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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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Food insecurity in Dutch disadvantaged neighbourhoods: a socio-ecological approach. J Nutr Sci 2022; 11:e52. [PMID: 35836698 PMCID: PMC9257769 DOI: 10.1017/jns.2022.48] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Revised: 05/27/2022] [Accepted: 05/31/2022] [Indexed: 11/06/2022] Open
Abstract
Food insecurity is an important public health concern; however, research into this phenomenon within the Netherlands is limited. Food insecurity is not solely related to individual factors, but can also be influenced by various factors in the social and physical environment. Therefore, this study aimed to identify determinants of food insecurity within the personal, social and physical environment, based on the social ecological model (SEM), and to identify their relative importance for experiencing food insecurity. The study population consisted of 307 participants living in disadvantaged neighbourhoods of the Dutch city The Hague, of which approximately one-quarter were food insecure. Participant characteristics showing bivariate associations P < 0⋅20 were placed in a predetermined level of the SEM, after which a multivariate logistic regression was performed for each level and the Nagelkerke pseudo R 2 was presented. Determinants of food insecurity were BMI, gross monthly income, highest educational attainment, smoking status, diet quality, employment status, marital status and religion (P < 0⋅05). The results showed that 29⋅7 % of the total variance in food insecurity status was explained by all included determinants together. The personal, social and physical environment explained 20⋅6, 14⋅0 and 2⋅4 % of the total variance, respectively. Our findings suggest that determinants within the personal environment are most important for explaining differences in experienced food insecurity. The present study contributes to furthering the knowledge about the relative importance of the personal, social and physical environment, indicating that determinants within the personal environment may be most promising for developing targeted interventions to reduce food insecurity.
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Key Words
- BMI, body mass index
- DHC, Dutch Health Council
- Determinants
- Explained variance
- FFQ, food frequency questionnaire
- FI, food insecure
- FS, food secure
- Food insecurity
- Food security
- IQR, interquartile range
- ISCED, International Standard Classification of Education
- LUMC, Leiden University Medical Center
- MAR, missing at random
- MCS, mental component summary
- MI, multiple imputation
- NNC, Netherlands Nutrition Center
- PCS, physical component summary
- SEM, social ecological model
- SEP, socio-economic position
- SF-12, 12-Item Short Form Health Survey
- SNAP, Supplement Nutrition and Assistance Program
- Social ecological model
- USDA, United States Department of Agriculture
- WMO, ‘Wet medisch-wetenschappelijk onderzoek’, in English: Medical Research Involving Human Subjects Act
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Teah GE, Conner TS. Psychological and Demographic Predictors of Vaping and Vaping Susceptibility in Young Adults. Front Psychol 2021; 12:659206. [PMID: 34484026 PMCID: PMC8415821 DOI: 10.3389/fpsyg.2021.659206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Accepted: 07/19/2021] [Indexed: 11/13/2022] Open
Abstract
Background The use of electronic nicotine delivery systems (ENDS), also known as vaping, is becoming popular among young adults. Few studies have explored the psychological factors that predict ENDS use and susceptibility in young adults, in addition to known demographic predictors. Method In a cross-sectional survey design, 521 young adults (37% male), ages 18-25 from the United States, were recruited via Amazon's Mechanical Turk (MTurk) in 2019, to answer an online survey measuring demographic characteristics and psychological characteristics related to mental health and the Big Five personality traits. The survey also included measures of ENDS ever-use, current use, and susceptibility (never users open to trying ENDS), which we predicted from the demographic and psychological measures using independent and multiple binary logistic regression analyses. Results Of those surveyed (n = 521), 282 (54.1%) were ENDS ever-users, 93 (17.9%) were current ENDS users, and 61 (11.7%) were ENDS susceptible; 62 (11.9%) were current smokers. Demographically, young adults lower in adulthood socioeconomic-status (SES), not pursuing education further than high school, and current smokers were more likely to be ENDS users. Psychologically, young adults higher in anxiety and lower in conscientiousness more likely to have ever-used ENDS. Lower conscientiousness further predicted current ENDS use and ENDS susceptibility. Conclusion In this sample of MTurk workers, young adults with experience in vaping were more demographically and psychologically vulnerable than young adults with no experience in vaping. Young adults interested in vaping, but without prior experience, were less conscientious than their non-interested peers. Interventions to target vaping use should focus on economically disadvantaged young adults and those lower in conscientiousness.
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Affiliation(s)
- Grace E Teah
- Department of Psychology, University of Otago, Dunedin, New Zealand
| | - Tamlin S Conner
- Department of Psychology, University of Otago, Dunedin, New Zealand
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Langlois S, Zern A, Anderson S, Ashekun O, Ellis S, Graves J, Compton MT. Subjective social status, objective social status, and substance use among individuals with serious mental illnesses. Psychiatry Res 2020; 293:113352. [PMID: 32795772 PMCID: PMC7669552 DOI: 10.1016/j.psychres.2020.113352] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Revised: 07/28/2020] [Accepted: 08/01/2020] [Indexed: 10/23/2022]
Abstract
Subjective social status (SSS) and objective socioeconomic status (OSS) may appear to be similar social determinants of mental health, but are actually independently associated with diverse health outcomes including substance use and substance use disorders (SUDs). Such associations have not been examined among individuals with serious mental illnesses (SMI) despite their high prevalence of comorbid substance use; frequent treatment and recovery complications associated with such use; and high levels of economic disadvantage, discrimination, and inequities in this marginalized population. These psychosocial adversities manifest as poor mental illness outcomes, poor physical health, and early mortality in populations with SMI. We hypothesized that both SSS and OSS would predict substance use severity and SUD diagnoses in 240 patients with SMI. SSS, measured by the MacArthur Scale of Subjective Social Status, was unassociated with a composite measure of income and education used to operationalize OSS. Additionally, SSS and OSS were differentially associated with various types of substance use disorders. Only OSS was associated with whether individuals smoked cigarettes, or the level of nicotine dependence. Conversely, only SSS was associated with drug use severity. Our results shed light on the potential for differential impacts of SSS and OSS among persons with SMI.
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Affiliation(s)
| | - Adria Zern
- Columbia University Vagelos College of Physicians and Surgeons, Department of Psychiatry, New York, NY, USA
| | | | | | | | | | - Michael T. Compton
- Columbia University Vagelos College of Physicians and Surgeons, Department of Psychiatry, New York, NY, USA,Corresponding Author: Michael T. Compton, M.D., M.P.H. Columbia University Vagelos College of Physicians and Surgeons, Department of Psychiatry, 722 W. 168th Street, Room R249, New York, NY 10032.
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Vyas P, Tsoh JY, Gildengorin G, Stewart SL, Yu E, Guan A, Pham A, Burke NJ, McPhee SJ. Disentangling individual and neighborhood differences in the intention to quit smoking in Asian American male smokers. Prev Med Rep 2020; 18:101064. [PMID: 32226728 PMCID: PMC7093831 DOI: 10.1016/j.pmedr.2020.101064] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2019] [Revised: 01/29/2020] [Accepted: 02/08/2020] [Indexed: 11/22/2022] Open
Abstract
Numerous studies have assessed individual-level factors associated with intention to quit smoking. However, fewer studies have assessed how neighborhood and built environment also contribute towards individual-level behavior. We used baseline data of 340 Chinese and Vietnamese male daily smokers from August 2015 to November 2017 living in the San Francisco Bay Area, who enrolled in a lifestyle intervention trial. The outcome variable was intention to quit in 30 days. To understand the role of contextual factors participants' residential addresses were geocoded, and neighborhood median income, ethnic composition, and tobacco retail density were computed. Individual level analysis suggested that Vietnamese American men had greater intention to quit smoking (OR = 2.90 CI = 1.59, 5.26) in comparison to Chinese Americans. However, after adding neighborhood level factors to the model, no ethnic group difference was observed. Neighborhood household median income (OR = 0.74, CI = 0.64, 0.86) and tobacco retail counts (OR = 0.79, CI = 0.67, 0.94) were negatively associated with intention to quit. Years lived in the U.S. was the only individual level factor associated with intention to quit. By comparing two Asian American groups that live in heterogeneous neighborhoods, we identify key environmental and policy drivers that are associated with quit intention. Future studies aimed at influencing individual-level behavior should take into consideration the neighborhood context and built environment characteristics.
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Affiliation(s)
- Priyanka Vyas
- Center for Tobacco Control Research and Education, University of California, San Francisco, United States
| | - Janice Y. Tsoh
- Center for Tobacco Control Research and Education, University of California, San Francisco, United States
- Department of Psychiatry, University of California, San Francisco, CA, United States
| | - Ginny Gildengorin
- Division of General Internal Medicine, University of California, San Francisco, United States
| | - Susan L. Stewart
- Department of Public Health Sciences, University of California, Davis, United States
| | - Edgar Yu
- Department of Psychiatry, University of California, San Francisco, CA, United States
| | - Alice Guan
- Department of Psychiatry, University of California, San Francisco, CA, United States
| | - Amber Pham
- DePaul University, Chicago, United States
| | | | - Steven J. McPhee
- Division of General Internal Medicine, University of California, San Francisco, United States
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6
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Heris CL, Chamberlain C, Gubhaju L, Thomas DP, Eades SJ. Factors Influencing Smoking Among Indigenous Adolescents Aged 10–24 Years Living in Australia, New Zealand, Canada, and the United States: A Systematic Review. Nicotine Tob Res 2019; 22:1946-1956. [DOI: 10.1093/ntr/ntz219] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2019] [Accepted: 11/26/2019] [Indexed: 11/13/2022]
Abstract
AbstractIntroductionSmoking rates are higher among Indigenous populations in most high-income countries with initiation primarily occurring in adolescence for all population groups. This review aims to identify protective and risk factors for smoking behavior among Indigenous adolescents and young adults.Aims and MethodsWe searched Medline, Embase, and Psychinfo for all original research published between January 2006 and December 2016 that reported influences on smoking for Indigenous adolescents or young adults aged 10–24 living in Australia, New Zealand, Canada, and the United States (US). Extracted data were coded to individual, social, and environmental level categories using a modified Theory of Triadic Influence framework.ResultsA total of 55 studies were included, 41 were descriptive quantitative and 14 qualitative, and 26 included Indigenous participants only. The majority were from the US (32). Frequently reported influences were at the individual and social levels such as increasing age; attitudes and knowledge; substance use; peer and family relationships; smoking norms; mental health; physical activity. At the environmental level, smoke-free spaces; second-hand smoke exposure; high community level prevalence; and social marketing campaigns were also frequently reported. Some studies referenced price, access, and traditional tobacco use. Few reported historical and cultural factors.ConclusionsYoung Indigenous people experience similar influences to other populations such as smoking among family and friends. Greater youth smoking is related to broader community level prevalence, but few studies explore the distal or historical contributing factors such as traditional tobacco use, colonization, experiences of intergenerational trauma and discrimination, or the role of cultural connection.ImplicationsThis review identified a range of factors that influence Indigenous youth smoking and contributes to an understanding of what prevention measures may be effective. Youth tobacco use occurs alongside other substance use and may also serve as an indicator of mental health. Comprehensive community-based programs that work more broadly to address the risk factors related to tobacco, including improving youth mental health, will be important for other behaviors as well. This research highlights the importance of social influence and need for ongoing denormalization of smoking. Future Indigenous led and community owned research is needed to identify likely protective cultural factors.
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Affiliation(s)
- Christina L Heris
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
| | | | - Lina Gubhaju
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
| | - David P Thomas
- Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia
| | - Sandra J Eades
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
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Lee PN, Fry JS, Thornton AJ. Updating the evidence relating smoking bans to incidence of heart disease. Regul Toxicol Pharmacol 2018; 101:172-186. [PMID: 30500390 DOI: 10.1016/j.yrtph.2018.11.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2018] [Revised: 10/25/2018] [Accepted: 11/26/2018] [Indexed: 11/18/2022]
Abstract
In our latest update of the evidence on smoking bans and heart disease we summarize 59 studies. We take account of the underlying trends in incidence rates as far as possible by using control data in eight studies, and by adjustment based on observed trends in cases pre- and post-ban in 40 studies, being unable to make an adjustment in the remaining 11 studies. Overall, based on 62 independent estimates from the 59 studies, we estimate that bans reduce incidence by 5.0% (95% CI 3.2-6.8%), though this estimate reduces to 2.9% (0.01-5.6%) when we exclude regional estimates where national estimates are available, and studies where trend adjustment is not possible. For 25 of the studies, quadratic rather than linear adjustment is possible, but this hardly affects the overall estimates. Ban effects are somewhat greater when the pre-ban period studied is relatively short, and in smaller studies. We compare our findings with those in other recent reviews, one of which totally ignored underlying trends and results from control populations. We discuss reasons why we believe there is likely to be a true small effect of smoking bans, and weaknesses in the data which preclude reaching any very confident conclusion.
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Affiliation(s)
- Peter N Lee
- P.N. Lee Statistics and Computing Ltd, 17 Cedar Road, Sutton, Surrey, SM2 5DA, UK.
| | - John S Fry
- ROELEE Statistics Ltd, 17 Cedar Road, Sutton, Surrey, SM2 5DA, UK
| | - Alison J Thornton
- Independent Consultant, Oak Cottage, Beer Farm, Okehampton, Devon, EX20 1SG, UK
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Lowrie C, Pearson AL, Thomson G. Inequities in coverage of smokefree outdoor space policies within the United States: school grounds and playgrounds. BMC Public Health 2018; 18:736. [PMID: 29902978 PMCID: PMC6003182 DOI: 10.1186/s12889-018-5602-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2017] [Accepted: 05/24/2018] [Indexed: 11/18/2022] Open
Abstract
Background Previous studies have found extensive geographic and demographic differences in tobacco use. These differences have been found to be reduced by effective public policies, including banning smoking in public spaces. Smokefree outdoor spaces reduce secondhand smoke exposure and de-normalize smoking. Methods After previously publishing a study of smokefree indoor and outdoor space policies, it was brought to the authors’ attention that the dataset used in analyses was incomplete (Lowrie et al., BMC Public Health 17:456, 2017). The current manuscript is a corrected version. Here, we include analyses for outdoor space policies. We evaluated regional and demographic differences in the proportion of the population (both adult and child) covered by smokefree outdoor space policies for school grounds and playgrounds enacted in the United States prior to 2014. Results Children had a low level of protection in playgrounds and schools (8% covered nationwide in both settings). Significant differences in coverage were found by ethnicity, region, income, and education (p < 0.001). The odds of having a smokefree playgrounds policy was lower for jurisdictions with higher proportions of poor households, households with no high school diploma, whites and the Alaska/Hawaii region. Increased ethnic heterogeneity was found to be a significant predictor of increased odds of having a smokefree playgrounds policy, meaning that diversity is protective, with differential effect by region (p < 0.001) – which may relate to urbanicity. Conclusions Disparities in smokefree outdoor space policies have potential to exacerbate existing health inequities. A national increase in smokefree outdoor space policies to protect children in playgrounds and schools is a crucial intervention to reduce such inequities.
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Affiliation(s)
- Christopher Lowrie
- Department of Geography, Environment, and Spatial Sciences, Michigan State University, 673 Auditorium Road, East Lansing, MI, 48824, USA
| | - Amber L Pearson
- Department of Geography, Environment, and Spatial Sciences, Michigan State University, 673 Auditorium Road, East Lansing, MI, 48824, USA. .,Department of Public Health, University of Otago, Wellington, 6021, New Zealand. .,Environmental Science and Policy Program, Michigan State University, East Lansing, MI, 48824, USA.
| | - George Thomson
- Department of Public Health, University of Otago, Wellington, 6021, New Zealand
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Kandasamy S, Anand SS. Cardiovascular Disease Among Women From Vulnerable Populations: A Review. Can J Cardiol 2018; 34:450-457. [PMID: 29571426 DOI: 10.1016/j.cjca.2018.01.017] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2017] [Revised: 01/11/2018] [Accepted: 01/16/2018] [Indexed: 12/14/2022] Open
Abstract
On a global scale, cardiovascular disease (CVD) is the leading cause of mortality. It is also the number 1 cause of death among women, resulting in 8.6 million deaths annually and constituting one third of all deaths in women worldwide. The burden of CVD and related risk factors has taken priority in the policy development for noncommunicable diseases. However, vulnerable populations, defined here as women who are socially or economically disadvantaged (eg, low income), nonwhite (specifically South Asian and indigenous women), and those who are elderly have often been overlooked in these discussions. These additional vulnerabilities, which may exist independently or in combination, place such women at higher risk for CVD. Specifically, these vulnerabilities include low socioeconomic status, a low sense of control, high stress, South Asian or indigenous ancestry, and increased age. Thus it is vital that we initiate a multipronged approach to CVD prevention that includes rigorous monitoring of CVD risk factors in high-risk populations and the implementation of timely, accurate, and contextually tailored prevention programs, services, and treatments. Well-trained nonphysician health care workers can support the accurate monitoring and management of CVD and CVD risk factors so that groups of women who may otherwise be overlooked can receive adequate attention.
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Affiliation(s)
- Sujane Kandasamy
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Sonia S Anand
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada; Department of Medicine, McMaster University, Hamilton, Ontario, Canada; Population Health Research Institute, Hamilton Health Sciences, McMaster University, Hamilton, Ontario, Canada.
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Lowrie C, Pearson AL, Thomson G. Inequities in coverage of smokefree space policies within the United States. BMC Public Health 2017; 17:456. [PMID: 28511682 PMCID: PMC5434634 DOI: 10.1186/s12889-017-4385-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2016] [Accepted: 05/07/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Previous studies have found extensive geographic and demographic differences in tobacco use. These differences have been found to be reduced by effective public policies, including banning smoking in public spaces. Smokefree indoor and outdoor spaces reduce secondhand smoke exposure and denormalize smoking. METHODS We evaluated regional and demographic differences in the proportion of the population covered by smokefree policies enacted in the United States prior to 2014, for both adults and children. RESULTS Significant differences in coverage were found by ethnicity, region, income, and education (p < 0.001). Smokefree policy coverage was lower for jurisdictions with higher proportions of poor households, households with no high school diploma and the Southeast region. Increased ethnic heterogeneity was found to be a significant predictor of coverage in indoor "public spaces generally", meaning that diversity is protective, with differential effect by region (p = 0.004) - which may relate to urbanicity. Children had a low level of protection in playgrounds and schools (~10% covered nationwide) - these spaces were found to be covered at lower rates than indoor spaces. CONCLUSIONS Disparities in smokefree space policies have potential to exacerbate existing health inequities. A national increase in smokefree policies to protect children in playgrounds and schools is a crucial intervention to reduce such inequities.
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Affiliation(s)
- Christopher Lowrie
- Department of Geography, Environment, and Spatial Sciences, Michigan State University, East Lansing, MI, 48824, USA
| | - Amber L Pearson
- Department of Geography, Environment, and Spatial Sciences, Michigan State University, East Lansing, MI, 48824, USA. .,Department of Public Health, University of Otago, Wellington, 6021, New Zealand. .,Environmental Science and Policy Program, Michigan State University, East Lansing, MI, 48824, USA.
| | - George Thomson
- Department of Public Health, University of Otago, Wellington, 6021, New Zealand
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11
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Sherratt FC, Field JK, Marcus MW. Association between smoking and health outcomes in an economically deprived population: the Liverpool Lung Project. J Epidemiol Community Health 2017; 71:806-810. [PMID: 28416569 DOI: 10.1136/jech-2016-208730] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2016] [Revised: 03/24/2017] [Accepted: 04/02/2017] [Indexed: 01/11/2023]
Abstract
BACKGROUND The association between smoking and several health outcomes among those from the most deprived communities in the UK has not previously been detailed. The aim of this study is to examine the impact of smoking on health outcomes specifically among a particularly deprived population in a developed country (Liverpool; one of the most deprived local authorities in England). METHODS The Liverpool Lung Project recruited a prospective cohort of 8753 participants from across Liverpool, aged 45-79 years between 1998 and 2008. Participants were followed annually through the Hospital Episode Statistics until 31 January 2013. Logistic regression models were used to identify health outcomes of smoking. RESULTS From our study population, 5195 were smokers and 3558 were non-smokers. Smoking was associated with male gender (OR 1.62, 95% CI 1.48 to 1.77), pneumonia (1.28, 95% CI 1.10 to 1.49), chronic obstructive pulmonary disease (1.30, 95% CI 1.14 to 1.48), emphysema (5.46, 95% CI 3.48 to 8.55), bronchitis (1.85, 95% CI 1.65 to 2.07), other cancers (1.69, 95% CI 1.44 to 1.99), lung cancer (6.0, 95% CI 3.72 to 9.69), diabetes (1.21, 95% CI 1.02 to 1.43) and cardiovascular disease (1.45, 95% CI 1.25 to 1.67). CONCLUSIONS Smokers from deprived backgrounds in Liverpool showed increased risk of developing pneumonia, emphysema, chronic obstructive pulmonary disease, bronchitis, lung cancer, other types of cancer, cardiovascular disease and diabetes. These findings are in line with the literature and may help to inform public health policies and ultimately work towards addressing smoking-related health inequalities.
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Affiliation(s)
- F C Sherratt
- Department of Psychological Sciences, University of Liverpool, Liverpool, UK
| | - J K Field
- Roy Castle Lung Cancer Research Programme, Department of Molecular and Clinical Cancer Medicine, University of Liverpool, Liverpool, UK
| | - M W Marcus
- Roy Castle Lung Cancer Research Programme, Department of Molecular and Clinical Cancer Medicine, University of Liverpool, Liverpool, UK
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12
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Yang T, Barnett R, Jiang S, Yu L, Xian H, Ying J, Zheng W. Gender balance and its impact on male and female smoking rates in Chinese cities. Soc Sci Med 2016; 154:9-17. [PMID: 26943009 DOI: 10.1016/j.socscimed.2016.02.035] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2015] [Revised: 01/27/2016] [Accepted: 02/21/2016] [Indexed: 11/19/2022]
Abstract
OBJECTIVE Although gender differences in smoking have received much attention, few studies have explored the importance of contextual effects on male and female smoking rates. The aim of this study is to examine the association between variations in city-level sex ratios and gender differences in smoking in China. METHODS Participants included 16,866 urban residents, who were identified through multi-stage sampling conducted in 21 Chinese cities. RESULTS The study found that, independent of personal characteristics, cities with more males had higher male smoking rates and lower female rates. CONCLUSIONS Our research underscores the importance of city-level contextual effects in understanding gender differences in smoking in China.
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Affiliation(s)
- Tingzhong Yang
- Center for Tobacco Control Research, Zhejiang University School of Medicine, Hangzhou 310058, China.
| | - Ross Barnett
- Department of Geography, University of Canterbury, Christchurch 8140, New Zealand
| | - Shuhan Jiang
- Center for Tobacco Control Research, Zhejiang University School of Medicine, Hangzhou 310058, China
| | - Lingwei Yu
- Center for Tobacco Control Research, Zhejiang University School of Medicine, Hangzhou 310058, China
| | - Hong Xian
- Department of Biostatistics, Saint Louis University, St. Louis, MO 63104-1314, USA
| | - Jun Ying
- Department of Environmental Health, University of Cincinnati, Cincinnati, OH 45221, USA
| | - Weijun Zheng
- Department of Preventive Medicine, Zhejiang Chinese Medical University, Hangzhou 310053, China
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Beyond Smoking Prevalence: Exploring the Variability of Associations between Neighborhood Exposures across Two Nested Spatial Units and Two-Year Smoking Trajectory among Young Adults. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2016; 13:ijerph13010106. [PMID: 26751461 PMCID: PMC4730497 DOI: 10.3390/ijerph13010106] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/19/2015] [Revised: 12/28/2015] [Accepted: 12/28/2015] [Indexed: 01/19/2023]
Abstract
Young adults have the highest prevalence of smoking amongst all age groups. Significant uptake occurs after high school age. Although neighborhood exposures have been found to be associated with smoking behavior, research on neighborhood exposures and the smoking trajectories among young adults, and on the role of geographic scale in shaping findings, is scarce. We examined associations between neighborhood exposures across two nested, increasingly large spatial units and smoking trajectory over two years among young adults living in Montreal, Canada. A sample of 2093 participants aged 18-25 years from the Interdisciplinary Study of Inequalities in Smoking (ISIS) was surveyed. The dependent variable was self-reported smoking trajectory over the course of two years. Residential addresses, data on presence of tobacco retail outlets, and the presence of smoking accommodation facilities were coded and linked to spatial units. Three-level multinomial models were used to examine associations. The likelihood of being a smoker for 2+ years was significantly greater among those living in larger spatial unit neighborhoods that had a greater presence of smoking accommodation. This association was not statistically significant at the smaller spatial units. Our findings highlight the importance of studying young adults' smoking trajectories in addition to static smoking outcomes, and point to the relevance of considering spatial scale in studies of neighborhoods and smoking.
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Knowledge, attitudes, and practices (KAP) of the relationship between air pollution and children's respiratory health in Shanghai, China. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2015; 12:1834-48. [PMID: 25664694 PMCID: PMC4344696 DOI: 10.3390/ijerph120201834] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/23/2014] [Revised: 01/21/2015] [Accepted: 01/30/2015] [Indexed: 12/01/2022]
Abstract
To assess the status of, and factors associated with, residents’ knowledge, attitudes, and practices (KAP) related to air pollution and respiratory health of children in Shanghai, we conducted a cross-sectional survey. Demographic factors associated with residents’ knowledge were identified by multiple logistic regressions. The questionnaires were completed by 972 participants, half from the Shanghai Children Hospital and the other half from the Jiading communities. Half of the participants’ scores of knowledge and attitudes were equal or greater than 8.0 on a 9-point scale, over 75% of respondents’ practice scores were equal to or less than 4.0. Our studies demonstrated a significant difference of average knowledge scores between the two groups (t = 1.27, p < 0.05). The parents’ educational level (OR = 1.89, 2.48) and average annual household income (AAHI) (OR = 2.37, 2.40, 2.12) were the two strongest factors on knowledge awareness. In addition, statistical analysis revealed a significant difference between the two groups in their attitudes towards air quality and their perception of the government’s efforts to alleviate it. The hospital and community groups also showed significant differences in practices geared towards protecting their children’s health. Nearly 90% of the respondents agreed that improving air quality is the responsibility of every citizen, and the joint action of governments and all citizens should be utilized for enhanced control. In addition, more resources should be allocated towards providing citizens with appropriate practices to help lessen the effects of poor air quality.
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Caldwell BO, Adamson SJ, Crane J. Combination rapid-acting nicotine mouth spray and nicotine patch therapy in smoking cessation. Nicotine Tob Res 2014; 16:1356-64. [PMID: 24872027 DOI: 10.1093/ntr/ntu084] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
INTRODUCTION Improved smoking cessation rates are urgently required if New Zealand is to reach its target of a smokefree nation by 2025, during which some 600,000 smokers will need to quit. Nicotine replacement therapy remains a core part of the pharmacological approach to smoking cessation. Oral nicotine solutions with rapid onset have recently become available. We have examined the effect of a nicotine spray and a nicotine patch on smoking cessation for 12 months. METHODS We enrolled potential participants-smokers wanting to quit aged 18-70 years, who smoked ≥9 cigarettes per day-with Fagerström Test of Nicotine Dependence score ≥3 in a double-blind trial in 3 trial sites. Smokers were randomized to a nicotine or placebo spray for 6 months, and all received nicotine patches daily for 5 months. They were followed at regular intervals for 12 months. RESULTS A total of 1,423 subjects were randomized to nicotine oral spray (1mg of nicotine free base per spray) plus nicotine patch or a placebo spray and nicotine patch. The nicotine mouth spray plus nicotine patch showed significant improvements in prolonged abstinence for all measures to 6 months (7 consecutive days at each visit for 6 months: 15.5% vs. 10.6%; p = .006) for the combination versus placebo and nicotine patch. Thereafter, the differences were not significant. CONCLUSIONS The addition of a nicotine mouth spray to a nicotine replacement patch in a population of smokers receiving a low level of behavioral support improved early quitting, but the effects were not sustained.
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Affiliation(s)
- Brent O Caldwell
- Department of Medicine, University of Otago Wellington, Wellington, New Zealand
| | - Simon J Adamson
- National Addiction Centre, University of Otago Christchurch, Christchurch, New Zealand
| | - Julian Crane
- Department of Medicine, University of Otago Wellington, Wellington, New Zealand;
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Corsi DJ, Boyle MH, Lear SA, Chow CK, Teo KK, Subramanian SV. Trends in smoking in Canada from 1950 to 2011: progression of the tobacco epidemic according to socioeconomic status and geography. Cancer Causes Control 2014; 25:45-57. [PMID: 24158778 DOI: 10.1007/s10552-013-0307-9] [Citation(s) in RCA: 68] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2013] [Accepted: 10/11/2013] [Indexed: 10/26/2022]
Abstract
PURPOSE Smoking has declined in Canada in recent years. However, it is not clear whether differences in current smoking by socioeconomic status have increased, decreased, or remained unchanged in Canada. METHODS We examined rates of current smoking by sex, education, and province from 1950 to 2011. Differences in current smoking, initiation, and cessation were summarized using relative and absolute measures. RESULTS Between 1950 and 2011, the prevalence of current smoking (including daily and non-daily) among adults aged 20 years and older decreased steadily in men from 68.9 % (95 % CI 63.9-73.3) to 18.6 % (14.9-22.1) but in women increased slightly from 38.2 % (32.3-42.2) in 1950 to 39.1 % (36.4-41.2) in 1959 before declining to 15.4 % (11.9-18.9) in 2011. Among men, there was an inverse association between educational attainment and smoking which was consistent from 1950 to 2011. A similar gradient emerged in the mid-1960s in women. Absolute differences in rates of smoking across levels of education increased despite overall declines in smoking across all levels of education. Rates of smoking in women and men were higher in the Atlantic Provinces and Quebec, although in men these differences have declined since the 1990s. In a subset of data from 1999 to 2011, those with lower levels of education had higher levels of smoking initiation and lower levels of cessation. CONCLUSIONS Smoking rates have fallen over time but socioeconomic differences have increased. Smoking prevalence peaked later in lower socioeconomic status (SES) groups, and rates of decline in lower SES groups and certain provinces have been less steep. This suggests that SES gradients emerge rapidly in later stages of the tobacco epidemic and may have increased through greater efficacy of tobacco control policies in reducing smoking among those of higher SES compared to those of lower SES. Tailored approaches may be required to reduce smoking rates in those of lower SES and narrow SES differences.
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Affiliation(s)
- Daniel J Corsi
- Harvard Center for Population and Development Studies, Harvard University, 9 Bow Street, Cambridge, MA, 02138, USA,
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Collins R, Hammond M, Carry CL, Kinnon D, Killulark J, Nevala J. Distance education for tobacco reduction with Inuit frontline health workers. Int J Circumpolar Health 2013; 72:21078. [PMID: 23984270 PMCID: PMC3752291 DOI: 10.3402/ijch.v72i0.21078] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Tobacco reduction is a major priority in Canadian Inuit communities. However, many Inuit frontline health workers lacked the knowledge, confidence and support to address the tobacco epidemic. Given vast distances, high costs of face-to-face training and previous successful pilots using distance education, this method was chosen for a national tobacco reduction course. OBJECTIVE To provide distance education about tobacco reduction to at least 25 frontline health workers from all Inuit regions of Canada. DESIGN Promising practices globally were assessed in a literature survey. The National Inuit Tobacco Task Group guided the project. Participants were selected from across Inuit Nunangat. They chose a focus from a "menu" of 6 course options, completed a pre-test to assess individual learning needs and chose which community project(s) to complete. Course materials were mailed, and trainers provided intensive, individualized support through telephone, fax and e-mail. The course ended with an open-book post-test. Follow-up support continued for several months post-training. RESULTS Of the 30 participants, 27 (90%) completed the course. The mean pre-test score was 72% (range: 38-98%). As the post-test was done using open books, everyone scored 100%, with a mean improvement of 28% (range: 2-62%). CONCLUSIONS Although it was often challenging to contact participants through phone, a distance education approach was very practical in a northern context. Learning is more concrete when it happens in a real-life context. As long as adequate support is provided, we recommend individualized distance education to others working in circumpolar regions.
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Affiliation(s)
- Rob Collins
- Consultancy for Alternative Education, Montreal, Canada.
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Neighbourhood deprivation and outlet density for tobacco, alcohol and fast food: first hints of obesogenic and addictive environments in Germany. Public Health Nutr 2012; 16:1168-77. [PMID: 22781559 DOI: 10.1017/s1368980012003321] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE The current discussion regarding ‘place effects on health’ is increasingly focusing on the characteristics of a specific physical environment. Our study investigated whether socially deprived residential areas are more likely than affluent neighbourhoods to provide access to addictive substances and fast food. DESIGN In this ecological study the total number of tobacco, alcohol and fastfood outlets was recorded and visualized using a geographic information system. Area affluence was measured through the percentage of parents with children of kindergarten or school age with joint annual taxable income ,h12 272. SETTING Eighteen social areas in Cologne, Germany. SUBJECTS All social areas in four districts in Cologne, Germany, with a total of 92 000 inhabitants, were analysed. RESULTS In the investigation area, 339 tobacco, 353 alcohol and sixty-seven fastfood outlets were identified. As area affluence declined the availability of the following potentially health damaging sources increased: cigarettes (Kendall’s tau50?433; P50?012), alcohol (Kendall’s tau50?341, P50?049) and fast food (Kendall’s tau50?473; P50?009). CONCLUSIONS The availability of addictive substances and fast food can be seen to have a contextual influence on an individual’s lifestyle and can, in the form of physical exposure to obesogenic and addictive environments, contribute to a culmination of health risks.
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Semyonov L, Iarocci G, Boccia A, La Torre G. Socioeconomic differences in tobacco smoking in Italy: is there an interaction between variables? ScientificWorldJournal 2012; 2012:286472. [PMID: 22536132 PMCID: PMC3317588 DOI: 10.1100/2012/286472] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2011] [Accepted: 11/21/2011] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVES To assess the influence of sociodemographic factors on smoking habits in Italy and if an interaction exists between these variables. METHODS Data from the national survey "Health Conditions and Healthcare Services Use" in 2005 were used. The independent association between tobacco smoking and sociodemographical variables was assessed using logistic regression analysis. Interactions between variables were investigated calculating the synergism index (SI). RESULTS Sample population consists of 109.829 subjects (over 15 years). 21.9% are current and 21.8% are former smokers. Current smokers are mostly 45-54-years old males, from Central Italy, unemployed, divorced or separated but having a good health status without chronic medical conditions. Ever smokers are mostly 45-54 years old males, from Northeast Italy, unemployed, with chronic conditions. People with a university degree and with a good household income have the lowest OR for both conditions. A synergistic effect was found between marital status and educational level (for ever smokers SI = 1.96; for current smokers SI = 1.67). CONCLUSIONS Smoking is prevalent in lower socioeconomic groups and there is the strong need to increase social, economic and cultural capital in order to reduce it.
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Affiliation(s)
- Leda Semyonov
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Viale Regina Elena 324, 00181 Rome, Italy
| | - Gianluca Iarocci
- Istituto Superiore per la Protezione e la Ricerca Ambientale (ISPRA), 00144 Rome, Italy
| | - Antonio Boccia
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Viale Regina Elena 324, 00181 Rome, Italy
| | - Giuseppe La Torre
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Viale Regina Elena 324, 00181 Rome, Italy
- Eleonora Lorillard Spencer Cenci Foundation Rome, Italy
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Affiliation(s)
- Rosemary Hiscock
- Tobacco Control Research Group, Department of Health, University of Bath, Bath, United Kingdom.
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Smith DM, Pearce JR, Harland K. Can a deterministic spatial microsimulation model provide reliable small-area estimates of health behaviours? An example of smoking prevalence in New Zealand. Health Place 2011; 17:618-24. [DOI: 10.1016/j.healthplace.2011.01.001] [Citation(s) in RCA: 55] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2010] [Revised: 11/05/2010] [Accepted: 01/05/2011] [Indexed: 11/26/2022]
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O'Reilly D, Rosato M, Catney G, Johnston F, Brolly M. Cohort description: the Northern Ireland Longitudinal Study (NILS). Int J Epidemiol 2011; 41:634-41. [PMID: 21296852 DOI: 10.1093/ije/dyq271] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Dermot O'Reilly
- Centre for Public Health, Queen's University Belfast, Belfast, Northern Ireland.
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Socio-demographic factors and processes associated with stages of change for smoking cessation in pregnant versus non-pregnant women. BMC WOMENS HEALTH 2011; 11:3. [PMID: 21261957 PMCID: PMC3037321 DOI: 10.1186/1472-6874-11-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/14/2010] [Accepted: 01/24/2011] [Indexed: 12/04/2022]
Abstract
Background The tobacco control community assumes that the most effective interventions are personalized. Nevertheless, little attention is paid to understanding differences between pregnant and non-pregnant European women in terms of the social factors that influence tobacco use and the processes of change used to quit smoking. Methods The study consecutively enrolled 177 pregnant women who acknowledged smoking the year before pregnancy and 177 non-pregnant women who acknowledged smoking the year before their clinic visit for a Pap test. Results With respect to socio-demographic factors, the stages of change in pregnant women were associated with level of education, marital status, and the presence of roommates, partners and friends who smoke. In pregnant women, there was no statistically significant difference in the processes used to stop smoking among the stages of change. Furthermore, behavioral processes were higher in non-pregnant women than in pregnant women, and the difference was statistically significant in the advanced stages of behavioral change. Both pregnant and non-pregnant women showed higher levels of acceptance towards smoking in the earlier stages of change, but the acceptability of smoking in the pre-contemplative stage was higher in non-pregnant women. Greater craving was detected in non-pregnant vs. pregnant women at all stages and reached a statistically significant level at the pre-contemplative stage. Conclusion Pregnancy is a favorable time to stop smoking since pregnant women are more likely to be in an advanced stage of behavioral change. Pregnant and non-pregnant women are distinct populations in the types and processes of change involved in smoking cessation. The intervention programs to promote smoking cessation and prevent relapses will need to take these differences into account.
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