Improvement in prevalence of tobacco use among teachers in Bihar after COTPA.

CONTEXT: A high prevalence of tobacco use, even among educated professionals like teachers, has been reported from Bihar. After passing of the Cigarette and Other Tobacco Products Act (COTPA) in 2003, there have been major improvements in tobacco control nationwide. AIMS: To compare tobacco use prevalence among school teachers in Bihar reported in 2000 with a survey in 2008 and investigate correlates of current and past tobacco‑use. METHODS: Data from the baseline survey of a cluster random sample of 72 government schools conducted during the beginning of two consecutive school years was analyzed. RESULTS: The prevalence of current tobacco use was 35.5% and past use, 11.3%. Likelihood of current use compared with no use increased with age (odds ratio [OR] =3.27 for > 50 years compared to < 30, 95% confidence interval [CI]: [1.50, 7.13]); whereas that of past use compared to current use decreased (OR = 0.25, 95% CI: [0.09–0.68] for age > 50 years compared to < 30 years). DISCUSSION: Compared to the tobacco use prevalence among Bihar school teachers reported from a survey in the year 2000 (77.4%), the prevalence in this survey in 2008 was much lower and past use, much higher. In the earlier survey, lal dantmajan was counted as a tobacco product. If we do the same in the current survey, and consider ever use, the prevalence even then was 53.9%, lower than the earlier figure. Although the tobacco use among teachers in Bihar is still high, it has decreased after the implementation of COTPA and the cessation has increased.

Impacto de la prohibición de fumar en espacios cerrados sobre los ingresos por infarto agudo de miocardio en Uruguay / The impact of banning indoor smoking on hospital admissions for acute myocardial infarction

Introducción: la exposición al humo de tabaco ambiental aumenta 31 por ciento el riesgo de infarto entre no fumadores. En países desarrollados se observó reducción de los ingresos por infartoagudo de miocardio al prohibirse fumar en espacios cerrados. El presente estudio evaluó el impacto de la prohibición de fumar sobre el infarto agudo de miocardio en Uruguay, el primer país libre de humo de tabaco en las Américas. Material y método: se realizó un estudio ecológico comparando los ingresos por infarto en los 24 meses anteriores y posteriores a marzo de 2006 (fecha de la aprobación de la normativa que estableció la prohibición de fumar en espacios cerrados de uso público). Se analizaron retrospectivamente las historias clínicas de los pacientes residentes en el país que tuvieran infarto de miocardio como diagnóstico principal de ingreso. El análisis estadístico se realizó mediante el test de chi cuadrado. Resultados: en las 37 instituciones participantes ingresaron 7.949 pacientes (66,4 ± 12,6 años, 35,1 por ciento mujeres), 4.346 en los dos años previos a las medidas y 3.603 en los dos años siguientes, lo que implicó una reducción de 17,1 por ciento. Hubo mayor reducción a menor edad de los pacientes: <45 años: 38,5 por ciento; 45 a 64 años: 14,8 por ciento; > 65 años: 16,9 por ciento, p < 0,05. Los viernes y sábados los ingresos descendieron 24,2 por ciento, de domingos a jueves 14,3 por ciento (p < 0,05). En los centros privados hubo 22,0 por ciento de reducción, en los públicos 6,3 por ciento, p < 0,05. Conclusiones: la prohibición de fumar en espacios cerrados se asoció a una disminución en los ingresos por infarto agudo de miocardio en nuestro país, siendo este efecto particularmente importante entre los más jóvenes. El beneficio predominó viernes y sábado yfue menor entre quienes se asisten en el sector público.

Introduction: exposure to environmental tobacco smoke increases the risk for infarction in 31 percent among nonsmokers.A decrease in hospital admission due to acute myocardial infarction was noticed in developed countries when indoor smoking was banned. The present studyanalyzed the impact of smoking bans on acute myocardial infarction in Uruguay, the first tobacco- smoke-freecountryin the Americas. Method: we conducted an ecological study that compared hospital admissions for infarction in the 24 months prior to March 2006 to admissions during the 24 months subsequent to that date (date when the anti-smoking regulation was passed, banning indoor public spaces). We retrospectively analyzed the medical records of patients residing in the country whose main diagnosis for admission was myocardial infarction. The statistic analysis was made by using the chi square test. Results: 7,949 patients were admitted in the 37 participating institutions (66,4 ± 12,6 years old, 35,1 percent women), 4,346 were admitted over the two year period prior to the new measures, and 3,603 during the two-year period subsequent to the prohibition, what implied a 17.1 percent drop. The younger the patients, the greater the drop: <45 years old: 38,5 percent; 45 to 64 years old: 14,8 percent; > 65 years old: 16,9 percent, p < 0,05. Admissions decreased by 24.2 percent on Fridays and Saturdays, and 14.3 percent from Sundays toThursdays (p < 0,05). Decrease was 22.0 percent in private institutions and 6.3 percent in public institutions, p < 0,05. Conclusions: Indoor smoking bans were associated to a decrease in hospital admission for acute myocardial infarction in our country, being this effect particularly important in the younger people. The benefit of this new legislation was more important on Fridays and Saturday and lower in those patients seen in the public sector.

Introdução: a exposição ao fumo de tabaco ambiental aumenta 31 por cento o risco de infarto entre os não fumantes. Nos países desenvolvidos observou-se uma diminuição das internações por infarto de miocárdio depois da proibição de fumar em espaços fechados. Este estudo faz uma avaliação do impacto da proibição de fumar sobre o infarto de miocárdio no Uruguai, o primeiro país livre de fumo de tabaco nas Américas. Material e método: fez-se um estudo ecológico comparando as internações por infarto de miocárdio nos 24 meses anteriores e posteriores a março de 2006, data da aprovação da legislação que proíbe fumar em espaços públicos fechados. Fez-se uma análise retrospectiva dos prontuários médicos dos pacientes residentes no Uruguaique apresentaram infarto como diagnóstico principal; os dados foram analisados utilizando o teste de Qui quadrado Resultados: Nas 37 instituições incluídas no estudo foram internados 7.949 pacientes (66,4 ± 12,6 anos, 35,1 por cento mulheres), 4.346 nos anos anteriores às medidas de proibição e 3.603 nos dois anos seguintes, com uma redução de 17,1 por cento. A redução foi maior nos pacientes mais jovens: <45 anos: 38,5 por cento; 45 a 64 anos: 14,8 por cento; > 65 anos: 16,9 por cento, p < 0,05. As internações nas sextas-feiras e sábados caíram 24,2 por cento, e de domingo a quinta-feira 14,3 por cento (p < 0,05). Nas instituições de assistência médica privada a redução foi de 22,0 por cento e de 6,3 por cento, p < 0,05 nos públicos. Conclusões: a proibição de fumar em espaços públicos fechados mostrou uma associação com uma redução das internações por infarto agudo de miocárdio observando-se um impacto especial em pacientes mais jovens. Este benefício foi predominante nas sextas-feiras e sábados e foi menor na população atendida no setor público.

Legislación para el control del tabaquismo en Cuba / Smoking control legislation in Cuba

La población cubana se encuentra protegida mediante una legislación nacional, el Acuerdo 5570 de 2005 del Comité Ejecutivo del Consejo de Ministros, que permite controlar la venta de cigarrillos a menores y regular la prohibición de fumar en lugares públicos cerrados, en instituciones de salud y educación. Caracterizar el cumplimiento de las regulaciones y prohibiciones de fumar definidas en el mencionado acuerdo. Estudio observacional descriptivo. El universo fue el municipio Habana del Este, de Ciudad de La Habana, se realizó un muestreo por conglomerado monoetápico de cada localidad. La información primaria se obtuvo mediante guías de observación estructuradas y entrevistas. Los datos se procesaron de forma computarizada y los resultados se expresaron en porcentajes. Se encontró que en el 13,8 por ciento de los lugares de expendio, se vendió cigarrillos a menores de 18 años y fueron las cafeterias donde único de produjo violación de lo establecido a pesar de ser los lugares más señalizados. El 45,9 por ciento de los lugares con prohibición de fumar se encontraban señalizados pero en ellos se localizó un alto porcentaje de personas asistentes fumando. Los dependientes estaban fumando durante la atención al público en el 41 por ciento de los lugares de expendio, el 85,7 por ciento de los trabajadores de centros de salud fumaban durante el ejercicio de su profesión, el mayor porcentaje encontrado; no siendo así en los trabajadores de centros educacionales. Los directivos desconocen la existencia de señalización en sus propias entidades. La aplicación y cumplimiento de las regulaciones de venta y prohibiciones de fumar en lugares públicos como está establecido en el Acuerdo 5570 de 2005 en el municipio Habana del Este en el año 2007 es insuficiente, los principales factores determinantes son la falta de exigencia y control.

The Resolution 5570 of 2005 passed by the Executive Commission of the Council of Ministers protects the Cuban population through the control of selling cigarettes to children and of forbidding smoking in closed public places and in health and educational institutions, and plays a role in promoting healthy lifestyles. To characterize the enforcement of the regulations and of the ban on smoking defined in the Resolution no. 5570 of the Executive Commission of the Council of Ministers. Methods An observational descriptive study. The universe of study was Habana del Este municipality in the City of Havana province where one-stage cluster sampling was conducted. Primary data were collected from structured observational guides and interviews. Data was computer-processed and the results were given as percentages. Signs indicating the ban on selling cigarettes to children were seen in 44,8 percent points of sale but they were less frequent in bars and restaurants (66.7 percent). 13.8 percent of these placed did not abide by the legislation. Signs were seen in 45.9 percent of no smoking places but in 48.6 of them, there were people who smoked, including 41.4 percent of the staff at work; the healthcare personnel accounted for the highest percentage. Managers ignored the placing of such signs in their entities. The enforcement of and compliance with regulations on cigarette sale control and ban on smoking in closed public places as established by Resolution 5570 of 2005 was poor in Habana del Este municipality in 2007; and in this regard, the main determining factors were lack of control and exigency.