Are there hardened smokers in low- and middle-income countries? Findings from the Global Adult Tobacco Survey

Ovarian toxicity of e-cigarette liquids: Effects of components and high and low nicotine concentration e-cigarette liquid in vitro

INTRODUCTION

Electronic cigarette use has become increasingly popular, with potential consequences for reproductive health. We aimed to investigate the effects of different components of e-liquid on the ovary and compare the impact of low nicotine concentration e-liquids (LN e-liquids) and high nicotine concentration e-liquids (HN e-liquids) on ovarian toxicity.

METHODS

A total of 378 rat ovaries were divided into seven groups, including control (no intervention), nicotine (0.05 mg/mL), flavoring (0.25 μL/mL), propylene glycol (PG) (2.5 μL/mL), vegetable glycerin (VG) (2.0 μL/mL), LN e-liquid (0.05 mg nicotine + 0.25 μL flavoring + 2.5 μL PG + 2.0 μL VG + 0.25 μL distilled water/mL medium) and HN e-liquid groups (0.05 mg nicotine + 0.05 μL flavoring + 0.5 μL PG + 0.4 μL VG + 0.05 μL distilled water/mL medium). After three hours of in vitro culture, ovarian morphology, oxidation levels [superoxide dismutase (SOD), catalase (CAT), glutathione peroxidase (GSH-Px) and malondialdehyde (MDA)], and apoptosis levels [factor related apoptosis (Fas), Cyt-c, Caspase-9, Caspase-3] were analyzed.

RESULTS

Our findings indicate that nicotine has limited impact on the ovary, while flavoring, PG, and VG all cause ovarian damage including morphological damage, disruption of oxidative balance and promotion of apoptosis, with VG having the most significant effect. Moreover, LN e-liquids may lead to more severe ovarian damage than HN e-liquids at an equal intake of total nicotine.

CONCLUSIONS

Our study highlights that in e-liquid formula, nicotine has a limited effect on the ovaries, but flavoring, PG, and VG all cause damage to the ovaries, with VG the most damaging. At a consistent level of total nicotine intake, e-liquids with low nicotine concentrations cause more damage to the ovaries than those with high nicotine concentrations. These findings contribute to a better understanding of the impact of e-liquids on ovarian health and have important implications for public health policy.

Trends and correlates of hardcore smoking in India: findings from the Global Adult Tobacco Surveys 1 & 2

Background: Data on the prevalence of hardcore smoking (HCS) among different socioeconomic status (SES) groups in low- and middle-income countries are limited. We looked at the prevalence and pattern of HCS in India with the following objectives: 1) to analyse the association between SES and HCS, 2) to find trends in HCS in different SES groups and 3) to find state-wide variations in hardcore smoking. Methods: Data of individuals aged ≥25 years from the Global Adult Tobacco Survey (GATS) India 2009-10 (N= 9223) and 2016-17 (N= 7647) were used for this study. If an individual met all the following criteria: (1) current smoker, (2) smokes 10 or more cigarettes/day, (3) smokes first puff within 30 minutes after waking up, (4) no quit attempt in the last 12 months, and (5) no intention to quit at all or in the next 12 months, s/he was identified as a hardcore smoker. Multiple regression analysis was done to find the factors associated with HCS. Results: Prevalence of HCS decreased from 3% in GATS 1 to 2.1% in GATS 2: males from 5.6% to 3.9% and females from 0.3% to 0.2%. Compared to the richest group the poorest, poor and those who belonged to the middle-income group were more likely to report HCS in GATS 1 and 2. However, only in the poorest SES group, there was an increase in the proportion of hardcore smokers in GATS 2 compared to GATS 1. Other factors that were significantly associated with HCS in both surveys were male gender, working adults, those with lower education,  and households without any rules for smoking inside the home. Conclusions: Tobacco control and cessation efforts need to focus on individuals of poor SES groups, particularly in the high prevalence Indian states.

Trends and correlates of hardcore smoking in India: findings from the Global Adult Tobacco Surveys 1 & 2

Background: Data on the prevalence of hardcore smoking (HCS) among different socioeconomic status (SES) groups in low- and middle-income countries are limited. We looked at the prevalence and pattern of HCS in India with the following objectives: 1) to analyse the association between SES and HCS, 2) to find trends in HCS in different SES groups and 3) to find state-wide variations in hardcore smoking. Methods: Data of individuals aged ≥25 years from the Global Adult Tobacco Survey (GATS) India 2009-10 (N= 9223) and 2016-17 (N= 7647) were used for this study. If an individual met all the following criteria: (1) current smoker, (2) smokes 10 or more cigarettes/day, (3) smokes first puff within 30 minutes after waking up, (4) no quit attempt in the last 12 months, and (5) no intention to quit at all or in the next 12 months, s/he was identified as a hardcore smoker. Multiple regression analysis was done to find the factors associated with HCS. Results: Prevalence of HCS decreased from 3% in GATS 1 to 2.1% in GATS 2: males from 5.6% to 3.9% and females from 0.3% to 0.2%. Compared to the richest group the poorest, poor and those who belonged to the middle-income group were more likely to report HCS in GATS 1 and 2. However, only in the poorest SES group, there was an increase in the proportion of hardcore smokers in GATS 2 compared to GATS 1. Other factors that were significantly associated with HCS in both surveys were male gender, working adults, those with lower education,  and households without any rules for smoking inside the home. Conclusions: Tobacco control and cessation efforts need to focus on individuals of poor SES groups, particularly in the high prevalence Indian states.

A cross-sectional investigation of softening indicators among South African smokers: Results from the South African Social Attitudes Survey between 2007 and 2018

Recent studies have shown softening among smokers in different countries and in different population groups i.e., as smoking prevalence declined remaining smokers made more quit attempts and smoked fewer cigarettes per day (CPD), as opposed to hardening. We examined tobacco use-related cross-sectional data from five waves of the South African Social Attitudes Survey (SASAS 2007-2018, N = 14,822). Accounting for the SASAS's complex survey design, we ran logistic and linear regressions for smoking prevalence, and for the following indicators of softening: plans to quit smoking within a month, time to first cigarette (5 min, TTFC) and cigarettes smoked per day (CPD). We controlled for survey wave, age, sex, race, marital status, educational level and urban/rural residence. Smoking prevalence remained stable from 2007 (20.7%) to 2018 (22.2%) in the overall population of smokers (p = 0.197), and within sex and race group of smokers. In the adjusted model, there was a significant decline in CPD over time, 0.12 cigarettes per year. There was also a significant decrease in TTFC among males over time. Among women, CPD declined significantly by 0.32 cigarettes per year. The proportion of Asians/Indians planning to quit also decreased over time. South African smokers do not consistently show significant change in the softening indicators overall. Stronger tobacco control policies and better-tailored smoking cessation interventions are needed to achieve a significant decrease in smoking prevalence across sex and other subpopulations in South Africa.

Trends and correlates of hardcore smoking in India: findings from the Global Adult Tobacco Surveys 1 & 2

Background: Data on prevalence of hardcore smoking (HCS) among different socioeconomic status (SES) groups in low- and middle-income countries are limited. We looked at the prevalence and pattern of HCS in India with the following objectives: 1) to analyse the association between SES and HCS, 2) to find trends in HCS in different SES groups and 3) to find state-wide variations in hardcore smoking. Methods: Data of individuals aged ≥25 years from the Global Adult Tobacco Survey (GATS) India 2009-10 (N= 9223) and 2016-17 (N= 7647) were used for this study. If an individual met all the following criteria: (1) current smoker, (2) smokes 10 or more cigarettes/day, (3) smokes first puff within 30 minutes after waking up, (4) no quit attempt in last 12 months, (5) no intention to quit at all or in the next 12 months, (6) lack of knowledge of harmful effect of smoking, s/he was identified as a hardcore smoker. Multiple regression analysis was done to find the factors associated with HCS. Results: Prevalence of HCS deceased from 2.5% in GATS 1 to 1.9% in GATS 2: males from 6.2% to 3.9% and females from 0.3% to 0.2%. Compared to the richest group the poorest, poor and those who belonged to the middle-income group were more likely to report HCS in GATS 1 and 2. However, only in the poorest SES group there was an increase in the proportion of hardcore smokers in GATS 2 compared to GATS 1. Other factors that were significantly associated with HCS in both surveys were male gender, working adults, those with lower education, early initiation of smoking and households without any rules for smoking inside the home. Conclusions: Tobacco control and cessation efforts need to focus on individuals of poor SES groups particularly in the high prevalence Indian states.

Prevalence of addictive behaviours among adolescents from 73 low-and middle-income countries

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The prevalence of regular alcohol use was the highest among adolescents in Zambia but the lowest in Senegal.

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The prevalence of problematic alcohol use was higher in Argentina and Colombia than in any other low- and middle-income countries.

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The prevalence of regular and problematic alcohol use was the lowest in countries with Muslim and Buddhist religions.

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Samoa had the highest prevalence of smoking as well as in marijuana and amphetamine consumption.

Introduction

Adolescence is a critical developmental stage for the initiation of substance use worldwide. However, the prevalence of various types of substances consumed by adolescents living in low- and middle- income countries (LMICs) across different continents is not fully understood.

The aims of the present study were to estimate the prevalence of regular and problematic substance use among adolescents in 73 LMICs across different continents and to explore the role of country-specific factors on this prevalence.

Method

Data of 314,187 adolescents (52.79% girls; median age = 15 years old) who participated in the Global School-based Student Health Survey (GSHS) were analysed. After estimating the weighted prevalence for each country, multilevel models were used to examine the influence of country-specific factors on the prevalence of substance use across 73 LMICs.

Results

The results indicated that problematic alcohol use was more prevalent in LMICs with higher income levels. The prevalence of regular alcohol use was the highest in Zambia. Regular and problematic alcohol use was the least prevalent in Senegal and Myanmar. The findings also revealed that smoking and the consumption of marijuana and amphetamine were the most common among adolescents in Samoa, whereas the prevalences for these substances were the lowest in Laos.

Conclusion

Economic wealth, religion and geographical factors seem to have a role in determining the prevalence of substance use among adolescents in LMICs.

Changes in adult smoking behaviours in ten global adult tobacco survey (GATS) countries during 2008-2018 - a test of 'hardening' hypothesis'

BACKGROUND

Hardcore smoking behaviours and test of hardening are seldom reported from low-and-middle-income countries (LMICs). We report country-wise changes in smoking behaviors between two sequential surveys and explored ecologically the relationship between MPOWER scores and smoking behaviors including hardcore smoking.

METHODS

We analysed sequential Global Adult Tobacco Survey (GATS) data done at least at five years interval in 10 countries namely India, Bangladesh, China, Mexico, Philippines, Russia, Turkey, Ukraine, Uruguay, and Vietnam. We estimated weighted prevalence rates of smoking behaviors namely current smoking (both daily and non-daily), prevalence of hardcore smoking (HCS) among current smokers (HCSs%) and entire surveyed population (HCSp%), quit ratios (QR), and the number of cigarettes smoked per day (CPD). We calculated absolute and relative (%) change in rates between two surveys in each country. Using aggregate data, we correlated relative change in current smoking prevalence with relative change in HCSs% and HCSp% as well as explored the relationship of MPOWER score with relative change in smoking behaviors using Spearman' rank correlation test.

RESULTS

Overall daily smoking has declined in all ten countries lead by a 23% decline in Russia. In India, Bangladesh, and Philippines HCSs% decreased as the smoking rate decreased while HCSs% increased in Turkey (66%), Vietnam (33%) and Ukraine (15%). In most countries, CPD ranged from 15 to 20 sticks except in Mexico (7.8), and India (10.4) where CPD declined by 18 and 22% respectively. MPOWER scores were moderately correlated with HCSs% in both sexes (r = 0.644, p = 0.044) and HCSp% (r = 0.632, p = 0.05) and among women only HCSs% (r = 0.804, p = 0.005) was significantly correlated with MPOWER score.

CONCLUSION

With declining smoking prevalence, HCS had also decreased and quit rates improved. Ecologically, a positive linear relationship between changes in smoking and HCS is a possible evidence against 'hardening'. Continued monitoring of the changes in quitting and hardcore smoking behaviours is required to plan cessation services.