Health-Related Behavioral Risk Factors and Obesity Among American Indians and Alaska Natives of the United States: Assessing Variations by Indian Health Service Region.

INTRODUCTION: Health-related behavioral risk factors and obesity are linked to high risk for multiple chronic diseases. We examined the prevalence of these risk factors among American Indians and Alaska Natives (AI/ANs) compared with that of non-Hispanic Whites and across Indian Health Service (IHS) regions. METHODS: We used 2017 Behavioral Risk Factor Surveillance System data from participants in 50 states and the District of Columbia to assess 4 behavioral risk factors (current cigarette smoking, heavy drinking, binge drinking, and physical inactivity) and obesity. We analyzed disparities in these risk factors between AI/AN and non-Hispanic White participants, nationwide and by IHS region, by conducting log-linear regression analyses while controlling for potential confounders. RESULTS: Nationwide, crude prevalence of current smoking, physical inactivity, and obesity were significantly higher among AI/AN than non-Hispanic White participants. After adjustment for sociodemographic characteristics, AI/AN participants were 11% more likely to report current smoking (P < .05) and 23% more likely to report obesity (P < .001) than non-Hispanic White participants. These patterns persisted in most IHS regions with some exceptions. In the Southwest region, AI/AN participants were 39% less likely to report current smoking than non-Hispanic White participants (P < .001). In the Pacific Coast region, compared with non-Hispanic White participants, AI/AN participants were 54% less likely to report heavy drinking (P < .01) but 34% more likely to report physical inactivity (P < .05). Across IHS regions, AI/AN participants residing in Alaska and the Northern Plains regions had the highest prevalence of current smoking and binge drinking, and those in the Southwest and Pacific Coast regions had the lowest prevalence of current smoking. AI/AN participants in the Southwest region had the lowest prevalence of physical inactivity, and those in the Southern Plains region had the highest prevalence of obesity. CONCLUSIONS: The findings of this study support the importance of public health efforts to address and improve behavioral risk factors related to chronic disease in AI/AN people, both nationwide and among IHS regions, through culturally appropriate interventions.

Health-related behaviors and health insurance status among US adults: Findings from the 2017 behavioral risk factor surveillance system.

Health insurance coverage has increased overtime in the US. This study examined the associations between health insurance status and adoption of health-related behaviors among US adults. Using data collected through the 2017 Behavioral Risk Factor Surveillance System on health insurance coverage and type of insurance, we examined four health-related behaviors (i.e., no tobacco use, nondrinking or moderate drinking, meeting aerobic physical activity recommendations, and having a healthy body weight) and their associations with health insurance status. We conducted log-linear regression analyses to assess the associations with adjustment for potential confounders. Results showed the percentages of adults who reported no tobacco use or meeting physical activity recommendations were significantly higher, and the percentages of adults with a healthy body weight were significantly lower among those who were insured versus uninsured, or among adults with private insurance versus uninsured. Adults with health insurance also had a higher prevalence of reporting all 4 health-related behaviors than those uninsured. These patterns persisted after multivariable adjustment for potential confounders including sociodemographics, routine checkup, and number of chronic diseases. Adults with public insurance were 7% more likely to report no tobacco use than adults who were uninsured. Additionally, adults with private insurance were 8% and 7% more likely to report no tobacco use and meeting physical activity recommendations, respectively, but 10% less likely to report nondrinking or moderate drinking than adults with public insurance. In conclusion, we found significant associations existed between having health insurance coverage and engaging in some health-related behaviors among US adults.

Estimating Undercoverage Bias of Internet Users.

INTRODUCTION: In the last decade, response rates to the Behavioral Risk Factor Surveillance System (BRFSS) surveys have been declining. Attention has turned to the possibility of using web surveys to complement or replace BRFSS, but web surveys can introduce coverage bias as a result of excluding noninternet users. The objective of this study was to describe undercoverage bias of internet use. METHODS: We used data from 402,578 respondents who completed BRFSS questions in 2017 on internet use, self-reported health, current smoking, and binge drinking. We examined undercoverage bias of internet use by partitioning it into a product of 2 components: proportion of noninternet use and difference in the prevalences of interest (self-reported health, current smoking, and binge drinking) between internet users and noninternet users. RESULTS: Overall, the weighted proportion of noninternet use overall was 15.0%; the proportion increased with an increase in age and a decrease in education and, by race/ethnicity, was lowest among non-Hispanic white respondents. The overall relative bias was -19.2% for self-reported health, -4.0% for current cigarette smoking, and 8.4% for binge drinking. For all 3 variables of interest, we found large biases and relative biases in some demographic subgroups. CONCLUSION: Undercoverage bias of internet use existed in the 3 studied variables. Both proportion of noninternet users and difference in prevalences of studied variables between internet users and noninternet users contributed to the bias to different degrees. These findings have implications on helping health-related behavioral risk factor surveys transition to more cost-effective survey modes than telephone only.

Comparisons of Estimates From the Behavioral Risk Factor Surveillance System and Other National Health Surveys, 2011-2016.

INTRODUCTION: The Behavioral Risk Factor Surveillance System (BRFSS) is composed of telephone surveys that collect state data from non-institutionalized U.S. adults regarding health-related risk behaviors and chronic health conditions. A new design was implemented in 2011 to include participants on cellular telephones. It is important to validate estimates since 2011. METHODS: A total of 10 key and widely used variables between BRFSS and the National Health and Nutrition Examination Survey (NHANES) or National Health Interview Survey (NHIS) in 2011-2016 were compared. Data analysis was conducted in 2018. RESULTS: Between BRFSS and NHANES, similar linear time trends of prevalences or means were found for 8 of 9 studied variables. There were no significant differences in the prevalences of the following variables: self-reported fair/poor health, ever told have diabetes, and ever told to have hypertension. In trend comparison of BRFSS versus NHIS, interactions of prevalence between survey and time period were not found for 5 variables: current smoking, self-reported fair/poor health, ever told have diabetes, and self-reported height and weight. Although there were significant differences in many estimates between BRFSS and either NHANES or NHIS, the absolute differences across years were rather small. CONCLUSIONS: Comparing BRFSS time trends with those of 2 national benchmark surveys in 10 key and widely used variables suggests that the trends of prevalences (or means) from BRFSS, NHANES, and NHIS are mostly similar. For many variables, despite statistically significant differences in the prevalences (or means) between surveys, absolute differences in most cases were small and not meaningful from a public health surveillance perspective.

Cigarettes point of purchase patterns in 19 low-income and middle-income countries: Global Adult Tobacco Survey, 2008-2012.

BACKGROUND: There is little information on cigarette-purchasing behaviour among smokers globally. Understanding cigarette purchase and point-of-sale patterns can help guide the development and implementation of tobacco-control strategies in retail environments. OBJECTIVE: The purpose of this study was to identify where adults in 19 countries last purchased cigarettes. METHODS: Data were from 19 low-income and middle-income countries that conducted the Global Adult Tobacco Survey (GATS) during 2008-2012. GATS is a nationally representative household survey of adults aged 15 years or older using a standardised protocol to measure tobacco-related behaviours. Data were weighted to yield nationally representative estimates within each country and summarised by using descriptive statistics. RESULTS: Overall prevalence of current cigarette smoking ranged from 3.7% in Nigeria to 38.5% in the Russian Federation. Among current cigarette smokers, locations of last purchase were as follows: stores, from 14.6% in Argentina to 98.7% in Bangladesh (median=66.8%); street vendors, from 0% in Thailand to 35.7% in Vietnam (median=3.0%); kiosks, from 0.1% in Thailand to 77.3% in Argentina (median=16.1%); other locations, from 0.3% in China and Egypt to 57.5% in Brazil (median=2.6%). CONCLUSION: Cigarettes are purchased at various retail locations globally. However, stores and kiosks were the main cigarette purchase locations in 18 of the 19 countries assessed. Knowledge of where cigarette purchases occur could help guide interventions to reduce cigarette accessibility and use.

Effect of Proxy Responses on Tobacco Use Surveys in Thailand, 2011.

Proxy responses are often allowed in household tobacco surveys when all household members are included in a sample. To assess the effect of proxy responses on prevalence estimates, we compared 2 surveys in 2011 that gauged tobacco use in Thailand: the Cigarette Smoking and Alcohol Drinking Survey (SADS) and the Global Adult Tobacco Survey (GATS). Both surveys had similar nonsampling errors and design, but SADS allowed proxy responses and GATS did not. When proxy responses were included in SADS, the prevalence estimate was 10% lower in GATS for men (41.69% in GATS vs 46.55% in SADS) and 18% lower in GATS for women (2.14% in GATS vs 2.61% in SADS). Eliminating proxy responses is recommended to increase accuracy of tobacco-use surveillance.

Evaluation of a federally funded mass media campaign and smoking cessation in pregnant women: a population-based study in three states.

OBJECTIVES: In 2012, theCenters for Disease Control and Prevention initiated a national anti-smoking campaign, Tips from Former Smokers (Tips). As a result of the campaign, quit attempts among smokers increased in the general population by 3.7 percentage points. In the current study, we assessed the effects of Tips on smoking cessation in pregnant women. METHODS: We used 2009-2013 certificates of live births in three US states: Indiana, Kentucky and Ohio. Smoking cessation by the third trimester of pregnancy was examined among women who smoked in the 3 months prepregnancy. Campaign exposure was defined as overlap between the airing of Tips 2012 (March 19-June 10) and the prepregnancy and pregnancy periods. Women who delivered before Tips 2012 were not exposed. Adjusted logistic regression was used to determine whether exposure to Tips was independently associated with smoking cessation. RESULTS: Cessation rates were stable during 2009-2011 but increased at the time Tips 2012 aired and remained elevated. Overall, 32.9% of unexposed and 34.7% of exposed smokers quit by the third trimester (p<0.001). Exposure to Tips 2012 was associated with increased cessation (adjusted OR: 1.07, 95% CI 1.05 to 1.10). CONCLUSIONS: Exposure to a national anti-smoking campaign for a general audience was associated with smoking cessation in pregnant women.

Cigarette Smoking Among Inmates by Race/Ethnicity: Impact of Excluding African American Young Adult Men From National Prevalence Estimates.

INTRODUCTION: Cigarette smoking prevalence is more than two times greater among incarcerated adults, a population usually excluded from national health surveys. African American young adult (18-25) men are less likely to smoke cigarettes than their white counterparts. However, they are two and a-half-times more likely to be incarcerated. This study estimated smoking prevalence with noninstitutionalized and incarcerated samples combined to determine if excluding incarcerated adults impacts smoking prevalence for certain populations. METHODS: The Bureau of Justice Statistics last fielded the Survey of Inmates in State and Federal Correction Facilities in 2003-2004. We combined data from Survey of Inmates in State and Federal Correction Facilities (n = 17 910) and the 2003 and 2004 National Health Interview Survey (n = 61 470) to calculate combined cigarette smoking estimates by race/ethnicity, sex, and age. RESULTS: Inmates represented the greatest proportion of smokers among African American men. Among African American young adult men, inmates represented 15.2% of all smokers in the combined population, compared to 2.0% among white young adult men. Cigarette smoking prevalence was 17.6% in the noninstitutionalized population of young adult African American men and 19.7% in the combined population. Among white young adult men, cigarette smoking prevalence was 29.8% in the noninstitutionalized population, and 30.2% in the combined population. There was little difference in estimates among women. CONCLUSIONS: The exclusion of incarcerated African American young adult men may result in a small underestimation of cigarette smoking prevalence in this population. Increasing access to smoking cessation support among inmates may reduce smoking prevalence in disproportionately incarcerated segments of the US population. IMPLICATIONS: The exclusion of incarcerated adults from national survey data should be considered when examining differences in cigarette smoking prevalence estimates between African American and white young adult men. Approximately one in six African American young adult men who smoke were incarcerated. Increasing access to smoking cessation support among inmates may reduce smoking prevalence among disproportionately incarcerated segments of the population.

Tobacco advertising, promotion, and sponsorship (TAPS) exposure, anti-TAPS policies, and students' smoking behavior in Botswana and South Africa.

OBJECTIVE: We examined the change over time in tobacco advertising, promotion and sponsorship exposure and the concurrent changes in cigarette smoking behavior among students age 13 to 15years in two African countries with different anti-tobacco advertising, promotion and sponsorship policies. In South Africa, anti-tobacco advertising, promotion and sponsorship policies became more comprehensive over time and were more strictly enforced, whereas the partial anti-tobacco advertising, promotion and sponsorship policies adopted in Botswana were weakly enforced. METHOD: We analyzed two rounds of Global Youth Tobacco Survey data from South Africa (1999, n=2342; 2011, n=3713) and in Botswana (2001, n=1073; 2008, n=1605). We assessed several indicators of tobacco advertising, promotion and sponsorship exposure along with prevalence of current cigarette smoking and smoking susceptibility for each data round. Logistic regression was used to examine changes over time in tobacco advertising, promotion and sponsorship exposure and smoking behavior in both countries. RESULTS: Between 1999 and 2011, South African students' exposure to tobacco advertising and sponsorship decreased significantly by 16% (p value, <0.0001) and 14% (p value, <0.0001), respectively. Exposure to tobacco promotion was lower and did not decrease significantly. Botswanan students' tobacco advertising, promotion and sponsorship exposure did not change significantly between 2001 and 2008. South African students' prevalence of cigarette smoking decreased over time (OR, 0.68) as did susceptibility to smoking (OR, 0.75), but declines did not remain significant after adjusting for parents' and friends' smoking. In Botswana, students' prevalence of cigarette smoking increased significantly over time (OR, 1.84), as did susceptibility to smoking (OR, 2.71). CONCLUSION: Enforcement of strong anti-tobacco advertising, promotion and sponsorship policies is a vital component of effective tobacco control programs in Africa. Such regulations, if effectively implemented, can reduce tobacco advertising, promotion and sponsorship exposure among adolescents and may influence cigarette smoking behavior.

Tobacco and Marijuana Initiation Among African American and White Young Adults.

INTRODUCTION: African American youth use marijuana at similar rates and tobacco at lower rates compared with white youth; however, in adulthood, tobacco use is similar. Tobacco and marijuana use are closely associated; differing initiation patterns may contribute to observed racial differences in tobacco prevalence by age. Therefore, it is important to assess tobacco and marijuana initiation patterns by race. METHODS: Data were obtained from 56,555 adults aged 18-25 who completed the 2005-2012 National Survey on Drug Use and Health. The analysis was restricted to those who reported ever use of marijuana and combustible tobacco (cigarettes and/or cigars). Three mutually exclusive categories of initiation patterns were evaluated: use of marijuana before tobacco; marijuana and tobacco at the same age; and tobacco before marijuana. Multivariable regression models were used to assess changes over time and compare these outcomes by race while controlling for sociodemographics, risk perceptions, and current substance use. RESULTS: In 2005, 26.6% of African American and 14.3% of white young adults used marijuana before tobacco, compared with 41.5% of African American and 24.0% of white young adults in 2012 (P < .001). Overall, African American young adults had greater odds of using marijuana before tobacco (AOR = 1.79; 95% CI: 1.67, 1.91) compared with whites. CONCLUSION: African American young adults were more likely than whites to use marijuana before tobacco and both groups were increasingly likely to use marijuana before tobacco over time. A greater understanding of how marijuana initiation interacts with tobacco initiation could inform more effective tobacco and marijuana use prevention efforts. IMPLICATIONS: Among ever users of combustible tobacco and marijuana, greater proportions of African American young adults used marijuana before tobacco or at the same age than their white counterparts. Moreover, both African Americans and whites were more likely to use marijuana before tobacco in 2012 compared with 2005. Tobacco control policy may benefit from a broader understanding of the patterns of initiation to tobacco and marijuana use. Some public health interventions aimed at preventing and reducing combustible tobacco use among African American young adults may be strengthened by considering marijuana use.

Tracking MPOWER in 14 countries: results from the Global Adult Tobacco Survey, 2008-2010.

BACKGROUND: The World Health Organization (WHO) MPOWER is a technical package of six tobacco control measures that assist countries in meeting their obligations of the WHO Framework Convention Tobacco Control and are proven to reduce tobacco use. The Global Adult Tobacco Survey (GATS) systematically monitors adult tobacco use and tracks key tobacco control indicators. METHODS: GATS is a nationally representative household survey of adults aged 15 and older, using a standard and consistent protocol across countries; it includes information on the six WHO MPOWER measures. GATS Phase I was conducted from 2008-2010 in 14 high-burden low- and middle-income countries. We selected one key indicator from each of the six MPOWER measures and compared results across 14 countries. RESULTS: Current tobacco use prevalence rates ranged from 16.1% in Mexico to 43.3% in Bangladesh. We found that the highest rate of exposure to secondhand smoke in the workplace was in China (63.3%). We found the highest 'smoking quit attempt' rates in the past 12 months among cigarette smokers in Viet Nam (55.3%) and the lowest rate was in the Russian Federation (32.1%). In five of the 14 countries, more than one-half of current smokers in those 5 countries said they thought of quitting because of health warning labels on cigarette packages. The Philippines (74.3%) and the Russian Federation (68.0%) had the highest percentages of respondents noticing any cigarette advertising, promotion and sponsorship. Manufactured cigarette affordability ranged from 0.6% in Russia to 8.0% in India. CONCLUSIONS: Monitoring tobacco use and tobacco control policy achievements is crucial to managing and implementing measures to reverse the epidemic. GATS provides internationally-comparable data that systematically monitors and tracks the progress of the other five MPOWER measures.

Methodology of the Global Adult Tobacco Survey - 2008-2010.

In 2008, the Centers for Disease Control and Prevention (CDC) and the World Health Organization developed the Global Adult Tobacco Survey (GATS), an instrument to monitor global tobacco use and measure indicators of tobacco control. GATS, a nationally representative household survey of persons aged 15 years or older, was conducted for the first time during 2008-2010 in 14 low- and middle-income countries. In each country, GATS used a standard core questionnaire, sample design, and procedures for data collection and management and, as needed, added country-specific questions that were reviewed and approved by international experts. The core questionnaire included questions about various characteristics of the respondents, their tobacco use (smoking and smokeless), and a wide range of tobacco-related topics (cessation; secondhand smoke; economics; media; and knowledge, attitudes, and perceptions). In each country, a multistage cluster sample design was used, with households selected proportionate to the size of the population. Households were chosen randomly within a primary or secondary sampling unit, and one respondent was selected at random from each household to participate in the survey. Interviewers administered the survey in the country's local language(s) using handheld electronic data collection devices. Interviews were conducted privately, and same-sex interviewers were used in countries where mixed-sex interviews would be culturally inappropriate. All 14 countries completed the survey during 2008-2010. In each country, the ministry of health was the lead coordinating agency for GATS, and the survey was implemented by national statistical organizations or surveillance institutes. This article describes the background and rationale for GATS and includes a comprehensive description of the survey methods and protocol.

Exposure to secondhand tobacco smoke and interventions among pregnant women in China: a systematic review.

INTRODUCTION: Smoking prevalence is high among men in China. One result is that a large number of nonsmoking Chinese women may be exposed daily to secondhand smoke (SHS). Exposure is particularly problematic for pregnant women because of potential adverse reproductive effects. To determine the extent of this exposure and to summarize existing intervention studies designed to reduce SHS exposure in China, a systematic review of the literature published from 1995 through 2012 was conducted. METHODS: We searched the PubMed and Wanfang databases for studies published from 1995 through 2012 using various search terms including SHS, pregnant women, and China. Only articles on prevalence of SHS exposure and interventions to reduce exposure to SHS were selected. RESULTS: We identified 132 studies during the initial searches. Eight of 13 eligible studies reported the prevalence of SHS exposure among pregnant women; estimates ranged from 38.9% to 75.1%. Few SHS prevention interventions among pregnant women in China have been studied; we found only 5 such studies. The interventions primarily focused on changing husbands' smoking behaviors; some interventions focused on women's avoidance behaviors. CONCLUSION: Prevalence of exposure to SHS among pregnant women is high in China. Information is limited on effective interventions to protect pregnant women from exposure. The results of this review can provide the basis for the design and evaluation of interventions to help pregnant women avoid SHS exposure.

Attitudes toward nonsmoking policies and tobacco tax increases: a cross-sectional study among Vietnamese adults.

Following the 2009 update of the 2005 Framework Convention on Tobacco Control, Vietnam issued a new policy to ban smoking at workplaces and public places. This cross-sectional survey explored public attitudes toward this new regulation and provides evidence to inform future laws. Using stratified cluster sampling, 10 383 Vietnamese people older than 15 years were drawn from 11 142 selected households. Policies mandating "no smoking at workplaces" were supported by 88.7% of Vietnamese adults, whereas "no smoking in public places" and "increasing the tobacco tax" received less support. Educational level, knowledge of health effects, access to information on quitting and smoking health risks, smoking status, ethnicity, and region had significant associations with positive attitudes toward all 3 tobacco control policies. Adults belonging to the non-Kinh ethnic group, those who do not live in the Red river delta, people with lower educational levels, and current smokers should be targeted in tobacco control communication programs.

Factors associated with exposure to antismoking information among adults in Vietnam, Global Adult Tobacco Survey, 2010.

INTRODUCTION: The media play a critical role in tobacco control. Knowledge about the exposure of a population to antismoking information can provide information for planning communication activities in tobacco control. We examined exposure to antismoking information associated with socioeconomic and demographic factors among adults (≥15 years) in Vietnam. METHODS: The Global Adult Tobacco Survey (GATS) is a nationally representative household survey of noninstitutionalized men and women aged 15 years or older and was conducted in Vietnam in 2010 (N = 9,925). We used GATS data on exposure to sources of antismoking information and analyzed associations among socioeconomic and demographic groups. RESULTS: An estimated 91.6% of the adult population was exposed to at least 1 source of antismoking information, and the mean number of sources of exposure was 3.7. Compared with their counterparts, respondents who were older, had higher education levels, higher economic status, and higher knowledge levels about the health consequences of smoking were more likely to be exposed to any source of antismoking information and to more informational sources. The most common source of exposure was television (85.9%). Respondents of higher social class (education, occupation, wealth) had more exposure through modern media sources (television), and respondents of lower social class were exposed to more traditional sources such as radio or loudspeakers. CONCLUSION: Exposure to at least 1 source of antismoking information is high in Vietnam, and the number and type of source varied by sociodemographic group. Use of multiple communication channels is recommended to reinforce antismoking messages and to reach different groups in the population.

Prevalence of waterpipe tobacco smoking among population aged 15 years or older, Vietnam, 2010.

INTRODUCTION: The prevalence of waterpipe tobacco smoking is increasing globally and is associated with adverse outcomes requiring tobacco control interventions. We estimated the prevalence of waterpipe tobacco use among adult populations in Vietnam in 2010 and examined its association with sociodemographic factors. METHODS: We used data from the Global Adult Tobacco Survey (GATS) conducted in Vietnam in 2010. GATS surveyed a national representative sample of adults aged 15 years or older from 11,142 households by using a 2-phase sampling design analogous to a 3-stage stratified cluster sampling. Descriptive statistical analyses and multivariate logistic regression modeling were conducted. RESULTS: A total of 6.4% of Vietnamese aged 15 years or older (representing about 4.1 million adult waterpipe smokers) reported current waterpipe tobacco smoking. The prevalence of waterpipe tobacco smoking was significantly higher among men than women (13% vs 0.1%). Area of residence (rural or urban), age group, asset-based wealth quintile, and geographic region of residence were significantly associated with waterpipe tobacco smoking among men. The significant correlates of current waterpipe tobacco smoking among men were lower education levels, being middle-aged (45-54 years), lower asset-based wealth levels, living in rural areas, not living in the South East and the Mekong River Delta geographic regions, and the belief that smoking does not causes diseases. CONCLUSION: Rural dwellers who are poor should be targeted in tobacco control programs. Further studies are needed that examine perceptions of the adverse health effects and the cultural factors of waterpipe tobacco smoking.

Current manufactured cigarette smoking and roll-your-own cigarette smoking in Thailand: findings from the 2009 Global Adult Tobacco Survey.

BACKGROUND: Current smoking prevalence in Thailand decreased from 1991 to 2004 and since that time the prevalence has remained flat. It has been suggested that one of the reasons that the prevalence of current smoking in Thailand has stopped decreasing is due to the use of RYO cigarettes. The aim of this study was to examine characteristics of users of manufactured and RYO cigarettes and dual users in Thailand, in order to determine whether there are differences in the characteristics of users of the different products. METHODS: The 2009 Global Adult Tobacco Survey (GATS Thailand) provides detailed information on current smoking patterns. GATS Thailand used a nationally and regionally representative probability sample of 20,566 adults (ages 15 years and above) who were chosen through stratified three-stage cluster sampling and then interviewed face-to-face. RESULTS: The prevalence of current smoking among Thai adults was 45.6% for men and 3.1% for women. In all, 18.4% of men and 1.0% of women were current users of manufactured cigarettes only, while 15.8% of men and 1.7% of women were current users of RYO cigarettes only. 11.2% of men and 0.1% of women used both RYO and manufactured cigarettes. Users of manufactured cigarettes were younger and users of RYO were older. RYO smokers were more likely to live in rural areas. Smokers of manufactured cigarettes appeared to be more knowledgeable about the health risks of tobacco use. However, the difference was confounded with age and education; when demographic variables were controlled, the knowledge differences no longer remained. Smokers of manufactured cigarettes were more likely than dual users and those who used only RYO to report that they were planning on quitting in the next month. Users of RYO only appeared to be more addicted than the other two groups as measured by time to first cigarette. CONCLUSIONS: There appears to be a need for product targeted cessation and prevention efforts that are directed toward specific population subgroups in Thailand and include information on manufactured and RYO cigarettes.

Knowledge of the health consequences of tobacco smoking: a cross-sectional survey of Vietnamese adults.

BACKGROUND: Although substantial efforts have been made to curtail smoking in Vietnam, the 2010 Global Adult Tobacco Survey (GATS) revealed that the proportion of male adults currently smoking remains high at 47.4%. OBJECTIVES: To determine the level of, and characteristics associated with, knowledge of the health consequences of smoking among Vietnamese adults. DESIGN: GATS 2010 was designed to survey a nationally representative sample of Vietnamese men and women aged 15 and older drawn from 11,142 households using a two-stage sampling design. Descriptive statistics were calculated and multivariate logistic regression was used to examine associations between postulated exposure factors (age, education, access to information, ethnic group etc.) and knowledge on health risks. RESULTS: General knowledge on the health risks of active smoking (AS) and exposure to second hand smoke (SHS) was good (90% and 83%, respectively). However, knowledge on specific diseases related to tobacco smoking (stroke, heart attack, and lung cancer) appeared to be lower (51.5%). Non-smokers had a significantly higher likelihood of demonstrating better knowledge on health risks related to AS (OR 1.6) and SHS (OR 1.7) than smokers. Adults with secondary education, college education or above also had significantly higher levels knowledge of AS/SHS health risks than those with primary education (AS: ORs 1.6, 1.7, and 1.9, respectively, and SHS: ORs 2.4, 3.9, and 5.7 respectively). Increasing age was positively associated with knowledge of the health consequences of SHS, and access to information was significantly associated with knowledge of AS/SHS health risks (ORs 2.3 and 1.9 respectively). Otherwise, non-Kinh ethnic groups had significantly less knowledge on health risks of AS/SHS than Kinh ethnic groups. CONCLUSIONS: It may be necessary to target tobacco prevention programs to specific subgroups including current smokers, adults with low education, non-Kinh ethnics in order to increase their knowledge on health risks of smoking. Comprehensive messages and/or images about specific diseases related to AS/SHS should be conveyed using of different channels and modes specific to local cultures to increase knowledge on smoking health consequences for general population.

Tobacco use in 3 billion individuals from 16 countries: an analysis of nationally representative cross-sectional household surveys.

BACKGROUND: Despite the high global burden of diseases caused by tobacco, valid and comparable prevalence data for patterns of adult tobacco use and factors influencing use are absent for many low-income and middle-income countries. We assess these patterns through analysis of data from the Global Adult Tobacco Survey (GATS). METHODS: Between Oct 1, 2008, and March 15, 2010, GATS used nationally representative household surveys with comparable methods to obtain relevant information from individuals aged 15 years or older in 14 low-income and middle-income countries (Bangladesh, Brazil, China, Egypt, India, Mexico, Philippines, Poland, Russia, Thailand, Turkey, Ukraine, Uruguay, and Vietnam). We compared weighted point estimates and 95% CIs of tobacco use between these 14 countries and with data from the 2008 UK General Lifestyle Survey and the 2006-07 US Tobacco Use Supplement to the Current Population Survey. All these surveys had cross-sectional study designs. FINDINGS: In countries participating in GATS, 48·6% (95% CI 47·6-49·6) of men and 11·3% (10·7-12·0) of women were tobacco users. 40·7% of men (ranging from 21·6% in Brazil to 60·2% in Russia) and 5·0% of women (0·5% in Egypt to 24·4% in Poland) in GATS countries smoked a tobacco product. Manufactured cigarettes were favoured by most smokers (82%) overall, but smokeless tobacco and bidis were commonly used in India and Bangladesh. For individuals who had ever smoked daily, women aged 55-64 years at the time of the survey began smoking at an older age than did equivalently aged men in most GATS countries. However, those individuals who had ever smoked daily and were aged 25-34-years when surveyed started to do so at much the same age in both sexes. Quit ratios were very low (<20% overall) in China, India, Russia, Egypt, and Bangladesh. INTERPRETATION: The first wave of GATS showed high rates of smoking in men, early initiation of smoking in women, and low quit ratios, reinforcing the view that efforts to prevent initiation and promote cessation of tobacco use are needed to reduce associated morbidity and mortality. FUNDING: Bloomberg Philanthropies' Initiative to Reduce Tobacco Use, Bill and Melinda Gates Foundation, Brazilian and Indian Governments.

Exposure to second-hand smoke at home and its associated factors: findings from the Global Adult Tobacco Use survey in Vietnam, 2010.

OBJECTIVE: The paper describes the pattern of exposure to second-hand smoke (SHS) at home among the adult population of Vietnam and examines associated socio-demographic factors. METHODS: A total of 11,142 households were selected for this survey using a two-phase sampling design analogous with three-stage stratified cluster sampling. The dependent variable was the status of exposure to SHS at home. Independent variables included gender, age, occupation, asset-based wealth quintile, ethnicity, marital status, residence. Logistic regression modelling was performed to examine the association with relevant factors of patterns of exposure to second-hand smoke among non-smokers. RESULTS: Of adults aged 15 years and above (representing approximately 47 million people) 73.1% reported they were exposed to SHS at home at least monthly. Considering non-smokers only, the prevalence of exposure to SHS at home was 67.6% (equivalent to approximately 33 million non-smokers). The significant correlates of the status of exposure to SHS at home among non-smokers were female gender, ethnic minority, low education, and lack of smoking restriction at home. CONCLUSION: The study showed that a high percentage of people are exposed to second-hand smoke at home. Disadvantaged people were more likely than the better-off to be exposed to SHS at home.