Comprehensive Tobacco Control Measures Research Articles

The feasibility of a novel national Quality Improvement programme for Tobacco Dependency Treatment Pathways in acute UK hospitals.

The prevalence of smoking remains stubbornly high in the UK despite comprehensive tobacco control measures. A national quality improvement (QI) approach to enhance the treatment of an estimated one million annual hospital admissions of tobacco smokers, could provide a new opportunity to improve population health and reduce healthcare demand. Barriers to QI include knowledge, costs and competing demands. This study aimed to evaluate the feasibility and effectiveness of a national QI programme hosted by the British Thoracic Society, focused on improving NHS tobacco dependency treatment in acute hospitals. The programme utilised the Model for Improvement as its QI framework and was delivered over a six month period. 25 teams from across the UK were upskilled through a series of webinars and coaching sessions and undertook QI projects focused on specific areas of their local tobacco dependency treatment pathways. Results of the programme demonstrated improvements across the treatment pathway including screening for smoking status, rapid provision of nicotine replacement therapy to prevent nicotine withdrawal, referrals to inpatient tobacco dependency treatment teams and transfers of care to community services. Other programme outcomes included increases in QI knowledge, confidence, and attitudes along with enhanced project management skills. This novel, national, online QI programme supported participating multidisciplinary teams in acute trusts across the UK to deliver tobacco dependency treatment pathway improvements using QI tools and methodology. This programme demonstrated the feasibility and effectiveness of delivering a national QI programme, at low cost using a microsystems approach applied to an important area of clinical medicine.

Changes in Prevalence of Childhood Exposure to Secondhand Smoke in India: A Secondary Analysis of GATS Survey (2009-2017).

Children are susceptible to early life inequalities stemming from their limited control over their environment and their physical incapability to handle the health and developmental consequences of smoke exposure. Additionally, their lack of awareness regarding the detrimental effects of secondhand smoke (SHS) exposure on their well-being emphasizes the crucial need to comprehend the extent of SHS exposure among the younger population. The study aims to analyze the magnitude and factors influencing SHS exposure among children under 15 years, along with the shifts in SHS exposure in India and its states between 2009-10 and 2016-17. The study utilized two rounds of the nationally representative cross-sectional Global Adult Tobacco Survey (GATS) conducted in 2009-10 and 2016-17, respectively. The study included a total of 47,494 households with 108,814 children under 15 years of age for GATS1 and 46,874 households with 1,000,167 children under 15 years of age for GATS2. Bivariate analysis and Multivariable logistic regression was employed. Forty-five percent of children experienced SHS exposure at home. Although most states saw a reduction in exposure rates, Jammu and Kashmir, Punjab, and Tamil Nadu exhibited increases between 2009-10 and 2016-17. Multivariate analysis revealed that children from the North-Eastern (OR = 6.51, CI = (5.93-7.15)) and North (OR = 7.51, CI = 6.88-8.19)) regions, rural areas (OR = 1.45, CI = (1.37-1.52)), Scheduled Tribes (OR = 1.76, CI = (1.63-1.90)), and those with household adults lacking knowledge of SHS's harmful health effects on children (OR = 1.15, CI = (1.04-1.27)) were more likely to be exposed to SHS at home. India has made strides in reducing child SHS exposure, yet challenges persist in rural and impoverished homes. Comprehensive tobacco control measures can break the cycle of poverty driven by smoking-related expenses, fostering a tobacco-free generation.

Prevalence and Sociodemographic Correlates of Smoking among Schoolchildren in Albania.

Smoking among children remains a critical public health issue, with millions of minors engaging in tobacco use, leading to addiction and long-term health consequences. Our objective was to assess the prevalence and sociodemographic distribution of smoking habits among Albanian children. A cross-sectional study was conducted in Albania in 2022, including a nationwide representative sample of 5454 schoolchildren aged 11, 13, and 15 years (N = 5454; ≈52% girls; response rate: 96%). Data on smoking habits were gathered, along with sociodemographic factors of schoolchildren. Binary logistic regression was used to assess the associations of smoking variables with sociodemographic factors. The prevalence of smoking variables was 12% for lifetime cigarette smoking, 7% for current cigarette smoking, 20% for lifetime smoking of e-cigarettes, and 13% for current smoking of e-cigarettes. Independent positive correlates of both cigarette and e-cigarette smoking included male gender, age 15, and pertinence to more affluent families (all p < 0.01). The prevalence of smoking among Albanian children is seemingly high, which should be a cause of serious concern to decisionmakers and policymakers in this transitional country. Albania should immediately consider the implementation of expanded comprehensive tobacco control measures, which will save lives, reduce illness, and help reduce the economic burden associated with tobacco-related illness.

Tobacco smoking-attributable mortality in Kenya, 2012-2021.

Tobacco smoking poses a significant risk for various diseases, including cardiovascular diseases, chronic respiratory diseases, and cancers. In Kenya, tobacco-related deaths contribute substantially to non-communicable disease mortality. This study aims to quantify the mortality attributed to tobacco smoking in Kenya from 2012 to 2021. Employing a prevalence-based analysis model, the study utilized population attributable fraction (PAF) to estimate age-specific smoke attributable mortality (SAM) rates for individuals aged ≥35 years. Causes of death associated with tobacco use, including cancers, cardiovascular diseases, respiratory diseases, tuberculosis, and diabetes, were analyzed based on age, sex, and death records between 2012 and 2021. Over the study period, 60228 deaths were attributed to tobacco-related diseases, with an annual increase observed until 2016 and subsequent fluctuations. Respiratory diseases, diabetes mellitus, malignant cancers, tuberculosis, and cardiovascular diseases collectively accounted for 16.5% of deaths among individuals aged ≥35 years. Notable contributors were pneumonia and influenza (respiratory diseases), esophageal cancer (cancers), and cerebrovascular diseases (cardiovascular diseases). Of the observed deaths, 16.5% were attributed to smoking, with respiratory diseases (40.5%), malignant cancers (31.4%), tuberculosis (13%), cardiovascular diseases (8.9%), and diabetes mellitus (6.1%) contributing. Pneumonia and influenza, esophageal cancer, chronic airway obstruction, and tuberculosis were primary causes, comprising 70% of all SAM. Tobacco-related mortality is a significant public health concern in Kenya. Efforts should focus on preventing tobacco use and managing associated disease burdens. Smoking cessation initiatives and comprehensive tobacco control measures are imperative to mitigate the impact on population health.

Analysis of the direct economic impact of smoking-related hospitalizations in Italy.

Tobacco-related diseases have a substantial economic impact in terms of medical expenses, loss of productivity, and premature death. Tobacco use is estimated to be responsible for more than 90000 deaths each year in Italy. We aimed to evaluate the annual direct economic impact on the National Health System of hospitalizations attributable to tobacco smoking in Italy. We analyzed data from all the hospitalizations of patients aged ≥30 years that occurred in Italy for 12 selected tobacco-related diseases, during 2018. These diseases included oropharyngeal cancer, esophageal cancer, gastric cancer, lung cancer, pancreatic cancer, bladder cancer, laryngeal cancer, ischemic heart disease, stroke, diseases of arteries, arterioles, and capillaries, pneumonia and influenza, and chronic obstructive pulmonary disease. We obtained information on 984322 hospital discharge records, including each hospitalization's direct costs. Using relative risk estimates from the scientific literature, we computed the population attributable fraction for various tobacco-related diseases to estimate the economic impact attributable to tobacco smoking. One-third of all hospitalizations occurred in 2018 in Italy among people aged ≥30 years for 12 tobacco-related diseases were found to be attributable to smoking, accounting for a total cost of €1.64 billion. Among the diseases considered, those with the highest expenditures attributable to tobacco smoking were ischemic heart disease, cerebrovascular disease, and lung cancer, accounting for €556 million, €290 million, and €229 million, respectively. Tobacco has a substantial economic impact in Italy, accounting for around 6% of the total cost of hospitalizations in 2018. This figure is expected to be largely underestimated due to several conservative assumptions adopted in the statistical analyses. It is imperative to prioritize comprehensive tobacco control measures to counteract the huge healthcare costs due to tobacco smoking.

Is "tobacco harm reduction" possible? Other countries' experiences and perspectives, and how they could inform tobacco control in Japan

"Tobacco harm reduction" is defined as a method to minimize harm and risk of death and disease without eliminating tobacco and nicotine use. In Japan, where heated tobacco products (HTPs) are prevalent, the tobacco industry is progressively endorsing the concept of "tobacco harm reduction." Therefore, stakeholders in tobacco control must urgently share perspectives and experiences surrounding this issue. This discussion paper aimed to propose four requirements for effectively implementing "tobacco harm reduction" as a public health measure: (1) disease risk reduction, (2) cigarette smoking cessation, (3) no additional public health concerns, and (4) regulatory authorities held by health agencies, and compile information on them regarding nicotine-containing electronic cigarettes (e-cigarettes) and HTPs. Another aim was to summarize policies related to "tobacco harm reduction" adopted by an international organization (World Health Organization (WHO) and health authorities in foreign countries (the United States of America (USA), the United Kingdom (UK), Australia, Italy, and the Republic of Korea) to explore the implications of these requirements on Japan's approach. Regarding the first three requirements, scientific evidence indicated that e-cigarettes offers some level of risk reduction and can assist with cigarette smoking cessation. The potential uptake of e-cigarettes among youth and their possibility to serve as a gateway to combusted cigarette use is a concern, though a definitive causal link is yet to be established between the uptake of e-cigarette in youth and the subsequent use of different tobacco products. There is insufficient scientific evidence for any of the three requirements for HTPs. Regarding the official policies, WHO took the position that the same regulations should be applied to all tobacco products. Only the UK and USA officially established a health system based on the concept of "tobacco harm reduction"; even in Italy and the Republic of Korea, where HTPs are relatively widespread, health authorities denied any risk reduction by introducing HTPs. The UK officially adopted a smoking cessation policy with e-cigarettes. The USA established a modified risk tobacco product system under federal legislation enacted in 2009, whereas of June 2023, no HTP or e-cigarettes were recognized as explicitly reducing health risk. Regarding the fourth requirement, the UK and USA institutionalized "tobacco harm reduction" under health authorities' regulation independent of the tobacco industry. The introduction of a tobacco harm reduction policy in Japan should be considered only in line with health authorities' regulation and implementation of comprehensive tobacco control measures independent of the tobacco industry.

Changes in E-cigarette Use, Cigarette Smoking, and Dual-Use Among the Youth (13-15 Years) in 10 Countries (2013-2019)-Analyses of Global Youth Tobacco Surveys.

The increasing use of e-cigarettes among the youth is a public health problem that needs surveillance. We report changes in e-cigarette use, cigarette smoking, and "dual use" among youth in 10 countries. Global Youth Tobacco Survey (GYTS)s from Georgia, Iraq, Italy, Latvia, Montenegro, Paraguay, Peru, Qatar, Romania, and San Marino were analyzed. Changes in prevalence of "awareness of e-cigarettes," "ever use" (even tried a few puffs) and "current use" (during last 30 days) of e-cigarettes and cigarette smoking, and "dual use" (both e-cigarette and cigarette smoking) between baseline (2013 and 2014) and most recent (2017-2019) surveys were estimated. "Awareness of e-cigarettes" and "ever e-cigarette use" significantly increased (p < .001). "Ever e-cigarette use" was highest in Italy, 93% (95% CI 90.9, 94.4). "Current e-cigarette use" significantly (p < .05) increased by > 50% in most countries. During the most recent surveys, "current e-cigarette" use was > 10% in five countries Italy (18.3%) and Latvia (18.5%) being the highest. Cigarette smoking significantly declined in Italy, Latvia, Peru, and San Marino (p < .05) but remains unchanged in other countries. "Dual use" (both electronic and conventional cigarettes) significantly increased in all countries (p < .001). During the most recent surveys "dual use" was highest in Italy (10%, 95% CI 8.1, 12.2) and Latvia (8.6%, 95% CI 7.2, 10.2). Youth aged 14 and ≥15 years the smokers, were more likely to be e-cigarette users. Awareness and use of e-cigarettes and "dual use" among youth have increased. Closer monitoring of tobacco use among youths and comprehensive tobacco control policies inclusive of e-cigarettes are needed. Secondary data analyses of serial GYTSs in 10 countries showed that both awareness of e-cigarette and e-cigarette use has increased among school-going youth aged 13-15 years. A concurrent increase in "dual use" of e-cigarettes and cigarette smoking during the last 30 days in all 10 countries indicates continued cigarette smoking in the absence of e-cigarettes because of the common risk construct of tobacco product use. Results call for continued surveillance of both e-cigarettes and cigarette smoking among school-going youth. Comprehensive tobacco control measures inclusive of e-cigarettes should be implemented to reduce tobacco use among the youth.

Evolution of smoking rates among immigrants in France in the context of comprehensive tobacco control measures, and a decrease in the overall prevalence

BackgroundThe evolution of smoking rates according to migrant status has not been examined in France, despite a recent reduction in overall smoking rates.MethodsDePICT is a two waves (2016: n = 4356; 2017: n = 4114) nationwide telephone survey, representative of the French adult population. We compared smoking-related behaviors before and after implementation of tobacco-control measures (2017), according to the geographical region of birth.ResultsCompared to 2016, individuals originating from Africa or the Middle East had a slightly higher smoking prevalence in 2017 (34.7% vs 31.3%), despite a higher intention to quit or attempt in the preceding year (adjusted OR(ORa) = 2.72[1.90; 3.90]) compared to non-immigrants. They were also less likely to experience an unsuccessful quit attempt (ORa = 1.76[1.18; 2.62]).ConclusionTobacco-control measures could have widened smoking inequalities related to migrant status. The evolution of smoking-related behaviors among immigrants should be examined when studying the long-term effects of such policies.

Gap analysis on Thailand’s regulatory framework vis-à-vis Framework Convention on Tobacco Control towards the policy development on more comprehensive tobacco control measures

Gap analysis on Thailand’s regulatory framework vis-à-vis Framework Convention on Tobacco Control towards the policy development on more comprehensive tobacco control measures

Assessing the Impact of Brand Loyalty on Tobac-co Purchasing Decisions and Spending Patterns

This study examines how brand loyalty affects tobacco industry expenditure patterns and purchase decisions. The study's primary aims were to investigate the impact of brand loyalty on customer behavior, appraise the efficacy of tobacco corporations' marketing tactics, and analyze the consequences for public health and consumer welfare. A review process based on secondary data was utilized, combining empirical evidence from government publications, industry reports, and academic journals. Important discoveries show that brand loyalty significantly influences tobacco purchase decisions, customer preferences, and spending habits. Advertising, promotions, and sponsorships are marketing tactics vital in building brand loyalty and influencing consumer behavior. Brand loyalty questions its implications for consumer welfare and public health outcomes to counteract the negative consequences. As a result, evidence-based policies and regulatory measures are required. The significance of comprehensive tobacco control measures, regulatory interventions, and public health initiatives in promoting better choices and addressing public health concerns related to tobacco smoking is highlighted by the policy implications.

Social differences in 20-year trends in daily smoking among Lithuanian adult population

Abstract Background Tobacco control measures carried out in the countries can affect social inequalities in the smoking habit. This study aimed to examine the 20-year trends in social patterning of daily smoking in Lithuania. Methods The data were obtained from 11 biannual cross-sectional postal surveys of Lithuanian Health Behaviour Monitoring, beginning in 1994. Each survey used a randomly selected nationally representative independent sample of 3000-4000 inhabitants aged 20-64 drawn from the population register. In total, 8738 men and 11822 women participated in the surveys. The analysis of daily smoking involved the respondents who had smoked daily for at least one year. Results The prevalence of daily smoking was increasing up to the year 2000, especially among women, while a decreasing trend in men and levelling off a trend in women was observed afterwards. In the last survey, 33.3% of men and 12.5% of women were daily smokers. The proportion of daily smokers was higher among younger than older participants; however, the age difference in smoking decreased over time. The highly educated men and women smoked less than those with low education. The odds ratio (OR) of smoking in men with university versus lower education was 0.42 (95% CI 0.37-0.47) and in women - 0.68 (95% CI 0.60-0.78). The proportion of smoking men decreased in all educational groups; however, the differences in the smoking prevalence remained. Since 2000, the educational gradient in smoking among women was increasing due to a decline in smoking prevalence among women with university education. More women living in big cities than in non-urban areas were daily smokers (OR 1.29; 95% CI 1.15-1.44). Over 20 years, no consistent difference in the smoking trends by place of residence was found in both genders. Conclusions The 20-year trends in social patterning of daily smoking differed between men and women. Inequalities in daily smoking by age and education remained in both genders. Key messages In Lithuania, the trends and social differences in daily smoking were related to gender. Comprehensive tobacco control measures targeting young and lower educated groups should be implemented aiming to reduce social inequalities in smoking.

Twenty-year health and economic impact of reducing cigarette use: Minnesota 1998–2017

BackgroundAdult smoking prevalence in Minnesota fell from 21.8% in 1997 to 15.2% in 2016. This reduction improved heart and lung health, prevented cancers, extended life and reduced healthcare costs, but...

Tobacco use and E-cigarette regulation: Perspectives of University Students in the Asia-Pacific

IntroductionThe Asia-Pacific is home to 30% of the world’s smokers. Additional efforts are needed to reduce negative health impacts of tobacco, including e-cigarettes. The study objectives were to 1. Investigate Asian-Pacific students’ knowledge, attitudes, and use of tobacco products; 2. Determine the level of student support for tobacco control policies; and 3. Examine differences in students’ attitudes by the strength of national tobacco control policies based on implementation of WHO’s MPOWER package, and e-cigarette regulation in their countries. MethodsA total of 1953 students from members of the Association of Pacific Rim Universities in 13 countries completed the online survey. We compared the results by the Fisher-Freeman-Halton test. ResultsWhile about 83% of students had heard of e-cigarettes; only 14.1% had tried them. Students in countries with e-cigarette bans were the least likely to report having experimented with e-cigarettes (8.1%). While the vast majority of students (87.9%) reported having seen health campaigns targeting combustible cigarettes, far fewer (42.5%) had seen any health campaigns targeting e-cigarettes. About 80% of students supported smoke-free campuses, with the most support coming from those in countries with the weakest adoption of MPOWER policies (88.7%) and no e-cigarette regulations (80.4%). Students in countries with the weakest MPOWER policies were also the most likely to support campus bans and government regulation of e-cigarettes. ConclusionsThe adoption of tobacco control polices by government may have an impact on e-cigarette smoking behavior among students, and student support for tobacco control, including noncombustible products, is high. Universities should take action by adopting comprehensive tobacco control measures that include e-cigarette regulations.

Factors influencing cigarette smoking among police and costs of an officer smoking in the workplace at Nsambya Barracks, Uganda

INTRODUCTIONStudies in several countries indicate that being a police officer is a risk factor for tobacco use. Currently, no such studies have been performed among police officers in Uganda, or in Africa generally. The aim of this study is to assess prevalence and costs of smoking among Ugandan police officers.METHODSA multistage survey model was employed to sample police officers (n=349) that included an observational cross-sectional survey and an annual cost-analysis approach. The study setting was confined to Nsambya Police Barracks, in Kampala city.RESULTSPolice officers smoke 4.8 times higher than the general public (25.5% vs 5.3%). Risk factors included lower age, higher education and working in guard and general duties units. The findings show that the annual cost of smoking due to productivity loss could be up to US$5.521 million and US$57.316 million for excess healthcare costs. These costs represent 45.1% of the UGX514.7 billion (in Ugandan Shillings, or about US$139.1 million) national police budget in the fiscal year 2018–19 and is equivalent to 0.24% of Uganda’s annual gross domestic product (GDP).CONCLUSIONSConsidering these data, prevalence of smoking among police officers are dramatically higher than in the general population. Consequently, smoking in police officers exerts a large burden on healthcare and productivity costs. This calls for comprehensive tobacco control measures designed to reduce smoking in the workplace so as to fit the specific needs of the Ugandan Police Force.

Lower smoking rates and increased perceived harm of cigarettes among French adults one year after comprehensive tobacco control measures

ContextFrance has high smoking rates, and recently intensified tobacco control policies spearheaded by the introduction of plain tobacco packaging (PP), and an increase in graphic health warnings (GHW). We examine smoking and e-cigarettes use rates, as well as smoking-related perceptions before (2016) and one year after (2017) comprehensive tobacco control measures. MethodsDePICT is a two waves cross-sectional national telephone survey of French adults aged 18–64 years (2016: 4456 – 2017: 4114). Data were weighted to be representative of the French adult population. Adjusted prevalence ratios (PR, 95% CI) estimating changes between the two study waves were calculated using multivariate Log-Binomial regression models. Main FindingsIn 2017, as compared with 2016, smoking rates (PR = 0.93 (0.88-0.99) and current e-cigarette use (PR = 0.76 (0.61-0.96)) decreased in France. Further, French adults were more likely to report fear of the consequences of smoking (PR = 1.10 (1.06–1.14)) and that smoking is dangerous (PR = 1.08 (1.06–1.11)). Smokers were also more likely to report that health messages on tobacco products are efficient (PR = 1.18 (1.05–1.32)). ConclusionsOur study provides early and encouraging results on potential effects of the comprehensive tobacco control strategies in France introduced in 2017, including PP and larger GHW. Our findings also suggest that e-cigarettes did not replace traditional smoking.

Burden of smoking in Lithuania: attributable mortality and years of potential life lost.

High mortality rates from smoking related diseases are a significant public health issue in Lithuania. Study aims to estimate the number of smoking attributable deaths (SADs) and years of potential life lost in Lithuania in 2013. Gender, age and disease specific mortality was calculated by applying the smoking attributable fractions (SAFs) to prevalence estimates of current and former smokers among Lithuanian adults aged ≥35 years that are based on the 2005 Lithuanian Health Interview Survey. Mortality data were obtained from the Institute of Hygiene Health Information Centre. Eight years lag was assumed between smoking rates and subsequent mortality. Sensitivity analysis was used to calculate SAFs applying smoking impact ratio method. In 2013, 13.9% of total mortality or 5771 deaths in Lithuania were attributable to smoking (5181 men and 590 women). The two leading causes of SADs were ischaemic heart disease (2861) and lung cancer (1054) that accounted for 67.8% of the smoking attributable mortality. In the same year, smoking accounted for 39 279 years of potential life lost (34 663 years for men and 4615 years for women). Smoking causes a considerable mortality burden in Lithuania, killing nine times more males than females. Therefore reduction of smoking prevalence is an urgent public health need, which calls for implementation of effective and comprehensive tobacco control measures consistent with the World Health Organization Framework Convention on Tobacco Control Articles and Protocols and The Tobacco Products Directive.

ED12.02 Tobacco Control: The Turkish Experience

ED12.02 Tobacco Control: The Turkish Experience

OA17.06 Make the World Beautiful and Healthy by Making Your Country Smoke Free: Case Study between Iceland and Thailand?

Globally, 600,000 non-smokers die due to tobacco related diseases and health care cost for tobacco related diseases are soaring especially in developing countries.Cigarette smoke contains 69 known carcinogens out of 7000 chemicals causing various health problems in children and infants including ear infections, bronchitis, pneumonia, frequent and severe asthma attacks, sudden infant death syndrome and cancer. Secondhand smoke can cause coronary heart disease, stroke and various kinds of cancer including lung cancer in adult. 2006 U.S. Surgeon General Report clearly confirmed that there is no safe level of exposure to secondhand smoke. Therefore, there is a strong need for comprehensive smoke free law in reducing the burden of tobacco use in the world. Section not applicable. Iceland is a high income country with a long history of tobacco control. The comprehensive tobacco control law was passed in 1984 which included restriction on smoking in service areas of public and private buildings, premises of health care facilities, schools, workplaces, and in public transport whereas Thailand is an upper middle income country and once had a very high smoking rate (70 percent for male and around 5 percent for female) in early 1970. Smoking ban in movie theaters and buses ordinance was issued by Bangkok Metropolitan Administration I n 1976 followed by the comprehensive interventions including smoke-free areas by the royal Thai government in 1991. As a result, the smoking prevalence went down to 32 percent in Thailand but this still demonstrated that one in three adults in 1991. It was found that the role of government and different civil society organizations in implementing smoke free policies was significant in both countries in this review paper. Although both countries issued smoke free policies, there are still challenges on implementation. Iceland try to overcome the challenges by developing comprehensive system including investigation after complaint and allocating budget for enforcement. Thailand also implemented 100% Smoke-Free Hospitals with the compliance rate of 86.4 percent according to a research in 2010. Thailand established the Thai Health Promotion Foundation (ThaiHealth) in 2001 which allowed Thailand to implement comprehensive tobacco control measures in a sustainable way. ThaiHealth used knowledge generation, social mobilization and policy advocacy called tri-power strategy in achieving the success. This paper concluded that civil society initiative and continuing efforts on tobacco control which leads to adoption of comprehensive tobacco control law is the heart of the success of tobacco control in both countries.

Race and Tobacco Use: A Global Perspective.

These findings suggest that there are no "fixed" racial patterns of tobacco use around the globe. Cross-country differences in tobacco use among races could be modified by cultural influences, domestic tobacco control, or socioeconomic factors. There is need for enhanced efforts to monitor tobacco use by race/ethnicity to identify existing and emerging patterns in tobacco use by race, as well as identify opportunities for interventions. Tailored interventions to reduce tobacco use within different settings and countries may help reduce tobacco use among racial/ethnic minorities. Implementation of comprehensive tobacco control measures could be facilitated by community-based efforts, ensuring that disadvantaged populations are engaged as partners to adapt tobacco control policies and interventions to local contexts and health equity issues.

Secondhand smoke exposure among nonsmoker adult females in rural households of Aligarh

2-test. Results: The SHS exposure rate at home among the participants (N = 320) was 32.8%. Several sociodemographic factors were associated with SHS exposure. The higher the level of education, the lower the SHS exposure, with the difference being statistically significant. Conclusion: Almost one-third of nonsmoking adult females are exposed to SHS at home. The findings suggest the need for comprehensive tobacco control measures that would improve public understanding about health hazards of SHS exposure at home and encourage educational initiatives to promote smoke-free homes. Interventions should deliver targeted messages to reach those in the low socioeconomic status group.