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Sharma N, Nazar GP, Chugh A, Chopra M, Mdege ND, John RM, Arora M, Karan A. Socio-Economic Status Differences in Changing Affordability of Tobacco Products from 2011-2012 to 2018-2019 in India. Nicotine Tob Res 2023; 25:709-717. [PMID: 36194171 PMCID: PMC10032189 DOI: 10.1093/ntr/ntac230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2022] [Revised: 09/19/2022] [Accepted: 10/03/2022] [Indexed: 11/14/2022]
Abstract
INTRODUCTION We studied the change in affordability of tobacco products, an important determinant of tobacco use, across the different socio-economic status (SES) in India. AIMS AND METHODS We calculated affordability in the form of relative income price (RIP-cost of tobacco products relative to income) for the years 2011-2012 and 2018-2019 using three different denominators, that is per capita gross domestic product (GDP) and net state domestic product at national and state levels, respectively; monthly per capita consumer expenditure (MPCE); and individual wages. We investigated RIP for cigarettes, bidis, and smokeless tobacco (SLT) across different SES groups (caste groups, type of employment, and education). RESULTS RIP increased marginally for cigarettes, bidis and remained almost constant for SLT across casual workers. However, when RIP was adjusted with SES variables, there was no significant change (p > .05) in the affordability of products for casual workers in the year 2018-2019 as compared to 2011-2012. For regular workers, cigarettes and bidis became marginally less affordable (β < 1), whereas affordability remained constant for SLT. All products became more affordable for backward caste groups within regular workers. When RIP was calculated using MPCE all tobacco products became less affordable in the year 2018-2019. However, after adjusting for SES variables SLT reported no change in affordability. There was a marginal increase in affordability for all products when RIP was calculated with GDP. CONCLUSIONS Although implementation of GST has increased the price of tobacco products, it is still not sufficient to reduce the affordability of tobacco products, particularly SLT and especially for the lower SES group. IMPLICATIONS Tobacco use and economic disadvantage conditions of the population are intricately linked. Affordability of tobacco products is influenced by socio-economic indicators like age, sex, income, education, etc. The literature measuring the affordability of tobacco products across different SES groups is scant in India. Additionally, existing literature measures affordability of tobacco products based on per capita GDP as a proxy for income. This is the first study in Indian context to report the change in affordability of tobacco products across different SES groups after adjusting for SES indicators, using individual-level income data. We have calculated the change in affordability of tobacco products between the year 2011-2012 and 2018-2019 using GDP, household income, and individual wages as a proxy for income.
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Affiliation(s)
| | | | | | | | - Noreen D Mdege
- Department of Health Sciences, University of York, York, UK
- Centre for Research in Health and Development, York, UK
| | - Rijo M John
- Rajagiri College of Social Sciences, Kochi, Kerala, India
| | - Monika Arora
- HRIDAY, New Delhi, India
- Public Health Foundation of India, Gurugram, India
| | - Anup Karan
- Public Health Foundation of India, Gurugram, India
- Indian Institute of Public Health, Delhi, India
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Argefa TG, Carnegie T, Kassa SA, Kitonyo-Devotsu R, Mdege ND. Tobacco advertising, promotion, and sponsorship (TAPS) in Ethiopia: a scoping review and narrative synthesis. Journal of Global Health Reports 2023. [DOI: 10.29392/001c.57372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
Background Tobacco advertising, promotion and sponsorship (TAPS) has been shown to increase tobacco use in both adults and young people. In Ethiopia, TAPS is recognised as a top priority for the government, and all tobacco advertising, promotion, and sponsorship forms are prohibited. There is recognition that there are gaps in the evidence needed to inform policy and practice on TAPS, but the extent and nature of these gaps have not been explored. This review was aimed at understanding the extent and nature of the evidence gaps on TAPS in Ethiopia and identifying primary research priorities to inform future research direction. Methods Systematic searches were conducted in February 2022 in the following research databases: Medline, EMBASE, and PsycInfo. Two reviewers independently screened the study reports for eligibility and extracted data from the eligible studies. The extracted data was collated and summarised descriptively and policy, practice, and research recommendations were drawn. Research topics on TAPS in Ethiopia that stakeholders perceived to be priorities for primary research were identified through a consultation workshop. Results 579 research reports were identified, and only six studies were included in the scoping review. The included studies explored the following topics: the use of tobacco imagery in movies/films (two studies); the association between mass media exposure or home internet access and tobacco use (two studies), watching of televised football and tobacco smoking in adolescents (one study), exposure to point-of-sale advertising of tobacco products and daily occurrence of smoking or second-hand smoke exposure in the home among women (one study), and exposure to anti-smoking messages through mass media and disparities in risk perceptions across socio-economic and urban-rural subgroups (one study). None of the included studies investigated tobacco-related sponsorship. The top research priority topics identified by stakeholders in Ethiopia were: 1) barriers and facilitators to TAPS policy implementation, enforcement, and compliance monitoring; and 2) developing and testing effective, low-cost, and scalable strategies for TAPS enforcement and compliance monitoring. Conclusions There is a need for research evidence to inform policy and practice on TAPS in Ethiopia, particularly on barriers and facilitators to TAPS policy implementation, enforcement, compliance monitoring, and effective, low-cost, and scalable strategies for TAPS enforcement and compliance monitoring.
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Affiliation(s)
- Terefe G. Argefa
- ICAP at Columbia University Mailman School of Public Health, Addis Ababa, Ethiopia
- Development Gateway: an IREX Venture, Washington, DC, United States
| | - Tyryn Carnegie
- Development Gateway: an IREX Venture, Washington, DC, United States
| | - Selam A. Kassa
- Development Gateway: an IREX Venture, Washington, DC, United States
| | | | - Noreen D. Mdege
- Development Gateway: an IREX Venture, Washington, DC, United States
- Department of Health Sciences, University of York, York, United Kingdom
- Centre for Research in Health and Development, Amos Drive, York, United Kingdom
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Nayak R, Kamath A, Li J, Kulkarni MM, Kamath VG, Kumar P, Naik A, Parrott S, Mdege ND. The association between the retail price of manufactured cigarettes and bidis on current smoking status in India. Tob Induc Dis 2022; 20:43. [PMID: 35600725 PMCID: PMC9074849 DOI: 10.18332/tid/146904] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2021] [Revised: 01/27/2022] [Accepted: 02/23/2022] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION In India, the retail prices of bidis and cigarettes varied between the two Global Adult Tobacco Surveys (GATS) conducted in 2009-2010 and 2016-2017. The relationship between the retail price of smoked tobacco products and their use is unclear for India. Our study thus aimed to use available datasets to investigate the association between the retail price and current smoking status of bidis and cigarettes in India. METHODS Current smoking status data for bidis and cigarettes were obtained from the two GATS rounds. The average state-level retail prices of bidis and cigarettes were obtained from India's Consumer Price Index- Industrial Workers database. Descriptive statistics were used to describe current smoking status patterns. Generalized Linear Mixed Models were used to investigate the association between the retail prices and current smoking status of bidis and cigarettes. RESULTS For cigarettes, an increase in the average retail price by one Indian Rupee was associated with a reduction in the odds of being a current smoker of 7% (OR=0.925; 95% CI: 0.918-0.932, p<0.001). For bidis, the association between the retail price and current smoking status was not statistically significant (OR=1.01; 95% CI: 1.00-1.02, p=0.082). CONCLUSIONS Current increases in the retail prices of tobacco products in India seem to have an impact on the use of cigarettes but not bidis. This highlights the need for tobacco product tax increases that result in sufficient retail prices increase to make all tobacco products less affordable and reduce their use.
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Affiliation(s)
- Radhika Nayak
- Department of Community Medicine, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, India
| | - Asha Kamath
- Department of Data Science, Prasanna School of Public Health, Manipal Academy of Higher Education, Manipal, India
| | - Jinshuo Li
- Department of Health Sciences, University of York, York, United Kingdom
| | - Muralidhar M. Kulkarni
- Department of Community Medicine, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, India
| | - Veena G. Kamath
- Department of Community Medicine, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, India
| | - Praveen Kumar
- Department of Commerce, Manipal Academy of Higher Education, Manipal, India
| | - Ashwath Naik
- Department of Community Medicine, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, India
| | - Steve Parrott
- Department of Health Sciences, University of York, York, United Kingdom
| | - Noreen D. Mdege
- Department of Health Sciences, University of York, York, United Kingdom
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Louwagie GM, Morojele N, Siddiqi K, Mdege ND, Tumbo J, Omole O, Pitso L, Bachmann MO, Ayo-Yusuf OA. Corrigendum to: Addressing tobacco smoking and drinking to improve TB treatment outcomes, in South Africa: a feasibility study of the ProLife program. Transl Behav Med 2022; 12:721. [DOI: 10.1093/tbm/ibac002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Alcohol and tobacco use may lead to negative treatment outcomes in tuberculosis (TB) patients, and even more so if they are HIV-infected. We developed and tested the feasibility of a complex behavioral intervention (ProLife) delivered by lay health workers (LHWs) to improve treatment outcomes in TB patients who smoke tobacco and/or drink alcohol, at nine clinics in South Africa. The intervention comprised three brief motivational interviewing (MI) sessions augmented with a short message service (SMS) program, targeting as appropriate: tobacco smoking, harmful or hazardous drinking and medication adherence. Patients received SMSs twice a week. We measured recruitment and retention rates and assessed fidelity to the MI technique (MI Treatment Integrity 4.1 tool). Finally, we explored LHWs’ and patients’ experiences through interviews and semistructured questionnaires, respectively. We screened 137 TB patients and identified 14 smokers, 13 alcohol drinkers, and 18 patients with both behaviors. Participants’ mean age was 39.8 years, and 82.2% were men. The fidelity assessments pointed to the LHWs’ successful application of key MI skills, but failure to reach MI competency thresholds. Nevertheless, most patients rated the MI sessions as helpful, ascribed positive attributes to their counselors, and reported behavioral changes. SMSs were perceived as reinforcing but difficult language and technical delivery problems were identified as problems. The LHWs’ interview responses suggested that they (a) grasped the basic MI spirit but failed to understand specific MI techniques due to insufficient training practice; (b) perceived ProLife as having benefitted the patients (as well as themselves); (c) viewed the SMSs favorably; but (d) considered limited space and privacy at the clinics as key challenges. The ProLife program targeting multiple risk behaviors in TB patients is acceptable but LHW training protocol, and changes in wording and delivery of SMS are necessary to improve the intervention.
Trial registration: ISRCTN14213432
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Affiliation(s)
- Goedele M Louwagie
- School of Health Systems and Public Health, University of Pretoria, Pretoria, South Africa
- Research, Postgraduate Studies and Innovation, Sefako Makgatho Health Sciences University, Pretoria, South Africa
| | - Neo Morojele
- Alcohol, Tobacco and Other Drug Research Unit, Medical Research Council, Pretoria, South Africa
| | - Kamran Siddiqi
- Department of Health Sciences, University of York, York, UK
| | - Noreen D Mdege
- Department of Health Sciences, University of York, York, UK
| | - John Tumbo
- Research, Postgraduate Studies and Innovation, Sefako Makgatho Health Sciences University, Pretoria, South Africa
| | - Olu Omole
- Department of Family Medicine, University of Witwatersrand, Johannesburg, South Africa
| | - Lerato Pitso
- School of Health Systems and Public Health, University of Pretoria, Pretoria, South Africa
| | - Max O Bachmann
- Department of Public Health and Health Services Research, Norwich Medical School, University of East Anglia, Norwich, UK
| | - Olalekan A Ayo-Yusuf
- School of Health Systems and Public Health, University of Pretoria, Pretoria, South Africa
- Research, Postgraduate Studies and Innovation, Sefako Makgatho Health Sciences University, Pretoria, South Africa
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Nazar GP, Sharma N, Chugh A, Abdullah SM, Lina S, Mdege ND, John RM, Huque R, Bauld L, Arora M. Impact of tobacco price and taxation on affordability and consumption of tobacco products in the South-East Asia Region: A systematic review. Tob Induc Dis 2021; 19:97. [PMID: 34992513 PMCID: PMC8669701 DOI: 10.18332/tid/143179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2021] [Revised: 09/29/2021] [Accepted: 10/19/2021] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION The objective of the review was to study the impact of tobacco taxes or prices on affordability and/or consumption of tobacco products in WHO South-East Asia Region (SEAR) countries, overall and by socioeconomic status; and change in consumption of one tobacco product for a given change in price/tax on another tobacco product. METHODS The searches were made in five databases (Medline, Embase, Cinahl, EconLit, Tobacconomics) using keywords such as 'tobacco', 'tax', 'price', 'impact' with their synonyms. Additionally, the first 100 articles through google search and e-reports from targeted sources were also reviewed. Studies illustrating the impact of prices/taxes on consumption/affordability of tobacco products in SEAR, in English and with no limitation on year, were included in the review. After two steps of screening, data from 28 studies were extracted using a structured and pre-tested data extraction form. RESULTS Of the 28 studies, 12 studies reported an inverse association between price and consumption/affordability, while 11 studies reported no or positive association between price and consumption/affordability of tobacco products. Five studies had unclear interpretations. The majority of studies estimated that the less affluent group were more price responsive compared to the more affluent group. Some studies indicated increased consumption of one product in response to price rise of another product, although, the findings were inconsistent. CONCLUSIONS The findings of our review support the use of tobacco tax and price measures as effective tools to address the tobacco epidemic. Our findings, however, also emphasize the importance of increasing tobacco product taxes and prices sufficiently to outweigh the effects of income growth, in order for the measures to be effective in reducing the affordability and consumption of tobacco products.
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Affiliation(s)
- Gaurang P. Nazar
- Health Related Information Dissemination Amongst Youth, New Delhi, India
- Health Promotion Division, Public Health Foundation of India, Gurugram, India
| | - Nitika Sharma
- Health Related Information Dissemination Amongst Youth, New Delhi, India
| | - Aastha Chugh
- Health Related Information Dissemination Amongst Youth, New Delhi, India
| | - S. M. Abdullah
- Department of Economics, University of Dhaka, Dhaka, Bangladesh
- ARK Foundation, Dhaka, Bangladesh
| | | | - Noreen D. Mdege
- Department of Health Sciences, University of York, York, United Kingdom
| | - Rijo M. John
- Rajagiri College of Social Sciences, Kochi, India
| | - Rumana Huque
- Department of Economics, University of Dhaka, Dhaka, Bangladesh
- ARK Foundation, Dhaka, Bangladesh
| | - Linda Bauld
- Usher Institute, University of Edinburgh, Edinburgh, United Kingdom
- SPECTRUM Consortium, University of Edinburgh, Edinburgh, United Kingdom
| | - Monika Arora
- Health Related Information Dissemination Amongst Youth, New Delhi, India
- Health Promotion Division, Public Health Foundation of India, Gurugram, India
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Nyamurungi Namusisi K, Thirlway F, Mdege ND, Matovu JKB. HIV healthcare providers' perceptions on smoking behavior among PLHIV and smoking cessation service provision in HIV clinics in Uganda. Tob Prev Cessat 2021; 7:60. [PMID: 34585028 PMCID: PMC8432410 DOI: 10.18332/tpc/140131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Revised: 07/09/2021] [Accepted: 07/10/2021] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Integration of smoking cessation interventions into HIV care can play a crucial role in reducing the growing burden of disease due to smoking among people living with HIV (PLHIV). However, there is a dearth of information on HIV care providers' perspectives towards integrating smoking cessation interventions into HIV care programs. We explored HIV healthcare providers' perceptions on the smoking behavior among PLHIV, and the provision of smoking cessation services to PLHIV who smoke within HIV care services in Uganda. METHODS Semi-structured face-to-face qualitative interviews were conducted with 12 HIV care providers between October and November 2019. Data were collected on perceptions on smoking among HIV-positive patients enrolled in HIV care, support provided to PLHIV who smoke to quit and integrating smoking cessation services into HIV care programs. Data were analyzed deductively following a thematic framework approach. RESULTS Findings show that: 1) HIV care providers in HIV clinics had low knowledge on the prevalence and magnitude of smoking among PLHIV who attended the clinics; 2) HIV care providers did not routinely screen HIV-positive patients for smoking and offered sub-optimal smoking cessation services; and 3) HIV care providers had a positive attitude towards integration of tobacco smoking cessation services into HIV care programs but called for support in form of guidelines, capacity building and strengthening of data collection and use as part of the integration process. CONCLUSIONS Our study shows that HIV care providers did not routinely screen for tobacco use among PLHIV and offered suboptimal cessation support to smoking patients, but had a positive attitude towards the integration of tobacco smoking into HIV care programs. These findings suggest a favorable ground for integrating tobacco smoking cessation interventions into HIV care programs.
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Affiliation(s)
- Kellen Nyamurungi Namusisi
- Department of Health Policy Planning and Management, School of Public Health, Makerere University, Kampala, Uganda
| | - Frances Thirlway
- Department of Sociology, University of York, York, United Kingdom
| | - Noreen D. Mdege
- Department of Health Sciences, University of York, York, United Kingdom
| | - Joseph K. B. Matovu
- Department of Disease Control and Environmental Health, School of Public Health, Makerere University, Kampala, Uganda
- Department of Community and Public Health, Busitema University Faculty of Health Sciences, Mbale, Uganda
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Louwagie GM, Morojele N, Siddiqi K, Mdege ND, Tumbo J, Omole O, Pitso L, Bachmann MO, Ayo-Yusuf OA. Addressing tobacco smoking and drinking to improve TB treatment outcomes, in South Africa: a feasibility study of the ProLife program. Transl Behav Med 2020; 10:1491-1503. [PMID: 31233146 DOI: 10.1093/tbm/ibz100] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Alcohol and tobacco use may lead to negative treatment outcomes in tuberculosis (TB) patients, and even more so if they are HIV-infected. We developed and tested the feasibility of a complex behavioral intervention (ProLife) delivered by lay health workers (LHWs) to improve treatment outcomes in TB patients who smoke tobacco and/or drink alcohol, at nine clinics in South Africa. The intervention comprised three brief motivational interviewing (MI) sessions augmented with a short message service (SMS) program, targeting as appropriate: tobacco smoking, harmful or hazardous drinking and medication adherence. Patients received SMSs twice a week. We measured recruitment and retention rates and assessed fidelity to the MI technique (MI Treatment Integrity 4.1 tool). Finally, we explored LHWs' and patients' experiences through interviews and semi-structured questionnaires, respectively. We screened 137 TB patients and identified 14 smokers, 13 alcohol drinkers, and 18 patients with both behaviors. Participants' mean age was 39.8 years, and 82.2% were men. The fidelity assessments pointed to the LHWs' successful application of key MI skills, but failure to reach MI competency thresholds. Nevertheless, most patients rated the MI sessions as helpful, ascribed positive attributes to their counselors, and reported behavioral changes. SMSs were perceived as reinforcing but difficult language and technical delivery problems were identified as problems. The LHWs' interview responses suggested that they (a) grasped the basic MI spirit but failed to understand specific MI techniques due to insufficient training practice; (b) perceived ProLife as having benefitted the patients (as well as themselves); (c) viewed the SMSs favorably; but (d) considered limited space and privacy at the clinics as key challenges. The ProLife program targeting multiple risk behaviors in TB patients is acceptable but LHW training protocol, and changes in wording and delivery of SMS are necessary to improve the intervention. Trial registration: ISRCTN62728852.
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Affiliation(s)
- Goedele M Louwagie
- School of Health Systems and Public Health, University of Pretoria, Pretoria, South Africa.,Research, Postgraduate Studies and Innovation, Sefako Makgatho Health Sciences University, Pretoria, South Africa
| | - Neo Morojele
- Alcohol, Tobacco and Other Drug Research Unit, Medical Research Council, Pretoria, South Africa
| | - Kamran Siddiqi
- Department of Health Sciences, University of York, York, UK
| | - Noreen D Mdege
- Department of Health Sciences, University of York, York, UK
| | - John Tumbo
- Research, Postgraduate Studies and Innovation, Sefako Makgatho Health Sciences University, Pretoria, South Africa
| | - Olu Omole
- Department of Family Medicine, University of Witwatersrand, Johannesburg, South Africa
| | - Lerato Pitso
- School of Health Systems and Public Health, University of Pretoria, Pretoria, South Africa
| | - Max O Bachmann
- Department of Public Health and Health Services Research, Norwich Medical School, University of East Anglia, Norwich, UK
| | - Olalekan A Ayo-Yusuf
- School of Health Systems and Public Health, University of Pretoria, Pretoria, South Africa.,Research, Postgraduate Studies and Innovation, Sefako Makgatho Health Sciences University, Pretoria, South Africa
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Levens SM, Sagui-Henson SJ, Padro M, Martin LE, Trucco EM, Cooperman NA, Baldwin AS, Kassianos AP, Mdege ND. The Effects of Positive Affect and Episodic Future Thinking on Temporal Discounting and Healthy Food Demand and Choice Among Overweight and Obese Individuals: Protocol for a Pilot 2×2 Factorial Randomized Controlled Study. JMIR Res Protoc 2019; 8:e12265. [PMID: 30892273 PMCID: PMC6446151 DOI: 10.2196/12265] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2018] [Revised: 11/16/2018] [Accepted: 12/10/2018] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Unhealthy behaviors (eg, poor food choices) contribute to obesity and numerous negative health outcomes, including multiple types of cancer and cardiovascular and metabolic diseases. To promote healthy food choice, diet interventions should build on the dual-system model to target the regulation and reward mechanisms that guide eating behavior. Episodic future thinking (EFT) has been shown to strengthen regulation mechanisms by reducing unhealthy food choice and temporal discounting (TD), a process of placing greater value on smaller immediate rewards over larger future rewards. However, these interventions do not target the reward mechanisms that could support healthy eating and strengthen the impact of EFT-anchored programs. Increasing positive affect (PosA) related to healthy food choices may target reward mechanisms by enhancing the rewarding effects of healthy eating. An intervention that increases self-regulation regarding unhealthy foods and the reward value of healthy foods will likely have a greater impact on eating behavior compared with interventions focused on either process alone. OBJECTIVE This study aimed to introduce a protocol that tests the independent and interactive effects of EFT and PosA on TD, food choice, and food demand in overweight and obese adults. METHODS This protocol describes a factorial, randomized, controlled pilot study that employs a 2 (affective imagery: positive, neutral) by 2 (EFT: yes, no) design in which participants are randomized to 1 of 4 guided imagery intervention arms. In total, 156 eligible participants will complete 2 lab visits separated by 5 days. At visit 1, participants complete surveys; listen to the audio guided imagery intervention; and complete TD, food demand, and food choice tasks. At visit 2, participants complete TD, food demand, and food choice tasks and surveys. Participants complete a daily food frequency questionnaire between visits 1 and 2. Analyses will compare primary outcome measures at baseline, postintervention, and at follow-up across treatment arms. RESULTS Funding notification was received on April 27, 2017, and the protocol was approved by the institutional review board on October 6, 2017. Feasibility testing of the protocol was conducted from February 21, 2018, to April 18, 2018, among the first 32 participants. As no major protocol changes were required at the end of the feasibility phase, these 32 participants were included in the target sample of 156 participants. Recruitment, therefore, continued immediately after the feasibility phase. When this manuscript was submitted, 84 participants had completed the protocol. CONCLUSIONS Our research goal is to develop novel, theory-based interventions to promote and improve healthy decision-making and behaviors. The findings will advance decision-making research and have the potential to generate new neuroscience and psychological research to further understand these mechanisms and their interactions. TRIAL REGISTRATION ISRCTN Registry ISRCTN11704675; http://www.isrctn.com/ISRCTN11704675 (Archived by WebCite at http://www.webcitation.org/760ouOoKG). INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/12265.
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Affiliation(s)
- Sara M Levens
- University of North Carolina at Charlotte, Department of Psychological Science, Charlotte, NC, United States
| | - Sara J Sagui-Henson
- Osher Center for Integrative Medicine, University of California, San Francisco, San Fransisco, CA, United States
| | - Meagan Padro
- Department of Psychological Science, University of North Carolina at Charlotte, Charlotte, NC, United States
| | - Laura E Martin
- Hoglund Brain Imaging Center, University of Kansas Medical Center, Kansas City, KS, United States
| | - Elisa M Trucco
- Department of Psychology, Florida International University, Miami, FL, United States
| | - Nina A Cooperman
- Department of Psychiatry, Rutgers Robert Wood Johnson Medical School, Piscataway, NJ, United States
| | - Austin S Baldwin
- Department of Psychology, Southern Methodist University, Dallas, TX, United States
| | - Angelos P Kassianos
- Department of Applied Health Research, University College London, London, United Kingdom
| | - Noreen D Mdege
- University of York, Department of Health Sciences, York, United Kingdom
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Mdege ND, Meader N, Lloyd C, Parrott S, McCambridge J. The Novel Psychoactive Substances in the UK Project: empirical and conceptual review work to produce research recommendations. Public Health Res 2017. [DOI: 10.3310/phr05040] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
BackgroundAlthough illegal drug use has largely been declining in the UK over the past decade, this period has witnessed the emergence of a range of novel psychoactive substances (NPS) (‘legal highs’). These are new, mostly synthetic, substances that mimic the effects of existing drugs). Despite there being many causes for concern in relation to NPS, there has been little prior study of the burden associated with their use in public health terms. Clarity is lacking on research priorities in this rapidly developing literature.ObjectivesTo inform the development of public health intervention research on NPS by reviewing existing data on their use, associated problems and potential responses to such problems.DesignA scoping review and narrative synthesis of selected bodies of evidence was undertaken to summarise and evaluate what is known about NPS use and the related harms of, and responses to, such use. Relevant literature was identified from electronic databases (covering January 2006 to June 2016 inclusive), Google (Google Inc., Mountain View, CA, USA), relevant websites and online drug forums and by contacting experts. Articles were included if they were primary studies, secondary studies involving the analysis and interpretation of primary research or discussion papers. A conceptual framework postulating an evidence-informed public health approach to NPS use in the UK was developed through a pragmatic literature review, the iterative development of concepts and finalisation in light of the results from the empirical review work. The process also involved feedback from various stakeholders. Research recommendations were developed from both strands of work.ResultsA total of 995 articles were included in the scoping review, the majority of which related to individual-level health-related adverse effects attributable to NPS use. The prevalence of lifetime NPS use varied widely between (e.g. with higher prevalence in young males) and within population subgroups. The most commonly reported adverse effects were psychiatric/other neurological, cardiovascular, renal and gastrointestinal manifestations, and there is limited evidence available on responses. In these and other respects, available evidence is at an early stage of development. Initial evidence challenges the view that NPS should be treated differently from other illicit drugs. The conceptual framework indicated that much of the evidence that would be useful to inform public health responses does not yet exist. We propose a systems-based prevention approach that develops existing responses, is multilevel and life course informed in character, and emphasises commonalities between NPS and other legal and illegal drug use. We make 20 recommendations for research, including nine key recommendations.LimitationsScoping reviews do not interrogate evidence in depth, and the disjunction between the scoping review and the conceptual framework findings is worthy of careful attention.ConclusionsKey research recommendations build on those that have previously been made and offer more evidence-based justification and detail, as previous recommendations have not yet been acted on. The case for decision-making on commissioning new research based on these recommendations is both strong and urgent.Future workThe validity of recommendations generated through this project could be enhanced via further work with research commissioners, policy-makers, researchers and the public.Study registrationThe systematic review element of this study is registered as PROSPERO CRD42016026415.FundingThe National Institute for Health Research Public Health Research programme.
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Affiliation(s)
- Noreen D Mdege
- Department of Health Sciences, University of York, York, UK
| | - Nick Meader
- Centre for Reviews and Dissemination, University of York, York, UK
| | - Charlie Lloyd
- Department of Health Sciences, University of York, York, UK
| | - Steve Parrott
- Department of Health Sciences, University of York, York, UK
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Mdege ND, Shah S, Ayo-Yusuf OA, Hakim J, Siddiqi K. Tobacco use among people living with HIV: analysis of data from Demographic and Health Surveys from 28 low-income and middle-income countries. Lancet Glob Health 2017; 5:e578-e592. [PMID: 28495263 PMCID: PMC5439027 DOI: 10.1016/s2214-109x(17)30170-5] [Citation(s) in RCA: 72] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2017] [Revised: 03/03/2017] [Accepted: 03/29/2017] [Indexed: 01/05/2023]
Abstract
BACKGROUND Tobacco use among people living with HIV results in excess morbidity and mortality. However, very little is known about the extent of tobacco use among people living with HIV in low-income and middle-income countries (LMICs). We assessed the prevalence of tobacco use among people living with HIV in LMICs. METHODS We used Demographic and Health Survey data collected between 2003 and 2014 from 28 LMICs where both tobacco use and HIV test data were made publicly available. We estimated the country-specific, regional, and overall prevalence of current tobacco use (smoked, smokeless, and any tobacco use) among 6729 HIV-positive men from 27 LMICs (aged 15-59 years) and 11 495 HIV-positive women from 28 LMICs (aged 15-49 years), and compared them with those in 193 763 HIV-negative men and 222 808 HIV-negative women, respectively. We estimated prevalence separately for males and females as a proportion, and the analysis accounted for sampling weights, clustering, and stratification in the sampling design. We computed pooled regional and overall prevalence estimates through meta-analysis with the application of a random-effects model. We computed country, regional, and overall relative prevalence ratios for tobacco smoking, smokeless tobacco use, and any tobacco use separately for males and females to study differences in prevalence rates between HIV-positive and HIV-negative individuals. FINDINGS The overall prevalence among HIV-positive men was 24·4% (95% CI 21·1-27·8) for tobacco smoking, 3·4% (1·8-5·6) for smokeless tobacco use, and 27·1% (22·8-31·7) for any tobacco use. We found a higher prevalence in HIV-positive men of any tobacco use (risk ratio [RR] 1·41 [95% CI 1·26-1·57]) and tobacco smoking (1·46 [1·30-1·65]) than in HIV-negative men (both p<0·0001). The difference in smokeless tobacco use prevalence between HIV-positive and HIV-negative men was not significant (1·26 [1·00-1·58]; p=0·050). The overall prevalence among HIV-positive women was 1·3% (95% CI 0·8-1·9) for tobacco smoking, 2·1% (1·1-3·4) for smokeless tobacco use, and 3·6% (95% CI 2·3-5·2) for any tobacco use. We found a higher prevalence in HIV-positive women of any tobacco use (RR 1·36 [95% CI 1·10-1·69]; p=0·0050), tobacco smoking (1·90 [1·38-2·62]; p<0·0001), and smokeless tobacco use (1·32 [1·03-1·69]; p=0·030) than in HIV-negative women. INTERPRETATION The high prevalence of tobacco use in people living with HIV in LMICs mandates targeted policy, practice, and research action to promote tobacco cessation and to improve the health outcomes in this population. FUNDING South African Medical Research Council and the UK Medical Research Council.
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Affiliation(s)
- Noreen D Mdege
- Department of Health Sciences, Faculty of Science, University of York, Heslington, York, UK,Correspondence to: Dr Noreen D Mdege, Department of Health Sciences, Faculty of Science, University of York, Heslington, York YO10 5DD, UKCorrespondence to: Dr Noreen D MdegeDepartment of Health SciencesFaculty of ScienceUniversity of YorkHeslingtonYorkYO10 5DDUK
| | - Sarwat Shah
- Department of Health Sciences, Faculty of Science, University of York, Heslington, York, UK
| | - Olalekan A Ayo-Yusuf
- School of Oral Health Sciences, Sefako Makgatho Health Sciences University, Medunsa, Pretoria, South Africa
| | - James Hakim
- Department of Medicine, College of Health Sciences, University of Zimbabwe, Harare, Zimbabwe
| | - Kamran Siddiqi
- Department of Health Sciences, Faculty of Science, University of York, Heslington, York, UK
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Watson R, Morris J, Isitt J, Barrio P, Ortega L, Gual A, Conner K, Stecker T, Maisto S, Paroz S, Graap C, Grazioli VS, Daeppen JB, Collins SE, Bertholet N, McNeely J, Kushnir V, Cunningham JA, Crombie IK, Cunningham KB, Irvine L, Williams B, Sniehotta FF, Norrie J, Melson A, Jones C, Briggs A, Rice P, Achison M, McKenzie A, Dimova E, Slane PW, Grazioli VS, Collins SE, Paroz S, Graap C, Daeppen JB, Baggio S, Dupuis M, Studer J, Gmel G, Magill M, Grazioli VS, Tait RJ, Teoh L, Kelty E, Geelhoed E, Mountain D, Hulse GK, Renko E, Mitchell SG, Lounsbury D, Li Z, Schwartz RP, Gryczynski J, Kirk AS, Oros M, Hosler C, Dusek K, Brown BS, Finnell DS, Holloway A, Wu LT, Subramaniam G, Sharma G, Wallhed Finn S, Andreasson S, Dvorak RD, Kramer MP, Stevenson BL, Sargent EM, Kilwein TM, Harris SK, Sherritt L, Copelas S, Knight JR, Mdege ND, McCambridge J, Bischof G, Bischof A, Freyer-Adam J, Rumpf HJ, Fitzgerald N, Schölin L, Toner P, Böhnke JR, Veach LJ, Currin O, Dongre LZ, Miller PR, White E, Williams EC, Lapham GT, Bobb JJ, Rubinsky AD, Catz SL, Shortreed S, Bensley KM, Bradley KA, Milward J, Deluca P, Khadjesari Z, Watson R, Fincham-Campbell S, Drummond C, Angus K, Bauld L, Baumann S, Haberecht K, Schnuerer I, Meyer C, Rumpf HJ, John U, Gaertner B, Barrault-Couchouron M, Béracochéa M, Allafort V, Barthélémy V, Bonnefoi H, Bussières E, Garguil V, Auriacombe M, Saint-Jacques M, Dorval M, M’Bailara K, Segura-Garcia L, Ibañez-Martinez N, Mendive-Arbeloa JM, Anoro-Perminger M, Diaz-Gallego P, Piñar-Mateos MA, Colom-Farran J, Deligianni M, Yersin B, Adam A, Weisner C, Chi F, Lu W, Sterling S, Kraemer KL, McGinnis KA, Fiellin DA, Skanderson M, Gordon AJ, Robbins J, Zickmund S, Korthuis PT, Edelman EJ, Hansen NB, Cutter CJ, Dziura J, Fiellin LE, O’Connor PG, Maisto SA, Bedimo R, Gilbert C, Marconi VC, Rimland D, Rodriguez-Barradas M, Simberkoff M, Justice AC, Bryant KJ, Berman AH, Shorter GW, Bray JW, Barbosa C, Johansson M, Hester R, Campbell W, Souza Formigoni MLO, Andrade ALM, Sartes LMA, Sundström C, Eék N, Kraepelien M, Kaldo V, Fahlke C, Hernandez L, Becker SJ, Jones RN, Graves HR, Spirito A, Diestelkamp S, Wartberg L, Arnaud N, Thomasius R, Gaume J, Grazioli V, Fortini C, Malan Z, Mash B, Everett-Murphy K, Grazioli VS, Studer J, Mohler-Kuo M, Bertholet N, Gmel G, Doi L, Cheyne H, Jepson R, Luna V, Echeverria L, Morales S, Barroso T, Abreu Â, Aguiar C, Stewart D, Abreu A, Brites RM, Jomar R, Marinho G, Parreira P, Seale JP, Johnson JA, Henry D, Chalmers S, Payne F, Tuck L, Morris A, Gonçalves C, Besser B, Casajuana C, López-Pelayo H, Balcells MM, Teixidó L, Miquel L, Colom J, Hepner KA, Hoggatt KJ, Bogart A, Paddock SM, Hardoon SL, Petersen I, Hamilton FL, Nazareth I, White IR, Marston L, Wallace P, Godfrey C, Murray E, Sovinová H, Csémy L. Proceedings of the 13th annual conference of INEBRIA. Addict Sci Clin Pract 2016; 11:13. [PMID: 27654147 PMCID: PMC5032602 DOI: 10.1186/s13722-016-0062-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Watson JM, Fairhurst C, Li J, Tober G, Crosby H, Lloyd C, Godfrey C, Mdege ND, Dale V, Toner P, Parrott S, Raistrick D. ADAPTA: A pilot randomised controlled trial of an alcohol-focused intervention versus a healthy living intervention for problem drinkers identified in a general hospital setting. Drug Alcohol Depend 2015; 154. [PMID: 26194955 PMCID: PMC4545229 DOI: 10.1016/j.drugalcdep.2015.06.030] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
AIM To examine the relative feasibility, acceptability, applicability, effectiveness and explore cost-effectiveness of a healthy living focused intervention (HL) compared to an alcohol-focused intervention (AF) for problem drinkers identified in hospital. METHODS A pragmatic, randomised, controlled, open pilot trial. Feasibility and acceptability were measured by recruitment, attrition, follow-up rates and number of treatment sessions attended. Effectiveness was measured using the Alcohol Use Disorders Identification Test score at six months. Additional economic and secondary outcome measures were collected. RESULTS Eighty-six participants were randomised and 72% (n=62) were retained in full participation. Forty-one participants attended at least one treatment session (48%). A greater proportion in the HL group attended all four treatment sessions (33% vs 19%). Follow-up rates were 29% at six months and 22% at twelve months. There was no evidence of a difference in AUDIT score between treatment groups at six months. Mean cost of health care and social services, policing and the criminal justice system use decreased while EQ-5D scores indicated minor improvement in both arms. However, this pilot trial was not powered to detect differences in either measure between groups. CONCLUSIONS While no treatment effect was observed, this study demonstrated a potential to engage patients drinking at harmful or dependent levels in a healthy living intervention. However, recruitment proved challenging and follow-up rates were poor. Better ways need to be found to help these patients recognise the harms associated with their drinking and overcome the evident barriers to their engagement with specialist treatment.
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Affiliation(s)
- Judith M. Watson
- University of York, Department of Health Sciences, Heslington, York YO10 5DD, United Kingdom
| | - Caroline Fairhurst
- University of York, Department of Health Sciences, Heslington, York YO10 5DD, United Kingdom.
| | - Jinshuo Li
- University of York, Department of Health Sciences, Heslington, York YO10 5DD, United Kingdom.
| | - Gillian Tober
- Leeds Addiction Unit, 19 Springfield Mount, Leeds LS2 9NG, United Kingdom.
| | - Helen Crosby
- Leeds Addiction Unit, 19 Springfield Mount, Leeds LS2 9NG, United Kingdom.
| | - Charlie Lloyd
- University of York, Department of Health Sciences, Heslington, York YO10 5DD, United Kingdom.
| | - Christine Godfrey
- University of York, Department of Health Sciences, Heslington, York YO10 5DD, United Kingdom.
| | - Noreen D. Mdege
- University of York, Department of Health Sciences, Heslington, York YO10 5DD, United Kingdom
| | - Veronica Dale
- University of York, Department of Health Sciences, Heslington, York YO10 5DD, United Kingdom.
| | - Paul Toner
- University of York, Department of Health Sciences, Heslington, York YO10 5DD, United Kingdom.
| | - Steve Parrott
- University of York, Department of Health Sciences, Heslington, York YO10 5DD, United Kingdom.
| | - Duncan Raistrick
- Leeds Addiction Unit, 19 Springfield Mount, Leeds LS2 9NG, United Kingdom.
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Mdege ND, Kanaan M. Response to Keriel-Gascou et al. Addressing assumptions on the stepped wedge randomized trial design. J Clin Epidemiol 2014; 67:833-4. [PMID: 24751180 DOI: 10.1016/j.jclinepi.2014.02.014] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2013] [Accepted: 02/26/2014] [Indexed: 10/25/2022]
Affiliation(s)
- Noreen D Mdege
- Department of Health Sciences, University of York, Heslington, York YO10 5DD, United Kingdom.
| | - Mona Kanaan
- Department of Health Sciences, University of York, Heslington, York YO10 5DD, United Kingdom
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Mdege ND, Raistrick D, Johnson G. Medical specialists' views on the impact of reducing alcohol consumption on prognosis of, and risk of, hospital admission due to specific medical conditions: results from a Delphi survey. J Eval Clin Pract 2014; 20:100-10. [PMID: 24118631 DOI: 10.1111/jep.12092] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/10/2013] [Indexed: 11/29/2022]
Abstract
RATIONALE, AIMS AND OBJECTIVES To find consensus, or lack thereof, on the impact of reducing alcohol consumption on prognosis and the risk of hospital admissions for a number of alcohol-attributable disorders. METHODS A modified two-round Delphi survey utilizing web-based questionnaires to collect quantitative and qualitative data was used. Alcohol treatment experts from cardiology, emergency medicine, gastroenterology and oncology in the United Kingdom were invited to participate. The main outcomes were median impact ratings (on a scale of 1-9) and consensus (unanimous, strong, moderate, weak or no consensus). RESULTS Of 192 experts invited to participate, 59 completed first questionnaires. The overall retention rate to the second questionnaires was about 51% (30/59). There was strong support that reducing alcohol consumption could result in improvement in prognosis for gastroenterology and emergency medicine patients; but uncertainty on the benefits for cardiology and oncology patients. Overall, the responses from the expert panel did not reflect the assumption that reducing alcohol consumption would result in benefits on hospital admissions for any of the specialties. The specialists viewed the severity of disorders as important when considering the impact of reducing alcohol consumption. CONCLUSIONS The highest impact of treatment for problem drinking in hospitals is considered to be for alcohol-related disorders associated with gastroenterology and emergency medicine. At policy level, if targeted screening for alcohol problems by presenting disease or condition is the strategy of choice, it would be logical to implement screening and easily accessible interventions or addiction specialists within these areas where alcohol treatment is considered as having a high impact.
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Affiliation(s)
- Noreen D Mdege
- Department of Health Sciences, University of York, York, UK
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Mdege ND, Fayter D, Watson JM, Stirk L, Sowden A, Godfrey C. Interventions for reducing alcohol consumption among general hospital inpatient heavy alcohol users: a systematic review. Drug Alcohol Depend 2013; 131:1-22. [PMID: 23474201 DOI: 10.1016/j.drugalcdep.2013.01.023] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2012] [Revised: 01/28/2013] [Accepted: 01/29/2013] [Indexed: 11/27/2022]
Abstract
BACKGROUND There is growing interest in pro-active detection and provision of interventions for heavy alcohol use in the general hospital inpatient population. We aimed to determine, from the available evidence, the effectiveness of interventions in reducing alcohol consumption among general hospital inpatient heavy alcohol users. METHODS The following databases were searched for completed and on-going randomised and non-randomised controlled studies published up to November 2012: MEDLINE; C2-SPECTR; CINAHL; The Cochrane Library; Conference Proceedings Citation Index: Science; EMBASE; HMIC; PsycInfo; Public Health Interventions Cost Effectiveness Database (PHICED); and ClinicalTrials.gov. Studies were screened independently by two reviewers. Data extraction was performed by one reviewer and independently checked by a second. RESULTS Twenty-two studies which met the inclusion criteria enrolled 5307 participants in total. All interventions were non-pharmacological and alcohol focused. Results from single session brief interventions and self-help literature showed no clear benefit on alcohol consumption outcomes, with indications of benefit from some studies but not others. However, results suggest brief interventions of more than one session could be beneficial on reducing alcohol consumption, especially for non-dependent patients. No active intervention was found superior over another on alcohol consumption and other outcomes. CONCLUSIONS Brief interventions of more than one session could be beneficial on reducing alcohol consumption among hospital inpatients, especially for non-dependent patients. However, additional evidence is still needed before more definitive conclusions can be reached.
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Affiliation(s)
- Noreen D Mdege
- Department of Health Sciences, University of York, Heslington, York, UK.
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Sweetman J, Raistrick D, Mdege ND, Crosby H. A systematic review of substance misuse assessment packages. Drug Alcohol Rev 2013; 32:347-55. [DOI: 10.1111/dar.12039] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2012] [Accepted: 02/20/2013] [Indexed: 11/29/2022]
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Abstract
The aim of this review was to analyze the impact of interventions designed to standardize collection and reporting of logistics data for managing essential medicines in developing countries. Literature was identified from searches of Medline, EMBASE and Web of Science until March 2011. Other relevant publications were identified from websites of organizations working in the study area and contacts working in the field. The search identified a total of 358 articles out of which 11 were selected for inclusion. All articles were before and after analysis without control areas. Standardizing the collection and reporting of logistics data through automation (full or partial) and manual tools resulted in improvements on the availability of quality logistics data for supply chain decision-making, and continual availability of essential medicines. Use of mobile technologies resulted in low error rates in forecasting and demand planning, and significantly reduced decision lead time. The findings from this review suggest that standardization of collection and reporting of logistics data to support decision-making on essential medicine supply can lead to improvements on availability and quality of logistics data and availability of essential medicines. However there is need for more robust experimental and quasi-experimental studies on the topic.
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Affiliation(s)
- Stanley Chindove
- Stanley Chindove, Department of Pharmacy, Ministry of Health, East Timor
- Noreen D. Mdege, Department of Health Sciences, University of York, United Kingdom
| | - Noreen D. Mdege
- Noreen D. Mdege, Department of Health Sciences, University of York, United Kingdom
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Mdege ND, Man MS, Taylor nee Brown CA, Torgerson DJ. There are some circumstances where the stepped-wedge cluster randomized trial is preferable to the alternative: no randomized trial at all. Response to the commentary by Kotz and colleagues. J Clin Epidemiol 2012; 65:1253-4. [PMID: 22968178 DOI: 10.1016/j.jclinepi.2012.06.003] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2012] [Accepted: 06/11/2012] [Indexed: 10/27/2022]
Affiliation(s)
- Noreen D Mdege
- Department of Health Sciences, York Trials Unit, University of York, Heslington, York YO10 5DD, UK.
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Abstract
OBJECTIVE To evaluate the effects of Helicrysum ceres root and leaf extracts on mean arterial blood pressure and renal fluid and electrolyte handling in anesthetized male Sprague-Dawley rats. DESIGN Cross sectional study. SETTING Departments of Physiology and Pharmacy, University of Zimbabwe. SUBJECTS Eight separate groups comprising of control and treated Male Sprague-Dawley rats (n =6 in each group) were anesthetized and placed on a continuous jugular infusion of 0.077 M NaCl at 150 microL min(-1). The left carotid artery was cannulated with polythene tubing and then connected to a pressure transducer for blood pressure measurements. After 3 h equilibration period, consecutive 20 min urine collections and blood pressure measurements were made over the subsequent 4 h of 1 h 20 min control, 1 h treatment and I h 40 min post-equilibration periods for measurements of urine flow and Na+ and K+ excretion rates. Helichrysum ceres leaf extracts at 0.3, 0.6 and 1.2 microg min(-1) roots 0.3, 3 and 6 microg min(-1) were added to the infusate during the treatment period. To establish whether the extracts had activities comparable to drugs already in use, a separate group of animals was administered furosemide (0.12 microg min(-1)) during the treatment period. MAIN OUTCOME MEASURES Hypotension, Natriuresis and Diuresis. RESULTS Infusion of graded doses of aqueous leaf extracts of Helicrysum ceres provoked an increase in urine flow rates but did not achieve statistical significance. However, the extracts produced dose dependent decrease in potassium excretion as well as increases in urinary Na+ outputs and diuresis. Administration of the various doses of aqueous root extracts of Helicrysum ceres significantly increased urine flow rate and urinary Na+ excretion in all groups. The intravenous (i.v.) administration of the aqueous root or leaf extracts of Helichrysum ceres significantly depressed mean arterial blood pressure (MAP). The diuretic and natriuretic effects of plant extracts were not significantly different to that of furosemide. CONCLUSION The results suggest that oral administration to rats of aqueous crude Helicrysum ceres root or leaves extracts induce hypotension and natriuresis.
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Affiliation(s)
- C T Musabayane
- Department of Pharmacy, University of Zimbabwe, Mount Pleasant, Harare.
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