Chronic illness and smoking cessation

Smoking cessation rate and predictors of successful quitting in Jordan: A cross-sectional study

Tobacco smoking in Jordan is the highest in the Middle East, with health consequences and economic burdens. Smoking cessation improves health and grows the economy. This study aimed to determine the prevalence of smoking cessation in Jordan and to identify the determinants of effective quitting. This cross-sectional study was conducted using an online survey directed towards the general population of Jordan. The questionnaire was formulated in Arabic and inquired about sociodemographic factors, health status, behaviors, smoking habits, previous quitting attempts, utilization of smoking cessation services, attitudes towards quitting, and barriers to quitting. Data were analyzed using Statistical Package for Social Science version 25. A total of 463 participants were included in this study. Twenty-one percent of them were ex-smokers (n = 97), 86% were male, 63.3% were from the middle governorates, and 29.2% were 24 years old or younger. The rate of sustained quitting for at least 3 months among participants was 13.6%. The factors associated with successful quitting included age > 50 years (P = .001), practicing regular physical activity (P = .003), using more than 1 tobacco product (P = .000), smoking waterpipes or e-cigarettes (P = .000 and .015, respectively), lower levels of nicotine dependence (P = .009), duration of smoking (P = .000), higher number of smoking cessation attempts (P = .000), having 1 or more chronic diseases (P = .049), and having DM (P = .003). More than half of the ex-smokers needed 2 to 5 attempts before successfully quitting smoking. There was a low rate of utilization of smoking cessation services and medications in both groups. On the other hand, there is a high rate of use of other smoking methods, particularly waterpipes and e-cigarettes, as an aid for quitting. Current smokers reported being in a stressful situation as a barrier to quitting significantly more often than did ex-smokers (P = .013). Both groups had moderately positive attitudes toward quitting. Ex-smokers had significantly better attitudes toward their ability to manage stress, weight gain, and increased appetite after quitting (P = .004, .004, and .007, respectively). This study provides valuable insights into the complex dynamics of smoking behavior, cessation attempts, and attitudes. These findings can inform the development of targeted smoking cessation programmes and policies.

Treatment Nonadherence among Multimorbid Chronic Disease Patients: Evidence from 3515 Subjects in Indonesia

Background and Objectives: Multimorbid patients require intensive treatment for their diseases. However, little research has been given to their treatment adherence as part of its management. This study aims to determine the prevalence and characteristics of chronic disease multimorbidity in Indonesia, alongside its treatment nonadherence. Materials and Methods: We conducted a cross-sectional study using the fifth Indonesian Family Life Survey database among adult subjects aged ≥ 15 years with multimorbidity. Our descriptive and multivariate analyses include sex, age, formal education, ethnicity, geographic residence, demographic residence, household size, insurance ownership, annual income, current self-perceived health status, missing active days, smoking behavior, and body mass index. Results: We identified 3515 multimorbid patients, constituting 30.8% prevalence across chronic disease patients. Hypertension was found to be a prevalent component of multimorbidity (61.2%), followed by digestive diseases (44.5%) and arthritis (30.3%). We identified that 36.4% of the subjects were nonadherent to their chronic disease treatment. Characteristics associated with nonadherence were found to be a good self-perception of health (aOR 1.79, 95% CI 1.54-2.08), active smoking behavior (aOR 1.51, 95% CI 1.14-1.99), no smoking behavior (aOR 1.44, 95% CI 1.08-1.90), missing seven active/productive days or less in the past month due to poor health (aOR 1.36, 95% CI 1.10-1.68), no insurance ownership (aOR 1.20, 95% CI 1.04-1.39), age of 15-65 years (aOR 1.25, 95% CI 1.01-1.55), income below IDR 40 million (aOR 1.23, 95% CI 1.04-1.46), and household size of 2-6 people (aOR 1.17, 95% CI 1.01-1.36). Conclusions: While the prevalence of multimorbidity in Indonesia is generally similar to that observed in previous studies, we have identified patient characteristics related to nonadherence. We suggest that patient's nonadherence was primarily dictated by their self-perception of health and treatment complexity. With the longstanding issue of nonadherence, this study indicated the need to consider creating patient-tailored treatment programs in clinical practice to improve adherence by considering individual patients' characteristics.

Social Participation and Persistent Smoking Among Older Chinese With Smoking-Related Morbidity

OBJECTIVES

Chronic diseases are common in midlife and old age and smoking can pose more health and longevity challenges for older people with chronic illnesses. In China where smoking is highly prevalent, older adults are likely to continue smoking even after developing severe chronic diseases. We examined the national prevalence of persistent smoking among older adults. We also investigated the sociodemographic characteristics of persistent smoking among ever-smokers with chronic diseases and its association with social participation (of various types).

METHODS

We used data from a nationally representative sample of older adults aged 45-80 in the China Health and Retirement Longitudinal Study (2011-2018). Multinomial logistic and multilevel logistic models were fitted.

RESULTS

The national prevalence of persistent smoking was around 24% of older men and 3% of older women. Among those with a history of smoking and chronic illness, younger, nonmarried/partnered, nonretired, or less educated individuals are more likely to continue smoking. Social participation is significantly associated with persistent smoking among those with chronic diseases, but the association differs across different forms of activities. Although the most popular but sedentary activities in China (playing Mahjong, chess, or cards) are associated with an elevated risk of persistent smoking, physical social activities (community-organized dancing, fitness, and qigong) are associated with a reduced risk of persistent smoking.

DISCUSSION

Given the enormous burden of persistent smoking on individuals and society, public smoking cessation inventions should address sociocultural factors of persistent smoking and target older adults who participate in specific social activities.

Epidemiology and prevalence of tobacco use in Tehran; a report from the recruitment phase of Tehran cohort study

INTRODUCTION

Tobacco use is a major health concern worldwide, especially in low/middle-income countries. We aimed to assess the prevalence of cigarette smoking, waterpipe, and pipe use in Tehran, Iran.

METHODS

We used data from 8272 participants of the Tehran Cohort Study recruitment phase. Tobacco use was defined as a positive answer to using cigarettes, waterpipes, or pipes. Participants who did not report tobacco use during the interview but had a previous smoking history were categorized as former users. Age- and sex-weighted prevalence rates were calculated based on the national census data, and characteristics of current and former tobacco users were analyzed.

RESULTS

Age- and sex-weighted prevalence of current tobacco users, cigarette smokers, waterpipe, and pipe users in Tehran was 19.8%, 14.9%, 6.1%, and 0.5%, respectively. Current tobacco use was higher in younger individuals (35-45 years: 23.4% vs. ≥ 75 years: 10.4%, P < 0.001) and men compared to women (32.9% vs. 7.7% P < 0.001). The prevalence of tobacco use increased with more years of education (> 12 years: 19.3% vs. illiterate: 9.7%, P < 0.001), lower body mass index (< 20 kg/m²: 31.3% vs. ≥ 35 kg/m²: 13.8%, P < 0.001), higher physical activity (high: 23.0% vs. low: 16.4%, P < 0.001), opium (user: 66.6% vs. non-user: 16.5%, P < 0.001), and alcohol use (drinker: 57.5% vs. non-drinker: 15.4%, P < 0.001). Waterpipe users were younger (46.1 vs. 53.2 years) and had a narrower gender gap in prevalence than cigarette smokers (male/female ratio in waterpipe users: 2.39 vs. cigarette smokers: 5.47). Opium (OR = 5.557, P < 0.001) and alcohol consumption (OR = 4.737, P < 0.001) were strongly associated with tobacco use. Hypertension was negatively associated with tobacco use (OR = 0.774, P = 0.005).

CONCLUSION

The concerning prevalence of tobacco use in Tehran and its large gender gap for cigarette and waterpipe use warrant tailored preventive policies.

Changes in Prevalence Over Time and Determinants of Dental Care Visits Amongst Tennessee Seniors

INTRODUCTION

Rates of dental visits of older adults in the United States, particularly in Tennessee, are rapidly increasing, coupled with the growing complexity of older adults' dental treatment. Notably, increased dental visits help detect and treat dental disease and offer opportunities for preventive care. This longitudinal study aimed to examine the prevalence and determinants of dental care visits amongst Tennessee seniors.

METHODS

This observational study combined multiple cross-sectional studies. Five even years of Behavioral Risk Factor Surveillance system data were used, including 2010, 2012, 2014, 2016, and 2018. Our data were limited to Tennessee seniors (60 years or older). Weighting was conducted to account for the complex sampling design. Logistic regression analysis was performed to determine the factors associated with dental clinic visits. A P value < .05 was considered statistically significant.

RESULTS

The current study comprised 5362 Tennessee seniors. Older individuals visiting dental clinics within 1 year gradually decreased from 76.5% in 2010 to 71.2% in 2018. The majority of participants were female (51.7%), White (81.3%), and located in Middle Tennessee (43.5%). Logistic regression showed that those more likely to visit dentists or dental clinics included females (odds ratio [OR], 1.4; 95% confidence interval [CI], 1.1-1.8), never-smokers and former smokers (OR, 2.2; 95% CI, 1.5-3.4), individuals with some college education (OR, 1.6; 95% CI, 1.1-2.4), college graduates (OR, 2.7; 95% CI, 1.8-4.1), and those with high incomes (eg, >$50,000; OR, 5.7; 95% CI, 3.7-8.7). Conversely, Black participants (OR, 0.6; 95% CI, 0.4-0.8), participants with fair/poor health (OR, 0.7; 95% CI, 0.5-0.8), and those who have never married (OR, 0.5; 95% CI, 0.3-0.8) were less likely to report dental visits.

CONCLUSIONS

Rates of Tennessee seniors visiting dental clinics within 1 year have gradually decreased from 76.5% in 2010 to 71.2% in 2018. Several factors were associated with seniors seeking dental treatment. Effective interventions to improve dental visits should take the identified factors into account.

Risk factors for deep surgical site infection following surgically treated peri-ankle fractures: a case-control study based on propensity score matching

AIMS

This study aims to identify the risk factors for deep surgical site infection (DSSI) following surgically treated peri-ankle fractures.

METHODS

We performed a retrospective case-control study using the propensity score matching (PSM) method in 1:2 ratio, based on the 6 baseline variables, including age, gender, living area, insurance type, fracture location and surgical date. Data on patients who underwent surgical treatment of peri-ankle fractures were collected by inquiring their hospitalization medical records and operative records, as well as the laboratory reports. Conditional logistic regression analysis was performed to identify the risk factors for DSSI.

RESULTS

A total of 2147 patients were eligibly included and 74 had a DSSI, indicating an incidence rate of 3.4%. After PSM, 70 cases of DSSI and 140 controls without DSSI were matched, constituting the study cohort. The univariate analyses showed significant differences between groups in terms of history of any surgery, time to operation, surgical wound classification, smoking, alcohol drinking, RBC count, hemoglobin concentration and hematocrit (%). The conditional logistic regression analysis showed time to operation of < 4 or > 9 (vs 4-9 days); unclean wound, current smoking, high-energy injury mechanism and lower hematocrit were independent risk factors for DSSI.

CONCLUSIONS

Timely modification of smoking and hematocrit (%), and limiting operation within a rational time frame for an optimized soft tissue condition, may provide potential clinical benefits for SSI prevention.

Socioeconomic status across the life course and smoking cessation among older adult smokers in the U.S

INTRODUCTION

Socioeconomic status (SES) at different stages of the life course impacts late-life health. However, whether SES across the life course impacts smoking cessation in late-life is not known.

PURPOSE

Assess how life course SES impacts smoking cessation among older smokers.

METHODS

We identified 5,124 smokers, 50 years and older, from the 1998 to 2018 waves of the Health and Retirement Study. The outcome was self-reported smoking cessation. The main exposure was life course SES, defined as: low child and low adult SES (persistent low); low child, high adult SES (upward mobility); high child, low adult SES (downward mobility); and high child, high adult SES (persistent high). A multilevel mixed-effect logistic model was used to examine how life course SES predicts smoking cessation at age 65 and over time, adjusted for covariates.

RESULTS

Compared to those with persistent high SES, those with persistent low SES, upward and downward SES were more likely to be Hispanic or non-Hispanic Black. The adjusted results showed that at age 65, compared to those with persistent high SES, those with persistent low SES (OR= 0.69, 95 % CI = [0.51-0.92]), upward SES (OR= 0.49, [0.32-0.75]), and downward SES (OR= 0.55, [0.40-0.76]) were less likely to quit. However, as age increased, only those with downward or persistent low SES were significantly less likely to quit compared to those with persistent high SES.

DISCUSSION

Social mobility of SES from childhood to adulthood significantly impacts smoking cessation. Both stages of the life course should be considered to understand smoking behaviors.

Short- and Long-Term Cigarette and Tobacco Abstinence Among Daily and Nondaily Older Smokers

INTRODUCTION

There is mixed evidence regarding whether older (vs. younger) smokers are more or less likely to quit smoking. We examined how age is associated with cigarette and all tobacco product abstinence and the potential moderating effects of smoking frequency.

AIMS AND METHODS

Data from a 4-year cohort of the Population Assessment of Tobacco and Health (PATH) study were used, including 7512 smokers at Wave 1 who had smoking status data at Wave 4. Logistic regression models were used to examine the effects of age (18-24, 25-34, 35-44, 45-54, and ≥55 years) on Wave 4, 30-day and 12-month cigarette and all tobacco product abstinence, adjusting for covariates and the interaction between age and cigarette use frequency (nondaily, light daily, and heavy daily).

RESULTS

Older smokers (≥55 years) were more likely to be heavy daily smokers than younger smokers 18-24 and 25-34 years, but were less likely to have a past-year cigarette quit attempt. Younger smokers 45-54 years were less likely to report 12-month cigarette abstinence than older smokers (odds ratio = 0.72 [0.54-0.95]). Younger smokers 18-24 and 45-54 years were less likely to report 12-month tobacco product abstinence than older smokers (odds ratio = 0.65 [0.45-0.93]; odds ratio = 0.73 [0.55-0.96], respectively). Thirty-day cigarette abstinence significantly decreased as age increased for nondaily smokers, significantly increased for heavier daily smokers, but remained similar across age for light daily smokers.

CONCLUSIONS

Older smokers were more likely to report 12-month cigarette and tobacco abstinence than younger smokers 45-54 years old, and the effect of age on abstinence differed by smoking frequency/intensity. Smoking cessation interventions need to be age specific and consider smoking frequency.

IMPLICATIONS

This study shows that although older smokers are more likely to be heavy smokers and less likely to have a quit attempt at baseline, they are more likely to have 12-month cigarette and tobacco abstinence than younger smokers. Furthermore, 30-day cigarette abstinence significantly decreases as age increases for nondaily smokers and significantly increases for heavy daily smokers, suggesting that the effect of cigarette smoking frequency and intensity changes with age. Smoking cessation interventions need to be age specific as well as consider the smoking frequency/intensity of each age group. Younger smokers may need more targeted cessation interventions to successfully quit.

Determinants of tobacco cessation among patients with chronic diseases (diabetes/hypertension) enrolled in Ministry of Health Tobacco Cessation Clinics, Kingdom of Saudi Arabia from 2012-2017: A case control study

OBJECTIVES

To investigate factors associated with tobacco cessation among patients with (diabetes or hypertension) who attended Ministry of Health (MOH) Tobacco Cessation Clinics (TCC), Saudi Arabia over the years 2012-2017.

METHODS

A case control study was conducted with 402 respondents. Data collection took place in Riyadh, Saudi Arabia from January 2018 to April 2018. Cases were patients with diabetes or hypertension who had been abstinent from tobacco for at least 6 months after attending MOH tobacco cessation clinics. Controls were patients with chronic diseases who had not quit tobacco after cessation clinics. Data were collected through a questionnaire by telephone interviews. Descriptive analysis, bivariate analysis, and multivariable regression were carried out.

RESULTS

Overall, 85 (21.1%) respondents had successfully quit tobacco, while 317 (78.9%) had not. Among those who had not quit cigarettes, 97 (42.4%) had reduced cigarette consumption, the mean difference in cigarette smoking from before to after MOH TCC was 01.812±5.928 (95% confidence interval [CI]: 2.584-1.040). Most of those who used other forms of tobacco 16 (72.7%) had not changed their consumption. The likelihood of successfully quitting tobacco increased with those lower educational level (adjusted odds ratio [AOR]=17.01, 95% CI: 1.00-289.2, p=0.05) and among those who reported controlled hypertension (AOR=17.8, 95% CI: 1.5-209.6, p=0.02).

CONCLUSION

To increase abstention rates, chronic disease counseling with regular follow-ups, providing toll-free telephone services should be considered. More effort is needed to reduce non-cigarette tobacco consumption.

Factors associated with smoking in low-income persons with and without chronic illness

INTRODUCTION

Tobacco disparities persist among low-income smokers who seek care from safety-net clinics. Many of these patients suffer from chronic illnesses (CILs) that are associated with and exacerbated by smoking. The objective of the current study was to examine the differences between safety-net patients with and without CILs in terms of nicotine dependence and related factors (such as depression, anxiety) and self-efficacy regarding ability to abstain from smoking.

METHODS

Sixty-four low-income smokers who thought about or intended to quit smoking were recruited from the San Francisco Health Network (SFHN) and assessed for CILs, nicotine dependence, depression, anxiety, and smoking abstinence self-efficacy. Four one-way analyses of variance were used to examine the difference between those with and without CIL on the latter four variables.

RESULTS

The CIL group had significantly higher anxiety (CIL: 8.0 ± 5.35; non-CIL: 4.44 ± 3.48; p=0.02) and tended to have higher nicotine dependence (CIL: 5.40 ± 2.58; non-CIL: 3.88 ± 2.28; p=0.04). In the CIL group, nicotine dependence was positively correlated with anxiety [r(62)=0.39; p<0.01] and negatively correlated with smoking abstinence self-efficacy [r(62)= -0.38; p<0.01]. Both depression (Spearman’s rho=0.39; p<0.01) and anxiety (Spearman’s rho=0.29; p<0.05) were associated with total number of CIL categories.

CONCLUSIONS

Safety-net patients who smoke and suffer from CILs may be suffering from higher levels of anxiety and have less confidence in their ability to quit smoking. Incorporating mood management and developing interventions that increase a sense of self-efficacy for refraining from smoking may be necessary to help low-income smokers quit smoking.

Smoking behavior after coronary artery bypass surgery: Quit, relapse, continuing

Objective:

Tobacco smoking represents a major risk factor for coronary artery disease. Our study aimed to investigate whether Coronary Artery Bypass Graft (CABG) surgery could act as a motivating factor to enforce smoking cessation. Specifically, we observed the success rate in individuals who quitted smoking, along with the number and reasons of relapse(s) at least one year after the operation.

Methods:

The pre-operative characteristics, pre-operative tobacco exposure, socioeconomic factors and perioperative complications in patients who underwent isolated Coronary Artery Bypass Graft surgery in our Department from June 2012 to September 2016 were reviewed. Our survey was conducted via phone interview and using a standardized questionnaire. Only patients who were current smokers at the time of surgery were interviewed.

Results:

Our study group consisted of a total of 120 patients, 91 (75.8%) reported initially quitting tobacco smoking. Because of relapse(s), one year after the procedure the number of patients who were still non-smokers dropped to 69 (57.5%). Smoking cessation attempts were not supported by professional assistance.

Conclusions:

Our findings demonstrate that there is a desire from CABG patients to quit smoking, as indicated by the high percentage of initial attempts in early postoperative period. However, a year after the procedure, only 57.5% of CABG patients were able to achieve or maintain smoking cessation. Patients who were retired or who were unemployed at the time of the surgery, found it easier to stop smoking than patients who were active employees. Patients who lived alone at the time of surgery also found it harder to stop smoking. Finally, patients with COPD also found quitting smoking harder in the post-operative period.

Lifestyle factors and multimorbidity among older adults (ELSI-Brazil)

The objective of the study was to evaluate the association between unhealthy lifestyle factors (individual and combined) and multimorbidity stratified by sex, in a national sample representative of Brazilians aged 50 years or older. Data from the Brazilian Longitudinal Study of Aging (ELSI-Brazil) baseline, conducted in 2015-2016, were used. Multimorbidity was defined by the existence of two or more of the 19 chronic diseases. Four unhealthy lifestyle factors were considered: (1) at-risk alcohol consumption, (2) current or past smoking, (3) insufficient physical activity and (4) below-recommended consumption of fruits and vegetables. The association between unhealthy lifestyle factors, individual and combined, was assessed by logistic regression. Among the 7918 study participants, the prevalence of multimorbidity was 75.8% (95% CI 73.7-77.7) among women and 58.7% (95% CI 56.0-61.3) among men. Among women, none of the analyzed behaviors presented an independent and statistically significant association (p < 0.05) with multimorbidity. Among men, at-risk alcohol consumption was associated with lower odds of multimorbidity. On the other hand, current or past smoking and insufficient physical activity were associated with greater odds of this condition. In addition, the presence of three or four unhealthy lifestyle factors was associated with greater odds of multimorbidity among men. The results reinforce the need for interventions to promote healthy behaviors among older men with two or more chronic diseases. In addition, it is evident that the health services need to act in an attempt to modify unhealthy behaviors after medical diagnosis of chronic diseases to reduce the risk of future complications.

The association between smokers' self-reported health problems and quitting: Findings from the ITC Four Country Smoking and Vaping Wave 1 Survey

INTRODUCTION

This study aimed to systematically examine whether having health conditions or concerns related to smoking are associated with quitting activities among smokers across four western countries.

METHODS

Data came from the 2016 International Tobacco Control Four Country Smoking and Vaping Survey conducted in Australia, Canada, England and US. We asked smokers and recent quitters (n=11838) whether they had a medical diagnosis for heart disease, cancer, chronic lung disease, depression, anxiety, alcohol problems, diabetes, severe obesity and chronic pain (nine conditions), and whether they believed smoking had harmed/would harm their health, along with questions on quitting activities.

RESULTS

General concerns about smoking harming health and all specific health conditions, except for alcohol problems, were positively associated with quit attempts, but the relationships between health conditions and other quitting measures (being abstinent, planning to quit, use of quitting medications) were less consistent. Positive associations between conditions and use of quitting medications were only significant for depression, anxiety and chronic pain (adjusted odds ratios ranged from 1.4 to 1.5). There was a general tendency to report lower self-efficacy for quitting among those with the health conditions.

CONCLUSIONS

While those with smoking related conditions are somewhat more aware of the links to their smoking, and are largely taking more action, the extent of this is lower than one might reasonably expect. Enhanced awareness campaigns are needed and health professionals need to do more to use health conditions to motivate quit attempts and to ensure they are made with the most effective forms of help.

Prevalence and determinants of cigarette smoking relapse among US adult smokers: a longitudinal study

OBJECTIVES

This research project aims at estimating the prevalence of cigarette smoking relapse and determining its predictors among adult former smokers in the USA.

SETTING

This research analysed secondary data retrieved from the Tobacco Use Supplement-Current Population Survey 2010-2011 cohort in the USA.

PARTICIPANTS

Out of 18 499 participants who responded to the survey in 2010 and 2011, the analysis included a total sample size of 3258 ever smokers, who were living in the USA and reported quitting smoking in 2010. The survey's respondents who never smoked or reported current smoking in 2010 were excluded from the study sample.

PRIMARY AND SECONDARY OUTCOME MEASURES

Smoking relapse was defined as picking up smoking in 2011 after reporting smoking abstinence in 2010. The prevalence of relapse over the 12-month follow-up period was estimated among different subgroups. Multivariable logistic regression models were applied to determine factors associated with relapse.

RESULTS

A total of 184 former smokers reported smoking relapse by 2011 (weighted prevalence 6.8%; 95% CI 5.7% to 8.1%). Prevalence and odds of relapse were higher among young people compared with elders. Former smokers living in smoke-free homes (SFHs) had 60% lower odds of relapse compared with those living in homes that allowed smoking inside (adjusted OR 0.40; 95% CI 0.25 to 0.64). Regarding race/ethnicity, only Hispanics showed significantly higher odds of relapse compared with Whites (non-Hispanics). Odds of relapse were higher among never married, widowed, divorced and separated individuals, compared with the married group. Continuous smoking cessation for 6 months or more significantly decreased odds of relapse.

CONCLUSIONS

Wider health determinants, such as race and age, but also living in SFHs showed significant associations with smoking relapse, which could inform the development of more targeted programmes to support those smokers who successfully quit, although further longitudinal studies are required to confirm our findings.

Patterns of alcohol consumption among people with major chronic diseases

Risky alcohol use places those with existing chronic conditions at increased risk of medical complications. Yet, there is little research assessing the alcohol consumption among this group. The aim of this study is to assess the prevalence of risky drinking among people with a range of chronic diseases. As part of the 2013 National Drug Strategy Household Survey (NDSHS), 22684 Australians aged ≥18 years answered questions about their experience of chronic diseases and their drinking patterns. Nearly 18% (CI: 17.2–19.3) of people with chronic disease reported drinking at a long-term risky level, roughly the same rate as those without chronic disease (19.3%, (CI: 18.6–20.2)). Nearly one-quarter, 24% (CI: 23.0–25.3), of people with chronic diseases drank at levels of increased short-term risk, significantly less than the rest of the sample. Respondents with mental illness were more likely to drink at risky levels than the rest of the sample, while the reverse was true of those with diabetes. Overall, those with chronic diseases have similar drinking patterns to the rest of the population, despite increased risks associated with this consumption. Regular screening and subsequent brief interventions for those with chronic disease, particularly mental illness and cancer, are recommended.

The association between smoking and blood pressure in men: a cross-sectional study

BACKGROUND

Cigarette smoking is a known risk factor for cardiovascular disease (CVD), but the association between smoking and blood pressure is unclear. Thus, the current study examined the association between cigarette smoking and blood pressure in men.

METHODS

Systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial pressure (MAP) and pulse pressure (PP) were examined using digital blood pressure measuring device, and smoking status was determined with China National Health Survey.

RESULTS

The ANCOVA showed that the adjusted DBP and MAP were lower in current smokers versus nonsmokers and the adjusted SBP was lower in current smokers versus former smokers (P < 0.05). Additionally, the adjusted PP tend to be decreased steadily as the pack·years increased in current smokers. In a fully adjusted logistic regression model, former smokers had increased ORs (95% CI) of 1.48 (1.01, 2.18) of hypertension and current smokers had not increased ORs (95% CI) of 0.83 (0.61, 1.12), compared with never smokers.

CONCLUSIONS

The findings revealed that the adjusted blood pressure were lower in current smokers versus nonsmokers and former smokers. No significant dose-dependent effect of current smoking on blood pressure indices except PP was observed. Smoking cessation was significantly associated with an increased risk of hypertension. However, current smoking was not a risk factor of hypertension.

Tobacco Use Disorder Among Patients With Smoking-related Chronic Medical Disease: Association With Comorbid Substance Use Disorders

INTRODUCTION

Very little is known of the behavioral vulnerabilities of patients diagnosed with smoking-related chronic medical illness who continue to smoke, potentially worsening morbidity and mortality risks. This study explores the association of tobacco use disorder (TUD) among those with smoking-related chronic medical illnesses with other substance use disorders (SUDs) and risk factors.

METHODS

Among veterans with smoking-related chronic medical illnesses identified from the National Veterans Health Administration administrative records from fiscal year 2012, we compared the characteristics of those with a diagnosis of TUD (International Classification of Diseases, 9th edition code 305.xx; n = 519,918), and those without such a diagnosis (n = 2,691,840). Using multiple logistic regression, we further explored the independent association of factors associated with TUD.

RESULTS

SUD prevalence was markedly higher among those with TUD (24.9% vs 5.44%), including alcohol use disorder (20.4% vs 4.3%) and drug use disorder (13.5% vs 2.6%), compared with nonsmokers. On multiple logistic regression analyses, alcohol use disorder (odds ratio [OR] 2.94, 95% confidence interval [CI] 2.90-2.97) and drug use disorder (OR 1.97, 95% CI 1.94-1.99) were independently associated with current TUD diagnosis. Having any single SUD was associated with considerably high odds of having TUD (OR 3.32, 95% CI 3.29-2.36), and having multiple SUDs with even further increased risk (OR 4.09, 95% CI 4.02-4.16).

CONCLUSIONS

A substantial proportion of people with TUD diagnosis despite concurrent smoking-related medical illnesses are also likely to have other comorbid SUDs, complicating efforts at smoking cessation, and requiring a broader approach than standard nicotine-dependence interventions.

Trends in tobacco use among US adults with chronic health conditions: National Survey on Drug Use and Health 2005-2013

INTRODUCTION

Chronic conditions are among the most common and costly of all health problems. Addressing tobacco use among adults with chronic conditions is a public health priority due to high prevalence as well as greater potential harm from continued use.

METHODS

Data were drawn from 9years (2005-2013) of the U.S. National Survey on Drug Use and Health. Adult (≥18years) tobacco use included any past 30-day use of cigarettes, cigars, pipes, or smokeless tobacco. Chronic conditions examined included anxiety, asthma, coronary heart disease, depression, diabetes, hepatitis, HIV, hypertension, lung cancer, stroke, and substance abuse. Controlling for sociodemographics, trends in product use for most conditions and a composite of any condition among those with chronic conditions were compared to respondents with no condition in weighted logistic regression analyses.

RESULTS

Cigarette smoking declined significantly over time among adults with no chronic condition. Adults with one or more chronic condition showed no comparable decrease, with cigarette smoking remaining especially high among those reporting anxiety, depression, and substance abuse. Cigar and pipe use remained stable and more prevalent among those with any chronic condition, with the exception of pipe use declining among those with heart disease. Smokeless tobacco use increased over time, with higher prevalence among those with asthma, mental health, and substance abuse conditions.

CONCLUSIONS

These findings have tobacco control and regulatory implications for addressing higher tobacco use among adults with chronic conditions. Provider advice and cessation resources targeting tobacco use among those with chronic conditions are recommended.

COMPARAÇÃO DA MODULAÇÃO AUTONÔMICA CARDÍACA DURANTE ESFORÇO DE FUMANTES E NÃO FUMANTES

Introdução O tabagismo é uma das principais causas de morbimortalidade em todo o mundo. Indivíduos fumantes têm risco aumentado de desenvolver disfunção autonômica, a qual pode ser avaliada tanto pela variabilidade da frequência cardíaca (VFC) como pela frequência cardíaca de recuperação (FCRec). A maioria dos estudos envolvendo esta análise é realizada em adultos de idade avançada e na condição de repouso. Objetivos Comparar a atividade autonômica cardíaca em repouso e esforço, em homens jovens, fumantes e não fumantes. Métodos Trinta e dois jovens voluntários, (idade 22,0 ± 2,8 anos) foram distribuídos em dois grupos: o grupo fumante (GF; n=15) e o não fumante (GNF; n=17). Realizou-se o teste de Cooper, com análise da VFC pelo cardiofrequencímetro Polar(r)s810i, em repouso e durante o esforço e FCRec. Resultados No GF, 73% foram classificados com nível de dependência nicotínica "muito baixa" segundo questionário de Fargeström. A classificação de ativos e muito ativos pelo questionário IPAQ correspondeu a mais de 50% da amostra em ambos os grupos. Não se observou diferenças significativas entre os grupos na VFC, tanto no repouso quanto no esforço. Entretanto, em cada grupo, notou-se diferença na maioria dos índices de VFC do repouso para o esforço. No teste de Cooper não foram observadas diferenças significativas na FCmédia, FCpico e de FCRec entre os grupos, mas notou-se uma melhor capacidade funcional no GNF pela distância caminhada (2050,2 ± 300,0 vs. 1780,3 ± 390,4 m, p=0,036). Conclusão O GF apresentou menor capacidade funcional e ativação parassimpática durante o esforço, além de menores índices de VFC durante repouso, o que pode sugerir um comprometimento precoce na modulação autonômica cardíaca.

Working to Eliminate Cancer Health Disparities from Tobacco: A Review of the National Cancer Institute's Community Networks Program

INTRODUCTION

In 2005, the National Cancer Institute funded the Community Networks Program (CNP), which aimed to reduce cancer health disparities in minority racial/ethnic and underserved groups through community-based participatory research, education, and training. The purpose of this study was to describe the CNP model and their tobacco-related work in community-based research, education, and training using a tobacco disparities research framework.

METHODS

We conducted a comprehensive review of the CNP tobacco-related activities including publications, published abstracts, research activities, trainee pilot studies, policy-related activities, educational outreach, and reports produced from 2005-2009. Two authors categorized the tobacco-related activities and publications within the framework.

RESULTS

Although there was no mandate to address tobacco, the CNPs produced 103 tobacco-related peer-reviewed publications, which reflects the largest proportion (12%) of all CNP cancer-related publications. Selected publications and research activities were most numerous under the framework areas "Psychosocial Research," "Surveillance," "Epidemiology," and "Treatment of Nicotine Addiction." Thirteen CNPs participated in tobacco control policymaking in mainstream efforts that affected their local community and populations, and 24 CNPs conducted 1147 tobacco-related educational outreach activities. CNP activities that aimed to build research and infrastructure capacity included nine tobacco-related pilot projects representing 16% of all CNP cancer-related pilot projects, and 17 publications acknowledging leveraged partnerships with other organizations, a strategy encouraged by the CNP.

CONCLUSIONS

The CNP is a promising academic-community model for working to eliminate tobacco-related health disparities. Future efforts may address scientific gaps, consider collaboration across groups, assess the extent of operationalizing community-based participatory research, and improve common tracking measures.

Identifying barriers to smoking cessation in rheumatoid arthritis

OBJECTIVE

The aim of this study was to investigate disease-related issues that make smoking cessation challenging for patients with rheumatoid arthritis (RA). There is currently a lack of research on tailoring smoking cessation interventions for RA patients. Qualitative exploration is a necessary first step in planning targeted interventions.

METHODS

A qualitative mixed-methods study was undertaken. Participants attended either a focus group or an individual interview and completed a set of standardized questionnaires. The sample consisted of 36 RA patients: 24 current smokers and 12 ex-smokers. The transcripts were analyzed thematically using a critical realist approach to inductively identify themes.

RESULTS

Five key barriers to smoking cessation that are faced by RA patients were identified. First, participants were unaware of the relationship between smoking and RA and therefore did not perceive this as a reason to quit. Second, smoking was used as a distraction from pain. Third, participants found it difficult to exercise and therefore were unable to use exercise as an alternative distraction. Fourth, smoking was used as a coping mechanism for the frustrations of living with RA. Fifth, participants felt unsupported and isolated from other RA patients.

CONCLUSION

Disease-related issues may hinder smoking cessation for RA patients. Through an understanding of patients' perspectives there is an opportunity to plan an effective targeted intervention that may increase the chance of smoking cessation in RA patients where smoking may adversely influence disease progression and comorbidities.

The relation between smoking status and medical conditions among incarcerated adults

OBJECTIVES

The rate of smoking among incarcerated adults is more than 3 times that of the general population. Negative health consequences of smoking have prompted many correctional facilities to become tobacco-free. This presents a unique opportunity to examine health conditions associated with motivation to remain tobacco-free after release from prison. We examined this association among individuals who participated in the WISE randomized clinical trial.

METHODS

A total of 247 participants completed a baseline questionnaire asking about illnesses (both smoking-related and non-smoking-related), family history of smoking-related illnesses, demographics, and smoking history. Smoking status was assessed 3 weeks postrelease.

RESULTS

Approximately 38% of participants reported having an illness caused by or worsened by smoking and 53.0% reported having "moderate" to "a lot" of concern about their health due to smoking; 22.9% reported having asthma and 26.8% reported hypertension. The adjusted odds of remaining tobacco-free at 3 weeks postrelease from a tobacco-free prison was significant only for individuals with a family history of smoking-related illnesses (odds ratio [OR] = 0.28; 95% confidence interval [CI], 0.12-0.68). For individuals with smoking-related conditions, the adjusted odds of remaining tobacco-free was nonsignificant (OR = 1.91; 95% CI, 0.85-4.27). Similarly, the adjusted odds of remaining tobacco-free for participants with non-smoking-related medical conditions was nonsignificant (OR = 0.27; 95% CI, 0.06-1.22).

CONCLUSIONS

These results offer a first look at understanding health conditions as a motivator to remain tobacco-free after release from prison. Although these findings require additional investigation, these results suggest that providing treatment to prisoners with chronic disease and specifically targeting smoking-related illnesses might be beneficial with regard to smoking cessation success.

Post-discharge tobacco cessation rates among hospitalized US veterans with and without diabetes

AIMS

Smoking is a major risk factor for cardiovascular complications among patients with diabetes. Hospitalization has been shown to enhance cessation rates. The purpose of this study was to compare 6-month post-hospitalization tobacco cessation rates among US veterans with and without diabetes.

METHODS

This was a longitudinal study among inpatient veterans who used tobacco in the past month (n = 496). Patients were recruited and surveyed from three Midwestern Department of Veterans Affairs hospitals during an acute-care hospitalization. They were also asked to complete a follow-up survey 6 months post-discharge. Bivariate- and multivariable-adjusted analyses were conducted to determine differences in tobacco cessation rates between patients with and without a diagnosis of diabetes.

RESULTS

The mean age of patients was 55.2 years and 62% were white. Twenty-nine per cent had co-morbid diabetes. A total of 18.8% of patients with diabetes reported tobacco cessation at 6 months compared with 10.9% of those without diabetes (P = 0.02). Cotinine-verified cessation rates were 12.5 vs. 7.4% in the groups with and without diabetes, respectively (P = 0.07). Controlling for psychiatric co-morbidities, depressive symptoms, age, self-rated health and nicotine dependence, the multivariable-adjusted logistic regression showed that patients with diabetes had three times higher odds of 6-month cotinine-verified tobacco cessation as compared with those without diabetes (odds ratio 3.17, P = 0.005).

CONCLUSIONS

Post-hospitalization rates of smoking cessation are high among those with diabetes. Intensive tobacco cessation programmes may increase these cessation rates further.