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Justafré S, Marino P, Touzani R, Dupeyre-Alvarez F, Dantin P, Viens P, Vey N, Calvin S. Construction and preliminary validation of a tool to measure the needs of adolescents and young adults (AYA) diagnosed with cancer: the QUestionnaire nEEd Cancer AYAs: QUEEC-AYAs. Health Qual Life Outcomes 2024; 22:36. [PMID: 38649987 PMCID: PMC11036591 DOI: 10.1186/s12955-024-02249-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Accepted: 04/02/2024] [Indexed: 04/25/2024] Open
Abstract
CONTEXT In France, 2300 adolescents and young adults (AYAs, 15-25 years old) are diagnosed with cancer each year. As soon as the disease is diagnosed, a number of physical, psychological and social needs may arise. The aim of this study is to develop a tool to measure unmet needs that will allow the specificities of AYAs to be understood while allowing health care staff to mobilise the necessary actors to resolve them. METHODS We developed the Questionnaire nEEd Cancer AYAs (QUEEC-AYAs questionnaire), from two existing questionnaires: the Cancer Needs Questionnaire Young People and the Needs Assessment & Service Bridge. A main sample of 103 AYAs then received and completed the questionnaire in order to conduct an exploratory factor analysis. RESULTS The final structure of the QUEEC-AYAs is composed of 7 dimensions and 48 items: information (8 items), cancer care team (6 items), Physical health (4 items), Emotional health (14 items), Sexual & reproductive health (6 items), Health behaviors & wellness (4 items), Daily life (6 items). The questionnaire has a good acceptability and all domains have a Cronbach's alphas value above 0.80. CONCLUSION The QUEEC-AYAs is the first measure of the psychosocial needs of AYAs available in French. Its systematic use in health care services should improve the coordination of care required by AYAs during and after treatment. TRIAL REGISTRATION This study was approved by the ethics committee of the Paoli-Calmettes Institute (IRB # IPC 2021-041, 2021 May 20).
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Affiliation(s)
- S Justafré
- Management Sport Cancer Laboratory UR20122035V, Aix Marseille University and Paoli Calmettes Institute, Marseille, France.
| | - P Marino
- Institut Paoli-Calmettes, Aix-Marseille Univ, IRD, SESSTIM, Inserm, Marseille, France
| | - R Touzani
- Institut Paoli-Calmettes, Aix-Marseille Univ, IRD, SESSTIM, Inserm, Marseille, France
| | | | - P Dantin
- Management Sport Cancer Laboratory UR20122035V, Aix Marseille University and Paoli Calmettes Institute, Marseille, France
| | - P Viens
- Management Sport Cancer Laboratory UR20122035V, Aix Marseille University and Paoli Calmettes Institute, Marseille, France
- Paoli Calmettes Institute, Marseille, France
| | - N Vey
- Paoli Calmettes Institute, Marseille, France
| | - S Calvin
- Management Sport Cancer Laboratory UR20122035V, Aix Marseille University and Paoli Calmettes Institute, Marseille, France
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Alwan NA, Stannard S, Berrington A, Paranjothy S, Hoyle RB, Owen RK, Fraser SDS. Risk factors for ill health: How do we specify what is 'modifiable'? PLOS GLOBAL PUBLIC HEALTH 2024; 4:e0002887. [PMID: 38437177 PMCID: PMC10911600 DOI: 10.1371/journal.pgph.0002887] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/06/2024]
Affiliation(s)
- Nisreen A. Alwan
- School of Primary Care, Population Sciences and Medical Education, Faculty of Medicine, University of Southampton, Southampton, United Kingdom
- University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom
| | - Seb Stannard
- School of Primary Care, Population Sciences and Medical Education, Faculty of Medicine, University of Southampton, Southampton, United Kingdom
| | - Ann Berrington
- Department of Social Statistics and Demography, Faculty of Social Science, University of Southampton, Southampton, United Kingdom
| | - Shantini Paranjothy
- School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, United Kingdom
| | - Rebecca B. Hoyle
- School of Mathematical Sciences, University of Southampton, Southampton, United Kingdom
| | - Rhiannon K. Owen
- Swansea University Medical School, Faculty of Medicine, Health and Life Sciences, Swansea University, Swansea, United Kingdom
| | - Simon D. S. Fraser
- School of Primary Care, Population Sciences and Medical Education, Faculty of Medicine, University of Southampton, Southampton, United Kingdom
- University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom
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Guindon GE, Mentzakis E, Buckley NJ. Cigarette packaging, warnings, prices, and contraband: A discrete choice experiment among smokers in Ontario, Canada. ECONOMICS AND HUMAN BIOLOGY 2024; 52:101340. [PMID: 38134576 DOI: 10.1016/j.ehb.2023.101340] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Revised: 11/22/2023] [Accepted: 12/09/2023] [Indexed: 12/24/2023]
Abstract
In Canada, despite substantial decline, tobacco use remains the leading risk factor responsible for mortality and morbidity. There is overwhelming evidence that higher tobacco taxes reduce tobacco use, even if high taxes create an incentive to avoid or evade tobacco taxes. Recently, in addition to taxes, plain and standardized packaging and printing a warning on each cigarette have been lauded to reduce tobacco use. In November 2019, Canada became the country with the most comprehensive cigarette packaging regulations; and in June 2022, Canada proposed to print health warnings on individual cigarettes, the first jurisdiction to ever do so. The regulations came into force on August 1, 2023, and are being implemented through a stepwise approach. Our objective was to examine the effects of plain and standardized packaging, warning on cigarettes, price, and the availability of illicit cigarettes on intention to purchase and risk perceptions. We conducted a discrete choice experiment, and examined heterogeneity in preferences using latent class models among smokers in Ontario, Canada. We found that using latent class analyses was essential in quantifying preferences for attributes of cigarettes and cigarette packs. First, nearly half of smokers stated a preference for cheaper illicit cigarettes in a branded pack without any health warnings, regardless of the licit cigarette alternatives. For about 20% of respondents, plain packaging and especially warning on cigarette sticks decreased the probability of stating a purchasing preference for these alternatives. Third, about a third of respondents chose competing alternatives with mostly one attribute in mind, price. Lastly, none of the products and attributes seem to have significantly influenced risk perception. Our findings attest to the importance of prices and taxes, to the potential of warnings on cigarette sticks to control tobacco use, and indicate that efforts to restrict the availability of illicit cigarettes may yield substantial benefits.
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Affiliation(s)
- G Emmanuel Guindon
- Centre for Health Economics and Policy Analysis, McMaster University, Hamilton, ON, Canada; Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada; Department of Economics, McMaster University, Hamilton, ON, Canada.
| | | | - Neil J Buckley
- Department of Economics, York University, Toronto, ON, Canada
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Bteddini D, Nakkash RT, Chalak A, Jawad M, Khader Y, Abu-Rmeileh NME, Mostafa A, Abla R, Awawda S, Salloum RG. Economic research in waterpipe tobacco smoking: reflections on data, demand, taxes, equity and health modelling. Tob Control 2023; 33:116-121. [PMID: 35902224 DOI: 10.1136/tc-2022-057383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Accepted: 07/22/2022] [Indexed: 11/03/2022]
Abstract
Economic evaluation of tobacco control policies is common in high-income settings and mainly focuses on cigarette smoking. Evidence suggests that increasing the excise tax of tobacco products is a consistently effective tool for reducing tobacco use and is an efficient mechanism for increasing government revenues. However, less research has been conducted in low/middle-income countries where other tobacco forms are common. This paper presents insights from our work on the economics of waterpipe tobacco smoking conducted in the Eastern Mediterranean Region where waterpipe smoking originated and is highly prevalent. The specific areas related to economics of waterpipe smoking considered herein are: price elasticity, taxation, government revenue, expenditure and healthcare costs. This paper aims to provide practical guidance for researchers investigating the economics of waterpipe tobacco with potential implications for other novel tobacco products. We present lessons learnt across five thematic areas: data, demand, taxes, equity and health modelling. We also highlight knowledge gaps to be addressed in future research. Research implications include designing comprehensive assessment tools that investigate heterogeneity in waterpipe smoking patterns; accounting for cross-price elasticity of demand with other tobacco products; exploring the change in waterpipe tobacco smoking in response to a tax increase and analysing the equity impact of waterpipe tobacco control interventions.
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Affiliation(s)
- Dima Bteddini
- Department of Health Outcomes and Biomedical Informatics, University of Florida, Gainesville, Florida, USA
| | - Rima T Nakkash
- Department of Health Promotion and Community Health, American University of Beirut, Beirut, Lebanon
- Department of Global and Community Health, George Mason University College of Health and Human Services, Fairfax, Virginia, USA
| | - Ali Chalak
- Department of Agriculture, American University of Beirut, Beirut, Lebanon
| | - Mohammed Jawad
- Public Health Policy Evaluation Unit, Imperial College London, London, UK
| | - Yousef Khader
- Department of Community Medicine, Jordan University of Science and Technology, Irbid, Jordan
| | | | - Aya Mostafa
- Department of Community, Environmental, and Occupational Medicine, Ain Shams University Faculty of Medicine, Cairo, Egypt
| | - Ruba Abla
- Department of Health Promotion and Community Health, American University of Beirut, Beirut, Lebanon
| | - Sameera Awawda
- Institute of Community and Public Health, Birzeit University, Birzeit, Palestine
| | - Ramzi G Salloum
- Department of Health Outcomes and Biomedical Informatics, University of Florida, Gainesville, Florida, USA
- Department of Health Promotion and Community Health, American University of Beirut, Beirut, Lebanon
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Buss VH, Cox S, Moore G, Angus C, Shahab L, Bauld L, Brown J. Alcohol and smoking brief interventions by socioeconomic position: a population-based, cross-sectional study in Great Britain. BJGP Open 2023; 7:BJGPO.2023.0087. [PMID: 37549977 PMCID: PMC11176676 DOI: 10.3399/bjgpo.2023.0087] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Revised: 07/17/2023] [Accepted: 07/23/2023] [Indexed: 08/09/2023] Open
Abstract
BACKGROUND Alcohol and smoking brief interventions (BIs) in general practice have been shown to be effective in lowering alcohol and smoking-related harm. AIM To assess prevalence of self-reported BI receipt among increasing or higher-risk drinkers and past-year smokers in England, Scotland, and Wales, and associations between intervention receipt and socioeconomic position. DESIGN & SETTING Cross-sectional study using data from a monthly population-based survey in England, Scotland, and Wales. METHOD The study comprised 47 799 participants (15 573 increasing or higher-risk drinkers [alcohol use disorders identification test consumption score ≥5] and 7791 past-year smokers) surveyed via telephone in 2020-2022 (during the COVID-19 pandemic). All data were self-reported. Prevalence of self-reported BI receipt was assessed descriptively; associations between receipt and socioeconomic position were analysed using logistic regression. RESULTS Among adults in England, Scotland, and Wales, 32.2% (95% confidence interval [CI] = 31.8 to 32.7) reported increasing or higher-risk drinking and 17.7% (95% CI = 17.3 to 18.1) past-year smoking. Among increasing or higher-risk drinkers, 58.0% (95% CI = 57.1 to 58.9) consulted with a GP in the past year, and of these, 4.1% (95% CI = 3.6 to 4.6) reported receiving BIs. Among past-year smokers, 55.8% (95% CI = 54.5 to 57.1) attended general practice in the past year; of these, 41.0% (95% CI = 39.4 to 42.7) stated receiving BIs. There was a tendency for patients from socioeconomically disadvantaged backgrounds to receive more alcohol (adjusted odds ratio [aOR] 1.38, 95% CI = 1.10 to 1.73) or smoking BIs (aOR 1.11, 95% CI = 0.98 to 1.26), but for the latter the results were statistically non-significant. Results did not differ notably by nation within Great Britain. CONCLUSION BIs in general practice are more common for smoking than for alcohol. A greater proportion of BIs for alcohol were found to be delivered to people who were from socioeconomically disadvantaged backgrounds and who were increasing or higher-risk drinkers.
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Affiliation(s)
- Vera Helen Buss
- Department of Behavioural Science and Health, University College London, London, UK
- SPECTRUM Research Consortium, Edinburgh, UK
| | - Sharon Cox
- Department of Behavioural Science and Health, University College London, London, UK
- SPECTRUM Research Consortium, Edinburgh, UK
| | - Graham Moore
- SPECTRUM Research Consortium, Edinburgh, UK
- DECIPHer, School of Social Sciences, Cardiff University, Cardiff, UK
| | - Colin Angus
- SPECTRUM Research Consortium, Edinburgh, UK
- Sheffield Alcohol Research Group, School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Lion Shahab
- Department of Behavioural Science and Health, University College London, London, UK
- SPECTRUM Research Consortium, Edinburgh, UK
| | - Linda Bauld
- SPECTRUM Research Consortium, Edinburgh, UK
- Usher Institute, College of Medicine and Veterinary Medicine, University of Edinburgh, Edinburgh, UK
| | - Jamie Brown
- Department of Behavioural Science and Health, University College London, London, UK
- SPECTRUM Research Consortium, Edinburgh, UK
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Barrett D, Dubal R, L Morgan C. The UK public and healthcare professionals' awareness of mouth cancer. Br Dent J 2023; 235:811-815. [PMID: 38001210 DOI: 10.1038/s41415-023-6490-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Revised: 05/22/2023] [Accepted: 05/28/2023] [Indexed: 11/26/2023]
Abstract
As the rate of new mouth cancer diagnoses continues to increase in the UK, awareness of risk factors and signs and symptoms remains low. This paper focuses on studies showing UK public awareness of risk factors, including alcohol, tobacco and human papillomavirus, as well as public understanding of signs and symptoms of mouth cancer. It includes a review of the effectiveness of campaigns in raising awareness of mouth cancer and examples of campaigns targeting other common cancers or risk factors that may provide useful learning ahead of upcoming mouth cancer campaigns. In addition, the awareness of the wider healthcare team and the importance of their role in identifying mouth cancer is explored. Current live campaigns in the UK are highlighted ahead of future initiatives now that the Mouth Cancer Action Charter has been launched and two new coalitions have been established.
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Affiliation(s)
- Danielle Barrett
- Dental Core Trainee, Barts Health NHS Trust, The Royal London Dental Hospital, Turner Street, London, E1 1FR, United Kingdom.
| | - Raj Dubal
- Consultant in Restorative Dentistry, Dental Core Training Lead for Restorative Dentistry, Barts Health NHS Trust, Royal London Dental Hospital, Turner Street, London, E1 1FR, United Kingdom
| | - Claire L Morgan
- Consultant in Restorative Dentistry, Barts Health Trust, Royal London Hospital, Turner Street, London, E1 1FR, United Kingdom
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Kim K. Scanned information exposure and support for tobacco regulations among US youth and young adult tobacco product users and non-users. HEALTH EDUCATION RESEARCH 2023; 38:426-444. [PMID: 37565566 PMCID: PMC10516358 DOI: 10.1093/her/cyad033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/27/2022] [Revised: 06/20/2023] [Accepted: 07/14/2023] [Indexed: 08/12/2023]
Abstract
The influences of information exposure on youth and young adults' (YYA) support for smoking/vaping regulations have been understudied. This study examines (i) the relationships between routine exposure to (i.e. scanning) anti-smoking/pro-vaping information and YYA support for anti-smoking/vaping regulations and (ii) whether these relationships differ across YYA users and non-users of tobacco products. We analyzed the data from a nationally representative two-wave rolling cross-sectional survey of YYA in the United States, collected from 2014 to 2017 (baseline n = 10 642; follow-up n = 4001). Less than 5% of the participants ever scanned pro-smoking and anti-vaping information. Scanning anti-smoking information had significant positive relationships with support for all anti-smoking policies cross-sectionally, and this pattern was longitudinally significant in two anti-smoking policy contexts. Scanning pro-vaping information had significant negative associations with support for anti-vaping policies cross-sectionally, but not longitudinally. The lagged positive relationships between scanning anti-smoking information and support for anti-smoking regulations were stronger among YYA smokers than among YYA non-smokers, whereas evidence from adult data suggested the opposite pattern. The findings suggest that scanning information can affect YYA support for tobacco regulations. Future efforts are required to investigate mechanisms underlying the influences of scanned information on YYA support for tobacco regulations.
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Affiliation(s)
- Kwanho Kim
- Department of Communication, Cornell University, 494 Mann Library Building, Ithaca, NY 14853, USA
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8
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Jarlstrup NS, Thygesen LC, Pisinger C, Vestbo J, Grønbæk M, Tolstrup JS. Trends in smoking-related diseases by socioeconomic position following a national smoking ban in 2007: a nationwide study in the Danish population. BMC Public Health 2023; 23:1648. [PMID: 37641031 PMCID: PMC10463393 DOI: 10.1186/s12889-023-16456-3] [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: 08/12/2022] [Accepted: 08/03/2023] [Indexed: 08/31/2023] Open
Abstract
BACKGROUND National comprehensive smoke-free legislation has been found to decrease the incidence of several smoking-related diseases. In 2007, Denmark introduced a national smoking ban, which banned smoking indoor in workplaces and public places, although only partial restrictions were applied in certain settings. We examined the impact of the smoking ban on smoking-related diseases and whether this differed across socioeconomic groups. METHODS Interrupted time series analyses of nationwide register data were performed using Poisson regression models to examine the differential impact of the smoking ban on monthly incidence rates of acute myocardial infarction, chronic obstructive pulmonary disease, and smoking-related cancers from 2002 to 2015. Immediate changes in incidence rates after the smoking ban and long-term changes in disease trends were estimated by comparing data from the pre- and post-ban period. Models were stratified by socioeconomic position. RESULTS Overall, we found neither immediate changes in rates of acute myocardial infarction, chronic obstructive pulmonary disease, and smoking-related cancers following the smoking ban nor long-term post-ban changes in disease trends as compared to before the ban. Results did not differ across socioeconomic groups. A pronounced socioeconomic gradient in incidence rates was observed for all outcomes both before and after the smoking ban. CONCLUSION The national smoking ban was not associated with a lower incidence of smoking-related diseases in the post-ban period compared to pre-ban levels and no differences between socioeconomic groups were observed. Future tobacco control in Denmark should consider which measures most effectively target the low socioeconomic groups to decrease the current strong socioeconomic inequality in health.
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Affiliation(s)
- Nanna Schneekloth Jarlstrup
- National Institute of Public Health, University of Southern Denmark, Studiestræde 6, 1455, Copenhagen, Denmark
| | - Lau C Thygesen
- National Institute of Public Health, University of Southern Denmark, Studiestræde 6, 1455, Copenhagen, Denmark
| | - Charlotta Pisinger
- Center for Clinical Research and Prevention, Bispebjerg and Frederiksberg Hospital, Capital Region, Copenhagen, Denmark
| | - Jørgen Vestbo
- University of Manchester and Manchester University NHS Foundation Trust, Manchester, UK
| | - Morten Grønbæk
- National Institute of Public Health, University of Southern Denmark, Studiestræde 6, 1455, Copenhagen, Denmark
| | - Janne S Tolstrup
- National Institute of Public Health, University of Southern Denmark, Studiestræde 6, 1455, Copenhagen, Denmark.
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Aida J, Ishimaru M, Kino S. Reconsidering economic interventions to reduce oral health inequalities. Community Dent Oral Epidemiol 2023; 51:600-605. [PMID: 37282745 DOI: 10.1111/cdoe.12883] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2022] [Revised: 05/25/2023] [Accepted: 05/29/2023] [Indexed: 06/08/2023]
Abstract
Despite the general recognition of economic factors as fundamental upstream social determinants of health inequalities, interventions to improve health and reduce inequalities tend to focus on proximal health determinants. However, recent socioeconomic crises have increased the focus on economic factors. Health-related approaches to address economic factors can be divided into two categories: (1) indirect approaches, such as financial support for obtaining dental care and fiscal policies targeting unhealthy commodities and (2) direct approaches, such as cash transfers or provision of a universal basic income. For indirect approaches, policies reducing out-of-pocket payments for dental care appear to improve access to services and reduce oral health inequalities. Price policies targeting tobacco and sugar through taxation are associated with declines in periodontal disease and caries, and sugar taxation appears to reduce oral health inequalities. As regards direct approaches, studies on cash transfers to low-income individuals have found no positive impact on dental visits, while results in relation to caries prevention were inconclusive. No dental studies examined the effect of a population approach to income security, such as basic income. Research on economic interventions for oral health inequalities is scarce, and studies using causal inference methods and natural experiments are urgently needed.
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Affiliation(s)
- Jun Aida
- Department of Oral Health Promotion, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Miho Ishimaru
- Department of Oral Health Promotion, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Shiho Kino
- Department of Oral Health Promotion, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
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Huang MZ, Liu TY, Zhang ZM, Song F, Chen T. Trends in the distribution of socioeconomic inequalities in smoking and cessation: evidence among adults aged 18 ~ 59 from China Family Panel Studies data. Int J Equity Health 2023; 22:86. [PMID: 37170095 PMCID: PMC10176762 DOI: 10.1186/s12939-023-01898-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Accepted: 04/24/2023] [Indexed: 05/13/2023] Open
Abstract
INTRODUCTION Cigarette smoking is usually more prevalent among those with a lower socioeconomic status (SES), which can be driven by inequalities in the initiation and cessation of smoking, giving rise to SES disparities in health. This study aimed to gauge the SES inequalities in smoking related behaviours and their evolving trends based on a nationally representative database. METHOD Data were extracted from repeated cross-sectional China Family Panel Studies (CFPS) of adults aged ≥18 and <60 years in 2012, 2014, 2016 and 2018. SES was constructed by principal component analysis based on income, education and occupation. Regression-based odds ratios and coefficients as the relative effect index of inequality were applied to quantify the degree of socioeconomic inequality in smoking related behaviours and to adjust for possible confounding factors. Multivariable regressions were utilized to explore the temporal trends in smoking inequalities. RESULTS The smoking prevalence among men decreased from 61.16% to 2012 to 57.88% in 2018, cigarette consumption among current smokers declined from 16.71 to 15.49 cigs/per day, and the cessation rate increased from 17.55% to 24.08%. Cigarette consumption for women decreased from 13.39 in 2012 to 11.01 cigs/per day in 2018. Smoking prevalence showed significant SES inequalities among men and women from 2012 to 2018 (men: OR2012 (95%CI)= 0.72 (0.63, 0.83), OR2014 = 0.60 (0.52, 0.69), OR2016 = 0.58 (0.50, 0.67), OR2018 = 0.56 (0.48, 0.66); women: OR2012 = 0.63 (0.41, 0.97), OR2014 = 0.50 (0.32, 0.79), OR2016 = 0.44 (0.26, 0.73), OR2018 = 0.50 (0.30, 0.85)). Cigarette consumption showed significant SES inequalities among men from 2012 to 2018 (β2012=-1.39 (-2.22, -0.57), β2014=-2.37 (-3.23, -1.50), β2016=-2.35 (-3.25, -1.44), β2018=-2.91 (-3.86, -1.97)). In 2018, inequality emerged in smoking cessation rates among men and smoking intensity among women. However, all tests for trends in changes over time were not statistically significant (P varied from 0.072 to 0.602). CONCLUSION The smoking prevalence declined between 2012 and 2018 in China. However, SES inequalities in smoking persist, while socioeconomic inequalities in smoking were not alleviated among adults aged 18 ~ 59 in China. Tobacco control measures should be implemented by giving more attention to people with lower SES who are more vulnerable to tobacco use.
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Affiliation(s)
- Ming Zhao Huang
- Institute of Social Development and Health Management, Hubei Province Key Laboratory of Occupational Hazard Identification and Control, School of Public Health, Wuhan University of Science and Technology, Wuhan, 430065, China
| | - Tai Yi Liu
- Suzhou Center for Disease Control and Prevention, Suzhou, China
| | - Zhong Min Zhang
- Institute of Social Development and Health Management, Hubei Province Key Laboratory of Occupational Hazard Identification and Control, School of Public Health, Wuhan University of Science and Technology, Wuhan, 430065, China
| | - Fujian Song
- Norwich Medical School, University of East Anglia, Norwich, Norfolk, UK
| | - Ting Chen
- Institute of Social Development and Health Management, Hubei Province Key Laboratory of Occupational Hazard Identification and Control, School of Public Health, Wuhan University of Science and Technology, Wuhan, 430065, China.
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Tam J, Levy DT, Feuer EJ, Jeon J, Holford TR, Meza R. Using the Past to Understand the Future of U.S. and Global Smoking Disparities: A Birth Cohort Perspective. Am J Prev Med 2023; 64:S1-S10. [PMID: 36781373 PMCID: PMC10033336 DOI: 10.1016/j.amepre.2022.12.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Revised: 12/05/2022] [Accepted: 12/06/2022] [Indexed: 02/13/2023]
Abstract
U.S. smoking-related disparities persist, but data evaluating how smoking patterns across diverse populations have changed by birth cohort are lacking. Worldwide, smoking continues to exact harm, especially to low- and middle-income nations with less historical data for smoking analyses. The Cancer Intervention and Surveillance Modeling Network (CISNET) Lung Working Group previously generated smoking histories for the whole U.S. population using an age, period, and birth cohort (APC) methodological framework. These inputs have been used in numerous models to simulate future patterns of smoking and to evaluate the potential impact of policies. However, the absence of detailed model-ready inputs on smoking behaviors for diverse U.S. populations has been a barrier to research evaluating future trends in smoking-related disparities or the projected impacts of policies across sociodemographic groups. This supplement issue provides new estimates of smoking behaviors with detailed historical data by race/ethnicity, educational attainment, family income, and for each of the 50 U.S. states and Washington, DC. All-cause mortality relative risks associated with smoking by race/ethnicity and educational attainment are also available for the first time. Finally, the supplement issue presents comprehensive smoking histories for Brazil, demonstrating the application of this methodology to resource-limited settings. Collectively, these data aim to offer insight into future U.S. and global smoking disparities and accelerate research on tobacco control policies that advance health equity. This effort will allow tobacco simulation models to account comprehensively for population diversity, thereby enabling researchers to develop more sophisticated analyses of tobacco use and control interventions.
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Affiliation(s)
- Jamie Tam
- Department of Health Policy and Management, Yale School of Public Health, New Haven, Connecticut.
| | - David T Levy
- Lombardi Comprehensive Cancer Center, Georgetown University, Washington, District of Columbia
| | - Eric J Feuer
- Division of Cancer Control & Population Sciences, National Cancer Institute, Bethesda, Maryland
| | - Jihyoun Jeon
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, Michigan
| | - Theodore R Holford
- Department of Biostatistics, Yale School of Public Health, New Haven, Connecticut
| | - Rafael Meza
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, Michigan; Department of Integrative Oncology, BC Cancer Research Institute, Vancouver, British Columbia, Canada
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Cho A, Chan G, Gartner C. Motivations to Change Smoking Behaviors Between 2007 and 2019 in Australia: A Repeated Cross-sectional Study. Nicotine Tob Res 2023; 25:674-681. [PMID: 35973439 DOI: 10.1093/ntr/ntac176] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2021] [Revised: 05/23/2022] [Accepted: 07/21/2022] [Indexed: 11/12/2022]
Abstract
INTRODUCTION In 2010, Australian tobacco excise (administered federally) increased by 25%, and by 12.5% annually from 2013 to 2020, with additional increases on roll-your-own (RYO) tobacco between 2017 and 2020. We estimated past year changes in smoking behavior among Australian adults who smoked (daily and non-daily) in the past year, and the association between consumer characteristics and stated motivations to change/attempt to change smoking behavior between 2007 and 2019. METHODS Logistic regression analysis of combined data from national representative triennial cross-sectional surveys in Australia (N = 22 977). RESULTS The main motivation cited for changing smoking behavior switched from health-related from 2007 to 2010 to cost-related from 2013 to 2019. Among those who quit between one and 12 months ago, living in a lower socioeconomic area (odds ratio (OR) = 1.61, 95% CI = 1.18% to -2.18%), was associated with reporting the cost of smoking motivated them to quit. Among those who reduced their smoking, smoking daily and >20 cigarettes/day vs. non-daily smoking (OR = 2.11, 95% CI = 1.60% to 2.78%), having high/very high psychological distress (OR = 1.33, 95% CI = 1.12% to 1.59%), and alcohol consumption (ORdaily drinking = 1.38, 95% CI = 1.05% to 1.81%) was associated with cost as a motivation. Exclusive (OR = 0.65, 95% CI = 0.53% to 0.80%) and non-exclusive (OR = 0.77, 95% CI = 0.65% to 0.91%) RYO use was associated with being less likely to report the cost of tobacco as motivation for cutting down. CONCLUSIONS The cost of smoking became the most cited motivator to change smoking behavior (eg, quitting and cutting down), particularly for those who lived in low socioeconomic areas, smoked more cigarettes per day, drank alcohol, and had high/very high psychological distress. IMPLICATIONS A change in the main federal tobacco control intervention implemented in Australia from mass-media campaigns to tobacco tax increases has likely led to cost, rather than health, being the main motivation cited for changing smoking behavior in Australia since 2013. Further monitoring is needed to ensure the harmonization in tax rates for RYO and factory-made cigarettes has effectively reduced the price difference between these products because the lower cost of RYO may have reduced the effectiveness of tax increases as a motivator to change smoking behavior.
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Affiliation(s)
- Ara Cho
- Faculty of Medicine, School of Public Health, The University of Queensland, Brisbane, Australia
| | - Gary Chan
- Centre for Youth Substance Abuse Research, The University of Queensland, Brisbane, Australia
| | - Coral Gartner
- Faculty of Medicine, School of Public Health, The University of Queensland, Brisbane, Australia
- School of Public Health, The University of Queensland, Brisbane, Australia
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van der Swaluw K, Hiemstra M, Lambooij M, Roordink E, van der Vliet N, Zantinge E, Proper K, Zeelenberg M, Prast HM. Lottery incentives for smoking cessation at the workplace: design and protocol of the smoke-free lottery - a cluster randomized trial. BMC Public Health 2023; 23:76. [PMID: 36627613 PMCID: PMC9831882 DOI: 10.1186/s12889-022-14915-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Accepted: 12/20/2022] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Smoking is the leading behavioral risk factor for the loss of healthy life years. Many smokers want to quit, but have trouble doing so. Financial incentives in workplace settings have shown promising results in supporting smokers and their design influences their impact. Lotteries that leverage behavioral economic insights might improve the effectiveness of workplace cessation support. METHODS AND DESIGN We examine in a cluster randomized trial if a workplace cessation group training paired with lottery deadlines will increase continuous abstinence rates over and above the cessation training alone. Organizations are randomized to either the control arm or lottery arm. The lotteries capitalize regret aversion by always informing winners at the deadline, but withholding prizes if they smoked. In the lottery-arm, winners are drawn out of all participants within a training group, regardless of their smoking status. In weeks 1-13 there are weekly lotteries. Winners are informed about their prize (€50), but can only claim it if they did not smoke that week, validated biochemically. After 26 weeks, there is a long-term lottery where the winners are informed about their prize (vacation voucher worth €400), but can only claim it if they were abstinent between weeks 13 and 26. The primary outcome is continuous abstinence 52 weeks after the quit date. DISCUSSION There is a quest for incentives to support smoking cessation that are considered fair, affordable and effective across different socioeconomic groups. Previous use of behavioral economics in the design of lotteries have shown promising results in changing health behavior. This cluster randomized trial aims to demonstrate if these lotteries are also effective for supporting smoking cessation. Therefore the study design and protocol are described in detail in this paper. Findings might contribute to the application and development of effective cessation support at the workplace. TRIAL REGISTRATION Netherlands Trial Register Identifier: NL8463 . Date of registration: 17-03-2020.
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Affiliation(s)
- Koen van der Swaluw
- grid.31147.300000 0001 2208 0118National Institute of Public Health and the Environment (RIVM), Centre for Nutrition, Prevention and Health Services, 3720 BA Bilthoven, The Netherlands ,grid.5590.90000000122931605Department of Economics and Business Economics, Nijmegen School of Management, Radboud University, 6500 HK Nijmegen, The Netherlands
| | - Marieke Hiemstra
- grid.31147.300000 0001 2208 0118National Institute of Public Health and the Environment (RIVM), Centre for Nutrition, Prevention and Health Services, 3720 BA Bilthoven, The Netherlands
| | - Mattijs Lambooij
- grid.31147.300000 0001 2208 0118National Institute of Public Health and the Environment (RIVM), Centre for Nutrition, Prevention and Health Services, 3720 BA Bilthoven, The Netherlands
| | - Eline Roordink
- grid.31147.300000 0001 2208 0118National Institute of Public Health and the Environment (RIVM), Centre for Nutrition, Prevention and Health Services, 3720 BA Bilthoven, The Netherlands
| | - Nina van der Vliet
- grid.31147.300000 0001 2208 0118National Institute for Public Health and the Environment (RIVM), Centre for Sustainability, Environment and Health, 3720 BA Bilthoven, The Netherlands ,grid.12295.3d0000 0001 0943 3265Tilburg University Graduate School, Tilburg School of Social and Behavioral Sciences, 5000 LE Tilburg, The Netherlands
| | - Else Zantinge
- grid.31147.300000 0001 2208 0118National Institute of Public Health and the Environment (RIVM), Centre for Health and Society, 3720 BA Bilthoven, The Netherlands
| | - Karin Proper
- grid.31147.300000 0001 2208 0118National Institute of Public Health and the Environment (RIVM), Centre for Nutrition, Prevention and Health Services, 3720 BA Bilthoven, The Netherlands ,grid.16872.3a0000 0004 0435 165XAmsterdam UMC, Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Marcel Zeelenberg
- grid.12295.3d0000 0001 0943 3265Tilburg University, Department of Social Psychology, Tilburg School of Social and Behavioral Sciences, 5000 LE Tilburg, the Netherlands ,grid.12380.380000 0004 1754 9227VU Amsterdam, Department of Marketing, School of Business and Economics, De Boelelaan 1105, 1081 HV Amsterdam, The Netherlands
| | - Henriette M. Prast
- grid.12295.3d0000 0001 0943 3265Tilburg University, 5000 LE Tilburg, the Netherlands ,grid.465164.40000 0004 0621 2610Dutch Senate, 2500 EA Den Haag, The Netherlands
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14
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Guindon GE, Montreuil A, Driezen P, Stahlbaum R, Giolat D, Baskerville NB. Do cigarette prices near secondary schools vary by area-level socioeconomic status? Findings from a field study in Ontario and Québec, Canada. Health Place 2023; 79:102936. [PMID: 36493496 DOI: 10.1016/j.healthplace.2022.102936] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Revised: 10/18/2022] [Accepted: 11/03/2022] [Indexed: 12/12/2022]
Abstract
OBJECTIVES To examine, in the context of youth smoking, whether cigarette prices near secondary schools varied by area-level socioeconomic status in Southwestern and Central Ontario, and the greater Montréal region. METHODS We collected cigarette prices four times between 2016 and 2019 from stores near secondary schools and used mixed-effects and ordinary least squares regressions. RESULTS We found consistent evidence that cigarette prices near secondary schools were lower in neighbourhoods with lower area-level household income, and that differences were large enough to be meaningful. In Ontario and Québec, our results indicate a Can$0.26 [0.04, 0.47] to Can$0.51 [0.33, 0.69] and Can$0.10 [-0.04, 0.24] to Can$0.37 [0.22, 0.52] difference in prices for a pack of 25 cigarettes between neighbourhoods with a median household income standard deviation below/above the provincial median, respectively. CONCLUSION Policy changes that limit area-level cigarette price differences without lowering cigarette prices may reduce inequities in youth smoking.
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Affiliation(s)
- G Emmanuel Guindon
- Centre for Health Economics and Policy Analysis, McMaster University, Hamilton, ON, Canada; Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada; Department of Economics, McMaster University, Hamilton, ON, Canada.
| | - Annie Montreuil
- Institut national de santé publique du Québec, Montréal, QC, Canada; Département de psychologie, Université du Québec à Montréal, Montréal, QC, Canada
| | - Pete Driezen
- Department of Psychology, University of Waterloo, Waterloo, ON, Canada; School of Public Health Sciences, University of Waterloo, Waterloo, ON, Canada
| | - Ryan Stahlbaum
- Centre for Health Economics and Policy Analysis, McMaster University, Hamilton, ON, Canada
| | - Didier Giolat
- Institut national de santé publique du Québec, Montréal, QC, Canada
| | - N Bruce Baskerville
- School of Pharmacy, University of Waterloo, Waterloo, ON, Canada; Canadian Institutes of Health Research, Ottawa, ON, Canada
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15
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Thaivalappil A, Bhattacharyya A, Young I, Gosselin S, Pearl DL, Papadopoulos A. Environmental determinants of infectious and chronic disease prevention behaviours: A systematic review and thematic synthesis of qualitative research. Health Psychol Open 2023; 10:20551029231179157. [PMID: 37255528 PMCID: PMC10226319 DOI: 10.1177/20551029231179157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023] Open
Abstract
Regulatory health policies facilitate desired health behaviours in communities, and among them, smoke-free policies and COVID-19 restrictions have been widely implemented. Qualitative research studies have explored how these measures and other environmental influences shape preventive behaviours. The objective of this systematic review was to synthesize previously published qualitative research, generate across-study themes, and propose recommendations for behaviour change interventions. We used a comprehensive search strategy, relevance screening and confirmation, data extraction, quality assessment, thematic synthesis, and quality-of-evidence assessment. In total, 87 relevant studies were identified. Findings were grouped under six overarching themes and mapped under three categories: (i) the political environment, (ii) the sociocultural environment, and (iii) the physical environment. These findings provide insights into the environmental influences of behaviour and indicate future interventions may be more effective by considering moral norms, community norms, policy support, and group identity.
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Affiliation(s)
| | | | - Ian Young
- School of Occupational and Public Health, Ryerson University, Toronto, Ontario, Canada
| | - Sydney Gosselin
- Department of Population Medicine, University of Guelph, Guelph, Ontario, Canada
| | - David L Pearl
- Department of Population Medicine, University of Guelph, Guelph, Ontario, Canada
| | - Andrew Papadopoulos
- Department of Population Medicine, University of Guelph, Guelph, Ontario, Canada
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16
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Yang YT, Stratmann T, Pillai D. Effects of State Preemption of Local Smoke-Free Restrictions on US Adult Cigarette Smoking Prevalence, 1997 to 2017. J Gen Intern Med 2022; 37:2591-2593. [PMID: 34495465 PMCID: PMC9360284 DOI: 10.1007/s11606-021-07115-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Accepted: 08/20/2021] [Indexed: 11/30/2022]
Affiliation(s)
- Y Tony Yang
- Center for Health Policy and Media Engagement, George Washington University, Washington, DC, USA.
| | - Thomas Stratmann
- Department of Economics, George Mason University, Fairfax, VA, USA
| | - Drishti Pillai
- Department of Health Policy and Management, George Washington University, Washington, DC, USA
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17
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Bold KW, Buta E, Simon P, Gueorguieva R, Jackson A, Suttiratana SC, Krishnan-Sarin S, O'Malley SS. Examining the potential role of e-cigarettes to reduce health disparities associated with menthol cigarette use: Characterizing e-cigarette use, flavors, and reasons for use among US adults smoking menthol cigarettes. Drug Alcohol Depend 2022; 236:109475. [PMID: 35594642 PMCID: PMC9248755 DOI: 10.1016/j.drugalcdep.2022.109475] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Revised: 04/20/2022] [Accepted: 04/21/2022] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Menthol cigarette use contributes to disproportionate tobacco-related health disparities amongst minoritized race/ethnic groups. E-cigarettes are available in flavors such as menthol and may be a less harmful substitute among adults who smoke. Yet little is known about e-cigarette flavor preference and reasons for use by race/ethnicity among adults who smoke menthol cigarettes. METHODS Nationally representative PATH wave 4 adult data (Dec. 2016-Jan. 2018) were used to examine how menthol cigarette status and race/ethnicity were associated with past 30-day e-cigarette use, flavors used, and reasons for use with adjusted logistic regression models. RESULTS Menthol (vs. non-menthol) cigarette use was associated with higher odds of e-cigarette use (AOR=1.33, 95%CI=1.16-1.52). However, non-Hispanic (NH) Black and Hispanic individuals (vs. NH White) had lower odds of e-cigarette use (p's ≤ 0.004). In terms of flavor used, adults smoking menthol cigarettes and NH Black and Hispanic individuals had greater odds of using menthol/mint-flavored e-cigarettes (p's ≤ 0.02), and older adults (vs. 18-24-year-olds) had lower odds of using sweet-flavored e-cigarettes (p's < 0.0001). Regarding reasons for use, adults smoking menthol cigarettes had higher odds of reporting using e-cigarettes due to liking flavors (AOR=1.63, 95%CI=1.30-2.04), while NH Black adults had lower odds of liking flavors (AOR=0.64, 95%CI=0.43-0.96), and Hispanic adults had lower odds of using e-cigarettes to cut down on cigarette smoking (AOR=0.59, 95%CI=0.42-0.83). CONCLUSIONS Findings suggest menthol flavored e-cigarettes may be important for adults who smoke menthol cigarettes, although racial disparities in current e-cigarette use and reasons for use may exacerbate tobacco-related health disparities.
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Affiliation(s)
- Krysten W Bold
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA; Yale Cancer Center, New Haven, CT, USA.
| | - Eugenia Buta
- Department of Biostatistics, Yale School of Public Health, New Haven, CT, USA
| | - Patricia Simon
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA
| | - Ralitza Gueorguieva
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA; Department of Biostatistics, Yale School of Public Health, New Haven, CT, USA
| | - Asti Jackson
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA
| | - Sakinah C Suttiratana
- Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, CT, USA
| | | | - Stephanie S O'Malley
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA; Yale Cancer Center, New Haven, CT, USA
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18
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Staudt A, Freyer-Adam J, Meyer C, Bischof G, John U, Baumann S. The Moderating Effect of Educational Background on the Efficacy of a Computer-Based Brief Intervention Addressing the Full Spectrum of Alcohol Use: Randomized Controlled Trial. JMIR Public Health Surveill 2022; 8:e33345. [PMID: 35771621 PMCID: PMC9284353 DOI: 10.2196/33345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Revised: 03/29/2022] [Accepted: 04/26/2022] [Indexed: 11/13/2022] Open
Abstract
Background The alcohol-attributable burden of disease is high among socially disadvantaged individuals. Interventional efforts intending to have a public health impact should also address the reduction of social inequalities due to alcohol. Objective The aim was to test the moderating role of educational background on the efficacy of a computer-based brief intervention addressing the full spectrum of alcohol use. Methods We recruited 1646 adults from the general population aged 18 to 64 years (920 women, 55.9%; mean age 31 years; 574 with less than 12 years of school education, 34.9%) who reported alcohol use in the past year. The participants were randomly assigned a brief alcohol intervention or to assessment only (participation rate, 66.9%, 1646/2463 eligible persons). Recruitment took place in a municipal registry office in one German city. All participants filled out a self-administered, tablet-based survey during the recruitment process and were assessed 3, 6, and 12 months later by study assistants via computer-assisted telephone interviews. The intervention consisted of 3 computer-generated and individualized feedback letters that were sent via mail at baseline, month 3, and month 6. The intervention was based on the transtheoretical model of behavior change and expert system software that generated the feedback letters automatically according to previously defined decision rules. The outcome was self-reported change in number of alcoholic drinks per week over 12 months. The moderator was school education according to highest general educational degree (less than 12 years of education vs 12 years or more). Covariates were sex, age, employment, smoking, and alcohol-related risk level. Results Latent growth modeling revealed that the intervention effect after 12 months was moderated by educational background (incidence rate ratio 1.38, 95% CI 1.08-1.76). Individuals with less than 12 years of school education increased their weekly alcohol use to a lesser extent when they received the intervention compared to assessment only (incidence rate ratio 1.30, 95% CI 1.05-1.62; Bayes factor 3.82). No difference was found between groups (incidence rate ratio 0.95, 95% CI 0.84-1.07; Bayes factor 0.30) among those with 12 or more years of school education. Conclusions The efficacy of an individualized brief alcohol intervention was moderated by the participants’ educational background. Alcohol users with less than 12 years of school education benefited, whereas those with 12 or more years did not. People with lower levels of education might be more receptive to the behavior change mechanisms used by brief alcohol interventions. The intervention approach may support the reduction of health inequalities in the population at large if individuals with low or medium education can be reached. Trial Registration German Clinical Trials Register DRKS00014274; https://www.drks.de/DRKS00014274
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Affiliation(s)
- Andreas Staudt
- Institute and Policlinic of Occupational and Social Medicine, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany.,Department of Methods in Community Medicine, Institute of Community Medicine, University Medicine Greifswald, Greifswald, Germany
| | - Jennis Freyer-Adam
- Institute for Medical Psychology, University Medicine Greifswald, Greifswald, Germany.,German Centre for Cardiovascular Research, Partner Site Greifswald, Greifswald, Germany
| | - Christian Meyer
- German Centre for Cardiovascular Research, Partner Site Greifswald, Greifswald, Germany.,Department of Prevention Research and Social Medicine, Institute of Community Medicine, University Medicine Greifswald, Greifswald, Germany
| | - Gallus Bischof
- Department of Psychiatry and Psychotherapy, University of Lübeck, Lübeck, Germany
| | - Ulrich John
- German Centre for Cardiovascular Research, Partner Site Greifswald, Greifswald, Germany.,Department of Prevention Research and Social Medicine, Institute of Community Medicine, University Medicine Greifswald, Greifswald, Germany
| | - Sophie Baumann
- Institute and Policlinic of Occupational and Social Medicine, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany.,Department of Methods in Community Medicine, Institute of Community Medicine, University Medicine Greifswald, Greifswald, Germany
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van Meurs T, Çoban FR, de Koster W, van der Waal J, Oude Groeniger J. Why are anti-smoking health-information interventions less effective among low-socioeconomic status groups? A systematic scoping review. Drug Alcohol Rev 2022; 41:1195-1205. [PMID: 35384097 DOI: 10.1111/dar.13466] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Revised: 03/10/2022] [Accepted: 03/15/2022] [Indexed: 11/29/2022]
Abstract
ISSUES This paper identifies and synthesises explanations proposed in the literature for the (in)effectiveness of institutional anti-smoking health-information interventions (HII) among low-socioeconomic status (SES) adults in high-income countries. APPROACH We searched eight databases for relevant papers from various disciplines: Studies published in English since 2009, on the effectiveness among low-SES adults of anti-smoking HIIs, aimed at changing knowledge/behaviour, and conducted by official institutions, were included. Through a scoping review, we synthesised: study design, SES indicator, intervention type, intervention source, study population, outcomes, low-SES effects, equity effects, proposed explanations and whether these were studied empirically. KEY FINDINGS Thirty-eight studies were included in this scoping review. Seventeen suggested explanations for the (in)effectiveness of the HIIs in low-SES adults, but only nine assessed them empirically. Thematic analysis yielded six themes: message engagement, material conditions, cognition, risk perception, social environment and self-efficacy. IMPLICATIONS Explanations for intervention results are not always present, and empirical evidence for explanations is often not provided. Including such explanations and testing their empirical merits in future research can provide the crucial information needed for developing more effective anti-smoking HIIs for low-SES adults. CONCLUSIONS To our knowledge, this is the first review to explore the explanations proposed for why anti-smoking HIIs are (in)effective among low-SES adults. It contains insights for future studies aiming to provide empirical evidence on the causes of this (in)effectiveness, and concludes that such research is yet largely missing, but crucial to the quest for more effective and equitable anti-smoking interventions.
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Affiliation(s)
- Tim van Meurs
- Department of Public Administration and Sociology, Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - Feray R Çoban
- Department of Public Administration and Sociology, Erasmus University Rotterdam, Rotterdam, The Netherlands.,Athena Institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Willem de Koster
- Department of Public Administration and Sociology, Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - Jeroen van der Waal
- Department of Public Administration and Sociology, Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - Joost Oude Groeniger
- Department of Public Administration and Sociology, Erasmus University Rotterdam, Rotterdam, The Netherlands.,Department of Public Health, Erasmus MC, Rotterdam, The Netherlands
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20
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Voigt EC, Mutter ER, Oettingen G. Effectiveness of a Motivational Smoking Reduction Strategy Across Socioeconomic Status and Stress Levels. Front Psychol 2022; 13:801028. [PMID: 35369175 PMCID: PMC8973437 DOI: 10.3389/fpsyg.2022.801028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Accepted: 02/15/2022] [Indexed: 11/13/2022] Open
Abstract
Smoking consequences are seen disproportionately among low-SES smokers. We examine the self-regulatory strategy of mental contrasting with implementation intentions (MCII) as a smoking reduction tool and whether its effectiveness depends on subjective-SES. This pre-registered online experiment comprised a pre-screening, baseline survey, and follow-up. Participants reported past-week smoking, subjective-SES, perceived stress, and were randomized to an active control (n = 161) or MCII condition (n = 164). Data were collected via MTurk, during the U.S.’ initial wave of COVID-19. Participants were moderate-to-heavy smokers open to reducing or quitting. The primary outcome was self-reported smoking reduction, computed as the difference between recent smoking at baseline and follow-up. The secondary outcome was cessation, operationalized as self-reported 7-day point-prevalence abstinence at follow-up. Among those low—but not high—in subjective-SES, MCII (vs. control) improved smoking reduction by an average of 1.09 fewer cigarettes smoked per day, though this effect was not conclusive (p = 0.11). Similarly, quitting was descriptively more likely for those in the MCII than control condition, but the effect was non-significant (p = 0.11). Per an exploratory analysis, we observed that stress significantly moderated the condition effect (p = 0.01), such that MCII (vs. control) facilitated reduction among those experiencing high (p = 0.03), but not low stress (p = 0.15). Consistent with prior findings that MCII works best in vulnerable populations, MCII may be more effective for smoking reduction among high-stress than low-stress individuals. These findings contribute to growing research on income-related health disparities and smoking behavior change tools.
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Affiliation(s)
- Elizabeth C. Voigt
- Department of Global Public Health, New York University, New York, NY, United States
- Department of Psychology, New York University, New York, NY, United States
- *Correspondence: Elizabeth C. Voigt,
| | | | - Gabriele Oettingen
- Department of Psychology, New York University, New York, NY, United States
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Alaouie H, Krishnamurthy Reddiar S, Tleis M, El Kadi L, A Afifi R, Nakkash R. Waterpipe tobacco smoking (WTS) control policies: global analysis of available legislation and equity considerations. Tob Control 2022; 31:187-197. [PMID: 35241587 DOI: 10.1136/tobaccocontrol-2021-056550] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Accepted: 01/06/2022] [Indexed: 11/04/2022]
Abstract
INTRODUCTION The Framework Convention on Tobacco Control (FCTC) offers guidance on evidence-based policies to reduce tobacco consumption and its burden of disease. Recently, it has provided guidance for alternative tobacco products, such as the waterpipe. Waterpipe tobacco smoking (WTS) is prevalent worldwide and policies to address it need to take into consideration its specificities as a mode of smoking. In parallel, a growing body of literature points to the potential of evidence-based tobacco control policies to increase health inequities. This paper updates a previous global review of waterpipe tobacco policies and adds an equity lens to assess their impact on health inequities. METHODS We reviewed policies that address WTS in 90 countries, including 10 with state-owned tobacco companies; 47 were included in our final analysis. We relied primarily on the Tobacco-Free Kids organisation's Tobacco Control Laws website, providing access to tobacco control laws globally. We categorised country tobacco policies by the clarity with which they defined and addressed waterpipe tobacco in relation to nine FCTC articles. We used the PROGRESS (Place of residence, Race/ethnicity/culture/language, Occupation, Gender/sex, Religion, Education, Socioeconomic status and Social capital) framework for the equity analysis, by reviewing equity considerations referenced in the policies of each country and including prevalence data disaggregated by equity axis and country where available. RESULTS Our results revealed very limited attention to waterpipe policies overall, and to equity in such policies, and highlight the complexity of regulating WTS. We recommend that WTS policies and surveillance centre equity as a goal. CONCLUSIONS Our recommendations can inform global policies to reduce WTS and its health consequences equitably across population groups.
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Affiliation(s)
- Hala Alaouie
- Department of Social and Policy Sciences, University of Bath, Bath, UK
| | | | - Malak Tleis
- Health Promotion and Community Health Department, American University of Beirut, Beirut, Lebanon
| | - Lama El Kadi
- Health Promotion and Community Health Department, American University of Beirut, Beirut, Lebanon
| | - Rima A Afifi
- College of Public Health, University of Iowa, Iowa City, Iowa, USA
| | - Rima Nakkash
- Health Promotion and Community Health Department, American University of Beirut, Beirut, Lebanon
- Global and Community Health Department, College of Health and Human Services, George Mason University, Fairfax, Virginia, USA
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22
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Kim DY, Jang Y, Heo DW, Jo S, Kim HC, Lee JH. Electronic Cigarette Vaping Did Not Enhance the Neural Process of Working Memory for Regular Cigarette Smokers. Front Hum Neurosci 2022; 16:817538. [PMID: 35250518 PMCID: PMC8894252 DOI: 10.3389/fnhum.2022.817538] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Accepted: 01/20/2022] [Indexed: 12/01/2022] Open
Abstract
Background Electronic cigarettes (e-cigs) as substitute devices for regular tobacco cigarettes (r-cigs) have been increasing in recent times. We investigated neuronal substrates of vaping e-cigs and smoking r-cigs from r-cig smokers. Methods Twenty-two r-cig smokers made two visits following overnight smoking cessation. Functional magnetic resonance imaging (fMRI) data were acquired while participants watched smoking images. Participants were then allowed to smoke either an e-cig or r-cig until satiated and fMRI data were acquired. Their craving levels and performance on the Montreal Imaging Stress Task and a 3-back alphabet/digit recognition task were obtained and analyzed using two-way repeated-measures analysis of variance. Regions-of-interest (ROIs) were identified by comparing the abstained and satiated conditions. Neuronal activation within ROIs was regressed on the craving and behavioral data separately. Results Craving was more substantially reduced by smoking r-cigs than by vaping e-cigs. The response time (RT) for the 3-back task was significantly shorter following smoking r-cigs than following vaping e-cigs (interaction: F (1, 17) = 5.3, p = 0.035). Neuronal activations of the right vermis (r = 0.43, p = 0.037, CI = [-0.05, 0.74]), right caudate (r = 0.51, p = 0.015, CI = [0.05, 0.79]), and right superior frontal gyrus (r = −0.70, p = 0.001, CI = [−0.88, −0.34]) were significantly correlated with the RT for the 3-back task only for smoking r-cigs. Conclusion Our findings suggest that insufficient satiety from vaping e-cigs for r-cigs smokers may be insignificant effect on working memory function.
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Affiliation(s)
- Dong-Youl Kim
- Department of Brain and Cognitive Engineering, Korea University, Seoul, South Korea
- Fralin Biomedical Research Institute at VTC, Virginia Tech, Roanoke, VA, United States
| | - Yujin Jang
- Department of Psychology, Korea University, Seoul, South Korea
| | - Da-Woon Heo
- Department of Brain and Cognitive Engineering, Korea University, Seoul, South Korea
| | - Sungman Jo
- Department of Brain and Cognitive Engineering, Korea University, Seoul, South Korea
| | - Hyun-Chul Kim
- Department of Brain and Cognitive Engineering, Korea University, Seoul, South Korea
- Department of Artificial Intelligence, Kyungpook National University, Daegu, South Korea
| | - Jong-Hwan Lee
- Department of Brain and Cognitive Engineering, Korea University, Seoul, South Korea
- *Correspondence: Jong-Hwan Lee,
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Phiri MM, Summers AD, Kress AC, de Quevedo IG, Caraballo R, Twentyman E. Demographic characteristics associated with awareness of cigarette health warnings and thinking about quitting among current adult cigarette smokers in Zambia, 2017. Tob Prev Cessat 2022; 8:05. [PMID: 35224314 PMCID: PMC8832506 DOI: 10.18332/tpc/144772] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Revised: 12/10/2021] [Accepted: 12/12/2021] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Noticing health warnings on cigarette packages has been associated with thinking about quitting. This study examined sociodemographic characteristics associated with awareness of health warnings on cigarette packages and thinking about quitting because of health warning labels among adults who currently smoked tobacco. METHODS We analyzed data from the 2017 Zambia WHO STEPS survey (STEPwise approach to surveillance) for noncommunicable disease risk factors. Descriptive analyses and logistic regression were performed to assess the association of select sociodemographic characteristics with awareness of health warnings and thinking about quitting because of health warnings. RESULTS Adults who currently smoked tobacco who were aged 30–44 years, of Chewa ethnicity, or with a formal education, were more likely to be aware of health warnings than those aged 18–29 years (adjusted prevalence ratio, APR=1.26; 95% CI: 1.02–1.54), of Bemba ethnicity (APR=1.43; 95% CI: 1.17–1.74), or with no formal education (APR: 2.61–5.95). Among all adults who currently smoked, those of Chewa ethnicity (APR=1.55; 95% CI: 1.03–2.35), or with a formal education (APR:1.80–4.38), were more likely to report thinking about quitting because of health warnings than those who were of Bemba ethnicity or with less than primary school education level. Women who currently smoked were 49% less likely (APR=0.51; 95% CI: 0.23–0.84) to report thinking about quitting than men. Among a subset of adults who currently smoked who were aware of health warning labels, no sociodemographic characteristics were significantly associated with thinking about quitting in unadjusted or adjusted models. CONCLUSIONS Sociodemographic characteristics such as sex, ethnicity, and education level were significantly associated with awareness of cigarette health warnings. Among cigarette smokers aware of health warnings, no sociodemographic differences in thinking about quitting were found. Tobacco control campaigns may need to target people of ethnicities with the highest smoking prevalence in the country.
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Affiliation(s)
- Masauso M. Phiri
- Tobacco Control Scholars Program Fellow Centre for Primary Care Research, School of Medicine, University of Zambia, Ridgeway, Zambia
| | - April D. Summers
- Global Tobacco Control Branch, Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, United States
| | - Alissa C. Kress
- Global Tobacco Control Branch, Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, United States
| | - Isabel Garcia de Quevedo
- Global Tobacco Control Branch, Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, United States
| | - Ralph Caraballo
- Global Tobacco Control Branch, Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, United States
| | - Evelyn Twentyman
- Global Tobacco Control Branch, Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, United States
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24
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Barbalich I, Gartner C, Edwards R, Hoek J. New Zealand Smokers' Perceptions of Tobacco Endgame Measures: A Qualitative Analysis. Nicotine Tob Res 2022; 24:93-99. [PMID: 34498088 DOI: 10.1093/ntr/ntab161] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Accepted: 08/06/2021] [Indexed: 11/12/2022]
Abstract
INTRODUCTION New Zealand's equity-focused endgame goal (Smokefree 2025) aims to reduce smoking prevalence to minimal levels (ie, <5%) in all population groups by 2025. Inadequate progress has stimulated discussion of innovative measures to reduce prevalence; because few studies have explored how marginalized groups perceive these measures, we addressed this knowledge gap. AIMS AND METHODS In November and December 2020, we conducted 20 in-depth interviews with people who smoked daily, were aged between 21 and 53, earned less than the median income (NZD33 900), and had marginal or inadequate income sufficiency. We explored participants' smoking history and used an elicitation exercise to probe their views on smokefree policies, including potential endgame measures. We used qualitative descriptive analysis and reflexive thematic analysis to interpret the data. RESULTS Participants favored increasing personal support to quit and reducing nicotine levels in cigarettes, but generally opposed tobacco excise tax increases and paying people to quit. While many privileged their right to "choose," some recognized that stronger policies could restore the loss of agency addiction caused. Participants felt smoking's powerful addictiveness remained poorly understood, and called for smoking to be recognized and treated as an addiction. CONCLUSIONS Several participants supported intensifying existing measures or introducing new measures. However, their use of tobacco industry rhetoric to frame smoking as a choice they had made could inadvertently reinforce the stigma they experienced. Reframing cigarettes as an addictive product engineered by a deceptive industry, may make it easier for participants to access the expanded support and compassion they sought. IMPLICATIONS Policy measures, such as reducing the nicotine level in cigarettes, could support endgame goals; however, greater public understanding of addiction is needed to reduce stigma, support self-efficacy, and foster smoking cessation. Industry denormalization campaigns could challenge views of smoking as a personal choice, decrease self-blame among people who smoke, and present endgame goals as likely to enhance agency.
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Affiliation(s)
- Ivana Barbalich
- Otago School of Medicine, University of Otago, Dunedin, New Zealand
| | - Coral Gartner
- School of Public Health, University of Queensland, St Lucia, QLD, Australia
| | - Richard Edwards
- Department of Public Health, University of Otago, Wellington, New Zealand
| | - Janet Hoek
- Department of Public Health, University of Otago, Wellington, New Zealand
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25
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Vidaña-Pérez D, Braverman-Bronstein A, Zepeda-Tello R, Camacho-García-Formentí D, Colchero MA, Rivera-Dommarco JA, Popkin BM, Barrientos-Gutierrez T. Equitability of Individual and Population Interventions to Reduce Obesity: A Modeling Study in Mexico. Am J Prev Med 2022; 62:105-113. [PMID: 34446315 DOI: 10.1016/j.amepre.2021.05.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Revised: 05/18/2021] [Accepted: 05/25/2021] [Indexed: 11/15/2022]
Abstract
INTRODUCTION Modeling studies have estimated the potential impact and cost effectiveness of interventions to reduce obesity; few have focused on their equity across socioeconomic groups. This study aims to compare the equitability of individual- and population-level interventions to reduce obesity in Mexico. METHODS Mathematical models were implemented to estimate the expected effect of 2 sugar-sweetened beverage tax scenarios (10% and 20%) and bariatric surgery, pharmacotherapy, and dietary advice as individual interventions to reduce body weight. Individual interventions were modeled using meta-analytical weight change, inclusion and exclusion criteria, and the probability of access to healthcare services. For the tax, investigators obtained the baseline consumption of sugar-sweetened beverages from the National Health Survey 2012 and applied the reduction in sales observed in 2016 to estimate the caloric change and weight reduction. Implementation costs and cost per person, per kilogram, and equity were calculated for all interventions over a 1-year timeframe. RESULTS The 20% tax produced the largest estimated increase (4.50%) in normal BMI prevalence, was the most cost effective, and had the largest and most equitable decrease in obesity across socioeconomic categories. Pharmacotherapy and bariatric surgery produced sizable decreases in obesity prevalence (3.68% and 1.18%), particularly among the middle and high socioeconomic groups, whereas dietary advice had the lowest impact on normal and obese categories. CONCLUSIONS Individual interventions were effective in reducing obesity; yet, they were more expensive and less equitable than population interventions. Obesity in Mexico affects all socioeconomic groups; available interventions need to be carefully analyzed to tailor a national strategy that is both effective and equitable.
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Affiliation(s)
- Dèsirée Vidaña-Pérez
- Center for Population Health Research, National Institute of Public Health, Cuernavaca, Mexico
| | | | - Rodrigo Zepeda-Tello
- Center for Population Health Research, National Institute of Public Health, Cuernavaca, Mexico
| | | | - M Arantxa Colchero
- Center for Health Services Research, National Institute of Public Health, Cuernavaca, Mexico
| | | | - Barry M Popkin
- Department of Nutrition, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina; UNC Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
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Erkoyun E, Mackenbach JP. Occupational class and educational level inequalities in major cardiovascular risk factors in Turkey: 2008-2016. J Public Health (Oxf) 2021; 43:e584-e592. [PMID: 32617567 DOI: 10.1093/pubmed/fdaa073] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Revised: 05/07/2020] [Accepted: 05/11/2020] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND We aimed to investigate the magnitude of occupational class (OC) and educational level (EL) inequalities in cardiovascular risk factors in Turkey from 2008 to 2016 and compare these inequalities with neighbouring European countries. METHODS We used the Turkey Health Survey among a representative sample of the Turkish population. We estimated relative index of inequality (RII) for four cardiovascular risk factors (obesity/overweight, hypertension, diabetes, smoking) by OC/EL with an interaction term for survey year and compared selected results with neighbouring countries. RESULTS Men with lower OC and EL smoked more (e.g. RII for EL = 1.40 [1.26-1.55]); however, the remaining risk factors were mostly lower in these groups. Women in lower socio-economic groups smoked less (e.g. RII for EL = 0.36 [0.29-0.44]), however, had higher prevalence of the remaining risk factors. Significant interactions with survey year were only found in a few cases. The pattern of inequalities in Turkey is largely similar to neighbouring countries. CONCLUSIONS Inequalities in cardiovascular risk factors are less systematic in Turkey than in most high-income countries, but ongoing trends suggest that this may change in the future.
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Affiliation(s)
- Erdem Erkoyun
- Department of Public Health, Erasmus Medical Center, 3015 GD Rotterdam, The Netherlands
| | - J P Mackenbach
- Department of Public Health, Erasmus Medical Center, 3015 GD Rotterdam, The Netherlands
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27
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Gagné T, Lapalme J, Ghenadenik AE, OLoughlin JL, Frohlich K. Socioeconomic inequalities in secondhand smoke exposure before, during and after implementation of Quebec's 2015 'An Act to Bolster Tobacco Control'. Tob Control 2021; 30:e128-e137. [PMID: 33115962 DOI: 10.1136/tobaccocontrol-2020-056010] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Revised: 08/26/2020] [Accepted: 09/21/2020] [Indexed: 11/03/2022]
Abstract
BACKGROUND To better understand whether tobacco control policies are associated with changes in secondhand smoke (SHS) exposure across socioeconomic groups, we monitored differences in socioeconomic inequalities in SHS exposure in households and private vehicles among youth and adults before, during and after adoption of Quebec's 2015 An Act to Bolster Tobacco Control. METHODS Using data from the Canadian Community Health Survey, we examined the prevalence of daily exposure to SHS in households and private vehicles among youth (ages 12 to 17) and adults (ages 18+) across levels of household education and income (separately) in 2013/2014, 2015/2016 and 2017/2018. We tested differences in the magnitude of differences in outcomes over time across education and income categories using logistic models with interaction terms, controlling for age and sex. RESULTS We detected inequalities in SHS exposure outcomes at each time point, most markedly at home among youth (OR of SHS exposure among youth living in the 20% poorest households vs the 20% richest=4.9, 95% CI 2.7 to 6.2). There were decreases in SHS exposure in homes and cars in each education/income group over time. The magnitude of inequalities in SHS exposure in homes and cars, however, did not change during this period. CONCLUSIONS The persistence of socioeconomic inequalities in SHS exposure despite implementation of new tobacco control laws represents an increasingly worrisome public health challenge, particularly among youth. Policymakers should prioritise the reduction of socioeconomic inequalities in SHS exposure and consider the specific needs of socioeconomically disadvantaged populations in the design of future legislation.
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Affiliation(s)
- Thierry Gagné
- Epidemiology and Public Health, University College London, London, UK
| | - Josée Lapalme
- Centre de recherche en santé publique, Montreal, Quebec, Canada
- École de santé publique de l'Université de Montréal, Montreal, Quebec, Canada
| | - Adrian E Ghenadenik
- Centre de recherche en santé publique, Montreal, Quebec, Canada
- École de santé publique de l'Université de Montréal, Montreal, Quebec, Canada
| | - Jennifer L OLoughlin
- École de santé publique de l'Université de Montréal, Montreal, Quebec, Canada
- Centre de recherche du Centre Hospitalier de l'Université de Montré, Montreal, Quebec, Canada
| | - Katherine Frohlich
- Centre de recherche en santé publique, Montreal, Quebec, Canada
- École de santé publique de l'Université de Montréal, Montreal, Quebec, Canada
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28
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van Trier TJ, Mohammadnia N, Snaterse M, Peters RJG, Jørstad HT, Bax WA, Mackenbach JD. An appeal to our government for nationwide policies in the prevention of cardiovascular disease. Neth Heart J 2021; 30:58-62. [PMID: 34606024 PMCID: PMC8489361 DOI: 10.1007/s12471-021-01628-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/27/2021] [Indexed: 11/30/2022] Open
Abstract
The high prevalence and burden of cardiovascular diseases (CVD) is largely attributable to unhealthy lifestyle factors such as smoking, alcohol consumption, physical inactivity and unhealthy food habits. Prevention of CVD, through the promotion of healthy lifestyles, appears to be a Sisyphean task for healthcare professionals, as the root causes of an unhealthy lifestyle lie largely outside their scope. Since most lifestyle choices are habitual and a response to environmental cues, rather than rational and deliberate choices, nationwide policies targeting the context in which lifestyle behaviours occur may be highly effective in the prevention of CVD. In this point-of-view article, we emphasise the need for government policies beyond those mentioned in the National Prevention Agreement in the Netherlands to effectively reduce the CVD risk, and we address the commonly raised concerns regarding ‘paternalism’.
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Affiliation(s)
- T J van Trier
- Department of Cardiology, Amsterdam University Medical Centre, University of Amsterdam, Amsterdam, The Netherlands.
| | - N Mohammadnia
- Department of Internal Medicine, Northwest Clinics, Alkmaar, The Netherlands.,Vascular Research Alkmaar, Alkmaar, The Netherlands.,Department of Cardiology, Northwest Clinics, Alkmaar, The Netherlands
| | - M Snaterse
- Centre of Expertise Urban Vitality, Faculty of Health, Amsterdam University of Applied Sciences, Amsterdam, The Netherlands
| | - R J G Peters
- Department of Cardiology, Amsterdam University Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| | - H T Jørstad
- Department of Cardiology, Amsterdam University Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| | - W A Bax
- Department of Internal Medicine, Northwest Clinics, Alkmaar, The Netherlands.,Vascular Research Alkmaar, Alkmaar, The Netherlands
| | - J D Mackenbach
- Department of Epidemiology and Data Science, Amsterdam Public Health Research Institute, Amsterdam UMC, location VUmc, Amsterdam, The Netherlands
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29
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Robson M, Lord J, Doran T. Estimating the equity impacts of the smoking ban in England on cotinine levels: a regression discontinuity design. BMJ Open 2021; 11:e049547. [PMID: 34548357 PMCID: PMC8458322 DOI: 10.1136/bmjopen-2021-049547] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE To estimate the equity impacts of the 2007 smoking ban in England, for both smokers and non-smokers. DESIGN Doubly robust regression discontinuity analysis of salivary cotinine levels. Conditional average treatment effects were used to estimate differential impacts of the ban by socioeconomic deprivation (based on the Index of Multiple Deprivation). Distributional impacts were further assessed using conditional quantile treatment effects and inequality treatment effects. SETTING In 2007, England introduced a ban on smoking in public places. This had little impact on tobacco consumption by smokers but was associated with decreases in environmental tobacco smoke exposure for non-smokers. However, the impact of the ban on socioeconomic inequalities in exposure is unclear. PARTICIPANTS 766 smokers and 2952 non-smokers responding to the Health Survey for England in 2007. OUTCOME MEASURE Levels of salivary cotinine. RESULTS Before the ban, socioeconomic deprivation was associated with higher cotinine levels for non-smokers but not for smokers. The ban caused a significant reduction in average cotinine levels for non-smokers (p=0.043) but had no effect for smokers (p=0.817). Reductions for non-smokers were greater for more deprived groups with higher levels of exposure, and there was a significant reduction in socioeconomic-related inequality in cotinine. Across the whole population (both smokers and non-smokers), there was no significant increase in the concentration of cotinine levels among the socioeconomically deprived. CONCLUSION The 2007 ban on smoking in public places had little impact on smokers, but was, as intended, associated with reductions in both (1) average levels of environmental tobacco smoke exposure and (2) deprivation-related inequality in exposure among non-smokers.
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Affiliation(s)
- Matthew Robson
- Department of Health Sciences, University of York, York, UK
| | - Joseph Lord
- Centre for Health Economics, University of York, York, UK
| | - Tim Doran
- Department of Health Sciences, University of York, York, UK
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30
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LeLaurin JH, Gurka MJ, Chi X, Lee JH, Hall J, Warren GW, Salloum RG. Concordance Between Electronic Health Record and Tumor Registry Documentation of Smoking Status Among Patients With Cancer. JCO Clin Cancer Inform 2021; 5:518-526. [PMID: 33974447 DOI: 10.1200/cci.20.00187] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Patients with cancer who use tobacco experience reduced treatment effectiveness, increased risk of recurrence and mortality, and diminished quality of life. Accurate tobacco use documentation for patients with cancer is necessary for appropriate clinical decision making and cancer outcomes research. Our aim was to assess agreement between electronic health record (EHR) smoking status data and cancer registry data. MATERIALS AND METHODS We identified all patients with cancer seen at University of Florida Health from 2015 to 2018. Structured EHR smoking status was compared with the tumor registry smoking status for each patient. Sensitivity, specificity, positive predictive values, negative predictive values, and Kappa statistics were calculated. We used logistic regression to determine if patient characteristics were associated with odds of agreement in smoking status between EHR and registry data. RESULTS We analyzed 11,110 patient records. EHR smoking status was documented for nearly all (98%) patients. Overall kappa (0.78; 95% CI, 0.77 to 0.79) indicated moderate agreement between the registry and EHR. The sensitivity was 0.82 (95% CI, 0.81 to 0.84), and the specificity was 0.97 (95% CI, 0.96 to 0.97). The logistic regression results indicated that agreement was more likely among patients who were older and female and if the EHR documentation occurred closer to the date of cancer diagnosis. CONCLUSION Although documentation of smoking status for patients with cancer is standard practice, we only found moderate agreement between EHR and tumor registry data. Interventions and research using EHR data should prioritize ensuring the validity of smoking status data. Multilevel strategies are needed to achieve consistent and accurate documentation of smoking status in cancer care.
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Affiliation(s)
- Jennifer H LeLaurin
- Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida, Gainesville, FL
| | - Matthew J Gurka
- Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida, Gainesville, FL
| | - Xiaofei Chi
- Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida, Gainesville, FL
| | - Ji-Hyun Lee
- Division of Quantitative Sciences, University of Florida Health Cancer Center, Gainesville, FL.,Department of Biostatistics, University of Florida, Gainesville, FL
| | - Jaclyn Hall
- Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida, Gainesville, FL
| | - Graham W Warren
- Department of Radiation Oncology, Medical University of South Carolina, Charleston, SC.,Department of Cell and Molecular Pharmacology, Medical University of South Carolina, Charleston, SC
| | - Ramzi G Salloum
- Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida, Gainesville, FL
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31
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Thrul J, Riehm KE, Cohen JE, Alexander GC, Vernick JS, Mojtabai R. Tobacco control policies and smoking cessation treatment utilization: A moderated mediation analysis. PLoS One 2021; 16:e0241512. [PMID: 34460821 PMCID: PMC8405013 DOI: 10.1371/journal.pone.0241512] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Accepted: 06/18/2021] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Tobacco policies, including clean indoor air laws and cigarette taxes, increase smoking cessation in part by stimulating the use of cessation treatments. We explored whether the associations between tobacco policies and treatment use varies across sociodemographic groups. METHODS We used data from 62,165 U.S. adult participants in the 2003 and 2010/11 Tobacco Use Supplement to the Current Population Survey (TUS-CPS) who reported smoking cigarettes during the past-year. We built on prior structural equation models used to quantify the degree to which smoking cessation treatment use (prescription medications, nicotine replacement therapy, counseling/support groups, quitlines, and internet resources) mediated the association between clean indoor air laws, cigarette excise taxes, and recent smoking cessation. In the current study, we added selected moderators to each model to investigate whether associations between tobacco polices and smoking cessation treatment use varied by sex, race/ethnicity, education, income, and health insurance status. RESULTS Associations between clean indoor air laws and the use of prescription medication and nicotine replacement therapies varied significantly between racial/ethnic, age, and education groups in 2003. However, none of these moderation effects remained significant in 2010/11. Higher cigarette excise taxes in 2010/2011 were associated with higher odds of using counseling among older adults and higher odds of using prescription medications among younger adults. No other moderator reached statistical significance. Smoking cessation treatments did not mediate the effect of taxes on smoking cessation in 2003 and were not included in these analyses. CONCLUSIONS Sociodemographic differences in associations between clean indoor air laws and smoking cessation treatment use have decreased from 2003 to 2010/11. In most cases, policies appear to stimulate smoking cessation treatment use similarly across varied sociodemographic groups.
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Affiliation(s)
- Johannes Thrul
- Department of Mental Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, United States of America
- Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, Maryland, United States of America
- Centre for Alcohol Policy Research, La Trobe University, Melbourne, Australia
| | - Kira E. Riehm
- Department of Mental Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, United States of America
| | - Joanna E. Cohen
- Department of Health, Behavior and Society, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, United States of America
- Institute for Global Tobacco Control, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, United States of America
| | - G. Caleb Alexander
- Center for Drug Safety and Effectiveness, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, United States of America
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, United States of America
- Division of General Internal Medicine, Johns Hopkins Medicine, Baltimore, Maryland, United States of America
| | - Jon S. Vernick
- Department of Health Policy and Management, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, United States of America
| | - Ramin Mojtabai
- Department of Mental Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, United States of America
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32
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Group Support for Smoking Cessation: Importance of the Smoker's Choice for Better Outcomes. BEHAVIOUR CHANGE 2021. [DOI: 10.1017/bec.2021.10] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AbstractSmoking cessation method effectiveness is discussed among socially disadvantaged smokers. Our aim was to measure real-life effectiveness of the choice of a multi-component group intervention in comparison with individual usual care. We report an observational study (N = 100). Disadvantaged smokers were screened with a validated tool. We designed a multi-component structured behavioural group intervention, delivered in weekly group sessions during 6 weeks. Usual care consisted of individual visits. Both groups received free nicotine replacement therapy. We observed 33 smokers participating in the group intervention, while 67 received usual care. Abstinence at 6 weeks was 24.2% (n = 8) in the group intervention versus 11.9% (n = 8) in usual care (p = .115). Also, 36.4% (n = 12) of group intervention patients had reduced their cigarette consumption versus 16.4% (n = 11) in usual care (p = .026). In addition, 6.1% (n = 2) dropped out of group versus 31.3% (n = 21) in usual care (p = .005). Finally, 6 months after their first visit, 15.2% (n = 5) of group intervention patients and 4.5% (n = 3) in usual care were abstinent (p = .111). Group intervention choice versus usual care might facilitate smoking abstinence, reduction, and follow-up adherence.
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33
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Kim DY, Tegethoff M, Meinlschmidt G, Yoo SS, Lee JH. Cigarette craving modulation is more feasible than resistance modulation for heavy cigarette smokers: empirical evidence from functional MRI data. Neuroreport 2021; 32:762-770. [PMID: 33901056 DOI: 10.1097/wnr.0000000000001653] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Modulation of cigarette craving and neuronal activations from nicotine-dependent cigarette smokers using real-time functional MRI (rtfMRI)-based neurofeedback (rtfMRI-NF) has been previously reported. OBJECTIVES The aim of this study was to evaluate the efficacy of rtfMRI-NF training in reducing cigarette cravings using fMRI data acquired before and after training. METHODS Treatment-seeking male heavy cigarette smokers (N = 14) were enrolled and randomly assigned to two conditions related to rtfMRI-NF training aiming at resisting the urge to smoke. In one condition, subjects underwent conventional rtfMRI-NF training using neuronal activity as the neurofeedback signal (activity-based) within regions-of-interest (ROIs) implicated in cigarette craving. In another condition, subjects underwent rtfMRI-NF training with additional functional connectivity information included in the neurofeedback signal (functional connectivity-added). Before and after rtfMRI-NF training at each of two visits, participants underwent two fMRI runs with cigarette smoking stimuli and were asked to crave or resist the urge to smoke without neurofeedback. Cigarette craving-related or resistance-related regions were identified using a general linear model followed by paired t-tests and were evaluated using regression analysis on the basis of neuronal activation and subjective craving scores (CRSs). RESULTS Visual areas were mainly implicated in craving, whereas the superior frontal areas were associated with resistance. The degree of (a) CRS reduction and (b) the correlation between neuronal activation and CRSs were statistically significant (P < 0.05) in the functional connectivity-added neurofeedback group for craving-related ROIs. CONCLUSION Our study demonstrated the feasibility of altering cigarette craving in craving-related ROIs but not in resistance-related ROIs via rtfMRI-NF training.
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Affiliation(s)
- Dong-Youl Kim
- Department of Brain and Cognitive Engineering, Korea University, Anam-ro, Seongbuk-gu, Seoul, Republic of Korea
| | - Marion Tegethoff
- Institute of Psychology, RWTH Aachen, Jägerstrasse, Aachen, Germany
- Division of Clinical Psychology and Psychiatry, Department of Psychology, University of Basel, Missionsstrasse, Basel, Switzerland
| | - Gunther Meinlschmidt
- Division of Clinical Psychology and Cognitive Behavioral Therapy, International Psychoanalytic University, Stromstrasse, Berlin, Germany
- Department of Psychosomatic Medicine, University Hospital Basel and University of Basel, Hebelstrasse, Basel, Switzerland
- Division of Clinical Psychology and Epidemiology, Department of Psychology, University of Basel, Missionsstrasse, Basel, Switzerland
| | - Seung-Schik Yoo
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Jong-Hwan Lee
- Department of Brain and Cognitive Engineering, Korea University, Anam-ro, Seongbuk-gu, Seoul, Republic of Korea
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Affiliation(s)
- Janet Hoek
- Department of Public Health, University of Otago, Wellington, New Zealand
| | - Richard Edwards
- Department of Public Health, University of Otago, Wellington, New Zealand
| | - George W Thomson
- Department of Public Health, University of Otago, Wellington, New Zealand
| | - Andrew Waa
- Department of Public Health, University of Otago, Wellington, New Zealand
| | - Nick Wilson
- Department of Public Health, University of Otago, Wellington, New Zealand
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Parks MJ, Patrick ME, Levy DT, Thrasher JF, Elliott MR, Fleischer NL. Tobacco Taxation and Its Prospective Impact on Disparities in Smoking Initiation and Progression Among Young Adults. J Adolesc Health 2021; 68:765-772. [PMID: 33041205 PMCID: PMC8012213 DOI: 10.1016/j.jadohealth.2020.08.031] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2020] [Revised: 08/13/2020] [Accepted: 08/28/2020] [Indexed: 11/30/2022]
Abstract
PURPOSE Limited research exists on tobacco taxes and cigarette smoking initiation and progression, particularly across different sociodemographic groups in young adulthood. This project examines how cigarette pack price in late adolescence prospectively relates to smoking initiation and progression by 21 years of age, focusing on differences across demographics. METHODS Data are from the longitudinal Monitoring the Future project (2001-2017). Monitoring the Future examines drug use behaviors with nationally representative samples of 12th graders annually. Subsamples of 12th graders are followed up longitudinally. We examined past 30-day cigarette smoking among baseline never smokers (N = 9,232) and daily smoking among youths who were not daily cigarette smokers at baseline (N = 15,141). Using logistic regression, we examined state-level cigarette pack price at a modal age of 18 years and smoking at follow-up ages 19-20 years; we used interaction terms to assess differences across sociodemographic groups (by gender, race/ethnicity, and parental education). RESULTS For each dollar increase in price at baseline, the odds of initiation by age 19-20 years were reduced by 12% (adjusted odds ratio = .88; 95% confidence interval = .78, .99) and the odds of progression to daily smoking were reduced by 16% (adjusted odds ratio = .84; 95% confidence interval = .76, .92). After adjusting for multiple testing, for both outcomes there were no statistically significant interactions between price and demographics. CONCLUSIONS Cigarette prices in late adolescence were associated with a prospective reduction in cigarette smoking initiation and progression among young adults, with limited differences across sociodemographic characteristics. Higher cigarette prices can prevent smoking initiation and progression; however, complementary interventions are needed to reduce initiation and progression among subgroups disproportionately affected by tobacco.
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Affiliation(s)
- Michael J Parks
- Institute for Translational Research in Children's Mental Health, University of Minnesota, Minneapolis, Minnesota.
| | - Megan E Patrick
- Institute for Translational Research in Children's Mental Health, University of Minnesota, Minneapolis, Minnesota; Institute of Child Development, University of Minnesota, Minneapolis, Minnesota
| | - David T Levy
- Lombardi Comprehensive Cancer Center, Georgetown University, Washington, District of Columbia
| | - James F Thrasher
- Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina; Department of Tobacco Research, Center for Population Health Research, National Institute of Public Health, Cuernavaca, Mexico
| | - Michael R Elliott
- Department of Biostatistics, School of Public Health, University of Michigan, Ann Arbor, Michigan; Survey Research Center, Institute for Social Research, University of Michigan, Ann Arbor, Michigan
| | - Nancy L Fleischer
- Center for Social Epidemiology and Population Health, Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, Michigan
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Saetta S, Kivits J, Frohlich K, Minary L. Stigmatisation et santé publique : le côté obscur des interventions anti-tabac. SANTE PUBLIQUE (VANDOEUVRE-LES-NANCY, FRANCE) 2021; 32:473-478. [PMID: 35724162 DOI: 10.3917/spub.205.0473] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Tobacco control strategies, considered legitimate and effective, are rarely the subject of critical analysis in France. This is specifically true with regard to their potentially harmful effects, particularly against people who continue to smoke. This article introduces this debate, focusing on the potentially stigmatizing effects of anti-smoking policies. It has been attested by numerous international studies, and by a study in France, that the general process of tobacco denormalization has led to the stigmatization of smokers who then may be subject to discrimination. To the extent that smoking is now concentrated in the most disadvantaged socio-economic populations in France, the latter are thus more exposed to stigma. While underscoring the need to develop targeted interventions against them, this article also warns and calls for vigilance regarding the potential iatrogenic effects of these interventions. It is therefore necessary to develop research and evaluations on this subject in order to accurately measure the effects of these interventions, particularly in terms of stigmatization and self-stigma, and to ensure that public health actors do not generate more problems than they solve.
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Garzón-Orjuela N, Samacá-Samacá DF, Luque Angulo SC, Mendes Abdala CV, Reveiz L, Eslava-Schmalbach J. An overview of reviews on strategies to reduce health inequalities. Int J Equity Health 2020; 19:192. [PMID: 33115482 PMCID: PMC7594271 DOI: 10.1186/s12939-020-01299-w] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Accepted: 10/13/2020] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Governments are incentivized to develop and implement health action programs focused on equity to ensure progress with effective strategies or interventions. OBJECTIVE Identify and synthesize strategies or interventions that facilitate the reduction of health inequalities. METHODS A systematic search strategy was carried out up until August 2019 in MEDLINE (Ovid), Embase (Elsevier), Cochrane Database of Systematic Reviews, LILACS, Scopus, Scielo and Epistemonikos. In addition, a snowball strategy was used. Literature reviews (LRs) of experimental and quasi-experimental studies were included. The identified interventions and outcomes were categorized based on the recommendation by the Cochrane group in "Effective Practice and Organization of Care". The quality of the included LRs was evaluated using the AMSTAR 2 tool. RESULTS Four thousand ninety-five articles were identified, of which 97 were included in the synthesis of evidence. Most of the studies included focused on the general population, vulnerable populations and minority populations. The subjects of general health and healthy lifestyles were the most commonly addressed. According to the classification of the type of intervention, the domain covered most was the delivery arrangements, followed by the domain of implementation strategies. The most frequent group of outcomes was the reported outcome in (clinical) patients, followed by social outcomes. CONCLUSION The strategies that facilitate the reduction of health inequalities must be intersectoral and multidisciplinary in nature, including all sectors of the health system. It is essential to continue generating interventions focused on strengthening health systems in order to achieve adequate universal health coverage, with a process of comprehensive and quality care.
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Affiliation(s)
- Nathaly Garzón-Orjuela
- Grupo de Equidad en Salud, Facultad de Medicina, Universidad Nacional de Colombia, Bogotá, Colombia
| | | | | | | | - Ludovic Reveiz
- Evidence and Intelligence for Action in Health Department, Pan American Health Organization, Washington DC, USA
| | - Javier Eslava-Schmalbach
- Grupo de Equidad en Salud, Facultad de Medicina, Universidad Nacional de Colombia, Bogotá, Colombia
- Hospital Universitario Nacional de Colombia, Bogotá, Colombia
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Nguyen-Grozavu FT, Pierce JP, Sakuma KLK, Leas EC, McMenamin SB, Kealey S, Benmarhnia T, Emery SL, White MM, Fagan P, Trinidad DR. Widening disparities in cigarette smoking by race/ethnicity across education level in the United States. Prev Med 2020; 139:106220. [PMID: 32693179 PMCID: PMC7494609 DOI: 10.1016/j.ypmed.2020.106220] [Citation(s) in RCA: 46] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Revised: 07/09/2020] [Accepted: 07/13/2020] [Indexed: 01/07/2023]
Abstract
Reducing tobacco use is an important public health objective. It is the largest preventable cause of death and disease, yet inequalities remain. This study examines combined educational and racial/ethnic disparities in the United States related to cigarette smoking for the three largest racial/ethnic groups (African Americans, Hispanics/Latinos, and non-Hispanic Whites). Data included nine Tobacco Use Supplements to the Current Population Surveys (TUS-CPS) conducted in the United States from 1992/1993-2018 for four smoking metrics: ever smoking rates, current smoking rates, consumption (cigarettes per day), and quit ratios. Across all TUS-CPS samples, there were 9.5% African Americans, 8.8% Hispanics/Latinos, and 81.8% non-Hispanic Whites who completed surveys. Findings revealed that lower educational attainment was associated with increased ever and current smoking prevalence over time across all racial/ethnic groups, and education-level disparities within each race/ethnicity widened over time. Disparities in ever and current smoking rates between the lowest and highest categories of educational attainment (less than a high school education vs. completion of college) were larger for African Americans and non-Hispanic Whites than Hispanics/Latinos. Non-Hispanic Whites had the highest cigarette consumption across all education levels over time. College graduates had the highest quit ratios for all racial/ethnic groups from 1992 to 2018, with quit ratios significantly increasing for Hispanics/Latinos and non-Hispanic Whites, but not African Americans. In conclusion, educational disparities in smoking have worsened over time, especially among African Americans and Hispanics/Latinos. Targeted tobacco control efforts could help reduce these disparities to meet public health objectives, although racial/ethnic disparities may persist regardless of educational attainment.
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Affiliation(s)
- France T Nguyen-Grozavu
- University of California, San Diego, Family Medicine and Public Health, La Jolla, CA, United States of America.
| | - John P Pierce
- University of California, San Diego, Family Medicine and Public Health, La Jolla, CA, United States of America
| | - Kari-Lyn K Sakuma
- Oregon State University, College of Public Health and Human Sciences, School of Social and Behavioral Health Sciences, Corvallis, OR, United States of America
| | - Eric C Leas
- University of California, San Diego, Family Medicine and Public Health, La Jolla, CA, United States of America
| | - Sara B McMenamin
- University of California, San Diego, Family Medicine and Public Health, La Jolla, CA, United States of America
| | - Sheila Kealey
- University of California, San Diego, Family Medicine and Public Health, La Jolla, CA, United States of America
| | - Tarik Benmarhnia
- University of California, San Diego, Family Medicine and Public Health, La Jolla, CA, United States of America
| | - Sherry L Emery
- University of Chicago, NORC, 1155 East 60th Street, 2nd Floor, Chicago, IL, United States of America
| | - Martha M White
- University of California, San Diego, Family Medicine and Public Health, La Jolla, CA, United States of America
| | - Pebbles Fagan
- University of Arkansas for Medical Sciences, Fay W. Boozman College of Public Health, Department of Health Behavior and Health Education, Little Rock, AR, United States of America
| | - Dennis R Trinidad
- University of California, San Diego, Family Medicine and Public Health, La Jolla, CA, United States of America
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Smith CE, Hill SE, Amos A. Impact of population tobacco control interventions on socioeconomic inequalities in smoking: a systematic review and appraisal of future research directions. Tob Control 2020; 30:tobaccocontrol-2020-055874. [PMID: 32994297 PMCID: PMC8666809 DOI: 10.1136/tobaccocontrol-2020-055874] [Citation(s) in RCA: 51] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Revised: 08/06/2020] [Accepted: 08/25/2020] [Indexed: 01/11/2023]
Abstract
BACKGROUND While price increases and targeted cessation support have been found to reduce inequalities in smoking by socioeconomic status (SES), evidence on other measures is mixed. We aimed to update the most recent (2014) previous review by identifying and appraising evidence published since 2013 on the equity impact of population tobacco control measures. METHODS Systematic searching of 10 electronic databases and hand-searching of four key journals identified 68 primary research articles published since 2013 that sought to examine the equity impact of population tobacco control measures in high-income countries with a negative socioeconomic gradient in smoking. Reported equity impacts were categorised as positive (greater impact among lower SES), neutral (no difference by SES), negative (greater impact among higher SES) or mixed/unclear. RESULTS There was substantial growth in research seeking to evaluate the equity impact of tobacco control interventions, but the majority of new studies showed mixed/unclear results. Findings for price increases and targeted cessation support continue to suggest an equity-positive impact, but limitations in the available evidence make further assessment difficult. Substantial differences in the context, scale and implementation of tobacco control policies make straightforward comparison of findings from the previous 2014 and current reviews problematic. CONCLUSION Researchers need to adopt more sophisticated, multidisciplinary approaches in evaluating the equity impact of tobacco control measures-developing robust measures of equity effect and using frameworks that take account of context, existing systems/processes and the likely mechanisms of action. Socioeconomic differences in intervention impact within low-income and middle-income countries require evaluation.
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Affiliation(s)
| | - Sarah E Hill
- Global Health Policy Unit, University of Edinburgh, Edinburgh, UK
| | - Amanda Amos
- Usher Institute, University of Edinburgh, Edinburgh, UK
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Stokes AC, Wilson AE, Lundberg DJ, Xie W, Berry KM, Fetterman JL, Harlow AF, Cozier YC, Barrington-Trimis JL, Sterling KL, Benjamin EJ, Blaha MJ, Hamburg NM, Bhatnagar A, Robertson RM. Racial/Ethnic Differences in Associations of Non-cigarette Tobacco Product Use With Subsequent Initiation of Cigarettes in US Youths. Nicotine Tob Res 2020; 23:900-908. [PMID: 32948872 PMCID: PMC8150136 DOI: 10.1093/ntr/ntaa170] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Accepted: 09/17/2020] [Indexed: 12/22/2022]
Abstract
Introduction Understanding which non-cigarette tobacco products precede smoking in youth across different racial/ethnic groups can inform policies that consider tobacco-related health disparities. Methods We used nationally representative, longitudinal data from the Population Assessment of Tobacco and Health Study waves 1–4. The sample was a dynamic cohort of cigarette-naïve youth aged 12–17 years. Mixed-effects models were used to assess non-cigarette product (e-cigarette, cigar product, or other product) use with cigarette use over 1-year intervals. Results Of the 28 788 observations pooled across waves 1–4, respondents were 48.7% non-Hispanic white, 13.9% non-Hispanic black, and 23.1% Hispanic. Odds of cigarette initiation over 1-year follow-up were higher among youth with prior use of e-cigarettes (odds ratio [OR], 2.76; 95% confidence interval [CI], 2.21–3.45), cigars (OR, 2.00; 95% CI, 1.42–2.80), or other products (OR, 1.66; 95% CI, 1.28–2.14) compared to never users. At the population level, 20.6% of cigarette initiation was attributable to e-cigarette use among white youth and 21.6% among Hispanic youth, while only 3.5% of cigarette initiation was attributable to e-cigarette use among black youth. In contrast, 9.1% of cigarette initiation for black youth was attributable to cigar use compared to only 3.9% for both white and Hispanic youth. Conclusions Prior use of e-cigarettes, cigars, and other non-cigarette products were all associated with subsequent cigarette initiation. However, white and Hispanic youth were more likely to initiate cigarettes through e-cigarette use (vs. cigar or other product use), while black youth were more likely to initiate cigarettes through cigar use (vs. e-cigarette or other product use). Implications Our findings suggest that previous studies on effects of non-cigarette tobacco products may overlook the critical role of cigar products as a pathway into cigarette smoking among US youth, particularly black youth. While our data support the importance of e-cigarette use as a pathway into smoking, regulatory actions aimed at addressing youth e-cigarette use alone may contribute to disparities in black versus white tobacco use and further exacerbate inequities in tobacco-related disease. Thus, contemporary policy development and discourse about the effects of non-cigarette tobacco products on cigarette initiation should consider cigar and other non-cigarette products as well as e-cigarettes.
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Affiliation(s)
- Andrew C Stokes
- American Heart Association Tobacco Regulation and Addiction Center, Dallas, TX.,Department of Global Health, Boston University School of Public Health, Boston, MA
| | - Anna E Wilson
- Department of Global Health, Boston University School of Public Health, Boston, MA
| | - Dielle J Lundberg
- Department of Global Health, Boston University School of Public Health, Boston, MA
| | - Wubin Xie
- Department of Global Health, Boston University School of Public Health, Boston, MA
| | - Kaitlyn M Berry
- Department of Epidemiology, University of Minnesota, Minneapolis, MN
| | - Jessica L Fetterman
- American Heart Association Tobacco Regulation and Addiction Center, Dallas, TX.,Evans Department of Medicine and Whitaker Cardiovascular Institute, Boston University School of Medicine, Boston, MA
| | - Alyssa F Harlow
- Department of Epidemiology, Boston University School of Public Health, Boston, MA
| | - Yvette C Cozier
- Department of Epidemiology, Boston University School of Public Health, Boston, MA
| | | | - Kymberle L Sterling
- School of Public Health, University of Texas Health Sciences Center, Dallas, TX
| | - Emelia J Benjamin
- American Heart Association Tobacco Regulation and Addiction Center, Dallas, TX.,Evans Department of Medicine and Whitaker Cardiovascular Institute, Boston University School of Medicine, Boston, MA.,Department of Epidemiology, Boston University School of Public Health, Boston, MA
| | - Michael J Blaha
- American Heart Association Tobacco Regulation and Addiction Center, Dallas, TX.,Department of Medicine, The Johns Hopkins University, Baltimore, MD
| | - Naomi M Hamburg
- American Heart Association Tobacco Regulation and Addiction Center, Dallas, TX.,Evans Department of Medicine and Whitaker Cardiovascular Institute, Boston University School of Medicine, Boston, MA
| | - Aruni Bhatnagar
- American Heart Association Tobacco Regulation and Addiction Center, Dallas, TX.,Department of Medicine, University of Louisville, Louisville, KY
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Kingsbury JH, D'Silva J, O'Gara E, Parks MJ, Boyle RG. How Much Progress Have We Made? Trends in Disparities in Tobacco Use. Prev Chronic Dis 2020; 17:E107. [PMID: 32945768 PMCID: PMC7553206 DOI: 10.5888/pcd17.200090] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
INTRODUCTION Reducing tobacco-related health disparities has been a public health priority for more than 2 decades, yet disparities in cigarette use have remained steady or worsened. Less is known about how disparities in other tobacco products have changed over time. Our study examined trends in cigarette and other tobacco product use in Minnesota with the goal of informing efforts aimed at reducing disparities. METHODS We examined tobacco use disparities as a function of education, income, and race across the Minnesota Adult Tobacco Survey results in 2010 (N = 7,057), 2014 (N = 9,304), and 2018 (N = 6,055). Tobacco use was captured by assessing past 30-day use of 4 tobacco products: cigarettes, cigars, e-cigarettes, and smokeless tobacco, plus combustibles (ie, cigarettes and/or cigars) and any tobacco (ie, use of any of the 4 products). RESULTS At each wave, those with lower income and education reported greater use of cigarettes, combustibles, and any tobacco than those with higher income and education. Black respondents were more likely to report cigar and combustibles use than White respondents in 2018, whereas White respondents were more likely to report smokeless tobacco use in 2014. We saw no significant wave-by-demographic interactions, suggesting that the magnitude of the disparity remained unchanged over time for any tobacco product. CONCLUSION Substantial disparities in tobacco use remain across education, income, and race, even in a state such as Minnesota with a strong tobacco control program. Additional efforts are needed to close disparity gaps and reach endgame tobacco use targets for all subpopulations.
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Affiliation(s)
- J H Kingsbury
- Minnesota Department of Health, 85 7th Place East, St. Paul, MN 55101.
| | - J D'Silva
- ClearWay Minnesota, Bloomington, Minnesota
| | - E O'Gara
- ClearWay Minnesota, Bloomington, Minnesota
| | - M J Parks
- Minnesota Department of Health, St. Paul, Minnesota
| | - R G Boyle
- University of California, Office of the President, Oakland, California
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[GRADE equity guidelines 3: considering health equity in GRADE guideline development: rating the certainty of synthesized evidence]. ZEITSCHRIFT FUR EVIDENZ FORTBILDUNG UND QUALITAET IM GESUNDHEITSWESEN 2020; 153-154:119-125. [PMID: 32727700 DOI: 10.1016/j.zefq.2020.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
OBJECTIVES The aim of this paper is to describe a conceptual framework for how to consider health equity in the Grading Recommendations Assessment and Development Evidence (GRADE) guideline development process. STUDY DESIGN AND SETTING Consensus-based guidance developed by the GRADE working group members and other methodologists. This is a German translation of the original paper published in English. RESULTS We developed consensus-based guidance to help address health equity when rating the certainty of synthesized evidence (i.e., quality of evidence). When health inequity is determined to be a concern by stakeholders, we propose five methods for explicitly assessing health equity: (1) include health equity as an outcome; (2) consider patient-important outcomes relevant to health equity; (3) assess differences in the relative effect size of the treatment; (4) assess differences in baseline risk and the differing impacts on absolute effects; and (5) assess indirectness of evidence to disadvantaged populations and/or settings. CONCLUSION The most important priority for research on health inequity and guidelines is to identify and document examples where health equity has been considered explicitly in guidelines. Although there is a weak scientific evidence base for assessing health equity, this should not discourage the explicit consideration of how guidelines and recommendations affect the most vulnerable members of society.
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Leão T, Perelman J, Clancy L, Mlinarić M, Kinnunen JM, Nuyts PAW, Mélard N, Rimpelä A, Lorant V, Kunst AE. Economic Evaluation of Five Tobacco Control Policies Across Seven European Countries. Nicotine Tob Res 2020; 22:1202-1209. [PMID: 31350556 PMCID: PMC7291799 DOI: 10.1093/ntr/ntz124] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2019] [Accepted: 08/08/2019] [Indexed: 11/25/2022]
Abstract
Introduction Economic evaluations of tobacco control policies targeting adolescents are scarce. Few take into account real-world, large-scale implementation costs; few compare cost-effectiveness of different policies across different countries. We assessed the cost-effectiveness of five tobacco control policies (nonschool bans, including bans on sales to minors, bans on smoking in public places, bans on advertising at points-of-sale, school smoke-free bans, and school education programs), implemented in 2016 in Finland, Ireland, the Netherlands, Belgium, Germany, Italy, and Portugal. Methods Cost-effectiveness estimates were calculated per country and per policy, from the State perspective. Costs were collected by combining quantitative questionnaires with semi-structured interviews on how policies were implemented in each setting, in real practice. Short-term effectiveness was based on the literature, and long-term effectiveness was modeled using the DYNAMO-HIA tool. Discount rates of 3.5% were used for costs and effectiveness. Sensitivity analyses considered 1%–50% short-term effectiveness estimates, highest cost estimates, and undiscounted effectiveness. Findings Nonschool bans cost up to €253.23 per healthy life year, school smoking bans up to €91.87 per healthy life year, and school education programs up to €481.35 per healthy life year. Cost-effectiveness depended on the costs of implementation, short-term effectiveness, initial smoking rates, dimension of the target population, and weight of smoking in overall mortality and morbidity. Conclusions All five policies were highly cost-effective in all countries according to the World Health Organization thresholds for public health interventions. Cost-effectiveness was preserved even when using the highest costs and most conservative effectiveness estimates. Implications Economic evaluations using real-world data on tobacco control policies implemented at a large scale are scarce, especially considering nonschool bans targeting adolescents. We assessed the cost-effectiveness of five tobacco control policies implemented in 2016 in Finland, Ireland, the Netherlands, Belgium, Germany, Italy, and Portugal. This study shows that all five policies were highly cost-effective considering the World Health Organization threshold, even when considering the highest costs and most conservative effectiveness estimates.
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Affiliation(s)
- Teresa Leão
- Escola Nacional de Saúde Pública, Universidade NOVA de Lisboa, Lisboa, Portugal.,Centro de Investigação em Saúde Pública, Lisboa, Portugal.,Local Health Unit of Matosinhos, Matosinhos, Portugal
| | - Julian Perelman
- Escola Nacional de Saúde Pública, Universidade NOVA de Lisboa, Lisboa, Portugal.,Centro de Investigação em Saúde Pública, Lisboa, Portugal
| | - Luke Clancy
- TobaccoFree Research Institute Ireland, Dublin, Ireland
| | - Martin Mlinarić
- Institute of Medical Sociology, Medical Faculty, Martin Luther University Halle-Wittenberg, Halle, Germany
| | - Jaana M Kinnunen
- Unit of Health Sciences, Faculty of Social Sciences, Tampere University, Tampere, Finland
| | | | - Nora Mélard
- Institute of Health and Society, Université catholique de Louvain, Brussels, Belgium
| | - Arja Rimpelä
- Unit of Health Sciences, Faculty of Social Sciences, Tampere University, Tampere, Finland.,Department of Adolescent Psychiatry, Tampere University Hospital, Tampere, Finland
| | - Vincent Lorant
- Institute of Health and Society, Université catholique de Louvain, Brussels, Belgium
| | - Anton E Kunst
- Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
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Chyderiotis S, Benmarhnia T, Spilka S, Beck F, Andler R, Legleye S, Menvielle G. Why do apprentices smoke much more than high school students? Understanding educational disparities in smoking with a Oaxaca-blinder decomposition analysis. BMC Public Health 2020; 20:924. [PMID: 32532252 PMCID: PMC7291761 DOI: 10.1186/s12889-020-09050-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2019] [Accepted: 06/04/2020] [Indexed: 12/04/2022] Open
Abstract
Background Educational disparities in daily smoking begin during adolescence and can lead to educational disparities in health among adults. In particular, vocational students including apprentices have higher daily smoking rates compared to non-vocational students. This study aimed to identify the determinants of the gap in daily smoking between French apprentices and high school students aged 17 in 2008 and in 2017. Methods We used data from a cross-sectional repeated survey representative of all French adolescents aged 17 in 2008 and 2017. We conducted a non-linear extension of the Oaxaca-Blinder decomposition technique and included the following variables: sociodemographic and familial characteristics, parental smoking, cannabis and alcohol use, suicidal attempt, grade repetition and money received. Results Daily smoking was about two times higher among French apprentices compared to high school students in 2008. This gap did not decrease between 2008 and 2017. Differences in measured characteristics between the two groups explained this gap partly, from 28.6 to 51.2%. Cannabis and alcohol use, money received and parental smoking contributed the most to the daily smoking gap. Conclusions Prevention programs could target cannabis and alcohol use as well as parental smoking to help decrease educational disparities in smoking status among French adolescents.
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Affiliation(s)
- Sandra Chyderiotis
- Université Paris-Sud, Université Paris-Saclay, faculté de médecine, faculté de médecine UVSQ, Inserm, CESP, 92541, Villejuif, France. .,Observatoire français des drogues et des toxicomanies (OFDT), 69, rue de Varenne, 75007, Paris, France.
| | - Tarik Benmarhnia
- Department of Family Medicine and Public Health, University of California, San Diego, 9500 Gilman Drive, La Jolla, CA, 92093, USA.,Scripps Institution of Oceanography, University of California, San Diego, CA, USA
| | - Stanislas Spilka
- Université Paris-Sud, Université Paris-Saclay, faculté de médecine, faculté de médecine UVSQ, Inserm, CESP, 92541, Villejuif, France.,Observatoire français des drogues et des toxicomanies (OFDT), 69, rue de Varenne, 75007, Paris, France
| | - François Beck
- Institut national de la statistique et des études économiques, 88, avenue Verdier, CS 70058, 92541, Montrouge Cedex, France
| | - Raphaël Andler
- Santé Publique France, 12, rue du Val d'Osne, 94415, Saint-Maurice Cedex, France
| | - Stéphane Legleye
- Université Paris-Sud, Université Paris-Saclay, faculté de médecine, faculté de médecine UVSQ, Inserm, CESP, 92541, Villejuif, France.,Institut national de la statistique et des études économiques, 88, avenue Verdier, CS 70058, 92541, Montrouge Cedex, France
| | - Gwenn Menvielle
- Department of Social Epidemiology, Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique IPLESP, 75012, Paris, France
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45
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Song F, Elwell-Sutton T, Naughton F, Gentry S. Future smoking prevalence by socioeconomic status in England: a computational modelling study. Tob Control 2020; 30:tobaccocontrol-2019-055490. [PMID: 32447314 PMCID: PMC8237189 DOI: 10.1136/tobaccocontrol-2019-055490] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2019] [Revised: 04/02/2020] [Accepted: 04/20/2020] [Indexed: 12/26/2022]
Abstract
BACKGROUND The difference in smoking across socioeconomic groups is a major cause of health inequality. This study projected future smoking prevalence by socioeconomic status, and revealed what is needed to achieve the tobacco-free ambition (TFA) by 2030 in England. METHODS Using data from multiple sources, the adult (≥18 years) population in England was separated into subgroups by smoking and highest educational qualification (HEQ). A discrete time state-transition model was used to project future smoking prevalence by HEQ deterministically and stochastically. RESULTS In a status quo scenario, smoking prevalence in England is projected to be 10.8% (95% uncertainty interval: 9.1% to 12.9%) by 2022, 7.8% (5.5% to 11.0%) by 2030 and 6.0% (3.7% to 9.6%) by 2040. The absolute difference in smoking rate between low and high HEQ is reduced from 12.2% in 2016 to 7.9% by 2030, but the relative inequality (low/high HEQ ratio) is increased from 2.48 in 2016 to 3.06 by 2030. When applying 2016 initiation/relapse rates, achievement of the TFA target requires no changes to future cessation rates among adults with high qualifications, but increased rates of 37% and 149%, respectively, in adults with intermediate and low qualifications. CONCLUSIONS If the current trends continue, smoking prevalence in England is projected to decline in the future, but with substantial differences across socioeconomic groups. Absolute inequalities in smoking are likely to decline and relative inequalities in smoking are likely to increase in future. The achievement of England's TFA will require the reduction of both absolute and relative inequalities in smoking by socioeconomic status.
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Affiliation(s)
- Fujian Song
- Norwich Medical School, University of East Anglia, Norwich, UK
| | | | - Felix Naughton
- School of Health Sciences, University of East Anglia, Norwich, UK
| | - Sarah Gentry
- Norwich Medical School, University of East Anglia, Norwich, UK
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46
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Alves J, Filipe R, Machado J, Nunes B, Perelman J. Change in the Prevalence and Social Patterning of First-and Second-Hand Smoking in PORTUGAL: A Repeated Cross-Sectional Study (2005 and 2014). INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17103594. [PMID: 32443801 PMCID: PMC7277527 DOI: 10.3390/ijerph17103594] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Revised: 05/12/2020] [Accepted: 05/14/2020] [Indexed: 11/16/2022]
Abstract
Between 2005 and 2007, important reinforcements of the tobacco legislation have been implemented in Portugal, which may have affected smoking patterns. The aim of this study was to measure the change in prevalence of first- and second-hand smoking (SHS) among adults, and its socio-demographic patterning in Portugal from 2005 to 2014. Data from the last two Portuguese National Health Interview Surveys (2005 and 2014) were used. The changes in daily smoking and SHS were measured using Poisson regressions, stratifying by sex and survey year. The inequalities were measured using relative inequality indexes (RII). From 2005 to 2014, there was a reduction in SHS (75%-54% among men, and 52%-38% among women), and a reduction in smoking among men (27%-26%), and an increase among women (9%-12%). SHS reduction was more marked among less privileged people. Among Portuguese men, inequalities in daily smoking have increased slightly, while among women the gap favoring low-educated reduced. Between 2005 and 2014, SHS decreased, but not daily smoking, particularly among women. Additionally, socioeconomic inequalities in smoking increased. Future policies should simultaneously tackle smoking and SHS prevalence, and their socioeconomic patterning. More comprehensive policies such as comprehensive national (non-partial) bans, combined with price increases could be more effective.
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Affiliation(s)
- Joana Alves
- NOVA National School of Public Health, Public Health Research Centre, Universidade NOVA de Lisboa, 1600-560 Lisboa, Portugal;
- Correspondence: ; Tel.: +351 217 512 186
| | - Rita Filipe
- ACES Lisboa Ocidental e Oeiras—Public Health Unit, 2780-163 Oeiras, Portugal;
| | - João Machado
- Department of Epidemiology, Instituto Nacional de Saúde Dr. Ricardo Jorge, 1649-016 Lisboa, Portugal; (J.M.); (B.N.)
| | - Baltazar Nunes
- Department of Epidemiology, Instituto Nacional de Saúde Dr. Ricardo Jorge, 1649-016 Lisboa, Portugal; (J.M.); (B.N.)
| | - Julian Perelman
- NOVA National School of Public Health, Public Health Research Centre, Universidade NOVA de Lisboa, 1600-560 Lisboa, Portugal;
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47
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Socio-spatial inequalities in smoking among young adults: What a ‘go-along’ study says about local smoking practices. Soc Sci Med 2020; 253:112920. [DOI: 10.1016/j.socscimed.2020.112920] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Revised: 01/27/2020] [Accepted: 03/12/2020] [Indexed: 11/20/2022]
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48
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Fleischer NL, Donahoe JT, McLeod MC, Thrasher JF, Levy DT, Elliott MR, Meza R, Patrick ME. Taxation reduces smoking but may not reduce smoking disparities in youth. Tob Control 2020; 30:264-272. [PMID: 32269173 DOI: 10.1136/tobaccocontrol-2019-055478] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Revised: 02/24/2020] [Accepted: 03/11/2020] [Indexed: 11/03/2022]
Abstract
OBJECTIVE This study examines the extent to which cigarette taxes affect smoking behaviour and disparities in smoking among adolescents by gender, socioeconomic status (SES) and race/ethnicity. METHODS We used US nationally representative, repeated cross-sectional data from the 2005 to 2016 Monitoring the Future study to evaluate the relationship between state cigarette taxes and past 30-day current smoking, smoking intensity, and first cigarette and daily smoking initiation using modified Poisson and linear regression models, stratified by grade. We tested for interactions between tax and gender, SES and race/ethnicity on the additive scale using average marginal effects. RESULTS We found that higher taxes were associated with lower smoking outcomes, with variation by grade. Across nearly all of our specifications, there were no statistically significant interactions between tax and gender, SES or race/ethnicity for any grades/outcomes. One exception is that among 12th graders, there was a statistically significant interaction between tax and college plans, with taxes being associated with a lower probability of 30-day smoking among students who definitely planned to attend college compared with those who did not. CONCLUSION We conclude that higher taxes were associated with reduced smoking among adolescents, with little difference by gender, SES and racial/ethnicity groups. While effective at reducing adolescent smoking, taxes appear unlikely to reduce smoking disparities among youth.
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Affiliation(s)
- Nancy L Fleischer
- Epidemiology, School of Public Health, University of Michigan, Ann Arbor, Michigan, USA
| | - J Travis Donahoe
- Graduate School of Arts & Sciences, Harvard University, Cambridge, Massachusetts, USA
| | - M Chandler McLeod
- Biostatistics Core, Rogel Cancer Center, University of Michigan, Ann Arbor, Michigan, USA
| | - James F Thrasher
- Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina, USA.,Tobacco Research, Center for Population Health Research, National Institute of Public Health, Cuernavaca, Mexico
| | - David T Levy
- Oncology, Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC, USA
| | - Michael R Elliott
- Biostatistics, School of Public Health, University of Michigan, Ann Arbor, Michigan, USA.,Survey Research Center, Institute for Social Research, University of Michigan, Ann Arbor, Michigan, USA
| | - Rafael Meza
- Epidemiology, School of Public Health, University of Michigan, Ann Arbor, Michigan, USA
| | - Megan E Patrick
- Institute of Child Development and Institute for Translational Research in Children's Mental Health, University of Minnesota Twin Cities, Minneapolis, Minnesota, USA
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49
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Partos TR, Hiscock R, Gilmore AB, Branston JR, Hitchman S, McNeill A. Impact of tobacco tax increases and industry pricing on smoking behaviours and inequalities: a mixed-methods study. PUBLIC HEALTH RESEARCH 2020. [DOI: 10.3310/phr08060] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background
Increasing tobacco prices through taxation is very effective for reducing smoking prevalence and inequalities. For optimum effect, understanding how the tobacco industry and smokers respond is essential. Tobacco taxation changes occurred in the UK over the study period, including annual increases, a shift in structure from ad valorem to specific taxation and relatively higher increases on roll-your-own tobacco than on factory-made cigarettes.
Objectives
Understanding tobacco industry pricing strategies in response to tax changes and the impact of tax on smokers’ behaviour, including tax evasion and avoidance, as well as the effect on smoking inequalities. Synthesising findings to inform how taxation can be improved as a public health intervention.
Design
Qualitative analysis and evidence synthesis (commercial and Nielsen data) and longitudinal and aggregate cross-sectional analyses (International Tobacco Control Policy Evaluation Project data).
Setting
The UK, from 2002 to 2016.
Data sources and participants
Data were from the tobacco industry commercial literature and retail tobacco sales data (Nielsen, New York, NY, USA). Participants were a longitudinal cohort (with replenishment) of smokers and ex-smokers from 10 surveys of the International Tobacco Control Policy Evaluation Project (around 1500 participants per survey).
Main outcome measures
(1) Tobacco industry pricing strategies, (2) sales volumes and prices by segments over time and (3) smokers’ behaviours, including products purchased, sources, brands, consumption, quit attempts, success and sociodemographic differences.
Review methods
Tobacco industry commercial literature was searched for mentions of tobacco products and price segments, with 517 articles extracted.
Results
The tobacco industry increased prices on top of tax increases (overshifting), particularly on premium products, and, recently, the tobacco industry overshifted more on cheap roll-your-own tobacco than on factory-made cigarettes. Increasingly, price rises were from industry revenue generation rather than tax. The tobacco industry raised prices gradually to soften impact; this was less possible with larger tax increases. Budget measures to reduce cheap product availability failed due to new cheap factory-made products, price marking and small packs. In 2014, smokers could buy factory-made (roll-your-own tobacco) cigarettes at real prices similar to 2002. Exclusive roll-your-own tobacco and mixed factory-made cigarettes and roll-your-own tobacco use increased, whereas exclusive factory-made cigarette use decreased, alongside increased cheap product use, rather than quitting. Quitting behaviours were associated with higher taxes. Smokers consumed fewer factory-made cigarettes and reduced roll-your-own tobacco weight over time. Apparent illicit purchasing did not increase. Disadvantaged and dependent smokers struggled with tobacco affordability and were more likely to smoke cheaper products, but disadvantage did not affect quit success.
Limitations
Different for each data set; triangulation increased confidence.
Conclusions
The tobacco industry overshifted taxes and increased revenues, even when tax increases were high. Therefore, tobacco taxes can be further increased to reduce price differentials and recoup public health costs. Government strategies on illicit tobacco appear effective. Large, sudden tax increases would reduce the industry’s ability to manipulate prices, decrease affordability and increase quitting behaviours. More disadvantaged, and dependent, smokers need more help with quitting.
Future work
Assessing the impact of tax changes made since 2014; changing how tax changes are introduced (e.g. sudden intermittent or smaller continuous); and tax changes on tobacco initiation.
Funding
This project was funded by the National Institute for Health Research (NIHR) Public Health Research programme and will be published in full in Public Health Research; Vol. 8, No. 6. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Timea R Partos
- National Addiction Centre, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK
| | | | | | - J Robert Branston
- Centre for Governance and Regulation, School of Management, University of Bath, Bath, UK
| | - Sara Hitchman
- National Addiction Centre, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK
| | - Ann McNeill
- National Addiction Centre, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK
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50
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Davies NM, Taylor AE, Taylor GM, Itani T, Jones T, Martin RM, Munafò MR, Windmeijer F, Thomas KH. Varenicline versus nicotine replacement therapy for long-term smoking cessation: an observational study using the Clinical Practice Research Datalink. Health Technol Assess 2020; 24:1-46. [PMID: 32079557 PMCID: PMC7061271 DOI: 10.3310/hta24090] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Smoking is the leading avoidable cause of illness and premature mortality. The first-line treatments for smoking cessation are nicotine replacement therapy and varenicline. Meta-analyses of experimental studies have shown that participants allocated to the varenicline group were 1.57 times (95% confidence interval 1.29 to 1.91 times) as likely to be abstinent 6 months after treatment as those allocated to the nicotine replacement therapy group. However, there is limited evidence about the effectiveness of varenicline when prescribed in primary care. We investigated the effectiveness and rate of adverse events of these medicines in the general population. OBJECTIVE To estimate the effect of prescribing varenicline on smoking cessation rates and health outcomes. DATA SOURCES Clinical Practice Research Datalink. METHODS We conducted an observational cohort study using electronic medical records from the Clinical Practice Research Datalink. We extracted data on all patients who were prescribed varenicline or nicotine replacement therapy after 1 September 2006 who were aged ≥ 18 years. We investigated the effects of varenicline on smoking cessation, all-cause mortality and cause-specific mortality and hospitalisation for: (1) chronic lung disease, (2) lung cancer, (3) coronary heart disease, (4) pneumonia, (5) cerebrovascular disease, (6) diabetes, and (7) external causes; primary care diagnosis of myocardial infarction, chronic obstructive pulmonary disease, depression, or prescription for anxiety; weight in kg; general practitioner and hospital attendance. Our primary outcome was smoking cessation 2 years after the first prescription. We investigated the baseline differences between patients prescribed varenicline and patients prescribed nicotine replacement therapy. We report results using multivariable-adjusted, propensity score and instrumental variable regression. Finally, we developed methods to assess the relative bias of the different statistical methods we used. RESULTS People prescribed varenicline were healthier at baseline than those prescribed nicotine replacement therapy in almost all characteristics, which highlighted the potential for residual confounding. Our instrumental variable analysis results found little evidence that patients prescribed varenicline had lower mortality 2 years after their first prescription (risk difference 0.67, 95% confidence interval -0.11 to 1.46) than those prescribed nicotine replacement therapy. They had similar rates of all-cause hospitalisation, incident primary care diagnoses of myocardial infarction and chronic obstructive pulmonary disease. People prescribed varenicline subsequently attended primary care less frequently. Patients prescribed varenicline were more likely (odds ratio 1.46, 95% confidence interval 1.42 to 1.50) to be abstinent 6 months after treatment than those prescribed nicotine replacement therapy when estimated using multivariable-adjusted for baseline covariates. Patients from more deprived areas were less likely to be prescribed varenicline. However, varenicline had similar effectiveness for these groups. CONCLUSION Patients prescribed varenicline in primary care were more likely to quit smoking than those prescribed nicotine replacement therapy, but there was little evidence that they had lower rates of mortality or morbidity in the 4 years following the first prescription. There was little evidence of heterogeneity in effectiveness across the population. FUTURE WORK Future research should investigate the decline in prescribing of smoking cessation products; develop an optimal treatment algorithm for smoking cessation; use methods for using instruments with survival outcomes; and develop methods for comparing multivariable-adjusted and instrumental variable estimates. LIMITATIONS Not all of our code lists were validated, body mass index and Index of Multiple Deprivation had missing values, our results may suffer from residual confounding, and we had no information on treatment adherence. TRIAL REGISTRATION This trial is registered as NCT02681848. FUNDING This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 24, No. 9. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Neil M Davies
- Medical Research Council Integrative Epidemiology Unit, University of Bristol, Bristol, UK
- Bristol Medical School, University of Bristol, Bristol, UK
- Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway
| | - Amy E Taylor
- Bristol Medical School, University of Bristol, Bristol, UK
- National Institute for Health Research Biomedical Research Centre, University Hospitals Bristol NHS Foundation Trust, University of Bristol, Bristol, UK
| | | | - Taha Itani
- Medical Research Council Integrative Epidemiology Unit, University of Bristol, Bristol, UK
- UK Centre for Tobacco and Alcohol Studies, School of Experimental Psychology, University of Bristol, Bristol, UK
| | - Tim Jones
- National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care West, University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | - Richard M Martin
- Medical Research Council Integrative Epidemiology Unit, University of Bristol, Bristol, UK
- Bristol Medical School, University of Bristol, Bristol, UK
- National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care West, University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | - Marcus R Munafò
- Medical Research Council Integrative Epidemiology Unit, University of Bristol, Bristol, UK
- UK Centre for Tobacco and Alcohol Studies, School of Experimental Psychology, University of Bristol, Bristol, UK
| | - Frank Windmeijer
- Medical Research Council Integrative Epidemiology Unit, University of Bristol, Bristol, UK
- Department of Economics, University of Bristol, Bristol, UK
| | - Kyla H Thomas
- Bristol Medical School, University of Bristol, Bristol, UK
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