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1.
PLoS One ; 15(6): e0233861, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32520979

RESUMO

OBJECTIVES: The primary objective of the present study was to compare the prevalence and patterns of second-hand smoke (SHS) exposure in the home, workplace, public places, and at all three places amongst the non-smoker respondents between the two rounds of Global Adult Tobacco Survey (GATS) in India. The secondary objectives were to assess the differences in various factors associated with SHS exposure among non-smokers. STUDY DESIGN: This secondary data analysis incorporated data generated from the previous two rounds of the cross-sectional, nationally representative GATS India, which covered 69,296 and 74,037 individuals aged 15 years and above. Exposure to the SHS at home, workplace, and public places amongst the non-smokers were the primary outcome variables. Standard definitions of the surveys were used. RESULTS: The overall weighted prevalence of exposure to SHS amongst the non-smokers inside the home and public places reduced. In contrast, the prevalence in the workplace increased marginally in round II compared to I. The proportion of adults who were exposed to SHS at all three places did not change much in two rounds of surveys. A decrease in the knowledge of the respondents exposed to SHS at home and public places was observed about the harmful effects of smoking in round II. Age, gender, occupation, place, and region of respondents were found to be significant determinants of SHS exposure at all the three places on multinomial logistic regression analysis. CONCLUSIONS: The study calls for focused interventions in India and stringent implementation of anti-tobacco legislation, especially in the workplaces for reducing the exposure to SHS amongst the non-smokers and to produce encouraging and motivating results by next round of the survey.


Assuntos
Exposição Ambiental/estatística & dados numéricos , não Fumantes , Poluição por Fumaça de Tabaco/estatística & dados numéricos , Fumar Tabaco/epidemiologia , Adolescente , Adulto , Estudos Transversais , Análise de Dados , Exposição Ambiental/prevenção & controle , Feminino , Habitação , Humanos , Índia/epidemiologia , Masculino , Pessoa de Meia-Idade , Prevalência , Instalações Privadas , Logradouros Públicos , Inquéritos e Questionários , Poluição por Fumaça de Tabaco/prevenção & controle , Fumar Tabaco/prevenção & controle , Local de Trabalho , Adulto Jovem
2.
NASN Sch Nurse ; 35(4): 196-197, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32469618

RESUMO

Annually, the National Association of School Nurses (NASN) sets advocacy goals. The goals include legislative and policy priorities. This article sets forth current NASN legislative priorities and results of advocacy that benefit students. The NASN Board of Directors are instrumental in moving policy priorities forward. In addition, this article shares NASN advocacy during the COVID-19 pandemic.


Assuntos
Betacoronavirus , Preconceito/legislação & jurisprudência , Preconceito/prevenção & controle , Serviços de Saúde Escolar/normas , Serviços de Enfermagem Escolar/normas , Fumar Tabaco/legislação & jurisprudência , Fumar Tabaco/prevenção & controle , Adolescente , Criança , Infecções por Coronavirus/prevenção & controle , Feminino , Guias como Assunto , Humanos , Almoço , Masculino , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Estados Unidos
3.
Am J Physiol Lung Cell Mol Physiol ; 318(5): L1004-L1007, 2020 05 01.
Artigo em Inglês | MEDLINE | ID: mdl-32233791
4.
PLoS One ; 15(3): e0230364, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32187225

RESUMO

INTRODUCTION: Tobacco control programs and policies reduce tobacco use and prevent health and economic harms. The majority of tobacco control programs and policies in the United States are implemented at local and state levels. Yet the literature on state-level initiatives reports a limited set of outcomes. To facilitate decision-making that is increasingly focused on costs, we provide estimates of a broader set of measures of the impact of tobacco control policy, including smoking prevalence, disease events, deaths, medical costs, productivity and tobacco tax revenues, using the experience of Minnesota as an example. METHODS: Using the HealthPartners Institute's ModelHealth™: Tobacco MN microsimulation, we assessed the impact of the stream of tobacco control expenditures and cigarette price increases from 1998 to 2017. We simulated 1.3 million individuals representative of the Minnesota population. RESULTS: The simulation estimated that increased expenditures on tobacco control above 1997 levels prevented 38,400 cancer, cardiovascular, diabetes and respiratory disease events and 4,100 deaths over 20 years. Increased prices prevented 14,600 additional events and 1,700 additional deaths. Both the net increase in tax revenues and the reduction in medical costs were greater than the additional investments in tobacco control. CONCLUSION: Combined, the policies address both short-term and long-term goals to reduce the harms of tobacco by helping adults who wish to quit smoking and deterring youth from starting to smoke. States can pay for initial investments in tobacco control through tax increases and recoup those investments through reduced expenditures on medical care.


Assuntos
Comércio/economia , Prevenção do Hábito de Fumar/economia , Impostos/legislação & jurisprudência , Produtos do Tabaco/economia , Fumar Tabaco/prevenção & controle , Adolescente , Adulto , Criança , Comércio/história , Comércio/legislação & jurisprudência , Comércio/estatística & dados numéricos , Simulação por Computador , Feminino , Política Fiscal/história , Gastos em Saúde/história , Gastos em Saúde/estatística & dados numéricos , História do Século XX , História do Século XXI , Humanos , Masculino , Minnesota/epidemiologia , Modelos Biológicos , Modelos Econômicos , Mortalidade/história , Prevalência , Prevenção do Hábito de Fumar/história , Prevenção do Hábito de Fumar/métodos , Impostos/história , Produtos do Tabaco/efeitos adversos , Produtos do Tabaco/história , Produtos do Tabaco/legislação & jurisprudência , Fumar Tabaco/efeitos adversos , Fumar Tabaco/economia , Fumar Tabaco/epidemiologia , Adulto Jovem
5.
Int J Equity Health ; 18(1): 169, 2019 11 05.
Artigo em Inglês | MEDLINE | ID: mdl-31690340

RESUMO

OBJECTIVE: This narrative review aimed to identify and categorize the barriers and facilitators to the provision of brief intervention and behavioral change programs that target several risk behaviors among the Indigenous populations of Australia, Canada, and New Zealand. METHODS: A systematic database search was conducted of six databases including PubMeD, Embase, CINAHL, HealthStar, PsycINFO, and Web of Science. Thematic analysis was utilized to analyze qualitative data extracted from the included studies, and a narrative approach was employed to synthesize the common themes that emerged. The quality of studies was assessed in accordance with the Joanna Briggs Institute's guidelines and using the software SUMARI - The System for the Unified Management, Assessment and Review of Information. RESULTS: Nine studies were included. The studies were classified at three intervention levels: (1) individual-based brief interventions, (2) family-based interventions, and (3) community-based-interventions. Across the studies, selection of the intervention level was associated with Indigenous priorities and preferences, and approaches with Indigenous collaboration were supported. Barriers and facilitators were grouped under four major categories representing the common themes: (1) characteristics of design, development, and delivery, (2) patient/provider relationship, (3) environmental factors, and (4) organizational capacity and workplace-related factors. Several sub-themes also emerged under the above-mentioned categories including level of intervention, Indigenous leadership and participation, cultural appropriateness, social and economic barriers, and design elements. CONCLUSION: To improve the effectiveness of multiple health behavior change interventions among Indigenous populations, collaborative approaches that target different intervention levels are beneficial. Further research to bridge the knowledge gap in this topic will help to improve the quality of preventive health strategies to achieve better outcomes at all levels, and will improve intervention implementation from development and delivery fidelity, to acceptability and sustainability.


Assuntos
Exercício Físico , Promoção da Saúde/métodos , Acesso aos Serviços de Saúde/estatística & dados numéricos , Estado Nutricional , Educação de Pacientes como Assunto/métodos , Fumar Tabaco/terapia , Austrália , Canadá , Promoção da Saúde/estatística & dados numéricos , Humanos , Nova Zelândia , Grupos Populacionais , Abandono do Hábito de Fumar/métodos , Abandono do Hábito de Fumar/estatística & dados numéricos , Fumar Tabaco/prevenção & controle
6.
Artigo em Inglês | MEDLINE | ID: mdl-31684033

RESUMO

In 2016, the Netherlands was required to introduce new European Union (EU)'s (pictorial) tobacco health warnings. Our objective was to describe the pathways through which the new EU tobacco health warnings may influence quit attempts and smoking cessation among Dutch smokers. Longitudinal data from 2016 and 2017 from the International Tobacco Control (ITC) Netherlands Survey were used. Smokers who participated in both surveys were included (N = 1017). Structural equation modeling was applied to examine the hypothesized pathways. Health warning salience was positively associated with more health worries (ß = 0.301, p < 0.001) and a more positive attitude towards quitting (ß = 0.180, p < 0.001), which, in turn, were associated with a stronger quit intention (health worries: ß = 0.304, p < 0.001; attitude: ß = 0.340, p < 0.001). Quit intention was a strong predictor of quit attempts (ß = 0.336, p = 0.001). Health warning salience was also associated with stronger perceived social norms towards quitting (ß = 0.166, p < 0.001), which directly predicted quit attempts (ß = 0.141, p = 0.048). Quit attempts were positively associated with smoking cessation (ß = 0.453, p = 0.043). Based on these findings, we posit that the effect of the EU's tobacco health warnings on quit attempts and smoking cessation is mediated by increased health worries and a more positive attitude and perceived social norms towards quitting. Making tobacco health warnings more salient (e.g., by using plain packaging) may increase their potential to stimulate quitting among smokers.


Assuntos
Abandono do Hábito de Fumar/estatística & dados numéricos , Prevenção do Hábito de Fumar/métodos , Fumar Tabaco/prevenção & controle , Adolescente , Adulto , União Europeia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Países Baixos , Rotulagem de Produtos , Abandono do Hábito de Fumar/psicologia , Inquéritos e Questionários , Tabaco , Fumar Tabaco/psicologia , Adulto Jovem
7.
Artigo em Inglês | MEDLINE | ID: mdl-31652694

RESUMO

Background: The smoking ban in public places has reduced Environmental Tobacco Smoke (ETS) exposure for non-smokers, but despite this, domestic environments still remain places at high risk of exposure, and, today, about 40% of children worldwide are exposed to ETS at home. The aims of the study are to investigate the contribution of several factors on ETS exposure among a group of Italian children and to evaluate the changes in smoking precautions adopted at home when the smoker is the mother, the father, or both parents, respectively. Methods: A cross-sectional study was performed on a sample of 519 Italian schoolchildren. Information was collected via a questionnaire. Results: 41.4% of the participants lived with at least one smoker. Almost half of the children exposed to ETS lived with one or more smokers who do not observe any home smoking ban. Lower maternal or paternal educational levels significantly increase the risk of ETS exposure at home and the "worst case" is represented by both parents who smoke. Conclusions: More effective preventive interventions are needed to protect children from ETS exposure. Some interventions should be specifically dedicated to smokers with a low educational level and to mothers that smoke.


Assuntos
Exposição Ambiental/efeitos adversos , Promoção da Saúde , Pais/educação , Poluição por Fumaça de Tabaco/efeitos adversos , Fumar Tabaco/efeitos adversos , Adulto , Criança , Estudos Transversais , Exposição Ambiental/prevenção & controle , Feminino , Humanos , Masculino , Inquéritos e Questionários , Poluição por Fumaça de Tabaco/análise , Poluição por Fumaça de Tabaco/prevenção & controle , Fumar Tabaco/prevenção & controle
8.
Artigo em Inglês | MEDLINE | ID: mdl-31623268

RESUMO

The aim of this study was to design and validate an instrument, based on the WHO 5As+5Rs model, to test the acquisition by nursing students of a brief tobacco intervention (BTI) learning. A validation design of an instrument following the criterion referenced tests model using videos of simulated BTIs in the primary care setting was carried out. The study included 11 experts in smoking prevention/care and 260 second-year nursing students. The study was in two stages: (1) selection and recording of clinical simulations (settings), and (2) test construction. Content was validated by applying the Delphi consensus technique and calculating the Content Validity Ratio (CVR) and Content Validity Index (CVI). A pilot test was conducted for item analysis. Reliability was evaluated as internal consistency (Kuder-Richardson [KR-20]) and test-retest temporal stability (intraclass correlation coefficient [ICC]). Three simulation settings were recorded. An instrument (BTI-St®) was developed with 23 items for dichotomous (yes/no) response. CVR was >70% for all items, KR-20 of 0.81-0.88, and ICC between 0.68 and0.73 (p < 0.0001). The BTI-St® is a robust and reliable instrument that is easily and rapidly applied. It follows the WHO 5As+5Rs model and offers objective criterion-referenced evaluation of BTI learning in nursing students.


Assuntos
Estudantes de Enfermagem , Fumar Tabaco/prevenção & controle , Feminino , Humanos , Psicometria/métodos , Reprodutibilidade dos Testes , Inquéritos e Questionários
9.
Asian Pac J Cancer Prev ; 20(7): 2027-2032, 2019 07 01.
Artigo em Inglês | MEDLINE | ID: mdl-31350961

RESUMO

Background: Known is the fact that adult tobacco users mostly had their initiation into the habit during the adolescence period. The current study was conducted to evaluate the impact of awareness programmes among adolescent students in rural Kerala, India, in terms of knowledge enhancement on tobacco hazards. Methods: A total of 10 high schools and higher secondary schools from one educational sub district were selected using multi stage sampling design. Male students in the age group 13-19 years studying in class IX and X (high school category) and class XI and XII (higher secondary school) were included in the study. The effectiveness was assessed using pre and post training evaluation forms based on mean knowledge scores. Results: 1,114 students participated by filling both the forms (mean age 15.6, SD 1.3). The response rate was 92.8%. The prevalence of 'current users' in the study was 4.3% (95% CI 3.11- 5.49). Overall difference in mean knowledge scores among study subjects was evident when pre and post training responses were compared (p<0.001). The difference in knowledge scores was evident among 'never users' of tobacco before and after the awareness programmes (p<0.0001). However, no significant difference in mean scores was observed among 'ever users' of tobacco (p = 0.584), age groups of ever users (p=0.208), students of high schools (p = 0.242) and higher secondary schools (p= 0.994). Comparison of never, ever and current users revealed significant difference between 'never' and 'current' users (p = 0.001). However, no such difference was observed between 'ever' and 'current' users (p =0.138) and 'ever' versus 'never' users (p =0.099). Conclusion: The study was useful to improve knowledge among school students in general. However, newer strategies have to be tested to understand the best possible measures for tobacco awareness training among adolescent tobacco users.


Assuntos
Educação em Saúde , Conhecimentos, Atitudes e Prática em Saúde , Instituições Acadêmicas/estatística & dados numéricos , Estudantes/estatística & dados numéricos , Produtos do Tabaco/estatística & dados numéricos , Fumar Tabaco/prevenção & controle , Adolescente , Adulto , Estudos Transversais , Seguimentos , Humanos , Índia/epidemiologia , Masculino , Prevalência , População Rural , Estudantes/psicologia , Inquéritos e Questionários , Fumar Tabaco/epidemiologia , Adulto Jovem
10.
BMC Public Health ; 19(1): 825, 2019 Jun 26.
Artigo em Inglês | MEDLINE | ID: mdl-31242893

RESUMO

BACKGROUND: Policymakers can adopt and implement various supply-side policies to limit youth access and exposure to tobacco, such as increasing the minimum age of sale, limiting the number or type of tobacco outlets, or banning the display of tobacco products. Many studies have assessed the impact of these policies, while less is known about the preceding policy process. The aim of our review was to assess the available evidence on the preceding process of agenda setting, policy formulation, and policy legitimation. METHODS: A systematic literature search was conducted using the PubMed and the Social Sciences Citation Index databases. After selection, 200 international peer-reviewed articles were identified and analyzed. Through a process of close reading, evidence based on scientific enquiry and anecdotal evidence on agenda setting, policy formulation and policy legitimation was abstracted from each article. RESULTS: Scientific evidence on the policy process is scarce for these policies, as most of the evidence found was anecdotal. Only one study provided evidence based on a scientific analysis of data on the agenda setting and legitimation phases of policy processes that led to the adoption of display bans in two Australian jurisdictions. CONCLUSION: The processes influencing the adoption of youth access and exposure policies have been grossly understudied. A better understanding of the policy process is essential to understand country variations in tobacco control policy.


Assuntos
Saúde do Adolescente , Formulação de Políticas , Política Pública , Prevenção do Hábito de Fumar , Indústria do Tabaco , Produtos do Tabaco , Fumar Tabaco/prevenção & controle , Adolescente , Fatores Etários , Austrália , Comércio/legislação & jurisprudência , Promoção da Saúde/métodos , Humanos , Marketing/legislação & jurisprudência , Países Baixos , Prevenção do Hábito de Fumar/legislação & jurisprudência , Tabaco , Indústria do Tabaco/legislação & jurisprudência , Produtos do Tabaco/legislação & jurisprudência , Fumar Tabaco/legislação & jurisprudência
11.
JAMA Netw Open ; 2(6): e195877, 2019 06 05.
Artigo em Inglês | MEDLINE | ID: mdl-31199453

RESUMO

Importance: It is unclear whether effective population-wide interventions that reduce risk factors and improve health result in sustained benefits to a community's health. If benefits do persist after a program is ended, interventions could be brief rather than maintained long term. Objective: To measure mortality and smoking rates in a rural community over decades before, during, and after prevention program reductions. Design, Setting, and Participants: This cross-sectional study compared smoking and mortality rates in a rural Maine county with other Maine counties over time by 5-year intervals. Multiple changes occurred between 2001 and 2015 in the physiological and behavioral risk factor reduction programs offered in the county. They included reductions in leadership, staff, institutional resources, data monitoring, and the programs themselves. Data were analyzed from May 2018 to March 2019. Intervention: Previous multifaceted interventions and outcome monitoring were withdrawn or diminished in the past decade. Main Outcomes and Measures: Smoking and age-adjusted mortality rates vs household income. Results: Reduced mortality rates in Franklin County in 1986 to 2005 reverted to those predicted by household incomes, relative to other Maine counties, by 2006 to 2015 (1986-1990 T score = -2.86 [P = .01] and 2001-2005 T score = -3.00 [P = .01] to 2006 to 2010 T score = -0.43 [P = .67] and 2011-2015 T score = -0.72 [P = .48]). Analysis of County Health Rankings data from 2010 to 2018 also showed that Franklin County's outcomes have reverted to no better than predicted by socioeconomic status. The county's T scores increased from -3.62 (P = .003) in 2010 to -0.41 (P = .69) in 2015 to 0.13 (P = .90) in 2018. Statewide association of income with mortality by analyses of variance showed that the R2 values have increased from the decades preceding 2000 (1976-1980, R2 = 0.21; P = .08; 1986-1990, R2 = 0.32; P = .02) to 2006 to 2010 (R2 = 0.73; P < .001) and 2011 to 2015 (R2 = 0.70; P < .001). Conclusions and Relevance: This study suggests that gains associated with population health interventions may be lost when the interventions are reduced. Adjusting outcome measures for socioeconomic status may allow quicker and more sensitive monitoring of intervention adequacy and success. The increasing trend of age-adjusted mortality in Maine and nationally to correlate inversely with incomes may warrant further community interventions, especially for poorer populations.


Assuntos
Doenças Cardiovasculares/epidemiologia , Serviços de Saúde Comunitária/estatística & dados numéricos , Promoção da Saúde , Prevenção Primária/estatística & dados numéricos , Fumar Tabaco/epidemiologia , Doenças Cardiovasculares/prevenção & controle , Doenças Cardiovasculares/psicologia , Serviços de Saúde Comunitária/economia , Estudos Transversais , Promoção da Saúde/economia , Humanos , Maine/epidemiologia , Avaliação de Resultados em Cuidados de Saúde , Prevenção Primária/economia , População Rural , Abandono do Hábito de Fumar , Fatores Socioeconômicos , Fumar Tabaco/prevenção & controle , Fumar Tabaco/psicologia
12.
BMC Health Serv Res ; 19(1): 297, 2019 May 09.
Artigo em Inglês | MEDLINE | ID: mdl-31072363

RESUMO

BACKGROUND: Smoking in pregnancy causes harm to mother and baby. Despite evidence from trials of what helps women quit, implementation in the real world has been hard to achieve. An evidence-based intervention, babyClear©, involving staff training, universal carbon monoxide monitoring, opt-out referral to smoking cessation services, enhanced follow-up protocols and a risk perception tool was introduced across North East England. This paper presents the results of the qualitative analyses, reporting acceptability of the system changes to staff, as well as aids and hindrances to implementation and normalization of this complex intervention. METHODS: Process evaluation was used to complement an effectiveness study. Interviews with maternity and smoking cessation services staff and observations of training were undertaken. Normalization Process Theory (NPT) was used to frame the interview guides and analysis. NPT is an empirically-derived theory, developed by sociologists, that uses four concepts to understand the process of routinising new practices. RESULTS: Staff interviews took place across eight National Health Service trusts at a time of widespread restructuring in smoking cessation services. Principally interviewees worked in maternity (n = 63) and smoking cessation services (n = 35). Five main themes, identified inductively, influenced the implementation: 1) initial preparedness of the organisations; 2) staff training; 3) managing partnership working; 4) resources; 5) review and planning for sustainability. CONCLUSIONS: NPT was used to show that the babyClear© package was acceptable to staff in a range of organisations. Illustrated in Themes 1, 2 & 3, staff welcomed ways to approach pregnant women about their smoking, without damaging their professional relationship with them. Predicated on producing individual behaviour change in women, the intervention does this largely through reorganising and standardising healthcare systems that are required to implement best practice guidelines. Changing organisational systems requires belief and commitment from staff, so that they set up and maintain practical adjustments to their practice and are reflective about adapting themselves and the work context as new challenges are encountered. The ongoing challenge is to identify and maintain the elements of the intervention package which are essential for its effectiveness and how to tailor them to local circumstances and resources without compromising its core ingredients.


Assuntos
Complicações na Gravidez/prevenção & controle , Abandono do Hábito de Fumar/métodos , Inglaterra , Feminino , Recursos em Saúde/estatística & dados numéricos , Humanos , Gravidez , Gestantes , Cuidado Pré-Natal/métodos , Avaliação de Processos em Cuidados de Saúde , Encaminhamento e Consulta , Prevenção do Hábito de Fumar/métodos , Fumar Tabaco/efeitos adversos , Fumar Tabaco/prevenção & controle
13.
Artigo em Inglês | MEDLINE | ID: mdl-31121850

RESUMO

Smoking during pregnancy is a leading cause of negative pregnancy and perinatal outcomes. While UK guidelines recommend nicotine replacement therapy (NRT) for smoking cessation during pregnancy, adherence to NRT is generally low and may partially explain why NRT appears less effective in pregnancy compared to non-pregnant smokers. This study aimed to identify and describe factors associated with NRT adherence from a health professional's perspective. Two focus groups and one expert group were conducted with 26 professionals involved in antenatal stop smoking services and the data were analysed thematically using a template methodology. From our analyses, we extracted two main themes: (i) 'Barriers to NRT use in pregnancy' explores the issues of how misinformation and unrealistic expectations could discourage NRT use, while (ii) 'Facilitators to NRT use in pregnancy' describes the different information, and modes of delivery, that stop smoking professionals believe will encourage correct and sustained NRT use. Understanding the barriers and facilitators to improve NRT adherence may aid the development of educational interventions to encourage NRT use and improve outcomes for pregnant women wanting to stop smoking.


Assuntos
Escolaridade , Conhecimentos, Atitudes e Prática em Saúde , Abandono do Hábito de Fumar/psicologia , Fatores Socioeconômicos , Dispositivos para o Abandono do Uso de Tabaco/estatística & dados numéricos , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Gravidez , Pesquisa Qualitativa , Abandono do Hábito de Fumar/métodos , Prevenção do Hábito de Fumar , Fumar Tabaco/prevenção & controle
14.
PLoS One ; 14(5): e0217397, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31125373

RESUMO

Gestational smoking is associated with various adverse maternal and fetal outcomes. Over the last three decades, despite considerable advances in tobacco control policy in Brazil, gestational smoking has caused a considerable number of fetal deaths and disabilities. The aim of this study is to estimate the prevalence of pre-gestational and gestational smoking and to identify the factors associated with smoking cessation up to the 20th gestational week. METHODS: "Birth in Brazil" was a nationwide hospital-based study conducted from February 2011 to October 2012. Smoking prevalence and smoking cessation during pregnancy was estimated through face-to-face interviews with postpartum women during hospitalization for birth care. We performed multivariate logistic regression to verify the factors associated with smoking cessation up to the 5th month of pregnancy. RESULTS: prevalence of pre-gestational smoking of 16.1% (CI 95% 15.3%-16.9%); prevalence of smoking any time during pregnancy of 9.6% (CI 95% 9.0%-10.3%); and prevalence of smoking cessation up to the 5th month of pregnancy of 56.7% (CI 95% 54.0%-59.4%). The factors associated with smoking cessation were residence in the North, Northeast, and Central-West of Brazil, having received at least one prenatal consultation (OR 3.51 CI 95% 1.85-6.67), more years of schooling (15 or more vs less than 7 years of schooling OR 5.54 CI 95% 2.97-10.34), living with a partner (OR 1.35 CI 95% 1.01-1.79), no children prior to the index pregnancy (OR 2.77 CI 95% 2.13-3.61), and absence of alcohol use (1.74 CI 95% 1.39-2.18) or of suspected alcohol abuse (OR 1.62 CI 95% 1.07-2.45). CONCLUSION: The estimated smoking rate during pregnancy in Brazil is still high and is associated with factors of increased maternal social vulnerability, which may contribute to the increased occurrence of unfavorable perinatal outcomes.


Assuntos
Complicações na Gravidez/epidemiologia , Abandono do Hábito de Fumar , Fumar Tabaco/epidemiologia , Adolescente , Adulto , Brasil , Criança , Feminino , Idade Gestacional , Humanos , Recém-Nascido , Modelos Logísticos , Gravidez , Complicações na Gravidez/prevenção & controle , Resultado da Gravidez , Cuidado Pré-Natal , Prevalência , Abandono do Hábito de Fumar/estatística & dados numéricos , Fumar Tabaco/efeitos adversos , Fumar Tabaco/prevenção & controle , Adulto Jovem
16.
PLoS One ; 14(3): e0212838, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30822321

RESUMO

There are more than one billion smokers globally according to the World Health Organization (WHO) report in 2017. Every year tobacco use causes nearly 6 million deaths worldwide. To deal with the smoking epidemic, society needs to invest resources efficiently. In this paper we introduce an optimal control model to determine the optimal mix of smoking initiation and cessation interventions to reduce smoking. We construct the model to reach a smoking prevalence target within a specific time horizon while minimizing cost. Our performance measure captures the cost of policy implementation over time, adjusting for inflation and social discounting. The analytical solutions to the model are presented in forms of ordinary differential equations (ODE). We then conduct several numerical simulations using data from the National Health Interview Survey (NHIS) and empirical studies. We first present analytical solutions for our model to solve for the optimal mix of smoking interventions. Then we simulate a public health policy to achieve 5% smoking prevalence in the US by 2030 using different combinations of real-life interventions. We examine the optimal trajectories, allocative efficiency and annual total cost of smoking cessation and initiation interventions. We find consistent results across all simulations. Our specific example reveals that the most efficient way to reach stated goal is by targeting cessation interventions first, and then gradually shifting resources to initiation interventions over time. While our numerical results are specific to the intervention we selected, our framework can be easily expanded to consider other potential interventions. We discuss the implications of our approach for the formulation of dynamic public health policies.


Assuntos
Política de Saúde , Abandono do Hábito de Fumar/métodos , Prevenção do Hábito de Fumar/métodos , Fumar Tabaco/prevenção & controle , Adolescente , Adulto , Humanos , Modelos Econômicos , Prevalência , Abandono do Hábito de Fumar/economia , Prevenção do Hábito de Fumar/economia , Fumar Tabaco/efeitos adversos , Fumar Tabaco/epidemiologia , Estados Unidos , Adulto Jovem
17.
BMJ Open ; 9(3): e026642, 2019 03 13.
Artigo em Inglês | MEDLINE | ID: mdl-30872554

RESUMO

OBJECTIVES: Smokers who use e-cigarettes (EC) do so mostly to stop smoking, but many continue to use both products. It is not known whether these 'dual users' are interested in stop-smoking medications and whether they can benefit from them. SETTING, PARTICIPANTS AND MEASURES: Dual users were recruited over social media and posted study questionnaire and saliva kits at baseline, 3 and 6 months. Those interested in varenicline were posted the medication and received weekly calls over the first 6 weeks, followed by three calls at fortnightly intervals. RESULTS: Of 204 participants, 124 (61%, CI=54% to 68%) expressed interest in receiving varenicline and 80 (39%, CI=32% to 45%) started varenicline (varenicline users, VU). VU were more dependent smokers (F=6.2, p=0.01) with higher cigarette consumption (F=8.7, p<0.01) who were using stronger nicotine e-liquids (F=13.9, p<0.001) than dual users not opting for varenicline (varenicline non-users, VN). In terms of abstinence for at least 3 months at the 6-month follow-up, VU were more likely than VN to report abstinence from smoking (17.5% vs 4.8%, p=0.006, RR=3.6, CI:1.4 to 9.0), vaping (12.5% vs 1.6%, p=0.007, RR=7.8, CI:1.7 to 34.5) and both smoking and vaping (8.8% vs 0.8%, p=0.02, RR=10.9, CI:1.4 to 86.6). The differences were significant across sensitivity analyses (RRs=4.9 to 14.0; p=0.02 to p<0.001 at 3 months; RRs=3.0 to 14.0; p=0.01 to p<0.001 at 6 months). VU reported a greater reduction in enjoyment of vaping by the end of the varenicline use period (F=4.1, p=0.04) and recorded a significantly greater reduction in nicotine intake than VN at 3 months (F=13.9, p<0.001) and 6 months (F=26.5, p<0.001). CONCLUSION: Varenicline offered to dual users is likely to promote successful abstinence from both smoking and vaping, although a randomised trial is needed to confirm this. Among dual users who want to stop smoking, there seems to be a high level of interest in smoking-cessation treatments.


Assuntos
Sistemas Eletrônicos de Liberação de Nicotina , Agonistas Nicotínicos/uso terapêutico , Abandono do Hábito de Fumar/métodos , Fumar/tratamento farmacológico , Fumar Tabaco/prevenção & controle , Vareniclina/uso terapêutico , Adulto , Estudos de Coortes , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Reino Unido
18.
J Med Internet Res ; 21(2): e12854, 2019 02 21.
Artigo em Inglês | MEDLINE | ID: mdl-30789347

RESUMO

BACKGROUND: Smoking is the largest preventable cause of mortality in Brazil. Education Against Tobacco (EAT) is a network of more than 3500 medical students and physicians across 14 countries who volunteer for school-based smoking prevention programs. EAT educates 50,000 adolescents per year in the classroom setting. A recent quasi-experimental study conducted in Germany showed that EAT had significant short-term smoking cessation effects among adolescents aged 11 to 15 years. OBJECTIVE: The aim is to measure the long-term effectiveness of the most recent version of the EAT curriculum in Brazil. METHODS: A randomized controlled trial was conducted among 2348 adolescents aged 12 to 21 years (grades 7-11) at public secondary schools in Brazil. The prospective experimental design included measurements at baseline and at 6 and 12 months postintervention. The study groups comprised randomized classes receiving the standardized EAT intervention (90 minutes of mentoring in a classroom setting) and control classes in the same schools (no intervention). Data were collected on smoking status, gender, social aspects, and predictors of smoking. The primary endpoint was the difference in the change in smoking prevalence between the intervention group and the control group at 12-month follow-up. RESULTS: From baseline to 12 months, the smoking prevalence increased from 11.0% to 20.9% in the control group and from 14.1% to 15.6% in the intervention group. This difference was statistically significant (P<.01). The effects were smaller for females (control 12.4% to 18.8% vs intervention 13.1% to 14.6%) than for males (control 9.1% to 23.6% vs intervention 15.3% to 16.8%). Increased quitting rates and prevented onset were responsible for the intervention effects. The differences in change in smoking prevalence from baseline to 12 months between the intervention and control groups were increased in students with low school performance. CONCLUSIONS: To our knowledge, this is the first randomized trial on school-based tobacco prevention in Brazil that shows significant long-term favorable effects. The EAT program encourages quitting and prevents smoking onset, especially among males and students with low educational background. TRIAL REGISTRATION: ClinicalTrials.gov NCT02725021; https://clinicaltrials.gov/ct2/show/NCT02725021. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): RR2-10.2196/resprot.7134.


Assuntos
Serviços de Saúde Escolar/normas , Abandono do Hábito de Fumar/métodos , Prevenção do Hábito de Fumar/métodos , Fumar Tabaco/prevenção & controle , Adolescente , Brasil , Criança , Feminino , Humanos , Masculino , Estudos Prospectivos , Instituições Acadêmicas , Estudantes de Medicina
19.
BMC Med ; 17(1): 26, 2019 02 04.
Artigo em Inglês | MEDLINE | ID: mdl-30712513

RESUMO

BACKGROUND: Tuberculosis (TB) remains a significant public health problem in Canadian Inuit communities. In 2016, Canadian Inuit had an incidence rate 35 times the Canadian average. Tobacco use is an important risk factor for TB, and over 60% of Inuit adults smoke. We aimed to estimate changes in TB-related outcomes and costs from reducing tobacco use in Inuit communities. METHODS: Using a transmission model to estimate the initial prevalence of latent TB infection (LTBI), followed by decision analysis modelling, we conducted a cost-effectiveness analysis that compared the current standard of care for management of TB and LTBI without additional tobacco reduction intervention (Status Quo) with (1) increased tobacco taxation, (2) pharmacotherapy and counselling for smoking cessation, (3) pharmacotherapy, counselling plus mass media campaign, and (4) the combination of all these. Projected outcomes included the following: TB cases, TB-related deaths, quality-adjusted life years (QALYs), and health system costs, all over 20 years. RESULTS: The combined strategy was projected to reduce active TB cases by 6.1% (95% uncertainty range 4.9-7.0%) and TB deaths by 10.4% (9.5-11.4%) over 20 years, relative to the status quo. Increased taxation was the only cost-saving strategy. CONCLUSIONS: Currently available strategies to reduce commercial tobacco use will likely have a modest impact on TB-related outcomes in the medium term, but some may be cost saving.


Assuntos
Fumar Tabaco/efeitos adversos , Fumar Tabaco/prevenção & controle , Abandono do Uso de Tabaco/economia , Abandono do Uso de Tabaco/métodos , Tuberculose/prevenção & controle , Adulto , Canadá/epidemiologia , Análise Custo-Benefício , Técnicas de Apoio para a Decisão , Humanos , Inuítes , Tuberculose Latente/epidemiologia , Tuberculose Latente/prevenção & controle , Prevalência , Saúde Pública/métodos , Fatores de Risco , Tuberculose/epidemiologia , Tuberculose/etiologia
20.
Artigo em Inglês | MEDLINE | ID: mdl-30609776

RESUMO

There are health consequences to exposure to secondhand smoke (SHS). About two-thirds of children in China live with at least one person, usually a parent, who smokes at home. However, none of the reviews of interventions for reducing SHS have targeted children in China. The purpose of this study was to review the effectiveness of interventions for reducing parental SHS exposure at home among children in China. We searched various electronic databases for English and Chinese publications appearing between 1997 and 2017. Thirteen relevant studies were identified. Common strategies used in intervention groups were non-pharmacological approaches such as counseling plus self-help materials, and attempting to persuade fathers to quit smoking. Family interactions and follow-up sessions providing counseling or using text messages could be helpful to successful quitting. Several encouraging results were observed, including lower cotinine levels in children (n = 2), reduced tobacco consumption (n = 5), and increased quit rates (n = 6) among parents. However, the positive effects were not sustained 3~6 months after the interventions. Self-reported quitting without bio-chemical validation was the most common outcome measure. A study design using biochemical validations, a longer follow-up period, and targeting all people living with children in the same household is recommended.


Assuntos
Exposição Ambiental/prevenção & controle , Poluição por Fumaça de Tabaco , Criança , China , Habitação , Humanos , Pais , Fumar Tabaco/prevenção & controle
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