Is the co-occurrence of smoking and poor consumption of fruits and vegetables confounded by socioeconomic conditions?

Effects of smoking on clinical treatment outcomes amongst patients with chronic inflammatory diseases initiating biologics: secondary analyses of the prospective BELIEVE cohort study

The prevalence and disease burden of chronic inflammatory diseases (CIDs) are predicted to rise. Patients are commonly treated with biological agents, but the individual treatment responses vary, warranting further research into optimizing treatment strategies. This study aimed to compare the clinical treatment responses in patients with CIDs initiating biologic therapy based on smoking status, a notorious risk factor in CIDs. In this multicentre cohort study including 233 patients with a diagnosis of Crohn's disease, ulcerative colitis, rheumatoid arthritis, axial spondyloarthritis, psoriatic arthritis or psoriasis initiating biologic therapy, we compared treatment response rates after 14 to 16 weeks and secondary outcomes between smokers and non-smokers. We evaluated the contrast between groups using logistic regression models: (i) a "crude" model, only adjusted for the CID type, and (ii) an adjusted model (including sex and age). Among the 205 patients eligible for this study, 53 (26%) were smokers. The treatment response rate among smokers (n = 23 [43%]) was lower compared to the non-smoking CID population (n = 92 [61%]), corresponding to a "crude" OR of 0.51 (95% CI: [0.26;1.01]) while adjusting for sex and age resulted in consistent findings: 0.51 [0.26;1.02]. The contrast was apparently most prominent among the 38 RA patients, with significantly lower treatment response rates for smokers in both the "crude" and adjusted models (adjusted OR 0.13, [0.02;0.81]). Despite a significant risk of residual confounding, patients with CIDs (rheumatoid arthritis in particular) should be informed that smoking probably lowers the odds of responding sufficiently to biological therapy. Registration: Clinical.Trials.gov NCT03173144.

A genetic risk score of alleles related to MGUS interacts with socioeconomic position in a population-based cohort

Environmental, genetic, and social factors are suggested to jointly influence monoclonal gammopathy of undetermined significance (MGUS), a precursor of multiple myeloma. Aim of this study was to investigate interactions between MGUS-related genetic variants and socioeconomic position (SEP) indicators education and income on MGUS in a population-based study. Two different MGUS-related genetic risk allele sum scores (GRS) were calculated based on recent genome-wide meta-analyses. Odds Ratios (OR) were estimated in 4329 participants including 238 MGUS cases to assess associations and multiplicative interaction. The relative excess risk due to interaction (RERI) was calculated to assess additive interaction. Both GRSs were associated with MGUS. A multiplicative interaction between one GRS and education was observed with genetic effects of OR 1.34 (95% CI 1.11–1.62) per risk allele in the highest and OR 1.06 (95% CI 0.86–1.31) in the lowest education group. A RERI of 0.10 (95% CI 0.05–0.14) also indicated additive interaction. Further, additive GRS by income interaction (RERI 0.07; 95% CI 0.01–0.13) for the same GRS was also indicated. Results indicate interaction between MGUS-related genetic risk and SEP. Non-genetic MGUS risk factors more common in higher education groups may influence the expression of MGUS-related genetic variants.

The impact of tobacco smoking on treatment choice and efficacy in inflammatory bowel disease

Smoking significantly increases the risk of developing and worsens Crohn's disease (CD), yet protects against the development and reduces the severity of ulcerative colitis. It is less clear whether smoking impacts the efficacy of therapeutics in inflammatory bowel disease (IBD). We review the literature regarding the relationship between smoking and the efficacy of medical and surgical therapy in IBD. Smoking is associated with alterations in thiopurine metabolism and may affect time to disease relapse. The outcomes of anti-tumor necrosis factor therapy in active smokers appear neutral with data lacking for newer biologics. Smoking increases the risk of postoperative recurrence in those requiring resection for CD, likely attributable to perturbations of the gut microbiota although further implications of these for disease onset/progression and treatment efficacy remain unclear. Multiple lifestyle and psychosocial confounders are likely under-recognized cofactors in the association between smoking and IBD. Despite the widely promulgated risks associated with cigarette smoking in CD, more incisive data are required to further elucidate the actual relationship between smoking and disease pathways, while accounting for the several negative cofactors prevalent in smokers which cast uncertainty on the magnitude of the direct effect of smoking on disease pathophysiology and the efficacy of therapy.

Lifestyle patterns and their nutritional, socio-demographic and psychological determinants in a community-based study: A mixed approach of latent class and factor analyses

Background

Lifestyle risk factors, such as unhealthy diet, physical inactivity or tobacco smoking can have detrimental effects on health and well-being. Therefore, it is important to examine multiple lifestyle risk factors instead of single ones. Cluster analysis allows the combination of single health behaviors in order to recognize distinguished behavior patterns. This study aimed to evaluate lifestyle patterns of general adult population in northwest of Iran with particular focus on dietary patterns, physical activity, and smoking status.

Methods

The current cross-sectional study consists of 525 adults aged 18–64 years from East-Azarbaijan Iran. Latent class analysis (LCA) was applied to recognize patterns of lifestyle behaviors with ingredients of diet, physical activity, and smoking status. Dietary intake was assessed using a validated food frequency questionnaire and dietary patterns were derived using factor analysis. Biochemical parameters including fasting blood sugar (FBS), serum lipids, liver enzyme and serum 25(OH)-D3 were measured with commercial ELIZA kits.

Results

Mean ages of participants were 42.90 ± 11.89 years. Using principal component analysis (PCA) three major dietary patterns were extracted including traditional dietary pattern (e.g. nuts and dry fruits), unhealthy dietary pattern (e.g. fast foods, refined grains) and the healthy dietary patterns (e.g. fruits, vegetables). Using LCA, three classes of lifestyles pattern were identified: 1^st class was characterized by a healthy dietary pattern, moderate physical activity, and low probability of smoking. 2^nd class was characterized by a traditional dietary pattern, low level of physical activity and low probability of smoking and 3^rd class was characterized by a unhealthy dietary pattern, low level of physical activity and low probability of smoking and further analysis found that there were significant differences in body mass index (BMI), Waist-to-hip ratio (WHR), FBS, Hemoglobin (Hb), education levels and anxiety status between classes (P <0.05).

Conclusion

This study attempts to classify Iranian adults by their own health behavior. Healthcare professionals should be aware of associations between different lifestyle risk factors and health promotion strategies should further focus on multiple behaviors at the same time. In our country, more studies about the adult population are needed to support the observed findings of our study and therefore allow for a certain generalization of the observations.

Socioeconomic Position is Positively Associated with Monoclonal Gammopathy of Undetermined Significance in a Population-based Cohort Study

Knowledge of social inequalities in monoclonal gammopathy of undetermined significance (MGUS) will contribute to understanding multiple myeloma (MM) etiology, as MGUS consistently precedes MM. The aim of the present study was to examine whether socioeconomic position (SEP) is associated with MGUS in a population-based cohort including information on potential MGUS risk factors. Overall, 4787 study participants aged 45-75 years with information on MGUS were included. SEP indicators (education, income) and potential risk factors (i.e., body mass index, diabetes, smoking, dietary factors) were assessed at baseline. Overall, 260 MGUS cases were detected at baseline and prospectively over a 10-year follow-up. In age-adjusted logistic regression models, a lower chance of having MGUS at baseline or developing MGUS during 10 years of follow-up was indicated for groups of low SEP with odds ratios (OR) of 0.39 (95% confidence interval [95%-CI] 0.19-0.76) for women and 0.48 (95% CI 0.10-1.16) for men in the lowest compared to the highest educational group. After additionally including potential mediating risk factors in the regression models, the estimated ORs changed only slightly in magnitude. Similar results were obtained for income. Current smoking and low fruit consumption were associated with MGUS independently of SEP in women, but not in men. The present study indicates a lower MGUS risk in lower SEP groups. Supporting evidence is given that smoking and diet play a role in the development of MGUS independently of SEP, while it has to be assumed that risk factors unknown to date are responsible for the observed social inequalities in MGUS.

Adolescent Behavioral Cancer Prevention in the United States: Creating a Composite Variable and Ranking States' Performance

Preventive behaviors established during adolescence can reduce cancer throughout the life span. Understanding the combinations of multiple behaviors, and how these behaviors vary across states, is important for identifying where additional interventions are needed. Using data on 2011-2015 vaccination, energy balance, and substance use from national surveys, we created state-level composite scores for adolescent cancer prevention. Hierarchical Bayesian linear mixed models were used to predict estimates for states with no data on select behaviors. We used a Monte Carlo procedure with 100,000 simulations to generate states' ranks and 95% confidence intervals. Across states, hepatitis B vaccination was 84.3% to 97.1%, and human papillomavirus vaccination was 41.8% to 78.0% for girls and 19.0% to 59.3% for boys. For energy balance, 20.2% to 34.6% of adolescents met guidelines for physical activity, 4.1% to 15.8% for fruit and vegetable consumption, and 66.4% to 82.0% for healthy weight. For substance use, 82.5% to 93.5% reported abstaining from binge alcohol use, 84.3% to 95.4% from cigarette smoking, and 62.9% to 92.8% from marijuana use. (1) Rhode Island, (2) Colorado, (4) Hawaii and New Hampshire (tied), and (5) Vermont performed the best for adolescent cancer prevention, and (47) Missouri, (48) Arkansas, Mississippi, and South Carolina (tied), and (51) Kentucky performed the worst. However, 95% CIs around ranks often overlapped, indicating lack of statistical differences. Adolescent cancer prevention behaviors clustered into a composite index. States varied on their performance on this index, especially for states at the high and low extremes, but most states did not differ statistically. These findings can inform decision makers about where and how to intervene to improve cancer prevention among adolescents.

Predicting healthy lifestyle patterns among retirement age older adults in the WELL study: a latent class analysis of sex differences

OBJECTIVES

The aim of this study was to identify subgroups of retirement age older adults with respect to their lifestyle patterns of eating, drinking, smoking, physical activity and TV viewing behaviors, and to examine the association between these patterns and socio-demographic covariates.

METHODS

The sample consisted of 3133 older adults aged 55-65 years from the Wellbeing, Eating and Exercise for a Long Life (WELL) study, 2010. This study used latent class analysis (stratified by sex), with a set of lifestyle indicators and including socio-demographic covariates. Statistical analyses were performed by generalized linear latent and mixed models in Stata.

RESULTS

Two classes of lifestyle patterns were identified: Healthy (53% men and 72% women) and less healthy lifestyles. Physical activity, TV-viewing time, and fruit intake were good indicators distinguishing the "Healthier" class, whereas consumption of vegetables, alcohol (men) and fast food (women) could not clearly discriminate older adults in the two classes. Class membership was associated with education, body mass index, and self-rated health.

CONCLUSIONS

This study contributes to the literature on lifestyle behaviors among older adults, and provides evidence that there are meaningful sex differences in lifestyle behaviors between subgroups of older adults. From a policy perspective, understanding indicators or "markers" of healthy and less healthy lifestyle patterns is important for identifying target groups for interventions.

Understanding oral health promotion needs and opportunities of tobacco quitline callers

OBJECTIVE

Improving oral health and oral health care are important public health goals. Tobacco users and smokers are at particularly high risk for oral disease and warrant targeted intervention efforts. We assessed the need for and acceptability of targeting tobacco quitline callers for an oral health promotion intervention.

METHODS

We surveyed 816 Washington State Quitline callers to assess their oral health, relevant self-care behaviors, and interest in oral health promotion intervention.

RESULTS

Most respondents were female, cigarette smokers, of low socioeconomic status, with no dental insurance. Of the respondents, 79.3% (n=647) had some or all of their natural teeth (e.g., dentate); however, most of these respondents failed to meet recommendations for daily oral hygiene (brushing and flossing) (83.9%, n=543) and had no dental visits in the past year (52.6%, n=340). Similar findings were observed among respondents with no insurance. Many respondents were interested in learning more about how to improve their oral health (57.4%, n=468), willing to speak with a quitline coach about improving their oral health (48.2%, n=393), and open to receiving additional oral health information by mail (62.7%, n=512) or the Internet (50.0%, n=408). People who were receptive to learning how to improve their oral health were significantly more likely to be nonwhite, have a low income, have no dental insurance, and not have visited a dentist in the past year.

CONCLUSION

There is a need and an opportunity to target quitline callers for oral health promotion services, as those most in need of these services were open to receiving them.

Plasma carotenoids are associated with socioeconomic status in an urban Indigenous population: an observational study

Background

Indigenous Australians experience poorer health than other Australians. Poor diet may contribute to this, and be related to their generally lower socioeconomic status (SES). Even within Indigenous populations, SES may be important. Our aim was to identify factors associated with plasma carotenoids as a marker of fruit and vegetable intake among urban dwelling Indigenous Australians, with a particular focus on SES.

Methods

Cross sectional study in urban dwelling Indigenous Australians participating in the DRUID (Darwin Region Urban Indigenous Diabetes) Study. An SES score, based on education, employment, household size, home ownership and income was computed and plasma carotenoids measured by high performance liquid chromatography in 897 men and women aged 15 - 81 years (mean 36, standard deviation 15). Linear regression analysis was used to determine the relationship between SES and plasma carotenoids, adjusting for demographic, health and lifestyle variables, including frequency of intakes of food groups (fruit, vegetables, takeaway foods, snacks and fruit/vegetable juice).

Results

SES was positively associated with plasma concentrations of lutein/zeaxanthin (p trend <0.001), lycopene (p trend = 0.001), α- and ß-carotene (p trend = 0.019 and 0.026 respectively), after adjusting for age, sex, glucose tolerance status, smoking, alcohol use, hypercholesterolemia, dyslipidemia, self-reported health, waist to hip ratio and body mass index. These associations remained after adjustment for self-reported frequency of intake of fruit, vegetables, takeaway foods and fruit juice, which all showed some association with plasma carotenoids. Even in the highest SES quintile, concentrations of all carotenoids (except lycopene) were lower than the mean concentrations in a non-Indigenous population.

Conclusions

Even within urban Indigenous Australians, higher SES was associated with higher concentrations of plasma carotenoids. Low plasma carotenoids have been linked with poor health outcomes; increasing accessibility of fruit and vegetables, as well as reducing smoking rates could increase concentrations and otherwise improve health, but our results suggest there may be additional factors contributing to lower carotenoid concentrations in Indigenous Australians.