RESUMO
AIMS: This paper presents updated prevalence estimates of awareness, ever-use, and current use of nicotine vaping products (NVPs) from 14 International Tobacco Control Policy Evaluation Project (ITC Project) countries that have varying regulations governing NVP sales and marketing. DESIGN, SETTING, PARTICIPANTS AND MEASUREMENTS: A cross-sectional analysis of adult (≥ 18 years) current smokers and ex-smokers from 14 countries participating in the ITC Project. Data from the most recent survey questionnaire for each country were included, which spanned the period 2013-17. Countries were categorized into four groups based on regulations governing NVP sales and marketing (allowable or not), and level of enforcement (strict or weak where NVPs are not permitted to be sold): (1) most restrictive policies (MRPs), not legal to be sold or marketed with strict enforcement: Australia, Brazil, Uruguay; (2) restrictive policies (RPs), not approved for sale or marketing with weak enforcement: Canada, Malaysia, Mexico, New Zealand; (3) less restrictive policies (LRPs), legal to be sold and marketed with regulations: England, the Netherlands, Republic of Korea, United States; and (4) no regulatory policies (NRPs), Bangladesh, China, Zambia. Countries were also grouped by World Bank Income Classifications. Country-specific weighted logistic regression models estimated adjusted NVP prevalence estimates for: awareness, ever/current use, and frequency of use (daily versus non-daily). FINDINGS: NVP awareness and use were lowest in NRP countries. Generally, ever- and current use of NVPs were lower in MRP countries (ever-use = 7.1-48.9%; current use = 0.3-3.5%) relative to LRP countries (ever-use = 38.9-66.6%; current use = 5.5-17.2%) and RP countries (ever-use = 10.0-62.4%; current use = 1.4-15.5%). NVP use was highest among high-income countries, followed by upper-middle-income countries, and then by lower-middle-income countries. CONCLUSIONS: With a few exceptions, awareness and use of nicotine vaping products varied by the strength of national regulations governing nicotine vaping product sales/marketing, and by country income. In countries with no regulatory policies, use rates were very low, suggesting that there was little availability, marketing and/or interest in nicotine vaping products in these countries where smoking populations are predominantly poorer. The higher awareness and use of nicotine vaping products in high income countries with moderately (e.g. Canada, New Zealand) and less (e.g. England, United States) restrictive policies, is likely due to the greater availability and affordability of nicotine vaping products.
Assuntos
Comércio/legislação & jurisprudência , Sistemas Eletrônicos de Liberação de Nicotina , Ex-Fumantes/estatística & dados numéricos , Conhecimentos, Atitudes e Prática em Saúde , Política Pública/legislação & jurisprudência , Fumantes/estatística & dados numéricos , Vaping/epidemiologia , Adulto , Austrália/epidemiologia , Bangladesh/epidemiologia , Brasil/epidemiologia , Canadá/epidemiologia , China/epidemiologia , Estudos Transversais , Inglaterra/epidemiologia , Feminino , Humanos , Modelos Logísticos , Malásia/epidemiologia , Masculino , Marketing/legislação & jurisprudência , México/epidemiologia , Pessoa de Meia-Idade , Países Baixos/epidemiologia , Nova Zelândia/epidemiologia , Prevalência , República da Coreia/epidemiologia , Estados Unidos/epidemiologia , Uruguai/epidemiologia , Zâmbia/epidemiologiaRESUMO
INTRODUCTION: More than 100 countries have implemented pictorial health warnings on cigarette packages. However, few studies have compared how consumers from different geographic and cultural contexts respond to health warning content. The current study compares perceptions of warnings among adult smokers and youth in seven countries, to examine the efficacy of different health warning themes and images. METHODS: Between 2010 and 2012, online and face-to-face surveys were conducted with ~500 adult smokers and ~500 youth (age 16-18) smokers and nonsmokers in each of Mexico, United States, China, Germany, India, Bangladesh, and Republic of Korea (total N = 8182). Respondents were randomized to view and rate sets of 5-7 health warnings (each set for a different health effect); each set included a text-only warning and various types (ie, themes) of pictorial warnings, including graphic health effects, "lived experience," symbolic images, and personal testimonials. Mixed-effects models were utilized to examine perceived effectiveness of warning themes, and between-country differences in responses. RESULTS: Overall, pictorial warnings were rated as more effective than text-only warnings (p < .001). Among pictorial themes, "graphic" health effects were rated as more effective than warnings depicting "lived experience" (p < .001) or "symbolic" images (p < .001). Pictorial warnings with personal testimonials were rated as more effective than the same images with didactic text (p < .001). While the magnitude of differences between warning themes varied across countries, the pattern of findings was generally consistent. CONCLUSIONS: The findings support the efficacy of graphic pictorial warnings across diverse geographic and cultural contexts, and support sharing health warning images across jurisdictions. IMPLICATIONS: Although over 100 countries have implemented pictorial health warnings on cigarette packages, there is little research on the most effective types of message content across geographic and cultural contexts. The current study examined perceived effectiveness of text and pictorial health warnings featuring different message content-graphic health effects, "lived experience," personal testimonials, and symbolic imagery-among more than 8000 adults and youth in Mexico, United States, China, Germany, India, Bangladesh, and Korea. Across countries, "graphic" pictorial messages were rated as most effective. Consistencies across countries in rating message content suggests there may be "globally effective" themes and styles for designing effective health warnings.
Assuntos
Rotulagem de Produtos/métodos , Fumantes/psicologia , Prevenção do Hábito de Fumar/métodos , Produtos do Tabaco/efeitos adversos , Adolescente , Adulto , Bangladesh/epidemiologia , China/epidemiologia , Feminino , Alemanha/epidemiologia , Humanos , Índia/epidemiologia , Masculino , México/epidemiologia , Rotulagem de Produtos/tendências , República da Coreia/epidemiologia , Prevenção do Hábito de Fumar/tendências , Estados Unidos/epidemiologiaRESUMO
INTRODUCTION: The ratio of trans 3'-hydroxycotinine (3HC) to cotinine (nicotine metabolite ratio [NMR]) is a biomarker of the rate of nicotine metabolism, with higher NMR indicating faster metabolism. Higher NMR has been found to be associated with higher daily cigarette consumption and less success stopping smoking in cessation trials. This study examines differences in NMR among population-based samples of smokers in the five countries and explores the relationship between NMR and smoking abstinence. METHODS: Participants (N = 874) provided saliva samples during International Tobacco Control (ITC) surveys in the United States, United Kingdom, Mauritius, Mexico, and Thailand conducted in 2010/2011 with follow-up surveys in 2012/2013. When all samples were received, they were sent to a common laboratory for analysis using liquid chromatography and tandem mass spectroscopy. RESULTS: There was significant variation in NMR across countries (F = 15.49, p < .001). Those who reported smoking at follow-up had a mean NMR of 0.32, compared to a mean NMR of 0.42 in participants who reported that they had stopped (F = 8.93; p = .003). Higher mean NMR values were also associated with longer quit duration (p = .007). There was no substantial difference in NMR between current smokers who made a failed quit attempt and those who made no attempt-both had significantly lower NMR compared to those who quit and remained abstinent. Smokers with a higher NMR were more likely to report that they stopped smoking compared to those with a lower NMR (odds ratio = 2.67; 95% confidence interval: 1.25 to 5.68). CONCLUSIONS: These results suggest faster nicotine metabolizers may be less likely to relapse following a quit attempt. This finding differs from results of clinical trials testing stop smoking medications, where slower metabolizers have been found to be more likely to maintain abstinence from smoking. IMPLICATIONS: Results of this study suggest faster nicotine metabolizers may be less likely to relapse following a quit attempt. This finding differs from results of clinical trials testing stop smoking medications, where slower metabolizers have been found to be more likely to maintain abstinence from smoking.
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Nicotina/metabolismo , Abandono do Hábito de Fumar/estatística & dados numéricos , Fumar , Tabagismo , Estudos Transversais , Humanos , Maurício/epidemiologia , México/epidemiologia , Recidiva , Saliva/química , Fumar/epidemiologia , Fumar/metabolismo , Tailândia/epidemiologia , Tabagismo/epidemiologia , Tabagismo/metabolismo , Reino Unido/epidemiologia , Estados Unidos/epidemiologiaRESUMO
We examined the effect of tobacco control policies in Mexico on smoking prevalence and smoking-related deaths using the Mexico SimSmoke model. The model is based on the previously developed SimSmoke simulation model of tobacco control policy, and uses population size, smoking rates and tobacco control policy data for Mexico. It assesses, individually, and in combination, the effect of six tobacco control policies on smoking prevalence and smoking-related deaths. Policies included: cigarette excise taxes, smoke-free laws, anti-smoking public education campaigns, marketing restrictions, access to tobacco cessation treatments and enforcement against tobacco sales youth. The model estimates that, if Mexico were to adopt strong tobacco control policies compared to current policy levels, smoking prevalence could be reduced by 30% in the next decade and by 50% by 2053; an additional 470,000 smoking-related premature deaths could be averted over the next 40 years. The greatest impact on smoking and smoking-related deaths would be achieved by raising excise taxes on cigarettes from 55% to at least 70% of the retail price, followed by strong youth access enforcement and access to cessation treatments. Implementing tobacco control policies in Mexico could reduce smoking prevalence by 50%, and prevent 470,000 smoking-related deaths by 2053.
Assuntos
Política de Saúde , Fumar/epidemiologia , Fumar/mortalidade , Uso de Tabaco/legislação & jurisprudência , Adolescente , Adulto , Idoso , Feminino , Humanos , Masculino , México/epidemiologia , Pessoa de Meia-Idade , Prevalência , Adulto JovemRESUMO
OBJECTIVE: Some researchers have raised concerns that pictorial health warning labels (HWLs) on cigarette packages may lead to message rejection and reduced effectiveness of HWL messages. This study aimed to determine how state reactance (i.e., negative affect due to perceived manipulation) in response to both pictorial and text-only HWLs is associated with other types of HWL responses and with subsequent cessation attempts. METHODS: Survey data were collected every 4 months between September 2013 and 2014 from online panels of adult smokers in Australia, Canada, Mexico, and the US were analyzed. Participants with at least one wave of follow-up were included in the analysis (n = 4,072 smokers; 7,459 observations). Surveys assessed psychological and behavioral responses to HWLs (i.e., attention to HWLs, cognitive elaboration of risks due to HWLs, avoiding HWLs, and forgoing cigarettes because of HWLs) and cessation attempts. Participants then viewed specific HWLs from their countries and were queried about affective state reactance. Logistic and linear Generalized Estimating Equation (GEE) models regressed each of the psychological and behavioral HWL responses on reactance, while controlling for socio-demographic and smoking-related variables. Logistic GEE models also regressed having attempted to quit by the subsequent survey on reactance, each of the psychological and behavioral HWL responses (analyzed separately), adjustment variables. Data from all countries were initially pooled, with interactions between country and reactance assessed; when interactions were statistically significant, country-stratified models were estimated. RESULTS: Interactions between country and reactance were found in all models that regressed psychological and behavioral HWL responses on study variables. In the US, stronger reactance was associated with more frequent reading of HWLs and thinking about health risks. Smokers from all four countries with stronger reactance reported greater likelihood of avoiding warnings and forgoing cigarettes due to warnings, although the association appeared stronger in the US. Both stronger HWLs responses and reactance were positively associated with subsequent cessation attempts, with no significant interaction between country and reactance. CONCLUSIONS: Reactance towards HWLs does not appear to interfere with quitting, which is consistent with its being an indicator of concern, not a systematic effort to avoid HWL message engagement.
Assuntos
Promoção da Saúde/métodos , Rotulagem de Produtos/métodos , Abandono do Hábito de Fumar/psicologia , Abandono do Hábito de Fumar/estatística & dados numéricos , Fumar/psicologia , Adolescente , Adulto , Austrália , Canadá , Feminino , Humanos , Masculino , México , Pessoa de Meia-Idade , Inquéritos e Questionários , Estados Unidos , Adulto JovemRESUMO
OBJECTIVE: To describe trends, correlates of use and consumer perceptions related to the product design innovation of flavour capsules in cigarette filters. METHODS: Quarterly surveys from 2012 to 2014 were analysed from an online consumer panel of adult smokers aged 18-64, living in the USA (n=6865 observations; 4154 individuals); Mexico (n=5723 observations; 3366 individuals); and Australia (n=5864 observations; 2710 individuals). Preferred brand varieties were classified by price (ie, premium; discount) and flavour (ie, regular; flavoured without capsule; flavoured with capsule). Participants reported their preferred brand variety's appeal (ie, satisfaction; stylishness), taste (ie, smoothness, intensity), and harm relative to other brands and varieties. GEE models were used to determine time trends and correlates of flavour capsule use, as well as associations between preferred brand characteristics (ie, price stratum, flavour) and perceptions of relative appeal, taste and harm. RESULTS: Preference for flavour capsules increased significantly in Mexico (6% to 14%) and Australia (1% to 3%), but not in the USA (4% to 5%). 18-24â year olds were most likely to prefer capsules in the USA (10%) and Australia (4%), but not Mexico. When compared to smokers who preferred regular brands, smokers who preferred brands with capsules viewed their variety of cigarettes as having more positive appeal (all countries), better taste (all countries), and lesser risk (Mexico, USA) than other brand varieties. CONCLUSIONS: Results indicate that use of cigarettes with flavour capsules is growing, is associated with misperceptions of relative harm, and differentiates brands in ways that justify regulatory action.
Assuntos
Comportamento do Consumidor , Aromatizantes/administração & dosagem , Fumar/psicologia , Fumar/tendências , Percepção Gustatória , Paladar , Produtos do Tabaco , Adolescente , Adulto , Austrália , Comércio , Feminino , Aromatizantes/efeitos adversos , Aromatizantes/economia , Comportamentos Relacionados com a Saúde , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Masculino , México , Pessoa de Meia-Idade , Rotulagem de Produtos , Medição de Risco , Fumar/efeitos adversos , Fumar/economia , Inquéritos e Questionários , Fatores de Tempo , Produtos do Tabaco/efeitos adversos , Produtos do Tabaco/economia , Estados Unidos , Adulto JovemRESUMO
Objective. To examine how policies adopted in Mexico in response to the Framework Convention on Tobacco Control affected smoking prevalence and smoking-attributable deaths. Methods. The SimSmoke simulation model of tobacco control policy is applied to Mexico. This discrete time, first-order Markov model uses data on population size, smoking rates and tobacco control policy for Mexico. It assesses, individually and jointly, the effects of seven types of policies: cigarette taxes, smoke-free air laws, mass media campaigns, advertising bans, warning labels, cessation treatment, and youth tobacco access policies. Results. The Mexico SimSmoke model estimates that smoking rates have been reduced by about 30% as a result of policies implemented since 2002, and that the number of smoking-attributable deaths will have been reduced by about 826 000 by 2053. Increases in cigarette prices are responsible for over 60% of the reductions, but health warnings, smoke-free air laws, marketing restrictions and cessation treatments also play important roles. Conclusions. Mexico has shown steady progress towards reducing smoking prevalence in a short period of time, as have other Latin American countries, such as Brazil, Panama and Uruguay. Tobacco control policies play an important role in continued efforts to reduce tobacco use and associated deaths in Mexico.
Objetivo. Analizar cómo las políticas adoptadas en México en respuesta al Convenio Marco para el Control del Tabaco han tenido efecto en la prevalencia de tabaquismo y en la mortalidad atribuible al tabaco. Métodos. Se aplicó en México el modelo de simulación SimSmoke de la política de control del tabaco. Este modelo de Markov de tiempo discreto y de primer orden utiliza datos sobre el tamaño de la población, las tasas de tabaquismo y la política de control del tabaco en México. También evalúa individual y conjuntamente los efectos de siete tipos de políticas: impuestos sobre el tabaco, legislaciones de ambientes libres de humo de tabaco, campañas en medios de comunicación, prohibiciones de publicidad, etiquetas de advertencias sanitarias, tratamientos de cesación y regulaciones del acceso al tabaco por parte de los jóvenes. Resultados. Mediante el modelo SimSmoke aplicado en México, se calculó que las tasas de tabaquismo se han reducido aproximadamente en un 30% como resultado de las políticas implantadas desde el 2002, y que el número de defunciones atribuibles al tabaquismo podrían reducirse aproximadamente en 826 000 para el 2053. Los aumentos de precios de los cigarros son responsables de más del 60% de las reducciones, pero las advertencias sanitarias, las leyes de ambientes libres de humo de tabaco, las restricciones a la mercadotecnia y los tratamientos de cesación también desempeñan una function importante. Conclusiones. En México, análogamente a lo ocurrido en otros países latinoamericanos, como Brasil, Panamá y Uruguay, se ha observado un constante progreso en la reducción de la prevalencia del tabaquismo en poco tiempo. Las políticas de control del tabaco desempeñan una importante función en las iniciativas continuadas para reducir el consumo de tabaco y las defunciones asociadas a este en México.
Assuntos
Uso de Tabaco , Fumar , Risco Atribuível , Mortalidade Prematura , Política Pública , México , Uso de Tabaco , Fumar , Risco Atribuível , Mortalidade Prematura , Política PúblicaRESUMO
OBJECTIVE: To examine how policies adopted in Mexico in response to the Framework Convention on Tobacco Control affected smoking prevalence and smoking-attributable deaths. METHODS: The SimSmoke simulation model of tobacco control policy is applied to Mexico. This discrete time, first-order Markov model uses data on population size, smoking rates and tobacco control policy for Mexico. It assesses, individually and jointly, the effects of seven types of policies: cigarette taxes, smoke-free air laws, mass media campaigns, advertising bans, warning labels, cessation treatment, and youth tobacco access policies. RESULTS: The Mexico SimSmoke model estimates that smoking rates have been reduced by about 30% as a result of policies implemented since 2002, and that the number of smoking-attributable deaths will have been reduced by about 826 000 by 2053. Increases in cigarette prices are responsible for over 60% of the reductions, but health warnings, smoke-free air laws, marketing restrictions and cessation treatments also play important roles. CONCLUSIONS: Mexico has shown steady progress towards reducing smoking prevalence in a short period of time, as have other Latin American countries, such as Brazil, Panama and Uruguay. Tobacco control policies play an important role in continued efforts to reduce tobacco use and associated deaths in Mexico.
OBJETIVO: Analizar cómo las políticas adoptadas en México en respuesta al Convenio Marco para el Control del Tabaco han tenido efecto en la prevalencia de tabaquismo y en la mortalidad atribuible al tabaco. MÉTODOS: Se aplicó en México el modelo de simulación SimSmoke de la política de control del tabaco. Este modelo de Markov de tiempo discreto y de primer orden utiliza datos sobre el tamaño de la población, las tasas de tabaquismo y la política de control del tabaco en México. También evalúa individual y conjuntamente los efectos de siete tipos de políticas: impuestos sobre el tabaco, legislaciones de ambientes libres de humo de tabaco, campañas en medios de comunicación, prohibiciones de publicidad, etiquetas de advertencias sanitarias, tratamientos de cesación y regulaciones del acceso al tabaco por parte de los jóvenes. RESULTADOS: Mediante el modelo SimSmoke aplicado en México, se calculó que las tasas de tabaquismo se han reducido aproximadamente en un 30% como resultado de las políticas implantadas desde el 2002, y que el número de defunciones atribuibles al tabaquismo podrían reducirse aproximadamente en 826 000 para el 2053. Los aumentos de precios de los cigarros son responsables de más del 60% de las reducciones, pero las advertencias sanitarias, las leyes de ambientes libres de humo de tabaco, las restricciones a la mercadotecnia y los tratamientos de cesación también desempeñan una función importante. CONCLUSIONES: En México, análogamente a lo ocurrido en otros países latinoamericanos, como Brasil, Panamá y Uruguay, se ha observado un constante progreso en la reducción de la prevalencia del tabaquismo en poco tiempo. Las políticas de control del tabaco desempeñan una importante función en las iniciativas continuadas para reducir el consumo de tabaco y las defunciones asociadas a este en México.
Assuntos
Nicotiana/efeitos adversos , Dispositivos para o Abandono do Uso de Tabaco/provisão & distribuição , Prevenção do Hábito de Fumar/organização & administração , MéxicoRESUMO
OBJECTIVE: To examine how policies adopted in Mexico in response to the Framework Convention on Tobacco Control affected smoking prevalence and smoking-attributable deaths. METHODS: The SimSmoke simulation model of tobacco control policy is applied to Mexico. This discrete time, first-order Markov model uses data on population size, smoking rates and tobacco control policy for Mexico. It assesses, individually and jointly, the effects of seven types of policies: cigarette taxes, smoke-free air laws, mass media campaigns, advertising bans, warning labels, cessation treatment, and youth tobacco access policies. RESULTS: The Mexico SimSmoke model estimates that smoking rates have been reduced by about 30% as a result of policies implemented since 2002, and that the number of smoking-attributable deaths will have been reduced by about 826 000 by 2053. Increases in cigarette prices are responsible for over 60% of the reductions, but health warnings, smoke-free air laws, marketing restrictions and cessation treatments also play important roles. CONCLUSIONS: Mexico has shown steady progress towards reducing smoking prevalence in a short period of time, as have other Latin American countries, such as Brazil, Panama and Uruguay. Tobacco control policies play an important role in continued efforts to reduce tobacco use and associated deaths in Mexico.
Assuntos
Nicotiana , Política de Saúde , Humanos , México , Prevalência , Fumar/epidemiologia , Abandono do Hábito de FumarRESUMO
INTRODUCTION: Health warning labels (HWLs) on tobacco packaging can be used to provide smoking cessation information, but the impact of this information is not well understood. METHODS: Online consumer panels of adult smokers from Canada, Australia and Mexico were surveyed in September 2012, January 2013 and May 2013; replenishment was used to maintain sample sizes of 1000 participants in each country at each wave. Country-stratified logistic Generalised Estimating Equation (GEE) models were estimated to assess correlates of citing HWLs as a source of information on quitlines and cessation websites. GEE models also regressed having called the quitline, and having visited a cessation website, on awareness of these resources because of HWLs. RESULTS: At baseline, citing HWLs as a source of information about quitlines was highest in Canada, followed by Australia and Mexico (33%, 19% and 16%, respectively). Significant increases over time were only evident in Australia and Mexico. In all countries, citing HWLs as a source of quitline information was significantly associated with self-report of having called a quitline. At baseline, citing HWLs as a source of information about cessation websites was higher in Canada than in Australia (14% and 6%, respectively; Mexico was excluded because HWLs do not include website information), but no significant changes over time were found for either country. Citing HWLs as a source of information about cessation websites was significantly associated with having visited a website in both Canada and Australia. CONCLUSIONS: HWLs are an important source of cessation information.
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Promoção da Saúde , Linhas Diretas , Internet , Rotulagem de Produtos , Abandono do Hábito de Fumar , Prevenção do Hábito de Fumar , Produtos do Tabaco , Adolescente , Adulto , Austrália , Canadá , Coleta de Dados , Rotulagem de Medicamentos , Feminino , Humanos , Disseminação de Informação , Estudos Longitudinais , Masculino , México , Pessoa de Meia-Idade , Adulto JovemRESUMO
BACKGROUND: Comprehensive smoke-free laws have been followed by drops in hospitalisations for acute myocardial infarction (AMI), including in a study with 2â years follow-up for such a law in Uruguay. METHODS: Multiple linear and negative binomial regressions for AMI admissions (ICD-10 code 121) from 37 hospitals for 2â years before and 4â years after Uruguay implemented a 100% nationwide smoke-free law. RESULTS: Based on 11â 135 cases, there was a significant drop of -30.9 AMI admissions/month (95% CI -49.8 to -11.8, p=0.002) following implementation of the smoke-free law. The effect of the law did not increase or decrease over time following implementation (p=0.234). This drop represented a 17% drop in AMI admissions following the law (IRR=0.829, 95% CI 0.743 to 0.925, p=0.001). CONCLUSIONS: Adding two more years of follow-up data confirmed that Uruguay's smoke-free law was followed by a substantial and sustained reduction in AMI hospitalisations.
Assuntos
Hospitalização , Infarto do Miocárdio , Saúde Pública/legislação & jurisprudência , Política Antifumo , Abandono do Hábito de Fumar/legislação & jurisprudência , Fumar/legislação & jurisprudência , Poluição por Fumaça de Tabaco/legislação & jurisprudência , Adulto , Feminino , Humanos , Masculino , Infarto do Miocárdio/terapia , Prevenção do Hábito de Fumar , Uruguai , Local de TrabalhoRESUMO
PURPOSE: Assessing tobacco use and providing cessation support is recommended by the American Society for Clinical Oncology (ASCO). The purpose of this study was to evaluate practice patterns and perceptions of tobacco use and barriers to providing cessation support for patients with cancer. METHODS: In 2012, an online survey was sent to 18,502 full ASCO members asking about their practice patterns regarding tobacco assessment, cessation support, perceptions of tobacco use, and barriers to providing cessation support for patients with cancer. Responses from 1,197 ASCO members are reported. RESULTS: At initial visit, most respondents routinely ask patients about tobacco use (90%), ask patients to quit (80%), and advise patients to stop using tobacco (84%). However, only 44% routinely discuss medication options with patients, and only 39% provide cessation support. Tobacco assessments decrease at follow-up assessments. Most respondents (87%) agree or strongly agree that smoking affects cancer outcomes, and 86% believe cessation should be a standard part of clinical cancer care. However, only 29% report adequate training in tobacco cessation interventions. Inability to get patients to quit (72%) and patient resistance to treatment (74%) are dominant barriers to cessation intervention, but only 8% describe cessation as a waste of time. CONCLUSION: Among ASCO members who responded to an online survey about their practice patterns regarding tobacco, most believe that tobacco cessation is important and frequently assess tobacco at initial visit, but few provide cessation support. Interventions are needed to increase access to tobacco cessation support for patients with cancer.
Assuntos
Padrões de Prática Médica , Abandono do Hábito de Fumar , Uso de Tabaco/prevenção & controle , Coleta de Dados , Humanos , Oncologia , Neoplasias/epidemiologia , Sociedades Médicas , Uso de Tabaco/epidemiologiaRESUMO
BACKGROUND: Stimulated by the WHO Framework Convention on Tobacco Control, many countries in Latin America adopted comprehensive smoke-free policies. In March 2006, Uruguay became the first Latin American country to adopt 100% smoke-free national legislation, which ended smoking in all indoor public places and workplaces, including restaurants and bars. The objective of this study was to evaluate trends in hospital admissions for cardiovascular disease 2 years before and 2 years after the policy was implemented in Uruguay. METHODS: Reports of hospital admissions for acute myocardial infarction (AMI) (International Classification of Disease-10 I21) from 37 hospitals (79% of all hospital admissions in the country), representing the period 2 years before and 2 years after the adoption of a nationwide smoke-free policy in Uruguay (between 1 March 2004 and 29 February 2008), were reviewed. A time series analysis was undertaken to compare the average monthly number of events of hospital admission for AMI before and after the smoke-free law. RESULTS: A total of 7949 hospital admissions for AMI were identified during the 4-year study period. Two years after the smoke-free policy was enacted, hospital admissions for AMI fell by 22%. The same pattern and roughly the same magnitude of reduction in AMI admissions were observed for patients seen in public and private hospitals, men, women and people aged 40-65 years and older than 65 years. CONCLUSIONS: The national smoke-free policy implemented in Uruguay in 2006 was associated with a significant reduction in hospital admissions for AMI.
Assuntos
Hospitalização/tendências , Infarto do Miocárdio/epidemiologia , Política Antifumo/legislação & jurisprudência , Adulto , Idoso , Feminino , Hospitalização/estatística & dados numéricos , Humanos , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio/diagnóstico , Infarto do Miocárdio/etiologia , Avaliação de Resultados em Cuidados de Saúde/métodos , Fumar/efeitos adversos , Fumar/legislação & jurisprudência , Prevenção do Hábito de Fumar , Poluição por Fumaça de Tabaco/efeitos adversos , Poluição por Fumaça de Tabaco/legislação & jurisprudência , Poluição por Fumaça de Tabaco/prevenção & controle , Uruguai/epidemiologiaRESUMO
AIM: Mexico implemented annual tax increases between 2009 and 2011. We examined among current smokers the association of price paid per cigarette and daily cigarette expenditure with smoking-induced deprivation (SID) and whether the association of price or expenditure with SID varies by income. METHODS: We used data (n=2410) from three waves of the International Tobacco Control Mexico survey (ie, 2008, 2010, 2011) and employed logistic regression to estimate the association of price paid per cigarette and daily cigarette expenditure with the probability of SID ('In the last 6 months, have you spent money on cigarettes that you knew would be better spent on household essentials like food?'). RESULTS: Price paid per cigarette increased from Mex$1.24 in 2008, to Mex$1.36 in 2010, to Mex$1.64 in 2011. Daily cigarette expenditure increased from Mex$6.9, to Mex$7.6 and to Mex$8.4 in the 3 years. There was no evidence of an association between price and SID. However, higher expenditure was associated with a higher probability of SID. There was no evidence that the association of price or expenditure with SID varied by income. CONCLUSION: Tax increases in Mexico have resulted in smokers paying more and spending more for their cigarettes. Those with higher cigarette expenditure experience more SID, with no evidence that poorer smokers are more affected.
Assuntos
Comércio , Política Pública , Abandono do Hábito de Fumar/economia , Fumar/economia , Impostos , Produtos do Tabaco/economia , Tabagismo/economia , Adolescente , Adulto , Idoso , Coleta de Dados , Humanos , Renda , Modelos Logísticos , México , Pessoa de Meia-Idade , Pobreza , Abandono do Hábito de Fumar/métodos , Adulto JovemRESUMO
AIMS: To describe some of the variability across the world in levels of quit smoking attempts and use of various forms of cessation support. DESIGN: Use of the International Tobacco Control Policy Evaluation Project surveys of smokers, using the 2007 survey wave (or later, where necessary). SETTINGS: Australia, Canada, China, France, Germany, Ireland, Malaysia, Mexico, the Netherlands, New Zealand, South Korea, Thailand, United Kingdom, Uruguay and United States. PARTICIPANTS: Samples of smokers from 15 countries. MEASUREMENTS: Self-report on use of cessation aids and on visits to health professionals and provision of cessation advice during the visits. FINDINGS: Prevalence of quit attempts in the last year varied from less than 20% to more than 50% across countries. Similarly, smokers varied greatly in reporting visiting health professionals in the last year (<20% to over 70%), and among those who did, provision of advice to quit also varied greatly. There was also marked variability in the levels and types of help reported. Use of medication was generally more common than use of behavioural support, except where medications are not readily available. CONCLUSIONS: There is wide variation across countries in rates of attempts to stop smoking and use of assistance with higher overall use of medication than behavioural support. There is also wide variation in the provision of brief advice to stop by health professionals.
Assuntos
Linhas Diretas/estatística & dados numéricos , Internet/estatística & dados numéricos , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Abandono do Hábito de Fumar/estatística & dados numéricos , Prevenção do Hábito de Fumar , Dispositivos para o Abandono do Uso de Tabaco/estatística & dados numéricos , Ásia/epidemiologia , Australásia/epidemiologia , Comparação Transcultural , Europa (Continente)/epidemiologia , Pesquisas sobre Atenção à Saúde , Acessibilidade aos Serviços de Saúde , Humanos , Renda , América do Norte/epidemiologia , Prevalência , Avaliação de Programas e Projetos de Saúde , Política Pública , Autorrelato , Fumar/epidemiologia , Abandono do Hábito de Fumar/métodos , Uruguai/epidemiologiaRESUMO
BACKGROUND: Single cigarette use and its implications have rarely been studied among adults. OBJECTIVE: To assess perceptions, prevalence and correlates of single cigarette purchase behaviour and its relation to harm reduction. DESIGN: Focus group transcripts and cross-sectional data were analysed. SETTING AND PARTICIPANTS: Focus groups among convenience samples of adult smokers in two Mexican cities and a population-based sample of 1079 adult smokers from the International Tobacco Control Policy Evaluation Project in four Mexican cities. MAIN OUTCOME MEASURES: Purchase of single cigarettes last time cigarettes were bought, frequency of purchasing single cigarettes in the previous month and intention to quit in the next 6 months. RESULTS: Focus group data indicated that smokers bought single cigarettes as a harm reduction strategy. Survey data indicated that 38% of participants purchased single cigarettes in the last month and 10% purchased them the last time they bought cigarettes, with more frequent consumption among young adults and those with lower income. Purchasing single cigarettes was independently associated with the frequency of using single cigarettes to reduce consumption and, less consistently, with the frequency of being cued to smoke after seeing single cigarettes for sale. Using single cigarettes to reduce consumption was positively associated with quit intention, whereas being cued to smoke by single cigarettes was negatively associated with quit intention. CONCLUSIONS: Study results suggest that some adult Mexican smokers purchase single cigarettes as a method to limit, cut down on and even quit smoking. Nevertheless, promotion of the availability of single cigarettes as a harm reduction strategy could provide additional smoking cues that undermine quit attempts and promote youth smoking.