Abstract
Background
The combustion of tobacco is the main cause of tobacco-related morbidity and mortality. E-cigarettes are potentially disruptive innovations with considerable potential for ...population health. A key question is whether e-cigarettes are replacing tobacco cigarettes, which requires mapping their prevalence. Collecting information on nicotine use is difficult for many countries due to cost. The objective of this study was to derive a global estimate of e-cigarette use (vaping).
Methods
Since 2018 we have collected information on the prevalence of e-cigarette use. To estimate the prevalence of vaping in countries lacking information, we used the method of assumed similarity between countries in the same region and economic condition. Based on surveys, we calculated the average prevalence of vaping for each WHO region, World Bank income classification group, and the legal status of e-cigarettes in each country. For each of these groups the average prevalence of vaping was calculated. These values were used as substitutes for the prevalence figures in the countries with absent data. The number of vapers was calculated by taking as the denominator the adult population.
Results
Survey data on e-cigarette users were available for 49 countries covering 2.8 b of the adult population in 2018 and unavailable for 2.9 b. Information on vaping was lacking for half of the world's population. We estimated a total of 58.1 m vapers worldwide in 2018. By reference to market growth the data were adjusted to arrive at estimates for 2020. Results were fitted to revenue data at the 2018. For the year 2020, the projection is for 68 m vapers globally.
Conclusions
Many global epidemiological studies use the method of assumed similarity between countries with shared characteristics in order to estimate missing data. The methodological limitations are likely to overestimate the global number of vapers. Our estimate of 68 m vapers indicates considerable uptake given that: e-cigarettes have been available on most markets for only a decade; there is either no support, or there is opposition to vaping in many countries; and countries which regulate e-cigarettes have controls over advertising and promotion. However, given the global scale of tobacco smoking (at 1.1 billion people), progress in adoption of alternative products is slow. Those using e-cigarettes are still a small fraction of those who smoke.
To provide global estimates of the prevalence of injecting drug use (IDU) and HIV prevalence among IDU, in particular to provide estimates for developing and transitional countries.
Collation and ...review of existing estimates of IDU prevalence and HIV prevalence from published and unpublished documents for the period 1998-2003. The strength of evidence for the information was assessed based on the source and type of study.
Estimates of IDU prevalence were available for 130 countries. The number of IDU worldwide was estimated as approximately 13.2 million. Over ten million (78%) live in developing and transitional countries (Eastern Europe and Central Asia, 3.1 million; South and South-east Asia, 3.3 million; East-Asia and Pacific, 2.3 million). Estimates of HIV prevalence were available for 78 countries. HIV prevalence among IDU of over 20% was reported for at least one site in 25 countries and territories: Belarus, Estonia, Kazakhstan, Russia, Ukraine, Italy, Netherlands, Portugal, Serbia and Montenegro, Spain, Libya, India, Indonesia, Malaysia, Myanmar, Nepal, Thailand, Viet Nam, China, Argentina, Brazil, Uruguay, Puerto Rico, USA and Canada.
These findings update previous assessments of the number of countries with IDU and HIV-infected IDU, and the previous quantitative global estimates of the prevalence of IDU. However, gaps remain in the information and the strength of the evidence often was weak.
Summary High prevalence of HIV infection and the over-representation of injecting drug users (IDUs) in prisons combined with HIV risk behaviour create a crucial public-health issue for correctional ...institutions and, at a broader level, the communities in which they are situated. However, data relevant to this problem are limited and difficult to access. We reviewed imprisonment, HIV prevalence, and the proportion of prisoners who are IDUs in 152 low-income and middle-income countries. Information on imprisonment was obtained for 142 countries. Imprisonment rates ranged from 23 per 100 000 population in Burkina Faso to 532 per 100 000 in Belarus and Russia. Information on HIV prevalence in prisons was found for 75 countries. Prevalence was greater than 10% in prisons in 20 countries. Eight countries reported prevalence of IDUs in prison of greater than 10%. HIV prevalence among IDU prisoners was reported in eight countries and was greater than 10% in seven of those. Evidence of HIV transmission in prison was found for seven low-income and middle-income countries. HIV is a serious problem for many countries, especially where injection drug use occurs. Because of the paucity of data available, the contribution of HIV within prison settings is difficult to determine in many low-income and middle-income countries. Systematic collection of data to inform HIV prevention strategies in prison is urgently needed. The introduction and evaluation of HIV prevention strategies in prisons are warranted.
Stimson discusses his time with the International Journal of Drug Policy. According to him, he started his job in 2011, and over the last 16 years he is pleased to see how the journal has developed. ...The Journal's impact factor is a healthy 3.119 making it the fourth highest rated journal in the 'addictions' grouping of journals. It has become a strong academic journal: it has lost the news, views and immediacy of our predecessor journal, but gained in strength of evidence and argument.
Purpose
The purpose of this paper is to compare the response to HIV/AIDS and drug use (drugs harm reduction) with tobacco harm reduction.
Design/methodology/approach
Analysis of historical and ...contemporary sources, combined with personal knowledge of key stakeholders in the history and development of both fields.
Findings
Both drugs harm reduction and tobacco harm reduction share a similar objective – to reduce health risks for people who are unwilling or unable to stop using their drug of choice. Both also share a broader public health aim of helping people to make healthier decisions. Drugs harm reduction – as a response to HIV/AIDS – included the adoption of a wide range of radical harm reduction interventions and was a public health success. It became an established part of the professional Public Health agenda. In contrast the Public Health response to e-cigarettes and tobacco harm reduction has ranged from the negative to the cautious. A recent Public Health England report is exceptional for its endorsement of e-cigarettes.
Originality/value
Highlights contradictions in Public Health responses to drugs and tobacco; and that public health interventions can be implemented without and despite the contribution of professional Public Health.
Introduction
The study investigated the role and activities of organizations that advocate for the adoption of and access to safer nicotine products (SNPs), such as nicotine vaping products ...(e‐cigarettes), Swedish‐style snus, nontobacco nicotine pouches, and heated tobacco products, as safer alternatives to combustible cigarettes and other high‐risk tobacco products, following a harm reduction approach. The aim was to map the number and locations of nicotine consumer organizations globally and describe their history, legal status, membership, structure, objectives, working methods and activities, and funding.
Methods
We identified active organizations through the use of existing networks and referrals. All identified organizations were contacted and asked to fill in an online self‐completion survey through the representatives of the organizations. The data collected were cleaned and anonymized. Categorization and analysis of variable distributions were carried out. Responses to open–ended questions were analyzed qualitatively.
Results
A total of 52 active organizations were identified: 13 in Latin America, 8 in Africa, 24 in Europe, 5 in the Asia‐Pacific region, and 2 in North America. Most were established from 2016 onward, and 39 were legally incorporated. Their reported objectives were to raise awareness about SNP, promote rights to access SNP, and advocate for a legal and regulatory environment in which SNPs are available. They are small organizations: Most are operated with volunteers, with only 7 having any contracted or paid staff, and only 13 persons globally with a paid position. A total of 31 organizations had not received any funding support. The total global funding for all organizations was US$ 309,810. None reported receiving funding from tobacco or pharmaceutical companies. All pointed to important achievements in the public debate about SNP and tobacco harm reduction.
Conclusion
The organizations are run by enthusiastic individuals, most of whom have successfully quit smoking with the help of SNP. Organizations depend on the input of a small number of core workers, all organizations are under‐resourced and potentially fragile, and yet, they report significant activity and success. The challenge for these groups is to gain recognition at national and international level as legitimate stakeholders in the development of tobacco control policy with respect to safer alternatives to smoking.
The worldwide shortage of organs for transplantation makes it important to understand why some oppose donation. Attitudes vary with religion and ethnicity. Accordingly, we undertook a qualitative ...study of the attitudes of 141 U.K. Muslim Indo‐Asians to organ donation. Participants were observed, focus group discussions held and in‐depth individual interviews conducted. We identified a high level of alienation from the health care system in general. With respect to organ donation in particular, its importance was generally discounted, often in deference to authority figures within the community who appeared negatively disposed. The culture‐specific issues arguing against donation included a sense of the sacredness of the body, a fatalistic approach to illness, a belief that organs took on an independent role as ‘witnesses’ to an individual's life on Judgement Day and an anxiety that the donor would have no control of the probity of the recipient of an organ. We believe these data suggest a need to improve in a culturally sensitive fashion the provision of health information provided to this community.
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