Tobacco use,exposure to secondhand smoke,and cessation counseling among medical students: cross-country data from the Global Health Professions Student Survey (GHPSS), 2005-2008

Background  

GHPSS is a school-based survey that collects self-administered data from students in regular classroom settings. GHPSS produces representative data at the national or city level in each country. This study aims to investigate the prevalence of tobacco use, exposure to secondhand smoke, and cessation counseling among medical students using the GHPSS data.     

Tobacco use prevalence, knowledge and attitudes, and tobacco cessation training among medical students: results of a pilot study of Global Health Professions Students Survey (GHPSS) in Italy

Aim

The aims of this study were to examine tobacco use prevalence, knowledge and attitudes, and tobacco cessation training among students attending Italian medical schools using the Global Health Professions Student Survey approach and to identify possible factors associated with smoking status.

Subjects and Methods

A multicentre cross-sectional pilot study was carried out in five Italian Schools of Medicine from March to April 2009. Questionnaires were administered in anonymous, voluntary and self-administered form to third year students attending medical schools. The outcome measure was ??being a current smoker??. A logistic regression was used to evaluate possible factors associated with smoking status.

Results

The prevalence of current smokers was 31.4%. More than half considered health professionals as models for patients, and around 90% thought health professionals have a role in giving advice or information about smoking cessation. Only 5.8% of responders had received smoking cessation training during medical school. Medical students who considered healthcare professionals as behavioural models had lower likelihood of smoking (OR?=?0.52).

Conclusions

Given the high prevalence of smokers among medical students and the poorness of smoking cessation programmes, it is important to create tobacco control training programmes addressed to healthcare students.     

Self exposure to secondhand smoke among prenatal smokers, abstainers, and nonsmokers

PURPOSE: Prenatal smoking cessation will not eliminate health risks if women continue to be exposed to passive smoking. This study compared the risks of secondhand smoke (SHS) exposure for low-income prenatal nonsmokers, abstainers, and smokers. METHODS: A questionnaire was administered to 225 pregnant women. Exposure to six sources of SHS was compared across smoking groups using chi-square and multivariate logistic regression. RESULTS: In adjusted analyses, patterns of SHS exposure were consistent. Abstainers were at lower risk of exposure than smokers for all sources except for having a partner who smoked. Abstainers were at higher risk of exposure than nonsmokers for most sources. For example, 11.7% of nonsmokers were exposed to < 4 hours of SHS daily compared with 33.3% of abstainers (adjusted odds ratio = .32, 95% confidence interval = .12-.88). Mean number of exposures for nonsmokers, abstainers, and smokers were 1.4, 2.7, and 4.2, respectively (p < .001). DISCUSSION: Interventions need to address the full range of health risks posed by cigarette smoke exposure during pregnancy.     

Tobacco use and secondhand smoke exposure during pregnancy: an investigative survey of women in 9 developing nations

Objectives. We examined pregnant women''s use of cigarettes and other tobacco products and the exposure of pregnant women and their young children to secondhand smoke (SHS) in 9 nations in Latin America, Asia, and Africa.Methods. Face-to-face surveys were administered to 7961 pregnant women (more than 700 per site) between October 2004 and September 2005.Results. At all Latin American sites, pregnant women commonly reported that they had ever tried cigarette smoking (range: 78.3% [Uruguay] to 35.0% [Guatemala]). The highest levels of current smoking were found in Uruguay (18.3%), Argentina (10.3%), and Brazil (6.1%). Experimentation with smokeless tobacco occurred in the Democratic Republic of the Congo and India; one third of all respondents in Orissa, India, were current smokeless tobacco users. SHS exposure was common: between 91.6% (Pakistan) and 17.1% (Democratic Republic of the Congo) of pregnant women reported that smoking was permitted in their home.Conclusions. Pregnant women''s tobacco use and SHS exposure are current or emerging problems in several low- and middle-income nations, jeopardizing ongoing efforts to improve maternal and child health.Tobacco use is widely recognized as one of the leading threats to global health.¹ Historically, the prevalence of smoking among women in the developing world has been very low, in part because of strong cultural constraints against women''s smoking; approximately 50% of men in developing nations smoke cigarettes, compared with 9% of women.² Averting an increase in the prevalence of smoking among women in developing nations is widely recognized as a significant public health opportunity.^3,4Pregnant women are a priority population for tobacco control efforts because both cigarette smoking and smokeless tobacco use during pregnancy pose serious risks to fetal health. Smoking during pregnancy may cause preterm delivery, low birthweight, and sudden infant death syndrome; smokeless tobacco use during pregnancy has been associated with stillbirth, preterm birth, and reduced birthweight.^5–8 Maternal tobacco use is also likely to expose infants and children to secondhand smoke (SHS) and to provide a role model for children''s use of tobacco. Intervening during pregnancy is also important because of the health risks to the woman, who potentially has many years of remaining life. For cigarette smoking, these health risks include lung and other cancers, coronary heart disease and stroke, and chronic obstructive pulmonary disease; health risks from smokeless tobacco products include oral and pancreatic cancer.^9,10The US National Institute of Child Health and Human Development''s Global Network for Women''s and Children''s Health Research consists of 10 research units chosen for scientific merit that are focused on improving maternal and children''s health in the developing world. To determine whether pregnant women''s tobacco use and SHS exposure are emerging public health issues, the Global Network undertook an investigative survey of pregnant women''s knowledge, attitudes, and behaviors regarding tobacco use and SHS exposure. Here we report findings on pregnant women''s experimentation with and use of tobacco products, their perceptions of the social acceptability of tobacco use by women, and their and their young children''s exposure to SHS.     

Mortality among lifelong nonsmokers exposed to secondhand smoke at home: cohort data and sensitivity analyses

Evidence is growing that secondhand smoke can cause death from several diseases. The association between household exposure to secondhand smoke and disease-specific mortality was examined in two New Zealand cohorts of lifelong nonsmokers ("never smokers") aged 45-77 years. Individual census records from 1981 and 1996 were anonymously and probabilistically linked with mortality records from the 3 years that followed each census. Age- and ethnicity-standardized mortality rates were compared for never smokers with and without home exposure to secondhand smoke (based on the reported smoking behavior of other household members). Relative risk estimates adjusted for age, ethnicity, marital status, and socioeconomic position showed a significantly greater mortality risk for never smokers living in households with smokers, with excess mortality attributed to tobacco-related diseases, particularly ischemic heart disease and cerebrovascular disease, but not lung cancer. Adjusted relative risk estimates for all cardiovascular diseases were 1.19 (95% confidence interval: 1.04, 1.38) for men and 1.01 (95% confidence interval: 0.88, 1.16) for women from the 1981-1984 cohort, and 1.25 (95% confidence interval: 1.06, 1.47) for men and 1.35 (95% confidence interval: 1.11, 1.64) for women from the 1996-1999 cohort. Passive smokers also had nonsignificantly increased mortality from respiratory disease. Sensitivity analyses indicate that these findings are not due to misclassification bias.     

Socioeconomic differences in exposure to tobacco smoke pollution (TSP) in Bangladeshi households with children: findings from the International Tobacco Control (ITC) Bangladesh Survey

This study assessed the pattern of exposure to tobacco smoke pollution (TSP; also known as, secondhand smoke) in Bangladeshi households with children and examined the variations in household smoking restrictions and perception of risk for children's exposure to TSP by socioeconomic status. We interviewed 1,947 respondents from Bangladeshi households with children from the first wave (2009) of the International Tobacco Control (ITC) Bangladesh Survey. 43.5% of the respondents had complete smoking restrictions at home and 39.7% were very or extremely concerned about TSP risk to children's health. Participants with lower level of education were significantly less likely to be concerned about the risk of TSP exposure to children's health and less likely to adopt complete smoking restrictions at home. Logistic regression revealed that the predictors of concern for TSP exposure risk were educational attainment of 1 to 8 years (OR = 1.94) or 9 years or more (OR = 4.07) and being a smoker (OR = 0.24). The predictors of having complete household smoking restrictions were: urban residence (OR = 1.64), attaining education of 9 years or more (OR = 1.94), being a smoker (OR = 0.40) and being concerned about TSP exposure risk to children (OR = 3.25). The findings show that a high proportion of adults with children at home smoke tobacco at home and their perceptions of risk about TSP exposure to children's health were low. These behaviours were more prevalent among rural smokers who were illiterate. There is a need for targeted intervention, customized for low educated public, on TSP risk to children's health and tobacco control policy with specific focus on smoke-free home.     

Findings from the Global Youth Tobacco Survey (GYTS) in Czech Republic, Hungary, Poland and Slovakia--smoking initiation, prevalence of tobacco use and cessation

Summary. Objectives To show selected findings from the Global Youth Tobacco Survey (GYTS) conducted in Czech Republic, Hungary, Poland and Slovakia. Methods Representative sample of 16 918 school children aged 13–15 years; data were obtained through uniform questionnaires. The fieldwork was conducted in 2002 and 2003. Results Age at initiation of smoking was particularly earlier in Czech Republic, Poland, and Slovakia than in Hungary. Over one third of the students reported current cigarette smoking in Czech Republic (34.9%) and Hungary (33.5%) compared to about one-fourth in Slovakia (24.3%) and Poland (23.3%). Among current smokers, about two thirds in Slovakia (64.0%) desired to stop smoking, while only one third in Hungary (36.7%). The prevalence of current cigarette smoking was similar between genders. Discussion Smoking prevalence in these countries is considerably higher than worldwide data. Women’s smoking could be an important public health problem in the future. Repeated surveys could show trends and give a clearer picture of the epidemiological situation. Submitted: 25 November 2004 Accepted: 25 April 2005     

The use of cessation assistance among smokers from China: Findings from the ITC China Survey

Background  

Stop smoking medications significantly increase the likelihood of smoking cessation. However, there are no population-based studies of stop-smoking medication use in China, the largest tobacco market in the world. This study examined stop-smoking medication use and its association with quitting behavior among a population-based sample of Chinese smokers.     

Tobacco use among youth: findings from the global youth tobacco survey in Montenegro

Smoking is a burning healthcare and economy issue, especially in underdeveloped countries. The aim of this study was to determine the number of smokers among elementary school students in Montenegro and to assess the correlates of tobacco use. The study was done in 2003 using the World Health Organization Global Youth Tobacco Survey. Our data showed that children as young as ten years smoked. There were 3.6% permanent smokers and one in three students (30.6%) experimented with smoking. More than two thirds who smoked agreed that they should quit smoking, and three fourths tried to quit. This study has also shown that children talk too little about smoking in schools and are exposed to passive smoking at home and elsewhere. Activities to solve the elementary school smoking problem should include preventive programs to be introduced into regular school curricula because this is the only way to address the issue properly. In addition, legislation prohibiting indoor tobacco smoking should be implemented rigorously to protect children from passive smoking in public places.     

A population study on the time trend of cigarette smoking,cessation, and exposure to secondhand smoking from 2001 to 2013 in Taiwan

Background

In 2001, the National Health Interview Survey (NHIS) commenced in Taiwan. This survey, conducted on a sample of the whole Taiwanese population, is nationally representative and has a high response rate (>80 %). As a result, the four already completed surveys from 2001 to 2013 can be used to investigate the time trend of smoking prevalence, the rate of cessation, and exposure to secondhand smoking.

Methods

There were 72918 adults combined from the 2001, 2005, 2009 and 2013 National Health Interview Surveys (NHIS). Smoking status, exposure to secondhand smoking, and smoking cessation were asked, as well as demographic characteristics and other variables. Statistical analyses with sampling weights were carried out using SAS and SUDAAN.

Results

In males, the prevalence of smoking significantly decreased (rates in 4 surveys were 44.4 %, 44.6 %, 38.9 %, and 34.2 %, respectively). Since 2005 the rate of smoking cessation increased significantly (p?=?0.033). The odd ratio (OR) exposure of secondhand among non-smokes (OR) in 2009 and 2013 were 0.96 (CI?=?0.85–1.08) and 0.78 (CI?=?0.70–0.88) comparing to 2005. In females, the prevalence of smoking was stable over time. The rate of smoking cessation only appeared significantly high in the older age group. The OR for exposure to secondhand smoking were 0.81 (CI?=?0.74–0.89) and 0.68 (CI?=?0.62–0.74), for 2009 and 2013 comparing to 2005, respectively.

Conclusion

Early anti-smoking legislation in Taiwan might have raised the awareness of the harm of smoking. However, the implementation of the Tobacco Hazards Prevention Act (THPA) in 2009 had great contribution to the reduction of smoking rate, especially in males.

     

Findings from the Global Youth Tobacco Survey (GYTS) in Czech Republic, Hungary, Poland and Slovakia – smoking initiation, prevalence of tobacco use and cessation

Objectives  

To show selected findings from the Global Youth Tobacco Survey (GYTS) conducted in Czech Republic, Hungary, Poland and Slovakia.     

Recent contributions of air- and biomarkers to the control of secondhand smoke (SHS): a review

Since the publication of the US Surgeon General Reports in 1996 and 2006 and the report of the California Environmental Protection Agency in 1999, many reports have appeared on the contribution of air and biomarkers to different facets of the secondhand smoke (SHS) issue, which are the targets of this review. These recent studies have allowed earlier epidemiological surveys to be biologically validated, and their plausibility demonstrated, quantified the levels of exposure to SHS before the bans in various environments, showed the deficiencies of mechanical control methods and of partial bans and the frequently correct implementation of the efficient total bans. More stringent regulation remains necessary in the public domain (workplaces, hospitality venues, transport sector, etc.) in many countries. Personal voluntary protection efforts against SHS are also needed in the private domain (homes, private cars). The effects of SHS on the cardiovascular, respiratory and neuropsychic systems, on pregnancy and fertility, on cancers and on SHS genotoxicity are confirmed through experimental human studies and through the relationship between markers and prevalence of disease or of markers of disease risk.     

Associations between respiratory illnesses and secondhand smoke exposure in flight attendants: A cross-sectional analysis of the Flight Attendant Medical Research Institute Survey

ABSTRACT: BACKGROUND: Secondhand tobacco smoke (SHS) is associated with increased risk of respiratory illness, cancer, and cardiovascular disease. Prior to smoking bans on airlines in the late 1980s, flight attendants were exposed to a significant amount of SHS. In the present study, we examine associations between flight attendant SHS exposure and development of respiratory illnesses and cardiovascular disease. METHODS: Between December 2006 and October 2010, three hundred sixty-two flight attendants completed an online questionnaire with information regarding experience as a flight attendant, medical history, smoking history, and SHS exposure. Rates of illnesses in flight attendants were compared with an age and smoking history matched population sample from NHANES 2005-2006. Logistic regression analysis was used to examine the association of reported medical conditions and pre-ban years of exposure. RESULTS: Compared with the sample from NHANES 2005-2006, flight attendants had increased prevalence of chronic bronchitis (11.7% vs. 7.2%, p < 0.05), emphysema/COPD (3.2% vs. 0.9%, p < 0.03), and sinus problems (31.5% vs. 20.9%, p < 0.002), despite a lower prevalence of medical illnesses including high blood pressure, diabetes, high cholesterol, heart failure, cancer, and thyroid disease. Amongst flight attendants who reported never smoking over their lifetimes, there was not a significant association between years of service as a flight attendant in the pre-smoking ban era and illnesses. However, in this same group, there was a significantly increased risk of daily symptoms (vs. no symptoms) of nasal congestion, throat, or eye irritation per 10-year increase of years of service as a flight attendant prior to the smoking ban (OR 2.14, 95% CI 1.41 - 3.24). CONCLUSIONS: Flight attendants experience increased rates of respiratory illnesses compared to a population sample. The frequency of symptoms of nasal congestion, throat or eye irritation is associated with occupational SHS exposure in the pre-smoking ban era.     

Tobacco use among Native Hawaiian middle school students: its prevalence, correlates and implications

Objectives. This study sought to explore whether Native Hawaiian primary ethnic identity is associated with cigarette use among Native Hawaiian middle school students. This study also explored whether social influence, psychosocial and cultural factors are associated with cigarette use in this sample.

Design. The data are from a cross-sectional survey of 1,695 Native Hawaiian middle school students at 22 public and private schools on five islands in Hawaii. A subset of these students from Native Hawaiian serving schools (N = 136) completed additional measures of Hawaiian cultural variables.

Results. Based on univariate analyses, students whose primary ethnic identification was Hawaiian were more likely to have tried smoking (p < 0.001) and to be current smokers (p < 0.05) as compared to those classified as part Hawaiian. However, these findings were no longer significant in multivariate analyses. Social influence variables (i.e. peer and parental smoking) were most influential in explaining both prior and current smoking. Attendance at public school was also an important factor in explaining previous (OR = 2.43; 95% CI = 1.74, 3.38) and current (OR = 7.20; 95% CI = 4.58, 11.32) smoking behavior. Finally, cultural variables such as valuing Hawaiian folklore, customs, activities and lifestyle were largely unassociated with smoking behavior among Native Hawaiian middle school youth.

Conclusions. Additional research is needed to understand what aspects of ethnic identity are associated with smoking behavior among Native Hawaiian youth. The strong influence of peer and parental smoking suggests the need for interventions that support the creation of social environments that discourage tobacco use.     

2015中国成人烟草调查:15岁及以上成年人群二手烟暴露及其对公共场所禁烟政策支持现状

目的 了解中国≥15岁成年人群二手烟暴露及其对公共场所禁烟政策支持情况,为公共场所禁烟提供科学证据。方法 参照全球成人烟草调查所设定的抽样原则及调查形式。使用全球烟草监测系统标准问卷,采用分层多阶段整群概率抽样法,在全国共抽取16800个家庭户;采用入户调查形式进行电子数据采集,每户家庭随机抽取一名合格的调查对象。对数据加权后,数据分析采用SAS 9.3和SUDAAN 10.0.1软件的复杂调查数据分析程序。结果 在过去30 d内调查对象在室内公共场所和工作场所看到有人吸烟的比例由高到低依次为酒吧/夜总会(93.1%,60128千人/64575千人)、餐馆(76.3%,455473千人/596782千人)、在家中(57.1%,621793千人/1089582千人)、工作场所(54.3%,218792千人/402732千人)、政府大楼(38.1%,61208千人/160574千人)、医疗机构(26.9%,119783千人/444679千人)、大学(23.8%,17598千人/73993千人)、中小学校(室内和室外;17.2%,41099千人/239022千人),以及公共交通工具(16.4%,102153千人/623015千人)。经标化,与5年前相比,在餐馆、政府大楼、医疗机构、中小学(室内和室外)、公共交通工具以及在家中的二手烟暴露情况下降幅度的差异均有统计学意义。此外,公众对室内公共场所和工作场所全面禁烟的支持度很高。尽管餐厅二手烟暴露率依然很高,但是有近70%的人支持在餐厅全面禁烟。结论 近年来我国室内公共场所、工作场所、公共交通工具及家中的二手烟暴露情况明显改善,公众支持公共场所禁烟政策。