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Educational and wealth inequalities in tobacco use among men and women in 54 low-income and middle-income countries

Sreeramareddy CT, Harper S, Ernstsen L

Tob Control, 2018 01;27(1):26-34.
PMID: 27885168 DOI: 10.1136/tobaccocontrol-2016-053266

BACKGROUND: Socioeconomic differentials of tobacco smoking in high-income countries are well described. However, studies to support health policies and place monitoring systems to tackle socioeconomic inequalities in smoking and smokeless tobacco use common in low-and-middle-income countries (LMICs) are seldom reported. We aimed to describe, sex-wise, educational and wealth-related inequalities in tobacco use in LMICs.
METHODS: We analysed Demographic and Health Survey data on tobacco use collected from large nationally representative samples of men and women in 54 LMICs. We estimated the weighted prevalence of any current tobacco use (including smokeless tobacco) in each country for 4 educational groups and 4 wealth groups. We calculated absolute and relative measures of inequality, that is, the slope index of inequality (SII) and relative index of inequality (RII), which take into account the distribution of prevalence across all education and wealth groups and account for population size. We also calculated the aggregate SII and RII for low-income (LIC), lower-middle-income (lMIC) and upper-middle-income (uMIC) countries as per World Bank classification.
FINDINGS: Male tobacco use was highest in Bangladesh (70.3%) and lowest in Sao Tome (7.4%), whereas female tobacco use was highest in Madagascar (21%) and lowest in Tajikistan (0.22%). Among men, educational inequalities varied widely between countries, but aggregate RII and SII showed an inverse trend by country wealth groups. RII was 3.61 (95% CI 2.83 to 4.61) in LICs, 1.99 (95% CI 1.66 to 2.38) in lMIC and 1.82 (95% CI 1.24 to 2.67) in uMIC. Wealth inequalities among men varied less between countries, but RII and SII showed an inverse pattern where RII was 2.43 (95% CI 2.05 to 2.88) in LICs, 1.84 (95% CI 1.54 to 2.21) in lMICs and 1.67 (95% CI 1.15 to 2.42) in uMICs. For educational inequalities among women, the RII varied much more than SII varied between the countries, and the aggregate RII was 14.49 (95% CI 8.87 to 23.68) in LICs, 3.05 (95% CI 1.44 to 6.47) in lMIC and 1.58 (95% CI 0.33 to 7.56) in uMIC. Wealth inequalities among women showed a pattern similar to that of men: the RII was 5.88 (95% CI 3.91 to 8.85) in LICs, 1.76 (95% CI 0.80 to 3.85) in lMIC and 0.39 (95% CI 0.09 to 1.64) in uMIC. In contrast to men, among women, the SII was pro-rich (higher smoking among the more advantaged) in 13 of the 52 countries (7 of 23 lMIC and 5 of 7 uMIC).
INTERPRETATION: Our results confirm that socioeconomic inequalities tobacco use exist in LMIC, varied widely between the countries and were much wider in the lowest income countries. These findings are important for better understanding and tackling of socioeconomic inequalities in health in LMIC.

Matched MeSH terms: Tobacco Use/economics; Tobacco Use/epidemiology*
Predictors of 3-month abstinence in smokers attending stop-smoking clinics in Malaysia

Wee LH, West R, Bulgiba A, Shahab L

Nicotine Tob Res, 2011 Feb;13(2):151-6.
PMID: 21186253 DOI: 10.1093/ntr/ntq221

INTRODUCTION: Much is known about the predictors of success in quitting smoking. In particular, nicotine dependence, but not strength of motivation to stop, appears to predict abstinence. However, to date, studies have come almost exclusively from Western countries. More data are needed on the cross-cultural generalizability of these findings.
METHODS: One hundred and ninety-eight smokers attending 5 stop-smoking clinics in Malaysia completed a questionnaire prior to their target quit date and were followed up 3 months after this date. Predictors included sociodemographic variables, smoking patterns, past history of quitting, characteristics of current quit attempt, and smoking motives as well as nicotine dependence (Fagerström Test for Nicotine Dependence [FTND]) and self-rated strength of motivation of stop.
RESULTS: At 3-month follow-up, 35.4% (95% CI: 28.7-42.0) of participants reported being abstinent. A backward elimination multiple logistic regression identified a number of significant predictors of success, including strength of motivation to stop (adjusted odds ratio [OR]: 3.05, 95% CI: 1.28-7.25). FTND did not predict success.
CONCLUSIONS: Motivation and nicotine dependence may play different roles in explaining variation in ability to stop smoking in different cultures.
Study site: Quit smoking clinics, Federal Territories and Putrajaya Hospital, Malaysia

Matched MeSH terms: Tobacco Use Disorder/epidemiology; Tobacco Use Disorder/rehabilitation*
Leptin and calorie intake among different nicotine dependent groups

Suhaimi MZ, Sanip Z, Jan HJ, Yusoff HM

Ann Saudi Med, 2016;36(6):404-408.
PMID: 27920412

BACKGROUND: Exposure to nicotine via tobacco smoking may influence leptin release and decrease food intake among smokers. However, the effect of nicotine exposure on leptin and food intake among different nicotine dependent groups is unclear.
OBJECTIVE: We aimed to measure leptin and calorie intake among different nicotine dependent groups.
DESIGN: Cross-sectional study.
SETTING: Research department in school of medical sciences.
PATIENTS AND METHODS: Subjects were selected by purposive (non-probability) sampling and categorized as having low, moderate and high nicotine dependency based on the Fagerstrom Test for Nicotine Dependence (FTND) score. Diet was recorded by interview. Anthropometry, blood pressure, body composition, lipid profile, and physical activity level were measured accordingly. Fasting serum leptin was measured using a commercial ELISA kit.
MAIN OUTCOME MEASURE(S): Nicotine dependency, 24-hour diet, clinical anthropometric and clinical measurements.
RESULTS: In 107 Malay male smokers leptin concentration was inversely correlated with nicotine dependence. However, body weight, smoking period, blood pressure, body composition, lipid profile and physical activity level were not significantly different among low, moderately and highly dependent smoking groups. Leptin concentration and total calorie intake were also not significantly different among these groups.
CONCLUSION: Leptin concentration was inversely correlated with nicotine dependence, but leptin concentration and total calorie intake status were not significantly different among our different nicotine dependency subjects.
LIMITATIONS: Purposive sampling for subject recruitment and inaccurate information in the self-administered questionnaire.

Matched MeSH terms: Tobacco Use Disorder/blood*; Tobacco Use Disorder/physiopathology
Fulltext Impact of Point-of-Sale Tobacco Display Bans in Thailand: Findings from the International Tobacco Control (ITC) Southeast Asia Survey

Li L, Borland R, Yong HH, Sirirassamee B, Hamann S, Omar M, et al.

Int J Environ Res Public Health, 2015 Aug;12(8):9508-22.
PMID: 26287219 DOI: 10.3390/ijerph120809508

In September 2005 Thailand became the first Asian country to implement a complete ban on the display of cigarettes and other tobacco products at point-of-sale (POS). This paper examined the impact of the POS tobacco display ban in Thailand, with Malaysia (which did not impose bans) serving as a comparison. The data came from the International Tobacco Control Southeast Asia Survey (2005-2011), a prospective cohort survey designed to evaluate the psychosocial and behavioral impacts of tobacco control policies. Main measures included smokers' reported awareness of tobacco displays and advertising at POS. At the first post-ban survey wave over 90% of smokers in Thailand were aware of the display ban policy and supported it, and about three quarters thought the ban was effective. Noticing tobacco displays in stores was lowest (16.9%) at the first post-ban survey wave, but increased at later survey waves; however, the levels were consistently lower than those in Malaysia. Similarly, exposure to POS tobacco advertising was lower in Thailand. The display ban has reduced exposure to tobacco marketing at POS. The trend toward increased noticing is likely at least in part due to some increase in violations of the display bans and/or strategies to circumvent them.

Matched MeSH terms: Tobacco Use Disorder/economics; Tobacco Use Disorder/prevention & control; Tobacco Use Disorder/psychology
Fulltext Effects of nicotine on schizophrenia and antipsychotic medications: a systematic review

Hamira Farahana Hamdan, Syahrir Zaini

Malaysian Journal of Psychiatry, 2018;27(1):0-0.
MyJurnal

Majority people with schizophrenia who smoke cigarettes, tend to be heavy smokers than other psychiatric patients and general population. Nicotine is one of the main components of cigarettes that can produce nicotinic interactions with antipsychotic drugs. Nicotine can also alleviate psychotic symptoms of schizophrenia. Aim: The objective for this systematic review is to examine the effects of nicotine and nicotine-based products in the treatment of schizophrenia, in comparison with placebo, no treatment or antipsychotic medication. Results: All studies comparing nicotine or other related products as the only treatment or adjunctive treatment for schizophrenia patients excluding the animal studies and case studies are reviewed. The use of traditional or known as typical antipsychotics may cause the patients to smoke frequently while patients taking atypical antipsychotics may smoke less. Patients who smoke may metabolize antipsychotics faster than non-smoking patients. There is less report related to smoking cessation among the schizophrenia patients. Conclusion: Neurobiological and psychosocial factors reinforce the high use of nicotine by patients with schizophrenia. Prior to smoking cessation implementation, it is crucial to understand on the ways and reasons for schizophrenia patients to consume nicotine for self-medicate symptoms which may lead to the development of new treatments for schizophrenia and nicotine dependence.

Matched MeSH terms: Tobacco Use Disorder
Fulltext The Development and Assessment of Modified Fagerstrom Test for Nicotine Dependence Scale among Malaysian Single Electronic Cigarette Users

Rahman AU, Mohamed MHN, Jamshed S, Mahmood S, Iftikhar Baig MA

J Pharm Bioallied Sci, 2020 Nov;12(Suppl 2):S671-S675.
PMID: 33828359 DOI: 10.4103/jpbs.JPBS_245_19

Background: The Fagerstrom test for nicotine dependence (FTND) is the most widely used scale for assessing nicotine dependence on conventional tobacco cigarettes (TCGs). But the FTND does not evaluate the subject's nicotine dependence to electronic cigarette (EC).
Objective: The aim of this study was to develop and assess an equivalent modified FTND scale that measures the nicotine dependency via EC.
Materials and Methods: The investigator developed the equivalent modified FTND scale that scores identical to the original scale, that is, 0-10. The developed scale piloted among 15 EC single users, that is, use only EC verified by carbon monoxide (CO) level of <8ppm. The assessment of the scale was done among 69 EC single users and observed for 1 year to determine their nicotine status.
Results: The modified scale revealed an acceptable Cronbach α value of 0.725. Further test-retest reliability of the scale showed a satisfactory Spearman's rank correlation coefficient value of 0.730 (P > 0.05). A 1-year observation showed that of 69 single users, 11 single users completely stopped nicotine intake, 24 remained as EC single users, 15 shifted to dual-use, and 19 relapsed to TCG. Surprisingly, the EC users who completely stopped nicotine intake after 1 year had a low average nicotine dependence value of 3 that was measured by the modified FTND scale at the baseline.
Conclusion: The modified FTND scale precisely identifies the physical dependence to nicotine via EC. Therefore, as per this study results the modified FTND scale can be applied in any EC-related studies to assess nicotine dependency via EC.

Matched MeSH terms: Tobacco Use Disorder
Fulltext Perception of the Islamic ruling on smoking among Muslim adults in Malaysia; a preliminary survey

Shahrin TCA, Azarisman Shah MS, Melor PAM, Jamalludin AR, How SH

International Medical Journal Malaysia, 2007;6(2):1-8.
MyJurnal

Introduction: Smoking is prevalent among Muslims in this country despite public knowledge regarding smoking as haram (unlawful). This may be due to ignorance of the consensus of the ' mufti ' on the ' fatwa ' on smoking or a result of poor education and understanding of health-related risks of smoking.
Methods: A cross-sectional, questionnaire-based survey was carried out among the public who attended the IIUM Faculty of Medicine open day in Kuantan, Pahang on June 12th, 2004. Knowledge of smoking-related illnesses and the religious ' fatwa '(edict) on smoking was assessed.
Results: Seventy four muslims participated in the survey. 46(63%) were smokers (including ex-smokers) and 28(37%) were non–smokers. There was no statistically significant difference between the knowledge of smoking-related illnesses and their knowledge of the religious edict which regards smoking as haram between smokers and non-smokers. Only 6.7% of smokers perceive smoking as haram compared to 48% of non-smokers (p<0.001).
Conclusion: The conviction that smoking is haram among smokers is still poor among smokers. This could be one of the main reasons contributing to the high prevalence of smoking in our society. There was no difference between smokers and non-smokers concerning their knowledge on the religious edict on smoking and the health-related hazards of smoking.

Matched MeSH terms: Tobacco Use Disorder
Fulltext Validation of The Malay Version Of Fagerstrom Test For Nicotine Dependence (FTND-M) Among a Group of Male Staffs in a University Hospital

Ng, C.G., Rusdi, A.R., Anne Yee, H.A.

Malaysian Journal of Psychiatry, 2011;20(1):1-7.
MyJurnal

Objective: The aim of this study was to evaluate the validity and reliability of the Malay version of the Fagerstrom Test for Nicotine Dependence (FTND-M) based on a group of male staffs in the hospital. This study will also determine whether an abbreviated version of the FTND-M can be used as a screening tool for nicotine dependence. Method: 107 male staffs participated in the study. They were given the FTND-M and Malay version of Mini-International Neuropsychiatric Interview (M.I.N.I.)-L component. Their carbon monoxide level measured in their breath by using exhaled air. One week later, these participants were again given FTND-M. Results: The discriminatory ability of FTND-M was good with AUC 0.74 (P2 with the sensitivity of 70.1%, specificity of 70%, PPV of 79.7% and NPV of 58.3%. The FTND-M had moderate internal consistency with a Cronbach’s alpha of 0.67. The testretest reliability after 1 week was fair (Spearman’s rho=0.5, p)

Matched MeSH terms: Tobacco Use Disorder
Fulltext Smoker Desaturation during General Anaesthesia: A Case Report

Hadi, M.A., Azrina, M.R., Zamzila, A., Ariff, O.

International Medical Journal Malaysia, 2009;8(1):57-59.
MyJurnal

We report a case of sudden hypoxaemia after intubation in a patient who had smoked a few hours prior to a surgical procedure. The cause of his desaturation was not related to bronchial secretions, bronchospasm or obstruction of the upper airways but most likely due to reduced oxygen saturation in the body prior to surgery. We managed to secure the airway and prevent prolonged desaturation by instituting remedial measures. Our conclusion is that cessation of smoking is very important and need to be emphasized in all patients having surgery under general anaesthesia. This applies to emergency cases as well.

Matched MeSH terms: Tobacco Use
Fulltext The correlation of two nicotine dependence measurement methods: Fagerstrom Test for Nicotine Dependence (FTND) and Saliva Cotinine among a group of Muslim smoker in Malaysia

Nuraisyah Hani Zulkifley, Suriani Ismail, Rosliza Abdul Manaf, Zulkifley Hamid

Malaysian Journal of Medicine and Health Sciences, 2017;13(3):43-50.
MyJurnal

Introduction: One of the known factors that hindered smoking cessation is nicotine dependence. Measurement of the nicotine dependence is important to better understand cigarette smoking addiction dependence and ways to overcome it. Among methods of nicotine dependence measurement are self-reported Fagerstrom Test for Nicotine Dependence (FTND) and biochemical assessment such as saliva cotinine. Biochemical assessment can be used to measure the accuracy of the self-reported measurement of nicotine dependence. Objective: To explore the correlation between the FTND and the saliva cotinine of the smokers in three different timeline. Methods: A total of 61 male smokers who currently smoke cigarette on daily basis were recruited. The study used the one-group pretest-posttest study design and the data were collected three times. The self-reported measurement were measured by using FTND and the biochemical assessment measured by using saliva cotinine from Saliva Bio oral swab (SOS) with the sensitivity of 0.15ng/ml. Data analysis was conducted by using Pearson correlation. Results: There was a significant association between the FTND score and saliva cotinine level of the smokers at baseline, second and third data collection (p=0.014, p=0.003, p

Matched MeSH terms: Tobacco Use Disorder
Fulltext Prevalence of smoking in Malaysian adolescents: are strategies enough to counter its ill effects?

Aliya, S., Shamim, A. K., Ilyas, M. N., Saif, U. K., Nordin, S., Atif, A. B.

Asian Journal of Medicine and Biomedicine, 2018;1(1):5-9.
MyJurnal

Smoking is a known established threat playing a definite role in destroying youth, the future foundation for any generation. Whether steps taken are being effective or not have to be tested vigilantly as most of the previous results are based on self-reported questionnaires and the reliability of the questionnaires can be dubious. For most of the Asian parents, tobacco consumption can be a taboo especially if the teenagers are involved. Different studies have shown that prevalence of smoking among youngsters are as high as 37% to as low as 11.5% in Malaysia. How can these figures are verified as they are self-reported and how can be generations protected from ill effects of tobacco consumption. The onus not only lies on the government but also on parents/guardians, healthcare setup at various levels of care and on general population. Despite of stringent steps taken there are loopholes in the system providing these children and adolescents easy access to tobacco.

Matched MeSH terms: Tobacco Use
Fulltext Tobacco Pouch Keratosis in a young individual: A brief description

Donald PM, Renjith G, Arora A

J Indian Soc Periodontol, 2018 2 15;21(3):249-251.
PMID: 29440796 DOI: 10.4103/jisp.jisp_109_17

Smokeless tobacco is used orally or nasally without burning tobacco. This is equally harmful as smokers due to the tobacco content and can cause oral cancer as well as systemic effects such as nicotinic dependence. Many other oral conditions have also been reported in association with smokeless tobacco. This paper presents features of tobacco pouch keratosis and aims to highlight the oral effects of smokeless tobacco, management, and guidelines for dentists in educating and counselling tobacco users.

Matched MeSH terms: Tobacco Use Disorder
Fulltext Electronic cigarettes use and 'dual use' among the youth in 75 countries: estimates from Global Youth Tobacco Surveys (2014-2019)

Sreeramareddy CT, Acharya K, Manoharan A

Sci Rep, 2022 Dec 05;12(1):20967.
PMID: 36470977 DOI: 10.1038/s41598-022-25594-4

We report the country-level prevalence of awareness about electronic cigarette use, and 'dual use' and its association with age, sex, country income, and e-cigarette regulatory status. We analyzed the most recent Global Youth Tobacco Surveys done on nationally representative samples of school-going youth aged 13-15 years in 75 countries/territories. The weighted prevalence of 'awareness' (heard about e-cigarettes), 'ever use' (even tried a few puffs), 'current use' (during the last 30 days), and 'dual use' (e-cigarette use and cigarette smoking during the last 30 days) were estimated. Awareness was > 80% in 13 countries mostly from Europe Poland being the highest at 95.8% (95% CI 94.8- 96.6). In seven countries, 30-50% of the youth had ever used an e-cigarette, Italy was the highest at 55.1% (95%CI 51-3,58.9). In 30 countries, current e-cigarette use was > 10%, the highest of 35.1% (95%CI 32.4-38.0) in Guam. Awareness and use were highest in the European region (74.6% and 34.5%) and HIC (83.6% and 39.4%). Youth from HIC (compared to lMIC) and countries having restrictive e-cigarette regulations (compared to NRP) had 2.4 times (aOR 2.2.4, 95% CI 2.2, 2.7) and 1.8 times (aOR 1.8, 95% CI 1.6, 2.0) higher odds of being current e-cigarette users respectively. Youth in countries with the most restrictive e-cigarette regulations (compared to NRP) had 0.6 times lower odds of being current e-cigarette users (aOR 0.6, 95% CI 0.6, 0.7). Awareness and e-cigarette use varied by sex, country income level, and region. Continued global surveillance of youth e-cigarette use is needed for the formulation of e-cigarette regulatory policy. Awareness and use of e-cigarettes were higher among boys, in countries in Europe and America regions, and among those with higher income and restrictive policies, whereas it was lower in countries having the most restrictive policies. Higher awareness is strongly correlated with a trial and current use of e-cigarettes. E-cigarette marketing should be restricted, and continued surveillance of e-cigarette use is needed. Most restrictive policies such as the ban on e-cigarettes appear to reduce e-cigarette use among the youth.

Matched MeSH terms: Tobacco Use
Intentions to Quit, Quit Attempts, and the Use of Cessation Aids Among Malaysian Adult Smokers: Findings From the 2020 International Tobacco Control (ITC) Malaysia Survey

Kamaludin IS, How LS, Yee A, Kaai SC, Yan M, Danaee M, et al.

Asia Pac J Public Health, 2024 Jan;36(1):69-77.
PMID: 38197364 DOI: 10.1177/10105395231220465

This study examined quitting behavior and use of cessation aids (CAs) among Malaysian adult smokers aged ≥18 years (n = 1,047). Data were from the 2020 International Tobacco Control (ITC) Malaysia Survey were analyzed. A total of 79.9% of Malaysian smokers attempted to quit in the past 12 months and 85.2% intended to quit in the next 6 months. The most common CAs were e-cigarettes (ECs) (61.4%), medication/nicotine replacement therapies (NRTs; 51.0%), and printed materials (36.7%); the least common CA was infoline/quitline services (8.1%). Multivariable logistic regression analysis was performed to examine the association between sociodemographic variables and CAs use. Male smokers were more likely to use infoline/quitline services (adjusted odds ratio [aOR] = 3.27; P = .034). Malay smokers were more likely to use infoline/quitline services (aOR = 3.36; P = .002), ECs (aOR = 1.90; P = .004), printed materials (aOR = 1.79; P = .009), and in-person services (aOR = 1.75; P = .043). Most Malaysian smokers wanted to quit smoking. Furthermore, ECs were the most popular CAs, highlighting the need to assess the effectiveness of ECs for quitting smoking in Malaysia.

Matched MeSH terms: Tobacco Use Cessation Products
Betel-quid dependence domains and syndrome associated with betel-quid ingredients among chewers: an Asian multi-country evidence

Lee CH, Chiang SL, Ko AM, Hua CH, Tsai MH, Warnakulasuriya S, et al.

Addiction, 2014 Jul;109(7):1194-204.
PMID: 24650227 DOI: 10.1111/add.12530

Betel-quid (BQ) contains biologically psychoactive ingredients; however, data are limited concerning the symptoms and syndrome of BQ dependence among chewers. The aims of this study were to evaluate the ingredients-associated BQ dependence syndrome and country-specific chewing features and behaviour for BQ dependence among chewers from six Asian communities.

Matched MeSH terms: Tobacco Use Disorder/epidemiology
Fulltext Impact of additional counselling sessions through phone calls on smoking cessation outcomes among smokers in Penang State, Malaysia

Blebil AQ, Sulaiman SA, Hassali MA, Dujaili JA, Zin AM

BMC Public Health, 2014;14:460.
PMID: 24886549 DOI: 10.1186/1471-2458-14-460

Studies all over the world reported that smoking relapses occur during the first two weeks after a quit date. The current study aimed to assess the impact of the additional phone calls counselling during the first month on the abstinence rate at 3 and 6 months after quit date among smokers in Penang, Malaysia.

Matched MeSH terms: Tobacco Use Disorder/therapy*
Suitability of a Group Behavioural Therapy Module for Workplace Smoking Cessation Programs in Malaysia: a Pilot Study

Maarof MF, Ali AM, Amit N, Bakry MM, Taha NA

Asian Pac J Cancer Prev, 2016;17(1):207-14.
PMID: 26838211

In Malaysia, data on components suitability the established smoking cessation module is limited. This exploratory study aimed to evaluate the suitability of the components developed in the module for group behavioural therapy in workplace smoking cessation programs. Twenty staff were identified but only eight individuals were selected according to the study criteria during the recruitment period in May 2014. Focus group discussion was conducted to identify themes relevant to the behavioural issues among smokers. Thematic analysis yielded seven major themes which were reasons for regular smoking, reasons for quitting, comprehending smoking characteristics, quit attempt experiences, support and encouragement, learning new skills and behaviour, and preparing for lapse/relapse or difficult situations. As a result, the developed module was found to be relevant and suitable for use based on these themes.

Matched MeSH terms: Tobacco Use Disorder/therapy*
Should the threshold for expired-air carbon monoxide concentration as a means of verifying self-reported smoking abstinence be reduced in clinical treatment programmes? Evidence from a Malaysian smokers' clinic

Wee LH, West R, Mariapun J, Chan CM, Bulgiba A, Peramalah D, et al.

Addict Behav, 2015 Aug;47:74-9.
PMID: 25889913 DOI: 10.1016/j.addbeh.2015.03.021

BACKGROUND: It has been proposed that the expired-air carbon monoxide (CO) threshold for confirming smoking abstinence in clinical practice be reduced below 10 ppm. Optimal thresholds may vary across regions. Data are needed to assess the impact of such a change on claimed success.
METHODS: A total of 253 smokers who attended the Tanglin quit smoking clinic in Malaysia were followed-up 1, 3 and 6 months after the target quit date. All participants received a standard behavioural support programme and were prescribed either varenicline or nicotine replacement therapy. Expired-air CO was measured at every visit. Respondents' smoking status was assessed using a range of different CO thresholds (3, 5 and 10 ppm) and the impact on quit rates was calculated. Predictors of success as defined using the different thresholds were assessed.
RESULTS: The 6-month abstinence rates were: 1 month - 54.9% at 10 ppm, 54.9% at 5 ppm and 48.6% at 3 ppm; 3 months - 36.0% at 10 ppm, 35.2% at 5 ppm and 30.4% at 3 ppm; 6 months - 24.1% at 10 ppm, 24.1% at 5 ppm and 20.6% at 3 ppm. Older smokers were more likely to be recorded as abstinent at 6 months regardless of the threshold used.
CONCLUSIONS: Reducing the threshold for expired-air carbon monoxide concentrations to verify claimed smoking abstinence from 10 ppm to 5 ppm makes minimal difference to documented success rates in Malaysian smoker's clinic patients. Reducing to 3 ppm decreases success rates slightly. Predictors of success at stopping appear to be unaffected by the threshold used.
KEYWORDS: Carbon monoxide; Predictors for abstinence; Smoking cessation; Success rates

Matched MeSH terms: Tobacco Use Disorder/therapy*
Fulltext Enhancing identification and counseling skills of dental undergraduate students using a customized Tobacco Counseling Training Module (TCTM) - A piloting of the process using ADDIE framework

Chandrashekar BR, Chacko TV, Anand KM, Suvetha K, Jaishankar HP, Suma S

Indian J Cancer, 2020 8 10;57(3):296-310.
PMID: 32769291 DOI: 10.4103/ijc.IJC_229_19

Background: Tobacco use has emerged as a major public health problem. But, most graduates in medical and dental schools receive limited systematic training. The objective of this education innovation project was to enhance dental undergraduate student's ability to identify tobacco users through oral manifestations and improve their counseling skills using a customized Tobacco Counseling Training Module (TCTM).
Methods: A TCTM for students of dentistry was developed using ADDIE framework as a guide. Content and construct validation of the module was done by six subject experts using Delphi technique for obtaining consensus. Pilot testing was done on 20 students of third year BDS. Pre- and post-intervention assessment of knowledge, attitude, self-confidence was done using learning outcomes questionnaire. Ability to correctly identify oral manifestations was assessed using extended item MCQs and tobacco counseling skills using a modified KEECC. The difference in mean scores were computed and subjected to further statistical analysis using SPSS version 22.
Results: There was a significant improvement in post intervention scores for mean knowledge (5.5 ± 1.4 to 13.2 ± 1.1), attitude (5.6 ± 0.9 and 8.5 ± 0.5), self-confidence (1.5 ± 0.5 and 3.1 ± 0.2), ability to correctly identify oral manifestations (5.2 ± 1.4 and 9.4 ± 0.8) and tobacco counseling skills.
Conclusion: It is possible to introduce the module in the existing curriculum and its effectiveness evaluation shows benefit in terms of Kirkpatrick's Level 1, 2, 3 (improvement in knowledge, attitude, self-confidence, ability to identify oral manifestations, and tobacco counseling skills) of training effectiveness.

Matched MeSH terms: Tobacco Use/psychology*
Tobacco Use and Cessation Among a National Online Sample of Men Who Have Sex With Men in Malaysia

Lim SH, Daghar L, Bullen C, Faiz HM, Akbar M, Amer Nordin AS, et al.

Asia Pac J Public Health, 2020 11;32(8):414-417.
PMID: 33084374 DOI: 10.1177/1010539520965370

Previous studies documented the health disparities in smoking among sexual minority populations, including men who have sex with men (MSM). However, smoking behaviors have never been examined among Malaysian MSM, a sexual minority group in a predominantly Muslim country. A total of 622 Malaysian MSM completed an anonymous online survey in 2017. Data on the demographics, smoking and substance use behaviors, psychosocial factors, and attitudes toward smoking cessation were collected and analyzed. The mean age was 28 years and 67% of participants were of Malay ethnicity. The prevalence of current smoking was 23% (n = 143), while former smokers were 9% (n = 59). Current smoking status was associated with HIV-positive status and risk behaviors, such as suicidality, alcohol use, and illicit drug use (P = .001). Almost two thirds of current smokers had attempted to quit in the past year. Hence, comprehensive smoking cessation interventions addressing the psychosocial needs of MSM should be prioritized.

Matched MeSH terms: Tobacco Use/epidemiology*

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