Prevalence and correlates of active and ever-smokers in metropolitan China

Effects of cigarette smoking and alcohol use on neurocognition and BDNF levels in a Chinese population

OBJECTIVE

Few studies have examined the potential interactive effect of both smoking and drinking on cognition. Brain-derived neurotrophic factor (BDNF) plays a critical role in cognition. This is the first study to examine the neurocognitive consequences of cigarette smoking combined with chronic alcohol consumption and their relationship to serum BDNF levels in a Chinese Han population.

MATERIALS AND METHODS

We recruited 191 healthy male subjects, including 47 isolated smokers, 31 isolated chronic alcohol users, 58 combined smokers and chronic alcohol users, and 55 non-smokers and non-alcohol users. We then compared the repeatable battery for the assessment of neuropsychological status (RBANS) scores and serum BDNF levels in these four groups.

RESULTS

When compared to the non-smoking + non-alcohol-using group, the smoking group performed worse on immediate memory, attention, language, and RBANS total score. There were no significant differences in the RBANS scores between the alcohol-using group and non-smoking + non-alcohol-using group, or between the smoking group and smoking + alcohol-using group. We did not find an association between BDNF and smoking or drinking status or between BDNF and cognitive performance. In the smoking group, there was a significant correlation between BDNF and carbon monoxide concentration, and between BDNF and the Fagerstrom Test for Nicotine Dependence (FTND) total score.

CONCLUSIONS

Our results suggest that smoking is associated with cognitive decline, but not with BDNF levels in a normal population. However, smoking severity is positively associated with BDNF levels. Concomitant alcohol use does not worsen the cognitive decline caused by smoking.

Evaluation of tobacco use on Chinese population through ATTOC model: a cross-sectional survey on hospitalized psychiatric patients

OBJECTIVES

To evaluate the feasibility of Addressing Tobaccos through Organizational Change (ATTOC) intervention to Chinese psychiatric patients, and to better address tobacco use through the ATTOC intervention model in the context of China.

METHODS

The study was conducted in Mental Health Center of West China Hospital in 2010. A total of 100 hospitalized psychiatric patients were recruited to carry out ATTOC intervention. Subjects suffers from mental illness were diagnosed by professional psychiatrists according to the International Statistical Classification of Diseases (ICD-10) criteria.

RESULTS

The prevalence of tobacco use in hospitalized psychiatric patients were closely correlated with the type of mental illness, family smoking history, sex, age, marital status, education status, etc. However, most psychiatric patients knew little about these, and tended to ignore the importance of smoking cessation.

CONCLUSIONS

The ATTOC intervention program of the U.S. may be suitable for hospitalized Chinese psychiatric patients, and it could be applied for the tobacco smoking treatment in China. However, the health effects of tobacco use still did not draw amount attentions from both the clinicians and general public. It is urgently needed to raise people's awareness and carry out ATTOC intervention to control tobacco use, and ultimately terminate tobacco use.

Sexual orientation and smoking history: results from a community-based sample of youth in Shanghai, China

OBJECTIVE

Cigarette smoking has been found to be more prevalent among adults and youths with a minority sexual orientation (lesbian, gay, bisexual, LGB) than among the general population, while less is known about smoking among LGB youth in low- and middle-income countries. The goal of the study was to examine cigarette smoking in relation to sexual orientation in a community-based sample of youth in Shanghai, China.

METHODS

A multi-center cross-sectional survey of 17,016 youth aged 15-24 years was conducted in rural and urban areas of Hanoi, Vietnam; Taipei, Taiwan; and Shanghai, China in 2006. In this article, analysis was restricted to the 6,299 respondents in Shanghai. Assessments included ever smoking, age at first smoking, frequency of smoking, and number of cigarettes smoked daily. Logistic regression was used to estimate the association between sexual orientation and cigarette smoking.

RESULTS

Nine percent (594/6,299) of eligible participants considered themselves as LGB youths; 34.2% ever smoked, 14.81% initiated smoking before age 13, 15.9% smoked in the past 30 days, and 14.1% were moderate or heavy smokers. LGB identity predicted moderate or heavy smoking (OR 2.2, 95% CI 1.3, 3.9). Male LGB youth smoked more cigarettes daily (OR 2.2, 95% CI 1.3, 3.9) whilst female LGB youth reported less any prior cigarette use (OR 0.7, 95% CI 0.5, 1.0).

CONCLUSIONS

Few meaningful disparities in cigarette smoking were related to sexual orientation, except male LGB youth consumed more cigarettes daily. Prevention and cessation should target this population, especially male LGB youth.

Utilization of cessation resources among HIV-positive and HIV-negative men who smoke and who have sex with men in Chengdu, China

INTRODUCTION

Given the implications for smoking among individuals living with HIV and the high rates of smoking and HIV among men who have sex with men (MSM) in China, we examined differences in prior use of and future interest in various cessation resources among MSM smokers with or without HIV.

METHODS

We conducted a cross-sectional survey of 381 MSM; HIV status was provided by 350 MSM, and complete data was provided by a total of 344 (188 HIV-positive and 156 HIV-negative) current smokers (past 30 days) recruited by a nongovernmental organization in Chengdu in 2012-2013. Participants reported tobacco and alcohol use; psychosocial factors; past-year quit attempts; health care provider interactions on smoking; and prior use of and interest in cessation resources.

RESULTS

Smokers living with HIV were more likely to have used behavioral interventions (p < .001) and pharmacotherapy (p = .033). Those who were HIV-positive were also more interested in behavioral interventions (p = .002) and pharmacotherapy (p = .008). Correlates of interest in behavioral interventions in the regression model included lower cigarette consumption (p = .011), higher confidence in quitting (p = .035), greater likelihood of attempting to quit in the past year (p = .026), and being HIV-positive (p = .008). Correlates of interest in pharmacotherapy included greater depressive symptoms (p = .047) and being HIV-positive (p = .015).

CONCLUSIONS

Smokers living with HIV were more likely to have ever attempted to quit smoking, to have used cessation resources, and to be interested in using cessation aids. These findings indicate the promise of greater dissemination of cessation resources, particularly if Chinese clinical practices are strengthened to offer cessation support.

Healthcare provider intervention on smoking and quit attempts among HIV-positive versus HIV-negative MSM smokers in Chengdu, China

Given the implications for smoking among HIV-positive individuals and high smoking and HIV rates among men who have sex with men (MSM) in China, we examined sociodemographic, smoking-related, psychosocial, and substance use factors in relation to HIV status; receiving some sort of healthcare provider intervention regarding smoking; and having made a quit attempt in the past year in a sample of MSM smokers in Chengdu. We conducted a cross-sectional survey of 381 MSM smokers recruited by a nongovernmental organization in Chengdu in 2012-2013. Of these, 350 disclosed their HIV status and 344 (188 HIV-positive and 156 HIV-negative) provided completed data. Half (50.0%) reported at least one quit attempt in their lifetime; 30.5% reported a quit attempt in the past year. The majority (59.4%) reported that a healthcare provider had intervened in some way (assessed smoking, advised quitting, provided assistance), most commonly by assessing smoking status (50.0%). HIV-positive individuals were more likely to report a healthcare provider intervening on their smoking (p < .001). Those who received provider intervention were more likely to have attempted to quit ever (p = .009) and in the past year (p < .001). Those HIV-positive were more likely to have attempted to quit since diagnosis if a provider had intervened (p = .001). Multivariate regression documented that being HIV-positive (p < .001), greater cigarette consumption (p = .02), less frequent drinking (p = .03), and greater depressive symptoms (p = .003) were significant correlates of healthcare provider intervention. Multivariate regression also found that healthcare provider intervention (p = .003), older age (p = .01), and higher autonomous motivation (p = .007) were significant correlates of attempting to quit in the past year. Given the impact of healthcare provider intervention regarding smoking on quit attempts among MSM, greater training and support is needed to promote consistent intervention on smoking in the clinical setting among HIV-positive and HIV-negative MSM smokers.

Awareness of tobacco advertising, perceived harms of smoking, and beliefs about tobacco control among a sample of Shanghainese in China

This study aims to examine beliefs among residents of Shanghai, China concerning tobacco advertising and control policies concurrent with new restrictions on tobacco use and advertising in the city. A total of 518 residents of Shanghai completed a telephone interview survey. We found that 51% of participants had seen or heard of the Zhonghua cigarette brand's 'Love China' tobacco ad campaign in the past 2 years, 59% believed that the campaign would influence people to buy this specific cigarette brand as a gift, and 30% believed that it would encourage smoking. More than 75% of respondents would support legislation banning tobacco advertising in all public places, and 88% would support legislation prohibiting smoking in all public places. Multivariate analyses indicated that those who were female, more than 50 years, have accepted college and above education, and perceived greater benefits to smoking cessation were more likely to support banning tobacco advertising and prohibiting smoking in public places. Non-smokers were more likely to support prohibiting smoking in public places. The findings suggest that although tobacco advertising is widely prevalent in Shanghai, it is disliked by the public. Respondents showed high levels of support for tobacco control policies.

Cigarette smoking, psychopathology and cognitive function in first-episode drug-naive patients with schizophrenia: a case-control study

BACKGROUND

Although patients with chronic schizophrenia have substantially higher smoking rates than either the general population or patients with other mental illnesses, drug-naive patients with a first episode of schizophrenia have received little systemic study. This study examined smoking rates, the association between smoking and symptom severity and cognitive function in Chinese first-episode schizophrenia (FES) patients using cross-sectional and case-control designs.

METHOD

Two hundred and forty-four drug-naive FES patients and 256 healthy controls matched for gender, age and education completed the Fagerström Test for Nicotine Dependence (FTND) and the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS). Patients were also rated on the Positive and Negative Symptom Scale (PANSS).

RESULTS

The rate and quantity of smoking were not significantly higher among FES patients compared to the general population. Among patients, smokers scored higher than non-smokers on the total PANSS and the positive symptom subscale scores. There were no significant associations between cognitive function and smoking in either FES patients or healthy controls.

CONCLUSIONS

In contrast to studies in patients with chronic schizophrenia, drug-naive FES patients did not smoke more frequently than the general population. Furthermore, patients with psychotic disorders who smoked did not exhibit significant cognitive differences compared with those who did not smoke. However, smoking may have other detrimental effects on physical and mental health, for example on positive symptoms.

BDNF Val66Met variant and smoking in a Chinese population

Several recent studies have supported the hypothesis that brain-derived neurotrophic factor (BDNF), a member of the neurotrophic factor family, might be associated with nicotine addiction. Association studies have also suggested that the BDNF gene might play a role in the susceptibility to nicotine dependence but results appear contradictory. The present work was therefore undertaken to examine the association of smoking with the BDNF Val66Met gene polymorphism in Chinese population. The BDNF Val66Met gene polymorphism was examined in 628 healthy male volunteers including 322 smokers and 306 non-smokers. Also, the BDNF serum levels were measured in 136 smokers and 97 nonsmokers. Our results showed no significant association between the BDNF Val66Met polymorphism or serum levels among smokers and non-smokers. Smokers with the Met allele however started smoking significantly earlier than those with the Val/Val genotype (mean age at smoking initiation of 17.4, 17.9 and 21.2 years for Met/Met, Met/Val, and Val/Val, respectively; both p<0.05). No other significant differences between other variables such as number of cigarettes per day, smoking severity as measured by the Fagerstrom Test for Nicotine Dependence (FTND) score and carbon monoxide (CO) levels (all p>0.05). In addition, there was no main effect of genotype on serum BDNF levels. Our findings suggest that the BDNF Val66Met polymorphism may not be involved in susceptibility to smoking among the Chinese male population, but may influence the age at which smoking is initiated. However, the findings must be interpreted with caution because of the relatively small sample size for an association study. Results should be confirmed in a larger cohort.

Cigarette smoking and cognitive function in Chinese male schizophrenia: a case-control study

Schizophrenic patients have higher smoking rates than the general population. Studies show that smoking may be a form of self-medication in an attempt to alleviate cognitive deficits in schizophrenic patients of European background. This study examined the relationships between smoking and cognitive deficits in Chinese schizophrenic patients, which have previously received little systemic study. We recruited 580 male chronic patients meeting DSM-IV criteria for schizophrenia and 175 male control subjects who were matched on age and education. The subjects completed a detailed cigarette smoking questionnaire, the Fagerstrom Test for Nicotine Dependence (FTND), and the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS). Patients also were rated on the Positive and Negative Symptom Scale (PANSS), the Simpson and Angus Extrapyramidal Symptom Rating Scale (SAES), and the Abnormal Involuntary Movement Scale (AIMS). All five RBANS subscales except for the Visuospatial/Constructional index showed significantly lower cognitive performance for schizophrenics than normal controls. The schizophrenic smokers scored lower than the schizophrenic non-smokers on the RBANS total score and the Visuospatial/Constructional and Immediate Memory indices. Similarly, the control smokers scored lower than the control non-smokers on the RBANS total score and the Immediate Memory index . Also, the schizophrenic smokers consistently performed the poorest on the cognitive domains of the RBANS. Among the schizophrenic patients, smokers displayed significantly fewer negative symptoms than non-smokers. Using multivariate regression analysis the following variables were independently associated with the RBANS total score: years of education, PANSS negative symptom score, age at schizophrenia onset, and number of hospitalizations. Our results show that smoking is associated with significant cognitive impairment in both schizophrenic patients and normal controls, but the smokers with schizophrenia had a reduced level of negative symptoms, suggesting that the benefits of smoking for those with schizophrenia may be limited to certain aspects of a given clinical phenotype.

Cigarette smoking in male patients with chronic schizophrenia in a Chinese population: prevalence and relationship to clinical phenotypes

The high prevalence of smoking in schizophrenia of European background may be related to smoking's reducing clinical symptoms and medication side effects. Because smoking prevalence and its associations with clinical phenotypes are less well characterized in Chinese than European patients with schizophrenia, we assessed these smoking behaviors using clinician-administered questionnaires and the Fagerstrom Test for Nicotine Dependence (FTND) in 776 Chinese male schizophrenia and 560 control subjects. Patients also were rated on the Positive and Negative Symptom Scale (PANSS), the Simpson and Angus Extrapyramidal Symptom Rating Scale (SAES), and the Abnormal Involuntary Movement Scale (AIMS). We found that the schizophrenia patients had a higher lifetime incidence of smoking (79% vs 63%), were more likely to be heavy smokers (61% vs 31%), and had lower smoking cessation rates (4% vs 9%) (all p<0.0001) than controls. Among the schizophrenia patients smoking prevalence increased with age, with the largest difference from controls in the age cohort of 55-75 years: 75% vs 46% (p<0.0001). Among the schizophrenia smokers 73% started to smoke before the onset of their illness by an average of 7.6 years. The patients with schizophrenia who were current smokers scored significantly lower on the PANSS negative symptom subscore (p<0.005), and on the SAES symptom scale (p<0.04; Bonferroni corrected p>0.05) than the non-smoking patients. These results suggest that Chinese males with schizophrenia smoke more frequently than the general population. Further, smokers with schizophrenia may display fewer negative symptoms and possibly less parkinsonism than non-smokers with schizophrenia.

Smoking and tardive dyskinesia in male patients with chronic schizophrenia

Interactions between smoking and movement disorders include the contrasting associations of more cigarette smoking with reductions in Parkinson's disease and increases in tardive dyskinesia (TD) symptoms. Here we examine the relationship between smoking and TD in a large sample of inpatients with schizophrenia. We used cross-sectional naturalistic methods to analyze the prevalence and severity of neuroleptic-induced TD in relation to cigarette smoking among 764 male chronic and medicated inpatients meeting DSM-IV criteria for schizophrenia. We administered a detailed questionnaire including general information, medical and psychological conditions, and smoking behaviors. We evaluated TD severity using the abnormal involuntary movement scale (AIMS) and psychopathology using the Positive and Negative Syndrome Scale (PANSS). The main statistical analyses used cross-tabulations for the prevalence of TD by smoking and multivariate regression analyses for continuous measures (AIMS and PANSS). We found that the prevalence of TD did not significantly differ between smokers (41%=237/578) and non-smokers (37%=69/186). Secondary outcomes showed a significant association between the AIMS total score and age, duration of illness and hospitalization times. Thus, smoking was not associated with TD in male Chinese schizophrenics, but consistent with previous reports, older patients with a longer duration of illness and more hospitalizations showed greater severity of TD.

Prevalence and correlates of tobacco use among a sample of MSM in Shanghai, China

INTRODUCTION

Men who have sex with men (MSM) have higher smoking rates than the general population in the United States, but less is known about smoking among MSM in developing countries. Thus, we examined the prevalence and correlates of smoking among MSM in China.

METHODS

We conducted a cross-sectional study of 404 MSM in Shanghai, China (half of whom were male sex workers), recruited through respondent-driven sampling. Assessments included sociodemographics; tobacco, alcohol, and drug use; the Center for Epidemiological Studies Depression Scale (CES-D); the Social Provisions Scale (SPS); and the Lesbian, Gay, and Bisexual Identity Scale (LGBIS).

RESULTS

Smoking prevalence was 65.9% in this sample. Recent smoking (i.e., in the past 3 months) was significantly associated with lower education, greater alcohol use, and higher LGBIS scores, after controlling for important sociodemographics. Among smokers, smoking ≥10 cigarettes per day (CPD), in comparison with <10 CPD, was related to older age and lower LGBIS scores and marginally related to heavy alcohol use. Although bivariate analyses indicated a relationship of CES-D and SPS scores to recent smoking, these factors did not contribute to the regression models.

CONCLUSIONS

Smoking rates among MSM in China are higher than MSM in the United States and men in China. Less comfort with one's sexual orientation was related to smoking, particularly light smoking. Heavier alcohol consumption, lower education, and older age were also associated with smoking. Future research should confirm these findings and examine mediators and moderators of these relationships in order to inform cessation interventions and tobacco control policy.

Sex difference in the prevalence of smoking in Chinese schizophrenia

Despite a large proportion of smoker in Chinese population, few studies address the prevalence of smoking in schizophrenia in such a homogeneous ethnic group. This study examined gender-specific relationships between smoking and schizophrenia, which have previously received little systematic study. The prevalence of smoking in 510 inpatients with schizophrenia and 793 normal controls was evaluated. The relationships between smoking and retrospectively assessed measures of the course of schizophrenia were evaluated by clinician-administered questionnaires. The results showed that the gender difference in smoking prevalence was in the opposite direction for males compared to females between schizophrenia and normal controls. Male patients had a higher smoking rate than controls (81% vs 66%, adjusted OR = 2.3, p < 0.0001), while female patients had a lower rate than controls (5% vs 9% p > 0.05). Smoking was associated with a family history of smoking, a personal history of alcohol use and age in men with schizophrenia. Our present findings suggest a significant gender difference in the prevalence of smoking in schizophrenia.

Smoking initiation and schizophrenia: a replication study in a Chinese Han population

Schizophrenia is associated with a greater probability of ever smoking daily and with higher rates of initiation of daily smoking after age 20 in Caucasian populations. The aims of the current study were to replicate that schizophrenia is associated with smoking and higher risk of initiating daily smoking before schizophrenia starts among a large sample of male Chinese patients. A survival analysis of onset age for daily smoking compared 776 DSM-IV male inpatients with schizophrenia to 560 male controls. The results showed that the cumulative hazard curves for age of smoking initiation in schizophrenia and controls were significantly different (p<0.001), even after controlling for education (p<0.001). After excluding the patients who started smoking within 5 years before schizophrenia started, the cumulative hazard curve for schizophrenia was significantly different from ever-smoked controls (p<0.001), even after adjusting for education (p<0.001). These findings suggest that schizophrenic patients have a higher risk of starting daily smoking suggesting that vulnerability to schizophrenia may be associated with a higher risk of becoming a daily smoker.