Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 32
Filtrar
1.
BMC Public Health ; 23(1): 759, 2023 04 25.
Artigo em Inglês | MEDLINE | ID: mdl-37098558

RESUMO

BACKGROUND: Early in the COVID-19 pandemic, reports about a possible protective effect of nicotine on COVID-19 conflicted with messaging by public health organizations about increased risks of COVID-19 due to smoking. The ambiguous information the public received, combined with COVID-19-induced anxiety, may have led to changes in tobacco or other nicotine product use. This study examined changes in use of combustible cigarettes (CCs), nargila (hookah/waterpipe), e-cigarettes, and IQOS and home-smoking behaviors. We also assessed COVID-19 related anxiety and perceptions regarding changes in risk of COVID-19 severity due to smoking. METHODS: We used cross-sectional data from a population telephone survey that was conducted in Israel in the early phase of the COVID-19 pandemic (May-June 2020) and included 420 adult (age 18+) individuals who reported having ever used CCs (n = 391), nargila (n = 193), and/or electronic cigarettes (e-cigarettes)/heated tobacco products (e.g., IQOS) (n = 52). Respondents were asked about the effect that COVID-19 had on their nicotine product use (quit/reduced use, no change, increased use). We assessed changes in product use, risk perceptions, and anxiety using adjusted multinomial logistic regression analyses. RESULTS: Most respondents did not change their frequency of product use (CCs: 81.0%, nargila: 88.2%, e-cigarettes/IQOS: 96.8%). A small percentage either decreased use (CCs: 7.2%, nargila: 3.2%, e-cigarettes/IQOS:2.4%) or increased use (CCs:11.8%, nargila:8.6%, e-cigarettes/IQOS:+ 0.9%). 55.6% of respondents used a product in the home prior to COVID-19; but during the first lockdown COVID-19 period, a greater percentage increased (12.6%) than decreased (4.0%) their home use. Higher levels of anxiety due to COVID-19 were associated with increased home smoking (aOR = 1.59, 95% CI:1.04-2.42, p = 0.02). Many respondents believed that increased severity of COVID-19 illness was associated with CCs (62.0%) and e-cigarettes/vaping (45.3%), with uncertainty about the association being lower for CCs (20.5%) than for vaping (41.3%). CONCLUSIONS: While many respondents believed that nicotine product use (particularly CCs and e-cigarettes) was associated with increased risk of COVID-19 disease severity, the majority of users did not change their tobacco/nicotine use. The confusion about the relationship between tobacco use and COVID-19 calls for clear evidence-based messaging from governments. The association between home smoking and increased COVID-19-related stress suggests the need for campaigns and resources to prevent smoking in the home, particularly during times of stress.


Assuntos
COVID-19 , Sistemas Eletrônicos de Liberação de Nicotina , Produtos do Tabaco , Adulto , Humanos , Adolescente , Nicotina/efeitos adversos , Autorrelato , Israel/epidemiologia , Estudos Transversais , Pandemias , COVID-19/epidemiologia , Controle de Doenças Transmissíveis , Ansiedade/epidemiologia
2.
Prev Med ; 150: 106567, 2021 09.
Artigo em Inglês | MEDLINE | ID: mdl-33957153

RESUMO

Smoking cessation medications (SCMs) are an evidence-based cornerstone of comprehensive tobacco control programs globally. However, the impact of SCMs on population smoking prevalence is controversial, with inconsistencies between randomized controlled trials (RCTs) and population-based observational studies. We estimated SCM impact on permanent cessation and population smoking prevalence by extrapolating efficacy estimates from meta-analyses of RCTs, using the standard population impact formula: efficacy*reach. We calculated the potential SCM impact under a range of assumptions for permanent cessation (20%,14%), behavioral support (yes/no), reach (40%-2%), and underlying smoking prevalence. Assuming behavioral support for all, depending on reach, 8%-0.3% of smokers are expected to quit permanently. Without behavioral support, permanent cessation is estimated to be 6.4%-0.2%. Assuming an underlying population smoking prevalence of 14%, (current U.S. prevalence), the maximum impact on population smoking prevalence is 1.12%. Impact on prevalence increases with increasing underlying country-specific levels of prevalence. With current U.S. levels of reach, behavioral support and smoking prevalence, we estimate that, based on a single course of treatment, 2.3% of smokers would quit permanently, contributing to a 0.3% decrease in population level smoking prevalence. Even under ideal conditions, the potential of current first-line SCMs to increase cessation in a substantial proportion of smokers, and reduce population smoking prevalence, is limited. In order to avert the predicted billion tobacco-caused deaths in this century, "safe and effective" medications are not sufficient: SCMs with high population impact are urgently needed. Policies to ensure the availability and accessibility of highly efficacious SCMs, with behavioral support, are crucial.


Assuntos
Abandono do Hábito de Fumar , Humanos , Fumantes , Fumar , Prevenção do Hábito de Fumar , Dispositivos para o Abandono do Uso de Tabaco
3.
Nicotine Tob Res ; 20(11): 1369-1377, 2018 09 25.
Artigo em Inglês | MEDLINE | ID: mdl-29059387

RESUMO

Introduction: Forty percent of young children worldwide are exposed to the harmful effects of tobacco smoke, predominantly by parental smoking. Little is known about why parents regularly expose their children to these risks; perhaps parents underestimate the degree of exposure. Qualitative methods were used to investigate parental perceptions of tobacco smoke exposure. Methods: Sixty-five in-depth interviews were conducted with parents of young children in smoking families in central Israel. Parents were asked to explain what "exposure to smoking" meant. Thematic analysis was performed, a conceptual model of perceptions was built, and misconceptions were identified. Results: Parents reported that exposure occurs when smoke or smokers are visible, when smoke can be smelled, felt, or inhaled, or when it "reaches" an individual. Conversely, some believed that exposure does not occur in the absence of odor, visible smoke, or smokers or if smoking occurs outdoors or in indoor ventilated environments. Proximity in space and time affected perceptions of exposure; some parents believed that smoke does not spread far but dissipates rapidly. There was some uncertainty regarding whether or not exposure was occurring. Conclusions: Awareness of child exposure to tobacco smoke among parents in this study was based on sensory perceptions in the context of the physical environment. The limited capacity of humans to perceive tobacco smoke can lead to misconceptions about exposure. In order to protect children, parents must be convinced that exposure can occur even in situations where they are unable to sense it. Implications: Parents use sensory perceptions (sight, smell, and feel) in the context of the physical environment to assess whether or not their children are exposed to tobacco smoke. Because 85% of smoke is invisible and the sense of smell is unreliable, assessments based on sensory perceptions cannot provide accurate information about the presence of tobacco smoke. In order to protect children, parents must be convinced that exposure can occur even in situations where they are unable to sense it. The scientific information summarized here about exposure in common situations should be useful in persuading parents to protect their children. Clinical Trial Registration: This study is registered as a Phase I study which is part of a larger research endeavor entitled: A program to protect young children from tobacco smoke exposure. Registration number: NCT01335178.


Assuntos
Relações Pais-Filho , Pais/psicologia , Fumantes/psicologia , Fumar/efeitos adversos , Fumar/psicologia , Poluição por Fumaça de Tabaco/efeitos adversos , Adulto , Criança , Pré-Escolar , Exposição Ambiental/efeitos adversos , Exposição Ambiental/prevenção & controle , Feminino , Humanos , Israel/epidemiologia , Masculino , Fumar/epidemiologia , Prevenção do Hábito de Fumar/métodos , Nicotiana , Poluição por Fumaça de Tabaco/prevenção & controle , Adulto Jovem
4.
Nicotine Tob Res ; 19(11): 1322-1329, 2017 Nov 01.
Artigo em Inglês | MEDLINE | ID: mdl-28115500

RESUMO

INTRODUCTION: Smoking in military settings is of major concern. We aimed to assess the association between personal, family, and military factors and smoking behavior change during compulsory military service in Israel. METHODS: Participants were soldiers recruited between 1987 and 2008 who were interviewed at recruitment and reinterviewed at discharge (1987-2011) (total: 29 189; males:15 136; females:14 053). The primary outcome variables were smoking initiation during service among nonsmokers at recruitment, and cessation during service among smokers at recruitment. We examined potential predictors of change, and trends by calendar year. RESULTS: Smoking prevalence increased by 39.4% during military service (recruitment: 26.2%, discharge: 36.5%). 18.4% of nonsmoking recruits initiated smoking, and 12.4% of smoking recruits quit smoking between recruitment and discharge. There was no observed trend in initiation between 1987 and 2011. The strongest predictor of smoking initiation among nonsmokers at recruitment was smoking history (former vs. never-smoker, odds ratio (OR) [95% confidence interval [CI]]: males: 5.63 [4.63,6.85], females: 6.76 [5.27, 8.68]. Other variables had smaller effects on initiation. Females were less likely to initiate smoking than males (OR [CI]): 0.75 [0.69,0.81]. Both males and females with high military fitness levels were more likely to initiate smoking. Among women, those with lower education, with fathers with lower education, of lower socioeconomic status, and ever-users of contraceptives were more likely to initiate smoking. Cessation among males modestly increased over the years (OR [CI]): 1.03 [1.01,1.05]. CONCLUSIONS: Smoking increased substantially during mandatory military service in Israel. Former smokers were at greatly increased risk of initiation and should be targeted for relapse prevention. Military service represents a golden opportunity for tobacco control. IMPLICATIONS: Military tobacco control policy is an important contributor to longevity among service personnel, and population-wide mortality in countries with compulsory service. The increased smoking prevalence among military personnel, and increases in smoking during military service should act as a wake-up call to governments and health systems in countries lacking strong military tobacco control policies. The substantial progress in military tobacco control in the United States, which includes strong antitobacco policies for prevention of smoking initiation, aid to smokers to quit smoking, and protection of nonsmokers from tobacco smoke, should be emulated by others. Former smokers and others at high risk should be targeted for relapse prevention. The closed environment of military service provides a golden opportunity for tobacco control.


Assuntos
Militares/estatística & dados numéricos , Abandono do Hábito de Fumar/estatística & dados numéricos , Fumar/epidemiologia , Adolescente , Estudos de Coortes , Feminino , Humanos , Entrevistas como Assunto , Israel/epidemiologia , Estudos Longitudinais , Masculino , Razão de Chances , Prevalência , Inquéritos e Questionários , Fumar Tabaco
5.
Tob Control ; 27(Suppl 1): s78-s81, 2018 11.
Artigo em Inglês | MEDLINE | ID: mdl-30341089
6.
Artigo em Inglês | MEDLINE | ID: mdl-36834219

RESUMO

Young children are particularly vulnerable to harms from tobacco smoke exposure (TSE). This study aimed to compare TSE: (1) between children who live in smoking families and those who do not; and (2) among children who live in smoking households with varying smoking locations. The data came from two studies that were conducted concurrently in Israel (2016-2018). Study 1: a randomized controlled trial of smoking families (n = 159); Study 2: a cohort study of TSE among children in non-smoking families (n = 20). Hair samples were collected from one child in each household. Baseline hair nicotine data were analyzed for 141 children in Study 1 and 17 children in Study 2. Using a logistic regression analysis (exposed vs. not exposed as per laboratory determination) and a linear regression (log hair nicotine), we compared TSE between: (1) children in Study 1 vs. Study 2; (2) children in families with different smoking locations in Study 1: balcony; garden, yard, or other place outside of the home; or inside the home (designated smoking areas within the home (DSAs) or anywhere). A higher proportion of children living in smoking households were measurably exposed to tobacco smoke (68.8%) compared to children living in non-smoking households (35.3%, p = 0.006). Among children from smoking families, 75.0% of those whose parents smoked in the house were exposed, while 61.8% of children whose parents restricted smoking to the porch (n = 55) were exposed, and 71.4% of those whose parents smoked outside the home (including gardens and yards) (n = 42) were exposed. In univariable and multivariable models, smoking location was not significantly associated with exposure. The majority of children in smoking families were measurably exposed to TSE, even if smoking was restricted to designated areas in the home, balconies, orgarden/yard/other outdoor areas. Reducing population smoking rates, particularly among parents, restricting smoking to at least 10 meters from homes and children, and denormalizing smoking around others are recommended to reduce population-level child TSE and tobacco-attributable disease and death.


Assuntos
Poluição por Fumaça de Tabaco , Criança , Humanos , Pré-Escolar , Poluição por Fumaça de Tabaco/análise , Nicotina/análise , Estudos de Coortes , Israel , Nicotiana
7.
Isr J Health Policy Res ; 12(1): 25, 2023 07 21.
Artigo em Inglês | MEDLINE | ID: mdl-37480100

RESUMO

BACKGROUND: Tobacco smoke incursion (TSI) into private residences is a widespread problem in many countries. We sought to assess the prevalence of self-reported TSI and public attitudes about TSI in Israel, a country with a relatively high smoking prevalence and high population density. METHODS: We conducted a random digit dial survey among residents in Israel (N = 285) in 2017, which examined the frequency, source, correlates of, and attitudes towards TSI and potential regulatory options. The cooperation rate was 63.9%. RESULTS: Among respondents, 44.7% reported ever experiencing home TSI, with higher exposure among residents of multi-unit housing (MUH) (MUH versus private homes: aOR (Adjusted Odds Ratio): 3.60, CI (Confidence Interval): [1.96, 6.58], p < .001). Most respondents (69.8%), including nearly half of smokers, prioritized the right of individuals to breath smoke-free air in their apartments over the right of smokers to smoke in their apartments. Women and non-smokers were more likely to support the right to breathe smoke-free air (Women versus men: aOR: 2.77 CI: [1.48, 5.16], p = .001; Nonsmokers versus smokers: aOR: 3.21 CI [1.59, 6.48], p = .001). However, only about a quarter (24.8%) of respondents who ever experienced TSI raised the issue with the neighbor who smoked, the neighbor's landlord, or the building committee. The vast majority (85.2%) of all respondents, including three-quarters of smokers, supported smoke-free legislation for multi-unit housing (MUH), with those ever-exposed to TSI and non-smokers more likely to support legislation (ever-exposed versus never-exposed aOR = 2.99, CI [1.28, 6.97], p = 0.011; nonsmokers versus smokers aOR = 3.00, CI [1.28, 7.01], p = 0.011). CONCLUSIONS: Among study participants, tobacco smoke incursion was a common, yet unwelcome experience. Most respondents believed that the right to breathe smoke-free air in one's apartment superseded that of neighbors to smoke anywhere in their home, and most supported legislation to prevent TSI. Though further study is needed to understand better TSI and effective methods for its prevention, our findings suggest that policy interventions, including legal action at the level of the Supreme Court and/or the Knesset, are needed. Regulation, policy initiatives and campaigns to denormalize smoking in proximity to other people and private residences globally could reduce the scope of this widespread problem, protect individuals from home TSI, and improve population health.


Assuntos
Opinião Pública , Poluição por Fumaça de Tabaco , Masculino , Humanos , Feminino , Estudos Transversais , Israel/epidemiologia , Poluição por Fumaça de Tabaco/prevenção & controle , Políticas
8.
Nicotine Tob Res ; 14(6): 648-56, 2012 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-22311964

RESUMO

INTRODUCTION: Adolescent secondhand smoke exposure (SHSe) is associated with smoking initiation and independently damages health. METHODS: We used data from the school-based 2003-2004 Israel National Health and Nutrition Youth survey (MABAT) to examine patterns and determinants of SHSe in a multiethnic sample of Israeli adolescents. School and child response rates were high (school: 91.8%, child: 87.9%), with 6,274 participants. We used generalized estimating equations to examine SHSe determinants. RESULTS: Most Israeli adolescents were exposed to SHS (total: 85.6%; home: 40%; school: 31.4%; entertainment: 73.3%; other: 16.3%). Exposure patterns differed between the Jewish and non-Jewish sectors. Jews were more frequently exposed at school and entertainment venues than were non-Jews but were less frequently exposed at home. Druze were the least exposed and non-Arab Christians the most exposed. Secular Jews were more exposed than were religious Jews; the opposite was true among Arabs. Children of less-educated fathers were exposed more than children of more-educated fathers. Adolescents who smoked were more exposed than were nonsmokers. CONCLUSIONS: The high levels of SHSe among Israeli adolescents were characterized by different patterns of exposure among different population groups. Interventions to reduce adolescent SHSe, with appropriate tailoring, are urgently needed. These findings provide support for sustainable implementation of the recent governmentally approved tobacco control plan, which includes extended legislation for, and increased enforcement of, laws about smoking bans in schools and entertainment venues. Researchers elsewhere should be aware that levels and patterns of SHSe may vary greatly by subpopulation.


Assuntos
Comportamento do Adolescente/etnologia , Fumar/etnologia , Poluição por Fumaça de Tabaco/estatística & dados numéricos , Adolescente , Comportamento do Adolescente/psicologia , Criança , Feminino , Política de Saúde , Inquéritos Epidemiológicos/estatística & dados numéricos , Humanos , Israel/etnologia , Judeus/psicologia , Judeus/estatística & dados numéricos , Modelos Logísticos , Masculino , Pais/educação , Religião , Instituições Acadêmicas , Prevenção do Hábito de Fumar , Poluição por Fumaça de Tabaco/efeitos adversos , Abandono do Uso de Tabaco/métodos , Adulto Jovem
9.
Tob Induc Dis ; 20: 62, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35854878

RESUMO

INTRODUCTION: Tobacco smoke exposure (TSE) harms children and adults. Studies of childhood TSE exposure often relies on parental reports, but may benefit from objective measures. The objective of our study was to study the relationship between reported and objective measures of TSE. METHODS: We analyzed data from four intervention trials, conducted in clinical or community settings, to identify objective measures most closely associated with parent-reported measures and the optimal set of parent-reported measures for predicting objective measures. We also assessed whether there was a learning curve in reported exposure over time, and the importance of replicate biomarker measures. RESULTS: Correlations between objective and parent-reported measures of child TSE were modest at best, ranging from zero to 0.41. Serum cotinine and urinary cotinine were most strongly associated with parental reports. Parental questions most closely related to biomarkers were number of cigarettes and home smoking rules; together these formed the best set of predictive questions. No trial included all objective measures and all questions, precluding definitive statements about relative advantages. Within-subject repeatability of biomarker measures varied across studies, suggesting that direct pilot data are needed to assess the benefit of replicate measurements. CONCLUSIONS: Improvements in objective and parent-reported child exposure measurements are needed to accurately monitor child TSE, evaluate efforts to reduce such exposure, and better protect child health.

10.
BMC Public Health ; 11: 508, 2011 Jun 28.
Artigo em Inglês | MEDLINE | ID: mdl-21711530

RESUMO

BACKGROUND: Tobacco smoke exposure (TSE) is a serious threat to child health. Roughly 40% of children worldwide are exposed to tobacco smoke, and the very young are often "captive smokers" in homes in which others smoke.The goal of this research project is to develop and evaluate an intervention to reduce young child tobacco smoke exposure. The objective of this paper is to document our approach to building the intervention, to describe the planned intervention, and to explore the conceptual issues regarding the intervention and its evaluation. METHODS/DESIGN: This project is being developed using an iterative approach. We are currently in the middle of Stage 1. In this first stage, Intervention Development, we have already conducted a comprehensive search of the professional literature and internet resources, consulted with experts in the field, and conducted several Design Workshops. The planned intervention consists of parental group support therapy, a website to allow use of an "online/offline" approach, involvement of pediatricians, use of a video simulation game ("Dr. Cruz") to teach parents about child TSE, and personalized biochemical feedback on exposure levels. As part of this stage we will draw on a social marketing approach. We plan to use in-depth interviews and focus groups in order to identify barriers for behavior change, and to test the acceptability of program components.In Stage II, we plan to pilot the planned intervention with 5-10 groups of 10 parents each.In Stage III, we plan to implement and evaluate the intervention using a cluster randomized controlled trial with an estimated 540 participants. DISCUSSION: The major challenges in this research are twofold: building an effective intervention and measuring the effects of the intervention. Creation of an effective intervention to protect children from TSE is a challenging but sorely needed public health endeavor. We hope that our approach will contribute to building a stronger evidence base for control of child exposure to tobacco smoke.


Assuntos
Desenvolvimento de Programas/métodos , Projetos de Pesquisa , Poluição por Fumaça de Tabaco/prevenção & controle , Pré-Escolar , Grupos Focais , Humanos , Entrevistas como Assunto , Masculino , Ensaios Clínicos Controlados Aleatórios como Assunto
11.
Eur J Public Health ; 21(1): 15-20, 2011 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-20110272

RESUMO

BACKGROUND: In 2007, Israel passed a law to extend existing restrictions on smoking in public places and to strengthen enforcement. Responsibility for ensuring smoke-free indoor public places was placed on establishment owners. Bars and pubs were included in the law for the first time. This study aimed to assess changes in air quality in popular Israeli bars, pubs and cafes after the implementation of law, and to examine changes in patron numbers, percentage of smoking patrons and venue-seating sections. METHODS: Air quality was determined by measuring respirable suspended particles (PM(2.5) µg(-3)) in 33 randomly selected venues in Jerusalem and Tel Aviv, including bars, pubs and cafes, before and after law implementation. Numbers of patrons and smoking patrons were recorded. RESULTS: Average respirable small particles (RSP) level was 245 µg(-3) prior to implementation and 161 µg(-3) following implementation of the law, representing a decline of 34% (P = 0.0043). RSP levels decreased in bars and pubs and in cafes. Percentage of smoking patrons declined from 19% to 9% (P = 0.0036). The magnitude of the effect decreased over time (P = 0.0039). Non-smoking establishments were more common following the legislation (P = 0.0047). CONCLUSION: Indoor air pollution from second-hand smoke in Israeli bars, pubs and cafes in Jerusalem and Tel Aviv declined following the implementation of law. This demonstrates that a law to extend existing restrictions and enforcement policies may help protect workers and patrons from tobacco smoke. However, RSP levels in Israeli bars and pubs, especially in Tel Aviv, remain unacceptably high. Enforced, 100% smoke-free laws are essential for complete protection.


Assuntos
Material Particulado/análise , Restaurantes/legislação & jurisprudência , Poluição por Fumaça de Tabaco/análise , Poluição por Fumaça de Tabaco/legislação & jurisprudência , Monitoramento Ambiental/métodos , Monitoramento Epidemiológico , Humanos , Israel , Fumar/epidemiologia
12.
BMC Med Res Methodol ; 10: 34, 2010 Apr 25.
Artigo em Inglês | MEDLINE | ID: mdl-20416114

RESUMO

BACKGROUND: The systematic review (SR) lies at the core of evidence-based medicine. While it may appear that the SR provides a reliable summary of existing evidence, standards of SR conduct differ. The objective of this research was to examine systematic review (SR) methods used by the Cochrane Collaboration ("Cochrane") and the Task Force on Community Preventive Services ("the Guide") for evaluation of effectiveness of tobacco control interventions. METHODS: We searched for all reviews of tobacco control interventions published by Cochrane (4th quarter 2008) and the Guide. We recorded design rigor of included studies, data synthesis method, and setting. RESULTS: About a third of the Cochrane reviews and two thirds of the Guide reviews of interventions in the community setting included uncontrolled trials. Most (74%) Cochrane reviews in the clinical setting, but few (15%) in the community setting, provided pooled estimates from RCTs. Cochrane often presented the community results narratively. The Guide did not use inferential statistical approaches to assessment of effectiveness. CONCLUSIONS: Policy makers should be aware that SR methods differ, even among leading producers of SRs and among settings studied. The traditional SR approach of using pooled estimates from RCTs is employed frequently for clinical but infrequently for community-based interventions. The common lack of effect size estimates and formal tests of significance limit the contribution of some reviews to evidence-based decision making. Careful exploration of data by subgroup, and appropriate use of random effects models, may assist researchers in overcoming obstacles to pooling data.


Assuntos
Abandono do Hábito de Fumar , Prevenção do Hábito de Fumar , Revisões Sistemáticas como Assunto , Indústria do Tabaco , Humanos , Medicina Baseada em Evidências , Projetos de Pesquisa , Abandono do Hábito de Fumar/métodos , Indústria do Tabaco/legislação & jurisprudência
13.
Artigo em Inglês | MEDLINE | ID: mdl-32414093

RESUMO

Around 40% of children are exposed to tobacco smoke, increasing their risk of poor health. Previous research has demonstrated misunderstanding among smoking parents regarding children's exposure. The parental perceptions of exposure (PPE) measure uses visual and textual vignettes to assess awareness of exposure to smoke. The study aimed to determine whether PPE is related to biochemical and reported measures of exposure in children with smoking parents. Families with at least one smoking parent and a child ≤ age 8 were recruited. In total, 82 parents completed the PPE questionnaire, which was assessed on a scale of 1-7 with higher scores denoting a broader perception of exposure. Parents provided a sample of their child's hair and a self-report of parental smoking habits. Parents who reported smoking away from home had higher PPE ratings than parents who smoke in and around the home (p = 0.026), constituting a medium effect size. PPE corresponded with home smoking frequency, with rare or no home exposure associated with higher PPE scores compared to daily or weekly exposure (p < 0.001). PPE was not significantly related to hair nicotine but was a significant explanatory factor for home smoking location. PPE was significantly associated with parental smoking behaviour, including location and frequency. High PPE was associated with lower exposure according to parental report. This implies that parental understanding of exposure affects protective behaviour and constitutes a potential target for intervention to help protect children.


Assuntos
Pais , Poluição por Fumaça de Tabaco , Adulto , Criança , Pré-Escolar , Humanos , Nicotina , Relações Pais-Filho , Fumar , Nicotiana , Fumar Tabaco
14.
Artigo em Inglês | MEDLINE | ID: mdl-32408551

RESUMO

Children who live with smokers are at risk of poor health, and of becoming smokers themselves. Misperceptions of the nature of tobacco smoke exposure have been demonstrated among parents, resulting in continued smoking in their children's environment. This study aimed to change parents' perceptions of exposure by providing information on second- and third-hand exposure and personalised information on children's exposure [NIH registry (NCT02867241)]. One hundred and fifty-nine families with a child < 8 years and at least one smoking parent were randomized into intervention (69), control (70), and enhanced control (20) groups. Reported exposure, parental smoking details, and a child hair sample were obtained at the start of the study and 6-8 months later. Parental perceptions of exposure (PPE) were assessed via a questionnaire. The intervention consisted of motivational interviews, feedback of home air quality and child's hair nicotine level, and information brochures. PPE were significantly higher at the study end (94.6 ± 17.6) compared to study beginning (86.5 ± 19.3) in intervention and enhanced control groups (t(72) = -3.950; p < 0.001). PPE at study end were significantly higher in the intervention group compared to the regular control group (p = 0.020). There was no significant interaction between time and group. Parallel changes in parental smoking behaviour were found. Parental perceptions of exposure were increased significantly post intervention, indicating that they can be altered. By making parents more aware of exposure and the circumstances in which it occurs, we can help parents change their smoking behaviour and better protect their children.


Assuntos
Abandono do Hábito de Fumar , Poluição por Fumaça de Tabaco , Fumar Tabaco , Tabagismo , Adulto , Criança , Exposição Ambiental , Humanos , Relações Pais-Filho , Pais , Fumar , Tabagismo/terapia
15.
Prev Med ; 49(1): 12-8, 2009 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-19289142

RESUMO

OBJECTIVE: To propose a scheme for comprehensive development and evaluation of lifestyle interventions. METHODS: We adapted the four-phase system used in drug development, the engine of progress in medicine for decades, to construct a system for developing lifestyle intervention programs. RESULTS: Phase I: The intervention is constructed and tested with a small number of individuals. Acceptability and feasibility are assessed. Evaluation is primarily qualitative. Phase II: Effectiveness on intermediate endpoints (e.g. behavior) is tested in a real field setting, with a limited number of individuals, using a before-and-after design. An iterative process of testing and refinement may be necessary. Phase III: The effectiveness of the intervention on health-related outcomes is tested, using, where possible, a randomized design. Phase IV: Large-scale implementation and penetration are assessed in other populations. Process variables and local and national health indicators are studied. The development and evaluation of our hygiene intervention, which took place in Jerusalem from 1999 to 2001, is presented as a case study. CONCLUSIONS: Adaptation of the phased system of drug development to lifestyle interventions is a conceptually simple approach to building effective, sustainable programs for community-based public health.


Assuntos
Pré-Escolar/educação , Ensaios Clínicos como Assunto/métodos , Promoção da Saúde/organização & administração , Estilo de Vida , Absenteísmo , Desinfecção das Mãos , Promoção da Saúde/métodos , Humanos , Higiene/educação , Estudos de Casos Organizacionais , Desenvolvimento de Programas/métodos , Avaliação de Programas e Projetos de Saúde , Escolas Maternais
16.
Tob Induc Dis ; 17: 18, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31582929

RESUMO

INTRODUCTION: Secondhand smoke (SHS) in the home is a serious cause of ill-health, especially for children. SHS indoors can be indirectly measured using particulate matter monitors, and interventions have been developed using feedback from these monitors to encourage smoke-free homes. These interventions often use data that are several days out of date, as the data must be downloaded manually from monitors. It would be advantageous to access this information remotely in real-time to provide faster feedback to intervention participants. METHODS: Using off-the-shelf computer components and the Dylos DC1700 air quality monitor, a portable internet-connected monitor was developed that can send data to a server remotely. Four of these monitors were tested in homes in Israel to test the reliability of the connection. Data were downloaded from the monitor's onboard memory and compared to the data sent to the server. RESULTS: Eight homes were monitored for 4 to 6 days, with a combined total count of 44 days. Less than 1% of data was lost, with no outage lasting longer than 1 hour 45 minutes. There was no significant difference in the mean concentrations measured in homes between mobile-transmitted data and data downloaded directly. CONCLUSIONS: This system appears to be a reliable way to monitor remotely home air quality for use in intervention studies, and could potentially have applications in other related research. Laboratories that own Dylos DC1700s may wish to consider converting them to such a system to obtain a cost-effective way of overcoming limitations in the Dylos design.

17.
BMJ Open ; 9(9): e031353, 2019 09 20.
Artigo em Inglês | MEDLINE | ID: mdl-31542761

RESUMO

OBJECTIVES: Physicians' demanding work conditions may reduce the time and energy required for maintaining healthy lifestyles. This study examined health-related behaviours, perceived health status and emotional stress among physicians, and analysed the effects of personal and work characteristics on these endpoints. DESIGN: A cross-sectional study using a digital questionnaire. SETTING AND PARTICIPANTS: All 25 590 physicians who were members of the Israeli Medical Association in 2015 were invited to participate by email. Of 14 694 who opened the e-mail, 4832 (32.9%) responded. OUTCOME MEASURES: Survey topics included physical activity (PA), nutrition and eating habits, smoking, sleep, perceived health status and emotional stress, body mass index (BMI) and contact with a regular physician, as well as personal and work characteristics. Univariate and multivariate analyses were performed. RESULTS: Of the 4832 respondents, 21% reported poor or fair health status, 36% felt considerable emotional stress, 57% were overweight or obese (according to BMI≥25 kg/m2), 71% did not meet the recommended PA level, 79% did not meet a composite measure of healthy nutrition, 8% were current smokers, 25% slept 5 hours or less and 57% did not have a regular physician. Residents and hospital physicians reported significantly less healthy lifestyles, lower perceived health status and higher stress levels, compared with senior and community physicians. Multivariate analysis demonstrated that being female (OR=0.74, 95% CI=0.64 to 0.85), younger (0.69, 0.64 to 0.74), having poor nutrition (0.66, 0.55 to 0.78), not meeting PA targets (0.68, 0.57 to 0.82), inadequate sleep (0.54, 0.40 to 0.56) and perceived poor health status (0.48, 0.40 to 0.56) were significantly associated with high stress levels (p<0.001). CONCLUSIONS: The unfavourable health behaviours reported among Israeli physicians may have negative effects on their health and well-being. An intervention program to help physicians to adopt a healthier lifestyle is urgently needed.


Assuntos
Atitude do Pessoal de Saúde , Atitude Frente a Saúde , Comportamentos Relacionados com a Saúde , Nível de Saúde , Estresse Ocupacional , Médicos/psicologia , Adulto , Idoso , Estudos Transversais , Autoavaliação Diagnóstica , Feminino , Humanos , Israel , Masculino , Pessoa de Meia-Idade , Estresse Ocupacional/epidemiologia
18.
Isr J Health Policy Res ; 8(1): 10, 2019 Jan 14.
Artigo em Inglês | MEDLINE | ID: mdl-30642402

RESUMO

BACKGROUND: Devastation from the tobacco epidemic continues, with strong government tobacco control policy absent in most countries. Knowledge of the full scope of tobacco harm in populations may form the basis for healthier behavior, de-normalization of smoking, and a consensus about necessary public policy. However, many populations may be poorly-informed about the risks, and this ignorance may undermine both effective policy-making and implementation of tobacco control policies. We present knowledge and risk perceptions about smoking tobacco smoke exposure in Israel. METHODS: A nationally-representative phone survey was conducted in Israel (n = 505; response rate = 61%). We assessed knowledge about active and passive smoking using four questions, three of which addressed knowledge about harm, and one of which addressed knowledge of tobacco-related harm relative to knowledge of harm due to traffic accidents. The three questions which addressed knowledge of harm were combined into a composite score. We also asked four risk perception questions concerning tobacco smoke exposure, which were measured on a 7-point Likert scale and then combined. Multivariable logistic regression and linear models were used to identify whether smoking status or socio-demographic variables were associated with knowledge of harm, comparative knowledge of harm, and risk perceptions. RESULTS: Just two in five respondents, and one in five respondents who were current smokers, accurately answered three simple questions about harms of smoking. Fewer than three in ten respondents, and fewer than one in five smokers, knew that smoking causes more damage than traffic accidents. Many (30.3%) were unaware that tobacco smoke exposure causes both lung cancer and heart disease, 27.7% did not know that smoking both shortens life and injures quality of life, and 31.1% did not know that smoking-attributable health problems will afflict all or most heavy smokers. Overall, risk perceptions regarding tobacco smoke exposure were high (mean = 24.5, SD:4.5, on a scale of 7-28, with 28 the indicating highest level). Smoking status was consistently associated with lower levels of knowledge, comparative knowledge, and risk perceptions, with current smokers having the lowest levels of knowledge and the lowest risk perceptions. CONCLUSIONS: Like many others, Israelis, and particularly Israeli smokers, do not fully grasp tobacco's true dangers. Effective communication of the full range of tobacco risks to the public, with a focus on communication with smokers, is an essential component of comprehensive tobacco control policy.


Assuntos
Conhecimentos, Atitudes e Prática em Saúde , Percepção , Assunção de Riscos , Fumar/psicologia , Adolescente , Adulto , Idoso , Feminino , Política de Saúde/tendências , Humanos , Israel , Masculino , Pessoa de Meia-Idade , Inquéritos e Questionários , Poluição por Fumaça de Tabaco/efeitos adversos , Poluição por Fumaça de Tabaco/estatística & dados numéricos
19.
Isr Med Assoc J ; 10(8-9): 584-7, 2008.
Artigo em Inglês | MEDLINE | ID: mdl-18847155

RESUMO

BACKGROUND: Secondhand smoke poses a serious health hazard. In Israel the recent passage of a law designed to protect people from secondhand smoke in public places was greeted with controversy. The debate is taking place without data on actual levels of pollution for secondhand smoke in public places. OBJECTIVES: To estimate levels of small respirable suspended particles, atmospheric markers of secondhand smoke, in Israeli bars, pubs and cafes, to compare them with levels in other countries, and to analyze RSP determinants. METHODS: This study was conducted in bars, pubs and cafes in Jerusalem and Tel Aviv prior to passage of the enforcement bill. Venues were randomly sampled from lists available in the local mass media. RESULTS: The average level of RSPs across all venues, 283 microg/m3, was nearly identical to levels in countries without enforced smoking bans. Bars and pubs had higher values than cafes (P = 0.0101). The effect of smoker concentration was borderline significant (P = 0.0540), with RSP levels increasing as smoker concentration increased. The effect of venue height was also borderline significant (P = 0.0642), with RSP levels decreasing as venue height increased. CONCLUSIONS: Levels of indoor air pollution from secondhand smoke in Israeli bars, pubs and cafes prior to the recent passage of the enforcement bill were similar to levels in countries without enforced smoking bans, and roughly 10 times as high as countries with enforced smoking bans. Whether the new law will successfully promote clean air in Israeli bars, pubs, cafes, and other indoor places is yet to be seen.


Assuntos
Poluição do Ar em Ambientes Fechados/análise , Restaurantes , Poluição por Fumaça de Tabaco/análise , Poluição do Ar em Ambientes Fechados/legislação & jurisprudência , Poluição do Ar em Ambientes Fechados/prevenção & controle , Humanos , Israel , Restaurantes/legislação & jurisprudência , Fumar/legislação & jurisprudência , Poluição por Fumaça de Tabaco/legislação & jurisprudência , Poluição por Fumaça de Tabaco/prevenção & controle
20.
Addiction ; 113(5): 805-816, 2018 05.
Artigo em Inglês | MEDLINE | ID: mdl-29377409

RESUMO

BACKGROUND AND AIMS: Although smoking cessation medications have shown effectiveness in increasing abstinence in randomized controlled trials (RCTs), it is unclear to what extent benefits persist over time. This paper assesses whether the benefits of smoking cessation medications decline over the first year. METHODS: We selected studies from three systematic reviews published by the Cochrane Collaboration. RCTs of first-line smoking cessation medications, with 6- and 12-month follow-up, were eligible for inclusion. Meta-analysis was used to synthesize information on sustained abstinence (SA) at 6 versus 12 months and 3 versus 6 months, using the risk difference (RD) ('net benefit') between intervention and control group quit rates, the relative risk (RR) and the odds ratio (OR). RESULTS: Sixty-one studies (27 647 participants) were included. Fewer than 40% of intervention group participants were sustained abstinent at 3 months (bupropion: 37.1%; nicotine replacement therapy (NRT): 34.8%; varenicline: 39.3%); approximately a quarter were sustained abstinent at 6 months (bupropion: 25.9%; NRT: 26.6%; varenicline: 25.4%), and approximately a fifth were sustained abstinent at 12 months (bupropion: 19.9%; NRT: 19.8%%; varenicline: 18.7%). There was only a small decline in RR (3 months: 1.95 [95% confidence interval (CI) = 1.74-2.18, P < 0.0001]; 6 months: 1.87 (95% CI = 1.67-2.08 P < 0.0001); 12 months: 1.75 (95% CI = 1.56-1.95, P < 0.0001) between intervention and control groups over time, but a substantial decline in net benefit [3 months: RD = 17.3% (14.5-20.1%); 6 months: RD = 11.8% (10.0-13.7%); 12 months: RD = 8.2% (6.8-9.6%)]. The decline in net benefit was statistically significant between 3 and 6 [RD = 4.95% (95% CI = 3.49-6.41%), P < 0.0001] and 6 and 12 months [RD = 3.00% (95% CI = 2.36%-3.64%), P < 0.0001)] for medications combined and individual medications. CONCLUSIONS: The proportion of smokers who use smoking cessation medications who benefit from doing so decreases during the course of the first year, but a net benefit still remains at 12 months.


Assuntos
Bupropiona/uso terapêutico , Agentes de Cessação do Hábito de Fumar/uso terapêutico , Abandono do Hábito de Fumar/métodos , Fumar/tratamento farmacológico , Dispositivos para o Abandono do Uso de Tabaco , Vareniclina/uso terapêutico , Humanos , Ensaios Clínicos Controlados Aleatórios como Assunto , Fatores de Tempo , Resultado do Tratamento
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA