Smoking Prevalence, Behaviour and Nicotine Addiction among Coal Workers in Zonguldak, Turkey

Environmental and occupational risk factors for COPD and its prevalence among miners worldwide: a Mendelian randomization and meta-analysis study

Chronic obstructive pulmonary disease (COPD) is the third leading cause of death after cardiovascular disease and stroke, and its incidence is associated with genetic, environmental, and occupational factors. Miner is high-risk population for COPD, but the global prevalence of COPD in this group is inaccurate. In this study, the environmental and occupational risk factors for COPD were explored comprehensively with a two-sample Mendelian randomization study by combining genome-wide association data from two large global sample sizes of publicly available databases, UK Biobank (n = 503,317) and FinnGen (n = 193,638), as well as the prevalence of COPD among miners was investigated with meta-analysis followed a random-effects model including seven studies (16,033 miners in total). This study found that asthma, smoking, shift work, and workplace dust exposure may increase an individual's risk of COPD. The pooled prevalence of COPD among miners globally was 12% (95% CI: 8%, 18%), with higher prevalence of COPD among ex-smokers and dust-exposed individuals, and was significantly influenced by the method of diagnosis. Our findings suggest that there is currently a lack of practical criteria for diagnosing COPD in the physical examination and screening of miners. The actual prevalence of COPD may be underestimated due to the healthy worker effect and the phenomenon of job switching, and appropriate policies should be favored in the future to reduce the risk of COPD in miner.

Update on the approach to smoking in patients with respiratory diseases

Smoking is the leading cause of respiratory disease (RD). The harmful effects of smoking on the respiratory system begin in utero and influence immune responses throughout childhood and adult life. In comparison with "healthy" smokers, smokers with RD have peculiarities that can impede smoking cessation, such as a higher level of nicotine dependence; nicotine withdrawal; higher levels of exhaled carbon monoxide; low motivation and low self-efficacy; greater concern about weight gain; and a high prevalence of anxiety and depression. In addition, they require more intensive, prolonged treatment. It is always necessary to educate such individuals about the fact that quitting smoking is the only measure that will reduce the progression of RD and improve their quality of life, regardless of the duration and severity of the disease. Physicians should always offer smoking cessation treatment. Outpatient or inpatient smoking cessation treatment should be multidisciplinary, based on behavioral interventions and pharmacotherapy. It will thus be more effective and cost-effective, doubling the chances of success.

Associations of psychological capital, demographic and occupational factors with cigarette smoking among Chinese underground coal miners

Background

As a specific male occupational group, underground coal miners have been commonly found to have a high prevalence of cigarette smoking. It is of urgent need to explore some factors that could be intervened to reduce smoking from personal or internal perspective. The purpose of the present study was to examine the associations of psychological capital (PsyCap), demographic and occupational factors with smoking among Chinese underground coal miners.

Methods

A cross-sectional survey was conducted in a coal-mining population in northeast China. Twenty-five hundreds of male underground miners were sampled from six coal mines. Self-administered questionnaires involving current smoking status, specific scales to measure the levels of PsyCap, effort-reward imbalance (ERI) and perceived physical environment (PPE), and some demographic and occupational factors were completed anonymously after a day shift. Complete responses were obtained from 1,956 participants (response rate: 78.2%). Multivariate logistic regression analysis was used to estimate the factors in relation to current smoking.

Results

The overall smoking prevalence was 52.4%. After controlling for demographic and occupational variables, PsyCap was not associated with smoking. Compared with the miners in the lowest tertile of resilience, the odds ratios (ORs) of smoking for the miners in the intermediate tertile and highest tertile were 1.30 (95% confidence intervals (CI): 0.99–1.70) and 1.58 (95% CI: 1.13–2.20), respectively. Compared with the miners in the lowest tertile of optimism, the ORs of smoking for the miners in the intermediate tertile and highest tertile were 0.79 (95% CI: 0.61–1.03) and 0.69 (95% CI: 0.51–0.92), respectively. Low education and high PPE were the risk factors of smoking, whereas ERI had no association with smoking.

Conclusions

More than half of the underground coal miners were current smokers, which indicated that cigarette smoking might be a common health risk behavior in this occupational population. High resilience and PPE, together with low education were the risk factors of smoking, whereas high optimism was a protective factor. Consequently, PsyCap had mixed effects on cigarette smoking. Investment in resilience and optimism should be given more attention for the purposes of the prevention and reduction of smoking among occupational populations.

Electronic supplementary material

The online version of this article (doi:10.1186/s12889-015-1349-6) contains supplementary material, which is available to authorized users.

A text messaging-based smoking cessation program for adult smokers: randomized controlled trial

BACKGROUND

Despite promising data in Western countries, there is a dearth of research into the efficacy of text messaging-based smoking cessation programs in other settings, including the Middle East, where smoking prevalence rates are higher.

OBJECTIVE

This paper reports cessation rates observed in SMS Turkey, a text messaging-based smoking cessation program for adult smokers in Ankara, Turkey.

METHODS

This study was a small-scale, parallel-group randomized controlled trial (RCT) conducted in Ankara, Turkey. Participants were adult daily smokers who were seriously thinking about quitting in the next 15 days and living in Ankara, Turkey. The text messaging intervention, SMS Turkey, provided 6 weeks of daily messages aimed at giving participants skills to help them quit smoking. Messages were sent in an automated fashion, except 2 days and 7 days after the initial quit day. On days 2 and 7, the research assistant manually assigned participants to content "paths" based on whether they were still not smoking or had relapsed. The control arm received a brochure that provided similar information about smoking cessation. The main outcome measure was self-reported 3-month sustained abstinence, verified by carbon monoxide (CO) readings. Neither participants nor researchers were blinded to arm assignment.

RESULTS

The 151 participants were randomly assigned to 1 of 2 groups: 76 to the SMS Turkey intervention group and 75 to the brochure control group. Using intention to treat, all 151 participants were included in analyses. Three-month cessation trends were not significantly higher in the intervention group: 11% intervention vs 5% control had quit (χ(2)(1)=1.4, P=.24; R(2)=2.0, 95% CI 0.62-6.3). When the sample was stratified by sex, female intervention participants (14%, n=5) were significantly more likely to have quit at 3 months than female control participants (0%, n=0; χ(2)(1)=3.7, P=.05). Among light smokers (ie, those smoking less than 20 cigarettes per day), intervention participants (17%, n=5) also were significantly more likely to have quit compared to control participants (0%, n=0; χ(2)(1)=5.3, P=.02). We noted no difference in cessation rates for males or heavy smokers. Participants experienced significant technology problems during the study. Some participants received duplicate text messages at least once during the trial; others failed to receive some program messages. Neither receiving duplicate messages (χ(2)(1)=0.12, P=.73), or missing 5 or more program messages (χ(2)(1)=0.75, P=.39) negatively affected quitting rates.

CONCLUSIONS

Although the study was not powered to detect statistically significant differences, as the primary aim was to provide estimates of effect size that could be used to better inform a power analysis for a larger trial, findings provide optimism that SMS Turkey may be able to affect quitting rates in environments with high smoking prevalence, such as Ankara, Turkey. The SMS Turkey software program did not work as well as it did 2 years previous. The system will need to be updated to maintain software compatibility with ongoing technology evolution.

TRIAL REGISTRATION

Clinicaltrials.gov NCT00912795 http://clinicaltrials.gov/ct2/show/NCT00912795 (Archived by WebCite® at http://www.webcitation.org/6Ch1cIA8l).

Respiratory disorders in the Middle East: a review

The spectrum of pulmonary pathology in the Middle East is as versatile as its civilizations and cultures. In this review, we outline the key challenges confronting pulmonologists in the Middle East. We shed light on the diverse conditions commonly encountered in the region, from the centuries-old illnesses of tuberculosis, to contemporary problems such as lung complications from chemical warfare. We specifically highlighted unique aspects related to respiratory illnesses in the Middle East, for example, climate factors in the desert region, cultural habits, for example, water-pipe smoking and disorders unique to the region, such as Behçet's disease. Pulmonologists are also faced with the consequences of modernization, including large immigrant population and associated social and health issues, rising incidence of obesity and sleep apnoea, and drug-resistant tuberculosis. Tackling these health issues will require an integrated approach involving public health, primary care as well as specialist pulmonology input, taking into consideration the unique cultural and environmental factors to ensure effective management and compliance to medical care.

Interest in technology-based and traditional smoking cessation programs among adult smokers in Ankara, Turkey

Background

Little is known about the demand for smoking cessation services in settings with high smoking prevalence rates. Furthermore, acceptability of text messaging and Internet as delivery mechanisms for smoking cessation programs in non-developed countries is under-reported. Given the cost effectiveness of technology-based programs, these may be more feasible to roll out in settings with limited public health resources relative to in-person programs.

Findings

148 adult smokers took part in a community-based survey in Ankara, Turkey. Two in five (43%) respondents reported typically smoking their first cigarette within 30 minutes of waking. Many participants expressed a desire to quit smoking: 27% reported seriously thinking about quitting in the next 30 days; 53% reported at least one quit attempt in the past year. Two in five smokers wanting to quit reported they were somewhat or extremely like to try a smoking cessation program if it were accessible via text messaging (45%) or online (43%).

Conclusions

Opportunities for low-cost, high-reach, technology-based smoking cessation programs are under-utilized. Findings support the development and testing of these types of interventions for adult smokers in Turkey.

Smoking status and levels of knowledge regarding cigarettes among primary school teachers

OBJECTIVES

Teachers are believed to be important role models for their students. This study's objective was to determine primary school teachers' smoking status, their level of knowledge regarding cigarettes and their attitude towards prohibition; and to obtain preliminary data that may contribute to the development of antismoking campaigns in schools.

METHODS

In total, 468 teachers were recruited and given a questionnaire.

RESULTS

The answers revealed that among respondents, 58.1% were current smokers, 36.1% were ex-smokers, and 5.8% had never smoked. The percentage of current smokers among females (71.7%) was significantly higher than among males (50.7%). The percentage of those who had begun smoking at age 15 or earlier was 32.0% in smoking males and 19.3% in females; this difference was also statistically significant. No significant difference regarding ideas about smoking and prohibitions on cigarettes was found among current smokers, ex-smokers, and nonsmokers.

CONCLUSIONS

Due to the high number of smoking teachers and their role model status, students may also be at risk of starting smoking. It was concluded that it would be beneficial to deliver educational programs and seminars encouraging smoking cessation to this professional group.

Airflow limitation among workers in a labour-intensive coal mine in Tanzania

OBJECTIVES

To describe the relationship between cumulative respirable dust and quartz exposure and lung functioning among workers in a labour-intensive coal mine.

METHODS

The study population comprised 299 men working at a coal mine in Tanzania. Lung function was assessed using a Vitalograph alpha III spirometer in accordance with American Thoracic Society recommendations. Multiple linear regression models were developed to study the relationship between forced expiratory volume in 1 s (FEV(1)), forced vital capacity (FVC) and FEV(1)/FVC and the cumulative dust or quartz exposure while adjusting for age, height and ever smoking. To evaluate trends for dose response, cumulative exposure concentrations for respirable dust and quartz were ranked and categorized in quartiles and the highest decile, with the first quartile as the reference group. Logistic regression models were used to determine odds ratios for FEV(1)/FVC < 0.7 and FEV(1)% < 80 for categories of cumulative dust or quartz exposure.

RESULTS

The prevalence of FEV(1)/FVC < 0.7 among the workers was 17.3%. Workers in the development team (20.5%) had the highest prevalence of FEV(1)% < 80%. The estimates of the effects of cumulative exposure on FEV(1)/FVC were -0.015% per mg years m(-3) for respirable dust and -0.3% per mg years m(-3) for respirable quartz. In logistic regression models, the odds ratios for airway limitation (FEV(1)/FVC < 0.7) for the workers in the highest decile of cumulative dust and quartz exposure versus the referents were 4.36 (95% confidence interval: 1.06, 17.96) and 3.49 (0.92, 13.21), respectively. The upper 10% of workers by cumulative dust and quartz exposure also had higher odds ratios for predicted FEV(1)% < 80% than the reference group odds ratio: 10.38 (1.38, 78.13) and 14.18 (1.72, 116.59), respectively. The results must be interpreted with caution due to a possible healthy worker effect and selection bias.

CONCLUSION

Exposure to respirable coal mine dust was associated with airway limitation as measured by FEV(1)/FVC and predicted FEV(1)%.

Evaluation of nasal mucociliary functions with rhinoscintigraphy in coal workers' pneumoconiosis

OBJECTIVE

To compare nasal mucociliary clearance (NMC) functions in coal workers with pneumoconiosis, coal workers without pneumoconiosis and healthy controls by using technetium-99m-labeled macroaggregated albumin rhinoscintigraphy.

METHODS

Sixty-five of the 86 coal workers were clinically documented as suffering from coal workers' pneumoconiosis (CWP group). CWP workers were divided into two groups according to smoking status: 44 smokers (CWP-S) and 21 nonsmokers (CWP-NS). Twenty-one workers without pneumoconiosis (NCWP group) were similarly divided into two groups: 12 smokers (NCWP-S) and 9 nonsmokers (NCWP-NS). Thirty-three healthy male volunteers were selected for the control group [15 smokers (control-S), 18 nonsmokers (control-NS)]. The half-time (t1/2) value for the clearance of the radiopharmaceutical was calculated for each patient.

RESULTS

Mean t1/2 values for CWP-S, CWP-NS, NCWP-S, NCWP-NS, control-S and control-NS were 25.10 +/- 7.75, 10.97 +/- 3.24, 14.68 +/- 4.98, 9.17 +/- 3.71, 19.15 +/- 5.04 and 15.08 +/- 5.11, respectively (p < 0.001, Kruskal-Wallis variance analysis). Further, mean t1/2 values of smokers versus nonsmokers in CWP, NCWP and control groups were compared, and it was found that although smoking prolonged nasal transport time in all three groups, the difference was significant only in the CWP group (p < 0.001, p < 0.023 and p < 0.027, respectively, Bonferroni-adjusted Mann-Whitney test).

CONCLUSION

Our findings demonstrated a synergistic detrimental effect of smoking with coal dust exposure on nasal transport time.