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Owusu D, Ndegwa LK, Ayugi J, Kinuthia P, Kalani R, Okeyo M, Otieno NA, Kikwai G, Juma B, Munyua P, Kuria F, Okunga E, Moen AC, Emukule GO. Use of Sentinel Surveillance Platforms for Monitoring SARS-CoV-2 Activity: Evidence From Analysis of Kenya Influenza Sentinel Surveillance Data. JMIR Public Health Surveill 2024; 10:e50799. [PMID: 38526537 PMCID: PMC11002741 DOI: 10.2196/50799] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Revised: 12/19/2023] [Accepted: 02/02/2024] [Indexed: 03/26/2024] Open
Abstract
BACKGROUND Little is known about the cocirculation of influenza and SARS-CoV-2 viruses during the COVID-19 pandemic and the use of respiratory disease sentinel surveillance platforms for monitoring SARS-CoV-2 activity in sub-Saharan Africa. OBJECTIVE We aimed to describe influenza and SARS-CoV-2 cocirculation in Kenya and how the SARS-CoV-2 data from influenza sentinel surveillance correlated with that of universal national surveillance. METHODS From April 2020 to March 2022, we enrolled 7349 patients with severe acute respiratory illness or influenza-like illness at 8 sentinel influenza surveillance sites in Kenya and collected demographic, clinical, underlying medical condition, vaccination, and exposure information, as well as respiratory specimens, from them. Respiratory specimens were tested for influenza and SARS-CoV-2 by real-time reverse transcription polymerase chain reaction. The universal national-level SARS-CoV-2 data were also obtained from the Kenya Ministry of Health. The universal national-level SARS-CoV-2 data were collected from all health facilities nationally, border entry points, and contact tracing in Kenya. Epidemic curves and Pearson r were used to describe the correlation between SARS-CoV-2 positivity in data from the 8 influenza sentinel sites in Kenya and that of the universal national SARS-CoV-2 surveillance data. A logistic regression model was used to assess the association between influenza and SARS-CoV-2 coinfection with severe clinical illness. We defined severe clinical illness as any of oxygen saturation <90%, in-hospital death, admission to intensive care unit or high dependence unit, mechanical ventilation, or a report of any danger sign (ie, inability to drink or eat, severe vomiting, grunting, stridor, or unconsciousness in children younger than 5 years) among patients with severe acute respiratory illness. RESULTS Of the 7349 patients from the influenza sentinel surveillance sites, 76.3% (n=5606) were younger than 5 years. We detected any influenza (A or B) in 8.7% (629/7224), SARS-CoV-2 in 10.7% (768/7199), and coinfection in 0.9% (63/7165) of samples tested. Although the number of samples tested for SARS-CoV-2 from the sentinel surveillance was only 0.2% (60 per week vs 36,000 per week) of the number tested in the universal national surveillance, SARS-CoV-2 positivity in the sentinel surveillance data significantly correlated with that of the universal national surveillance (Pearson r=0.58; P<.001). The adjusted odds ratios (aOR) of clinical severe illness among participants with coinfection were similar to those of patients with influenza only (aOR 0.91, 95% CI 0.47-1.79) and SARS-CoV-2 only (aOR 0.92, 95% CI 0.47-1.82). CONCLUSIONS Influenza substantially cocirculated with SARS-CoV-2 in Kenya. We found a significant correlation of SARS-CoV-2 positivity in the data from 8 influenza sentinel surveillance sites with that of the universal national SARS-CoV-2 surveillance data. Our findings indicate that the influenza sentinel surveillance system can be used as a sustainable platform for monitoring respiratory pathogens of pandemic potential or public health importance.
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Affiliation(s)
- Daniel Owusu
- Influenza Division, US Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Linus K Ndegwa
- Global Influenza Branch, Influenza Division, US Centers for Disease Control and Prevention, Nairobi, Kenya
| | - Jorim Ayugi
- Centre for Global Health Research, Kenya Medical Research Institute, Kisumu, Kenya
| | | | - Rosalia Kalani
- Disease Surveillance and Response Unit, Ministry of Health, Nairobi, Kenya
| | - Mary Okeyo
- National Influenza Centre Laboratory, National Public Health Laboratories, Ministry of Health, Nairobi, Kenya
| | - Nancy A Otieno
- Centre for Global Health Research, Kenya Medical Research Institute, Kisumu, Kenya
| | - Gilbert Kikwai
- Centre for Global Health Research, Kenya Medical Research Institute, Kisumu, Kenya
| | - Bonventure Juma
- Global Influenza Branch, Influenza Division, US Centers for Disease Control and Prevention, Nairobi, Kenya
| | - Peninah Munyua
- Global Influenza Branch, Influenza Division, US Centers for Disease Control and Prevention, Nairobi, Kenya
| | - Francis Kuria
- Directorate of Public Health, Ministry of Health, Nairobi, Kenya
| | - Emmanuel Okunga
- Disease Surveillance and Response Unit, Ministry of Health, Nairobi, Kenya
| | - Ann C Moen
- Influenza Division, US Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Gideon O Emukule
- Global Influenza Branch, Influenza Division, US Centers for Disease Control and Prevention, Nairobi, Kenya
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Ilboudo AK, Cissé A, Milucky J, Tialla D, Mirza SA, Diallo AO, Bicaba BW, Charlemagne KJ, Diagbouga PS, Owusu D, Waller JL, Talla-Nzussouo N, Charles MD, Whitney CG, Tarnagda Z. Predictors of severity and prolonged hospital stay of viral acute respiratory infections (ARI) among children under five years in Burkina Faso, 2016-2019. BMC Infect Dis 2024; 24:331. [PMID: 38509462 PMCID: PMC10953152 DOI: 10.1186/s12879-024-09219-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Accepted: 03/13/2024] [Indexed: 03/22/2024] Open
Abstract
BACKGROUND Viruses are the leading etiology of acute respiratory infections (ARI) in children. However, there is limited knowledge on drivers of severe acute respiratory infection (SARI) cases involving viruses. We aimed to identify factors associated with severity and prolonged hospitalization of viral SARI among children < 5 years in Burkina Faso. METHODS Data were collected from four SARI sentinel surveillance sites during October 2016 through April 2019. A SARI case was a child < 5 years with an acute respiratory infection with history of fever or measured fever ≥ 38 °C and cough with onset within the last ten days, requiring hospitalization. Very severe ARI cases required intensive care or had at least one danger sign. Oropharyngeal/nasopharyngeal specimens were collected and analyzed by multiplex real-time reverse-transcription polymerase chain reaction (rRT-PCR) using FTD-33 Kit. For this analysis, we included only SARI cases with rRT-PCR positive test results for at least one respiratory virus. We used simple and multilevel logistic regression models to assess factors associated with very severe viral ARI and viral SARI with prolonged hospitalization. RESULTS Overall, 1159 viral SARI cases were included in the analysis after excluding exclusively bacterial SARI cases (n = 273)very severe viral ARI cases were common among children living in urban areas (AdjOR = 1.3; 95% CI: 1.1-1.6), those < 3 months old (AdjOR = 1.5; 95% CI: 1.1-2.3), and those coinfected with Klebsiella pneumoniae (AdjOR = 1.9; 95% CI: 1.2-2.2). Malnutrition (AdjOR = 2.2; 95% CI: 1.1-4.2), hospitalization during the rainy season (AdjOR = 1.71; 95% CI: 1.2-2.5), and infection with human CoronavirusOC43 (AdjOR = 3; 95% CI: 1.2-8) were significantly associated with prolonged length of hospital stay (> 7 days). CONCLUSION Younger age, malnutrition, codetection of Klebsiella pneumoniae, and illness during the rainy season were associated with very severe cases and prolonged hospitalization of SARI involving viruses in children under five years. These findings emphasize the need for preventive actions targeting these factors in young children.
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Affiliation(s)
- Abdoul Kader Ilboudo
- Laboratoire National de Référence-Grippes (LNR-G), Institut de Recherche en Sciences de la Santé (IRSS), Ouagadougou, Burkina Faso.
| | - Assana Cissé
- Laboratoire National de Référence-Grippes (LNR-G), Institut de Recherche en Sciences de la Santé (IRSS), Ouagadougou, Burkina Faso
| | - Jennifer Milucky
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Dieudonné Tialla
- Laboratoire National de Référence-Grippes (LNR-G), Institut de Recherche en Sciences de la Santé (IRSS), Ouagadougou, Burkina Faso
| | - Sara A Mirza
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Alpha Oumar Diallo
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Brice W Bicaba
- Direction de la Protection de la Santé de la Population, Ministère de la Santé, Ouagadougou, Burkina Faso
| | - Kondombo Jean Charlemagne
- Direction de la Protection de la Santé de la Population, Ministère de la Santé, Ouagadougou, Burkina Faso
| | - Potiandi Serge Diagbouga
- Laboratoire National de Référence-Grippes (LNR-G), Institut de Recherche en Sciences de la Santé (IRSS), Ouagadougou, Burkina Faso
| | - Daniel Owusu
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Jessica L Waller
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Ndahwouh Talla-Nzussouo
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
- Noguchi Memorial Institute for Medical Research, Legon, Accra, Ghana
- Dexis Professional Services, 1331 Pennsylvania Avenue NW Suite 300, Washington, DC, 20004, USA
| | - Myrna D Charles
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Cynthia G Whitney
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Zekiba Tarnagda
- Laboratoire National de Référence-Grippes (LNR-G), Institut de Recherche en Sciences de la Santé (IRSS), Ouagadougou, Burkina Faso
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Osei SKJ, Owusu MB, Frimpong S, Dela Bosro D, Asamoah CF, Owusu D, Ntriwaa Amoako-Mensah D, Barimah SK, Agbavor JKE, Agbesi BDA. Systematic review and meta-synthesis protocol for examining policies mitigating the determinants of African nurses' and midwives' migration. BMJ Open 2023; 13:e073203. [PMID: 37775295 PMCID: PMC10546122 DOI: 10.1136/bmjopen-2023-073203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Accepted: 08/22/2023] [Indexed: 10/01/2023] Open
Abstract
BACKGROUND There has been a notable rise in the number of African nurses and midwives migrating to high-income countries despite varying policies and restrictions to promote retention. The need to comprehensively evaluate existing policies addressing the exodus is crucial to future policy formulation and steps in addressing drivers of nurses and midwives brain drain in Africa. AIM To explore the existence of migration policies that address the drivers of nurse and midwives' migration outside Africa and determine the characteristics and implementation of these policies. METHODS The review would be guided by the JBI methodology for systematic reviews of text and non-research evidence. Databases including CINAHL, PubMed, Academic Search Complete via Ebscohost and ISI Web of Science will be searched using a PICOS selection criteria framework. Grey literature would be gathered from Google Scholar, government and organisational websites. Two independent reviewers would be involved in searching, study selection, data extraction and data analysis. A third reviewer would provide an arbitrary judgement during conflicts when disagreements persist after discussion. A meta-synthesis would be used to identify and report emerging themes in the literature. ETHICS AND DISSEMINATION The study does not require ethical approval. The findings would be published in peer-review journals and presented at research conferences. PROSPERO REGISTRATION NUMBER CRD42023395013.
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Affiliation(s)
| | | | - Sandra Frimpong
- Surgical Department, Tafo Government Hospital, Kumasi, Ghana
| | | | | | - Daniel Owusu
- Medical Directorate, Komfo Anokye Teaching Hospital, Kumasi, Ghana
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Azziz‐Baumgartner E, Neyra J, Yau TS, Soto G, Owusu D, Zhang C, Romero C, Yoo YM, Gonzales M, Tinoco Y, Silva M, Bravo E, Serrano NR, Matos E, Chavez‐Perez V, Castro JC, Esther Castillo M, Porter R, Munayco C, Rodriguez A, Levine MZ, Prouty M, Thompson MG, Arriola CS. Healthcare personnel in 2016-2019 prospective cohort infrequently got vaccinated, worked while ill, and frequently used antibiotics rather than antivirals against viral influenza illnesses. Influenza Other Respir Viruses 2023; 17:e13189. [PMID: 37693773 PMCID: PMC10485305 DOI: 10.1111/irv.13189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Revised: 08/08/2023] [Accepted: 08/09/2023] [Indexed: 09/12/2023] Open
Abstract
Background Uncertainty about risk of illness and the value of influenza vaccines negatively affects vaccine uptake among persons targeted for influenza vaccination. Methods During 2016-2019, we followed a cohort of healthcare personnel (HCP) targeted for free-of-charge influenza vaccination in five Lima hospitals to quantify risk of influenza, workplace presenteeism (coming to work despite illness), and absenteeism (taking time off from work because of illness). The HCP who developed acute respiratory illnesses (ARI) (≥1 of acute cough, runny nose, body aches, or feverishness) were tested for influenza using reverse-transcription polymerase chain reaction (rt-PCR). Findings The cohort (2968 HCP) contributed 950,888 person-days. Only 36 (6%) of 605 HCP who participated every year were vaccinated. The HCP had 5750 ARI and 147 rt-PCR-confirmed influenza illnesses. The weighted incidence of laboratory-confirmed influenza was 10.0/100 person-years; 37% used antibiotics, and 0.7% used antivirals to treat these illnesses. The HCP with laboratory-confirmed influenza were present at work while ill for a cumulative 1187 hours. Interpretation HCP were frequently ill and often worked rather than stayed at home while ill. Our findings suggest the need for continuing medical education about the risk of influenza and benefits of vaccination and stay-at-home-while-ill policies.
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Affiliation(s)
| | - Joan Neyra
- US Naval Medical Research Unit No. 6BellavistaPeru
| | - Tat S. Yau
- Influenza DivisionCenters for Disease Control and PreventionAtlantaGeorgiaUSA
| | - Giselle Soto
- US Naval Medical Research Unit No. 6BellavistaPeru
| | - Daniel Owusu
- Influenza DivisionCenters for Disease Control and PreventionAtlantaGeorgiaUSA
| | - Chao Zhang
- Influenza DivisionCenters for Disease Control and PreventionAtlantaGeorgiaUSA
| | | | - Young M. Yoo
- Influenza DivisionCenters for Disease Control and PreventionAtlantaGeorgiaUSA
| | | | - Yeny Tinoco
- US Naval Medical Research Unit No. 6BellavistaPeru
| | - María Silva
- US Naval Medical Research Unit No. 6BellavistaPeru
| | | | | | | | | | | | - Maria Esther Castillo
- Instituto Nacional de Salud del NiñoLimaPeru
- Medicine School from Universidad Peruana Cayetano HerediaLimaPeru
| | - Rachael Porter
- Influenza DivisionCenters for Disease Control and PreventionAtlantaGeorgiaUSA
| | | | - Angel Rodriguez
- Health Emergencies Department, Pan American Health Organization (PAHO/WHO)WashingtonDistrict of ColumbiaUSA
| | - Min Z. Levine
- Influenza DivisionCenters for Disease Control and PreventionAtlantaGeorgiaUSA
| | | | - Mark G. Thompson
- Influenza DivisionCenters for Disease Control and PreventionAtlantaGeorgiaUSA
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Mbulo L, Palipudi K, Smith T, Owusu D, Williams F, Dean AK, Mamudu HM. Secondhand Smoke Exposure Inside the Home Among Adults in Eight Countries in Sub-Saharan Africa: Global Adult Tobacco Survey, 2012-2018. Nicotine Tob Res 2023; 25:828-837. [PMID: 36272102 PMCID: PMC10032190 DOI: 10.1093/ntr/ntac247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Revised: 10/06/2022] [Accepted: 10/21/2022] [Indexed: 11/12/2022]
Abstract
INTRODUCTION Secondhand tobacco smoke (SHS) exposure causes diseases and death in adults and children. Evidence indicates that most SHS exposures occur at home and in the workplace. Therefore, home is a major place where adults and children can be effectively protected from SHS. This study examined the magnitude of SHS exposure at home and associated factors in eight sub-Saharan African countries. AIMS AND METHODS We analyzed 2012-2018 Global Adult Tobacco Survey data for Botswana, Cameroon, Ethiopia, Kenya, Nigeria, Senegal, Tanzania, and Uganda. We computed prevalence estimates of self-reported monthly SHS exposure at home reported as anyone smoking inside their home daily, weekly, or monthly. We calculated SHS exposure at home prevalence and applied multivariable logistic regression models to identify related factors. RESULTS Overall median prevalence of SHS exposure at home was 13.8% in the eight countries; ranging from 6.6% (95% CI: 5.7%, 7.6%) in Nigeria to 21.6% (95% CI: 19.4%, 24.0%) in Senegal. In multivariable analysis across the countries, SHS exposure at home was associated with living with a smoker, ranging from an adjusted odds ratio (AOR) of 4.6 (95% CI: 3.6, 5.8) in Botswana to 27.6 (95% CI: 20.1, 37.8) in Nigeria. SHS exposure at home was significantly associated with lower education attainment (Kenya and Ethiopia), and lower wealth index (Uganda, Senegal, and Botswana). CONCLUSIONS SHS exposure in homes was associated with the presence of a smoker in the home and lower socioeconomic status.
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Affiliation(s)
- Lazarous Mbulo
- Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Krishna Palipudi
- Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Tenecia Smith
- Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Daniel Owusu
- Influenza Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Faustine Williams
- Division of Intramural Research, National Institute on Minority Health and Health Disparities, National Institutes of Health, Bethesda, MD, USA
| | - Anna K Dean
- Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, USA
- Noninfectious Diseases Program, CDC Foundation, Atlanta, GA, USA
| | - Hadii M Mamudu
- College of Public Health, East Tennessee State University, Johnson City, TN, USA
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6
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Owusu D, Dawood FS, Azziz-Baumgartner E, Tinoco Y, Soto G, Gonzalez O, Cabrera S, Florian R, Llajaruna E, Hunt DR, Wesley MG, Yau T, Arriola CS. Effectiveness of Maternal Influenza Vaccination in Peru PRIME Cohort. Open Forum Infect Dis 2023; 10:ofad033. [PMID: 36817741 PMCID: PMC9927556 DOI: 10.1093/ofid/ofad033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Accepted: 01/17/2023] [Indexed: 02/04/2023] Open
Abstract
Background Few studies have examined influenza vaccine effectiveness (VE) among women during pregnancy in middle-income countries. We used data from a prospective cohort of women who were pregnant in Peru to estimate effectiveness of the 2018 Southern Hemisphere influenza vaccine. Methods Women at <28 weeks gestation were enrolled from 4 tertiary level hospitals in Lima, Peru at the start of the 2018 influenza season and followed until the end of their pregnancies. Participants had mid-turbinate nasal swabs collected and tested for influenza by reverse-transcription polymerase chain reaction (RT-PCR) with onset of ≥1 of myalgia, cough, runny nose or nasal congestion, sore throat, or difficulty breathing. Time-varying Cox proportional hazard regression models were used to estimate the risk of RT-PCR-confirmed influenza infection after adjusting for inverse probability treatment weight. Results We followed 1896 women for a median of 127 days (interquartile range [IQR], 86-174). Participants had a median age of 29 years (IQR, 24-34). Among the 1896 women, 49% were vaccinated with the 2018 influenza vaccine and 1039 (55%) developed influenza-like illness, 76 (7%) of whom had RT-PCR-confirmed influenza. Incidence rates of RT-PCR-confirmed influenza were 36.6 and 15.3 per 100 000 person-days among women who were unvaccinated and vaccinated, respectively. Adjusted influenza VE was 22% (95% confidence interval, -64.1% to 62.9%). Conclusions Participants vaccinated against influenza had more than 50% lower incidence of RT-PCR-confirmed influenza illness. Although the VE estimated through propensity weight-adjusted time-varying Cox regression did not reach statistical significance, our findings provide additional evidence about the value of maternal influenza vaccination in middle-income countries.
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Affiliation(s)
- Daniel Owusu
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Fatimah S Dawood
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | | | - Yeny Tinoco
- U.S. Naval Medical Research Unit No. 6, Bellavista, Peru
| | - Giselle Soto
- U.S. Naval Medical Research Unit No. 6, Bellavista, Peru
| | | | | | | | | | | | - Meredith G Wesley
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
- Abt Associates, Inc., Atlanta, Georgia, USA
| | - Tat Yau
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Carmen S Arriola
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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7
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Owusu D, Rolfes MA, Arriola CS, Daily Kirley P, Alden NB, Meek J, Anderson EJ, Monroe ML, Kim S, Lynfield R, Angeles K, Spina N, Felsen CB, Billing L, Thomas A, Keipp Talbot H, Schaffner W, Chatelain R, Reed C, Garg S. Rates of Severe Influenza-Associated Outcomes Among Older Adults Living With Diabetes-Influenza Hospitalization Surveillance Network (FluSurv-NET), 2012-2017. Open Forum Infect Dis 2022; 9:ofac131. [PMID: 35450083 PMCID: PMC9017364 DOI: 10.1093/ofid/ofac131] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Accepted: 03/14/2022] [Indexed: 10/29/2023] Open
Abstract
BACKGROUND Diabetes mellitus (DM) is common among older adults hospitalized with influenza, yet data are limited on the impact of DM on risk of severe influenza-associated outcomes. METHODS We included adults aged ≥65 years hospitalized with influenza during 2012-2013 through 2016-2017 from the Influenza Hospitalization Surveillance Network (FluSurv-NET), a population-based surveillance system for laboratory-confirmed influenza-associated hospitalizations conducted in defined counties within 13 states. We calculated population denominators using the Centers for Medicare and Medicaid Services county-specific DM prevalence estimates and National Center for Health Statistics population data. We present pooled rates and rate ratios (RRs) of intensive care unit (ICU) admission, pneumonia diagnosis, mechanical ventilation, and in-hospital death for persons with and without DM. We estimated RRs and 95% confidence intervals (CIs) using meta-analysis with site as a random effect in order to control for site differences in the estimates. RESULTS Of 31 934 hospitalized adults included in the analysis, 34% had DM. Compared to those without DM, adults with DM had higher rates of influenza-associated hospitalization (RR, 1.57 [95% CI, 1.43-1.72]), ICU admission (RR, 1.84 [95% CI, 1.67-2.04]), pneumonia (RR, 1.57 [95% CI, 1.42-1.73]), mechanical ventilation (RR, 1.95 [95% CI, 1.74-2.20]), and in-hospital death (RR, 1.48 [95% CI, 1.23-1.80]). CONCLUSIONS Older adults with DM have higher rates of severe influenza-associated outcomes compared to those without DM. These findings reinforce the importance of preventing influenza virus infections through annual vaccination, and early treatment of influenza illness with antivirals in older adults with DM.
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Affiliation(s)
- Daniel Owusu
- Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Melissa A Rolfes
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Carmen S Arriola
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Pam Daily Kirley
- California Emerging Infections Program, Oakland, California, USA
| | - Nisha B Alden
- Colorado Department of Public Health and Environment, Denver, Colorado, USA
| | - James Meek
- Connecticut Emerging Infections Program, Yale School of Public Health, New Haven, Connecticut, USA
| | - Evan J Anderson
- Department of Medicine and Pediatrics, Emory University School of Medicine, Atlanta, Georgia, USA
- Georgia Emerging Infections Program, Georgia Department of Health, Atlanta, Georgia, USA
- Atlanta Veterans Affairs Medical Center, Atlanta, Georgia, USA
| | - Maya L Monroe
- Maryland Department of Health, Baltimore, Maryland, USA
| | - Sue Kim
- Michigan Department of Health and Human Services, Lansing, Michigan, USA
| | - Ruth Lynfield
- Minnesota Department of Health, St Paul, Minnesota, USA
| | - Kathy Angeles
- New Mexico Department of Health, Santa Fe, New Mexico, USA
| | - Nancy Spina
- New York State Department of Health, Albany, New York, USA
| | - Christina B Felsen
- University of Rochester School of Medicine and Dentistry, Rochester, New York, USA
| | | | - Ann Thomas
- Oregon Public Health Authority, Portland, Oregon, USA
| | - H Keipp Talbot
- Vanderbilt University School of Medicine, Nashville, Tennessee, USA
| | | | - Ryan Chatelain
- Salt Lake County Health Department, Salt Lake City, Utah, USA
| | - Carrie Reed
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Shikha Garg
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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8
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Harris JR, Owusu D, O'Laughlin K, Cohen AL, Ben Hamida A, Patel JC, Freeman MM, Nsibambi T, Nieves R, Marston BJ, Wasike S, Galbraith JS, Boore AL, Nelson LJ, Guagliardo SAJ, Klena JD, Patel K, Ma M. SARS-CoV-2 Breakthrough Infections among US Embassy Staff Members, Uganda, May-June 2021. Emerg Infect Dis 2022; 28:1279-1280. [PMID: 35470796 PMCID: PMC9155868 DOI: 10.3201/eid2806.220427] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
The SARS-CoV-2 Delta variant emerged shortly after COVID-19 vaccines became available in 2021. We describe SARS-CoV-2 breakthrough infections in a highly vaccinated, well-monitored US Embassy community in Kampala, Uganda. Defining breakthrough infection rates in highly vaccinated populations can help determine public health messaging, guidance, and policy globally.
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Wadhwa A, Yin S, Freeman B, Hershow RB, Killerby M, Yousaf AR, Lester S, Mills L, Buono SA, Pomeroy M, Owusu D, Chu VT, Tate JE, Bhattacharyya S, Hall P, Thornburg NJ, Kirking HL. Comparison of the SARS-CoV-2 spike protein ELISA and the Abbott Architect SARS-CoV-2 IgG nucleocapsid protein assays for detection of antibodies. PLoS One 2021; 16:e0255208. [PMID: 34324576 PMCID: PMC8320896 DOI: 10.1371/journal.pone.0255208] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Accepted: 07/13/2021] [Indexed: 11/18/2022] Open
Abstract
Serologic assays developed for SARS-CoV-2 detect different antibody subtypes and are based on different target antigens. Comparison of the performance of a SARS-CoV-2 Spike-Protein ELISA and the nucleocapsid-based Abbott ArchitectTM SARS-CoV-2 IgG assay indicated that the assays had high concordance, with rare paired discordant tests results.
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Affiliation(s)
- Ashutosh Wadhwa
- COVID-19 Response Team, CDC, Atlanta, Georgia, United States of America
- Laboratory Leadership Service, CDC, Atlanta, Georgia, United States of America
| | - Sherry Yin
- COVID-19 Response Team, CDC, Atlanta, Georgia, United States of America
| | - Brandi Freeman
- COVID-19 Response Team, CDC, Atlanta, Georgia, United States of America
- Laboratory Leadership Service, CDC, Atlanta, Georgia, United States of America
| | - Rebecca B. Hershow
- COVID-19 Response Team, CDC, Atlanta, Georgia, United States of America
- Epidemic Intelligence Service, CDC, Atlanta, Georgia, United States of America
| | - Marie Killerby
- COVID-19 Response Team, CDC, Atlanta, Georgia, United States of America
| | - Anna R. Yousaf
- COVID-19 Response Team, CDC, Atlanta, Georgia, United States of America
- Epidemic Intelligence Service, CDC, Atlanta, Georgia, United States of America
| | - Sandra Lester
- COVID-19 Response Team, CDC, Atlanta, Georgia, United States of America
| | - Lisa Mills
- COVID-19 Response Team, CDC, Atlanta, Georgia, United States of America
| | - Sean A. Buono
- COVID-19 Response Team, CDC, Atlanta, Georgia, United States of America
- Laboratory Leadership Service, CDC, Atlanta, Georgia, United States of America
| | - Mary Pomeroy
- COVID-19 Response Team, CDC, Atlanta, Georgia, United States of America
- Epidemic Intelligence Service, CDC, Atlanta, Georgia, United States of America
| | - Daniel Owusu
- COVID-19 Response Team, CDC, Atlanta, Georgia, United States of America
- Epidemic Intelligence Service, CDC, Atlanta, Georgia, United States of America
| | - Victoria T. Chu
- COVID-19 Response Team, CDC, Atlanta, Georgia, United States of America
- Epidemic Intelligence Service, CDC, Atlanta, Georgia, United States of America
| | | | - Sanjib Bhattacharyya
- City of Milwaukee Health Department Laboratory, Milwaukee, Wisconsin, United States of America
| | - Patricia Hall
- COVID-19 Response Team, CDC, Atlanta, Georgia, United States of America
| | | | - Hannah L. Kirking
- COVID-19 Response Team, CDC, Atlanta, Georgia, United States of America
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10
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Lim HJ, Robson R, Alexander N, Cunningham R, Encisa D, Jhurry R, Owusu D, Remolan A. 100 Frailty Hot Clinics: Rapid Cga and Speciality Diagnostics Reduces Rates of Hospitalisation and Re-Attendance. Age Ageing 2021. [DOI: 10.1093/ageing/afab030.61] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Introduction
Acute hospitalisation is associated with an increased risk of progressive frailty, morbidity and subsequent institutionalisation. North Middlesex University Hospital is an Acute District General Hospital with over 550 attendances to A&E per day. Comprehensive Geriatric Assessment (CGA) is the gold standard approach for a holistic multi-disciplinary assessment (MDT) of frail patients. A rapid access daily hot clinic service for frail patients opened using quality improvement (QI) methodology to deliver rapid CGA focusing on admission avoidance and early supported discharge.
Method
4 PDSA cycles were conducted. A process map identifying key moments in patient care was derived from time studies of the first 10 patients’ journeys. Patients were triaged through the Geriatrician “hotphone” for acute admissions into the Hot Clinic. Dedicated clinic and waiting rooms were placed on the acute frailty unit (Amber) staffed by a dedicated Consultant Geriatrician and Health Care Support Worker working with the Frailty Ward Clerk, Frailty Specialist Nurse, Therapies, specialities in-reach and same-day diagnostics. A shared clerking proforma and subsequent CGA Discharge Summary were completed and emailed to the referrer the same day. Qualitative and Quantitative feedback was gained from referrers, patients and relatives through a structured questionnaire. Metrics were gathered including rate of admissions, re-attendance and use of enhanced community services.
Results
From the first 48 Hot Clinic patients, there was a low 30-day re-attendance rate (17%—for unrelated reasons), low 30-day re-admission rates (4%) and low Did Not Attend rate (6%) for new referrals and high satisfaction scores for recommending the service (9-10/10) from patients, relatives and referrers.
Conclusions
Early rapid MDT can reduce re-attendances and re-admissions to hospital in frail patients. A streamlined patient journey can be delivered by frailty-trained staff and in a suitable environment. QI Methodology enables a structured measurable approach to development of the Acute Frailty Pathway.
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Affiliation(s)
- H J Lim
- North Middlesex University Hospital
| | - R Robson
- North Middlesex University Hospital
| | | | | | - D Encisa
- North Middlesex University Hospital
| | - R Jhurry
- North Middlesex University Hospital
| | - D Owusu
- North Middlesex University Hospital
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11
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Owusu D, Kim L, O'Halloran A, Whitaker M, Piasecki AM, Reingold A, Alden NB, Maslar A, Anderson EJ, Ryan PA, Kim S, Como-Sabetti K, Hancock EB, Muse A, Bennett NM, Billing LM, Sutton M, Talbot HK, Ortega J, Brammer L, Fry AM, Hall AJ, Garg S. Characteristics of Adults Aged 18-49 Years Without Underlying Conditions Hospitalized With Laboratory-Confirmed Coronavirus Disease 2019 in the United States: COVID-NET-March-August 2020. Clin Infect Dis 2021; 72:e162-e166. [PMID: 33270136 PMCID: PMC7799269 DOI: 10.1093/cid/ciaa1806] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Accepted: 12/01/2020] [Indexed: 12/19/2022] Open
Abstract
Among 513 adults aged 18-49 years without underlying medical conditions hospitalized with coronavirus disease 2019 (COVID-19) during March 2020-August 2020, 22% were admitted to an intensive care unit, 10% required mechanical ventilation, and 3 patients died (0.6%). These data demonstrate that healthy younger adults can develop severe COVID-19.
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Affiliation(s)
- Daniel Owusu
- CDC COVID-NET Team.,Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Lindsay Kim
- CDC COVID-NET Team.,US Public Health Service, Rockville, Maryland, USA
| | | | | | | | - Arthur Reingold
- California Emerging Infections Program, Oakland, California, USA.,School of Public Health, University of California, Berkeley, Berkeley, California, USA
| | - Nisha B Alden
- Colorado Department of Public Health and Environment, Denver, Colorado, USA
| | - Amber Maslar
- Connecticut Emerging Infections Program, Yale School of Public Health, New Haven, Connecticut, USA
| | - Evan J Anderson
- Departments of Pediatrics and Medicine, Emory University School of Medicine, Atlanta, Georgia, USA.,Emerging Infections Program, Atlanta Veterans Affairs Medical Center, Atlanta, Georgia, USA
| | | | - Sue Kim
- Michigan Department of Health and Human Services, Lansing, Michigan, USA
| | | | - Emily B Hancock
- New Mexico Emerging Infections Program, Santa Fe, New Mexico, USA
| | - Alison Muse
- New York State Department of Health, Albany, New York, USA
| | - Nancy M Bennett
- University of Rochester School of Medicine and Dentistry, Rochester, New York, USA
| | | | | | - H Keipp Talbot
- Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Jake Ortega
- Salt Lake County Health Department, Salt Lake City, Utah, USA
| | | | - Alicia M Fry
- CDC COVID-NET Team.,US Public Health Service, Rockville, Maryland, USA
| | | | - Shikha Garg
- CDC COVID-NET Team.,US Public Health Service, Rockville, Maryland, USA
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12
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Owusu D, Pomeroy MA, Lewis NM, Wadhwa A, Yousaf AR, Whitaker B, Dietrich E, Hall AJ, Chu V, Thornburg N, Christensen K, Kiphibane T, Willardson S, Westergaard R, Dasu T, Pray IW, Bhattacharyya S, Dunn A, Tate JE, Kirking HL, Matanock A. Persistent SARS-CoV-2 RNA Shedding without Evidence of Infectiousness: A Cohort Study of Individuals with COVID-19. J Infect Dis 2021; 224:1362-1371. [PMID: 33649773 PMCID: PMC7989388 DOI: 10.1093/infdis/jiab107] [Citation(s) in RCA: 62] [Impact Index Per Article: 20.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Accepted: 02/17/2021] [Indexed: 12/23/2022] Open
Abstract
Background To better understand SARS-CoV-2 shedding duration and infectivity, we estimated SARS-CoV-2 RNA shedding duration, described characteristics associated with viral RNA shedding resolution1, and determined if replication-competent viruses could be recovered ≥10 days after symptom onset among individuals with mild to moderate COVID-19. Methods We collected serial nasopharyngeal specimens at various time points from 109 individuals with rRT-PCR-confirmed COVID-19 in Utah and Wisconsin. We calculated probability of viral RNA shedding resolution using the Kaplan-Meier estimator and evaluated characteristics associated with shedding resolution using Cox proportional hazards regression. We attempted viral culture for 35 rRT-PCR-positive nasopharyngeal specimens collected ≥10 days after symptom onset. Results The likelihood of viral RNA shedding resolution at 10 days after symptom onset was approximately 3%. Time to shedding resolution was shorter among participants aged <18 years (adjusted hazards ratio [aHR]: 3.01; 95% CI: 1.6–5.6) and longer among those aged ≥50 years (aHR: 0.50; 95% CI: 0.3–0.9) compared to participants aged 18–49 years. No replication-competent viruses were recovered. Conclusions Although most patients were positive for SARS-CoV-2 for ≥10 days after symptom onset, our findings suggest that individuals with mild to moderate COVID-19 are unlikely to be infectious ≥10 days after symptom onset.
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Affiliation(s)
- Daniel Owusu
- COVID-19 Response Team and Epidemic Intelligence Service, CDC, Atlanta, USA
| | - Mary A Pomeroy
- COVID-19 Response Team and Epidemic Intelligence Service, CDC, Atlanta, USA
| | - Nathaniel M Lewis
- Epidemic Intelligence Service, CDC, and Utah Department of Health, Salt Lake City, USA
| | - Ashutosh Wadhwa
- COVID-19 Response Team and Laboratory Leadership Service, CDC, Atlanta, USA
| | - Anna R Yousaf
- COVID-19 Response Team and Epidemic Intelligence Service, CDC, Atlanta, USA
| | | | | | | | - Victoria Chu
- COVID-19 Response Team and Epidemic Intelligence Service, CDC, Atlanta, USA
| | | | | | - Tair Kiphibane
- Salt Lake County (UT) Health Department, Salt Lake City, USA
| | | | | | | | - Ian W Pray
- Epidemic Intelligence Service, CDC, and Wisconsin Department of Health Services, Madison, USA
| | | | - Angela Dunn
- Utah Department of Health, Salt Lake City, USA
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13
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Laws RL, Chancey RJ, Rabold EM, Chu VT, Lewis NM, Fajans M, Reses HE, Duca LM, Dawson P, Conners EE, Gharpure R, Yin S, Buono S, Pomeroy M, Yousaf AR, Owusu D, Wadhwa A, Pevzner E, Battey KA, Njuguna H, Fields VL, Salvatore P, O'Hegarty M, Vuong J, Gregory CJ, Banks M, Rispens J, Dietrich E, Marcenac P, Matanock A, Pray I, Westergaard R, Dasu T, Bhattacharyya S, Christiansen A, Page L, Dunn A, Atkinson-Dunn R, Christensen K, Kiphibane T, Willardson S, Fox G, Ye D, Nabity SA, Binder A, Freeman BD, Lester S, Mills L, Thornburg N, Hall AJ, Fry AM, Tate JE, Tran CH, Kirking HL. Symptoms and Transmission of SARS-CoV-2 Among Children - Utah and Wisconsin, March-May 2020. Pediatrics 2021; 147:peds.2020-027268. [PMID: 33033178 DOI: 10.1542/peds.2020-027268] [Citation(s) in RCA: 67] [Impact Index Per Article: 22.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/30/2020] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Limited data exist on severe acute respiratory syndrome coronavirus 2 in children. We described infection rates and symptom profiles among pediatric household contacts of individuals with coronavirus disease 2019. METHODS We enrolled individuals with coronavirus disease 2019 and their household contacts, assessed daily symptoms prospectively for 14 days, and obtained specimens for severe acute respiratory syndrome coronavirus 2 real-time reverse transcription polymerase chain reaction and serology testing. Among pediatric contacts (<18 years), we described transmission, assessed the risk factors for infection, and calculated symptom positive and negative predictive values. We compared secondary infection rates and symptoms between pediatric and adult contacts using generalized estimating equations. RESULTS Among 58 households, 188 contacts were enrolled (120 adults; 68 children). Secondary infection rates for adults (30%) and children (28%) were similar. Among households with potential for transmission from children, child-to-adult transmission may have occurred in 2 of 10 (20%), and child-to-child transmission may have occurred in 1 of 6 (17%). Pediatric case patients most commonly reported headache (79%), sore throat (68%), and rhinorrhea (68%); symptoms had low positive predictive values, except measured fever (100%; 95% confidence interval [CI]: 44% to 100%). Compared with symptomatic adults, children were less likely to report cough (odds ratio [OR]: 0.15; 95% CI: 0.04 to 0.57), loss of taste (OR: 0.21; 95% CI: 0.06 to 0.74), and loss of smell (OR: 0.29; 95% CI: 0.09 to 0.96) and more likely to report sore throat (OR: 3.4; 95% CI: 1.04 to 11.18). CONCLUSIONS Children and adults had similar secondary infection rates, but children generally had less frequent and severe symptoms. In two states early in the pandemic, we observed possible transmission from children in approximately one-fifth of households with potential to observe such transmission patterns.
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Affiliation(s)
- Rebecca L Laws
- COVID-19 Response Team, .,Contributed equally as co-first authors
| | | | | | - Victoria T Chu
- COVID-19 Response Team.,Epidemic Intelligence Service, and
| | - Nathaniel M Lewis
- COVID-19 Response Team.,Epidemic Intelligence Service, and.,Utah Department of Health, Salt Lake City, Utah
| | | | | | - Lindsey M Duca
- COVID-19 Response Team.,Epidemic Intelligence Service, and
| | - Patrick Dawson
- COVID-19 Response Team.,Epidemic Intelligence Service, and
| | | | | | | | - Sean Buono
- COVID-19 Response Team.,Laboratory Leadership Service, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Mary Pomeroy
- COVID-19 Response Team.,Epidemic Intelligence Service, and
| | - Anna R Yousaf
- COVID-19 Response Team.,Epidemic Intelligence Service, and
| | - Daniel Owusu
- COVID-19 Response Team.,Epidemic Intelligence Service, and
| | - Ashutosh Wadhwa
- COVID-19 Response Team.,Laboratory Leadership Service, Centers for Disease Control and Prevention, Atlanta, Georgia
| | | | | | | | | | | | | | | | | | | | - Jared Rispens
- COVID-19 Response Team.,Epidemic Intelligence Service, and
| | | | | | | | - Ian Pray
- COVID-19 Response Team.,Epidemic Intelligence Service, and.,Wisconsin Department of Health Services, Madison, Wisconsin
| | | | - Trivikram Dasu
- City of Milwaukee Health Department, Milwaukee, Wisconsin
| | | | | | - Lindsey Page
- City of Milwaukee Health Department, Milwaukee, Wisconsin
| | - Angela Dunn
- Utah Department of Health, Salt Lake City, Utah
| | | | | | - Tair Kiphibane
- Salt Lake County Health Department, Salt Lake City, Utah; and
| | | | | | | | | | | | - Brandi D Freeman
- COVID-19 Response Team.,Laboratory Leadership Service, Centers for Disease Control and Prevention, Atlanta, Georgia
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14
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Owusu D, Rolfes MA, Velezmoro CSA, Reed C, Kirley PD, Alden NB, Anderson EJ, Monroe M, Kim S, Lynfield R, McMullen CL, Spina N, Bennett NM, Billing LM, Thomas A, Talbot H, McCaffrey K, Yousey-Hindes K, Garg S. 1504. Risk of Influenza-Associated Hospitalization Among Older Adults Living with Diabetes — United States, 2012–2017. Open Forum Infect Dis 2020. [PMCID: PMC7778317 DOI: 10.1093/ofid/ofaa439.1685] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Background Older adults account for tens to hundreds of thousands of influenza-associated hospitalizations annually. Diabetes mellitus (DM) is common among patients hospitalized with influenza, yet data are limited on the impact of DM on influenza-associated hospitalizations. We compared influenza-associated hospitalization rates among older adults living with and without DM Methods We included adults ≥65 years hospitalized with influenza during 2012–13 through 2016–17 from the Influenza Hospitalization Surveillance Network (FluSurv-Net), a population-based surveillance system for laboratory-confirmed influenza-associated hospitalizations conducted in defined catchment areas within 13 states. Influenza testing is clinician-directed, and surveillance officers identify cases through infection control logs, laboratory records and other disease reporting systems. Data on underlying conditions, including DM, were abstracted from medical records Population denominators were calculated using county-specific estimates of DM prevalence from the Centers for Medicare and Medicaid Services. We calculated hospitalization rates by state and season, and present pooled rates and rate ratios, with 95% confidence intervals (CI), using meta-analysis with state as a random effect. Results Of 31,934 patients included in the analysis, 34% had DM. DM prevalence in the FluSurv-Net source population aged ≥65 years was 25%. Accounting for variability by state, the average influenza-associated hospitalization rate per 100,000 person years from 2012-13 through 2016-17 was 276 (95% CI: 230–330/100,000) in those with DM and 181 (95% CI:150–217/100,000) in those without DM. Though the magnitude of the association varied by season, hospitalization rates among those with DM was consistently greater than those without DM (pooled rate ratio: 1.57; 95% CI: 1.43–1.72; P< .0001). Conclusion Older adults have high influenza-associated hospitalization rates, and those with DM have a 57% increased risk compared to those without DM. These findings reinforce the importance of annual influenza vaccination in adults ≥65 years of age, particularly those with DM. Disclosures Nisha B. Alden, MPH, CDC (Grant/Research Support) Evan J. Anderson, MD, Sanofi Pasteur (Scientific Research Study Investigator) Sue Kim, MPH, Council of State and Territorial Epidemiologists (CSTE) (Grant/Research Support)
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Affiliation(s)
- Daniel Owusu
- Centers for Disease Control and Prevention, Atlanta, Georgia
| | | | | | | | | | - Nisha B Alden
- Colorado Department of Public Health and Environment, Denver, Colorado
| | - Evan J Anderson
- Emory University, Atlanta VA Medical Center, Atlanta, Georgia
| | - Maya Monroe
- Maryland Department of Health and Mental Hygiene, Baltimore, Maryland
| | - Sue Kim
- Michigan Department of Health and Human Services, Lansing, Michigan
| | | | | | - Nancy Spina
- New York State Department of Health, Albany, NY
| | - Nancy M Bennett
- University of Rochester School of Medicine and Dentistry, Rochester, NY
| | | | - Ann Thomas
- Oregon Health Authority, Portland, Oregon
| | | | | | | | - Shikha Garg
- Centers for Disease Control and Prevention, Atlanta, Georgia
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15
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Mamudu HM, Owusu D, Asare B, Williams F, Asare M, Oke A, Poole A, Osedeme F, Ouma OAE. Support for smoke-free public places among adults in four countries in sub-Saharan Africa. Nicotine Tob Res 2020; 22:2141-2148. [PMID: 31927591 DOI: 10.1093/ntr/ntaa008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2019] [Accepted: 01/08/2020] [Indexed: 11/12/2022]
Abstract
INTRODUCTION There is no known safe level of secondhand smoke exposure; yet, less than 30% of the global population is covered by comprehensive smoke-free policies as of 2016 and there are few smoke-free policies in sub-Saharan Africa (SSA). This study examines the support for smoke-free public places in SSA and delineates their correlates. METHODS Data collected through the Global Adult Tobacco Survey (2012-2017) were analyzed using SAS for descriptive and multivariable analyses, with a significance level set at p < .05. RESULTS No SSA country had comprehensive smoke-free policies, defined as a prohibition of smoking in eight public places. In the four countries whose Global Adult Tobacco Survey data were analyzed (Nigeria, Cameroon, Kenya, and Uganda), support for the prohibition of smoking in public places was over 90% in all eight public places except bars. Support for smoking prohibition in bars was 65.8%, 81.1%, 81.4%, and 91.0% in Nigeria, Cameroon, Kenya, and Uganda, respectively. Factors associated with support for smoke-free bars differed across the four countries, but in all countries, current smokers had decreased odds of support for smoke-free bars. Knowledge of secondhand smoke harm and living in smoke-free homes were associated with increased odds of support for smoke-free bars in all countries except Kenya. CONCLUSION The high support for smoke-free public places should inform the efforts of the public health community and policymakers in these four SSA countries toward meeting their obligations of Article 8 of the World Health Organization Framework Convention on Tobacco Control (WHO FCTC). IMPLICATIONS Much of the population in SSA is not protected by comprehensive smoke-free policies. It was found that the overwhelming majority of adults in four large countries in SSA support the prohibition of smoking in public places and that knowledge of the health dangers of smoking and exposure to secondhand smoke and home smoking rules increased support for the prohibition. High support for the prohibition of smoking in these four SSA countries suggests tobacco control proponents should advocate for comprehensive smoke-free policies.
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Affiliation(s)
- Hadii M Mamudu
- Department of Health Services Management and Policy, College of Public Health, East Tennessee State University, Johnson City, TN
| | - Daniel Owusu
- Tobacco Center of Regulatory Science (GSU TCORS), Georgia State University, Atlanta, GA
| | | | - Faustine Williams
- Intramural Research Program, National Institute on Minority Health and Health Disparities, National Institutes of Health, Bethesda, MD
| | - Matthew Asare
- Department of Public Health, Robbins College of Health and Human Sciences, Baylor University, Waco, TX
| | - Adekunle Oke
- Department of Health Services Management and Policy, College of Public Health, East Tennessee State University, Johnson City, TN
| | - Amy Poole
- Department of Health Services Management and Policy, College of Public Health, East Tennessee State University, Johnson City, TN
| | - Fenose Osedeme
- Department of Health Services Management and Policy, College of Public Health, East Tennessee State University, Johnson City, TN
| | - Ogwell A E Ouma
- Africa Centers for Disease Control and Prevention, Addis Ababa, Ethiopia
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16
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Abstract
There has been an upsurge of e-cigarette use in the United States in recent years. While e-cigarettes may contain lower levels of toxic chemicals than combusted cigarettes, they still pose serious health hazards, including increased risk for heart and respiratory disease. Despite these risks, public awareness of the health harms of e-cigarettes remains low. Thus, it is important to educate the public about the potential harms of e-cigarettes. This study took themes commonly found in antismoking messages and used them to develop messages about harms of e-cigarettes. A national sample of 2801 current smokers and nonsmokers (aged 18+ years) were randomized to view one of four e-cigarette messages (harmful effect of chemicals, uncertainty about ingredients, distrust of big tobacco, or cost of vaping) or a control message (bottled water ad). Participants' reactions to the messages and behavioral intentions were assessed immediately following the exposure. MANOVA examined effects of the messages on blocks of the outcome variables and univariate analyses estimated adjusted means for each experimental condition for each outcome. The message about harmful chemicals was perceived as the most informative and effective and elicited the highest levels of negative emotions (Ps<0.05). However, on measures of actual effectiveness, the other messages performed equally well. Specifically, messages with different themes (harmful chemicals, uncertainty about ingredients, anti-industry, or financial cost) increased perceived risk of e-cigarettes, support for e-cigarette control, and lowered self-exempting beliefs and intentions to use e-cigarettes (Ps<0.05). Themes commonly used in anti-smoking messages may be effective in educating the public about the potential harm of e-cigarettes. The observed differential effects of the messages suggest the need to use multiple themes in a public education campaign about e-cigarettes.
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Affiliation(s)
- Daniel Owusu
- School of Public Health, Georgia State University, Atlanta, Georgia, United States of America
| | - Zachary Massey
- School of Public Health, Georgia State University, Atlanta, Georgia, United States of America
| | - Lucy Popova
- School of Public Health, Georgia State University, Atlanta, Georgia, United States of America
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17
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Lewis NM, Chu VT, Ye D, Conners EE, Gharpure R, Laws RL, Reses HE, Freeman BD, Fajans M, Rabold EM, Dawson P, Buono S, Yin S, Owusu D, Wadhwa A, Pomeroy M, Yousaf A, Pevzner E, Njuguna H, Battey KA, Tran CH, Fields VL, Salvatore P, O'Hegarty M, Vuong J, Chancey R, Gregory C, Banks M, Rispens JR, Dietrich E, Marcenac P, Matanock AM, Duca L, Binder A, Fox G, Lester S, Mills L, Gerber SI, Watson J, Schumacher A, Pawloski L, Thornburg NJ, Hall AJ, Kiphibane T, Willardson S, Christensen K, Page L, Bhattacharyya S, Dasu T, Christiansen A, Pray IW, Westergaard RP, Dunn AC, Tate JE, Nabity SA, Kirking HL. Household Transmission of SARS-CoV-2 in the United States. Clin Infect Dis 2020; 73:1805-1813. [PMID: 33185244 PMCID: PMC7454394 DOI: 10.1093/cid/ciaa1166] [Citation(s) in RCA: 97] [Impact Index Per Article: 24.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2020] [Indexed: 01/08/2023] Open
Abstract
Background Although many viral respiratory illnesses are transmitted within households, the evidence base for SARS-CoV-2 is nascent. We sought to characterize SARS-CoV-2 transmission within US households and estimate the household secondary infection rate (SIR) to inform strategies to reduce transmission. Methods We recruited laboratory-confirmed COVID-19 patients and their household contacts in Utah and Wisconsin during March 22–April 25, 2020. We interviewed patients and all household contacts to obtain demographics and medical histories. At the initial household visit, 14 days later, and when a household contact became newly symptomatic, we collected respiratory swabs from patients and household contacts for testing by SARS-CoV-2 rRT-PCR and sera for SARS-CoV-2 antibodies testing by enzyme-linked immunosorbent assay (ELISA). We estimated SIR and odds ratios (OR) to assess risk factors for secondary infection, defined by a positive rRT-PCR or ELISA test. Results Thirty-two (55%) of 58 households had evidence of secondary infection among household contacts. The SIR was 29% (n = 55/188; 95% confidence interval [CI]: 23–36%) overall, 42% among children (<18 years) of the COVID-19 patient and 33% among spouses/partners. Household contacts to COVID-19 patients with immunocompromised conditions had increased odds of infection (OR: 15.9, 95% CI: 2.4–106.9). Household contacts who themselves had diabetes mellitus had increased odds of infection (OR: 7.1, 95% CI: 1.2–42.5). Conclusions We found substantial evidence of secondary infections among household contacts. People with COVID-19, particularly those with immunocompromising conditions or those with household contacts with diabetes, should take care to promptly self-isolate to prevent household transmission.
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Affiliation(s)
- Nathaniel M Lewis
- COVID-19 Response Team, CDC, Atlanta, Georgia, USA.,Epidemic Intelligence Service, CDC, Atlanta, Georgia, USA.,Utah Department of Health, Salt Lake City, Utah, USA
| | - Victoria T Chu
- COVID-19 Response Team, CDC, Atlanta, Georgia, USA.,Epidemic Intelligence Service, CDC, Atlanta, Georgia, USA
| | - Dongni Ye
- COVID-19 Response Team, CDC, Atlanta, Georgia, USA
| | - Erin E Conners
- COVID-19 Response Team, CDC, Atlanta, Georgia, USA.,Epidemic Intelligence Service, CDC, Atlanta, Georgia, USA
| | - Radhika Gharpure
- COVID-19 Response Team, CDC, Atlanta, Georgia, USA.,Epidemic Intelligence Service, CDC, Atlanta, Georgia, USA
| | | | | | - Brandi D Freeman
- COVID-19 Response Team, CDC, Atlanta, Georgia, USA.,Laboratory Leadership Service, CDC, Atlanta, Georgia, USA
| | - Mark Fajans
- COVID-19 Response Team, CDC, Atlanta, Georgia, USA
| | - Elizabeth M Rabold
- COVID-19 Response Team, CDC, Atlanta, Georgia, USA.,Epidemic Intelligence Service, CDC, Atlanta, Georgia, USA
| | - Patrick Dawson
- COVID-19 Response Team, CDC, Atlanta, Georgia, USA.,Epidemic Intelligence Service, CDC, Atlanta, Georgia, USA
| | - Sean Buono
- COVID-19 Response Team, CDC, Atlanta, Georgia, USA.,Laboratory Leadership Service, CDC, Atlanta, Georgia, USA
| | - Sherry Yin
- COVID-19 Response Team, CDC, Atlanta, Georgia, USA
| | - Daniel Owusu
- COVID-19 Response Team, CDC, Atlanta, Georgia, USA.,Epidemic Intelligence Service, CDC, Atlanta, Georgia, USA
| | - Ashutosh Wadhwa
- COVID-19 Response Team, CDC, Atlanta, Georgia, USA.,Laboratory Leadership Service, CDC, Atlanta, Georgia, USA
| | - Mary Pomeroy
- COVID-19 Response Team, CDC, Atlanta, Georgia, USA.,Epidemic Intelligence Service, CDC, Atlanta, Georgia, USA
| | - Anna Yousaf
- COVID-19 Response Team, CDC, Atlanta, Georgia, USA.,Epidemic Intelligence Service, CDC, Atlanta, Georgia, USA
| | - Eric Pevzner
- COVID-19 Response Team, CDC, Atlanta, Georgia, USA
| | | | | | - Cuc H Tran
- COVID-19 Response Team, CDC, Atlanta, Georgia, USA
| | - Victoria L Fields
- COVID-19 Response Team, CDC, Atlanta, Georgia, USA.,Epidemic Intelligence Service, CDC, Atlanta, Georgia, USA
| | - Phillip Salvatore
- COVID-19 Response Team, CDC, Atlanta, Georgia, USA.,Epidemic Intelligence Service, CDC, Atlanta, Georgia, USA
| | | | - Jeni Vuong
- COVID-19 Response Team, CDC, Atlanta, Georgia, USA
| | | | | | | | - Jared R Rispens
- COVID-19 Response Team, CDC, Atlanta, Georgia, USA.,Epidemic Intelligence Service, CDC, Atlanta, Georgia, USA
| | | | - Perrine Marcenac
- COVID-19 Response Team, CDC, Atlanta, Georgia, USA.,Epidemic Intelligence Service, CDC, Atlanta, Georgia, USA
| | | | - Lindsey Duca
- COVID-19 Response Team, CDC, Atlanta, Georgia, USA.,Epidemic Intelligence Service, CDC, Atlanta, Georgia, USA
| | | | - Garrett Fox
- COVID-19 Response Team, CDC, Atlanta, Georgia, USA
| | | | - Lisa Mills
- COVID-19 Response Team, CDC, Atlanta, Georgia, USA
| | | | - John Watson
- COVID-19 Response Team, CDC, Atlanta, Georgia, USA
| | | | | | | | - Aron J Hall
- COVID-19 Response Team, CDC, Atlanta, Georgia, USA
| | - Tair Kiphibane
- Salt Lake County Health Department, Salt Lake City, Utah, USA
| | | | | | - Lindsey Page
- City of Milwaukee Health Department, Milwaukee, Wisconsin, USA
| | | | - Trivikram Dasu
- City of Milwaukee Health Department, Milwaukee, Wisconsin, USA
| | | | - Ian W Pray
- COVID-19 Response Team, CDC, Atlanta, Georgia, USA.,Epidemic Intelligence Service, CDC, Atlanta, Georgia, USA.,Wisconsin Department of Health Services, Madison, Wisconsin, USA
| | | | - Angela C Dunn
- Utah Department of Health, Salt Lake City, Utah, USA
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18
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Yousaf AR, Duca LM, Chu V, Reses HE, Fajans M, Rabold EM, Laws RL, Gharpure R, Matanock A, Wadhwa A, Pomeroy M, Njuguna H, Fox G, Binder AM, Christiansen A, Freeman B, Gregory C, Tran CH, Owusu D, Ye D, Dietrich E, Pevzner E, Conners EE, Pray I, Rispens J, Vuong J, Christensen K, Banks M, O'Hegarty M, Mills L, Lester S, Thornburg NJ, Lewis N, Dawson P, Marcenac P, Salvatore P, Chancey RJ, Fields V, Buono S, Yin S, Gerber S, Kiphibane T, Dasu T, Bhattacharyya S, Westergaard R, Dunn A, Hall AJ, Fry AM, Tate JE, Kirking HL, Nabity S. A prospective cohort study in non-hospitalized household contacts with SARS-CoV-2 infection: symptom profiles and symptom change over time. Clin Infect Dis 2020; 73:e1841-e1849. [PMID: 32719874 PMCID: PMC7454397 DOI: 10.1093/cid/ciaa1072] [Citation(s) in RCA: 50] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Accepted: 07/23/2020] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Improved understanding of SARS-CoV-2 spectrum of disease is essential for clinical and public health interventions. There are limited data on mild or asymptomatic infections, but recognition of these individuals is key as they contribute to viral transmission. We describe the symptom profiles from individuals with mild or asymptomatic SARS-CoV-2 infection. METHODS From March 22 to April 22, 2020 in Wisconsin and Utah, we enrolled and prospectively observed 198 household contacts exposed to SARS-CoV-2. We collected and tested nasopharyngeal (NP) specimens by RT-PCR two or more times during a 14-day period. Contacts completed daily symptom diaries. We characterized symptom profiles on the date of first positive RT-PCR test and described progression of symptoms over time. RESULTS We identified 47 contacts, median age 24 (3-75) years, with detectable SARS-CoV-2 by RT-PCR. The most commonly reported symptoms on the day of first positive RT-PCR test were upper respiratory (n=32, 68%) and neurologic (n=30, 64%); fever was not commonly reported (n=9, 19%). Eight (17%) individuals were asymptomatic at the date of first positive RT-PCR collection; two (4%) had preceding symptoms that resolved and six (13%) subsequently developed symptoms. Children less frequently reported lower respiratory symptoms (age <18: 21%, age 18-49: 60%, age 50+ years: 69%; p=0.03). CONCLUSIONS Household contacts with lab-confirmed SARS-CoV-2 infection reported mild symptoms. When assessed at a single time-point, several contacts appeared to have asymptomatic infection; however, over time all developed symptoms. These findings are important to inform infection control, contact tracing, and community mitigation strategies.
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Affiliation(s)
- Anna R Yousaf
- COVID-19 Response Team, CDC.,Epidemic Intelligence Service, CDC
| | - Lindsey M Duca
- COVID-19 Response Team, CDC.,Epidemic Intelligence Service, CDC
| | - Victoria Chu
- COVID-19 Response Team, CDC.,Epidemic Intelligence Service, CDC
| | | | | | | | | | | | | | - Ash Wadhwa
- COVID-19 Response Team, CDC.,Laboratory Leadership Service, CDC
| | - Mary Pomeroy
- COVID-19 Response Team, CDC.,Epidemic Intelligence Service, CDC
| | | | | | | | | | - Brandi Freeman
- COVID-19 Response Team, CDC.,Laboratory Leadership Service, CDC
| | | | | | - Daniel Owusu
- COVID-19 Response Team, CDC.,Epidemic Intelligence Service, CDC
| | | | | | | | | | - Ian Pray
- COVID-19 Response Team, CDC.,Epidemic Intelligence Service, CDC.,Wisconsin Department of Health
| | - Jared Rispens
- COVID-19 Response Team, CDC.,Epidemic Intelligence Service, CDC
| | | | | | | | | | | | | | | | - Nathaniel Lewis
- COVID-19 Response Team, CDC.,Epidemic Intelligence Service, CDC.,Utah Department of Health
| | - Patrick Dawson
- COVID-19 Response Team, CDC.,Epidemic Intelligence Service, CDC
| | | | | | | | - Victoria Fields
- COVID-19 Response Team, CDC.,Epidemic Intelligence Service, CDC
| | - Sean Buono
- COVID-19 Response Team, CDC.,Laboratory Leadership Service, CDC
| | | | | | | | - Trivikram Dasu
- Davis County (UT) Health Department.,City of Milwaukee (WI) Health Department
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19
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Mamudu HM, Osedeme F, Robertson C, Littleton MA, Owusu D, Wang L, Studlar DT. A Qualitative Study to Explore Perception of Impacts of Preemption of Tobacco Regulation on Counties in Appalachian Tennessee. Int J Environ Res Public Health 2020; 17:E3230. [PMID: 32384710 PMCID: PMC7246887 DOI: 10.3390/ijerph17093230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Accepted: 04/30/2020] [Indexed: 11/16/2022]
Abstract
Bottom-up processes, starting at the local government level, are valuable for more-stringent tobacco control measures. The existence of industry-backed state-level tobacco control preemption in states has impeded policy progress within the state and localities/communities. A national public health goal under Healthy People 2020 is to eliminate state-level preemption across the United States. This study explored individual-level perceptions of the impact of state-level preemption in Appalachian Tennessee-a high-smoking, low-income region. During 2015-2016, a community-engagement project to develop a Population Health Improvement Plan (PHIP) involving over 200 stakeholders and 90 organizations was conducted in Appalachian Tennessee to identify policies/programs to address tobacco use. Using a multifaceted framework approach that focused on prevention, protection, and cessation, interviews and meeting discussions were audio-recorded and transcribed. Content analysis using NVivo 11 was conducted to generate themes. Although the central focus of the PHIP was not preemption, the issue emerged naturally in the discussions as a major concern among participants. Cultural and normative factors in Appalachian Tennessee were identified as key rationales for participants' aversion to state preemption. Thus, repealing preemption would facilitate culturally tailored and region-specific policies/programs to the high tobacco use among Appalachian Tennessee communities where statewide/nationwide policies/programs have not had the intended impacts.
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Affiliation(s)
- Hadii M. Mamudu
- Department of Health Services Management and Policy, College of Public Health, East Tennessee State University, P.O Box 70264, Johnson City, TN 37614, USA
| | - Fenose Osedeme
- Department of Behavioral and Community Health, College of Public Health, East Tennessee State University, P.O Box 70264, Johnson City, TN 37614, USA; (F.O.); (M.A.L.); (D.T.S.)
| | - Crystal Robertson
- School of Plant Environmental and Soil Sciences, Louisiana State University, Baton Rouge, LA 70808, USA;
| | - Mary Ann Littleton
- Department of Behavioral and Community Health, College of Public Health, East Tennessee State University, P.O Box 70264, Johnson City, TN 37614, USA; (F.O.); (M.A.L.); (D.T.S.)
| | - Daniel Owusu
- Tobacco Center of Regulatory Science (GSU TCORS), Georgia State University, Urban Life Building 850, 140 Decatur St, Atlanta, GA 30030, USA;
| | - Liang Wang
- Department of Biostatics and Epidemiology, College of Public Health, East Tennessee State University, P.O Box 70659, Johnson City, TN 37614, USA;
| | - Donley T. Studlar
- Department of Behavioral and Community Health, College of Public Health, East Tennessee State University, P.O Box 70264, Johnson City, TN 37614, USA; (F.O.); (M.A.L.); (D.T.S.)
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20
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Popova L, Owusu D, Nyman AL, Weaver SR, Yang B, Huang J, Ashley DL. Effects of Framing Nicotine Reduction in Cigarettes on Anticipated Tobacco Product Use Intentions and Risk Perceptions Among US Adult Smokers. Nicotine Tob Res 2020; 21:S108-S116. [PMID: 31867652 PMCID: PMC6939750 DOI: 10.1093/ntr/ntz146] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2019] [Accepted: 08/16/2019] [Indexed: 12/29/2022]
Abstract
Introduction In 2017, the US Food and Drug Administration (FDA) proposed lowering the amount of nicotine in combusted cigarettes to minimally addictive levels. If used, to encourage cessation and maximize the benefits of this action, the FDA needs to determine the most effective way to communicate to the public the practical impact of this nicotine tobacco product standard. Methods Data were collected in 2018 from a nationally representative, online probability sample of 1198 adult smokers (aged ≥18 years old) in the United States. Smokers were randomly assigned one of five versions of the question regarding what they would most likely do if nicotine in cigarettes was reduced (nicotine levels were reduced by 95%; the government reduced nicotine levels by 95%; cigarettes were no longer addictive; cigarettes no longer relieved cravings; cigarettes were changed so that you would be able to quit more easily). Effects of framing on anticipated tobacco use intentions and perceived risk of very low nicotine cigarettes (VLNCs) were evaluated with multinomial logistic regressions. Results Framing the nicotine tobacco product standard as cigarettes no longer relieved cravings resulted in the highest proportion of smokers reporting they intend to quit in response to this standard (43.9%), lowest proportions reporting anticipated intentions to continue using combusted tobacco products (45.3%), and lowest proportion believing that VLNCs are less harmful than regular cigarettes (26%). Conclusions Different frames of nicotine reduction in cigarettes differentially affected smokers’ anticipated tobacco use intentions and perceived risk of VLNCs. Presenting reduction as making cigarettes unable to relieve cravings might be particularly effective at motivating cessation.
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Affiliation(s)
- Lucy Popova
- School of Public Health, Georgia State University, Atlanta, GA
| | - Daniel Owusu
- School of Public Health, Georgia State University, Atlanta, GA
| | - Amy L Nyman
- School of Public Health, Georgia State University, Atlanta, GA
| | - Scott R Weaver
- School of Public Health, Georgia State University, Atlanta, GA
| | - Bo Yang
- Department of Communication, University of Arizona, Tucson, AZ
| | - Jidong Huang
- School of Public Health, Georgia State University, Atlanta, GA
| | - David L Ashley
- School of Public Health, Georgia State University, Atlanta, GA
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21
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Owusu D, Hand J, Tenforde MW, Feldstein LR, DaSilva J, Barnes J, Lee G, Tran J, Sokol T, Fry AM, Brammer L, Rolfes MA. Early season pediatric influenza B/Victoria virus infections associated with a recently emerged virus subclade — Louisiana, 2019. Am J Transplant 2020. [DOI: 10.1111/ajt.15782] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Daniel Owusu
- Epidemic Intelligence Service CDC Atlanta Georgia
- Influenza Division National Center for Immunization and Respiratory Diseases CDC Atlanta Georgia
| | - Julie Hand
- Louisiana Department of Health New Orleans Louisiana
| | - Mark W. Tenforde
- Epidemic Intelligence Service CDC Atlanta Georgia
- Influenza Division National Center for Immunization and Respiratory Diseases CDC Atlanta Georgia
| | - Leora R. Feldstein
- Influenza Division National Center for Immunization and Respiratory Diseases CDC Atlanta Georgia
| | - Juliana DaSilva
- Influenza Division National Center for Immunization and Respiratory Diseases CDC Atlanta Georgia
| | - John Barnes
- Influenza Division National Center for Immunization and Respiratory Diseases CDC Atlanta Georgia
| | - Grace Lee
- Tulane University Preventive Medicine Residency New Orleans Louisiana
| | - Juliet Tran
- Tulane University Preventive Medicine Residency New Orleans Louisiana
| | - Theresa Sokol
- Louisiana Department of Health New Orleans Louisiana
| | - Alicia M. Fry
- Influenza Division National Center for Immunization and Respiratory Diseases CDC Atlanta Georgia
| | - Lynnette Brammer
- Influenza Division National Center for Immunization and Respiratory Diseases CDC Atlanta Georgia
| | - Melissa A. Rolfes
- Influenza Division National Center for Immunization and Respiratory Diseases CDC Atlanta Georgia
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22
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Owusu D, Hand J, Tenforde MW, Feldstein LR, DaSilva J, Barnes J, Lee G, Tran J, Sokol T, Fry AM, Brammer L, Rolfes MA. Early Season Pediatric Influenza B/Victoria Virus Infections Associated with a Recently Emerged Virus Subclade - Louisiana, 2019. MMWR Morb Mortal Wkly Rep 2020; 69:40-43. [PMID: 31945035 PMCID: PMC6973347 DOI: 10.15585/mmwr.mm6902e1] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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23
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Yang B, Owusu D, Popova L. Effects of a Nicotine Fact Sheet on Perceived Risk of Nicotine and E-Cigarettes and Intentions to Seek Information About and Use E-Cigarettes. Int J Environ Res Public Health 2019; 17:ijerph17010131. [PMID: 31878111 PMCID: PMC6981818 DOI: 10.3390/ijerph17010131] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/01/2019] [Revised: 12/19/2019] [Accepted: 12/19/2019] [Indexed: 11/16/2022]
Abstract
We examined how a nicotine fact sheet influenced smokers’ beliefs about nicotine and electronic cigarettes (e-cigarettes), a potentially less harmful alternative to conventional cigarettes. In an exploratory online experiment, 756 US adult current and recent former smokers (quit in the past 2 years) were randomized to view a nicotine fact sheet or control messages (bottled water ads). Effects of the nicotine fact sheet on perceived nicotine addictiveness, nicotine risk, comparative risk of e-cigarettes, and dual use intentions were analyzed using log-Poisson regression with robust error. Linear regression analyzed effects on perceived absolute risk and switching and information seeking intentions about e-cigarettes. Compared to control, the nicotine fact sheet doubled the probability of disagreeing that nicotine is the main cause of smoking-related disease (26.2% vs. 12.7%, RR = 2.06, 95% CI = 1.51, 2.82, p < 0.001). However, nearly three quarters of participants viewing the nicotine fact sheet still thought that nicotine is the main cause of smoking-related disease. The nicotine fact sheet increased smokers’ intentions to seek information about e-cigarettes (b = 0.45, 95% CI = 0.15, 0.74, p = 0.003). We did not find evidence suggesting unintended consequences of the nicotine fact sheet on smokers’ e-cigarettes risk perceptions or use intentions (e.g., increased dual use intentions or reduced absolute e-cigarette risk perception).
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Affiliation(s)
- Bo Yang
- Department of Communication, University of Arizona, Tucson, AZ 85721, USA
| | - Daniel Owusu
- School of Public Health, Georgia State University, Atlanta, GA 30302, USA
| | - Lucy Popova
- School of Public Health, Georgia State University, Atlanta, GA 30302, USA
- Correspondence:
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24
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Owusu D, Mamudu HM, Collins C, Robertson C, Wang L, Rafie B, Littleton MA. The Usage and Associated Factors of Alternative Tobacco Products among School-going Youth in Central Appalachia. J Health Care Poor Underserved 2019; 30:249-264. [PMID: 30827981 DOI: 10.1353/hpu.2019.0019] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
OBJECTIVE To examine alternative tobacco product (ATP) use and associated factors among middle school students in Appalachian Tennessee. METHOD Data (2015-2016; N=573) from school-based tobacco surveys in 11 middle schools in Appalachian Tennessee were analyzed. Multiple logistic regression model described factors associated with ATP use. RESULTS More than one-tenth (13.2%) of participants have ever used ATPs. Approximately 9%, 7%, 6%, and 2% of participants have ever used e-cigarettes, cigarettes, smokeless tobacco, and little cigars or cigarillos, respectively. The following were significantly associated with ever use of ATPs: believing tobacco users have more friends, owning tobacco-branded item(s), living with a tobacco user, having ever smoked cigarettes, and living in homes where smoking is allowed. CONCLUSION More than one in 10 of participants have ever used at least one ATP, and association with desirable objects and situations may promote ATP use. Interventions should seek to reduce these positive images and make all tobacco products unappealing.
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25
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Owusu D, Huang J, Weaver SR, Pechacek TF, Ashley DL, Nayak P, Eriksen MP. Patterns and trends of dual use of e-cigarettes and cigarettes among U.S. adults, 2015-2018. Prev Med Rep 2019; 16:101009. [PMID: 31763161 PMCID: PMC6861646 DOI: 10.1016/j.pmedr.2019.101009] [Citation(s) in RCA: 74] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2019] [Revised: 08/20/2019] [Accepted: 10/20/2019] [Indexed: 11/30/2022] Open
Abstract
Prevalence of current e-cigarette use among smokers remained relatively stable from 2015 (29.8%) to 2018 (27.7%). Prevalence of current e-cigarette use among never and former smokers increased significantly. Among e-cigarettes users, prevalence of current cigarette smoking decreased from 56.9% (2015) to 40.8% (2018). Approximately 1 in 5 smokers with no plan to quit smoking were current e-cigarette users from 2015 to 2018. About 3 in 10 heavy smokers who were dual users frequently used e-cigarettes from 2015 to 2018.
Introduction If dual use of cigarettes and e-cigarettes is a transition state to tobacco and nicotine use cessation, it may be a tolerable temporary condition. But, if a long-term behavior, dual use may increase tobacco harm to the population as a whole, and efforts should aim to reduce it as much as possible. To develop effective tobacco control policy, the changes in dual use of e-cigarettes and cigarettes need to be better understood. Methods National probability samples of U.S. adults in 2015 (n = 6051), 2016 (n = 6014), 2017 (n = 5992), and 2018 (n = 5989) reported their smoking and e-cigarette use status, including frequency of use. Weighted multinomial logistic regression models were used to examine temporal trends and patterns of cigarette and e-cigarette use. Results Between 2015 and 2018, the prevalence of current e-cigarette use (29.8% in 2015, 22.3% in 2016, 29.1% in 2017, and 27.7% in 2018) did not change significantly among current smokers. This result was consistent among light, moderate, and heavy smokers, and did not change when stratified by sex, age and race. However, the prevalence of cigarette smoking in current e-cigarette users declined from 56.9% in 2015 to 40.8% in 2018 (p < 0.001). Among never (p = .012) and former (ps < 0.001) smokers the prevalence of current e-cigarette use increased significantly. Conclusion The continued high prevalence of dual use and increased prevalence of current e-cigarette use among never smokers highlight the need for better communication about the risks of prolonged dual use for e-cigarette users, and the risks of nicotine initiation and addiction for nonusers.
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Affiliation(s)
- Daniel Owusu
- School of Public Health, Georgia State University Atlanta, GA, USA
| | - Jidong Huang
- School of Public Health, Georgia State University Atlanta, GA, USA
| | - Scott R Weaver
- School of Public Health, Georgia State University Atlanta, GA, USA
| | - Terry F Pechacek
- School of Public Health, Georgia State University Atlanta, GA, USA
| | - David L Ashley
- School of Public Health, Georgia State University Atlanta, GA, USA
| | - Pratibha Nayak
- Public Health Center for Tobacco Research, Battelle, Atlanta, GA, USA
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26
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Li Y, Yang B, Owusu D, Popova L. Higher negative emotions in response to cigarette pictorial warning labels predict higher quit intentions among smokers. Tob Control 2019; 29:496-501. [PMID: 31420374 DOI: 10.1136/tobaccocontrol-2019-055116] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2019] [Revised: 07/17/2019] [Accepted: 07/18/2019] [Indexed: 11/04/2022]
Abstract
BACKGROUND Cigarette pictorial warning labels (PWLs) could produce stronger quit intentions than text-only warning labels (TWLs) due to greater emotional arousal. Yet, it remains unclear whether PWLs that elicit different levels of emotions produce different outcomes. To better understand the role of negative emotions in the effects of PWLs, this study developed two sets of PWLs arousing different emotional levels (high vs low) but equally high on informativeness and compared them to each other and to the current TWLs. METHODS Adult US smokers (n=1503) were randomised to view nine high-emotion-arousing or low-emotion-arousing PWLs or TWLs. After each label, participants reported the negative emotions they felt while looking at the label. After seeing all the labels, participants reported their intentions to quit smoking. Mediation analyses tested whether message condition influenced quit intentions indirectly through negative emotions. RESULTS Compared with TWLs, PWLs produced higher levels of negative emotions (b=0.27, SE=0.04, p<0.001). Compared with low-emotion arousing PWLs, high-emotion-arousing PWLs produced higher levels of negative emotions (b=0.24, SE=0.07, p<0.001). Higher negative emotions predicted stronger quit intentions (b=0.20, SE=0.03, p<0.001). Negative emotions mediated the effects of PWLs versus TWLs and high-emotion-arousing versus low- emotion-arousing PWLs on quit intentions. CONCLUSIONS The results provide additional evidence for negative emotions as the mechanism through which PWLs motivate smokers to consider quitting. The findings call on the Food and Drug Administration to design and implement high-emotion-arousing cigarette warning labels.
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Affiliation(s)
- Yachao Li
- Department of Communication Studies and Department of Public Health, The College of New Jersey, Ewing, New Jersey, USA
| | - Bo Yang
- Department of Communication, University of Arizona, Tucson, Arizona, USA
| | - Daniel Owusu
- School of Public Health, Georgia State University, Atlanta, Georgia, USA
| | - Lucy Popova
- School of Public Health, Georgia State University, Atlanta, Georgia, USA
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27
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Owusu D, Lawley R, Yang B, Henderson K, Bethea B, LaRose C, Stallworth S, Popova L. 'The lesser devil you don't know': a qualitative study of smokers' responses to messages communicating comparative risk of electronic and combusted cigarettes. Tob Control 2019; 29:217-223. [PMID: 31040224 DOI: 10.1136/tobaccocontrol-2018-054883] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2018] [Revised: 03/12/2019] [Accepted: 03/12/2019] [Indexed: 11/03/2022]
Abstract
INTRODUCTION Communicating to smokers that e-cigarettes deliver lower levels of harmful chemicals than combusted cigarettes is a challenging issue. This study qualitatively explored smokers' interpretations of messages communicating the risk of e-cigarettes relative to cigarettes (comparative risk messages). METHOD We developed 12 print comparative risk messages and evaluated them in 12 focus groups with 72 adult smokers (18+ years old) in Atlanta, Georgia. RESULTS Participants interpreted uncertainty about health effects of e-cigarettes as an indicator of significant unknown risks, which some believed to be potentially more severe than the known effects of cigarettes (such as cancer and heart disease). Also, participants were sceptical about the lower risk claims. Some participants misinterpreted what 'switching completely' or 'switching 100% of the time' means, perceiving switching from e-cigarettes to combusted cigarettes as comparable with the use of both products. When chemicals in e-cigarettes were mentioned (eg, nicotine or formaldehyde), participants viewed e-cigarettes as very harmful and had difficulty reconciling this belief with the reduced risk claim. Comparative risk messages emphasising smoking risks were perceived as effective. Participants also appreciated being given an option to switch if they cannot quit. Participants suggested the inclusion of more facts and statistics and a credible message source (eg, public health agencies) to increase message effectiveness. CONCLUSION Comparative risk messages may be more acceptable to smokers if they show direct comparisons of the number of toxic chemicals in cigarettes and e-cigarettes, are attributed to a credible source(s), and emphasise smoking risks.
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Affiliation(s)
- Daniel Owusu
- School of Public Health, Georgia State University, Atlanta, Georgia, USA
| | - Rachel Lawley
- School of Public Health, Georgia State University, Atlanta, Georgia, USA
| | - Bo Yang
- School of Public Health, Georgia State University, Atlanta, Georgia, USA
| | | | - Brittaney Bethea
- Department of Communication, Georgia State University, Atlanta, Georgia, USA
| | | | | | - Lucy Popova
- School of Public Health, Georgia State University, Atlanta, Georgia, USA
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28
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Mamudu HM, Wang L, Owusu D, Robertson C, Collins C, Littleton MA. Prospective study of dual use of e-cigarettes and other tobacco products among school-going youth in rural Appalachian Tennessee. Ann Thorac Med 2019; 14:127-133. [PMID: 31007764 PMCID: PMC6467020 DOI: 10.4103/atm.atm_217_18] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
INTRODUCTION: E-cigarettes have emerged as the most commonly used tobacco or nicotine products among youth in the United States (US), and usage with other products (dual use) is not well understood. This study assessed dual use and identified associated factors of usage in school-going youth in the high tobacco burdened region of rural Appalachian Tennessee. METHODS: Two waves of data for the same cohort of students were collected in 2014 (Wave 1) and 2016 (Wave 2). Dual use of e-cigarettes with any other tobacco product was the dependent variable. The independent variables consisted of exposure to tobacco use at home, home smoking rules, smoking inside the vehicle, attitudes toward smoking, exposure to tobacco industry marketing/promotion, and peer/family pressure. Descriptive statistics and multivariate logistic regression analyses were conducted to determine the prevalence of dual use and delineate factors associated with usage. RESULTS: Dual use increased from 13.3% in Wave 1 to 18.6% in Wave 2. Results of logistic regression show that exposure to tobacco industry marketing/promotion was significantly associated with dual use in the two waves, odds ratio (OR) = 4.18 (confidence interval [CI] = 1.69–10.38) and OR = 4.43 (CI = 2.03–9.67), respectively. While allowing smoking inside the vehicles, sometimes, significantly increased dual use in Wave 1 (OR = 3.18 [CI = 1.19–8.48]), exposure to tobacco use at home (OR = 2.94 [1.24–6.97]), and peer/family pressure (OR = 2.92 [1.87–7.19]) increased usage in Wave 2. CONCLUSION: The increasing trend in dual use of e-cigarettes and other tobacco products among youth in Appalachia Tennessee suggests a critical need for comprehensive tobacco control programs to avert exacerbating disparities in tobacco use and tobacco-related diseases in the US.
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Affiliation(s)
- Hadii M Mamudu
- Department of Health Services Management and Policy, College of Public Health, East Tennessee State University, Johnson City, TN, USA
| | - Liang Wang
- Department of Biostatistics and Epidemiology, College of Public Health, East Tennessee State University, Johnson City, TN, USA
| | - Daniel Owusu
- Georgia State University Tobacco Center of Regulatory Science, Atlanta, GA, USA
| | | | - Candice Collins
- Department of Biostatistics and Epidemiology, College of Public Health, East Tennessee State University, Johnson City, TN, USA
| | - Mary A Littleton
- Department of Community and Behavioral Health, East Tennessee State University, Johnson City, TN, USA
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Owusu D, Mamudu HM, Robertson C, Wang L, Guy H, Collins C, Boghozian R, Littleton MA. Intention to Try Tobacco Among Middle School Students in a Predominantly Rural Environment of Central Appalachia. Subst Use Misuse 2019; 54:449-458. [PMID: 30618325 PMCID: PMC6615940 DOI: 10.1080/10826084.2018.1504080] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
BACKGROUND Disparities in tobacco use exist across regions in the United States. The Central Appalachian region carries some of the very high rates of tobacco use prevalence but research on tobacco use initiation is sparse. OBJECTIVE To investigate the intention to try tobacco and its associated factors among nonsmoking youth. METHOD Data were obtained from school-based tobacco surveys (n = 539) conducted in 11 middle schools (6th-8th grades; aged 10-15 years) in Northeast Tennessee in 2015-2016. Nonsmoking participants without firm commitment to abstain from trying tobacco in the next year were considered to have an intention to try tobacco. The Full Information Maximum Likelihood estimation (FIML) method in Mplus was employed to conduct a multivariable logistic regression analysis to delineate correlates of intention to try tobacco. RESULTS Overall, 20.0% of participants had intention to try tobacco. Among participants with intention to try tobacco, 53.7% owned tobacco-branded item(s), 86.1% believed that tobacco users have more friends, and 88.9% lived with tobacco users. In the adjusted logistic model, ever use of tobacco products, home smoking rules, owning tobacco-branded item(s), living with tobacco users, believing that tobacco users have more friends, and perception of easy access to tobacco products were significantly associated with intention to try tobacco (p < .02). CONCLUSION This study suggests that individual, interpersonal, and community level factors influence intention to try tobacco in this environment where tobacco pre-emption laws impede development of local tobacco control policies and regulations. Thus, efforts should focus on tobacco use initiation preventive programs, including school-based tobacco control programs.
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Affiliation(s)
- Daniel Owusu
- Georgia State University Tobacco Center of Regulatory Science (GSU TCORS), Urban Life Building 850, 140 Decatur St, Atlanta, GA 30030, USA.
| | - Hadii M Mamudu
- Department of Health Services Management and Policy, East Tennessee State University, P.O. Box 70264 Johnson City, TN, USA.
| | - Crystal Robertson
- Louisiana States University, School of Plant Environmental and Soil Sciences, Baton Rouge, LA.
| | - Liang Wang
- Department of Biostatistics and Epidemiology, East Tennessee State University, College of Public Health P.O. Box 70259, Johnson City, TN 37614.
| | - Holdon Guy
- Department of Health Services Management and Policy, East Tennessee State University, College of Public Health, P.O. Box 70264 Johnson City, TN, USA.
| | - Candice Collins
- Department of Biostatistics and Epidemiology, East Tennessee State University, College of Public Health P.O. Box 70259, Johnson City, TN 37614.
| | | | - Mary A Littleton
- Department of Community and Behavioral Health, East Tennessee State University, P.O. Box 70674, Johnson City, TN, USA.
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Owusu D, Wang KS, Quinn M, Aibangbee J, John RM, Mamudu HM. Health Care Provider Intervention and Utilization of Cessation Assistance in 12 Low- and Middle-Income Countries. Nicotine Tob Res 2019; 21:188-196. [PMID: 29420833 PMCID: PMC6329400 DOI: 10.1093/ntr/nty028] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2017] [Accepted: 02/02/2018] [Indexed: 11/14/2022]
Abstract
Background and Aim There is a need to improve utilization of cessation assistance in low- and middle-income countries (LMICs), and tobacco cessation research has been identified as priority in LMICs. This study evaluates the relationship between health care provider intervention and cessation assistance utilization in LMICs. Methods Data from 13 967 participants (aged ≥15 years, 90.3% males) of the Global Adults Tobacco Survey conducted in 12 LMICs (74.3%-97.3% response rates) were analyzed with utilization of counseling/cessation clinic, WHO-recommended medications, and quitline as outcome variables. Health care provider intervention ("no intervention," only "tobacco screening," "quit advice") was the exposure variable. Weighted multiple logistic regression models were used to examine the relationship between each outcome variable and the exposure variable, adjusting for other covariates. Adjusted odds ratios (ORs) with 95% confidence intervals (CIs) are reported. Results Approximately 52%, 8%, and 40% of participants received no intervention, only tobacco screening, and advice to quit, respectively. Overall, 0.4%, 1.9%, 3.0%, and 4.5% used quitline, WHO-recommended medications, counseling/cessation clinic, and any cessation assistance, respectively. Compared with no intervention, quit advice was associated with increased utilization of quitline (OR = 2.24, 95% CI = 1.2 to 4.4), WHO-recommended medications (OR = 1.67, 95% CI = 1.2 to 2.3), counseling/cessation clinic (OR = 4.41, 95% CI = 3.2 to 6.1), and any assistance (any of the three types) (OR = 2.80, 95% CI = 2.2 to 3.6). Conclusion The findings of this study suggest that the incorporation of quit advice by health care providers in tobacco control programs and health care systems in LMICs could potentially improve utilization of cessation assistance to improve smoking cessation in LMICs. Implications This first study of association between health care provider intervention and the utilization of cessation assistance in LMICs reports that there was a missed opportunity to provide quit advice to about 60% of smokers who visited a health care provider in the past year. The odds of utilization of counseling/cessation clinic, WHO-recommended medications, and quitline were significantly increased in participants who were advised to quit smoking. The results suggest that effective integration and implementation of advice to quit in tobacco control programs and the national health care systems may increase the use of cessation assistance to quit smoking.
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Affiliation(s)
- Daniel Owusu
- Tobacco Center of Regulatory Science (TCORS), School of Public Health, Georgia State University, Atlanta, GA
| | - Ke-Sheng Wang
- Department of Biostatistics and Epidemiology, East Tennessee State University, Johnson City, TN
| | - Megan Quinn
- Department of Biostatistics and Epidemiology, East Tennessee State University, Johnson City, TN
| | - Jocelyn Aibangbee
- Department of Biostatistics and Epidemiology, East Tennessee State University, Johnson City, TN
| | - Rijo M John
- Centre for Public Policy Research, Kochi, India
| | - Hadii M Mamudu
- Department of Health Services Management and Policy, East Tennessee State University, Johnson City, TN
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Abstract
BACKGROUND The Extended Parallel Process Model (EPPM) responses have not been evaluated from verbal reactions to cigarette warning labels. We identified the EPPM responses in reactions to cigarette warning labels and evaluated their predictors and relationship with warning perceptions. METHODS U.S. adult current smokers, transitioning smokers (quit in the past two years or currently quitting) and never smokers (n=1,838) saw nine of 81 cigarette warning labels. Participants freely wrote their thoughts after viewing the first label and reported perceived informativeness, negative emotions, and denial for this label. Responses were coded for the presence of the EPPM response categories. Multivariable logistic regression models described adaptive and maladaptive respondent characteristics, and linear regression models assessed the relationship between the response categories and label perceptions. RESULTS Participants' responses contained adaptive (65.4%), maladaptive (16.5%), no response (14.7%), and mixed responses (both adaptive and maladaptive; 3.4%). Current smokers had decreased odds of adaptive response compared to never and transitioning smokers. Compared to text warnings, pictorial warnings were associated with increased odds of adaptive and decreased odds of maladaptive responses. Adaptive response was associated with increased odds of intentions to quit smoking. Adaptive respondents reported the highest levels of informativeness and negative emotions among the four response categories. CONCLUSIONS The finding demonstrating predominantly adaptive (and few maladaptive) responses to warning labels supports the continued use of fear appeals in warning label design. The greater adaptive and lower maladaptive responses to pictorial warnings could serve as additional evidence for FDA to implement pictorial warning labels.
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Affiliation(s)
- Daniel Owusu
- Tobacco Center of Regulatory Science, School of Public Health, Georgia State University, Atlanta, GA, USA
| | - Jiyeon So
- Department of Communication Studies, University of Georgia, Athens, GA, USA
| | - Lucy Popova
- Tobacco Center of Regulatory Science, School of Public Health, Georgia State University, Atlanta, GA, USA
- Corresponding author: P.O. Box 3995, Atlanta, GA 30302.
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Mamudu HM, Subedi P, Alamin AE, Veeranki SP, Owusu D, Poole A, Mbulo L, Ogwell Ouma AE, Oke A. The Progress of Tobacco Control Research in Sub-Saharan Africa in the Past 50 Years: A Systematic Review of the Design and Methods of the Studies. Int J Environ Res Public Health 2018; 15:E2732. [PMID: 30518024 PMCID: PMC6313754 DOI: 10.3390/ijerph15122732] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/02/2018] [Revised: 11/26/2018] [Accepted: 11/29/2018] [Indexed: 01/25/2023]
Abstract
Over one billion of the world's population are smokers, with increasing tobacco use in low- and middle-income countries. However, information about the methodology of studies on tobacco control is limited. We conducted a literature search to examine and evaluate the methodological designs of published tobacco research in Sub-Saharan Africa (SSA) over the past 50 years. The first phase was completed in 2015 using PubMed, Embase, CINAHL, and Cochrane Central Register of Controlled Trials. An additional search was completed in February 2017 using PubMed. Only tobacco/smoking research in SSA countries with human subjects and published in English was selected. Out of 1796 articles, 447 met the inclusion criteria and were from 26 countries, 11 of which had one study each. Over half of the publications were from South Africa and Nigeria. The earliest publication was in 1968 and the highest number of publications was in 2014 (n = 46). The majority of publications used quantitative methods (91.28%) and were cross-sectional (80.98%). The commonest data collection methods were self-administered questionnaires (38.53%), interviews (32.57%), and observation (20.41%). Around half of the studies were among adults and in urban settings. We conclud that SSA remains a "research desert" and needs more investment in tobacco control research and training.
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Affiliation(s)
- Hadii M Mamudu
- Department of Health Services Management and Policy, College of Public Health, East Tennessee State University, Johnson City, TN 37614, USA.
| | - Pooja Subedi
- Department of Biostatistics and Epidemiology, East Tennessee State University, Johnson City, TN 37614, USA.
| | - Ali E Alamin
- Department of Health Services Management and Policy, College of Public Health, East Tennessee State University, Johnson City, TN 37614, USA.
| | - Sreenivas P Veeranki
- Department of Preventive Medicine and Community Health, University of Texas Medical Branch, Galveston, TX 77555, USA.
| | - Daniel Owusu
- Tobacco Center of Regulatory Science (GSU TCORS), Georgia State University, Atlanta, GA 30340, USA.
| | - Amy Poole
- Department of Health Services Management and Policy, College of Public Health, East Tennessee State University, Johnson City, TN 37614, USA.
| | - Lazarous Mbulo
- Global Tobacco Control Branch, Office on Smoking and Health, Centers for Disease Control and Prevention, Atlanta, GA 30329, USA.
| | - A E Ogwell Ouma
- Tobacco Control Division, WHO Regional Office for Africa, P.O.Box 06 Brazzaville, Congo.
| | - Adekunle Oke
- Department of Health Services Management and Policy, College of Public Health, East Tennessee State University, Johnson City, TN 37614, USA.
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Popova L, Majeed B, Owusu D, Spears CA, Ashley DL. Who are the smokers who never plan to quit and what do they think about the risks of using tobacco products? Addict Behav 2018; 87:62-68. [PMID: 29958136 PMCID: PMC6109416 DOI: 10.1016/j.addbeh.2018.06.024] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2017] [Revised: 06/18/2018] [Accepted: 06/21/2018] [Indexed: 12/15/2022]
Abstract
INTRODUCTION Smoking cigarettes is the most harmful way to use tobacco. Smokers who do not plan to quit present a particular challenge in reducing the morbidity and mortality from tobacco use. Switching to a lower harm product might encourage them to end their use of combusted cigarettes. This study aimed to better understand smokers who do not intend to quit (including their demographic and worldviews as indicators of their social, cultural, and political dispositions) and their perceived risks of cigarettes and possible lower-risk products such as e-cigarettes. METHODS Participants were 2572 current smokers. Data were pooled from 2015 and 2016 cross-sectional surveys of national probability samples of U.S. adults and analyzed with multivariable logistic regressions. RESULTS Smokers who never plan to quit comprise 14.3% of current U.S. smokers and are more likely to be older (24.2% among 65+ years old vs. 9.8% among 18-24) and less likely to have ever used e-cigarettes. A one-unit increase in hierarchical worldview (measured on a 1-6 scale) was associated with a 20% increase in the odds of never planning to quit. Those who denied that cigarettes cause disease or death (aORs between 1.6 and 2.0) or were uncertain (aORs: 2.5-2.7) were more likely to never plan to quit compared to those who agreed. They did not view risks of e-cigarettes substantially different compared to smokers who plan to quit. CONCLUSION One in seven U.S. smokers never plans to quit and might benefit from interventions which reflect their hierarchical worldviews and increase their risk perceptions of combustible cigarettes.
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Affiliation(s)
- Lucy Popova
- School of Public Health, Georgia State University, P.O. Box 3995, Atlanta, Georgia 30302, USA.
| | - Ban Majeed
- Department of Population Health Sciences, Medical College of Georgia, 1120 15th Street, Augusta, Georgia 30912, USA
| | - Daniel Owusu
- School of Public Health, Georgia State University, P.O. Box 3995, Atlanta, Georgia 30302, USA
| | - Claire Adams Spears
- School of Public Health, Georgia State University, P.O. Box 3995, Atlanta, Georgia 30302, USA
| | - David L Ashley
- School of Public Health, Georgia State University, P.O. Box 3995, Atlanta, Georgia 30302, USA
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Owusu D, Weaver SR, Yang B, Ashley DL, Popova L. Trends in Trust in the Sources of Health Information on E-Cigarettes Among US Adults, 2015-2017. Am J Public Health 2018; 109:145-147. [PMID: 30496009 DOI: 10.2105/ajph.2018.304754] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Objectives. To evaluate recent levels and trends in trust in sources of health information on e-cigarettes in the United States.Methods. We obtained data from nationally representative samples of adults in 2015 (n = 5389), 2016 (n = 5273), and 2017 (n = 5389) that reported trust in 13 sources of health information on e-cigarettes in the United States. We used weighted linear regression models to examine temporal trends in trust levels.Results. Doctors, health organizations, the Centers for Disease Control and Prevention (CDC), health experts and scientists, the National Institutes of Health (NIH), the Food and Drug Administration (FDA), and family and friends were trusted, whereas news media, e-cigarette users, social media, vape shop employees, and e-cigarette and cigarette companies were distrusted. From 2015 to 2017, trust significantly increased for CDC, FDA, health experts and scientists, and news media (Ps < .01). Trust also increased for NIH between 2016 and 2017 (P < .01).Conclusions. US adults trust public health sources and distrust entities with commercial interest in e-cigarettes. This suggests that evidence-based messaging and information on health effects of e-cigarettes from public health professionals can effectively counter e-cigarette promotion and improve public understanding about e-cigarettes.
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Affiliation(s)
- Daniel Owusu
- All of the authors are with the Tobacco Center of Regulatory Science, School of Public Health, Georgia State University, Atlanta
| | - Scott R Weaver
- All of the authors are with the Tobacco Center of Regulatory Science, School of Public Health, Georgia State University, Atlanta
| | - Bo Yang
- All of the authors are with the Tobacco Center of Regulatory Science, School of Public Health, Georgia State University, Atlanta
| | - David L Ashley
- All of the authors are with the Tobacco Center of Regulatory Science, School of Public Health, Georgia State University, Atlanta
| | - Lucy Popova
- All of the authors are with the Tobacco Center of Regulatory Science, School of Public Health, Georgia State University, Atlanta
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Yang B, Owusu D, Popova L. Testing messages about comparative risk of electronic cigarettes and combusted cigarettes. Tob Control 2018; 28:440-448. [PMID: 30104408 DOI: 10.1136/tobaccocontrol-2018-054404] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2018] [Revised: 07/16/2018] [Accepted: 07/26/2018] [Indexed: 12/31/2022]
Abstract
INTRODUCTION Health agencies are grappling with communicating risks of electronic cigarettes (e-cigarettes) compared with combusted cigarettes. This study examined smokers' responses to two types of comparative risk messages with one type incorporating more negative antismoking elements in the design. METHODS In an online experiment, 1400 US adult (18+ years) current smokers and recent quitters were randomised to view one of three comparative risk messages about e-cigarettes (CR messages), one of three comparative risk messages that included more negative antismoking elements in the design (CR- messages) or a control message. Selection of outcomes was guided by the antismoking message impact framework. Multivariate analyses of covariance and logistic regression models analysed effects of messages on message evaluations, e-cigarette-related and cigarette-related beliefs and behavioural intentions. RESULTS Both CR and CR- messages decreased smokers' intentions to smoke cigarettes, increased intentions to switch to e-cigarettes completely and increased perceptions that e-cigarettes are less harmful than combusted cigarettes. Neither message type increased dual use intentions relative to exclusive e-cigarettes use or smoking cessation. CR messages decreased perceived absolute risks of e-cigarettes and self-exempting beliefs about smoking, whereas CR- versus CR messages produced higher self-efficacy to quit smoking. CONCLUSION Comparative risk communication might encourage smokers to switch to lower-harm tobacco products. Comparative risk messages with more negative antismoking elements in the design might be particularly effective, because they led to higher self-efficacy to quit smoking. Regulatory agencies may consider using comparative risk messages with more negative antismoking elements to educate the public about lower risk of e-cigarettes.
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Affiliation(s)
- Bo Yang
- Tobacco Center of Regulatory Science, School of Public Health, Georgia State University, Atlanta, Georgia, USA
| | - Daniel Owusu
- Tobacco Center of Regulatory Science, School of Public Health, Georgia State University, Atlanta, Georgia, USA
| | - Lucy Popova
- Tobacco Center of Regulatory Science, School of Public Health, Georgia State University, Atlanta, Georgia, USA
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Popova L, Owusu D, Weaver SR, Kemp CB, Mertz CK, Pechacek TF, Slovic P. Affect, risk perception, and the use of cigarettes and e-cigarettes: a population study of U.S. adults. BMC Public Health 2018; 18:395. [PMID: 29566752 PMCID: PMC5863900 DOI: 10.1186/s12889-018-5306-z] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2016] [Accepted: 03/13/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Tobacco companies argue that the decision to smoke is made by well-informed rational adults who have considered all the risks and benefits of smoking. Yet in promoting their products, the tobacco industry frequently relies on affect, portraying their products as part of a desirable lifestyle. Research examining the roles of affect and perceived risks in smoking has been scant and non-existent for novel tobacco products, such as electronic cigarettes (e-cigarettes). METHODS We examined the relationship between affect, perceived risk, and current use for cigarettes and e-cigarettes in 2015 in a nationally representative sample of 5398 U.S. adults who were aware of e-cigarettes. RESULTS Participants held various affective associations with tobacco products, and affect towards cigarettes was more negative than affect towards e-cigarettes. Using structural equation modeling (SEM), affect towards cigarettes and e-cigarettes was associated with cigarette smoking and e-cigarette use respectively, and these associations were both direct and partially mediated by risk perceptions towards smoking and e-cigarette use. More positive affect towards cigarettes or e-cigarettes was associated with lower perceived risks, which in turn was associated with higher odds of being a current cigarette or e-cigarette user. CONCLUSIONS In developing models explaining tobacco use behavior, or in creating public communication campaigns aimed at curbing tobacco use, it is useful to focus not only on the reason based predictors, such as perceptions of risks and benefits, but also on affective predictors. Educational efforts aimed at further smoking reductions should highlight and reinforce negative images and associations with cigarettes.
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Affiliation(s)
- Lucy Popova
- School of Public Health and Tobacco Center of Regulatory Science, Georgia State University, P.O. Box 3995, Atlanta, GA, 30302-3995, USA.
| | - Daniel Owusu
- School of Public Health and Tobacco Center of Regulatory Science, Georgia State University, P.O. Box 3995, Atlanta, GA, 30302-3995, USA
| | - Scott R Weaver
- School of Public Health and Tobacco Center of Regulatory Science, Georgia State University, P.O. Box 3995, Atlanta, GA, 30302-3995, USA
| | - Catherine B Kemp
- School of Public Health and Tobacco Center of Regulatory Science, Georgia State University, P.O. Box 3995, Atlanta, GA, 30302-3995, USA
| | - C K Mertz
- Decision Research, 1201 Oak Street, Suite 200, Eugene, OR, 97401, USA
| | - Terry F Pechacek
- School of Public Health and Tobacco Center of Regulatory Science, Georgia State University, P.O. Box 3995, Atlanta, GA, 30302-3995, USA
| | - Paul Slovic
- Decision Research, 1201 Oak Street, Suite 200, Eugene, OR, 97401, USA.,Department of Psychology, University of Oregon, Eugene, OR, USA
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Asare B, Owusu D, Mamudu HM, John RM, Ibrahim A, Brenya E, Ouma AE. Support for ban on smoking in public places among adults in Sub-Saharan Africa. Tob Induc Dis 2018. [DOI: 10.18332/tid/84627] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Owusu D, Wang KS, Quinn M, Aibangbee J, John RM, Mamudu HM. Health-care provider intervention and utilization of cessation assistance in low- and middle-income countries. Tob Induc Dis 2018. [DOI: 10.18332/tid/84289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Owusu D, Quinn M, Wang KS, Aibangbee J, John RM, Mamudu HM. Impact of smoke-free home on smoking intensity in low- and middle-income countries. Tob Induc Dis 2018. [DOI: 10.18332/tid/84286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Mamudu H, Wang L, Owusu D, John R, Asare B, Ibrahim A, Brenya E, Ouma A. Exposure to the number of tobacco control policies and tobacco use cessation among adults in Sub-Saharan Africa. Tob Induc Dis 2018. [DOI: 10.18332/tid/84651] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Owusu D, Aibangbee J, Collins C, Robertson C, Wang L, Littleton MA, Boghozian R, Casenburg V, Mamudu HM. The Use of E-cigarettes Among School-Going Adolescents in a Predominantly Rural Environment of Central Appalachia. J Community Health 2018; 42:624-631. [PMID: 27868166 DOI: 10.1007/s10900-016-0297-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
E-cigarette use among youth in the United States (U.S.) continues to increase. In the rural Northeast Tennessee, where prevalence of tobacco use is higher than national and state averages, there is no literature on e-cigarette use to inform policies and programs. This study aimed to estimate the prevalence of e-cigarette use and examine association of e-cigarette use with two tobacco products among school-going adolescents. Data from 894 participants of a school-based survey conducted in 2016 in Northeast Tennessee were analyzed. Descriptive statistics and logistic regression analyses were conducted to estimate the prevalence and delineate the associations between e-cigarette use and other tobacco products. Approximately 11% of the participants currently used e-cigarettes, and 35% had ever used e-cigarettes. About 6% of the participants were current users of both e-cigarettes and cigarettes; 4% were current users of e-cigarettes and smokeless tobacco; 3% were current users of all three products, and 15% had ever tried all three products. More than one-half of current e-cigarette users (52%) also smoked cigarettes. Adjusting for covariates, current e-cigarette use was positively associated with cigarette smoking [Odds Ratio (OR) 27.32, 95% confidence interval (CI) 14.4-51.7] and smokeless tobacco use [OR 7.92, 95% CI 3.8-16.5]. E-cigarette use was more common among the high school students than cigarette and smokeless tobacco use, and a significant proportion of users either smoked cigarettes, used smokeless tobacco, or both. Thus, there is a critical need for preventive policies and programs to address dual and poly-use of these products.
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Affiliation(s)
- Daniel Owusu
- Georgia State University Tobacco Center of Regulatory Science (GSU TCORS), Atlanta, GA, USA
| | | | - Candice Collins
- Department of Biostatistics and Epidemiology, East Tennessee State University, Johnson City, TN, USA
| | - Crystal Robertson
- Louisiana Department of Health, Office of Public Health, Baton Rouge, LA, USA
| | - Liang Wang
- Department of Biostatistics and Epidemiology, East Tennessee State University, Johnson City, TN, USA
| | - Mary A Littleton
- Department of Community and Behavioral Health, East Tennessee State University, Johnson City, TN, USA
| | | | | | - Hadii M Mamudu
- Department of Health Services Management and Policy, College of Public Health, East Tennessee State University, P.O. Box 70264, Johnson City, TN, USA.
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Owusu D, Quinn M, Wang KS, Aibangbee J, Mamudu HM. Intentions to quit tobacco smoking in 14 low- and middle-income countries based on the transtheoretical model. Drug Alcohol Depend 2017; 178:425-429. [PMID: 28710966 DOI: 10.1016/j.drugalcdep.2017.05.033] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2016] [Revised: 05/08/2017] [Accepted: 05/15/2017] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Over 80% of the world's one billion tobacco smokers reside in low- and middle-income countries (LMICs); therefore, it is important to understand factors that promote intention to quit smoking in these countries. This study evaluated factors associated with three stages of intention to quit tobacco smoking among adults in LMICs. METHODS Data from 43,540 participants of the Global Adult Tobacco Survey in 14 LMICs were analyzed. Intentions to quit smoking were categorized into precontemplation (referent category), contemplation, and preparation stages based on the transtheoretical model. A multinomial logit model was used to estimate odds ratios (OR) and 95% confidence intervals (CI). RESULTS Approximately 82%, 14%, and 4% of the smokers were in precontemplation, contemplation, and preparation stages, respectively. Rural residents had increased odds of being in contemplation stage (OR=1.41, 95% CI=1.09-1.83) compared to urban residents. Compared to homes where smoking was allowed, smoke-free homes were associated with increased odds of contemplation (OR=1.77, 95% CI=1.41-2.23) and preparation (OR=2.18, 95% CI=1.78-2.66). Exposure to anti-smoking messages in more than one media channel was associated with increased odds of contemplation (OR=1.60, 95% CI=1.33-1.92) and preparation (OR=1.73, 95% CI=1.28-2.33) compared to no exposure to anti-smoking messages. CONCLUSION The results suggest that anti-smoking media campaigns and smoke-free policies may promote intention to quit smoking in LMICs. While these suggest the need for implementation of comprehensive anti-smoking campaigns and smoke-free policies, longitudinal studies are required to confirm these findings and to evaluate how intention to quit translates into quit attempts in LMICs.
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Affiliation(s)
- Daniel Owusu
- Department of Biostatistics and Epidemiology, East Tennessee State University, Johnson City, TN, USA.
| | - Megan Quinn
- Department of Biostatistics and Epidemiology, East Tennessee State University, Johnson City, TN, USA
| | - Ke-Sheng Wang
- Department of Biostatistics and Epidemiology, East Tennessee State University, Johnson City, TN, USA
| | - Jocelyn Aibangbee
- Department of Biostatistics and Epidemiology, East Tennessee State University, Johnson City, TN, USA
| | - Hadii M Mamudu
- Department of Health Services Management and Policy, East Tennessee State University, Johnson City, TN, USA
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Popova L, Owusu D, Jenson D, Neilands TB. Factual text and emotional pictures: overcoming a false dichotomy of cigarette warning labels. Tob Control 2017; 27:tobaccocontrol-2016-053563. [PMID: 28428337 PMCID: PMC5650578 DOI: 10.1136/tobaccocontrol-2016-053563] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2016] [Revised: 03/15/2017] [Accepted: 03/17/2017] [Indexed: 11/04/2022]
Abstract
BACKGROUND In reviewing the first set of pictorial warning labels in the USA, the courts equated textual labels with facts and information, and images with emotion. This study tested the differences in perceived informativeness and emotion between textual and pictorial cigarette warning labels. METHODS An online study with 1838 US adults who were non-smokers (n=764), transitioning smokers (quit smoking in the past 2 years or currently trying to quit, n=505) or current smokers (n=569). Each participant evaluated 9 out of 81 text and pictorial cigarette warning labels. Participants reported to what extent they perceived the label as informative and factual and the negative emotions they felt while looking at each label. We used linear mixed models to account for the nesting of multiple observations within each participant. RESULTS There were no significant differences in perceived informativeness between textual (mean 6.15 on a 9-point scale) and pictorial labels (6.14, p=0.80, Cohen's d=0.003). Textual labels evoked slightly less emotion (4.21 on a 9-point scale) than pictorial labels (4.42, p<0.001, Cohen's d=0.08). Perceived informativeness and emotion were strongly correlated (Pearson r=0.53, p<0.001). CONCLUSION Our findings contradict courts' conclusions that pictorial messages are emotional and not factual. Pictorial labels are rated as informative and factual, textual labels evoke emotion, and emotionality and informativeness are strongly correlated. These findings serve as evidence for the Food and Drug Administration (FDA) to counteract the claim that pictorial warning labels, by definition, are not 'purely factual and uncontroversial'.
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Affiliation(s)
- Lucy Popova
- School of Public Health, Georgia State University, Atlanta, Georgia, USA
| | - Daniel Owusu
- School of Public Health, Georgia State University, Atlanta, Georgia, USA
| | - Desmond Jenson
- TobaccoControl Legal Consortium, a program of the Public Health Law Center, at the Mitchell Hamline School of Law, Saint Paul, Minnesota, USA
| | - Torsten B Neilands
- Department of Medicine, University of California San Francisco, San Francisco, California, USA
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Gong S, Xu C, Wang L, Liu Y, Owusu D, Bailey BA, Li Y, Wang K. Genetic association analysis of polymorphisms in PSD3 gene with obesity, type 2 diabetes, and HDL cholesterol. Diabetes Res Clin Pract 2017; 126:105-114. [PMID: 28237857 DOI: 10.1016/j.diabres.2017.02.006] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2016] [Accepted: 02/02/2017] [Indexed: 01/29/2023]
Abstract
BACKGROUND The pleckstrin and Sec7 domain-containing 3 (PSD3) gene has been linked to immune diseases. We examined whether the genetic variants within the PSD3 gene are associated with obesity, type 2 diabetes (T2D), and high-density lipoprotein (HDL) cholesterol level. METHODS Multiple logistic regression model and linear regression model were used to examine the associations of 259 single nucleotide polymorphisms (SNPs) within the PSD3 gene with obesity and T2D as binary traits, and HDL level as a continuous trait using the Marshfield data, respectively. A replication study of obesity was conducted using the Health Aging and Body Composition (Health ABC) sample. RESULTS 23SNPs were associated with obesity (p<0.05) in the Marshfield sample and rs4921966 revealed the strongest association (p=3.97×10-6). Of the 23SNPs, 20 were significantly associated with obesity in the meta-analysis of two samples (p<0.05). Furthermore, 6SNPs revealed associations with T2D in the Marshfield data (top SNP rs12156368 with p=3.05×10-3); while two SNPs (rs6983992 and rs7843239) were associated with both obesity and T2D (p=0.0188 and 0.023 for obesity and p=8.47×10-3 and 0.0128 for T2D, respectively). Furthermore, 11SNPs revealed associations with HDL level (top SNP rs13254772 with p=2.79×10-3) in the Marshfield data; meanwhile rs7009615 was associated with both T2D (p=0.038) and HDL level (p=4.44×10-3). In addition, haplotype analyses further supported the results of single SNP analysis. CONCLUSIONS Common variants in PSD3 were associated with obesity, T2D and HDL level. These findings add important new insights into the pathogenesis of obesity, T2D and HDL cholesterol.
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Affiliation(s)
- Shaoqing Gong
- Department of Biostatistics and Epidemiology, College of Public Health, East Tennessee State University, Johnson City, TN, USA
| | - Chun Xu
- Department of Health and Biomedical Science, University of Texas Rio Grande Valley, Brownsville, TX, USA
| | - Liang Wang
- Department of Biostatistics and Epidemiology, College of Public Health, East Tennessee State University, Johnson City, TN, USA
| | - Ying Liu
- Department of Biostatistics and Epidemiology, College of Public Health, East Tennessee State University, Johnson City, TN, USA
| | - Daniel Owusu
- Department of Biostatistics and Epidemiology, College of Public Health, East Tennessee State University, Johnson City, TN, USA
| | - Beth A Bailey
- Department of Family Medicine, Quillen College of Medicine, East Tennessee State University, Johnson City, TN, USA
| | - Yujing Li
- Department of Human Genetics, School of Medicine, Emory University, Atlanta, GA, USA
| | - Kesheng Wang
- Department of Biostatistics and Epidemiology, College of Public Health, East Tennessee State University, Johnson City, TN, USA.
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Abstract
The PDZ and LIM domain 5 (PDLIM5) gene may play a role in cancer, bipolar disorder, major depression, alcohol dependence and schizophrenia; however, little is known about the interaction effect of steroid and PDLIM5 gene on cancer. This study examined 47 single-nucleotide polymorphisms (SNPs) within the PDLIM5 gene in the Marshfield sample with 716 cancer patients (any diagnosed cancer, excluding minor skin cancer) and 2848 noncancer controls. Multiple logistic regression model in PLINK software was used to examine the association of each SNP with cancer. Bayesian logistic regression in PROC GENMOD in SAS statistical software, ver. 9.4 was used to detect gene- steroid interactions influencing cancer. Single marker analysis using PLINK identified 12 SNPs associated with cancer (P< 0.05); especially, SNP rs6532496 revealed the strongest association with cancer (P = 6.84 × 10⁻³); while the next best signal was rs951613 (P = 7.46 × 10⁻³). Classic logistic regression in PROC GENMOD showed that both rs6532496 and rs951613 revealed strong gene-steroid interaction effects (OR=2.18, 95% CI=1.31-3.63 with P = 2.9 × 10⁻³ for rs6532496 and OR=2.07, 95% CI=1.24-3.45 with P = 5.43 × 10⁻³ for rs951613, respectively). Results from Bayesian logistic regression showed stronger interaction effects (OR=2.26, 95% CI=1.2-3.38 for rs6532496 and OR=2.14, 95% CI=1.14-3.2 for rs951613, respectively). All the 12 SNPs associated with cancer revealed significant gene-steroid interaction effects (P < 0.05); whereas 13 SNPs showed gene-steroid interaction effects without main effect on cancer. SNP rs4634230 revealed the strongest gene-steroid interaction effect (OR=2.49, 95% CI=1.5-4.13 with P = 4.0 × 10⁻⁴ based on the classic logistic regression and OR=2.59, 95% CI=1.4-3.97 from Bayesian logistic regression; respectively). This study provides evidence of common genetic variants within the PDLIM5 gene and interactions between PLDIM5 gene polymorphisms and steroid use influencing cancer.
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Affiliation(s)
- Ke-Sheng Wang
- Department of Biostatistics and Epidemiology, College of Public Health, East Tennessee State University, Johnson City, TN 37614,
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Owusu D, Pan Y, Xie C, Harirforoosh S, Wang KS. Polymorphisms in PDLIM5 gene are associated with alcohol dependence, type 2 diabetes, and hypertension. J Psychiatr Res 2017; 84:27-34. [PMID: 27693979 DOI: 10.1016/j.jpsychires.2016.09.015] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2016] [Revised: 08/29/2016] [Accepted: 09/15/2016] [Indexed: 12/15/2022]
Abstract
The PDZ and LIM domain 5 (PDLIM5) gene may play a role in alcohol dependence (AD), bipolar disorder, and major depressive disorder; however, no study has identified shared genetic variants within PDLIM5 gene among AD, type 2 diabetes (T2D), and hypertension. This study investigated the association of 72 single nucleotide polymorphism (SNPs) with AD (1066 AD cases and 1278 controls) in the Study of Addiction - Genetics and Environment (SAGE) sample and 47 SNPs with T2D (878 cases and 2686 non-diabetic) and hypertension (825 cases and 2739 non-hypertensive) in the Marshfield sample. Multiple logistic regression models in PLINK software were used to examine the associations of genetic variants with AD, T2D, and hypertension and SNP x alcohol consumption interactions for T2D and hypertension. Twenty-five SNPs were associated with AD in the SAGE sample (p < 0.05); rs1048627 showed the strongest association with AD (p = 5.53 × 10-4). Of the 25 SNPs, 5 SNPs showed associations with both AD in the SAGE sample and T2D in the Marshfield sample (top SNP rs11097432 with p = 0.00107 for T2D and p = 0.0483 for AD) while 6 SNPs showed associations with both AD in the SAGE sample and hypertension in the Marshfield sample (top SNP rs12500426 with p = 0.0119 for hypertension and p = 1.51 × 10-3 for AD). SNP (rs6532496) showed significant interaction with alcohol consumption for hypertension. Our results showed that several genetic variants in PDLIM5 gene influence AD, T2D and hypertension. These findings offer the potential for new insights into the pathogenesis of AD, T2D, and hypertension.
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Affiliation(s)
- Daniel Owusu
- Department of Biostatistics and Epidemiology, College of Public Health, East Tennessee State University, Johnson City, TN 37614, USA
| | - Yue Pan
- Department of Public Health Sciences, Miller School of Medicine, University of Miami, Miami, FL 33136, USA
| | - Changchun Xie
- Division of Biostatistics and Bioinformatics, Department of Environmental Health, University of Cincinnati, Cincinnati, OH 45267, USA
| | - Sam Harirforoosh
- Department of Pharmaceutical Sciences, Gatton College of Pharmacy, East Tennessee State University, Johnson City, TN 37614, USA
| | - Ke-Sheng Wang
- Department of Biostatistics and Epidemiology, College of Public Health, East Tennessee State University, Johnson City, TN 37614, USA.
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Owusu D, Mamudu HM, John RM, Ibrahim A, Ouma AEO, Veeranki SP. Never-Smoking Adolescents' Exposure to Secondhand Smoke in Africa. Am J Prev Med 2016; 51:983-998. [PMID: 27866598 DOI: 10.1016/j.amepre.2016.08.040] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2016] [Revised: 08/26/2016] [Accepted: 09/14/2016] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Though Africa is in Stage 1 of the tobacco epidemic, lack of effective public smoking laws or political will implies that secondhand smoke (SHS) exposure may be high in youth. The study objective is to estimate prevalence and identify determinants of SHS exposure among never-smoker adolescents in Africa and make cross-country comparisons. METHODS Pooled data from the Global Youth Tobacco Surveys conducted in 25 African countries during 2006-2011 were used. Based on the venue of exposure in past 7 days, SHS was categorized into exposure inside, outside, and overall exposure (either inside or outside of the home), respectively. Data were analyzed in 2015 using logistic regression models to identify factors related to SHS exposure in three venues. RESULTS About 21% and 39% of adolescents were exposed to SHS inside or outside of the home, with overall exposure of 45%. In all 25 African countries, parental smoking was significantly associated with SHS exposure inside the home (ORs ranging from 3.02 [95% CI=2.0, 4.5] to 14.65 [95% CI=10.0, 21.5]). Peer smoking was associated with SHS exposure outside the home in 18 countries (ORs ranging from 1.45 [95% CI=1.0, 2.1] to 3.00 [95% CI=1.8, 5.1]). Parental smoking, peer smoking, and anti-smoking messages in media were identified as three major factors associated with SHS exposure. CONCLUSIONS A significant proportion of never-smoking adolescents in Africa are exposed to SHS, suggesting the need for countries to adopt policies to protect never smokers through the implementation of the WHO Framework Convention on Tobacco Control.
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Affiliation(s)
- Daniel Owusu
- Departments of Biostatistics and Epidemiology, Health Policy and Management, College of Public Health, East Tennessee State University, Johnson City, Tennessee
| | - Hadii M Mamudu
- Departments of Biostatistics and Epidemiology, Health Policy and Management, College of Public Health, East Tennessee State University, Johnson City, Tennessee
| | - Rijo M John
- Indian Institute of Technology, Jodhpur, Rajasthan, India
| | - Abdallah Ibrahim
- School of Public Health, University of Ghana, Legon, Accra, Ghana
| | | | - Sreenivas P Veeranki
- Department of Preventive Medicine and Community Health, University of Texas Medical Branch, Galveston, Texas.
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Veeranki SP, John RM, Ibrahim A, Pillendla D, Thrasher JF, Owusu D, Ouma AEO, Mamudu HM. Age of smoking initiation among adolescents in Africa. Int J Public Health 2016; 62:63-72. [PMID: 27572496 DOI: 10.1007/s00038-016-0888-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2016] [Revised: 08/22/2016] [Accepted: 08/23/2016] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVES To estimate prevalence and identify correlates of age of smoking initiation among adolescents in Africa. METHODS Data (n = 16,519) were obtained from nationally representative Global Youth Tobacco Surveys in nine West African countries. Study outcome was adolescents' age of smoking initiation categorized into six groups: ≤7, 8 or 9, 10 or 11, 12 or 13, 14 or 15 and never-smoker. Explanatory variables included sex, parental or peer smoking behavior, exposure to tobacco industry promotions, and knowledge about smoking harm. Weighted multinomial logit models were conducted to determine correlates associated with adolescents' age of smoking initiation. RESULTS Age of smoking initiation was as early as ≤7 years; prevalence estimates ranged from 0.7 % in Ghana at 10 or 11 years age to 9.6 % in Cote d'Ivoire at 12 or 13 years age. Males, exposures to parental or peer smoking, and industry promotions were identified as significant correlates. CONCLUSIONS West African policymakers should adopt a preventive approach consistent with the World Health Organization Framework Convention on Tobacco Control to prevent an adolescent from initiating smoking and developing into future regular smokers.
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Affiliation(s)
- Sreenivas P Veeranki
- Department of Preventive Medicine and Community Health, University of Texas Medical Branch, 301 University Blvd, Ewing Hall Suite 1.128, Galveston, TX, USA.
| | - Rijo M John
- Indian Institute of Technology, Jodhpur, Rajasthan, India
| | - Abdallah Ibrahim
- School of Public Health, University of Ghana, Legon, Accra, Ghana
| | - Divya Pillendla
- Department of Preventive Medicine and Community Health, University of Texas Medical Branch, 301 University Blvd, Ewing Hall Suite 1.128, Galveston, TX, USA
| | - James F Thrasher
- Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
| | - Daniel Owusu
- Department of Biostatistics and Epidemiology, Health Policy and Management, College of Public Health, East Tennessee State University, Johnson City, TN, USA
| | - Ahmed E O Ouma
- Tobacco Control, WHO Regional Office for Africa, Brazzaville, Congo
| | - Hadii M Mamudu
- Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
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Owusu D, Quinn M, Wang KS. Alcohol Consumption, Depression, Insomnia and Colorectal Cancer Screening: Racial Differences. Int J High Risk Behav Addict 2015; 4:e23424. [PMID: 26097837 PMCID: PMC4464573 DOI: 10.5812/ijhrba.4(2)2015.23424] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/08/2014] [Accepted: 10/24/2014] [Indexed: 01/22/2023]
Abstract
Background: Mortality from colorectal cancer (CRC) can be reduced drastically by early detection and early treatment. However, uptake of CRC screening is relatively low, about 50% for those whom the test is highly recommended. Objectives: We examined the influence of and racial differences in depression, insomnia, alcohol use, and tobacco use on CRC screening uptake in the US. Patients and Methods: Analysis of the 2012 National Health Information Survey data was conducted. Both weighted univariate and multiple logistic regression analyses were performed in SAS to estimate the odds ratios (ORs) and their 95% confidence intervals (CIs). A total of 21511 participants were included in the analysis. Results: Prevalence of CRC screening in the participants was 19%. Adjusting for all factors, insomnia (OR = 1.18, 95%CI = 1.06 - 1.32), moderate alcohol drinking (OR = 1.16, 95%CI = 1.01 - 1.30), past smoking (OR = 1.17, 95%CI = 1.04 - 1.32), depression (OR = 1.37, 95%CI = 1.18 - 1.58), African American (AA) race, and cancer history were positively associated with CRC screening. Females and Single were inversely associated with CRC screening prevalence. In stratified analysis by races (White and AA), depression was associated with CRC screening in both races. Marital status, smoking, cancer history and insomnia were associated with CRC screening in Whites only; while alcohol use was associated with CRC screening in AAs only. Conclusions: We have found significant associations between lifestyle factors (alcohol consumption and smoking) and mental health problems (depression and insomnia) and CRC screening uptake. To improve overall CRC screening uptake in the US, it is important to consider racial differences in predictors and tailor appropriate interventions to each racial/ethnic group.
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Affiliation(s)
- Daniel Owusu
- Department of Biostatistics and Epidemiology, College of Public Health, East Tennessee State University, Johnson City, USA
| | - Megan Quinn
- Department of Biostatistics and Epidemiology, College of Public Health, East Tennessee State University, Johnson City, USA
| | - Ke Sheng Wang
- Department of Biostatistics and Epidemiology, College of Public Health, East Tennessee State University, Johnson City, USA
- Corresponding author: Ke Sheng Wang, Department of Biostatistics and Epidemiology, College of Public Health, East Tennessee State University, Johnson City, USA. Tel: +1-4234394481, Fax: +1-4234394606, E-mail:
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50
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Wang KS, Zuo L, Owusu D, Pan Y, Luo X. Prostate Cancer Related JAZF1 Gene is Associated with Schizophrenia. J Schizophr Res 2014; 1:1002. [PMID: 27570842 PMCID: PMC4996122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
BACKGROUND Epidemiological studies have shown that there is a reduced risk of prostate cancer among persons diagnosed with schizophrenia (SCZ). However, the mechanism of such relationship is not clear. The reduced incidence of cancer observed in SCZ patients may be related to differences in genetic background. Recently, the JAZF1 gene is found to be associated with prostate cancer and type 2 diabetes. However, no study has focused on the association of JAZF1 with the risk of SCZ. METHODS We examined genetic associations of 118 single-nucleotide polymorphisms (SNPs) within the JAZF1 gene with SCZ using one European American (EA) sample of 1,149 cases and 1,347 controls. Logistic regression analysis of SCZ as a binary trait was performed using PLINK software. RESULTS The most significant association with SCZ was observed with rs10258132 (p = 0.0011); while the next best signal was rs17156259 (p = 0.0031). The third best associated SNP was rs7791865 (p = 0.00889). In addition, haplotype analyses revealed that the A-C haplotype from rs10244184 and rs10258132 was associated with SCZ (p = 0.00093); and the G-G haplotype from rs17156238 and rs17156259 was associated with SCZ (p = 0.00455). CONCLUSION These findings provide evidence of several genetic variants in JAZF1 gene influencing the risk of SCZ and will serve as a resource for replication in other populations.
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Affiliation(s)
- Ke-Sheng Wang
- Department of Biostatistics and Epidemiology, College of Public Health, East Tennessee State University, Johnson City, TN, USA
| | - Lingjun Zuo
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
| | - Daniel Owusu
- Department of Biostatistics and Epidemiology, College of Public Health, East Tennessee State University, Johnson City, TN, USA
| | - Yue Pan
- Department of Public Health Sciences, Miller School of Medicine, University of Miami, Miami, FL, USA
| | - Xingguang Luo
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
- Biological Psychiatry Research Center, Beijing Huilongguan Hospital, Beijing, China
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