Date of Award

Fall 1-10-2020

Degree Type

Closed Thesis

Degree Name

Master of Public Health (MPH)


Public Health

First Advisor

David L. Ashley

Second Advisor

Dora Il'yasova



To determine if there is any difference in the prevalence of pre-cancerous oral lesions in people using smokeless tobacco compared to people who are not using smokeless tobacco from wave 1 of Population Assessment of Tobacco and Health dataset


One of the major reasons of chronic disease and death all around the world including United States is the use of tobacco. Smokeless tobacco is one of the most prevalent forms of tobacco used in adults. (2) Antioxidant defense mechanisms are affected in oral epithelium due to free radicals of oxygen and nitrogen, which are produced during the consumption of snuff. Free radicals are capable of promoting mutations by complex mechanisms (11) According to an article by Galucci et al. purchase of smokeless tobacco by retailers and wholesalers from manufacturers rose by 2.22 million pounds within one year. They found that the sales of moist snuff accounted to 85.6% of total smokeless tobacco sales in 2011. (17)


Data that is used for the analysis are from wave 1 of PATH dataset which has used a four- stage stratified area probability sample design with a two-phase design for sampling adults in the final stage. Population Assessment of Tobacco Health screens households by using computer assisted personal interviewing while adult and youth interviews were done using parent interview and computer assisted self-interviewing. Statistical analysis of the data is done using SAS 9.4 software


In the adjusted multivariable regression model the covariate age is the only one which yielded statistically significant results (p


Public health research plays a very significant role in preventing major global health issues. Oral cancer is one such problem which is affecting people world-wide based on the empirical evidence of many studies. Research shows that use of smokeless tobacco can result in the occurrence of pre- cancerous oral lesions and oral cancer. Considering other covariates such as age and smoking the results of this analysis showed that there is a statistically significant association between usage of smokeless tobacco and occurrence of pre-cancerous oral lesions.

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Available for download on Tuesday, December 15, 2020