Cigarette health warning label compliance in Nigeria: A multi-city observational study.

INTRODUCTION: Tobacco remains the world's leading preventable cause of death, with the majority of tobacco-caused deaths occurring in low- and middle-income countries. The first global health treaty, the Framework Convention on Tobacco Control (FCTC), outlines a set of policy initiatives that have been demonstrated as effective in reducing tobacco use. Article 11 of the FCTC focuses on using the tobacco package to communicate tobacco-caused harms; it also seeks to restrict the delivery of misleading information on the pack about the product.The objective of his study is to establish a surveillance system for tobacco packs in Nigeria to assess pack compliance with in-country health warning label requirements. The Tobacco Pack Surveillance System (TPackSS) monitors whether required health warnings on tobacco packages are being implemented as intended and identifies pack designs that might violate the communication of harm-related information and undermine the impact of the country's tobacco packaging laws. METHODS: Tobacco cigarette packs were collected in three cities in 2019-2020. The intention was, to the extent possible, to construct a census of 'unique' pack presentations available for purchase in Nigeria. We implemented the TPackSS standardized Protocol for acquiring packs from 36 diverse neighborhoods across three cities. At the time of purchase, data on the price and place of acquisition of each pack were recorded. We photographed packs, coded, and archived them. Each pack was coded for compliance according to the current health warning label laws. Each pack was coded by two independent coders consistently. We routinely measured intercoder reliability and only retained variables for which a good level of reliability was achieved. RESULTS: Across the three cities in Nigeria, the team collected 90 tobacco packs. Overall, 77% of packs evaluated for HWL compliance complied with all the relevant common indicators of HWL compliance. There was a 92% compliance with the location of the HWL (e.g. top or bottom of pack, front or back panel) with in-country requirements. Of the four compliance indicators, the size of the HWL (the minimum required coverage) showed the lowest compliance (31%) (i.e. the HWL was too small on most of the packs). Label elements (such as color contrast or content of warnings) showed 85% compliance overall. CONCLUSIONS: The analysis of the packs showed various levels of compliance with Health Warning Label provisions for Nigeria. Periodic evaluations are required to ensure that minimum requirements are met.

Predictors of Palliative Care Knowledge: Findings from the Health Information National Trends Survey.

BACKGROUND: Palliative care plays an important role in improving the quality of life for patients with cancer and their caregivers and has been associated with increased patient satisfaction. However, palliative care knowledge in the general population is limited, and often physician referral occurs late in prognosis. The objective of this analysis was to examine factors associated with palliative care knowledge. METHOD: Using data from the 2018 NCI's Health Information National Trends Survey (HINTS) 5 Cycle 2, descriptive statistics, bivariate analyses, and multivariable logistic regressions were used to assess factors associated with respondents' palliative care knowledge using ORs and 95% confidence intervals as measures of association. The outcome of interest was measured with the item "How would you describe your level of knowledge about palliative care?" Possible response selections were "I've never heard of it," "I know a little bit about palliative care," and "I know what palliative care is and could explain it to someone else." To reduce the risk of type 1 error, jackknife variance estimations with repeated replications were used. All analyses were conducted with the SURVEYLOGISTIC command using SAS 9.4 (SAS Institute Inc.), and the statistical significance level was set at P < 0.05. RESULTS: A total of 3,450 respondents (weighted sample size: 249,489,772) met the inclusion criteria. About 89% (n = 3,000) of all respondents had inadequate knowledge of palliative care. Multivariable analyses indicated that frequent health care utilization as defined as ≥ 2 times per year [OR, 3.01; 95% confidence interval (CI), 2.65-3.58], female gender (OR, 2.15; 95% CI, 1.31-3.59), being married (OR, 2.02; 95% CI, 1.14-3.59), having a college degree or higher (OR, 13.83; 95% CI, 1.71-12.04), and having a regular source of care (OR, 2.67; 95% CI, 1.37-1.90) had greater odds of adequate palliative care knowledge. Those without a cancer diagnosis were less likely to have adequate knowledge of palliative care (OR, 0.49; 95% CI, 0.41-0.89). CONCLUSIONS: Knowledge of palliative care in the United States is low, particularly for those not already actively using their available healthcare system. Public health education efforts are needed to target subgroups of the U.S. population identified by this analysis to increase palliative care knowledge. IMPACT: Healthcare providers have a major role to play in improving palliative care knowledge.

COVID-19: implications for NCDs and the continuity of care in Sub-Saharan Africa.

There has been a rise in non-communicable diseases (NCD) in Sub-Saharan Africa (SSA), driven by westernization, urbanization and unhealthy lifestyles. The prevalence of NCDs and their risk factors vary considerably in SSA between countries and the various sub-populations. A study documented the prevalence of stroke ranging from 0.07 to 0.3%, diabetes mellitus from 0 to 16%, hypertension from 6 to 48%, obesity from 0.4 to 43%, and current smoking from 0.4 to 71%. The numbers of these NCD cases are predicted to rise over the next decade. However, in the context of a global pandemic such as COVID-19, with the rising cases, lockdowns and deaths recorded worldwide, many people living with NCDs may find accessing care more difficult. The majority of the available resources on the subcontinent have been diverted to focus on the ongoing pandemic. This has caused interruptions in care, complication management, drug pick-up alongside the almost neglected silent NCD epidemic, with major consequences for the health system post the COVID-19 era. We explore the issues surrounding the continuity of care and offer some solutions for Sub-Saharan Africa.

Prevalence, patterns and correlates of smokeless tobacco use in Nigerian adults: An analysis of the Global Adult Tobacco Survey.

INTRODUCTION: The global tobacco epidemic contributes to more than 8 million deaths annually. However, most tobacco control interventions have been driven by an emphasis on smoked tobacco. Globally and more so in Nigeria, less attention has been paid to the similarly harmful smokeless tobacco (SLT) whose use appeals to a different demography. We examined the prevalence, patterns of use and correlates of SLT in Nigerian adults to guide targeted control efforts. METHODS: We conducted a secondary analysis of the 2012 Global Adult Tobacco Survey (GATS) data. We obtained data on 9,765 non-institutionalised adults aged 15 years and older. Variables included current SLT use, sociodemographic characteristics and perceived harm of SLT use. We used Chi-square test to examine associations and binary logistic regression to assess predictors of current SLT use. All analyses were conducted with sample-weighted data. RESULTS: The prevalence of current SLT use was 1.9% of all adults. About 1.4% were daily users. The main types were snuff by nose (1.6%) and snuff by mouth (0.8%). There were higher odds of current SLT use for those in the South-East region (aOR = 13.99; 95% CI: 4.45-43.95), rural area residents (aOR = 1.56; 95% CI: 1.04-2.35), males (aOR = 4.43; 95% CI: 2.75-7.11), the 45-64 years age-group (aOR = 10.00; 95% CI: 4.12-24.29), those with no formal education (aOR = 2.67; 95% CI: 1.01-7.05), and those with no perception of harm from SLT use (aOR = 3.81, 95% CI: 2.61-5.56). CONCLUSION: The prevalence of SLT use among Nigerian adults was low with clearly identified predictors. While a majority were aware of harm from SLT use, an unacceptably high proportion remain unaware. We recommended targeted interventions to increase awareness of the harmful effects of SLT use especially among residents of the South-East, those in rural areas, males, and individuals with no formal education. We also recommended a follow-up survey.

Behavioural risk factors for non-communicable diseases among undergraduates in South-west Nigeria: knowledge, prevalence and correlates: a comparative cross-sectional study.

Low- and middle-income countries are experiencing a transition from a preponderance of infectious to Non-Communicable Diseases (NCDs). Many of the behaviours that produce these risks often commence in late adolescence. The study assessed the prevalence and knowledge of the major risk factors for NCDs among undergraduates in Ibadan Metropolis. This was a comparative cross-sectional study using a systematic random sampling technique. Data were collected using the WHO STEPs questionnaire and were entered and analysed using SPSS version 21. Data were analyzed with descriptive statistics, Chi-square test, and logistic regression at p < 0.05. Of 1,200 undergraduates, 646 (53.8%) were male and 1062 (88.5%) were aged 15-24 years; mean age was 20.4 (+/-3.5) years; 673 (56.1%) lived on campus. Only 3.1% of the respondents were current tobacco smokers. Also, 51.3% of respondents currently take alcohol with 11.2% classified as having excess alcohol use (> 6 standard drinks in one sitting in the last 30 days). About three quarters (70.6%) of respondents were classified as having unhealthy diets based on fruit/vegetable servings per day. Only 29.3% had adequate physical activity. Moreover, 48.3% were classified as having poor knowledge of the risk factors for NCDs. Overall, 99.3% of respondents had at least one behavioural risk factor. Public university undergraduates were more likely to have good knowledge of these risk factors OR 1.485 (95% CI: 1.485-2.398, p < 0.001). Behavioural risk factors for NCDs were prevalent among these undergraduates. Knowledge of NCD risk factors was average and those who attended public universities were more likely to have good knowledge of the risk factors for NCDs.