Internationalization of teaching and learning in public health

Due to the increased interconnectedness in the world, healthcare workers and policy makers now widely recognize that health transcends national boundaries, with global political and economic impact. Unfortunately, existing evidence suggests that the current global public health workforce is unprepared to confront the challenges posed by globalization. There is growing recognition of the need for the internationalization of curriculum (IoC), and the development of educational programmes that adequately prepare the public health workforce to deal with global health issues. The present literature review aims to examine the current perspectives, pedagogical approaches, theoretical or policy issues and debates related to (and explores different ways of improving) IoC in public health. A systematic search of literature up to 22 January 2018 was undertaken in the following databases in addition to google scholar: MEDLINE; EMBASE and PsycInFo. Data analysis involved writing annotated summaries of each paper and classifying the papers according to which of the questions they address, displaying the data, comparing the themes across papers, and drawing inferences and conclusions. The results suggest that internationalization of the public health curriculum, overall, can enable universities and individuals to meet both local and global social accountabilities and responsibilities. However, the way that IoC is defined, along with the internationalization model and pedagogical approach taken, have an impact on the benefits that can be realised

The effects of price and non-price policies on cigarette consumption in South Africa

The health consequences of smoking are serious and have been frequently detailed. A reduction in tobacco-related mortality hinges upon the ability to reduce tobacco usage. There is overwhelming evidence that higher cigarette prices reduce cigarettes demand, but little is known about the combined e⁄ect of price and non-price policies. This paper extends the analysis of price elasticities by estimating the e⁄ect of changes in price and non-price legislations in South Africa. Annual time-series data from 1961 to 2016 are used, with a policy index constructed to capture the instances of non-price tobacco legislation. The combined impact is estimated using a vector error correction model and a two-stage least squares (2SLS) model. The long-run own-price elasticities lie between -0.55 and -0.72, while the income elasticities lie between 0.39 and 0.49. The coefcients of the changing tobacco policies and changing market structure show that they contribute to a modest reduction in cigarette consumption. The short-run deviations from the steady state are presented using the error correction term. Cigarette demand is responsive to prices and non-pricing policies but failure to control for non-pricing policies overstates the price e⁄ect. This suggests that both prices and non-pricing legislation are e⁄ective in reducing cigarette consumption

HIV health care providers’ perspectives on smoking behavior among PLHIV and smoking cessation service provision in HIV clinics in Uganda

Introduction: Integration of smoking cessation interventions into HIV care can play a crucial role in reducing the growing burden of disease due to smoking among people living with HIV (PLHIV). However, there is a dearth of information on HIV care providers’ perspectives towards integrating smoking cessation interventions into HIV care programs. We explored HIV health care providers’ perceptions on the smoking behaviour among PLHIV, and the provision of smoking cessation services to PLHIV who smoke within HIV care services in Uganda. Methods: Semi structured face-to-face qualitative interviews were conducted with 12 HIV care providers between October and November 2019. Data were collected on perceptions on smoking among HIV-positive patients enrolled in HIV care, support provided to PLHIV who smoke to quit and integrating smoking cessation services into HIV care programs. Data were analysed deductively following a thematic framework approach. Results: Findings show that: a); HIV care providers in HIV clinics had low knowledge on the prevalence and magnitude of smoking among PLHIV who attended the clinics b) HIV care providers did not routinely screen HIV-positive patients for smoking and offered sub-optimal smoking cessation services; c) HIV care providers had a positive attitude towards integration of tobacco smoking cessation services into HIV care programs but called for support in form of guidelines, capacity building and strengthening of data collection and use as part of the integration process. Conclusion: Our study shows that HIV care providers did not routinely screen for tobacco use among PLHIV and offered suboptimal cessation support to smoking patients but they have a positive attitude towards the integration of tobacco smoking into HIV care programs. These findings suggest a favourable ground for integrating tobacco smoking cessation interventions to into HIV care programmes

Muslim Communities Learning About Second-hand Smoke in Bangladesh (MCLASSII): a combined evidence and theory-based plus partnership intervention development approach.

Introduction: Deaths from second-hand smoke (SHS) exposure are increasing but there is not sufficient evidence to recommend a particular SHS intervention or intervention development approach. Despite the available guidance on intervention reporting, and on the role and nature of pilot and feasibility studies, partial reporting of SHS interventions is common. The decision-making while developing such interventions is often under-reported. This paper describes the processes and decisions employed during transitioning from the aim of adapting an existing mosque-based intervention focused on public health messages, to the development of the content of novel community-based Smoke-Free Home (SFH) intervention. The intervention aims to promote smoke-free homes to reduce non-smokers’ exposure to SHS in the home via faith-based messages. Methods: The development of the SFH intervention had four sequential phases: in-depth interviews with adults in households in Dhaka; identification of an intervention programme theory and content with Islamic scholars from the Bangladesh Islamic Foundation (BIF); user testing of candidate intervention content with adults, and iterative intervention development workshops with Imams and khatibs who trained at the BIF. Results: It was judged inappropriate to take an intervention adaptation approach. Following the identification of an intervention programme theory and collaborating with stakeholders in an iterative and collaborative process to identify barriers, six potentially modifiable constructs were identified. These were targeted with a series of behaviour change techniques operationalised as Quranic verses with associated health messages to be used as the basis for Khutbahs. Following iterative user testing, acceptable intervention content was generated. Conclusion: The potential of this community-based intervention to reduce SHS exposure at home and improve lung health among non-smokers in Bangladesh is the result of an iterative and collaborative process. It is the result of the integration of behaviour change evidence and theory, and community stakeholder contributions to the production of the intervention content. This novel combination of intervention development frameworks demonstrates a flexible approach that could provide insights for intervention development in related contexts

Exposure to second-hand smoke in public places and barriers to the implementation of smoke free regulations in the Gambia : a population-based survey

Introduction. Second-hand smoke is associated with more than 1.2 million deaths per year among non-smokers. Smoking in public places is prohibited in The Gambia but there is no information on the level of exposure to second-hand smoke among adolescents and adults 15-64 years. The aim of this study was to assess the level and predictors of exposure to second-hand smoke in public places and compliance with smoke free regulations in The Gambia. Methods. A population-based survey was conducted in an established Health and Demographic Surveillance System (HDSS). A total of 4547 participants (15-64 years)from households within the Farafenni HDSS were interviewed at their homes but only 3533 were included in our analysis. Factors associated with exposure to second-hand smoke in public places were assessed by three different multivariable regression models. Results. Exposure to tobacco smoke in public places was high (66.1%, ), and higher in men (79.9%) than women (58.7%). Besides being male, less education, lower household income, urban residence and not aware of smoke free regulations were strongly associated with exposure to second-hand smoke. Conclusion. Despite existing smoke-free regulations, reported exposure to second-hand smoke remains high in public places in The Gambia. The Ministry of Health should continue to strengthen their advocacy and sensitization programs to ensure smoke free regulations are fully implemented. Some population subgroups are at a higher risk of exposure and could be targeted by interventions; and settings where these subgroups are exposed should be targeted by enforcement efforts

Tobacco advertising, promotion, and sponsorship (TAPS) in Ethiopia : A scoping review and narrative synthesis

Background: Tobacco advertising, promotion and sponsorship (TAPS), has been shown to increase tobacco use in both adults and young people. In Ethiopia, TAPS is recognized as a top priority for the government, and all forms of tobacco advertising, promotion as well as sponsorship are prohibited. There is recognition that there are gaps in the evidence needed to inform policy and practice on TAPS, but the extent and nature of these gaps have not been explored. This review was aimed to understand the extent, and nature of the evidence gaps on TAPS in Ethiopia and identify primary research priorities to inform future research direction. Methods: Systematic searches were conducted in February 2022 in the following research databases: Medline, EMBASE, and PsycInfo. Two reviewers independently screened the study reports for eligibility and extracted data from the eligible studies. The extracted data was collated and summarized descriptively, and policy, practice, and research recommendations were drawn. Research topics on TAPS in Ethiopia that stakeholders perceived to be priorities for primary research were identified through a consultation workshop. Results: Overall, 579 research reports were identified, and only six studies were included in the scoping review. The included studies explored the following topics: the use of tobacco imagery in movies/films (two studies); the association between mass media exposure or home internet access and tobacco use (two studies), watching of televised football and tobacco smoking in adolescents (one study), exposure to point-of-sale advertising of tobacco products and daily occurrence of smoking or second-hand smoke exposure in the home among women (one study), and exposure to anti-smoking messages through mass media and disparities in risk perceptions across socioeconomic and urban-rural subgroups (one study). None of the included studies investigated tobacco-related sponsorship. The top research priority topics identified by stakeholders in Ethiopia were: 1) barriers and facilitators to TAPS policy implementation, enforcement, and compliance monitoring; and 2) developing and testing effective, low-cost, and scalable strategies for TAPS enforcement and compliance monitoring. Conclusions: There is a need for research evidence to inform policy and practice on TAPS in Ethiopia, particularly on barriers and facilitators to TAPS policy implementation, enforcement, and compliance monitoring; and effective, low-cost, and scalable strategies for TAPS enforcement and compliance monitoring

Tobacco use and cessation in the context of ART adherence : insights from a qualitative study in HIV clinics in Uganda

Sub-Saharan Africa carries a disproportionate burden of human immunodeficiency virus (HIV). Tobacco use amongst people living with HIV is higher than in the general population even though it increases the risk of life-threatening opportunistic infections including tuberculosis (TB). Research on tobacco use and cessation amongst people living with HIV in Africa is sparse and it is not clear what interventions might achieve lasting cessation. We carried out qualitative interviews in Uganda in 2019 with 12 current and 13 former tobacco users (19 men and 6 women) receiving antiretroviral therapy (ART) in four contrasting locations. We also interviewed 13 HIV clinic staff. We found that tobacco use and cessation were tied into the wider moral framework of ART adherence, but that the therapeutic citizenship fashioned by ART regimes was experienced more as social control than empowerment. Patients were advised to stop using tobacco; those who did not concealed this from health workers, who associated both tobacco and alcohol use with ART adherence failure. Most of those who quit tobacco did so following the biographical disruption of serious TB rather than HIV diagnosis or ART treatment, but social support from family and friends was key to sustained cessation. We put forward a model of barriers and facilitators to smoking cessation and ART adherence based on engagement with either ‘reputation’ or ‘respectability’. Reputation involved pressure to enjoy tobacco with friends whereas family-oriented respectability demanded cessation, but those excluded by isolation or precarity escaped anxiety and depression by smoking and drinking with their peers

Second-Hand Tobacco Smoke Exposure: Results from a Particulate Matter (PM2.5) Measurement at Hospitality Venues in Addis Ababa, Ethiopia

Introduction: In Ethiopia, a comprehensive smoke-free law, which bans smoking in all public areas, has been implemented since 2019. This study aimed to evaluate compliance with these laws by measuring the air quality and conducting covert observations at 154 hospitality venues (HVs) in Addis Ababa. Methods: Indoor air quality was measured using Dylos air quality monitors during peak hours of the venues, with concentrations of particulate matter <2.5 microns in diameter (PM2.5) used as a marker of second-hand tobacco smoke. A standardized checklist was used to assess compliance with smoke-free laws during the same peak hours. The average PM2.5 concentrations were classified as good, moderate, unhealthy for sensitive groups, unhealthy for all, or hazardous using the World Health Organization's (WHO) standard air quality index breakpoints. Results: Only 23.6% of the venues complied with all smoke-free laws indicators. Additionally, cigarette and shisha smoking were observed at the HVs. Overall, 63.9% (95% confidence interval:56-72%) of the HVs had PM2.5 concentrations greater than 15 µg/m3. The presence of more than one cigarette smoker in the venue, observing shisha equipment in the indoor space, and the sale of tobacco products in the indoor space were significantly associated with higher median PM2.5 concentration levels (p< 0.005). Hazardous level of PM2.5 concentration, 100 times overfold than the WHO standard was recorded from HVs where several people were smoking shisha and cigarette. Conclusions: Most HVs had PM2.5, which exceeded the WHO average air quality standard. Stricter enforcement of smoke-free laws is necessary, particularly for bars, nightclubs/lounges