Search

Background: Adolescents are susceptible to using tobacco because of early exposure to tobacco through family members, easy access, or peer pressure. School-based educational programs are crucial for raising awareness of the harms of tobacco, thus preventing its uptake among adolescents. Studies conducted recently have recognized the need to bring change and reinforce ongoing school-based anti-tobacco education programs. Our study protocol aims to evaluate the effectiveness of a revised school-based anti-tobacco education on susceptibility to tobacco use among school-going adolescents. Method: Project TEACH (Tobacco Education and Awareness for Creating Healthier Adolescents) is an educational intervention that will comprise an animated video on the effects of tobacco on physical and mental health, along with dispelling myths about tobacco, which will be delivered along with a standard education program. The control group will only receive the standard school-based anti-tobacco education program. It will be conducted among students between 6 th to 10 th grade, with a sample size of 3,310 students. Results: Bivariate relations between the main socio-demographic characteristics and susceptibility to tobacco use will be tested using Pearson or Spearman’s correlation coefficients. For multivariable analyses, the binary logistic regression analysis is used to establish a risk model to correlate the socio-demographic factors with susceptibility to tobacco use and awareness of the harms of tobacco. Conclusion: Project TEACH aims to provide a sustainable school-based anti-tobacco education intervention. It will help test the effectiveness of the revised intervention, which could be incorporated into the current school education program being conducted in the district.

Introduction India has unique tobacco-free film and TV rules designed to prevent tobacco uptake. In this study, we examined the potential influence of exposure to smoking imagery in regionally famous films, on susceptibility to smoke in teenagers enrolled in schools in a district in Southern India. Methods A longitudinal survey of students, in grades 6 to 8 at baseline in 2017 and grades 7 to 9 one year later in 2018, ascertained prospective incident susceptibility to smoking during the study period in relation to baseline exposure to 27 locally popular films with actual or implied smoking imagery. Results We analyzed linked data from 33676 participants, and 3973 (11.8%) of the adolescents reported incident susceptibility. There was a significant increase in susceptibility to smoking with increasing exposure at baseline to smoking imagery in films on univariable analysis, highest tertile of exposure relative to no exposure (OR=1.4; 95% CI: 1.0 –2.1, ptrend

Introduction: Muscular Fitness (MF) is a potent indicator and reliable marker of children’s and adolescents’ general health and well-being. Further, MF is a significant predictor of biopsychosocial well-being among children. Aim: To compare Hearing Impaired (HI) and normal hearing childrens’ minimum MF utilising the Kraus-Weber (K-W) test. Materials and Methods: This was a cross-sectional study conducted at Holy Cross School for the Hearing Impaired and Sacred Heart High School at Vellore, Tamil Nadu, India. The duration of the study was from July 10, 2018 to 20 December, 2018. A total of 167 children of both genders aged 12 to 16 years, from a boarding school in southern India with congenital hearing loss (n=82) and normal hearing (n=85) children were included in this study. The demographic information of the participants, anthropometric measures, and six subtests of the K-W tests for minimum MF were evaluated. JASP (Jeffreys’s Amazing Statistics Program) version 0.16.1 was used for all statistical analyses. Descriptive statistics and Chi-squared test compared K-W test item success and failure rates. MannWhitney test evaluated physical differences. The level of significance was fixed 0.05. Results: The current research found that children with HI had a significantly lower minimum level of MF than children with normal hearing on K-W Test-3 (Abdominal minus psoas), K-W Test-5 (Lower back muscles), and K-W Test-6 (Back and Hamstrings) (p-value

Introduction In India there is insufficient knowledge of the risks associated with tobacco use. Increasing awareness of these risks is critical, with pictorial warnings on tobacco packs a cost-effective way to communicate this information. We explored perceptions of the current warning, ‘Tobacco causes cancer’, displayed on packs in India and four novel warnings about other potential impacts of tobacco use including social, financial, and environmental, but also complications with diabetes. As loose cigarette sales are common in India, we also explored perceptions of warnings on cigarette sticks. Methods A cross-sectional survey of college students aged ≥18 years in Karnataka, India, was conducted between January 2019 and February 2020. Participants were asked about salience, believability, and cognitive processing of warnings currently on packs. They were then shown an image of one current and four novel warnings and asked about their perceived effectiveness in preventing uptake and reducing and stopping tobacco use. They were then asked about warnings on cigarette sticks. Results Most participants (70.2%) recalled warnings on packs and considered them believable (55.7%), but only 12.0% read and 12.4% thought about them often. Warnings about the health impacts of tobacco use were viewed as most effective in preventing uptake, and reducing and stopping tobacco use. Nevertheless, at least a third of participants rated warnings pertaining to financial, social, and environmental impacts effective in preventing uptake, and reducing and stopping tobacco use. Approximately one-fifth (22.0%) thought that warnings on cigarette sticks would deter initiation. Conclusions Our results suggest that health warnings are perceived as most effective in discouraging tobacco use among college students in Karnataka. While viewed as less effective than health warnings, novel non-health related messages were viewed as effective in preventing uptake, and reducing and stopping tobacco use by at least one in three participants. Warnings on cigarette sticks may help complement warnings on cigarette packs.

Plain English summary Supporting patients to stop smoking when they attend lung cancer screening will improve the overall benefit and value for money of the service. This study developed a booklet containing pictures of a person’s own lungs and heart taken during a lung cancer screening scan. The booklet shows areas of damage to the heart and lungs caused by smoking, delivered alongside positive messages to build confidence to stop smoking and let patients know about the benefits of stopping smoking. To develop the booklet, we worked with members of public who currently or used to smoke. Eight members of public completed a survey asking about the best ways to present information about risk. Thirteen members of the public took part in focus groups to co-develop the booklet. One workshop with academic and healthcare professionals and one workshop with a public involvement panel were held to develop and finalise the booklet. Members of the public said they wanted information about the short-term benefits of quitting smoking, and that coloured drawings next to the scan picture would help them to understand what the scan picture meant. Having someone specially trained to guide them through the booklet was considered important. Being told about their risk for lung cancer in the future was off-putting and might discourage a quit attempt. We have co-developed a booklet to support people to quit smoking when they go for lung cancer screening. The booklet is currently being tested to see whether it can support people to quit smoking.

Objective This study explored multistakeholder perspectives on existing adolescent-specific tobacco control policies and programmes, to advance India’s transition towards a tobacco-free generation.Design Qualitative semi-structured interviews.Setting Interviews were conducted with officials involved in tobacco control at the national (India), state (Karnataka), district (Udupi) and village level. Interviews were audio recorded, transcribed verbatim and analysed thematically.Participants Thirty-eight individuals representing national (n=9), state (n=9), district (n=14) and village (n=6) levels, participated.Results The study findings highlighted the need to strengthen and amend the existing Tobacco Control Law (2003) provisions, particularly in the vicinity of schools (Sections 6a and 6b). Increasing the minimum legal age to buy tobacco from 18 to 21 years, developing an ‘application’ for ‘compliance and monitoring indicators’ in Tobacco-Free Educational Institution guidelines were proposed. Policies to address smokeless tobacco use, stricter enforcement including regular monitoring of existing programmes, and robust evaluation of policies was underscored. Engaging adolescents to co-create interventions was advocated, along with integrating national tobacco control programmes into existing school and adolescent health programmes, using both an intersectoral and whole-societal approach to prevent tobacco use, were recommended. Finally, stakeholders mentioned that when drafting and implementing a comprehensive national tobacco control policy, there is a need to adopt a vision striving toward a tobacco-free generation.Conclusion Strengthening and developing tobacco control programmes and policies are warranted which are monitored and evaluated rigorously, and where adolescents should be involved, accordingly.

With the increasing need for energy efficiency, fiber-reinforced composites are being widely used in the automotive industry. This study investigates the inter-laminar fracture behavior of fiber-reinforced composite double cantilever beam specimens considering a non-zero slope at the root. Experiments were conducted on unidirectional and cross-ply glass fiber reinforced epoxy composite specimens and the critical delamination toughness $\left({G}_{IC}\right)$ has been evaluated by the proposed weighted residual equation. The proposed mathematical model requires crack length and the load versus displacement data to evaluate delamination fracture energy. This method accounts the measurement scatter and the rotation at the crack tip. For a particular specimen, the proposed model gives a unique value of critical delamination toughness value. The critical interface failure load estimates utilizing the evaluated delamination toughness agrees well with literature and in-house test results of double cantilever beam specimens.

Abstract Background Advertising alcoholic drinks and food high in fat, sugar, and salt (HFSS) is a driver of alcohol use and HFSS consumption, among children and young people. Whilst advertising legislation and broadcasting regulation protect children from alcohol and HFSS imagery, the 2018 FIFA World Cup, which attracted a global audience, was sponsored and partnered by alcohol and HFSS brands. This study investigated the exposure of viewers to HFSS and alcohol imagery in a selection of group matches, and the final match, of the FIFA 2018 World Cup. Methods The frequency and duration of appearances (to the nearest second) of branding from two sponsors (McDonald’s and Budweiser), one official partner (Coca-Cola) and the official sports drink (Powerade) were recorded during all active play in live coverage of a sample of 13 matches (Six in Group A, which included the host nation, Russia, which has stringent alcohol promotion regulations in place; six in Group G, which featured England; and the final) broadcast in the UK. We used census and viewing data to calculate gross and per capita impressions generated by this imagery in the UK population. Results The 13 matches included 1262 min of active play and a total of 1806 appearances of alcohol and HFSS food advertisements, delivering approximately 7.5 billion branded HFSS impressions, including 759 million to children (age

Abstract Background Excessive alcohol consumption is an important risk factor for increased morbidity, mortality and other social harms globally. Televised sport allows the promotion of alcoholic drinks to a large and often young audience, and thus can be used to develop new markets for alcohol in low- and middle-income countries. This study aimed to analyse the alcohol advertising displayed during televised English Premier League (EPL) games, which is widely viewed in Ethiopia, and are particularly popular among young people. Methods Nineteen live televised EPL football matches broadcast in Ethiopia on the SuperSport channels over 4 weeks of the 2018/19 season were digitally recorded from the digital satellite television. Exposure to alcohol advertising was measured by calculating the total elapsed time duration with the alcohol content from the pre-match to the end of the post-game period of the broadcast. Results Data were available for a total of 2451 min broadcast time. Alcohol advertising accounted for 205.2 min (8.4%) with a mean duration of 10.8 min per match (range 5.5 to 22.6). The dominant format of alcohol advertisement was the display of logos associated with an alcoholic drink on the television (TV) screen, which accounted for approximately 43% of the total alcohol advertising time. This was followed by pitch side virtual display (17.7%) and a glass of alcohol drink on the TV screen (17.6%). Over three quarters of alcoholic drink advertising (77.7%) was during active football playing time. None of the advertisements on the televised football games showed cigarettes. Conclusion There is a high frequency of exposure to alcohol advertising during televised EPL matches in Ethiopia. It is important to ensure that the newly introduced domestic ban on alcohol advertising is also applied to foreign satellite broadcasters. This is likely to have relevance to other sub-Saharan African countries in promoting public health strategies to reduce harm from alcohol consumption.

Context: Emotion regulation (ER) is vital for well-being. Yogic personality traits, gunas, influence the expression of ER. Aims: To investigate the expression of ER based on guna-related personality traits employing explicit, implicit, and objective eye-tracking techniques. Settings and Design: Quota sampling was used, with a cross-sectional design with three groups, sattva, rajas, and tamas. Three hundred and ninety-four female students were screened and finally, 30 from sattva, 34 from rajas, and 36 from tamas were analyzed. Methods: Participants were given State and Trait Mindfulness Scales, Gita Inventory, Social Desirability Scale, state-trait anxiety inventory, Adult Attachment Scale, and Emotional Regulation Questionnaire. ER-Implicit Association Test (ER-IAT) and Eye Tracker were also used to evaluate the participants. Statistical Analysis Used: One-way repeated-measures analysis of variance was used to examine differences between sattva, rajas, and tamas. Results: Sattva group adopted a higher level of regulation strategy, ER-IAT scores were positive for sattva, negative for rajas and tamas. Mindfulness was highest and anxiety was least in sattva. In the eye tracker, within the non-emotional areas of interest (eAOI) regions of pleasant condition, and eAOI regions of unpleasant condition, sattva group had considerably higher dwell time. Pupil dilation was lowest in sattva for all the conditions, both within and outside eAOIs. Conclusions: Sattva guna was found to foster healthy ER, and other psychological attributes. Conscious cultivation of sattva is needed for healthy emotional life.

Most of the dyes are a dangerous class of water contaminants that have affected the environment drastically. Nano-sized compositeis the best decision cutting edge adsorbent for the evacuation of water poisons as such materials are related to the attributes of straightforwardness, adaptability, adequacy, and high surface reactivity. In this investigation, we have synthesized a nanostructured Chitosan-Selenium nanoparticle by green synthesis method using Justicia adhatoda plant leaves extract. Synthesis and characterization of Chitosan-Selenium nanoparticle were described by UV-visible spectroscopy, FTIR spectrum examinations, Particle Size Analysis, and XRD Spectrum analysis. From the outcomes, it was inferred that the Chitosan-Selenium nanoparticle was additionally utilized as an adsorbent for the expulsion of Rhodamine dye from the aqueous solution. Langmuir isotherm model was effectively usedfor the adsorption study of Chitosan-Selenium nanoparticle adsorbent. For the adsorption studies, parameters such asdosages, pH, and temperature were studied. The adsorption process was remarkably fast and reached equilibrium within 24hrs. The isotherm information was steady with the Langmuir model, and the most extreme adsorption limits of the Chitosan-Selenium nanoparticle adsorbent was 34.5mg.g-1 for Rhodamine dye. Accordingly, nanoparticleswill be the only wayfor the future planned water treatment process.

Abstract Recently, learning-based models have enhanced the performance of single-image super-resolution (SISR). However, applying SISR successively to each video frame leads to a lack of temporal coherency. Convolutional neural networks (CNNs) outperform traditional approaches in terms of image quality metrics such as peak signal to noise ratio (PSNR) and structural similarity (SSIM). On the other hand, generative adversarial networks (GANs) offer a competitive advantage by being able to mitigate the issue of a lack of finer texture details, usually seen with CNNs when super-resolving at large upscaling factors. We present iSeeBetter, a novel GAN-based spatio-temporal approach to video super-resolution (VSR) that renders temporally consistent super-resolution videos. iSeeBetter extracts spatial and temporal information from the current and neighboring frames using the concept of recurrent back-projection networks as its generator. Furthermore, to improve the “naturality” of the super-resolved output while eliminating artifacts seen with traditional algorithms, we utilize the discriminator from super-resolution generative adversarial network. Although mean squared error (MSE) as a primary loss-minimization objective improves PSNR/SSIM, these metrics may not capture fine details in the image resulting in misrepresentation of perceptual quality. To address this, we use a four-fold (MSE, perceptual, adversarial, and total-variation loss function. Our results demonstrate that iSeeBetter offers superior VSR fidelity and surpasses state-of-the-art performance.

Prevalence of non-communicable diseases (NCDs) is growing globally, with the greatest increase in NCD deaths expected to occur in sub-Saharan Africa (SSA) over the next five to 15 years. Tobacco use is implicated in all leading NCDs, and is one of the biggest global public health threats. Despite the projected increase in tobacco-related NCD deaths in low- and Middle-income countries (LMICs), research on tobacco control policy and implementation in SSA and more specifically, Ghana, is a low priority. To address these challenges, the School of Public Health (KNUST, Ghana) with support from the Tobacco Control Capacity Program (TCCP) funded by the Global Challenges Research Fund (GCRF) organized a 1-day stakeholder’s meeting to discuss the advancement of tobacco control research in Ghana. The aim was to propose the way forward for strengthening applied research that can inform the development of health policies and programs focused on tobacco control. Participants were drawn from academia, research and health institutions, civil society and non-governmental organisations. In this meeting overview, we present the key themes that emerged from the meeting and some strategies for advancing tobacco control research in Ghana and beyond. Directions for future research agenda include building institutional research capacity, strengthening stakeholder and public engagement on tobacco control, need for more local and comprehensive data and research, improve sustainable funding of comprehensive programs on tobacco control in Ghana and social and behavior change communication on tobacco use.

Objectives Though exposure to alcohol imagery in films is a significant determinant of uptake and severity of alcohol consumption among young people, there is poor evidence regarding the content of alcohol imagery in films in low-income and middle-income countries. We have measured alcohol imagery content and branding in popular Indian films, in total and in relation to language and age rating.Design In this observational study we measured alcohol imagery semiquantitatively using 5-minute interval coding. We coded each interval according to whether it contained alcohol imagery or brand appearances.Setting India.Participants None. Content analysis of a total of 30 national box office hit films over a period of 3 years from 2015 to 2017.Primary and secondary outcome measures To assess alcohol imagery in Indian films and its distribution in relation to age and language rating has been determined.Results The 30 films included 22 (73%) Hindi films and 8 (27%) in regional languages. Seven (23%) were rated suitable for viewing by all ages (U), and 23 (77%) rated as suitable for viewing by children subject to parental guidance for those aged under 12 (UA). Any alcohol imagery was seen in 97% of the films, with 195 of a total of 923 5-minute intervals, and actual alcohol use in 25 (83%) films, in 90 (10%) intervals. The occurrence of these and other categories of alcohol imagery was similar in U-rated and UA-rated films, and in Hindi and local language films. Episodes of alcohol branding occurred in 10 intervals in five films.Conclusion Almost all films popular in India contain alcohol imagery, irrespective of age rating and language. Measures need to be undertaken to limit alcohol imagery in Indian films to protect the health of young people, and to monitor alcohol imagery in other social media platforms in future.

The main causes of non-communicable diseases (NCDs), health inequalities and health inequity include consumption of unhealthy commodities such as tobacco, alcohol and/or foods high in fat, salt and/or sugar. These exposures are preventable, but the commodities involved are highly profitable. The economic interests of ‘Unhealthy Commodity Producers’ (UCPs) often conflict with health goals but their role in determining health has received insufficient attention. In order to address this gap, a new research consortium has been established. This open letter introduces the SPECTRUM (Shaping Public hEalth poliCies To Reduce ineqUalities and harM) Consortium: a multi-disciplinary group comprising researchers from 10 United Kingdom (UK) universities and overseas, and partner organisations including three national public health agencies in Great Britain (GB), five multi-agency alliances and two companies providing data and analytic support. Through eight integrated work packages, the Consortium seeks to provide an understanding of the nature of the complex systems underlying the consumption of unhealthy commodities, the role of UCPs in shaping these systems and influencing health and policy, the role of systems-level interventions, and the effectiveness of existing and emerging policies. Co-production is central to the Consortium’s approach to advance research and achieve meaningful impact and we will involve the public in the design and delivery of our research. We will also establish and sustain mutually beneficial relationships with policy makers, alongside our partners, to increase the visibility, credibility and impact of our evidence. The Consortium’s ultimate aim is to achieve meaningful health benefits for the UK population by reducing harm and inequalities from the consumption of unhealthy commodities over the next five years and beyond.

BackgroundExposure to tobacco imagery in films causes young people to start smoking. Popular Indian films contain high levels of tobacco imagery, but those that do are required by law to display onscreen health warnings when smoking imagery occurs and to include other health promotion messaging before and during the film. We report a prospective cohort study of incident smoking in relation to exposure to film tobacco imagery and anti-tobacco messaging in a cohort of children in southern India.MethodsWe carried out a one-year longitudinal follow up questionnaire survey in 2018 of a cohort of 39,282 students in grades 6, 7 and 8 (aged between 10 and 15 years) in schools in the Udupi district of Karnataka State in India who participated in a 2017 cross-sectional study of exposure to smoking in films and ever smoking status.ResultsWe obtained usable linked data in 2018 from 33,725 of the 39,282 (86%) participants with data from 2017. Incident smoking was reported by 382 (1.1%) participants. After adjusting for age, sex and common confounders significantly associated with incident smoking there was no significant independent effect of exposure to film smoking, either as a binary (Odds Ratio 1.6, 95% Confidence Interval (CI) 0.5 to 4.9) or as a graded variable, on smoking uptake. An exploratory analysis indicated that the presence of on-screen health warnings that complied fully with Indian law was associated with a significantly lower odds of smoking uptake (Odds Ratio 0.8 (0.6 to 1.0, p = 0.031) relative to the same exposure sustained in absence of compliant warnings.ConclusionExposure to tobacco imagery in Indian films was not associated with a significantly increased risk of incident smoking in South Indian children. While it is possible that this finding is a false negative, it is also possible that the effect of film exposure has been attenuated by the presence of on-screen health warnings or other Indian tobacco-free film rules. Our findings therefore support the wider implementation of similar tobacco-free film measures in other countries.

Introduction Integration of smoking cessation (SC) into lung cancer screening is essential to optimise clinical and cost effectiveness. The most effective way to use this ‘teachable moment’ is unclear. The Yorkshire Enhanced Stop Smoking study will measure the effectiveness of an SC service integrated within the Yorkshire Lung Screening Trial (YLST) and will test the efficacy of a personalised SC intervention, incorporating incidental findings detected on the low-dose CT scan performed as part of YLST.Methods and analysis Unless explicitly declined, all smokers enrolled in YLST will see an SC practitioner at baseline and receive SC support over 4 weeks comprising behavioural support, pharmacotherapy and/or a commercially available e-cigarette. Eligible smokers will be randomised (1:1 in permuted blocks of random size up to size 6) to receive either an enhanced, personalised SC support package, including CT scan images, or continued standard best practice. Anticipated recruitment is 1040 smokers (January 2019–December 2020). The primary objective is to measure 7-day point prevalent carbon monoxide (CO) validated SC after 3 months. Secondary outcomes include CO validated cessation at 4 weeks and 12 months, self-reported continuous cessation at 4 weeks, 3 months and 12 months, attempts to quit smoking and changes in psychological variables, including perceived risk of lung cancer, motivation to quit smoking tobacco, confidence and efficacy beliefs (self and response) at all follow-up points. A process evaluation will explore under which circumstances and on which groups the intervention works best, test intervention fidelity and theory test the mechanisms of intervention impact.Ethics and dissemination This study has been approved by the East Midlands-Derby Research Ethics Committee (18/EM/0199) and the Health Research Authority/Health and Care Research Wales. Results will be disseminated through publication in peer-reviewed scientific journals, presentation at conferences and via the YLST website.Trial registration numbers ISRCTN63825779, NCT03750110.

Objectives Exposure to alcohol imagery is associated with subsequent alcohol use among young people, and UK broadcasting regulations protect young people from advertising alcohol content in UK television. However, alcohol promotion during sporting events, a significant potential medium of advertising to children, is exempt. We report an analysis and estimate the UK population exposure to, alcohol content, including branding, in UK broadcasts of the 2018 Formula 1 (F1) Championship.Setting UK.Participants None. Content analysis of broadcast footage of 21 2018 F1 Championship races on Channel 4, using 1-minute interval coding of any alcohol content, actual or implied use, other related content or branding. Census data and viewing figures were used to estimate gross and per capita alcohol impressions.Results Alcohol content occurred in all races, in 1613 (56%) 1-minute intervals of race footage and 44 (9%) of intervals across 28% of advertisement breaks. The most prominent content was branding, occurring in 51% of race intervals and 7% of advertisement break intervals, appearing predominantly on billboard advertisements around the track, with the Heineken and Johnnie Walker brands being particularly prominent. The 21 races delivered an estimated 3.9 billion alcohol gross impressions (95% CI 3.6 to 4.3) to the UK population, including 154 million (95% CI 124 to 184) to children, and 3.6 billion alcohol gross impressions of alcohol branding, including 141 million impressions to children. Branding was also shown in race footage from countries where alcohol promotion is prohibited.Conclusions Alcohol content was highly prevalent in the 2018 F1 Championship broadcasts, delivering millions of alcohol impressions to young viewers. This exposure is likely to represent a significant driver of alcohol consumption among young people.

Objectives Asthma has not been extensively studied in low-income and middle-income countries, where risk factors and access to treatment may differ from more affluent countries. We aimed to identify the prevalence of asthma and local risk factors in Havana, Cuba.Setting Four municipalities in Havana, Cuba.Participants A population-based cohort study design of young children living in Havana, Cuba. Children were recruited from primary care centres at age 12–15 months.Primary and secondary outcome measures Data on wheeze in the past 12 months, asthma treatment and environmental exposures collected regularly until the age of 6 years, when forced expiratory volume in 1 s (FEV1) and reversibility to aerosolised salbutamol were also measured.Results 1106 children provided data at the age of 6 years old. The prevalence of wheeze in the previous 12 months was 422 (38%), and 294 (33%) of the study population had bronchodilatation of 12% or more in FEV1 after administration of inhaled salbutamol. In the previous 12 months, 182 (16%) of the children had received inhaled corticosteroids, 416 (38%) salbutamol inhalers and 283 (26%) a course of systemic steroids.Wheeze in the first year and a family history of asthma were both positively associated with bronchodilatation to inhaled salbutamol (1.94%; 95% CI 0.81 to 3.08 and 1.85%; CI 0.14 to 3.57, respectively), while paracetamol use in the first year was associated with wheeze at 6 years (OR 1.64, 95% CI 1.14 to 2.35). There were large differences in FEV1, bronchodilatation and risk of wheeze across different geographical areas.Conclusions Asthma is common in young children living in Havana, and the high prevalence of systemic steroids administrated is likely to reflect the underuse of regular inhaled corticosteroids. If replicated in other comparable low-income and middle-income countries, this represents an important global public health issue.

Tobacco use is the leading cause of preventable deaths in the world, with most of these deaths now occurring in low and middle-income countries (LMICs). Sub-Saharan Africa (SSA) is at an early stage of a tobacco epidemic and is, therefore, particularly vulnerable to rapid growth in tobacco consumption. More than a decade into the implementation of the World Health Organization's Framework Convention on Tobacco Control (FCTC), State Parties in several countries in SSA, such as Ghana, have yet to fully fulfil their obligations. Despite early ratification of the FCTC in 2004, progress in implementing tobacco control measures in Ghana has been slow and much work remains to be done. The aim of this paper is to critically reflect on tobacco control implementation in Ghana, identify significant research priorities and make recommendations for future action to support tobacco control implementation. We emphasize the need for stronger implementation of the FCTC and its MPOWER policy package, particularly in the area of tobacco taxes, illicit trade and industry interference.

Abstract Background Second-hand smoke (SHS) causes numerous health problems in children such as asthma, respiratory tract infections and sudden infant death syndrome. The home is the main source of exposure to SHS for children, particularly for young children. We estimated the cost-effectiveness of a complex intervention designed to reduce SHS exposure of children whose primary caregiver feels unable or unwilling to quit smoking. Methods A cost-effectiveness analysis was carried out alongside an open-label, parallel, randomised controlled trial in deprived communities in Nottingham, England. A complex intervention combining behavioural support, nicotine replacement therapy and personalised feedback on home air quality was compared with usual care. A total number of 205 households were recruited, where the main caregivers were aged 18 and over, with a child aged under five years living in their household reporting smoking inside their home. Analyses for this study were undertaken from the National Health Service/Personal Social Services perspective. All costs were estimated in UK pounds (£) at 2013/14 prices. The primary outcome was the incremental cost-effectiveness of change in air quality in the home, measured as average 16–24 h levels of particulate matter of

Abstract Background Exposure to audio-visual alcohol content in media is associated with subsequent alcohol use among young people. In 2016 Heineken launched its global Formula One (F1) partnership and had a significant brand presence at a number of 2017 F1 race events. We have measured the extent to which Heineken and other alcohol content appears in a sample of the first 6 races broadcast in the UK during the 2017 F1 Championship. Methods We used 1-min interval coding to quantify alcohol content in all broadcast footage, including advertisement breaks. Results Alcohol content occurred in all of the races shown and in 41% of all advertisement breaks in the programming. The most prominent content was alcohol branding, occurring in 39% of race footage intervals. Alcohol branding consisted mostly of billboard advertisements or branding on the side of cars or racing suits with Heineken and Johnnie Walker being most prominent. Alcohol branding was shown in race footage from countries where alcohol promotion is prohibited. All of the race footage was broadcast on Channel 4 on a Sunday, with start times ranging from 12:35 to 18:45. Conclusion Audio-visual alcohol content, including branding, was highly prevalent footage of 2017 F1 races broadcast during peak viewing times in the UK. This content is likely to be a significant driver of alcohol consumption among children and adolescents.

Abstract Background Alcohol advertising is a key driver of alcohol consumption, and is prohibited in France by the Loi Evin. In 2016 the Danish brewer Carlsberg sponsored the UEFA Euro 2016 finals, held in France, and used the alibis ‘Probably’ and ‘…the best in the world’ in place of Carlsberg in pitch-side advertising. We have quantified the advertising exposure achieved during the final seven games in the UEFA Euro 2016 championship. Methods Appearances of the Carlsberg alibis ‘Probably’ and ‘the best in the world’ were counted and timed to the nearest second during all active play in live coverage of quarter final, semi-final and final matches broadcast in the UK. We used census data and viewing figures from Kantar Media to estimate gross and per capita impressions of these advertisements in the UK population. Results In 796 min, 29 s of active play there were 746 alibi appearances, totalling 68 min 35 s duration and representing 8.6% of active playing time. Appearances were particularly frequent at the end of normal time, extra time and penalties. The seven matches delivered up to 7.43 billion Carlsberg alibi impressions to UK adults and 163.3 million to children. In the only match involving a second country with laws prohibiting alcohol advertising (France versus Iceland), exposure occurred for only 1.8% of playing time. Conclusions Alibi marketing achieved significant advertising coverage during the final seven EURO 2016 championship games, particularly to children. Since ‘Probably’ is registered by Carlsberg as a wordmark this advertising appears to contravene the Loi Evin, though Carlsberg have defended their marketing actions.

Abstract Background ‘Vape shops’ are a popular source for buying electronic cigarettes (e-cigarettes) and related products. The products that vape shops sell, their marketing techniques and the extent to which they provide information or encouragement to smokers to quit tobacco use, as well as the patterns of tobacco and e-cigarette use of their customers are not well understood. Methods We conducted cross-sectional surveys in vape shops in the East Midlands region of the United Kingdom, one with shop staff (n = 41), and one with customers (n = 197). Results The majority of customers (84%) currently used e-cigarettes. Among current vapers, 19% were dual users and 78% had quit smoking. Over half of vapers reported using a lower level of nicotine in their current e-liquid than when they started using e-cigarettes. There was a wide variety in products and price ranges between the shops. Many staff reported that customers ask for information about quitting smoking (90%). Less than half reported providing smoking cessation advice, although 76% of staff reported feeling confident about delivering cessation advice to customers who ask for it. Just under half of customers and shop staff said they thought it was appropriate to deliver formal in-store smoking cessation support. Conclusions The majority of vape shop customers are vapers who have quit smoking. Shop staff play a central role in providing customers with product information, and many provide smoking cessation advice. Further research is needed to investigate the potential for smoking cessation interventions in vape shops, including the extent to which these would appeal to non-vapers.

Introduction The Government of India has taken several steps to reduce tobacco use, including legislation in the Cigarettes and Other Tobacco Products Act (COTPA) requiring health warnings on tobacco products. This study assessed compliance with the legislation on warnings, and awareness of these warnings and their perceived impact in preventing tobacco uptake among college students in a district of Karnataka, India. Material and Methods This study consisted of two components, pack collection and a survey. For the first, tobacco packs were obtained from all tobacco selling shops in an urban and a rural locality in the Karkala block of Udupi district. Empty cigarette packs were collected from shops, and full packs were purchased if empty packs were not available . The packs were collected to measure their dimensions, as per the Tobacco Pack Surveillance System guidelines, and assessed for compliance, as per COTPA. For the second component of the study, a questionnaire was distributed to each college student to fill in; this was done to assess awareness of the new warnings at the time of the pilot survey, knowledge of harms, and perceptions of the warnings in reducing tobacco uptake. Results We collected 26 tobacco packs. Two (8%) packs had warnings that were the correct size (85% of the main display areas), 15 (58%) packs had clear and legible warnings, and 18 (69%) packs had warning messages in the appropriate language. In the student survey, 60% of males and 52% of females indicated that they would not start using any tobacco products on seeing the new warnings. Conclusions Only a few studies other than our pilot study have assessed compliance with legislation on health warnings in low- or middle-income countries. Although health warnings were perceived as a deterrent to tobacco use among students, compliance with national legislation in this pilot study was found to be low.

Table of contents A1 Characterization of the immunoallergic profile towards the proteins of the wheat flour in Cuban population Raúl Lázaro Castro Almarales, Mary Carmen Reyes Zamora, Beatriz Tamargo, Damaris Torralba Averoff, Raysa Cruz, Yunia Oliva Diaz, Mirta Alvarez Castello, Alexander Ciria, Alexis Labrada, Maytee Mateo A2 Are peanuts causing food allergy in Cuba? Maytee Mateo, Damaris Torralba Averoff, Raysa Cruz, Yunia Oliva Diaz, Mirta Alvarez Castello, Alexander Ciria, Mary Carmen Reyes Zamora, Beatriz Tamargo, Alexis Labrada A3 Prick test and immunoallergic profile to soy allergens in Cuban population Omar Herrera, Maytee Mateo, Raysa Cruz, Mirta Alvarez Castello, Alexander Ciria, Raúl Lázaro Castro Almarales, Mary Carmen Reyes Zamora, Alexis Labrada A4 Skin sensitization and immunoallergic profile to hen's egg in Cuban population José Severino Rodríguez Canosa, Raysa Cruz, Maytee Mateo, Mirta Alvarez Castello, Alexander Ciria, Raúl Lázaro Castro Almarales, Mary Carmen Reyes Zamora, Alexis Labrada A5 Sensitization to three domestic mites in patients with adverse food events to shellfish Mirta Alvarez Castello, Raúl Lázaro Castro Almarales, Alexis Labrada, Biocen A6 Diagnostic efficacy by skin prick test with allergenic extracts of legumes in Cuban patients Yamilet Ibizate Novales, Ilonka Estruch Fajardo, Alexis Labrada, Maytee Mateo, Armando Ginard A7 Baked egg goods without wheat flour carry an increased risk of reaction Bruce Lanser, Anna Faino, Erwin Gelfand, Pia Hauk A8 Prevalence, incidence and associated risk factors of adverse reaction to food in Cuban infants - a population-based prospective study Silvia Venero Fernández, Julia Urbina, Mirta Alvarez Castello, Raúl Lázaro Castro Almarales, Ramón Suárez Medina, Hermes Fundora Hernández, John Britton, Andrew William Fogarty A9 Microbiome in ice machines and assessing the plasma nanotechnology in breaking the biofilm and improving air quality Nabarun Ghosh, Clinton Ross Bell, Chandini Revanna, Constantine Saadeh, Jeff Bennert, Danius Bouyi, Mitsy Veloz, Nelofar Sherali A10 Characteristics of patients with food allergy in health public service Magna Coelho A11 Allergic rhinitis and asthma index increased in Texas panhandle and AHPCO and plasma nanotechnology as solutions Nabarun Ghosh, Jeff Bennert, Danius Bouyi, Constantine Saadeh, Clinton Ross Bell, Mitsy Veloz, Chandini Revanna, Nelofar Sherali A12 Antigen-specific T follicular helper cells mediate peanut allergy in mice Joseph J. Dolence, Takao Kobayashi, Koji Iijima, Hirohito Kita, Hirohito Kita, Ashli Moore, James Krempski A13 Production of recombinant Mal d 3, a major apple allergen, in Pichia Pastoris, to investigate the impact of the food matrix and post-translational modifications on Mal d 3 immuno-reactivity Roberta Aina, Riccardo Asero, Sabine Pfeifer, Pawel Dubiela, Merima Bublin, Christian Radauer, Piotr Humeniuk, Karin Hoffmann-Sommergruber A14 Reaction to sports drink: no whey! Whey allergy in absence of clinical cow’s milk allergy Frank Eidelman, Ves Dimov, Charl Khalil A15 Food allergy on Tumblr: focus on teenage audience may increase educational impact Ves Dimov, Frank Eidelman, Charl Khalil A16 Changes in IgE levels following one-year immunizations in two children with food allergy Alice E. W. Hoyt, Peter Heymann, Alexander Schuyler, Scott Commins, Thomas Platts-Mills A17 IgE and IgG4 antibodies to cow's milk components in children with eosinophilic esophagitis: higher specific IgG4 antibodies and IgG4:IgE ratios compared with subjects with IgE-mediated food allergy Alexander Schuyler, Patrice Kruszewski, John Russo, Lisa Workman, Thomas Platts-Mills, Elizabeth Erwin, Anubha Tripathi A18 Frequency of Sensitization to Food Allergens in Patients with Rhinitis and Asthma in the National Medical Center La Raza “Dr. Antonio Fraga Mouret”, Mexico City Gabriela Yvette Castellanos, Elizabeth Mendieta, Martín Becerril-Angeles

Abstract Background Evidence from the US Truth campaign suggests that interventions focusing on tobacco industry tactics can be effective in preventing smoking uptake by children. Operation Smoke Storm is the first school-based intervention based on this premise and comprises three classroom sessions in which students act as secret agents uncovering tobacco industry tactics through videos, quizzes, discussions, and presentations. We report a qualitative evaluation of its acceptability. Methods We conducted eight focus groups with 79 students aged 11-12 who participated in Operation Smoke Storm at two UK schools in Autumn 2013, and 20 interviews with teachers who delivered the intervention. These were digitally audio-recorded, transcribed verbatim and analysed using the framework method. Results Students enjoyed the secret agent scenario and reported acquiring new knowledge about smoking and the tobacco industry, which seemed to strengthen their aversion to smoking. Teachers felt confident delivering the ‘off the shelf’ resource, although they would have welcomed more background information about the topic and guidance on steering discussions. Teachers highlighted a need for the resource to be flexible and not dependent on lesson length, teacher confidence, or expertise. Students and teachers endorsed the idea of developing a booster component for older students and supported the development of printed information complementing the resource to encourage parents to support their child not to smoke. Conclusions These findings demonstrate that Operation Smoke Storm can be delivered by teachers to raise awareness about smoking-related issues. The ideas and issues raised are now being used to improve and extend the resource for further evaluation.

The practice of delayed cord clamping (DCC) in premature infants has proven benefit to the neonate. In a community-based perinatal centre, the practice of DCC for more than 60 s for premature infants with gestational age of

Background Hospital admission provides an ideal opportunity to promote smoking cessation. Clinical guidelines recommend delivery of cessation interventions for all admissions but no research to date has focused on supporting smokers who successfully abstain from smoking whilst in hospital to maintain abstinence after discharge. We therefore designed a trial to test the effectiveness of an intensive home support intervention to maintain abstinence from smoking for newly abstinent smokers leaving hospital Methods Participants were recruited from 18 medical wards in one large teaching hospital in the UK and were individually randomised to either intervention or usual care using concealed allocation. During inpatient stay both treatment groups received smoking cessation support as recommended in NICE PH48 guidance. At discharge, patients randomised to usual care were offered a referral to a community Stop Smoking Service (SSS). Patients randomised to the intervention group were offered a home visit (or telephone call if a home visit is refused), as soon as practicable after discharge and typically within 48 hours, to deliver a multi-component intervention which included personalised behavioural support and nicotine replacement therapies (NRT). All smokers were asked to give consent to be contacted at four-weeks and three-months after discharge to assess smoking status and use of cessation support. Results 404 patients were randomised in total. 200 to intervention and 204 to usual care. Primary outcome data were available at four-weeks for 149 and 134 patients, respectively. Preliminary results demonstrate no statistically significant difference in quit rates between treatment groups at either 4 (21.00% intervention, 19.12% usual care) or 12 weeks (19.50% Intervention and 16.18% Usual Care) following discharge. Conclusions Adding a home visit to deliver additional smoking cessation support to patients who have remained abstinent during their hospital stay and treated according to NICE PH48 guidance does not increase quit rates.