scholarly journals Serious limitations of the current strategy to control Soil-Transmitted Helminths and added value of Ivermectin/Albendazole mass administration: A population-based observational study in Cameroon

2020 ◽  
Vol 14 (11) ◽  
pp. e0008794
Author(s):  
Linda Djune-Yemeli ◽  
Hugues C. Nana-Djeunga ◽  
Cédric G. Lenou-Nanga ◽  
Cyrille Donfo-Azafack ◽  
André Domche ◽  
...  
Keyword(s):  
Population Based ◽  
Sub Saharan Africa ◽  
Health District ◽  
Added Value ◽  
Health Concern ◽  
Chi Square ◽  
Cross Sectional ◽  
Transmission Interruption ◽  
The Impact ◽  
Health Districts

Background Soil-transmitted helminth (STH) infections remain a public health concern in sub-Saharan Africa. School-based mass drug administration (MDA) using the anthelminthic drug Mebendazole/Albendazole have succeeded in controlling morbidity associated to these diseases but failed to interrupt their transmission. In areas were filarial diseases are co-endemic, another anthelminthic drug (Ivermectin) is distributed to almost the entire population, following the community-directed treatment with ivermectin (CDTI) strategy. Since Ivermectin is a broad spectrum anthelmintic known to be effective against STH, we conducted cross-sectional surveys in two health districts with very contrasting histories of Ivermectin/Albendazole-based PC in order to investigate whether CDTI might have contributed in STH transmission interruption. Methodology Cross-sectional surveys were conducted in two health districts with similar socio-environmental patterns but with very contrasting CDTI histories (Akonolinga health district where CDTI was yet to be implemented vs. Yabassi health district where CDTI has been ongoing for two decades). Stool samples were collected from all volunteers aged >2 years old and analyzed using the Kato-Katz technique. Infections by different STH species were compared between Akonolinga and Yabassi health districts to decipher the impact of Ivermectin/Albendazole-based MDA on STH transmission. Principal findings A total of 610 and 584 participants aged 2–90 years old were enrolled in Akonolinga and Yabassi health districts, respectively. Two STH species (Ascaris lumbricoides and Trichuris trichiura) were found, with prevalence significantly higher in Akonolinga health district (43.3%; 95% CI: 38.1–46.6) compared to Yabassi health district (2.5%; 95% CI: 1.1–5.1) (chi-square: 90.8; df: 1; p < 0.001). Conclusion/significance These findings (i) suggest that Mebendazole- or Albendazole-based MDA alone distributed only to at-risk populations might not be enough to eliminate STH, (ii) support the collateral impact of Ivermectin/Albendazole MDA on A. lumbricoides and T. trichiura infections, and (iii) suggest that Ivermectin/Albendazole-based PC could accelerate STH transmission interruption.

scholarly journals Hubungan Pemakaian Jenis Sikat Gigi Dengan Status Gingiva Pada Siswa Pengguna Alat Orthodontik Cekat di Sekolah Menengah Atas

2018 ◽  
Vol 6 (1) ◽  
pp. 1-7
Author(s):  
Zul Afni ◽  
Dwi Suyatmi ◽  
Etty Yuniarly
Keyword(s):  
Medical Personnel ◽  
Population Based ◽  
World Health ◽  
Health Examination ◽  
Oral Diseases ◽  
Orthodontic Appliance ◽  
Chi Square ◽  
Cross Sectional ◽  
The Impact ◽  
Fixed Orthodontic Appliance

Dental and oral diseases are still suffered by 25,9 % of Indonesia's population. Based on that percentage 31,1 % are receiving treatment and treatment from dental medical personnel, while 68,9 % are not treated. The use of orthodontic devices has spread among teenagers, especially high school children aged 14-17 with the aim of following trends and lifestyles without thinking about the impact. According to World Health Organization, schools and adolescents are important target groups for an oral health examination. To know the correlation of use of toothbrush type with gingival status on fixed orthodontic user students. This research type is analytic observation with a cross-sectional design. This study was conducted in October-November 2017. The study population of this study is the students of class X who wear the fixed orthodontic appliance. Data analysis used chi-square. Respondents of fixed orthodontic appliance users orthodontic toothbrush are 60,5 %. Respondents of fixed orthodontic appliance users had a healthy gingival status is 57,9 %. The result of statistical analysis obtained significant value = 0,029<0,05. The type of toothbrush used has a correlation with the status of the gingiva on the students of a fixed orthodontic appliance.

scholarly journals Prevalence and Determinants of Hypertension Awareness, Treatment, and Control in Botswana: A Nationally Representative Population-Based Survey

2020 ◽  
Vol 2020 ◽  
pp. 1-12
Author(s):  
Neo M. Tapela ◽  
Lei Clifton ◽  
Gontse Tshisimogo ◽  
Moagi Gaborone ◽  
Tebogo Madidimalo ◽  
...  
Keyword(s):  
Population Based ◽  
Self Report ◽  
Sub Saharan Africa ◽  
Health Concern ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
Adherence Support ◽  
Hypertension Awareness ◽  
Nationally Representative ◽  
And Control

Introduction. Hypertension is a leading risk factor for cardiovascular mortality and an emerging public health concern in sub-Saharan Africa. Few studies have examined performance on the management of hypertension in this region, where the context may be distinct from other developing regions. Objectives. We aimed to determine the prevalence and correlates of hypertension, awareness, treatment, and control among adults in Botswana, a middle-income African country undergoing rapid demographic transition and with high HIV burden. Methods. In this 2014 cross-sectional survey of adults aged 15–69 years, information on sociodemographic characteristics, lifestyle behavior, and medical history was collected through in-person interviews and physical measurements (body mass index and triplicate blood pressure (BP)). Hypertension was defined as self-report of use of antihypertensives in the previous two weeks and/or having elevated BP (≥140/90 mmHg). Multivariable logistic regression was employed to explore factors associated with hypertension, awareness (report of previous diagnosis), treatment (antihypertensives), and control (BP < 140/90). Results. Our analysis (N = 4,007) yielded an age-standardized hypertension prevalence of 30% (95% CI: 28%–32%, N = 1,393). Among hypertensives, 54% (50–58%) were unaware of their condition, 45% (40–50%) of those aware were untreated, and 63% (55–70%) of those on medications were suboptimally treated (BP ≥ 140/90 mmHg). A fifth of hypertensives who were diagnosed but not on medications had BP ≥ 180/110 mmHg. Diabetes was the strongest correlate of hypertension and awareness (aOR 4.00, 1.86–8.59; aOR 3.30, 1.44–7.55, respectively). Males were less likely to be aware (aOR 0.62, 0.41–0.94) or controlled (aOR 0.36, 0.16–0.83). Obese individuals were more likely to be treated (aOR 2.17, 1.12–4.22), yet less likely to be controlled (aOR 0.32, 0.15–0.66). Conclusions. We report the first nationally representative estimates of the hypertension care cascade performance in Botswana, which will support planning and future policy evaluations. Findings contribute to the relatively sparse evidence on this subject and may inform development of innovations that improve quality of hypertension management and adherence support in similar settings.

scholarly journals The impact of front of package label design on consumer understanding of nutrient amounts among residents of the urban area in Chennai

2020 ◽  
Vol 11 (SPL4) ◽  
pp. 2141-2148
Author(s):  
Viswanath B ◽  
Manju ◽  
Timsi Jain
Keyword(s):  
Urban Area ◽  
Population Based ◽  
Cross Sectional Study ◽  
Nutritional Knowledge ◽  
Chi Square ◽  
Cross Sectional ◽  
Essential Information ◽  
Chi Square Test ◽  
Nutrient Amounts ◽  
The Impact

The producer, selling and utilisation of packed nourishments have supported a preeminent flood lately in India. Food labelling is one of the vital population-based methods that can help customers make beneficial food selections by offering essential information about the food on the packaging. The present study aims to assess the impact of front of package label design on consumer understanding of nutrient amounts among residents of the urban area in Chennai. A cross-sectional study was conducted in an urban area in Chennai. Four hundred participants were studied by convenient sampling method. Participants were from 18 years age and above. The study duration was about three months. A pretested and semi-structured questionnaire was given, and the desired information was elicited. Data was then analysed with the help of statistical package for the social sciences software (SPSS). Chi-square test was done to test the significance (p<0.05). The mean age was of the participants was found to be 27.52 ± 11SD. About 63% of participants preferred packed foods over unpacked foods. And 68% of participants have nutritional knowledge and looked into nutrition facts on the back of the pack. Association of gender and socioeconomic class with knowledge of participants were found to be insignificant. Association of occupation with the frequency of purchasing packed food products was significant. Many people look into the nutrition facts table and do not understand and fail to interpret. It is important to provide front of pack labels for better understanding of the consumers.

scholarly journals Point prevalence mapping reveals hotspot for onchocerciasis transmission in the Ndikinimeki Health District (Centre Region, Cameroon)

2020 ◽  
Author(s):  
Afor René Aza’ah ◽  
Laurentine Sumo ◽  
Ngum Helen Ntonifor ◽  
Jean Bopda ◽  
Rolph Bamou Heumou ◽  
...  
Keyword(s):  
Health District ◽  
River Blindness ◽  
Cross Sectional Survey ◽  
Preventive Chemotherapy ◽  
Chi Square ◽  
Cross Sectional ◽  
Breeding Sites ◽  
The Past ◽  
Centre Region ◽  
The Impact

Abstract Background Ivermectin-based preventive chemotherapy is distributed annually to all at risk eligible individuals to fight onchocerciasis. Data reporting the impact of mass ivermectin administration on onchocerciasis transmission are scanty, and it is tricky to appreciate the progress towards elimination and engage adapted corrective measures. To fill that gap in the Centre Region in Cameroon, this study aimed at assessing onchocerciasis endemicity level in the Ndikinimeki Health District after almost three decades of mass treatments. Methods As part of a cluster-based cross-sectional survey, all volunteers aged ≥ 5 years were (i) interviewed on their compliance to ivermectin over the past five years and (ii) underwent clinical (nodule palpation and visual search for onchocercal lesions) and parasitological examinations (skin snip) for onchocerciasis. Results The overall O. volvulus prevalence was 7.0% (95% CI: 5.2–9.3), significantly higher in the communities Kiboum 1 and Kiboum 2 compared to the other communities (highest prevalence in Makénéné Town Water: 8.5%; 95% CI: 2.3–20.4) (Chi-square = 51.314; df = 11; p = 0.0001). The proportion of systematic non compliers was relatively high (23.3%; 95% CI: 19.9–27.1) among individuals interviewed. In the sentinel sites (Kiboum communities), river blindness prevalence decreased from 95.2% (95% CI: 88.3–98.1) to 23.7% (95% CI: 14.7–36.0) thanks to 28 years of annual ivermectin but was still meso-endemic to onchocerciasis. Conclusions After almost three decades of preventive chemotherapy, onchocerciasis is now hypo-endemic in the Ndikinimeki Health District. However, transmission is ongoing, with a potential hotspot near Kiboum 1 and Kiboum 2 known as first line communities (closest to breeding sites of the vector). Alternative or complementary strategies to annual ivermectin appear compulsory to accelerate the momentum towards onchocerciasis elimination.

Adolescent Suicidality as Seen in Rural Northeastern Uganda

Crisis ◽  
2011 ◽  
Vol 32 (1) ◽  
pp. 43-51 ◽  
Author(s):  
Eugene Kinyanda ◽  
Ruth Kizza ◽  
Jonathan Levin ◽  
Sheila Ndyanabangi ◽  
Catherine Abbo
Keyword(s):  
Low Socioeconomic Status ◽  
Sub Saharan Africa ◽  
Psychosocial Risk ◽  
Psychiatric Nurses ◽  
Health Concern ◽  
Cross Sectional ◽  
Childhood Experiences ◽  
Low Socioeconomic ◽  
Dsm Iv ◽  
Sub Saharan

Background: Suicidal behavior in adolescence is a public health concern and has serious consequences for adolescents and their families. There is, however, a paucity of data on this subject from sub-Saharan Africa, hence the need for this study. Aims: A cross-sectional multistage survey to investigate adolescent suicidality among other things was undertaken in rural northeastern Uganda. Methods: A structured protocol administered by trained psychiatric nurses collected information on sociodemographics, mental disorders (DSM-IV criteria), and psychological and psychosocial risk factors for children aged 3–19 years (N = 1492). For the purposes of this paper, an analysis of a subsample of adolescents (aged 10–19 years; n = 897) was undertaken. Results: Lifetime suicidality in this study was 6.1% (95% CI, 4.6%–7.9%). Conclusions: Factors significantly associated with suicidality included mental disorder, the ecological factor district of residence, factors suggestive of low socioeconomic status, and disadvantaged childhood experiences.

HUBUNGAN PEMBERIAN ASI EKSKLUSIF DENGAN KEJADIAN STUNTING PADA BALITA USIA 1-5 TAHUN DIPUSKESMAS SUKAHENING KECAMATAN SUKAHENING KABUPATEN TASIKMALAYA

2020 ◽  
Vol 13 (2) ◽  
pp. 109
Author(s):  
Yuyun Sarinengsih
Keyword(s):  
Public Health ◽  
Health Center ◽  
Exclusive Breastfeeding ◽  
Growth Failure ◽  
Sampling Technique ◽  
Not Given ◽  
Chi Square ◽  
Cross Sectional ◽  
Public Health Center ◽  
The Impact

ABSTRAKStunting yaitu keadaan gagal tumbuh akibat dari kekurangan gizi kronis. Prevalensi stunting di Kabupaten Tasikmalaya menempati urutan keempat, dimana kecamatan Sukahening menempati urutan pertama tertinggi dengan jumlah 155 balita mengalami stunting. Faktor yang dapat mempengaruhi kejadian stunting yaitu pengasuhan anak yang kurang baik dimana tidak diberikannya ASI secara Ekslusif. Pencegahan stunting yaitu pada 1000 hari kehidupan dimana salah satunya pemberian ASI secara Ekslusif.Penelitian ini bertujuan untuk mengetahui hubungan antara pemberian ASI Ekslusif dengan kejadian stunting pada balita 1-5 tahun di Puskesmas Sukahening Kecamatan Sukahening Kabupaten Tasikmalaya.Jenis Penelitian yang digunakan adalah deskriptif korelasional dengan pendekatan cross-sectional. Populasi total sampling sebanyak 95 responden menggunakan teknik purposive sampling.Hasil Penelitian diperoleh lebih dari setengah responden 51,6% tidak diberikan ASI secara Ekslusif, dan sebagian besar 65,3% balita mengalami stunting. Hasil perhitungan chi-square diperoleh ρ.value (0,000<0,05) maka H0 ditolak sehingga terdapat hubungan antara Pemberian ASI Ekslusif dengan kejadian stunting pada balita 1-5 tahun di Puskesmas Sukahening Kecamatan Sukahening Kabupaten Tasikmalaya.Hasil penelitian ini diharapkan dapat memberi informasi yang bermanfaat dan perlu dilakukan pendidikan kesehatan ulang yang terjadwal terkait nutrisi yang terjangkau dan sehat sehingga dapat meningkatkan cakupan ASI Ekslusif dan dapat menurunkan angka stunting.Kata Kunci : ASI Ekslusif, StuntingDaftar Pustaka : 25 buku (2010-2018)9 jurnal (2013-2019)2 Website (2010-2017) ABSTRACTStunting is a condition of growth failure due to chronic malnutrition. The stunting prevalence in Tasikmalaya Regency was at the fourth place where Sukahening sub-district was at the highest with 155 stunting. Factor that can influence the occurrence of stunting is a poor parenting where exclusive breastfeeding is not given. The best prevention of stunting is on 1000 days of life where exclusive breastfeeding is given. The impact, if the baby is not given exclusive breastfeeding, they will lack of nutrition and also will have an impact on the growth or inappropriate height. This aims of the research is to determine the relationship between exclusive breastfeeding and the incidence of stunting on toddler under 5 years of at Sukahening Public Health Center, Sukahening Sub district, Tasikmalaya Regency. The type of research used is descriptive correlation with a cross-sectional approach. The total samplings were 95 respondents which used purposive sampling technique. The results of the research were obtained more than half of the respondents 51.6% were given exclusive breastfeeding, and most 65.3% of children under five had stunting. The chi-square calculation results obtained that ρ.value (0,000 <0,05) then H0 is rejected so that there is a relationship between exclusive breastfeeding and the incidence of stunting on toddlers under 5 years in Sukahening Public Health Center, Sukahening Sub district, Tasikmalaya Regency. Performed the health education related to affordable and healthy nutrition so that it can increase the coverage of exclusive breastfeeding and can reduce stunting rates. Keywords : Exclusive breastfeeding, Stunting Bibliography : 25 books (2010-2018) 9 journals (2013-2019) 2 Websites (2010-2017) 

scholarly journals Prevalence of nocturia among community-dwelling adults: a population-based study in Malaysia

BMC Urology ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Hui-Yin Yow ◽  
John Jeh Lung Tiong ◽  
Chun-Wai Mai ◽  
Esther van der Werf ◽  
Zulkifli Md Zainuddin ◽  
...  
Keyword(s):  
Medical Condition ◽  
Population Based ◽  
Community Dwelling ◽  
Medical Attention ◽  
Night Time ◽  
Cross Sectional ◽  
Population Based Study ◽  
Waking Up ◽  
The Impact

Abstract Background Nocturia is widely prevalent condition with detrimental effects on quality of life and general health. In Malaysia, there is a lack of up-to-date prevalence study on nocturia. This study aimed to investigate the prevalence of nocturia and awareness pertaining to nocturia among Malaysian adults. Methods A cross-sectional population-based study was conducted among Malaysian adults aged ≥ 18 years old. The data was collected by mixed mode self-administered questionnaire from May 2019 to September 2019. Nocturia was defined as one or more voids at night. Results There were a total of 4616 respondents with 74.5% of response rate. The overall prevalence of nocturia among Malaysian adults was found to be 57.3%. In multivariate analysis, respondents aged 31–40 (1.91 [1.52–2.40]) or > 60 years old (2.03 [1.48–2.71]), and those who presented with hypertension (2.84 [2.28–3.53]), diabetes mellitus (1.78 [1.42–2.25]), renal disease (3.58 [1.93–6.63]) or overactive bladder (1.61 [1.10–2.35]) were associated with higher prevalence of nocturia. A significantly lower disease prevalence (p < 0.05) was noted among those aged 41–50 (0.73 [0.59–0.91]), male (0.78 [0.69–0.88]) and Chinese (0.47 [0.30–0.74]) or Indian (0.34 [0.21–0.54]) ethnicities. A total of 37.3% of respondents with nocturia reported that they faced sleeping difficulty about half the time or more after waking up in the middle of night. Those who had ≥ 2 voids per night experienced significantly higher mean bother score than those who had 1 void per night (p < 0.001). Approximately half (56.7%) of all respondents were not aware that night time urination is a medical condition. Only 25.2% of respondents with nocturia had sought medical attention for their nocturia. Conclusions The prevalence of nocturia among Malaysian adults is high and strongly influenced by age, sex, race and comorbidities. However, the general awareness pertaining to nocturia being a health issue remains low among Malaysians. The findings also highlighted the impact of nocturia on sleep and the need for nocturia education to better address this disease.

scholarly journals Shift Work and Dry Eye Disease in the Korean Working Population: A Population-Based Cross-Sectional Study

2021 ◽  
Vol 18 (10) ◽  
pp. 5492
Author(s):  
Joonho Ahn ◽  
So-Jung Ryu ◽  
Jihun Song ◽  
Hyoung-Ryoul Kim
Keyword(s):  
Shift Work ◽  
Dry Eye ◽  
Population Based ◽  
Cross Sectional Study ◽  
Dry Eye Disease ◽  
Eye Disease ◽  
Chi Square ◽  
Cross Sectional ◽  
Shift Workers ◽  
Chi Square Test

This study aimed to evaluate the association between shift work and dry eye disease (DED) in the general population. The 2011 Korea Health Panel (KHP) was used. Chi-square test and multivariate logistic regression were used to assess the relationship between shift work and DED. Stratification analysis was conducted by sex and age. Overall, the odds ratio (OR) of DED according to shift work did not showed significant results (adjusted OR = 1.230, 95% CI 0.758–1.901). When findings were stratified based on age older or younger than 40 years, the OR of DED increased to 2.85 (95% CI: 1.25–5.90) in shift workers under 40 years of age. Our results show an association between shift work and DED in a group of younger subjects.

scholarly journals The characteristics and risk factors of human papillomavirus infection: an outpatient population-based study in Changsha, Hunan

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Bingsi Gao ◽  
Yu-Ligh Liou ◽  
Yang Yu ◽  
Lingxiao Zou ◽  
Waixing Li ◽  
...  
Keyword(s):  
Risk Factors ◽  
Protective Factor ◽  
Hpv Infection ◽  
Population Based ◽  
Cross Sectional Study ◽  
Categorical Variables ◽  
Chi Square ◽  
Cross Sectional ◽  
Hpv Dna ◽  
Test Kit

AbstractThis cross-sectional study investigated the characteristics of cervical HPV infection in Changsha area and explored the influence of Candida vaginitis on this infection. From 11 August 2017 to 11 September 2018, 12,628 outpatient participants ranged from 19 to 84 years old were enrolled and analyzed. HPV DNA was amplified and tested by HPV GenoArray Test Kit. The vaginal ecology was detected by microscopic and biochemistry examinations. The diagnosis of Candida vaginitis was based on microscopic examination (spores, and/or hypha) and biochemical testing (galactosidase) for vaginal discharge by experts. Statistical analyses were performed using SAS 9.4. Continuous and categorical variables were analyzed by t-tests and by Chi-square tests, respectively. HPV infection risk factors were analyzed using multivariate logistic regression. Of the total number of participants, 1753 were infected with HPV (13.88%). Females aged ≥ 40 to < 50 years constituted the largest population of HPV-infected females (31.26%). The top 5 HPV subtypes affecting this population of 1753 infected females were the following: HPV-52 (28.01%), HPV-58 (14.83%), CP8304 (11.47%), HPV-53 (10.84%), and HPV-39 (9.64%). Age (OR 1.01; 95% CI 1–1.01; P < 0.05) and alcohol consumption (OR 1.30; 95% CI 1.09–1.56; P < 0.01) were found to be risk factors for HPV infection. However, the presence of Candida in the vaginal flora was found to be a protective factor against HPV infection (OR 0.62; 95% CI 0.48–0.8; P < 0.001). Comparing with our previous study of 2016, we conclude that the subtype distribution of HPV infection is relatively constant in Changsha. Our data suggest a negative correlation between vaginal Candida and HPV, however, more radical HPV management is required in this area for perimenopausal women and those who regularly consume alcohol.

Support for cigarette filter waste policies among US adults

2021 ◽  
pp. tobaccocontrol-2020-056451
Author(s):  
Minal Patel ◽  
Alison F Cuccia ◽  
Shanell Folger ◽  
Adam F Benson ◽  
Donna Vallone ◽  
...  
Keyword(s):  
Smoking Status ◽  
Population Based ◽  
Tobacco Product ◽  
Cross Sectional ◽  
Cigarette Filter ◽  
Logistic Regression Models ◽  
Knowledge And Beliefs ◽  
Cigarette Butts ◽  
Using Data ◽  
The Impact

IntroductionLittle is known on whether cigarette filter-related knowledge or beliefs are associated with support for policies to reduce their environmental impact.MethodsA cross-sectional, population-based sample of US adults aged 18–64 years (n=2979) was used to evaluate filter-related knowledge and beliefs by smoking status using data collected between 24 October 2018 and 17 December 2018. Multivariate logistic regression models explored whether these knowledge and belief items were associated with support for two policies, a US$0.75 litter fee and a ban on sales of filtered cigarettes, controlling for demographic characteristics and smoking status.ResultsRegardless of smoking status, 71% did not know plastic was a cigarette filter component and 20% believed filters were biodegradable. Overall, 23% believed filters reduce health harms and 60% believed filters make it easier to smoke; 90% believed cigarette butts are harmful to the environment. Individuals believing cigarette butts harmed the environment were more likely to support a litter fee (adjusted OR (aOR)=2.33, 95% CI: 1.71 to 3.17). Individuals believing that filters are not biodegradable had higher odds of supporting a litter fee (OR=1.47, 95% CI: 1.15 to 1.88). Respondents believing that filters do not make cigarettes less harmful were more likely to support a litter fee (aOR=1.50, 95% CI: 1.20 to 1.88) and filter ban (aOR=2.03, 95% CI: 1.64 to 2.50). Belief that filters make it easier to smoke was associated with decreased support for a filter ban (aOR=0.69, 95% CI: 0.58 to 0.83).ConclusionsComprehensive efforts are needed to educate the public about the impact of cigarette filters in order to build support for effective tobacco product waste policy.

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