Beliefs Toward Smoking and COVID-19, and the Pandemic Impact on Smoking Behavior and Quit Intention: Findings from a Community-Based Cross-Sectional Study in Jordan

Validity and reliability of the Arabic version of knowledge, attitudes, and practices toward COVID-19 preventative behaviors (KAP COVID-19)

Background

Even though the innovation of COVID-19 vaccination effectively protects against the virus, practicing preventative behaviors is still essential. However, public adherence to preventive behaviors relies mainly on the individuals' knowledge, attitudes, and practices (KAP) toward COVID-19 preventative behaviors. Therefore, it is crucial to evaluate these aspects. Nevertheless, there is no validated scale that assesses KAP toward COVID-19 preventative behaviors. To evaluate the psychometric properties of the Arabic version of knowledge, attitudes, and practices toward coronavirus disease 2019 (COVID-19) preventative behaviors.

Methods

A quantitative descriptive cross-sectional design was used to develop and evaluate the psychometric properties of KAP through specific stages: item development, face, content, convergent and construct validity evaluation, and internal consistency. Data were collected online through "google forms" from June 2020 to July 2020. Both exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) were used to assess the construct validity.

Results

A total of 1,363 participants completed the scale. The overall Cronbach's alpha was 0.83, indicating good internal consistency. Exploratory factor analysis supported structural validity for all the scale items with KMO 0.78, 0.60, and 0.81, respectively, and Bartlett's Test of Sphericity = (p < 0.05). Convergent validity was confirmed by a moderate correlation between the KAP scale items, knowledge ranging from r = 0.11 (p < 0.01) to r = 0.62 (p < 0.01), attitude ranging from r = 0.158 (p < 0.01) to r = 0.584 (p < 0.01), and practice ranging from r = 0.383 (p < 0.01) to r = 0.774 (p < 0.01).

Conclusion

The psychometric properties of the scale indicate that the KAP is a valid and reliable scale that can be utilized to evaluate the level of KAP toward COVID-19 preventative behaviors among the population in Saudi Arabia.

Public awareness, prevalence, and regulations for the sale of electronic cigarettes in Arab countries: A narrative review

The majority of the Arab countries have high records of daily tobacco smoking. Electronic cigarettes (e-cigarettes) use has exponentially increased in the past decade in Arab countries. Consumers' willingness to quit smoking traditional cigarettes and their perception of e-cigarettes as a safer alternative to conventional cigarettes have increased the demand for these devices. This narrative review aimed to gather and discuss the available literature on the awareness, prevalence, and sales regulations of e-cigarettes in Arab countries. A search was conducted on electronic databases such as PubMed, Medline, Scopus, and Google Scholar with no time limits until the end of 2021. Some of the recent studies (2019-2021) considered in this review have reported that more than 25% of participants were e-cigarettes users. The prevalence of e-cigarettes has increased drastically with raised awareness of e-cigarettes among the population in these Arab countries. Most of the users of e-cigarettes are young males. In addition, an increase in e-cigarettes use has been reported in females. The policies which regulate trade and sale of e-cigarettes and related products were issued in only three Arab countries. In contrast, regulations for the trade and sale of traditional cigarette products are also applied in some countries to e-cigarette products, banning the sale of e-cigarettes to minors and/or amend smoke-free laws to restrict public use of e-cigarettes. There is a need for a concerted effort to assess the prevalence and significant rise of e-cigarettes consumption in Arab societies to help implement and improve harm reduction policies.

The impact of COVID-19 pandemic on tobacco use: A population-based study

BACKGROUND

Various aspects of lifestyle seem to change during confinement, particularly during the COVID-19 pandemic. The current study examines confinement's effects on tobacco smoking habits (SH).

METHODS

A survey was distributed among adults living in Jordan (age >18 years) of both genders during April-May of 2020, of which 1925 responded to the survey.

RESULTS

The prevalence of smoking was 33.3%, 46.1%, and 21.1% for cigarettes (Cg), waterpipe (Wp), and E-cigarettes (ECg), respectively. Among the smokers, 38.5-45.8% reported a "no-change," while 32.1-41.7% reported a "decrease" in SH during confinement. On the other hand, 18.0-22.1% reported an "increase" in the SH. However, concerning the factors that might affect SH, the results showed that age, gender, income, and job sector contribute to the observed changes.

CONCLUSIONS

Changes in the SH during COVID-19 have been reported in about 50% of participants who smoke tobacco, with a more reported decrease than increase in use. Studies and interventions are needed to confirm further and understand the current results and discourage smoking during the COVID-19 pandemic.

COPD awareness among the Syrian community: population-based study

Chronic obstructive pulmonary disease (COPD) is a common disease and among the top causes of mortality worldwide but can be prevented and treated. This study aims to estimate the awareness of COPD among the Syrian population. A cross-sectional anonymous self-administered online survey was conducted by using Google Forms on Social Media platforms. The questionnaire included demographic, smoke-related and COPD-related questions. This study included 1607 participants with 930 (57.8%) females, 40% aging 21-25 years old, more than 90% being university students/graduates and 67.8% living in cities. Around half were either active smokers or had second-hand smoke exposure. After excluding participants in health-related fields who were 950 participants, only 25.4% of the remaining had ever heard of the term COPD. Knowing about COPD was not associated with reported smoking habits. No significant differences in awareness were seen between city and countryside dwellers, governate groups, genders, or age groups. Being in a health-related field was a major factor of being aware of COPD. COPD awareness in Syria is low, even amongst the well-educated group. Moreover, COPD risk factors of smoking and exposure to indoor and outdoor pollutants are common. Raising awareness is crucial in the Syrian community as COPD is highly prevalence.

Impact of media trust and personal epidemic experience on epidemic prevention behaviors in the context of COVID-19: A cross-sectional study based on protection motivation theory

Objective

This study aimed to elucidate the impact of media trust on epidemic prevention motivation and behaviors based on the Protection Motivation Theory (PMT) and to evaluate the moderation effect of personal epidemic experience, which focused on the differences in two groups with or without epidemic experience.

Methods

The exogenous constructs and PMT model and scale were constructed through literature analysis, and a web-based questionnaire survey was conducted among 428 individuals aged above 18 years in China. Statistical analysis and hypothesis testing were performed in SPSS 26 and SmartPLS 3.

Results

Traditional media trust accounted for the largest weight in media trust (w = 0.492, p-value < 0.001), followed by social media (w = 0.463, p-value < 0.001), and interpersonal communication (w = 0.290, p-value < 0.001). Media trust was positively and significantly related to both threat appraisal (β = 0.210, p-value < 0.001) and coping appraisal (β = 0.260, p-value < 0.001). Threat appraisal (β = 0.105, p-value < 0.05) and coping appraisal (β = 0.545, p-value < 0.001) were positively and significantly related to epidemic prevention motivation, which positively and significantly related to epidemic prevention behaviors (β = 0.492, p-value < 0.001). The R² values of epidemic prevention motivation and behavior are 0.350 and 0.240, respectively, indicating an acceptable explanation. Multiple-group analysis revealed five significant differences in paths between the two groups, indicating personal epidemic experience acting as a slight moderator on these paths.

Conclusion

Traditional media trust and social media trust were the important elements in COVID-19 prevention and control, and public health departments and governments should ensure the accuracy and reliability of information from traditional and social media. Simultaneously, the media should balance threat information and efficacy information in order to generate the public's prevention motivation and behaviors.

Mediated effects of insomnia in the association between problematic social media use and subjective well-being among university students during COVID-19 pandemic

Recently, the use of social media has penetrated many aspects of our daily lives. Therefore, it has stimulated much debate and polarisation regarding its impact on mental well-being. The present study investigated the association between problematic use of social media, subjective well-being, and insomnia's potential mediator. A proportionate random sample was collected from a Univerity in Algeria between March and April 2020.The participants (n=288; mean [SD] age = 20.83 [2.13]) involved 101 (35.1%) males. Nearly three-fourths of the participants (n=214; 74.3%) used up more-than three hours daily surfing on social media. Their mean (SD) score was 15.64 (4.80) on the Bergan Social Media Addiction Scale, 16.19 (9.15) on the Arabic Scale of Insomnia, and 28.13 (7.90) on the overall subjective well-being. Structural equation modeling (SEM) revealed an indirect correlation between problematic use of social media and the overall subjective well-being of users. Similarly, the indirect but not direct effects were found for the overall subjective well-being subdomains. Moreover, all SEM models have a satisfactory fit with the data. Based on the results, it can be concluded that insomnia appears to play an important role in mediating the association between subjective well-being and problematic social media use. This suggests the importance of tackling the issues of insomnia and problematic use of social media for university students. It also has important implications in dealing with the misuse of social media, especially during the covid-19 pandemic.

Rasch Modeling and Multilevel Confirmatory Factor Analysis for the Usability of the Impact of Event Scale-Revised (IES-R) during the COVID-19 Pandemic

BACKGROUND

Several instruments are currently used to assess Coronavirus Disease 2019 (COVID-19) -induced psychological distress, including the 22-item Impact of Event Scale-Revised (IES-R). The IES-R is a self-administered scale used to assess post-traumatic stress disorder (PTSD). The current study aimed to examine the construct validity of the IES-R, based on the Rasch model, with COVID-19-related data, as well as to test the multilevel construct validity of the IES-R within and among countries during the pandemic crisis.

METHODS

A multi-country web-based cross-sectional survey was conducted utilizing the 22-item IES-R. A total of 1020 participants enrolled in our survey, of whom 999 were included in the analyses. Data were analyzed using Rasch modeling and multilevel confirmatory factor analysis (MCFA).

RESULTS

The Rasch modeling results of the IES-R demonstrated that the IES-R is a satisfactory instrument with the five-point Likert scale, asserting that its 22 items are significant contributors to assessing PTSD as a unidimensional construct covered by the items of the IES-R. The MCFA confirmed that the 22-item IES-R, with its three factors, including intrusion, avoidance, and hyperarousal, demonstrates adequate construct validity at the within- and among-country levels. However, the results of the Akaike information criterion (AIC) model determined that the 16-item IES-R is better than the 22-item IES-R.

CONCLUSION

The results suggested that the 22-item IES-R is a reliable screening instrument for measuring PTSD related to the COVID-19 pandemic, and can be utilized to provide timely psychological health support, when needed, based on the screening results.

The Impact of the Covid-19 Pandemic on Smoking Among Vulnerable Populations

AIM

While accumulating evidence suggests that people modified their smoking during the ongoing COVID-19 pandemic, it remains unclear whether those most at risk for tobacco-related health disparities did so. The current study examined changes in smoking among several vulnerable smoker populations during the COVID-19 pandemic.

METHODS

A web-based survey was distributed in 2020 to 709 adults with socioeconomic disadvantage, affective disorders, or opioid use disorder who participated in a previous study investigating the effects of very low nicotine content (VLNC) cigarettes on smoking. Current smoking status and rate, and adoption of protective health behaviors in response to the pandemic (eg social distancing, mask wearing) were examined.

RESULTS

Among 332 survey respondents (46.8% response rate), 84.6% were current smokers. Repeated measures ANOVA showed that current cigarettes/day (CPD) was higher during COVID than pre-COVID (12.9 ± 1.0 versus 11.6 ± 1.0; p < .001). Most respondents had adopted protective health behaviors to prevent infection (>79% for all behaviors). More than half indicated that they were still leaving their homes specifically to buy cigarettes (64.6%) and were buying more packs per visit to the store (54.5%) than pre-COVID. Individuals unemployed at the time of the survey experienced greater increases in CPD (from 11.4 ± 1.4 to 13.3 ± 1.4, p = .024) as did those with higher levels of anxiety (from 11.5 ± 1.1 to 13.6 ± 1.1, p < .001).

CONCLUSIONS

Smoking increased during the COVID-19 pandemic in this sample of adults from vulnerable populations, even while most adopted protective health measures to prevent infection. Unemployment and anxiety might identify those at greatest risk for increases in tobacco use.

IMPLICATIONS

Individuals from populations especially vulnerable to smoking might be at risk for greater harm from cigarette smoking during times of pandemic-related stress. Public health interventions are warranted to ameliorate increases in smoking among these populations. Special attention should be paid to those experiencing unemployment and high anxiety.

Short and Long-Term Impact of COVID-19 Infection on Previous Respiratory Diseases

On March 11, 2020, the World Health Organization declared Coronavirus Disease 2019 (COVID-19) a pandemic. Till now, it affected 452.4 million (Spain, 11.18 million) persons all over the world with a total of 6.04 million of deaths (Spain, 100,992). It is observed that 75% of hospitalized COVID-19 patients have at least one COVID-19 associated comorbidity. It was shown that people with underlying chronic illnesses are more likely to get it and grow seriously ill. Individuals with COVID-19 who have a past medical history of cardiovascular disorder, cancer, obesity, chronic lung disease, diabetes, or neurological disease had the worst prognosis and are more likely to develop acute respiratory distress syndrome or pneumonia. COVID-19 can affect the respiratory system in a variety of ways and across a spectrum of levels of disease severity, depending on a person's immune system, age and comorbidities. Symptoms can range from mild, such as cough, shortness of breath and fever, to critical disease, including respiratory failure, shock and multi-organ system failure. So, COVID-19 infection can cause overall worsening of these previous respiratory diseases, such as asthma, chronic obstructive pulmonary disease (COPD), interstitial lung disease, etc. This review aims to provide information on the impact of the COVID-19 disease on pre-existing lung comorbidities.

The COVID-19 Pandemic and Smoking Cessation-A Real-Time Data Analysis from the Polish National Quitline

Since the outbreak of the COVID-19 pandemic, tobacco research has delivered new evidence on the harmfulness of smoking in the context of SARS-CoV-2 infection and the course of the COVID-19 disease. More and more research proves that smoking is an important risk factor contributing to increased risk of mortality among COVID-19 patients. The aim of this study was to assess whether and how the COVID-19 pandemic impacted decisions about quitting smoking. A total of 4072 records of anonymized data were obtained from the Polish National Quitline. Between 15 April 2020 and 31 May 2021, the callers were asked about the COVID-19 pandemic and its influence on their decisions on smoking continuation or cessation. Our results indicate that smokers are very receptive to communication concerning COVID-19 and smoking risk. This phenomenon can possibly be connected to the immediate potential health consequences of smoking and COVID-19 virus infection. Results may indicate that putting emphasis on arguments combined with short-term health consequences of smoking may result in better outcomes in smoking cessation. There is a need for further and constant education on tobacco-related health harm. Our results showed that an irregular and mass communication on health consequences may result in high effectiveness in smoking cessation.