Tobacco Smoking and Associated Factors among People Living with HIV in Uganda

Introduction The prevalence of smoking among people living with HIV (PLWH) in Uganda is high. Aims and Methods We assessed the smoking patterns, behaviors, and associated factors among PLWH in Uganda through a cross-sectional survey. Descriptive statistics were used to describe smoking patterns and behaviors. Logistic regression was used to identify factors associated with current smoking status. Results We recruited 777 participants between October and November 2019: 387 (49.8%) current smokers and 390 (50.2%) nonsmokers. 60.9% were males, and the mean age was 40.5 (SD 10.7) years. In multivariate logistic regression, the following increased the odds of being a current smoker: being male (odds ratio [OR] 6.60 [95% confidence interval, CI = 4.34–10.04]), having at least two smokers among five closest friends (OR 3.97 [95% CI = 2.08–7.59]), living in smoking-permitted households (OR 5.83 [95% CI = 3.32–10.23]), alcohol use (OR 3.96 [95% CI = 2.34–6.71]), a higher perceived stress score (OR 2.23 [95% CI = 1.50–3.34]), and higher health-related quality of life (OR 5.25 [95% CI = 1.18–23.35]). Among smokers, the mean Fagerström Test for Nicotine Dependence score was 3.0 (SD 1.9), and 52.5% were making plans to quit. Self-efficacy to resist smoking and knowledge of the impact of smoking on PLWH’s health were low. Conclusions Being male, having at least two smokers among five closest friends, living in smoking-permitted households, alcohol use, higher perceived stress scores, and higher health-related quality of life were associated with being a current smoker. Smokers had low to moderate nicotine dependence, high willingness to quit, and low self-efficacy. Implications Future behavioral smoking cessation interventions for PLWH should address co-consumption with alcohol and comorbid mental health conditions that are common among PLWH such as stress. In addition, they should take into account the lack of knowledge among this population of the impact of smoking on their health, and low self-efficacy. Given the relatively low levels of nicotine dependency and high levels of willingness to quit in our sample, smoking cessation interventions, if offered, are likely to support this population in achieving long-term smoking abstinence

Inequalities, harm reduction and non-combustible nicotine products:A meta-ethnography of qualitative evidence

BACKGROUND: We sought to review qualitative evidence on how smokers in different socioeconomic groups engage with non-combustible nicotine products (NCNP), including electronic cigarettes and nicotine replacement therapies, in order to provide insight into how these products might impact on smoking inequalities. METHODS: We searched ten electronic databases in February 2017 using terms relating to NCNP and socioeconomic status. We included qualitative studies that were published since 1980 and were available in English. We used guidelines adapted from the Critical Appraisal Skills Programme for appraising qualitative research. RESULTS: The review only identified studies exploring the attitudes of socioeconomically disadvantaged smokers towards NCNP for harm reduction or cessation purposes (i.e. we did not identify any relevant studies of more advantaged socioeconomic groups). Using a lines-of-argument meta-ethnographic approach, we identified a predominantly pessimistic attitude to NCNP for harm reduction or cessation of smoking due to: wider circumstances of socioeconomic disadvantage; lack of a perceived advantage of alternative products over smoking; and a perceived lack of information about relative harms of NCNP compared to smoking. Optimistic findings, although fewer, suggested the potential of NCNP being taken up among smokers experiencing socioeconomic disadvantage. CONCLUSIONS: Overall, our review highlights the importance of considering the social, cultural and economic circumstances that influence experiences of smoking and of alternative product use

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

Between history and values: A study on the nature of interpretation in international law

My thesis discusses the place of evaluative judgements in the interpretation of general international law. It concentrates on two questions. First, whether it is possible to interpret international legal practices without making an evaluative judgement about the point or value that provides the best justification of these practices. Second, whether the use of evaluative judgements in international legal interpretation threatens to undermine the objectivity of international law, the neutrality of international lawyers or the consensual and voluntary basis of the international legal system. I answer both questions in the negative. As regards the first, I argue that international legal practice has an interpretive structure, which combines appeals to the history of international practice with appeals to the principles and values that these practices are best understood as promoting. This interpretive structure is apparent not only in the claims of international lawyers about particular rules of international law (here I use the rule of estoppel as an example) but also in the most basic intuitions of international theorists about the theory and sources of general international law. I then argue that some popular concerns to the effect that the exercise of evaluation in the interpretation of international law will undermine the coherence or the usefulness of the discipline are generally unwarranted. The fact that international legal practice has an interpretive structure does not entail that propositions of international law are only subjectively true, that the interpreter enjoys license to manipulate their meaning for self-serving purposes, or that international law will collapse under the weight of irresolvable disagreements, divisions and conflicts about its proper interpretation

Interim evaluation of an integrated approach to improving health and wellbeing in County Durham, UK

Background: The County Durham Wellbeing for Life (WFL) service was developed in recognition that the previous ‘silo’ approach to provision of single-issue lifestyle services had made little impact on inequalities. It involves targeting the most disadvantaged communities locally, as well as specialist populations at increased risk of poor health. The model draws on evidence relating to the clustering of unhealthy behaviours, coupled with calls for behaviour change to be addressed in a more integrated and holistic manner. The service launched on 1st April 2015 and this paper reports interim findings from the academic evaluation. Methods: The impact of the WFL service is being evaluated via secondary analysis of routinely collected monitoring data, which includes EQ-5DTM and the short Warwick Edinburgh Mental Wellbeing Scale (SWEMWBS). Data have been analysed descriptively to examine key characteristics of the WFL user population (n = 1345). Appropriate statistical analyses have been performed to assess changes amongst those with data available at pre- and post-intervention periods (n = 224). Results: WFL users are predominantly female (73.4%), white British (97.6%) and living in the least affluent areas (80.4%). Mean BMI at baseline was 32.9kg/m2 (s.d. 7.7). Pre/post analysis of the intervention data revealed significant improvements across all outcome measures. These were: BMI, physical activity, alcohol intake, self-efficacy, self-rated health, quality of life and mental wellbeing. Furthermore, the largest changes were observed in those with the least positive results at baseline. Conclusions: The interim evaluation findings are being used to inform commissioning decisions and future WFL service delivery in County Durham. They also add to the evidence base around complex, community-based interventions that aim to tackle multiple health-related behaviours using an integrated wellbeing approach. Key messages: An integrated wellbeing approach can be used to reach those living in disadvantaged areas Improvements in health, quality of life and wellbeing were observed amongst service users

Interim evaluation of an integrated approach to improving health and wellbeing in County Durham, UK

Background: The County Durham Wellbeing for Life (WFL) service was developed in recognition that the previous ‘silo’ approach to provision of single-issue lifestyle services had made little impact on inequalities. It involves targeting the most disadvantaged communities locally, as well as specialist populations at increased risk of poor health. The model draws on evidence relating to the clustering of unhealthy behaviours, coupled with calls for behaviour change to be addressed in a more integrated and holistic manner. The service launched on 1st April 2015 and this paper reports interim findings from the academic evaluation. Methods: The impact of the WFL service is being evaluated via secondary analysis of routinely collected monitoring data, which includes EQ-5DTM and the short Warwick Edinburgh Mental Wellbeing Scale (SWEMWBS). Data have been analysed descriptively to examine key characteristics of the WFL user population (n = 1345). Appropriate statistical analyses have been performed to assess changes amongst those with data available at pre- and post-intervention periods (n = 224). Results: WFL users are predominantly female (73.4%), white British (97.6%) and living in the least affluent areas (80.4%). Mean BMI at baseline was 32.9kg/m2 (s.d. 7.7). Pre/post analysis of the intervention data revealed significant improvements across all outcome measures. These were: BMI, physical activity, alcohol intake, self-efficacy, self-rated health, quality of life and mental wellbeing. Furthermore, the largest changes were observed in those with the least positive results at baseline. Conclusions: The interim evaluation findings are being used to inform commissioning decisions and future WFL service delivery in County Durham. They also add to the evidence base around complex, community-based interventions that aim to tackle multiple health-related behaviours using an integrated wellbeing approach. Key messages: An integrated wellbeing approach can be used to reach those living in disadvantaged areas Improvements in health, quality of life and wellbeing were observed amongst service users

Provisional Measures under the African Human Rights System

This chapter discusses the legal characteristics of provisional measures under the African Human Rights System, partly with the aim to fill the gaps found in the works of the Rapporteur on provisional measures of the Institute of International Law. After a brief overview of the provisional measures issued by the African Commission, it examines the precautionary power of the African Court, reaching the conclusion that the Court is inconsistent in the use of such power. This conclusion derives from an analysis of three main and interrelated critical issues, namely: (i) the binding or recommendatory nature of the provisional measures of the African Court; (ii) their domestic implementation; and (iii) the potential responsibility of States that fail to implement them. These critical issues are introduced and observed through the lens of the paradigmatic Sa\ueff al-Islam Kadhafi case, where the African Court first stated that the provisional measures were binding on the State concerned but then, after ascertaining the lack of compliance with such measures, abstained from declaring any resulting international responsibility of that State