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.

     

Lifestyle factors in somatic patients with and without potential alcohol problems

Background

In the present study, we investigated the overall lifestyles of patients with hazardous alcohol use and alcohol dependence who were admitted to the hospital and investigated unhealthy lifestyle factors and their clustering in inpatients.

Methods

Patients admitted to the gastrointestinal, neurologic or orthopedic departments at Odense University Hospital or to the emergency department at Aabenraa Hospital in the inclusion period, October 2013 to June 2016, completed a lifestyle questionnaire asking questions about their diet, alcohol consumption, exercise and smoking habits. Patients were divided into three groups depending on their score from the alcohol use disorder identification test, which was embedded in the lifestyle questionnaire, and odds ratios were calculated using logistic regression.

Results

Patients with alcohol dependence had statistically significantly higher odds of being smokers, having unhealthy diets and being physically inactive compared with patients without alcohol problems. Among patients with hazardous alcohol drinking, we found an increased occurrence of smokers and an inverse association between hazardous alcohol drinking and being physically inactive. Many of the patients had attempted to change their unhealthy lifestyles.

Conclusion

We found that alcohol problems are related to a clustering of other lifestyle factors and that many of the patients admitted to certain departments showed signs of various kinds of alcohol problems. Therefore, specific hospital departments could be opportune settings for preventive alcohol interventions.

     

Cost-Effectiveness Analysis of Smoking Cessation Interventions in Japan Using a Discrete-Event Simulation

Background

Smoking cessation medications have been shown to yield higher success rates and sustained abstinence than unassisted quit attempts. In Japan, the treatments available include nicotine replacement therapy (NRT) and varenicline; however, unassisted attempts to quit smoking remain common.

Objective

The objective of this study was to compare the health and economic consequences in Japan of using pharmacotherapy to support smoking cessation with unassisted attempts and the current mix of strategies used.

Methods

A discrete-event simulation that models lifetime quitting behaviour and includes multiple quit attempts (MQAs) and relapses was adapted for these analyses. The risk of developing smoking-related diseases is estimated based on the duration of abstinence. Data collected from a survey conducted in Japan were used to determine the interventions selected by smokers initiating a quit attempt and the time between MQAs. Direct and indirect costs are assessed (expressed in 2014 Japanese Yen).

Results

Using pharmacotherapy (NRT or varenicline) to support quit attempts proved to be dominant when compared with unassisted attempts or the current mix of strategies (most are unassisted). The results of stratified analyses by age imply that smoking cessation improves health outcomes across all generations. Indirect costs due to premature death leading to lost wages are an important component of the total costs, exceeding the direct medical cost estimates.

Conclusions

Increased utilisation of smoking cessation pharmacotherapy to support quit attempts is predicted to lead to an increase in the number of smokers achieving abstinence, and provide improvements in health outcomes over a lifetime with no additional costs.

     

Family characteristics and health-related behaviours influence physical fighting involvement in late adolescence: a study from 13 to 17 years of age

Aim

We aimed to assess the contribution of early characteristics in adolescence as associated factors of later involvement in physical fighting.

Subject and methods

Based on data from a cohort of adolescents, we evaluated 1,687 participants, recruited in public and private schools in Porto, Portugal. Information on social and behavioural characteristics was collected using the same self-administered questions at 13 and 17 years of age. Logistic regression was used to estimate the magnitude of associations.

Results

In both genders, physical fighting was significantly associated with living in a sole parent family, in particular only with the mother, and with early grade retention. Also, early cigarette smoking and alcohol drinking initiation were significantly associated with later involvement in fights.

Conclusion

Our results show that family characteristics and modifiable behavioural trajectories are important determinants of later involvement in physical fighting.

     

A Trial-Based Predictive Microsimulation Assessing the Public Health Benefits of Nalmefene and Psychosocial Support for the Reduction of Alcohol Consumption in Alcohol Dependence

Background

Alcohol dependence causes considerable harm to patients. Treatment with nalmefene, aiming to reduce consumption rather than maintain complete abstinence, has been licensed based on trials demonstrating a reduction in total alcohol consumption and heavy drinking days. Relating these trial outcomes to harmful events avoided is important to demonstrate the clinical relevance of nalmefene treatment.

Methods

A predictive microsimulation model was developed to compare nalmefene plus brief psychosocial intervention (BRENDA) versus placebo plus BRENDA for the treatment of patients with alcohol dependence and a high or very high drinking risk level based on three pooled clinical trials. The model simulated patterns and level of alcohol consumption, day-by-day, for 12 months, to estimate the occurrence of alcohol-attributable diseases, injuries and deaths; assessing the clinical relevance of reducing alcohol consumption with treatment.

Results

The microsimulation model predicted that, in a cohort of 100,000 patients, 971 (95 % confidence interval [CI] 904–1038) alcohol-attributable diseases and injuries and 133 (95 % CI 117–150) deaths would be avoided with nalmefene versus placebo. This level of benefit has been considered clinically relevant by the European Medicines Agency.

Conclusions

This microsimulation model supports the clinical relevance of the reduction in alcohol consumption, and has estimated the extent of the public health benefit of treatment with nalmefene in patients with alcohol dependence and a high or very high drinking risk level.

     

Association between fish intake and depressive symptoms among community-living older Chinese adults in Singapore: A cross-sectional study

Objective

Our aim of this study was to investigate the association between fish consumption and depressive symptoms in senior ethnic Chinese residents of Singapore.

Design

A population-based crosssectional study.

Setting

The Singapore Longitudinal Aging Studies (SLAS).

Participant

The study consisted of 2,034 participants from the Singapore Longitudinal Aging Studies (SLAS) project who were at least 55 years old.

Measurements

The presence of depressive symptoms was compared between those who self-reported eating fish at least three times a week versus those who ate fish less often. A score of 5 or greater on the 15-item Geriatric Depression Scale (GDS-15) was the cutoff for being designated as having depressive symptoms.

Results

Fish intake was associated with a lower prevalence of depressive symptoms ([odds ratio] OR = 0.60, 95% [confidence interval] CI 0.40–0.90; P =.015) after controlling for age, sex, marital status, housing, smoking, alcohol consumption, physical exercise, social and productive activities, self-rated health, hypertension, diabetes, heart failure or attack, stroke, fruit and vegetable intake, and Mini-Mental State Examination (MMSE) scores.

Conclusion

Our results suggest that eating fish at least three times a week is associated with a lower odds of having depressive symptoms among Chinese adults over 55 years old living in Singapore.

     

Heavy drinking and contextual risk factors among adults in South Africa: findings from the International Alcohol Control study

Background

There is limited information about the potential individual-level and contextual drivers of heavy drinking in South Africa. This study aimed to identify risk factors for heavy drinking in Tshwane, South Africa.

Methods

A household survey using a multi-stage stratified cluster random sampling design. Complete consumption and income data were available on 713 adults. Heavy drinking was defined as consuming ≥120?ml (96?g) of absolute alcohol (AA) for men and?≥?90?ml (72?g) AA for women at any location at least monthly.

Results

53% of the sample were heavy drinkers. Bivariate analyses revealed that heavy drinking differed by marital status, primary drinking location, and container size. Using simple logistic regression, only cider consumption was found to lower the odds of heavy drinking. Persons who primarily drank in someone else’s home, nightclubs, and sports clubs had increased odds of heavy drinking. Using multiple logistic regression and adjusting for marital status and primary container size, single persons were found to have substantially higher odds of heavy drinking. Persons who drank their primary beverage from above average-sized containers at their primary location had 7.9 times the odds of heavy drinking as compared to persons who drank from average-sized containers. Some significant associations between heavy drinking and age, race, and income were found for certain beverages.

Conclusion

Rates of heavy drinking were higher than expected giving impetus to various alcohol policy reforms under consideration in South Africa. Better labeling of the alcohol content of different containers is needed together with limiting production, marketing and serving of alcohol in large containers.

     

“<Emphasis Type="Italic">I’m not strong enough; I’m not good enough. I can’t do this,I’m failing</Emphasis>”: a qualitative study of low-socioeconomic status smokers’ experiences with accessing cessation support and the role for alternative technology-based support

Background

The social gradient in smoking rates persist with an overrepresentation of smoking and its associated harms concentrated within lower socioeconomic status (SES) populations. Low-SES smokers are motivated to quit but face multiple barriers when engaging a quit attempt. An understanding of the current treatment service model from the perspectives of treatment-seeking low-SES smokers is needed to inform the design of alternative smoking cessation support services tailored to the needs of low-SES populations. This qualitative study aimed to: i) explore low-SES smokers’ recent quitting experiences; ii) assess factors that impact treatment engagement; and iii) determine the acceptability and feasibility of alternative approaches to smoking cessation.

Method

Low-SES participants (n = 24) previously enrolled in a smoking cessation RCT participated in either a semi-structured focus group or in-depth telephone interview. Data was obtained and analysed using thematic analysis from October 2015 to June 2016. Analysis was deductive from the interview guide and supplemented inductively.

Results

Participants expressed feelings of guilt and shame around their smoking behaviour and experienced stigmatisation for their smoking. Guilt, shame, and stigmatisation negatively impacted treatment seeking behaviours with most avoiding current quit services. Costs of pharmacotherapy and treatment adherence were commonly cited barriers to treatment success. Electronic-cigarettes were perceived to be unsafe due to uncertainty on their legal status and regulatory restrictions. Technology-based text-messaging quit support was endorsed as a more favourable alternative compared to existing behavioural treatment services.

Conclusion

Stigmatisation was commonly endorsed and acted as an impediment to current treatment utilisation. Electronic-cigarettes may present a viable harm reduction alternative, but their likely uptake in socioeconomically disadvantaged groups in Australia is limited by smokers’ uncertainty about their regulation and legality. Mobile phone based cessation support may provide an alternative to telephone counselling and overcome the stigmatisation low-SES smokers face while trying to quit.

     

The association of alcohol use and quality of life in depressed and non-depressed individuals: a cross-sectional general population study

Purpose

To compare the associations of alcohol-related variables with Quality of Life (QoL) in depressed and non-depressed individuals of the general population.

Methods

This cross-sectional study utilized data from the FINRISK 2007 general population survey. A subsample (n?=?4020) was invited to participate in an interview concerning alcohol use. Of them, 2215 (1028 men, 1187 women; response rate 55.1%) were included in the analyses. Bivariate associations between mean weekly alcohol consumption, frequency of binge drinking, Alcohol Use Disorders Identification Test (AUDIT)-score and QoL were analysed according to categorization into depressed and non-depressed using the Beck Depression Inventory, Short Form. Linear regression models were calculated in order to determine the associations of the alcohol variables and QoL after adjusting for socio-demographic variables as well as somatic and mental illness.

Results

Depressed individuals had lower mean QoL and higher AUDIT-scores than non-depressed respondents. Bivariate correlations showed that mean weekly alcohol consumption, frequency of binge drinking and AUDIT-scores were statistically significantly associated with impaired QoL in depressed individuals. Abstinence was not associated with QoL. After adjustment for covariates, frequency of binge drinking and AUDIT-score were statistically significantly associated with QoL in depressed individuals and AUDIT-score in the non-depressed group. When analysing all respondents regardless of depression, both AUDIT-score and binge drinking were associated with QoL.

Conclusions

Of the alcohol-related variables, binge drinking and alcohol problems indicated by AUDIT-score contributed to impaired QoL in depressed individuals and both should be assessed as part of the clinical management of depression.

     

Incorporating environmental variables as precursor background variables of the theory of planned behavior to predict quitting-related intentions: a comparative study between adult and young adult smokers

Background

As previous studies suggest that the theory of planned behavior (TPB) is open to the inclusion of further predictors, identifying a number of additional background variables within the context of the TPB may help improve the predictive power of the theory. The purpose of this study is to incorporate environmental variables as precursor background variables of the TPB to predict quitting-related intentions.

Methods

This study consists of two sub-studies. Sub-study 1 and 2 analyzed different data sets and were conducted using the similar methodology for the comparison. A total of 395 Texas adult smokers (sub-study 1) and 379 university student smokers (sub-study 2) were analyzed using multiple structural equation modeling.

Results

The extent of agreement with regulating smoking in public places had positive indirect effects on intention to quit through subjective norm among both Texas adult smokers (β?=?0.03, p?<?.01) and university students (β?=?0.01, p?<?.05), and through attitude among Texas adult smokers only (β?=?0.02, p?<?.01). The number of smokers among 5 closest friends had negative indirect effect on intention to take measures to quit through subjective norm among Texas adult smokers (β?=???0.02, p?<?.05).

Conclusions

The results of this study indicate that environmental variables need to be considered as precursor background variables of the TPB to predict quitting-related intentions.

     

Breast cancer screening beliefs by practice location

Background

This study examines variations in breast cancer screening among primary care clinicians by geographic location of clinical practice.

Methods

A cross-sectional survey design was used to examine approaches to breast cancer screening among physicians, nurse practitioners, and physician assistants involved in primary care practice. A summary index of beliefs about breast cancer screening was created by summing the total number of responses in agreement with each of four survey items; values for this summary variable ranged between zero and four. Respondents were classified into urban, rural and suburban categories based upon practise location.

Results

Among the 428 respondents, agreement with "correct" responses ranged from 50% to 71% for the individual survey items; overall, half agreed with three or more of the four breast cancer screening items. While no significant differences were noted by practice location, variation in responses were evident. Reported use of written breast cancer guidelines was less in both suburban (OR = 0.51) and urban areas (OR = 0.56) when compared to clinicians in rural areas.

Conclusion

Development of an evidence-based consensus statement regarding breast cancer screening would support a single set of unambiguous guidelines for implementation in all primary care settings, thus decreasing variations in how breast cancer screening is approached across varied clinical settings.

     

Estimate of undergraduate university student alcohol use in China: a systematic review and meta-analysis

Objective

To develop an estimate of self-reported last 30 day alcohol use by university students in China.

Methods

A search of papers published in English and Chinese between 2006 and 2015, following pre-established selection criteria, identified 30 papers that were included in this meta-analysis. Nine moderator variables were preselected for this analysis.

Results

A total of 749 papers were identified in the keyword search, and 30 studies (28 in Chinese, 2 in English) met all selection criteria and were included in the meta-analysis. The self-reported last-30-day alcohol use for undergraduate university students was 66.8% for males and 31.7% for females. Meta-regression identified three moderators associated with the different drinking rates reported: the definition of drinking, the origin of the questionnaire used in the survey, and the geographic region where the survey was conducted. These three moderators explained 56% of the heterogeneity of reported drinking rates for the male students and 47% of the heterogeneity of reported drinking rates for the female students.

Conclusions

The results of this meta-analysis provide an estimate of last 30 day alcohol use by university students (age 18–23) and increase our understanding of drinking by young people in China. The meta-analysis suggested three variables that could have affected the results and which are worthy of further study. The discussion places these results in the context of Chinese drinking culture and university life.

     

A survey of physicians knowledge regarding awareness of maternal alcohol use and the diagnosis of FAS.

Background

Alcohol is the most widely used drug in the world that is a human teratogen whose use among women of childbearing age has been steadily increasing. It is also probable that Fetal Alcohol Syndrome is under diagnosed by physicians. The objectives of this study were twofold: 1) to evaluate the experience, knowledge and confidence of family physicians with respect to the diagnosis of FAS and 2) to evaluate physicians awareness of maternal drinking patterns.

Methods and Participants

A multiple choice anonymous questionnaire was sent to a randomly selected group of family physicians in the Metropolitan Toronto area.

Results

There was a 73% (75/103) total response rate; Overall, 6/75 (8%) of family physicians reported that they had actually diagnosed a child with FAS. 17.9% had suspicions but did not make a diagnosis and 12.7% reported making a referral to confirm the diagnosis. Physician rated confidence in the ability to diagnosis FAS was low, with 49% feeling they had very little confidence. 75% reported counselling pregnant women and 60.8% reported counselling childbearing women in general on the use of alcohol. When asked what screening test they used to detect the use of alcohol, 75% described frequency/quantity. Not a single respondent identified using the current accepted screening method for alcohol use (TWEAK) which is recommended by The Centre for Addiction and Mental Health.

Conclusions

Family physicians do not feel confident about diagnosing FAS. None of the physicians were aware of the current screening methods to accurately gage alcohol use in pregnant and childbearing women

     

Association between longevity and element levels in food and drinking water of typical Chinese longevity area

Objectives

To carrying out an integrated analysis on regional environment and human health in China and to detect the association between longevity and daily element intake from food and drinking water.

Design

Cross-sectional study.

Setting

All the 18 cities and counties in Hainan Province.

Measurements

The distribution of elderly population and longevity indexes at a county level in Hainan Province were investigated. Quality of food and drinking water in Hainan was evaluated by comparing the chemical elements with National Standards. In addition, the association between element concentrations in food and water and longevity was examined using spearman’s rank correlation.

Results

The proportion of elderly people is higher in the northern part of the province compared with southern counties. Food contributes a greater proportion of daily element intake than drinking water. Compared with the National Standards, reaching rates for elements were over 85% for both food and drinking water. There was a positive correlation between daily intake of Cu, Se, and Zn from food and water and aging and longevity indexes, and a negative correlation between Pb intake and these indexes.

Conclusion

The quality of food and water in Hainan Province are good and that, compared with water, food is a more important source of trace elements. An appropriate supply of Cu, Se, and Zn is important, whereas excessive intake of Pb should be avoided. The findings also provide basic data to support further studies on regional variations in longevity and their relationship to diet and drinking water.

     

Smoking,alcohol consumption,and illicit substances use among adolescents in Poland

Background

The use of alcohol, tobacco, and illicit substances typically first occurs in adolescence. The purpose of this study was to examine alcohol, cigarette, and illicit substance use among adolescents in Poland, including the age of initiation, frequency of use, methods of access, location of use, and parental knowledge and attitude.

Methods

An author-derived questionnaire was used to cross-sectionally survey 541 participants aged 13–17?years old. Due to the fact that some answers were lacking, the number of questionnaires analysed was 538 in case of smoking and illicit substances use, and 535 in case of alcohol drinking.

Results

The use of alcohol, cigarette, and illicit substance among the investigated group was 36.1, 37.6, and 10.8% respectively. The average age of initiation was 13–14?years old. Parents were aware of alcohol, cigarette, and illicit substance use 49.5, 35.8 and 22.4% of the time, respectively, and the rate of acceptance was 5.7 and 6.7% for alcohol and cigarettes. More than 28% of participants smoked in school, and 32.7% accessed illicit substances in the school’s neighborhood.

Conclusions

The rate of alcohol, cigarette, and illicit substance use in Poland is high and increasing, despite globally designed preventative actions. Parents’ awareness of children’s alcohol, cigarette, or illicit substance use is low, and schools hardly fulfil their educational and protective role. Preventative actions are necessary, and local challenges should be considered.

     

Long and Short Sleep Duration and Physical Frailty in Community-Dwelling Older Adults

Objective

The objective of this study was to investigate whether older adults who have a particularly long sleep duration are likely to exhibit physical frailty, similar to those with a particularly short sleep duration.

Design

Cross-sectional study.

Setting

The National Center for Geriatrics and Gerontology – Study of Geriatric Syndromes.

Participants

A total of 9,824 older adults (mean age: 73.6 ± 5.5 years, 4,812 men and 5,012 women) met the entry criteria for this study.

Measurements

We divided the participants into three groups according to self-reported sleep duration (Short: ≤ 6 h, Mid: 6.1–8.9 h (control), Long: ≥ 9 h). Physical frailty was characterized based on the criteria from the Cardiovascular Health Study. Multinomial logistic regression analysis was performed to evaluate the effect of sleep duration on physical frailty by sex.

Results

Among all participants, the prevalence of physical frailty was higher in the Short (10.5%) and Long (17.9%) groups than in the Mid (7.4%) group (p < 0.001). Multinomial logistic regression analysis showed that both Short and Long groups had a significantly higher odds ratio (OR) for physical frailty than the Mid group [Short: OR 1.53, 95% confidence interval (CI) 1.26–1.87; Long: OR 2.39, 95% CI 1.90–3.00], even after adjusting for age, educational level, number of medications, body mass index, Mini Mental State Examination score, current smoking and alcohol habits, self-perceived health, and medical history.

Conclusion

Both long and short sleep durations were associated with physical frailty. Further studies are required to confirm the effect of sleep duration on the incidence or worsening of physical frailty in older adults.

     

Relationship between diet-related indicators and overweight and obesity in older adults in rural Japan

Objectives

To identify the relationship between diet-related indicators and overweight and obesity in older adults in rural Japan.

Design

Cross-sectional survey.

Setting

Obira, Hokkaido, Japan.

Participants

Local residents aged between 65 and 74 years, except for those with poor health, were included.

Intervention

A health- and diet-related questionnaire was applied to participants house-to-house by trained health professionals.

Measurements

The following indicators were examined: number of meals, number of balanced meals, food diversity, food group diversity, chewing ability, alcohol intake habit, smoking habit, instrumental activities of daily living scores, age, and residing alone or with family.

Results

Of 550 residents, 317 residents completely responded to the questionnaire. Of these, 41 were had low body mass index (BMI≤20) and were excluded. This resulted in a sample of 307 subjects comprising 117 men and 190 women; 37.6% and 46.8% of men and women were classified as obese (BMI≥25), respectively. Women with a normal BMI (20<BMI<25) had significantly higher food diversity in diet-related indicators compared with women with high BMI. The mean number of meals per day of normal men was significantly higher than of obese men. Using logistic regression analysis (stepwise), it was found that the number of meals per day was associated with obesity in men (OR=3.02; 95% CI 0.91–9.98; P=0.071), and food diversity was significantly associated with obesity in women (OR=1.95; 95% CI 1.12–3.38; P=0.018).

Conclusions

The associations between dietary indicators and obesity differed by sex. Food diversity may be a potential indicator to measure nutritional status in women.

     

Associations of smoking status with other lifestyle behaviors are modified by sex and occupational category among urban civil servants in Japan

Objectives

The aim of the present study was to examine the associations of current smoking with five other unhealthy lifestyle behaviors among urban civil servants in Japan according to sex and occupational category.

Methods

The study included 10,232 urban civil servants in Japan who presented for a health check-up in 2011. We analyzed data on anthropometric measurements and self-reported lifestyle factors.

Results

Current smokers had a higher BMI than never smokers in white-collar workers, but not in blue-collar workers of both sexes. There were strong associations of current smoking with irregular breakfasting regardless of sex and occupational category. In males, current smokers were less likely to take exercise than ex-smokers in both occupational categories.

Conclusions

The associations of current smoking with other unhealthy behaviors were modified by sex and occupational category. These results are useful for understanding the health risks among smokers according to sex and occupational category.