Time trends of socioeconomic inequalities in adolescent smoking in Okinawa, Japan, 2008-2016: a repeated cross-sectional study

Trends in prevalence and correlates of tobacco use among school-going adolescents in Bhutan: A secondary data analysis of the 2004-2019 Global Youth Tobacco Survey

Tobacco use remains a major public health challenge globally. In Bhutan, despite the implementation of strict tobacco control measures, the tobacco uses among the students continue to be alarmingly high compared to neighboring countries. This study aims to analyze the trends and correlates of tobacco use among students in Bhutan, utilizing the nationally representative Global Youth Tobacco Survey (GYTS) data from multiple survey years. Secondary analyses of GYTS data collected during 2004-2019 with 12,594 students aged 11-18 years were employed. Use of tobacco was defined as either smoked or smokeless tobacco use in last 30 days of the survey. Prevalence was estimated over time and multivariable log-binomial regression was used to determine the correlates of current tobacco use. Overall tobacco use prevalence increased from 18.5% in 2004 to 27.3% in 2019. Males had higher prevalence (20.4% in 2019) than females (7.0% in 2019). Smokeless tobacco use increased substantially from 8.2% to 19.4% over the study period. Earlier age of initiation had adjusted odds ratio (aOR) of 9.2 for <11 years and 12.8 for 13-16 years vs. never smoking), betel quid use (aOR 3.3), peer pressure (aOR 3.6), and lower cost were significant correlates of adolescent tobacco use. Despite tobacco control policies, tobacco use among Bhutanese students is high and has been increasing over time, especially smokeless forms. Tobacco uses regulation, targeted interventions for high-risk junior high school students, and addressing social influences are urgently needed to curb this epidemic. Sustained tobacco use surveillance and public health action is imperative to protect students in Bhutan from this harmful habit.

Prevalence and reasons for use of heated tobacco products among Malaysian adults who smoked: Findings from the 2020 International Tobacco Control Malaysia Survey

INTRODUCTION

There have been rapid expansions in heated tobacco products (HTPs) outside of Japan and the Republic of Korea. In November 2018, HTPs were first introduced in Malaysia and since then, no studies have been conducted on Malaysians' use of HTPs. This study is the first to examine the prevalence of HTP use and reasons for use among Malaysian adults who smoked cigarettes.

METHODS

Data came from the 2020 ITC Malaysia Survey, a web-based survey of a nationally representative sample of adults who smoked (n=1047) aged 18 and older. They were asked on ever heard of, ever used, and currently using HTPs, and their reasons for using HTPs.

RESULTS

Overall, 25.4% (n= 324; 95% CI:22.3%-28.7%) of Malaysians who smoked reported ever used HTPs with 6.7% (n=85; 95% CI:22.3%-28.7%) were using them daily and 8.1% (n=110; 95% CI:6.4% -10.2%) were using HTPs non-daily. Most of them (57.2%) who dual use were of aged 25-39 and 97.3% were males. Among those who smoked daily, almost half (49.3%) were also using HTP daily. Among those who used HTPs daily and non-daily, curiosity (84.2%, 95% CI:78.4%-90.0%), taste (83.2%, 95% CI:77.3%-89.1%), and appealing technology (78.5%, 95% CI:71.3%-85.6%) were the most reported reasons. Among those who used HTPs daily, curiosity was the top reason (87.9%, 95% CI:78.9%-93.4%), while among non-daily, taste good was the top reason (81.9%, 95% CI:71.9%-88.8%).

CONCLUSIONS

The very high use of HTPs among Malaysians who smoked requires continued public health surveillance that can inform the regulation of these novel tobacco products.

Secondhand Smoke Exposure and Smoking Prevalence Among Adolescents

Importance

Secondhand smoke is a substantial risk factor for youth health globally, including in Japan, where tobacco control policies should be reassessed.

Objective

To assess trends in the prevalence of secondhand smoke exposure among Japanese adolescents from 2008 to 2017 and to examine the association between its frequency and smoking during the study period.

Design, Setting, and Participants

This study comprised a nationally representative, self-administered, school-based, cross-sectional survey focusing on tobacco and alcohol use and related factors among students in grades 7 to 12 (ages 12-18 years) in Japan. This random sampling survey used single-stage cluster sampling. Using the national school directory, junior and senior high schools throughout Japan were randomly extracted from each regional block. All students enrolled in the sampled schools were included as participants, and school-based surveys were completed in 2008, 2012, and 2017. Data analysis was performed from January 1 to March 15, 2023.

Main Outcomes and Measures

Prevalence of secondhand smoke exposure among adolescents in Japan from 2008 to 2017 and changes in the association between secondhand smoke exposure frequency and prevalence of smoking were examined using multiple logistic regression analysis.

Results

Data were analyzed for 95 680 adolescents in 2008 (50.7% boys), 100 050 in 2012 (51.6% boys), and 64 152 in 2017 (53.9% boys). At baseline, 42.0%, 38.5%, and 34.6% of the participants were junior high school students in 2008, 2012, and 2017, respectively. Based on the 2008 surveys, 51.0% of adolescents in grades 7 to 12 were exposed to secondhand smoke in any place (≥1 day during the past 7 days), 37.2% were exposed at home, and 36.5% were exposed in public places. In 2017, 36.3% of participants were exposed to secondhand smoke in any place, 23.8% were exposed at home, and 27.0% were exposed in public places. An association between secondhand smoke exposure frequency and prevalence of smoking was observed consistently regardless of survey year, location, or pattern of exposure (adjusted odds ratios ranged from 2.29 [95% CI, 1.81-2.91] for 1-2 days at home to 11.15 [95% CI, 8.50-14.62] for 7 days in public places). Stratified analysis by higher education intention indicated that the prevalence of smoking and secondhand smoke exposure decreased but remained higher among adolescents who did not intend to pursue higher education. The association between secondhand smoke and smoking did not differ substantially between groups.

Conclusions and Relevance

In this cross-sectional study, the prevalence of secondhand smoke exposure among adolescents in Japan decreased but remained at high levels overall. There may not be a hazard-free threshold for smoking. Enhancing comprehensive tobacco control strategies is Japan's first step toward achieving smoke-free environments to protect youths. Implementation and verification of the effectiveness of smoke-free legislation should be considered.

Factors Associated with Variability in Pulse Wave Transit Time Using Pulse Oximetry: A Retrospective Study

Pulse wave transit time (PWTT) is the time difference between the occurrence of an R-wave on an electrocardiogram and the detection of pulsatile signals on a pulse oximeter, which reflects changes in blood pressure (BP) corresponding to the vessel wall compliance. However, the factors affecting PWTT variability have not been determined. Thus, we investigated the BP changes associated with variations in PWTT and identified the clinical characteristics associated with these variations. Data related to 605 cases of dental procedures performed under intravenous conscious sedation from April 2020 to November 2021 were collected, and 485 cases were enrolled. Heart rate, systolic blood pressure before and after local anesthesia (LA) administration, and crest and trough PWTT waves during LA administration were recorded. Thereafter, PWTT variability was calculated; cases were divided into two groups: large PWTT variability (LPV, n = 357) and small PWTT variability (SPV, n = 128). The index of large PWTT variability could not detect changes in BP. Logistic regression analysis revealed that factors, such as LA use, age, hypertension, and dental treatment phobia were associated with PWTT variability. The use of epinephrine more than 36.25 µg in each LA resulted in PWTT variability of more than 15 ms.

Academic Achievements, Satisfaction with Studies and Risky Behaviours among First-Year Students of Kaunas (Lithuania) Universities, 2000-2017

Risky behaviours are prevalent among university students and may affect academic achievements. This study aimed to evaluate the associations between academic achievements, satisfaction with studies and risky behaviours among first-year students of Kaunas (Lithuania) universities. Three cross-sectional surveys were conducted in 2000, 2010, and 2017. The self-administered questionnaires were filled in during lectures and assessed frequency and amount of alcohol consumption, drinking problems (CAGE test), smoking and drug use frequency, and academic achievements. The associations between risky behaviours and academic achievements were analysed using multivariable logistic regression analysis. Altogether 3325 students (1341 men and 1984 women) aged 20.0 (1.5) years participated in the survey. The proportion of students who consumed alcohol at least once a week and drank 11 or more standard alcoholic units (SAU) a week decreased. Every fifth student reported a drinking problem. Daily smoking prevalence declined, and drug use increased among male students. Multivariable logistic regression analysis revealed that frequent alcohol consumption and problem drinking were associated with low importance of good grades. Students who rated their academic performance below average and were dissatisfied with studies were more likely to consume ≥11 SAU a week. Daily smoking was more common among students who reported low importance of good grades and academic performance below average. A higher prevalence of drug use was found only in male students who declared low importance of good grades. Health promoting interventions at the individual and student community level are required to reduce the prevalence of substance use and improve the academic achievements of students.