Socio-economic health disparities in tobacco smoking among Afro-Caribbean adults: Findings from the Jamaica Health and Lifestyle Survey 2007–2008

OBJECTIVES: To evaluate whether education attainment oroccupation class was associated with the prevalence of tobacco smoking among Jamaican adults. SUBJECTS AND METHODS: This study was a secondary analysis of data collected from the Jamaica Health and Lifestyle Survey 2007–2008 (JHLS-II) and included participants who were 25–74 years old. Data on current tobacco smoking, highest educational attainment and usual occupation were collected using an interviewer-administered questionnaire. Poisson regression models were used to estimate sex-specific, age-adjusted prevalence and prevalence ratios (PR). RESULTS: Analyses included 2299 participants (696 men,1603 women) with mean age of 42.9 years. Prevalence of current smoking among men and women was 25.8% and 7.8%, respectively (p < 0.001). Age-adjusted prevalence of current smoking in men was highest in the primary education group (36.5%) and lowest in the post-secondary education group (10.2%), p (trend) = 0.003. Among women, prevalence was highest among those with junior secondary education (10.2%) and lowest among those with primary education (4.7%), p (trend) = 0.014. Using post secondary education as the reference category, age adjusted PR showed statistically significant two- to three fold higher prevalence of current smoking for all the lower education groups among men. Prevalence ratios for women were lower and not statistically significant. Disparity patterns for occupation were similar, with statistically significant higher age-adjusted prevalence among men in the lower occupational categories, but not among women. CONCLUSION: There are large socio-economic disparities in tobacco smoking among men, but less so among women in Jamaica. Interventions to reduce smoking should consider these socio-economic disparities.

Racism triggers smoking in British ethnic minority adolescents: evidence from the determinants of young adult social wellbeing and health (DASH) longitudinal study

OBJECTIVE: Racism may have a negative impact on the health behaviours in adolescence, however there were few longitudinal studies. We examined the impact of perceived racism on smoking in an ethnically diverse sample of adolescents in the UK, and potential modifying factors. DESIGN AND METHODS: In 2002/03, 6643 11-13 year olds in London, ~80% ethnic minorities, participated in the baseline survey. In 2005/06 4,782 were followed-up. In 2012-14 665 took part in a pilot follow-up aged 21-23y, including 42 qualitative interviews. Measures of socio- economic and psychosocial factors and health were collected. RESULTS: Ethnic minority adolescents were more likely to report racism compared with White British, but smoking was generally lower. Reported racism in adolescence was associated with having ever smoked (e.g. males Odds Ratio 2.20, 95% CI 1.59-3.02), and with smoking initiation (males 4.09, 2.45-6.83). Smoking initiation was greatest among Black Caribbeans. Attendance to a place of worship, being a Muslim and a good parent-child relationship were independent protective factors. Qualitative interviews supported evidence for reported racism as well as protective factors including increasing ethnic diversity, a sense of identity and belonging, supportive parenting, high aspirations, and religious faith. CONCLUSIONS: This is the first UK study to show the negative impact of racism on smoking in adolescence, regardless of ethnic origin. Religious involvement and parenting may provide social support and reinforce cultural and religious values which may prevent the uptake of harmful health behaviours such as smoking. This has implications for health promotion among young people of all ethnicities.

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 and Health in the Americas: a 1992 report of the surgeon general, in collaboration with the Pan American Health Organization

This 1992 report of the Surgeon General, Smoking and Health in the Americas, is the second on smoking and health during my tenure as Surgeon General. Over the years, the reports have systematically examined the effect of smoking on human health: the biologic effects of substances in tobacco, the risks of disease, the susceptibility of target organs, the addictive nature of nicotine, and the evolving epidemiology of the problem. The reports summarize a massive amount of information that has accumulated on the untoward effects of tobacco use, now easily designated the single most important risk to human health in the United States. The 1990 report, The Health Benefits of Smoking Cessation, documented the positive impact of quitting and thus furthered the logical argument leading to a smoke-free society. This report is a departure from its predecessors in that it treats the evidence against smoking as an underlying assumption. The issue for the future is how we will go about achieving a smoke-free society, and a consideration of smoking in the Americas is an early step in that direction. The report explores the historical, epidemiologic, economic, and social issues that surround tobacco use in the Americas. It focuses on cultural antecedents and trends, on social and economic structure, and on the local, national, and regional efforts that are currently under way to control tobacco use (SURGEON GENERAL-Antonia C. Novello)

Prevalence of smoking in Latin America and the Caribbean

The expansion of transnational corporations into international markets began in the early 1950s, accelerated in the 1960s, and was characterized by denationalization of local tobacco industries and development of consumer preference for the products of these corporations. In Latin America and the Caribbean, these events occurred along with complex social and demographic changes- often characterized as a demographic transition-that made the area an attractive market for tobacco. These changes were not uniform throughout the region nor even, in some instances, uniform within a single country. Nonetheless, four main sociodemographic factors have contributed to the potential of the population in Latin America and the Caribbean to initiate cigarette smoking. These factors are growth of groups likely to smoke, dissemination of an urban lifestyle, greater access to education, and the entry of women into the labor force. These factors are summarized and related to available data on the prevalence of smoking

Smoking-attributable mortality in Latin America and the Caribbean

In the discussion, an attempt is made to specify the number of deaths in Latin America and the Caribbean attributable to smoking, while keeping in mind the limitations of common disease measures. The result is an approximation, an early step in an iterative process for determining the health impact of tobacco use in the Americas