The relationship between home smoking bans and exposure to state tobacco control efforts and smoking behaviors

PURPOSE: To examine the relationship between home smoking bans and adult smokers' exposure to the statewide California Tobacco Control Program (TCP) and their cigarette smoking behavior. DESIGN: Cross-sectional survey that was part of the statewide Independent Evaluation of the California Tobacco Control, Prevention and Education Program. SETTING: Random telephone interviews within 18 California counties. SUBJECTS: A representative sample of 1315 adult smokers, aged 25 years and older. MEASURES: The telephone survey included questions about smoking behavior, quitting smoking, exposure to tobacco control program components, home smoking rules, and attitudes related to tobacco use and environmental tobacco smoke (ETS). RESULTS: Smokers with a home smoking ban were twice as likely (OR = 2.29; 95% CI 1.22, 4.29) to have heard of TCP community programs and three times more likely (OR = 3.18; 95% CI 1.34, 7.57) to have seen and talked about the ETS media spot than smokers with no home smoking policy. Multivariate regression models indicated that having a home smoking ban was related to smoking fewer cigarettes per day and greater interest in quitting smoking compared with smokers with no smoking rules in the home (p < .05). CONCLUSIONS: These findings suggest that smokers reporting exposure to the California TCP were more likely to have restrictive home smoking policies and that more restrictive home smoking policies were associated with reduced smoking behavior.     

The effect of smoke-free homes on smoking behavior in the U.S

BACKGROUND: Evidence from longitudinal population surveys is needed to establish whether smoke-free homes might influence smoking behavior. METHODS: The Tobacco Use Supplement of the nationally representative U.S. Current Population Survey (TUS-CPS) interviewed 3292 adult recent smokers in 2002 and again 12 months later. Both surveys measured smoking status, rules on smoking in the home, and the number of cigarettes smoked per day (cpd). For the main study outcome, an early marker of successful cessation (>/=90 days quit) was used. Analysis was completed in 2008. RESULTS: In the 12 months ending February 2003, the prevalence of smoke-free homes among recent smokers increased from 33% to 39%. A smoke-free home at baseline was associated with >/=90 days cessation at follow-up (10.9% vs 6.2%, AOR=1.44; 95% CI=0.97, 2.21), and those who maintained a smoke-free home were more likely to be >/=90 days quit than those who did not (12.9% vs 5.7%, AOR=1.99; 95% CI=0.93, 4.25). However, adopting a smoke-free home during the year was associated with a nearly fivefold increase in the percentage of >/=90 days quit (AOR=4.81; 95% CI=3.06, 7.59). This increase was seen among all smokers, including moderate-to-heavy smokers (>/=90 days quit: a smoke-free home=13.0% vs no smoke-free home=2.9%, p<0.001). Among continuing smokers with a smoke-free home at baseline, maintenance of the smoke-free home was associated with a decline in consumption (mu=-2.18; 95% CI=-1.24; -3.10 cpd). Among continuing smokers with no smoke-free home at baseline, adoption of that status was also associated with a decline in consumption (mu=-1.72; 95% CI=-0.58; -2.85 cpd). CONCLUSIONS: This study provides strong evidence that the adoption of a smoke-free home is associated with successful quitting among smokers in the U.S.     

Smoking in the workplace in the Latium Region,Italy, after the smoking ban

Background:In Italy, an anti-smoking law was issued in 2003, with the aim of reducing tobacco smoking inside public places.Objectives:The aim of the study was to assess the observance of the smoking ban in Italy, during the period 2010-2014, in several workplaces and to evaluate the perception of workers, both smokers and non-smokers, on this issue.Methods:This cross-sectional study analyzed data resulting from a self-administered questionnaires in 59 companies, from several working sectors (transport, healthcare and building), in the Latium Region in Italy.Results:Out of 7200 questionnaires, 6996 were included in the analysis: 43.7% of the employees think that the smoking ban is respected in the workplace; women are more prone to think that the ban is not observed. Smokers tend to perceive the ban to be respected (AOR: 0.69; 95% CI: 0.62-0.77) while non-smokers feel more exposed to second-hand smoke (AOR: 1.57; 95% CI: 1.39-1.77). Workers in intellectual and highly specialized professions (AOR: 1.63; 95% CI: 1.25-2.13), technical professions (AOR: 1.64; 95% CI: 1.28-2.10) and craftsmen, skilled workers and farmers (AOR: 1.42; 95% CI: 1.09-1.85) tend to perceive the smoking ban not to be observed and the last two classes are the ones who feel the most exposed to second-hand smoke (AOR: 6.68; 95% CI: 0.50-0.90; AOR: 0.52; 95% CI: 0.38-0.70).Discussion:The results of this study can be used as a starting point for the implementation of new strategies to reduce tobacco addiction, beginning from the compliance with the ban on smoking in the workplace and the promotion of a healthy lifestyle.     

Factors influencing quit attempts among male daily smokers in China

BackgroundChina has the largest population of smokers in the world, yet the quit rate is low. We used data from the 2010 Global Adult Tobacco Survey China to identify factors influencing quit attempts among male Chinese daily smokers.MethodsThe study sample included 3303 male daily smokers. To determine the factors that were significantly associated with making a quit attempt, we conducted logistic regression analyses. In addition, mediation analyses were carried out to investigate how the intermediate association among demographics (age, education, urbanicity) and smoking-related variables affected making a quit attempt.ResultsAn estimated 11.0% of male daily smokers tried to quit smoking in the 12 months prior to the survey. Logistic regression analysis indicated that younger age (15–24 years), being advised to quit by a health care provider (HCP) in the past 12 months, lower cigarette cost per pack, monthly or less frequent exposure to smoking at home, and awareness of the harms of tobacco use were significantly associated with making a quit attempt. Additional mediation analyses showed that having knowledge of the harm of tobacco, exposure to smoking at home, and having been advised to quit by an HCP were mediators of making a quit attempt for other independent variables.ConclusionEvidence-based tobacco control measures such as conducting educational campaigns on the harms of tobacco use, establishing smoke-free policies at home, and integrating tobacco cessation advice into primary health care services can increase quit attempts and reduce smoking among male Chinese daily smokers.     

Smoking cessation behavior among intermittent smokers versus daily smokers

Nondaily intermittent smokers (ITS) are common, but their cessation behavior remains elusive. We examined cessation of native-ITS (n = 2040), converted-ITS (n = 1808), and daily smokers (DS; n = 25 344). All ITS were more likely than were DS to make a quit attempt (native-ITS adjusted odds ratio [AOR] = 1.60, 95% confidence interval [CI] = 1.42, 1.80; converted-ITS AOR = 3.33, 95% CI = 2.93, 3.78). Native-ITS (18%) and converted-ITS (27%) were more likely than were DS (13%) to quit smoking (native-ITS AOR = 1.34, 95% CI = 1.07, 1.67; converted-ITS AOR = 2.36, 95% CI = 2.01, 2.78), but the low cessation rates of ITS challenge their nonaddicted status.     

Tobacco use behaviors and household smoking bans among Chinese Americans

PURPOSE: To assess the relationship between household smoking restrictions and smoking patterns among Chinese American adults. DESIGN: This is a cross-sectional analysis based on a National Institutes of Health-funded population-based household and telephone survey of 2537 Chinese American adults. SETTING: Two communities in New York City. SUBJECTS: The analyses focused on male current smokers (N = 600). MEASURES: Demographic characteristics, smoking status, household smoking restrictions, cigarettes smoked per day, and past quit attempts were based on self-reported data. RESULTS: Among current smokers, 37% reported living in a home with a complete smoking ban. Smokers with a full household smoking ban smoked fewer cigarettes on weekdays and weekends than smokers with no household smoking ban (p < or = .05) and were 3.4 times (p < .01) more likely to report having at least one quit attempt in the past 12 months. Smokers with knowledge of the dangers of environmental tobacco smoke (ETS) exposure were 2.8 times (p < or = .01) more likely to have at least one quit attempt in the last 12 months compared with those who were unaware of the danger of ETS and more likely to live in a smoke-free household. CONCLUSIONS: Smoke-free home policies and interventions to raise awareness among smokers of the dangers of ETS have the potential to significantly reduce tobacco use and exposure to household ETS among this immigrant population.     

Smoking Policy Change Within Permanent Supportive Housing

Smoke-free policies effectively reduce secondhand smoke (SHS) exposure among non-smokers, and reduce consumption, encourage quit attempts, and minimize relapse to smoking among smokers. Such policies are uncommon in permanent supportive housing (PSH) for formerly homeless individuals. In this study, we collaborated with a PSH provider in San Diego, California to assess a smoke-free policy that restricted indoor smoking. Between August and November 2015, residents completed a pre-policy questionnaire on attitudes toward smoke-free policies and exposure to secondhand smoke, and then 7–9 months after policy implementation residents were re-surveyed. At follow-up, there was a 59.7% reduction in indoor smoking. The proportion of residents who identified as current smokers reduced by 13% (95% CI: ?38, 10.2). The proportion of residents who reported never smelling SHS indoors (apartment 24.2%, 95% CI: 4.2, 44.1; shared areas 17.2%, 95% CI: 1.7, 32.7); in outdoor areas next to the living unit (porches or patio 56.7%, 95% CI: 40.7, 72.8); and in other outdoor areas (parking lot 28.6%, 95% CI: 8.3, 48.9) was lower post-policy compared with pre-policy. Overall, resident support increased by 18.7%; however, the greatest increase in support occurred among current smokers (from 14.8 to 37.5%). Fewer current smokers reported that the policy would enable cessation at post-policy compared to pre-policy. Our findings demonstrate the feasibility of implementing smoke-free policies in PSH for formerly homeless adults. However, policy alone appears insufficient to trigger change in smoking behavior, highlighting the need for additional cessation resources to facilitate quitting.     

Smoking Bans in the Home and Car: Do Those Who Really Need Them Have Them?

Background. This paper addresses the question of whether individuals who are most in need of household and car smoking bans, such as individuals with children living at home or who have many friends who smoke, are the ones who have them.Method. A representative sample of 6985 California adults ages 18 and older participated in telephone interviews.Results. Overall, 76% of adults report having home smoking bans and 66% have car smoking bans. Being a smoker or African American, not having children in the home, having more friends who smoke, and lower household income were associated with lower prevalence of both home and car smoking bans (P < 0.01). In multivariate analyses, nonsmokers were 7.9 (95% CI = 3.56, 17.31) times more likely to have a home smoking ban when none of their friends were smokers compared to when most of their friends were smokers. Among smokers, there was an interaction between having children at home and the proportion of friends who smoke. Only 27 to 55% of smokers had home smoking bans unless most of their friends were smokers, then the odds of having a ban were 6.1 (95% CI = 2.76, 13.68) times higher for smokers with children (67% with home bans) than for smokers without children at home (25% with home bans).Conclusions. Efforts to increase home and car smoking bans for nonsmokers who have friends who smoke and smokers with children living at home are needed.     

Factors Associated With Quitting Smoking in Indonesia

Objectives:The aim of this study was to identify factors associated with quitting smoking in Indonesia Methods:Data on 11 115 individuals from the fifth wave of the Indonesia Family Life Survey were analyzed. Quitting smoking was the main outcome, defined as smoking status based on the answer to the question “do you still habitually (smoke cigarettes/smoke a pipe/use chewing tobacco) or have you totally quit?” Logistic regression was performed to identify factors associated with successful attempts to quit smoking. Results:The prevalence of quitting smoking was 12.3%. The odds of successfully quitting smoking were higher among smokers who were female (adjusted odds ratio [aOR], 2.69; 95% confidence interval [CI], 2.08 to 3.33), were divorced (aOR, 2.45; 95% CI, 1.82 to 3.29), did not chew tobacco (aOR, 3.01; 95% CI, 1.79 to 5.08), found it difficult to sacrifice smoking at other times than in the morning (aOR, 1.29; 95% CI, 1.14 to 1.46), and not smoke when sick (aOR, 1.32; 95% CI, 1.14 to 1.54). About 59% of variance in successful attempts to quit smoking could be explained using a model consisting of those variables. Conclusions:Female sex, being divorced, not chewing tobacco, and nicotine dependence increased the odds of quitting smoking and were associated with quitting smoking successfully. Regular and integrated attempts to quit smoking based on individuals’ internal characteristics, tobacco use activity, and smoking behavior are needed to quit smoking.     

Young adult social smokers: Their co-use of tobacco and alcohol,tobacco-related attitudes,and quitting efforts

ObjectiveYoung adults frequently report social smoking. This study examined the relationship between different social smoking definitions and the co-use of cigarettes and alcohol, tobacco-related attitudes, and quitting efforts.MethodCross-sectional data were collected at bars using randomized time location sampling among young adults aged 21–26 in San Diego, California from 2010 to 2011 (73% response rate). Multivariable logistic regression examined if current smoking and quit attempts were associated with tobacco-related attitudes, and whether social smoking self-identification or behavior was associated with cigarette-and-alcohol co-use, tobacco-related attitudes, quit attempts, or quitline use.ResultsAmong 537 current smokers, 80% self-identified and 49% behaved as social smokers. Social smoking self-identification was positively associated with cigarette-and-alcohol co-use, and quit attempts. Social smoking behavior was negatively associated with tobacco marketing receptivity, quit attempts, and quitline use. Tobacco-related attitudes were associated with smoking but did not generally differ by social smoking status.ConclusionIdentification and behavior as a social smoker have opposing associations with co-use of cigarettes and alcohol and quit attempts. Tobacco cessation programs for self-identified social smokers should address co-use. Interventions denormalizing the tobacco industry or emphasizing the health effects of temporary smoking and secondhand smoke may address smoking among young adult bar patrons regardless of social smoking status.     

Risk factors associated with smokeless tobacco use and cigarette smoking among teenagers in a sub-urban area of south west Nigeria

Aims

To evaluate the prevalence of, and identify risk factors associated with smokeless tobacco (SLT) use and cigarette smoking (CS) among Nigerian teenagers.

Methods

Using a validated self-administered questionnaire adapted from the Global Youth Tobacco Survey, we surveyed 1,272 teenagers selected from the five schools in Ilisan-Remo Nigeria regarding use of CS and SLT products. We used the Pearson chi-squared test and logistic regression to assess correlates of both SLT use and CS. Adjusted odds ratios (AOR) with 95?% confidence intervals (CI) were used to measure magnitudes of associations.

Results

Prevalence of ever users of SLT and CS were 5.0?% (CI: 3.8, 6.2) and 6.9?% (CI: 5.5, 8.3) respectively. Higher prevalence of SLT user was recorded among male (7.9?%), 18–19?years (11.1?%), those who had parents cigarette smokers (35.9?%), those whose best friends were cigarette smokers (47.1?%) and those working after school (9.4?%) compared with their counterparts (p?<?0.05). Similarly, higher prevalence of CSwas recorded among male (9.6?%), 18–19?years (12.7?%), those whose parents smoke (56.4?%), those whose best friends were cigarette smokers (100.0?%) and Muslims (11.1?%) compared with their counterparts. Major factors associated with SLT use were being a cigarette smokers (AOR?=?29.9; CI: 16.5, 54.4), parents smoking (AOR?=?16.1; CI: 9.0, 29.8) and having best friends who smoke (AOR?=?15.1; CI: 7.0, 32.4). Main factors associated with CS included SLT use (AOR?=?29.9; CI: 16.5, 54.4), parent smoking (AOR?=?31.7; CI: 18.2, 55.4 and Muslim (AOR?=?1.8; CI: 1.1, 2.9).

Conclusion

Prevention programmes aimed at reducing cigarette smoking need to be improved to reduce SLT use. The home and places of after school work must also be factored.     

Factors Associated With Quitting Smoking During Pregnancy Among Women Veterans

IntroductionLittle is known about the rates of smoking among pregnant veterans. Our objective was to examine rates of smoking during pregnancy and factors associated with quitting smoking during pregnancy.MethodsWe used data from a cohort study of pregnant veterans from 15 Veterans Health Administration facilities nationwide. Veterans who reported smoking during pregnancy were included in this analysis. Poisson regression models were used to estimate the relative risk (RR) of quitting smoking during pregnancy.ResultsOverall, 133 veterans reported smoking during pregnancy. Among this group of women who smoked, the average age was 31.6 years, 20% were Black, and 14% were Hispanic/Latino. More than one-half of women (65%) who reported smoking at the start of pregnancy quit smoking during pregnancy. Multivariable models, adjusted for history of deployment and age, indicated that prenatal care initiation at 12 or fewer weeks compared with more than 13 weeks (relative risk [RR], 2.06; 95% confidence interval [CI], 1.18–3.58), living without household smokers compared with any household smokers (RR, 1.58; 95% CI, 1.14–2.17), and first pregnancy (RR, 1.51; 95% CI, 1.17–1.95) were significant predictors of quitting versus persistent smoking during pregnancy.ConclusionsWomen veterans who quit smoking may be different than those who continue to smoke during pregnancy. Establishing prenatal care early in pregnancy, which likely includes counseling about smoking cessation, seems to be an important factor in quitting. Those for whom it is not a first pregnancy and who live with other smokers may especially benefit from such counseling.     

Changes in Smoking Behavior Since the Declaration of the COVID-19 State of Emergency in Japan: A Cross-sectional Study From the Osaka Health App

BackgroundIn April 2020, the Japanese government declared a state of emergency due to the COVID-19 pandemic, and infection control measures, including requests to work from home and stay-at-home restrictions, were introduced. This study examined changes in smoking behavior during the COVID-19 state of emergency.MethodsAn online cross-sectional survey was conducted in Osaka, Japan. To assess differences in smoking behavior among 5,120 current smokers before and after the declaration of a state of emergency, prevalence ratios (PRs) for two outcomes, increased smoking and quitting smoking, were calculated using multivariable Poisson regression, adjusting for potential covariates.ResultsWe found 32.1% increased the number of cigarettes smoked and 11.9% quit smoking. After adjustment for all variables, we found risk factors for COVID-19 (men and older age group) had both significantly higher PR for quitting smoking (men: PR 1.38; 95% confidence interval [CI], 1.17–1.62) and participants aged ≥65 years: PR 2.45; 95% CI, 1.92–3.12) and significantly lower PR of increased smoking (men: PR 0.85; 95% CI, 0.78–0.93 and participants ≥65 years: PR 0.38; 95% CI, 0.29–0.49). Additionally, respondents working from home or living alone had significantly higher PR for increased smoking (working from home: PR 1.29; 95% CI, 1.17–1.41 and living alone: PR 1.23; 95% CI, 1.10–1.38) and respondents who changed from cigarettes to heated tobacco products (HTPs) had significantly lower PR for quitting smoking (PR 0.150; 95% CI, 0.039–0.582).ConclusionsWe suggest people who have high-risk factors for COVID-19 might change their smoking behavior for the better, while people who work from home or live alone might change their smoking behavior for the worse, during the COVID-19 state of emergency. Additionally, changing from smoking cigarettes to using HTPs makes smokers less likely to quit.Key words: tobacco, cigarette, COVID-19, declaring the state of emergency     

State of transition: Marijuana use among young adults in the San Francisco Bay Area

BackgroundCalifornia may vote on marijuana legalization in 2016. Young adults have the highest rates of marijuana use, but little is known about the correlates of use in this age group, including factors that may be affected by policy change. We investigated whether there are differences in marijuana use by sociodemographic characteristics, psychological distress, loneliness and social support, controlling for risk factors such as alcohol and cigarette use as well as perceived harm of marijuana.MethodsBivariate and multivariable analysis of past 30 day marijuana use using the 2014 San Francisco Bay Area Young Adult Health Survey, a probabilistic multi-mode survey of (N = 1324) young adults (aged 18–26 years) residing in Alameda and San Francisco Counties, stratified by race/ethnicity.Results291 (27%) sample participants reported current marijuana use. Compared to non-Hispanic Whites (referent) Asian/Pacific Islander respondents were less likely to use marijuana (AOR, 0.42; 95% CI, 0.22–0.80) while multiracial participants were twice as likely (AOR, 2.27; 95% CI, 1.06–4.85). Psychological distress was not related to marijuana use, but social support (AOR, 1.42; 95% CI, 1.08–1.88) and loneliness (AOR, 1.42; 95% CI, 1.09–1.86) were. Perceived harm of marijuana was inversely related to marijuana use (AOR, 0.60; 95% CI, 0.51–0.70), while smoking cigarettes (AOR, 3.95; 95% CI, 2.28–6.84) and binge drinking (AOR, 1.13; 95% CI, 1.03–1.24) were positively related.ConclusionsLegalization policies should include public education campaigns addressing potential harms of marijuana use particularly targeting multiracial young adults who also engage in other risk behaviors, such as cigarette smoking and binge drinking.     

Nicotine replacement therapy and other interventions for pregnant smokers: Pregnancy Risk Assessment Monitoring System, 2009–2010

BackgroundCurrent U.S. guidelines recommend consideration of nicotine replacement therapy (NRT) for pregnant smokers if behavioral therapies fail, only under close supervision of a provider, and after discussion of known risks of continued smoking and possible risks of NRT. The percentage of pregnant smokers offered NRT by their prenatal care providers is unknown.PurposeThe study aims to calculate the percentage of pregnant smokers offered cessation intervention and NRT and assess independent associations between selected maternal characteristics and being offered NRT.MethodsData were analyzed from the 2009–2010 Pregnancy Risk Assessment Monitoring System from four states that asked about provider practices for prenatal smoking cessation. Adjusted prevalence ratios were calculated to examine associations between being offered NRT, selected maternal characteristics, and smoking level. Variables used in adjusted models were based on factors associated with smoking cessation during pregnancy from prior literature and included race, age, education, insurance type, and stress.ResultsOf 3559 women who smoked 3 months before pregnancy, 77.4% (95% CI: 74.2, 80.3) of 3rd trimester smokers and 42% (95% CI: 38.5, 46.4) of women who quit smoking during pregnancy were offered at least one cessation method. Among smokers, 19.1% (95% CI: 16.5, 22.1) were offered NRT and of these, almost all (94%) were offered another cessation method.ConclusionsOne in five pregnant smokers was offered NRT. About a quarter of pregnant smokers did not receive any interventions to stop smoking. There may still be reluctance to provide NRT to pregnant women, despite known harms of continued smoking during pregnancy.     

Electronic Cigarette Use Among Korean Adolescents: A Cross-Sectional Study of Market Penetration,Dual Use,and Relationship to Quit Attempts and Former Smoking

PurposeAs elsewhere, in South Korea electronic cigarettes (e-cigarettes) are marketed, in part, as a smoking cessation aid. We assessed the prevalence of e-cigarette use among Korean adolescents and the relationship between e-cigarette use and current (past 30-day) smoking, cigarettes/day, attempts to quit conventional cigarettes, and ceasing to use cigarettes.MethodsData from the 2011 Korean Youth Risk Behavior Web-based Survey of 75,643 students aged 13–18 years were analyzed with logistic regression.ResultsA total of 9.4% (8.0% ever–dual users who were concurrently using e-cigarettes and smoking conventional cigarettes and 1.4% ever–e-cigarette only users) of Korean adolescents have ever used e-cigarettes and 4.7% were current (past 30-day) e-cigarette users (3.6% dual users and 1.1% e-cigarettes only). After adjusting for demographics, current cigarette smokers were much more likely to use e-cigarettes than were nonsmokers. Among current cigarette smokers, those who smoked more frequently were more likely to be current e-cigarette users. The odds of being an e-cigarette user were 1.58 times (95% confidence interval, 1.39–1.79) higher among students who had made an attempt to quit than for those who had not. It was rare for students no longer using cigarettes to be among current e-cigarette users (odds ratio, .10; confidence interval, .09–.12).ConclusionsSome Korean adolescents may be responding to advertising claims that e-cigarettes are a cessation aid: those who had made an attempt to quit were more likely to use e-cigarettes but less likely to no longer use cigarettes. E-cigarette use was strongly associated with current and heavier cigarette smoking.     

Risk Factors for DOTS Treatment Default Among New HIV-TB Coinfected Patients in Nalgonda (Dist.) Telangana (State): A Case Control Study

Background:The therapeutic regimens as recommended by the Revised National TB Control Programme (RNTCP) have been shown to be highly effective for both preventing and treating tuberculosis, but poor adherence to medication is a major barrier to its global control.Results:The mean age was 36.5 ± 9 years; the majority (23.3%) of patients defaulted during the second month of treatment. Significant risk factors associated with defaulting included unskilled occupation [adjusted odds ratio (AOR: 3.56; 95% confidence interval (CI): 1.1-11.56], lower middle class socioeconomic status (AOR: 17.16; 95% CI: 3.93-74.82), small family size (AOR: 21.3; 95% CI: 6.4-70.91), marital disharmony (AOR: 6.78; 95% CI: 1.93-23.76), not being satisfied with the conduct of health personnel (AOR: 7.38; 95% CI: 2.32-23.39), smoking (AOR: 8.5; 95% CI: 2.31-31.21), and side effects of drugs (AOR: 4.18; 95% CI: 1.35-12.9).Conclusion:Unskilled occupation, marital disharmony, small family size, lower middle class socioeconomic status, not being satisfied with the conduct of health personnel, smoking, and drug side effects were significantly associated with defaulting. Information on the pattern of tuberculosis (TB), the outcome of anti-tuberculosis treatment (ATT), and the factors associated with it will help in planning interventions to improve adherence to DOTS treatment.     

Transitions in Smoking Across a Pregnancy: New Information from the Growing Up in New Zealand Longitudinal Study

Introduction Maternal smoking remains a modifiable cause of adverse maternal and child health outcomes. This study investigated smoking transitions across pregnancy. Methods Data from the contemporary child cohort study Growing Up in New Zealand (n?=?6822) were used to analyse smoking status across three points across a pregnancy: pre-pregnancy, during pregnancy and after pregnancy. Odds-ratios (OR) were calculated for maternal, socio-economic and pregnancy-related factors associated with each transition using multivariate logistic regression. Results The prevalence of smoking pre-pregnancy was 20.3%. The cessation rate during pregnancy was 48.5%, while the postpartum relapse rate was 36.0%. Heavy smokers were less likely to quit during pregnancy (OR 0.13, 95% CI 0.08–0.20), and more likely to relapse at 9 months (OR 2.63, CI 1.60–4.32), relative to light smokers. Women in households with another smoker were less likely to quit during pregnancy (OR 0.35, CI 0.25–0.48), and more likely to relapse postpartum (OR 2.00, CI 1.14–3.51), relative to women in a smoke-free household. Women without high school qualifications were less likely to quit during pregnancy than women with bachelor degrees (OR 0.21, CI 0.11–0.41) but no more likely to relapse. Maori women were less likely to quit during pregnancy than European women (OR 0.35, CI 0.25–0.49) but no more likely to relapse. Conclusion Heavy smokers and those with another smoker in the household are at high risk of smoking during pregnancy or relapsing after pregnancy. Decreasing smoking across a pregnancy therefore requires a focus on cessation in all households with heavy smokers of child-bearing age. The association between smoking and ethnicity may be confounded as it not consistent across the pregnancy.     

The association between pain and measures of well-being among nursing home residents

ObjectivesTo determine the extent to which pain is associated with well-being indices among nursing home residents.DesignCross-sectional.SettingA total of 185 for-profit nursing homes from 19 states.ParticipantsParticipants were 9952 long-stay residents without cancer.MeasurementsMinimum Data Set assessments on pain; analgesics; and cognitive, functional, and emotional status. Logistic regression models provided estimates of the association between persistent/intensified pain and intermittent pain on increases in depressed or anxious mood, reduced time involved in activities, resisting care, as well as verbal and physical aggression.ResultsTwenty-five percent had pain documented on 2 consecutive assessments; these residents were more likely to have arthritis, an anxiety disorder, depression, or insomnia and less likely to have cognitive impairment than patients without pain. Residents with persistent pain were 79% as likely to experience mood impairments (adjusted odds ratio [AOR]: 1.79; 95% confidence interval [CI]: 1.61–1.99) and 90% as likely to have less than one-third of time involved with activities (AOR: 1.90; 95% CI: 1.32–2.75) relative to those without pain. Residents with intermittent pain were 30% as likely to experience mood impairments (AOR: 1.30; 95% CI: 1.18–1.45) and 55% as likely to have less than one-third of time involved with activities (AOR: 1.55; 95% CI: 1.08–2.23) relative to those without pain. No association was observed with resisting care or verbal or physical aggression.ConclusionIn nursing home residents, pain is highly prevalent and affects measures of well-being. Initiatives to recognize and appropriately treat pain may lead to increased measures of well-being.