Sex/gender differences in smoking cessation: A review

Breaking Bonds, Changing Habits: Understanding Health Behaviors during and after Marital Dissolution

Marital dissolution is a stressful transition that can lead to unhealthy coping strategies, including smoking and drinking. Using fixed effect linear probability models to assess health behavior changes, we analyzed 6,607 women and 6,689 men in the Household, Income, and Labour Dynamics in Australia data set who were either continuously married or experienced marital separation between 2002 and 2020. We observed 1,376 separations (744 women, 632 men). We found that drinking and smoking increases leading to and in the year of separation, with variability by gender, education, and parenthood status. From Cox proportional hazards models, we showed that among individuals who smoked (N = 337) or drank (N = 756) in the year of separation, cessation was most likely for the highly educated and/or women. Unhealthy coping mechanisms throughout marital dissolution suggests a need for targeted support to those separating, especially for men and those with children and lower education.

Incorporating technology in smoking cessation interventions: In-person vs. Video-call formats

INTRODUCTION

The use of video calls to provide health-related interventions has grown significantly, showing positive results in a broad range of psychological interventions. Scarce research has examined video-call use in smoking cessation treatments. The purpose of this study was to compare two randomised controlled trials conducting a cognitive-behavioral intervention to quit smoking in-person versus using video calls.

MATERIAL AND METHODS

This study is a secondary analysis of two randomised controlled trial studies (RCTs) conducted using two delivery formats: in-person vs. video calls. The sample comprised 498 adults seeking smoking cessation treatment. We analysed smoking cessation, cigarette reduction, and treatment satisfaction outcomes according to delivery format.

RESULTS

No significant differences were found in sex, age, and baseline smoking-related variables. A significantly higher proportion of participants in the video-call format had university studies, were actively working, and had a history of depression compared to the in-person format. No significant differences were found in cessation, smoking reduction, and satisfaction with treatment. Predictive variables of 12-month abstinence were: baseline number of cigarettes smoked per day (OR = 0.93) in the case of the in-person format; and being a woman (OR = 0.53), cigarette dependence (OR = 0.46), and last year quit attempt (OR = 0.52) in the video-call format.

CONCLUSIONS

Both delivery formats showed similar abstinence rates at 12 months and satisfaction with the intervention. Therefore, in-person and video calls could be used to deliver smoking cessation treatments. Given that predictors of long-term abstinence differed across these delivery formats, further research is needed.

TRIALS REGISTRATION

ClinicalTrials.gov IDs: NCT02844595: NCT04765813.

Steroid Receptors and Coregulators: Dissemination of Sex Differences and Emerging Technologies

Steroid receptors are ligand-induced transcription factors that have broad functions among all living animal species, ranging from control of sex differences, body weight, stress responses, and many others. Their binding to coregulator proteins is regulated by corepressors and coactivators that interchange upon stimulation with a ligand. Coregulator proteins are an imperative and understudied aspect of steroid receptor signaling. Here, we discuss steroid receptor basics from protein domain structures that allow them to interact with coregulators and other proteins, their essential functions as transcription factors, and other elemental protein-protein interactions. We deliberate about the mechanisms that coregulators control in steroid receptor signaling, sex hormone signaling differences, sex hormone treatment in the opposite sex, and how these affect the coregulator and sex steroid receptor complexes. The steroid receptor-coregulator signaling mechanisms are essential built-in components of the mammalian DNA that mediate physiological and everyday functions. Targeting their crosstalk might be useful when imbalances lead to disease. We introduce novel technologies, such as the PamGene PamStation, that make investigating the heterogeneity of the steroid receptor-coregulator complexes and targeting their binding more feasible. This review provides an extensive understanding of steroid receptor-coregulator signaling and how these interactions are intrinsic to many physiological functions that may offer therapeutic advantages.

App Use and Abstinence Outcomes: The Moderating Role of Sociodemographic Variables in a Psychological Intervention to Quit Smoking

BACKGROUND

App use is related to smoking cessation outcomes in mobile-based interventions but studies that examine its impact on traditional interventions combined with an app are still scarce. Moreover, the interplay between app use and participants' sociodemographic characteristics remains unexplored, particularly in blended smoking cessation interventions.

OBJECTIVES

The study aims to explore the main effect of app use and the interactive effect of this variable and sociodemographic variables on abstinence outcomes. The sample composed of 102 participants (Mage= 44.96, SD= 9.97; 57.8% female) who received a psychological cognitive-behavioral smoking cessation intervention combined with the "Non Fumo" app. The Mann-Whitney U-test was used to examine differences in app use according to the smoking status at the end of the intervention, and moderation analyses were conducted to examine the interaction between app use and sociodemographic variables.

RESULTS

Results showed that abstinent participants, compared to participants who smoke, used the "Non Fumo" app significantly more. However, app use did not predict abstinence at the end of treatment. Regarding moderation analyses, younger participants with greater app use were more likely to achieve abstinence at the end of the treatment compared to older participants.

CONCLUSIONS/IMPORTANCE

This study suggests that the association between app use and cessation outcomes could vary according to specific sociodemographic variables. Findings highlight the relevance of further investigating the relationship between personal characteristics and tobacco outcomes in app-based interventions. This would allow tailoring interventions according to individual characteristics to improve their effectiveness.

Beyond self-reports: serum cotinine reveals sex-and age-related differences of smoking on all-cause and disease-specific mortality

Background

It is well-known that sex and age play critical roles in smoking-related diseases and mortality. However, quantification of the extent of smoking requires self-reports in these studies, which may yield only partially accurate results. This study investigated sex-and age-related differences in the association between smoking and all-cause, cardiovascular disease, and cancer mortality by measuring serum cotinine levels.

Methods

Participants aged 20-85 years from the US National Health and Nutrition Examination Survey (1999-2018) were included. All-cause and disease-specific mortality data were obtained from publicly available user-linked mortality files. Multivariate Cox regression was performed to identify serum cotinine as an independent risk factor of mortality. Subgroup and interaction analyses were performed to investigate these sex and age differences. Smooth curve fitting was conducted to discover potential nonlinear relationships and threshold saturation effects.

Results

Sex was significantly associated with all-cause and cancer mortality. Threshold saturation effects were observed in all-cause mortality among both males and females, cancer mortality among females, and cardiovascular disease mortality among males. Age markedly associated with all-cause and cardiovascular disease mortality. Threshold saturation effects were found in cardiovascular disease mortality among younger adults and cancer mortality among the all-age population.

Conclusion

These findings suggest that there are threshold saturation effects between smoking and mortality, and sex and age differences in smoking-related mortality are inconsistent in different diseases.

Smoking Cessation Programs for Women in Non-reproductive Contexts: A Systematic Review

BACKGROUND

Women's smoking and cessation behaviors are influenced by various sex- and gender- (SaG) related factors; however, most smoking cessation programs that do not target pregnant women follow a gender-neutral approach. We aimed to systematically review the literature on smoking cessation programs for women outside reproductive contexts to assess their effectiveness and how they address SaG-related barriers.

METHODS

We selected experimental studies published between June 1, 2009, and June 7, 2023, that describe smoking cessation interventions designed exclusively for women. Two independent reviewers extracted study characteristics, intervention effectiveness, strategies to address SaG-related factors, and the studies' approach to gender equity using the gender integration continuum. We searched multiple databases to comprehensively identify relevant studies for inclusion. The protocol was registered with PROSPERO #CRD42023429054.

RESULTS

Twenty-five studies were selected and summarized using a narrative synthesis. Of these, nine (36%) found a greater reduction in smoking in the intervention group relative to the comparison group. Nine studies addressed women's concerns about post-cessation weight gain; however, in only one of these did the intervention group show a greater likelihood of quitting smoking relative to the comparison group. In contrast, three of four studies tailored for women facing socioeconomic disadvantage, and three of four studies designed for women with medical comorbidities, reported a greater reduction in smoking behaviors in the intervention relative to the comparison group. Ten studies relied solely on counseling and did not provide participants with smoking cessation pharmacotherapy. Overall, studies addressed individual and community-level barriers to quitting, including post-cessation weight gain, lack of social support, psychological distress, and cultural influences. All but one study avoided using harmful gender norms to promote cessation.

CONCLUSIONS

Strategies that address SaG-related barriers to quitting may improve cessation outcomes among women, particularly when tailored to meet the unique needs of specific groups such as those facing socioeconomic disadvantage. Future studies should combine best practices in smoking cessation treatment-behavioral counseling and pharmacotherapy-with new knowledge on how SaG factors influence motives for smoking and barriers to quitting. Such an approach could lead to more effective and equitable smoking cessation interventions for women.

Integrating variable centered and person centered approaches for personality and nicotine use

This study explored the relationship between Big Five personality traits and nicotine use, integrating both variable-centered and person-centered approaches to capture the complexity of trait interactions. Data were drawn from a publicly available online survey of 1885 English-speaking adults, categorized as never users (n = 428), former users (n = 582), or current users (n = 875) based on nicotine use. Personality traits were assessed using the Five-Factor Personality Inventory, measuring neuroticism, extraversion, openness, agreeableness, and conscientiousness, with additional data on age, sex, and education. Multinomial logistic regression identified openness, conscientiousness, and agreeableness as significant predictors of nicotine use. Latent Profile Analysis (LPA) revealed four personality profiles: "Ordinary," "Expressive," "Cautious," and "Unstable," with significant differences in nicotine use patterns. The "Unstable" and "Expressive" profiles were associated with current use, while the "Cautious" profile was linked to never use. Sociodemographic factors varied significantly across profiles. These findings underscore the importance of integrating both variable-centered and person-centered approaches to better understand the role of personality traits in nicotine use. Tailored interventions, considering the unique characteristics of each personality profile, may improve nicotine cessation and prevention efforts.

Sex differences and trends in managing cardiovascular risk factors in primary care: a dynamic cohort study

BACKGROUND

Treatment targets for cardiovascular risk management (CVRM) make no distinction between women and men.

AIM

To explore sex differences in achieving treatment targets in patients who participated in a nurse-led, integrated CVRM care programme in primary care between 2013 and 2019.

DESIGN & SETTING

We conducted a dynamic cohort study in the Eindhoven region, which is the south-eastern part of the Netherlands.

METHOD

We assessed outcomes of three biological risk factors (systolic blood pressure [SBP], low-density lipoprotein [LDL] cholesterol, and estimated glomerular filtration rate [eGFR]) and four lifestyle factors (smoking, physical activity, alcohol intake, and body mass index [BMI]). Points (1 = on target; 0 = not on target) were assigned for biological risk factors, lifestyle factors, and an overall score. Using the annual results, we applied multivariable regression models to study trends over time and differences in trends between women and men.

RESULTS

The number of participants increased from 24,889 to 38,067, mean age increased from 67.3 years to 71.5 years, with around 52 % women each year. The average of seven risk factors on target increased significantly from 4.6 to 4.9 in women, and from 4.7 to 5.0 in men, with no statistical difference between women and men. Differences between women and men in 2013 in the number of both biological and lifestyle factors on target did not materially change over time.

CONCLUSION

Integrated cardiovascular management care led to improvements in cardiovascular risk factors on target, equally well in women than in men. Differences in risk factors on target between women and men in 2013 were still present in 2019.

Sex differences in dorsal striatal volume and interest in quitting smoking

AIMS

Over the recent decades, smoking among women has become an increasingly pressing public health challenge. Mounting evidence suggests that, compared to men, women's smoking is more strongly influenced by habitual responses to sensorimotor cues. To understand the brain mechanisms underlying the cessation challenges commonly reported by women who smoke, the present study used voxel-based morphometry (VBM) to investigate sex-related volumetric differences in the dorsal striatum, a region implicated in habitual substance use behavior, and their associations with self-reported quit interest among daily smoking adults.

METHODS

Structural magnetic resonance imaging (MRI) data were collected from 41 women and 52 men (30.1 ± 7.5 years) who reported smoking an average of 15-40 cigarettes per day for at least past 24 months. Multiple regression analyses were carried out with sex and average gray matter volumes (GMV) of predetermined brain regions of interest (ROIs; bilateral caudate, putamen) and control regions (bilateral nucleus accumbens, thalamus) as predictors of self-reported interest in quitting smoking.

FINDINGS

Women displayed greater striatal GMV and lower current quit interest than men. ROI-based analyses revealed an interaction between sex and putamen GMV, wherein putamen GMV was more strongly and negatively linked to quit interest in women than men.

CONCLUSIONS

Greater GMV in the putamen could be linked to an attenuated desire to stop smoking among women. This may serve as a neuroanatomical mechanism underlying the higher prevalence of habit-driven smoking behavior observed in women as compared to men.

Differences in anxiety, depression and pain experience among adults with chronic low back pain as a function of nicotine product use

The landscape of nicotine use in the United States (US) has continued to evolve, with electronic cigarette use (hereafter e-cigarette) becoming more evident in recent years. Patterns of dual nicotine use, or using combustible nicotine in conjunction with e-cigarettes, may increase dependence on nicotine, continued exposure to toxins, and corresponding health risks. One of the most prevalent health problems related to nicotine use is the experience of chronic pain. Past work has established a bidirectional relationship between nicotine use and pain, such that pain motivates nicotine use and nicotine use contributes to pain. However, no work has explored differences in negative mood and pain experience as a product of nicotine use type among adults with chronic low back pain. The current cross-sectional study examined whether dual cigarette/e-cigarette use was associated with greater anxiety, depression, and pain experience among a sample of adult nicotine users (cigarettes and/or e-cigarettes) with self-reported mild to severe chronic low back pain (N = 1034, 66.0% female, Mage= 44.47 years, SD = 11.63). Results indicated that, compared to exclusive combustible nicotine users, dual cigarette/e-cigarette users had statistically significantly higher anxiety, depression, and pain disability scores, beyond the effects of age, sex, education, and use of opioid medications for pain. No significant group differences emerged as a function of exclusive e-cigarette use. The current findings highlight that dual cigarette/e-cigarette use may serve to mark a subpopulation of persons with chronic low back pain who present more complicated clinical features that require comprehensive care.

Sex and Gender Health Education Tenets: An Essential Paradigm for Inclusivity in Dentistry

Sex and gender are essential components of person-centered care. This article presents and discusses four important tenets regarding sex and gender health that should be incorporated into dental education and oral health care to foster inclusivity and improve care for all patients, including a sex and gender-diverse patient population.

Sex differences in cigarette smoking following a mindfulness-based cessation randomized controlled trial

Some interventions for smoking cessation such as quit smoking aids show sex-specific effects on outcomes, but behavioral interventions such as mindfulness-based interventions (MBIs) for smoking cessation lack formal reporting of sex-intervention tests of interaction to date. To address this gap, we conducted a secondary analysis of a RCT dataset (N = 213), recruiting participants from California, to statistically test a sex-intervention interaction effect on complete 7-day point prevalence abstinence (PPA), proportion of days abstinent, and daily cigarettes smoked. Smoking was assessed using the timeline follow back method spanning the four weeks following a daily 14-day app-based intervention and a planned smoking quit date immediately following the intervention phase. All models adjusted for baseline nicotine dependence. The study groups had comparable sex proportions (MBI: 56 % female; control: 55 % female) and the ratio of outcome assessment completion by group was not dependent on sex. Adjusted analyses revealed a significant sex-intervention interaction effect for daily cigarettes smoked ([female coded 1]: two-way interaction effect IRR = 0.59, 95 % CI: 0.46-0.77, p < 0.0001; effect for female: IRR = 0.68, 95 % CI: 0.57-0.81, effect for male: IRR = 1.14, 95 % CI: 0.95-1.37), but not for complete 7-day PPA ([female coded 1] two-way interaction effect OR = 1.24, 95 % CI: 0.31-4.89, p = 0.76) or proportion of total days abstinent ([female coded 1] two-way interaction effect OR = 1.97, 95 % CI: 0.53-7.37, p = 0.31). Females, but not males, allocated to a daily app-based MBI with a quit plan and quit aid workbook smoked fewer cigarettes per day compared to females in the control group. Males, but not females, showed significantly less use of the MBI app compared to the control app.

Correlates of nicotine patch adherence in daily life

BACKGROUND

African Americans who smoke are disproportionately affected by the health consequences of smoking. Nicotine replacement therapy (NRT) is effective for helping people successfully quit, yet there are well-documented issues with nicotine patch adherence. This study aimed to examine the real-time associations of risk factors for patch non-adherence [lapse, motivation, self-efficacy, urge, cigarette availability] with patch adherence in a sample of African Americans who smoke and are attempting to quit.

METHODS

Participants were 239 African American adults, 50 % female, and ages 18-74. Ecological momentary assessment was used to assess patch use and risk factors. Multilevel modeling for binary outcomes was used to test concurrent and lagged associations between risk factors and patch use.

RESULTS

Lapse at a previous assessment (OR=0.61, 95 % CI: 0.42, 0.88), and urge (OR=0.77, 95 % CI: 0.66, 0.89) and cigarette availability (OR=0.84, 95 % CI: 0.71, 0.99) at concurrent assessments were associated with lower likelihood of patch use. Concurrent motivation (OR=1.28, 95 % CI: 1.05, 1.55) and self-efficacy (OR=1.31, 95 % CI: 1.06, 1.62) were associated with greater likelihood of patch use. There were no significant lagged associations between motivation, self-efficacy, urge, or cigarette availability with patch use.

DISCUSSION

It is critical to examine correlates of non-adherence among African Americans who smoke because they are less likely to quit and are disproportionately impacted by the health consequences of tobacco use. The results suggest that interventions might focus on promoting patch adherence at certain times (e.g., when cigarettes are available) and/or leveraging the benefits of protective factors (e.g., motivation and self-efficacy).

Repeated participation in hospital smoking cessation services and its effectiveness in smoking cessation: a seven-year observational study in Taiwan

OBJECTIVE

The purpose of this study was to evaluate repeated participation in hospital smoking cessation services and its related factors and to explore the correlation between the frequency of participation and its effectiveness in smoking cessation. This study uniquely follows participants over a seven-year period after the removal of financial barriers, with a maximum charge of TWD 200 (USD 6.4) for cessation medications in Taiwan.

METHODS

A secondary analysis of data from a regional teaching hospital in Central Taiwan was conducted, utilizing the database of the Smoking Cessation Therapy Management Center of Health Promotion Administration and the hospital's documentation from 2013 to 2019. Successful smoking cessation was defined as a non-smoking status at the six-month follow-up stages. Repeat participation was identified through the hospital's smoking cessation logs. Logistic and Cox regression analyses were conducted to meet the study objectives, with all statistical procedures performed on SAS version 9.4.

RESULTS

In this study, 19.16% of the smoking cessation service users participated repeatedly over a period of seven years. After adjusting for the observation time, the Cox regression analysis showed that those who experienced the side effects of smoking cessation, long-term smokers, and those with a history of disease were more likely to participate again (HR:1.39;1.17;2.60). However, those who smoked heavily, drank alcohol, and failed to quit smoking after previous participation were significantly less likely to participate again (HR:0.59,0.55,0.70;0.89;0.66). Finally, this study found no significant correlation between the frequency of repeated participation and the effectiveness of the last smoking cessation service.

CONCLUSION

A certain proportion of smokers repeatedly participate in the same hospital's smoking cessation program, which does not diminish its effectiveness. It is implied that relaxing the limit on the quantity of smoking cessation services subsidies will contribute to overall tobacco harm control efforts.

A Gender-Informed Smoking Cessation App for Women: Protocol for an Acceptability and Feasibility Study

BACKGROUND

Tobacco smoking remains the leading preventable cause of death and disease among women. Quitting smoking offers numerous health benefits; however, women tend to have less success than men when attempting to quit. This discrepancy is partly due to sex- and gender-related factors, including the lower effectiveness of smoking cessation medication and the presence of unique motives for smoking and barriers to quitting among women. Despite the gendered nature of smoking, most smoking cessation apps are gender-neutral and fail to address women's specific needs.

OBJECTIVE

This study aims to test the acceptability and feasibility of a smartphone app that delivers gender-informed content to support women in quitting smoking.

METHODS

We co-developed a smoking cessation app specifically tailored for women, named My Change Plan-Women (MCP-W). This app builds upon our previous gender-neutral app, MCP, by retaining its content grounded in behavioral change techniques aimed at supporting tobacco reduction and cessation. This includes goal setting for quitting, identifying triggers to smoking, creating coping strategies, tracking cigarettes and cravings, and assessing financial savings from quitting smoking. The MCP-W app contains additional gender-informed content that acknowledges barriers to quitting, such as coping with stress, having smokers in one's social circle, and managing unpleasant emotions. This content is delivered through testimonials and animated videos. This study is a prospective, single-group, mixed methods investigation in which 30 women smokers will trial the app for a period of 28 days. Once participants provide informed consent, they will complete a baseline survey and download the app on their smartphones. After 28 days, participants will complete follow-up surveys. Acceptability will be assessed using the Theoretical Framework of Acceptability, which evaluates whether participants perceive the app as helpful in changing their smoking. The app will be deemed acceptable if the majority of participants rate it as such, and feasible if the majority of the participants use it for at least 7 days. Furthermore, after the 28-day trial period, participants will complete a semistructured interview regarding their experience with the app and suggestions for improvement.

RESULTS

Development of the MCP-W app was completed in September 2023. Participant recruitment for testing of the app commenced in February 2024 and was completed in July 2024. We will analyze the data upon completion of data collection from all 30 participants. We expect to share the results of this acceptability trial in the middle of 2025.

CONCLUSIONS

Offering smoking cessation support tailored specifically to address the unique needs of women through a smartphone app represents a novel approach. This study will test whether women who smoke perceive this approach to be acceptable and feasible in their journey toward smoking cessation.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/60677.

The American Cancer Society National Lung Cancer Roundtable strategic plan: Lung cancer in women

Lung cancer in women is a modern epidemic and represents a global health crisis. Cigarette smoking remains the most important risk factor for lung cancer in all patients and, among women globally, rates of smoking continue to increase. Although some data exist supporting sex-based differences across the continuum of lung cancer, there is currently a dearth of research exploring the differences in risk, biology, and treatment outcomes in women. Consequently, the American Cancer Society National Lung Cancer Roundtable recognizes the urgent need to promote awareness and future research that will close the knowledge gaps regarding lung cancer in women. To this end, the American Cancer Society National Lung Cancer Roundtable Task Group on Lung Cancer in Women convened a summit undertaking the following to: (1) summarize existing evidence and identify knowledge gaps surrounding the epidemiology, risk factors, biologic differences, and outcomes of lung cancer in women; (2) develop and prioritize research topics and questions that address research gaps and advance knowledge to improve quality of care of lung cancer in women; and (3) propose strategies for future research. PLAIN LANGUAGE SUMMARY: Lung cancer is the leading cause of cancer mortality in women, and, despite comparatively lower exposures to occupational and environmental carcinogens compared with men, disproportionately higher lung cancer rates in women who ever smoked and women who never smoked call for increased awareness and research that will close the knowledge gaps regarding lung cancer in women.

Health and Wellness Coaching Can Improve Tobacco Quit Rates and Weight Management Efforts in an Employee Population

PURPOSE

This study aims to investigate gender differences in tobacco quit rates and weight gain among employees undergoing a cessation program with a health and wellness coach.

DESIGN

This project was a retrospective observational study of an employee population.

SETTING

All data were collected during health coaching sessions by nationally certified health coaches.

SUBJECTS

211 men and women (116 males, 95 females, age 51.3 ± 9.9 years) enrolled in a Tobacco cessation health coaching program (TCHC) between January 2020 and December 2021.

MEASURES

Data were compared between genders for quit rate, weight, body mass index (BMI), and nicotine replacement therapy (NRT) usage across 12-month follow-ups.

ANALYSIS

Descriptive statistics, repeated measures ANOVA, and independent samples t-test.

RESULTS

Significantly more men than women successfully quit by the goal date set with their coach (P < 0.05). There was a significant reduction in tobacco use across 12 months, leading to the participant's quit date (P < 0.001). Women (Weight lost ± SD= 1.49 lbs. ±16.06 lbs.) lost significantly more weight than men (0.7 lbs. ± 8.5 lbs.; P < 0.001). NRT users lost significantly more weight than non-users (P = .007).

CONCLUSION

Health and wellness coaching was effective for participants to successfully stop tobacco use while in this program by their quit date. The coaching program also elicited weight loss while achieving smoking cessation for both men and women.

Disparities in Exposure to Pro-Tobacco and anti-Tobacco Advertisements in the United States

OBJECTIVES

This study investigates the prevalence of exposure to pro- and anti-tobacco advertisements across different sociodemographic groups and sources of exposure in the United States.

METHODS

The study included 6252 participants from the Health Information National Trends Survey. Binary logistic regression was used to examine associations between exposure to pro and anti-tobacco advertisements, the sources of exposure, and demographic factors.

RESULTS

10% of our sample were current smokers. A rate of 48.14% reported exposure to pro-tobacco ads, and 61.28% reported exposure to anti-tobacco ads. Findings reveal notable disparities in exposure to both pro and anti-tobacco advertisements. Exposure to pro-tobacco ads was more common among current smokers (OR = 0.53 (95% CI 0.44-0.64), p < 0.001), male participants (female: OR = 0.85 (95% CI 0.77-0.95), p = 0.003), and younger adults. Reported exposure to anti-tobacco ads was more common among younger adults, individuals with lower levels of education and income, and current smokers. Radio, TV, and billboards were among the most common sources of ad exposure for both types. Stores were among the most common sources of exposure to pro-tobacco ads (stores: 35.58% (18-34), 39.58% (35-49), and online sources (21.71%) were among the sources where people encountered anti-tobacco messages most frequently.

CONCLUSIONS

The findings underscore the importance of understanding the changing media consumption patterns and advertising awareness across various demographic groups. They also highlight the urgent need for targeted tobacco prevention interventions, especially via Radio, TV, billboards, and stores, particularly among younger adults, racial minorities, and current smokers who show higher exposure to pro-tobacco ads.

Negative emotional reactivity to racial/ethnic stress among Black adults who smoke

Black/African American (hereafter, Black) adults who smoke are at risk for tobacco-related health disparities in the United States (US). Although racial-based stressors (e.g., discrimination) are associated with smoking among this group, past work has not characterized individual differences in negative emotional reactivity to racial/ethnic stress in terms of smoking. The present investigation sought to address this limitation and evaluate the incremental validity of negative emotional reactivity to racial/ethnic stress on smoking processes after accounting for clinically important covariates. Participants included 517 Black individuals from the US who endorsed daily cigarette smoking (≥5 cigarettes per day, Mage = 45.1 years of age, 51.5% female). Results indicated that negative emotional reactivity to racial/ethnic minority stress was associated with an increased risk of severity of problems when quitting (ΔR2 = .01), perceived barriers for smoking cessation (ΔR2 = .03), and addictive (ΔR2 = .03) as well as negative mood reduction smoking motives (ΔR2 = .04); with effects evident after adjusting for frequency of racial/ethnic discrimination and other factors (e.g., drug use problems). Overall, the present findings provide novel empirical evidence that negative emotional reactivity to racial/ethnic minority stress among Black adults in the US is associated with several smoking processes implicated in the maintenance and relapse of smoking.

Differential effects of cigarette smoking on cardiovascular disease in females: A narrative review and call to action

OBJECTIVE

Cigarette smoking continues to be a major driver in the incidence and progression of cardiovascular disease (CVD). As females become an increasingly larger fraction of those who smoke it is imperative that the sex-specific effects of smoking be further explored and acted upon.

METHODS

This narrative review describes current evidence on the differential effects of smoking on CVD in females and the need to improve treatment.

RESULTS

Evidence to date suggests that smoking has disproportionately negative effects on the cardiovascular (CV) system in females, especially in those who are younger. Usually, the onset of CVD is later in females than males, but smoking decreases or eliminates this gap. Females are also more likely to develop types of CVD closely tied to smoking, such as ST-elevated myocardial infarctions, with even higher rates among those who are younger. Possible mechanisms for these worse outcomes in females include a complex interplay between nicotine, other products of combusted cigarettes, and hormones. Sex differences also exist in treatment for smoking. In females, Varenicline appears more effective than either Bupropion or nicotine replacement therapy while in males, all three therapies show similar efficacy. Disparities in smoking are also apparent in secondary prevention settings. Females and males are entering secondary prevention with equal rates of smoking, with potentially higher levels of exposure to the byproducts of smoking in females.

CONCLUSIONS

These disproportionately negative outcomes for females who smoke require additional research and these persisting rates of smoking suggest a need for female-specific approaches for treating smoking.

Sex differences in tobacco use, attempts to quit smoking, and cessation among dual users of cigarettes and e-cigarettes: Longitudinal findings from the US Population Assessment of Tobacco and Health Study

SIGNIFICANCE

A growing number of adults use more than one tobacco product, with dual use of cigarettes and e-cigarettes being the most common combination. Monitoring sex disparities in tobacco use is a public health priority. However, little is known regarding whether dual users differ by sex.

METHODS

Data came from Waves 4-6 (12/2016-11/2021) of the Population Assessment of Tobacco and Health Study, a US nationally-representative longitudinal survey. This analysis included current adult dual users of cigarettes and e-cigarettes. We used weighted generalized estimating equations to assess the association between sex and (1) making a cigarette quit attempt (n = 1882 observations from n = 1526 individuals) and (2) smoking cessation (n = 2081 observations from n = 1688 individuals) across two wave pairs, adjusting for age, education, ethnicity, time-to-first cigarette after waking, and e-cigarette use frequency.

RESULTS

Among US dual users, 14.1% (95% Confidence Intervals [Cl] = 11.9-16.4) of females and 23.4% (20.0-26.9) of males were young adults (aged 18-24), 11.7% (9.2-14.2) of females and 14.4% (11.6-17.2) of males had

CONCLUSION

US females who dually use e-cigarettes and cigarettes were more likely to attempt to quit smoking, but not more likely to succeed at quitting, than males.

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Key Words

• Cigarette smoking
• Cohort studies
• Dual use
• E-cigarette
• Electronic nicotine delivery systems
• Nicotine dependence
• Quit attempt
• Sex differences
• Smoking cessation

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MESH Headings

• Humans
• Female
• Male
• Smoking Cessation/statistics & numerical data
• Longitudinal Studies
• Adult
• United States/epidemiology
• Electronic Nicotine Delivery Systems/statistics & numerical data
• Middle Aged
• Sex Factors
• Tobacco Use/epidemiology
• Adolescent
• Young Adult
• Tobacco Products/statistics & numerical data
• Cigarette Smoking/epidemiology
• Vaping/epidemiology

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Affiliation(s)

Elias M Klemperer Vermont Center on Behavior & Health, Department of Psychiatry, University of Vermont, United States of America.
Loren Kock Vermont Center on Behavior & Health, Department of Psychiatry, University of Vermont, United States of America
Marc Jerome P Feinstein Vermont Center on Behavior & Health, Department of Psychiatry, University of Vermont, United States of America
Sulamunn R M Coleman Vermont Center on Behavior & Health, Department of Psychiatry, University of Vermont, United States of America
Diann E Gaalema Division of Cardiovascular Medicine, University of Texas Medical Branch, United States of America
Stephen T Higgins Vermont Center on Behavior & Health, Department of Psychiatry, University of Vermont, United States of America

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Reprint of: Smoking and pulmonary health in women: A narrative review and behavioral health perspective

OBJECTIVE

Cigarette smoking prevalence has declined slower among women than men, and smoking-related pulmonary disease (PD) has risen among women. Given these trends, there is a critical need to understand and mitigate PD risk among women who smoke. The purpose of this narrative review and commentary is to highlight important evidence from the literature on smoking and PD among women.

METHODS

This review focuses broadly on examining cigarette smoking and PD among women within six topic areas: (1) demographic characteristics and prevalence of smoking, (2) smoking behavior, (3) lung cancer, (4) obstructive PD, (5) diagnostic and treatment disparities, and (6) gaps in the literature and potential directions for future research and treatment.

RESULTS

Growing evidence indicates that compared to men, women are at increased risk for developing smoking-related PD and poorer PD outcomes. Gender disparities in smoking-related PD may be largely accounted for by genetic differences and sex hormones contributing to PD pathogenesis and presentation, smoking behavior, nicotine dependence, and pathogen/carcinogen clearance. Moreover, gender disparities in smoking-related PD may be exacerbated by important social determinants (e.g., women with less formal education and those from minoritized groups may be at especially high risk for poor PD outcomes due to higher rates of smoking).

CONCLUSION

Rising rates of smoking-related PD among women risk widening diagnostic and treatment disparities. Ongoing research is needed to explore potentially complex relationships between sex, gender, and smoking-related PD processes and outcomes, and to improve smoking-cessation and PD treatment for women.

Efficacy of Smoking Cessation Interventions among People with HIV in Kenya

BACKGROUND

People with human immunodeficiency virus (HIV) smoke at much higher rates than the general population, resulting in higher risk for tobacco-related morbidity and mortality. The efficacy of smoking cessation interventions among people with HIV in lower-middle-income countries remains unclear.

METHODS

We conducted a randomized, 2 × 2 factorial design trial based in Nairobi, Kenya, to evaluate the efficacy of bupropion versus placebo, and a culturally tailored behavioral cessation therapy, called Positively Smoke Free (PSF), versus standard of care for people with HIV who smoke. The primary outcome was 7-day point prevalence abstinence confirmed by exhaled carbon monoxide <7 ppm at 36 weeks.

RESULTS

Between June 2020 and August 2023, 300 participants were randomly assigned. Most participants were men (71.4%) who were moderately dependent on nicotine (Fagerström Test of Cigarette Dependence, mean [SD]: 4.5 [2.3]; range: 0-10; higher scores represent greater physical dependence on nicotine); nearly all participants (99.7%) were taking antiretroviral medication. At 36 weeks, 31.3% of participants who received bupropion were abstinent from smoking, compared with 13.3% in the placebo group (odds ratio, 2.95; 95% confidence interval [CI], 1.64-5.32, P<0.001). Among participants randomized to receive PSF therapy, 29.5% were abstinent from smoking, compared with 14.9% in the standard of care group (odds ratio, 2.39; 95% CI, 1.34-4.25, P=0.003). The combination of bupropion+PSF was associated with increased abstinence compared with either bupropion (38.9% vs. 23.6%; odds ratio, 2.06; 95% CI, 1.00-4.23) or PSF (38.9% vs. 20.3%; odds ratio, 2.50; 95% CI, 1.20-5.24) alone. Participants randomized to receive bupropion were significantly more likely to report excessive sweating compared with placebo (50.7% vs. 37.6%; P=0.024).

CONCLUSIONS

Both bupropion and PSF cessation counseling were effective in promoting abstinence from smoking at 36 weeks. The combined intervention was associated with higher abstinence rates than either therapy alone. (The National Cancer Institute provided support for this trial through grant R01CA225419.).

Prospective Association Between Tobacco Use and at-Risk Alcohol Consumption Among Swedish Adolescents: Outlining the Influence of Tobacco Product, Frequency of Use and Gender in the LoRDIA Cohort

Introduction: Tobacco use is not only a major risk factor for morbidity and mortality but also associated with alcohol misuse. While personality traits may be driving this association, the psychoactive component of tobacco, nicotine, may also be a major risk factor. The aim with this study was to further assess the prospective association between tobacco use and alcohol consumption, with special emphasis on the role of the tobacco product used (cigarettes and Swedish snus), frequency of use, and gender. Methods: Data was extracted from the prospective cohort Longitudinal Research on Development In Adolescence (LoRDIA), following Swedish adolescents over four waves (∼13 to 17 years of age). Tobacco use was reported with respect to product used and frequency of use, while alcohol use was assessed using AUDIT-C, as well as frequency of use within the last year. Results: Use of tobacco, independent of product used and gender, was associated with increased alcohol consumption. High frequency of use and dual use strengthened to association. Individuals initiating tobacco use during the study period progressively increased their frequency of alcohol consumption compared to non-users during consecutive waves. Furthermore, tobacco use was associated with at-risk consumption of alcohol at follow up, even when adjusting for previous alcohol inebriation, socioeconomical factors, gender and novelty seeking. Conclusions: The data presented here suggests that nicotine use during adolescence, and especially dual use, is a major risk factor for future hazardous alcohol intake. This finding is especially important considering the escalated use of nicotine pouches, which in many ways resembles Swedish snus. From a public health perspective, preventive measures and policies designed to counteract all forms of nicotine use among youths is warranted.

Hypothalamic pituitary adrenal and autonomic nervous system biomarkers of stress and tobacco relapse: Review of the research

Tobacco smoking is a risk factor for countless diseases, and smoking relapse remains a major public health concern. Subjective reports of stress by smokers are a common theme for relapse, however, the role of objective stress-related biomarkers in predicting tobacco relapse risk has been less studied. The aim of this manuscript was to review existing literature on the connection between biomarkers of stress and smoking relapse. Overall, trends indicate that blunted hypothalamic-pituitary-adrenal (HPA) responses to acute stress, larger reductions in HPA biomarkers during the initial days of abstinence during cessation (compared to pre-cessation levels), and exaggerated autonomic responses to stress predict increased risk of relapse. In addition, successful cessation is followed by changes in stress biomarkers (e.g., reductions in cortisol and heart rate, HR). This review also identifies potential modifiers, such as methodological differences, biological sex, and chronic stress, to account for heterogeneity of findings within and across studies. In addition, we identify gaps in the literature and suggest future research directions focusing on the roles of genetics and gene expression as well as the influence of neurobiological mechanisms on stress and relapse risk. Future clinical implications of this research include identifying reliable indicators of relapse risk and the potential of pharmacotherapeutic treatments to target stress response systems to correct dysregulation and potentially reduce stress-related risk of relapse.

The Indirect Effects of Negative Affect Reduction Motives on the Relationship Between Sex and Severity of Problems When Trying to Quit Among Black Adults Who Smoke

BACKGROUND

African American/Black (hereafter referred to as Black) persons who smoke constitute a tobacco disparities group in the United States. Within the Black population, female smokers experience a disproportionate percentage of these disparities and are less likely to quit cigarettes than their male counterparts. Two factors implicated in female smokers' relatively worse quit success are (1) motives to smoke to reduce negative affect and (2) expectancies that smoking will reduce negative affect.

OBJECTIVES

The present study sought to test sex differences in these two clinically relevant cognitive constructs and evaluate the indirect effects of sex and severity of problems when trying to quit via smoking motives and expectancies for negative affect reduction among Black adults who smoke. Participants included 103 Black adults who smoke daily (72% male; Mage = 44.5 years, SD = 11.5 years).

RESULTS

Results revealed sex differences in both negative affect reduction motives and expectancies, as well as a partial indirect effect for sex on the severity of problems when trying to quit through negative affect reduction motives (a1b1 = 0.18, 95% CI [0.04, 0.38]) but not negative affect reduction expectancies (a2b2 = -0.01, 95% CI [-0.11, 0.09]) in a simultaneous model of indirect effects.

CONCLUSIONS

These findings shed light on the complex relationship between race, sex, and severity of problems when trying to quit, particularly when complicated by smoking motives and expectancies. Current data should be considered when developing sex-specific, tailored smoking cessation interventions for Black women.

"I'm both smoking and vaping": a longitudinal qualitative study of US young adults who tried to quit smoking cigarettes by using electronic cigarettes

OBJECTIVE

To describe how young adults use electronic cigarettes (electronic nicotine delivery systems (ENDS)) for smoking cessation and reasons why they may or may not successfully quit smoking.

METHODS

Longitudinal qualitative data were collected annually from 2017 to 2019 for 25 young adult tobacco users (aged 18-29 years) in California (USA) who used ENDS to quit/reduce smoking. Thematic and trajectory analyses were used to identify key within-person and between-person changes in tobacco/nicotine use over time.

RESULTS

Five types of tobacco use transition were identified among baseline dual users of cigarettes and ENDS: sustained dual use without reduced smoking (n=8), transition to exclusive daily ENDS use (n=6), sustained dual use with reduced smoking (n=5), transition back to exclusive smoking (n=4) and transition to neither smoking nor vaping (n=2). Participants' ENDS use behaviour varied over time in terms of vaping quantity and device characteristics (eg, changing nicotine concentrations/flavours, switching between multiple devices). Three themes that related to successfully replacing cigarettes with ENDS were perceived positive physical effects, perceived satisfaction and enjoyment and context changes. Four themes for unsuccessful replacement were perceived negative physical discomforts, perceived addictiveness and harm, unsatisfactory substitution for cigarettes and device malfunction.

CONCLUSIONS

Young adults' experiences with using ENDS as a smoking cessation aid were highly variable. Adequate nicotine delivery and perceived safety and benefits contributed to successfully reducing or quitting cigarettes. Providing behavioural counselling and standardising ENDS products may enhance cessation for young adults.

Sex-specific predictive factors of smoking cessation in subjects at high cardiovascular risk

Smoking is a major risk factor for cardiovascular diseases (CVD), in particular in women, but smoking cessation (SC) reduces or even cancels the risk for both sexes. Using a nationwide SC services database, we aimed to determine the predictive factors of SC in men and women smokers with CV risk factors (CVRF) or CVD. A retrospective study from the French CDTnet database was conducted. Inclusion criteria were age ≥18years, and≥1 CVRF (Body Mass Index ≥25kg/m2, hypertension, diabetes, hypercholesterolemia) or CVD (myocardial infarction (MI) or angina pectoris, stroke, peripheral arterial disease [PAD]). Self-reported smoking abstinence (≥28 consecutive days) was confirmed by exhaled carbon monoxide<10ppm. Logistic regression analysis assessed the association between SC and sociodemographic, medical characteristics, and smoking profile. Among the 36,864 smokers at high CV risk, abstinence rate was slightly lower in women than in men, (52.6% [n=8,102] vs 55.0% [n=11,848], P<0.001). For both sexes, factors associated with the lowest abstinence rates were diabetes, respiratory and psychiatric diseases, anxiolytic/antidepressant use, and cannabis consumption. In women, the factors associated with smoking abstinence were suffering from MI or angina and taking contraceptive pill and the factors associated with persistent smoking were alcohol disorder and high cigarette consumption. In men, there was a positive relationship between overweight and abstinence while being dual users of cigarettes and electronic cigarettes at first visit, having tobacco-related diseases (cancer and PAD) and taking opioid substitution treatment were associated with persistent smoking. Finally, in both sexes, the factors associated with abstinence were: age≥65years, having a diploma, being employed, self-referred or encouraged by entourage, ≥1 previous quit attempt, ≤20 cigarettes per day consumption, benefiting from SC medication prescription and ≥4 follow-up visits. In conclusion, our results suggest the relevance of SC intensive management in smokers at high CV risk, based on sociodemographic, medical, and smoking behaviour characteristics, as well as a gender-specific SC approach.

Sex differences in tobacco use, attempts to quit smoking, and cessation among dual users of cigarettes and e-cigarettes: Longitudinal findings from the US Population Assessment of Tobacco and Health Study

SIGNIFICANCE

A growing number of adults use more than one tobacco product, with dual use of cigarettes and e-cigarettes being the most common combination. Monitoring sex disparities in tobacco use is a public health priority. However, little is known regarding whether dual users differ by sex.

METHODS

Data came from Waves 4-6 (12/2016-11/2021) of the Population Assessment of Tobacco and Health Study, a US nationally-representative longitudinal survey. This analysis included current adult dual users of cigarettes and e-cigarettes. We used weighted generalized estimating equations to assess the association between sex and (1) making a cigarette quit attempt (n = 1882 observations from n = 1526 individuals) and (2) smoking cessation (n = 2081 observations from n = 1688 individuals) across two wave pairs, adjusting for age, education, ethnicity, time-to-first cigarette after waking, and e-cigarette use frequency.

RESULTS

Among US dual users, 14.1% (95% Confidence Intervals [Cl] = 11.9-16.4) of females and 23.4% (20.0-26.9) of males were young adults (aged 18-24), 11.7% (9.2-14.2) of females and 14.4% (11.6-17.2) of males had

CONCLUSION

US females who dual use e-cigarettes and cigarettes were more likely to attempt to quit smoking, but not more likely to succeed at quitting, than males.

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Key Words

• Cigarette smoking
• Cohort studies
• Dual use
• E-cigarette
• Electronic nicotine delivery systems
• Nicotine dependence
• Quit attempt
• Sex differences
• Smoking cessation

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MESH Headings

• Humans
• Male
• Female
• Smoking Cessation/statistics & numerical data
• Longitudinal Studies
• Adult
• United States/epidemiology
• Electronic Nicotine Delivery Systems/statistics & numerical data
• Middle Aged
• Sex Factors
• Tobacco Use/epidemiology
• Adolescent
• Young Adult
• Tobacco Products/statistics & numerical data
• Cigarette Smoking/epidemiology
• Vaping/epidemiology

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Grants

• P30 GM149331 NIGMS NIH HHS
• R01 DA059562 NIDA NIH HHS
• T32 DA007242 NIDA NIH HHS
• U54 DA036114 NIDA NIH HHS

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Affiliation(s)

Elias M Klemperer Vermont Center on Behavior & Health, Department of Psychiatry, University of Vermont, United States of America.
Loren Kock Vermont Center on Behavior & Health, Department of Psychiatry, University of Vermont, United States of America
Marc Jerome P Feinstein Vermont Center on Behavior & Health, Department of Psychiatry, University of Vermont, United States of America
Sulamunn R M Coleman Vermont Center on Behavior & Health, Department of Psychiatry, University of Vermont, United States of America
Diann E Gaalema Division of Cardiovascular Medicine, University of Texas Medical Branch, United States of America
Stephen T Higgins Vermont Center on Behavior & Health, Department of Psychiatry, University of Vermont, United States of America

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Adverse Childhood Experiences and Tobacco Use among Latinx Parents in the USA

The current study aimed to understand the effects of adverse childhood experiences (ACEs) and cultural factors on Latinx parents' tobacco use. Tobacco use is the leading cause of death among Latinx individuals in the USA, and parental use has long-term secondary harm for children. Thus, it is important to examine cultural protective factors that could prevent Latinx parents and children from the negative health effects of tobacco use. Data came from 2813 18- to 50-year-old Latinx respondents who participated in the Wave 3 of the National Epidemiological Survey on Alcohol and Related Conditions. They reported having children living in their household and had complete data for the variables of interest. In this sample (mean age = 33.5 years, 53.7% female), 16.4% (95%CI = 14.7%, 18.4%) and 7.4% (95%CI = 6.4%, 8.6%) were current and former smokers, respectively. The multivariate multinomial logistic regression analysis showed that experiencing more ACEs categories was associated with increased likelihood of current and former tobacco use compared to never use. Past year discrimination experiences and being US born (2nd and 3rd-generation parents) also increased the likelihood of current use. Differences in risk of current and former tobacco use were found based on respondents' country of origin, with protection against tobacco use found for most countries compared to being from Puerto Rico. Stronger ethnic-racial identity was not protective against tobacco use. Findings show the importance of considering ACEs and cultural factors when designing and implementing tobacco cessation programs for Latinx parents and increasing awareness of the impact of parents' tobacco use on their children.

Smoking and pulmonary health in women: A narrative review and behavioral health perspective

OBJECTIVE

Cigarette smoking prevalence has declined slower among women than men, and smoking-related pulmonary disease (PD) has risen among women. Given these trends, there is a critical need to understand and mitigate PD risk among women who smoke. The purpose of this narrative review and commentary is to highlight important evidence from the literature on smoking and PD among women.

METHODS

This review focuses broadly on examining cigarette smoking and PD among women within six topic areas: (1) demographic characteristics and prevalence of smoking, (2) smoking behavior, (3) lung cancer, (4) obstructive PD, (5) diagnostic and treatment disparities, and (6) gaps in the literature and potential directions for future research and treatment.

RESULTS

Growing evidence indicates that compared to men, women are at increased risk for developing smoking-related PD and poorer PD outcomes. Gender disparities in smoking-related PD may be largely accounted for by genetic differences and sex hormones contributing to PD pathogenesis and presentation, smoking behavior, nicotine dependence, and pathogen/carcinogen clearance. Moreover, gender disparities in smoking-related PD may be exacerbated by important social determinants (e.g., women with less formal education and those from minoritized groups may be at especially high risk for poor PD outcomes due to higher rates of smoking).

CONCLUSION

Rising rates of smoking-related PD among women risk widening diagnostic and treatment disparities. Ongoing research is needed to explore potentially complex relationships between sex, gender, and smoking-related PD processes and outcomes, and to improve smoking-cessation and PD treatment for women.

Global burden of cardiovascular disease attributable to smoking, 1990-2019: an analysis of the 2019 Global Burden of Disease Study

AIMS

This study aims to investigate the trends in the global cardiovascular disease (CVD) burden attributable to smoking from 1990 to 2019.

METHODS AND RESULTS

Global Burden of Disease Study 2019 was used to analyse the burden of CVD attributable to smoking (i.e. ischaemic heart disease, peripheral artery disease, stroke, atrial fibrillation and flutter, and aortic aneurysm). Age-standardized mortality rates (ASMRs) per 100 000 and age-standardized disability-adjusted life year rates (ASDRs) per 100 000, as well as an estimated annual percentage change (EAPC) in ASMR and ASDR, were determined by age, sex, year, socio-demographic index (SDI), regions, and countries or territories. The global ASMR of smoking-attributed CVD decreased from 57.16/100 000 [95% uncertainty interval (UI) 54.46-59.97] in 1990 to 33.03/100 000 (95% UI 30.43-35.51) in 2019 [EAPC -0.42 (95% UI -0.47 to -0.38)]. Similarly, the ASDR of smoking-attributed CVD decreased between 1990 and 2019. All CVD subcategories showed a decline in death burden between 1990 and 2019. The burden of smoking-attributed CVD was higher in men than in women. Significant geographic and regional variations existed such that Eastern Europe had the highest ASMR and Andean Latin America had the lowest ASMR in 2019. In 2019, the ASMR of smoking-attributed CVD was lowest in high SDI regions.

CONCLUSION

Smoking-attributed CVD morbidity and mortality are declining globally, but significant variation persists, indicating a need for targeted interventions to reduce smoking-related CVD burden.

Clinical factors associated with smoking cessation among smokers with Chronic Obstructive Pulmonary Disease by sex: Longitudinal analyses from French smoking cessation services

Background

Smoking is responsible for 80 % of cases of Chronic Obstructive Pulmonary Disease (COPD), while the prognosis is improved by smoking cessation (SC). We examined clinical factors associated with SC among smokers with COPD comparing women and men.

Methods

The study comprised a cohort of 1470 smokers who visited a SC service and completed at least 28-day of follow-up visits. The outcome was smoking status at follow-up (abstinence, reduction, no change). Abstinence was defined as continuous abstinence for at least 28 days, validated by the measurement of expired Carbon Monoxide. Reduction was defined as a halving of the baseline tobacco consumption.

Results

The average age of the population was 53 (±11) years and 58.2 % were women. Men were 2 years younger than women and consulted more likely after a hospital contact, whereas women consulted on their own initiative. Women more often had a depression history, whereas men had medical comorbidities and co-addictions. There was no significant difference by sex regarding the abstinence rate (41.0 % in women vs 40.7 in men, p > 0.9). The factors significantly associated with higher abstinence rates in both sexes were: at least one previous quit attempt and number of follow-up visits ≥4. The factors negatively associated with quitting in women were diabetes, intake of mood stabilizers and consuming more than 10 cigarettes per day while having a chronic bronchitis, taking antidepressants and having consumed cannabis in the last 30 days hampered SC in men.

Conclusions

Concerning factors associated with SC, few differences were found between female and male smokers suffering from COPD. However, due to the different medical and smoking behavior characteristics according to sex, it might be important to take these differences into account in order to provide tailored SC management.

The effectiveness of a standardized tobacco cessation program on psychophysiological parameters in patients with addiction undergoing long-term rehabilitation: a quasi-experimental pilot study

BACKGROUND

Although there is a very high comorbidity between tobacco dependence and other addictive disorders, there are only few studies examining the implementation and outcomes of a tobacco cessation program in patients with addictive diseases. Therefore, the aim of this study is to investigate to what extent a standardized tobacco cessation program leads to improvements regarding psychological/physical parameters in patients with addiction undergoing therapy and whether there is a reduction in tobacco consumption.

METHODS

The study took place in a therapeutic community specialized in addiction therapy. A total sample of 56 participants were non-randomly assigned to an intervention group (IG; n = 31) and a treatment as usual group (TAUG; n = 25). The IG participated in a 6-week tobacco cessation program, while the TAUG received no additional treatment. Both groups were assessed for changes in primary outcomes (tobacco dependence, smoked cigarettes per day (CPD), and general substance-related craving) and secondary outcomes (heart rate variability (HRV): root mean square of successive differences, self-efficacy, and comorbid psychiatric symptoms) at two measurement time points (pre- and post-treatment/6 weeks).

RESULTS

We observed significant improvements in self-efficacy (F(1,53) = 5.86; p < .05; ηp2 = .11) and decreased CPD in the IG (β = 1.16, ρ < .05), while no significant changes were observed in the TAUG. No significant interaction effects were observed in psychiatric symptoms, general substance-related craving, and HRV.

CONCLUSIONS

The results highlight the potential benefit of an additional tobacco cessation program as part of a general addiction treatment. Although no improvements in the physiological domain were observed, there were significant improvements regarding self-efficacy and CPD in the IG compared to the TAUG. Randomized controlled trials on larger samples would be an important next step.

TRIAL REGISTRATION

ISRCTN15684371.

Type-switching of short-acting nicotine replacement therapy products and its implications for treatment

INTRODUCTION

The frequency with which people change from one medical treatment to another partly reflects satisfaction with the initial intervention. In this secondary analysis of observational data, we explore switch rates for short-acting nicotine replacement therapy (NRT) products, which differ in mode of use, rapidity of action, and adverse effect profiles.

METHODS

We analyzed data from 46,882 participants in the Smoking Treatment for Ontario Patients program who received short-acting NRT (gum, lozenge, oral spray, or inhaler) at their initial visit. We used discrete-time survival analysis to model the time elapsing before a change was made to another product and included time-by-product interactions to explore differences over time and product-by-previous-quit-attempts interactions to examine the importance of potential previous exposure to NRT. We adjusted both models for a range of sociodemographic and tobacco use variables.

RESULTS

Overall, 37.9% (95% CI = 37.5%, 38.4%) of participants switched to a different product at their first follow-up visit. Time-averaged and adjusted switch probabilities were 21.1% for gum, 23.8% for lozenge, 26.0% for inhaler, and 28.8% for oral spray. Switch rates were highest for people without past quit attempts, for women, and for people also using the nicotine patch.

CONCLUSIONS

People frequently switch from one type of short-acting NRT to another. We did not assess reasons for switching, but they may include adverse effects, impracticality, and perceived ineffectiveness. Given the superior effectiveness of combination treatment, making multiple products available may improve outcomes by allowing some people to continue with short-acting products for longer.

Closing the sex gap in cardiovascular mortality by achieving both horizontal and vertical equity

Addressing sex differences and disparities in coronary heart disease (CHD) involves achieving both horizontal and vertical equity in healthcare. Horizontal equity in the context of CHD means that both men and women with comparable health statuses should have equal access to diagnosis, treatment, and management of CHD. To achieve this, it is crucial to promote awareness among the general public about the signs and symptoms of CHD in both sexes, so that both women and men may seek timely medical attention. Women often face inequity in the treatment of cardiovascular disease. Current guidelines do not differ based on sex, but their applications based on gender do differ. Vertical equity means tailoring healthcare to allow equitable care for all. Steps towards achieving this include developing treatment protocols and guidelines that consider the unique aspects of CHD in women. It also requires implementing guidelines equally, when there is not sex difference rather than inequities in application of guideline directed care.

Differences in Risk Factors for Coronary Atherosclerosis According to Sex

Interest in sex differences related to coronary artery disease (CAD) has steadily increased, and the risk factors for CAD show distinct sex differences. For women, cardiovascular risk increases significantly after menopause due to a decrease in estrogen levels. In older individuals, increased arterial stiffness results in a higher pulse pressure, leading to a more common occurrence of isolated systolic hypertension; these changes are more noticeable in women. While the incidence of diabetes is similar in both sexes, women with diabetes face a 50% higher relative risk of fatal coronary heart disease compared to men. Smoking significantly increases the risk of ischemic heart disease in women, particularly those who are younger. The decrease in estrogen in women leads to a redistribution of fat, resulting in increased abdominal obesity and, consequently, an elevated cardiovascular risk. Pregnancy and reproductive factors also have a significant impact on CAD risks in women. Additionally, disparities exist in medical practice. Women are less likely to be prescribed cardioprotective drugs, referred for interventional or surgical treatments, or included in clinical research than men. By increasing awareness of these sex differences and addressing the disparities, we can progress toward more personalized treatment strategies, ultimately improving patient outcomes.

V, Babu D, Nakamura Y, Thamodaran V, Balasubramanian P, Velayudhan SR. Efficient deletion of microRNAs using CRISPR/Cas9 with dual guide RNAs

MicroRNAs (miRNAs) are short non-coding RNAs that play crucial roles in gene regulation, exerting post-transcriptional silencing, thereby influencing cellular function, development, and disease. Traditional loss-of-function methods for studying miRNA functions, such as miRNA inhibitors and sponges, present limitations in terms of specificity, transient effects, and off-target effects. Similarly, CRISPR/Cas9-based editing of miRNAs using single guide RNAs (sgRNAs) also has limitations in terms of design space for generating effective gRNAs. In this study, we introduce a novel approach that utilizes CRISPR/Cas9 with dual guide RNAs (dgRNAs) for the rapid and efficient generation of short deletions within miRNA genomic regions. Through the expression of dgRNAs through single-copy lentiviral integration, this approach achieves over a 90% downregulation of targeted miRNAs within a week. We conducted a comprehensive analysis of various parameters influencing efficient deletion formation. In addition, we employed doxycycline (Dox)-inducible expression of Cas9 from the AAVS1 locus, enabling homogeneous, temporal, and stage-specific editing during cellular differentiation. Compared to miRNA inhibitory methods, the dgRNA-based approach offers higher specificity, allowing for the deletion of individual miRNAs with similar seed sequences, without affecting other miRNAs. Due to the increased design space, the dgRNA-based approach provides greater flexibility in gRNA design compared to the sgRNA-based approach. We successfully applied this approach in two human cell lines, demonstrating its applicability for studying the mechanisms of human erythropoiesis and pluripotent stem cell (iPSC) biology and differentiation. Efficient deletion of miR-451 and miR-144 resulted in blockage of erythroid differentiation, and the deletion of miR-23a and miR-27a significantly affected iPSC survival. We have validated the highly efficient deletion of genomic regions by editing protein-coding genes, resulting in a significant impact on protein expression. This protocol has the potential to be extended to delete multiple miRNAs within miRNA clusters, allowing for future investigations into the cooperative effects of the cluster members on cellular functions. The protocol utilizing dgRNAs for miRNA deletion can be employed to generate efficient pooled libraries for high-throughput comprehensive analysis of miRNAs involved in different biological processes.

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

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.

Adolescent restraint stress enhances adult nicotine reinforcement in male and female rats

Adolescent stress is a risk factor for the initiation of nicotine use, but whether adolescent stress can enhance nicotine reinforcement when it is initiated later in adulthood is unknown, and it is unclear whether males and females are equally impacted. Therefore, this study assessed physiological responses (body weight and blood serum corticosterone - CORT) to restraint stress (RS) during adolescence (P28-55) or during adulthood (P70-96) in male and female Sprague-Dawley rats. When all subjects reached adulthood (P69 or 110; 2 weeks after termination of stress exposure), they were tested on sucrose preference and intravenous single-dose nicotine (0.03 mg/kg/infusion) self-administration. It was found that all rats displayed a significant CORT response to RS. Importantly, stress during adolescence, but not during adulthood, enhanced subsequent acquisition of nicotine intake tested in adulthood. Although this effect was observed in both sexes, only males displayed reduced body weight gain and adult sucrose preference. Moreover, regardless of stress exposure, females were more stimulated by nicotine, consumed more nicotine overall, and displayed enhanced nicotine seeking. These results suggest that adolescence is a period of heightened sensitivity to the enhancing effect of repeated stress on the susceptibility to develop nicotine dependence later in life in both sexes.

Acceptability of Hormonal Contraceptives as a Smoking Cessation Aid for Women of Reproductive Age: A Web-Based Cross-Sectional Survey

Introduction

Cigarette smoking is the most common cause of preventable cancers and other premature morbidity and mortality. Modifying hormonal patterns using hormonal contraceptives (HCs) may lead to improved smoking cessation outcomes in women, though the acceptability of this is unknown. Therefore, we explored the willingness of reproductive-age women who smoke to use HC for cessation.

Methods

A cross-sectional online survey was conducted with a convenience sample of reproductive-age women living in the United States who self-reported smoking combustible cigarettes. Questions covered smoking history, previous HC use, and willingness to use various HC methods (i.e., injectable, oral, patch, vaginal insert) for cessation. Chi-squared tests and logistic regression were conducted using StataBE 17.1.

Results

Of 358 eligible respondents, n = 312 (86.9%) reported previous HC use. Average age of those with HC use history was 32.1 ± 6.1 years compared with 27.8 ± 6.7 years for those without history of HC use (p = 0.001). Of respondents who reported previous HC use, 75.6% reported willingness to use HCs, compared with 60.9% of those without a history of HC use. Overall, willingness to use various types of HC ranged from 22.6% for the vaginal insert to 59.2% willing to use an oral contraceptive.

Discussion

These observations indicate that most women who smoke cigarettes are willing to use HC for a smoking cessation aid, especially if they have a history of HC use and with an oral form of HC. To improve the rate of smoking cessation for women of reproductive age, future interventions should explore how to incorporate HC for cessation.

Effects of Ovarian Hormone Levels on Stress, Cigarette Craving, and Smoking in a Laboratory Relapse Paradigm Among Females Who Smoke Daily

INTRODUCTION

Females, versus males, have shown a slower decline in smoking prevalence, greater smoking-related mortality and morbidity, and tend to have more difficulty achieving and maintaining abstinence. Identifying sex-specific risk factors is needed to improve outcomes. Though ovarian hormones have been evaluated for their role in smoking and relapse, measures tend to be static and infrequent, failing to capture the influence of increasing or decreasing levels.

AIMS AND METHODS

The present study evaluated the effect of static and fluctuating levels of ovarian hormones (ie, progesterone, estradiol, and estrogen to progesterone [E/P] ratio) on stress reactivity, cigarette craving, and smoking during a laboratory relapse paradigm. Female participants (assigned female at birth) reporting daily cigarette smoking (N = 91, ages 18-45) were recruited from the community. Participants provided daily salivary ovarian hormone levels leading up to a laboratory session, in which stress was induced and stress reactivity, cigarette craving, latency to smoke, and ad-libitum smoking were measured.

RESULTS

Static levels of estradiol were associated with stress reactivity (β = 0.28, SE = 0.13) and static E/P ratio was associated with smoking in the laboratory (HR = 1.4). Preceding 3-day changes in estradiol and E/P ratio, but neither static levels nor preceding 3-day changes in progesterone were associated with stress reactivity, cigarette craving, or smoking in a relapse paradigm.

CONCLUSIONS

Ovarian hormones are among several sex-specific factors involved in the complex neuroendocrine response to stress, and their interaction with other biological, social, and psychological factors in the real-world environment is not yet fully understood.

IMPLICATIONS

Findings of the present study provide novel information regarding the role of ovarian hormones among female participants who smoke daily in stress reactivity and smoking in the context of a laboratory relapse paradigm and highlight several avenues for future research. We found that same-day estradiol levels were associated with increased subjective stress reactivity and same-day estrogen to progesterone ratio was associated with increased likelihood of smoking in a relapse paradigm. Ovarian hormones are among several sex-specific factors contributing to the complex neuroendocrine response to stress, and their interaction with other biological, social, and psychological factors in the real-world environment is not yet fully understood.

Gender, smoking, and tobacco cessation with pharmacological treatment in a cluster randomized clinical trial

INTRODUCTION

Whether men find it easier to quit smoking than women is still controversial. Different studies have reported that the efficacy of pharmacological treatments could be different between men and women. This study conducted a secondary analysis of 'Subsidized pharmacological treatment for smoking cessation by the Spanish public health system' (FTFT-AP study) to evaluate the effectiveness of a drug-funded intervention for smoking cessation by gender.

METHODS

A pragmatic randomized clinical trial by clusters was used. The population included smokers aged ≥18 years, smoking >10 cigarettes per day, randomly assigned to an intervention group receiving regular practice and financed pharmacological treatment, or to a control group receiving only regular practice. The main outcome was continued abstinence at 12 months, self-reported and validated with CO-oximetry. The percentage, with 95% confidence intervals, of continued abstinence was compared between both groups at 12 months post-intervention, by gender and the pharmacological treatment used. Multilevel logistic regression analysis was performed.

RESULTS

A total of 1154 patients from 29 healthcare centers were included. The average age was 46 years (SD=11.78) and 51.7% were men. Overall, the self-reported abstinence at 12 months was 11.1% (62) in women and 15.7% (93) in men (AOR=1.4; 95% CI: 1.0-2.0), and abstinence validated by CO-oximetry was 4.6% (26) and 5.9% (35) in women and men, respectively (OR=1.3; 95% CI: 0.7-2.2). In the group of smokers receiving nicotine replacement treatment, self-reported abstinence was higher in men compared to women (29.5% vs 13.5%, OR=2.7; 95% CI: 1.3-5.8).

CONCLUSIONS

The effectiveness of a drug-financed intervention for smoking cessation was greater in men, who also showed better results in self-reported abstinence with nicotine replacement treatment.

Rising trends in the burden of cardiovascular comorbidities and major adverse cardiovascular events among young female smokers in two national cohorts studied ten years apart (2017 vs. 2007)

BACKGROUND

Ample evidence suggests that female smokers face a greater risk of smoking-related health problems than male smokers. Due to the growing number of young smokers in the United States, there has been limited information on the effects of smoking on young female smokers over the past decade.

METHODS

Hospitalizations of young (18-44 years) female tobacco smokers were identified using the National Inpatient Sample datasets from 2007 and 2017. We compared differences in admission frequency, comorbidity burden, in-hospital outcomes [all-cause mortality and major adverse cardiac events (MACE)], and resource utilization between two young cohorts separated by 10 years.

RESULTS

In 2007, there were 665,901 admissions among young female smokers (median age: 35), compared to 1,224,479 admissions (median age: 32) in 2017. In both cohorts, white female smokers accounted for most admissions, followed by blacks. In 2017, the prevalence of alcohol abuse, hyperlipidemia, uncomplicated diabetes, and chronic pulmonary disease decreased relative to the 2007 cohort, whereas the prevalence of deficiency and chronic blood loss anemias, diabetes with complications, drug abuse, hypertension, congestive heart failure, depression, liver disease, and obesity increased significantly (p<0.001). The 2017 cohort had significantly higher odds of all-cause mortality [aOR 1.25 (95%CI: 1.16-1.35)] and a higher risk of MACE [aOR 1.17 (95%CI:1.14-1.20)] upon multivariable adjustment. (p<0.001). Comparatively, the 2017 cohort had fewer routine discharges and higher home healthcare needs than the 2007 cohort.

CONCLUSIONS

In this decade-apart analysis, the study reveals rising trends in the burden of comorbidities, MACE, and healthcare resource utilization in admissions (regardless of the primary cause) among relatively younger female smokers. It is crucial to educate young female smokers about the detrimental effects of tobacco and polysubstance abuse on cardiovascular outcomes.

Cannabis cravings predict cigarette use in schizophrenia: a secondary analysis from two cannabis abstinence studies

CLINICAL TRIAL NAME

Effects of Repetitive Transcranial Magnetic Stimulation (rTMS) on Cannabis Use and Cognitive Outcomes in SchizophreniaURL: www.clinicaltrials.gov; Registration Number: NCT03189810.

Exercise and Smoking Cessation

Smoking is a public health crisis, leading to a multitude of health complications. Exercise is associated with numerous health benefits and is accepted by health professionals and smokers as a potentially effective smoking cessation aid. This chapter discusses the extant literature on the relation between exercise and smoking, including cross-sectional studies, experiments, and randomized clinical trials. There is robust evidence for exercise's efficacy in reducing cigarette craving, tobacco withdrawal symptoms, and negative affect. Further, exercise-based interventions appear to boost short-term abstinence yet may fall short of facilitating long-term abstinence. Methodological limitations of extant work are reviewed. We conclude with a discussion of the next steps in this line of work to fine-tune exercise interventions and their application for smoking cessation.

Factors Associated With Receipt of Tobacco Treatment Integrated With Nurse Navigation in a Centralized Lung Cancer Screening Program at an Urban Academic Medical Center

PURPOSE

Optimal approaches for tobacco treatment counseling among individuals who currently smoke and are undergoing shared decision-making (SDM) and lung cancer screening (LCS) are unknown. The objective of this cross-sectional study was to determine the rate of reported interest in tobacco treatment counseling and pharmacotherapy among individuals who currently smoke and are receiving integrated nurse navigation for LCS and tobacco treatment in a centralized LCS Program.

METHODS

We identified individuals undergoing SDM through our centralized LCS Program between March 2021 and March 2022. The LCS Program tobacco treatment protocol includes counseling both in-person and via telephone during SDM, LCS results review, and an optional 4-week follow-up. Sociodemographic and clinical data for currently smoking individuals participating in LCS were extracted from the LCS Registry.

RESULTS

Among 1034 individuals undergoing LCS through the centralized program, 605 were currently smoking and comprised the study cohort. Nearly half (49.8%) reported interest in tobacco treatment counseling and pharmacotherapy and received a personalized treatment plan. On multivariate analysis, factors significantly associated with expressing interest in treatment included African-American/Black race, higher educational attainment, and returning visit type. Among the 301 individuals expressing interest in tobacco treatment, 35 (11.6%) had documentation of self-reported smoking cessation in the electronic health record. Successful smoking cessation for any length of time was significantly associated with receiving at least one longitudinal tobacco cessation counseling telephone call.

CONCLUSIONS

In a centralized LCS Program offering tobacco treatment integrated with screening services, race, education, and visit type were significantly associated with expressing interest in tobacco treatment counseling and pharmacotherapy, while longitudinal tobacco counseling telephone calls were associated with smoking cessation. Randomized controlled trials are needed to test whether this integrated strategy leads to LCS- and tobacco-related outcomes.

Do Determinants of Smoking Cessation and Relapse Differ between Men and Women? Data from a French National Study

Introduction: There is limited understanding of different predictors of smoking cessation success (SCS) among women and men, despite well-documented differences in smoking behavior.Methods: Using data from DePICT (Description des Perceptions, Images, et Comportements liés au Tabagisme), a national survey of French adults which recruited 2377 regular and former smokers we investigated whether major determinants of SCS differed by sex. Factors associated with unsuccessful vs. No successful quit attempt; vs. SCS were studied using multivariate multinomial logistic regression analyses stratified by sex.Results: Women and men share some determinants of SCS including no cannabis use, living in a nonsmoker household and importance giving to being a nonsmoker. However, no e-cigarette use, low-to-moderate alcohol consumption, early smoking initiation, and higher education were associated with SCS only among women. No use of nicotine replacement, having family members who smoke, family opinion on smoking and current employment, were associated with SCS only among men. Neutral or negative friends' opinion on smoking or living with a smoker were associated with unsuccessful smoking attempts among men.Conclusions: Our results show differences between determinants of SCS according to sex, which highlights the importance of developing tailored interventions that account for sex/gender differences in smoking cessation.

Characterization of trajectories of physical activity and cigarette smoking from early adolescence to adulthood

BACKGROUND

Cigarette smoking and physical inactivity are two critical risk factors for noncommunicable diseases and all-cause mortality. However, few studies have compared the long-term trajectories of both behaviors, as well as multilevel factors associated with trajectory patterns. Using the National Longitudinal Study of Adolescent to Adult Health (Add Health) Wave I through V survey data, this study characterized distinct subgroups of the population sharing similar behavioral patterns from adolescence to adulthood, as well as predictors of subgroup membership for physical activity (PA) and cigarette smoking behavior respectively.

METHODS

Using the Add Health Wave I through V survey data, we identified the optimal number of latent classes and class-specific trajectories of PA and cigarette smoking from early adolescence to adulthood, fitting latent growth mixture models with standardized PA score and past 30-day cigarette smoking intensity as outcome measures and age as a continuous time variable. Associations of baseline sociodemographic factors, neighborhood characteristics, and sociopsychological factors with trajectory class membership were assessed using multinomial logistic regression.

RESULTS

We identified three distinct subgroups of non-linear PA trajectories in the study population: moderately active group (N = 1067, 5%), persistently inactive group (N = 14,257, 69%) and worsening activity group (N = 5410, 26%). Foror cigarette smoking, we identified three distinct non-linear trajectory subgroups: persistent non-smoker (N = 14,939, 72%), gradual quitter (N = 2357, 11%), and progressing smoker (N = 3393, 16%). Sex, race/ethnicity, neighborhood environment and perceived peer support during adolescence were significant predictors of both physical activity and cigarette smoking trajectory subgroup membership from early adolescence to adulthood.

CONCLUSIONS

There are three distinct subgroups of individuals sharing similar PA and cigarette smoking behavioral profile respectively from adolescence to adulthood in the Add Health study population. Behavioral interventions that focus on neighborhood environment (e.g. establish community-based activity center) and relationship to peers during adolescence (e.g. peer counseling) could be key to long-term PA promotion and cigarette smoking cessation.