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Siddiqi K, Dogar O, Gabe R, Sheikh A. The systematic review and meta-analysis of cytisine. Addiction 2024. [PMID: 38321591 DOI: 10.1111/add.16441] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Accepted: 01/09/2024] [Indexed: 02/08/2024]
Affiliation(s)
- Kamran Siddiqi
- Department of Health Sciences, University of York, York, UK
| | - Omara Dogar
- Department of Health Sciences, University of York, York, UK
| | - Rhian Gabe
- Wolfson Institute of Population Health, Queen Mary University London, London, UK
| | - Aziz Sheikh
- Usher Institute, The University of Edinburgh, Old Medical School, Edinburgh, UK
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Vidyasagaran AL, Readshaw A, Boeckmann M, Jarde A, Siddiqui F, Marshall AM, Akram J, Golub JE, Siddiqi K, Dogar O. Is Tobacco Use Associated With Risk of Recurrence and Mortality Among People With TB?: A Systematic Review and Meta-Analysis. Chest 2024; 165:22-47. [PMID: 37652295 PMCID: PMC10790178 DOI: 10.1016/j.chest.2023.08.021] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Revised: 06/20/2023] [Accepted: 08/23/2023] [Indexed: 09/02/2023] Open
Abstract
BACKGROUND Associations between tobacco use and poor TB treatment outcomes are well documented. However, for important outcomes such as TB recurrence or relapse and mortality during treatment, as well as for associations with smokeless tobacco (ST), the evidence is not summarized systematically. RESEARCH QUESTION Is tobacco use associated with risk of poor treatment outcomes among people with TB? STUDY DESIGN AND METHODS The MEDLINE, Embase, and Cumulative Index of Nursing and Allied Health Literature databases were searched on November 22, 2021. Epidemiologic studies reporting associations between tobacco use and at least one TB treatment outcome were eligible. Independent double-screening, extractions, and quality assessments were undertaken. Random effects meta-analyses were conducted for the two primary review outcomes (TB recurrence or relapse and mortality during treatment), and heterogeneity was explored using subgroups. Other outcomes were synthesized narratively. RESULTS Our searches identified 1,249 records, of which 28 were included in the meta-analyses. Based on 15 studies, higher risk of TB recurrence or relapse was found with ever using tobacco vs never using tobacco (risk ratio [RR], 1.78; 95% CI, 1.31-2.43; I2 = 85%), current tobacco use vs no tobacco use (RR, 1.95; 95% CI, 1.59-2.40; I2 = 72%), and former tobacco use vs never using tobacco (RR, 1.84; 95% CI, 1.21-2.80; I2 = 4%); heterogeneity arose from differences in study quality, design, and participant characteristics. Thirty-eight studies were identified for mortality, of which 13 reported mortality during treatment. Ever tobacco use (RR, 1.55; 95% CI, 1.32-1.81; I2 = 0%) and current tobacco use (RR, 1.51; 95% CI, 1.09-2.10; I2 = 87%) significantly increased the likelihood of mortality during treatment among people with TB compared with never using tobacco and not currently using tobacco, respectively; heterogeneity was explained largely by differences in study design. Almost all studies in the meta-analyses scored high or moderate on quality assessments. Narrative synthesis showed that tobacco use was a risk factor for other unfavorable TB treatment outcomes, as previously documented. Evidence on ST was limited, but identified studies suggested an increased risk for poor outcomes with its use compared with not using it. INTERPRETATION Tobacco use significantly increases the risk of TB recurrence or relapse and mortality during treatment among people with TB, highlighting the need to address tobacco use to improve TB outcomes. TRIAL REGISTRY PROSPERO; No.: CRD42017060821; URL: https://www.crd.york.ac.uk/prospero/.
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Affiliation(s)
| | - Anne Readshaw
- Department of Health Sciences, University of York, York, England; Yorkshire and North Lincolnshire Area Team, Natural England
| | - Melanie Boeckmann
- Department of Global Health, Institute of Public Health and Nursing Research (IPP), University of Bremen, Bremen, Germany
| | - Alexander Jarde
- Université de Paris, Centre d'Épidémiologie Clinique, Hôpital Hôtel-Dieu, and Cochrane France, Paris, France
| | - Faraz Siddiqui
- Department of Health Sciences, University of York, York, England
| | - Anna-Marie Marshall
- Department of Health Sciences, University of York, York, England; Research Fellow in Public Health and lecturer in Public Health and Psychology, Helen McArdle Nursing and Care Research Institute, Faculty of Health Sciences and Wellbeing, University of Sunderland, Sunderland, England
| | - Janita Akram
- Hull York Medical School, University of York, York, England
| | - Jonathan E Golub
- Center for Tuberculosis Research, School of Medicine, Johns Hopkins University, Baltimore, MD
| | - Kamran Siddiqi
- Department of Health Sciences, University of York, York, England; Hull York Medical School, University of York, York, England
| | - Omara Dogar
- Department of Health Sciences, University of York, York, England; Usher Institute, The University of Edinburgh, Edinburgh, Scotland.
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Chugh A, Arora M, Jain N, Vidyasagaran A, Readshaw A, Sheikh A, Eckhardt J, Siddiqi K, Chopra M, Mishu MP, Kanaan M, Rahman MA, Mehrotra R, Huque R, Forberger S, Dahanayake S, Khan Z, Boeckmann M, Dogar O. The global impact of tobacco control policies on smokeless tobacco use: a systematic review. Lancet Glob Health 2023; 11:e953-e968. [PMID: 37202029 DOI: 10.1016/s2214-109x(23)00205-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Revised: 03/22/2023] [Accepted: 04/18/2023] [Indexed: 05/20/2023]
Abstract
BACKGROUND Smokeless tobacco, used by more than 300 million people globally, results in substantial morbidity and mortality. For smokeless tobacco control, many countries have adopted policies beyond the WHO Framework Convention on Tobacco Control, which has been instrumental in reducing smoking prevalence. The impact of these policies (within and outside the Framework Convention on Tobacco Control) on smokeless tobacco use remains unclear. We aimed to systematically review policies that are relevant to smokeless tobacco and its context and investigate their impact on smokeless tobacco use. METHODS In this systematic review, we searched 11 electronic databases and grey literature between Jan 1, 2005, and Sept 20, 2021, in English and key south Asian languages, to summarise smokeless tobacco policies and their impact. Inclusion criteria were all types of studies on smokeless tobacco users that mentioned any smokeless tobacco relevant policies since 2005, except systematic reviews. Policies issued by organisations or private institutions were excluded as well as studies on e-cigarettes and Electronic Nicotine Delivery System except where harm reduction or switching were evaluated as a tobacco cessation strategy. Two reviewers independently screened articles, and data were extracted after standardisation. Quality of studies was appraised using the Effective Public Health Practice Project's Quality Assessment Tool. Outcomes for impact assessment included smokeless tobacco prevalence, uptake, cessation, and health effects. Due to substantial heterogeneity in the descriptions of policies and outcomes, data were descriptively and narratively synthesised. This systematic review was registered in PROSPERO (CRD42020191946). FINDINGS 14 317 records were identified, of which 252 eligible studies were included as describing smokeless tobacco policies. 57 countries had policies targeting smokeless tobacco, of which 17 had policies outside the Framework Convention on Tobacco Control for smokeless tobacco (eg, spitting bans). 18 studies evaluated the impact, which were of variable quality (six strong, seven moderate, and five weak) and reported mainly on prevalence of smokeless tobacco use. The body of work evaluating policy initiatives based on the Framework Convention on Tobacco Control found that these initiatives were associated with reductions in smokeless tobacco prevalence of between 4·4% and 30·3% for taxation and 22·2% and 70·9% for multifaceted policies. Two studies evaluating the non-Framework policy of sales bans reported significant reductions in smokeless tobacco sale (6·4%) and use (combined sex 17·6%); one study, however, reported an increased trend in smokeless tobacco use in the youth after a total sales ban, likely due to cross-border smuggling. The one study reporting on cessation found a 13·3% increase in quit attempts in individuals exposed (47·5%) to Framework Convention on Tobacco Control policy: education, communication, training, and public awareness, compared with non-exposed (34·2%). INTERPRETATION Many countries have implemented smokeless tobacco control policies, including those that extend beyond the Framework Convention on Tobacco Control. The available evidence suggests that taxation and multifaceted policy initiatives are associated with meaningful reductions in smokeless tobacco use. FUNDING UK National Institute for Health Research.
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Affiliation(s)
| | - Monika Arora
- HRIDAY, New Delhi, India; Health Promotion Division, Public Health Foundation of India, Gurugram, India.
| | - Neha Jain
- Health Promotion Division, Public Health Foundation of India, Gurugram, India
| | | | - Anne Readshaw
- Department of Health Sciences, University of York, York, UK
| | - Aziz Sheikh
- Usher Institute, University of Edinburgh, Edinburgh, UK
| | | | - Kamran Siddiqi
- Department of Health Sciences, University of York, York, UK
| | | | | | - Mona Kanaan
- Department of Health Sciences, University of York, York, UK
| | - Muhammad Aziz Rahman
- Institute of Health and Wellbeing, Federation University Australia, Berwick, VIC, Australia
| | - Ravi Mehrotra
- Indian Council of Medical Research, India Cancer Research Consortium, New Delhi, India
| | | | - Sarah Forberger
- Leibniz Institute for Prevention Research and Epidemiology, Bremen, Germany
| | - Suranji Dahanayake
- Department of Health Sciences, University of York, York, UK; Ministry of Health, Nutrition and Indigenous Medicine, Colombo, Sri Lanka
| | - Zohaib Khan
- Khyber Medical University, Peshawar, Pakistan
| | - Melanie Boeckmann
- Faculty of Human and Health Sciences, University of Bremen, Breman, Germany
| | - Omara Dogar
- Department of Health Sciences, University of York, York, UK; Usher Institute, University of Edinburgh, Edinburgh, UK
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Weir CJ, Adamestam I, Sharp R, Ennis H, Heed A, Williams R, Cresswell K, Dogar O, Pontefract S, Coleman J, Lilford R, Watson N, Slee A, Chuter A, Beggs J, Slight S, Mason J, Yardley L, Sheikh A. A complex ePrescribing-based Anti-Microbial Stewardship (ePAMS+) intervention for hospitals combining technological and behavioural components: protocol for a feasibility trial. Pilot Feasibility Stud 2023; 9:18. [PMID: 36709308 PMCID: PMC9883604 DOI: 10.1186/s40814-022-01230-w] [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] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Accepted: 12/16/2022] [Indexed: 01/29/2023] Open
Abstract
BACKGROUND Antimicrobial resistance is a leading global public health threat, with inappropriate use of antimicrobials in healthcare contributing to its development. Given this urgent need, we developed a complex ePrescribing-based Anti-Microbial Stewardship intervention (ePAMS+). METHODS ePAMS+ includes educational and organisational behavioural elements, plus guideline-based clinical decision support to aid optimal antimicrobial use in hospital inpatients. ePAMS+ particularly focuses on prompt initiation of antimicrobials, followed by early review once test results are available to facilitate informed decision-making on stopping or switching where appropriate. A mixed-methods feasibility trial of ePAMS+ will take place in two NHS acute hospital care organisations. Qualitative staff interviews and observation of practice will respectively gather staff views on the technical component of ePAMS+ and information on their use of ePAMS+ in routine work. Focus groups will elicit staff and patient views on ePAMS+; one-to-one interviews will discuss antimicrobial stewardship with staff and will record patient experiences of receiving antibiotics and their thoughts on inappropriate prescribing. Qualitative data will be analysed thematically. Fidelity Index development will enable enactment of ePAMS+ to be measured objectively in a subsequent trial assessing the effectiveness of ePAMS+. Quantitative data collection will determine the feasibility of extracting data and deriving key summaries of antimicrobial prescribing; we will quantify variability in the primary outcome, number of antibiotic defined daily doses, to inform the future larger-scale trial design. DISCUSSION This trial is essential to determine the feasibility of implementing the ePAMS+ intervention and measuring relevant outcomes, prior to evaluating its clinical and cost-effectiveness in a full scale hybrid cluster-randomised stepped-wedge clinical trial. Findings will be shared with study sites and with qualitative research participants and will be published in peer-reviewed journals and presented at academic conferences. TRIAL REGISTRATION The qualitative and Fidelity Index research were approved by the Health and Research Authority and the North of Scotland Research Ethics Service (ref: 19/NS/0174). The feasibility trial and quantitative analysis (protocol v1.0, 15 December 2021) were approved by the London South East Research Ethics Committee (ref: 22/LO/0204) and registered with ISRCTN ( ISRCTN 13429325 ) on 24 March 2022.
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Affiliation(s)
- Christopher J. Weir
- grid.4305.20000 0004 1936 7988Edinburgh Clinical Trials Unit, Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Imad Adamestam
- grid.4305.20000 0004 1936 7988Edinburgh Clinical Trials Unit, Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Rona Sharp
- grid.4305.20000 0004 1936 7988Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Holly Ennis
- grid.4305.20000 0004 1936 7988Edinburgh Clinical Trials Unit, Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Andrew Heed
- grid.420004.20000 0004 0444 2244Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle, UK
| | - Robin Williams
- grid.4305.20000 0004 1936 7988Institute for the Study of Science, Technology and Innovation, University of Edinburgh, Edinburgh, UK
| | - Kathrin Cresswell
- grid.4305.20000 0004 1936 7988Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Omara Dogar
- grid.4305.20000 0004 1936 7988Usher Institute, University of Edinburgh, Edinburgh, UK ,grid.5685.e0000 0004 1936 9668Department of Health Sciences, University of York, York, UK
| | - Sarah Pontefract
- grid.6572.60000 0004 1936 7486Institute of Clinical Sciences, University of Birmingham, Birmingham, UK
| | - Jamie Coleman
- grid.6572.60000 0004 1936 7486Institute of Clinical Sciences, University of Birmingham, Birmingham, UK
| | - Richard Lilford
- grid.6572.60000 0004 1936 7486University of Birmingham, Birmingham, UK
| | - Neil Watson
- grid.420004.20000 0004 0444 2244Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle, UK ,NHS Covid Vaccine North East and North Cumbria, Carlisle, UK
| | - Ann Slee
- grid.451052.70000 0004 0581 2008NHS England, London, UK
| | - Antony Chuter
- grid.4305.20000 0004 1936 7988Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Jillian Beggs
- grid.4305.20000 0004 1936 7988Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Sarah Slight
- grid.1006.70000 0001 0462 7212School of Pharmacy, Newcastle University, Newcastle, UK
| | - James Mason
- grid.7372.10000 0000 8809 1613Warwick Medical School, University of Warwick, Coventry, UK
| | - Lucy Yardley
- grid.5337.20000 0004 1936 7603School of Psychological Science, University of Bristol, Bristol, UK ,grid.5491.90000 0004 1936 9297School of Psychology, University of Southampton, Southampton, UK
| | - Aziz Sheikh
- grid.4305.20000 0004 1936 7988Usher Institute, University of Edinburgh, Edinburgh, UK
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Krishnan N, Siddiqi K, Dogar O, Gabe R, Keding A. Predictors of long-term smoking abstinence in TB patients. Int J Tuberc Lung Dis 2022; 26:1074-1076. [DOI: 10.5588/ijtld.22.0236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Affiliation(s)
- N. Krishnan
- Department of Prevention and Community Health, Milken Institute School of Public Health, The George Washington University, Washington, DC, USA
| | - K. Siddiqi
- Department of Health Sciences, University of York, York, USA, Hull York Medical School, York, USA
| | - O. Dogar
- Department of Health Sciences, University of York, York, USA, Usher Institute, University of Edinburgh, Edinburgh, Scotland
| | - R. Gabe
- Centre for Evaluation and Methods, Wolfson Institute of Population Health, Queen Mary University of London, London, UK
| | - A. Keding
- Department of Health Sciences, University of York, York, USA
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Li J, Parrott S, Keding A, Dogar O, Gabe R, Marshall AM, Huque R, Barua D, Fatima R, Khan A, Zahid R, Mansoor S, Kotz D, Boeckmann M, Elsey H, Kralikova E, Readshaw A, Sheikh A, Siddiqi K. Cost-utility of cytisine for smoking cessation over and above behavioural support in people with newly diagnosed pulmonary tuberculosis: an economic evaluation of a multicentre randomised controlled trial. BMJ Open 2022; 12:e049644. [PMID: 36028279 PMCID: PMC9422837 DOI: 10.1136/bmjopen-2021-049644] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVES To assess the cost-effectiveness of cytisine over and above brief behavioural support (BS) for smoking cessation among patients who are newly diagnosed with pulmonary tuberculosis (TB) in low-income and middle-income countries. DESIGN An incremental cost-utility analysis was undertaken alongside a 12-month, double-blind, two-arm, individually randomised controlled trial from a public/voluntary healthcare sector perspective with the primary endpoint at 6 months post randomisation. SETTING Seventeen subdistrict hospitals in Bangladesh and 15 secondary care hospitals in Pakistan. PARTICIPANTS Adults (aged ≥18 years in Bangladesh and ≥15 years in Pakistan) with pulmonary TB diagnosed within the last 4 weeks who smoked tobacco daily (n=2472). INTERVENTIONS Two brief BS sessions with a trained TB health worker were offered to all participants. Participants in the intervention arm (n=1239) were given cytisine (25-day course) while those in the control arm (n=1233) were given placebo. No significant difference was found between arms in 6-month abstinence. PRIMARY AND SECONDARY OUTCOME MEASURES Costs of cytisine and BS sessions were estimated based on research team records. TB treatment costs were estimated based on TB registry records. Additional smoking cessation and healthcare costs and EQ-5D-5L data were collected at baseline, 6-month and 12-month follow-ups. Costs were presented in purchasing power parity (PPP) adjusted US dollars (US$). Quality-adjusted life years (QALYs) were derived from the EQ-5D-5L. Incremental total costs and incremental QALYs were estimated using regressions adjusting for respective baseline values and other baseline covariates. Uncertainty was assessed using bootstrapping. RESULTS Mean total costs were PPP US$57.74 (95% CI 49.40 to 83.36) higher in the cytisine arm than in the placebo arm while the mean QALYs were -0.001 (95% CI -0.004 to 0.002) lower over 6 months. The cytisine arm was dominated by the placebo arm. CONCLUSIONS Cytisine plus BS for smoking cessation among patients with TB was not cost-effective compared with placebo plus BS. TRIAL REGISTRATION NUMBER ISRCTN43811467.
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Affiliation(s)
- Jinshuo Li
- Department of Health Sciences, University of York, York, North Yorkshire, UK
| | - Steve Parrott
- Department of Health Sciences, University of York, York, North Yorkshire, UK
| | - Ada Keding
- Department of Health Sciences, University of York, York, North Yorkshire, UK
| | - Omara Dogar
- Department of Health Sciences, University of York, York, North Yorkshire, UK
- Usher Institute, The University of Edinburgh, Edinburgh, UK
| | - Rhian Gabe
- Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Queen Mary University of London, London, UK
| | - Anna-Marie Marshall
- Department of Health Sciences, University of York, York, North Yorkshire, UK
| | - Rumana Huque
- Department of Economics, University of Dhaka, Dhaka, Bangladesh
- ARK Foundation, Dhaka, Bangladesh
| | | | - Razia Fatima
- TB/HIV and Malaria Common Management Unit, Global Fund Grant, Islamabad, Pakistan
| | | | | | - Sonia Mansoor
- Institute of Psychiatry, Rawalpindi Medical University, Rawalpindi, Pakistan
| | - Daniel Kotz
- Usher Institute, The University of Edinburgh, Edinburgh, UK
- Institute of General Practice, Addiction Research and Clinical Epidemiology Unit, Medical Faculty, Heinrich-Heine-Universität Düsseldorf, Dusseldorf, Nordrhein-Westfalen, Germany
- Department of Family Medicine, CAPHRI School for Public Health and Primary Care, Maastricht University, Maastricht, The Netherlands
| | - Melanie Boeckmann
- Department of Health Sciences, University of York, York, North Yorkshire, UK
- Institute of General Practice, Addiction Research and Clinical Epidemiology Unit, Medical Faculty, Heinrich-Heine-Universität Düsseldorf, Dusseldorf, Nordrhein-Westfalen, Germany
| | - Helen Elsey
- Department of Health Sciences, University of York, York, North Yorkshire, UK
| | - Eva Kralikova
- Institute of Hygiene and Epidemiology, First Faculty of Medicine, Charles University and the General University Hospital in Prague, Praha, Czech Republic
- 3rd Medical Department, First Faculty of Medicine, Charles University and General University Hospital in Prague, Praha, Czech Republic
| | - Anne Readshaw
- Department of Health Sciences, University of York, York, North Yorkshire, UK
| | - Aziz Sheikh
- Usher Institute, The University of Edinburgh, Edinburgh, UK
| | - Kamran Siddiqi
- Department of Health Sciences, University of York, York, North Yorkshire, UK
- Hull York Medical School, University of York, York, North Yorkshire, UK
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Forberger S, Khan Z, Ahmad F, Ahmed F, Frense J, Kampfmann T, Ullah S, Dogar O, Siddiqi K, Zeeb H. Scoping Review of Existing Evaluations of Smokeless Tobacco Control Policies: What Is Known About Countries Covered, Level of Jurisdictions, Target Groups Studied, and Instruments Evaluated? Nicotine Tob Res 2022; 24:1344-1354. [PMID: 35428887 DOI: 10.1093/ntr/ntac102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Revised: 03/17/2022] [Accepted: 04/12/2022] [Indexed: 11/13/2022]
Abstract
OBJECTIVE The implementation of smokeless tobacco control policies lags behind those for smoking. This scoping review summarizes the studies that evaluated public policies on smokeless tobacco regulation (SLT) and provides an overview of the jurisdictional level, target groups, and policy instruments. METHODS Seven databases were systematically searched for studies reporting on public policies regulating SLT. Two reviewers independently screened all studies. Data extraction was performed using a predefined extraction form. Extraction was replicated for 10% of the identified studies for quality assurance. A narrative synthesis of the included studies was used to analyze and interpret the data. The protocol was published beforehand with the Open Science Foundation (OSF). RESULTS Fourty articles comprising 41 studies were included. Most of the studies reported in the articles were conducted in the United States (n = 17) or India (n = 14). Most studies reported outcomes for students (n = 8), retailers/sellers (n = 8), and users/former users (n = 5). The impact of public policies on smokeless tobacco use, in general, was most frequently assessed (n = 9), followed by the impact of taxes (n = 7), product bans (n = 6), sales/advertising bans near educational institutions (n = 4), and health warnings (n = 3) on consumer behavior. CONCLUSIONS There are significant gaps in the evaluation of smokeless tobacco regulation studies that need to be filled by further research to understand the observed outcomes. WHO reporting on Framework Convention on Tobacco Control (FCTC) implementation should be linked to studies evaluating smokeless tobacco control measures at all levels of jurisdictions and in countries not members of the WHO FCTC or do not provide data. IMPLICATION Large gaps in the evaluation of SLT control policies exist. For some countries, WHO FCTC evaluations are available for different levels of jurisdictions. In countries with a strong federal structure, there is a lack of data beyond the national level to provide a more detailed look at compliance, indirect effects, or implementation gaps. More research is needed at all levels of jurisdictions, which add to the work of the WHO to understand what works for which target group, how the different levels of jurisdiction interact, how the real-world context can be incorporated, and what indirect effects may occur.
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Affiliation(s)
- Sarah Forberger
- Department Prevention and Evaluation, Leibniz Institute for Prevention Research and Epidemiology - BIPS, Achterstrasse 30, 28359 Bremen, Germany
| | - Z Khan
- Office of Research, Innovation, and Commercialization (ORIC), Khyber Medical University, Phase 5 Hayatabad, Peshawar, Khyber Pakhtunkhwa, Pakistan
| | - F Ahmad
- Faculty Institute of Public Health & Social Sciences, Khyber Medical University, F1 Phase-6 Rd, Phase 5 Hayatabad, Peshawar, Khyber Pakhtunkhwa 25100, Pakistan
| | - F Ahmed
- Department Prevention and Evaluation, Leibniz Institute for Prevention Research and Epidemiology - BIPS, Achterstrasse 30, 28359 Bremen, Germany
| | - J Frense
- Department Prevention and Evaluation, Leibniz Institute for Prevention Research and Epidemiology - BIPS, Achterstrasse 30, 28359 Bremen, Germany
| | - T Kampfmann
- Institute for Ethics and Transdisciplinary Sustainability Research, Leuphana University Universitätsallee 1, 21335 Lüneburg, Germany
| | - S Ullah
- Office of Research Innovation and Commercialization, Khyber Medical University Peshawar; Phase 5 Hayatabad, Peshawar, Khyber Pakhtunkhwa, Pakistan
| | - O Dogar
- Department of Health Sciences, University of York, Heslington, York YO10 5DD, UK
- Usher Institute, The University of Edinburgh, Old College, South Bridge, Edinburgh EH8 9YLUK
| | - K Siddiqi
- Department of Health Sciences, University of York, Heslington, York YO10 5DD, UK
- Hull York Medical School, John Hughlings Jackson Building, University Rd, Heslington, York YO10 5DD, UK
| | - H Zeeb
- Department Prevention and Evaluation, Leibniz Institute for Prevention Research and Epidemiology - BIPS, Achterstrasse 30, 28359 Bremen, Germany
- Health Sciences Bremen, University of Bremen, 28359 Bremen, Germany
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8
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Salloum RG, Rojewski AM, Piper ME, Blalock JA, Borrelli B, Boyce LM, Minnix JA, Dogar O, Tomko RL, Jorenby DE, Kotsen C, Ostroff JS. Reporting Treatment Fidelity in Behavioral Tobacco Treatment Clinical Trials: Scoping Review and Measurement Recommendations. Nicotine Tob Res 2022; 24:150-159. [PMID: 34197617 PMCID: PMC9013002 DOI: 10.1093/ntr/ntab140] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2021] [Accepted: 06/29/2021] [Indexed: 11/13/2022]
Abstract
INTRODUCTION Adoption of rigorous standards for reporting treatment fidelity is essential for advancing discovery, validation, and implementation of behavioral treatments. Whereas the NIH Behavior Change Consortium (BCC) developed an assessment tool to assess the quality of reporting and monitoring of treatment fidelity across health behavior change interventions, it has not yet been applied specifically to treatment fidelity in behavioral tobacco treatment trials. AIMS AND METHODS We conducted a scoping review of peer-reviewed, clinical trials of behavioral adult tobacco treatment interventions published in English between 2006 and 2018. Using the BCC treatment fidelity checklist, articles were coded for the presence or absence of various treatment fidelity strategies within each of 5 domains: Design, Training, Delivery, Receipt, and Enactment. Eligible articles (N = 755) were coded by two independent coders. RESULTS The proportion of reporting strategies varied within the fidelity domains, ranging from 5.2% to 96.3% in Design, 1.9% to 24.9% in Training, 2.6% to 32.3% in Delivery, 5.2% to 44.3% in Receipt, and 6.7% to 43.2% in Enactment. The mean proportion of adherence to treatment fidelity strategies within each domain was: Design (68%), Training (14%), Delivery (15%), Receipt (16%), and Enactment (25%). Only 11 studies achieved ≥80% reporting across >1 fidelity domain. There was no evidence for improvement in fidelity reporting across the 13-year time frame from the initial BCC publication to the present. CONCLUSIONS These findings illustrate the lack of consistency in fidelity reporting in tobacco treatment trials and underscore the challenges faced in evaluating rigor and reproducibility, as well as interpretation and dissemination of findings. Recommendations are made for improving fidelity reporting in tobacco treatment trials. IMPLICATIONS The SRNT Treatment Research Network sponsored a scoping review to summarize the current state of reporting treatment fidelity and make recommendations for best practices in reporting fidelity in tobacco treatment trials. The review identified a lack of consistency in fidelity reporting, illustrating the challenges faced in evaluating rigor, and reproducibility, as well as interpretation and dissemination of findings.
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Affiliation(s)
- Ramzi G Salloum
- Department of Health Outcomes and Biomedical Informatics, University of Florida, College of Medicine, Gainesville, FL, USA
| | - Alana M Rojewski
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC, USA
| | - Megan E Piper
- Center for Tobacco Research and Intervention, University of Wisconsin-Madison, Madison, WI, USA
| | - Janice A Blalock
- Department of Behavioral Science, University of Texas, MD Anderson Cancer Center, Houston, TX, USA
| | - Belinda Borrelli
- Center for Behavioral Science Research, Boston University, Henry M. Goldman School of Dental Medicine, Boston, MA, USA
| | - Lindsay M Boyce
- Department of Psychiatry and Behavioral Science, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Jennifer A Minnix
- Department of Behavioral Science, University of Texas, MD Anderson Cancer Center, Houston, TX, USA
| | - Omara Dogar
- Department of Health Sciences, University of York, York, United Kingdom
| | - Rachel L Tomko
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC, USA
| | - Douglas E Jorenby
- Center for Tobacco Research and Intervention, University of Wisconsin-Madison, Madison, WI, USA
| | - Chris Kotsen
- Department of Psychiatry and Behavioral Science, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Jamie S Ostroff
- Department of Psychiatry and Behavioral Science, Memorial Sloan Kettering Cancer Center, New York, NY, USA
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Faisal MR, Mishu MP, Jahangir F, Younes S, Dogar O, Siddiqi K, Torgerson DJ. The effectiveness of behaviour change interventions delivered by non-dental health workers in promoting children’s oral health: A systematic review and meta-analysis. PLoS One 2022; 17:e0262118. [PMID: 35015771 PMCID: PMC8751985 DOI: 10.1371/journal.pone.0262118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2021] [Accepted: 12/17/2021] [Indexed: 11/18/2022] Open
Abstract
Objectives
Dental caries is the most common preventable childhood condition. Non-dental professionals and health workers are often well placed to support parents in adopting positive oral health behaviours for their children. The aim of this study was to determine the effectiveness of behaviour change interventions and their individual component behaviour change techniques (BCTs), that were delivered by non-dental professionals and health workers.
Methods
A systematic search of Ovid MEDLINE, PubMed, CINAHL, Cochrane Library, Web of Science, TRoPHI and PROQUEST from inception until March 2021 was conducted. Randomised controlled trials and quasi-experimental studies for improving oral health outcomes in children were included. Quality assessment was carried out using Cochrane Risk of Bias tool and ROBINS-I tool. Publication bias was assessed using funnel plots and Egger’s regression intercept. Effect sizes were estimated as standardised mean difference (SMD) and odds ratio/risk ratio for proportions. Meta-analyses were performed for studies reporting mean decayed, missing, filled surfaces (dmfs) and mean decayed, missing, filled, teeth (dmft) indices. Behaviour change technique coding was performed using behaviour change technique taxonomy v1 (BCTTv1).
Results
Out of the 9,101 records retrieved, 36 studies were included with 28 showing a significant effect either in clinical and/or behavioural/knowledge outcomes. Most studies (n = 21) were of poor methodological quality. The pooled SMD for caries experience showed statistically significant result for caries prevention at surface level -0.15 (95% CI -0.25, -0.04) and at the tooth level -0.24 (95% CI -0.42, -0.07). In 28 effective interventions, 27 individual BCTs were identified and the most frequently used were: “Instructions on how to perform the behaviour” and “Information about health consequences”.
Conclusion
There is low quality of evidence suggesting non-dental professionals and health workers may help improve oral health outcomes for children. To confirm these findings, further high-quality studies incorporating a variety of BCTs in their interventions for adoption of good oral health behaviours are needed.
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Affiliation(s)
- Mehreen Riaz Faisal
- Department of Health Sciences, University of York, York, United Kingdom
- * E-mail:
| | | | - Faisal Jahangir
- Department of Oral Medicine, Margalla Institute of Health Sciences, Rawalpindi, Pakistan
| | - Sabahat Younes
- Department of Community Health & Wellbeing, University of Central Lancashire, Preston, United Kingdom
| | - Omara Dogar
- Department of Health Sciences, University of York, York, United Kingdom
- Usher Institute, The University of Edinburgh, Edinburgh, United Kingdom
| | - Kamran Siddiqi
- Department of Health Sciences, University of York, York, United Kingdom
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Siddiqi K, Keding A, Marshall AM, Dogar O, Li J, Huque R, Fatima R, Khan A, Elsey H, Gabe R, Kotz D, Sheikh A. Effect of quitting smoking on health outcomes during treatment for tuberculosis: secondary analysis of the TB & Tobacco Trial. Thorax 2022; 77:74-78. [PMID: 34272336 DOI: 10.1136/thoraxjnl-2020-215926] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2020] [Accepted: 06/24/2021] [Indexed: 01/10/2023]
Abstract
BACKGROUND Despite treatment, patients with tuberculosis (TB) who smoke have poorer outcomes compared with non-smokers. It is unknown, however, if quitting smoking during the 6 months of TB treatment improves TB outcomes. METHODS The TB & Tobacco Trial was a double-blind, placebo-controlled randomised trial of cytisine for smoking cessation in 2472 patients with pulmonary TB in Bangladesh and Pakistan. In a secondary analysis, we investigated the hypothesis that smoking cessation improves health outcomes in patients during the TB treatment course. The outcomes included an eight-point TB clinical score, sputum conversion rates, chest X-ray grades, quality of life (EQ-5D-5L), TB cure plus treatment completion rates and relapse rates. These were compared between those who stopped smoking and those who did not, using regression analysis. RESULTS We analysed the data of 2273 (92%) trial participants. Overall, 25% (577/2273) of participants stopped smoking. Compared with non-quitters, those who quit had better TB cure plus treatment completion rates (91% vs 80%, p<0.001) and lower TB relapse rates (6% vs 14%, p<0.001). Among quitters, a higher sputum conversion rate at week 9 (91% vs 87%, p=0.036), lower mean TB clinical scores (-0.20 points, 95% CI -0.31 to -0.08, p=0.001) and slightly better quality of life (mean EQ-5D-5L 0.86 vs 0.85, p=0.015) at 6 months were also observed. These differences, except quality of life, remained statistically significant after adjusting for baseline values, trial arm and TB treatment adherence rates. CONCLUSION Patients with TB who stop smoking may have better outcomes than those who don't. Health professionals should support patients in stopping smoking.
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Affiliation(s)
- Kamran Siddiqi
- Health Sciences, University of York, York, UK
- Hull York Medical School, York, UK
| | - Ada Keding
- Health Sciences, University of York, York, UK
| | | | - Omara Dogar
- Health Sciences, University of York, York, UK
| | - Jinshuo Li
- Health Sciences, University of York, York, UK
| | - Rumana Huque
- Economics, Dhaka University, Dhaka, Bangladesh
- Research and Development, ARK Foundation, Dhaka, Bangladesh
| | - Razia Fatima
- Common Unit (HIV,TB,Malaria), Pakistan Ministry of National Health Services, Regulation and Coordination, Islamabad, Pakistan
| | - Amina Khan
- Research, The Initiative, Islamabad, Pakistan
| | - Helen Elsey
- Health Sciences, University of York, York, UK
- Hull York Medical School, York, UK
| | - Rhian Gabe
- Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Queen Mary University of London, London, UK
| | - Daniel Kotz
- Institute of General Practice, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Aziz Sheikh
- Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, UK
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Mishu MP, Elsey H, Choudhury AR, Dastagir S, Khan S, Tahsin T, Suma HM, Karmaker R, Dogar O. Co-producing an intervention for tobacco cessation and improvement of oral health among diabetic patients in Bangladesh. BMC Oral Health 2021; 21:516. [PMID: 34641838 PMCID: PMC8507134 DOI: 10.1186/s12903-021-01861-0] [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] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2021] [Accepted: 09/29/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Tobacco consumption is a major risk factor for many diseases including diabetes and has deleterious effects on oral health. Diabetic patients are vulnerable to developing certain oral conditions. So far, no studies have attempted to co-develop a tobacco cessation intervention to be delivered in dental clinics for people with diabetes in Bangladesh. AIM To co-produce a tobacco cessation intervention for people with diabetes for use in dental clinics in Bangladesh. OBJECTIVES To assess: (1) tobacco use (patterns) and perceptions about receiving tobacco cessation support from dentists among people with diabetes attending the dental department of Bangladesh Institute of Research and Rehabilitation in Diabetes, Endocrine and Metabolic Disorders (BIRDEM) who smoke or use smokeless tobacco (ST) (2) current tobacco cessation support provision by the dentists of the dental department of BIRDEM (3) barriers and facilitators of delivering a tobacco cessation intervention at a dental clinic, and (4) to co-produce a tobacco cessation intervention with people with diabetes, and dentists to be used in the proposed context. METHODS The study was undertaken in two stages in the dental department of BIRDEM, which is the largest diabetic hospital in Bangladesh. Stage 1 (July-August 2019) consisted of a cross-sectional survey among people with diabetes who use tobacco to address objective 1, and a survey and workshop with dentists working in BIRDEM, and consultations with patients to address objectives 2 and 3. Stage 2 (January 2020) consisted of consultations with patients attending BIRDEM, and a workshop with dentists to co-produce the intervention. RESULT All survey participants (n = 35) were interested in receiving tobacco cessation support from their dentist. We identified important barriers and facilitators to deliver tobacco cessation intervention within dental services. Barriers reported by dentists included lack of a structured support system and lack of training. As a facilitator, we identified that dentists were willing to provide support and it would be feasible to deliver tobacco cessation intervention if properly designed and embedded in the routine functioning of the dental department of BIRDEM. Through the workshops and consultations at stage 2, a tobacco cessation intervention was co-developed. The intervention included elements of brief cessation advice (using a flipbook and a short video on the harmful effects of tobacco) and pharmacotherapy. CONCLUSION Incorporation of tobacco cessation within dental care for people with diabetes was considered feasible and would provide a valuable opportunity to support this vulnerable group in quitting tobacco.
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Affiliation(s)
- Masuma Pervin Mishu
- Department of Health Sciences, University of York, Heslington, York, YO10 5DD, UK.
| | - Helen Elsey
- Department of Health Sciences, University of York, Heslington, York, YO10 5DD, UK
| | - Arup Ratan Choudhury
- Department of Dentistry, Bangladesh Institute of Research and Rehabilitation in Diabetes, Endocrine and Metabolic Disorders (BIRDEM), Dhaka, Bangladesh
| | - Shahana Dastagir
- Department of Dentistry, Bangladesh Institute of Research and Rehabilitation in Diabetes, Endocrine and Metabolic Disorders (BIRDEM), Dhaka, Bangladesh
| | - Saeed Khan
- Department of Dentistry, Bangladesh Institute of Research and Rehabilitation in Diabetes, Endocrine and Metabolic Disorders (BIRDEM), Dhaka, Bangladesh
| | - Tania Tahsin
- Department of Dentistry, Bangladesh Institute of Research and Rehabilitation in Diabetes, Endocrine and Metabolic Disorders (BIRDEM), Dhaka, Bangladesh
| | - Hena Moni Suma
- Department of Dentistry, Bangladesh Institute of Research and Rehabilitation in Diabetes, Endocrine and Metabolic Disorders (BIRDEM), Dhaka, Bangladesh
| | - Rajesh Karmaker
- Department of Dentistry, Bangladesh Institute of Research and Rehabilitation in Diabetes, Endocrine and Metabolic Disorders (BIRDEM), Dhaka, Bangladesh
| | - Omara Dogar
- Department of Health Sciences, University of York, Heslington, York, YO10 5DD, UK
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Dogar O, Vidyasagaran A. Supporting tobacco cessation in tuberculosis patients. Indian J Tuberc 2021; 68S:S89-S92. [PMID: 34538399 DOI: 10.1016/j.ijtb.2021.08.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Revised: 07/15/2021] [Accepted: 08/06/2021] [Indexed: 11/24/2022]
Abstract
Tobacco is a key determinant of health inequalities, both across and within countries. 80% of tobacco users live in economically developing countries, which also face a huge tuberculosis (TB) burden. TB being an archetypal disease, affects low income groups, and has a higher proportion of smokers than the general population. The sub-group of TB patients who smoke disproportionately suffer from poorer outcomes, despite treatment. Behavioural interventions aimed at helping smokers quit by modifying their health beliefs and attitudes are highly successful in TB patients. However, integrating them in routine TB care is challenging, and requires a cultural shift at several levels, including individual, structural and organisational. We offer recommendations for policy, practice and research to address the dual burden of tobacco use and TB. Acting on these are vital towards achieving the United Nations (UN) Sustainable Development Goal (SDG) target of ending the TB epidemic by 2030.
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Affiliation(s)
- Omara Dogar
- University of York, Department of Health Sciences, YO10 5DD, York, United Kingdom; The University of Edinburgh, Usher Institute, EH8 9AG, Edinburgh, United Kingdom.
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Mishu MP, Siddiqui F, Shukla R, Kanaan M, Dogar O, Siddiqi K. Predictors of Cigarette Smoking, Smokeless Tobacco Consumption, and Use of both forms in Adolescents in South Asia: A Secondary Analysis of the Global Youth Tobacco Surveys. Nicotine Tob Res 2021; 23:956-965. [PMID: 33022045 DOI: 10.1093/ntr/ntaa202] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Accepted: 09/29/2020] [Indexed: 11/14/2022]
Abstract
INTRODUCTION Tobacco uptake in adolescents is associated with a range of predictors. We examined the predictors of cigarette smoking, smokeless tobacco (ST) consumption, and use of both ST and cigarettes among adolescents in four South Asian countries. METHODS We analyzed the Global Youth Tobacco Surveys (GYTS) data for Bangladesh (2013), India (2009), Pakistan (2013), and Sri Lanka (2015), using multinomial regression to examine associations between several predictors and tobacco use. RESULTS Data from 23 681 adolescents were analyzed. Overall, 82.8% of the study population were between 13 and 15 years and 52.7% were girls, 2% were cigarette smokers, 6.5% were ST users, and 1.1% used both ST and cigarettes, in the past 30 days. Exposure to smoking in public places was associated with past 30-day smoking (relative risk ratio [RRR] 5.59, 95% confidence intervals [CI] 4.28-7.28), ST use (RRR 2.07, 95% CI 1.84-2.32), and use of both ST and cigarettes (RRR 11.42, 95% CI 7.44-17.54). Exposure to tobacco use in electronic media and being offered free tobacco products were associated with all forms of tobacco use. Shopkeepers' refusal to sell cigarettes protected adolescents from smoking (RRR 0.47, 95% CI 0.36-0.63) and ST use (RRR 0.65, 95% CI 0.45-0.95). However, exposure to antitobacco mass media messages was not protective for any form of tobacco use. Adolescents taught at school about harmful effects of tobacco were less likely to use ST; no evidence of this association was observed for smoking. CONCLUSION The associations between tobacco use and protobacco factors were strong, but the associations with antitobacco factors lacked strength and consistency in this study population. IMPLICATIONS The predictors of adolescents using different tobacco products, crucial to inform and evaluate tobacco control efforts, are poorly understood. We investigated the associations between several environmental-level factors and cigarette smoking, ST consumption, and use of both forms among adolescents, whereas most of the previous studies focused on individual-level factors. Our study found strong associations between tobacco use and protobacco factors and lack of strength and consistency in associations between antitobacco factors and tobacco use in the study population. Our results indicate that the current tobacco control policies need strengthening to curb the tobacco epidemic in these countries.
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Affiliation(s)
| | - Faraz Siddiqui
- Department of Health Science, University of York, York, UK
| | - Radha Shukla
- Department of Health Science, University of York, York, UK
| | - Mona Kanaan
- Department of Health Science, University of York, York, UK
| | - Omara Dogar
- Department of Health Science, University of York, York, UK
- Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Kamran Siddiqi
- Department of Health Science, University of York, York, UK
- Centre for Health and Population Sciences, Hull York Medical School, University of York, York, UK
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14
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Boeckmann M, Dogar O, Saeed S, Majidulla A, Swami S, Khan A, Siddiqi K, Kotz D. Measuring fidelity to delivery of a new smoking cessation intervention integrated into routine tuberculosis care in Pakistan and Bangladesh: Contextual differences and opportunities. Tob Induc Dis 2021; 19:24. [PMID: 33841063 PMCID: PMC8029647 DOI: 10.18332/tid/133054] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Revised: 01/10/2021] [Accepted: 02/04/2021] [Indexed: 01/29/2023] Open
Abstract
INTRODUCTION Tobacco smoking among tuberculosis (TB) patients leads to poorer treatment outcomes. Smoking cessation support should be integrated into routine TB care. We measured healthcare providers' fidelity to a smoking cessation intervention integrated into routine TB care, in Bangladesh and Pakistan. We aimed to understand the role of providers and settings in the implementation of behavior support (BS) messages for TB and smoking cessation. METHODS The integrated BS intervention was implemented in TB clinics (24 public and 1 private). Cross-sectional data were collected on the fidelity of delivery of the BS intervention using a predefined fidelity index based on an existing validated method of measuring intervention fidelity. Audio-recordings of patient-provider BS sessions were coded using the fidelity index. Intervention fidelity was presented as the proportion of sessions that implemented BS messages. RESULTS A total of 96 sessions were conducted, 37 in Bangladesh and 59 in Pakistan. In public settings, TB medication advice was offered in 91.9% (95% CI: 78.7- 97.2) of sessions in Bangladesh, and in 75.5% (95% CI: 62.4-85.1) of sessions in Pakistan; whilst it was offered in 83.3% (95% CI: 43.7-97.0) of sessions in the private setting in Pakistan. Patients' smoking status was assessed in 70.3% (95% CI: 54.2-82.5) of sessions in Bangladesh, and in 34.0% (95% CI: 22.7-47.4) of sessions in the public setting and in 66.7% (95% CI: 30.0-90.3) of sessions in the private setting in Pakistan. A quit date was set in 32.4% (95% CI: 19.6-48.5) of all sessions in Bangladesh, and in 33.3% (95% CI: 9.6-70.0) of all sessions in the public setting in Pakistan. CONCLUSIONS Fidelity to the intended delivery of the intervention was found to be high for TB-related messages but not for smoking cessation messages. Clinic contexts may play a mediating role in health workers' opportunities to deliver the intervention as planned. TRIAL REGISTRATION International Standard Randomized Clinical Trial Number (ISRCTN43811467). Registered 23 March 2016, https://doi.org/10.1186/ISRCTN43811467.
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Affiliation(s)
- Melanie Boeckmann
- School of Public Health, Bielefeld University, Bielefeld, Germany
- Department of Health Sciences, University of York, York, United Kingdom
- Addiction Research and Clinical Epidemiology Unit, Institute of General Practice, Medical Faculty of the Heinrich-Heine-University, Düsseldorf, Germany
| | - Omara Dogar
- Department of Health Sciences, University of York, York, United Kingdom
- Usher Institute, University of Edinburgh, Edinburgh, United Kingdom
| | | | | | - Shilpi Swami
- Department of Health Sciences, University of York, York, United Kingdom
- Evidera, London, United Kingdom
| | | | - Kamran Siddiqi
- Department of Health Sciences, University of York, York, United Kingdom
- Hull York Medical School, University of York, York, United Kingdom
| | - Daniel Kotz
- Addiction Research and Clinical Epidemiology Unit, Institute of General Practice, Medical Faculty of the Heinrich-Heine-University, Düsseldorf, Germany
- Usher Institute, University of Edinburgh, Edinburgh, United Kingdom
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Siddiqi K, Islam Z, Khan Z, Siddiqui F, Mishu M, Dogar O, Shah V, Khan J, Pokhrel S, Iqbal R, Bauld L, Sheikh A, Grugel J. Identification of Policy Priorities to Address the Burden of Smokeless Tobacco in Pakistan: A Multimethod Analysis. Nicotine Tob Res 2021; 22:2262-2265. [PMID: 31570940 PMCID: PMC7733056 DOI: 10.1093/ntr/ntz163] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Accepted: 08/27/2019] [Indexed: 12/14/2022]
Abstract
Introduction We assessed the magnitude of smokeless tobacco (ST) use in Pakistan and identified policy gaps to help ascertain short-, medium-, and long-term priorities. We then elicited stakeholders’ views as to which of these identified priorities are most important. Methods In a multimethod study, we: analyzed Global Tobacco Surveillance System data sets to estimate ST consumption and disease burden; conducted a documentary review to identify gaps in policies to control ST in comparison with smoking; elicited stakeholders’ views in an interactive workshop to identify a set of policy options available to address ST burden in Pakistan; and ranked policy priorities using a postevent survey. Results Among all tobacco users in Pakistan (n = 24 million), one-third of men and two-thirds of women consume ST. In 2017, its use led to an estimated 18 711 deaths due to cancer and ischemic heart disease. Compared to smoking, policies to control ST lag behind significantly. Priority areas for ST policies included: banning ST sale to and by minors, advocacy campaigns, introduction of licensing, levying taxes on ST, and standardizing ST packaging. A clear commitment to close cooperation between state actors and stakeholder groups is needed to create a climate of support and information for effective policy making. Conclusions Smokeless tobacco control in Pakistan should focus on four key policy instruments: legislation, education, fiscal policies, and quit support. More research into the effectiveness of such policies is also needed. Implications A number of opportunities to improve ST regulation in Pakistan were identified. Among these, immediate priorities include banning ST sale to and by minors, mobilizing advocacy campaign, introduction of licensing through the 1958 Tobacco Vendors Act, levying taxes on ST, and standardizing ST packaging.
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Affiliation(s)
- Kamran Siddiqi
- Department of Health Sciences, University of York, York YO10 5DD, UK
| | - Ziauddin Islam
- Tobacco Control Cell, Ministry of National Health Services, Regulation and Coordination, Islamabad, Pakistan
| | - Zohaib Khan
- Office of Research Innovation and Commercialization, Khyber Medical University, Peshawar, Pakistan
| | - Faraz Siddiqui
- Department of Health Sciences, University of York, York YO10 5DD, UK
| | - Masuma Mishu
- Department of Health Sciences, University of York, York YO10 5DD, UK
| | - Omara Dogar
- Department of Health Sciences, University of York, York YO10 5DD, UK
| | - Vandana Shah
- Campaign for Tobacco Free Kids, Washington, DC 20005
| | - Javaid Khan
- Department of Medicine, Aga Khan University, Karachi, Pakistan
| | - Subhash Pokhrel
- Department of Clinical Sciences, Brunel University London, Uxbridge, Middlesex UB8 3PH, UK
| | - Romaina Iqbal
- Department of Community Health Sciences, Aga Khan University, Karachi, Pakistan
| | - Linda Bauld
- Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh EH8 9DX, UK
| | - Aziz Sheikh
- Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh EH8 9DX, UK
| | - Jean Grugel
- Department of Politics, University of York, York YO10 5DD, UK
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Arora M, Chugh A, Jain N, Mishu M, Boeckmann M, Dahanayake S, Eckhardt J, Forberger S, Huque R, Kanaan M, Khan Z, Mehrotra R, Rahman MA, Readshaw A, Sheikh A, Siddiqi K, Vidyasagaran A, Dogar O. Global impact of tobacco control policies on smokeless tobacco use: a systematic review protocol. BMJ Open 2020; 10:e042860. [PMID: 33361080 PMCID: PMC7768955 DOI: 10.1136/bmjopen-2020-042860] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Revised: 10/15/2020] [Accepted: 12/02/2020] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Smokeless tobacco (ST) was consumed by 356 million people globally in 2017. Recent evidence shows that ST consumption is responsible for an estimated 652 494 all-cause deaths across the globe annually. The WHO Framework Convention on Tobacco Control (FCTC) was negotiated in 2003 and ratified in 2005 to implement effective tobacco control measures. While the policy measures enacted through various tobacco control laws have been effective in reducing the incidence and prevalence of smoking, the impact of ST-related policies (within WHO FCTC and beyond) on ST use is under-researched and not collated. METHODS AND ANALYSIS A systematic review will be conducted to collate all available ST-related policies implemented across various countries and assess their impact on ST use. The following databases will be searched: Medline, EMBASE, PsycINFO, Cumulative Index to Nursing and Allied Health Literature, Scopus, EconLit, ISI Web of Science, Cochrane Library (CENTRAL), African Index Medicus, LILACS, Scientific Electronic Library Online, Index Medicus for the Eastern Mediterranean Region, Index Medicus for South-East Asia Region, Western Pacific Region Index Medicus and WHO Library Database, as well as Google search engine and country-specific government websites. All ST-related policy documents (FCTC and non-FCTC) will be included. Results will be limited to literature published since 2005 in English and regional languages (Bengali, Hindi and Urdu). Two reviewers will independently employ two-stage screening to determine inclusion. The Effective Public Health Practice Project's 'Quality Assessment Tool for Quantitative Studies' will be used to record ratings of quality and risk of bias among studies selected for inclusion. Data will be extracted using a standardised form. Meta-analysis and narrative synthesis will be used. ETHICS AND DISSEMINATION Permission for ethics exemption of the review was obtained from the Centre for Chronic Disease Control's Institutional Ethics Committee, India (CCDC_IEC_06_2020; dated 16 April 2020). The results will be disseminated through publications in a peer-reviewed journal and will be presented in national and international conferences. PROSPERO REGISTRATION NUMBER CRD42020191946.
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Affiliation(s)
- Monika Arora
- HRIDAY, New Delhi, India
- Health Promotion Division, Public Health Foundation of India, Gurugram, Haryana, India
| | | | - Neha Jain
- Health Promotion Division, Public Health Foundation of India, Gurugram, Haryana, India
| | - Masuma Mishu
- Department of Health Sciences, University of York, York, UK
| | | | - Suranji Dahanayake
- Department of Health Sciences, University of York, York, UK
- Ministry of Health, Nutrition and Indigenous Medicine, Colombo, Sri Lanka
| | | | - Sarah Forberger
- Leibniz Institute for Prevention Research and Epidemiology, Bremen, Germany
| | | | - Mona Kanaan
- Department of Health Sciences, University of York, York, UK
| | - Zohaib Khan
- Khyber Medical University, Peshawar, Pakistan
| | - Ravi Mehrotra
- Indian Council of Medical Research, India Cancer Research Consortium, New Delhi, India
| | - Muhammad Aziz Rahman
- School of Health, Federation University Australia, Berwick, Victoria, Australia
- La Trobe University, Melbourne, Victoria, Australia
| | - Anne Readshaw
- Department of Health Sciences, University of York, York, UK
| | - Aziz Sheikh
- Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Kamran Siddiqi
- Department of Health Sciences, University of York, York, UK
| | | | - Omara Dogar
- Department of Health Sciences, University of York, York, UK
- Usher Institute, University of Edinburgh, Edinburgh, UK
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Dogar O, Keding A, Gabe R, Marshall AM, Huque R, Barua D, Fatima R, Khan A, Zahid R, Mansoor S, Kotz D, Boeckmann M, Elsey H, Kralikova E, Parrott S, Li J, Readshaw A, Sheikh A, Siddiqi K. Cytisine for smoking cessation in patients with tuberculosis: a multicentre, randomised, double-blind, placebo-controlled phase 3 trial. The Lancet Global Health 2020; 8:e1408-e1417. [DOI: 10.1016/s2214-109x(20)30312-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/13/2020] [Revised: 06/19/2020] [Accepted: 06/24/2020] [Indexed: 12/17/2022]
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Marshall AM, Barua D, Mitchell A, Keding A, Huque R, Khan A, Zahid R, Dogar O, Siddiqi K. Smoking prevalence among tuberculosis patients: A crosssectional study in Bangladesh and Pakistan. Tob Induc Dis 2020; 18:70. [PMID: 32934616 PMCID: PMC7485439 DOI: 10.18332/tid/125452] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Revised: 06/09/2020] [Accepted: 07/16/2020] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION Smoking has a negative impact on TB outcomes. We estimated the proportion of TB patients who smoke and are willing to quit in two high TB burden countries, Bangladesh and Pakistan. METHODS A cross-sectional survey was conducted among TB patients to assess their eligibility and recruit them to a smoking cessation randomized controlled trial. Adults diagnosed with TB were recruited from 32 health facilities in Bangladesh and Pakistan. Data on smoking behaviour and willingness to quit were collected and analysed. RESULTS In total, 13934 TB patients completed the survey between June 2017 and April 2018. The prevalence of smoking in these TB patients was estimated to be 22.5% (95% CI: 21.8, 23.2). Moreover, the prevalence of smoking in TB patient population was 8% (RR=1.49; 95% CI: 7.1–8.9; p<0.01) and 8.3% (RR=1.24; 95% CI: 7.3–9.4; p<0.01) higher than smoking prevalence in the general population in Bangladesh and Pakistan, respectively. Among TB patients who smoke, 97.7% (95% CI: 97.2–98.2) were willing to quit. CONCLUSIONS The estimated prevalence of smoking was higher in TB patients than the general population; however, a vast majority of TB patients who smoke were willing to quit.
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Affiliation(s)
| | | | - Alex Mitchell
- Department of Health Sciences, University of York, York, United Kingdom
| | - Ada Keding
- Department of Health Sciences, University of York, York, United Kingdom
| | | | | | | | - Omara Dogar
- Department of Health Sciences, University of York, York, United Kingdom
| | - Kamran Siddiqi
- Department of Health Sciences, University of York, York, United Kingdom
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Dogar O, Boehnke JR, Lorencatto F, Sheldon TA, Siddiqi K. Measuring fidelity to behavioural support delivery for smoking cessation and its association with outcomes. Addiction 2020; 115:368-380. [PMID: 31496033 PMCID: PMC7004188 DOI: 10.1111/add.14804] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2019] [Revised: 07/16/2019] [Accepted: 09/02/2019] [Indexed: 11/28/2022]
Abstract
BACKGROUND AND AIMS Behavioural support increases smoking cessation in clinical settings, but effect sizes differ among providers, due possibly to variations in delivery. This study evaluates a measure ('fidelity index') intended to capture fidelity to delivery of content- and interaction-based items of a behavioural support (BS) for smoking cessation and the association of fidelity with quit rates. METHODS A fidelity index for scoring the adherence and quality domains of a specific BS intervention, '5As for quit', was developed by classifying the intervention components using the taxonomy of behaviour change techniques. The index was applied to code 154 BS sessions audiotaped among 18 chest clinics in Pakistan to assess their fidelity and explore reliability of coding. The association between intervention fidelity and successful quit achieved by the same providers in a previous study was explored using regression analysis. RESULTS The index represented two domains: adherence to delivery of content-based activities of 5As (37 items) and quality of interaction-based activities (eight items). The intercoder reliability was good for content-based (average Krippendorff's α = 0.80) and moderate for interaction-based (average Krippendorff's α = 0.66) items. Approximately 70% (intraclass correlation coefficient: adherence scores = 0.72, quality scores = 0.71) of variation in BS delivery was contributed by providers, which increased to 97% (g-coefficient: adherence scores = 0.973, quality scores = 0.974) after accounting for other sources of variation. Higher quit rates were positively associated with average quality scores [risk ratio = 2.15; 95% confidence interval (CI) = 1.43-3.24], but negatively associated with average adherence scores (risk ratio = 0.55; 95% CI = 0.40-0.77) within services. CONCLUSIONS The fidelity index is a reliable measure for quantifying intervention fidelity of delivering smoking cessation behavioural support. Recommended revisions of the fidelity index include incorporation of additional interaction-based items, such as the relational techniques used in motivational interviewing.
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Affiliation(s)
- Omara Dogar
- Department of Health SciencesUniversity of YorkYorkUK
- The University of Edinburgh, Usher InstituteEdinburghUK
| | - Jan R. Boehnke
- Department of Health SciencesUniversity of YorkYorkUK
- School of Nursing and Health SciencesUniversity of DundeeDundeeUK
| | | | - Trevor A. Sheldon
- Department of Health SciencesUniversity of YorkYorkUK
- Hull York Medical SchoolUniversity of YorkYorkUK
| | - Kamran Siddiqi
- Department of Health SciencesUniversity of YorkYorkUK
- Hull York Medical SchoolUniversity of YorkYorkUK
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Jawad M, Dogar O, Kanaan M, Ahluwalia J, Siddiqi K. Factors associated with dual use of waterpipe tobacco and cigarettes among adults in Pakistan. East Mediterr Health J 2020; 26:47-54. [PMID: 32043545 DOI: 10.26719/2020.26.1.47] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/09/2019] [Accepted: 07/14/2019] [Indexed: 11/09/2022]
Abstract
Background Little is known about dual use of waterpipe tobacco and cigarettes, especially in countries where both are prevalent. Aims This study aimed to assess demographic correlates, patterns of use and quit behaviours of waterpipe users in Pakistan who also smoke cigarettes. Methods Data were taken from a randomized controlled trial in Pakistan that assessed smoking cessation in 510 adult waterpipe users, stratified on concurrent cigarette use. Logistic regression analysis was done to assess the association between waterpipe tobacco users who also smoke cigarettes (dual use) and their demographic characteristics, smoking history and quit behaviour. Unadjusted odds ratios (OR) and adjusted OR (ORa) and 95% confidence intervals (CI) were determined. Results Dual use was significantly associated with younger age (ORa = 0.36, 95% CI: 0.19-0.70) and middle-school educational level (11-15 years), versus no formal education, (ORa = 2.01, 95% CI: 1.15-3.50). Dual use was also associated with smoking less than all day versus all day (defined as continuously for several hours) (ORa = 2.71, 95%: CI 1.73-4.25) and younger age at starting smoking (ORa = 0.95, 95% CI: 0.93-0.98). No association was found between dual use and sex, marital status, duration of smoking, nicotine dependence or quit history. Conclusion Waterpipe tobacco users who also smoke cigarettes differ from waterpipe-only users, particularly in demographic characteristics. More research is needed to explore the interaction between these two smoking behaviours. Health promotion and cessation interventions in Pakistan should consider tailoring their approach to account for the unique characteristics of dual waterpipe and cigarette users.
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Affiliation(s)
- Mohammed Jawad
- Public Health Policy Evaluation Unit, Imperial College London, London, United Kingdom of Great Britain and Northern Ireland
| | - Omara Dogar
- Department of Health Sciences, University of York, York, United Kingdom
| | - Mona Kanaan
- Department of Health Sciences, University of York, York, United Kingdom
| | - Jasjit Ahluwalia
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, Rhode Island, United States of America
| | - Kamran Siddiqi
- Department of Health Sciences, University of York, York, United Kingdom
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Shah S, Kanaan M, Huque R, Sheikh A, Dogar O, Thomson H, Parrott S, Siddiqi K. Secondhand Smoke Exposure in Primary School Children: A Survey in Dhaka, Bangladesh. Nicotine Tob Res 2020; 21:416-423. [PMID: 29228385 PMCID: PMC6472694 DOI: 10.1093/ntr/ntx248] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2016] [Accepted: 11/04/2017] [Indexed: 12/02/2022]
Abstract
Introduction We report on second-hand smoke (SHS) exposure based on saliva cotinine levels among children in Bangladesh—a country with laws against smoking in public places. Methods A survey of primary school children from two areas of the Dhaka district was conducted in 2015. Participants completed a questionnaire and provided saliva samples for cotinine measurement to assess SHS exposure with a cut-off range of ≥0.1ng/mL. Results Four hundred and eighty-one children studying in year-5 were recruited from 12 primary schools. Of these, 479 saliva samples were found sufficient for cotinine testing, of which 95% (453/479) were positive for recent SHS exposure. Geometric mean cotinine was 0.36 (95% CI = 0.32 to 0.40); 43% (208/479) of children lived with at least one smoker in the household. Only 21% (100/479) reported complete smoking restrictions for residents and visitors; 87% (419/479) also reported being recently exposed to SHS in public spaces. Living with a smoker and number of tobacco selling shops in the neighborhood had positive associations with recent SHS exposure. Conclusions Despite having a ban on smoking in public places, recent SHS exposure among children in Bangladesh remains very high. There is an urgent need to reduce exposure to SHS in Bangladeshi children. Implications Children bear the biggest burden of disease due to SHS exposure than any other age group. However, children living in many high-income countries have had a sharp decline in their exposure to SHS in recent years. What remains unknown is if children living in low-income countries are still exposed to SHS. Our study suggests that despite having a ban on smoking in public places, most primary school children in Dhaka, Bangladesh are still likely to be exposed to SHS.
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Affiliation(s)
- Sarwat Shah
- Department of Health Sciences, University of York, Heslington, York, UK
| | - Mona Kanaan
- Department of Health Sciences, University of York, Heslington, York, UK
| | - Rumana Huque
- Department of Economics, University of Dhaka, Social Science Building, Nilkhet, Dhaka, Bangladesh
| | - Aziz Sheikh
- Centre for Medical Informatics, Usher Institute of Population Health Sciences and Informatics, The University of Edinburgh, Medical School, Teviot Place, Edinburgh, UK
| | - Omara Dogar
- Department of Health Sciences, University of York, Heslington, York, UK
| | | | - Steve Parrott
- Department of Health Sciences, University of York, Heslington, York, UK
| | - Kamran Siddiqi
- Department of Health Sciences, University of York, Heslington, York, UK
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Boeckmann M, Warsi S, Noor M, Dogar O, Mustagfira EH, Firoze F, Zahid R, Readshaw A, Siddiqi K, Kotz D. Health worker and patient views on implementation of smoking cessation in routine tuberculosis care. NPJ Prim Care Respir Med 2019; 29:34. [PMID: 31481678 PMCID: PMC6722140 DOI: 10.1038/s41533-019-0146-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2019] [Accepted: 08/02/2019] [Indexed: 11/10/2022] Open
Abstract
Smoking worsens tuberculosis (TB) outcomes. Persons with TB who smoke can benefit from smoking cessation. We report findings of a multi-country qualitative process evaluation assessing barriers and facilitators to implementation of smoking cessation behaviour support in TB clinics in Bangladesh and Pakistan. We conducted semi-structured qualitative interviews at five case study clinics with 35 patients and 8 health workers over a period of 11 months (2017-2018) at different time points during the intervention implementation phase. Interviews were conducted by trained researchers in the native languages, audio-recorded, transcribed into English and analysed using a combined deductive-inductive approach guided by the Consolidated Framework for Implementation Research and Theoretical Domains Framework. All patients report willingness to quit smoking and recent quit attempts. Individuals' main motivations to quit are their health and the need to financially provide for a family. Behavioural regulation such as avoiding exposure to cigarettes and social influences from friends, family and colleagues are main themes of the interviews. Most male patients do not feel shy admitting to smoking, for the sole female patient interviewee stigma was an issue. Health workers report structural characteristics such as high workload and limited time per patient as primary barriers to offering behavioural support. Self-efficacy to discuss tobacco use with women varies by health worker. Systemic barriers to implementation such as staff workload and socio-cultural barriers to cessation like gender relations, stigma or social influences should be dealt with creatively to optimize the behaviour support for sustainability and scale-up.
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Affiliation(s)
- Melanie Boeckmann
- Institute of General Practice, Addiction Research and Clinical Epidemiology Unit, Medical Faculty of the Heinrich-Heine-University, Werdener Str. 4, 40227, Duesseldorf, Germany. .,Department of Health Sciences, University of York, Seebohm Rowntree Building, Heslington, York, YO10 5DD, UK. .,Department of Environment and Health, School of Public Health, Bielefeld University, Universitätsstr. 25, 33615, Bielefeld, Germany.
| | | | - Maryam Noor
- The Initiative, Orange Grove Farm, Main Korung Road, Banigala, Islamabad, 44000, Pakistan
| | - Omara Dogar
- Department of Health Sciences, University of York, Seebohm Rowntree Building, Heslington, York, YO10 5DD, UK
| | | | - Fariza Firoze
- ARK Foundation, Suite C-3 & C-4, House #06, Road #109, Gulshan-2, Dhaka, 1212, Bangladesh
| | - Raana Zahid
- The Initiative, Orange Grove Farm, Main Korung Road, Banigala, Islamabad, 44000, Pakistan
| | - Anne Readshaw
- Department of Health Sciences, University of York, Seebohm Rowntree Building, Heslington, York, YO10 5DD, UK
| | - Kamran Siddiqi
- Department of Health Sciences, University of York, Seebohm Rowntree Building, Heslington, York, YO10 5DD, UK
| | - Daniel Kotz
- Institute of General Practice, Addiction Research and Clinical Epidemiology Unit, Medical Faculty of the Heinrich-Heine-University, Werdener Str. 4, 40227, Duesseldorf, Germany.,Usher Institute of Population Health Sciences and Informatics, Old Medical School, University of Edinburgh, Teviot Place, Edinburgh, EH8 9AG, UK.,Department of Family Medicine, CAPHRI School for Public Health and Primary Care, Maastricht University, PO Box 616, 6200 MD, Maastricht, The Netherlands
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O'Neill N, Dogar O, Jawad M, Kellar I, Kanaan M, Siddiqi K. Which Behavior Change Techniques May Help Waterpipe Smokers to Quit? An Expert Consensus Using a Modified Delphi Technique. Nicotine Tob Res 2019; 20:154-160. [PMID: 27798091 DOI: 10.1093/ntr/ntw297] [Citation(s) in RCA: 7] [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] [Received: 02/16/2016] [Accepted: 10/24/2016] [Indexed: 11/13/2022]
Abstract
Introduction Waterpipe smoking is addictive and harmful. The determinants of waterpipe smoking may differ from those of cigarette smoking; therefore, behavioral approaches to support quitting may also differ between these two tobacco products. While some evidence exists on effective behavioral change techniques (BCTs) to facilitate cigarette smoking cessation, there is little research on waterpipe smoking cessation. Methods Twenty-four experts were selected from the author lists of peer-reviewed, randomized controlled trials on waterpipe smoking cessation. They were invited to two rounds of a consensus development exercise using modified Delphi technique. Experts ranked 55 BCTs categorized further into those that promote; "awareness of harms of waterpipe smoking and advantages of quitting" (14), "preparation and planning to quit" (29), and "relapse prevention and sustaining an ex-smoker identity" (12) on their potential effectiveness. Kendall's W statistics was used to assess agreement. Results Fifteen experts responded in round 1 and 14 completed both rounds. A strong consensus was achieved for BCTs that help in "relapse prevention and sustaining ex-smoker identity" (w = 0.7; p < .001) and a moderate for those that promote "awareness of harms of waterpipe smoking and advantages of quitting" (w = 0.6; p < .001) and "preparation and planning to quit" (w = 0.6; p < .001). Providing information on the consequences of waterpipe smoking and its cessation, assessing readiness and ability to quit, and making people aware of the withdrawal symptoms, were the three highest-ranking BCTs. Conclusion Based on expert consensus, an inventory of BCTs ordered for their potential effectiveness can be useful for health professionals offering cessation support to waterpipe smokers. Implications Waterpipe smoking is addictive, harmful, and gaining global popularity, particularly among youth. An expert consensus on behavior change techniques, likely to be effective in supporting waterpipe smokers to quit, has practice and research implications. Smoking cessation advisors can use these techniques to counsel waterpipe smokers who wish to quit. Behavioral and public health scientists can also use these to develop and evaluate behavioral support interventions for this client group.
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Affiliation(s)
- Nancy O'Neill
- Department of Health Sciences, University of York, York, UK
| | - Omara Dogar
- Department of Health Sciences, University of York, York, UK
| | - Mohammed Jawad
- Department of Primary Care and Public Health, Imperial College London, London, UK.,Department of Primary Care and Population Sciences, University of Southampton, Southampton, UK
| | - Ian Kellar
- Institute of Psychological Sciences, University of Leeds, Leeds, UK
| | - Mona Kanaan
- Department of Health Sciences, University of York, York, UK
| | - Kamran Siddiqi
- Department of Health Sciences, University of York, York, UK
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Roderick P, Turner V, Readshaw A, Dogar O, Siddiqi K. The global prevalence of tobacco use in type 2 diabetes mellitus patients: A systematic review and meta-analysis. Diabetes Res Clin Pract 2019; 154:52-65. [PMID: 31202865 DOI: 10.1016/j.diabres.2019.05.035] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2019] [Revised: 05/22/2019] [Accepted: 05/28/2019] [Indexed: 01/03/2023]
Abstract
BACKGROUND A multi-layered association between tobacco use and type 2 diabetes mellitus (T2DM) is well established. However, global epidemiological patterns of tobacco use among T2DM patients are not well documented; this review thus aims to estimate the overall global burden of tobacco use in T2DM. METHODS A systematic review of studies published from Jan 1, 1990 to October 5, 2017 was undertaken, comprising: a comprehensive literature search on multiple electronic databases; quality assessment of studies; data extraction for the primary (prevalence of tobacco use in T2DM patients) and secondary outcomes (patterns of tobacco use in T2DM patients); and a meta-analysis. The review was conducted using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement guidelines. A protocol for this review is available on PROSPERO (CRD42016038793). FINDINGS 74 studies were included in the review, reporting data from 3.2 million participants across 33 countries. Global mean prevalence of tobacco use in T2DM was 20·81% (95% CI 18·93-22·76), and was higher in the WHO East Asia and Pacific and South Asia regions, compared to the Americas, Middle East and North Africa, Europe and Central Asia. In studies which compared prevalence of tobacco use in patients to non-patients, patients with T2DM were 26% less likely to use tobacco (pooled OR = 0·74 (CI 0·61-0·88). INTERPRETATION Tobacco is used by one in five T2DM patients globally, but usage is less likely in patients than in non-patients. Global patterns of use demonstrated by this review have implications for both prevention and The understanding of diabetes burden, and the success of tobacco cessation strategies.
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Affiliation(s)
| | | | - Anne Readshaw
- Department of Health Sciences, University of York, United Kingdom
| | - Omara Dogar
- Department of Health Sciences, University of York, United Kingdom
| | - Kamran Siddiqi
- Department of Health Sciences, University of York, United Kingdom
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Warsi S, Elsey H, Boeckmann M, Noor M, Khan A, Barua D, Nasreen S, Huque S, Huque R, Khanal S, Shrestha P, Newell J, Dogar O, Siddiqi K. Using behaviour change theory to train health workers on tobacco cessation support for tuberculosis patients: a mixed-methods study in Bangladesh, Nepal and Pakistan. BMC Health Serv Res 2019; 19:71. [PMID: 30683087 PMCID: PMC6347762 DOI: 10.1186/s12913-019-3909-4] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2018] [Accepted: 01/15/2019] [Indexed: 12/25/2022] Open
Abstract
Background Low- and middle-income countries (LMICs) are disproportionately impacted by interacting epidemics of tuberculosis (TB) and tobacco consumption. Research indicates behavioural support delivered by health workers effectively promotes tobacco cessation. There is, however, a paucity of training to support LMIC health workers deliver effective tobacco cessation behavioural support. The TB and Tobacco Consortium undertook research in South Asia to understand factors affecting TB health workers’ delivery of tobacco cessation behavioural support, and subsequently developed a training package for LMICs. Methods Using the “capability, opportunity, and motivation as determinants of behaviour” (COM-B) framework to understand any issues facing health worker delivery of behaviour support, we analysed 25 semi-structured interviews and one focus group discussion with TB health workers, facility in-charges, and national tuberculosis control programme (NTP) staff members in each country. Results were integrated with findings of an adapted COM-B questionnaire on health worker confidence in tobacco cessation support delivery, administered to 36 TB health workers. Based on findings, we designed a guide and training programme on tobacco cessation support for health workers. Results Qualitative results highlighted gaps in the majority of health workers’ knowledge on tobacco cessation and TB and tobacco interaction, inadequate training on patient communication, insufficient resources and staff support, and NTPs’ non-prioritization of tobacco cessation in all three countries. Questionnaire results reiterated the knowledge deficits and low confidence in patient communication. Participants suggested strengthening knowledge, skills, and competence through training and professional incentives. Based on findings, we developed an interactive two-day training and TB health worker guide adaptable for LMICs, focusing on evidence of best practice on TB and tobacco cessation support, communication, and rapport building with patients. Conclusions TB health workers are essential in addressing the dual burden of TB and tobacco faced by many LMICs. Factors affecting their delivery of tobacco cessation support can be identified using the COM-B framework, and include issues such as individuals’ knowledge and skills, as well as structural barriers like professional support through monitoring and supervision. While structural changes are needed to tackle the latter, we have developed an adaptable and engaging health worker training package to address the former that can be delivered in routine TB care. Trial registration ISRCTN43811467. Electronic supplementary material The online version of this article (10.1186/s12913-019-3909-4) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Sahil Warsi
- Leeds Institute of Health Sciences, Level 10 Worsley Building, Clarendon Way, Leeds, LS2 9NL, UK
| | - Helen Elsey
- Leeds Institute of Health Sciences, Level 10 Worsley Building, Clarendon Way, Leeds, LS2 9NL, UK.
| | - Melanie Boeckmann
- Institute of General Practice, Addiction Research and Clinical Epidemiology Unit, Medical Faculty of the Heinrich-Heine-University Düsseldorf, Werdener Str. 4, 40227, Düsseldorf, Germany
| | - Maryam Noor
- The Initiative, Orange Grove Farm, Banigala, Islamabad, Pakistan
| | - Amina Khan
- The Initiative, Orange Grove Farm, Banigala, Islamabad, Pakistan
| | - Deepa Barua
- ARK Foundation, House B130, Road 21, New DOHS, Mohakhali, Dhaka, 1206, Bangladesh
| | - Shammi Nasreen
- ARK Foundation, House B130, Road 21, New DOHS, Mohakhali, Dhaka, 1206, Bangladesh
| | - Samina Huque
- ARK Foundation, House B130, Road 21, New DOHS, Mohakhali, Dhaka, 1206, Bangladesh
| | - Rumana Huque
- ARK Foundation, House B130, Road 21, New DOHS, Mohakhali, Dhaka, 1206, Bangladesh
| | - Sudeepa Khanal
- HERD International, P O Box Number: 24144, Thapathali 11, Kathmandu, Nepal
| | - Prabin Shrestha
- HERD International, P O Box Number: 24144, Thapathali 11, Kathmandu, Nepal
| | - James Newell
- Leeds Institute of Health Sciences, Level 10 Worsley Building, Clarendon Way, Leeds, LS2 9NL, UK
| | - Omara Dogar
- The Hull York Medical School, University of York, York, YO10 5DD, UK
| | - Kamran Siddiqi
- The Hull York Medical School, University of York, York, YO10 5DD, UK
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Dogar O, Zahid R, Mansoor S, Kanaan M, Ahluwalia JS, Jawad M, Siddiqi K. Varenicline versus placebo for waterpipe smoking cessation: a double-blind randomized controlled trial. Addiction 2018; 113:2290-2299. [PMID: 30187978 DOI: 10.1111/add.14430] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [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] [Received: 03/23/2018] [Revised: 06/01/2018] [Accepted: 08/20/2018] [Indexed: 11/30/2022]
Abstract
BACKGROUND AND AIMS Waterpipe tobacco smoking is a growing public health concern. There is limited research using pharmacotherapy and no research using varenicline (established treatment for smoking cessation) in waterpipe smokers. We tested the efficacy of varenicline in achieving abstinence from all tobacco use among waterpipe smokers. DESIGN Two-arm, parallel group, placebo-controlled, double-blind, multi-centre (n = 4), individually randomized trial with follow-up to 25 weeks. SETTINGS District general hospitals and catchment communities within four districts of Punjab, Pakistan. PARTICIPANTS Adult daily waterpipe smokers (n = 510; 253 in varenicline and 257 in placebo arms), who were interested in quitting, were recruited and analysed between March and November 2016. Of these, 220 (87%) in the varenicline and 239 (93%) in the placebo arms completed all follow-ups. Participants were on average aged 49 [standard deviation (SD) = 15.2] years, daily smokers and smoked for the last 27 (SD = 15.9) years. More than half (261, 51.2%) also smoked cigarettes. INTERVENTION AND COMPARATOR All trial participants received two structured sessions of behavioural support (of 30 and 10 minutes) one at the time of registration and the other 1 week later. Participants were randomized to varenicline (active arm) and placebo (control arm) stratified on district, sex and concomitant cigarette smoking. Varenicline and placebo were dispensed as identical unlabelled tablets for 12 weeks: 0.5 mg for 1 week (once on days 1-3, twice on days 4-7) and 1 mg for the subsequent 11 weeks (twice daily). MEASUREMENTS The trial participants were followed-up for a period of 25 weeks post-randomization. The primary outcome was 7-day repeated point prevalence abstinence from all forms of tobacco, self-reported at each of weeks 5, 12 and 25, verified by carbon-monoxide cut-off < 10 parts per million. FINDINGS No evidence of statistically significant difference in repeated point prevalence abstinence between the varenicline (12 of 253; 4.7%) and placebo (11 of 257; 4.3%) arms (relative risk = 1.11, 95% confidence interval = 0.50-2.47, P = 0.80) was observed (Bayes factor = 0.048). Adverse events reported in 27 participants were 34 (15 in varenicline and 19 in placebo); none was serious. CONCLUSIONS Varenicline was not more effective than placebo in aiding cessation of tobacco use in long-term daily waterpipe smokers.
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Affiliation(s)
- Omara Dogar
- Department of Health Sciences, University of York, York, UK
| | - Raana Zahid
- Orange Grove Farm, The Initiative, Pakistan, Islamabad, Pakistan
| | - Sonia Mansoor
- Orange Grove Farm, The Initiative, Pakistan, Islamabad, Pakistan
| | - Mona Kanaan
- Department of Health Sciences, University of York, York, UK
| | | | - Mohammed Jawad
- Public Health Policy Evaluation Unit, School of Public Health, Imperial College London, London, UK
| | - Kamran Siddiqi
- Department of Health Sciences, University of York, York, UK
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Dogar O, Barua D, Boeckmann M, Elsey H, Fatima R, Gabe R, Huque R, Keding A, Khan A, Kotz D, Kralikova E, Newell JN, Nohavova I, Parrott S, Readshaw A, Renwick L, Sheikh A, Siddiqi K. The safety, effectiveness and cost-effectiveness of cytisine in achieving six-month continuous smoking abstinence in tuberculosis patients-protocol for a double-blind, placebo-controlled randomized trial. Addiction 2018; 113:1716-1726. [PMID: 29676824 PMCID: PMC6099220 DOI: 10.1111/add.14242] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2017] [Revised: 01/24/2018] [Accepted: 04/06/2018] [Indexed: 01/13/2023]
Abstract
BACKGROUND AND AIMS Tuberculosis (TB) patients who quit smoking have much better disease outcomes than those who continue to smoke. In general populations, behavioural support combined with pharmacotherapy is the most effective strategy in helping people to quit. However, there is no evidence for the effectiveness of this strategy in TB patients who smoke. We will assess the safety, effectiveness and cost-effectiveness of cytisine-a low-cost plant-derived nicotine substitute-for smoking cessation in TB patients compared with placebo, over and above brief behavioural support. DESIGN Two-arm, parallel, double-blind, placebo-controlled, multi-centre (30 sites in Bangladesh and Pakistan), individually randomized trial. SETTING TB treatment centres integrated into public health care systems in Bangladesh and Pakistan. PARTICIPANTS Newly diagnosed (in the last 4 weeks) adult pulmonary TB patients who are daily smokers (with or without dual smokeless tobacco use) and are interested in quitting (n = 2388). MEASUREMENTS The primary outcome measure is biochemically verified continuous abstinence from smoking at 6 months post-randomization, assessed using Russell Standard criteria. The secondary outcome measures include continuous abstinence at 12 months, lapses and relapses; clinical TB outcomes; nicotine dependency and withdrawal; and adverse events. COMMENTS This is the first smoking cessation trial of cytisine in low- and middle-income countries evaluating both cessation and TB outcomes. If found effective, cytisine could become the most affordable cessation intervention to help TB patients who smoke.
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Affiliation(s)
- Omara Dogar
- University of YorkDepartment of Health Sciences, Faculty of SciencesYorkUK
| | | | - Melanie Boeckmann
- University of YorkDepartment of Health Sciences, Faculty of SciencesYorkUK
- Institute of General Practice, Addiction Research and Clinical Epidemiology UnitMedical Faculty of the Heinrich‐Heine‐UniversityDüsseldorfGermany
| | - Helen Elsey
- University of LeedsLeeds Institute of Health SciencesLeedsUK
| | - Razia Fatima
- National Tuberculosis Control Programme (NTP)IslamabadPakistan
| | - Rhian Gabe
- University of YorkDepartment of Health Sciences, Faculty of SciencesYorkUK
- Hull York Medical SchoolUniversity of YorkHeslingtonYorkUK
| | - Rumana Huque
- ARK FoundationDhakaBangladesh
- Department of EconomicsUniversity of DhakaBangladesh
| | - Ada Keding
- University of YorkDepartment of Health Sciences, Faculty of SciencesYorkUK
| | | | - Daniel Kotz
- Institute of General Practice, Addiction Research and Clinical Epidemiology UnitMedical Faculty of the Heinrich‐Heine‐UniversityDüsseldorfGermany
- University of Edinburgh, Usher Institute of Population Health Sciences and InformaticsEdinburghUK
- Department of Family Medicine, CAPHRI School for Public Health and Primary CareMaastricht Universitythe Netherlands
| | - Eva Kralikova
- Centre for Tobacco‐Dependent of the 3rd Medical Department, Department of Endocrinology and Metabolism, 1st Faculty of MedicineCharles University and the University Hospital PragueCzech Republic
- Institute of Hygiene and Epidemiology, 1st Faculty of MedicineCharles University and the University Hospital PragueCzech Republic
| | - James N. Newell
- University of LeedsLeeds Institute of Health SciencesLeedsUK
| | - Iveta Nohavova
- Centre for Tobacco‐Dependent of the 3rd Medical Department, Department of Endocrinology and Metabolism, 1st Faculty of MedicineCharles University and the University Hospital PragueCzech Republic
- Institute of Hygiene and Epidemiology, 1st Faculty of MedicineCharles University and the University Hospital PragueCzech Republic
| | - Steve Parrott
- University of YorkDepartment of Health Sciences, Faculty of SciencesYorkUK
| | - Anne Readshaw
- University of YorkDepartment of Health Sciences, Faculty of SciencesYorkUK
| | - Lottie Renwick
- University of YorkDepartment of Health Sciences, Faculty of SciencesYorkUK
| | - Aziz Sheikh
- University of Edinburgh, Usher Institute of Population Health Sciences and InformaticsEdinburghUK
| | - Kamran Siddiqi
- University of YorkDepartment of Health Sciences, Faculty of SciencesYorkUK
- Hull York Medical SchoolUniversity of YorkHeslingtonYorkUK
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Boeckmann M, Nohavova I, Dogar O, Kralikova E, Pankova A, Zvolska K, Huque R, Fatima R, Noor M, Elsey H, Sheikh A, Siddiqi K, Kotz D. Protocol for the mixed-methods process and context evaluation of the TB & Tobacco randomised controlled trial in Bangladesh and Pakistan: a hybrid effectiveness-implementation study. BMJ Open 2018; 8:e019878. [PMID: 29602847 PMCID: PMC5887198 DOI: 10.1136/bmjopen-2017-019878] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2017] [Revised: 01/11/2018] [Accepted: 02/14/2018] [Indexed: 11/05/2022] Open
Abstract
INTRODUCTION Tuberculosis (TB) remains a significant public health problem in South Asia. Tobacco use increases the risks of TB infection and TB progression. The TB& Tobacco placebo-controlled randomised trial aims to (1) assess the effectiveness of the tobacco cessation medication cytisine versus placebo when combined with behavioural support and (2) implement tobacco cessation medication and behavioural support as part of general TB care in Bangladesh and Pakistan. This paper summarises the process and context evaluation protocol embedded in the effectiveness-implementation hybrid design. METHODS AND ANALYSIS We are conducting a mixed-methods process and context evaluation informed by an intervention logic model that draws on the UK Medical Research Council's Process Evaluation Guidance. Our approach includes quantitative and qualitative data collection on context, recruitment, reach, dose delivered, dose received and fidelity. Quantitative data include patient characteristics, reach of recruitment among eligible patients, routine trial data on dose delivered and dose received, and a COM-B ('capability', 'opportunity', 'motivation' and 'behaviour') questionnaire filled in by participating health workers. Qualitative data include semistructured interviews with TB health workers and patients, and with policy-makers at district and central levels in each country. Interviews will be analysed using the framework approach. The behavioural intervention delivery is audio recorded and assessed using a predefined fidelity coding index based on behavioural change technique taxonomy. ETHICS AND DISSEMINATION The study complies with the guidelines of the Declaration of Helsinki. Ethics approval for the study and process evaluation was granted by the University of Leeds (qualitative components), University of York (trial data and fidelity assessment), Bangladesh Medical Research Council and Bangladesh Drug Administration (trial data and qualitative components) and Pakistan Medical Research Council (trial data and qualitative components). Results of this research will be disseminated through reports to stakeholders and peer-reviewed publications and conference presentations. TRIAL REGISTRATION NUMBER ISRCTN43811467; Pre-results.
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Affiliation(s)
- Melanie Boeckmann
- Institute of General Practice, Addiction Research and Clinical Epidemiology Unit, Medical Faculty of the Heinrich-Heine-University, Düsseldorf, Germany
| | - Iveta Nohavova
- University Hospital Prague VFN v. PRAZE, Prague, Czech Republic
| | - Omara Dogar
- Department of Health Sciences, University of York, York, UK
| | - Eva Kralikova
- University Hospital Prague VFN v. PRAZE, Prague, Czech Republic
| | | | - Kamila Zvolska
- University Hospital Prague VFN v. PRAZE, Prague, Czech Republic
| | | | - Razia Fatima
- National Tuberculosis Control Programme (NTP), Islamabad, Pakistan
| | | | - Helen Elsey
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Aziz Sheikh
- Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, UK
| | - Kamran Siddiqi
- Department of Health Sciences, University of York, York, UK
| | - Daniel Kotz
- Institute of General Practice, Addiction Research and Clinical Epidemiology Unit, Medical Faculty of the Heinrich-Heine-University, Düsseldorf, Germany
- Department of Family Medicine, CAPHRI School for Public Health and Primary Care, Maastricht University, Maastricht, The Netherlands
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Kanaan M, Dogar O, Zahid R, Mansoor S, Jawad M, Ahluwalia JS, Siddiqi K. Dependence and withdrawal symptoms among waterpipe tobacco smokers enrolled in a double-blind, placebo-controlled, randomised trial. Tob Induc Dis 2018. [DOI: 10.18332/tid/84638] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Dogar O, Kanaan M, Zahid R, Mansoor S, Jawad M, Ahluwalia JS, Siddiqi K. A double-blind, placebo-controlled, randomized trial of varenicline in hookah tobacco smokers in Pakistan. Tob Induc Dis 2018. [DOI: 10.18332/tid/84550] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Zahid R, Dogar O, Mansoor S, Khan A, Kanaan M, Jawad M, Ahluwalia JS, Siddiqi K. The efficacy of varenicline in achieving abstinence among waterpipe tobacco smokers - study protocol for a randomized controlled trial. Trials 2017; 18:14. [PMID: 28077163 PMCID: PMC5225555 DOI: 10.1186/s13063-016-1761-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2016] [Accepted: 12/20/2016] [Indexed: 11/29/2022] Open
Abstract
Background Waterpipe tobacco smoking has increased among youth across the globe including in the US, and it continues as a common and traditional form of smoking tobacco in Pakistan. A range of behavioral and pharmacological therapies are available to support people in quitting cigarette smoking; however, little evidence exists for the efficacy of these therapies in achieving abstinence among waterpipe tobacco smokers. The objective of this study is to assess the efficacy of varenicline when added to behavioral support for waterpipe tobacco smoking cessation, by measuring biochemically validated continuous abstinence in waterpipe tobacco smokers. Methods/design This is a two-arm, double-blind, placebo-controlled randomized trial conducted in four districts in Punjab, Pakistan. Study participants include adults using a waterpipe (with or without concomitant cigarette, bidi or other forms of tobacco smoking) on a daily basis for at least 6 months and who are willing to quit. We will individually randomize 510 participants to one of the two arms of the trial. Participants in the intervention arm will receive varenicline and behavioral support and those in the control arm will receive placebo and behavioral support. The primary outcome will be continuous abstinence for at least 6 months (week 25) which is biochemically verified by a carbon monoxide level of <10 ppm. Secondary outcomes will include biochemically verified 7-day point abstinence at 5, 12 and 25 weeks and any lapses and relapses between the different assessment points. Tertiary outcomes will include assessment of withdrawal symptoms using the Mood and Physical Symptoms Scale (MPSS), smoking dependency using the Lebanon Waterpipe Dependency Scale (LWDS-11) and monitoring adverse outcomes. Discussion This is an efficacy trial and would require a subsequent effectiveness trial for a definitive evaluation of the intervention. Trial registration ISRCTN, ISRCTN94103375. Registered on 1 December 2015. Electronic supplementary material The online version of this article (doi:10.1186/s13063-016-1761-y) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Raana Zahid
- The Initiative, Islamabad, Pakistan. .,Orange Grove Farm, Korung Road, Banigala, Islamabad, Pakistan.
| | - Omara Dogar
- Department of Health Sciences, University of York, Seebohm Rowntree Building, Heslington, York, YO10 5DD, UK
| | - Sonia Mansoor
- The Initiative, Islamabad, Pakistan.,Orange Grove Farm, Korung Road, Banigala, Islamabad, Pakistan
| | - Amina Khan
- Orange Grove Farm, Korung Road, Banigala, Islamabad, Pakistan
| | - Mona Kanaan
- Department of Health Sciences, University of York, ARRC Building, Heslington, York, YO10 5DD, UK
| | - Mohammed Jawad
- Department of Primary Care and Public Health, Imperial College London, Hammersmith, W6 8RP, UK
| | | | - Kamran Siddiqi
- Department of Health Sciences, University of York, Seebohm Rowntree Building, Heslington, York, YO10 5DD, UK
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Affiliation(s)
- Faraz Siddiqui
- Research Instructor, Department of Medicine, The Aga Khan University, Pakistan
| | | | - Omara Dogar
- Research Fellow, Department of Health Sciences, University of York, UK
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Abstract
BACKGROUND Tobacco use is highly prevalent amongst people living with HIV/AIDS (PLWHA) and has a substantial impact on morbidity and mortality. OBJECTIVES To assess the effectiveness of interventions to motivate and assist tobacco use cessation for people living with HIV/AIDS (PLWHA), and to evaluate the risks of any harms associated with those interventions. SEARCH METHODS We searched the Cochrane Tobacco Addiction Group's Specialised Register, Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE, and PsycINFO in June 2015. We also searched EThOS, ProQuest, four clinical trial registries, reference lists of articles, and searched for conference abstracts using Web of Science and handsearched speciality conference databases. SELECTION CRITERIA Controlled trials of behavioural or pharmacological interventions for tobacco cessation for PLWHA. DATA COLLECTION AND ANALYSIS Two review authors independently extracted all data using a standardised electronic data collection form. They extracted data on the nature of the intervention, participants, and proportion achieving abstinence and they contacted study authors to obtain missing information. We collected data on long-term (greater than or equal to six months) and short-term (less than six months) outcomes. Where appropriate, we performed meta-analysis and estimated the pooled effects using the Mantel-Haenszel fixed-effect method. Two authors independently assessed and reported the risk of bias according to prespecified criteria. MAIN RESULTS We identified 14 studies relevant to this review, of which we included 12 in a meta-analysis (n = 2087). All studies provided an intervention combining behavioural support and pharmacotherapy, and in most studies this was compared to a less intensive control, typically comprising a brief behavioural intervention plus pharmacotherapy.There was moderate quality evidence from six studies for the long-term abstinence outcome, which showed no evidence of effect for more intense cessation interventions: (risk ratio (RR) 1.00, 95% confidence interval (CI) 0.72 to 1.39) with no evidence of heterogeneity (I(2) = 0%). The pooled long-term abstinence was 8% in both intervention and control conditions. There was very low quality evidence from 11 studies that more intense tobacco cessation interventions were effective in achieving short-term abstinence (RR 1.51, 95% CI 1.15 to 2.00); there was moderate heterogeneity (I(2) = 42%). Abstinence in the control group at short-term follow-up was 8% (n = 67/848) and in the intervention group was 13% (n = 118/937). The effect of tailoring the intervention for PLWHA was unclear. We further investigated the effect of intensity of behavioural intervention via number of sessions and total duration of contact. We failed to detect evidence of a difference in effect according to either measure of intensity, although there were few studies in each subgroup. It was not possible to perform the planned analysis of adverse events or HIV outcomes since these were not reported in more than one study. AUTHORS' CONCLUSIONS There is moderate quality evidence that combined tobacco cessation interventions provide similar outcomes to controls in PLWHA in the long-term. There is very low quality evidence that combined tobacco cessation interventions were effective in helping PLWHA achieve short-term abstinence. Despite this, tobacco cessation interventions should be offered to PLWHA, since even non-sustained periods of abstinence have proven benefits. Further large, well designed studies of cessation interventions for PLWHA are needed.
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Affiliation(s)
- Erica RM Pool
- Brighton and Sussex University Hospitals NHS TrustBrightonUK
| | - Omara Dogar
- University of YorkDepartment of Health SciencesSeebohm Rowntree BuildingHeslingtonYorkUKYO10 5DD
| | - Ryan P Lindsay
- Idaho State UniversityDepartment of Community and Public HealthMeridianIdahoUSA
| | - Peter Weatherburn
- London School of Hygiene and Tropical MedicineSigma Research, Department of Social & Environmental Health ResearchLondonUK
| | - Kamran Siddiqi
- York UniversityDepartment of Health Sciences/Hull York Medical SchoolYorkUKYO10 5DD
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Siddiqi K, Dogar O, Rashid R, Jackson C, Kellar I, O’Neill N, Hassan M, Ahmed F, Irfan M, Thomson H, Khan J. Behaviour change intervention for smokeless tobacco cessation: its development, feasibility and fidelity testing in Pakistan and in the UK. BMC Public Health 2016; 16:501. [PMID: 27287429 PMCID: PMC4902895 DOI: 10.1186/s12889-016-3177-8] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2015] [Accepted: 06/02/2016] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND People of South Asian-origin are responsible for more than three-quarters of all the smokeless tobacco (SLT) consumption worldwide; yet there is little evidence on the effect of SLT cessation interventions in this population. South Asians use highly addictive and hazardous SLT products that have a strong socio-cultural dimension. We designed a bespoke behaviour change intervention (BCI) to support South Asians in quitting SLT and then evaluated its feasibility in Pakistan and in the UK. METHODS We conducted two literature reviews to identify determinants of SLT use among South Asians and behaviour change techniques (BCTs) likely to modify these, respectively. Iterative consensus development workshops helped in selecting potent BCTs for BCI and designing activities and materials to deliver these. We piloted the BCI in 32 SLT users. All BCI sessions were audiotaped and analysed for adherence to intervention content and the quality of interaction (fidelity index). In-depth interviews with16 participants and five advisors assessed acceptability and feasibility of delivering the BCI, respectively. Quit success was assessed at 6 months by saliva/urine cotinine. RESULTS The BCI included 23 activities and an interactive pictorial resource that supported these. Activities included raising awareness of the harms of SLT use and benefits of quitting, boosting clients' motivation and self-efficacy, and developing strategies to manage their triggers, withdrawal symptoms, and relapse should that occur. Betel quid and Guthka were the common forms of SLT used. Pakistani clients were more SLT dependent than those in the UK. Out of 32, four participants had undetectable cotinine at 6 months. Fidelity scores for each site varied between 11.2 and 42.6 for adherence to content - maximum score achievable 44; and between 1.4 and 14 for the quality of interaction - maximum score achievable was 14. Interviews with advisors highlighted the need for additional training on BCTs, integrating nicotine replacement and reducing duration of the pre-quit session. Clients were receptive to health messages but most reported SLT reduction rather than complete cessation. CONCLUSION We developed a theory-based BCI that was also acceptable and feasible to deliver with moderate fidelity scores. It now needs to be evaluated in an effectiveness trial.
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Affiliation(s)
- Kamran Siddiqi
- />Department of Health Sciences, University of York, York, YO10 5DD UK
| | - Omara Dogar
- />Department of Health Sciences, University of York, York, YO10 5DD UK
| | - Rukhsana Rashid
- />Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK
| | - Cath Jackson
- />Department of Health Sciences, University of York, York, YO10 5DD UK
| | - Ian Kellar
- />School of Psychology, University of Leeds, Leeds, LS2 9JT UK
| | - Nancy O’Neill
- />Department of Health Sciences, University of York, York, YO10 5DD UK
| | - Maryam Hassan
- />Department of Medicine, The Aga Khan University, Karachi, Pakistan
| | | | - Muhammad Irfan
- />Department of Medicine, The Aga Khan University, Karachi, Pakistan
| | - Heather Thomson
- />Department of Public Health, Leeds City Council, Leeds, LS7 3NB UK
| | - Javaid Khan
- />Department of Medicine, The Aga Khan University, Karachi, Pakistan
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Jawad M, Choaie E, Brose L, Dogar O, Grant A, Jenkinson E, McEwen A, Millett C, Shahab L. Waterpipe Tobacco Use in the United Kingdom: A Cross-Sectional Study among University Students and Stop Smoking Practitioners. PLoS One 2016; 11:e0146799. [PMID: 26745806 PMCID: PMC4706414 DOI: 10.1371/journal.pone.0146799] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2015] [Accepted: 12/21/2015] [Indexed: 02/06/2023] Open
Abstract
INTRODUCTION Despite cigarette-like adverse health outcomes associated with waterpipe tobacco smoking and increase in its use among youth, it is a much underexplored research area. We aimed to measure the prevalence and patterns of waterpipe tobacco use and evaluate tobacco control policy with respect to waterpipe tobacco, in several universities across the UK. We also aimed to measure stop smoking practitioners' encounter of waterpipe tobacco smoking. METHODS We distributed an online survey to six UK universities, asking detailed questions on waterpipe tobacco. Multivariable logistic regression models, adjusted for age, gender, ethnicity, graduate status, university and socioeconomic status (SES) assessed associations between waterpipe tobacco smoking (single use and dual use with cigarettes) and sociodemographic variables. SES was ascertained by average weekly self-spend on non-essentials. We also descriptively analysed data from a 2012 survey of stop smoking practitioners to assess the proportion of clients that used waterpipe regularly. RESULTS f 2217 student responses, 66.0% (95% CI 63.9-68.0%) had tried waterpipe tobacco smoking; 14.3% (95% CI 12.8-15.8%) reported past-30 day use, and 8.7% (95% CI 7.6-9.9%) reported at least monthly users. Past-30 day waterpipe-only use was associated with being younger (AOR 0.95, 95% CI 0.91-0.99), male (AOR 1.44, 95% CI 1.08-1.94), higher SES (AOR 1.16, 95% CI 1.06-1.28) and belonging to non-white ethnicities (vs. white, AOR 2.24, 95% CI 1.66-3.04). Compared to less than monthly users, monthly users were significantly more likely to have urges to smoke waterpipe (28.1% vs. 3.1%, p<0.001) report difficulty in quitting (15.5% vs. 0.8%, p<0.001), report feeling guilty, and annoyed when criticised about waterpipe smoking (19.2% vs. 9.2%, p<0.001). Nearly a third (32.5%) of respondents who had tried waterpipe had violated the UK smokefree law and a quarter (24.5%) reporting seeing health warnings on waterpipe tobacco packaging or apparatuses. Of 1,282 smoking cessation practitioners, a quarter (23.4%, 95% CI 21.5-26.1%) reported having some clients who regularly use waterpipes, but 69.5% (95% CI 67.0-72.0%) never ask clients about waterpipe use. Three quarters (74.8%, 95% CI 72.4-77.1%) want more information about waterpipe tobacco smoking. CONCLUSIONS While two thirds of university students have ever tried waterpipe tobacco, at least monthly use is less common. Regular users display features of waterpipe tobacco dependence, and a substantial minority of SSS practitioners encounter clients who regularly use waterpipe. The lack of training on waterpipe for SSS practitioners and reported violations of smokefree laws for waterpipe highlight the need for regular surveillance of and a coordinated tobacco control strategy for waterpipe use.
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Affiliation(s)
- Mohammed Jawad
- Department of Primary Care and Public Health, Imperial College London, Hammersmith, W6 8RP, United Kingdom
- Academic Unit of Primary Care and Population Sciences, University of Southampton, Hampshire, SO16 6YD, United Kingdom
- * E-mail:
| | - Elham Choaie
- Department of Epidemiology and Public Health, University College London, London, WC1E 6BT, United Kingdom
| | - Leonie Brose
- Addictions Department, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, SE5 8BB, United Kingdom
| | - Omara Dogar
- Department of Health Sciences, University of York, York, YO10 5DD, United Kingdom
| | - Aimee Grant
- Institute of Primary Care and Public Health, Cardiff University School of Medicine, Cardiff, CF14 4YS, United Kingdom
| | - Elizabeth Jenkinson
- Centre for Appearance Research, University of the West of England, Bristol, BS16 1QY, United Kingdom
| | - Andy McEwen
- Department of Epidemiology and Public Health, University College London, London, WC1E 6BT, United Kingdom
| | - Christopher Millett
- Department of Primary Care and Public Health, Imperial College London, Hammersmith, W6 8RP, United Kingdom
| | - Lion Shahab
- Department of Epidemiology and Public Health, University College London, London, WC1E 6BT, United Kingdom
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Elsey H, Dogar O, Ahluwalia J, Siddiqi K. Predictors of cessation in smokers suspected of TB: Secondary analysis of data from a cluster randomized controlled trial. Drug Alcohol Depend 2015; 155:128-33. [PMID: 26297296 DOI: 10.1016/j.drugalcdep.2015.08.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [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] [Received: 05/08/2015] [Revised: 08/04/2015] [Accepted: 08/05/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND Smoking cessation services are rarely found within health services in low income countries. Given the interactions between Tuberculosis (TB) and tobacco, including cessation support within TB programs offers a promising cost-effective solution. We conducted secondary analysis of data from a cluster randomized controlled trial of smoking cessation in health centers in Pakistan to identify predictors of continuous and short-term abstinence in smokers suspected of TB using cigarettes or hookah. METHODS Predictor variables of those continuously abstinent at 5 and 25 weeks post quit-date (continuous abstinence) and those abstinent only at 5 weeks (short-term abstinence) were compared with those who continued smoking and with each other. Self-reported abstinence at both time points was confirmed biochemically. RESULTS Data obtained from 1955 trial participants were analyzed. The factors that predicted continued smoking when compared to continuous abstinence were: being older RR 0.97 (0.95 to 0.98), smoking higher quantities of tobacco RR 0.975 (0.97 to 0.98) and sharing a workplace with other smokers RR 0.88 (0.77 to 0.99). Those with a confirmed TB diagnosis were more likely to remain continuously abstinent than those without RR 1.27 (1.10-1.47). CONCLUSIONS Those diagnosed with TB are more likely to be abstinent than those diagnosed with other respiratory conditions. Beyond this, predictors of continued smoking in Pakistan are similar to those in high income contexts. Taking advantage of the 'teachable moment' that a TB diagnosis provides is an efficient means for resource-poor TB programs in low income settings to increase tobacco cessation and improve health outcomes.
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Affiliation(s)
- H Elsey
- Nuffield Centre for International Health and Development, Leeds Institute of Health Sciences, University of Leeds, G22 Charles Thackrah Building, 101 Clarendon Road, LS2 9LJ Leeds, UK.
| | - O Dogar
- ARRC, Heslington, University of York, Room 105, York YO10 5DD, UK.
| | - J Ahluwalia
- School of Public Health Rutgers, The State University of New Jersey, 683 Hoes Lane West, Room 235, Piscataway, NJ 08854, USA.
| | - K Siddiqi
- Epidemiology and Public Health, Department of Health Sciences and Hull York Medical School, University of York, York YO10 5DD, UK.
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Siddiqi K, Huque R, Jackson C, Parrott S, Dogar O, Shah S, Thomson H, Sheikh A. Children Learning About Secondhand Smoke (CLASS II): protocol of a pilot cluster randomised controlled trial. BMJ Open 2015; 5:e008749. [PMID: 26307620 PMCID: PMC4550726 DOI: 10.1136/bmjopen-2015-008749] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
INTRODUCTION Exposure to secondhand smoke (SHS) increases children's risk of acquiring chest and ear infections, tuberculosis, meningitis and asthma. Smoking bans in public places (where implemented) have significantly reduced adults' exposure to SHS. However, for children, homes remain the most likely place for them to be exposed to SHS. Additional measures are therefore required to protect children from SHS. In a feasibility study in Dhaka, Bangladesh, we have shown that a school-based smoke-free intervention (SFI) was successful in encouraging children to negotiate and implement smoking restrictions in homes. We will now conduct a pilot trial to inform plans to undertake a cluster randomised controlled trial (RCT) investigating the effectiveness and cost-effectiveness of SFI in reducing children's exposure to SHS. METHODS AND ANALYSIS We plan to recruit 12 primary schools in Dhaka, Bangladesh. From these schools, we will recruit approximately 360 schoolchildren in year 5 (10-12 years old), that is, 30 per school. SFI consists of six interactive educational activities aimed at increasing pupils' knowledge about SHS and related harms, motivating them to act, providing skills to negotiate with adults to persuade them not to smoke inside homes and helping families to 'sign-up' to a voluntary contract to make their homes smoke-free. Children in the control arm will receive the usual education. We will estimate: recruitment and attrition rates, acceptability, fidelity to SFI, effect size, intracluster correlation coefficient, cost of intervention and adverse events. Our primary outcome will consist of SHS exposure in children measured by salivary cotinine. Secondary outcomes will include respiratory symptoms, lung function tests, healthcare contacts, school attendance, smoking uptake, quality of life and academic performance. ETHICS AND DISSEMINATION The trial has received ethics approval from the Research Governance Committee at the University of York. Findings will help us plan for the definitive trial. TRIAL REGISTRATION NUMBER ISRCTN68690577.
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Affiliation(s)
- Kamran Siddiqi
- Department of Health Sciences, The University of York, York, UK
| | | | - Cath Jackson
- Department of Health Sciences, The University of York, York, UK
| | - Steve Parrott
- Department of Health Sciences, The University of York, York, UK
| | - Omara Dogar
- Department of Health Sciences, The University of York, York, UK
| | - Sarwat Shah
- Department of Health Sciences, The University of York, York, UK
| | | | - Aziz Sheikh
- Centre for Medical Informatics, Usher Institute of Population Heath Sciences and Informatics, The University of Edinburgh, Edinburgh, UK
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Siddiqi K, Shah S, Abbas SM, Vidyasagaran A, Jawad M, Dogar O, Sheikh A. Global burden of disease due to smokeless tobacco consumption in adults: analysis of data from 113 countries. BMC Med 2015; 13:194. [PMID: 26278072 PMCID: PMC4538761 DOI: 10.1186/s12916-015-0424-2] [Citation(s) in RCA: 122] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2015] [Accepted: 07/17/2015] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Smokeless tobacco is consumed in most countries in the world. In view of its widespread use and increasing awareness of the associated risks, there is a need for a detailed assessment of its impact on health. We present the first global estimates of the burden of disease due to consumption of smokeless tobacco by adults. METHODS The burden attributable to smokeless tobacco use in adults was estimated as a proportion of the disability-adjusted life-years (DALYs) lost and deaths reported in the 2010 Global Burden of Disease study. We used the comparative risk assessment method, which evaluates changes in population health that result from modifying a population's exposure to a risk factor. Population exposure was extrapolated from country-specific prevalence of smokeless tobacco consumption, and changes in population health were estimated using disease-specific risk estimates (relative risks/odds ratios) associated with it. Country-specific prevalence estimates were obtained through systematically searching for all relevant studies. Disease-specific risks were estimated by conducting systematic reviews and meta-analyses based on epidemiological studies. RESULTS We found adult smokeless tobacco consumption figures for 115 countries and estimated burden of disease figures for 113 of these countries. Our estimates indicate that in 2010, smokeless tobacco use led to 1.7 million DALYs lost and 62,283 deaths due to cancers of mouth, pharynx and oesophagus and, based on data from the benchmark 52 country INTERHEART study, 4.7 million DALYs lost and 204,309 deaths from ischaemic heart disease. Over 85 % of this burden was in South-East Asia. CONCLUSIONS Smokeless tobacco results in considerable, potentially preventable, global morbidity and mortality from cancer; estimates in relation to ischaemic heart disease need to be interpreted with more caution, but nonetheless suggest that the likely burden of disease is also substantial. The World Health Organization needs to consider incorporating regulation of smokeless tobacco into its Framework Convention for Tobacco Control.
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Affiliation(s)
- Kamran Siddiqi
- Department of Health Sciences, Hull York Medical School, University of York, Room 105a, First floor, ARRC Building, Heslington, York, YO10 5DD, UK.
| | - Sarwat Shah
- Department of Health Sciences, Hull York Medical School, University of York, Room 105a, First floor, ARRC Building, Heslington, York, YO10 5DD, UK.
| | - Syed Muslim Abbas
- Fatima Memorial Hospital College of Medicine and Dentistry, Fatima Memorial System, Shadman, Lahore, 48000, Pakistan.
| | - Aishwarya Vidyasagaran
- Department of Health Sciences, Hull York Medical School, University of York, Room 105a, First floor, ARRC Building, Heslington, York, YO10 5DD, UK.
| | - Mohammed Jawad
- Department of Primary Care and Public Health, Imperial College London, Charing Cross Campus, Reynold's Building, Hammersmith, W6 8RP, UK.
| | - Omara Dogar
- Department of Health Sciences, Hull York Medical School, University of York, Room 105a, First floor, ARRC Building, Heslington, York, YO10 5DD, UK.
| | - Aziz Sheikh
- Usher Institute of Population Health Sciences and Informatics, The University of Edinburgh, Medical School Doorway 3, Teviot Place, Edinburgh, EH8 9AG, UK.
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Huque R, Dogar O, Cameron I, Thomson H, Amos A, Siddiqi K. Children Learning About Second-Hand Smoking: A Feasibility Cluster Randomized Controlled Trial. Nicotine Tob Res 2015; 17:1465-72. [PMID: 25634936 DOI: 10.1093/ntr/ntv015] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2014] [Accepted: 01/13/2015] [Indexed: 11/13/2022]
Abstract
BACKGROUND Exposure to second-hand smoke is a threat to children's health. We developed a school-based smoke-free intervention (SFI) to support families in implementing smoke-free homes in Bangladesh, and gathered preliminary evidence of its effectiveness. METHODS A feasibility cluster randomized controlled trial of SFI was conducted in 24 schools in Mirpur, an urban area within Dhaka. Using simple stratified randomization, schools were allocated to: Arm A (SFI only), Arm B (SFI plus reminders), and Arm C (the control group). A total of 781 year-5 children (10-12 years old) in the consenting schools, participated in the study. Outcomes including "smoke-free homes" and "social visibility" that is, not smoking in front of children at home were assessed through questionnaire-based children's surveys, administered by researchers, at baseline and at weeks 1, 12, 27, and 52 in all arms. RESULTS "Smoke-free homes" were significantly higher in Arm A (odds ratio [OR] = 4.8; 95% CI = 2.6-9.0) and in Arm B (OR = 3.9; 95% CI = 2.0-7.5) than in Arm C, when controlled for the baseline levels, at year 1. Similarly, "social visibility" was significantly reduced in Arm A (OR = 5.8; 95% CI = 2.8-11.7) and in Arm B (OR = 7.2; 95% CI = 3.3-15.9) than Arm C, when controlled for the baseline levels, at year 1. We observed an increasing trend (Cochrane Armitage test statistic [Z] = 3.8; p < .0001) in homes becoming smoke-free with increasing intensity of the intervention (control < Arm A < Arm B), and a decreasing trend (Z = -5.13; p < .0001) in social visibility at homes. CONCLUSION SFI has the potential to encourage children to negotiate a smoke-free environment in their homes.
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Affiliation(s)
- Rumana Huque
- Department of Economics, University of Dhaka, Dhaka, Bangladesh;
| | - Omara Dogar
- Department of Health Sciences, University of York, York, UK
| | | | - Heather Thomson
- Office of the Director of Public Health, Leeds City Council, Leeds, UK
| | - Amanda Amos
- Centre for Population Health Sciences Medical School, University of Edinburgh, Edinburgh, UK
| | - Kamran Siddiqi
- Department of Health Sciences/Hull York Medical School, University of York, York, UK
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Affiliation(s)
- Kamran Siddiqi
- Department of Health Sciences and Hull York Medical School, University of York, York YO10 5DD, UK.
| | - Omara Dogar
- Department of Health Sciences and Hull York Medical School, University of York, York YO10 5DD, UK
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Pool ERM, Dogar O, Siddiqi K. Interventions for tobacco use cessation in people living with HIV and AIDS. THE COCHRANE DATABASE OF SYSTEMATIC REVIEWS 2014. [DOI: 10.1002/14651858.cd011120] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Dogar O, Jawad M, Shah SK, Newell JN, Kanaan M, Khan MA, Siddiqi K. Effect of cessation interventions on hookah smoking: post-hoc analysis of a cluster-randomized controlled trial. Nicotine Tob Res 2013; 16:682-8. [PMID: 24376277 DOI: 10.1093/ntr/ntt211] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
INTRODUCTION We explored the differential effect of cessation interventions (behavioral support sessions with [BSS+] and without [BSS] bupropion) between hookah and cigarette smokers. METHODS We reanalyzed the data from a major cluster-randomized controlled trial, ASSIST (Action to Stop Smoking In Suspected Tuberculosis), which consisted of 3 conditions: (a) behavioral support sessions (BSS), (b) behavioral support sessions plus 7 weeks of bupropion therapy (BSS+), and (c) controls receiving usual care. The trial originally recruited 1,955 adult smokers with suspected tuberculosis from 33 health centers in the Jhang and Sargodha districts of Pakistan between 2010 and 2011. The primary endpoint was continuous 6-month smoking abstinence, which was determined by carbon monoxide levels. Subgroup-specific relative risks (RRs) of smoking abstinence were computed and tested for differential intervention effect using log binomial regression (generalized linear model) between 3 subgroups (cigarette-only: 1,255; mixed: 485; and hookah-only: 215). RESULTS The test result for homogeneity of intervention effects between the smoking forms was statistically significant (p-value for BSS+: .04 and for BSS: .02). Compared to the control, both interventions appeared to be effective among hookah smokers (RR = 2.5; 95% CI = 1.3-4.7 and RR = 2.2; 95% CI = 1.3-3.8, respectively) but less effective among cigarette smokers (RR = 6.6; 95% CI = 4.6-9.6 and RR = 5.8; 95% CI = 4.0-8.5), respectively. CONCLUSIONS The differential intervention effects on hookah and cigarette smokers were seen (a) because the behavioral support intervention was designed primarily for cigarette smokers; (b) because of differences in demographic characteristics, behavioral, and sociocultural determinants; or (c) because of differences in nicotine dependency levels between the 2 groups.
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Affiliation(s)
- Omara Dogar
- Department of Health Sciences, University of York, York, UK
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Dogar O, Bullen C, Novotny TE, Siddiqi K. Smoking cessation and respiratory disease in low-income and middle-income countries. Lancet Respir Med 2013; 1:e23-4. [PMID: 24429210 DOI: 10.1016/s2213-2600(13)70123-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Omara Dogar
- Department of Health Sciences, University of York, York, YO10 5ZF, UK.
| | - Chris Bullen
- School of Population Health, The University of Auckland, Auckland, New Zealand
| | - Thomas E Novotny
- Division of Epidemiology, Graduate School of Public Health, San Diego State University, San Diego, CA, USA
| | - Kamran Siddiqi
- Department of Health Sciences, University of York, York, YO10 5ZF, UK
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Siddiqi K, Khan A, Ahmad M, Dogar O, Kanaan M, Newell JN, Thomson H. Action to stop smoking in suspected tuberculosis (ASSIST) in Pakistan: a cluster randomized, controlled trial. Ann Intern Med 2013; 158:667-75. [PMID: 23648948 DOI: 10.7326/0003-4819-158-9-201305070-00006] [Citation(s) in RCA: 79] [Impact Index Per Article: 7.2] [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] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Tobacco use is responsible for a large proportion of the total disease burden from tuberculosis. Pakistan is one of the 10 high-burden countries for both tuberculosis and tobacco use. OBJECTIVE To assess the effectiveness of a behavioral support intervention and bupropion in achieving 6-month continuous abstinence in adult smokers with suspected pulmonary tuberculosis. DESIGN Cluster randomized, controlled trial. (Current Controlled Trials: ISRCTN08829879) SETTING Health centers in the Jhang and Sargodha districts in Pakistan. PATIENTS 1955 adult smokers with suspected tuberculosis. INTERVENTION Health centers were randomly assigned to provide 2 brief behavioral support sessions (BSS), BSS plus 7 weeks of bupropion therapy (BSS+), or usual care. MEASUREMENTS The primary end point was continuous abstinence at 6 months after the quit date and was determined by carbon monoxide levels in patients. Secondary end points were point abstinence at 1 and 6 months. RESULTS Both treatments led to statistically significant relative risks (RRs) for abstinence compared with usual care (RR for BSS+, 8.2 [95% CI, 3.7 to 18.2]; RR for BSS, 7.4 [CI, 3.4 to 16.4]). Equivalence between the treatments could not be established. In the BSS+ group, 275 of 606 patients (45.4% [CI, 41.4% to 49.4%]) achieved continuous abstinence compared with 254 of 620 (41.0% [CI, 37.1% to 45.0%]) in the BSS group and 52 of 615 (8.5% [CI, 6.4% to 10.9%]) in the usual care group. There was substantial heterogeneity of program effects across clusters. LIMITATIONS Imbalances in the urban and rural proportions and smoking habits among treatment groups, and inability to confirm adherence to bupropion treatment and validate longer-term abstinence or the effect of smoking cessation on tuberculosis outcomes. CONCLUSION Behavioral support alone or in combination with bupropion is effective in promoting cessation in smokers with suspected tuberculosis. PRIMARY FUNDING SOURCE International Development Research Centre.
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