Burden Of Smoking Research Articles

Synergistic and Non-synergistic Associations for Cigarette Smoking and Non-tobacco Risk Factors for Cardiovascular Disease Incidence in the Atherosclerosis Risk In Communities (ARIC) Study.

Cigarette smoking, various metabolic and lipid-related factors and hypertension are well-recognized cardiovascular disease (CVD) risk factors. Since smoking affects many of these factors, use of a single imprecise smoking metric, for example, ever or never smoked, may allow residual confounding and explain inconsistencies in current assessments of interactions. Using a comprehensive model in pack-years and cigarettes/day for the complex smoking-related relative risk (RR) of CVD to reduce residual confounding, we evaluated interactions with non-tobacco risk factors, including additive (non-synergistic) and multiplicative (synergistic) forms. Data were from the prospective Atherosclerosis Risk in Communities (ARIC) Study from four areas of the United States recruited in 1987-1989 with follow-up through 2008. Analyses included 14 127 participants, 207 693 person-years and 2857 CVD events. Analyses revealed distinct interactions with smoking: including statistical consistency with additive (body mass index [BMI], waist to hip ratio [WHR], diabetes mellitus [DM], glucose, insulin, high density lipoproteins [HDL] and HDL(2)); and multiplicative (hypertension, total cholesterol [TC], low density lipoproteins [LDLs], apolipoprotein B [apoB], TC to HDL ratio and HDL(3)) associations, as well as indeterminate (apolipoprotein A-I [apoA-I] and triglycerides) associations. The forms of the interactions were revealing but require confirmation. Improved understanding of joint associations may help clarify the public health burden of smoking for CVD, links between etiologic factors and biological mechanisms, and the consequences of joint exposures, whereby synergistic associations highlight joint effects and non-synergistic associations suggest distinct contributions. Joint associations for cigarette smoking and non-tobacco risk factors were distinct, revealing synergistic/multiplicative (hypertension, TC, LDL, apoB, TC/HDL, HDL(3)), non-synergistic/additive (BMI, WHR, DM, glucose, insulin, HDL, HDL(2)) and indeterminate (apoA-I and TRIG) associations. If confirmed, these results may help better define the public health burden of smoking on CVD risk and identify links between etiologic factors and biologic mechanisms, where synergistic associations highlight joint impacts and non-synergistic associations suggest distinct contributions from each factor.

Measuring Burden of Unhealthy Behaviours Using a Multivariable Predictive Approach: Life Expectancy Lost in Canada Attributable to Smoking, Alcohol, Physical Inactivity, and Diet.

BackgroundBehaviours such as smoking, poor diet, physical inactivity, and unhealthy alcohol consumption are leading risk factors for death. We assessed the Canadian burden attributable to these behaviours by developing, validating, and applying a multivariable predictive model for risk of all-cause death.MethodsA predictive algorithm for 5 y risk of death—the Mortality Population Risk Tool (MPoRT)—was developed and validated using the 2001 to 2008 Canadian Community Health Surveys. There were approximately 1 million person-years of follow-up and 9,900 deaths in the development and validation datasets. After validation, MPoRT was used to predict future mortality and estimate the burden of smoking, alcohol, physical inactivity, and poor diet in the presence of sociodemographic and other risk factors using the 2010 national survey (approximately 90,000 respondents). Canadian period life tables were generated using predicted risk of death from MPoRT. The burden of behavioural risk factors attributable to life expectancy was estimated using hazard ratios from the MPoRT risk model.FindingsThe MPoRT 5 y mortality risk algorithms were discriminating (C-statistic: males 0.874 [95% CI: 0.867–0.881]; females 0.875 [0.868–0.882]) and well calibrated in all 58 predefined subgroups. Discrimination was maintained or improved in the validation cohorts. For the 2010 Canadian population, unhealthy behaviour attributable life expectancy lost was 6.0 years for both men and women (for men 95% CI: 5.8 to 6.3 for women 5.8 to 6.2). The Canadian life expectancy associated with health behaviour recommendations was 17.9 years (95% CI: 17.7 to 18.1) greater for people with the most favourable risk profile compared to those with the least favourable risk profile (88.2 years versus 70.3 years). Smoking, by itself, was associated with 32% to 39% of the difference in life expectancy across social groups (by education achieved or neighbourhood deprivation).ConclusionsMultivariable predictive algorithms such as MPoRT can be used to assess health burdens for sociodemographic groups or for small changes in population exposure to risks, thereby addressing some limitations of more commonly used measurement approaches. Unhealthy behaviours have a substantial collective burden on the life expectancy of the Canadian population.

Combination Extended Smoking Cessation Treatment Plus Home Visits for Smokers With Schizophrenia: A Randomized Controlled Trial.

The majority of people with schizophrenia have a diagnosis of tobacco dependence during their lifetime. A major obstacle to reducing the burden of cigarette smoking in this population is that these smokers have lower quit rates when undergoing standard treatment compared to smokers with no mental illness. We sought to determine if combination extended treatment (COMB-EXT) and home visits (HV) would lead to improved outcomes in smokers with schizophrenia. Thirty-four cigarette smokers with schizophrenia completed either COMB-EXT with HV, COMB-EXT without HV, or treatment as usual (TAU) (random assignment). COMB-EXT consisted of group cognitive-behavioral therapy (CBT), bupropion, nicotine patch, and nicotine lozenge, which were initiated within 2 weeks and continued for 26 weekly visits. HV consisted of biweekly visits to the home with assessment of secondhand smoke (SHS) exposure and brief behavioral therapy with participants and others in the home environment. TAU consisted of group CBT plus serial single or combination medication trials as per standard care. Smokers with schizophrenia who received COMB-EXT (with or without HV) had greater reductions in cigarettes per day than those treated with TAU (both ps < .01). In addition, 7-day point prevalence abstinence rates for the three groups were 45%, 20%, and 8%, respectively, which was significantly higher for COMB-EXT plus HV than TAU (χ2(1) = 4.8, p = .03). Groups did not differ significantly in the number of adverse events, and HV were easily scheduled. COMB-EXT improves outcomes for smokers with schizophrenia. HV appeared to provide additional benefit for smoking cessation in this treatment-resistant population. The clear benefit found here of rapidly initiated, combination, extended treatment over TAU suggests that aggressive and extended treatment should be considered in clinical practice for smokers with schizophrenia. Furthermore, HV to address SHS exposure showed initial promise for assisting smokers with schizophrenia in maintaining abstinence, indicating that this intervention may be worthy of future research.

Curricular Innovations in Tobacco Cessation Education for Prelicensure Baccalaureate Nursing Students.

Tobacco use is the primary preventable cause of morbidity and mortality in the United States, resulting in enormous health care expenditures. The burden of smoking is higher among disadvantaged populations, such as individuals with mental illness. As the largest group of health care providers, nurses must assume a leading role in tobacco control efforts to decrease the deleterious impact on health outcomes. Investigators used a randomized control group design to assess the effectiveness of a theory-based tobacco education program on the perceived competence and intrinsic motivation of prelicensure BSN students (N = 134) to engage in cessation interventions with patients with mental illness. Students completing the program reported a significant increase in perceived competence, compared with their peers who received standard instruction only. Intrinsic motivation did not increase significantly for either group. Findings suggest that the program improves students' perceived competence, but further research is needed to determine its effect on motivation and its usefulness in other health care contexts. [J Nurs Educ. 2016;55(8):425-431.].

Burden of tobacco smoking and its awareness

Burden of tobacco smoking and its awareness

The fraction of breast cancer attributable to smoking: The Norwegian women and cancer study 1991-2012.

Background:Results from several recent cohort studies on smoking and breast cancer incidence and mortality suggest that the burden of smoking on society is underestimated. We estimated the fraction of breast cancer attributable to smoking in the Norwegian Women and Cancer Study, a nationally representative prospective cohort study.Methods:We followed 130 053 women, aged 34–70 years, who completed a baseline questionnaire between 1991 and 2007, through linkages to national registries through December 2012. We used Cox proportional hazards models to estimate hazard ratios (HRs) with 95% confidence intervals (CIs), while adjusting for confounders. Never smokers, excluding passive smokers, were used as the reference group in all main analyses. We estimated attributable fractions (AFs) % in smokers and in the population (PAFs) % with 95% CIs.Results:Altogether, 4293 women developed invasive breast cancer, confirmed by histology. Compared with never active, never passive smokers, ever (former and current) smokers had an overall risk of breast cancer that was 21% higher (HR=1.21; 95% CI=1.08–1.34). For ever smokers, the AF was 17.3% (95% CI =7.4–25.4) and for the population the PAF of breast cancer was 11.9% (95% CI=5.3–18.1). For passive smokers, the PAF of breast cancer was 3.2% (95% CI=1.0–5.4). When we applied PAF estimates for ever smoking on the 2907 new breast cancer cases among Norwegian women aged 35+ at diagnosis in 2012, this yielded 345 (95% CI=154–526) breast cancer cases that could have been avoided in the absence of active smoking that year.Conclusions:In smokers, one in six and in the population, one in nine breast cancer cases could have been avoided in the absence of active smoking. Our findings support the notion that the global cancer burden due to smoking is substantially underestimated.

Chronic obstructive pulmonary disease and HIV: are we appropriately screening?

ABSTRACTIndividuals with human immunodeficiency virus (HIV) represent a population that is at a higher risk of developing chronic obstructive pulmonary disease (COPD). In this study, we sought to determine the effects of smoking on respiratory symptoms and diseases among HIV-positive patients and to determine if symptomatic patients are being appropriately screened for COPD. HIV-positive individuals completed a self-administered questionnaire. The effects of smoking on respiratory symptoms and diseases were reported as odds ratios (ORs). The COPD screening criteria were adapted from the Canadian Thoracic Society (CTS) guidelines. Two hundred and forty-seven participants were recruited. The median age was 49 years; 75% were male and 92% were on highly active antiretroviral therapy. Smokers represented 66% of the population. Smoking had a statistically significant effect on respiratory symptoms including wheeze (OR 4.8 [95% confidence interval (CI) 1.6–14.2]), phlegm production (OR 4.9 [95% CI: 2.2–10.5]), cough (OR 7.0 [95% CI: 3.0–16.2]), and dyspnea (OR 7.2 [95% CI: 1.7–31.2]). Smoking had a higher odds of respiratory diseases including COPD (OR 4.9 [95% CI: 1.1–21.9]) and bronchitis (OR 3.8 [95% CI: 1.9–7.7]). Among HIV-positive smokers, 40% met the CTS screening criteria, while only 12% self-reported a diagnosis of COPD. The burden of smoking in the HIV population is significant. HIV-positive smokers are more likely to report both respiratory symptoms and diseases than HIV-positive non-smokers. A discrepancy exists between patients who met the CTS screening criteria and those who were diagnosed with COPD, raising the concern for under-recognition and under-diagnosis of COPD in this population.

The dynamic of non-communicable disease control policy in Indonesia

Objective The aim of the present study was to examine non-communicable disease (NCD) policy formation and implementation in Indonesia. Methods Interviews were conducted with 13 Indonesian health policy workers. The processes and issues relating to NCD policy formation were mapped, exploring the interactions between policy makers, technical/implementation bodies, alliances across various levels and the mobilisation of non-policy actors. Results Problems in NCD policy formation include insufficient political interest in NCD control, disconnected policies and difficulty in multisectoral coordination. These problems are well illustrated in relation to tobacco control, but also apply to other control efforts. Nevertheless, participants were optimistic that there are plentiful opportunities for improving NCD control policies given growing global attention to NCD, increases in the national health budget and the growing body of Indonesia-relevant NCD-related research. Conclusion Indonesia's success in the creation and implementation of NCD policy will be dependent on high-level governmental leadership, including support from the President, the Health Minister and coordinating ministries. What is known about the topic? The burden of NCD in Indonesia has increased gradually. Nationally, NCD-related mortality accounted for 65% of deaths in 2010. Indonesia is also a country with the highest burden of tobacco smoking in the world. However, the government has not instituted sufficient policy action to tackle NCDs, including tobacco control. What does this paper add? This paper deepens our understanding of current NCD control policy formation in Indonesia, including the possible underlying reason why Indonesia has weak tobacco control policies. It describes the gaps in the current policies, the actors involved in policy formation, the challenges in policy formation and implementation and potential opportunities for improving NCD control. What are the implications for practitioners? An effective NCD control program requires strong collaboration, including between government and health professionals. Health professionals can actively engage in policy formation, for example through knowledge production.

Health, Stigma, and the Burden of Smoking in College: A Thematic Analysis.

Authorities estimate that 16.7% of adults 18-24 smoke, and many initiate or increase cigarette smoking while in college. Thus, college represents a critical time for intervention. Simmons et al developed and tested an interactive Web-based intervention that includes a component for inducing dissonance through creating video testimonials about the negatives of smoking. We applied thematic analysis to video content to identify smoking's negative consequences as reflected in testimonials from 78 college smokers. We identified common themes and calculated the amount of time spent discussing each theme and the strength of language used. Social stigma and health consequences of smoking emerged as multidimensional themes; other common topics included financial burden, chemicals in cigarettes, and cravings/addiction. These results provide insight into the attitudes of college student smokers. Addressing these topics may be important for message development in intervention and prevention studies.

Psoriasis and smoking: links and risks.

Smoking is a complex environmental exposure influenced by genetic, environmental, and social factors. Nicotine is the principal alkaloid in tobacco that mediates the addicting effects of tobacco products. Tobacco is a mixture of more than 7,000 chemicals, and smoking is recognized as a risk factor for many diseases in humans, including cardiovascular and pulmonary disease and several cancers, and is the single most preventable cause of mortality worldwide. A number of inflammatory immune-related conditions have been associated with smoking, including psoriasis. Smoking affects the onset of psoriasis. In a pooled analysis of 25 case–control studies, the odds ratio of psoriasis among smokers was 1.78 (95% confidence interval [CI]: 1.53–2.06). A dose–effect relationship is also documented. In a pooled analysis of three cohort studies, the risk of incident psoriasis was 1.81 (95% CI: 1.38–2.36) in those who smoked 1–14 cigarettes per day, and 2.29 (95% CI: 1.74–3.01) in those who smoked ≥25 cigarettes per day. Smoking also impacts on the clinical severity of psoriasis, its response to treatment, and explains some of the associated comorbidities, eg, cardiovascular disease, inflammatory bowel disease, and several cancers (especially those of the respiratory tract). Data on the role of smoking in psoriatic arthritis are less consistent compared with those concerning psoriasis. Several pathophysiological mechanisms may explain the association of psoriasis with smoking, including oxidative stress, interaction with signaling pathways active in psoriasis, and vascular influences. In conclusion, psoriasis is just one of the many diseases associated with smoking, but it is visible and disabling. Dermatologists could play a major role in reducing the health burden of smoking by influencing the patients to change their behavior.

Cigarette smoking in a Middle Eastern country and its association with hospitalisation use: a nationwide cross-sectional study

ObjectivesLittle is known about the distribution of cigarette smoking by place and persons at the national level or its burden on healthcare expenditure in countries of the Middle East. We...

Association between Smoking Status and Obesity in a Nationwide Survey of Japanese Adults.

ObjectiveA positive association between the number of cigarettes smoked per day and obesity has been reported, whereas how other smoking-related indices, such as pack-years and duration of smoking, are related with obesity has been less investigated. We analyzed the age-adjusted cross-sectional association between smoking and obesity in a general Japanese population.MethodsWe used data from a nationwide epidemiological study of Japanese adults (N = 23,106). We compared the prevalence of obesity (defined as body mass index ≥ 25kg/m2) among groups classified by smoking behavior, pack-years, number of cigarettes per day, duration of smoking, and duration and time of smoking cessation.ResultsIn men, current smokers had a lower odds ratio (OR) for obesity of 0.80 (95% confidence interval (CI): 0.72–0.88) compared to non-smokers, whereas past smokers had a higher OR of 1.23 (95% CI: 1.09–1.37) compared to current smokers. In women, there were no differences in obesity between the three groups classified by smoking behavior. However, in both sexes, the prevalence of obesity tended to increase with pack-years and the number of cigarettes per day, but not with duration of smoking in current and past smokers. Further, in male smokers, the risks for obesity were markedly higher in short-term heavy smokers compared with long-term light smokers, even with the same number of pack-years. Regarding the impact of smoking cessation, female past smokers who quit smoking at an age > 55-years had an elevated OR of 1.60 (95% CI:1.05–2.38) for obesity.ConclusionsIn a general Japanese population, obesity is progressively associated with pack-years and number of cigarettes per day, but not with the duration of smoking. When investigating the association between obesity and cigarette smoking, the daily smoking burden and the duration of smoking require to be independently considered.

Risk of ARI among Non-exclusively Breastfed Under-Five Passive Smoker Children: A Hospital-Based Cross-sectional Study of Nepal.

As Nepal witnesses high burden of both acute respiratory infection (ARI) and passive smoking among under-five children, studies on effect modification of exclusive breastfeeding on passive smoking and ARI carry huge significance. With Nepal holding no evidence in this regard, findings would be useful to promote a cost-effective intervention: exclusive breastfeeding. This study was therefore conceived as an effort to bring to light the modifying effect that exclusive breastfeeding may have on the association between household passive smoking and ARI among under-five children. One hundred and ninety-eight parents of under-five children from Kanti Children's Hospital, Kathmandu, Nepal, participated in this descriptive, cross-sectional study carried out in October 2012. Data collected from a semi-structured questionnaire were subjected to univariate, bivariate, and multivariable analysis in R version 3.1.2. Non-exclusively breastfed children with presence of anyone smoking at their house [aOR = 4.8, 95% confidence interval (CI): 1.7-13.2] and smoking in presence of children (aOR = 6.4, 95% CI: 1.1-38.3) had higher chances of ARI; nevertheless, this remained insignificant among the exclusively breastfed ones. Having a separate kitchen in the house showed protective effect against ARI among exclusively breastfed children (aOR = 0.2, 95% CI: 0.1-0.6). Children whose mothers spent at least 2 h per day in the kitchen had a higher chance of developing ARI, regardless of being exclusively breastfed (aOR = 4.5, 95% CI: 1.5-13.1) or non-exclusively breastfed (aOR = 4.5, 95% CI: 1.4-14.2) compared to those who spent <2 h per day. Non-exclusive breastfeeding may increase the chances of deleterious effects of household passive smoking, such as ARI, among under-five children. As these findings are not conclusive, studies with better design and larger samples are warranted to confirm the effect.

Abstract P1-07-20: The smoking related risk of breast cancer and proportion of avoidable breast cancer cases due to passive and active smoking in middle-aged women in Norway in 2012: The Norwegian women and cancer study 1991-2012

Abstract Background: The burden of smoking on society may be underestimated as previous estimates of cancer due to smoking have generally not included breast cancer. We utilized the Norwegian Women and Cancer Study, a nationally representative prospective cohort study to examine the risk of breast cancer due to passive and active smoking. We also estimated the proportion of breast cancer attributable to passive and active smoking. Material and methods: Our study included 130053 women, aged 34 to 70 years, who completed a baseline questionnaire between 1991 and 2007. We followed the women through linkages to the Cancer Registry of Norway and the Norwegian Central Population Register, to identify all cancer cases, emigrations, and deaths, respectively, using the unique national 11-digit personal identification number. Person-years were calculated from the start of follow-up to the date of any incident cancer diagnosis, emigration, death, or the end of follow-up December 31, 2012, whichever came first. Breast cancer cases were classified according to the original codes in the International Classification of Diseases, Seventh Revision including estrogen and progesterone hormone tumor receptor status. We used Cox proportional hazards models, adjusting for relevant confounders, to estimate multivariate adjusted hazard ratios (HRs) with 95% confidence intervals (CIs). Never smokers, excluding passive, served as the reference group. We estimated attributable fractions in smokers and in the population with 95% CIs. Results: Ever compared with passive and never smokers were younger at breast cancer diagnosis, at first childbirth and at menopause; they were less likely to have higher education, more likely to have used hormonal contraceptives and postmenopausal hormone therapy and to consume alcohol. The alcohol drinkers were consuming more alcohol. During follow-up 4293 women developed invasive breast cancer confirmed by histology. Compared with never smokers, the multivariate adjusted breast cancer HR was for ever smokers 1.21 (1.08-1.34). Compared with parous never smokers, the HR estimate for breast cancer for ever smokers who had smoked five or more years before giving birth was 1.29 (1.14-1.46) after adjustment. A trend test for number of pack-years and breast cancer risk was significant (ptrend= 0.007). We found similar HR estimates when we stratified by menopausal and parous status at entry. The attributable fraction for breast cancer was 17.3 (7.4-25.4) for active smokers. The population attributable fraction of breast cancer for active smoking was 11.9 (5.3-18.1). Conclusion: In smokers, one in six, and in the population almost one in eight breast cancer cases could have been avoided in the absence of smoking. Citation Format: Gram IT, Little MA, Lund E, Braaten T. The smoking related risk of breast cancer and proportion of avoidable breast cancer cases due to passive and active smoking in middle-aged women in Norway in 2012: The Norwegian women and cancer study 1991-2012. [abstract]. In: Proceedings of the Thirty-Eighth Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2015 Dec 8-12; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2016;76(4 Suppl):Abstract nr P1-07-20.

A review of approaches to estimate wildfire plume injection height within large-scale atmospheric chemical transport models

Abstract. Landscape fires produce smoke containing a very wide variety of chemical species, both gases and aerosols. For larger, more intense fires that produce the greatest amounts of emissions per unit time, the smoke tends initially to be transported vertically or semi-vertically close by the source region, driven by the intense heat and convective energy released by the burning vegetation. The column of hot smoke rapidly entrains cooler ambient air, forming a rising plume within which the fire emissions are transported. The characteristics of this plume, and in particular the height to which it rises before releasing the majority of the smoke burden into the wider atmosphere, are important in terms of how the fire emissions are ultimately transported, since for example winds at different altitudes may be quite different. This difference in atmospheric transport then may also affect the longevity, chemical conversion, and fate of the plumes chemical constituents, with for example very high plume injection heights being associated with extreme long-range atmospheric transport. Here we review how such landscape-scale fire smoke plume injection heights are represented in larger-scale atmospheric transport models aiming to represent the impacts of wildfire emissions on component of the Earth system. In particular we detail (i) satellite Earth observation data sets capable of being used to remotely assess wildfire plume height distributions and (ii) the driving characteristics of the causal fires. We also discuss both the physical mechanisms and dynamics taking place in fire plumes and investigate the efficiency and limitations of currently available injection height parameterizations. Finally, we conclude by suggesting some future parameterization developments and ideas on Earth observation data selection that may be relevant to the instigation of enhanced methodologies aimed at injection height representation.

Generating a neoantigen map of advanced urothelial carcinoma by whole exome sequencing.

354 Background: immune-checkpoint blockade is a promising treatment of advanced urothelial carcinoma (UC) that unleashes pre-existing immune responses against recognized tumor antigens. Somatic mutations lead to the formation of neoantigens, which are highly antigenic mutant proteins. Methods: Our objective was to generate a neoantigen map through analysis of whole exome sequencing data of our cohort of patients (pts) with platinum-resistant UC. Whole exome sequencing (WES) data from 73 prospectively collected UC samples from 34 patients were analyzed using our neoantigen prediction pipeline. We defined neoantigens as mutant nonamers with high affinity binding to predicted class I MHC molecules for each patient. HLA haplotypes were inferred from WES of matched germline DNA. Results: A significant correlation between global somatic mutation rates, and neo-epitope burden was observed (R2 = 0.93), a similar correlation was observed between single nucleotide variants (SNV) and neo-epitope burdens (R2 = 0.94). We identified a strong positive correlation between the numbers of pack-years of smoking and neoepitope burden in patients with advanced UC (p = 0.0004). No correlation between global somatic mutational and predicted neoepitope burdens with overall survival was identified. Metastatic samples had a trend of harboring more SNVs (median 49 vs. 22, P = 0.13), and neoepitopes (median 17 vs 12, P = 0.22) compared to primary samples. Interestingly, only 32% of total SNVs and 8 % of neoepitopes (with binding affinities of ≤ 50nM) that were initially identified, reappeared in metastatic samples from the same patients obtained at a later time point. A significant selection against strong binding neo-epitopes was observed in subsequent samples from metastatic tumors (p-value &lt; 0.005). Conclusions: A strong correlation between mutational burden and predicted neoantigenic load was observed in UC. Neoantigenic signatures were shaped by environmental exposures such as smoking. The significant heterogeneity in primary and metastatic neoantigens was possibly due to immunoediting as the tumor evolved. These findings may have important implications for selecting patients for immunotherapeutic approaches.

Differential Burden and Determinants of Tobacco Smoking: Population-Based Observations from the Zambia Demographic and Health Survey (2002 and 2007)

Background: Tobacco smoking has been said to be on the increase in sub-Saharan countries which could potentially result in higher rates of associated non-communicable diseases (NCDs). We investigated the prevalence and factors associated with tobacco smoking in Zambian general population, and how they changed over time. Method: Data stem from the Zambia Demographic and Health Survey conducted in 2002 (n=9803) and 2007 (n=13646). Extracted data on men aged 15-59 and women aged 15-49 was analyzed using a weighted analysis in STATA 12. Descriptive statistics involved investigation of demographic and socio-economic features of the study population. Predictors of tobacco smoking were examined using bivariate and multivariate stepwise binary logistic regression stratified by sex. Tobacco smoking prevalence and its associated factors were compared between 2002 and 2007 to assess the change. Overall non-response rates in these surveys were 5% and 6% respectively. Results: Of all the respondents in 2002 (n=9803) 22% were men and 78% were women, whereas in 2007 (n=13646) 48% were men and 52% were women. Tobacco smoking prevalence decreased by about 2% in 2007 for both men (26.4% vs. 24.2%, P=0.038) and women (2.7% vs. 0.8%, P<0.001). Prevalence of smoking cigarettes in rural settings increased from 12% to 26% (P<0.001) among men, and from 0.4% to 1.1% (P<0.001) among women while it did not change in urban areas. Older ages, drinking alcohol, and lower education levels were common factors associated with higher odds of tobacco smoking in both 2002 and 2007 survey rounds. Conclusion: We find contrasting rural urban smoking burden differentials contributing to the unchanging smoking burden overall in this population. The concentration of this burden in rural and less educated groups suggests past limitations to health promotion initiatives. This calls for a reformation in behavior information targeting these most at risk groups.

Costs of the Smoking Cessation Program in Brazil.

ABSTRACTOBJECTIVE To assess the costs of the Smoking Cessation Program in the Brazilian Unified Health System and estimate the cost of its full implementation in a Brazilian municipality.METHODS The intensive behavioral therapy and treatment for smoking cessation includes consultations, cognitive-behavioral group therapy sessions, and use of medicines. The costs of care and management of the program were estimated using micro-costing methods. The full implementation of the program in the municipality of Goiania, Goias was set as its expansion to meet the demand of all smokers motivated to quit in the municipality that would seek care at Brazilian Unified Health System. We considered direct medical and non-medical costs: human resources, medicines, consumables, general expenses, transport, travels, events, and capital costs. We included costs of federal, state, and municipal levels. The perspective of the analysis was that from the Brazilian Unified Health System. Sensitivity analysis was performed by varying parameters concerning the amount of activities and resources used. Data sources included a sample of primary care health units, municipal and state secretariats of health, and the Brazilian Ministry of Health. The costs were estimated in Brazilian Real (R$) for the year of 2010.RESULTS The cost of the program in Goiania was R$429,079, with 78.0% regarding behavioral therapy and treatment of smoking. The cost per patient was R$534, and, per quitter, R$1,435. The full implementation of the program in the municipality of Goiania would generate a cost of R$20.28 million to attend 35,323 smokers.CONCLUSIONS The Smoking Cessation Program has good performance in terms of cost per patient that quit smoking. In view of the burden of smoking in Brazil, the treatment for smoking cessation must be considered as a priority in allocating health resources.

Prevalence and pattern of secondhand smoking in Abia State, Nigeria

Background: Several studies have reported the burden of smoking and associated risk factors. However, only a few studies have explored the prevalence, pattern of exposure, and risk factors associated with exposure to secondhand smoke (SHS) in Sub-Saharan Africa and particularly Nigeria. Objective: This study was, therefore, aimed at ascertaining the prevalence and risk factors of exposure to SHS in Abia State, Nigeria. Methods: Data of 2787 respondents selected using multi-staged cluster sampling technique were analyzed. Prevalence of exposure to SHS at home and public places was calculated for each sociodemographic and economic group. Results: Exposure to tobacco smoke was more common in respondents who were young, males, unmarried or used alcohol. Females were less frequently and intensely exposed to SHS both at home and public places than males. Predictors of SHS at home were gender, odds ratio (OR) =1.85 (95% confidence interval [CI] 1.20-2.83) and use of alcohol OR = 2.06 (95% CI 1.04-4.09); and in public places were age OR = 1.55 (95% CI 1.10-2.20), gender OR = 2.73 (95% CI 1.96-3.81), and use of alcohol OR = 2.55 (95% CI 1.51-4.28). Conclusions: The findings of study provide basis for designing tobacco control interventions to address exposure to SHS at home and public places.

Smoking among Lebanese medical students: Prevalence and attitudes.

INTRODUCTION:The tobacco epidemic is a major public health threat facing the world. Tobacco dependence is recognized as the greatest preventable cause of disease and death. Medical students are in key position influencing future tobacco cessation programs.OBJECTIVES:The primary objective of this study is to evaluate the prevalence of smoking among medical students across Lebanon and their smoking attitudes. It also investigates their attitude toward smoking, showing where they really stand on this major public health issue. This study helps better tackle anti-smoking campaigns among both physicians and patients.METHODS:This cross-sectional study was conducted by sending a questionnaire to currently enrolled medical students at all seven medical schools in Lebanon. The 32-item questionnaire was used, comprised three sections assessing sociodemographic characteristics, smoking habits, and attitudes toward smoking among Lebanese medical students. The questionnaire was launched online on Limesurvey to retain anonymity. The data were then transferred to Statistical Package for Social Sciences for analysis. Data were expressed as percentages for discrete variables and as mean ± standard deviation for continuous variables.RESULTS:One hundred sixty-three complete responses remained of the 182 obtained responses. Forty-two of the total 163 students identified themselves as either daily or occasional smokers yielding a prevalence of 25.8%. Smokers were less likely to ask patients about their smoking habit and to counsel them about smoking cessation. Almost one-third of smokers felt that they had no obligations toward the society.CONCLUSION:Approximately 1 in 4 Lebanese medical students is a smoker. Students who smoke are less likely to ask patients about their smoking habits and to counsel them on smoking cessation. This is a major drawback in the fight against tobacco. This calls for better education of our future doctors on smoking cessation to decrease the smoking burden on our Lebanese society and worldwide.