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Pradipta IS, Aprilio K, Ningsih YF, Pratama MAA, Alfian SD, Abdulah R. Treatment Nonadherence among Multimorbid Chronic Disease Patients: Evidence from 3515 Subjects in Indonesia. MEDICINA (KAUNAS, LITHUANIA) 2024; 60:634. [PMID: 38674280 PMCID: PMC11052292 DOI: 10.3390/medicina60040634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/17/2024] [Revised: 04/05/2024] [Accepted: 04/08/2024] [Indexed: 04/28/2024]
Abstract
Background and Objectives: Multimorbid patients require intensive treatment for their diseases. However, little research has been given to their treatment adherence as part of its management. This study aims to determine the prevalence and characteristics of chronic disease multimorbidity in Indonesia, alongside its treatment nonadherence. Materials and Methods: We conducted a cross-sectional study using the fifth Indonesian Family Life Survey database among adult subjects aged ≥ 15 years with multimorbidity. Our descriptive and multivariate analyses include sex, age, formal education, ethnicity, geographic residence, demographic residence, household size, insurance ownership, annual income, current self-perceived health status, missing active days, smoking behavior, and body mass index. Results: We identified 3515 multimorbid patients, constituting 30.8% prevalence across chronic disease patients. Hypertension was found to be a prevalent component of multimorbidity (61.2%), followed by digestive diseases (44.5%) and arthritis (30.3%). We identified that 36.4% of the subjects were nonadherent to their chronic disease treatment. Characteristics associated with nonadherence were found to be a good self-perception of health (aOR 1.79, 95% CI 1.54-2.08), active smoking behavior (aOR 1.51, 95% CI 1.14-1.99), no smoking behavior (aOR 1.44, 95% CI 1.08-1.90), missing seven active/productive days or less in the past month due to poor health (aOR 1.36, 95% CI 1.10-1.68), no insurance ownership (aOR 1.20, 95% CI 1.04-1.39), age of 15-65 years (aOR 1.25, 95% CI 1.01-1.55), income below IDR 40 million (aOR 1.23, 95% CI 1.04-1.46), and household size of 2-6 people (aOR 1.17, 95% CI 1.01-1.36). Conclusions: While the prevalence of multimorbidity in Indonesia is generally similar to that observed in previous studies, we have identified patient characteristics related to nonadherence. We suggest that patient's nonadherence was primarily dictated by their self-perception of health and treatment complexity. With the longstanding issue of nonadherence, this study indicated the need to consider creating patient-tailored treatment programs in clinical practice to improve adherence by considering individual patients' characteristics.
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Affiliation(s)
- Ivan Surya Pradipta
- Department of Pharmacology and Clinical Pharmacy, Faculty of Pharmacy, Universitas Padjadjaran, Sumedang 45363, Indonesia
- Drug Utilization and Pharmacoepidemiology Research Group, Center of Excellence in Higher Education for Pharmaceutical Care Innovation, Universitas Padjadjaran, Sumedang 45363, Indonesia
| | - Kevin Aprilio
- Department of Pharmacology and Clinical Pharmacy, Faculty of Pharmacy, Universitas Padjadjaran, Sumedang 45363, Indonesia
- Drug Utilization and Pharmacoepidemiology Research Group, Center of Excellence in Higher Education for Pharmaceutical Care Innovation, Universitas Padjadjaran, Sumedang 45363, Indonesia
| | - Yozi Fiedya Ningsih
- Department of Pharmacology and Clinical Pharmacy, Faculty of Pharmacy, Universitas Padjadjaran, Sumedang 45363, Indonesia
- Drug Utilization and Pharmacoepidemiology Research Group, Center of Excellence in Higher Education for Pharmaceutical Care Innovation, Universitas Padjadjaran, Sumedang 45363, Indonesia
| | - Mochammad Andhika Aji Pratama
- Drug Utilization and Pharmacoepidemiology Research Group, Center of Excellence in Higher Education for Pharmaceutical Care Innovation, Universitas Padjadjaran, Sumedang 45363, Indonesia
| | - Sofa Dewi Alfian
- Department of Pharmacology and Clinical Pharmacy, Faculty of Pharmacy, Universitas Padjadjaran, Sumedang 45363, Indonesia
- Drug Utilization and Pharmacoepidemiology Research Group, Center of Excellence in Higher Education for Pharmaceutical Care Innovation, Universitas Padjadjaran, Sumedang 45363, Indonesia
| | - Rizky Abdulah
- Department of Pharmacology and Clinical Pharmacy, Faculty of Pharmacy, Universitas Padjadjaran, Sumedang 45363, Indonesia
- Drug Utilization and Pharmacoepidemiology Research Group, Center of Excellence in Higher Education for Pharmaceutical Care Innovation, Universitas Padjadjaran, Sumedang 45363, Indonesia
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Poole NL, Candel MJJM, Willemsen MC, van den Brand FA. Real-Life Effectiveness of Smoking Cessation Delivery Modes: A Comparison Against Telephone Counseling and the Role of Individual Characteristics and Health Conditions in Quit Success. Nicotine Tob Res 2024; 26:452-460. [PMID: 37930890 PMCID: PMC10959160 DOI: 10.1093/ntr/ntad195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Revised: 09/22/2023] [Accepted: 09/29/2023] [Indexed: 11/08/2023]
Abstract
INTRODUCTION Professional behavioral counseling for smoking cessation can be delivered in many forms, which may not work equally well for everyone. We aim to explore in a real-world setting whether different delivery modes yield different rates of quit success and whether quit success varies based on gender, age, educational level, and being treated for a health condition. AIMS AND METHODS We used monitoring data (n = 13 747) from a smoking cessation counseling provider in the Netherlands (September 2018 to August 2021) to compare differences in quit success immediately after the end of counseling and at 12-month follow-up between telephone and other modes of counseling. Participants chose which mode of counseling they received. At the 12-month follow-up, we also examined differences in quit success based on demographic characteristics and whether one is being treated for various health conditions. RESULTS Participants of in-person group counseling and online in-company group counseling were significantly more likely to have quit immediately after the counseling compared with telephone counseling (OR = 1.25, 95% CI = 1.08-1.44; OR = 1.63, 95% CI = 1.18-2.24). Analyses revealed no significant differences in quit success between telephone and other modes of counseling after 12 months. Those treated for a respiratory or psychological condition were less likely to have maintained quit success, as were women, and participants with a lower educational level. CONCLUSIONS When chosen by oneself, the mode of smoking cessation counseling received does not appear to be important for long-term quit success. However, certain groups warrant extra support to prevent excessive program attrition and unsuccessful quit attempts. IMPLICATIONS Our findings suggest that when chosen by oneself, the delivery mode of smoking cessation counseling does not appear to be important for long-term quit success. This finding is of particular relevance for those who are unable to attend in-person cessation counseling due to, for instance, reduced accessibility or mobility. We also found that women, lower educated, and younger participants were more likely to dropout of the cessation program or to not have maintained a quit attempt, signaling that disparities in smoking cessation persist when standardized counseling is given, and therefore more tailored counseling may be necessary for these groups.
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Affiliation(s)
- Nikita L Poole
- Department of Health Promotion, Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, The Netherlands
- IVO Research Institute, The Hague, The Netherlands
| | - Math J J M Candel
- Department of Methodology and Statistics, Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, The Netherlands
| | - Marc C Willemsen
- Department of Health Promotion, Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, The Netherlands
| | - Floor A van den Brand
- Department of Family Medicine, Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, The Netherlands
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Chen LS, Baker TB, Ramsey A, Amos CI, Bierut LJ. Genomic medicine to reduce tobacco and related disorders: Translation to precision prevention and treatment. ADDICTION NEUROSCIENCE 2023; 7:100083. [PMID: 37602286 PMCID: PMC10434839 DOI: 10.1016/j.addicn.2023.100083] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/22/2023]
Abstract
Genomic medicine can enhance prevention and treatment. First, we propose that advances in genomics have the potential to enhance assessment of disease risk, improve prognostic predictions, and guide treatment development and application. Clinical implementation of polygenic risk scores (PRSs) has emerged as an area of active research. The pathway from genomic discovery to implementation is an iterative process. Second, we provide examples on how genomic medicine has the potential to solve problems in prevention and treatment using two examples: Lung cancer screening and evidence-based tobacco treatment are both under-utilized and great opportunities for genomic interventions. Third, we discuss the translational process for developing genomic interventions from evidence to implementation by presenting a model to evaluate genomic evidence for clinical implementation, mechanisms of genomic interventions, and patient desire for genomic interventions. Fourth, we present potential challenges in genomic interventions including a great need for evidence in all diverse populations, little evidence on treatment algorithms, challenges in accommodating a dynamic evidence base, and implementation challenges in real world clinical settings. Finally, we conclude that research to identify genomic markers that are associated with smoking cessation success and the efficacy of smoking cessation treatments is needed to empower people of all diverse ancestry. Importantly, genomic data can be used to help identify patients with elevated risk for nicotine addiction, difficulty quitting smoking, favorable response to specific pharmacotherapy, and tobacco-related health problems.
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Affiliation(s)
- Li-Shiun Chen
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, United States
- Alvin J. Siteman Cancer Center at Barnes-Jewish Hospital, Washington University School of Medicine, St. Louis, MO, United States
| | - Timothy B. Baker
- Center for Tobacco Research and Intervention, School of Medicine and Public Health, University of Wisconsin, Madison, WI, United States
| | - Alex Ramsey
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, United States
- Alvin J. Siteman Cancer Center at Barnes-Jewish Hospital, Washington University School of Medicine, St. Louis, MO, United States
| | - Christopher I. Amos
- Department of Biomedical Data Science, Geisel School of Medicine, Dartmouth College, Hanover, NH, United States
- Department of Medicine, Baylor College of Medicine, Institute for Clinical and Translational Research, Houston, TX, United States
| | - Laura J. Bierut
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, United States
- Alvin J. Siteman Cancer Center at Barnes-Jewish Hospital, Washington University School of Medicine, St. Louis, MO, United States
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Elf JL, Horn K, Abroms L, Stanton CA, Cohn AM, Spielberg F, Gray T, Harvey E, Debnam C, Kierstead L, Levy ME, Castel A, Monroe A, Niaura R. Prevalence and Correlates of Cardiovascular, Pulmonary, Cancer, and Mental Health Comorbidities Among Adults With HIV Who Smoke. J Assoc Nurses AIDS Care 2023; 34:363-375. [PMID: 37378565 PMCID: PMC10803179 DOI: 10.1097/jnc.0000000000000416] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/29/2023]
Abstract
ABSTRACT Using data from the D.C. Cohort Longitudinal HIV Study, we examined (a) diagnosed mental health and (b) cardiovascular, pulmonary, or cancer (CPC) comorbidity among adults with HIV who smoked. Among 8,581 adults, 4,273 (50%) smoked; 49% of smokers had mental health, and 13% of smokers had a CPC comorbidity. Among smokers, non-Hispanic Black participants had a lower risk for mental health (prevalence ratio [PR]: 0.69; 95% confidence interval [CI] [0.62-0.76]) but a higher risk for CPC (PR: 1.17; 95% CI [0.84-1.62]) comorbidity. Male participants had a lower risk for mental health (PR: 0.88; 95% CI [0.81-0.94]) and CPC (PR: 0.68; 95% CI [0.57-0.81]) comorbidity. All metrics of socioeconomic status were associated with a mental health comorbidity, but only housing status was associated with a CPC comorbidity. We did not find any association with substance use. Gender, socioeconomic factors, and race/ethnicity should inform clinical care and the development of smoking cessation strategies for this population.
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Affiliation(s)
| | | | | | | | - Amy M. Cohn
- University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
| | | | - Tiffany Gray
- George Washington University, Washington, D.C., USA
| | | | - Charles Debnam
- Deputy Chief Executive Officer of Community Wellness Alliance, Washington, D.C., USA
| | | | | | | | - Anne Monroe
- George Washington University, Washington, D.C., USA
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Jeon J, Inoue-Choi M, Mok Y, McNeel TS, Tam J, Freedman ND, Meza R. Mortality Relative Risks by Smoking, Race/Ethnicity, and Education. Am J Prev Med 2023; 64:S53-S62. [PMID: 36775754 PMCID: PMC11186465 DOI: 10.1016/j.amepre.2022.12.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Revised: 12/08/2022] [Accepted: 12/15/2022] [Indexed: 02/13/2023]
Abstract
INTRODUCTION The impact of cigarette smoking on mortality is well studied, with estimates of the relative mortality risks for the overall population widely available. However, age-specific mortality estimates for different sociodemographic groups in the U.S. are lacking. METHODS Using the 1987-2018 National Health Interview Survey Linked Mortality Files through 2019, all-cause mortality relative risks (RRs) were estimated for current smokers or recent quitters and long-term quitters compared with those for never smokers. Stratified Cox proportional hazards regression models were used to estimate RRs by age, gender, race/ethnicity, and educational attainment. RRs were also assessed for current smokers or recent quitters by smoking intensity and for long-term quitters by years since quitting. The analysis was conducted in 2021-2022. RESULTS All-cause mortality RRs among current smokers or recent quitters were generally highest for non-Hispanic White individuals than for never smokers, followed by non-Hispanic Black individuals, and were lowest for Hispanic individuals. RRs varied greatly by educational attainment; generally, higher-education groups had greater RRs associated with smoking than lower-education groups. Conversely, the RRs by years since quitting among long-term quitters did not show clear differences across race/ethnicity and education groups. Age-specific RR patterns varied greatly across racial/ethnic and education groups as well as by gender. CONCLUSIONS Age-specific all-cause mortality rates associated with smoking vary considerably by sociodemographic factors. Among high-education groups, lower underlying mortality rates for never smokers result in correspondingly high RR estimates for current smoking. These estimates can be incorporated in modeling analyses to assess tobacco control interventions' impact on smoking-related health disparities between different sociodemographic groups.
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Affiliation(s)
- Jihyoun Jeon
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, Michigan.
| | - Maki Inoue-Choi
- Metabolic Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, NIH, Bethesda, Maryland
| | - Yoonseo Mok
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, Michigan; Department of Integrative Oncology, BC Cancer Research Institute, Vancouver, British Columbia, Canada
| | | | - Jamie Tam
- Department of Health Policy and Management, Yale School of Public Health, New Haven, Connecticut
| | - Neal D Freedman
- Metabolic Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, NIH, Bethesda, Maryland
| | - Rafael Meza
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, Michigan; Department of Integrative Oncology, BC Cancer Research Institute, Vancouver, British Columbia, Canada
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Lee J, Contrera Avila J, Ahluwalia JS. Differences in cessation attempts and cessation methods by race/ethnicity among US adult smokers, 2016-2018. Addict Behav 2023; 137:107523. [PMID: 36279711 PMCID: PMC9875492 DOI: 10.1016/j.addbeh.2022.107523] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2022] [Revised: 09/20/2022] [Accepted: 10/09/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND Advice to quit smoking and cessation patterns vary by race/ethnicity in the United States. This study aims to provide the up-to-date prevalence of quit advice, quit attempts and use of smoking cessation methods (particularly e-cigarettes) by race/ethnicity among US adult smokers. METHODS We used data from Wave 4 (2016-2018) of the Population Assessment of Tobacco and Health (PATH) Study. Using past-12-month and current adult cigarette smokers (n = 9,272), we conducted multivariable models to examine the association between race/ethnicity and advice to quit and quit attempts. Further, using a subset of those who made quit attempts (n = 5,046), we examined the use of smoking cessation methods, including e-cigarettes, by race/ethnicity, controlling for associated factors. RESULTS Compared to Non-Hispanic [NH] White smokers, Hispanic smokers were less likely to receive quit advice (aPR [95 % CI] = 0.88 [0.78, 1.00]), but more likely to make quit attempts (1.14 [1.06, 1.23]). NH Black smokers (vs. NH Whites) were more likely to receive quit advice (1.06 [1.00, 1.12]) and more likely to make quit attempts (1.22 [1.15, 1.29]). NH Black smokers (vs. NH Whites) were more likely to use behavioral treatment (e.g., counseling) (1.84 [1.22, 2.77]). Hispanic smokers were less likely to use e-cigarettes to quit smoking than Whites (0.48 [0.33, 0.71]) and use pharmacotherapy (0.62 [0.44, 0.88]). CONCLUSIONS We found different patterns in cessation attempts and cessation methods by race/ethnicity among US adult smokers. Efforts to eliminate disparities must increase access and use of proven cessation therapies for these groups.
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Affiliation(s)
- Juhan Lee
- Department of Psychiatry, Yale School of Medicine, United States.
| | - Jaqueline Contrera Avila
- Department of Behavioral and Social Sciences and Center for Alcohol and Addiction Studies, Brown University School of Public Health, United States
| | - Jasjit S Ahluwalia
- Department of Behavioral and Social Sciences and Center for Alcohol and Addiction Studies, Brown University School of Public Health, United States; Department of Medicine, Brown University Alpert School of Medicine, United States
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Abstract
Tobacco use will kill a projected 1 billion people in the 21st century in one of the deadliest pandemics in history. Tobacco use disorder is a disease with a natural history, pathophysiology, and effective treatment options. Anesthesiologists can play a unique role in fighting this pandemic, providing both immediate (reduction in perioperative risk) and long-term (reduction in tobacco-related diseases) benefits to their patients who are its victims. Receiving surgery is one of the most powerful stimuli to quit tobacco. Tobacco treatments that combine counseling and pharmacotherapy (e.g., nicotine replacement therapy) can further increase quit rates and reduce risk of morbidity such as pulmonary and wound-related complications. The perioperative setting provides a great opportunity to implement multimodal perianesthesia tobacco treatment, which combines multiple evidence-based tactics to implement the four core components of consistent ascertainment and documentation of tobacco use, advice to quit, access to pharmacotherapy, and referral to counseling resources.
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Loretan CG, Cornelius ME, Jamal A, Cheng YJ, Homa DM. Cigarette Smoking Among US Adults With Selected Chronic Diseases Associated With Smoking, 2010-2019. Prev Chronic Dis 2022; 19:E62. [PMID: 36173703 PMCID: PMC9541675 DOI: 10.5888/pcd19.220086] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION People who smoke cigarettes are at greater risk of developing chronic diseases and related complications. Our study provides recent estimates and trends in cigarette smoking among people with respiratory and cardiovascular diseases, cancers, and diabetes. METHODS Using data from the 2019 National Health Interview Survey, we calculated the prevalence of current and former cigarette smoking among adults aged 18 to 44 years, 45 to 64 years, and 65 years or older with chronic diseases. Those diseases were cancers associated with smoking, chronic obstructive pulmonary disease, diabetes, coronary heart disease, and/or stroke (N = 3,741). Using data from the 2010-2019 National Health Interview Surveys, we assessed trends in current cigarette smoking by chronic disease by using the National Cancer Institute's Joinpoint Regression Program. RESULTS In 2019, current cigarette smoking prevalence among adults with chronic diseases associated with smoking ranged from 6.0% among adults aged 65 or older with diabetes to 51.9% among adults aged 18 to 44 years with 2 or more chronic diseases. During 2010 through 2019, a significant decrease occurred in current cigarette smoking among adults aged 45 to 64 years with diabetes. CONCLUSION Overall, smoking prevalence remains high and relatively unchanged among people with chronic diseases associated with smoking, even as the overall prevalence of cigarette smoking in the US continues to decrease. The lack of progress in smoking cessation among adults with chronic diseases associated with smoking suggests that access, promotion, and integration of cessation treatment across the continuum of health care (ie, oncology, pulmonology, and cardiology settings) may be important in the success of smoking cessation in this population.
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Affiliation(s)
- Caitlin G Loretan
- Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, 4770 Buford Hwy, MS S107-7, Atlanta, GA 30341.
| | - Monica E Cornelius
- Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Ahmed Jamal
- Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Yiling J Cheng
- Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - David M Homa
- Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
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Osibogun O, Bursac Z, Maziak W. Longitudinal transition outcomes among adult dual users of e-cigarettes and cigarettes with the intention to quit in the United States: PATH Study (2013-2018). Prev Med Rep 2022; 26:101750. [PMID: 35256929 PMCID: PMC8897625 DOI: 10.1016/j.pmedr.2022.101750] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Revised: 02/21/2022] [Accepted: 02/26/2022] [Indexed: 11/16/2022] Open
Abstract
Many dual users of e-cigarettes/cigarettes report using e-cigarettes with the ITQ. Data was from 3,542 adults (≥18 years) from the PATH cohort (2013–2018). Dual users with ITQ were compared with mono cigarette smokers with ITQ. Dual users with ITQ were less likely to transition to cessation. This needs to be considered when assessing the population impact of e-cigarettes.
Many adult dual users of e-cigarettes and cigarettes in the United States report using e-cigarettes with the intention to quit (ITQ) smoking. This study examined transition outcomes among adult dual users of e-cigarettes and cigarettes with the ITQ compared to mono cigarette smokers with ITQ. We conducted a longitudinal analysis of 3,542 adults aged ≥ 18 years with data from Waves 1 and 4 of the United States Population Assessment of Tobacco and Health study (2013–2018) between May 2021 and January 2022. Current dual users (e-cigarettes and cigarettes use on ≥ 20 days in the past month) with the ITQ were compared to current mono cigarette smokers with the ITQ for transition outcomes (cessation, mono e-cigarette, mono cigarette and dual use) three years later. We conducted multinomial logistic regression modeling adjusting for potential confounders and reported the adjusted relative risk ratios (aRRR) with 95% confidence intervals (CI) for the transition outcomes. Approximately 10.7% (7.8–14.3) of dual users with the ITQ (in 2013) reported cessation (no past-month use of any tobacco) three years later, compared to 16.1% (14.6–17.7) of mono cigarette smokers. Dual users were 83% and 79% less likely to transition to cessation (aRRR: 0.17, 95% CI:0.09–0.32) or mono cigarette use (0.21, 0.14–0.32), respectively, compared to mono cigarette smokers. Our findings show that in a real-world scenario, dual e-cigarette and cigarette use may hinder rather than facilitate smoking cessation among those interested in quitting. This needs consideration when assessing the population impact of e-cigarettes and their role in harm reduction.
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Affiliation(s)
- Olatokunbo Osibogun
- Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, Miami, FL, United States
| | - Zoran Bursac
- Department of Biostatistics, Robert Stempel College of Public Health and Social Work, Florida International University, Miami, FL, United States
| | - Wasim Maziak
- Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, Miami, FL, United States
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Kim Y, Lee JS, Cho WK. Factors Associated with Successful Smoking Cessation According to Age Group: Findings of an 11-Year Korea National Survey. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18041576. [PMID: 33562345 PMCID: PMC7915736 DOI: 10.3390/ijerph18041576] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Revised: 01/16/2021] [Accepted: 02/04/2021] [Indexed: 12/23/2022]
Abstract
Previous studies suggest that factors related to smoking cessation may vary with age. This study examined the factors affecting smoking cessation by age among Korean adult male smokers using data from the Korea National Health and Nutrition Examination Survey from 2007 to 2018 (excluding 2013). Logistic regression analyses were used to investigate various factors associated with smoking cessation in three different age groups. Out of a total of 15,492 individuals, 31.5% of the 3523 individuals aged 19–39 years (young adult), 54.7% of the 7390 individuals aged 40–64 years (middle-aged), and 78.6% of the 4589 individuals aged ≥65 years (older adults) succeeded in quitting. In the young adult and middle-aged groups, being married was associated with successful quitting, and lifetime smoking was associated with unsuccessful quitting. Willpower and several comorbidities were related to successful cessation in the middle-aged and older adult groups. Skipping any meal, which suggests unhealthy behavior, was negatively related to quitting in the young adult group. We observed that factors associated with smoking cessation success or failure differed by age, which should be considered when developing smoking cessation policies and programs.
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Affiliation(s)
- Youngmee Kim
- Red Cross College of Nursing, Chung-Ang University, Seoul 06974, Korea; or
| | - Ji Sung Lee
- College of Medicine, University of Ulsan, Seoul 05505, Korea;
- Asan Institute for Life Sciences, Clinical Research Center, Asan Medical Center, Seoul 05505, Korea
| | - Won-Kyung Cho
- College of Medicine, University of Ulsan, Seoul 05505, Korea;
- Department of Pulmonary and Critical Care Medicine, International Healthcare Center, Asan Medical Center, Seoul 05505, Korea
- Correspondence: or ; Tel.: +82-2-3010-5001
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Lee J, Cheong J, Markham MJ, Lam J, Warren GW, Salloum RG. Negative affect and the utilization of tobacco treatment among adult smokers with cancer. Psychooncology 2021; 30:93-102. [PMID: 32885884 DOI: 10.1002/pon.5543] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2020] [Revised: 07/13/2020] [Accepted: 08/31/2020] [Indexed: 12/30/2022]
Abstract
OBJECTIVE We investigated the patterns of tobacco treatment utilization among US adult smokers with cancer and the role of negative affect as potential individual-level psychosocial barriers and facilitators influencing quit attempts and tobacco treatment utilization. METHODS We analyzed data from the adult sample in Wave 1 (2013-2014) of the Population Assessment of Tobacco and Health (PATH) Study. Using structural equation modeling, we examined (1) the association between cancer diagnosis and negative affect (e.g., depressive mood, anxiety, and distress) and (2) the associations between negative affect and smoking cessation behaviors (i.e., quit attempts and tobacco treatment utilization). RESULTS Compared to adults without cancer, cancer survivors were more likely to have attempted to quit tobacco use in the past 12 months (p < 0.05) and experienced increased negative affect (p < 0.01). However, negative affect appeared to be a psychological barrier to quit attempts, as it was associated with lower likelihood of attempting to quit (p < 0.05). On the other hand, among past-12-month quit attempters, negative affect was related to higher likelihood of using any type of tobacco treatment (p < 0.001). CONCLUSIONS Negative affect may be a potential underlying mechanism in the relationship between cancer diagnosis status and quit attempts and tobacco treatment utilization, influencing the utilization of tobacco treatment among smokers with cancer. Research is needed to investigate whether integrating emotional management in the oncology setting may effectively aid smoking cessation among patients with cancer.
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Affiliation(s)
- Juhan Lee
- Department of Health Education and Behavior, College of Health and Human Performance, University of Florida, Gainesville, Florida, USA
| | - JeeWon Cheong
- Department of Health Education and Behavior, College of Health and Human Performance, University of Florida, Gainesville, Florida, USA
| | - Merry Jennifer Markham
- Division of Hematology/Oncology, Department of Medicine, College of Medicine, University of Florida, Gainesville, Florida, USA
| | - Jillian Lam
- Department of Health Education and Behavior, College of Health and Human Performance, University of Florida, Gainesville, Florida, USA
| | - Graham W Warren
- Department of Radiation Oncology, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Ramzi G Salloum
- Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida, Gainesville, Florida, USA
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Jang D, Choe S, Park JW, Jeong SY, Shin A. Smoking status before and after colorectal cancer diagnosis and mortality in Korean men: A population-based cohort study. Cancer Med 2020; 9:9641-9648. [PMID: 33230884 PMCID: PMC7774713 DOI: 10.1002/cam4.3609] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Revised: 09/17/2020] [Accepted: 10/26/2020] [Indexed: 12/24/2022] Open
Abstract
Background Smoking is a well‐known risk factor for colorectal cancer incidence; however, the effect of smoking before and after cancer diagnosis on mortality has not been addressed well. Thus, we aimed to evaluate the association of prediagnosis and postdiagnosis smoking status and mortality among colorectal cancer patients. Methods A retrospective cohort consisted of 37,079 male colorectal cancer patients. Smoking status was defined from information within 2 years of colorectal cancer diagnosis for prediagnosis and at least 1 year later for postdiagnosis. The prediagnostic and postdiagnostic smoking status were categorized into four groups (nonsmoker/nonsmoker, nonsmoker/smoker, smoker/nonsmoker, and smoker/smoker). Hazard ratios (HRs) and 95% confidence intervals (CIs) were estimated using the Cox proportional hazard model. Results During a median of 6.3 years of follow‐up, a total of 3980 deaths and 2137 deaths from colorectal cancer occurred. The number of prediagnosis smokers were 11,100 and 62.4% of them quitted smoking after the diagnosis. Significantly elevated mortality rate in prediagnosis smokers was observed regardless of postdiagnosis smoking status (smoker/nonsmoker [HR, 1.30; 95% CI, 1.20–1.41] and smoker/smoker [HR, 1.21; 95% CI, 1.09–1.34]). Among patients treated with surgical operation only, those who quit smoking after diagnosis showed lower mortality rates compared to continual smokers (HR, 0.80; 95% CI, 0.67–0.96). Conclusions Smoking before cancer diagnosis rather than postdiagnosis has stronger impact on prognosis colorectal cancer patients, and quitting smoking may improve survival, especially among early stage colorectal cancer patients.
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Affiliation(s)
- Doeun Jang
- Department of Preventive Medicine, Seoul National University College of Medicine, Seoul, Korea.,Cancer Research Institute, Seoul National University, Seoul, Korea
| | - Sunho Choe
- Department of Preventive Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Ji Won Park
- Cancer Research Institute, Seoul National University, Seoul, Korea.,Division of Colorectal Surgery, Department of Surgery, Seoul National University College of Medicine, Seoul, Korea
| | - Seung-Yong Jeong
- Cancer Research Institute, Seoul National University, Seoul, Korea.,Division of Colorectal Surgery, Department of Surgery, Seoul National University College of Medicine, Seoul, Korea
| | - Aesun Shin
- Department of Preventive Medicine, Seoul National University College of Medicine, Seoul, Korea.,Cancer Research Institute, Seoul National University, Seoul, Korea
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Kalkhoran S, Chang Y, Rigotti NA. Electronic Cigarette Use and Cigarette Abstinence Over 2 Years Among U.S. Smokers in the Population Assessment of Tobacco and Health Study. Nicotine Tob Res 2020; 22:728-733. [PMID: 31298296 PMCID: PMC7171267 DOI: 10.1093/ntr/ntz114] [Citation(s) in RCA: 53] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2019] [Accepted: 07/10/2019] [Indexed: 01/08/2023]
Abstract
INTRODUCTION Electronic cigarettes (e-cigarettes) could benefit public health if they help current smokers to stop smoking long term, but evidence that they do so is limited. We aimed to determine the association between e-cigarette use and subsequent smoking cessation in a nationally representative cohort of US smokers followed for 2 years. METHODS We analyzed data from adult cigarette smokers in Waves 1 through 3 of the Population Assessment of Tobacco and Health study. The primary exposure was e-cigarette use at Wave 1. The primary outcome was prolonged cigarette abstinence, defined as past 30-day cigarette abstinence at Waves 2 and 3 (1- and 2-year follow-up). RESULTS Among Wave 1 cigarette smokers, 3.6% were current daily e-cigarette users, 18% were current non-daily e-cigarette users, and 78% reported no current e-cigarette use. In multivariable-adjusted analyses, daily e-cigarette use at Wave 1 was associated with higher odds of prolonged cigarette smoking abstinence at Waves 2 and 3 compared to nonuse of e-cigarettes (11% vs. 6%, adjusted odds ratio [AOR] = 1.77, 95% confidence interval [CI] = 1.08 to 2.89). Non-daily e-cigarette use was not associated with prolonged cigarette smoking abstinence. Among Wave 1 daily e-cigarette users who were abstinent from cigarette smoking at Wave 3, 63% were using e-cigarettes at Wave 3. CONCLUSIONS In this longitudinal cohort study of US adult cigarette smokers, daily but not non-daily e-cigarette use was associated with higher odds of prolonged cigarette smoking abstinence over 2 years, compared to no e-cigarette use. Daily use of e-cigarettes may help some smokers to stop smoking combustible cigarettes. IMPLICATIONS In this nationally representative longitudinal cohort study of US adult cigarette smokers, daily e-cigarette use, compared to no e-cigarette use, was associated with a 77% increased odds of prolonged cigarette smoking abstinence over the subsequent 2 years. Regular use of e-cigarettes may help some smokers to stop smoking combustible cigarettes.
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Affiliation(s)
- Sara Kalkhoran
- Tobacco Research and Treatment Center, Division of General Internal Medicine, Department of Medicine, Massachusetts General Hospital, Boston, MA
- Department of Medicine, Harvard Medical School, Boston, MA
| | - Yuchiao Chang
- Tobacco Research and Treatment Center, Division of General Internal Medicine, Department of Medicine, Massachusetts General Hospital, Boston, MA
- Department of Medicine, Harvard Medical School, Boston, MA
| | - Nancy A Rigotti
- Tobacco Research and Treatment Center, Division of General Internal Medicine, Department of Medicine, Massachusetts General Hospital, Boston, MA
- Department of Medicine, Harvard Medical School, Boston, MA
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14
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Kalkhoran S, Chang Y, Rigotti NA. E-cigarettes and Smoking Cessation in Smokers With Chronic Conditions. Am J Prev Med 2019; 57:786-791. [PMID: 31753259 PMCID: PMC6876707 DOI: 10.1016/j.amepre.2019.08.017] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2018] [Revised: 08/07/2019] [Accepted: 08/08/2019] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Many smokers with chronic medical conditions use e-cigarettes. This study assessed the association between e-cigarette use and subsequent smoking-cessation efforts in adult smokers with and without chronic medical conditions. METHODS This was a longitudinal cohort study of adult cigarette smokers using Waves 1 and 2 of the Population Assessment of Tobacco and Health Study (2013-2015), analyzed in 2018‒2019. The exposure was the initiation of e-cigarette use by Wave 2. The outcomes at Wave 2 were: (1) past 12-month attempts to quit, (2) cigarette abstinence, (3) ≥50% reduction in cigarette use, and (4) past 12-month use of evidence-based smoking-cessation treatment. RESULTS E-cigarette use initiation was associated with increased odds of attempting to quit smoking at Wave 2 among smokers with any chronic medical condition (AOR=1.92, 95% CI=1.42, 2.59) and without chronic medical conditions (AOR=1.81, 95% CI=1.50, 2.18). E-cigarette use initiation was also significantly associated with Wave 2 smoking abstinence in smokers with (AOR=1.95, 95% CI=1.11, 3.43) and without chronic medical conditions (AOR=1.63, 95% CI=1.17, 2.28). CONCLUSIONS At a population level, e-cigarette use by smokers with chronic medical conditions is associated with more quitting activity and smoking abstinence. Future studies are needed to assess e-cigarette safety and efficacy to determine whether they may provide an alternative smoking-cessation or harm-reduction strategy for adults with smoking-sensitive disease who cannot achieve these goals with other methods.
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Affiliation(s)
- Sara Kalkhoran
- Tobacco Research and Treatment Center, Division of General Internal Medicine, Massachusetts General Hospital, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts.
| | - Yuchiao Chang
- Tobacco Research and Treatment Center, Division of General Internal Medicine, Massachusetts General Hospital, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts
| | - Nancy A Rigotti
- Tobacco Research and Treatment Center, Division of General Internal Medicine, Massachusetts General Hospital, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts
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15
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Pericot-Valverde I, Elliott RJ, Priest JS, Barret T, Yoon JH, Miller CC, Okoli CTC, Haliwa I, Ades PA, Gaalema DE. Patterns of tobacco use among smokers prior to hospitalization for an acute cardiac event: Use of combusted and non-combusted products. Prev Med 2019; 128:105757. [PMID: 31254538 PMCID: PMC7248643 DOI: 10.1016/j.ypmed.2019.105757] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Revised: 04/30/2019] [Accepted: 06/21/2019] [Indexed: 10/26/2022]
Abstract
Use of tobacco products before or after a cardiac event increases risk of morbidity and mortality. Unlike cigarette smoking, which is generally screened in the healthcare system, identifying the use of other tobacco products remains virtually unexplored. This study aimed at characterizing the use of other non-combusted tobacco products in addition to combusted products among cardiac patients and identifying a profile of patients who are more likely to use non-combusted products. Patients (N = 168) hospitalized for a coronary event who reported being current cigarette smokers completed a survey querying sociodemographics, cardiac diagnoses, use of other tobacco products, and perceptions towards these products. Classification and regression tree (CART) analysis was used to identify which interrelationships of participants characteristics led to profiles of smoking cardiac patients more likely to also be using non-combusted tobacco products. Results showed that non-combusted tobacco product use ranged from 0% to 47% depending on patient characteristic combinations. Younger age and lower perception that cigarette smoking is responsible for their cardiac condition were the strongest predictive factors for use of non-combusted products. Tobacco product use among cardiac patients extends beyond combusted products (13.7% non-combusted product use), and consequently, screening in health care settings should be expanded to encompass other tobacco product use. This study also characterizes patients likely to be using non-combusted products in addition to combusted, a group at high-risk due to their multiple product use, but also a group that may be amenable to harm reduction approaches and evidence-based tobacco treatment strategies.
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Affiliation(s)
- Irene Pericot-Valverde
- Vermont Center on Behavior and Health, University of Vermont, Burlington, VT, United States of America; Departments of Psychiatry, University of Vermont, Burlington, VT, United States of America; School of Health Research, Clemson University, Greenville, SC, United States of America.
| | - Rebecca J Elliott
- Vermont Center on Behavior and Health, University of Vermont, Burlington, VT, United States of America; Departments of Psychiatry, University of Vermont, Burlington, VT, United States of America
| | - Jeff S Priest
- Vermont Center on Behavior and Health, University of Vermont, Burlington, VT, United States of America; Biostatistical Unit, University of Vermont, Burlington, VT, United States of America
| | - Trace Barret
- Division of Cardiology, University of Vermont, Burlington, VT, United States of America
| | - Jin H Yoon
- Department of Psychiatry and Behavioral Sciences, University of Texas Health Science at Houston, Houston, TX, United States of America
| | - Charles C Miller
- Department of Cardiothoracic and Vascular Surgery, University of Texas Health Science at Houston, Houston, TX, United States of America
| | - Chizimuzo T C Okoli
- College of Nursing, University of Kentucky, Lexington, KY, United States of America
| | - Ilana Haliwa
- Department of Behavioral Neuroscience, West Virginia University, Morgantown, WV, United States of America
| | - Philip A Ades
- Division of Cardiology, University of Vermont, Burlington, VT, United States of America
| | - Diann E Gaalema
- Vermont Center on Behavior and Health, University of Vermont, Burlington, VT, United States of America; Departments of Psychiatry, University of Vermont, Burlington, VT, United States of America
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16
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Rhoades DA, Comiford AL, Dvorak JD, Ding K, Driskill LM, Hopkins AM, Spicer P, Wagener TL, Doescher MP. Dual Versus Never Use of E-Cigarettes Among American Indians Who Smoke. Am J Prev Med 2019; 57:e59-e68. [PMID: 31377092 PMCID: PMC6702079 DOI: 10.1016/j.amepre.2019.04.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2018] [Revised: 04/01/2019] [Accepted: 04/02/2019] [Indexed: 01/02/2023]
Abstract
INTRODUCTION Many American Indian communities have a high prevalence of smoking and e-cigarette use, but factors associated with their dual use are rarely studied. METHODS In 2016, a total of 375 American Indian adults who smoke completed paper surveys regarding cigarette and e-cigarette use and provided saliva for cotinine levels. In 2018, cross-sectional analyses were performed, comparing dual users (12%), defined as using e-cigarettes on some or every day for the past 30 days, with never users of e-cigarettes (37%). RESULTS Compared with never users, dual users were younger, more often reported history of depression (56% and 29%, respectively; p<0.01) and family history of smoking-related disease (77% and 59%, respectively; p<0.05), had lower harm perceptions of e-cigarettes (27% and 47%, respectively; p<0.01) or vapor (14% and 35%, respectively; p<0.01), and more often perceived e-cigarettes as cessation aids (75% and 16%, respectively; p<0.01) and as less harmful than cigarettes (70% and 17%, respectively; p<0.01). Dual users were less often uncertain/unknowing about e-cigarette benefits or harms (p<0.01) and more often reported likelihood to quit smoking (49% and 24%, respectively; p<0.01) and prior attempt to quit smoking, ever (89% and 67%, respectively; p<0.01) or in the past year (55% and 32%, respectively; p=0.01). Cigarette consumption and cotinine levels did not differ between groups. Dual users more often tried other nicotine products (p<0.02) and more often lived with a vaping partner/spouse (45% and 6%, respectively; p<0.01). CONCLUSIONS Dual users perceived e-cigarettes as less harmful than cigarettes and more as cessation aids than cigarette-only users did, but cigarette consumption did not differ between groups. Whether e-cigarettes will reduce smoking-related disparities among American Indian people remains undetermined.
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Affiliation(s)
- Dorothy A Rhoades
- Department of Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma; Stephenson Cancer Center, Oklahoma City, Oklahoma.
| | | | - Justin D Dvorak
- College of Public Health, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma
| | - Kai Ding
- College of Public Health, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma
| | - Leslie M Driskill
- Oklahoma Tobacco Research Center, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma
| | - Audrea M Hopkins
- College of Public Health, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma
| | - Paul Spicer
- Center for Applied Social Research, University of Oklahoma, Norman, Oklahoma
| | - Theodore L Wagener
- Oklahoma Tobacco Research Center, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma
| | - Mark P Doescher
- Stephenson Cancer Center, Oklahoma City, Oklahoma; Department of Family Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma
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17
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A Novel Risk-based Approach Simulating Oncological Surveillance After Radical Nephroureterectomy in Patients with Upper Tract Urothelial Carcinoma. Eur Urol Oncol 2019; 3:756-763. [PMID: 31395480 DOI: 10.1016/j.euo.2019.06.021] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2019] [Revised: 06/19/2019] [Accepted: 06/27/2019] [Indexed: 11/21/2022]
Abstract
BACKGROUND The current guideline lacks evidence for creating individualized surveillance strategies for upper tract urothelial carcinoma (UTUC) patients after radical nephroureterectomy (RNU). OBJECTIVE To create a novel risk model and to simulate individualized surveillance duration that dynamically illustrates the changing risk relationship of UTUC-related death and non-UTUC death, considering the impact of cigarette smoking. DESIGN, SETTING, AND PARTICIPANTS This multicenter cohort study comprised 714 pTa-T4N0M0 UTUC patients, with a median follow-up duration of 65mo. There were 279 (39.1%) nonsmokers, 260 (36.4%) current smokers, and 175 (24.5%) ex-smokers. INTERVENTION All patients underwent RNU. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS The risks of UTUC death and non-UTUC death over time were estimated using parametric models for time to failure with Weibull distributions. Age-specific, stage-specific, and smoking status-specific surveillance durations were simulated based upon Weibull estimates. RESULTS AND LIMITATIONS The hazard rate (HR) of non-UTUC death gradually increased over time in all age groups regardless of the smoking status, whereas that of UTUC-related death decreased markedly according to the pathological T (pT) stage and was affected by the smoking status. Among current smokers, the baseline HR of UTUC-related death in pT3/4 was higher than that of pT ≤2 and remained high even 10yr after RNU. Among heavy smokers, the HR of UTUC-related death in all pT stages was highest at baseline and remained high after RNU, compared with nonsmokers, current smokers, or ex-smokers. We simulated specific time points when the risk of non-UTUC death was greater than that of UTUC-related death. Among patients ≥80yr of with pT3N0M0, the risk of non-UTUC death was greater than that of UTUC-related death 1yr after RNU in nonsmokers, but 7yr for heavy smokers. CONCLUSIONS Our result revealed that smokers bear a long-term risk burden of UTUC-related death more than the risk of non-UTUC death. For UTUC smokers, longer-term surveillance duration is recommended even in elderly stage. PATIENT SUMMARY In the present study, we evaluated the risk transition of upper tract urothelial carcinoma (UTUC)-related death and non-cancer-related death over time. We found that smoking weighed a huge impact upon UTUC-related death compared with death from other cause, and therefore, we created a more individualized surveillance duration model.
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Hedman L, Katsaounou PA, Filippidis FT, Ravara SB, Lindberg A, Janson C, Gratziou C, Rohde G, Kyriakos CN, Mons U, Fernández E, Trofor AC, Demjén T, Przewoźniak K, Tountas Y, Fong GT, Vardavas CI. Receiving support to quit smoking and quit attempts among smokers with and without smoking related diseases: Findings from the EUREST-PLUS ITC Europe Surveys. Tob Induc Dis 2019; 16:A14. [PMID: 31516468 PMCID: PMC6661851 DOI: 10.18332/tid/102787] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2018] [Revised: 01/11/2019] [Accepted: 01/12/2019] [Indexed: 02/03/2023] Open
Abstract
INTRODUCTION Having a chronic disease either caused or worsened by tobacco smoking does not always translate into quitting smoking. Although smoking cessation is one of the most cost-effective medical interventions, it remains poorly implemented in healthcare settings. The aim was to examine whether smokers with chronic and respiratory diseases were more likely to receive support to quit smoking by a healthcare provider or make a quit attempt than smokers without these diseases. METHODS This population-based study included a sample of 6011 adult smokers in six European countries. The participants were interviewed face-to-face and asked questions on sociodemographic characteristics, current diagnoses for chronic diseases, healthcare visits in the last 12 months and, if so, whether they had received any support to quit smoking. Questions on smoking behavior included nicotine dependence, motivation to quit smoking and quit attempts in the last 12 months. The results are presented as weighted percentages with 95% confidence intervals (CI) and as adjusted odds ratios with 95% CI based on logistic regression analyses. RESULTS Smokers with chronic respiratory disease, those aged 55 years and older, as well as those with one or more chronic diseases were more likely to receive smoking cessation advice from a healthcare professional. Making a quit attempt in the last year was related to younger age, high educational level, higher motivation to quit, lower nicotine dependence and having received advice to quit from a healthcare professional but not with having chronic diseases. There were significant differences between countries with smokers in Romania consistently reporting more support to quit as well as quit attempts. CONCLUSIONS Although smokers with respiratory disease did indeed receive smoking cessation support more often than smokers without disease, many smokers did not receive any advice or support to quit during a healthcare visit.
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Affiliation(s)
- Linnea Hedman
- The Tobacco Control Committee of the European Respiratory Society, Lausanne, Switzerland
- Division of Occupational and Environmental Medicine, Department of Public Health and Clinical Medicine, The OLIN Unit, Umeå University, Umeå, Sweden
- Contributed equally
| | - Paraskevi A. Katsaounou
- The Tobacco Control Committee of the European Respiratory Society, Lausanne, Switzerland
- National and Kapodistrian University of Athens (UoA), Athens, Greece
- Contributed equally
| | - Filippos T. Filippidis
- The Tobacco Control Committee of the European Respiratory Society, Lausanne, Switzerland
- National and Kapodistrian University of Athens (UoA), Athens, Greece
- Department of Primary Care and Public Health, Imperial College, London, United Kingdom
| | - Sofia B. Ravara
- The Tobacco Control Committee of the European Respiratory Society, Lausanne, Switzerland
- Health Sciences Research Centre (CICS-UBI), Faculty of Health Sciences, University of Beira Interior, Covilha, Portugal
- Public Health Research Centre, National School of Public Health, NOVA University, Lisbon, Portugal
| | - Anne Lindberg
- Division of Occupational and Environmental Medicine, Department of Public Health and Clinical Medicine, The OLIN Unit, Umeå University, Umeå, Sweden
| | - Christer Janson
- The Tobacco Control Committee of the European Respiratory Society, Lausanne, Switzerland
- Department of Medical Sciences, Uppsala University, Uppsala, Sweden
| | - Christina Gratziou
- The Tobacco Control Committee of the European Respiratory Society, Lausanne, Switzerland
- National and Kapodistrian University of Athens (UoA), Athens, Greece
| | - Gernot Rohde
- Medical Clinic I, Department of Respiratory Medicine, Goethe University Hospital, Frankfurt, Germany
| | - Christina N. Kyriakos
- European Network for Smoking and Tobacco Prevention (ENSP), Brussels, Belgium
- University of Crete (UoC), Heraklion, Greece
| | - Ute Mons
- Cancer Prevention Unit and WHO Collaborating Centre for Tobacco Control, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Esteve Fernández
- Institut Català d’Oncologia and Bellvitge Biomedical Research Institute (IDIBELL), Catalonia, Spain
- School of Medicine and Health Sciences, Universitat de Barcelona, Catalonia, Spain
| | - Antigona C. Trofor
- University of Medicine and Pharmacy ‘Grigore T. Popa’ Iasi, Iasi, Romania
- Aer Pur Romania, Bucharest, Romania
| | - Tibor Demjén
- Smoking or Health Hungarian Foundation (SHHF), Budapest, Hungary
| | - Krzysztof Przewoźniak
- Health Promotion Foundation (HPF), Warsaw, Poland
- Maria Skłodowska-Curie Institute-Oncology Center (MSCI), Warsaw, Poland
| | - Yannis Tountas
- National and Kapodistrian University of Athens (UoA), Athens, Greece
| | - Geoffrey T. Fong
- Department of Psychology and School of Public Health and Health Systems, University of Waterloo (UW), Waterloo, Canada
- Ontario Institute for Cancer Research, Toronto, Canada
| | - Constantine I. Vardavas
- The Tobacco Control Committee of the European Respiratory Society, Lausanne, Switzerland
- European Network for Smoking and Tobacco Prevention (ENSP), Brussels, Belgium
- University of Crete (UoC), Heraklion, Greece
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Gaalema DE, Pericot-Valverde I, Bunn JY, Villanti AC, Cepeda-Benito A, Doogan NJ, Keith DR, Kurti AN, Lopez AA, Nighbor T, Parker MA, Quisenberry AJ, Redner R, Roberts ME, Stanton CA, Ades PA, Higgins ST. Tobacco use in cardiac patients: Perceptions, use, and changes after a recent myocardial infarction among US adults in the PATH study (2013-2015). Prev Med 2018; 117:76-82. [PMID: 29746974 PMCID: PMC6195824 DOI: 10.1016/j.ypmed.2018.05.004] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2018] [Revised: 04/30/2018] [Accepted: 05/05/2018] [Indexed: 11/29/2022]
Abstract
Smoking status following cardiac events strongly predicts future morbidity and mortality. Using a nationally representative sample of United States adults, aims of this study were (1) to estimate use of, and attitudes towards, tobacco products as a function of level of cardiac risk, and (2) to explore changes in attitudes and tobacco use among adults experiencing a recent myocardial infarction (MI). Data were obtained from the first and second waves of the Population Assessment of Tobacco and Health (PATH) study. Use and attitudes towards tobacco products were examined at Wave 1 among adults with no chronic health condition (n = 18,026), those with risk factors for heart disease (n = 4593), and those who reported ever having had an MI (n = 643). Changes in perceived risk of tobacco and use between the two waves and having an MI in the last 12 months (n = 240) were also examined. Those who reported lifetime MI were more likely to believe that smoking/using tobacco was causing/worsening a health problem. Having had a recent MI event increased perceived tobacco-related risk and attempts at reduction/quitting, but did not significantly impact combusted tobacco cessation/reduction or uptake of non-combusted tobacco products. Sociodemographic characteristics and use of other tobacco products were associated with change in use of tobacco products. Those who have an MI are sensitized to the harm of continued smoking. Nonetheless, having an MI does not predict quitting combusted tobacco use or switching to potentially reduced harm products. Intense intervention is necessary to reduce combusted use in this high-risk population.
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Affiliation(s)
- Diann E Gaalema
- Vermont Center on Behavior and Health, University of Vermont, Burlington, VT, USA; Departments of Psychiatry, University of Vermont, Burlington, VT, USA; Psychological Science, University of Vermont, Burlington, VT, USA.
| | - Irene Pericot-Valverde
- Vermont Center on Behavior and Health, University of Vermont, Burlington, VT, USA; Departments of Psychiatry, University of Vermont, Burlington, VT, USA
| | - Janice Y Bunn
- Medical Biostatistics, University of Vermont, Burlington, VT, USA
| | - Andrea C Villanti
- Vermont Center on Behavior and Health, University of Vermont, Burlington, VT, USA; Departments of Psychiatry, University of Vermont, Burlington, VT, USA
| | - Antonio Cepeda-Benito
- Vermont Center on Behavior and Health, University of Vermont, Burlington, VT, USA; Psychological Science, University of Vermont, Burlington, VT, USA
| | - Nathan J Doogan
- Center of Excellence in Regulatory Tobacco Science, College of Public Health, The Ohio State University, Columbus, OH, USA
| | - Diana R Keith
- Vermont Center on Behavior and Health, University of Vermont, Burlington, VT, USA; Departments of Psychiatry, University of Vermont, Burlington, VT, USA
| | - Allison N Kurti
- Vermont Center on Behavior and Health, University of Vermont, Burlington, VT, USA; Departments of Psychiatry, University of Vermont, Burlington, VT, USA
| | - Alexa A Lopez
- Vermont Center on Behavior and Health, University of Vermont, Burlington, VT, USA
| | - Tyler Nighbor
- Vermont Center on Behavior and Health, University of Vermont, Burlington, VT, USA; Departments of Psychiatry, University of Vermont, Burlington, VT, USA
| | - Maria A Parker
- Vermont Center on Behavior and Health, University of Vermont, Burlington, VT, USA; Departments of Psychiatry, University of Vermont, Burlington, VT, USA
| | - Amanda J Quisenberry
- Center of Excellence in Regulatory Tobacco Science, College of Public Health, The Ohio State University, Columbus, OH, USA
| | - Ryan Redner
- Vermont Center on Behavior and Health, University of Vermont, Burlington, VT, USA; Rehabilitation Institute, Southern Illinois University, Carbondale, IL, USA
| | - Megan E Roberts
- Center of Excellence in Regulatory Tobacco Science, College of Public Health, The Ohio State University, Columbus, OH, USA
| | - Cassandra A Stanton
- Westat, Center for Evaluation and Coordination of Training and Research (CECTR) in Tobacco Regulatory Science, Department of Oncology, Georgetown University Medical Center, Washington, DC, USA
| | - Philip A Ades
- Vermont Center on Behavior and Health, University of Vermont, Burlington, VT, USA; Division of Cardiology, University of Vermont College of Medicine, Burlington, VT, USA
| | - Stephen T Higgins
- Vermont Center on Behavior and Health, University of Vermont, Burlington, VT, USA; Departments of Psychiatry, University of Vermont, Burlington, VT, USA; Psychological Science, University of Vermont, Burlington, VT, USA
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20
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Streck JM, Bergeria CL, Parker MA, Davis DR, DeSarno M, Sigmon SC, Hughes JR, Gaalema DE, Heil SH, Tidey JW, Stitzer ML, Rothman M, Higgins ST. Response to reduced nicotine content cigarettes among smokers with chronic health conditions. Prev Med Rep 2018; 12:321-329. [PMID: 30416951 PMCID: PMC6224320 DOI: 10.1016/j.pmedr.2018.10.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2018] [Revised: 09/30/2018] [Accepted: 10/13/2018] [Indexed: 12/15/2022] Open
Abstract
Individuals with chronic health conditions persist in smoking despite the presence of smoking-related illness. The aim of this study was to examine whether chronic health conditions moderate response to reduced nicotine content cigarettes (0.4, 2.4, 5.2, 15.8 mg/g of tobacco). This is a secondary analysis of a controlled clinical laboratory study that examined the acute effects of cigarettes varying in nicotine content among individuals especially vulnerable to smoking and tobacco dependence. Participants in the present study were categorized as having 0, 1–2, or ≥3 smoking-related chronic health conditions (i.e., chronic condition severity, CCS). Repeated-measures analysis of variance was used to examine whether CCS moderated response to cigarettes across measures of addiction potential (i.e., concurrent choice testing between nicotine dose pairs, Cigarette Purchase Task (CPT) performance, positive subjective effects), tobacco withdrawal, cigarette craving, and smoking topography. No main effects of CCS or interactions of CCS and nicotine dose were observed for concurrent choice testing, positive subjective effects, tobacco withdrawal, or smoking topography. Main effects of CCS were noted on the CPT with greater CCS being associated with less persistent demand. There was an interaction of CCS and nicotine dose on Factor 1 of the Questionnaire on Smoking Urges with the effects of dose significant only among those with 1–2 chronic conditions. Overall, we see minimal evidence that chronic condition severity affects response to reduced nicotine content cigarettes. A policy that reduces the nicotine content of cigarettes to minimally addictive levels may benefit smokers already experiencing smoking-related chronic conditions.
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Affiliation(s)
- Joanna M Streck
- Vermont Center on Tobacco Regulatory Science, Departments of Psychiatry and Psychological Science, University of Vermont, Burlington, VT, United States of America
| | - Cecilia L Bergeria
- Vermont Center on Tobacco Regulatory Science, Departments of Psychiatry and Psychological Science, University of Vermont, Burlington, VT, United States of America
| | - Maria A Parker
- Vermont Center on Tobacco Regulatory Science, Departments of Psychiatry and Psychological Science, University of Vermont, Burlington, VT, United States of America
| | - Danielle R Davis
- Vermont Center on Tobacco Regulatory Science, Departments of Psychiatry and Psychological Science, University of Vermont, Burlington, VT, United States of America
| | - Michael DeSarno
- Vermont Center on Tobacco Regulatory Science, Departments of Psychiatry and Psychological Science, University of Vermont, Burlington, VT, United States of America
| | - Stacey C Sigmon
- Vermont Center on Tobacco Regulatory Science, Departments of Psychiatry and Psychological Science, University of Vermont, Burlington, VT, United States of America
| | - John R Hughes
- Vermont Center on Tobacco Regulatory Science, Departments of Psychiatry and Psychological Science, University of Vermont, Burlington, VT, United States of America
| | - Diann E Gaalema
- Vermont Center on Tobacco Regulatory Science, Departments of Psychiatry and Psychological Science, University of Vermont, Burlington, VT, United States of America
| | - Sarah H Heil
- Vermont Center on Tobacco Regulatory Science, Departments of Psychiatry and Psychological Science, University of Vermont, Burlington, VT, United States of America
| | - Jennifer W Tidey
- Center for Alcohol and Addiction Studies, Brown University, Providence, RI, United States of America
| | - Maxine L Stitzer
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, United States of America
| | - Matthew Rothman
- Vermont Center on Tobacco Regulatory Science, Departments of Psychiatry and Psychological Science, University of Vermont, Burlington, VT, United States of America
| | - Stephen T Higgins
- Vermont Center on Tobacco Regulatory Science, Departments of Psychiatry and Psychological Science, University of Vermont, Burlington, VT, United States of America
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