Smoking,smoking cessation,and 7-year mortality in a cohort of Thai adults

Background

Smoking is a strong risk factor for mortality in both the developed and the developing world. However, there is still limited research to examine the impact of smoking cessation and mortality in middle-income Southeast Asian populations.

Methods

We use longitudinal data from a large Thai cohort of adult Open University students residing nationwide, linked with official death records to assess the association of smoking status and mortality risks during a 7-year follow-up. The log-rank test was used to evaluate the statistical probability of differential survival according to baseline smoking status. Multivariate hazard ratios (HR) were reported for smoking status and all-cause and cause-specific mortality.

Results

From 2005 baseline to 2012, current smokers were more likely to die than cohort members who ceased smoking and never smokers (1.9 vs 1.3 vs 0.6 %, p?<?0.05). The hazard of all-cause mortality increased with the daily amount of cigarette consumption among both current and former smokers. Cause of death analyses showed that current male smokers had a significantly increased risk of cardiovascular disease related mortality (HR 3.9 [95 % CI 1.8–8.1]). Former male smokers had a moderate increase in risk of dying from cardiovascular diseases compared to never smokers (HR 1.6 [95 % CI 0.7–3.4]). Current male smokers between 2005 and 2009 experienced highest subsequent mortality hazards during the period 2009–2012 compared to never smokers (HR 2.1 [95 % CI 1.4–3.4]). The higher risk of dying reduced if people quit smoking during the 2005–2009 follow-up period (HR 1.5 [95 % CI 0.7–3.3]). Risk for mortality fell even further among long-term quitters (HR 1.4 [95 % CI 0.9–2.2]).

Conclusion

Among a large nationwide cohort of Thai adults, current smokers were at a significantly and substantially higher risk of all-cause mortality, especially cardiovascular-related mortality. The higher risk of dying fell if people quit smoking and the risk for mortality was even lower among long-term quitters. Promotion of smoking cessation will contribute substantially to the reduction in avoidable mortality in Thailand.

     

Physicians discuss the risks of smoking with their patients,but seldom offer practical cessation support

Background

Our aim was to study the smoking cessation-related 1) attitudes & experiences and 2) consultation practices of Finnish physicians and to determine if there is a relationship between the two.

Methods

An online survey on smoking cessation was sent to 39 % of all Finnish physicians, with emphasis on physicians working in fields relevant to smoking cessation. A total of 1141 physicians (response rate 15 %) responded to the online survey, 53 % of whom were employed in primary health care. A total of 1066 respondents were eligible for the analysis. The questionnaire included questions on the physician’s own smoking status, their attitudes and experiences on smoking cessation, and the implementation of smoking cessation in clinical practice. Two sub-scales concerning smoking-related consultation activities were constructed: one for conversation, and another for practical actions.

Results

The most common consultation activities (respondents who reported doing the following actions “nearly always”) were asking how much the patient smokes (65 %), marking smoking status in patient records (58 %) and recommending quitting to the patient (55 %). The least common activity was prescribing withdrawal medication (4 %). Primary care physicians were more active than those working in secondary health care in nearly all activities mapped. A positive attitude and experiences on smoking cessation were associated with actively offering withdrawal support. Those who were familiar with the local treatment guidelines for tobacco addiction were 30 % more active in offering practical cessation help to their patient. The respondents were more active in discussing smoking with their patients than in offering practical cessation help.

Conclusion

Physicians offer their patients practical cessation support relatively infrequently. Practical cessation calls for continuous education of physicians about the nature of tobacco and nicotine addiction, the role of smoking as a risk factor for various diseases, and the practical measures needed for smoking cessation. Secondary care physicians should acknowledge the authority they pose toward smoking patients.

     

Prozessevaluation einer Intervention zur kooperativen Raucherentwöhnung

Background

The study “ENTER: Evaluation of a collaborative smoking cessation intervention” is a cluster-randomized controlled trial to assess the effectiveness of a smoking cessation intervention implemented in the German primary care setting in collaboration with AOK NORDWEST in Westphalia-Lippe and Schleswig-Holstein.

Objectives

A process evaluation was performed with the aim of investigating barriers and facilitators to intervention implementation and giving recommendations for future interventions.

Materials and methods

Between November 2015 and January 2016 semistructured qualitative interviews were conducted with AOK employees and general practitioners of the intervention group. Interviews focused on contextual factors (e.?g. responsibilities for implementing the intervention), the communication between network partners and the process of referring patients to smoking cessation courses.

Results

Overall, 21 interviews were completed (8 AOK employees, 13 general practitioners). Intervention implementation was facilitated because physicians perceived smoking cessation counseling to be important and were supported by their office staff. Challenges were seen in patients’ motivation for participation in smoking cessation courses and meeting the minimum number of course participants.

Conclusions

Successful intervention implementation would be facilitated by motivating patients to participate in smoking cessation courses and informing them about the effectiveness of the courses. Patient’s preferences for different smoking cessation aids should be investigated in order to increase the use of effective aids.

     

Small area synthetic estimates of smoking prevalence during pregnancy in England

Background

Complete and accurate data on maternal smoking prevalence during pregnancy are not available at a local geographical scale in England. We employ a synthetic estimation approach to predict the expected prevalence of smoking during pregnancy and smoking at delivery by Primary Care Trust (PCT).

Methods

Multilevel logistic regression models were used with data from the 2010 Infant Feeding Survey and 2011 Census to predict the probability of mothers (a) smoking at any point during pregnancy and (b) smoking at delivery, according to age, deprivation, and the ethnic profile of the home area. These probabilities were applied to demographic information on mothers giving birth from 2010/11 Hospital Episode Statistics data to produce expected counts, and prevalence figures, of smokers by PCT, with Bayesian 95 % credible intervals. The expected prevalence of smoking at delivery by PCT was compared with midwife-collected Smoking at the Time of Delivery (SATOD) data using a Bland-Altman plot.

Results

The expected prevalence of smoking during pregnancy by PCT ranged from 8.1 % (95 % CI 5.6–1.0) to 31.6 % (27.5–34.8). The expected prevalence of smoking at delivery ranged from 2.5 % (1.4–4.0) to 17.1 % (13.7–20.4). Figures for expected smoking prevalence at delivery showed some agreement with SATOD, though SATOD data were generally higher than the synthetic estimates (mean difference 2.99 %).

Conclusions

It is possible to derive good estimates of expected smoking prevalence during pregnancy for small areas, potentially at much lower cost than conducting large surveys. Such data may be useful to help plan and commission smoking cessation services and monitor their effectiveness.

     

Smoking status and health-related quality of life: a longitudinal study in young adults

Purpose

The possibility that tobacco use affects health-related quality of life (HRQoL) has attracted interest. However, a lack of prospective evidence weakens the case for a causal relationship. The aim was to examine the longitudinal relationship between change in smoking status and change in HRQoL in young adults.

Methods

We conducted a population-based cohort study with data collected in 2004–2006 (aged 26–36) and 2009–2011 (aged 31–41). Exposure was change in self-reported smoking status during follow-up. Outcomes were changes in physical and mental HRQoL measured by SF-12.

Results

For physical HRQoL (n = 2080), quitters had a 2.12 (95 % confidence interval (CI) 0.73, 3.51) point improvement than continuing smokers, whereas former smokers who resumed smoking had a 2.08 (95 % CI 0.21, 3.94) point reduction than those who maintained cessation. Resumed smokers were 39 % (95 % CI 10, 75 %) more likely to have a clinically significant (>5 point) reduction of physical HRQoL than former smokers who maintained cessation. In contrast, quitters were 43 % (95 % CI 3, 98 %) more likely to have a clinically significant (>5 point) improvement in physical HRQoL than continuing smokers. Change in smoking status was not significantly associated with change in mental HRQoL (n = 1788).

Conclusions

Smoking by young adults was cross-sectionally associated with lower physical HRQoL and longitudinally associated with reductions in physical HRQoL. The expectation of short- to medium-term gains in physical HRQoL as well as long-term health benefits may help motivate young adult smokers to quit.

     

Analysis of smoking cessation beliefs in pregnant smokers and ex-smokers using the Theory of Planned Behavior

Aim

To analyze the association between smoking cessation beliefs and smoking status, and between smoking cessations beliefs and intention to quit, using the Theory of Planned Behavior (TPB).

Subjects and methods

An observational study using a questionnaire was performed; data were collected from 264 Flemish pregnant smokers and ex-smokers before week 16 of pregnancy.

Results

There was a significant difference in the behavioral beliefs of the TPB between smokers and ex-smokers, after controlling for education and age. All respondents experienced more support from their non-smoking partners to maintain abstinence during pregnancy. We found no significant difference in the behavioral beliefs of the TPB between respondents with low and high intention to quit smoking.

Conclusion

Our results suggest that attitude, subjective norms, support especially from the partner, and perceived behavioral control are associated with actual smoking behavior in pregnant women and not with intention to quit smoking. It is important to engage the partner and/or significant others in smoking cessation counselling so that they can support the pregnant woman in an attempt to quit or to maintain abstinence.

     

Prevalence,habits and personal attitudes towards smoking among health care professionals

Background

Tobacco use is the second major cause of morbidity and the 4th most common health risk factor in the world. Medical professionals have a critical role in the process of smoking cessation both as advisers and behavioural models for the citizens. The aim of this study was to investigate the prevalence of smoking among health care professionals, their smoking habits and personal attitudes toward smoking, role and the responsibility of health care professionals in the prevention of smoking.

Results

Out of the total number of examinees, 175 (35,1%) are active smokers, 29 (5,8%) are former smokers, and 295 (59,1%) are non-smokers. Nurses with secondary education disagree the most with the claim that passive smoking is more harmful to health (χ2 test, p = .008), also with the claim that the introduced Smoking Act is fair to smokers (χ2 test, p = .021). More nurses with secondary education disagree completely or partially that one should pay attention to smoking in the presence of non-smokers (χ2 test, p = .012).

Conclusion

Training programs for health care workers are needed to improve their ability in smoking cessation techniques to provide active support to their patients.

     

Effect of training program regarding smoking cessation counseling for primary health care physicians in Port Said City,Egypt

Background

Smoking is a major risk factor for death-related diseases. Not all healthcare professionals are following evidence-based guidelines for smoking cessation counseling in primary care settings. The WHO, Framework Convention on Tobacco Control (FCTC), and United States Public Health Service (USPHS) guidelines recommend that all healthcare professionals, including students in healthcare training programs, receive education in the management of tobacco use and dependence.

Objective

To evaluate the effect of training programs for primary healthcare physicians on the knowledge, attitude, and practice of smoking cessation counseling.

Methods

This was a pre-post intervention study. The study included 74 primary care physicians working in primary healthcare centers affiliated with the Ministry of Health and Suez Canal University Hospitals in Port Said City. The study was conducted between June 2015 and March 2016 using a structured questionnaire and observation checklist to assess counseling of patients willing to quit smoking.

Results

There were highly statistically significant improvements in the physicians’ median scores of knowledge (30%–80%), attitude (65% -100%), and practice (20%–70%) (p?<?0.001) pre-post intervention. The most frequent correct knowledge was consequences of smoking (73%–87.3%) (p?<?0.001) pre-post intervention. The most favorable attitude was the importance of smoking cessation (70.3%–100%) (p?<?0.001) pre-post intervention. The best observed correct practice was asking about smoking (70.3%–100%) (p?<?0.001) pre-post intervention.

Conclusion

Knowledge, attitude, and practice skills regarding smoking cessation counseling among primary healthcare physicians were markedly improved after implementation of the education program.

     

Economic evaluation of a telephone- and face-to-face-delivered counseling intervention for smoking cessation in patients with coronary heart disease

Objective

This study examined the cost-effectiveness and cost-utility of two smoking cessation counseling interventions differing in their modality for patients diagnosed with coronary heart disease from a societal perspective.

Methods

In a randomized controlled trial conducted in Dutch hospital wards, cardiac patients who smoked prior to admission were allocated to usual care (n = 245), telephone counseling (n = 223) or face-to-face counseling (n = 157). The counseling interventions lasted for 3 months and were complemented by nicotine patches. Baseline histories were obtained, and interviews took place 6 months after hospitalization to assess self-reported smoking status and quality adjusted life years (QALYs). Incremental cost-effectiveness ratios per quitter and cost-utility ratios per QALY were calculated and presented in acceptability curves. Uncertainty was accounted for by sensitivity analysis.

Results

Using continued abstinence as the outcome measure showed that telephone counseling had the highest probability of being cost-effective. Face-to-to-face counseling was also more cost-effective than usual care. No significant improvements and differences in QALYs between the three conditions were found. Varying costs and effect estimations revealed that the results of the primary analyses were robust.

Conclusions

Assuming a willingness-to-pay of €20,000 per abstinent patient, telephone counseling would be a highly cost-effective smoking cessation intervention assisting cardiac patients to quit. However, the lack of consensus concerning the willingness-to-pay per quitter impedes drawing firm conclusions. Moreover, studies with extended follow-up periods are needed to capture late relapses and possible differences in QALYs.

     

Differences in tobacco smoking prevalence and frequency between adolescent Palestine refugee and non-refugee populations in Jordan,Lebanon, Syria,and the West Bank: cross-sectional analysis of the Global Youth Tobacco Survey

Background

Evidence is conflicting as to the whether tobacco smoking prevalence is higher in refugee than non-refugee populations. The aim of this study was to compare the prevalence and frequency of tobacco smoking in Palestine refugee and non-refugee adolescent populations in the Middle East.

Methods

We conducted a cross-sectional analysis of the Global Youth Tobacco Survey (GYTS) conducted in Jordan, Lebanon, Syria, and the West Bank among adolescent Palestine refugees and non-refugees. Age- and sex-adjusted regression models assessed the association between refugee status and current (past-30 day) tobacco use prevalence and frequency.

Results

Prevalence estimates for current tobacco smoking were similar between Palestine refugee and non-refugee groups in Jordan (26.7 % vs. 24.0 %), Lebanon (39.4 % vs. 38.5 %), and the West Bank (39.5 % vs. 38.4 %). In Syria, Palestine refugees had nearly twice the odds of current tobacco smoking compared to non-refugees (23.2 % vs. 36.6 %, AOR 1.96, 95 % CI 1.46–2.62). Palestine refugees consumed more cigarettes per month than non-refugees in Lebanon (β 0.57, 95 % CI 0.17–0.97) and Palestine refugees consumed more waterpipe tobacco per month than non-refugees in Syria (β 0.40, 95 % CI 0.19–0.61) and the West Bank (β 0.42, 95 % CI 0.21–0.64).

Conclusions

Current tobacco smoking prevalence is in excess of 20 % in both adolescent Palestine refugee and non-refugee populations in Middle Eastern countries, however Palestine refugees may smoke tobacco more frequently than non-refugees. Comparison of simple prevalence estimates may therefore mask important differences in tobacco use patterns within population groups.

     

Rauchgewohnheiten von deutschen Medizinstudierenden in Deutschland und Ungarn

Background

Although many anti-tobacco measures have reduced the number of smokers in Germany, every fourth person still smokes and smoking is still an enormous burden for both the affected person and their relatives as well as for the healthcare system and society. Physicians have a key position in tobacco cessation, their health and smoking behavior is therefore of great importance.

Objective

To provide information about the distribution of tobacco consumption among medical students and to examine the influence of study site on tobacco consumption.

Material and methods

In a multicenter cross-sectional study, data on the health behavior of German medical students in two German and two Hungarian universities were collected in 2014 using a questionnaire.

Results

Of the 1384 students, 7.3% smoked daily, 9.1% occasionally and 11.9% were ex-smokers. The consumption of e?cigarettes was rare, whereas shisha smoking was more widespread among medical students. Among the study locations Munich had the lowest rates of occasional smoking for men and for women consuming shisha.

Conclusions

Medical students must be encouraged not to smoke. Our results highlight the need for smoking cessation programs at medical schools, including education about detrimental health effects of shisha use.

     

Looking at the smoking epidemic through the lens of population pyramids: sociodemographic patterns of smoking in Italy, 1983 to 2005

Background

Surveillance systems often present data by means of summary measures, like age-standardised rates. In this study, we aimed at comparing information derived from commonly used measures of smoking with that presented in modified population pyramids (PPs), using the example of the diffusion of smoking in Italy over the past two decades.

Methods

Data were derived from four National Health Interview Surveys carried out in 1983, 1990 to 1991, 1999 to 2000, and 2004 to 2005. After computing both age-specific and age-standardised rates of current, former, and never smoking, we constructed modified PPs by stratifying the male and female populations according to smoking status and educational level.

Results

Modified PPs showed several features of the smoking epidemic in Italy that were not apparent from conventional surveillance techniques. First, they showed that the population of smokers is aging, with most current smokers in 2005 being males aged 25 to 39 and females aged 40 to 49, whereas in 1983 most smokers belonged to the youngest age groups. Second, they showed that in 2005 most smokers were found among subjects with middle and higher education, whereas two decades earlier most smokers were (male) subjects with the lowest education.

Conclusions

Modified PPs were able to show how absolute numbers of smokers were distributed by age and sex, how these numbers varied between population subgroups, and how they changed over time. PPs may help provide information on past and future trends in the absolute number of smokers and in their sociodemographic characteristics, which may be missed using only traditional surveillance methods.

     

Factors associated with adherence to Antiretroviral Therapy (ART) among adult people living with HIV and attending their clinical care,Eastern Ethiopia

Background

To attain a successful treatment outcome, Antiretroviral Therapy (ART) treatment for people living with HIV requires more than 95 % adherence level. The adherence level varies depending on different population contexts. Thus, the objective of this study was to investigate ART adherence level among HIV positive patients attending their clinical care in public health facilities in Harar and Dire Dawa, Eastern Ethiopia.

Methods

We conducted a cross-sectional study among 626 ART attendees. Data were collected using a structured questionnaire with a face-to-face interview. ART adherence was considered when taking all antiretroviral treatment in a correctly prescribed doses at a right time (no dose missed or delayed for greater than or equal to 90 min) in the week prior to the study. Multivariable logistic analysis was applied to examine the association between the dependent and independent variables. Statistical significance was set at p-value <0.05.

Results

The level of ART adherence was 85 %. Adherence was more likely among patients of 35–44 years (AOR?=?2.39; 95 % CI?=?1.15–5.01), had monthly income of 501.00–999.00 Ethiopian Birr (ETB) (AOR?=?6.73; 95 % CI?=?2.71–16.75), no history of opportunistic infection (AOR?=?2.81; 95 % CI?=?1.47–5.36), and had good family support (AOR?=?2.61; 95 % CI?=?1.45–4.72). However, those who did not disclose their sero-status (AOR?=?0.45; 95 % CI?=?0.21–0.97) and did experience depression (AOR?=?0.36; 95 % CI?=?0.21–0.61) were less likely adherent than their counter parts.

Conclusions

The level of ART adherence was sub-optimal. Concerted and collaborative efforts through effective and efficient interventions are needed in view of the identified factors in order to improve the adherence level.

     

Infant mortality among the Canadian-born offspring of immigrants and non-immigrants in Canada: a population-based study

Background

Adult immigrants in Canada have a survival advantage over their Canadian-born counterparts. It is unknown whether migrants are able to transmit their survival advantage to their Canadian-born children.

Methods

Neonatal and postneonatal mortality between the Canadian-born population and 12 immigrant subgroups were compared using 1990–2005 linked birth-infant death records. Age-at-death specific mortality rates and rate differences were calculated by nativity status and maternal birthplace. A chi-square statistic was used to compare group differences in maternal sociodemographic characteristics. Multivariate survival analysis was used to estimate the effect of maternal birthplace on neonatal and postneonatal mortality, net of maternal sociodemographic and infant characteristics.

Results

Overall, immigrants had lower rates of neonatal and postneonatal mortality than the Canadian-born population. But the adjusted risk of neonatal mortality was higher for Sub-Saharan African (hazard ratio [HR]?=?1.32; 95 % confidence interval [CI]?=?1.05, 1.66), Haitian (HR?=?2.29, 95 % CI?=?1.90, 2.76), non-Spanish Caribbean (HR?=?1.38; 95 % CI?=?1.01, 1.89), and Pakistani (HR?=?1.87; 95 % CI?=?1.31, 2.68) migrants relative to Canadian-born women. There were fewer significant disparities in postneonatal death, with higher adjusted risks of mortality observed for Pakistani (HR?=?2.67, 95 % CI?=?1.77, 4.02) and Haitian (HR?=?1.41, 95 % CI?=?1.02, 1.97) migrants only.

Conclusion

Inequalities in infant mortality are more concentrated in the neonatal period. Contingent on surviving the first 27 days after birth, the infants of most immigrants (except those from Haiti and Pakistan) have the same chances of survival as the infants of Canadian-born women. Improvements in prenatal care and access to postpartum care may reduce disparities in infant mortality.

     

Coffee consumption is positively related to insulin secretion in the Shanghai High-Risk Diabetic Screen (SHiDS) Study

Background

It has been proved that coffee consumption was associated with a lower risk of type 2 diabetes mellitus. But the benefit effect of coffee on hyperglycemia in Chinese population was largely unknown. Besides, the relationship of coffee intake and diabetic pathogenesis was still unclear.

Methods

The study population was selected from the Shanghai High-Risk Diabetic Screen (SHiDS) project. A total of 1328 individuals over 18?years of age who have the information of coffee intake were enrolled in the study from 2012 to 2016. Each participant finished a five-point 75?g oral glucose tolerance test and finished a standard questionnaire. Insulin resistance was evaluated by HOMA-IR and insulin secretion was evaluated by HOMA-β, Stumvoll first phase and second phase indexes.

Results

Coffee consumption group had lower plasma glucose levels at 2-h and 3-h and higher insulin levels at fasting, 30-min and 1-h during OGTT after adjustment with age, fat%, BMI, waist, tea intake, smoking habit, alcohol intake, diabetes family history and educational status (P for PG2h?=?0.002; P for PG3h?=?0.010; P for FIN?=?0.010; P for IN30min?=?0.001; P for IN1h?=?0.002). Both HOMA-β and Stumvoll formula indexes were positively related to coffee consumption (P for HOMA-β?=?0.033; P for Stumvoll first phase?=?0.003; P for Stumvoll second phase?=?0.001). Logistic regression analysis further confirmed that coffee intake was independently associated with higher levels of HOMA-β and Stumvoll insulin secretion indexes [OR (95% CI) for HOMA-β?=?2.270 (1.456–3.538); OR (95% CI) for Stumvoll first phase?=?2.071 (1.352–3.173); OR (95% CI) for Stumvoll second phase?=?1.914 (1.260–2.906)].

Conclusions

Coffee intake is independently and positively related to pancreatic beta cell function in a large high-risk diabetic Chinese population.

     

E-Zigaretten und Tabakerhitzer: repräsentative Daten zu Konsumverhalten und assoziierten Faktoren in der deutschen Bevölkerung (die DEBRA-Studie)

Background

Electronic cigarettes (ECs) and heat-not-burn (HNB) devices are relatively new products that are increasingly used alternatively or complementary to ordinary tobacco products.

Objectives

To analyse current data from the German Study on Tobacco Use (DEBRA) regarding the prevalence of EC and HNB device use and associated socioeconomic factors and smoking behaviour; compare reasons for EC use between adolescents and adults; describe the self-perceived risk of HNB devices.

Material and methods

DEBRA is an ongoing, representative, face-to-face household survey of the population aged 14 years and older. We analysed data from the first nine waves (June/July 2016 to October/November 2017; n?=?18,415) for the current study.

Results

During the observation period, 1.9% (95% confidence interval (CI)?=?1.7–2.2%) of the German population used ECs (2.8% of the 14- to17-year-olds) and 74.5% (95% CI?=?69.4–79.2%) of current EC users also smoked tobacco (“dual use”). Three-quarters of adolescents used ECs mainly “for fun”, whereas reasons for use among adults related more to smoking tobacco (e.?g., less harmful, to quit smoking). Among current smokers and recent ex-smokers (<12 months smoke-free), 0.3% (95% CI?=?0.09–0.64%) currently used HNB devices, and 6.0% (95% CI?=?5.0–7.2%) had ever used them. Consumption of HNB products increased with increasing education and income. The majority perceived HNB products as somewhat (41.0%, n?=?25) or much (14.8%, n?=?9) less harmful, and 37.7% (n?=?23) as equally harmful compared with tobacco cigarettes.

Conclusions

In Germany, ECs are mainly consumed as “dual use” together with tobacco. Consumption of HNB products currently occurs at a very low rate and is relatively more common among smokers with higher education and income. It remains important to monitor the use of new electronic inhalation products in the total population and in relevant subgroups.