Consumption of tobacco products and associated factors among outpatient visitors of two healthcare facilities in Northern Cyprus: a descriptive cross-sectional study

BACKGROUND

Tobacco use is one of the leading causes of preventable mortality and morbidity. Although Cyprus is considered a developed country, the tobacco prevalence and related issues have not been explored sufficiently in the general population of North Cyprus.

OBJECTIVE

The objective of this study is to determine the rate of tobacco product consumption and related factors among the visitors of a community health center and a university hospital in Northern Cyprus.

METHODS

The study was designed as a cross-sectional study The data were collected using a questionnaire developed in compliance with WHO guidelines. The data were analyzed using IBM-SPSS18.0 with p < 0.05 evaluated as significant.

RESULTS

Out of a total of 635 individuals approached, 615 provided responses. The participation rate was 96%. The frequency of male smokers was 47.2%, while the frequency of female smokers was 34.0%, with a total smoking rate of 40.7%, much higher than world averages. The survey identified friendship influence as the primary reason for starting tobacco use, accounting for 42%, followed by being stressed at 34.6%. Male gender, being single, having no children, Turkish nationality were predictors of smoking, while financial status was not. The participants indicated a high frequency regarding exposure to passive smoke (51.1%). More than half of the respondents thought tobacco control in Northern Cyprus is not satisfactory.

CONCLUSION

More research needs to be done to determine the exact overall prevalence of tobacco consumption in the population, which was found high in this study. Moreover, implementation of comprehensive tobacco control strategies is essential to control the prevalent tobacco dependence.

Enhancing Emotion Regulation Skills in High-Risk Adolescents Due to the Existence of Psychopathology in the Family: Feasibility and Uncontrolled Pilot Study of a Group Intervention in a Naturalistic School Setting

BACKGROUND

Emotion regulation skills form part of many interventions for youth with internalizing and externalizing difficulties. This pilot study examines a prevention program delivered at school to improve adolescents' emotion regulation skills, focusing on those at risk for mental health problems.

METHODS

Adolescents 12-18 years old were referred to a six-session group program by their school counselors, based on inclusion criteria related to family sociodemographic and mental health characteristics. Group sessions took place during school hours to facilitate participation and reduce dropout. The intervention targeted emotion regulation skills, drawing from central components of different cognitive behavioral approaches. To assess clinical outcomes, participants answered questionnaires before and after the program, which covered emotion regulation strategies, addictive behaviors, and internalizing and externalizing symptoms. The acceptability of the program was also assessed.

RESULTS

Emotion regulation skills improved after the program, and there was a significant reduction in internalizing and externalizing problems. The program was evaluated as useful by participants. Counsellors reported satisfaction with the program.

CONCLUSIONS

Targeted emotion regulation skills training is a potentially useful transdiagnostic intervention to prevent mental health problems in youth. Bringing the intervention to the school setting and involving counsellors in referring at-risk students can facilitate uptake and reduce dropout.

An Avatar-Led Intervention Promotes Smoking Cessation in Young Adults: A Pilot Randomized Clinical Trial

BACKGROUND

Smoking remains a global concern, especially for young adults. There is a dearth of smoking cessation programs for this population, who seldom seek help or are motivated to quit.

PURPOSE

This pilot study assessed the effectiveness of a digital avatar-led Acceptance and Commitment Therapy (ACT) smoking cessation program (Flexiquit) for young adult smokers at all levels of motivation to quit.

METHODS

Smokers with no particular interest in quitting smoking (65.45% reported being in pre-contemplation or contemplation stages of change) were recruited from three universities (105 smoking ≥ 1 cigarette per day during the past 30 days, 68 females). Those who completed questionnaires online (N = 84; M = 22.44 years, SD = 2.61, range 18-28 years old) were randomized to either a six-session avatar-led intervention (Flexiquit; N = 49) or a wait-list control (N = 35). Primary outcomes included cessation status (7-day point prevalence) and number of cigarettes smoked per day; secondary outcomes were nicotine dependence, intention-to-quit smoking and self-efficacy, assessed at pre- and post-intervention, and only for Flexiquit at 6-month follow-up.

RESULTS

In intention-to-treat analysis more participants (OR = 3.10, 95% CI = 0.92-10.41) in the treatment group (28.57%) versus the control group (11.43%) reported quitting smoking; however, the difference was not statistically significant (p = .067). There were statistically significant decreases in average number of cigarettes, nicotine dependence and increases in self-efficacy, and intention-to-quit smoking compared to controls. Treatment gains in the Flexiquit group were maintained through the 6-month follow-up.

CONCLUSIONS

An avatar-led digitized smoking cessation intervention based on ACT could increase the odds of quitting smoking. Findings suggest that a digitized program designed to engage young adults in smoking cessation may result in quitting smoking and has a high applicability potential especially among the hard-to-reach population of young adults.

QUESTION

Can an avatar-led digitized Acceptance and Commitment Therapy (ACT) smoking cessation intervention result in quitting smoking and increasing intention to quit among young smokers at various levels of motivation to quit, compared to a wait-list control group?

FINDINGS

In this pilot randomized clinical trial that included 84 smokers, 28.57% in the treatment condition versus 11.43% in the wait-list control group were abstinent at post (intention-to-treat [ITT] analysis). An avatar-led digitized ACT smoking cessation intervention results in high quitting smoking rates and has a high applicability potential especially among the hard-to-reach population of young adult smokers.

Smoking Consequences Questionnaire: Factor Structure and Invariance among Smokers and Non-Smokers

BACKGROUND

The Smoking Consequences Questionnaire was developed to assess smoking expectancies, which have been found to be linked to the initiation and maintenance of smoking.

OBJECTIVES

The purpose of the current study was to examine the factor structure of a modified brief version of the instrument in Greek and to test its invariance between groups of smokers and nonsmokers.

METHODS

Participants were 813 Greek-Cypriot university students (524 females; Mean age =20.94, SD = 2.70) who completed this brief version of the instrument translated into Greek using the forward-backward method.

RESULTS

Confirmatory factor analysis supported a four-factor structure: Negative Consequences, Positive Reinforcement, Negative Reinforcement and Appetite/Weight Control. Multigroup confirmatory factor analysis indicated configural, metric and partial scalar invariance of the instrument in groups of smokers and nonsmokers. Comparison of the mean difference in the invariant factors showed significant difference in appetite/weight control mean scores, whereas mean difference in negative consequences was not significant. Conclusions/Importance. Findings support the four-factor structure of the brief Greek version of the SCQ in a sample of young adults, and factorial invariance between smokers and nonsmokers. More expectancies about appetite/weight control among smokers compared to nonsmokers suggest focusing on this category of smoking expectancies in smoking prevention and cessation programs.

Geographic trends of tobacco-related cancers in Cyprus

BACKGROUND

Causal relationships have been previously established between smoking and various cancers. In Cyprus, 39 % of men and 14 % of women reported daily smoking in 2008. The objective of this study was to compare the incidence of tobacco-related cancers to all other cancers by district and rural-urban classification to understand the impact of tobacco in Cyprus.

METHODS

Data on lung, urinary bladder, oral, pharyngeal, head/neck, and laryngeal cancers were obtained from the Cyprus Cancer Registry (1998-2008). There were 3,635 patients with tobacco-related cancers and 18,780 with non-tobacco cancers. Univariate analysis comparing tobacco-related cancers and all other cancers were conducted with regards to age at diagnosis, age groups, sex, smoking status, disease stage, and rural/urban status, with a p-value of 0.05 considered significant. Smoking prevalence, lung cancer, and bladder cancer rates of Cyprus were also compared to a number of other European countries.

RESULTS

Patients with tobacco-related cancers were older than those with non-tobacco cancers (mean age 67.2 ± 12.4 vs. 62.4 ± 17.1, p < 0.0001). Among those with tobacco-related cancers, 80.1 % were male compared to 45.4 % males with other cancer types. The proportion of ever smokers was higher among males compared to females in urban and rural districts. Sub-districts 41 (Age Adjusted Rate (AAR) 41.9, 95 % CI: 35.7-48.1), 60 (AAR 40.3, 95 % CI: 35.2-45.3), and 50 (AAR 36.3, 95 % CI: 33.8-38.7) had the highest rates of tobacco-related cancers. The overall tobacco-related cancer rate was the highest among males in urban districts (AAR 60.8, 95 % CI: 58.2-63.5). Among tobacco-related cancers, lung cancer had the highest overall AAR (17.9 per 100,000) while head and neck cancer had the lowest overall AAR (5.3 per 100,000). Additionally, even though Cypriot males aged 65-69 years old exhibited higher smoking prevalence than other European countries, the overall lung and bladder cancer rates were lower in Cyprus.

CONCLUSION

Despite the high proportion of smokers in Cyprus, cancer rates are low compared to other countries. Future in-depth measurements of relevant risk factors and smoking exposure can help understand this phenomenon and provide insights for cancer prevention.

The effect of smoke-free policies on hospitality industry revenues in Cyprus: an econometric approach

OBJECTIVE

Smoke-free policies aiming to improve quality of indoor air and significantly reduce exposure to secondhand smoke in the hospitality industry are faced with strong opposition from the tobacco industry and hospitality venue owners claiming that they lead to reductions of revenues. The objective of our study was to examine the impact of a recently introduced smoke-free legislation on the revenues of the hospitality industry in Cyprus.

METHODS

Anonymous information on revenues was obtained from the Cyprus government value added tax office for the entire hospitality industry in Cyprus including hotels, bars, restaurants and cafeterias between 2005 and 2011. Panel data methodology was used to examine the effect of a smoke-free legislation, on tourism, businesses' revenues adjusting for gross domestic product, inflation, unemployment rate, tourists' arrivals, seasonal variation and the economic crisis.

RESULTS

Our study showed that the implementation of the smoke-free policy did not have negative effects on the hospitality industry profitability.

CONCLUSIONS

We conclude that even in regions with relatively high smoking rates, pro-smoking societal attitudes and weak social norms against tobacco control, and even during periods of economic crisis, smoke-free legislation does not impact negatively on hospitality industry revenues and if anything may lead to a small positive increase.

[Cigarette smoking prevalence and associated factors in secondary school children in Catalunya]

Objetivos

Analizar aquellos factores asociados al consumo de tabaco en adolescentes para plantear futuras intervenciones de promoción de la salud desarrolladas por las escuelas y centros de atención primaria.

Diseño

Estudio transversal, muestreo por conglomerados bietápico.

Emplazamiento

Se incluyeron 97 centros escolares de Cataluña, 2005-2006.

Participantes

Se obtuvieron 9.340 cuestionarios completos de estudiantes entre 14-16 años.

Mediciones principales

Encuesta autoadministrada que recogía variables sociodemográficas, académicas, estado de salud, familiares, relaciones sexuales, sustancias adictivas, estados de ánimo y variables de opinión sobre el consumo. Se analizó la asociación de estas variables con la variable dependiente fumador/no fumador y también fueron analizadas como factores que aumentaban la probabilidad de ser fumador mediante modelos multinivel.

Resultados

Se incluyeron 4.653 chicos y 4.687 chicas, con una edad media de 15,2 años. El 71,1% de los estudiantes eran no fumadores, el 75% de los chicos y el 67,3% de las chicas. Aumentaban la probabilidad de ser fumador (OR e IC 95%): ser chica 0,60 (0,53-0,68), cursar 4.^o ESO 1,27 (1,12-1,43), tener un rendimiento escolar bajo 3,38 (2,74-4,17), tener una autopercepción de salud regular/mala 2,81 (2,21-3,58), tener padres fumadores 1,68 (1,45-1,95), consumir alcohol 5,05 (4,35-5,86), tener 3 o más problemas de estado de ánimo 1,22 (1,05-1,41), vivir sin ningún progenitor 1,59 (1,07-2,38), estar de acuerdo en que exista publicidad sobre tabaco 1,64 (1,45-1,85), y opinar que el tabaco ayuda a relajarse 3,57 (3,23-4,17).

Conclusiones

Aunque la mayoría de los estudiantes eran no fumadores, el consumo de tabaco era más prevalente en las chicas. Factores sociodemográficos, socioculturales, del entorno y opinión se asociaban con el consumo de tabaco entre los jóvenes.