Behavioral problems and tobacco use among adolescents in Central America and the Dominican Republic

Objectives: The purpose of this study was to examine the association between behavioral problems and tobacco use among adolescent students in six countries of Central America and in the Dominican Republic. Methods: Data were drawn from a multinational collaborative study that included questionnaire surveys of between 451 and 1 170 school-attending adolescents in each of the seven countries studied. Assessments were based on an adapted, Spanish-language version of the Drug Use Screening Inventory (DUSI). The conditional form of logistic regression was employed for analysis, matching students on type of school and area, with further statistical adjustments for sex, age, and selected risk factors. Results: Occurrence of tobacco use was observed to vary dramatically from country to country. Nevertheless, for the combined group of countries, the estimated odds of tobacco use in youths at the highest levels of behavioral problems was more than five times that for youths at the lowest levels, after controlling for sex, age, lack of participation in recreational activities, level of irritability, and levels of problems with school, family, and mental health. Country-specific analyses show that youths at the highest levels of behavioral problems have a consistently greater occurrence of tobacco use as compared to youths at the lowest levels of behavioral problems. Conclusions: These findings are concordant with prior studies on tobacco use among adolescents with behavioral problems. Although the magnitude of observed associations varied according to the country of residence, the strength of these associations and their significance by conventional standards were observed in nearly all the countries sampled. This is the first study in these seven countries on potentially causal relationships such as these. More research is needed to augment our knowledge regarding the observed cross-country differences and ultimately to develop, implement, and evaluate effective tobacco preventative intervention programs (AU)

Smoking cessation - the role of the dental team implications for the Caribbean [abstract]

There is increasing awareness that cigarette smoking not only threatens systemic health but also compromises oral health. For example, smoking can result in staining of teeth, halitosis (bad breath), altered salivary flow, predisposition to chronic and acute periodontal disease and oral candidosis, delayed wound healing, failure of dental implants, oral mucosal lesions, oral precancer and cancer. Although data from the United Kingdom show a reduction in the prevalence of smoking since the 1960s, there is an upward trend of smoking among young adults, particularly teenage girls. There are no comparable data for the Caribbean but it is plausible to assume a similar trend may exist, suggesting the need for primary prevention strategies. The dental team often treats patients in a primary care setting and, apart from an important role in early detection of smoking-related oral conditions, may also be well placed to aid in preventive strategies through the implementation of chair-side smoking cessation programmes. These programmes are based on the 4-As strategy: Ask, Advise, Assist, Arrange, and have been recently developed specifically for the dental team. There should also be close collaboration between the dental team and other primary health care professionals to improve health promotion strategies aimed at reducing the prevalence of smoking. Dental health professionals in the Caribbean must be made aware of smoking cessation programmes for their patients and research into their effectiveness, in a Caribbean population, is required. (AU)

Two-Year Mortality and its determinants following acute myocardial infarction in Trinidad and Tobago

The purpose of this study was to determine the occurrence of coronary artery disease risk factors in patients presenting with acute myocardial infarction(AMI) to a tertiary care institution in Trinidad and to determine the factors associated with increased mortality following AMI. All patients admitted to the Eric Williams Medical Sciences Complex (EWMSC) between January 1 and December 31, 1996, with a diagnosis of AMI were identified using the hospital admissions and discharge diagnosis databases. Demographic, clinical and laboratory variables were extracted from the hospital case records of patients with confirmed AMI. Sixty-one AMI patients (38 men) were admitted during the study period. Mean age of admittance was 60 ñ 11 years with an ethnic case mix of thirty-nine (62 percent) of East Indian descent, eight (13 percent) of African descent, twelve (20 percent) mixed ethnicity and three of Caucasian descent. Thirty patients (49 percent) were hypertensive. Thirty-two patients (53 percent) were diabetic and eighteen patients (30 percent) gave a history of cigarette smoking. The mean left venticular ejection fraction was 53 ñ 14 percent. The mean serum cholesterol from 29 patients was 228.2 ñ 49.0 mg/dl. Increasing age, female gender, an ejection fraction less than 40 percent, non treatment with streptokinase and in-hospital ventricular fibrillation were associated with poor survival. Multiple regression analyses identified three independent predictors of mortality. These were gender (p = 0.04), in-hospital ventricular fibrillation (p = 0.001) and an ejection fraction less than 40 percent (p = 0.02). Diabetes mellitus, hypertension, hyperlipidaemia and cigarette smoking were prevalent amongst patients presenting with AMI. Ventricular function was a major determinant of two-year mortality following AMI. Aggressive risk factor modification is recommended to prevent both first and recurrent coronary events.(AU)

Tobacco use by youth: a surveillance report from the Global Youth Survey project

The Global Youth Tobacco Survey (GYTS) project was developed by the World Health Organization and the US Centers for Disease Control and Prevention to track tobacco use among youth in countries across the world, using a common methodology and core questionnaire. The GYTS is school based and employs a two stage sample design to produce representative data on smoking among students aged 13-15 years. The first stage consists of a probabilistic selection of schools. All students in the selected classes are eligible for the survey. In 1999, the GYTS was conducted in 13 countries and is currently in progress in over 30 countries. This report describes data from 12 countries: Barbados, China, Costa Rica, Fiji, Jordan, Poland and the Russian Federation (Moscow), South Africa, Sri Lanka, Ukraine (Kiev), Venezuela and Zimbabwe. The findings show that tobacco use in the surveyed age group ranged from a high of 33 percent to a low of 10 percent. While the majority of current smokers wanted to stop smoking, very few were able to attend a cessation programme. In most countries the majority of young people reported seeing advertisements for cigarettes in media outlets, but anti-tobacco advertising was rare. The majority of young people being taught in school about the dangers of smoking. Environmental tobacco smoke exposure was very high in all countries. These results show that the GYTS surveillance system is enhancing the capacity of countries to design, implement, and evaluate tobacco prevention and control programmes. (AU)

Disseminated histoplasmosis detected by lingual and tonsillar erosions in an immunocompetent patient

BACKGROUND: Histioplasmosis is a usually asymptomatic fungal infection. In the immunocompetent patient, it leads to chronic disseminated infection. Mucosal involvement is common and can provide the diagnosis. CASE REPORT: A metropolitan Frenchman with a history of alcoholism and smoking and living in Guyana consulted for lingual and tonsil erosion. Squamous cell carcinoma was suspected but not confirmed at pathology. The patient had bi-apical infiltration on the chest x-ray and was treated empirically for tuberculosis. The diagnosis of histoplasmosis was reached when rare Histoplasma capsulatum were evidenced from a buccal swab. Itraconazole led to cure in 6 months. DISCUSSION: This case illustrates the importance of mucosal signs in the diagnosis of disseminated histoplasmosis in immunocompetent subjects. Histoplasmosis is rarely the cause of active infection in immunocompetent subjects. In these patients, the fungal infection generally progresses to chronic dissemination. Mucosal signs are frequent in this from but are rare in the case of cutaneous histoplasmosis. Itraconazole (200 mg/d) is indicated for 6 months. (AU)

Smoking and health; tobacco use and anti-smoking campaigns in Jamaica

Lifestyle-related diseases of the cardiovascular, respiratory and digestive systems continue to be major causes of morbidity and mortality in Jamaica. The aims of the study were to obtain data on: a) Knowledge, attitudes, perceptions and use of tobacco products particularly cigarettes; b) The impact of the Medical Association of Jamaica/Pan American Health Organization media campaign against tobacco use. The Methodology: An islandwide sample of 628 persons, comprising 364 males and 264 females, and ranging in age from under 24, to over 70 years, was interviewed, using a modified World Health Organization (WHO) Comprehensive Tobacco Survey instrument with 12 additional questions relating to the media campaign. The sample was obtained via a two-stage systemic sampling system. Data processing was done at the UWI Computing Centre. Results: Lifetime prevalence of use was 54 percent (N=339). Current daily use was 27.7 percent (N=174). Concerning health effects, 80.5 percent (N=441) strongly agreed that smoking was harmful to health. 78 percent of persons had concerns about passive smoking. Regarding the Anti-smoking Campaign, 34.7 percent of the sample had seen the ads first-hand. The impact of the campaign on smokers was assessed by their level of use pre- and post-campaign. The paired t-test was used to test the level of significance. The mean use level before the campaign was 2.5217 and after, 2,1196, yielding a difference in means of 0.1112. The t value was 3.61 with degrees of freedom and a two-tailed probability of 0.001 - a highly significant and desirable result. Implications of the study, for behaviour change, are discussed.(AU)

A behaviour risk factor survey in Jamaica

A population based probability sample of 958 persons (454 males and 504 females) aged 15 to 49 years was surveyed in Jamaica in late 1993 for lifestyle and behaviour risk factors. Demographic characteristics of the sample were comparable to the general population. 60 percent of persons visited a private doctor the last time that they were ill. Based on self-reporting, 18 percent of the women and 8 percent of the men had never their blood pressure taken. 40 percent of the women had never had a Papanicolaou smear, 29 percent had never had a breast examination and 33 percent said that they were overweight compared with 18 percent of men. Smoking cigarettes and marijuana was more common among men (36 percent) than women (11 percent) as were drinking alcohol (79 percent of men, 41 percent of women) and heavy alcohol use (30 percent of men, 9 percent of women). Injuries requiring medical attention in the previous five years were reported by 40 percent of the men and 15 percent of the women. 34 percent of the men and 12 percent of the women regularly carried a weapon and 18 percent of the sample had participated in or witnessed at least one violent act in the previous month. Most of the people interviewed used a contraceptive method; 10 percent were not sexually active. Significantly more men than women had two or more sexual partners in the previous year (54 percent vs 17 percent, p<0.001) or reported ever having a sexually transmitted disease (29 percent vs 9 percent, p<0.001). Younger persons were more sexually active and more likely to use condoms during the most recent sexual intercourse. Higher socio-economic status and educational level generally had a more positive effect on health behaviour. This survey provides vital information relevant to planning health promotion campaigns and assessing their success.(AU)

Maternal lifestyle and pregnancy outcome in Jamaica: the effects of cigarette and marijuana smoking, alcohol use and sexual activity

Cigarette smoking, marijuana and alcohol use, and coital activity have been investigated for effect on foetal birth weight and gestation chiefly in developed countries. Apart from the relationship between cigarette smoking and heavy alcohol intake and growth retardation, the evidence for poor birth outcome is controversial. Little is known of the effect of these lifestyle factors in developing countries where poor pregnancy outcome is common. Using data from a population based perinatal study in Jamaica, the effect of lifestyle factors was ivestigated in 8486 babies. Data collected by midwives at birth included the date of the last menstrual period, socio-demographic characteristics and frequency of tobacco, marijuana and alcohol use during pregnancy, as well as coital frequency at quickening and at delivery. Babies were weighed and measured. Live birth outcomes investigated were low birth weight, preterm birth and growth retardation, with population rates of 10.1 percent, 8.7 percent and 9.7 percent, respectively. Data were processed using SPSS and BMDP statistical packages. The prevalence of cigarette, marijuana and alcohol use was 7.0 percent, 2.1 percent and 16.4 percent respectively. 74 percent and 27 percent of women were having sexual intercourse at quickening and in the week prior to delivery, respectively. Apart from coital frequency at quickening, life style factors were strongly associated with each other. All life style factors were associated with social class. On univate analysis, significant associations were found between cigarette smoking and low birth weight (p,0.04) and growth retardation ,0.05). Association between marijuana use and low birth weight and between alcohol use and lower incidence of preterm birth failed to reach significance (p=0.05, p=0.16). When stratified by frequency of use, there was a significant trend in both cases (p<0.05, p<0.04). After controlling for socio-demographic characteristics and other life style factors, associations were maintained between cigarette smoking and low birth weight. Foetal effects of maternal cigarette smoking are present even in al low prevalence country. The effect of marijuana use is less conclusive, but the data suggest that this activity may be detrimental to the foetus. (Au)

Use of alcohol, tobacco and non prescription drugs among Jamaican high school students

The prevalence of alcohol, tobacco and non-prescription drugs was investigated among 2417 Jamaican high school students (1063 boys, 1354 girls). 1317 were grade 10 (form four or 16 years old) and 1100 were grade 11 (form five or 17 years old): 1072 and 1345 were from rural and urban schools, respectively; and 1126 and 1291 were children of professionals and non-professionals, respectively. The prevalence of alcohol and tobacoo use was 50.2 percent and 16.6 percent, respectively; and there was a high level of non-prescription drug use: paracetamol (85.7 percent), aspirin (76.7 percent), multivitmains (41.9 percent) and bismuth (29.9 percent). Drugs use among males, urban students, and children of professionals was higher than among females, rural students and children of non-professionals.(AU)

Increased levels of malondialdehyde in urine and plasma from diabetic patients and smokers: evidence for free radical damage - abstract

Malondialdehyde [MDA] is a major end product of lipid peroxidation which causes tissue damage and its presence is often used as an indicator for free radical damage in tissues. MDA was therefore measured in the urine and plasma of 15 non-insulin dependent diabetics (NIDDM) between the ages of 33 and 67 (mean 52) years, 10 chronic smokers 29 - 33 years old and control group of 14 healthy individuals 17 to52 years old. The average age of both the normal controls and smokers was 32 years with an average Body Metabolic Index (BMI) of 24 in both groups and 26 in the diabetic group. (A table showing mean + SEM values for urinary and plasma malondialdehyde is shown in abstract). We conclude that diabetics and smokers have significantly (p<0.008) higher levels of urinary MDA than the controls. Plasma MDA levels were only significantly higher for the diabetic group. When corrected for muscle mass and BMI, urinary MDA levels for the two test groups were sigificantly (p<0.001) higher than normal. There was a good correlation between urinary MDA and plasma MDA (r=0.74), p<0.001, df= 21. These data suggest (1) NIDM and smokers have increased exposure to free radical damage (2) urinary MDA provides a good indicator of lipid peroxidation. (AU)

A survey of the smoking habits of physicians in Curacao in 1995 - abstract

We sent a self-administered WHO smoking survey to all 245 physicians working on the island of Curacao. A response rate of 61 percent was reached without sending reminder letters. 33 percent were current smokers, smoking was more prevalent in males (68 percent) than females (34 percent), and the mean daily consumption was 11.8 cigarettes. Smoking prevalence and smoking behaviour amongst Curacaoan physicians proved to be highly similar to the data that have been revealed by Dutch studies, even though the smoking prevalence within Curacaoan population is lower than in the Netherlands. These findings may support the hypothesis of professional socialisation in medical school. Curacaoan and Dutch physicians also expressed similar opinions towards smoking. Among doctors the knowledge of smoking and diseases were found to be suboptimal. Curacaoan doctors report they want more information about smoking cessation programmes. (AU).

Lifestyle in Curacao: smoking, alcohol consumption, eating habits and exercise

The Curacao Health Study was carried out among a randomized sample (n = 2248, response rate = 85 percent) of the adult non-institutionalized population in order to assess aspects of lifestyle that may pose health risks. Factors examined were tobacco and alcohol use, eating habits and exercise behaviour. Outcome variables were cross-tabulated by gender, age and socioeconomic status. 17.1 percent of the participants were smokers and 20.5 percent regular drinkers, including 6.3 percent of the men who consumed alcohol excessively (4 or more glasses of alcohol a day). 75 percent of the participants did not excercise regularly, 37 percent did not eat vegetables daily, and half did not eat fruit daily. Other poor eating habits were the addition of extra sugar and salt to prepared food by 33 percent and 20 percent of the participants, respectively. On the whole, men had less healthy lifestyles than women, with the exception of execise behaviour. People of high socioeconomic status (SES) drank less alcohol, and exercised more often than those of low SES. Considering the high prevalence of diabetes mellitus and hypertension in the Caribbean, research of lifestyle factors in other Caribbean countries is required to facilitate the development of regional prevention and intervention programmes. (AU)

Characteristics of HIV-infected pregnant women in the Bahamas

The Commonwealth of the Bahamas has one of the highest rates of acquired immunodeficiency syndrome (AIDS) in the English-speaking Caribbean. A seropositive study of the pregnant women attending antenatal clinics in New Providence in 1990-91 showed that of 3,914 pregnant women tested, 2.9 percent were human immunodeficiency virus (HIV) infected. Women born in the Bahamas constituted 79.2 percent of the women tested; 17.7 percent were born in Haiti. The rate of HIV infection was 2.5 percent in the Bahamian women as compared with 4.5 percent in those born in Haiti. The highest incidence was in women aged 25-34 years and in women who had multiple pregnancies. There was a significant association with a history of crack cocaine use by the Bahamian women. There was also a significant association between a lack of education and HIV infection in this group. There was a lower rate of condom use among women with less education and also among women in common-l

Preventing and reversing a deadly life-style - abstract

One of the highest priorities of the Barbados Cancer Society since it was founded in December, 1980 has been controlling and reducing tobacco consumption. This is because smoking is the single most common and important preventable cause of cancer and it generates more diseases, disabilities and deaths in all developed countries and many developing countries than all other causes put together. Since it was founded, the most notable success of the Barbados Cancer Society has been a significant reduction in tobacco consumption. The Society is the only organization in Barbados which has consistently and systematically disseminated information about the health risks of tobacco smoking. It has used two strategies for tobacco control: first, public education in the media (press, radiio, TV) and second, a smoking cessation programme for smokers desiring to quit. The results achieved have been encouraging: there was a 32 percent decline in tobacco consumption between Janaury, 1982 and December, 1993. The success rate (i.e., abstinence without relapse for 1 to 4 years) for smokers using the Smoking Cessation Programme was 50 percent. Other strategies besides education are needed for tobacco control, most of which require Government intervention. These include explicit warnings on all tobacco products; teaching the skills of health education in teacher training colleges and all medical, dental and nursing schools; banning advertising and sponsorship by the tobacco in public places and work places; providing tobacco cessation classes in hospitals and other health institutions and at the international level, co-operating in agreements to discontinue generous subsidies to tobacco production (AU)

Present trends in drug use and abuse in new secondary schools in the Kingston Metropolitan Area

Within recent years, drug abuse has become a priority health problem affecting individuals and threatening the social, political and legal institutions of the region. Sadly, children, including those at school are the main victims of the consequences of drug abuse. A survey was conducted among 200 students, grades 9-11, in 4 new secondary schools in the metropolitan area of Jamaica. Through a self administered questionnaire, the study sought information on the lifetime and current prevalence of licit and illicit drugs, students' perception of the ease of obtaining these drugs, the risk involved and their attitude towards drug use. The findings revealed that there were increases in the lifetime and current prevalence in the use of cannabis, cocaine, crack, psychedelics, opiates, tobacco and alcohol. Students reported increased accessibility to these drugs and less risk involved in drug use, and many reported that they did not disapprove of trying drugs, including cocaine and crack. The highest prevalence of drug use was with alcohol, followed by tobacco and inhalants, and more males reported drugs use than females. These were compared generally to the findings of the NCDA (1987) school survey. The author concluded that drug abuse has increased in this category of students, and made recommendations including, re-evaluation of the drug abuse prevention programmes in schools; strengthening of peer counselling in schools; banning of tobacco and alcohol advertisments, and of smoking in public places and to create a data base on drug abuse for the region. (AU)

Quality of diabetes care in Trinidad and Tobago: surveillance for risk factors and complications - abstract

Long-term complications of diabetes mellitus cause increasing disability and health care costs in many Caribbean countries. Clinical care of people with diabetes mellitus should detect and treat arterial hypertension and cigarette smoking which are risk factors for the development of long-term complications. Patients should also be screened for signs of complications of diabetes mellitus so that these may be treated at the earliest stage. This study aimed to evaluate the extent to which these objectives were achieved by health care services in Trinidad and Tobago. Data were abstracted from the case notes of 1723 patients with diabetes mellitus attending two hospital clinics, nine government health centres and eight general practitioners. Blood pressure (BP) was measured within the preceding 12 months for 94 percent of patients but 30 percent had BP o160/95 mm Hg despite anti-hypertensive drug use in 41 percent of all patients. Among diabetic patients treated for hypertension, only 40 percent had BP ó140/90 mm Hg. Smoking habits were recorded for 67 percent of hospital patients but only for 15 percent of primary care patients. For cases with available date, 17 percent were current smokers and 8 percent were ex-smokers. Examination of the feet was recorded for 14 percent of patients within the last twelve months and fundoscopy was recorded in only 4 percent. The BP was regularly measured and a high proportion of patients were treated for hypertension but BP control was unsatisfactory. Cigarette smoking was a significant and neglected problem. Screening for signs of diabetic complications was not performed systematically. Improved strategies for the preventive care of people with diabetes mellitus require implementation (AU)

Cuban neuromyelopathy epidemic

During the last semester of 1991 an unexpected increase in the number of cases of optic neuropathy was detected by the Cuban Epidemiological Surveillance System in the Pina del Rio province of Western Cuba. Reported cases occurred mainly in middle-aged men, usually tobacco farmers with a history of cigarette smoking and moderate alcohol consumption. Patients complained of weight loss, blurred vision, photophobia, and progressive decrease in visual acuity over a period of 1-4 weeks. Examination disclosed the presence of bilateral and usually symmetrical central or cecocentral visual field defects with the loss of red-green colour vision, pallor of temporal border of optic disc and loss of fibres in maculopapillary bundle. A diagnosis of tobacco-alcohol amblyopia or nutritional optic neuropathy was made at the time. By the end of July 1992, a total of 168 cases had been reported (monthly range, 14-36), all confirmed to this province. By December 1992, the number had increases to 472 cases, including reports from five of fourteen provinces of Cuba, mainly in Havana, Sancti Spiritus, Holguin and Santiago de Cuba (AU)

Some health issues on the Cave Hill Campus, U.W.I. - abstract

In response to concerns expressed about drug abuse among students attending the Cave Hill Campus, a survey was conducted among the entire campus community to determine views about a wide range of health related issues. The survey was conducted by a pretested, self-administered, anonymous questionnaire, and was done on a single day on campus. The sample was chosen as a stratified sample of the campus personnel from the staff and student lists. Thirty-six per cent of the 1 in 4 sample responded to the questionnaire (7.9 per cent of all students, and 14 per cent of all staff). The age, sex, race and religious affiliations of the respondents were representative of the campus community. The numbers of responding students, administrative, academic and clerical staff were sufficient for their conclusions to be considered in the analysis. Staff and students generally considered themselves to be in good health. They were conscious of the bad effects on health of smoking cigarettes, and the use of ganja or cocaine. They also considered being overweight, worry and stress as being bad for health. Drugs were not a regular subject for discussion on the campus. While 3 of 5 respondents said they could recognise cocaine, crack or speed. Less than 1 per cent admitted to the use of any of these drugs and 80 per cent said they had never used cigarettes. Alcohol use was far more frequent, particularly among members of the academic staff, as was the use of cigarettes. Generally, members of the campus community were aware of the lifestyles that were at high risk for HIV, although 30 per cent of respondents considered lesbians as being at high risk. Using "one night stands" as indicative of high-risk sexual behaviour, 28.6 per cent of academics and 14.5 per cent of students said they had had such experiences within the last five years. Respondents reported a reduction in sexual partners compared to the previous year, and five years before. As regards problems which students considered may affect their health, concerns were expressed about stress, overwork, and insufficient money. Academics and students considered drug use as a minor problem among students, while clerical staff were more concerned about this as a problem. Generally, students did not consider themselves to be sexually harassed, although administrative and clerical staff expressed concerns in this regard. The campus emerges as a relatively abstemious one in every regard. However, both students and staff expressed significant concerns about stress and underfunding of students (AU)