Attitudes & behaviors toward the management of tobacco smoking patients: qualitative study with French primary care physicians

Background Smoking cessation is a major public health issue. In France, primary care physicians (PCP) are the first contact points for tobacco management. The objective of this study was to understand how PCPs are involved in the management of smoking cessation: ownership, commitment, barriers. Methods A qualitative study was conducted using group and individual semi-structured techniques with PCPs. A thematic analysis of verbatim transcripts was performed to identify concepts and sub-concepts of interest. Saturation was evaluated retrospectively to ensure adequate sample size. Results A sample of 35 PCPs were interviewed, 31 in four focus groups and four in individual interviews. PCPs discussed their roles in the management of tobacco smoking cessation, including the different strategies they are using (e.g., Minimal Intervention Strategy, Motivational Interviewing), the multiple barriers encountered (e.g., lack of time, patients’ resistance to medical advice), the support resources and the treatment and intervention they prescribed (e.g. nicotine replacement therapy, supporting therapist). Conclusions This study provides a better understanding of the beliefs, attitudes, and behaviors of PCPs in managing smoking cessation. Guiding and encouraging patients toward smoking cessation remains a major objective of PCPs. While PCPs reported that progress has been made in recent years in terms of tools, technology and general awareness, they still face major barriers, some of which could be overcome by appropriate training.

Joint effect of particulate matter and cigarette smoke on women’s sex hormones

Background Although relationships between exposure to air pollution and reproductive health are broadly studied, mechanisms behind these phenomena are still unknown. The aim of the study was to assess whether exposure to particulate matter (PM10) and tobacco smoking have an impact on menstrual profiles of 17β-estradiol (E2) and progesterone (P) and the E2/P ratio. Methods Levels of sex hormones were measured daily in saliva during the entire menstrual cycle among 132 healthy, urban women. Exposure to smoking (active or passive) was assessed by questionnaire, whilst exposure to PM10 with municipal monitoring data. Results During the early luteal phase, profiles of E2 were elevated among women with higher versus lower exposure to PM10 (p = 0.02, post-hoc tests). Among those who were exposed versus unexposed to tobacco smoking, the levels of mean E2 measured during the entire cycle were higher (p = 0.02). The difference in mean E2 levels between the group of joint exposure (i.e. to high PM10 and passive or active smoking) versus the reference group (low PM10, no smoking) was statistically significant at p = 0.03 (18.4 vs. 12.4 pmol/l, respectively). The E2/P ratios were higher among women with higher versus lower exposure to PM10 and this difference was seen only in the early luteal phase (p = 0.01, exploratory post-hoc tests). Conclusions We found that PM10 and tobacco smoking affect ovarian hormones independently and do not interact with each other. Both exposures appear to have estrogenic effects even though women's susceptibility to these effects differs across the menstrual cycle. We propose that the hormonal mechanisms are involved in observed relationships between air pollution and smoking with women’s reproductive health.

Disputes over the permissibility of tobacco smoking among the ulama of Ottoman Syria

The article analyzes the history of tobacco smoking in Great Syria of the 17th - mid-18th centuries. The consumption of tobacco, brought to the Ottoman Empire by European merchants from the New World, began to spread rapidly among various groups of society, including women and children. The popularity of the new habit caused a wary attitude to it of the Ottoman theologians from the Turkish Kadizadeli movement. In the middle of the 17th century, they managed to achieve significant influence on the sultans court and banned tobacco smoking in the Ottoman Empire for a while. However, after the unsuccessful military campaign of the Turks initiated by the Kadizadeli near Vienna in 1683, the Hanafi Puritans of Islam were expelled from the capital. This time, they chose Greater Syria as one of the main strongholds of the movement. In Damascus, the question of the legality of tobacco smoking from the point of view of the norms of Islamic law was defended by Sufis under the leadership of the Syrian mystic ʻAbd al-Ghani al-Nablusi. As a result of the disputes, the Kadizadeli lost their influence in Syria, which partly contributed to the further rejection by the inhabitants of the region of another Puritanical movement in Islam, led by Muhammad ibn ʻAbd al-Wahhab.