Epidemiology and site-specific risk factors for oral cancer

To outline the global epidemiology of oral cancer and recent changes in disease prevalence with the emergence of HPV-induced cancers

Qualitative analysis to identify determinants of use among different occupational settings and channels of communication to address smokeless tobacco use in Sri Lanka.

Smokeless tobacco (SLT) use is a leading cause for oral and pharyngeal cancers in the Southeast Asian region which leads to considerable morbidity and mortality. This study aims to Identify the determinants of use and channels of communication to address smokeless tobacco use among specific user groups in Sri Lanka. The study uses a qualitative approach with purposive, snowballing sampling among groups. Specific high-risk demographic and occupational groups that are known to have high prevalence of SLT use were identified in five of the 25 administrative districts of Sri Lanka, were approached. Sixty-two in-depth interviews and 10 focus group discussions were carried out among different occupational groups in five districts. Thematic analysis coding each reported determinants and communication methods was carried out. Users of SLT of different groups revealed different determinants of use. Some of the determinants were common to several groups. When investigated the preferred methods to address SLT, it is found that the media use was also different among these groups. All preferred group level awareness programmes to individual level awareness programmes. Most groups watch specific television channels at specific times of the day. Most groups stated that they accepted the messages of religious leaders and cancer victim groups. Radio and newspapers were used rarely by these groups that were studied. Smart phones were used only by urban youth and others used basic mobile phones only for calling. Different risk groups were identified allowing preparation of an overall communication approach to address use of SLT. The findings here Identify determinants of use and the communication approaches that can be used to prepare an effective communication strategy to address SLT use among different and sometimes hidden groups in resource poor settings in low a middle-income country

Smokeless tobacco control: Litigation & judicial measures from Southeast Asia

Recourse to litigation and positive judicial interventions is one of the most effective tools to meet public health objectives. The present review envisions compiling litigation and judicial measures in Southeast Asia Region (SEAR) while assessing their role in advancing smokeless tobacco (SLT) control, and equally highlighting, how tobacco industry has used litigation to undermine tobacco control efforts in the Region. The litigation, especially from the SEAR, up to 2017, that have facilitated SLT control or have been used by the tobacco industry to challenge an SLT control policy decision were reviewed. Most of the litigation related to SLT control from the Region are on pictorial health warnings. Bhutan has imposed a complete prohibition on sale, manufacture and import of all kinds of tobacco products and the litigation there relates to the prosecution of offenders for violating the ban. Judiciary in the Region is well informed about the ill-effects of tobacco use and remains positive to tobacco control initiatives in the interest of public health. In India, several SLT-specific litigation helped in better regulation of SLT products in the country. Litigation has compelled governments for effective enforcement of the domestic tobacco control laws and the World Health Organization (WHO) Framework Convention on Tobacco Control (FCTC). Parties to the WHO FCTC must now use Treaty Article 19 to strengthen their legal procedures and make the tobacco industry liable, for both criminal and civil wrongs

Oral Cancer Disease among the Poor: A Sri Lankan Context

Oral cancer (OC) is the 16th most common cancer worldwide. In Sri Lanka, OC is the most prevalent cancer among men and the eighth among women. In most instances, OC is preceded by clinically recognizable disorders appearing on the oral mucosa, termed oral potentially malignant disorders (OPMD). The distribution of OC among low- and middle-income socioeconomic groups contributes to various factors. Poor oral health literacy, a lower quality of higher education, and the economic burden results in neglected oral health. The further economic recession has led to the formation of risk habits, such as chewing betel quid, smoking and the consumption of alcohol, among these groups to minimize stress levels. But with a lack of oral health awareness, the incidences of OC increase in this category. This review elaborates on a few cross-sectional studies conducted in various locations in Sri Lanka, discussing the low awareness of neglected oral health, the usage of tobacco in a smokeless and non-smokeless manner, consuming alcohol, and the chewing of betel nuts. This review aims to overcome the barriers in these low- and middle-income socioeconomic groups in developing nations such as Sri Lanka by creating more awareness and minimizing the incidence and diagnosis and treatment at early stages to improve the quality of life as well as longevity

Public awareness of oral cancer, of oral potentially malignant disorders and of their risk factors in some rural populations in Sri Lanka

Amarasinghe HK, Usgodaarachchi US, Johnson NW, Lalloo R, Warnakulasuriya S. Public awareness of oral cancer, of oral potentially malignant disorders and of their risk factors in some rural populations in Sri Lanka. Community Dent Oral Epidemiol 2010; 38: 540-548. Ǎ 2010 John Wiley & Sons A/S Abstract-Objective: The aim of this study was to investigate the level of public awareness of oral cancer, of oral potentially malignant disorders (OPMD) and of risk factors for developing these diseases in a province of Sri Lanka, a country with one of the highest incidences of these diseases in the world. Methods: A cross-sectional community-based survey was carried out in Sabaragamuwa province by interviewing 1029 subjects above 30years of age, over a 1-year period from November 2006. Results: The level of public awareness of oral cancer was 84%, but only 23% for OPMD. Awareness was especially poor in low socioeconomic groups. The majority of subjects were not aware of the symptoms of oral cancer and of OPMD. Thirty-two percent were unaware that chewing betel quid was a risk factor for these diseases, as were 65% for tobacco smoking and 81% for heavy consumption of alcohol. Overall, 76% were not aware of any of the dangers inherent in the frequent use of areca nut. The majority of smokers, betel quid chewers and alcohol consumers were not aware that their lifestyles were placing their long-term health at serious risk. Conclusions: Knowledge of oral cancer, OPMD and their associated risk factors was poor among this population, indicating an urgent need to implement public health education and promotion strategies

Betel-quid chewing with or without tobacco is a major risk factor for oral potentially malignant disorders in Sri Lanka: a case-control study

We investigated the prevalence of, and risk factors for, oral potentially malignant disorders (OPMDs) in rural Sri Lanka. A cross-sectional community-based study was conducted by interview and oral examination of 1029 subjects aged over 30 years. A community-based nested case-control study then took those with OPMDs as 'cases', "controls" being those with no oral abnormalities at time of initial screening. The prevalence of OPMD was 11.3% (95% CI: 9.4-13.2), after weighting for place of residence and gender. Risk factors were betel-quid (BQ) chewing daily [OR = 10.6 (95% CI: 3.6-31.0)] and alcohol drinking daily or weekly [OR = 3.55 (1.6-8.0)]. A significant dose-response relationship existed for BQ chewing. Smoking did not emerge when adjusted for covariates. A synergistic effect of chewing and alcohol consumption existed. The attributable risk (AR) of daily BQ chewing was 90.6%, the population AR 84%. This study demonstrates high prevalence of OPMD, betel-quid chewing with or without tobacco being the major risk factor

Focus group guide.

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Communication strategy.

Communication strategy.</p

In-depth interview guide.

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