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Thailand's Indorama Chases Growth Ambitions
Indorama Ventures PCL has been on a global spending spree. The Bangkok-based company is the world's largest manufacturer of polyethylene terephthalate, better known as PET, which is used by bottlers, and supplies the material for brands like Coca-Cola and Pepsi.
Armed with $30 million handed him from his father, now Indorama Chief Executive Aloke Lohia came to Thailand from Indonesia in 1988 and set up a chemical business on the advice of a Burmese friend of his father.
But Mr. Lohia's big break came when he established a PET resin business in Thailand in 1995. Two years later, Thailand devalued the baht. Indorama—which reaped the bulk of its earnings in U.S. dollars—took advantage by acquiring other businesses around Thailand.
The company listed on the Stock Exchange of Thailand last February and became one of Thailand's largest listed companies, with a market capitalization of 196.11 billion Thai baht ($6.43 billion).
For the first nine months of the year, it posted profit of 6.55 billion baht, up 90% from a year earlier, on 73.43 billion baht in revenue.
In the past two months it has unveiled a slew of deals, including paying $420 million to acquire assets in South Carolina then owned by an arm of Koch Industries Inc., along with its Latin American polyester resins and staple business in Mexico.
Indorama has also announced plans to acquire a plant in China, several PET businesses in Poland and Indonesia and said it will spend $1.2 billion on two polyester plants in India and the Middle East.
Mr. Lohia, an Indian national, says Indorama will invest $3.8 billion by 2014—up from the previously planned $2 billion—as it ramps up production capacity to 10 million metric tons from 3.5 million tons.
Mr. Lohia, 52 years old, was raised in India but spent 10 years working in Indonesia with his father and brother.
WSJ: Have you been surprised by the rapid growth in recent years?
Mr: Lohia: In 2002 we looked back and we said…"Okay, we've got four businesses. We've got the chemical business, we've got the wool business, we have a resin business and then we have this polyester fiber business. Now where are we going?" This is probably the first time we sat down in an organized manner with the team and said, "Okay, where are we going?" So far we have just grabbed onto things that came our way.
The team made a vision that by 2010 we would be among the top five producers of PET resin in the world. We in 2006 had already done everything that we had targeted to do by 2010. So that gave us a lot of confidence that our view of the business was correct.
WSJ: How have you managed the baht's sharp gains?
Mr. Lohia: We basically use a natural hedge. The Asian business is the only one which has a Thai baht element in it. The U.S. business is all dollars, in Europe everything is in euros. The Asian business is a dollar business but based in Thailand, so what we do is we have dollar borrowings to hedge that position. So it's basically nicely hedged. Two-thirds of the business is a natural hedge, one third is hedged through currencies.
WSJ: Where is your focus now?
Mr. Lohia: Future growth for us would come from emerging markets. China, India, other parts of Asia, some parts of east Europe, former [Commonwealth of Independent States] countries, Brazil, Mexico. So the lesser-developed countries, that's where the growth is and that's where our focus of growth is.
WSJ: Do you expect more expansion in China?
Mr. Lohia: We do expect more expansion in China. And we are also very keen to expand in India because that's the other big market where we are not present. In China, now we have a foothold. I'm sure that foothold is going to lead to bigger things.
WSJ: So further acquisitions in China are more likely than in India?
Mr. Lohia: In China, a lot more fragmented businesses got built in 2002, and at that time they were building a lot of capacity. Not all of them were successful. So there are opportunities in China where you can go and acquire. In India, there weren't that many build-ups, so there isn't a distress opportunity in India.
WSJ: You mentioned Brazil. What sort of opportunities do you see there?
Mr. Lohia: One is that we are now tapping into that market through the plant we acquired in Mexico, so we will be present in the Latin American market through that.
At the moment, all our free stock is petroleum-based. We are looking at the ethanol side of Brazil, and ethanol can be converted into plastic. So we are looking if we can have a good tie-up on the ethanol side and then convert it into what they call a bioplastic which is much greener than a petrol-based [plastic].
We would like to partner with somebody who has ethanol availability.
WSJ: In terms of Latin America, Europe, the U.S. and Asia, which region offers the greatest opportunities in terms of growth?
Mr. Lohia: Asia at the moment has the biggest opportunity to grow because we're relatively small in polyester and PET in Asia. And it's a growing region for us, so this has maximum potential for us.…
The Middle East and Africa don't have much polyester at the moment, so there will be a lot of future growth.


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By Roxanne McKnight
Staff Writer
County commissioners approved the final contract its electricity broker worked out for the county, with the rate dropping about 44 percent for the county and about 43 percent for the Limestone County Detention Center, whose electricity is supplied by a different provider.
The county uses a company called Texas Energy, which helps businesses and other entities find the most competitive energy rates. The court approved at its June 22 meeting allowing Texas Energy to pursue the deal, and the court approved the contract with TXU Energy at its July 13 meeting.
County Judge Daniel Burkeen told the court the new contract will begin in June 2017, when the current contract with Hudson Energy expires. Hudson is charging about 8 cents a kilowatt hour, Burkeen told the court at the previous meeting.
To read more of this story, pick up a copy of Thursday's edition of The Mexia News, or subscribe to our online edition.
By Roxanne McKnight
Staff Writer
Limestone County's new AgriLife Extension Agent for Family and Consumer Science, has been on the job since May and is looking to get feedback from residents about what kind of programming residents would like her to pursue.
Gabrielle Washington, who began her Limestone County Extension Agent post May 1, said she would like to gear some of her programming to the health issues associated with the top three causes of death in Limestone County: heart disease, cancer and stroke.
Some programs she plans to continue were begun by her predecessor, Vanessa Casad, who transferred to Coryell County in December 2014.
One of those programs is called 'Do Well, Be Well with Diabetes,' which teaches the basics of that condition, including medications and lifestyle changes that can help a person diagnosed with diabetes to manage it.
Brother Dale Hergett, Justin Campbell and Hannah McCord all earned a pie in the face at a fundraiser on the last night of Kirvin Baptist Church's Vacation Bible School. Sponsors were Bush's Chicken of Mexia and FBC of Mexia. Offerings totaling $200 were collected for local mission projects.
By Roxanne McKnight
Staff Writer
Limestone County commissioners are moving funds in and out of various budget lines to keep the budget balanced through the end of the fiscal year, but they were able also to get two needed salary raises through at their meeting Monday, July 13.
The court addressed those and other issues concerning the Law Enforcement Center, which includes the Sheriff's Office and jail: taming the overgrown grass, hearing the statistics for June and a report on old car sales, and correcting a vehicle title.
At the court's June 22 meeting, a difference of opinion had arisen about when certificate-based salary increases should go through, as soon as the employee earns certification or at the beginning of the next fiscal year.
By Roxanne McKnight
Staff Writer
R.Q. Sims Intermediate School students got their hands dirty this past spring when they started their own community garden, and in doing so learned many lessons.
Fourth-grade science teacher Rhonda Mills had wanted to create a community garden for the past couple of years. Likewise, Sims librarian Jodi Huff had been wanting to start a garden for the ACE (Afterschool Centers on Education) after-school program she works with. So Mills and Huff planned together and made the community garden a reality.
Mills incorporated many lessons from science to make the gardening an academic pursuit as well as a fun activity.
First she issued each of her 148 fourth-graders a gallon-size plastic bag and had them take it home and ask their parents to help them find fertile soil.
By Brenda Sommer
Managing Editor
Turmoil is rocking the 19th of June Organization, which owns Booker T. Washington Park at Comanche Crossing on Lake Mexia and has organized Juneteenth celebrations there for more than 100 years.
The Mexia News was inadvertently drawn into the conflict when an ad was placed in the Saturday, July 11 edition, congratulating William "Pete" Kirvin for being elected the new president of the organization. The ad was placed by Jackie Gee of Mexia, who did not return a call requesting comment.
That advertisement drew immediate and multiple objections from at least a dozen people who attended the July 3 meeting during which an election was held. The organization elects new officers every two years, as proscribed in its bylaws, which were drafted in 1910.
The ad stated Kirvin received 39 votes out of 59 eligible voting members, defeating Dana Busby and Renee Turner for the position of president.
A state trooper and emergency responders look over the remains of a 2015 Jeep SUV that rolled through a fence and into a pasture off FM 39, about two miles south of CR 425, shortly after 10 p.m. Friday night. The driver is believed to have been trying to avoid a deer when her vehicle left the roadway. The ditch at the site is filled with deep sand and she was unable to regain control of the Jeep. The SUV ended up resting on the driver's side. The driver and a male passenger, both of Streetman, were not wearing seatbelts, and the male passenger was ejected. A 4-year-old, who was using a child safety seat, and the driver were taken to Parkview Regional Hospital by Mexia EMS; the man, who was cited for open container, was taken to Baylor Scott & White Hillcrest Medical Center in Waco by Air Evac helicopter ambulance.
By Brenda Sommer
Managing Editor
Texas saw a the first drop in sales tax revenue in more than five years in June, but the city of Mexia's sales tax rebates for June rose nearly six percent compared to last year. Totals in all but one of the other four taxing entities in Limestone County were also up for the month.
State sales tax revenue in June was $2.2 billion, down 1.4 percent compared to June 2014. This marks the first decline in state sales tax revenue following 62 consecutive months of growth.
"This slight decline was expected due to the slowdown in the oil and gas mining sector, and is in line with the biennial revenue estimate presented in January," Texas Comptroller Glenn Hegar said. "Receipts from the construction, information, restaurant and services sectors continued to grow, however, which is a testament to Texas' diverse and dynamic economy."
By Roxanne McKnight
Staff Writer
Limestone County Sheriff Dennis Wilson has noted many changes during his 40 years in law enforcement, and he's also seen the difficulty of the job increase in light of increased levels of hostility toward all peace officers.
Wilson, who has been sheriff of Limestone County about 14 years, recently gave the Mexia Lions Club an update on law enforcement in the county,
"Right now is not a very popular time to be a police officer," he told the Lions. "All you've got to do is turn on the news and find out the hatred that's going on in our nation toward our police. But let me tell you something: We're the last line of defense between you and the bad guys. And if we don't get the citizens of our state, our county, of our nation to stand up for our police officers, we're in sad shape. It is becoming alarming for me and my personnel, knowing the violence we face every day."
Vanessa Salazar prepares to let go of a cast-iron skillet in the Women's Skillet Toss while other participants watch to see if Salazar can match the distance they were able to throw the same heavy kitchen pan.
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Skip to comments.ELCA Repents for Holding Biblical View
Posted on 10/02/2013 2:40:58 AM PDT by rhema
Last week the Evangelical Lutheran Church in America installed Rev. Guy Erwin as Bishop of the Southwest California Synod. Rev. Erwin is the first practicing homosexual to be a bishop in the ELCA. The ELCA's Living Lutheran website reported that there were at least 10 ELCA bishops in attendance. (see here) Presiding Bishop Mark S. Hanson, the highest ranking ELCA leader, delivered the sermon at the installation. Bishop Hanson's sermon made it clear that there is no more debate in the denomination about whether homosexuality is sinful or godly. He then proclaimed the ELCA's repentance for once holding the Biblical position that homosexuality is sinful.
Below are some quotes and my thoughts from the ELCA leader's sermon.
I think I hear the hoof beats of the Four Horsemen.
Freep-mail me to get on or off my pro-life and Catholic List:
Please ping me to note-worthy Pro-Life or Catholic threads, or other threads of general interest.
There's no longer debate if queers are sinful or Godly?
If any of you freepers are Lutheran, I REALLY want to hear from you, you betch'a
2 Timothy 3:1-9
But know this, that in the last days grievous times will be upon us.
For men will be lovers of themselves, money-lovers, braggarts, arrogant, blasphemers, disobedient to parents, unthankful, unholy, without natural feeling, unyielding, slanderers, without self-control, savage, haters of good,
betrayers, reckless, puffed up, lovers of pleasure rather than lovers of Yahweh, having a form of righteousness, but denying the power of it; even turn away from these. For of these are those creeping into houses and leading silly women captive, the ones having been heaped with sins, being led away by various lusts, always learning, but never being able to come to a full knowledge of the truth. But in the way Jannes and Jambres withstood Moses, so also these withstand the truth, men having been corrupted in mind, found worthless concerning the faith. But they will not go further, for their foolishness will be plain to all, as also that of those became.
Isaiah 5:20
Woe to those who call evil good and good evil, who put darkness for light and light for darkness, who put bitter for sweet and sweet for bitter
Proverbs 17:15
Acquitting the guilty and condemning the innocent— the LORD detests them both
These people can call themselves whatever they want. It's clear they are simply immoral pagans.
There are still many Lutherans in America that hold true to Biblical fundamentals, and would easily fall into the 'extreme' category by most of mainstream reformed synods. The WELS and the CLC come to mind.
There seems to be a simple fact that all the different liberal theologians forget; its not up to them.
The ELCA was already heading for a cliff, what with the gradual natural attrition of gullible old folks with assets the "shepherds" can fleece, and Mark Hanson's heresy is just a bit more pressure on the gas pedal. There's going to be a lot of run-down buildings and sites available in a buyer's market.
Mr. niteowl77
Another reason we left the ELCA church. Bad policy there.
What is all the excitement about??
This faggot bishop has just stated what ELCA based their decision on when they allowed Homosexual in the leadership.
What does anyone expect a faggot to say? Of course he believes this way and anyone who stays in his Church believes the same way.
They may as well toss the Bible out the window and no longer read it, because if they do not believe part of it they do not believe any of it.
* as of August 19, AD 2009, a liberal protestant SECT, not part of the holy, catholic and apostolic CHURCH.
Be rooted in Christ!
Practicing? How much practice does he need? Are there special techniques known only to initiates? If he hasn't mastered the material perhaps they've chosen the wrong shepherd.
there. Fixed it for you. If they are not Christian, and any church accepting homosexuality is not Christian, then they are not Protestant either.
"There are still many Lutherans in America that hold true to Biblical fundamentals, and would easily fall into the extreme category by most of mainstream reformed synods. The WELS and the CLC come to mind."
The Missouri Synod is quite conservative, also.
I grew up in an ELCA'S church and have seen the steady march to hell over the years by listening to my parents talk about the policy changes. It is sad to see them holding on to their membership and actually buying in to what the church says about homosexuality, etc...
Pray they will come out of it while there is still time..
aaah, the bible alone is all we need according to some....and see what it gets you when you use the bible alone.....
Was ELCA, but now Missouri synod after this debacle.
Yeah, the authority of the Pope sure has kept all nominal Catholics in line. When pro-abortion politicians are made to answer by the Magisterium for their sponsorship of infanticide, get back to us.
Well, at least now I know for absolute sure I cannot go to an ELCA.
Thankfully I do have a few LCMS nearby. Our own small rented church is becoming "modern" though, and I cannot take it anymore. Pastor is nice but far too informal, plays guitar. Congregation is very nice and diverse. But the music-concert stuff has gotten on my last nerve, so we are going to try another not far, which at least has an actual traditional building. But at least I think they all hold against homos.
Sadly, if the Magisterium endorsed homosexuality, many Catholics would follow along.
hey, we are not talking catholic, we are talking sola scriptura striking again....and this isnt the only time this has occured...
when you put yourself on par with the bible and use personal interpretation, you can come up with anything to justify abborent lifestyles....
aaaah, the joy of the reformation, splintering the body of christ continuously into itty bitty bible alone kingdoms, all fighting with each other as to who is wrong and right about salvation....
Once Christianity decided to change one of God's commandments it was only a matter of time until they abandoned everything....
And yet, there you have this story, amongst many lutheran churches with similar issues...
by the way mr lucky, i was perusing my bible and couldnt find the Book of Concord anywhere in there......since scripture alone is all that is supposed to be used.....
The point of most posters on this thread is that the ELCA is no longer Lutheran, precisely because Lutheran doctrine is unmistakable on the sanctity of life. Just as, presumably, you know that Nancy Pelosi's faith is not Catholic for the same reason.
sure, but nancy isnt making decisions effecting a church, whereas this bible alone lutheran is making decisions. based on his personal interpretation of the bible,since he is guided by the holy spirit, etc that effect the entire congregation....
I have a fine grasp of it, especially of it in action, over the last five hundred years of splintered christianity and one of the great things about it is that you can also make sola scriptura mean anything to cover up the obvious mistakes it has caused....and wikipedia? seriously?
I see.
About two weeks ago, I emailed ELCA Presiding Bishop-elect Eaton, and I asked for her opinion about the 2009 decision that allows the ELCA to ordain gays. I said, "I think that Christian churches should follow teachings of the Bible. If the Bible says that homosexuality is a sin, we shouldn't have gay pastors. If the Bible says that God approves of homosexuality, we should have gay pastors." I didn't get a response.
Missouri Synod ping....
Thanks, MNGal.
ELCA isn't dead yet?
Well, it's not for lack of effort.
You statement showed too much discernment and logic for her to understand.
Is there anyone sane still left in ELCA?
I think insanity is a requirement to be a member of the ELCA, the PCUSA, the UCC, the Episcopagans, etc.
Post 2009, at least.:)
Lutheran, but left the ELCA. Now in a Lutheran Church affiliated with the North American Lutheran Church and the Lutheran Church Missions for Christ. NALC and LCMC. My congregation left a rather large ELCA Church because of this vote they had a few years back.
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Changes in Exposure to Secondhand Smoke Among Youth in Nebraska, 2002–2006
Mbulo, Lazarous
Preventing Chronic Disease
Secondhand smoke is a major cause of morbidity and mortality. It has been associated with serious health problems in both children and adults. Efforts to reduce exposure to secondhand smoke in Nebraska have included programs to prevent tobacco use among young people and campaigns for smoke-free workplaces and homes. Despite these interventions, young people continue to be exposed to secondhand smoke at an unacceptably high rate. The objective of this study was to examine the extent to which Nebraska public middle and high school students were exposed to secondhand smoke in 2002 and 2006, to evaluate factors associated with this exposure, and to propose interventions.
The Nebraska Youth Tobacco Survey was administered in 2002 and 2006 to a representative sample of students from public middle and high schools. All students who chose to participate completed an anonymous, self-administered survey that included questions on demographics, tobacco use, tobacco-related knowledge and attitudes, and exposure to secondhand smoke. Data were weighted to account for nonresponses at both student and school levels and to ensure generalizability of the estimates for public school students in Nebraska according to their grade, sex, and race/ethnicity. This study analyzed a subset of responses on secondhand smoke exposure, which was defined as being in a room or vehicle during the previous 7 days with someone who was smoking cigarettes.
Secondhand smoke exposure in a room, a vehicle, or both declined significantly among all students from 2002 (69.0%) to 2006 (61.3%). In both 2002 and 2006, students were significantly more likely to be exposed to secondhand smoke in a room than in a vehicle (64.4% vs 48.2% in 2002 and 56.9% vs 40.2% in 2006). Among racial and ethnic groups, only white students experienced a significant decline in exposure from 2002 (70.0%) to 2006 (61.4%). Girls were significantly more likely to be exposed to secondhand smoke in 2006 than were boys, and only boys experienced a significant overall decline in exposure from 2002 (69.3%) to 2006 (57.7%). Smoking behaviors and attitudes continued to influence secondhand smoke exposure from 2002 to 2006, although students experienced significant declines whether they were smokers or nonsmokers, and whether they lived with a smoker or not. Those with close friends who smoked and those who did not perceive secondhand smoke as harmful, however, did not benefit.
These data indicate reductions in exposure to secondhand smoke among Nebraska's middle and high school students, but exposure remains a problem, particularly in rooms. Adoption of a comprehensive statewide smoke-free policy will contribute to significantly reduced exposure to secondhand smoke among young people in public places, but other measures to address exposure in the home and private vehicles are needed or should be strengthened. These include physician counseling based on behavioral change theory to encourage cessation and home-based no-smoking rules, in addition to interventions that target minorities, who are disproportionately affected by secondhand smoke exposure. Evaluation of existing measures, such as programs to prevent tobacco use among young people and campaigns to collect pledges for smoke-free homes, will be required to determine their effectiveness in reducing exposure to secondhand smoke among youth in Nebraska.
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"Efforts to Reprioritise the Agenda" in China: British American Tobacco's Efforts to Influence Public Policy on Secondhand Smoke in China
Muggli, Monique E
Lee, Kelley
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Ebbert, Jon O
Hurt, Richard D
PLoS Medicine
Each year, 540 million Chinese are exposed to secondhand smoke (SHS), resulting in more than 100,000 deaths. Smoke-free policies have been demonstrated to decrease overall cigarette consumption, encourage smokers to quit, and protect the health of nonsmokers. However, restrictions on smoking in China remain limited and ineffective. Internal tobacco industry documents show that transnational tobacco companies (TTCs) have pursued a multifaceted strategy for undermining the adoption of restrictions on smoking in many countries.
Methods and Findings
To understand company activities in China related to SHS, we analyzed British American Tobacco's (BAT's) internal corporate documents produced in response to litigation against the major cigarette manufacturers to understand company activities in China related to SHS. BAT has carried out an extensive strategy to undermine the health policy agenda on SHS in China by attempting to divert public attention from SHS issues towards liver disease prevention, pushing the so-called "resocialisation of smoking" accommodation principles, and providing "training" for industry, public officials, and the media based on BAT's corporate agenda that SHS is an insignificant contributor to the larger issue of air pollution.
The public health community in China should be aware of the tactics previously used by TTCs, including efforts by the tobacco industry to co-opt prominent Chinese benevolent organizations, when seeking to enact stronger restrictions on smoking in public places.
Monique Muggli and colleagues study British American Tobacco (BAT) internal documents and find that from the mid 1990s BAT pursued a strategy aimed at influencing the public debate on secondhand smoke in China.
Editors' Summary
Each year, about one million people die in China from tobacco-caused diseases, including cancer, heart disease, and lung disease. Although most of these deaths occur among smokers—300 million people smoke in China, accounting for one-third of the global "consumption" of cigarettes—more than 100,000 deaths from tobacco-related causes occur annually among the 540 million Chinese people who are exposed to secondhand smoke. Tobacco smoke contains 4,000 known chemicals, 69 of which are known or probable carcinogens, and, when it is produced in enclosed spaces, both smokers and nonsmokers are exposed to its harmful effects. The only effective way to reduce tobacco smoke exposure indoors to acceptable levels is to implement 100% smoke-free environments—ventilation, filtration, and the provision of segregated areas for smokers and nonsmokers are insufficient. Importantly, as well as protecting nonsmokers from secondhand smoke, the implementation of smoke-free public places also reduces the number of cigarettes smoked among continuing smokers, increases the likelihood of smokers quitting, and reduces the chances of young people taking up smoking.
Why Was This Study Done?
Article 8 of the World Health Organization's Framework Convention on Tobacco Control (FCTC; an international public-health treaty that seeks to reduce tobacco-caused death and disease) calls on countries party to the treaty to protect their citizens from secondhand smoke exposure. China became a party to the FCTC in 2005 but restrictions on smoking in public places in China remain limited and ineffective. Previous analyses of internal tobacco industry documents have revealed that transnational tobacco companies (TTCs) have used a multifaceted approach to undermine the adoption of restrictions on smoking in many countries. TTCs have been shown to influence media coverage of secondhand smoke issues and to promote ineffective ventilation and separate smoking and nonsmoking areas in restaurants, bars, and hotels (so-called "resocalization of smoking" accommodation principles) with the aim of undermining smoke-free legislation. In addition, TTCs have created organizations interested in non-tobacco-related diseases to draw attention away from the public-health implications of secondhand smoke. In this study, the researchers ask whether TTCs have used a similar approach to undermine the adoption of restrictions on smoking in China, one of the most coveted cigarette markets in the world by the major TTCs.
What Did the Researchers Do and Find?
The researchers analyzed internal corporate documents produced by British American Tobacco (BAT; the predominant TTC in China) in response to litigation against major cigarette manufacturers stored in document depositories in Minnesota, USA and Guildford, UK. Among these documents, they found evidence that BAT had attempted to divert attention from secondhand smoke issues toward liver disease prevention by funding the Beijing Liver Foundation (BFL) from its inception in 1997 until at least 2002 (the most recent year that BAT's corporate records are available for public review). The researchers also found evidence that BAT had promoted "resocialization of smoking" accommodation principles as a "route to avoid smoking bans" and pushed ventilation and air filtration in airports and in establishments serving food and drink. Finally, the researchers found evidence that BAT had sought to "present the message that 'tobacco smoke is just one of the sources of air polution [sic] and a very insignificant one compared with other pollutants'" through presentations given to the Chinese tobacco industry and media seminars aimed at Chinese journalists.
What Do These Findings Mean?
These findings indicate that, beginning in the mid 1990s and continuing until at least 2002, BAT has followed an intensive, multi-pronged strategy designed to undermine the health policy agenda on secondhand smoke in China. Given their findings, the researchers suggest that BFL and other charitable organizations in China must be wary of accepting tobacco money and that measures must be taken to improve the transparency and accountability of these and other public organizations. To meet FCTC obligations under Article 5.3 (industry interference), policy makers in China, they suggest, must be made aware of how BAT and other TTCs have repeatedly sought to influence health policy in China by focusing attention toward the adoption of ineffective air filtration and ventilation systems in hospitality venues rather than the implementation of 100% smoke-free environments. Finally, Chinese policy makers and the media need to be better informed about BAT's long-standing attempts to communicate misleading messages to them about the health effects of secondhand smoke.
Additional Information.
Please access these Web sites via the online version of this summary at http://dx.doi.org/10.1371/journal.pmed.0050251.
The World Health Organization's Regional Office for the Western Pacific provides smoking statistics for China and other countries in the region
The World Health Organization provides information on the health problems associated with secondhand smoke, about its Tobacco Free Initiative (available in several languages), and about the Framework Convention on Tobacco Control (also available in several languages)
MedlinePlus provides links to information about the dangers of secondhand smoke (available in English and Spanish)
The UK National Health Service Smokefree Web site provides information about the advantages of giving up smoking, how to give up smoking, and the dangers associated with secondhand smoke
British American Tobacco documents stored in the Minnesota and Guildford Depositories, including those analyzed in this study, can be searched through the British American Tobacco Documents Archive
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Kremastinou, Jenny
International Journal of Environmental Research and Public Health
We conducted the GHPSS (Global Health Professions Student Survey) to obtain information regarding health profession students' smoking habits and perceptions, exposure to secondhand smoke (SHS) as well as level of knowledge and training on tobacco use and smoking cessation counseling. GHPSS is a survey for third-year students in the following fields: health visitors, dentistry, medicine, nursing and/or pharmacy. The highest tobacco use prevalence rate and exposure to SHS were recorded among health visitor students with 46.4% and 33.3% respectively. The majority of the respondents believed that their profession serves as a role model for their patients. Formal training on cessation counseling ranged between 10.7% for health visitor students to 22.4% for nursing students. The relatively high percentage of health profession students who currently smoke and the alarmingly high percentage of those exposed to SHS indicate lack of concerted efforts for implementation and effective enforcement of the anti-tobacco policy measures. Despite its significance, formal training on cessation counseling for students is strikingly low. These results indicate the urgent need to train health professional students on tobacco cessation counseling and educate them on the dangers of tobacco use, SHS and the positively influential role they can play to affect their patients' smoking habits.
tobacco; smoking; prevalence; students; secondhand smoke; health profession; cessation; survey
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Association of Secondhand Smoke Exposure with Pediatric Invasive Bacterial Disease and Bacterial Carriage: A Systematic Review and Meta-analysis
Lee, Chien-Chang
Middaugh, Nicole A.
Howie, Stephen R. C.
Ezzati, Majid
PLoS Medicine
Majid Ezzati and colleagues report the findings of a systematic review and meta-analysis that probes the association between environmental exposure to secondhand smoke and the epidemiology of pediatric invasive bacterial disease.
A number of epidemiologic studies have observed an association between secondhand smoke (SHS) exposure and pediatric invasive bacterial disease (IBD) but the evidence has not been systematically reviewed. We carried out a systematic review and meta-analysis of SHS exposure and two outcomes, IBD and pharyngeal carriage of bacteria, for Neisseria meningitidis (N. meningitidis), Haemophilus influenzae type B (Hib), and Streptococcus pneumoniae (S. pneumoniae).
Methods and Findings
Two independent reviewers searched Medline, EMBASE, and selected other databases, and screened articles for inclusion and exclusion criteria. We identified 30 case-control studies on SHS and IBD, and 12 cross-sectional studies on SHS and bacterial carriage. Weighted summary odd ratios (ORs) were calculated for each outcome and for studies with specific design and quality characteristics. Tests for heterogeneity and publication bias were performed. Compared with those unexposed to SHS, summary OR for SHS exposure was 2.02 (95% confidence interval [CI] 1.52–2.69) for invasive meningococcal disease, 1.21 (95% CI 0.69–2.14) for invasive pneumococcal disease, and 1.22 (95% CI 0.93–1.62) for invasive Hib disease. For pharyngeal carriage, summary OR was 1.68 (95% CI, 1.19–2.36) for N. meningitidis, 1.66 (95% CI 1.33–2.07) for S. pneumoniae, and 0.96 (95% CI 0.48–1.95) for Hib. The association between SHS exposure and invasive meningococcal and Hib diseases was consistent regardless of outcome definitions, age groups, study designs, and publication year. The effect estimates were larger in studies among children younger than 6 years of age for all three IBDs, and in studies with the more rigorous laboratory-confirmed diagnosis for invasive meningococcal disease (summary OR 3.24; 95% CI 1.72–6.13).
When considered together with evidence from direct smoking and biological mechanisms, our systematic review and meta-analysis indicates that SHS exposure may be associated with invasive meningococcal disease. The epidemiologic evidence is currently insufficient to show an association between SHS and invasive Hib disease or pneumococcal disease. Because the burden of IBD is highest in developing countries where SHS is increasing, there is a need for high-quality studies to confirm these results, and for interventions to reduce exposure of children to SHS.
Please see later in the article for the Editors' Summary
Editors' Summary
The deleterious health effects of smoking on smokers are well established, but smoking also seriously damages the health of nonsmokers. Secondhand smoke (SHS), which is released by burning cigarettes and exhaled by smokers, contains hundreds of toxic chemicals that increase the risk of adults developing lung cancer and heart disease. Children, however, are particularly vulnerable to the effects of SHS exposure (also known as passive smoking) because they are still developing physically. In addition, children have little control over their indoor environment and thus can be heavily exposed to SHS. Exposure to SHS increases the risk of ear infections, asthma, respiratory symptoms (coughing, sneezing, and breathlessness), and lung infections such as pneumonia and bronchitis in young children and the risk of sudden infant death syndrome during the first year of life.
Why Was This Study Done?
Several studies have also shown an association between SHS exposure (which damages the lining of the mouth, throat, and lungs and decreases immune defenses) and potentially fatal invasive bacterial disease (IBD) in children. In IBD, bacteria invade the body and grow in normally sterile sites such as the blood (bacteremia) and the covering of the brain (meningitis). Three organisms are mainly responsible for IBD in children—Streptococcus pneumoniae, Haemophilus influenzae type B (Hib), and Neisseria meningitidis. In 2000, S. pneumonia (pneumococcal disease) alone killed nearly one million children. Here, the researchers undertake a systematic review and meta-analysis of the association between SHS exposure in children and two outcomes—IBD and the presence of IBD-causing organisms in the nose and throat (bacterial carriage). A systematic review uses predefined criteria to identify all the research on a given topic; meta-analysis is a statistical method that combines the results of several studies. By combining data, it is possible to get a clearer view of the causes of a disease than is possible from individual studies.
What Did the Researchers Do and Find?
The researchers identified 30 case-control studies that compared the occurrence of IBD over time in children exposed to SHS with its occurrence in children not exposed to SHS. They also identified 12 cross-sectional studies that measured bacterial carriage at a single time point in children exposed and not exposed to SHS. The researchers used the data from these studies to calculate a "summary odds ratio" (OR) for each outcome—a measure of how SHS exposure affected the likelihood of each outcome. Compared with children unexposed to SHS, exposure to SHS doubled the likelihood of invasive meningococcal disease (a summary OR for SHS exposure of 2.02). Summary ORs for invasive pneumococcal disease and Hib diseases were 1.21 and 1.22, respectively. However, these small increases in the risk of developing these IBDs were not statistically significant unlike the increase in the risk of developing meningococcal disease. That is, they might have occurred by chance. For bacterial carriage, summary ORs for SHS exposure were 1.68 for N. meningitidis, 1.66 for S. pneumonia (both these ORs were statistically significant), and 0.96 for Hib (a nonsignificant decrease in risk).
What Do These Findings Mean?
These findings indicate that SHS exposure is significantly associated with invasive meningococcal disease among children. However, the evidence that SHS exposure is associated with invasive pneumococcal and Hib disease is only suggestive. These findings also indicate that exposure to SHS is associated with an increased carriage of N. meningitidis and S. pneumoniae. The accuracy and generalizability of these findings is limited by the small number of studies identified, by the lack of studies from developing countries where SHS exposure is increasing and the burden of IBD is high, and by large variations between the studies in how SHS exposure was measured and IBD diagnosed. Nevertheless, they suggest that, by reducing children's exposure to SHS (by, for example, persuading parents not to smoke at home), the illness and death caused by IBDs among children could be greatly reduced. Such a reduction would be particularly welcome in developing countries where vaccination against IBDs is low.
Additional Information
Please access these Web sites via the online version of this summary at http://dx.doi.org/10.1371/journal.pmed.1000374.
The US Centers for Disease Control and Prevention provides information on secondhand smoke, on children and secondhand smoke exposure, on meningitis, and on Hib infection
The US Environmental Protection Agency also provides information on the health effects of exposure to secondhand smoke (in English and Spanish) and a leaflet (also in English and Spanish) entitled Secondhand Tobacco Smoke and the Health of Your Family
The US Office of the Surgeon General provides information on the health consequences of involuntary exposure to tobacco smoke
The World Health Organization provides a range of information on the global tobacco epidemic
The World Health Organization has information on meningococcal disease (in English only) and on Hib (in several languages)
The US National Foundation for Infectious Diseases provides a fact sheet on pneumococcal disease
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Public Place Smoke-Free Regulations, Secondhand Smoke Exposure and Related Beliefs, Awareness, Attitudes, and Practices among Chinese Urban Residents
Yang, Tingzhong
Abdullah, Abu S.
Li, Li
Rockett, Ian R. H.
Lin, Yan
Ying, Jun
Guo, Wei
Wu, Dan
Li, Mu
International Journal of Environmental Research and Public Health
Objective: To evaluate the association between smoke-free regulations in public places and secondhand smoke exposure and related beliefs, awareness, attitudes, and behavior among urban residents in China. Methods: We selected one city (Hangzhou) as the intervention city and another (Jiaxing) as the comparison. A structured self-administered questionnaire was used for data collection, and implemented at two time points across a 20-month interval. Both unadjusted and adjusted logistic methods were considered in analyses. Multiple regression procedures were performed in examining variation between final and baseline measures. Results: Smoke-free regulations in the intervention city were associated with a significant decline in personal secondhand smoke exposure in government buildings, buses or taxis, and restaurants, but there was no change in such exposure in healthcare facilities and schools. In terms of personal smoking beliefs, awareness, attitudes, and practices, the only significant change was in giving quitting advice to proximal family members. Conclusions: There was a statistically significant association between implementation of smoke-free regulations in a city and inhibition of secondhand tobacco smoking exposure in public places. However, any such impact was limited. Effective tobacco control in China will require comprehensive laws implemented fully and supported by penalties and a combination of strong public health education.
tobacco control; smoke-free regulations; secondhand smoke
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Demographic and Geographic Differences in Exposure to Secondhand Smoke in Missouri Workplaces, 2007-2008
Harris, Jenine K.
Geremakis, Caroline
Moreland-Russell, Sarah
Carothers, Bobbi J.
Shelton, Sarah C.
Kariuki, Barbara
Kuhlenbeck, Matthew
Preventing Chronic Disease
African Americans, Hispanics, service and blue-collar workers, and residents of rural areas are among those facing higher rates of workplace secondhand smoke exposure in states without smokefree workplace laws. Consequently, these groups also experience more negative health effects resulting from secondhand smoke exposure. The objective of this study was to examine disparities in workplace secondhand smoke exposure in a state without a comprehensive statewide smokefree workplace law and to use this information in considering a statewide law.
We developed a logistic multilevel model by using data from a 2007-2008 county-level study to account for individual and county-level differences in workplace secondhand smoke exposure. We included sex, age, race, annual income, education level, smoking status, and rural or urban residence as predictors of workplace secondhand smoke exposure.
Factors significantly associated with increased exposure to workplace secondhand smoke were male sex, lower education levels, lower income, living in a small rural or isolated area, and current smoking. For example, although the overall rate of workplace exposure in Missouri is 11.5%, our model predicts that among young white men with low incomes and limited education living in small rural areas, 40% of nonsmokers and 56% of smokers may be exposed to secondhand smoke at work.
Significant disparities exist in workplace secondhand smoke exposure across Missouri. A statewide smokefree workplace law would protect all citizens from workplace secondhand smoke exposure.
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The association of active and secondhand smoking with oral health in adults: Japan public health center-based study
Ueno, Masayuki
Ohara, Satoko
Sawada, Norie
Inoue, Manami
Tsugane, Shoichiro
Kawaguchi, Yoko
Tobacco Induced Diseases
Smoking is one of the major risk factors for oral diseases, and many studies have found that active smoking is closely associated with the prevalence or severity of periodontal disease and fewer remaining teeth. In contrast to the established association between active smoking and oral health, there have been very few studies investigating the effects of secondhand smoking on oral health, and whether secondhand smoking deteriorates oral health has not been fully clarified. The purpose of the present study was to examine whether active and secondhand smoking were associated with the prevalence of severe periodontal disease and number of teeth among Japanese adults.
Subjects were 1,164 dentate adults aged 55–75 years as of May 2005 who participated in both the Japan Public Health Center-Based Study Cohort I in 1990 and a dental survey in 2005. The dental survey was implemented in the Yokote health center jurisdiction, Akita Prefecture. Participating subjects completed a self-administered questionnaire and a clinical oral examination. The association of smoking status with prevalence of periodontal disease was analyzed using a logistic regression, and with number of teeth or functional tooth units of natural teeth (n-FTUs) using a generalized linear model.
After adjusting for age, education level, history of diabetes, BMI, alcohol consumption, perceived mental stress, presence of a family dentist, and oral hygiene, the odds ratio (OR) of risk for periodontal disease in male subjects was significantly increased in non-smokers with secondhand smoking only at home (OR = 3.14, 95 % CI: 1.08−9.12, p = 0.036), non-smokers with secondhand smoking both at home and other places (OR = 3.61, 95 % CI: 1.33−9.81, p = 0.012) and current smokers (OR = 3.31, 95 % CI: 1.54−7.08, p = 0.002), compared to non-smokers without secondhand smoking. Further in men, current smokers had significantly fewer numbers of teeth (19.7 ± 6.82) and n-FTUs (4.92 ± 4.12) than non-smokers without secondhand smoking (22.2 ± 6.92, p = 0.014 and 6.56 ± 4.18, p = 0.007). Such significant relationships of smoking status with periodontal disease and dentition were not observed in women.
The present study indicates that active smoking as well as secondhand smoking may have harmful effects on periodontal health in men. Therefore, it is imperative for health and oral health professionals to enlighten people about the negative influence of smoking, not only on their own health but also on others' health.
Active smoking; Secondhand smoking; Periodontal disease; Dentition; Functional tooth units
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Potential Unintended Consequences of Smoke-Free Policies in Public Places on Pregnant Women in China
Yao, Tingting
Lee, Anita H.
Mao, Zhengzhong
American journal of preventive medicine
Smoke-free policies in public places have become more common in China. Little is known, however, about the potential unintended consequences of such policies on pregnant women.
The study was conducted in 2006 in Chengdu, China. Nonsmoking pregnant women (N = 55) whose husband were smokers participated in a study of their knowledge about secondhand smoke and smoke-free policies, their exposure to secondhand smoke, and their husbands' smoking status at home. This study presents descriptive statistics, analyses based on family income and pregnant women's education level, and the findings of focus group discussions that examined the potential unintended consequences of the smoke-free policies on pregnant women.
Exposure to secondhand smoke at home was reported by 69.1% of the pregnant women. Both family income and the education level of the pregnant women had a significant (p < 0.05) association with exposure to secondhand smoke. The four main potential unintended consequences of the smoke-free policies were: (1) increased exposure of pregnant women to secondhand smoke at home; (2) reduced work efficiency; (3) adverse effect on family harmony; and (4) poor air quality at home.
Education is needed to increase knowledge of secondhand smoke among smokers and nonsmokers alike. When the smoking location is shifted from public places and workplaces to home, women, and in particular pregnant women, become the victims. Policymakers should recognize such potential unintended consequences and take necessary measures to increase awareness about the harms of secondhand smoke.
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Tobacco use, exposure to secondhand smoke, and cessation counseling among medical students: cross-country data from the Global Health Professions Student Survey (GHPSS), 2005-2008
Warren, Charles W
Sinha, Dhirendra N
Lee, Juliette
Lea, Veronica
Jones, Nathan R
BMC Public Health
GHPSS is a school-based survey that collects self-administered data from students in regular classroom settings. GHPSS produces representative data at the national or city level in each country. This study aims to investigate the prevalence of tobacco use, exposure to secondhand smoke, and cessation counseling among medical students using the GHPSS data.
The Global Health Professions Student Survey (GHPSS) was conducted among 3rd year medical students in 47 countries and the Gaza Strip/West Bank from 2005-2008 to determine the prevalence of tobacco use and amount of formal training in cessation counseling.
In 26 of the 48 sites, over 20% of the students currently smoked cigarettes, with males having higher rates than females in 37 sites. Over 70% of students reported having been exposed to secondhand smoke in public places in 29 of 48 sites. The majority of students recognized that they are role models in society (over 80% in 42 of 48 sites), believed they should receive training on counseling patients to quit using tobacco (over 80% in 41 of 48 sites), but few reported receiving formal training (less than 40% in 46 of 48 sites).
Tobacco control efforts must discourage tobacco use among health professionals, promote smoke free workplaces, and implement programs that train medical students in effective cessation-counseling techniques.
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Antismoking Mass Media Campaigns and Support for Smoke-Free Environments, Mobile County, Alabama, 2011–2012
Fosson, Gabriel H.
McCallum, Debra M.
Conaway, Michael B.
Preventing Chronic Disease
In 2011, the Mobile County Health Department began a 12-month antismoking educational media campaign to educate citizens on the dangers of secondhand smoke. The campaign overlapped with the Centers for Disease Control and Prevention's 3-month national antismoking Tips from Former Smokers media campaign. We aimed to evaluate the effect of these campaigns on support for smoke-free environments and knowledge of the dangers of secondhand smoke.
Cross-sectional precampaign and postcampaign telephone surveys collected data from a random sample of Mobile County adults in the summers of 2011 and 2012. Outcome measures included changes in support for smoke-free environments and knowledge of the dangers of secondhand smoke. The participation rate among the households that were successfully reached was 45% in 2011 and 44% in 2012.
On the postcampaign survey, 80.9% of respondents reported seeing a television advertisement, 29.9% reported hearing a radio advertisement, and 49.0% reported seeing a billboard. Overall, support for smoke-free bars increased significantly after the intervention (38.1% to 43.8%; P = .01) but not for workplaces or restaurants. Self-reported exposure to the media campaign was associated with higher levels of support for smoke-free workplaces, restaurants, and bars.
Educational mass media campaigns have the potential to increase support for smoke-free protections and may increase knowledge about the dangers of secondhand smoke among certain populations.
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Health Literacy Practices and Educational Competencies for Health Professionals: A Consensus Study
Coleman, Clifford A.
Hudson, Stan
Maine, Lucinda L.
Journal of Health Communication
2013;18(Suppl 1):82-102.
Health care professionals often lack adequate knowledge about health literacy and the skills needed to address low health literacy among patients and their caregivers. Many promising practices for mitigating the effects of low health literacy are not used consistently. Improving health literacy training for health care professionals has received increasing emphasis in recent years. The development and evaluation of curricula for health professionals has been limited by the lack of agreed-upon educational competencies in this area. This study aimed to identify a set of health literacy educational competencies and target behaviors, or practices, relevant to the training of all health care professionals. The authors conducted a thorough literature review to identify a comprehensive list of potential health literacy competencies and practices, which they categorized into 1 or more educational domains (i.e., knowledge, skills, attitudes) or a practice domain. The authors stated each item in operationalized language following Bloom's Taxonomy. The authors then used a modified Delphi method to identify consensus among a group of 23 health professions education experts representing 11 fields in the health professions. Participants rated their level of agreement as to whether a competency or practice was both appropriate and important for all health professions students. A predetermined threshold of 70% agreement was used to define consensus. After 4 rounds of ratings and modifications, consensus agreement was reached on 62 out of 64 potential educational competencies (24 knowledge items, 27 skill items, and 11 attitude items), and 32 out of 33 potential practices. This study is the first known attempt to develop consensus on a list of health literacy practices and to translate recommended health literacy practices into an agreed-upon set of measurable educational competencies for health professionals. Further work is needed to prioritize the competencies and practices in terms of relative importance.
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Hispanic physicians' tobacco intervention practices: a cross-sectional survey study
Soto Mas, Francisco G
Papenfuss, Richard L
Jacobson, Holly E
Ed Hsu, Chiehwen
Urrutia-Rojas, Ximena
Kane, William M
BMC Public Health
U.S. Hispanic physicians constitute a considerable professional collective, and they may be most suited to attend to the health education needs of the growing U.S. Hispanic population. These educational needs include tobacco use prevention and smoking cessation. However, there is a lack of information on Hispanic physicians' tobacco intervention practices, their level of awareness and use of cessation protocols, and the type of programs that would best address their tobacco training needs. The purpose of this study was to assess the tobacco intervention practices and training needs of Hispanic physicians.
Data was collected through a validated survey instrument among a cross-sectional sample of self-reported Hispanic physicians. Data analyses included frequencies, descriptive statistics, and factorial analyses of variance.
The response rate was 55.5%. The majority of respondents (73.3%) were middle-age males. Less than half of respondents routinely performed the most basic intervention: asking patients about smoking status (44.4%) and advising smoking patients to quit (42.2%). Twenty-five percent assisted smoking patients by talking to them about the health risks of smoking, providing education materials or referring them to cessation programs. Only 4.4% routinely arranged follow-up visits or phone calls for smoking patients. The majority of respondents (64.4%) indicated that they prescribe cessation treatments to less than 20% of smoking patients. A few (4.4%) routinely used behavioral change techniques or programs. A minority (15.6%) indicated that they routinely ask their patients about exposure to tobacco smoke, and 6.7% assisted patients exposed to secondhand smoke in understanding the health risks associated with environmental tobacco smoke (ETS). The most frequently encountered barriers preventing respondents from intervening with patients who smoke included: time, lack of training, lack of receptivity by patients, and lack of reimbursement by third party payers. There was no significant main effect of type of physician, nor was there an interaction effect (gender by type of physician), on tobacco-related practices.
The results indicate that Hispanic physicians, similarly to U.S. physicians in general, do not meet the level of intervention recommended by health care agencies. The results presented will assist in the development of tobacco training initiatives for Hispanic physicians.
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Secondhand Tobacco Smoke: An Occupational Hazard for Smoking and Non-Smoking Bar and Nightclub Employees
Jones, Miranda R
Wipfli, Heather
Shahrir, Shahida
Avila-Tang, Erika
Samet, Jonathan M
Breysse, Patrick N
Navas-Acien, Ana
Tobacco control
In the absence of comprehensive smoking bans in public places, bars and nightclubs have the highest concentrations of secondhand tobacco smoke, posing a serious health risk for workers in these venues.
To assess exposure of bar and nightclub employees to secondhand smoke, including non-smoking and smoking employees.
Between 2007 and 2009, we recruited approximately 10 venues per city and up to 5 employees per venue in 24 cities in the Americas, Eastern Europe, Asia and Africa. Air nicotine concentrations were measured for 7 days in 238 venues. To evaluate personal exposure to secondhand smoke, hair nicotine concentrations were also measured for 625 non-smoking and 311 smoking employees (N=936).
Median (interquartile range [IQR]) air nicotine concentrations were 3.5 (1.5, 8.5) µg/m3 and 0.2 (0.1, 0.7) µg/m3 in smoking and smoke-free venues, respectively. Median (IQR) hair nicotine concentrations were 6.0 (1.6, 16.0) ng/mg and 1.7 (0.5, 5.5) ng/mg in smoking and non-smoking employees, respectively. After adjustment for age, sex, education, living with a smoker, hair treatment and region, a 2-fold increase in air nicotine concentrations was associated with a 30% (95% confidence interval 23%, 38%) increase in hair nicotine concentrations in non-smoking employees and with a 10% (2%, 19%) increase in smoking employees.
Occupational exposure to secondhand smoke, assessed by air nicotine, resulted in elevated concentrations of hair nicotine among non-smoking and smoking bar and nightclub employees. The high levels of airborne nicotine found in bars and nightclubs and the contribution of this exposure to employee hair nicotine concentrations support the need for legislation measures that ensure complete protection from secondhand smoke in these venues.
nicotine; tobacco smoke pollution; workplace
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The Effect of Tobacco Control Measures during a Period of Rising Cardiovascular Disease Risk in India: A Mathematical Model of Myocardial Infarction and Stroke
Basu, Sanjay
Glantz, Stanton
Bitton, Asaf
Millett, Christopher
PLoS Medicine
In this paper from Basu and colleagues, a simulation of tobacco control and pharmacological interventions to prevent cardiovascular disease mortality in India predicted that Smokefree laws and increased tobacco taxation are likely to be the most effective measures to avert future cardiovascular deaths in India.
Please see later in the article for the Editors' Summary
We simulated tobacco control and pharmacological strategies for preventing cardiovascular deaths in India, the country that is expected to experience more cardiovascular deaths than any other over the next decade.
Methods and Findings
A microsimulation model was developed to quantify the differential effects of various tobacco control measures and pharmacological therapies on myocardial infarction and stroke deaths stratified by age, gender, and urban/rural status for 2013 to 2022. The model incorporated population-representative data from India on multiple risk factors that affect myocardial infarction and stroke mortality, including hypertension, hyperlipidemia, diabetes, coronary heart disease, and cerebrovascular disease. We also included data from India on cigarette smoking, bidi smoking, chewing tobacco, and secondhand smoke. According to the model's results, smoke-free legislation and tobacco taxation would likely be the most effective strategy among a menu of tobacco control strategies (including, as well, brief cessation advice by health care providers, mass media campaigns, and an advertising ban) for reducing myocardial infarction and stroke deaths over the next decade, while cessation advice would be expected to be the least effective strategy at the population level. In combination, these tobacco control interventions could avert 25% of myocardial infarctions and strokes (95% CI: 17%–34%) if the effects of the interventions are additive. These effects are substantially larger than would be achieved through aspirin, antihypertensive, and statin therapy under most scenarios, because of limited treatment access and adherence; nevertheless, the impacts of tobacco control policies and pharmacological interventions appear to be markedly synergistic, averting up to one-third of deaths from myocardial infarction and stroke among 20- to 79-y-olds over the next 10 y. Pharmacological therapies could also be considerably more potent with further health system improvements.
Smoke-free laws and substantially increased tobacco taxation appear to be markedly potent population measures to avert future cardiovascular deaths in India. Despite the rise in co-morbid cardiovascular disease risk factors like hyperlipidemia and hypertension in low- and middle-income countries, tobacco control is likely to remain a highly effective strategy to reduce cardiovascular deaths.
Please see later in the article for the Editors' Summary
Editors' Summary
Cardiovascular diseases (CVDs) are conditions that affect the heart and/or the circulation. In coronary heart disease, for example, narrowing of the heart's blood vessels by fatty deposits slows the blood supply to the heart and may eventually cause a heart attack (myocardial infarction). Stroke, by contrast, is a CVD in which the blood supply to the brain is interrupted. CVD has been a major cause of illness and death in high-income countries for many years, but the burden of CVD is now rapidly rising in low- and middle-income countries. Indeed, worldwide, three-quarters of all deaths from heart disease and stroke occur in low- and middle-income countries. Smoking, high blood pressure (hypertension), high blood cholesterol (hyperlipidemia), diabetes, obesity, and physical inactivity all increase an individual's risk of developing CVD. Prevention strategies and treatments for CVD include lifestyle changes (for example, smoking cessation) and taking drugs that lower blood pressure (antihypertensive drugs) or blood cholesterol levels (statins) or thin the blood (aspirin).
Why Was This Study Done?
Because tobacco use is a key risk factor for CVD and for several other noncommunicable diseases, the World Health Organization has developed an international instrument for tobacco control called the Framework Convention on Tobacco Control (FCTC). Parties to the FCTC (currently 176 countries) agree to implement a set of core tobacco control provisions including legislation to ban tobacco advertising and to increase tobacco taxes. But will tobacco control measures reduce the burden of CVD effectively in low- and middle-income countries as other risk factors for CVD are becoming more common? In this mathematical modeling study, the researchers investigated this question by simulating the effects of tobacco control measures and pharmacological strategies for preventing CVD on CVD deaths in India. Notably, many of the core FCTC provisions remain poorly implemented or unenforced in India even though it became a party to the convention in 2005. Moreover, experts predict that, over the next decade, this middle-income country will contribute more than any other nation to the global increase in CVD deaths.
What Did the Researchers Do and Find?
The researchers developed a microsimulation model (a computer model that operates at the level of individuals) to quantify the likely effects of various tobacco control measures and pharmacological therapies on deaths from myocardial infarction and stroke in India between 2013 and 2022. They incorporated population-representative data from India on risk factors that affect myocardial infarction and stroke mortality and on tobacco use and exposure to secondhand smoke into their model. They then simulated the effects of five tobacco control measures—smoke-free legislation, tobacco taxation, provision of brief cessation advice by health care providers, mass media campaigns, and advertising bans—and increased access to aspirin, antihypertensive drugs, and statins on deaths from myocardial infarction and stroke. Smoke-free legislation and tobacco taxation are likely to be the most effective strategies for reducing myocardial infarction and stroke deaths over the next decade, according to the model, and the effects of these strategies are likely to be substantially larger than those achieved by drug therapies under current health system conditions. If the effects of smoke-free legislation and tobacco taxation are additive, the model predicts that these two measures alone could avert about 9 million deaths, that is, a quarter of the expected deaths from myocardial infarction and stroke in India over the next 10 years, and that a combination of tobacco control policies and pharmacological interventions could avert up to a third of these deaths.
What Do These Findings Mean?
These findings suggest that the implementation of smoke-free laws and the introduction of increased tobacco taxes in India would yield substantial and rapid health benefits by averting future CVD deaths. The accuracy of these findings is likely to be affected by the many assumptions included in the mathematical model and by the quality of the data fed into it. Importantly, however, these finding suggest that, despite the rise in other CVD risk factors such as hypertension and hyperlipidemia, tobacco control is likely to be a highly effective strategy for the reduction of CVD deaths over the next decade in India and probably in other low- and middle-income countries. Policymakers in these countries should, therefore, work towards fuller and faster implementation of the core FCTC provisions to boost their efforts to reduce deaths from CVD.
Additional Information
Please access these websites via the online version of this summary at http://dx.doi.org/10.1371/journal.pmed.1001480.
The American Heart Association provides information on all aspects of cardiovascular disease; its website includes personal stories about heart attacks and stroke
The US Centers for Disease Control and Prevention has information on heart disease and on stroke (in English and Spanish
The UK National Health Service Choices website provides information about cardiovascular disease and stroke
MedlinePlus provides links to other sources of information on heart diseases, vascular diseases, and stroke (in English and Spanish)
The World Health Organization provides information (in several languages) about the dangers of tobacco, about the Framework Convention on Tobacco Control, and about noncommunicable diseases; its Global Noncommunicable Disease Network (NCDnet) aims to help low- and middle- income countries reduce illness and death caused by CVD and other noncommunicable diseases
SmokeFree, a website provided by the UK National Health Service, offers advice on quitting smoking and includes personal stories from people who have stopped smoking
Smokefree.gov, supported by the US National Cancer Institute and other US agencies, offers online tools and resources to help people quit smoking
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Using Indoor Air Quality Monitoring in 6 Counties to Change Policy in North Carolina
Proescholdbell, Scott
Steiner, Julea
Goldstein, Adam O.
Herndon Malek, Sally
Preventing Chronic Disease
Indoor air quality monitoring has become a valuable tool for states wanting to assess levels of particulate matter before and after smoke-free policies are implemented. However, many states face barriers in passing comprehensive smoke-free legislation, making such study comparisons unlikely. We used indoor air monitoring data to educate decision makers about the value of comprehensive smoke-free laws in a state with strong historical ties to tobacco.
We trained teams in 6 counties in North Carolina to monitor air quality in hospitality venues with 1 of 3 possible smoking policy designations: 1) smoke-free, 2) separate smoking and nonsmoking sections (mixed), or 3) smoking allowed in all areas. Teams monitored 152 venues for respirable suspended particles that were less than 2.5 μm in diameter and collected information on venue characteristics. The data were combined and analyzed by venue policy and by county. Our findings were presented to key decision makers, and we then collected information on media publicity about these analyses.
Overall, smoke-free venues had the lowest particulate matter levels (15 µg/m3), well below established Environmental Protection Agency standards. Venues with mixed policies and venues that permitted smoking in all areas had particulate matter levels that are considered unhealthy by Environmental Protection Agency standards. The media coverage of our findings included newspaper, radio, and television reports. Findings were also discussed with local health directors, state legislators, and public health advocates.
Study data have been used to quantify particulate matter levels, raise awareness about the dangers of secondhand smoke, build support for evidence-based policies, and promote smoke-free policies among policy makers. The next task is to turn this effort into meaningful policy change that will protect everyone from the harms of secondhand smoke.
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Racial, Ethnic, and Language Disparities in Children's Exposure to Secondhand Smoke
Anand, Vibha
Downs, Stephen M.
Pediatric Allergy, Immunology, and Pulmonology
Race and ethnicity affect children's risk of secondhand smoke exposure. However, little is known about how race and language preference impact parents' self-reported smoking and stopping smoking rates. We analyzed data for 16,523 children aged 0–11 years from a pediatric computer decision support system (Child Health Improvement through Computer Automation [CHICA]). CHICA asks families in the waiting room about household smokers. We examined associations between race, insurance, language preference, and household smoking and reported stopping smoking rates using logistic regression. Almost a quarter (23%) of the children's families reported a smoker at home. Hispanic children are least likely (odds ratio [OR]: 0.17, confidence interval [CI]: 0.12–0.24) to have secondhand smoke exposure when compared to African American and white children, as were those with private insurance (OR: 0.52, CI: 0.43–0.64) or no insurance (OR: 0.79, CI: 0.71–0.88) compared to publicly insured. Children from English speaking families were more likely (OR: 1.55, CI: 1.24–1.95) to have secondhand smoke exposure compared to Spanish speaking families. Among smoking families, 30% reported stopping smoking subsequently. Stopping rates were higher in Hispanic (OR: 3.25, CI: 2.06–5.13) and African American (OR: 1.39, CI: 1.01–1.91) families compared to white children's families. Uninsured families were less likely than publicly insured families to report stopping smoking (OR: 0.76, CI: 0.63–0.92). English speaking families were less likely (OR: 0.56, CI: 0.41–0.75) to report stopping smoking compared to Spanish speaking even in a subgroup analyses of Hispanic families (OR: 0.55, CI: 0.39–0.76). In our safety net practices serving children predominantly on public insurance, Spanish speaking families reported the lowest risk of secondhand smoke exposure in children and the highest rate of stopping smoking in the household. Hispanic families may have increasing secondhand exposure and decreasing rates of stopping smoking as they acculturate.
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Maternal educational level, parental preventive behavior, risk behavior, social support and medical care consumption in 8-month-old children in Malmö, Sweden
Mangrio, Elisabeth
Hansen, Kristina
Lindström, Martin
Köhler, Marie
Rosvall, Maria
BMC Public Health
The social environment in which children grow up is closely associated with their health. The aim of this study was to investigate the relationship between maternal educational level, parental preventive behavior, parental risk behavior, social support, and use of medical care in small children in Malmö, Sweden. We also wanted to investigate whether potential differences in child medical care consumption could be explained by differences in parental behavior and social support.
This study was population-based and cross-sectional. The study population was 8 month-old children in Malmö, visiting the Child Health Care centers during 2003-2007 for their 8-months check-up, and whose parents answered a self-administered questionnaire (n = 9,289 children).
Exclusive breast feeding ≥4 months was more common among mothers with higher educational level. Smoking during pregnancy was five times more common among less-educated mothers. Presence of secondhand tobacco smoke during the first four weeks of life was also much more common among children with less-educated mothers. Less-educated mothers more often experienced low emotional support and low practical support than mothers with higher levels of education (>12 years of education). Increased exposure to unfavorable parental behavioral factors (maternal smoking during pregnancy, secondhand tobacco smoke and exclusive breastfeeding <4 months) was associated with increased odds of in-hospital care and having sought care from a doctor during the last 8 months. The odds were doubled when exposed to all three risk factors. Furthermore, children of less-educated mothers had increased odds of in-hospital care (OR = 1.34 (95% CI: 1.08, 1.66)) and having sought care from a doctor during the last 8 months (OR = 1.28 (95% CI: 1.09, 1.50)), which were reduced and turned statistically non-significant after adjustment for unfavorable parental behavioral factors.
Children of less-educated mothers were exposed to more health risks, fewer health-promoting factors, worse social support, and had higher medical care consumption than children with higher educated mothers. After adjustment for parental behavioral factors the excess odds of doctor's visits and in-hospital care among children with less-educated mothers were reduced. Improving children's health calls for policies targeting parents' health-related behaviors and social support.
Epidemiology; Medical care consumption; Children; Education; Health-related behaviors
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Smoking cessation and smokefree environments for tuberculosis patients in Indonesia-a cohort study
Bam, Tara Singh
Aditama, Tjandra Yoga
Chiang, Chen-Yuan
Rubaeah, Rubaeah
Suhaemi, Acep
BMC Public Health
Research indicates that smoking substantially increases the risk of tuberculosis (TB), delay in diagnosis, failure of TB treatment and death from TB. Quitting smoking is one of the best ways to prevent unwanted outcomes. Exposure to secondhand smoke increases the risks of both TB infection and development of active TB disease among children and adults. TB patients who smoke in the home are also placing their families at a greater risk of TB infection. It is very important to keep homes smokefree. The present study assessed the implementation and effectiveness of an intervention that promotes smoking cessation and smokefree environments for TB patients.
All consecutive new sputum smear-positive TB patients (aged ≥15 years old) diagnosed and registered in 17 health centres between 1 January 2011 and 31 December 2012 were enrolled. The ABC (A=ask, B=brief advice, C=cessation support) intervention was offered for 5 to 10 minutes within DOTS services at each visit. Smoking status and smokefree environments at home were assessed at the first visit, each monthly follow up and at month six. Factors associated with quitting were analysed by univariable and multivariable analysis
Of the 750 TB patients registered, 582 (77.6 %) were current smokers, 40 (5.3 %) were ex-smokers and 128 (17.1 %) were never smokers. Of the 582 current smokers, 66.8 % had quit smoking at month six. A time from waking to first cigarette of >30 minutes, having a smokefree home and the display of "no smoking" signage at home at month six were significantly associated with quitting. Of the 750 TB patients, 86.1 % had created a smokefree home at six month follow-up compared with 18.5 % at baseline. All 80 health facilities were 100 % tobacco-free at the end of 2012 compared with only 52 (65 %) when the intervention began in March 2011.
Brief advice of 5–10 minutes with minimal cessation support at every visit of TB patients resulted in high quit rates and higher awareness of adverse health effects of secondhand smoke exposure, which led patients to make their homes smokefree and health providers to make health care tobacco-free.
Smoking; Cessation; Smokefree home; ABC-approach; Tuberculosis
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Factors Associated with Active Smoking, Quitting, and Secondhand Smoke Exposure among Pregnant Women in Greece
Vardavas, Constantine I.
Patelarou, Evridiki
Chatzi, Leda
Roumeliotaki, Theano
Sarri, Katerina
Murphy, Sharon
Koutis, Antonis
Kafatos, Anthony G.
Kogevinas, Manolis
Journal of Epidemiology
Pregnant women are exposed to tobacco smoke through active smoking and contact with secondhand smoke (SHS), and these exposures have a significant impact on public health. We investigated the factors that mediate active smoking, successful quitting, and SHS exposure among pregnant women in Crete, Greece.
Using a cotinine-validated questionnaire, data were collected on active smoking and exposure to secondhand smoke from 1291 women who had successfully completed the first contact questionnaire of the prospective mother-child cohort (Rhea) in Crete during the 12th week of pregnancy.
Active smoking at some time during pregnancy was reported by 36% of respondents, and 17% were current smokers at week 12 of gestation. Those less likely to quit smoking during pregnancy were those married to a smoker (OR, 1.76; P = 0.008), those who were multiparous (1.72; P = 0.011), and those with young husbands. Of the 832 (64%) nonsmokers, almost all (94%, n = 780) were exposed to SHS, with the majority exposed at home (72%) or in a public place (64%). Less educated women and younger women were exposed more often than their better educated and older peers (P < 0.001). Adjusting for potential confounders, parental level of education, age, and ethnicity were the main mediators of exposure to SHS during pregnancy.
Active smoking and exposure to SHS are very prevalent among pregnant women in Greece. The above findings indicate the need for support of population-based educational interventions aimed at smoking cessation in both parents, as well as of the importance of establishing smoke-free environments in both private and public places.
smoking; cessation; pregnancy; fetal health; passive smoking; SHS
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A novel pain interprofessional education strategy for trainees: Assessing impact on interprofessional competencies and pediatric pain knowledge
Hunter, Judith P
Stinson, Jennifer
Campbell, Fiona
Stevens, Bonnie
Wagner, Susan J
Simmons, Brian
White, Meghan
van Wyk, Margaret
Pain Research & Management : The Journal of the Canadian Pain Society
It is well known that pain education in Canadian medical schools needs to be improved, and there have been many initiatives to improve pain education at the preprofessional stage of training. However, the majority of pain education still occurs in a classroom setting. The authors of this article implemented a novel interprofessional education-based teaching strategy in a tertiary care-based setting. This article presents a pilot study of this education model.
Health care trainees/students lack knowledge and skills for the comprehensive clinical assessment and management of pain. Moreover, most teaching has been limited to classroom settings within each profession.
To develop and evaluate the feasibility and preliminary outcomes of the 'Pain-Interprofessional Education (IPE) Placement', a five-week pain IPE implemented in the clinical setting. The utility (content validity, readability, internal consistency and practical considerations) of the outcome measures was also evaluated.
A convenience sample of 21 trainees from eight professions was recruited over three Pain-IPE Placement cycles. Pre- and postcurriculum assessment included: pain knowledge (Pediatric Pain Knowledge and Attitudes Survey), IPE attitudes (Interdisciplinary Education Perception Scale [IEPS]) and IPE competencies (Interprofessional Care Core Competencies Global Rating Scales [IPC-GRS]), and qualitative feedback on process/acceptability.
Recruitment and retention met expectations. Qualitative feedback was excellent. IPE measures (IEPS and IPC-GRS) exhibited satisfactory utility. Postcurriculum scores improved significantly: IEPS, P<0.05; IPC-GRS constructs, P<0.01; and competencies, P<0.001. However, the Pediatric Pain Knowledge and Attitudes Survey exhibited poor utility in professions without formal pharmacology training. Scores improved in the remaining professions (n=14; P<0.01).
There was significant improvement in educational outcomes. The IEPS and IPC-GRS are useful measures of IPE-related learning. At more advanced training levels, a single pain-knowledge questionnaire may not accurately reflect learning across diverse professions.
The Pain-IPE Placement is a successful collaborative learning model within a clinical context that successfully changed interprofessional competencies. The present study represents a first step at defining and assessing change in interprofessional competencies gained from Pain-IPE.
Collaboration; Competencies; Education; Interprofessional; Interdisciplinary; Pain; Trainees
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Analysis of awareness of health knowledge among rural residents in Western China
Yuan, Fang
Qian, Dongfu
Huang, Chenglong
Tian, Miaomiao
Xiang, Yuanxi
He, Zhifei
Feng, Zhanchun
BMC Public Health
Lifestyle diseases could be prevented and controlled by disseminating health knowledge. This study explored the health knowledge awareness and the impact factors of health knowledge awareness, and the way people received health knowledge in western China.
We undertook a cross-sectional survey in 8 counties, 24 townships and 72 villages from July 2011 to April 2012 in Inner Mongolia, Xinjiang, Chongqing and Qinghai in China. Collected data, which were publicly available, consisted of two parts, namely, socio-demographic information and the 1466 corresponding rural residents' awareness and the approach of health knowledge. Analysis of Variance (ANOVA) was used to explore the impact factors of health knowledge awareness. Multiple linear regressions was then applied to examine the potential predictors of health knowledge awareness.
Four predictors-age (negative factor), educational level (positive factor), distance from home to the nearest medical institution (negative factor) and annul disposable household income (negative factor) were in the final liner regression model (p < 0.05). The results showed that awareness of health knowledge associated with risk factors was the highest (58.85%). The highest awareness rate of health knowledge is the title "Whether secondhand smoke is harmful to myself" (69.78%) and the lowest title is "Whether eating with hepatitis B patients will be infected Hepatitis B" (21.69%). The main way to receive health knowledge was traditional way such as doctors (80.45%). About more than half of the residents received health knowledge through television, video, newspaper and magazines (65.78%), family members, neighbors (67.38%) and the village health bulletin boards (53.16%).
Health knowledge awareness of rural residents was quite low and the way of receiving health knowledge was simple and traditional. One of the critical factors was education level. Direct results showed that lower income families always obtained higher health knowledge level than the rich families. The main way to receive health knowledge was traditional ways. In the process of health education, different means of education should be adopted for different groups so as to achieve ideal effect. Potential interventions may be different from education process which should be adapted to different income level families.
Electronic supplementary material
The online version of this article (doi:10.1186/s12889-015-1393-2) contains supplementary material, which is available to authorized users.
Health education; Awareness of health knowledge; Education; Rural areas; Western China
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Smoke-Free Policies Among Asian-American Women: Comparisons by Education Status
Tong, Elisa K
Tang, Hao
Tsoh, Janice
Wong, Candice
Chen, Moon S.
American journal of preventive medicine
California has significantly decreased racial/ethnic and educational disparities in smoke-free home and indoor work policies. California's ethnic-specific surveys present an opportunity to disaggregate data and examine the impact of California's smoke-free social norm campaign for Asian-American women.
The California Tobacco Use Surveys for Chinese Americans and Korean Americans were conducted in 2003 and analyzed in 2008 to compare women with lower (≤ high school graduate) or higher education status for smoke-free policy adoption and enforcement.
Lower-educated and higher-educated women had similar proportions of smoke-free policies at home (58%) or indoor work (90%). However, lower-educated women were more likely than higher-educated women to report anyone ever smoking at home (OR=1.62, 95% CI=1.06, 2.48, p=0.03) and exposure during the past 2 weeks at an indoor workplace (OR=2.43, 95% CI= 1.30, 4.55, p=0.005), even after controlling for ethnicity, smoke-free policy, knowledge about the health consequences of secondhand smoke exposure, and acculturation. There was no interaction between education and knowledge about secondhand smoke health harms.
The intended consequences of California's tobacco-control efforts have resulted in similar rates of smoke-free policies at home and in indoor work environments among Asian-American women across educational levels. However, an unintended consequence of this success is a disparity in enforcement by educational status, with lower-educated Asian-American women reporting greater smoke exposure despite similar rates of knowledge about the health consequences of secondhand smoke exposure. Besides establishing policies, lower-educated Asian-American women may need to be empowered to assert and enforce their right to smoke-free environments.
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The effects of secondhand smoke on chronic obstructive pulmonary disease in nonsmoking Korean adults
Kim, Woong Jun
Song, June Seok
Park, Dong Won
Kwak, Hyun Jung
Moon, Ji-Yong
Kim, Sang-Heon
Sohn, Jang Won
Yoon, Ho Joo
Shin, Dong Ho
Park, Sung Soo
Kim, Tae-Hyung
The Korean Journal of Internal Medicine
Smoking is widely acknowledged as the single most important risk factor for chronic obstructive pulmonary disease (COPD). However, the risk of COPD in nonsmokers exposed to secondhand smoke remains controversial. In this study, we investigated the association of secondhand smoke exposure with COPD prevalence in nonsmokers who reported never smoking.
This study was based on data obtained from the Korean National Health and Nutrition Examination Surveys (KNHANES) conducted from 2008 to 2010. Using nationwide stratified random sampling, 8,596 participants aged ≥ 40 years of age with available spirometry results were recruited. After selecting participants who never smoked, the duration of exposure to secondhand smoke was assessed based on the KNHANES questionnaire.
The prevalence of COPD was 6.67% in participants who never smoked. We divided the participants who had never smoked into those with or without exposure to secondhand smoke. The group exposed to secondhand smoke was younger with less history of asthma and tuberculosis, higher income, and higher educational status. Multivariate logistic regression analysis determined that secondhand smoke did not increase the prevalence of COPD.
There was no significant difference in the prevalence of COPD between participants who had never smoked with or without exposure to secondhand smoke in our study. Thus, secondhand smoke may not be an important risk factor for the development of COPD in patients who have never smoked.
Never smoker; Secondhand smoke; Chronic obstructive pulmonary disease
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eHealth Literacy Among College Students: A Systematic Review With Implications for eHealth Education
Stellefson, Michael
Hanik, Bruce
Chaney, Beth
Chaney, Don
Tennant, Bethany
Chavarria, Enmanuel Antonio
Journal of Medical Internet Research
eHealth literacy refers to the ability of individuals to seek, find, understand, and appraise health information from electronic resources and apply such knowledge to addressing or solving a health problem. While the current generation of college students has access to a multitude of health information on the Internet, access alone does not ensure that students are skilled at conducting Internet searches for health information. Ensuring that college students have the knowledge and skills necessary to conduct advanced eHealth searches is an important responsibility particularly for the medical education community. It is unclear if college students, especially those in the medical and health professions, need customized eHealth literacy training for finding, interpreting, and evaluating health- and medical-related information available on the Internet.
The objective of our review was to summarize and critically evaluate the evidence from existing research on eHealth literacy levels among college students between the ages of 17 and 26 years attending various 4-year colleges and universities located around the world.
We conducted a systematic literature review on numerous scholarly databases using various combinations of relevant search terms and Boolean operators. The records were screened and assessed for inclusion in the review based on preestablished criteria. Findings from each study that met inclusion criteria were synthesized and summarized into emergent themes.
In the final review we analyzed 6 peer-reviewed articles and 1 doctoral dissertation that satisfied the inclusion criteria. The number of participants in each reviewed study varied widely (from 34 to 5030). The representativeness of the results from smaller studies is questionable. All studies measured knowledge and/or behaviors related to college student ability to locate, use, and evaluate eHealth information. These studies indicated that many college students lack eHealth literacy skills, suggesting that there is significant room for improvement in college students' ability to obtain and evaluate eHealth information.
Although college students are highly connected to, and feel comfortable with, using the Internet to find health information, their eHealth literacy skills are generally sub par. College students, especially in the health and medical professions, would be well served to receive more customized college-level instruction that improves general eHealth literacy.
eHealth literacy; college students; health occupations; professional preparation
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Tobacco Use, Exposure to Secondhand Smoke, and Training on Cessation Counseling Among Nursing Students: Cross-Country Data from the Global Health Professions Student Survey (GHPSS), 2005–2009
Warren, Charles W.
Sinha, Dhirendra N.
Lee, Juliette
Lea, Veronica
Jones, Nathan R.
International Journal of Environmental Research and Public Health
The Nursing Global Health Professions Student Survey (GHPSS) has been conducted in schools in 39 countries and the Gaza Strip/West Bank (identified as "sites" for the remainder of this paper). In half the sites, over 20% of the students currently smoked cigarettes, with males having higher rates than females in 22 sites. Over 60% of students reported having been exposed to secondhand smoke in public places in 23 of 39 sites. The majority of students recognized that they are role models in society, believed they should receive training on counseling patients to quit using tobacco, but few reported receiving any formal training. Tobacco control efforts must discourage tobacco use among health professionals, promote smoke free workplaces, and implement programs that train health professionals in effective cessation-counseling techniques.
tobacco use; health professionals; nursing students; counseling training
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text:
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Thanks alot!