This document provides an overview of tobacco use and counseling in India. It discusses the various types of tobacco used in India including smoked forms like beedis, cigarettes, and hookah as well as smokeless forms like khaini, gutkha, paan, and mishri. It outlines the constituents of tobacco that are linked to health risks like cancer. It also discusses the prevalence of tobacco use in India, the health effects of tobacco, and methods for quitting tobacco and providing counseling to patients.
This document discusses the dangers of tobacco use and provides information about World No Tobacco Day on May 31st. It notes that tobacco is the single largest preventable cause of death and disability globally. The document then provides details on the history and spread of tobacco use, the various forms of smoking and smokeless tobacco products consumed in India, health effects of tobacco including increased cancer and heart disease risks, and statistics on tobacco use and related deaths in India.
This document summarizes a seminar presentation on tobacco cessation. It discusses the large number of tobacco users in India and the health impacts of tobacco use. It outlines regulatory, service-based, and educational approaches to tobacco control and the role of dentists in counseling patients. The 5 A's model for tobacco cessation counseling is described. Nicotine replacement therapies and other pharmacological aids are discussed. The presentation emphasizes the importance of dentists' involvement in tobacco control through counseling, advocacy, and community education efforts.
1) Tobacco use is responsible for a significant number of cancers, especially in India which has high rates of oral cancer. Tobacco-related cancers account for half of all cancers in men and a quarter in women.
2) Smokeless tobacco products like gutkha, khaini and paan are commonly used in India and absorb nicotine into the bloodstream when placed in the mouth. These products increase the risk of conditions like oral submucous fibrosis and various cancers.
3) Precancerous lesions in the mouth include leukoplakia and erythroplakia, which have the potential to develop into cancers if caused by tobacco or alcohol use. Oral cancer prevention requires regulatory,
This document provides an overview of a tobacco cessation programme, including:
- Details on tobacco production, consumption, and the Global Adult Tobacco Survey.
- Scales to measure nicotine dependence like the Fagerstrom test.
- Models of behavior change like the Transtheoretical Model.
- Approaches to cessation like nicotine replacement therapy, pharmacotherapy, and behavioral counseling.
- Studies showing the success of tobacco cessation programs in India, including higher success rates for programs involving hospitals, counseling, and certain drug combinations.
- Barriers to cessation like a lack of trained health professionals and knowledge about tobacco's harms.
This document provides an overview of smoking cessation. It begins with an introduction discussing the negative health impacts of smoking and statistics on smoking rates. It then covers the chemical components in cigarettes and negative effects of smoking on various parts of the body. Benefits of smoking cessation are outlined. The document also summarizes several research studies on smoking cessation methods and their effectiveness, including enhanced motivational interviewing versus brief advice, nicotine replacement therapy, and a randomized trial of nicotine replacement therapy patches in pregnancy. Barriers to smoking cessation and electronic cigarettes are also discussed.
This document provides information on brief tobacco cessation counseling. It discusses the three-link chain of tobacco dependence, including biological, psychological, and socio-cultural factors. It describes the five stages of change in the transtheoretical model: precontemplation, contemplation, preparation, action, and maintenance. The 5 A's approach to brief counseling is explained as Ask, Advise, Assess, Assist, and Arrange. Under each step, techniques for counseling patients on quitting tobacco are outlined, including setting a quit date, developing a quit plan, and providing resources and support.
This document discusses methods of tobacco cessation. It begins with an introduction to tobacco use as the leading preventable cause of death globally. It then covers the history of tobacco, forms of tobacco used in India, and the health effects of tobacco use. Barriers to cessation like nicotine addiction and lack of support are examined. The document outlines goals of cessation programs like long term abstinence. It discusses behavioral management, pharmacotherapies, and counseling approaches. India's tobacco control laws aiming to restrict advertising and smoking in public are also summarized.
Noble Dental Care is a family oriented Tempe AZ dentist office with staff and doctors that truly care about you and your health. Give us the opportunity to give you the smile of your dreams. Call us for an appointment at (480) 820-3515. Visit site: http://nobledentalcare.com
This document discusses the dangers of tobacco use and provides information about World No Tobacco Day on May 31st. It notes that tobacco is the single largest preventable cause of death and disability globally. The document then provides details on the history and spread of tobacco use, the various forms of smoking and smokeless tobacco products consumed in India, health effects of tobacco including increased cancer and heart disease risks, and statistics on tobacco use and related deaths in India.
This document summarizes a seminar presentation on tobacco cessation. It discusses the large number of tobacco users in India and the health impacts of tobacco use. It outlines regulatory, service-based, and educational approaches to tobacco control and the role of dentists in counseling patients. The 5 A's model for tobacco cessation counseling is described. Nicotine replacement therapies and other pharmacological aids are discussed. The presentation emphasizes the importance of dentists' involvement in tobacco control through counseling, advocacy, and community education efforts.
1) Tobacco use is responsible for a significant number of cancers, especially in India which has high rates of oral cancer. Tobacco-related cancers account for half of all cancers in men and a quarter in women.
2) Smokeless tobacco products like gutkha, khaini and paan are commonly used in India and absorb nicotine into the bloodstream when placed in the mouth. These products increase the risk of conditions like oral submucous fibrosis and various cancers.
3) Precancerous lesions in the mouth include leukoplakia and erythroplakia, which have the potential to develop into cancers if caused by tobacco or alcohol use. Oral cancer prevention requires regulatory,
This document provides an overview of a tobacco cessation programme, including:
- Details on tobacco production, consumption, and the Global Adult Tobacco Survey.
- Scales to measure nicotine dependence like the Fagerstrom test.
- Models of behavior change like the Transtheoretical Model.
- Approaches to cessation like nicotine replacement therapy, pharmacotherapy, and behavioral counseling.
- Studies showing the success of tobacco cessation programs in India, including higher success rates for programs involving hospitals, counseling, and certain drug combinations.
- Barriers to cessation like a lack of trained health professionals and knowledge about tobacco's harms.
This document provides an overview of smoking cessation. It begins with an introduction discussing the negative health impacts of smoking and statistics on smoking rates. It then covers the chemical components in cigarettes and negative effects of smoking on various parts of the body. Benefits of smoking cessation are outlined. The document also summarizes several research studies on smoking cessation methods and their effectiveness, including enhanced motivational interviewing versus brief advice, nicotine replacement therapy, and a randomized trial of nicotine replacement therapy patches in pregnancy. Barriers to smoking cessation and electronic cigarettes are also discussed.
This document provides information on brief tobacco cessation counseling. It discusses the three-link chain of tobacco dependence, including biological, psychological, and socio-cultural factors. It describes the five stages of change in the transtheoretical model: precontemplation, contemplation, preparation, action, and maintenance. The 5 A's approach to brief counseling is explained as Ask, Advise, Assess, Assist, and Arrange. Under each step, techniques for counseling patients on quitting tobacco are outlined, including setting a quit date, developing a quit plan, and providing resources and support.
This document discusses methods of tobacco cessation. It begins with an introduction to tobacco use as the leading preventable cause of death globally. It then covers the history of tobacco, forms of tobacco used in India, and the health effects of tobacco use. Barriers to cessation like nicotine addiction and lack of support are examined. The document outlines goals of cessation programs like long term abstinence. It discusses behavioral management, pharmacotherapies, and counseling approaches. India's tobacco control laws aiming to restrict advertising and smoking in public are also summarized.
Noble Dental Care is a family oriented Tempe AZ dentist office with staff and doctors that truly care about you and your health. Give us the opportunity to give you the smile of your dreams. Call us for an appointment at (480) 820-3515. Visit site: http://nobledentalcare.com
The Chandler dentists at Shumway Dental Care will make sure you have a healthy mouth and a beautiful smile. Whether you need cosmetic dentistry, bridges or crowns, or just a checkup, their staff will make sure your visit is comfortable. Visit http://www.shumwaydental.com/
3150 S Gilbert Rd Suite 1
Chandler, AZ 85286
(480) 659-7800
This document discusses the harmful effects of tobacco use on oral health. It notes that tobacco use is responsible for many diseases and deaths worldwide each year. Tobacco increases the risk of various oral health issues like periodontal disease, oral cancer, and tooth loss. Quitting tobacco is important to reducing these health risks and preventing tobacco-related diseases.
The document discusses the tobacco industry in India and argues that smokeless tobacco products like jarda and khaini are being unfairly targeted, while the more harmful smoking industry is being favored. It notes that smokeless tobacco provides livelihood to millions but policies are focusing on prevalence rather than relative harm. The document contends that smokeless tobacco is much less harmful than smoking and passive smoking, and banning smokeless tobacco could significantly increase deaths by pushing users to take up smoking instead. It questions the evidence used to demonize smokeless tobacco and argues current regulations and warnings are imbalanced and not scientifically justified.
The document discusses protecting youth from tobacco and nicotine use. It notes that the theme for World No Tobacco Day 2020 is protecting youth from industry manipulation and preventing tobacco and nicotine use. It states that for decades the tobacco industry has deliberately employed strategic tactics to attract youth to tobacco products. The global campaign aims to expose these devious tactics and empower youth to stand up against the tobacco industry. It lists some of the tactics used by the tobacco industry to market to children and adolescents, such as flavored products, social media influencers, and product placement. The document urges action to ensure a new generation is not deceived by the tobacco industry's lies and calls for empowering youth to refuse tobacco products.
The document discusses the harmful effects of tobacco use on health. It notes that tobacco kills over 16,000 people in Bangladesh every year. It also reports that over 17 million children and adults in Bangladesh use tobacco daily. The document then outlines the various diseases and health risks caused by smoking, including various cancers, heart disease, stroke, lung disease, and more. It discusses the benefits of quitting smoking and describes methods and resources to help people quit.
The document summarizes tobacco cessation legislation in India. It provides background on the history of tobacco use in India, current prevalence rates, and health impacts of tobacco. It then outlines key events in India's tobacco control efforts, including various acts passed between 1975-2003 to regulate tobacco advertising, sales, and use. The summary highlights challenges in implementing these laws and the need for continued education strategies to curb tobacco consumption.
Smile Care is a chain of dental clinics providing high quality dental care, dental treatment and dental services by specialised health care professionals in Bandra, Kolhapur, Nashik, Vashi, Mumbai, India. http://www.smilecareworld.com
Brief Counseling for tobacco use Cessation Ashraf ElAdawy
The document discusses smoking cessation interventions and counseling. It covers:
- Smoking cessation is one of the most cost-effective medical interventions.
- There are different levels of smoking cessation interventions from minimal to intensive counseling and treatment.
- The 5 A's model is presented as an effective brief intervention approach which includes Ask, Advise, Assess, Assist, and Arrange.
- Stages of change are discussed from precontemplation to maintenance to explain how readiness to quit smoking changes over time. Relapse is also part of the process for many smokers.
Nicotine replacement therapies (NRT) such as gum, patches, lozenges, inhalers, and sprays provide nicotine to help people quit smoking without the harmful chemicals in cigarettes. They are available in varying doses by prescription or over-the-counter to address different levels of nicotine addiction. While NRTs are more effective for quitting than going cold turkey, some people prefer alternative cessation medications like Zyban or Champix that do not contain nicotine but help curb cravings and withdrawal symptoms. Recent studies show that stop smoking programs combined with NRT can quadruple success rates for quitting permanently.
This document discusses smoking cessation and tobacco use. It begins with a brief history of tobacco use and cultivation. It then covers nicotine addiction including the mechanisms of action of nicotine in the brain and body. Withdrawal symptoms and reasons for smoking are explored. The 5 A's model of smoking cessation counseling is described involving asking about smoking history, advising smokers to quit, assessing readiness, assisting with a plan, and arranging follow up. Non-pharmacological and pharmacological cessation methods are summarized.
This document provides information on tobacco dependence treatment. It begins with objectives and an introduction noting the global impact of tobacco use. It then describes various types of tobacco products and their significant health side effects. Signs and symptoms of nicotine dependence are outlined using the Fagerstrom Test. The benefits of quitting and roles of medical staff in treatment are discussed. Treatment methods covered include counseling, nicotine replacement therapy, medications, and support groups. Nicotine withdrawal symptoms and specifics of nicotine patches, gum, and other replacement products are also summarized.
This document provides information on a presentation about tobacco. Some key points:
- Smoking remains a leading cause of preventable illness and death in Canada. Saskatchewan has high smoking rates, especially among youth.
- Secondhand and thirdhand smoke harm others exposed to tobacco smoke. Quitting tobacco can be challenging due to nicotine addiction and behavioral factors.
- Healthcare providers should use the 5 A's approach (Ask, Advise, Assess, Assist, Arrange) to counsel patients on quitting smoking. This involves discussing reasons to quit, barriers to quitting, and treatment options like nicotine replacement therapy.
- While some providers may hesitate to counsel patients due to their own smoking status,
Tobacco is a plant grown for its leaves, which are dried, fermented, and used in various smoked and smokeless tobacco products. Tobacco contains nicotine, an addictive substance. People use tobacco by smoking cigarettes, cigars, pipes, hookahs, or bidis, or by chewing or sniffing smokeless tobacco products. Tobacco smoking causes over 3 million premature deaths per year worldwide. While smoking shortens life and increases health risks, quitting smoking allows the body to begin recovering and reduces risks over time, with cancer risk reduced after 10 years and heart disease risk of a nonsmoker after 15 years without smoking.
This document discusses the epidemiology of oral cancer. It begins by introducing oral cancer as a major public health threat worldwide. India has a high prevalence of oral cancer, particularly among males. Common risk factors include tobacco, alcohol, and HPV/EBV infections. The document then examines tobacco products and consumption patterns in India. It also covers clinical features of oral cancer and precancerous lesions. Global initiatives for oral cancer prevention focus on tobacco control policies, education programs, and early detection services.
The document discusses the health effects of tobacco use and provides advice for quitting smoking. It notes that tobacco use is a leading cause of death globally and is linked to various cancers and respiratory and heart diseases. It then gives tips for creating a quit plan, dealing with withdrawal symptoms, using cessation products, and seeking professional help if needed. The overall document provides information on the dangers of tobacco and guidance for developing a strategy to quit smoking successfully.
5 A’s of smoking cessation guidelines, Nicotine replacement therapy (NRT), Bupropion, Varenicline, Tips to quit smoking and Complementary Health Approaches for Smoking Cessation are discussed in this presentation.
This is a short presentation to tell about word no tobacco day. this presentation also tells tobacco and its harmful effects, status in india, government act for its use, sale and distribution
Tobacco contains the highly addictive drug nicotine and can be consumed through smoking, chewing, dipping, or sniffing in products like cigarettes, gutkha, and snuff. Smoking cigarettes exposes a person to over 4000 toxic chemicals and 60 carcinogens and significantly increases the risks of various cancers, heart disease, lung disease, and other health issues. Tobacco use is directly linked to many forms of cancer as well as other serious diseases.
The Chandler dentists at Shumway Dental Care will make sure you have a healthy mouth and a beautiful smile. Whether you need cosmetic dentistry, bridges or crowns, or just a checkup, their staff will make sure your visit is comfortable. Visit http://www.shumwaydental.com/
3150 S Gilbert Rd Suite 1
Chandler, AZ 85286
(480) 659-7800
This document discusses the harmful effects of tobacco use on oral health. It notes that tobacco use is responsible for many diseases and deaths worldwide each year. Tobacco increases the risk of various oral health issues like periodontal disease, oral cancer, and tooth loss. Quitting tobacco is important to reducing these health risks and preventing tobacco-related diseases.
The document discusses the tobacco industry in India and argues that smokeless tobacco products like jarda and khaini are being unfairly targeted, while the more harmful smoking industry is being favored. It notes that smokeless tobacco provides livelihood to millions but policies are focusing on prevalence rather than relative harm. The document contends that smokeless tobacco is much less harmful than smoking and passive smoking, and banning smokeless tobacco could significantly increase deaths by pushing users to take up smoking instead. It questions the evidence used to demonize smokeless tobacco and argues current regulations and warnings are imbalanced and not scientifically justified.
The document discusses protecting youth from tobacco and nicotine use. It notes that the theme for World No Tobacco Day 2020 is protecting youth from industry manipulation and preventing tobacco and nicotine use. It states that for decades the tobacco industry has deliberately employed strategic tactics to attract youth to tobacco products. The global campaign aims to expose these devious tactics and empower youth to stand up against the tobacco industry. It lists some of the tactics used by the tobacco industry to market to children and adolescents, such as flavored products, social media influencers, and product placement. The document urges action to ensure a new generation is not deceived by the tobacco industry's lies and calls for empowering youth to refuse tobacco products.
The document discusses the harmful effects of tobacco use on health. It notes that tobacco kills over 16,000 people in Bangladesh every year. It also reports that over 17 million children and adults in Bangladesh use tobacco daily. The document then outlines the various diseases and health risks caused by smoking, including various cancers, heart disease, stroke, lung disease, and more. It discusses the benefits of quitting smoking and describes methods and resources to help people quit.
The document summarizes tobacco cessation legislation in India. It provides background on the history of tobacco use in India, current prevalence rates, and health impacts of tobacco. It then outlines key events in India's tobacco control efforts, including various acts passed between 1975-2003 to regulate tobacco advertising, sales, and use. The summary highlights challenges in implementing these laws and the need for continued education strategies to curb tobacco consumption.
Smile Care is a chain of dental clinics providing high quality dental care, dental treatment and dental services by specialised health care professionals in Bandra, Kolhapur, Nashik, Vashi, Mumbai, India. http://www.smilecareworld.com
Brief Counseling for tobacco use Cessation Ashraf ElAdawy
The document discusses smoking cessation interventions and counseling. It covers:
- Smoking cessation is one of the most cost-effective medical interventions.
- There are different levels of smoking cessation interventions from minimal to intensive counseling and treatment.
- The 5 A's model is presented as an effective brief intervention approach which includes Ask, Advise, Assess, Assist, and Arrange.
- Stages of change are discussed from precontemplation to maintenance to explain how readiness to quit smoking changes over time. Relapse is also part of the process for many smokers.
Nicotine replacement therapies (NRT) such as gum, patches, lozenges, inhalers, and sprays provide nicotine to help people quit smoking without the harmful chemicals in cigarettes. They are available in varying doses by prescription or over-the-counter to address different levels of nicotine addiction. While NRTs are more effective for quitting than going cold turkey, some people prefer alternative cessation medications like Zyban or Champix that do not contain nicotine but help curb cravings and withdrawal symptoms. Recent studies show that stop smoking programs combined with NRT can quadruple success rates for quitting permanently.
This document discusses smoking cessation and tobacco use. It begins with a brief history of tobacco use and cultivation. It then covers nicotine addiction including the mechanisms of action of nicotine in the brain and body. Withdrawal symptoms and reasons for smoking are explored. The 5 A's model of smoking cessation counseling is described involving asking about smoking history, advising smokers to quit, assessing readiness, assisting with a plan, and arranging follow up. Non-pharmacological and pharmacological cessation methods are summarized.
This document provides information on tobacco dependence treatment. It begins with objectives and an introduction noting the global impact of tobacco use. It then describes various types of tobacco products and their significant health side effects. Signs and symptoms of nicotine dependence are outlined using the Fagerstrom Test. The benefits of quitting and roles of medical staff in treatment are discussed. Treatment methods covered include counseling, nicotine replacement therapy, medications, and support groups. Nicotine withdrawal symptoms and specifics of nicotine patches, gum, and other replacement products are also summarized.
This document provides information on a presentation about tobacco. Some key points:
- Smoking remains a leading cause of preventable illness and death in Canada. Saskatchewan has high smoking rates, especially among youth.
- Secondhand and thirdhand smoke harm others exposed to tobacco smoke. Quitting tobacco can be challenging due to nicotine addiction and behavioral factors.
- Healthcare providers should use the 5 A's approach (Ask, Advise, Assess, Assist, Arrange) to counsel patients on quitting smoking. This involves discussing reasons to quit, barriers to quitting, and treatment options like nicotine replacement therapy.
- While some providers may hesitate to counsel patients due to their own smoking status,
Tobacco is a plant grown for its leaves, which are dried, fermented, and used in various smoked and smokeless tobacco products. Tobacco contains nicotine, an addictive substance. People use tobacco by smoking cigarettes, cigars, pipes, hookahs, or bidis, or by chewing or sniffing smokeless tobacco products. Tobacco smoking causes over 3 million premature deaths per year worldwide. While smoking shortens life and increases health risks, quitting smoking allows the body to begin recovering and reduces risks over time, with cancer risk reduced after 10 years and heart disease risk of a nonsmoker after 15 years without smoking.
This document discusses the epidemiology of oral cancer. It begins by introducing oral cancer as a major public health threat worldwide. India has a high prevalence of oral cancer, particularly among males. Common risk factors include tobacco, alcohol, and HPV/EBV infections. The document then examines tobacco products and consumption patterns in India. It also covers clinical features of oral cancer and precancerous lesions. Global initiatives for oral cancer prevention focus on tobacco control policies, education programs, and early detection services.
The document discusses the health effects of tobacco use and provides advice for quitting smoking. It notes that tobacco use is a leading cause of death globally and is linked to various cancers and respiratory and heart diseases. It then gives tips for creating a quit plan, dealing with withdrawal symptoms, using cessation products, and seeking professional help if needed. The overall document provides information on the dangers of tobacco and guidance for developing a strategy to quit smoking successfully.
5 A’s of smoking cessation guidelines, Nicotine replacement therapy (NRT), Bupropion, Varenicline, Tips to quit smoking and Complementary Health Approaches for Smoking Cessation are discussed in this presentation.
This is a short presentation to tell about word no tobacco day. this presentation also tells tobacco and its harmful effects, status in india, government act for its use, sale and distribution
Tobacco contains the highly addictive drug nicotine and can be consumed through smoking, chewing, dipping, or sniffing in products like cigarettes, gutkha, and snuff. Smoking cigarettes exposes a person to over 4000 toxic chemicals and 60 carcinogens and significantly increases the risks of various cancers, heart disease, lung disease, and other health issues. Tobacco use is directly linked to many forms of cancer as well as other serious diseases.
Occupational hazards are common in the field of dentistry. Dentists face a variety of biological, physical, ergonomic, and psychological hazards. Biological hazards, like exposure to Hepatitis B and HIV, pose serious risks due to the potential for transmission through needle sticks or contact with blood and saliva. Dentists have a higher risk of contracting certain infections compared to the general population. Other common occupational hazards for dentists include musculoskeletal problems, noise exposure, radiation exposure, allergic reactions, and job-related stress. Proper training, immunization, and safety precautions are needed to help protect dental workers from the various occupational health risks they may encounter.
Infamattion in dentistry (dept of public health dentistry )NPDCH VISNAGAR
1. The document discusses inflammation and its chemical mediators. It defines inflammation and outlines its classification into acute and chronic types.
2. Acute inflammation is described in detail, including its vascular and cellular events like increased permeability and leukocyte migration.
3. The document then covers the various chemical mediators involved in inflammation, such as histamine, prostaglandins, cytokines, and complement proteins.
4. Chronic inflammation is introduced as prolonged inflammation where tissue damage and repair occur simultaneously. Its causes and features are briefly outlined.
This document discusses the relationship between social sciences and dentistry. It defines key terms from various social sciences like sociology, cultural anthropology, social psychology, economics, and political science. It explains how social environment, health behaviors, lifestyle, social norms, and culture can directly and indirectly impact individual and community health. The document also analyzes how social scientists can help design dental public health programs that are tailored to different social classes and address barriers to care like traditions, attitudes towards healthcare providers, and expectations of treatment.
The document discusses bio-medical waste management. It defines bio-medical waste and classifies it according to the WHO into 10 categories such as human anatomical waste, animal waste, microbiology waste, and sharps. It describes the sources, generation, segregation, storage, transportation, treatment techniques and disposal methods for different categories of waste. Treatment includes incineration, deep burial, autoclaving, chemical treatment, and disposal in secured landfills. The goal is to properly manage waste to prevent contamination and infection.
Classification of Partially Edentulous ArchesKanika Manral
This document summarizes several classification systems for partially edentulous arches. It begins with an introduction and the need for classification. It then describes classification systems based on major connector material and various topographic classification systems proposed between 1920-1999. These include Cummer's (1920), Kennedy's (1925), Kennedy & Applegate (1960), Bailyn's (1928), Neurohr's (1939), Mauk's (1942), Wild's (1949), Godfrey's (1951), Beckett's (1953), Friedman (1953), Craddock's (1954), Austin & Lidge's (1957), Watt's (1957), Skinner's (1957), Avant's (1960), and others
This document discusses dental prevention. It defines prevention and describes its history from the 20th century onward, including the identification of oral diseases and establishment of fluoride's anticaries effects. The principles of prevention are described as primary, secondary, and tertiary. Types of prevention interventions are outlined for dental caries, periodontal disease, oral cancer, and malocclusion. The conclusion emphasizes that combined efforts of dental professionals, patients, and communities can achieve optimal oral health through prevention practices and community health programs.
This document provides an overview of economic evaluation in healthcare. It defines economic evaluation as the comparative analysis of costs and consequences of alternative healthcare interventions. The main types of economic evaluation are described as cost-minimization analysis, cost-effectiveness analysis, cost-utility analysis, and cost-benefit analysis. Examples of economic evaluations in dentistry are also provided. The document discusses the history of economic evaluation and its importance in informing healthcare resource allocation decisions.
This document provides an overview and summary of various dental indices used to measure oral health conditions. It defines key indices like DMFT/DMFS for dental caries, deft for primary dentition, RCI for root caries, and OHI for oral hygiene. Properties of an ideal index and purposes/uses of indices are outlined. The document also discusses indices like Sic, SCI, and Nyvad's criteria which provide additional information beyond traditional indices. Limitations of various indices are noted.
Health complications of various forms of tobacco such as Chewing tobacco, Snuff, Creamy snuff, Dipping tobacco, Gutka, Snus, Cigarette, Cigar, Bidi, Kretek and Hookah are discussed in this presentation.
This document discusses socio-cultural barriers to oral health. It begins by defining key terms like social environment, society, culture, and the five social sciences. It then classifies barriers according to different frameworks like the FDI, US Academy of General Dentistry, and an Indian study. Reasons for changing global oral disease patterns are outlined. The Indian scenario shows disparities in oral healthcare access between rural and urban areas. Social factors like socioeconomic status, education, age, gender, and culture influence oral health behaviors and disease patterns. Strategies are needed to break down socio-cultural barriers to improve oral health.
This document discusses India's need for a national oral health policy. It provides background on oral health issues in India, including high prevalence of dental caries and periodontal diseases. It outlines India's 10-point resolution for an oral health policy from 1995, which proposed establishing oral health programs, education, research, and workforce development. While India has made some efforts to improve oral healthcare through programs like the National Oral Health Care Program, a comprehensive national oral health policy is still needed to better address oral health issues, access to care, education, and workforce issues in India.
School dental health programs aim to improve children's oral health through education, prevention, and treatment services directly in schools. The key aspects of such programs include conducting dental inspections and health education, providing preventive interventions like fluoride varnish and sealants, and making referrals for treatment when needed. Evaluations show such programs can reduce dental caries by 20-30% through approaches like water fluoridation, fluoride tablets, and toothbrushing programs in schools. The community benefits from improving children's oral health as it helps establish healthy habits that can last a lifetime.
The document discusses the field of public health dentistry. It provides definitions of key terms like public health and dental public health. It describes the historical development of public health and changing concepts in public health from disease control to health promotion to social engineering to health for all. It outlines tools used in dental public health like epidemiology and biostatistics. It discusses characteristics of ideal public health measures and services provided through public health dentistry.
This document summarizes the effects of smoking on periodontium. It discusses how smoking leads to an increased prevalence and severity of periodontal diseases by altering the subgingival biofilm and impairing the host response. Smoking is associated with higher counts of pathogenic bacteria like Tannerella forsythia and increased colonization of sites with shallow pockets. It also negatively impacts the response to periodontal therapy and outcomes are better in smokers who quit. The document provides information on various tobacco products, definitions of smoking status, and smoking rates globally and in India.
This document summarizes the harmful effects of tobacco use and strategies for tobacco cessation. It notes that tobacco kills over 5 million people annually worldwide, with over 80% of deaths occurring in developing countries. In India, tobacco use causes about 700,000 deaths per year. The document outlines the various forms of tobacco use and their health impacts, including cancer, heart and lung diseases, reproductive issues, and passive smoking effects. It discusses the global and Indian burden of tobacco and provides an overview of tobacco cessation methods like the 5 A's and 5 R's approaches.
1. The document discusses smoking habits in India, including the types of tobacco smoked as well as health risks. It provides statistics on smoking prevalence and related deaths in India.
2. Smoking is responsible for several diseases and premature death in India, killing over 900,000 people per year according to one study. Certain forms of smoking like bidis are associated with greater health risks than others.
3. The study found high smoking rates among Indian men, with over 60% of male smokers expected to die between ages 30-69, compared to 41% of non-smoking men. Female smoking rates were also linked to over 60% mortality for smokers versus 38% for non-smokers between ages 30-
Tobacco use, legislation and health implications2.pptxOpeyemi Muyiwa
This document provides an overview of tobacco use in Nigeria, including legislation and health implications. It discusses the epidemiology of tobacco use in Nigeria, including regional smoking prevalence rates. Tobacco legislation in Nigeria, including the 1990 Tobacco Decree and 2015 Tobacco Control Act, is outlined. Challenges to enforcing tobacco control regulations in Nigeria are also summarized.
This document discusses tobacco use among adolescents in India. It begins by outlining the various tobacco products used in India and the extent of adolescent tobacco use. It then examines the psychosocial factors that lead adolescents to initiate tobacco use, such as family and peer influence. The document concludes by recommending preventive strategies like education programs, restricting tobacco advertising, and community development initiatives to curb adolescent tobacco use in India.
The document discusses the history and health effects of tobacco use. It notes that tobacco use is the leading preventable cause of death and thousands of kids start smoking daily. Different tobacco products like cigars, water pipes, chewing tobacco are described along with their health risks. Secondhand smoke is highlighted as responsible for 600,000 non-smoker deaths annually. Effective policies to prevent youth tobacco use include increasing prices, restricting marketing and banning public smoking. The conclusion emphasizes the need to prevent youth use and help current users quit to end the tobacco epidemic.
The document discusses World No Tobacco Day, which is observed annually on May 31st to discourage tobacco use and its health hazards. It aims to help users refrain from tobacco for 24 hours. The summary highlights the negative health impacts of tobacco, including that it kills over 800,000 people yearly in India from diseases like cancer. It also notes that tobacco consumption disproportionately affects the poor and that increased taxes could generate billions for public health programs while reducing use.
Spread & Ill effects of Smoking: A statistical & Infographical approachDhiraj Jhunjhunwala
1) The document is a research paper on the spread and ill-effects of smoking with a statistical and infographic approach. It includes an introduction, methodology, findings with statistics and graphs, data analysis, and conclusion.
2) The findings section shows statistics on men vs women smokers in India, world smoking statistics, graphs on smoking rates by age and cancer risk by cigarettes smoked. India has over 12 million female smokers, the highest of any country.
3) The data analysis notes the increased cancer risk with higher smoking consumption. India ranks 2nd in the world for smoking rates. Smoking causes the highest economic losses globally compared to terrorism.
World No Tobacco Day is observed annually on May 31st to raise awareness of the threats posed by tobacco consumption and the tobacco industry. The 2017 theme is "Tobacco - a threat to development" which will demonstrate how tobacco undermines public health and economic development. Tobacco is consumed in various forms in India like cigarettes, bidis, gutkha and paan masala. It poses severe health risks like cancer, heart disease, and lung disease and results in premature death. The tobacco industry targets youth and uses misleading marketing techniques to lure new users. Governments and the public must confront the tobacco epidemic through bans on advertising and health education campaigns to save lives and support national development.
Tobacco use is associated with many harmful oral health effects. It is a major risk factor for oral cancer, with smokeless tobacco increasing risk by 2-4 times and smoking further increasing risk, especially when combined with alcohol. Tobacco-related oral cancers most often occur on the tongue, floor of mouth, and lips. Quitting tobacco use reduces the risk of oral cancer within 5-10 years. Tobacco is also linked to periodontal disease and precancerous oral lesions. Dentists are well-positioned to educate patients about tobacco's oral health risks and support cessation efforts.
Effects of smoking in the public places: a proposal for safe smoking placespaperpublications3
Abstract: This is basically exploratory study and was conducted at Nilkhet, Dhaka city, Dhaka, Bangladesh over a period of two months started from October, 2010 to November, 2010. The main objective of this study is to know the effects of smoking in the public places and propose safe place for smoking. Total 30 respondents were selected based on age class (10 respondents below 30 years, 10 respondents between 30 to 40 years and rest 10 respondents were over 40 years of age). All respondents were interviewed with semi structure questionnaire. Smoking in the public places caused serious problems for second hand smokers including lung cancer, respiratory disorders, coronary heart diseases, bronchitis pneumonia. Lots of effects were mentioned by the respondents. Even it is not well accepted to smoke in the public places. 100% respondents were mentioned that Lung cancer and bronchitis may occur for the second hand smokers due to smoke in the public places. The ultimate results of smoking in the public places for second hand smokers may be Esophagus, coronary heart diseases, oral cavity, larynx and infertility. We may minimize the negative impacts of smoking in the public places or elsewhere but do nothing else. In our survey, 100% respondents were mentioned to make provision of separate room in the hospitals for safe smoking, while 93.33% respondents were mentioned to keep booth on the roadside. 90% respondents were agreed for separate room in the market for safe smoking. Corresponding figure, 83.33% respondents were agreed for separate room in the house and restaurants for safe smoking places instead of open public places.We need to undertake motivational program (using booklets, billboard, seminar/workshop, rally and class room lectures on effects of smoking in the public places) to stop smoking in the public places. There is an urgent need to construct and develop designated places( separate room at restaurants, universities, hospitals, home, cinema halls and special booth in the roadside and parks) the for safer smoking rather than smoking in the public places.
Keywords: Chain smoker; public places; second hand smoker; smoking.
This document summarizes key findings from the 2009 Philippines Global Adult Tobacco Survey (GATS). The survey found that 28% of Filipino adults, or 17.3 million people, are current smokers. Males have higher smoking rates at 48% compared to 9% for females. On average, male daily smokers consume 11 cigarettes per day and female daily smokers consume 7. Cigarettes are the most commonly smoked tobacco product. While 48% of past smokers tried to quit in the past year, only 5% successfully quit. Over a third of adults are exposed to secondhand smoke at work or on public transportation.
the concept of World No-Tobacco Day was initiated because millions of people die each year around the world owing to tobacco intake and mistreatment. Initially, April 7 was chosen as the “world no-smoking day” when the World Health Assembly passed a resolution regarding the same in 1987. In 1988, the World Health Assembly passed another resolution calling for May 31 to be celebrated as “World No- Tobacco Day
Tobacco smoking has been practiced for thousands of years and involves burning tobacco leaves and inhaling the smoke. While tobacco originated in the Americas, it spread to Europe and Asia in the 17th century. Tobacco smoking can cause various diseases such as lung cancer, heart disease, and chronic bronchitis. Over 25 diseases are caused or exacerbated by smoking. The World Health Organization works to implement tobacco control policies through the WHO Framework Convention on Tobacco Control to reduce both the supply and demand of tobacco products globally.
World No Tobacco Day is observed annually on May 31 to raise awareness about the harmful and deadly effects of tobacco use. The World Health Organization promotes this day to encourage tobacco users to refrain from using tobacco and its products for at least 24 hours. India has one of the largest tobacco user populations, with over 200 million tobacco consumers who face serious health risks like cancer, heart disease, and stroke from tobacco consumption. The government is working to increase taxes on tobacco and implement other policies to reduce tobacco use and its health and economic impacts.
EFFECTS OF SMOKING IN THE PUBLIC PLACES: A PROPOSAL FOR SAFE SMOKING PLACESpaperpublications3
Abstract: This is basically exploratory study and was conducted at Nilkhet, Dhaka city, Dhaka, Bangladesh over a period of two months started from October, 2010 to November, 2010. The main objective of this study is to know the effects of smoking in the public places and propose safe place for smoking. Total 30 respondents were selected based on age class (10 respondents below 30 years, 10 respondents between 30 to 40 years and rest 10 respondents were over 40 years of age). All respondents were interviewed with semi structure questionnaire. Smoking in the public places caused serious problems for second hand smokers including lung cancer, respiratory disorders, coronary heart diseases, bronchitis pneumonia. Lots of effects were mentioned by the respondents. Even it is not well accepted to smoke in the public places. 100% respondents were mentioned that Lung cancer and bronchitis may occur for the second hand smokers due to smoke in the public places. The ultimate results of smoking in the public places for second hand smokers may be Esophagus, coronary heart diseases, oral cavity, larynx and infertility. We may minimize the negative impacts of smoking in the public places or elsewhere but do nothing else. In our survey, 100% respondents were mentioned to make provision of separate room in the hospitals for safe smoking, while 93.33% respondents were mentioned to keep booth on the roadside. 90% respondents were agreed for separate room in the market for safe smoking. Corresponding figure, 83.33% respondents were agreed for separate room in the house and restaurants for safe smoking places instead of open public places.We need to undertake motivational program (using booklets, billboard, seminar/workshop, rally and class room lectures on effects of smoking in the public places) to stop smoking in the public places. There is an urgent need to construct and develop designated places( separate room at restaurants, universities, hospitals, home, cinema halls and special booth in the roadside and parks) the for safer smoking rather than smoking in the public places.
World No Tobacco Day is observed annually on May 31st to raise awareness about the harmful effects of tobacco. The World Health Organization promotes this day to encourage tobacco users to refrain from its use for 24 hours and to reduce tobacco consumption overall. Tobacco kills over 800,000 people in India each year and leads to diseases like cancer. India has a high rate of tobacco consumption, especially smokeless tobacco, and tobacco use imposes large economic costs on the country in terms of health spending and lost productivity. Higher taxes on tobacco are recommended to reduce its use and generate government revenues.
Prevalence and Pattern of Tobacco Use among Adults in an Urban Community iosrjce
Tobacco use is a global pandemic and is the leading cause of preventable death. Most of the deaths
are occurring in the low and middle income countries.
Objectives: To determine the prevalence and pattern of tobacco use among adults in an urban community.
Materials and methods: A cross sectional study was conducted using face to face interviews on 403 individuals
aged 18 years and above residing in an urban community of Imphal West, Manipur. Descriptive statistics and
Chi –square test was used for analysis.
Results: The prevalence of ever use of tobacco use was 66.3% and of which 95.5% were current users. Tobacco
was used predominantly in smokeless form (zarda pan, khaini, gutkha) by 85% of the users. Smoked tobacco
was used only by 15% of the users. The commonest influencing factor for tobacco use was peer pressure.
Conclusion: Prevalence of tobacco use in this community was high. There is a need to develop effective health
education and multifactorial tobacco quitting strategies with focus on help and support for those who wish to
quit tobacco.
Tobacco smoking is a major public health issue in India, killing nearly 420,000 people per year. It is estimated that 120 million people in India smoke, and studies have found smokers have significantly higher risks of early death from diseases like cancer and heart disease. The prevalence of smoking is much higher among men (28.5%) than women (2.1%) in India, though youth smoking rates are significant as well at 9.7% of females and 17.3% of males aged 13-14. Addressing the tobacco epidemic will be an important part of improving health outcomes in India.
Integrating Ayurveda into Parkinson’s Management: A Holistic ApproachAyurveda ForAll
Explore the benefits of combining Ayurveda with conventional Parkinson's treatments. Learn how a holistic approach can manage symptoms, enhance well-being, and balance body energies. Discover the steps to safely integrate Ayurvedic practices into your Parkinson’s care plan, including expert guidance on diet, herbal remedies, and lifestyle modifications.
Histololgy of Female Reproductive System.pptxAyeshaZaid1
Dive into an in-depth exploration of the histological structure of female reproductive system with this comprehensive lecture. Presented by Dr. Ayesha Irfan, Assistant Professor of Anatomy, this presentation covers the Gross anatomy and functional histology of the female reproductive organs. Ideal for students, educators, and anyone interested in medical science, this lecture provides clear explanations, detailed diagrams, and valuable insights into female reproductive system. Enhance your knowledge and understanding of this essential aspect of human biology.
These lecture slides, by Dr Sidra Arshad, offer a quick overview of the physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar lead (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
6. Describe the flow of current around the heart during the cardiac cycle
7. Discuss the placement and polarity of the leads of electrocardiograph
8. Describe the normal electrocardiograms recorded from the limb leads and explain the physiological basis of the different records that are obtained
9. Define mean electrical vector (axis) of the heart and give the normal range
10. Define the mean QRS vector
11. Describe the axes of leads (hexagonal reference system)
12. Comprehend the vectorial analysis of the normal ECG
13. Determine the mean electrical axis of the ventricular QRS and appreciate the mean axis deviation
14. Explain the concepts of current of injury, J point, and their significance
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. Chapter 3, Cardiology Explained, https://www.ncbi.nlm.nih.gov/books/NBK2214/
7. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
Does Over-Masturbation Contribute to Chronic Prostatitis.pptxwalterHu5
In some case, your chronic prostatitis may be related to over-masturbation. Generally, natural medicine Diuretic and Anti-inflammatory Pill can help mee get a cure.
Rasamanikya is a excellent preparation in the field of Rasashastra, it is used in various Kushtha Roga, Shwasa, Vicharchika, Bhagandara, Vatarakta, and Phiranga Roga. In this article Preparation& Comparative analytical profile for both Formulationon i.e Rasamanikya prepared by Kushmanda swarasa & Churnodhaka Shodita Haratala. The study aims to provide insights into the comparative efficacy and analytical aspects of these formulations for enhanced therapeutic outcomes.
TEST BANK For An Introduction to Brain and Behavior, 7th Edition by Bryan Kol...rightmanforbloodline
TEST BANK For An Introduction to Brain and Behavior, 7th Edition by Bryan Kolb, Ian Q. Whishaw, Verified Chapters 1 - 16, Complete Newest Versio
TEST BANK For An Introduction to Brain and Behavior, 7th Edition by Bryan Kolb, Ian Q. Whishaw, Verified Chapters 1 - 16, Complete Newest Version
TEST BANK For An Introduction to Brain and Behavior, 7th Edition by Bryan Kolb, Ian Q. Whishaw, Verified Chapters 1 - 16, Complete Newest Version
Muktapishti is a traditional Ayurvedic preparation made from Shoditha Mukta (Purified Pearl), is believed to help regulate thyroid function and reduce symptoms of hyperthyroidism due to its cooling and balancing properties. Clinical evidence on its efficacy remains limited, necessitating further research to validate its therapeutic benefits.
Cell Therapy Expansion and Challenges in Autoimmune DiseaseHealth Advances
There is increasing confidence that cell therapies will soon play a role in the treatment of autoimmune disorders, but the extent of this impact remains to be seen. Early readouts on autologous CAR-Ts in lupus are encouraging, but manufacturing and cost limitations are likely to restrict access to highly refractory patients. Allogeneic CAR-Ts have the potential to broaden access to earlier lines of treatment due to their inherent cost benefits, however they will need to demonstrate comparable or improved efficacy to established modalities.
In addition to infrastructure and capacity constraints, CAR-Ts face a very different risk-benefit dynamic in autoimmune compared to oncology, highlighting the need for tolerable therapies with low adverse event risk. CAR-NK and Treg-based therapies are also being developed in certain autoimmune disorders and may demonstrate favorable safety profiles. Several novel non-cell therapies such as bispecific antibodies, nanobodies, and RNAi drugs, may also offer future alternative competitive solutions with variable value propositions.
Widespread adoption of cell therapies will not only require strong efficacy and safety data, but also adapted pricing and access strategies. At oncology-based price points, CAR-Ts are unlikely to achieve broad market access in autoimmune disorders, with eligible patient populations that are potentially orders of magnitude greater than the number of currently addressable cancer patients. Developers have made strides towards reducing cell therapy COGS while improving manufacturing efficiency, but payors will inevitably restrict access until more sustainable pricing is achieved.
Despite these headwinds, industry leaders and investors remain confident that cell therapies are poised to address significant unmet need in patients suffering from autoimmune disorders. However, the extent of this impact on the treatment landscape remains to be seen, as the industry rapidly approaches an inflection point.
share - Lions, tigers, AI and health misinformation, oh my!.pptxTina Purnat
• Pitfalls and pivots needed to use AI effectively in public health
• Evidence-based strategies to address health misinformation effectively
• Building trust with communities online and offline
• Equipping health professionals to address questions, concerns and health misinformation
• Assessing risk and mitigating harm from adverse health narratives in communities, health workforce and health system
share - Lions, tigers, AI and health misinformation, oh my!.pptx
Anti tobacco counceling
1. Anti-Tobacco Counseling
Guided by:
Dr. Girish R. Shavi
H.O.D
Public Health Dentistry
Presented by:
Dr. Preyas Joshi
2nd year Post-Graduate Student
Public Health Dentistry
2. CONTENTS
• Introduction
• Tobacco Use in India
• Tobacco Preparations
• Constituents in Tobacco
• Tobacco Dependence
• Benefits Of Quitting Tobacco
• Methods Of Quitting Tobacco
• Anti-Tobacco Counselling
• Pharmacotherapy
• Tobacco Cessation Centres in India
• Actions in The Community & Nation
• Conclusion
• References
3. The History of Tobacco
• “In ancient times, when the land was barren and the people were starving, the Great Spirit sent forth
a woman to save humanity. As she travelled over the world everywhere her right hand touched the
soil, there grew potatoes. And everywhere her left hand touched the soil, there grew corn. And in the
place where she had sat, there grew tobacco.” Huron Indian myth
• “The Spaniards upon their journey met with great multitudes of people, men and women with
firebrands in their hands and herbs to smoke after their custom.”
Christopher Columbus’ journal, 6 November 1492
• “Smoking is a custom loathsome to the eye, hateful to the nose, harmful to the brain, dangerous to
the lungs, and in the black, stinking fume there of nearest resembling the horrible Stygian smoke of
the pit that is bottomless.”
James I of England A Counterblaste to Tobacco 1604
• “I say, if you can’t send money, send tobacco.”
First US President George Washington’s request to help finance the American Civil War, 1776
4. • Within 150 years of Columbus’s finding “strange leaves” in the New World,
tobacco was being used around the globe. Its rapid spread and widespread
acceptance characterise the addiction to the plant Nicotina tobacum. Only the mode
of delivery has changed. In the 18th century, snuff held sway; the 19th century was
the age of the cigar; the 20th century saw the rise of the manufactured cigarette, and
with it a greatly increased number of smokers. At the beginning of the 21st century
about one third of adults in the world, including increasing numbers of women,
used tobacco. Despite thousands of studies showing that tobacco in all its forms
kills its users, and smoking cigarettes kills non-users, people continue to smoke,
and deaths from tobacco use continue to increase.
11. Prevalence and Pattern of Tobacco Consumption in India1
• Prevalence of Tobacco Use in India: In India, the National Sample Survey Organization (NSSO)
has been conducting yearly surveys since 1950-1951. Tobacco use is part of the consumer behaviour
component of the National Sample Survey (NSS), conducted every five years. The nationwide
survey was undertaken as the 50th round of the National Sample Survey (NSS, 1993-1994) and a
total of 115,354 households located in 6951 villages and 4650 urban blocks were visited and
information on tobacco use including product types were obtained for all members aged 10 years
and above residing in each surveyed household. This information was obtained from one member of
the household, usually the male head.
• The NSSO tabulated the survey results for urban and rural resident’s gender - wise and age – wise
for 32 states and union territories. In the report the age groupings were as follows: 10-14, 15-29, 30-
44, 45-60 and 60 + years.
• The NSSO survey showed that 432,393 individuals of all ages were tobacco users. The major
findings were 51.3% males and 10.3% of females were regular tobacco users; 35.3% males and
2.6% females were regular smokers; 24.0% males and 8.6% females were regular users of smokeless
tobacco and about 250 million users were aged 10 + years in the country.
12. The National Family Health Survey (NFHS)
• Another nationwide household survey, the National Family Health Survey (NFHS), in its second
round (1998-1999), collected information on tobacco use and health-related practices and behaviour
in 26 states.
• Over 90,000 households were surveyed and information on paan/tobacco chewing and tobacco
smoking were obtained for 315,597 persons aged 15 years and above.
• In the NFHS-2 report, the age categorization adopted was 15-19, 20-24, 25-29, 30-39, 40-49, 50-59
and 60 years and above.
• It was found that tobacco use among men was 46.5% and the same among women was 13.8%. The
prevalence of smoking and chewing varied widely between different states and had a strong
association with individual’s socio-cultural characteristics.
While the two surveys have similar sampling methods, it should be kept in mind that in the
National Sample Survey the male head of the household responded for all members, while
in the National Family Health Survey the female head of the household responded for all
members, which is an important difference in methodology.
13. THE HINDU (GUNTUR, September 24, 2013)
• India earned the distinction of being the world’s third largest producer of tobacco in 2012-13
with an estimated production of 681 million kilos, next only to China and Brazil and the second
largest exporter of FCV tobacco with Brazil leading the table.
• Flue Cured Virginia (FCV) tobacco, which is the main exportable variety produced in Andhra
Pradesh and Karnataka, accounted for about 263.55 million kilos of the total tobacco production.
• India makes a significant contribution to the national economy by earning about US$ 914.43
million foreign exchange (2012-13) besides accruing US$ 3.65 billion (2012-13) to the exchequer
by way of excise levies on manufactured tobacco.
• The tobacco industry is providing employment to nearly 38 million people, who are engaged in
the various processes of tobacco cultivation, curing, grading, manufacturing and marketing.
• Nearly 76,100 metric tons (mt) of unmanufactured tobacco is exported to Western Europe
between April 2012 and March 2013 followed by about 47,350 mt to South & Southeast Asia and
nearly 30,710 mt to East Europe. The grand total quantity of unmanufactured tobacco exports
stood at 228,025 mt.
14. Patterns of Tobacco Consumption in India
• There has also been a complex interplay of sociocultural factors which influenced not only the
acceptance or rejection of tobacco by sections of society but also determined the patterns of use.
• In traditional Indian joint families smoking at home was initially a taboo. It was restricted to only
the dominant male members of the family. The younger members of the family would desist from
using it in the presence of the elders and even the master of the house would not use it when an
elderly relative, especially an aged parent, was around.
• The increasing replacement of the joint family by nuclear families, especially in the urban setting,
has provided a more permissive atmosphere to use tobacco at home.2
• Although smoking tobacco was a taboo in traditional families but smokeless forms of tobacco
was widely accepted.
• Inclusion of tobacco as one of the ingredients of paan highlights the importance of this product
and wide social acceptability of tobacco chewing in ancient India.
• The social acceptance and importance of paan increased further during the mughal era and paan
chewing became a widely prevalent form of smokeless tobacco use in India. Women ate paan for
cosmetic reasons as chewing it produced a bright red juice that coloured their mouth and lips.3
15. Smoked tobacco in India
• Beedis: Crushed and dried tobacco is wrapped in tendu leaves and rolled into a beedi.
Beedis are smaller in size than the regular company-made cigarettes so more beedis are smoked
to achieve the desired feeling caused by nicotine. Beedi smokers are at least at an equal risk of
developing cancers as cigarette smokers due to use of smoked tobacco. Beedi making is a source
of livelihood for many families. In some families, everyone – including children – helps make
beedis. The frequent inhalation of tobacco flakes has similar effects as the actual use of the
tobacco product. Therefore, these families have an increased risk of lung diseases and cancers of
the digestive tract. And, addiction is common among these families.
16. • Cigarettes and cigars: A cigar is a roll of tobacco wrapped in leaf tobacco, and a cigarette is
a roll of tobacco wrapped in paper. Cigarettes may come with filters, as thins, low-tar, menthol,
and flavored – to entice more users, including women and youth and also to suggest the cigarettes
have a lower health risk, which they do not. Many people view cigar smoking as less dangerous
than cigarette smoking. Yet one large cigar can contain as much tobacco as an entire pack of
cigarettes. Cigarette smoking is more common in the urban areas of India, and cigar use is seen in
the big cities. Cigarette smoking in on the rise and is now also seen among teenage girls and
young women.
17. While cigarette smoking among Indian men has fallen from 33.8 per cent in 1980
to 23 per cent in 2012, it has risen from three per cent to 3.2 per cent among
Indian women within the same time frame.
(THE TIMES OF INDIA May 30, 2014 )
In absolute terms, the number of female smokers in India has more than doubled,
from about 5.3 million to 12.2 million in that time frame.
18. • Chillum: This involves smoking tobacco in a clay pipe. Chillum smoking increases chances
of oral cancer and lung cancer. A chillum is shared by a group of individuals, so in addition to
increasing their risk of cancer, people who share a chillum increase their chances of spreading
colds, flu, and other lung illnesses. A chillum is also used for smoking narcotics like opium.
• Hookah: Hookah smoking involves a device that heats the tobacco and passes it through
water before it is inhaled. It is not a safer way to use tobacco. The use of hookah was once
on the decline, but it has increased in recent years. Hookah is thought to be a sign of royalty
and prestige and is available in highpriced coffee shops in flavors like apple, strawberry, and
chocolate. It is marketed as a "safe" recreational activity, but it is not safe and is finding
increasing use among college students of both sexes. Use of tobacco in this form can result in
tobacco addiction.
19.
20. • Chutta smoking and reverse chutta smoking: Chuttas are coarse tobacco cigars that are
smoked in the coastal areas of India. Reverse chutta smoking involves keeping the burning end of
the chutta in the mouth and inhaling it. This practice increases the chance of oral cancer.
Palatal lesion associated with reverse smoking
21. Smokeless tobacco use
• Smokeless tobacco is very common in India. Tobacco or tobacco-containing products are chewed
or sucked as a quid, or applied to gums, or inhaled.
• Khaini: This is one of the most common methods of chewing tobacco. Dried tobacco leaves are
crushed and mixed with slaked lime and chewed as a quid. The practice of keeping the quid in the
mouth between the cheeks and gums causes most of the cancers of the gums – the commonest
mouth cancer in India.
• Gutkha: This is rapidly becoming the most popular form of chewed tobacco in India. It is very
popular among teenagers and children because it is available in small packets (convenient for a
single use), uses flavoring agents and scents, and is inexpensive (as low as Re 1/- equivalent to 2
cents). Gutkha consists of areca nut (betel nut) pieces coated with powdered tobacco, flavoring
agents, and other “secret” ingredients that increase the addiction potential. Gutkha use is
responsible for increased cases of oral cancers and other disorders of the mouth and teeth in
young adults.
22. • Paan with tobacco: The main ingredients of paan are the betel leaf, areca nut (supari), slaked
lime (chuna), and catechu (katha). Sweets and other condiments can also be added. The varieties
of paan are named for the different strengths of tobacco in it. Some people think that chewing
paan without tobacco is harmless, but this is not true. The International Agency for Research on
Cancer (IARC) has established that people who chew both the betel leaf and the areca nut have a
higher risk of damaging their gums and having cancers of the mouth, pharynx, esophagus, and
stomach.
Khaini Paan with tobacco Gutkha
23. • Paan masala: Paan masala is a commercial preparation containing the areca nut, slaked lime,
catechu, and condiments, with or without powdered tobacco. It comes in attractive sachets and
tins, which are easy to carry and store. The tobacco powder and areca nut are responsible for
oral cancers in those who use these products a lot.
• Mawa: This is a combination of areca nut pieces, scented tobacco, and slaked lime that is
mixed on the spot and chewed as a quid. The popularity of mawa and its ability to cause cancer
matches that of gutkha. Its use is rising among teenagers and young adults in India.
• Mishri, gudakhu and toothpastes: These preparations are popular because people believe –
incorrectly – that tobacco in the product is a germicidal chemical that helps in cleaning teeth.
Mishri is roasted tobacco powder that is applied as a toothpowder. Mishri users often become
addicted and start applying it as pastime. Gudakhu is a paste of tobacco and sugar molasses.
These preparations are commonly used by women and involve direct application of tobacco to
the gums, thus increasing the risk of cancer of the gums. Tobacco-containing toothpastes, which
are promoted as antibacterial pastes, are popular among children. This habit often becomes an
addiction, and the children graduate to other forms of tobacco, thus increasing their chance for
cancers.
24. • Dry snuff: This is a mixture of dried tobacco powder and some scented chemicals. It is inhaled
and is common in the elderly population of India. Snuff is responsible for cancers of the nose
and jaw.
Pan Masala Mawa Tobacco Mishri Tobacco
Dry Snuff Creamy Snuff – applied using toothbrush or fingers
25. A Three(3) Year old girl living in Village lakhpadar, Distt. Kalahandi rubbing gudakhu powder
Chhattisgarh’s state Health Minister Amar
Agrawal runs a flourishing business in gudakhu,
a highly harmful tobacco product believed to be
the biggest cause of oral cancer in the state,
despite Chhattisgarh itself having banned
manufacture, storage, distribution and sale of
“tobacco and nicotine-containing gutkha and
pan masala”.
A mix of tobacco and decomposed gud (jaggery), gudakhu is widely consumed across rural Chhattisgarh
26. • A wide variety of tobaccos are grown in 16 states in India under diverse agroclimatic conditions.
• However, most of the varieties grown are of non-cigarette types. These include natu, bidi, chewing, hooka (hookah),
cigar and cheroot tobaccos and account for about 77 percent of the total output.
• Cultivation of FCV tobacco was initially confined to the traditional black soil areas of Andhra Pradesh. However, to
suit the quality requirements in internal and export markets, cultivation of FCV was encouraged in light soils in
Karnataka and Andhra Pradesh.
• In the initial years, the varieties grown were limited to Havana tobacco used in cigars, and Lanka tobacco used in the
manufacture of snuff and bidis. Subsequently, other forms, like FCV, were introduced.4
27. CONSTITUENTS IN TOBACCO5
• Polycyclic aromatic hydrocarbon- causes carcinogenesis
• Nicotine- potential carcinogenic agent
• Phenol- produces ganglionic stimulation & depression & tumour promotion
• Benzopyrene- plays an important role in tumour promotion & irritation
• Carbon monoxide- produces impaired oxygen transport & repair
• Formaldehyde & oxides of nitrogen- toxicity to cilia & irritation
• Nitrosamine- potential carcinogenic agent
28. Ill Effects Of Tobacco6,7
• Tobacco is a major contributor to oral disease.
• Tobacco use slows wound healing after dental surgery, promotes periodontal disease, halitosis
and oral infections.
• When tobacco use is combined with the intake of areca nut or alcohol, health risks due to
tobacco increase.
• Smoking causes cancer of the oral cavity and tongue, larynx and pharynx, oesophagus,
stomach, uterine cervix and lung.16 Many cases of lung cancer in India are due to smoking.
• Smokeless tobacco is known to cause oral cancer. There is some evidence that it causes some
other cancers as well. Chewing of paan (with supari) with or without tobacco is a major cause
of oral and oesophageal cancers in India.
• Smoking is a known cause of cardiovascular disease. Emerging evidence points to smokeless
tobacco use also as a cause of cardiovascular disease.
• Smoking causes most cases of chronic obstructive lung disease – emphysema and chronic
bronchitis.
29. • Exposure of non-smokers to second-hand smoke is an important cause of respiratory
infections, worsening of asthma and poor lung function. Many of the sufferers are women and
children.
• Newer research findings indicate that smoking is a major risk factor for tuberculosis in India.
Tuberculosis is about 3 times more common among ever-smokers than among never-smokers
and mortality due to this disease is 3–4 times greater among smokers than non-smokers.
• Pregnant women exposed to passive smoke may deliver lower weight babies. Evidence is
accumulating that pregnant women who use smokeless tobacco are more likely to have low
birth weight or stillborn babies. The birth of a baby with congenital cleft lip or palate can be a
consequence of cigarette smoking.
• Additionally, there are often long-term effects on surviving children born of mothers who
smoke or are passively exposed to smoke.
• Men who smoke or use smokeless tobacco may develop reduced fertility and sexual
impotence.
30. Health Benefits of Smoking Cessation8
There are immediate and long-term health benefits of quitting for all smokers
Time Since Quitting Beneficial health changes that take place
Within 20 minutes Your heart rate and blood pressure drop.
12 hours The carbon monoxide level in your blood drops to normal.
2-12 weeks Your circulation improves and your lung function increases.
1-9 months Coughing and shortness of breath decrease.
1 year Your risk of coronary heart disease is about half that of a smoker.
5 years Your stroke risk is reduced to that of a nonsmoker 5 to 15 years after
quitting.
10 years Your risk of lung cancer falls to about half that of a smoker and your
risk of cancer of the mouth, throat, esophagus, bladder, cervix, and
pancreas decreases.
15 years The risk of coronary heart disease is that of a nonsmoker's.
31. Time of quitting smoking Benefits in comparison with those who
continue
At about 30 Gain almost 10 years of life expectancy
At about 40 Gain 9 years of life expectancy
At about 50 Gain 6 years of life expectancy
At about 60 Gain 3 years of life expectancy
After the onset of life-threatening disease Rapid benefit, people who quit smoking after
having a heart attack reduce their chances of
having another heart attack by 50%.
32. Impact Of Government Policies On Production Of Tobacco9
• Even though tobacco comes under state jurisdiction, the Government of India plays an important
role in the growth and development of the tobacco industry.
• In fact, at least six ministries of the Union Government – Agriculture, Commerce, Finance,
Industry, Labour, and Rural Development – deal with one or another specified aspects of the
industry.
• Following the increasing health concern about tobacco consumption, the central Ministry of
Agriculture has not launched any development scheme for the crop since the completion of the
Seventh Five-Year Plan (1985–90).
• However, in general, government policy has been to promote production, improve quality and
ensure remunerative prices for growers.
33. Government interventions in support of the industry can broadly be classified into:
(i) Institutional and regulatory support;
(ii) Price and market support;
(iii) Export promotion;
(iv) Research and development (R&D); and
(v) Direct fertilizer and credit subsidies.
• The Tobacco Board has the responsibility for regulating production, marketing and exports of
FCV tobacco grown in the states of Andhra Pradesh, Karnataka and Mahaarshtra.
• The Directorate of Tobacco Development handles marketing of non-FCV tobacco.
34. • Field studies carried out by the National Council of Applied Economic Research (NCAER,
1994) and by Centre for Multidisciplinary Development Research (CMDR) showed a number
of major socio-economic factors encouraging tobacco growing:
1. Richer farmers tend to prefer tobacco to other crops. Small-scale farmers take to tobacco
cultivation as something inevitable in the absence of a suitable alternative.
2. Tobacco as a crop gives superior net economic returns compared with alternative crops.
3. Tobacco is preferred due to its drought resistance and suitability for growing under rainfed
conditions. Due to tobacco’s soil preferences, cultivation is concentrated in certain states, and even
within major tobacco growing states, the crop is grown in specific districts.
4. A widespread belief prevails among farmers, especially in bidi growing areas, that no other crops
should be grown in the same land where tobacco is cultivated, as it will lower the quality of the
subsequent crops. However, this is contrary to scientific recommendation that tobacco should be
grown alternate years.
35. 5. The prevalent practice of growing only tobacco every year is reinforced by bidi manufacturers
through their agents, who may refuse to purchase tobacco if any other crop has been grown on the
same plot. Marketing of non-FCV tobacco has been a major problem and there have been
allegations of agents exploiting farmers.
6. A well organized marketing system for FCV tobacco through the Tobacco Board assures prompt
payment to farmers, which is not the case for many other crops.
7. Farmers are reluctant to give up tobacco cultivation because of heavy investment in irrigation
equipment and barns.
8. A change in cropping is practicable only when some assured irrigation is available. For example,
the coming online of Nagarjuna Sagar dam led to a radical change in cropping pattern – from
tobacco to sugar cane.
9. Failure of other crops raised in the past.
36.
37. The Bidi Industry
• Bidi is tobacco rolled in a tendu leaf and tied by a string. Tendu leaf accounts for 74 percent by
weight of bidi.
• Dark and sun-dried tobacco varieties are used in bidi production. Almost 80 percent of bidi
tobacco comes from Gujarat, and the rest comes from Karnataka.
• Bidis account for over 50 percent of total tobacco use, compared with less than 20 percent by
the cigarette segment.
• There are an estimated 290 000 growers of bidi tobacco.
• Tendu leaf is almost wholly grown on government-owned forestland, with around 62 percent of
tendu leaf being grown in Madhya Pradesh.
• Annual production of tendu leaf in 1994/95 had an estimated value of Rs 14700 million. About
2 million people are engaged in leaf collection, while another 4.4 million people are employed
directly for bidi rolling. Bidi rolling is concentrated in the states of Madhya Pradesh, Andhra
Pradesh, Tamil-Nadu, Uttar Pradesh and West Bengal. Bidis are manufactured largely in the
independent small-scale and cottage industry sector. There are a few large manufacturers of
branded bidis, which tend to be closely-held, family-run businesses. The bidi industry is
estimated to have used 268000 tonnes of tobacco in 1998/99, 54.4 percent of the total apparent
tobacco use.
38. Role of Women in the Bidi Industry
• There are different estimates of female involvement in bidi rolling. One source estimated that
women constitute 76% of the total employment in bidi manufacture. The All India Bidi, Cigar and
Tobacco Workers Federation pay the figure at 90% to 95%. In some regions of India, bidi making
is largely regarded as “women’s work”, with the exception of young boys. In other areas, men roll
bidies if and when other work is not available or they are unable to engage in manual labor.
• In areas where the bidi cottage industry is pervasive, some women engage in bidi rolling as a full-
time occupation and are able to roll 800–1200 bidies during an 8-12 hour day. Other women work
part-time while caring for children and attending to household duties and roll 300–500 bidies a
day. Bidi wages are generally higher than those for manual labor and in some areas, such as
southwest coastal Karnataka, the siphoning off of women into the bidi cottage industry has raised
local agricultural wages and affected cropping patterns.
• The increasing shift of bidi rolling from the factory to a home-based setting and the constant
relocation of bidi companies in search of cheap transport and labor also cause insecurity and
instability among bidi workers.
39. Tobacco Health Warnings & Messages on Cigarette Packages in India10
India’s health warnings policy was drafted in 2006. After 2 rounds of revisions in 2006 and 2007, a
final set of health warnings were released in 2008 and were implemented on all cigarette packages on
May 31, 2009. Two warnings were rotated on cigarette packages and a separate warning was rotated
on all smokeless tobacco products.
In 2011, India’s Ministry of Health and Family Welfare proposed an amendment to the rules which
included 4 additional pictorial warnings to be used on tobacco and bidi packages, and 4 additional
pictorial warnings for smokeless packages. Implementation of these rules began on December 1, 2011
and allowed tobacco companies to choose any one picture out of each set of 4 images for smoking and
smokeless tobacco products.
On September 27, 2012, India proposed a new round of picture warnings that were to be required in
India as of April 1, 2013, although implementation of these warnings varied. A set of 3 new pictorial
warnings were developed for smoked tobacco products, and a separate set of 3 new warnings were
developed for smokeless tobacco products. Health warnings were required to cover 40% of the front
of all cigarette packages.
40. At present, the space covered by the warning is 40%
The government of India on Wednesday, Oct 15,2014 announced new pictorial warnings for
cigarette packs and other tobacco products. According to the new guidelines, effective from
April 2015, 85% of space on cigarette packs and other tobacco products in India will have to
be mandatorily covered with graphic and text warnings about adverse health effects,
becoming the country with the highest element of warning on packages. Of the 85% space,
60% will be devoted to pictoral warnings while 25% will be covered by textual warnings.
41. TEXTUAL & PICTORAL HEALTH WARNINGS PROPOSED FOR APRIL 2015
For packages containing smoking forms of
tobacco products
For packages containing smokeless forms of
tobacco products
The size of the specified health warning on each panel of the tobacco package shall not be
less than 3.5 cm (width) × 4 cm (height), so as to ensure that the warning is legible,
prominent and conspicuous.
The size of all components of the specified health warning shall be increased proportionally
according to increase of the package size to ensure that the specified health warning covers
eighty-five per cent (85%) of the principal display area of the package
42. Centre defers notification on 85 per cent pictorial health warning on tobacco products
• Tuesday, March 31, 2015. the Union government
decided to defer the implementation of a notification
for increasing the size of pictorial health warning on
cigarette packets and various other tobacco products.
• The deferment move comes in the wake of
Parliamentary Committee on Subordinate Legislations
(2014-15), headed by BJP MP Dilipkumar Mansukhhal
Gandhi, who has been examining the provisions of the
Cigarettes and Other Tobacco Products Act, 2003.
The move mandating 85 percent pictorial
health warnings on tobacco product packages
from April 1 has earned India praise from the
WHO on the opening day of the 16th World
Conference on Tobacco OR Health. “It is
beautiful that India has notified the
regulation. That is the biggest pictorial
warning in the world. Whatever assistance
India needs in that direction, we are willing to
provide it to them,” said Dr Douglas Bettcher,
director, WHO department for prevention of
non-communicable diseases. The decision
was notified in October last year and comes
into effect next month.
March 20, 2015
43. Do favorite movie stars influence
adolescent smoking initiation?
Distefan JM et al. Am J Public Health. 2004 Aug;94(8):1296
Objective:
The study checked whether adolescents whose favorite movie stars smoke on-screen are at increased risk of
tobacco use.
Results:
The researchers found that viewing a popular movie star smoking on screen created a powerful incentive for girls
to begin smoking, but the influence was not as strong for boys.
Conclusion of the article was:
Public health efforts to reduce adolescent smoking must confront smoking in films as a tobacco marketing strategy
The take-home message is that eliminating smoking in movies may prevent a substantial number of adolescents
from smoking.
44. Neha Dhupuia Kareena KapoorRaima Sen
Priyanaka Chopra Aishwarya Rai Deepika Padukone
45. Arjun Rampal Ajay Devgan Salman Khan
Shahrukh Khan John Abraham Akshay Kumar
46. METHODS OF QUITTING TOBACCO
• There are three ways that people typically use to quit tobacco-
• Cold turkey
• Nicotine fading
• Tapering off
COLD TURKEY –
• Most people try to go “cold turkey”, which means they decide to give up tobacco abruptly and totally all at
once.
• Going cold turkey has been very successful- put the tobacco in the trash can on your quit date; say goodbye and
be done with it.
• The "cold turkey" approach can cause mild to severe nicotine withdrawal symptoms. Drastic reductions in
tobacco use will result in withdrawal symptoms that can include irritability, fatigue, headache, insomnia,
constipation, sweating, coughing, poor concentration, depression, increased appetite, and cravings for tobacco.
• Medication or over-the-counter aids like nicotine patches or gums help to mitigate these effects, and can
therefore double or even triple your chance of success. But when you quit cold turkey, there is nothing in your
body to serve as a buffer for withdrawal symptoms.
47. • Experts say chances of success depend on several factors, not just a person's willpower. The extent of your
addiction, your daily habits and routines, and the amount of support you get from friends and family can all
have a big effect.
• In a 2007 study published in Nicotine and Tobacco Research, researchers interviewed more than 8,000 adult
smokers from four countries attempting to quit the cigarette habit. Participants were contacted at three
separate intervals to see how their quitting methods had worked out. The researchers then compared success
rates of smokers who were trying the cold turkey approach with those who were employing other
methods.11
• The study found that 68.5 percent of the smokers made an attempt to quit using the cold turkey method, and
of those, 22 percent succeeded after the second contact with researchers and 27 percent succeeded after the
third contact. Among people using the cut down method, in which a person smokes successively fewer
cigarettes before abstaining completely, only 12 percent and 16 percent, respectively, were successful.
48. NICOTINE FADING-
• Nicotine fading is for those who smoke cigarettes.
• It involves switching to a cigarette with a lower level of nicotine so the addiction to nicotine can be brought
down before quitting smoking.
• If you are smoking a high-nicotine brand, switch to a medium-nicotine brand.
• If you are smoking a medium-nicotine brand, switch to low-nicotine brand.
• If you are smoking a low-nicotine brand, just switch to different low-nicotine brand.
• If you decide to try nicotine fading, make sure you do not:
Switch from a high-nicotine brand directly to a low nicotine brand
• Don’t smoke more cigarettes than you normally do, or inhale more often or more deeply
High-Nicotine Brand Medium-Nicotine Brand Low-Nicotine Brand
Benson & Hedges
Camel
Dunhill
Marlboro
More
Benson & Hedges Lights
Camel Lights
Marlboro Lights
More Lights
Benson & Hedges
Ultra Lights
49. • The basic mechanism of action is simple: A gradual reduction in an addictive substance allows the body to
adjust to small changes, which results in fewer and more minor withdrawal symptoms. This is the same
principle behind nicotine replacement therapy, but instead of replacing nicotine from cigarettes with
nicotine from some other source, nicotine fading simply gradually reduces the nicotine intake from
cigarettes.
Pros
• There are no side effects to this technique, and done properly, it significantly reduces withdrawal
symptoms.
• The technique itself is free - no product to buy or pills to take.
• This is one off the most 'natural' of all of the techniques or products, since you're not introducing any
additional chemicals or drugs into your body.
Cons
• The primary 'con' to trying to quit smoking gradually is that it may be difficult to self-monitor - that is,
people attempting to use nicotine fading outside of a structured program may end up just 'cutting down,'
which isn't very effective over the long term.
50. TAPERING OFF-
• Tapering off works in a similar way to nicotine fading, but rather than reducing the nicotine level, you
reduce the amount of nicotine you are using.
• Tapering off can be used for all types of tobacco use since you just reduce the amount (e.g., fewer cigarettes
or cigars, less chew or snuff, etc.)
• This method also helps you gradually reduce the amount of nicotine in your body, preparing you for your
quit date when you will stop using tobacco completely.
• Some people who taper off see a doctor. The doctor may prescribe either nicotine chewing gum or a patch.
Both work the same way to decrease the amount of nicotine in the person's system. With nicotine gum, the
smoker chews it whenever he/she feels the desire to smoke. Over time he/she chews fewer and fewer pieces
of gum and feels less desire for a cigarette.
• The patch releases a continuous amount of nicotine through the skin into the bloodstream. Over a period of
time, the doctor changes the patch to smaller and smaller ones. Eventually it is removed. If a smoker
continues to smoke with either the nicotine patch or chewing gum, he/she could get very sick or even die
from too much nicotine in the body.
• People who quit can expect to have headaches, dry mouth, a cough, and trouble sleeping. They may feel
nervous, irritable or in a bad mood, depressed, tired, and hungry. They need to drink a lot of water and fruit
juices, especially during the first week of quitting. They should also eat plenty of fruits and vegetables,
chew sugarless gum and toothpicks, and suck on cough drops and hard candies.
51. ANTI- TOBACCO COUNSELLING
• Tobacco cessation counseling is defined as information given in the form of health education to the patient
on topics related to tobacco use in any form, including cigarettes, cigars, snuff, and chewing tobacco, or on
exposure to secondhand smoke. Tobacco cessation counseling includes information on smoking cessation
and prevention of tobacco use, as well as referrals to other health professionals for smoking cessation
programs.12
• DEFINITION OF TOBACCO COUNSELLING UNDER DENTAL CODE #01320-
Under this code, tobacco cessation counselling is defined as the act of giving specific advice and practical
guidance in helping an interested, generally healthy individual to quit the use of smoke and/or smokeless
tobacco. Counselling strategies and formats, delivered either individually or in groups, can include the use
of problem identification, problem solving, stress coping skills, weight control concepts, skills
development, educational materials, self-help ideas, and relapse prevention techniques. The provision of
continuing social support, care, and encouragement by the counselor(s) is essential in the effectiveness of a
tobacco cessation program.
CDT: Code on Dental Procedures and Nomenclature
The purpose of the CDT Code is to achieve uniformity, consistency and specificity in accurately
documenting dental treatment. One use of the CDT Code is to provide for the efficient processing of
dental claims, and another is to populate an Electronic Health Record.
52. ROLE MODEL & TOBACCO CESSATION TRAINING-
• Among the 1499 third -year dental students surveyed in the Indian Dental Students Global Health Professional
Survey (GHPS), 2005-
97.2% thought dentists serve as role models for their patients
99.8% thought dentists have a role in giving advice about smoking cessation to patients
10.5% recieved formal training in smoking cessation approaches during dental school
99.0% thought health professionals should get specific training on cessation techniques.13
ROLE OF THE DENTIST-
• During the course of oral examination, dentist should try to correlate the effect of the patient’s tobacco use on
the oro-dental problem for which the patient is attending the clinic. They should also counsel the patient to
quit between treatments as not doing so might worsen the situation.
• Dentists should understand that they are in an advantageous position to address the issue of tobacco control
during an oral check-up, as patients would listen because they are in pain.
• Nearly half of 351 dental surgeons (48.7%) surveyed in Bangalore felt that it is the responsibility of the dentist
to persuade patients to quit tobacco and just over half (54.4%) of the respondents were ‘very willing’ to
receive formal training on tobacco cessation and other intervention strategies.14
• Unfortunately, most of the dentists are unfamiliar with counselling techniques for quitting tobacco use.
53. Role of dentists in the clinics:
• In the clinic, dentists have an important role in helping patients quit tobacco and, at the community and national
levels, to promote tobacco prevention and control strategies.
• See the harmful effects of tobacco on the mouth.
• Are in an ideal position to counsel patients.
• See children and youth as patients and can influence them to adopt a tobacco-free lifestyle.
• Treat women of childbearing age and can inform them of the dangers of tobacco use during pregnancy.
• Can spend more time with patients than other clinicians and use this time to counsel tobacco users to quit.
• Can reinforce messages given to patients by physicians and other caregivers about the dangers of tobacco use and
the need to quit.
• Can build their patients’ interest in discontinuing tobacco use by showing them the actual effects in the mouth.
• Have a duty to promote oral health and healthy lifestyles among their patients..
Role of Dentists at the community and national level:
• Can be role models by not using tobacco or by quitting successfully. Tobacco use by dentists is a significant
barrier to tobacco cessation counselling.
• Can speak with authority in the community about the dangers of tobacco use; for example, the need to curb
tobacco use in public and educate children about the dangers of tobacco use.
• Can be effective advocates for tobacco control in the community.14
54. BENEFITS OF INTERVENTIONS FOR CESSATION OF TOBACCO USE
• One message which is important for dentists is that by helping people to quit tobacco and talking on this issue, they are
not wasting their time but are rather building on their practice.
• Patients prefer attending those clinics where the doctor listens to them and advices them honestly.
• Just 5 minutes of focused talk during the examination is enough to make the patient aware and conscious of the harms of
tobacco use.
• Dentists can give brief advice to non-users of tobacco, especially adolescents, and counsel them to never take up tobacco
use.
• To users of tobacco, advice and counselling by dentists on quitting tobacco use have been shown to be effective.
• Patient unwilling to quit also need to hear about the benefits of quitting.
• A good way to manage a variety of chronic oral conditions, including tobacco use and its consequences is to work with
patient to set goals and monitor therapies.
• Dentists must recognize that every interaction on tobacco use, however brief, can lead to a significant change in the
patient’s attitude and behaviour.
• Smokers can be helped to recognize that temporary abstinence is a small success that can lead to greater success in
quitting.
A BRIEF TOBACCO INTERVENTION-
• Takes only a few minutes.
• Is practical for a busy office.
• Assesses, diagnoses, educates, works with the patient.
• Is preferred by patients.
• Must encourage the patient and not be critical.14
55. Counselling for tobacco cessation
Means
Counselling those who’re willing to quit
Counseling should be provided using the 5-A method (ask, advise, assess, assist, and arrange)7,14,15
• Ask about tobacco use at each appointment.
• Advise all adolescents who are smoking to stop and non-smokers to never start using it.
• Assess adolescent's willingness/ readiness to quit.
• Assist efforts to quit.
• Arrange reliable follow-up.
56. Look for oral signs of tobacco use
The dentist sees the inside of the mouth and knows if the patient is using tobacco.
Implement a system to record tobacco use status
57.
58. Assess the patient’s readiness to quit:
Ask every tobacco user if he/she is willing to quit at this time.
• If the patient is willing to quit (in preparation) → Assess the level of dependence
• If the patient is only thinking of quitting but not willing to quit now (in contemplation),
provide a ‘tailored’ message to increase motivation.
• If the patient is not preparing to quit → Shift to the 5 ‘R’ method
Tobacco users who are heavily
dependent on tobacco usually have a
harder time quitting than less dependent
users. In a simplified way of assessing
dependence, the clinician poses two
questions:
59. Assess the level of dependence
• High level of dependence: Individuals who use tobacco within 30 minutes of waking up or who
use it 25 or more times (e.g. smoke 25 or more cigarettes/beedis per day).
• Moderate level of dependence: Individuals who use tobacco more than 30 minutes after waking
up or less than 25 times per day.
• Low level of dependence: Those who neither use tobacco before 30 minutes of waking up nor use
it more than 25 times a day.
Patients highly dependent on tobacco will need longer & more frequent follow up.
Assess the risk of relapse-
An individual who has quit before, even for just 30 days, has a lower risk of relapse.
Those with a higher level of dependence usually need a more intensive intervention to help them avoid relapse.
Individuals with depression or a concurrent habit such as regular alcohol drinking may be at increased risk for
relapse.
Rigorous follow up reduces the risk of relapse – on a schedule. Such patients could be referred to a counsellor or
a tobacco use cessation facility.
60. Assist tobacco users to make a QUIT PLAN
a) Ask the patient to -
Set a firm quit date, ideally within 2 weeks
Get support from family, friends & co-workers
Review past quit attempts, what helped, or led to relapse
Identify reasons for quitting in writing & keep a copy
Reduce tobacco use during the two weeks before quitting
Anticipate challenges, particularly during the first few weeks, including nicotine withdrawal symptoms.
Typical high-risk situations- ‘Triggers’ for tobacco use:
1. During morning toilet
2. With coffee or tea
3. After meals
4. Drinking alcohol
5. Using the telephone
6. Driving
7. Seeing others smoke
8. Tension/Anxiety
9. Before starting a task
10. After completing a task
11. Relaxing or taking a break
12. Concentrating or wanting to stay
alert
13. Studying
14. Watching TV
61. Remove tobacco products from home/office
Throw out all tobacco products in his/her possession.
Avoid places where tobacco is available.
Encourage other tobacco users around to quit along with him or her.
Apply faith
b) Advise the patient -
Total abstinence is essential to quitting- not a single puff or portion.
Withdrawal symptoms typically decrease considerably after 1-3 weeks of quitting
Suggest alternatives to tobacco:
Chewing aniseed (saunf) or ajwain, or eating nuts or fruits, drinking water, taking walks or exercising are
helpful during the periods of craving & can be planned as a part of the daily routine.
No supari is allowed, as it is carcinogenic & may be mentally associated with tobacco by the patient.
Recommend or provide pharmacotherapy:
For depressed patients & those who have tried to quit several times & failed, pharmacotherapy can be
especially helpful.
Provide resources on quitting:
Provide reading materials on quitting that are appropriate for the patient’s age, culture, language,
educational level & pregnancy status.
62. • Arrange for follow up visits
• Methods: revisits, telephone contact or assist patient to arrange an appointment with his/her physician or trained
community health worker
• Timing- set a schedule
1st follow up- within a week of quit date
2nd follow up- within one month of quit date
Further- after 3 months, 6 months, 1 year
• Actions during follow-up contact-
Congratulate the patient on success (even small ones)
Empathize with difficulties: Ask the patient how he/she can overcome the difficulties
Assess pharmacotherapy: Ask the patient about the severity of withdrawal symptoms & about any possible
side-effects of medication being taken, such as irritation of the mouth, dry mouth, confusion, abdominal pain,
back pain, bodyache, sleep disturbance, dizziness, palpitations.
Counsel for relapse:
a) If a relapse occurs, encourage a new quit attempt.
b) Tell the patient that relapse is a part of the quitting process.
c) Review the circumstances that caused the relapse.
d) Use relapse as a learning experience.
Assess the need for intensive counselling: Patient especially needing it would include those with heavy
tobacco use, alcohol use or depression.
63. PHARMACOTHERAPY FOR TOBACCO CESSATION
• Why use pharmacotherapy for tobacco cessation???
On account of the addictive nature of nicotine, although many tobacco users attempt to quit only 3-5% of
them are able to quit without any help,
Pharmacotherapy has been shown to double or triple the chances of quitting.
• Barriers to the use of pharmacotherapy among clinicians-
Limited availability of pharmacotherapy
Limited knowledge of pharmacotherapy
Limited experience with using pharmacotherapy
Therapeutic nihilism (“nothing works”) regarding treatment of nicotine dependence.
Tobacco user’s hesitation to accept pharmacotherapy.
• When to recommend pharmacotherapy???
All persons with severe dependence.
Tobacco users with multiple failed self-attempts.
Tobacco users unable to abstain with brief intervention alone.
64. Broad approaches to pharmacotherapy
Type of treatment Rationale
Nicotine replacement therapy • Supplies the nicotine but eliminates other (harmful)
chemicals in the tobacco
• Decreases the intensity of cravings and withdrawal
symptoms, enabling people to function better while
dealing with the social and psychological aspects of
their dependence
• May provide some of the effects for which the
tobacco user used the particular tobacco product (eg-
the desired mood or immediate support to cope with
stress)
Non-nicotine treatments • Act on central brain receptors and minimize
withdrawal from nicotine when the tobacco user
suddenly stops use
66. NICOTINE CHEWING GUMS
• Commonest form
• Advantage- person can control craving more effectively
• Strength- 2mg & 4 mg
• Two flavours available in India-
Gutkha flavoured- for pan parag users
Mint flavoured- for smokers
• Dosing-
1 gum every 1-2 hrs for 1st 6 weeks
1 gum every 2-4 hrs for 3 weeks
1 gum every 4-8 hrs for 3 weeks
• Duration of treatment- 4-6 weeks
• Start weaning after 2-3 months
• Weaning usually requires only education and reassurance.
• About 10-20% of those who stop smoking with the help of nicotine gum continue to use nicotine gum for 9
months or more, but few use the gum longer than 2 years.
67.
68. NICOTINE SKIN PATCHES
• Simple to use & better compliance rates
• Strength-
21mg/day, 15mg/day and 7mg/day
16 hrs worn during waking hrs or 24 hrs
• Duration of treatment- 6-12 weeks
• Not freely available in India
• Side effects-
Skin rash
Sleep disturbance
69. NICOTINE INHALER
• Resembles a cigarette.
• Nicotine cartridges are inserted into it & inhaled like a cigarette.
• Each cartridge----3 to 20 min session.
• Recommended dose-6-12 cartridges a day for 8-12 wks, with gradual reduction over subsequent 4 wks.
• Suitable for smokers who miss the hand-to-mouth action of smoking.
70. NICOTINE TABLETS AND LOZENGES
• Dissolve under the tongue
• Strength - 2 mg high dose lozenge
1 mg low dose lozenge
• Advantage-
Easy to use
Facilitate nicotine absorption
71. NICOTINE NASAL SPRAY
• Allows rapid nicotine absorption through the nose
• Mimics the rapid nicotine levels achieved from smoking
• May help to relieve sudden urges
• Side effects-
Irritation of the nose and throat
Coughing
Watering of the eyes
72. NON-NICOTINE AGENTS
BUPROPRION HYDROCHLORIDE SUSTAINED RELEASE TABLETS
• Antidepressant drug; first line therapy for treating tobacco dependence
• Doubles the odds success in quitting
• Strength- 150 mg and 300 mg
• Dosing-
Set quit date 1-2 wks after beginning bupropion t/t
Continue 150 mg b.i.d for 7-12 wks after quitting
Maintenance therapy- 150 mg b.i.d for upto 6 month
73. SELEGELINE HYDROCHLORIDE
Dosage- 5mg p.o. Twice daily
NORTRYPTYLINE
Tricyclic antidepressant with mostly nonadrenergic properties and little dopaminergic activity
Doubles the quit rates
CLONIDINE
Central alpha agonist
0.2 to 0.4 mg/day
VARENICILINE
Partial agonist of the nicotine receptor
74. ANTI-TOBACCO COUNSELLING -THOSE UNWILLING TO QUIT
THE 5 ‘R’ METHOD
• ASK/ADVISE THE PATIENT ABOUT-
RELEVANCE of quitting
RISKS of continuing tobacco
REWARDS of quitting
ROADBLOCKS of quitting
REPEAT these at every visit
1. RELEVANCE:
Personal relevance is highly motivating
Ask the patient why quitting is personally relevant
Enlighten the patient on what he/she doesn’t know.
2. RISKS of continuing tobacco use:
Acute risks-
Oral wounds do not heal
Periodontal disease develops
Blood cholesterol increases
There may be harm to pregnancy (in women)
Impotence & infertility (in men)
Increased level of carbon monoxide in the blood (in smokers)
75. ANTI-TOBACCO COUNSELLING -THOSE UNWILLING TO QUIT
Long-term risks-
Tooth loss
OSF in users of products containing areca nut (supari)
Oral & other cancers
Heart attack & stroke
Lung disease
Disability
Financial losses due to prolonged healthcare needs.
Environmental risks-
For smokers, there is an increased risk of the spouse developing lung cancer & heart disease.
Women may give birth to low birth weight children.
Children exposed to tobacco smoke are in danger of developing sudden infant death, respiratory infections,
asthma, middle ear disease.
Chewers spread germs & make a mess by spitting.
76. ANTI-TOBACCO COUNSELLING -THOSE UNWILLING TO QUIT
3. REWARDS of quitting:
Improved health
Improved taste of food
Improved sense of smell
Saving of money
Feeling better about self
Set as good example to children
Worry about quitting stops
Withdrawal symptoms
Fear of failure
Lack of support
Weight gain
Depression
Enjoyment of tobacco
77. ANTI-TOBACCO COUNSELLING -THOSE UNWILLING TO QUIT
4. ROADBLOCKS to quitting:
Fear of withdrawal symptoms
Fear of failure
Lack of support
Enjoyment of tobacco
Fear of weight gain
Depression
5. REPEAT these messages at each visit:
Repeat the motivational messages each time an unmotivated patient visis.
Tobacco users who have tried to quit previously & failed need to hear that most people make repeated
attempts before they are successful.
78. TOBACCO CESSATION CLINICS IN INDIA
Tata Memorial Centre Mumbai
Postgraduate Institute of Medical Education & Research Chandigarh
Institute of Human Behaviour and Allied Sciences Delhi
Pramukhswami Medical College & Shree Krishna Hospital Karamsad, GUjrat
Acharya Harihar Regional Cancer Centre Cuttack
Indira Gandhi Institute of Cardiology Patna
Chtrapati Shahuji Maharaj Meedical University Lucknow
Jawaharlal Cancer Hospital & Research Centre Bhopal
Salgaokar Medical Research Centre Chilcalim, Goa
Bhagwan Mahavir Cancer Hospital & S.M.S Hospital(Govt.) Jaipur
National Institute of Mental Health and Neuro Sciences (NIMHANS) Bangalore
Cancer Institute (WIA) Chennai
Department of Respiratory Medicine, Vallabhbhai Patel Chest Institute Delhi
MNJ Institute of Oncology & Regional Cancer Centre Hyderabad
Dr. B. Borooah Cancer Institute Guwahati, Assam
79. Chittaranjan National Cancer Institute (CNCI) Kolkata
Regional Cancer Centre (RCC) Thiruvananthapuram
Regional Cancer Centre(RCC) Aizwal, Mizoram
80. Some of the main De-Addiction Centres functioning in Rajasthan
1. Maa Gayatri Hospital Psychiatry Department, Udaipur
2. Swami Swasthya Kendra & De-addiction, Jaipur
3. Bhagwan Mahaveer Psychiatric & De-Addiction Centre, Jaipur
4. Rajasthan Wellness Clinic, Jaipur
5. Sanjeevani Nasha Mukti Kendra, Jaipur
6. Nav Vikalp Sansthan, Jaipur
7. Nasha Mukti Kendra District Hospital, Amber, Jaipur
8. Nai Aasha Nasha Mukti Kendra, Sri Ganganagar
9. Prerna De-addiction & Rehabilitation Centre, Sri Ganganagar
10. Nav Jivan, Hanumangarh
11. U-Turn Nasha Mukti Kendra, Hanumangarh
12. Sant Nasha Mukti Center, Hanumangarh
13. Mannat Sewa Sansthan, Jodhpur
14. Asha Bhawan, Jodhpur
15. Fortis Modi Hospital Psychiatry Department, Kota
16. Mittal Hospital Psychiatry Department, Ajmer
81. National Tobacco Control Programme (NTCP)
Only two DTCCs are supported in each state.
In Rajasthan the two DTCCs are located at
Jaipur and Jhunjhunu Distts.
A sustainable mechanism has been put in place in
Jhunjhunu district and the district administration has
now taken ownership of declaring Jhunjhunu as
Smoke free in the coming months. Squads have been
formed at the district level, challans printed, raids are
being conducted and the same model is now being
repeated at the block level as well.
After repeated requests to the Jaipur district and state
administration, challan books have finally been
printed on the basis of sample challan designs
provided by Rajasthan VHA and raids are expected to
begin soon, to penalize violations.
82. ACTION IN THE COMMUNITYAND THE NATION
• IN THE COMMUNITY -
Dentists are highly respected, trusted and influential community leaders in any society.
Their voices are heard across a vast range, economic and political arenas.
• Public education-
Dentists can display educational material on anti-tobacco themes in their clinics and hospitals, and prohibit
the use of any kind of tobacco product within 100 metres of their hospitals.
Dentist can link up with non-governmental organizations to spread health awareness about the ill-effects of
tobacco and promote cessation in schools, colleges and communities.
Dentists can sensitize youth groups to become efficient awareness generators in the community and monitor
the implementation of tobacco control laws.
• Media advocacy-
Dentists can actively engage the media in creating awareness among the masses about tobacco control
issues.
Dentists can participate in talk shows on television and radio to talk about tobacco use issues.
83. • AT THE STATE AND NATIONAL LEVELS -
Dentists can use their influence to encourage governments to put in place tobacco control measures.
Dentists can be involved in both direct advocacy (influencing decision- makers) and indirect advocacy
(building support among the general public to put pressure on decision-makers to initiate change).
As members of professional organizations, dentists can play an important role in tobacco control advocacy
at the state and national levels.
• Making the profession and dental facilities tobacco- free-
Dentist associations can prepare a national ‘Code of practice on tobacco control for dentists’. This code of
practice on would highlight the potential role of dentists and their organizations in the treatment of tobacco
dependence and provide guidance on organizational challenges and activities that can be undertaken to
promote a tobacco-free profession.
• Advocacy with the state and national governments-
Dental associations can advocate for the inclusion of tobacco cessation as an important component in
national health programmes such as-
o National Rural Health Mission
o National Cancer Control Programme
o Reproductive and Child Health Programme
84. Dentists can advocate for the levy of a ‘health tax’ on the sale of every packet of tobacco, beedi, paan
masala and cigarettes, which could be used for health education on the dangers of tobacco use.
Dentists and their associations, along with other health professionals can participate in the development of
a national plan of action for tobacco control in accordance with the Indian Tobacco Act, 2003.
All conferences and events organized by dental professionals should be declared tobacco free.
85. CONCLUSION
• Tobacco cessation in simple words means stopping tobacco use, which is in some ways the most difficult,
as well as for many the most successful, thing the person concerned may have done.
• Only 5% of the world’s population has access to comprehensive tobacco cessation services.
• It is sad that the biggest cause of preventable death and disease has the least amount of effective
intervention available.
• As health professionals, our core responsibility is two-fold:
Play a role in reducing the use of tobacco in the community by providing clear and definite advice on
the dangers of tobacco to the public in general and to patients in particular.
Encourage tobacco cessation with proper advice, support and treatment.
86.
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