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Sun S, Yu H, Ling J, Yao D, Chen H, Liu G. The influence of health literacy and knowledge about smoking hazards on the intention to quit smoking and its intensity: an empirical study based on the data of China's health literacy investigation. BMC Public Health 2023; 23:2355. [PMID: 38017398 PMCID: PMC10685583 DOI: 10.1186/s12889-023-17292-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Accepted: 11/22/2023] [Indexed: 11/30/2023] Open
Abstract
OBJECTIVE This study explored the relationship between smokers' health literacy, knowledge of smoking hazards, and their intention to quit. METHODS Based on data from the 2019 Health Literacy and Tobacco Use Surveillance among residents of a city in Zhejiang Province, 1120 male smokers were screened. Differential tests were used to analyze whether smokers with varying levels of health literacy and knowledge about smoking hazards differed in their intention to quit smoking and the intensity of their intention. A multi-factor logistic regression model was constructed to explore the extent of these differences. RESULTS Only 24.8% of smokers had higher health literacy. Among smokers, those with an intention to quit had a higher health literacy level compared to those without such intention (32.7% vs. 17.0%, p < 0.001). Health literacy levels did not differ significantly between groups with different intensity of intention to quit (34.2% vs. 31.9% vs. 30.1%, p = 0.435). About 48.7% of the smokers a higher level of knowledge about smoking hazards. It was more prevalent in the intent to quit group compared to the no intent to quit group (54.0% vs. 43.4%, p < 0.001), and the low intent to quit group had lower knowledge compared to the moderate and high intent to quit groups (49.1% vs. 56.6% vs. 63.4%, p = 0.011). After adjusting for other influences, smokers with lower health literacy were less likely to have intention to quit (OR = 0.659, p = 0.016). And the association between knowledge about smoking hazards and whether smokers have the intention to quit is no longer significant, but it significantly affects the intensity of the intention to quit among smokers who already have the intention (OR = 0.623, p = 0.005). CONCLUSION General health literacy may play a role in facilitating smokers' progression from the stage of no intent to quit to one of intent to quit, but a more specific understanding of the harms of smoking may be needed to increase the strength of intent to quit.
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Affiliation(s)
- Siwen Sun
- Taizhou Hospital of Zhejiang Province affiliated to Wenzhou Medical University, Taizhou, Zhejiang, China
- School of Public Health and Management, Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Huifang Yu
- Jiaxing Center for Disease Control and Prevention, Jiaxing, Zhejiang, China
| | - Jie Ling
- Jiaxing Center for Disease Control and Prevention, Jiaxing, Zhejiang, China
| | - Dingming Yao
- Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, Zhejiang, China
| | - Haixiao Chen
- Taizhou Hospital of Zhejiang Province affiliated to Wenzhou Medical University, Taizhou, Zhejiang, China.
| | - Guilin Liu
- School of Public Health and Management, Wenzhou Medical University, Wenzhou, Zhejiang, China.
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Marzo R, El-Fass K, Osman N, Kyaw T, Arivanandan P, Morgan L, Latchumana K, Arasu K, Obaromi A, Lin Y. Identifying the barriers of smoking cessation and predictors
of nicotine dependence among adult Malaysian smokers:
A cross-sectional study. Tob Induc Dis 2022; 20:109. [DOI: 10.18332/tid/154964] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Revised: 06/24/2022] [Accepted: 09/27/2022] [Indexed: 12/12/2022] Open
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Barreiro RG, de Oliveira Lopes MV. Content validity of the nursing diagnosis low self-efficacy in health. Int J Nurs Knowl 2022. [PMID: 36217864 DOI: 10.1111/2047-3095.12395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Accepted: 08/30/2022] [Indexed: 11/27/2022]
Abstract
PURPOSE The purpose of this study was to verify the validity of the content of the proposal for the nursing diagnosis of low self-efficacy in health. METHODS Content validation study using the approach proposed by Lopes, a panel of 47 experts on the phenomenon of interest analyzed the content of the diagnosis using a Likert-type scale to evaluate the relevance of 16 clinical indicators and 18 etiological factors of the nursing diagnosis under investigation. These components were previously identified and defined through a middle-range theory. Based on the predictive diversity model, the experts' verifications were weighted according to their level of expertise. The pseudomedian and 95% confidence intervals were calculated. A content validity index above 0.9 was considered valid, and the Wilcoxon test was used to validate each pseudomedian with a p-value above 0.05. FINDINGS Thirteen clinical indicators were considered relevant, demonstrating the importance of these elements for the clinical identification of low self-efficacy in health. Three clinical indicators were excluded because they were not representative for this diagnosis. The eighteen etiological factors analyzed were considered relevant. CONCLUSION The findings of the present study may help nurses to identify low self-efficacy in health early and direct effective interventions to increase people's confidence in their abilities to promote their health. IMPLICATIONS FOR NURSING PRACTICE A new diagnostic framework is presented with peer-reviewed content, representing a phenomenon frequently reported by clinicians. This new diagnosis can guide nursing care and produce better health outcomes that depend on patients' confidence in their ability to take care of their own health.
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Affiliation(s)
- Reinaldo Gutiérrez Barreiro
- Program in Nursing, Federal University of Ceará, Fortaleza, Brazil.,Nursing Diagnosis, Interventions, and Results Study Group (GEDIRE), Federal University of Ceará, Fortaleza, Brazil
| | - Marcos Venícios de Oliveira Lopes
- Nursing Diagnosis, Interventions, and Results Study Group (GEDIRE), Federal University of Ceará, Fortaleza, Brazil.,Department of Nursing, Federal University of Ceará, Fortaleza, Brazil
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Barreiro RG, Lopes MVDO, Cavalcante LDP. Middle-Range Theory for the Nursing Diagnosis of Low Self-Efficacy in Health. Rev Bras Enferm 2021; 73:e20190370. [PMID: 32638935 DOI: 10.1590/0034-7167-2019-0370] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2019] [Accepted: 11/01/2019] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVES theoretical validation of the concept of low self-efficacy in health as a nursing diagnosis construct. METHODS construction of a middle-range theory for validating diagnoses, comprised of five stages: definition of the approach for building the theory; definition of the main concepts; creation of a pictorial diagram; formulation of proposals; establishment of causal relationships and evidence for clinical practice. The main concepts were identified through a literature review and the studies were taken from the LILACS, SCOPUS, CINAHL and PubMed/MEDLINE databases. The final sample was comprised of 92 articles. RESULTS eighteen etiological factors and 16 clinical indicators were identified; characterized as antecedents and manifestations for inferring a diagnosis of low self-efficacy in health. CONCLUSIONS the related concepts of the new nursing diagnosis of low self-efficacy in health, to be applied in clinical nursing practice, were identified and defined.
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Yong HH, Karmakar C, Borland R, Kusmakar S, Fuller-Tyszkiewicz M, Yearwood J. Identifying smoker subgroups with high versus low smoking cessation attempt probability: A decision tree analysis approach. Addict Behav 2020; 103:106258. [PMID: 31884376 DOI: 10.1016/j.addbeh.2019.106258] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2019] [Revised: 11/28/2019] [Accepted: 12/13/2019] [Indexed: 10/25/2022]
Abstract
BACKGROUND Regression-based research has successfully identified independent predictors of smoking cessation, both its initiation and maintenance. However, it is unclear how these various independent predictors interact with each other and conjointly influence smoking behaviour. As a proof-of-concept, this study used decision tree analysis (DTA) to identify the characteristics of smoker subgroups with high versus low smoking cessation initiation probability based on the conjoint effects of four predictor variables, and determine any variations by socio-economic status (SES). METHODS Data come from the Australian arm of the ITC project, a longitudinal cohort study of adult smokers followed up approximately annually. Reported wanting to quit smoking, worries about smoking negative health impact, quitting self-efficacy and quit intentions assessed in 2005 were used as predictors and reported quit attempts at the 2006 follow-up survey were used as the outcome for the initial model calibration and validation analyses (n = 1475), and further cross-validated using the 2012-2013 data (n = 787). RESULTS DTA revealed that while all four predictor variables conjointly contributed to the identification of subgroups with high versus low smoking cessation initiation probability, quit intention was the most important predictor common across all SES strata. The relative importance of the other predictors showed differences by SES. CONCLUSIONS Modifiable characteristics of smoker subgroups associated with making a quit attempt and any variations by SES can be successfully identified using a decision tree analysis approach, to provide insights as to who might benefit from targeted intervention, thus, underscoring the value of this approach to complement the conventional regression-based approach.
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Nargis N, Yong HH, Driezen P, Mbulo L, Zhao L, Fong GT, Thompson ME, Borland R, Palipudi KM, Giovino GA, Thrasher JF, Siahpush M. Socioeconomic patterns of smoking cessation behavior in low and middle-income countries: Emerging evidence from the Global Adult Tobacco Surveys and International Tobacco Control Surveys. PLoS One 2019; 14:e0220223. [PMID: 31490958 PMCID: PMC6730869 DOI: 10.1371/journal.pone.0220223] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2018] [Accepted: 07/11/2019] [Indexed: 12/14/2022] Open
Abstract
INTRODUCTION Tobacco smoking is often more prevalent among those with lower socio-economic status (SES) in high-income countries, which can be driven by the inequalities in initiation and cessation of smoking. Smoking is a leading contributor to socio-economic disparities in health. To date, the evidence for any socio-economic inequality in smoking cessation is lacking, especially in low- and middle-income countries (LMICs). This study examined the association between cessation behaviours and SES of smokers from eight LMICs. METHODS Data among former and current adult smokers aged 18 and older came from contemporaneous Global Adult Tobacco Surveys (2008-2011) and the International Tobacco Control Surveys (2009-2013) conducted in eight LMICs (Bangladesh, Brazil, China, India, Mexico, Malaysia, Thailand and Uruguay). Adjusted odds ratios (AORs) of successful quitting in the past year by SES indicators (household income/wealth, education, employment status, and rural-urban residence) were estimated using multivariable logistic regression controlling for socio-demographics and average tobacco product prices. A random effects meta-analysis was used to combine the estimates of AORs pooled across countries and two concurrent surveys for each country. RESULTS Estimated quit rates among smokers (both daily and occasional) varied widely across countries. Meta-analysis of pooled AORs across countries and data sources indicated that there was no clear evidence of an association between SES indicators and successful quitting. The only exception was employed smokers, who were less likely to quit than their non-employed counterparts, which included students, homemakers, retirees, and the unemployed (pooled AOR≈0.8, p<0.10). CONCLUSION Lack of clear evidence of the impact of lower SES on adult cessation behaviour in LMICs suggests that lower-SES smokers are not less successful in their attempts to quit than their higher-SES counterparts. Specifically, lack of employment, which is indicative of younger age and lower nicotine dependence for students, or lower personal disposable income and lower affordability for the unemployed and the retirees, may be associated with quitting. Raising taxes and prices of tobacco products that lowers affordability of tobacco products might be a key strategy for inducing cessation behaviour among current smokers and reducing overall tobacco consumption. Because low-SES smokers are more sensitive to price increases, tobacco taxation policy can induce disproportionately larger decreases in tobacco consumption among them and help reduce socio-economic disparities in smoking and consequent health outcomes.
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Affiliation(s)
- Nigar Nargis
- American Cancer Society, Atlanta, Georgia, United States of America
| | - Hua-Hie Yong
- School of Psychology, Deakin University, Geelong, Victoria, Australia
| | - Pete Driezen
- Department of Psychology, University of Waterloo, Waterloo, Ontario, Canada
- School of Public Health and Health Systems, University of Waterloo, Waterloo, Ontario, Canada
| | - Lazarous Mbulo
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Luhua Zhao
- CDC Foundation, Atlanta, Georgia, United States of America
| | - Geoffrey T. Fong
- Department of Psychology, University of Waterloo, Waterloo, Ontario, Canada
- School of Public Health and Health Systems, University of Waterloo, Waterloo, Ontario, Canada
- Ontario Institute for Cancer Research, Toronto, Ontario, Canada
| | - Mary E. Thompson
- Department of Statistics and Actuarial Science, University of Waterloo, Waterloo, Ontario, Canada
| | - Ron Borland
- School of Psychological Sciences, University of Melbourne, Melbourne, Australia
- VicHealth Centre for Tobacco Control, Cancer Council Victoria, Melbourne, Victoria, Australia
| | - Krishna M. Palipudi
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Gary A. Giovino
- School of Public Health and Health Professions, University at Buffalo, SUNY, Buffalo, New York, United States of America
| | - James F. Thrasher
- Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina, United States
- Departamento de Investigación sobre Tabaco, Instituto Nacional de Salud Pública, Cuernavaca, México
| | - Mohammad Siahpush
- Department of Health Promotion, Social & Behavioral Health, College of Public Health, University of Nebraska Medical Center, Nebraska, United States of America
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Wang Q, Shen JJ, Sotero M, Li CA, Hou Z. Income, occupation and education: Are they related to smoking behaviors in China? PLoS One 2018; 13:e0192571. [PMID: 29420649 PMCID: PMC5805321 DOI: 10.1371/journal.pone.0192571] [Citation(s) in RCA: 63] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2017] [Accepted: 01/25/2018] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND The association between socioeconomic status (SES) and smoking behaviors may differ across countries. This study aimed to estimate the association between socioeconomic status (income, occupation and education) and multiple measures of smoking behaviors among the Chinese elderly population. METHODS Using data from the China Health and Retirement Longitudinal Study in 2013, we examined the relationship between socioeconomic status and smoking behaviors through multivariate regression analysis. Sample selection models were applied to correct for sample selection bias. Smoking behaviors were measured by four indicators: smoking status, cigarette consumption, health risks related to smoking, and smoking dependence. Analyses were stratified by gender and urban-rural residence. RESULTS Among Chinese people aged 45 years or older, smokers accounted for 40% of the population in 2013, smoking 19 cigarettes per day. It was also found that 79% of smokers were at an increased health risk. Overall, although the influence of income on smoking behaviors was small and even insignificant, occupation and education levels were significantly associated with smoking behaviors. Managers or professionals were more likely to smoke, however there was no significant relationship with smoking dependence. Individuals with higher educational attainment were less likely to be associated with smoking behaviors. In addition, gender and urban-rural differences existed in the relationship between SES and smoking behaviors. CONCLUSIONS Smoking disparities among diverse levels of socioeconomic status existed but varied greatly by SES indicators and population characteristics. Tobacco control policies in China should be increasingly focused on populations with low socioeconomic status in order to break the link between socioeconomic disadvantage and smoking behaviors. Further actions should mitigate inequalities in education, improve the social culture of cigarette use, and tailor interventions based on characteristics of the population.
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Affiliation(s)
- Qing Wang
- School of Business, Dalian University of Technology, Panjin, Liaoning, China
| | - Jay J. Shen
- Department of Health Care Administration and Policy, School of Community Health Sciences, University of Nevada Las Vegas, Las Vegas, Nevada, United States of America
| | - Michelle Sotero
- Department of Health Care Administration and Policy, School of Community Health Sciences, University of Nevada Las Vegas, Las Vegas, Nevada, United States of America
| | - Casey A. Li
- Green Valley High School, Henderson, Nevada, United States of America
| | - Zhiyuan Hou
- Department of Social Medicine, School of Public Health, Fudan University, Shanghai, China
- National Key Laboratory of Health Technology Assessment (Health and Family Planning Commission), Fudan University, Shanghai, China
- Collaborative Innovation Center of Social Risks Governance in Health, Fudan University, Shanghai, China
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Cai L, Cui W, You D, He J, Zhao K. Socioeconomic variations in nicotine dependence in rural southwest China. BMC Public Health 2015; 15:1158. [PMID: 26597724 PMCID: PMC4657195 DOI: 10.1186/s12889-015-2492-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2015] [Accepted: 11/16/2015] [Indexed: 11/16/2022] Open
Abstract
Background This study examines how nicotine dependence is distributed across socioeconomic gradients in rural Yunnan province, which has the most ethnic minorities in one province in southwest China. Methods A cross-sectional survey was conducted in four rural areas of Yunnan province among 17,158 consenting individuals aged ≥18 years in 2011. Information on demographic characteristics and smoking habits was obtained using a standard questionnaire. The Fagerstrom Test for Nicotine Dependence (FTND) was applied to assess nicotine dependence. Multilevel logistic regression was used to model the variation in prevalence of nicotine dependence. Results In the study population, the overall prevalence of current smokers and nicotine dependence was 32.4 % and 31.6 %, respectively. Females were much less likely to have nicotine addiction than males: odds ratio (OR) of 0.01 (95 % CI: 0.008 – 0.012). Higher annual household income was associated with a greater risk of nicotine dependence (OR 1.09, 95 % CI: 1.01 – 1.17). Adults who grew tobacco were more likely to have nicotine addiction (OR 1.22, 95 % CI 1.07 – 1.41). Individual educational level was inversely associated with the probability of nicotine dependence (OR 0.63, 95 % CI 0.55 – 0.72), lower community educational level was also associated with an increased risk of nicotine dependence (OR 0.94, 95 % CI 0.92 – 0.98). Conclusions Nicotine dependence showed significant variations across different indicators of both contextual and individual socioeconomic status in rural southwest China. Future interventions on tobacco cessation should give increased attention to men, tobacco farmers, less educated or poorer persons, and lower educational level communities.
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Affiliation(s)
- Le Cai
- Cheng Gong New City, School of Public Health, Kunming Medical University, 1168 Yu Hua Street Chun Rong Road, Kunming, 650500, China.
| | - Wenlong Cui
- Cheng Gong New City, School of Public Health, Kunming Medical University, 1168 Yu Hua Street Chun Rong Road, Kunming, 650500, China
| | - Dingyun You
- Cheng Gong New City, School of Public Health, Kunming Medical University, 1168 Yu Hua Street Chun Rong Road, Kunming, 650500, China
| | - Jianhui He
- Cheng Gong New City, School of Public Health, Kunming Medical University, 1168 Yu Hua Street Chun Rong Road, Kunming, 650500, China
| | - Keying Zhao
- Cheng Gong New City, School of Public Health, Kunming Medical University, 1168 Yu Hua Street Chun Rong Road, Kunming, 650500, China
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The impact of regional economic reliance on the tobacco industry on current smoking in China. Health Place 2015; 33:159-71. [DOI: 10.1016/j.healthplace.2014.12.015] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2014] [Revised: 12/18/2014] [Accepted: 12/24/2014] [Indexed: 11/23/2022]
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Muilenburg JL, Laschober TC, Eby LT. Relationship between Low-Income Patient Census and Substance Use Disorder Treatment Programs' Availability of Tobacco Cessation Services. JOURNAL OF DRUG ISSUES 2015; 45:69-79. [PMID: 25530629 PMCID: PMC4266556 DOI: 10.1177/0022042614552020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Low income adults with substance use disorders (SUDs) have a high prevalence of tobacco use and often limited access to tobacco cessation treatment. This study examines the relationship between low-income SUD patient census (i.e., percentage of patients whose treatment costs are covered by Medicaid and Federal block grants) and SUD programs' availability of three evidence-based tobacco cessation services: behavioral treatments, system-level support, and pharmacotherapy. Data were collected from a random sample of 1,006 program administrators in 2010. Mixed-effects models results show that the percentage of low-income patients is significantly positively associated with the availability of behavioral treatments and system-level support but not pharmacotherapy. Thus, low-income patients may have similar access to tobacco cessation pharmacotherapy but greater access to behavioral treatments and system-level support. However, the availability of tobacco cessation services is not widespread overall, which may hamper access to extensive services to address low-income SUD patients' high smoking rates.
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Affiliation(s)
- Jessica L. Muilenburg
- University of Georgia, 322 Psychology Building, Athens, GA 30602, USA, Phone: 706-542-4365, Fax: 706-542-4956
- Department of Health Promotion and Behavior
| | - Tanja C. Laschober
- University of Georgia, 322 Psychology Building, Athens, GA 30602, USA, Phone: 706-542-4365, Fax: 706-542-4956
- Owens Institute for Behavioral Research
| | - Lillian T. Eby
- University of Georgia, 322 Psychology Building, Athens, GA 30602, USA, Phone: 706-542-4365, Fax: 706-542-4956
- Owens Institute for Behavioral Research
- Industrial-Organizational Psychology Program
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