oral health tobacco cessation

7/31/2019 Oral Health Tobacco Cessation

1/41


2/41

1

A QUICK REFERENCE GUIDE FOR DENTISTS

HELP YOUR PATIENTSREMAIN TOBACCO-FREE

Author Dr. Mihir N. Shah

Co-authors Cecily S. RayMonika Arora


3/41

2

AUTHORDr Mihir N. Shah

BDS, MDS, PhD.

Prof & Head, Dept. of Periodontics &Public HealthDentistry, Ahmedabad Dental College andHospital, Gujarat State, India Email: [email protected]

[email protected]

CO-AUTHORSCecily S. Ray, M.P.H.Sr. Research AssistantHealis-Sekhsaria Institute for Public Health.Navi Mumbai.Email: [email protected]

Monika Arora, M.ScDirector.

HRIDAY-SHANNew Delhi.Email: [email protected]

Disclaimer The views expressed in this guide do not necessarily represent the official views of the Ministry of Health and Family Welfare, Government of India or the World Health Organization. The authors have done their utmost toensure accuracy of all information, however, the inclusion of links andreferences does not entail recognition and endorsement of informationgiven under these links nor can they be held liable for any wronginformation. The responsibility for the interpretation and use of thematerial lies with the reader.

Published in May 2006

Technically edited by

Byword Editorial Consultants(email: [email protected])


4/41

3

CONTENTS

Foreword 4, 5

I. THE MAGNITUDE OF THE TOBACCO PROBLEM 6A. Health consequences of tobacco use 8B. Tobacco dependence 12

C. Role of the dentist 12

II. IN THE CLINIC 14A. Benefits of interventions for cessation of tobacco use 14B. Guide to counselling for tobacco cessation 16

1. Counselling those willing to quit: The 5 A method 162. Counselling those unwilling to quit: The 5 R method 263. Key counselling concepts 28

III. ACTION IN THE COMMUNITY AND NATION 32A. In the community 32B. At the state and national levels 33

REFERENCES 36


5/41


6/41

5


7/41


8/41


9/41

8

5ROH PRGHO DQG WREDFFR FHVVDWLRQ WUDLQLQJ$PRQJ WKH WKLUG \HDU GHQWDO VWXGHQWV VXUYH\HG LQWKH ,QGLDQ 'HQWDO 6WXGHQWV *OREDO +HDOWK 3URIHVVLRQDO6XUYH\ *+36 WKRXJKW GHQWLVWV VHUYH DV UROH PRGHOV IRU WKHLU

SDWLHQWV

WKRXJKW GHQWLVWV KDYH D UROH LQ JLYLQJ DGYLFHDERXW VPRNLQJ FHVVDWLRQ WR SDWLHQWV

UHFHLYHG IRUPDO WUDLQLQJ LQ VPRNLQJ F HVVDWLRQDSSURDFKHV GXULQJ GHQWDO VFKRRO

WKRXJKW KHDOWK SURIHVVLRQDOV VKRXOG JHWVSHFLILF WUDLQLQJ RQ FHVVDWLRQ WHFKQLTXHV

This guide aims to equip dental health practitioners with the latest scientific informationand strategies to become important players in preventing and reducing tobacco use.

A. Health consequences of tobacco use

Tobacco is a major contributor to oral disease. Tobacco use slows woundhealing after dental surgery, promotes periodontal disease, halitosis and oralinfections. 15 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 Indiaare due to smoking.

Smokeless tobacco is known to cause oral cancer. There is some evidence that itcauses some other cancers as well. Chewing of paan (with supari ) with or withouttobacco is a major cause of oral and oesophageal cancers in India. 17

Smoking is a known cause of cardiovascular disease. Emerging evidence points tosmokeless tobacco use also as a cause of cardiovascular disease. 18

Smoking causes most cases of chronic obstructive lung disease emphysema andchronic bronchitis. 19

Exposure of non-smokers to second-hand smoke is an important cause of respiratoryinfections, worsening of asthma and poor lung function. Many of the sufferers are

women and children.20


10/41

9

Newer research findings indicate that smoking is a major risk factor for tuberculosisin India. Tuberculosis is about 3 times more common among ever-smokers thanamong never-smokers and mortality due to this disease is 34 times greater amongsmokers than non-smokers. 21

Pregnant women exposed to passive smoke may deliver lower weight babies.Evidence is accumulating that pregnant women who use smokeless tobacco are morelikely to have low birth weight or stillborn babies. 22 The birth of an infant withcongenital cleft lip or palate can be a consequence of cigarette smoking. 23

Additionally, there are often long-term effects on surviving children born of motherswho smoke or are passively exposed to smoke. 24

Men who smoke or use smokeless tobacco may develop reduced fertility and sexualimpotence. 25, 26

Oral and pharyngeal cancer

In 2002, South Central Asia (Fig. 1), with nearly 120,000 cases (59% males) accountedfor almost half (43.6%) of the oral cancers occurring globally. 27 India alone was estimatedto have 30.3% of the worlds cases of oral cancers at least 52,000 cases in males and30,900 cases in females.

An age-standardized incidence rate of 12.8 per 100,000 males per year was estimated forIndia in 2002. Over half of these patients die within one year of diagnosis.

Similarly, nearly half of the worlds 130,300 oropharyngeal and hypopharyngeal cancersoccurred in South Central Asia in 2002 (about 46,300 in India alone, i.e. 35.5%).

The major causes of these cancers are tobacco smoking and the use of smokeless tobacco, paan masala , gutkha and mawa. Another important cause is the frequent alcohol use,especially among those who are tobacco users as well.

People who use tobacco and whose diets are poor in vegetables, fruits and dairy productsare more at risk for precancerous lesions and cancers than other tobacco users.


11/41


12/41

11

)RU GLDJQRVLQJ WKH W\SH RI OHVLRQ WKH IROORZLQJ RQOLQHPDQXDO FDQ EH FRQVXOWHG

Mehta FS, Hamner JE III. Tobacco related oral mucosal lesions and conditions in IndiaA guide for dental students, dentists, and physicians. Mumbai: BasicDental Research Unit, Tata Institute of Fundamental Research; 1993. Availablefrom: http://www.eis.ernet.in/dental/dental.htm

Patients with leukoplakia, erythroplakia or OSF should be referred to a diagnostic facilitysuch as a cancer hospital, as their lesion may already be cancerous.

Tobacco chewing/smoking Areca nut ( supari ) use Alcohol use Diet low in vegetables and fruits

Educational interventions have been found useful in reducing tobacco use and theconsequent incidence of precancerous lesions. 28

Oral cancer can occur in youth

An epidemic of mouth cancer in persons younger than 50 years of age in India was

predicted several years ago. This was based on the finding of an increased incidence of mouth cancer in persons younger than 50 years in the Ahmedabad population-basedcancer registry in 1995, and increased prevalence of OSF in a population survey inBhavnagar, Gujarat, where mawa use was common. Over 90% of the OSF patients in thesurvey were mawa users. 33 The story of Sean Marcee, a high school star athlete in theUSA, who used smokeless tobacco from the age of 12 years and died of oral cancer whenhe was only 19 years old, is given on a website to motivate young people to quit usingtobacco. 34

Dentists need to be alert to the use of tobacco and oral lesions in paediatric patients as wellas adults of all ages.


13/41

12

B. Tobacco dependence

Many tobacco users in India are unaware of the harmful effects of tobacco. Many believethat tobacco is good for health. On the other hand, there are users who know the dangers

but continue to use tobacco. Some have even suffered the consequences but continue usingit.

Tobacco use is addictive. Tobacco causes an abnormally large flow of certain brainchemicals, followed by an abnormally reduced flow, causing cravings, which the addictrelieves by repeated use of tobacco. The cravings induced in the brain by tobacco arestrong enough to cause users to minimize, deny or temporarily forget the harm thattobacco causes. Many users say they are unable to quit. Some feel helpless.

According to the policy recommendations of the World Health Organization, treatment of tobacco dependence should be part of a comprehensive national tobacco control policy. 35

C. Role of the dentist

In the clinic, dentists have an important role in helping patients quit tobacco and, at thecommunity and national levels, to promote tobacco prevention and control strategies.

Dentists in the clinic 36 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.

Dentists in the community and nation 15

Can be role models by not using tobacco or by quitting successfully. Tobacco use bydentists is a significant barrier to tobacco cessation counselling.


14/41

13

Can speak with authority in the community about the dangers of tobacco use; forexample, the need to curb tobacco use in public and educate children about thedangers of tobacco use

Can be effective advocates for tobacco control in the community.

:KDW DERXWPH" ,I ,P

XVLQJ WREDFFR


15/41

14

II. IN THE CLINIC

Nearly half of 351 dental surgeons (48.7%) surveyed in Bangalore felt that it is theresponsibility 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 andother intervention strategies. 37 Most dentists are unfamiliar with counselling techniques forquitting tobacco use. Surveys of dental students in India under the WHO-sponsoredGlobal Health Professional Survey found that very few schools train students in how tocounsel patients for tobacco use cessation. 14

A. Benefits of interventions for cessation of tobacco use

One message which is important for dentists is that by helping people to quit tobacco andtalking on this issue, they are not wasting their time but are rather building on theirpractice. Patients prefer attending those clinics where the doctor listens to them andadvises them honestly. Just 5 minutes of focused talk during the examination is enough tomake the patient aware and conscious of the harms of tobacco use.


16/41


17/41


18/41

17

Look for oral signs of tobacco use

The dentist sees the inside of the mouth and knows if the patient is using tobacco.

25$/ 6,*16 2) 72%$&&2 86(

Stained teeth Foul-smelling breath (halitosis) Gum disease Loose teeth Discoloured patches on the mucosa: White, red, darkprecancerous lesions

Mention your observations to the patientthis will help him or her face facts.

Implement a system to record tobacco use status 41

Document tobaccouser status and change

Vital signs Blood pressure 130/85Weight 70 kg Height 170 cmRespiratory rate 65 per minTemperature 36.6 o Tobacco use Current Former Never

(circle one )Chewer highly dependent -advised wants to quit in twoweeks needs rigorous follow-

up.

Medical/Dental history- Gum disease- Seven teen fillings- Allergy to Novocain


19/41


20/41

19

$VV HVV the patients 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 (p. 26 )

Assess the level of dependence

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 posestwo questions: 42

(Modify these questions according to the form of tobacco used.)

High level of dependence : Individuals who use tobacco within 30 minutes of waking upor 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.

+RZ VRRQ DIWHU ZDNLQJ XS GR \RX XVH WREDFFR"

$ERXW KRZ PDQ\ WLPHV GR \RX

XVH WREDFFR GDLO\"


21/41

20

Low level of dependence : Those who neither use tobacco before 30 minutes of waking upnor use it more than 25 times a day.

Patients highly dependent on tobacco will need longer and 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 tohelp them avoid relapse.

Individuals with depression or a concurrent habit such as regular alcohol drinking maybe at increased risk for relapse.

Rigorous follow up reduces the risk of relapse on a schedule. Such patients could bereferred to a counsellor or a tobacco use cessation facility.

$VVLVW tobacco users to make a 48,7 3/$1

D $VN WKH SDWLHQW WR

6 et a firm quit date, ideally within 2 weeks.

* et support from family, friends, co-workers. 5 eview past quit attemptswhat helped, or led to

relapse.

, dentify reasons for quitting in writing and keep acopy.

5 educe tobacco use during the two weeks before

quitting. $ nticipate challenges, particularly during the first few

weeks, including nicotine withdrawal symptoms.

Help the patient develop coping skills such as avoiding certain situations, taking walks,using distraction techniques, listening to music or doing yoga.


22/41


23/41


24/41


25/41

24

Many people have successfully quit using tobacco without any medication whatsoever(cold turkey). Patients who would benefit most from pharmacotherapy are those whohave attempted to quit several times without success or those who suffer from chronicdepression. Available therapies are shown below:

Antidepressants for tobacco use cessation

First-line therapiesBuproprion SRSelegeline

Second-line therapiesClonidine

Nortryptiline

These can be combined with nicotine replacement therapies.

Nicotine replacement therapies (NRT) for tobacco use cessationNicotine gum (available in India in 4 mg nicotine pieces: G utkha or mint flavour)Nicotine patchNicotine inhalerNicotine nasal spray

Nicotine lozenges

Basic principles for prescribing NRTs: Medical supervision is important. Use a lowerdose for less dependent tobacco users. A combination of products can be helpful. Thismust be done with caution, as nicotine toxicity may develop with a combination of products or if patient has not yet quit using tobacco. Some users may have side-effects.

Precautions: Pregnancy, lactation, cardiovascular disease, peripheral vascular disease,endocrine disorders, inflammation of the mouth and throat, oesophagitis, gastric

ulcers, diabetes.

Brief guidelines for the use of pharmacotherapy are available in the Manual for tobacco cessation of the National Cancer Control Programme. 44

Websites with guidelines on prescribing, precautions and side-effects:

Suggestions for the clinical use of pharmacotherapies for smoking cessation.Available from: http://www.hhs.gov/surgeongeneral/tobacco/clinicaluse.pdf and thePublic health service clinical practice guideline, Treating tobacco use and

dependence , http://www.ahrq.gov/path/tobacco/htm .45


26/41


27/41

26

1,&27,1( :,7+'5$:$/ 6


28/41


29/41

28

52$'%/2&.6 to quittingFear of withdrawal symptoms

Fear of failure

Lack of supportEnjoyment of tobaccoFear of weight gain

Depression

5(3($7 these messages at each visitRepeat the motivational messages each time an unmotivated patient visits.

Tobacco users who have tried to quit previously and failed need to hear thatmost people make repeated attempts before they are successful.

3. Key counselling concepts 43

A non-judgemental attitude: This puts patients at ease and helps themwant to listen to you.

Caring: A caring attitude can be expressed through your words and motivatespatients to follow your advice.

Empathy: Your words affect the patients attitude. Use your words as therapy tomotivate and encourage the patient to quit.

Listening: Listen carefully and patiently to what the patient is saying. Listeningalso conveys empathy.

Raising awareness: Raise patients awareness levels about the negativeconsequences of tobacco use. Prompting self-evaluation: Ask the patient to think about how tobaccouse fits in or conflicts with his goals and values in life. When the patient feels thebenefits of quitting tobacco use outweigh the costs, he/she will be more motivated tochange.

Offering support while emphasizing personalresponsibility: Provide encouragement and assistance for quitting. At the sametime, the patient needs to accept personal responsibility for change.


30/41

29

Asking open-ended questions: These help the patient to disclosehis/her values and priorities, and to become more aware of those that conflict witheach other.

Clarifying: You can ask a question to be sure you have understood what thepatient said.

Reflecting feelings: Rephrase the emotional content of what the patient hassaid to assure him/her that you have understood.

Summarizing: Condense into a few words the essence of what you have heard.

Affirming: This conveys respect, acceptance and understanding of the patientsposition, even if it is not positive.

Eliciting self-motivational statements: Find out, on a scale of 0 to10, how important quitting is to the patient. How optimistic are they about quitting?What difficult goals have they achieved in the past?

Setting realistic goals: Change the patients behaviour in stages by settingrealistic goals.

Countering fatalism: Give a response that matches the patients attitude, butcontradicts the premise.

, EHOLHYH \RX FDQ TXLW7KDQNV'RFWRU


31/41

30

Responding to tricky questions: When your patients test you withtricky questions or statements, you will need to come up with answers that will shock theminto thinking. 45

Tailoring messages to the patients stage of change: 46 Quittingis a process rather than an event. The clinicians intervention can help the tobacco usermove forward on the road to permanent abstinence.

If the patient is not willing to quit at this time but is thinking about it, he/she is in thecontemplation phase. If the patient is not thinking about quitting, then he/she is a

precontemplator . Contemplators may be asked:

When are you thinking of quitting?

The answer to this question will distinguish between a person who is positively preparingto quit and one in an earlier phase. You can then tailor your messages to the patients stage

of change, as shown in the table on the next page:

'RFWRU LI LW LV LQ P\

GHVWLQ\ WR KDYHFDQFHU KRZ FDQ \RXKHO PH"

+PP :HOO ZRXOG \RX OLNH WR KHDU P\VLGH RI WKH VWRU\"

$OO ULJKW

,W ZDV LQ P\ GHVWLQ\ WRVWXG\ GHQWLVWU\ DQG WRDVN \RX 6KUL -RVKLEKDLWRVWRS XVLQJ WREDFFR. 7KHQ , ZLOO

QHYHU XVHWREDFFR D DLQ

Based on an experience at an oral check-up camp in Bhavnagar District, Gujarat.; the patientsname has been changed (Personal communication, Dr Dinesh Daftry, Oral Pathologist).


32/41

31

TAILOR MESSAGES AND GOALS TO THE PATIENTS STAGE OF CHANGE 46

If the patient reports: Goals Examples of messages

Im not ready to quit

Get the patient to think about quitting

Praise prior attempts

Examine reasons forusing tobacco

I want to quit but Imnot ready right now

Enhance the patientsdesire to quit

Praise prior attempts

Help him identify thebenefits of quitting

Legitimize the challenge

Im ready to quit now

Provide support and assistance for users wanting toquit. Self-helpreading materialsare useful and follow-up contactis essential.

Develop treatment plan(using the 5 A method)

Set a quit date

Counsel briefly

Refer for intensivecounselling if needed

Follow-up

I quit recently

Help the patient maintainabstinence

Review ways toavoid slips

Identify socialsupports

I quit long ago Congratulate the patient

I relapsed recently

Reassess the patientsmotivation

Praise the attempt toquit

Turn feeling of failure into smallsuccess


33/41

32

III. ACTION IN THE COMMUNITY ANDTHE NATION

As health professionals, dentists involvement in curtailing tobacco use is critical. Dentistscan play a crucial role in tobacco control through their participation as educators,spokespersons, role models and advocates at the community level, and nationally throughprofessional organizations.

A. IN THE COMMUNITY 15,4749

Dentists are highly respected, trusted and influential community leaders in any

society. Their voices are heard across a vast range of social, economic and politicalarenas.

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 100metres of their hospitals.

Dental organizations can reach out to different age and social groups to informthem on tobacco issues, and encourage them to recommend policies to the

government on tobacco control. Dentists can link up with non-governmental organizations (NGOs) 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 inthe community and monitor the implementation of tobacco control laws.

Dentists need to keep themselves informed through professional publications andtobacco control organizations on the latest scientific information regarding theharmful effects of tobacco and measures for its control.


34/41

33

Media advocacy Dentists can actively engage the media in creating awareness among the masses

about tobacco control issues. Dentists can prepare educational materials using up-to-date, scientifically accurate

information such as posters and school health materials. Dentists can write articles in newspapers and magazines about the benefits of

implementing tobacco control policies, including letters to the editor. Dentists can participate in talk shows on television and radio to talk about tobacco

use issues. Dentists can bring into the limelight some success stories related to tobacco

control.

B. AT THE STATE AND NATIONAL LEVELS

Dentists can use their influence to encourage governments to put in place tobaccocontrol measures. Dentists can be involved in both direct advocacy (influencingdecision-makers) and indirect advocacy (building support among the general public to putpressure on decision-makers to initiate change). As members of professionalorganizations, dentists can play an important role in tobacco control advocacy at the stateand national levels.

Making the profession and dental facilities tobacco-free

Dental associations can prepare a national Code of practice on tobacco control fordentists. This code of practice would highlight the potential role of dentists andtheir organizations in the treatment of tobacco dependence and provide guidanceon organizational changes and activities that can be undertaken to promote atobacco-free profession.

Dentists can provide the needed emphasis on tobacco-related health information inthe undergraduate and postgraduate curricula and examinations.

Dentists can motivate hospital administrators and fellow colleagues to keep thehospital environment tobacco-free and thus convey to the public that theirinstitution is committed to protecting public health. Workshops can be organizedto motivate all staff members to avoid tobacco use on the premises.

All conferences and other events organized by associations of dental professionalsshould be declared completely tobacco-free by the organizers.

Dentists should avoid accepting or allowing sponsorship of any kind from tobaccocompanies or their affiliates for professional conferences.

All government/private healthcare and dental care facilities can carry anti-tobaccoslogans on items of stationery.


35/41

34

Dental associations can share with their members new scientific research findings,new developments in tobacco cessation and new policy developments.

As members of professional organizations, dentists can raise the issue of litigationagainst the tobacco industrys unfair marketing practices. Strong professional

support in a legal suit can be crucial for the success of such litigations in India.

Advocacy with the state and national governments

Dental associations can advocate for the inclusion of tobacco cessation as animportant component in national health programmes such as the National RuralHealth Mission, National Cancer Control Programme and Reproductive and ChildHealth Programme.

Dental associations can join hands with civil society groups working in the area of

tobacco control to develop a state and a national plan to create awareness amongdental professionals on tobacco control issues.

Dentists along with their professional organizations can lobby with thegovernment to set up community-based tobacco cessation programmes.

Dentists can request the government to appoint a nodal officer atdistrict/block/state level for tobacco control.

Dentists can advocate with the government to stop the subsidy on tobaccofarming.

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 healtheducation on the dangers of tobacco use.

Dentists and their associations, along with other health professionals, canparticipate in the development of a national plan of action for tobacco control inaccordance with the Indian Tobacco Control Act, 2003.

A special section on tobacco control initiatives should be taken up during nationaland international conferences for dentists.

All conferences and other events organized by associations of dental professionalsshould be declared completely tobacco-free.


36/41


37/41

36

REFERENCES

1. World Health Organization. Tobacco Free Initiative: Why is tobacco a public healthpriority? Geneva: World Health Organization; 2006. Available from: http://www.who.int/tobacco/en/ or http://w3.whosea.org/EN/Section1174/section1462/default.

Aspn/index.html

2. Higher world tobacco use expected by 2010growth rate slowing down. Rome: Foodand Agriculture Organization of the United Nations; Newsroom, 8 January 2004.Available from: http://www.fao.org/english/newsroom/news/2003/26919-en.html

3. FAOSTAT database, Agricultural data. Agricultural production. Crops primary.tobacco. Provisional production data, 2005. Rome: Food and Agriculture

Organization; 2006. Available from: http://faostat.fao.org/faostat/servlet/XteServlet3? Areas=%3E862&Items=826&Elements=51&Years=2004&Format=Table&Xaxis=Y ears&Yaxis=Countries&Aggregate=&Calculate=&Domain=SUA&ItemTypes=Production.Crops.Primary&language=EN

4. USDA United States Department of Agriculture. Foreign Agricultural Service.Commodities and products. Tobacco, unmanufactured total, beginning stocks; 2006.Available from: http://ffas.usda.gov/psd/complete_files/TOB-1211000.csv

5. World Health Organization. The World Health Organization says that tobacco is bad

economics all around. Geneva: Media Centre, WHO; 28 May 2004. Available from:http://www.who.int/mediacentre/news/releases/2004/pr36/en/

6. Subramanian SV, Nandy S, Kelly M, Gordon D, Davey Smith G. Patterns anddistribution of tobacco consumption in India: Cross-sectional multilevel evidence fromthe 19989 National Family Health Survey. BMJ 2004; 328: 8016.

7. Rani M, Bonu S, Jha P, Nguyen SN, Jamjoum L. Tobacco use in India: Prevalenceand predictors of smoking and chewing in a national cross sectional household survey.Tobacco Control 2003; 12: e4. Available from: http://wwwtobaccocontrol.com/cgi/ content/full/12/4/e4

8. Prevalence of tobacco use among the youth. In: Reddy KS, Gupta PC (eds). Report ontobacco control in India . New Delhi: Ministry of Health and Family Welfare,


38/41

37

Government of India; 2004:617. Available online from: http://www.whoindia.org/ SCN/Tobacco/ Report/TCI-Report.htm

9. Overall (all-cause) mortality due to tobacco. In: Reddy KS, Gupta PC (eds). Report ontobacco control in India . New Delhi: Ministry of Health and Family Welfare,

Government of India; 2004:878. Available online from: http://www.whoindia.org/ SCN/Tobacco/ Report/TCI-Report.htm

10. Health care costs. In: Reddy KS, Gupta PC (eds). Report on tobacco control in India .New Delhi: Ministry of Health and Family Welfare, Government of India; 2004:12938. Available online from: http://www.whoindia.org/SCN/Tobacco/Report/TCI-

Report.htm

11. World Health Assembly Resolution 56.1. Annex: The WHO FCTC. Full text Englishversion. Adopted on 21 May 2003. Available from: http://www.who.int/gb/ ebwha/pdf_files/WHA56/ea56r1.pdf

12. The WHO Framework Convention on Tobacco Control (FCTC) and its implicationsfor India. In: Reddy KS, Gupta PC (eds). Report on tobacco control in India . NewDelhi: Ministry of Health and Family Welfare, Government of India; 2004:16879.Available online from: http://www.whoindia.org/SCN/Tobacco/Report/TCI-

Report.htm

13. Schroeder SA. Tobacco still is oral health enemy number one. J Am Dent Assoc 2006; 137: 144, 146, 148.

14. Centers for Disease Control and Prevention (CDC). India Dental Students GlobalHealth Professionals Survey (GHPS), 2005, Factsheet. Atlanta: CDC. Available from:http://www.cdc.gov/tobacco/Global/GHPS/factsheets/2005/PDF_2005/India_Dental.pdf

15. FDI World Dental Federation and WHO. In: Beaglehole RH, Benzian HM (eds).Tobacco or oral health: An advocacy guide for oral health professionals . Lowestoft,UK: FDI World Dental Federation, Ferney Voltaire, France/World Dental Press; 2005.Available from: www.fdiworldental.org

16. US Department of Health and Human Services. The health consequences of smoking: A report of the Surgeon General. Atlanta, Georgia: Centers for Disease Control andPrevention, National Center for Chronic Disease Prevention and Health Promotion,Office on Smoking and Health; 2004. Available from: http://www.cdc.gov/ tobacco/sgr/sgr_2004/index.htm

17. Tobacco and cancer. In: Reddy KS, Gupta PC (eds ). Report on tobacco control in India. New Delhi: Ministry of Health and Family Welfare, Government of India;2004:903. Available online from: http://www.whoindia.org/SCN/Tobacco/Report/ TCI-Report.htm

18. Spangler JG, Salisbury PL 3rd. Smokeless tobacco: Epidemiology, health effects andcessation strategies. Am Fam Physician 1995; 52: 142130, 14334.


39/41

38

19. Tobacco and lung disease. In: Reddy KS, Gupta PC (eds). Report on tobacco controlin India . New Delhi: Ministry of Health and Family Welfare, Government of India;2004:99102. Available online from: http://www.whoindia.org/SCN/Tobacco/Report/ TCI-Report.htm

20. Ducatman AM, McLellan RK. Epidemiologic basis for an occupational andenvironmental policy on environmental tobacco smoke. J Occup Environ Med 2000;42: 113741.

21. Gajalakshmi V, Peto R, Kanaka S, Jha P. Smoking and mortality from tuberculosisand other diseases in India: Retrospective study of 43,000 adult male deaths and35,000 controls . Lancet 2003; 362: 50715.

22. Tobacco use and reproductive outcomes. In: Reddy KS, Gupta PC (eds). Report ontobacco control in India. New Delhi: Ministry of Health and Family Welfare,Government of India; 2004:10810. Available online from: http://www.whoindia.org/ SCN/Tobacco/Report/TCI-Report.htm

23. Ericson A, Kallen B, Westerholm P. Cigarette smoking as an etiologic factor in cleftlip and palate. Am J Obstet Gynecol 1979; 135: 34851.

24. US Department of Health and Human Services. The health consequences of involuntary smoking. A report of the Surgeon General. US DHHS, PublicHealthService, Centers for Disease Control. DHHS Publication No. (CDC) 87-8398, 1986.

25. Peate I. The effects of smoking on the reproductive health of men. Br J Nurs

2005; 14: 3626.26. Banerjee A, Pakrashi A, Chatterjee S, Ghosh S, Dutta SK. Semen characteristics of

tobacco users in India. Arch Androl 1993; 30: 3540.

27. Ferlay J, Bray F, Pisani P, Parkin DM. GLOBOCAN 2002: Cancer incidence,mortality and prevalence worldwide. IARC Press, Lyon: International Agency forResearch on Cancer (IARC), Cancer Base No. 5. Version 2.0. 2004. Available from:http://www-depdb.iarc.fr/globocan/GLOBOframe.htm

28. Tobacco-related oral mucosal lesions and dental diseases. In: Reddy KS, Gupta PC

(eds). Report on tobacco control in India. New Delhi: Ministry of Health and FamilyWelfare, Government of India; 2004:11114.

29. Gupta PC, Sinor PN, Bhonsle RB, Pawar VS, Mehta HC. Oral submucous fibrosis inIndia: A new epidemic? Natl Med J India 1998; 11: 11316.

30. Babu S, Bhat RV, Kumar PU, Sesikaran B, Rao KV, Aruna P, et al. A comparativeclinico-pathlogical study or oral submucous fibrosis in habitual chewers of pan masalaand betelquid. J Toxicol Clin Toxicol l996;34: 31722.

31. Murlidhar V, Upmanyu G. Tobacco chewing, oral submucous fibrosis, and anaesthetic

risk. Lancet 1996; 347: 1840.


40/41

39

32. Daftary DK, Murti PR, Bhonsle RB, Gupta PC, Mehta FS, Pindborg JJ. Oralprecancerous lesions and conditions of tropical interest. In: Prabhu SR, Wilson DF,Daftary DK, Johnson NW (eds). Oral diseases in the tropics. Oxford MedicalPublications: Oxford, 1992;40228.

33. Gupta PC. Mouth cancer in India: A new epidemic? J Indian Med Assoc 1999; 97:3703.

34. Nineteen year old Sean Marcees tobacco message. Whyquit. Mount Pleasant, SC:USA. Available from: http://whyquit.com/whyquit/SeanMarsee.html

35. World Health Organization. Tobacco Free Initiative. Policy recommendations forsmoking cessation and treatment of tobacco dependence. Geneva: WHO, 2006.Available from: http ://www.who.int/tobacco/resources/publications/tobacco_dependence/en/

36. Petersen PE. Tobacco and oral health. Preventive Oral Health Prev Dent 2003; 1: 30915. (Reprint requests: Poul Erik Petersen, Chief Oral Health Programme, NonCommunicable Disease Prevention and Health Promotion, World HealthOrganization, Avenue Appia 20, 1211 Geneva 27, Switzerland, www.who.int/ oral_health )

37. Ajwani. S, Ainamo A, Hiremath S. A KAP Survey on tobacco counselling and theirperceived barriers of dentists in Banglore city, India. Poster # 1457. Chiba, Tokyo:Japan, 79th Annual general Session of International Association for Dental Research(IADR), 2529 June 2001.

38. Sunday SR, Folan P. Smoking in adolescence: What a clinician can do to help. Med Clin North Am 2004; 88: 1495515.

39. Office on Smoking and Health. What you(th) should know about tobacco . NationalCenters for Chronic Disease Prevention and Health Promotion. Centers for DiseaseControl and Prevention [homepage on the internet]. United States Department of Health and Human Services; 2005. Available from: http ://www.cdc.gov/tobacco

/christy/WYSKAT.htm

40. Fiore MC, Bailey WC, Cohen SJ, Dorfman SF, Goldstein MG, Gritz ER, et al. Treating tobacco use and dependence. Quick reference guide for clinicians. Rockville,Maryland: US Department for Health and Human Services, Public Health Service,October 2000. Available from: http://www.ncbi.nlm.nih.gov/books/bv.fcgi?rid=hstat2.chapter.7644

41. USDHHS. Public Health Service. Helping smokers quit: A guide for nurses. TobaccoFree Nurses. 2005. Available from: http://tobaccofreenurses.org/resources/ http://www.ahrq.gov/about/nursing/hlpsmksqt.pdf

42. Talwar A, Jain M, Vijayan VK. Pharmacotherapy of tobacco dependence. Med Clin

North Am 2004; 88: 151734.


41/41

43. Brief intervention in tobacco cessation: A physicians manual. Chandigarh: TobaccoCessation Clinic, Department of Psychiatry, Post Ggraduate Institute of MedicalEducation and Research (PGIMER).

44. National Cancer Control Programme. Manual for tobacco cessation . New Delhi:

Directorate General of Health Services, Ministry of Health and Family Welfare,Government of India; November 2005.

45. Office of the Surgeon General [homepage on the internet]. Public health priorities:Disease prevention, Tobacco use, Tobacco Cessation Guideline. Tobacco cessationYou can quit smoking now! Clinicians packet: Treating tobacco use and dependence,suggestions for the clinical use of pharmacotherapies for smoking cessation .Washington, DC: United States Department of Health and Human Services: 2005.Available from: http ://www.hhs.gov/surgeongeneral/tobacco/clinicaluse.pdf

46. Swartz SH, Hays JT. Office-based intervention for tobacco dependence. Med Clin North Am 2004; 88: 162341.

47. Lindsay EA, Hymowitz N, Mecklenburg RE, Churchill LC, Poland B. Activities topromote health care providers as participants in community-based tobacco control , Smoking and tobacco control monograph no. 6; 13352. Available online from:http://cancercontrol.cancer.gov/tcrb/monographs/6/m6_9.pdf

48. World Health Organization. WHO Tobacco Free Initiative. The role of health professionals in tobacco control Geneva: WHO; 2005. Available online from:http://www.whoindia.org/LinkFiles/Tobacco_Free_Initiative_HP-role-tfa.pdf

49. American Cancer Society/International Union against Cancer (UICC). Engagingdoctors in tobacco control. Tobacco control strategy planning, Companion guide #2. .Available online from: http://www.paho.org/English/AD/SDE/RA/Guide2a_

Engaging_Doctors_in_Tobacco_Control.pdf

oral health tobacco cessation

Documents