Shisha (waterpipe) smoking initiation among youth in Malaysia and global perspective: a scoping review (2006-2015)

OBJECTIVE

To explore the initiating factors of waterpipe tobacco smoking (WTS) among youth.

STUDY DESIGN

The analytic framework for this scoping review was performed using the methodology outlined by Arksey and O'Malley, which includes identification of the research question, study selection, charting the data, collating, summarizing and reporting the results that were primarily guided by the research question; 'what is known about the initiation of shisha smoking among youth?'

METHODS

Electronic databases such as Cochrane, MEDLINE and PsycINFO were used to search for relevant articles. Articles included were all in English and published within the year of 2006 to 2015. Inclusion criteria; i) age range of 10 to 29 years; ii) examined the reasons why youth started or tried WTS; iii) in full text. Therefore, 26 articles were included in this scoping review.

RESULTS

This review has identified and classified the initiating factors of WTS among youth in four subtopics: individual factors, interpersonal influences, cigarettes and alcohol use, and media influences. Individual factors and interpersonal influences played an important role in initiation factors of WTS among youth.

CONCLUSION

This study concludes that public health professionals within the Southeast Asia region need to promote innovative preventive measures through peer-to-peer led interventions that are also easily assessable on social media platforms. The public health messages need to address the misconceptions of risk associated to WTS use.

Sustainable development goals, universal health coverage and equity in health systems: the Orang Asli commons approach

Universal health coverage is a key health target in the Sustainable Development Goals (SDGs) that has the means to link equitable social and economic development. As a concept firmly based on equity, it is widely accepted at international and national levels as important for populations to attain 'health for all' especially for marginalised groups. However, implementing universal coverage has been fraught with challenges and the increasing privatisation of health care provision adds to the challenge because it is being implemented in a health system that rests on a property regime that promotes inequality. This paper asks the question, 'What does an equitable health system look like?' rather than the usual 'How do you make the existing health system more equitable?' Using an ethnographic approach, the authors explored via interviews, focus group discussions and participant observation a health system that uses the commons approach such as which exists with indigenous peoples and found features that helped make the system intrinsically equitable. Based on these features, the paper proposes an alternative basis to organise universal health coverage that will better ensure equity in health systems and ultimately contribute to meeting the SDGs.

Is obesity an ineluctable consequence of development? A case study of Malaysia

Effective population-level solutions to the obesity pandemic have proved elusive. In low- and middle-income countries the problem may be further challenged by the perceived internal tension between economic development and sustainable solutions which create the optimal conditions for human health and well-being. This paper discusses some of the ecological obstacles to addressing the growing problem of obesity in 'aspiring' economies, using Malaysia as a case study. The authors conclude that current measures to stimulate economic growth in Malaysia may actually be exacerbating the problem of obesity in that country. Public health solutions which address the wider context in which obesity exists are needed to change the course of this burgeoning problem.

Methodological considerations in the measurement of institutional and structural forms of HIV discrimination

The systematic measurement of HIV/AIDS-related discrimination is imperative within the current rhetoric that holds discrimination as one of the two 'biggest' barriers to HIV/AIDS pandemic intervention. This paper provides a methodological critique of the UNAIDS (2000b) Protocol for the Identification of Discrimination against People Living with HIV (the Protocol). Specifically, the paper focuses on the Protocol's capacity to accurately identify and measure institutional levels of HIV-related discrimination that allows data that are reliable and comparable across time and contexts. Conceptual issues including the Protocol's objective as an indicator versus a direct measure of discrimination and the role of the Protocol as a tool of research versus a tool of advocacy are explored. Design issues such as the operationalization of discrimination, appropriateness of indicator content, sampling and data collection strategies and issues of scoring are also evaluated. It is hoped that the matters outlined will provide readers with ways of critically reflecting and evaluating the findings of the research papers presented in this Special Issue, as well as pointing to ways of improving research design.

An Asia Pacific six-country study on HIV-related discrimination: Introduction

This paper outlines a six-country study of institutionalised forms of HIV/AIDS-related discrimination in the Asia-Pacific region. Although recognised as a barrier to disease prevention and treatment, very limited data are available on the effects of institutionalised HIV-related stigma and discrimination. Understanding the forms of discrimination within the institutions where they occur is the first step to identifying effective ways of promoting compassionate, non-discriminatory treatment of PLWHA. Thus, the goal of this research project was to document institutional discrimination against PLWHA, as guided by the UNAIDS Protocol for the Identification of Discrimination Against People Living with HIV (2000), in six Asian countries: India, Thailand, Philippines, China, Vietnam and Indonesia. As a precursor to the six individual studies, this paper provides a brief overview of the literature on HIV discrimination, and then describes the UNAIDS Protocol and the shared methodological considerations relevant to all of the study sites. Commonalities in sampling, procedures and analysis are also discussed.

A situational analysis of HIV/AIDS-related discrimination in Hanoi, Vietnam

The laws in Vietnam provide a framework within which one may judge the nature and type of health care-related discrimination to which people living with HIV (PLWHA) are subject. Despite the existence of stringent legislation protecting the rights of PLWHA, this study found that, in practice, PLWHA experienced significant structural discrimination in their daily lives. The discrimination experienced by PLWHA was exacerbated by the fact that, historically, HIV is associated with high-risk, marginalized groups such as drug users and sex workers. In the health care sector, discriminatory practices (for instance, refusal to treat), differential treatment and non-confidentiality were frequent. For the development of successful prevention and treatment strategies, a mutually desirable and equitable balance must be achieved between individual rights and needs and individual obligations to the broader society.

HIV discrimination: integrating the results from a six-country situational analysis in the Asia Pacific

The findings of the six independent studies on institutional forms of HIV discrimination in the Asia Pacific presented in this Special Issue of AIDS Care are integrated. At first glance, the general pattern of the results across the study sites suggests that discrimination is most pertinent in the domain of 'practice' rather than in the domains of law or institutional policy. On closer analysis, however, utilising the qualitative data, this conclusion does not take sufficient account of the cultural context within which the interpersonal interaction (practice) between the health carers and people living with HIV/AIDS occurs. Limitations on the use of anti-discrimination legislations and protective written policies for reducing discrimination in these contexts are discussed. The need for alternative approaches to thinking about discrimination intervention is raised and this is done through a consideration of the strategy of universal precautions.

Future research on structural and institutional forms of HIV discrimination

There is scant research into HIV discrimination, particularly structural and institutional forms of it. This appears, in part, to arise from a prevailing view that the solutions to HIV discrimination are known a priori and in the absence of additional data. The six country studies into HIV discrimination presented in this AIDS Care supplement suggest that this is not the case. There needs to be an acceptance that if the issue of HIV discrimination is to be tackled successfully and based on evidence, then incremental and effortful steps need to be taken to develop that evidence base. This is discussed.

Institutional and structural forms of HIV-related discrimination in health care: a study set in Beijing

This paper presents key findings of a situational analysis of institutional and structural levels of HIV/AIDS-related discrimination in Beijing, China, with a focus on the area of health care. Initially slow to respond to the presence of HIV, China has altered its approach and enacted strict legislative protection for people living with HIV/AIDS (PLWHA). In order to determine whether this has altered discrimination against PLWHA, this study examined existing legislation and policy, and interviewed key informants working in health care and PLWHA. The overall findings revealed that discrimination in its many forms continued to occur in practice despite China's generally strong legislative protection, and it is the actual practice that is hindering PLWHAs' access to health services. A number of legislative and policy gaps that allow discrimination to occur in practice were also identified and discussed. The paper concludes with a call to rectify specific gaps between legislation, policy and practice. An understanding of the underlying factors that drive discrimination will also be necessary for effective strategic interventions to be developed and implemented.

A method for the quantitative analysis of the layering of HIV-related stigma

HIV-related stigma is regarded as one of the major barriers in the development of effective prevention and care programs; but the stigma associated with HIV stigma is not a singular entity. The stigma of the infection is layered with other stigmas, such as those associated with the routes of transmission (e.g., sex work and injecting drug use) and personal characteristics (e.g., race, religion, ethnicity and gender). In developing programs and policies to overcome HIV-related stigma, cognisance needs to be taken of all the sources of stigma, and how they may interact. A novel method is described for examining the layers of HIV/AIDS-related stigma, and secondary data are adapted to illustrate this. The importance of understanding the layering of stigma for the development of effective interventions is also discussed.

Infant mortality rate as an indicator of population health

BACKGROUND

The infant mortality rate (IMR) has been criticised as a measure of population health because it is narrowly based and likely to focus the attention of health policy on a small part of the population to the exclusion of the rest. More comprehensive measures such as disability adjusted life expectancy (DALE) have come into favour as alternatives. These more comprehensive measures of population health, however, are more complex, and for resource poor countries, this added burden could mean diverting funds from much needed programmes. Unfortunately, the conjecture, that DALE is a better measure of population health than IMR, has not been empirically tested.

METHODS

IMR and DALE data for 1997 were obtained from the World Bank and the World Health Organisation, respectively, for 180 countries.

FINDINGS

There is a strong (generally) linear association between DALE and IMR (r=0.91). Countries with low DALE tend to have a high IMR. The countries with the lowest IMRs had DALEs above that predicted by the regression line.

INTERPRETATION

There is little evidence that the use of IMR as a measure of population health has a negative impact on older groups in the population. IMR remains an important indicator of health for whole populations, reflecting the intuition that structural factors affecting the health of entire populations have an impact on the mortality rate of infants. For countries with limited resources that require an easily calculated, pithy measure of population health, IMR may remain a suitable choice.

Data sharing in medical research: an empirical investigation

BACKGROUND

Scientific research entails systematic investigation. Publishing the findings of research in peer reviewed journals implies a high level of confidence by the authors in the veracity of their interpretation. Therefore it stands to reason that researchers should be prepared to share their raw data with other researchers, so that others may enjoy the same level of confidence in the findings.

METHOD

In a prospective study, 29 corresponding authors of original research articles in a medical journal (the British Medical Journal) were contacted to ascertain their preparedness to share the data from their research. The email contact was in one of two forms, a general request and a specific request. The type of request a researcher received was randomly allocated.

FINDINGS

Researchers receiving specific requests for data were less likely, and slower, to respond than researchers receiving general requests. Only one researcher released data. Most researchers were reluctant to release their data. Some required further information, clarification, or authorship.

INTERPRETATION

The general reluctance of researchers to consider requests for their data is of concern. It raises questions about the level of confidence that should be placed on their interpretations of the data. It also highlights an unfortunate situation where researchers are more concerned with losing an advantage than advancing science.

Improving interpretability: gamma as an alternative to R(2) as a measure of effect size

A traditional measure of effect size associated with tests for difference between two groups is the variance explained by group membership (R(2)). If exposure to a disease causes a small but long term deficit in performance, however, R(2) does not capture that cumulating effect. We propose an alternative statistic, gamma, based on the probability of an unexposed person outperforming an exposed person. Although gamma is also a point estimate, it more easily conveys what the cumulating effect of a deficit would be. We discuss some of the advantages of this measure.