Inequalities in smoking prevalence : a missed opportunity for tobacco control in Pakistan

Background: Pakistan is one of the highest tobacco consuming countries in South Asia and consumption is increasing. To implement equity orientated tobacco control policies, the most vulnerable groups must be identified. We aimed to identify these groups using the Pakistan Demographic and Health Survey (PDHS) 2012–13. Methods: Descriptive statistics, univariate and multivariate analyses were used to explore household and participant characteristics associated with smoking inside the home or tobacco smoking, respectively. Survey weights were used to give nationally representative findings. Results: Data for 12 931 households, 3132 men and 13 538 women were examined. About 58.3% of surveyed households were smoke-free, 39.1% were exposed to indoor tobacco smoke every day, 2.6% less frequently. Significantly more rural households were exposed to indoor tobacco smoke than urban households (45.2% versus 34.9%). Of men, 28.3% reported smoking compared with 1.3% of women. Smoking prevalence was higher in older age groups. Increasing wealth was associated with lower smoking prevalence and indoor smoking. For men, but not women, increasing education was associated with reduced smoking. Conclusions: Inequalities in smoking behaviour impose harm to those who can least afford the financial and health costs. Future tobacco control policies in Pakistan must be sensitive to gender, geography and socio-economic status

Tracking progress of tobacco control in Pakistan against the MPOWER package of interventions : challenges and opportunities

MPOWER is an evidence-based package of the six most effective demand reduction interventions to reduce tobacco use. Global evidence shows that introduction of this package has accelerated and strengthened tobacco control worldwide with over 5 billion people living in 136 countries covered by at least one of these key interventions. This paper comments on how tobacco control laws in a low and middle income country, Pakistan, are meeting the MPOWER package provisions and what the challenges and opportunities for tobacco control are in the country. Pakistan is home to over 24 million tobacco users consuming a variety of tobacco products including 10 million smokeless tobacco users. Pakistan has introduced several laws to meet its international commitments under the framework convention against tobacco control and MPOWER package. However, gaps in existing policies, poor law enforcement, and a conflicting political economy of tobacco in the country pose major challenges for effective tobacco control. The changing political environment with renowned public health activists in current government, an active and independent judiciary, increasing use of social media, and a dynamic civil society offer opportunities to strengthen its efforts for effective policy actions against tobacco use

Experiences of young smokers in quitting smoking in twin cities of Pakistan : a phenomenological study

Background: Smoking is highly prevalent in Pakistan claiming the lives of over 100,000 individuals every year. A significant proportion of smokers (24.7%) make an attempt to quit each year but 97.4% fail to quit successfully. Little is known about the reasons for, and experiences of, failed quit attempts. This study was carried out to explore the experiences of young male smokers in quitting smoking in the twin cities of Pakistan Method: A qualitative study was carried out using a phenomenological approach in Rawalpindi and Islamabad. A total of 11 participants were interviewed. All study participants were male and had made at least one quit attempt. Study participants were a mix of smokers who failed to quit smoking, intermittent smokers and successful quitters. Streubert’s (1991) method of phenomenology was followed during data analysis. Results: The experiences of smokers while smoking “the smoking phase” have major effects on their journey towards quitting smoking. The smoking phase consists of three major stages: contact with initial smoking stimuli, the journey from first puff to enjoying smoking and then finally smoking becoming part of life. However, the journey towards quitting smoking is not as simple as the journey towards becoming a smoker. Instead, smokers get trapped in three overlapping cycles of smoking and quit attempts: smoking & forced quitting, smoking & intentional quitting, and smoking & intermittent smoking before successful quitting. Breaking the cycle is not easy in the presence of trapping factors (addiction, high availability, easy affordability, conducive social setup and low perceived risks of smoking). Three factors play a major role in breaking these cycles which are strong will power, continuous peer support and avoidance of smokers’ company. Conclusion: A young smoker, during his experience of quitting smoking gets entrapped in several overlapping cycles of smoking & quit attempts before successful quitting. There are known entrapping factors as well as factors which help in breaking these cycles. Targeted interventions are needed to facilitate smoking cessation among young smokers in Pakistan

Reducing the affordability of tobacco products in Pakistan : a political economy analysis

Background Tobacco taxation is one of the most effective yet underused intervention to control tobacco use globally. Several LMICs including Pakistan have failed over the years to implement effective taxation measures for tobacco products to control its use and reduce harms. One of the reasons for this underutilisation is the poorly understood political economy of tobacco taxation in the LMICs context. This thesis aims to present a political economy analysis for introducing tobacco taxation and pricing policy (TTPP) reforms in Pakistan to achieve public health objectives. Methods A mixed-methods approach was used as follows: 1) a qualitative documents analysis of the regulatory framework for tobacco taxation, 2) econometric analysis to estimate the price elasticity and building econometric simulation models to predict fiscal and public health outcomes, 3) qualitative study based on in-depth interviews with key stakeholders in TTPP arena, and 4) a mixed methods analytical integration to ascertain policy, practice and research implications. Results Study component 1 highlighted that Pakistan does not have a clear strategy on using tobacco taxation as a public health tool in the country. Existing TTPP face dual issues of flawed structure and poor administration translating into highly affordable tobacco products and low revenues. Study component 2 found negative price elasticity estimates for Pakistani adults (n=7831), indicating an increase in the price will decrease consumption. It was found that an increase in the price of low-priced cigarettes would have a greater impact on smoking prevalence and daily consumption by smokers. Study component 3 predicted positive fiscal and public health outcomes for a 10% annual increase in taxation even in expanding illicit market activity. Study component 4 identified the position-power dynamics of key stakeholders and revealed the key facilitators and challenges for introducing TTPP reforms in the country. Mixed methods analytical integration found the best-fit taxation policy considering the political economy scenario in the country will be a long-term commitment to slowly and regularly increase excise duty on tobacco products along with control of illicit market activity. Conclusions The findings provide a detailed understanding of the political economy of tobacco taxation in Pakistan, which can be used for designing future policies

Experiences of young smokers in quitting smoking in twin cities of Pakistan: a phenomenological study

Background Smoking is highly prevalent in Pakistan claiming lives of over 100,000 individuals every year. A significant proportion of smokers makes quit attempt each year but 97.4% fails to quit successfully. Little is known about the reasons of failed quit attempts. Methods A qualitative study was carried out using phenomenological approach in Rawalpindi and Islamabad to document experience of smokers during quitting. Eleven male participants were interviewed. All study participants had made at least one quit attempt. The study participants were a mix of smokers who failed to quit smoking, intermittent smokers and successful quitters. Streubert's (1991) method of phenomenology was followed during data analysis. Results The journey of quitting smoking is deeply embedded in smoking phase experiences of smokers. Smoking phase experiences consist of three stages: getting in contact with stimuli to smoke, journey from first puff to enjoying smoking and then finally smoking becomes part of life. However, the quitting phase is not as smooth and simple as is the case with smoking phase. Instead, smokers get trapped into three overlapping vicious circles of smoking and quit attempts: smoking & forced quitting, smoking & intentional quitting, and smoking & intermittent smoking before successful quitting at young age. Breaking the vicious circle is not easy in the presence of trapping factors (addiction, high availability, easy affordability, conducive social setup and low perceived risks of smoking). Three factors play a major role in breaking these circles which are strong will power, continuous peer support and avoidance of smokers' company. Conclusions A young smoker, during his experience of quitting smoking gets entrapped into several overlapping vicious circles of smoking & quit attempts before successful quitting. There are known entrapping factors as well as factors which help in breaking these circles. Targeted interventions are needed to facilitate smoking cessation among young smokers in Pakistan

Epigrafia Paleocristiana de la Antigua Cisamo- Fortunatae 24

El autor del artículo, tras la revisión de las piedras, reedita —con aparato crítico, traducción española y un extenso comentario— ocho inscripciones cristianas de Císamo en Creta

Vision-related quality of life in Pakistani subjects with early or moderate glaucoma

Background: The aim of this study was to report the vision-related quality of life (QoL) in Pakistani subjects with early or moderate glaucoma. Methods: This case control study was conducted at Al-Shifa Trust Eye Hospital, Pakistan, from 1 January 2014 to 31 December 2015. All the patients having early or moderate glaucoma, with a disease duration of at least 6 mo, and presenting during the study period, were included. Subjects in the control group were recruited from the hospital volunteer staff, spouses and friends of patients. QoL assessment was done using the NEIVFQ25 questionnaire translated into the Urdu language. A two-tailed t-test was used to test the significance of difference between the mean QoL scores and a p-value of ≤0.05 was considered significant. Multiple linear regression was carried out to assess the predictors of QoL scores. Results: A total of 698 participants were enrolled, including 247 cases and 451 controls. The mean QoL score was higher in controls 81.31 (mean=81.31, SD=26.33) than in cases (mean=53.89, SD=30.32), p<0.001. The lowest NEIVFQ-25 scores for glaucoma patients were for mental health (mean=23.88, SD=28.80) followed by general vision (mean=27.73, SD=29.74). The difference in all the mean subscale scores of two groups was statistically significant (p<0.001). Conclusion: QoL scores are significantly reduced in Pakistani glaucoma patients with early and moderate glaucoma, with more pronounced effect on mental health and general vision

Availability of amenities at health facilities.

<p>Availability of amenities at health facilities.</p

Additional file 2: of Experiences of young smokers in quitting smoking in twin cities of Pakistan: a phenomenological study

‘Example of a part of the analysis process. An example of the analysis process: From transcript to essence. (DOCX 13 kb