Health policymakers' knowledge and opinions of physicians smoking and tobacco policy control in Lao PDR

Tobacco use in Lao People's Democratic Republic: Results from the 2015 National Adult Tobacco Survey

INTRODUCTION

Tobacco use is a burden for Lao People's Democratic Republic (Lao PDR). No published report has examined determinants of various tobacco uses to inform appropriate policies and prevention strategies. This paper reports tobacco uses by sociodemographic characteristics using data from the most recent Lao National Adult Tobacco Survey (NATS) in 2015.

METHODS

The NATS included a nationally representative sample of 7562 people aged ≥15 years, recruited through a stratified 2-stage cluster sampling approach in 18 provinces. All analyses were weighted. Multivariable logistic regression models were used to evaluate unadjusted and adjusted associations between variables of interest.

RESULTS

The NATS results showed that 32.4% of Lao people aged ≥15 years were current tobacco users (men: 51.2%, women: 15.4%). Cigarette smoking accounted for approximately 95% of all tobacco use in men, while tobacco chewing accounted for 60% of tobacco use in women. Current tobacco use was strongly associated with older ages and lower education levels (p<0.001). There were interactions between sex, education level, and income associated with tobacco use; specifically, women were more likely to have a lower education level and lower income than men, and these women were more likely to use tobacco.

CONCLUSIONS

Tobacco use prevalence in Lao PDR was among the highest in the region. There were variations in types and prevalence of tobacco use across sociodemographic subpopulations. The Lao government should continue current national tobacco control efforts and implement additional proven strategies to reduce tobacco use.

Cigarettes and Water Pipe Smoking Prevalence, Knowledge, and Attitudes Among the Palestinian Physicians in the West Bank

Background

Tobacco use is one of the major public health threats nowadays. Smoking can affect everybody organ. Health professionals should play pivotal roles in tobacco control, and their attitude and practice toward tobacco use can affect the health of the community. Therefore, assessing and influencing physicians' attitudes and practice are one of the alternatives to reduce smoking prevalence in the community. We aimed to assess smoking status among medical physicians in the West Bank, Palestine to better understand their future role in any smoking cessation program.

Material and methods

A cross-sectional study using the World Health Organization Global Health Professional Survey questionnaire was conducted. A non-probability sampling technique from a total of 6500 physicians registered in the Palestinian Medical Association in the West Bank was used.

Results

The age ranged from 23 to 78 years with a mean of 34.92 years. Current smokers represented 60.3%. Of them, 18.5% were both cigarettes and water pipe smokers. The main reason that motivates the physician to smoke is experimenting (57.9%). Also stress (31.8%) and social pressure (26.4%) were of the most common causes to start smoking. Almost all medical doctors have a high level of knowledge regarding the health consequences of smoking. Smokers were less likely to hold favorable attitudes toward smoking cessation and support tobacco control policy compared with non-smokers (P-values < .05).

Conclusions

Physicians' degree of awareness and knowledge about their role in aiding patients to quit smoking are high. However, smokers' attitudes toward smoking cessation programs need to be improved to increase their involvement in such interventional programs.

Examining Implementation of Tobacco Control Policy at the District Level: A Case Study Analysis from a High Burden State in India

Introduction. While extensive scientific evidence exists on the tobacco epidemic, a lack of understanding of both policies and their appropriate way of implementation continues to hinder effective tobacco control. This is especially so in the developing countries such as India. The present study aims to understand current implementation practices and the challenges faced in mainstreaming tobacco control policy and program. Methods. We chose a qualitative study design to conduct the case analysis. A total of 42 in-depth interviews were undertaken with seven district officials in six districts of Andhra Pradesh. A conceptual framework was developed by applying grounded theory for analysis. Analysis was undertaken using case analysis approach. Results and Discussion. Our study revealed that most program managers were unfamiliar with the comprehensive tobacco control policy. Respondents have an ambiguous opinion regarding integration of tobacco control program into existing health and development programs. Respondents perceive lack of resources, low prioritization of tobacco control, and lack of monitoring and evaluation of smoke-free laws as limiting factors affecting implementation of tobacco control policy. Conclusion. The findings of this study highlighted the need for a systematic, organized action plan for effective implementation of tobacco control policy and program.

Tobacco related knowledge and support for smoke-free policies among community pharmacists in Lagos state, Nigeria

Background:

There are no safe levels of exposure to second hand smoke and smoke-free policies are effective in reducing the burden of tobacco-related diseases and death. Pharmacists, as a unique group of health professionals, might be able to play a role in the promotion of smoke-free policies.

Objective:

To determine the tobacco-related knowledge of community pharmacists and assess their support for smoke-free policies in Lagos state, Nigeria.

Methods:

A cross-sectional descriptive study design using both quantitative and qualitative methods was employed. Two hundred and twelve randomly selected community pharmacists were surveyed using a pre-tested self-administered questionnaire. In addition, one focus group discussion was conducted with ten members of the Lagos state branch of the Association of Community Pharmacists of Nigeria.

Results:

The quantitative survey revealed that the majority (72.1%) of the respondents were aged between 20 and 40 years, predominantly male (60.8%), Yoruba (50.2%) or Igbo (40.3%) ethnicity and had been practicing pharmacy for ten years or less (72.2%). A majority (90.1%) of respondents were aware that tobacco is harmful to health. Slightly less (75.8%) were aware that second hand smoke is harmful to health. Among the listed diseases, pharmacists responded that lung (84.4%) and esophageal (68.9%) cancers were the most common diseases associated with tobacco use. Less than half of those surveyed associated tobacco use with heart disease (46.9%), chronic obstructive pulmonary disease (27.8%), bladder cancer (47.2%), peripheral vascular disease (35.8%) and sudden death (31.1%). Only 51.9% had heard of the World Health Organization Framework Convention on Tobacco Control (WHO FCTC). A little over half of the respondents (53.8%) were aware of any law in Nigeria controlling tobacco use. The majority of respondents supported a ban on smoking in homes (83.5%), in public places (79.2%), and in restaurants, nightclubs and bars (73.6%). For every additional client attended to daily, knowledge scores increased by 0.022 points. Current smokers were 1.3 times less likely to support smoke-free policies compared with non-smokers. The findings emanating from the focus group discussion reinforced the fact that the pharmacists were in support of smoke-free policies particularly in homes and public places. It also demonstrated that most of them were aware of the health risks associated with tobacco use and second hand smoke however some misconceptions seemed to exist.

Conclusion:

The pharmacists surveyed expressed support of smoke-free policies and most of them were aware of the health risks associated with tobacco use. However, awareness of WHO FCTC and country-level tobacco legislation was low. Current smokers were less likely to support smoke-free policies. Community pharmacists should therefore be considered worth engaging for the promotion of smoke-free policies. Efforts should also be made to educate pharmacists about country level smoke-free laws.

Cross-sectional survey: smoking among medical, pharmacy, dental and nursing students, University of Health Sciences, Lao PDR

OBJECTIVES

To investigate the prevalence of and attitudes to smoking among third year medical, pharmacy, dentistry and nursing students in Lao People's Democratic Republic (PDR).

DESIGN

A cross-sectional survey conducted among third year university level, health professional students. The survey used a self-administered questionnaire which was originally developed by WHO, and modified to suit the setting.

SETTING

The setting was the University of Health Sciences in Vientiane, the capital of Lao PDR. Participants were recruited from the Faculties of Medicine, Pharmacy, Dentistry and Nursing. At the time of the survey, 521 third year students were enrolled.

PRIMARY AND SECONDARY OUTCOME MEASURES

The primary outcome measure was prevalence of current cigarette smoking and other tobacco use. Smoking status was categorised as: current smoker, ex-smoker and non-smoker with current smokers defined as those who had smoked cigarettes or used other tobacco on one or more days during the previous 30 days.

RESULTS

In total, 506 respondents completed the questionnaire, giving a response rate of 97.1% to 98.5% across the different faculties. Overall smoking prevalence was 5.07% (95% CI 3.2% to 7.1%), which is lower than previously reported national prevalence rates. Women reported smoking less than men did (OR=0.56, 95% CI=0.013 to 0.242; p=0.003). The majority of students supported tobacco control measures. The number of people who reported receiving formal training in tobacco cessation counselling ranged from 10.9% (95% CI 5.3% to 19.1%) among nursing students to 51.1% (95% CI 40.4% to 61.7%) among medical students.

CONCLUSIONS

Smoking prevalence among this cohort was relatively low. Students were supportive of tobacco control policies. Further research is needed to understand what is working in this context, in order to apply lessons learnt in similar settings. In the meantime, health professional students should be provided health education to discourage tobacco use. Information on tobacco control policies needs to be more widely disseminated.