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Extending Application of the 'Hardcore' Definition to Smokeless Tobacco Use: Estimates from a Nationally Representative Population in India and its Implications

  • Jena, Pratap Kumar;Bandyopadhyay, Chandan;Mathur, Manu Raj;Das, Sagarika
    • Asian Pacific Journal of Cancer Prevention
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    • v.13 no.12
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    • pp.5959-5963
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    • 2012
  • Background: The term 'hardcore' has been applied to use of smoking tobacco and generally referred to as the inability or unwillingness of regular smokers to quit. The component constructs of hardcore except nicotine dependence are product neutral. With the use of 'time to first chew' as a measure of nicotine dependence, hardcore definition can be extended to characterize smokeless tobacco users. Hardcore users respond less to tobacco cessation interventions, and are prone to tobacco induced diseases including cancer. Thus identifying hardcore users would help in estimate the burden of high risk population for tobacco induced diseases. Smokeless tobacco use is predominant and accounts for more than 50% of oral cancer in India. Hence, hardcore chewing information could be used for planning of tobacco and cancer control interventions. The objective of this study was to assess the prevalence and associated factors of hardcore smokeless tobacco use in India. Materials and Methods: Global Adult Tobacco Survey (GATS)-India 2010 data were analyzed to quantify hardcore smokeless tobacco use in India with following five criteria: (1) current daily smokeless tobacco use; (2) no quit attempt in the past 12 months of survey or last quit attempt of less than 24 hours duration; (3) no intention to quit in next 12 months or not interested in quitting; (4) time to first use of smokeless tobacco product within 30 minutes of waking up; and (5) knowledge of smokeless tobacco hazards. Results: The number of hardcore smokeless tobacco users among adult Indians is estimated to be 5% (39.5 million). This group comprises 23.2% of daily smokeless tobacco users. The population prevalence varied from 1.4-9.1% across different national regions of India. Logistic regression modeling indicated age, education and employment status to be the major predictors of hardcore smokeless tobacco use in India. Conclusions: The presence of a huge number (39.5 million) of hardcore smokeless tobacco users is a challenge to tobacco control and cancer prevention in India. There is an unmet need for a universal tobacco cessation programme and intensification of anti-tobacco education in communities.

Use of Smokeless Tobacco among Male Students of Zahedan Universities in Iran: a Cross Sectional Study

  • Honarmand, Marieh;Farhadmollashahi, Leila;Bekyghasemi, Mahmoud
    • Asian Pacific Journal of Cancer Prevention
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    • v.14 no.11
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    • pp.6385-6388
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    • 2013
  • Background: Smokeless tobacco consumption is one of the causes of oral cancer. The aim of this study was to determine the prevalence of smokeless tobacco consumption among male students of Zahedan universities and associated factors in 2012. Materials and Methods: In this cross-sectional study, 431 students were selected from the universities of Zahedan using multi-stage random cluster sampling. The data collection tool was a questionnaire including questions about demographic information, history of smokeless tobacco consumption, and awareness of smokeless tobacco hazards. Data were analyzed by SPSS19 using Chi-square test and multinomial logistic regression, with p<0.05 considered significant. Results: At the time of conducting this study, 102 students (23.7%) had already consumed smokeless tobacco and 49 students (11.4%) were current users (consuming at least once in 30 days before the study). There was a significant relationship between history of smokeless tobacco consumption, university/college, place of living, mean GPA, and mother's education level (p<0.05). Also there was a significant association between knowledge and prevalence of smokeless tobacco use (p<0.001). Conclusions: There is a relatively high prevalence of smokeless tobacco consumption among the male students of universities of Zahedan, which shows the need to emphasize the provision and implementation of prevention programs in universities.

Perception and Practices of Physicians in Addressing the Smokeless Tobacco Epidemic: Findings from Two States in India

  • Panda, Rajmohan;Persai, Divya;Mathur, Manu;Sarkar, Bidyut Kanti
    • Asian Pacific Journal of Cancer Prevention
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    • v.14 no.12
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    • pp.7237-7241
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    • 2013
  • Background: Smokeless tobacco use in South Asia is believed to be a significant contributor to morbidity and mortality. In India, only a few studies involving health educational intervention by health care providers have demonstrated reduction in smokeless tobacco usage. In the present study we assessed the cessation efforts towards smokeless tobacco by physicians in two high tobacco prevalence states of India. The study also identified opportunities and barriers for integration of tobacco cessation services in routine practices of physicians. Materials and Methods: This mixed method study involved qualitative (phase I) and quantitative research study (phase II). In phase I, 59 in-depth interviews with physicians were conducted. In phase II, a quantitative study conducted among 238 physicians. An inductive approach was followed to analyze qualitative data using ATLAS. Ti software. The Chi-square test was employed to test the association between different variables of interest using SPSS version 17. Results: The majority of physicians related only respiratory problems and cancer with smokeless tobacco. Other major health effects like cardio-vascular problems, oral diseases, and effects on reproductive and neonatal health were recognized only by a few physicians. The age-group of 10-19 years was identified as most vulnerable to smokeless tobacco use. Less than one-third of physicians reported recording smokeless tobacco history of all patients. Findings indicated that less than half of physicians provided information on harmful health effects of smokeless tobacco with regard to specific diseases. Conclusions: The study revealed a low level of knowledge of physicians about harmful effects of tobacco and their suboptimal engagement in tobacco control practices. The study indicates the need of capacity building initiatives to equip physicians with skills in tobacco cessation.

Socioeconomic Inequality in the Prevalence of Smoking and Smokeless Tobacco use in India

  • Thakur, Jarnail Singh;Prinja, Shankar;Bhatnagar, Nidhi;Rana, Saroj;Sinha, Dhirendra Narain;Singh, Poonam Khetarpal
    • Asian Pacific Journal of Cancer Prevention
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    • v.14 no.11
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    • pp.6965-6969
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    • 2013
  • Background: Tobacco consumption has been identified as the single biggest cause of inequality in morbidity and mortality. Understanding pattern of socioeconomic equalities in tobacco consumption in India will help in designing targeted public health control measures. Materials and Methods: Nationally representative data from the India Global Adult Tobacco Survey (GATS) conducted in 2009-2010 was analyzed. The survey provided information on 69,030 respondents aged 15 years and above. Data were analyzed according to regions for estimating prevalence of current tobacco consumption (both smoking and smokeless) across wealth quintiles. Multiple logistic regression analysis predicted the impact of socioeconomic determinants on both forms of current tobacco consumption adjusting for other socio-demographic variables. Results: Trends of smoking and smokeless tobacco consumption across wealth quintiles were significant in different regions of India. Higher prevalence of smoking and smokeless tobacco consumption was observed in the medium wealth quintiles. Risk of tobacco consumption among the poorest compared to the richest quintile was 1.6 times higher for smoking and 3.1 times higher for smokeless forms. Declining odds ratios of both forms of tobacco consumption with rising education were visible across regions. Poverty was a strong predictor in north and south Indian region for smoking and in all regions for smokeless tobacco use. Conclusions: Poverty and poor education are strong risk factors for both forms of tobacco consumption in India. Public health policies, therefore, need to be targeted towards the poor and uneducated.

Determinants of Tobacco Cessation Behaviour among Smokers and Smokeless Tobacco Users in the States of Gujarat and Andhra Pradesh, India

  • Sarkar, Bidyut K.;Arora, Monika;Gupta, Vinay K.;Reddy, K. Srinath
    • Asian Pacific Journal of Cancer Prevention
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    • v.14 no.3
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    • pp.1931-1935
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    • 2013
  • Background: This study was undertaken to identify the socio-demographic determinants of quit attempts among smokers and smokeless tobacco users to identify correlates of tobacco cessation behaviour in India Materials and Methods: This was a cross-sectional study for the outcome of quit attempts made by current tobacco users in last 12 months in twelve districts in two states. Simple and multivariable logistic regression analysis was used to obtain the odds ratios (ORs) of socio-demographic variables (age, gender, education, occupation, socio-economic status, community, area, type of family) and tobacco user status (smoker/smokeless). Results: In the combined analysis, a smoker had higher predicted probability of attempting quitting (OR-1.41,CI 1.14-1.90), in comparison to a smokeless tobacco user and a tobacco user in the state of Gujarat was less likely to attempt quitting than a user in Andhra Pradesh (OR-0.60, CI 0.47-0.78). The probability of making a quit attempt was higher among tobacco users who were more educated (OR-1.40, CI 1.04-1.94), having a higher socio-economic status (SES) (OR-2.39, CI 1.54-3.69), and belonging to non-agricultural labourer occupational group (OR-1.90, CI 1.29-2.78). The effects were maintained even after adjusting for all other variables. In disaggregated analysis, findings were similar except in smokeless as a separate group, education level was not significantly associated with quit attempts and with lower odds (OR-0.91, CI 0.58-1.42). Conclusions: This is one of the first studies to provide useful insight into potential determinants for quit attempts of tobacco users in India including smokeless tobacco users, exploring the socio-demographic patterning of correlates of quit attempts.

Analysis of Combustion Instability in a Smokeless Propellant Rocket Motor (무연추진제 로켓모터에서의 연소불안정 해석)

  • 강경택;윤재건
    • Transactions of the Korean Society of Mechanical Engineers
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    • v.18 no.11
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    • pp.3032-3038
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    • 1994
  • The paper discusses a combustion instability phenomena encountered in recent solid rocket motor development efforts at ADD(Agency for Defense Development). It has happened to occur as an irregular burning in development of smokeless propellant rocket motor. Through investigating the spectral analysis of accelerometer and strain gage signals which are recorded in static firing tests and acoustic modal analysis of motor inside cavity with ANSYS, the instability is found to be the second tangential mode.

Studies on the Utilization of Low Quality Coals (1) Determination of combustion velocity of smokeless solid fuels (低質炭의 利用硏究 (第一報) 無燃固體燃料의 燃燒速度의 測定))

  • Oh, Shin-Sub;Kim, Chung-Hyuk
    • Journal of the Korean Chemical Society
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    • v.4 no.1
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    • pp.78-80
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    • 1957
  • Up to now, only superficial studies on the combustion velocity of smokeless fuels have been reported, while it should be a basical factor on the utilization of low quality coals and some other smokeless solid fuels. It was, therefore, difficult to choose raw material coals in manufacturing gaseous fuels. With the intent to solve above problem, we have determined combustion velocity of domestic anthracites, graphites, coalites of lignite and cokes from Japanese bituminous coal. The results show that the cokes from Japanese bituminous coal which has been used as raw material in the manufacturing gaseous fuels such as water gas, or producer gas in Korea can be replaced by some sources of domestic anthracite or coalite of lignite.

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A study of the smokeless liner formulation and smoke characteristics (무연 라이너 조성 및 연기 특성 연구)

  • 유지창;류문삼;백국현;류백능
    • Journal of the Korean Society of Propulsion Engineers
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    • v.6 no.2
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    • pp.19-27
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    • 2002
  • The smokeless liner, was required to propulsion system of gas generator, was developed by appling oxamide as a filler and HTPB system as a binder. Relative quantities of smoke produced during burning of liner by propellant combustion was measured by using smoke chamber. The smoke of the smokeless liner containing 50% of oxamide as filler was reduced to 1/10 as compared with conventional liner containing silica as filler. This result was showed by ground test of gas generator.

Burden of Smoked and Smokeless Tobacco Consumption in India - Results from the Global adult Tobacco Survey India (GATS-India)- 2009-2010

  • Bhawna, Gupta
    • Asian Pacific Journal of Cancer Prevention
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    • v.14 no.5
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    • pp.3323-3329
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    • 2013
  • Background: The Global Adult Tobacco Survey (GATS) was carried out for systematically monitoring tobacco use and for tracking key tobacco control indicators. Materials and Methods: A total of 70,802 households, including 42,647 in rural areas and 28,155 in urban areas, were covered with a three stage sampling design. Data were collected on sociodemographic characteristics, knowledge, attitude and practices of tobacco consumption.Results: GATS-India highlighted that total tobacco use among its residents is overall 34.6%, varying for males (47.9%) and females (20.7%). The rural areas of the country exhibit comparatively higher prevalence rates (38.4%) in comparison to urban areas (25.3%). Overall, Khaini, a smokeless tobacco product (12.0%), is the most popular form of tobacco use among males and females, followed by bidi smoking (9.0%). Conclusion: Results of GATS data can be used as baseline for evaluation of new tobacco control approaches in India integrating culturally acceptable and cost effective measures.

Analysis of Motivating Factors for Smokeless Tobacco Use in Two Indian States

  • Danawala, Saba Ashraf;Arora, Monika;Stigler, Melissa Harrell
    • Asian Pacific Journal of Cancer Prevention
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    • v.15 no.16
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    • pp.6553-6558
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    • 2014
  • Background: This study was conducted to gauge how the demographic profile of smokeless tobacco (SLT) users from Gujarat and Andhra Pradesh, India, differs from that of smokers. It also addresses how factors associated with the initiation and continuation of smokeless tobacco vary by age, gender, and education. Materials and Methods: We analyzed 2011 cross-sectional survey data collected from 4,759 respondents (smokers/SLT users/non-users) in both states. Chi-square analysis was used to make comparisons between the demographic profiles of smokers and SLT users. Multivariable logistic regression analysis was used to obtain the odds ratios (ORs) for initiation and continuation factors regressed on socio-demographic variables (age, gender, education). Results: Initiation-women were less likely than men to report "peer pressure", "fashion statement", and "stress/coping" as relevant factors for SLT use (OR: 0.45 CI: 0.30-0.70; OR: 0.42 CI: 0.24-0.74; OR: 2.47, CI: 1.47-4.15). Older age groups had lower odds of choosing "peer pressure" than the 15-24 year olds. Respondents with 11 or more years of education were more likely to report "stress/coping" than those with no education (OR: 2.82, CI: 1.06-7.48). Continuation-women were less likely than men to choose "relaxation", and "distance from family" as important continuation factors (OR: 0.50, CI:0.32-0.80; OR: 0.20, CI: 0.06-0.65). All age groups were less likely to choose "stimulation" as a factor than the youngest group. Conclusions: Along with confirming and expanding upon previous literature, the findings of this study should encourage further SLT research in women and younger age groups (15-24 and 24-44). They also confirm the need for SLT prevention and cessation interventions in India in other community-based settings, besides schools.