中国烟草流行监测的发展及挑战

烟草使用是导致全球疾病负担主要的可预防危险因素, 是我国面临的重大公共卫生问题。连续动态的烟草监测可以为制定控烟策略和措施、评价控烟效果提供关键指标数据。WHO将烟草监测纳入控烟的重要内容并在《烟草控制框架公约》中提出相关履约要求。中国政府积极推进控烟工作, 特别是《烟草控制框架公约》生效以来, 烟草监测得到不断加强, 2021年起, 我国的烟草监测工作被WHO评为达到最高等级。本文主要对全国范围内开展的成人和青少年烟草流行病学专项调查抽样设计、监测内容、关键指标定义和基于复杂抽样的数据加权进行阐述, 并提出我国当前烟草监测面临的挑战, 以期为我国烟草流行专项调查数据的理解和利用、调查结果的比较以及今后我国烟草监测工作的开展提供参考。     

2018年中国15岁及以上人群吸烟现况及变化趋势研究

目的描述中国≥15岁人群的吸烟现况, 并与既往调查比较, 分析其发展变化趋势。方法本次调查采用全球成人烟草调查的多阶段分层整群随机抽样, 覆盖全国31个省(自治区/直辖市)的200个区/县。于2018年7-12月收集个人问卷19 376份, 应答率为91.50%。数据采用SAS 9.4软件进行复杂抽样加权分析。结果 2018年我国≥15岁人群吸烟率为26.59%, 男性(50.47%)高于女性(2.07%), 农村(28.87%)高于城市(25.05%)。吸烟者戒烟率为20.10%, 女性(30.22%)高于男性(19.64%), 城乡差异无统计学意义(P=0.864)。与既往调查结果相比, 吸烟率呈现下降趋势, 其中, 25～44岁和45～64岁人群吸烟率下降明显, 大专及以上文化程度人群的吸烟率下降幅度最大。此外, 2018年我国≥15岁吸烟者平均每日吸烟量为16.00支, 现在每日吸烟者开始每日吸烟的平均年龄为20.95岁。结论我国≥15岁人群吸烟率下降速度不足以保证《健康中国行动(2019-2030年)》既定控烟目标的顺利实现, 需加大控烟工作力度。     

基于人群的身体活动水平与脑卒中发病风险的队列研究

目的 探讨≥40岁成年人身体活动水平对脑卒中发病的影响。方法 通过宁波市2015年具有人群代表性的成年人慢性病监测调查获得身体活动和人口特征基线数据,利用2015-2019年宁波市慢性病监测信息协同管理系统获得脑卒中发病数据,将数据库进行匹配形成队列。身体活动按照每周身体活动量（METs）分为低、中等和高强度身体活动。采用Cox回归分析计算不同身体活动分类脑卒中的发病风险。结果 2015年基线调查共纳入3 353名研究对象,截至2019年12月31日,随访时间（50.28±2.54）个月,共发生脑卒中事件31人,累积发病率为242/10万。多因素Cox回归分析结果显示,在控制性别、年龄、文化程度、吸烟情况、饮酒情况、BMI、是否高血压等因素后,身体活动强度越高,脑卒中发病风险越低,平均降低37.9%（HR=0.621,95%CI：0.393~0.983）。与低强度身体活动者相比,高强度身体活动者脑卒中发病风险降低了63.1%（HR=0.369,95%CI：0.139~0.976）,而中等强度身体活动者与低强度身体活动者的脑卒中发病风险差异无统计学意义（HR=0.712,95%CI：0.323~1.569）。结论 身体活动强度越高,脑卒中发病风险越低,应加强社区支持性环境建设,提高人群身体活动水平。     

Examining Life-Course Socioeconomic Position,Contextualized Stress,and Depression among Well-Educated African-American Pregnant Women

PurposeThis article explores how childhood and adulthood socioeconomic position (SEP) and socioeconomic mobility, as indicators of life-course experiences, impact the relationship between contextualized stress and depression among well-educated, pregnant African-American women.MethodsThe Jackson, Hogue, Phillips Contextualized Stress Measure and the Beck Depression Inventory were administered to 101 well-educated, pregnant African-American women during their first and second trimesters. Bivariate associations and regression analysis were conducted to assess life-course SEP, mobility, and contextualized stress as predictors of depression. Based on the demographic data for childhood and adult SES, the SEP and mobility variables were created.ResultsResults from χ² analysis revealed that high contextual stress was significantly associated with no change in mobility, that is, staying the same. Results from regression models found that contextualized stress was the only predictor for depression. Additionally, life-course SEP and mobility did not moderate the relationship between contextualized stress and depression.ConclusionsOur findings illuminated the persistence of racial and gendered stress as risk factors for depression among well-educated, pregnant African-American women, regardless of life-course SEP. We offer an explanation as to why African-American women who possess the material and social resources thought to mediate psychosocial and pregnancy risks remain in jeopardy.     

State-specific estimates of complete smoke-free home rules among postpartum women, 2010

BackgroundSecondhand smoke exposure increases an infant's risk of morbidity and mortality. We provide state-specific estimates for and characterize postpartum women with complete smoke-free home rules.MethodsData were analyzed from 26 states and New York City (n = 37,698) from the 2010 Pregnancy Risk Assessment Monitoring System, a population-based survey of women who recently delivered live-born infants. We calculated state-specific estimates of complete rules and assessed associations between complete rules and selected characteristics.ResultsOverall, 93.6% (95% CI: 93.1–94.1) of women with recent live births had complete smoke-free home rules (86.8% [West Virginia] to 98.6% [Utah]). Demographic groups with the lowest percentage of rules were women who smoked during pregnancy/postpartum (77.6%), were non-Hispanic Black (86.8%), never initiated breastfeeding (86.8%), < 20 years of age (87.1%), < $15,000 annual income (87.6%), < 12 years of education (88.6%), unmarried (88.6%), initiated prenatal care late/had no prenatal care (88.8%), had Medicaid coverage (89.7%), had an unintended pregnancy (90.3%), and enrolled in WIC (90.6%).ConclusionsPrevalence of complete smoke-free home rules was high among women with recent live births; however, disparities exist by state and among certain sub-populations. Women, particularly smokers, should be educated during and after pregnancy about secondhand smoke and encouraged to maintain 100% smoke-free homes.     

Measuring perceptions related to e-cigarettes: Important principles and next steps to enhance study validity

Measuring perceptions associated with e-cigarette use can provide valuable information to help explain why youth and adults initiate and continue to use e-cigarettes. However, given the complexity of e-cigarette devices and their continuing evolution, measures of perceptions of this product have varied greatly. Our goal, as members of the working group on e-cigarette measurement within the Tobacco Centers of Regulatory Science (TCORS) network, is to provide guidance to researchers developing surveys concerning e-cigarette perceptions. We surveyed the 14 TCORS sites and received and reviewed 371 e-cigarette perception items from seven sites. We categorized the items based on types of perceptions asked, and identified measurement approaches that could enhance data validity and approaches that researchers may consider avoiding. The committee provides suggestions in four areas: (1) perceptions of benefits, (2) harm perceptions, (3) addiction perceptions, and (4) perceptions of social norms. Across these 4 areas, the most appropriate way to assess e-cigarette perceptions depends largely on study aims. The type and number of items used to examine e-cigarette perceptions will also vary depending on respondents' e-cigarette experience (i.e., user vs. non-user), level of experience (e.g., experimental vs. established), type of e-cigarette device (e.g., cig-a-like, mod), and age. Continuous formative work is critical to adequately capture perceptions in response to the rapidly changing e-cigarette landscape. Most important, it is imperative to consider the unique perceptual aspects of e-cigarettes, building on the conventional cigarette literature as appropriate, but not relying on existing conventional cigarette perception items without adjustment.     

Age of alcohol use initiation and psychiatric symptoms among young adult trauma survivors

Alcohol use disorder (AUD) evidences high rates of comorbidity with a range of psychiatric disorders, particularly within high-risk populations, such as individuals exposed to physical or sexual violence. Increasing efforts are focused on understanding the role of early alcohol use (e.g., during adolescence) on emotional and psychiatric functioning over time, as well as sex differences in these associations. The aim of the current study was to evaluate patterns of association between age of initiation of regular alcohol use and posttraumatic stress disorder (PTSD), anxiety, and depressive symptoms as a function of sex. Participants were 269 college students with a history of interpersonal trauma and alcohol use who completed a battery of questionnaires regarding alcohol use and emotional health. Neither bivariate correlations nor results from structural equation models covarying for key factors showed a relationship between age of alcohol use initiation and current psychiatric symptoms among men (n = 63). Results of a structural equation model supported an association between earlier age of alcohol use initiation and greater levels of current PTSD (β = −0.14), anxiety (β = −0.15), and depression symptoms (β = −0.16) in the female sub-sample (n = 202), after controlling for covariates, as well as intercorrelations among criterion variables. Statistical support for sex as a moderator of these associations was not detected. The current study provides preliminary evidence for potential sex differences in the role of early alcohol use in the development of psychiatric symptoms and highlights the need for systematic longitudinal research.     

User-identified electronic cigarette behavioral strategies and device characteristics for cigarette smoking reduction

BackgroundThere is limited evidence on how cigarette smokers use electronic cigarettes (ECIGs) for smoking cessation and reduction. This study used concept mapping, a participatory mixed-methods research approach, to identify ECIG use behaviors and device characteristics perceived to be associated with cigarette smoking cessation or reduction.MethodsCurrent ECIG users aged 18–64 were recruited from seven cities selected randomly from U.S. census tract regions. Participants were invited to complete concept mapping tasks: brainstorming, sorting and rating (n = 72). During brainstorming, participants generated statements in response to a focus prompt (“A SPECIFIC WAY I HAVE USED electronic cigarettes to reduce my cigarette smoking or a SPECIFIC WAY electronic cigarettes help me reduce my cigarette smoking is…”) and then sorted and rated the statements. Multidimensional scaling and hierarchical cluster analyses were used to generate a cluster map that was interpreted by the research team.ResultsEight thematic clusters were identified: Convenience, Perceived Health Effects, Ease of Use, Versatility and Variety, Advantages of ECIGs over Cigarettes, Cigarette Substitutability, Reducing Harms to Self and Others, and Social Benefits. Participants generated several statements that related to specific behavioral strategies used when using ECIGs for smoking reduction/complete switching behaviors such as making rapid transitions from smoking to ECIG use or using certain ECIG liquids or devices. Former smokers rated the Perceived Health Effects cluster and several behavioral strategy statements higher than current smokers.ConclusionsThese results help to identify ECIG use behaviors and characteristics perceived by ECIG users to aid in cigarette smoking cessation or reduction.     

US adult tobacco users' absolute harm perceptions of traditional and alternative tobacco products,information-seeking behaviors,and (mis)beliefs about chemicals in tobacco products

IntroductionHarm perceptions about tobacco products may influence initiation, continued use, and cessation efforts. We assessed associations between adult traditional tobacco product use and absolute harm perceptions of traditional and alternative tobacco products. We also described the topics individuals looked for during their last search for information, their beliefs about chemicals in cigarettes/cigarette smoke, and how both relate to harm perceptions.MethodsWe ran multivariable models with jackknife replicate weights to analyze data from the 2015 administration of the National Cancer Institute's Health Information National Trends Survey (N = 3376).ResultsCompared to never users, individuals reported lower perceived levels of harm for products they use. Among current tobacco users, ethnicity, thinking about chemicals in tobacco, and information-seeking were all factors associated with tobacco product harm perceptions. In the full sample, some respondents reported searching for information about health effects and cessation and held misperceptions about the source of chemicals in tobacco.ConclusionsThis study fills a gap in the literature by assessing the absolute harm perceptions of a variety of traditional and alternative tobacco products. Harm perceptions vary among tobacco products, and the relationship among tobacco use, information seeking, thoughts about chemicals in tobacco products, and harm perceptions is complex. Data suggest that some individuals search for information about health effects and cessation and hold misperceptions about chemicals in tobacco products. Future inquiry could seek to understand the mechanisms that contribute to forming harm perceptions and beliefs about chemicals in tobacco products.