Smoking habits in HIV-infected people compared with the general population in Italy: a cross-sectional study.

BACKGROUND: Tobacco use is a leading cause of preventable diseases and death for all individuals, even more so for people living with HIV (PLWH), due to their status of chronic inflammation. To date, in Italy no study was performed to compare smoking habits in PLWH and the general population. We aimed to investigate smoking habits in PLWH, as compared to the general population. METHODS: Multi-center cross-sectional study. Smoking habits were compared between PLWH and the general population. PLWH were enrolled in the STOPSHIV Study. The comparison group from the general population was derived from a survey performed by the National Statistics Institute (ISTAT), with a stratified random sampling procedure matching 2:1 general population subjects with PLWH by age class, sex, and macro-area of residence. RESULTS: The total sample consisted of 1087 PLWH (age 47.9 ± 10.8 years, male 73.5%) and 2218 comparable subjects from the general population. Prevalence of current smokers was 51.6% vs 25.9% (p < 0.001); quitting smoking rate was 27.1% vs. 50.1% (p < 0.001) and the mean number of cigarettes smoked per day was 15.8 vs. 11.9 (p < 0.001), respectively for PLWH and the general population. Smoking and heavy smoking rates amongst PLWH were significantly higher even in subjects who reported diabetes, hypertension and extreme obesity (p < 0.001). Logistic regressions showed that PLWH were more likely current smokers (adjusted Odds Ratio, aOR = 3.11; 95% Confidence Interval (CI) =2.62-3.71; p < 0.001) and heavy smokers (> 20 cigarettes per day) (aOR = 4.84; 95% CI = 3.74-6.27; p < 0.001). PLWH were less likely to have quitted smoking (aOR = 0.36; 95% CI = 0.29-0.46; p < 0.001). CONCLUSION: HIV-infected patients showed a higher rate of current smokers, a larger number of cigarettes smoked and a lower quitting rate than the general population. Our findings emphasize the need for smoking cessation strategies targeting HIV persons.

The Economic Impact of Smoke-Free Policies on Restaurants, Cafés, and Bars: Panel Data Estimates From European Countries.

In this paper, we investigate the extent to which the economic outcomes of restaurants, bars, and cafés have been affected by the introduction of anti-smoking regulations in Europe. We use an unexploited panel database to collect a comprehensive set of information on financial indicators regarding the balance sheets of private and public companies in various economic sectors. The results show that smoke-free policies did not significantly affect the firms' economic performance, irrespective of the balance sheet indicators analyzed. Moreover, the results are robust to various econometric specifications and suggest that the recent enforcement of anti-smoking legislation in Europe has improved public health without a corresponding negative impact on revenues and employment in the hospitality industry.

Economic Evaluation of the effect of Quitting Smoking on Weight Gains: Evidence from the United Kingdom.

OBJECTIVE: This article estimated the causal effect of quitting smoking on body weight gains in the United Kingdom to evaluate whether savings in health costs deriving from smoking prevention and its related diseases are greater than the costs associated with increased obesity. METHODS: We used a longitudinal data set extracted from two waves (2004-2006) of the British Household Panel Survey, which includes information on smoking and a large number of sociodemographic variables. We modeled the effect of quitting smoking on body weight accounting for heterogeneous responses from individuals belonging to different clinical classes of body mass index (BMI) (i.e., overweight and obese individuals). National Health Service costs associated with smoking were then used to implement a cost-benefit analysis, comparing the advantages of smoking reductions with the costs associated with increased obesity. RESULTS: The BMI was found to increase by 0.26 points for quitters compared with those who continued to smoke. The estimated BMI increase was larger for overweight (0.49 points) and obese (0.76 points) people. This result does not change when different control groups are examined. From an economic perspective, the National Health Service cost reductions attributable to quitting smoking were £156.81 million whereas the lost benefit for unintended increases in body weight was £24.07 million. CONCLUSIONS: This article found that the health benefits associated with quitting smoking are greater than the costs associated with increased overweight and obesity.

Fathers matter: Intrahousehold responsibilities and children's wellbeing during the COVID-19 lockdown in Italy.

The lockdown imposed during the spring of 2020 as a result of the COVID-19 pandemic upset families lives, in addition to the health consequences of the virus, forcing parents to completely reorganize their labor, domestic work and childcare time. At the same time, school closures forced children to rearrange their lives and learning processes: in Italy, schools and nurseries were closed for four months, and the incidence and quality of distance learning activities was heterogeneous across education levels and among schools. Using real-time survey data on families with under-16 children collected in April 2020, which include information on parents' market and household work, and their perception of their children's wellbeing, we estimate how the lockdown has affected children's use of time, their emotional status and their home learning, and whether the reallocation of intrahousehold responsibilities during the lockdown played a role in this process. Changes in the parental division of household tasks and childcare, mostly induced by the labor market restrictions imposed during the lockdown, point to a greater involvement of fathers in childcare and homeschooling activities. This positive variation in fathers' involvement is accompanied by an increase in children's emotional wellbeing and by a reduction in TV and passive screen time. On the other hand, the quality of children's home learning does not appear to depend on which parent is overseeing their work, but rather on the type of distance learning activities proposed by their teachers.

The effect of smoking habit changes on body weight: Evidence from the UK.

This paper evaluates the causal relationship between smoking and body weight through two waves (2004-2006) of the British Household Panel Survey. We model the effect of changes in smoking habits, such as quitting or reducing, and account for the heterogeneous responses of individuals located at different points of the body mass distribution by quantile regression. We test our results by means of a large set of control groups and investigate their robustness by using the changes-in-changes estimator and accounting for different thresholds to define smoking reductions. Our results reveal the positive effect of quitting smoking on weight changes, which is also found to increase in the highest quantiles, whereas the decision to reduce smoking does not affect body weight.

Immigrant mothers and access to prenatal care: evidence from a regional population study in Italy.

OBJECTIVES: We addressed the question of whether use of adequate prenatal care differs between foreign-born and Italian mothers and estimated the extent to which unobservable characteristics bias results. SETTING: This study is on primary care and especially on adequate access to prenatal healthcare services by immigrant mothers. PARTICIPANTS: Approximately 37,000 mothers of both Italian and foreign nationality were studied. Data were obtained from the Standard Certificate of Live Birth between 2005 and 2010 in Umbria. RESULTS: Estimates from the bivariate probit model indicate that immigrant mothers are three times more likely to make fewer than four prenatal visits (OR=3.35) and 1.66 times more likely to make a late first visit (OR=1.66). The effect is found to be strongest for Asian women. CONCLUSIONS: Standard probit models lead to underestimation of the probability of inadequate use of prenatal care services by immigrant women, whereas bivariate probit models, which allow us to consider immigrant status as an endogenous variable, estimated ORs to be three times larger than those obtained with univariate models.

Immigration policy and birth weight: Positive externalities in Italian law.

A decade ago, the political party of the Italian center-right voted a law restricting immigration. The law became effective in early 2005, when the Italian parliament approved the decree for its application, but one of its articles, granting amnesty for illegal immigrant workers, became immediately effective in July 2002. As a result, 650,000 immigrants were granted the status of foreign nationals in Italy. In this paper, we examine whether the increase in the prevalence of "regular immigrants" has led to an improvement in health outcomes of babies born to migrant women, measured in terms of birth weight. Two hitherto unexploited birth sample surveys published by Italian Institute of Statistics were used for this study. Our estimates show that regularized immigration reduced the probability of low birth weight.

Estimating the Smoking Ban Effects on Smoking Prevalence, Quitting and Cigarette Consumption in a Population Study of Apprentices in Italy.

OBJECTIVES: We evaluated the effects of the Italian 2005 smoking ban in public places on the prevalence of smoking, quitting and cigarette consumption of young workers. DATA AND METHODS: The dataset was obtained from non-computerized registers of medical examinations for a population of workers with apprenticeship contracts residing in the province of Viterbo, Italy, in the period 1996-2007. To estimate the effects of the ban, a segmented regression approach was used, exploiting the discontinuity introduced by the application of the law on apprentices' smoking behavior. RESULTS: It is estimated that the Italian smoking ban generally had no effect on smoking prevalence, quitting ratio, or cigarette consumption of apprentices. However, when the estimates were applied to subpopulations, significant effects were found: -1% in smoking prevalence, +2% in quitting, and -3% in smoking intensity of apprentices with at least a diploma.

Differences in birthweight outcomes: a longitudinal study based on siblings.

OBJECTIVES: We investigate the differences in birthweight between first- and second-borns, evaluating the impact of changes in pregnancy (e.g., gestational age), demographic (e.g., age), and social (e.g., education level, marital status) maternal characteristics. DATA AND METHODS: All analyses are performed on data collected in Umbria (Italy) taking into account a set of 792 women who delivered twice from 2005 to 2008. Firstly, we use a univariate paired t-test for the comparison between weights of first- and second-borns; Secondly, we use linear and nonlinear regression approaches in order to: (i) evaluate the effect of demographic and social maternal characteristics and (ii) predict the odds-ratio of low and high birthweight infants, respectively. RESULTS: We find that the birthweight of second-borns is significantly higher than that of first-borns. Statistically significant effects are related with a longer gestational age, an increased number of visits during the pregnancy, and the gender of infants. On the other hand, we do not observe any significant effect related with mother's age and with other characteristics of interest.

The role of anti-smoking legislation on cigarette and alcohol consumption habits in Italy.

The short-term effects of public smoking bans on individual smoking and drinking habits were investigated in this paper. In 2005, a smoking ban was introduced in Italy, and we exploited this exogenous variation to measure the effect on both smoking participation and intensity and the indirect effect on alcohol consumption. Using data from the Everyday Life Aspects survey, for the period 2001-2007, we show that the introduction of smoke-free legislation in Italy significantly affected smoking behavior. We also document significant indirect effects on alcohol consumption for the main alcoholic beverage categories. A robustness analysis is also performed, to test the extent to which unobservable variables may bias our estimated parameters. Our results are then used to perform a cost-effectiveness analysis of the anti-smoking legislation in Italy.

Effects of individual and social factors on preterm birth and low birth weight: empirical evidence from regional data in Italy.

OBJECTIVES: We examine the effects of mother's characteristics and socioeconomic condition on weight at birth and preterm delivery in an Italian region (Umbria). METHODS: The study concerns all live-born singleton infants in 2007 with at least a gestational age of 22 weeks. Information derived from the Standard Certificate of Live Birth was linked to information from census statistics, so as to obtain a deprivation index. RESULTS: On the basis of the fitting of two separate logistic regression models, we conclude that all individual socioeconomic factors are strongly associated with the outcomes at birth, apart from the deprivation index. Older and less educated mothers, and those with lower occupational level, have a higher probability to run into preterm delivery with respect to the other mothers. The relative risk ratios for low birth weight are significantly higher for older mothers, non-European, and not married. Lower weight rates are found in infants from complicated pregnancy and non-spontaneous conception. CONCLUSIONS: Effects of mother's characteristics on weight at birth and weeks of gestation are confirmed. The deprivation index does not affect these outcomes, showing the proper implementation of the Health System.