NASWAR DIPPING, SHIFT IN BEHAVIOR IN MULTI ETHNICITY SETTING

Abstract

Background: Easy availability of various chewable options in big cities has lead to a shift in behavior in the ethnicity specific habit of smokeless tobacco (SLT). This study was designed to find out the usage of naswar and other SLTs in naswar specific ethnicity as well as non naswar ethnicities and frequency of Human Papilloma virus (HPV) in their oral cavities. Methods: Oral rinse (20-40ml) was collected and questionnaire was filled by 293 multiple ethnicity subjects habitual of naswar dipping, from Karachi and Peshawar after an informed consent. They were given dental floss with brush to gently sweep around oral cavity and over lesions. Floss was left in oral rinse and stored at 4°C. DNA was extracted and PCR was performed using HPV consensus primers Gp5+/Gp6+. Results: The 293 subjects selected were divided into 3 groups; i. Original naswar users (56, Pathan residents of Peshawar), ii. Settler naswar users (79, Pathan residents of Karachi), and iii. adapted naswar users (158, various non naswar ethnicities). Peshawar subjects were not positive for leukoplakia or rough mucosa compared to rough mucosa in 43(54.4%) and leukoplakia in 30(37.9%) in subjects living in Karachi. Genetic testing for HPV showed 15(18.9%) samples from Karachi and 20(35.7%) samples from Peshawar, positive for HPV with significance difference of p-value of 0.029. Conclusion: Epidemiological shift in behavior occurred due to change in ecology. Naswar dippers (Pathans) (40%) developed other addictions, whereas, subjects (22%) of other ethnicities became habitual to naswar. More comparative studies are required to further prove this.