A global assessment of knowledge of dental students about nicotine replacement therapy : findings from 43 countries

OBJECTIVES : Knowledge of nicotine replacement therapy (NRT) is a competency that is expected from receiving training in the treatment for tobacco dependence. This study therefore assessed the knowledge of dental students in 43 countries about NRT. METHODS : The 2005–2011 dental Global Health Professions Student Survey data were analysed for 13,040 third-year dental students from 43 countries. Knowledge about NRT was self-reported and country-specific prevalence estimates were calculated. To assess for correlates of knowledge about NRT amongst dental students, a multivariate logistic regression model was fitted (P < 0.05), with pooled data from all 43 countries. The model assessed for geographical location, gross national income, tobacco cessation training in school, sex, current tobacco use and survey year. RESULTS : Amongst all dental students, the proportion that knew about NRT ranged from 37.0% (Mongolia) to 97.6% (Slovakia). The odds of knowing about NRT were lower amongst dental students in the Eastern Mediterranean region (aOR = 0.52; 95%CI: 0.34–0.79) compared to those in the European region. Dental students in upper-middle-income (aOR = 2.46; 95% CI: 1.57–3.85) and high-income countries (aOR=4.55; 95% CI: 2.28–9.09) both had higher odds of knowing about NRT com-pared to dental students in low-income countries. Also, current use of any tobacco product and receipt of tobacco cessation training in school were both associated with higher likelihood of knowing about NRT. No significant gender differences in knowl-edge of NRT were observed. CONCLUSIONS : A large proportion of dental students in several countries knew about NRT. However, disparities in knowledge existed across regions. Enhanced efforts are needed to formally train dental students on tobacco cessation techniques.http://onlinelibrary.wiley.com/journal/10.1111/(ISSN)1600-05792015-08-31hb201

Cigarette smoking trends and social disparities among South African adults, 2003-2011

INTRODUCTION : Cigarette prices have almost doubled in South Africa within the past decade due to pricing/taxation policies. Little is known about the equity impact of these price increases in concert with other tobacco control policies. This study therefore examined trends in current cigarette smoking overall and by socioeconomic status (SES) in South Africa during 2003-2011. METHODS : Data were obtained from the 2003 (n = 2,855), 2007 (n = 2,907), and 2011 (n = 3,003) South African Social Attitudes Survey. Educational attainment (> grade 12, grade 12, grade 1-11, or no education) was used as a proxy for SES, and all analyses were restricted to respondents aged ≥25 years. Trends in current cigarette smoking-defined as daily or some days use of cigarettes-during 2003-2011 were assessed with estimates of annual percentage change (APC), while smoking disparities were assessed with relative concentration index (RCI). RESULTS : Although no significant change was observed in the overall prevalence of current smoking during 2003-2011, declines were observed among those with no education (APC = -8.2; p < .05 for linear trend). However, increased smoking was observed among the most educated women (from 4.0% in 2003 to 13.1% in 2011; p < .05 for linear trend). The RCI by educational status changed significantly during the study period, from 0.80 (2003) to 1.35 (2007) to 1.94 (2011). CONCLUSIONS : The policy environment in South Africa during 2003-2011 had a significant positive equity impact by SES, even though no aggregate change in smoking prevalence was observed. Intensified implementation of taxation measures as part of a comprehensive tobacco control may further reduce smoking disparities.The South African National Research Foundation (#93093) and the American Cancer Society (NHINTLTAA02).http://ntr.oxfordjournals.org2016-10-31hb2016Community Dentistr

Potential revenue from taxing e-cigarettes and comparison of annual costs of daily e-cigarette use versus daily cigarette smoking among South African adults

INTRODUCTION : To inform policy making under the proposed The Control of Tobacco and Electronic Delivery Systems Bill, we compared annual costs of using e-cigarettes versus cigarettes, and estimated revenue from e-cigarette taxation. METHODS : We extracted e-cigarette retail prices from 231 South African e-cigarette vendor websites. We compared annual costs associated with daily cigarette smoking (self-reports from daily smokers in the 2018 South African Social Attitudes Survey, SASAS) versus daily e-cigarette use (based on cumulative costs of consumables plus device costs). We estimated revenue from excise tax if e-cigarettes were taxed at 75% (the rate proposed by the government) and 37.5% (half of the government’s proposal as a hypothetical scenario) of the cigarette excise rate. We applied the different rates to e-cigarette consumption in 2018 SASAS and projected for 2021. RESULTS : Mean annual cost associated with daily use was ZAR 6693 (US$460.32, based on an exchange rate of about 69 US$ to 1000 ZAR) for manufactured cigarettes; for e-cigarettes, this ranged from ZAR 8574.69/year (with price minimizing strategies) to ZAR 19780.83/year (retail products exclusively). Expected revenue from e-cigarette excise tax at 75% of the cigarette tax rate was up to ZAR 2.20 billion (95% CI: 0.96–3.44). If taxed at 37.5% of the cigarette tax rate – half of the government’s proposed rate – the projected revenue was up to ZAR 1.10 billion (95% CI: 0.48–1.72). Of the projected revenue from e-cigarette excise tax at 75% of the cigarette rate, the portion attributable to hardware (device and batteries) was 61% (ZAR 1.35 billion), while the portion attributable to e-liquid was 39% (ZAR 0.86 billion). CONCLUSIONS : Calculated daily costs were higher for e-cigarettes than cigarettes. We recommend an e-cigarette excise tax. The government’s proposed tax rate may reduce youth e-cigarette access, while allowing adult smokers wishing to switch exclusively to e-cigarettes to reduce their tobacco-related harm.African Capacity Building Foundationhttp://www.tobaccoinduceddiseases.orgdm2022School of Health Systems and Public Health (SHSPH

Associations between electronic cigarette use and quitting behaviours among South African adult smokers

DATA AVAILABILITY STATEMENT : Requests should be directed to the corresponding and will be considered on a case-by- case basis.BACKGROUND : The South African Medicines Control Council classifies e-cigarettes as Schedule 3 substances and requires them to be dispensed only within pharmacies. e-Cigarettes are however ubiquitous and are marketed as cessation aids. We investigated the relationship between e-cigarette use and smoking cessation among South African adult smokers. METHODS : Data came from a 2018 web survey of South African adults aged ≥18 years (n=18 208). Cessation-related attitudes and behaviours were assessed. Using multivariable logistic regression, we measured the association between e-cigarette use and cessation behaviours among ever-established combustible tobacco smokers who tried to quit. FINDINGS : Among current combustible smokers, more e-cigarette ever versus never users believed e-cigarettes could assist smokers to completely quit (35.5% vs 20.4%) or cut down (51.7% vs 26.5%) (all p<0.05). Among ever-established smokers, the odds of sustained quitting at the 12-month mark were lower among those who used e-cigarettes once off/rarely (adjusted OR (AOR)=0.20, 95% CI=0.16–0.24), former e-cigarette users (AOR=0.30, 95% CI=0.24–0.38) and current e-cigarette users (AOR=0.23, 95% CI=0.18–0.29), compared with never e-cigarette users. Among ever-established smokers who had ever tried to quit, 53.6% relapsed into smoking after quitting for any length of time. The odds of relapsing among ever-established smokers who had made a quit attempt and had a quit intention were higher among those who used e-cigarettes once off/rarely (AOR=2.66; 95% CI=2.31–3.08), former e-cigarette users (AOR=1.41; 95% CI=1.18–1.69) and current e-cigarette users (AOR=1.85; 95% CI=1.55–2.22) than never e-cigarette users. CONCLUSION : e-Cigarette use depressed long-term cessation. These findings can inform restrictions on unsubstantiated claims of e-cigarettes as cessation aids within South Africa.The African Capacity Building Foundation.https://tobaccocontrol.bmj.comhj2023School of Health Systems and Public Health (SHSPH

Tobacco cessation training among dental and other health professions students in eight low- and middle-income countries

This study assessed differences among health professions students in exposure to didactic tobacco cessation training in asking about patients' tobacco use status ("ask") and assisting smoking patients to quit by providing educational materials ("assist"). Data from the 2005-08 Global Health Professions Student Survey were analyzed for 28,420 medical, dental, nursing, and pharmacy students in eight low- and middle-income countries. Country-specific prevalence of exposure to training in tobacco cessation was calculated for each profession category; differences were assessed using logistic regression analysis (p<0.05). The proportion of dental students taught to implement the "ask" intervention ranged from 45.4 percent (Armenia) to 95.2 percent (Chile). Only about one-third of these dental students reported being taught to implement the "assist" intervention in most countries. After adjusting for survey year, country, gender, and tobacco use, the odds of dental students' being taught to implement the "ask" intervention were lower than for medical students (adjusted odds ratio [aOR]=0.63; 95% CI: 0.42-0.96). Similarly, the odds of being taught to implement the "assist" intervention were significantly higher for medical (aOR=1.65; 95% CI: 1.26-2.17), nursing (aOR=2.84; 95% CI: 2.37-3.40), and pharmacy students (aOR=1.36; 95CI:1.05-1.76) than for dental students. These findings underscore the need for enhanced measures to incorporate tobacco cessation training as a formal component of dental education globally.http://www.jdentaled.orghb201

E-cigarette advertising exposure among South African adults in 2017 : findings from a nationally representative cross-sectional survey

OBJECTIVES : In South Africa, the Control of Tobacco and Electronic Delivery Systems Bill seeks to regulate e-cigarettes as tobacco products, including their advertising, promotion and sponsorship. Population data on e-cigarette advertising in South Africa are needed to inform public health programs, practice and policy. We examined self-reported e-cigarette advertising exposure during 2017. DESIGN Cross-sectional. SETTING : Household-based survey. PARTICIPANTS : 3063 individuals who participated in the 2017 South African Social Attitudes survey, a nationally representative, in-person survey of the non-institutionalised civilian adult population aged ≥16 years EXPOSURE ‘In the past 12 months, have you seen advertisements or promotions for e-cigarettes (including e-shisha, e-pipe) on any of the following media: newspapers/ magazines, billboards, in the malls or any other source?’ MAIN OUTCOMES : Beliefs and attitudes regarding e-cigarettes. FINDINGS : Participants’ mean age was 37.7 years. Overall, 20.1% reported exposure to e-cigarette advertisements. By age, exposure was most prevalent among those aged 16–19 years (24.6%). Top sources of exposure among those exposed were stores, 40.7%; malls, 30.9%; and television, 32.5%. Of those aware of e-cigarettes, 61.2% believed ‘e-cigarette advertisements and promotion may make adolescents think of smoking traditional cigarettes’; 62.7% believed that ‘e-cigarette advertisements and promotions may make ex-smokers think of starting smoking cigarettes again’; and 59.5% supported the statement that ‘e-cigarette smoking should be banned indoors just as traditional cigarette smoking’. Notably, teens aged 16–19 reported the lowest prevalence (49.0%) of those believing that ‘e-cigarette advertisements and promotion may make adolescents think of smoking traditional cigarettes’, whereas this percentage was highest among those aged 55–64 years (73.2%). CONCLUSION : Comprehensive regulatory efforts are needed to address e-cigarette advertising, marketing and sponsorship in order to protect public health. The urgent enactment of the new tobacco control legislation, The Control of Tobacco Products and Electronic Delivery Systems Bill, can help reduce youth exposure to e-cigarette advertising in South Africa.http://bmjopen.bmj.comam2022School of Health Systems and Public Health (SHSPH