The measurement of exhaled carbon monoxide in healthy smokers and non-smokers

Toward Addiction Prediction: An Overview of Cross-Validated Predictive Modeling Findings and Considerations for Future Neuroimaging Research

Substance use is a leading cause of disability and death worldwide. Despite the existence of evidence-based treatments, clinical outcomes are highly variable across individuals, and relapse rates following treatment remain high. Within this context, methods to identify individuals at particular risk for unsuccessful treatment (i.e., limited within-treatment abstinence), or for relapse following treatment, are needed to improve outcomes. Cumulatively, the literature generally supports the hypothesis that individual differences in brain function and structure are linked to differences in treatment outcomes, although anatomical loci and directions of associations have differed across studies. However, this work has almost entirely used methods that may overfit the data, leading to inflated effect size estimates and reduced likelihood of reproducibility in novel clinical samples. In contrast, cross-validated predictive modeling (i.e., machine learning) approaches are designed to overcome limitations of traditional approaches by focusing on individual differences and generalization to novel subjects (i.e., cross-validation), thereby increasing the likelihood of replication and potential translation to novel clinical settings. Here, we review recent studies using these approaches to generate brain-behavior models of treatment outcomes in addictions and provide recommendations for further work using these methods.

Can visual nudges reduce smoking tobacco expenditure? Evidence from a clustered randomized controlled trial in rural Bangladesh

Introduction

A household-level constant visual deterrent advocacy campaign to reduce tobacco intake was conducted in rural Bangladesh.

Aims

To evaluate smoking tobacco expenditure by campaign components.

Methods

We conducted a single-blind clustered randomized controlled trial on 630 adult male household heads from 16 chars (riverine islands) in rural northern Bangladesh, between November 2018 and January 2019. Intervention allotment was randomized at the char level to minimize spillovers, with 8 chars in treatment and control groups each. The intervention provided households in treatment chars (n = 323) with two visual warning posters, detailing the health effects of tobacco on oneself and external actors, to be hung inside the household for 4 weeks. Households in control chars (n = 307) received nothing. Reported daily smoking (log) tobacco expenditure values were the primary outcome of interest.

Results

Final analysis was conducted using 251 and 210 smokers in treatment and control chars respectively. The intervention reduced relative smoking tobacco expenditure by 12.8% (95% CI −31.45 to 5.81) but was not statistically significant (P-value = 0.163). Weak to moderate emotional reactions to the posters was identified as a reason for the statistical insignificance.

Conclusion

For a visual anti-tobacco intervention to have a substantial impact, it must induce strong emotional responses.

Acute Effects of a Heat-Not-Burn Tobacco Product on Pulmonary Function

Background and objectives: During the last decade, conventional tobacco smoking is experiencing a decline and new smoking products have been introduced. IQOS ("I-Quit-Ordinary-Smoking") is a type of "heat-not-burn" (HNB) tobacco product. The impact of IQOS on respiratory health is currently not defined. The objectives of this study were to evaluate the acute effects of IQOS on pulmonary function in non-smokers and current smokers. Materials and Methods: Fifty male healthy non-smokers and current smokers with no known co-morbidity underwent an exhaled CO measurement, oximetry (SaO2%), pulmonary function tests (flows, volumes and diffusion capacity), and a measurement of respiratory resistances with an impulse oscillometry system (IOS) before and immediately after IQOS use. Results: In the whole group of 50 participants, SaO2%, forced expiratory flow at 25% and 50% of vital capacity (FEF 25%, FEF 50%, respectively), peak expiratory flow (PEF), and diffusion lung capacity for carbon monoxide/VA (KCO) decreased significantly after IQOS use, whereas exhaled CO and airway resistance (R5 Hz, R10 Hz, r15 Hz, R20 Hz, R25 Hz, R35 Hz) increased. When the groups of smokers and non-smokers were compared, in both groups (all males, 25 smokers and 25 non-smokers), exhaled CO increased and SaO2% decreased after IQOS use (p < 0.001). In the group of non-smokers, PEF (pre 8.22 ± 2.06 vs. post 7.5 ± 2.16, p = 0.001) and FEF 25% (pre 7.6 ± 1.89 vs. 7.14 ± 2.06, p = 0.009) decreased significantly; respiratory resistances R20 Hz (pre 0.34 ± 0.1 vs. post 0.36 ± 0.09, p = 0.09) and R25 Hz (pre 0.36 ± 0.1 vs. post 0.38 ± 0.09, p = 0.08) increased almost significantly. In smokers, PEF (pre 7.69 ± 2.26 vs. post 7.12 ± 2.03, p = 0.007) and expiratory reserve volume (ERV) (pre 1.57 ± 0.76 vs. post1.23 ± 0.48, p = 0.03) decreased and R35 Hz (pre 0.36 ± 0.11 vs. post 0.39 ± 0.11, p = 0.047) increased. The differences in the changes after the use of IQOS did not differ between groups. Conclusions: IQOS had an impact on exhaled CO, SaO2%, and airways function immediately after use. Even though these changes were rather small to be considered of major clinical importance, they should raise concerns regarding the long-term safety of this product. Further research is needed for the short- and long-term effects of IQOS, especially in patients with respiratory disease.

A case study of salivary microbiome in smokers and non-smokers in Hungary: analysis by shotgun metagenome sequencing

Objective

To investigate the role of cigarette smoking in disease-development through altering the composition of the oral microbial community. Periodontitis and oral cancer are highly prevalent in Hungary; therefore, the salivary microbiome of smoker and non-smoker Hungarian adults was characterized.

Methods

Shotgun metagenome sequencing of salivary DNA samples from 22 individuals (11 non-smokers and 11 current smokers) was performed using the Ion Torrent PGM^TM platform. Quality-filtered reads were analysed by both alignment-based sequence similarity searches and genome-centric binning.

Results

Prevotella, Veillonella and Streptococcus were the predominant genera in the saliva of both groups. Although the overall composition and diversity of the microbiota were similar, Prevotella was significantly more abundant in salivary samples of current smokers compared to non-smokers. Members of the genus Prevotella were implicated in the development of inflammatory diseases and oral cancer. The abundance of the genus Megasphaera also increased in current smokers, whereas the genera Neisseria, Oribacterium, Capnocytophaga and Porphyromonas were significantly reduced. The data generated by read-based taxonomic classification and genome-centric binning mutually validated the two distinct metagenomic approaches.

Conclusion

Smoking-associated dysbiosis of the salivary microbiome in current cigarette smokers, especially increased abundance of Prevotella and Megasphaera genera, may facilitate disease development.

Association of secondhand smoke exposure with mental health in men and women: Cross-sectional and prospective analyses using the UK Health and Lifestyle Survey

Objectives:

We examine cross-sectional and prospective associations between objectively measured SHS exposure and mental health using data from the Health and Lifestyle Survey (HALS), a large, UK-wide, general population-based, prospective cohort study with measurements of carbon monoxide or salivary cotinine levels.

Methods:

Mental health was assessed using the 30-item version of the General Health Questionnaire (GHQ). Multivariate logistic regression models adjusting for age, sex, height, body mass index, alcohol intake, social status, and longstanding illness were used to analyze the association between exposure to SHS (exhaled CO and salivary cotinine categories) and psychological distress (≥ 5 GHQ).

Results:

Fully adjusted cross-sectional analysis revealed a positive relationship between exhaled carbon monoxide and psychological distress among smokers (OR 1.36; 95% CI 1.04-1.78) but not among non-smoking adults. In a similar cross-sectional analysis between cotinine level and psychological distress, non-significant associations were found among smokers and non-smokers. Prospective analyses of the cotinine-psychological distress relationship among participants without psychological distress at baseline showed no significant increased risk of psychological distress among both smokers and non-smokers. In a prospective analysis of poor mental health outcome with respect to self-report smoking and SHS status, smokers had an increased risk of psychological distress while SHS and non-smokers did not.

Conclusions:

A non-significant association between objectively measured SHS exposure and poor mental health was found in this study. Our findings show discrepancies with recent studies suggesting the need for additional future research in this growing field of study.

The effect of a multidisciplinary approach for smoking cessation in patients with Crohn's disease: Results from an observational cohort study

INTRODUCTION

Cigarette smoking is the most important risk factor for Crohn’s disease (CD). The effectiveness of smoking cessation programs (SCPs) in patients with CD is still poorly understood.

METHODS

This was a retrospective, observational, single-centre, cohort study of 136 active smokers with mean age 55 years (SD=11), 58% males, including 27 (19.8%) patients with CD who entered the multidisciplinary SCP of the Luigi Sacco University Hospital of Milan from January 2017 through January 2019. A pulmonologist was responsible for the clinical and pharmacological management, while a psychiatrist and a psychologist conducted the counselling and assessed the motivation to quit, anxiety and depression using the Brief Psychiatric Rating Scale (BPRS) and the nicotine dependence with the Fagerström test. Patients were defined as quitters after 12 months.

RESULTS

Demographic and clinical characteristics, and Fagerström score, did not differ in patients with and without CD. At baseline, patients with CD had a higher BPRS (median: 27, IQR: 22–32; vs 25 and 22–28.5; p=0.03), and a lower motivation to quit score (median: 10, IQR: 9–13; vs 14 and 12–15; p<0.001). After 12 months, the quitting rate of smokers with CD was significantly lower (14.8% vs 36.7%; p<0.022) and the chance of quitting was negatively associated with the baseline BPRS (r=-0.256; p<0.003). Varenicline and nicotine replacement therapy tended to be less effective in patients with CD.

CONCLUSIONS

The lower efficacy of SCPs in patients with CD might be secondary to a higher prevalence of anxiety and depression. Psychological issue recognition and support should be enhanced to increase SCP effectiveness in CD.

Health consequences of thick forest fire smoke to healthy residents in Riau, Indonesia: a cross-sectional study

BACKGROUND Indonesia forest fire in 2015 emitted a huge amount of pollutants into the air. This study was aimed to assess the health consequences of forest fire smoke in healthy residents in Riau during forest fire disaster in 2015. METHODS This cross-sectional study was performed in healthy residents who lived in Pekanbaru, Riau Province, Sumatera, for at least 6 months during forest fire disaster in 2015, and data were taken in October 2015. Questionnaires consisting of respiratory and non-respiratory symptoms were collected. Lung function was assessed by spirometry (MIR II Spirolab™ spirometer, Medical International Research, Italy) and exhaled carbon monoxide (CO) was assessed using piCO+ Smokerlyzer®. Heart rate at rest and oxygen saturation in the room air were measured using Onyx 9591 Pulse Oximeter®. RESULTS A total of 89 subjects were mostly female (75.3%), housewife (37.7%), nonsmoker (86.5%) with mean age of 38.9 years old. The non-respiratory and respiratory symptoms were reported in 84.7% and 71.4% subjects, respectively. Lung function was impaired in 72.6% subjects, mostly with mild obstruction and mild restriction. Exhaled CO was highly detected over normal values (mean [standard deviation] = 32.6 [9.97] ppm) with predicted carboxyhemoglobin (COHb) of 5.74 (1.56). CONCLUSIONS Forest fire smoke exposure increased the respiratory and nonrespiratory symptoms among healthy individuals, which showed impairment in lung function, exhaled CO, and predicted COHb. Long term health effects on healthy individuals exposed to forest fire smoke warrant further evaluation.

Feasibility of a Smartphone-Based Tobacco Treatment for HIV-Infected Smokers

BACKGROUND

Cigarette smoking is common among persons living with HIV (PLWH) in the United States. It is the leading cause of mortality in this group, and efforts to promote cessation have been largely unsuccessful.

METHODS

From 2015 to 2017, we performed a randomized controlled trial of Positively Smoke Free-Mobile (PSF-M) versus standard care. PSF-M is a mobile Web site that offers a 42-day text message-based quit-smoking program with smartphone features including quit-day selection/calendar, educational/motivational videos, and HELP button for cravings.

RESULTS

One hundred individuals enrolled, 48 were randomized to PSF-M (mean age = 45 years, 54% male, 81% black, 31% Latino) and 52 to the standard care condition. All participants were offered a 3-month supply of nicotine patches. Participants randomized to the mobile intervention visited the PSF-M home page a mean of 83 times, viewed 5.6/8 videos, logged in on 13 of 42 possible days, and received 131 texts. Among them, 77% tapped HELP for cravings, and craving response options were used by the following proportions: phone-a-friend, 58%; play-a-game, 29%; play-a-song, 4%. Older age and nonblack race were both associated with higher levels of engagement with the site. Of participants, 61% rated PSF-M very or extremely helpful, and 98% would recommend PSF-M to PLWH family or friends. Abstinence at 3 months, quit attempts, and daily cigarette intake all favored PSF-M over standard care but did not achieve statistical significance in our pilot sample.

CONCLUSIONS

Smartphone-based tobacco treatment for PLWH was feasible and achieved moderate-high rates of engagement and satisfaction in a middle-aged, ethnic or racial minority group in the poorest urban community in the United States.

IMPLICATIONS

Cigarette smoking has emerged as the leading killer of PLWH. Behavioral interventions have achieved only limited success in promoting cessation in this population. In this study, we explore the feasibility and preliminary efficacy of a multimodal, Web-based, quit-smoking intervention delivered to PLWH smokers via their smartphones.

A single-blind clustered randomised controlled trial of daily record-keeping for reducing smoking tobacco expenditure among adult male household heads in rural Bangladesh

Introduction

This study aims to assess the impact of a behavioural intervention, in the form of a self-monitoring record-keeping logbook, in reducing smoking tobacco expenditure amongst adult male household heads in rural Bangladesh.

Method

The experiment was designed as a single-blind clustered randomised controlled trial utilising two-stage random sampling. A total of 650 adult male household heads were sampled from 16 chars (riverine islands) from Gaibandha, Northern Bangladesh, with eight chars in treatment and control groups each, between November 2018 and January 2019. The intervention consisted of a logbook to record daily smoking tobacco intake for 4 weeks provided only to participants in treatment chars (n = 332) while households in control chars received nothing (n = 318).

Results

Final analysis was conducted using 222 and 210 households in the treatment and control chars respectively. The logbook intervention had a significant impact (P-value = 0.040) on reducing daily tobacco expenditure by 14% (α = 95%; CI: −0.273, −0.008) for the treatment group relative to the control group based on a difference-in-difference estimator. This is equivalent to a reduction of 20 cigarettes or 140 bidis smoked in a month.

Conclusion

Our minimal contact intervention successfully induced a reduction in smoking tobacco expenditure, which could effectively be incorporated with existing programs in the char regions of Bangladesh.

Passive exposure of non-smokers to E-Cigarette aerosols: Sensory irritation, timing and association with volatile organic compounds

AIM

The current study examined symptoms of irritation reported by non-smokers passively exposed to e-cigarette aerosols and their timing and association with the concentrations of volatile organic compounds (VOCs) produced.

METHODS

40 healthy non-smoking adults were exposed to e-cigarette aerosols for 30 min in a 35 m³ room. Second-hand e-cigarette aerosol (SHA) was produced by an experienced e-cigarette user using a standardized topography and two resistance settings (exposure 0.5 Ohm and 1.5 Ohm), in addition to a control session (no emissions). PM_2.5 and PM_1.0 were continuously measured over the duration of exposure, while Volatile Organic Compounds (VOCs) were recorded at 0, 15 and 30 min (t₀, t₁₅ and t₃₀) of exposure. Each participant completed an irritation questionnaire at t₀, t_15, t₃₀ of exposure and t₆₀ (30 min post-exposure) on ocular, nasal, throat-respiratory symptoms of irritation and general complaints. Kruskal-Wallis H test for PM comparisons, repeated measures ANOVA for VOCs and Generalized Estimating Equations for symptoms of irritation and association with VOCs were used for statistical analysis.

RESULTS

20 males and 20 females, with a mean age of 24.6 years (SD = 4.3) and exhaled CO < 7 ppm participated. PM concentrations in both experimental sessions were higher than the Control (p < 0.001). The most commonly reported symptoms were burning, dryness, sore throat, cough, breathlessness and headache. During both experimental sessions, ocular, nasal, throat-respiratory symptoms and general complaints increased significantly (p < 0.05). Ocular and nasal symptoms returned to baseline by t₆₀ (p > 0.05) while throat-respiratory symptoms were still significantly higher at t₆₀ (p = 0.044). VOCs were significantly associated with reported nasal and throat-respiratory symptoms in both experimental sessions (p < 0.05).

CONCLUSION

A 30-min exposure to SHA provoked symptoms of sensory irritation and general complaints that lasted up to 30 min after the exposure and were positively associated with the concentrations of the VOC mixture emitted.

Comparison of End Tidal Carbon Monoxide Levels between Conventional Cigarette, Electronic Cigarette and Heated Tobacco Product among Asiatic Smokers

Electronic nicotine delivery systems (ENDS) and heated tobacco products (HTPs) are noncombustible tobacco products which have been found to generate aerosols containing lower levels of Harmful and Potentially Harmful Constituents (HPHCs) in comparison to conventional cigarettes. Objective: This quasi experimental study measured and compared the end tidal carbon monoxide (eCO) levels of participants after use of ENDS, HTPs and conventional cigarettes. Methods: In total 45 smokers, each smoking at least 10 conventional cigarettes per day for 5 years participated in the study. Based on their preference, participants used only one of the tobacco products (ENDS, HTPs, or conventional cigarette) and were briefed about the product use based on manufacturer's instructions. The eCO levels were obtained at baseline, followed by 5, 10, 15, 30 and 45 min respectively after the product use. Results: There was significant increase in eCO levels for conventional cigarettes as compared to other modes. Peak eCO levels of 20.2 ± 0.86 ppm, 8.8 ± 1.56 ppm and 6.0 ± 1.36 ppm was achieved at 30 min, 15 min and 10 min for conventional cigarettes, ENDS and HTPs respectively. However, the levels were significantly lower in ENDS and HTPs. Conclusion: Even though ENDS and HTPs may have produced significantly lower eCO than conventional cigarettes, the significantly increasing levels over time from baseline which was not shown before is a cause of concern. As of now, their use as an alternate to cigarettes needs to be considered under regulatory framework.

Behavioral trainings and manipulations to reduce delay discounting: A systematic review

In everyday decision-making, individuals make trade-offs between short-term and long-term benefits or costs. Depending on many factors, individuals may choose to wait for larger delayed reward, yet in other situations they may prefer the smaller, immediate reward. In addition to within-subject variation in the short-term versus long-term reward trade-off, there are also interindividual differences in delay discounting (DD), which have been shown to be quite stable. The extent to which individuals discount the value of delayed rewards turns out to be associated with important health and disorder-related outcomes: the more discounting, the more unhealthy or problematic choices. This has led to the hypothesis that DD can be conceptualized as trans-disease process. The current systematic review presents an overview of behavioral trainings and manipulations that have been developed to reduce DD in human participants aged 12 years or older. Manipulation studies mostly contain one session and measure DD directly after the manipulation. Training studies add a multiple session training component that is not per se related to DD, in between two DD task measurements. Ninety-eight studies (151 experiments) were identified that tested behavioral trainings and manipulations to decrease DD. Overall, results indicated that DD can be decreased, showing that DD is profoundly context dependent and changeable. Most promising avenues to pursue in future research seem to be acceptance-based/mindfulness-based trainings, and even more so manipulations involving a future orientation. Limitations and recommendations are discussed to identify the mechanistic processes that allow for changes in discount rate and behavior accordingly.

The Effect of Brief Mindfulness Training on Brain Reactivity to Food Cues During Nicotine Withdrawal: A Pilot Functional Imaging Study

Objectives

Many individuals who smoke relapse due to weight gain. Mindfulness training has been shown to help smokers quit smoking, and, in other populations, has been used to help people lose weight. This study was designed to assess the effect of one week of mindfulness practice on food cravings in smokers during 12-hour smoking abstinence.

Methods

We assessed daily smokers with a history of smoking lapse after weight gain. Participants were provided with brief training in mindfulness meditation and mindful eating and were asked to practice each skill daily for one week. Before and after this week of mindfulness practice, participants completed surveys to rate their nicotine dependence and food cravings and underwent testing via functional magnetic resonance imaging.

Results

Study results included pre-post intervention reduction in brain activity in dorsomedial prefrontal cortex, visual areas, and pre-motor areas, regions potentially associated with response to food images.

Conclusions

The study was small; however, it suggests the possibility that mindfulness training might be used to decrease food cravings after smoking cessation.

Novel Application of Exhaled Carbon Monoxide Monitors: Smoking Cessation in Orthopaedic Trauma Patients

OBJECTIVES

To determine whether an in-office exhaled carbon monoxide (CO) monitor can increase interest in smoking cessation among the orthopaedic trauma population.

DESIGN

Prospective.

SETTING

Level I trauma center.

PATIENTS

One hundred twenty-four orthopaedic trauma patients.

INTERVENTION

In-office measurement of exhaled CO.

MAIN OUTCOME MEASURES

Stage of change, Likert scale score on willingness to quit today, patient's request for referral to a quitline, and increase in readiness to quit.

RESULTS

The use of an exhaled CO monitor increased willingness to quit in 71% of participants still smoking and increased willingness to quit on average by 0.8 points on a 10-point Likert scale (P < 0.001). Fifteen percent of patients modified their stage of change toward quitting. Forty percent of patients after exhaled CO monitor requested referral to a quitline, compared with 4% presurvey (P < 0.001). Anecdotally, most participants were very interested in the monitoring device and its reading, expressing concern with the result. The value of exhaled CO was not associated with any measured outcomes.

CONCLUSIONS

The use of an exhaled CO monitor increased willingness to quit smoking in 71% of patients, but the effect size was relatively small (0.8 points on a 10-point Likert scale). However, use of the CO monitor resulted in a large increase (40% vs. 4%) in referral to the national Quitline. Use of the Quitline typically increases the chance of smoking cessation by 10 times the baseline rate, suggesting that this finding might be clinically important.

LEVEL OF EVIDENCE

Therapeutic Level II. See Instructions for Authors for a complete description of levels of evidence.

Addressing Postpartum Smoking Relapse Among Low-Income Women: A Randomized Control Trial

PURPOSE

Smoking during pregnancy can have dire consequences for both the baby and mother. Low-income pregnant women smoke at particularly high rates. Among women who quit during pregnancy, postpartum relapse is high. This randomized control trial tested the effect of adding postpartum assistance to an existing smoking cessation program (First Breath) designed for low-income women.

METHODS

Of 185 study participants, 94 women were randomly assigned to the standard First Breath program (control) and 91 to an enhanced program. First Breath consisted of evidence-based smoking cessation counseling provided at every prenatal visit. The enhanced program included all First Breath services plus 4 in-home counseling visits (3 postpartum), 3 postpartum counseling calls, support to others in the home, and incentives (gift cards) totaling $100. The primary outcome was biochemically verified abstinence at 6 months postpartum.

RESULTS

Among the 98 women who completed the study, the abstinence rate among the intervention participants (n=41) was significantly greater than among the control participants (n=57) (36.6% vs 12.3%, respectively; P<0.01). Analyzed on an intent-to-treat basis, with those lost to follow-up assumed to be smoking, the abstinence rate among intervention subjects (n=91) was 16.5% vs 7.4% among control participants (n=94); P=0.07.

CONCLUSIONS

Extending smoking cessation interventions into the postpartum period may help address postpartum relapse.

Effectiveness of smoking cessation in smokers with COPD and nocturnal oxygen desaturation: Functional analysis

INTRODUCTION

Chronic obstructive pulmonary disease (COPD) is the fourth cause of mortality and it's frequently associated with breathing sleep disorders.

OBJECTIVE

The aim of the study is to point out the benefit of smoking cessation over three months in terms of improvement of respiratory functional variables.

METHODS

A retrospective analysis was performed evaluating the impact of smoking cessation on 145 patients with COPD and nocturnal oxygen desaturation. For this purpose, for all patients, overnight pulse oxymetry detection on room air, arterial blood sampling, plethysmography and exhaled test for carbon monoxide were performed at baseline and 3 months after the beginning. Smoking cessation was achieved by varenicline plus individual counselling.

RESULTS

About 51% of patients quit smoking which was established by exhaledcarbon monoxide (eCO) measure (cut-off 5 ppm). Patients who quit smoking displayed notably better results compared with patients who did not. The eCO significantly decreased by 16 ppm versus 4 (P = 0.01), oxygen desaturation index (ODI) was reduced by 3 points versus 0.8 (P = 0.01) and forced expiratory in 1 second volume increased by 7% of predicted value versus 1% (P = 0.01). The walking test was improved by 102 m versus 25 in sustainers (P = 0.01). The CAT score was also improved by 10 versus 8 in sustainers (P = 0.01) and PaO2 increased by 5 mm Hg versus 0.5 (P = 0.04). The percentage of SaO2 < 90% was improved by 6.7 versus 2.1 (P = 0.04).The logistic regression analysis displayed the possible influence of CAT (P = 0.02) and modified medical research council dyspnea test (P = 0.05) on ODI value.

CONCLUSIONS

Smoking cessation notably improves pulmonary functional parameters in quitters reporting nocturnal oxygen desaturation.

A randomized controlled trial to test the effectiveness of a peer-based social mobile game intervention to reduce smoking in youth

Smoking is a major cause of worldwide morbidity and mortality. Almost no evidence-based intervention programs are available to help youth quit smoking. We argue that ineffective targeting of peer influence and engagement difficulties are significant barriers to successful youth smoking cessation. To address these barriers, we developed the mobile game intervention HitnRun. A two-armed randomized controlled trial (RCT; n = 144) was conducted and young smokers (Mage = 19.39; SDage = 2.52) were randomly assigned to either play HitnRun or read a psychoeducational brochure. Prior to, directly following the intervention period, and after three-month follow-up, weekly smoking behavior, abstinence rates, intervention dose, and peer- and engagement-related factors were assessed. Results indicated similar reductions in weekly smoking levels and similar abstinence rates for both groups. Yet, we found a dose effect with HitnRun only: The longer participants played HitnRun, the lower their weekly smoking levels were. In the brochure group, a higher dose was related to higher weekly smoking levels at all measurement moments. Exploratory analyses showed the most powerful effects of HitnRun for participants who connected with and were engaged by the intervention. Future work should build on the promising potential of HitnRun by increasing personalization efforts and strengthening peer influence components.

Cooking/Window Opening and Associated Increases of Indoor PM2.5 and NO2 Concentrations of Children’s Houses in Kaohsiung, Taiwan

High concentrations of air pollutants and increased morbidity and mortality rates are found in industrial areas, especially for the susceptible group, children; however, most studies use atmospheric dispersion modeling to estimate household air pollutants. Therefore, the aim of this study was to assess the indoor air quality, e.g., CO, CO2, NO2, SO2, O3, particulate matter with aerodynamic diameter less than 2.5 μm (PM2.5), and their influence factors in children’s homes in an industrial city. Children in the “general school”, “traffic school”, and “industrial school” were randomly and proportionally selected. Air pollutants were sampled for 24 h in the living rooms and on the balcony of their houses and questionnaires of time–microenvironment–activity-diary were recorded. The indoor CO concentration of the traffic area was significantly higher than that of the industrial area and the general area. In regard to the effects of window opening, household NO2 and PM2.5 concentrations during window opening periods were significantly higher than of the reference periods. For the influence of cooking, indoor CO2, NO2, and PM2.5 levels during the cooking periods were significantly higher than that of the reference periods. The indoor air quality of children in industrial cities were affected by residential areas and household activities.

Addressing Tobacco Use in Underserved Communities Through a Peer-Facilitated Smoking Cessation Program

Communities Engaged and Advocating for a Smoke-Free Environment (CEASE) is a long-standing research partnership between a university and the neighboring community that was established to reduce tobacco use among poor and underserved residents. The CEASE tobacco cessation program was implemented in four phases, with each new phase applying lessons learned from the previous phases to improve outcomes. This study describes CEASE's community-based approach and reports results from implementing the second phase of the intervention which, among other things, varied in the type of incentives, setting, and providers used. CEASE implemented a mixed-methods study following the Community-Based Participatory Research (CBPR) approach. During Phase II, a total of 398 smokers were recruited into two 12-session group counseling interventions facilitated by trained peers in community venues, which differed in the type of incentives used to increase participation and reward the achievement of milestones. At 12-week follow-up, 21% of all participants reported not smoking, with a retention rate (i.e., attendance at six or more of the 12 cessation classes offered) of 51.9%. No significant differences in cessation outcomes were found between the two study arms. Using a CBPR approach resulted in a peer-led model of care with improved outcomes compared to Phase I, which was provided by clinicians. The combined use of monetary and non-monetary incentives was helpful in increasing participation in the program but did not significantly impact smoking cessation. A CBPR approach can increase the acceptability and effectiveness of cessation services for underserved populations.

Systemic biomarkers of inflammation, oxidative stress and tissue injury and repair among waterpipe, cigarette and dual tobacco smokers

BACKGROUND

Waterpipe tobacco (WPT) smoking is associated with deleterious effects on cardio-pulmonary systems which may have adverse repercussions in pathophysiology and progression of chronic lung and cardiovascular diseases. We compared the biomarkers of systemic inflammation, lipid mediators, injury/repair and oxidative stress between groups of non-smokers (NS), exclusive WPT smokers (WPS), exclusive cigarette smokers (CS) and dual WPS and CS (DS).

METHODS

Two cohorts were recruited. Cohort I consisted of WPS (n=12), CS (n=26), DS (n=10) and NS (n=25). Cohort II consisted of WPS (n=33) and NS (n=24). Plasma and urine samples were collected and analysed for various systemic biomarkers.

RESULTS

Compared with NS, plasma levels of inflammatory mediators (interleukin (IL)-6, IL-8, IL1β and tumor necrosis factor-α) were significantly higher in WPS and CS, and were further augmented in DS. Endothelial biomarkers (intracellular adhesion molecule-1, prostaglandin E-2 and metalloproteinase-9) were significantly higher in CS. Most notably, pro-resolving lipid mediator (resolvin E1) and biomarkers of immunity, tissue injury, and repair were significantly lower in WPS and CS. Urinary levels of 8-isoprostane were significantly higher in all smoking groups in cohort I, while 8-isoprostane, myeloperoxidase, receptor for advanced glycation end products (RAGE), En-RAGE and matrix metalloproteinase-9 were significantly higher in all smoking groups in cohort II.

CONCLUSIONS

Biomarkers of inflammation, oxidative stress, immunity, tissue injury and repair were elevated in WPS and CS groups. Furthermore, concurrent use of WPT and cigarettes is more harmful than cigarette or WPT smoking alone. These data may help inform the public and policy-makers about the dangers of WPT smoking and dual use of tobacco products.

A bidirectional path analysis model of smoking cessation self-efficacy and concurrent smoking status: impact on abstinence outcomes

Self-efficacy is routinely associated with abstinence in the addictions literature, and is a major component relapse-prevention models. The magnitude of this relationship has been brought into question following equivocal results in studies controlling for concurrent smoking status. The aim of our study was to clarify the relationship between cessation self-efficacy, smoking status, and cessation outcomes in a cohort of treatment-seeking smokers. Smokers participating in the FLEX trial, a randomized trial investigating the efficacy of three pharmacologic treatments for smoking cessation, completed questionnaires assessing cessation self-efficacy at baseline and at weeks 1, 3, 5 and 10 post-target quit date; smoking status was verified using expired carbon monoxide. Structural models were fit in order to ascertain the relationship between cessation self-efficacy and concurrent smoking at each time-point, and to assess the association between cessation self-efficacy, smoking and seven-day point prevalence smoking status at week 10. A total of 737 treatment-seeking smokers participated. In our path model, self-efficacy and smoking status at all time points were associated with week 10 abstinence (except week 3 self-efficacy), after controlling these values' previous time-points. All direct pathways between cessation self-efficacy and smoking were also significant, supporting a bidirectional relationship. Our results support a bidirectional and reciprocal relationship between cessation self-efficacy and concurrent smoking behavior; participants with higher confidence were more likely to be smoke-free, and concurrent smoking status predicted levels of confidence over the ensuing weeks. Both measures were associated with week 10 abstinence. Our results indicate that while correlated, both cessation self-efficacy and current smoking behavior during a cessation attempt are important independent markers of ultimate cessation success.

Evaluating the effects of switching from cigarette smoking to using a heated tobacco product on health effect indicators in healthy subjects: study protocol for a randomized controlled trial

Tobacco heating products (THPs) are a potentially safer alternative to combustible cigarette smoking. Through continued use, THPs may reduce smoking-related disease risk, whilst maintaining the sensorial experience and nicotine delivery sought by smokers. While literature evidence of the biological effects of THP aerosol exposure is increasing, there remains a knowledge gap with respect to substantiation of THP reduced risk potential in longer term real-life use. This randomized, multi-centre, controlled clinical study will test the hypotheses that following a switch from combustible cigarettes to a THP for 1 year, participants will experience a sustained reduction in exposure to tobacco-related toxicants that will lead to favourable changes in health effect indicators associated with smoking-related disease development. Changes in such indicators will be contextualized against smoking cessation and never-smoker cohorts. Up to 280 participants who do not intend to quit smoking will be randomized to continued combustible smoking (arm A, up to n = 80) or a commercially available THP (arm B n = 200). Furthermore, up to 190 participants with a high intent to quit smoking will undergo smoking cessation (arm D), and 40 never smokers will serve as a control group (arm E). Recruitment numbers were determined to be sufficient to achieve n = 50 in arms A, B and D, at study end. Enrolment started in March 2018 and the trial is scheduled to be completed in March 2020. Data from this study will be a valuable addition to the growing body of evidence in the field of understanding the individual and public health impact of THPs.Clinical Trial Registration: https://www.isrctn.com/ISRCTN81075760.

Female ponderal index at birth and idiopathic infertility

Epidemiological studies have demonstrated an increased risk of developing non-transmittable diseases in adults subjected to adverse early developmental conditions. Metabolic and cardiovascular diseases have been the focus of most studies. Nevertheless, data from animal models also suggest early programming of fertility. In humans, it is difficult to assess the impact of the in utero environment retrospectively. Birthweight is commonly used as an indirect indicator of intrauterine development. This research is part of the ALIFERT study. We investigated a potential link between ponderal index at birth and female fertility in adulthood. Data from 51 infertile and 74 fertile women were analysed. BW was on average higher in infertile women, whereas birth length did not differ between the two groups; thus, resulting in a significantly higher ponderal index at birth in infertile women. Ponderal index at birth has been identified as a risk factor for infertility. These results suggest the importance of the intra-uterine environment, not only for long-term metabolic health but also for fertility.

Metabolic syndrome and smoking are independent risk factors of male idiopathic infertility

Background

Overweight and obesity are known to impact male fertility and are commonly associated with abdominal obesity and metabolic disorders. The association between abdominal obesity or metabolic syndrome with male reproduction has not been fully investigated. Moreover, many factors may interfere with the evaluation of the impact of metabolic syndrome on male fertility. Thus, tobacco is known to alter the spermatic parameters and phenomena linking smoking with metabolic syndrome are therefore complex. The main objective of this study has been to investigate the potential association of metabolic syndrome with male idiopathic infertility given smoking status.

Materiel and methods

The data of this study concerned infertile (n = 96) and fertile (n = 100) men under 45 years of age who have been recruited in the ALIFERT case-control study. Body mass index and waist circumference were measured. Serum triglycerides, cholesterol (total, high density lipoprotein, and low density lipoprotein cholesterol) and fasting blood glucose were assayed. Metabolic syndrome has been diagnosed in the presence of at least three of the following criteria: increased waist circumference, high triglycerides, fasting glucose or arterial blood pressure and low high density lipoprotein cholesterol.

Results

The present study reports that infertile men are in poorer health condition compared to fertile men and are more often smokers. The results of this study suggested metabolic syndrome and smoking to be independent risk factor for idiopathic infertility.

Conclusions

Metabolic syndrome and smoking should systematically be checked at the beginning of medical care in infertile males and personal and multifaceted coaching should be proposed to deal jointly with smoking and metabolic disorders.

Trial registration

NCT01093378 ALIFERT. Registered: March 25, 2010.

Exhaled carbon monoxide levels correlate with incidence of oral mucosal lesions independent of smoking status

Carbon monoxide (CO) is an important component of tobacco smoke, but also environmental toxicity. This study analyzed possible correlation between exhaled CO level and oral health indicators in two geographically distributed populations during health-promoting public events organized for local communities in cities with high and low environmental pollution in Poland (907 patients). Self-reported, instructor-led, oral health questionnaire was developed to monitor current and previous mucosal lesion incidence. Exhaled CO correlated with subjects smoking status and environmental CO exposure: highest in smoking inhabitants of Krakow (12 ppm), with lower levels in smokers from Kozienice (6.5 ppm) and non-smokers from Krakow (6 ppm), and lowest for Kozienice non-smokers (2 ppm) (p < 0.001). After propensity score matching and adjustment for smoking status, demography and comorbidities odds ratio for mucosal lesion incidence was 1.46 (1.31-1.63), p < 0.001) per 1 ppm increase of exhaled CO level. This result might implicate a possible role of environmental pollution factors in oral health pathology.

Comparison of indoor air quality during sleep in smokers and non-smokers' bedrooms: A preliminary study

People spend one third of their life sleeping, but the bedroom, as a specific micro-environment, is often neglected when assessing human exposure to air pollutants. However, exposure during sleep may be significant in the long-term to the integrated individual exposure. This study aimed to assess the exposure during sleep, focusing on a multi-pollutant approach (comfort parameters, carbon dioxide - CO₂, carbon monoxide - CO, formaldehyde (CH₂O), total volatile organic compounds (VOCs), particulate matter - PM_2.5 and PM₁₀ - and ultrafine particles, particle number concentrations - PNC - and lung deposited surface area - LDSA). For that, the air quality during sleep (in real conditions) was monitored using real-time devices in 12 bedrooms of urban (Lisbon and Vila Franca de Xira) and rural (Ponte de Sor) areas of Portugal for one night. Volunteers were smokers and non-smokers. Considering the Portuguese legislation for indoor air quality (IAQ), 67% of the bedrooms registered CO₂ levels above the limit value, while CH₂O, VOC, PM₁₀ and PM_2.5 thresholds were exceeded in 30, 100, 36, and 45% of cases, respectively. Regarding ultrafine parameters, LDSA and PNC ranged from 7.3 to 95.2 μm²/cm³ and from 0.6 to 4.8 × 10³/cm³, respectively. Even with no smoking indoors, smokers' bedrooms were found to have significant higher levels of CO, CH₂O, PM_2.5, PM₁₀ and LDSA than non-smokers' bedrooms, showing the effect of thirdhand smoke, exhalation of pollutants after smoking and infiltration on the degradation of the air quality in the bedroom. A recent new model of real-time monitor was also used for a wide set of IAQ parameters. Its performance to measure PM_2.5 and CO₂ was assessed, showing its applicability in real conditions. Although often neglected, these micro-environments should be considered in the integrated individual exposure to air pollutants and further studied. MAIN FINDINGS OF THE WORK: Several pollutants (CO₂, PM, VOCs and CH₂O) exceeded the guidelines during sleep; smokers are exposed to higher levels of CO, CH₂O, PM, and LDSA than non-smokers while sleeping.

Air pollution may affect the assessment of smoking habits by exhaled carbon monoxide measurements

BACKGROUND

While European air quality policies reduce ambient carbon monoxide (CO) concentrations in general, there are still areas affected by high environmental CO exposure from transportation, industry and burning low-quality fossil fuels. We investigated, how these CO amounts might influence exhaled CO measurements used to monitor the smoking status of healthy subjects.

METHODS

A cross-sectional study of healthy adults living in areas of high air pollution (N = 742) and low air pollution (N = 197) in Poland. They completed a survey regarding their smoking habits and underwent necessary body measurements including exhaled CO concentration levels.

RESULTS

Ambient CO levels were much higher in highly pollutes cities. Also exhaled CO levels in subjects from high pollution areas were significantly higher, independent of subject smoking status (8.25 ppm vs. 3.26 ppm). Smokers exhaled more CO than non-smokers. Although the duration of smoking did not affect the CO levels, they were proportional to the number of cigarettes smoked during the day, especially for higher amounts of cigarettes and in unpolluted areas. It was possible to differentiate active from passive smokers in all areas, but the difference for passive smokers vs. non-smokers was significant only in low pollution city inhabitants.

CONCLUSIONS

Exhaled CO levels were confirmed to be a good indicator of smoking status and smoking pattern in healthy subjects. However, high environmental CO levels both increase baseline exhaled CO concentrations in non-smokers affecting their discrimination from passive smokers, and obscure categorizing cigarette consumption in heavy smokers. These findings add important evidence on both understanding of exhaled CO monitoring results and a significance of environmental CO exposure in areas with high pollution.

A Versatile Method to Enhance the Operational Current of Air-Stable Organic Gas Sensor for Monitoring of Breath Ammonia in Hemodialysis Patients

Point-of-care (POC) application for monitoring of breath ammonia (BA) in hemodialysis (HD) patients has emerged as a promising noninvasive health monitoring approach. In this context, many organic gas sensors have been reported for BA detection. However, one of the major challenges for its integration with affordable household POC application is to achieve stable performance for accuracy and high operational current at low voltage for low-cost read-out circuitry. Herein, we exploited the stability of the Donor-Acceptor polymer on the cylindrical nanopore structure to realize the sensors with a high sensitivity and stability. Then, we proposed a double active layer (DL) strategy that exploits an ultrathin layer of Poly(3-hexylthiophene-2,5-diyl) (P3HT) to serve as a work function buffer to enhance the operational current. The DL sensor exhibits a sustainable enhanced operational current of microampere level and a stable sensing response even with the presence of P3HT layer. This effect is carefully examined with different aspects, including vertical composition profile of DL configuration, lifetime testing on different sensing layer, morphological analysis, and the versatility of the DL strategy. Finally, we utilize the DL sensor to conduct a tracing of BA concentration in two HD patients before and after HD, and correlate it with the blood urea nitrogen (BUN) levels. A good correlation coefficient of 0.96 is achieved. Moreover, the feasibility of DL sensor integrated into a low-cost circuitry was also verified. The results demonstrate the potential of this DL strategy to be used to integrate organic sensor for affordable household POC devices.

Effect of Smoked Cannabis on Vigilance and Accident Risk Using Simulated Driving in Occasional and Chronic Users and the Pharmacokinetic-Pharmacodynamic Relationship

BACKGROUND

The pharmacokinetic-pharmacodynamic relationship between whole blood δ-9-tetrahydrocannabinol (THC) and driving risk is poorly understood.

METHODS

Fifteen chronic cannabis consumers (1-2 joints/day; CC) and 15 occasional cannabis consumers (1-2 joints/week; OC) of 18 to 34 years of age were included. A pharmacokinetic study was conducted with 12 blood samplings over a 24-h period before and after controlled random inhalation of placebo or 10 mg or 30 mg of THC. THC and metabolites were quantified using LC-MS/MS. Effects on reaction time by psychomotor vigilance tests and driving performance through a York driving simulator were evaluated 7 times. A pharmacokinetic-pharmacodynamic analysis was performed using R software.

RESULTS

Whole blood peak THC was 2 times higher in CC than in OC for a same dose and occurred 5 min after the end of consumption. THC remained detectable only in CC after 24 h. Despite standardized consumption, CC consumed more available THC from each cigarette regardless of dose. Maximal effect for reaction time was dose- and group-dependent and only group-dependent for driving performance, both being decreased and more marked in OC than in CC. These effects were maximal around 5 h after administration, and the duration was longer in OC than in CC. A significant pharmacokinetic-pharmacodynamic relationship was observed only between T _max for blood THC and the duration effect on mean reciprocal reaction time.

CONCLUSIONS

Inhalation from cannabis joints leads to a rapid increase in blood THC with a delayed decrease in vigilance and driving performance, more pronounced and lasting longer in OC than in CC. ClinicalTrials.gov Identifier: NCT02061020.

Preliminary exploration of secondhand smoke exposure in youth with Sickle Cell Disease: biochemical verification, pulmonary functioning, and health care utilization

Exposure to secondhand smoke (SHSe) can compound an already challenging set of health problems for youth with Sickle Cell Disease (SCD). Exposure to electronic cigarettes may also impact SCD symptomology and respiratory functioning. This study built on these previous findings by a) utilizing two objective measures of SHSe, salivary cotinine and exhaled carbon monoxide and b) examining the association of SHSe with emergency department utilization, physician-reported sickle cell crises, and pulmonary functioning. Caregivers (N = 31 dyads; Mage = 37.6 years; SD = 8.5 years) of youth with SCD (Mage = 9.0 years; SD = 4.5 years) completed self-report measures of tobacco/nicotine use. Youth provided a saliva sample to assess cotinine levels, and performed pulmonary function tests. Dyads provided breath samples for measurement of eCO. A chart review was conducted to obtain medical history and utilization. Majority of youth (88%) were exposed to SHS via salivary cotinine. Interestingly, no significant associations were observed between youth cotinine levels and emergency department utilization, physician-reported sickle cell crises, or pulmonary functioning. Present findings indicate a need to assess for SHSe using objective assessment measures. Future research should investigate which specific factors contribute to increase SHSe/SHVe in youth with SCD.

Bangladesh Chars Tobacco Assessment Project (CTAP) 2018: a data note

OBJECTIVES

The Chars Tobacco Assessment Project 2018 is a holistic survey conducted in the chars (riverine islands) of Gaibandha in Northern Bangladesh, covering 985 households over 24 clusters. The survey was conducted with two objectives: (1) to assess levels of tobacco consumption and evaluate prevailing socio-economic, behavioral and health status of the chars population, and (2) to look at the effectiveness of advocacy campaigns to reduce tobacco consumption through behavioral nudges via randomized controlled trials (RCTs) in rural Bangladesh. The study site was purposively chosen due to its high tobacco consumption rate, and the geographical segregation of the chars aided in reducing spillovers for RCT design.

DATA DESCRIPTION

In addition to detailed information on tobacco (smoking and smokeless) consumption and perception, data was collected on: household composition, housing and plot ownership, consumption, risks and shocks coping, dowry, farm production, loans, savings and lending, labor income, asset holdings, migration and remittance, anthropometry, respiratory diseases, co-morbidities, reproductive history, risk and time preference. Unique to the dataset are carbon monoxide readings for accurate short term smoking measurement and FEV1 and PEF values for identification of long term lung damage. The data is representative only for the chars of Gaibandha.

Biomarkers of Exposure to Secondhand and Thirdhand Tobacco Smoke: Recent Advances and Future Perspectives

Smoking is the leading preventable disease worldwide and passive smoking is estimated to be the cause of about 1.0% of worldwide mortality. The determination of tobacco smoke biomarkers in human biological matrices is key to assess the health effects related to the exposure to environmental tobacco smoke. The biomonitoring of cotinine, the main nicotine metabolite, in human biofluids-including urine, serum or saliva-has been extensively used to assess this exposure. However, the simultaneous determination of cotinine together with other tobacco biomarkers and the selection of alternative biological matrices, such as hair, skin or exhaled breath, would enable a better characterization of the kind and extent of tobacco exposure. This review aims to perform a critical analysis of the up-to-date literature focused on the simultaneous determination of multiple tobacco smoke biomarkers studied in different biological matrices, due to the exposure to secondhand smoke (SHS) and thirdhand smoke (THS). Target biomarkers included both tobacco-specific biomarkers-nicotine and tobacco specific nitrosamine biomarkers-and tobacco-related biomarkers, such as those from polycyclic aromatic hydrocarbons, volatile organic compounds, metals and carbon monoxide. To conclude, we discuss the suitability of determining multiple biomarkers through several relevant examples of SHS and THS exposure.

Exercise performance increase in smokeless tobacco-user athletes after overnight nicotine abstinence

The use of nicotine administered through smokeless tobacco (snus) has increased among athletes. The purpose of this study was to investigate the ergogenic effects of snus on aerobic performance during exercise until exhaustion in athletes after abstinence or satiety nicotine conditions. The study utilized a randomized, controlled, within-subject design experiment. Sixteen male snus-user athletes completed an exercise until exhaustion at a constant load of their 80% of V ˙ O 2 max (calculated by a maximal incremental test) in two separate sessions, corresponding to nicotine conditions: 12-hour overnight abstinence and satiety. A portion of 1 g of snus (~8 mg/g of nicotine) was administered 25 minutes before each experimental test. In each session, time to exhaustion (TTE), global rating of perceived exertion, cardiovascular and metabolic responses, and muscle and cerebral oxygenation were measured. Nicotine and cotinine analysis confirmed session conditions (abstinence or satiety). Snus induced a significant increase (+13.1%) of TTE following abstinence (24.1 ± 10.7 minutes) compared to satiety condition (20.9 ± 8.0 minutes; P = 0.0131). The baseline values revealed that abstinence of snus induced significant increase in the oxygenation of the muscular tissues (+4%), in metabolic values and in cardiovascular parameters, when compared to satiety condition. Our results indicate an increase of exercise performance (+13.1% TTE) due to snus administration in an abstinence condition. Considering that twelve hours of abstinence from snus-contained nicotine affected metabolic, cardiovascular and muscular tissue oxygenation, we suggest that snus administration at test time might relieve these withdrawal changes and yield an increase in time to exhaustion.

Association between exhaled carbon monoxide and asthma outcomes in Peruvian children

BACKGROUND

Asthma prevalence continues to increase in low and middle-income countries, presenting challenges in assessing asthma control in resource-poor settings. Previous studies suggest that exhaled carbon monoxide (eCO) is higher with asthma severity and lower with treatment. We hypothesized that eCO levels may be elevated in children with asthma, particularly in children with partially controlled or uncontrolled asthma in a low-resource setting in Lima, Peru.

METHODS

We compared average eCO levels between 248 children with asthma and 221 healthy controls as well as the odds of asthma by eCO quartiles (0-1, 2, 3, and ≥4 ppm) using multivariable linear and logistic regression. eCO quartiles were also used to compare the odds of partially controlled or uncontrolled asthma (score ≤19 on the Asthma Control Test) in a multivariable logistic regression model.

FINDINGS

Average adjusted eCO level was 0.56 ppm (95% CI 0.07-1.05) higher in children with asthma. The adjusted odds of asthma were 1.22 (95% CI 0.75-1.97), 1.46 (0.81-2.63), and 1.76 (0.96-3.23) in the second, third, and fourth eCO quartiles compared to the first eCO quartile, respectively. Among children with asthma, the adjusted odds of partially controlled or uncontrolled asthma in those in the second, third, and fourth eCO quartiles, compared to the first, were 1.61 (95% CI 0.74-3.48), 3.66 (95% CI 1.51-8.87), and 2.50 (95% CI 1.06-5.90), respectively.

INTERPRETATION

eCO may serve as an inexpensive biomarker for asthma control, particularly in low-resource settings.

The effects of oral smokeless tobacco administration on endurance performance

BACKGROUND

Smokeless tobacco is widely used by athletes to enhance performance. Nicotine is a central nervous system stimulant and acts on cardiocirculatory and metabolic systems, involving tissue blood flow and circulatory vasoreactivity. The aim of this study was to investigate the effects of the oral smokeless tobacco (Swedish snus (SS)) on the perception of fatigue and time to exhaustion (TTE) during moderate-intensity aerobic exercise.

METHODS

Fourteen healthy non-tobacco male users were recruited for a double-blind, controlled crossover design (SS vs. snus placebo (SP)). Subjects were tested for 3 sessions: experimental session 1 (Exp1) consisted of an incremental test to determine the maximal aerobic power output (W_max), whereas Exp2 and Exp3 consisted of exercising at 65%W_max until exhaustion in SS or SP conditions. During Exp2 and Exp3, muscle and cerebral oxygenation was assessed by means of near-infrared spectroscopy, and the rating of perceived exertion (RPE) was recorded.

RESULTS

Comparing SS with SP tests, significant differences (p < 0.05) were found in the values of cerebral (~3%) and muscular tissues oxygenation (~4%) in the first 30 min of exercise. The RPE values were not significantly different between the 2 conditions (SS vs. SP). No significant difference was found in TTE (SS: 54.25 ± 21.84 min; SP: 50.01 ± 17.03 min).

CONCLUSION

This study showed that muscular and cerebral oxygenation increased significantly with snus administration during an endurance exercise until exhaustion, but this did not affect fatigue perception and TTE. The results showed that snus could not be considered an ergogenic substance in non-tobacco users.

Neural correlates of tobacco cue reactivity predict duration to lapse and continuous abstinence in smoking cessation treatment

It has been hypothesized that neural reactivity to drug cues in certain limbic/paralimbic regions of the brain is an indicator of addiction severity and a marker for likelihood of success in treatment. To address this question, in the current study, 32 participants (44 percent female) completed a functional magnetic resonance imaging cigarette cue exposure paradigm 2 hours after smoking, and then enrolled in a 9-week smoking cessation treatment program. Neural activation to smoking cues was measured in five a priori defined limbic/paralimbic regions previously implicated with cue reactivity across substances. These included regions of the ventral striatum, anterior cingulate cortex and amygdala. Cox proportional hazard modeling was conducted to predict the number of days to first smoking lapse by using neural activation in these regions. Greater neural activation during pre-treatment exposure to smoking cues in the right ventral striatum, the left amygdala, and the anterior cingulate was associated with longer periods of abstinence following cessation. A similar pattern was present for continuous abstinence for the full duration of treatment. While baseline levels of nicotine dependence were strongly associated with treatment outcome, activation in the right ventral striatum predicted duration of abstinence beyond level of nicotine dependence. These results suggest that pre-treatment reactivity to smoking cues in areas associated with cue reactivity may be associated with successfully maintaining abstinence during treatment. This is consistent with models that propose that as addiction becomes more severe, motivational processing shifts from regions that subserve reward salience and learning to regions responsible motor behavior and habit learning.

A prospective, observational study investigating the use of carbon monoxide screening to identify maternal smoking in a large university hospital in Ireland

OBJECTIVES

This study evaluated breath carbon monoxide (BCO) testing in identifying maternal smokers as well as the difference between disclosers and non-disclosers of smoking status. We also investigated if other extrinsic factors affected the women's BCO levels in pregnancy.

DESIGN

A prospective observational study.

SETTING

A university obstetric hospital in an urban setting in Ireland.

PARTICIPANTS

Women (n=250) and their partners (n=54) were recruited at their first antenatal visit. Women <18 years and those who did not understand English were excluded. A booking history, including recording of smoking status, was collected by midwives. Following this, women were recruited and completed a detailed research questionnaire on smoking and extrinsic/environmental BCO sources. A BCO test was performed on both the woman and her partner.

PRIMARY AND SECONDARY OUTCOME MEASURES

The number of self-reported smokers and those that were positive on the BCO test. The characteristics of women who disclosed and did not disclose smoking status. The effect of extrinsic factors on the BCO test results.

RESULTS

Based on the receiver-operating characteristic curve, a BCO cut-off point of ≥3 ppm was the optimal level to identify ongoing smoking. At booking history, 15% of women reported as current smokers. Based on BCO levels ≥3 ppm combined with self-reported smoking in the research questionnaire, the rate increased to 25%. Non-disclosers had similar characteristics to non-smokers. No extrinsic factors affected maternal BCO levels.

CONCLUSIONS

Based on self-report and BCO levels, a quarter of women presenting for antenatal care continued to smoke, but only 60% reported their smoking to midwives. BCO measurement is an inexpensive, practical method of improving identification of maternal smoking, and it was not effected by extrinsic sources of BCO. Improved identification means more smokers can be supported to stop smoking in early pregnancy potentially improving the short-term and long-term health of both mother and child.

Salivary cotinine concentration and carbon monoxide levels in young adults smoking midwakh in comparison with cigarette smokers

Objectives

To estimate and compare the salivary cotinine levels using a semiquantitative method, called NicAlert, between three groups: non-smokers, daily smokers of cigarettes and daily smokers of midwakh, and to compare the carbon monoxide (CO) levels among these groups.

Materials and methods

A total of 159 adult male volunteers aged 20 and above were included, with 54 current cigarette smokers, 52 current midwakh smokers and 53 non-smokers. Estimate of breath carbon monoxide and salivary cotinine were collected, as well as sociodemographic characteristics and details of smoking habits and second-hand smoke exposure among participants. Institutional review board approval was obtained and data were analysed using SPSS V.21 with the Kruskal-Wallis test used to obtain differences in the distribution.

Results

There was no significant difference in the median breath CO and salivary cotinine levels between cigarette and midwakh smokers. Levels of breath CO were significantly higher in cigarette and midwakh smokers as compared with non-smokers (19.5, 17.5 and 6.0, respectively, p<0.05); the same relationship was observed for cotinine levels among cigarette and midwakh smokers as compared with non-smokers (4.0, 3.0 and 0.0, respectively, p≤0.05). Additionally, the values of both salivary cotinine and breath CO increased with the frequency of tobacco use.

Conclusion

These are the first data that we are aware of that demonstrate that in terms of at least two key biomarkers of tobacco use, there are comparable levels of exposure between cigarettes and midwakh users, demonstrating a need for intensified attention to the use of midwakh.

[Biomarkers of Smoking - Which Cut-Off Values Should be Used?]

Biomarkers of Smoking - Which Cut-Off Values Should be Used? Abstract. Verification of smoking status by means of biomarkers is important for treatment decisions of patients with smoking-related diseases. Cotinine is currently the best biomarker to document nicotine consumption. A low cost alternative method to determine smoking status is by measurement of carboxyhemoglobin (CO-Hb) in the exhaled breath. The main disadvantage of CO-Hb is the short half-life. The appropriate cut-off value for active nicotine consumption in Switzerland is 50 ng/ml or higher cotinine in the urine or 10 ng/ml and 12 ng/ml in serum and saliva, respectively. CO-Hb levels greater than 2 % indicate smoking with high probability, levels above 3 % with very high probability.

Smoking behaviour and sensations during the pre-quit period of an exercise-aided smoking cessation intervention

INTRODUCTION

Previous research has shown reductions in cigarette consumption during the pre-quit period of exercise-aided smoking cessation interventions. Smoking topography and sensation patterns during this period is unknown and may provide valuable insight into compensation and cessation readiness.

METHODS

Female smokers (N = 236, M age = 43, M cigarettes/day = 17.0) enrolled in an exercise-aided smoking cessation intervention self-reported daily cigarette use and cigarette sensory experiences. Breath carbon monoxide and smoking topography data were collected during the period leading up to the targeted quit date (i.e., baseline, week 1, and week 3), which was set for week 4.

RESULTS

Repeated measures ANOVAs revealed that cigarette consumption (p < 0.001, eta = 0.32), carbon monoxide (p < 0.001, eta = 0.14), puff duration (p = 0.01, eta = 0.05), smoking satisfaction (p < 0.001, eta = 0.34), psychological reward (p < 0.001, eta = 0.43), enjoyment of respiratory tract sensations (p < 0.001, eta = 0.29), and craving (p < 0.001, eta = 0.39) decreased, whereas average puff flow (p = 0.01, eta = 0.05) increased.

CONCLUSIONS

This is the first study to establish that regular exercise during the pre-quit period served as a conduit for facilitating behavioral and sensory harm reduction with cigarettes. Furthermore, the pattern of change observed between cigarette consumption and smoking topography does not support compensation. These findings imply that female smokers who exercise prior to a quit attempt are in a favourable state to achieve cessation.

Smoking Cessation Programs for Lesbian, Gay, Bisexual, Transgender, and Intersex People: A Content-Based Systematic Review

Introduction

Tobacco use among lesbian, gay, bisexual, and transgender (LGBT) people is double the general population. Limited evidence suggests high smoking rates among intersex people. Lesbian, gay, bisexual, transgender, and intersex (LGBTI) people are a priority population in Australian health policy, particularly mental health and aging. Despite associations between smoking and noncommunicable diseases relevant to aging and mental health, LGBTI-targeted smoking cessation interventions in Australia have been limited to people living with HIV. Applying existing interventions to marginalized populations without modification and evaluation may fail and exacerbate inequities.

Aims

To assess outcomes and characterize the populations served, cultural modifications, and behavior change techniques (BCTs) of interventions to reduce LGBTI smoking.

Methods

We searched MEDLINE, six additional databases, and contacted authors to retrieve published and unpublished program evaluations.

Results

We retrieved 19 studies (3663 participants). None used control groups. Overall quit rate was 61.0% at the end of interventions and stabilized at 38.6% at 3-6 months. All studies included gay men, 13 included lesbians, 13 "LGBT," 12 bisexual people, five transgender people, and none included intersex people. Transgender people comprised 3% of participants. Of programs open to women, 27.8% of participants were women. Cultural modifications were used by 17 (89.5%) studies, commonly meeting in LGBT spaces, discussing social justice, and discussing LGBT-specific triggers. Common BCTs included providing normative information, boosting motivation/self-efficacy, relapse prevention, social support, action planning, and discussing consequences.

Conclusions

Quit rates were high; using control groups would improve evaluation. Existing programs may fail to reach groups other than gay men.

Implications

This review examines the evidence for LGBTI-targeted smoking cessation interventions. Populations within LGBTI are not proportionally represented in smoking cessation research, and no study addressed intersex smoking. Overall, LGBT-targeted interventions appear to be effective, and simply having an LGBT-specific group may be more effective than groups for the general population. More rigorous research is necessary to draw firm conclusions. Our study space analysis provides suggestions for areas of more targeted research on mechanisms underlying these complex interventions' success.

Passive exposure to e-cigarette emissions: Immediate respiratory effects

INTRODUCTION

The present work examined the effect of passive exposure to electronic-cigarette (e-cigarette) emissions on respiratory mechanics and exhaled inflammatory biomarkers.

METHODS

A cross-over experimental study was conducted with 40 healthy nonsmokers, 18-35 years old with normal physical examination and spirometry, with body mass index <30 kg/m², who were exposed to e-cigarette emissions produced by a smoker, according to a standardized protocol based on two resistance settings, 0.5 ohm and 1.5 ohm, for e-cigarette use. All participants underwent a 30-minute control (no emissions) and two experimental sessions (0.5 and 1.5 ohm exposure) in a 35 m³ room. The following Impulse Oscillometry (IOS) parameters were measured at pre and post sessions: impedance, resistance, reactance, resonant frequency (fres), frequency dependence of resistance (fdr=R5-R20), reactance area (AX), and fractional exhaled nitric oxide (FeNO). Differences between pre and post measurements were compared using t-tests and Wilcoxon signed rank tests, while analysis of variance (ANOVA) was used for comparisons between experimental sessions (registered under ClinicalTrials.gov ID: NCT03102684).

RESULTS

IOS and FeNO parameters showed no significant changes during the control session. For IOS during the 1.5 ohm exposure session, fres increased significantly from 11.38 Hz at baseline to 12.16 Hz post exposure (p=0.047). FeNO decreased significantly from 24.16 ppb at baseline to 22.35 ppb post exposure in the 0.5 ohm session (p=0.006).

CONCLUSIONS

A 30-minute passive exposure to e-cigarette emissions revealed immediate alterations in respiratory mechanics and exhaled biomarkers, expressed as increased fres and reduced FeNO.

Sniffing Entrapped Humans with Sensor Arrays

Earthquakes are lethal natural disasters frequently burying people alive under collapsed buildings. Tracking entrapped humans from their unique volatile chemical signature with hand-held devices would accelerate urban search and rescue (USaR) efforts. Here, a pilot study is presented with compact and orthogonal sensor arrays to detect the breath- and skin-emitted metabolic tracers acetone, ammonia, isoprene, CO2, and relative humidity (RH), all together serving as sign of life. It consists of three nanostructured metal-oxide sensors (Si-doped WO3, Si-doped MoO3, and Ti-doped ZnO), each specifically tailored at the nanoscale for highly sensitive and selective tracer detection along with commercial CO2 and humidity sensors. When tested on humans enclosed in plethysmography chambers to simulate entrapment, this sensor array rapidly detected sub-ppm acetone, ammonia, and isoprene concentrations with high accuracies (19, 21, and 3 ppb, respectively) and precision, unprecedented by portable sensors but required for USaR. These results were in good agreement (Pearson's correlation coefficients ≥0.9) with benchtop selective reagent ionization time-of-flight mass spectrometry (SRI-TOF-MS). As a result, an inexpensive sensor array is presented that can be integrated readily into hand-held or even drone-carried detectors for first responders to rapidly screen affected terrain.

Associations of urinary polycyclic aromatic hydrocarbon metabolites with fractional exhaled nitric oxide and exhaled carbon monoxide: A cross-sectional study

Exposure to Polycyclic aromatic hydrocarbons (PAHs) has been associated with inflammatory responses. Fractional exhaled nitric oxide (FeNO) and exhaled carbon monoxide (eCO) are both important inflammatory mediators especially in airways. However, few studies have investigated associations of PAH exposures with FeNO or eCO. Therefore, we aimed to quantify the associations of urinary PAH metabolites with FeNO and eCO levels, and investigate their potential effect modifiers by linear mixed models among 4133 participants from the Wuhan-Zhuhai cohort in China. We further performed stratified analyses to estimate effect modification. We found significant associations of increased urinary PAH metabolites with elevated eCO and FeNO. Among all participants, each 1% increase of 1-hydroxynaphthalene, 2-hydroxynaphthalene, 2-hydroxyfluorene, 4-hydroxyphenanthrene, 3-hydroxyphenanthrene, and total PAH metabolites was significantly associated with a 12.6% (95% confidence interval: 9.3%, 15.9%), 9.7% (6.5%, 12.9%), 7.5% (4.1%, 10.9%), 3.2% (0.2%, 6.2%), 2.7% (0.1%, 5.3%), and 6.5% (2.7%, 10.4%) increased eCO level, respectively; while each 1% increase of urinary 1-hydroxynaphthalene, 9-hydroxyphenanthrene, 3-hydroxyphenanthrene, and 2-hydroxyphenanthrene was associated with a -3.0% (-5.8%, -0.2%), 2.9% (0.3%, 5.6%), 3.2% (1.0%, 5.4%), and 4.5% (2.2%, 6.9%) change of FeNO level, respectively. Positive associations between certain urinary PAH metabolites and eCO were observed among both ever-smokers and non-smokers, and the associations were stronger among ever-smokers than that among non-smokers. Increased urinary PAH metabolites were associated with decreased FeNO among ever-smokers and elevated FeNO levels among non-smokers. Our findings suggest that PAH exposures may impair airway through inducing inflammatory response, especially among ever-smokers.

The effect of smoking on obesity: Evidence from a randomized trial

This paper aims to identify the causal effect of smoking on body mass index (BMI) using data from the Lung Health Study, a randomized trial of smoking cessation treatments. Since nicotine is a metabolic stimulant and appetite suppressant, quitting or reducing smoking could lead to weight gain. Using randomized treatment assignment to instrument for smoking, we estimate that quitting smoking leads to an average long-run weight gain of 1.8-1.9 BMI units, or 11-12 pounds at the average height. Semi-parametric models provide evidence of a diminishing marginal effect of smoking on BMI, while subsample regressions show that the impact is largest for younger individuals, those with no college degree, and those in the lowest quartile of baseline BMI.