Summary Background Ending the global tobacco epidemic is a defining challenge in global health. Timely and comprehensive estimates of the prevalence of smoking tobacco use and attributable disease burden are needed to guide tobacco control efforts nationally and globally. Methods We estimated the prevalence of smoking tobacco use and attributable disease burden for 204 countries and territories, by age and sex, from 1990 to 2019 as part of the Global Burden of Diseases, Injuries, and Risk Factors Study. We modelled multiple smoking-related indicators from 3625 nationally representative surveys. We completed systematic reviews and did Bayesian meta-regressions for 36 causally linked health outcomes to estimate non-linear dose-response risk curves for current and former smokers. We used a direct estimation approach to estimate attributable burden, providing more comprehensive estimates of the health effects of smoking than previously available. Findings Globally in 2019, 1·14 billion (95% uncertainty interval 1·13–1·16) individuals were current smokers, who consumed 7·41 trillion (7·11–7·74) cigarette-equivalents of tobacco in 2019. Although prevalence of smoking had decreased significantly since 1990 among both males (27·5% [26·5–28·5] reduction) and females (37·7% [35·4–39·9] reduction) aged 15 years and older, population growth has led to a significant increase in the total number of smokers from 0·99 billion (0·98–1·00) in 1990. Globally in 2019, smoking tobacco use accounted for 7·69 million (7·16–8·20) deaths and 200 million (185–214) disability-adjusted life-years, and was the leading risk factor for death among males (20·2% [19·3–21·1] of male deaths). 6·68 million [86·9%] of 7·69 million deaths attributable to smoking tobacco use were among current smokers. Interpretation In the absence of intervention, the annual toll of 7·69 million deaths and 200 million disability-adjusted life-years attributable to smoking will increase over the coming decades. Substantial progress in reducing the prevalence of smoking tobacco use has been observed in countries from all regions and at all stages of development, but a large implementation gap remains for tobacco control. Countries have a clear and urgent opportunity to pass strong, evidence-based policies to accelerate reductions in the prevalence of smoking and reap massive health benefits for their citizens. Funding Bloomberg Philanthropies and the Bill & Melinda Gates Foundation.
There is presently no internationally agreed upon set of indicators for assessing adolescent health and what “health and wellbeing” means to adolescents. The psychosocial context of family, friends, and school plays a crucial role in the construction of health and wellbeing by adolescents. In spite of this, not much is known about the meaning Ghanaian adolescents attach to their health and wellbeing and the role of stress and social support in the construction of this meaning. This study explores how perceived social support and stress influence the construction of the meaning of health and wellbeing to Ghanaian adolescents. Eleven respondents purposively selected from 770 males and females participated in semi-structured interviews, which were transcribed verbatim and analysed with thematic analysis. Findings pointed to the fact that health and wellbeing was largely construed as “ability to perform daily functions,” such as ability to take critical decisions and a general sense of vitality and mental strength. These were influenced by perceived social support (“encouragement and advice” and “religiosity or spirituality”) and stress (“teasing, strictness, quarrels, and arguments”). These findings suggest that effective communication, mutual respect, and support from significant others, in the midst of stressful life events, contribute substantially to a holistic construction and meaning of health and wellbeing by Ghanaian adolescents.
The aim of this study is to gain a better understanding of the role psychosocial factors play in promoting the health and academic success of adolescents. A total of 770 adolescent boys and girls in Senior High Schools were randomly selected to complete a self-report questionnaire. School reported latest terminal examination grades were used as the measure of academic success.Structural equation modelling indicated a relatively good fit to the posteriori model with four of the hypothesised paths fully supported and two partially supported. Perceived social support was negatively related to stress and predictive of health and wellbeing but not academic success. Stress was predictive of health but not academic success. Finally, health and wellbeing was able to predict academic success. These findings have policy implications regarding efforts aimed at promoting the health and wellbeing as well as the academic success of adolescents in Ghana.Keywords: adolescents; perceived social support; stress; health; wellbeing; academic success 3 INTRODUCTIONThe academic success of children does not occur within a vacuum, but rather is situated within nested environments characterised by dynamic and subtle influences. Data from the Global School-based Health Survey in Ghana indicates that over 80% of adolescents report experiences such as feeling worried, feeling sad and hopeless, and feeling lonely which in turn had a negative effect on their daily life activities (Owusu, 2008). The psychosocial needs of adolescents play a critical role in their academic success. Several studies have demonstrated that social support has a positive effect on adolescents' health and wellbeing (Gini, Carli, & Pozzoli, 2009;Lindsey, Joe, & Nebbitt, 2010) and on their academic success (Azmitia, Cooper, & Brown, 2009;Danielsen, Wiium, Wilhelmsen, & Wold, 2010).Conversely, stress has negative effects on health and wellbeing (Flouri & Kallis, 2011;Hjern, Alfven, & Ostberg, 2008) and on academic success (Alva & de los Reyes, 1999;Chung & Cheung, 2008;Flook & Fuligni, 2008). These findings also suggest that social support mitigates the deleterious effects of stress on heath (Gayman, Turner, Cislo, & Eliassen, 2011) and academic success (Danielsen et al., 2010). Stress is known to be deleterious to health by promoting maladaptive behavioural coping responses (e.g. smoking, alcohol intake, binge eating). Cohen, Gottlieb, and Underwood (2000) assert that beliefs of perceived social support may reduce or even annihilate an emotional reaction to stressful situations and prevent or alter maladaptive behavioural response, and may also alleviate the deleterious effects of stress appraisal by providing a solution to a problem, either in terms of health or academic success.In response to concerns that academic standards are falling in Ghana, policy makers have placed considerable emphasis on factors such as school feeding programmes, curriculum modification, and education reforms among others (Ghana Ministry of Education, 2003). Although these school-b...
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