Assessment of Exclusive, Dual, and Polytobacco E-Cigarette Use and COVID-19 Outcomes Among College Students

Purpose This study examined current (past 30-day) dual- and polytobacco use patterns and COVID-19 symptomatology, testing, and diagnosis status among college student electronic cigarette (e-cigarette) users. Design Cross-sectional online questionnaire administered during October–December 2020. Setting Four large, U.S. public universities in geographically diverse locations. Sample College students (N=756) ages 18–24 who reported current e-cigarette use. Measures Current use of e-cigarettes, combustible cigarettes, and cigars, and self-reported COVID-19 symptomatology, testing, and diagnosis status were measured. Analysis Multivariable logistic regression models accounting for students’ demographics, university site, fraternity/sorority membership, and current residence. Results Over half (53.6%) of students were exclusive e-cigarette users, 20.4% were dual e-cigarette and combustible cigarette users, 4.6% were dual e-cigarette and cigar users, and 21.4% were poly users of e-cigarettes, combustible cigarettes, and cigars. Compared to exclusive e-cigarette users, dual users of e-cigarettes and combustible cigarettes (AOR=2.12, 95%CI=1.05–4.27) and poly users of e-cigarettes, combustible cigarettes, and cigars (AOR=3.70, 95%CI=1.78–7.70) had increased odds of COVID-19 symptomatology, even when accounting for covariates. While current tobacco use groups did not differ based on COVID-19 testing, polytobacco users had significantly increased odds (AOR=2.16, 95%CI=1.11–4.20) of having received a positive COVID-19 diagnosis. Conclusion Given use of two or more tobacco products increased COVID-19-related risks, results underscore the need to prevent dual- and polytobacco use behaviors in college student e-cigarette users.

Tobacco Control Measures in Bangladesh: KAP Survey on Informal Tobacco Economy

This research aims to explore the ‘Knowledge, Attitude and Practices (KAP)’ of government’s current tobacco control measures among informal tobacco sellers in Bangladesh. The KAP survey method was applied for collecting information from 400 sellers over seven regional divisions in Bangladesh. The subsequent data analysis was performed using SPSS software to derive the findings from the survey. The study explores that more than half of tobacco sellers are tobacco consumers themselves, of which more than four-fifth consumed tobacco at their Point of Sale (POS). Majority of informal tobacco shops were found in the public places although these sellers reported their acquaintance with the government’s tobacco control Act prohibiting the tobacco usage in such locations. Indirect advertisement was prevalent in about half of those shops. Majority of the sellers used to sell tobacco to minors. About one-fifth of sellers received some form of incentive from tobacco companies while two-third of them received gift items. Since informal tobacco sellers, mostly mobile, reach out the largest pool of consumers making tobacco available near-at-hand, government’s current tobacco control regulations should encompass the informal economy of tobacco sales to prevent massive violation of tobacco control Act by these sellers. Social Science Review, Vol. 37(2), Dec 2020 Page 201-215

Utilization of complementary and traditional medicine practitioners among middle-aged and older adults in India: results of a national survey in 2017–2018

Background Lack of information exists about the use of traditional and complementary medicine (TCM) use among middle-aged and older adults in India, which led to studying the estimates of past-12-month Ayurveda/Yoga/Naturopathy/Unani/Siddha/Homeopathy (AYUSH) practitioner and traditional health practitioner (THP) utilization in India. Methods The study included 72,262 individuals (45 years and older) from the cross-sectional 2017–2018 Longitudinal Ageing Study in India (LASI) Wave 1. Results The prevalence of past 12-month AYUSH practitioner utilization was 6.5%, THP use 7.0%, and AYUSH or THP use 13.0%. The rate of AYUSH practitioner utilization was determined by older age (≥60 years) (Adjusted Odds Ratio-AOR: 1.20, 95% Confidence Interval-CI: 1.07–1.34), having pain (AOR: 1.48, 95% CI: 1.29–1.69), any bone or joint diseases (AOR: 1.57, 95% CI: 1.35–1.82), current tobacco use (AOR: 1.30, 95% CI: 1.12–1.50), male sex (AOR: 0.76, 95% CI: 0.68–0.85), high subjective socioeconomic status (AOR: 0.72, 95% CI: 0.60–0.87), urban residence (AOR: 0.71, 95% CI: 0.57–0.88), diabetes (AOR: 0.66, 95% CI: 0.55–0.81), chronic heart disease (AOR: 0.52, 95% CI: 0.37–0.73), and having a health insurance cover (AOR: 0.36, 95% CI: 0.30–0.44). The rate of THP utilization was determined by depressive symptoms (AOR: 1.17, 95% CI: 1.01–1.35), sleep problems (AOR: 1.28, 95% CI: 1.08–1.51), having pain (AOR: 1.82, 95% CI: 1.55–2.15), current tobacco use (AOR: 1.35, 95% CI: 1.22–1.51), having health insurance cover (AOR: 0.41, 95% CI: 0.33–0.51), hypertension (AOR: 0.82, 95% CI: 0.71–0.95), diabetes (AOR: 0.50, 95% CI: 0.39–0.65), urban residence (AOR: 0.25, 95% CI: 0.19–0.34), and high subjective socioeconomic status (AOR: 0.70, 95% CI: 0.58–0.85). Conclusion A moderate prevalence of AYUSH practitioner and THP use among middle-aged and older adults in India was found and several factors associated with AYUSH practitioner and THP use were identified.

Alcohol use and misuse among school adolescents from national surveys in Saint Lucia and Saint Vincent and the Grenadines in 2018

The study aimed to estimate the prevalence of alcohol use and misuse and associated factors among adolescents in Saint Lucia and Saint Vincent and the Grenadines. Data from 3,847 adolescents (mean age:14.6 years, SD = 1.7) that took part in national cross-sectional school surveys in 2018 in Saint Lucia, and Saint Vincent and the Grenadines were analysed. Students responded in a classroom setting to self-administered questions on substance use and othe variables. The results indicate that 42.7% of the students reported current alcohol use, 27.9% were ever drunk and 11.4% had trouble with alcohol use. In adjusted logistic regression analyses, compared to students from Saint Lucia, students from Saint Vincent and the Granadines had higher odds of trouble from drinking. Older age was associated with current alcohol use and ever drunk but not with trouble from drinking. Severe food insecurity and suicidal ideation were associated with trouble from alcohol use. Current tobacco use and current cannabis use were highly associated with current alcohol use, ever drunk, and trouble with alcohol use, while ever use of amphetamines was associated with ever drunk. School truancy, participation in physical fights, injury, and multiple sexual partners increased the odds, while parental support decreased the odds of current alcohol use, ever drunk, and trouble from alcohol use. In conclusion, high alcohol use and misuse has been identified calling for interventions.

Tobacco 21: Retailer Perceptions, Experiences, and Challenges Before and After a New Minimum Legal Sales Age Law in Maryland

Objectives: By raising the legal age of sale from 18 to 21 years old, Tobacco 21 laws (T21) are reshaping the tobacco landscape in the United States. In 2019, Maryland became the 13th state to adopt T21. This study is among the first to examine the perception, awareness, and ease of compliance of T21 among tobacco retailers through a two-wave survey conducted pre-T21 and post-T21. Design: Surveys were conducted among the states more than 6,000 registered retailers prior to the states T21 law going into effect and eight months later after T21 had been enacted. The pre-T21 and post-T21 survey instruments measured retailer awareness, support, and perceived ability to comply with T21, current tobacco practices, revenue from tobacco products, and challenges faced in compliance. 414 retailers completed the pre-T21 survey and 360 completed the post-T21 survey. The final survey data was weighted to reflect the geographic distributions of licensed tobacco retailers in Maryland. Results: There was no significant difference in retailer awareness, support and challenges comparing pre and post T21. One notable caveat is lack of consumer knowledge about T21, resulting in retailers being responsible for educating customers. Conclusions: The evaluation of T21 and impact to retailers is a valuable tool in determining the laws success and barriers to implementation. Results support the idea that T21 laws have had a minor impact on how retailers conduct their business. As a result of the communication and materials provided by the state, retailers largely understand the law and how to adhere to guidelines.

Smoking habits and the influence of war on cigarette and shisha smoking in Syria

Tobacco smoking might be impacted by various influences, including psychological, socio-cultural, and economic factors. A community-based cross-sectional survey was conducted in Syrian Arab Republic from March to April 2019 using a web-based questionnaire. The survey aimed at assessing tobacco use (shisha and cigarettes) as well as examining the association between current tobacco use and various sociodemographic and war-related factors. The sample comprised 978 participants (251 males: 727 females) and had a mean age of 24.7 years (SD: 7.60). Most participants were single (n = 825, 84.4%), reside in Damascus and Rif-Dimashq (n = 579, 59.2%), and had a college/university education (n = 911, 93.1%). Concerning smoking, a total of 371 participants (37.9%) were identified to be current tobacco smokers, of whom 211, 84, 76 were exclusive shisha smokers, exclusive cigarette smokers, and dual smokers, respectively. The prevalence of cigarette smoking (exclusive and dual) among males and females was found to be 34.7%, and 10.0%, respectively. On the other hand, the prevalence of shisha smoking (exclusive and dual) among males and females was around 34.3% and 27.6%, respectively. Additionally, various factors have predicted a higher likelihood of cigarette smoking including male gender (AOR = 4.152; 95% CI: 2.842–6.064; p<0.001), and losing someone due to the war (AOR = 1.487; 95% CI: 1.028–2.151; p = 0.035), while unemployed individuals were found to have lower odds of being cigarette smokers (AOR = 0.634; 95% CI: 0.429–0.937; p = 0.022). Concerning shisha smoking, married (AOR = 0.622; 95% CI: 0.402–0.963; p = 0.033), and unemployed individuals (AOR = 0.679; 95% CI: 0.503–0.916; p = 0.011) were found to have lower odds of shisha smoking. Amid the tobacco epidemic in the region, rates of tobacco use in Syria are still worrying. The Syrian armed conflicts may possess a double-edged effect on smoking, and tobacco users who adopt smoking to cope with various stressors should be targeted with well-structured health education, along with appropriate psychological services.

1392Decline in current tobacco use and socio-economic inequalities in 22 Sub-Saharan African countries- 2003-2018

Background Tobacco companies have shifted their marketing and production to Sub-Saharan African countries which are in an early stage of tobacco epidemic. We report changes in current tobacco use and socio-economic inequalities between 2003 and 2019. Methods We estimated country-level, sex-wise, age-standardized prevalence estimates of current tobacco use in 22 SSA countries using sequential Demographic and Health Survey data. On pooled baseline (2003-11) and most recent survey (2011-19) data, prevalence by education, wealth, and age groups; Slope index of inequality and relative index of inequality were estimated. Change in prevalence in each country and by socio-economic subgroups and change in socio-economic inequalities (pooled data) were calculated. Results Tobacco use among men ranging [6·1% (Ghana) to 38·3 (Lesotho)] at baseline and [4·5% (Ghana) to 46·0% (Lesotho)] most recent surveys. Decline in prevalence points ranged from 1·5% (Ghana) to 9·6% (Sierra Leone). For women countries where prevalence was &lt;1% rose from nine to 15. In most countries prevalence of current tobacco use significantly declined. WHO target of 30% decline was achieved in 15 and 10 countries for women and men, respectively. In both sexes, tobacco use rate and decline were higher among less educated and poor while magnitude and direction of inequalities were consistently declined. Absolute inequalities three-fold higher among men, while relative inequalities were nearly twice higher among women. Conclusions Tobacco use declined in a third of SSA countries. Persistence of socio-economic inequalities warrants stricter implementation of tobacco control measures to reach the vulnerable groups and continued monitoring of inequalities. Key messages Contrary to the projections, tobacco use had significantly declined in most of the countries, and many achieved the WHO target of 30% reduction. Country-level monitoring by regular surveys is needed to track the equitable progress to international goals.

Current Tobacco Use and Susceptibility To Using Tobacco Among Non-Users of Tobacco: A Cross-Sectional Study Among School-Going Adolescents in Sierra Leone

Background Tobacco use is a global health threat associated with a high disease burden and deaths. Studies concerning current tobacco use and susceptibility to using tobacco products among adolescents who are potential adult tobacco users in Sierra Leone have not been explored. We aimed to estimate the prevalence and correlates of current tobacco use and tobacco non-users susceptibility to using tobacco amongst Sierra Leonean high-school students. Method We used data obtained from the 2017 Sierra Leone Global Youth Tobacco Survey (GYTS), which presented information collected from 6680 students aged 11-17years nationwide. Gender-based correlates of current use and susceptibility to using tobacco among non-tobacco users were determined by complex sample logistic regression analyses. Adjusted odds ratios (AOR) and respective 95% confidence intervals (CIs) were reported. p-values less than 0.005 were considered significant. Results The prevalence of current tobacco use among high school adolescents in Sierra Leone was 10.7% and was higher in males (12.2%) than in females (7.4%). Male [AOR = 1.32 (95%CI:1.01–1.72)], exposure to household secondhand smoke [AOR = 2.68(95%CI:1.71–4.20)], having peers who smoke [AOR = 3.07(1.53–6.16)] were more likely to be currently using tobacco. On the other hand, adolescents exposed to antismoking media messages were less likely to be current tobacco users [AOR = 0.45(95%CI: 0.24–0.83)]. The overall tobacco non-users susceptibility to using tobacco among adolescents in Sierra Leone was 18.2% [male (18.0%), female (18.5%)]. Exposure to tobacco promotion [AOR = 1.50(95%CI:1.07–2.11)] and non-exposure to antismoking education [AOR = 1.39(95%CI:1.04–1.85)] were significantly associated with tobacco non-users’ susceptibility to using tobacco. Conclusion Our study suggests that one-in-ten school-going adolescents currently use tobacco, with nearly one in five non-users susceptible to using tobacco. Given the high prevalence of tobacco product use among Sierra Leonean adults, our findings highlight the need for policies and interventions to prevent tobacco use behaviour among adolescents aimed at averting tobacco use in adulthood.

Behavioral impact of national health campaigns on healthy lifestyle practices among young adults in Singapore: a cross-sectional study

Background National health campaigns are often used to improve lifestyle behaviors in the general population. However, evidence specifically in the young adult population is scarce. Given the general deterioration of healthy lifestyle practices from adolescence to young adulthood, it is imperative to study this age group. This study aimed to investigate the behavioral impact of a national health campaign in Singapore on the lifestyle practices of young adults, and whether sex or full-time working and schooling status affected lifestyle practices. Methods A total of 594 Singaporean respondents aged 18–39 years old were interviewed via a cross-sectional study in December 2019. Lifestyle practices assessed were diet, exercise, alcohol consumption, current tobacco use, and participation in health screening programs. Other factors investigated included exposure to the national health campaign “War on Diabetes” (WoD), sex, ethnicity, and working/schooling status. Multivariable modified Breslow-Cox proportional hazards models were used to estimate prevalence risk ratios (PRRs) as measures for the associations in this study, after adjusting for potential confounders. Results Exposure to the WoD campaign had a significant association with meeting dietary recommendations (PRR = 1.6, 95% CI: 1.0–2.5, p = 0.037), participation in screening (PRR = 1.2, 95% CI: 1.0–1.5, p = 0.028), and current tobacco use (PRR = 0.5, 95% CI: 0.3–0.8, p = 0.003). Males were significantly more likely to meet exercise recommendations (PRR = 2.0, 95% CI: 1.5–2.7, p < 0.001), currently use tobacco (PRR = 3.9, 95% CI: 2.2–6.9, p < 0.001), and consume alcohol excessively (PRR = 1.5, 95% CI: 1.0–2.3, p = 0.046), as compared to females. Working young adults were significantly less likely to meet exercise recommendations (PRR = 0.7, 95% CI: 0.5–0.9, p = 0.019) but significantly more likely to be current tobacco users (PRR = 1.8, 95% CI: 1.1–3.1, p = 0.024), as compared to those who were in school. Conclusions While this paper affirms that national health campaigns have significant beneficial associations in diet, health screenings and current tobacco use, policymakers should acknowledge that young adults are an age group with different influences that impact their healthy lifestyle habits. Specific interventions that target these subgroups may be required for better health outcomes. Future studies should evaluate other socio-environmental factors that could play a role in modifying the effect of health campaigns among young adults.

Hypomethylation of AHRR (cg05575921) Is Related to Smoking Status in the Mexican Mestizo Population

Tobacco smoking results in a multifactorial disease involving environmental and genetic factors; epigenome-wide association studies (EWAS) show changes in DNA methylation levels due to cigarette consumption, partially reversible upon tobacco smoking cessation. Therefore, methylation levels could predict smoking status. This study aimed to evaluate the DNA methylation level of cg05575921 (AHRR) and cg23771366 (PRSS23) and their correlation with lung function variables, cigarette consumption, and nicotine addiction in the Mexican smoking population. We included 114 non-smokers (NS) and 102 current tobacco smokers (TS); we then further subclassified them as heavy smokers (HS) (n = 53) and light smokers (LS) (n = 49). We used restriction enzymes (MspI/HpaII) and qPCR to determine the DNA methylation level. We observed significant hypomethylation of cg05575921 in smokers compared to NS (p = 0.003); further analysis found a difference between HS and NS (p = 0.02). We did not observe differences between other groups or a positive correlation between methylation levels and age, BMI, cigarette consumption, nicotine addiction, or lung function. In conclusion, the cg05575921 site of AHRR is significantly hypomethylated in Mexican smokers, especially in HS (≥20 cigarettes per day).