Symptoms of cough and shortness of breath among occasional young adult smokers

Associations of Combustible Cigarette, Electronic Cigarette, and Dual Use With COVID Infection and Severity in the U.S.: A Cross-sectional Analysis of the 2021 National Health Information Survey

Given the potential respiratory health risks, the association of COVID infection and the use of combustible cigarettes, electronic nicotine delivery systems (ENDS), and concurrent dual use is a priority for public health. Many published reports have not accounted for known covarying factors. This study sought to calculate adjusted odds ratios for self-reported COVID infection and disease severity as a function of smoking and ENDS use, while accounting for factors known to influence COVID infection and disease severity (i.e., age, sex, race and ethnicity, socioeconomic status and educational attainment, rural or urban environment, self-reported diabetes, COPD, coronary heart disease, and obesity status). Data from the 2021 U.S. National Health Interview Survey, a cross-sectional questionnaire design, were used to calculate both unadjusted and adjusted odds ratios for self-reported COVID infection and severity of symptoms. Results indicate that combustible cigarette use is associated with a lower likelihood of self-reported COVID infection relative to non-use of tobacco products (AOR = .64; 95% CI [.55, .74]), whereas ENDS use is associated with a higher likelihood of self-reported COVID infection (AOR = 1.30; 95% CI [1.04, 1.63]). There was no significant difference in COVID infection among dual users (ENDS and combustible use) when compared with non-users. Adjusting for covarying factors did not substantially change the results. There were no significant differences in COVID disease severity between those of varying smoking status. Future research should examine the relationship between smoking status and COVID infection and disease severity utilizing longitudinal study designs and non-self-report measures of smoking status (e.g., the biomarker cotinine), COVID infection (e.g., positive tests), and disease severity (e.g., hospitalizations, ventilator assistance, mortality, and ongoing symptoms of long COVID).

Presence of physical symptoms in healthy adolescence found to be associated with female gender, obesity, tachycardia, diastolic hypertension and smoking

BACKGROUND

The goal of this study was to evaluate any association between physical symptoms and abnormal clinical history in adolescence undergoing screening echocardiography performed by Anthony Bates Foundation.

METHOD

The Anthony Bates Foundation has been performing screening echocardiography across the United States for the prevention of sudden death since 2001. We performed uni- and multivariate analysis to evaluate any association between physical symptoms with gender, smoking, obesity, heart rate, and hypertension.

RESULTS

We found a strong association between symptoms and the female gender (33% vs. 17.5% of males, P < 0.001). Furthermore, obesity (46.5% vs. 22.5%, P < 0.001), smoking (46.2% vs. 22.5%, P = 0.04), heart rate > 90 (34.8 vs. 22.8%, P = 0.001), and diastolic blood pressure > 90 (34.9% vs. 23.4%, P = 0.03) were all associated with symptoms. Increased systolic pressure was not associated with physical symptoms (24.3% vs. 21.9%, P = 0.4). Using multivariate analysis, female gender, diastolic blood pressure and obesity remained independently associated with physical symptoms. (Female gender: OR: 2.2, CI: 1.7-2.9, P < 0.001, obesity: OR: 2.5, CI 1.2-5.05, P = 0.009, and high diastolic blood pressure: OR: 2.08, CI 1.1-3.7, P = 0.01).

CONCLUSION

Physical symptoms are associated with smoking, female gender, obesity, tachycardia, and high diastolic blood pressure but not systolic pressure in adolescence undergoing routine screening echocardiography.

Secondhand nicotine vaping at home and respiratory symptoms in young adults

RATIONALE

Despite high prevalence of e-cigarette use (vaping), little is currently known regarding the health effects of secondhand nicotine vape exposure.

OBJECTIVE

To investigate whether exposure to secondhand nicotine vape exposure is associated with adverse respiratory health symptoms among young adults.

METHOD

We investigated the effect of secondhand nicotine vape exposure on annually reported wheeze, bronchitic symptoms and shortness of breath in the prospective Southern California Children Health Study cohort. Data were collected from study participants (n=2097) with repeated annual surveys from 2014 (average age: 17.3 years) to 2019 (average age: 21.9). We used mixed effect logistic regression to evaluate the association between secondhand nicotine vape and respiratory symptoms after controlling for relevant confounders.

RESULTS

Prevalence of secondhand nicotine vape increased from 11.7% to 15.6% during the study period in this population. Prevalence of wheeze, bronchitic symptoms and shortness of breath ranged from 12.3% to 14.9%, 19.4% to 26.0% and 16.5% to 18.1%, respectively, during the study period. Associations of secondhand nicotine vape exposure with bronchitic symptoms (OR 1.40, 95% CI 1.06 to 1.84) and shortness of breath (OR 1.53, 95% CI 1.06 to 2.21) were observed after controlling for vaping, active and passive exposure to tobacco or cannabis, and demographic characteristics (age, gender, race/ethnicity and parental education). Stronger associations were observed when analysis was restricted to participants who were neither smokers nor vapers. There were no associations with wheezing after adjustment for confounders.

CONCLUSION

Secondhand nicotine vape exposure was associated with increased risk of bronchitic symptoms and shortness of breath among young adults.

Association between electronic cigarette use in children and adolescents and coughing a systematic review

BACKGROUND

The use of electronic cigarettes (e-cigarettes) among adolescents is increasing worldwide. E-cigarettes are marketed as a safe alternative to other tobacco products. The aim of this systematic review is to evaluate whether e-cigarette use in children and adolescents is associated with coughing.

METHOD

Studies were identified through systematic searches of Excerpta Medica Database, Medline, Cumulative Index to Nursing and Allied Health Literature, British Nursing Index, OVID Emcare, Health Management Information Consortium, PsycINFO, and Allied and Complementary Medicine. The Grey Literature was also searched. Selected studies either contained only children and adolescents as study participants or if adults were included, the data for adolescents and children must be presented separately.

RESULTS

Seven studies were selected from 104. Three studies compared e-cigarette users with nonusers; two studies found a significant association between coughing and e-cigarette use in adolescence. Two studies investigated whether adolescents attributed their symptoms to their e-cigarette use. One study reported that coughing was the most likely negative symptom reported by adolescents on initiation of e-cigarette use; the other study found that adolescents, on initiation of e-cigarette use, reported coughing. Two studies looked at the cases of children and adolescents who had presented to the hospital after e-cigarette use and found coughing was a common presenting symptom.

CONCLUSION

This systematic review shows that adolescent use of e-cigarettes is associated with increased coughing and e-cigarette users are more likely to report coughing compared to non-users.

Cigarette Consumption Patterns of Non-Smokers, Occasional Smokers, and Daily Smokers in Selected ASEAN Countries

Background:

This study investigates the socio-demographic factors associated with smoking status in five Southeast Asian countries: Malaysia, Thailand, Indonesia, Vietnam, and Philippines.

Methods:

This cross-sectional study utilizes data of adults ≥15 years who completed the Global Adult Tobacco Surveys. Ordered probit analysis is used to account for the smoking statuses of non-smokers, occasional smokers, and daily smokers.

Results:

Malaysian and Vietnamese households with more family members face lower smoking likelihoods than otherwise. Urbanites in Philippines and rural residents in Thailand and Indonesia are more likely to smoke on occasional and daily basis than others. Males are consistently more likely to smoke occasionally or daily and less likely to be non-smokers than females across all countries. Younger middle-age (retiree) individuals aged 30-35 (≥60) years in Malaysia and Thailand exhibit higher (lower) likelihoods to smoke occasionally or daily than their younger cohorts aged 15-29 years. Individuals aged 30 years and above in Indonesia, Vietnam, and Philippines display higher daily smoking propensities than others. Higher education levels dampens smoking likelihoods and increases non-smoking propensities in all countries. Non-government or self-employed workers in all countries are more likely to smoke occasionally or daily than unemployed persons. Being married is associated with higher non-smoking likelihoods in Thailand although this association is not evident in Malaysia.

Conclusion:

These findings suggest that a portfolio of targeted interventions is necessary to meet the needs of specific subpopulations within the various countries.

Smoking increases the risk of infectious diseases: A narrative review

Smoking is relevant to infectious diseases resulting in increased prevalence and mortality. In this article, we aim to provide an overview of the effects of smoking in various infections and to explain the potential mechanisms. We searched PubMed and other relevant databases for scientific studies that explored the relationship between smoking and infection. The mechanisms of susceptibility to infection in smokers may include alteration of the structural, functional and immunologic host defences. Smoking is one of the main risk factors for infections in the respiratory tract, digestive tract, reproductive tract, and other systems in humans, increasing the prevalence of HIV, tuberculosis, SARS-CoV, and the current SARS-CoV-2. Smoking cessation can reduce the risk of infection. Smoking increases the incidence of infections and aggravates the progress and prognosis of infectious diseases in a dose-dependent manner. Smoking cessation promotion and education are the most practical and economical preventive measures to reduce aggravation of disease infection owing to tobacco use.

Negative health symptoms reported by youth e-cigarette users: Results from a national survey of US youth

BACKGROUND

E-cigarettes are the most prevalent tobacco product among US youth, but little is known about the health symptoms users experience.

METHODS

Between August 2016 and May 2017, we conducted a nationally representative cross-sectional telephone survey of 975 US youth ages 13-17. Respondents who reported ever trying e-cigarettes were asked whether they ever experienced six physical health symptoms they thought were caused by e-cigarette use. We examined whether symptoms varied by demographics and tobacco use.

RESULTS

Approximately 12.4% of respondents (n = 141) reported ever trying e-cigarettes. Of lifetime e-cigarette users, 37.0% reported past 30-day e-cigarette use, 17.2% reported past 30-day cigarette use, and 23.7% reported past 30-day use of another tobacco product. Most (63.3%) reported a symptom, most often cough (42.3%), followed by dizziness or lightheadedness (31.5%), headache or migraine (25.4%), dry or irritated mouth or throat (14.9%), shortness of breath (13.7%), change in or loss of taste (3.5%), and other (5.7%; nausea, dry eyes, earache, and tight chest). Headaches were more common among past 30-day e-cigarette users than non-users (43.8% vs. 14.6%). Shortness of breath was more common among past 30-day cigarette (33.8% vs. 9.5%) and other tobacco users (31.6% vs. 8.2%). Past 30-day cigarette users were also more likely to report any symptom (86.0% vs. 58.6%).

CONCLUSIONS

Most youth e-cigarette users attribute health symptoms to their e-cigarette use. Past 30-day users were more likely to report certain symptoms than non-users. Findings can educate health practitioners and school nurses about common symptoms youth may experience and inform prevention messages.

Smoking, health and academic outcomes: evidence from a limited smoking campus policy

Although there is substantial literature on the impact of smoking laws, the number of studies that investigate the impact of such policies on college campuses is sparse. Using a rich data set from various waves of the American College Health Association National College Health Assessment survey for a mid-sized public university in the southern United States, we investigate a possible causal link between a limited smoking policy and smoking behaviours, health and academic outcomes among college students. We employ propensity score matching methods to control for endogeneity of unobservable characteristics. Our results show a significant reduction in the propensity to smoke cigarettes and cigars following the introduction of the policy. Further, we find that the policy has increased academic outcomes; however, it has no significant effect on student health. These findings have important policy implications for schools that are considering instituting comprehensive smoking bans on college.

Reasons for Marijuana and Tobacco Co-use Among Young Adults: A Mixed Methods Scale Development Study

BACKGROUND

Marijuana-tobacco co-use has increased recently, particularly in young adults.

OBJECTIVES

We conducted a mixed-methods study to: (1) examine reasons for co-use; and (2) develop a scale assessing reasons for co-use among participants in a longitudinal cohort study of 3,418 students aged 18-25 from 7 Georgia colleges and universities.

METHODS

Phone-based semi-structured interviews were conducted in Summer 2015 among 46 current (past 30-day, n = 26) or lifetime (n = 20) marijuana users. Subsequently, scale items were developed and included at Wave 3. Participants reporting past 4-month tobacco and marijuana use (n = 328) completed the Reasons for Marijuana-Tobacco Co-use section.

RESULTS

Per qualitative data, reasons for marijuana-tobacco co-use included synergistic effects, one triggering or preceding the other's use, using one to reduce the other's use, co-administration, social context, and experimentation. The survey subsample included 37.1% who used cigarettes, 30.4% LCCs, 9.4% smokeless, 23.7% e-cigarettes, and 30.4% hookah. Four subscale factors emerged: (1) Instrumentality, indicating synergistic effects; (2) Displacement, indicating using one product to reduce/quit the other; (3) Social context, indicating use in different settings/social situations; and (4) Experimentation, indicating experimentation with both but no specific reasons for co-use. These subscales demonstrated distinct associations with tobacco type used; nicotine dependence; marijuana and alcohol use frequency; tobacco and marijuana use motives, respectively; perceptions of tobacco and marijuana; and parental and friend use. Including these subscales in regressions predicting nicotine dependence and days of marijuana use significantly contributed to each model.

CONCLUSIONS

These findings might inform theoretical frameworks upon which marijuana-tobacco co-use occurs and direct future intervention studies.

The Effects of Nicotine and Nicotine Abstinence on Stress-Induced Cardiovascular Reactivity

Abstract. The effects of 12 hr nicotine administration and abstinence on stress-induced cardiovascular reactivity were assessed within Light/Intermittent cigarette smokers and Habitual cigarette smokers. One hundred thirty-two male smokers (66 Habitual, 66 Light/Intermittent) were assigned to a Nicotine (21 mg) or Placebo patch condition. Cardiovascular reactivity was assessed during Baseline, a 6-min mental arithmetic task (Paced Auditory Serial Arithmetic Task) and a 5-min mirror-tracing task (Star Mirror Tracing Task). Within the Nicotine condition, Light/Intermittent smokers showed greater cardiac output (CO) increases, smaller stroke volume decreases, and smaller total peripheral resistance (TPR) increases than Light/Intermittent smokers in the Placebo condition. No condition differences in cardiovascular reactivity were demonstrated for Habitual smokers. Light/Intermittent smokers also showed greater CO increases than Habitual smokers during the mirror-tracing task but during the Nicotine condition only. During mental arithmetic, Light/Intermittent smokers had greater CO increases and smaller TPR increases than Habitual smokers across nicotine conditions. Habitual smokers responded to stress with increases in peripheral responses whereas Light/Intermittent smokers responded myocardially. Light/Intermittent smokers may have increased density of β-adrenergic receptors whereas Habitual smokers may have decreased density due to chronic smoking.

Psychographic characteristics, tobacco, and alcohol use in a sample of young adults on the U.S./México border

Few studies using psychographic segmentation have been conducted; even fewer in minority samples. Study aims were to identify psychographic clusters and their relation to tobacco and alcohol use within a predominantly Hispanic (87%) young adult (ages 18-25) sample. Participants (N=754; 72.5% female; Mage=20.7 [2.2]) completed the following measures online: sociodemographics, tobacco use history, the Daily Drinking Questionnaire (Collins, Parks, & Marlatt, 1985), a social activities scale, a psychographic survey, a music preference item, the Brief Sensation Seeking Scale (Hoyle, Stephenson, Palmgreen, Lorch, & Donohew, 2002), and the Mini-International Personality Item Pool (Donnellan, Oswald, Baird, & Lucas, 2006). Two step cluster analysis identified two groups. 'Popular Extroverts' (49.3% of sample) reported higher: extroversion scores F(1, 652)=40.03, sensation seeking scores F(1, 652)=20.38, alcohol use (greater number of drinks per week [F(1, 652)=9.69]; and past month binge drinking [χ² (1)=12.80]), and lifetime tobacco use (χ² [1]=10.61) (all ps≤0.002). 'Mainstream/Conventionals' (50.7% of sample) reported greater intentions to smoke in the next month F(1, 284)=11.81, p=0.001. 'Popular Extroverts' may benefit from prevention/cessation messaging promoting peer support and intensity-oriented activities. For 'Mainstream/Conventionals,' messaging communicating negative attitudes toward smoking and the tobacco industry may be effective. Future directions include testing targeted messages which may be incorporated into mass media tobacco and alcohol interventions for young adults on the U.S./México border.

Review of hookah tobacco smoking among college students: policy implications and research recommendations

BACKGROUND

About 30% of college students have smoked hookah tobacco. Although most students perceive this product to be innocuous and non-addictive, hookah tobacco increases the risk for disease and nicotine dependence. Currently, the US Food and Drug Administration (FDA) does not regulate the manufacture, distribution, or sale of hookah tobacco.

OBJECTIVE

Empirical literature pertaining to hookah tobacco smoking is reviewed with a focus on the implications for regulatory policy.

METHODS

PubMed, PsycINFO, and Scopus databases were searched to locate articles published in English. The literature search combined several key words including "hookahs", "college", "advertising", "health effects", and "health policy".

RESULTS

Smoking hookah tobacco may play a role in the initiation of smoking among tobacco-naïve college students and may portend persistent smoking among those who have smoked cigarettes. College students are typically nondaily, social smokers. They do not perceive that their heightened risk for tobacco diseases and nicotine dependence relates to their smoking behavior. However, few public health messages target college-age adults to counter media messages that endorse hookah tobacco smoking.

CONCLUSION

Given that the FDA is not authorized to ban specific tobacco products, policy actions should focus on the development of effective risk communication strategies that target college-age adults and on limiting the accessibility of hookah tobacco products to these adults. Accordingly, a research agenda that would inform these policy actions is proposed.

Allowing cigarette or marijuana smoking in the home and car: prevalence and correlates in a young adult sample

Given the increased marijuana use, negative health consequences of marijuana secondhand smoke exposure (SHSe) and dearth of research regarding marijuana SHSe in personal settings, we examined the prevalence and correlates of allowing marijuana versus cigarette smoking in personal settings among 2002 online survey respondents at two southeastern US universities in 2013. Findings indicated that 14.5% allowed cigarettes in the home, 17.0% marijuana in the home, 35.9% cigarettes in cars and 27.3% marijuana in cars. Allowing cigarettes in the home was associated with younger age, racial/ethnic minority status, living off campus, personal marijuana use, parental tobacco use and positive perceptions of cigarettes (P < 0.05). Correlates of allowing marijuana in the home included older age, not having children, living off campus, positive perceptions of marijuana and personal, parental and friend marijuana use (P < 0.05). Correlates of allowing cigarettes in cars included personal cigarette and marijuana use, parental tobacco and marijuana use, more cigarette-smoking friends and positive perceptions of cigarettes (P < 0.05). Correlates of allowing marijuana in cars included being non-Hispanic black; positive perceptions of marijuana; and personal, parental and friend marijuana use (P < 0.05). Interventions must target distinct factors influencing policies regarding cigarette versus marijuana use in personal settings to address the consequences of marijuana and cigarette SHSe.

Scales of Smoking-Related Self-Efficacy, Beliefs, and Intention: Assessing Measurement Invariance among Intermittent and Daily High School Smokers

Purpose.

To examine the factorial validity and measurement invariance of scales that measure smoking-related self-efficacy, beliefs, and intention between daily and intermittent adolescent smokers.

Design.

Cross-sectional survey design.

Setting.

Selected high schools in eastern Texas.

Subjects.

Subjects were 2888 high school current smokers; mean age 16.2 years; 53.5% male; 67.4% White, 17.8% Hispanic, 6.2% Black, 8.6% “other.” Daily smokers comprised 37.9% of the sample (i.e., smoked at least one cigarette every day 30 days prior to the survey).

Measures.

Smoking-related self-efficacy and intention were measured by three items; beliefs were measured by four items.

Analysis.

Confirmatory factor analyses were conducted to test the invariance of the measures between daily and intermittent smokers. Fit indices included comparative fit index (CFI), nonnormed fix index (NNFI), and root mean square error of approximation (RMSEA).

Results.

The three-factor measurement model had good fit for daily (CFI = .97, NNFI = .95, RMSEA = .09) and intermittent (CFI = .96, NNFI = .95, RMSEA = .09) smokers. Evidence of strong factorial invariance was found for the factors between the smoking subgroups (CFI = .96, NNFI = .96, RMSEA = .08).

Conclusion.

These measures may be used to capture and compare scores on self-efficacy to resist smoking, beliefs about benefits of smoking, and intention to smoke between daily and intermittent adolescent smokers.

Psychosocial and behavioral characteristics among subgroups of nondaily college student smokers

Nondaily smoking is becoming common in young adults and there appear to be different characteristics associated with past month smoking frequency among nondaily smokers. The present study examines behavioral and psychosocial correlates of smoking among subgroups of nondaily college student smokers (N = 80; 18–25 years of age) attending a large, public university. Nondaily smokers were categorized based on the frequency of days smoked in the past month and were divided into two subgroups: 1–5 days and 6–29 days. A quarter of nondaily smokers considered themselves as a smoker and significantly more 6–29 nondaily smokers were identified as a smoker and smoked more cigarettes per day (CPD). Almost half (45%) of nondaily smokers have attempted to quit smoking completely and 71% of the 6–29 nondaily smokers reported significantly higher quit attempts. The 6–29 nondaily smokers had significantly higher perceived risk related to smoking. Self-efficacy to abstain from smoking was significantly higher for 1–5 nondaily smokers. These results suggest heterogeneity among subgroups of nondaily college student smokers exists in a number of behavioral and psychosocial factors. Prevention and cessation strategies may be improved by considering frequency of nondaily smoking and targeting subgroups differently.

Perceptions of addiction, attempts to quit, and successful quitting in nondaily and daily smokers

We aimed to qualitatively examine differences in perceptions of addiction, attempts to quit, and successful quitting among nondaily versus daily college student smokers. We conducted 16 focus groups with a total of 73 college student smokers from the southeastern U.S. Focus groups were homogenous in terms of gender, smoking status (nondaily, daily), and type of school (2-year college, 4-year university). Questions centered on perceptions of addiction, their own addiction, what constitutes a quit attempt, and successful quitting. Themes that emerged among all smokers regarding conceptualization of general addiction included physiological and psychological dependence and an inability to quit smoking. In terms of their own addiction, nondaily smokers referenced their ability to quit and sense of choice to smoke as factors indicating a lack of addiction, whereas daily smokers reported dependence symptoms and their inability to control their smoking indicating addiction. Nondaily smokers discussed quit attempts in terms of making the decision to quit and avoiding situational triggers, whereas daily smokers reported taking more behavioral steps toward cessation (e.g., not buying cigarettes, reducing cigarette consumption). With regard to successful cessation, both groups identified losing the desire to smoke as a hallmark. However, nondaily smokers reported that the decision to quit might constitute successful cessation; daily smokers had more strict behavioral criteria such as abstinence for an extended period of time. The different perceptions of one's own addiction, attempting to quit smoking, and successful quitting suggest the need to improve assessments of these factors, particularly among nondaily smokers.

Young adult former ever smokers: the role of type of smoker, quit attempts, quit aids, attitudes/beliefs, and demographics

OBJECTIVE

Young adults who smoke are often nondaily users who either quit or transition into dependent smokers. Further, this age group often has been considered an extension of the adult population. This study aims to examine young adult former ever smokers to understand factors associated with their stopping smoking.

METHOD

Telephone interviews were conducted in 2010 with 4401 young adults in Florida. We examined the association between former ever smokers and sociodemographics, smoking behavior, quit attempts, quit aids, and attitudes/beliefs about smoking.

RESULTS

Thirty-seven percent of young adults were former smokers, 20% were current smokers, and 43% were never smokers. Former smokers were more likely to be female, situational smokers (compared to occasional or established), more likely to have stopped smoking without acknowledging making a quit attempt, less likely to have used a quit aid, and less likely to display pro-tobacco attitudes/beliefs.

CONCLUSION

Young adult former and current smokers have unique patterns of smoking and stopping smoking. Young adults may require novel intervention techniques to promote prevention and cessation based on these unique smoking patterns. Future research is needed to understand motivations to quit smoking among young adults.

Craving effect of smoking cues in smoking and antismoking stimuli in light smokers

Cue-reactivity models may be able to inform light and intermittent smoking patterns not yet explained by withdrawal models. For instance, smoking cues in smoking and antismoking advertisements may elicit cravings in smokers at equal rates, which may promote smoking maintenance. Moreover, smoking has been associated with impulsivity, but has not been explored in light and intermittent smokers (LITS). Aims of this study included the assessment of the impact of smoking and antismoking advertisements on post-exposure cravings in LITS and assessment of impulsivity as a moderator between cue exposure and cravings. Data from 155 LITS were analyzed. Participants were exposed to one of three stimuli conditions (i.e., smoking, antismoking, and neutral) and completed measures of demographics, tobacco use and history, impulsivity, and cravings. Univariate analysis demonstrated that smoking stimuli produced higher cravings relative to antismoking and neutral stimuli, whereas no differences between antismoking and neutral stimuli were observed. Impulsivity did not moderate the relationship between stimuli condition and cravings. Implications stemming from these findings include the further regulation of smoking advertisements and future exploration of smoking and smoking cessation in the context of cue-reactivity.

Level of cigarette consumption and quit behavior in a population of low-intensity smokers--longitudinal results from the International Tobacco Control (ITC) survey in Mexico

BACKGROUND

Mexican smokers are more likely to be non-daily smokers and to consume fewer cigarettes per day than smokers in other countries. Little is known about their quit behaviors.

AIM

The aim of this study is to determine factors associated with having made a quit attempt and being successfully quit at 14-month follow-up in a population-based cohort of adult Mexicans who smoke at different levels of intensity.

DESIGN

A longitudinal analysis of wave-III and wave-IV (2010) Mexican administration of International Tobacco Control Policy Evaluation Project was conducted.

SETTING

This study was conducted in six large urban centers in Mexico

PARTICIPANTS

The participants of this study comprised 1206 adults who were current smokers at wave-III and who were followed to wave-IV.

MEASUREMENTS

We compared three groups of smokers: non-daily smokers-who did not smoke every day in the past 30 days (n=398), daily light smokers who smoked every day at a rate of ≤5 cigarettes per day (n=368) and daily heavy smokers who smoked every day at a rate of >5 cigarettes per day (n=434). Data on smoking behavior, psychosocial characteristics and socio-demographics were collected at baseline and after 14 months.

FINDINGS

In multivariate logistic regression predicting having made a quit attempt at follow-up, significant factors included being a non-daily smoker versus a heavy daily smoker (ORadj=1.83, 95% CI: 1.19-2.83), less perceived addiction (ORadj=1.86, 95% CI: 1.20-2.87), greater worry that cigarettes will damage health (ORadj=2.04, 95% CI: 1.16-3.61) and having made a quit attempt in the past year at baseline (ORadj=1.70, 95% CI: 1.23-2.36). In multivariate logistic regression predicting being successfully quit at one-year follow-up, significant factors included being a non-daily smoker versus a heavy daily smoker (ORadj=2.54, 95% CI: 1.37-4.70) and less perceived addiction (not addicted: ORadj=3.26, 95% CI: 1.73-6.14; not much: ORadj=1.95, 95% CI: 1.05-3.62 versus very much).

CONCLUSIONS

Mexican adult smokers who are non-daily smokers were more likely than daily heavy smokers to have attempted to quit during follow-up and to succeed in their quit attempt. Future research should determine whether tobacco control policies and programs potentiate this tendency and which interventions are needed to help heavier smokers to quit.

A review of the evidence on technology-based interventions for the treatment of tobacco dependence in college health

BACKGROUND

The college years are a critical time in the development of smoking behavior and tobacco use. Smoking is linked to 30% of cancer deaths, 80% of deaths from chronic obstructive pulmonary disease, and early cardiovascular disease and death. Effective cessation interventions at this time provide an opportunity to drastically reduce premature morbidity and mortality.

AIMS

To review available evidence on Internet interventions with young adults, including methodology, theoretical frameworks and outcome measures for tobacco treatment to guide the development of a program in college health.

METHODS

A comprehensive literature search for studies published from January 1999 to February 2011, in multiple databases was conducted, along with hand-searching of reference lists. Inclusion criteria were: participants aged 18-30 years, intervention involved the Internet through either Web sites or e-mail or texting, and outcome measurement of tobacco cessation/abstinence. Studies were evaluated utilizing a tool synthesized from guidelines presented by the Cochrane Collaboration.

FINDINGS

Eight studies met the inclusion criteria (four randomized controlled trials, four cohort studies). Theoretical frameworks utilized were the Transtheoretical Model of Change, Health Belief Model, Theory of Social Support, and social cognitive theory. Interventions varied and included computer-generated advice letters, Web-based cessation guides, computer-generated text messages, and peer e-mail support. With smoking abstinence as the primary outcome measure, there was a statistically significant improvement in quit rates. Because of the use of multiple components, differences in interventions and the number of contacts, it is not clear what types of computer-based applications are most effective. Small sample sizes, lack of control groups, and inconsistency in outcome measures limit the ability to provide conclusive evidence to support these interventions-but support the feasibility to use in the design of future programs.

CONCLUSIONS

Use of technology-based interventions, such as the Internet, may be an effective tool for tobacco treatment interventions, especially with college students. There is great potential to reach large numbers of students, many who may not identify themselves as smokers or seek traditional methods for treatment. Additional research is needed to determine which technology-based interventions are most effective and to provide more conclusive evidence.

Environmental and non-infectious factors in the aetiology of pharyngitis (sore throat)

OBJECTIVES

The aim of this review is to examine the causes, pathophysiology and experimental models of non-infectious pharyngitis (sore throat).

INTRODUCTION

The causes of sore throat can be infectious (viruses, bacteria, and fungi) or non-infectious, although the relative proportion of each is not well documented.

METHODS

A PubMed database search was performed for studies of non-infectious sore throat.

RESULTS AND CONCLUSIONS

Non-infectious causes of sore throat include: physico-chemical factors, such as smoking, snoring, shouting, tracheal intubation, medications, or concomitant illness; and environmental factors including indoor and outdoor air pollutants, temperature and humidity, and hazardous or occupational irritants. The pathophysiology underlying non-infectious sore throat is largely uncharacterised, although neurogenic inflammation looks to be a promising candidate. It is likely that there will be individual disposition factors or the coincidence of more than one irritant with possible--up to now unknown--interactions between them. Therefore, experimental models with defined conditions and objective endpoints are needed. A new model using cold dry air to directly induce pharyngeal irritation in humans, with pharyngeal lavage to measure biomarkers, may provide a useful tool for the study of mechanisms and treatment of non-infectious sore throat.

Results of a feasibility and acceptability trial of an online smoking cessation program targeting young adult nondaily smokers

Despite increases in nondaily smoking among young adults, no prior research has aimed to develop and test an intervention targeting this group. Thus, we aimed to develop and test the feasibility, acceptability, and potential effectiveness of an online intervention targeting college student nondaily smokers. We conducted a one-arm feasibility and acceptability trial of a four-week online intervention with weekly contacts among 31 college student nondaily smokers. We conducted assessments at baseline (B), end of treatment (EOT), and six-week followup (FU). We maintained a 100% retention rate over the 10-week period. Google Analytics data indicated positive utilization results, and 71.0% were satisfied with the program. There were increases (P < .001) in the number of people refraining from smoking for the past 30 days and reducing their smoking from B to EOT and to FU, with additional individuals reporting being quit despite recent smoking. Participants also increased in their perceptions of how bothersome secondhand smoke is to others (P < .05); however, no other attitudinal variables were altered. Thus, this intervention demonstrated feasibility, acceptability, and potential effectiveness among college-aged nondaily smokers. Additional research is needed to understand how nondaily smokers define cessation, improve measures for cessation, and examine theoretical constructs related to smoking among this population.

Smoking frequency among current college student smokers: distinguishing characteristics and factors related to readiness to quit smoking

Given the increased prevalence of non-daily smoking and changes in smoking patterns, particularly among young adults, we examined correlates of smoking level, specifically motives for smoking, and readiness to quit smoking among 2682 college undergraduates who completed an online survey. Overall, 64.7% (n = 1736) were non-smokers, 11.6% (n = 312) smoked 1-5 days, 10.5% (n = 281) smoked 6-29 days and 13.2% (n = 353) were daily smokers. Ordinal regression analyses modeling smoking level indicated that correlates of higher smoking level included having more friends who smoke (β = 0.63, 95% CI 0.57-0.69) and more frequent other tobacco use (β = 0.04, 95% CI 0.02-0.05), drinking (β = 0.04, 95% CI 0.02-0.07) and binge drinking (β = 0.09, 95% CI 0.06-0.13). Bivariate analyses indicated that daily smokers (versus the subgroups of non-daily smokers) were less likely to smoke for social reasons but more likely to smoke for self-confidence, boredom, and affect regulation. Controlling for sociodemographics, correlates of readiness to quit among current smokers included fewer friends who smoke (P = 0.002), less frequent binge drinking (P = 0.03), being a social smoker (P < 0.001), smoking less for self-confidence (P = 0.04), smoking more for boredom (P = 0.03) and less frequent smoking (P = 0.001). Specific motives for smoking and potential barriers to cessation particularly may be relevant to different groups of college student smokers.

Use of and interest in smoking cessation strategies among daily and nondaily college student smokers

OBJECTIVE

To examine use of and interest in cessation strategies among nondaily and daily college student smokers.

PARTICIPANTS

800 undergraduate student smokers aged 18 to 25.

METHODS

The authors examined nondaily versus daily smoking in relation to use of and interest in cessation strategies using an online survey.

RESULTS

Nondaily (65.8%) versus daily smokers (34.3%) were more likely to have made a quit attempt (p = .01) but less likely to have used any assistance (p < .001). Nondaily smokers were less interested in pharmacotherapy and traditional behavioral interventions; however, there was no difference in interest in technology-based interventions among nondaily versus daily smokers. Controlling for covariates, there were no significant differences in interest in traditional or technology-based behavioral interventions. Higher motivation, lower confidence, and depressive symptomatology were related to interest in each intervention. Smoking for social reasons was related to interest in technology-based interventions.

CONCLUSIONS

Different intervention strategies may be appropriate for nondaily and daily smokers.

Occasional smoking in college: who, what, when and why?

INTRODUCTION

The majority of college students who smoke do so on an occasional basis and generally do not define themselves as smokers. This represents a considerable challenge for public health efforts to prevent escalation of use and to promote cessation. Strengthening such efforts will require further examination of the motivations behind occasional smoking within this vulnerable group.

METHODS

Based within a priori identified content areas, we conducted eight focus groups of occasional smokers (N=53) at two demographically diverse colleges in the southeastern U.S.

RESULTS

Few participants self-identified as a smoker and few had immediate desire to quit. Most identified extrinsic motivations for future quitting, including college graduation and parenthood. Although participants acknowledged smoking-related health risks, they minimized them as being personally irrelevant. Participants highlighted social (i.e., alcohol and other smokers) and stress-related smoking triggers. They also described how they carefully managed the situations in which they would, and would not smoke in order to preserve their identity.

CONCLUSIONS

College students who smoke occasionally appear to engage in impression management, taking effort to shape their personal image to not appear as a smoker. They use smoking mainly as a social engagement tool, but also to alleviate negative emotions. They express minimal desire to quit and believe they are immune to the health risks of smoking. Public health messages should address this common pattern of smoking among young adults differently than regular smoking patterns by highlighting the social, emotional, and health consequences of occasional smoking before nicotine dependence has fully developed.

The development and validation of a scale assessing individual schemas used in classifying a smoker: implications for research and practice

INTRODUCTION

Half of college students who have smoked in the past month do not consider themselves smokers. Understanding one's schema of smokers is important, as it might relate to smoking behavior. Thus, we aimed to develop a scale assessing how young adults classify smokers and establish reliability and validity of the scale.

METHODS

Of 24,055 students at six Southeast colleges recruited to complete an online survey, 4,840 (20.1%) responded, with complete smoking and scale development data from 3,863.

RESULTS

The Classifying a Smoker Scale consisted of 10 items derived from prior research. Factor analysis extracted a single factor accounting for 40.00% of score variance (eigenvalue = 5.52). Higher scores (range 10-70) indicate stricter criteria in classifying a smoker. The scale yielded a Cronbach's alpha of .91. Current smoking (past 30-day) prevalence was 22.8%. Higher Classifying a Smoker Scale scores (p = .001) were significant predictors of current smoking, controlling for sociodemographics. Higher scores were related to being nondaily versus daily smokers (p = .009), readiness to quit in the next month (p = .04), greater perceived smoking prevalence (p = .007), not identifying as smokers (p < .001), less perceived harm of smoking (p < .001), greater concern about smoking health risks (p = .01), and less favorable attitudes toward smoking restrictions (p < .001). Among current smokers, higher scores were related to greater smoking frequency (p = .02), not identifying as smokers (p < .001), and less perceived harm of smoking (p < .001), controlling for sociodemographics.

CONCLUSION

This scale, demonstrating good psychometric properties, highlights potential intervention targets for prevention and cessation, as it relates to smoking, risk perception, and interest in quitting.

Light smoking in a predominantly Hispanic college student sample: a 7 day diary assessment

Both Hispanic and college student populations smoke at non trivial rates but less frequently than other smoking groups. Limited information exists about the at risk times for smoking among those who smoke fewer than 10 cigarettes per day, particularly college students. Participants (n=116 young adults) completed a 7 day Tobacco Consumption Diary by recording for each cigarette smoked: time and day, location, number of people present, number of smokers present, mood, and whether alcohol was consumed. Descriptive analyses suggest a variety of psycho-social contexts within which light smoking may occur for a predominantly Hispanic sample of college students. Inferential analyses reveal a somewhat heterogeneous pattern of light smoking. Nevertheless, Thursday, Friday, and Saturday, as well as later hours of each day in particular are associated with an increased likelihood of smoking. Further study of intra-individual patterns of both Hispanic and college student light smoking is needed to identify the ideographic triggers that can be intervened upon to aid light smokers in cessation.

The epidemiology of cough

Cough is a common symptom that affects a large proportion of the general population, but has been somewhat neglected in the epidemiological literature in the recent years. Various types of coughs are described based on life-long epidemiological surveys. Using published and unpublished data from three epidemiological studies (the European Community Respiratory Health survey, the French Epidemiological study on the Genetics and environment of asthma (EGEA) and the French E3N study), some specific aspects are discussed in detail. Phenotypic heterogeneity according to chronicity, or its productive nature, or its daytime or nocturnal characteristics are discussed. The association of cough with asthma and gender is described, together with its evolution over a 12-year period. The potential for genetic studies of cough is discussed.

Defining "smoker": college student attitudes and related smoking characteristics

INTRODUCTION

Less than half of college students who have smoked in the past month identify themselves as smokers. Thus, we examined (a) how college students define the term "smoker" and (b) how this definition impacts smoking behavior and attitudes.

METHODS

We conducted 12 focus groups with a total of 73 college student smokers drawn from survey participants at two colleges in Minnesota (a two-year technical college and a four-year university). Each group was homogenous in terms of gender and school (two-year, four-year).

RESULTS

The majority (56.2%) were female, 49.3% attended a 2-year college, and 32.9% were regular smokers (smoked > or = 25 of the last 30 days). Participants described a "smoker" in terms of (a) smoking frequency, ranging from smoking infrequently to smoking daily; (b) contextual factors, such that smoking alone indicates being a smoker rather than smoking at parties; (c) time since initiation; (d) whether one purchases cigarettes, such that "smokers" buy cigarettes while nonsmokers borrow them; (e) addiction and being able to quit without great effort; (f) whether smoking is habitual; and (g) personality and physical characteristic. These beliefs had implications on experiences in quitting smoking, motivation to quit, and perceived barriers. Many participants indicated confidence in being able to quit but believed that they were not "smokers" and thus did not need to quit.

DISCUSSION

College students use a broad range of criteria to define who is a smoker. These criteria impact how motivated students are to quit smoking and their perception of needing to "quit smoking."

Differences between intermittent and light daily smokers in a population of U.S. military recruits

INTRODUCTION

Few studies have assessed differences between intermittent and light smokers, particularly among young adults. Exploring these differences promotes a systematic approach to research and treatment in low-level smokers. This study explored demographic, tobacco-related, and psychosocial predictors of intermittent nondaily smoking relative to light smoking among basic military training (BMT) recruits. The impact of smoking status on abstinence rates at follow-up was also assessed.

METHODS

Participants were 5,603 U.S. Air Force BMT intermittent nondaily (n = 3,134) or light daily (n = 2,469) smoking recruits participating in a population-based group randomized trial targeting tobacco use prevention and cessation (Klesges et al., 2006, Efficacy of a tailored tobacco control program on long-term use in a population of U.S. military troops. Journal of Consulting and Clinical Psychology, 74, 295-306.). Participants completed baseline measures assessing demographics; tobacco use and history; and common social, attitudinal, and behavioral risk factors for tobacco use. Flights of recruits were randomly assigned to a tobacco use intervention or health education control intervention. At the 1-year follow-up, participants reported 7-day point prevalence and continuous abstinence.

RESULTS

Intermittent nondaily smoking relative to light daily smoking was associated with lesser perceived addiction, intermittent and daily use of smokeless tobacco, nonsmoking male and female heads of household, lesser likelihood of smoking while stressed or while bored, and higher likelihood of intentions to quit smoking. Intermittent smokers were significantly more likely than light daily smokers to report abstinence at follow-up.

DISCUSSION

Intermittent and daily light smokers differ on several tobacco-related and psychosocial variables. Attending to these factors in prevention and cessation programs may enhance abstinence in both groups.

Cigarette smoking and associated health risks among students at five universities

INTRODUCTION

While most college students and other young adults who smoke fall into the light and intermittent smoking (LITS) category, they remain at risk for tobacco dependence and other adverse health effects from their smoking. This study examines smoking patterns, tobacco dependence, and other health variables among students at five universities to better understand how to identify and address tobacco use and related risks in a college health clinic setting.

METHODS

A health screening survey was completed by 2,091 college and graduate student volunteers seeking routine care at their university health centers or participating in a health class. Independent health variables were analyzed descriptively and in regression analyses with three levels of smoking (none, non-daily, and daily) and tobacco dependence to determine predictors and associated risks.

RESULTS

Nearly a quarter of students reported any current smoking, 41% of whom reported smoking less than 1 cigarette/day (cpd). Of the daily smokers, 80% smoked less than 10 cpd but 45% met criteria for tobacco dependence. Any smoking was associated with high-risk alcohol use, risky driving, relational abuse, depression, less exercise, and utilization of emergency and mental health services. In regression analyses, students who experienced depression had more than double the odds of being dependent smokers (odds ratio [OR] = 2.32), as did those who reported abuse (OR = 2.07) or sought mental health counseling (OR = 2.09).

DISCUSSION

Student health providers should be alerted to the multiple risks and comorbidities that occur among all smokers, including LITS, and intervene concurrently to help prevent or mitigate adverse outcomes that result from these conditions and behaviors.