The Progress of Tobacco Control Research in Sub-Saharan Africa in the Past 50 Years: A Systematic Review of the Design and Methods of the Studies

Over one billion of the world’s population are smokers, with increasing tobacco use in low-and middle-income countries. However, information about the methodology of studies on tobacco control is limited. We conducted a literature search to examine and evaluate the methodological designs of published tobacco research in Sub-Saharan Africa (SSA) over the past 50 years. The first phase was completed in 2015 using PubMed, Embase, CINAHL, and Cochrane Central Register of Controlled Trials. An additional search was completed in February 2017 using PubMed. Only tobacco/smoking research in SSA countries with human subjects and published in English was selected. Out of 1796 articles, 447 met the inclusion criteria and were from 26 countries, 11 of which had one study each. Over half of the publications were from South Africa and Nigeria. The earliest publication was in 1968 and the highest number of publications was in 2014 (n = 46). The majority of publications used quantitative methods (91.28%) and were cross-sectional (80.98%). The commonest data collection methods were self-administered questionnaires (38.53%), interviews (32.57%), and observation (20.41%). Around half of the studies were among adults and in urban settings. We conclud that SSA remains a “research desert” and needs more investment in tobacco control research and training

Changes in Exposure to Secondhand Smoke Among Youth in Nebraska, 2002–2006

Secondhand smoke is a major cause of morbidity and mortality. It has been associated with serious health problems in both children and adults. Efforts to reduce exposure to secondhand smoke in Nebraska have included programs to prevent tobacco use among young people and campaigns for smoke-free workplaces and homes. Despite these interventions, young people continue to be exposed to secondhand smoke at an unacceptably high rate. The objective of this study was to examine the extent to which Nebraska public middle and high school students were exposed to secondhand smoke in 2002 and 2006, to evaluate factors associated with this exposure, and to propose interventions

Alcohol use and alcohol -sexual expectations as risk factors for HIV/AIDS among young people in Zambia

This study examined the role of alcohol use, sexual behavior, alcohol-sexual expectations, education level, gender, religion and language as risk factors for HIV/AIDS among high school, college and university students in Lusaka and Chipata, Zambia. The study also examined the differences in drinking behavior and sexual behavior by gender, education level and religion. A survey questionnaire, developed through focus groups and consultations, was administered to 961 high school, college and university students. Results showed that 33.9% of the students were drinkers, and 41.6% have had sexual relationship. Among the sexually active, 26.8% reported multiple sexual partners and 37.3% reported not having used a condom at least once during their sexual relationships. Logistic regression analysis showed that drinking behavior and positive-alcohol sexual expectations were significantly related to having multiple sexual partners. Females were also more likely to have multiple sexual partners than males. Catholics were more likely to have multiple sexual partners than Protestants and Pentecostals. Alcohol-sexual expectations and other demographic variables were not related to condom use. Student drinkers in college and university, had higher positive alcohol-sexual expectations and were more likely to have had multiple sexual partners and more likely to have engaged in unsafe post-drinking sexual behavior. Addressing risky factors for HIV/AIDS among students in Zambia will require among other things, an emphasis on changing drinking behavior, sexual behaviors, condom use, and alcohol-sexual expectations

A cross-country comparison of secondhand smoke exposure in public places among adults in five African countries - The Global Adult Tobacco Survey, 2012 - 2015

Background Secondhand smoke (SHS) causes approximately 600,000 deaths annually worldwide. Timely surveillance can inform the development and enforcement of comprehensive smoke-free policies in indoor public places; yet, in many African countries, there is limited data on SHS exposure in this environment. This study examined self-reported SHS exposure in public places in five African countries. Methods Data from the Global Adult Tobacco Survey (GATS) were analyzed for Cameroon (2013), Kenya (2014), Nigeria (2012), Senegal (2015), and Uganda (2013). GATS is a standardized, nationally representative household survey of individuals aged ≥15 years. Point prevalence estimates for past 30-day SHS exposure were assessed for the following environments: bars/nightclubs, restaurants, government buildings, public transportation, and healthcare facilities. Analyses were restricted to persons who reported visiting each environment. Estimates were calculated separately for all adults and nonsmokers; nonsmokers were defined as those who answered “not at all” to the question, “Do you currently smoke tobacco on a daily basis, less than daily, or not at all?” Data were weighted and analyzed using SPSS V.24. Results Among all adults who visited each environment, country-specific SHS exposure ranged as follows: bars/nightclubs, 86.1% (Kenya) to 62.3% (Uganda); restaurants, 31.9% (Cameroon) to 16.0% (Uganda); government buildings, 24.2% (Senegal) to 5.7 % (Uganda); public transportation, 22.9% (Cameroon) to 7.8% (Uganda); and healthcare facilities, 10.2% (Senegal) to 4.5% (Uganda). SHS exposure among nonsmokers was as follows: bars/nightclubs, 85.6% (Kenya) to 60.9% (Uganda); restaurants, 32.0% (Cameroon) to 16.1% (Uganda); government buildings, 24.2% (Senegal) to 5.8 % (Uganda); public transportation, 22.2% (Cameroon) to 7.7% (Uganda); and healthcare facilities, 9.9% (Senegal) to 4.5% (Uganda). Conclusions In the assessed African countries, SHS exposure was lowest in healthcare facilities and highest in bars/nightclubs. Smoke-free policies in indoor public places, consistent with the World Health Organization's MPOWER framework, are important to protect nonsmokers from SHS exposure

Being Bullied and Psychosocial Adjustment among Middle School Students in China

Background: Using the Chinese version of the Global School-based Health Survey (GSHS), this article describes the prevalence of being bullied among a nationally representative sample of Chinese students in grades 6-10 and explores the relationships between being bullied and selected indicators of psychosocial adjustment. Methods: A total of 9015 students in middle schools in Beijing, Hangzhou, Wuhan, and Urumqi completed the Chinese version of the GSHS. Researchers analyzed the results from 2 questions about the frequency and form of being bullied and 11 questions about psychosocial adjustment. Descriptive statistics and logistic regression were used in the analysis. Results: About 25.7% of middle school students reported being bullied on 1 or more of the past 30 days. Rates of being bullied were similar for males and females, but the forms of being bullied were different. Being bullied was significantly lower in Beijing than in the other 3 cities. There were significant psychosocial differences between students who had been bullied and students who had not been bullied. Students who had been involved in a physical fight, often felt lonely, or had considered suicide in the past 30 days were more likely to report being bullied. Students who thought that other students in their school were often kind and helpful, who felt parents often understood their troubles, or who were taught in school how to handle stress were less likely to report being bullied. Conclusions: Being bullied is not uncommon in Chinese middle schools. Chinese schools typically place great emphasis on academic achievement, perhaps at the expense of the social climate of the school. Results indicated schools could implement changes to the school climate to reduce the likelihood of students’ being bullied

Decrease in Secondhand Smoke Exposure in Work and Public Places among Adults in the Philippines: An Analysis of the Global Adult Tobacco Survey, 2009 and 2015

The implementation of several tobacco control policies in the Philippines may have contributed to a decrease in secondhand smoke (SHS) exposure. We examined changes in SHS exposure at work and in public places between 2009 and 2015 among adults aged ≥15 years and interpreted these results within the tobacco policy landscape in the Philippines. We analyzed the Philippines Global Adult Tobacco Survey 2009 and 2015 data. We examined marginal effects in logistic regression to get the adjusted prevalence of SHS exposure at five work and public places, controlling for selected characteristics. We calculated adjusted prevalence ratios and adjusted prevalence differences between 2009 and 2015. Adjusted prevalence of SHS exposure decreased from 2009 to 2015 by 19% (5.7 percentage points) at work, 45% (11.2 percentage points) in government buildings, 48% (3.2 percentage points) in healthcare facilities, 29% (8.2 percentage points) in restaurants, and 33% (19.9 percentage points) on public transportation. Although the prevalence of SHS exposure at work and in public places decreased significantly between 2009 and 2015, a substantial proportion of adults remain exposed to SHS. This study highlights the importance of continued implementation, enforcement, monitoring, and evaluation of tobacco control and prevention measures in the Philippines