The association between health literacy and e-cigarette use: evidence from Zhejiang, China
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ABSTRACT:
SUBMITTER: Zhang X
PROVIDER: S-EPMC10794489 | biostudies-literature | 2023 Jan
REPOSITORIES: biostudies-literature
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| S-EPMC11003150 | biostudies-literature
Project description:PURPOSE:The objective of this article is to examine the factors associated with smoking of flavor capsule cigarettes in Chile, where the popularity of these products has increased dramatically, a trend increasingly observed across the world. METHODS:A representative poll of 851 smokers in Metropolitan Santiago de Chile, which comprises 40% of the country's total population, was implemented in mid-2017. Smokers were given a questionnaire that collected socio-demographic information and information on smoking patterns. Four discrete-choice models were estimated on the decision to smoke flavor capsule cigarettes to better understand the statistical relationships between traits of smokers and the consumption of flavor capsule cigarettes. RESULTS:The results of these models show that each year less in a smoker's age increases the likelihood of preferring flavor capsule cigarettes by, on average, between 0.8 and 0.9 percentage points. If the smoker is a woman, the likelihood of preferring flavor capsule cigarettes increases between 13.4 and 13.5 percentage points. Results also reveal a positive relationship between the price paid and the consumption of flavor capsule cigarettes, indicating that these cigarettes tend to be more expensive. There is no statistical relationship between participation in the labor market and smoking these products. CONCLUSIONS:Chile has the world's highest prevalence of flavor capsule cigarette smoking, which is concentrated among young people (25 years and younger) and females. No relationship between socioeconomic status and use of these products is found, though there are indications that such relationship may exist, as they were at the time of study 14% more expensive, on average, than conventional non-flavored cigarettes. As in most countries, the tobacco industry appears to be deliberately promoting these products with the goal of halting or slowing the decline in cigarette consumption in Chile. Thus, to reduce cigarette consumption (especially among youth), restricting or forbidding cigarette flavorings of all types, including flavor capsules, would be an effective strategy.
| S-EPMC6808557 | biostudies-literature
Project description:OBJECTIVE:To determine the prevalence of cigarette use among adolescents and to identify associated health risk behaviors. METHODS:This is a cross-sectional study with a representative sample, composed of 1059 adolescents between 13 and 19 years old, enrolled in primary and secondary public schools of Olinda, Pernambuco, in 2014. Information was obtained through self-administered questionnaires (validated version of YRBS 2007). Cigarette experimentation was defined as smoking at least once in life. Adolescents who smoked at least one day within 30 days prior to the survey were considered current smokers. Most students were female and 16 years old or older. RESULTS:Almost 30% used it in life and about 10% smoked within the 30 days before the survey. Suicidal ideation (PR = 1.51, 95%CI 1.25-1.82), alcohol use (PR = 1.41, 95%CI 1.03-1.92), marijuana (PR = 1.64, 95%CI 1.37-1.96), excessive alcohol consumption (PR = 1.57, 95%CI 1.15-2.16) and sexual experience (PR = 1.78, 95%CI 1.43-2.21) have increased the risk of using cigarettes. Feelings of sadness (PR = 1.70, 95%CI 1.22-2.36), alcohol use (PR=2.40, 95%CI 1.12-5.12), excessive alcohol consumption (PR = 2.5, 95% CI 1.24-5.38), marijuana (PR = 2.31, 95%CI.57-3.39) and cocaine (PR = 1.99, 95%CI.32-3.01) increased the risk of cigarette use within the 30 days before the survey. CONCLUSIONS:Cigarette use among adolescents from Olinda was high, being considered higher than the national prevalence. Possible factors associated with cigarette use were drug use (alcohol, marijuana, and cocaine) and behaviors related to sexual experience, feelings of sadness and suicidal ideation.
| S-EPMC7087483 | biostudies-literature
Project description:BackgroundTo address social inequalities in adolescent substance use and consequent disparities in health, it is important to identify the mechanisms of the association between substance use and academic performance. We study the role of health literacy (HL) in the association between academic performance and weekly smoking, monthly alcohol use and cannabis ever-use among adolescents in Europe.MethodsSILNE-R school survey data, which was collected in 2016-17 with paper-and-pencil-method from Hanover (GE), Amersfoort (NL) and Tampere (FI), were used (N = 5088, age 13-19). Health Literacy for School-aged Children instrument was used to assess students' HL. Logistic regression analyzed the association of substance use with academic performance and HL, separately and in the same model. Linear and multinomial logistic regression analyzed the association between academic performance and HL.ResultsPoor academic performance compared with high was associated with smoking [odds ratio (OR) 3.94, 95% confidence interval (CI) 2.83-5.49], alcohol use (OR: 2.94, 95% CI: 2.34-3.68) and cannabis use (OR: 2.56, 95% CI: 1.89-3.48). Poor HL was also associated with each substance use (with ORs of 2.32, 1.85 and 1.29). HL was positively associated with academic performance (β = 1.04, 95% CI: 0.89-1.20). The associations between academic performance and substance use were only slightly attenuated after controlling for HL.ConclusionsAcademic performance and HL were both determinants of substance use, confirming their role in tackling the disparities in substance use. However, HL did not demonstrably mediate the association between academic performance and substance use. A wider set of factors needs to be tackled to address emerging social inequalities in adolescent substance use.
| S-EPMC8975541 | biostudies-literature
Project description:BackgroundLimited health literacy is a public health challenge contributing to the rising health care costs. We assess the economic costs of limited health literacy in China using data from the National Health Literacy Surveillance survey.MethodsOur data includes a sample of 6316 residents aged 15-69 years old living in Ningbo, China, in 2019. We use box plots to examine the distribution of out-of-pocket health expenditure by the level of health literacy. We then use the estimates from a two-part model to assess the contribution of limited health literacy to individual medical spending and the aggregate health expenditure at different levels of health literacy for the adult population in Ningbo.ResultsMedical costs of limited health literacy are about 10% (177 CNY or about 25 USD) of the annual medical expense of a resident aged 15-69 living in Ningbo. The medical cost of limited health literacy is greater among the rural, female, and older groups than others. If the proportion of people with adequate health literacy increases from 22 to 30% (the target level by 2030), the aggregate out-of-pocket health expenditure in Ningbo will decrease by 100 million CNY (14 million USD), or 0.88% of the 2019 Ningbo government expenditure on health care.ConclusionsThis paper highlights the direct and indirect economic costs associated with limited health literacy. The results should help policymakers evaluate the cost-effectiveness of relevant programs that aim to improve residents' health literacy.
| S-EPMC9020016 | biostudies-literature
Project description:IntroductionElectronic cigarettes (e-cigarettes) are promoted as a less risky alternative to conventional cigarettes and have grown in popularity. Experimental and clinical evidence suggests that they could increase the risk of myocardial infarction.MethodsThe National Health Interview Surveys of 2014 (n=36,697) and 2016 (n=33,028) were used to examine the cross-sectional association between e-cigarette use (never, former, some days, daily) and cigarette smoking (same categories) and myocardial infarction in a single logistic regression model that also included demographics (age, gender, BMI) and health characteristics (hypertension, diabetes, and hypercholesterolemia) using logistic regression. Data were collected in 2014 and 2016 and analyzed in 2017 and 2018.ResultsDaily e-cigarette use was independently associated with increased odds of having had a myocardial infarction (OR=1.79, 95% CI=1.20, 2.66, p=0.004) as was daily conventional cigarette smoking (OR=2.72, 95% CI=2.29, 3.24, p<0.001). Former and some day e-cigarette use were not significantly associated with having had a myocardial infarction (p=0.608 and p=0.392) whereas former (OR=1.70, p<0.001) and some day cigarette smoking (OR=2.36, p<0.001) were. Odds of a myocardial infarction were also increased with history of hypertension (OR=2.32, p<0.001); high cholesterol (OR=2.36, p<0.001); and diabetes (OR=1.77, p<0.001); and age (OR=1.65 per 10 years, p<0.001). Women (OR=0.47, p<0.001) had lower odds of myocardial infarction.ConclusionsDaily e-cigarette use, adjusted for smoking conventional cigarettes as well as other risk factors, is associated with increased risk of myocardial infarction.
| S-EPMC6208321 | biostudies-literature
Project description:BackgroundCigarette smoking has been reported to be associated with SARS-CoV-2 negative conversion, while little is known about the effect of its dual use with e-cigarettes. This study aimed to investigate whether tobacco product use patterns including e-cigarette use were linked with delayed negative conversion of SARS-CoV-2.MethodsAn online national survey was conducted from January 28 through February 21, 2023, targeting a community-based population in mainland of China after peak waves of the coronavirus disease 2019 (COVID-19). Participants were followed from the onset of COVID-19 symptoms until the negative conversion day or the day of answering the questionnaire as the endpoint of the study. Multi-variable adjusted Cox proportional hazard models were used to compare the negative conversion time of SARS-CoV-2 across different cigarette and e-cigarette use patterns.ResultsA total of 66,537 participants infected with COVID-19 were enrolled and 13,294 were included in the analyses. During the median duration of 7 days (interquartile range 5 to 10 days), a total of 11,587 (87.2%) had a negative conversion. Compared with never users, current exclusive smokers (multi-variable adjusted HR 0.59, 95% CI 0.48-0.71), current dual users (HR 0.31, 95% CI 0.22-0.44), and previous smokers (HR 0.56, 95% CI 0.37-0.83) took longer to turn negative after 10 days of follow-up.ConclusionsBoth current exclusive cigarette use and dual use of cigarettes and e-cigarettes were associated with the delayed negative conversion of SARS-CoV-2, which strengthens the importance of smoking and vaping cessation messaging and community-based tobacco control strategies during pandemics like COVID-19 next time.
| S-EPMC11792595 | biostudies-literature
Project description:BackgroundThere is an ongoing debate about whether e-cigarettes act as a gateway to tobacco smoking or contribute to smoking cessation, and relevant studies are limited among Chinese adolescents. This cross-sectional study therefore aimed to explore the relationship between e-cigarette use and susceptibility to tobacco product use among Chinese high school students.MethodsThe study population comprised 107,633 never smokers and 19,377 former smokers, generated from the 2019 China National Youth Tobacco Survey. The primary independent variables of interest were ever e-cigarette use, current e-cigarette use, and the frequency of current e-cigarette use. The main outcome was the susceptibility to tobacco product use. Multilevel logistic regression was used to estimate the association between the primary independent variables of interest and the outcome variable. Moreover, two additional multilevel logistic regression models were fitted using two alternative definitions of the outcome as the sensitivity analyses.ResultsAmong never smokers, students who ever used e-cigarettes were more likely to be susceptible to tobacco product use compared to students who never used e-cigarettes (AOR = 2.83, 95%CI = 2.59-3.08). Students who currently used e-cigarettes were more likely to be susceptible to tobacco product use than those who did not currently use e-cigarettes (AOR = 3.89, 95%CI = 3.21-4.72). Among former smokers, with the same settings of modeling, the AORs were 1.76 (95%CI = 1.62-1.91) and 3.16 (95%CI = 2.52-3.97), respectively. Similar results were obtained from the two sensitivity analyses.ConclusionAmong Chinese high school students, both never smokers and former smokers, e-cigarette use, especially current e-cigarette use, was positively associated with susceptibility to tobacco product use. It is recommended to strengthen the monitoring of e-cigarettes and to provide targeted health education to adolescents.
| S-EPMC10823011 | biostudies-literature
Project description:ObjectivesThe objective of this study is to investigate the relationships between health literacy and numeracy (HLN) and patient portal use, measured in inpatient and outpatient settings.MethodsUsing data collected as part of a pragmatic randomized controlled trial conducted across the inpatient population of a U.S.-based academic medical center, the present study evaluated the relationships between patients' perceptions of health literacy and their skills, interpreting medical information with metrics of engagement with patient portals.ResultsSelf-reported levels of HLN for patients in the study sample (n = 654) were not significantly associated with inpatient portal use as measured by frequency of use or the number of different inpatient portal functions used. Use of the outpatient version of the portal over the course of 6 months following hospital discharge was also not associated with HLN. A subsequent assessment of patients after 6 months of portal use postdischarge (response rate 40%) did not reveal any differences with respect to portal use and health numeracy; however, a significant increase in self-reported levels of health literacy was found at this point.ConclusionWhile previous studies have suggested that low HLN might represent a barrier to inpatient portal adoption and might limit engagement with outpatient portals, we did not find these associations to hold. Our findings, however, suggest that the inpatient setting may be effective in facilitating technology acceptance. Specifically, the introduction of an inpatient portal made available on hospital-provided tablets may have practical implications and contribute to increased adoption of patient-facing health information technology tools.
| S-EPMC9259204 | biostudies-literature
Project description:ImportanceThe electronic cigarette (EC) has become popular among smokers who wish to reduce their tobacco use levels or quit smoking, but its effectiveness as a cessation aid is uncertain.ObjectiveTo examine the association of regular EC use with the number of cigarettes smoked per day, smoking cessation among current smokers, and smoking relapse among former smokers.Design, setting, and participantsThe CONSTANCES (Consultants des Centres d'Examens de Santé) cohort study, based in France, began recruiting participants January 6, 2012, and is currently ongoing. Participants were enrolled in CONSTANCES through 2015, and included 5400 smokers (mean [SD] follow-up of 23.4 [9.3] months) and 2025 former smokers (mean [SD] follow-up of 22.1 [8.6] months) at baseline who quit smoking in 2010, the year in which ECs were introduced in France, or afterward. Analyses were performed from February 8, 2017, to October 15, 2018.Main outcomes and measuresThe association between EC use and the number of cigarettes smoked during follow-up was studied using mixed regression models. The likelihood of smoking cessation was studied using Poisson regression models with robust sandwich variance estimators. The association between EC use and smoking relapse among former smokers was studied using Cox proportional hazards regression models. All statistical analyses were adjusted for sociodemographic characteristics, duration of follow-up, and smoking characteristics.ResultsAmong the 5400 daily smokers (2906 women and 2494 men; mean [SD] age, 44.9 [12.4] years), regular EC use was associated with a significantly higher decrease in the number of cigarettes smoked per day compared with daily smokers who did not use ECs (-4.4 [95% CI, -4.8 to -3.9] vs -2.7 [95% CI, -3.1 to -2.4]), as well as a higher adjusted relative risk of smoking cessation (1.67; 95% CI, 1.51-1.84]). At the same time, among the 2025 former smokers (1004 women and 1021 men; mean [SD] age, 43.6 [12.1] years), EC use was associated with an increase in the rate of smoking relapse among former smokers (adjusted hazard ratio, 1.70; 95% CI, 1.25-2.30).Conclusions and relevanceThis study's findings suggest that, among adult smokers, EC use appears to be associated with a decrease in smoking level and an increase in smoking cessation attempts but also with an increase in the level of smoking relapse in the general population after approximately 2 years of follow-up.
| S-EPMC6632120 | biostudies-literature