Uncontrolled hypertension among tobacco-users: women of prime childbearing age at risk in India.

BACKGROUND: Uncontrolled hypertension and tobacco use are two major public health issues that have implications for reproductive outcomes. This paper examines the association between tobacco-use status and uncontrolled hypertension among prime childbearing age (20-35) women in India. METHODS: We used the India National Family Health Survey (NFHS-4) 2015-2016 to obtain data on hypertension status and tobacco use for 356,853 women aged 20-35. We estimated multivariate logistic regressions to obtain the adjusted odds ratio for tobacco users in favor of having uncontrolled hypertension. We examined the adjusted odds at different wealth index quintiles, at different educational attainment, and at different level of nutritional status measured by body mass index. RESULTS: We found that the odds of having uncontrolled hypertension for the tobacco user women in India was 1.1 (95% CI: 1.01-1.19) times that of tobacco non-users at prime childbearing age. The odds were higher for tobacco-users at the poorest quintile (1.27, 95% CI: 1.14-1.42) and with no education (1.22, 95% CI: 1.10-1.34). The odds were also higher for tobacco-users who were overweight (1.88, 95% CI: 1.57-2.29) or obese (2.82, 95% CI: 1.88-4.24). CONCLUSIONS: Our findings highlight the disproportionate dual risk of uncontrolled hypertension and tobacco use among lower-income women of prime childbearing age, identifying an opportunity for coordinated tobacco control and hypertension prevention initiatives to ensure better health of reproductive-age women in India.

Effect of cigarette prices on smoking initiation and cessation in China: a duration analysis.

BACKGROUND: China is the world's largest producer and consumer of cigarettes. The status of tobacco as both a contributor to China's economy and a liability for the health of its population may complicate the use of taxes for addressing smoking in the country. Understanding how cigarette prices affect transitions in smoking behaviour in China can increase understanding of how China's high smoking rates can be influenced by tax policy. METHODS: In order to estimate the effect of cigarette prices on smoking initiation and cessation in China, we construct pseudo-longitudinal samples for duration analysis using data from the Global Adult Tobacco Survey China 2010. We use the historical variation in prices representative of 4 China regions over a 20-year period to identify the average price effect on the hazards of initiation and cessation while controlling for unobserved fixed and time-varying region characteristics. FINDINGS: We find that initiation rates fall in response to higher prices (with a price elasticity of initiation estimated at -0.95 for men and -1.07 overall). CONCLUSIONS: The effect of prices on smoking in China is likely to occur through averting initiation over time. At the population level, cessation behaviour may be less responsive to price increases as the wide range of cigarette prices in China may provide relatively high opportunity for switching to lower priced brands.

Fatigue in ankylosing spondylitis: treatment should focus on pain management.

OBJECTIVES: Fatigue is an important symptom associated with ankylosing spondylitis (AS). This study examines patients' perspectives and clinical associations of fatigue to help inform potential strategies to alleviate fatigue in AS. METHODS: A mixed methods approach was taken to examine fatigue in a cohort of people with AS. Fatigue levels were evaluated from 3 consecutive monthly questionnaires. Open-ended questions on fatigue were analyzed using thematic analysis and logistic regression was used to examine quantitative data. In addition, fatigue levels were examined before and after treatment with anti-tumor necrosis factor (TNF) compared to nontreated controls. RESULTS: Three hundred forty-eight of 385 participants completed a fatigue questionnaire. Fatigue was reported to have significant physical, social, and psychological effects. A third of the participants reported that there was nothing they could do to reduce their fatigue, whereas other participants reported that medication, exercise, and resting helped. The main factor associated with fatigue was pain [ß-coefficient: 0.74 (95% CI: 0.66 to 0.81)], whereas depression was much less strongly associated. However, these factors only explained 40% of the variation in fatigue levels. Starting anti-TNF therapy reduced fatigue and pain levels compared to the period of time before taking anti-TNF [difference: 14.4 (95% CI: 5.3 to 23.5) on a scale of 0-100] and this reduction was not seen in controls over the same period. CONCLUSIONS: Fatigue is not strongly associated with anxiety, motivation, and depression; instead the factor most associated with fatigue is pain. This suggests that in addition to treatments to reduce disease activity, strategies for alleviating fatigue in AS should focus on pain management techniques and actively treating inflammation.