Socioeconomic Determinants of Inequality in Smoking Stages: A Distributive Analysis on a Sample of Male High School Students

A Web-Based Education Program to Empower Family in Smoking Prevention among Adolescents in Indonesia: A Randomized Controlled Trial

BACKGROUND: Stronger family connections, communications, and parental respect reduce smoking initiation. Web-based computer-tailored smoking prevention programs may help decrease smoking initiation rates among adolescents. However, there is currently no conclusive evidence regarding the efficacy of a web-based, computer-tailored smoking prevention program to empower families in adolescent smoking prevention. AIM: This study aimed to investigate the effects of web-based education program to empower family, improve skill to refuse, and prevent smoking initiation among adolescent in Indonesia. METHODS: A randomized controlled trial was employed on family members in Bogor, West Java, Indonesia. The following criteria were the mother or legal guardian of children aged 10 to 14 years who are not currently smoking. Data were collected 3 times: One week before the start of the training (baseline), immediately after intervention (T1), and three months after the training concluded (T2). RESULTS: 77 participants completed the study, 37 in the intervention group and 40 in the control group. The average age in this sample of the family (mother) was 37.34 (SD:7.51) years in the intervention group and 11.75 (SD:6.81) for the control group. From baseline to follow-up, family empowerment, smoking refusal skill, and smoking intention increased 38%, 24%, and 33%, respectively. CONCLUSIONS: A web-based education program appears to be a suitable catalyst for empowering family and smoking prevention among adolescents. It should be regarded as a valuable and supportive addition to existing and future programs.

Determinant of Smoking Behavior among Elementary Student in Indonesia: A Structure Equation Model

BACKGROUND: Initial smoking exposure may occur during early adolescence (aged 10–12 years old), and it increases overtime. Although several factors for smoking behaviors exist among adolescents, there are few studies address determinant of smoking behavior by adding others variables in theory of plan behavior such as smoking refusal skills, self-regulation, parenting, family function, environment, and culture. AIM: The aim of this study was, therefore, to evaluate the determinant of smoking behavior among elementary student in Indonesia using a structural equation model. METHODS: A cross-sectional survey was carried out from June to October 2019 in West Java, Indonesia. For each school, students were selected using a systematic random sampling technique. The study included girls and boys ages 10–12. The consent was obtained by the parent or guardian. Structural equation modeling was used for analysis. RESULTS: The mean age was 10.56 years (SD = 0.37). About 28.6% of them were currently smoking with aged of first use was 10.02 (SD = 0.19). More than half (56%) of their family were currently smoking too and friend smoking was 41.7%. The final model accounted for 27% and 39% of the variance of intention and smoking behavior, respectively, has both direct and indirect effects through empowerment on self-care behaviors toward pregnancy-related complication. CONCLUSION: The present study was intended to expand the theory of planned behavior by including additional variables in its model: Smoking refusal skills, self-regulation, parenting, family function, environment, and culture. This study also provides a significant contribute for clinical a practice and policy-maker as a basic data to establish future intervention to promote no tobacco use among elementary student to achieve optimal well-being to prevent a fatal disease.

Transition in Smoking Stages and Its Relationship with Family Psychological Function and Perceived Social Support in Adolescents of Tabriz, Iran

BACKGROUND

There is limited information on the relationship between family psychological functions and perceived social support with progress in cigarette smoking stages in adolescents. This study was aimed to determine the relationship between family psychological function and perceived social support through a transition in different stages of cigarette smoking in adolescents of Tabriz, Iran.

METHODS

In this study, 4,216 students (14-19 years old) from high schools were selected by multistage cluster sampling method. Initially, we used valid and reliable questionnaires for demographic characteristics, risk factors, Iranian family psychological function, and perceived social support. The smoking status questionnaire was administered twice, with an interval of 6 months. Data were analyzed using univariate and multivariate logistic regression analysis.

RESULTS

Overall, 3,968 students with the mean (standard deviation) age of 15.96 (0.75) years completed the questionnaire in the first phase of the study. The results showed that lower levels of family psychosocial function (P < 0.001) and perceived social support (P < 0.001) in the univariate state were significantly associated with progress in cigarette smoking stages. By controlling the potential confounding factors, the weak and moderate family psychological function compared to the strong function increased the chance of progress in the cigarette smoking stages by almost 11 and 4 times, respectively (P < 0.001). The low and moderate level of perceived social support compared to the high level increased the chance of progress in cigarette smoking stages by almost 7 and 2 times, respectively (P < 0.001).

CONCLUSIONS

It is suggested to perform an organized, precise, and operational planning for strengthening the family psychological functions and providing an appropriate social support condition among adolescents to prevent the tendency toward cigarette smoking and its more advanced phases.

Socioeconomic inequalities in tobacco smoking in women aged 15-54 in Iran: a multilevel model

Significant evidence suggests an inverse relationship between socioeconomic status and tobacco smoking, where inequality is visible among different social and economic strata. The aim of this study was to investigate the prevalence and economic and social inequalities in tobacco smoking in women aged 15-54 in Iran. This study is a cross-sectional study. Sampling in this study was a randomized clustered multistage sampling with equal clusters. A total of 35,305 women aged 15-55 enrolled in the study. Data analysis was in two stages. In the first stage, the social and economic inequalities were investigated using the concentration index and concentration curve method, and in the second method, and multilevel method was used to identify the determinants. The prevalence of tobacco smoking in women was 12.24%. The concentration index for smoking was CI = -0.07 [95% CI (-0.09, -0.05)], which represents smoking in people with low socioeconomic status. The results of the multilevel analysis indicated that the marital status of people over the age of 35 and the economic class was related to smoking in women. Inequality in tobacco smoking in women is to the interest of the well-off group, and this inequality varies in different provinces. Marital status, place of residence, age and socioeconomic status of women are factors influencing the prevalence of tobacco smoking in women, and these issues should be noticed to reduce inequalities.

The Cigarette Smoking Initiation and Continuation in Adolescents Undergoing a Long-Term Behavioral Intervention

INTRODUCTION

Targeting adolescents' smoking reduces its burden on health systems. We investigated the effects of the first multidisciplinary community-based lifestyle intervention in the Eastern Mediterranean region, on smoking initiation, continuation, and risk of current smoking in Iranian adolescents.

METHODS

The current analyses were conducted on 945 nonsmoker adolescents (12-18 years) who participated in Phase II of Tehran Lipid and Glucose Study (TLGS) and were examined four times in 12 years. The lifestyle intervention including school-based and public programs was implemented, focusing on all components of healthy lifestyle. Using a two-step cluster analysis, families were classified as high and low risk, based on parental risk factors of adolescents' smoking. Participants who failed to complete all the follow-ups (n = 99) and those with missing smoking data were excluded. Subsequently, 872 adolescents (538 control, 334 intervention) were included in the Cox model on smoking initiation, and 674 adolescents (414 control, 260 intervention) were included in the logistic regression on smoking status.

RESULTS

Mean age of adolescents was 15.08 ± 1.94 years at baseline. The hazard of the smoking initiation was significantly lower in the intervention (hazard ratio = 0.71, 95% confidence interval: 0.51-0.99; p = .044) compared with control group. At the end of the fourth follow-up, intervention reduced the odds of current cigarette smoking by 29%. Within the intervention group, the high-risk cluster was at a 35% lower risk of initiating smoking and had 37% lower odds of becoming a current smoker. However, the intervention could not make a difference in preventing those who initiated smoking from maintaining it during the follow-ups.

CONCLUSIONS

Our results demonstrate that lifestyle modification programs targeting at-risk populations could reduce risk of smoking initiation and current smoking in adolescents in long term.

IMPLICATIONS

Experiencing cigarette smoking at the critical period of adolescence could result in adulthood habitual smoking. Therefore, identifying adolescents who are more at risk of smoking initiation and implementing targeted interventions are of great importance in public health. Our findings highlight the long-term effectiveness of a multidisciplinary community-based behavioral intervention on forming smoking behaviors in adolescents. The current intervention was successful in reducing smoking uptake in adolescents living in high-risk families.

The First Cigarette Smoking Experience and Future Smoking Behaviors Among Adolescents with Different Parental Risk: a Longitudinal Analysis in an Urban Iranian Population

BACKGROUND

Longitudinal research among Iranian adolescent smoking is limited. The current study aimed to investigate (1) the first smoking experience (FSE) and future smoking behaviors of adolescents with different parental risk factors and (2) the association between age of the FSE and future smoking behaviors over a 12-year follow-up.

METHOD

Based on Tehran Lipid and Glucose Study (TLGS) database, 1487 adolescents (12-18 years) with complete baseline parental data were recruited. Using two-step cluster analysis, families were classified as either high or low risk; these were based on parental risk factors including age, education, employment, and smoking status. Participants were examined four times in 12 years and their data were used for survival analysis. After exclusion of 24 cases who were smokers at baseline, Cox proportional hazard modeling was used to evaluate the effect of parental clusters on the FSE in 1463 nonsmoking adolescents who completed all prospective follow-ups. Logistic regression analysis was used to examine the effect of the age of FSE on future smoking behaviors.

RESULTS

The mean age of adolescents was 14.63 ± 2.07 years at baseline. Adolescents in the high-risk cluster group were 49% more likely to try smoking for their first time, and 55% more likely to smoke in the future. Compared with girls, boys had 83% higher chance of trying their first cigarette. Moreover, 1-year delay in the FSE resulted in 25% reduction in the probability of smoking in the future.

CONCLUSION

The findings show that compared with adolescents living in low-risk families, teenagers living in high-risk families are at greater risk of smoking at an earlier age; therefore, this group could benefit from gender- and culture specific preventive interventions.

Socioeconomic inequality in tobacco expenditure in Iran: a cross-sectional analysis at national and subnational levels

BACKGROUND

Tobacco expenditure has adverse impacts on expenditure on basic needs and resource allocation of the households. Using data from a nationally representative survey, we measured socioeconomic inequality in tobacco expenditure as the share of household budget (TEHB) and explained its main determinants among Iranian households at the national and sub-national levels.

METHODS

This cross-sectional study used data from the Iranian Household Income and Expenditure Survey (IHIES), 2018. We included a total of 7649 households with tobacco expenditure more than zero in the analysis. Province-level data on the Human Development Index (HDI) was obtained from the Institute for Management Research at Radbound University. The concentration curve (CC) and the concentration index (C) were used to measure socioeconomic inequality in TEHB at national and sub-national levels. The C was decomposed to identify the factors explaining the observed socioeconomic inequality in TEHB.

RESULTS

At the national level, households with at least one smoker spent more than 5% of their budget for tobacco consumption in the last month. Households from the urban areas allocated less of their budgets on tobacco products compared to rural households (4.6% vs. 5.8%). Overall, TEHB was more concentrated among the poorer households (C = 0.1423, 95% CI: - 0.1552 to - 0.1301). In other words, the distribution of TEHB was pro-poor in Iran. Pro-poor inequality in TEHB was also found in urban (C = - 0.1707, 95% CI: - 0.1998 to - 0.1516) and rural (C = - 0.1314, 95% CI: - 0.1474 to - 0.1152) areas. We also found that pro-poor inequalities were higher in Iranian provinces with low HDI. The decomposition results indicate that wealth and education were the main factors contributing to the concentration of TEHB among the poorer households.

CONCLUSION

This study found that TEHB was disproportionality concentrated among poorer households in Iran. The extent of inequality in TEHB was higher in urban areas and less developed provinces. Designing and implementing tobacco control interventions to decrease the smoking prevalence and increase smoking cessation could protect worse-off households against the financial burden of tobacco spending.

Socioeconomic inequalities in metastasis, recurrence, stage and grade of breast cancer: a hospital-based retrospective cohort study

Introduction

This study aims to estimate the Socio-Economic Status (SES) inequality on the metastasis, recurrence, stage and grade in Breast Cancer (BC).

Methods

This retrospective cohort study conducted on 411 BC patients in Arak, Iran. Asset-based questionnaire used to estimate the household SES. For calculate of SES inequality was used from Concentration Index (C). Moreover for investigate the association between recurrence and metastasis with other variables were used from multilevel logistic regression and analysis of variance were used to investigate the relationship between SES and other variables. The data were analyzed with Stata (v.13) software.

Results

Results of analysis of variance showed statistical significant relationship between SES with, insurance, surgery, grade, stage, recurrence and metastasis (p-value < 0.05). Moreover the Odds Ratio (OR) were significant of recurrence with age, academic level of education, supplementary insurance history of BC in first-degree relatives, stage and grade, also, metastasis with age of > 80 years, insurance, supplementary insurance, history of BC in first-degree relatives, chemotherapy, radiotherapy, stage and grade four. The total C index obtained 0.015 (0.002, 0.026), 0.011 (0.003, 0.031), – 0.014 (– 0.034, – 0.001) and – 0.042 (– 0.061, – 0.002) for metastasis, recurrence, stage and grade of BC respectively.

Conclusions

Our results showed evidence of inequality in the metastasis, recurrence, stage and grade in BC patients.

Measurement components of socioeconomic status in health-related studies in Iran

OBJECTIVE

The socioeconomic status (SES) is as a symbol of social determinants of health which has a dominant influence on population health. The purpose of this study was collecting, weighing, and determining the most relevant SES measurement items in Iran.

RESULTS

The SES health studies conducted in Iran was searched from 2007 to 2017. First, the SES items were categorized. Then, each item was weighed based on its reliability and generalizability. Finally, the necessity of items was determined, weighed, and ranked. This is the two-round Delphi technique. After weighing 57 SES items, 37 items were selected with ≥ 1 weight and classified in 7 categories. According to the Delphi evaluation, 15 items were identified ≥ 3.5 for measuring SES of Iranian households: household size, head of household education, head of household job, household monthly income, type of school that children attend, house ownership, local value of residence, number of rooms in the house, house area, personal computer/laptop, smart cell phone, 3D TV, dishwasher, microwave, and car ownership. The SES items for the present society are categorized in 7 domains. The items collected in this study have the most comprehension of all studies related to income, life facilities, and assets.

A Qualitative Study on Chinese Canadian Male Immigrants' Perspectives on Stopping Smoking: Implications for Tobacco Control in China

China has the largest number of smokers in the world; more than half of adult men smoke. Chinese immigrants smoke at lower rates than the mainstream population and other immigrant groups do. This qualitative study was to explore the influence of denormalization in Canada on male Chinese immigrant smoking after migration. Semistructured interviews were conducted with 22 male Chinese Canadian immigrants who were currently smoking or had quit smoking in the past 5 years. The study identified that, while becoming a prospective/father prompted the Chinese smokers to quit or reduce their smoking due to concern of the impacts of their smoking on the health of their young children, changes in smoking were also associated with the smoking environment. Four facilitators were identified which were related to the denomormalized smoking environment in Canada: (a) the stigma related to being a smoker in Canada, (b) conformity with Canadian smoking bans in public places, (c) the reduced social function of smoking in Canadian culture, and (d) the impact of graphic health messages on cigarette packs. Denormalization of tobacco in Canada in combination with collectivist values among Chinese smokers appeared to contribute to participants' reducing and quitting smoking. Although findings of the study cannot be claimed as generalizable to the wider population of Chinese Canadian immigrants due to the small number of the participants, this study provides lessons for the development of tobacco control measures in China to reverse the current prosmoking social environment.