Physicians should only claim the credit commensurate with the extent of their participation in the activity
Even today, the symbolic meaning remains recognizable, especially among older generations and traditional families
Assessments include (1) demographic information, (2) smoking history and a timeline-follow-back interview to assess tobacco use including smoking quantity and frequency such as number of cigarettes per day and number of years smoked, (3) expired breath carbon monoxide (CO) measured in parts per million, (4) a urine sample for screening for cotinine, pregnancy, and recent drug use, and (5) a health interview to rule out high-risk participants with unstable conditions
This shift may reflect increasing market penetration, price accessibility of disposable devices, and a narrowing of information gap regarding e-cigarettes
Economic factors also played a role, particularly during the COVID-19 lockdown, when price hikes led some women to switch from Paan to affordable commercial brands or from commercial brands to Khaini to avoid staining their teeth and mouth
If they do the same in India, it could be one of the biggest public health wins in a generation