Oluwakemi Odukoya

Poly-tobacco use among adults in 44 countries during 2008-2012: Evidence for an integrative and comprehensive approach in tobacco control

INTRODUCTION The concurrent use of multiple tobacco products (i.e., poly-tobacco use) might hinder efforts to reduce overall tobacco use, particularly considering that use of some non-cigarette tobacco products may be popular in some regions due to social, cultural, or economic reasons. This study assessed poly-tobacco use patterns among persons aged ≥15 years old from 44 countries. METHODS Data from 44 countries in all six World Health Organization regions were obtained from the 2008 to 2012 Global Adult Tobacco Surveys (n=19 countries), and the Special Eurobarometer 385 (77.1) survey, 2012 (n=25 countries). Correlates of poly-tobacco use were assessed using multivariate logistic regression analyses (p<0.05). RESULTS Overall prevalence of poly-tobacco use ranged from 0.8% (Mexico) to 11.9% (Denmark). In 28 countries, 20% or more of current smokers of manufactured cigarettes concurrently used at least one other tobacco product and this proportion was highest in India (66.2%) and lowest in Argentina (4.4%). After adjusting for other factors, the likelihood of being a poly-tobacco user among all respondents was lower among females (aOR=0.09; 95% CI: 0.08-0.11), and among respondents from upper-middle-income (aOR=0.53, 95% CI: 0.43-0.66), and lower-middle-income countries (aOR=0.64; 95% CI: 0.51-0.81) compared to high-income countries. Increased likelihood of poly-tobacco use was observed among respondents from the South-East Asian region compared to those from the European region (aOR=1.58, 95% CI: 1.35-1.85), as well as among respondents aged ≥65 years (aOR=2.10; 95% CI: 1.73-2.54), compared to those aged <25 years. CONCLUSIONS The pattern of tobacco use varied widely, underscoring the need for intensified efforts towards implementing policies that address all tobacco products, not only manufactured cigarettes.

Determinants of Smoking Initiation and Susceptibility to Future Smoking among School-Going Adolescents in Lagos State, Nigeria

BACKGROUND It is projected that low and middle-income countries will bear a major burden of tobacco related morbidity and mortality, yet, only limited information is available on the determinants of smoking initiation among youth in Africa. This study aimed to assess the determinants of smoking initiation and susceptibility to future smoking among a population of high school school students in Lagos, Nigeria. MATERIALS AND METHODS Baseline data from an intervention study designed to assess the effect of an anti-smoking awareness program on the knowledge, attitudes and practices of adolescents was analyzed. The survey was carried out in six randomly selected public and private secondary schools in local government areas in Lagos state, Nigeria. A total of 973 students completed self-administered questionnaires on smoking initiation, health related knowledge and attitudes towards smoking, susceptibility to future smoking and other factors associated with smoking. RESULTS Of the respondents, 9.7% had initiated smoking tobacco products with the predominant form being cigarettes (7.3%). Males (OR: 2.77, 95%CI: 1.65-4.66) and those with more pro-smoking attitudes (OR: 1.44, 95%CI: 1.34-1.54) were more likely to have initiated smoking. Those with parents and friends who are smokers were 3.47 (95%CI: 1.50-8.05) and 2.26 (95%CI: 1.27-4.01) times more likely to have initiated smoking. Non-smoking students, in privately owned schools (OR: 5.08), with friends who smoke (5.09), with lower knowledge (OR: 0.87) and more pro-smoking attitudes (OR 1.13) were more susceptible to future smoking. In addition, respondents who had been sent to purchase cigarettes by an older adult (OR: 3.68) were also more susceptible to future smoking. CONCLUSIONS Being male and having parents who smoke are predictors of smoking initiation among these students. Consistent with findings in other countries, peers not only influence smoking initiation but also influence smoking susceptibility among youth in this African setting. Prevention programs designed to reduce tobacco use among in-school youth should take these factors into consideration. In line with the recommendations of article 16 of the WHO FCTC, efforts to enforce the ban on the sales of cigarettes to minors should be also emphasised.

High neonatal mortality rates in rural India: what options to explore?

The neonatal mortality rate in India is amongst the highest in the world and skewed towards rural areas. Nonavailability of trained manpower along with poor healthcare infrastructure is one of the major hurdles in ensuring quality neonatal care. We reviewed case studies and relevant literature from low and middle income countries and documented alternative strategies that have proved to be favourable in improving neonatal health. The authors reiterate the fact that recruiting and retaining trained manpower in rural areas by all means is essential to improve the quality of neonatal care services. Besides this, other strategies such as training of local rural healthcare providers and traditional midwives, promoting home-based newborn care, and creating community awareness and mobilization also hold enough potential to influence the neonatal health positively and efforts should be made to implement them on a larger scale. More research is demanded for innovations such as “m-health” and public-private partnerships as they have been shown to offer potential in terms of improving the standards of care. The above proposed strategy is likely to reduce morbidity among neonatal survivors as well.

Alcohol consumption and cigarette smoking pattern among brothel-based female sex workers in two local government areas in Lagos state, Nigeria.

BACKGROUND Alcohol and tobacco use are known risk factors for non communicable diseases especially among women. Brothel based female sex workers may be at increased risk of exposure to these two substances. OBJECTIVE To assess the pattern of alcohol and tobacco use among female sex workers in two selected local government areas in Lagos state, Nigeria. METHODS A cross-sectional descriptive study was carried out among 323 brothel-based female sex workers in 39 consenting brothels. Data was collected by trained interviewers using a pretested structured questionnaire. RESULTS Majority (67.8%) were current drinkers with 89.5% of these having their most recent drink less than a week ago. Most of them (89%) consumed more than the reference limits for alcohol use among women. Up to 20.7% were current smokers with (92.5%) having their most recent cigarette less than a week ago. More than a third (37.4%) were heavy smokers while 19% were dual users. Current drinking was associated with current smoking. Smokers consumed significantly more units of alcohol than non-smokers. CONCLUSION The prevalence of harmful alcohol use and cigarette smoking are very high among this group of female sex workers. Programs that address the use of these substances should be made available for these women.

Trained Community Volunteers Improve Tuberculosis Knowledge and Attitudes Among Adults in a Periurban Community in Southwest Nigeria

Nigeria has the worlds 10th largest tuberculosis (TB) burden. Targeted community-based interventions can potentially help reduce TB incidence. We designed an intervention in a periurban community where 10 community volunteers were trained to provide community TB education and also detect and refer TB suspects to a nearby clinic. To determine the effect of the intervention on knowledge, attitude, and preventive practices of TB, we compared results from a pre-intervention survey with those of a post-intervention survey. Pre-intervention, respondents had a mean knowledge score of 10.6 ± 7.0 of a possible 34, a mean attitude score of 5.8 ± 3.3 of a possible 10, and a mean practice score of 5.3 ± 1.4 of a possible 7. The intervention significantly increased the mean knowledge score to 16 ± 5.4 (P < 0.001) and mean attitude score to 7.0 ± 1.8 (P < 0.001); however, there was no statistically significant difference in the mean practice score. Eight TB suspects were referred to the clinic, and one suspect was subsequently diagnosed with TB. The use of trained community volunteers to share information on TB improved the overall knowledge and attitudes of respondents. Continued empowerment of the community should be encouraged to promote TB prevention and care.

Tobacco-free schools as a core component of youth tobacco prevention programs: a secondary analysis of data from 43 countries

BACKGROUND Preventing tobacco use is a key aspect of health promotion during adolescence. We assessed prevalence and impact of school-based tobacco prevention programs in 43 countries. METHODS We performed a secondary analysis of national data of students aged 13-15 years (Global Youth Tobacco Surveys) from 43 countries during 2005-2011. National surveys of the corresponding school personnel (Global School Personnel Surveys) were performed in each country during the same year as the student surveys. Data on status of enforcement of national smoke-free school policies were obtained from the 2008 and 2009 WHO MPOWER reports. Logistic regression was used to measure ecologic-level associations between school-based tobacco prevention programs and tobacco-related knowledge and behaviour among students (P < 0.05). RESULTS The proportion of students who were taught in class about the dangers of tobacco use during the school year ranged from 31.4% (Georgia) to 83.4% (Papua New Guinea). For every 10% increase (country level) in the proportion of teachers who reported having a tobacco prevention curriculum in their school, the odds of students reporting exposure to education in class about the dangers of tobacco increased by 6.0% (AOR = 1.06; 95% CI: 1.04-1.08). However, didactic education in class about the dangers of tobacco use was not independently associated with student current cigarette smoking behavior. Conversely, the likelihood of being a current smoker was significantly lower among students in countries with moderate/strongly enforced national smoke-free school policies compared with those in countries with poorly enforced/no national smoke-free school policies (AOR = 0.59; 95% CI: 0.45-0.76). CONCLUSIONS Comprehensive tobacco prevention programs that include well-enforced smoke-free school policies may help reduce youth smoking.

Access to information technology and willingness to receive text message reminders for childhood immunisation among mothers attending a tertiary facility in Lagos, Nigeria

Background. Effective communication is imperative for the delivery and receipt of adequate health care services. Aim. To determine access to information technology and willingness to receive short message service (SMS) text message reminders for childhood immunisation services among mothers in Lagos, Nigeria. Method. In this descriptive cross-sectional study, interviews using structured questionnaires were conducted with 399 mothers of children aged <5 years who brought their children to attend the immuno-prophylaxis and child welfare clinic of Lagos University Teaching Hospital during July and August 2011. Results. The age of the respondents ranged from 16 to 51 years with a mean of 31.1±4.7 years. Almost all (98%) were current owners of mobile phones, 68% had computer access, 66% were current users of the Internet though most used it occasionally and 65% had e-mail addresses. About three-quarters (77%) were willing to receive future SMS reminders about childhood immunisations although 67% preferred telephonic reminders to SMS and only 53% were willing to pay for the reminders. Respondents who were currently married and had at least a post-secondary education were more willing to receive SMS reminders. Conclusion. The mothers had better access to mobile phones than the Internet and were willing to receive SMS immunisation reminders. Future intervention strategies should explore payment mechanisms for SMS reminders, as there is an unwillingness to bear the cost by the respondents.

Knowledge and Attitude toward Smoke-Free Legislation and Second-Hand Smoking Exposure among Workers in Indoor Bars, Beer Parlors and Discotheques in Osun State of Nigeria

BACKGROUND One of the requirements of the Osun State smoke-free legislation is to ensure smoke-free enclosed and partially enclosed workplaces. This survey was conducted to assess the knowledge and attitude of workers in indoor bars, beer parlors and discotheques to smoke-free legislation in general and the Osun State smoke-free law in particular. METHODS A convenience sampling of 36 hospitality centers was conducted. Interviewer-administered questionnaires were used to elicit responses about the objectives from non-smoking workers. The questionnaires had sections on knowledge of the Osun State smoke-free law, attitude toward the law and smoke-free legislation in general and exposure to second-hand tobacco smoke by the workers. Questions were also asked about the second-hand tobacco smoking status of these workers. The data were analyzed using SPSS version 15.0. RESULTS We had 154 participants recruited into the study. There were 75 males (48.0%) and 79 females (52.0%). On the overall, respondents had a good knowledge of the effects of second-hand smoke on health (70.2%) with 75.0% of them being aware of the general smoke-free law and 67.3% being aware of the Osun State smoke-free law although none of them had ever seen a copy of the law. A high proportion (60.0%) was in support of the Osun smoke-free law although all of them think that the implementation of the law could reduce patronage and jeopardize their income. Attitude toward second-hand smoking was generally positive with 72.0% of them having no tolerance for second-hand tobacco smoke in their homes. Most participants (95.5%) had been exposed to tobacco smoke in the workplace within the past week. CONCLUSION Despite the high level of awareness of the respondents about the dangers of second hand smoke and their positive attitude to smoke-free laws, nearly all were constantly being exposed to second hand smoke at work. This calls for policy level interventions to improve the implementation of the smoke-free law.

Results From Nigeria’s 2013 Report Card on Physical Activity for Children and Youth

BACKGROUND Physical activity (PA) promotion in children and youth is an impetus for prevention and control of NCD morbidity and mortality, but evidence is needed for effective interventions. The aim of the present paper is to summarize the results of the 2013 Nigerian Report Card on Physical Activity for children and youth. METHODS The Technical Report Committee conducted a comprehensive review of available literature in Nigeria. Grades were assigned to 10 PA indicators modeled after the Active Healthy Kids Canada (AHKC) grading system. RESULTS Specific grades were assigned for several indicators: Overall Physical Activity Levels, C; Organized Sport and Physical Activity Participation, Incomplete; Active Play and Leisure, C-; Active Transportation, B; Sedentary Behaviors, F; Overweight and Obesity, B+. The following indicators were graded as INCOMPLETE: Physical Activity in School setting, Family and Peers, Community and Built Environment, and Government Strategies and Investments. CONCLUSIONS PA levels of Nigerian children and youth are moderate while sedentary behaviors are high. The development of national guidelines for PA and sedentary behaviors can better inform policy and practice on healthy living among Nigerian children and youth.

Cigarette purchase and accessibility among children in a developing country. A study among in-school youth in Lagos state, Nigeria

INTRODUCTION Tobacco use among youth remains a significant global public health challenge especially in low and middle Income countries (LMICs). The vast majority of smokers begin using tobacco products well before the age of 18 years.If current trends continue, a lifetime of tobacco use would result in the deaths of 250 million children and young people alive today, most of them in low-and middle-income countries (LMICs). In recent years, the tobacco control community has shifted its focus to LMICs, which are becoming a major market for tobacco companies seeking to expand their profits and compensate for dwindling markets in higher-income countries. Many countries in sub-Saharan Africa are in the first stage of the tobacco epidemic .Nigeria, the most populous country in Africa, with an estimated 44% of her population under the age of 18 years, remains an attractive market for the tobacco industry. The 2008 Global Youth Tobacco Survey (GYTS) conducted among children aged 13-15 years in five sites across Nigeria showed rates of smoking experimentation ranging from 4.7% in Ibadan (South Western region) to 16.1% in Kano (North central region), while current smoking rates ranged from 0.3% to 11.4% among girls and boys in Kano state respectively.6 Furthermore, 2.9% of girls in Ibadan and up to 17.8% of girls in Lagos state who had never smoked cigarettes reported that they were likely to initiate cigarette smoking within the next year . Availability and accessibility of different types of tobacco products to youth have been identified as an important determinant of tobacco use. Reducing the availability and accessibility of cigarettes to young people can significantly reduce youth smoking. While there is paucity of data from many African countries, studies in more developed countries showed that youth who perceived cigarettes as Cigarette purchase and accessibility among children in a developing country. A study among in-school youth in Lagos state, Nigeria Oluwakemi Ololade Odukoya1, Olanrewaju Onigbogi1, Chife Jacob1, Kolawole Okuyemi2