Burden of waterpipe smoking and chewing tobacco use among women of reproductive age group using data from the 2012-13 Pakistan Demographic and Health Survey.

BACKGROUND: Despite the general decline in cigarette smoking, use of alternative forms of tobacco has increased particularly in developing countries. Waterpipe (WP) and Chewing Tobacco (CT) are two such alternative forms, finding their way into many populations. However, the burden of these alternative forms of tobacco and their socio demographic determinants are still unclear. We assessed the prevalence of WP and CT use among women of reproductive age group in Pakistan. METHODS: Data from the most recent Pakistan Demographic and Health Survey 2012-13 (n = 13,558) was used for this analysis. Information obtained from ever married women, aged between 15 and 49 years were analyzed using two separate data subgroups; exclusive WP smokers (total n = 12,995) and exclusive CT users (total n = 12,771). Univariate and Multivariate logistic regression analyses were conducted and results were reported as crude and adjusted Odds Ratio with 95% confidence intervals. RESULTS: Prevalence of WP smoking and CT were 4% and 2%, respectively. After multivariate adjustments, ever married women who were: older than 35 years (OR; 4.68 95% CI, 2.62-8.37), were poorest (OR = 4.03, 95% CI 2.08-7.81), and had no education (OR = 9.19, 95% CI 5.10-16.54), were more likely to be WP smokers. Similarly, ever married women who were: older than 35 years (OR = 3.19, 95% CI 1.69-6.00), had no education (OR = 4.94, 95% CI 2.62-9.33), were poor (OR = 1.64, 95% CI 1.07-2.48) and had visited health facility in last 12 months (OR = 1.81, 95% CI 1.22-2.70) were more likely to be CT users as well. CONCLUSION: Older women with lower socio-economic profile were more likely to use WP and CT. Focused policies aiming towards reducing the burden of alternate forms of tobacco use among women is urgently needed to control the tobacco epidemic in the country.

Anti-smoking initiatives and current smoking among 19,643 adolescents in South Asia: findings from the Global Youth Tobacco Survey.

BACKGROUND: Cigarette smoking habit usually begins in adolescence. The developing countries in South Asia like Pakistan, India, Bangladesh, and Nepal, where the largest segment of the population is comprised of adolescents, are more susceptible to smoking epidemic and its consequences. Therefore, it is important to identify the association between anti-smoking initiatives and current smoking status in order to design effective interventions to curtail the smoking epidemic in this region. METHODS: This is a secondary analysis of national data from the Global Youth Tobacco Survey (GYTS) conducted in Pakistan (year 2003), India (year 2006), Bangladesh (year 2007), and Nepal (year 2007). GYTS is a school-based survey of students targeting adolescents of age 13-15 years. We examined the association of different ways of delivering anti-smoking messages with students' current smoking status. RESULTS: A total of 19,643 schoolchildren were included in this study. The prevalence of current smoking was 5.4% with male predominance. No exposure to school teachings, family discussions regarding smoking hazards, and anti-smoking media messages was significantly associated with current smoking among male students. Participants who were deprived of family discussion regarding smoking hazards (girls: odds ratio (OR) 1.56, 95% confidence interval (CI) 0.84-2.89, p value 0.152; boys: OR 1.37, 95% CI 1.04-1.80, p value 0.025), those who had not seen media messages (girls: OR 2.89, 95% CI 1.58-5.28, p value <0.001; boys: OR 1.32, 95% CI 0.91-1.88, p value 0.134), and those who were not taught the harmful effects of smoking at school (girls: OR 2.00, 95% CI 0.95-4.21, p value 0.066; boys: OR 1.89, 95% CI 1.44-2.48, p value <0.001) had higher odds of being current smokers after multivariate adjustment. CONCLUSION: School-going adolescents in South Asia (Pakistan, India, Nepal, and Bangladesh) who were not exposed to anti-tobacco media messages or were not taught about the harmful effects in school or at home had higher odds of being current smokers than their counterparts.

Concurrent outbreaks of circulating vaccine-derived poliovirus types 1 and 2 affecting the Republic of the Philippines and Malaysia, 2019-2021.

Concurrent outbreaks of circulating vaccine-derived poliovirus serotypes 1 and 2 (cVDPV1, cVDPV2) were confirmed in the Republic of the Philippines in September 2019 and were subsequently confirmed in Malaysia by early 2020. There is continuous population subgroup movement in specific geographies between the two countries. Outbreak response efforts focused on sequential supplemental immunization activities with monovalent Sabin strain oral poliovirus vaccine type 2 (mOPV2) and bivalent oral poliovirus vaccines (bOPV, containing Sabin strain types 1 and 3) as well as activities to enhance poliovirus surveillance sensitivity to detect virus circulation. A total of six cVDPV1 cases, 13 cVDPV2 cases, and one immunodeficiency-associated vaccine-derived poliovirus type 2 case were detected, and there were 35 cVDPV1 and 31 cVDPV2 isolates from environmental surveillance sewage collection sites. No further cVDPV1 or cVDPV2 have been detected in either country since March 2020. Response efforts in both countries encountered challenges, particularly those caused by the global COVID-19 pandemic. Important lessons were identified and could be useful for other countries that experience outbreaks of concurrent cVDPV serotypes.

Emergence of vaccine-derived poliovirus type 2 after using monovalent type 2 oral poliovirus vaccine in an outbreak response, Philippines.

Objective: In response to an outbreak of circulating vaccine-derived poliovirus (cVDPV) type 2 in the Philippines in 2019-2020, several rounds of supplementary immunization activities using the monovalent type 2 oral poliovirus vaccine (OPV) were conducted for the first time in the Western Pacific Region. After use of the monovalent vaccine, the emergence of vaccine-derived poliovirus unrelated to the outbreak virus was detected in healthy children and environmental samples. This report describes the detection of this poliovirus in the Philippines after use of the monovalent type 2 OPV for outbreak response. Methods: We describe the emergence of vaccine-derived poliovirus unrelated to the outbreak detected after supplementary immunization activities using the monovalent type 2 OPV. This analysis included virus characterization, phylogenetic analyses and epidemiological investigations. Results: Three environmental samples and samples from six healthy children tested positive for the emergent vaccine-derived poliovirus. All isolates differed from the Sabin type 2 reference strain by 6-13 nucleotide changes, and all were detected in the National Capital Region and Region 4, which had conducted supplementary immunization activities. Discussion: Since the 2016 removal of type 2 strains from the OPV, vaccine-derived poliovirus outbreaks have occurred in communities that are immunologically naive to poliovirus type 2 and in areas with recent use of monovalent OPV. To prevent the emergence and further spread of cVDPV type 2, several interventions could be implemented including optimizing outbreak responses by using the monovalent type 2 OPV, accelerating the availability of the novel type 2 OPV, strengthening routine immunization using inactivated polio vaccine and eventually replacing OPV with inactivated poliovirus vaccine for routine immunization.

Systemic Inflammatory Markers Among Waterpipe Smokers, Cigarette Smokers, and Nonsmokers.

OBJECTIVE: To determine the levels of neutrophil to lymphocyte ratio (NLR) and platelet to lymphocyte ratio (PLR) among exclusive groups of waterpipe (WP) smokers, cigarette smokers, and nonsmokers. METHODS: This cross-sectional study was conducted among adults, apparently healthy individuals, aged between 18 and 40 years of either gender. NLR and PLR as measures of systemic inflammation were studied in association with individuals' sociodemographic, health, and tobacco use related characteristics. The results of linear and logistic regression models were reported as crude and adjusted beta coefficients and odds ratios with 95% confidence intervals (CIs). RESULTS: Out of 190 participants, 34.2% (n = 65) exclusively smoked WP, 32.6% (n = 62) smoked cigarettes, and 33.2% (n = 63) were nonsmokers. The mean NLR and PLR were significantly higher among WP smokers when compared with nonsmokers; however, the comparison between WP smokers and cigarette smokers for both NLR and PLR was not statistically significant. The odds of raised NLR was 4.40 times higher (AOR = 4.40, 95% CI = 1.97, 9.85), and the odds of raised PLR was 3.48 times higher (AOR = 3.48, 95% CI = 1.60, 7.57) for WP smokers compared to nonsmokers. CONCLUSIONS: WP smoking has a significant association with systemic inflammation as measured by NLR and PLR. The study and existing evidence implicate an urging need to regulate WP industry and its policies.

Environmental determinants of aplastic anemia in Pakistan: a case-control study.

AIM: Aplastic anemia (AA) affects the Asian population two to three fold more than people in other regions. Besides the host genetics and socioeconomic status, several other environmental exposures have been linked with an AA etiology. We aimed to examine the association of various environmental exposures with AA occurrence among Pakistani individuals. SUBJECTS AND METHODS: A case-control study was conducted in Karachi, Pakistan, where cases (diagnosed AA patients) were selected from the National Institute of Blood Disease and Bone Marrow Transplantation (NIBD), while for each case, a single control (who was free of AA and visited the outpatient department of the same hospital for the treatment of minor ailments) was selected matched by age and sex. A total of 428 participants were included in this study with equal proportions of cases and controls. Information related to disease characteristics, sociodemographics and exposure to chemicals was collected through a survey questionnaire, laboratory investigations and medical records. Descriptive results were reported as frequencies and proportions, adjusted odds ratios with 95 % confidence intervals and population attributable risk (PAR) as percentage. RESULTS: Among study participants (n = 428), AA was significantly associated with various environmental exposures. Participants residing in rural settings (OR = 2.29, 95 % CI 1.12-4.67, p-value < 0.01) and those who reported exposure to pesticides (OR = 3.58, 95 % CI 1.27-10.10, p-value 0.01; PAR = 18.16 %) were significantly more likely to report AA. Participants with a formal education were significantly less likely to have AA (OR = 0.27, 95 % CI 0.10-0.71, p-value < 0.01). CONCLUSIONS: This study observed a significant association of aplastic anemia with a lower socioeconomic profile, and certain environmental exposures among the Pakistani population. The evidence may be helpful in understanding the pathophysiology of aplastic anemia in the context of environmental exposures.

Awareness and support for anti-tobacco policies among health professional students in Pakistan: findings from the Global Health Professional Students Survey, 2011.

BACKGROUND: Health professional (HP) students may have an important role in controlling future tobacco use of their patients, and public at large. It is important to understand their existing level of awareness and support for national anti-tobacco policies. We thus aim to explore Pakistani HP students' existing attitudes towards national anti-tobacco policy and examine factors associated with lack of awareness, and support amongst them. METHODS: Secondary data analysis of the Global Health Professional Students Survey, Pakistan, 2011 was performed. Study population included 4,235 health professional students enrolled in third year of graduate level HP programs. The policy support metrics were developed using six questions from the survey. Univariate and multivariate analyses were conducted to analyze association between HP students' awareness, and support for anti-tobacco policy (outcome variables), and various socio-demographic, attitudinal, and knowledge related factors. Descriptive statistics are reported as proportions, and results of logistic regression analysis were reported as odds ratios with 95% confidence interval. RESULTS: Overall, among HP students, 10.8% (n=391) were current smokers, and 26.7% (n=965) of them were cigarette experimenters. Almost half, (46.1%, n=1666) of the HP students did not have an awareness of the official policy banning tobacco use in their school buildings and clinics; and only one in ten (9.4%, n=338) of them did not support anti-tobacco policies. Students were less likely to be aware if they had second hand exposure at home/work (OR=0.73, 95% CI (0.57-0.92), p-value <0.01). Furthermore, students who were current smokers (OR=0.21, 95% CI (0.08-0.56), or cigarette experimenters (OR=0.42, 95% CI (0.26-0.70), p-value <0.01), were least likely to support anti-tobacco policies. CONCLUSION: We found that HP students lack awareness of anti-tobacco policies; and were less likely to support such efforts if they were current smokers. These findings may help in understanding existing perceptions of the future care givers in Pakistan. Future anti-tobacco efforts and HP training programs may target the smoking HPs to enhance their full support in this regard.

Health professional students' perceptions regarding their role in tobacco control: findings from the Global Health Professional Students Survey, Pakistan, 2011.

BACKGROUND: An important way of reducing tobacco use is to train the health professional (HP) students to assist in tobacco cessation by educating patients and public. In order to shape their thoughts for the desired role, it is vital to understand their existing perceptions regarding HP's role in tobacco control. Thus, the aim of our study was to find out the perceptions of Pakistani HP students regarding their future role in tobacco control, and examine factors associated with negative perceptions. METHODS: Secondary data analysis of the Global Health Professional Students Survey, Pakistan, 2011 was performed. Study population included 3445 health professional students in third year of graduate level programs. The dependent variable (perceptions of HP students), was developed using four questions from the survey. Students who did not regard HP's role in tobacco control were labeled as having negative perceptions. Logistic regression analyses were conducted to analyze association between HP students' perceptions and various socio-demographic, attitudinal and knowledge related factors; and were reported as adjusted odds ratios with 95% confidence interval. RESULTS: We found that 44.8% (n = 1542) of students do not regard HPs as role model for their patients and public, and perceive that HPs do not play an important part in patient's quitting tobacco use. These negative perceptions were associated with male sex (OR = 1.25, 95% CI 1.02 - 1.53, p value 0.028), and poor knowledge about tobacco cessation techniques (OR = 1.32, 95% CI 1.12 - 1.55, p value < 0.001). Negative perceptions were also associated with their attitudes towards ban on: tobacco advertisements (OR = 1.67, 95% CI 1.13 - 2.48, p value 0.010); and tobacco use at public places (OR = 1.60, 95% CI 1.26 - 2.03, p value < 0.001). CONCLUSION: The role of HPs for tobacco control is fairly under-perceived by HP students, and the undesired negative perceptions are associated with male sex, poor knowledge about tobacco use cessation techniques and negative attitudes towards legislative control. A comprehensive approach, focusing on these aspects should be adopted to train HPs, in order to utilize them as an effective manpower for tobacco control.

Prevalence and determinants of susceptibility to cigarette smoking among school students in Pakistan: secondary analysis of Global Youth Tobacco Survey.

BACKGROUND: Susceptibility to smoke has been recognized as a strong predictor of smoking experimentation and taking up regular smoking habit. The identification of smoking susceptible individuals and its determinants is important in the efforts to reduce future smoking prevalence. The aims of this study are to estimate prevalence of susceptibility to smoke among adolescents, and identify factors associated with it. METHODS: Cross sectional data was obtained from Global Youth Tobacco Survey conducted in three cities of Pakistan in year 2004. Study population consisted of students in grades, 8th, 9th, and 10th; aged 13 to 15 years. Secondary analysis using univariate and multivariate logistic regression analyses were performed to estimate the associations between smoking susceptibility and co-variates. Descriptive statistics were reported in proportions, and adjusted odds ratios with 95% confidence interval were used to report logistic regression analyses. RESULTS: Approximately 12% of nonsmoking students were found susceptible to smoking. Students, who were females (OR = 1.53, 95% CI [1.24-1.89]); whose parents (OR = 1.64, 95% CI [1.35-1.99]); or close friend smoked (OR = 2.77, 95% CI [2.27- 3.40]) were more susceptible to cigarette smoking. Students who had good knowledge about harmful effects of smoking (OR = 0.54, 95% CI [0.43-0.69]); and had access to anti-smoking media (OR = 0.73, 95% CI [0.59-0.89]) were less likely to be susceptible to smoking. CONCLUSION: Students who were females, had smoking parents, friends or exposure to newspaper/magazines cigarette marketing, were more susceptible to cigarette smoking among Pakistani adolescents. While knowledge of harmful effects of smoking and access to anti-smoking media served as protective factors against susceptibility to smoking.