Tobacco: A Looming Epidemic in Sub-Saharan African Countries

Sub-Saharan Africa, a region already burdened with HIV/AIDS, other infectious diseases, and competing priorities, is battling with the increasing burden of COVID-19 and non-communicable diseases (e.g., cardiovascular diseases, lung cancer). Africa's statistics on young people aged 13-15 years already hooked to tobacco are at an alarming 17%, matching the global trend. It is estimated that the number of smokers in sub-Saharan Africa will increase to 208 million (148%) by 2030, if robust tobacco control measures are not implemented. The chapter highlights the global trends of tobacco use, and exposure to tobacco smoke, all of which aggravate the prevalence of communicable and non-communicable diseases. The chapter also explores the harmful impact of tobacco use on people's health, suggesting that tobacco control should be a public health priority. The chapter presents the evidence for effective community-based interventions on tobacco control and prevention to reverse the tobacco epidemic in sub-Saharan Africa. © The Editor(s) (if applicable) and The Author(s), under exclusive licence to Springer Nature Switzerland AG 2021.

Sex-Specific Association between Environmental Tobacco Smoke Exposure and Asthma Severity among Adults with Current Asthma

Background: Tobacco smoke has been associated with negative health outcomes, including those with chronic respiratory illnesses, such as asthma. This study aimed to assess the relationship between exposure to environmental tobacco smoke (ETS), as well as tobacco use (cigarette and electronic cigarettes), on asthma severity among adults with current asthma, with stratification by sex to understand potential biological sex differences. Methods: The study population consisted of Californian adults 18 years or older with self-reported physician/health care diagnosis of asthma and still having current asthma from 2020 California Health Interview Survey. All descriptive statistics and analyses were sex-stratified and survey-weighted. Crosstabulations were used to understand the association between asthma attack and ETS or firsthand smoke exposure, while binary logistic regression models were used to assess the effect of ETS exposure, current smoking status, and control variables on asthma attack in the past 12 months, with a sub-analysis among non-smoking adults with asthma. Results: Among the primary variable of interest, 35% of males and 30% of females reported ETS exposure in the past 12 months, while 13% of males and 6% of females reported being a current smoker. Past year asthma attack was reported among 43% and 55% of males and females, respectively. Among males, after adjusting for all control variables, asthma attack was significantly higher among those with ETS exposure (OR: 1.75, 95% CI: 1.01–3.02) and among current smokers (OR: 3.82, 95% CI: 1.49, 9.81). Male non-smokers with ETS exposure had a 109% higher odds of asthma attack, compared to non-exposure individuals. Conclusion: Using a population-based survey, our results highlight the ongoing burden of tobacco use and exposure particularly among males with current asthma, further corroborate the literature on the relationship between tobacco and asthma, and highlight putative sex-specific outcomes.

Parental Knowledge, Attitude, and Practice on Tobacco Use, Smoking Cessation, and Children's Environmental Tobacco Smoke Exposure.

Background: Environmental tobacco smoke (ETS) exposure in children ranks one of the major public health problems in our time. Poor parental knowledge, attitude, and practice (KAP) on ETS often contribute to worse exposure of the kids. Thus, we aimed to document parental KAP regarding tobacco use, smoking cessation and children's ETS exposure, and to analyse how knowledge and attitude relate to practice. Methods: Self-administered KAP questionnaires were distributed to smoking parents recruited from the pediatric unit at the Prince of Wales Hospital, which provides pediatric service to a population of 1.2 million in Hong Kong. The 60-item questionnaire had a range of 0-38 for knowledge, 0-44 for attitude, and 0-40 for practice. Descriptive analyses were performed for KAP response, regression analyses were performed for the exploration of associations and identification of predictive indicators. Results: 145 smoking parents (mean age: 38.0 ± 6.7 yrs.; male: 85.5%) were included. Less than half (39.3%) of them reported a smoke-free policy at home. Among those parents who had private cars, less than half (45.2%) of them had smoke-free policy in their car that they never smoked in the car. Only 25.5% of the participants correctly answered ≥70% of the knowledge questions, and 11.8 % of the participants gave favorable responses to ≥70% of the attitude questions. The total knowledge and the total attitudes score were positively associated (r = 0.49, 95% CI: 0.35-0.79, p < 0.001), yet they were only modestly correlated with parental practice on children's ETS exposure. By multivariate regressions, potential predictive factors for more favorable parental KAP included higher household income, lower parental nicotine dependence level and breastfeeding practice. Conclusions: Parental KAP related to tobacco use and children's ETS exposure needs improvement to address the significant gap between recommended and actual practice. The weak association between knowledge and practice suggested that parental education alone is not adequate to combat ETS exposure in children.

Exposure to PM4 in Homes with Tobacco Smoke in and around Katowice, Poland

The results of a PM4 (airborne particles with an aerodynamic diameter less than 4 µm) study in Katowice and in the surrounding area in homes with and without environmental tobacco smoke (ETS) are presented. It was found that the average concentration of PM4 inside the homes with ETS was between 126 µg m−3 (in Jaworzno) and 208 µg m−3 (in Katowice)—significantly higher than in the homes without smokers (55–65 µg m−3). The mean of the indoor to outdoor ratios (I/O) for PM4 varied greatly, ranging from 0.6 in the apartments without smokers in Katowice to 5.2 in the homes with smokers in Jaworzno. The highly polluted by ETS indoor air causes children aged 14–15 living in these homes to inhale from 2.5 to 6.6 mg of PM4 more per day than their peers living in non-ETS homes. X-ray photoelectron spectroscopy (XPS) was used to determine the surface chemical composition of the studied indoor airborne particles. Carbon, including elemental carbon, and oxygen-containing species dominated the particulate surface, with traces of Si, N, S, Na, Al, Zn, and K present. The surface layer of PM4 from the homes with ETS contains significantly more carbon and less oxygen than the airborne particles collected in the homes without smokers, which can be explained by the high emission of carbon during tobacco smoking.

Demographic and Clinical Characteristics of COVID-19 in Children and the Effect of Household Tobacco Smoke Exposure on COVID-19.

OBJECTIVE: Environmental tobacco smoke (ETS) exposure is associated with many diseases, including lower respiratory tract infections, in pediatric age groups. In this study, we aimed to assess the effect of household ETS exposure on symptom frequency and clinical severity in children and adolescents with COVID-19. MATERIALS AND METHODS: This retrospective study included pediatric cases (<18 years old) with a positive SARS-CoV-2 test, who were admitted to our hospital between 20.03.2020 and 01.05.2020. Patients with respiratory diseases and active smokers were excluded. Demographic characteristics, symptoms, and clinical severity of COVID-19 were obtained from parents and children using a questionnaire and from patients' files. Household ETS exposure was assessed by questionnaire. RESULTS: A total of 167 patients (median age 145 months, 50.7 % male) were included in the study. The frequency of household ETS exposure was 50.9%, and the frequency of cough was significantly higher in exposed children than non-exposed children (71.4% vs 50.8% respectively, p=0.02). The frequency of both fever and cough was significantly higher ETS-exposed in the subgroup of cases with a mild clinical course (69.5% vs 48.1% respectively, p= 0.02 for fever and 67.8% vs 44.4% respectively, p=0.01 for cough). There was no relationship between clinical severity and household ETS exposure. CONCLUSION: Household ETS exposure may impact COVID-19 pediatric cases as demonstrated by the increased frequency of cough and fever in ETS-exposed children. As new lockdown measures are implemented, increasing public awareness about the effect of household ETS exposure on COVID-19as well as encouraging a decrease in ETS exposure are essential.