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Shankar A, Parascandola M, Sakthivel P, Kaur J, Saini D, Jayaraj NP. Advancing Tobacco Cessation in LMICs. Curr Oncol 2022; 29:9117-9124. [PMID: 36547127 PMCID: PMC9777415 DOI: 10.3390/curroncol29120713] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Revised: 11/08/2022] [Accepted: 11/21/2022] [Indexed: 11/25/2022] Open
Abstract
Tobacco kills more than 8 million people worldwide every year. Over 80% of the world's 1.3 billion tobacco users live in low- and middle-income countries (LMICs), where the future burden is projected to grow. At the same time, progress in tobacco control has not advanced as far as in many LMICs. In particular, the implementation of tobacco-cessation programs and interventions remains limited. The bulk of the evidence for tobacco-cessation interventions comes from high-income countries and may not reflect the context in LMICs, particularly as resources and training for tobacco cessation are limited. This paper summarizes the current evidence for tobacco-cessation interventions in LMICs and highlights some key challenges and research gaps. Overall, there is a need to build capacity for locally relevant research and implementation science to support tailored cessation interventions and strategies for LMICs.
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Affiliation(s)
- Abhishek Shankar
- Department of Radiation Oncology, All India Institute of Medical Sciences, Patna 801507, India
- Correspondence:
| | - Mark Parascandola
- Research and Training Branch, Center for Global Health, National Cancer Institute, Bethesda, MD 20892, USA
| | - Pirabu Sakthivel
- Department of ENT & Head-Neck Surgery, KMCH Institute of Health Sciences and Research, Coimbatore 641014, India
| | - Jagdish Kaur
- Department of Healthier Populations and Non-Communicable Diseases (NCDs), WHO Regional Office for South-East Asia, New Delhi 110011, India
| | - Deepak Saini
- Materia Medica Department, Lal Bahadur Shastri Homoeopathic Medical College and Hospital, Prayagraj 211013, India
| | - Naveen Prabhu Jayaraj
- Department of Community Medicine, Karpagam Faculty of Medical Sciences and Research, Coimbatore 641032, India
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Kumar N, Janmohamed K, Jiang J, Ainooson J, Billings A, Chen GQ, Chumo F, Cueto L, Niaura R, Zhang A. Tobacco cessation in low- to middle-income countries: A scoping review of randomized controlled trials. Addict Behav 2021; 112:106612. [PMID: 33002679 DOI: 10.1016/j.addbeh.2020.106612] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Revised: 07/24/2020] [Accepted: 08/15/2020] [Indexed: 12/24/2022]
Abstract
OBJECTIVE The growing prevalence of tobacco use in low "to middle" income countries (LMICs) and the hurdles of conducting tobacco cessation in that context necessitates a focus on the scope of randomized controlled trials (RCTs) in LMICs to guide tobacco cessation in this environment. We conducted a scoping review to identify LMIC tobacco cessation RCTs. METHODS Consistent with PRISMA-ScR guidelines and without language restrictions, we systematically searched peer-reviewed databases (MEDLINE, Embase, PsycINFO, articles published since inception, latest searches in March 2020) and gray literature (clinical trials registries, searches between September and December 2019). We searched for data on RCT type, outcome significance and intervention description. Inclusion: research conducted in LMICs; tobacco cessation; RCT. Exclusion: research conducted in high income countries; non-RCT; studies involving only those aged <18. Data was extracted from published reports. We generated narrative summaries of each LMIC's tobacco cessation RCT research environment. RESULTS Of 8404 articles screened, we identified 92 studies. Tobacco cessation RCTs were recorded in 16 of 138 countries/territories in LMICs. Evidence was weak in quality and severely limited. Most RCTs were psychosocial, with limited behavioral and pharmacological variants. CONCLUSIONS Tobacco control within LMICs is essential to reduce the tobacco mortality burden. Researchers should be cognizant that tobacco cessation in LMICs is still not an environment where best practice has been established. We suggest that developing solutions specific for LMICs is key to effective tobacco control in LMICs.
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Abraham EA, Egbe CO, Ayo-Yusuf OA. News media coverage of shisha in Nigeria from 2014 to 2018. Tob Induc Dis 2019; 17:33. [PMID: 31516476 PMCID: PMC6662787 DOI: 10.18332/tid/106139] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2019] [Revised: 04/03/2019] [Accepted: 04/03/2019] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION Shisha which was formally popular mostly in the Eastern Mediterranean region is now gaining popularity globally and has become a trending tobacco product in Nigeria. The increasing popularity of shisha is possibly driven by the attractive flavours and the misperception that it is safer than traditional cigarettes. Since the media plays a significant influence on public awareness, perception and understanding of various issues, this study sought to explore the coverage of shisha use by five national newspapers in Nigeria. METHODS Five newspapers were selected based on their website traffic (online readership). The software NVIVO 12 was used to organise the content of the articles into themes. RESULTS Between 2014 and 2018, we found 30 relevant publications about shisha. Some newspaper articles reported that shisha smoking was gaining popularity among youths, especially in tertiary institutions across the country. Similarly, some misconceptions about the safety of smoking shisha among shisha users was reported. Addiction to shisha was also reported as being so common that many shisha users were no longer satisfied with just visiting nightclubs and shisha cafes but now own the shisha paraphernalia. There were also reports that the tobacco in shisha was in some instances being replaced or mixed with other hard drugs like marijuana. Subtle advertisement of shisha lounges, which is a violation of the Nigeria National Tobacco Control Act, was also observed. CONCLUSIONS There is a need for increased sensitization of the public through the media on the dangers of shisha smoking and other tobacco product use. There is also a need for a national survey to determine the prevalence of shisha use in Nigeria.
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Affiliation(s)
- Emmanuel A Abraham
- Tobacco Control Unit, Non-Communicable Diseases Division, Federal Ministry of Health, Abuja, Nigeria.,Africa Centre for Tobacco Industry Monitoring and Policy Research, Sefako Makgatho Health Sciences University, Pretoria, South Africa
| | - Catherine O Egbe
- Alcohol, Tobacco and Other Drug Research Unit, South African Medical Research Council, Pretoria, South Africa.,Faculty of Public Health, Sefako Makgatho Health Sciences University, Pretoria, South Africa
| | - Olalekan A Ayo-Yusuf
- Africa Centre for Tobacco Industry Monitoring and Policy Research, Sefako Makgatho Health Sciences University, Pretoria, South Africa
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Arshad A, Matharoo J, Arshad E, Sadhra SS, Norton-Wangford R, Jawad M. Knowledge, attitudes, and perceptions towards waterpipe tobacco smoking amongst college or university students: a systematic review. BMC Public Health 2019; 19:439. [PMID: 31029118 PMCID: PMC6487066 DOI: 10.1186/s12889-019-6680-x] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2018] [Accepted: 03/19/2019] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Despite evidence for the harms of waterpipe tobacco smoking (WTS), its use is increasing amongst college and university students worldwide. This systematic review aims to assess the knowledge of, attitudes towards and perceptions of WTS among college or university students. METHODS We electronically searched MEDLINE, EMBASE, CINAHL, PSYCHINFO and ISI the Web of Science in October 2018, restricting our search to studies published since January 1990. We included studies among university or college students that used qualitative or quantitative methods, and addressed either knowledge, attitudes, or perceptions towards WTS. We excluded studies where WTS could not be distinguished from other forms of tobacco use and studies reported as abstracts where the full text could not be identified. Data were synthesised qualitatively and analysed data by region (global north/ south), and by reasons for use, knowledge of health hazards, how knowledge influences use, perceptions towards dependence, and policy knowledge. RESULTS Eighty-six studies were included; 45 from the global north and 41 from the global south. Socio-cultural and peer influences were major contributing factors that encouraged students to initiate WTS. Furthermore, WTS dependence had two components: psychological and social. This was compounded by the general perception that WTS is a less harmful, less addictive and more sociable alternative to cigarette smoking. Knowledge of WTS harms failed to correlate with a reduced risk of WTS use, and some students reported symptoms of WTS addiction. A large proportion of students believed that quitting WTS was easy, yet few were able to do so successfully. Finally, students believed current public health campaigns to educate on WTS harms were inadequate and, particularly in the global north, were not required. CONCLUSION Reasons for WTS amongst university students are multi-faceted. Overall, interventions at both the individual and community level, but also policy measures to portray a message of increased harm amongst students, are required. Additional studies are necessitated to understand temporal changes in students' beliefs, thus allowing for better targeted interventions.
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Affiliation(s)
- Adam Arshad
- Medical School, College of Medical and Dental Sciences, University of Birmingham, Edgbaston, Birmingham, B15 2TT UK
| | - Jaideep Matharoo
- Medical School, College of Medical and Dental Sciences, University of Birmingham, Edgbaston, Birmingham, B15 2TT UK
| | - Ebrahim Arshad
- University Hospitals of North Midlands, Stoke on Trent, UK
| | - Simardeep Singh Sadhra
- Medical School, College of Medical and Dental Sciences, University of Birmingham, Edgbaston, Birmingham, B15 2TT UK
| | - Rosemary Norton-Wangford
- Medical School, College of Medical and Dental Sciences, University of Birmingham, Edgbaston, Birmingham, B15 2TT UK
| | - Mohammed Jawad
- Public Health Policy Evaluation Unit, School of Public Health, Imperial College, London, UK
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Kabir K, Bahari A, Hajizadeh M, Allahverdipour H, Tarrahi MJ, Fakhari A, Ansari H, Mohammadpoorasl A. Substance abuse behaviors among university freshmen in Iran: a latent class analysis. Epidemiol Health 2018; 40:e2018030. [PMID: 30056643 PMCID: PMC6178368 DOI: 10.4178/epih.e2018030] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2018] [Accepted: 07/02/2018] [Indexed: 11/09/2022] Open
Abstract
OBJECTIVES Substance abuse behaviors among university freshmen in Iran are poorly understood. This study aimed to identify, for the first time, subgroups of university freshmen in Iran on the basis of substance abuse behaviors. Moreover, it examined the effects of socio-demographic characteristics on membership in each specific subgroup. METHODS Data for the study were collected cross-sectionally in December 2013 and January 2014 from 4 major cities in Iran: Tabriz, Qazvin, Karaj, and Khoramabad. A total of 5,252 first-semester freshmen were randomly selected using a proportional cluster sampling methodology. A survey questionnaire was used to collect data. Latent class analysis (LCA) was performed to identify subgroups of students on the basis of substance abuse behaviors and to examine the effects of students' socio-demographic characteristics on membership in each specific subgroup. RESULTS The LCA procedure identified 3 latent classes: the healthy group; the hookah experimenter group; and the unhealthy group. Approximately 82.8, 16.1, and 2.1% of students were classified into the healthy, hookah experimenter, and unhealthy groups, respectively. Older age, being male, and having a family member or a close friend who smoked increased the risk of membership in classes 2 and 3, compared to class 1. CONCLUSIONS Approximately 2.1% of freshmen exhibited unhealthy substance abuse behaviors. In addition, we found that older age, being male, and having a close friend or family member who smoked may serve as risk factors for substance abuse behaviors.
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Affiliation(s)
- Kourosh Kabir
- School of Medicine, Alborz University of Medical Sciences, Karaj, Iran
| | - Ali Bahari
- Department of Statistics and Epidemiology, Faculty of Health, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Mohammad Hajizadeh
- School of Health Administration, Faculty of Health, Dalhousie University, Halifax, Canada
| | - Hamid Allahverdipour
- Research Center of Psychiatry and Behavioral Sciences, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Mohammad Javad Tarrahi
- Department of Epidemiology and Biostatistics, School of Public Health, Esfahan University of Medical Sciences, Esfahan, Iran
| | - Ali Fakhari
- Research Center of Psychiatry and Behavioral Sciences, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Hossein Ansari
- Health Promotion Research Center, Zahedan University of Medical Sciences, Zahedan, Iran
| | - Asghar Mohammadpoorasl
- Research Center of Psychiatry and Behavioral Sciences, Tabriz University of Medical Sciences, Tabriz, Iran
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Omotehinwa OJ, Japheths O, Damascene IJ, Habtu M. Shisha use among students in a private university in Kigali city, Rwanda: prevalence and associated factors. BMC Public Health 2018; 18:713. [PMID: 29884163 PMCID: PMC5994055 DOI: 10.1186/s12889-018-5596-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2018] [Accepted: 05/23/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND All over the globe shisha smoking is fast growing among different age brackets. Shisha use has been reported to be increasing among youths in African major cities. Its use is documented to result in health effects such as lung cancer, cardiovascular and respiratory conditions, periodontal diseases, keratoacanthoma which are also associated with cigarette smoking. In Kigali, Rwanda's capital, reports indicate that shisha use is increasing among the youths, particularly the university students. The study aimed at determining the prevalence, and establishing factors associated with shisha use among students in a university in Kigali Rwanda, which will be a significant step in stemming shisha fame among youths in Rwanda as there was no previously documented evidence-based study. METHODS A total of 427 students were selected for this cross-sectional study using stratified sampling method. A questionnaire was used to collect data on shisha use, knowledge about shisha, attitude towards shisha, and factors associated with use of shisha. The association between the independent variables and shisha use was assessed using chi-square p value < 0.05. Binary logistic regression was used to determine variables that were independently associated with shisha smoking. RESULTS Prevalence of ever smoking shisha among the university students was 26.1% and that of those that smoked in the last month (30 days) was 20.8%. About 40 % (39.9%) of the participants that had heard about shisha before demonstrated low level of knowledge, and 41.6% of these reported shisha use in the last 30 days. Logistic regression revealed that the followings were independently associated with shisha smoking: always drink alcohol (p = 0.003); drink alcohol occasionally (p = 0.045); having friend(s) who smoke shisha (p = 0.001); being aware of shisha's availability in cafes, bars and restaurants in Kigali (p = 0.022); positive attitude towards shisha smoking (p < 0.001) and participants with age < 20 years (p = 0.039). CONCLUSIONS There is a relative high prevalence of shisha smoking and a poor knowledge about its impact on health among these university students. Regular medical education and health promotion targeting the youths could improve knowledge and practices about shisha use. Shisha laws and regulations should be enacted, and fines imposed on individuals or group who flout them.
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Affiliation(s)
- Omoboriowo Joad Omotehinwa
- Department of Public Health, Mount Kenya University, School of Health Sciences, P. O. Box 5826, Kigali Campus, Kigali, Rwanda
| | - Ogendi Japheths
- Department of Public Health, Mount Kenya University, School of Health Sciences, P. O. Box 5826, Kigali Campus, Kigali, Rwanda
| | | | - Michael Habtu
- Department of Public Health, Mount Kenya University, School of Health Sciences, P. O. Box 5826, Kigali Campus, Kigali, Rwanda
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