Search

Decades of research show that constituents other than nicotine are the harmful agents in tobacco products. This knowledge is incorporated into the nicotine regulatory policies of countries leading in tobacco control, such as the UK and New Zealand. Alternative nicotine products, such as nicotine replacement therapy and e-cigarettes, are now endorsed in the UK by a number of healthcare bodies in a tobacco harm reduction approach that encourages tobacco users to completely switch to a less risky nicotine-containing product. The potential role of 'clean' nicotine alternatives to reduce the harms from tobacco is, however, not being translated into practice. Many healthcare practitioners still bundle tobacco, cigarettes, smoking, cancer and nicotine into one, thus preventing them from supporting their patients to make informed choices on safer nicotine alternatives. This misperception among healthcare professionals, in turn, is a hurdle to effective tobacco control policymaking in many low- and middle-income countries and effective cessation support everywhere in the world. Nicotine confidence based on nicotine literacy among the key decision-makers should start with reforming medical curricula and myth-busting in the lay media to include factual statements about nicotine and public health policy discussions on the principles of harm reduction.

Nicotine pouches to be put under the upper lip are a new category of products that are being rapidly developed and marketed as consumer goods with little research or regulatory oversight. We have identified research gaps in assessing their harm and benefit potential, and possible regulatory science approaches to inform the policies that can allow a maximization of the category’s public health potential while minimizing unintended consequences. Implications: This commentary presents a potential blueprint for a comprehensive assessment of the nicotine pouches category. Data from the proposed research areas can better inform the regulatory policy decisions around the category, with the aim to maximize the category’s tobacco harm reduction potential while minimizing unintended harms.

PurposeThe COVID-19 pandemic has resulted in unprecedented circumstances and changes in behaviour. This research sought to better understand the impact of the COVID-19 pandemic, and lockdown, on smoking behaviour in the UK from the perspectives of consumers (current and former smokers) and some of their smoking-related behaviour-influencers.Design/methodology/approachThis research project encompassed two surveys, one for current and former smokers (Consumers) and one for those individuals in professions with the potential to influence smoking behaviours (Influencers). Both surveys were conducted online and were infield for approximately two weeks during UK’s first COVID-19 lockdown. Because of the unprecedented times the society was experiencing, several questions relating directly to COVID-19 were added to the survey and this paper is based only on findings only from those questions and not the whole project. The results were analysed descriptively.FindingsA total of 954 consumers and 1027 influencers participated in the surveys. Increased smoking was reported by 67% of the consumers mainly due to stress and boredom arising out of COVID-19 lockdown. Consumers under 45 years of age, those in professional and managerial occupations, and among dual users reported increased smoking in lockdown. The COVID-19 situation changed the plans to quit smoking in 36% of consumers, with only 6% deciding to quit. Only 40% of healthcare professionals (HCPs) documented patient smoking status in over half their interactions.Originality/ valueThis research among current and former smokers and their influencers highlights important changes in behaviour during the COVID-19 times and underscores urgent measures to be taken by HCPs and policymakers for staying on course of achieving smokefree goals despite challenges posed by COVID-19.

Nicotine extracted from tobacco and purified from other constituents can be delivered in the form of nicotine replacement products for helping people move away from tobacco dependence. Nicotine pouches to be put under the upper lip are one such new category of products that are being rapidly developed and marketed as consumer goods with little research or regulatory oversight. We review the available data on these products and their harm reduction potential for reducing the disease and death burden from tobacco globally. Finally, we have identified research gaps in assessing their harm and benefit potential, and possible regulatory approaches to ensure that these products do not lead to unintended consequences.

Nicotine extracted from tobacco and purified from other constituents can be delivered in the form of nicotine replacement products for helping people move away from tobacco dependence. Nicotine pouches to be put under the upper lip are one such new category of products that are being rapidly developed and marketed as consumer goods with little research or regulatory oversight. We review the available data on these products and their harm reduction potential for reducing the disease and death burden from tobacco globally. Finally, we have identified research gaps in assessing their harm and benefit potential, and possible regulatory approaches to ensure that these products do not lead to unintended consequences.

A wide range of microbes inhabit the oral cavity, and bacterial and fungal communities most often exist as structured communities or biofilms. The use of tobacco alters the structure of the oral microbiome, including that of potentially malignant lesions, and the altered oral microbiome influences key microenvironmental changes such as chronic inflammation, secretion of carcinogenic toxins, cellular and tissue remodelling and suppression of apoptosis. Given this, it is clear that the bacterial and fungal biofilms in potentially malignant states are likely not passive entities, but could play a critical role in shaping potential malignant and carcinogenic conditions. This holds potential towards leveraging the oral microbiome for the management of tobacco-associated potentially malignant lesions and oral cancer. Here, we explore this line of investigation by reviewing the effects of tobacco in shaping the oral microbiome, and analyse the available evidence in the light of the microbiome of oral potentially malignant and cancerous lesions, and the role of dysbiosis in carcinogenesis. Finally, we discuss possible interventions and approaches using which the oral microbiome could be leveraged towards precision-based oral cancer therapeutics.

The reported increase in the non-medical use of opioid prescription medication in West Africa and Middle East coinciding with the ongoing problems in North America has moved the International Narcotic Control Board and the United Nations Office on Drugs and Crime to talk about a global opioid crisis requiring global solutions. The measures proposed include the strengthening of the global control system by adding the opioid analgesic tramadol to the list of internationally scheduled substances. Yet North America and West Africa have profoundly different health care systems as well as different access pathways to opioid medications and consumer motivation for non-medical use. Further, the substances driving the US opioid crisis are exponentially more powerful and dangerous than the falsified tramadol circulating in West Africa. Across West Africa patients are suffering from untreated pain, whereas one of the main drivers behind the different problems that has come to be known as the North American opioid crisis has been the overprescribing of opioid analgesics. Far from constituting a global opioid crisis, the two regions are facing fundamentally different challenges that need to be treated with specifically tailored policy responses. In particular, the urgent call for reducing opioid prescription levels in North America should not discourage medical professionals and public health agencies from rapidly improving pain management and opioid prescribing in Africa and other low and middle income countries.

The end of the 20th century and the advent of the new millennium have brought in a true merger of sciences for the benefit of mankind. The biggest promise it holds is that of improving the quality of human life by the discovery of newer medicines and better cures for diseases such as cancer and heart disease. Pharmaceutical companies and academic institutions alike have not failed to deliver on part of the promise by bringing out technologies and products that have significantly decreased mortality and morbidity associated with these diseases. An increase in the scale and complexity of the technologies has made it increasingly important to develop intelligent tools to analyze their output, and numerous mathematical and statistical techniques have been explored and exploited to do exactly this. Bayesian networks (BN) and similar graphical models for multivariate analysis are being used for analyzing these data with great success. They have made possible a high resolution insight into disease mechanisms like never before. These insights into the biological processes of health and disease have helped identify the appropriate targets for drug discovery and aided in the process of bringing better drugs faster to the market for patients in need. This chapter briefly explains the application and contribution of Bayesian networks to the drug discovery and development process.