Progress on smoking control in Western Australia.

In 1990, 20 years of campaigning by the Western Australian branch of the Australian Council on Smoking and Health succeeded in getting tobacco advertising banned in Western Australia and a fund set up to replace the sponsorship of sport by tobacco companies. The council coordinated the activities of the mainly professional medical organisations that formed its members, ensuring that messages about the dangers of tobacco were consistently presented from different angles. The campaigners also ensured that medical data were reworked for presentation to decision makers and public, invaded the corporate world, and minimised opposition by enlisting the support of sportspeople opposed to tobacco sponsorship. The council hopes now that elimination of advertising will reduce the prevalence of smoking.     

Hydatid disease in Western Australia: a novel approach to education and surveillance

Hydatid disease (echinococcosis) remains a public health and economic problem of global proportion. Treatment usually requires major surgery and the prognosis for some forms of the disease is poor. The variable transmission patterns exhibited by the causative agents of this complex zoonosis, and inadequate support both internationally and nationally, have resulted in the establishment of control campaigns that are usually organized and funded at a local level. Here, Andrew Thompson, Ian Robertson, Robin Gasser and Clare Constantine describe a novel, targeted campaign of education and surveillance that has recently been initiated in Western Australia, where a totally artificial cycle of transmission for Fchinococcus granulosus has been established as a result of human activity.     

Smoking and health

Cigarette smoking is the leading cause of preventable death and disease in Canada, accounting for some 30 000 deaths annually. This enormous health cost to Canadians has led the Canadian Medical Association (CMA) to promote initiatives regarding smoking prevention programs in schools, legislation to prevent smoking in government buildings and controls on smoking in private buildings, particularly places of work. The CMA recommends the prohibition of all forms of tobacco advertising/promotion in Canada, including advertising in conjunction with athletic events. The CMA also supports the taxation of tobacco products at a level to discourage their purchase, with revenue earmarked for health budgets, and the association is encouraging the federal government to develop alternative crop incentives for tobacco farmers. The norm of nonsmoking is a social attitude the CMA is working toward developing in all Canadians.     

The Influence of Antismoking Television Advertisements on Cessation by Race/Ethnicity,Socioeconomic Status,and Mental Health Status

Disparities in tobacco use and smoking cessation by race/ethnicity, education, income, and mental health status remain despite recent successes in reducing tobacco use. It is unclear to what extent media campaigns promote cessation within these population groups. This study aims to (1) assess whether exposure to antitobacco advertising is associated with making a quit attempt within a number of population subgroups, and (2) determine whether advertisement type differentialy affects cessation behavior across subgroups. We used data from the New York Adult Tobacco Survey (NY-ATS), a cross-sectional, random-digit-dial telephone survey of adults aged 18 or older in New York State conducted quarterly from 2003 through 2011 (N = 53,706). The sample for this study consists of 9,408 current smokers from the total NY-ATS sample. Regression methods were used to examine the effect of New York State’s antismoking advertising, overall and by advertisement type (graphic and/or emotional), on making a quit attempt in the past 12 months. Exposure to antismoking advertising was measured in two ways: gross rating points (a measure of potential exposure) and self-reported confirmed recall of advertisements. This study yields three important findings. First, antismoking advertising promotes quit attempts among racial/ethnic minority smokers and smokers of lower education and income. Second, advertising effectiveness is attributable in part to advertisements with strong graphic imagery or negative emotion. Third, smokers with poor mental health do not appear to benefit from exposure to antismoking advertising of any type. This study contributes to the evidence about how cessation media campaigns can be used most effectively to increase quit attempts within vulnerable subgroups. In particular, it suggests that a general campaign can promote cessation among a range of sociodemographic groups. More research is needed to understand what message strategies might work for those with poor mental health.     

A Systematic Review of Tobacco Smoking Prevalence and Description of Tobacco Control Strategies in Sub-Saharan African Countries; 2007 to 2014

ObjectiveTo systematically review current smoking prevalence among adults in sub-Saharan Africa from 2007 to May 2014 and to describe the context of tobacco control strategies in these countries.ResultsStudies represented 13 countries. Current smoking prevalence varied widely ranging from 1.8% in Zambia to 25.8% in Sierra Leone. The prevalence of smoking was consistently lower in women compared to men with the widest gender difference observed in Malawi (men 25.9%, women 2.9%). Rwanda had the highest prevalence of women smokers (12.6%) and Ghana had the lowest (0.2%). Rural, urban patterns were inconsistent. Most countries have implemented demand-reduction measures including bans on advertising, and taxation rates but to different extents.ConclusionSmoking prevalence varied widely across sub-Saharan Africa, even between similar country regions, but was always higher in men. High smoking rates were observed among countries in the eastern and southern regions of Africa, mainly among men in Ethiopia, Malawi, Rwanda, and Zambia and women in Rwanda and rural Zambia. Effective action to reduce smoking across sub-Saharan Africa, particularly targeting population groups at increased risk remains a pressing public health priority.     

Going like Gangbusters: Transnational Tobacco Companies "Making a Killing" in South America

This article reports on the recent growth of transnational tobacco companies (TTCs) in South America. Although some scholarly attention has been directed toward such growth in Asia and eastern Europe, South America has also been targeted by the TTCs' aggressive expansionist practices in recent years. Fighting "Big Tobacco" is entirely different from combating most public health problems. Unlike cigarettes, most infectious diseases and maternal and child health problems never provide profits to transnational corporations and governments. Also, most public health problems (with alcohol being another notable exception) are not exacerbated by extensive advertising campaigns that promote the cause of the health problems. Supported by data gathered during three months of fieldwork in Ecuador, Peru, Chile, and Argentina in 1997, this article suggests that the TTCs' marketing strategies override cultural differences in the choices people make regarding smoking and health. Combining critical medical anthropology and public health, this article concludes that unless dramatic actions are taken, an avoidable outbreak of tobacco-related diseases will eventually reach epidemic proportions on the South American continent. It is also a "call to arms" for more medical anthropologists to investigate tobacco-related matters around the world.     

Reintegrating Coastal Development and Public Health in Western Australia

This article presents three case studies that take a socio-ecological perspective to highlight an interconnectedness between the environment, human participation and organization, and public health, in Western Australian marine, coastal, and near-coastal places. We examine the degree to which coastal zone planning and management interact with public health practitioner, and the consequences of this interaction for biophysical surroundings and human health. The case studies demonstrate the limited roles the public health sector has played, and the indispensable expanded role it might play, in what is traditionally seen as the domain of natural resource management. A socio-ecological analysis highlighted the value of decision-making processes for coastal developments that emphasize dialogue, place, public health issues, resource distribution, as well as ecology. These adaptive capabilities offer scope for understanding the consequences of coastal planning and management actions on both the biophysical condition of the environment and human health, break the cycles of reaction, and provide an alternative framework for regulating the developmental expansion of the Western Australian coastline.David Galloway is a sustainability designer and has undertaken work for some of the pastoralists on the Ningaloo coast. The analysis of the third case study is based, in part, on information gained through these consultancies.     

宠物源性人兽共患病

随着城市化进程的加快和人民生活水平的提高,城市中宠物的饲养数量急速上升,由此产生的一系列问题也逐步显现,尤其是与人类密切相关的＂卫生与健康＂问题,诸如狂犬病、弓形体病等＂人兽共患病＂引发的公共卫生安全问题已引起社会和国家各主管部门的高度关注。强化宠物源人兽共患病的防范意识,采取有效的措施控制此类人兽共患病的发生,具有十分重要的现实意义。     

What factors influence smoking prevalence and smoke free policy enactment across the European Union Member States

Background

Smoking prevention should be a primary public health priority for all governments, and effective preventive policies have been identified for decades. The heterogeneity of smoking prevalence between European Union (EU) Member States therefore reflects, at least in part, a failure by governments to prioritise public health over tobacco industry or possibly other financial interests, and hence potentially government corruption.The aims of this study were to test the hypothesis that smoking prevalence is higher in countries with high levels of public sector corruption, and explore the ecological association between smoking prevalence and a range of other national characteristics in current EU Member States.

Methods

Ecological data from 27 EU Member States were used to estimate univariate and multivariate correlations between smoking prevalence and the Transparency International Corruption Perceptions Index, and a range of other national characteristics including economic development, social inclusion, quality of life and importance of religion. We also explored the association between the Corruption Perceptions Index and measures of the extent to which smoke-free policies have been enacted and are enforced.

Results

In univariate analysis, smoking prevalence was significantly higher in countries with higher scores for corruption, material deprivation, and gender inequality; and lower in countries with higher per capita Gross Domestic Product, social spending, life satisfaction and human development scores. In multivariate analysis, only the corruption perception index was independently related to smoking prevalence. Exposure to tobacco smoke in the workplace was also correlated with corruption, independently from smoking prevalence, but not with the measures of national smoke-free policy implementation.

Conclusions

Corruption appears to be an important risk factor for failure of national tobacco control activity in EU countries, and the extent to which key tobacco control policies have been implemented. Further research is needed to assess the causal relationships involved.     

The impact of routine advice on smoking cessation from family physicians.

Cigarette smoking continues to be a major health problem. Therefore, physicians have been asked to advise all their patients on the hazards of smoking. A controlled trial was undertaken to measure the impact of family physicians'' advice to cigarette smokers during a routine office visit. No significant differences were found in the three measures used to determine outcome--desire to stop smoking, an attempt to stop and success in stopping--between the control and intervention groups. These results are discussed in relation to the health belief model, and suggestions are made on how to increase the impact family physicians could have on smoking cessation to their practices.     

Public support for invasive alien species eradication programs: insights from the Netherlands

Over the last few decades, the number of invasive alien species (IAS) has increased worldwide. IAS can have negative impacts on biodiversity, human health, and the economy. For a number of reasons, IAS policies and management schemes that have been implemented have not been sufficient to tackle the problem. In this article, we focus on IAS eradication and a main obstacle to eradication, namely a lack of public support. By analyzing three specific cases of IAS eradication in the Netherlands (Indian house crow; Pallas's squirrel; and American bullfrog), we show how factors initially affecting public support for eradication interact with each other and influence the effectiveness of the measures that IAS eradication managers implement in order to achieve support for their eradication programs. Our analysis provides a better understanding of the manipulability of factors affecting public support. Finally, it reveals concrete measures that IAS managers can implement in order to gain public support. A lesson for IAS eradication managers is that they can effectively aim for support for eradication, even if low public support for eradication is to be expected in first instance. In addition, this article provides insight into practical measures that IAS eradication managers can implement.     

Health care cost effects of public use of a regional poison control center.

Poison control centers in the United States are threatened with closure, and attempts at a cost-benefit analysis of these services have been indeterminate. The purpose of this study was to compare the operating costs of a regional poison control center resulting from public use of its telephone hotline services with those of hypothetical alternative sources of advice and care. We conducted a follow-up telephone survey among 589 public callers to the San Francisco Bay Area Regional Poison Control Center who had been managed at home without medical referral after an unintentional poisoning. All survey respondents were asked what alternative action they would have taken had the poison control center not been available to assist them by telephone consultation. We then surveyed emergency departments and physicians'' offices cited as alternatives by the callers to determine their response and charges for evaluating a suspected poisoning case. A total of 464 (79%) of the callers surveyed would have sought assistance from their local emergency health care system had the poison control center not been available. We conservatively estimated that the total charges for such evaluations would be +71,900. Comparatively, the total actual operating cost of services provided by the poison control center for all 589 poisoning cases was +13,547. Most of the study subjects (429 [73%]) had private insurance coverage. Direct public access to these services probably reduces the use of emergency health care resources, thus lowering health care costs.     

Regulating pharmaceutical advertising: What will work?

As Dr. Joel Lexchin makes painfully obvious in this issue (see pages 351 to 356), regulatory processes governing pharmaceutical advertising in Canada and elsewhere are seriously compromised. However, the remedial measures Lexchin proposes are not sufficient. Financial sanctions against improper advertising are likely to be regarded by manufacturers as the cost of doing business, and any regulatory body that includes drug industry representatives or individuals receiving financial support from the drug industry cannot be genuinely independent. Moreover, manufacturers are now using promotional strategies that are particularly difficult to regulate. These include providing drugs at lower than the usual cost to ensure their inclusion in managed-care formularies, and using direct-to-consumer advertising to take advantage of the public''s lack of sophistication in interpreting scientific evidence. Our best hope of counteracting the power and influence of the drug industry lies in regulation by government agencies, whose interest is the protection of the public.     

The anti-tobacco campaign of the Nazis: a little known aspect of public health in Germany, 1933-45.

Historians and epidemiologists have only recently begun to explore the Nazi anti-tobacco movement. Germany had the world''s strongest antismoking movement in the 1930s and early 1940s, encompassing bans on smoking in public spaces, bans on advertising, restrictions on tobacco rations for women, and the world''s most refined tobacco epidemiology, linking tobacco use with the already evident epidemic of lung cancer. The anti-tobacco campaign must be understood against the backdrop of the Nazi quest for racial and bodily purity, which also motivated many other public health efforts of the era.     

Conflicts of interest in e-cigarette research: A public good and public interest perspective

The tobacco industry’s involvement in the electronic cigarette research that informs public health policy is controversial. On the one hand, some are concerned that their involvement presents conflicts of interest that bias research outputs and invalidate the policies that use them. On the other hand, some have argued that the tobacco industry may support valid research and contribute to the goals of public health, for instance, if the interests of the e-cigarette industry could be part of a tobacco smoking cessation policy. We approach this debate from the ethical perspective of the public interest and the public good, considering how legitimate researchers can square their expert opinion with validating tobacco industry-funded research, given the perfidy of the tobacco industry and paucity of robust, conclusive evidence on the public health impacts of liberalizing e-cigarette use.     

Can mosquitoes help to unravel the community structure of Plasmodium species?

There has been a recent revival in attempts to understand changes in patterns of abundance of Plasmodium spp. that infect humans. This has been driven by the purportedly beneficial effects of co-infection on clinical pathology and the recognition of Plasmodium vivax as a public health problem in its own right. In contrast to the attention given to mixed-species infections in humans, parasite infections and interactions within the mosquito vector remain poorly documented, even though the distribution of vector-borne parasites such as Plasmodium spp. depends on vector-vertebrate and, crucially, vector-parasite interactions. To understand malaria epidemiology and to design appropriate control measures, this gap must be re-addressed.     

Preparedness for SARS in the UK in 2003

Severe acute respiratory syndrome (SARS) has been described as the first major emerging infectious disease of the twenty-first century. Having initially emerged, almost unnoticed, in southern China, it rapidly spread across the globe. It severely tested national public health and health systems. However, it also resulted in rapid, intensive international collaboration, led by the World Health Organization, to elucidate its characteristics and cause and to contain its spread. The UK mounted a vigorous public health response. Some particular issues concerned: the practicalities of implementing exit screening had this been required; the likely efficacy of this and other control measures; the legal base for public health action; and the surge capacity in all systems should the disease have taken hold in the UK. We have used this experience of 2003 to inform our preparation of a framework for an integrated, escalating response to a future re-emergence of SARS according to the levels of disease activity worldwide. Recent cases confirm that SARS has not "gone away". We cannot be complacent about our contingency planning.     

The USAID/Government of Egypt's Schistosomiasis Research Project (SRP)

Schistosomiasis is the major public health problem in rural Egypt, with almost six million Egyptians infected as at mid-1996. In 1983, the prevalence of schistosomiasis in rural Egypt was greater than 50%, but a ten-year campaign of diagnosis and treatment has reduced the prevalence and intensity of infection. Parallel to this campaign, the government of the USA has funded a research project to examine all aspects of schistosomiasis with a view to improving the control strategy. As outlined here by Taha El Khoby, Nabil Galal and Alan Fenwick, after almost ten years, the project's achievements include: assisting WHO in its attempts to develop a vaccine against schistosomiasis, developing a suspension formulation of praziquantel suitable for young children, and establishing a unit to monitor reports of resistance to praziquantel. In addition, a large epidemiological study has established the extent of the problem in Egypt. Slow-release formulation of niclosamide, health education material for use on TV, dipstick diagnostic tests, and evaluation of ultrasound as a diagnostic tool have also been achieved. As the project closes, Egypt is left with an effective strategy for the control of schistosomiasis and several back-up tools for use in the event of development of resistance to praziquantel. The Ministry of Health and Population has the basis of a Geographical Information System (GIS) unit and the country has a trained and equipped scientific community capable of biomedical research, and almost 100 scientific papers published on their work.     

The hierarchy of approaches to tobacco control

Tobacco represents the single most preventable cause of disease and death in the world today. Of 260 million male deaths in the developed world between 1950 and 2000, it is estimated that 50 million will be due to smoking. In the oral and craniofacial region tobacco use has been associated with the occurrence of cleft palate, periodontal disease and tooth loss, and a variety of soft tissue lesions including oral cancer. For example, smoking is estimated to account for 92% of cancers of the lip, oral cavity and pharynx. Few studies have examined relative efficiency of the many different approaches to tobacco control but, in general, legislative approaches such as increasing tobacco taxes and prohibiting advertising are most effective and those based on printed educational materials and cessation groups, the least effective. In all cases, advice or intervention by health care professionals ranked among the most effective non-legislative approaches to control. A very wide range of professionally-based interventions have been described, including pharmacologic interventions, behavioral approaches and group counseling. The dental profession has a unique opportunity to influence tobacco use by their patients. Its use is almost always immediately evident to the dentist or dental assistant in terms of odor, staining, poor oral hygiene or obvious oral disease. There is also a tendency for the length of personal contact with the dentist to be greater than with a physician. Guidelines are now available that provide the dental professional with advice on the best approaches to tobacco control with their patients.