Smoking, awareness of smoking-associated health risks, and knowledge of national tobacco legislation in Gaza, Palestine

Predictors and health outcomes of tobacco smoking among the population of Gaza: A large-scale study

Tobacco smoking, a significant public health concern globally, is associated with a rise in noncommunicable diseases and preventable deaths, with pronounced impacts in conflict zones like Gaza. A study in Gaza focused on individuals over 40 years of age, aiming to identify predictors of tobacco use and its links to diseases like coronary artery disease, chronic lung disease, and stroke. The research, based on the Gaza NCD study data with 4576 participants and a 96.6% response rate, found an overall tobacco smoking prevalence of 19.4%, with higher rates among men. Adjusting for various factors, the study revealed significant associations between cigarette smoking in men and adverse health outcomes, such as coronary artery disease and chronic lung disease. However, after adjusting for independent variables, shisha smoking in men showed no association with these health outcomes. In conflict-affected regions like Gaza, this large-scale study sheds light on predictors of cigarette and shisha smoking and their impact on health outcomes, offering valuable insights for researchers, public health officials, healthcare professionals, and policymakers. The findings aid in predicting smoking prevalence, addressing current health challenges, and mitigating potential health and financial burdens associated with tobacco use in conflict zones.

Predictors of Smoking Preventive Behavior Based on Empowerment Components among Male Students of High Schools: A Cross-Sectional Study in Iran

Background

Smoking among adolescents and young adults is believed to be one of the most important preventable health problems. The etiology of smoking is one of the most pivotal activities in designing prevention programs. The aim of this study was to determine the correlates between components of empowerment in the context of smoking prevention in adolescents.

Methods

This cross-sectional descriptive study was carried out on 422 high school male students in spring 2020. The data collection tool of this study was a valid and reliable researcher-made questionnaire containing demographic characteristics, items related to various components of empowerment, and items related to the smoking preventive behavior (SPB). A linear regression model was used, where the "SPB" outcome variable assumed three possible values: sensation seeking, problem-solving skills, self-efficacy, self-esteem, dependence on group, and attitude towards smoking reported in the previous literature were taken as independent variables, and smoking preventive behavior was considered as a dependent variable.

Results

The results revealed that 10.42% of the students were active smokers and 40.75% of them had the experience of smoking. The results also showed a positive and significant relationship between problem-solving skills (r = 0.394, P < 0.001), self-efficacy (r = 0.340, P < 0.001), self-esteem (r = 0.310, P < 0.001), and attitude (r = 0.333, P < 0.001) with the SPB. In addition, a negative and significant correlation was observed between group dependence (r = -0.313, P < 0.001) and the SPB. Overall, the components of empowerment were able to explain 26.5% of the variance in the SPB. Among the components, problem-solving skills solely explained 15.5% of variance of the SPB.

Conclusion

According to the results of this study, it can be said that most adolescents are at risk of smoking. Explanatory factors for adopting the SPB include improving problem-solving skills, creating a negative attitude towards smoking, increasing self-efficacy to prevent smoking, reducing group dependence, and increasing self-esteem in adolescents. Multilevel interventions and actions by policymakers, educators, and related organizations to prevent adolescent smoking and educate them about adolescent empowerment skills to prevent smoking should be considered.

Tobacco Use and Its Associated Factors among Undergraduate Public Health Students in Kathmandu Valley, Nepal

Background. Despite the crucial role of public health students in tobacco control, there is a paucity of information regarding tobacco use among this population in Nepal. This study aims to assess the prevalence of tobacco use among undergraduate public health students in Kathmandu valley, Nepal. Methods. A web-based survey was conducted among 386 undergraduate public health students in Kathmandu valley, Nepal, using the Global Health Professions Student Survey (GHPSS) questionnaire. Associated factors were examined using multivariate logistic regression analyses at the level of significance of 0.05. Results. A total of 16.8% of students were current cigarette smokers, 39.9% had ever smoked cigarettes, and 62.2% had smoked their first cigarettes during adolescence. Among the participants, 11.7% currently used other tobacco products. Male students (aOR: 15.4; 95% CI: 4.9–47.8), students with higher age (aOR: 2.4; 95% CI: 1.0–5.4), students belonging to non-Brahmin/Chhetri ethnic group (aOR: 2.3; 95% CI: 1.2–4.4), and those staying without family (aOR: 2.0; 95% CI: 1.1–5.0) had higher odds of being current smoker. Similarly, students with a parental history of tobacco use (aOR: 2.4; 95% CI: 1.3–5.0) and friends with smoking habits (aOR: 7.9; 95% CI: 2.3–27.0) were more likely to be a current smoker. Conclusion. There is a notable prevalence of tobacco use among public health students in Kathmandu valley, Nepal. Concerned stakeholders should work jointly to implement a cessation program to discourage tobacco use among these populations who have a potential role in educating communities about the hazards of tobacco smoking, tobacco use prevention, and control.

An ADePT evaluation for incorporating the TIPPS periodontal health intervention into primary care antenatal programmes to enhance infant birth weight in Palestine: a feasibility study

Background

A feasibility study was conducted to implement the Talk, Instruct, Practice, Plan and Support (TIPPS) intervention for pregnant women to enhance infant birth weight in a conflict area in Low- and Middle-Income Countries (LMIC). The decision tool, A process for Decision-making after Pilot and feasibility Trials (ADePT), examines the methodological factors identified in a feasibility study, that may require modification for a full trial. Thus, this study aimed to use the ADePT decision tool to evaluate if the feasibility study had achieved its objectives and to identify the need for intervention, clinical context and trial design modification.

Methods

A one-arm, pretest–posttest feasibility study recruited 25 pregnant women in their first trimester and clinic staff from a primary healthcare clinic located in Gaza City, Palestine. The TIPPS periodontal health intervention was delivered by antenatal care nurses to the pregnant women during their regular follow-up appointments. The ADePT framework was applied to evaluate the findings from the feasibility study. The ADePT checklist demonstrated sample size estimation, recruitment, consent, intervention adherence, intervention acceptability, costs and duration, completion and appropriateness of outcome assessments, retention, logistics, and synergy between protocol components.

Results

All recruited pregnant women (25, aged 16–35 years old) consented to participate in the study, and the adherence to the intervention was 88% (22 women). The TIPPS intervention was acceptable, but there was ambivalence over who should deliver it in the clinic. Only the cost of toothbrushing and TIPPS information materials was calculated, while the cost of nurses’ time was not included. The missing values of data were few (12% of gingival bleeding data and 22% from infant birth weight data). This intervention significantly reduced the mean percentage of plaque and bleeding scores after 3 months. The sample size for future randomised controlled trial was estimated around 400 participants. The participants stated the value of the intervention. The clinic staff voiced concerns regarding time and the cost of nurses providing the TIPPS intervention. This allowed suggestions to be made regarding the modification of trial design and context of implementation.

Conclusions

The ADePT evaluation showed it was possible to progress to full trial with modifications in the trial design.

Comparison between Smoking and Nonsmoking Palestinian Medical Students in the Health-Promoting Behaviors and Lifestyle Characteristics

Objectives

This study was aimed at comparing the predictors of health-promoting lifestyle behaviors between smoking and nonsmoking medical students at An-Najah National University located in Palestine.

Methods

A descriptive cross-sectional study was performed during the academic year 2017/2018. Medical students were asked to complete a self-reported questionnaire that involved the predictors of Health-Promoting Lifestyle Profile-II. With the use of a suitable available sample composed of a total of 430 medical students, 400 had successfully completed the questionnaire and were included in the study. The data was analyzed by using SPSS version 24 software.

Results

The sample included 400 medical students with a mean age of 18.7 years, 311 (77.7%) were females, and 89 (22.3%) were males. The prevalence of smokers in the sample was 110 (27.5%). For the health status of over half the students, 211 (52.8%) were excellent. The total HPLP-II score for smoking students resulted to be significantly lower in comparison to nonsmoking students (131.2 versus 135.7). This significant difference was clear in the interpersonal relation subscale (25.6 versus 26.8) for smoking and nonsmoking students, respectively. The score differences in other subscales were generally lower in smoking students. However, these differences were not consistent with statistical significance.

Conclusion

The significant lower total Health-Promoting Lifestyle Profile-II score in smoking students necessitates the urgent need for awareness programs, not only towards smoking but also on how to enhance student health-promoting lifestyle behaviors.

Knowledge, attitudes, and perceptions towards waterpipe tobacco smoking amongst college or university students: a systematic review

BACKGROUND

Despite evidence for the harms of waterpipe tobacco smoking (WTS), its use is increasing amongst college and university students worldwide. This systematic review aims to assess the knowledge of, attitudes towards and perceptions of WTS among college or university students.

METHODS

We electronically searched MEDLINE, EMBASE, CINAHL, PSYCHINFO and ISI the Web of Science in October 2018, restricting our search to studies published since January 1990. We included studies among university or college students that used qualitative or quantitative methods, and addressed either knowledge, attitudes, or perceptions towards WTS. We excluded studies where WTS could not be distinguished from other forms of tobacco use and studies reported as abstracts where the full text could not be identified. Data were synthesised qualitatively and analysed data by region (global north/ south), and by reasons for use, knowledge of health hazards, how knowledge influences use, perceptions towards dependence, and policy knowledge.

RESULTS

Eighty-six studies were included; 45 from the global north and 41 from the global south. Socio-cultural and peer influences were major contributing factors that encouraged students to initiate WTS. Furthermore, WTS dependence had two components: psychological and social. This was compounded by the general perception that WTS is a less harmful, less addictive and more sociable alternative to cigarette smoking. Knowledge of WTS harms failed to correlate with a reduced risk of WTS use, and some students reported symptoms of WTS addiction. A large proportion of students believed that quitting WTS was easy, yet few were able to do so successfully. Finally, students believed current public health campaigns to educate on WTS harms were inadequate and, particularly in the global north, were not required.

CONCLUSION

Reasons for WTS amongst university students are multi-faceted. Overall, interventions at both the individual and community level, but also policy measures to portray a message of increased harm amongst students, are required. Additional studies are necessitated to understand temporal changes in students' beliefs, thus allowing for better targeted interventions.

Oral Cancer Screening among Smokers and Nonsmokers

Aims and Objectives:

The aim of visual systematic screening is early identification of oral cancer (OC) precursor lesion. OC mortality improves when cancer is identified at early stages. This is important in patients whose lifestyle choices render them at higher risk of developing OC. This study described the prevalence of OC screening among smokers and nonsmokers in Kuwait and ascertained demographic predictors.

Materials and Methods:

This cross-sectional study utilized a self-administered online survey in English and Arabic through Survey Monkey^® and disseminated using the social networking app “WhatsApp.” The survey included 21 questions on demographics, smoking status, and knowledge of OC. Screening questions were adopted from the Maryland Cancer Screening and Risk Behavior Survey. Data were analyzed using the computer software “Statistical Package for Social Sciences, SPSS version 24.0” (IBM Corp, Armonk, NY, USA).

Results:

The study included 404 Kuwaiti respondents, 311 (77%) nonsmokers and 93 (23%) smokers. Prevalence of OC screening was 7.2, 7.7% among nonsmokers and 5.4% in smokers. Only 36.6% were aware of OC, with more nonsmokers (38.9%) than smokers (29%). Logistic regression revealed twice more males likely to go for screening than females and with the likelihood of those being in the age group of 25–44 years four times more (P < 0.012) than other age groups.

Conclusion:

There was low prevalence of screening and poor awareness of OC among sampled. Increased efforts are needed by health professionals to spread awareness and improve knowledge on OC and demand the inclusion of screening during their routine and opportunistic oral examinations.

Tobacco Control Law awareness, enforcement, and compliance among high school students in Myanmar

In Myanmar, the Control of Smoking and Consumption of Tobacco Products Law (Tobacco Control Law; TCL), which covers the prohibition of sale of tobacco to minors and all forms of tobacco advertisement, was enacted in 2006. This study aimed to examine the awareness of the TCL among high school students. A cross-sectional study was conducted in November 2015. Participants were 1,339 high school students (554 boys and 785 girls) from two regions and two states of Myanmar. Data were collected using anonymous self-administered questionnaires and revealed that 78.0% of boys and 86.5% of girls responded the sale of tobacco products in or within 100 feet from school, and 83.4% of boys had ever seen someone selling tobacco products to minors. More than half of the students had ever seen minors selling or distributing tobacco products, and had knowledge about the TCL, while only 9.7% knew about the penalties. The adjusted odds ratio (95% confidence interval) of awareness of the TCL was 2.12 (1.35-3.31) for students who had ever received tobacco products free of charge, or seen/heard about their distribution free of charge, 1.86 (1.20-2.89) for current smokeless tobacco users, and 0.58 (0.43-0.77) for students who had ever seen someone selling tobacco products to minors. The majority of high school students did not know that the violation of the TCL could be punished with a fine and/or imprisonment. These findings suggest that awareness of the TCL was very low among high school students, highlighting that TCL enforcement and compliance, and tobacco-related health education programs are not satisfactory in Myanmar.

Awareness About Anti-Smoking Related Laws and Legislation Among General Population in Slums of Delhi, India

Introduction

Almost 40% of Delhi's population lives in slums and is vulnerable to tobacco use. It is therefore important to assess their opinion and ensure compliance to antismoking legislation. The present study was undertaken to assess the awareness of the general public residing in slums in Delhi regarding the smoke-free initiative of 2009, 3 years after intensive implementation.

Methods

It was a cross-sectional study conducted among participants selected by cluster sampling from the slums in six districts of Delhi using a pretested semistructured questionnaire. A total of 708 slum dwellers were interviewed.

Results

Out of the total, only 16.1% (n = 114) of the participants had heard of The Cigarettes and Other Tobacco Products (Prohibition of Advertisement and Regulation of Trade and Commerce, Production, Supply and Distribution) Act, 2003 (COTPA), though, they were aware about some of the provisions of the COTPA. Majority (n = 529; 74.7%) perceived the smoke-free zones as the places where smoking forms of tobacco are banned. Regarding the awareness about the places designated as smoke-free zones, 82.1% (n = 581) of the respondents named educational institutions. About 61% of the people interviewed reported to have seen people smoking at public places on the day of interview while only 21.5% reported to have seen any one getting punished for smoking.

Conclusions

Awareness about COTPA was low. The study respondents perceived that no action was being taken against persons acting in violation of the law. Thus, there is a need for stricter implementation of COTPA and increased spreading of awareness among the general public.

Implications

While awareness about antismoking legislation among general population (particularly slums) has been studied world over, this has not been the case in India. The study depicts opinion of one of the susceptible populations regarding tobacco control legislation, which has hitherto not been studied in the Indian context. This study has an important implication as it highlights the need for stringent enforcement of antismoking legislation for tobacco control.

Smoking Cessation Is Associated With Lower Indirect Costs

Objective:

This study quantified differences in indirect costs due to decreased work productivity between current and former smokers. Former smokers were further categorized by number of years since quitting to assess corresponding differences.

Methods:

Data on employed individuals were obtained from the 2013 US National Health and Wellness Survey (NHWS; N = 75,000). Indirect costs were calculated for current smokers and former smokers from weekly wages based on age and sex.

Results:

The annual total indirect costs for current smokers were $1327.53, $1560.18, and $1839.87 higher than for those who quit 0 to 4 years, 5 to 10 years, and more than or equal to 11 years prior, respectively. There were no significant differences in mean total indirect costs between the former smoker groups.

Conclusions:

Current smokers showed significantly higher total annual indirect costs compared with former smokers, independently of the number of years since quitting smoking.

Waterpipe and cigarette tobacco smoking among Palestinian university students: a cross-sectional study

BACKGROUND

During the last two decades, waterpipe tobacco smoking (WTS), also known as hookah, witnessed a global increase in use, especially among youth. Little information is known about the burden of WTS among Palestinian youth. A cross-sectional study was conducted to estimate the prevalence of WTS and cigarette smoking and explore the associated factors among a sample of Palestinian university students.

METHODS

1891 students, from five Palestinian universities in the West Bank and Gaza Strip, completed a self-administered, web-based survey in 2014-2015. The questionnaire, which was based on the Global Adults Tobacco Survey (GATS), had questions on WTS and cigarette smoking patterns and socio-demographic and university-related characteristics. Binary logistic regression analyses were computed to investigate associated factors with WTS and cigarette smoking.

RESULTS

50.9% of the sample was women. The mean age was 20.1 ± 2.0. Overall, 30.0% of participants were current tobacco smokers and 33.4% reported ever smoking tobacco through a waterpipe. The prevalence of current WTS (24.4%) surpassed the prevalence of current cigarette smoking (18.0%), with a significantly higher prevalence among men compared to women. The gender gap for WTS (36.4% vs. 12.9%) was smaller than that for cigarette smoking (32.8% vs. 3.6%). Binary logistic regression models for the total sample (men and women) revealed that men were more likely to be current waterpipe and cigarette tobacco smokers compared to women (AOR = 4.20, 95% CI = 3.22-5.48, and AOR = 10.91, 95% CI = 7.25-16.42, respectively). Geographic area of residence, faculty of study and self-reported academic achievement were also associated with the likelihood of being current waterpipe and cigarette tobacco smokers.

CONCLUSION

A high prevalence of WTS was reported among our study sample, and it surpassed the prevalence of cigarette smoking. Interventions to curb the practice of tobacco smoking among Palestinian youth should be tailored differently to WTS and cigarette smoking, be gender-sensitive and specific and target the regional variation in the smoking behavior.

Smoking Habits and Attitudes in Students of the Third Faculty of Medicine of Charles University in Prague

AIM

This study seeks to assess smoking habits, attitudes and intention to quit in students of the Third Faculty of Medicine of Charles University in Prague, Czech Republic.

METHODS

A cross-sectional survey designed to obtain information on smoking history, current smoking status, cessation attempts, and attitudes towards smoking among health professionals was conducted in 452 students of the first and last years of a 6-year Master's Study Programme (General Medicine) and a 3-year Bachelor's Study Programme (Public Health). An anonymous questionnaire was administered during the classes in the course of academic years 2011-12 and 2012-13.

RESULTS

5.7% of the Master's Study Programme students (3.3% women and 9.0% men ) and 4.8% of the Bachelor's Study Programme students reported that they are regular smokers. The share of regular smokers was almost twice as big in students of the English Curriculum of the Master's Programme (10.7%) in comparison with the students of the Czech Curriculum (4.5%), and more than twice as big in students of the last years of both study programmes (3.9% in students of the 1st year and 10.8% in students of the 6th year of the Master's Programme; 3.2% in students of the 1st year and 7.0% in students of the 3rd year of the Bachelor's Study Programme). At the time of the research, 18.9% of students of the Master's Programme and 17.1% of students of the Bachelor's Programme were occasional smokers. 5.9% of students of the Master's Programme and 19.0% of students of the Bachelor's Programme reported that they quit smoking during their studies at the medical faculty; on the contrary, 9.8% of students of the Master's Programme and 14.3% of students of the Bachelor's Programme started smoking during that time.

CONCLUSIONS

Smoking in health professionals undermines their significant role in health promotion and prevention of chronic diseases in their patients. Therefore, education at the medical faculty should focus on motivation of future health professionals towards non-smoking except providing knowledge on current research and guidance on early identification and further intervention in smokers.

Perceptions of Turkish University Students about the Effects of Water Pipe Smoking on Health

BACKGROUND

The popularity of the water pipe, also referred to as hookah, narghile, shisha or hubble-bubble, has increased tremendously during the past few decades. This study was conducted to determine student water pipe smoking status and perceptions about the effects of water pipe smoking on health in a state university in Ankara.

MATERIALS AND METHODS

This cross-sectional study was conducted between September 2014 and January 2015. The data were collected with a questionnaire and "The Scale of Perception about the Effects of Water Pipe Smoking on Health". The data obtained were evaluated in IBM SPSS (version 20.0) statistical package program in computer. One-way analysis of variance (ANOVA) was used for the analyses by checking homogeneity of variances and Student's t-test. Values of p<0.05 were considered statistically significant.

RESULTS

The total mean score obtained by young people who took part in the study was determined as (X_=65.20±1.25, min=33, max=75). Upon comparison of the total mean scores obtained by young people from the Scale of Perception about the effects of water pipe smoking on health and gender variable, the scores obtained by the females students were higher than those of the male students with a statistically significant difference (t=7.525, p<0.05). A statistically significant difference was observed between the total mean scores obtained by young people with cigarette and water pipe smoking status (for each, t=-3.731, p<0.05; t=-13.987, p<0.05).

CONCLUSIONS

In conclusion, university students have wrong knowledge on the dangers of water pipe smoking. There was a high prevalence of using water pipes among university students. Gender significantly affected the perceptions about the effect of water pipe smoking on health in our sample.

Smoking and attitudes toward smoking policy at a University in Egypt

To assess smoking behavior, knowledge of smoking harm, and attitudes toward campus smoking policy at an Egyptian university, an online survey of students, staff, and faculty was conducted (N = 992). The smoking prevalence of 38% among men was in line with Egypt's national average, but the smoking prevalence among women of 20% was much higher than the national average. Smoking status influenced beliefs about smoking harm and attitudes toward smoking policy, with nonsmokers having stronger beliefs about the harm of smoking and showing stronger support for smoking regulations than smokers. Smokers were more knowledgeable about smoking policy than were nonsmokers and differed slightly in their preferences for smoking policy enforcement strategies. These findings contribute to our understanding of how to tailor college smoking policy and programs to an Egyptian context.

Relationships Between Tobacco Abuse and Self-Assessment of Health

Smoking cigarettes negatively influences the functioning of the body. Among other effects, it has an important impact on the respiratory system, circulation, and behavior. It leads to morphological and physiological changes in organs and tissues, so it can change mood. The aim of this study was to assess the relationships between tobacco abuse and self-assessment of health. The survey was conducted among Polish (243) and foreign (80) medical students at the Pomeranian Medical University in Szczecin, Poland. The study was based on a survey questionnaire of the authors' own design, comprising open and multi-choice questions. Our questionnaire was based on the international standard questionnaire from the Health Behavior in School-Aged Children study (Currie et al. 2009). 80 % of students surveyed were free of any chronic diseases. The results showed that only 23 % of the women and 20 % of the men assessed their health as very good, over 60 % as good, and the remaining at lower levels. We did not observe significant differences between smokers and non-smokers. Physical activity in both groups was generally assessed as good or sufficient. We did not observe significant differences between groups in the incidence of headache, abdominal pain, or vertigo. Significant differences were found in the intake of painkillers.