Background: Hardcore smoking is represented by a subset of daily smokers with high nicotine dependence, inability to quit and unwillingness to quit. Estimating the related burden could help us in identifying a high risk population prone to tobacco induced diseases and improve cessation planning for them. This study assessed the prevalence and associated factors of hardcore smoking in three South-East Asian countries and discussed its implication for smoking cessation intervention in this region. Materials and Methods: Global Adult Tobacco Survey (GATS) data of India, Bangladesh and Thailand were analyzed to quantify the hardcore smoking prevalence in the region. On the basis of review, an operational definition of hardcore smoking was adopted that includes (1) current daily smoker, (2) no quit attempt in the past 12 months of survey or last quit attempt of less than 24 hours duration, (3) no intention to quit in next 12 months or not interested in quitting, (4) time to first smoke within 30 minutes of waking up, and (5) knowledge of smoking hazards. Logistic regression analysis was carried out using hardcore smoking status as response variable and gender, type of residence, occupation, education, wealth index and age-group as possible predictors. Results: There were 31.3 million hardcore smokers in the three Asian countries. The adult prevalence of hardcore smoking in these countries ranges between 3.1% in India to 6% in Thailand. These hardcore smokers constitute 18.3-29.7% of daily smokers. The logistic regression model indicated that age, gender, occupation and wealth index are the major predictors of hardcore smoking with varied influence across countries. Conclusions: Presence of a higher number of hardcore smoking populations in Asia is a major public health challenge for tobacco control and cancer prevention. There is need of intensive cessation interventions with due consideration of contextual predictors.

The study highlights a lack of preparedness of primary care physicians to deliver tobacco cessation services. Both the curriculum in medical school and on-the-job training require an addition of a learning component on tobacco cessation. The addition of this component will enable existing primary care facilities to deliver tobacco cessation services.

Background: Comprehensive tool is not available to assess health literacy status across different languages, contexts and population structures except European health literacy survey scale (HLS-EU-Q47) which is widely used adapted and tested in different countries and languages. However, it was not tested for Ethiopian populations. This study aim was to validate and test the reliability of the Amharic version of the HLS-EU-Q47 survey questionnaire (HLS-Amh) among school adolescents and university students in Dire Dawa, Ethiopia. Method: A cross-sectional study with multistage random sampling was done on urban school adolescents and university students from public schools and Dire Dawa University in Dire Dawa city, Ethiopia, Africa. After translating HLS‐EU‐Q47 into Amharic by translation and back- translation, data was collected using a self-reported questionnaire from samples of 744 participants with 9% non-response rate in October and November, 2018. Confirmatory factor analysis and correlation analysis was done using SPSS and AMOS. Goodness of fit indices, item-scale convergent validity, Pearson correlation coefficient, floor and ceiling effects, Cronbach's alpha and split-half spearman-brown coefficient was computed taking the cut-off values from guidelines and literatures. Ethical issue was contemplated and informed consent was obtained from institutions and participants. Result: Amharic version of HLS- EU-Q47, (HLS-Amh) was reliable but weak for its validity to measure health literacy among urban school adolescents and university students in Dire Dawa, Ethiopia. Goodness-of-fit indices (GFI, AGFI, CFI and IFI) were within range of 0.90-0.80. Although, RMSEA indices were less 0.10, others have made it insufficient to be said as a good model-data fit and was not tolerable for its validity, and the model lacked strength to meet the model-fit indices satisfaction with higher apparent floor/ceiling effects. However, it showed high levels of internal consistency of reliability with relatively higher Cronbach’s alpha coefficient (α=0.910). Conclusions: HLS-Amh was reliable but weak for its validity on these population groups. It can be used for a general survey on awareness and knowledge other than screening substantial and clinical related inquiries. It needs further adaptation and validation for comprehensiveness for demographic, multi-lingual and cultural contexts in Ethiopia.

Background: In India bilateral corneal blindness constitute one percent of total blindness, With huge addition of cases of corneal blindness annually. Corneal transplantation offers the potential for sight restoration. The patients for corneal transplantation are growing due to insufficient number of eye donations in India. The gap between demand and supply is due to low awareness. Especially there is a need to study the knowledge of first line health counsellor in health facility where potential donors are available.Methods: A cross-sectional study was conducted on May 2016 with 140 first year Nursing students to assess their perception towards eye donation. Data were expressed as proportions and percentages using SPSS 16.Results: All participants knew about eye donation and 95.7% said these can be done irrespective of age and sex of the deceased. 55% students told HIV is a contraindication, 10% said that request for eye donations can be made by person himself alive or relatives after death. 15% knew that eye can be donated within six hours of death but none were aware regarding storage of donated eyes before transplantation. Only 2.1% of them heard about Hospital Corneal Retrieval Programme. Television (100%) was the main source of information. All of them personally supported eye donation.Conclusions: The present study revealed that nursing students had heard about eye donation but knew less about the details of the procedure. They can contribute to awareness and motivating people for eye donation during their postings in various department in hospital.

Background: The Global Adult Tobacco Survey has 15 key indicators, cigarettes smoked per day (CPD) among daily smokers being one of them. The first wave of GATS in 14 countries indicated that mean CPD use is higher in women than men in India only, which is contrary to the current understanding of tobacco use globally. This study was undertaken to understand the unusual findings for mean CPD use in the GATS-India survey. Materials and Methods: Items B06a and B06b of the GATS India survey questionnaire that collected information on daily consumption of manufactured and rolled cigarettes were analyzed using SPSS software. Exclusive users were identified from these items after excluding the concurrent users of other tobacco products. Cigarette type, exclusive use and gender stratified analyses were made. Consumption of different types of cigarettes among the mixed users of manufactured and rolled cigarettes were correlated. Results: Higher mean number of CPD use among male daily-smokers was observed than their female counterparts in product specific analysis. Mean CPD as per GATS cigarette definition was higher in males than females for exclusive users but a reverse trend was observed in case of non-exclusive users. Use of manufactured cigarettes increased with increase in use of rolled cigarette among the mixed users and around half of these users reported equal CPD frequency for the both types of cigarettes. Conclusions: The anomaly in mean CPD estimate in GATS-India data was due to inclusion of two heterogeneous products to define cigarettes, variation in cigarette product specific user proportions contributing to the average and non-exclusive concurrent use of other tobacco products. The consumption pattern of cigarettes among the mixed users highlights bias in CPD reporting. Definition, analysis and interpretation of 'cigarettes per day' in the GATS India survey need to be improved by redefining cigarettes and making product specific analyses.