disability in over 100 countries and accounts for over 11% of global deaths, disproportionately affecting low- and middle-income countries. The purpose of the study was to examine a variety of social determinants of tobacco use in the Democratic Republic of the Congo, including region, sex, ethnicity, education, literacy, wealth index and place of residence, to gain insights with regard to tobacco use among sub-national groups.Methods: This project was a secondary data analysis of the 2013-2014 Demographics and Health Survey (DHS) for the Democratic Republic of the Congo. Logistic regressions predicting smoking, use of snuff and smoking cigars or natural tobacco as dichotomous variables were conducted. Independent variables included age, educational level, religion, rurality, literacy, wealth index, occupation and ethnicity.Results: Tobacco use is highest among those with less education and low literacy. It was also highest among the working poor. Older age and living in larger cities were predictive of smoking, although the relationship between age and smoking was not linear. There was a strong linear effect for wealth. Being in a professional, technical or managerial position was highly protective against smoking while being engaged in services, skilled and unskilled manual labor, and the army had significantly greater odds of smoking.Conclusions: Data indicate that tobacco use in the DRC, as is common in the developing world, is heavily concentrated in the working poor with lower educational status. Higher educational status is consistently predictive of avoiding tobacco use. Additionally, examining only national-level data to ascertain tobacco use levels and patterns may lead to mistaken conclusions that can lead to inefficient and ineffective allocation of resources aimed at controlling tobacco use. [ABSTRACT FROM AUTHOR]

Background/aim: Smokeless tobacco has been associated with oral cavity cancer for several decades. The incidence of oral cavity cancer is higher in some parts of the world especially South and South-East Asia including Pakistan. The aim of current study was to evaluate the risk of oral cavity cancer among smokeless tobacco users in our country. Materials and methods: A case-control study was conducted between November 2016 and September 2017. Patients diagnosed with oral cavity cancer receiving treatment were included as cases and the attendants of various cancer patients visiting the hospital during the study period were included in the study as controls. Odds ratios (OR) and 95% confidence intervals (CI) were calculated and all reported P-values were considered significant at < 0.05. Results: The crude OR for the "ever smokeless tobacco users" among cases and controls came out to be 4.98 (95%CI; 2.76-9.01). The OR for snuff users among cases and controls was 4.82 (95%CI; 2.37-9.80) and that for betel leaf users was 4.42 (95%CI; 1.66-11.91) after adjusting for smoking and age. Conclusion: Our study provided strong evidence for snuff and betel leaf to be independent risk factors for oral cavity cancer. [ABSTRACT FROM AUTHOR]

Background: The range of risk reduced alternatives to smoking tobacco is increasing and so is use among pregnant women. The substantial harms of smoking during pregnancy are well established and there is reason to believe that nicotine alone is somewhat harmful. Differences in the exposure chemistry strongly suggest that the effects of using smoke-free nicotine products (including pharmaceutical nicotine products, smokeless tobacco, and electronic cigarettes containing nicotine) fall somewhere in the range between zero risk to the risk from smoking. How much lower risk these consumption choices are in terms of pregnancy outcomes, however, remains uncertain. Methods: We reviewed the literature on smoke-free nicotine and tobacco product exposure and birth-outcome endpoints. Studies were included if they compared outcomes to either no nicotine use or smoking. We searched Google Scholar using broad search terms and additional articles were snowballed from citations. We report what could be learned from each study, given its methods. Results: Of the 21 studies reviewed, 12 reported on the use of nicotine replacement therapies, 7 on Swedish snus, 1 on Alaskan iq'mik, and 1 on e-cigarettes. The range of results tends to support the prediction that smoke-free product use during pregnancy probably increases the risk of some negative birth outcomes, but that any effect is less than that from smoking. However, the limitations of epidemiology are such that no more-precise a conclusion is possible. Discussion: The available epidemiology does not change our prior beliefs, based on other evidence and knowledge, that the risks from smoke-free nicotine and tobacco are lower than those for smoking, though it suggests they are non-zero. However, it also demonstrates that the epidemiology is unlikely to provide precise quantitative estimates. This is not just a matter of lack of studies; given the inherent limitation of these studies, doubling or tripling the corpus of available studies would add little precision. For the foreseeable future, decisions about using these products will need to be made based on rough estimates, based on a variety of forms of evidence, and qualitative comparisons. [ABSTRACT FROM AUTHOR]

Objectives: To investigate the factors associated with snuff usage and its neurocognitive effects among women. Design: A cross sectional study encompassing a sample of 73 females with an average age range between 18 and 60 years was employed. Participants in this study came from three townships namely Masala having 28 (38.4%), Mushili with 25 (27.4%) and Kabushi with 20 (34.2%) and primary as their education level. Measures: Validated snuff questionnaire was used to determine the factors to snuff usage then Trail Making test and WAIS-III Symbol Search test were used to measure attention and working memory. The Statistical Package for Social Sciences (SPSS) version 20 computer software was used to analyse quantitative data in order to generate simple descriptive statistics in form of frequencies and tables. An analysis of the correlation with Pearson analysis was conducted to find out the relationship between the frequency of snuff usage with attention and working memory among women. Results: From the Trail Making test administered, 62 (84 %) had deficits on attention and 56 (77%) had severe memory impairment according to WAIS III Symbol Search test. Concurrently, most women use snuff for physical (body weight loss/gain, sexual pleasure whitening of teeth, energy for ADL etc) and Pharmacology (Cure for headache, toothache, flu, regulate Bp, siphoning vagina fluid, boost immune system etc) factors. Conclusion: The analysis from this study showed a statistically significant relationship between frequency of snuff usage (1-10 times per day) with attention and working memory as snuff impairs both attention and memory. The more one uses snuff the more impairment in memory and attention. In addition, the study revealed social, pharmacology and physical as most factors leading to the use of snuff among women. It is hoped that the results of this study will open research prospects on women using snuff and policy makers to come up with intervention measures in order to arrest this mushrooming problem among women. [ABSTRACT FROM AUTHOR]

Objectives: To determine the prevalence of Smokeless Tobacco Consumption Among Patients Seen at Altamash Institute of Dental Medicine, Karachi. Study design: Descriptive cross-sectional study. Place and duration: Th is survey was conducted at Altamash Institute of Dental Medicine, Karachi. Th e survey was initiated on the March 2019 and was concluded on the May 2019. Method and Materials: A total of 230-participants have participated in the study. A sample of 230-patients was selected by random sampling technique. A questionnaire was used to evaluate the prevalence of smokeless tobacco among patients. Results: According to the results 87.82% were males, and 12.17% were females. Majority of the people were noted to be in their second decade of life and uneducated. Th e most common form of smokeless tobacco (SLT) being used was snuff 47.82%, with the least preference being given to paan with tobacco (13.04%). While the data showed that the main reason as to started the use of smokeless is pressure from friends and colleagues. Majority of the people had been using the product since more than 7-years, and they use the product 3-5 times in 1-day. Conclusions: Th e fi ndings of this study concluded that indulgence in smokeless tobacco habit usually starts as a pressure from friends and colleagues, youngsters and adults both can get addicted to this habit of consuming smokeless tobacco. [ABSTRACT FROM AUTHOR]

Abstract There is considerable interest in the chemical composition of smokeless tobacco products (STPs), owing to health concerns associated with their use. Previous studies have documented levels of 210Po, 210Pb and uranium in STP samples. Here, the levels of 13 α-particle and 15 β-radiation emitting radionuclides have been measured in a broad and representative range of contemporary STPs commercially available in the United States and Sweden. For each radionuclide, the level of radioactivity and calculated mass per gram of STP are reported. The results indicate that, among 34 Swedish snus and 44 US STPs, a more complex radionuclide content exists than previously reported for these products. Of the 28 radionuclides examined, 13 were detected and quantified in one or more STPs. The most frequently identified radionuclides in these STPs were 40K, 14C, 210Po and 226Ra. Over half the STPs also contained 228Th, and an additional 8 radionuclides were identified in a small number of STPs. The presence of 14C, 3H and 230Th are reported in tobacco for the first time. The activity of β-emitters was much greater than those of α-emitters, and the β-emitter 40K was present in the STPs with both the greatest radioactivity and mass concentrations. Since the three radionuclides included in the FDA’s HPHC list were either not detected (235U), identified in only three of 78 samples (238U), and/or had activity levels over fifty times lower than that of 40K (210Po, 238U), there may be a rationale for reconsidering the radionuclides currently included in the FDA HPHC list, particularly with respect to 40K. Using a model of the physical and biological compartments which must be considered to estimate the exposure of STP users to radionuclides, we conclude that exposure from α-emitters may be minimal to STP users, but 40K in particular may expose the oral cavities of STP users to β-radiation. Although a more comprehensive picture of the radioisotope content of STPs has emerged from this study, epidemiological evidence suggests that the levels of radionuclides measured in this study appear unlikely to present significant risks to STP users.