Relationship of Smoking with the CD4+ T cell count and Viral Load in Patients with the Human Immunodeficiency Virus in the HIV health care center at the Hospital Regional Universitario José María Cabral y Báez in the Dominican Republic: a Cross-sectional Descriptive Study / Relación entre tabaquismo, conteo de CD4+ y carga viral en pacientes con infección por Virus de Inmunodeficiencia Humana en el centro de atención para VIH del Hospital Regional Universitario José María Cabral y Báez de Republica Dominicana: estudio descriptivo transversal

Abstract Objective: To evaluate the relationship between tobacco use and viral load and CD4+ T cell count in HIV patients. Results: The research conducted was a descriptive study of 317 patients on highly active antiretroviral therapy (HAART), 18 years old and above, who attended the "Unidad de Atención Integral" (UAI) at the Hospital Regional Universitario José María Cabral y Báez, in Santiago, Dominican Republic. Of those 317 patients, 172 were included in the data analysis. It was found that a 77.3% of smokers had a CD4+ T cell count equal to or below 250 cells/mm3. 75% of smokers had a viral load equal to or greater than 400 copies/ml. In addition, 82.9% of nonsmokers presented with a viral load below 400 copies/ml. The smokers were more likely to have a viral load equal to or greater than 400 copies/ml (OR = 6.285, P < 0.001), in comparison with nonsmokers. Patients younger than 45 years old were more likely to have a viral load equal to or above 400 copies/ml compared to older patients (OR = 3.313, P = 0.024).

Resumen Objetivo: Evaluar la relación entre el consumo de tabaco, la carga viral y el recuento de linfocitos T CD4+ en pacientes con VIH. Resultados: La investigación fue realizada mediante un estudio descriptivo a 317 pacientes en terapia antirretroviral de alta actividad (TARGA), de 18 años o ma yores, que asistían a la Unidad de Atención Integral (UAI) del Hospital Regional Universitario José María Cabral y Báez, en Santiago, República Dominicana. De esos 317 pacientes, 172 se incluyeron en el análisis de datos. Se encontró que un 77,3% de los fumadores tenían un recuento de células T CD4 + igual o inferior a 250 células / mm3. El 75% de los fumadores tenían una carga viral igual o superior a 400 copias / ml. Además, el 82,9% de los no fumadores presentaba una carga viral inferior a 400 copias / ml. Los fumadores tenían más probabilidades de tener una carga viral igual o superior a 400 copias / ml (OR = 6.285, P <0.001), en comparación con los no fumadores. Los pacientes menores de 45 años tenían más probabilidades de tener una carga viral igual o superior a 400 copias / ml en comparación con los pacientes mayores (OR = 3,313, P = 0,024).

Cohort study of smoke-free homes in economically disadvantaged communities in the Dominican Republic.

OBJECTIVE: To analyze household smoking-ban prevalence over time and predictors among communities in the Dominican Republic, historically a significant tobacco-growing country with few tobacco control regulations. METHODS: Baseline (2004) and follow-up surveillance surveys (2006, 2007) (each n > 1 000 randomly selected households) conducted in six economically disadvantaged communities (three tobacco-growing and two each urban, peri-urban, and rural) assessed household members' demographics, health status, and household characteristics, including smoking restrictions. RESULTS: Between 2004 and 2007, household smoking-ban prevalence increased in all communities, with overall rates increasing from 23.9% (2004) to 45.3% (2007). Households with smokers adopted smoking bans at lower rates (6%-17%) versus those without smokers (which had an adoption rate of 35%-58%). Logistic regression models demonstrated that the associations between allowing smoking in households with no members who smoked and being located in a tobacco-growing community, being a Catholic household, and having a member with a cardiovascular problem were statistically significant. The association between having a child under age 5 or a member with a respiratory condition and prohibiting smoking in the home was not statistically significant. CONCLUSIONS: Prevalence of households banning smoking increased in all communities but remained well below rates in industrialized countries. For low- and middle-income countries or those in early stages of tobacco control, basic awareness-raising measures (including surveillance activities) may lead to statistically significant increases in household smoking-ban adoption, particularly among households with no smokers. An increase in household smoking-ban prevalence may result in changes in community norms that can lead to a further increase in the adoption of smoking bans. Having household members who smoke and being in a tobacco-growing community may mitigate the establishment of household bans. Increasing individuals' knowledge about the far-reaching health effects of secondhand smoke exposure on children and nonsmoking adults (healthy or unhealthy) may help overcome these obstacles.

Cohort study of smoke-free homes in economically disadvantaged communities in the Dominican Republic / Estudio de cohortes de hogares libres de humo de tabaco en comunidades económicamente desfavorecidas de la República Dominicana

OBJECTIVE: To analyze household smoking-ban prevalence over time and predictors among communities in the Dominican Republic, historically a significant tobacco-growing country with few tobacco control regulations. METHODS: Baseline (2004) and follow-up surveillance surveys (2006, 2007) (each n > 1 000 randomly selected households) conducted in six economically disadvantaged communities (three tobacco-growing and two each urban, peri-urban, and rural) assessed household members’ demographics, health status, and household characteristics, including smoking restrictions. RESULTS: Between 2004 and 2007, household smoking-ban prevalence increased in all communities, with overall rates increasing from 23.9% (2004) to 45.3% (2007). Households with smokers adopted smoking bans at lower rates (6%-17%) versus those without smokers (which had an adoption rate of 35%-58%). Logistic regression models demonstrated that the associations between allowing smoking in households with no members who smoked and being located in a tobacco-growing community, being a Catholic household, and having a member with a cardiovascular problem were statistically significant. The association between having a child under age 5 or a member with a respiratory condition and prohibiting smoking in the home was not statistically significant. CONCLUSIONS: Prevalence of households banning smoking increased in all communities but remained well below rates in industrialized countries. For low- and middle-income countries or those in early stages of tobacco control, basic awareness-raising measures (including surveillance activities) may lead to statistically significant increases in household smoking-ban adoption, particularly among households with no smokers. An increase in household smoking-ban prevalence may result in changes in community norms that can lead to a further increase in the adoption of smoking bans. Having household members who smoke and being in a tobacco-growing community may mitigate the establishment of household bans. Increasing individuals’ knowledge about the far-reaching health effects of secondhand smoke exposure on children and nonsmoking adults (healthy or unhealthy) may help overcome these obstacles.

OBJETIVO: Analizar la evolución de las prohibiciones de fumar en los hogares con el transcurso del tiempo, y los factores predictivos de estas prohibiciones en las comunidades de la República Dominicana, un país que históricamente ha sido un importante productor de tabaco con pocas regulaciones en cuanto a su control. MÉTODOS: Se llevaron a cabo un estudio inicial (2004) y estudios de vigilancia posterior (2006 y 2007) (cada uno de ellos con un tamaño de muestra n superior a 1 000 hogares seleccionados aleatoriamente) en seis comunidades económicamente desfavorecidas (tres productoras de tabaco, y dos de cada uno de los entornos urbano, periurbano y rural), y se evaluaron los datos demográficos de los miembros de los hogares, su estado de salud y las características de los hogares, incluidas las restricciones al consumo de tabaco. RESULTADOS: Entre el 2004 y el 2007, la prevalencia de la prohibición de fumar en los hogares aumentó en todas la comunidades, con un incremento general de las tasas de 23,9 (2004) a 45,3% (2007). Las tasas de adopción de prohibiciones de fumar en los hogares con fumadores fueron inferiores (de 6 a 17%) a las de los hogares sin fumadores (de 35 a 58%). Los modelos de regresión logística demostraron una asociación estadísticamente significativa entre la permisividad con el tabaco en los hogares sin miembros fumadores y la pertenencia a una comunidad productora de tabaco, profesar la religión católica y la presencia de un miembro afectado por una enfermedad cardiovascular. La asociación entre la presencia de un niño menor de cinco años o de un miembro afectado por una enfermedad respiratoria y la prohibición de fumar en el hogar no fue estadísticamente significativa. CONCLUSIONES: La prevalencia de hogares en los que se prohibía fumar aumentó en todas las comunidades pero se mantuvo bastante por debajo de las tasas de los países industrializados. En los países con ingresos bajos y medianos, o que se encuentran en fases iniciales del control del tabaco, las medidas básicas de sensibilización (incluidas las actividades de vigilancia) pueden conducir a incrementos estadísticamente significativos de la adopción de la prohibición de fumar, en particular en los hogares sin fumadores. Un aumento de la prevalencia de hogares en los que se prohíba fumar puede dar lugar a cambios en las normas de la comunidad que a su vez comporten un aumento adicional de la adopción de prohibiciones de fumar. La presencia en el hogar de miembros fumadores y la pertenencia a una comunidad productora de tabaco pueden mitigar el establecimiento de prohibiciones en los hogares. El incremento de la información proporcionada a las personas sobre los importantes efectos sobre la salud de la exposición pasiva al humo de tabaco de los niños y los adultos no fumadores (sanos o enfermos) puede ayudar a superar estos obstáculos.

Tobacco use and exposure to secondhand smoke among pregnant women in the Dominican Republic: an exploratory look into attitudes, beliefs, perceptions, and practices.

INTRODUCTION: The purpose of this study is to assess the attitudes, beliefs, perceptions, and practices regarding tobacco use and exposure among pregnant women in the Dominican Republic. METHODS: The survey was conducted in two public health hospitals in Santiago, Dominican Republic, and was administered to a convenience sample of 192 women during prenatal care visits. Analyses examined pregnant women's tobacco use, secondhand smoke exposure (SHS), knowledge about risks of smoking and benefits of quitting, and attitudes toward women's tobacco use. All data were collected between April and August 2009. RESULTS: Respondents' age ranged from 18 to 41 years, with a mean age of 25 years (SD = 4.59), a high literacy level (82%), low educational levels (48% less than high school education), and a high unemployment rate (65%). Levels of ever having experimented with cigarettes were 14%, and 5% had ever been a regular smoker. Among all respondents, 3% of women reported being current smokers. When respondents were asked if they would try smoking next year, 7% responded yes, maybe, or don't know. Rates of self-reported SHS among pregnant women were 16%, and 14% reported their young children being exposed to secondhand smoke. More than half of the pregnant women in this study allowed smoking in their home (76%). CONCLUSIONS: This study provides a preliminary understanding of tobacco use and exposure among pregnant women and its potential impact on the Dominican Republic's public health efforts that include improving maternal and child health.

Health care workers in the Dominican Republic: self-perceived role in smoking cessation.

A Dominican Republic (DR)-based multi-community trial of smoking cessation viewed health care workers (HCWs) as potential interventionists. Effectively engaging them requires a clear understanding of their attitudes and practices regarding smoking. A Rapid Assessment Procedure, conducted among HCWs in six economically disadvantaged communities, included physicians, nurses, other health professionals, paraprofessionals, and lay workers. Attitudes and practices about smoking were consistent across the 82 HCWs and mostly reflected community views. HCWs lacked proactiveness related to smoking cessation and had a limited view of their role, attributing clients' quitting successes to personal will. Prior cessation training was limited, although interest was generally high. Material resources about smoking cessation were virtually absent. DR HCWs' views represented features both distinct from and common to HCWs elsewhere. Any intervention with HCWs must first raise awareness before addressing their role in smoking cessation, discussing implementation barriers, and include training and materials about risks and effective interventions.