1
|
Cummings KM, Talbot V, Roberson A, Bliss AA, Likins E, Brownstein NC, Stansell S, Adams-Ludd D, Harris B, Louder D, McCutcheon E, Zebian R, Rojewski AM, Toll BA. Implementation of an "opt-out" tobacco treatment program in six hospitals in South Carolina. BMC Health Serv Res 2024; 24:741. [PMID: 38886764 PMCID: PMC11184783 DOI: 10.1186/s12913-024-11205-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Accepted: 06/13/2024] [Indexed: 06/20/2024] Open
Abstract
OBJECTIVE Describe the screening, referral, and treatment delivery associated with an opt-out tobacco treatment program (TTP) implemented in six hospitals varying in size, rurality and patient populations. METHODS Between March 6, 2021 and December 17, 2021, adult patients (≥ 18 years) admitted to six hospitals affiliated with the Medical University of South Carolina were screened for smoking status. The hospitals ranged in size from 82 to 715 beds. Those currently smoking were automatically referred to one of two tobacco treatment options: 1) Enhanced care (EC) where patients could receive a bedside consult by a trained tobacco treatment specialist plus an automated post-discharge follow-up call designed to connect those smoking to the South Carolina Quitline (SCQL); or 2) Basic care (BC) consisting of the post-discharge follow-up call only. An attempt was made to survey patients at 6-weeks after hospitalization to assess smoking status. RESULTS Smoking prevalence ranged from 14 to 49% across the six hospitals; 6,000 patients were referred to the TTP.The delivery of the bedside consult varied across the hospitals with the lowest in the Charleston hospitals which had the highest caseload of referred patients per specialist. Among patients who received a consult visit during their hospitalization, 50% accepted the consult, 8% opted out, 3% claimed not to be current smokers, and 38% were unavailable at the time of the consult visit. Most of those enrolled in the TTP were long-term daily smokers.Forty-three percent of patients eligible for the automated post-discharge follow-up call answered the call, of those, 61% reported smoking in the past seven days, and of those, 34% accepted the referral to theSCQL. Among the 986 of patients surveyed at 6-weeks after hospitalization quit rates ranged from 20%-30% based on duration of reported cessation and were similar between hospitals and for patients assigned to EC versus BC intervention groups. CONCLUSION Findings demonstrate the broad reach of an opt-out TTP. Elements of treatment delivery can be improved by addressing patient-to-staffing ratios, improving systems to prescribe stop smoking medications for patients at discharge and linking patients to stop smoking services after hospital discharge.
Collapse
Affiliation(s)
- K Michael Cummings
- Department of Psychiatry and Behavioral Sciences, HCC Tobacco Control Program, Hollings Cancer Center, Medical University of South Carolina, 86 Jonathan Lucas Street, Charleston, SC, 29425, USA.
| | | | - Avery Roberson
- Department of Psychiatry and Behavioral Sciences, HCC Tobacco Control Program, Hollings Cancer Center, Medical University of South Carolina, 86 Jonathan Lucas Street, Charleston, SC, 29425, USA
| | - Asia A Bliss
- Department of Psychiatry and Behavioral Sciences, HCC Tobacco Control Program, Hollings Cancer Center, Medical University of South Carolina, 86 Jonathan Lucas Street, Charleston, SC, 29425, USA
| | - Emily Likins
- University of Pikeville, Kentucky College of Osteopathic Medicine, Pikeville, USA
| | - Naomi C Brownstein
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, USA
| | - Stephanie Stansell
- Department of Population Health, Medical University of South Carolina, Charleston, USA
| | - Demetress Adams-Ludd
- Department of Population Health, Medical University of South Carolina, Charleston, USA
| | - Bridget Harris
- Department of Population Health, Medical University of South Carolina, Charleston, USA
| | - David Louder
- MUSC Health Alliance, Medical University of South Carolina, Charleston, USA
| | | | - Rami Zebian
- MUSC Health Florence Division, Florence, USA
| | - Alana M Rojewski
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, USA
| | - Benjamin A Toll
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, USA
| |
Collapse
|
2
|
Fox CB, Butler K, Flynn D. Primary Prevention of Cardiovascular Disease for People Living with Human Immunodeficiency Virus. Nurs Clin North Am 2024; 59:219-233. [PMID: 38670691 DOI: 10.1016/j.cnur.2023.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/28/2024]
Abstract
People living with HIV (PLWH) have a risk of cardiovascular disease (CVD) that is 1.5 to 2 times higher than the general population owing to traditional risk factors, HIV-mediated factors like chronic inflammation and immune dysfunction, and exposure to antiretroviral therapy. Currently available CVD risk estimation calculators tend to underestimate risk in PLWH but can be useful when an individual's HIV history is considered. Improving modifiable risks is the primary intervention for reducing CVD risk in PLWH. Statin therapy is important for specific individuals, but attention should be given to drug interactions with antiretroviral agents used to treat HIV.
Collapse
Affiliation(s)
- Christopher B Fox
- Division of General Internal Medicine & Geriatrics, Oregon Health & Science University School of Medicine, 3270 Southwest Pavilion Loop, Mail Code: L-475, Portland, OR 97239, USA.
| | - Kristine Butler
- Division of General Cardiology, Oregon Health & Science University School of Medicine, 3270 Southwest Pavilion Loop, Mail Code: L-475, Portland, OR 97239, USA
| | - Devon Flynn
- Oregon Health & Science University, 3270 Southwest Pavilion Loop, PPV 350, Portland, OR 97239, USA
| |
Collapse
|
3
|
Wahbeh F, Restifo D, Laws S, Pawar A, Parikh NS. Impact of tobacco smoking on disease-specific outcomes in common neurological disorders: A scoping review. J Clin Neurosci 2024; 122:10-18. [PMID: 38428126 DOI: 10.1016/j.jocn.2024.02.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Revised: 01/27/2024] [Accepted: 02/12/2024] [Indexed: 03/03/2024]
Abstract
Although the association of smoking with the risk of incident neurological disorders is well established, less is known about the impact of smoking and smoking cessation on outcomes of these conditions. The objective of this scoping review was to synthesize what is known about the impact of smoking and smoking cessation on disease-specific outcomes for seven common neurological disorders. We included 67 studies on the association of smoking and smoking cessation on disease-specific outcomes. For multiple sclerosis, smoking was associated with greater clinical and radiological disease progression, relapses, risk for disease-related death, cognitive decline, and mood symptoms, in addition to reduced treatment effectiveness. For stroke and transient ischemic attack, smoking was associated with greater rates of stroke recurrence, post-stroke cardiovascular outcomes, post-stroke mortality, post-stroke cognitive impairment, and functional impairment. In patients with cognitive impairment and dementia, smoking was associated with faster cognitive decline, and smoking was also associated with greater cognitive decline in Parkinson's disease, but not motor symptom worsening. Patients with amyotrophic lateral sclerosis who smoked faced increased mortality. Last, in patients with cluster headache, smoking was associated with more frequent and longer cluster attack periods. Conversely, for multiple sclerosis and stroke, smoking cessation was associated with improved disease-specific outcomes. In summary, whereas smoking is detrimentally associated with disease-specific outcomes in common neurological conditions, there is growing evidence that smoking cessation may improve outcomes. Effective smoking cessation interventions should be leveraged in the management of common neurological disorders to improve patient outcomes.
Collapse
Affiliation(s)
- Farah Wahbeh
- Clinical and Translational Neuroscience Unit, Feil Family Brain and Mind Research Institute and Department of Neurology, Weill Cornell Medicine, New York, NY, USA
| | - Daniel Restifo
- Clinical and Translational Neuroscience Unit, Feil Family Brain and Mind Research Institute and Department of Neurology, Weill Cornell Medicine, New York, NY, USA
| | - Sa'ad Laws
- Education and Research, Health Sciences Library, Weill Cornell Medicine - Qatar, Doha, Qatar
| | - Anokhi Pawar
- Clinical and Translational Neuroscience Unit, Feil Family Brain and Mind Research Institute and Department of Neurology, Weill Cornell Medicine, New York, NY, USA
| | - Neal S Parikh
- Clinical and Translational Neuroscience Unit, Feil Family Brain and Mind Research Institute and Department of Neurology, Weill Cornell Medicine, New York, NY, USA.
| |
Collapse
|
4
|
Kang Y, Bai H, Storch JB, Chen J, Kibrik P, Ting W. Diabetes, Hypertension, and Smoking Do Not Affect Outcomes of Iliofemoral Vein Stenting for Chronic Proximal Venous Outflow Obstruction. Ann Vasc Surg 2024; 99:41-49. [PMID: 37944896 DOI: 10.1016/j.avsg.2023.09.098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2023] [Revised: 09/07/2023] [Accepted: 09/29/2023] [Indexed: 11/12/2023]
Abstract
BACKGROUND Diabetes, hypertension, and smoking are well-recognized risk factors for peripheral artery disease (PAD), but little is known of their impact on chronic venous insufficiency (CVI). This study evaluates these factors in patients undergoing iliac vein stenting (IVS) for CVI. METHODS A registry of 708 patients who underwent IVS from August 2011 to June 2021 was retrospectively analyzed. Symptoms were quantified using venous clinical severity score (VCSS) and CEAP classification. Both major and minor reinterventions were recorded. Logistic regression models were used to determine the unadjusted and adjusted odds ratio of any reintervention. Log-rank test was used to assess differences in reintervention-free survival. RESULTS The prevalence of hypertension was 51.1% (N = 362), diabetes was 23.0% (N = 163), and smoking was 22.2% (N = 157). Patients with diabetes (3.6 vs. 3.4; P = 0.062), hypertension (3.6 vs. 3.3; P < 0.001), and smoking (3.7 vs. 3.4; P = 0.003) had higher CEAP scores than those without these comorbidities. Improvement in VCSS composite scores showed no differences postoperatively (diabetes: P = 0.513; hypertension: P = 0.053; smoking: P = 0.608), at 1-year follow-up (diabetes: P = 0.666; hypertension: P = 0.681; smoking: P = 0.745), or at 5-year follow-up (diabetes: P = 0.525; hypertension: P = 0.953; smoking: P = 0.146). Diabetes (P = 0.454), smoking (P = 0.355), and hypertension (P = 0.727) were not associated with increased odds of major reintervention. Log-rank test similarly showed no differences in reintervention-free survival for major or minor reoperations between those with and without diabetes (P = 0.79), hypertension (P = 0.14), and smoking (P = 0.80). CONCLUSIONS Diabetes, hypertension, and smoking were prevalent among CVI patients, but unlike in PAD patients, they had little to no impact on long-term outcomes or reinterventions after IVS.
Collapse
Affiliation(s)
- Yeju Kang
- Division of Vascular Surgery, Department of Surgery, Icahn School of Medicine at Mount Sinai, New York, NY.
| | - Halbert Bai
- Division of Vascular Surgery, Department of Surgery, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Jason B Storch
- Division of Vascular Surgery, Department of Surgery, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Jenny Chen
- Division of Vascular Surgery, Department of Surgery, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Pavel Kibrik
- Division of Vascular Surgery, Department of Surgery, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Windsor Ting
- Division of Vascular Surgery, Department of Surgery, Icahn School of Medicine at Mount Sinai, New York, NY
| |
Collapse
|
5
|
Steinberg ML, Rosen RL, Ganz O, Wackowski OA, Jeong M, Delnevo CD. Communicating the benefits of quitting smoking on mental health increases motivation to quit in people with anxiety and/or depression. Addict Behav 2024; 149:107903. [PMID: 37924583 DOI: 10.1016/j.addbeh.2023.107903] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Revised: 09/22/2023] [Accepted: 10/30/2023] [Indexed: 11/06/2023]
Abstract
BACKGROUND Although smoking rates have declined over time, this decline has not been observed among those with mental health concerns. It is therefore important to develop effective messaging to support quitting in this population. METHODS We conducted an online experiment with 419 adults who smoke cigarettes daily. Participants with, or without a lifetime history of anxiety and/or depression were randomized to view a message focused on the benefits of quitting smoking on mental or physical health. Participants then reported motivation to quit smoking, mental health concerns about quitting, and perceived effectiveness of the message. RESULTS Participants with a lifetime history of anxiety and/or depression who saw the message focused on the benefits of quitting smoking on mental health reported greater motivation to quit than when they saw a message focused on the benefits to physical health. This was not replicated when examining current symptoms instead of lifetime history. Pre-existing beliefs that smoking improves one's mood were greater in those experiencing current symptoms and in those with a lifetime history of anxiety and/or depression. There was no main or interaction (message type X mental health status) effect of message type received on mental health related concerns about quitting. CONCLUSIONS This study is one of the first to evaluate a smoking cessation message with content specifically targeted to those with mental health concerns about quitting smoking. Additional work is needed to determine how to best target those with mental health concerns with messages focused on the benefits of quitting on mental health.
Collapse
Affiliation(s)
- Marc L Steinberg
- Rutgers Robert Wood Johnson Medical School, USA; Rutgers Institute for Nicotine & Tobacco Studies, USA.
| | - Rachel L Rosen
- Rutgers, The State University of New Jersey, USA; Rutgers Institute for Nicotine & Tobacco Studies, USA
| | - Ollie Ganz
- Rutgers School of Public Health, USA; Rutgers Institute for Nicotine & Tobacco Studies, USA
| | - Olivia A Wackowski
- Rutgers School of Public Health, USA; Rutgers Institute for Nicotine & Tobacco Studies, USA
| | - Michelle Jeong
- Rutgers School of Public Health, USA; Rutgers Institute for Nicotine & Tobacco Studies, USA
| | - Cristine D Delnevo
- Rutgers School of Public Health, USA; Rutgers Institute for Nicotine & Tobacco Studies, USA
| |
Collapse
|
6
|
Rojewski AM, Palmer AM, Baker NL, Toll BA. Smoking Cessation Pharmacotherapy Efficacy in Comorbid Medical Populations: Secondary Analysis of the Evaluating Adverse Events in a Global Smoking Cessation Study (EAGLES) Randomized Clinical Trial. Nicotine Tob Res 2024; 26:31-38. [PMID: 37474127 PMCID: PMC10734386 DOI: 10.1093/ntr/ntad126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Revised: 07/11/2023] [Accepted: 07/18/2023] [Indexed: 07/22/2023]
Abstract
INTRODUCTION This study sought to compare medication efficacy in participants with medical comorbidities who smoke in the Evaluating Adverse Events in a Global Smoking Cessation Study (EAGLES) trial, a double-blind, triple-dummy, placebo- and active-controlled randomized controlled trial. AIMS AND METHODS Participants were from the U.S. cohort of the main trial and randomized (1:1:1:1) to varenicline, bupropion, nicotine replacement therapy (NRT) patch, or placebo for 12 weeks with follow-up through week 24. Medical comorbidity data were derived from the baseline medical screening questionnaire and categorized into four subgroups (cardiac, respiratory, vascular, and diabetes). Within each comorbidity, generalized linear mixed models were used to assess the association between treatment and continuous abstinence rates from weeks 9-12 to 9-24. Similar models were used to test the effect of number of comorbidities on abstinence. RESULTS Varenicline resulted in the highest week 12 abstinence rates across all pharmacotherapies and compared to placebo in all comorbidity subgroups: Cardiac (40.0% vs. 3.6%; odds ratios [OR] = 23.3 [5.1-107.1]), respiratory (24.7% vs. 12.8%; OR = 2.2 [1.3-3.8]), vascular (29.1% vs. 10.4%; OR = 3.6 [2.3-5.7]), and diabetes (30.9% vs. 8.3%; OR = 6.5 [2.3-19.0]). This was maintained at week 24 for those with cardiac (23.3% vs. 1.8%; OR = 21.7 [2.7-178.2]), vascular (18.9% vs. 7.1%; OR = 3.1 [1.8-5.3]), and diabetes (20.6% vs. 4.2%; OR = 8.4 [2.1-33.7]) comorbidities. Treatment contrasts within some comorbidity subgroups revealed superior efficacy of varenicline over other pharmacotherapies. All pharmacotherapies increased the odds of abstinence regardless of number of comorbidities. CONCLUSIONS Varenicline is the most efficacious option for patients with manageable cardiac, respiratory, vascular, and diabetes conditions to quit smoking, supporting recent clinical practice guidelines that recommend varenicline as first-line pharmacotherapy. Bupropion and NRT demonstrated efficacy for some comorbidity subgroups. IMPLICATIONS This secondary analysis of the EAGLES trial demonstrated that varenicline is the most efficacious option for patients with cardiac, respiratory, vascular, and diabetes diagnoses to quit smoking. This demonstration of varenicline efficacy among individuals with comorbid medical conditions supports recent clinical practice guidelines that recommend varenicline as a first-line pharmacotherapy for smoking cessation.
Collapse
Affiliation(s)
- Alana M Rojewski
- Department of Public Health Sciences, Medical University of South Carolina, Charleston SC, USA
- Hollings Cancer Center, Medical University of South Carolina, Charleston, SC, USA
| | - Amanda M Palmer
- Department of Public Health Sciences, Medical University of South Carolina, Charleston SC, USA
| | - Nathaniel L Baker
- Department of Public Health Sciences, Medical University of South Carolina, Charleston SC, USA
| | - Benjamin A Toll
- Department of Public Health Sciences, Medical University of South Carolina, Charleston SC, USA
- Hollings Cancer Center, Medical University of South Carolina, Charleston, SC, USA
| |
Collapse
|
7
|
Baldassarri SR, Chu JH, Deng A, Xu Z, Blohowiak RF, Byrne S, Kushida C, Yaggi HK, Zinchuk A. Nicotine, alcohol, and caffeine use among individuals with untreated obstructive sleep apnea. Sleep Breath 2023; 27:2479-2490. [PMID: 37058215 PMCID: PMC10576010 DOI: 10.1007/s11325-023-02830-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Revised: 02/22/2023] [Accepted: 04/07/2023] [Indexed: 04/15/2023]
Abstract
BACKGROUND Psychoactive substance use (i.e., nicotine, alcohol, and caffeine) has substantial effects on sleep architecture in healthy individuals, but their effects in those with obstructive sleep apnea (OSA) have not been well described. We aimed to describe the association between psychoactive substance use and sleep characteristics and daytime symptoms in individuals with untreated OSA. METHODS We performed a secondary, cross-sectional analysis of The Apnea Positive Pressure Long-term Efficacy Study (APPLES). Exposures included current smoking, alcohol and caffeine use in individuals with untreated OSA. Outcome domains included subjective and objective sleep characteristics, daytime symptoms, and comorbid conditions. Linear or logistic regression assessed the association between substance use and each domain (e.g., self-reported sleep duration, total polysomnographic sleep time, sleepiness, and anxiety). RESULTS Of the 919 individuals with untreated OSA, 116 (12.6%) were current cigarette smokers, 585 (63.7%) were moderate or heavy alcohol users, and 769 (83.7%) were moderate or heavy caffeine users. Participants were on average 52.2±11.9 years old, 65.2% were male with a median BMI of 30.6 (IQR: 27.2, 35.9, kg/m2). Current smokers exhibited lower sleep duration (0.3 h), longer sleep latency (5 min) compared with non-smokers (all p-values < 0.05). People with heavy or moderate alcohol use exhibited more REM sleep (2.5 and 5% of total sleep time respectively), as did those with moderate caffeine use (2%, p-values < 0.05). The combined smoker plus caffeine group exhibited shorter sleep duration (0.4 h, p-value < 0.05) and higher risk for chronic pain [Odds Ratio (95%CI) = 4.83 (1.57, 14.9) compared with non-users. CONCLUSIONS Psychoactive substance use is associated with sleep characteristics and clinically relevant correlates in people with untreated OSA. Further investigation into the effects that various substances have on this population may present opportunities to understand disease mechanisms more fully and increase the effectiveness of treatment in OSA.
Collapse
Affiliation(s)
- Stephen R Baldassarri
- Department of Internal Medicine, Section of Pulmonary, Critical Care, and Sleep Medicine, Yale School of Medicine, 300 Cedar Street, TAC-455E South, New Haven, CT, 06520, USA.
- Program in Addiction Medicine, Yale School of Medicine, New Haven, CT, USA.
- Program in Sleep Medicine, Yale School of Medicine, New Haven, CT, USA.
| | - Jen-Hwa Chu
- Department of Internal Medicine, Section of Pulmonary, Critical Care, and Sleep Medicine, Yale School of Medicine, 300 Cedar Street, TAC-455E South, New Haven, CT, 06520, USA
| | - Annan Deng
- Department of Internal Medicine, Section of Pulmonary, Critical Care, and Sleep Medicine, Yale School of Medicine, 300 Cedar Street, TAC-455E South, New Haven, CT, 06520, USA
| | - Zhichao Xu
- Department of Biostatistics, Yale University School of Public Health, New Haven, CT, USA
| | - Reagan F Blohowiak
- Department of Internal Medicine, Section of Pulmonary, Critical Care, and Sleep Medicine, Yale School of Medicine, 300 Cedar Street, TAC-455E South, New Haven, CT, 06520, USA
| | - Sean Byrne
- Department of Internal Medicine, Section of Pulmonary, Critical Care, and Sleep Medicine, Yale School of Medicine, 300 Cedar Street, TAC-455E South, New Haven, CT, 06520, USA
- Program in Sleep Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Clete Kushida
- Department of Psychiatry and Behavioral Sciences, Stanford University Medical Center, Palo Alto, CA, USA
| | - H Klar Yaggi
- Department of Internal Medicine, Section of Pulmonary, Critical Care, and Sleep Medicine, Yale School of Medicine, 300 Cedar Street, TAC-455E South, New Haven, CT, 06520, USA
- Program in Addiction Medicine, Yale School of Medicine, New Haven, CT, USA
- Program in Sleep Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Andrey Zinchuk
- Department of Internal Medicine, Section of Pulmonary, Critical Care, and Sleep Medicine, Yale School of Medicine, 300 Cedar Street, TAC-455E South, New Haven, CT, 06520, USA
- Program in Sleep Medicine, Yale School of Medicine, New Haven, CT, USA
- Advanced Apnea Management Program, Yale School of Medicine, New Haven, CT, USA
| |
Collapse
|
8
|
McGeoch LJ, Ross S, Massa MS, Lewington S, Clarke R. Cigarette smoking and risk of severe infectious respiratory diseases in UK adults: 12-year follow-up of UK biobank. J Public Health (Oxf) 2023; 45:e621-e629. [PMID: 37347589 PMCID: PMC10687597 DOI: 10.1093/pubmed/fdad090] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Indexed: 06/24/2023] Open
Abstract
BACKGROUND The relevance of tobacco smoking for infectious respiratory diseases (IRD) is uncertain. We investigated the associations of cigarette smoking with severe IRD resulting in hospitalization or death in UK adults. METHODS We conducted a prospective study of cigarette smoking and risk of severe IRD in UK Biobank. The outcomes included pneumonia, other acute lower respiratory tract infections (OA-LRTI) and influenza. Multivariable Cox regression analyses were used to estimate hazard ratios (HRs) of severe IRD associated with smoking habits after adjusting for confounding factors. RESULTS Among 341 352 participants with no prior history of major chronic diseases, there were 12 384 incident cases with pneumonia, 7054 with OA-LRTI and 795 with influenza during a 12-year follow-up. Compared with non-smokers, current smoking was associated with ⁓2-fold higher rates of severe IRD (HR 2.40 [2.27-2.53] for pneumonia, 1.99 [1.84-2.14] for OA-LRTI and 1.82 [95% confidence interval: 1.47-2.24] for influenza). Incidence of all severe IRDs were positively associated with amount of cigarettes smoked. The HRs for each IRD (except influenza) also declined with increasing duration since quitting. CONCLUSIONS Current cigarette smoking was positively associated with higher rates of IRD and the findings extend indications for tobacco control measures and vaccination of current smokers for prevention of severe IRD.
Collapse
Affiliation(s)
- Luke J McGeoch
- Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford OX3 7LF, UK
| | - Stephanie Ross
- Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford OX3 7LF, UK
| | - M Sofia Massa
- Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford OX3 7LF, UK
| | - Sarah Lewington
- Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford OX3 7LF, UK
- MRC Population Health Research Unit, Nuffield Department of Population Health, University of Oxford, Oxford OX3 7LF, UK
| | - Robert Clarke
- Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford OX3 7LF, UK
- MRC Population Health Research Unit, Nuffield Department of Population Health, University of Oxford, Oxford OX3 7LF, UK
| |
Collapse
|
9
|
Seng EK, Weinberger AH. Understanding the links between airborne hazards and headache disorders. Headache 2023; 63:1337-1338. [PMID: 37882325 PMCID: PMC10841836 DOI: 10.1111/head.14648] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Accepted: 10/09/2023] [Indexed: 10/27/2023]
Affiliation(s)
- Elizabeth K Seng
- Ferkauf Graduate School of Psychology, Yeshiva University, New York, New York, USA
- Albert Einstein College of Medicine, New York, New York, USA
- Veterans Health Administration Headache Centers of Excellence, Orange, Connecticut, USA
| | - Andrea H Weinberger
- Ferkauf Graduate School of Psychology, Yeshiva University, New York, New York, USA
- Albert Einstein College of Medicine, New York, New York, USA
| |
Collapse
|
10
|
Dirisanala S, Laller S, Ganti N, Taj S, Patel N, Singh Arora K, Williams I, Hameed A, Kuditipudi AD, Lei YW, Tirupathi R, Gupta S, Patel U, Venkata VS. E-cigarette use and prevalence of lung diseases among the U.S. population: a NHANES survey. J Investig Med 2023; 71:613-622. [PMID: 37052242 DOI: 10.1177/10815589231167357] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/14/2023]
Abstract
The primary aim of this study was to evaluate epidemiological characteristics and prevalence of lung disease among e-cigarettes users in the United States. A population-based, cross-sectional survey was performed using the National Health and Nutrition Examination Survey (NHANES) of 2015-2018. Adults using e-cigarettes (SMQ900), traditional smoking (SMQ020: > 100 cigarettes in lifetime or SMQ040: current cigarettes use), and dual smoking (e-cigarettes and traditional smoking) were identified and compared in their sociodemographic characteristics and prevalence of lung diseases (Asthma: MCQ010 and COPD: MCQ160O). We used the chi square test (categorical variables) and Mann-Whitney test and unpaired-student t test (continuous variables). p-value <0.05 was used as a reference. We excluded respondents <18 years and missing data on demographics and outcomes. Out of 178,157 respondents, 7745 (4.35%), 48,570 (27.26%), and 23,444 (13.16%) were e-cigarette smokers, traditional smokers, and dual smokers, respectively. Overall prevalence of asthma was 15.16% and COPD was 4.26%. E-cigarette smokers were younger in comparison to traditional smokers (median: 25 years vs 62 years; p < 0.0001). In females (49.34% vs 37.97%), Mexican (19.82% vs 13.35%), annual household income above $100,000 (23.97% vs 15.56%), prevalence of e-cigarette smoking was higher in comparison to traditional smoking (p < 0.0001). The prevalence of COPD was higher among dual smokers in comparison to e-cigarette and traditional smoking (10.14% vs 0.25% vs 8.11%; p < 0.0001). Prevalence of asthma was higher among dual and e-cigarette smokers in comparison with traditional smokers and non-smokers (22.44% vs 21.10% vs 14.46% vs 13.30%; p < 0.0001). Median age (Q1-Q3) was lower at which asthma (7 years (4-12) vs 25 years (8-50)) was diagnosed first among e-cigarettes smokers in comparison with traditional smokers. In a mixed effect multivariable logistic regression analysis, we found higher odds of asthma among e-cigarette users in comparison with non-smokers (Odds ratio (OR): 1.47; 95% Confidence Interval (CI): 1.21-1.78; p = 0.0001). Chronic Obstructive Pulmonary Disease (COPD) respondents were also associated with 11.28 higher odds of e-cigarette utilization (Oddsratio (OR): 11.28; 95% Confidence Interval (CI): 5.59-22.72; p < 0.0001). We conclude the higher prevalence of e-cigarette users is seen among the younger population, female, Mexican race, and annual income above $100,000 in comparison to traditional smokers. Chronic Obstructive Pulmonary Disease (COPD) and asthma were both more prevalent in dual smokers. As asthma was more prevalent and diagnosed at an early age in e-cigarette smokers, more prospective studies are needed to understand the effects of e-cigarette among the population at risk to mitigate the sudden rise in utilization and to create awareness.
Collapse
Affiliation(s)
- Sudha Dirisanala
- Department of Internal Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - Srishti Laller
- Department of Internal Medicine, University of Maryland Baltimore Washington Medical Center, Glen Burnie, MD, USA
| | - Naga Ganti
- Department of Internal Medicine, Keystone Health, Chambersburg, PA, USA
| | - Shafaq Taj
- Department of Internal Medicine, Larkin Community Hospital, Hialeah, FL, USA
| | - Neel Patel
- Massachusetts General Hospital, Boston, MA, USA
| | | | - Inemesit Williams
- Department of Internal Medicine, Kingsbrook Jewish Medical Center, Brooklyn, NY, USA
| | - Ayesha Hameed
- Department of Internal Medicine, Jinnah Hospital, Lahore, Pakistan
| | - Aasa Deepika Kuditipudi
- Department of Internal Medicine, Dr. Pinnamaneni Siddhartha Institute of Medical Sciences and Research Foundation, Gannavaram, Andhra Pradesh, India
| | - Yadanar Win Lei
- Department of Internal Medicine, St. Barnabas Hospital, Bronx, NY, USA
| | | | - Sachin Gupta
- Department of Internal Medicine, Penn State Health Milton S. Hershey Medical Center, Hershey, PA, USA
| | - Urvish Patel
- Department of Public Health and Neurology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | | |
Collapse
|
11
|
Elf JL, Horn K, Abroms L, Stanton CA, Cohn AM, Spielberg F, Gray T, Harvey E, Debnam C, Kierstead L, Levy ME, Castel A, Monroe A, Niaura R. Prevalence and Correlates of Cardiovascular, Pulmonary, Cancer, and Mental Health Comorbidities Among Adults With HIV Who Smoke. J Assoc Nurses AIDS Care 2023; 34:363-375. [PMID: 37378565 PMCID: PMC10803179 DOI: 10.1097/jnc.0000000000000416] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/29/2023]
Abstract
ABSTRACT Using data from the D.C. Cohort Longitudinal HIV Study, we examined (a) diagnosed mental health and (b) cardiovascular, pulmonary, or cancer (CPC) comorbidity among adults with HIV who smoked. Among 8,581 adults, 4,273 (50%) smoked; 49% of smokers had mental health, and 13% of smokers had a CPC comorbidity. Among smokers, non-Hispanic Black participants had a lower risk for mental health (prevalence ratio [PR]: 0.69; 95% confidence interval [CI] [0.62-0.76]) but a higher risk for CPC (PR: 1.17; 95% CI [0.84-1.62]) comorbidity. Male participants had a lower risk for mental health (PR: 0.88; 95% CI [0.81-0.94]) and CPC (PR: 0.68; 95% CI [0.57-0.81]) comorbidity. All metrics of socioeconomic status were associated with a mental health comorbidity, but only housing status was associated with a CPC comorbidity. We did not find any association with substance use. Gender, socioeconomic factors, and race/ethnicity should inform clinical care and the development of smoking cessation strategies for this population.
Collapse
Affiliation(s)
| | | | | | | | - Amy M. Cohn
- University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
| | | | - Tiffany Gray
- George Washington University, Washington, D.C., USA
| | | | - Charles Debnam
- Deputy Chief Executive Officer of Community Wellness Alliance, Washington, D.C., USA
| | | | | | | | - Anne Monroe
- George Washington University, Washington, D.C., USA
| | | |
Collapse
|
12
|
Zou X, Zou S, Guo Y, Peng D, Min H, Zhang R, Qin R, Mai J, Wu Y, Sun X. Association of smoking status and nicotine dependence with multi-morbidity in China: A nationally representative crosssectional study. Tob Induc Dis 2023; 21:81. [PMID: 37333503 PMCID: PMC10273826 DOI: 10.18332/tid/166110] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Revised: 04/11/2023] [Accepted: 05/12/2023] [Indexed: 06/20/2023] Open
Abstract
INTRODUCTION Multi-morbidity is a public health priority as it is associated with an increased risk of mortality and a substantial healthcare burden. Smoking is considered a predisposing factor for multi-morbidity, but evidence for an association between multi-morbidity and nicotine dependence is insufficient. This study aimed to explore the association between smoking status, nicotine dependence, and multi-morbidity in China. METHODS We recruited 11031 Chinese citizens from 31 provinces in 2021 using a multistage stratified cluster sampling strategy to ensure the study population represented national population characteristics. The association between smoking status and multi-morbidity was analyzed using binary logistic regression and multinomial logit regression models. We then analyzed the associations between four kinds of smoking status (age at smoking initiation, cigarette consumption per day, smoking when ill in bed, and inability to control smoking in public places), nicotine dependence, and multi-morbidity among participants who were current smokers. RESULTS Compared with non-smokers, the odds of multi-morbidity were higher among ex-smokers (adjusted odd ratio, AOR=1.40, 95% CI: 1.07-1.85). The risk of multi-morbidity was greater in participants who were underweight/overweight/obese (AOR=1.90; 95% CI: 1.60-2.26) compared with those who were normal weight. and also greater for drinkers (AOR=1.34; 95% CI: 1.09-1.63) than non-drinkers. Compared with children who began smoking at the age of <15 years, participants aged >18 years had a lower likelihood of multi-morbidity (AOR=0.52; 95% CI: 0.32-0.83). People who consumed ≥31 cigarettes per day (AOR=3.77; 95% CI: 1.47-9.68) and those who smoked when ill in bed (AOR=1.70; 95% CI: 1.10-2.64) were more likely to have multi-morbidity. CONCLUSIONS Our findings show that smoking behavior, including initiation age, frequency of daily smoking, and still smoking during illness or in public, is a critical risk factor for multi-morbidity, especially when combined with alcohol consumption, physical inactivity, and abnormal weight (underweight, overweight, or obese). This highlights the crucial effect of smoking cessation in the prevention and control of multi-morbidity, especially in patients with three or more diseases. Implementing smoking and lifestyle interventions to promote health would both benefit adults and prevent the next generation from initiating habits that increase the risk of multi-morbidity.
Collapse
Affiliation(s)
- Xinye Zou
- Faculty of Education, University of Cambridge, Cambridge, United Kingdom
- School of Public Health, Peking University, Beijing, China
| | - Siyu Zou
- School of Public Health, Peking University, Beijing, China
| | - Yi Guo
- School of Public Health, Peking University, Beijing, China
| | - Di Peng
- School of Education, Qingdao Hengxing University of Science and Technology, Qingdao, China
| | - Hewei Min
- School of Public Health, Peking University, Beijing, China
| | - Ruolin Zhang
- Department of Natural and Applied Science, Duke Kunshan University, Jiangsu, China
| | - Ruiwen Qin
- College of Foreign Languages, Nanjing University of Aeronautics and Astronautics, Nanjing, China
| | - Jianrong Mai
- School of Public Health, Peking University, Beijing, China
- School of Nursing, Guangzhou Xinhua University, Guangzhou, China
| | - Yibo Wu
- School of Public Health, Peking University, Beijing, China
| | - Xinying Sun
- School of Public Health, Peking University, Beijing, China
| |
Collapse
|
13
|
The Relationship of Tobacco Use and Migraine: A Narrative Review. Curr Pain Headache Rep 2023; 27:39-47. [PMID: 36905552 PMCID: PMC10006570 DOI: 10.1007/s11916-023-01103-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/14/2023] [Indexed: 03/12/2023]
Abstract
PURPOSE OF REVIEW Tobacco use is associated with significant health consequences especially for people with medical conditions. Although lifestyle strategies (e.g., sleep, diet) are commonly recommended as part of migraine treatment, tobacco-related strategies (e.g., smoking cessation) are rarely included. This review is aimed at elucidating what is known about tobacco use and migraine and at identifying gaps in the research. RECENT FINDINGS The prevalence of smoking is higher among people with migraine, and people with migraine believe that smoking makes migraine attacks worse. There is also evidence that smoking may exacerbate migraine-related consequences (e.g., stroke). Very few studies have examined other aspects of smoking and migraine or tobacco products other than cigarettes. There are significant gaps in our knowledge of smoking and migraine. More research is needed to understand the relationship of tobacco use to migraine and potential benefits of adding smoking cessation efforts into migraine care.
Collapse
|
14
|
Steinberg ML, Rosen RL, Ganz O, Wackowski OA, Jeong M, Delnevo CD. Communicating the benefits of quitting smoking on mental health increases motivation to quit in people with anxiety and/or depression: A randomized trial of two health messages. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.02.17.23286103. [PMID: 36865337 PMCID: PMC9980264 DOI: 10.1101/2023.02.17.23286103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/23/2023]
Abstract
Background Although smoking rates have declined over time, this decline has not been observed among those with mental health concerns. It is therefore important to develop effective messaging to support quitting in this population. Methods We conducted an online experiment with 419 adults who smoke cigarettes daily. Participants with, or without a lifetime history of anxiety and/or depression were randomized to view a message focused on the benefits of quitting smoking on mental or physical health. Participants then reported motivation to quit smoking, mental health concerns about quitting, and perceived effectiveness of the message. Results Participants with a lifetime history of anxiety and/or depression who saw the message focused on the benefits of quitting smoking on mental health reported greater motivation to quit than when they saw a message focused on the benefits to physical health. This was not replicated when examining current symptoms instead of lifetime history. Pre-existing beliefs that smoking improves one's mood were greater in those experiencing current symptoms and in those with a lifetime history of anxiety and/or depression. There was no main or interaction (message type X mental health status) effect of message type received on mental health related concerns about quitting. Conclusions This study is one of the first to evaluate a smoking cessation message with content specifically targeted to those with mental health concerns about quitting smoking. Additional work is needed to determine how to best target those with mental health concerns with messages focused on the benefits of quitting on mental health. Implications These data can begin to inform regulatory efforts to address tobacco use in those with comorbid anxiety and/or depression by providing information on how to effectively communicate the benefits of quitting smoking on mental health.
Collapse
Affiliation(s)
- Marc L. Steinberg
- Rutgers Robert Wood Johnson Medical School
- Rutgers Center for Tobacco Studies
| | - Rachel L. Rosen
- Rutgers, The State University of New Jersey
- Rutgers Center for Tobacco Studies
| | - Ollie Ganz
- Rutgers School of Public Health
- Rutgers Center for Tobacco Studies
| | | | - Michelle Jeong
- Rutgers School of Public Health
- Rutgers Center for Tobacco Studies
| | | |
Collapse
|
15
|
Kim N, Estrada J, Chow I, Ruseva A, Ramasamy A, Burudpakdee C, Blanchette CM. The Relative Value of Anti-Obesity Medications Compared to Similar Therapies. Clinicoecon Outcomes Res 2023; 15:51-62. [PMID: 36726966 PMCID: PMC9886521 DOI: 10.2147/ceor.s392276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Accepted: 01/11/2023] [Indexed: 01/27/2023]
Abstract
Purpose To demonstrate a need for improved health insurance coverage for anti-obesity medications (AOMs) by comparing clinical and economic benefits of obesity treatments to covered medications for selected therapeutic areas. Methods Using a grey literature search, we identified and prioritized therapeutic areas and treatment analogues for comparison to obesity. A targeted literature review identified clinical and economic outcomes research across the therapeutic area analogues. Associated comorbidities, clinical evidence, indirect costs (ie, absenteeism and productivity loss), and direct medical costs were evaluated to determine the relative value of treating obesity. Results Four therapeutic areas/treatment analogues were selected for comparison to obesity: smoking cessation (varenicline), daytime sleepiness (modafinil), migraines (erenumab), and fibromyalgia (pregabalin). Obesity was associated with 17 comorbidities, more than migraine (9), smoking (8), daytime sleepiness (5), and fibromyalgia (2). Economic burden was greatest for obesity, followed by smoking, with yearly indirect and direct medical costs totaling $676 and $345 billion, respectively. AOMs resulted in cost savings of $2586 in direct medical costs per patient per year (PPPY), greater than that for varenicline at $930 PPPY, modafinil at $1045 PPPY, and erenumab at $468 PPPY; pregabalin utilization increased costs by $924 PPPY. AOMs were covered by 10-16% of United States health insurance plans, compared to 45-59% for the four comparators. Conclusion Compared to four therapeutic analogues, obesity represented the highest economic burden and was associated with more comorbidities. AOMs provide greater cost savings compared to selected analogues. However, AOMs have limited formulary coverage. Improved coverage of AOMs may increase access to these treatments and may help address the clinical and economic burden associated with obesity and its comorbidities.
Collapse
Affiliation(s)
- Nina Kim
- Novo Nordisk, Inc, Plainsboro, NJ, USA
| | | | | | - Aleksandrina Ruseva
- Novo Nordisk, Inc, Plainsboro, NJ, USA,Correspondence: Aleksandrina Ruseva, Novo Nordisk, Inc, 800 Scudders Mill Road, Plainsboro, NJ, 08536, USA, Tel +1 609-598-8146, Email
| | | | | | | |
Collapse
|
16
|
Burke LA, Steffen AD, Kataria S, Watson KS, Winn RA, Oyaluade D, Williams B, Duangchan C, Asche C, Matthews AK. Associations in Cigarette Smoking and Health Conditions by Race/Ethnicity Among a Diverse Sample of Patients Receiving Treatment in a Federally Qualified Health Care Setting in Chicago. Health Equity 2023; 7:80-88. [PMID: 36876237 PMCID: PMC9982142 DOI: 10.1089/heq.2022.0056] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/19/2022] [Indexed: 02/05/2023] Open
Abstract
Purpose To examine the association of cigarette use and smoking-related health conditions by race/ethnicity among diverse and low-income patients at a federally qualified health center (FQHC). Methods Demographics, smoking status, health conditions, death, and health service use were extracted from electronic medical data for patients seen between September 1, 2018, and August 31, 2020 (n=51,670). Smoking categories included everyday/heavy smoker, someday/light smoker, former smoker, or never smoker. Results Current and former smoking rates were 20.1% and 15.2%, respectively. Males, Black, White, non-partnered, older, and Medicaid/Medicare patients were more likely to smoke. Compared with never smokers, former and heavy smokers had higher odds for all health conditions except respiratory failure, and light smokers had higher odds of asthma, chronic obstructive pulmonary disease, emphysema, and peripheral vascular disease. All smoking categories had more emergency department visits and hospitalizations than never smokers. The associations between smoking status and health conditions differed by race/ethnicity. White patients who smoked had a greater increase in odds of stroke and other cardiovascular diseases compared with Hispanic and Black patients. Black patients who smoked had a greater increase in odds of emphysema and respiratory failure compared with Hispanic patients. Black and Hispanic patients who smoked had a greater increase in emergency care use compared with White patients. Conclusion Smoking was associated with disease burden and emergency care and differed by race/ethnicity. Health Equity Implications Resources to document smoking status and offer cessation services should be increased in FQHCs to promote health equity for lower income populations.
Collapse
Affiliation(s)
- Larisa A Burke
- College of Nursing, University of Illinois Chicago, Chicago, Illinois, USA
| | - Alana D Steffen
- College of Nursing, University of Illinois Chicago, Chicago, Illinois, USA
| | - Sandeep Kataria
- Oncology Bioinformatics, University of Illinois Cancer Center, Chicago, Illinois, USA
| | - Karriem S Watson
- Office of Director, All of Us Research Program, National Institute of Health, Bethesda, Maryland, USA
| | | | - Damilola Oyaluade
- Oncology Bioinformatics, University of Illinois Cancer Center, Chicago, Illinois, USA
| | - Barbara Williams
- Oncology Bioinformatics, University of Illinois Cancer Center, Chicago, Illinois, USA
| | - Cherdsak Duangchan
- College of Nursing, University of Illinois Chicago, Chicago, Illinois, USA
| | - Carl Asche
- University of Illinois College of Medicine, Peoria, Illinois, USA
| | - Alicia K Matthews
- College of Nursing, University of Illinois Chicago, Chicago, Illinois, USA
| |
Collapse
|
17
|
Näslund-Koch C, Vedel-Krogh S, Bojesen SE, Skov L. Smoking is an independent but not a causal risk factor for moderate to severe psoriasis: A Mendelian randomization study of 105,912 individuals. Front Immunol 2023; 14:1119144. [PMID: 36911745 PMCID: PMC9992829 DOI: 10.3389/fimmu.2023.1119144] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Accepted: 02/06/2023] [Indexed: 02/24/2023] Open
Abstract
Background Smoking is strongly associated with higher risk of psoriasis in several observational studies; however, whether this association is causal or can be explained by confounding or reverse causation is not fully understood. Randomized controlled trials are the gold standard when examining causality; however, when this method is not feasible, the Mendelian randomization design is an alternative. Herein genetic variants can be used as robust proxies for modifiable exposures and thereby avoiding confounding and reverse causation.In this study, we hypothesized that smoking is an independent and causal risk factor for psoriasis and tested this using a Mendelian randomization design. Methods We used data from the Copenhagen General Population Study including 105,912 individuals with full information on lifestyle factors, biochemistry, and genotype data. In total, 1,240 cases of moderate to severe psoriasis were included to investigate the association between smoking and psoriasis. To assess causality of the association, we used the genetic variant CHRNA3 rs1051730, where the T-allele is strongly associated with high lifelong cumulative smoking, as a proxy for smoking. Results In observational analyses, the multivariable adjusted hazard ratio of developing moderate to severe psoriasis was 1.64 (95% confidence interval: 1.35-2.00) in ever smokers with ≤ 20 pack-years and 2.23 (1.82-2.73) in ever smokers with > 20 pack-years compared to never smokers. In genetic analyses, the odds ratio of developing moderate to severe psoriasis was 1.05 (0.95-1.16) per CHRNA3 rs10511730 T-allele in ever smokers. Conclusion Smoking was an independent risk factor for moderate to severe psoriasis in observational analyses. However, using a genetic variant as a robust proxy for smoking, we did not find this association to be causal.
Collapse
Affiliation(s)
- Charlotte Näslund-Koch
- Department of Dermatology and Allergy, Copenhagen University Hospital - Herlev and Gentofte, Copenhagen, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Signe Vedel-Krogh
- Department of Clinical Biochemistry, Copenhagen University Hospital - Herlev and Gentofte, Copenhagen, Denmark
| | - Stig Egil Bojesen
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark.,Department of Clinical Biochemistry, Copenhagen University Hospital - Herlev and Gentofte, Copenhagen, Denmark.,Copenhagen General Population Study, Copenhagen University Hospital - Herlev and Gentofte, Copenhagen, Denmark
| | - Lone Skov
- Department of Dermatology and Allergy, Copenhagen University Hospital - Herlev and Gentofte, Copenhagen, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| |
Collapse
|
18
|
Baldassarri SR, Asch RH, Hillmer AT, Pietrzak RH, DellaGioia N, Esterlis I, Davis MT. Nicotine Use and Metabotropic Glutamate Receptor 5 in Individuals With Major Depressive and Posttraumatic Stress Disorders. CHRONIC STRESS (THOUSAND OAKS, CALIF.) 2023; 7:24705470231154842. [PMID: 36843572 PMCID: PMC9943964 DOI: 10.1177/24705470231154842] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Accepted: 01/18/2023] [Indexed: 02/12/2023]
Abstract
Metabotropic glutamate receptor 5 (mGluR5) dysregulation has been implicated in the pathophysiology of many psychiatric disorders, as well as nicotine use and dependence. We used positron emission tomography with [18F]FPEB to measure mGluR5 availability in vivo in 6 groups: (1) nicotine users (NUs) without other psychiatric comorbidities (n = 23); (2) comparison controls (CCs) without nicotine use or psychiatric comorbidities (n = 38); (3) major depressive disorder subjects with concurrent nicotine use (MDD-NU; n = 19); (4) MDD subjects without concurrent nicotine use (MDD-CC; n = 20); (5) posttraumatic stress disorder subjects with concurrent nicotine use (PTSD-NU; n = 17); and (6) PTSD subjects without concurrent nicotine use (PTSD-CC; n = 16). The goal of the study was to test the hypothesis that mGluR5 availability in key corticolimbic regions of interest (ROIs) is different in NU with versus without comorbid psychiatric disorders (ROI: dorsolateral prefrontal cortex [dlPFC], orbitofrontal cortex [OFC], ventromedial prefrontal cortex [vmPFC], anterior cingulate cortex [ACC], amygdala, hippocampus). We found that NU had 11%-13% lower mGluR5 availability in OFC, vmPFC, dlPFC, and ACC as compared with CC, while PTSD-NU had 9%-11% higher mGluR5 availability in OFC, dlPFC, and ACC compared with PTSD. Furthermore, relationships between mGluR5 availability and psychiatric symptoms varied as a function of psychiatric diagnosis among NUs. NU showed a negative correlation between mGluR5 and smoking cravings and urges (r's = -0.58 to -0.70, p's = 0.011 - 0.047), while PTSD-NU had the reverse relationship (r's = 0.60-0.71, p's = 0.013-0.035 in ACC, vmPFC, and dlPFC). These findings have substantial implications for our understanding of glutamate homeostasis in psychiatric subgroups and for identifying key neural phenotypes among NU. mGluR5 is a potential treatment target for precision medicine in individuals with nicotine use.
Collapse
Affiliation(s)
- Stephen R. Baldassarri
- Section of Pulmonary, Critical Care, & Sleep Medicine,
Department of Internal Medicine, Yale University School of
Medicine, New Haven, CT, USA
- Program in Addiction Medicine, Yale University School of
Medicine, New Haven, CT, USA
| | - Ruth H. Asch
- Departments of Psychiatry, Yale University School of
Medicine, New Haven, CT, USA
| | - Ansel T. Hillmer
- Departments of Psychiatry, Yale University School of
Medicine, New Haven, CT, USA
- Department of Radiology and Biomedical Imaging, Radiology, and
Biomedical Imaging, New Haven, CT, USA
| | - Robert H. Pietrzak
- Departments of Psychiatry, Yale University School of
Medicine, New Haven, CT, USA
- VA National Center for PTSD Clinical Neurosciences Division, New
Haven, CT, USA
| | - Nicole DellaGioia
- Departments of Psychiatry, Yale University School of
Medicine, New Haven, CT, USA
| | - Irina Esterlis
- Departments of Psychiatry, Yale University School of
Medicine, New Haven, CT, USA
- VA National Center for PTSD Clinical Neurosciences Division, New
Haven, CT, USA
| | - Margaret T. Davis
- Departments of Psychiatry, Yale University School of
Medicine, New Haven, CT, USA
| |
Collapse
|
19
|
Clement L, Gencer B, Muller O, Klingenberg R, Räber L, Matter CM, Lüscher TF, Windecker S, Mach F, Rodondi N, Nanchen D, Clair C. Smoking Cessation in People With and Without Diabetes After Acute Coronary Syndrome. NICOTINE & TOBACCO RESEARCH : OFFICIAL JOURNAL OF THE SOCIETY FOR RESEARCH ON NICOTINE AND TOBACCO 2023; 25:58-65. [PMID: 35788681 DOI: 10.1093/ntr/ntac161] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Revised: 05/24/2022] [Accepted: 06/30/2022] [Indexed: 01/03/2023]
Abstract
INTRODUCTION People with diabetes smoke at similar rates as those without diabetes, with cardiovascular consequences. Smoking cessation rates were compared between people with and without diabetes 1 year after an acute coronary syndrome (ACS). AIMS AND METHODS People with ACS who smoked and were part of an observational prospective multicenter study in Switzerland were included from 2007 to 2017 and followed for 12 months. Seven-day point prevalence abstinence was assessed at 12 months follow-up. Association between diabetes and smoking cessation was assessed using multivariable-adjusted logistical regression model. RESULTS 2457 people with ACS who smoked were included, the mean age of 57 years old, 81.9% were men and 13.3% had diabetes. At 1 year, smoking cessation was 35.1% for people with diabetes and 42.6% for people without diabetes (P-value .01). After adjustment for age, sex, and educational level, people with diabetes who smoked were less likely to quit smoking compared with people without diabetes who smoked (odds ratio [OR] 0.76, 95% confidence interval [CI] 0.59-0.98, P-value = .037). The multivariable-adjusted model, with further adjustments for personal history of previous cardiovascular disease and cardiac rehabilitation attendance, attenuated this association (OR 0.85, 95% CI 0.65-1.12, P-value = .255). Among people with diabetes, cardiac rehabilitation attendance was a positive predictor of smoking cessation, and personal history of cardiovascular disease was a negative predictor of smoking cessation. CONCLUSIONS People with diabetes who smoke are less likely to quit smoking after an ACS and need tailored secondary prevention programs. In this population, cardiac rehabilitation is associated with increased smoking cessation. IMPLICATIONS This study provides new information on smoking cessation following ACSs comparing people with and without diabetes. After an ACS, people with diabetes who smoked were less likely to quit smoking than people without diabetes. Our findings highlight the importance of tailoring secondary prevention to people with diabetes.
Collapse
Affiliation(s)
- Ludivine Clement
- Service of Internal Medicine, Department of medicine, Fribourg Hospital, Fribourg, Switzerland
| | - Baris Gencer
- Division of Cardiology, Department of medicine, Faculty of Medicine, Geneva University Hospitals, Geneva, Switzerland.,Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland
| | - Olivier Muller
- Service of Cardiology, Department Hearth and Vessels, Lausanne University Hospital, Lausanne, Switzerland
| | - Roland Klingenberg
- Department of Cardiology, University Heart Center, University Hospital Zurich, Zurich, Switzerland
| | - Lorenz Räber
- Department of Cardiology, University Hospital Bern, Bern, Switzerland
| | - Christian M Matter
- Department of Cardiology, University Heart Center, University Hospital Zurich, Zurich, Switzerland
| | - Thomas F Lüscher
- Royal Brompton and Harefield Hospital Trust and Imperial College, London, UK
| | - Stephan Windecker
- Department of Cardiology, University Hospital Bern, Bern, Switzerland
| | - François Mach
- Division of Cardiology, Department of medicine, Faculty of Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - Nicolas Rodondi
- Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland.,Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - David Nanchen
- Center for Primary Care and Public Health (Unisanté), Department of Training Research and Innovation, University of Lausanne, Lausanne, Switzerland
| | - Carole Clair
- Center for Primary Care and Public Health (Unisanté), Department of Training Research and Innovation, University of Lausanne, Lausanne, Switzerland
| |
Collapse
|
20
|
Weinberger AH, Steinberg ML, Mills SD, Dermody SS, Heffner JL, Kong AY, Pang RD, Rosen RL. Assessing Sex, Gender Identity, Sexual Orientation, Race, Ethnicity, Socioeconomic Status, and Mental Health Concerns in Tobacco Use Disorder Treatment Research: Measurement Challenges and Recommendations From a Society for Research on Nicotine and Tobacco Pre-conference Workshop. Nicotine Tob Res 2022; 24:643-653. [PMID: 34622932 PMCID: PMC8962699 DOI: 10.1093/ntr/ntab201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Accepted: 10/04/2021] [Indexed: 11/15/2022]
Abstract
This paper reports on topics discussed at a Society for Research on Nicotine and Tobacco pre-conference workshop at the 2019 annual Society for Research on Nicotine and Tobacco meeting. The goal of the pre-conference workshop was to help develop a shared understanding of the importance of several tobacco-related priority groups in tobacco use disorder (TUD) treatment research and to highlight challenges in measurement related to these groups. The workshop focused on persons with minoritized sex, gender identity, and sexual orientation identities; persons with minoritized racial and ethnic backgrounds; persons with lower socioeconomic status (SES); and persons with mental health concerns. In addition to experiencing commercial tobacco-related health disparities, these groups are also underrepresented in tobacco research, including TUD treatment studies. Importantly, there is wide variation in how and whether researchers are identifying variation within these priority groups. Best practices for measuring and reporting sex, gender identity, sexual orientation, race, ethnicity, SES, and mental health concerns in TUD treatment research are needed. This paper provides information about measurement challenges when including these groups in TUD treatment research and specific recommendations about how to measure these groups and assess potential disparities in outcomes. The goal of this paper is to encourage TUD treatment researchers to use measurement best practices in these priority groups in an effort to conduct meaningful and equity-promoting research. Increasing the inclusion and visibility of these groups in TUD treatment research will help to move the field forward in decreasing tobacco-related health disparities. Implications: Tobacco-related disparities exist for a number of priority groups including, among others, women, individuals with minoritized sexual and gender identities, individuals with minoritized racial and ethnic backgrounds, individuals with lower SES, and individuals with mental health concerns. Research on TUD treatments for many of these subgroups is lacking. Accurate assessment and consideration of these subgroups will provide needed information about efficacious and effective TUD treatments, about potential mediators and moderators, and for accurately describing study samples, all critical elements for reducing tobacco-related disparities, and improving diversity, equity, and inclusion in TUD treatment research.
Collapse
Affiliation(s)
- Andrea H Weinberger
- Ferkauf Graduate School of Psychology, Yeshiva University, Bronx, NY, USA
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Marc L Steinberg
- Department of Psychiatry, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | - Sarah D Mills
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Sarah S Dermody
- Department of Psychology, Ryerson University, Toronto, Ontario, Canada
| | - Jaimee L Heffner
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA,USA
| | - Amanda Y Kong
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Raina D Pang
- Department of Preventive Medicine, Keck School of Medicine at University of Southern California, Los Angeles, CA, USA
- Department of Psychology, University of Southern California, Los Angeles, CA, USA
| | - Rachel L Rosen
- Department of Psychiatry, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
- Department of Psychology, Rutgers, The State University of New Jersey, Piscataway, NJ, USA
| |
Collapse
|
21
|
Kim Y, Cho WK. Factors associated with quitting status of smoking in Korean
men with and without chronic kidney disease: A national
population-based study. Tob Induc Dis 2022; 20:17. [PMID: 35280044 PMCID: PMC8851896 DOI: 10.18332/tid/145698] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Revised: 11/30/2021] [Accepted: 01/11/2022] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION Adverse effects of smoking on kidney function have been demonstrated in both general populations and in populations with chronic kidney disease (CKD). Therefore, quitting smoking can have a significant impact on the mortality and disease progression of CKD. This study examined and compared factors associated with quitting status of smoking, in patients with and without CKD, among Korean adult male smokers, using the Korea National Health and Nutrition Examination Survey from 2008 to 2019, excluding 2013. METHODS Wald test with multiple logistic regression was performed to investigate factors associated with quitting smoking in both CKD and non-CKD groups, along with the interaction effects between groups. RESULTS Of the 15747 eligible individuals, 909 had CKD, of whom 703 (weighted percentage: 74.4%) were quitters. In the non-CKD group, 8393 (weighted percentage: 50.4%) succeeded in quitting. Regular exercise was the only factor associated with quitting in both groups. The adjusted odd ratios with confidence intervals were 1.29 (95% CI: 1.17–1.42) and 2.84 (95% CI: 1.52–5.31) in the non-CKD and CKD groups, respectively (interaction p=0.0153). Unlike in the CKD group, marriage and higher systolic blood pressure were also associated with quitting, and lifetime smoking amount and secondhand smoke exposure at home were negatively associated with smoking cessation in the non-CKD group. CONCLUSIONS Exercise was the only factor associated with quitting smoking in the CKD group.
Collapse
Affiliation(s)
- Youngmee Kim
- Red Cross College of Nursing, Chung-Ang University, Seoul, Republic of Korea
| | - Won-Kyung Cho
- Department of Pulmonology and Critical Care Medicine, Asan Medical Center, University of Ulsan, Seoul, Republic of Korea
- International Healthcare Center, Asan Medical Center, University of Ulsan, Seoul, Republic of Korea
| |
Collapse
|
22
|
Abstract
OBJECTIVE Chronic cough (CC) is a debilitating respiratory symptom, now increasingly recognised as a discrete disease entity. This study evaluated the burden of CC in a primary care setting. DESIGN Cross-sectional, retrospective cohort study. SETTING Discover dataset from North West London, which links coded data from primary and secondary care. The index date depicted CC persisting for ≥8 weeks and was taken as a surrogate for date of CC diagnosis. PARTICIPANTS Data were extracted for individuals aged ≥18 years with a cough persisting ≥8 weeks or cough remedy prescription, between Jan 2015 and Sep 2019. MAIN OUTCOME MEASURES Demographic characteristics, comorbidities and service utilisation cost, including investigations performed and treatments prescribed were determined. RESULTS CC was identified in 43 453 patients from a total cohort of 2 109 430 (2%). Median (IQR) age was 64 years (41-87). Among the cohort, 31% had no recorded comorbidities, 26% had been given a diagnosis of asthma, 17% chronic obstructive pulmonary disease, 12% rhinitis and 15% reflux. Prevalence of CC was greater in women (57%) and highest in the 65-74 year age range. There was an increase in the number of all investigations performed in the 12 months before and after the index date of CC diagnosis, and in particular for primary care chest X-ray and spirometry which increased from 6535 to 12 880 and from 5791 to 8720, respectively. This was accompanied by an increase in CC-associated healthcare utilisation costs. CONCLUSION One-third of individuals had CC in the absence of associated comorbidities, highlighting the importance of recognising CC as a condition in its own right. Overall outpatient costs increased in the year after the CC index date for all comorbidities, but varied significantly with age. Linked primary-care datasets may enable earlier detection of individuals with CC for specialist clinic referral and targeted treatment.
Collapse
Affiliation(s)
- James H Hull
- Department of Respiratory Medicine, Royal Brompton and Harefield NHS Foundation Trust, London, UK
| | | | - Zia Ul-Haq
- Imperial College Health Partners, London, UK
| | | | | | - Mark L Levy
- Self Employed General Practitioner, London, UK
| |
Collapse
|
23
|
Mistry SK, Ali ARMM, Yadav UN, Huda MN, Ghimire S, Rahman MA, Reza S, Huque R, Rahman MA. Perceived Change in Tobacco Use and Its Associated Factors among Older Adults Residing in Rohingya Refugee Camps during the COVID-19 Pandemic in Bangladesh. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182312349. [PMID: 34886073 PMCID: PMC8657143 DOI: 10.3390/ijerph182312349] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Revised: 11/15/2021] [Accepted: 11/22/2021] [Indexed: 12/13/2022]
Abstract
This study explored the perceived change in tobacco use during the COVID-19 pandemic and its associated factors among older adults residing in Rohingya refugee camps, also referred to as Forcibly Displaced Myanmar Nationals in Bangladesh. The study followed a cross-sectional design and was conducted in October 2020 among 416 older adults aged 60 years and above. A purposive sampling technique was applied to identify eligible participants, and face-to-face interviews were conducted using a pre-tested semi-structured questionnaire to collect the data. Participants were asked if they noted any change in their tobacco use patterns (smoking or smokeless tobacco) during the COVID-19 pandemic compared to pre-pandemic. Binary logistic regression models determined the factors associated with the perceived change in tobacco use. More than one in five participants (22.4%) were current tobacco users, of whom 40.8% reported a perceived increase in tobacco use during the COVID-19 pandemic. Adjusted analysis revealed that participants who were concerned about COVID-19 had significantly (p < 0.05) lower odds of perceived increase in tobacco use (aOR = 0.22, 95% CI: 0.06–0.73), while older adults who were overwhelmed by COVID-19 (aOR = 0.26, 95% CI: 0.06–1.18) and communicated less frequently with others during the pandemic than before (aOR = 0.19, 95% CI: 0.03–1.20) had marginally significantly (p < 0.1) lower odds of perceived increase in tobacco use during this pandemic. Relevant stakeholders, policymakers, and practitioners need to focus on strengthening awareness-raising initiatives as part of an emergency preparedness plan to control tobacco use during such a crisis period.
Collapse
Affiliation(s)
- Sabuj Kanti Mistry
- ARCED Foundation, Dhaka 1216, Bangladesh;
- Centre for Primary Health Care and Equity, University of New South Wales, Kensington, NSW 2052, Australia;
- BRAC James P Grant School of Public Health, BRAC University, Dhaka 1213, Bangladesh
- Department of Public Health, Daffodil International University, Dhaka 1207, Bangladesh
- Correspondence: ; Tel.: +61-4068-63358
| | - ARM Mehrab Ali
- ARCED Foundation, Dhaka 1216, Bangladesh;
- Global Research and Data Support, Innovations for Poverty Action, New Haven, CT 06510, USA
| | - Uday Narayan Yadav
- Centre for Primary Health Care and Equity, University of New South Wales, Kensington, NSW 2052, Australia;
- National Centre for Epidemiology and Population Health, Research School of Population Health, The Australian National University, Canberra, ACT 2600, Australia
| | - Md. Nazmul Huda
- School of Health Sciences, Western Sydney University, Sydney, NSW 2560, Australia;
- The School of Liberal Arts and Social Sciences, Independent University, Dhaka 1229, Bangladesh
| | - Saruna Ghimire
- Department of Sociology and Gerontology and Scripps Gerontology Center, Miami University, Oxford, OH 45056, USA;
| | | | - Sompa Reza
- Institute of Nutrition and Food Science, University of Dhaka, Dhaka 1000, Bangladesh;
| | - Rumana Huque
- Department of Economics, University of Dhaka, Dhaka 1000, Bangladesh;
- ARK Foundation, Gulshan, Dhaka 1212, Bangladesh
| | - Muhammad Aziz Rahman
- School of Health, Federation University Australia, Berwick, VIC 3350, Australia;
- Department of Non-Communicable Diseases, Bangladesh University of Health Sciences (BUHS), Dhaka 1216, Bangladesh
- Faculty of Public Health, Universitas Airlangga, Surabaya 60115, Indonesia
| |
Collapse
|
24
|
Parikh NS, Parasram M, White H, Merkler AE, Navi BB, Kamel H. Smoking Cessation in Stroke Survivors in the United States: A Nationwide Analysis. Stroke 2021; 53:1285-1291. [PMID: 34784739 DOI: 10.1161/strokeaha.121.036941] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE Continued smoking after stroke is associated with a high risk of stroke recurrence and other cardiovascular disease. We sought to comprehensively understand the epidemiology of smoking cessation in stroke survivors in the United States. Furthermore, we compared smoking cessation in stroke and cancer survivors because cancer is another smoking-related condition in which smoking cessation is prioritized. METHODS We performed a cross-sectional analysis of data from the Centers for Disease Control and Prevention Behavioral Risk Factor Surveillance System, an annual, nationally representative health survey. Using pooled data from 2013 to 2019, we identified stroke and cancer survivors with a history of smoking. We used survey procedures to estimate frequencies and summarize quit ratios with attention to demographic and geographic (state-wise and rural-urban) factors for stroke survivors. The quit ratio is conventionally defined as the proportion of ever smokers who have quit. Then, we used multivariable logistic regression to compare quit ratios in stroke and cancer survivors while adjusting for demographics and smoking-related comorbidities. RESULTS Among 4 434 604 Americans with a history of stroke and smoking, the median age was 68 years (interquartile range, 59-76), and 45.4% were women. The overall quit ratio was 60.8% (95% CI, 60.1%-61.6%). Quit ratios varied by age group, sex, race and ethnicity, and several geographic factors. There was marked geographic variation in quit ratios, ranging from 48.3% in Kentucky to 71.5% in California. Furthermore, compared with cancer survivors, stroke survivors were less likely to have quit smoking (odds ratio, 0.72 [95% CI, 0.67-0.79]) after accounting for differences in demographics and smoking-related comorbidities. CONCLUSIONS There were considerable demographic and geographic disparities in smoking quit ratios in stroke survivors, who were less likely to have quit smoking than cancer survivors. A targeted initiative is needed to improve smoking cessation for stroke survivors.
Collapse
Affiliation(s)
- Neal S Parikh
- Clinical and Translational Neuroscience Unit, Feil Family Brain and Mind Research Institute and Department of Neurology, Weill Cornell Medicine, New York, NY
| | - Melvin Parasram
- Clinical and Translational Neuroscience Unit, Feil Family Brain and Mind Research Institute and Department of Neurology, Weill Cornell Medicine, New York, NY
| | - Halina White
- Clinical and Translational Neuroscience Unit, Feil Family Brain and Mind Research Institute and Department of Neurology, Weill Cornell Medicine, New York, NY
| | - Alexander E Merkler
- Clinical and Translational Neuroscience Unit, Feil Family Brain and Mind Research Institute and Department of Neurology, Weill Cornell Medicine, New York, NY
| | - Babak B Navi
- Clinical and Translational Neuroscience Unit, Feil Family Brain and Mind Research Institute and Department of Neurology, Weill Cornell Medicine, New York, NY
| | - Hooman Kamel
- Clinical and Translational Neuroscience Unit, Feil Family Brain and Mind Research Institute and Department of Neurology, Weill Cornell Medicine, New York, NY
| |
Collapse
|
25
|
Salloum RG, D'Angelo H, Theis RP, Rolland B, Hohl S, Pauk D, LeLaurin JH, Asvat Y, Chen LS, Day AT, Goldstein AO, Hitsman B, Hudson D, King AC, Lam CY, Lenhoff K, Levinson AH, Prochaska J, Smieliauskas F, Taylor K, Thomas J, Tindle H, Tong E, White JS, Vogel WB, Warren GW, Fiore M. Mixed-methods economic evaluation of the implementation of tobacco treatment programs in National Cancer Institute-designated cancer centers. Implement Sci Commun 2021; 2:41. [PMID: 33836840 PMCID: PMC8033545 DOI: 10.1186/s43058-021-00144-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2021] [Accepted: 04/01/2021] [Indexed: 11/25/2022] Open
Abstract
Background The Cancer Center Cessation Initiative (C3I) was launched in 2017 as a part of the NCI Cancer Moonshot program to assist NCI-designated cancer centers in developing tobacco treatment programs for oncology patients. Participating centers have implemented varied evidence-based programs that fit their institutional resources and needs, offering a wide range of services including in-person and telephone-based counseling, point of care, interactive voice response systems, referral to the quitline, text- and web-based services, and medications. Methods We used a mixed methods comparative case study design to evaluate system-level implementation costs across 15 C3I-funded cancer centers that reported for at least one 6-month period between July 2018 and June 2020. We analyzed operating costs by resource category (e.g., personnel, medications) concurrently with transcripts from semi-structured key-informant interviews conducted during site visits. Personnel salary costs were estimated using Bureau of Labor Statistics wage data adjusted for area and occupation, and non-wage benefits. Qualitative findings provided additional information on intangible resources and contextual factors related to implementation costs. Results Median total monthly operating costs across funded centers were $11,045 (range: $5129–$20,751). The largest median operating cost category was personnel ($10,307; range: $4122–$19,794), with the highest personnel costs attributable to the provision of in-person program services. Monthly (non-zero) cost ranges for other categories were medications ($17–$573), materials ($6–$435), training ($96–$516), technology ($171–$2759), and equipment ($10–$620). Median cost-per-participant was $466 (range: $70–$2093) and cost-per-quit was $2688 (range: $330–$9628), with sites offering different combinations of program components, ranging from individually-delivered in-person counseling only to one program that offered all components. Site interviews provided context for understanding variations in program components and their cost implications. Conclusions Among most centers that have progressed in tobacco treatment program implementation, cost-per-quit was modest relative to other prevention interventions. Although select centers have achieved similar average costs by offering program components of various levels of intensity, they have varied widely in program reach and effectiveness. Evaluating implementation costs of such programs alongside reach and effectiveness is necessary to provide decision makers in oncology settings with the important additional information needed to optimize resource allocation when establishing tobacco treatment programs.
Collapse
Affiliation(s)
- Ramzi G Salloum
- Department of Health Outcomes and Biomedical Informatics, University of Florida College of Medicine, 2004 Mowry Road, Gainesville, FL, USA.
| | | | - Ryan P Theis
- Department of Health Outcomes and Biomedical Informatics, University of Florida College of Medicine, 2004 Mowry Road, Gainesville, FL, USA
| | - Betsy Rolland
- University of Wisconsin Carbone Cancer Center, Madison, WI, USA.,University of Wisconsin Institute for Clinical and Translational Research, Madison, WI, USA
| | - Sarah Hohl
- University of Wisconsin Carbone Cancer Center, Madison, WI, USA
| | - Danielle Pauk
- University of Wisconsin Carbone Cancer Center, Madison, WI, USA
| | - Jennifer H LeLaurin
- Department of Health Outcomes and Biomedical Informatics, University of Florida College of Medicine, 2004 Mowry Road, Gainesville, FL, USA
| | - Yasmin Asvat
- Rush University Medical Center and Rush Cancer Center, Chicago, IL, USA
| | - Li-Shiun Chen
- Washington University Siteman Cancer Center, St Louis, MO, USA
| | - Andrew T Day
- University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Adam O Goldstein
- University of North Carolina Lineberger Cancer Center, Chapel Hill, NC, USA
| | - Brian Hitsman
- Northwestern University Feinberg School of Medicine and Lurie Comprehensive Cancer Center of Northwestern University, Chicago, IL, USA
| | - Deborah Hudson
- Indiana University Simon Cancer Center, Indianapolis, IN, USA
| | - Andrea C King
- University of Chicago Medicine Comprehensive Cancer Center, Chicago, IL, USA
| | - Cho Y Lam
- Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA
| | - Katie Lenhoff
- Dartmouth-Hitchcock Norris Cotton Cancer Center, Lebanon, NH, USA
| | | | - Judith Prochaska
- Stanford Cancer Institute, Stanford University, Stanford, CA, USA
| | | | - Kathryn Taylor
- Georgetown University Lombardi Comprehensive Cancer Center, Washington, DC, USA
| | - Janet Thomas
- University of Minnesota Masonic Cancer Center, Minneapolis, MN, USA
| | - Hilary Tindle
- Vanderbilt University Medical Center Vanderbilt-Ingram Cancer Center, Nashville, TN, USA
| | - Elisa Tong
- University of California Davis Comprehensive Cancer Center, Sacramento, CA, USA
| | - Justin S White
- Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, CA, USA
| | - W Bruce Vogel
- Department of Health Outcomes and Biomedical Informatics, University of Florida College of Medicine, 2004 Mowry Road, Gainesville, FL, USA
| | - Graham W Warren
- Medical University of South Carolina Hollings Cancer Center, Charleston, SC, USA
| | - Michael Fiore
- University of Wisconsin Carbone Cancer Center, Madison, WI, USA.,University of Wisconsin Institute for Clinical and Translational Research, Madison, WI, USA.,University of Wisconsin Center for Tobacco Research and Intervention, Madison, WI, USA
| |
Collapse
|
26
|
Loutradis C, Pickup L, Law JP, Dasgupta I, Townend JN, Cockwell P, Sharif A, Sarafidis P, Ferro CJ. Acute kidney injury is more common in men than women after accounting for socioeconomic status, ethnicity, alcohol intake and smoking history. Biol Sex Differ 2021; 12:30. [PMID: 33832522 PMCID: PMC8034098 DOI: 10.1186/s13293-021-00373-4] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Accepted: 03/19/2021] [Indexed: 12/03/2022] Open
Abstract
Background The association of several comorbidities, including diabetes mellitus, hypertension, cardiovascular disease, heart failure and chronic kidney or liver disease, with acute kidney injury (AKI) is well established. Evidence on the effect of sex and socioeconomic factors are scarce. This study was designed to examine the association of sex and socioeconomic factors with AKI and AKI-related mortality and further to evaluate the additional relationship with other possible risk factors for AKI occurrence. Methods We included 3534 patients (1878 males with mean age 61.1 ± 17.7 and 1656 females 1656 with mean age 60.3 ± 20.0 years) admitted to Queen Elizabeth or Heartlands Hospitals, Birmingham, between October 2013 and January 2016. Patients were prospectively followed-up for a median 47.70 [IQR, 18.20] months. Study-endpoints were incidence of AKI, based on KDIGO-AKI Guidelines, and all-cause mortality. Data acquisition was automated, and information on mortality was collected from the Hospital Episode Statistics and Office of National Statistics. Socioeconomic status was evaluated with the Index of Multiple Deprivation (IMD). Results Incidence of AKI was higher in men compared to women (11.3% vs 7.1%; P < 0.001). Model regression analysis revealed significant association of male sex with higher AKI risk (OR, 1.659; 95% CI, 1.311–2.099; P < 0.001); this association remained significant after adjustment for age, eGFR, IMD, smoking, alcohol consumption, ethnicity, existing comorbidities and treatment (OR, 1.599; 95% CI, 1.215–2.103; P = 0.001). All-cause mortality was higher in patients with compared to those without AKI. Males with AKI had higher mortality rates in the first 6-month and 1-year periods after the index AKI event. The association of male sex with mortality was independent of socioeconomic factors but was not statistically significant after adjustment for existing comorbidities. Conclusions Men are at higher risk of AKI and this association is independent from existing risk factors for AKI. The association between male sex and AKI-related mortality was not independent from existing comorbidities. A better understanding of factors associated with AKI may help accurately identify high-risk patients. Supplementary Information The online version contains supplementary material available at 10.1186/s13293-021-00373-4.
Collapse
Affiliation(s)
- Charalampos Loutradis
- Department of Renal Medicine, University Hospitals Birmingham NHS Foundation Trust, Birmingham, B15 2GW, UK. .,Department of Nephrology, Hippokration Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece.
| | - Luke Pickup
- Institute of Cardiovascular Sciences, College of Medical and Dental Sciences, Edgbaston, Birmingham, B15 2TT, UK.,Warwick Medical School, University of Warwick, Coventry, CV4 7HL, UK
| | - Jonathan P Law
- Department of Renal Medicine, University Hospitals Birmingham NHS Foundation Trust, Birmingham, B15 2GW, UK.,Institute of Cardiovascular Sciences, College of Medical and Dental Sciences, Edgbaston, Birmingham, B15 2TT, UK
| | - Indranil Dasgupta
- Department of Renal Medicine, University Hospitals Birmingham NHS Foundation Trust, Birmingham, B15 2GW, UK.,Warwick Medical School, University of Warwick, Coventry, CV4 7HL, UK
| | - Jonathan N Townend
- Institute of Cardiovascular Sciences, College of Medical and Dental Sciences, Edgbaston, Birmingham, B15 2TT, UK.,Department of Cardiology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, B15 2GW, UK
| | - Paul Cockwell
- Department of Renal Medicine, University Hospitals Birmingham NHS Foundation Trust, Birmingham, B15 2GW, UK
| | - Adnan Sharif
- Department of Renal Medicine, University Hospitals Birmingham NHS Foundation Trust, Birmingham, B15 2GW, UK
| | - Pantelis Sarafidis
- Department of Nephrology, Hippokration Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Charles J Ferro
- Department of Renal Medicine, University Hospitals Birmingham NHS Foundation Trust, Birmingham, B15 2GW, UK.,Institute of Cardiovascular Sciences, College of Medical and Dental Sciences, Edgbaston, Birmingham, B15 2TT, UK
| |
Collapse
|
27
|
Abstract
Electronic cigarettes (EC) are battery-operated devices that heat and aerosolize a liquid solution that typically contains nicotine. ECs have become commonly used among youth and may pose substantial risks of future addiction and health problems in this population. However, ECs are far less toxic per puff compared with combustible cigarettes, and as a result, might present an important harm reduction opportunity for cigarette smokers who cannot stop smoking by traditional means. The long-term health effects of ECs on individuals and the net effect on public health will remain unknown for many years.
Collapse
|
28
|
Abstract
COPD represents a major cause of mortality and morbidity worldwide, is linked to systemic inflammation and tends to coexist with a variety of comorbidities. Inflammation, oxidative stress and protease-antiprotease imbalance represent the pathogenic triad of COPD. Even though oxidative stress and mitochondrial dysfunction is a well-studied phenomenon in COPD and there is a variety of studies that aim to counteract its effect, there is limited data available on the use of coenzyme Q10 in COPD. The aim of the current review is to analyze the current data on the use of coenzyme Q10 in the management of COPD and frequently encountered comorbidities.
Collapse
Affiliation(s)
- V I Zozina
- Department of Clinical Pharmacology and Propaedeutics of Internal Diseases, Federal State Autonomous Educational Institution of Higher Education I.M. Sechenov First Moscow State Medical University of the Ministry of Health of the Russian Federation, Moscow, Russian Federation
| | - S Covantev
- Russian Medical Academy of Continuous Professional Education, Moscow, Russian Federation
| | - V G Kukes
- Department of Clinical Pharmacology and Propaedeutics of Internal Diseases, Federal State Autonomous Educational Institution of Higher Education I.M. Sechenov First Moscow State Medical University of the Ministry of Health of the Russian Federation, Moscow, Russian Federation
| | - A Corlateanu
- Department of Respiratory Medicine, State University of Medicine and Pharmacy N. Testemitanu, Chisinau, Republic of Moldova
| |
Collapse
|
29
|
Palmer AM, Rojewski AM, Chen LS, Fucito LM, Galiatsatos P, Kathuria H, Land SR, Morgan GD, Ramsey AT, Richter KP, Wen X, Toll BA. Tobacco Treatment Program Models in US Hospitals and Outpatient Centers on Behalf of the SRNT Treatment Network. Chest 2020; 159:1652-1663. [PMID: 33259805 DOI: 10.1016/j.chest.2020.11.025] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Revised: 11/17/2020] [Accepted: 11/18/2020] [Indexed: 01/13/2023] Open
Abstract
Because tobacco use remains one of the leading causes of disease, disability, and mortality, tobacco treatment programs should be integrated into medical systems such as hospitals and outpatient centers. Medical providers have a unique, high-impact opportunity to initiate smoking cessation treatment with patients. However, there are several barriers that may hinder the development and implementation of these programs. The purpose of this review was to address such barriers by illustrating several examples of successful tobacco treatment programs in US health-care systems that were contributed by the authors. This includes describing treatment models, billing procedures, and implementation considerations. Using an illustrative review of vignettes from existing programs, various models are outlined, emphasizing commonalities and unique features, strengths and limitations, resources necessary, and other relevant considerations. In addition, clinical research and dissemination trials from each program are described to provide evidence of feasibility and efficacy from these programs. This overview of example treatment models designed for hospitals and outpatient centers provides guidelines for any emerging tobacco cessation services within these contexts. For existing treatment programs, this review provides additional insight and ideas about improving these programs within their respective medical systems.
Collapse
Affiliation(s)
- Amanda M Palmer
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC
| | - Alana M Rojewski
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC
| | - Li-Shiun Chen
- Department of Psychiatry, Washington University in St. Louis, St. Louis, MO
| | - Lisa M Fucito
- Department of Psychiatry, Yale School of Medicine, New Haven, CT
| | - Panagis Galiatsatos
- Department of Pulmonary and Critical Care Medicine, Johns Hopkins University, Baltimore MD
| | - Hasmeena Kathuria
- The Pulmonary Center, Boston University Medical Center, Boston University, Boston, MA
| | - Stephanie R Land
- Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, MD
| | - Glen D Morgan
- Department of Family Medicine, University of North Carolina, Chapel Hill, NC
| | - Alex T Ramsey
- Department of Psychiatry, Washington University in St. Louis, St. Louis, MO
| | - Kimber P Richter
- Department of Population Health, University of Kansas Medical Center, Kansas City, KS
| | - Xiaozhong Wen
- Department of Pediatrics, Jacobs School of Medicine and Biomedical Sciences, State University of New York at Buffalo, Buffalo, NY
| | - Benjamin A Toll
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC.
| |
Collapse
|
30
|
Sifat AE, Nozohouri S, Villalba H, Vaidya B, Abbruscato TJ. The Role of Smoking and Nicotine in the Transmission and Pathogenesis of COVID-19. J Pharmacol Exp Ther 2020; 375:498-509. [PMID: 33033170 DOI: 10.1124/jpet.120.000170] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Accepted: 09/30/2020] [Indexed: 01/08/2023] Open
Abstract
Coronavirus disease 2019 (COVID-19), caused by the severe acute respiratory syndrome coronavirus 2 virus, is turning out to be one of the most devastating global pandemics in the history of humankind. There is a shortage of effective therapeutic strategies or preventative vaccines for this disease to date. A rigorous investigation is needed for identifying and developing more effective therapeutic strategies for COVID-19. Angiotensin-converting enzyme 2 (ACE2), a crucial factor in COVID-19 pathogenesis, has been identified as a potential target for COVID-19 treatment. Smoking and vaping are potential risk factors for COVID-19 that are also shown to upregulate ACE2 expression. In this review, we have discussed the pathobiology of COVID-19 in the lungs and brain and the role of ACE2 in the transmission and pathobiology of this disease. Furthermore, we have shown possible interactions between nicotine/smoking and ACE2 in the lungs and brain, which could aggravate the transmission and pathobiology of COVID-19, resulting in a poor disease outcome. SIGNIFICANCE STATEMENT: This review addresses the present global pandemic of coronavirus disease 2019 (COVID-19) with respect to its pathobiology in the lungs and brain. It focuses on the potential negative impact of tobacco and nicotine exposure on the outcomes of this disease by interaction with the angiotensin-converting enzyme 2 receptor. It adds to the time-sensitive and critically important growing knowledge about the risk factors, transmission, pathobiology, and prognosis of COVID-19.
Collapse
Affiliation(s)
- Ali Ehsan Sifat
- Department of Pharmaceutical Sciences, School of Pharmacy, Texas Tech University Health Sciences Center, Amarillo, Texas
| | - Saeideh Nozohouri
- Department of Pharmaceutical Sciences, School of Pharmacy, Texas Tech University Health Sciences Center, Amarillo, Texas
| | - Heidi Villalba
- Department of Pharmaceutical Sciences, School of Pharmacy, Texas Tech University Health Sciences Center, Amarillo, Texas
| | - Bhuvaneshwar Vaidya
- Department of Pharmaceutical Sciences, School of Pharmacy, Texas Tech University Health Sciences Center, Amarillo, Texas
| | - Thomas J Abbruscato
- Department of Pharmaceutical Sciences, School of Pharmacy, Texas Tech University Health Sciences Center, Amarillo, Texas
| |
Collapse
|
31
|
The role of physiotherapists in smoking cessation. J Physiother 2020; 66:207-210. [PMID: 33036933 DOI: 10.1016/j.jphys.2020.09.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Revised: 09/11/2020] [Accepted: 09/18/2020] [Indexed: 11/21/2022] Open
|
32
|
Icick R, Forget B, Cloëz-Tayarani I, Pons S, Maskos U, Besson M. Genetic susceptibility to nicotine addiction: Advances and shortcomings in our understanding of the CHRNA5/A3/B4 gene cluster contribution. Neuropharmacology 2020; 177:108234. [PMID: 32738310 DOI: 10.1016/j.neuropharm.2020.108234] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Revised: 06/28/2020] [Accepted: 07/07/2020] [Indexed: 12/12/2022]
Abstract
Over the last decade, robust human genetic findings have been instrumental in elucidating the heritable basis of nicotine addiction (NA). They highlight coding and synonymous polymorphisms in a cluster on chromosome 15, encompassing the CHRNA5, CHRNA3 and CHRNB4 genes, coding for three subunits of the nicotinic acetylcholine receptor (nAChR). They have inspired an important number of preclinical studies, and will hopefully lead to the definition of novel drug targets for treating NA. Here, we review these candidate gene and genome-wide association studies (GWAS) and their direct implication in human brain function and NA-related phenotypes. We continue with a description of preclinical work in transgenic rodents that has led to a mechanistic understanding of several of the genetic hits. We also highlight important issues with regards to CHRNA3 and CHRNB4 where we are still lacking a dissection of their role in NA, including even in preclinical models. We further emphasize the use of human induced pluripotent stem cell-derived models for the analysis of synonymous and intronic variants on a human genomic background. Finally, we indicate potential avenues to further our understanding of the role of this human genetic variation. This article is part of the special issue on 'Contemporary Advances in Nicotine Neuropharmacology'.
Collapse
Affiliation(s)
- Romain Icick
- Neurobiologie Intégrative des Systèmes Cholinergiques, CNRS UMR3571, Institut Pasteur, 25 Rue du Dr Roux, 75724, Paris Cedex 15, France; Département de Psychiatrie et de Médecine Addictologique, Groupe Hospitalier Saint-Louis, Lariboisière, Fernand Widal, Assistance-Publique Hôpitaux de Paris, Paris, F-75010, France; INSERM UMR-S1144, Paris, F-75006, France; FHU "NOR-SUD", Assistance-Publique Hôpitaux de Paris, Paris, F-75001, France
| | - Benoît Forget
- Neurobiologie Intégrative des Systèmes Cholinergiques, CNRS UMR3571, Institut Pasteur, 25 Rue du Dr Roux, 75724, Paris Cedex 15, France; Génétique Humaine et Fonctions Cognitives, CNRS UMR3571, Institut Pasteur, 25 Rue du Dr Roux, 75724, Paris Cedex 15, France
| | - Isabelle Cloëz-Tayarani
- Neurobiologie Intégrative des Systèmes Cholinergiques, CNRS UMR3571, Institut Pasteur, 25 Rue du Dr Roux, 75724, Paris Cedex 15, France; FHU "NOR-SUD", Assistance-Publique Hôpitaux de Paris, Paris, F-75001, France
| | - Stéphanie Pons
- Neurobiologie Intégrative des Systèmes Cholinergiques, CNRS UMR3571, Institut Pasteur, 25 Rue du Dr Roux, 75724, Paris Cedex 15, France; FHU "NOR-SUD", Assistance-Publique Hôpitaux de Paris, Paris, F-75001, France
| | - Uwe Maskos
- Neurobiologie Intégrative des Systèmes Cholinergiques, CNRS UMR3571, Institut Pasteur, 25 Rue du Dr Roux, 75724, Paris Cedex 15, France; FHU "NOR-SUD", Assistance-Publique Hôpitaux de Paris, Paris, F-75001, France
| | - Morgane Besson
- Neurobiologie Intégrative des Systèmes Cholinergiques, CNRS UMR3571, Institut Pasteur, 25 Rue du Dr Roux, 75724, Paris Cedex 15, France; FHU "NOR-SUD", Assistance-Publique Hôpitaux de Paris, Paris, F-75001, France.
| |
Collapse
|
33
|
Baliunas D, Zawertailo L, Voci S, Gatov E, Bondy SJ, Fu L, Selby PL. Variability in patient sociodemographics, clinical characteristics, and healthcare service utilization among 107,302 treatment seeking smokers in Ontario: A cross-sectional comparison. PLoS One 2020; 15:e0235709. [PMID: 32650339 PMCID: PMC7351500 DOI: 10.1371/journal.pone.0235709] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2020] [Accepted: 06/19/2020] [Indexed: 11/19/2022] Open
Abstract
Background Since 2005, the Smoking Treatment for Ontario Patients (STOP) program has provided smoking cessation treatment of varying form and intensity to smokers through 11 distinct treatment models, either in-person at partnering healthcare organizations or remotely via web or telephone. We aimed to characterize the patient populations reached by different treatment models. Methods We linked self-report data to health administrative databases to describe sociodemographics, physical and mental health comorbidity, healthcare utilization and costs. Our sample consisted of 107,302 patients who enrolled between 18Oct2005 and 31Mar2016, across 11 models operational during different time periods. Results Patient populations varied on sociodemographics, comorbidity burden, and healthcare usage. Enrollees in the Web-based model were youngest (median age: 39; IQR: 29–49), and enrollees in primary care-based Family Health Teams were oldest (median: 51; IQR: 40–60). Chronic Obstructive Pulmonary Disease and hypertension were the most common physical health comorbidities, twice as prevalent in Family Health Teams (32.3% and 30.8%) than in the direct-to-smoker (Web and Telephone) and Pharmacy models (13.5%-16.7% and 14.7%-17.7%). Depression, the most prevalent mental health diagnosis, was twice as prevalent in the Addiction Agency (52.1%) versus the Telephone model (25.3%). Median healthcare costs in the two years up to enrollment ranged from $1,787 in the Telephone model to $9,393 in the Addiction Agency model. Discussion While practitioner-mediated models in specialized and primary care settings reached smokers with more complex healthcare needs, alternative settings appear better suited to reach younger smokers before such comorbidities develop. Although Web and Telephone models were expected to have fewer barriers to access, they reached a lower proportion of patients in rural areas and of lower socioeconomic status. Findings suggest that in addition to population-based strategies, embedding smoking cessation treatment into existing healthcare settings that reach patient populations with varying disparities may enhance equitable access to treatment.
Collapse
Affiliation(s)
- Dolly Baliunas
- Addictions Program, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- * E-mail:
| | - Laurie Zawertailo
- Addictions Program, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Department of Pharmacology and Toxicology, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Sabrina Voci
- Addictions Program, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | | | - Susan J. Bondy
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | | | - Peter L. Selby
- Addictions Program, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| |
Collapse
|
34
|
Carroll AJ, Mathew AR, Leone FT, Wileyto EP, Miele A, Schnoll RA, Hitsman B. Extended Nicotine Patch Treatment Among Smokers With and Without Comorbid Psychopathology. Nicotine Tob Res 2020; 22:24-31. [PMID: 30215785 DOI: 10.1093/ntr/nty191] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2018] [Accepted: 09/08/2018] [Indexed: 11/13/2022]
Abstract
INTRODUCTION Individuals with psychiatric conditions smoke at higher rates than the general population and may need more intensive treatment to quit. We examined whether or not extended treatment with nicotine patch, combined with behavior counseling, would disproportionally benefit smokers with versus without a lifetime psychiatric condition. METHODS We conducted a secondary analysis of data from an effectiveness trial of treatment with 12 counseling sessions (48 weeks) and 21-mg nicotine patch (8, 24, or 52 weeks) among 525 adult daily smokers. A structured clinical interview assessed past and current psychiatric disorders (major depression, generalized anxiety disorder, alcohol abuse and/or dependence, and substance abuse and/or dependence), as described in the Diagnostic and Statistical Manual of Mental Disorders (Fourth Edition). Abstinence was bioverified at week 52. Logistic regression evaluated the effect of the psychiatric status × treatment duration interaction on abstinence at week 52, covarying for sociodemographics, baseline psychological symptoms, and treatment adherence. RESULTS At baseline, 115 (21.9%) participants were diagnosed with one or more psychiatric conditions. The psychiatric status × treatment duration interaction was significant for week 52 abstinence (p = .027). Abstinence rates between smokers with versus without a psychiatric condition in the 24-week treatment arm (9.3% vs. 31.5% abstinent) significantly differed from the 8-week treatment arm (18.8% vs. 22.3%), p = .017. Abstinence rates for smokers with (22.5%) versus without a psychiatric condition (19.7%) in the 52-week treatment arm did not differ from those in the 8-week arm. CONCLUSIONS Targeted smoking cessation treatment, rather than extending treatment duration, may be especially warranted to optimize treatment for smokers with comorbid mood, anxiety, and substance use disorders. IMPLICATIONS Individuals with psychiatric conditions smoke at higher rates and have greater difficulty quitting compared to those in the general population, but little is known about how to best optimize treatment for this high tobacco burden population. The present study found that cessation response to extended duration treatment with the transdermal nicotine patch did not differ for smokers with versus without comorbid anxiety, mood, and substance use disorders in a large-scale clinical effectiveness trial. Development of targeted behavioral treatments may be required to optimize abstinence outcomes for this high-risk population, rather than simply extending the duration of pharmacotherapy treatments.
Collapse
Affiliation(s)
- Allison J Carroll
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Amanda R Mathew
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Frank T Leone
- Division of Pulmonary, Allergy, and Critical Care, Department of Medicine, Presbyterian Medical Center, University of Pennsylvania, Philadelphia, PA
| | - E Paul Wileyto
- Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Andrew Miele
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Robert A Schnoll
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Brian Hitsman
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL
| |
Collapse
|
35
|
Rojewski AM, Bailey SR, Bernstein SL, Cooperman NA, Gritz ER, Karam-Hage MA, Piper ME, Rigotti NA, Warren GW. Considering Systemic Barriers to Treating Tobacco Use in Clinical Settings in the United States. Nicotine Tob Res 2020; 21:1453-1461. [PMID: 29917118 DOI: 10.1093/ntr/nty123] [Citation(s) in RCA: 48] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2017] [Accepted: 06/14/2018] [Indexed: 01/19/2023]
Abstract
The Comorbidity Workgroup of the Tobacco Treatment Research Network, within the Society for Research on Nicotine and Tobacco, previously highlighted the need to provide tobacco treatment to patients diagnosed with comorbid physical and mental health conditions. Yet, systemic barriers in the United States health care system prevent many patients who present for medical treatment from getting the evidence-based tobacco treatment that they need. The identified barriers include insufficient training in the epidemiologic impact of tobacco use, related disorders, and pharmacological and behavioral treatment approaches; misunderstanding among clinicians about the effectiveness of tobacco treatment; lack of therapeutic support from clinical staff; insufficient use of health information technology to improve tobacco use identification and treatment; and limited time and reimbursement for clinicians to provide treatment. We highlight three vignettes demonstrating the complexities of practical barriers at the health care system level. We consider each of the barriers in turn and discuss evidence-based strategies that could be implemented in the clinical care of patients with comorbid conditions. In addition, in the absence of compelling data to guide implementation approaches, we offer suggestions for potential strategies and avenues for future research. Implications: Three vignettes highlighted in this article illustrate some systemic barriers to providing tobacco treatment for patients being treated for comorbid conditions. We explore the barriers to tobacco treatment and offer suggestions for changes in training, health care systems, clinical workflow, and payment systems that could enhance the reach and the quality of tobacco treatment within the US health care system.
Collapse
Affiliation(s)
- Alana M Rojewski
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC
| | - Steffani R Bailey
- Department of Family Medicine, Oregon Health and Science University, Portland, OR
| | - Steven L Bernstein
- Department of Emergency Medicine, Yale School of Medicine, New Haven, CT
| | - Nina A Cooperman
- Department of Psychiatry, Rutgers Robert Wood Johnson Medical School, Piscataway, NJ.,Rutgers Cancer Institute of New Jersey, New Brunswick, NJ
| | - Ellen R Gritz
- Department of Behavioral Science, University of Texas MD Anderson Cancer Center, Houston, TX
| | - Maher A Karam-Hage
- Department of Behavioral Science, University of Texas MD Anderson Cancer Center, Houston, TX
| | - Megan E Piper
- Center for Tobacco Research and Intervention, School of Medicine and Public Health, University of Wisconsin, Madison, WI
| | - Nancy A Rigotti
- Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA
| | - Graham W Warren
- Department of Radiation Oncology, Medical University of South Carolina, Charleston, SC.,Department of Cell and Molecular Pharmacology, Medical University of South Carolina, Charleston, SC
| |
Collapse
|
36
|
Brake SJ, Barnsley K, Lu W, McAlinden KD, Eapen MS, Sohal SS. Smoking Upregulates Angiotensin-Converting Enzyme-2 Receptor: A Potential Adhesion Site for Novel Coronavirus SARS-CoV-2 (Covid-19). J Clin Med 2020; 9:E841. [PMID: 32244852 PMCID: PMC7141517 DOI: 10.3390/jcm9030841] [Citation(s) in RCA: 344] [Impact Index Per Article: 86.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Accepted: 03/18/2020] [Indexed: 12/22/2022] Open
Abstract
The epicenter of the original outbreak in China has high male smoking rates of around 50%, and early reported death rates have an emphasis on older males, therefore the likelihood of smokers being overrepresented in fatalities is high. In Iran, China, Italy, and South Korea, female smoking rates are much lower than males. Fewer females have contracted the virus. If this analysis is correct, then Indonesia would be expected to begin experiencing high rates of Covid-19 because its male smoking rate is over 60% (Tobacco Atlas). Smokers are vulnerable to respiratory viruses. Smoking can upregulate angiotensin-converting enzyme-2 (ACE2) receptor, the known receptor for both the severe acute respiratory syndrome (SARS)-coronavirus (SARS-CoV) and the human respiratory coronavirus NL638. This could also be true for new electronic smoking devices such as electronic cigarettes and "heat-not-burn" IQOS devices. ACE2 could be a novel adhesion molecule for SARS-CoV-2 causing Covid-19 and a potential therapeutic target for the prevention of fatal microbial infections, and therefore it should be fast tracked and prioritized for research and investigation. Data on smoking status should be collected on all identified cases of Covid-19.
Collapse
Affiliation(s)
- Samuel James Brake
- Respiratory Translational Research Group, Department of Laboratory Medicine, School of Health Sciences, University of Tasmania, Launceston, Tasmania 7248, Australia; (S.J.B.); (W.L.); (K.D.M.); (M.S.E.)
| | - Kathryn Barnsley
- School of Medicine, University of Tasmania, Hobart, Tasmania 7001, Australia;
| | - Wenying Lu
- Respiratory Translational Research Group, Department of Laboratory Medicine, School of Health Sciences, University of Tasmania, Launceston, Tasmania 7248, Australia; (S.J.B.); (W.L.); (K.D.M.); (M.S.E.)
| | - Kielan Darcy McAlinden
- Respiratory Translational Research Group, Department of Laboratory Medicine, School of Health Sciences, University of Tasmania, Launceston, Tasmania 7248, Australia; (S.J.B.); (W.L.); (K.D.M.); (M.S.E.)
| | - Mathew Suji Eapen
- Respiratory Translational Research Group, Department of Laboratory Medicine, School of Health Sciences, University of Tasmania, Launceston, Tasmania 7248, Australia; (S.J.B.); (W.L.); (K.D.M.); (M.S.E.)
| | - Sukhwinder Singh Sohal
- Respiratory Translational Research Group, Department of Laboratory Medicine, School of Health Sciences, University of Tasmania, Launceston, Tasmania 7248, Australia; (S.J.B.); (W.L.); (K.D.M.); (M.S.E.)
| |
Collapse
|
37
|
LaRocca CJ, Li A, Lafaro K, Clark K, Loscalzo M, Melstrom LG, Warner SG. The impact of financial toxicity in gastrointestinal cancer patients. Surgery 2020; 168:167-172. [PMID: 32197785 DOI: 10.1016/j.surg.2020.02.006] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2019] [Revised: 02/04/2020] [Accepted: 02/10/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND Biopsychosocial distress screening is a critical component of comprehensive cancer care. Financial issues are a common source of distress in this patient population. This study uses a biopsychosocial distress screening tool to determine the factors associated with financial toxicity and the impact of these stressors on gastrointestinal cancer patients. METHODS A 48-question, proprietary distress screening tool was administered to patients with gastrointestinal malignancies from 2009 to 2015. This validated, electronically-administered tool is given to all new patients. Responses were recorded on a 5-point Likert scale from 1 (not a problem) to 5 (very severe problem), with responses rated at ≥3 indicative of distress. Univariate and multivariate logistic regressions were used to analyze the data. RESULTS Most of the 1,027 patients had colorectal (50%) or hepatobiliary (31%) malignancies. Additionally, 34% of all patients expressed a high level of financial toxicity. Age greater than 65 (odds ratio: 0.63, 95% confidence interval: 0.47-0.86, P < .01), college education (odds ratio: 0.53, 95% confidence interval: 0.38-0.73, P < .0001), being partnered (odds ratio: 0.61, 95% confidence interval: 0.44-0.84, P < .01), and annual income greater than $40,000 (odds ratio: 0.27, 95% confidence interval: 0.19-0.38, P < .0001) were all protective against financial toxicity on univariate analysis. Also, heavy tobacco use was associated significantly with increased distress on univariate analysis (odds ratio: 2.79, 95% confidence interval: 1.38-5.78, P < .01). With the exception of partnered status (odds ratio: 1.18, 95% confidence interval: 0.76-1.85, P = .46), all these variables retained their significant association with financial toxicity in the multivariate model. CONCLUSION Financial toxicity impacts a large number of cancer patients. Further study of at-risk populations may identify patients who would benefit from pre-emptive education and counseling interventions as part of their routine cancer care.
Collapse
Affiliation(s)
- Christopher J LaRocca
- Division of Surgical Oncology, Department of Surgery, University of Minnesota, Minneapolis, MN
| | - Arthur Li
- Department of Information Sciences, City of Hope National Medical Center, Duarte, CA
| | - Kelly Lafaro
- Department of Surgery, City of Hope National Medical Center, Duarte, CA
| | - Karen Clark
- Department of Supportive Medicine, City of Hope National Medical Center, Duarte, CA
| | - Matthew Loscalzo
- Department of Supportive Medicine, City of Hope National Medical Center, Duarte, CA
| | - Laleh G Melstrom
- Department of Surgery, City of Hope National Medical Center, Duarte, CA
| | - Susanne G Warner
- Department of Surgery, City of Hope National Medical Center, Duarte, CA.
| |
Collapse
|
38
|
Notier AE, Hager P, Brown KS, Petersen L, Bedard L, Warren GW. Using a Quitline to Deliver Opt-Out Smoking Cessation for Cancer Patients. JCO Oncol Pract 2020; 16:e549-e556. [PMID: 32048929 DOI: 10.1200/jop.19.00296] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Although smoking by patients with cancer and survivors causes adverse outcomes, many patients with cancer do not receive access to evidence-based tobacco use treatment. The purpose of this article is to report on delivery of tobacco use treatment to patients with cancer using a state-supported Quitline. METHODS Statewide agencies in Michigan partnered with the Michigan Oncology Quality Consortium to develop and implement a clinical quality improvement initiative with the goal of addressing tobacco use by patients with cancer across Michigan oncology practices. The collaborative designed an opt-out approach for identifying tobacco users and referring them to the Michigan Tobacco Quitline (hereafter known as Quitline) within participating practices. As the initiative progressed, patients with cancer who were not referred through the initiative also became eligible for enrollment in the Quitline program. RESULTS A total of 4,347 patients with cancer enrolled in the Quitline between 2012 and 2017, and annual referrals from oncology practices increased from 364 (5% of Quitline participants) to 876 (17% of Quitline participants). The 2013-2016 Michigan Behavioral Risk Factor Surveillance System also demonstrated an increase from 60% to 80% of cancer survivors receiving smoking cessation resources. Of 3,892 patients with cancer who had Quitline follow-up data through 2017, 79% completed one or more counseling calls. The 6-month self-reported quit rate for patients with cancer assessed between 2013 and 2016 was 26%. CONCLUSION Using statewide resources to increase access to evidence-based smoking cessation assistance to patients with cancer is achievable. In an increasingly cost-conscious health care environment, collaborative initiatives that use or enhance existing resources should be considered and refined to deliver effective evidence-based care.
Collapse
Affiliation(s)
- Anna E Notier
- University of Pittsburgh Medical Center, Pittsburgh, PA
| | - Polly Hager
- Cancer Prevention and Control Section, Michigan Department of Health and Human Services, Lansing, MI
| | - Karen S Brown
- Tobacco Prevention and Control Section, Michigan Department of Health and Human Services, Lansing, MI
| | | | - Louise Bedard
- Michigan Oncology Quality Consortium, University of Michigan, Ann Arbor, MI
| | - Graham W Warren
- Department of Radiation Oncology, Department of Cell and Molecular Pharmacology, Medical University of South Carolina, Charleston, SC
| |
Collapse
|
39
|
Kar S, Roy P, Dalal P. Clinical correlates of tobacco use among hospitalized psychiatric patients. JOURNAL OF CLINICAL SCIENCES 2020. [DOI: 10.4103/jcls.jcls_95_18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
|
40
|
Ganz O, Rimal RN, Cohn AM, Johnson AL, Delnevo CD, Horn K. Receptivity to Tobacco Advertising among Young Adults with Internalizing Problems: Findings from the Population Assessment of Tobacco and Health Study. Subst Use Misuse 2020; 55:546-556. [PMID: 31718377 DOI: 10.1080/10826084.2019.1688349] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Background: Many risk factors for tobacco use among the general young adult population, such as tobacco advertising receptivity, have gone unexamined among those with internalizing problems, despite disproportionately high rates of tobacco use. Objective: The objective of this study was to examine the interrelationship of internalizing problems, tobacco advertising receptivity, and tobacco use among young adults using data from Wave 1 of the Population Assessment for Tobacco and Health Study. Methods: The sample included 9,110 young adults (ages 18-24). Multivariable logistic regression models examined the association between internalizing problems and advertising receptivity and tobacco use. Separate models were run for cigarettes, cigars, e-cigarettes, smokeless tobacco and any tobacco use. An interaction term (receptivity × internalizing problems) was added to each model. Results: Except for smokeless tobacco, individuals with high internalizing problems reported greater odds of product use compared to those with low internalizing problems. There was no association between internalizing problems and use of smokeless tobacco. For all products, receptivity was positively associated with tobacco use. A borderline significant interaction was detected between cigarette advertising receptivity and internalizing problems, such that the magnitude of the relationship between receptivity to cigarette advertising and cigarette use was stronger for those with high internalizing problems compared those with low internalizing problems. Conclusions/Importance: The relationship between cigarette advertising receptivity and cigarette use may differ for those with and without internalizing problems. Disproportionate receptivity to risk-promoting messages among young adults with internalizing problems could exacerbate disparities in cigarette use.
Collapse
Affiliation(s)
- Ollie Ganz
- Department of Prevention and Community Health, George Washington University Milken Institute School of Public Health, Washington, DC, USA
| | - Rajiv N Rimal
- Department of Prevention and Community Health, George Washington University Milken Institute School of Public Health, Washington, DC, USA
| | - Amy M Cohn
- Department of Oncology, Georgetown University Medical Center, Washington, DC, USA.,Oklahoma Tobacco Research Center, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
| | - Amanda Lee Johnson
- Oklahoma Tobacco Research Center, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
| | - Cristine D Delnevo
- Center for Tobacco Studies, Rutgers School of Public Health, Piscataway, New Jersey, USA
| | - Kimberly Horn
- Department of Population Health Sciences, Virginia Tech Carilion Research Institute, Virginia Tech, Roanoke, Virginia, USA
| |
Collapse
|
41
|
Ganz O, Rimal RN, Johnson AL, Cohn AM, Horn K, Delnevo CD, Villanti AC. Tobacco use and the interplay of internalizing, externalizing and substance use problems: A latent class analysis of data from the Population Assessment of Tobacco and Health Study. Drug Alcohol Depend 2019; 205:107686. [PMID: 31706253 DOI: 10.1016/j.drugalcdep.2019.107686] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2019] [Revised: 10/04/2019] [Accepted: 10/14/2019] [Indexed: 12/24/2022]
Abstract
BACKGROUND Cigarette smoking is disproportionately high among adults with two or more psychiatric disorders (psychiatric comorbidities), yet research on non-cigarette tobacco use among this population is scant. Additionally, most studies on tobacco use this among this population rely on psychiatric diagnoses rather than individual symptoms, potentially excluding individuals with symptom-specific issues that increase their risk for tobacco use but do not meet the criteria for diagnosis. The objectives of this study were to identify unique classes of individuals based on symptoms of psychiatric disorders and to assess differences in demographic characteristics and tobacco use behaviors between classes. METHODS This study used data from Wave 2 of the Population Assessment of Tobacco and Health Study adult dataset. Latent class analysis was used to classify individuals based on internalizing, externalizing and substance use problems. Bivariate and multivariable models examined the association between latent class membership and current use of cigarettes, cigar products, electronic nicotine delivery systems, pipe, hookah and smokeless tobacco products. Poly tobacco use was also examined. RESULTS Three latent classes were identified. The "normative" class reported low prevalence of all symptoms, the "severe internalizing and non-violent externalizing" class reported severe internalizing problems and non-violent externalizing problems and the "severe" class reported high prevalence of all symptoms. Tobacco use was highest for the "severe" class and lowest for the "normative" class across products. CONCLUSIONS Individuals in the "severe" class may be at elevated risk of tobacco-related morbidity and mortality and would likely benefit from targeted tobacco control interventions.
Collapse
Affiliation(s)
- Ollie Ganz
- Department of Prevention and Community Health, George Washington University Milken Institute School of Public Health, 950 New Hampshire Avenue NW, Washington, DC 20052, United States.
| | - Rajiv N Rimal
- Department of Prevention and Community Health, George Washington University Milken Institute School of Public Health, 950 New Hampshire Avenue NW, Washington, DC 20052, United States; Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe St., Baltimore, MD 21205, United States
| | - Amanda L Johnson
- Oklahoma Tobacco Research Center, University of Oklahoma Health Sciences Center, 655 Research Parkway, Oklahoma City, Oklahoma 73104, United States
| | - Amy M Cohn
- Oklahoma Tobacco Research Center, University of Oklahoma Health Sciences Center, 655 Research Parkway, Oklahoma City, Oklahoma 73104, United States; Department of Oncology, Georgetown University Medical Center, 3800 Reservoir Rd. NW, Washington D.C. 20057, United States
| | - Kimberly Horn
- Department of Population Health Sciences, Virginia Tech Carilion Research Institute, 2 Riverside Circle, Roanoke, VA 24016, United States
| | - Cristine D Delnevo
- Center for Tobacco Studies, Rutgers School of Public Health, 683 Hoes Lane West, Piscataway, NJ 08854, United States
| | - Andrea C Villanti
- Vermont Center on Behavior and Health, University of Vermont, 1 South Prospect Street, Burlington, VT 05401, United States; Department of Psychiatry, University of Vermont, 1 South Prospect Street, Burlington, VT 05401, United States
| |
Collapse
|
42
|
Tidey JW. The Bad and Good News About Tobacco Treatment for People With Comorbid Conditions in the US Health Care System. Nicotine Tob Res 2019; 21:1451-1452. [DOI: 10.1093/ntr/ntz150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2019] [Accepted: 08/14/2019] [Indexed: 11/14/2022]
Affiliation(s)
- Jennifer W Tidey
- Center for Alcohol and Addiction Studies, Brown University, Providence, RI
| |
Collapse
|
43
|
Cooper M, Yaqub M, Hinds JT, Perry CL. A longitudinal analysis of tobacco use in younger and older U.S. veterans. Prev Med Rep 2019; 16:100990. [PMID: 31890466 PMCID: PMC6931232 DOI: 10.1016/j.pmedr.2019.100990] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2019] [Revised: 08/16/2019] [Accepted: 09/15/2019] [Indexed: 01/20/2023] Open
Abstract
United States (U.S.) veterans are prone to higher rates of smoking and smoking-related disease. We describe the prevalence of cigarette and non-cigarette product use and determine longitudinal predictors of tobacco use transitions in this vulnerable population. Data are from Waves 1 (2013–2014) and 2 (2014–2015) of the adult cohort in the Population Assessment of Tobacco and Health. Wave 1 prevalence was calculated for past 30-day use of all queried tobacco products, and compared by veteran status. Weighted multinomial logistic regression was used to determine predictors—demographics, substance use, and physical and psychological comorbidities—of tobacco use transitions (continued use, initiation, and cessation) among veterans. Compared to non-veterans, use of nearly all tobacco products was significantly higher among veterans and was highest among younger veterans. Compared to continued nonusers, continued users were more likely to: be of younger age (OR = 0.95, 95% CI: 0.95–0.96), have poorer physical health (OR = 1.58, 95% CI: 1.22–2.06) and mental health (OR = 1.48, 95% CI: 1.18–1.85), report substance use (OR = 1.79, 95% CI: 1.21–2.64), and report problematic alcohol use (OR = 4.23, 95% CI: 2.38–7.52) and were less likely to be female (OR = 0.57, 95% CI: 0.35–0.93). Compared to continued nonusers, initiators were more likely to report problematic alcohol use (OR = 8.63, 95% CI: 3.79–19.63), and those in the cessation category were more likely to be of younger age (OR = 0.97, 95% CI: 0.95–0.99). Cigarette and non-cigarette use is especially prevalent among young veterans, so prevention should begin during military service. Tobacco cessation programs should be tailored for this population, incorporating aspects related to concomitant health conditions.
Collapse
Affiliation(s)
- Maria Cooper
- Michael & Susan Dell Center for Healthy Living, UTHealth, School of Public Health in Austin, 1616 Guadalupe Street, Suite 6.300, Austin, TX 78701, USA
- Corresponding author.
| | - Maha Yaqub
- Michael & Susan Dell Center for Healthy Living, UTHealth, School of Public Health in Austin, 1616 Guadalupe Street, Suite 6.300, Austin, TX 78701, USA
| | - Josephine T. Hinds
- The University of Texas at Austin, Department of Kinesiology and Health Education, 2109 San Jacinto Blvd, D3700, Austin, TX 78712, USA
| | - Cheryl L. Perry
- Michael & Susan Dell Center for Healthy Living, UTHealth, School of Public Health in Austin, 1616 Guadalupe Street, Suite 6.300, Austin, TX 78701, USA
| |
Collapse
|
44
|
Luxton NA, Shih P, Rahman MA, Adams R, MacKenzie R. Use of electronic cigarettes in the perioperative period: A mixed-method study exploring perceptions of cardiothoracic patients in Australia. Tob Induc Dis 2019; 16:53. [PMID: 31516450 PMCID: PMC6659508 DOI: 10.18332/tid/98957] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2018] [Revised: 10/11/2018] [Accepted: 10/14/2018] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION Electronic cigarettes (e-cigarettes) may reduce tobacco use and achieve tobacco abstinence in the perioperative period of cardiothoracic surgery for patients who smoke. However, research on patients' views on the role of e-cigarettes as a smoking cessation tool is lacking. This mixed-methods study explored perceptions on the use of e-cigarettes among current smokers and ex-smokers awaiting cardiothoracic surgery in Australia. METHODS A cross-sectional study and semi-structured interviews were conducted with 62 patients who were diagnosed with coronary artery disease or lung cancer and were scheduled for elective cardiothoracic surgery at six metropolitan hospitals in Sydney. Data were collected on demographic characteristics, smoking history, surgical risk index, self-efficacy, interest in, perceived benefits of, and barriers to using e-cigarettes in the perioperative period. RESULTS Current smokers reported significantly higher interest in the use of e-cigarettes (p=0.008), and perceived fewer barriers (p=0.048) and more health benefits (p=0.079), compared to ex-smokers. Current smokers considered e-cigarettes to be either a safer alternative to tobacco or a novel method for quitting. Recent ex-smokers, defined as those who quit 2-8 weeks, were a distinct group with high nicotine dependency, a long history of smoking, and multiple failed quit attempts. Compared to longer-term ex-smokers (8-52 weeks quit), recent ex-smokers were more interested in e-cigarettes (p=0.029) and considered e-cigarettes a useful aid to prevent relapse in the lead up to surgery and to manage their nicotine cravings. CONCLUSIONS E-cigarettes may be considered a short-term novel aid and a bridge to evidence-based methods to reduce harm from continued tobacco use for some patients awaiting cardiothoracic surgery for coronary artery disease or lung cancer. This study presents reasons why patients awaiting cardiothoracic surgery may enquire about or use e-cigarettes, which will help clinicians identify those who need more consistent, sustained cessation support.
Collapse
Affiliation(s)
- Nia A Luxton
- Department of Psychology, Macquarie University, Sydney, Australia
| | - Patti Shih
- Australian Institute of Health Innovation, Macquarie University, Sydney, Australia
| | | | - Roger Adams
- Discipline of Physiotherapy, University of Sydney, Sydney, Australia
| | - Ross MacKenzie
- Department of Psychology, Macquarie University, Sydney, Australia
| |
Collapse
|
45
|
Ashour AA, Haik MY, Sadek KW, Yalcin HC, Bitharas J, Aboulkassim T, Batist G, Yasmeen A, Al Moustafa AE. Substantial Toxic Effect of Water-Pipe Smoking on the Early Stage of Embryonic Development. Nicotine Tob Res 2019; 20:502-507. [PMID: 28605482 DOI: 10.1093/ntr/ntx135] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2017] [Accepted: 06/09/2017] [Indexed: 02/07/2023]
Abstract
Background Water-pipe smoking (WPS) is the most widespread tobacco use in the Middle-East, and is rapidly spreading globally. Smoke from WP contains most of the compounds present in cigarette smoke, although in different proportions. WPS is associated with the risk of several human diseases; however, its impact on the early stage of normal development has not been investigated yet. Thus, in this investigation, we assess the effect of WPS on the embryo at the early stage of development. Methods Chicken embryos at 3 days of incubations were used in this study. Meanwhile, we explored the outcome of WPS on angiogenesis using the chorioallantoic membrane (CAM) of the chicken embryos. Finally, quantitative real-time polymerase chain reaction was used to study the regulation of some key control genes of cell proliferation, apoptosis, and migration. Results Our data reveal that WPS inhibits angiogenesis of the CAM and in embryos in comparison with their matched controls; in addition, WPS-exposed embryos show slight reduction in their sizes. We also noted that around 80% of WPS-exposed embryos die before 10 days of incubation. More significantly, WPS induces upregulations of BCL-2, Caspase-8, ATF-3, INHIB-A, and Cadherin 6 genes, which are important key regulators of cell apoptosis, proliferation, and migration. Conclusion Our data reveal, for the first time, that WPS has very toxic effects during the early stage of embryogenesis. Thus, we believe that further studies are required to elucidate the pathogenic effect of WPS on human health especially on the embryo at the early stage of its development. Implications This investigation addresses an important gap on the outcome of WPS during the early stage of embryogenesis. Data of this study point out that WPS can have a very toxic effect on the embryo at this stage. Additionally, results from this report display for the first time that WPS can damage normal angiogenesis of the embryo thus provoking a significant number of embryonic death. Moreover, this study reveals that this effect can occur via the deregulation of several genes related to cell apoptosis, proliferation, and migration.
Collapse
Affiliation(s)
| | | | | | | | - Joanna Bitharas
- Segal Cancer Centre, Lady Davis Institute for Medical Research of the Sir Mortimer B. Davis-Jewish General Hospital, Montreal, QC, Canada
| | - Tahar Aboulkassim
- Segal Cancer Centre, Lady Davis Institute for Medical Research of the Sir Mortimer B. Davis-Jewish General Hospital, Montreal, QC, Canada
| | - Gerald Batist
- Segal Cancer Centre, Lady Davis Institute for Medical Research of the Sir Mortimer B. Davis-Jewish General Hospital, Montreal, QC, Canada.,Oncology Department, McGill University, Montreal, QC, Canada
| | - Amber Yasmeen
- Segal Cancer Centre, Lady Davis Institute for Medical Research of the Sir Mortimer B. Davis-Jewish General Hospital, Montreal, QC, Canada.,Oncology Department, McGill University, Montreal, QC, Canada
| | - Ala-Eddin Al Moustafa
- College of Medicine, Qatar University, Doha, Qatar.,Biomedical Research Centre, Qatar University, Doha, Qatar.,Oncology Department, McGill University, Montreal, QC, Canada.,Syrian Research Cancer Centre of the Syrian Society against Cancer, Aleppo, Syria
| |
Collapse
|
46
|
Sadek KW, Haik MY, Ashour AA, Baloch T, Aboulkassim T, Yasmeen A, Vranic S, Zeidan A, Al Moustafa AE. Water-pipe smoking promotes epithelial-mesenchymal transition and invasion of human breast cancer cells via ERK1/ERK2 pathways. Cancer Cell Int 2018; 18:180. [PMID: 30473629 PMCID: PMC6234648 DOI: 10.1186/s12935-018-0678-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2018] [Accepted: 11/06/2018] [Indexed: 12/12/2022] Open
Abstract
Background With the increasing popularity of water-pipe smoking (WPS), it is critical to comprehend how WPS may affect women's health. The main goal of this study is to identify the potential outcome of WPS on human breast cancer progression. Methods Two breast cancer cell lines, MCF7 and BT20, were used in this investigation. We explored the outcome of WPS on cell morphology and cell invasion using inverted microscope and Biocoat Matrigel invasion chambers. On the other hand, Western blot was employed to study the expression patterns of key control genes of cell adhesion and invasion. Results Our data reveal that WPS induces epithelial-mesenchymal transition (EMT) of MCF7 and BT20 breast cancer cell lines; thus, WPS enhances cell invasion ability of both cell lines in comparison with their matched controls. More significantly, WPS provokes a down- and up-regulation of E-cadherin and focal adhesion kinase (FAK), respectively, which are important key regulators of cancer progression genes. Finally, our data point out that WPS incites the activation of Erk1/Erk2, which could be behind the stimulation of EMT and invasion as well as the deregulation of E-cadherin and FAK expression. Conclusion Our data show, for the first time, that WPS initiates EMT and stimulates cell invasion of breast cancer cells, which could incite metastatic development in breast cancer patients. Thus, we believe that further studies, both in vitro and in vivo, are required to elucidate the pathogenic outcome of WPS on cancer progression of several human carcinomas including breast.
Collapse
Affiliation(s)
- Khaled W Sadek
- 1College of Medicine, Qatar University, Doha, Qatar.,2Biomedical Research Centre, Qatar University, Doha, Qatar
| | - Mahmoud Y Haik
- 1College of Medicine, Qatar University, Doha, Qatar.,2Biomedical Research Centre, Qatar University, Doha, Qatar
| | - Anas A Ashour
- 1College of Medicine, Qatar University, Doha, Qatar.,2Biomedical Research Centre, Qatar University, Doha, Qatar
| | - Tahira Baloch
- 3Segal Cancer Centre, Lady Davis Institute for Medical Research of the Sir Mortimer B. Davis-Jewish General Hospital, Montreal, QC Canada
| | - Tahar Aboulkassim
- 3Segal Cancer Centre, Lady Davis Institute for Medical Research of the Sir Mortimer B. Davis-Jewish General Hospital, Montreal, QC Canada
| | - Amber Yasmeen
- 3Segal Cancer Centre, Lady Davis Institute for Medical Research of the Sir Mortimer B. Davis-Jewish General Hospital, Montreal, QC Canada
| | - Semir Vranic
- 1College of Medicine, Qatar University, Doha, Qatar
| | - Asad Zeidan
- 1College of Medicine, Qatar University, Doha, Qatar
| | - Ala-Eddin Al Moustafa
- 1College of Medicine, Qatar University, Doha, Qatar.,2Biomedical Research Centre, Qatar University, Doha, Qatar.,4Oncology Department, McGill University, Montreal, QC Canada.,Syrian Research Cancer Centre of the Syrian Society against Cancer, Aleppo, Syria
| |
Collapse
|
47
|
Luxton NA, Shih P, Rahman MA. Electronic Cigarettes and Smoking Cessation in the Perioperative Period of Cardiothoracic Surgery: Views of Australian Clinicians. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:ijerph15112481. [PMID: 30405035 PMCID: PMC6266597 DOI: 10.3390/ijerph15112481] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/05/2018] [Revised: 11/05/2018] [Accepted: 11/05/2018] [Indexed: 12/22/2022]
Abstract
For patients who smoke, electronic cigarettes may offer a pathway to achieve tobacco abstinence and reduce the risk of postoperative complications. Clinicians have a pivotal role in supporting smoking cessation by patients with lung cancer and coronary artery disease throughout the perioperative period of cardiothoracic surgery. However, the views of Australian cardiothoracic clinicians on electronic cigarettes and smoking cessation are unknown. Semi-structured interviews were conducted with 52 cardiothoracic surgeons, anaesthetists, nurses and physiotherapists in six hospitals in Sydney and thematically analysed. Clinicians’ knowledge about electronic cigarettes and the regulatory environment surrounding them was limited. Clinicians believed that: electronic cigarettes, though unlikely to be safe, were safer than tobacco cigarettes; electronic cigarettes may have a harm reduction role in public health; and electronic cigarettes were a potential smoking cessation tool for the extraordinary circumstances of surgery. The professional role of a clinician and their views about electronic cigarettes as a perioperative smoking cessation aid had an influence on future clinician-patient interactions. Electronic cigarette use is increasing in Australia and clinicians are likely to receive more frequent questions about electronic cigarettes as a cessation aid. Stronger guidance for clinicians is needed on the topic of electronic cigarettes and cardiothoracic surgery.
Collapse
Affiliation(s)
- Nia A Luxton
- Department of Psychology, Macquarie University, Sydney 2109, Australia.
| | - Patti Shih
- Australian Institute of Health Innovation, Macquarie University, Sydney 2109, Australia.
| | - Muhammad Aziz Rahman
- Austin Clinical School of Nursing, La Trobe University, Melbourne 3084, Australia.
| |
Collapse
|
48
|
Goding Sauer A, Fedewa SA, Kim J, Jemal A, Westmaas JL. Educational attainment & quitting smoking: A structural equation model approach. Prev Med 2018; 116:32-39. [PMID: 30170014 DOI: 10.1016/j.ypmed.2018.08.031] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2018] [Revised: 06/20/2018] [Accepted: 08/26/2018] [Indexed: 11/15/2022]
Abstract
In the United States, disparities in smoking prevalence and cessation by socioeconomic status are well documented, but there is limited research on reasons why and none conducted in a national sample assessing multiple potential mechanisms. We identified smoking and cessation-related behavioral and environmental variables associated with both educational attainment and quitting success. We used a structural equation model of cross-sectional data from respondents ≥25 years from the United States 2010-2011 Tobacco Use Supplement-Current Population Survey. Quitting success was defined as former (n = 2607) versus continuing smokers (n = 7636); categories of educational attainment were ≤high school degree, some college/college degree, and advanced degree. Results indicated that using nicotine replacement therapy (NRT) >1 month and having a home smoking restriction were associated with both educational attainment and quitting success. Those with lower educational attainment versus those with an advanced degree were less likely to report using NRT >1 month (≤high school: β = -0.50, p < 0.001; college: β = -0.24, p = 0.019). Use of NRT >1 month, in turn, was positively associated with quitting success (β = 0.25, p < 0.001). Those with lower educational attainment were also less likely to report a home smoking restriction (≤high school: β = -0.42, p < 0.001; college: β = -0.21, p = 0.009). Having a home smoking restriction was positively associated with quitting success (β = 0.50, p < 0.001). Results were similar with income substituted for education. Using NRT >1 month and having a home smoking restriction are two strategies that may explain the association between low education and lower cessation success; these strategies should be further tested for their potential ability to mitigate this association.
Collapse
Affiliation(s)
- Ann Goding Sauer
- Intramural Research Department, American Cancer Society, 250 Williams Street NW, Atlanta, GA 30303, United States of America.
| | - Stacey A Fedewa
- Intramural Research Department, American Cancer Society, 250 Williams Street NW, Atlanta, GA 30303, United States of America
| | - Jihye Kim
- Bagwell College of Education, Kennesaw State University, 580 Parliament Garden Way, Kennesaw, GA 30144, United States of America
| | - Ahmedin Jemal
- Intramural Research Department, American Cancer Society, 250 Williams Street NW, Atlanta, GA 30303, United States of America
| | - J Lee Westmaas
- Intramural Research Department, American Cancer Society, 250 Williams Street NW, Atlanta, GA 30303, United States of America
| |
Collapse
|
49
|
Huffman AL, Bromberg JE, Augustson EM. Lifetime Depression, Other Mental Illness, and Smoking Cessation. Am J Health Behav 2018; 42:90-101. [PMID: 29973314 PMCID: PMC6050019 DOI: 10.5993/ajhb.42.4.9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Objectives In this study, we attempt to elucidate the relationship between lifetime mental illness (LMI), particularly a depression diagnosis, and smoking cessation. Methods Data were drawn from a previous study and include LMI, demographics, mood, and smoking cessation outcomes. We evaluated the relationship between multiple LMIs and smoking cessation at 7 months post-intervention, and depression in combination with another LMI. Results At 7 months, the adjusted odds of cessation for those with one LMI, including depression, were 0.74 (p = .102), and for those with 2+ LMIs, 0.69 (p = .037), both in comparison with participants who reported no history of LMI. Among those with 2+ LMIs, the adjusted odds of cessation for those with a depression diagnosis were 0.34 (p = .007) compared to those whose multiple LMIs did not include depression. Conclusions Among smokers seeking cessation treatment, those who had 2+ LMIs were at greater risk of relapse, an effect particularly marked in smokers with depression. This study adds to the literature examining the potential impact of LMI on smokers' ability to quit by considering the potential impact of 2+ LMIs and highlights the potential impact of depression as a risk factor for continued smoking.
Collapse
|
50
|
Higgins ST, Redner R, Priest JS, Bunn JY. Socioeconomic Disadvantage and Other Risk Factors for Using Higher-Nicotine/Tar-Yield (Regular Full-Flavor) Cigarettes. Nicotine Tob Res 2018; 19:1425-1433. [PMID: 27613929 DOI: 10.1093/ntr/ntw201] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2016] [Accepted: 07/23/2016] [Indexed: 12/27/2022]
Abstract
Introduction Use of machine-estimated higher nicotine/tar yield (regular full-flavor) cigarettes is associated with increased risk of nicotine dependence. The present study examined risk factors for using full-flavor versus other cigarette types, including socioeconomic disadvantage and other risk factors for tobacco use or tobacco-related adverse health impacts. Associations between use of full-flavor cigarettes and risk of nicotine dependence were also examined. Methods Data were obtained from nationally representative samples of adult cigarette smokers from the US National Survey on Drug Use and Health. Logistic regression and classification and regression tree modeling were used to examine associations between use of full-flavor cigarettes and educational attainment, poverty, race/ethnicity, age, sex, mental illness, alcohol abuse/dependence, and illicit drug abuse/dependence. Logistic regression was used to examine risk for nicotine dependence. Results Each of these risk factors except alcohol abuse/dependence independently predicted increased odds of using full-flavor cigarettes (p < .001), with lower educational attainment the strongest predictor, followed by poverty, male sex, younger age, minority race/ethnicity, mental illness, and drug abuse/dependence, respectively. Use of full-flavor cigarettes was associated with increased odds of nicotine dependence within each of these risk factor groupings (p < .01). Cart modeling identified how prevalence of full-flavor cigarette use can vary from a low of 25% to a high of 66% corresponding to differing combinations of these independent risk factors. Conclusions Use of full-flavor cigarettes is overrepresented in socioeconomically disadvantaged and other vulnerable populations, and associated with increased risk of nicotine dependence. Greater regulation of this cigarette type may be warranted. Implications Greater regulation of commercially available Regular Full-Flavor Cigarettes may be warranted. Use of this type of cigarette is overrepresented in socioeconomically disadvantaged and other vulnerable populations and associated with increased risk for nicotine dependence.
Collapse
Affiliation(s)
- Stephen T Higgins
- Vermont Center on Tobacco Regulatory Science, University of Vermont, Burlington, VT.,Departments of Psychiatry and Psychological Science, University of Vermont, Burlington, VT
| | - Ryan Redner
- Vermont Center on Tobacco Regulatory Science, University of Vermont, Burlington, VT.,Rehabilitation Institute, Southern Illinois University, Carbondale, IL
| | - Jeff S Priest
- Vermont Center on Tobacco Regulatory Science, University of Vermont, Burlington, VT.,Department of Medical Biostatistics, University of Vermont, Burlington, VT
| | - Janice Y Bunn
- Vermont Center on Tobacco Regulatory Science, University of Vermont, Burlington, VT.,Department of Medical Biostatistics, University of Vermont, Burlington, VT
| |
Collapse
|