RESUMO
The expansion in the scope, scale, and sources of data on the wider social determinants of health (SDH) in the last decades could bridge gaps in information available for decision-making. However, challenges remain in making data widely available, accessible, and useful towards improving population health. While traditional, government-supported data sources and comparable data are most often used to characterize social determinants, there are still capacity and management constraints on data availability and use. Conversely, privately held data may not be shared. This study reviews and discusses the nature, sources, and uses of data on SDH, with illustrations from two middle-income countries: Kenya and the Philippines. The review highlights opportunities presented by new data sources, including the use of big data technologies, to capture data on social determinants that can be useful to inform population health. We conducted a search between October 2010 and September 2020 for grey and scientific publications on social determinants using a search strategy in PubMed and a manual snowball search. We assessed data sources and the data environment in both Kenya and the Philippines. We found limited evidence of the use of new sources of data to study the wider SDH, as most of the studies available used traditional sources. There was also no evidence of qualitative big data being used. Kenya has more publications using new data sources, except on the labor determinant, than the Philippines. The Philippines has a more consistent distribution of the use of new data sources across the HEALTHY determinants than Kenya, where there is greater variation of the number of publications across determinants. The results suggest that both countries use limited SDH data from new data sources. This limited use could be due to a number of factors including the absence of standardized indicators of SDH, inadequate trust and acceptability of data collection methods, and limited infrastructure to pool, analyze, and translate data.
Assuntos
Países em Desenvolvimento , Determinantes Sociais da Saúde , Humanos , Renda , Armazenamento e Recuperação da Informação , QuêniaRESUMO
La hipertensión arterial es el principal factor de riesgo corregible de las enfermedades cardiovasculares y, a nivel mundial, afecta a más de mil millones de personas y causa más de diez millones de muertes evitables cada año. Aunque puede diagnosticarse y tratarse de forma satisfactoria, solo una de cada siete personas hipertensas tiene la presión arterial controlada. A fin de abordar este reto, se ha puesto en marcha el Proyecto de Prevención y Tratamiento Estandarizado de la Hipertensión Arterial con el propósito de mejorar el control de la hipertensión, particularmente en los países de ingresos bajos y medianos. Este proyecto consiste en aplicar un enfoque de fortalecimiento de los sistemas de salud que promueva el tratamiento estandarizado de la hipertensión arterial por medio de intervenciones basadas en la evidencia, como el uso de protocolos estandarizados de tratamiento y de un conjunto básico de medicamentos, junto con mecanismos optimizados de compra para aumentar su disponibilidad y asequibilidad, el uso de registros clínicos para el seguimiento y la evaluación de cohortes de pacientes, el empoderamiento de los pacientes, el trabajo en equipo (delegación de tareas), y la participación de la comunidad. Si se dispone de voluntad política y se establecen alianzas fuertes, este enfoque permite sentar las bases para reducir la hipertensión arterial y la morbilidad y mortalidad asociadas a las enfermedades cardiovasculares.
Hypertension is the leading remediable risk factor for cardiovascular disease, affecting more than 1 billion people worldwide, and is responsible for more than 10 million preventable deaths globally each year. While hypertension can be successfully diagnosed and treated, only one in seven persons with hypertension have controlled blood pressure. To meet the challenge of improving the control of hypertension, particularly in low- and middle-income countries, the authors developed the Standardized Hypertension Treatment and Prevention Project, which involves a health systems– strengthening approach that advocates for standardized hypertension management using evidence-based interventions. These interventions include the use of standardized treatment protocols, a core set of medications along with improved procurement mechanisms to increase the availability and affordability of these medications, registries for cohort monitoring and evaluation, patient empowerment, team-based care (task shifting), and community engagement. With political will and strong partnerships, this approach provides the groundwork to reduce high blood pressure and cardiovascular disease-related morbidity and mortality.
Assuntos
Hipertensão , Doenças Cardiovasculares , Morbidade , MortalidadeRESUMO
RESUMEN La hipertensión arterial es el principal factor de riesgo corregible de las enfermedades cardiovasculares y, a nivel mundial, afecta a más de mil millones de personas y causa más de diez millones de muertes evitables cada año. Aunque puede diagnosticarse y tratarse de forma satisfactoria, solo una de cada siete personas hipertensas tiene la presión arterial controlada. A fin de abordar este reto, se ha puesto en marcha el Proyecto de Prevención y Tratamiento Estandarizado de la Hipertensión Arterial con el propósito de mejorar el control de la hipertensión, particularmente en los países de ingresos bajos y medianos. Este proyecto consiste en aplicar un enfoque de fortalecimiento de los sistemas de salud que promueva el tratamiento estandarizado de la hipertensión arterial por medio de intervenciones basadas en la evidencia, como el uso de protocolos estandarizados de tratamiento y de un conjunto básico de medicamentos, junto con mecanismos optimizados de compra para aumentar su disponibilidad y asequibilidad, el uso de registros clínicos para el seguimiento y la evaluación de cohortes de pacientes, el empoderamiento de los pacientes, el trabajo en equipo (delegación de tareas), y la participación de la comunidad. Si se dispone de voluntad política y se establecen alianzas fuertes, este enfoque permite sentar las bases para reducir la hipertensión arterial y la morbilidad y mortalidad asociadas a las enfermedades cardiovasculares.
ABSTRACT Hypertension is the leading remediable risk factor for cardiovascular disease, affecting more than 1 billion people worldwide, and is responsible for more than 10 million preventable deaths globally each year. While hypertension can be successfully diagnosed and treated, only one in seven persons with hypertension have controlled blood pressure. To meet the challenge of improving the control of hypertension, particularly in low- and middle-income countries, the authors developed the Standardized Hypertension Treatment and Prevention Project, which involves a health systems–strengthening approach that advocates for standardized hypertension management using evidence-based interventions. These interventions include the use of standardized treatment protocols, a core set of medications along with improved procurement mechanisms to increase the availability and affordability of these medications, registries for cohort monitoring and evaluation, patient empowerment, team-based care (task shifting), and community engagement. With political will and strong partnerships, this approach provides the groundwork to reduce high blood pressure and cardiovascular disease-related morbidity and mortality.
Assuntos
Doenças Cardiovasculares/etiologia , Doenças Cardiovasculares/prevenção & controle , Doenças Cardiovasculares/epidemiologia , Hipertensão/prevenção & controle , Hipertensão/terapiaRESUMO
BACKGROUND: This study assessed the construct validity of a measure of nicotine dependence that was used in the Global Youth Tobacco Survey (GYTS). METHODS: Using 2007-2009 data from the GYTS, subjects from 6 countries were used to assess current smokers' odds of reporting time to first cigarette or craving positive (TTFC/C+) by the number of cigarette smoking days per month (DPM) and the number of cigarettes smoked per day (CPD). RESULTS: The percentage of GYTS smokers who reported TTFC/C+ ranged from 58.0% to 69.7%. Compared with students who smoked on 1-2 DPM, those who smoked on 3-9 DPM had 3 times the adjusted odds of reporting TTFC/C+. The adjusted odds of reporting TTFC/C+ were 3 to 7 times higher among those who smoked 10-29 DPM and 6 to 20 times higher among daily smokers. Similarly, the adjusted odds of TTFC/C+ were 3-6 times higher among those who smoked 2-5 CPD and 6 to 20 times higher among those who smoked >6 CPD, compared to those who smoked <1 CPD. CONCLUSION: Associations of TTFC/C+ prevalence with both frequency and intensity of cigarette smoking provide a construct validation of the GYTS question used to assess respondents' TTFC/C status.
Assuntos
Inquéritos Epidemiológicos/normas , Fumar/epidemiologia , Adolescente , Comportamento do Adolescente , Distribuição por Idade , Argentina/epidemiologia , Feminino , Humanos , Jordânia/epidemiologia , Modelos Logísticos , Malásia/epidemiologia , Masculino , Prevalência , Reprodutibilidade dos Testes , Instituições Acadêmicas , Distribuição por Sexo , Eslováquia/epidemiologia , Abandono do Hábito de Fumar/estatística & dados numéricos , África do Sul/epidemiologia , Inquéritos e Questionários/normas , Tailândia/epidemiologia , Nicotiana , Organização Mundial da SaúdeRESUMO
INTRODUCTION: Evidence on the relationship between cigarette prices and adult smoking in low- and middle-income countries (LMICs) is relatively limited. This study offers new descriptive evidence on this relationship using data from a set of 13 LMICs. METHODS: We use Global Adult Tobacco Survey (GATS) cross-country data from approximately 200,000 participants aged 15 and older. Estimates on the relationship between prices and adult smoking were obtained from logit models of smoking participation and ordinary least squares models of conditional cigarette demand. RESULTS: Higher prices were associated with lower demand across countries, in terms of both smoking prevalence and daily number of cigarettes smoked among smokers. Our estimates suggest that the total price elasticity of cigarette demand in LMICs is approximately -0.53. We find that higher socioeconomic status (SES), represented through wealth and education effects is associated with lower chance of smoking overall, but among existing smokers, it may be associated with a larger number of cigarettes smoked. CONCLUSIONS: After controlling for a set of individual demographic and country characteristics, cigarette prices retain a significant role in shaping cigarette demand across LMICs. Because higher SES is associated with a reduced chance of smoking overall but also with increased daily consumption among current smokers, optimal tobacco tax policies in LMICs may face an added need to accommodate to shifting SES structures within the populations of these countries.
Assuntos
Comércio , Abandono do Hábito de Fumar/estatística & dados numéricos , Fumar/economia , Produtos do Tabaco/estatística & dados numéricos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Ásia/epidemiologia , Estudos Transversais , Coleta de Dados , Países em Desenvolvimento , Egito/epidemiologia , Europa Oriental/epidemiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , Fumar/epidemiologia , Abandono do Hábito de Fumar/economia , Prevenção do Hábito de Fumar , Classe Social , América do Sul/epidemiologia , Produtos do Tabaco/economia , Adulto JovemRESUMO
INTRODUCTION: In 2004, Peru ratified the Health Organization (WHO) Framework Convention on Tobacco Control (FCTC) and in 2006 passed Law 28705 for tobacco consumption and exposure reduction. The Global Youth Tobacco Survey (GYTS) provides data on youth tobacco use for development of tobacco control programs. Findings from the GYTS conducted in four main cities in Peru in 2000 and 2003 are reported in this paper and can be used to monitor provisions of the WHO FCTC. METHODS: The GYTS is a school-based survey that uses a standardized methodology for sampling, questionnaire construction, field procedures, and data management. In total, 5,332 and 7,824 students aged 13 to 15 years participated in the 2000 and 2003 surveys conducted in Huancayo, Lima, Tarapoto and Trujillo. RESULTS: In both years, Lima had the highest lifetime (54.6% and 59.6%) and current use of tobacco (18.6% and 19.2%) of the four cities. According to gender, boys smoked more than girls and less than 20% of students initiated smoking before the age of 10. Among smokers, more than 60% bought their cigarettes in a store with no restriction for their age, and approximately 12% had ever been offered "free cigarettes". Around 90% of students were in favor of banning smoking in public places. Changes between 2000 and 2003 included an increase in the percentage of smokers who wanted to have a cigarette first thing in the morning in Tarapoto (from 0% to 1.2%) and a decrease in exposure to tobacco at home in Huancayo (from 23.7% to 17.8%) and Trujillo (from 27.8% to 19.8%) CONCLUSION: While few changes in tobacco use among youth have been observed in the GYTS in Peru, the data in this report can be used as baseline measures for future evaluation efforts. At this time, tobacco control efforts in Peru need to focus on enhancing Law 28705 to include enforcement of existing provisions and inclusion of new laws and regulations. Most of these provisions are required of all countries, such as Peru, that have ratified the WHO FCTC.
Assuntos
Comportamento do Adolescente , Vigilância da População , Política Pública , Fumar/epidemiologia , Tabagismo/epidemiologia , Saúde da População Urbana/estatística & dados numéricos , Adolescente , Humanos , Programas Nacionais de Saúde , Peru/epidemiologia , Prevalência , Informática em Saúde Pública , Assunção de Riscos , Serviços de Saúde Escolar/estatística & dados numéricos , Fumar/legislação & jurisprudência , Abandono do Hábito de Fumar/estatística & dados numéricos , Prevenção do Hábito de Fumar , Inquéritos e Questionários , Indústria do Tabaco , Poluição por Fumaça de Tabaco/estatística & dados numéricos , Tabagismo/prevenção & controle , Organização Mundial da SaúdeRESUMO
BACKGROUND: The adoption of the World Health Organization Framework Convention on Tobacco Control (WHO FCTC) in 2004 marked a critical achievement in efforts to stem the tobacco epidemic in Mexico. The Global Youth Tobacco Survey (GYTS) findings are useful for evaluating achievement of FCTC articles and designing tobacco control programs. OBJECTIVE: To use data from the GYTS conducted in 21 Mexican cities between 2000 and 2005 to monitor Articles in the WHO FCTC. METHODS: The GYTS uses a two-stage cluster sample survey design that produces representative samples of students aged 13-15 years enrolled in public, private and technical schools. The survey was undertaken at 542 schools in 21 cities. The GYTS surveyed 43,950 students during 2000-2005. RESULTS: The current smoking rate ranged from 10.7% to 29.4%. Among never smokers, susceptibility to initiate smoking ranged from 20.2% to 34.4%. Among current smokers, the percentage who bought their cigarettes in a store was above 40% in 6 cities, but significantly declined over five years in the only city with two assessments (Monterrey). Exposure to secondhand smoke in public places was greater than 50% in 15 of the 21 cities. Over 80% of students in all 21 cities reported that they saw of advertisements for cigarettes on billboards. CONCLUSION: Using determinants measured by GYTS in Mexico, the government can monitor the impact of enforcing various provisions of the National Health Law and the progress made in achieving the goals of the WHO FCTC and the Regional strategy. When these goals are met, tobacco consumption and exposure in Mexico will have declined substantially.
Assuntos
Comportamento do Adolescente , Fumar/epidemiologia , Poluição por Fumaça de Tabaco/estatística & dados numéricos , Tabagismo/epidemiologia , Adolescente , Publicidade , Idade de Início , Criança , Exposição Ambiental , Humanos , México/epidemiologia , Vigilância da População , Prevalência , Abandono do Hábito de Fumar , Prevenção do Hábito de Fumar , Estudantes , Poluição por Fumaça de Tabaco/prevenção & controle , Tabagismo/prevenção & controle , Organização Mundial da SaúdeRESUMO
OBJECTIVE: The Global Youth Tobacco Survey (GYTS) in Brazil was developed to provide data on youth tobacco use to the National Tobacco Control Program. METHOD: The GYTS uses a standardized methodology for constructing sampling frames, selecting schools and classes, preparing questionnaires, carrying out field procedures, and processing data. The GYTS questionnaire is self-administered and includes questions about: initiation; prevalence; susceptibility; knowledge and attitudes; environmental tobacco smoke; cessation; media and advertising. SUDDAN and Epi-Info Software were used for analysis. Weighted analysis was used in order to obtain percentages and 95% confidence intervals. RESULTS: Twenty-three studies were carried out between 2002 and 2005 in Brazilian capitals: 2002 (9); 2003 (4); 2004 (2) and 2005 (9). The total number of students was 22832. The prevalence rate among the cities varied from 6.2% (João Pessoa, 2002) to 17.7% (Porto Alegre, 2002). CONCLUSION: The tobacco use prevalence rates in 18 Brazilian cities show significant heterogeneity among the macro regions. Data in this report can be used to evaluate the efforts already done and also as baseline for evaluation of new steps for tobacco control in Brazil regarding the goals of the WHO FCTC.
Assuntos
Comportamento do Adolescente , Fumar/epidemiologia , Tabagismo/epidemiologia , Adolescente , Idade de Início , Brasil/epidemiologia , Criança , Saúde Global , Humanos , Vigilância da População/métodos , Prevalência , Fumar/psicologia , Abandono do Hábito de Fumar/estatística & dados numéricos , Prevenção do Hábito de Fumar , Tabagismo/prevenção & controle , Tabagismo/psicologia , Organização Mundial da SaúdeRESUMO
The Global Youth Tobacco Survey (GYTS) project was developed by the World Health Organization and the US Centers for Disease Control and Prevention to track tobacco use among youth in countries across the world, using a common methodology and core questionnaire. The GYTS is school based and employs a two stage sample design to produce representative data on smoking among students aged 13-15 years. The first stage consists of a probabilistic selection of schools. All students in the selected classes are eligible for the survey. In 1999, the GYTS was conducted in 13 countries and is currently in progress in over 30 countries. This report describes data from 12 countries: Barbados, China, Costa Rica, Fiji, Jordan, Poland and the Russian Federation (Moscow), South Africa, Sri Lanka, Ukraine (Kiev), Venezuela and Zimbabwe. The findings show that tobacco use in the surveyed age group ranged from a high of 33 percent to a low of 10 percent. While the majority of current smokers wanted to stop smoking, very few were able to attend a cessation programme. In most countries the majority of young people reported seeing advertisements for cigarettes in media outlets, but anti-tobacco advertising was rare. The majority of young people being taught in school about the dangers of smoking. Environmental tobacco smoke exposure was very high in all countries. These results show that the GYTS surveillance system is enhancing the capacity of countries to design, implement, and evaluate tobacco prevention and control programmes. (AU)