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Dalmau R, Alanazi AM, Arora M, Banerjee A, Bianco E, Gaalema DE, Goma FM, Hasegawa K, Komiyama M, Pérez Ríos M, Willett J, Wang Y. A Complex Interplay: Navigating the Crossroads of Tobacco Use, Cardiovascular Disease, and the COVID-19 Pandemic: A WHF Policy Brief. Glob Heart 2024; 19:55. [PMID: 38973985 PMCID: PMC11225561 DOI: 10.5334/gh.1334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2024] [Accepted: 06/10/2024] [Indexed: 07/09/2024] Open
Abstract
The Coronavirus Disease 2019, commonly referred to as COVID-19, is responsible for one of the deadliest pandemics in human history. The direct, indirect and lasting repercussions of the COVID-19 pandemic on individuals and public health, as well as health systems can still be observed, even today. In the midst of the initial chaos, the role of tobacco as a prognostic factor for unfavourable COVID-19 outcomes was largely neglected. As of 2023, numerous studies have confirmed that use of tobacco, a leading risk factor for cardiovascular and other diseases, is strongly associated with increased risks of severe COVID-19 complications (e.g., hospitalisation, ICU admission, need for mechanical ventilation, long COVID, etc.) and deaths from COVID-19. In addition, evidence suggests that COVID-19 directly affects multiple organs beyond the respiratory system, disproportionately impacting individuals with comorbidities. Notably, people living with cardiovascular disease are more prone to experiencing worse outcomes, as COVID-19 often inherently manifests as thrombotic cardiovascular complications. As such, the triad of tobacco, COVID-19 and cardiovascular disease constitutes a dangerous cocktail. The lockdowns and social distancing measures imposed by governments have also had adverse effects on our lifestyles (e.g., shifts in diets, physical activity, tobacco consumption patterns, etc.) and mental well-being, all of which affect cardiovascular health. In particular, vulnerable populations are especially susceptible to tobacco use, cardiovascular disease and the psychological fallout from the pandemic. Therefore, national pandemic responses need to consider health equity as well as the social determinants of health. The pandemic has also had catastrophic impacts on many health systems, bringing some to the brink of collapse. As a result, many health services, such as services for cardiovascular disease or tobacco cessation, were severely disrupted due to fears of transmission and redirection of resources for COVID-19 care. Unfortunately, the return to pre-pandemic levels of cardiovascular disease care activity has stagnated. Nevertheless, digital solutions, such as telemedicine and apps, have flourished, and may help reduce the gaps. Advancing tobacco control was especially challenging due to interference from the tobacco industry. The industry exploited lingering uncertainties to propagate misleading information on tobacco and COVID-19 in order to promote its products. Regrettably, the links between tobacco use and risk of SARS-CoV-2 infection remain inconclusive. However, a robust body of evidence has, since then, demonstrated that tobacco use is associated with more severe COVID-19 illness and complications. Additionally, the tobacco industry also repeatedly attempted to forge partnerships with governments under the guise of corporate social responsibility. The implementation of the WHO Framework Convention on Tobacco Control could address many of the aforementioned challenges and alleviate the burden of tobacco, COVID-19, and cardiovascular disease. In particular, the implementation of Article 5.3 could protect public health policies from the vested interests of the industry. The world can learn from the COVID-19 pandemic to better prepare for future health emergencies of international concern. In light of the impact of tobacco on the COVID-19 pandemic, it is imperative that tobacco control remains a central component in pandemic preparedness and response plans.
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Affiliation(s)
| | - Abdullah M. Alanazi
- King Saud Bin Abdulaziz University for Health Sciences, Saudi Arabia
- King Abdullah International Medical Research Center, Saudi Arabia
| | | | | | | | | | | | - Koji Hasegawa
- National Hospital Organization Kyoto Medical Center, Japan
| | - Maki Komiyama
- National Hospital Organization Kyoto Medical Center, Japan
| | - Mónica Pérez Ríos
- University of Santiago de Compostela, Spain
- Health Research Institute of Santiago de Compostela, Spain
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van Walbeek C, Hill R, Filby S. Quitting behavior during the tobacco sales ban in South Africa: Results from a broadly nationally representative survey. Tob Induc Dis 2023; 21:102. [PMID: 37551390 PMCID: PMC10398832 DOI: 10.18332/tid/168594] [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: 10/30/2022] [Revised: 06/20/2023] [Accepted: 06/23/2023] [Indexed: 08/09/2023] Open
Abstract
INTRODUCTION In response to COVID-19, the South African government banned the sale of tobacco products for 20 weeks. Before the ban, the illicit cigarette market was well-entrenched and smoking cessation services were not widely available. Several surveys conducted to ascertain cigarette smokers' responses to the ban reported substantial differences in the proportion of smokers who quit. This study provides a broadly nationally representative ex-post investigation into cigarette smokers' quitting behavior related to the sales ban. METHODS We used data from wave three of NIDS-CRAM (the National Income Dynamics Study-Coronavirus Rapid Mobile Survey) conducted in November-December 2020. We first investigated the proportion of people who quit and who continued smoking during and after the sales ban. We subsequently linked the NIDS-CRAM survey to the fifth wave of NIDS (2017) to identify a subset of established smokers, and considered whether their quitting behavior differed from that of all smokers who smoked at the start of the sales ban. RESULTS The cross-sectional analysis showed that 7.8% of cigarette smokers quit during the sales ban, but that 55% of these quitters relapsed after it was lifted. Of the pre-ban smokers, 3.5% indicated that they did not smoke both during and after the sales ban, and 3.7% quit after the ban was lifted. The longitudinal analysis showed that 7% of people who were smoking in 2017, quit smoking cigarettes during the tobacco sales ban, but that >70% of quitters relapsed after it was lifted. Only 2% of pre-ban established smokers indicated that they did not smoke during or after the ban. CONCLUSIONS The sales ban did not have the intended objective of encouraging large-scale smoking cessation. This reflects policy failures to provide smokers with appropriate cessation support and to effectively control the illicit market both prior to and during the sales ban.
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Affiliation(s)
- Corné van Walbeek
- Research Unit on the Economics of Excisable Products, School of Economics, University of Cape Town, Rondebosch, South Africa
| | - Robert Hill
- Development Policy Research Unit, School of Economics, University of Cape Town, Rondebosch, South Africa
| | - Samantha Filby
- Research Unit on the Economics of Excisable Products, School of Economics, University of Cape Town, Rondebosch, South Africa
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Ovung S, Nair S, Hijam M, Alee NT, Aheibam S, Singh SR, Da Costa EL, Siddiqui S, Sharma S, Singh L, Singh KJ, Haobijam N, Kaur H, Rao MVV. Smokeless Tobacco Use and Cessation Attempts during COVID-19 Lockdown: A Qualitative Study. Asian Pac J Cancer Prev 2023; 24:1979-1985. [PMID: 37378927 PMCID: PMC10505867 DOI: 10.31557/apjcp.2023.24.6.1979] [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: 01/31/2023] [Accepted: 06/19/2023] [Indexed: 06/29/2023] Open
Abstract
BACKGROUND Smokeless tobacco (SLT) use among women is widely prevalent in Manipur state accounting for 45% users as per Global Adult Tobacco Survey (GATS)-2 India. Studies from India and elsewhere indicate changes in the way people used SLT during COVID-19 lockdown. This study explores individual and economic influences on SLT consumption and cessation attempts by tribal women in Manipur during the first COVID-19 lockdown (March-June, 2020) in India. METHODS Twenty in-depth interviews, both in-person and telephonically, were conducted among tribal women from Imphal west, Manipur, India, who used any SLT, from April to September 2020. Objective of the study was to understand the use, factors associated with consumption, purchasing behaviors, and cessation attempts of SLT during the lockdown. Thematic content analysis was used to identify core themes and codes. RESULTS Study participants reported of changes in current SLT use during restrictions imposed to contain COVID-19 pandemic in India. Majority reported of reduction or quit attempts in SLT use. Reasons included inaccessibility due to travel restrictions, limited availability and price rise of SLT products, fear of COVID-19, and disposable income for purchase of SLT products. However, a few women reported of increased consumption due to bulk purchasing, or switching to other SLT products as a result of unavailability or price rise of preferred products or to cope up with social isolation caused by the lockdown. CONCLUSION Study findings on factors influencing quit attempts and strategies used for reducing SLT use by tribal women in Imphal, Manipur provide valuable insights for development of appropriate intervention for prevention of SLT use among women.
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Affiliation(s)
- Senthanro Ovung
- Indian Council of Medical Research-National Institute of Medical Statistics, New Delhi, India.
| | - Saritha Nair
- Indian Council of Medical Research-National Institute of Medical Statistics, New Delhi, India.
| | - Meena Hijam
- Indian Council of Medical Research-National Institute of Medical Statistics, New Delhi, India.
| | | | - Sharmila Aheibam
- Indian Council of Medical Research-National Institute of Medical Statistics, New Delhi, India.
| | - Sagolsem Roshan Singh
- Indian Council of Medical Research-National Institute of Medical Statistics, New Delhi, India.
| | - Elsa Lumia Da Costa
- Indian Council of Medical Research-National Institute of Medical Statistics, New Delhi, India.
| | - Saher Siddiqui
- Indian Council of Medical Research-National Institute of Medical Statistics, New Delhi, India.
| | - Saurabh Sharma
- Indian Council of Medical Research-National Institute of Medical Statistics, New Delhi, India.
| | - Lucky Singh
- Indian Council of Medical Research-National Institute of Medical Statistics, New Delhi, India.
| | - Kh. Jitenkumar Singh
- Indian Council of Medical Research-National Institute of Medical Statistics, New Delhi, India.
| | - Nirendra Haobijam
- Department of Community Medicine, Jawaharlal Institute of Medical Sciences, Imphal, Manipur, India.
| | - Harpreet Kaur
- Division of Epidemiology and Communicable Diseases, Indian Council of Medical Research, New Delhi, India.
| | - M. Vishnu Vardhana Rao
- Indian Council of Medical Research-National Institute of Medical Statistics, New Delhi, India.
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Sharma N, Chopra M, Bauld L, Nazar GP, Joshi N, Chugh A, Mohan S, Mohan D, Ali MK, Mohan V, Tandon N, Venkat Narayan KM, Srinath Reddy K, Prabhakaran D, Arora M. Impact of a tobacco sales ban on the frequency of tobacco consumption in India during the COVID-19 pandemic. Tob Induc Dis 2023; 21:51. [PMID: 37123348 PMCID: PMC10141826 DOI: 10.18332/tid/161855] [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] [Received: 11/03/2022] [Revised: 02/15/2023] [Accepted: 03/03/2023] [Indexed: 05/02/2023] Open
Abstract
INTRODUCTION Measures to address the COVID-19 pandemic in India included a ban on the sale and use of tobacco products during 2020 when stay at home guidance (lockdown) was in place. In this study we examined the extent of reduction in frequency of tobacco consumption across all products. METHODS Telephone survey was conducted between July and August 2020 across an existing cohort of tobacco users (n=801) residing in Delhi (55.4%) and Chennai (44.6%), India. The participants were recruited irrespective of their gender and use of any kind of tobacco product(s). The survey questionnaire was based on the STOP (Studying Tobacco users Of Pakistan) survey and adapted to the context of smoking and smokeless tobacco use in India. RESULTS Cigarette consumption declined from a median value of 5.0 (IQR: 2-10) sticks in the pre-lockdown period to 2.0 (IQR: 0.4-5) sticks during the lockdown period. Reductions were reported in the daily use of bidis, from 8 (IQR: 4-12) sticks to 5 (IQR: 2-10) sticks and for smokeless tobacco users from 3.5 (IQR: 2-5) packs to 2 (IQR: 1-4) packs during the lockdown. Furthermore, the number of daily cigarette smokers in our cohort decreased from 32.6% (n=261) in the pre-lockdown period to 27.5% (n=220) during lockdown and smokeless tobacco users decreased from 35.8% (n=287) in pre-lockdown period to 30.3% (n=243) during the lockdown period. CONCLUSIONS The decrease in tobacco use can be attributed to various societal and environmental factors. However, the pandemic-linked lockdown provided an opportune condition to reduce the use of tobacco products, which could be due to restricted access and increase in health awareness during the COVID-19 lockdown.
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Affiliation(s)
- Nitika Sharma
- Health Related Information Dissemination Amongst Youth, New Delhi, India
| | - Mansi Chopra
- Health Related Information Dissemination Amongst Youth, New Delhi, India
| | - Linda Bauld
- Usher Institute, University of Edinburgh, Edinburgh, United Kingdom
- SPECTRUM Consortium, University of Edinburgh, Edinburgh, United Kingdom
| | - Gaurang P. Nazar
- Health Related Information Dissemination Amongst Youth, New Delhi, India
- Public Health Foundation of India, Gurugram, India
| | - Nishigandha Joshi
- Health Related Information Dissemination Amongst Youth, New Delhi, India
| | - Aastha Chugh
- Health Related Information Dissemination Amongst Youth, New Delhi, India
| | - Sailesh Mohan
- Public Health Foundation of India, Gurugram, India
- Centre for Chronic Disease Control, New Delhi, India
| | - Deepa Mohan
- Madras Diabetes Research Foundation, Chennai, India
| | - Mohammed K. Ali
- Rollins School of Public Health, Emory University, Atlanta, United States
- Emory Global Diabetes Research Center, Emory University, Atlanta, United States
| | | | - Nikhil Tandon
- All India Institute of Medical Sciences, New Delhi, India
| | - K. M. Venkat Narayan
- Rollins School of Public Health, Emory University, Atlanta, United States
- Emory Global Diabetes Research Center, Emory University, Atlanta, United States
| | | | | | - Monika Arora
- Health Related Information Dissemination Amongst Youth, New Delhi, India
- Public Health Foundation of India, Gurugram, India
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Shrivastav R, Rawal T, Kataria I, Mehrotra R, Bassi S, Arora M. Accelerating policy response to curb non-communicable diseases: an imperative to mitigate the dual public health crises of non-communicable diseases and COVID-19 in India. THE LANCET REGIONAL HEALTH. SOUTHEAST ASIA 2023; 10:100132. [PMID: 36570060 PMCID: PMC9763206 DOI: 10.1016/j.lansea.2022.100132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Revised: 12/04/2022] [Accepted: 12/09/2022] [Indexed: 12/24/2022]
Abstract
Non-communicable Diseases (NCDs) are a threat to public health and sustainable development. NCDs were equated to being a 'pandemic' before COVID-19 originated. Globally, NCDs caused approximately 74% of deaths (2019). India accounted for nearly 14.5% of these deaths. NCDs and COVID-19 have a lethal bi-directional relationship with both exacerbating each other's impact. Health systems and populations, particularly in Low- and Middle-Income Countries (LMICs) like India have among the highest burden of COVID-19. This narrative review tracks key policy and programmatic developments on NCD prevention and control in India, with a focus on commercially-driven risk factors (tobacco and alcohol use, unhealthy diet, physical inactivity, and air pollution), and the corresponding NCD targets. It identifies lacunae and recommends urgent policy-focussed multi-dimensional action, to ameliorate the dual impact of NCDs and COVID-19. India's comprehensive response to NCDs can steer national, regional and global progress towards time-bound NCD targets and NCD-related Sustainable Development Goals (SDGs). Funding This work is supported by the Commonwealth Foundation. None of the authors were paid to write this article by a pharmaceutical company or other agency. The authors were not precluded from accessing data and accept responsibility to submit for publication.
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Affiliation(s)
- Radhika Shrivastav
- HRIDAY (Health Related Information Dissemination Amongst Youth), New Delhi, India
| | - Tina Rawal
- HRIDAY (Health Related Information Dissemination Amongst Youth), New Delhi, India,Public Health Foundation of India, Gurugram, Haryana, India
| | - Ishu Kataria
- Center for Global Noncommunicable Diseases, RTI International, New Delhi, India
| | - Ravi Mehrotra
- Centre for Health Innovation and Policy (CHIP) Foundation, Noida, Uttar Pradesh, India
| | - Shalini Bassi
- HRIDAY (Health Related Information Dissemination Amongst Youth), New Delhi, India,Public Health Foundation of India, Gurugram, Haryana, India
| | - Monika Arora
- HRIDAY (Health Related Information Dissemination Amongst Youth), New Delhi, India,Public Health Foundation of India, Gurugram, Haryana, India,Corresponing author. HRIDAY, N-25, Second Floor, Green Park Extension, New Delhi, 110016, India
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Siddiqi K, Arora M, Gupta PC. Common assumptions in tobacco control that may not hold true for South-East Asia. THE LANCET REGIONAL HEALTH. SOUTHEAST ASIA 2023; 8:100088. [PMID: 36644450 PMCID: PMC9831008 DOI: 10.1016/j.lansea.2022.100088] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Tobacco is a threat to public health in South-East Asia and its control should be a priority. However, many common assumptions about tobacco control may not hold true for the region and can misdirect policy. The substantial health risks associated with smokeless tobacco have been largely misunderstood and neglected. The syndemic association between tuberculosis and tobacco has also been overlooked. Similarly, less attention has been paid to address second-hand smoke exposure of pregnant women to indoor smoking (caused predominantly by men). On the other hand, our poor understanding of the diverse tobacco supply chain has been blocking progress in tobacco control. Finally, the rising popularity of electronic cigarettes has thrown new challenges; many governments, concerned for its youth, have banned such products. We argue for a nuanced approach to tobacco control in South-East Asia. We also encourage a wider debate in public health, where other established assumptions may be hampering progress.
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Affiliation(s)
- Kamran Siddiqi
- Department of Health Sciences, University of York and Hull York Medical School, Seebohm Rowntree building, University of York, York YO10 5DD, United Kingdom
| | - Monika Arora
- HRIDAY, New Delhi, and Public Health Foundation of India, New Delhi, India
| | - Prakash C Gupta
- Healis Sekhsaria Institute for Public Health, Thane, Maharashtra, India
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Xing J, Liu J, Han M, Jiang Y, Jiang J, Huang H. Bibliometric analysis of traditional Chinese medicine for
smoking cessation. Tob Induc Dis 2022; 20:97. [DOI: 10.18332/tid/154961] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2022] [Revised: 08/11/2022] [Accepted: 09/27/2022] [Indexed: 11/11/2022] Open
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