Smoking habits, awareness of risks, and attitude towards tobacco control policies among medical students in Lagos, Nigeria.

BACKGROUND: This study aimed to assess the prevalence of cigarette smoking among medical students, and to determine their level of knowledge regarding risk associated with cigarette smoking and their attitude and behavior towards tobacco control strategies and policies. MATERIALS AND METHODS: A stratified random sampling approach was used to select participants. A modified version of the the Global Health Professional Students Survey questionnaire was self-administered. Descriptive statistics were applied and comparisons were done using chi-square test. Multivariate logistic regression was used to obtain the significant determinants of smoking. A P < 0.05 was considered significant. RESULTS: A total of 250 students participated in the study with a response rate of 89.2%. The mean age (years) was 21.4 ± 3. Rate of ever smoking and current smoking was 9.6 and 1.2%, respectively. Age > 21, having a smoking father, and use of alcohol were significantly associated with ever smoking. Knowledge of smoking as a risk for emphysema was 72.8%, coronary artery disease 82.8%, stroke 68.8%, and low birth weight 76.4%. There were 103 (41.2%) students aware of antidepressant usage in smoking cessation. One hundred and ninety-five (78%) offered smoking cessation advice if a smoker had no smoking-related disease and did not seek their opinion about smoking, 68.8% affirmed to having adequate knowledge on smoking cessation, and 56.8% had received formal training on smoking cessation techniques. The ban on cigarette smoking in enclosed public places was supported by 92.4%. CONCLUSIONS: The prevalence of current cigarette smoking among medical students in Lagos is relatively low. Gaps exist in the level of knowledge of the students regarding risks of cigarette smoking, tobacco cessation strategies, and in their attitude and behavior towards offering tobacco cessation advice. There is need therefore to include formal training on tobacco control strategies at an early stage in the medical curriculum.

The ACT and the ATAQ are useful surrogates for asthma control in resource-poor countries with inadequate spirometric facilities.

OBJECTIVE: The objective of this study is to determine the utility of simple asthma control questionnaires in assessing the asthma control in our practice setting. METHODS: The Asthma Control Test (ACT), Asthma Therapy Assessment Questionnaire (ATAQ), and mini Asthma Quality of Life Questionnaire (mini AQLQ) were administered to previously diagnosed asthma patients. Spirometry was performed to obtain the prebronchodilator forced expiratory volume in 1 second (FEV1). The relationship between test scores (ACT and ATAQ) and the FEV1 and mini AQLQ scores, respectively, was explored. RESULTS: A total of 106 patients (mean age 41 ± 15.3 years, 61 (57.5%) females) participated in the study. The mean ACT score was 17 ± 5.3 and the mean ATAQ score was 1.46 ± 1.34. There was a significant positive correlation between the ACT score and FEV1% predicted indicating the improvement in asthma control when FEV1% predicted increases (Pearson's correlation = 0.518, R² = 0.268, p < .0001) and a negative correlation between the ATAQ score and FEV1% predicted also indicating the improvement in asthma control when FEV1% predicted increases (Pearson's correlation = -0.516, R² = 0.266, p < .0001). The ACT score was significantly and positively related to the mini AQLQ score signifying an improvement in quality of life with increasing ACT score (Pearson's correlation = 0.691, R² = 0.461, p < .0001).The ATAQ score was significantly and negatively related to the mini AQLQ score indicating an improvement in quality of life with decreasing ATAQ score (Pearson's correlation = -0.654, R² = 0.428, p ≤ .0001). The FEV1% predicted and the mini AQLQ score were the only significant determinants of both the ACT score and the ATAQ score. CONCLUSION: The ACT and ATAQ are the objective and reliable tools in determining asthma control due to their strong correlation with the FEV1 and the asthma-specific health-related quality of life. Use of either questionnaire routinely will identify more patients with poor asthma control even when spirometry services are not readily available.

Eligibility of Nigerians with type 2 diabetes mellitus for inhaled insulin.

BACKGROUND: Parenteral delivery of insulin has been shown to reduce acceptance of insulin as a treatment option in type 2 diabetes mellitus (DM) patients. The advent of inhaled insulin is aimed at circumventing this problem; however inhaled insulin is a treatment option only for DM patients with normal lung function. OBJECTIVE: The study set out to evaluate the forced expiratory volume in the first second in Liters (FEV1) of Nigerians with type 2 DM and thus determine the proportion potentially eligible for inhaled insulin. METHODS: FEV1 was measured in 101 subjects with type 2 DM and 104 age, gender and body mass index matched controls without DM. All subjects were 'never smokers' without any physical condition that could compromise lung function. We then determined the proportion of subjects with FEV1, more than 70% of normal, which defines eligibility for inhaled insulin. RESULTS: On the basis of the mean FEV1 in Liters of matched controls in this study being 2.58+ 0.62, the cot off for minimium FEV1 to qualify for inhaled insulin therapy was determined as 1.80 liters (i.e 70% of 2.58). A total of 83 (84%) of the 101 subjects with type 2 DM had FEV1 >1.8 liters indicative of eligibility for inhaled insulin. Male sex, shorter duration of DM, normal body mass index (BMI) and younger age were associated with eligibility. CONCLUSION: A high proportion of Nigerians with type 2 DM attending tertiary care are eligible for inhaled insulin therapy making it a treatment option. The feasibility of this treatment option in terms of acceptability, affordability, side effect profile and efficacy in blood glucose control in Nigerians is an important research focus.