Prevalence and Predictors of Smoking among Gambian Men: A Cross-Sectional National WHO STEP Survey

BACKGROUND: Tobacco use is the leading cause of preventable death in the world, with a higher burden in low- and middle-income countries. The aim of this study was to quantify the prevalence and predictors of smoking among Gambian men using nationally representative data. METHODS: Data was collected in 2010 from a random, nationally representative sample of 4111 adults aged 25-64 years (78% response rate) using the World Health Organization (WHO) STEPwise cross-sectional survey methods. Our analyses focused on men with valid information on smoking status (n = 1766) because of the low prevalence of smoking among women (1%). RESULTS: The prevalence of current smoking among men was 31.4% (95% CI: 27.2-35.9). The median age of starting smoking was 19 years; 25% started before the age of 18 years and 10% started aged 8-10 years. Rural residence, underweight, and hypertension were significantly associated with smoking. CONCLUSION: The study reveals a high prevalence of smoking among Gambian men. It is evident that cigarettes are obtained by minors in The Gambia, as a high proportion of current smokers started at a young age. Advice and support to quit smoking should be extended to all smokers regardless of their age and whether or not they have any underlying health conditions

Long-lasting consequences of war on disability

This article investigates the impact of exposure to United States air force bombing during 1965–75 on the disability status of individuals in Vietnam in 2009. Using a combination of national census and US military data and an instrumental variable strategy which exploits the distance to the former North–South border as a quasi-experiment, the article finds a positive and significant impact of bombing exposure on district level disability rates 40 years after the war. The overall effect of bombing on the long-term disability rate among the Vietnamese population is highest among heavily bombed districts. Districts in the top bombing quintile experience a 25% relative increase in the rate of disability attributable to bombing compared with districts in the lowest bombing quintile. Effects are highest on the prevalence of severe disability and among cohorts before the war’s end. A smaller, yet significant, effect is found among cohorts born after the war. The article finds further evidence of indirect channels through which bombing may have impacted on long-term disability including adverse effects on nutritional environment and human capital attainment. These findings add to the evidence from Vietnam and indicate that wars inflict costs on the health of human populations that last longer than those relating to economic growth and welfare

Intergenerational Poverty and Disability: The implications of inheritance policy and practice on persons with disabilities in the developing world

Inheritance is a significant means of transferring wealth from one generation to the next, and therefore increasingly attracts attention from researchers and policy-makers working on intergenerational and multidimensional poverty. However, until now disabled persons have been overlooked in these discussions. This oversight is particularly unfortunate because, as a group, the estimated one billion people with disabilities (some 15% of the world’s population) are among the poorest and most marginalized of the global population. Over the past decade, a small but growing literature has examined the recursive connections between poverty and disability throughout the developing world. In this paper, we argue that disabled individuals are routinely denied inheritance rights in many low-income and middle-income countries, and that this is a significant and largely unrecognized contributor to their indigence. The denial of inheritance is both a social justice issue and a practice that can no longer be overlooked if disabled persons are to be brought into the development mainstream

Mental illness, poverty and stigma in India: a case-control study

OBJECTIVE: To assess the effect of experienced stigma on depth of multidimensional poverty of persons with severe mental illness (PSMI) in Delhi, India, controlling for gender, age and caste. DESIGN: Matching case (hospital)–control (population) study. SETTING: University Hospital (cases) and National Capital Region (controls), India. PARTICIPANTS: A case–control study was conducted from November 2011 to June 2012. 647 cases diagnosed with schizophrenia or affective disorders were recruited and 647 individuals of same age, sex and location of residence were matched as controls at a ratio of 1:2:1. Individuals who refused consent or provided incomplete interview were excluded. MAIN OUTCOME MEASURES: Higher risk of poverty due to stigma among PSMI. RESULTS: 38.5% of PSMI compared with 22.2% of controls were found poor on six dimensions or more. The difference in multidimensional poverty index was 69% between groups with employment and income of the main contributors. Multidimensional poverty was strongly associated with stigma (OR 2.60, 95% CI 1.27 to 5.31), scheduled castes/scheduled tribes/other backward castes (2.39, 1.39 to 4.08), mental illness (2.07, 1.25 to 3.41) and female gender (1.87, 1.36 to 2.58). A significant interaction between stigma, mental illness and gender or caste indicates female PSMI or PSMI from ‘lower castes’ were more likely to be poor due to stigma than male controls (p<0.001) or controls from other castes (p<0.001). CONCLUSIONS: Public stigma and multidimensional poverty linked to SMI are pervasive and intertwined. In particular for low caste and women, it is a strong predictor of poverty. Exclusion from employment linked to negative attitudes and lack of income are the highest contributors to multidimensional poverty, increasing the burden for the family. Mental health professionals need to be aware of and address these issues