Although smoking rates have declined in most of the countries in the world, there are population groups within these countries whose smoking rates remain significantly higher than the general population. These “forgotten groups” who have not been receiving the needed attention in tobacco control policies and tobacco cessation efforts include people with serious mental illness, substance use disorders, tuberculosis, people living with human immunodeficiency virus (HIV), lesbian-gay-bisexual-transgender-queer people, and pregnant women. A number of steps are needed at the national level in countries where these disparities exist, including modifications to national smoking cessation treatment guidelines that address the special needs of these populations, as well as targeted smoking cessation research, since these populations are often not included in clinical trials. Because of the higher smoking prevalence in these populations, as well as their lower smoking cessation treatment success rates than the general population, more resources are needed if we are to reduce health disparities in these vulnerable populations. Additionally, we believe that more effort should be focused on integrating smoking cessation treatment in the specialized care settings frequented by these subpopulations.

Background: There are no safe levels of exposure to second hand smoke and smoke-free policies are effective in reducing the burden of tobacco-related diseases and death. Pharmacists, as a unique group of health professionals, might be able to play a role in the promotion of smoke-free policies. Objective: To determine the tobacco-related knowledge of community pharmacists and assess their support for smoke-free policies in Lagos state, Nigeria. Methods: A cross-sectional descriptive study design using both quantitative and qualitative methods was employed. Two hundred and twelve randomly selected community pharmacists were surveyed using a pre-tested self-administered questionnaire. In addition, one focus group discussion was conducted with ten members of the Lagos state branch of the Association of Community Pharmacists of Nigeria. Results: The quantitative survey revealed that the majority (72.1%) of the respondents were aged between 20 and 40 years, predominantly male (60.8%), Yoruba (50.2%) or Igbo (40.3%) ethnicity and had been practicing pharmacy for ten years or less (72.2%). A majority (90.1%) of respondents were aware that tobacco is harmful to health. Slightly less (75.8%) were aware that second hand smoke is harmful to health. Among the listed diseases, pharmacists responded that lung (84.4%) and esophageal (68.9%) cancers were the most common diseases associated with tobacco use. Less than half of those surveyed associated tobacco use with heart disease (46.9%), chronic obstructive pulmonary disease (27.8%), bladder cancer (47.2%), peripheral vascular disease (35.8%) and sudden death (31.1%). Only 51.9% had heard of the World Health Organization Framework Convention on Tobacco Control (WHO FCTC). A little over half of the respondents (53.8%) were aware of any law in Nigeria controlling tobacco use. The majority of respondents supported a ban on smoking in homes (83.5%), in public places (79.2%), and in restaurants, nightclubs and bars (73.6%). For every additional client attended to daily, knowledge scores increased by 0.022 points. Current smokers were 1.3 times less likely to support smoke-free policies compared with non-smokers. The findings emanating from the focus group discussion reinforced the fact that the pharmacists were in support of smoke-free policies particularly in homes and public places. It also demonstrated that most of them were aware of the health risks associated with tobacco use and second hand smoke however some misconceptions seemed to exist. Conclusion: The pharmacists surveyed expressed support of smoke-free policies and most of them were aware of the health risks associated with tobacco use. However, awareness of WHO FCTC and country-level tobacco legislation was low. Current smokers were less likely to support smoke-free policies. Community pharmacists should therefore be considered worth engaging for the promotion of smoke-free policies. Efforts should also be made to educate pharmacists about country level smoke-free laws.

Antecedentes: No hay niveles seguros de exposición de fumador pasivo y las políticas de sin-humo han mostrado ser efectivas en la reducción del daño de las enfermedades y muertes producidas por tabaco. Los farmacéuticos, como grupo destacado de profesionales de la salud, pueden jugar un papel en la promoción de políticas sin-humo. Objetivo: Determinar el conocimiento sobre el tabaco de los farmacéuticos comunitarios y su apoyo a políticas sin-humo en el estado de Lagos, Nigeria. Métodos: Se utilizó un estudio transversal usando tanto métodos cuantitativos como cualitativos. Se entrevistó a 212 farmacéuticos comunitarios aleatoriamente seleccionados utilizando un cuestionario auto-administrado pre-pilotado. Además, se realizó una discusión en grupo focal con 10 farmacéuticos de la sección del estado de Lagos de la Asociación de Farmacéuticos Comunitarios de Nigeria. Resultados: El cuestionario cuantitativo reveló que la mayoría (72,1%) de los respondentes tenían entre 20 y 40 años, eran predominantemente hombres (60,8%), de las etnias Yoruba (50,2%) o Igbo (40,3%) y estaban ejerciendo durante 10 años o menos (72,2%). La mayoría (90,1%) sabía que el tabaco es malo para la salud. Ligeramente menos (75,8%) sabía que ser fumador pasivo es malo para la salud. Entre las enfermedades identificadas, los farmacéuticos respondieron que los canceres de pulmón (84,4%) y de esófago (68,9%) eran las enfermedades más frecuentemente asociadas con el tabaco. Menos de la mitad de los entrevistados asoció el tabaco con enfermedad cardiaca (46,9%), enfermedad pulmonar obstructiva crónica (27,8%), cáncer de vejiga (47,2%), enfermedad vascular periférica (35,8%) y muerte súbita (31,1%). Sólo el 51,9% había oído sobre el World Health Organization Framework Convention on Tobacco Control (WHO FCTC). Algo más de la mitad de los respondentes (53,8%) conocía la ley en Nigeria sobre el control de tabaco. La mayoría de los respondentes apoyaba la prohibición de fumar en los hogares (83,5%), en lugares públicos (79,2%) y en restaurantes, clubs nocturnos y bares (73,6%). Por cada cliente de más atendido en la farmacia, las puntuaciones de conocimiento crecían en 0.022 puntos. Los actuales fumadores tenían 1,3 veces menos de probabilidad de apoyar políticas sin-humo que los no fumadores. Los hallazgos del grupo focal reforzaron el hecho de que los farmacéuticos apoyan las políticas sin-humo, especialmente en los hogares y lugares públicos. También demostraron que la mayoría de ellos conocían los riesgos del tabaco y de los fumadores pasivos, aunque parecía haber algunos errores de concepto. Conclusión: Los farmacéuticos entrevistados apoyaron las políticas sin-humo y la mayoría conocía los riesgos asociados al uso de tabaco. Sin embardo, el conocimiento del WHO FCTC y de la legislación era bajo. Era menos probable que los fumadores apoyasen las políticas sin-humo. Debería considerarse valioso enrolar a los farmacéuticos comunitarios en la promoción de políticas sin-humo. Deberían realizarse esfuerzos para educar a los farmacéuticos sobre la legislación nacional sobre tabaco.