A Comparison of Gender Differences in Smoking Behaviors, Intention to Quit, and Nicotine Dependence among Thai University Students

Intensive Intervention on Smoking Cessation in Patients Undergoing Elective Surgery: The Role of Family Physicians

Background and Objectives: The aim of this study was to determine the role of physicians in the intensive intervention and education regarding the smoking cessation of patients undergoing elective surgery under general anaesthesia. Materials and Methods: A randomised prospective study was conducted in family physicians' clinics in which smokers of both sexes, aged 21-65 years, without cognitive impairments, and who were not addicted to psychoactive substances voluntarily participated. Four weeks preoperatively, 120 smokers were randomised into two equal groups; the intervention group (IG) underwent an intervention for the purpose of smoking cessation and the control group (CG) underwent no intervention. Biochemical tests were performed in order to determine the smoking status of the participants in the phase of randomisation, one week preoperatively, as well as 40, 120, and 180 days and 12 months postoperatively. The examinees of the IG talked to the physician five times and received 140 telephone messages, leaflets, and motivational letters along with the pharmacotherapy, while the participants in the CG received little or no advice on smoking cessation. Results: The results of this study confirmed a significant influence of the intervention and education on the smoking abstinence in the IG compared to the CG (p < 0.001). The smokers in the IG had 7.31 (95% CI: 2.32-23.04) times greater odds of abstinence upon the 12-month follow-up than the smokers in the CG. The smokers in the IG who did not stop smoking had a lower degree of dependence and smoked fewer cigarettes (p < 0.0001) compared to those in the CG, as well as a multiple times higher prevalence of short- and long-term abstinence. Conclusions: It can be concluded that the intensive intervention and education can motivate patients preparing for elective surgery to stop smoking in the short- and long term.

Prevalence and Determinants of Current Cigarette Smoking Among Adolescents in Thailand: Evidence From 2021 Global School-Based Health Survey

BACKGROUND

Adolescent cigarette smoking remains a concern globally, including in Thailand. This research aimed to elucidate the prevalence and determinants of cigarette smoking among Thai adolescents. Study Design: A cross-sectional study.

METHODS

A cross-sectional analysis of data from the 2021 Thailand Global School-Based Health Survey with 5545 adolescents aged 13-17 with complete information was conducted on their cigarette smoking status. Bivariate analysis and multivariable logistic regression were performed to discern the determinants of tobacco smoking among adolescents.

RESULTS

The overall weighted prevalence of cigarette smoking was 11.5% (95% confidence interval [CI]=9.7%, 13.5%), with adolescent males at 18.2% (95% CI=15.3%, 21.4%) and adolescent females at 5.6% (95% CI=4.2%, 7.4%). The multivariable logistic regression also revealed that males were more likely to be smokers (Adjusted Odd Ratio [AOR]=1.58; 95% CI=1.02, 2.45, P=0.040) compared to females. The presence of smokers in their vicinity significantly increased the odds of smoking (AOR=2.21, 95% CI=1.46, 3.36, P<0.001). Current alcohol use (AOR=3.37, 95% CI=2.21-5.14, P<0.001) and current marijuana use (AOR=4.53, 95% CI=2.06, 9.99, P<0.001) were both significant determinants of smoking. Notably, early initiation of cigarette use (before age 14) was associated with a lower likelihood of current smoking (AOR=0.54, 95% CI=0.33, 0.92, P=0.022).

CONCLUSION

With an overall prevalence of smoking among adolescents at 11.5%, our study highlights a significant public health concern. The positive determinants of the identified tobacco smoking include being male, having smokers in their vicinity, and currently using alcohol, and marijuana, while early initiation of cigarette use before age 14 is identified as an inverse determinant.

Multi-centre Study of Vaping Effects on COVID-19 Presentations in Western Sydney Australia

Aim: This preliminary pilot study aimed to explore a correlation between COVID-19 presentation with e-cigarette vapers in the Western Sydney region of Australia.

METHOD

Extracted data from questionnaires completed by 100 Australians residing in the Western Sydney region who were infected with COVID-19 during the pandemic from March 2020 to March 2022 were analyzed. Data collected included patient age, biological gender, years of vaping, if vaping began prior to COVID-19, weekly vaping frequency, the year that COVID-19 was contracted, and the category of COVID-19 symptoms. The symptoms are scaled into four categories for this study, from lowest severity to high severity based on the World Health Organization's classifications.

RESULTS

Vapers in Western Sydney Australia experienced higher severity COVID-19 presentations compared to non-vapers. Biological males were found to be more susceptible than biological females for experiencing the highest severity. Vapers with higher years of vaping had severe COVID-19 presentations compared to lesser years of vaping.

CONCLUSION

Among adults in Western Sydney Australia aged 18 years and above, the collected data showed a correlation between e-cigarette vapers reporting higher severity of COVID-19 presentations compared to non-vapers of the same demographic when they contracted COVID-19.

Exploring gender disparities in the disease and economic tobacco-attributable burden in Latin America

Introduction

Tobacco use has significant health consequences in Latin America, and while studies have examined the overall impact, the gender-specific effects have not been thoroughly researched. Understanding these differences is crucial for effective tobacco control policies. The objective of this study was to explore the differences in tobacco-attributable disease and economic burden between men and women in Argentina, Brazil, Chile, Colombia, Costa Rica, Ecuador, Mexico, and Peru.

Methods

We used a previously validated economic model to quantify the impact of tobacco-related illnesses, including morbidity, mortality, healthcare costs, productivity losses, informal care expenses, and DALYs, by gender and age. We utilized data from national surveys, records, studies, and expert opinions to populate the model.

Results

In 2020, there were 351,000 smoking-attributable deaths. Men accounted for 69% and women 31%. Ecuador and Mexico had the highest male-to-female death ratio, while Peru and Chile had the smallest disparities. 2.3 million tobacco-related disease events occurred, with 65% in men and 35% in women. Ecuador and Mexico had higher disease rates among men, while Peru had a more balanced ratio. Regarding DALYs, men lost 6.3 million due to tobacco, while women lost 3.3 million, primarily from COPD, cardiovascular disease, and cancer. Brazil and Mexico had the highest DALY losses for both genders. Costa Rica had a lower male-to-female tobacco use prevalence ratio but ranked second in deaths, disease events, and DALYs attributed to tobacco. Colombia had a unique pattern with a male-to-female death ratio of 2.08 but a higher ratio for disease events. The health systems spent $22.8 billion to treat tobacco-attributable diseases, with a male-to-female cost ratio 2.15. Ecuador showed the greatest gender cost difference, while Peru had the lowest. Productivity loss due to tobacco was $16.2 billion, with Ecuador and Mexico exhibiting the highest gender disparities and Peru the lowest. Informal care costs amounted to $10.8 billion, with men incurring higher costs in Ecuador, Costa Rica, and Mexico.

Discussion

Tobacco causes significant health and economic burdens in Latin America, with gender-based differences. There is a need for gender-disaggregated data to improve tobacco control policies.

University students' and staff attitudes toward the implementation of a "tobacco-free" policy: A view from Qatar

Objectives

Tobacco-free campus policies are needed to create environments conducive to prevention or quitting in the Eastern Mediterranean Region (EMR), where the use of various tobacco products is on the rise among university students. The objectives of this study were to assess overall support for a 100% tobacco-free campus policy and its predictors among different stakeholder groups at the largest national university in Qatar and to understand attitudes towards specific policy components.

Study design

A cross-sectional online survey of faculty and students.

Methods

We measured sociodemographic variables, tobacco use, and support for components of a 100% tobacco-free campus policy. A total score for support was calculated, and associations with selected predictors were assessed using multivariable linear regression.

Results

413 respondents participated in the survey. A majority of faculty/staff and students (76.6% and 75.5%, respectively) supported the implementation of a 100% tobacco-free campus policy, with a majority supporting extension of the policy beyond cigarettes. Support for other components of the policy varied. Among students, overall support was lower among males and tobacco users and higher among the married. Among faculty and staff, support was lower among Qatari nationals and tobacco users.

Conclusion

In the context of a growing tobacco crisis in the EMR, implementing and understanding the impact of tobacco-free campus policies is essential. This paper underscores the importance of addressing diverse stakeholder attitudes and providing empirical evidence to guide policy implementation and evaluation.

Factors predicting the intention of drug abuse avoidance among adolescents in Pinlaung Township, Myanmar: predictive correlational design

BACKGROUND

Adolescence is a critical transition period and is at high risk for drug/substance abuse. In Myanmar, drug use is common among adolescents and is a public health concern. There are no studies of drug abuse prevention among Myanmar adolescents. Intentions to avoid drug abuse can be a protective factor for preventing drug abuse among adolescents. This study investigated the effects of sex, parental history of drug/alcohol abuse, self-efficacy, parental marital status, and family functioning on the intention of drug abuse avoidance among Myanmar adolescents.

METHODS

This is a predictive correlational study. The Biopsychosocial model was used as the theoretical framework of this study. A convenient sampling method was used to collect data from 157 students aged 13-18 years in a government school, middle school level and high school level, Pinlaung Town, Southern Shan State, Myanmar during the COVID-19 pandemic and political protests. G* power software was used to calculate the sample size. Data was collected by four self-administered questionnaires: a socio-demographic questionnaire, Thai Family Functioning Scale (TFFS), General Self-Efficacy Scale (GSE), and Intention of Drug Avoidance Scale (IDAS). Multiple linear regression was employed to analyze the data.

RESULTS

Five predictors, including biological sex, parental history without drug/alcohol abuse, self-efficacy, parental marital status, and family functioning, explained 24.4% of the variance in the intention of drug abuse avoidance among Myanmar adolescents (R 2 = .244, F (5,151) = 9.738, p = .000). In addition, only three factors, family functioning (β = .31, p < .001), biological sex (β = -.25, p < .01), and self-efficacy (β = .16, p < .05) statistically and significantly predicted the intention of drug abuse avoidance among Myanmar adolescents.

CONCLUSIONS

Family functioning, female gender, and self-efficacy predicted the intention of drug abuse avoidance among Myanmar adolescents in Pinlaung Township, Southern Shan State, Myanmar.

IMPLICATIONS OF THIS STUDY

The results of this study have implications for all stakeholders through research, education, practice, and policymaking leading to improve the intentions of drug abuse avoidance among Myanmar adolescents. Furthermore, the results of this study specifically contribute to create psychoeducational intervention programs for increasing intention to avoid substance use by promoting family functioning and self-efficacy of adolescents. This is especially proper for male adolescents who have less intention to avoid substance use.

Cost-effectiveness analysis of adding tuberculosis household contact investigation on passive case-finding strategy in Southwestern Uganda

INTRODUCTION

The standard passive case-finding strategy implemented by most developing countries is inadequate to detect new cases of Tuberculosis. A household contact investigation is an alternative approach. However, there is limited cost-effectiveness data to support planning and implementation in low and middle-income countries. The study aimed to evaluate the cost-effectiveness of adding household contact investigation (HCI) to the passive case-finding (PCF) strategy in the Tuberculosis control program in Southwestern Uganda.

METHODS

We conducted an economic evaluation using a retrospective study approach and bottom-up costing (ingredients) techniques. It was a synthesis-based evaluation of existing data extracted from the District Health Information System (DHIS 2), TB registers, and a primary cost survey. The study compared two methods of Tuberculosis (TB) case finding (PCF and HCI) strategies. Regarding PCF, patients either self-reported their signs and symptoms or were prompted by healthcare workers. At the same time, HCI was done by home visiting and screening contacts of TB patients. Patients and household contacts presumed to have Tuberculosis were requested to produce samples for analysis. We applied a static decision-analytic modeling framework to examine both strategies' costs and effectiveness. The study relied on cost and probability estimates from National Tuberculosis (TB) program data, activity costs, and published literature. It was performed from the societal and provider perspectives over 1.5 years across 12 facilities in Ntungamo, Sheema, and Rwampara Districts. The primary effectiveness measure was the number of TB cases detected (yield) and the number needed to screen (NNS). The TB yield was calculated from the number of patients screened during the period under study. The incremental cost-effectiveness ratio (ICER) was expressed as cost in 2021 US$ per additional TB case detected. We did not apply a discount rate because of the short analytic time horizon.

RESULTS

The unit costs of detecting a Tuberculosis case were US$ (United States dollar) 204.22 for PCF and US$ 315.07 for HCI. Patient and caregiver costs are five times more in PCF than in HCI [US$26.37 Vs. US$ 5.42]. The ICER was US$ 3,596.94 per additional TB case detected. The TB screening yields were 0.52% (1496/289140) for passive case finding and 5.8% (197/3414) for household contact investigation. Household contact investigation yield among children 0-14 Vs. 15+ years [6.2% Vs.5.4%] P = 0.04. The Yield among People living with HIV (PLHIV) Vs. HIV-negative [15.8% Vs.5.3%] P = 0.03 in HHCI. The PCF yield in men Vs. Women [1.12% Vs.0.28%] P<0.01. The NNS in PCF was 193 [95% CI: 186-294] and 17 [95% CI: 14-22] in HCI.

CONCLUSION

Our baseline assumptions and the specific implementations of adding HCI to existing PCF programs in the context of rural African settings prove to be not cost-effective, rather than HCI as a strategy. HCI effectively identifies children and PLHIV with TB and should be prioritized. Meanwhile, the Passive case-finding strategy effectively finds men with TB and costs lower than household contact investigation.

Tobacco use in Haiti: findings from demographic and health survey

INTRODUCTION

Although tobacco has harmful effects on the physical and mental health of individuals, its use remains significant, according to the World Health Organization. To understand this phenomenon, studies have been carried out in many countries around the world, while in Haiti where more than 5,000 people die each year due to tobacco use, little is known about the use of this substance. The aim of this study was to examine the prevalence and the factors associated with tobacco use in Haiti.

METHODS

We used data from the 2016/17 Haitian Demographic Health Survey. Both descriptive and multivariate analyses were conducted using STATA 16.0 software to assess the prevalence and identify factors associated with tobacco use. Results were reported as adjusted odds ratios with 95% confidence intervals. Statistical significance was declared at p < 0.05.

RESULTS

The prevalence of tobacco use was estimated at 9.8% (95% CI: 9.2-10.4) among men and 1.7% (95% CI: 1.5-1.9) among women. Although the prevalence of tobacco use was low among young people, it increased with age. Respondents aged 35 and above, with no formal education, non-Christians, divorced/separated/widowed, from poorest households, rural areas, "Aire Métropolitaine de Port-au-Prince" region, with high media exposure had a higher likelihood of tobacco use.

CONCLUSION

The low prevalence of tobacco use among Haitian women and youth represents a public policy opportunity to prevent these vulnerable groups from starting smoking. Adult male smokers should also be targeted by appropriate policy to reduce the different health burdens associated with tobacco, both for the smokers and other people they may expose to passive smoking. Government and health sector stakeholders, along with community leaders, should create and enforce awareness strategies and rules to control advertisements that encourage irresponsible and health-risky consumption behaviors.

Strengths and Limitations of Web-Based Cessation Support for Individuals Who Smoke, Dual Use, or Vape: Qualitative Interview Study

BACKGROUND

Tobacco use has shifted in recent years, especially with the introduction of e-cigarettes. Despite the current variable and intersecting tobacco product use among tobacco users, most want to quit, which necessitates cessation programs to adapt to these variable trends (vs focusing on combustible cigarettes alone). The use of web-based modalities for cessation support has become quite popular in recent years and has been compounded by the COVID-19 pandemic. Therefore, understanding the current strengths and limitations of existing programs to meet the needs of current various tobacco users is critical for ensuring the saliency of such programs moving forward.

OBJECTIVE

The purpose of this study was to understand the strengths and limitations of web-based cessation support offered through QuitNow to better understand the needs of a variety of end users who smoke, dual use, or vape.

METHODS

Semistructured interviews were conducted with 36 nicotine product users in British Columbia. Using conventional content analysis methods, we inductively derived descriptive categories and themes related to the strengths and limitations of QuitNow for those who smoke, dual use, or vape. We analyzed the data with the support of NVivo (version 12; QSR International) and Excel (Microsoft Corporation).

RESULTS

Participants described several strengths and limitations of QuitNow and provided suggestions for improvement, which fell under 2 broad categories: look and feel and content and features. Shared strengths included the breadth of information and the credible nature of the website. Individuals who smoke were particularly keen about the site having a nonjudgmental feeling. Moreover, compared with individuals who smoke, individuals who dual use and individuals who vape were particularly keen about access to professional quit support (eg, quit coach). Shared limitations included the presence of too much text and the need to create an account. Individuals who dual use and individuals who vape thought that the content was geared toward older adults and indicated that there was a lack of information about vaping and personalized content. Regarding suggestions for improvement, participants stated that the site needed more interaction, intuitive organization, improved interface esthetics, a complementary smartphone app, forum discussion tags, more information for different tobacco user profiles, and user testimonials. Individuals who vape were particularly interested in website user reviews. In addition, individuals who vape were more interested in an intrinsic approach to quitting (eg, mindfulness) compared with extrinsic approaches (eg, material incentives), the latter of which was endorsed by more individuals who dual use and individuals who smoke.

CONCLUSIONS

The findings of this study provide directions for enhancing the saliency of web-based cessation programs for a variety of tobacco use behaviors that hallmark current tobacco use.

Support for nicotine reduction in cigarettes: findings from the 2016 and 2020 ITC Four Country Smoking and Vaping Surveys

INTRODUCTION

The USA and New Zealand have sought to establish a product standard to set a maximum nicotine level for cigarettes to reduce their addictiveness. This study examined support for very low nicotine cigarettes (VLNCs) in Australia, Canada, England and the USA between 2016 and 2020.

METHODS

Repeated cross-sectional data were analysed from participants who currently smoke, formerly smoked or vaped and/or currently vape in the 2016 (n=11 150) and/or 2020 (n=5432) International Tobacco Control (ITC) Four Country Smoking and Vaping Survey. Respondents were asked if they would support a law that reduces the amount of nicotine in cigarettes to make them less addictive. Adjusted and weighted logistic regression analyses estimated the prevalence and predictors of support, such as country, age, sex, education, income, race and smoking/vaping status for VLNCs (support vs oppose/do not know).

RESULTS

A majority of respondents supported a VLNC law, with support highest in Canada (69%; 2016 and 2020 combined), followed by England (61%), Australia (60%) and the USA (58%). Overall, support decreased from 62% in 2016 to 59% in 2020 (p=0.004), which did not differ by country. Levels of support differed by smoking/vaping status, where those who exclusively smoked daily showed the lowest level of support (59%) and those who exclusively vaped non-daily had the highest level of support (72%).

CONCLUSION

More than half of respondents in all four countries-including those who smoked daily-supported a hypothetical VLNC standard to render cigarettes less addictive. It is important to examine if support is sustained after policies are implemented.

Association of serum leptin and ghrelin levels with smoking status on body weight: a systematic review and meta-analysis

Background and aims

Smoking cigarettes is a major global health problem that affects appetite and weight. The aim of this systematic review was to determine how smoking affected plasma leptin and ghrelin levels.

Methods

A comprehensive search of PubMed, Scopus, Web of Science, and Ovid was conducted using a well-established methodology to gather all related publications.

Results

A total of 40 studies were included in the analysis of 11,336 patients. The overall effect showed a with a mean difference (MD) of -1.92[95%CI; -2.63: -1.20] and p = 0.00001. Subgroup analysis by study design revealed significant differences as well, but with high heterogeneity within the subgroups (I2 of 82.3%). Subgroup by sex showed that there was a significant difference in mean difference between the smoking and non-smoking groups for males (MD = -5.75[95% CI; -8.73: -2.77], p = 0.0002) but not for females (MD = -3.04[95% CI; -6.6:0.54], p = 0.10). Healthy, pregnant, diabetic and CVD subgroups found significant differences in the healthy (MD = -1.74[95% CI; -03.13: -0.35], p = 0.01) and diabetic (MD = -7.69[95% CI, -1.64: -0.73], p = 0.03). subgroups, but not in the pregnant or cardiovascular disease subgroups. On the other hand, the meta-analysis found no statistically significant difference in Ghrelin serum concentration between smokers and non-smokers (MD = 0.52[95% CI, -0.60:1.63], p = 0.36) and observed heterogeneity in the studies (I2 = 68%).

Conclusion

This study demonstrates a correlation between smoking and serum leptin/ghrelin levels, which explains smoking's effect on body weight.

Systematic review registration

https://www.crd.york.ac.uk/ prospero/display_record.php, identifier (Record ID=326680).

Sex differences in frailty among older adults

By definition, aging is a natural, gradual and continuous process. On the other hand, frailty reflects the increase in vulnerability to stressors and shortens the time without disease (health span) while longevity refers to the length of life (lifespan). The average life expectancy has significantly increased during the last few decades. A longer lifespan has been accompanied by an increase in frailty and decreased independence in older adults, with major differences existing between men and women. For example, women tend to live longer than men but also experience higher rates of frailty and disability. Sex differences prevent optimization of lifestyle interventions and therapies to effectively prevent frailty. Sex differences in frailty and aging are rooted in a complex interplay between uncontrollable (genetic, epigenetic, physiological), and controllable factors (psychosocial and lifestyle factors). Thus, understanding the underlying causes of sex differences in frailty and aging is essential for developing personalized interventions to promote healthy aging and improve quality of life in older men and women. In this review, we have discussed the key contributors and knowledge gaps related to sex differences in aging and frailty.

The Global Burden of premature cardiovascular disease, 1990-2019

Aims

Premature cardiovascular disease (pCVD) definition varies in literature, with age cut-offs ranging from 50-65 years. While there is some literature available on pCVD in North America, comprehensive data on its global burden is still lacking which hinders the development of efficient strategies for early detection and prevention. In this study we aimed to investigate the global trends in pCVD related morbidity and mortality from 1990 to 2019.

Methods

The 1990-2019 Global Burden of Disease (GBD) database was utilized to examine global trends in cardiovascular disease-related total mortality, mortality rates, and Disability-Adjusted Life Years (DALYs) within individuals aged 15-49 years. The findings were further analyzed based on factors such as age, sex, and Socio-Demographic Index (SDI).

Results

From 1990 to 2019, the number of global annual pCVD deaths increased by 25%, from 992,067 (95% UI 1,042,261 - 946,383) to 1,241,484 (95% UI 1,339,193 -1,146,252). The rate of associated mortality decreased by 13%. Metabolic conditions were the most significant risk factors for pCVD mortality. Ischemic heart disease and stroke are the leading causes of death across all age groups. pCVD mortality presented progressive widening between high and low SDI regions. Additionally, sex-specific disparities in CVD mortality were significantly greater in the premature age group as compared to all-age groups.

Conclusion

pCVD is an increasingly significant global cause of morbidity and mortality that disproportionately affects males and individuals living in less privileged regions. Furthermore, ischemic heart disease and stroke were identified as the main drivers of pCVD global burden.

Assessment of prevalence, predictors, reasons and regulations of substance smoking among children in Ghana

BACKGROUND

In Ghana, it is against the law for children to smoke. Nevertheless, a portion of children in the country do smoke. However, there is a paucity of research on young smokers in Ghana and other sub-Saharan African nations. This study, therefore, investigated the prevalence of smoking, the kinds of substances children smoke, predictors of smoking, reasons for and factors that lead children to smoke, and regulation of smoking among children in Ghana.

METHODS

In total, 5024 children aged 8-17 were studied using a cross-sectional convergent parallel mixed method. Descriptive statistics, Person's Chi-square test, Fisher Exact test, and binary logistic regression were used to analyse the quantitative data. In contrast, thematic analysis was used to analyse the qualitative data.

RESULTS

The results showed that 3.2% of children had ever smoked. Male children smoked more often than female children. The prevalence of cigarette, marijuana, and shisha smoking was 78.3%, 18%, and 3.7%, respectively. While more male children than female children smoked cigarettes and marijuana, more female children than male children used shisha. Children mainly smoked for fun and due to group culture. In addition, children were influenced by friends; parents, family members, and neighbours who smoke; curiosity; and advertisements and videos to initiate smoking. Despite the availability of regulations and laws regulating tobacco products in public places, tobacco advertisement, promotion, and sale to persons under 18, children are still smoking.

CONCLUSIONS

Children who have ever engaged in smoking reported using cigarettes, marijuana, and shisha. Policymakers urgently need to strategise and strengthen their policies, programmes, and interventions to address smoking among children.

An Update on the Use of Wearable Devices in Men's Health

Men's health represents an often-overlooked aspect of public health. Men have higher mortality rates worldwide and are more negatively affected by chronic conditions such as obesity and heart disease, as well as addiction to alcohol and tobacco. Men also have health issues such as prostate cancer and male sexual dysfunction which only affect them. Because of the skewed burden of morbidity and mortality on men, it is imperative from a public health perspective to make a concerted effort to specifically improve men's health. The use of wearable devices in medical practice presents a novel avenue to invest in men's health in a safe, easily scalable, and economic fashion. Wearable devices are now ubiquitous in society, and their use in the healthcare setting is only increasing with time. There are commercially available devices such as smart watches which are available to lay people and healthcare professionals alike to improve overall health and wellness, and there are also purpose-built wearable devices which are used to track or treat a specific disease. In our review of the literature, we found that while research in the field of wearable devices is still in its early stages, there is ample evidence that wearable devices can greatly improve men's health in the long-term.

Efficacy of insula deep repetitive transcranial magnetic stimulation combined with varenicline for smoking cessation: A randomized, double-blind, sham controlled trial

BACKGROUND

Current smoking cessation treatments are limited in terms of efficacy, particularly with regards to long term abstinence. There is a large amount of evidence implicating the insula in nicotine addiction.

OBJECTIVE

To examine the efficacy of bilateral repetitive transcranial magnetic stimulation (rTMS) directed to the insular cortex with the H11 coil, relative to sham stimulation, on smoking abstinence and smoking outcomes in smokers who are receiving standard varenicline treatment.

METHODS

This randomized, double-blind, sham controlled trial recruited 42 participants who were randomized to receive either active (n = 24) or sham (n = 18) high frequency rTMS directed to the insula (4 weeks), while receiving varenicline treatment (12 weeks). The primary outcome was 7-day point prevalence abstinence at the end of 12 weeks.

RESULTS

Smokers in the active group had significantly higher abstinence rates than those in the sham group (82.4% vs. 30.7%, p = 0.013) at the end of treatment (Week 12). Secondary outcome measures of abstinence rate at the end of rTMS treatment (Week 4), abstinence rate at 6 months, and smoking outcomes (e.g., craving, withdrawal) showed no significant differences between groups. No differences were found in adverse events reported between the groups.

CONCLUSION

This study provides evidence of the potential benefit of having a combined treatment for smoking cessation using insula rTMS with the H11 coil and varenicline. Maintenance rTMS sessions and continuation of varenicline for those in abstinence may induce longer-term effects and should be considered in future studies.

Monitoring the Effectiveness of Treatment in Women with Schizophrenia: New Specialized Cooperative Approaches

Women with schizophrenia have specific health needs that differ from those of men and that change through successive life stages. We aimed to review the biopsychosocial literature on schizophrenia that addresses clinically important questions related to the treatment of women, including somatic morbi-mortality, hyperprolactinemia, comorbid substance use disorders, social risk factors, and medication effectiveness/safety. Data search terms were as follows: (Morbidity AND mortality) OR hyperprolactinemia OR ("substance use disorders" OR addictions) OR ("social risk factors") OR ("drug safety" OR prescription) AND women AND schizophrenia. A secondary aim was to describe a method of monitoring and interdisciplinary staff strategies. Schizophrenia patients show an increased risk of premature death from cardiovascular/respiratory disease and cancer compared to the general population. The literature suggests that close liaisons with primary care and the introduction of physical exercise groups reduce comorbidity. Various strategies for lowering prolactin levels diminish the negative long-term effects of hyperprolactinemia. Abstinence programs reduce the risk of victimization and trauma in women. Stigma associated with women who have serious psychiatric illness is often linked to reproductive functions. The safety and effectiveness of antipsychotic drug choice and dose differ between men and women and change over a woman's life cycle. Monitoring needs to be multidisciplinary, knowledgeable, and regular.

Nativity Status Predicts Tobacco Use: A Comparative Analysis of US-Born and Foreign-Born Adults From the Health Information National Trends Survey (HINTS)

Introduction Tobacco smoking remains one of the leading causes of morbidity and mortality globally and in the United States (USA). We hypothesize that US-born naturals have higher odds of tobacco smoking compared to their foreign-born counterparts, and our study aims to assess the relationship between nativity status and odds of tobacco smoking using a nationally representative sample. Methods We utilized the Health Information National Trends Survey (HINTS) 5 Cycle 1 (2017) and Cycle 2 (2018) for this study. Our main outcome variable was smoking status divided as ever smoker and never smoker. The main predictor was US birth status. We controlled for sociodemographic characteristics such as age, race, gender, educational status, and marital status. We performed weighted descriptive statistics and bivariate analysis with chi-square for our variables. Unadjusted and adjusted logistic regression was used to ascertain the odds of our outcome given our predictor. Significance was set at 95% confidence, and the alpha level was set to 0.05. All analyses were performed using SAS version 9.4 (SAS Institute Inc., Cary, NC, USA). Results Our final sample consisted of 5,677 individuals (weighted: 429,613,693). Of our sample, 36.89% were ever smokers, females were 50.73%, and the majority (57.90%) were high school graduates. In terms of nativity status, those born in the USA were 85.65%, while the non-US-born population was 14.35%. After adjusting for confounders, we found that non-US-born respondents had 42% lower odds of being ever smokers compared to their US-born counterparts (adjusted odds ratio (AOR) = 0.576; 95% confidence interval (CI) = 0.388-0.854; P = 0.0062). Females were 24% less likely to be ever smokers compared to males (AOR = 0.758; 95% CI = 0.644-0.893; P = 0.0010). Having a bachelor's degree or a graduate degree was associated with 42% and 53% lower odds of being ever smokers compared to high school graduates (AOR = 0.583; 95% CI = 0.474-0.717; P < 0.0001) (AOR = 0.471; 95% CI = 0.377-0.588; P < 0.0001). Whites had 97% higher odds of being ever smokers compared to Hispanics (AOR = 1.977; 95% CI = 1.459-2.679; P < 0.0001). Conclusion Our finding of lower odds of tobacco use among foreign-born nationals compared to US-born nationals is consistent with previous studies and suggests the need for equity in tobacco use prevention between the two populations assessed in our study. This is poised to improve overall tobacco use burden, morbidity, and mortality.

Assessment of health-related behaviors among medical students: A cross-sectional study

Background and Aim

Students sometimes participate in harmful activities that adversely influence their behaviors and well-being throughout college, which is one of the sensitive phases in an individual's life. Aim: To assess the health-related behaviors of university students.

Methods

A cross-sectional study that includes systematic randomly selected 383 students from various colleges of Ras Al Khaimah Medical and Health Sciences University (RAKMHSU), Ras Al Khaimah Emirate, United Arab Emirates. A self-reported questionnaire included students' demographic traits and behaviors, including safety, medication intake, cigarette smoking, nutrition, physical activity, and health-related topics.

Results

Most participants were females (69.7%), 13.3% were obese while 28.2% were overweight. The data revealed a significant difference between male and female students regarding medication intake without prescription, nutrition, physical activity, and health-related topics. The data also revealed that the majority of the students were attempting to lose weight, and the former male smokers had fewer trials to quit the use of all tobacco products than females.

Conclusion

More than a quarter of participants were overweight, and the majority of students did not adhere to the guidelines for safety and nutritious eating. This study recognized significant health promotion opportunities for university students that can be carried out to establish a healthier youth for society.

Nursing students' attitudes, behaviour, and knowledge toward smoking cessation: Results from a descriptive survey at a regional university

BACKGROUND

Smoking is the largest single cause of lifestyle-related preventable morbidity and mortality. Nurses form the largest cohort of health professionals and are strategically placed to implement smoking cessation interventions. However their capacity is underutilised, particularly in rural and remote areas in countries such as Australia where the incidence of smoking in is higher than average and access to healthcare is limited. One strategy to address the underutilisation of nurses in smoking cessation interventions is to include training in the university/college nursing curriculum. To effectively implement this training, it is vital to have an in-depth knowledge of student nurses' attitudes towards smoking including the role of healthcare professionals in smoking cessation, their smoking behaviour and that of their peers, and knowledge regarding smoking cessation techniques and resources.

OBJECTIVES

Investigate nursing students' attitudes, behaviour, and knowledge towards smoking cessation, determine the impact of demographics and educational experienced on these, and develop recommendations for future research and educational practice.

DESIGN

Descriptive survey.

PARTICIPANTS

Non-probability sample of undergraduate nursing students (n = 247) from a regional Australian university.

RESULTS

Significantly more participants had tried smoking cigarettes than had not (p = 0.026). There were no significant relationships between gender and smoking (p = 0.169) or e-cigarette use (p = 0.200), but a significant relationship was found between age and smoking status where older participants (48-57 years) were more likely to smoke (p < 0.001). Most participants (70 %) were supportive of public health measures to reduce cigarette smoking but felt that they lacked specific knowledge to assist their patients to cease smoking.

CONCLUSIONS

Within education there needs to be an emphasis on the central role that nurses play in smoking cessation with a greater focus on training nursing students about smoking cessation strategies and resources. There is also a need to ensure that students know it falls within their duty of care to address smoking cessation with patients.

Lifestyle Assessment of Primary Healthcare Physicians in Taif, Saudi Arabia in the Year 2022

Objective This study aims to evaluate primary healthcare physicians' lifestyles to promote their well-being and improve care quality for the general population. Methods This cross-sectional quantitative study was conducted on primary healthcare physicians in Taif, Kingdom of Saudi Arabia (KSA), using self-administered questionnaires. Results We included 206 participants aged 26-66. Most participants were 35 years old or younger (67%), male (62.1%), and residents (52.4%). Of all participants, 49.5% held a Bachelor's degree, 40.8% had completed their board certificate or Ph.D., and 69.9% had at least 10 years of experience. Of all participants, 16.5% and less than 9% reported having hypercholesterolemia and other comorbidities, respectively. More than 50% were physically inactive, 26.2% were moderately inactive, and 17.4% were moderately active or active individuals. Physical activity was significantly associated with job titles (p < 0.018). The qualification was associated with dietary score (p = 0.034), and 42.7% of participants were in need of diet change. About a quarter (25.2%) were smokers, and 92.3% of them smoked daily. Male participants were associated with a greater likelihood of smoking (p < 0.001). Overall, 41.7% were overweight, and 25.7% were obese. Increased BMI was associated with older age and male gender (p < 0.001 and p < 0.002, respectively), as well as the title of the physician and years of experience (p < 0.001 and p < 0.002, respectively). Conclusion Participants' unhealthy lifestyles indicate the need to establish measures to promote healthy lifestyles among physicians.

Gendered Pattern and Predictors of Tobacco use in India: Evidence from the Second Round of Global adult Tobacco Survey

Background

India has completed the second round of the Global Adult Tobacco Survey (GATS) to monitor adult tobacco use and progress in tobacco control efforts. This study assesses the gendered pattern of tobacco use and its predictors in the second rounds of GATS.

Material and Methods

Publicly available GATS-2 (2016-2017) data was analyzed which contains self-reported tobacco use information of ≥15 years Indians (n = 74,037). The independent predictors of "smoking only," "smokeless only," and "dual use" among current male and female tobacco users were assessed using the multinomial regression model.

Results

The burden of "smoking only," "smokeless only," and "dual-use" of tobacco were 8.9% (8.74-9.15), 16.69% (16.42-16.96), and 3.89% (3.75-4.03), respectively, in the second round with wide regional variation as well as male dominance in use. Region, age, education, caste, and religion were significantly and consistently associated with different types of tobacco use in both genders. Other contextual predictors of tobacco use were residence, marital status, occupation, awareness, and wealth index (WI).

Conclusions

Tobacco use predictors and their gendered patterns are contextual. Monitoring the predictors for tobacco use, which may change over time, should be given priority in the national tobacco control program.

Does combined training of biofeedback and neurofeedback affect smoking status, behavior, and longitudinal brain plasticity?

Introduction: Investigations of biofeedback (BF) and neurofeedback (NF) training for nicotine addiction have been long documented to lead to positive gains in smoking status, behavior and to changes in brain activity. We aimed to: (a) evaluate a multi-visit combined BF/NF intervention as an alternative smoking cessation approach, (b) validate training-induced feedback learning, and (c) document effects on resting-state functional connectivity networks (rsFCN); considering gender and degree of nicotine dependence in a longitudinal design. Methods: We analyzed clinical, behavioral, and electrophysiological data from 17 smokers who completed five BF and 20 NF sessions and three evaluation stages. Possible neuroplastic effects were explored comparing whole-brain rsFCN by phase-lag index (PLI) for different brain rhythms. PLI connections with significant change across time were investigated according to different resting-state networks (RSNs). Results: Improvements in smoking status were observed as exhaled carbon monoxide levels, Total Oxidative Stress, and Fageström scores decreased while Vitamin E levels increased across time. BF/NF promoted gains in anxiety, self-esteem, and several aspects of cognitive performance. BF learning in temperature enhancement was observed within sessions. NF learning in theta/alpha ratio increase was achieved across baselines and within sessions. PLI network connections significantly changed across time mainly between or within visual, default mode and frontoparietal networks in theta and alpha rhythms, while beta band RSNs mostly changed significantly after BF sessions. Discussion: Combined BF/NF training positively affects the clinical and behavioral status of smokers, displays benefit in smoking harm reduction, plays a neuroprotective role, leads to learning effects and to positive reorganization of RSNs across time. Clinical Trial Registration: https://clinicaltrials.gov/ct2/show/NCT02991781.

Environmental determinants of infectious and chronic disease prevention behaviours: A systematic review and thematic synthesis of qualitative research

Regulatory health policies facilitate desired health behaviours in communities, and among them, smoke-free policies and COVID-19 restrictions have been widely implemented. Qualitative research studies have explored how these measures and other environmental influences shape preventive behaviours. The objective of this systematic review was to synthesize previously published qualitative research, generate across-study themes, and propose recommendations for behaviour change interventions. We used a comprehensive search strategy, relevance screening and confirmation, data extraction, quality assessment, thematic synthesis, and quality-of-evidence assessment. In total, 87 relevant studies were identified. Findings were grouped under six overarching themes and mapped under three categories: (i) the political environment, (ii) the sociocultural environment, and (iii) the physical environment. These findings provide insights into the environmental influences of behaviour and indicate future interventions may be more effective by considering moral norms, community norms, policy support, and group identity.

Cytotoxic Labdane Diterpenes, Norlabdane Diterpenes and Bis-Labdanic Diterpenes from the Zingiberaceae: A Systematic Review

Over the years, labdane diterpenes, norlabdane diterpenes, and bis-labdanic diterpenes with cytotoxic activities have been identified across various families in the plant kingdom including the Zingiberaceae. The present review discusses the distribution of these labdane-type diterpenes within the Zingiberaceae; their extraction, isolation, and characterization from the respective Zingiberaceae species; the structural similarities and differences within each group and between the different groups of the labdane-type diterpenes; and their cytotoxic activities against breast, cervical, liver, colorectal, pancreatic, lung and prostate cancer cell lines. The review will also provide insight into how the cytotoxic activities of the labdane-type diterpenes are influenced by their structural features.

Perceived Loneliness, Peer, and Parental Relationship With Smoking: A Cross-Sectional Analysis of Adolescents Across South-East Asia

Tobacco use among youth in the South-East Asian region is quite prevalent. This study aims to examine if psychosocial factors (perceived loneliness, peer, and parental relationships) were associated with adolescent smoking, and whether the effects were different according to sex and age. Data came from the Global School-based Student Health Surveys collected between 2012 and 2015 in Brunei, Cambodia, Indonesia, Laos, Malaysia, Philippines, Thailand, Timor-Leste, and Vietnam. 64 578 (males = 48.5%) adolescents aged 13-18 completed the survey. Prevalence of past-month cigarette use was 10.6%. Adolescent smoking was associated with loneliness (OR = 1.75), lack of close friends (OR = 1.43), and lack of parental understanding (OR = 1.35). There was significant interactions between sex with loneliness, close friends, and parental understanding (p < .001). Interactions indicated having no close friends is associated with smoking and is stronger for females than males. Conversely, loneliness was associated with smoking more strongly in males than females. Results indicate that psychosocial factors are linked to adolescent smoking in South-East Asia, suggesting a further need for research on the relation of psychosocial factors with smoking, and their underlying factors.

Pattern and Predictors of Tobacco Use Among Undergraduates in Three Tertiary Institutions in North-Western Nigeria

BACKGROUND

Tobacco use is associated with medical, social and economic problems. There is paucity of data on tobacco use among undergraduates in northern Nigeria. This study assessed pattern and predictors of tobacco use among undergraduates in Zaria, North-western Nigeria.

METHOD

It was a cross-sectional study of undergraduates in three tertiary institutions. Multi-stage sampling technique was used to select 1,080 undergraduates. Data was collected using a questionnaire adapted from Global Adult Tobacco Survey and Global Youth Tobacco Survey. Bi-variate analysis was used to identify independent variables showing statistically significant association with current tobacco use. These were entered into step-wise logistic regression.

RESULTS

Their median age was 24 years (range:15-47). Prevalence of current tobacco use was 27.0%. About 58.7% smoked tobacco daily and 40.0% used smokeless tobacco daily. Commonest places where tobacco was used were off campus accommodation (30.2%), social center (30.2%) and bar or club (28.1%). Predictors of tobacco use were being a male [2.64(1.82-3.84)], married [2.33(1.49-3.70)], experiencing tobacco promotional activity [1.56(1.12-2.17)], willing to use promotional objects [2.06(1.35-3.14)], using of promotional objects [2.74(1.90-3.96)], and exposure to secondhand smoke [14.10(4.16-47.81)]. Predictors of non-use of tobacco were spending two years or less awaiting university admission [0.65 (0.46-0.91)], parents currently together [0.48(0.33-0.69)], and supporting ban on tobacco [0.34 (0.23-0.48)].

CONCLUSION

Prevalence of tobacco use and expenditure on tobacco were high. University authorities should commence programs to identify tobacco users and encourage cessation. The findings also highlight the need to establish effective tobacco surveillance system that includes students of tertiary institutions.

The Association between Acute Myocardial Infarction-Related Outcomes and the Ramadan Period: A Retrospective Population-Based Study

Fasting throughout the Muslim month of Ramadan may impact cardiovascular health. This study examines the association between the Ramadan period and acute myocardial infarction (AMI)-related outcomes among a Muslim population. The data were retrospectively extracted from a tertiary hospital (Beer-Sheva, Israel) database from 2002–2017, evaluating Muslim patients who endured AMI. The study periods for each year were: one month preceding Ramadan (reference period (RP)), the month of Ramadan, and two months thereafter (1840 days in total). A comparison of adjusted incidence rates between the study periods was performed using generalized linear models; one-month post-AMI mortality data were compared using a generalized estimating equation. Out of 5848 AMI hospitalizations, 877 of the patients were Muslims. No difference in AMI incidence between the Ramadan and RP was found (p = 0.893). However, in the one-month post-Ramadan period, AMI incidence demonstrably increased (AdjIRR = 3.068, p = 0.018) compared to the RP. Additionally, the highest risk of mortality was observed among the patients that underwent AMI in the one-month post-Ramadan period (AdjOR = 1.977, p = 0.004) compared to the RP. The subgroup analyses found Ramadan to differentially correlate with AMI mortality with respect to smoking, age, sex, diabetes mellitus, and hypertension, suggesting the Ramadan period is a risk factor for adverse AMI-related outcomes among select Muslim patients.

Electronic Cigarettes in Thailand: Behaviour, Rationale, Satisfaction, and Sex Differences

Electronic cigarettes (e-cigarettes) use is trending in Thailand. Electronic cigarettes are banned and illegally imported. This study aimed to investigate the behaviour, rationale, and satisfaction of e-cigarettes users and compared them between males and females. A cross-sectional study was conducted involving 1050 participants using e-cigarettes from December 2019 to February 2020. The participants were recruited by an online questionnaire posted on social media. The participants were current e-cigarettes users aged 18 years and older. Of 1050 participants, 936 were male (89.1%). The average age was 31.2 ± 8.4 years. The participants were from all regions of the country, but most (64.5%) were from central Thailand. Most e-cigarettes users comprised private employees (43.2%). The main source of e-cigarettes in Thailand is online sources such as social media. Tank-style e-cigarettes were popular among users. Amongst e-cigarettes users, the top three rationales for using e-cigarettes were fewer harmful effects from e-cigarettes than conventional cigarettes (81.0%), smoking cessation aids (80.6%), and their lack of attaching cigarette odour (58.2%). The top three reasons for satisfaction were using e-cigarettes as a conventional cigarette cessation aid (5.1 ± 1.3), lessening cravings for conventional cigarettes (5.1 ± 1.3), and reducing conventional cigarettes withdrawal symptoms (5.0 ± 1.3). Online purchase was the main source of e-cigarettes in Thailand. The general rationale for using electronic cigarettes was that they are less harmful and to quit conventional cigarettes. Thai users were satisfied to use e-cigarettes as a conventional cigarette cessation aid. Males and females differed in behaviour, rationale, and satisfaction of e-cigarettes. Public health organisations should provide accurate information about the harm of electronic cigarettes and their efficacy for tobacco cessation.

Spatial Distribution and Factors Associated With Risky Health Behavior Among Adult Males Aged 15-59 Years in Ethiopia: Generalized Structural Equation Modeling

Background

Alcohol drinking and tobacco smoking are the largest preventable causes of death and important risk factors for a number of non-communicable diseases and cause premature death and many socioeconomic consequences. Therefore, the present study is aimed to assess the spatial distribution of risky health behavior and its associated factors among adult males in Ethiopia.

Methods

All men (12,688) within the age range of 15-59 years were included in the final analysis. The distribution of risky health behavior across the country was observed by using ArcGIS software. In SaTScan software, the Bernoulli model was fitted by Kulldorff methods to identify the purely spatial clusters of risky health behavior. Generalized Structural Equation Model (GSEM) was used to determine factors associated with risky health behavior (regular alcohol drinking and tobacco smoking).

Results

Risky health behavior had spatial variation across the country. The primary clusters were located in Tigray, Amhara, and north-eastern Benishangul national regional states. Spatial scan statistics identified 118 primary clusters [Log-Likelihood ratio (LLR) = 524.8, p < 0.001]. Residence, frequency of listening to a radio, occupation, and frequency of watching television were significantly associated with drinking alcohol, whereas wealth index was associated with tobacco smoking. Age, region, educational status, marital status, and religion had association with both domains of risky health behavior.

Conclusion

Risky health behavior had spatial variation across the country. Bans on advertising and promotion of alcohol and tobacco on national press media should be strengthened. Aggressive health education efforts should be directed toward this high-risk population (Tigray, Amhara, and north-eastern Benishangul regional states). Improving risky health behavior is an important approach to reducing health disparities and promoting a more cost-effective utilization of scarce resources in the public health sector.

Comparison and determination of factors associated with smoking status, smoking knowledge, attitude and practice (S-KAP) between smoke-free and non-smoke-free campuses in public universities in Malaysia: a cross-sectional study

OBJECTIVES

We compared the smoking prevalence, smoking knowledge, attitudes and practices (S-KAP) between smoke-free campuses (SFCs) and non-SFCs (NSFCs) and determined the associated factors of smoking status and S-KAP.

DESIGN

Cross-sectional study.

SETTINGS

The research was conducted in four public universities in Malaysia; two SFCs and two NSFCs.

PARTICIPANTS

Students and staff from SFCs (n=1063) and NSFCs (n=1040).

MAIN OUTCOME MEASURES

Compared the smoking prevalence, S-KAP between SFCs and NSFCs and determined the associated factors.

RESULTS

The prevalence of smokers among the SFC and NSFC respondents was 5.2% and 6.7%, respectively. University type and smoking attitude were significantly related (p=0.02). At the SFCs, the factors associated with becoming a smoker were male gender (p<0.001), monthly income ≥RM3000 (p=0.02), positive smoking attitude (p=0.003) and positive smoking practice (p<0.001); at NSFCs, the associated factors were male gender (p<0.001), low smoking knowledge (p=0.004), positive smoking attitude (p=0.001) and practice (p<0.001). The factors associated with good smoking knowledge were female gender (SFCs: p=0.001; NSFCs: p=0.004), and monthly income ≥RM3000 (NSFCs: p=0.02). Male respondents were likely to have positive smoking attitudes (SFCs: p<0.001; NSFCs: p<0.001) and negative smoking practices (SFCs: p<0.001; NSFCs: p<0.001).

CONCLUSION

Overall, smoking prevalence, knowledge and practice were not much different between SFCs and NSFCs. However, there was a significant relationship between university type and smoking attitude due to the existence of the SFC policy likely rendering smoking a less acceptable social norm. Continual education programmes on smoking harms and smoking cessation strategies are highly recommended to aid the SFC policy in preventing secondhand smoke in universities.

Predictors of smoking initiation among Thai adolescents from low-income backgrounds: A case study of Nakhon Pathom low-cost housing estates

INTRODUCTION

Globally, an estimated 1.3 billion people in the world smoke tobacco products, of which more than 8 million die annually. A disproportionate number of these deaths occur in low- and middle-income countries like Thailand. Over 19% (10.7 million) of the Thai population aged ≥15 years were estimated to be smokers; of these, 7.8% were aged 15–18 years. Nearly 1 in 10 Thai students is a current tobacco user; about 20% of these smokers had initiated smoking before their 10th birthday. This shows that early smoking initiation among Thai youths is indeed a public health problem. This study was conducted to examine the factors associated with smoking initiation among adolescents from low-income backgrounds.

METHODS

A cross-sectional study was conducted among youth aged 15–18 years living in low-cost housing estates in Nakhon Pathom province between 1 December 2019 and 30 July 2020. A total of 290 participants were recruited by stratified random sampling. A proprietary questionnaire was used to collect the data, which were analyzed by binary logistic regression.

RESULTS

Risk factors for smoking initiation were having one or both parents deceased (OR=2.28; 95% CI: 1.218–3.471, p=0.001), having divorced parents (OR=1.67; 95% CI: 1.158–2.509, p=0.013), and poor academic performance (OR=2.50; 95% CI: 0.133–3.551, p=0.032). Protective factors were having knowledge of cigarettes (OR=0.65; 95% CI: 0.179–0.895, p=0.004) and correct perception of legal public smoking places (OR=0.45; 95% CI: 0.140–0.850, p=0.025).

CONCLUSIONS

To curb the risks of early smoking initiation among youths of low-income backgrounds, both education and health authorities need to collaboratively design interventions tailored to raise awareness of the negative health impacts of tobacco, improve the performance of underperforming students, and meet the social needs of students whose parents are either deceased or separated to improve their social ties.

Theoretical constructs of smoking cessation among current tobacco smokers in India: a secondary analysis of Global Adult Tobacco Survey-2 (2016-2017)

BACKGROUND

Quitting tobacco smoking is a complex process, and the transtheoretical model describes the various stages of behaviour change that smokers experience to stop smoking. Predictors of intention to quit and stage of behavioural change could assist policy-makers in establishing tailor-made strategies to offer support.

OBJECTIVE

In the current study, we analysed the determinants of cessation among 9499 current smokers of India recorded during the second Global Adult Tobacco Survey (2016-2017).

METHODS

Bivariate analysis, multivariate analysis (binary logistic regression was performed for past quit attempts and intention to quit smoking in the future; multinomial logistic regression to understand predictors of various stages of change determining cessation behaviour of current smokers) was undertaken.

RESULTS

The majority of the smokers was men (91.0%), in 25-44 years age group, (42.3%), daily wagers (37.4%) and resided in the rural area (73.3%), with bidi being the most commonly smoked product (72%). Nearly 72% tried to quit without any assistance with 36.6% (precontemplation), 27% (contemplation), 28% (preparation (or action)) and 8.1% in (relapse) stage. Men ((1.049); 95% CI 1.047 to 1.051), the primary (1.192; 95% CI 1.190 to 1.193) as well as higher education, being married (1.231; 95% CI 1.229 to 1.234) and urban residence (1.167; 95% CI 1.1.65 to 1.168) were found to be associated with higher prevalence of previous quit attempts. The regression modelling found out that intent to quit reduced with increasing age and was similarly prevalent with any level of education.

CONCLUSION

Understanding stages of behavioural change could assist the stakeholders in developing individualised interventions along with the development of intensive cessation protocols in clinical and public health settings.

Electronic Cigarette Use and Other Factors Associated with Cigarette Smoking among Thai Undergraduate Students

The prevalence of smoking among young adults in Thailand has gradually increased. Therefore, this study aimed to identify factors associated with cigarette smoking among undergraduate students. This cross-sectional study used a self-administered, anonymous online questionnaire to gather data from undergraduate students across four universities in Chiang Mai Province, Thailand. All 1126 participants were an average age of 21.30 years old (SD 1.48). The findings revealed seven factors significantly associated with cigarette smoking (p < 0.05), including male sex, having no medical conditions, consuming alcohol daily and consuming alcohol in the past, having brothers or sisters who smoked cigarettes, having a father or mother who smoked cigarettes, having parents who considered smoking acceptable and having parents who had uncertain concerns about smoking, and had or have used electronic cigarettes (e-cigarettes). These associated factors could be useful in implementing appropriate tobacco-control programs to prevent cigarette smoking among undergraduate students. Relevant organizations, universities and healthcare professionals should communicate correct and appropriate information about the illness and diseases caused by using tobacco products to strengthen the correct perceptions of the harms of cigarette smoking and e-cigarette use among undergraduate students. Furthermore, smoke-free policies should be monitored and strictly enforced, particularly in university areas.

The effect of anxiety on nicotine dependence among university students during the COVID-19 pandemic

PURPOSE

This study investigated the effect of anxiety on nicotine dependence among university students during the COVID-19 pandemic.

DESIGN AND METHODS

This was a descriptive and correlational study. The sample consisted of 503 university students in Turkey. Data were collected online using a demographic characteristics form, the State-Trait Anxiety Inventory (STAI), and the Fagerström Test for Nicotine Dependence (FTND).

FINDINGS

FTND scores differed by gender, family type, and grade level, while STAI scores differed by gender, income, and region of residence (p < 0.05). Fifty-one percent of the participants had moderate anxiety, while 65.2% had low nicotine dependence. FTND and STAI mean scores were strongly correlated (p < 0.05).

PRACTICAL IMPLICATIONS

The higher the anxiety, the higher the nicotine dependence among university students during the COVID-19 pandemic.

Explaining the Craving for Cigarette Smoking Based on Adverse Childhood Experiences and Subjective Socioeconomic Status among University Students in Isfahan, Iran

Background: Adverse childhood experiences are linked to a wide range of physical, social, sexual, and family dysfunctions. These experiences, such as smoking, may have negative health consequences. Objective: The goal of this study was to explain the desire to smoke in university students in Isfahan, Iran based on adverse childhood events and subjective socioeconomic status. Methods: This cross-sectional study was conducted on 450 young adults who were recruited randomly from Isfahan universities in 2020. To collect data, a checklist of adverse childhood events, craving for smoking, and a question about subjective socioeconomic status were used. Multivariate logistic regression was used to analyze the data. Results: According to the findings, 46.5 percent of all university students had at least one Adverse Childhood Experience, and 68.8 percent of all university students had some level of smoking craving. Controlling for demographic variables, respondents with one to five adverse childhood experiences (OR: 1.84; 95 percent of CI: 1.11-3.04) and six or more adverse childhood experiences (OR: 5.37; 95 percent of CI: 2.58-11.71) were more likely to crave smoking than respondents with no adverse childhood experiences. Furthermore, among all students, a higher subjective socioeconomic status reduced the likelihood of smoking by 19%. Conclusions and implications: It can be concluded that university students who have had adversity in their childhood are more likely to engage in high-risk behaviors like smoking. Because smoking is recognized as a coping mechanism for stressful events, it is suggested that personal, local, and national strategies aimed at young adults in Iran be developed.

Factors Related to Adolescent Smoking: A Nationally Representative Cross-Sectional Study in Thailand

Objective: This study aimed to explore the individual, familial, and social factors associated with different smoking status in Thai adolescents from the 2017 Cigarette Smoking and Alcohol Drinking Behavior Survey (CSAD) Methods: The nationally representative sample of 6046 adolescents aged 15-19 years who took part in the 2017 CSAD in Thailand. Multinomial logistic regression analysis was conducted to explore the associations between the individual, familial, and social factors and different smoking status.   Results: The daily smoking and occasional smoking was 6.4% and 3.3%, respectively. Gender, alcohol use, substance use, attitudes toward smoking, exposure to secondhand smoke at home, anti-smoking social media campaign, and graphic warning labels were related to both daily and occasional smoking. Daily smoking was associated with exposure to secondhand smoke at school, restaurant, and public transport, and exposure to tobacco advertising. Conclusion: These findings suggest that smoking prevention intervention should particularly focus on these factors and also need to develop the anti-smoking policies for smoking prevention among adolescents.

Perceived Change in Tobacco Use and Its Associated Factors among Older Adults Residing in Rohingya Refugee Camps during the COVID-19 Pandemic in Bangladesh

This study explored the perceived change in tobacco use during the COVID-19 pandemic and its associated factors among older adults residing in Rohingya refugee camps, also referred to as Forcibly Displaced Myanmar Nationals in Bangladesh. The study followed a cross-sectional design and was conducted in October 2020 among 416 older adults aged 60 years and above. A purposive sampling technique was applied to identify eligible participants, and face-to-face interviews were conducted using a pre-tested semi-structured questionnaire to collect the data. Participants were asked if they noted any change in their tobacco use patterns (smoking or smokeless tobacco) during the COVID-19 pandemic compared to pre-pandemic. Binary logistic regression models determined the factors associated with the perceived change in tobacco use. More than one in five participants (22.4%) were current tobacco users, of whom 40.8% reported a perceived increase in tobacco use during the COVID-19 pandemic. Adjusted analysis revealed that participants who were concerned about COVID-19 had significantly (p < 0.05) lower odds of perceived increase in tobacco use (aOR = 0.22, 95% CI: 0.06–0.73), while older adults who were overwhelmed by COVID-19 (aOR = 0.26, 95% CI: 0.06–1.18) and communicated less frequently with others during the pandemic than before (aOR = 0.19, 95% CI: 0.03–1.20) had marginally significantly (p < 0.1) lower odds of perceived increase in tobacco use during this pandemic. Relevant stakeholders, policymakers, and practitioners need to focus on strengthening awareness-raising initiatives as part of an emergency preparedness plan to control tobacco use during such a crisis period.

Smoking cessation, but not reduction, reduces cardiovascular disease incidence

AIMS

The aim of this study was to assess the association of smoking cessation and reduction with risk of cardiovascular disease (CVD).

METHODS AND RESULTS

A total of 897 975 current smokers aged ≥40 years who had undergone two consecutive national health examinations (in 2009 and 2011) were included. Participants were classified as quitters (20.6%), reducers I (≥50% reduction, 7.3%), reducers II (20-50% reduction, 11.6%), sustainers (45.7%), and increasers (≥20% increase, 14.5%). During 5 575 556 person-years (PY) of follow-up, 17 748 stroke (3.2/1000 PY) and 11 271 myocardial infarction (MI) (2.0/1000 PY) events were identified. Quitters had significantly decreased risk of stroke [adjusted hazard ratio (aHR) 0.77 95% confidence interval (CI) 0.74-0.81; absolute risk reduction (ARR) -0.37, 95% CI -0.43 to -0.31] and MI (aHR 0.74, 95% CI 0.70-0.78; ARR -0.27, 95% CI -0.31 to -0.22) compared to sustainers after adjustment for demographic factors, comorbidities, and smoking status. The risk of stroke and MI incidence in reducers I (aHR 1.02, 95% CI 0.97-1.08 and aHR 0.99, 95% CI 0.92-1.06, respectively) and reducers II (aHR 1.00, 95% CI 0.95-1.05 and aHR 0.97, 95% CI 0.92-1.04, respectively) was not significantly different from the risk in sustainers. Further analysis with a subgroup who underwent a third examination (in 2013) showed that those who quit at the second examination but had starting smoking again by the third examination had 42-69% increased risk of CVD compared to sustained quitters.

CONCLUSIONS

Smoking cessation, but not reduction, was associated with reduced CVD risk. Our study emphasizes the importance of sustained quitting in terms of CVD risk reduction.

The Impact of Smoking on Psoriasis Patients with Biological Therapies in a Bucharest Hospital

Psoriasis is an immune-mediated chronic inflammatory skin disease with extracutaneous manifestations, that affects about 1–3% of the world’s population. The disease is not life-threatening, but the disability which comes with it is comparable to the disability caused by other serious chronic diseases, such as oncologic or cardiovascular disease. Several risk factors, such as infections, stress, smoking, excessive alcohol consumption and genetic predisposition have been involved in inducing psoriasis. Smoking status is a risk factor for many chronic diseases, including psoriasis. Moreover, recent studies have tried to answer the question of whether smoking also influences the response to biologic therapy in patients with psoriasis. Through the current study, our intention is to find out how smoking affects the response to biologic treatment. A hospital-based cross-sectional, observational, non-interventional, retrospective study of moderate and severe psoriasis patients receiving biologic treatment was developed. Two groups were defined based on smoking status: group 1 included smokers (more than 10 cigarettes/day) and former smokers, and group 2 included non-smokers. The data that resulted from the analysis of the cohort of patients demonstrate that smoking status does not affect the response of biologic therapy in patients with moderate and severe psoriasis.

Identification of the relationship between nicotine dependence levels and cessation fatigue

PURPOSE

This study aims to identify the relationship between nicotine dependence levels and cessation fatigue.

DESIGN AND METHODS

This descriptive study was conducted in a city located in the eastern part of Turkey between December 2019 and March 2020. The sample consisted of 107 students who met the research criteria. Data were collected using the sociodemographic form, the Fagerstrom test for nicotine dependence test, and the cessation fatigue scale (CFS).

FINDINGS

The CFS mean score was found to be significantly higher in women and in those who had high and very high nicotine dependence levels (p < 0.05). A positive and statistically significant relationship was found between cessation fatigue and nicotine dependence (p < 0.001). In addition, relationships were also found between cessation fatigue and variables, such as age, age of starting to smoke regularly, age of trying smoking for the first time, and the number of cigarettes smoked daily (p < 0.05).

PRACTICE IMPLICATIONS

This study detected a relationship between smoking cessation fatigue, and nicotine dependence. Studies have revealed that nursing practices on the struggle against smoking are effective. A better understanding of these processes could support nursing practices development.

Awareness regarding the adverse effect of tobacco among adults in India: findings from secondary data analysis of Global Adult Tobacco Survey

OBJECTIVE

To quantify the extent of awareness regarding the harmful effects of tobacco among the users (both smoked and smokeless) and non-users in India, and explore the determinants of comprehensive knowledge among the participants of the Global Adult Tobacco Survey (GATS), India.

DESIGN

Cross-sectional study.

SETTING AND PARTICIPANTS

The nationally representative GATS I (2009-2010) included 69 296 participants using a multistage sampling method, while GATS II (2015-2016) interviewed 74 037 respondents aged >15 years using a similar sampling method from all the states and union territories in India.

PRIMARY AND SECONDARY OUTCOME MEASURES

Comprehensive score were derived from nine items that explored awareness regarding the adverse effects of tobacco use among both users and non-users of tobacco in GATS II. Secondary outcome included predictors of awareness regarding adverse effects of tobacco and changes in the awareness compared with the previous round of the survey.

RESULTS

About 60.2%, 57.5% and 66.5% of the smokers, smokeless tobacco (SLT) users and non-users were aware of the adverse effects of tobacco, respectively. The awareness depicted significant age, gender, marital status, education status, urban-rural, wealth and regional disparities (p<0.05). Intention to quit tobacco use also varied significantly with awareness. Among smokers, awareness was high in those residing in eastern India and the poorest participants. Among SLT users, awareness was more among male participants, those who were poorest and lived in western India. Among non-users, awareness was more among middle-aged, more educated, rich participants of west India. Compared with GATS I, an increase in awareness was observed in GATS II across gender, age groups, residential areas and geographical regions in India.

CONCLUSIONS

Comprehensive awareness of tobacco's harmful effects is far from desirable among Indian users. We recommend further customised health promotion campaigns to counter the regional disparities, adopt a gender-neutral approach and target adolescents.

Changes in prevalence, and factors associated with tobacco use among Bangladeshi school students: evidence from two nationally representative surveys

Background

Globally, tobacco kills more than nine million people per year. Annually in Bangladesh, smoking accounts for 1.2 million illnesses and over one hundred fifty thousand deaths. Worldwide, about one out of five school students smoke tobacco, and this problem is also growing significantly in Bangladesh. There is a need to address this problem. However, to the best of knowledge, no published study has been evaluated the changes in factors associated with tobacco use over time among Bangladeshi adolescent students using large, nationally representative comparable surveys. Our objective was to identify the factors associated with tobacco use among school going students, examine any changes in them over time, and explore policy options based on national surveys.

Methods

We analysed the data from the 2007 and the 2013 Global Youth Tobacco Survey (GYTS), a school-based survey targeting adolescents age 13–15 years (7th–9th grade), developed by the World Health Organization (WHO) and the Centres for Disease Control and Prevention (CDC). The samples were selected based on a two-stage cluster sample design. The data were collected in school classes using a self-administered anonymous survey. We applied chi-square tests and survey logistic regression models for analysing the data.

Results

Overall tobacco usage significantly declined from 8.4 to 6.9% over six years. The prevalence of tobacco use decreased among females (5.22 to 2.84%), those who received anti-tobacco messages (8.93 to 7.24%) and because of age restriction could not buy tobacco products (18.86 to 15.78%). Compared with the female, the odds of overall tobacco smoking among male students was 1.97 (CI: 0.99–3.92) in the year 2007 and it increased (OR = 3.07; CI: 1.56–6.04) in the year 2013. Moreover, the odds of smoking among those exposed to tobacco smoke had increased (OR = 3.26; CI: 1.46–7.29 vs 5.43; CI: 1.63–18.07) from 2007 to 2013.

Conclusion

There was a decline in tobacco use, especially among female students. Male students were higher tobacco user. It appeared anti-smoking campaign and age restriction policies were working.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-021-10623-0.

The Effect of Peer Education on Decision-Making, Smoking-Promoting Factors, Self-Efficacy, Addiction, and Behavior Change in the Process of Quitting Smoking of Young People

Purpose

The study aims to examine the effect of peer education on the decision to quit smoking, factors that encourage smoking, self-efficacy, addiction, and behavior change in students who apply to the Youth Friendly Center to quit smoking.

Participants and Methods

This research is a Randomized Controlled Trials study. The experimental group consisted of students who were enrolled in the peer education course (n=759). The control group has consisted of students (n=1095) who did not enroll in this course.

Results

Participants in the experimental group to quit smoking, more than the control group (p>0,01). The addiction level of the participants in the experimental group, less than the participants in the control group (p>0,01). According to the scores of the participants in the control group of the participants in the experimental group, the factors that trigger smoking, and the benefit sub-dimension scores in the Decision Balance Scale were low. Loss sub-dimension scores, which show the losses from the harms of smoking, increased significantly in the Self-Efficacy Scale, Behavior Change Process Scale, and Decision Balance Scale (p>0,01).

Conclusion

Peer educators trained by the researcher and her team in the Youth Friendly Center Smoking Quit Program have an important effect in supporting/improving the cognitive and behavioral change processes of university students in smoking quit compared to those who do not receive an education. 94% success of the smoking quit program; Students’ voluntary application to receive professional support, students’ voluntary attendance of the treatment program for 6 months, strong communication and feedback, effective and functional professional counseling, and social support depend on strengthening the program with peer education. Especially with peer education, the development of leadership and role model characteristics made the smoking quit program preferred by students.

Do Financial Literacy and Financial Education Influence Smoking Behavior in the United States?

Smoking is still a serious economic, health, and social problem despite various efforts to curb its prevalence. We examined the influence of financial literacy and financial education on the smoking behavior in the United States in terms of the use of rational decision-making abilities to reduce irrational behavior. We hypothesized that financial literacy and financial education, as proxies for rational decision making, would reduce the likelihood of smoking. We used data from the Preference Parameters Study (PPS) of Osaka University conducted in the United States in 2010 and applied probit regression models to test our hypothesis on a sample of 3831 individuals. We found that financially literate people are less likely to be smokers, though we found no clear role of financial education in reducing the likelihood of smoking. Further, respondents' gender, age, unemployment status, and risky health behaviors such as drinking and gambling, have a significantly positive association with smoking, while marital status, university degree, family size, household income, household assets, physical exercise, and level of happiness have a significantly negative association. Our findings suggest that financial literacy, as an instrument encouraging rational decision making, could be a tool to help reduce smoking in the United States.

Black carbon over an urban atmosphere in northern peninsular Southeast Asia: Characteristics, source apportionment, and associated health risks

Black carbon (BC) has been demonstrated to pose significant negative impacts on climate and human health. Equivalent BC (EBC) measurements were conducted using a 7-wavelength aethalometer, from March to May 2016, over an urban atmosphere, viz., Chiang Mai (98.957°E, 18.795°N, 373 m above sea level), Thailand in northern peninsular Southeast Asia. Daily variations in aerosol light absorption were mainly governed by open fire activities in the region. The mean mass-specific absorption cross-section (MAC) value of EBC at 880 nm was estimated to be 9.3 m² g^-1. The median EBC mass concentration was the highest in March (3.3 μg m^-3) due to biomass-burning (comprised of forest fire and agricultural burning) emissions accompanied by urban air pollution within the planetary boundary layer under favorable meteorological conditions. Daily mean absorption Ångström exponent (AAE_470/950) varied between 1.3 and 1.7 and could be due to variations in EBC emission sources and atmospheric mixing processes. EBC source apportionment results revealed that biomass-burning contributed significantly more to total EBC concentrations (34-92%) as compared to fossil-fuel (traffic emissions). Health risk estimates of EBC in relation to different health outcomes were assessed in terms of passive cigarette equivalence, highlighting the considerable health effects associated with exposure to EBC levels. As a necessary action, the reduction of EBC emissions would promote considerable climate and health co-benefits.

The interaction of gender and smoking on bladder cancer risks

PURPOSE OF REVIEW

Although smoking and gender are well-established bladder cancer (BCa) risk factors, a significant interaction with other risk factors could help in the identification of patterns for early detection and prevention strategies.

RECENT FINDINGS

Smoking appears to be more strongly associated with BCa risk in women than in men, which could be related to differences in metabolism, smoking behavior, exposure patterns, and DNA repair mechanisms. BMI is associated with a higher risk of BCa with negligible difference between genders. The risk for BCa is increased in postmenopausal women, specifically in women with earlier menopausal age (<45 years). Other potential risk factors such as alcohol, arsenic exposure, and particulate matter inhalation seem to affect the genders differently.Female smokers experience a higher risk of disease recurrence after bacillus Calmette-Guérin therapy than their male counterparts. Lastly, smoking appears to negatively affect the outcome of radiotherapy in women, but not that of men.

SUMMARY

Several lines of evidence point to an interaction between smoking and gender, whereas their impact on other potential risk factors remains to be elucidated. Identifying such differential effects could allow for gender-specific prevention, early detection, and treatment strategies.

Functional and Structural Changes of the Retinal Nerve Fiber Layer and Ganglion Cell Complex in Heavy Smokers

PURPOSE

To assess the functional and structural changes in the retinal nerve fiber layer (RNFL) and the ganglion cell complex (GCC) in heavy smokers using pattern electroretinogram (PERG), photopic negative response(PhNR) and spectral domain optical coherence tomography (SD-OCT).

PATIENTS AND METHODS

Sixty eyes of 30 heavy smokers (at least 15 cigarettes/day for 10 years) (study group) and 60 eyes of 30 age and gender-matched healthy non-smoker subjects (control group) were included. After full ophthalmologic examination (PERG), (PhNR) using RETI-port/scan 21 (Roland Consult, Brandenburg, Germany) and (SD-OCT using Topcon 3D OCT model 2000 FA version.8.30) were tested for all participants. Statistical analysis was performed to compare GCC, RNFL thicknesses, PERG and phNR values between groups.

RESULTS

The mean age was 36.67±4.13 years in the study group and 36.0±4.76 years in the control group. There were no statistical significant differences between the two groups regarding intraocular pressure (p=0.43), axial length (p=0.37), and central corneal thickness (p=0.86). There were significant differences of GCC thickness values between the study group (88.4±6.6 µm) and control group (94.83±5.25 µm) (p<0.001). The mean RNFL values of study and control groups were 97.87±5.88 and 106.43±6.59 µm, respectively (p<0.001). In the study group the superior and inferior quadrants of RNFL were significantly thinner, but there were no significant differences between the two groups in nasal and temporal quadrants. There were no significant differences of PERG-P50 amplitude (p=0.49) and latency (p=0.71); however, PERG-N95 amplitude and latency showed significant differences between the two groups (p<0.001).There were significant differences of phNR amplitude and latency between the two groups (p<0.001). Multiple regression analyses demonstrated that the PhNR, PERG amplitude and latency are the most important determinants for both RNFL and GCC thicknesses.

CONCLUSION

In heavy smokers RNFL thickness was decreased, the PhNR, PERG-N95 amplitudes were diminished and the implicit times were prolonged compared to non-smokers. PhNR and PERG reflect both dysfunction and loss of ganglion cells and their axons.

Association Between Solid Cooking Fuels and Respiratory Disease Across Socio-Demographic Groups in India

BACKGROUND

The use of solid fuels in household cooking contributes to indoor air pollution and is the cause of more than 4 million deaths around the world annually. Solid fuel use varies with the level of development and ranges from 0% in high-income countries to more than 80% in low- and middle-income countries. Three billion people (more than 40% of the global population) are still dependent on solid fuels like firewood, dung cakes, coal, wood and agricultural residues in these countries.

OBJECTIVES

The present study aims to analyze the association of certain respiratory diseases (tuberculosis (TB), acute upper respiratory infections (AURI), chronic obstructive pulmonary diseases (COPD), and bronchial asthma) with the use of solid fuels for cooking across sociodemographic groups in India.

METHODS

The 71st round of the National Sample Survey, conducted in 2014, was used. In total, 54,985 inpatients who received medical treatment from any medical institution during the last 365 days preceding the survey and who reported various diseases, such as infections, cancers, blood diseases, cardiovascular diseases, and respiratory diseases were included in the analysis. Of these inpatients, 2513 participants who reported TB, AURI, COPD and bronchial asthma were considered the dependent variables in the study. The main variable was exposure to different types of fuels used as a primary source of energy for cooking. Multinomial logistic regression was used to explain associations.

RESULTS

The results reveal a significant association between solid fuel use and respiratory diseases in India. Overall, more than 60% of the population uses firewood and cow dung as their primary source of energy for cooking and are at a higher risk of TB, COPD and bronchial asthma. In rural areas there is a high dependence on solid fuels (80.5%) and a higher risk of respiratory diseases compared to those residing in urban areas where people are less dependent on solid fuels (22%). Among different socio-demographic groups, the dependence on solid fuels is highest among Scheduled Tribes (87.42%), followed by Scheduled Castes (74.78%) and Other Backward Classes (OBCs) (a term used by the Indian government to categorize castes that face social or educational challenges) (64.47%). Scheduled Tribes have the highest risk of TB, followed by Scheduled Castes and OBCs, respectively.

CONCLUSIONS

Exposure to solid fuels for cooking increases the potential risk of TB, COPD and bronchial asthma. Access to clean and efficient fuels for cooking is essential to reduce the burden of respiratory disease. Measures are needed to increase the availability of clean fuels for households, especially among socially disadvantaged and marginalized groups, to reduce the burden of respiratory diseases in India.

COMPETING INTERESTS

The authors declare no competing financial interests.