Smoking as a weight control strategy of Serbian adolescents.

OBJECTIVES: The objective is to determine association of age, gender, BMI, body image (body satisfaction, body appearance), depression, unhealthy weight control behaviors with smoking among Serbian adolescents and specifically association of these variables with smoking for weight control among adolescent smokers. METHODS: This is a secondary analysis of data collected from 2763 students aged 13-15 years old (49.9% boys; 50.1% girls) obtained through cross-sectional Health Behavior in School-aged Children Survey conducted in Serbia in 2018 and analyzed using multivariable logistic regression. RESULTS: In Serbia, 12.9% adolescents 13-15 years old smoke and 6.6% smoke for weight control, while this practice was present among 48.8% of the smokers. Higher odds of smoking were found among adolescents who perceive themselves thin and good looking, while these two factors didn't play role for the smoking for weight control among smokers. Depression and unhealthy weight control behavior other than smoking significantly predicted smoking and smoking for weight control. Gender was not associated with smoking in adolescents, but among adolescent smokers, boys had two times higher chance compared to girls to report smoking for weight control. CONCLUSIONS: Findings call for incorporating and strengthening interventions for adolescents' weight control management and mental health as part of smoking prevention and cessation programs.

Prevalence and correlates of concurrent use of cigarettes, electronic cigarettes, and waterpipes among Serbian youth.

INTRODUCTION: Concurrent use of tobacco products is associated with an increased risk of nicotine dependence and smoking-related health complications. Growing popularity of concurrent use of cigarettes and electronic cigarettes and/or waterpipe tobacco is of concern, especially due to the adolescents' exposure to nicotine and call for the better understanding of patterns and predictors of multiple product use. METHODS: This is a secondary analysis of cross-sectional data obtained through the 2017 Global Youth Tobacco Survey conducted in Serbia on a nationally representative sample of 3362 students aged 13-15 years. Students were categorized into eight groups based on their experience with cigarette, e-cigarette and waterpipe use. To explore differences in sociodemographic and psychosocial characteristics, students were further placed in four groups: non-users; exclusive cigarette users; users of e-cigarette and/or waterpipe who do not smoke cigarettes; cigarette and other product users. RESULTS: We show that among the 13-15 years old students, the most common pattern of tobacco/nicotine use is waterpipe and/or e-cigarette use with no cigarette smoking (7.5%, 95% CI: 6.6-8.4) followed by exclusive cigarette use (5.8 %, 95% CI: 5.0-6.6). Among cigarette smokers, 52.8% were exclusive cigarette smokers. Having the majority of their friends smoking is a mutual predictor for exclusive cigarette (AOR=33.2, 95% CI: 14.52-75.90) waterpipe and/or e-cigarette (AOR=2.57, 95% CI: 1.56-4.25) and cigarette and other products use (AOR=52.3, 95% CI:12.28-223.22) compared to no use of any product, and the same in the case of exposure at the point-of-sale marketing: exclusive cigarette vs not any product users (AOR=1.82, 95% CI: 1.22-2.73); waterpipe and or/e-cigarette vs not any product users (AOR=1.64, 95% CI:1.18-2.28); and cigarette and other products vs not any product users (AOR=3.40, 95% CI: 1.99-5.80). CONCLUSIONS: Tobacco control interventions should address dual- and poly-tobacco use with special focus on inter-personal factors and protection from exposure to advertising of e-cigarettes and waterpipes.

Occupational Risk Factors for Prostate Cancer: A Meta-analysis.

Prostate cancer is the second most common cancer in men worldwide. There are many occupational factors that have been suggested to cause prostate cancer. Our aim was to evaluate the evidence for causality by a literature review of occupational factors. We searched literature in Medline and SCOPUS from 1966 to June 30, 2015 to identify occupational risk factors for prostate cancer. The following risk factors were selected: farmers/agricultural workers, pesticides - whole group, and separately organophosphate and organochlorine pesticides, carbamates and triazines, cadmium, chromium, cutting fluids, acrylonitrile, rubber manufacturing, whole body vibration, shift work, flight personnel, ionizing radiation, and occupational physical activity. For each factor a literature search was performed and presented as meta-analysis of relative risk and heterogeneity (Q and I2 index). A total of 168 original studies met the inclusion criteria with 90,688 prostate cancer cases. Significantly increased risks were observed for the following occupational exposures: pesticides (metaRR = 1.15, 95% confidence interval [CI] = 1.01-1.32; I2 = 84%), and specifically group of organochlorine pesticides (meta relative risk [metaRR] = 1.08, 95% CI = 1.03-1.14; I2 = 0%), chromium (metaRR = 1.19, 95% CI = 1.07-1.34; I2 = 31%), shift work (metaRR = 1.25, 95% CI = 1.05-1.49; I2 = 78%) and pilots (metaRR = 1.41, 95% CI = 1.02-1.94; I2 = 63%) and occupational physical activity in cohort studies (metaRR = 0.87, 95% CI = 0.81-0.94; I2 = 0%). The literature review supports a causal association for a few of the previously suggested factors.

Mortality among Coast Guard Shipyard workers: A retrospective cohort study of specific exposures.

In a previous analysis of a cohort of shipyard workers, we found excess mortality from all causes, lung cancer, and mesothelioma for longer work durations and in specific occupations. Here, we expand the previous analyses by evaluating mortality associated with 5 chemical exposures: asbestos, solvents, lead, oils/greases, and wood dust. Data were gathered retrospectively for 4,702 workers employed at the Coast Guard Shipyard, Baltimore, MD (1950-1964). The cohort was traced through 2001 for vital status. Associations between mortality and these 5 exposures were calculated via standardized mortality ratios (SMRs). We found all 5 substances to be independently associated with mortality from mesothelioma, cancer of the respiratory system, and lung cancer. Findings from efforts to evaluate solvents, lead, oils/greases, and wood dust in isolation of asbestos suggested that the excesses from these other exposures may be due to residual confounding from asbestos exposure.

Determinants of smoking and smoking cessation among health professionals in Serbia: A cross-sectional study.

BACKGROUND/AIM: Bearing in mind a high smoking prevalence in Serbia (34% in adult population; men 38%, women 30%) and leading role of health professionals in intervention and prevention, a cross-sectional study was performed smong the representative sample of health professionals in Serbia. The aim of the study was to identify predictors of smoking and smoking cessation prior to the total smoking ban in November 2010. METHODS: In this nationwide study, 3,084 physicians and nurses from 4 types of institutions and four geographical regions were selected and 2,282 included (response rate 74.0%). Data were collected using a self-administered structured questionnaire. Standard statistical methods were used to calculate prevalence rates, and multivariate logistic regressions to evaluate independent predictors of smoking pattern. Risks were expressed as odds ratios (OR) which represent approximation of relative risks of exposed persons with 95% confidence intervals (95% CI). RESULTS: We found a high smoking prevalence of 38.0%, the same for women and men (37.8% and 37.6%, respectively; p = 0.138), higher among nurses (41.7%) than physicians (29.1%) (p = 0.000), as well as among those employed in general hospitals (42.6%) and institutes of public health (43.8%) (p = 0.000). Significantly increased risk of being an ever or current smoker was noticed for nurses (OR = 1.75, 95% CI 1.42-2.14; and OR = 1.91, 95% CI 1.52-2.40, respectively), those employed in general hospitals (OR = 1.37, 95% CI 1.09-1.73 and OR = 1.40, 95% CI 1.09-1.79, respectively), and with worse self-estimated health (OR = 1.15, 95% CI 1.02-1.30; and OR = 1.17, 95% CI 1.02-1.34, respectively). Intentions to quit smoking or to reduce the number of cigarettes were more frequent in women (OR = 1.51, 95% CI 1.01-2.27) and participants who worse evaluated their health (OR = 1.74, 95% CI 1.39-2.18). CONCLUSION: High smoking prevalence in health professionals could be a barrier for the full implementation of smoking ban in health institutions in Serbia. Smoking cessation programs at workplaces, formal education in smoking cessation techniques, and better Law enforcement by health administrations should be implemented.

The influence of maternal smoking and exposure to residential ETS on pregnancy outcomes: a retrospective national study.

In a nationwide study of Serbian births, in 2008, we estimated the influence of maternal prenatal smoking and environmental tobacco smoke (ETS) exposure on birth outcomes. Using stratified two-stage random cluster sampling, 2,721 women were interviewed in-person (response rates 98.1 %), and 2,613 singleton live births were included. Date of birth, gender, birthweight, birth height and head circumference were copied from the official hospital Birth Certificate. Six exposure categories were defined according to mother's smoking history and exposure to ETS. We calculated adjusted mean values and group differences by analysis of covariance, and adjusted odds ratios for the low birthweight (LBW < 2,500 g). Compared to the reference category (non-smoking, non-exposed to ETS) we observed birthweight reductions in infants whose mothers smoked continuously during the pregnancy and were exposed to ETS (-162.6 g) and whose mothers were not exposed to ETS (-173 g) (p = 0.000, and p = 0.003, respectively), as well as reduction in birth length (-1.01 and -1.06 cm; p = 0.003 and p = 0.000, respectively). Reduction in birthweight and birth length related to exposure categories was not linear. Adjusted OR for LBW was almost tripled for mothers who smoked over the entire pregnancy and were non-exposed to ETS (aOR 2.85; 95 % CI 1.46-5.08), and who were exposed to ETS (aOR 2.68; 95 % CI 1.15-6.25). Our results showed strong effects of smoking throughout the pregnancy on reduced birthweight, birth length and head circumference, and increased risk for LBW. We were not able to detect an effect for ETS exposure alone.

Prevalence and predictors of smoking and quitting during pregnancy in Serbia: results of a nationally representative survey.

OBJECTIVES: Middle- and low-income countries rarely have national surveillance data on smoking in pregnancy. This nationwide population-representative survey investigated pre- and post-partum smoking and their predictors in Serbia. METHODS: Using stratified two-stage random cluster sampling, 2,721 women in 66 health care centres were interviewed at 3 and 6 months post-partum. RESULTS: 37.2% of women smoked at some point in pregnancy (average 8.8 cigarettes/per day). Smoking at pregnancy onset and during pregnancy was associated with smoking by others in the home and lower education and family socio-economic status. Almost a quarter of women (23.2%) who quit smoking during pregnancy did not relapse 6 months post-partum. Older women, primiparae, university students and white-collar workers were more likely to successfully quit smoking. More than a half of women were exposed to SHS in their homes (57.6%) and 84.6% allowed smoking in their homes. CONCLUSION: Smoking during pregnancy in Serbia was two- to threefold higher than in the most affluent western countries. Target groups for action are women with lower education and socio-economic status, as well as health professionals and family members who smoke.

Occupation and chronic bronchitis among Chinese women.

OBJECTIVE: To examine the association between occupation and chronic bronchitis among a cross section of Chinese women who participated in the Shanghai Women's Health Study. METHODS: Cases were 4873 women who self-reported a physician-diagnosed bronchitis during adulthood. Controls were 9746 women randomly selected from Shanghai Women's Health Study participants and matched with the cases by year of birth and age at diagnosis. Lifetime occupational histories were obtained. Logistic regressions were used to evaluate the association between chronic bronchitis and occupation, adjusting for smoking, education, family income, and concurrent asthma. RESULTS: We observed excess prevalence of bronchitis for textile occupation (odds ratio, OR = 1.09; 95% CI = 1.00-1.18) and industry (OR = 1.11; 95% CI = 1.03-1.19), welders (OR = 1.40; 95% CI = 1.01-1.92), packing and baling workers (OR = 1.39; 95% CI = 1.15-1.68), and warehousing industry (OR = 1.58; 95% CI = 1.08-2.30) We also identified several new associations that may warrant further exploration and confirmation, including employment in some metal fabrication industries, postal and telecommunication industry, and a few white-collar occupations and industries. CONCLUSIONS: Our study indicates that the risk of chronic bronchitis among women may be increased in some occupations and industries.

Occupation and adult-onset asthma among Chinese women in a population-based cohort.

BACKGROUND: Exposure to industrial irritants is believed to have contributed to the increasing prevalence of asthma worldwide. We examined the associations between occupation and asthma among women in a case-control study nested in the population-based Shanghai Women's Health Study cohort in China. METHODS: Cases were 1,050 women who reported a physician-diagnosed asthma as adults. Controls were 4,200 women matched to the cases by year of birth and age at diagnosis. Lifetime occupational histories were obtained. Logistic regression was applied to estimate odds ratios (ORs) adjusting for smoking, education, family income, and concurrent chronic bronchitis. RESULTS: Asthma is more prevalent in production industries for metal tools (OR = 2.4; 1.3-4.7), metal products for everyday use (OR = 1.6; 1.1-2.4), ships (OR = 2.6; 1.0-6.8), and clocks (OR = 1.9; 1.0-3.4), and in occupations as farm workers (OR = 4.0; 1.2-13.0), laboratory technicians and analyzers (OR = 2.2; 1.2-3.9), and installation and maintenance workers for weaving and knitting machineries (OR = 2.4; 1.1-5.4). Other associations less commonly reported were identified for electricians (OR = 2.1; 1.1-4.1), performers (OR = 3.2; 1.4-7.4), administrative workers in organizations and enterprises (OR = 1.8; 1.1-2.8), and postal and telecommunication workers (OR = 3.5; 1.6-7.6). CONCLUSIONS: Our findings suggest that occupational exposures contribute to the development of asthma in women.

Neuropsychiatric effects in workers with occupational exposure to carbon disulfide.

In a cross-sectional study, prevalence of dysfunctions of the central nervous system was assessed in 134 male workers exposed to different levels of carbon disulfide (CS2) in a rayon viscose plant and compared to 38 non-exposed workers. In three groups of workers from the same plant with different levels of CS2 (heavy, intermediate, none) estimated by personal samplers, disorders in the central nervous system were examined by means of psychiatric examination and questionnaire 16 (Q16). Unconditional logistic regression was calculated adjusted for age, alcohol consumption and education. Psychoorganic syndrome was diagnosed significantly more often in workers with heavy CS2 exposure, with adjusted OR of 17.9 (95% CI 2.18-146.73), and insignificantly in workers with intermediate exposure. Prevalence of workers with more than 6 positive answers on the Q16 was higher in the heavily exposed workers (OR=4.76; 95% CI 1.80-12.60). A similar result was found for almost all the questions in the Q16, and the most pronounced psychological symptom was of less interest in sex (adjusted OR=8.14; 95% CI 2.19-30.22). High correlation was found between symptoms recorded on neuropsychiatric examination and on Q16. Both neuropsychiatric exams and Q16 indicated disturbances in the central nervous system due to the long-term heavy exposure to CS2. Disorders of the central nervous system were found more often in workers with heavy exposure to CS2. Questionnaire Q16 is a valuable means for selecting workers for further neuropsychiatric testing.

Occupational health in Yugoslavia.

Occupational health in Yugoslavia was once well organized in accordance with WHO declarations and ILO conventions and recommendations. Since the 1990s, the system has been disrupted by destruction of the former Yugoslavia, wars, refugees, changes in the economy, and NATO bombardment. Economic trends, main industries, and employment and unemployment conditions in Yugoslavia are presented. The organization of occupational health services, their tasks, and prevailing problems are discussed. Occupational diseases and relevant research and educational opportunities are described. The authors conclude by suggesting approaches to improving worker's health in the future.