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Pulicherla NK, Kodali PB. Tobacco Imagery in Indian Over-the-Top (OTT) Media and Its Compliance With Existing Tobacco Laws: A Content Analysis. Nicotine Tob Res 2024; 26:752-758. [PMID: 38147534 DOI: 10.1093/ntr/ntad260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Revised: 12/10/2023] [Accepted: 12/20/2023] [Indexed: 12/28/2023]
Abstract
INTRODUCTION Over-the-top (OTT) media are internet-based content delivery systems offering media services to the viewers bypassing the traditional broadcasting platforms. The OTT media, with limited regulatory oversight, can serve as a source of exposure to tobacco-promoting content. AIMS AND METHODS This study analyzed the depiction of tobacco imagery in Indian OTT programs and assessed their compliance with existing Indian tobacco control policies. We conducted a content analysis of 28 purposively sampled OTT exclusive programs (14 movies and 14 web series) in India. Breathe California method was used to code the OTT content for tobacco imagery. We assessed the prevalence of tobacco imagery, its duration per episode or program, product placements, and brand appearances. We also evaluated OTT programs adherence to existing tobacco control policies in India. RESULTS Tobacco imagery was identified in all of the web series and most OTT-exclusive movies. On average the web series depicted seven incidents of tobacco imagery per episode, whereas there were close to 19 incidents of tobacco imagery per movie. Ten minutes of OTT programming (including movies and web series) had on average 8.40 s of tobacco imagery. None of the OTT programs studied fully complied with Indian tobacco control policies. CONCLUSIONS Depiction of tobacco imagery in OTT exclusive programs is common in India. Streaming platforms need to comply with existing tobacco control policies. Furthermore, there is a need to strengthen these policies and strictly enforce them to ensure tobacco-free mass media. IMPLICATIONS India has more than 267 million tobacco users and accounts for the largest share of smokeless tobacco use globally. OTT platforms are largely unregulated and are considered drivers for global tobacco use. This is one of the few studies examining tobacco imagery in Indian OTT content, reporting the gaps in tobacco control policies in India. This study documents the product placement of smokeless tobacco, duration of exposure to tobacco imagery, and empirically report the compliance of OTT platforms with Indian tobacco control policies. The study findings can aid in strengthening tobacco control policies in India.
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Affiliation(s)
- Naveen Kumar Pulicherla
- Department of Public Health and Community Medicine, Central University of Kerala, Kasaragod, Kerala, India
| | - Prakash Babu Kodali
- Department of Public Health and Community Medicine, Central University of Kerala, Kasaragod, Kerala, India
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Quadri MFA, Kamel AM, Nayeem M, John T, Thacheril A, Tartaglia G, Tadakamadla S. Smokeless tobacco and periodontitis: A systematic review with meta-analysis. J Periodontal Res 2024. [PMID: 38757716 DOI: 10.1111/jre.13274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Revised: 04/04/2024] [Accepted: 04/10/2024] [Indexed: 05/18/2024]
Abstract
AIM The present systematic review with meta-analysis aimed to investigate the global association between smokeless tobacco (SLT) use and periodontitis, considering significant effect size variation based on the income levels of countries. METHODS We searched seven databases to identify studies that assessed the prevalence of periodontitis in adult SLT users compared to non-users. The quality of studies was evaluated using the 10-item risk-of-bias tool, and publication bias was addressed through the trim-and-fill method. Sensitivity analysis utilized the leave-one-out approach. Meta-analysis and meta-regression, stratified by country income, SLT type, and smoking status, employed robust variance estimation. RESULTS From an initial pool of 484 studies, 29 studies met the selection criteria and were subjected to qualitative synthesis. Subsequently, data from 19 studies were included in the meta-analysis. SLT users exhibited a nearly threefold greater likelihood of periodontitis compared to non-users (OR = 2.99; 95% CI: 2.10, 4.27; p < .01). The pooled estimate did not vary significantly based on the type of SLT used or concurrent smoking. However, the odds of periodontitis varied according to the economic level of the country; the pooled estimate was higher in high-income countries (OR = 1.69; 95% CI: 1.20, 2.37; p < .01) and even higher in lower-middle-income and lower-income countries (OR = 3.91; 95% CI: 2.66, 5.77; p < .01). CONCLUSIONS Smokeless tobacco users have a higher likelihood of developing periodontitis. This study underscores global disparities in the SLT-periodontitis relationship, highlighting the need for targeted interventions, particularly in economically challenged areas where SLT use is largely unregulated.
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Affiliation(s)
- Mir Faeq Ali Quadri
- Texas Tech University of El Paso, El Paso, Texas, USA
- Saveetha Dental College and Hospitals, Chennai, India
- University of Milan, Milan, Italy
| | | | | | - Tenny John
- Saveetha Dental College and Hospitals, Chennai, India
| | | | | | - Santosh Tadakamadla
- Dentistry and Oral Health, La Trobe University, Bendigo, Victoria, Australia
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Arakeri G, Rao Us V, Dhananjay KV, Chaturvedi P, Brennan PA. Unsuccessful ban on gutkha in India needs authentication - Authors' reply. Lancet 2024; 403:1238-1239. [PMID: 38555131 DOI: 10.1016/s0140-6736(23)01893-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Accepted: 09/06/2023] [Indexed: 04/02/2024]
Affiliation(s)
- Gururaj Arakeri
- Department of Head and Neck Oncology, HCG Cancer Center, Bengaluru 560027, India; Department of Oral and Maxillofacial Surgery, HKDET Dental College and Hospital, Humnabad, India.
| | - Vishal Rao Us
- Department of Head and Neck Oncology, HCG Cancer Center, Bengaluru 560027, India
| | | | - Pankaj Chaturvedi
- Department of Head and Neck Surgery, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - Peter A Brennan
- Department of Oral and Maxillofacial Surgery, Queen Alexandra Hospital, Portsmouth, UK
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Arakeri G, Vishal Rao US, Patil S, Patil S, Krishnamurthy MVSR, Krishnan M, Brennan PA. Evaluation of fluoride levels in areca nut, tobacco, and commercial smokeless tobacco products: a pilot study. Br J Oral Maxillofac Surg 2024; 62:76-82. [PMID: 38092568 DOI: 10.1016/j.bjoms.2023.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2023] [Accepted: 11/10/2023] [Indexed: 01/16/2024]
Abstract
Oral submucous fibrosis (OSMF) is a premalignant condition associated with chewing areca nut and tobacco products. We observed increased fluoride levels in some OSMF-endemic regions,and the observation suggested that fluoride exposure may contribute to its pathogenesis. This study aimed to assess the fluoride content of various smokeless tobacco items as a potential influencing source. Fluoride concentration was analysed in commercial areca nut products, including gutkha, pan masala, and raw areca nut, along with tobacco, slaked lime, and catechu samples from Karnataka, India. Fluoride was measured using alkali fusion and the ion selective electrode method. All products showed high fluoride, with catechu having the highest mean concentration at 51.20 mg/kg, followed by tobacco, gutkha, pan masala, processed areca nut, and raw areca nut. Fluoride was also elevated in soil, but not in water. The findings demonstrate substantial fluoride levels in popular types of smokeless tobacco, and highlight an overlooked source of exposure among consumers of gutkha, pan masala and similar oral tobacco-products. The fluoride content warrants an investigation of potential links with the occurrence and severity of OSMF.
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Affiliation(s)
- Gururaj Arakeri
- Department of Head and Neck Oncology, Health Care Global (HCG) Cancer Centre, Bengaluru, India; Department of Oral and maxillofacial Surgery, Saveetha Dental College and Hospital, Chennai, India; Department of Oral and maxillofacial Surgery, HKDET Dental College and Hospital, Humnabad, Karnataka, India.
| | - U S Vishal Rao
- Department of Head and Neck Oncology, Health Care Global (HCG) Cancer Centre, Bengaluru, India
| | - Shekar Patil
- Department of Medical Oncology, Health Care Global (HCG) Cancer Centre, Bengaluru, India
| | - Shankargouda Patil
- College of Dental Medicine, Roseman University of Health Sciences, South Jordan, Utah, USA
| | - M V S R Krishnamurthy
- Department of Rural Water Supply and Sanitation, State Level Water Testing Laboratory, Vijayawada, Andhra Pradesh, India
| | - Murugesan Krishnan
- Department of Oral and maxillofacial Surgery, Saveetha Dental College and Hospital, Chennai, India
| | - Peter A Brennan
- Department of Oral & Maxillofacial Surgery, Queen Alexandra Hospital, Portsmouth, UK
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Kodali PB, Longchar W, Pulicherla NK, Thankappan KR. Chewing tobacco use among pregnant women in India: Analysis of national family health surveys. Eur J Obstet Gynecol Reprod Biol 2023; 289:79-84. [PMID: 37643549 DOI: 10.1016/j.ejogrb.2023.08.377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Revised: 07/11/2023] [Accepted: 08/21/2023] [Indexed: 08/31/2023]
Abstract
BACKGROUND India accounts for over 67% of chewing tobacco users globally and more than 50 million women in India chew tobacco. Chewing tobacco is documented to have negative effects on health of mother and foetus. This research was conducted to study the trends in chewing tobacco use among pregnant women in India, and identify factors associated with chewing tobacco use among pregnant women. METHODS We analyzed micro-data from two representative national surveys i.e., National Family Health Survey (NFHS)-4 (2015-16) & NFHS-5 (2019-21). A sample of 32,428 & 28,408 pregnant women were extracted from NFHS-4 & NFHS-5 respectively. Weighted prevalence and 95% confidence levels of chewing tobacco use were computed. State wide comparisons in chewing tobacco use were made. Employing binary logistic regression, adjusted odds ratios (AOR) were computed to identify factors associated with chewing tobacco use. RESULTS From NFHS-4 to 5 the prevalence of chewing tobacco use among pregnant women decreased from 4.0%(95% CI = 3.9-4.0) to 2.3%(95% CI = 2.2-2.4) respectively indicating a relative reduction of 42.5%. The highest prevalence remains to be in north-eastern India at 13.0%. Belonging to north-eastern region AOR = 7.0(95 %CI = 6.2-7.9), no-education AOR = 13.2(95 %CI = 10.5-16.5), poorest wealth index AOR = 6.7(95 %CI = 5.6-8.0) and belonging to scheduled tribe AOR = 2.6(95 %CI = 2.4-2.9) was significantly associated with chewing tobacco use among pregnant women. CONCLUSION From NFHS-4 to 5, chewing tobacco use during pregnancy has shifted more towards socio-economically vulnerable population. Targeted approaches with accessible and affordable tobacco cessation advice integrated to primary healthcare system are needed.
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Affiliation(s)
- Prakash Babu Kodali
- Department of Public Health and Community Medicine, Central University of Kerala, Kasaragod, Kerala, India.
| | - Wapangjungla Longchar
- Department of Public Health and Community Medicine, Central University of Kerala, Kasaragod, Kerala, India
| | - Naveen Kumar Pulicherla
- Department of Public Health and Community Medicine, Central University of Kerala, Kasaragod, Kerala, India
| | - Kavumpurathu Raman Thankappan
- Department of Public Health and Community Medicine, Central University of Kerala, Kasaragod, Kerala, India; Amrita Institute of Medical Sciences, Kochi, Kerala, India
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Arakeri G, Us VR, Patil S, Brennan PA. Unsuccessful ban on gutkha and need for tobacco control in India. Lancet 2023; 401:1154. [PMID: 37030883 DOI: 10.1016/s0140-6736(23)00406-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Accepted: 02/16/2023] [Indexed: 04/10/2023]
Affiliation(s)
- Gururaj Arakeri
- Department of Head and Neck Oncology, HCG Cancer Center, Bengaluru 560002, India; Department of Oral and Maxillofacial Surgery, HKDET Dental College and Hospital, Humnabad, India.
| | - Vishal Rao Us
- Department of Head and Neck Oncology, HCG Cancer Center, Bengaluru 560002, India
| | - Shekar Patil
- Department of Medical Oncology, HCG Cancer Center, Bengaluru 560002, India
| | - Peter A Brennan
- Department of Oral and Maxillofacial Surgery, Queen Alexandra Hospital, Portsmouth, UK
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Dsouza V, Kembhavi PM, Rao S P, P K, Hebbar PB. How does Indian news media report smokeless tobacco control? A content analysis of the gutka ban enforcement. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0001724. [PMID: 36972290 PMCID: PMC10042338 DOI: 10.1371/journal.pgph.0001724] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Accepted: 02/17/2023] [Indexed: 03/29/2023]
Abstract
Smokeless tobacco (SLT) products like gutka and paan masala are a growing public health crisis in India. Despite enacting a ban-the highest form of regulation-little is known about implementation progress. The purpose of this study was to look at how enforcement of gutka ban is covered in Indian news media and if media is a reliable source of data. We conducted a content analysis of online news reports (n = 192) from 2011 to 2019. News characteristics such as name and type of publication, language, location, slant and beat coverage, visuals, and administrative focus were quantified. Similarly, news contents were inductively coded to examine dominant themes and the implementation landscape. We found that coverage was initially low but increased after 2016. Overall, news reports were in favor of the ban. Five leading English newspapers covered the majority of the ban enforcement reports. Prominent themes like consumption, health hazards, tobacco control responses, impact on livelihoods, and illicit trade were drawn from the textual analysis as the main arguments in relation to the ban. Gutka is largely seen as an issue of crime reflected by the contents, sources, and frequent use of pictures depicting law enforcement. The interconnected distribution channels of the gutka industry hindered enforcement, highlighting the need to study the complexities of regional and local SLT supply chains.
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Affiliation(s)
- Vivek Dsouza
- Chronic Conditions and Public Policies cluster, Institute of Public Health Bengaluru (IPH), Karnataka, India
| | - Pratiksha Mohan Kembhavi
- Chronic Conditions and Public Policies cluster, Institute of Public Health Bengaluru (IPH), Karnataka, India
| | - Praveen Rao S
- Chronic Conditions and Public Policies cluster, Institute of Public Health Bengaluru (IPH), Karnataka, India
| | - Kumaran P
- Chronic Conditions and Public Policies cluster, Institute of Public Health Bengaluru (IPH), Karnataka, India
| | - Pragati B Hebbar
- Chronic Conditions and Public Policies cluster, Institute of Public Health Bengaluru (IPH), Karnataka, India
- Department of Health Promotion, Maastricht University (CAPHRI), Maastricht, The Netherlands
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