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Alkan Ö, Ünver Ş. Secondhand smoke exposure for different education levels: findings from a large, nationally representative survey in Turkey. BMJ Open 2022; 12:e057360. [PMID: 35177464 PMCID: PMC8860053 DOI: 10.1136/bmjopen-2021-057360] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Accepted: 01/28/2022] [Indexed: 12/03/2022] Open
Abstract
OBJECTIVES The aim of this study is to determine the factors that influence individuals' exposure to tobacco smoke in Turkey according to their education level. DESIGN Secondary data analysis. PARTICIPANTS Altogether, 17 084 individuals aged 15 and over were included in this study. SETTINGS Data set of the Turkey Health Survey in 2019. METHODS Binary logistic regression analysis was used to determine the factors associated with individuals' exposure to tobacco smoke. PRIMARY AND SECONDARY OUTCOME MEASURES The variables age, gender, marital status, general health status, employment status, receipt of psychosocial support and tobacco use were found to be correlated with exposure to tobacco smoke. RESULTS The study determined that individuals who are illiterate/unschooled were exposed to tobacco smoke at a rate of 32.61%, primary school graduates at a rate of 34.32%, primary education graduates at a rate of 41.75%, high school graduates at a rate of 41.04% and university graduates at a rate of 40.34%. CONCLUSION As a result of the study, it is emphasised that men, young individuals, individuals with moderate and very good general health status, those who use tobacco, those who are unemployed and those who receive psychosocial support should be targeted. In addition, appropriate strategies for reducing secondhand smoke (SHS) exposure should be developed, taking into account public health strategies for increasing awareness of the adverse health effects of SHS exposure and the determinants of tobacco exposure according to the study.
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Affiliation(s)
- Ömer Alkan
- Department of Econometrics, Faculty of Economics and Administrative Sciences, Ataturk University, Erzurum, Turkey
| | - Şeyda Ünver
- Department of Econometrics, Faculty of Economics and Administrative Sciences, Ataturk University, Erzurum, Turkey
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Jackson C, Huque R, Ahmed F, Nasreen S, Shah S, Ahluwalia JS, Kanaan M, Sheikh A, Siddiqi K. Children Learning About Second-hand Smoke (CLASS II): a mixed methods process evaluation of a school-based intervention. Pilot Feasibility Stud 2021; 7:112. [PMID: 34030729 PMCID: PMC8142478 DOI: 10.1186/s40814-021-00853-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Accepted: 05/11/2021] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Children are vulnerable to the effects of second-hand smoke exposure. Creating smoke-free homes is an effective strategy to limit exposure. We developed a smoke-free intervention (SFI) using children as a catalyst for change and teaching skills to negotiate a smoke-free home. In this paper, we present the process evaluation conducted within a pilot trial. METHODS This was a mixed-methods study comprising qualitative interviews and quantitative fidelity assessment of SFI delivery. Interviews in the six intervention schools were conducted with six headteachers and 12 teachers. These explored experiences of delivering the SFI, perceived impact, barriers and facilitators to success, and ideas for improvement and for scaling up. The data were analysed using framework analysis. Delivery of the SFI was observed and fidelity scores calculated. RESULTS The SFI was acceptable to headteachers and teachers. Fidelity scores ranged from 27/40 to 37/40. Didactic components were more fully implemented than interactive components. Time to complete the sessions, timing in the school day and school calendar were key challenges. Embedding the SFI into the curriculum was a potential solution. CONCLUSIONS These findings provide useful information to finalise the content and delivery and inform the scale-up of the SFI for our definitive trial, which is now underway. TRIAL REGISTRATION ISRCTN68690577.
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Affiliation(s)
- Cath Jackson
- Department of Health Sciences, University of York, ARRC Building, Heslington, York, Y010 5DD UK
| | - Rumana Huque
- Department of Economics, University of Dhaka and ARK Foundation, House No 6, Road NO 109, Gulshan 2, Dhaka, Bangladesh
| | - Farid Ahmed
- ARK Foundation, House No 6, Road NO 109, Gulshan 2, Dhaka, Bangladesh
| | - Shammi Nasreen
- ARK Foundation, House No 6, Road NO 109, Gulshan 2, Dhaka, Bangladesh
| | - Sarwat Shah
- Department of Health Sciences, University of York, ARRC Building, Heslington, York, Y010 5DD UK
| | - Jasjit S. Ahluwalia
- Department of Behavioral and Social Sciences, Brown University School of Public Health, 121 South Main St, Providence, RI 02912 USA
| | - Mona Kanaan
- Department of Health Sciences, University of York, ARRC Building, Heslington, York, Y010 5DD UK
| | - Aziz Sheikh
- Usher Institute of Population Health Sciences, The University of Edinburgh, Edinburgh, EH8 9DX UK
| | - Kamran Siddiqi
- Department of Health Sciences, University of York, ARRC Building, Heslington, York, Y010 5DD UK
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Suteerangkul P, Lagampan S, Kalampakorn S, Auemaneekul N. The effects of community participation program on smoke-free homes in a suburban community of Thailand. Tob Induc Dis 2021; 19:35. [PMID: 34007259 PMCID: PMC8106388 DOI: 10.18332/tid/133876] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Revised: 03/02/2021] [Accepted: 03/02/2021] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION Smoking inside the home affects the health of both the smoker and family members via secondhand exposure. This research examined the impact of a community participation program on creating smoke-free homes in a suburban community in Thanyaburi district, Pathumthani province in Thailand. METHODS The study involved families, with a smoker in the home, that were randomly assigned to intervention and control groups each containing 27 families. The intervention group was administered with the community participation program for smoke-free homes for 5 sessions during the 6-month period of study. The program included providing information on secondhand smoking and harms, knowledge about quitting smoking and healthcare support, practice skills, campaigns in the community, visiting and encouraging, and reflecting and evaluation. The control group was normally treated by the community committee and health volunteers. Data collection was undertaken at baseline and at 6 months after implementation by an interview with questionnaires. RESULTS Our results show that after the implementation, the intervention group reported significantly higher mean score on skills in negotiating with smokers for a smoking-ban inside home and mean score on emotional support for non-smoking inside the home than those at baseline and those of the control group. The proportion having smoking ban home rules in the intervention group was significantly higher than at baseline and that of the control group (92.6% vs 18.5%). The proportion of smoke-free homes was higher in the intervention than in the control group (75% vs 0%). CONCLUSIONS These findings suggest that community participation programs for smoke-free home may be effective in raising awareness on the impact of secondhand smoke among family members and in working together to manage smoke-free home environments. The program may be applicable for further development within communities to achieve smoke-free homes.
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Affiliation(s)
| | - Sunee Lagampan
- Department of Public Health Nursing, Faculty of Public Health, Mahidol University, Bangkok, Thailand
| | - Surintorn Kalampakorn
- Department of Public Health Nursing, Faculty of Public Health, Mahidol University, Bangkok, Thailand
| | - Naruemon Auemaneekul
- Department of Public Health Nursing, Faculty of Public Health, Mahidol University, Bangkok, Thailand
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Wu C, Yang M, Liu R, Hu H, Ji L, Zhang X, Huang S, Wang L. Nicotine Reduces Human Brain Microvascular Endothelial Cell Response to Escherichia coli K1 Infection by Inhibiting Autophagy. Front Cell Infect Microbiol 2020; 10:484. [PMID: 33042863 PMCID: PMC7522313 DOI: 10.3389/fcimb.2020.00484] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Accepted: 08/04/2020] [Indexed: 01/22/2023] Open
Abstract
Studies have shown that exposure to environmental tobacco smoke can increase the risk of bacterial meningitis, and nicotine is the core component of environmental tobacco smoke. Autophagy is an important way for host cells to eliminate invasive pathogens and resist infection. Escherichia coli K1 strain (E. coli K1) is the most common Gram-negative bacterial pathogen that causes neonatal meningitis. The mechanism of nicotine promoting E. coli K1 to invade human brain microvascular endothelial cells (HBMECs), the main component of the blood–brain barrier, is not clear yet. Our study found that the increase of HBMEC autophagy level during E. coli K1 infection could decrease the survival of intracellular bacteria, while nicotine exposure could inhibit the HBMEC autophagic response of E. coli K1 infection by activating the NF-kappa B and PI3K/Akt/mTOR pathway. We concluded that nicotine could inhibit HBMEC autophagy upon E. coli K1 infection and decrease the scavenging effect on E. coli K1, thus promoting the occurrence and development of neonatal meningitis.
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Affiliation(s)
- Chao Wu
- Department of Histology and Embryology, School of Basic Medical Sciences, Wuhan University, Wuhan, China
| | - Mengzhen Yang
- Department of Histology and Embryology, School of Basic Medical Sciences, Wuhan University, Wuhan, China
| | - Rui Liu
- Department of Histology and Embryology, School of Basic Medical Sciences, Wuhan University, Wuhan, China.,Department of Human Anatomy, School of Basic Medical Sciences, Hubei University of Medicine, Shiyan, China
| | - Hanyang Hu
- Department of Histology and Embryology, School of Basic Medical Sciences, Wuhan University, Wuhan, China
| | - Lulu Ji
- Department of Histology and Embryology, School of Basic Medical Sciences, Wuhan University, Wuhan, China
| | - Xiaoli Zhang
- Department of Ultrasound Imaging, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Shenghe Huang
- Kunming Key Laboratory of Children Infection and Immunity, Yunnan Institute of Pediatrics, Kunming Children's Hospital, Kunming, China.,Department of Pediatrics, Children's Hospital Los Angeles, University of Southern California, Los Angeles, CA, United States
| | - Lin Wang
- Department of Histology and Embryology, School of Basic Medical Sciences, Wuhan University, Wuhan, China.,Hubei Provincial Key Laboratory of Developmentally Originated Disease, Wuhan, China
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Siddiqi K, Huque R, Kanaan M, Ahmed F, Ferdous T, Shah S, Jackson C, Parrott S, Ahluwalia JS, Sheikh A. Children Learning About Secondhand Smoke (CLASS II): A Pilot Cluster Randomized Controlled Trial. Nicotine Tob Res 2020; 21:670-677. [PMID: 29771390 PMCID: PMC6468126 DOI: 10.1093/ntr/nty090] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2017] [Accepted: 05/15/2018] [Indexed: 02/02/2023]
Abstract
Introduction Children exposed to secondhand smoke (SHS) are at increased risk of respiratory illnesses. We piloted a Smoke Free Intervention (SFI) and trial methods before investigating its effectiveness and cost-effectiveness in primary school children. Methods In a pilot cluster randomized controlled trial in Bangladesh, primary schools were allocated to usual education (control) or SFI, using minimization. Year-5 children were recruited. Masking treatment allocation was not possible. Delivered by schoolteachers, SFI consisted of two 45-min and four 15-min educational sessions. Our primary outcome was SHS exposure at two months post randomization, verified by children’s salivary cotinine. The trial is registered at ISRCTN.com; ISRCTN68690577. Results Between April 1, 2015 and June 30, 2015, we recruited 12 schools. Of the 484 children present in Year-5, 481 consented. Six schools were allocated to both SFI (n = 245) and to usual education only (n = 236). Of them, 450 children (SFI = 229; control = 221) who had cotinine levels indicative of SHS exposure were followed-up. All schools were retained, 91% children (208/229) in SFI and 88% (194/221) in the control arm completed primary outcome assessment. Their mean cotinine at the cluster level was 0.53 ng/ml (SD 0.36) in SFI and 1.84 ng/ml (SD 1.49) in the control arm—a mean difference of −1.31 ng/ml (95% CI = −2.86 to 0.24). Conclusion It was feasible to recruit, randomize, and retain primary schools and children in our trial. Our study, though not powered to detect differences in mean cotinine between the two arms, provides estimates to inform the likely effect size for future trials. Implications In countries with high smoking prevalence, children remain at risk of many conditions due to secondhand smoke exposure. There is little empirical evidence on the effectiveness and cost-effectiveness of interventions that can reduce their exposure to secondhand smoke at homes. CLASS II trial found that a school-based intervention (SFI) has the potential to reduce children’s exposure to SHS—an approach that has been rarely used, but has considerable merit in school-based contexts. CLASS II trial provides key information to conduct a future definitive trial in this area of public health, which despite its importance has so far received little attention.
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Affiliation(s)
- Kamran Siddiqi
- Department of Health Sciences, University of York Seebohm Rowntree Building, Heslighton, York, UK
| | - Rumana Huque
- Department of Economics, University of Dhaka Social Science Building, Dhaka, Bangladesh
| | - Mona Kanaan
- Department of Health Sciences, University of York Seebohm Rowntree Building, Heslighton, York, UK
| | | | | | - Sarwat Shah
- Department of Health Sciences, University of York ARRC Building, University of York, Heslington, York, UK
| | - Cath Jackson
- Department of Health Sciences, University of York ARRC Building, University of York, Heslington, York, UK
| | - Steve Parrott
- Department of Health Sciences, University of York ARRC Building, University of York, Heslington, York, UK
| | | | - Aziz Sheikh
- Usher Institute of Population Health Sciences and Informatics, The University of Edinburgh Teviot Place, Edinburgh, UK
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Shah S, Kanaan M, Huque R, Sheikh A, Dogar O, Thomson H, Parrott S, Siddiqi K. Secondhand Smoke Exposure in Primary School Children: A Survey in Dhaka, Bangladesh. Nicotine Tob Res 2020; 21:416-423. [PMID: 29228385 PMCID: PMC6472694 DOI: 10.1093/ntr/ntx248] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2016] [Accepted: 11/04/2017] [Indexed: 12/02/2022]
Abstract
Introduction We report on second-hand smoke (SHS) exposure based on saliva cotinine levels among children in Bangladesh—a country with laws against smoking in public places. Methods A survey of primary school children from two areas of the Dhaka district was conducted in 2015. Participants completed a questionnaire and provided saliva samples for cotinine measurement to assess SHS exposure with a cut-off range of ≥0.1ng/mL. Results Four hundred and eighty-one children studying in year-5 were recruited from 12 primary schools. Of these, 479 saliva samples were found sufficient for cotinine testing, of which 95% (453/479) were positive for recent SHS exposure. Geometric mean cotinine was 0.36 (95% CI = 0.32 to 0.40); 43% (208/479) of children lived with at least one smoker in the household. Only 21% (100/479) reported complete smoking restrictions for residents and visitors; 87% (419/479) also reported being recently exposed to SHS in public spaces. Living with a smoker and number of tobacco selling shops in the neighborhood had positive associations with recent SHS exposure. Conclusions Despite having a ban on smoking in public places, recent SHS exposure among children in Bangladesh remains very high. There is an urgent need to reduce exposure to SHS in Bangladeshi children. Implications Children bear the biggest burden of disease due to SHS exposure than any other age group. However, children living in many high-income countries have had a sharp decline in their exposure to SHS in recent years. What remains unknown is if children living in low-income countries are still exposed to SHS. Our study suggests that despite having a ban on smoking in public places, most primary school children in Dhaka, Bangladesh are still likely to be exposed to SHS.
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Affiliation(s)
- Sarwat Shah
- Department of Health Sciences, University of York, Heslington, York, UK
| | - Mona Kanaan
- Department of Health Sciences, University of York, Heslington, York, UK
| | - Rumana Huque
- Department of Economics, University of Dhaka, Social Science Building, Nilkhet, Dhaka, Bangladesh
| | - Aziz Sheikh
- Centre for Medical Informatics, Usher Institute of Population Health Sciences and Informatics, The University of Edinburgh, Medical School, Teviot Place, Edinburgh, UK
| | - Omara Dogar
- Department of Health Sciences, University of York, Heslington, York, UK
| | | | - Steve Parrott
- Department of Health Sciences, University of York, Heslington, York, UK
| | - Kamran Siddiqi
- Department of Health Sciences, University of York, Heslington, York, UK
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