Compliance with smoke-free policies at indoor and outdoor public places: an observational study in Pakistan.

BACKGROUND: In 2002, the Government of Pakistan implemented a national law governing the use of tobacco products. The law included smoke-free policies banning smoking in all public places, and required no-smoking signage to be displayed at all such venues. Compliance with smoke-free policies is imperative, as it protects the health of nonsmokers. Almost two decades later, efforts to assess compliance with smoke-free policies in Karachi have been lacking, with only one study conducted in 2016. AIMS: To investigate smoke-free compliance across public places in Karachi, the most populous city in Pakistan. METHODS: A cross-sectional observational study was conducted in the east and south districts of Karachi between October and December 2019. Data pertaining to evidence of smoking (observed smoking, cigarette butt litter, and display of ashtrays/ similar instruments), the presence of designated smoking areas/rooms (DSAs/DSRs), and the display and location of no-smoking signage were collected via direct observations. Results are reported using descriptive statistics. RESULTS: Observations were conducted at 1704 indoor and outdoor public venues. Among the sample, 972 (57%) were compliant with the composite indicator assessing evidence of smoking. DSAs were observed at 104 (6%) places and DSRs at 16 (1%) places. No-smoking signage was displayed at the main entrance of 104 (6%) places and inside 174 (10%) places. CONCLUSION: Compliance with smoke-free policies is lacking in Karachi. Enhanced efforts by enforcement agencies and venue managers are needed to establish 100% smoke-free public places across Karachi.

Eradicating polio in Pakistan: a systematic review of programs and policies.

Introduction: Established in 1994, Pakistan's polio program demonstrated early success. However, despite over 120 supplementary immunization activities in the last decade, polio eradication efforts in Pakistan have been unable to achieve their objective of halting polio transmission. Variable governance, and inconsistent leadership and accountability have hindered the success of the polio program and the quality of the campaigns. Insecurity and terrorism has interrupted polio activities, and community fears and misbeliefs about polio vaccinations continue to persist.Areas covered: The article consists of a systematic review of the barriers and facilitators associated with the delivery of polio eradication activities in Pakistan. We also provide a comprehensive review of the policy and programmatic decisions made by the Pakistan Polio Programme since 1994. Searches were conducted on Embase and Medline databases and 25 gray literature sources.Expert opinion: Polio eradication efforts must be integrated with other preventive health services, particularly immunization services. Addressing the underlying causes of polio refusals including underdevelopment and social exclusion will help counteract resistance to polio vaccination. Achieving polio eradication will require building health systems that provide comprehensive community-centered care, and improving governance and systems of accountability.

Enforcement agencies and smoke-free policy compliance: An observational study in Qingdao, China.

INTRODUCTION: In recent years, tobacco control policy initiatives have emerged at the subnational level in China. In 2013, for example, Qingdao enacted a 100% smoke-free policy that gave regulatory authority to multiple enforcement agencies. Given that little is known about the extent of smoke-free policy compliance in smaller Chinese cities, this study assessed compliance with Qingdao's Tobacco Control Regulation and whether compliance differed by enforcement agency. METHODS: A cross-sectional observational study was undertaken between October and November 2018. Venues were selected based on enforcement agency and included restaurants, retail stores, schools, government buildings, hospitals, business offices, and other hospitality venues. Comprehensive lists of venues were identified where they existed, and a random sample of venues were subsequently selected. For venue categories for which there were no comprehensive lists, a walking protocol was used. Observational data included evidence of smoking, the presence of no-smoking signage, and designated smoking areas (DSAs). Descriptive statistics were obtained. Subsequently, logistic regression models were used to determine the association between enforcement agency and policy compliance. RESULTS: A total of 694 venues were observed. For all venue types, 64.7% were compliant with the composite indicator 'evidence of smoking'. Findings also showed that smoke-free compliance varied by enforcement agency (p<0.001). Venues with evidence of smoking and not posting of no-smoking signs at the main entrance were lowest among venues that fall under Public Security Bureau. Compliance with posting no-smoking signs inside was lowest in venues that fall under the Industry and Commercial Administration (I&C). While Qingdao's smoke-free policy prohibits DSAs, our findings showed that 2% of venues that fall under the jurisdiction of I&C had DSAs. CONCLUSIONS: An effective coordination mechanism that can ensure a consistent and standardized approach is urgently needed in Qingdao. With such a concerted effort, it will be possible to achieve the target of 100% smoke-free indoor places in Qingdao.

Assessing Allied Health-Care Professional Time in Pediatric Type 1 Diabetes: Associations With Clinical Factors, Technology and Social Determinants.

OBJECTIVES: The factors associated with allied health-care professional (HCP) time spent face-to-face with patients in clinic have not been well described in type 1 diabetes (T1D) given the introduction of resource-intensive technologies and gaps in socioeconomic circumstances. The objective of this study was to evaluate clinical and social factors associated with nonphysician HCP time in a pediatric T1D practice. METHODS: Nonphysician HCP workload data, including time spent in direct clinical care over a 1-year period and nonclinic contacts, were linked to data from 723 pediatric subjects with T1D and evaluated in relation to key demographic, social and diabetes treatment factors. RESULTS: HCPs spent 145.7 min per patient on a median of 3 clinic visits, with certified diabetes educators (CDEs) being responsible for most clinic interactions compared with psychosocial staff. CDE time varied considerably according to T1D duration, with new-onset patients (≤1 year) taking a median of 392.0 min compared with 114.5 min for their established counterparts (p<0.0001). Among the established group (n=629), CDE time was strongly associated with continuous subcutaneous insulin infusion therapy initiation, psychosocial service use, glycated hemoglobin (A1C) and degree of marginalization (p<0.0001). Overall, CDE time increased by 8.6 min for each 1.0% increase in A1C (p=0.022) and by 16.3 min for each 1-U increase in marginalization (p=0.01). CONCLUSIONS: We observed HCP time was associated with multiple clinical factors in addition to overall marginalization. Although initial investments in education and continuous subcutaneous insulin infusion training were considerable, our results suggest that these lead to a decrease in time spent in clinic over time, and is largely driven by lower A1C.