The Center for Disease Control and Prevention (CDC) describes smokeless tobacco and it’s products as nicotine-containing substances that can be consumed without burning. These products are consumed in various ways other than smoking, including chewing, sucking, dipping, sniffing, placing the product between the teeth and gum and application to the skin. There are numerous smokeless tobacco products around the world and they vary in composition, preparation and consumption methods and potential health risks. Smokeless tobacco is highly addictive since it still contains nicotine, and stopping it’s use can be as challenging as quitting smoking.

South and South-East Asia are locations with the highest prevalence of smokeless tobacco use. In these regions, smokeless tobacco is often served at social occasions and may contain slaked lime, areca nut, flavourings, and aromatic substances. Other areas where the consumption of smokeless tobacco is also evident include Nordic countries and North America, Venezuela, Uzbekistan, Kyrgyzstan, Sudan, Chad, Nigeria, Ghana and South Africa. In these parts of world, common products include Snus, Chimó, Nass, Tambook, Snuff and soluble tobacco such as tobacco lozenges, orbs, pellets, breath strips and toothpick-sized sticks. Some tobacco products are made like candy, containing contain sweeteners and flavors, however, they all have nicotine. Given the widespread international use and potential risks of smokeless tobacco, it is important to extensively assess its impact on health.

A 2010 study by Siddiqi et al. showed adult smokeless tobacco consumption data and estimated disease burden of over 100 countries. The estimates showed that the use of smokeless tobacco resulted in about 1.7 million DALYs lost and 62,283 deaths. The majority of the death were due to mouth, pharynx and oesophagus cancer. As expected, South-East, where the use of smokeless tobacco products is most prevalent, had the highest burden of death and disease. Furthermore, several studies have shown increased rates of leukoplakia in the areas of the mouth where tobacco is chewed or dipped. Leukoplakia is a cancerous painless grayish white patch, spot or sore in the mouth which usually clears when tobacco use is terminated. The likelihood of having leukoplakia increases with increase in the length of time oral tobacco is used. Additionally, tobacco use may cause teeth stains or decays, cavities, receding gums, bad breath and gum tissue irritation and disease, bone loss around the teeth and tooth loss. Given the above facts, it is quite obvious that all tobacco products are harmful, irrespective of their form, composition and method of consumption. Therefore, “smokeless” doesn’t translate to harmless as misconceived by a lot of people.

The use of smokeless tobacco results in significant but preventable global morbidity and mortality, especially from cancer. Consequently, health regulatory organizations such as CDC and World Health Organization need to consider the establishment of  smokeless tobacco regulations as part of tobacco control initiatives. Currently, WHO recommends that consumers must be informed on probable negative health effects by ensuring that health warnings and labelling are shown on smokeless tobacco products. In addition, further research should be conducted to assess nicotine and risks to individuals, as well as to identify health effects of changing patterns of smokeless tobacco use in populations.

According to the World Health Organization (WHO), Physical Activity encompasses all skeletal, muscular and bodily movements which require the use of energy. Consequently, it include all activities carried out during work, play, household chores, travelling, and recreational pursuits. Physical activity is different from exercise, which is a deliberate, organised and repetitive type of physical activity aimed to improve or maintain components of physical fitness. All  forms of physical activity have health benefits, however, achieving specific fitness or weight targets may require exercise. There are various forms of physical activity ranging from moderately intense activities – such as walking, cleaning and playing, to vigorously  intense activities such as sports (running, cycling and climbing). These activities are important in maintaining a healthy body, as well as improving the quality of life. Some specific health benefits and  advantages of engaging in adequate amount of physical activity include:

• Decreased risk of fracture, hypertension, coronary heart disease, stroke and diabetes
• Improved energy balance and weight control
• Prevents falls, depression and improves mood
• Reduced risk for noncommunicable diseases such as cardiovascular diseases and cancers
• Stable brain function and reduced stress in older adults
• Improved digestion and regular bowel movements
• Increased bone density and reduced blood pressure
• Increased chances of aging more gracefully by maintaining looks and agility
• Improved quality of rest and sleep
• General improvement in the overall quality of life.

On the other hand, physical inactivity is a major public health problem. It is identified as the fourth leading risk factor for global mortality and associated with approximately 3.2 million deaths annually. Statistics around the world show that 1 in 4 adults is not active enough. More so, over 80% of the world’s teenage population are not physically active and do not engage in sufficient amount of physical activity. These situations have led to the institutions of policies to address insufficient physical activity in 56% of WHO Member States, aimed reduce insufficient physical activity by 10% before 2025.

The importance of physical activity can not be overemphasized. It’s health, social and economic benefits are numerous in the body of literature. Given the benefits of physical activity, the following are ways to encourage and provide individuals with more opportunities to be active:

• Provide and ensure safety of walk ways to promote daily activities such as walking, cycling and other forms of active transportation
• Build recreational parks and ensure safe spaces for people to spend their free time actively
• Increase accessibility to sports and recreation facilities to provide opportunities for everyone to do sports.

Summary of WHO Physical Activity Recommendations

• Children and adolescents aged 5-17 years: At least 60 minutes of moderate to vigorous-intensity physical activity daily.
• Adults aged 18–64 years: At least 150 minutes of moderate-intensity physical activity throughout the week, or 75 minutes of vigorous-intensity physical activity throughout the week.
• Adults aged 65 years and above: At least 150 minutes of moderate-intensity physical activity throughout the week, or 75 minutes of vigorous-intensity physical activity throughout the week.

Prescription drugs are  pharmaceutical drugs or medications that require a medical prescription to be dispensed or purchased, and used. They are strong drugs which must be given in cognisance of a patient’s personal information and medical history as well as the drug’s form, dose and side effects. As a consequence, they require a doctor’s prescription following a careful deliberation on the potential benefits and risks of the drugs for each patient. When misused, these medications become as harmful and as addictive hard or street drugs. In contrast, over-the-counter drugs (OTC) are those drugs that can be dispensed without prescription, to treat illnesses that do not require the extensive care  of healthcare professionals. They have lower strength and higher safety standards compared to prescription drugs, and can be used by patients for self-medication.

Prescription drug abuse and overdose occurs when these medications are taken in ways different, or for reasons different than that prescribed by the doctor. These may include taking them without prescription, taking higher doses than prescribed, combining them with other substances, crushing the tablets to snort or inject them and using them for recreational purposes. It is illegal to obtain prescription drugs over-the-counter or without a medical prescription. Therefore, these drugs should be dispensed exclusively for medical reasons, as prescribed by a doctor. Generally, the misuse and abuse of prescription drugs have increased in recent decades, resulting in the subsequent increase in emergency room visits due to drug overdose. The National Institute on Drug Abuse (NIDA) estimates that approximately 40 million people, aged 12 and above, have used prescription drugs for reasons other than medical, in their lifetime. Common classes of prescription drugs include opioids, depressants, sedatives, tranquilizers and stimulants.

Prescription drug abuse is a public health problem which leads to addiction or death from overdose. Following marijuana and alcohol, these drugs are the most commonly misused substances in the United States. The number of teenagers who use these drugs have continued to increase due to the recreational effects of the drugs.  The most salient reasons for which these drugs are misused include to get high and have fun, to stay alert or awake, to lose weight and to reduce pain or feel numb. Many people have the misconception that prescription drugs are safer and less addictive than street or hard drugs since they can be prescribed for medical use. On the contrary, these drugs are only safe for the patients for whom they are prescribed because a doctor would have examined them, and then, specified the appropriate dose of the drug for a specific medical condition. The doctor would also have explained the side effects and how to minimize them as well as the foods or activities (such as smoking and drinking) to avoid while taking them to ensure safety.

Preventing and reducing the problematic misuse of prescription drugs should be a global priority. To achieve this aim, collaborations and partnerships should be made within and between countries, especially by governments and organizations whose goal is to reduce the use, and harms associated with prescription drugs. In Canada, the Canadian Center on Substance Use and Addiction (CCSA) developed a Naloxone Costing Tool to evaluate the accessibility of naloxone and potentially decrease the number deaths due to opioids overdose. Additionally, CCSA’s “Do No Harm” strategy emphasizes actions- notably policy, promotion, education and empowerment, required to address, prevent, treat and monitor prescription drug misuse.

Let’s start by deliberating on a few critical questions… How important is health awareness and education to you? How much do you know about your health and the risks of becoming diseased? How acquainted are you with the health issues in the world today? Why is it necessary to know about these health issues and how to prevent them?

The United Nations, through the Virtual Knowledge Center to End Violence Against Women, defines public awareness as the public’s level of understanding about the consequence and implications of women’s safety. Applying this definition to this topic, public health awareness generally means the public’s level of understanding about the importance, causes and implications of health. Public health awareness is important because good health and well being are produced when the government, health organizations or institutions and individuals  partner to educate and promote health in communities. The public also has to believe that health awareness and disease prevention are important issues in the community. Public health awareness involves health education and knowledge sharing through campaigns, media and promotions. It does not mean dictating or commanding, but rather explaining issues and disseminating information, thereby empowering and allowing people to make their own decisions.

Increased rate of public awareness occurs when a substantial proportion of the public know and agree that an issue, notably health, is of great importance to all citizens. On the contrary, low rate of public awareness occurs when majority of the public do not think an issue is of significance. Public health awareness involves two levels which include general public health awareness and a personal or self awareness. General public health awareness is a situation  where the public has a basic knowledge of good hygiene and healthy habits as well as know where and how to seek help and obtain resources to maintain either optimum health, prevent diseases or obtain treatment for diseases.  On the other hand, personal or self-awareness involves an understanding of how the environment and the health of the public affects  an individual so as to prevent diseases. Disease prevention focuses on strategies targeted towards reducing the risk of developing acute or chronic diseases. Health promotion and disease prevention programs are ways of raising public awareness. These programs are often aimed to address the social determinants of health, which influence risk behaviors such as tobacco use, poor eating habits, and physical inactivity.

Major ways to promote health and increase public health awareness in order to prevent diseases include:

1. Communication: This involves sharing information and raising awareness about healthy behaviors through public service announcements, health fairs, mass media campaigns, and newsletters.
2. Education: Educating people to inform, empower and inspire them to make behavior change and take actions through increased knowledge. This can be achieved through formal and informal courses, trainings, workshops and support groups.
3. Policy making: Governments, organizations and public agencies can make health enhancing policies that regulate and mandate activities that encourage healthy decision-making and behaviours.
4. Enabling environment: This involves creating, enhancing and changing structures in environment to increase the likelihood and easiness of making healthy choices.