Reasons for betel quid chewing amongst dependent and non-dependent betel quid chewing adolescents: a school-based cross-sectional survey

Background: Betel quid (BQ) chewing in children is initiated in their adolescence. It is pivotal to understand adolescents’ reasons behind chewing BQ. In this study, we aimed to evaluate the reasons for BQ chewing amongst adolescents using reasons for betel quid chewing scale (RBCS) and their associated dependency on it. Methods: This is a cross-sectional school based survey. Out of 2200 adolescents from 26 schools of Karachi, 874 BQ chewers were assessed for their reasons of BQ chewing and dependency on it. Regression analyses were employed to report crude and adjusted (after adjusting for all reasons of BQ chewing) effect sizes with 95% confidence interval and P-value was set significant at < 0.05. Results: Students who believed that BQ chewing relaxes them (stimulation construct) were twice as likely to be dependent on BQ (OR = 2.36, 95% CI (1.20–4.65) as compared with others. Participants who thought it eases their decision making (stimulation construct), were sizably more likely to be dependent on BQ (OR = 9.65, 95% CI (4.15–22.43) than those who did not consider ease in decision making important. Adolescents who considered not chewing as rude (social/cultural construct), were thrice more likely to be dependent on BQ (OR = 2.50, 95% CI (1.11–5.63) than others. Conclusions: Stimulation remained fundamental chewing reason followed by social/cultural trigger amongst adolescents. Any future intervention may get favorable results if it addresses ways to overcome stimulation and social/cultural barriers that are strongly associated with BQ chewing and dependency

Maternal education, empowerment, economic status and child polio vaccination uptake in Pakistan: a population based cross sectional study

Objectives: To explore the association of maternal education and empowerment with childhood polio vaccination using nationally representative data of Pakistani mothers in a reproductive age group. Design: Cross-sectional. Setting: Secondary analysis of Pakistan Demographic and Health Survey (PDHS), 2012–2013 data was performed. Participants: Of the 13 558 mothers included in the survey sample, 6982 mothers were able to provide information regarding polio vaccinations. Main outcome measures: Polio vaccination coverage among children aged up to 5 years was categorised as complete vaccination (all four oral polio vaccine (OPV) doses), incomplete vaccination, and no vaccination (zero OPV dose received). Mothers' empowerment status was assessed using standard ‘Measure DHS’ questions regarding their involvement in decision-making related to health, household possessions and visits among family and friends. Education was categorised as no education, primary, secondary and higher education. Results of multinomial regression analyses were reported as adjusted OR with 95% CI. We adjusted for age, wealth index, urban/rural residence, place of delivery, and antenatal and postnatal visits. Results: Only 56.4% (n=3936) of the children received complete polio vaccination. Women with no education had significantly higher odds of their child receiving no polio vaccination (OR 2.34, 95% CI 1.05 to 5.18; p<0.01) and incomplete vaccination (OR 1.40, 95% CI 1.04 to 1.87; p<0.01). Further, unempowered women also had significantly higher odds of not taking their child for any polio vaccination (OR 1.58, 95% CI 1.17 to 2.12; p<0.01) and incomplete vaccination (OR 1.18, 95% CI 1.00 to 1.41; p=0.04). Conclusions: Illiteracy, socioeconomic status and empowerment of women remained significant factors linked to poorer uptake of routine polio vaccination

Health professional students’ perceptions regarding their role in tobacco control: findings from the Global Health Professional Students Survey, Pakistan, 2011

Background: An important way of reducing tobacco use is to train the health professional (HP) students to assist in tobacco cessation by educating patients and public. In order to shape their thoughts for the desired role, it is vital to understand their existing perceptions regarding HP’s role in tobacco control. Thus, the aim of our study was to find out the perceptions of Pakistani HP students regarding their future role in tobacco control, and examine factors associated with negative perceptions.<p></p> Methods: Secondary data analysis of the Global Health Professional Students Survey, Pakistan, 2011 was performed. Study population included 3445 health professional students in third year of graduate level programs. The dependent variable (perceptions of HP students), was developed using four questions from the survey. Students who did not regard HP’s role in tobacco control were labeled as having negative perceptions. Logistic regression analyses were conducted to analyze association between HP students’ perceptions and various socio-demographic, attitudinal and knowledge related factors; and were reported as adjusted odds ratios with 95% confidence interval.<p></p> Results: We found that 44.8% (n = 1542) of students do not regard HPs as role model for their patients and public, and perceive that HPs do not play an important part in patient’s quitting tobacco use. These negative perceptions were associated with male sex (OR = 1.25, 95% CI 1.02 – 1.53, p value 0.028), and poor knowledge about tobacco cessation techniques (OR = 1.32, 95% CI 1.12 – 1.55, p value < 0.001). Negative perceptions were also associated with their attitudes towards ban on: tobacco advertisements (OR = 1.67, 95% CI 1.13 – 2.48, p value 0.010); and tobacco use at public places (OR = 1.60, 95% CI 1.26 – 2.03, p value < 0.001).<p></p> Conclusion: The role of HPs for tobacco control is fairly under-perceived by HP students, and the undesired negative perceptions are associated with male sex, poor knowledge about tobacco use cessation techniques and negative attitudes towards legislative control. A comprehensive approach, focusing on these aspects should be adopted to train HPs, in order to utilize them as an effective manpower for tobacco control

Prevalence and determinants of susceptibility to cigarette smoking among school students in Pakistan: secondary analysis of Global Youth Tobacco Survey

Background: Susceptibility to smoke has been recognized as a strong predictor of smoking experimentation and taking up regular smoking habit. The identification of smoking susceptible individuals and its determinants is important in the efforts to reduce future smoking prevalence. The aims of this study are to estimate prevalence of susceptibility to smoke among adolescents, and identify factors associated with it.<p></p> Methods: Cross sectional data was obtained from Global Youth Tobacco Survey conducted in three cities of Pakistan in year 2004. Study population consisted of students in grades, 8th, 9th, and 10th; aged 13 to 15 years. Secondary analysis using univariate and multivariate logistic regression analyses were performed to estimate the associations between smoking susceptibility and co-variates. Descriptive statistics were reported in proportions, and adjusted odds ratios with 95% confidence interval were used to report logistic regression analyses.<p></p> Results: Approximately 12% of nonsmoking students were found susceptible to smoking. Students, who were females (OR = 1.53, 95% CI [1.24-1.89]); whose parents (OR = 1.64, 95% CI [1.35-1.99]); or close friend smoked (OR = 2.77, 95% CI [2.27- 3.40]) were more susceptible to cigarette smoking. Students who had good knowledge about harmful effects of smoking (OR = 0.54, 95% CI [0.43-0.69]); and had access to anti-smoking media (OR = 0.73, 95% CI [0.59-0.89]) were less likely to be susceptible to smoking.<p></p> Conclusion: Students who were females, had smoking parents, friends or exposure to newspaper/magazines cigarette marketing, were more susceptible to cigarette smoking among Pakistani adolescents. While knowledge of harmful effects of smoking and access to anti-smoking media served as protective factors against susceptibility to smoking.<p></p&gt

Analysis of the incidence and patient survival for prostate cancer in the West of Scotland

Prostate cancer has emerged as the most frequently diagnosed cancer, except for non-melanoma skin cancer, among men in many Western countries in the last decade. In the United Kingdom (UK), prostate cancer accounts for nearly a quarter of all new male cancer diagnoses. Increasing age and some genetic and ethnic risk factors have been identified but few modifiable risk factors are known. The introduction of Prostate Specific Antigen (PSA) testing has increased the detection of previously undiagnosed disease but its contribution to the observed increases in prostate cancer incidence is not clear. Considerable variations in the incidence of prostate cancer have been observed in different geographic regions and socio-economic groups across the UK but it is not known whether, or to what extent, these may be attributed to differential uptakes of PSA testing. Prostate cancer is the third most common cause of cancer death in men but many cases do not progress. There is therefore an important clinical need for better prognostic markers so that the increasing numbers of men with prostate cancer can be appropriately managed. This thesis begins with a descriptive epidemiological study using cancer registry incidence data from the West of Scotland from 1991 to 2007. The aim was to determine whether the incidence of prostate cancer was continuing to rise and to describe any demographic or socio-economic patterns that might suggest particular at-risk groups. To understand whether any socio-economic differentials in incidence might be due to PSA testing, I examined Gleason grade-specific prostate cancer incidence by socio-economic groups over time. Socio-economic circumstances were measured using census-derived Carstairs scores. Overall (age adjusted) prostate cancer incidence increased by 70% from 44 per 100,000 in 1991 to 75 per 100,000 in 2007, an average annual growth of 3.59%. This pattern was driven by significant increases in both low and high grade cancers with no convincing change in their proportions over time. Incidence was inversely associated with deprivation with the highest rates among the most affluent groups. To explore the role of potentially modifiable risk factors on prostate cancer incidence, the Midspan and Collaborative prospective cohort studies were analysed. An analysis of the relationship between cholesterol and prostate cancer incidence was conducted on the Midspan cohort, which comprises 12,926 men who were enrolled between 1970 and 1976 and followed up to 31st December 2007. Cox Proportional Hazards Models were used to evaluate the association between baseline plasma cholesterol and Gleason grade-specific prostate cancer incidence. Following up to 37 years’ follow-up, 650 men developed prostate cancer. Their baseline plasma cholesterol level was positively associated with hazard of high grade (Gleason score ≥8) prostate cancer incidence (n=119). The association was greatest among men in the 4th highest quintile for cholesterol, 6.1 to <6.69 mmol/l, Hazard Ratio 2.28, 95% CI 1.27 to 4.10, compared with the baseline of <5.05 mmol/l. This association remained significant after adjustment for age, body mass index, smoking and socio-economic status. Evidence on the possible role of tea and coffee consumption in the development of prostate cancer remains limited to a small number of studies with short follow-up and small numbers of cases. Therefore to understand the relationship of tea and coffee consumption with overall as well as grade-specific prostate cancer, a prospective cohort study of 6016 men was carried out, who were enrolled in the Collaborative cohort study between 1970 and 1973 and followed up to 31st December 2007. Three hundred and eighteen men developed prostate cancer in up to 37 years’ follow-up. I found a positive association between consumption of tea and overall risk of prostate cancer incidence (p=0.02). The association was greatest among men who drank ≥7 cups of tea per day (HR 1.50, 95% CI 1.06 to 2.12) compared with the baseline of 0-3 cups per day. However, I did not find any significant association between tea intake and low (Gleason < 7) or high grade (Gleason 8-10) prostate cancer incidence. Higher coffee consumption was inversely associated with risk of high grade disease (HR 0.46, 95% CI 0.21-0.99) but not with overall risk of prostate cancer. These associations remained significant after adjustment for age, Body Mass Index, smoking, social class, cholesterol level, systolic blood pressure and alcohol consumption. Although survival of prostate cancer patients has improved over time, little is known about the major prognostic factors. To understand the socio-economic differences and major determinants of survival, an investigation was carried out using cancer registry incidence data from the West of Scotland from 1991 to 2007, linked with General Registrar Office (Scotland) death records up to 31st December 2008. Socio-economic circumstances were measured using the Scottish Index for Multiple Deprivation (SIMD). Age, sex and deprivation specific mortality rates were obtained from General Registrar Office for Scotland (GRO(S)). One, three and five year relative survival was estimated using the complete approach. Survival gradients across deprivation quintiles were estimated using linear regression, weighted by the variance of the relative survival estimate, using STATA software (StataCorp, version 11). Five year relative survival increased from 58.2% to 78.6% in men over the same period (an average deprivation adjusted increase of 10.2% between six years periods). Despite substantial improvements in survival of prostate cancer patients, there was a deprivation gap (that is, better survival for the least deprived compared with the most deprived) between the three time periods. The deprivation gap in five year relative survival widened from -4.76 in 1991-1996 to -10.08 in 2003-2007. Age, Gleason grade and socio-economic status appeared as significant determinants of survival. There is some evidence that systemic inflammation may be associated with survival in patients with prostate cancer although its relationship to tumour grade and socio-economic circumstances has not been previously studied. I therefore investigated the association between inflammation-based prognostic scores and survival, using the modified Glasgow Prognostic Score (mGPS) and Neutrophil Lymphocyte Ratio (NLR) as well as Gleason grade. The patient cohort within the Glasgow Inflammation Outcome Study who had a diagnosis of prostate cancer was included in this study. The mGPS is a categorical score constructed by combining serum C-reactive protein and albumin levels, while the NLR is obtained by calculating the ratio of neutrophils to lymphocytes. The relationship between mGPS and NLR and five-year relative survival was explored after adjusting for age, socio-economic circumstances and Gleason grade. Of the 897 prostate cancer patients in the Glasgow Inflammation Outcome Study, 422 (47%) died during a maximum follow-up of 6.2 years. Systemic inflammation had a significant prognostic value. The mGPS predicted poorer 5-year overall and relative survival independent of age, socio-economic circumstances, disease grade and NLR. Raised mGPS also had a significant association with excess risk of death (mGPS 2: Relative Excess Risk = 2.08, 95% CI 1.13-3.81) among aggressive, clinically significant prostate cancer (Gleason score 8-10). Prostate cancer patients with a raised mGPS had significantly higher risks of death overall as well as for high grade disease. Inflammation-based prognostic scores can potentially predict patient outcome and a further prospective study is warranted to assess their clinical value. Although the study of the epidemiology of prostate cancer is complicated by changing diagnostic sensitivity and disease grade definitions, the increasing number of men diagnosed with the disease demands continuing research into understanding risk factors, prognostic factors and more effective treatment. However, it seems unlikely that a simple, modifiable risk factor exists for prostate cancer and that PSA testing and an aging population will continue to drive increasing incidence

Analysis of the incidence and patient survival for prostate cancer in the West of Scotland

Prostate cancer has emerged as the most frequently diagnosed cancer, except for non-melanoma skin cancer, among men in many Western countries in the last decade. In the United Kingdom (UK), prostate cancer accounts for nearly a quarter of all new male cancer diagnoses. Increasing age and some genetic and ethnic risk factors have been identified but few modifiable risk factors are known. The introduction of Prostate Specific Antigen (PSA) testing has increased the detection of previously undiagnosed disease but its contribution to the observed increases in prostate cancer incidence is not clear. Considerable variations in the incidence of prostate cancer have been observed in different geographic regions and socio-economic groups across the UK but it is not known whether, or to what extent, these may be attributed to differential uptakes of PSA testing. Prostate cancer is the third most common cause of cancer death in men but many cases do not progress. There is therefore an important clinical need for better prognostic markers so that the increasing numbers of men with prostate cancer can be appropriately managed. This thesis begins with a descriptive epidemiological study using cancer registry incidence data from the West of Scotland from 1991 to 2007. The aim was to determine whether the incidence of prostate cancer was continuing to rise and to describe any demographic or socio-economic patterns that might suggest particular at-risk groups. To understand whether any socio-economic differentials in incidence might be due to PSA testing, I examined Gleason grade-specific prostate cancer incidence by socio-economic groups over time. Socio-economic circumstances were measured using census-derived Carstairs scores. Overall (age adjusted) prostate cancer incidence increased by 70% from 44 per 100,000 in 1991 to 75 per 100,000 in 2007, an average annual growth of 3.59%. This pattern was driven by significant increases in both low and high grade cancers with no convincing change in their proportions over time. Incidence was inversely associated with deprivation with the highest rates among the most affluent groups. To explore the role of potentially modifiable risk factors on prostate cancer incidence, the Midspan and Collaborative prospective cohort studies were analysed. An analysis of the relationship between cholesterol and prostate cancer incidence was conducted on the Midspan cohort, which comprises 12,926 men who were enrolled between 1970 and 1976 and followed up to 31st December 2007. Cox Proportional Hazards Models were used to evaluate the association between baseline plasma cholesterol and Gleason grade-specific prostate cancer incidence. Following up to 37 years’ follow-up, 650 men developed prostate cancer. Their baseline plasma cholesterol level was positively associated with hazard of high grade (Gleason score ≥8) prostate cancer incidence (n=119). The association was greatest among men in the 4th highest quintile for cholesterol, 6.1 to <6.69 mmol/l, Hazard Ratio 2.28, 95% CI 1.27 to 4.10, compared with the baseline of <5.05 mmol/l. This association remained significant after adjustment for age, body mass index, smoking and socio-economic status. Evidence on the possible role of tea and coffee consumption in the development of prostate cancer remains limited to a small number of studies with short follow-up and small numbers of cases. Therefore to understand the relationship of tea and coffee consumption with overall as well as grade-specific prostate cancer, a prospective cohort study of 6016 men was carried out, who were enrolled in the Collaborative cohort study between 1970 and 1973 and followed up to 31st December 2007. Three hundred and eighteen men developed prostate cancer in up to 37 years’ follow-up. I found a positive association between consumption of tea and overall risk of prostate cancer incidence (p=0.02). The association was greatest among men who drank ≥7 cups of tea per day (HR 1.50, 95% CI 1.06 to 2.12) compared with the baseline of 0-3 cups per day. However, I did not find any significant association between tea intake and low (Gleason < 7) or high grade (Gleason 8-10) prostate cancer incidence. Higher coffee consumption was inversely associated with risk of high grade disease (HR 0.46, 95% CI 0.21-0.99) but not with overall risk of prostate cancer. These associations remained significant after adjustment for age, Body Mass Index, smoking, social class, cholesterol level, systolic blood pressure and alcohol consumption. Although survival of prostate cancer patients has improved over time, little is known about the major prognostic factors. To understand the socio-economic differences and major determinants of survival, an investigation was carried out using cancer registry incidence data from the West of Scotland from 1991 to 2007, linked with General Registrar Office (Scotland) death records up to 31st December 2008. Socio-economic circumstances were measured using the Scottish Index for Multiple Deprivation (SIMD). Age, sex and deprivation specific mortality rates were obtained from General Registrar Office for Scotland (GRO(S)). One, three and five year relative survival was estimated using the complete approach. Survival gradients across deprivation quintiles were estimated using linear regression, weighted by the variance of the relative survival estimate, using STATA software (StataCorp, version 11). Five year relative survival increased from 58.2% to 78.6% in men over the same period (an average deprivation adjusted increase of 10.2% between six years periods). Despite substantial improvements in survival of prostate cancer patients, there was a deprivation gap (that is, better survival for the least deprived compared with the most deprived) between the three time periods. The deprivation gap in five year relative survival widened from -4.76 in 1991-1996 to -10.08 in 2003-2007. Age, Gleason grade and socio-economic status appeared as significant determinants of survival. There is some evidence that systemic inflammation may be associated with survival in patients with prostate cancer although its relationship to tumour grade and socio-economic circumstances has not been previously studied. I therefore investigated the association between inflammation-based prognostic scores and survival, using the modified Glasgow Prognostic Score (mGPS) and Neutrophil Lymphocyte Ratio (NLR) as well as Gleason grade. The patient cohort within the Glasgow Inflammation Outcome Study who had a diagnosis of prostate cancer was included in this study. The mGPS is a categorical score constructed by combining serum C-reactive protein and albumin levels, while the NLR is obtained by calculating the ratio of neutrophils to lymphocytes. The relationship between mGPS and NLR and five-year relative survival was explored after adjusting for age, socio-economic circumstances and Gleason grade. Of the 897 prostate cancer patients in the Glasgow Inflammation Outcome Study, 422 (47%) died during a maximum follow-up of 6.2 years. Systemic inflammation had a significant prognostic value. The mGPS predicted poorer 5-year overall and relative survival independent of age, socio-economic circumstances, disease grade and NLR. Raised mGPS also had a significant association with excess risk of death (mGPS 2: Relative Excess Risk = 2.08, 95% CI 1.13-3.81) among aggressive, clinically significant prostate cancer (Gleason score 8-10). Prostate cancer patients with a raised mGPS had significantly higher risks of death overall as well as for high grade disease. Inflammation-based prognostic scores can potentially predict patient outcome and a further prospective study is warranted to assess their clinical value.EThOS - Electronic Theses Online ServiceGBUnited Kingdo

Nutritional and lifestyle risk behaviors and their association with mental health and violence among Pakistani adolescents: results from the National Survey of 4583 individuals

Background: Unhealthy behaviors are associated with mental health problems and violence in adolescents, yet their combined association has been understudied. Using the Global School Health Survey, this study examined the association between combined unhealthy behaviors (including fast food, soft drink, smoking, other tobacco products and physical inactivity) and anxiety, suicidal ideation and involvement in physical fight among Pakistani adolescents. Methods: Data were obtained from the Global School Health Survey conducted in Pakistan (2009). The study population consisted of school going adolescents aged 13 to 15 years. Association of combined unhealthy behaviors with anxiety, suicidal ideation and involvement in physical fight were studied through secondary analysis. We used univariate and multivariate logistic regression analysis by complex sample method, accounting for cluster sampling technique used for data collection. Results: Of the total 4583 students, weighted percentage and unweighted count for one, two, three and four or more unhealthy behaviors was 39.4% (n = 1770), 22.1% (n = 963), 5.9% (n = 274) and 1.2% (n = 62) respectively. The weighted prevalence for anxiety, suicidal ideation and involvement in physical fight were 8.4%, 7.3% and 37.4% respectively. The results of multivariate logistic regression analysis after adjustment showed that students who had four or more unhealthy behaviors had higher odds of; being anxious (OR 2.45, 95% CI 1.31-4.59, p value 0.004), suicide ideation (OR 4.56, 95% CI 2.58-8.07, p value &lt;0.001) and being involved in physical fight (OR 3.15, 95% CI 1.63–6.08, p value &lt;0.001) as compared to those who had not adopted any unhealthy behaviors. Conclusions: This study suggests that the co-occurrence of unhealthy behaviors is associated with anxiety, suicidal ideation and physical fight among adolescents. These findings should be considered when developing interventions to combat detrimental outcomes of unhealthy behaviors during adolescence.</p

Betel quid dependency and associated intrapersonal, interpersonal, and environmental factors among adolescents: a school-based cross-sectional survey

Background: Betel quid (BQ) is one of the fourth most commonly used substance globally. Though BQ is a psycho-active substance, yet little has been explored regarding dependency on it particularly among adolescents. Objectives: Therefore, in this study, we aimed to determine adolescents' dependency on BQ, along with their intrapersonal, interpersonal and environmental determinants of dependency. Methods: This cross-sectional study focused on 2200 school-going adolescents of Karachi, Pakistan in 2016. Primary outcome was dependency on BQ among adolescents. Both univariate and multivariate regressions were used to estimate crude and adjusted odds ratios (after adjustments for all intrapersonal, interpersonal, and environmental factors) with 95% confidence level. Results: Out of 2200 students, 874 (39.7%) were found to be BQ users amongst whom 69 (7.9%) were dependent on BQ. Comparing the groups with only areca nut users as reference category, betel quid with tobacco additives chewers were considerably dependent (OR = 14.08, 95% CI 3.64–54.16). The individuals who chewed &gt;5 chews per day (OR = 1.87, 95% CI 1.08–3.29) and chronic users (&gt;1year) (OR = 2.02, 95% CI 1.09–3.74) were more likely to be dependent. Older students (&gt;12 years) (OR = 2.12, 95% CI 1.06–4.23), and who studied in government schools were significantly dependent (OR = 3.32, 95% CI 1.80–6.10) than those who studied in private schools. Conclusions: In conclusion, intrapersonal characteristics like more than 5 chews per day, chronic chewers of more than a year, BQ with tobacco chewers, older adolescents and children studying in government schools were significantly associated with BQ dependency

Individual, social and environmental determinants of smokeless tobacco and betel quid use amongst adolescents of Karachi: a school-based cross-sectional survey

Background: With 600 million people using betel quid (BQ) globally, and smokeless tobacco (SLT) use being more wide-spread; the duo is an uphill public health concern in South Asian countries. SLT and/or BQ use increases the risk for morbidity and mortality from oral cancer. Because SLT and/or BQ use is initiated during adolescence, it renders this group more vulnerable; and particular attention is needed to curb SLT and/or BQ use to reduce related disease burden. We aimed to observe the differential individual, social and environmental features amongst SLT and/or BQ users to determine the key influencers of its use in adolescents. Methods: This study was a cross-sectional survey of 2140 adolescents from secondary schools of Karachi, Pakistan. The main outcome measure was SLT and/or BQ use based on their consumption in the past 30 days. Univariate and multivariate regression binary logistic analyses were employed while reporting results in both crude form and adjusted odds ratio (after adjusting for all remaining individual, social and environmental level variables) with 95% confidence level. A p-value of &#60; .05 was considered significant for all analyses. Results: The overall prevalence of SLT and/or BQ use was 42.6% (n = 912) of the total sample. The SLT and/or BQ consumer group had more males than females. A significant proportion of user (n = 558, 61.2%) was found in co-education schools. Students whose peers (OR = 6.79, 95% CI 4.67–9.87, p-value &#60;0.001) and/or either of the parents (OR = 2.16, 95% CI 1.73–2.65, p-value &#60;0.001) used SLT and/or BQ, alongside, adolescents who had not attended knowledge based sessions in schools regarding harmful effects of SLT and/or BQ were more likely to consume it. It’s availability with outside school hawkers increased the odds of its use by 6 times, as indicated by both univariate and multivariate models after adjusting for the remaining variables. Conclusion: In conclusion, students studying in co-education, parents and peers use, lack of knowledge based sessions on harmful health effects of SLT and/or BQ, and easy availability of the product from hawkers outside school all contribute towards enhanced risk of SLT and/or BQ use in adolescents

Areca nut chewing and the risk of re-hospitalization and mortality among patients with acute coronary syndrome in Pakistan

Objectives: Areca nut is widely consumed in many parts of the world, especially in South and Southeast Asia, where cardiovascular disease (CVD) is also a huge burden. Among the forms of CVD, acute coronary syndrome (ACS) is a major cause of mortality and morbidity. Research has shown areca nut chewing to be associated with diabetes, hypertension, oropharyngeal and esophageal cancers, and CVD, but little is known about mortality and re-hospitalization secondary to ACS among areca nut users and non-users. Methods: A prospective cohort was studied to quantify the effect of areca nut chewing on patients with newly diagnosed ACS by categorizing the study population into exposed and non-exposed groups according to baseline chewing status. Cox proportional hazards models were used to examine the associations of areca nut chewing with the risk of re-hospitalization and 30-day mortality secondary to ACS. Results: Of the 384 ACS patients, 49.5% (n=190) were areca users. During 1-month of follow-up, 20.3% (n=78) deaths and 25.1% (n=96) re-hospitalizations occurred. A higher risk of re-hospitalization was found (adjusted hazard ratio [aHR], 2.05; 95% confidence interval [CI], 1.29 to 3.27; p=0.002) in areca users than in non-users. Moreover, patients with severe disease were at a significantly higher risk of 30-day mortality (aHR, 2.77; 95% CI, 1.67 to 4.59; p&lt;0.001) and re-hospitalization (aHR, 2.72; 95% CI, 1.73 to 4.26; p&lt;0.001). Conclusions: The 30-day re-hospitalization rate among ACS patients was found to be significantly higher in areca users and individuals with severe disease. These findings suggest that screening for a history of areca nut chewing may help to identify patients at a high risk for re-hospitalization due to secondary events