Prevalence and determinants of smoking in Tirana city, Albania: a population-based survey

Clinical Profile and Management of Patients with Incident and Recurrent Acute Myocardial Infarction in Albania - a Call for More Focus on Prevention Strategies

Background

The clinical profile of acute myocardial infarction (AMI) patients reflects the burden of risk factors in the general population. Differences between incident (first) and recurrent (repeated) events and their impact on treatment are poorly described. We studied potential differences in the clinical profile and in-hospital treatment between patients hospitalised with an incident and recurrent AMI.

Methods

A total of 324 patients admitted in the Coronary Care Unit of ‘Mother Teresa’ hospital, Tirana, Albania (2013-2014), were included in the study. Information on AMI type, complications and risk factors was obtained from patient’s medical file.

Logistic regression analyses were used to explore differences between the incident and recurrent AMIs regarding clinical profile and in-hospital treatment.

Results

Of all patients, 50 (15.4%) had a prior AMI. Compared to incident cases, recurrent cases were older (P=0.01), more often women (P=0.01), less educated (P=0.01), and smoked less (P=0.03). Recurrent cases experienced more often heart failure (HF) (OR=2.48; 95% CI: 1.31–4.70), impaired left ventricular ejection fraction (OR=1.97; 95% CI:1.05–3.71), and multivessel disease (OR=6.32; 95% CI: 1.43–28.03) than incident cases. In-hospital use of beta-blockers was less frequent among recurrent compared to incident cases (OR=0.45; 95% CI: 0.24–0.85), while no statistically significant differences between groups were observed regarding angiotensin-converting enzyme inhibitor/angiotensin receptor blocker, statin, aspirin or invasive procedures.

Conclusion

A more severe clinical expression of the disease and underutilisation of treatment among recurrent AMIs are likely to explain their poorer prognosis compared to incident AMIs.

Smoking Behaviors in Kosova: Results of Steps Survey

Introduction

Tobacco use continues to be the leading global cause of preventable death. Most of these deaths occur in low and middle-income countries, and this trend is expected to widen further over the next several decades. The overall objective of the study is to describe and analyse the smoking behaviours of adults in Kosova.

Methods

According to the STEPs methodology, 6,400 respondents, aged 15 - 64 years, are selected randomly within each sex and 10-year age-group. Out of 6,400 participants, 6,117 were selected, which is approximately 95.6%.

Results

The prevalence of smoking was higher among males (37.4%) compared with females (19.7%). In all age groups, the prevalence of smoking was higher among males compared with females. Regarding the age group of 15 - 24 years, the prevalence of smoking was 16.0%, but in the age group of 25 - 34 years, it nearly doubled to the rate of 31.9%. We have a smaller increase in the age group of 35 - 44 years, and after the age of 45, it falls gradually.

Conclusions

The prevalence of smoking in Kosova is high compared with other countries in Eastern Europe. In future decades, Kosova will face a high probability of an increased burden of smoking-related diseases.

Demographic and social correlates of tobacco, alcohol and cannabis use among 15-16-year-old students in Albania: Results of the ESPAD survey

Aims

Our aim was to assess the demographic and social factors associated with lifetime use of tobacco, alcohol and cannabis among school students aged 15-16 in Albania in order to make information and knowledge available for health promotion specialists working on substance use prevention.

Design

This cross-sectional study was conducted in March-May 2011 in the framework of the European School Survey Project on Alcohol and Other Drugs (ESPAD). In total, 3189 students born in 1995 participated in the survey. The standardised ESPAD questionnaire was used to collect data about substance use.

Results

Our multivariable adjustment analysis showed that being a male and having easy access to cigarettes were the only universal factors significantly increasing the likelihood of ever using tobacco, alcohol or cannabis. Own smoking was strongly and significantly associated with alcohol and cannabis use. The associations of own substance use with peer substance consumption were weak to moderate.

Conclusions

Own smoking seems to be the most important single independent risk factor which strongly and significantly predicted alcohol and cannabis use among Albanian school students. Policy makers need to strengthen the rule of law whereas health promotion professionals should firmly address smoking in adolescence through target interventions.

Focus points in prevention actions against legal substances' abuse

AIM

To determine the factors associated with alcohol and tobacco abuse in Slovenian general population.

MATERIAL AND METHODS

We performed an observational cross-sectional study in a representative sample of 1002 Slovenian inhabitants in June 2011. It was performed using a method of computer-assisted telephone interview. The telephone interview consisted of questions about the prevalence and duration of preselected health-related symptoms in the past month, questions about the presence of chronic diseases, question about the presence of current smoking, EQ-5D questionnaire and AUDIT-C questionnaire.

RESULTS

Risky drinking was found in 103 (14.3 %) of the sample and smoking was found in 226 (22.6 %) of the sample. Men reported risky drinking more often when compared with women (17.7 vs. 10.5 %, P = 0.007). Multivariate analysis showed that male sex, current tobacco smoking, lower education level, self-reported presence of anxiety/depression and self-reported presence of muscle pain and excessive fatigue in the past month were independently associated with risky drinking and that male sex, lower education and income, the presence of chronic disease, self-reported problems in daily activities, risky drinking, self-reported troubles in sleeping and restless leg syndrome were independently associated with current tobacco smoking.

CONCLUSION

Risky alcohol drinking and smoking are still major public health problems in Slovenia and are associated with known demographic risk factors but also with some symptoms of somatoform disorders. These findings should be incorporated into the guidelines for family physicians as the important focus points for screening and intervening against legal substances' abuse in their patients.

Reduction of ST-elevation myocardial infarction in Canton Ticino (Switzerland) after smoking bans in enclosed public places--No Smoke Pub Study

BACKGROUND

Second-hand smoke increases the risk of acute myocardial infarction. Canton Ticino (CT) first introduced a smoking ban in public places in 2007. This offered the opportunity to assess the long-term impact of a smoking ban on the incidence of ST-elevation myocardial infarctions (STEMI) compared with a population where the law was not yet implemented.

METHODS

We assessed the incidence of STEMI hospitalizations per 100 000 inhabitants both during 3 years before and after the ban application in CT and in Canton Basel City (CBC), where this law was not yet applied. Data were obtained from the codified hospital registry (ICD-10 codes).

RESULTS

In CT, the mean incidence of STEMI admissions during the 3 pre-ban years (123.7) was significantly higher than the incidence of admissions in each of the 3 post-ban years (92.9, 101.6 and 89.6 respectively; P <.024). Analysing population subsets, a post-ban reduction was observed among ≥65-year-old people of both sexes in each of the 3 post-ban years and in the <65-year age group during the first post-ban year (P = 0.02). Conversely, the mean incidence of STEMI hospitalizations in CBC (92.4) didn't change significantly in each of the 3 post-ban years (83.9, 83.3 and 79.5, P = NS) during the same period. However, a significant long-term reduction in STEMI admissions was observed in CBC among the male group with ≥65 years (P < 0.01).

CONCLUSION

Our work suggests a significant impact of the smoke-free policy on the number of annual STEMI. Specific population subsets (i.e. ≥65-year-old females) were particularly affected by the smoking ban, showing a significant reduction in STEMI hospitalizations.

Epidemiology of smoking among Malaysian adult males: prevalence and associated factors

BACKGROUND

Three National Health and Morbidity Surveys (NHMSs) had been conducted in Malaysia in 10-year intervals from 1986-2006. Based on the latest NHMS survey in 2006, we describe the prevalence of smoking and identify the social and demographic factors associated with smoking among adult males in Malaysia.

METHODS

A cross-sectional study among 15,639 Malaysian adult males aged 18 years and above was conducted using proportional to size stratified sampling method. The socio-demographic variables examined were level of education, occupation, marital status, residential area, age group and monthly household income.

RESULTS

The prevalence of smoking among adult males in Malaysia was 46.5% (95% CI: 45.5-47.4%), which was 3% lower than a decade ago. Mean age of smoking initiation was 18.3 years, and mean number of cigarettes smoked daily was 11.3. Prevalence of smoking was highest among the Malays (55.9%) and those aged 21-30 years (59.3%). Smoking was significantly associated with level of education (no education OR 2.09 95% CI (1.67-2.60), primary school OR 1.95, 95% CI (1.65-2.30), secondary school OR 1.88, 95% CI (1.63-2.11), with tertiary education as the reference group). Marital status (divorce OR 1.67, 95% CI (1.22-2.28), with married as the reference group), ethnicity (Malay, OR 2.29, 95% CI ( 1.98-2.66; Chinese OR 1.23 95% CI (1.05-1.91), Other Bumis OR 1.75, 95% CI (1.46-2.10, others OR 1.48 95% CI (1.15-1.91), with Indian as the reference group), age group (18-20 years OR 2.36, 95% CI (1.90-2.94); 20-29 years OR 3.31 , 95% CI 2.82-3.89; 31-40 years OR 2.85 , 95% CI ( 2.47-3.28); 41-50 years OR 1.93, 95% CI (1.69-2.20) ; 51-60 years OR 1.32, 95% CI (1.15-1.51), with 60 year-old and above as the reference group) and residential area (rural OR 1.12 , 95% CI ( 1.03-1.22)) urban as reference.

CONCLUSION

The prevalence of smoking among Malaysian males remained high in spite of several population interventions over the past decade. Tobacco will likely remain a primary cause of premature mortality and morbidity in Malaysia. Continuous and more comprehensive anti-smoking policy measures are needed in order to further prevent the increasing prevalence of smoking among Malaysian men, particularly those who are younger, of Malay ethnicity, less educated, reside in rural residential area and with lower socio-economic status.

Tobacco use among the elderly: a systematic review and meta-analysis

The aim of this study was to combine the results of identified surveys on the prevalence of tobacco use in old age to estimate world prevalence of tobacco use and possible factors related to such behavior among the elderly. The literature search included electronic databases such as MEDLINE, LILACS, and Biological Abstracts, hand-searching of specialist journals and cited reference searches. The combined global prevalence was estimated using the random effects model. The total number of elderly subjects included in all surveys was 140,058, with data available from all the continents. Overall prevalence of tobacco use was 13% in both genders (22% male and 8% female). The prevalence rates were heterogeneous among surveys and were associated with smoking definition, questionnaire application, and country economic status. Few epidemiological studies assessed tobacco use among the elderly. A higher prevalence rate of tobacco use in males who live in higher income countries could be found, although additional evidence regarding elderly samples is still required.

The impact of tobacco control policies in Albania

Objective

To assess the impact of a tobacco control law adopted in Albania in 2007 and to estimate the share of illicit cigarettes on the market.

Design

Comparative analysis of two waves of a nationally representative household survey, one conducted before the new law went into effect and the other after 2 years. Official sales data were contrasted with the consumption estimate based on the survey.

Main outcome measures

Smoking prevalence, quit attempts, exposure to cigarette advertising, exposure to second-hand smoke, total cigarette consumption, share of illicit packs among packs possessed by smokers.

Results

Despite the adoption of strong smoke-free policies and adverting restrictions, smoking prevalence in Albania has risen. The increase in prevalence has been driven by higher smoking rates among females (18.9% in 2007 vs 29.3% in 2009) and young adults (23.2% in 2007 vs 38.5% in 2009 among 18–19 year olds). Self-reported exposure to second-hand smoke and cigarette advertising have been reduced since 2007. The majority of respondents are still exposed to second-hand smoke and more than half are exposed to tobacco advertising. Nevertheless, there are signs that the consumption of illicit cigarettes is declining.

Conclusions

The impacts of smoke-free policies and an advertising ban have been limited due to lack of enforcement and failure to adopt a comprehensive set of tobacco control measures. These measures should include sizeable and regular tobacco tax increases in excess of the general level of inflation and income growth. The decline in the share of illicit cigarettes should improve the effectiveness of the cigarette tax policy.

Results from the Albanian Adult Tobacco Survey

Tobacco use prevalence in Europe is characterized by large disparities, with Western nations reporting smoking rates generally below 25%, while Eastern nations have smoking rates usually above 30%. Albania provides a distressing case study for Eastern Europe in which the exposure to the West after the fall of the communist regime dramatically increased the availability of Western-type cigarettes, while adoption of counterbalancing tobacco control measures lagged far behind. Results based on the representative Albanian Adult Tobacco Survey (AATS) conducted in 2007 suggest that smoking is a major problem, with a 64% smoking prevalence among Albanian men. It is becoming an increasingly greater concern among women, whose smoking prevalence more than doubled since 1990, reaching 19% in 2007. Young women living in urban areas are particularly susceptible to tobacco use; about one-third of them reported that they smoke. About 85% of current smokers smoke daily and with very high intensity, which further increases their risk of dying of smoking-attributable diseases. Smoking and secondhand exposure kill about 3,800 Albanians per year, about one-fifth of all deaths in the country. In addition, tobacco use imposes opportunity costs on Albanian households, which spent $358.6 million on cigarettes in 2007, or about 6% of the gross domestic product (GDP). To reduce the health and economic burden caused by tobacco use, the Albanian government should implement and enforce evidence-based tobacco control policies such increasing cigarette taxes; promoting cessation, particularly via the health care system; and enacting stricter clean indoor air laws.

Partner's smoking status and acute coronary syndrome: population-based case-control study in Tirana, Albania

AIM

To assess the association between partners' smoking status and acute coronary syndrome in never smokers in Albania.

METHODS

This population-based case-control study was conducted in Tirana in the period 2003-2006. It involved 467 consecutive patients with non-fatal acute coronary syndrome and 737 controls. Only married never-smokers (169 patients with acute coronary syndrome and 323 controls) were included in the analysis. Information on socioeconomic status, coronary risk factors, and partners' current smoking status was obtained by a structured questionnaire. Multivariate logistic regression was used to assess the association between partner's smoking status and acute coronary syndrome.

RESULTS

Among patients with acute coronary syndrome, 49% of women and 25% of men had a partner who was a current smoker, as opposed to 44% of women and 16% of men in the control group. In age-adjusted models, non-smoking men with smoking partners had a greater acute coronary syndrome risk (odds ratio [OR], 1.76; 95% confidence interval [CI], 0.98-3.18), while no association was found in women with smoking partners (OR, 1.05; 95% CI, 0.48-2.30). After adjustment for socioeconomic characteristics, coronary risk factors, and psychosocial factors, the acute coronary syndrome risk in men was somewhat lower (1.68; 95% CI, 0.81-3.47), while for women it was somewhat greater but still non-significant (1.19; 95% CI, 0.25-5.64). Sex-pooled estimate of the risk was OR 1.64 (95% CI, 0.96-2.83).

CONCLUSION

Partner's current smoking status was positively associated with a greater acute coronary syndrome risk in men but not in women, both before and after adjustment for socioeconomic characteristics and coronary risk factors. Programs aimed at reducing the exposure to passive smoking are need in countries with high prevalence of active smoking.

A prevalence study of current tobacco smoking in later life community and its association with sociodemographic factors, physical health and mental health status

OBJECTIVE

Evaluate the frequency of current smoking in elderly people living in urban areas of Rio Grande do Sul, Brazil.

METHODS

Cross-sectional design. A representative sample of 6,961 elderly, randomly selected subjects, living in a community, was examined to estimate the frequency of current tobacco smoking. Tobacco use was measured by means of a household questionnaire administered by trained interviewers that inquired about current tobacco use, sociodemographic characteristics, self-rated physical and health status. Mental health was evaluated using the Short Psychiatric Evaluation Schedule (SPES).

RESULTS

The prevalence of tobacco use was 28.9% among men, 13.6% among women and 18.8% for both sexes. Male gender (OR = 3.25), low income (OR = 1.52), years of schooling (illiterate) (OR = 1.35), non-Protestant religion (OR = 2.17) and absence of physical exercise (OR = 1.21) presented positive and independent association with tobacco use. Presence of pulmonary disease (OR = 1.93) and mental distress (OR = 1.32) and absence of cardiac disease (OR = 1.51), high blood pressure (OR = 1.51) and diabetes (OR = 1.50) were independently associated with an increased chance of current tobacco use. Increasing age (OR = 0.93) and marital status (married) (OR = 0.66) presented independent and negative association with smoking.

CONCLUSION

Factors associated with an increased chance of tobacco smoking were: being men, illiterate, with lower income, presence of respiratory and mental disease, and absence of cardiac disease, high blood pressure and diabetes. Factors associated with a decreased risk of tobacco smoking were: aging, exercise, Protestant religion and marriage.

Smoking behaviour, cessation attempts and the influence of parental smoking in older adult women: a cross-sectional analysis from Italy

OBJECTIVES

To investigate the association between parental smoking during infancy/adolescence and smoking prevalence in older adult women, and to provide a description of smoking and smoking cessation patterns in this subset of the population.

STUDY DESIGN

Cross-sectional survey.

METHODS

Between 1999 and 2001, trained physicians in 11 health agencies throughout the Abruzzo Region, Italy, conducted semi-structured interviews on 9708 women aged 50-70 years attending mammographic screening (overall response rate 89%). Information was collected on sociodemographic characteristics, smoking habits, parental smoking during their infancy and/or adolescence, and exposure to environmental tobacco smoke (ETS) inside or outside the family.

RESULTS AND CONCLUSIONS

The overall prevalence of current smoking was 15.6% (n=1516), and that of former smoking was 13.2%. Women whose parent(s) smoked were more likely to be current smokers, especially if only the mother smoked (adjusted odds ratio 4.27; 95% confidence interval 2.24-8.12). Other factors significantly associated with current smoking in the multivariate analysis were younger age, lower body mass index, higher level of education, unmarried status, and exposure to ETS either inside or outside the family environment. Eighteen percent of all current smokers were non-inhalers, and more than 60% of ex-smokers quit smoking on their first attempt. Our findings expand the existing evidence suggesting that a strong effect of parental conduct on a daughter's smoking behaviour may persist throughout life. Although more research is needed, especially to clarify the role of genetic and environmental factors in determining the mother-child smoking association, our results suggest that intensifying smoking prevention efforts directed at women with children might considerably reduce the risk of ever smoking in future female generations.

Smoking Prevalence, Behaviour and Nicotine Addiction among Coal Workers in Zonguldak, Turkey

To assess the smoking status of coal workers, as coal dust exposure and concomitant cigarette smoking contribute to the increased prevalence of pulmonary interstitial fibrosis, chronic obstructive pulmonary disease and other pulmonary diseases. A survey was conducted to determine the smoking prevalence, behaviour and nicotine addiction in coal workers. The target population consisted of 475 underground coal workers who lived in Zonguldak city of Turkey, and we reached 389 of them. Each subject completed a detailed smoking history questionnaire (included 56 question). Chest X-rays and pulmonary function tests were performed to evaluate patients' related diseases and complications. Smoking status of the workers was as follows; Sixty-nine never smokers (17.7%), 62 ex-smokers (15.9%) and 258 current smokers (66.3%). The mean age of starting smoking was similar among ex and current smokers (15.9 +/- 4.2 versus 15.0 +/- 4.0). The most common reason for starting smoking was smoking interest (50%) and friends' influence (15.5%). The most frequent reason stated for successful smoking cessation was experience of smoking-related symptoms or development of a medical condition (51%). The most important reason given by current smokers for smoking cessation attempts was increased chance of developing lung cancer, pneumoconiosis and other diseases (22.9%). Nicotine addiction was assessed by the Fagerstroem test. Mild (0-3 points), moderate (4-6) and severe (7 or more) addiction ratios were found to be 39.1%, 44.2% and 16.7% respectively. Ex-smokers had the highest prevalence of large and small airway obstruction on spirometry. Smoking prevalence is high in coal workers living in Zonguldak city of Turkey. Most of the smokers know that smoking is dangerous and want to quit smoking. A detailed smoking history during medical surveillance may help the occupational physician to develop a system in which such individuals can be referred to comprehensive smoking cessation programs.

Type 2 diabetes in Tirana City, Albania: a rapid increase in a country in transition

AIMS

To determine how the prevalence of Type 2 diabetes mellitus has changed in Tirana, the capital of Albania, over 20 years.

METHODS

Cluster sampling was used to select 700 households including 1540 adults 25 years of age and over in Tirana City, Albania in 2001.

RESULTS

Of 1540 potential subjects, 1120 participated (response rate 72.7%). Using the 1985 WHO criteria to provide comparability with earlier data, the overall prevalence of Type 2 diabetes mellitus in the age group 25+ was 6.3% (95% confidence interval 4.8-7.7); 6.9% (4.8-9.1%) male; 5.6% (3.8-7.5%) female. The age-adjusted prevalence in those aged 25+ was 5.4%. Of respondents, 3.4% were known to have diabetes, and 2.9% were newly identified through the survey. The prevalence of diabetes increased with age, although among men there was a slight decline after age 65. Impaired glucose tolerance was found in a further 2.9% of respondents, again increasing with age. The prevalence of diabetes has increased significantly since 1980, doubling in the age group 50+. Use of the 1999 WHO diagnostic criteria produces a higher unadjusted prevalence, at 9.7% (8-11.4%). In a logistic regression model, obesity and family history were independent determinants of the probability of having diabetes. Among those known to have diabetes, control was poor.

CONCLUSIONS

The prevalence of diabetes in Albania has increased rapidly, consistent with what has been seen in other countries undergoing rapid modernization. It is likely to increase further in the future, with important implications for health policy.