Association between Shammah Use and Oral Leukoplakia-like Lesions among Adult Males in Dawan Valley, Yemen

  • Al-Tayar, Badr Abdullah (Community Dentistry, School of Dental Sciences,Universiti Sains Malaysia) ;
  • Tin-Oo, Mon Mon (Dental Public Health, School of Dental Sciences,Universiti Sains Malaysia) ;
  • Sinor, Modh Zulkarnian (Dental Public Health, School of Dental Sciences,Universiti Sains Malaysia) ;
  • Alakhali, Mohammed Sultan (Department of Periodontology, Faculty of Dentistry, Jazan University)
  • Published : 2016.01.11


Background: Shammah is a traditional form of snuff dipping tobacco (a smokeless tobacco form) that is commonly used in Yemen. Oral mucosal changes due to the use of shammah can usually be observed in the mucosal surfaces that the product touches. The aim of this study was to determine the association between shammah use and oral leukoplakia-like lesions. Other associated factors were also determined. Materials and Methods: A cross sectional study was conducted on 346 randomly selected adult males. Multi-stage random sampling was used to select the study location. After completing the structured questionnaire interviews, all the participants underwent clinical exanimation for screening of oral leukoplakia-like lesions Clinical features of oral leukoplakia-like lesion were characterized based on the grades of $Ax{\acute{e}}ll$ et al (1976). Univariable logistic regression and multivariable logistic regression were used to assess the potential associated factors. Results: Out of 346 male participants aged 18 years and older, 68 (19.7%) reported being current shammah users. The multivariable analysis revealed that age, non-formal or primary level of education, former shammah user, current shammah user, and frequency of shammah use per day were statistically associated with the presence of oral leukoplakia-like lesions [Adjusted odds ratio (AOR) = 1.03; 95% confidence interval (CI) : 1.01, 1.06; P=0.006], (AOR=8.65; 95% CI: 2.81, 26.57; P=0.001), (AOR=3.65; 95% CI: 1.40, 9.50; P=0.008), (AOR=12.99; 95% CI: 6.34, 26.59; P=0.001), and (AOR=1.17; 95% CI: 1.02, 1.36; P=0.026), respectively. Conclusions: The results revealed oral leukoplakia-like lesions to be significantly associated with shammah use. Therefore, it is important to develop comprehensive shammah prevention programs in Yemen.


Shammah;smokeless tobacco;oral leukoplakia-like lesions;Yemen


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