COVID-19: Acing the Treatment.

Angiotensin converting enzyme 2 is the functional receptor that the SARS-Cov-2 virus requires to enter cells and cause dysregulated inflammatory conditions that contribute towards acute lung injuries. The renin-angiotensin-aldosterone system with its physiological surveillance and regulation system can be implicated in both harm and therapeutic benefit. The initial observational studies suggesting the discontinuation of angiotensin converting enzyme inhibitors and angiotensin receptor blockers have been firmly rebutted by international societies. On the contrary, these therapeutics may confer a survival benefit in COVID-19 infections. Understanding the biological plausibility of this pathway alongside the emerging therapeutic evidence may yield new modes of treatment. Such developments appear fundamentally important in the battle against the inevitable emergence of new variants and their potential to drive future waves of COVID-19 pandemics.

Poor smoke-free status of airports in a country with a smoke-free goal: New Zealand.

BACKGROUND: To survey the smoke-free status of airports in New Zealand (NZ), a country with a smoke-free goal for 2025, and where public indoor areas are required to be smoke-free. METHODS: A cross-sectional survey of a convenience sample of airports with data collection on smoke-free signage, observed smoking behaviour, cigarette butt litter and designated smoking areas. RESULTS: A total of 23 airports were surveyed, including all those for the 10 most populous urban areas in NZ (82% of all airports with scheduled flights on the main islands). There were no smoke-free signs found at entrances/exits to the terminal building in 26% of airports, with a mean of 1.7 such signs per entrance/exit. Only one airport had any signage stating that all the grounds were smoke-free. Qualitatively, the signage was often small in size (<15 cm diameter). There was also ambiguity as to what the signage related to (indoors or outdoors). Observed smoking and vaping outside of the main entrances/exits was relatively uncommon, but the great majority of these sites (91%) had discarded cigarette butts present. Most airports (70%) had some form of designated or implied outdoor smoking area, with 38% of these areas being within 10 m distance of a terminal entrance/exit. CONCLUSIONS: Despite this country having a smoke-free goal, it has largely deficient smoke-free policies at its airports. There is a case to make airport grounds entirely smoke-free as part of an upgrade of the national smoke-free law.

The long-term supply of tobacco and nicotine: some goals, principles and policy implications.

There is a growing literature on regulating the supply of tobacco products to achieve tobacco-free goals. This article suggests three goals and eight principles that could underpin regulatory approaches to the supply of tobacco and non-prescription nicotine products. The primary principles are that tobacco and nicotine products should not be seen as normal consumer products, should not be supplied for profit, and that the tax revenue from the supply of the products should first be used to reduce tobacco and nicotine use.

Personal protective equipment (PPE) and infection among healthcare workers - What is the evidence?

BACKGROUND: The worldwide outbreak of coronavirus disease-19 (COVID-19) has already put healthcare workers (HCWs) at a high risk of infection. The question of how to give HCWs the best protection against infection is a priority. METHODS: We searched systematic reviews and original studies in Medline (via Ovid) and Chinese Wan Fang digital database from inception to May, 2020, using terms 'coronavirus', 'health personnel', and 'personal protective equipment' to find evidence about the use of full-body PPEs and other PPEs by HCW exposed highly infectious diseases. RESULTS: Covering more of the body could provide better protection for HCWs. Of importance, it is not just the provision of PPE but the skills in donning and doffing of PPE that are important, this being a key time for potential transmission of pathogen to the HCW and in due time from them to others. In relation to face masks, the evidence indicates that a higher-level specification of face masks and respirators (such as N95) seems to be essential to protect HCWs from coronavirus infection. In community setting, the use of masks in the case of well individuals could be beneficial. Evidence specifically around PPE and protection from the COVID-19 virus is limited. CONCLUSION: Covering more of the body, and a higher-level specification of masks and respirators could provide better protection for HCWs. Community mask usecould be beneficial. High quality studies still need to examine the protection of PPE against COVID-19.

Are children smoke-free at home? Using wearable cameras to study children's exposure to smoking and smoking paraphernalia in private spaces.

BACKGROUND: There is limited evidence available on the nature of children's exposure to smoking and smoking paraphernalia in private spaces (homes and cars). We aimed to evaluate the extent and nature of children's exposure to smoking in these settings using image data captured by wearable cameras. METHODS: One-hundred and sixty-eight children wore wearable cameras for 4 days that automatically took pictures every 7 s. Images captured in private spaces (n = 140,818) by children living in households with a smoker (n = 34) were screened for instances of smoking and smoking paraphernalia. RESULTS: A total of 37 incidents of smoking-four indoor, 21 outdoor, and two in-vehicles-and 62 incidents of smoking paraphernalia were observed. Most smoking incidents in homes (21 of 33) took place outdoors. CONCLUSIONS: The findings support health promotion efforts to make smokers more aware that smoking paraphernalia may normalize smoking for children. The methodology (wearable cameras) appears to have high utility for studying health behaviours in private spaces.

Retraction Note: Inequities in coverage of smokefree space policies within the United States.

The authors have retracted this article [1] because of an error with the data extraction process.

Inequities in coverage of smokefree outdoor space policies within the United States: school grounds and playgrounds.

BACKGROUND: Previous studies have found extensive geographic and demographic differences in tobacco use. These differences have been found to be reduced by effective public policies, including banning smoking in public spaces. Smokefree outdoor spaces reduce secondhand smoke exposure and de-normalize smoking. METHODS: After previously publishing a study of smokefree indoor and outdoor space policies, it was brought to the authors' attention that the dataset used in analyses was incomplete (Lowrie et al., BMC Public Health 17:456, 2017). The current manuscript is a corrected version. Here, we include analyses for outdoor space policies. We evaluated regional and demographic differences in the proportion of the population (both adult and child) covered by smokefree outdoor space policies for school grounds and playgrounds enacted in the United States prior to 2014. RESULTS: Children had a low level of protection in playgrounds and schools (8% covered nationwide in both settings). Significant differences in coverage were found by ethnicity, region, income, and education (p < 0.001). The odds of having a smokefree playgrounds policy was lower for jurisdictions with higher proportions of poor households, households with no high school diploma, whites and the Alaska/Hawaii region. Increased ethnic heterogeneity was found to be a significant predictor of increased odds of having a smokefree playgrounds policy, meaning that diversity is protective, with differential effect by region (p < 0.001) - which may relate to urbanicity. CONCLUSIONS: Disparities in smokefree outdoor space policies have potential to exacerbate existing health inequities. A national increase in smokefree outdoor space policies to protect children in playgrounds and schools is a crucial intervention to reduce such inequities.

International trade and investment law: a new framework for public health and the common good.

BACKGROUND: International trade and investment agreements can have positive outcomes, but also have negative consequences that affect global health and influence fundamental health determinants: poverty, inequality and the environment. This article proposes principles and strategies for designing future international law to attain health and common good objectives. ARGUMENT: Basic principles are needed for international trade and investment agreements that are consistent with the common good, public health, and human rights. These principles should reflect the importance of reducing inequalities, along with social and environmental sustainability. Economic growth should be recognised as a means to common good objectives, rather than an end in itself. Our favoured approach is both radical and comprehensive: we describe what this approach would include and outline the strategies for its implementation, the processes and capacity building necessary for its achievement, and related governance and corporate issues. The comprehensive approach includes significant changes to current models for trade and investment agreements, in particular (i) health, social and environmental objectives would be recognised as legitimate in their own right and implemented accordingly; (ii) changes to dispute-resolution processes, both state-to-state and investor-state; (iii) greater deference to international legal frameworks for health, environmental protection, and human rights; (iv) greater coherence across the international law framework; (v) limitations on investor privileges, and (vi) enforceable corporate responsibilities for contributing to health, environmental, human rights and other common good objectives. We also identify some limited changes that could be considered as an alternative to the proposed comprehensive approach. Future research is needed to develop a range of model treaties, and on the means by which such treaties and reforms might be achieved. Such research would focus also on complementary institutional reforms relevant to the United Nations and other international agencies. Advocacy by a range of communities is needed for effective change. Reform will require informed debate, determined engagement with decision-makers and stakeholders, and some agreement across health, social and environmental sectors on alternatives. CONCLUSIONS: Current frameworks of international law that govern trade and economic development need radical change, in relation to treaty processes, content, and contexts, to better attain public health objectives.

Inequities in coverage of smokefree space policies within the United States.

BACKGROUND: Previous studies have found extensive geographic and demographic differences in tobacco use. These differences have been found to be reduced by effective public policies, including banning smoking in public spaces. Smokefree indoor and outdoor spaces reduce secondhand smoke exposure and denormalize smoking. METHODS: We evaluated regional and demographic differences in the proportion of the population covered by smokefree policies enacted in the United States prior to 2014, for both adults and children. RESULTS: Significant differences in coverage were found by ethnicity, region, income, and education (p < 0.001). Smokefree policy coverage was lower for jurisdictions with higher proportions of poor households, households with no high school diploma and the Southeast region. Increased ethnic heterogeneity was found to be a significant predictor of coverage in indoor "public spaces generally", meaning that diversity is protective, with differential effect by region (p = 0.004) - which may relate to urbanicity. Children had a low level of protection in playgrounds and schools (~10% covered nationwide) - these spaces were found to be covered at lower rates than indoor spaces. CONCLUSIONS: Disparities in smokefree space policies have potential to exacerbate existing health inequities. A national increase in smokefree policies to protect children in playgrounds and schools is a crucial intervention to reduce such inequities.

Attitudes to smoke-free outdoor regulations in the USA and Canada: a review of 89 surveys.

OBJECTIVE: To review the published survey data on public support for smoke-free outdoor regulations in the USA and Canada (two countries at the forefront of such policies). DATA SOURCES AND STUDY SELECTION: We searched for English language articles and reports using Medline, Google Scholar and Google for the period to December 2014. We retained population-based surveys of the adult general population in jurisdictions in the USA and Canada, with a minimum survey sample of 500. DATA EXTRACTION: The analysis focused on assessing levels and trends in public support for different types of places and also explored how support varied between population groups. RESULTS: Relevant data were found from 89 cross-sectional surveys between 1993 and 2014. Support for smoke-free regulations in outdoor places tended to be highest for smoke-free school grounds (range: 57-95%) playgrounds (89-91%), and building entrances (45-89%) and lowest for smoke-free outdoor workplaces (12-46%) and sidewalks (31-49%). Support was lower among smokers, though for some types of places there was majority smoker support (eg, school grounds with at least 77% support in US state surveys after 2004). Trend data involving the same questions and the same surveyed populations suggested increased general public and smoker support for smoke-free regulations over time (eg, from 67% to 78% during 2002-2008 for smoke-free school grounds in the USA). Higher support was typically seen from women and some ethnic groups (eg, African-Americans). CONCLUSIONS: Outdoor smoke-free regulations can achieve majority public support, including from smokers.

Alcohol in urban streetscapes: a comparison of the use of Google Street View and on-street observation.

BACKGROUND: Alcohol-related harm is a major global health issue, and controls on alcohol marketing are one intervention utilized by governments. This study investigated the use of Google Street View (GSV) as a novel research method for collecting alcohol-related data in the urban environment. METHODS: The efficacy of GSV and on-street observation by observer teams was compared by surveying 400 m stretches of 12 streets in Wellington, the capital city of New Zealand. Data on alcohol sale, alcohol-related advertising, health promotion materials, regulatory information and visible alcohol consumption were collected. RESULTS: A total of 403 retailers with evidence of alcohol sales and 1161 items of alcohol-related communication were identified in on-street observation. Of the latter, 1028 items (89 %) were for alcohol marketing and 133 (11 %) were for alcohol-related health promotion and alcohol regulation. GSV was found to be a less sensitive tool than on-street observation with only 50 % of the alcohol venues identified and 52 % of the venue-associated brand marketing identified. A high degree of inter-observer reliability was generally found between pairs of observers e.g., for the detection of alcohol retail venues the intra-class correlation coefficient (ICC) was 0.93 (95 % CI: 0.78 to 0.98) for on-street observation and 0.85 (95 % CI: 0.49 to 0.96) for using GSV. CONCLUSIONS: GSV does not seem suitable for the comprehensive study of the influences on alcohol consumption in the urban streetscape. However, it may still have value for large, static objects in the environment and be more time efficient than traditional on-street observation measures, especially when used to collect data across a wide geographical area. Furthermore, GSV might become a more useful research tool in settings with better image quality (such as more 'footpath views') and with more regularly updated GSV imagery.

Do changes in neighborhood and household levels of smoking and deprivation result in changes in individual smoking behavior? A large-scale longitudinal study of New Zealand adults.

Health behavior takes place within social contexts. In this study, we investigated whether changes in exposure to neighborhood deprivation and smoking prevalence and to household smoking were associated with change in personal smoking behavior. Three waves of biannual data collection (2004-2009) in a New Zealand longitudinal study, the Survey of Family, Income and Employment (SoFIE)-Health, were used, with 13,815 adults (persons aged ≥15 years) contributing to the analyses. Smoking status was dichotomized as current smoking versus never/ex-smoking. Fixed-effects regression analyses removed time-invariant confounding and adjusted for time-varying covariates (neighborhood smoking prevalence and deprivation, household smoking, labor force status, income, household tenure, and family status). A between-wave decile increase in neighborhood deprivation was significantly associated with increased odds of smoking (odds ratio (OR) = 1.08, 95% confidence interval (CI): 1.02, 1.14), but a between-wave increase in neighborhood smoking prevalence was not (OR = 1.04, 95% CI: 0.98, 1.10). Changing household exposures between waves to live with another smoker (compared with a nonsmoker (referent)) increased the odds of smoking (OR = 2.48, 95% CI: 1.84, 3.34), as did changing to living in a sole-adult household (OR = 1.52, 95% CI: 1.07, 2.14). Tobacco control policies and programs should address the broader household and neighborhood circumstances within which individual smoking takes place.

Youth exposure to in-vehicle second-hand smoke and their smoking behaviours: trends and associations in repeated national surveys (2006-2012).

OBJECTIVE: To extend the limited international evidence on youth in-vehicle second-hand smoke (SHS) exposure by examining trends in New Zealand, a country with a national smoke-free goal and indoors smoke-free environment legislation. METHODS: We tracked exposure rates and explored the associations between in-vehicle SHS exposure and smoking behaviours. In-home exposure was also examined for comparative purposes. Data were collected in annual surveys of over 25 000 year 10 school students (14-15-year olds) for a 7-year period (2006-2012). Questions covered smoking behaviour, exposure to smoking and demographics. RESULTS: Youth SHS exposure rates in-vehicle and in-home trended down slightly over time (p<0.0001 for both) with 23% exposed in-vehicle in the previous week in 2012. However, marked inequalities in exposure between ethnic groups, and by school-based socioeconomic position, persisted. The strongest association with SHS exposure was parental smoking (eg, for both parents versus neither smoking in 2012: in-vehicle SHS exposure adjusted OR: 7.4; 95% CI: 6.5 to 8.4). After adjusting for seven other factors associated with initiation, logistic regression analyses revealed statistically significant associations of in-vehicle SHS exposure with susceptibility to initiation and smoking. CONCLUSIONS: The slow decline in SHS exposure in vehicles and the lack of progress in reducing relative inequalities is problematic. To accelerate progress, the New Zealand Government could follow the example of other jurisdictions and prohibit smoking in cars carrying children. Other major policy interventions, beside enhanced smoke-free environments, will also likely be required if New Zealand is to achieve its 2025 smoke-free nation goal.