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Hayrumyan V, Abrahamyan A, Harutyunyan A, Libaridian L, Sahakyan S. Impact of COVID-19 on essential healthcare services at the primary healthcare level in Armenia: a qualitative study. BMC Prim Care 2024; 25:131. [PMID: 38658818 PMCID: PMC11044568 DOI: 10.1186/s12875-024-02377-6] [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] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Accepted: 04/09/2024] [Indexed: 04/26/2024]
Abstract
BACKGROUND The COVID-19 pandemic has presented significant global healthcare challenges, particularly impacting the continuity of essential health services in low- and middle-income countries. This study investigates the impact of the COVID-19 pandemic on the utilization and provision of essential health services in Armenia. METHODS We employed a conventional qualitative study design, conducting semi-structured in-depth interviews (n = 17) within public and private primary healthcare (PHC) facilities in Armenia in 2021. Our study participants encompassed physicians providing specialty services in PHC facilities (e.g. endocrinologists, gynecologists/obstetricians, and pediatricians), regular visitors to PHC facilities (e.g. adults with chronic diseases, parents of children), and policymakers. Thematic analysis was conducted, yielding five emergent categories: mobilization and organization of PHC services during COVID-19; PHC visits during COVID-19; worsening of chronic conditions due to the decline in PHC visits; problems with routine childhood vaccinations; and patient-provider communication challenges. RESULTS The number of in-person visits to PHC facilities declined due to adaptations in service delivery, imposed lockdown measures, and the public's fear of visiting healthcare facilities. Maternal and child health services continued with no major disruptions. PHC providers deliberately limited the number of maternal and child visits to essential antenatal care, newborn screenings, and routine childhood immunizations. Still, children experienced some delays in vaccination administration. The pandemic resulted in a notable reduction in follow-up visits and monitoring of patients with chronic conditions, thereby exacerbating their chronic conditions. Phone calls were the primary method of patient-provider communication during the pandemic. CONCLUSIONS The COVID-19 pandemic has had a profound impact on the delivery and utilization of essential healthcare services at PHC facilities, especially for those with chronic conditions who needed continuous care. Unified national-level guidance and technical capacity are needed to direct the provision of essential services at the PHC level, promote effective health communication, and implement digital platforms for the uninterrupted provision of essential care during public health emergencies.
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Affiliation(s)
- Varduhi Hayrumyan
- Turpanjian College of Health Sciences, American University of Armenia, 40 Baghramyan Ave, Yerevan, 0019, Armenia.
| | - Arpine Abrahamyan
- Turpanjian College of Health Sciences, American University of Armenia, 40 Baghramyan Ave, Yerevan, 0019, Armenia
| | - Arusyak Harutyunyan
- Turpanjian College of Health Sciences, American University of Armenia, 40 Baghramyan Ave, Yerevan, 0019, Armenia
| | - Lorky Libaridian
- Turpanjian College of Health Sciences, American University of Armenia, 40 Baghramyan Ave, Yerevan, 0019, Armenia
| | - Serine Sahakyan
- Turpanjian College of Health Sciences, American University of Armenia, 40 Baghramyan Ave, Yerevan, 0019, Armenia
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Berg CJ, Haardörfer R, Torosyan A, Dekanosidze A, Grigoryan L, Sargsyan Z, Hayrumyan V, Sturua L, Topuridze M, Petrosyan V, Bazarchyan A, Kegler MC. Examining local smoke-free coalitions in Armenia and Georgia: context and outcomes of a matched-pairs community-randomised controlled trial. BMJ Glob Health 2024; 9:e013282. [PMID: 38325896 PMCID: PMC10859987 DOI: 10.1136/bmjgh-2023-013282] [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: 06/30/2023] [Accepted: 01/10/2024] [Indexed: 02/09/2024] Open
Abstract
INTRODUCTION Local coalitions can advance public health initiatives such as smoke-free air but have not been widely used or well-studied in low-income and middle-income countries. METHODS We conducted a matched-pairs community-randomised controlled trial in 28 communities in Armenia and Georgia (N=14/country) in which we helped establish local coalitions in 2019 and provided training and technical assistance for coalition activity promoting smoke-free policy development and enforcement (2019-2021). Surveys of ~1450 households (Fall 2018, May-June 2022) were conducted to evaluate coalition impact on smoke-free policy support, smoke-free home adoption, secondhand smoke exposure (SHSe), and coalition awareness and activity exposure, using multivariable mixed modelling. RESULTS Bivariate analyses indicated that, at follow-up versus baseline, both conditions reported greater smoke-free home rates (53.6% vs 38.5%) and fewer days of SHSe on average (~11 vs ~12 days), and that intervention versus control condition communities reported greater coalition awareness (24.3% vs 12.2%) and activity exposure (71.2% vs 64.5%). Multivariable modelling indicated that intervention (vs control) communities reported greater rates of complete smoke-free homes (adjusted Odds Ratio [aOR] 1.55, 95% confiedence interval [CI] 1.11 to 2.18, p=0.011) and coalition awareness (aOR 2.89, 95% CI 1.44 to 8.05, p=0.043) at follow-up. However, there were no intervention effects on policy support, SHSe or community-based activity exposure. CONCLUSIONS Findings must be considered alongside several sociopolitical factors during the study, including national smoke-free policies implementation (Georgia, 2018; Armenia, 2022), these countries' participation in an international tobacco legislation initiative, the COVID-19 pandemic and regional/local war). The intervention effect on smoke-free homes is critical, as smoke-free policy implementation provides opportunities to accelerate smoke-free home adoption via local coalitions. TRIAL REGISTRATION NUMBER NCT03447912.
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Affiliation(s)
- Carla J Berg
- Milken Institute School of Public Health, The George Washington University, Washington, District of Columbia, USA
| | - Regine Haardörfer
- Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Arevik Torosyan
- National Institute of Health Named After Academician Suren Avdalbekyan, Yerevan, Armenia
| | - Ana Dekanosidze
- National Center for Disease Control and Public Health, Tbilisi, Georgia
- Tbilisi State Medical University, Tbilisi, Georgia
| | - Lilit Grigoryan
- National Institute of Health Named After Academician Suren Avdalbekyan, Yerevan, Armenia
| | - Zhanna Sargsyan
- Turpanjian College of Health Sciences, American University of Armenia, Yerevan, Armenia
| | - Varduhi Hayrumyan
- Turpanjian College of Health Sciences, American University of Armenia, Yerevan, Armenia
| | - Lela Sturua
- National Center for Disease Control and Public Health, Tbilisi, Georgia
- Petre Shotadze Tbilisi Medical Academy, Tbilisi, Georgia
| | - Marina Topuridze
- National Center for Disease Control and Public Health, Tbilisi, Georgia
- Petre Shotadze Tbilisi Medical Academy, Tbilisi, Georgia
| | - Varduhi Petrosyan
- Turpanjian College of Health Sciences, American University of Armenia, Yerevan, Armenia
| | - Alexander Bazarchyan
- National Institute of Health Named After Academician Suren Avdalbekyan, Yerevan, Armenia
| | - Michelle C Kegler
- Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
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Grigoryan Z, Sargsyan Z, Muradyan D, Mnatsakanyan K, Hayrumyan V, Petrosyan V. A mixed-methods evaluation of the indoor and outdoor smoking ban in dining venues in Armenia: Early successes and challenges. Tob Induc Dis 2023; 21:167. [PMID: 38098749 PMCID: PMC10720263 DOI: 10.18332/tid/174899] [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] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Revised: 11/06/2023] [Accepted: 11/09/2023] [Indexed: 12/17/2023] Open
Abstract
INTRODUCTION Since March 2022, Armenia introduced a comprehensive smoking ban on all types of tobacco products in indoor and outdoor areas of hospitality venues. We aimed to rapidly appraise the implementation of the ban in the dining areas of the capital Yerevan and explore any differences in compliance and enforcement patterns between indoor and outdoor areas of the venues. METHODS We used a mixed-methods approach through quantitative air quality monitoring, qualitative observations, and in-depth interviews (IDIs). We visited one venue in each remote district of the city and more venues from the central districts that have a much higher density of dining areas. Overall, we made 24 measurements of PM2.5 particles, 24 unobtrusive observations in the 19 visited venues, and 11 IDIs with six visitors and five workers. We used Stata13 for the analysis of numerical data and completed direct deductive content analysis of the textual data. RESULTS Active tobacco use was observed in 12 out of 24 venues (50.0%) with more cases of smoking in outdoor areas (10 out of 12; 83.3%). No warning by workers or no reports to the police were observed. We detected elevated levels of PM2.5 particles in indoor and outdoor areas. The IDIs revealed predominantly negative attitudes towards the outdoor ban and the lack of awareness of and readiness to engage in the enforcement measures. The lack of enforcement by the owners and the respective bodies was mentioned as a contributor to continued violations of the ban. The change in the dynamic and the characteristics of the visitors, cleaner air, and less unpleasant work were mentioned as important positive aftermaths of the ban. CONCLUSIONS The Government of Armenia should enhance the monitoring and enforcement activities and organize tailored awareness-raising campaigns to inform the general public and the hospitality industry of the health and social implications of the ban.
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Affiliation(s)
- Zaruhi Grigoryan
- Turpanjian College of Health Sciences, American University of Armenia, Yerevan, Armenia
| | - Zhanna Sargsyan
- Turpanjian College of Health Sciences, American University of Armenia, Yerevan, Armenia
| | - Diana Muradyan
- Turpanjian College of Health Sciences, American University of Armenia, Yerevan, Armenia
| | - Kristina Mnatsakanyan
- Turpanjian College of Health Sciences, American University of Armenia, Yerevan, Armenia
| | - Varduhi Hayrumyan
- Turpanjian College of Health Sciences, American University of Armenia, Yerevan, Armenia
| | - Varduhi Petrosyan
- Turpanjian College of Health Sciences, American University of Armenia, Yerevan, Armenia
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Berg CJ, Dekanosidze A, Hayrumyan V, LoParco CR, Torosyan A, Grigoryan L, Bazarchyan A, Haardörfer R, Kegler MC. Smoke-free home restrictions in Armenia and Georgia: motives, barriers and secondhand smoke reduction behaviors. Eur J Public Health 2023; 33:864-871. [PMID: 37500602 PMCID: PMC10567255 DOI: 10.1093/eurpub/ckad129] [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] [Indexed: 07/29/2023] Open
Abstract
BACKGROUND Promoting smoke-free homes (SFHs) in Armenia and Georgia is timely given high smoking and secondhand smoke exposure (SHSe) rates and recent national smoke-free policy implementation. This study examined theoretical predictors (e.g. motives, barriers) of SFH status, and among those without SFHs, past 3-month SFH attempts and intent to establish SFHs in the next 3 months. METHODS Multilevel logistic regression analyzed these outcomes using 2022 survey data from 1467 adults (31.6% past-month smokers) in Armenia (n = 762) and Georgia (n = 705). Correlates of interest included SHSe reduction behaviors and SFH motives and barriers; models controlled for country, community, age, sex, smoking status and other smokers in the home. RESULTS In this sample, 53.6% had SFHs (Armenia: 39.2%; Georgia: 69.2%). Among those without SFHs, one-fourth had partial restrictions, no smokers in the home and/or recent SFH attempts; 35.5% intended to establish SFHs; and ∼70% of multiunit housing residents supported smoke-free buildings. We documented common SHSe reduction behaviors (opening windows, limiting smoking areas), SFH motives (prevent smell, protect children/nonsmokers) and barriers (smokers' resistance). Correlates of SFHs were being from Georgia, other smokers in the home, fewer SHSe reduction behaviors, greater motives and fewer barriers. Among participants without SFHs, correlates of recent SFH attempts were other smokers in the home, greater SHSe reduction behaviors and SFH motives, and fewer barriers; correlates of SFH intentions were being female, greater SHSe reduction behaviors, greater motives, and fewer barriers. CONCLUSIONS SFH interventions should address motives, barriers and misperceptions regarding SHSe reduction behaviors. Moreover, smoke-free multiunit housing could have a great population impact.
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Affiliation(s)
- Carla J Berg
- Department of Prevention and Community Health, Milken Institute School of Public Health, George Washington Cancer Center, George Washington University, Washington, DC, USA
| | - Ana Dekanosidze
- Georgia National Center for Disease Control and Public Health, Tbilisi, Georgia
| | - Varduhi Hayrumyan
- Turpanjian College of Health Sciences, American University of Armenia, Yerevan, Armenia
| | - Cassidy R LoParco
- Department of Prevention and Community Health, Milken Institute School of Public Health, George Washington Cancer Center, George Washington University, Washington, DC, USA
| | - Arevik Torosyan
- National Institute of Health named after academician S. Avdalbekyan, MOH, Yerevan, Armenia
| | - Lilit Grigoryan
- National Institute of Health named after academician S. Avdalbekyan, MOH, Yerevan, Armenia
| | - Alexander Bazarchyan
- National Institute of Health named after academician S. Avdalbekyan, MOH, Yerevan, Armenia
| | - Regine Haardörfer
- Department of Behavioral, Social, and Health Education Sciences, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Michelle C Kegler
- Department of Behavioral, Social, and Health Education Sciences, Rollins School of Public Health, Emory University, Atlanta, GA, USA
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Kegler MC, Dekanosidze A, Torosyan A, Grigoryan L, Rana S, Hayrumyan V, Sargsyan Z, Berg CJ. Community coalitions for smoke-free environments in Armenia and Georgia: A mixed methods analysis of coalition formation, implementation and perceived effectiveness. PLoS One 2023; 18:e0289149. [PMID: 37535574 PMCID: PMC10399883 DOI: 10.1371/journal.pone.0289149] [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: 02/07/2023] [Accepted: 07/12/2023] [Indexed: 08/05/2023] Open
Abstract
Effective models for aligning public health and civil society at the local level have the potential to impact various global health issues, including tobacco. Georgia and Armenia Teams for Healthy Environments and Research (GATHER) is a collaboration between Armenia, Georgia and U.S. researchers involving a community randomized trial testing the impact of community coalitions to promote smoke-free policy adoption and compliance in various settings. Community Coalition Action Theory (CCAT) was used to guide and describe coalition formation, implementation and effectiveness. Mixed methods were used to evaluate 14 municipality-based coalitions in Georgia and Armenia, including semi-structured interviews (n = 42) with coalition leaders and active members, coalition member surveys at two timepoints (n = 85 and n = 83), and review of action plans and progress reports. Results indicated successful creation of 14 multi-sectoral coalitions, most commonly representing education, public health, health care, and municipal administration. Half of the coalitions created at least one smoke-free policy in specific settings (e.g., factories, parks), and all 14 promoted compliance with existing policies through no-smoking signage and stickers. The majority also conducted awareness events in school, health care, and community settings, in addition to educating the public about COVID and the dangers of tobacco use. Consistent with CCAT, coalition processes (e.g., communication) were associated with member engagement and collaborative synergy which, in turn, correlated with perceived community impact, skills gained by coalition members, and interest in sustainability. Findings suggest that community coalitions can be formed in varied sociopolitical contexts and facilitate locally-driven, multi-sectoral collaborations to promote health. Despite major contextual challenges (e.g., national legislation, global pandemic, war), coalitions were resilient, nimble and remained active. Additionally, CCAT propositions appear to be generalizable, suggesting that coalition-building guidance may be relevant for local public health in at least some global contexts.
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Affiliation(s)
- Michelle C. Kegler
- Department of Behavioral, Social, and Health Education Sciences, Rollins School of Public Health, Emory University, Atlanta, Georgia, United States of America
| | - Ana Dekanosidze
- Georgia National Center for Disease Control and Public Health, Tbilisi, Georgia, United States of America
| | - Arevik Torosyan
- National Institute of Health, Ministry of Health, Yerevan, Armenia
| | - Lilit Grigoryan
- National Institute of Health, Ministry of Health, Yerevan, Armenia
| | - Shaheen Rana
- Intervention Development, Dissemination and Implementation Shared Resource, Winship Cancer Institute, Emory University, Atlanta, Georgia, United States of America
| | - Varduhi Hayrumyan
- Turpanjian College of Health Sciences, American University of Armenia, Yerevan, Armenia
| | - Zhanna Sargsyan
- Turpanjian College of Health Sciences, American University of Armenia, Yerevan, Armenia
| | - Carla J. Berg
- Department of Prevention and Community Health, Milken Institute School of Public Health, George Washington Cancer Center, George Washington University, Washington, DC, United States of America
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Sahakyan S, Gharibyan N, Aslanyan L, Hayrumyan V, Harutyunyan A, Libaridian L, Grigoryan Z. Multi-Perspective Views and Hesitancy toward COVID-19 Vaccines: A Mixed Method Study. Vaccines (Basel) 2023; 11:vaccines11040801. [PMID: 37112713 PMCID: PMC10147024 DOI: 10.3390/vaccines11040801] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Revised: 03/15/2023] [Accepted: 03/29/2023] [Indexed: 04/09/2023] Open
Abstract
The worldwide uptake of COVID-19 vaccines was suboptimal throughout the pandemic; vaccine hesitancy played a principle role in low vaccine acceptance both globally and in Armenia. In order to understand the factors behind the slow vaccine uptake in Armenia, we aimed to explore the prevailing perceptions and experiences of healthcare providers and the general public related to COVID-19 vaccines. The study applied a convergent parallel mixed-methods study design (QUAL-quant) through in-depth interviews (IDI) and a telephone survey. We completed 34 IDIs with different physician and beneficiary groups and a telephone survey with 355 primary healthcare (PHC) providers. The IDIs found that physicians held variable views on the need for COVID-19 vaccination which, combined with mixed messaging in the media landscape, fueled the public’s vaccine hesitancy. The survey results were mostly consistent with the qualitative findings as 54% of physicians hypothesized that COVID-19 vaccines were rushed without appropriate testing and 42% were concerned about the safety of those vaccines. Strategies to improve vaccination rates must target the main drivers of hesitancy, such as physicians’ poor knowledge of specific vaccines and spiraling misconceptions about them. Meanwhile, timely educational campaigns with targeted messaging for the general public should address misinformation, promote vaccine acceptance, and empower their capacity to make decisions about their health.
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Affiliation(s)
- Serine Sahakyan
- Turpanjian College of Health Sciences, American University of Armenia, Yerevan 0019, Armenia
| | - Natella Gharibyan
- Turpanjian College of Health Sciences, American University of Armenia, Yerevan 0019, Armenia
| | - Lusine Aslanyan
- Turpanjian College of Health Sciences, American University of Armenia, Yerevan 0019, Armenia
| | - Varduhi Hayrumyan
- Turpanjian College of Health Sciences, American University of Armenia, Yerevan 0019, Armenia
| | - Arusyak Harutyunyan
- Turpanjian College of Health Sciences, American University of Armenia, Yerevan 0019, Armenia
| | - Lorky Libaridian
- Cambridge Health Alliance, Harvard Medical School, Cambridge, MA 02139, USA
| | - Zaruhi Grigoryan
- Turpanjian College of Health Sciences, American University of Armenia, Yerevan 0019, Armenia
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Sargsyan Z, Grigoryan Z, Sahakyan S, Kelenjian K, Hayrumyan V, Agopian A, Harutyunyan T. Socio-demographic determinants of infectious disease knowledge in Armenia. Eur J Public Health 2022. [DOI: 10.1093/eurpub/ckac129.652] [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: 11/12/2022] Open
Abstract
Abstract
Background
There is substantial evidence that infectious disease knowledge (IDK) predicts people's behavioral intentions and preventive practices. Since level of IDK varies across socio-economic contexts and imposes a substantial burden on vulnerable groups, we aimed to assess the relationship between socio-demographic factors and IDK in the adult population of Armenia.
Methods
A cross-sectional nationwide phone survey was conducted in the capital Yerevan and all Armenian provinces in 2021, using a stratified two-stage cluster sampling to complete a sample of 3,483 respondents. The questions on socio-demographic characteristics and IDK were included in a multi-domain structured survey questionnaire. Four questions measured IDK; a summative IDK score (0-4) was used in bivariate and multivariate linear regression analysis.
Results
Females constituted 71.0% of the sample. The mean age was 49.5 years. About 68% of the study participants had some vocational (12-13 years) or university degree education and 54.4% were employed. About one fifth of the respondents reported family monthly expenditures of less than 100,000 Armenian drams (AMD) ≈ $200, while the majority reported spending 101,000AMD to 400,000 AMD per month. The mean IDK score was 2.48. In the adjusted analysis, being female, holding a higher education level, being employed, having younger age and higher family monthly expenditures were positively associated with IDK score.
Conclusions
Our findings suggest that there is a gap in IDK affecting specific population groups such as older people, those with incomplete or secondary education, unemployed and financially disadvantaged people. Educational interventions and campaigns should target these groups to minimize the gap and ensure even prerequisites for good health.
Key messages
• Gender, age, education level, employment status and income level all independently influence population’s infectious disease knowledge.
• Health communication campaigns on infectious disease knowledge should particularly target males, older people and socially disadvantaged groups.
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Affiliation(s)
- Z Sargsyan
- Turpanjian College of Health Sciences, American University of Armenia , Yerevan, Armenia
| | - Z Grigoryan
- Turpanjian College of Health Sciences, American University of Armenia , Yerevan, Armenia
| | - S Sahakyan
- Turpanjian College of Health Sciences, American University of Armenia , Yerevan, Armenia
| | - K Kelenjian
- Turpanjian College of Health Sciences, American University of Armenia , Yerevan, Armenia
| | - V Hayrumyan
- Turpanjian College of Health Sciences, American University of Armenia , Yerevan, Armenia
| | - A Agopian
- Turpanjian College of Health Sciences, American University of Armenia , Yerevan, Armenia
| | - T Harutyunyan
- Turpanjian College of Health Sciences, American University of Armenia , Yerevan, Armenia
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Hayrumyan V, Abrahamyan A, Harutyunyan A, Sahakyan S. Impact of COVID-19 on the essential healthcare services at primary healthcare level. Eur J Public Health 2022. [PMCID: PMC9593975 DOI: 10.1093/eurpub/ckac131.064] [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: 11/20/2022] Open
Abstract
Background The COVID-19 pandemic triggered numerous challenges for the healthcare systems worldwide, particularly affecting the continuity of essential health services in low- and middle-income countries. We explored the effects of the COVID-19 pandemic on the utilization and delivery of essential health services in Armenia. Methods We applied a conventional qualitative study design using semi-structured in-depth interviews (n = 17) in public and private primary healthcare (PHC) facilities in Armenia (2021). Participants included physicians providing primary health services (e.g. endocrinologists, gynecologists/obstetricians, and pediatricians), regular PHC facility patients (e.g. adults with chronic diseases, parents of children), and policymakers. Iterative thematic analysis was done based on inductively emerged 3 main themes: patient-provider communications, maternal and child health services, and management of chronic diseases. Results Overall, visits to the PHC facilities were decreased due to fear to contract COVID-19 coupled with lack of information, misinformation and panic. There was a lack of digital platforms for ensuring continuous patient-provider communication and phone calls were the main way of communication. PHC providers intentionally limited the number of maternal and child visits to only essential antenatal visits, newborn screenings and routine child immunizations. Still, the latter has suffered resulting in delayed and decreased vaccinations. The pandemic remarkably decreased the number of follow-up visits and monitoring of patients with chronic conditions resulting in more critical and severe conditions. Conclusions The COVID-19 pandemic affected the provision and utilization of essential health services at PHC facilities by changing people’s health-seeking behavior. Unified national-level guidance for PHC facilities is needed to direct the provision of essential services, effective health communication and usage of digital platforms. Key messages • Though provider encounters should be limited during outbreaks, continuous provision of essential services is critical in the prevention of morbidity, complications and worsened disease severity. • Efforts are needed to develop effective health and risk communication strategies and enhance appropriate usage of digital platforms to promote adequate health-seeking behavior among the public.
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Affiliation(s)
- V Hayrumyan
- Turpanjian College of Health Sciences, American University of Armenia , Yerevan, Armenia
| | - A Abrahamyan
- Turpanjian College of Health Sciences, American University of Armenia , Yerevan, Armenia
| | - A Harutyunyan
- Turpanjian College of Health Sciences, American University of Armenia , Yerevan, Armenia
| | - S Sahakyan
- Turpanjian College of Health Sciences, American University of Armenia , Yerevan, Armenia
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Hayrumyan V, Sargsyan Z, Grigoryan Z, Harutyunyan A, Harutyunyan T. COVID-19 protective health behaviors among
smokers and non-smokers in Armenia. Tob Prev Cessat 2022. [DOI: 10.18332/tpc/150950] [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]
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Sargsyan Z, Hayrumyan V, Grigroyan Z, Harutyunyan A, Harutyunyan T. Perceived susceptibility and severity of COVID-19 by smoking status. Tob Prev Cessat 2022. [DOI: 10.18332/tpc/150962] [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]
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Hayrumyan V, Harutyunyan A, Torosyan A, Grigoryan L, Sargsyan Z, Bazarchyan A, Petrosyan V, Dekanosidze A, Sturua L, Kegler MC, Berg CJ. Tobacco-related risk perceptions, social influences and public smoke-free policies in relation to smoke-free home restrictions: findings from a baseline cross-sectional survey of Armenian and Georgian adults in a community randomised trial. BMJ Open 2022; 12:e055396. [PMID: 35131832 PMCID: PMC8823221 DOI: 10.1136/bmjopen-2021-055396] [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] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2021] [Accepted: 01/19/2022] [Indexed: 11/20/2022] Open
Abstract
OBJECTIVES Given high prevalence of smoking and secondhand smoke exposure in Armenia and Georgia and quicker implementation of tobacco legislation in Georgia versus Armenia, we examined correlates of having no/partial versus complete smoke-free home (SFH) restrictions across countries, particularly smoking characteristics, risk perceptions, social influences and public smoking restrictions. DESIGN Cross-sectional survey study design. SETTING 28 communities in Armenia and Georgia surveyed in 2018. PARTICIPANTS 1456 adults ages 18-64 in Armenia (n=705) and Georgia (n=751). MEASUREMENTS We used binary logistic regression to examine aforementioned correlates of no/partial versus complete SFH among non-smokers and smokers in Armenia and Georgia, respectively. RESULTS Participants were an average age of 43.35, 60.5% women and 27.3% smokers. In Armenia, among non-smokers, having no/partial SFHs correlated with being men (OR=2.63, p=0.001) and having more friend smokers (OR=1.23, p=0.002); among smokers, having no/partial SFHs correlated with being unmarried (OR=10.00, p=0.001), lower quitting importance (OR=0.82, p=0.010) and less favourable smoking attitudes among friends/family/public (OR=0.48, p=0.034). In Georgia, among non-smokers, having no/partial SFHs correlated with older age (OR=1.04, p=0.002), being men (OR=5.56, p<0.001), lower SHS risk perception (OR=0.43, p<0.001), more friend smokers (OR=1.49, p=0.002) and fewer workplace (indoor) restrictions (OR=0.51, p=0.026); among smokers, having no/partial SFHs correlated with being men (OR=50.00, p<0.001), without children (OR=5.88, p<0.001), daily smoking (OR=4.30, p=0.050), lower quitting confidence (OR=0.81, p=0.004), more friend smokers (OR=1.62, p=0.038) and fewer community restrictions (OR=0.68, p=0.026). CONCLUSIONS Private settings continue to lack smoking restrictions in Armenia and Georgia. Findings highlight the importance of social influences and comprehensive tobacco legislation, particularly smoke-free policies, in changing household smoking restrictions and behaviours. TRIAL REGISTRATION NUMBER NCT03447912.
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Affiliation(s)
- Varduhi Hayrumyan
- Turpanjian College of Health Sciences, American University of Armenia, Yerevan, Armenia
| | - Arusyak Harutyunyan
- Turpanjian College of Health Sciences, American University of Armenia, Yerevan, Armenia
| | - Arevik Torosyan
- MOH National Institute of Health Named After Academician Suren Avdalbekyan, Yerevan, Armenia
| | - Lilit Grigoryan
- MOH National Institute of Health Named After Academician Suren Avdalbekyan, Yerevan, Armenia
| | - Zhanna Sargsyan
- Turpanjian College of Health Sciences, American University of Armenia, Yerevan, Armenia
| | - Alexander Bazarchyan
- MOH National Institute of Health Named After Academician Suren Avdalbekyan, Yerevan, Armenia
| | - Varduhi Petrosyan
- Turpanjian College of Health Sciences, American University of Armenia, Yerevan, Armenia
| | - Ana Dekanosidze
- Non-Communicable Disease Department, National Center for Disease Control and Public Health, Tbilisi, Georgia
| | - Lela Sturua
- Non-Communicable Disease Department, National Center for Disease Control and Public Health, Tbilisi, Georgia
| | - Michelle C Kegler
- Department of Behavioral, Social, and Health Education Sciences, Emory University, Atlanta, Georgia, USA
| | - Carla J Berg
- Department of Prevention and Community Health, George Washington University, Washington, District of Columbia, USA
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Hayrumyan V, Sargsyan Z, Harutyunyan A, Torosyan A, Grigoryan L, Petrosyan V, Bazarchyan A, Kegler M, Berg C. Public attitude towards tobacco taxation policy in Armenia. Tob Prev Cessat 2021. [DOI: 10.18332/tpc/143636] [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]
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13
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Sargsyan Z, Hayrumyan V, Harutyunyan A, Torosyan A, Grigoryan L, Petrosyan V, Bazarchyan A, Kegler M, Berg C. Youth access to tobacco products in Armenia. Tob Prev Cessat 2021. [DOI: 10.18332/tpc/143635] [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]
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14
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Harutyunyan A, Hayrumyan V, Sargsyan Z, Torosyan A, Dekanosidze A, Kegler M, Sturua L, Berg CJ. Smokers' and non-smokers' secondhand smoke experiences and interactions to reduce exposure in Armenia and Georgia. Tob Prev Cessat 2021; 7:6. [PMID: 33537511 PMCID: PMC7845734 DOI: 10.18332/tpc/131059] [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] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Revised: 11/17/2020] [Accepted: 11/30/2020] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Armenia and Georgia have high rates of smoking and secondhand smoke exposure (SHSe). Greater progress in recent smoke-free legislation in Georgia and Armenia provides a pivotal time for examining the impact on smokers' and non-smokers' experiences and interactions regarding SHSe. METHODS Surveys were conducted in 28 communities in Armenia (n=705) and Georgia (n=751) in 2018 and assessed past 30-day SHSe and smoking in different contexts, as well as attitudes toward and interactions regarding SHSe. RESULTS In this sample (mean age 43.4 years, SD=13.5; 60.5% female; 27.3% smokers), SHSe among non-smokers was usually in homes (42.7%), cars (42.4%), and outdoor public places (38.2%); smokers also reported smoking usually in these places (70.0%, 62.1%, and 60.0%, respectively). Smokers indicated greater likelihood of putting out cigarettes and non-smokers indicated greater likelihood of asking smokers to put them out in places where smoking was prohibited versus allowed (76.5% vs 57.3%, and 46.6% vs 30.7%, respectively). Moreover, 89.9% of smokers indicated being very likely to put out cigarettes around small children if asked and 75.8% indicated trying to minimize SHSe. While 39.7% of participants reported seeing requests to smokers to put out cigarettes in the past 6 months, only 23.3% of smokers reported being asked to do so. Non-smokers in Georgia versus Armenia reported greater likelihood of engaging in behaviors to lower SHSe (p<0.001). CONCLUSIONS Smoke-free legislation may catalyze more behaviors to lower SHSe, particularly among non-smokers; however, private settings (e.g. homes) remain prominent SHSe sources. Public health efforts must consider implications of such policies on SHSe in private settings.
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Affiliation(s)
- Arusyak Harutyunyan
- Turpanjian School of Public Health, American University of Armenia, Yerevan, Armenia
| | - Varduhi Hayrumyan
- Turpanjian School of Public Health, American University of Armenia, Yerevan, Armenia
| | - Zhanna Sargsyan
- Turpanjian School of Public Health, American University of Armenia, Yerevan, Armenia
| | - Arevik Torosyan
- National Institute of Health named after academician S. Avdalbekyan, Ministry of Health, Yerevan, Armenia
| | - Ana Dekanosidze
- Georgia National Center for Disease Control and Public Health, Tbilisi, Georgia
| | - Michelle Kegler
- Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, Atlanta, United States.,Winship Cancer Institute, Emory University, Atlanta, United States
| | - Lela Sturua
- Georgia National Center for Disease Control and Public Health, Tbilisi, Georgia.,Petre Shotadze Tbilisi Medical Academy, Tbilisi, Georgia
| | - Carla J Berg
- Department of Prevention and Community Health, Milken Institute School of Public Health, George Washington University, Washington, United States.,George Washington Cancer Center, George Washington University, Washington, United States
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15
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Harutyunyan A, Abrahamyan A, Grigoryan Z, Hayrumyan V, Truzyan N, Petrosyan V. Smoking cessation knowledge, attitude and practices among tuberculosis physicians: A qualitative study. Tob Prev Cessat 2020; 6:70. [PMID: 33409424 PMCID: PMC7762926 DOI: 10.18332/tpc/130475] [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] [Received: 07/30/2020] [Revised: 11/11/2020] [Accepted: 11/14/2020] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Smoking cessation interventions within tuberculosis (TB) care are feasible, effective and efficient for increasing smoking cessation rates. We aimed to assess TB physicians’ smoking cessation knowledge, attitude, and practices (KAP). METHODS We conducted a qualitative study with 21 TB physicians and utilized directed deductive content analysis with predefined knowledge, attitude, and practice categories. Physicians’ practice was analyzed using the ABC approach (Ask, Brief advice, and Cessation support). RESULTS Physicians acknowledged the importance of quitting for improved treatment outcomes and decreased risk of TB relapse. Physicians revealed presumed drug interactions, possible side effects of pharmacotherapy, and reluctance to take additional medications as challenges of smoking cessation interventions. Physicians asked about smoking behavior and provided a brief quitting advice to TB patients; however, implementation of cessation support was limited due to poor knowledge of evidence-based cessation methods and the absence of formal tobacco dependence treatment algorithms within TB care. CONCLUSIONS TB physicians’ KAP on smoking cessation was limited. Interventions targeting physicians’ knowledge and skills, and formalization of tobacco dependence treatment within TB care, are core for improving their smoking cessation practices in Armenia.
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Affiliation(s)
- Arusyak Harutyunyan
- Turpanjian School of Public Health, American University of Armenia, Yerevan, Armenia
| | - Armine Abrahamyan
- Turpanjian School of Public Health, American University of Armenia, Yerevan, Armenia
| | - Zaruhi Grigoryan
- Turpanjian School of Public Health, American University of Armenia, Yerevan, Armenia
| | - Varduhi Hayrumyan
- Turpanjian School of Public Health, American University of Armenia, Yerevan, Armenia
| | - Nune Truzyan
- Turpanjian School of Public Health, American University of Armenia, Yerevan, Armenia
| | - Varduhi Petrosyan
- Turpanjian School of Public Health, American University of Armenia, Yerevan, Armenia
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16
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Hayrumyan V, Harutyunyan A, Sargsyan Z, Torosyan A, Dekanosidze A, Kegler M, Sturua L, Berg C. Smoking cessation practices in Armenia and Georgia. Tob Prev Cessat 2020. [DOI: 10.18332/tpc/128404] [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]
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17
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Topuridze M, Berg C, Dekanosidze A, Torosyan A, Sargsyan Z, Hayrumyan V, Maglakelidze N, Sturua L, Kegler M. Smokers’ and non-smokers’ receptivity to smoke-free air policies and related messaging in support and opposition in Armenia and Georgia. Tob Prev Cessat 2020. [DOI: 10.18332/tpc/128303] [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]
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18
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Grigoryan Z, Harutyunyan A, Sargsyan Z, Hayrumyan V. Motivations and barriers to smoking cessation among TB patients. Tob Prev Cessat 2020. [DOI: 10.18332/tpc/128407] [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]
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19
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Harutyunyan A, Sargsyan Z, Grigoryan Z, Hayrumyan V, Petrosyan V. Effectiveness of tobacco dependence treatment training: Experiences of Armenian TB patients. Tob Prev Cessat 2020. [DOI: 10.18332/tpc/128400] [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]
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20
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Grigoryan Z, Hayrumyan V, Sargsyan Z, Petrosyan V. Do primary healthcare providers have the competency of providing adolescent-friendly health services? Eur J Public Health 2020. [DOI: 10.1093/eurpub/ckaa166.917] [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: 11/15/2022] Open
Abstract
Abstract
Background
Investment in adolescents' health is one of the most rewarding efforts for meeting the Sustainable Development Goals. The national standard on state assured free-of-charge services defines the minimum requirements of adolescent-friendly healthcare services (AFHS) in primary healthcare facilities (PHCFs); however, services for adolescents are highly inconsistent in terms of quality and coordination. We aimed to assess the PHC providers' (PHPs) capacity to provide AFHS in PHC facilities in Armenia.
Methods
A qualitative cross-sectional study through in-depth interviews and focus-group discussions was conducted in two biggest cities of Armenia. Overall, six focus group discussions and 16 in-depth interviews were conducted with adolescents (18 and 19 years old), PHPs, managers of PHCFs, and experts in adolescent health. Eight PHC facilities were chosen for conducting observations. The WHO Global standards for quality health-care services for adolescents guided the deductive content analysis.
Results
PHPs' capacity to provide AFHS in assessed PHCFs was not satisfactory. PHPs did not know the specific age range of adolescence and the content of AFHS in the national standard. PHPs perceived friendliness of services as welcoming and good attitude. Facility managers and most PHPs did not participate in professional education activities to advance their expertise in adolescent health. Experts concluded that services provided to adolescents were not “friendly” and PHPs did not have appropriate competencies. However, PHPs' had the opposite opinion - they were confident in their knowledge and skills to work with adolescents. Adolescents complained that PHPs did not provide explanations for provided services and lacked appropriate communication skills.
Conclusions
The PHCFs have formal grounds to provide AFHS, however lack of appropriate competencies among PHPs and managers of PHCs hinder advancement of AFHS.
Key messages
Qualitative findings suggest that visited PHCFs fail to appropriately implement AFHS as guided by the national standard. Provision of AFHS can be promoted in PHCFs through strengthening PHPs' competencies via continuous professional development activities.
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Affiliation(s)
- Z Grigoryan
- Turpanjian School of Public Health, American University of Armenia, Yerevan, Armenia
| | - V Hayrumyan
- Turpanjian School of Public Health, American University of Armenia, Yerevan, Armenia
| | - Z Sargsyan
- Turpanjian School of Public Health, American University of Armenia, Yerevan, Armenia
| | - V Petrosyan
- Turpanjian School of Public Health, American University of Armenia, Yerevan, Armenia
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21
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Hayrumyan V, Grigoryan Z, Sargsyan Z, Harutyunyan A, Petrosyan V. Barriers to reproductive health services utilization among adolescents. Eur J Public Health 2020. [DOI: 10.1093/eurpub/ckaa166.959] [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: 11/13/2022] Open
Abstract
Abstract
Background
Adolescents' access to quality reproductive health services is crucial for their psychosocial and physical wellbeing. Yet, adolescents encounter various barriers while utilizing reproductive health services, globally. Adolescent-friendly health services (AFHS) is an evidence-based intervention to meet the reproductive health needs inclusively of all adolescents. The study aimed to explore adolescents' experiences while seeking reproductive health services in primary healthcare facilities (PHCF) in Armenia.
Methods
We conducted a qualitative cross-sectional study using in-depth interviews, focus group discussions and observations of PHCFs. The study participants included adolescents (aged 18-19 years) (n = 17), PHC providers (PHP) (n = 29), managers of PHCFs (n = 7) and experts in the field of adolescent health (n = 5) from the two largest cities in Armenia. The Global standards for quality healthcare services for adolescents guided the instrument development process and deductive content analysis.
Results
Barriers to the utilization of reproductive health services by adolescents at PHCFs were related to various personal, cultural, and social factors. PHPs and experts blamed adolescents' insufficient knowledge of reproductive health and related services for being a major barrier. However, adolescents' reported a different set of important barriers to reproductive health services: PHPs' judgmental attitude, lack of efforts to protect privacy and confidentiality (due to lack of PHP competencies to provide AFHS and inadequate PHCF infrastructure), negative public opinion and lack of community support.
Conclusions
The study findings shed light on different perspectives related to various challenges adolescents come across in PHCFs. Addressing identified barriers have the potential of positively influencing adolescents' experiences while utilizing reproductive health services in PHCFs.
Key messages
Adolescents’ insufficient knowledge, PHPs’ judgmental attitude, lack of privacy and confidentiality, and negative public opinion are among the main barriers to the reproductive health services. Further enforcement of adolescent-friendly health services in primary healthcare facilities is needed to ensure accessibility of quality reproductive health services for all adolescents.
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Affiliation(s)
- V Hayrumyan
- Turpanjian School of Public Health, American University of Armenia, Yerevan, Armenia
| | - Z Grigoryan
- Turpanjian School of Public Health, American University of Armenia, Yerevan, Armenia
| | - Z Sargsyan
- Turpanjian School of Public Health, American University of Armenia, Yerevan, Armenia
| | - A Harutyunyan
- Turpanjian School of Public Health, American University of Armenia, Yerevan, Armenia
| | - V Petrosyan
- Turpanjian School of Public Health, American University of Armenia, Yerevan, Armenia
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Abstract
Abstract
Background
Stress is an important issue in academic institutions and can have a negative impact on overall academic performance. This study was conducted as a research assignment during the Basics of Healthy Lifestyle course and aimed to investigate the stress level among undergraduate students at the American University of Armenia (AUA).
Methods
A cross-sectional survey was conducted among undergraduate students recruited by non-random convenience sampling. The study utilized a structured questionnaire to conduct face to face interviews. The questionnaire contained 40 close-ended questions on students' perceived stress level, the Student Stress Scale (SSS) (sum of scores of 31 questions) to measure actual stress, and socio-demographic characteristics. Data entry, descriptive and comparative statistics were performed using SPSS software. Secondary data analysis was conducted to explore gender differences in stress level.
Results
Overall, 111 AUA students participated and slightly over half of participants (59.5%) were female. The SSS revealed that 46.0% of students experience medium stress levels (self-perceived mean stress score =-5.8). Only 21.6% perceived themselves as having high stress levels; however, SSS showed that about one third had high stress. Female participants' perception of being highly stressed and having high stress level based on SSS were similar (28.8% and 27.3%, respectively). In contrast, less males perceived being highly stressed (13.3%), though, SSS showed that 40.0% of males experienced high stress levels.
Conclusions
The majority of AUA undergraduate students experienced medium or low stress levels. Male students experience higher stress levels, but their perceived stress level was much lower than in among females. Research is needed to explore the gender differences in stress levels and coping mechanisms among students. These findings may be useful for university administration for developing stress-reduction and stress-management strategies.
Key messages
There are disparities in perceived stress and actual stress levels between male and female students that warrant further exploration. Gender differences in stress level of the students should be considered for stress-reduction and stress-management strategies.
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Affiliation(s)
- A Harutyunyan
- School of Public Health, American University of Armenia, Yerevan, Armenia
| | - L Musheghyan
- School of Public Health, American University of Armenia, Yerevan, Armenia
| | - V Hayrumyan
- School of Public Health, American University of Armenia, Yerevan, Armenia
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Topuridze M, Berg CJ, Dekanosidze A, Torosyan A, Grigoryan L, Bazarchyan A, Sargsyan Z, Hayrumyan V, Maglakelidze N, Sturua L, Haardörfer R, Kegler MC. Smokers' and Nonsmokers' Receptivity to Smoke-Free Policies and Pro- and Anti-Policy Messaging in Armenia and Georgia. Int J Environ Res Public Health 2020; 17:ijerph17155527. [PMID: 32751714 PMCID: PMC7432748 DOI: 10.3390/ijerph17155527] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [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: 07/08/2020] [Revised: 07/24/2020] [Accepted: 07/27/2020] [Indexed: 12/02/2022]
Abstract
Garnering support for smoke-free policies is critical for their successful adoption, particularly in countries with high smoking prevalence, such as Armenia and Georgia. In 2018, we surveyed 1456 residents (ages 18–64) of 28 cities in Armenia (n = 705) and Georgia (n = 751). We examined support for cigarette and electronic nicotine delivery systems (ENDS)/heated tobacco product (HTP) smoke-free policies in various locations and persuasiveness of pro- and anti-policy messaging. Participants were an average age of 43.35, 60.5% female, and 27.3% current smokers. Nonsmokers versus smokers indicated greater policy support for cigarette and ENDS/HTP and greater persuasiveness of pro-policy messaging. Armenians versus Georgians generally perceived pro- and anti-policy messaging more persuasive. In multilevel linear regression, sociodemographics (e.g., female) and tobacco use characteristics (e.g., smoking less frequently, higher quitting importance) correlated with more policy support. Greatest policy support was for healthcare, religious, government, and workplace settings; public transport; schools; and vehicles carrying children. Least policy support was for bar/restaurant outdoor areas. The most compelling pro-policy message focused on the right to clean air; the most compelling anti-policy message focused on using nonsmoking sections. Specific settings may present challenges for advancing smoke-free policies. Messaging focusing on individual rights to clean air and health may garner support.
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Affiliation(s)
- Marina Topuridze
- Non-Communicable Diseases Department, National Center for Disease Control and Public Health, Tbilisi 0198, Georgia; (M.T.); (A.D.); (N.M.); (L.S.)
- School of Natural Sciences and Medicine, Ilia State University, Tbilisi 0162, Georgia
| | - Carla J. Berg
- Department of Prevention and Community Health, Milken Institute School of Public Health, George Washington Cancer Center, George Washington University, Washington, DC 20052, USA
- Correspondence:
| | - Ana Dekanosidze
- Non-Communicable Diseases Department, National Center for Disease Control and Public Health, Tbilisi 0198, Georgia; (M.T.); (A.D.); (N.M.); (L.S.)
| | - Arevik Torosyan
- National Institute of Health Named after Academician S. Avdalbekyan, MoH, Yerevan 0051, Armenia; (A.T.); (L.G.); (A.B.)
| | - Lilit Grigoryan
- National Institute of Health Named after Academician S. Avdalbekyan, MoH, Yerevan 0051, Armenia; (A.T.); (L.G.); (A.B.)
| | - Alexander Bazarchyan
- National Institute of Health Named after Academician S. Avdalbekyan, MoH, Yerevan 0051, Armenia; (A.T.); (L.G.); (A.B.)
| | - Zhanna Sargsyan
- Turpanjian School of Public Health, American University of Armenia, Yerevan 0019, Armenia; (Z.S.); (V.H.)
| | - Varduhi Hayrumyan
- Turpanjian School of Public Health, American University of Armenia, Yerevan 0019, Armenia; (Z.S.); (V.H.)
| | - Nino Maglakelidze
- Non-Communicable Diseases Department, National Center for Disease Control and Public Health, Tbilisi 0198, Georgia; (M.T.); (A.D.); (N.M.); (L.S.)
| | - Lela Sturua
- Non-Communicable Diseases Department, National Center for Disease Control and Public Health, Tbilisi 0198, Georgia; (M.T.); (A.D.); (N.M.); (L.S.)
- Public Health Department Petre Shotadze Tbilisi Medical Academy, Tbilisi 0144, Georgia
| | - Regine Haardörfer
- Department of Behavioral, Social, and Health Education Sciences, Rollins School of Public Health, Emory University, Atlanta, GA 30322, USA; (R.H.); (M.C.K.)
| | - Michelle C. Kegler
- Department of Behavioral, Social, and Health Education Sciences, Rollins School of Public Health, Emory University, Atlanta, GA 30322, USA; (R.H.); (M.C.K.)
- Winship Cancer Institute, Emory University, Atlanta, GA 30322, USA
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Grigoryan Z, Hayrumyan V, Sargsyan ZH, Harutyunyan A. Compliance with smoke-free policy at tuberculosis facilities in Armenia: a mixed-methods study. Eur J Public Health 2019. [DOI: 10.1093/eurpub/ckz186.378] [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: 11/12/2022] Open
Abstract
Abstract
Background
Smoke-free environments in tuberculosis (TB) facilities promote a tobacco-free lifestyle among patients and healthcare providers and advance their healthy image. Though the national law of Armenia prohibits indoor smoking in healthcare facilities, enforcement of the law is still insufficient. This study aimed to explore compliance with the smoke-free policy in TB facilities in Armenia.
Methods
An exploratory sequential mixed-methods study was conducted. Overall 21 TB physicians and five key informants in the field of TB and tobacco control participated in qualitative interviews. To further quantify and validate the findings, structured observations of smoke-free policy implementation were conducted in 36 facilities.
Results
All physicians expressed a positive attitude towards the smoke-free environment and were satisfied with the level of implementation of a smoke-free policy in their TB facilities. According to the respondents, they already have smoke-free environments established in their facilities. “No smoking” signs, warnings about health consequences and financial penalties, and pictures of damaged lungs were the most common measures against indoor smoking. However, only in 17.1% (n = 6) and 8.6% (n = 3) of observed TB facilities there were posted “No smoking” signs and financial penalties, respectively. In 5.7% (n = 2) of facilities, the research team found ashtrays inside the building, and in 20.0% (n = 7) of facilities, there were smoking patients, physicians, and visitors.
Conclusions
While the qualitative study indicated good compliance, the quantitative findings were controversial with this regard. In fact, in most of the facilities, the smoke-free policy was not properly implemented and enforced. Additional efforts are needed to harmonize the current practices with national policies and recommendations.
Key messages
There was a discrepancy between practices reported by physicians and the actual observed compliance. Further interventions are needed to ensure 100% compliance with smoke-free policy in TB healthcare facilities.
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Affiliation(s)
- Z Grigoryan
- Turpanjian School of Public Health, American University of Armenia, Yerevan, Armenia
| | - V Hayrumyan
- Turpanjian School of Public Health, American University of Armenia, Yerevan, Armenia
| | - Z h Sargsyan
- Turpanjian School of Public Health, American University of Armenia, Yerevan, Armenia
| | - A Harutyunyan
- Turpanjian School of Public Health, American University of Armenia, Yerevan, Armenia
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Berg CJ, Dekanosidze A, Torosyan A, Grigoryan L, Sargsyan Z, Hayrumyan V, Topuridze M, Sturua L, Harutyunyan A, Kvachantiradze L, Maglakelidze N, Gamkrelidze A, Abovyan R, Bazarchyan A, Kegler MC. Examining smoke-free coalitions in Armenia and Georgia: baseline community capacity. Health Educ Res 2019; 34:495-504. [PMID: 31504495 PMCID: PMC6758643 DOI: 10.1093/her/cyz024] [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] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/22/2019] [Accepted: 08/02/2019] [Indexed: 06/10/2023]
Abstract
Local coalitions can advance public health initiative but have not been widely used or well-studied in low- and middle-income countries. This paper provides (i) an overview of an ongoing matched-pairs community-randomized controlled trial in 28 communities in Armenia and Georgia (N = 14/country) testing local coalitions to promote smoke-free policies/enforcement and (ii) characteristics of the communities involved. In July-August 2018, key informants (e.g. local public health center directors) were surveyed to compare their non-communicable disease (NCD) and tobacco-related activities across countries and across condition (intervention/control). More than half of the informants (50.0-57.1%) reported their communities had programs addressing hypertension, diabetes, cancer and human papilloma virus, with 85.7% involving community education and 32.1% patient education programs. Eleven communities (39.3%) addressed tobacco control, all of which were in Georgia. Of those, all included public/community education and the majority (72.7-81.8%) provided cessation counseling/classes, school/youth prevention programs, healthcare provider training or activities addressing smoke-free environments. Informants in Georgia versus Armenia perceived greater support for tobacco control from various sectors (e.g. government, community). No differences were found by condition assignment. This paper provides a foundation for presenting subsequent analyses of this ongoing trial. These analyses indicate wide variability regarding NCD-related activities and support across communities and countries.
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Affiliation(s)
- Carla J Berg
- Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, 1518 Clifton Road NE, Atlanta, GA, USA
- Winship Cancer Institute, Emory University, 1365 Clifton Road NE, Atlanta, GA, USA
| | - Ana Dekanosidze
- National Center for Disease Control and Public Health, 4 Kakheti Hwy, Tbilisi, Georgia
| | - Arevik Torosyan
- National Institute of Health named after academician S. Avdalbekyan, MoH, Komitasi Ave. 49/4, Yerevan, Armenia
| | - Lilit Grigoryan
- National Institute of Health named after academician S. Avdalbekyan, MoH, Komitasi Ave. 49/4, Yerevan, Armenia
| | - Zhanna Sargsyan
- Turpanjian School of Public Health, American University of Armenia, 40 Marshal Baghramyan Ave., Yerevan, Armenia
| | - Varduhi Hayrumyan
- Turpanjian School of Public Health, American University of Armenia, 40 Marshal Baghramyan Ave., Yerevan, Armenia
| | - Marina Topuridze
- National Center for Disease Control and Public Health, 4 Kakheti Hwy, Tbilisi, Georgia
| | - Lela Sturua
- National Center for Disease Control and Public Health, 4 Kakheti Hwy, Tbilisi, Georgia
| | - Arusyak Harutyunyan
- Turpanjian School of Public Health, American University of Armenia, 40 Marshal Baghramyan Ave., Yerevan, Armenia
| | - Lela Kvachantiradze
- National Center for Disease Control and Public Health, 4 Kakheti Hwy, Tbilisi, Georgia
| | - Nino Maglakelidze
- National Center for Disease Control and Public Health, 4 Kakheti Hwy, Tbilisi, Georgia
| | - Amiran Gamkrelidze
- National Center for Disease Control and Public Health, 4 Kakheti Hwy, Tbilisi, Georgia
| | - Romela Abovyan
- Department of Epidemiology of Noncommunicable and Nosocomial Infectious Disease, National Center for Disease Control and Prevention, MOH RA, Mkhitar Heratsu St. 12, Yerevan, Armenia
| | - Alexander Bazarchyan
- National Institute of Health named after academician S. Avdalbekyan, MoH, Komitasi Ave. 49/4, Yerevan, Armenia
| | - Michelle C Kegler
- Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, 1518 Clifton Road NE, Atlanta, GA, USA
- Winship Cancer Institute, Emory University, 1365 Clifton Road NE, Atlanta, GA, USA
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Sargsyan Z, Harutyunyan A, Hayrumyan V, Grigoryan Z, Petrosyan V. Smoking cessation counseling: a survey among tuberculosis patients in Armenia. Tob Prev Cessat 2019. [DOI: 10.18332/tpc/105227] [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]
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Hayrumyan V, Harutyunyan A, Grigoryan Z, Sargsyan Z, Petrosyan V. Tobacco dependence treatment provision by tuberculosis physicians in Armenia. Tob Prev Cessat 2019. [DOI: 10.18332/tpc/105273] [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]
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Harutyunyan A, Abrahamyan A, Hayrumyan V, Petrosyan V. Perceived barriers of tobacco dependence treatment: a mixed-methods study among primary healthcare physicians in Armenia. Prim Health Care Res Dev 2019; 20:e17. [PMID: 30421696 PMCID: PMC6476393 DOI: 10.1017/s1463423618000828] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2018] [Revised: 08/22/2018] [Accepted: 10/04/2018] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Despite compelling evidence that physicians play a prominent role in smoking cessation, most smokers do not receive the recommended smoking cessation counseling.AimTo identify perceived barriers that hinder primary healthcare physicians (PHPs) from providing smoking cessation treatment to patients in Armenia. METHODS A sequential exploratory mixed-methods study was conducted among PHPs from two Armenian cities (Yerevan and Gyumri). We implemented qualitative phase through focus group discussions (FGDs) using a semi-structured guide. For the subsequent quantitative phase, the data were collected through cross-sectional survey. A directed deductive content analysis technique was used to analyze the FGDs and questionnaires were analyzed descriptively. Following the data collection (March 2015-May 2016) and descriptive analysis, the qualitative and quantitative data sets were merged by drawing quantitative data onto qualitative categories.FindingsOverall, 23 PHPs participated in five FGDs and 108 participants completed the survey. Three main categories of barriers were identified: physician-based, patient-based, and system-based barriers. The main physicians-based barriers were insufficient knowledge and inadequate training on tobacco-dependence treatment. Lack of patients' motivation to quit, poor compliance with the treatment, patients' withdrawal symptoms were identified as patient-based disincentives. System-based barriers included lack of reimbursement for providing smoking cessation counseling, high price and low availability of smoking cessation medications. Most of the qualitative descriptions were confirmed by quantitative findings. CONCLUSIONS Targeted interventions are needed to address barriers that limited PHPs' involvement in providing smoking cessation services in Armenia. There is an urgent need to enhance PHPs' knowledge and skills in delivering smoking cessation counseling, to increase patients' demand for smoking cessation services, and to ensure availability and affordability of smoking cessation services in Armenia.
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Affiliation(s)
- Arusyak Harutyunyan
- Gerald and Patricia Turpanjian School of Public Health, American University of Armenia, Yerevan, Armenia
| | - Armine Abrahamyan
- Gerald and Patricia Turpanjian School of Public Health, American University of Armenia, Yerevan, Armenia
| | - Varduhi Hayrumyan
- Gerald and Patricia Turpanjian School of Public Health, American University of Armenia, Yerevan, Armenia
| | - Varduhi Petrosyan
- Gerald and Patricia Turpanjian School of Public Health, American University of Armenia, Yerevan, Armenia
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Grigoryan Z, Harutyunyan A, Abrahamyan A, Hayrumyan V. Smoking cessation services provided by tuberculosis physicians in Armenia: A qualitative study. Tob Prev Cessat 2018. [DOI: 10.18332/tpc/90320] [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]
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Harutyunyan A, Hayrumyan V, Girvalaki C, project partners EPACTT. Availability of Smoking Cessation Products among 14 European Countries. Tob Prev Cessat 2018. [DOI: 10.18332/tpc/90456] [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]
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Abrahamyan A, Harutyunyan A, Grigoryan Z, Hayrumyan V. Tuberculosis and Tobacco in Armenia: Physicians’ perspective on two global epidemics. Tob Prev Cessat 2018. [DOI: 10.18332/tpc/90317] [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]
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Hayrumyan V, Harutyunyan A, Girvalaki C, project partners EPACTT. Price and Affordability of Cigarettes among 14 European Countries. Tob Prev Cessat 2018. [DOI: 10.18332/tpc/90455] [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]
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Harutyunyan A, Abrahamyan A, Hayrumyan V, Petrosyan V. Evaluation of smoking cessation training in Armenia. Tob Induc Dis 2018. [DOI: 10.18332/tid/84572] [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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Hayrumyan V, Harutyunyan A, Harutyunyan T. Self-efficacy predicts the outcome of smoking cessation attempts. Tob Induc Dis 2018. [DOI: 10.18332/tid/84431] [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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Harutyunyan A, Abrahamyan A, Hayrumyan V, Petrosyan, V. Training impact on physicians' knowledge in smoking cessation in Armenia. Eur J Public Health 2017. [DOI: 10.1093/eurpub/ckx187.183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- A Harutyunyan
- Gerald and ParticiaTurpanjian School of Public Health, American University of Armenia, Yerevan, Armenia
| | - A Abrahamyan
- Gerald and ParticiaTurpanjian School of Public Health, American University of Armenia, Yerevan, Armenia
| | - V Hayrumyan
- Gerald and ParticiaTurpanjian School of Public Health, American University of Armenia, Yerevan, Armenia
| | - V Petrosyan,
- Gerald and ParticiaTurpanjian School of Public Health, American University of Armenia, Yerevan, Armenia
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Abrahamyan A, Harutyunyan A, Hayrumyan V, Petrosyan V. Limited availability of smoking cessation products in the Armenian pharmaceutical market. Eur J Public Health 2017. [DOI: 10.1093/eurpub/ckx187.181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- A Abrahamyan
- American University of Armenia, Yerevan, Armenia
| | | | - V Hayrumyan
- American University of Armenia, Yerevan, Armenia
| | - V Petrosyan
- American University of Armenia, Yerevan, Armenia
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Hayrumyan V, Harutyunyan A. Social Support and Smoking Cessation among Patients with Myocardial Infarction in Armenia. Eur J Public Health 2017. [DOI: 10.1093/eurpub/ckx187.179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- V Hayrumyan
- Gerald and Patricia Turpanjian School of Public Health, American University of Armenia, Yerevan, Armenia
| | - A Harutyunyan
- Gerald and Patricia Turpanjian School of Public Health, American University of Armenia, Yerevan, Armenia
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Hayrumyan V, Harutyunyan A, Harutyunyan T. The Use of Five “A’s” Tobacco Cessation Strategy among Patients Hospitalized for Myocardial Infarction in Armenia. Tob Prev Cessat 2017. [DOI: 10.18332/tpc/70218] [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]
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Harutyunyan A, Abrahamyan A, Hayrumyan V, Petrosyan V. Discrepancy between primary healthcare physicians’ attitude and practice in providing smoking cessation. Tob Prev Cessat 2017. [DOI: 10.18332/tpc/70302] [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]
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