Disparities and Trends in Indoor Exposure to Secondhand Smoke among U.S. Adolescents: 2000-2009

Introduction: Secondhand smoke (SHS) exposure causes disease and death among nonsmokers. With a plethora of smoke-free legislation implemented and a steady decrease in cigarette consumption noted over the past decade in the U.S., this study assessed trends in indoor SHS exposure among U.S. adolescents in grades 6–12 during 2000–2009. Methods: Data were obtained from the 2000–2009 National Youth Tobacco Survey – a national survey of U.S. middle and high school students. SHS exposure within an indoor area within the past seven days was self-reported. Trends in indoor SHS exposure during 2000–2009 were assessed overall and by socio-demographic characteristics, using the Wald's test in a binary logistic regression. Within-group comparisons were performed using chi-squared statistics (p<0.05). Results: The proportion of U.S. middle and high school students who were exposed to indoor SHS declined from 65.5% in 2000 to 40.5% in 2009 (p<0.05 for linear trend). Significant declines were also observed across all population subgroups. Between 2000 and 2009, prevalence of indoor SHS exposure declined significantly among both middle (58.5% to 34.3%) and high school (71.5% to 45.4%) students. Prevalence of indoor SHS exposure was significantly higher among girls (44.0% in 2009) compared to boys (37.2% in 2009) during each survey year. Similarly, prevalence of indoor SHS exposure during 2000–2009 was highest among non-Hispanic whites (44.2% in 2009) and lowest among non-Hispanic Asians (30.2% in 2009). During each survey year, prevalence was highest among the oldest age group (≥18 years) and lowest among the youngest (9–11 years). Also, prevalence was significantly higher among current cigarette smokers (83.8% in 2009) compared to nonsmokers (34.0% in 2009). Conclusion: Significant declines in indoor SHS exposure among U.S. middle and high school students occurred during 2000–2009. While the results are encouraging, additional efforts are needed to further reduce youth indoor SHS exposure

Intention to Switch to Smokeless Tobacco Use among South African Smokers: Results from the 2007 South African Social Attitudes Survey

Background: Some smokeless tobacco products (SLT) have been shown to be associated with only a fraction of the risks of cigarettes. This study assessed South African smokers’ interest in switching to a hypothetical reduced harm SLT product. Methods: The 2007 South African Social Attitudes Survey was analysed for 678 exclusive cigarette smokers. Respondents were asked about their perceptions about relative harm of snuff compared to cigarettes, and their interest in switching to snuff if informed it was 99% less harmful than cigarettes. Results: About 49.7% of exclusive cigarette smokers believed that snuff was equally as harmful as cigarettes; 12.9% thought snuff was more harmful; 5.7% thought snuff was less harmful; while 31.8% did not know if there was a difference in harm between snuff and cigarettes. Approximately 24.2% of exclusive cigarette smokers indicated interest in switching to snuff, with significantly greater interest observed among those exposed to 100% smoke-free work environment. Interest in switching was highest (34.7%) among smokers who believed a priori that using snuff was more harmful than cigarettes, and lowest (14.5%) among those who did not know if there was a difference in harm. In a multi-variable adjusted logistic regression model, this latter group remained less likely to be interested in harm reduction switching (adjusted odds ratio = 0.42; 95% CI: 0.19–0.91). Conclusion: About a quarter of smokers indicated interest in harm reduction switching to snuff. SLT products have a potential role in reducing the harm from smoking in South Africa, but only if they are not used to circumvent smoke-free laws that have been associated with reduced smoking

Exposure to secondhand smoke and voluntary adoption of smoke-free home and car rules among non-smoking South African adults

Background: Secondhand smoke (SHS) exposure is a well-established health hazard. To determine the effectiveness of existing smoke-free policies and adoption of smoke-free rules in South Africa, we assessed exposure to SHS from several sources among non-smoking adults during 2010. Methods: Data were analyzed for 3,094 adults aged ≥16 years who participated in the 2010 South African Social Attitudes Survey. Descriptive statistics and multivariate analyses were used to assess presence of smoke-free rules among all South Africans, and prevalence and correlates of SHS exposure at work, at home, and at hospitality venues among non-smokers. Results: Overall, 70.6% of all South African adults had 100% smoke-free rules in their private cars, 62.5% in their homes, while 63.9% worked in places with 100% smoke-free policies. Overall, 55.9% of all non-smokers reported exposure to SHS from at least one source (i.e., in the home, workplace or at a hospitality venue). By specific source of exposure, 18.4% reported being exposed to SHS at work, 25.2% at home, 33.4% in a restaurant, and 32.7% at a bar. Presence of work bans on indoor smoking conferred lower likelihood of SHS exposure at work among non-smokers (adjusted odds ratio [aOR] = 0.23; 95% CI: 0.09-0.60). Similarly, smoke-free home rules decreased the odds of being exposed to SHS at home among non-smokers (aOR =0.16; 95% CI: 0.09-0.30). Conclusion: Over half of South African adults reported SHS exposure in the home or at public places such as the workplace and at hospitality venues. This underscores the need for comprehensive smoke-free laws that prohibit smoking in all public indoor areas without exemptions

A global assessment of knowledge of dental students about nicotine replacement therapy : findings from 43 countries

OBJECTIVES : Knowledge of nicotine replacement therapy (NRT) is a competency that is expected from receiving training in the treatment for tobacco dependence. This study therefore assessed the knowledge of dental students in 43 countries about NRT. METHODS : The 2005–2011 dental Global Health Professions Student Survey data were analysed for 13,040 third-year dental students from 43 countries. Knowledge about NRT was self-reported and country-specific prevalence estimates were calculated. To assess for correlates of knowledge about NRT amongst dental students, a multivariate logistic regression model was fitted (P < 0.05), with pooled data from all 43 countries. The model assessed for geographical location, gross national income, tobacco cessation training in school, sex, current tobacco use and survey year. RESULTS : Amongst all dental students, the proportion that knew about NRT ranged from 37.0% (Mongolia) to 97.6% (Slovakia). The odds of knowing about NRT were lower amongst dental students in the Eastern Mediterranean region (aOR = 0.52; 95%CI: 0.34–0.79) compared to those in the European region. Dental students in upper-middle-income (aOR = 2.46; 95% CI: 1.57–3.85) and high-income countries (aOR=4.55; 95% CI: 2.28–9.09) both had higher odds of knowing about NRT com-pared to dental students in low-income countries. Also, current use of any tobacco product and receipt of tobacco cessation training in school were both associated with higher likelihood of knowing about NRT. No significant gender differences in knowl-edge of NRT were observed. CONCLUSIONS : A large proportion of dental students in several countries knew about NRT. However, disparities in knowledge existed across regions. Enhanced efforts are needed to formally train dental students on tobacco cessation techniques.http://onlinelibrary.wiley.com/journal/10.1111/(ISSN)1600-05792015-08-31hb201

Utilisation of smoking cessation aids among South African adult smokers: findings from a national survey of 18 208 South African adults

OBJECTIVE : To examine the use of different cessation aids among current South African smokers who have ever tried to quit smoking. DESIGN : Cross-sectional design. SETTING : South Africa has progressively passed several policies over the past few decades to encourage smoking cessation. Data on cessation behaviours are needed to inform policymaking. We investigated utilisation of evidence-based cessation aids and e-cigarettes among current combustible smokers. Current tobacco use, past quit attempts and use of evidence-based cessation aids (counselling, nicotine replacement therapy or prescription medication) were self-reported. Data were weighted and analysed using descriptive and multivariable approaches (p<0.05). PARTICIPANTS : Online participants were recruited from the national consumer database for News24-South Africa's largest digital publisher. Of the 18 208 participants aged 18 years or older, there were 5657 current smokers of any combustible tobacco product (cigarettes, cigars, pipes or roll-your-own cigarettes), including 4309 who had ever attempted to quit during their lifetime. RESULTS : Current combustible tobacco smoking prevalence was 22.4% (95% CI: 21.2% to 23.5%), and 98.7% of all current smokers of any combustible tobacco were current cigarette smokers. Awareness of cessation aids was as follows among current combustible tobacco smokers: smoking cessation counselling programmes, 50.8% (95% CI: 48.1% to 53.6%); nicotine replacement therapy, 92.1% (95% CI: 90.5% to 93.6%); prescription cessation medication, 68.2% (95% CI: 65.2% to 70.6%). Awareness of cessation aids was lowest among Black Africans, men, and persons with little or no income. Of all current combustible tobacco smokers, 74.6% (95% CI: 72.2% to 76.7%) had ever attempted to quit and 42.8% (95% CI: 40.0% to 45.4%) of these quit attempters had ever used any cessation aid. Among current combustible smokers who attempted to quit in the past, ever e-cigarette users were more likely than never e-cigarette users to have ever used any cessation aid (50.6% vs 35.9%, p<0.05). Of current combustible smokers intending to quit, 66.7% (95% CI: 64.2% to 68.9%) indicated interest in using a cessation aid for future quitting. By specific aids, 24.7% (95% CI: 21.3% to 28.1%) of those planning to use any cessation aid were interested in getting help from a pharmacist, 44.6% (95% CI: 40.9% to 48.4%) from a doctor, 49.8% (95% CI: 46.0% to 53.6%) from someone who had successfully quit, 30.0% (95% CI: 26.7% to 33.4%) from a family member and 26.5% (95% CI: 23.0% to 30.0%) from web resources. CONCLUSION : Only two in five past quit attempters had ever used counselling/pharmacotherapy. Any putative benefits of e-cigarettes on cessation may be partly attributable to pharmacotherapy/counselling given concurrent use patterns among past quit attempters using e-cigarettes. Comprehensive tobacco control and prevention strategies can help reduce aggregate tobacco consumption.The African Capacity Building Foundation Grant number 333.https://fmch.bmj.comam2022School of Health Systems and Public Health (SHSPH

Potential revenue from taxing e-cigarettes and comparison of annual costs of daily e-cigarette use versus daily cigarette smoking among South African adults

INTRODUCTION : To inform policy making under the proposed The Control of Tobacco and Electronic Delivery Systems Bill, we compared annual costs of using e-cigarettes versus cigarettes, and estimated revenue from e-cigarette taxation. METHODS : We extracted e-cigarette retail prices from 231 South African e-cigarette vendor websites. We compared annual costs associated with daily cigarette smoking (self-reports from daily smokers in the 2018 South African Social Attitudes Survey, SASAS) versus daily e-cigarette use (based on cumulative costs of consumables plus device costs). We estimated revenue from excise tax if e-cigarettes were taxed at 75% (the rate proposed by the government) and 37.5% (half of the government’s proposal as a hypothetical scenario) of the cigarette excise rate. We applied the different rates to e-cigarette consumption in 2018 SASAS and projected for 2021. RESULTS : Mean annual cost associated with daily use was ZAR 6693 (US$460.32, based on an exchange rate of about 69 US$ to 1000 ZAR) for manufactured cigarettes; for e-cigarettes, this ranged from ZAR 8574.69/year (with price minimizing strategies) to ZAR 19780.83/year (retail products exclusively). Expected revenue from e-cigarette excise tax at 75% of the cigarette tax rate was up to ZAR 2.20 billion (95% CI: 0.96–3.44). If taxed at 37.5% of the cigarette tax rate – half of the government’s proposed rate – the projected revenue was up to ZAR 1.10 billion (95% CI: 0.48–1.72). Of the projected revenue from e-cigarette excise tax at 75% of the cigarette rate, the portion attributable to hardware (device and batteries) was 61% (ZAR 1.35 billion), while the portion attributable to e-liquid was 39% (ZAR 0.86 billion). CONCLUSIONS : Calculated daily costs were higher for e-cigarettes than cigarettes. We recommend an e-cigarette excise tax. The government’s proposed tax rate may reduce youth e-cigarette access, while allowing adult smokers wishing to switch exclusively to e-cigarettes to reduce their tobacco-related harm.African Capacity Building Foundationhttp://www.tobaccoinduceddiseases.orgdm2022School of Health Systems and Public Health (SHSPH

Associations between electronic cigarette use and quitting behaviours among South African adult smokers

DATA AVAILABILITY STATEMENT : Requests should be directed to the corresponding and will be considered on a case-by- case basis.BACKGROUND : The South African Medicines Control Council classifies e-cigarettes as Schedule 3 substances and requires them to be dispensed only within pharmacies. e-Cigarettes are however ubiquitous and are marketed as cessation aids. We investigated the relationship between e-cigarette use and smoking cessation among South African adult smokers. METHODS : Data came from a 2018 web survey of South African adults aged ≥18 years (n=18 208). Cessation-related attitudes and behaviours were assessed. Using multivariable logistic regression, we measured the association between e-cigarette use and cessation behaviours among ever-established combustible tobacco smokers who tried to quit. FINDINGS : Among current combustible smokers, more e-cigarette ever versus never users believed e-cigarettes could assist smokers to completely quit (35.5% vs 20.4%) or cut down (51.7% vs 26.5%) (all p<0.05). Among ever-established smokers, the odds of sustained quitting at the 12-month mark were lower among those who used e-cigarettes once off/rarely (adjusted OR (AOR)=0.20, 95% CI=0.16–0.24), former e-cigarette users (AOR=0.30, 95% CI=0.24–0.38) and current e-cigarette users (AOR=0.23, 95% CI=0.18–0.29), compared with never e-cigarette users. Among ever-established smokers who had ever tried to quit, 53.6% relapsed into smoking after quitting for any length of time. The odds of relapsing among ever-established smokers who had made a quit attempt and had a quit intention were higher among those who used e-cigarettes once off/rarely (AOR=2.66; 95% CI=2.31–3.08), former e-cigarette users (AOR=1.41; 95% CI=1.18–1.69) and current e-cigarette users (AOR=1.85; 95% CI=1.55–2.22) than never e-cigarette users. CONCLUSION : e-Cigarette use depressed long-term cessation. These findings can inform restrictions on unsubstantiated claims of e-cigarettes as cessation aids within South Africa.The African Capacity Building Foundation.https://tobaccocontrol.bmj.comhj2023School of Health Systems and Public Health (SHSPH

Prevalence and correlates of roll-your-own cigarette smoking among South African adults during 2010-2011 and 2017-2018

INTRODUCTION : The increasing use of roll-your own (RYO) cigarettes has been documented globally, but there are no recent data from South Africa, particularly among youths and low-income groups. We assessed changes in prevalence and correlates of RYO smoking among South African adults during 2010-2011 and 2017-2018, and explored expenditure differences between daily smokers of RYO and manufactured cigarettes. METHODS : Nationally representative data of South Africans aged ≥16 years used in this study were from the South African Social Attitudes Survey (SASAS) for 2010-2011 (n=6116), and 2017-2018 (n=5799). Current RYO cigarette use included daily and non-daily use. Annual expenditures were estimated based on typical usage patterns for daily users. Descriptive and multivariable analyses were performed using Stata Version 15 with the level of statistical significance set at p<0.05. RESULTS : The prevalence of ever RYO cigarette use increased from 6.5% (95% CI: 5.6-7.5) during 2010-2011, to 8.5% (95% CI: 7.0-10.0) during 2017-2018 (p=0.026). Current RYO cigarette use prevalence however remained largely unchanged when we compared 2010-2011 to 2017-2018 (5.2% vs 6.3%, p=0.544). During 2017-2018, current RYO cigarette use prevalence was highest among men (11.6%), those who self-identified as Coloreds (11.1%), people aged 25-34 years (7.8%), those with no schooling (7.5%), and those unemployed (9.8%). Annual expenditures associated with typical patterns of daily RYO cigarette smoking were substantially less than for smoking of manufactured cigarettes. CONCLUSIONS : The prevalence of ever RYO cigarette use increased between 2010-2011 and 2017-2018. Current RYO cigarette use during 2017-2018 was more prevalent among Coloreds, Black Africans, youths, those with lower education, and the unemployed. This study's findings highlight the need to harmonize taxation of cigarettes and RYO cigarettes, and to intensify implementation of evidence-based tobacco control and prevention interventions in South Africa.The African Capacity Building Foundation.http://www.tobaccoinduceddiseases.orghj2022School of Health Systems and Public Health (SHSPH

Tobacco cessation training among dental and other health professions students in eight low- and middle-income countries

This study assessed differences among health professions students in exposure to didactic tobacco cessation training in asking about patients' tobacco use status ("ask") and assisting smoking patients to quit by providing educational materials ("assist"). Data from the 2005-08 Global Health Professions Student Survey were analyzed for 28,420 medical, dental, nursing, and pharmacy students in eight low- and middle-income countries. Country-specific prevalence of exposure to training in tobacco cessation was calculated for each profession category; differences were assessed using logistic regression analysis (p<0.05). The proportion of dental students taught to implement the "ask" intervention ranged from 45.4 percent (Armenia) to 95.2 percent (Chile). Only about one-third of these dental students reported being taught to implement the "assist" intervention in most countries. After adjusting for survey year, country, gender, and tobacco use, the odds of dental students' being taught to implement the "ask" intervention were lower than for medical students (adjusted odds ratio [aOR]=0.63; 95% CI: 0.42-0.96). Similarly, the odds of being taught to implement the "assist" intervention were significantly higher for medical (aOR=1.65; 95% CI: 1.26-2.17), nursing (aOR=2.84; 95% CI: 2.37-3.40), and pharmacy students (aOR=1.36; 95CI:1.05-1.76) than for dental students. These findings underscore the need for enhanced measures to incorporate tobacco cessation training as a formal component of dental education globally.http://www.jdentaled.orghb201

E-cigarette advertising exposure among South African adults in 2017 : findings from a nationally representative cross-sectional survey

OBJECTIVES : In South Africa, the Control of Tobacco and Electronic Delivery Systems Bill seeks to regulate e-cigarettes as tobacco products, including their advertising, promotion and sponsorship. Population data on e-cigarette advertising in South Africa are needed to inform public health programs, practice and policy. We examined self-reported e-cigarette advertising exposure during 2017. DESIGN Cross-sectional. SETTING : Household-based survey. PARTICIPANTS : 3063 individuals who participated in the 2017 South African Social Attitudes survey, a nationally representative, in-person survey of the non-institutionalised civilian adult population aged ≥16 years EXPOSURE ‘In the past 12 months, have you seen advertisements or promotions for e-cigarettes (including e-shisha, e-pipe) on any of the following media: newspapers/ magazines, billboards, in the malls or any other source?’ MAIN OUTCOMES : Beliefs and attitudes regarding e-cigarettes. FINDINGS : Participants’ mean age was 37.7 years. Overall, 20.1% reported exposure to e-cigarette advertisements. By age, exposure was most prevalent among those aged 16–19 years (24.6%). Top sources of exposure among those exposed were stores, 40.7%; malls, 30.9%; and television, 32.5%. Of those aware of e-cigarettes, 61.2% believed ‘e-cigarette advertisements and promotion may make adolescents think of smoking traditional cigarettes’; 62.7% believed that ‘e-cigarette advertisements and promotions may make ex-smokers think of starting smoking cigarettes again’; and 59.5% supported the statement that ‘e-cigarette smoking should be banned indoors just as traditional cigarette smoking’. Notably, teens aged 16–19 reported the lowest prevalence (49.0%) of those believing that ‘e-cigarette advertisements and promotion may make adolescents think of smoking traditional cigarettes’, whereas this percentage was highest among those aged 55–64 years (73.2%). CONCLUSION : Comprehensive regulatory efforts are needed to address e-cigarette advertising, marketing and sponsorship in order to protect public health. The urgent enactment of the new tobacco control legislation, The Control of Tobacco Products and Electronic Delivery Systems Bill, can help reduce youth exposure to e-cigarette advertising in South Africa.http://bmjopen.bmj.comam2022School of Health Systems and Public Health (SHSPH