Functionings and Capabilities as Tools for Explaining Differences in Self- Assessed Health: The Case of Women’s Health in Accra, Ghana

We apply the Capability Approach on the data from a survey of women’s health in Accra to illustrate how such a framework can capture health differentials. We identified endowment groups by based on the wealth of the households and the socio-economic status of the neighbourhood of residence and analysed their association with the functionings, measured by summary indicators of physical and mental health. Regression analysis reveals that socio-cultural and household factors do not have a significant association with health status. In turn, education appears to have the predicted association with both physical and mental health. Unemployed women suffer poorer health even when compared with women in informal jobs. Being childless is associated with better health, remembering that this is now a low fertility population. The two dimensions of health measured here – physical and mental – do have different determinants. The socio-economic status of the neighbourhood affects physical health while family wealth affects mental health more strongly

La montée de l’obésité dans un contexte où la dénutrition n’est pas éradiquée. Application de l’approche des Capabilités sur des données mixtes au Mali

Nous analysons ici les données de l’EDS 2006 à la lumière des opinions sur la corpulence, exprimée dans des groupes de discussion, pour examiner les facteurs associés au maintien de la dénutrition et à la montée de l’obésité au Mali. La dénutrition chronique est l’expression d’un manque de ressources du contexte, caractérisant la vulnérabilité alimentaire du milieu rural, mais aussi des modes de vie et situations personnelles plus à risques, telle l’absence de conjoint. La montée de l’obésité est rendue possible lorsqu’un certain seuil de ressources alimentaires est atteint. Elle exprime aussi les inégalités de Capabilités des femmes à utiliser ces ressources pour les transformer en bien-être et, donc, leur ambivalence face à la valorisation sociale d’une forte corpulence, et aux transformations des modes de vie liées à l’urbanisation. Cette ambivalence expliquerait, en particulier, le risque accru d’obésité parmi les femmes scolarisées

Adoption d’une culture contraceptive et maîtrise du projet familial. La contraception constitue-t-elle une Capabilité?

Nous examinons les facteurs d’adoption d’une « culture contraceptive », décrite par la connaissance, la pratique et les intentions, et ses liens avec l’espacement des naissances. L’analyse des enquêtes EDS Mali (2006) et Ghana (2008) montre la persistance du fossé entre connaissance et pratique - la connaissance de la contraception ne gomme pas les inégalités de pratique - et le rôle des « facteurs de conversion ». Ainsi l’avantage des habitants des grandes villes disparaît lorsque l’on contrôle pour les caractéristiques personnelles. Les comportements des femmes apparaissent influencés par la réalité de leur situation familiale, alors que ceux des hommes reposeraient plus sur des valeurs. Finalement, ce n’est pas l’adoption de la contraception qui importe pour l’espacement des naissances, mais le profil des femmes qui l’adoptent : la contraception ne constitue pas une Capabilité - une dimension de la liberté de planifier sa famille - mais un moyen parmi d’autres pour espacer les naissances

Nicotine delivery to users from cigarettes and from different types of e-cigarettes

BACKGROUND: Delivering nicotine in the way smokers seek is likely to be the key factor in e-cigarette (EC) success in replacing cigarettes. We examined to what degree different types of EC mimic nicotine intake from cigarettes. METHODS: Twelve participants (‘dual users’ of EC and cigarettes) used their own brand cigarette and nine different EC brands. Blood samples were taken at baseline and at 2-min intervals for 10 min and again at 30 min. RESULTS: Eleven smokers provided usable data. None of the EC matched cigarettes in nicotine delivery (C (max) = 17.9 ng/ml, T (max) = 4 min and AUC(0–>30) = 315 ng/ml/min). The EC with 48 mg/ml nicotine generated the closest PK profile (C (max) = 13.6 ng/ml, T (max) = 4 min, AUC(0–>30) = 245 ng/ml/min), followed by a third generation EC using 20 mg/ml nicotine (C (max) = 11.9 ng/ml, T (max) = 6 min, AUC(0–>30) = 232 ng/ml/min), followed by the tank system using 20 mg/ml nicotine (C (max) = 9.9 ng/ml, T (max) = 6 min, AUC(0–>30) = 201 ng/ml/min). Cig-a-like PK values were similar, ranging from C (max) 7.5 to 9.7 ng/ml, T (max) 4-6 min, and AUC(0–>30) 144 to 173 ng/ml/min. Moderate differences in e-liquid nicotine concentrations had little effect on nicotine delivery, e.g. the EC with 24 mg/ml cartridge had the same PK profile as ECs with 16 mg/ml cartridges. Using similar strength e-liquid, the tank EC provided significantly more nicotine than cig-a-like ECs. CONCLUSIONS: EC brands we tested do not deliver nicotine as efficiently as cigarettes, but newer EC products deliver nicotine more efficiently than cig-a-like brands. Moderate variations in nicotine content of e-liquid have little effect on nicotine delivery. Smokers who are finding cig-a-like EC unsatisfactory should be advised to try more advanced systems

Potential for non-combustible nicotine products to reduce socioeconomic inequalities in smoking: a systematic review and synthesis of best available evidence

While some experts have emphasised the potential for e-cigarettes to facilitate cessation among smokers with low socioeconomic status (SES), there is limited evidence of their likely equity impact. We assessed the potential for electronic cigarettes and other non-combustible nicotine-containing products (NCNPs) to reduce inequalities in smoking by systematically reviewing evidence on their use by SES in countries at stage IV of the cigarette epidemic

Electronic cigarettes for smoking cessation

Background Electronic cigarettes (ECs) are handheld electronic vaping devices which produce an aerosol formed by heating an e‐liquid. Some people who smoke use ECs to stop or reduce smoking, but some organizations, advocacy groups and policymakers have discouraged this, citing lack of evidence of efficacy and safety. People who smoke, healthcare providers and regulators want to know if ECs can help people quit and if they are safe to use for this purpose. This is an update of a review first published in 2014. Objectives To examine the effectiveness, tolerability, and safety of using electronic cigarettes (ECs) to help people who smoke achieve long‐term smoking abstinence. Search methods We searched the Cochrane Tobacco Addiction Group's Specialized Register, the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, Embase, and PsycINFO to 1 February 2021, together with reference‐checking and contact with study authors. Selection criteria We included randomized controlled trials (RCTs) and randomized cross‐over trials in which people who smoke were randomized to an EC or control condition. We also included uncontrolled intervention studies in which all participants received an EC intervention. To be included, studies had to report abstinence from cigarettes at six months or longer and/or data on adverse events (AEs) or other markers of safety at one week or longer. Data collection and analysis We followed standard Cochrane methods for screening and data extraction. Our primary outcome measures were abstinence from smoking after at least six months follow‐up, adverse events (AEs), and serious adverse events (SAEs). Secondary outcomes included changes in carbon monoxide, blood pressure, heart rate, blood oxygen saturation, lung function, and levels of known carcinogens/toxicants. We used a fixed‐effect Mantel‐Haenszel model to calculate the risk ratio (RR) with a 95% confidence interval (CI) for dichotomous outcomes. For continuous outcomes, we calculated mean differences. Where appropriate, we pooled data from these studies in meta‐analyses. Main results We included 56 completed studies, representing 12,804 participants, of which 29 were RCTs. Six of the 56 included studies were new to this review update. Of the included studies, we rated five (all contributing to our main comparisons) at low risk of bias overall, 41 at high risk overall (including the 25 non‐randomized studies), and the remainder at unclear risk. There was moderate‐certainty evidence, limited by imprecision, that quit rates were higher in people randomized to nicotine EC than in those randomized to nicotine replacement therapy (NRT) (risk ratio (RR) 1.69, 95% confidence interval (CI) 1.25 to 2.27; I2 = 0%; 3 studies, 1498 participants). In absolute terms, this might translate to an additional four successful quitters per 100 (95% CI 2 to 8). There was low‐certainty evidence (limited by very serious imprecision) that the rate of occurrence of AEs was similar) (RR 0.98, 95% CI 0.80 to 1.19; I2 = 0%; 2 studies, 485 participants). SAEs occurred rarely, with no evidence that their frequency differed between nicotine EC and NRT, but very serious imprecision led to low certainty in this finding (RR 1.37, 95% CI 0.77 to 2.41: I2 = n/a; 2 studies, 727 participants). There was moderate‐certainty evidence, again limited by imprecision, that quit rates were higher in people randomized to nicotine EC than to non‐nicotine EC (RR 1.70, 95% CI 1.03 to 2.81; I2 = 0%; 4 studies, 1057 participants). In absolute terms, this might again lead to an additional four successful quitters per 100 (95% CI 0 to 11). These trials mainly used older EC with relatively low nicotine delivery. There was moderate‐certainty evidence of no difference in the rate of AEs between these groups (RR 1.01, 95% CI 0.91 to 1.11; I2 = 0%; 3 studies, 601 participants). There was insufficient evidence to determine whether rates of SAEs differed between groups, due to very serious imprecision (RR 0.60, 95% CI 0.15 to 2.44; I2 = n/a; 4 studies, 494 participants). Compared to behavioral support only/no support, quit rates were higher for participants randomized to nicotine EC (RR 2.70, 95% CI 1.39 to 5.26; I2 = 0%; 5 studies, 2561 participants). In absolute terms this represents an increase of seven per 100 (95% CI 2 to 17). However, this finding was of very low certainty, due to issues with imprecision and risk of bias. There was no evidence that the rate of SAEs differed, but some evidence that non‐serious AEs were more common in people randomized to nicotine EC (AEs: RR 1.22, 95% CI 1.12 to 1.32; I2 = 41%, low certainty; 4 studies, 765 participants; SAEs: RR 1.17, 95% CI 0.33 to 4.09; I2 = 5%; 6 studies, 1011 participants, very low certainty). Data from non‐randomized studies were consistent with RCT data. The most commonly reported AEs were throat/mouth irritation, headache, cough, and nausea, which tended to dissipate with continued use. Very few studies reported data on other outcomes or comparisons and hence evidence for these is limited, with confidence intervals often encompassing clinically significant harm and benefit. Authors' conclusions There is moderate‐certainty evidence that ECs with nicotine increase quit rates compared to ECs without nicotine and compared to NRT. Evidence comparing nicotine EC with usual care/no treatment also suggests benefit, but is less certain. More studies are needed to confirm the size of effect, particularly when using modern EC products. Confidence intervals were for the most part wide for data on AEs, SAEs and other safety markers, though evidence indicated no difference in AEs between nicotine and non‐nicotine ECs. Overall incidence of SAEs was low across all study arms. We did not detect any clear evidence of harm from nicotine EC, but longest follow‐up was two years and the overall number of studies was small. The evidence is limited mainly by imprecision due to the small number of RCTs, often with low event rates. Further RCTs are underway. To ensure the review continues to provide up‐to‐date information, this review is now a living systematic review. We run searches monthly, with the review updated when relevant new evidence becomes available. Please refer to the Cochrane Database of Systematic Reviews for the review's current status

The health of adult women in Accra, Ghana: self-reporting and objective assessments 2008-2009

Objectives: The study provides a full description of the state of women’s health in Accra, Ghana using self reported as well as objective health measures. Using data from the Women’s Health Survey of Accra, Wave 2 (WHSA-2), the authors a) examine the consistency of the objective measures of health status (anthropometry and blood pressures) with self-report measures, including the Short Form 36 indices for 8 separate domains of health; and b) describe the main socio-economic differentials in morbidity.Methods: Cross-sectional household survey with field measurements. 2814 women aged 18 and over were interviewed and measured in their homes in late 2008 and early 2009. The physical measurements included height, weight, waist and hip measurement and 3 or more measures of resting blood pressure.Results: Using the 8 domains of self-reported health captured by the Short Form 36 instrument, we find that physical health worsens more sharply with age than mental health. Social class differentials are narrow in the younger cohorts but widen amongst the elderly. The physical measurements reveal unhealthy levels of obesity and hypertension, worsening steadily with rising age. Age and the wealth of the household influence women’s health more than their individual characteristics such as education.Conclusions: Younger women appear to be in good health with steady declines in physical and mental health with age. The major threat to women’s health appears to be the rising levels of obesity and hypertension with mean BMIs for all women over age 45 in excess of 30, producing elevated blood pressures and associated high risks of heart attacks and stroke rising sharply amongst the elderly

Use of electronic cigarettes among young Swiss men.

A prevalence survey of e-cig us

Symptoms of common mental disorders and their correlates among women in Accra, Ghana: a population-based survey

Introduction: To comply with its new mental health bill, Ghana needs to integrate mental health within other health and social services. Mental disorders represent 9% of disease burden in Ghana. Women are more affected by common mental disorders, and are underrepresented in treatment settings. This study examines physical and social correlates of mental illness in adult women in Accra, Ghana, so as to inform general clinical practice and health policy.Methods: The SF-36 and K6 forms and 4 psychosis questions were administered in three languages to 2,814 adult women living in Accra, as part of a larger cross-sectional population-based survey of women’s health. The validity of these tools was assessed through correlations within and between measures. Risk factors for mental distress were analysed using multivariate regression. Health service use was also described using statistical frequencies.Results: Both the SF36 and K6 appear valid in a female Ghanaian population. Low levels of education, poverty and unemployment are negatively associated with mental health. Physical ill health is also associated with mental distress. No association was found between mental distress and religion or ethnicity. Some additional risk factors were significant for one, but not both of the outcome variables. Only 0.4% of women reported seeing a mental health professional in the previous year, whereas 58.6% had visited a health centre.Conclusion: The implications for women are that marriage is neither good nor bad for mental health, but education and employment are strong protective factors. Researchers should note that the SF36 and K6 can be used in a Ghanaian population, however more research is needed to determine the cut-off point for serious mental illness on the K6, as well as research into mental disorders in a mixed-gender population