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Khalis M, Tembo JMW, Elmouden L, Hatim A, Bouaddi O, Charaka H, Assarag B, El Badisy I, Lucero-Prisno Iii DE, Soliman AS, Nejjari C. Tobacco Use Among Dental Students in Morocco: Opportunities for Professional Cancer Education. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2023; 38:821-828. [PMID: 35729316 DOI: 10.1007/s13187-022-02191-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 06/10/2022] [Indexed: 06/02/2023]
Abstract
The study aimed to evaluate tobacco use, attitudes, knowledge, and perceptions about tobacco control policies and smoking cessation counseling among dental students in Morocco. This cross-sectional study was conducted at the Dentistry Faculty of the Mohammed VI University of Health Sciences of Casablanca, using the Global Health Professions Student Survey (GHPSS) tool. Participants completed a self-administered survey questionnaire, including information on socio-demographic characteristics, tobacco use, exposure to secondhand smoke, attitudes, behavior and cessation, curriculum, and training. A total of 426 dental students were included in the study. Over 15% of the participants were current smokers, and 31.2% had tried smoking at least once. About 29.3% reported having been exposed to secondhand smoke in family settings and 49.5% in other environments. The majority of the students had felt that health professionals were role models for their patients. However, only 20% had felt they had received formal training in smoking cessation approaches. More than 70% of smokers had tried to quit smoking in the past year; however, only 41.7% reported having received help or advice. It is crucial that education and public health officials join efforts to plan and carry out programs aimed at training dental students in evidence-based cessation counseling methods, in order to change their own smoking behavior and assist their future patients. Improving dental school curriculums with regard to tobacco use prevention and cessation is also a powerful means of alleviating the national burden of cancer.
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Affiliation(s)
- Mohamed Khalis
- International School of Public Health, Mohammed VI University of Health Sciences (UM6SS), Casablanca, Morocco.
| | - Jonathan Muhunga Wa Tembo
- International School of Public Health, Mohammed VI University of Health Sciences (UM6SS), Casablanca, Morocco
| | - Latifa Elmouden
- Faculty of Dentistry, Mohammed VI University of Health Sciences (UM6SS), Casablanca, Morocco
| | - Asmaa Hatim
- Faculty of Dentistry, Mohammed VI University of Health Sciences (UM6SS), Casablanca, Morocco
| | - Oumnia Bouaddi
- International School of Public Health, Mohammed VI University of Health Sciences (UM6SS), Casablanca, Morocco
| | - Hafida Charaka
- Department of Research and Development, Ibn Sina University Hospital, Rabat, Morocco
| | - Bouchra Assarag
- National School of Public Health of Rabat, Ministry of Health, Rabat, Morocco
| | - Imad El Badisy
- International School of Public Health, Mohammed VI University of Health Sciences (UM6SS), Casablanca, Morocco
| | | | - Amr S Soliman
- Department of Community Health and Social Medicine, City University of New York, School of Medicine, New York, NY, USA
| | - Chakib Nejjari
- International School of Public Health, Mohammed VI University of Health Sciences (UM6SS), Casablanca, Morocco
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Cosgrave EJ, Blake M, Murphy E, Sheridan A, Doyle F, Kavanagh P. Is the public ready for a tobacco-free Ireland? A national survey of public knowledge and attitudes to tobacco endgame in Ireland. Tob Control 2023:tc-2023-057958. [PMID: 37236784 DOI: 10.1136/tc-2023-057958] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Accepted: 04/25/2023] [Indexed: 05/28/2023]
Abstract
AIM Ireland will not meet the tobacco endgame goal set in its 2013 Tobacco-Free Ireland (TFI) policy of reducing smoking prevalence to less than 5% by 2025. Public opinion on tobacco endgame, a key lever to realise this goal, is uncharted in Ireland. This study aimed to measure public knowledge and attitudes to tobacco endgame. METHODS A telephone-administered cross-sectional survey of 1000 randomly dialled members of the general public was conducted in 2022. Prevalence of awareness, perceived achievability and support for the TFI goal and tobacco endgame measures was calculated and compared across tobacco product use status. Logistic regression identified factors independently associated with goal support. FINDINGS Although TFI goal awareness was low (34.0%), support was high (74.6%), although most (60.2%) believed it achievable beyond 2025. Product-focused measures were popular while support for supply-focused measures was mixed: for example, 86.1% supported nicotine content reduction while 40.3% supported user licencing. Phasing out tobacco sales was highly supported (82.8%); for most, this was contingent on support for currently addicted users. TFI goal support was independently associated with female sex (adjusted odds ratio (aOR) 1.47, 95% CI 1.05 to 2.07), higher education (aOR 1.80, 95% CI 1.21 to 2.66) and non-tobacco product use (aOR 2.67, 95% CI 1.66 to 4.30). CONCLUSIONS Despite low awareness, tobacco endgame support is strong in Ireland. Public appetite for radically reducing tobacco product appeal and availability combined with public views on endgame achievability subject to extended timelines should be used to re-invigorate tobacco endgame discussion and planning in countries at risk of failing to meet declared targets.
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Affiliation(s)
| | - Martina Blake
- HSE Tobacco-Free Ireland Programme, Health Service Executive, Dublin, Ireland
| | - Edward Murphy
- HSE Tobacco-Free Ireland Programme, Health Service Executive, Dublin, Ireland
| | - Aishling Sheridan
- HSE Tobacco-Free Ireland Programme, Health Service Executive, Dublin, Ireland
| | - Frank Doyle
- Department of Health Psychology, School of Population Health, RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Paul Kavanagh
- HSE Tobacco-Free Ireland Programme, Health Service Executive, Dublin, Ireland
- Department of Public Health and Epidemiology, School of Population Health, RCSI University of Medicine and Health Sciences, Dublin, Ireland
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Boderie NW, Sheikh A, Lo E, Sheikh A, Burdorf A, van Lenthe FJ, Mölenberg FJ, Been JV. Public support for smoke-free policies in outdoor areas and (semi-)private places: a systematic review and meta-analysis. EClinicalMedicine 2023; 59:101982. [PMID: 37256097 PMCID: PMC10225670 DOI: 10.1016/j.eclinm.2023.101982] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Revised: 04/10/2023] [Accepted: 04/12/2023] [Indexed: 06/01/2023] Open
Abstract
Background Smoke-free policies are essential to protect people against tobacco smoke exposure. To successfully implement smoke-free policies that go beyond enclosed public places and workplaces, public support is important. We undertook a comprehensive systematic review of levels and determinants of public support for indoor (semi-)private and outdoor smoke-free policies. Methods In this systematic review and meta-analysis, six electronic databases were searched for studies (published between 1 January 2004 and 19 January 2022) reporting support for (semi-)private and outdoor smoke-free policies in representative samples of at least 400 respondents aged 16 years and above. Two reviewers independently extracted data and assessed risk of bias of individual reports using the Mixed Methods Appraisal Tool. The primary outcome was proportion support for smoke-free policies, grouped according to location covered. Three-level meta-analyses, subgroup analyses and meta-regression were performed. Findings 14,749 records were screened, of which 107 were included; 42 had low risk of bias and 65 were at moderate risk. 99 studies were included in the meta-analyses, reporting 326 measures of support from 896,016 individuals across 33 different countries. Support was pooled for indoor private areas (e.g., private cars, homes: 73%, 95% confidence interval (CI): 66-79), indoor semi-private areas (e.g., multi-unit housing: 70%, 95% CI: 48-86), outdoor hospitality areas (e.g., café and restaurant terraces: 50%, 95% CI: 43-56), outdoor non-hospitality areas (e.g., school grounds, playgrounds, parks, beaches: 69%, 95% CI: 64-73), outdoor semi-private areas (e.g., shared gardens: 67%, 95% CI: 53-79) and outdoor private areas (e.g., private balconies: 41%, 95% CI: 18-69). Subcategories showed highest support for smoke-free cars with children (86%, 95% CI: 81-89), playgrounds (80%, 95% CI: 74-86) and school grounds (76%, 95% CI: 69-83). Non-smokers and ex-smokers were more in favour of smoke-free policies compared to smokers. Support generally increased over time, and following implementation of each smoke-free policy. Interpretation Our findings suggested that public support for novel smoke-free policies is high, especially in places frequented by children. Governments should be reassured about public support for implementation of novel smoke-free policies. Funding Dutch Heart Foundation, Lung Foundation Netherlands, Dutch Cancer Society, Dutch Diabetes Research Foundation and Netherlands Thrombosis Foundation.
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Affiliation(s)
- Nienke W. Boderie
- Department of Public Health, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, Netherlands
| | - Asiyah Sheikh
- Edinburgh Medical School, The University of Edinburgh, Edinburgh, UK
| | - Erika Lo
- Edinburgh Medical School, The University of Edinburgh, Edinburgh, UK
| | - Aziz Sheikh
- Centre for Medical Informatics, Usher Institute, The University of Edinburgh, Edinburgh, UK
| | - Alex Burdorf
- Department of Public Health, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, Netherlands
| | - Frank J. van Lenthe
- Department of Public Health, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, Netherlands
| | - Famke J.M. Mölenberg
- Department of Public Health, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, Netherlands
| | - Jasper V. Been
- Department of Public Health, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, Netherlands
- Division of Neonatology, Department of Neonatal and Paediatric Intensive Care, Erasmus MC Sophia Children’s Hospital, University Medical Centre Rotterdam, Rotterdam, Netherlands
- Department of Obstetrics and Gynaecology, Erasmus MC Sophia Children’s Hospital, University Medical Centre Rotterdam, Rotterdam, Netherlands
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Avishai A, Ribisl KM, Sheeran P. Realizing the Tobacco Endgame: Understanding and mobilizing public support for banning combustible cigarette sales in the United States. Soc Sci Med 2023; 327:115939. [PMID: 37172336 DOI: 10.1016/j.socscimed.2023.115939] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Revised: 03/27/2023] [Accepted: 04/28/2023] [Indexed: 05/14/2023]
Abstract
BACKGROUND There is little research on public support for banning the sale and purchase of combustible cigarettes even though a ban is an essential step towards achieving the endgame for tobacco products. PURPOSE We report the first studies designed to (a) examine predictors of support for a ban (Study 1), and (b) test interventions to increase such support (Studies 2-4). METHODS In Study 1, current, former, and never smokers (N = 479) were randomized to conditions measuring their willingness to ban the sale of cigarettes vs. an unspecified product. Smokers were randomized to a persuasive communication in Study 2 and a paradoxical thinking intervention in Study 3 (Ns = 300 and 302, respectively). In Study 4 (N = 336), we randomized smokers to self-persuasion and issue-framing interventions. RESULTS Whereas nonsmokers were willing to ban the sale of both cigarettes and equivalent products, current and former smokers exempted cigarettes from a ban. Reactance to prohibition and perceived effectiveness predicted willingness to ban cigarette sales in all three smoking status groups (Study 1). Neither persuasive communication nor paradoxical thinking increased support for banning cigarette sales in Studies 2-3. However, self-persuasion and framing the ban as "protecting Americans from avoidable harm" both led to increased support for banning cigarette sales (Study 4). CONCLUSIONS Reactance and doubt about the effectiveness of banning the sale of cigarettes are key barriers to supporting a ban. Self-persuasion and issue framing may be effective means of mobilizing policy support among smokers. The present research offers new insights relevant to promoting the "Tobacco Endgame" and helps specify directions for future research on public support for health policies.
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Affiliation(s)
- Aya Avishai
- Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, Chapel Hill, USA
| | - Kurt M Ribisl
- Department of Health Behavior, Gillings School of Public Health, University of North Carolina at Chapel Hill, Chapel Hill, USA; Lineberger Comprehensive Cancer Center, Chapel Hill, USA
| | - Paschal Sheeran
- Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, Chapel Hill, USA; Lineberger Comprehensive Cancer Center, Chapel Hill, USA.
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Mlinarić M, Kastaun S, Kotz D. Exposure to Tobacco Smoking in Vehicles, Indoor, and Outdoor Settings in Germany: Prevalence and Associated Factors. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:4051. [PMID: 35409733 PMCID: PMC8998599 DOI: 10.3390/ijerph19074051] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Revised: 03/12/2022] [Accepted: 03/23/2022] [Indexed: 11/16/2022]
Abstract
Little is known on whether secondhand smoke (SHS) exposure in vehicles, indoor, and outdoor settings is similarly patterned in terms of different socio-epidemiological indicators in Germany. This study aims to estimate the current national-level prevalence and associated socio-epidemiological indicators of SHS exposure in vehicles, indoor, and outdoor settings in the German population, using current data from a representative household survey. We used cross-sectional data (N = 3928 respondents aged 14-99 years) from two waves of the DEBRA survey (German Study on Tobacco Use), conducted between January and March 2020. The reported prevalence of SHS exposure during the last seven days was 19% in vehicles, 25% in indoor settings, and 43% in outdoor settings. We found that younger age and current smoking were consistently associated with higher SHS exposure. Furthermore, people with low education were more likely to be exposed to SHS in vehicles and indoor settings than people with high education. This study found that the prevalence of SHS exposure in vehicles, indoor, and outdoor settings is a relevant feature of everyday life in Germany, especially for younger people and people with lower education, leading to potentially persistent socioeconomic and tobacco-attributable inequalities in morbidity and mortality.
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Affiliation(s)
- Martin Mlinarić
- Medical Faculty, Institute of Medical Sociology (IMS), Martin Luther University Halle-Wittenberg, 06112 Halle (Saale), Germany
- Institute of Applied Marketing and Communication Studies (IMK), 99084 Erfurt, Germany
| | - Sabrina Kastaun
- Institute of General Practice, Addiction Research and Clinical Epidemiology Unit, Centre for Health and Society, Medical Faculty of the Heinrich-Heine-University Düsseldorf, 40225 Düsseldorf, Germany
| | - Daniel Kotz
- Institute of General Practice, Addiction Research and Clinical Epidemiology Unit, Centre for Health and Society, Medical Faculty of the Heinrich-Heine-University Düsseldorf, 40225 Düsseldorf, Germany
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6
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Siddiqi K, Siddiqui F, Boeckmann M, Islam Z, Khan A, Dobbie F, Khan Z, Kanaan M. Attitudes of smokers towards tobacco control policies: findings from the Studying Tobacco users of Pakistan (STOP) survey. Tob Control 2022; 31:112-116. [PMID: 33318127 DOI: 10.1136/tobaccocontrol-2020-055995] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Revised: 10/22/2020] [Accepted: 10/30/2020] [Indexed: 11/04/2022]
Abstract
BACKGROUND Public attitude is a political driver in successful implementation of tobacco control policies. We assessed support for a range of tobacco control policies among smokers in Pakistan. METHODS We conducted a household survey among adult smokers in 10 cities of Pakistan, using a two-stage random sampling strategy to select households and Kish grid method to select one smoker per household. Attitudes were measured using a five-point ordinal scale on four policy statements: a complete ban on tobacco sale within 10 years; raising the legal age to buy tobacco from 18 to 21; increasing tobacco taxes to fund healthcare and a ban on smoking in cars with minors. RESULTS 6014 participants were interviewed between September 2019 and March 2020. Most participants demonstrated strong support for all policy statements: a ban on smoking in cars with minors (86.5%); a complete ban on tobacco sale within 10 years (82.1%); raising the legal age to buy tobacco (77.9%) and increasing tobacco taxes (68.1%). Smokers' support for tobacco control policies increased with age but decreased with higher educational attainment and heaviness of smoking. CONCLUSIONS There is strong support among smokers in Pakistan to strengthen tobacco control. Given this, policy-makers should strongly consider strengthening existing national policies on tobacco control.
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Affiliation(s)
- Kamran Siddiqi
- Department of Health Sciences, University of York, UK, York, North Yorkshire, UK
- Hull York Medical School, York, UK
| | - Faraz Siddiqui
- Department of Health Sciences, University of York, UK, York, North Yorkshire, UK
| | - Melanie Boeckmann
- School of Public Health, University of Bielefeld-Germany, Bielefeld, Germany
| | - Ziauddin Islam
- Tobacco Control Cell, Pakistan Ministry of National Health Services Regulations and Coordination, Islamabad, Islamabad, Pakistan
| | | | - Fiona Dobbie
- Usher Institute, University of Edinburgh, University of Stirling, Edinburgh, UK
| | - Zohaib Khan
- Office of Research Innovation and Commercialisation, Khyber Medical University, Peshawar, Pakistan
| | - Mona Kanaan
- Department of Health Sciences, University of York, UK, York, North Yorkshire, UK
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Feng GC, Zhu S, Zhao X. Antecedents and Consequences of Smoking Cessation Intention in the Context of the Global COVID-19 Infodemic. Front Public Health 2021; 9:684683. [PMID: 34497791 PMCID: PMC8419308 DOI: 10.3389/fpubh.2021.684683] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Accepted: 07/12/2021] [Indexed: 11/18/2022] Open
Abstract
A growing body of scientific studies has been published to inform responses to the ongoing coronavirus pandemic, and some have claimed that cigarette smoking has a beneficial or mixed effect on the prevention and treatment of COVID-19. The presentation of such findings, unfortunately, has created an infodemic. This study integrated the theory of planned behavior and the health belief model and incorporated findings on addiction from the medical literature to predict cessation intention and support for tobacco control measures in the context of the COVID-19 infodemic. The study found that cessation intention partially mediated the effect of perceived severity and fully mediated the effects of perceived benefits, self-efficacy, and addiction on support for control measures. In addition, a positively-valenced message of the effect of smoking on the prevention and treatment of COVID-19 vs. a mixedly-valenced message was significant in predicting cessation intention, and the positively-valenced message of smoking indirectly predicted support for tobacco control measures. Perceived susceptibility, barriers, and subjective norms, however, exerted neither direct nor indirect effects on the two outcome variables.
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Affiliation(s)
| | - Shan Zhu
- College of Communication, Shenzhen University, Shenzhen, China
| | - Xinshu Zhao
- Department of Communication, University of Macau, Macau, China
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Polus S, Burns J, Hoffmann S, Mathes T, Mansmann U, Been JV, Lack N, Koller D, Maier W, Rehfuess EA. Interrupted time series study found mixed effects of the impact of the Bavarian smoke-free legislation on pregnancy outcomes. Sci Rep 2021; 11:4209. [PMID: 33603103 PMCID: PMC7892567 DOI: 10.1038/s41598-021-83774-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Accepted: 02/01/2021] [Indexed: 11/20/2022] Open
Abstract
In 2007 the German government passed smoke-free legislation, leaving the details of implementation to the individual federal states. In January 2008 Bavaria implemented one of the strictest laws in Germany. We investigated its impact on pregnancy outcomes and applied an interrupted time series (ITS) study design to assess any changes in preterm birth, small for gestational age (primary outcomes), and low birth weight, stillbirth and very preterm birth. We included 1,236,992 singleton births, comprising 83,691 preterm births and 112,143 small for gestational age newborns. For most outcomes we observed unclear effects. For very preterm births, we found an immediate drop of 10.4% (95%CI - 15.8, - 4.6%; p = 0.0006) and a gradual decrease of 0.5% (95%CI - 0.7, - 0.2%, p = 0.0010) after implementation of the legislation. The majority of subgroup and sensitivity analyses confirm these results. Although we found no statistically significant effect of the Bavarian smoke-free legislation on most pregnancy outcomes, a substantial decrease in very preterm births was observed. We cannot rule out that despite our rigorous methods and robustness checks, design-inherent limitations of the ITS study as well as country-specific factors, such as the ambivalent German policy context have influenced our estimation of the effects of the legislation.
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Affiliation(s)
- Stephanie Polus
- Institute for Medical Information Processing, Biometry, and Epidemiology - IBE, LMU Munich, Munich, Germany.
- Pettenkofer School of Public Health, Munich, Germany.
| | - Jacob Burns
- Institute for Medical Information Processing, Biometry, and Epidemiology - IBE, LMU Munich, Munich, Germany
- Pettenkofer School of Public Health, Munich, Germany
| | - Sabine Hoffmann
- Institute for Medical Information Processing, Biometry, and Epidemiology - IBE, LMU Munich, Munich, Germany
- Pettenkofer School of Public Health, Munich, Germany
| | - Tim Mathes
- Institute for Research in Operative Medicine, Faculty of Health, School of Medicine, Witten/Herdecke University, Cologne, Germany
| | - Ulrich Mansmann
- Institute for Medical Information Processing, Biometry, and Epidemiology - IBE, LMU Munich, Munich, Germany
- Pettenkofer School of Public Health, Munich, Germany
| | - Jasper V Been
- Division of Neonatology, Department of Paediatrics, Department of Obstetrics and Gynaecology, Department of Public Health, Erasmus MC - Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Nicholas Lack
- German Bavarian Quality Assurance Institute for Medical Care, Munich, Germany
| | - Daniela Koller
- Institute for Medical Information Processing, Biometry, and Epidemiology - IBE, LMU Munich, Munich, Germany
- Pettenkofer School of Public Health, Munich, Germany
| | - Werner Maier
- Institute of Health Economics and Health Care Management, Helmholtz Zentrum München - German Research Center for Environmental Health (GmbH), Neuherberg, Germany
| | - Eva A Rehfuess
- Institute for Medical Information Processing, Biometry, and Epidemiology - IBE, LMU Munich, Munich, Germany
- Pettenkofer School of Public Health, Munich, Germany
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Oral Health Attitudes among Preclinical and Clinical Dental Students in Germany. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17124253. [PMID: 32549206 PMCID: PMC7344414 DOI: 10.3390/ijerph17124253] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/17/2020] [Revised: 06/04/2020] [Accepted: 06/09/2020] [Indexed: 12/21/2022]
Abstract
Oral health care providers are expected to show good examples of oral health behaviours and attitudes to their community. Previous studies displayed the constructive effect of dental education on oral hygiene manners of undergraduate students. The aim of this survey was to assess and compare aspects of oral health attitudes and behaviours between preclinical and clinical dental students in German universities. The German-language version of the HU-DBI was distributed to preclinical and clinical students from different German universities. Dichotomized (agree/disagree) responses to 20 HU-DBI items were provided in this study, with a maximum possible score of 19. A quantitative estimate of oral health attitudes and behaviours was provided by the total of appropriate answers given to every statement by each group. Data were analysed statistically. The overall mean score of answers favouring good oral hygiene was marginally higher in preclinical (14.62) than clinical students (14.31) but showed no statistical significance. Similarly, the analysis of each item individually displayed no statistically significant differences between preclinical and clinical participants, except in a single item of the survey. This study showed no effective differences in oral hygiene attitudes and behaviour between preclinical and clinical students in German universities. This reveals a weak effect of dental education on improving students' oral health attitudes in Germany and might demand the introduction of more courses emphasizing the importance of correct oral health behaviour of health care providers.
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10
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Nuyts PAW, Kuipers MAG, Willemsen MC, Kunst AE. An Increase in the Tobacco Age-of-Sale to 21: For Debate in Europe. Nicotine Tob Res 2020; 22:1247-1249. [PMID: 31408159 PMCID: PMC7291794 DOI: 10.1093/ntr/ntz135] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2019] [Accepted: 07/30/2019] [Indexed: 11/24/2022]
Abstract
A debate on the adoption of a tobacco age-of-sale of 21 in Europe has not occurred, with the recent exception of the United Kingdom. The current legally set age of 18 years is proving to be inadequate as adolescents continue to access cigarettes. Tobacco 21 laws have the potential to further limit access to cigarettes by minors. We believe that soon the time will be ripe for this discussion to spread throughout Europe, specifically among countries that have adopted a smoke-free generation movement.
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Affiliation(s)
- Paulien A W Nuyts
- Department of Public Health, University of Amsterdam, Amsterdam UMC, Amsterdam, The Netherlands
| | - Mirte A G Kuipers
- Department of Public Health, University of Amsterdam, Amsterdam UMC, Amsterdam, The Netherlands
| | - Marc C Willemsen
- Department of Health Promotion, CAPHRI School for Public Health and Primary Care, Maastricht University, Maastricht, The Netherlands
- Netherlands Expertise Center for Tobacco Control (NET), Trimbos Institute, Utrecht, The Netherlands
| | - Anton E Kunst
- Department of Public Health, University of Amsterdam, Amsterdam UMC, Amsterdam, The Netherlands
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11
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Mlinarić M, Schreuders M, Mons U, Kunst AE. Exposure to car smoking among youth in seven cities across the European Union. Drug Alcohol Depend 2019; 204:107561. [PMID: 31563096 DOI: 10.1016/j.drugalcdep.2019.107561] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2019] [Revised: 08/06/2019] [Accepted: 08/12/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND In the United States and Canada, cars were found to be a major source of harmful secondhand smoke (SHS) exposure among youth. Little is known about the magnitude of this public health problem in European countries. We study SHS exposure in vehicles among adolescents across seven cities of the European Union (EU), with a particular focus on socioeconomic characteristics and smoking in adolescents' social environment. METHODS Self-reported survey data on SHS exposure in cars during the past seven days was obtained from the 2016/17 cross-sectional SILNE-R study for 14- to 17 year old adolescents in seven EU cities (N = 10,481). We applied two multivariable logistic regression models with sociodemographic characteristics and mediating smoking-related factors. RESULTS SHS exposure in cars varied widely across the seven EU cities: 6% in Tampere (Finland), 12% in Dublin (Ireland), 15% in Amersfoort (the Netherlands), 19% in Hanover (Germany), 23% in Coimbra (Portugal), 36% in Namur (Belgium) and 43% in Latina (Italy). Low paternal (OR 1.65, CI95% 1.38-1.98) and maternal (OR 1.40, CI95% 1.16-1.68) educational levels and parental migration (OR 1.37, CI95% 1.14-1.64) backgrounds were correlated with SHS exposure in cars. Other correlates were one's own or peer smoking and environmental family factors, such as having at least one parental smoker (OR 4.04, CI95% 3.49-4.68) and partial smoking bans at home. CONCLUSIONS In most of these seven cities, a considerable proportion of youth riding in cars, particularly those from disadvantaged and smoking-permissive backgrounds, is exposed to SHS in cars.
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Affiliation(s)
- Martin Mlinarić
- Institute of Medical Sociology, Medical Faculty, Martin Luther University Halle-Wittenberg, Magdeburger Str. 8, 06112, Halle (Saale), Germany.
| | - Michael Schreuders
- Department of Public Health, Amsterdam UMC, University of Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, the Netherlands
| | - Ute Mons
- Cancer Prevention Unit, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Anton E Kunst
- Department of Public Health, Amsterdam UMC, University of Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, the Netherlands
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12
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Kastaun S, Kotz D, Brown J, Shahab L, Boeckmann M. Public attitudes towards healthcare policies promoting tobacco cessation in Germany: results from the representative German study on tobacco use (DEBRA study). BMJ Open 2019; 9:e026245. [PMID: 31462463 PMCID: PMC6720139 DOI: 10.1136/bmjopen-2018-026245] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2018] [Revised: 04/23/2019] [Accepted: 08/01/2019] [Indexed: 12/23/2022] Open
Abstract
OBJECTIVE The aim of this study was to assess public acceptance of four possible healthcare policies supporting tobacco dependence treatment in line with the Framework Convention for Tobacco Control, Article 14 recommendations in Germany. DESIGN Cross-sectional household survey. SETTING Data were drawn from the German population and collected through computer-assisted, face-to-face interviews. PARTICIPANTS Representative random sample of 2087 people (>14 years) from the German population. OUTCOME MEASURES Public acceptance was measured regarding (1) treatment cost reimbursement, (2) standard training for health professionals on offering cessation treatment, and making cessation treatment a standard part of care for smokers with (3) physical or (4) mental disorders. Association characteristics with smoking status and socio-economic status (SES) were assessed. RESULTS Support for all policies was high (50%-68%), even among smokers (48%-66%). Ex-smokers and never-smokers were more likely to support standard training on cessation for health professionals than current smokers (OR 1.43, 95% CI 1.07 to 1.92; OR 1.43; 95% CI 1.14 to 1.79, respectively). Ex-smokers were also more likely than current smokers to support cessation treatment for smokers with mental disorders (OR 1.39, 95% CI 1.11 to 1.73). Men were less likely than women to support cessation treatment for smokers with physical diseases (OR 0.74, 95% CI 0.60 to 0.91) and free provision of treatment (OR 0.80, 95% CI 0.66 to 0.97). Offering cessation treatment to smokers with physical disorders was generally more accepted than to those with mental health issues. CONCLUSIONS The majority of the German population supports healthcare policies to improve the availability and affordability of tobacco dependence treatment. Non-smokers were more supportive than current smokers of two of the four policies, but odds of support were only about 40% higher. SES characteristics were not consistently associated with public acceptance. TRIAL REGISTRATION NUMBER DRKS00011322.
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Affiliation(s)
- Sabrina Kastaun
- Institute of General Practice, Addiction Research and Clinical Epidemiology Unit, Heinrich-Heine-University, Düsseldorf, Düsseldorf, Germany
| | - Daniel Kotz
- Institute of General Practice, Addiction Research and Clinical Epidemiology Unit, Heinrich-Heine-University, Düsseldorf, Düsseldorf, Germany
- Department of Behavioural Science and Health, University College London, London, UK
| | - Jamie Brown
- Department of Behavioural Science and Health, University College London, London, UK
| | - Lion Shahab
- Department of Behavioural Science and Health, University College London, London, UK
| | - Melanie Boeckmann
- Institute of General Practice, Addiction Research and Clinical Epidemiology Unit, Heinrich-Heine-University, Düsseldorf, Düsseldorf, Germany
- Department of Environment and Health, School of Public Health, Bielefeld University, Bielefeld, Germany
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13
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Jankowski M, Krzystanek M, Zejda JE, Majek P, Lubanski J, Lawson JA, Brozek G. E-Cigarettes are More Addictive than Traditional Cigarettes-A Study in Highly Educated Young People. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16132279. [PMID: 31252671 PMCID: PMC6651627 DOI: 10.3390/ijerph16132279] [Citation(s) in RCA: 85] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/13/2019] [Revised: 06/19/2019] [Accepted: 06/24/2019] [Indexed: 11/16/2022]
Abstract
E-cigarettes are often considered less addictive than traditional cigarettes. This study aimed to assess patterns of e-cigarette use and to compare nicotine dependence among cigarette and e-cigarette users in a group of highly educated young adults. From 3002 healthy adults, a representative group of 30 cigarette smokers, 30 exclusive e-cigarette users, and 30 dual users were recruited. A 25-item questionnaire was used to collect information related to the patterns and attitudes towards the use of cigarettes and e-cigarettes. The Fagerström test for nicotine dependence (FTND) and its adapted version for e-cigarettes were used to analyze nicotine dependence in each of the groups. The nicotine dependence levels measured with FTND were over two times higher among e-cigarette users (mean 3.5) compared to traditional tobacco smokers (mean 1.6; p<0.001). Similarly, among dual users, nicotine dependence levels were higher when using an e-cigarette (mean 4.7) compared to using traditional cigarettes (mean 3.2; p=0.03). Habits and behaviors associated with the use of e-cigarettes did not differ significantly (p>0.05) between exclusive e-cigarette users and dual users. The findings suggest that e-cigarettes may have a higher addictive potential than smoked cigarettes among young adults.
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Affiliation(s)
- Mateusz Jankowski
- Department of Epidemiology, School of Medicine in Katowice, Medical University of Silesia in Katowice, Medykow 18 Str, 40-752 Katowice, Poland.
| | - Marek Krzystanek
- Department of Psychiatric Rehabilitation, Department of Psychiatry and Psychotherapy, School of Medicine in Katowice, Medical University of Silesia in Katowice, Ziolowa 45/47 Str, 40-635 Katowice, Poland
| | - Jan Eugeniusz Zejda
- Department of Epidemiology, School of Medicine in Katowice, Medical University of Silesia in Katowice, Medykow 18 Str, 40-752 Katowice, Poland
| | - Paulina Majek
- Department of Epidemiology, School of Medicine in Katowice, Medical University of Silesia in Katowice, Medykow 18 Str, 40-752 Katowice, Poland
| | - Jakub Lubanski
- Department of Epidemiology, School of Medicine in Katowice, Medical University of Silesia in Katowice, Medykow 18 Str, 40-752 Katowice, Poland
| | - Joshua Allan Lawson
- Canadian Centre for Health and Safety in Agriculture, College of Medicine, University of Saskatchewan, 104 Clinic Place, P.O. Box 23, Saskatoon, SK S7N 2Z4, Canada
- Department of Medicine, College of Medicine, University of Saskatchewan, 103 Hospital Drive, Saskatoon, SK S7N 0W8, Canada
| | - Grzegorz Brozek
- Department of Epidemiology, School of Medicine in Katowice, Medical University of Silesia in Katowice, Medykow 18 Str, 40-752 Katowice, Poland
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14
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Weinmann T, Radon K, Sukalla F, Gerlich J, Barth S, Nowak D, Karnowski V. Developing an Awareness Campaign to Reduce Second Hand Smoke Among Disadvantaged Families-A Participatory M-Health Approach. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:ijerph15091945. [PMID: 30200621 PMCID: PMC6164457 DOI: 10.3390/ijerph15091945] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/14/2018] [Revised: 09/03/2018] [Accepted: 09/05/2018] [Indexed: 12/22/2022]
Abstract
Children from disadvantaged families are particularly exposed to second hand smoke in their home environment. Using a mixed methods participatory approach, we aimed at identifying suitable media channels and appropriate content for a campaign increasing caregivers' knowledge about the risks of second hand smoke (SHS) exposure for their children and appropriate measures for exposure reduction. In the first phase of the mixed method design, we evaluated knowledge and norms about children's SHS and perceived barriers for avoiding it. To this end, we conducted 26 one-to-one interviews with smoking caregivers of children below the age of six years. Subsequently, we developed and illustrated core messages and identified appropriate communication channels. These were evaluated in focus group discussions by 20 of the 26 interview participants. After a final revision, 121 caregivers evaluated the campaign via an online questionnaire. Online social networks were identified as the most suitable media channel. For these, we developed animated photos with voiceovers addressing the potential consequences of SHS for children. The overall rating of the campaign messages was promising. Participants confirmed that it was important to address the issue in social media. However, sharing the pictures was considered unlikely due to the sensitive topic of the campaign, while the importance of doctors or scientists being recognizable as a source was highlighted. Employing a participatory approach, we developed an m-health campaign, which can now be disseminated in social networks to reach the target population. The effectiveness of the campaign should be evaluated.
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Affiliation(s)
- Tobias Weinmann
- Institute and Clinic for Occupational, Social and Environmental Medicine, University Hospital, LMU Munich, Ziemssenstr. 1, 80336 Munich, Germany.
- Munich Center of Health Sciences (MC-Health), LMU Munich, Ludwigstr. 28, 80539 Munich, Germany.
- Comprehensive Pneumology Center Munich (CPC-M), Deutsches Zentrum für Lungenforschung (DZL), Max-Lebsche-Platz 31, 81377 Munich, Germany.
| | - Katja Radon
- Institute and Clinic for Occupational, Social and Environmental Medicine, University Hospital, LMU Munich, Ziemssenstr. 1, 80336 Munich, Germany.
- Munich Center of Health Sciences (MC-Health), LMU Munich, Ludwigstr. 28, 80539 Munich, Germany.
- Comprehensive Pneumology Center Munich (CPC-M), Deutsches Zentrum für Lungenforschung (DZL), Max-Lebsche-Platz 31, 81377 Munich, Germany.
| | - Freya Sukalla
- Munich Center of Health Sciences (MC-Health), LMU Munich, Ludwigstr. 28, 80539 Munich, Germany.
- Department of Communication Studies and Media Research, LMU Munich, Oettingenstr. 67, 80538 Munich, Germany.
- Institute of Communication and Media Studies, University of Leipzig, Burgstr. 21, 04109 Leipzig, Germany.
| | - Jessica Gerlich
- Institute and Clinic for Occupational, Social and Environmental Medicine, University Hospital, LMU Munich, Ziemssenstr. 1, 80336 Munich, Germany.
- Munich Center of Health Sciences (MC-Health), LMU Munich, Ludwigstr. 28, 80539 Munich, Germany.
- Comprehensive Pneumology Center Munich (CPC-M), Deutsches Zentrum für Lungenforschung (DZL), Max-Lebsche-Platz 31, 81377 Munich, Germany.
| | - Swaantje Barth
- Institute and Clinic for Occupational, Social and Environmental Medicine, University Hospital, LMU Munich, Ziemssenstr. 1, 80336 Munich, Germany.
- Munich Center of Health Sciences (MC-Health), LMU Munich, Ludwigstr. 28, 80539 Munich, Germany.
- Comprehensive Pneumology Center Munich (CPC-M), Deutsches Zentrum für Lungenforschung (DZL), Max-Lebsche-Platz 31, 81377 Munich, Germany.
| | - Dennis Nowak
- Institute and Clinic for Occupational, Social and Environmental Medicine, University Hospital, LMU Munich, Ziemssenstr. 1, 80336 Munich, Germany.
- Munich Center of Health Sciences (MC-Health), LMU Munich, Ludwigstr. 28, 80539 Munich, Germany.
- Comprehensive Pneumology Center Munich (CPC-M), Deutsches Zentrum für Lungenforschung (DZL), Max-Lebsche-Platz 31, 81377 Munich, Germany.
| | - Veronika Karnowski
- Munich Center of Health Sciences (MC-Health), LMU Munich, Ludwigstr. 28, 80539 Munich, Germany.
- Department of Communication Studies and Media Research, LMU Munich, Oettingenstr. 67, 80538 Munich, Germany.
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