Adult Smoking Prevalence Research Articles

Effectiveness of Indiana's Statewide Smoke-Free Indoor Air Law in Reducing Prevalence of Adult Cigarette Smoking.

Indiana recently implemented a statewide smoke-free indoor air law that has prohibited smoking in both restaurants and non-hospitality workplaces. Evidence for the effectiveness of the recent statewide smoke-free indoor law may persuade 14 states that do not have any statewide smoke-free laws to enact such laws. We evaluated the effectiveness of Indiana's State Smoke-Free Air Law, implemented July 2012, in reducing adult smoking prevalence. We analyzed samples of U.S. adults using a nonequivalent control group design with multi-year, cross-sectional data from the 2011-2016 Behavioral Risk Factor Surveillance System ( N= 2,259,014). Four state groups with different levels of comprehensiveness in regard to statewide smoke-free indoor air laws in 2011-2016 served as the comparison groups, namely those with: (1) no law; (2) a partial law (prohibiting smoking in either one or two of these three settings, namely non-hospitality workplaces, restaurants, and bars); (3) a comprehensive law (prohibiting smoking in all non-hospitality workplaces, restaurants, and bars); and (4) those that changed from a partial to a comprehensive law. We used a difference-in-differences approach with multiple logistic regressions to assess the net effect of the policy with a secular trend removed. The decline rate of cigarette smoking in Indiana was steeper, from 21.2% in 2011-2012 to 17.8% in 2013-2016, than in states in our four comparison groups, which suggests a significant reduction in adult cigarette smoking prevalence above and beyond the downward secular trend observed. All the comparison groups showed higher odds of cigarette smoking than Indiana (adjusted odds ratios range from 1.08 to 1.16). Although a long-term effect of Indiana's State Smoke-Free Air Law has yet to be evaluated, current data indicate that such a policy appears to be effective in reducing smoking prevalence. The implementation of statewide smoke-free indoor air laws in all restaurants and non-hospitality workplaces may help reduce smoking rates in the 14 states that still do not have any statewide smoke-free indoor air laws.

Predictive validation and forecasts of short-term changes in healthcare expenditure associated with changes in smoking behavior in the United States.

ObjectivesOut-of-sample forecasts are used to evaluate the predictive adequacy of a previously published national model of the relationship between smoking behavior and real per capita health care expenditure using state level aggregate data. In the previously published analysis, the elasticities between changes in state adult current smoking prevalence and mean cigarette consumption per adult current smoker and healthcare expenditures were 0.118 and 0.108 This new analysis provides evidence that the model forecasts out-of-sample well.MethodsOut-of-sample predictive performance was used to find the best specification of trend variables and the best model to bridge a break in survey data used in the analysis. Monte-Carlo simulation was used to calculate forecast intervals for the effect of changes in smoking behavior on expected real per capita healthcare expenditures.ResultsThe model specification produced good-out-of-sample forecasts and stable recursive regression parameter estimates spanning the break in survey methodology. In 2014, a 1% relative reduction in adult current smoking prevalence and mean cigarette consumption per adult current smoker decreased real per capita healthcare expenditure by 0.104% and 0.113% the following year, respectively (elasticity). A permanent relative reduction of 5% reduces expected real per capita healthcare expenditures $99 (95% CI $44, $154) in the next year and $31.5 billion for the entire US (in 2014 dollars), holding other factors constant. The reductions accumulate linearly for at least five years following annual permanent decreases of 5% each year. Given the limitations of time series modelling in a relatively short time series, the effect of changes in smoking behavior may occur over several years, even though the model contains only one lag for the explanatory variables.ConclusionReductions in smoking produce substantial savings in real per capita healthcare expenditure in short to medium term. A 5% relative drop in smoking prevalence (about a 0.87% reduction in absolute prevalence) combined with a 5% drop in consumption per remaining smoker (about 16 packs/year) would be followed by a $31.5 billion reduction in healthcare expenditure (in 2014 dollars).

Inequity in California's Smokefree Workplace Laws: A Legal Epidemiologic Analysis of Loophole Closures

California's landmark 1994 Smokefree Workplace Act contained numerous exemptions, or loopholes, believed to contribute to inequities in smokefree air protections among low-income communities and communities of color (e.g., permitting smoking in warehouses, hotel common areas). Cities/counties were not prevented from adopting stronger laws. This study coded municipal laws and state law changes (in 2015-2016) for loophole closures and determined their effects in reducing inequities in smokefree workplace protections. Public health attorneys reviewed current laws for 536 of California's 539 cities and counties from January 2017 to May 2018 and coded for 19 loophole closures identified from legislative actions (inter-rater reliability, 87%). The local policy data were linked with population demographics from intercensal estimates (2012-2016) and adult smoking prevalence (2014). The analyses were cross-sectional and conducted in February-June 2019. Between 1994 and 2018, jurisdictions closed 6.09 loopholes on average (SD=5.28). Urban jurisdictions closed more loopholes than rural jurisdictions (mean=6.40 vs 3.94, p<0.001), and loophole closure scores correlated positively with population size, median household income, and percentage white, non-Hispanic residents (p<0.001 for all). Population demographics and the loophole closure score explained 43% of the variance in jurisdictions' adult smoking prevalence. State law changes in 2015-2016 increased loophole closure scores and decreased jurisdiction variation (mean=9.74, SD=3.56); closed more loopholes in rural versus urban jurisdictions (meangain=4.44 vs 3.72, p=0.002); and in less populated, less affluent jurisdictions, with greater racial/ethnic diversity, and higher smoking prevalence (p<0.001 for all). Although jurisdictions made important progress in closing loopholes in smokefree air law, state law changes achieved greater reductions in inequities in policy coverage.

Policy options for endgame planning in tobacco control: a simulation modelling study

ObjectiveTo investigate the potential impacts of several tobacco control interventions on adult daily smoking prevalence in the Australian state of Queensland, using a system dynamics model codeveloped with local and...

24-Year trends in educational inequalities in adult smoking prevalence in the context of a national tobacco control program: The case of Brazil

Brazil was a low and middle-income country (LMIC) in the late-1980s when it implemented a robust national tobacco-control program (NTCP) amidst rapid gains in national incomes and gender equality. We assessed changes in smoking prevalence between 1989 and 2013 by education level and related these changes to trends in educational inequalities in smoking. Data were from four nationally representative cross-sectional surveys (1989, n = 25,298; 2003 n = 3845; 2008 n = 28,938; 2013 n = 47,440, ages 25–69 years). We estimated absolute (slope index of inequality, SII) and relative (relative index of inequality, RII) educational inequalities in smoking prevalence, separately for males and females. Additional analyses stratified by birth-cohort to assess generational differences. Smoking declined significantly between 1989 and 2013 in all education groups but declines among females were steeper in higher-educated groups. Consequently, both absolute and relative educational inequalities in female smoking widened threefold between 1989 and 2013 (RII: 1.31 to 3.60, SII: 5.3 to 15.0), but absolute inequalities in female smoking widened mainly until 2003 (SII: 15.8). Conversely, among males, declines were steeper in higher-educated groups only in relative terms. Thus, relative educational inequalities in male smoking widened between 1989 and 2013 (RII: 1.58 to 3.19) but mainly until 2008 (3.22), whereas absolute equalities in male smoking were unchanged over the 24-year period (1989: 21.1 vs. 2013: 23.2). Younger-cohorts (born ≥1965) had wider relative inequalities in smoking vs. older-cohorts at comparable ages, particularly in the youngest female-cohorts (born 1979–1988). Our results suggest that younger lower-SES groups, especially females, may be particularly vulnerable to differentially higher smoking uptake in LMICs that implement population tobacco-control efforts amidst rapid societal gains.

Tobacco Product Use and Cessation Indicators Among Adults - United States, 2018.

Cigarette smoking is the leading cause of preventable disease and death in the United States (1). The prevalence of adult cigarette smoking has declined in recent years to 14.0% in 2017 (2). However, an array of new tobacco products, including e-cigarettes, has entered the U.S. market (3). To assess recent national estimates of tobacco product use among U.S. adults aged ≥18 years, CDC, the Food and Drug Administration (FDA), and the National Cancer Institute analyzed data from the 2018 National Health Interview Survey (NHIS). In 2018, an estimated 49.1 million U.S. adults (19.7%) reported currently using any tobacco product, including cigarettes (13.7%), cigars (3.9%), e-cigarettes (3.2%), smokeless tobacco (2.4%), and pipes* (1.0%). Most tobacco product users (83.8%) reported using combustible products (cigarettes, cigars, or pipes), and 18.8% reported using two or more tobacco products. The prevalence of any current tobacco product use was higher in males; adults aged ≤65 years; non-Hispanic American Indian/Alaska Natives; those with a General Educational Development certificate (GED); those with an annual household income <$35,000; lesbian, gay, or bisexual adults; uninsured adults; those with a disability or limitation; and those with serious psychological distress. The prevalence of e-cigarette and smokeless tobacco use increased during 2017-2018. During 2009-2018, there were significant increases in all three cigarette cessation indicators (quit attempts, recent cessation, and quit ratio). Implementing comprehensive population-based interventions in coordination with regulation of the manufacturing, marketing, and distribution of all tobacco products can reduce tobacco-related disease and death in the United States (1,4).

A Prospective Study of Community Mediators on the Risk of Sepsis After Cancer.

Few studies have examined whether community factors mediate the relationship between patients surviving cancer and future development of sepsis. We determined the influence of community characteristics upon risk of sepsis after cancer, and whether there are differences by race. We performed a prospective analysis using data from the REasons for Geographic and Racial Differences in Stroke cohort years 2003 to 2012 complemented with county-level community characteristics from the American Community Survey and County Health Rankings. We categorized those with a self-reported prior cancer diagnosis as "cancer survivors" and those without a history of cancer as "no cancer history." We defined sepsis as hospitalization for a serious infection with ≥2 systemic inflammatory response syndrome criteria. We examined the mediation effect of community characteristics on the association between cancer survivorship and sepsis incidence using Cox proportional hazards models adjusted for age, sex, race, and total number of comorbidities. We repeated analysis stratified by race. There were 28 840 eligible participants, of which 2860 (9.92%) were cancer survivors, and 25 289 (90.08%) were no cancer history participants. The only observed community-level mediation effects were from income (% mediated 0.07%; natural indirect effect [NIE] on hazard scale] = 1.001, 95% confidence interval [95% CI]: 1.000-1.005) and prevalence of adult smoking (% mediated = 0.21%; NIE = 1.002, 95% CI: 1.000-1.004). We observed similar effects when stratified by race. Cancer survivors are at increased risk of sepsis; however, this association is weakly mediated by community poverty and smoking prevalence.

County-level associations between tobacco retailer density and smoking prevalence in the USA, 2012.

We examine whether county-level tobacco retailer density and adult smoking prevalence are positively associated in the United States and determine whether associations differ in metropolitan vs. nonmetropolitan counties. We merged a list of likely tobacco retailers from the 2012 National Establishment Time-Series with smoking prevalence data from the Behavioral Risk Factor Surveillance System for 2828 US counties, as well as state tobacco policy information and county-level demographic data for the same year. We modeled adult smoking prevalence as a function of tobacco retailer density, accounting for clustering of counties within states. Average density in US counties was 1.25 retailers per 1000 people (range = 0.3–4.5). Smoking prevalence was 0.86 percentage points higher in the most retailer-dense counties, compared to the least. This association, however, was only significant for metropolitan counties. Metropolitan counties in the highest tobacco retailer density quartile had smoking prevalence levels that were 1.9 percentage points higher than metropolitan counties in the lowest density quartile. Research should examine whether policies limiting the quantity, type and location of tobacco retailers could reduce smoking prevalence.

Chronic Disease Surveillance Using Electronic Health Records From Health Centers in a Large Urban Setting.

To assess the validity of electronic health records (EHRs) from a network of health centers for chronic disease surveillance among an underserved population in an urban setting. EHRs from a network of health centers were used to calculate the prevalence of chronic disease among adult and child patient populations during 2016. Two population-based surveys with local estimates of chronic disease prevalence were compared with the EHR prevalences. A network of health centers that provides health care services to an underserved population in a large urban setting. A total of 187 292 patients who had at least 1 health care visit recorded in the Philadelphia health center network. Chronic disease indicator (CDI) prevalence of adult obesity, adult smoking, adult diabetes, adult hypertension, child obesity, and child asthma. Health center CDI proportions were compared with survey estimates. Overall consistency between the health center estimates and surveys varied by CDI. With the exception of childhood obesity, all health center CDI proportions fell within the 95% CI for at least 1 comparison survey estimate. Statistically significant differences were observed and varied by CDI. This analysis presents a novel use of existing EHR data to estimate chronic disease prevalence among underserved populations. With the increased use of EHRs in health centers, data from health center networks may supplement chronic disease surveillance efforts, if used appropriately.

ES20.05 Tobacco Control in Indonesia

Indonesia is the largest archipelago country of more than 17,000 islands over 5,200 km width, with population over 260 million makes it fourth most populated country in the world. As the largest economy in South East Asia, and member of G20 country, Indonesia’s economy growth is second fastest growing economy after China. A changing in socioeconomic profile of Indonesia is in paralel with increase prevalence of tobacco smoking. Current data showed prevalence of current adult male tobacco smoking is 64.9% which predicted to increase to 79% in the year of 2030, while youth male prevalence of current tobacco use is 23.0% and current cigarette smoking is 21.4%. This number is highest for daily smoking rate in male, and two third Indonesian women are regularly exposed to second-hand tobacco smoke. Indonesia’s life expectancy increased between 1990 and 2016 at 8 years to 71.7 years (7.4 years for male and 8.7 years for female). Double health burden due to mix of communicable and noncommunicable diseases. Of all proportional mortality, 35% are cardiovascular diseases, 12% cancer, 6% chronic respiratory diseases, 21% communicable, maternal, perinatal and nutritional conditions, 6% injuries, 6% diabetes. Noncommunicable disease are estimated to responsible for 73% of all death in Indonesia. The increasing leading causes of DALYs in 2017 as compared to 1990 are ischaemic heart disease, cerebrovascular diseases, diabetes, COPD, lung cancer. Tobacco listed as fourth risk factor of cause of death after high systolic blood pressure, dietary risks, high fasting plasma glucose. Tobacco control remains contradictory within the country, despite strong national tobacco control program and government law implementation, Indonesia has yet to sign the WHO Framework Convention on Tobacco Control. National tobacco control program in Indonesia were transformed into specific national government objectives in tobacco control, such as national agency of technical unit for tobacco control, through MPOWER activities. Monitor tobacco use and prevention policies were implemented in Indonesian Law Article 26/2009 for Health and translated in Government Ordinate Article 109/2012 for the Security and Restriction of Addictive Substance of Tobacco and other several Presidential Decrees and Ministerial Decrees. Protect people from tobacco smoke were implemented in Ministerial Decree, and Provincial Decree for Tobacco Smoke Free policy. Offer help to quit tobacco use were included in Ministerial of Health Decree and implemented in National Smoking Cessation Program. Warn about the dangers of tobacco were translated in Ministerial Decrees Article 56/2017 for tobacco health effect warning in tobacco products and pictorial warning of tobacco smoke. Enforce bans on tobacco advertising, promotion and sponsorship were implemented through Indonesian Broadcasting Law Article 46 Clause 3B prohibits promotion of addictive substances and Raise taxes on tobacco were implemented in Ministry of Finance Decree article 222/2017 regarding using, monitoring and evaluation of tobacco tax income. Moreover, Presidential Decree article 44/2016 and Ministry of Industry Decree Article 64/2014 for Regulation and Control of tobacco industry. Tobacco and related industries argued against tobacco control policy by mentioning largescale effects of tobacco industry for Indonesian economy, and controlling tobacco industry will create massive unemployment, and economic crisis. Ministry of Industry of Republic Indonesia mentioned that tobacco industry creates 5.98 million employments, in which 4.28 million in manufacture and distribution, and 1.7 million people working in tobacco farming. In 2018, export rate of tobacco as cigarettes and cigar were 931.6 million USD, increasing 2.98% as compared to 2017. Tobacco company links closely to small medium enterprises as the tobacco company’s social responsibility (CSR) program. One CSR program as retail community, was founded in 34 provinces, 408 cities which included 60,000 small business retail. Other tobacco related industry's CSR are including sports, youth and creative activities nationwide. Since 1968, Indonesia National Health insurance system was only implemented for formal sector, individual, civil servants, police and military member, but, since 2014, Indonesian Government launched Universal Health System called Jaminan Kesehatan Nasional (JKN) for all Indonesian. In 2017 approximately 180.7 million people are insured through JKN, 70% of total population and planned to reach 95% target in 2019. While tobacco industry tax income were IDR 153 trillion (approximately USD 10.9 billion) in the year of 2018, tobacco related lost due to early death and disease were IDR 4,200 trillion (one third of national GDP), and economy related lost due to tobacco consumption were approximately IDR 596 trillion. This should be bear in mind, that amount of tax income from tobacco company is incomparable to high burden loss due to tobacco related morbidity and mortality.

Prevalence and Effects of Cigarette Smoking, Cannabis Consumption, and Co-use in Adults From 15 Countries With Congenital Heart Disease

BackgroundThe prevalence and effects of cigarette smoking and cannabis use in persons with congenital heart disease (CHD) are poorly understood. We (1) described the prevalence of cigarette smoking, cannabis consumption, and co-use in adults with CHD; (2) investigated intercountry differences; (3) tested the relative effects on physical functioning, mental health, and quality of life (QOL); and (4) quantified the differential effect of cigarette smoking, cannabis use, or co-use on those outcomes. MethodsAPPROACH-IS was a cross-sectional study, including 4028 adults with CHD from 15 countries. Patients completed questionnaires to measure physical functioning, mental health, and QOL. Smoking status and cannabis use were assessed by means of the Health Behaviour Scale—Congenital Heart Disease. Linear models with doubly robust estimations were computed after groups were balanced with the use of propensity weighting. ResultsOverall, 14% of men and 11% of women smoked cigarettes only; 8% of men and 4% of women consumed cannabis only; and 4% of men and 1% of women used both substances. Large intercountry variations were observed, with Switzerland having the highest prevalence for smoking cigarettes (24% of men, 19% of women) and Canada the highest for cannabis use (19% of men, 4% of women). Cigarette smoking had a small negative effect on patient-reported outcomes, and the effect of cannabis was negligible. The effect of co-use was more prominent, with a moderate negative effect on mental health. ConclusionsWe found significant intercountry variability in cigarette and cannabis use in adults with CHD. Co-use has the most detrimental effects on patient-reported outcomes.

Social and Physical Environmental Characteristics Associated With Adult Current Cigarette Smoking.

IntroductionOur objective was to identify social and physical environmental factors associated with current cigarette smoking among adults by metropolitan county in the United States.MethodsWe linked cigarette smoking data from the 2012 Behavioral Risk Factor Surveillance System (BRFSS) Selected Metropolitan Area Risk Trends (SMART) data set to 7 social and physical environmental characteristics: county type (metropolitan designation), primary care physician density, income inequality, percentage of the population that was a racial/ethnic minority, violent crime rate, education, and percentage of county residents with low income and no health insurance, all obtained from several county data sets. Spatial regression and hierarchical logistic regression modeling were performed.ResultsResults showed that metropolitan counties with a high proportion of non-Hispanic white adults (P < .001), lower education levels (high school graduate or less) (P < .001), and high violent crime rates (P < .001) had a higher adult cigarette smoking prevalence than other metropolitan counties. Spatial models showed 63.3% of the variability in county cigarette smoking prevalence was explained by these 3 factors as well as county type (based on population size of the of metropolitan area), primary care physician density, and percentage of county residents with low income and no health insurance. At an individual level, results showed that as the density (population) of primary care physicians increased in a county, the odds of being a current smoker decreased (OR, 0.980; P = .02).ConclusionWe found a significant association between adult cigarette smoking and county social and physical environmental factors. These place-based factors, especially social environmental characteristics, may reveal tobacco-related disparities to be considered when developing strategies to reduce tobacco use.

Applying Publicly Available Contextual Factors to Predict Smoking Relapse in a National Sample

Background: The ecological fallacy is broadly understood, though its complimentary problem, the individualistic or atomistic fallacy, isless often considered. Multilevel models offer the statistical tools needed to avoid both errors by allowing simultaneous considerationof individual, contextual, and policy factors. This study applies such methods to smoking cessation data. Tobacco control is of particularconcern in Ohio where the adult smoking prevalence remains around 22%.Methods: Data from the 1,785 participants in the Technology Enhanced Quitline Study were used to test the theory that contextualfactors impact relapse rates and program effectiveness, employing a mixed-effects model to account for the nested nature of the datawhile testing for the relationship between contextual factors and relapse, controlling for individual characteristics.Results: No contextual factors or policy variables were significant predictors of smoking relapse in the sample, nor were any associated with the success of the intervention.Conclusions: While this work could not identify specific influences of contextual and policy factors on smoking outcomes in our sample, it demonstrates the feasibility of adding such predictors to future clinical trials. This project clearly does not rule out the possibility that contextual and policy factors may influence smoking even after controlling for individual characteristics, but does not provide strong evidence of such a link. It is possible that these negative findings may be due to geocoded mailing addresses being a poor proxy for relevant contextual factors, use of the wrong geographic unit of analysis (modifiable areal unit problem), or a lack of temporal resolution in contextual variables.

“Everyone Needs a Breath of Fresh Air”

Europe continues to have among the highest worldwide prevalence of adult smoking (28%) and the highest among females (19%). Nurses' rates of smoking in the region are comparable or higher than the general female population. Nurses who smoke are less likely to intervene with patients who smoke; therefore, supporting nurses' efforts to quit is critical to promoting nurses' well-being and strengthening the profession's impact on prevention of tobacco-induced diseases. The aim of this study was to explore nurses' perceptions of hospital workplace factors that influence nurses' smoking and quitting behaviors in Central and Eastern Europe. Each country had a project director involved in the recruitment of participants and the translation of instruments. Using a moderator guide, focus groups (N = 9) about smoking and quitting were conducted in 5 countries (Czech Republic, Hungary, Romania, Slovakia, Slovenia) among 82 nurses who self-reported as current or former smokers. Recorded transcripts were translated and analyzed using content analysis methods. The majority of nurses were female (94%) and currently smoking (65%). Four major themes were identified that describe workplace factors influencing nurses' smoking behaviors and efforts to quit: (1) taking breaks, (2) effect of smoking on patient interactions, (3) perceived collegial support for quitting, and (4) impact of workplace policies. Workplace factors influence nurses smoking and quitting behaviors. Changes in healthcare systems and policies are needed to support nurses' quit efforts. Additional education is needed to ensure that nurses understand issues related to smoking and interactions with patients.

Abstract 023: The Natural History of Cigarette Smoking From Childhood to Middle-Age: The International Childhood Cardiovascular Cohort (i3C) Consortium

Background: Smoking is known to cause clinical cardiovascular disease. We report the natural history of smoking from childhood until average age 47 years in the large cohort followed in the International Childhood Cardiovascular Cohort (i3C) Consortium, which consists of seven long-standing cohorts in the US, Finland and Australia. Methods: Data on childhood smoking status were obtained from questionnaires answered during age 6-19 during the 1980s. Childhood smoking status was categorized as never smoker, tried smoking only a few times, tried more extensively (including quitters), and regular smoker. The i3C participants had follow-up visits until 2015-18 (Finland 2010-12), when they reported whether they were smokers during their 20s and/or 40s. Results: Of the 9977 participants, prevalence of regular smoking decreased from 35.5% in their 20s, to 20.5% in their 40s; cessation was unrelated to childhood smoking status. As shown in the Figure, among 1816 participants queried at age 18/19, prevalence of regular smoking in their 20s was 4.1% (36/886) in those who never smoked even during adolescence, 12% (22/183) in those who tried only a few times, 21.5% (40/186) in those who tried more extensively, and 76.5% (429/561) in those who were regular smokers during childhood. The pattern was similar among 860 whose last childhood smoking status was queried at age 16/17 (some probably experimented more during the remainder of childhood), but smoking in their 20s was more common for all smoking experimentation groups than in 18/19 year olds. Conclusions: These long-term follow-up data suggest that prevalence of adult smoking was significantly related to level of smoking experimentation during adolescence. However, cessation during adulthood does not depend on childhood smoking status. Policy change (such as taxes and restrictions on smoking indoors) has proven to be one of the most powerful tobacco control tools. These data support an emerging new policy strategy, namely raising the legal cigarette purchase age to 21 years

Effect of the comprehensive smoke-free law on time trends in smoking behaviour in primary healthcare patients in Spain: a longitudinal observational study

ObjectiveThis study aimed to analyse the impact of comprehensive smoke-free legislation (SFL) on the prevalence and incidence of adult smoking in primary healthcare (PHC) patients from three Spanish regions, overall...

Tobacco Smoking: Findings from 20 Years of the Tehran Lipid and Glucose Study.

ContextSmoking is a global public health priority and accurate data of the local population is essential to improve the health policies against its use. Hence, this study aimed to summarize the important findings available on the prevalence of smoking and its association with non-communicable diseases, documented by one of the largest prospective community-based studies of Iran.Evidence AcquisitionAll articles derived from the Tehran Lipid and Glucose Study (TLGS) in the last two decades, from the earliest publications until 30 January 2018 were reviewed for their findings on tobacco smoking.ResultsThe prevalence of smoking in non-diabetic adults ≥ 20 years increased between baseline (phase I, 1999 - 2001) and follow-up (phase V, 2008 - 2011) from 25.5% to 35.4% among men and from 3.4% to 6.8% among women. In TLGS adolescents (10 - 18 years) water pipe use increased between 2003 and 2005 from 35.5% to 40.9% among boys and from 19.7% to 26.1% among girls. Regarding health hazards, smoking in men was associated with increased risk of combined impaired fasting glucose/impaired glucose tolerance [hazard ratio (HR) 1.69; confidence interval (CI) 95% 1.15 - 2.48] and hypertension (HR 1.26; CI 95% 0.98 - 1.63). Moreover, men, even smoking less than 10 cigarettes per day, were at increased risk for cardiovascular diseases by HR 2.12 (CI 95% 1.14 - 3.95). For women, the risk of chronic kidney disease dramatically increased 5.74-fold (CI 95% 2.71 - 12.15) among smokers. In the whole population, smoking contributed to 7.7% of all-cause mortality with HR 1.75 (CI 95% 1.38 - 2.22). Other health aspects of tobacco smoke, including its impact on metabolic status, thyroid function, female reproductive system and life style have also been reviewed.ConclusionConsidering hazards of smoking, there is the urgency for more effective preventive measures in Iran; emphasizing the need for further local studies on the hazards of smoking with special attention to women and adolescents and the independent hazards of water pipe use.

IQOS campaign in Israel

At present, IQOS, Philip Morris’s (PM’s) heated tobacco product, is being test-marketed in 30 countries worldwide.1 Similarly to electronic cigarettes,2 regulation varies widely by country. In the USA, for example,...

Effects of tobacco control policy on cardiovascular morbidity and mortality in Russia.

BackgroundAccording to the Global Adult Tobacco Survey carried out in Russia in 2009, the country had one of the highest smoking prevalence rates in Europe. In response to this health and economic burden, Russia implemented a comprehensive Tobacco Control Law (TCL) in 2013, which has been associated with a 21.5% relative decline in adult smoking prevalence in 2016 compared with 2009. This study tests the impact of the TCL on cardiovascular disease (CVD) related health outcomes, including morbidity and mortality.MethodThe study evaluated the TCL as an intervention in a natural experiment during the period 2003–2015. A synthetic control was created as a comparator, using data from countries that did not have a comparable comprehensive tobacco control intervention. Changes in trends in CVD outcomes – hospital discharge rates (HDRs) and standardized death rates (SDRs) – were then compared to test for an impact associated with the TCL.ResultsPre-intervention trends in CVD-related HDRs were similar between Russia and the synthetic control, but became divergent after the TCL with greater benefit observed in Russia. This implies a beneficial impact of the TCL on CVD related morbidity in the Russian population. Whilst SDRs continued to reduce in both Russia and the control, the impact of TCL is less clear.ConclusionThis study provides further evidence to support comprehensive tobacco control in line with the WHO Framework Convention for Tobacco Control (WHO FCTC). Alongside a reduction in tobacco consumption, smoking-related CVD morbidity appears to benefit quite soon after implementation, whilst smoking-related deaths might need a longer post-intervention period to be detectable.

Global Alliance Against Tobacco Marketing: Do Increased Taxation of Tobacco Products Decrease Tobacco Consumption?

The prevailing wisdom in tobacco control literature is that adroit use of taxation policy will reduce the prevalence of tobacco use because when tobacco prices go up, consumption goes down. Empirical evidence of this axiomatic inverse relationship has been sparse. This paper analyzes the effects of increased taxation on consumption of tobacco products in 136 countries during 2009-2015. Results indicate that there is weak negative relationship between change in adult smoking prevalence and change in taxation suggesting that higher tax rates on tobacco products tend to lower adult smoking prevalence, but in a modest rather than robust sort of way.