The impact of early life stress on risk of tobacco smoking initiation by adolescents.

AIMS: Our study aimed to examine the association between early life stress and early initiation of alcohol and tobacco use. DESIGN: This prospective cohort study of women and children belongs to the Ukrainian component of the European Longitudinal Study of Pregnancy and Childhood. SETTING: Dniprodzerzhynsk, a city of some 250,000 inhabitants in south central Ukraine. PARTICIPANTS: All 4398 women who visited antenatal clinics between December 25, 1992 and July 23, 1994, planned to continue their pregnancy, and were permanent residents of the city were invited to participate. Of the 4398 invitees, 2148 agreed and 1020 of the mother-child pairs were available for complete follow-up until the children were 16 years old. MEASUREMENTS: When study children reached ages 3 and 7, their mothers completed questionnaires about their children's exposure to and impact from a standard list of recent stressful life events. From the data on event prevalence and severity, we assigned each child to low, medium, or high early life stress. When the children became age 16, they completed questionnaires about their history of smoking and drinking. FINDINGS: In multivariate analysis that controlled for current level of family income, current family type, current school type, year of child's birth, lifetime smoking and current drinking by mother, and education of mother and father, girls with high stress at age 3 had 2.2 times (95% confidence interval: 1.23-4.08) higher odds than girls with low stress to start smoking early. CONCLUSIONS: Our study may be the first to use a longitudinal study design to examine early life stress as a risk factor for early smoking initiation in adolescence.

Smoke-Free Universities Help Students Avoid Establishing Smoking by Means of Facilitating Quitting.

BACKGROUND: This study aimed to clarify whether smoke-free policies affect the initiation or the quitting of smoking among young adults. METHODS: In this natural quasi-experiment study, three universities with different enforcement of smoke-free policies were considered in Kazan City, Russian Federation. Exposure data were collected in 2008-2009 through measurement of particulate matter concentrations in typical sets of premises in each university to distinguish smoke-free universities (SFU) and those not smoke-free (NSFU). All present third year students were surveyed in class in April-June 2011. Number of valid questionnaires equaled 635. The questionnaire was adapted from the Health Professions Students Survey and contained questions on smoking initiation, current tobacco use, willingness to quit, quit attempts, percep-tion of smoke-free policies enforcement, and the demographic data. RESULTS: Among students of SFU, the percentage of current smokers was smaller than in NSFU: 42% vs. 64% in men and 32% vs. 43% in women. Prevalence of daily smoking was 11-12% in SFU, 26% in NSFU overall and 42% among male students. No advantage of SFU in limiting smoking initiation was found. Percentage of former smokers in SFU was 33% vs. 10% in NSFU. Among current smokers, 57% expressed willingness to quit in SFU and only 28% in NSFU. About 60% of current smokers in SFU attempted to quit within a year and only 36% did so in NSFU with 23% vs. 3% having done three or more attempts. CONCLUSION: Smoke-free universities help young adults to avoid establishing regular smoking by means of facilitating quitting smoking.

The potential for bridging: HIV status awareness and risky sexual behaviour of injection drug users who have non-injecting permanent partners in Ukraine.

OBJECTIVE: To quantify potential bridging of HIV transmission between the injection drug using subpopulation to the non-injection drug using population through unprotected heterosexual sex. DESIGN: Secondary analysis of cross-sectional data. METHODS: A sub-sample of participants who reported having a permanent partner who are not injection drug users and have not injected drugs in the past (N=1379) was selected from a survey implemented in 26 Ukrainian cities in 2011. This study evaluates the association between consistent condom use and awareness of HIV status as measured by rapid testing during the study (known/unknown HIV+, known/unknown HIV- and undetermined) among a sub-sample of male injection drug users (IDUs) who have a non-injecting permanent partner. Poisson regression, with robust variance estimates, was utilized to identify associations while adjusting for other factors. RESULTS: Reported consistent condom use varied between 15.5% (unknown HIV-) and 37.5% (known HIV+); average use was 19.3%. In multivariate analysis, males who were aware of their HIV+ status were more likely to report recent consistent condom use compared to those who were unaware of their HIV+ status. This association remains after adjustment for age, region, education level, years of injection, alcohol use, self-reported primary drug use and being an NGO client (prevalence ratio=1.65; 95% CI 1.03-2.64). No such association was found for those who were HIV-. CONCLUSIONS: Our results regarding HIV-positive male IDUs reinforce previous findings that HIV testing and counselling may be an effective means of secondary prevention. Further research is needed to understand how to effectively promote safer sex behaviours for IDUs who are currently HIV-.

Recall of tobacco pack health warnings by the population in Ukraine and its association with the perceived tobacco health hazard.

OBJECTIVES: After years of prevalence of smoking increase, Ukraine observes its decline. Recent tobacco control measures included smoke-free policies, new textual health warnings (THW) since late 2006, ban of outdoor tobacco advertising since January 2009 and tobacco tax increase since late 2008. The objective was to estimate potential contribution of THW to smoking decline process in Ukraine. METHODS: The study is based on a nationwide omnibus survey of 2008 Ukrainian adults (18+). OUTCOME MEASURES: quitting smoking after 2006 and perception of tobacco-related hazards. To measure the exposure to THW respondents were asked to describe the warnings they recall. Multivariate regression analysis was performed in SPSS 15.0. RESULTS: Those who considered health hazard of smoking as serious were significantly more likely to quit. Male smokers were more likely to perceive health hazard if they recalled health warnings 'Smoking is addictive, do not start to smoke!' and 'Smokers die early'. CONCLUSIONS: THW reach those groups of the population they are aimed to and may potentially result in consequent quitting smoking in male smokers.

Changes in smoking prevalence in Ukraine in 2001-5.

OBJECTIVES: To analyse trends in smoking prevalence in Ukraine from three surveys conducted in 2001-5, and to explore correlates of observed changes, in order to estimate the stage of tobacco epidemic in Ukraine. DESIGN: Repeated national interview surveys in Ukraine in 2001, 2002 and 2005. MAIN OUTCOME MEASURE: Prevalence of current smoking among the population aged > or = 15 years. RESULTS: The age-standardised prevalence of current smoking in Ukrainian men was 54.8% in 2001 and 66.8% in 2005. Among Ukrainian women, prevalence increased from 11.5% in 2001 to 20.0% in 2005. ORs for yearly increase in prevalence were estimated as 1.164 (95% CI 1.111 to 1.220) for men and 1.187 (1.124 to 1.253) for women, which implies that, on average, 3-4% of men and 1.5-2% of women living in Ukraine join the smoking population each year. CONCLUSIONS: In Ukraine, smoking prevalence is increasing in most population groups. Among men, the medium deprivation group with secondary education has the highest smoking prevalence. Among women, while the most educated, young and those living in larger cities are the leading group for tobacco use, other groups are also increasing their tobacco use. Tobacco promotion efforts appear to have been significantly more effective in Ukraine than smoking control efforts. The decrease in real cigarette prices in Ukraine in 2001-5 could be the main factor explaining the recent growth in smoking prevalence.

Correlates of smoking initiation among young adults in Ukraine: a cross-sectional study.

AIM: To estimate the impact of smoking restrictions in homes and schools, and tobacco advertising and information on smoking initiation by young people in Ukraine. METHODS: Data of 609 young people aged 15-29 was taken from the national representative survey conducted in June 2005. OUTCOME MEASURES: The reported age of cigarette initiation was used to characterize the start of smoking experimentation, and the reported age of daily smoking initiation was considered to be a characteristic of established smoking. ANALYSIS: survival analysis Cox proportional hazard regression models were used. RESULTS: Age of smoking initiation was reported by 87% of young men and 61% of young women, the beginning of daily smoking by 71% and 33% respectively. Being frequently exposed to second-hand smoke and having no household smoking restrictions was associated with a higher risk of earlier smoking initiation both for men and women. For women, this risk was associated with age, HR = 0.95, (95% CI 0.91-0.98), that is, younger girls were more likely to smoke their first cigarette earlier in their lifetime. Those women had a higher risk of early smoking initiation who reported to receive tobacco-related information from magazines, HR = 1.40 (1.01-1.92), and outdoor tobacco advertising, HR = 1.99 (1.45-2.75). With both men and women, the risk of establishing daily smoking was higher in those with lower levels of tobacco-related knowledge and less household smoking restrictions. For women, the risk was higher in those who live in larger cities HR = 1.77 (1.10-2.86), and who received information about tobacco smoking from colleagues or friends HR = 1.83 (1.13-2.95). CONCLUSION: Encouraging people to eliminate their homes of tobacco smoke and tobacco advertising bans can be effective measures in preventing the initiation of smoking among young people. Young female smoking initiation is of special concern in Ukraine, since they are more responsive to tobacco marketing and pro-smoking peer influence.