Fire injuries, disasters, and costs from cigarettes and cigarette lights: a global overview

Injuries from electronic cigarettes, and cigarette/cigar-related paraphernalia, NEISS, 2012-2022

There is a need to determine the role of smoking/vaping related products in Emergency Department (ED) product-related injuries by age and sex to determine if interventions are warranted. These products include the combustible tobacco products' paraphernalia to light them (CTPP), electronic nicotine delivery systems (ENDS), and electronic non-nicotine delivery system (ENNDS). Data from the National Electronic Injury Surveillance System (NEISS), years 2012-2022, were examined for injury data associated with CTPP and ENDS/ENNDS. Bivariate comparisons were conducted. There were an estimated 3,142 (95%CI: 2,384-3,975) ED-treated ENDS/ENNDS product-related injuries and 46,116 (95%CI: 38,712-53,520) CTPP product-related injuries. Males were more likely to have an ED-treated ENDS/ENNDS product-related injury than females (proportion 0.93 [95%CI: 0.82, 0.98] versus 0.70 [95%CI: 0.02, 0.19]) as well as a CTPP product-related injury than females (proportion, 0.60 [95%CI: 0.56, 0.64] versus 0.40 [95%CI: 0.37, 0.44]). There were more ED-treated ENDS/ENNDS product-related injuries among persons ≥18 years than <18 years (proportion, 0.89 [95%CI: 0.75, 0.96] versus 0.11 [95% CI: 0.4, 0.35]). There were also more ED-treated CTPP product injuries among persons ≥ 18 years than <18 years (proportion, 0.73 [95%CI: 0.68, 0.78] versus 0.27 [95%CI: 0.22, 0.32]). No change in the proportion of injuries in our sample associated with END/ENNDS over time were observed. There is a need to consider injuries related to ENDS/ENNDS and CTPP product-related injuries in the discussion of the risks associated with smoking/vaping. Although ENDS/ENNDS have had fewer ED-treated injuries, the number of such injuries has remained stable, rather than declined over the previous decade. Injury prevention is a public health imperative and targeted interventions by healthcare providers during routine care, and the use of public service announcements could specifically target adults ≥18 years. Providing peer-to-peer educational programs, and initiating similar programs targeted at males who use CTP and ENDS/ENNDS have the potential to decrease injury risk.

A Class Act? Regulating Organohalogen Flame Retardants in Groups versus Singly

Regulating chemicals by class based on chemical similarities may help reduce risk of regrettable substitutions while enhancing health protection. A new Commentary summarizes OFR toxicity and exposure research to inform this effort.

The incidence of cancer following hospitalisation for a burn injury in Scotland 2009-2019: A retrospective cohort study

BACKGROUND

Studies suggest increased occurrence of cancer in persons who have experienced a burn injury with hospital admission.

OBJECTIVE

To determine the incidence of cancer among those hospitalised for burn injuries in Scotland compared with a similar group without a history of burn injury hospitalisation.

METHOD

A retrospective cohort design was used to compare cancer (ICD10 C00-97, excluding C44) incidence in two groups: 6805 burn injury patients discharged from Scottish hospitals between 2009 and 2019, and 25,946 subjects from the general population who were matched to burn patients by sex, year of birth, and degree of social deprivation. Cancer incidence was identified from the Scottish cancer registry. Cox proportional hazard regression was used to model time to cancer incidence adjusting for age, sex, degree of deprivation and presence of a comorbidity. Cancer risk was presented as standardised incidence ratios (SIRs) and hazard ratios (HR).

RESULTS

We found a higher prevalence of pre-existing conditions, particularly alcohol abuse among patients with burns. Pre-existing cancers were more common in the burn cohort (3.5%) than the comparison group (1.7%) and were excluded from further analysis. Over a median follow-up of 4-5 years, a total of 236 (3.5%) burn patients and 969 (3.7%) persons in the comparison group were diagnosed with cancer. At 0-6 months the cancer SIR for burn patients was 1.88 95% CI (1.40-2.52). After excluding the first six months of follow-up, the overall incidence of cancer was marginally elevated in burn patients (SIR 1.04, 95% CI 0.90-1.19, p = 0.62) and not statistically different from the incidence in comparison subjects (adjusted HR 1.03, 95% CI 0.88-1.21, p = 0.71).

CONCLUSIONS

Patients that suffer burn injury have a higher incidence of cancer than the general population and a group matched by age, sex and degree of deprivation. A higher incidence of adverse health-related behaviours such as smoking, alcohol use and pre-existing health conditions among many patients that suffer a burn most likely explain this observed increase. Any persisting inflammatory or immune dysfunction following burn injury is unlikely to account for the increase in cancers in this study.

Electric vehicle fire risk assessment framework using Fault Tree Analysis

Background

In the near future, the rapid adoption of electric vehicles is inevitable, driven by environmental concerns and climate change awareness. However, this progressive trend also brings forth safety concerns and hazards, notably regarding the risk of EV fires, which have garnered significant media attention. This necessitates the need to study for comprehensive fire risk assessment strategies aimed at preventing and mitigating such incidents.

Methods

This study presents a framework for assessing fire risks in EVs using Fault Tree Analysis (FTA). By integrating disparate data sources into a unified dataset, the proposed methodology offers a holistic approach to understanding potential hazards. The study embarked on a comprehensive exploration of EV fire causes through qualitative FTA.

Results

Through this approach, the work discerned five major causes: human factors, vehicle factors, management factors, external factors, and unknown factors. Using a meticulous weighted average approach, the annual EV fire frequency for each country was deduced, revealing an average annual EV fire rate of 2.44 × 10 -4 fires per registered EV. This metric provides a significant benchmark, reflecting both the probability and inherent risk of such incidents. However, uncertainties in data quality and reporting discrepancies highlight the imperative of continued research.

Conclusions

As EV adoption surges, this study underscores the importance of comprehensive, data-driven insights for proactive risk management, emphasizing the necessity for vigilant and adaptive strategies. The findings emphasize the pivotal role of this assessment in shaping response strategies, particularly for first responders dealing with EV fires. In essence, this research not only elevates the understanding of EV fire risks but also offer a foundation for future safety measures and policies in the domain.

A comprehensive review on triple R eco-management strategies to reduce, reuse and recycle of hazardous cigarette butts

Cigarettes are the globally consumed product that contributes to public health problems and is the source of the most prevalent form of litter in the world, Cigarette butts. Cigarette butts are a major source 4000 toxic chemicals, affecting the health of wildlife, humans, and the environment and their decomposition can take years due to the resistance of cellulose acetate to bacterial and fungal degradation. In 2016, the world production of cigarettes exceeded 5.7 trillion, with the majority of them consisting of cellulose acetate filters. Consequently, a massive amount of hazardous waste leaches out in the environment. Incineration and landfilling are methods of disposal, but they can result in the emission of harmful fumes and be costly. To combat this environmental issue, researchers have explored the recycling of cigarette butts in various materials, including asphalt concrete, fired clay bricks, and as a carbon source, among others. Various approaches can be used to reduce cigarette butts pollution, but efficient collection logistics by consumers remains a crucial factor for successful recycling. This paper provides innovative solutions to mitigate the cigarette butts litter problem and the feasibility of recycling methods. Despite recent progress in cigarette butts recycling solutions, there is still much room for research in this area.

Nursing students' attitudes, behaviour, and knowledge toward smoking cessation: Results from a descriptive survey at a regional university

BACKGROUND

Smoking is the largest single cause of lifestyle-related preventable morbidity and mortality. Nurses form the largest cohort of health professionals and are strategically placed to implement smoking cessation interventions. However their capacity is underutilised, particularly in rural and remote areas in countries such as Australia where the incidence of smoking in is higher than average and access to healthcare is limited. One strategy to address the underutilisation of nurses in smoking cessation interventions is to include training in the university/college nursing curriculum. To effectively implement this training, it is vital to have an in-depth knowledge of student nurses' attitudes towards smoking including the role of healthcare professionals in smoking cessation, their smoking behaviour and that of their peers, and knowledge regarding smoking cessation techniques and resources.

OBJECTIVES

Investigate nursing students' attitudes, behaviour, and knowledge towards smoking cessation, determine the impact of demographics and educational experienced on these, and develop recommendations for future research and educational practice.

DESIGN

Descriptive survey.

PARTICIPANTS

Non-probability sample of undergraduate nursing students (n = 247) from a regional Australian university.

RESULTS

Significantly more participants had tried smoking cigarettes than had not (p = 0.026). There were no significant relationships between gender and smoking (p = 0.169) or e-cigarette use (p = 0.200), but a significant relationship was found between age and smoking status where older participants (48-57 years) were more likely to smoke (p < 0.001). Most participants (70 %) were supportive of public health measures to reduce cigarette smoking but felt that they lacked specific knowledge to assist their patients to cease smoking.

CONCLUSIONS

Within education there needs to be an emphasis on the central role that nurses play in smoking cessation with a greater focus on training nursing students about smoking cessation strategies and resources. There is also a need to ensure that students know it falls within their duty of care to address smoking cessation with patients.

Toward a sustainable circular economy for cigarette butts, the most common waste worldwide on the coast

The circular economy is based on the maximum use of resources by reducing, reusing, and recycling the elements used. Currently, the items littered most frequently in the world are cigarettes butts (CB) as these debris are freely disseminated in the marine habitat, they are generally difficult to collect and very complex to recycle. Litter CB is a great social problem that generates excessive economic costs and serious environmental problems. CB is also not biodegradable and highly toxic to marine organisms and presents a distinctive mixture of physical and chemical contamination. However, little research has been done on the management and recycling of this dangerous waste. Several proposals have been made to incorporate this waste into high-volume articles of direct production or recycling, but collection logistics are lacking since the current system is inefficient, in addition to the poor environmental behaviour of citizens. This work presents a current synthesis of the CB problem from all its possible aspects in order to have a global vision of the life cycle of the CB, indicating both the known and the gaps in the knowledge of each of them, and intends to give a general outline of the steps to follow to try to end such a worrying problem at the global level.

Fire/flames mortality in Australian children 1968-2016, trends and prevention

INTRODUCTION

Mortality attributed to fire and flame for children (0-14 years) over a fifty-year period has not been previously analyzed in Australia. The literature has focused on these deaths over a shorter time period or disaggregated with other causes of burns or deaths in one burns center. However, mortality associated with fire/flames affects this age group the greatest. The aims of this study are to: (1) develop a trends analysis of fire and flames mortality between1968 to 2016, using the Australian Bureau of Statistics (ABS) mortality database and, (2) determine the association of interventions with fire and flames mortality using the Haddon's categorical intervention framework.

METHODS

International Classification of Disease (ICD) codes were extracted and code equivalencies between ICD 8, 9, 10 and the Australian Bureau of Statistics for fire/flames data between 1968--2016 were assessed. To determine whether population changes affected the risks of mortality, the frequency and, rates per 100,000 were used. A literature review was conducted that summarized the current knowledge of interventions associated with the major decreases in the fire and flames mortality rate.

RESULTS

In Australia, we found was a downward trend for the period although with significant variation from year to year when compared to external cause mortality. Additionally, there were multiple successful interventions associated with a sustained decrease in mortality. After 2016, child fire-related mortality remains a problem particularly in low socioeconomic groups and indigenous peoples. A combination of research, public awareness, engineering, legal enforcement, advancements in burns care and, evidence-based policy development all have a role to play in future injury prevention initiatives. Although direct causation to an individual is not possible, associations can be drawn from interventions on a population level to decreases in mortality.

CONCLUSION

We found was a steady decline in both rates and frequency of childhood fire and flames mortality from 1968 to 2016 associated with multiple interventions.

Smoke-Free Policy Disparities in Long-Term Care Facilities

Older adults in long-term care (LTC) facilities suffer disproportionately from health conditions caused or worsened by secondhand smoke. Long-term care facilities in many states and municipalities permit smoking. Americans for Nonsmokers’ Rights compiles data on smoke-free policies only in institutional facilities (e.g., nursing homes), but not in transitional (e.g., independent living) or community-based settings (e.g., adult day). A cross-sectional, observational study was conducted of smoke-free policies using cluster random sampling in Kentucky to compare differences in policy location of coverage and strength of smoke-free policies in institutional, transitional, and community-based LTC facilities by rural/urban status. Online or phone surveys of LTC administrators representing 306 facilities were conducted. Of the facilities sampled, 35.5% were institutional, 33.4% transitional, 25.1% community-based, and 6.0% multi-type. Only one in five (19.6%) facilities restricted smoking indoors and outdoors. Only 17.3% of the policies were comprehensive (i.e., prohibiting use of all tobacco products by all persons living, frequenting, or working in LTC facilities). Compared to transitional facilities, institutional and community-based facilities were more likely to have comprehensive policies and restrict smoking indoors and outdoors. Facilities located in rural communities were less likely to restrict smoking indoors or outdoors and less likely to have comprehensive smoke-free policies, reflecting a disparity in policy protections. Strong, consistent smoke-free policies and policy enforcement are needed to reduce the disparity in smoke-free protections for older adults, LTC employees, and visitors. More research is needed to investigate the best strategies for implementing and enforcing policies that completely restrict smoking in all LTC facilities.

Burn Injuries in People Who Used Drug, 2009-2017: A Case-Control Study in Shiraz, Southern Iran

BACKGROUND

Burn injury is a critical health issue, which is associated with several morbidities and mortalities. Substance abuse, which is an important public health problem in Iran, can affect burn injury outcomes and etiologies in victims. This study was aimed to evaluate different aspects of burn injuries in people who used drug (PWUD) in two referral centers in the south of Iran.

METHODS

This Case-Control Study was conducted on burn victims referred to Amir-al Momenin Hospital and Ghotb-al-din Hospital from 2009 to 2017. Patients with a history of drug consumption were selected from the database and compared to randomly selected burn victims with no history of drug use. Demographics, burn etiology, underlying disease, total body surface area, hospitalization duration, and also the outcomes were collected and recorded in both groups. Data analysis was done by SPSS software.

RESULTS

A total of 5,912 inpatients were included in this study, which 2,397 of them (40.54%) were female. The mean age of the patients was 26.12 ± 19.18. Drug history was positive in 659 patients (11.15%). Familial issues and mental disorders were significantly higher in the PWUD group compared to the control group (P<0.001). Explosion etiology was significantly higher in the PWUD group (P<0.001). Psychiatric disorders (P<0.001), total body surface area (P=0.023), and hospital stay (P<0.001) were significantly higher in PWUD; however, the mortality rate had no statistically significant differences between the groups (P=0.583).

CONCLUSION

Substance abuse is a risk factor in burn victims, which can affect burn etiology and burn-related morbidities.

Evaluation of a mobile safety center's impact on pediatric home safety behaviors

BACKGROUND

A Mobile Safety Center (MSC) provides safety resources to families to prevent pediatric injury. The primary objective of this study was to assess the impact of an MSC on home safety behaviors.

METHODS

We conducted a prospective observational study with 50 parents and guardians recruited at community events attended by an MSC. Participants completed a pre-test assessing demographics and home safety behaviors prior to participating in the MSC's home safety educational program. We conducted follow-up with participants 4 weeks (follow-up 1) and 6 months (follow-up 2) after their visit to the MSC to reassess home safety behaviors. We used descriptive statistics in addition to Friedman, Wilcoxon sum-rank, and Fisher's exact testing to analyze respondent demographics and changes in home safety practices. Friedman and Wilcoxon sum-rank testing was performed only for participants who completed all surveys.

RESULTS

Of our 50 participants, 29 (58%) completed follow-up 1, 30 (60%) completed follow-up 2, and 26 (52%) completed both. Participants were more likely to have a fire-escape plan at follow-up 1 than on the pre-test (p = 0.014). They were also more likely to have the Poison Control Hotline number accessible in their cellphone or near a home phone at follow-up 1 compared to the pre-test (p = 0.002) and follow-up 2 compared to the pre-test (p < 0.001). Families with at least one household member who smoked or used e-cigarettes at any point during the study (n = 16 for the total population, n = 9 for those who completed both surveys) were less likely to have more than two smoke detectors installed at home during the pre-test (p = 0.049). However, this significantly changed across timepoints (p = 0.018), and while 44.4% reported more than two detectors during the pre-test, 88.9% reported this at both follow-ups.

CONCLUSIONS

Home safety education through an MSC positively changed some reported safety behaviors and maintained these changes at long-term follow-up. By encouraging the adoption of better home safety practices, education at an MSC may decrease pediatric injury rates.

Quantifying the social costs and benefits of tobacco in Estonia

BACKGROUND

The tobacco cost literature has predominantly focused on estimating direct healthcare costs and productivity losses from morbidity and mortality. This study places a greater focus on the effects that arise through the fiscal system, illicit trade and fire accidents to estimate the social costs and benefits of tobacco use in Estonia in 2018.

METHODS

A prevalence-based cost-of-illness approach was used, relying on data from the 2017-2018 period. Age-specific tobacco-attributable fractions were employed to estimate the costs and benefits of tobacco-related morbidity and mortality. Data on mortality, morbidity and healthcare costs were received from the National Institute of Health Development and the Estonian Health Insurance Fund. We used data for offences and fires from the Estonian Rescue Board and the Estonian Tax and Customs Board.

RESULTS

It was estimated that the total social cost attributable to tobacco in Estonia in 2018 was €174 million, representing 0.67% of the nation's GDP. If future benefits are also considered, the net social cost is €78 million. While the greatest cost components are productivity losses from mortality and morbidity, the level of tobacco-related law enforcement costs are comparable to direct healthcare costs, both of which exceed €10 million annually.

CONCLUSIONS

Despite the substantial social benefits arising through the fiscal system, tobacco-related costs outweighed these benefits in Estonia in 2018. In addition, a considerable portion of the economic burden of tobacco is associated with illicit trade. Therefore, the healthcare and law enforcement sectors would both benefit from effective tobacco control policies.

A randomized controlled trial to compare group motivational interviewing to very brief advice for the effectiveness of a workplace smoking cessation counseling intervention

BACKGROUND

Studies show that smokers have a lower work performance due to time spent smoking, increased fatigue perception and are more absent from work due to smoking-related diseases. The workplace could represent an important location to promote smoking cessation.

METHODS

This study is a multi-center, controlled trial for smoking cessation counseling at the participants' workplace, where 656 randomized participants received four sessions of group motivational interviewing or four sessions of very brief advice and were followed up for 52 weeks.

RESULTS

The Continuous Quit Rate (CQR) was higher for the smoking cessation counseling group than for the very brief advice group during weeks 9 to 12 (17.5% vs. 3.6%) weeks 9 to 24 (13.4% vs. 3.4%) and weeks 9 to 52 (10.3% vs. 3.1%).

CONCLUSIONS

This study demonstrated that motivational interviewing is an efficacious smoking cessation approach for smokers at their workplace. The short-term and long-term cessation rate of the intervention of the smoking cessation counseling group exceeded that of very brief advice.

Online Simulation Model to Estimate the Total Costs of Tobacco Product Waste in Large U.S. Cities

Tobacco product waste (TPW) is one of the most ubiquitous forms of litter, accumulating in large amounts on streets, highways, sidewalks, beaches, parks, and other public places, and flowing into storm water drains, waste treatment plants, and solid waste collection facilities. In this paper, we evaluate the direct and indirect costs associated with TPW in the 30 largest U.S. cities. We first developed a conceptual framework for the analysis of direct and indirect costs of TPW abatement. Next, we applied a simulation model to estimate the total costs of TPW in major U.S. cities. This model includes data on city population, smoking prevalence rates, and per capita litter mitigation costs. Total annual TPW-attributable mean costs for large US cities range from US$4.7 million to US$90 million per year. Costs are generally proportional to population size, but there are exceptions in cities that have lower smoking prevalence rates. The annual mean per capita TPW cost for the 30 cities was US$6.46, and the total TPW cost for all 30 cities combined was US$264.5 million per year. These estimates for the TPW-attributable cost are an important data point in understanding the negative economic externalities created by cigarette smoking and resultant TPW cleanup costs. This model provides a useful tool for states, cities, and other jurisdictions with which to evaluate a new economic cost outcome of smoking and to develop new laws and regulations to reduce this burden.

Estimating burn severity and carbon emissions from a historic megafire in boreal forests of China

Wildfires, especially those of large size, worsen air quality and alter the carbon cycle through combustion of large quantities of biomass and release of carbon into the atmosphere. The Black Dragon fire, which occurred in 1987 in the boreal forests of China is among the top five of such megafires ever recorded in the world. With over 30 years of accumulation of data and availability of new greenhouse gas emission accounting methods, carbon emissions from this megafire can now be estimated with improved precision and greater spatial resolution. To do this, we combined field and remote sensing data to map four burn severity classes and calculated combustion efficiency in terms of the biomass immediately consumed in the fire. Results of the study showed that 1.30 million hectares burned and 52% of that area burned with high severity. The emitted carbon dioxide equivalents (CO₂e), accounted for approximately 10% of total fossil fuel emissions from China in 1987, along with CO (2%-3% of annual anthropogenic CO emissions from China) and non-methane hydrocarbons (NMHC) contributing to the atmospheric pollutants. Our study provides an important basis for carbon emission estimation and understanding the impacts of megafires.

Claire AW, Keller PA, Xu Z, Schillo BA. The 20-year impact of tobacco price and tobacco control expenditure increases in Minnesota, 1998-2017

Introduction

Tobacco control programs and policies reduce tobacco use and prevent health and economic harms. The majority of tobacco control programs and policies in the United States are implemented at local and state levels. Yet the literature on state-level initiatives reports a limited set of outcomes. To facilitate decision-making that is increasingly focused on costs, we provide estimates of a broader set of measures of the impact of tobacco control policy, including smoking prevalence, disease events, deaths, medical costs, productivity and tobacco tax revenues, using the experience of Minnesota as an example.

Methods

Using the HealthPartners Institute’s ModelHealth^™: Tobacco MN microsimulation, we assessed the impact of the stream of tobacco control expenditures and cigarette price increases from 1998 to 2017. We simulated 1.3 million individuals representative of the Minnesota population.

Results

The simulation estimated that increased expenditures on tobacco control above 1997 levels prevented 38,400 cancer, cardiovascular, diabetes and respiratory disease events and 4,100 deaths over 20 years. Increased prices prevented 14,600 additional events and 1,700 additional deaths. Both the net increase in tax revenues and the reduction in medical costs were greater than the additional investments in tobacco control.

Conclusion

Combined, the policies address both short-term and long-term goals to reduce the harms of tobacco by helping adults who wish to quit smoking and deterring youth from starting to smoke. States can pay for initial investments in tobacco control through tax increases and recoup those investments through reduced expenditures on medical care.

Injury-Related Deaths according to Environmental, Demographic, and Lifestyle Factors

Background

Environmental, demographic, and lifestyle variables have been associated with injury-related deaths. The current study identifies the simultaneous association of selected environmental, demographic, and lifestyle variables with deaths from homicide, unintentional injuries, and suicide.

Materials and Methods

Analyses are based on county-level mortality data in the contiguous United States, 2011–15. Basic summary statistics and Poisson regression were used to evaluate the data.

Results

The selected causes of death were impacted differently by age, sex, and race: for homicide, mortality rates were greater in ages 20–39, males, and blacks; for unintentional injuries, the rates increased with age, most noticeably in the oldest age group, and were highest among males and whites; and for suicide, the rates tended to increase with age and were greater in males and whites. Mortality rates from homicide were positively associated with poverty, cigarette smoking, air temperature, and leisure-time physical inactivity. They were negatively associated with precipitation and sunlight. Mortality rates from unintentional injuries were positively associated with altitude, cigarette smoking, air temperature, poverty, obesity, and precipitation. They were negatively associated with population density. Mortality rates from suicides were positively associated with altitude, cigarette smoking, obesity, air temperature, and precipitation and negatively associated with population density.

Conclusion

The results confirm and extend previous research in which death from homicide, unintentional injuries, and suicide are distinctly associated with a combination of environmental, demographic, and lifestyle variables. The findings may be useful in developing strategies for reducing injury-related deaths.

Primary Care Opportunities to Prevent Unintentional Home Injuries: A Focus on Children and Older Adults

Unintentional injuries are a persistent public health problem in the United States. A new health care landscape has the potential to create a clinical environment that fosters greater involvement by health care providers in injury prevention. The aim of this article is to provide evidence supporting the need for engagement by primary care providers in unintentional home injury prevention along with examples of how this could be accomplished. We know a great deal about what population groups are at risk for certain types of injuries. We also know that many injuries can be prevented through policies, programs, and resources that ensure safe environments and promote safe behaviors. For example, the Centers for Disease Control and Prevention's STEADI (Stopping Elderly Accidents, Deaths, and Injuries) initiative comprises clinical decision support tools and educational materials for health care providers. Two effective interventions that have demonstrated a reduction in falls among children are the redesign of baby walkers (engineering) and the mandated use of window guards (enforcement). Primary care clinicians can play a key role in promoting their patient's safety. Taken collectively, a focused attention on preventing unintentional home injuries by primary care providers can contribute to the reduction of injuries and result in optimal health for all.

Shared and divergent neural reactivity to non-drug operant response outcomes in current smokers and ex-smokers

Addiction to cigarettes presents with considerable health risks and induces high costs on healthcare resources. While the majority of cigarette smokers endorse the desire to quit, only a small percentage of quit attempts lead to full abstinence. Failure to achieve abstinence may arise from maladaptive reactivity in fronto-striatal regions that track positive and negative valence outcomes, thus biasing the choice to smoke in the presence of alternative, non-drug reinforcement. Alternatively, long-term nicotine abstinence may reveal neural substrates of adaptive valence outcome processing that promote and maintain smoking cessation. The present study set out to examine the neural correlates of operant response outcomes in current smokers, ex-smokers and matched controls using a monetary incentive delay task during functional MRI. Here we report that compared to controls, both current smokers and ex-smokers showed significantly less activation change in the left amygdala during positive response outcomes, and in the anterior cingulate cortex, during both positive and negative response outcomes. Ex-smokers, however, demonstrated significantly greater activation change compared to smokers and controls in the right amygdala during negative response outcomes. Activation change in the anterior cingulate cortex and middle frontal gyrus of smokers was significantly negatively correlated with nicotine dependence and cigarette pack-years. These results suggest a pattern of shared and divergent reactivity in current smokers and ex-smokers within corticolimbic regions that track both positive and negative operant response outcomes. Exaggerated adaptive processing in ex-smokers may promote long-term smoking cessation through amplified negative valence outcome monitoring.

The Contributing Risk of Tobacco Use for ARDS Development in Burn-Injured Adults With Inhalation Injury

BACKGROUND

This study aims to determine the relationship between tobacco use, inhalation injury, and ARDS in burn-injured adults.

METHODS

This study was an observational cohort of 2,485 primary burn admissions to a referral burn center between January 1, 2008 and March 15, 2015. Subjects were evaluated by methods used to account for mediation and traditional approaches (multivariable logistic regression and propensity score analysis). Mediation analysis examined both the (1) indirect effect of tobacco use via inhalation injury as the mediator on ARDS development and (2) the direct effect of tobacco use alone on ARDS development.

RESULTS

ARDS development occurred in 6.8% (n = 170) of the cohort. Inhalation injury occurred in 5.0% (n = 125) of the cohort, and ARDS developed in 48.8% (n = 83) of the subjects with inhalation injury. Tobacco use was 2-fold more common in subjects with ARDS. In the mediated model, the direct effect of tobacco use on ARDS, including interaction between tobacco use and inhalation injury, was not significant (odds ratio [OR] 1.63, 95% CI 0.91-2.92, P = .10). However, the indirect effect of tobacco use via inhalation injury as the mediator was significant (OR 1.61, 95% CI 1.25-2.07, P < .001), and the proportion of the total effect of tobacco use operating through the mediator was 55.6%. In the non-mediation models (multivariable logistic regression and propensity score analysis), which controlled for inhalation injury and other covariables, the OR for the association between tobacco use and ARDS was 1.84 (95% CI 1.22-2.81, P < .001) and 1.69 (95% CI 1.04-2.75, P = .03), respectively.

CONCLUSIONS

In mediation analysis, inhalation injury was the overwhelming predictor for ARDS development, whereas tobacco use has its strongest effect indirectly through inhalation injury. Patients with at least moderate inhalation injury are at greatest risk for ARDS development despite baseline risk factors like tobacco use.

Fire disaster preparedness and situational analysis in higher learning institutions of Tanzania

Fire disasters are accompanied with devastating impact affecting both lives and properties. The magnitude of the impacts has been severe in places with low levels of fire disaster preparedness. A study was conducted in Dar es Salaam, Tanzania, to investigate the level of fire disaster preparedness considering the availability and condition of firefighting facilities as well as the knowledge on fire management among the selected 10 higher learning institutions. Information for the buildings was obtained from the interviews with the managers of the buildings and field observations; information on the user's preparedness was obtained from interviews using structured questionnaire conducted with the users of the buildings including the visitors. Results from the studied buildings indicated that 60% of the firefighting facilities were not regularly serviced; 50% stored some hazardous materials; 70% of them had not enough water storage for firefighting purposes; 60% had no identifiable fire assembly points; and 90% of the sessions conducted in the buildings involved more than 100 people in a single venue. Further results indicated that 51% of the respondents were not able to operate the installed firefighting facilities; 80.7% of the respondents had never received any training on firefighting and prevention; 95.6% of the respondents had never participated in any fire drills; and 81.5% of them were not aware of the fire responder's contacts. General situation indicated that higher learning institutions are not well prepared to manage fire outbreaks suggesting that plans to rectify the situation are imperative.

Epidemiology and Outcomes of Hospitalized Burn Patients in Gaza Strip: A Descriptive Study

BACKGROUND

Burns are serious health problems and leading causes of mortality and morbidity in the Eastern Mediterranean Region. This study aimed to overview the epidemiological profile and to present outcomes among hospitalized burn patients in AL Alamy burn center in Gaza.

METHODS

This was a cross-sectional retrospective study of medical records of hospitalized patients from July 2013 to June 2014. Descriptive analysis for studied variables was applied and P ≤ 0.05 considered statistically significant.

RESULTS

One humdred eighty nime admissions, 60.8% were males and 63% were under 10 years old. Burn patients in the age range between 19-40 years represented 25.9%. Most common burn injuries were accidental (86.2%), located at home (88.9%), caused by scald (66.1%) and by fire flame (23.8%). On admission, the majority of cases presented with second degree burn (45.5%) or mixed burn (38.6%). The mean TBSA was 11.86 (SD ± 10.78) ranging from 1% to 75% whereas, the mean hospital length of stay was 11.45 (SD ± 12.60) ranging from 1 to 115 days. Total in hospital mortality rate was 2.1% and length of stay was significantly associated with TBSA (P < 0.001).

CONCLUSION

Young children below 10 years seem to be at a higher risk for burn injuries. A significant improvement in burn patients care is observed and practiced and in hospital mortality rate is better compared to neighbouring countries. Preventive programs focusing on safety measures, especially for mothers working in the home, should be implemented urgently to save our children.

Epidemiology of burns in pediatric patients of Beijing City

Background

This study aimed to assess the epidemiological characteristics of pediatric burns in Beijing City.

Methods

This was a retrospective study of pediatric patients (n = 400) admitted to four burn centers in Beijing City between June 2010 and May 2011. Burn severity was determined according to total body surface area (TBSA) percentage and degree. Patients were followed up for one year. Multivariate analyses were carried out to determine the factors (burn etiology, time and place of injury, living conditions, hospital type, first-aid treatment methods, and parent/guardian knowledge of burns, educational level, occupation) affecting burn properties (severity and pigmentation/scar).

Results

191/400 (47.8 %) patients were aged 2-3 years, and scalding was the leading etiology (355/400, 88.8 %). Burn incidence peaked in May (14.8 %), at 10:00-12:00 and 17:00-20:00. Most burn events occurred indoors (272/400, 68.0 %), especially in the kitchen (180/400, 45.0 %). Roughly half of them involved head and neck; 188 (47.0 %) patients had mild burns, 140 (35.0 %) moderate, 44 (11.0 %) extensive, and 28 (7.0 %) critical burns; 184 (46.0 %) patients were treated only with cold-water rinsing or compress; 120 (30.0 %) received no first aid. Only 32 (8.0 %) patients visited a specialized institution. 164 patients underwent surgery. Hospitalization lasted for 14.8 ± 8.1 days. Independent risk factors for burn severity were occurrence month, living conditions, occupation of the mother, and first aid. 288 (72.0 %) patients developed pigmentation and scar within a year while no independent risk factors was observed.

Conclusions

Pediatric burns often occurred indoors, especially in the kitchen, and a substantial proportion receives no first aid.

Electronic supplementary material

The online version of this article (doi:10.1186/s12887-016-0686-7) contains supplementary material, which is available to authorized users.

Nicotinic acetylcholine receptor availability in cigarette smokers: effect of heavy caffeine or marijuana use

RATIONALE

Upregulation of α4β2* nicotinic acetylcholine receptors (nAChRs) is one of the most well-established effects of chronic cigarette smoking on the brain. Prior research by our group gave a preliminary indication that cigarette smokers with concomitant use of caffeine or marijuana have altered nAChR availability.

OBJECTIVE

We sought to determine if smokers with heavy caffeine or marijuana use have different levels of α4β2* nAChRs than smokers without these drug usages.

METHODS

One hundred and one positron emission tomography (PET) scans, using the radiotracer 2-FA (a ligand for β2*-containing nAChRs), were obtained from four groups of males: non-smokers without heavy caffeine or marijuana use, smokers without heavy caffeine or marijuana use, smokers with heavy caffeine use (mean four coffee cups per day), and smokers with heavy marijuana use (mean 22 days of use per month). Total distribution volume (Vt/fp) was determined for the brainstem, prefrontal cortex, and thalamus, as a measure of nAChR availability.

RESULTS

A significant between-group effect was found, resulting from the heavy caffeine and marijuana groups having the highest Vt/fp values (especially for the brainstem and prefrontal cortex), followed by smokers without such use, followed by non-smokers. Direct between-group comparisons revealed significant differences for Vt/fp values between the smoker groups with and without heavy caffeine or marijuana use.

CONCLUSIONS

Smokers with heavy caffeine or marijuana use have higher α4β2* nAChR availability than smokers without these drug usages. These findings are likely due to increased nicotine exposure but could also be due to an interaction on a cellular/molecular level.

Unintentional home injuries across the life span: problems and solutions

Home injuries cause more than 30,000 deaths and 12 million nonfatal injuries annually in the United States. They generate an estimated $222 billion in lifetime costs annually. Despite some data limitations in documenting home as the location of an injury, much progress has been made in identifying effective prevention strategies that reduce injury or mitigate risk behaviors. The current interest in public health in the role of housing in health offers unparalleled opportunities for injury prevention professionals concerned with home injuries. Sharing the science of injury prevention with the wide array of professionals-such as architects, home builders, home visitors, and fire and emergency medical services providers-who create home environments and interact with residents could be a useful approach. A collaborative national effort to reduce the burden of home injuries is needed.

Dual role of nicotine in addiction and cognition: a review of neuroimaging studies in humans

Substantial evidence demonstrates both nicotine's addiction liability and its cognition-enhancing effects. However, the neurobiological mechanisms underlying nicotine's impact on brain function and behavior remain incompletely understood. Elucidation of these mechanisms is of high clinical importance and may lead to improved therapeutics for smoking cessation as well as for a number of cognitive disorders such as schizophrenia. Neuroimaging techniques such as positron emission tomography (PET), single photon emission computed tomography (SPECT), and functional magnetic resonance imaging (fMRI), which make it possible to study the actions of nicotine in the human brain in vivo, play an increasingly important role in identifying these dual mechanisms of action. In this review, we summarize the current state of knowledge and discuss outstanding questions and future directions in human neuroimaging research on nicotine and tobacco. This research spans from receptor-level PET and SPECT studies demonstrating nicotine occupancy at nicotinic acetylcholine receptors (nAChRs) and upregulation of nAChRs induced by chronic smoking; through nicotine's interactions with the mesocorticolimbic dopamine system believed to mediate nicotine's reinforcing effects leading to dependence; to functional activity and connectivity fMRI studies documenting nicotine's complex behavioral and cognitive effects manifest by its actions on large-scale brain networks engaged both during task performance and at rest. This article is part of the Special Issue Section entitled 'Neuroimaging in Neuropharmacology'.

Brain nicotinic acetylcholine receptor availability and response to smoking cessation treatment: a randomized trial

IMPORTANCE

Cigarette smoking leads to upregulation of nicotinic acetylcholine receptors (nAChRs) in the human brain, including the common α4β2* nAChR subtype. While subjective aspects of tobacco dependence have been extensively examined as predictors of quitting smoking with treatment, no studies to our knowledge have yet reported the relationship between the extent of pretreatment upregulation of nAChRs and smoking cessation.

OBJECTIVE

To determine whether the degree of nAChR upregulation in smokers predicts quitting with a standard course of treatment.

DESIGN, SETTING, AND PARTICIPANTS

Eighty-one tobacco-dependent cigarette smokers (volunteer sample) underwent positron emission tomographic (PET) scanning of the brain with the radiotracer 2-FA followed by 10 weeks of double-blind, placebo-controlled treatment with nicotine patch (random assignment). Pretreatment specific binding volume of distribution (VS/fP) on PET images (a value that is proportional to α4β2* nAChR availability) was determined for 8 brain regions of interest, and participant-reported ratings of nicotine dependence, craving, and self-efficacy were collected. Relationships between these pretreatment measures, treatment type, and outcome were then determined. The study took place at academic PET and clinical research centers.

MAIN OUTCOMES AND MEASURES

Posttreatment quit status after treatment, defined as a participant report of 7 or more days of continuous abstinence and an exhaled carbon monoxide level of 3 ppm or less.

RESULTS

Smokers with lower pretreatment VS/fP values (a potential marker of less severe nAChR upregulation) across all brain regions studied were more likely to quit smoking (multivariate analysis of covariance, F8,69 = 4.5; P < .001), regardless of treatment group assignment. Furthermore, pretreatment average VS/fP values provided additional predictive power for likelihood of quitting beyond the self-report measures (stepwise binary logistic regression, likelihood ratio χ21 = 19.8; P < .001).

CONCLUSIONS AND RELEVANCE

Smokers with less upregulation of available α4β2* nAChRs have a greater likelihood of quitting with treatment than smokers with more upregulation. In addition, the biological marker studied here provided additional predictive power beyond subjectively rated measures known to be associated with smoking cessation outcome. While the costly, time-consuming PET procedure used here is not likely to be used clinically, simpler methods for examining α4β2* nAChR upregulation could be tested and applied in the future to help determine which smokers need more intensive and/or lengthier treatment.

TRIAL REGISTRATION

clinicaltrials.gov Identifier: NCT01526005.

Effectiveness of the cigarette ignition propensity standard in preventing unintentional residential fires in Massachusetts

OBJECTIVES

We evaluated the Massachusetts Fire Safe Cigarette Law's (FSCL's) effectiveness in preventing residential fires.

METHODS

We examined unintentional residential fires reported to the Massachusetts Fire Incident Reporting System from 2004 to 2010. We analyzed FSCL effect on the likelihood of cigarette- versus noncigarette-caused fires and effect modification by fire scenario factors by using an interrupted time series regression model. We analyzed the effect of FSCL on monthly fire rates with Poisson regression.

RESULTS

Cigarettes caused 1629 unintentional residential fires during the study period. The FSCL was associated with a 28% (95% confidence interval = 12%, 41%) reduction in the odds of cigarette- versus noncigarette-caused fires, although not in analyses restricted to casualty fires, with smaller sample size. The largest reductions were among fires in which human factors were involved; that were first ignited on furniture, bedding, or soft goods; that occurred in living areas; or that occurred in the summer or winter.

CONCLUSIONS

The FSCL appears to have decreased the likelihood of cigarette-caused residential fires, particularly in scenarios for which the ignition propensity standard was developed. Current standards should be adopted, and the need for strengthening should be considered.

Impact of reduced ignition propensity cigarette regulation on consumer smoking behavior and quit intentions: evidence from 6 waves (2004-11) of the ITC Four Country Survey

Background

Although on the decline, smoking-related fires remain a leading cause of fire death in the United States and United Kingdom and account for over 10% of fire-related deaths worldwide. This has prompted lawmakers to enact legislation requiring manufacturers to implement reduced ignition propensity (RIP) safety standards for cigarettes. The current research evaluates how implementation of RIP safety standards in different countries influenced smokers’ perceptions of cigarette self-extinguishment, frequency of extinguishment, and the impact on consumer smoking behaviors, including cigarettes smoked per day and planning to quit.

Methods

Participants for this research come from Waves 3 through 8 of the International Tobacco Control (ITC) Four Country Survey conducted longitudinally from 2004 through 2011 in the United States, United Kingdom, Australia, and Canada.

Results

Perceptions of cigarette self-extinguishment and frequency of extinguishment increased concurrently with an increase in the prevalence of RIP safety standards for cigarettes. Presence of RIP safety standards was also associated with a greater intention to quit smoking, but was not associated with the number of cigarettes smoked per day. Intention to quit was higher among those who were more likely to report that their cigarettes self-extinguish sometimes and often, but we found no evidence of an interaction between frequency of extinguishment and RIP safety standards on quit intentions.

Conclusions

Overall, because these standards largely do not influence consumer smoking behavior, RIP implementation may significantly reduce the number of cigarette-related fires and the associated death and damages. Further research should assess how implementation of RIP safety standards has influenced smoking-related fire incidence, deaths, and other costs associated with smoking-related fires.

Validity of proposed DSM-5 diagnostic criteria for nicotine use disorder: results from 734 Israeli lifetime smokers

BACKGROUND

The fifth edition of the diagnostic and statistical manual of mental disorders (DSM-5) proposes aligning nicotine use disorder (NUD) criteria with those for other substances, by including the current DSM fourth edition (DSM-IV) nicotine dependence (ND) criteria, three abuse criteria (neglect roles, hazardous use, interpersonal problems) and craving. Although NUD criteria indicate one latent trait, evidence is lacking on: (1) validity of each criterion ; (2) validity of the criteria as a set ; (3) comparative validity between DSM-5 NUD and DSM-IV ND criterion sets ; and (4) NUD prevalence.

METHOD

Nicotine criteria (DSM-IV ND, abuse and craving) and external validators (e.g., smoking soon after awakening, number of cigarettes per day) were assessed with a structured interview in 734 lifetime smokers from an Israeli household sample. Regression analysis evaluated the association between validators and each criterion. Receiver operating characteristic analysis assessed the association of the validators with the DSM-5 NUD set (number of criteria endorsed) and tested whether DSM-5 or DSM-IV provided the most discriminating criterion set. Changes in prevalence were examined.

RESULTS

Each DSM-5 NUD criterion was significantly associated with the validators, with strength of associations similar across the criteria. As a set, DSM-5 criteria were significantly associated with the validators, were significantly more discriminating than DSM-IV ND criteria, and led to increased prevalence of binary NUD (two or more criteria) over ND.

CONCLUSIONS

All findings address previous concerns about the DSM-IV nicotine diagnosis and its criteria and support the proposed changes for DSM-5 NUD, which should result in improved diagnosis of nicotine disorders.

Ignition strength of 25 international cigarette brands

BACKGROUND

Cigarette-ignited fires are a leading cause of fire death and injury throughout the world and remain a global public health and safety problem. To reduce this harm, a small number of countries now require cigarettes to have reduced ignition propensity (RIP). It is not known if cigarette manufacturers are voluntarily introducing RIP cigarettes in other countries to help save lives.

METHODS

Using the ASTM E2187-04 test method, per cent full length burn (%FLB) was measured for three popular brands from each of seven countries that did not have RIP legislation at the time of purchase. Results were compared with %FLB measurements from four popular US brands purchased in a jurisdiction (Vermont) with an RIP law. SRM 1082 reference cigarette was also tested to assure laboratory quality control.

RESULTS

All cigarette brands purchased in countries not requiring fire safety standards for cigarettes exceeded 75% FLB. In contrast, none of the cigarette brands from the USA exceeded 10% FLB. The SRM 1082 reference cigarette demonstrated 5% FLB.

CONCLUSION

Cigarette ignition propensity can be greatly reduced through legislation that requires cigarette fire safety standards. RIP cigarettes have the potential to significantly decrease the number of fire deaths, injuries and destruction of property caused by cigarette-ignited fires. Appropriate standards should be applied in cigarette markets globally.

Epidemiology of burn injuries II: psychiatric and behavioural perspectives

Modern technological advances have decreased the incidence and severity of burn injuries, and medical care improvements of burn injuries have significantly increased survival rates, particularly in developed countries. Still, fire-related burn injuries are responsible for 300,000 deaths and 10 million disability-adjusted life years lost annually worldwide. The extent to which psychiatric and behavioural factors contribute to the incidence and outcomes of these tragedies has not been systematically documented, and the available data is often insufficient to reach definitive conclusions. Accordingly, this article reviews the evidence of psychiatric and behavioural risk factors and prevention opportunities for burn injuries worldwide. Psychiatric prevalence rates and risk factors for burn injuries, prevalence and risks associated with 'intentional' burn injuries (self-immolation, assault, and child maltreatment), and prevention activities targeting the general population and those with known psychiatric and behavioural risk factors are discussed. These issues are substantially interwoven with many co-occurring risk factors. While success in teasing apart the roles and contributions of these factors rests upon improving the methodology employed in future research, the nature of this entanglement increases the likelihood that successful interventions in one problem area will reap benefits in others.

From the American Academy of Pediatrics: Technical report--Secondhand and prenatal tobacco smoke exposure

Secondhand tobacco smoke (SHS) exposure of children and their families causes significant morbidity and mortality. In their personal and professional roles, pediatricians have many opportunities to advocate for elimination of SHS exposure of children, to counsel tobacco users to quit, and to counsel children never to start. This report discusses the harms of tobacco use and SHS exposure, the extent and costs of tobacco use and SHS exposure, and the evidence that supports counseling and other clinical interventions in the cycle of tobacco use. Recommendations for future research, policy, and clinical practice change are discussed. To improve understanding and provide support for these activities, the harms of SHS exposure are discussed, effective ways to eliminate or reduce SHS exposure are presented, and policies that support a smoke-free environment are outlined.

From the American Academy of Pediatrics: Policy statement--Tobacco use: a pediatric disease

Tobacco use and secondhand tobacco-smoke (SHS) exposure are major national and international health concerns. Pediatricians and other clinicians who care for children are uniquely positioned to assist patients and families with tobacco-use prevention and treatment. Understanding the nature and extent of tobacco use and SHS exposure is an essential first step toward the goal of eliminating tobacco use and its consequences in the pediatric population. The next steps include counseling patients and family members to avoid SHS exposures or cease tobacco use; advocacy for policies that protect children from SHS exposure; and elimination of tobacco use in the media, public places, and homes. Three overarching principles of this policy can be identified: (1) there is no safe way to use tobacco; (2) there is no safe level or duration of exposure to SHS; and (3) the financial and political power of individuals, organizations, and government should be used to support tobacco control. Pediatricians are advised not to smoke or use tobacco; to make their homes, cars, and workplaces tobacco free; to consider tobacco control when making personal and professional decisions; to support and advocate for comprehensive tobacco control; and to advise parents and patients not to start using tobacco or to quit if they are already using tobacco. Prohibiting both tobacco advertising and the use of tobacco products in the media is recommended. Recommendations for eliminating SHS exposure and reducing tobacco use include attaining universal (1) smoke-free home, car, school, work, and play environments, both inside and outside, (2) treatment of tobacco use and dependence through employer, insurance, state, and federal supports, (3) implementation and enforcement of evidence-based tobacco-control measures in local, state, national, and international jurisdictions, and (4) financial and systems support for training in and research of effective ways to prevent and treat tobacco use and SHS exposure. Pediatricians, their staff and colleagues, and the American Academy of Pediatrics have key responsibilities in tobacco control to promote the health of children, adolescents, and young adults.

Inhalation injury associated with smoking, alcohol and drug abuse: an increasing problem

This study investigated the association of inhalation injury (IHI) with smoking, alcohol and drug abuse in patients admitted to the Welsh Centre for Burns between 1995 and 2006. Common characteristics of these individuals were identified and contrasted with inhalation injury not associated with these social factors. Two hundred and fourteen patients were identified with inhalation injury. Ninety-two of these were associated with smoking, alcohol abuse and/or drug abuse. The proportion of IHI cases associated with smoking remained stable but IHI associated with alcohol and drug abuse increased dramatically over the course of the study and if current trends continue will increase further in future years. This study also showed that IHI associated with smoking alcohol and drug abuse were found to be largely caused by housefires and deliberate self-harm, and occurred between 22:00 and 05:59 h. These results were in sharp contrast with IHI not associated with these factors.

In vivo brain imaging of human exposure to nicotine and tobacco

While most cigarette smokers endorse a desire to quit smoking, only 14-49% will achieve abstinence after 6 months or more of treatment. A greater understanding of the effects of smoking on brain function may result in improved pharmacological and behavioral interventions for this condition. Research groups have examined the effects of acute and chronic nicotine/cigarette exposure on brain activity using functional imaging; the purpose of this chapter is to synthesize findings from such studies and present a coherent model of brain function in smokers. Responses to acute administration of nicotine/smoking include reduced global brain activity; activation of the prefrontal cortex, thalamus, and visual system; activation of the thalamus and visual cortex during visual cognitive tasks; and increased dopamine (DA) concentration in the ventral striatum/nucleus accumbens. Responses to chronic nicotine/cigarette exposure include decreased monoamine oxidase (MAO) A and B activity in the basal ganglia and a reduction in alpha4beta2 nicotinic acetylcholine receptor (nAChR) availability in the thalamus and putamen (accompanied by an overall upregulation of these receptors). These findings indicate that smoking enhances neurotransmission through cortico-basal ganglia-thalamic circuits by direct stimulation of nAChRs, indirect stimulation via DA release or MAO inhibition, or a combination of these and possibly other factors. Activation of this circuitry may be responsible for the effects of smoking seen in tobacco-dependent smokers, such as improvements in attentional performance, mood, anxiety, and irritability.

Smoking behaviors and perceived risk of injuries in Italy, 2007

OBJECTIVE

Apart from cancer, cardiovascular and respiratory diseases, smoking is associated with an increased risk of accidents and injuries. Many of these can be accounted for by dangerous smoking behaviors such as smoking in bed or while driving. We estimated therefore the prevalence of these hazardous smoking behaviors and the perceived risk of accidents associated with them in Italy.

METHODS

Data were derived by a survey on smoking on 3057 subjects, representative of the Italian population aged > or =15 years. Specific questions were included on prevalence and risk perception of smoking while driving or in bed.

RESULTS

Of all current smokers (23.5% of the Italian population), 12% reported smoking while in bed, 69% reported smoking while driving a car, and 17% reported smoking while driving a motorcycle. Predictors of smoking while driving were younger age, male sex, and being a heavy smoker. Of the total population, 81% reported that smoking while driving increased the risk of accident, but public perception was lower in men, the young, current smokers, and among the subjects engaging in these behaviors. About 7% of car injuries in Italy could involve a subject who smokes while driving.

CONCLUSION

Efforts should be taken, therefore, to disseminate knowledge about the smoking behaviors associated to high risk of injuries.

Prevalence of behaviors related to cigarette-caused fires: a survey of Ontario smokers

OBJECTIVE

To identify the prevalence and correlates of behaviors related to the risk of cigarette-caused fires.

DESIGN AND SETTING

Random-digit-dialed telephone survey in Ontario, Canada, July-September, 2005.

SUBJECTS

596 current cigarette smokers.

OUTCOME MEASURES

Prevalence of fire-risk events and behaviors such as burning clothing or objects in the home, leaving lit cigarettes unattended, dozing while smoking, and smoking in bed and correlates of these behaviors. Respondents were also asked if they ever worry about cigarette-caused fires.

RESULTS

One in four smokers admitted to leaving lit cigarettes unattended in the last 30 days, while 15% admitted to smoking while in bed. Leaving lit cigarettes unattended was independent of demographic, socioeconomic or nicotine dependence indicators, but was related to worry about burning other persons with a cigarette (OR 1.72, 95% CI 1.04 to 2.85) and smoking inside the home (OR 2.98, 95% CI 1.66 to 5.35). Persons who were not white (OR 3.97, 95% CI 1.80 to 8.80), aged 18-24 years (OR 3.75, 95% CI 1.41 to 9.96), who had high nicotine dependence (OR 9.13, 95% CI 2.22 to 37.52) and worried about burning objects in their home (OR 2.43, 95% CI 1.31 to 4.52) were more likely to smoke in bed. 10 (1.7%) smokers reported having ever had a fire in their home started by a cigarette.

CONCLUSIONS

Smokers engage in behaviors such as smoking in bed and leaving lit cigarettes unattended that may place them at an increased risk of cigarette-caused fires. As governments move to regulate cigarette ignition propensity, it is important to establish surveillance for behaviors related to fire risk.

Analysis of injury- and violence-related fatalities in the Ohio Medicaid population: identifying opportunities for prevention

BACKGROUND

To identify the leading causes of injury- and violence-related deaths in demographic subgroups of the population in Ohio, by Medicaid status.

METHODS

We used linked Ohio Medicaid and death certificate files, 1992 to 1998, and obtained the probability (p) of dying from a specific mechanism of injury--given death from injury--by Medicaid status, using multinomial multivariable logistic regression analysis. Probabilities were rank-ordered to identify the leading causes of death in each subgroup.

RESULTS

The leading cause of injury-related deaths was homicide among Medicaid decedents in the age groups 0 to 4, 15 to 24, and 25 to 44 (p = 0.283, 0.380, and 0.269, respectively), and motor vehicle crashes among nonMedicaid decedents aged 5 to 14, 15 to 24, 25 to 44, and 45 to 74 (p = 0.448, 0.462, 0.293, and 0.293, respectively). Accidental falls ranked first among the elderly (p = 0.593 and 0.414, respectively in Medicaid and nonMedicaid decedents). Suicide and accidental exposure to smoke, fire, and flames also ranked high among the leading causes of injury-related deaths in many population subgroups.

CONCLUSIONS

Findings from this study, pointing to the vulnerability of population subgroups to certain mechanisms of injury, can be used to formulate targeted prevention strategies.

Twenty-year trends in fatal injuries to very young children: the persistence of racial disparities

OBJECTIVE

Mortality trends across modifiable injury mechanisms may reflect how well effective injury prevention efforts are penetrating high-risk populations. This study examined all-cause, unintentional, and intentional injury-related mortality in children who were aged 0 to 4 years for evidence of and to quantify racial disparities by injury mechanism.

METHODS

Injury analyses used national vital statistics data from January 1, 1981, to December 31, 2003, that were available from the Centers for Disease Control and Prevention. Rate calculations and chi2 test for trends (Mantel extension) used data that were collapsed into 3-year intervals to produce cell sizes with stable estimates. Percentage change for mortality rate ratios used the earliest (1981-1983) and the latest (2001-2003) study period for black, American Indian/Alaskan Native, and Asian/Pacific Islander children, with white children as the comparison group.

RESULTS

All-cause injury rates declined during the study period, but current mortality ratios for all-cause injury remained higher in black and American Indian/Alaskan Native children and lower in Asian/Pacific Islander children compared with white children. Trend analyses within racial groups demonstrate significant improvements in all groups for unintentional but not intentional injury. Black and American Indian/Alaskan Native children had higher injury risk as a result of residential fire, suffocation, poisoning, falls, motor vehicle traffic, and firearms. Disparities narrowed for residential fire, pedestrian, and poisoning and widened for motor vehicle occupant, unspecified motor vehicle, and suffocation for black and American Indian/Alaskan Native children.

CONCLUSIONS

These findings identify injury areas in which disparities narrowed, improvement occurred with maintenance or widening of disparities, and little or no progress was evident. This study further suggests specific mechanisms whereby new strategies and approaches to address areas that are recalcitrant to improvement in absolute rates and/or narrowing of disparities are needed and where increased dissemination of proven efficacious injury prevention efforts to high-risk populations are indicated.

Non-fatal occupational injury among active and passive smokers in small- and medium-scale manufacturing enterprises in Japan

Active smoking is a risk factor for occupational injury, whereas its association with passive smoking is unknown. To evaluate the contribution of active and passive smoking to non-fatal occupational injury in manufacturing sectors, 2302 randomly selected workers aged 16-83 years working in 244 small- and medium-scale enterprises in Yashio city, Japan, were surveyed by means of a self-administered questionnaire. Smoking history, exposure to passive smoking, and occupational injury were evaluated by self-report. Exposure levels to passive smoking were assessed separately at work and at home as never, occasional, or regular exposure. Overall, 61.4% of men and 22.3% of women were current smokers. Among never smokers, 62.2% of men and 68.6% of women reported exposure to passive smoking either at work or home. Prevalence of occupational injuries was 36.2% for never, 43.3% for former, and 41.2% for current smokers among men and 19.7% for never, 22.2% for former, and 25.2% for current smokers among women. Among never smoking men, odds ratios (ORs) of occupational injury were 2.11 when regularly exposed to passive smoking at work or at home (p=0.025), 2.27 at work (p=0.015), and 3.08 at home (p=0.106), in comparison to never smoking men who were never exposed to passive smoking either at work or at home (referent group). These associations were attenuated to be non-significant, after controlling for potential confounders. Never smoking men with occasional exposure to passive smoking were not significant ORs (1.11-1.19). In contrast, current and former smoking men had significant increases in adjusted ORs (1.57-2.00). In women exposed to smoking there was a non-significant increase in occupational injury. The present study indicates an expected increase in the risk of, occupational injury for current and former smoking men and suggests that exposure to passive smoking is a possible risk factor for never smoking men.

When risk factors combine: the interaction between alcohol and smoking for aerodigestive cancer, coronary heart disease, and traffic and fire injury

BACKGROUND

Alcohol and tobacco are responsible for a significant amount of burden of disease, but some diseases may be a result of the interaction between these two risk factors.

METHODS

Systematic literature review identified articles on the interaction of alcohol and smoking on a number of outcomes related to both risk behaviours.

RESULTS

The interaction of smoking and alcohol significantly increases risk for aerodigestive cancers, and may increase risk for traffic injury and fire injury, but there were very few quality studies on injury. The indication that the cardioprotective effect of alcohol on coronary heart disease is only valid for smokers, but this result is inconclusive because of small evidence base.

CONCLUSIONS

The interaction between smoking and alcohol consumption seems to be responsible for a significant amount of disease. Unfortunately, little is known on the mechanisms and details of this interaction on disease outcomes. Future studies, especially for coronary heart disease and injury outcomes, are warranted.

Functional brain imaging of tobacco use and dependence

While most cigarette smokers endorse a desire to quit smoking, only about 14% to 49% will achieve abstinence after 6 months or more of treatment. A greater understanding of the effects of smoking on brain function may (in conjunction with other lines of research) result in improved pharmacological (and behavioral) interventions. Many research groups have examined the effects of acute and chronic nicotine/cigarette exposure on brain activity using functional imaging; the purpose of this paper is to synthesize findings from such studies and present a coherent model of brain function in smokers. Responses to acute administration of nicotine/smoking include: a reduction in global brain activity; activation of the prefrontal cortex, thalamus, and visual system; activation of the thalamus and visual cortex during visual cognitive tasks; and increased dopamine (DA) concentration in the ventral striatum/nucleus accumbens. Responses to chronic nicotine/cigarette exposure include decreased monoamine oxidase (MAO) A and B activity in the basal ganglia and a reduction in alpha4beta2 nicotinic acetylcholine receptor (nAChR) availability in the thalamus and putamen. Taken together, these findings indicate that smoking enhances neurotransmission through cortico-basal ganglia-thalamic circuits either by direct stimulation of nAChRs, indirect stimulation via DA release or MAO inhibition, or a combination of these factors. Activation of this circuitry may be responsible for the effects of smoking seen in tobacco dependent subjects, such as improvements in attentional performance, mood, anxiety, and irritability.

Smokers' reactions to reduced ignition propensity cigarettes

BACKGROUND

On 28 June 2004, New York State (NY) became the first jurisdiction to require cigarettes to meet a reduced ignition propensity (RIP) standard. This law resulted in cigarette manufacturers modifying nearly all of their brands sold in NY. However, the same cigarette brands sold in other states were not modified to meet the RIP standard.

OBJECTIVES

This paper examines relationships between the RIP law and smokers' awareness of changes in the performance of their cigarettes (that is, going out more frequently, change in taste), and smoking behaviour.

METHODS

Data for this analysis come from a nationwide survey of 2088 adult smokers (> 18 years of age) conducted in the USA between July and December 2004. 143 of the smokers included in the survey were residents of NY while the remainder were from other states (n = 1945). Survey participants were asked whether their cigarettes "ever go out between puffs" and whether they had noticed any change in the taste of their cigarettes in the past 12 months.

RESULTS

NY smokers were three times more likely than smokers in other states to report that their cigarettes often went out between puffs (17.3% v 5.6%). However, NY smokers appeared no more likely to report noticing differences in cigarette taste, an intention to quit smoking, or to have made quit attempts.

CONCLUSIONS

A significant minority of smokers in NY reported noticing changes in the performance of their cigarettes following the RIP law, as would be expected. However, the RIP law appears to have had no impact on the smoking habits of New Yorkers, countering arguments made by cigarette manufacturers that the law would impact consumer acceptability.