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Research Guide: Dr Ganesh Shenoy Panchmal Senior Professor & HOD

A STUDY AMONG 18-24 YEAR OLD STUDENTS IN COLLEGES OF MANGALURU TALUKA,SOUTH INDIA FOR TOBACCO SURVEILLANCE. Research Guide: Dr Ganesh Shenoy Panchmal Senior Professor & HOD Department of Public Health Dentistry Yenepoya Dental College. PhD Scholar:

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Research Guide: Dr Ganesh Shenoy Panchmal Senior Professor & HOD

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  2. Research Guide: Dr Ganesh Shenoy Panchmal Senior Professor & HOD Department of Public Health Dentistry Yenepoya Dental College PhD Scholar: Dr Praveen Jodalli Reader 088/July 2012 Department of Public Health Dentistry Yenepoya Dental College

  3. Action taken against previous review Title modified and finalized- Approval from BOS pending Data collection is under progress

  4. Introduction Tobacco use is a major preventable cause of premature death and disease worldwide. Just over five million people die each year due to tobacco illness- a figure expected to increase more than eight million a year by 2030. unless a current trend is changed, the vast majority of these deaths are projected to occur in the developing world. 

  5. Prevalence and practices of tobacco use in India are varied and disparate. Tobacco consumption continues to grow at 2-3% per annum, and by 2020 it is predicted that it will account for 13% of all deaths in the country. Young adults aged 18-24 years, many of whom are in college, represent the youngest legal targets for tobacco industry marketing.

  6. College is a prime time in students lives where they have the choice to start, quit, or continuing using tobacco. A social context has been shown to be an important factor in the initiation of smoking, as well as becoming an established smoker.

  7. Mangalore taluka in Dakshina Kannada is hub for educational centres in India; lack of knowledge on tobacco use, type of tobacco use is a clear barrier to tobacco cessation initiatives.

  8. Literature survey Jitender S, Sarika G, Sharma P, MishraP(2017). Bidismoking: an underestimated issue of Indian society. Relevance: Bidi smoking has always been an under-talked issue of Indian society. Bidis are rolled in tendu leaves which are non porous and have low combustibility due to which they affect the smoker's lungs even more. In spite of the increased toxicology associated with bidis, they are often ignored. The reason for this can be attributed to their home-made production, decreased taxation and the greater prevalence of bidis in rural areas. Since bidis are rolled and packed at home, packaging does not have any warnings about the harmful effects of bidi smoking. Many cases of smoking-associated cancer have been recorded in the country lately. This raises a concern about the economic balance of the nation, as to whether there is a revenue generation with tax on the sale of tobacco or if there is an economic loss due to the various diseases that result from bidi smoking.

  9. Araghi M et al (2017) Use of moist oral snuff (snus) and pancreatic cancer: Pooled analysis of nine prospective observational studies. Relevance: While smoking is a well-established risk factor for pancreatic cancer, the effect of smokeless tobacco is less well understood. We used pooled individual data from the Swedish Collaboration on Health Effects of Snus Use to assess the association between Swedish snus use and the risk of pancreatic cancer. A total of 424,152 male participants from nine cohort studies were followed up for risk of pancreatic cancer through linkage to health registers. We used shared frailty models with random effects at the study level, to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) adjusted for confounding factors. During 9,276,054 person-years of observation, 1,447 men developed pancreatic cancer. Compared to never-snus use, current snus use was not associated with risk of pancreatic cancer (HR 0.96, 95% CI 0.83-1.11) after adjustment for smoking. Swedish snus use does not appear to be implicated in the development of pancreatic cancer in men. Tobacco smoke constituents other than nicotine or its metabolites may account for the relationship between smoking and pancreatic cancer.

  10. Osazuwa- Peters N st al (2017) Characteristics and predictors of oral cancer knowledge in a predominantly African American community. Relevance: To characterize smoking and alcohol use, and to describe predictors of oral cancer knowledge among a predominantly African-American population. A cross-sectional study was conducted between September, 2013 among drag racers and fans in East St. Louis. Oral cancer knowledge was derived from combining questionnaire items to form knowledge score. Covariates examined included age, sex, race, marital status, education status, income level, insurance status, tobacco and alcohol use. Adjusted linear regression analysis measured predictors of oral cancer knowledge. Three hundred and four participants completed questionnaire; 72.7% were African Americans. Smoking rate was 26.7%, alcohol use was 58.3%, and mean knowledge score was 4.60 ± 2.52 out of 17. In final adjusted regression model, oral cancer knowledge was associated with race and education status. Compared with Caucasians, African Americans were 29% less likely to have high oral cancer knowledge (β = -0.71; 95% CI: -1.35, -0.07); and participants with a high school diploma or less were 124% less likely to have high oral cancer knowledge compared with college graduates (β = -1.24; 95% CI: -2.44, -0.41).There was lower oral cancer knowledge among African Americans and those with low education. The prevalence of smoking was also very high. Understanding predictors of oral cancer knowledge is important in future design of educational interventions specifically targeted towards high-risk group for oral cancer.

  11. Wang TH (2017) Association of Smoking, Alcohol Use, and Betel Quid Chewing with Epigenetic Aberrations in Cancers. Relevance: Numerous environmental factors such as diet, alcohol use, stress, and environmental chemicals are known to elicit epigenetic changes, leading to increased rates of cancers and other diseases. The incidence of head and neck cancer, one of the most common cancers in Taiwanese males, is increasing: oral cancer and nasopharyngeal carcinoma are ranked fourth and tenth respectively, among the top ten cancers in this group, and a major cause of cancer-related deaths in Taiwanese males. Previous studies have identified smoking, alcohol use, and betel quid chewing as the three major causes of head and neck cancers; these three social habits are commonly observed in Taiwanese males, resulting in an increasing morbidity rate of head and neck cancers in this population. In this literature review, we discuss the association between specific components of betel quid, alcohol, and tobacco, and the occurrence of head and neck cancers, lung cancer, gastrointestinal cancers, and urethral cancer. We focus on regulatory mechanisms at the epigenetic level and their oncogenic effects. The review further discusses the application of FDA-approved epigenetic drugs as therapeutic strategies against cancer.

  12. Present status :International, national and local scenarios International : There are 1.1 billion tobacco users in the world. This number is expected to increase to 1.6 billion over the next two decades. Fourteen countries (Bangladesh, Brazil, China, Egypt, India, Mexico, Philippines, Poland, Russian Federation, Thailand, Turkey, Ukraine, Uruguay and Viet Nam) completed GATS during 2008-2010. Eight countries (Argentina, Indonesia, Malaysia, Nigeria, Pakistan, Panama, Romania and South Africa) planned to implement GATS in 2011.

  13. National : According to Indian fact sheets 2009-2010 Current Tobacco use in any form : 34.6% adults ; 47.9% males and 20.3% females. Current smokers: 14% adults; 24.3% males and2.9% females. Current smokeless tobacco users: 25.9% adults; 32.9% males and 18.4% females.

  14. CURRENT TOBACCO-USE IN INDIA In India, the use of tobacco shows a clear and continual increase with the decreasing wealth quintiles among both men and women . Seven in 10 men in the lowest wealth quintile consume tobacco products while four in 10 men in the highest wealth quintile do so. Twenty-two percent of women in the lowest wealth quintile consume tobacco. There is an equally clear and continual increase in tobacco-use with decreasing levels of education. Women and men from the scheduled castes and scheduled tribes (the poorest among poor in India) are more likely to use tobacco than those from other castes or tribes . India is now demonstrating a steely resolve to contain the menace of tobacco through a comprehensive control strategy that combines several demand and supply reduction measures. 

  15. Social relevance of the study Tobacco results in damage to the personal health, social costs like reduced productivity and health care burden, environmental damage and poverty to the family. Tobacco use by the young adults may be considerably higher than has been detected by previous analyses limited to cigarettes. Little is known about the full spectrum of tobacco use among the college population or about risk factors for the use of different tobacco product. This information is essential to guide the development of interventions. The purpose of this research is to provide a comprehensive overview of this tobacco problem among college students. This research enhances the role of government and the non governmental sector in surveillance, monitoring of tobacco use and key tobacco control indicators, and policy and program.

  16. Aim To assess the tobacco use among 18-24 year old college students in Mangalore taluka, Dakshina Kannada

  17. Objectives • To assess the tobacco use, exposure to second hand smoke, and quit attempts • To measure the key aspects of tobacco surveillance • To assess indirectly the impact of tobacco control and prevention initiatives • To evaluate comprehensive tobacco control policies • To determine the prevalence of various potentially malignant disorders (oral premalignant lesions and conditions). • To develop an implementable design for tobacco control program.

  18. Methodology Overview: • The study is designed to produce the estimate among college students across Mangalore taluka. • The target population will include 18-24 year old male and female college students Target population and study eligibility: • The study includes all eligible 18-24 year college students. • Individuals who are native of DakshinaKanadaTaluka. • The study design excludes institutionalized population.

  19. Sample size and expected precision: The study is designed to produce the estimate by urban/rural classification, by gender and by the cross of gender and urbanicity with a confidential interval of 95%, margin of error 3% for a tobacco use rate of 40% and assuming a design effect of 2 %. N = Z21 – α/2 p(1-p) * δ d2 where p= expected proportion = 0.4 d= absolute precision=3 δ=design effect=2 α=significance level=95% z=1.96 n= 2049 which will be rounded to 2060 (for convenience) .

  20. Data collection procedure: The tobacco questions for this study used will be a validated, recommended subset of key GATS (Global Adult Tobacco survey) question. A face to face interview method will be used for data collection which will be followed by oral screening for any precancerous lesions or condition. Statistical methods to be used for data analysis: The data analysis was performed using the Statistical Package for Social Studies version 21.0 (SPSS Inc., IBM 2012, USA).

  21. Basic study design: The sampling will be carried out in 3 stages: Stage I: primary sampling units • Information regarding total number of colleges in Mangalore taluka is collected (n=148) • Among the colleges by using a proportionality sampling( 20% proportion) randomly 30 colleges will be selected ( N= 148X20 = 29.6) 100 • N= 30

  22. Stage II: selection of secondary sampling units (study subjects) • Information regarding total strength of each sampling unit will be collected (N). • formula= a X b N Where a= study subjects from the college b= constant = 2060 N= constant= Total strength of the selected colleges. Example : 600X2060 = 69 subjects per college 18000

  23. Stage III: selection of study population: • Both male and female college students of age 18-24 years will be selected using a simple random sampling technique. • Data Collection Progress: Colleges completed : 13 Study participants : 1070

  24. Proposed work for the study duration

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  36. Thank You

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