Tobacco and the Third World

Epidemiological Imaginaries of the Social: Epidemiologists and Pathologies of Modernization in Postcolonial Africa

There is a growing anthropological literature analyzing the place that epidemiological surveillance occupies in contemporary global health. In this article, I build on this literature and take it into new directions by exploring what I call the epidemiological imaginaries of the social. Drawing on science and technology studies, I suggest that epidemiologists help make up the world, articulating complex and normatively loaded visions of social life that both enable and constrain action. More specifically, I argue that epidemiologists tell stories about the type of societies and people that compose the world and that these stories often shape global health policies and programs in powerful ways. To substantiate this argument, I examine epidemiologists' efforts to map smoking in postcolonial Africa, documenting how they have imagined smokers and smoking through the lense of modernization theory and showing how these imaginaries have shaped tobacco control policies in the region up to this day.

Impact of Smoking on Nutrition and the Food Poverty Level in Tanzania

This study considers the effect of household cigarette expenditure on food poverty indicators in Tanzania. We first compare expenditure patterns as well as the household size of non-smokers and smokers. We find that the majority of non-smokers and smokers have low incomes, and that the mean total per capita expenditure (proxy for income) of non-smokers is slightly higher than those of smokers. On the other hand, the mean household size of non-smokers was smaller compared to that of smokers suggesting that smokers should have spent more on food. Next, we estimate and compare daily calorie intake between both groups. Almost 19 percent of non-smokers were found to be below the poverty line. The corresponding value for smokers was almost 24 percent. Estimates from a multiple linear regression on the determinants of per capita daily calorie intake reveal that per capita cigarette consumption appears to negatively affect daily calorie intake significantly. Given that the majority of all respondents belong to a low income group, this suggests that expenditure on cigarettes may be at the expense of calorie intake.

Smoking prevalance and the degree of nicotine dependence among healthcare workers at the ataturk university medical facility

OBJECTIVE

In this study, we aimed to investigate smoking prevalence and the degree of nicotine dependence in our hospital healthcare workers.

MATERIALS AND METHODS

This study was conducted between January 2008 and June 2008 in our hospital (Medical Facility of Atatürk University). A total of 691 (370 females, 321 males) subjects were included in this study. A questionnaire, including demographic findings, tobacco consumption information and the Fagerström nicotine dependence test, was distributed to healthcare workers and collected.

RESULTS

The questionnaire was answered by 691 health workers, 46.5% of whom were male, and 53.5% of whom were female. Overall, the rate of smoking was 36.9%; 48% of males and 27.6% of females were current smokers. When classified according to clinic, the greatest rate of smoking was in the psychiatry clinic (60.0%), and the lowest rate of smoking was in the ear, nose and throat (ENT) Clinic (0.0%). Thirty-four percent of nurses, 18.7% of doctors, 45.5% of officers, and 50.4% of ancillary staff were smokers. According to education level, 50% of the cases (smokers) graduated from primary school, 45% of the cases graduated from high school and 26.9% of the cases graduated from university. The major reason for the initiation of smoking was attention-seeking behavior. The age at smoking initiation was 7 to 20 years in 83.9% of cases and 21 to 35 years in the remaining 16.1%. Thirty-five percent of smokers had very low levels of dependence, while 11.9% had very high levels dependence. Ninety-two percent of cases indicated they would prefer to work at a smoke-free hospital. Ninety-five percent of cases would support making this facility a smoke-free hospital.

CONCLUSION

The smoking rate was 36.9% amongst our hospital health workers. Smoking prevalence was higher in males (48%) than females (27.6%). The greatest smoking rate was amongst ancillary staff. Ninety-five percent of healthcare workers were supportive of a law requiring hospitals to be smoke-free.

Smoking and smoking cessation in Latin America: a review of the current situation and available treatments

Tobacco smoking is a growing problem throughout Latin American countries, especially in underdeveloped countries where poverty and lack of education about the dangers of smoking may make people more susceptible to becoming smokers. Moreover, the economies of many Latin American countries have become dependent on the production of tobacco. Furthermore, because of the associated promotion of tobacco, smoking has integrated into many Latin American cultures. Nevertheless, the harmful health effects of tobacco use are well documented, including greatly increased risks of developing chronic obstructive pulmonary disease, cardiovascular disease, and many forms of cancer. The medical costs associated with treating these diseases far outweigh the economic benefits of producing and selling this deadly crop. To control the tobacco pandemic in Latin American countries, nicotine addiction must be recognized and treated as a disease. Governments, both national and local, need to be more involved in enacting anti-smoking policies such as higher tobacco taxation, control of illegal tobacco smuggling, and reimbursement of medical smoking cessation interventions. The training of health professions in the area of nicotine addiction must also be improved, so that they may better assist smokers in their quit attempts and advise patients on, and prescribe, effective smoking cessation pharmacotherapies.

Adequacy of outpatient management of asthma patients admitted to a state hospital in Argentina

OBJECTIVE

The aim of this study was to assess chronic outpatient management of adult patients admitted with asthma.

METHODOLOGY

A cross-sectional survey was conducted of 98 consecutive asthma admissions to a specialized pulmonary State Hospital in Buenos Aires, Argentina, over a 12-month period. Patients were surveyed, within 48 h of admission, with a previously validated questionnaire which deals with chronic outpatient management and measures taken by patients or physicians to treat symptoms during asthma exacerbations.

RESULTS

FEV1% predicted was 30.2 +/- 10.7. Mean admission rate and emergency department (ED) visits in the previous year were 0.7 +/- 1.2 and 4.6 +/- 5.1, respectively. A total of 96, 65 and 9% of the patients had been treated previously in the ED, admitted to hospital or mechanically ventilated, respectively. Only 62% had been prescribed inhaled corticosteroids (IC) by their physician; 38% had been prescribed nebulized beta agonists (Nbeta2) and 68% a metered dose inhaler (MDIbeta2). Inhaled beta2-agonist usage during acute exacerbations over the 24 h prior to admission was 14.4 +/- 7.4 puffs for MDIbeta2 and 8.6 +/- 5.4 occasions for Nbeta2. Only 11% of the patients were able to perform all the steps of the MDI inhalation technique correctly. An action plan had been provided by their physicians to 43% of patients, while 58% changed their medication on their own. Only three patients had a peak flow meter (PFM) prescribed. ED was used by 26% for their routine care. No health insurance coverage was available to 75.5% of the patients.

CONCLUSIONS

Underuse of IC, poor MDI inhalation technique, and low prescription of an action plan was common and a PFM was seldom prescribed. During exacerbations, many patients changed their medication spontaneously and MDIbeta2 underuse was observed.

The global epidemic of tobacco and cancer

OBJECTIVES

To provide a global context for understanding the epidemic of tobacco-induced disease, and the need for nursing action.

DATA SOURCES

International cancer and tobacco statistics; published articles.

CONCLUSION

Tobacco use is a global problem and a significant issue for cancer control. The efforts of health professionals, especially those concerned about cancer, are needed to confront this epidemic.

IMPLICATIONS FOR NURSING PRACTICE

Worldwide action of nurses, the largest group of health professionals, is critical in preventing tobacco use, helping with tobacco cessation, and decreasing exposure to second-hand smoke.

Individual differences in smoking: gender and nicotine addiction

Understanding individual differences in smoking behavior and nicotine dependence can increase knowledge of smoking dynamics and aid in the development of treatment regimens. Nicotine dependence among smokers is variable, and in some cases, fails to develop even after years of smoking. This variation can influence treatment outcome and presents a challenge to treatment developers. Gender differences are evident sometimes in smoking prevalence, in smoking cessation, and smoking rate. Gender, however, may be a superficial indicator; reasons for smoking, individual reactions to nicotine, and cultural sanctions and role definitions may be more influential. Analyses of individual differences should focus on identifying the underlying processes that control smoking behavior.

[Smoking in the general population: a description of prevalence, degree of consolidation and phase of cessation]

Smoking is a risk factor associated with high and preventable mortality and morbidity. An understanding of smoking consolidation and the desire to quit in specific subgroups of the general population will facilitate appropriate planning of health care resource utilization. We performed a multistage, random, stratified cross-sectional study in the general population of Valladolid (Spain) during 1998 and 1999 as part of a cardiovascular disease risk survey. Data collected by questionnaire and interview included number of cigarettes smoked per day, nicotine dependence and stage in the process of smoking cessation. Venous carboxyhemoglobin was also measured. The percentage of reported smokers in the general population was 29.3% (95% CI: 25.7-32.9%). Prevalence was 41.8% (95% CI: 39.2-44.5%) in the 26-to-45-year-old age group and fell to 6% (95% CI: 5.6-6.5%) among subjects over 66 years of age. Analysis by sex, 31.2% (95% CI: 26.1-36.4%) of men and 27.4% (95% CI: 24.1-30.7%) of women were smokers. In rural areas the percentage of smokers was 26.9% (95% CI: 20.2-33.5%) whereas the percentage in urban areas was 31.2% (95% CI: 26.1-36.4%). The number of cigarettes/day, venous carboxyhemoglobin and nicotine dependence differed by age range, sex and place of residence and helped to describe the degree of consolidation of smoking by strata. Phases of cessation were distributed similarly by age range but not by sex. The prevalence of smoking is still high, particularly among young people and women, although it is tending to decrease. Smoking is better established in the 26-45 year-old age range, among men, among those living in rural areas and among older smokers who, probably, can not quit smoking alone.

Hypercholesterolemia and 5-year risk of development of coronary heart disease among university and school workers in Jeddah, Saudi Arabia

BACKGROUND

A study was performed among university and school employees as a step in detecting the prevalence of coronary heart disease (CHD) risk factors among school and university staff and the relation of the various risk factors to hypercholesterolemia and to predict the 5-years probability of development of CHD.

METHODS

All university staff and a sample of school workers in Jeddah were included in the study. Data were collected by interview and self-administered questionnaires, as well as by direct observation and measurement of weight, height, blood pressure, and total blood cholesterol. Logistic regression analysis was performed to identify the impact of various risk factors on hypercholesterolemia. The 5-year risk of development of CHD was calculated to identify the proportion at highest risk.

RESULTS

Some CHD risk factors were detected among the participants as 18.8% were current cigarette smokers, around half were classified as overweight, and 19.9% were classified as hypertensive. Hypercholesterolemia was present in 10.1% and was significantly related to older age (40 years and over) and place of work. The estimated risk of CHD in the coming half-decade for those classified in the fifth quintile was 0.068. The Q(5)/Q(1) ratio has shown that those classified in the fifth quintile were at 3.6 times more risk of developing CHD in the coming 5 years than those classified in the first quintile.

CONCLUSION

CHD risk factors are becoming prevalent in our society. The risk of development of CHD in the coming decades is not trivial. Short- and long-term health strategies are recommended to decrease the risk of CHD and improve the quality of life.

Prevalence of smoking among currently married Kuwaiti males and females

A structured questionnaire was administered to a random sample of 608 Kuwaiti couples through a household face-to-face interview. Both spouses were non-smokers in more than half (50.8%) of all the couples, and there was a single couple (0.2%) with both spouses currently smoking. Only 0.5% of the wives reported current smoking. The prevalence of smoking was 3.2% among divorced/widowed women from the same households. The difference between the two groups of women remained significant upon controlling for the confounding effect of age. Among the husbands, frequencies of current and ex-smokers were 37% and 11%, respectively. Younger respondents consumed more tobacco and were initiated to smoking at an earlier age. Logistic regression showed that people with one to 11 years of formal education were more likely to be current smokers as compared to the rest of the respondents (adjusted relative risk: 2.07, 95% confidence interval (CI): 1.46-2.93). Reasons for the observed findings have been discussed.

Prevention: tobacco control and cancer nursing

In the next century, tobacco will become the number-one cause of preventable death throughout the world, resulting in half a billion deaths. As global patterns of tobacco use change, tobacco-related morbidity and mortality will shift from developed countries to developing countries. Internationally, lung cancer will become the fifth leading cause of preventable death, affecting an increasing number of women. Tobacco cessation after a diagnosis of cancer may decrease treatment-related morbidity and increase survival. With the increasing number of cancer survivors, tobacco cessation becomes an important part of rehabilitation. This article aims to provide a foundation for developing strategies to involve cancer nurses throughout the world in an international campaign to prevent tobacco-related morbidity and mortality. The devastating health impacts of tobacco are reviewed, and highlights of new scientific findings about nicotine addiction are presented. New approaches to tobacco prevention, legislation, and regulatory policies are discussed. Tobacco assessment strategies and treatment interventions for use in cancer nursing clinical practice are reviewed, and global strategies for nursing action in tobacco control are offered.

Smoking or Health? International Trends and Marketing of Tobacco and Possible Interventions

This article focuses on the trends in cigarette smoking in both developed and developing countries. There is a change in the smoking patterns from developed to the developing countries due to the shift of emphasis upon marketing of tobacco in the developing countries by the transnational tobacco industry. This is achieved due to the tobacco company's advertising strategies and its impact on the population. The harmful effects of tobacco production and its impact on the environment and health levels in these countries is discussed. Intervention strategies for smoking cessation and the benefits of such interventions is also discussed. This article focuses on these changes from a political economic of illness approach rather than just focusing on individual smokers and holding only them responsible for their healthy or non-healthy conditions.

Soluble interleukin 2 receptor in lung cancer. An indirect marker of tumor activity?

Circulating levels of the soluble interleukin 2 receptor (sIL-2R) could provide an in vivo measure of the immunologic response to human tumors. We performed a total of 326 sIL-2R serum assays in 126 patients with lung cancer (67 at diagnosis, 59 during and after treatment), 112 patients with pulmonary benign diseases, and 63 voluntary healthy subjects. Patients with lung cancer had a median value of sIL-2R of 791 U/ml, which was superior to that of both controls (398 U/ml, p less than 0.001) and patients with noninflammatory benign diseases (583 U/ml, p less than 0.02). However, infectious pulmonary disorders, such as tuberculosis and pneumonia, were associated with the highest values of the substance (median, 1150 U/ml; p less than 0.001). At the diagnosis of lung cancer, sIL-2R correlated neither with the stage of disease nor with the cell type. On the contrary, posttreatment levels of the receptor were significantly related to disease status (RO = .41, p less than 0.002), particularly in the subgroup of nonsurgical patients (RO = .48, p less than 0.001). Patients with abnormal sIL-2R levels had a nearly significant reduction in survival as compared with patients with normal values (p less than 0.1). Measurements of sIL-2R could be useful in monitoring patients under treatment for bronchogenic carcinoma, as well as in prognostication. In this setting, sIL-2R might open a new class of biologic markers, providing information that is complementary to those of the more classic tumor-derived markers.