Abu S. Abdullah

Socioeconomic Differences in Exposure to Tobacco Smoke Pollution (TSP) in Bangladeshi Households with Children: Findings from the International Tobacco Control (ITC) Bangladesh Survey

This study assessed the pattern of exposure to tobacco smoke pollution (TSP; also known as, secondhand smoke) in Bangladeshi households with children and examined the variations in household smoking restrictions and perception of risk for children’s exposure to TSP by socioeconomic status. We interviewed 1,947 respondents from Bangladeshi households with children from the first wave (2009) of the International Tobacco Control (ITC) Bangladesh Survey. 43.5% of the respondents had complete smoking restrictions at home and 39.7% were very or extremely concerned about TSP risk to children’s health. Participants with lower level of education were significantly less likely to be concerned about the risk of TSP exposure to children’s health and less likely to adopt complete smoking restrictions at home. Logistic regression revealed that the predictors of concern for TSP exposure risk were educational attainment of 1 to 8 years (OR = 1.94) or 9 years or more (OR = 4.07) and being a smoker (OR = 0.24). The predictors of having complete household smoking restrictions were: urban residence (OR = 1.64), attaining education of 9 years or more (OR = 1.94), being a smoker (OR = 0.40) and being concerned about TSP exposure risk to children (OR = 3.25). The findings show that a high proportion of adults with children at home smoke tobacco at home and their perceptions of risk about TSP exposure to children’s health were low. These behaviours were more prevalent among rural smokers who were illiterate. There is a need for targeted intervention, customized for low educated public, on TSP risk to children’s health and tobacco control policy with specific focus on smoke-free home.

Prevalence and Patterns of Tobacco Use in Bangladesh from 2009 to 2012: Evidence from International Tobacco Control (ITC) Study.

Background Smoking and passive smoking are collectively the biggest preventable cause of death in Bangladesh, with major public health burden of morbidity, disability, mortality and community costs. The available studies of tobacco use in Bangladesh, however, do not necessarily employ nationally representative samples needed to monitor the problem at a national scale. This paper examines the prevalence and patterns of tobacco use among adults in Bangladesh and the changes over time using large nationally representative comparable surveys. Methods Using data from two enumerations of the International Tobacco Control (ITC) Bangladesh Project conducted in 2009 and 2012, prevalence estimates are obtained for all tobacco products by socio-economic determinants and sample types of over 90,000 individuals drawn from over 30,000 households. Household level sample weights are used to obtain nationally representative prevalence estimates and standard errors. Statistical tests of difference in the estimates between two time periods are based on a logistic regression model that accounts for the complex sampling design. Using a multinomial logit model, the time trend in tobacco use status is identified to capture the effects of macro level determinants including changes in tobacco control policies. Results Between 2009 and 2012, overall tobacco use went down from 42.4% to 36.3%. The decline is more pronounced with respect to smokeless tobacco use than smoking. The prevalence of exclusive cigarette smoking went up from 7.2% to 10.6%; exclusive bidi smoking remained stable at around 2%; while smoking both cigarette and bidi went down from 4.6% to 1.8%; exclusive smokeless tobacco use went down from 20.2% to 16.9%; and both smokeless tobacco use and smoking went down from 8.4% to 5.1%. In general, the prevalence of tobacco use is higher among men, increases from younger to older age groups, and is higher among poorer people. Smoking prevalence is the highest among the slum population, followed by the tribal population, the national population and the border area population, suggesting greater burden of tobacco use among the disadvantaged groups. Conclusions The overall decline in tobacco use can be viewed as a structural shift in the tobacco market in Bangladesh from low value products such as bidi and smokeless tobacco to high value cigarettes, which is expected with the growth in income and purchasing power of the general population. Despite the reduction in overall tobacco use, the male smoking prevalence in Bangladesh is still high at 37%. The world average of daily smoking among men is 31.1%. The Tobacco Control Act 2005 and the Amendment have yet to make a significant impact in curbing tobacco usage in Bangladesh. The findings in this paper further suggest that the tobacco control policies in Bangladesh need to include targeted interventions to restrain the use of particular types of tobacco products among specific demographic and socio-economic groups of the population, such as smoked tobacco among men, smokeless tobacco among women, and both smoked and smokeless tobacco among those living in rural areas, those in low socio-economic status and those belonging to the tribal and the slum population.

Secondhand Smoke Exposure Reduction Intervention in Chinese Households of Young Children: A Randomized Controlled Trial.

OBJECTIVE To assess whether a theory-based, community health worker-delivered intervention for household smokers will lead to reduced secondhand smoke exposure to children in Chinese families. METHODS Smoking parents or caregivers who had a child aged 5 years or younger at home were randomized to the intervention group (n = 164) to receive smoking hygiene intervention or to the comparison group (n = 154). The intervention was delivered by trained community health workers. Outcomes were assessed at 2- and 6- month follow-up. RESULTS Of the 318 families randomized, 98 (60%) of 164 intervention group and 82 (53%) of 154 of controls completed 6-month follow-up assessment. At the 6-month follow-up, 62% of intervention and 45% of comparison group households adopted complete smoking restrictions at home (P = .022); total exposure (mean number of cigarettes per week ± standard deviation) from all smokers at home in the past 7 days was significantly lower among children in the intervention (3.29 ± 9.06) than the comparison (7.41 ± 14.63) group (P = .021); and mean urine cotinine level (ng/mL) was significantly lower in the intervention (0.030 ± .065) than the comparison (0.087 ± .027) group, P < .001). Participants rating of the overall usefulness of the intervention was 4.8 + 0.8 (1 standard deviation) on the 5 point scale (1 not at all and 5 = very useful). CONCLUSIONS The findings of this very first study in China showed that smoking hygiene intervention was effective in reducing childrens exposure to secondhand smoke. These findings have implications for the development of primary health care-based secondhand smoke exposure reduction and family oriented smoking cessation interventions as China moves toward a smoke-free society.

Public place smoke-free regulations, secondhand smoke exposure and related beliefs, awareness, attitudes, and practices among Chinese urban residents.

Objective: To evaluate the association between smoke-free regulations in public places and secondhand smoke exposure and related beliefs, awareness, attitudes, and behavior among urban residents in China. Methods: We selected one city (Hangzhou) as the intervention city and another (Jiaxing) as the comparison. A structured self-administered questionnaire was used for data collection, and implemented at two time points across a 20-month interval. Both unadjusted and adjusted logistic methods were considered in analyses. Multiple regression procedures were performed in examining variation between final and baseline measures. Results: Smoke-free regulations in the intervention city were associated with a significant decline in personal secondhand smoke exposure in government buildings, buses or taxis, and restaurants, but there was no change in such exposure in healthcare facilities and schools. In terms of personal smoking beliefs, awareness, attitudes, and practices, the only significant change was in giving quitting advice to proximal family members. Conclusions: There was a statistically significant association between implementation of smoke-free regulations in a city and inhibition of secondhand tobacco smoking exposure in public places. However, any such impact was limited. Effective tobacco control in China will require comprehensive laws implemented fully and supported by penalties and a combination of strong public health education.

Addressing Parental Smoking in Pediatric Settings of Chinese Hospitals: A Qualitative Study of Parents

This study explored factors associated with SHS exposure from parental smoking in Chinese families and assessed nature of antismoking discussions parents had with their childrens pediatricians and how pediatricians might best engage with parents in an effort to reduce childrens exposure to SHS. Six focus group discussions (FGDs) were conducted among 33 Chinese parents attending six major hospitals in Guangxi province, China. Most participants (32/33) had family members who smoke, and only 21% had strict restriction on smoking at home. Some parents did not know about health consequences of smoking and effects of SHS exposure on children. Situations that made it especially hard to avoid the childs SHS exposure were having an elderly smoker at home and having a visitor who smoked. Only few parents were asked by pediatricians about childs exposure to SHS at home, but only when childs illness was related to smoking. Parents believed that suggestions coming from pediatricians about smoke-free home and parental quitting would be acceptable to parents and other household members. The findings provide insight into SHS exposure reduction effort among Chinese parents and underscore the demand for pediatricians engagement in addressing parental tobacco use.

Willingness to pay for preventive travel health measures among Hong Kong Chinese residents.

BACKGROUND The effectiveness of preventive measures in combating travel-related illnesses is well recognized. However, there is a lack of information on the economic value of any travel-associated preventive measures in the literature. OBJECTIVES The purpose of this article is to report the values of willingness to pay (WTP) to prevent travel health problems in Hong Kongs travelers. METHODS A cross-sectional telephone survey for a sample of Hong Kong population was conducted in 1998 using a random digit dialing technique. The sample WTP values were elicited using an open-ended question. Logistic regression was performed to identify predictors of WTP. Mean WTP was estimated using Heckmans sample selection model on log-WTP. RESULTS Of the subjects interviewed, 77% (285/369) offered positive values of WTP to prevent travel health problems. The observable WTP (zero excluded) had a higher mean (447 Hong Kong dollars) than did the zero-inclusive data (351 Hong Kong dollars). The median values were 200 Hong Kong dollars in both cases because there were a large number of protest responses. Age, travel frequency, ability to assess travel health risk, precautionary behavior, and previous exposure to health protection materials explained ones willingness to pay a positive amount for preventing travel health problems. Age, education level, and precautionary behavior were predictors of the WTP levels. CONCLUSION The findings of this study suggest that Chinese travelers are willing to pay for the prevention of travel-related illnesses. The predictors of WTP identified could be used to suggest policy changes. However, future studies are needed to explore further the relationship between the experience of travel illnesses, the magnitude of travel health risks, and WTP.

Effectiveness of smoking reduction intervention for hardcore smokers

BackgroundThe prevalence and correlates of hardcore smokers, who have high daily cigarette consumption, no quitting history and no intention to quit, have been studied in several western developed countries, but no previous trials of smoking cessation have tested intervention effectiveness for these smokers. The current study examined if hardcore smokers can benefit from smoking reduction intervention to achieve cessation, and explored the underlying reasons.MethodsA posteriori analysis was conducted on data from a randomized controlled trial of smoking reduction intervention on 1,154 smokers who did not want to quit. Odds ratios of 7-day point prevalence of abstinence, smoking reduction by at least 50% and quit attempt at the 6-month follow-up comparing subgroups of smokers were analyzed.ResultsIn hardcore smokers, the odds ratio comparing the quit rate between the intervention and control group was 4.18 (95% CI: 0.51-34.65), which was greater than non-hardcore smokers (OR = 1.58, 95% CI: 0.98-2.54). The number needed to treat for hardcore and non-hardcore smokers was 8.33 (95% CI: 5.56-16.67) and 16.67 (95% CI: 8.33-233.64), respectively. In smokers who did not have quit attempt experience and those who smoked more than 15 cigarettes daily, the odds ratio comparing intervention and control group was 3.29 (95% CI: 0.72-14.98) and 1.36 (95% CI: 0.78-2.36), respectively.ConclusionsThe a posteriori analysis provided pilot results that smoking reduction intervention may be effective to help hardcore smokers to quit and reduce smoking. Having no previous quit attempt was identified as more important than having large cigarette consumption in explaining the greater effectiveness of the intervention.

Secondhand smoke exposure assessment and counseling in the Chinese pediatric setting: a qualitative study

BackgroundAssisting smoking parents to quit smoking and eliminating the secondhand smoke (SHS) exposure of their children is a global health priority. Engaging healthcare workers in developing countries to address this priority has been a challenge. This study intends to explore issues around current practice related to SHS exposure assessment and counseling and identify barriers to SHS exposure reduction counseling in the Chinese pediatric setting.MethodsWe conducted qualitative interviews (11 focus groups discussions (FGDs) with pediatricians, 6 FGDs with pediatric nurses and 11 in-depth interviews (IDIs) with hospital administrators) among 101 health-care professionals (HCP) from 5 hospitals in four major cities of Guangxi Province, China. All FGDs/ IDIs were audio recorded and analysed thematically.ResultsThe findings suggest that few Chinese pediatricians routinely address the SHS exposure of children in their usual practice. All HCPs felt the need for clinical interventions to promote SHS exposure reduction for children. Primary barriers to SHS exposure reduction counseling in the Chinese pediatric setting included: lack of skills and training in tobacco use reduction and cessation counseling; time constraints and heavy workloads, uncertainty about the usefulness of smoking cessation interventions and lack of hospital-wide systems requiring pediatricians to record tobacco use or SHS exposure information. Ideas for overcoming these barriers were building capacity of pediatricians, collaboration with international organization to initiate training, engaging top level leaders in the effort and ensuring financial resources to support the program.ConclusionsThis study among hospital administrators and service providers in China demonstrated a high level of interest in delivering SHS exposure reduction interventions in the pediatric setting. The findings can inform the creation and delivery of clinical interventions in China to promote SHS exposure reduction to children in the pediatric setting.

Knowledge, Attitude, and Behaviors Related to Eating Out among University Students in China.

In many countries the frequency of eating out has steadily increased over the last few decades, and this behavioris often associated with unhealthy dietary patterns. This study aimed to describe the levels of knowledge, attitude, and behaviors (KAB) related to eating out among university students. A cross-sectional study was conducted in the college town in Chongqing, China with a total of 1634 participants. The mean eating out related KAB scores were: knowledge 11.5 ± 2.9, attitude 17.0 ± 2.8, and behaviors 24.2 ± 4.8 (possible total scores: 20, 24, 40 respectively). As the level of knowledge increased, the percentage of highly satisfactory attitude and behaviors increased. Only 10% of the participants did not eat out for lunch and dinner during weekends in the last month. Gender, ethnicity, mother’s education, monthly boarding expenses, living place during the study, and the frequency of eating out for breakfast were statistically associated with the scores of KAB. In conclusion, Chinese junior students had poor knowledge of and behaviors towards eating out and ate out frequently. Educational interventionsto improve knowledge related eating out are needed in order to promote healthy eating out behaviors among Chinese university students.

Preventive behaviours in avoiding indoor secondhand smoke exposure among pregnant women in China

Secondhand smoke (SHS) is a major indoor pollutant that causes serious health problems among all those exposed, especially pregnant women.1 Prevalence of exposure to SHS among pregnant women is high in China.2 In the 2010 Global Adult Tobacco Survey in China, 65.1% of non-smoking women of childbearing age were exposed to SHS at home and another 52.6% were exposed to SHS in the workplace.3 Globally, it was estimated that about one-third of adults (33% men and 35% women) are exposed to SHS,4 which is comparatively lower than the exposure level in Chinese women. This pattern of exposure to SHS among adults highlights the fact that many of the over 100 million annual pregnant women globally will be exposed to SHS, and will expose their unborn children to tobacco-induced harms.1 Therefore, public health implications of exposure to SHS during pregnancy by women and their babies are substantial3 and need urgent attention. This study examined the behavioural practices of pregnant Chinese women in avoiding exposure to SHS in indoor environments. A cross-sectional survey, using a structured questionnaire, was conducted among pregnant women, recruited from 16 hospitals in 5 provinces of China, from June to August 2015. The study protocol was approved by the Ethics Committee of Chongqing Medical …