‘Smoke gets in your eyes’: a research-informed professional education and advocacy programme

Through the Smoke: An In-Depth Review on Cigarette Smoking and Its Impact on Ocular Health

Smoking is a widespread and pervasive habit, impacting health across various care settings, including acute care, subacute care, home-based care, and long-term care. Smoking is a serious global public health concern that has been related to many chronic diseases. However, the effect of smoking on eye disorders has been less studied. Cigarette smoke contains a complex mixture of harmful constituents, including nicotine and toxic chemicals, which permeate the bloodstream, affecting ocular tissues. The oxidative stress and inflammation induced by smoking are central to its detrimental effects on ocular health. Age-related macular degeneration (AMD), a leading cause of vision loss, exhibits a strong association with smoking. Research consistently demonstrates that smokers face a heightened risk of both early and advanced AMD. Cataracts, another prevalent ocular condition, develop earlier and progress more rapidly in smokers. The oxidative stress on the lens and reduced antioxidants among smokers contribute to the increased severity of cataracts. Moreover, the health of the eyes may be compromised by smoking-related chemicals that reduce blood flow and/or hasten thrombus formation in ocular capillaries thus increasing the chance of acquiring glaucoma, cataracts, AMD, and Graves' eye disease. Beyond individual health concerns, the societal implications of smoking on ocular health are substantial, including increased healthcare costs and diminished quality of life for affected individuals. Understanding the underlying mechanisms can provide insights into potential therapeutic interventions for preventing and managing smoking-related ocular damage. Given the global prevalence of smoking, raising awareness about the ocular risks associated with smoking is crucial for promoting eye health. The review underscores the urgent need for comprehensive anti-smoking initiatives and smoking cessation programs to alleviate the burden of ocular diseases associated with smoking.

Investigation of time to first presentation and extrahospital factors in the treatment of neovascular age-related macular degeneration: a retrospective cross-sectional study

OBJECTIVES

To assess the time from symptom onset to treatment for neovascular age-related macular degeneration (nvAMD) and to measure the awareness of AMD in Southeast Scotland.

DESIGN

Retrospective cross-sectional study.

SETTING

Secondary care, Southeast of Scotland.

METHODS

Patients treated with intravitreal therapy (IVT) for nvAMD in Southeast Scotland between 2013 and 2015 were identified using a treatment register. Notes were retrospectively reviewed. We measured time from: (A) symptom onset to first presentation at primary care, (B) referral to ophthalmic clinic appointment and (C) ophthalmic clinic appointment to first IVT treatment. To investigate AMD awareness, we performed a cluster random sample survey of patients visiting non-AMD ophthalmic clinics using a previously validated 12-item questionnaire.

RESULTS

195 patients (mean age 78 years) were included in the study. The mean delays between the different stages-A, B and C-were 54.2 (95% CI ±13), 28.2 (95% CI ±4.0) and 31.5 (95% CI ±3.6) days, respectively. There was an additional mean delay of 7.5 (95% CI ±1.6) days when patients were indirectly referred by optometrists via general practitioners (P<0.05). 140 patients (mean age 78) participated in the awareness survey; 62.1% reported being 'aware' of AMD but only 37.3% described AMD symptoms correctly.

CONCLUSIONS

There was a significant delay at every step of the nvAMD care pathway. The causes for this were multifactorial and included delays in first presentation to a healthcare provider, referral from primary care and initiation of secondary care treatment. Our data are likely to underestimate prehospital delays as a large number of cases are likely to have undefined symptoms and onset. We also identified suboptimal awareness of AMD which could account for a substantial delay in presentation from symptom onset. These findings highlight the need to address AMD awareness and the need for urgent treatment to prevent avoidable vision loss resulting from nvAMD.

Academic advocacy in public health: Disciplinary 'duty' or political 'propaganda'?

The role of 'advocacy' within public health attracts considerable debate but is rarely the subject of empirical research. This paper reviews the available literature and presents data from qualitative research (interviews and focus groups conducted in the UK in 2011-2013) involving 147 professionals (working in academia, the public sector, the third sector and policy settings) concerned with public health in the UK. It seeks to address the following questions: (i) What is public health advocacy and how does it relate to research?; (ii) What role (if any) do professionals concerned with public health feel researchers ought to play in advocacy?; and (iii) For those researchers who do engage in advocacy, what are the risks and challenges and to what extent can these be managed/mitigated? In answering these questions, we argue that two deeply contrasting conceptualisations of 'advocacy' exist within public health, the most dominant of which ('representational') centres on strategies for 'selling' public health goals to decision-makers and the wider public. This contrasts with an alternative (less widely employed) conceptualisation of advocacy as 'facilitational'. This approach focuses on working with communities whose voices are often unheard/ignored in policy to enable their views to contribute to debates. We argue that these divergent ways of thinking about advocacy speak to a more fundamental challenge regarding the role of the public in research, policy and practice and the activities that connect these various strands of public health research.

Positive impact of Australian 'blindness' tobacco warning labels: findings from the ITC four country survey

BACKGROUND

Smokers with greater knowledge of the health effects of smoking are more likely to quit and remain abstinent. Australia has communicated the causal association of smoking and blindness since the late 1990s. In March 2007, Australia became the first country to include a pictorial warning label on cigarette packages with the message that smoking causes blindness. The current study tested the hypothesis that the introduction of this warning label increased smokers' knowledge of this important health effect.

METHODS

Six waves of the International Tobacco Control Four Country Survey were conducted, as a telephone survey of 17,472 adult smokers in Australia, Canada, United Kingdom and the United States, with three waves before and three waves after the blindness health warning was introduced in Australia. The survey measured adult smokers' knowledge that smoking causes blindness.

RESULTS

Australian smokers were significantly more likely to report that smoking causes blindness, compared to Canadian, UK and US smokers, where there were neither health campaigns nor health warnings labels about blindness. After the introduction of the blindness warning, Australian smokers were more likely than before the blindness warning to report that they know that smoking causes blindness (62 versus 49 per cent; OR = 1.68, 95% CI: 1.03, 2.76, p = 0.04). In Australia, smokers aged over 55 years were less likely than those aged 18 to 24 to report that smoking causes blindness (OR = 0.43; 95% CI: 0.29, 0.62, p < 0.001).

CONCLUSION

While more smokers report that smoking causes blindness in Australia compared to other countries, which have not had national social marketing campaigns, further gains in knowledge were found after pictorial warning labels were introduced in Australia. Findings suggest there is still a need to educate the public about the causal association of smoking and blindness. More education may be needed to redress the knowledge gap in older Australian smokers as the incidence of age-related macular degeneration increases with age.

How Influences on Teenage Smoking Reflect Gender and Society in Mali, West Africa

Objectives

To provide further understanding and discussion on the influences on smoking in young people in Mali.

Design

A generic qualitative methodological approach was used following Caelli's generic principles. Six focus group discussions were conducted with a total of 31 participants followed by two semi-structured interviews. A reflexive account was kept to record development in the researcher's theoretical position

Setting

The setting was recreational areas of Bamako, capital city of Mali, West Africa.

Participants

Participants aged 13–15 years were recruited opportunistically in a recreational area of Bamako.

Mainoutcome measures

To develop further understanding of the influences of teenage smoking in Mali, West Africa.

Results

Five main categories that explained influences on youth smoking emerged: knowledge and awareness of smoking; associations with smoking; influential people; key messages in Malian society; and access to tobacco. The results showed that influences were complex and interwoven, notable gender differences were revealed, and the role of elder members of the community proved decisive in participants' smoking experiences. Participants described vague knowledge of the impact on health of smoking and reported trying smoking from an early age. Often contact with smoking was through elders and being sent to buy and sometimes light cigarettes for them. Associations with smoking were influenced by gender with smoking more desirable for boys than girls.

Conclusions

Any approach to preventing smoking initiation in young people requires an understanding of the social influences and pressures on young people. A tobacco control strategy is required to look at all areas of influence on smoking behaviours. Different needs should also account for the differing characteristics and perceptions of specific population groups.

Penetrating eye injuries from writing instruments

PURPOSE

To consider the potential for ocular injury from writing implements by presenting four such cases, and to consider the incidence of such eye injuries from analysis of a national trauma database.

METHODS

The Home and Leisure Accident Surveillance System was searched for records of eye injuries from writing instruments to provide UK estimates of such injuries. Four patients with ocular penetrating injury from pens or pencils (especially when caused by children), and examined by the authors, are described which illustrate mechanisms of injury.

RESULTS

It is estimated that around 748 ocular pen injuries and 892 ocular pencil injuries of undetermined severity occurred annually in the UK during the database surveillance period 2000-2002. No eye injuries from swords, including toy swords and fencing foils, were reported.

CONCLUSION

Ocular perforation sometimes occur from writing instruments that are thrown in the community, especially by children. Implications for policy and prevention are discussed. Non-specialists should have a low threshold for referring patients with eye injuries if suspicious of ocular penetration, even where caused by everyday objects, such as writing instruments.

Smoking cessation support in community pharmacies: is the association of smoking and eye disease an additional tool to increase uptake?

Objective

Community pharmacists have a central role in provision of smoking-cessation support. Evidence is growing that tobacco smoking is associated with development and progression of several potentially blinding eye diseases. As part of an ongoing programme of raising awareness of this link, we investigated whether community pharmacists are aware of this association and incorporate relevant advice into their smoking-cessation guidance.

Setting

Two-thousand and eighty community pharmacists in north west England, UK.

Method

A postal self-completion questionnaire asked pharmacists about their current practice with regard to smoking habits of their clients. Data were extracted and entered onto a database for statistical analyses.

Key findings

The response rate was 50.5%; 685 (65.2%) pharmacists asked clients about smoking habits; the most common situation was when clients complained of respiratory symptoms. Of these pharmacists, 52.7% always/usually recommended that smokers should stop and 37.2% always/usually assessed motivation to succeed. Help provided by pharmacists included brief advice on smoking cessation, leaflets, more structured support, referral to smoking-cessation services, and nicotine replacement therapies. The most common reason why pharmacists did not ask about smoking was lack of time (83.1%); 52.0% were aware of the causal association of smoking with eye disease, and 19.8% of those who asked about smoking habits mentioned this association when discussing smoking cessation.

Conclusion

Our study shows that community pharmacists are actively involved in smoking cessation. Many pharmacists are aware of the causal association between smoking and eye disease, but few are actively counselling patients about the eye heath risks of smoking. Community pharmacists could include this information in their advice to clients who smoke, as an additional means to promote smoking cessation.

Awareness of smoking risks and attitudes towards graphic health warning labels on cigarette packs: a cross-cultural study of two populations in Singapore and Scotland

BACKGROUND

Little is known about the level of awareness of blindness as a smoking-related condition, although the relationship has been well established.

AIM

To compare the awareness of smoking risks and the impact of graphic health warning labels on cigarette packs in discouraging smoking among adults in Singapore and Scotland.

METHODS

A cross-sectional survey using a structured interview of adults in ophthalmic, general medical, and general surgical outpatient clinics in Singapore and Scotland.

RESULTS

One hundred and fifteen out of 163 (70.6%) outpatients in Singapore and 105 out of 112 (93.8%) outpatients in Scotland responded to the study. In both samples, awareness levels for smoking-related diseases such as lung cancer, mouth and throat cancer, heart disease, and stroke were all greater than 85%. These were found to be significantly higher than the level of awareness of blindness as a smoking-related condition (chi (2)-test, P<0.001). Although the awareness of blindness as a smoking-related condition was greater in Singapore (36.5%) than in Scotland (30.5%), this difference was not statistically significant. More than half of the respondents indicated that graphic health warning labels would be effective in discouraging them from smoking.

CONCLUSION

Graphic health warning labels reading 'Smoking causes blindness' printed on cigarette packs may be useful in raising public awareness of blindness as a smoking-related condition and discouraging the habit of smoking in Singapore and Scotland.

Cigarette smoking and primary open angle glaucoma: a systematic review

PURPOSE

To evaluate the epidemiologic evidence for a causal association between tobacco smoking and primary open angle glaucoma (POAG).

METHODS

Systematic review, including quality assessment, of published analytical epidemiologic studies and evaluation of the evidence using established causality criteria (strength, consistency, temporality, dose response, reversibility, and biologic plausibility).

RESULTS

Eleven papers describing 9 case-control studies, 1 prospective cohort study, and a paper describing a pooled analysis based on 2 prospective cohort studies were included in the review. The methodologic quality of most included studies was poor. The strongest studies methodologically were the cohort studies on which the pooled analysis was based. Neither the prospective cohort study (rate ratio not reported) nor the pooled analysis of 2 prospective cohort studies (adjusted rate ratio 0.9) found an association between smoking and POAG. There was a significant positive association between smoking and POAG in only 2 of the case-control studies (adjusted odds ratio 2.9 and 10.8). There was no evidence of a dose-response relationship with smoking or of reversibility of effect in the studies where this was assessed.

CONCLUSIONS

This systematic review provided little evidence for a causal association between smoking and development of POAG. Given the limited evidence from high quality studies, and the possibility that flaws in many of the studies reviewed biased the results toward the null, further high quality research to confirm our conclusions is needed. However, it remains important to warn ophthalmic patients of the dangers of smoking and provide cessation support owing to the clear evidence of links between smoking and other ocular and systemic diseases.