Last data update: May 06, 2024. (Total: 46732 publications since 2009)
Records 1-30 (of 77 Records) |
Query Trace: Ahluwalia N[original query] |
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Data related to social determinants of health captured in the National Health and Nutrition Examination Survey
Lau DT , Ahluwalia N , Fryar CD , Kaufman M , Arispe IE , Paulose-Ram R . Am J Public Health 2023 113 (12) 1290-1295 Health equity is defined as “attainment of the highest level of health for all people” and encompasses fair and just opportunities for everyone to be as healthy as possible.1 Health equity research examines the existence of health disparities and their underlying factors, which can be categorized into broad determinants of health, including genetics, behavior, environmental influences, medical care, and social factors.2 The last category, also known as social determinants of health (SDOH), includes social and structural factors, such as racism and discriminatory practices and policies.3 Healthy People 2030 categorizes SDOH into five domains4: education access and quality, economic stability, health care access and quality, social and community context, and neighborhood and built environment. Evidence shows that SDOH influence a wide range of health outcomes5,6 and nutritional status.7 Exposures to adverse SDOH, such as food deserts and unsafe neighborhoods, are inequitably experienced by subgroups that vary by race and ethnicity, socioeconomic status, and other characteristics historically associated with discrimination or exclusion. Variation among groups in access to resources and their differential vulnerability to adverse exposures result in health disparities.8 |
WHO Framework Convention on Tobacco Control learnings
Cohen JE , Myers ML , Ahluwalia IB . Health Secur 2023 21 (5) 428-429 We are pleased that the World Health Organization (WHO) is developing a pandemic treaty to improve the global response to future pandemics. In their article, De Luca and Ramirez1 rightly argue that a pandemic treaty should be informed by experiences with WHO's existing treaty, the WHO Framework Convention on Tobacco Control (WHO FCTC), which came into force in 2005. However, the authors have mischaracterized the WHO FCTC and made criticisms that could hinder a productive discussion about a treaty for pandemics. | | The authors identify a limited emphasis on “harm reduction” as a key limitation of the WHO FCTC. However, the treaty itself includes “harm reduction strategies” in its definition of tobacco control.2 As the authors indicate, harm reduction encompasses actions “aimed at reducing the negative effects of health behaviors without necessarily extinguishing the problematic health behaviors completely or permanently.”1,3 The WHO FCTC and its guidelines for implementation—which include requiring smoke-free public places; banning tobacco advertising, promotion, and sponsorship; and reducing the attractiveness of tobacco products by limiting flavoring agents—allow the continuation of product use, while reducing t |
Reasons to decrease or stop nicotine and tobacco use among adults and association with MPOWER scores in twenty-one middle- and high-income countries, 2019-2020
Sharapova SR , Whitney C , Sulentic R , Pan L , Ahluwalia IB . Tob Prev Cessat 2023 9 25 INTRODUCTION: This study examined reasons why people planned to reduce or stop tobacco consumption and their relationship with MPOWER scores, adjusting for sociodemographic, cultural, and economic factors. METHODS: Data used were Euromonitor International's Voice of the Consumer: Nicotine Survey 2019-2020, World Bank's country income and WHO's MPOWER policy scores. Analytical sample included 21913 adults of legal smoking age in 21 middle- and high-income countries who used nicotine and tobacco products and planned to reduce or stop their consumption in the next 12 months. Poisson regression models with robust error variance, adjusted for sociodemographic and tobacco use covariables, generated adjusted risk ratios (ARRs) of selecting a certain reason to reduce tobacco consumption dependent on continuous MPOWER scores. RESULTS: Main reasons to reduce or stop tobacco consumption were improving health (85%), saving money (65%), pressure from family (19%), and using another substance instead (4%). Country variation was observed by MPOWER scores. Positive associations were found between some MPOWER scores and reasons to reduce or stop tobacco consumption: enforcing bans on tobacco advertising and using another substance (ARR=1.28; 95% CI: 1.11-1.47); warning about dangers of tobacco and saving money (ARR=1.25; 95% CI: 1.19-1.32); offering help to quit tobacco and using another substance (ARR=1.26; 95% CI: 1.10-1.45) or family pressure (ARR=1.11; 95% CI: 1.04-1.17); anti-tobacco campaigns and using another substance (ARR=1.15; 95% CI: 1.08-1.23); and raising taxes and saving money (ARR=1.11; 95% CI: 1.09-1.13). CONCLUSIONS: MPOWER scores are associated with reported reasons to quit tobacco including to improve health, save money, respond to family pressure or use another substance instead. |
Response to Correspondence: The impact of smoking on TB treatment outcomes includes recurrent TB
Wang EY , Ahluwalia IB , Mase SR . Int J Tuberc Lung Dis 2020 24 (11) 1225a-1225 Thank you for the opportunity to respond to the Correspondence by Drs. Chiang and Bam1 with regards to recurrent TB as a treatment outcome associated with smoking. We appreciate their interest in our article and their questions concerning the three manuscripts that were not included in our meta-analysis.2 The first, by Balian et al.2 was not identified in our updated search in August of 2017. The two other articles, by Masjedi et al.3 and Leung et al.,4 were excluded from our meta-analysis as they included former smokers in their smoking definitions and models. Our meta-analysis attempted to focus solely on current smokers and we excluded articles that specifically identified their exposure group as including former smokers. However, we agree that former smoking may be an important risk factor to consider in future research regarding smoking and TB treatment outcomes. | | We also concur with the conclusion that recurrent TB is an important treatment outcome that should be considered in the context of smoking behavior. This was not explored in our meta-analysis, but we encourage others to include this in future research and reviews of this topic. |
Percentage of current tobacco smoking students receiving help or advice to quit: Evidence from the Global Youth Tobacco Survey, 56 countries, 2012-2015
Arrazola RA , Seidenberg AB , Ahluwalia IB . Tob Prev Cessat 2019 5 5 INTRODUCTION: We assessed self-reported receipt of help or advice to stop smoking among current tobacco smoking students enrolled in school. METHODS: Using cross-sectional data collected between 2012-2015 from the Global Youth Tobacco Survey (GYTS), and representing the latest year for which data were collected, we calculated prevalence of receipt of help or advice to stop smoking among current tobacco smoking students aged 13-15 years from 56 countries. The sources of help or advice assessed in the GYTS were: 1) from a program or professional, 2) from a friend, and 3) from a family member. Overall response rates ranged from 60.3% in Nicaragua to 99.2% in Sudan. The analytic sample size ranged from 55 in Gabon to 950 in Bulgaria. RESULTS: In 53 of the 56 assessed countries, more than half of current tobacco smoking students received help or advice to quit from either a program or professional, friend, or family member (range=39.9% San Marino to 96.9% Timor-Leste). From a friend or family member only, the range was 37.2% Bahamas to 69.9% Montenegro, and from a program or professional only, the range was 3.7% Latvia to 34.2% Togo. CONCLUSIONS: Family and friends are the most common sources of help or advice to quit smoking among current tobacco smoking students in the GYTS countries assessed, while programs and professionals were the least common. The use of evidence-based measures is critical to prevent and reduce tobacco use among youth and to ensure they are receiving appropriate help or advice to quit. |
Perspective: Human milk composition and related data for national health and nutrition monitoring and related research
Ahuja JKC , Casavale KO , Li Y , Hopperton KE , Chakrabarti S , Hines EP , Brooks SPJ , Bondy GS , MacFarlane AJ , Weiler HA , Wu X , Borghese MM , Ahluwalia N , Cheung W , Vargas AJ , Arteaga S , Lombo T , Fisher MM , Hayward D , Pehrsson PR . Adv Nutr 2022 13 (6) 2098-2114 National health and nutrition monitoring is an important federal effort in the United States and Canada, and the basis for many of their nutrition and health policies. Understanding of child exposures through human milk (HM) remains out of reach due to lack of current and representative data on HM's composition and intake volume. This article provides an overview of the current national health and nutrition monitoring activities for HM-fed children, HM composition (HMC) and volume data used for exposure assessment, categories of potential measures in HM, and associated variability factors. In this Perspective, we advocate for a framework for collection and reporting of HMC data for national health and nutrition monitoring and programmatic needs, including a shared vision for a publicly available Human Milk Composition Data Repository (HMCD-R) to include essential metadata associated with HMC. HMCD-R can provide a central, integrated platform for researchers and public health officials for compiling, evaluating, and sharing HMC data. The compiled compositional and metadata in HMCD-R would provide pertinent measures of central tendency and variability and allow use of modeling techniques to approximate compositional profiles for subgroups, providing more accurate exposure assessments for purposes of monitoring and surveillance. HMC and related metadata could facilitate understanding the complexity and variability of HM composition, provide crucial data for assessment of infant and maternal nutritional needs, and inform public health policies, food and nutrition programs, and clinical practice guidelines. |
Changes in prevalence and predictors of tobacco smoking and interest in smoking cessation in Turkey: Evidence from the Global Adult Tobacco Survey, 20082016
Summers AD , Sirin H , Palipudi K , Erguder T , Ciobanu A , Ahluwalia IB . Tob Prev Cessat 2022 8 35 INTRODUCTION Turkey conducted three rounds of the Global Adult Tobacco Survey (GATS) in 2008, 2012, and 2016 to monitor tobacco use and key tobacco control indicators. The prevalence estimate of adult tobacco use was 31.2% in 2008 and it declined to 27.1% in 2012. METHODS GATS is a nationally-representative, cross-sectional household survey of tobacco-use and related behaviors among adults aged 15 years. Outcome measures were prevalence of current tobacco smoking and interest in quitting smoking. Multivariable logistic regression analyses assessed changes in the adjusted prevalence and predictors of the outcome variables. RESULTS The unadjusted prevalence of tobacco smoking among adults was 31.6% in 2016; a significant increase in the adjusted prevalence of 4.5% from 2012 to 2016. A significant 19.4% decline was observed in interest in quitting smoking from 2012 to 2016. Tobacco smoking was lower among women (adjusted prevalence ratio, APR=0.38) and rural residents (APR=0.79), and higher among adults aged 2564 years compared to those aged 1524 years (APR=1.63), and those who lived with other adults who smoke tobacco (APR=1.55). Predictors of increased interest in quitting smoking included rural residence (APR=1.13), higher education level (APR=1.211.36), awareness of anti-tobacco warnings and advertisements (APR=1.30), and belief that smoking causes severe health consequences (APR=1.57). CONCLUSIONS This study identified opportunities to reduce tobacco smoking and increase interest in quitting, including increasing awareness of the health consequences of smoking and of evidence-based cessation resources. This study highlights Turkeys commitment to assessing or monitoring tobacco use and key tobacco indicators to inform their policies and programs in a changing tobacco landscape. 2022 Summers A. D. et al. This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 International License. (http://creativecommons.org/licenses/by/4.0) |
Frequency of eating in the US population: A narrative review of the 2020 Dietary Guidelines Advisory Committee Report
Bailey RL , Leidy HJ , Mattes RD , Heymsfield SB , Boushey CJ , Ahluwalia N , Cowan AE , Pannucci T , Moshfegh AJ , Goldman JD , Rhodes DG , Stoody EE , de Jesus J , Casavale KO . Curr Dev Nutr 2022 6 (9) nzac132 BACKGROUND: A person's daily nutrient intake and overall nutritional status are determined by a complex interplay of the types and amounts of foods ingested in combination with the timing and frequency of eating. OBJECTIVES: The aim was to summarize frequency of eating occasion data examined by the 2020 Dietary Guidelines Advisory Committee, the macronutrient contributions they provide, and meal frequency relative to dietary quality among the US population (≥2 y), with a focus on sex, age, race/Hispanic origin, and income. METHODS: Demographic and 24-h recall data from the 2013-2016 NHANES were examined. An eating occasion was defined as "any ingestive event (e.g., solid food, beverage, water) that is either energy yielding or non-energy yielding"; all eating occasions were further divided into discrete meals and snacks. Frequency of meals and snacks was defined as "the number of daily EOs [eating occasions]," respectively. Diet quality was assessed via the Healthy Eating Index (HEI)-2015. RESULTS: Most Americans consume 2 (28%) to 3 (64%) meals on a given day and >90% consume 2 to 3 snacks on that day. Adult, Hispanic, and non-Hispanic Black and lower-income (<131% family poverty-to-income ratio) Americans had a lower frequency of eating than children or adolescents, non-Hispanic White, and non-Hispanic Asian Americans and higher-income Americans, respectively. Americans who reported 3 meals on a given day consumed a diet higher in dietary quality than Americans who consumed 2 meals on a given day (HEI-2015: 61.0 vs. 55.0), regardless of population subgroup. CONCLUSIONS: The frequency of the types of eating occasions differs according to age, race and Hispanic origin, and income. Dietary quality is associated with the number of meals consumed. Healthy dietary patterns can be constructed in a variety of ways to suit different life stages, cultural practices, and income levels; improved diet quality and careful consideration of nutrient density when planning meals are warranted. |
Vitamin D status and prevalence of metabolic syndrome by race and Hispanic origin in U.S. adults: findings from 2007-2014 NHANES
Ahluwalia N , Raghavan R , Zhang G , Talegawkar SA , Jacques PF . Am J Clin Nutr 2022 116 (5) 1400-1408 BACKGROUND: Vitamin D status has been found to be inversely associated with metabolic syndrome (MetS) in some studies. Vitamin D status varies by race and ethnicity, and the association of MetS with Vitamin D status in U.S. adults and by race and Hispanic origin has not been evaluated extensively. OBJECTIVES: To examine the associations between Vitamin D status and MetS overall, and across race and Hispanic origin groups in a nationally representative sample of U.S. adults who participated in the National Health and Nutrition Examination Survey (NHANES) from 2007 to 2014. DESIGN: The total sample included 8,639 adults, 20 years of age and over. Serum Vitamin D was measured using a standardized liquid chromatography-tandem mass spectrometry method and was categorized using data driven tertiles. MetS was defined using measured waist circumference, triglycerides, HDL cholesterol, blood pressure, and fasting glucose. Multivariable logistic regression models were fitted (accounting for sociodemographic and lifestyle factors, dietary supplement use, and BMI) to examine the associations of serum Vitamin D with MetS among adults overall, and by race and Hispanic origin. RESULTS: Serum Vitamin D in the lowest tertile (≤ 56 nmol/L) was significantly associated with increased odds of MetS compared to the highest tertile (> 77.9 nmol/L); fully adjusted model OR: 1.85 and 95% CI: 1.51, 2.27. Inverse associations were noted for all race-Hispanic origin groups: non-Hispanic White (OR: 2.24; and 95% CI: 1.67, 3.01), non-Hispanic Black (OR: 1.56; and 95% CI: 1.06, 2.29) and Hispanic (OR: 1.48; and 95% CI: 1.03, 2.14) adults. CONCLUSIONS: Lower Vitamin D status was significantly associated with MetS among U.S. adults after adjusting for sociodemographic and lifestyle factors, dietary supplement use, and BMI. This finding was noted across all race and Hispanic origin groups, although the strength of the association varied being strongest for non-Hispanic White adults. |
The contribution of discrete vegetables, mixed dishes, and other foods to total vegetable consumption: US ages 2 years and over, 2017-2018
Wambogo EA , Ansai N , Ahluwalia N , Ogden CL . J Acad Nutr Diet 2022 122 (11) 2115-2126 e2 BACKGROUND: The 2020-2025 Dietary Guidelines for Americans (DGAs) recommend intake of a variety of vegetables, including dark green, red and orange, starchy, and other vegetables. OBJECTIVES: This study aims to describe sociodemographic differences in the contribution of different categories of vegetables, and the form in which they are consumed, i.e., discrete vegetables, mixed dishes, and other foods such as savory snacks to total vegetables intake on a given day. DESIGN: This is a cross-sectional, secondary analysis of the 2017-2018 National Health and Nutrition Examination Survey (NHANES). PARTICIPANTS: /Setting: This study included the data of 7122 persons aged 2 years with reliable day 1 24-hour dietary recalls. MAIN OUTCOME MEASURES: Serving equivalents of vegetables from 20 discrete categories of vegetables, and from mixed dishes and other foods as a percentage of total vegetables. STATISTICAL ANALYSES: Pairwise differences by age, sex, and race and Hispanic origin, and family income were examined using univariate t statistics, and trends by age and income examined using orthogonal polynomials. RESULTS: Mean serving equivalents of vegetables was 1.4 cups. The serving equivalents increased with age among youth, was higher among non-Hispanic Asian (NHA) persons than other subgroups and increased with increasing family income. Overall, discrete vegetables contributed 55.2% of total vegetable intake and the contribution increased with age in adults, and with increasing family income. The top five discrete vegetable contributors were other vegetables and combinations, French fries and other fried white potatoes, lettuce and lettuce salads, mashed potatoes and white potato mixtures, and baked or boiled white potatoes. Non-starchy discrete vegetables contributed more to total vegetables for adults (37.6%) than youth (28.0%), and the contribution increased with increasing family income. On the other hand, the contribution of mixed dishes and other foods decreased with increasing family income. CONCLUSIONS: Discrete vegetables only contributed 55.2% of total vegetables intake, and the top sources were not varied, three of them potato-based, which may explain the reported low vegetables intake, relative to the DGAs. More than one-third of vegetables consumed were non-starchy discrete vegetables, many of which are high in vitamins. Non-starchy discrete vegetable intake was higher in adults than youth and increased with family income. |
Electronic cigarette use among adults in 14 countries: A cross-sectional study
Pan L , Morton J , Mbulo L , Dean A , Ahluwalia IB . EClinicalMedicine 2022 47 101401 BACKGROUND: The tobacco product landscape continues to change. No recent data for electronic cigarette (e-cigarette) use have been reported for multiple countries based on nationally representative surveys. We examined prevalence of e-cigarette use and variations by sociodemographic characteristics in 14 countries using Global Adult Tobacco Survey (GATS) data between Jan 1, 2015, and Dec 31, 2018. METHODS: GATS is a nationally representative household survey of tobacco use among adults aged ≥15 years. The analytic sample size ranged from 4347 in Senegal to 74,037 in India. Prevalence of current e-cigarette use was stratified by sociodemographic subgroups. Age-standardized prevalence was estimated according to world 2000-2025 standard population. Significant differences in adjusted prevalence across sociodemographic subgroup was determined by p value for marginal effect contrast in multivariable logistic regression models. FINDINGS: More than 50% of adults in Russia, Romania, and Ukraine and additionally more than 30% of adults in China, Costa Rica, Uruguay, Mexico, and Philippines were aware of e-cigarettes. Crude prevalence of current e-cigarette use ranged from 0.02% (95% CI 0.01%-0.04%) in India to 3.5% (2.9%-4.2%) in Russia. Prevalence was <1% in nine countries. Approximately 18.3 million adults currently used e-cigarettes across the 14 countries. Men had a significantly higher prevalence of current e-cigarette use than women in eight countries. Additionally, higher adjusted prevalence was observed in some countries among young adults aged 15‒24 years, urban residents, and adults with higher education levels and higher wealth index. INTERPRETATION: The study provides needed baseline data on e-cigarette awareness and use. Continued surveillance is essential to inform interventions and policies to prevent initiation and enhance cessation support. FUNDING: None. |
The National Health and Nutrition Examination Survey (NHANES), 2021-2022: Adapting Data Collection in a COVID-19 Environment.
Paulose-Ram R , Graber JE , Woodwell D , Ahluwalia N . Am J Public Health 2021 111 (12) 2149-2156 The National Health and Nutrition Examination Survey (NHANES) is a unique source of national data on the health and nutritional status of the US population, collecting data through interviews, standard exams, and biospecimen collection. Because of the COVID-19 pandemic, NHANES data collection was suspended, with more than a year gap in data collection. NHANES resumed operations in 2021 with the NHANES 2021-2022 survey, which will monitor the health and nutritional status of the nation while adding to the knowledge of COVID-19 in the US population. This article describes the reshaping of the NHANES program and, specifically, the planning of NHANES 2021-2022 for data collection during the COVID-19 pandemic. Details are provided on how NHANES transformed its participant recruitment and data collection plans at home and at the mobile examination center to safely collect data in a COVID-19 environment. The potential implications for data users are also discussed. (Am J Public Health. 2021;111(12):2149-2156. https://doi.org/10.2105/AJPH.2021.306517). |
Combating the tobacco epidemic in North America: challenges and opportunities
King BA , Ahluwalia IB , Bacelar Gomes A , Fong GT . Tob Control 2021 31 (2) 169-172 According to the WHO, the Region of the Americas has the second lowest tobacco use prevalence of any WHO region.1 WHO projections based on trends since 2000 indicate that the Region of the Americas, which includes both North and South America, is the only region expected to achieve a 30% relative reduction in tobacco use by 2025.1 However, there are approximately 127 million persons who report smoking tobacco in the Americas Region,2 a majority of whom reside in North America.3 North America consists of 23 countries (see table 1) with a combined population of nearly 600 million people, or approximately 7.5% of the world’s population in 2019.4 Among North American countries, data from 2017 for persons aged 15 years or older show current tobacco smoking prevalence ranged from 6.0% in Panama to 27.8% in Cuba.5 Among students aged 13–15 years old in North American countries with available data through 2017, current tobacco smoking prevalence ranged from 4.4% in Dominican Republic to 18.1% in Mexico.5 Tobacco smoking among adults is higher among males than females across North America. However, the difference in prevalence between sexes in the Region of the Americas is among the lowest of any WHO region5; this pattern is particularly pronounced among youth, where tobacco smoking among girls is similar to or higher among boys in most countries.2 5 |
Implementation of the Uttarakhand Tobacco Free Initiative in schools, India, 2016
Garcia de Quevedo I , Arrazola RA , Yadav R , Soura BD , Ahluwalia IB . Prev Chronic Dis 2021 18 E74 PURPOSE AND OBJECTIVES: A process evaluation, the Uttarakhand Tobacco Free Initiative (UTFI), was conducted in 49 public high schools and colleges in the state of Uttarakhand, India, to measure program implementation, provide feedback to school administrators, and identify barriers to tobacco control. INTERVENTION APPROACH: UTFI aims to 1) raise awareness and provide education and tools for teachers and school administrators about the dangers of tobacco use and secondhand smoke, 2) encourage participation in student-led activities to promote tobacco-free initiatives, and 3) enforce tobacco-free school policies in the state of Uttarakhand. EVALUATION METHODS: We used the CDC evaluation framework to document key components and lessons learned from the UTFI. We distributed questionnaires to 71 teachers and principals in December 2016, to assess awareness of school activities and policies related to the initiative. Descriptive statistics were computed for quantitative data, and a thematic content analysis was used for qualitative data. RESULTS: Of the 71 participants, 66 (92.9%) were aware of tobacco use policies in schools, and 63 (88.7%) agreed policies were enforced. Sixty-six participants (93.0%) said that they taught tobacco prevention-related topics, and 41 of 70 respondents (58.6%) reported that a student-led group helped to enforce tobacco-free policies in their schools. Of 69 respondents, almost all (n = 66) reported satisfaction with UTFI implementation. Challenges identified were related to tobacco products being readily accessible near school premises, lack of tobacco prevention materials, and tobacco use by school staff. IMPLICATIONS FOR PUBLIC HEALTH: Successes of UTFI were documented by measuring different components of the process, including implementation of program activities and teacher and principal satisfaction. Results might help enhance key processes for the initiative and highlight some barriers to implementation, such as enforcing tobacco control policy off school premises. Continued efforts are needed to prevent tobacco use among young people. |
Evaluation of Five Data-to-Action Workshops to Enhance Capacity for Tobacco Control
Garcia de Quevedo I , Tripp A , Twentyman E , Smith R , Ahluwalia IB . Health Promot Pract 2021 23 (6) 15248399211019984 BACKGROUND: Five data-to-action workshops were conducted during 2016-2019 with participants from 38 countries. The purpose of the workshops is to use data to inform and disseminate tobacco prevention and control strategies. We evaluated the workshops using the Kirkpatrick Model for evaluation of trainings. METHODS: We evaluated the data-to-action workshops in three topic areas: (1) if the workshop was clear, useful, engaging, and relevant to the participant's work, (2) self-reported knowledge and skills for tobacco control topics, and (3) intention to apply the knowledge learned. We used nonparametric tests (one-sided Wilcoxon signed-rank test) and conducted descriptive analysis to assess the difference between pre- and postworkshop scores in each topic area. Free text data from open-ended responses were analyzed in Excel using thematic content analysis. RESULTS: Participants reported the workshop had a clear purpose (93.6%, n = 73), was well organized (94.9%, n = 74), and relevant to their work (96.2%, n = 76). There was a statistically significant increase in median learning scores across all three knowledge and five skills topic areas (p < 0.05); more than 95% of participants intended to apply the knowledge they obtained during the workshop and planned to perform new skills learned in the workshop. CONCLUSIONS: Programs interested in replicating a similar successful model may incorporate a mix of modes of instruction and hands-on experiences, as well as focus on the selection of the right audience, for their workshops. These workshops pose an opportunity for countries to enhance use and dissemination of their tobacco control data. |
Tobacco smoking cessation and quitline use among adults aged 15 years in 31 countries: Findings from the Global Adult Tobacco Survey
Ahluwalia IB , Tripp AL , Dean AK , Mbulo L , Arrazola RA , Twentyman E , King BA . Am J Prev Med 2021 60 (3) S128-S135 Introduction: About 80% of the 1.1 billion people who smoke tobacco worldwide reside in low- and middle-income countries. Evidence-based approaches to promote cessation include brief advice from health professionals and referrals through quitlines. This study assesses cessation behaviors and the use of cessation services in the past 12 months among current tobacco smokers in 31 countries who attempted to quit. Methods: Data came from the Global Adult Tobacco Survey, a household-based survey of non-institutionalized adults aged ≥15 years. Surveys were conducted in 31 countries during 2008–2018; sample sizes ranged from 4,250 (Malaysia) to 74,037 (India), and response rates ranged from 64.4% (Ukraine) to 98.5% (Qatar). In 2019, data from the 31 countries were assessed in June 2019, and indicators included self-reported current (daily or less than daily) tobacco smoking, past-year quit attempts, and cessation methods used in the past 12 months. Results: Current tobacco smoking prevalence ranged from 3.7% (Ethiopia) to 38.2% (Greece). Overall, an estimated 176.8 million adults from the 31 countries made a quit attempt in the past 12 months, with country-level prevalence ranging from 16.4% (Greece) to 54.7% (Botswana). Most individuals who made a quit attempt did so without assistance (median=74.4%). Other methods were less prevalent, including quitlines (median=0.2%) and counseling (median=7.2%). Conclusions: In the assessed countries, the majority of those who currently smoked tobacco and made a quit attempt did so without assistance; very few reported using quitlines, partly because of the lack of quitlines in some countries. In resource-limited settings, quitlines can play a greater role in helping people quit smoking as part of a comprehensive approach. |
COVID-19 pandemic: an opportunity for tobacco use cessation.
Ahluwalia IB , Myers M , Cohen JE . Lancet Public Health 2020 5 (11) e577 Data from the Global Adult Tobacco Survey from 31 countries between 2008–18 show that more than 176 million smokers attempted to quit in the past 12 months, and most reported little to no assistance when quitting.1 During the COVID-19 pandemic, researchers have highlighted the association between tobacco smoking and adverse COVID-19 disease outcomes, and the need for smokers to quit.2 Evidence from the US Surgeon General's report shows that cigarette smoking can suppress the immune system, increase the risk of respiratory infections, increase the risk of respiratory illnesses such as chronic obstructive pulmonary disease and asthma, and cause heart and lung diseases. Cigarette smoking is associated with severe clinical outcomes for people with other types of coronaviruses, including Middle East respiratory syndrome.3 |
Revisiting the association between worldwide implementation of the MPOWER package and smoking prevalence, 2008-2017
Husain MJ , Datta BK , Nargis N , Iglesias R , Perucic AM , Ahluwalia IB , Tripp A , Fatehin S , Husain MM , Kostova D , Richter P . Tob Control 2020 30 (6) 630-637 BACKGROUND: We revisited the association between progress in MPOWER implementation from 2008 to 2016 and smoking prevalence from 2009 to 2017 and offered an in-depth understanding of differential outcomes for various country groups. METHODS: We used data from six rounds of the WHO Reports on the Global Tobacco Epidemic and calculated a composite MPOWER Score for each country in each period. We categorised the countries in four initial conditions based on their tobacco control preparedness measured by MPOWER score in 2008 and smoking burden measured by age-adjusted adult daily smoking prevalence in 2006: (1) High MPOWER - high prevalence (HM-HP). (2) High MPOWER - low prevalence (HM-LP). (3) Low MPOWER - high prevalence (LM-HP). (4) Low MPOWER - low prevalence (LM-LP). We estimated the association of age-adjusted adult daily smoking prevalence with MPOWER Score and cigarette tax rates using two-way fixed-effects panel regression models including both year and country fixed effects. RESULTS: A unit increase of the MPOWER Score was associated with 0.39 and 0.50 percentage points decrease in adult daily smoking prevalence for HM-HP and HM-LP countries, respectively. When tax rate was controlled for separately from MPOWE, an increase in tax rate showed a negative association with daily smoking prevalence for HM-HP and LM-LP countries, while the MPOWE Score showed a negative association for all initial condition country groups except for LM-LP countries. CONCLUSION: A decade after the introduction of the WHO MPOWER package, we observed that the countries with higher initial tobacco control preparedness and higher smoking burden were able to reduce the adult daily smoking prevalence significantly. |
Protecting youth from tobacco around the globe: Evidence to practice
Ahluwalia IB , Wilson K , Gorzkowski J . Pediatrics 2020 146 (4) Tobacco use and secondhand smoke (SHS) exposure are harmful to development and have significant health risks across the life span, including asthma, respiratory infections, cardiovascular disease, and cancer.1 Most adults begin smoking during adolescence, highlighting the importance of clinical and public health interventions to prevent tobacco use and encourage youth cessation. Data from the US Centers for Disease Control and Prevention (CDC) Global Youth Tobacco Surveys (GYTS) from 61 countries reveal that a substantial number of youth report current cigarette smoking (mean prevalence: 10.7%, range: 1.7%–35%), and .50% of young smokers wish to quit.2 Globally, GYTS data indicate that youth who have never used tobacco products are susceptible to begin using them (Fig 1). In the United States, 5.8% of high schoolers currently smoke cigarettes, 58% of young smokers want to quit, and nearly half are susceptible to using cigarettes or electronic cigarettes (e-cigarettes).3 Thus, global efforts to protect youth against such vulnerabilities are critical to ensure future tobacco-free generations. In this report, we describe a partnership between CDC and the American Academy of Pediatrics (AAP) that highlights how strategic relationships can foster change. |
Association of tobacco control policies with cigarette smoking among school youth aged 13-15 years in the Philippines, 2000-2015
Arrazola RA , Dutra LM , Twentyman E , Seidenberg AB , Hemendez-Gonzales R , Ahluwalia IB . Tob Prev Cessat 2020 6 35 INTRODUCTION: In 2003, the Philippines implemented legislation that prohibited the sale of tobacco products to youth, placed text warning labels on tobacco products, and prohibited tobacco smoking in public places. This study assessed if this legislation was associated with reduced cigarette smoking among youth. METHODS: Data came from the 2000-2015 Philippines Global Youth Tobacco Survey (GYTS), a nationally representative, cross-sectional survey of students aged 13-15 years. GYTS data were used to determine associations between tobacco control legislation and current, past 30-day, current cigarette smoking (CCS). Logistic regression models were adjusted for age, sex, current other tobacco product use (COTPU), and price per cigarette stick (PPCS). RESULTS: In the unadjusted model, the 2003 legislation was not associated with CCS (OR=0.77; 95% CI: 0.54-1.10). After adjusting for covariates, it was negatively associated (AOR=0.65; 95% CI: 0.53-0.80). Being 15 years old (OR=1.31; 95% CI: 1.08-1.58), male (OR=2.54; 95% CI: 2.17-2.98), and COTPU (OR=4.12; 95% CI: 3.47-4.91) were positively associated with CCS in unadjusted models. In adjusted models, being 14 years old (AOR=1.29; 95% CI: 1.08-1.53), 15 years old (AOR=1.55; 95% CI: 1.31-1.84), male (AOR=2.49; 95% CI: 2.13-2.91), and COTPU (AOR=3.96; 95% CI: 3.32-4.73), were associated with CCS. PPCS was not associated with CCS in either the unadjusted (OR=1.32; 95% CI: 0.82-2.11) or adjusted (AOR=1.32; 95% CI: 0.79-2.18) models. CONCLUSIONS: After adjusting for covariates, the 2003 tobacco control legislation was associated with lower current cigarette smoking, but price per cigarette stick was not. |
The impact of smoking on tuberculosis treatment outcomes: a meta-analysis
Wang EY , Arrazola RA , Mathema B , Ahluwalia IB , Mase SR . Int J Tuberc Lung Dis 2020 24 (2) 170-175 BACKGROUND: Cigarette smoking contributes to tuberculosis (TB) epidemiology. However, limited evidence exists on how smoking impacts TB treatment outcomes such as treatment loss to follow-up and culture conversion.METHODS: This meta-analysis assessed current evidence of the impact of active cigarette smoking on TB treatment outcomes. PubMed, Scopus, Embase, and the Cochrane Library were searched for English-language articles published from database inception through 2017. Articles addressing active pulmonary TB and cigarette smoking were identified and data abstracted. Smokers were defined as those who smoked every day or some days at the time of interview/diagnosis. Non-smokers did not smoke at the time of interview/diagnosis. Unfavorable outcomes included any outcome other than cure or completion of TB treatment. Three different data sets were examined: 8 articles addressing unfavorable treatment outcomes, 9 analyzing only treatment loss to follow-up, and 5 addressing delayed smear or culture conversion. Studies that had <20 subjects or that addressed only populations with comorbidities were excluded.RESULTS: We identified 1030 studies; 21 studies fulfilled the inclusion/exclusion criteria. Smokers had greater odds of unfavorable outcomes (pooled odds ratio [pOR] 1.23, 95%CI 1.14-1.33), delayed smear or culture conversion (pOR 1.55, 95%CI 1.04-2.07), and treatment loss to follow-up (pOR 1.35, 95%CI 1.21-1.50).CONCLUSION: Cigarette smoking is associated with negative treatment results and delayed conversion to negative smear or culture, suggesting smoking is an important factor for consideration in TB elimination efforts. |
Intimate partner violence around the time of pregnancy and postpartum contraceptive use
Stevenson AA , Bauman BL , Zapata LB , Ahluwalia IB , Tepper NK . Womens Health Issues 2020 30 (2) 98-105 OBJECTIVES: We sought to examine postpartum contraceptive use among women who reported physical intimate partner violence (IPV) during or within 12 months before pregnancy compared with women who did not report physical IPV and to identify factors associated with nonuse of contraception among women who reported physical IPV. METHODS: Data were obtained from women with a recent live birth from 2012 to 2015 who participated in the Pregnancy Risk Assessment and Monitoring System. We described characteristics of women and postpartum contraceptive use by method effectiveness (most effective [female sterilization, male sterilization, intrauterine device, implant], moderately effective [injectable, pill, patch, ring], less effective [condoms, natural family planning, withdrawal, other]) or no method, stratified by reported physical IPV. Multivariable logistic regression was used to examine characteristics associated with nonuse of contraception among women who reported physical IPV. RESULTS: The proportion of women using most or moderately effective contraception was similar for women reporting and not reporting physical IPV. Less effective contraceptive use was lower among women who reported physical IPV (13.9%) than who did not report physical IPV (25.1%) (p < .001). Nonuse was higher among women who reported physical IPV (33%) than who did not report physical IPV (21%) (p < .001). Having no health insurance at the time of survey and experiencing traumatic stress within 12 months before delivery were associated with nonuse of contraception among women who reported physical IPV. CONCLUSIONS: The higher proportion of contraception nonuse among women who reported physical IPV indicates a potential unmet need for contraception among this vulnerable population. Recommended screening for IPV and counseling about the full range of contraceptive methods should begin during pregnancy and continue through the postpartum period. |
Tobacco use and tobacco-related behaviors - 11 countries, 2008-2017
Ahluwalia IB , Arrazola RA , Zhao L , Shi J , Dean A , Rainey E , Palipudi K , Twentyman E , Armour BS . MMWR Morb Mortal Wkly Rep 2019 68 (41) 928-933 Each year, tobacco use is responsible for approximately 8 million deaths worldwide, including 7 million deaths among persons who use tobacco and 1.2 million deaths among nonsmokers exposed to secondhand smoke (SHS) (1). Approximately 80% of the 1.1 billion persons who smoke tobacco worldwide reside in low- and middle-income countries (2,3). The World Health Organization's (WHO's) Framework Convention on Tobacco Control (FCTC) provides the foundation for countries to implement and manage tobacco control through the MPOWER policy package,* which includes monitoring tobacco use, protecting persons from SHS, warning them about the danger of tobacco, and enforcing bans on tobacco advertising, promotion, or sponsorship (tobacco advertising) (4). CDC analyzed data from 11 countries that completed two or more rounds of the Global Adult Tobacco Survey (GATS) during 2008-2017. Tobacco use and tobacco-related behaviors that were assessed included current tobacco use, SHS exposure, thinking about quitting because of warning labels, and exposure to tobacco advertising. Across the assessed countries, the estimated percentage change in tobacco use from the first round to the most recent round ranged from -21.5% in Russia to 1.1% in Turkey. Estimated percentage change in SHS exposure ranged from -71.5% in Turkey to 72.9% in Thailand. Estimated percentage change in thinking about quitting because of warning labels ranged from 77.4% in India to -33.0% in Turkey. Estimated percentage change in exposure to tobacco advertising ranged from -66.1% in Russia to 44.2% in Thailand. Continued implementation and enforcement of proven tobacco control interventions and strategies at the country level, as outlined in MPOWER, can help reduce tobacco-related morbidity and mortality worldwide (3,5,6). |
Are there hardened smokers in low- and middle-income countries Findings from the Global Adult Tobacco Survey
Yin S , Ahluwalia IB , Krishna P , Mbulo L , Arrazola RA . Tob Induc Dis 2019 17 11 Introduction: Hardened smokers are those who do not want to quit, or find it very difficult to quit. This study assessed the prevalence and predictors of hardened smokers in 19 low- and middle-income countries (LMICs). | | Methods: We used nationally representative data from 19 LMICs that conducted the Global Adult Tobacco Survey during 2009-2013. Our analysis is restricted to adults aged ≥25 years. Hardened smokers were defined as daily smokers who smoked for 5 or more years, and who reported the following: no quit attempt in the past year that lasted 24 or more hours; no interest in quitting, or not planning to quit in the next year; and currently smoked within 30 minutes after waking. For each country, the prevalence of hardened smokers was analyzed by sex, age, residence (urban or rural), educational attainment, wealth index, and knowledge of the danger of smoking. Multivariable logistic regression was used to assess predictors of hardened smoking. | | Results: Prevalence of hardened smokers among adults (aged ≥25 years) ranged from 1.1% (Panama) to 14.3% (Russia). Among current smokers (aged ≥25 years), the proportion of hardened smokers ranged from 7.5% (Mexico) to 38.4% (Romania). Adjusted odds of hardened smokers were significantly higher for males (9 of 19 countries), smokers aged 65 years or older (12 of 19 countries), adults with lower educational attainment (9 of 19 countries), and no knowledge of the danger of smoking (8 of 19 countries). | | Conclusions: The spectrum of smokers in the LMICs includes hardened smokers and prevalence varies across population groups. Full implementation of proven tobacco control strategies could reduce hardened smoking in LMICs. |
Nutrition monitoring of children aged birth to 24 mo (B-24): Data collection and findings from the NHANES
Ahluwalia N . Adv Nutr 2019 11 (1) 113-127 The first 2 y of life are characterized by several transitions that can affect growth, development, and eating patterns long term. These include a shift from a primarily milk-based eating pattern to introduction of complementary foods at approximately 4-6 mo of age, and passage to family-meal patterns in toddler years. Recognizing the importance of this critical period, the Dietary Guidelines for Americans from 2020 onwards will include guidance for children aged birth to 24 mo (B-24). Few large-scale surveys provide comprehensive, nationally representative, quantitative, recent data on infant and toddler nutrition in the United States. The continuous NHANES has collected data relevant to this initiative since 1999 using standardized interview and examination protocols. These include data on infant feeding practices, dietary intakes (foods, beverages, and supplements), anthropometry, and blood-based nutritional status on nationally representative samples of infants and toddlers. NHANES data can be used to describe large group-level consumption patterns, as well as trends over time for B-24 children overall, and by demographic groups (e.g., race-ethnic and income groups). In addition, NHANES data can be analyzed to examine adherence to nutrition-related recommendations, such as those from the American Academy of Pediatrics (AAP), and to track Healthy People 2020 objectives. This paper provides an update on NHANES nutrition monitoring in B-24 children since our previous publication (which provided details through NHANES 2009-2010) and describes data collection since 2010 and plans for upcoming cycles. It also describes key NHANES-based findings published in the last 5 y on infant feeding practices, dietary intakes and supplement use, and nutritional status of US children aged <2 y. Findings related to existing recommendations, such as from the AAP, are presented when available. This information can inform researchers and policymakers on the state of nutrition in the US B-24 population and its subgroups of interest. |
Prevalence and maternal characteristics associated with receipt of prenatal care provider counseling about medications safe to take during pregnancy
D'Angelo DV , Bauman BL , Broussard CS , Tong VT , Ko JY , Kapaya M , Harrison L , Ahluwalia IB . Prev Med 2019 126 105743 Use of some medications during pregnancy can be harmful to the developing fetus, and discussion of the risks and benefits with prenatal care providers can provide guidance to pregnant women. We used Pregnancy Risk Assessment Monitoring System data collected for 2015 births aggregated from 34 US states (n=40,480 women) to estimate the prevalence of self-reported receipt of prenatal care provider counseling about medications safe to take during pregnancy. We examined associations between counseling and maternal characteristics using adjusted prevalence ratios (aPR). The prevalence of counseling on medications safe to take during pregnancy was 89.2% (95% confidence interval [CI]: 88.7-89.7). Women who were nulliparous versus multiparous (aPR 1.03; 95% CI: 1.02-1.04), who used prescription medications before pregnancy versus those who did not, (aPR 1.03; 95% CI: 1.02-1.05), and who reported having asthma before pregnancy versus those who did not, (aPR 1.05; 95% CI: 1.01-1.08) were more likely to report receipt of counseling. There was no difference in counseling for women with pre-pregnancy diabetes, hypertension, and/or depression compared to those without. Women who entered prenatal care after the first trimester were less likely to report receipt of counseling (aPR 0.93; 95% CI: 0.91-0.96). Overall, self-reported receipt of counseling was high, with some differences by maternal characteristics. Although effect estimates were small, it is important to ensure that information is available to prenatal care providers about medication safety during pregnancy, and that messages are communicated to women who are or might become pregnant. |
Dietary supplement use among infants and toddlers aged <24 months in the United States, NHANES 2007-2014
Gahche JJ , Herrick KA , Potischman N , Bailey RL , Ahluwalia N , Dwyer JT . J Nutr 2019 149 (2) 314-322 Background: Limited nationally representative data are available on dietary supplement (DS) use and resulting nutrient exposures among infants and toddlers. Objective: This study evaluated DS use among US infants and toddlers to characterize DS use, estimate nutrient intake from DSs, and assess trends in DS use over time. Methods: Using nationally representative data from NHANES (2007-2014) and trends over time (1999-2014), we estimated prevalence of DS use and types of products used for US infants and toddlers aged <2 y (n = 2823). We estimated median daily intakes of vitamins and minerals consumed via DSs for all participants aged <2 y, by age groups (0-11.9 mo and 12.0-23.9 mo), and by feeding practices for infants 0-5.9 mo. Results: Overall, 18.2% (95% CI: 16.2%, 20.3%) of infants and toddlers used >/=1 DS in the past 30 d. Use was lower among infants (0-5.9 mo: 14.6%; 95% CI: 11.5%, 18.1%; 6-11.9 mo: 11.6%; 95% CI: 8.8%, 15.0%) than among toddlers (12-23.9 mo: 23.3%; 95% CI: 20.4%, 26.3%). The most commonly reported DSs were vitamin D and multivitamin infant drops for those <12 mo, and chewable multivitamin products for toddlers (12-23.9 mo). The nutrients most frequently consumed from DSs were vitamins D, A, C, and E for those <2 y; for infants <6 mo, a higher percentage of those fed breast milk than those fed formula consumed these nutrients via DSs. DS use remained steady for infants (6-11.9 mo) and toddlers from 1999-2002 to 2011-2014, but increased from 7% to 20% for infants aged 0-5.9 mo. Conclusions: One in 5 infants and toddlers aged <2 y use >/=1 DS. Future studies should examine total nutrient intake from foods, beverages, and DSs to evaluate nutrient adequacy overall and by nutrient source. |
Lessons from leading US Public Health Service physicians
Iskander J , Ahluwalia J , Luckhaupt S , Lewis B . Mil Med 2019 184 127-130 The Commissioned Corps of the United States Public Health Service (USPHS), an all-officer uniformed service, includes more than 730 physicians who serve in multiple federal agencies within and outside of the Department of Health and Human Services (DHHS) and are stationed in more than 60 locations, including state and local health departments. These officers serve in direct patient care and applied public health roles, working on the clinical, science, and policy frontlines of key public health challenges including the opioid epidemic and antimicrobial resistance.1,2 These physicians’ professional interests are represented by a Chief Professional Officer (CPO) and the Physicians Professional Advisory Committee (PPAC) leadership team, which includes 2 co-chairs and a vice-chair. The authors currently serve as the leadership team of the PPAC. We serve in these roles on a voluntary basis, in addition to our primary duties with our agencies. |
Federal monitoring of dietary supplement use in the resident, civilian, noninstitutionalized US Population: National Health and Nutrition Examination Survey
Gahche JJ , Bailey RL , Potischman N , Ershow AG , Herrick KA , Ahluwalia N , Dwyer JT . J Nutr 2018 148 (8) 1436S-1444S This review summarizes the current and previous data on dietary supplement (DS) use collected from participants in the NHANES, describes the NHANES DS database used to compute nutrient intakes from DSs, discusses recent developments and future directions, and describes many examples to show the utility of these data in informing nutrition research and policy. Since 1971, NHANES has been collecting information on the use of DSs from participants. These data are critical to national nutrition surveillance and have been used to characterize usage patterns, examine trends over time, assess the percentage of the population meeting or exceeding nutrient recommendations, and help to elucidate the sources contributing nutrients to the diet of the US population. More than half of adults and approximately one-third of children in the United States currently use ≥1 DS in the course of 30 d. DSs contribute to the dietary intake of nutrients and bioactive compounds in the United States and therefore need to be assessed when monitoring nutritional status of the population and when studying diet-health associations. With the recent development and availability of the Dietary Supplement Label Database, a comprehensive DS database that will eventually contain labels for all products marketed in the United States, NHANES DS data will be more easily linked to product information to estimate nutrient intake from DSs. NHANES provides a rich source of nationally representative data on the usage of dietary supplements in the United States. Over time, NHANES has both expanded and improved collection methods. The continued understanding of sources of error in collection methods will continue to be explored and is critical to improved accuracy. |
Current tobacco smoking, quit attempts, and knowledge about smoking risks among persons aged 15 years - Global Adult Tobacco Survey, 28 countries, 2008-2016
Ahluwalia IB , Smith T , Arrazola RA , Palipudi KM , Garcia de Quevedo I , Prasad VM , Commar A , Schotte K , Garwood PD , Armour BS . MMWR Morb Mortal Wkly Rep 2018 67 (38) 1072-1076 Each year, tobacco use causes approximately 7 million deaths worldwide, including approximately 6 million among tobacco users and an estimated 890,000 among nonsmokers exposed to secondhand smoke (1). Tobacco use is a leading preventable cause of disease globally and has been determined to cause adverse health outcomes such as coronary heart disease, stroke, and multiple types of cancer, including lung cancer (2-4). Approximately 80% of the world's 1.1 billion tobacco smokers reside in low- and middle-income countries (4). Some persons do not fully understand the health risks associated with tobacco smoking (5-9), and studies have indicated that increasing knowledge about the adverse health effects of smoking can contribute to decreases in smoking, increases in cessation attempts, and increases in successful cessation (3,7,10). CDC analyzed 2008-2016 Global Adult Tobacco Survey (GATS) data from 28 countries to assess tobacco smoking prevalence, quit attempts, and knowledge about tobacco smoking risks among persons aged >/=15 years. Across countries, the median prevalence of tobacco smoking was 22.5%, and a median of 42.5% of tobacco smokers had made a quit attempt in the preceding 12 months. The median prevalences of knowing that tobacco smoking causes stroke, heart attack, and lung cancer were 73.6%, 83.6%, and 95.2%, respectively. Implementation of proven tobacco control interventions, including strategies that increase knowledge about the health risks posed by tobacco use, might help to reduce tobacco use and tobacco-related disease, including heart disease, stroke, and lung cancer (3-5). |
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