• Asian Pacific Journal of Cancer Prevention
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• v.13 no.12
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• pp.5959-5963
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• 2012

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

• The Korean Society of Law and Medicine
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• v.9 no.2
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• pp.231-267
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• 2008

Tobacco has become the world's leading cause of deaths and diseases. And !be tobacco use and dependence itself is a kind of diseases, so-called "mental and be-havioural disorders due to use of tobacco" in "International Statistical Classification of Diseases and Related Health Problems(ICD-10)" and "Korean Standard Classification of Diseases". The tobacco use and dependence is a chronic disease that requires repeated clinical interventions and multiple attempts to quit. But effective treatments to the tobacco use and dependence are developed and exist that can significantly increase the rate of long-tenn smoking abstinence. So the physicians should warn smoking patients about the dangers of smoking to the health and the life, and the clinicians ought to provide one of more of the treatments which have been proven effective in helping smokers quit to smoke. It has been concluded that if a doctor failed to provide effective treatment for smokers, and the smokers subsequently died of the smokers-related conditions(tobaccosis) or became incapacitated by the tobaccosis the smokers were considered in the medical malpractice. Thus the smokers could sue the physician for medical malpractice, claiming that the doctor's legal responsibility of appropriate treatments including smoking-cessation which the physician deliberately or negligently breached.

• Journal of Preventive Medicine and Public Health
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• v.51 no.1
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• pp.1-5
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• 2018

Smokers keep smoking despite knowing that tobacco claims many lives, including their own and others'. What makes it hard for them to quit smoking nonetheless? Tobacco companies insist that smokers choose to smoke, according to their right to self-determination. Moreover, they insist that with motivation and willpower to quit smoking, smokers can easily stop smoking. Against this backdrop, this paper aims to discuss the addictive disease called tobacco use disorder, with an assessment of the addictiveness of tobacco and the reasons why smoking cessation is challenging, based on neuroscientific research. Nicotine that enters the body via smoking is rapidly transmitted to the central nervous system and causes various effects, including an arousal response. The changes in the nicotine receptors in the brain due to continuous smoking lead to addiction symptoms such as tolerance, craving, and withdrawal. Compared with other addictive substances, including alcohol and opioids, tobacco is more likely to cause dependence in smokers, and smokers are less likely to recover from their dependence. Moreover, the thinning of the cerebral cortex and the decrease in cognitive functions that occur with aging accelerate with smoking. Such changes occur in the structure and functions of the brain in proportion to the amount and period of smoking. In particular, abnormalities in the neural circuits that control cognition and decision-making cause loss of the ability to exert self-control and autonomy. This initiates nicotine dependence and the continuation of addictive behaviors. Therefore, smoking is considered to be a behavior that is repeated due to dependence on an addictive substance, nicotine, instead of one's choice by free will.

• Asian Pacific Journal of Cancer Prevention
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• v.14 no.4
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• pp.2673-2680
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• 2013

Tobacco abuse is a major preventable cause of premature death and disease, including various cancers. The Global Adult Tobacco Survey India (GATS) 2009-10 revealed that more than one-third of adults use tobacco in one form or the other. Nearly two in five smokers and smokeless tobacco users made attempts to quit the habit in the past 12 months. Tobacco dependence is a chronic condition characterized by susceptibility of relapse over years. It can be well handled by sustained professional support from health care providers mainly through behavioral counseling and pharmacotherapy. Dental professionals can play a pivotal role in diagnosing and effectively managing tobacco dependence. Dental Institutions have rapidly grown in last two decades across the country and so has the curriculum been adapted to improve student competencies to accommodate changing disease patterns and technological advances, but not in regard to tobacco cessation. Untapped dental manpower like undergraduates, dental hygienists and other paramedical staff need effective training to be more penetrative. The present review paper explores the potential role of dental training institutions and recommends various approaches to counter public health jeopardy of tobacco related diseases.

• Journal of Preventive Medicine and Public Health
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• v.54 no.2
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• pp.137-144
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• 2021

Objectives: The aim of this study was to identify factors associated with quitting smoking in Indonesia Methods: Data on 11 115 individuals from the fifth wave of the Indonesia Family Life Survey were analyzed. Quitting smoking was the main outcome, defined as smoking status based on the answer to the question "do you still habitually (smoke cigarettes/smoke a pipe/use chewing tobacco) or have you totally quit?" Logistic regression was performed to identify factors associated with successful attempts to quit smoking. Results: The prevalence of quitting smoking was 12.3%. The odds of successfully quitting smoking were higher among smokers who were female (adjusted odds ratio [aOR], 2.69; 95% confidence interval [CI], 2.08 to 3.33), were divorced (aOR, 2.45; 95% CI, 1.82 to 3.29), did not chew tobacco (aOR, 3.01; 95% CI, 1.79 to 5.08), found it difficult to sacrifice smoking at other times than in the morning (aOR, 1.29; 95% CI, 1.14 to 1.46), and not smoke when sick (aOR, 1.32; 95% CI, 1.14 to 1.54). About 59% of variance in successful attempts to quit smoking could be explained using a model consisting of those variables. Conclusions: Female sex, being divorced, not chewing tobacco, and nicotine dependence increased the odds of quitting smoking and were associated with quitting smoking successfully. Regular and integrated attempts to quit smoking based on individuals' internal characteristics, tobacco use activity, and smoking behavior are needed to quit smoking.

• Asian Pacific Journal of Cancer Prevention
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• v.17 no.2
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• pp.829-833
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• 2016

Purpose: To investigate the work associated stress and nicotine dependence among law enforcement personnel in Mangalore, India. Materials and Methods: A cross-sectional questionnaire survey was conducted among law enforcement personnel in Mangalore, India. Demographic details, stress factors experienced at work and nicotine dependency were the variables studied. The extent of stress factors experienced at work was assessed using the Effort-Reward Imbalance scale (ERI). Nicotine dependence was measured using the Fagerstrom Test for Nicotine Dependence (FTND) and the Fagerstrom Test for Nicotine Dependence-Smokeless Tobacco (FTND-ST). Logistic regression was used for the statistical analysis. Results: Three hundred and four law enforcement personnel participated in the study, among whom 68 had the presence of one or more habits like tobacco smoking, tobacco chewing and alcohol use. The mean effort score was $15.8{\pm}4.10$ and the mean reward and mean overcommitment scores were $36.4{\pm}7.09$ and $17.8{\pm}5.32$ respectively. Effort/Reward ratio for the total participants was 1.0073 and for those with nicotine habit was 1.0850. Results of our study demonstrated no significant association between domains of ERI scale and presence of habits but work associated stress was associated with the presence of one or more habits. Compared to constables, head constables had 1.12 times higher risk of having a nicotine habit. Conclusions: Our study implies job designation is associated with nicotine habits. However, there was no association between work associated stress and nicotine dependence among law enforcement personnel in Mangalore.

• Asian Pacific Journal of Cancer Prevention
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• v.14 no.5
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• pp.3299-3304
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• 2013

Background: The Global Adult Tobacco Survey has 15 key indicators, cigarettes smoked per day (CPD) among daily smokers being one of them. The first wave of GATS in 14 countries indicated that mean CPD use is higher in women than men in India only, which is contrary to the current understanding of tobacco use globally. This study was undertaken to understand the unusual findings for mean CPD use in the GATS-India survey. Materials and Methods: Items B06a and B06b of the GATS India survey questionnaire that collected information on daily consumption of manufactured and rolled cigarettes were analyzed using SPSS software. Exclusive users were identified from these items after excluding the concurrent users of other tobacco products. Cigarette type, exclusive use and gender stratified analyses were made. Consumption of different types of cigarettes among the mixed users of manufactured and rolled cigarettes were correlated. Results: Higher mean number of CPD use among male daily-smokers was observed than their female counterparts in product specific analysis. Mean CPD as per GATS cigarette definition was higher in males than females for exclusive users but a reverse trend was observed in case of non-exclusive users. Use of manufactured cigarettes increased with increase in use of rolled cigarette among the mixed users and around half of these users reported equal CPD frequency for the both types of cigarettes. Conclusions: The anomaly in mean CPD estimate in GATS-India data was due to inclusion of two heterogeneous products to define cigarettes, variation in cigarette product specific user proportions contributing to the average and non-exclusive concurrent use of other tobacco products. The consumption pattern of cigarettes among the mixed users highlights bias in CPD reporting. Definition, analysis and interpretation of 'cigarettes per day' in the GATS India survey need to be improved by redefining cigarettes and making product specific analyses.

• Asian Pacific Journal of Cancer Prevention
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• v.13 no.10
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• pp.4973-4977
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• 2012

Introduction: Tobacco use is a global health care problem. Repetitive exposure to nicotine produces neuroadaptation resulting in nicotine dependence. Smoking is associated with a range of diseases, causing high levels of morbidity and mortality and is one of the leading causes of preventable deaths, with more than 4.6 million smokers worldwide dying each year from smoking related illnesses. Stopping smoking has major health benefits. Quitting at any age provides both short and long term benefits. Materials and methods: 45 patients attending the outpatient department at the Oxford Dental College, Bangalore, were randomly allocated to three groups of interventions namely placebo, counseling and nicotine replacement therapy (NRT). Initially each one was assessed for carbon monoxide levels using a breath analyser (pico smokerlyser bedfont UK). They were followed up for six months and the carbon monoxide levels were again assessed using the same instrument. The paired t test was used to compare the results before and after the intervention. Results: The scores before the initiation of intervention and after treatment were compared and all three interventions were found to be statistically significant after six months. It was noticed that patients with very low or low dependence followed by high dependence had good response in the placebo group (68% and 47.6% respectively), in the counseling group maximum response was seen in the medium followed by the very low group (61% and 59% respectively), and maximum response was seen in very high followed by the very low group with NRT (78.7% and 60.5% respectively). Conclusion: The inference that can be drawn from the present study is that non-invasive, non pharmacological methods like placebo and counseling are effective in low to medium groups, and NRT is effective with higher nicotine dependence.

• Journal of Korean Public Health Nursing
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• v.34 no.3
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• pp.368-379
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• 2020

Purpose: This study aimed to identify factors influencing nicotine dependence among male college students intending to quit smoking on the basis of the PRECEDE model. Methods: A cross-sectional survey of smokers, enrolled at the Smoking Cessation Support Center in W city in Korea was conducted between September 2015 and December 2016. Data was analyzed using the SPSS program for descriptive statistics, bivariate analyses, and hierarchical multiple regression. Results: The mean score of nicotine dependence was determined to be 2.9. Tobacco craving (β =.34, p<.001), social smoking (β =-.23, p=.004), allowance (β =.22, p=.010) and age of smoking initiation (β =-.20, p=.022) were factors that predicted nicotine dependence of male college students. The final model explained 28.3% of the variation in nicotine dependence (adjusted R2=.28), and was significant (F=7.22, p<.001). Conclusions: We determined that to support smoking cessation, it is necessary to develop anti-smoking programs that consider the social and cultural factors of male college students as well as their personal psychological characteristics.

• Asian Pacific Journal of Cancer Prevention
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• v.13 no.11
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• pp.5483-5488
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• 2012

Background: Although nicotine dependence plays a role as a main barrier for smoking cessation, there is still a lack of solid evidence on the validity of biomarkers to determine nicotine dependence in clinical settings. This study aimed to investigate whether urinary cotinine levels could reflect the severity of nicotine dependence in active smokers. Materials and Methods: Data regarding general characteristics and smoking status was collected using a self-administered smoking questionnaire. The Fagerstr$\ddot{o}$m test for nicotine dependence (FTND) was used to determine nicotine dependence of the participants, and a total of 381 participants were classified into 3 groups of nicotine dependence: low (n=205, 53.8%), moderate (n=127, 33.3%), and high dependence groups (n=49, 12.9%). Stepwise multiple linear regression model and receiver operating characteristic (ROC) curves analyses were used to determine the validity of urinary cotinine for high nicotine dependence. Results: In correlation analysis, urinary cotinine levels increased with FTND score (r=0.567, P<0.001). ROC curves analysis showed that urinary cotinine levels predicted the high-dependence group with reasonable accuracy (optimal cut-off value=1,000 ng/mL; AUC=0.82; P<0.001; sensitivity=71.4%; specificity=74.4%). In stepwise multiple regression analysis, the total smoking period (${\beta}$=0.042, P=0.001) and urinary cotinine levels (${\beta}$=0.234, P<0.001) were positively associated with nicotine dependence, whereas an inverse association was observed between highest education levels (>16 years) and nicotine dependence (${\beta}$=-0.573, P=0.034). Conclusions: The results of this study support the validity of using urinary cotinine levels for assessment of nicotine dependence in active smokers.