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1.
Addict Behav ; 113: 106692, 2021 02.
Artigo em Inglês | MEDLINE | ID: mdl-33099250

RESUMO

Despite a growing body of research examining correlates and consequences of COVID-19, few findings have been published among military veterans. This limitation is particularly concerning as preliminary data indicate that veterans may experience a higher rate of mortality compared to their civilian counterparts. One factor that may contribute to increased rates of death among veterans with COVID-19 is tobacco use. Indeed, findings from a recent meta-analysis highlight the association between lifetime smoking status and COVID-19 progression to more severe or critical conditions including death. Notably, prevalence rates of tobacco use are higher among veterans than civilians. Thus, the purpose of the current study was to examine demographic and medical variables that may contribute to likelihood of death among veterans testing positive for SARS-CoV-2. Additionally, we examined the unique influence of lifetime tobacco use on veteran mortality when added to the complete model. Retrospective chart reviews were conducted on 440 veterans (80.5% African American/Black) who tested positive for SARS-CoV-2 (7.3% deceased) at a large, southeastern Veterans Affairs (VA) hospital between March 11, 2020 and April 23, 2020, with data analysis occurring from May 26, 2020 to June 5, 2020. Older age, male gender, immunodeficiency, endocrine, and pulmonary diseases were positively related to the relative risk of death among SARS-CoV-2 positive veterans, with lifetime tobacco use predicting veteran mortality above and beyond these variables. Findings highlight the importance of assessing for lifetime tobacco use among SARS-CoV-2 positive patients and the relative importance of lifetime tobacco use as a risk factor for increased mortality.


Assuntos
/mortalidade , Doenças do Sistema Endócrino/epidemiologia , Síndromes de Imunodeficiência/epidemiologia , Pneumopatias/epidemiologia , Fumar/epidemiologia , Veteranos/estatística & dados numéricos , Afro-Americanos/estatística & dados numéricos , Fatores Etários , Idoso , Grupo com Ancestrais do Continente Europeu/estatística & dados numéricos , Feminino , Hospitais de Veteranos , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Risco , Fatores Sexuais , Uso de Tabaco/epidemiologia , Estados Unidos/epidemiologia
2.
MMWR Morb Mortal Wkly Rep ; 69(50): 1881-1888, 2020 Dec 18.
Artigo em Inglês | MEDLINE | ID: mdl-33332300

RESUMO

Tobacco use is the leading cause of preventable disease and death in the United States; nearly all tobacco product use begins during youth and young adulthood (1,2). CDC and the Food and Drug Administration (FDA) analyzed data from the 2019 and 2020 National Youth Tobacco Surveys (NYTS) to determine changes in the current (past 30-day) use of seven tobacco products among U.S. middle (grades 6-8) and high (grades 9-12) school students. In 2020, current use of any tobacco product was reported by 16.2% (4.47 million) of all students, including 23.6% (3.65 million) of high school and 6.7% (800,000) of middle school students. Electronic cigarettes (e-cigarettes) were the most commonly used tobacco product among high school (19.6%; 3.02 million) and middle school (4.7%; 550,000) students. From 2019 to 2020, decreases in current use of any tobacco product, any combustible tobacco product, multiple tobacco products, e-cigarettes, cigars, and smokeless tobacco occurred among high school and middle school students; these declines resulted in an estimated 1.73 million fewer current youth tobacco product users in 2020 than in 2019 (6.20 million) (3). From 2019 to 2020, no significant change occurred in the use of cigarettes, hookahs, pipe tobacco, or heated tobacco products. The comprehensive and sustained implementation of evidence-based tobacco control strategies at the national, state, and local levels, combined with tobacco product regulation by FDA, is warranted to help sustain this progress and to prevent and reduce all forms of tobacco product use among U.S. youths (1,2).


Assuntos
Estudantes/psicologia , Produtos do Tabaco/estatística & dados numéricos , Uso de Tabaco/epidemiologia , Adolescente , Criança , Estudos Transversais , Feminino , Inquéritos Epidemiológicos , Humanos , Masculino , Instituições Acadêmicas/estatística & dados numéricos , Estudantes/estatística & dados numéricos , Estados Unidos/epidemiologia
3.
PLoS One ; 15(11): e0242872, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33232381

RESUMO

BACKGROUND: Tobacco, alcohol, and marijuana are the top three substances used by adolescents. The adverse health effects of these three substances are well documented in epidemiological literature, yet little is known about the substance use and associated factors among adolescents in Bangladesh. This study examines the risk factors for tobacco and other substances use among school-going adolescents in Bangladesh. METHODS: We analyzed data from the 2014 Bangladesh Global School-based Student Health Survey (GSHS) of adolescents aged 13-17 years. We used two outcome measures: tobacco use (TU) and other substance use (SU; alcohol and/or marijuana). We examined a set of reported psychosocial and socio-environmental adverse events as risk factors. Logistic regression analyses were used to identify associations. RESULTS: The prevalence of TU and other SU among school-going adolescents was 9.6% and 2.3%, respectively. The likelihood of TU and other SU was higher among adolescents who reported being bullied (TU: adjusted odd ratio [AOR]: 1.93; 95% confidence interval [CI]: 1.24-3.00; and other SU: AOR: 3.43; 95% CI: 1.46-7.99) and having sexual history (TU: AOR: 19.38; 95% CI: 12.43-30.21; and other SU: AOR: 5.34; 95% CI: 2.17-13.29). Moreover, anxiety-related sleep loss was associated with adolescents' TU (AOR: 2.41; 95% CI: 1.02-5.82) whereas the likelihood of other SU (AOR: 3.27; 95% CI: 1.14-9.44) was higher among lonely adolescents. Experience of adverse socio-environmental factors, such as parental substance use (TU: AOR: 7.81; 95% CI: 5.08-12.01), poor monitoring (TU: AOR: 1.96; 95% CI: 1.16-3.31) and poor understanding (TU: AOR: 2.22; 95% CI: 1.36-3.65), and lack of peer support (TU: AOR: 3.13; 95% CI: 1.84-5.31; and other SU: AOR: 2.45; 95% CI: 1.02-5.91), and truancy (other SU: AOR: 4.29; 95% CI: 1.81-10.12) were also positively associated with TU and/or other SU. Additionally, higher odds of tobacco use were observed among adolescents who reported 1 (AOR: 4.36 times; 95% CI: 1.34-14.24), 2 (AOR: 8.69 95% CI: 1.67-28.23), and ≥3 (AOR: 17.46; 95% CI: 6.20-49.23) adverse psychosocial experiences than who did not report any psychosocial events. CONCLUSIONS: Tobacco and other substance use among school-going adolescents are prevalent in Bangladesh. Several psychosocial and socio-environmental events are associated with TU and other SU, which should be incorporated into adolescent substance use and health promotion programs.


Assuntos
Comportamento do Adolescente/psicologia , Transtornos Relacionados ao Uso de Substâncias/psicologia , Uso de Tabaco/psicologia , Tabaco/efeitos adversos , Absenteísmo , Adolescente , Bangladesh/epidemiologia , Bullying/psicologia , Criança , Feminino , Humanos , Masculino , Abuso de Maconha , Fatores de Risco , Instituições Acadêmicas , Comportamento Sexual/psicologia , Estudantes/psicologia , Transtornos Relacionados ao Uso de Substâncias/epidemiologia , Uso de Tabaco/epidemiologia
5.
Environ Health Prev Med ; 25(1): 62, 2020 Oct 14.
Artigo em Inglês | MEDLINE | ID: mdl-33054709

RESUMO

BACKGROUND: Tobacco consumption causes almost 638,000 premature deaths per year in India. This study sought to examine the prevalence and determinants of tobacco use among men in India. METHODS: We analyzed data from the fourth round of the National Family Health Survey in India. These nationally representative cross-sectional sample data were collected from January 20, 2015, to December 4, 2016. A total of 112,122 men aged 15-54 years were included in this study. Primary outcomes were tobacco use categorized into smoking, smokeless, any tobacco, and both smoked and smokeless tobacco use. Complex survey design and sampling weights were applied in both the descriptive analyses and logistic regression models. We present the findings using odds ratios. RESULTS: The prevalence of tobacco use among men in India for the studied period was 45.5% (95% CI 44.9-46.1), smoking was 24.6% (95% CI 24.1-25.1), smokeless tobacco use was 29.1% (95% CI 28.6-29.6), and both smoked and smokeless tobacco use was 8.4% (95% CI 8.1-8.7). The prevalence of tobacco use among men was higher among the elderly, separated/divorced/widowed individuals, those with lower education and wealth status, alcohol consumers, manual workers, and residents of the northeast region. Multivariate analysis showed that age, lower education, occupation, region, alcohol consumption, separated/divorced/widowed status, and economic status were substantially associated with tobacco use among Indian men. CONCLUSIONS: Innovative and cost-effective strategies targeting high-risk groups are crucial to curbing the tobacco epidemic in India. Anti-smoking campaigns should also focus on mitigating alcohol abuse. Reducing tobacco marketing and implementing formal education about the dangers of tobacco use, progressive taxing, packaging, and labeling of tobacco products and price strategies should be harmonized in legal provisions.


Assuntos
Fatores Socioeconômicos , Adolescente , Adulto , Humanos , Índia/epidemiologia , Masculino , Pessoa de Meia-Idade , Prevalência , Uso de Tabaco/epidemiologia , Adulto Jovem
6.
Pediatrics ; 146(5)2020 11.
Artigo em Inglês | MEDLINE | ID: mdl-33020248

RESUMO

BACKGROUND AND OBJECTIVES: Noncigarette tobacco use is increasing. In this study, we reexamined (1) parental knowledge or suspicion of their children's tobacco use and (2) associations of household tobacco-free rules with youth initiation. METHODS: Participants were youth (aged 12-17) in waves 1 to 4 (2013-2018) of the Population Assessment of Tobacco and Health Study. A pseudo cross-sectional time-series analysis (N = 23 170) was used to examine parent or guardian knowledge or suspicion of their child's tobacco use according to youth-reported use categories: cigarette only, electronic cigarette only, smokeless tobacco only, noncigarette combustible only, and poly use. A longitudinal analysis among wave 1 never users (n = 8994) was used to examine rules barring tobacco inside the home and whether parents talked with youth about not using tobacco as predictors of youth tobacco initiation after 1 to 3 years. Survey-weighted multivariable models were adjusted for tobacco use risk factors. RESULTS: In all waves, parents or guardians much less often knew or suspected that their children used tobacco if youth only reported use of electronic cigarettes, noncigarette combustible products, or smokeless tobacco compared with cigarettes. Youth tobacco initiation was lower when youth and parents agreed that rules prohibited all tobacco use throughout the home (1-year adjusted odds ratio: 0.74; 95% confidence interval: 0.59-0.94) but not when parents talked with youth about tobacco (adjusted odds ratio: 1.08; 95% confidence interval: 0.94-1.23). CONCLUSIONS: Many parents are unaware of their children's noncigarette tobacco use. Setting expectations for tobacco-free environments appears more effective at preventing youth tobacco initiation than parents advising children not to use tobacco.


Assuntos
Características da Família , Conhecimentos, Atitudes e Prática em Saúde , Pais , Política Antifumo , Uso de Tabaco , Adolescente , Criança , Intervalos de Confiança , Estudos Transversais , Sistemas Eletrônicos de Liberação de Nicotina/estatística & dados numéricos , Feminino , Humanos , Análise de Séries Temporais Interrompida/estatística & dados numéricos , Masculino , Razão de Chances , Fumar/epidemiologia , Prevenção do Hábito de Fumar , Uso de Tabaco/epidemiologia , Uso de Tabaco/prevenção & controle , Tabaco sem Fumaça/estatística & dados numéricos
7.
BMC Public Health ; 20(1): 1368, 2020 Sep 07.
Artigo em Inglês | MEDLINE | ID: mdl-32894104

RESUMO

BACKGROUND: Tobacco and alcohol use are major behavioural risks in developing countries like Nepal, which are contributing to a rapid increase in non-communicable diseases (NCDs). This causal relationship is further complicated by the multi-level social determinants such as socio-political context, socio-economic factors and health systems. The systems approach has potential to facilitate understanding of such complex causal mechanisms. The objective of this paper is to describe the role of tobacco and alcohol use in the interaction of social determinants of NCDs in Nepal. METHOD: The study adopted a qualitative study design guided by the Systemic Intervention methodology. The study involved key informant interviews (n = 63) and focus group discussions (n = 12) at different levels (national, district and/or community) and was informed by the adapted Social Determinants of Health Framework. The data analysis involved case study-based thematic analysis using framework approach and development of causal loop diagrams. The study also involved three sense-making sessions with key stakeholders. RESULTS: Three key themes and causal loop diagrams emerged from the data analysis. Widespread availability of tobacco and alcohol products contributed to the use and addiction of tobacco and alcohol. Low focus on primary prevention by health systems and political influence of tobacco and alcohol industries were the major contributors to the problem. Gender and socio-economic status of families/communities were identified as key social determinants of tobacco and alcohol use. CONCLUSION: Tobacco and alcohol use facilitated interaction of the social determinants of NCDs in the context of Nepal. Socio-economic status of families was both driver and outcome of tobacco and alcohol use. Health system actions to prevent NCDs were delayed mainly due to lack of system insights and commercial influence. A multi-sectoral response led by the health system is urgently needed.


Assuntos
Consumo de Bebidas Alcoólicas/epidemiologia , Doenças não Transmissíveis/epidemiologia , Determinantes Sociais da Saúde , Meio Social , Uso de Tabaco/epidemiologia , Feminino , Humanos , Masculino , Nepal/epidemiologia , Prevenção Primária/normas , Pesquisa Qualitativa , Fatores de Risco
8.
MMWR Suppl ; 69(1): 56-63, 2020 Aug 21.
Artigo em Inglês | MEDLINE | ID: mdl-32817607

RESUMO

Tobacco product use is the leading cause of preventable disease, disability, and death in the United States. This report used data from the 2019 Youth Risk Behavior Survey to assess the following among U.S. high school students: ever use of cigarettes and electronic vapor products, current use (≥1 day during the 30 days before the survey) of tobacco products, frequent use (≥20 days during the 30 days before the survey) among current users of tobacco products, trends in use over time, and usual source of electronic vapor products among current electronic vapor product users. In 2019, a total of 50.1% of U.S. high school students had ever used electronic vapor products, and 24.1% had ever tried cigarette smoking. Current electronic vapor product use was 32.7%, current cigarette smoking was 6.0%, current cigar smoking was 5.7%, and current smokeless tobacco use was 3.8%. Approximately 36.5% of students were current users of any tobacco product, and 8.2% were current users of two or more tobacco products. Frequent use among users of individual products was 32.6% for electronic vapor products, 28.5% for smokeless tobacco, 22.2% for cigarettes, and 18.4% for cigars. Among current electronic vapor product users who were aged ≤17 years, the most commonly reported source was borrowing them from someone else (42.8%). Significant decreases occurred in current cigarette smoking (1991: 27.5%; 2019: 6.0%), cigar smoking (1997: 22.0%; 2019: 5.7%), and smokeless tobacco use (2017: 5.5%; 2019: 3.8%). However, significant increases occurred in current electronic vapor product use (2015: 24.1%; 2019: 32.7%) and any tobacco product use (2017: 19.5%; 2019: 36.5%). Although current cigarette smoking, cigar smoking, and smokeless tobacco use has decreased among high school students, the increased prevalence of electronic vapor product use among youths is concerning. Continued surveillance for all tobacco product use is warranted for guiding and evaluating public health policy at the local, state, tribal, and national levels.


Assuntos
Estudantes/psicologia , Produtos do Tabaco/estatística & dados numéricos , Uso de Tabaco/epidemiologia , Adolescente , Feminino , Humanos , Masculino , Assunção de Riscos , Instituições Acadêmicas , Estudantes/estatística & dados numéricos , Inquéritos e Questionários , Estados Unidos/epidemiologia
9.
Pan Afr Med J ; 36: 51, 2020.
Artigo em Francês | MEDLINE | ID: mdl-32774626

RESUMO

Introduction: Breast cancer is a major public health challenge. The purpose of this study is to describe the sociodemographic profile, toxic habits and diet profile of patients suffering from breast cancer treated in the Mohammed VI Cancer Treatment Center, in Casablanca. Methods: We conducted a cross-sectional study of 305 female patients newly diagnosed with breast cancer. Results: The average age of patients was 50 years; Fifty-six percent (55.7%) of patients were married and 12.8% were widows. Among the surveyed women, 83% were housewives, 63.3% lived in an urban environment and 47.9% were illiterate. With respect to patients' toxic habits, only 5,9% of the surveyed women reported that they had consumed alcohol and a minority of them reported they were ex-smokers or smokers (4.3% and 2.3%respectively). With respect to diet, our patients consumed bread and red meat with an average frequency of 8.26 and 5.84 times/week respectively and, finally, dairy products with an average frequency ranging from 3.55 to 4.57 times/week. In addition, patients mostly consumed potatoes and fresh fruit, with an average frequency of 5.74 and 5.38 times/week respectively. Tea was the most widely consumed beverage, with a very high average frequency of 8.12 times/week. Conclusion: Given our results, most of the surveyed women were housewives, illiterate women and resided in an urban environment. Many foods were frequently consumed by our patients. On the other hand, the consumption of psychoactive substances such as alcohol and tobacco was low. Analytical case-control studies are necessary to establish a possible association between these risk factors and breast cancer.


Assuntos
Consumo de Bebidas Alcoólicas/epidemiologia , Neoplasias da Mama/patologia , Dieta , Uso de Tabaco/epidemiologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Institutos de Câncer , Estudos Transversais , Feminino , Humanos , Pessoa de Meia-Idade , Marrocos , Inquéritos e Questionários , Adulto Jovem
10.
Public Health ; 186: 28-30, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32758710

RESUMO

OBJECTIVES: The objective of this short communication is to provide a previous empirical analysis to locate the regions that have distortions in per capita tobacco consumption. The location of these regions and their proximity to other countries allow us to detect the need that governments have to harmonize policies. STUDY DESIGN: The design of this study is a cross-sectional spatial descriptive analysis. METHODS: By using panel data from the 47 Spanish provinces from 2002 to 2017, we implement the Moran's I test which allows us to detect areas where low or high per capita tobacco consumption clusters are generated. RESULTS: The results show that areas of Spain bordering countries with high price differentials, such as Gibraltar and France, generate clusters of low and high per capita tobacco consumption, respectively. Indeed, maintaining a low price differential seems not to generate distortions, as revealed by the Portugal case. CONCLUSIONS: Spatial clusters of per capita tobacco consumption are located in regions close to countries where there is high price differential.


Assuntos
Uso de Tabaco/epidemiologia , Comércio/estatística & dados numéricos , Estudos Transversais , Humanos , Política Pública , Fumar/epidemiologia , Espanha/epidemiologia , Análise Espacial
11.
BMC Public Health ; 20(1): 1031, 2020 Jun 29.
Artigo em Inglês | MEDLINE | ID: mdl-32600457

RESUMO

BACKGROUND: Tobacco expenditure has adverse impacts on expenditure on basic needs and resource allocation of the households. Using data from a nationally representative survey, we measured socioeconomic inequality in tobacco expenditure as the share of household budget (TEHB) and explained its main determinants among Iranian households at the national and sub-national levels. METHODS: This cross-sectional study used data from the Iranian Household Income and Expenditure Survey (IHIES), 2018. We included a total of 7649 households with tobacco expenditure more than zero in the analysis. Province-level data on the Human Development Index (HDI) was obtained from the Institute for Management Research at Radbound University. The concentration curve (CC) and the concentration index (C) were used to measure socioeconomic inequality in TEHB at national and sub-national levels. The C was decomposed to identify the factors explaining the observed socioeconomic inequality in TEHB. RESULTS: At the national level, households with at least one smoker spent more than 5% of their budget for tobacco consumption in the last month. Households from the urban areas allocated less of their budgets on tobacco products compared to rural households (4.6% vs. 5.8%). Overall, TEHB was more concentrated among the poorer households (C = 0.1423, 95% CI: - 0.1552 to - 0.1301). In other words, the distribution of TEHB was pro-poor in Iran. Pro-poor inequality in TEHB was also found in urban (C = - 0.1707, 95% CI: - 0.1998 to - 0.1516) and rural (C = - 0.1314, 95% CI: - 0.1474 to - 0.1152) areas. We also found that pro-poor inequalities were higher in Iranian provinces with low HDI. The decomposition results indicate that wealth and education were the main factors contributing to the concentration of TEHB among the poorer households. CONCLUSION: This study found that TEHB was disproportionality concentrated among poorer households in Iran. The extent of inequality in TEHB was higher in urban areas and less developed provinces. Designing and implementing tobacco control interventions to decrease the smoking prevalence and increase smoking cessation could protect worse-off households against the financial burden of tobacco spending.


Assuntos
Gastos em Saúde/estatística & dados numéricos , Disparidades nos Níveis de Saúde , Disparidades em Assistência à Saúde/economia , Fatores Socioeconômicos , Uso de Tabaco/economia , Adolescente , Adulto , Estudos Transversais , Características da Família , Feminino , Humanos , Irã (Geográfico)/epidemiologia , Masculino , Pessoa de Meia-Idade , Pobreza/estatística & dados numéricos , Prevalência , População Rural/estatística & dados numéricos , Inquéritos e Questionários , Uso de Tabaco/epidemiologia , População Urbana/estatística & dados numéricos , Adulto Jovem
12.
Pediatrics ; 146(2)2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32661188

RESUMO

Cannabinoids, the psychoactive compounds in marijuana, are one of the most commonly used substances in the United States. In this review, we summarize the impact of marijuana on child and adolescent health and discuss the implications of marijuana use for pediatric practice. We review the changing epidemiology of cannabis use and provide an update on medical use, routes of administration, synthetic marijuana and other novel products, the effect of cannabis on the developing brain, other health and social consequences of use, and issues related to marijuana legalization.


Assuntos
Cannabis , Uso da Maconha , Adolescente , Comportamento do Adolescente/efeitos dos fármacos , Animais , Encéfalo/efeitos dos fármacos , Encéfalo/embriologia , Encéfalo/crescimento & desenvolvimento , Canabidiol/farmacologia , Canabidiol/uso terapêutico , Canabinoides/efeitos adversos , Canabinoides/síntese química , Canabinoides/farmacologia , Cannabis/efeitos adversos , Cannabis/química , Cannabis/envenenamento , Criança , Comportamento Infantil/efeitos dos fármacos , Interações Medicamentosas , Endocanabinoides/fisiologia , Feminino , Feto/efeitos dos fármacos , Humanos , Drogas Ilícitas/efeitos adversos , Masculino , Abuso de Maconha/epidemiologia , Abuso de Maconha/terapia , Uso da Maconha/efeitos adversos , Uso da Maconha/epidemiologia , Uso da Maconha/legislação & jurisprudência , Uso da Maconha/psicologia , Meios de Comunicação de Massa , Maconha Medicinal/efeitos adversos , Maconha Medicinal/uso terapêutico , Leite Humano/química , Transtornos Neurocognitivos/induzido quimicamente , Gravidez , Efeitos Tardios da Exposição Pré-Natal , Receptores de Canabinoides/efeitos dos fármacos , Receptores de Canabinoides/fisiologia , Uso de Tabaco/epidemiologia
13.
Womens Health Issues ; 30(5): 345-352, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32622582

RESUMO

PURPOSE: Despite the prevalence of alcohol, tobacco, and other drug (ATOD) use screening as part of prenatal care, pregnant women's perspectives on screening are largely absent from research and clinical practice. This study examines pregnant women's acceptability of ATOD screening and willingness to disclose their ATOD use in prenatal care. METHODS: Pregnant women completed a self-administered survey and structured interview at four prenatal care facilities in Louisiana and Maryland (N = 589). Participants reported the acceptability of screening and their willingness to honestly disclose their ATOD use to their provider. Data were analyzed through descriptive statistics, tests of proportions, simple regression models, and coding of open-ended responses. RESULTS: Nearly all pregnant women found screening acceptable for alcohol (97%), tobacco (98%), and other drug use (97%) during prenatal care. The acceptability of alcohol use screening was higher among those who reported binge drinking (98% vs. 96%; p = .002) and risky alcohol consumption (99% vs. 96%; p = .018). The acceptability of screening for other drugs was higher among women reporting binge drinking (98% vs. 96%; p = .032) and other drug use (98% vs. 96%; p = .058). Almost all pregnant women indicated that they were willing to disclose their alcohol (99%), tobacco (99%), and other drug use (98%) to their provider. CONCLUSIONS: Almost all women considered verbal screening for ATOD use during prenatal care acceptable and indicated that they were willing to honestly disclose their ATOD use. Verbal screening may allow for the opportunity to initiate safe, nonjudgmental conversations about women's substance use, risk, and goals for their ATOD use, pregnancy, and parenting.


Assuntos
Consumo de Bebidas Alcoólicas/epidemiologia , Programas de Rastreamento/psicologia , Gestantes/psicologia , Autorrevelação , Transtornos Relacionados ao Uso de Substâncias/epidemiologia , Uso de Tabaco/epidemiologia , Adulto , Feminino , Humanos , Louisiana , Maryland , Gravidez , Cuidado Pré-Natal , Detecção do Abuso de Substâncias , Inquéritos e Questionários , Adulto Jovem
14.
PLoS One ; 15(7): e0234135, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32614848

RESUMO

BACKGROUND: Educational inequalities in health and mortality in European countries have often been studied in the context of welfare regimes or political systems. We argue that the healthcare system is the national level feature most directly linkable to mortality amenable to healthcare. In this article, we ask to what extent the strength of educational differences in mortality amenable to healthcare vary among European countries and between European healthcare system types. METHODS: This study uses data on mortality amenable to healthcare for 21 European populations, covering ages 35-79 and spanning from 1998 to 2006. ISCED education categories are used to calculate relative (RII) and absolute inequalities (SII) between the highest and lowest educated. The healthcare system typology is based on the latest available classification. Meta-analysis and ANOVA tests are used to see if and how they can explain between-country differences in inequalities and whether any healthcare system types have higher inequalities. RESULTS: All countries and healthcare system types exhibited relative and absolute educational inequalities in mortality amenable to healthcare. The low-supply and low performance mixed healthcare system type had the highest inequality point estimate for the male (RII = 3.57; SII = 414) and female (RII = 3.18; SII = 209) population, while the regulation-oriented public healthcare systems had the overall lowest (male RII = 1.78; male SII = 123; female RII = 1.86; female SII = 78.5). Due to data limitations, results were not robust enough to make substantial claims about typology differences. CONCLUSIONS: This article aims at discussing possible mechanisms connecting healthcare systems, social position, and health. Results indicate that factors located within the healthcare system are relevant for health inequalities, as inequalities in mortality amenable to medical care are present in all healthcare systems. Future research should aim at examining the role of specific characteristics of healthcare systems in more detail.


Assuntos
Escolaridade , Disparidades em Assistência à Saúde , Mortalidade , Programas Nacionais de Saúde/estatística & dados numéricos , Adulto , Idoso , Consumo de Bebidas Alcoólicas/epidemiologia , Europa (Continente)/epidemiologia , Feminino , Gastos em Saúde/estatística & dados numéricos , Humanos , Seguro Saúde , Masculino , Pessoa de Meia-Idade , Prevenção Primária , Seguridade Social , Medicina Estatal/estatística & dados numéricos , Uso de Tabaco/epidemiologia
15.
South Med J ; 113(6): 292-297, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32483639

RESUMO

OBJECTIVE: To assess patient- and hospital-level characteristics associated with opioid use in human immunodeficiency virus (HIV)-positive pregnant women and fetal health outcomes. METHODS: Using the 2002-2014 Nationwide Inpatient Sample database, we analyzed discharge records to describe the rates of opioid use among HIV-positive pregnant women. Logistic regression was used to quantify the magnitude of the association between exposure status and maternal-fetal outcomes. RESULTS: Opioid use was fourfold greater among HIV-positive pregnant women compared with their HIV-negative counterparts (odds ratio 4.0; 95% confidence interval 3.15-5.12). Relatively smaller but significant increases in the early onset of delivery, poor fetal growth, abortive pregnancy, and spontaneous abortion also were observed in association with HIV-positive status and opioid drug use during pregnancy. CONCLUSIONS: An increased risk of negative maternal-fetal complications persists among HIV-positive women who use opioids during pregnancy. Focusing on predisposing factors and monitoring opioid dispensing may mitigate overuse or abuse in this vulnerable population.


Assuntos
Aborto Espontâneo/epidemiologia , Retardo do Crescimento Fetal/epidemiologia , Infecções por HIV/epidemiologia , Transtornos Relacionados ao Uso de Opioides/epidemiologia , Complicações Infecciosas na Gravidez/epidemiologia , Nascimento Prematuro/epidemiologia , Aborto Induzido/estatística & dados numéricos , Adolescente , Adulto , Consumo de Bebidas Alcoólicas/epidemiologia , Estudos de Casos e Controles , Depressão/epidemiologia , Feminino , Humanos , Modelos Logísticos , Pessoa de Meia-Idade , Trabalho de Parto Prematuro/epidemiologia , Gravidez , Complicações na Gravidez/epidemiologia , Sepse/epidemiologia , Uso de Tabaco/epidemiologia , Estados Unidos/epidemiologia , Adulto Jovem
16.
BMC Public Health ; 20(1): 815, 2020 May 30.
Artigo em Inglês | MEDLINE | ID: mdl-32473627

RESUMO

BACKGROUND: Few data were available on smoking and smokeless tobacco use in South Asian migrants in the United Arab Emirates (UAE). This study aimed to identify the prevalence and correlates of cigarette smoking and smokeless tobacco use in male South Asian migrants in the UAE. METHODS: We used a cross-sectional study to recruit a random representative sample of male South Asian migrants, including Indian (n = 433), Pakistani (n = 383) and Bangladeshi (n = 559) nationalities. We used multivariable logistic regression analysis to identify significant correlates of cigarettes smoking and smokeless tobacco use. RESULTS: 1375 South Asian migrant adult males participated in the study (response rate 76%) with a mean age of 34 years (SD ± 10). The overall prevalence of cigarette smoking was 28% (95%CI 25-30%) and smokeless tobacco use was 11% (95%CI 10-13%). The prevalence of current cigarette smoking was 21, 23, and 37% among participants from India, Pakistan and Bangladesh, respectively. The prevalence of current smokeless tobacco use was 6, 12, and 16% for Indian, Pakistani, and Bangladeshi participants, respectively. Among study participants, Bangladeshi nationality, hypertension, and alcohol use were significant correlates of current cigarette smoking. Significant correlates of smokeless tobacco use included increased age, less than college level education, alcohol use, and Pakistani or Bangladeshi nationality. CONCLUSIONS: Current smoking and smokeless tobacco use in South Asian migrants represent a significant public health burden in the UAE. Effective public health measures are needed to reduce tobacco use in this migrant population.


Assuntos
Fumar Cigarros/etnologia , Fumar Cigarros/psicologia , Fumantes/psicologia , Uso de Tabaco/etnologia , Uso de Tabaco/psicologia , Tabaco sem Fumaça/estatística & dados numéricos , Migrantes/psicologia , Adolescente , Adulto , Grupo com Ancestrais do Continente Asiático/psicologia , Grupo com Ancestrais do Continente Asiático/estatística & dados numéricos , Bangladesh , Fumar Cigarros/epidemiologia , Estudos Transversais , Humanos , Índia , Masculino , Pessoa de Meia-Idade , Paquistão , Prevalência , Fumantes/estatística & dados numéricos , Uso de Tabaco/epidemiologia , Migrantes/estatística & dados numéricos , Emirados Árabes Unidos/epidemiologia , Emirados Árabes Unidos/etnologia , Adulto Jovem
17.
Nicotine Tob Res ; 22(12): 2134-2140, 2020 12 12.
Artigo em Inglês | MEDLINE | ID: mdl-32531046

RESUMO

Most tobacco-focused clinical trials are based on locally conducted studies that face significant challenges to implementation and successful execution. These challenges include the need for large, diverse, yet still representative study samples. This often means a protracted, costly, and inefficient recruitment process. Multisite clinical trials can overcome some of these hurdles but incur their own unique challenges. With recent advances in mobile health and digital technologies, there is now a promising alternative: Remote Trials. These trials are led and coordinated by a local investigative team, but are based remotely, within a given community, state, or even nation. The remote approach affords many of the benefits of multisite trials (more efficient recruitment of larger study samples) without the same barriers (cost, multisite management, and regulatory hurdles). The Coronavirus Disease 2019 (COVID-19) global health pandemic has resulted in rapid requirements to shift ongoing clinical trials to remote delivery and assessment platforms, making methods for the conduct of remote trials even more timely. The purpose of the present review is to provide an overview of available methods for the conduct of remote tobacco-focused clinical trials as well as illustrative examples of how these methods have been implemented across recently completed and ongoing tobacco studies. We focus on key aspects of the clinical trial pipeline including remote: (1) study recruitment and screening, (2) informed consent, (3) assessment, (4) biomarker collection, and (5) medication adherence monitoring. Implications With recent advances in mobile health and digital technologies, remote trials now offer a promising alternative to traditional in-person clinical trials. Remote trials afford expedient recruitment of large, demographically representative study samples, without undo burden to a research team. The present review provides an overview of available methods for the conduct of remote tobacco-focused clinical trials across key aspects of the clinical trial pipeline.


Assuntos
/epidemiologia , Ensaios Clínicos como Assunto/métodos , Telemedicina/métodos , Uso de Tabaco/epidemiologia , Uso de Tabaco/terapia , /prevenção & controle , Humanos , Adesão à Medicação/psicologia , Uso de Tabaco/psicologia
18.
JAMA Netw Open ; 3(6): e206436, 2020 06 01.
Artigo em Inglês | MEDLINE | ID: mdl-32492162

RESUMO

Importance: An increasing proportion of US smokers smoke at low intensity and not every day. Some nondaily smokers have always had this pattern, whereas others previously smoked daily. The effect of reducing the level of smoking from daily to nondaily smoking and the dose response at low smoking levels are poorly understood. Objective: To evaluate risk of all-cause and cause-specific mortality among nondaily and daily cigarette smokers, by cigarettes per month, years after reducing from daily to nondaily smoking, and years since quitting. Design, Setting, and Participants: A prospective cohort study using harmonized data from multiple cycles of the Tobacco Use Supplements to the Current Population Survey (TUS-CPS), linked to the National Death Index, were analyzed during the period from 2018 to 2020. Adults completed the 1992-1993, 1995-1996, 1998-1999, 2000, 2001-2002, 2003, 2006-2007, or 2010-2011 TUS-CPS. Cigarette smokers were classified as daily or nondaily users; current nondaily smokers were further categorized by whether they previously smoked every day. Main Outcomes and Measures: Hazard ratios (HRs) and 95% CIs for risks of mortality vs never smoking. Age was the underlying time metric, adjusted for sex, race/ethnicity, education, survey year, and household income. Results: Among 505 500 participants (aged 18-103 years), approximately 47 000 deaths occurred. The median number of cigarettes smoked per month was 600 (interquartile range, 300-600) (20 cigarettes per day [interquartile range, 10-20 cigarettes per day]) for daily cigarette smokers and 40 (interquartile range, 15-90) for lifelong nondaily smokers. Nevertheless, both current daily (HR, 2.32; 95% CI, 2.25-2.38) and lifelong nondaily (HR, 1.82; 95% CI, 1.65-2.01) smokers had higher all-cause mortality risks than never smokers. Associations were observed for 6 to 10 cigarettes per month and increased with greater-intensity use. Nondaily smokers who previously smoked every day had lower mortality risks than daily smokers, with similar HRs after 10 or more years of nondaily smoking as lifelong nondaily smokers (HR vs never smokers, 1.73; 95% CI, 1.56-1.92). Yet, their risks were higher than former smokers who quit 10 or more years before (HR vs never smokers, 1.18; 95% CI, 1.15-1.22). Conclusions and Relevance: Although reducing smoking from daily to nondaily was associated with decreased mortality risk, cessation was associated with far greater benefit. Lifelong nondaily smokers have higher mortality risks than never smokers, even among those smoking 6 to 10 cigarettes per month. Thus, all smokers should quit, regardless of how infrequently they smoke.


Assuntos
Fumantes/educação , Abandono do Hábito de Fumar/estatística & dados numéricos , Fumar/mortalidade , Uso de Tabaco/efeitos adversos , Adulto , Idoso , Idoso de 80 Anos ou mais , Grupos Étnicos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Observacionais como Assunto , Estudos Prospectivos , Medição de Risco , Fumantes/estatística & dados numéricos , Fumar/epidemiologia , Fumar/tendências , Abandono do Hábito de Fumar/métodos , Inquéritos e Questionários , Uso de Tabaco/epidemiologia , Estados Unidos/epidemiologia
19.
Ann Otol Rhinol Laryngol ; 129(12): 1215-1220, 2020 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-32546006

RESUMO

BACKGROUND: Oral cavity carcinomas individually are the fifth-leading cause of overall cancer mortality in the Northern Mariana Islands, which is likely a representative statistic for many other betel-nut-endemic Pacific islands. Factors associated with survival have been minimally evaluated in this region. The purpose of this study is to further characterize oral cavity carcinoma outcomes and associated prognostic factors in the United States commonwealth of the Northern Mariana Islands (CNMI). METHODS: A single-institution retrospective review was undertaken for 81 patients diagnosed with head and neck cancers at the CNMI's only regional hospital complex from 2005 to 2019. A subset of patients diagnosed with oral cavity carcinoma was further evaluated for survival outcomes. Cox proportional hazard regressions were performed to evaluate for variables associated with survival. RESULTS: A majority of patients had cancer of the oral cavity (64/81, 79%). Fifty-five of these patients had sufficient data for review. The average age at the time of diagnosis was 48 and over half were diagnosed with stage IV disease (29/55, 53%). Five-year overall survival (OS) was 49.5% (95% CI, 33.3-63.7%). Factors associated with worse OS were lymph node metastases at presentation (P = .031), higher overall stage (III or IV vs I or II, P = .016), and higher T-stage (III or IV vs I or II, P = .027). Those who used betel nut were diagnosed at a significantly younger age than those who did not (47.2 vs 55.4, P = .001). CONCLUSIONS: The head and neck cancer burden in the CNMI is dominated by betel nut related oral cavity disease that is characterized by delayed presentations in younger patients and decreased OS. Future studies are indicated to improve health literacy as well as to investigate the potential for screening programs.


Assuntos
Antineoplásicos/uso terapêutico , Areca , Carcinoma/terapia , Neoplasias Bucais/terapia , Procedimentos Cirúrgicos Otorrinolaringológicos , Radioterapia , Adulto , Carcinoma/mortalidade , Carcinoma/patologia , Intervalo Livre de Doença , Feminino , Humanos , Linfonodos/patologia , Metástase Linfática , Masculino , Pessoas sem Cobertura de Seguro de Saúde/estatística & dados numéricos , Micronésia/epidemiologia , Pessoa de Meia-Idade , Mucosa Bucal , Neoplasias Bucais/mortalidade , Neoplasias Bucais/patologia , Estadiamento de Neoplasias , Grupo com Ancestrais Oceânicos , Modelos de Riscos Proporcionais , Estudos Retrospectivos , Fatores de Risco , Taxa de Sobrevida , Uso de Tabaco/epidemiologia , Adulto Jovem
20.
Arch Phys Med Rehabil ; 101(10): 1704-1710, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32445845

RESUMO

OBJECTIVES: To evaluate whether tobacco use, alcohol consumption, and weight gain are associated with the diagnosis of overuse musculoskeletal injuries within the first 12 months after lower limb amputation. DESIGN: Retrospective cohort study. SETTING: Military treatment facilities. PARTICIPANTS: Service members (N=681) with a deployment-related lower limb amputation. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Clinical diagnosis codes associated with musculoskeletal overuse injuries of the lower limb, upper limb, and low back regions. RESULTS: In the first three months after amputation, tobacco use and alcohol consumption were reported in 55.7% and 72.0%, respectively, of the retrospective sample. The overall mean weight change was 22.9±23.6 pounds. The prevalence of reporting at least 1 overuse injury within 4 to 12 months after amputation was 57.0% in the sample, with prevalence rates of lower limb, upper limb and low back pain diagnoses at 28.3%, 21.7%, and 21.1%, respectively. Service members reporting tobacco use in the first 3 months after amputation were nearly twice as likely to be diagnosed with a lower limb musculoskeletal injury 4 to 12 months after amputation. Similarly, service members reporting alcohol consumption within the first 3 months after amputation were more than twice as likely to be diagnosed with at least 1 overuse musculoskeletal injury 4 to 12 months after amputation. However, weight change or maximum weight after amputation were not associated with the diagnosis of an overuse musculoskeletal injury. CONCLUSIONS: Development of secondary overuse musculoskeletal injury appears to be related to tobacco use and alcohol consumption, but not to weight gain. These findings warrant focused research efforts toward developing preventive interventions.


Assuntos
Consumo de Bebidas Alcoólicas/epidemiologia , Amputação/reabilitação , Transtornos Traumáticos Cumulativos/epidemiologia , Uso de Tabaco/epidemiologia , Ganho de Peso/fisiologia , Adulto , Fatores Etários , Feminino , Humanos , Dor Lombar/epidemiologia , Extremidade Inferior/fisiopatologia , Masculino , Militares , Prevalência , Estudos Retrospectivos , Fatores Sexuais , Índices de Gravidade do Trauma , Extremidade Superior/fisiopatologia , Adulto Jovem
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