Barriers to the provision of smoking cessation intervention/services: A mixed-methods study among health care workers in Zambezi region, Namibia

Background. Healthcare workers (HCWs) can play a significant role in tobacco prevention by delivering smoking cessation (SC) interventions to patients who smoke. Objective: To identify and explore the perceived barriers which prevent healthcare workers from delivering SC counselling to patients in Zambezi region, Namibia. Methods: A regional-based, concurrent mixed-methods study was conducted between March and October 2020 among HCWs of the 8 constituencies of Zambezi region, Namibia. In the study, 129 respondents, who had been residents of the selected constituencies for over 5 years and aged between 17 to 60 years, participated. Results: 129 respondents participated in the study. Majority of respondents were females (62.9% and 68.1%) compared to (37.1% and 31.9%) males. The mean age of respondents was 35.91 (SD=9.3) and 36.61 (SD=8.7) respectively and their ages ranged between 18 and 59 years. Key barriers were identified: (i) HCWs based barriers included lack of time to provide SC, inadequate training and insufficient knowledge on SC interventions; (ii) system-based barriers identified lack of SC guidelines and educational materials for patients, and specialists to refer patients; and (iii) patient/client-based barriers included lack of patient interest in SC information, patients not adhering to advise given on SC. Conclusions: This study showed that SC delivery in Zambezi region is inadequate. Barriers were identified regarding the delivery of SC intervention for the first time. Targeted SC interventions are required to combat these identified specific barriers. There is a crucial need to improve HCWs skills and knowledge in providing SC intervention.

Knowledge, practices and beliefs of students regarding health effects of shisha use in Ouagadougou, Burkina Faso: A cross­sectional study

Background.The tobacco epidemic is one of the biggest public health threats the world has ever faced. Shisha use has recently been gaining increased popularity in many developed and developing countries.Objective. To determine the prevalence of shisha use among students in Ouagadougou, Burkina Faso, and associated knowledge, smoking practices and beliefs about health effects.Method. A total of 443 students were selected for this cross-sectional study, using a stratified sampling method. Data on shisha use, knowledge about shisha, shisha smoking practices, and factors associated with use of shisha were collected via a questionnaire. The association between the independent variables and shisha use was assessed using a χ2 test (p<0.05). Binary logistic regression analysis was used to determine variables that were independently associated with shisha smoking.Results.Of the 421 respondents, 162 (38.5%) indicated that they had smoked shisha; 14.0% were regular smokers. We found that 183 students (43.5%) had poor knowledge about the health effects of shisha. The main reasons for shisha smoking were being in the company of friends who were users (57.4%), the pleasant flavour and fragrance of shisha (25.9%), and fashion (22.2%). Ninety-nine shisha smokers (61.1%) also consumed alcohol. Factors associated with shisha smoking included age <20 years (p<0.001), gender (p=0.034), and educational level of the respondent's father (p=0.0001) and mother (p=0.0004).Conclusion. We found a relatively high prevalence of shisha smoking among the students, and that 43.5% of them had poor knowledge about its effects on health. Developing surveillance, intervention and regulatory/policy frameworks specific to shisha has become a public health priority.

Factors associated with smoking and transitioning to nyaope injection amongst women in the City of Tshwane Municipality: A self-report by women

Background: Substance use disorder has emerged as a key health and social challenge in South Africa (SA). It is projected that about 15% of South African youth, especially young women are prone to engage in drug use and the prospects of coming into contact with nyaope, a highly addictive drug, are higher. Nyaope is mainly smoked, but the prevalence of injecting it is increasing in most regions. Aim: This study aimed to explore and describe the perception of women, who use nyaope, about the factors contributing to nyaope smoking and transitioning to injecting nyaope amongst women in the City of Tshwane Municipality (CoT), Gauteng. Setting: The research was conducted within Community Oriented Substance Use Programme sites across the CoT Municipality. Methods: Qualitative research methods were utilised to explore and describe the perceptions of the participants on factors contributing to the use of nyaope amongst women residing in the CoT. Data were collected through face-to-face interviews and thematically analysed. Results: Intimate partner influence (IPI), peer pressure, being misled by friends, weight loss, lack of effective coping mechanisms and counteracting other drugs contributed to women smoking nyaope. Additionally, a need for an intense high, IPI, influence by the social network, curiosity and cost-effectiveness contributed to women transitioning from smoking to injecting nyaope. Conclusion: The study has established factors contributing to smoking and transition to injecting nyaope as viewed by women residing in the CoT.

Effect of heavy cigarette and water pipe smoking on antioxidants and lipids in Sudanese male smokers: a case-control study

Background: Tobacco smoking is a source of many toxins such as free radicals, mutagenic substances as well as cause for developing cardiovascular diseases (CVD), particularly atherosclerosis. This study aims to assess the impact of smoking on antioxidants in Sudanese male smokers. Methods: Cases were 85 and 48 men who smoke cigarettes (CS) and water pipe (WPS) respectively and they were compared with matching 50 non-smoking controls. Blood samples were collected and following parameters: Glutathione peroxidase, Superoxide dismutase, Total cholesterol, Triglyceride, LDL, HDL, Paraoxinase, and Malondialdehyde were measured. Results: There were no significant differences in biochemical parameters between light CS and WPS compared to controls. In heavy smokers of both WPS and CS, the TC, TG, LDL, and MDA were higher than controls (p>0.05), GPx, SOD, HDL, and PON were lower in smokers than controls (p>0.05). In both groups of smokers, HDL, GPx, SOD, and PON were inversely correlated with duration of smoking (p>0.05), also, HDL was positively correlated with SOD and GPx (p>0.05). Moreover, GPx and SOD were correlated with each other in both groups of smokers (p>0.05). Conclusion: In Sudanese male smokers' biochemical profile disturbances suggest that heavy smoking was leading to developing CVD, particularly WPS

Prevalence of cervical cancer in Ain Defla region (Algeria)

The high rate of cervical cancer in Algeria and the absence of organized screening programs are well shown in this study, which aims to determine the prevalence of cervical cancer and describe the risk factors associated with this alarming prevalence. This retrospective study is based on data collected from medical records and A questionnaire was developed to assess the risk factors (such as: parity, age at first marriage, smoking, oral contraceptive, and Hormonal status) of cervical cancer among the participants. Face to Face interview were conducted with the participants. The result obtained from this study revealed that cervical cancer occupies the fourth place of cancer in the Wilaya of Ain Defla (4,71 %); the results confirm the effect of several risk factors such as early marriage age (below 20 years: 46.66 %), multiparity (53.33%), menopause (66.66 %); taking contraception (53.33%) and smoking in the development of this pathology. The adoption of an early and annual screening program in our region would be very important to us. In addition, the interest of annual screening is to raise women's awareness of this pathology, particularly in isolated regions. (

Evolution of attitudes, trends and perceptions of smoking among middle and secondary school students in the Gharb Region, Morocco, 2010­2015

Background: Tobacco use is an important public health issue. Morocco implemented a tobacco control programme, which has been ongoing among students at middle and secondary schools since 2010. Aim: This study aims to compare the trend in smoking among the programme beneficiaries with the results of the initial study conducted prior to the implementation of the programme. Setting: This study was conducted in middle and secondary schools of the Gharb Region in Morocco between 2010 and 2015. Methods: Two cross-sectional studies were conducted in 2010 and 2015 in the middle and secondary schools of the Gharb Region. Multistage cluster sampling was used. The information was collected using a self-administered questionnaire. Results: In the first study in 2010, 5312 students participated, and in the second one in 2015, 4208 students participated. The level of information on smoking and its effects was higher in 2015 (94.0%) than in 2010 (92.5%). In 2010, parents, primary schools and television and radio were more involved in student information on smoking compared to 2015. The proportion of students claiming that tobacco was not a pleasure (86.3%) and that it does not calm nerves (76.5%) was significantly higher in 2015 than in 2010. The prevalence of smoking increased significantly in 2015 (2.9%) against 2010 (1.8%). Conclusion: This study reports the general positive evolution in knowledge about smoking and its effects. Despite that the prevalence of smokers increased in 2015. The results suggest the need to address family influences on adolescent smoking and to investigate participation of schools in education and training students in tobacco dependence prevention

Current concepts in Asthma control: Is it achievable?

Asthma control is the central focus of Global Initiative for Asthma (GINA) guidelines, which is defined as the extent to which the various manifestations of asthma observed in the patient are reduced or removed by treatment. It is determined by the interaction between the patient's genetic background, underlying disease processes, the treatment that they are tak-ing, environment and psychological factors.The long-term goals of asthma management are to achieve good symptom control, and to minimise future risk of exacer-bations, fixed airflow limitation and side-effects of treatment. The patient's own goals regarding their asthma and its treat-ment should also be identified.Several factors have been identified which contribute to failure in achieving asthma control despite adequate drug therapy. To assist in assessing asthma control, several validated questionnaires have been developed.Despite the goal of asthma management is attaining optimal control; majority of asthmatics are not well controlled. Global surveys of asthma care have suggested only 5% of asthmatics meet the goals of asthma management as set out in guidelines.Global multi centre research should be conducted especially in developing countries on asthma control to assess the impact and adequacy of asthma care in all the regions of the wor

Second and third year medical students' self-reported alcohol and substance use, smoking habits and academic performance at a South African medical school

Background: Health professional students frequently use alcohol and narcotics. The potential impact on academic performance and professional behaviour is concerning. Aim: This study aimed to determine self-reported use of alcohol, illicit substances (e.g.cannabis, lysergic acid diethylamide [LSD], magic mushroom, cocaine, crack, ecstasy, methamphetamine and heroin), prescription medication and smoking habits, correlating academic performance. Setting: Faculty of Health Sciences, University of the Free State. Methods: An observational, descriptive, cross-sectional study design was used. Information was obtained using a self-administered questionnaire, capturing demographics, self-reported academic performance, drinking and smoking habits, and substance use. Coded responses were analysed using the Remark Office OMR 8 Software System. Descriptive statistics were calculated for categorical variables. Results: Completed questionnaires comprised 171 students. A total of 78.4% of second year and 82.8% of third year students reported using alcohol. Twenty-two per cent of second year and 24.1% of third year students reported cannabis use. In the second year group, three (2.7%) students reported using magic mushroom, two (1.8%) reported cocaine, two (1.8%) reported ecstasy and one (0.9%) reported using methamphetamine. Only third year students reported using LSD or 'crack'. Cigarette smoking was common ­ 31.5% and 35.1% in both groups, respectively. Smokeless tobacco devices were used by 8.5% of second year and 7.1% of third year students. Almost 40% of both groups reported that they had smoked a water pipe. Academic performance achieved was mostly 60% ­ 69% (38.9%) among second year students and 70% ­ 79% (46.6%) among third year students. Conclusion: Self-reported use of alcohol and drugs and smoking among medical students is alarming. Additional student support, early identification and referral for management and/or rehabilitation should be a priority at tertiary institutions responsible for training future healthcare professionals

Tobacco growing and the sustainable development goals, Malawi

Negative impacts of tobacco result from human consumption and from tobacco-growing activities, most of which now occur in low- and middle-income countries. Malawi is the world's largest producer of burley tobacco and its population is affected by the negative consequences of both tobacco consumption and production. In countries like Malawi, tobacco control refers to control of the tobacco supply chain, rather than control of consumption. We review the impact of tobacco cultivation, using Malawi as an example, to illustrate the economic, environmental, health and social issues faced by low- and middle-income countries that still produce significant tobacco crops. We place these issues in the context of the sustainable development goals (SDGs), particularly 3a which calls on all governments to strengthen the implementation of the World Health Organization Framework Convention on Tobacco Control. Other goals address the negative effects that tobacco cultivation has on development. The SDGs offer an opportunity for low- and middle-income countries that are dependent on tobacco production and that are not yet parties to the Convention, to reconsider joining the FCTC

Modulation in airway smooth muscle reactivity and improvement in lung function of cigarette smokers and passive non-smokers following garcinia kola treatment

Inhalation of tobacco smoke is a major risk factor for the development of airway hyperreactivity (AHR) in non-cigarette smokers and increase respiratory distress in smokers. Garcinia kola has been linked to smooth muscle relaxation and may ameliorate obstruction and resistance to airflow. This study examined the effect of Garcinia kola on airflow and reactivity of the airway smooth muscles (ASM) of asymptomatic regular cigarette smokers (CS) and passive non-smokers (PNS) following 10 minutes cigarette smoking and exposure to cigarette smoke. Sixty apparently healthy male undergraduates comprising cigarette smokers and non-smokers volunteered as subjects. Changes in peak expiratory flow rate (PEFR) in L/min in CS and PNS was measured with Spirometer before and after 10 minutes of smoking and/or exposure to cigarette smoke. Thereafter, half the population of CS and PNS were given G. kola (200 mg/kg body weight) and PEFR measured at intervals of 30 minutes for a maximum of 90 minutes. Peak expiratory flow rate significantly decreased (p < 0.05) following 10 minutes of smoking and exposure to smoke in both CS and PNS, however, G. kola ingestion marginally increased PEFR values significantly at 30, 60 and 90 minutes intervals. Comparatively, increase in PEFR was greater in PNS than in CS (P < 0.05) treated with G. kola and climaxed at 60 minutes. Conclusively, cigarette smoking and exposure to cigarette smoke compromise lung function with a decrease in peak expiratory flow rate. G. kola treatment significantly reversed this trend, cleared the airways, enhanced airflow and improved lung function

Trends in HIV Risk Behaviour of Incoming First-Year Students at a South African University: 2007-2012

he aim of the research on which this article is based was to understand the behavioural changes of the target student population over time to ensure that future prevention programmes are more effective in changing behaviour. This study reports on quantitative data collected at the University of the Western Cape over a six-year period between 2007 and 2012. All the students attending the orientation sessions and who were willing to complete the anonymous questionnaire during each of the six years were included in the study. Data were collected on the following aspects and subjects: sexual activity; age at first sexual encounter; number of sexual partners; condom usage; knowledge of how to use a condom; perceived ability to discuss condoms usage with a sexual partner; perception of HIV risk and HIV testing as well as the intention to be tested. Reported alcohol and drug usage; as well as depressive symptoms; was also recorded. The percentage of students reporting having had vaginal sex prior to entering university increased from 44% in 2007 to 51% in 2012 but; alarmingly; the consistent use of condoms decreased from 60% in 2007 to 51% in 2012. The average onset age of about 15.6 years for males and 16.7 years for females for vaginal sex did not change over the six-year period. No difference in smoking patterns or drug use was seen over the period of the study; but the number of entering students who indicated that they consumed alcohol increased significantly from 48% in 2007 to 58% in 2012. HIV testing increased from 19% in 2007 to 47% in 2012; whereas the intention to be tested showed no significant change over the period. Although students increasingly reported that they knew enough about HIV/AIDS (63% in 2007 and 69% in 2012); about a third reported suffering from AIDS fatigue. Prevention efforts targeted at those incoming first-year students who are not yet sexually active (about 45% in this study) should be developed and should take into account the multiplicity of factors that appear to influence their sexual debut

Correlates of Sexual Activity Versus Non-Activity of Incoming First-Year Students at a South African University

In order to contribute to the design of more effective programmes to curb the spread of HIV at tertiary institutions; this study compares the profile of students who are sexually active versus those who are not yet sexually active when entering university. The study was conducted among three cohorts of first-year university students at the University of the Western Cape from 2007 to 2009. A range of correlates of sexual activity versus non-activity were explored using logistic regression analysis. The predicted probabilities of the logit link function depict marked differences between genders and racial groups. Males were more likely than females to be sexually active when entering university and the Black racial group was more likely than other racial groups to be sexually active. Risk-taking behaviours such as smoking; alcohol and drug use were shown to increase the likelihood of being sexually active when entering university; as did indicators of depression and suicidal ideation. The results indicate that religion plays an important role in influencing sexual behaviour; highlighting the important potential role that religious organisations can play in addressing HIV risk at tertiary institutions

Exposure of Undergraduate Students to Cigarette Adverts: A Case Study of University of Abuja; Nigeria

Context: Cigarette smoking has became prevalent particularly in developing countries where youths get initiated at an earlier age than in the past two decades and there is only rudimentary support for smoking cessation. Although the relationship between cigarette smoking and health hazards is well documented; the incidence of cigarette smoking continues to increase despite global and local tobacco control efforts. Aims: The study objective was to determine the level of exposure of respondents to cigarette smoking and the factors associated with it. Materials and Methods: A pre-tested; self-administered questionnaire was used to collect data on socio-demographic features; knowledge about smoking and exposure to media for health information including exposure to tobacco adverts. Subjects were selected by multistage sampling technique. Results: One-third of the students were current smokers and most of them had poor knowledge of the consequences of smoking. All of the students were exposed to some level smoking adverts through electronic/print media. Over 90 of the students had no exposure to smoking prevention and none of the smokers were exposed to cessation interventions. One-fifth believed they were not at health risk as a result of smoking. The school had no smoking control policy. Conclusions: There was a strong; constant exposure of the youths to cigarette adverts in the media; on the streets; the school and homes. There is need to protect the youths from such excessive exposures to factors that encourage smoking and establish intervention strategies to prevent continued exposure to cigarette adverts

Prevalence and correlates of atypical patterns of drug use progression: findings from the South African Stress and Health Study

Objective: Atypical sequences of drug use progression are thought to have important implications for the development of substance dependence. The extent to which this assumption holds for South African populations is unknown. This paper attempts to address this gap by examining the prevalence and correlates of atypical patterns of drug progression among South Africans.Method: Data on substance use and other mental health disorders from a nationally representative sample of 4351 South Africans were analysed. Weighted cross tabulations were used to estimate prevalence and correlates of atypical patterns of drug use progression. Results: Overall; 12.2of the sample reported atypical patterns of drug use progression. The most common violation was the use of extra-medical drugs prior to alcohol and tobacco. Gender was significantly associated with atypical patterns of drug use with the risk pattern varying by the type of drug. None of the anxiety or mood disorders were associated with atypical patterns of use. Atypical patterns of drug use were not associated with increased risk for a lifetime substance use disorder. Conclusion: Atypical patterns of drug use initiation seem more prevalent in South Africa compared to other countries. The early use of extra-medical drugs is common; especially among young women. Drug availability and social environmental factors may influence patterns of drug use. The findings have important implications for prevention initiatives and future research

The Prevalence of Substance Use and its Associations amongst Students Attending High School in Mitchells Plain; Cape Town

Purpose: In South Africa; there has been an increase in illicit drug trafficking and consumption and associated problems since the 1990s. Mitchells Plain in Cape Town is seen as a community battling with crime; gangsterism; unemployment; overcrowding; substance abuse and poverty. This study evaluated the actual prevalence of substance abuse amongst high school students in this community and factors associated with substance use. In particular; the study evaluated the use of tik (crystal methamphetamine); a relatively new drug. Method: A cross-sectional study was performed amongst 12 secondary schools in Mitchells Plain; Grade 8 and Grade 11 classes were randomly selected to produce a sample of 438 learners. The students completed an anonymous questionnaire that contained enquiries on substance use; demographic and school performance details; and personal and sexual risks. Results: Lifetime and annual prevalence rates were: alcohol (50.6/41.0); tobacco smoking (49.7/36.2); cannabis (32.1/21.1); crystal methamphetamine (9.2/4.6); ecstasy (4.4/2.7); mandrax (2.1/0.9); solvents (3.0/0.9) and cocaine (0.9/0.9). Illicit substance use was significantly associated with age (OR 1.6; CI 1.2-2.2); substance use by other members of the household (OR 2.8; CI 1.2-6.3); carrying a knife (OR 10.9; CI 4.2-28.8); attempted suicide (OR 3.7; CI 1.4-9.5) and higher sexual risk (OR 1.6; CI 1.2-2.3). Conclusion: The prevalence of substance use amongst adolescent students attending high schools in Mitchells Plain; Cape Town; is high for all substances relative to national and international figures. Government officials; educators and health care workers are alerted to the need for more comprehensive interventions to prevent and treat substance abuse in this and similar communities

Prevalence of Tobacco Use and Physical Activity among Adult Sierra Leonean Population

The current burden of non-communicable diseases (NCDs) and their risk factors such as tobacco use and physical inactivity remain largely unknown in Sierra Leone. Thus; this study was conducted to document the prevalence of tobacco use and physical activity among the adult Sierra Leonean population with a specific objective of determining the sex and age prevalence. A cross sectional population based survey utilising the multi-stage cluster sampling strategy was used. A total of 5;483 individuals aged 25-64 years of both sexes were recruited into the survey. The World Health Organisation (WHO) STEPwise approach to surveillance instrument was adapted and questionnaire was administered to one individual in selected household. The data was analysed and graphed using Epi-Info software version 3.4.3 and graph pad prism version 5.1 respectively. The analyses showed that 34 of the respondents use tobacco products with 26 engaged in smoking tobacco products and 8 were smokeless tobacco users at the time of this study. The average age of commencing tobacco smoking was 21 years; with 92 and 96 of the male and female daily smokers smoking at least six manufactured tobacco respectively. Seventy four percent (74) and 69 of the non-smoking respondents were exposed to environmental tobacco smoke (ETS) at home and workplace respectively. The study further revealed that 15; 23 and 87 of the total respondents reported no work-; transport- or recreational- related physical activity respectively; and were therefore classified as physically inactive. The lowest level of physical activity was reported in the recreation domain. Even those who reported moderate physical activity at work or from travel; their median metabolic equivalent (MET) was not sufficient to achieve a level of physical activity that is beneficial to their health. In conclusion; a significant proportion of the population is exposed either directly or indirectly to tobacco smoke; and a large proportion of the adult population is physically inactivity. Thus; NCD prevention policy addressing lifestyle changes such as no smoking should not be limited to work places but should be population based

The Appropriateness of the South African Thoracic Society's (SATS) Guidelines for Antibiotic Treatment of Patients with COPD Exacerbation in the Universitas Academic Hospital; Bloemfontein

Chronic obstructive pulmonary disease (COPD) is a progressive disease predominantly associated with smoking. Exacerbation of COPD frequently results from respiratory infections. The South African Thoracic Society (SATS) recommends treatment with amoxicillin/ clavulanate; cefuroxime or a fluoroquinolone. The study aimed to determine the appropriateness of these guidelines regarding organisms isolated from sputum of patients with COPD exacerbation at Universitas Academic Hospital; Bloemfontein. A descriptive study was performed. Seventeen hospitalised patients diagnosed with COPD exacerbation from July - October 2007; not treated with antibiotics or corticosteroids or having a respiratory infection four weeks prior to admission; were included. Demographic information (age; gender; area of residence; smoking history) was obtained from patients' files; as well as FEV1 values; FEV1/FVC ratio; infection markers; microorganisms isolated from sputum and their antibiotic susceptibility profiles. Nine patients were male and eight female; with a median age of 72 years (range 53 - 82 years). Twelve (70.6) patients resided in the Bloemfontein urban area. Three patients (18.8) never smoked; 25 smoked previously and 56.3 were active smokers (median pack years 45 years; range 17 - 70 years). Eight patients had culture-positive sputum specimens. Haemophilus influenzae; H. parainfluenzae; Streptococcus pneumoniae; Staphylococcus aureus; Pseudomonas aeruginosa; Serratia marcescens and Escherichia coli were isolated from sputa. With the exception of S. aureus; all isolates were susceptible to at least one antibiotic recommended by SATS. The guidelines proposed by SATS for treatment of COPD exacerbation were appropriate and would be effective in the management of these patients in the Free State region

Higher Prevalence Rates of Smoking in Rural than Urban Areas among School-Going Adolescents in the Lusaka Province; Zambia

Objectives: The objective of the study was to compare prevalence rates of smoking in school-going adolescents among urban; peri-urban; and rural districts. Design: Secondary analysis of the Zambia Global Youth Tobacco Survey (GTYS) data of 2007. Main outcome measure: Tobacco smoking status. Results: Totals of 2378 adolescents in Lusaka urban; 1 7 5 6 in Ka f u e p e r-u r ba n ; a nd 1 38 6 i n Chongwe/Luangwa rural districts were enrolled into the study. Smoking rates were 10.5in urban; 11.1in peri-urban; and 13.5in rural districts. After adjusting for age; sex; grade; parental and best friend smoking status; and knowing that smoking is harmful to health; compared to adolescents in L u s a k a u r b a n d i s t r i c t ; a d o l e s c e n t s i n Chongwe/Luangwa rural districts were 17(AOR=1.17; 95CI [1.10; 1.23]) more likely to smoke cigarettes. No significant difference in smoking rates was observed between adolescents in urban and peri-urban districts. Conclusions: The prevalence rate of smoking among adolescents was higher in rural than urban district. Antismoking interventions should be more targeted to adolescents in rural than urban areas