title: Association between Shammah Use and Oral Leukoplakia-like Lesions among Adult Males in Dawan Valley, Yemen.
abstract: BACKGROUND
  Shammah is a traditional form of snuff dipping tobacco (a smokeless tobacco form) that is commonly used in Yemen. Oral mucosal changes due to the use of shammah can usually be observed in the mucosal surfaces that the product touches. The aim of this study was to determine the association between shammah use and oral leukoplakia-like lesions. Other associated factors were also determined.
  
  
  METHODS
  A cross sectional study was conducted on 346 randomly selected adult males. Multi-stage random sampling was used to select the study location. After completing the structured questionnaire interviews, all the participants underwent clinical exanimation for screening of oral leukoplakia-like lesions Clinical features of oral leukoplakia-like lesion were characterized based on the grades of Axell et al (1976). Univariable logistic regression and multivariable logistic regression were used to assess the potential associated factors.
  
  
  RESULTS
  Out of 346 male participants aged 18 years and older, 68 (19.7%) reported being current shammah users. The multivariable analysis revealed that age, non-formal or primary level of education, former shammah user, current shammah user, and frequency of shammah use per day were statistically associated with the presence of oral leukoplakia-like lesions [Adjusted odds ratio (AOR) = 1.03; 95% confidence interval (CI) : 1.01, 1.06; P= 0.006], (AOR= 8.65; 95% CI: 2.81, 26.57; P= 0.001), (AOR= 3.65; 95% CI: 1.40, 9.50; P= 0.008), (AOR= 12.99; 95% CI: 6.34, 26.59; P= 0.001), and (AOR= 1.17; 95% CI: 1.02, 1.36; P= 0.026), respectively.
  
  
  CONCLUSIONS
  The results revealed oral leukoplakia-like lesions to be significantly associated with shammah use. Therefore, it is important to develop comprehensive shammah prevention programs in Yemen.
authors.affiliation: Community Dentistry, School of Dental Sciences, Universiti Sains Malaysia , Kubang Kerian, Kelantan, Malaysia E-mail : drmonmontinoo@gmail.com.
authors.forename: Badr Abdullah
authors.initials: BA
authors.lastname: Al-Tayar
authors.forename: Mon Mon
authors.initials: MM
authors.lastname: Tin-Oo
authors.forename: Modh Zulkarnian
authors.initials: MZ
authors.lastname: Sinor
authors.forename: Mohammed Sultan
authors.initials: MS
authors.lastname: Alakhali
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D003430:Cross-Sectional Studies; D005500:Follow-Up Studies; D006801:Humans; D007972:Leukoplakia, Oral / Q000453:epidemiology / Q000209:etiology*; D008297:Male; D008875:Middle Aged; D009062:Mouth Neoplasms / Q000453:epidemiology / Q000209:etiology*; D011379:Prognosis; D011795:Surveys and Questionnaires; D014029:Tobacco Use Disorder / Q000453:epidemiology / Q000209:etiology*; D014030:Tobacco, Smokeless / Q000009:adverse effects*; D015006:Yemen / Q000453:epidemiology; D055815:Young Adult