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Wei LC. Concerns About the Safety of Electronic Cigarettes and Recent Amendments to Taiwan's Tobacco Control Law. Nicotine Tob Res 2024; 26:649. [PMID: 37934590 DOI: 10.1093/ntr/ntad215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Indexed: 11/09/2023]
Affiliation(s)
- Lien-Chung Wei
- Department of Addiction Psychiatry, Taoyuan Psychiatric Center, Ministry of Health and Welfare, Taoyuan City, Taiwan (ROC)
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2
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Jong HC, Zheng JQ, Zheng CM, Lin CH, Chiu CC, Hsu MH, Fang YA, Hao WR, Chen CC, Yang TY, Lee KY, Liu JC. Effect of Annual Influenza Vaccination on the Risk of Lung Cancer Among Patients With Hypertension: A Population-Based Cohort Study in Taiwan. Int J Public Health 2023; 68:1605370. [PMID: 37849687 PMCID: PMC10577198 DOI: 10.3389/ijph.2023.1605370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2022] [Accepted: 09/19/2023] [Indexed: 10/19/2023] Open
Abstract
Objectives: Lung cancer is a main contributor to all newly diagnosed cancers worldwide. The chemoprotective effect of the influenza vaccine among patients with hypertension remains unclear. Methods: A total of 37,022 patients with hypertension were retrospectively enrolled from the Taiwan National Health Insurance Research Database. These patients were further divided into a vaccinated group (n = 15,697) and an unvaccinated group (n = 21,325). Results: After adjusting for sex, age, comorbidities, medications, level of urbanization and monthly income, vaccinated patients had a significantly lower risk of lung cancer occurrence than unvaccinated patients (adjusted hazard ratio [aHR]: 0.56, 95% confidence interval [CI]: 0.47-0.67). A potential protective effect was observed for both sexes and in the elderly age group. With a greater total number of vaccinations, a potentially greater protective effect was observed (aHR: 0.75, 95% CI 0.60-0.95; aHR: 0.66, 95% CI: 0.53-0.82; aHR: 0.26, 95% CI: 0.19-0.36, after receiving 1, 2-3 and ≥4 vaccinations, respectively). Conclusion: Influenza vaccination was associated with a lower risk of lung cancer among patients with hypertension. The potentially chemoprotective effect appeared to be dose dependent.
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Affiliation(s)
- Hung-Chang Jong
- Division of Cardiology, Department of Internal Medicine, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan
| | - Jing-Quan Zheng
- Graduate Institute of Clinical Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
- Division of Pulmonary Medicine, Department of Internal Medicine, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan
- Division of Pulmonary Medicine, Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Cai-Mei Zheng
- Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
- Division of Nephrology, Department of Internal Medicine, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan
- Taipei Medical University Research Center of Urology and Kidney, Taipei Medical University, Taipei, Taiwan
| | - Cheng-Hsin Lin
- Taipei Heart Institute, Taipei Medical University, Taipei, Taiwan
- Division of Cardiovascular Surgery, Department of Surgery, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan
- Division of Cardiovascular Surgery, Department of Surgery, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Chun-Chih Chiu
- Division of Cardiology, Department of Internal Medicine, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan
- Taipei Heart Institute, Taipei Medical University, Taipei, Taiwan
- Division of Cardiology, Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Min-Huei Hsu
- Graduate Institute of Data Science, College of Management, Taipei Medical University, Taipei, Taiwan
- Department of Neurosurgery, Shuang Ho Hospital, Taipei Medical University, Taipei, Taiwan
| | - Yu-Ann Fang
- Division of Cardiology, Department of Internal Medicine, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan
- Taipei Heart Institute, Taipei Medical University, Taipei, Taiwan
- Division of Cardiology, Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Wen-Rui Hao
- Division of Cardiology, Department of Internal Medicine, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan
- Taipei Heart Institute, Taipei Medical University, Taipei, Taiwan
- Division of Cardiology, Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Chun-Chao Chen
- Division of Cardiology, Department of Internal Medicine, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan
- Taipei Heart Institute, Taipei Medical University, Taipei, Taiwan
- Division of Cardiology, Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
- Graduate Institute of Medical Sciences, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Tsung Yeh Yang
- Division of Cardiology, Department of Internal Medicine, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan
- Taipei Heart Institute, Taipei Medical University, Taipei, Taiwan
- Division of Cardiology, Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Kang-Yun Lee
- Graduate Institute of Clinical Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
- Division of Pulmonary Medicine, Department of Internal Medicine, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan
- Division of Pulmonary Medicine, Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Ju-Chi Liu
- Division of Cardiology, Department of Internal Medicine, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan
- Taipei Heart Institute, Taipei Medical University, Taipei, Taiwan
- Division of Cardiology, Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
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Chen CC, Tsai SS, Yang CY. Effects of the implementation of a mass rapid transit system on mortality rates attributed to cardiorespiratory complications in Taipei. JOURNAL OF TOXICOLOGY AND ENVIRONMENTAL HEALTH. PART A 2021; 84:914-921. [PMID: 34304721 DOI: 10.1080/15287394.2021.1954571] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Although Taipei City has encountered a fall in ambient air pollutant levels since 1996, the year its mass rapid transit (MRT) system commenced operation, no apparent study investigated changes in risks of death attributed to respiratory, cardiovascular, and cerebrovascular diseases in Taipei during this 23-year period. In order to examine the relationship between MRT and occurrence of respiratory and cardiovascular illnesses attributed to air contaminants, exposure over the 23 year duration was subdivided into the following periods: reference period 1 (1992-1995); period 2 (1996-2004), a time when there was a total track length of 67 km; period 3 (2005-2015), when the total track length was lengthened to 131.1 km; and period 4 (2016-2020), when it was further extended to 146.2 km. Taichung City, no MRT system, was used as an external reference population. The effect of Taipei's MRT system on rates of cause-specific death rates was analyzed using robust generalized Poisson regression models. After adjusting for age-standardized rates (ASRs), a decrease in relative risks (RRs) was found for non-trauma death and respiratory disease from periods 2 to 4. Even though the RRs were greater than 1.0 for cardiovascular and cerebrovascular diseases for periods 2 to 4, a downward trend was still noted in these RRs in Taipei. These findings suggest a relationship exists between air pollutant exposure and mortality. In addition, data demonstrated that implementation of the MRT in Taipei exerted beneficial health effects as evidenced by lower mortality rates.
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Affiliation(s)
- Chih-Cheng Chen
- Department of Pediatrics, College of Medicine, Kaohsiung Chang-Gung Memorial Hospital and Chang-Gung University, Kaohsiung, Taiwan
| | - Shang-Shyue Tsai
- Department of Healthcare Administration, I-Shou University, Kaohsiung, Taiwan
| | - Chun-Yuh Yang
- Department of Public Health, College of Health Sciences, Kaohsiung Medical University, Kaohsiung, Taiwan
- National Institute of Environmental Health Sciences, National Health Research Institute, Miaoli, Taiwan
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Role of Annual Influenza Vaccination against Lung Cancer in Type 2 Diabetic Patients from a Population-Based Cohort Study. J Clin Med 2021; 10:jcm10153434. [PMID: 34362218 PMCID: PMC8347140 DOI: 10.3390/jcm10153434] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Revised: 07/14/2021] [Accepted: 07/16/2021] [Indexed: 01/16/2023] Open
Abstract
Type 2 diabetes mellitus (DM) patients are at a higher risk for developing lung cancer due to immune dysfunction and chronic inflammation. They also have increased morbidity and mortality related to influenza, and it is recommended that they receive an annual influenza vaccination. In this study, we evaluate whether influenza vaccination could reduce the incidence of lung cancer in DM patients. This cohort study included DM patients (≥55 years old) between 1 January 2002 and 31 December 2012 by using the Taiwan Health Insurance Database. Cox proportional hazard regression method was used to compare the relation between the influenza vaccination and lung cancer incidence after adjusting for potential confounders. Sub-group analyses were done according to vaccination status (unvaccinated, total number of vaccinations: 1, 2–3, ≥4) and evaluated the dose-dependent effects on lung cancer events. Among 22,252 eligible DM patients, 7860 (35.32%) received an influenza vaccination and 67.68% (14392) did not receive an influenza vaccination. Lung cancer incidence was significantly lower in the vaccinated group versus the unvaccinated group (adjusted HR 0.77; 95% CI 0.62–0.95, p < 0.05). Significant protective effects were observed among male sex (adjusted HR 0.72; 95% CI 0.55–0.94, p < 0.05) and 55–64 year (adjusted HR 0.61; 95% CI 0.40–0.94, p < 0.05) and ≥75 year (adjusted HR 0.63; 95% CI 0.42–0.92, p < 0.05) age groups, respectively. A dose-dependent protective effect was noted with a significant protective effect in those that received ≥4 vaccinations (adjusted HR 0.42; 95% CI 0.29–0.61, p < 0.001). In sub-group analysis, elder patients with ≥65 years of age were significantly protected from ≥4 vaccinations (adjusted HR 0.37; 95% CI 0.23–0.62, p < 0.001 in 65–74 years and adjusted HR 0.31; 95% CI 0.15–0.66, p = 0.002 in ≥75 years group, respectively). Male sex with ≥4 vaccinations had a significantly lower risk of lung cancer (adjusted HR 0.35; 95% CI 0.21–0.57, p < 0.001). Patients with comorbid conditions that received ≥4 vaccinations were also protected, and was especially significant among those with CCI ≥ 3 (adjusted HR 0.38; 95% CI 0.18–0.80, p = 0.009) as compared to 1 and 2–3 vaccination groups, including those with hypertension (adjusted HR 0.35; 95% CI 0.22–0.57, p < 0.001). This population-based cohort study demonstrated that annual influenza vaccination significantly reduced the lung cancer risk in DM patients and specifically demonstrates that a higher number of vaccinations is related with a more protective effect. Whether this is due to vaccine booster effects on anti-tumor immune regulation among DM patients still needs to be explored.
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Gender Differences in the Extended Theory of Planned Behaviour on Smoking Cessation Intention in Young Soldiers. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18157834. [PMID: 34360123 PMCID: PMC8345414 DOI: 10.3390/ijerph18157834] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Revised: 07/10/2021] [Accepted: 07/19/2021] [Indexed: 11/16/2022]
Abstract
Background: The theory of planned behaviour (TPB) explanation of smoking cessation intentions consists of gender differences. The purpose of this study is to adopt the extended TPB to discuss factors influencing the smoking cessation intentions of young adult volunteer soldiers and to further compare the respective factors for both genders. Methods: This is a cross-sectional study. Data were collected from 139 and 165 male and female volunteer soldiers who smoked, respectively. Research participants completed a self-administered questionnaire that comprised items pertaining to the participants’ demographic characteristics, smoking behaviours, smoking cessation experiences, social environments, and TPB variables. Results: Subjective norms (friends) are a positive key factor for young adult male (β = 0.033, p = 0.012) and female (β = 0.076, p < 0.001) volunteer soldiers’ smoking cessation intentions, and perceived behavioural control is a key factor for male young (β = 0.226, p = 0.040) adult volunteer soldiers’ smoking cessation intention. The extended TPB accounted for 27.9% and 53.2% of the variance in the intention to quit smoking in the male and female volunteer soldiers, respectively. Conclusions: We suggest that smoking cessation strategies can reinforce gender-specific intervention strategies to assist young adult volunteer soldiers in smoking cessation.
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Nicotine Replacement Therapy and Healthy Lifestyle Psychoeducation for Smoking Reduction in Acute Psychiatric Inpatients: A Cluster-Randomized Parallel Study. J Clin Psychopharmacol 2020; 40:149-156. [PMID: 32032137 DOI: 10.1097/jcp.0000000000001170] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
BACKGROUND Effectiveness of nicotine replacement therapies in acute psychiatric inpatient settings remains under-researched. The aim of this study was to compare effectiveness and acceptability of 3 different forms of nicotine replacement therapy in achieving smoking reduction among acute psychiatric inpatients. METHODS This cluster-randomized, parallel study compared effectiveness and acceptability of nicotine inhalers, nicotine gum, and nicotine patches for smoking reduction in the acute psychiatric inpatient setting. The primary outcome was the exhaled breath carbon monoxide (CO) level change from baseline at weeks 4 and 8. Secondary outcomes included changes in nicotine withdrawal symptoms and psychiatric symptom severity. RESULTS Three hundred ten inpatients on the acute care wards were randomly assigned to nicotine inhalers (n = 184), gum (n = 71), and patches (n = 55). Only the nicotine inhaler group showed statistically significant reduction in CO level from baseline at both weeks 4 and 8 (P < 0.001 and P = 0.032, respectively). The nicotine inhaler and the patch group showed significant decrease in nicotine withdrawal symptoms from baseline at both weeks 4 and 8. Meanwhile, the nicotine inhaler and the gum group showed significant decrease in psychiatric symptom severity from baseline at both weeks 4 and 8. Post hoc comparisons revealed that the inhaler group had a greater decrease in psychiatric symptom severity compared with the patch group. CONCLUSIONS Nicotine inhalers may be an effective choice for smoking reduction in acute psychiatric inpatient settings given its significant effects on CO level, withdrawal symptoms, and psychiatric symptom severity, particularly during the first 4 weeks of treatment.
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Yarmohammadi S, Mousavi S, Ghaffari M, Ranaei V. The effect of personal and environmental factors on smoking behaviors in students: structural equation model. JOURNAL OF SUBSTANCE USE 2020. [DOI: 10.1080/14659891.2020.1846806] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- Soudabeh Yarmohammadi
- Student Research committee, Department and Faculty of Health Education and Health Promotion, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Samira Mousavi
- MS in Biostatistics, Tehran University of Medical Sciences,Tehran, Iran
| | - Mohtasham Ghaffari
- Health Education & Health Promotion, Environmental and Occupational Hazards Control Research Centre, School of Public Health & Safety, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Vahid Ranaei
- Social Determinants in Health Promotion Research Center, Hormozgan Health in Stitute, Hormozgan University of Medical Sciences, Bandar Abbas, Iran
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Keeler C, Max W, Yerger VB, Yao T, Wang Y, Ong MK, Sung HY. Effects of Cigarette Prices on Intention to Quit, Quit Attempts, and Successful Cessation Among African American Smokers. Nicotine Tob Res 2020; 22:522-531. [PMID: 30032184 DOI: 10.1093/ntr/nty149] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2018] [Accepted: 07/16/2018] [Indexed: 01/28/2023]
Abstract
INTRODUCTION This study examined the effects of cigarette price on intention to quit, quit attempts, and successful cessation among African American smokers in the United States and explored whether price effects differed by income level and menthol use status. Price effects were further compared to White counterparts. METHODS We used pooled cross-sectional data from 2006 to 2007 and 2010 to 2011 Tobacco Use Supplements to the Current Population Survey to analyze 4213 African American recent active smokers. Three dependent variables were examined: any quit attempts in the past 12 months, successful cessation for at least 3 months, and intention to quit in the next 6 months. For each dependent variable, separate multiple logistic regression models were estimated to determine the impact of cigarette prices. RESULTS There was no indication that price was associated with quit attempts or successful cessation, but price was positively associated with increased odds of intending to quit among African American smokers (p < .001). In contrast, prices were positively associated with intention to quit and quit attempts for White smokers. The association between price and intention to quit was significantly positive for African American low-income and menthol smokers but was not statistically significant for African American high-income and non-menthol smokers. There was no evidence of a price effect on quit attempts and successful cessation for each subgroup of African Americans. CONCLUSIONS Tobacco tax policy alone may not be enough to increase quit attempts or successful cessation among African Americans. Community-based cessation programs tailored toward African American smokers, especially low-income menthol smokers, are needed. IMPLICATIONS The results revealed that, among African American smokers, particularly among low-income and menthol smoking African American smokers, price appears to be positively associated with intention to quit; nevertheless, this deterrent effect does not appear to translate to actualized quit attempts or successful cessation. Increasing cigarette prices as a standalone policy may not be independently effective in increasing quit attempts and successful cessation within the African American community. Community-based cessation interventions tailored for African Americans are needed to help further translate desired cessation into actualized quit attempts.
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Affiliation(s)
- Courtney Keeler
- Population Health Sciences Department, School of Nursing and Health Professions, University of San Francisco, San Francisco, CA
| | - Wendy Max
- Institute for Health and Aging, School of Nursing, University of California San Francisco, San Francisco, CA
| | - Valerie B Yerger
- Department of Social and Behavioral Sciences, School of Nursing, University of California San Francisco, San Francisco, CA
| | - Tingting Yao
- Institute for Health and Aging, School of Nursing, University of California San Francisco, San Francisco, CA
| | - Yingning Wang
- Institute for Health and Aging, School of Nursing, University of California San Francisco, San Francisco, CA
| | - Michael K Ong
- Department of Medicine, University of California Los Angeles, Los Angeles, CA.,Department of Medicine, VA Greater Los Angeles Healthcare System, Los Angeles, CA
| | - Hai-Yen Sung
- Institute for Health and Aging, School of Nursing, University of California San Francisco, San Francisco, CA
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Liang HJ, Wu MJ, Jerng JS, Yang CH. Reinforcement of Tobacco Control and Reduction in Medical Utilization for Asthma in Taiwan: A Population-Based Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:E3950. [PMID: 31627282 PMCID: PMC6844081 DOI: 10.3390/ijerph16203950] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/23/2019] [Revised: 09/26/2019] [Accepted: 10/15/2019] [Indexed: 11/21/2022]
Abstract
Environmental air quality can affect asthma control and the development of overt asthmatic manifestations. In this population-based study, we investigated the effect of reinforcing a smoking ban in Taiwan through the enactment of the Tobacco Hazards and Prevention Act (THPA) on healthcare utilization rate by asthmatics. Analysis was performed based on data relevant to non-hospitalized asthmatic patients with insurance claims between 2005 and 2013 from the National Health Insurance Research Database of Taiwan, reported data on Asian dust storms, and penalty rates for violations of the tobacco ban. Poisson regression showed that the risk for outpatient visits for asthma was lower after enactment of the THPA (RR = 0.98, 95% CI = 0.98-0.99), with a yearly trend of a reduced risk (RR = 0.99, 95% CI = 0.99-1.00), also lower in geographic regions with medium (RR = 0.79, 95% CI = 0.79-0.80) and high (RR = 0.91, 95% CI = 0.91-0.92) penalty rates. Subgroup analysis showed that asthma visit rates were reduced in both male and female groups after the enactment of the THPA. The risk of an asthma ER visit was increased after the enactment of the amended THPA (RR = 1.07, 95% CI = 1.05-1.09), although the yearly trend was not significant (RR = 1.00, 95% CI = 1.00-1.00). The risk of emergency room visits for asthma was significantly reduced in regions with medium (RR = 0.68, 95% CI = 0.68-0.69) and high (RR = 0.75, 95% CI = 0.74-0.76) penalty rates. Subgroup analysis showed that the visit rates were similar in both male and female groups. The effectiveness of reinforcing the smoking ban warrants further policies aimed at further reducing passive smoking.
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Affiliation(s)
- Huang-Ju Liang
- Department of Health Care Management, National Taipei University of Nursing and Health Sciences, Taipei 108, Taiwan.
- Center for Quality Management, National Taiwan University Hospital, Taipei 100, Taiwan.
| | - Ming-Jiuan Wu
- Department of Business and Management, Ming Chi University of Technology, New Taipei City 243, Taiwan.
| | - Jih-Shuin Jerng
- Center for Quality Management, National Taiwan University Hospital, Taipei 100, Taiwan.
- Department of Internal Medicine, National Taiwan University Hospital, Taipei 100, Taiwan.
| | - Chiang-Hsing Yang
- Department of Health Care Management, National Taipei University of Nursing and Health Sciences, Taipei 108, Taiwan.
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Gao W, Sanna M, Branston JR, Chiou HY, Chen YH, Wu A, Wen CP. Exploiting a low tax system: non-tax-induced cigarette price increases in Taiwan 2011-2016. Tob Control 2019; 28:e126-e132. [PMID: 31164488 PMCID: PMC6996108 DOI: 10.1136/tobaccocontrol-2018-054908] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2018] [Revised: 04/11/2019] [Accepted: 04/26/2019] [Indexed: 11/20/2022]
Abstract
Introduction This study aims to analyse the non-tax-induced price increasing strategies adopted by tobacco industry in Taiwan, a high-income country with comprehensive tobacco control policies but low tobacco taxes and a declining cigarette market. Methods Using governmental tax, price and inflation data, we analysed cigarette sales volume, affordability, affordability elasticity of demand, market share, pricing and net revenue of the top five tobacco companies in Taiwan from 2011 to 2016 when no tax increases occurred. Results Total revenue after tax grew significantly for all the major transnational tobacco companies between 2011 and 2016 at the expense of the state-owned Taiwan Tobacco and Liquor Corporation. In terms of market share, Japan Tobacco (JT) was the leading company, despite experiencing a small decline, while British American Tobacco and Imperial Brands remained stable, and Philip Morris International increased from 4.7% to 7.0%. JT adopted the most effective pricing strategy by increasing the real price of its two most popular brands (Mevius and Mi-Ne) and, at the same time, doubling the sales of its cheaper and less popular brand Winston by leaving its nominal retail price unaltered. Conclusions Low and unchanged tobacco taxes enable tobacco companies to use aggressive pricing and segmentation strategies to increase the real price of cigarettes without making them less affordable while simultaneously maintaining customers’ loyalty. It is crucial to continue monitoring the industry’s pricing strategies and to regularly increase taxes to promote public health and to prevent tobacco industry from profiting at the expense of government revenues.
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Affiliation(s)
- Wayne Gao
- Master's Program in Global Health and Development, Taipei Medical University, Taipei, Taiwan
| | - Mattia Sanna
- Master's Program in Global Health and Development, Taipei Medical University, Taipei, Taiwan
| | | | - Hung-Yi Chiou
- School of Public Health, Taipei Medical University, Taipei, Taiwan
| | - Yi-Hua Chen
- School of Public Health, Taipei Medical University, Taipei, Taiwan
| | - Allison Wu
- Master's Program in Global Health and Development, Taipei Medical University, Taipei, Taiwan
| | - Chi Pang Wen
- Institute of Population Health Sciences, National Health Research Institutes, Miaoli County, Taiwan.,China Medical University Hospital, Taichung, Taiwan
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Huang CM, Liao JY, Huang SF, Hsu YT, Hsu HP, Guo JL. Patterns of parents' perspectives on protecting young children from secondhand smoke exposure: A Q-methodology study. J Adv Nurs 2019; 75:2591-2602. [PMID: 30993733 DOI: 10.1111/jan.14029] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2018] [Revised: 01/29/2019] [Accepted: 03/05/2019] [Indexed: 11/29/2022]
Abstract
AIMS To identify and describe the various patterns of parents' perspectives on avoiding secondhand smoke exposure. DESIGN Q methodology was applied to investigate the parental perspectives of 50 parents. METHODS The study was implemented from September-December 2016. Forty-two Q-statements were constructed based on the literature related to parental attitudes and prevention practices regarding preventing young children from experiencing secondhand smoke exposure. A series of Q-sorts was performed by the participants to rank the statements into a Q-sort grid. PQMethod 2.35 software was used to perform principal component analysis to identify different patterns of parents' perspectives. RESULTS Five patterns of shared perspectives, which accounted for 62% of the total variance, were derived from the analysis: (a) lack of confidence to confront smokers in non-smoking areas; (b) awareness of health hazards but not ready to take preventive actions; (c) emphasis on parental responsibility and behavioural guidance; (d) awareness of health rights protected by legislation; and (e) strong willingness to take protective actions. CONCLUSION Our findings revealed the shared perspectives of five groups of parents. The exploration of clusters of parents could assist healthcare professionals in acknowledging parents' tendencies related to attitudes and responses towards secondhand smoke exposure. IMPACT Using a forced distribution through the Q-sorting technique, the particular perspective patterns of parents' experiences would be captured. These findings can serve as a useful guide for researchers and practitioners to develop tailored intervention programs for parents with the purpose of reducing secondhand smoke exposure in young children.
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Affiliation(s)
- Chiu-Mieh Huang
- Institute of Clinical Nursing, School of Nursing, National Yang-Ming University, Taipei, Taiwan
| | - Jung-Yu Liao
- Department of Health Promotion and Health Education, College of Education, National Taiwan Normal University, Taipei, Taiwan
| | - Su-Fei Huang
- Department of Senior Citizen Service, Mackay Junior College of Medicine, Taipei, Taiwan
| | | | - Hsiao-Pei Hsu
- Institute of Clinical Nursing, School of Nursing, National Yang-Ming University, Taipei, Taiwan
| | - Jong-Long Guo
- Department of Health Promotion and Health Education, College of Education, National Taiwan Normal University, Taipei, Taiwan
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Tsay MD, Hsieh MJ, Wang SS, Wang WC, Chou YY, Shih CH, Yang SF, Chou YE. Impact of endothelial nitric oxide synthase polymorphisms on urothelial cell carcinoma development. Urol Oncol 2019; 37:293.e1-293.e9. [PMID: 30611644 DOI: 10.1016/j.urolonc.2018.12.023] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2018] [Revised: 12/03/2018] [Accepted: 12/22/2018] [Indexed: 01/04/2023]
Abstract
OBJECTIVES Urothelial cell carcinoma (UCC), a major malignancy of the genitourinary tract, is induced through carcinogenic etiological factors. Endothelial nitric oxide synthase (eNOS) is one of the major isoforms of nitric oxide synthase and is involved in various pathophysiologic and physiologic processes. In this study, eNOS single-nucleotide polymorphisms were investigated to evaluate UCC susceptibility and clinicopathological characteristics. MATERIALS AND METHODS Two single-nucleotide polymorphisms of eNOS in 431 patients with UCC and 862 controls without cancer were analyzed using real-time polymerase chain reaction. RESULTS The results showed that 272 men with UCC having eNOS 894 G > T rs1799983 "GT + TT" variants had a high risk of developing a large tumor (T1-T4, P = 0.038). Furthermore, a correlation was observed between the expressions of eNOS and invasive tumor, metastasis and poor survival in urothelial carcinoma in The Cancer Genome Atlas data set. CONCLUSION Our results indicated that male patients with UCC carrying eNOS 894 G > T rs1799983 "GT + TT" genetic variants have a high risk of developing a large tumor, and eNOS polymorphisms may serve as a marker or therapeutic target in UCC treatment.
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Affiliation(s)
- Ming-Dow Tsay
- Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan; Department of Family medicine, Tungs' Taichung MetroHarbor Hospital, Taichung, Taiwan
| | - Ming-Ju Hsieh
- Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan; Cancer Research Center, Changhua Christian Hospital, Changhua, Taiwan; Graduate Institute of Biomedical Sciences, China Medical University, Taichung, Taiwan
| | - Shian-Shiang Wang
- Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan; School of Medicine, Chung Shan Medical University, Taichung, Taiwan; Division of Urology, Department of Surgery, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Wen-Chen Wang
- School of Medical Laboratory and Biotechnology, Chung Shan Medical University, Taichung, Taiwan
| | - Ya-Yi Chou
- School of Medical Laboratory and Biotechnology, Chung Shan Medical University, Taichung, Taiwan
| | - Chen-Ho Shih
- School of Medical Laboratory and Biotechnology, Chung Shan Medical University, Taichung, Taiwan
| | - Shun-Fa Yang
- Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan; Department of Medical Research, Chung Shan Medical University Hospital, Taichung, Taiwan
| | - Ying-Erh Chou
- Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan; School of Medicine, Chung Shan Medical University, Taichung, Taiwan; Department of Medical Research, Chung Shan Medical University Hospital, Taichung, Taiwan.
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13
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Chen CC, Huang YT, Yang CY. Effects of national smoke-free legislation on the rates of preterm births and low birthweights in Taiwan. JOURNAL OF TOXICOLOGY AND ENVIRONMENTAL HEALTH. PART A 2018; 81:1207-1213. [PMID: 30465629 DOI: 10.1080/15287394.2018.1547669] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
This study evaluated the effects of partial and complete island-wide smoking bans on perinatal outcomes in Taiwan. Trends were determined in the yearly prevalence rates for preterm births and low birth weight (LBW) for a 1978 to 1997 pre-ban period, a 1998 to 2008 Phase 1 partial ban period, and a 2009 to 2016 Phase 2 complete ban period. Poisson regression with a yearly time-series model was employed to determine alterations in trends in prevalence rates for preterm births and LBW. Compared with pre-ban period, the rate ratio (RR) for Phase 1 preterm births was 0.969 (95% confidence interval [CI] = 0.968-0.971) and Phase 2 0.995 (95% CI = 0.992-0.998). The Phase 1 RR LBW fell 0.4% (95% CI = 0.2%-0.5%), but Phase 2 RR rose 1.7% (95% CI = 1.4%-2.1%). Data indicated that the risk of preterm births and LBW in Taiwan was reduced significantly after implementation of the smoking ban. These findings are in agreement with growing evidence suggesting that smoke-free legislation exerted a beneficial health effect on pregnant women and their newborn infants.
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Affiliation(s)
- Chih-Cheng Chen
- a Department of Pediatrics, College of Medicine , Kaohsiung Chang-Gung Memorial Hospital and Chang-Gung University , Kaohsiung , Taiwan
| | - Yu-Tung Huang
- b Master program in Aging and Long-term Care, College of Nursing , Kaohsiung Medical University , Kaohsiung , Taiwan
| | - Chun-Yuh Yang
- c Faculty of Public Health, College of Health Sciences , Kaohsiung Medical University , Kaohsiung , Taiwan
- d National Institute of Environmental Health Sciences, National Health Research Institute , Miaoli , Taiwan
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14
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Chen YL, Wu SC, Chen YT, Hsiao PC, Yu YH, Ting TT, Chen CY, Tu YK, Huang JH, Yang HJ, Li CY, Strong C, Yen CF, Yen CF, Chen WJ. E-Cigarette Use in a Country With Prevalent Tobacco Smoking: A Population-Based Study in Taiwan. J Epidemiol 2018; 29:155-163. [PMID: 30175730 PMCID: PMC6414808 DOI: 10.2188/jea.je20170300] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND The different profiles of e-cigarette users in different age groups have seldom been investigated, particularly in populations facing a high prevalence of cigarette smoking. This study aims to examine the prevalence and correlates of e-cigarette use separately for adolescents and adults in nationally representative samples in Taiwan. METHODS Among 17,837 participants in the 2014 National Survey of Substance Use in Taiwan, 4445 were aged 12 to 17 years and 13,392 were aged 18 to 64 years. Individuals' lifetime tobacco use was divided into four groups: non-use, exclusive e-cigarette use, exclusive cigarette use, and dual use. Questions on sociodemographic features, use and problematic use of tobacco, alcohol, and other drugs, and psychosocial distress, among others, were administered using a computer-assisted self-interview on tablet computers. RESULTS Among lifetime users of e-cigarette (2.2% for adults and 0.8% for adolescents), 4.5% for adults and 36.6% for adolescents were exclusive e-cigarette users. From use of exclusive e-cigarettes to use of exclusive cigarettes to dual use, those usage groups were related to an increasing trend of adjusted odds ratios for use of other psychoactive substances, particularly problematic use of alcohol or drugs, and with more depressive symptoms. Two correlates were specific to e-cigarette use: alcohol use had stronger relationships with e-cigarette use among adolescents, and younger adults (18-34) were more likely to try e-cigarettes compared to older adults. CONCLUSIONS These results provide essential information regarding e-cigarette use in the general population, and future prevention strategies should account for its specific correlates in young people.
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Affiliation(s)
- Yi-Lung Chen
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University
| | - Shang-Chi Wu
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University
| | - Yen-Tyng Chen
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University.,Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University
| | - Po-Chang Hsiao
- Genetic Epidemiology Core, Center of Genomic Medicine, National Taiwan University
| | - Ya-Hui Yu
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University
| | - Te-Tien Ting
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University.,School of Big Data Management, Soochow University
| | - Chuan-Yu Chen
- Department of Public Health, College of Public Health, National Taiwan University.,Institute of Public Health, National Yang-Ming University.,Center of Neuropsychiatric Research, National Health Research Institutes
| | - Yu-Kang Tu
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University.,Department of Public Health, College of Public Health, National Taiwan University
| | - Jiun-Hau Huang
- Department of Public Health, College of Public Health, National Taiwan University.,Institute of Health Behaviors and Community Sciences, College of Public Health, National Taiwan University
| | - Hao-Jan Yang
- Department of Public Health, College of Health Care and Management, Chung Shan Medical University
| | - Chung-Yi Li
- Department of Public Health, College of Medicine, National Cheng Kung University
| | - Carol Strong
- Department of Public Health, College of Medicine, National Cheng Kung University
| | - Cheng-Fang Yen
- Department of Psychiatry, Kaohsiung Medical University Hospital & School of Medicine and Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University
| | - Chia-Feng Yen
- Department of Public Health, College of Medicine, Tzu Chi University
| | - Wei J Chen
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University.,Genetic Epidemiology Core, Center of Genomic Medicine, National Taiwan University.,Department of Public Health, College of Public Health, National Taiwan University
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15
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Keeler C, Max W, Yerger V, Yao T, Ong MK, Sung HY. The Association of Menthol Cigarette Use With Quit Attempts, Successful Cessation, and Intention to Quit Across Racial/Ethnic Groups in the United States. Nicotine Tob Res 2018; 19:1450-1464. [PMID: 27613927 DOI: 10.1093/ntr/ntw215] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2016] [Accepted: 08/16/2016] [Indexed: 11/13/2022]
Abstract
Introduction Few studies have examined the relationship between menthol use and smoking cessation across various racial/ethnic groups; the findings were mixed. This study explored the association of menthol cigarette use with quit attempts, smoking cessation, and intention-to-quit among US adults and by race/ethnicity. Methods Using the 2006/2007 and 2010/2011 Tobacco Use Supplements to the Current Population Survey data, this study analyzed 54 448 recent active smokers, defined as current smokers or former smokers who quit less than 12 months ago. Three behaviors were examined: any quit attempts in the past 12 months, successful cessation for ≥3 months, and intention-to-quit smoking in the next 6 months. For each cessation behavior, multiple logistic regression models were estimated separately for the full-sample and stratified racial/ethnic subsamples. Results While 72.3% of African American recent active smokers typically smoked menthol cigarettes, this proportion was 21.7%, 21.5%, and 28.0% for whites, Asians, and Hispanics, respectively. African American menthol smokers had higher odds of quit attempts compared to non-African American, non-menthol smokers (full-sample analysis), as well as African American non-menthol smokers (subsample analysis). Menthol use was not significantly associated with quit attempts in other racial/ethnic subsamples. There was no significant difference in either successful cessation or intention-to-quit between menthol and non-menthol smokers. Conclusions African American menthol smokers were more likely to attempt to quit smoking than non-menthol smokers but these quit attempts did not translate into successful cessation. This study revealed no association of menthol use with quit attempts, successful cessation, and intention-to-quit among other racial/ethnic groups. Implications The findings suggested that African American menthol smokers were more motivated to quit smoking; yet, the results also indicated no significant differences in successful cessation between African American menthol and non-menthol smokers. Interventions targeting menthol smokers within the African American community may help bridge this gap. While more local sales restrictions are beginning to occur (eg, Tobacco 21 efforts), additional policies restricting price discounting as well as the regulation of access to and the time, place, and/or manner of menthol tobacco advertising could also improve cessation rates. Further evaluation is needed to determine the viability of these policies.
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Affiliation(s)
- Courtney Keeler
- Department of Population Health Sciences, School of Nursing, University of San Francisco, San Francisco, CA
| | - Wendy Max
- Institute for Health and Aging, School of Nursing, University of California, San Francisco, CA
| | - Valerie Yerger
- Department of Social and Behavioral Sciences, School of Nursing, University of California, San Francisco, CA
| | - Tingting Yao
- Institute for Health and Aging, School of Nursing, University of California, San Francisco, CA
| | - Michael K Ong
- Department of Medicine, University of California, Los Angeles, CA.,Department of Medicine, VA Greater Los Angeles Healthcare System, Los Angeles, CA
| | - Hai-Yen Sung
- Institute for Health and Aging, School of Nursing, University of California, San Francisco, CA
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16
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Eckhardt J, Fang J, Lee K. The Taiwan Tobacco and Liquor Corporation: To 'join the ranks of global companies'. Glob Public Health 2017; 12:335-350. [PMID: 28139964 PMCID: PMC5553428 DOI: 10.1080/17441692.2016.1273366] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Until the late 1990s, the Taiwan Tobacco and Liquor Corporation (TTL) focused almost exclusively on serving the domestic market as a highly protected monopoly. This paper describes how the company has adopted a more outward looking strategy since 2000, with ambitions to become a regional, and eventually global, business by 2021. Drawing on company documents and industry sources, the paper argues that this shift in strategy was a direct reaction to the decline in domestic market share following liberalisation of the Taiwanese tobacco market and adoption of tougher domestic tobacco control measures. Market opening occurred as a result of pressure from the U.S. Trade Representative in the 1980s, as well as World Trade Organization membership in 2002. It is argued that TTL’s efforts to globalise operations have been limited by bureaucratic company management and structures, and ongoing political tension between Taiwan and China. However, the relative success of TTL’s alcohol branch, and potential détente as the Taiwanese government reaches out to improve relations with China, may provide TTL with new opportunities to achieve its goal of becoming a regional player with global ambitions. This article is part of the special issue ‘The Emergence of Asian Tobacco Companies: Implications for Global Health Governance.’
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Affiliation(s)
- Jappe Eckhardt
- a Department of Politics , University of York , York , UK
| | - Jennifer Fang
- b Faculty of Health Sciences , Simon Fraser University , Burnaby , British Columbia , Canada
| | - Kelley Lee
- b Faculty of Health Sciences , Simon Fraser University , Burnaby , British Columbia , Canada
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17
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Shu BC, Lung FW, Guo SE, Chen KC, Fang SY, Wang AL. Ineffectiveness of the Tobacco Hazards Prevention Act in patients with severe and persistent mental illness. Public Health 2017; 153:118-127. [PMID: 29032168 DOI: 10.1016/j.puhe.2017.08.006] [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: 01/04/2017] [Revised: 08/03/2017] [Accepted: 08/20/2017] [Indexed: 11/28/2022]
Abstract
OBJECTIVES The effect of the Tobacco Hazards Prevention Act (THPA) on the reduction of tobacco use in the general population in Taiwan is understood. However, there has been little research on how these policies affect people with severe and persistent mental illness (SPMI). Hence, the influence of the THPA on daily cigarette use by patients with SPMI was investigated in a 3-year follow-up. The risk and protective factors in smoking behavior and cessation were investigated. STUDY DESIGN This is an observational study. METHODS A total of 144 participants (78 of whom had smoked >100 cigarettes throughout their lifetime) were randomly selected from a healthcare network. Then, 100 of 144 patients with SPMI, included 50 smokers and 50 non-smokers, have agreed with 1st year follow-up. Eighty-two patients with SPMI, consisted of 44 smokers and 38 non-smokers, have agreed with 2nd year follow-up. RESULTS Although women were less likely to smoke than men, those who did smoke reduced the number of cigarettes less than men over the 3-year period. Less-educated patients were more likely to smoke than those who were more educated but reduced the number of daily cigarettes more after implementation of the THPA. Maternal overprotection was a risk factor and paternal care a protective factor for smoking. Addiction, a perception of pleasure, interpersonal relationships, and self-destructive behavior increased cigarette smoking. Patients perceived that smoking alleviated their depressive symptoms. CONCLUSIONS The THPA was ineffective for patients with SPMI. Some factors had different effects on the development of smoking behavior and the cessation process. Understanding the etiology of smoking can help policymakers establish more effective programs for smoking prevention and cessation.
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Affiliation(s)
- B-C Shu
- Institute of Allied Health Sciences and Department of Nursing, National Cheng Kung University, Tainan, Taiwan
| | - F-W Lung
- Calo Psychiatric Center, Pingtung County, Taiwan; Graduate Institute of Medical Science, National Defense Medical University, Taipei, Taiwan; Department of Neurology, Kaohsiung Medical University, Kaohsiung, Taiwan.
| | - S-E Guo
- Graduate Institute of Nursing and Chronic Diseases and Health Promotion Research Center, Chang Gung University of Science and Technology, Chiayi, Taiwan
| | - K-C Chen
- Department of Psychiatry, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Addiction Research Center, National Cheng Kung University, Tainan, Taiwan
| | - S-Y Fang
- Department of Nursing, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - A-L Wang
- National Cheng Kung University Hospital Dou-Liou Branch, Tainan, Taiwan
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18
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Yang YN, Huang YT, Yang CY. Effects of a national smoking ban on hospital admissions for cardiovascular diseases: a time-series analysis in Taiwan. JOURNAL OF TOXICOLOGY AND ENVIRONMENTAL HEALTH. PART A 2017; 80:562-568. [PMID: 28880815 DOI: 10.1080/15287394.2017.1367085] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
On January 11, 2009, a comprehensive smoking ban was implemented in Taiwan. The aim of this study was to evaluate the effect of this ban on hospital admissions for ischemic heart disease (IHD). Trends in the country-level monthly hospital admission rates for IHD were determined and frequency compared to other conditions such as control conditions cholecystitis, bowel obstruction, and appendicitis from January 1997 (1 year before the first phase of smoke-free laws was implemented) to December 2012 (3 years after the second phase of the ban). Poisson regression with a monthly time-series model was used to determine alterations in the trend of admission rates for IHD with comparison to rates of other disorders after the ban. Hospital admissions for IHD decreased by 0.8% (incidence rate ratio [RR]: 0.992; 95% confidence interval [CI] = 0.991-0.994) and 1.1% (incidence RR: 0.989; 95% CI = 0.988-0.991) following the first (September 19, 1997 to January 10, 2009) and second (January 11, 2009 to December 31, 2012) phases of the ban, respectively, compared with those prior to the pre-ban period, the corresponding values for the control conditions were 0.6% (95% CI = 0.5%-0.7%) and 0.7% (95% CI = 0.6%-0.9%). The admission rates significantly fell for both men and women and for all examined age categories after both first and second phases of the ban. The present findings provide evidence of a significant reduction in hospital admissions for IHD in Taiwan following smoking bans.
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Affiliation(s)
- Yue-Nin Yang
- a Department of Public Health , College of Health Sciences, Kaohsiung, Medical University , Kaohsiung , Taiwan
| | - Yu-Tung Huang
- b Master program in Aging and Long-term Care , College of Nursing, Kaohsiung Medical University , Kaohsiung , Taiwan
| | - Chun-Yuh Yang
- c Faculty of Public Health , College of Health Sciences, Kaohsiung, Medical University , Kaohsiung , Taiwan
- d Division of Environmental Health and Occupational Medicine , National Health Research Institute , Miaoli , Taiwan
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Mori T, Tsuge T. Best-worst scaling survey of preferences regarding the adverse effects of tobacco use in China. SSM Popul Health 2017; 3:624-632. [PMID: 29349250 PMCID: PMC5769045 DOI: 10.1016/j.ssmph.2017.07.011] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2017] [Revised: 07/09/2017] [Accepted: 07/26/2017] [Indexed: 11/16/2022] Open
Abstract
We use best–worst scaling to assess two types of concern levels of the adverse consequences of smoking in China. While the smoking cessation policy has worked well in Taiwan, more than 1 million people in mainland China are estimated to die every year from tobacco use. This study compares the preferences of Chinese individuals in the two jurisdictions (mainland versus Taiwan) and explores the possibility of information-based interventions. The relative importance of 13 adverse effects was assessed by conducting a web-based survey on a sample of 480 Chinese participants. The 13 items consist of various adverse effects of tobacco use: from long-term health risk, such as lung cancer and cardiovascular diseases, to reduction of physical capacity and sexual dysfunction, and disturbance to non-smokers. The resulting data suggest possible strategies to curb smoking. Subgroup analysis, focusing on gender, smoking status, and nicotine dependence, was also conducted. Lung cancer, cardiovascular diseases, and chronic obstructive pulmonary disease, in this order, rank highest for both types of respondents. On the other hand, high expenditures (13th) and weight gain after cessation (12th) are the lowest ranked for both. Measuring individual best–worst scores reveals substantial heterogeneity among respondents and that information-based intervention can help curb smoking. Best-worst scaling (BWS) is used to assess concerns on tobacco adverse effects. Adverse effects of tobacco are assessed for mainland and Taiwan residents. Lung cancer, cardiovascular diseases, and COPD rank highest for both. Information-based interventions are explored for Chinese smokers. Comparative results provide insights for a future anti-smoking policy.
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Affiliation(s)
- Takeshi Mori
- Faculty of Economics, Konan University, 8-9-1 Okamoto, Higashinada-ku, Kobe, Hyogo 658-8501 Japan
| | - Takahiro Tsuge
- Faculty of Economics, Konan University, 8-9-1 Okamoto, Higashinada-ku, Kobe, Hyogo 658-8501 Japan
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20
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Cheng KW, Chiang WL, Chiang TL. In utero and early childhood exposure to secondhand smoke in Taiwan: a population-based birth cohort study. BMJ Open 2017; 7:e014016. [PMID: 28674129 PMCID: PMC5734351 DOI: 10.1136/bmjopen-2016-014016] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES This study provides secondhand smoke (SHS) exposure data in utero and after birth when children were at 18 months, 36 months and 66 months old, and it identifies risk factors for the early childhood SHS among 18-month-old infants living in smoker and non-smoker households. STUDY DESIGN The data come from the Taiwan Birth Cohort Study, a longitudinal survey of a birth cohort born in 2005. This study used the survey wave when children were 18 months old (n=18 845) for statistical analysis of early childhood SHS exposure. Logistic regression was used to identify the risk factors of the SHS exposure. RESULTS Approximately 62% of the 18-month-old infants lived in a household with at least one smoker, with the father being the smoker in 84% of those households. Among these infants living in a smoker household, 70% were exposed to SHS and 36% were exposed to heavy SHS in utero, and the prevalence was approximately 66% and 17% after birth for SHS and heavy SHS, respectively. The number and the existence of smokers in the household, parents' smoking status, father's educational attainment and being a first-born baby are strong predictors of early childhood heavy SHS exposure. CONCLUSIONS Encouraging families to have a smoke-free home environment, empowering women to ensure their perspectives and rights are embedded into tobacco control efforts and educating families about the health risks from childhood SHS exposure, especially among people living in households with smokers, will protect non-smoking adults and children from SHS exposure.
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Affiliation(s)
- Kai-Wen Cheng
- Institute for Health Research and Policy and Department of Economics, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Wan-Lin Chiang
- Institute of Health Policy and Management, College of Public Health, National Taiwan University, Taipei, Taiwan
| | - Tung-Liang Chiang
- Institute of Health Policy and Management, College of Public Health, National Taiwan University, Taipei, Taiwan
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21
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Smoking cessation and receipt of cessation advice from health professionals among older smokers in Taiwan. Prev Med 2016; 91:89-95. [PMID: 27496393 DOI: 10.1016/j.ypmed.2016.08.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2016] [Revised: 06/01/2016] [Accepted: 08/01/2016] [Indexed: 11/21/2022]
Abstract
OBJECTIVES To examine the prevalence and correlates of smoking cessation and receiving professional cessation advice among older smokers in Taiwan. METHODS Cross-sectional data from the 2008-2010 and 2012 Taiwan Adult Smoking Behavior Survey was used to form a sample of 4081 recent active smokers aged 50+, comprising current smokers and former smokers who quit smoking within the past 12months. We examined three outcome variables: quit attempt in the past 12months, successful cessation for at least 3months, and receipt of health professional cessation advice. Multivariate logistic regressions were used to identify significant correlates. RESULTS During the study period, the annual quit attempt rate was 41.4%, annual successful cessation rate was 4.7%, and prevalence of receiving cession advice among smokers who visited health professionals within the past 12months was 72.3%. After controlling for other covariates, quit attempts were significantly higher in 2009 and positively associated with higher education, poorer health status, smoke-free homes, and receipt of cessation advice. Successful cessation was significantly higher in 2009, positively associated with older age, higher income, and smoke-free homes, and negatively associated with receiving cessation advice. Receipt of cessation advice was significantly lower in 2010 and 2012, positively associated with male gender, older age, and poorer health status, and negatively associated with higher education. CONCLUSIONS Our results suggest that targeting lower educated and lower income subgroups, adopting effective strategies to increase voluntary smoke-free home rules, and improving professional cessation advice will have great potential to further reduce smoking prevalence in older smokers.
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22
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Brewer NT, Hall MG, Noar SM, Parada H, Stein-Seroussi A, Bach LE, Hanley S, Ribisl KM. Effect of Pictorial Cigarette Pack Warnings on Changes in Smoking Behavior: A Randomized Clinical Trial. JAMA Intern Med 2016; 176:905-12. [PMID: 27273839 PMCID: PMC5458743 DOI: 10.1001/jamainternmed.2016.2621] [Citation(s) in RCA: 187] [Impact Index Per Article: 23.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE Pictorial warnings on cigarette packs draw attention and increase quit intentions, but their effect on smoking behavior remains uncertain. OBJECTIVE To assess the effect of adding pictorial warnings to the front and back of cigarette packs. DESIGN, SETTING, AND PARTICIPANTS This 4-week between-participant randomized clinical trial was carried out in California and North Carolina. We recruited a convenience sample of adult cigarette smokers from the general population beginning September 2014 through August 2015. Of 2149 smokers who enrolled, 88% completed the trial. No participants withdrew owing to adverse events. INTERVENTIONS We randomly assigned participants to receive on their cigarette packs for 4 weeks either text-only warnings (one of the Surgeon General's warnings currently in use in the United States on the side of the cigarette packs) or pictorial warnings (one of the Family Smoking Prevention and Tobacco Control Act's required text warnings and pictures that showed harms of smoking on the top half of the front and back of the cigarette packs). MAIN OUTCOMES AND MEASURES The primary trial outcome was attempting to quit smoking during the study. We hypothesized that smokers randomized to receive pictorial warnings would be more likely to report a quit attempt during the study than smokers randomized to receive a text-only Surgeon General's warning. RESULTS Of the 2149 participants who began the trial (1039 men, 1060 women, and 34 transgender people; mean [SD] age, 39.7 [13.4] years for text-only warning, 39.8 [13.7] for pictorial warnings), 1901 completed it. In intent-to-treat analyses (n = 2149), smokers whose packs had pictorial warnings were more likely than those whose packs had text-only warnings to attempt to quit smoking during the 4-week trial (40% vs 34%; odds ratio [OR], 1.29; 95% CI, 1.09-1.54). The findings did not differ across any demographic groups. Having quit smoking for at least the 7 days prior to the end of the trial was more common among smokers who received pictorial than those who received text-only warnings (5.7% vs 3.8%; OR, 1.53; 95% CI, 1.02-2.29). Pictorial warnings also increased forgoing a cigarette, intentions to quit smoking, negative emotional reactions, thinking about the harms of smoking, and conversations about quitting. CONCLUSIONS AND RELEVANCE Pictorial warnings effectively increased intentions to quit, forgoing cigarettes, quit attempts, and successfully quitting smoking over 4 weeks. Our trial findings suggest that implementing pictorial warnings on cigarette packs in the United States would discourage smoking. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT02247908.
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Affiliation(s)
- Noel T Brewer
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina, Chapel Hill2Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill
| | - Marissa G Hall
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina, Chapel Hill2Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill
| | - Seth M Noar
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill3School of Media and Journalism, University of North Carolina, Chapel Hill
| | - Humberto Parada
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill
| | - Al Stein-Seroussi
- Pacific Institute for Research and Evaluation, Chapel Hill Center, Chapel Hill, North Carolina
| | - Laura E Bach
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina, Chapel Hill
| | - Sean Hanley
- Pacific Institute for Research and Evaluation, Chapel Hill Center, Chapel Hill, North Carolina
| | - Kurt M Ribisl
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina, Chapel Hill2Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill
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Sarris J, Nishi D, Xiang YT, Su KP, Bannatyne A, Oliver G, Kua EH, Ng CH. Implementation of psychiatric-focused lifestyle medicine programs in Asia. Asia Pac Psychiatry 2015; 7:345-54. [PMID: 26403310 DOI: 10.1111/appy.12212] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2015] [Accepted: 08/23/2015] [Indexed: 12/11/2022]
Abstract
Lifestyle-focused health programs are growing in interest throughout Western society, and a range of lifestyle factors are known to enhance both physical and mental health. However, it remains largely unknown as to whether this approach is salient for the Asian context. The major components of integrative lifestyle-focused health programs to enhance mental and physical health are considered to include the evidence-based adoption of physical activity and exercise, dietary modification, general psychoeducation, adequate relaxation/sleep and social interaction, use of mindfulness techniques, the reduction of substance use, attention of intersecting environmental factors, and the potential use of motivation and goal-setting techniques. This paper outlines an overview of the evidence underpinning these elements, and discusses potential barriers and challenges, and what logistical considerations may need to be addressed in the implementation of such programs within the context of Asian cultures.
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Affiliation(s)
- Jerome Sarris
- Department of Psychiatry, The Melbourne Clinic, The University of Melbourne, Melbourne, Victoria, Australia.,Centre for Human Psychopharmacology, Swinburne University of Technology, Melbourne, Victoria, Australia
| | - Daisuke Nishi
- Department of Mental Health Policy and Evaluation, National Institute of Mental Health, National Center of Neurology and Psychiatry, Kodaira, Tokyo, Japan
| | - Yu-Tao Xiang
- Unit of Psychiatry, Faculty of Health Sciences, University of Macau, Macao SAR, China
| | - Kuan-Pin Su
- Department of Psychiatry & Mind-Body Interface Laboratory (MBI-Lab), China Medical University Hospital, Taichung, Taiwan.,Graduate Institute of Neural and Cognitive Sciences, China Medical University, Taichung, Taiwan
| | - Amy Bannatyne
- Department of Psychiatry, The Melbourne Clinic, The University of Melbourne, Melbourne, Victoria, Australia
| | - Georgina Oliver
- Department of Psychiatry, The Melbourne Clinic, The University of Melbourne, Melbourne, Victoria, Australia
| | - Ee-Heok Kua
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Chee Hong Ng
- Department of Psychiatry, The Melbourne Clinic, The University of Melbourne, Melbourne, Victoria, Australia
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Wu PC, Hsueh KC, Mar GY, Hsueh SC, Tu MS, McRobbie H, Hajek P. Gender Differences in Outcome of an Attempt to Stop Smoking Among Smokers Attending a Smoking Cessation Clinic in Taiwan: 3-Year Follow-Up Study. Eval Health Prof 2015; 39:317-25. [PMID: 26604017 DOI: 10.1177/0163278715616439] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Studies that have examined gender differences in smoking cessation have produced mixed results. The purpose of the study was to examine whether there are gender differences in long-term smoking abstinence rates in smokers treated with nicotine patches at a smoking cessation clinic in Taiwan, where 39% of men and 5% of women smoke. This study included 1,065 smokers, comprising of 940 men and 125 women. Smokers were invited to attend the clinic every 1-2 weeks for a maximum of eight visits over 90 days, where they received prescriptions for nicotine patches, counseling, and educational materials. Participants were contacted by telephone at 1 and 3 years after the first visit and were asked whether they had smoked at all over the past 7 days. The results showed that women were significantly less likely than men to be abstinent at 1 year (adjusted odds ratio [aOR] = 0.64; 95% CI [confidence interval] = [0.41, 0.99]; p = .044) and 3 years (aOR = 0.44; 95% CI = [0.27, 0.74]; p = .02). More effective ways are needed to help female smokers quit in societies where smoking in women is rare and may be associated with social stigma.
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Affiliation(s)
- Pin-Chieh Wu
- Department of Family Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan Department of Physical Examination Center, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - Kuang-Chieh Hsueh
- Department of Family Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan Shu-Zen College of Medicine and Management, Kaohsiung, Taiwan
| | - Guang-Yuan Mar
- Department of Physical Examination Center, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan Division of Cardiology, Department of Internal Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - Shu-Chun Hsueh
- Department of Health Business Administration, Meiho University, Pingtung, Taiwan
| | - Ming-Shium Tu
- Department of Family Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - Hayden McRobbie
- Wolfson Institute of Preventive Medicine, Queen Mary University of London, London, United Kingdom
| | - Peter Hajek
- Wolfson Institute of Preventive Medicine, Queen Mary University of London, London, United Kingdom
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25
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Tsai YW, Chang HC, Chiou ST. The impact of multipolicy tobacco control legislation on smoking behavior. Public Health 2015; 129:1003-6. [PMID: 26116932 DOI: 10.1016/j.puhe.2015.05.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2013] [Revised: 01/30/2015] [Accepted: 05/13/2015] [Indexed: 10/23/2022]
Affiliation(s)
- Y-W Tsai
- Institute of Health and Welfare Policy, National Yang-Ming University, Taipei, Taiwan
| | - H-C Chang
- Institute of Health and Welfare Policy, National Yang-Ming University, Taipei, Taiwan
| | - S-T Chiou
- Health Promotion Administration, Ministry of Health and Welfare, New Taipei City, Taiwan; School of Medicine, National Yang-Ming University, Taipei, Taiwan.
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26
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Abstract
Multicomponent tobacco control strategies are crucial to combat the ongoing global smoking challenge. In the twenty-first century, many countries have signed up to the World Health Organization Framework Convention on Tobacco Control, and in recent years a mounting number of countries and regions have implemented partial or complete smoking bans to protect the general public from passive smoke exposure. There is substantial evidence that workers, particularly in the hospitality sector, benefit from reduced exposure. More recently, several reports have appeared from different countries showing a temporal relationship between the introduction of a smoking ban and reduced hospital admissions for cardiovascular, respiratory and maternity outcomes. This will have a measurable benefit for public health, saving many lives. Multicomponent strategies could also reduce active smoking significantly if successfully implemented worldwide.
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27
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Sung HY, Chang LC, Wen YW, Tsai YW. The costs of smoking and secondhand smoke exposure in Taiwan: a prevalence-based annual cost approach. BMJ Open 2014; 4:e005199. [PMID: 25009135 PMCID: PMC4091540 DOI: 10.1136/bmjopen-2014-005199] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
OBJECTIVES To assess the costs of the health effects of cigarette smoking and secondhand smoke (SHS) exposure to society. DESIGN Prevalence-based, disease-specific cost-of-illness study. We used an epidemiological population-attributable risk method to determine the costs that can be attributed to smoking and SHS exposure. SETTING Taiwan. PARTICIPANTS All adult population aged 35 and older. PRIMARY OUTCOME MEASURES Direct costs of healthcare expenditures spent for treating tobacco-related diseases, indirect mortality costs measured by the value of lost productivity due to tobacco-related premature deaths and indirect morbidity costs measured by the value of time lost from work due to tobacco-related illness. RESULTS In 2010, direct costs of smoking and SHS exposure amounted to US$828 million, accounting for 3.4% of Taiwan's total personal healthcare expenditures. Smoking and SHS exposure also contributed to 15 555 premature deaths-corresponding to a loss of 284 765 years of life and US$820 million in productivity-and US$22 million in indirect morbidity costs. These direct and indirect costs totalled US$1670 million, representing 0.4% of Taiwan's gross domestic product and averaging about US$720/adult smoker. The share of the total costs was greater from active smoking (92%) than SHS exposure (8%), and greater for men (92%) than women (8%). CONCLUSIONS Smoking and SHS exposure impose a huge financial loss in Taiwan. Sustained tobacco control efforts to encourage people to quit smoking, prevent smoking uptake by children and young adults and protect all people from SHS exposure are needed.
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Affiliation(s)
- Hai-Yen Sung
- Institute for Health & Aging, University of California, San Francisco, California, USA
| | - Li-Chuan Chang
- Institute of Health and Welfare Policy, National Yang-Ming University, Taipei, Taiwan
| | - Yu-Wen Wen
- Clinical Informatics and Medical Statistics Research Center, Chang Gung University, Tao-Yuan, Taiwan
| | - Yi-Wen Tsai
- Institute of Health and Welfare Policy, National Yang-Ming University, Taipei, Taiwan
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28
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Hsieh FI, Chiou HY. Stroke: morbidity, risk factors, and care in taiwan. J Stroke 2014; 16:59-64. [PMID: 24949310 PMCID: PMC4060269 DOI: 10.5853/jos.2014.16.2.59] [Citation(s) in RCA: 90] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2014] [Revised: 05/19/2014] [Accepted: 05/20/2014] [Indexed: 11/18/2022] Open
Abstract
Stroke is the third leading cause of death and the most common cause of complex disability in Taiwan. The annual age-standardized mortality rate of stroke is steadily decreasing between 2001 and 2012. The average years of potential life lost before age 70 for stroke is 13.8 years, ranked the fifth in the cause of death. Its national impact is predicted to be greater accompany aging population. The most common type of stroke was ischemic stroke in Taiwan. Small vessel occlusion was the majority of ischemic strokes subtype. Age, gender, hypertension, diabetes hyperlipidemia, obesity, atrial fibrillation, and smoking were important contributory factors to stroke morbidity. The standard treatment for acute ischemic stroke in Taiwan is providing the intravenous thrombolysis with recombinant tissue plasminogen activator (IV tPA) therapy for ischemic stroke patients within 3 hours of symptom onset. However, the rate of IV tPA therapy for patients with acute ischemic stroke is still low in Taiwan. Therefore, improving the public awareness of stroke warning signs and act on stroke and improving in-hospital critical pathway for thrombolysis would be the most important and urgent issues in Taiwan. To improve acute stroke care quality, a program of Breakthrough Series-Stroke activity was conducted from 2010 to 2011 and stroke centers were established in the medical centers. For the prevention of stroke, it was successful to increased annual smoke cessation rate through the 2009 Tobacco Hazards Prevention Act and decreased obesity rate through a nationwide weight-loss program conducted by Health Promotion Administration from 2011 to 2013 in Taiwan.
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Affiliation(s)
- Fang-I Hsieh
- School of Public Health, College of Public Health and Nutrition, Taipei Medical University, Taipei, Taiwan
| | - Hung-Yi Chiou
- School of Public Health, College of Public Health and Nutrition, Taipei Medical University, Taipei, Taiwan
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