Gender and smoking behavior in a worksite smoking cessation program

Developing a Dementia Platform Databank Using Multiple Existing Cohorts

This study was conducted as a pilot project to evaluate the feasibility of building an integrate dementia platform converging preexisting dementia cohorts from several variable levels. The following four cohorts were used to develop this pilot platform: 1) Clinical Research Center for Dementia of South Korea (CREDOS), 2) Korean Brain Aging Study for Early Diagnosis and Prediction of Alzheimer's disease (K-BASE), 3) Environmental Pollution-induced Neurological Effects (EPINEF) study, and 4) a prospective registry in Dementia Platform Korea project (DPKR). A total of 29916 patients were included in the platform with 348 integrated variables. Among participants, 13.9%, 31.5%, and 44.2% of patients had normal cognition, mild cognitive impairment, and dementia, respectively. The mean age was 72.4 years. Females accounted for 65.7% of all patients. Those with college or higher education and those without problems in reading or writing accounted for 12.3% and 46.8%, respectively. Marital status, cohabitation, family history of Parkinson's disease, smoking and drinking status, physical activity, sleep status, and nutrition status had rates of missing information of 50% or more. Although individual cohorts were of the same domain and of high quality, we found there were several barriers to integrating individual cohorts, including variability in study variables and measurements. Although many researchers are trying to combine pre-existing cohorts, the process of integrating past data has not been easy. Therefore, it is necessary to establish a protocol with considerations for data integration at the cohort establishment stage.

Trends in self-efficacy to quit and smoking urges among homeless smokers participating in a smoking cessation RCT

INTRODUCTION

In the U.S., approximately 73% of homeless adults smoke cigarettes and they experience difficulty quitting. Homeless smokers report low self-efficacy to quit and that smoking urges are a barrier to quitting. Self-efficacy to quit and smoking urges are dynamic and change throughout smoking cessation treatment. This study examines changes in self-efficacy to quit and smoking urges throughout a smoking cessation intervention among the homeless and identifies predictors of change in these characteristics.

METHODS

Homeless smokers (n=430) participating in a smoking cessation randomized controlled trial in the U.S. completed surveys at baseline, and weeks 1, 2, 4, 6, 8, and 26 on demographic and smoking characteristics (i.e., confidence to quit, self-efficacy to refrain from smoking, and smoking urges). A growth curve analysis was conducted by modeling change in the smoking characteristics over time and examining the variability in the change in smoking characteristics by demographic characteristics and treatment group.

RESULTS

Among the full sample, self-efficacy to refrain from smoking increased linearly over time, confidence to quit increased until the midpoint of treatment but subsequently decreased, and smoking urges decreased until the midpoint of treatment but subsequently increased. There were race differences in these trajectories. Racial minorities experienced significantly greater increases in self-efficacy to refrain from smoking than Whites and Blacks had higher confidence to quit than Whites.

CONCLUSIONS

White participants experienced less increase in self-efficacy to refrain from smoking and lower confidence to quit and therefore may be a good target for efforts to increase self-efficacy to quit as part of homeless-targeted smoking cessation interventions. Sustaining high confidence to quit and low smoking urges throughout treatment could be key to promoting higher cessation rates among the homeless.

Factors associated with study attrition in a pilot randomised controlled trial to explore the role of exercise-assisted reduction to stop (EARS) smoking in disadvantaged groups

Background

Study attrition has the potential to compromise a trial’s internal and external validity. The aim of the present study was to identify factors associated with participant attrition in a pilot trial of the effectiveness of a novel behavioural support intervention focused on increasing physical activity to reduce smoking, to inform the methods to reduce attrition in a definitive trial.

Methods

Disadvantaged smokers who wanted to reduce but not quit were randomised (N = 99), of whom 61 (62 %) completed follow-up assessments at 16 weeks. Univariable logistic regression was conducted to determine the effects of intervention arm, method of recruitment, and participant characteristics (sociodemographic factors, and lifestyle, behavioural and attitudinal characteristics) on attrition, followed by multivariable logistic regression on those factors found to be related to attrition.

Results

Participants with low confidence to quit, and who were undertaking less than 150 mins of moderate and vigorous physical activity per week at baseline were less likely to complete the 16-week follow-up assessment. Exploratory analysis revealed that those who were lost to follow-up early in the trial (i.e., by 4 weeks), compared with those completing the study, were younger, had smoked for fewer years and had lower confidence to quit in the next 6 months. Participants who recorded a higher expired air carbon monoxide reading at baseline were more likely to drop out late in the study, as were those recruited via follow-up telephone calls. Multivariable analyses showed that only completing less than 150 mins of physical activity retained any confidence in predicting attrition in the presence of other variables.

Conclusions

The findings indicate that those who take more effort to be recruited, are younger, are heavier smokers, have less confidence to quit, and are less physically active are more likely to withdraw or be lost to follow-up.

Perceptions of Lung Cancer and Smoking Among College Students in Jordan

A descriptive, cross-sectional design was adopted to identify college students’ knowledge and perceptions of lung cancer and smoking. A random sample of 400 students at the Jordan University of Science and Technology in northern Jordan was subjected to the Lung Cancer and Smoking Survey, which is based on the Health Belief Model. The results show that the prevalence of current smoking is 16.5% and that the prevalence of former smoking is 10.0%. Most (75.3%) of the respondents were aware of the prevalence of lung cancer. Almost all (90.3%) were aware of the cancer risk from air pollution, but fewer (57.5%) were concerned about the risk caused by side-stream smoke. Most disagreed that lung cancer could be easily cured. Former smokers were more knowledgeable than current smokers about the health hazards of smoking, and those who never smoked were more knowledgeable than both. Engineering students were more likely to agree with the benefits of quitting smoking than were medical or science students. Addiction and friends were the reasons most frequently given for not quitting smoking.

Current sources of lead exposure and their relative contributions to the blood lead levels in the general adult population of Northern France: The IMEPOGE Study, 2008-2010

There is justification for limiting lead (Pb) exposure as much as possible, given its impact on health at low concentrations. Consequently, the aim of this study was to measure blood lead levels (BLL) and examine exposure factors related to BLL variations in the general adult population of northern France, a current and past industrial area. Two thousand inhabitants of northern France, aged between 20 and 59 years, were recruited using the quota method with caution. Blood lead levels were quantified by inductively coupled plasma-mass spectroscopy (ICP-MS), and variation factors were studied separately in men and women using multivariate stepwise linear and logistic regression models. The geometric mean of the BLL was 18.8 μg/L (95% confidence interval [CI]: 18.3-19.3). Occupational factors affected BLL only in men and represented 14% of total explained variance of BLL. External occupational factors significantly increasing mean levels of BLL were tobacco, consumption of some beverages (wine, coffee, tea, and/or tap water), raw vegetables, housing characteristics (built prior to 1948, Pb piping in the home) and do-it-yourself or leisure activities (paint stripping or rifle shooting). Consumption habits accounted together for 25% and 18% of the total explained variance, respectively, in men and women. Industrial environment did not significantly contribute to BLL variations. Blood lead levels observed in the general population of this industrial part of France did not appear to be excessively elevated compared to values found internationally. Nonetheless, these BLL remain a public health issue in regard to nonthreshold toxicity attributed to Pb.

An Exploratory Analysis of the Smoking and Physical Activity Outcomes From a Pilot Randomized Controlled Trial of an Exercise Assisted Reduction to Stop Smoking Intervention in Disadvantaged Groups

INTRODUCTION

Economically disadvantaged smokers not intending to stop may benefit from interventions aimed at reducing their smoking. This study assessed the effects of a behavioral intervention promoting an increase in physical activity versus usual care in a pilot randomized controlled trial.

METHODS

Disadvantaged smokers who wanted to reduce but not quit were randomized to either a counseling intervention of up to 12 weeks to support smoking reduction and increased physical activity (n = 49) or usual care (n = 50). Data at 16 weeks were collected for various smoking and physical activity outcomes. Primary analyses consisted of an intention to treat analysis based on complete case data. Secondary analyses explored the impact of handling missing data.

RESULTS

Compared with controls, intervention smokers were more likely to initiate a quit attempt (36 vs. 10%; odds ratio 5.05, [95% CI: 1.10; 23.15]), and a greater proportion achieved at least 50% reduction in cigarettes smoked (63 vs. 32%; 4.21 [1.32; 13.39]). Postquit abstinence measured by exhaled carbon monoxide at 4-week follow-up showed promising differences between groups (23% vs. 6%; 4.91 [0.80; 30.24]). No benefit of intervention on physical activity was found. Secondary analyses suggested that the standard missing data assumption of "missing" being equivalent to "smoking" may be conservative resulting in a reduced intervention effect.

CONCLUSIONS

A smoking reduction intervention for economically disadvantaged smokers which involved personal support to increase physical activity appears to be more effective than usual care in achieving reduction and may promote cessation. The effect does not appear to be influenced by an increase in physical activity.

Expectancies for the effectiveness of different tobacco interventions account for racial and gender differences in motivation to quit and abstinence self-efficacy

INTRODUCTION

Racial and gender disparities for smoking cessation might be accounted for by differences in expectancies for tobacco interventions, but few studies have investigated such differences or their relationships with motivation to quit and abstinence self-efficacy.

METHODS

In this cross-sectional study, 673 smokers (African American: n = 443, 65.8%; women: n = 222, 33.0%) under criminal justice supervision who enrolled in a clinical smoking cessation trial in which all received bupropion and half received counseling. All participants completed pretreatment measures of expectancies for different tobacco interventions, motivation to quit, and abstinence self-efficacy. The indirect effects of race and gender on motivation to quit and abstinence self-efficacy through expectancies for different tobacco interventions were evaluated.

RESULTS

African Americans' stronger expectancies that behavioral interventions would be effective accounted for their greater motivation to quit and abstinence self-efficacy. Women's stronger expectancies for the effectiveness of pharmacotherapy accounted for their greater motivation to quit, whereas their stronger expectancies for the effectiveness of behavioral treatments accounted for their greater abstinence self-efficacy.

CONCLUSIONS

Findings point to the mediating role of expectancies for treatment effectiveness and suggest the importance of exploring expectancies among African Americans and women as a way to augment motivation and self-efficacy.

[Prevalence of tobacco use and associated factors among women in Paraná State, Brazil]

This study aimed to estimate the prevalence of tobacco use and to describe the demographic profile of female smokers in Paraná State, Brazil. The study used a cross-sectional population-based design with cluster sampling (n = 2,153) of women 18 years or older in seven cities. Prevalence of smoking was 13.4%, ranging from 10% in Cascavel to 19% in Irati. According to multivariate analysis, city of residence, marital status, and schooling were significantly associated with tobacco use. Women in Irati (OR = 2.08; 95%CI: 1.22-3.54) were more likely to smoke than those in Cambé. Married women and widows were less likely to smoke (OR = 0.47; 95%CI: 0.30-0.73 and OR = 0.43; 95%CI: 0.22-0.87) than single women. Women living with a partner (but not married) were more likely to smoke than single women (OR = 2.49; 95%CI: 1.12-5.53), and women with university degrees were less likely to smoke than those with eight years of school or less (OR = 0.41; 95%CI: 0.22-0.87). The results confirm the need for tobacco control programs that take gender and regional differences into account.

Missing data assumptions and methods in a smoking cessation study

AIM

A sizable percentage of subjects do not respond to follow-up attempts in smoking cessation studies. The usual procedure in the smoking cessation literature is to assume that non-respondents have resumed smoking. This study used data from a study with a high follow-up rate to assess the degree of bias that may be caused by different methods of imputing missing data.

DESIGN AND METHODS

Based on a large data set with very little missing follow-up information at 12 months, a simulation study was undertaken to compare and contrast missing data imputation methods (assuming smoking, propensity score matching and optimal matching) under various assumptions as to how the missing data arose (randomly generated missing values, increased non-response from smokers and a hybrid of the two).

FINDINGS

Missing data imputation methods all resulted in some degree of bias which increased with the amount of missing data.

CONCLUSION

None of the missing data imputation methods currently available can compensate for bias when there are substantial amounts of missing data.

Relationship between smoking and dyslipidemia in western Chinese elderly males

The relationship between smoking and dyslipidemia was studied in 2,160 elderly Chinese males. Levels of triglycerides (TGs) in current smokers were shown to be significantly higher and levels of high-density lipoprotein cholesterol (HDL-C) lower than for those who had never smoked or had stopped smoking. Interestingly, the level of apoprotein B (apoB) was more frequently abnormal in very heavy smokers compared with light smokers, while low-density lipoprotein cholesterol (LDL-C) levels were more frequently normal in very heavy smokers. When comparing other factors that influence blood lipids, such as alcohol intake, body mass index (BMI), and age, smoking had the greatest influence and was shown to be an independent risk factor for dyslipidemia.

The R219K polymorphism in the ATP-binding cassette transporter 1 gene has a protective effect on atherothrombotic cerebral infarction in Chinese Han ethnic population

The association of R219K and V825I polymorphisms of ABCA1 gene with cerebral infarction has been rarely reported. Here we wish to address this issue. A total of 476 subjects from Chinese Han ethnic population were investigated, including 152 control individuals and 324 patients with cerebral infarction. Genotyping of R219K and V825I were performed by PCR-RFLP analysis. Data were analyzed using a statistical package. The R219K genotype frequency distributions were significantly different between patients with atherothrombotic cerebral infarction (ACI) and control individuals, with fewer KK genotypes and more RR genotypes in ACI patients (chi(2)=9.89, P<0.01). The K allele is less frequent among ACI patients than in controls (chi(2)=9.16, P<0.005). A significant association of KK with decreased ACI risk was exhibited, especially in male patients, aged patients and individuals with hypertension. These results indicate that the K allele of R219K polymorphism is an independent protective factor against ACI. In addition, though there is no association of V825I with ACI, this polymorphism may have certain synergistic effect with hypertension in susceptibility to ACI.

Sociocultural factors associated with cigarette smoking among women in Brazilian worksites: a qualitative study

This study examined the contextual factors associated with smoking initiation and cessation among women in Brazilian worksites (Curitiba, Paraná, Brazil). A total of 22 focus groups were conducted among 108 women in private and public worksites. The most frequently endorsed negative factors that contributed to smoking initiation included exposure to smoking-prompting behaviors through family members, peer pressure, media and easy access/low cost of cigarettes. Positive factors that served as protective mechanisms against initiation included smoking-related health effects and strong influence from parents and family members. The most salient negative factors associated with smoking cessation included stress/anxiety-relieving benefits, weight control, access/low cost of cigarettes, being around smokers and risk-exempting beliefs. Positive factors included smoking restrictions at home and workplace and concerns about appearance. Current and former smokers reported that they had never received any assistance from their physicians to quit smoking, nor did they rely on smoking cessation programs or aids or believe in their effectiveness. There are specific contextual factors that contribute to smoking initiation/cessation among women in Brazilian worksites which have important clinical, research and policy implications.

Examining smoking and cessation during pregnancy among an Appalachian sample: a preliminary view

BACKGROUND

Several transitions that a woman experiences prenatally may influence her desire or ability to discontinue smoking. This study explores the role of smoking for young, Appalachian, nulliparous pregnant women and their plans for smoking during their pregnancies.

RESULTS

The reports of women and their male partners were taken from baseline interviews conducted during the first trimester of pregnancy. Cigarette smoking appeared to be more than an isolated addictive activity; rather, smoking was interwoven in women's social and personal realms, often changing as their perceptions of self changed. Women and their partners who continued to smoke appeared to be depressed, reject authority, and perceived little control over issues related to being pregnant.

CONCLUSION

These findings support the argument that standard substance use treatments and polices based on stages-of-change theories may not be effective for all individuals particularly those experiencing significant developmental changes in their lives. Greater success might be obtained from treatment programs designed to recognize the impact of these transitions as it relates to the substance use. The changing experiences of pregnant women in terms of their identity development, views of others, and their relationships have not been adequately addressed in existing cessation programs. Empirically-based interventions targeting these lifestyle characteristics may lead to increased cessation success among pregnant women.

Racial and ethnic differences in predictors of smoking cessation

Racial/ethnic differences in the determinants of smoking cessation could have important treatment implications. The current study examined racial/ethnic differences in smoking cessation, prospective predictors of cessation, and whether the predictive ability of these factors differed by race/ethnicity. Participants were 709 employed adults recruited through the National Rural Electric Co-op Association or through natural gas pipeline corporations. Data were collected in 1990 and 1994. Although race/ethnicity was not predictive of abstinence, Hispanic, African American, and White smokers displayed differential on tobacco-, alcohol-, and work-related variables. These racial/ethnic differences highlight the specific factors that should be considered when providing smoking cessation treatment to specific populations. Limitations are noted.

Naltrexone augments the effects of nicotine replacement therapy in female smokers

BACKGROUND

There is increased recognition that gender differences may influence outcomes and may modify vulnerability to tobacco addiction, severity of course and response to different treatments. We hypothesized that naltrexone, which has been used to successfully treat opioid and alcohol dependence, when combined with nicotine replacement therapy (NRT) and psychosocial therapy (PT) may enhance smoking cessation rates in women.

METHODS

Forty-four adult female smokers meeting DSM-IV criteria for nicotine dependence with expired carbon monoxide content of > or = 15 ppm were randomly assigned in a double blind placebo controlled clinical trial of naltrexone 50 mg + NRT patch + psychosocial therapy (N + NRT + PT)(N = 12) or placebo + NRT patch + psychosocial therapy (P + N + PT)(N=12) for 12 weeks.

RESULTS

Twelve weeks of treatment was completed by 54.5%. Smoking cessation among females who completed the 12 weeks for N + NRT + PT was 91.7% (11/12) and for P + NRT + PT was 50% (6/12).

CONCLUSION

Naltrexone combined with NRT and psychosocial therapy appears to have a positive cessation effect on women and may be a new treatment option for recidivist female smokers.

An Exploratory Study of Multicomponent Treatment Intervention for Tobacco Dependency

PURPOSE

To conduct an exploratory study of two interventions to help smokers abstain over a period of 3 months. The specific aims were to describe the outcomes, test feasibility of the study design, and evaluate effect size.

DESIGN AND METHODS

A randomized experimental design was used in a sample of 42 patients who received multicomponent treatment intervention (MTI) or standard care (SC) in a midwestern city in the United States. Variables were behavioral (quit rate, self-efficacy, motivation), psychosocial (depression, partner interaction), and symptom management (use of nicotine replacement therapy [NRT]). Data analysis included descriptive statistics and repeated measures ANOVA.

RESULTS

The typical participant was Caucasian, middle aged, nicotine dependent, married or partnered, and employed, and had a high school education. Participants in the MTI group were more likely to use NRT and to have higher self-reported quit rates at follow-up. Statistically significant differences were found between groups over time for self-efficacy and positive to negative behavior ratio. Barriers to quitting were relapse, stress, weight gain, lack of support, and depression that were more frequent in the SC group. For effect size (0.25), probability level (.05), and power (.80), a sample size of 140 patients was calculated.

CONCLUSIONS

The MTI group had higher quit rates, more NRT, higher self-efficacy, and more positive behavioral interactions. Limitations of the study included self-report of tobacco use, small sample, and attrition. The investigators suggest a future study with a larger sample to test whether multicomponent interventions with telephone calls after discharge are more effective than is standard care in helping patients to quit and continue to abstain from smoking.

A 2-year follow-up study of cigarette smoking and risk of dementia

The report focused on investigating the relationship between cigarette smoking and dementia in elderly people through prospective studies. We did a 2-year follow-up study of elderly people. A total of 2820 participants aged 60 years old and over from six communities of Chongqing agreed to take part. Dementia was diagnosed with MMSE (Mini-Mental State Examination) and DSM-III-R (Diagnostic and Statistical Manual of Mental Disorders). Participants were classified as never smokers, past smokers, and current smokers. During follow-up, we recorded incident cases of dementia. The association of smoking and dementia was investigated using proportional hazards regression analysis. A total of 121 incident cases of dementia were detected, of which 84 (69%) were Alzheimer's disease, 17 (14%) were vascular dementia, and 21(17%) were other dementia. Compared with never smokers, current smokers had an increased risk of Alzheimer's disease (RR = 2.72; 95% CI = 1.63-5.42) and vascular dementia (RR = 1.98; 95% CI = 1.53-3.12) adjusting for age, sex, education, blood pressure, and alcohol intake. Compared with light smokers, the adjusted risk of Alzheimer's disease was significantly increased among smokers with a medium level of exposure (RR = 2.56; 95% CI = 1.65-5.52), with an even higher risk of Alzheimer's disease in the heavy smoking group (RR = 3.03; 95% CI = 1.25-4.02). Smoking was associated with the risk of dementia. This study suggests that both smoking status and amount is associated with dementia.

Relationships among smoking status, ethnicity, socioeconomic indicators, and lifestyle variables in a biracial sample of women

BACKGROUND

Smoking prevalence rates remain high among women and smoking initiation has increased for young adults. Little is known about the unique patterns of smoking, risk factors, and correlates of quitting in Black versus White women of child-bearing age.

METHOD

This study examined the relationships among smoking, ethnicity, socioeconomic status (SES), and lifestyle variables among 715 women (43.6% Blacks and 56.4% Whites). Stringent inclusion criteria were used for ethnicity, which allows for distinct comparisons but may reduce generalizability of results.

RESULTS

Black current smokers smoked fewer cigarettes per day and reported initiating smoking at a later age than Whites. Current versus never smoking was associated with income, education, and caffeine intake. There was a significant ethnicity by alcohol interaction (at lower levels of alcohol intake Whites were more likely to smoke but at higher levels of alcohol there were no ethnic differences). Former smoking versus current smoking was associated with alcohol intake, education, and pack years of smoking.

CONCLUSIONS

The results of the study suggest several ethnic differences in smoking patterns as well as several correlates of smoking status. These results have implications for the tailoring of interventions and illustrate the association of other health risk factors with smoking status.