U.K. general practitioners' beliefs, attitudes, and reported prescribing of nicotine replacement therapy in pregnancy.

Clinical guidelines recommend that U.K. health professionals prescribe NRT in pregnancy. The present study was conducted to determine (a) general practitioners' confidence in their ability to deliver a range of smoking cessation interventions, including NRT, in pregnancy, (b) the frequency with which general practitioners recall prescribing NRT in pregnancy, and (c) the factors that influence general practitioners to prescribe NRT in pregnancy. We conducted a mail survey of 368 general practitioners (family physicians) working in four districts of Nottingham, England (response rate = 68.6%). Some 27.1% of respondents recalled prescribing NRT to pregnant women (9.2% were unsure). General practitioners were less confident about their ability to prescribe NRT in pregnancy than they were of their ability to deliver other simple smoking cessation interventions in pregnancy. Most general practitioners (62%) believed NRT to be effective in pregnancy and safer than smoking (70%), but fewer (45%) believed NRT to be safe in pregnancy per se. Multiple logistic regression demonstrated that general practitioners who believed NRT use in pregnancy was safer than smoking were most likely to recall having prescribed it, OR = 4.94, 95% CI = 1.31-18.71. Many general practitioners were unsure about the safety of NRT in pregnancy, which may explain their relatively low confidence in their ability to prescribe NRT in pregnancy, compared with other interventions. The key factor influencing general practitioners' prescribing decisions was a belief that NRT use in pregnancy was likely to be safer than smoking. Empirical evidence about the safety and efficacy of NRT use in pregnancy is required to inform general practitioners' decisions about prescribing NRT to pregnant women who smoke.     

Waterpipe smoking: construction and validation of the Lebanon Waterpipe Dependence Scale (LWDS-11).

Waterpipe smoking is becoming fashionable in Lebanon, but no studies have studied nicotine dependence related to waterpipe smoking. A score was constructed from 21 items and subsequently submitted to two factor analyses, which led to the extraction of four factors. Reliability and test-retest reproducibility were measured. Convergent construct validity and discriminant validity also were assessed for different smokers' samples. The Lebanon Waterpipe Dependence Scale-11 (LWDS-11) was composed of four subscales, the first representing nicotine dependence, the second negative reinforcement, the third psychological craving, and the fourth positive reinforcement. Internal consistency and test-retest reproducibility were adequate, and the subscales correlated adequately with measurements of nicotine metabolites, exhaled carbon monoxide levels, and the frequency of waterpipe smoking. The LWDS-11 discriminated between mild, moderate, and heavy waterpipe smokers, based on a threshold score of 10. Results were biologically and psychologically sound. This is the first scale to characterize waterpipe dependence. With further improvement and confirmation, it could become a useful clinical and epidemiological tool.     

Food handlers and foodborne diseases: knowledge, attitudes, and reported behavior in Italy

The purpose of this study was to evaluate knowledge, attitudes, and behavior concerning foodborne diseases and food safety issues among food handlers in Italy. Face-to-face interviews were conducted within a random sample using a structured questionnaire. Of the 411 food handlers responding, 48.7% knew the main foodborne pathogens (Salmonella spp., Staphylococcus aureus, Vibrio cholerae or other Vibrio spp., Clostridium botulinum, hepatitis A virus), and this knowledge was significantly greater among those with a higher education level, in practice from a longer period of time, and who had attended education courses (P < 0.05). A vast majority (90.4%) correctly indicated those foods classified as common vehicles for foodborne diseases, and only 7.1% of food handlers were able to name five different food vehicles, each of which transmit one of the five pathogens. The proportion of those who were able to specify a food vehicle that transmitted hepatitis A virus was significantly higher for those with a higher educational level and with a longer food-handling activity. A positive attitude toward foodborne diseases control and preventive measures was reported by the great majority of food handlers, and it was more likely achieved by those who had attended education courses. This attitude was not supported by some of the self-reported safe practices observed for hygienic principles, because only 20.8% used gloves when touching unwrapped raw food, and predictors of their use were educational level and attending education courses. Results strongly emphasize the need for educational programs for improving knowledge and control foodborne diseases.     

Waterpipe smoking and nicotine exposure: a review of the current evidence.

The waterpipe, also known as shisha, hookah, narghile, goza, and hubble bubble, has long been used for tobacco consumption in the Middle East, India, and parts of Asia, and more recently has been introduced into the smokeless tobacco market in western nations. We reviewed the published literature on waterpipe use to estimate daily nicotine exposure among adult waterpipe smokers. We identified six recent studies that measured the nicotine or cotinine levels associated with waterpipe smoking in four countries (Lebanon, Jordan, Kuwait, and India). Four of these studies directly measured nicotine or cotinine levels in human subjects. The remaining two studies used smoking machines to measure the nicotine yield in smoking condensate produced by the waterpipe. Meta-analysis of the human data indicated that daily use of the waterpipe produced a 24-hr urinary cotinine level of 0.785 microg/ml (95% CI = 0.578-0.991 microg/ml), a nicotine absorption rate equivalent to smoking 10 cigarettes/day (95% CI = 7-13 cigarettes/day). Even among subjects who were not daily waterpipe smokers, a single session of waterpipe use produced a urinary cotinine level that was equivalent to smoking two cigarettes in one day. Estimates of the nicotine produced by waterpipe use can vary because of burn temperature, type of tobacco, waterpipe design, individual smoking pattern, and duration of the waterpipe smoking habit. Our quantitative synthesis of the limited human data from four nations indicates that daily use of waterpipes produces nicotine absorption of a magnitude similar to that produced by daily cigarette use.     

Western media's influence on Egyptian adolescents' smoking behavior: the mediating role of positive beliefs about smoking.

Western media has been implicated as an adolescent smoking risk factor in numerous Western studies, but little research has investigated that influence on adolescents from developing Arab countries. One such country is Egypt, which has the highest rate of smoking in the Arab world. An estimated 34% of Egyptians are daily smokers, 4% of whom are under the age 15 years and 0.6% of whom are under the age 10. The present study investigated the association between exposure and receptivity to Western media, positive beliefs about smoking, and Egyptian adolescents' smoking behavior. A school-based cross-sectional survey of 1,930 Egyptian adolescents in 7th, 9th, and 12th grades, from randomly selected schools in Alexandria, Egypt, was conducted in May 2003. Self-reported smoking behaviors, demographics, psychosocial factors, and exposure to Western and pro-tobacco media were assessed. Controlling for demographics, psychosocial smoking risk factors, and pro-tobacco media exposure, we found that Western media exposure was positively associated with ever-smoking across genders and 30-day smoking among adolescent males only. Positive beliefs about smoking partially mediated this association among ever-smokers and completely mediated it among 30-day male smokers. The results indicate that the influence of Western media on Egyptian adolescents' smoking behavior is at least partially mediated by its influence in increasing adolescents' positive beliefs about smoking and consequently their smoking behavior. Regulation of the glamorization of smoking behavior in Western media and correction of the erroneous perception of positive beliefs about smoking among adolescents is necessary to help curb the rising smoking epidemic in Egypt.     

Smoking behavior, knowledge, attitudes and practice among health care providers in Changsha city, China.

With the smoking epidemic in China, the role that health care providers (HCPs) could play in tobacco control will be critical. As a preliminary step, this study identified smoking behavior, knowledge, attitudes, and practice (KAP) regarding smoking and smoking control among HCPs in Changsha city, China. The study design was cross-sectional. The instruments - Demographic Information Scale and KAP Scale - were distributed to 420 physicians and 400 nurses in four hospitals in Changsha city. The effective response rate was 77.56% (636/820). Among the respondents, 20.8% were current smokers, which represented 35.7% of the physicians and 1.4% of the nurses, and 43.0% of the males and 1.2% of the females. The mean knowledge score was 22.3+/-4.4 (n = 30). Knowledge regarding smoking's harmful effects and smoking-related respiratory system diseases was high. Nonetheless, tobacco addiction was underestimated. The mean attitudes and practice score was 17.7+/-2.3, 15.1+/-3.4 (n = 20). Eighty-seven percent approved their role in smoking control, but only 45% HCPs practically informed patients about methods of smoking cessation. Smoking behavior was negatively associated with KAP, and 59.7% of the HCPs thought that inadequate knowledge affected their practice. In conclusion, HCPs had some knowledge and positive attitudes regarding the cessation of smoking, but were relatively unoptimistic regarding putting smoking control into practice. The high smoking rate among male HCPs and knowledge insufficiency about smoking may pose barriers in tobacco control efforts for HCPs. As such, interventions for the cessation of smoking, and continual education on smoking control for HCPs, are indicated in China.     

Consumers and foodborne diseases: knowledge, attitudes and reported behavior in one region of Italy

A survey was conducted to investigate knowledge, attitudes and related behavior on foodborne diseases and food-handling practices among consumers in one region of Italy. A self-administered questionnaire was offered to a random sample of mothers of children attending public schools. Of the 394 responding mothers, 36% knew about all the six foodborne pathogens investigated but only 11.1% correctly indicated six related different food vehicles; education level was a predictor of this knowledge. A positive attitude towards foodborne disease control, significantly higher in older and more educated women, was reported by the great majority, who agreed that improper storage of food represents a health hazard (95.7%), that washing hands before handling unwrapped raw or cooked food reduces the risk of food poisoning (93.2%), and that the awareness of the temperature of the refrigerator is crucial in reducing risk of food poisoning (90.1%). Only 53.9% reported washing hands before and after touching raw or unwrapped food and 50.4% reported using soap to wash hands. A total of 75.6% clean kitchen benches after every use and 81.1% use hot water and soap for this purpose. Only 25.6% thaw food in the refrigerator and 49.9% put leftovers in the refrigerator soon after meals. Washing hands before and after touching unwrapped food was significantly higher in women living in larger families and who had been informed by physicians about foodborne diseases. Educational programs and the counseling efforts of physicians, particularly focused to less educated subjects, are greatly needed.     

Smoking behavior among hospital staff still influences attitudes and counseling on smoking.

Smoking among health professionals has been shown to influence smoking-related knowledge and counseling in clinical practice. The evidence regarding smoking as a risk factor has increased in the past decade. The present study was carried out in 2000 and investigated the associations between individual smoking behavior among hospital staff and (a). smoking-related knowledge, (b). attitudes toward counseling on smoking, and (c). self-reported smoking-related counseling provided by the staff. The study was based on a survey using self-administered questionnaires given to all hospital staff in a large university hospital in Denmark. Altogether, 82% of staff (2561) returned a completed questionnaire. Analyses focused on a subsample consisting of health professionals in the clinical wards (1429). Multivariate analyses were performed in which smoking-related knowledge, attitudes toward smoking-related counseling, smoking-related counseling practices, and self-rated qualifications for counseling were main outcome measures. Health professionals who were current smokers systematically underestimated the health consequences of smoking and differed significantly from nonsmokers in their assessments of smoking as a risk factor. Nonsmokers might overestimate smoking as a risk factor. Nonsmokers gave patients advice on smoking cessation significantly more often than did current smokers (ex-smokers, OR=2.5, 95% CI=1.8-3.4; never-smokers, OR=1.5, 95% CI=1.1-2.0). Ex-smokers and smokers felt significantly more qualified to counsel patients about smoking than did never-smokers (ex-smokers, OR=1.8, 95% CI=1.3-2.5; smokers, OR=1.4, 95% CI=1.0-1.9). Individual smoking behavior among hospital staff was strongly associated with smoking-related knowledge, attitudes, and counseling practices. Lack of self-rated qualifications was a major barrier to professional counseling on smoking in a hospital framework.     

Smoking in Ecuador: prevalence, knowledge, and attitudes

OBJECTIVE: To evaluate the prevalence of, attitudes towards, and knowledge about cigarette smoking in Ecuador in 1991. DESIGN: Survey using in-person interviews; stratified and multiple regression analyses. SUBJECTS AND SETTING: Eight hundred people (> or = 18 years old) representative of the adult populations in the cities of Quito and Guayaquil, Ecuador. MAIN OUTCOME MEASURES: Smoking prevalence, daily cigarette consumption, reasons for smoking, desire to quit smoking, knowledge about the health effects of smoking. RESULTS: About a third of the population in the two major cities of Ecuador are cigarette smokers. Men are not only more likely to be smokers than women (45% vs 17%, respectively), but when they do smoke, they also smoke significantly more cigarettes per day (60% more) than women. Cigarette smoking appears to be more common among younger populations, and among more educated people. Housekeepers are significantly less likely to be smokers compared with people in other occupations. About 80% of smokers consume fewer than 10 cigarettes per day. In Quito, a 40% increase in the number of cigarettes smoked per day on weekdays compared with weekends suggests an effect of the environment on smoking patterns. About 60% of smokers stated their desire to quit smoking, and there was almost universal knowledge about the harmful effects of cigarette smoking on the health of active and passive smokers. CONCLUSIONS: About a third of the population in the two major cities of Ecuador reported smoking cigarettes. Smoking is more common among men, those of younger age, and the more educated. The findings in this study should help the development of antismoking policies in Ecuador and other countries in the region.




     

Initial impact of the new Australian tobacco health warnings on knowledge and beliefs

BACKGROUND: New health warnings and contents labelling on tobacco products were introduced in Australia in 1995. OBJECTIVE: To assess awareness of the new warnings at a time when a mix of packs with old and new warnings were being sold and on changes in relevant knowledge and attitudes from shortly before the implementation of the new warnings. DESIGN AND SUBJECTS: Approximately 500 smokers and 500 non- smokers were surveyed in December 1994, before implementation of the new warnings. Similar numbers were also surveyed in May 1995, part-way through implementation. Respondents were selected by random-digit dialling of telephone numbers in Australia. Smokers were oversampled. In addition, 243 smokers from the initial survey were re-surveyed in May 1995. MAIN OUTCOME MEASURES: Awareness of change to health warnings, knowledge of health warnings and tobacco smoke constituents, beliefs about the health effects of smoking, and perceived impact of the warnings. RESULTS: There was high awareness of the new warnings, particularly among smokers, with the increased size of the new warnings being the most salient feature. More than a third of smokers reported being affected by the warnings, with reductions in consumption and talking about warnings being the most common effects. Among smokers, there was an increase in knowledge about the main constituents of tobacco smoke. The number of types of health effects mentioned also increased as did the number of warnings correctly recalled. Overall beliefs about the six warning statements became stronger. Few changes were found for non-smokers. The knowledge and recall effects were replicated in the re-contact subsample, but the belief changes were not. CONCLUSIONS: These results suggest the new health warnings are resulting in better informed smokers and thus suggest that informative health warnings can play an important role in better informing consumers.


     

Changes of knowledge, attitudes, beliefs, and preference of bar owner and staff in response to a smoke-free bar law

Design: Bar owners and staff were random selected and telephone interviewed in June 1998, shortly after a smoke-free bar law was enacted, and October 2002. Similar instruments were used in both surveys to collect data on attitudes related to secondhand smoke (SHS) and behaviours related to the smoke-free bar law.

Participants: 651 and 650 respondents worked for either stand alone bars or combination bars.

Measures: Preference of working in a smoke-free environment, concerns of the effect of SHS, and how to comply with the law.

Results: The percentage of bar owners or staff working in stand alone bars who prefer to work in a smoke-free environment increased from 17.3% in 1998 to 50.9% in 2002 (p < 0.001). Significantly more respondents (45.5%) working in stand alone bars were concerned about the effects of SHS on their health, comparing to 21.6% in 1998 (p < 0.001). When patrons smoked in the bar, 82.1% of stand alone bar owners or staff in the 2002 survey would ask them to stop or to smoke outside, increased from only 43.0% in the 1998 survey (p < 0.001).

Conclusion: A positive and significant attitudinal change related to the smoke-free bar law occurred among California bars.

     

Rural adolescent attitudes toward smoking and weight loss: relationship to smoking status.

Perceptions that smoking contributes to weight loss are widespread among youth. We examined the association between weight loss and smoking to determine whether supportive attitudes were associated with smoking status and whether this is a particular problem in rural areas. High school students (N=730) completed a survey assessing smoking-related characteristics and behaviors. Attitudes assessed included perceptions of whether weight concerns were the reasons others smoke and personal beliefs about tobacco's effect on weight gain. Smoking status was categorized as never (44%), experimental (42%), and current (14%). Multinomial logistic regressions investigated relationships between attitudes and smoking, adjusting for weight goals, gender, ethnicity, parent/peer smoking, and body mass index. Both attitudinal measures were associated with smoking (p< .05). Nonsmokers and experimental smokers were more likely than current smokers to believe that people smoke to lose weight. Although current smokers were less likely to report that others smoke for weight control, they believed they would gain weight if they quit. Conversely, nonsmokers and experimental smokers were less likely to believe they would gain weight if they do not smoke compared with current smokers. Thus personal attitudes differ from attitudes toward others with respect to weight loss and smoking. Moreover, endorsement of these attitudes can reliably distinguish current versus experimental smokers and may help better clarify the transition to current smoker. Because weight concerns are a significant factor in youth smoking, these issues should be included in intervention efforts, particularly in rural communities where smoking rates are higher and age at initiation is earlier.     

美国肯塔基白肋烟生产过程中的保护耕作法应用进展

肯塔基大学长期以来一直在研究并推动中耕作物生产的保护耕作法。肯塔基的农民是世界上接受保护耕作大规模种植玉米和大豆的首批农户之一。保护耕作用于白肋烟生产的研究始于二十世纪七十年代早期,但此前烟农的兴趣始终不高。烟农不愿放弃传统的耕作方式,缺乏合适的移植机技术,对于控制杂草的担忧以及更多的是近来对于未来生产水平的不确定性使得采用保护耕作的进展减缓。二十世纪九十年代中期关于烟草的保护耕作研究再度恢复,引发了关于移植机,杂草控制的新概念的产生,包括作物的管理。本文将以一个个独立的研究结果演示考虑采用保护耕作的…     

The relationship of smoking cessation to sociodemographic characteristics, smoking intensity, and tobacco control policies.

The present study examined the relationship between recent smoking cessation activities and sociodemographic characteristics, smoking intensity, and tobacco control policies among daily smokers in the United States. The study used the U.S. Current Population Survey 1998-1999 Tobacco Use Supplement, supplemented with information on state-level tobacco control policies. The sample was limited to individuals aged 25 years or older who were smoking daily 1 year ago. We estimated frequencies and multivariate logistic equations for making a quit attempt and remaining abstinent at least 3 months. These measures were related to demographic characteristics, smoking intensity, and tobacco control policies. Younger, higher socioeconomic status (SES), and less intense (fewer cigarettes per day) daily smokers were more likely to make quit attempts, but the likelihood of remaining abstinent for those making a quit attempt was greater for older, higher SES, and heavy daily smokers. We found evidence that cessation behaviors were related to higher cigarette prices and the presence of state-level media/comprehensive campaigns, but less clear evidence exists for an association with bans restricting workplace smoking. The results indicate that certain types of smokers are more likely to attempt to quit and to have success and that the characteristics of these smokers differ. Price policies can have an important role in helping daily smokers to quit. Further research is needed regarding the role of quantity smoked.     

Contribution of occupational factors to current smoking among active-duty U.S. Navy careerists.

Rates of cigarette smoking among active-duty U.S. military personnel remain elevated, ranging from 23% among Air Force personnel to 38% among Army personnel. The purpose of this study was to estimate the contribution of occupational factors to current smoking and heavy smoking among a sample of Navy careerists (those with at least 7 years of military service), and to determine if gender moderates these associations. Participants in the study (n = 2,922) were randomly recruited within over-sampled strata of women and racial/ethnic minorities, and voluntarily completed confidential self-administered questionnaires on drinking, smoking, demographic, and occupational factors during 2001-2002. Approximately 23% of study participants reported current smoking; 9% reported heavy smoking. Multivariate logistic regression models were developed to estimate the contribution of occupational factors to current smoking and heavy smoking. The results indicated that careerists in the enlisted ranks were significantly more likely to be current smokers and heavy smokers compared with careerist officers. In addition, those who were deployed at sea were significantly more likely to report current smoking compared with those not currently deployed at sea. Mean daily ounces of alcohol were also significantly associated with likelihood of current and heavy smoking. Gender did not modify the association between occupational factors and smoking. Because aspects of the work environment are potentially modifiable, understanding the role of occupational factors vis-à-vis smoking can aid in smoking prevention and cessation efforts within the military.