Journal of Preventive Medicine and Public Health

Perspective

Epidemiological Model for Conventional Tobacco Control Measures and Tobacco Endgame Policies: Heewon Kang, Sung-il Cho; J Prev Med Public Health. 2023;56(5):481-484. Published online September 26, 2023; DOI: https://doi.org/10.3961/jpmph.23.239

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Epidemiological models, also known as host-agent-vector-environment models, are utilized in public health to gain insights into disease occurrence and to formulate intervention strategies. In this paper, we propose an epidemiological model that incorporates both conventional measures and tobacco endgame policies. Our model suggests that conventional measures focus on relationships among agent-vector-host-environment components, whereas endgame policies inherently aim to change or eliminate those components at a fundamental level. We also found that the vector (tobacco industry) and environment (physical and social surroundings) components were insufficiently researched or controlled by both conventional measures and tobacco endgame policies. The use of an epidemiological model for tobacco control and the tobacco endgame is recommended to identify areas that require greater effort and to develop effective intervention measures.

Summary

Korean summary
이 연구는 기존의 담배규제와 관련된 역학 모형을 확장하여 담배 수요를 줄이기 위한 조치인 MPOWER 정책과 담배 종결전의 주요 정책을 아우르는 개념적 모형을 제시하였다. 각 정책을 개념적 모형 내 배치한 결과, MPOWER 정책은 모형 내 구성요소 간의 연결을 끊는 것을 목표로 하는 반면, 종결전 정책은 모형 내 요소들을 영구적으로 변화시키거나 제거하려는 특성을 가지고 있는 것으로 나타났다. 담배규제정책이 개체, 병원체, 벡터 및 환경 요소에 대한 균형 잡힌 포트폴리오를 갖추고 있는지 평가하기 위해 이 개념적 모형을 활용할 수 있다.

Key Message
We extended the conceptual epidemiological model for tobacco control by incorporating measures to reduce the demand for tobacco (MPOWER measures) and key endgame policies. The model suggests that MPOWER measures focus on disconnecting the relationships between model components, while endgame policies aim to permanently change or eliminate the components themselves. This model can be used to examine whether a country or jurisdiction's tobacco control policy maintains a balanced portfolio across agent, host, vector, and environmental factors.

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Public support for tobacco endgame policies in South Korea: Findings from the 2020 International Tobacco Control Korea Survey
Heewon Kang, Wonjeong Yoon, Hong Gwan Seo, Sungkyu Lee, Sujin Lim, Gil-yong Kim, Su Young Kim, Steve S Xu, Mi Yan, Anne C K Quah, Janet Chung-Hall, Lorraine V Craig, Coral E Gartner, Geoffrey T Fong, Sung-il Cho
Tobacco Control.2024; : tc-2023-058454. CrossRef
Decrease in household secondhand smoking among South Korean adolescents associated with smoke-free policies: grade-period-cohort and interrupted time series analyses
Hana Kim, Heewon Kang, Sung-il Cho
Epidemiology and Health.2023; : e2024009. CrossRef

Original Articles

Association Between Tobacco Smoking and Dental Caries in the Indonesian Population: Results of a National Study in 2018: Lelly Andayasari, Rofingatul Mubasyiroh, Iin Nurlinawati, Irna Sufiawati; J Prev Med Public Health. 2023;56(4):357-367. Published online July 10, 2023; DOI: https://doi.org/10.3961/jpmph.22.417

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Abstract PDF

Objectives
The 2018 Basic Health Research (RISKESDAS), conducted by the Ministry of Health of the Republic of Indonesia showed a high prevalence of dental caries (88.8%) in Indonesia and suggested that smoking tobacco was associated with an increased risk of dental caries. This study analyzed the association between tobacco smoking and dental caries in the Indonesian population.
Methods
This was a cross-sectional analysis of secondary data collected from RISKESDAS 2018. The study population included 35 391 Indonesians aged ≥10 years from all 34 provinces. The decayed, missing, and filled teeth (DMFT) index was used to measure dental caries. Smoking status was assessed qualitatively based on smoking activity, and the level of smoking exposure was assessed based on the Brinkman index. A multivariable logistic regression analysis was employed to examine the relationships of smoking status and smoking exposure levels with the DMFT index.
Results
Of the population aged ≥10 years, 36% had a DMFT≥8 (females: 37.5%, males: 33.9%). Almost one-fourth (23.4%) were current smokers, and 4.1% were ex-smokers. Furthermore, 26.4% had a Brinkman index ≥400, indicating heavy smoking. According to the multivariate analysis, current smoking status was associated with the risk of DMFT≥8 in males (adjusted odds ratio [aOR], 1.40; 95% CI, 1.27 to 1.55; p<0.001) and overall (aOR, 1.07; 95% CI, 1.00 to 1.14; p=0.037). In females, ex-smoking was associated with a 41% higher risk of DMFT≥8 (aOR, 1.41; 95% CI, 1.07 to 1.84; p=0.014). Heavy smoking was associated with a higher risk of DMFT≥8 in males (aOR, 1.38; 95% CI, 1.25 to 1.52; p<0.001) and females (aOR, 1.24; 95% CI, 1.03 to 1.50; p=0.022).
Conclusions
Tobacco smoking was associated with dental caries in the Indonesian population.

Summary

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Potential interaction of sugar intake and tobacco exposure on dental caries in adults-A cross-sectional study from the National Health and Nutrition Examination Survey
Xuewei Niu, Xiaoan Rong, Hantang Sun
Journal of Dental Sciences.2023;[Epub] CrossRef
Letter to the Editor: Tobacco Use: Strategies for Prevention in Low and Middle-income Countries
Israel Oluwasegun Ayenigbara
Journal of Preventive Medicine and Public Health.2023; 56(5): 485. CrossRef

Tobacco Control Stakeholder Perspectives on the Future of Tobacco Marketing Regulation in Indonesia: A Modified Delphi Study: Putu Ayu Swandewi Astuti, Mary Assunta, Becky Freeman; J Prev Med Public Health. 2021;54(5):330-339. Published online August 26, 2021; DOI: https://doi.org/10.3961/jpmph.21.181

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Objectives
Tobacco control in Indonesia is very lenient compared to international standards. This study explored the perspectives of tobacco control stakeholders (TCSs) on the likelihood of advancing tobacco marketing regulation in Indonesia.
Methods
Data were collected from TCSs who were members of the Indonesia Tobacco Control Network group in a modified Delphi study. We collected the data in 2 waves using a questionnaire that comprised a set of closed and open-ended questions. For this paper, we analysed 2 of the 3 sections of the questionnaire: (1) tobacco advertising, promotions, and sponsorship (TAPS) bans, and (2) marketing and retailing regulations. We conducted a descriptive analysis of the scores using Stata/IC.13 and summarised the comments for each item.
Results
The TCSs viewed the measures/strategies across all aspects of TAPS and tobacco marketing regulation as highly desirable, but provided varied responses on their feasibility. They rated political feasibility lower than technical feasibility for most measures. Advancing TAPS measures and prohibition of selling to minors were considered more attainable by sub-national governments, while prohibition of tobacco corporate social responsibility was considered as the least feasible measure in the next 5 years.
Conclusions
Despite little optimism for substantial national-level change, there is a positive expectation that sub-national governments will strengthen their tobacco control regulation. It is paramount that the government reduce tobacco industry leverage by implementing Article 5.3 of the World Health Organization Framework Convention on Tobacco Control. Extending advocacy networks beyond tobacco control groups and framing tobacco control more effectively are necessary steps.

Summary

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Tobacco policy (in)coherence in Mozambique: an examination of national and subnational stakeholder perspectives
Nicole Nguenha, Charo Rodriguez, Jeffrey Drope, Stella Aguinaga Bialous, Benedito Cunguara, Raphael Lencucha
Health Policy and Planning.2024; 39(4): 333. CrossRef
Achieving a tobacco-free Bangladesh by 2040: a qualitative analysis of the tobacco advertising environment and prohibitions in Bangladesh
Arsenios Tselengidis, Sally Adams, Becky Freeman, Syed Mahbubul Alam, Putu Ayu Swandewi Astuti, Jo Cranwell
BMJ Open.2023; 13(5): e069620. CrossRef

Factors Associated With Quitting Smoking in Indonesia: Rimawati Aulia Insani Sadarang; J Prev Med Public Health. 2021;54(2):137-144. Published online March 8, 2021; DOI: https://doi.org/10.3961/jpmph.20.293

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Objectives
The aim of this study was to identify factors associated with quitting smoking in Indonesia
Methods
Data on 11 115 individuals from the fifth wave of the Indonesia Family Life Survey were analyzed. Quitting smoking was the main outcome, defined as smoking status based on the answer to the question “do you still habitually (smoke cigarettes/smoke a pipe/use chewing tobacco) or have you totally quit?” Logistic regression was performed to identify factors associated with successful attempts to quit smoking.
Results
The prevalence of quitting smoking was 12.3%. The odds of successfully quitting smoking were higher among smokers who were female (adjusted odds ratio [aOR], 2.69; 95% confidence interval [CI], 2.08 to 3.33), were divorced (aOR, 2.45; 95% CI, 1.82 to 3.29), did not chew tobacco (aOR, 3.01; 95% CI, 1.79 to 5.08), found it difficult to sacrifice smoking at other times than in the morning (aOR, 1.29; 95% CI, 1.14 to 1.46), and not smoke when sick (aOR, 1.32; 95% CI, 1.14 to 1.54). About 59% of variance in successful attempts to quit smoking could be explained using a model consisting of those variables.
Conclusions
Female sex, being divorced, not chewing tobacco, and nicotine dependence increased the odds of quitting smoking and were associated with quitting smoking successfully. Regular and integrated attempts to quit smoking based on individuals’ internal characteristics, tobacco use activity, and smoking behavior are needed to quit smoking.

Summary

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Predictor of smoking cessation among school-going adolescents in Indonesia: a secondary analysis based on the transtheoretical model of behavioral change
Omid Dadras
Frontiers in Psychiatry.2024;[Epub] CrossRef
Individual-, social- and policy- factors associated with smoking cessation among adult male cigarette smokers in Hanoi, Vietnam: a longitudinal study
Thi Ngoc Phuong Nguyen, Jesper Love, Monica Hunsberger, Thi Phuong Thao Tran, Thuy Linh Nguyen, Thi Hai Phan, Ngoc Khue Luong, Van Minh Hoang, Nawi Ng
BMC Public Health.2023;[Epub] CrossRef
Quit Smoking Clinic: Factors Associated with Successful Quit Smoking in Besut District, Terengganu State of Malaysia
Nur Raihan Ismail, Hafizuddin Awang, Nurul Jannah A Rahman, Arfizah Ahmad Daud, Mohd Fariz Zulrushdi, Azmi Zainuddin, Mohd Anuar Abd Rahman, Kasemani Embong
European Journal of Medical and Health Sciences.2022; 4(6): 6. CrossRef

Brief Reports

Monitoring Compliance and Examining Challenges of a Smoke-free Policy in Jayapura, Indonesia: Wahyuti Wahyuti, Suci Hasairin, Sherly Mamoribo, Abdillah Ahsan, Dian Kusuma; J Prev Med Public Health. 2019;52(6):427-432. Published online November 22, 2019; DOI: https://doi.org/10.3961/jpmph.19.240

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Background
In Indonesia, 61 million adults smoked in 2018 and 59 million were exposed to secondhand smoke at offices or restaurants in 2011. The Presidential Decree 109/2012 encouraged local governments to implement smoke-free policy (SFP) with Jayapura city enacted a local bill (1/2015) in 2015. Objective: This study aims to evaluate the compliance and explore the challenges in implementing. Methods: We conducted a mixed-methods study. The quantitative method assessed the compliance to six criteria (as per the bill) including having signage, no smoking activity, no selling, no advertisement, no smoke, and no ashtray at SFP facilities. We surveyed 192 facilities including health facilities, educational facilities, places of worship, government offices, and indoor/outdoor public facilities. The qualitative method explored challenges in implementing through by interviewing 19 informants (government officers, students and community). Results: The compliance rate to all six criteria was 17% overall, ranging from 0% at outdoor public facilities to 50% at health facilities. We found no spatial patterning as shown by similar compliance rates between SFP facilities within and outside of 1-kilometer around the provincial and city health offices. Implementation challenges included (a) limited budget for enforcement, (b) lack of support from local non-government organizations and universities, (c) lack of public awareness at facilities, and (c) lack of examples from local leaders. Conclusion: The overall compliance was low in Jayapura city due to many challenges. This provides lessons learnt for tobacco control policy in the areas that are least developed and farthest from the central government.

Summary

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State of the literature discussing smoke-free policies globally: A narrative review
Jacqueline A. Teed, Meagan O. Robichaud, Michelle Duren, Hebe N. Gouda, Ryan David Kennedy
Tobacco Induced Diseases.2024; 22(January): 1. CrossRef
Barriers and opportunities for improving smoke-free area implementation in Banda Aceh city, Indonesia: a qualitative study
Sofyan Sufri, Nurhasanah Nurhasanah, Abdillah Ahsan, Irwan Saputra, Misbahul Jannah, Cut Meurah Yeni, Ainal Mardhiah, Saiful Bakri, Said Usman
BMJ Open.2023; 13(12): e072312. CrossRef
Decrease in household secondhand smoking among South Korean adolescents associated with smoke-free policies: grade-period-cohort and interrupted time series analyses
Hana Kim, Heewon Kang, Sung-il Cho
Epidemiology and Health.2023; : e2024009. CrossRef
Compliance With Tobacco Control Policy and Visibility of Cigarette Retailers Around Educational Facilities in Riyadh, Saudi Arabia
Hala AlJishi, Dian Kusuma, Alaa AlQurashi, Ali AlFaiz, Abdulaziz AlSaad, Maha Aljishi
Frontiers in Public Health.2022;[Epub] CrossRef
The Framework Convention on Tobacco Control (FCTC) and implementation of tobacco control policies: Lessons learned from Indonesia and Thailand
Faizal Rahmanto Moeis, Renny Nurhasana, Fandy Rahardi, Danty Novitasari, Ni Made Shellasih, Inayati, Murwendah, Paibul Suriyawongpaisal, Roengrudee Patanavanich, Suci Puspita Ratih
World Medical & Health Policy.2022; 14(4): 750. CrossRef
Worshippers smoking in mosques: Violation of fatwas of ulemas and governor regulation
Watni Marpaung, Muhammad A. Adly, Rustam Rustam, Akmaluddin Syahputra, Putra A. Siregar, Syahrial Arif Hutagalung, Muhammad S.A. Nasution, Fitri Hayati, Rahmad Efendi, Dhiauddin Tanjung
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Triasih Djutaharta, Nachrowi Djalal Nachrowi, Aris Ananta, Drajat Martianto
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Is Youth Smoking Related to the Density and Proximity of Outdoor Tobacco Advertising Near Schools? Evidence from Indonesia
Sri Handayani, Enny Rachmani, Kriswiharsi Kun Saptorini, Yusthin Merianti Manglapy, Nurjanah, Abdillah Ahsan, Dian Kusuma
International Journal of Environmental Research and Public Health.2021; 18(5): 2556. CrossRef
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Leonieke J Breunis, Metehan Bebek, Nazmi Dereci, Marlou L A de Kroon, Márta K Radó, Jasper V Been
Nicotine & Tobacco Research.2021; 23(12): 2075. CrossRef
Effect of tobacco outlet density on quit attempts in Korea: a multi-level analysis of the 2015 Korean Community Health Survey
Jaehyung Kong, Sung-il Cho
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Removal of point-of-sale tobacco displays in Bogor city, Indonesia: A spatial analysis
Bambang Priyono, Balqis Hafidhah, Wihardini Wihardini, Ramadhani Nuryunawati, Fathi Rahmadi, Dian Kusuma
Tobacco Prevention & Cessation.2020;[Epub] CrossRef
Improvement in Compliance With Smoke-Free Environment Regulations at Hotels and Restaurants in Vietnam After an Administrative Intervention
Kim Bao Giang, Pham Bich Diep, Hoang Van Minh, Nguyen Thi Diem Huong, Nguyen Tuan Lam, Pham Quynh Nga, Momoe Takeuchi, Kidong Park
Environmental Health Insights.2020; 14: 117863022093992. CrossRef

National Trends in Smoking Cessation Medication Prescriptions for Smokers With Chronic Obstructive Pulmonary Disease in the United States, 2007-2012: Min Ji Kwak, Jongoh Kim, Viraj Bhise, Tong Han Chung, Gabriela Sanchez Petitto; J Prev Med Public Health. 2018;51(5):257-262. Published online August 23, 2018; DOI: https://doi.org/10.3961/jpmph.18.119

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Abstract PDF

Objectives
Smoking cessation decreases morbidity and mortality due to chronic obstructive pulmonary disease (COPD). Pharmacotherapy for smoking cessation is highly effective. However, the optimal prescription rate of smoking cessation medications among smokers with COPD has not been systemically studied. The purpose of this study was to estimate the national prescription rates of smoking cessation medications among smokers with COPD and to examine any disparities therein.
Methods
We conducted a retrospective study using National Ambulatory Medical Care Survey data from 2007 to 2012. We estimated the national prescription rate for any smoking cessation medication (varenicline, bupropion, and nicotine replacement therapy) each year. Multiple survey logistic regression was performed to characterize the effects of demographic variables and comorbidities on prescriptions.
Results
The average prescription rate of any smoking cessation medication over 5 years was 3.64%. The prescription rate declined each year, except for a slight increase in 2012: 9.91% in 2007, 4.47% in 2008, 2.42% in 2009, 1.88% in 2010, 1.46% in 2011, and 3.67% in 2012. Hispanic race and depression were associated with higher prescription rates (odds ratio [OR], 5.15; 95% confidence interval [CI], 1.59 to 16.67 and OR, 2.64; 95% CI, 1.26 to 5.51, respectively). There were no significant differences according to insurance, location of the physician, or other comorbidities. The high OR among Hispanic population and those with depression was driven by the high prescription rate of bupropion.
Conclusions
The prescription rate of smoking cessation medications among smokers with COPD remained low throughout the study period. Further studies are necessary to identify barriers and to develop strategies to overcome them.

Summary

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Amanda S. Weissman, Varun Ranpariya, Alan B. Fleischer, Steven R. Feldman
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Special Article

Scientific Evidence for the Addictiveness of Tobacco and Smoking Cessation in Tobacco Litigation: Sungwon Roh; J Prev Med Public Health. 2018;51(1):1-5. Published online November 29, 2017; DOI: https://doi.org/10.3961/jpmph.16.088

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Abstract PDF

Smokers keep smoking despite knowing that tobacco claims many lives, including their own and others’. What makes it hard for them to quit smoking nonetheless? Tobacco companies insist that smokers choose to smoke, according to their right to self-determination. Moreover, they insist that with motivation and willpower to quit smoking, smokers can easily stop smoking. Against this backdrop, this paper aims to discuss the addictive disease called tobacco use disorder, with an assessment of the addictiveness of tobacco and the reasons why smoking cessation is challenging, based on neuroscientific research. Nicotine that enters the body via smoking is rapidly transmitted to the central nervous system and causes various effects, including an arousal response. The changes in the nicotine receptors in the brain due to continuous smoking lead to addiction symptoms such as tolerance, craving, and withdrawal. Compared with other addictive substances, including alcohol and opioids, tobacco is more likely to cause dependence in smokers, and smokers are less likely to recover from their dependence. Moreover, the thinning of the cerebral cortex and the decrease in cognitive functions that occur with aging accelerate with smoking. Such changes occur in the structure and functions of the brain in proportion to the amount and period of smoking. In particular, abnormalities in the neural circuits that control cognition and decision-making cause loss of the ability to exert self-control and autonomy. This initiates nicotine dependence and the continuation of addictive behaviors. Therefore, smoking is considered to be a behavior that is repeated due to dependence on an addictive substance, nicotine, instead of one’s choice by free will.

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Original Articles

Using Focus Group Interviews to Analyze the Behavior of Users of New Types of Tobacco Products: Jinyoung Kim, Sungkyu Lee; J Prev Med Public Health. 2017;50(5):336-346. Published online September 18, 2017; DOI: https://doi.org/10.3961/jpmph.17.052

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Objectives
To characterize the usage patterns of new types of tobacco products (NTTPs) to develop effective strategies for the regulation of NTTPs in Korea. Methods: We conducted focus group interviews to identify the NTTP usage patterns of research subjects. The NTTPs were limited to electronic cigarettes (e-cigarettes), waterpipe tobacco, and rolling tobacco. We categorized 30 research subjects into 4 groups. The e-cigarette group was divided into adult and adolescent groups. Each group contained 7-8 subjects. An interview lasting approximately 2 hours was conducted with each group. Results: Ninety percent of NTTP users used an NTTP in combination with conventional cigarettes. Subjects mostly bought NTTPs online, unlike how they bought cigarettes. Additionally, a great deal of information, such as how to use NTTPs and descriptions of NTTP products, was exchanged through online or offline societies. The primary reason why the subjects used NTTPs was that NTTPs offer a greater range of flavors and aromas than cigarettes. Moreover, NTTPs were felt to be less repulsive than cigarettes. NTTPs were not used as a cigarette substitute; rather, they were mostly used in places and situations where traditional cigarette smoking was not allowed. Conclusions: Based on the results of this study, the government should conduct studies on the effects of the combined use of NTTPs and cigarettes on the human body, obtain and provide accurate data regarding NTTP use, and develop and implement polices to ban NTTP advertising, which may arouse adolescents’ curiosity, and the addition of flavoring substances to tobacco products.

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Determinants of e-cigarette use among a sample of high school students in Jakarta, Indonesia
Mouhamad Bigwanto, Mochamad Iqbal Nurmansyah, Elizabeth Orlan, Yoli Farradika, Tri Bayu Purnama
International Journal of Adolescent Medicine and Health.2022;[Epub] CrossRef
Youth use of e‐liquid flavours—a systematic review exploring patterns of use of e‐liquid flavours and associations with continued vaping, tobacco smoking uptake or cessation
Caitlin Notley, Sarah Gentry, Sharon Cox, Martin Dockrell, Michelle Havill, Angela S. Attwood, Matthew Smith, Marcus R. Munafò
Addiction.2022; 117(5): 1258. CrossRef
The emerging norms of e-cigarette use among adolescents: A meta-ethnography of qualitative evidence
Hannah Smith, Mark Lucherini, Amanda Amos, Sarah Hill
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Effects of education methods on self-efficacy of smoking cessation counseling among medical students
Ara Cho, Jeonggyu Lee, YunJin Kim, Byung Mann Cho, Sang Yeoup Lee, Eunhee Kong, Minjeong Kim, Jinseung Kim, Dong Sik Jung, Seongho Han
PeerJ.2021; 9: e11408. CrossRef
Impact of tobacco and/or nicotine products on health and functioning: a scoping review and findings from the preparatory phase of the development of a new self-report measure
Esther F. Afolalu, Erica Spies, Agnes Bacso, Emilie Clerc, Linda Abetz-Webb, Sophie Gallot, Christelle Chrea
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Evolution of tobacco products
Sungkyu Lee, Jinyoung Kim
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Anne Kienhuis, Reinskje Talhout
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Heewon Kang, Sung-il Cho
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Assessment of Tobacco Habits, Attitudes, and Education Among Medical Students in the United States and Italy: A Cross-sectional Survey: Grayson W. Armstrong, Giacomo Veronese, Paul F. George, Isacco Montroni, Giampaolo Ugolini; J Prev Med Public Health. 2017;50(3):177-187. Published online April 14, 2017; DOI: https://doi.org/10.3961/jpmph.15.061

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Objectives
Medical students represent a primary target for tobacco cessation training. This study assessed the prevalence of medical students’ tobacco use, attitudes, clinical skills, and tobacco-related curricula in two countries, the US and Italy, with known baseline disparities in hopes of identifying potential corrective interventions.
Methods
From September to December 2013, medical students enrolled at the University of Bologna and at Brown University were recruited via email to answer survey questions assessing the prevalence of medical students’ tobacco use, attitudes and clinical skills related to patients’ smoking, and elements of medical school curricula related to tobacco use.
Results
Of the 449 medical students enrolled at Brown and the 1426 enrolled at Bologna, 174 Brown students (38.7%) and 527 Bologna students (36.9%) participated in this study. Italian students were more likely to smoke (29.5% vs. 6.1%; p<0.001) and less likely to receive smoking cessation training (9.4% vs. 80.3%; p<0.001) than their American counterparts, even though the majority of students in both countries desired smoking cessation training (98.6% at Brown, 85.4% at Bologna; p<0.001). Additionally, negative beliefs regarding tobacco usage, the absence of formal training in smoking cessation counseling, and a negative interest in receiving specific training on smoking cessation were associated with a higher risk of not investigating a patient’s smoking status during a routine history and not offering tobacco cessation treatment to patients.
Conclusions
Medical curricula on tobacco-related health hazards and on smoking cessation should be mandatory in order to reduce smoking among medical students, physicians, and patients, thereby improving tobacco-related global health.

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Tobacco Use Among Students Aged 13-15 Years in South Korea: The 2013 Global Youth Tobacco Survey: Sunhye Choi, Yoonjung Kim, Jihye Lee, Mina Kashiwabara, Kyungwon Oh; J Prev Med Public Health. 2017;50(1):60-65. Published online January 11, 2017; DOI: https://doi.org/10.3961/jpmph.16.079

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Abstract PDF

Objectives
We examined the prevalence of tobacco use and exposure to secondhand smoke among middle-school students in Korea using the Global Youth Tobacco Survey (GYTS) in 2013.
Methods
The GYTS in Korea was conducted between July and August 2013 by the Korea Centers for Disease Control and Prevention. Data were collected using a self-administered anonymous questionnaire from a nationally representative sample of middle-school students aged 13-15 years in sampled classrooms.
Results
The GYTS in Korea was completed by 4235 students aged 13-15 years in 43 middle schools. Approximately one in five of the students (17.8%) reported that they had tried cigarettes in the past, while 5.2% reported currently being cigarette smokers. Current cigarette smoking was higher in boys (7.5%) than in girls (2.6%). Of the students, 29.7% had been exposed to secondhand smoke at home, 47.4% inside enclosed public places, and 53.9% in outdoor public places. Of the current cigarette smokers, 25.7% bought their cigarettes from a store despite a law prohibiting this. Additionally, 58.0% of students noticed point-of-sale tobacco advertisements or promotions, 66.8% of current cigarette smokers wanted to stop smoking, and 70.9% of students had been taught about the dangers of tobacco use in school.
Conclusions
These findings provide an opportunity to develop, implement, and evaluate a comprehensive tobacco control policy. The results suggest that youth have relatively easy access to cigarettes and are regularly exposed to secondhand smoke in public places, as well as to point-of-sale tobacco advertisements and promotions. Strict enforcement of the ban on tobacco sales to youth, expanding smoke-free areas, and advertising bans are needed to reduce tobacco use among youth.

Summary

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Special Articles

Proving Causation With Epidemiological Evidence in Tobacco Lawsuits: Sun Goo Lee; J Prev Med Public Health. 2016;49(2):80-96. Published online March 31, 2016; DOI: https://doi.org/10.3961/jpmph.16.002

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Abstract PDF Supplementary Material

Recently, a series of lawsuits were filed in Korea claiming tort liability against tobacco companies. The Supreme Court has already issued decisions in some cases, while others are still pending. The primary issue in these cases is whether the epidemiological evidence submitted by the plaintiffs clearly proves the causal relationship between smoking and disease as required by civil law. Proving causation is difficult in tobacco lawsuits because factors other than smoking are involved in the development of a disease, and also because of the lapse of time between smoking and the manifestation of the disease. The Supreme Court (Supreme Court Decision, 2011Da22092, April 10, 2014) has imposed some limitations on using epidemiological evidence to prove causation in tobacco lawsuits filed by smokers and their family members, but these limitations should be reconsidered. First, the Court stated that a disease can be categorized as specific or non-specific, and for each disease type, causation can be proven by different types of evidence. However, the concept of specific diseases is not compatible with multifactor theory, which is generally accepted in the field of public health. Second, when the epidemiological association between the disease and the risk factor is proven to be significant, imposing additional burdens of proof on the plaintiff may considerably limit the plaintiff’s right to recovery, but the Court required the plaintiffs to provide additional information such as health condition and lifestyle. Third, the Supreme Court is not giving greater weight to the evidential value of epidemiological study results because the Court focuses on the fact that these studies were group-level, not individual-level. However, group-level studies could still offer valuable information about individual members of the group, e.g., probability of causation.

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The Tobacco Industry’s Abuse of Scientific Evidence and Activities to Recruit Scientists During Tobacco Litigation: Sungkyu Lee; J Prev Med Public Health. 2016;49(1):23-34. Published online January 27, 2016; DOI: https://doi.org/10.3961/jpmph.15.063

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Abstract PDF Supplementary Material

South Korea’s state health insurer, the National Health Insurance Service (NHIS), is in the process of a compensation suit against tobacco industry. The tobacco companies have habitually endeavored to ensure favorable outcomes in litigation by misusing scientific evidence or recruiting scientists to support its interests. This study analyzed strategies that tobacco companies have used during the NHIS litigation, which has been receiving world-wide attention. To understand the litigation strategies of tobacco companies, the present study reviewed the existing literature and carried out content analysis of petitions, preparatory documents, and supporting evidence submitted to the court by the NHIS and the tobacco companies during the suit. Tobacco companies misrepresented the World Health Organization (WHO) report’s argument and misused scientific evidence, and removed the word “deadly” from the title of the citation. Tobacco companies submitted the research results of scientists who had worked as a consultant for the tobacco industry as evidence. Such litigation strategies employed by the tobacco companies internationally were applied similarly in Korean lawsuits. Results of tobacco litigation have a huge influence on tobacco control policies. For desirable outcomes of the suits, healthcare professionals need to pay a great deal of attention to the enormous volume of written opinions and supporting evidence that tobacco companies submit. They also need to face the fact that the companies engage in recruitment of scientists. Healthcare professionals should refuse to partner with tobacco industry, as recommended by Article 5.3 of the WHO Framework Convention on Tobacco Control.

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We must win the tobacco litigation for public health
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Review

Cancer Control Programs in East Asia: Evidence From the International Literature: Malcolm A. Moore; J Prev Med Public Health. 2014;47(4):183-200. Published online July 31, 2014; DOI: https://doi.org/10.3961/jpmph.2014.47.4.183

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Abstract PDF

Cancer is a major cause of mortality and morbidity throughout the world, including the countries of North-East and South-East Asia. Assessment of burden through cancer registration, determination of risk and protective factors, early detection and screening, clinical practice, interventions for example in vaccination, tobacco cessation efforts and palliative care all should be included in comprehensive cancer control programs. The degree to which this is possible naturally depends on the resources available at local, national and international levels. The present review concerns elements of cancer control programs established in China, Taiwan, Korea, and Japan in North-East Asia, Viet Nam, Thailand, Malaysia, and Indonesia as representative larger countries of South-East Asia for comparison, using the published literature as a guide. While major advances have been made, there are still areas which need more attention, especially in South-East Asia, and international cooperation is essential if standard guidelines are to be generated to allow effective cancer control efforts throughout the Far East.

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Original Article

Airborne Nicotine Concentrations in the Workplaces of Tobacco Farmers: Seok-Ju Yoo, Sung-Jun Park, Byoung-Seok Kim, Kwan Lee, Hyun-Sul Lim, Jik-Su Kim, In-Shik Kim; J Prev Med Public Health. 2014;47(3):144-149. Published online May 30, 2014; DOI: https://doi.org/10.3961/jpmph.2014.47.3.144

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Abstract PDF

Objectives

Nicotine is a natural alkaloid and insecticide in tobacco leaves. Green tobacco sickness (GTS) is known as a disease of acute nicotine intoxication among tobacco farmers. Until now, GTS has been recognized globally as a disease that results from nicotine absorption through the skin. However, we assumed that GTS might also result from nicotine inhalation as well as absorption. We aimed to measure the airborne nicotine concentrations in various work environments of Korean tobacco farmers.

Methods

We measured the nicotine concentrations in the tobacco fields, private curing barns, and joint curing barns of farmers from July to October 2010. All sampling and analyses of airborne nicotine were conducted according to the National Institute for Occupational Safety and Health manual of analytic methods.

Results

The airborne nicotine concentrations (geometric mean [geometric standard deviation]) in the tobacco field were 83.4 mg/m³ (1.2) in the upper region and 93.3 mg/m³ (1.2) in the lower region. In addition, the nicotine concentration by personal sampling was 150.1 mg/m³. Similarly, the nicotine concentrations in the private curing barn, workers in curing barns, the front yard of the curing barn, and in the joint curing barn were 323.7 mg/m³ (2.0), 121.0 mg/m³ (1.5), 73.7 mg/m³ (1.7), and 610.3 mg/m³ (1.0), respectively.

Conclusions

The nicotine concentration in the workplaces of tobacco farmers was very high. Future studies should measure the environmental concentration of nicotine that is inhaled by tobacco farmers.

Summary

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Special Article

The Status and Future Challenges of Tobacco Control Policy in Korea: Hong-Jun Cho; J Prev Med Public Health. 2014;47(3):129-135. Published online May 30, 2014; DOI: https://doi.org/10.3961/jpmph.2014.47.3.129

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Abstract PDF

Tobacco use is the most important preventable risk factor for premature death. The World Health Organization (WHO) Framework Convention on Tobacco Control (FCTC), the first international public health treaty, came into force in 2005. This paper reviews the present status of tobacco control policies in Korea according to the WHO FCTC recommendations. In Korea, cigarette use is high among adult males (48.2% in 2010), and cigarette prices are the lowest among the Organization for Economic Cooperation and Development countries with no tax increases since 2004. Smoke-free policies have shown incremental progress since 1995, but smoking is still permitted in many indoor public places. More than 30% of non-smoking adults and adolescents are exposed to second-hand smoke. Public education on the harmful effects of tobacco is currently insufficient and the current policies have not been adequately evaluated. There is no comprehensive ban on tobacco advertising, promotion, or sponsorship in Korea. Cigarette packages have text health warnings on only 30% of the main packaging area, and misleading terms such as "mild" and "light" are permitted. There are nationwide smoking cessation clinics and a Quitline service, but cessation services are not covered by public insurance schemes and there are no national treatment guidelines. The sale of tobacco to minors is prohibited by law, but is poorly enforced. The socioeconomic inequality of smoking prevalence has widened, although the government considers inequality reduction to be a national goal. The tobacco control policies in Korea have faltered recently and priority should be given to the development of comprehensive tobacco control policies.

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