Last data update: May 06, 2024. (Total: 46732 publications since 2009)
Records 1-21 (of 21 Records) |
Query Trace: Palipudi KM[original query] |
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Patterns and related factors of bidi smoking in India
Mbulo L , Palipudi KM , Smith T , Yin S , Munish VG , Sinha DN , Gupta PC , Swasticharan L . Tob Prev Cessat 2020 6 28 INTRODUCTION: Bidis are the most commonly smoked tobacco product in India. Understanding bidi smoking is important to reducing overall tobacco smoking and health-related consequences in India. We analyzed 2009-2010 and 2016-2017 Global Adult Tobacco Survey (GATS) India data to examine bidi smoking and its associated sociodemographic correlates and perceptions of dangers of smoking. METHODS: GATS is a nationally representative household survey of adults aged ≥15 years, designed to measure tobacco use and tobacco control indicators. Current bidi smoking was defined as current smoking of one or more bidis during a usual week. We computed bidi smoking prevalence estimates and relative change during 2009-2010 and 2016-2017. Used pooled multilevel logistic regression to identify individual-level determinants of bidi smoking and neighborhood-level and state-level variations. RESULTS: Overall, 9.2% and 7.7% of adults smoked bidis in India during 2009-2010 and 2016-2017, respectively, reflecting 16.4% significant relative decline. In pooled analysis, male, older age, rural residence, lower education level, lower wealth index, less knowledge about harms of smoking, and survey year were associated with increased odds of bidi smoking. Results also showed variance in odds of smoking bidis is associated with neighborhood (15.9%) and state (31.8%) level. CONCLUSIONS: Higher odds of bidi smoking were found among males, older age groups, and among those with lower socioeconomic status. Accordingly, health education interventions designed for these groups across India and other population-level interventions, such as WHO recommendation on increasing price on tobacco products, could help reduce bidi smoking. In addition, state/neighborhood-specific interventions could also help address differential bidi smoking across India. |
Socioeconomic patterns of smoking cessation behavior in low and middle-income countries: Emerging evidence from the Global Adult Tobacco Surveys and International Tobacco Control Surveys
Nargis N , Yong HH , Driezen P , Mbulo L , Zhao L , Fong GT , Thompson ME , Borland R , Palipudi KM , Giovino GA , Thrasher JF , Siahpush M . PLoS One 2019 14 (9) e0220223 INTRODUCTION: Tobacco smoking is often more prevalent among those with lower socio-economic status (SES) in high-income countries, which can be driven by the inequalities in initiation and cessation of smoking. Smoking is a leading contributor to socio-economic disparities in health. To date, the evidence for any socio-economic inequality in smoking cessation is lacking, especially in low- and middle-income countries (LMICs). This study examined the association between cessation behaviours and SES of smokers from eight LMICs. METHODS: Data among former and current adult smokers aged 18 and older came from contemporaneous Global Adult Tobacco Surveys (2008-2011) and the International Tobacco Control Surveys (2009-2013) conducted in eight LMICs (Bangladesh, Brazil, China, India, Mexico, Malaysia, Thailand and Uruguay). Adjusted odds ratios (AORs) of successful quitting in the past year by SES indicators (household income/wealth, education, employment status, and rural-urban residence) were estimated using multivariable logistic regression controlling for socio-demographics and average tobacco product prices. A random effects meta-analysis was used to combine the estimates of AORs pooled across countries and two concurrent surveys for each country. RESULTS: Estimated quit rates among smokers (both daily and occasional) varied widely across countries. Meta-analysis of pooled AORs across countries and data sources indicated that there was no clear evidence of an association between SES indicators and successful quitting. The only exception was employed smokers, who were less likely to quit than their non-employed counterparts, which included students, homemakers, retirees, and the unemployed (pooled AOR approximately 0.8, p<0.10). CONCLUSION: Lack of clear evidence of the impact of lower SES on adult cessation behaviour in LMICs suggests that lower-SES smokers are not less successful in their attempts to quit than their higher-SES counterparts. Specifically, lack of employment, which is indicative of younger age and lower nicotine dependence for students, or lower personal disposable income and lower affordability for the unemployed and the retirees, may be associated with quitting. Raising taxes and prices of tobacco products that lowers affordability of tobacco products might be a key strategy for inducing cessation behaviour among current smokers and reducing overall tobacco consumption. Because low-SES smokers are more sensitive to price increases, tobacco taxation policy can induce disproportionately larger decreases in tobacco consumption among them and help reduce socio-economic disparities in smoking and consequent health outcomes. |
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). |
Methodology of the Global Adult Tobacco Survey - 2008-2010
Palipudi KM , Morton J , Hsia J , Andes L , Asma S , Talley B , Caixeta RD , Fouad H , Khoury RN , Ramanandraibe N , Rarick J , Sinha DN , Pujari S , Tursan d'Espaignet E . Glob Health Promot 2016 23 3-23 In 2008, the Centers for Disease Control and Prevention (CDC) and the World Health Organization developed the Global Adult Tobacco Survey (GATS), an instrument to monitor global tobacco use and measure indicators of tobacco control. GATS, a nationally representative household survey of persons aged 15 years or older, was conducted for the first time during 2008-2010 in 14 low- and middle-income countries. In each country, GATS used a standard core questionnaire, sample design, and procedures for data collection and management and, as needed, added country-specific questions that were reviewed and approved by international experts. The core questionnaire included questions about various characteristics of the respondents, their tobacco use (smoking and smokeless), and a wide range of tobacco-related topics (cessation; secondhand smoke; economics; media; and knowledge, attitudes, and perceptions). In each country, a multistage cluster sample design was used, with households selected proportionate to the size of the population. Households were chosen randomly within a primary or secondary sampling unit, and one respondent was selected at random from each household to participate in the survey. Interviewers administered the survey in the country's local language(s) using handheld electronic data collection devices. Interviews were conducted privately, and same-sex interviewers were used in countries where mixed-sex interviews would be culturally inappropriate. All 14 countries completed the survey during 2008-2010. In each country, the ministry of health was the lead coordinating agency for GATS, and the survey was implemented by national statistical organizations or surveillance institutes. This article describes the background and rationale for GATS and includes a comprehensive description of the survey methods and protocol. |
Prevalence of tobacco use among adults in Egypt, 2009
Fouad H , Awa FE , Naga RA , Emam AH , Labib S , Palipudi KM , Andes LJ , Asma S , Talley B . Glob Health Promot 2016 23 38-47 INTRODUCTION: We assessed the differences in overall use of tobacco and in the use of various tobacco products, by sex and by frequency of use across various demographic groups. METHODS: We used data from the Global Adult Tobacco Survey (GATS), conducted in 2009 in Egypt. The data consist of answers to GATS by 20,924 respondents from a nationally representative, multistage probability sample of adults aged 15 years or older from all regions of Egypt. Current tobacco use was defined as current smoking or use of smokeless tobacco products, either daily or occasionally. We analyzed the differences in current cigarette, shisha, and smokeless tobacco use by sex and frequency of use (daily or occasional); and by demographic characteristics that included age, region, education level and employment status. RESULTS: Overall, 19.7% of the Egyptian population currently use some form of tobacco. Men (38.1% [95% confidence interval (CI) 36.8-39.4]) are much more likely than women (0.6% [95% CI 0.4-0.9]) to use tobacco. Almost 96% of men who use tobacco, do so daily. Men are more likely to use manufactured cigarettes (31.8% [95% CI 30.6-33.1]) than shisha (6.2% [95% CI 5.6-6.9]) or smokeless tobacco (4.1% [95% CI 3.4-4.8]). Few women use tobacco (cigarettes (0.2%), shisha (0.3%) and smokeless tobacco (0.3%)); however, all women who currently smoke shisha, do so daily. Lower educational status, being between ages 25-64 and being employed predicted a higher use of tobacco. CONCLUSION: Egypt has implemented several initiatives to reduce tobacco use. The World Health Organization (WHO) MPOWER technical package, which aims to reverse the tobacco epidemic, is implemented at various levels throughout the country. Our findings show that there is significant variation in the prevalence of tobacco use and types of tobacco used by adult men and women in Egypt. GATS data can be used to better understand comparative patterns of tobacco use by adults, which in turn can be used to develop interventions. |
Exposure to anti- and pro-tobacco advertising, promotions or sponsorships: Turkey, 2008
Erguder T , Bilir N , Ozcebe H , Irmak H , Tasti E , Ilter H , Palipudi KM , Andes LJ , Asma S , Khoury RN , Talley B . Glob Health Promot 2016 23 58-67 INTRODUCTION: In 2008, Turkey became one of 26 countries with a complete ban on all forms of direct and indirect tobacco marketing. We assessed the level of exposure to anti- and pro-cigarette advertising and to cigarette promotions and sponsorships among various demographic groups in Turkey. METHODS: We used the data from the Global Adult Tobacco Survey (GATS), conducted in November 2008 in Turkey. The data consist of answers to GATS questions by 9030 respondents from a nationally representative, multistage probability sample of adults 15 years of age or older. To find differences in exposure to the advertising by sex, age, education level and smoking status, we analyzed responses to GATS questions about cigarette advertisements and anti-cigarette smoking information in various forms and through various advertising channels, during the 30 days before the survey, using bivariate analysis. RESULTS: Overall, 13.3% of respondents aged 15 years or older noticed some type of cigarette marketing during the 30 days before the survey: 7.1% saw advertisements, 5.3% saw promotions and 3.3% saw sports sponsorships. Men were more likely than women to have seen cigarette promotions (7.8% versus 3.0%) and sports sponsorships (5.3% versus 1.4%). Respondents aged 15-24 years were more likely than those aged 25 years or older to have seen cigarette advertisements (10.2% versus 6.2%), promotions (8.7% versus 4.4%) and sponsorships (6.6% versus 2.3%), respectively. Respondents were most likely to have seen cigarette advertisements on television (3.4%) or in shops (2.7%). In addition, 2.8% of respondents reported seeing a clothing item with a brand name or logo, 2.5% reported that they received free samples of cigarettes and 0.3% received gifts along with the purchase of cigarettes. Almost 9 of 10 survey respondents (88.8%) reported having noticed some anti-cigarette information during the 30 days before the survey. Most anti-cigarette information was seen on television (85.5%). The anti-cigarette information was seen by slightly more cigarette smokers (91.6%) than nonsmokers (87.6%). Persons with less than a primary education were less likely to notice anti-cigarette information than those with a higher level of education, in all examined media channels. CONCLUSIONS: Our findings showed a low prevalence of noticing cigarette marketing, which indicates high compliance with the Turkish law banning such marketing. GATS data provide an in-depth understanding of the level of exposure to pro- and anti-cigarette information in 2008 and they are of practical assistance to those who implement policies to reduce the demand for tobacco. The challenge now is to maintain rigorous enforcement. To do so requires ongoing surveillance to produce data on the effectiveness of the enforcement efforts. |
Exposure to secondhand smoke among adults - Philippines, 2009
Baquilod MM , Segarra AB , Barcenas G , Mercado SP , Rarick J , Palipudi KM , Asma S , Andes LJ , Talley B . Glob Health Promot 2016 23 48-57 INTRODUCTION: We assessed the differences in exposure to secondhand smoke (SHS) among adults at home, in indoor workplaces, and in various public places in the Philippines across various socio-demographic groups. METHODS: Data from the Global Adult Tobacco Survey conducted in 2009 in the Philippines were used. The data consist of survey answers from 9705 respondents from a nationally representative, multistage probability sample of adults aged 15 years or older. We considered that respondents were exposed to SHS if during the previous 30 days they reported that they lived in a home, worked in a building, or visited a public place where people smoked. The public places included in our analysis were indoor workplaces, public transportation vehicles, restaurants, government buildings or offices, and healthcare facilities. The differences in various socioeconomic and demographic groups' exposure to SHS in these places were also examined. RESULTS: Of respondents who reported working indoors, 36.8% were exposed to SHS. Men (43.3% [95% CI 39.7-46.9]) were more likely than women (28.8% [95% CI 25.4-32.4]) to be exposed to SHS (p < 0.001). Of those working in sites where smoking was not allowed, 13.9% were exposed to SHS, whereas 66.5% were exposed where smoking is allowed in some enclosed areas, and 90.7% were exposed where smoking is allowed everywhere. During the 30 days preceding the survey, more than 50% of those who took public transportation were exposed to SHS; exposure for those who visited public buildings was 33.6% in restaurants, 25.5% in government buildings or offices, and 7.6% in healthcare facilities. CONCLUSION: Despite a national law passed and several local government ordinances that have promulgated smoke-free workplaces, schools, government offices, and healthcare facilities, our findings show that a large proportion of adults were exposed to SHS at work and in public places, which offers opportunities to strengthen and improve enforcement of the smoke-free initiatives and ordinances in the Philippines. |
Tracking MPOWER in 14 countries: results from the Global Adult Tobacco Survey, 2008-2010
Song Y , Zhao L , Palipudi KM , Asma S , Morton J , Talley B , Hsia J , Ramanandraibe N , Caixeta R , Fouad H , Khoury R , Sinha D , Rarick J , Bettcher D , Peruga A , Deland K , D'Espaignet ET . Glob Health Promot 2016 23 24-37 BACKGROUND: The World Health Organization (WHO) MPOWER is a technical package of six tobacco control measures that assist countries in meeting their obligations of the WHO Framework Convention Tobacco Control and are proven to reduce tobacco use. The Global Adult Tobacco Survey (GATS) systematically monitors adult tobacco use and tracks key tobacco control indicators. METHODS: GATS is a nationally representative household survey of adults aged 15 and older, using a standard and consistent protocol across countries; it includes information on the six WHO MPOWER measures. GATS Phase I was conducted from 2008-2010 in 14 high-burden low- and middle-income countries. We selected one key indicator from each of the six MPOWER measures and compared results across 14 countries. RESULTS: Current tobacco use prevalence rates ranged from 16.1% in Mexico to 43.3% in Bangladesh. We found that the highest rate of exposure to secondhand smoke in the workplace was in China (63.3%). We found the highest 'smoking quit attempt' rates in the past 12 months among cigarette smokers in Viet Nam (55.3%) and the lowest rate was in the Russian Federation (32.1%). In five of the 14 countries, more than one-half of current smokers in those 5 countries said they thought of quitting because of health warning labels on cigarette packages. The Philippines (74.3%) and the Russian Federation (68.0%) had the highest percentages of respondents noticing any cigarette advertising, promotion and sponsorship. Manufactured cigarette affordability ranged from 0.6% in Russia to 8.0% in India. CONCLUSIONS: Monitoring tobacco use and tobacco control policy achievements is crucial to managing and implementing measures to reverse the epidemic. GATS provides internationally-comparable data that systematically monitors and tracks the progress of the other five MPOWER measures. |
Secondhand smoke exposure and susceptibility to initiating cigarette smoking among never-smoking students in selected African countries: Findings from the Global Youth Tobacco Survey
Lee KA , Palipudi KM , English LM , Ramanandraibe N , Asma S . Prev Med 2016 91S S2-S8 BACKGROUND: Exposure to secondhand smoke (SHS) causes premature death and illness in non-smokers. We examined SHS exposure at home and in public places, as well as susceptibility to initiate cigarette smoking among never cigarette smokers. We used 2006-2011 Global Youth Tobacco Survey (GYTS) data from 29 African countries (56,967 students). METHODS: GYTS is a nationally representative, self-administered school-based survey, conducted among students aged 13-15years.Prevalence ratio, estimates and 95% confidence intervals were computed for SHS exposure in the homes and public places separately. The two-sample t-test was used to assess the difference in susceptibility to smoking by SHS exposure among never-smoking students (alpha=0.05). RESULTS: Among never-smoking students, exposure to SHS at home ranged from 12.7% (Cape Verde) to 44.0% (Senegal). The prevalence ratio (PR) comparing susceptibility to smoking initiation among never smokers exposed to SHS at home to those who were not exposed at home ranged from 1.2 to 2.6. Exposure to SHS in public places ranged from 23.9% (Cape Verde) to 80.4% (Mali). Of the countries being studied, 8 countries showed a significant difference in susceptibility to smoking initiation among never smokers exposed to SHS in public places compared to those not exposed in public places. (PR ranged from 0.5-3.5). CONCLUSION: In many African countries in the study, a substantial proportion of students who never smoked are exposed to SHS at home and in public places. Majority of never smokers who were exposed to SHS at home and in public places had a higher prevalence of susceptibility to initiate smoking than those that were not exposed to SHS at home and in public places. Adoption and enforcement of smoke-free policies in public places and smoke-free rules at home could substantially contribute to reducing SHS exposure in many of these countries. |
Secondhand smoke exposure at home among one billion children in 21 countries: findings from the Global Adult Tobacco Survey (GATS)
Mbulo L , Palipudi KM , Andes L , Morton J , Bashir R , Fouad H , Ramanandraibe N , Caixeta R , Dias RC , Wijnhoven TM , Kashiwabara M , Sinha DN , Tursan d'Espaignet E . Tob Control 2016 25 e95-e100 OBJECTIVE: Children are vulnerable to secondhand smoke (SHS) exposure because of limited control over their indoor environment. Homes remain the major place where children may be exposed to SHS. Our study examines the magnitude, patterns and determinants of SHS exposure in the home among children in 21 countries (19 low-income and middle-income countries and 2 high-income countries). METHODS: Global Adult Tobacco Survey (GATS) data, a household survey of people 15 years of age or older. Data collected during 2009-2013 were analysed to estimate the proportion of children exposed to SHS in the home. GATS estimates and 2012 United Nations population projections for 2015 were also used to estimate the number of children exposed to SHS in the home. RESULTS: The proportion of children younger than 15 years of age exposed to SHS in the home ranged from 4.5% (Panama) to 79.0% (Indonesia). Of the approximately one billion children younger than 15 years of age living in the 21 countries under study, an estimated 507.74 million were exposed to SHS in the home. China, India, Bangladesh, Indonesia and the Philippines accounted for almost 84.6% of the children exposed to SHS. The prevalence of SHS exposure was higher in countries with higher adult smoking rates and was also higher in rural areas than in urban areas, in most countries. CONCLUSIONS: A large number of children were exposed to SHS in the home. Encouraging of voluntary smoke-free rules in homes and cessation in adults has the potential to reduce SHS exposure among children and prevent SHS-related diseases and deaths. |
Youth access to cigarettes in six sub-Saharan African countries
Chandora R , Song Y , Chaussard M , Palipudi KM , Lee KA , Ramanandraibe N , Asma S . Prev Med 2016 91S S23-S27 OBJECTIVE: Tobacco smoking is initiated and established mostly during adolescence. The World Health Organization (WHO) Framework Convention on Tobacco Control (FCTC) Article 16 outlines the obligation of parties to prohibit the sale of tobacco products to minors. This study examined where and how student smokers obtain cigarettes. METHODS: We examined Global Youth Tobacco Survey (GYTS) data from 2009 to 2011 on cigarette access among students aged 13-15 in six sub-Saharan African countries. RESULTS: In all countries analyzed, over 20% of student smokers obtained their cigarettes in a store or shop (52.6% in South Africa, 37.7% in Republic of Congo, 28.2% in Swaziland, 27.4% in Cote d'Ivoire, 26.9% in Ghana, and 22.6% in Uganda). In Cote d'Ivoire and South Africa, 68.9% and 68.7% of student cigarette smokers, respectively, were not refused the sale of cigarettes because of age. The percentage of students who were offered free cigarettes by a tobacco company representative ranged from 4.7% in Cote d'Ivoire to 12.1% in South Africa. CONCLUSIONS: The method of obtaining cigarettes and access to cigarettes among students varies among sub-Saharan African countries. Adopting and enforcing interventions that prevent youth from accessing tobacco products could be an effective strategy for reducing smoking initiation among youth in sub-Saharan African countries. |
Cigarette smoking and cigarette marketing exposure among students in selected African countries: Findings from the global youth tobacco survey
Zhao L , Palipudi KM , Ramanandraibe N , Asma S . Prev Med 2015 91S S35-S39 OBJECTIVE: To investigate cigarette smoking prevalence and exposure to various forms of cigarette marketing among students in 10 African countries. METHODS: We used data collected during 2009-2011 from the Global Youth Tobacco Survey (GYTS), a school based cross-sectional survey of students aged 13-15years, to measure the prevalence of cigarette smoking and exposure to cigarette marketing; comparisons to estimates from 2005 to 2006 were conducted for five countries where data were available. The correlations between country-level cigarette smoking prevalence and exposure to cigarette marketing were also studied. RESULTS: Current cigarette smoking ranged from 3.4% to 13.6% among students aged 13-15 in the 10 countries studied, although use of tobacco products other than cigarettes was more prevalent in all countries except in Cote D'Ivoire. Cigarette smoking was higher among boys than girls in seven out of the 10 countries. Among the five countries with two rounds of surveys, a significant decrease in cigarette smoking prevalence was observed in Mauritania and Niger; these two countries also experienced a decline in three measures of cigarette marketing exposure. It is also possible that smoking prevalence might have risen faster among girls than boys. CONCLUSION: Cigarette smoking among youth was noticeable in 10 African countries evaluated, with the prevalence over 10% in Cote D'Ivoire, Mauritania and South Africa. Cigarette marketing exposure varied by the types of marketing; traditional venues such as TV, outdoor billboards, newspapers and magazines, were still prominent. |
The process of cessation among current tobacco smokers: a cross-sectional data analysis from 21 countries, Global Adult Tobacco Survey, 2009-2013
Mbulo L , Palipudi KM , Nelson-Blutcher G , Murty KS , Asma S . Prev Chronic Dis 2015 12 E151 We analyzed data from the Global Adult Tobacco Survey (GATS) from 21 countries to categorize smokers by stages of cessation and highlight interventions that could be tailored to each stage. GATS is a nationally representative household survey that measures tobacco use and other key indicators by using a standardized protocol. The distribution of smokers into precontemplation, contemplation, and preparation stages varied by country. Using the stages of change model, each country can design and implement effective interventions suitable to its cultural, social, and economic situations to help smokers advance successfully through the stages of cessation. |
Awareness and current use of electronic cigarettes in Indonesia, Malaysia, Qatar, and Greece: findings from 2011-2013 Global Adult Tobacco Surveys
Palipudi KM , Mbulo L , Morton J , Mbulo L , Bunnell R , Blutcher-Nelson G , Kosen S , Tee GH , Abdalla AM , Mutawa KA , Barbouni A , Antoniadou E , Fouad H , Khoury RN , Rarick J , Sinha DN , Asma S . Nicotine Tob Res 2015 18 (4) 501-7 INTRODUCTION: Increases in electronic cigarette (e-cigarette) awareness and current use have been documented in high income countries but less is known about middle and low income countries. METHODS: Nationally representative household survey data from the first four Global Adult Tobacco Surveys to assess e-cigarettes were analyzed, including Indonesia (2011), Malaysia (2011), Qatar (2013), and Greece (2013). Correlates of e-cigarette awareness and current use were calculated. Sample sizes for Greece and Qatar allowed for further analysis of e-cigarette users. RESULTS: Awareness of e-cigarettes was 10.9% in Indonesia, 21.0% in Malaysia, 49.0% in Qatar, and 88.5% in Greece. In all four countries, awareness was higher among male, younger, more educated, and wealthier respondents. Current e-cigarette use among those aware of e-cigarettes was 3.9% in Malaysia, 2.5% in Indonesia, 2.2% in Greece and 1.8% in Qatar. Across these four countries, an estimated 818 500 people are currently using e-cigarettes. Among current e-cigarette users, 64.4% in Greece and 84.1% in Qatar also smoked cigarettes, and, 10.6% in Greece and 6.0% in Qatar were never-smokers. CONCLUSIONS: E-cigarette awareness and use was evident in all four countries. Ongoing surveillance and monitoring of awareness and use of e-cigarettes in these and other countries could help inform tobacco control policies and public health interventions. Future surveillance should monitor use of e-cigarettes among current smokers and uptake among never-smokers and relapsing former smokers. |
Smokeless tobacco use: a meta-analysis of risk and attributable mortality estimates for India
Sinha DN , Palipudi KM , Gupta PC , Singhal S , Ramasundarahettige C , Jha P , Indrayan A , Asma S , Vendhan G . Indian J Cancer 2014 51 Suppl S73-7 BACKGROUND: Use of smokeless tobacco (SLT) is widely prevalent in India and Indian subcontinent. Cohort and case-control studies in India and elsewhere report excess mortality due to its use. OBJECTIVE: The aim was to estimate the SLT use-attributable deaths in males and females, aged 35 years and older, in India. MATERIALS AND METHODS: Prevalence of SLT use in persons aged 35 years and older was obtained from the Global Adult Tobacco Survey in India and population size and deaths in the relevant age-sex groups were obtained from UN estimates (2010 revision) for 2008. A meta-relative risk (RR) based population attributable fraction was used to estimate attributable deaths in persons aged 35 years and older. A random effects model was used in the meta-analysis on all-cause mortality from SLT use in India including four cohort and one case-control study. The studies included in the meta-analysis were adjusted for smoking, age and education. RESULTS: The prevalence of SLT use in India was 25.2% for men and 24.5% for women aged 35 years and older. RRs for females and males were 1.34 (1.27-1.42) and 1.17 (1.05-1.42), respectively. The number of deaths attributable to SLT use in India is estimated to be 368127 (217,076 women and 151,051 men), with nearly three-fifth (60%) of these deaths occurring among women. CONCLUSION: SLT use caused over 350,000 deaths in India in 2010, and nearly three-fifth of SLT use-attributable deaths were among women in India. This calls for targeted public health intervention focusing on SLT products especially among women. |
Levels and trends of smokeless tobacco use among youth in countries of the World Health Organization South-East Asia Region
Sinha DN , Palipudi KM , Jones CK , Khadka BB , Silva PD , Mumthaz M , Shein N , Gyeltshen T , Nahar K , Asma S , Kyaing NN . Indian J Cancer 2014 51 Suppl S50-3 BACKGROUND: At least two rounds of the Global Youth Tobacco Survey (GYTS) have been completed in most of the countries in the World Health Organization South-East Asia region. Comparing findings from these two rounds provides trend data on smokeless tobacco (SLT) use for the first time. METHODS: This study uses GYTS data from Bangladesh, Bhutan, India, Indonesia, Maldives, Myanmar, Nepal, Sri Lanka, Thailand, and Timor-Leste during 2006-2013. GYTS is a nationally representative survey of 13-15-year-old students using a consistent and standard protocol. Current SLT use is defined as using any kind of SLT products, such as chewing betel quid or nonbetel quid or snuffing any other products orally or through the nasal route, during the 30 days preceding the survey. Prevalence and 95% confidence intervals were computed using SAS/SUDAAN software. RESULTS: According to most recent GYTS data available in each country, the prevalence of current use of SLT among youth varied from 5.7% in Thailand to 23.2% in Bhutan; among boys, from 7.1% in Bangladesh to 27.2% in Bhutan; and among girls, from 3.7% in Bangladesh to 19.8% in Bhutan. Prevalence of SLT was reported significantly higher among boys than girls in Bhutan (boys 27.2%; girls 19.8%), India (boys 11.1%; girls 6.0%), Maldives (boys 9.2%; girls 2.9%), Myanmar (boys 15.2%; girls 4.0%), and Sri Lanka (boys 13.0%; girls 4.1%). Prevalence of current SLT use increased in Bhutan from 9.4% in 2009 to 23.2% in 2013, and in Nepal from 6.1% in 2007 to 16.2% in 2011. CONCLUSION: The findings call for countries to implement corrective measures through strengthened policy and enforcement. |
Influence of tobacco industry advertisements and promotions on tobacco use in India: findings from the Global Adult Tobacco Survey 2009-2010
Sinha DN , Palipudi KM , Oswal K , Gupta PC , Andes LJ , Asma S . Indian J Cancer 2014 51 Suppl S13-8 INTRODUCTION: The developing world, including countries like India, has become a major target for the tobacco industry to market its products. This study examines the influence of the marketing (advertising and promotion) of tobacco products on the use of tobacco by adults (ages 15 and over) in India. METHOD: Data from Global Adult Tobacco Survey 2009-2010 was analyzed using methods for complex (clustered) sample designs. Multivariate logistic regression was employed to predict the use of different tobacco products by level of exposure to tobacco marketing using adults who have never used tobacco as the reference category. Odds ratios (ORs) were adjusted for education, gender, age, state of residence, wealth index, and place of residence (urban/rural). RESULTS: Adults in India were almost twice as likely to be current smokers (versus never users) when they were exposed to a moderate level of bidi or cigarette marketing. For bidis, among adults with high exposure, the OR for current use was 4.57 (95% confidence interval [CI]: 1.6, 13.0). Adults were more likely to be current users of smokeless tobacco (SLT) with even a low level of exposure to SLT marketing (OR = 1.24 [95% CI: 1.1, 1.4]). For SLT, the ORs showed an increasing trend (P for trend < 0.001) with greater level of exposure (moderate, OR = 1.55 [95% CI: 1.1, 2.2]; high, OR = 2.05 [95% CI: 0.8, 5.1]). The risk of any current tobacco use rose with increasing level of exposure to any marketing (minimum, OR = 1.25 [1.1-1.4]; moderate, OR = 1.38 [1.1-1.8]; and high, OR = 2.73 [1.8-4.2]), with the trend highly significant (P < 0.001). CONCLUSION: Exposure to the marketing of tobacco products, which may take the form of advertising at the point of sale, sales or a discounted price, free coupons, free samples, surrogate advertisements, or any of several other modalities, increased prevalence of tobacco use among adults. An increasing level of exposure to direct and indirect advertisement and promotion is associated with an increased likelihood of tobacco use. |
Tobacco use among youths - Argentina, 2007 and 2012
Konfino J , Ferrante D , Goldberg L , Caixeta R , Palipudi KM . MMWR Morb Mortal Wkly Rep 2014 63 (27) 588-90 Tobacco use is the leading preventable cause of deaths worldwide. The MPOWER package, the six recommended policies of the World Health Organization (WHO) to reverse the tobacco epidemic, strongly recommends monitoring tobacco use trends. Because evidence indicates that smoking addiction often starts before the age of 18 years, there is a need to monitor tobacco use among youths. During 2011, a National Tobacco Control Law was enacted in Argentina that included implementation of 100% smoke-free environments, a comprehensive advertising ban (prohibiting advertising, promotion, and sponsorship of cigarettes or tobacco products through any media or communications outlets), pictorial health warnings, and a prohibition against the sale of tobacco products through any means to persons aged <18 years. To ascertain trends in tobacco use among youths in Argentina, the Argentina Ministry of Health and CDC analyzed data from the Global Youth Tobacco Survey (GYTS) for 2007 and 2012 (the next year that it was administered in Argentina). The findings indicated that the overall proportion of youths aged approximately 13-15 years who reported ever smoking a cigarette declined from 52.0% in 2007 to 41.9% in 2012 with significant decreases among both males and females. In 2012, 52.5% of youths in Argentina reported secondhand smoke (SHS) exposure in their homes and 47.5% in enclosed public places in the 7 days preceding the survey. Increased public education and tobacco control efforts will be important to discouraging tobacco use and decreasing SHS exposure among youths in Argentina. |
Tobacco use in 3 billion individuals from 16 countries: an analysis of nationally representative cross-sectional household surveys
Giovino GA , Mirza SA , Samet JM , Gupta PC , Jarvis MJ , Bhala N , Peto R , Zatonski W , Hsia J , Morton J , Palipudi KM , Asma S . Lancet 2012 380 (9842) 668-79 BACKGROUND: Despite the high global burden of diseases caused by tobacco, valid and comparable prevalence data for patterns of adult tobacco use and factors influencing use are absent for many low-income and middle-income countries. We assess these patterns through analysis of data from the Global Adult Tobacco Survey (GATS). METHODS: Between Oct 1, 2008, and March 15, 2010, GATS used nationally representative household surveys with comparable methods to obtain relevant information from individuals aged 15 years or older in 14 low-income and middle-income countries (Bangladesh, Brazil, China, Egypt, India, Mexico, Philippines, Poland, Russia, Thailand, Turkey, Ukraine, Uruguay, and Vietnam). We compared weighted point estimates and 95% CIs of tobacco use between these 14 countries and with data from the 2008 UK General Lifestyle Survey and the 2006-07 US Tobacco Use Supplement to the Current Population Survey. All these surveys had cross-sectional study designs. FINDINGS: In countries participating in GATS, 48.6% (95% CI 47.6-49.6) of men and 11.3% (10.7-12.0) of women were tobacco users. 40.7% of men (ranging from 21.6% in Brazil to 60.2% in Russia) and 5.0% of women (0.5% in Egypt to 24.4% in Poland) in GATS countries smoked a tobacco product. Manufactured cigarettes were favoured by most smokers (82%) overall, but smokeless tobacco and bidis were commonly used in India and Bangladesh. For individuals who had ever smoked daily, women aged 55-64 years at the time of the survey began smoking at an older age than did equivalently aged men in most GATS countries. However, those individuals who had ever smoked daily and were aged 25-34-years when surveyed started to do so at much the same age in both sexes. Quit ratios were very low (<20% overall) in China, India, Russia, Egypt, and Bangladesh. INTERPRETATION: The first wave of GATS showed high rates of smoking in men, early initiation of smoking in women, and low quit ratios, reinforcing the view that efforts to prevent initiation and promote cessation of tobacco use are needed to reduce associated morbidity and mortality. FUNDING: Bloomberg Philanthropies' Initiative to Reduce Tobacco Use, Bill and Melinda Gates Foundation, Brazilian and Indian Governments. |
Social determinants of health and tobacco use in thirteen low and middle income countries: evidence from Global Adult Tobacco Survey
Palipudi KM , Gupta PC , Sinha DN , Andes LJ , Asma S , McAfee T . PLoS One 2012 7 (3) e33466 BACKGROUND: Tobacco use has been identified as the single biggest cause of inequality in morbidity. The objective of this study is to examine the role of social determinants on current tobacco use in thirteen low-and-middle income countries. METHODOLOGY/PRINCIPAL FINDINGS: We used nationally representative data from the Global Adult Tobacco Survey (GATS) conducted during 2008-2010 in 13 low-and-middle income countries: Bangladesh, China, Egypt, India, Mexico, Philippines, Poland, Russian Federation, Thailand, Turkey, Ukraine, Uruguay, and Viet Nam. These surveys provided information on 209,027 respondent's aged 15 years and above and the country datasets were analyzed individually for estimating current tobacco use across various socio-demographic factors (gender, age, place of residence, education, wealth index, and knowledge on harmful effects of smoking). Multiple logistic regression analysis was used to predict the impact of these determinants on current tobacco use status. Current tobacco use was defined as current smoking or use of smokeless tobacco, either daily or occasionally. Former smokers were excluded from the analysis. Adjusted odds ratios for current tobacco use after controlling other cofactors, was significantly higher for males across all countries and for urban areas in eight of the 13 countries. For educational level, the trend was significant in Bangladesh, Egypt, India, Philippines and Thailand demonstrating decreasing prevalence of tobacco use with increasing levels of education. For wealth index, the trend of decreasing prevalence of tobacco use with increasing wealth was significant for Bangladesh, India, Philippines, Thailand, Turkey, Ukraine, Uruguay and Viet Nam. The trend of decreasing prevalence with increasing levels of knowledge on harmful effects of smoking was significant in China, India, Philippines, Poland, Russian Federation, Thailand, Ukraine and Viet Nam. CONCLUSIONS/SIGNIFICANCE: These findings demonstrate a significant but varied role of social determinants on current tobacco use within and across countries. |
Exposure to tobacco smoke among adults in Bangladesh
Palipudi KM , Sinha DN , Choudhury S , Mustafa Z , Andes L , Asma S . Indian J Public Health 2011 55 (3) 210-9 OBJECTIVE: To examine exposure to second-hand smoke (SHS) at home, in workplace, and in various public places in Bangladesh. MATERIALS AND METHODS: Data from 2009 Global Adult Tobacco Survey (GATS) conducted in Bangladesh was analyzed. The data consists of 9,629 respondents from a nationally representative multi-stage probability sample of adults aged 15 years and above. Exposure to second-hand smoke was defined as respondents who reported being exposed to tobacco smoke in the following locations: Indoor workplaces, homes, government building or office, health care facilities, public transportation, schools, universities, restaurants, and cafes, coffee shops or tea houses. Exposure to tobacco smoke in these places was examined by gender across various socioeconomic and demographic sub-groups that include age, residence, education and wealth index using SPSS 17.0 for complex samples. RESULTS: The study shows high prevalence of SHS exposure at home and in workplace and in public places. Exposure to SHS among adults was reported high at home (54.9%) (male-58.2% and female-51.7%), in workplace (63%) (male-67.8% and female-30.4%), and in any public place (57.8%) (male-90.4% and female-25.1%) 30 days preceding the survey. Among the public places examined exposure was low in the educational institutions (schools-4.3%) and health care facilities (5.8%); however, exposure was high in public transportation (26.3%), and restaurants (27.6%). SHS exposure levels at home, in workplace and public places were varied widely across various socioeconomic and demographic sub-groups. CONCLUSIONS: Exposure was reported high in settings having partial ban as compared to settings having a complete ban. Following the WHO FCTC and MPOWER measures, strengthening smoke-free legislation may further the efforts in Bangladesh towards creating and enforcing 100% smoke-free areas and educating the public about the dangers of SHS. Combining these efforts can have a complementary effect on protecting the people from hazardous effect of SHS as well as reducing the social acceptance of smoking both at home and in public and workplaces. Ongoing surveillance in Bangladesh is necessary to measure progress towards monitoring SHS exposure. |
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