Tobacco smoking: From 'glamour' to 'stigma'. A comprehensive review

Electronic Health Records Versus Survey Small Area Estimates for Public Health Surveillance

INTRODUCTION

Electronic health records (EHRs) are increasingly being leveraged for public health surveillance. EHR-based small area estimates (SAEs) are often validated by comparison to survey data such as the Behavioral Risk Factor Surveillance System (BRFSS). However, survey and EHR-based SAEs are expected to differ. In this cross-sectional study, SAEs were generated using MDPHnet, a distributed EHR-based surveillance network, for all Massachusetts municipalities and zip code tabulation areas (ZCTAs), compared to BRFSS PLACES SAEs, and reasons for differences explored.

METHODS

This study delineated reasons a priori for how SAEs derived using EHRs may differ from surveys by comparing each strategy's case classification criteria and reviewing the literature. Hypertension, diabetes, obesity, asthma, and smoking EHR-based SAEs for 2021 in all ZCTAs and municipalities in Massachusetts were estimated with Bayesian mixed effects modeling and poststratification in the summer/fall of 2023. These SAEs were compared to BRFSS PLACES SAEs published by the U.S. Centers for Disease Control and Prevention.

RESULTS

Mean prevalence was higher in EHR data versus BRFSS in both municipalities and ZCTAs for all outcomes except asthma. ZCTA and municipal symmetric mean absolute percentages ranged from 12.0 to 38.2% and 13.1 to 39.8%, respectively. There was greater variability in EHR-based SAEs versus BRFSS PLACES in both municipalities and ZCTAs.

CONCLUSIONS

EHR-based SAEs tended to be higher than BRFSS and more variable. Possible explanations include detection of undiagnosed cases and over-classification using EHR data, and under-reporting within BRFSS. Both EHR and survey-based surveillance have strengths and limitations that should inform their preferred uses in public health surveillance.

The relationship between substance use and self-reported aspects of social functioning in patients with a psychotic disorder

BACKGROUND

In patients with a psychotic disorder, rates of substance use (tobacco, cannabis, and alcohol) are higher compared to the general population. However, little is known about associations between substance use and self-reported aspects of social functioning in patients with a psychotic disorder.

METHODS

In this cross-sectional study of 281 community-dwelling patients with a psychotic disorder, linear regression models were used to assess associations between substance use (tobacco, cannabis, or alcohol) and self-reported aspects of social functioning (perceived social support, stigmatization, social participation, or loneliness) adjusting for confounders (age, gender, and severity of psychopathology).

RESULTS

Compared to nonsmokers, both intermediate and heavy smokers reported lower scores on loneliness (E = -0.580, SE = 0.258, p = 0.025 and E = -0.547, SE = 0,272, p = 0.046, respectively). Daily cannabis users reported less social participation deficits than non-cannabis users (E = -0.348, SE = 0.145, p = 0.017). Problematic alcohol use was associated with more perceived social support compared to non-alcohol use (E = 3.152, SE = 1.102, p = 0.005). Polysubstance users reported less loneliness compared to no users (E = -0.569, SE = 0.287, p = 0.049).

CONCLUSIONS

Substance use in patients with psychosis is associated with more favorable scores on various self-reported aspects of social functioning.

The stigma of smoking among women: A systematic review

BACKGROUND

Smoking stigma has been well documented, but little is known regarding its specific features and effects on women. Notably, women face unique social, cultural, and economic challenges that may interact with smoking stigma and impact health outcomes. This review investigates the extent to which smoking women encounter and internalise stigma, while examining the various coping mechanisms they employ to manage these negative experiences.

METHODS

In November 2022, major databases were systematically searched with no time restrictions. After applying inclusion and exclusion criteria, 23 studies (three quantitative and 20 qualitative) met our criteria. We conducted a quality assessment and summarised the findings pertaining to public stigma, self-stigma, and coping strategies.

RESULTS

The stigma about smoking emerges from a variety of sources, such as family, healthcare providers, or internet forums. Women smokers are universally aware of the negative image they have in society. Yet, their experiences and management of the stigma of smoking are shaped by other variables such as cultural background, social class, or motherhood status. Smoking stigma produces ambivalent effects, such as concealment, reduced usage of support services, and to a lesser extent, smoking cessation motivation.

CONCLUSIONS

These results indicate that smoking stigma is an important social justice and public health issue and that further research is needed to better prevent its effects on women's well-being and health behaviours.

The Awareness of the Role of Commercial Determinants of Health and the Readiness to Accept Restrictions on Unhealthy Food Advertising in Polish Society

The negative consequences of commercial determinants of health (CDoH) have become a major challenge for public health systems, especially in terms of non-communicable diseases (NCDs). CDoH are defined as profit-driven factors that influence health. In this study, we assessed the awareness of CDoH and the attitudes toward potential restrictions on advertising, as well as fiscal interventions targeting food products with harmful effects on health in Polish society. Our analysis is based on data from a computer-based web interviewing (CAWI) survey performed in May 2022 among 2008 adult internet users from Poland. Multivariable logistic regression models were developed for variables derived from three items exploring the respondents' understanding of the relationship between CDoH and NCDs, as well as three items asking about their acceptance of a prohibition of advertising unhealthy products during sports events, a general ban on unhealthy food advertising, and their attitudes toward sugar-sweetened beverages (SSBs). Food (FL) and e-health literacy (eHL) levels were consistently positive predictors of both awareness of CDoH and acceptance of the proposed actions. Both higher FL and eHL were significantly associated with the opinion that advertising unhealthy food is associated with the prevalence of NCDs (OR, 95% CI: 1.03, 1.02-1.05, and 1.04, 1.02-1.06, respectively). Health literacy was less frequently a significant predictor of the dependent variables. Among sociodemographic factors, a respondent's level of education and age showed a significant relationship with their awareness and acceptance of countermeasures against CDoH. Respondents with a university master's level of education were more likely to agree with the statement on the relationship between big industry profits and harm to society's health (OR, 95% CI: 1.96, 1.42-2.69) and to support a ban on advertising unhealthy food similar to that for tobacco products (OR, 95% CI: 1.66, 1.21-2.27). Respondents suffering from chronic diseases were also consistently more likely to show a greater understanding of the harmful impact of CDoH and support proposed restrictions. For example, they were more likely to agree with restrictions on advertising harmful products during sports events (OR, 95% CI: 1.23, 1.02-1.50) and the introduction of a sugar tax (OR, 95% CI: 1.26, 1.03-1.54). Our study revealed that more than 50% of the Polish population is conscious of the problem of the harmful effects of big industries producing and selling processed food, sugar-sweetened beverages, and alcoholic beverages. Interestingly, slightly more than half of the respondents supported the introduction of restrictions on advertising such products. Still, only approximately 30% of them accepted a sugar tax to counter the obesity epidemic. The results of our study indicate that Polish society is open to the introduction of regulations aimed at limiting the impact of commercial determinants of health. To our knowledge, this is one of the first studies to assess the awareness of CDoH and the acceptance of restrictions to limit their impact.

Sexy, trashy, cool: Perceptions of electronic cigarette users across sociodemographic groups and E-cigarette use among United States Air Force Airmen

E-cigarette use has increased in recent years. Military personnel have higher rates of e-cigarette use than civilian populations, with 15.3% of Air Force recruits using e-cigarettes. The current study assessed associations between perceptions of e-cigarette users and current use of e-cigarettes, and differences in sociodemographic characteristics to determine if there were different beliefs among different groups to inform intervention development among these straight-to-work young adults. Participants (N = 17,314) were United States Air Force Airmen (60.7% White, 29.7% women) who completed a survey during their first week of Technical Training. Regression results indicated that identifying as a man (B = 0.22, SE = 0.02), identifying as Black (B = 0.06, SE = 0.02), reporting younger age (B = -0.15, SE = 0.02), having less education (B = -0.04, SE = 0.02), and current e-cigarette use (B = 0.62, SE = 0.02) were associated with endorsing more positive e-cigarette user perceptions. Identifying as a woman (B = -0.04, SE = 0.02) and being younger (B = -0.06, SE = 0.02) were associated with endorsing more negative perceptions of e-cigarette users. Current e-cigarette use was inversely associated with negative e-cigarette user perceptions (B = -0.59, SE = 0.02). Differences across groups were found for individual e-cigarette user characteristics. Future intervention strategies among Airmen may benefit from addressing e-cigarette user perceptions to change use behaviors, as these perceptions may result in stigmatized beliefs related to e-cigarette users.

Impact of Heated Tobacco Products, E-Cigarettes, and Cigarettes on Inflammation and Endothelial Dysfunction

In addition to the market launch of heated tobacco products (HTPs) and the JUUL as well as the EVALI, they caused a widespread discussion on the risk reduction compared to a combustible cigarette. Furthermore, first data showed harmful effects on the cardiovascular system. We, therefore, conducted investigations including a control group with a nicotine-free liquid. Forty active smokers were studied in two different approaches during and after consuming an HTP, a cigarette, a JUUL, or a typical electronic cigarette with or without nicotine in a partly double-blinded randomised, cross-over trial. Inflammation, endothelial dysfunction, and blood samples (full blood count, ELISA, multiplex immunoassay) were analysed, and arterial stiffness was measured. In addition to the cigarette, an increase in the white blood cell count but also in proinflammatory cytokines was shown for the various nicotine delivery systems. These correlated with the parameters of arterial vascular stiffness as a clinical parameter of endothelial dysfunction. It can be shown that even a single consumption of the different nicotine delivery system or cigarette leads to a significant inflammatory reaction followed by endothelial dysfunction and increased arterial stiffness causing cardiovascular disease. Inflammation, endothelial dysfunction, and arterial stiffness should be addressed in long-term observational studies.

Preventive Behaviors Among Leukemia and Lymphoma Cancer Survivors: Results From the 2020 Behavioral Risk Factor Surveillance System Survey

Introduction

Maintaining a healthy lifestyle is an important factor in promoting positive outcomes for cancer survivors. Health behaviors, such as engaging in physical activity, not consuming large amounts of alcohol, abstaining from cigarette smoking, receiving routine immunizations, and undergoing recommended cancer screening tests, may lead to improved physical health, health status, and quality of life.

Methods

We examined preventive behaviors among hematologic cancer survivors in a cross-sectional analysis, using data from the 2020 Behavioral Risk Factor Surveillance System.

Results

Adherence to cancer screening test and immunization recommendations among hematologic cancer survivors compares favorably with that among persons with no history of cancer. However, no statistically significant differences in the frequency of current smoking, heavy drinking, and physical activity were observed across these 2 groups. No important differences were observed in health behaviors between male and female cancer survivors, except that female hematologic cancer survivors were more likely to adhere to influenza and pneumococcal pneumonia immunization recommendations than female survivors of other types of cancer, whereas no such differences were found among their male counterparts.

Conclusions

Although hematologic cancer survivors were more adherent to preventive health behaviors such as cancer screening and immunization, they were not different from persons without any history of cancer in exhibiting behavioral risk factors such as smoking and heavy drinking. Intervention studies are needed to identify effective ways to assist hematologic cancer survivors to quit smoking and refrain from hazardous alcohol consumption.

The great decline in adolescent risk behaviours: Unitary trend, separate trends, or cascade?

In many high-income countries, the proportion of adolescents who smoke, drink, or engage in other risk behaviours has declined markedly over the past 25 years. We illustrate this behavioural shift by collating and presenting previously published data (1990-2019) on smoking, alcohol use, cannabis use, early sexual initiation and juvenile crime in Australia, England, the Netherlands, New Zealand, and the USA, also providing European averages where comparable data are available. Then we explore empirical evidence for and against hypothesised causes of these declines. Specifically, we explore whether the declines across risk behaviours can be considered 1) a 'unitary trend' caused by common underlying drivers; 2) separate trends with behaviour-specific causes; or 3) the result of a 'cascade' effect, with declines in one risk behaviour causing declines in others. We find the unitary trend hypothesis has theoretical and empirical support, and there is international evidence that decreasing unstructured face-to-face time with friends is a common underlying driver. Additionally, evidence suggests that behaviour-specific factors have played a role in the decline of tobacco smoking (e.g. decreasing adolescent approval of smoking, increasing strength of tobacco control policies) and drinking (e.g. more restrictive parental rules and attitudes toward adolescent drinking, decreasing ease of access to alcohol). Finally, declining tobacco and alcohol use may have suppressed adolescent cannabis use (and perhaps other risk behaviours), but evidence for such a cascade is equivocal. We conclude that the causal factors behind the great decline in adolescent risk behaviours are multiple. While broad contextual changes appear to have reduced the opportunities for risk behaviours in general, behaviour-specific factors have also played an important role in smoking and drinking declines, and 'knock-on' effect from these behavioural domains to others are possible. Many hypothesised explanations remain to be tested empirically.

Does Religious Participation Predict Future Expectations About Health? Using a Life Course Framework to Test Multiple Mechanisms

Though an impressive array of health outcomes has been studied, research within the field of religion and health has not yet considered how religious involvement may affect future expectations about health. This is a significant shortcoming because the teachings of many religions direct adherent's focus to the distant future, and future self-ratings of health are a known predictor of subjective life expectancy and eventual mortality risk. Recognizing the need for a life course approach to conceptualizing patterns of religious involvement, we assess how stability or change in religious attendance from childhood to adulthood structures individual expectations of future health. Drawing on data from the 2017 Values and Beliefs of the American Public Study (Baylor Religion Survey Wave 5), we find that stable high (weekly) attendance between childhood and adulthood is associated with higher future health expectations. Parametric mediation analyses conducted in the counterfactual framework suggest that this association is explained by the tendency of frequent stable attenders to have (a) higher levels of beliefs in the sense of divine control and (b) a lower likelihood of engaging in harmful health behaviors (smoking).

A comparative assessment of e-cigarette aerosol extracts and tobacco cigarette smoke extracts on in vitro endothelial cell inflammation response

With the development of the times, electronic cigarettes (e-cigarettes) are being received by more and more people. We compared the different effects of e-cigarettes and tobacco cigarettes on human umbilical vein endothelial cells (HUVECs) treated with the typical e-cigarette aerosol extracts (ECA) and cigarette smoking extracts (CS) sourced from commercial retail stores. HUVECs were treated with different kinds of ECA or CS with different nicotinic concentrations (0.03125, 0.125, 0.5, 2, 8, or 32 μg/mL). Cell viability was examined by the MTT assay. The cell apoptosis was investigated by acridine orange (AO) and Hoechst 33258 staining. The RT-PCR and western blot assays were used to analyze the adhesion molecules and inflammation cytokines released by HUVECs. Furthermore, the intracellular reactive oxygen species (ROS) was observed by fluorescence microscopy. Our data showed that the CS (nicotine concentration at 0.125 μg/mL could decrease the viability of HUVECs by 71%, but not the four kinds of ECA. The apoptotic ratio was about 32.5% in the CS group. No matter the levels of adhesion molecules, inflammation cytokines or ROS, they were higher in CS groups than in ECA groups. Overall, the four kinds of e-cigarettes induced significantly less cytotoxicity than the commercially available tobacco cigarettes in HUVECs. The CS showed the most severe impact on HUVECs. ECA might provide a harm reduction measure, especially in cardiovascular risk, after people switch from tobacco cigarettes to e-cigarettes.

Smoking self-concept moderates the effects of self-affirmation on smoking-related beliefs and behavioral intentions

OBJECTIVE

Smoking stigmatization has been shown to hinder cigarette smoking cessation, especially among individuals with a strong smoker identity. Self-affirmation, a psychological threat-management coping strategy, can promote smoking cessation, and may mitigate the adverse consequences of stigmatization.

DESIGN

Data from an online sample of 1,020 U.S. adult smokers were analyzed using multiple linear regression.

MAIN OUTCOME MEASURES

Participants completed a self-affirmation (or no-affirmation control) writing task before viewing a smoking stigma (or non-stigma control) anti-smoking public service announcement video. Participants then reported smoking-related cognitions and behavioral intentions.

RESULTS

Among participants with strong-but not weak-ties to a smoker identity (smoking self-concept), self-affirming led to higher quit intentions compared to the control condition. Among participants with weak-but not strong-smoking self-concepts, those who self-affirmed had lower intentions to switch completely to e-cigarettes relative to the control condition. Exposure to stigmatization reduced intentions to seek cessation counseling, particularly among those with weak smoking self-concepts.

CONCLUSION

Findings demonstrate the critical role that smoking identity centrality plays in moderating reactions to both affirming and stigmatizing stimuli. Additional research is needed to better understand how self-affirmation and stigma-reduction interventions can be tailored and implemented in natural contexts.

Sex differences in cigarette brand purchases among adult smokers: results from the DePICT national repeated survey of French adults (2016-2017)

OBJECTIVE

The tobacco industry has been reported to employ sex-specific marketing strategies, which include different types of tobacco packaging, publicity, as well as price strategies. We examined whether characteristics associated with the purchase of more expensive cigarette brands varied by sex, in the context of the introduction of plain tobacco packaging and the strengthening of tobacco control policies in France.

METHODS

Our study population consists of 1380 regular smokers of manufactured cigarettes from the DePICT study, a nation-wide two-wave survey of French adults aged 18-64 years. Participants were interviewed by telephone in 2016 and 2017. Factors associated with the use of more vs. less expensive cigarette brands were determined by multivariable logistic regression stratified by sex.

RESULTS

Several sex-specific factors were associated with the purchase of more expensive cigarette brands. In women, those factors included higher education, cannabis use, and no use of roll-your-own tobacco. While in men purchase of more expensive cigarette brands was linked to younger age, being born outside of France, living with a non-smoker, and attachment to the cigarette brand.

DISCUSSION

Factors which predict tobacco purchase patterns are different in women and men, highlighting the need for sex-specific tobacco control initiatives to counter the tobacco industry's gendered marketing.

Nicotine Replacement Therapy and Healthy Lifestyle Psychoeducation for Smoking Reduction in Acute Psychiatric Inpatients: A Cluster-Randomized Parallel Study

BACKGROUND

Effectiveness of nicotine replacement therapies in acute psychiatric inpatient settings remains under-researched. The aim of this study was to compare effectiveness and acceptability of 3 different forms of nicotine replacement therapy in achieving smoking reduction among acute psychiatric inpatients.

METHODS

This cluster-randomized, parallel study compared effectiveness and acceptability of nicotine inhalers, nicotine gum, and nicotine patches for smoking reduction in the acute psychiatric inpatient setting. The primary outcome was the exhaled breath carbon monoxide (CO) level change from baseline at weeks 4 and 8. Secondary outcomes included changes in nicotine withdrawal symptoms and psychiatric symptom severity.

RESULTS

Three hundred ten inpatients on the acute care wards were randomly assigned to nicotine inhalers (n = 184), gum (n = 71), and patches (n = 55). Only the nicotine inhaler group showed statistically significant reduction in CO level from baseline at both weeks 4 and 8 (P < 0.001 and P = 0.032, respectively). The nicotine inhaler and the patch group showed significant decrease in nicotine withdrawal symptoms from baseline at both weeks 4 and 8. Meanwhile, the nicotine inhaler and the gum group showed significant decrease in psychiatric symptom severity from baseline at both weeks 4 and 8. Post hoc comparisons revealed that the inhaler group had a greater decrease in psychiatric symptom severity compared with the patch group.

CONCLUSIONS

Nicotine inhalers may be an effective choice for smoking reduction in acute psychiatric inpatient settings given its significant effects on CO level, withdrawal symptoms, and psychiatric symptom severity, particularly during the first 4 weeks of treatment.

Trends in the psychosocial characteristics of 11-15-year-olds who still drink, smoke, take drugs and engage in poly-substance use in England

INTRODUCTION AND AIMS

Youth substance use is declining in many high-income countries. As adolescent substance use becomes less common, it may concentrate in higher-risk groups. This paper aims to examine how the psychosocial characteristics of young substance users in England have changed over time.

DESIGN AND METHODS

Annual cross-sectional data from the 2001-2014 Smoking, Drinking and Drug Use Among Young People in England survey are analysed (n = 112 792, age: 11-15). Logistic and Poisson regression analyses are used to test whether the sex, socioeconomic status (SES) and prevalence of truancy and exclusion from school of those who drink alcohol, smoke cigarettes, take cannabis, take other drugs and engage in poly-substance use changed across the study period.

RESULTS

Use of all substances decreased and there were shifts in the psychosocial characteristics of young smokers, illicit drug users and poly-substance users. The proportion of current smokers and ever-users of cannabis of low SES and who had been excluded increased significantly between 2001/2003-2014. The proportion of last month drug users who had been excluded from school also increased significantly and there were increases in the proportion of polysubstance-users who had truanted and been excluded. The proportion of low SES alcohol users who had been excluded also increased significantly, but this change was very small. There was no evidence of substance use becoming more or less concentrated in one gender.

DISCUSSION AND CONCLUSIONS

There is some evidence that smoking, illicit drug use and poly-substance use are becoming more concentrated in potentially at risk populations. There is limited evidence of concentration amongst young drinkers.

Experiences of tobacco cessation including a prescription approach among patients in Swedish primary health care with a focus on socioeconomically disadvantaged areas

Background

Tobacco Cessation on Prescription (TCP) is a new intervention that is being evaluated in socioeconomically disadvantaged areas in Swedish primary health care (PHC). Patients’ perceptions of TCP are important to understand as this may have implications for the acceptability and adherence to treatment and explain cessation outcomes. Patients’ general experiences of tobacco cessation are also important to explore to improve cessation support in this setting.

Aim

To explore experiences of tobacco cessation and TCP among patients in Swedish PHC focusing on socioeconomically disadvantaged areas.

Methods

Inductive content analysis of transcripts from eight semi-structured interviews with patients recruited from the intervention group in a randomized controlled trial evaluating the effectiveness of TCP in socioeconomically disadvantaged areas in PHC in Stockholm.

Results

Two themes were identified: needing individualized support to quit, taking differences in patients’ experiences of tobacco use and cessation into account, acknowledging individual factors such as impact of health and wellbeing on tobacco use and differing attitudes towards tobacco and cessation and needing a supportive environment to facilitate tobacco cessation, taking contextual factors like professional support from the health care system, the importance of the social environment and supportive societal structures into account. Regarding TCP, the prescription form was perceived as useful for providers but did not appear to have a direct impact on tobacco cessation from the informants’ perspective. However, individualized counseling from a tobacco cessation specialist, an empathetic approach in the treatment and long-term follow-up was considered important.

Conclusion

A holistic approach may be needed in cessation treatment, combined with interventions outside the health care system, to facilitate tobacco cessation among patients in socioeconomically disadvantaged areas in Swedish PHC. The TCP prescription form may be helpful for PHC providers but counseling and follow-up appear to be the most important components of TCP for patients in this setting.

Smoking-Related Social Interactions as Experienced by Persons Who Smoked Long-term

PURPOSE/AIMS

Smoking-related stigma is manifested in the everyday social interactions of persons who smoke and can result in low self-esteem, diminished self-efficacy, and resistance to smoking cessation. The purpose of this study was to describe smoking-related social interactions as experienced by persons with a history of long-term smoking.

DESIGN

This study used a qualitative descriptive approach.

METHODS

This study is part of a larger study designed to identify factors that influence lung cancer screening participation. Data were drawn from 39 qualitative interviews with persons from the parent study. All descriptions about smoking-related social interactions found in the narratives were extracted, coded, categorized, and summarized with content analytic techniques.

RESULTS

Seven different types of social interactions were identified: (a) being looked down on for smoking, (b) being humiliated for smoking in public, (c) being banished while smoking, (d) being blamed for one's health problems, (e) not "really" being blamed for smoking, (f) being told "just quit," and (g) being worried about hurting others.

CONCLUSIONS

Clinical nurse specialists should promote antismoking campaigns that are not stigmatizing, discuss health risks of smoking in a respectful manner, provide evidence-based cessation resources, improve communication with persons who smoke, and address stigma in programs to improve screening for smoking-related illnesses.

Personality and impulsivity as predictors of tobacco use among emerging adults: A latent class analysis

The tobacco industry markets their products toward emerging adults (18-29), with the goal of increasing use among this age group. To inform prevention efforts, researchers are investigating how specific demographic and psychological traits may predict tobacco initiation and continuation. Participants were 578 incoming university freshmen from the Appalachian region. Participants provided information on demographics, personality traits, impulsivity characteristics, lifetime use of cigarettes and electronic cigarettes (ECIGs), and current use of cigarettes, ECIGs, small cigars/cigarillos, large cigars, smokeless tobacco, and waterpipe. Latent class analysis identified tobacco-use classes and regressions identified psychological predictors of class membership. Participants were Nonusers, Experimenters, and Polytobacco Users. Lower agreeableness and conscientiousness as well as higher extraversion and neuroticism were associated with being Experimenters or Polytobacco Users. Lower impulsivity was associated with being Nonusers. Distinct types of emerging adults belong to each tobacco use class, suggesting that individual differences be incorporated in prevention efforts.

Lifestyle Medicine and Psychological Well-Being toward Health Promotion: A Cross-Sectional Study on Palermo (Southern Italy) Undergraduates

(1) Aim: To assess the attitude toward Lifestyle Medicine and healthy behaviours among students in the healthcare area and to demonstrate its association to psychological well-being; (2) Methods: A cross-sectional study is conducted among 508 undergraduates of the University of Palermo (140 (27.6%) in the healthcare area and 368 (72.4%) in the non-healthcare area), during the academic year 2018-2019. Psychological well-being is measured through two dimensions of eudaimonia and hedonia, using the 10-item Hedonic and Eudaimonic Motives for Activities-Revised (HEMA-R) scale, with answers coded on a 7-point scale. The association between demographic and modifiable behavioural risk factors for chronic diseases is assessed through crude and adjusted Odds ratios with 95% confidence intervals; (3) Results: Orientation to both hedonia and eudaimonia is significantly associated to the Mediterranean diet (ORAdj = 2.28; 95% CI = (1.42-3.70)) and drinking spirits less than once a week (ORAdj = 1.89; 95% CI = (1.10-3.27)) and once a week or more (ORAdj = 6.02; 95% CI = (1.05-34.52)), while these conditions occur together less frequently for current smokers (ORAdj = 0.38; 95% CI = (0.18-0.81)). Students inclined to well-being consider healthcare professionals as models for their patients and all people in general (OR = 1.96, 95% CI = (1.28-3.00)); (4) Conclusions: The positive relation found between a virtuous lifestyle and psychological well-being suggests the construction, development and cultivation of individual skills are a means to succeed in counteracting at risk behaviours for health.

Do the Yolŋu people of East Arnhem Land experience smoking related stigma associated with local and regional tobacco control strategies?: An Indigenous qualitative study from Australia

In remote Aboriginal communities in East Arnhem Land, Northern Territory of Australia, the Yolŋu people, traditional owners of this remote and isolated region, have a long tradition of ŋarali' [tobacco] use, which is commemorated within funeral ceremony, as manikay [songlines] and buŋgul [dancing]. Today, smoking is very prevalent and a highly normalised social activity among Yolŋu. There are concerns that tobacco control activities aiming to denormalise smoking may lead to stigma in already disadvantaged communities with high smoking prevalence. Interviews were conducted from August 2014 until December 2015 to ascertain whether smokers may have experienced smoking-related stigma through their interactions and engagement with health services and regional tobacco control activities including denormalisation strategy. Informants described their experiences, observations and perceptions of smokefree environments, television and media advertising, and smoking cessation support. We found that while tobacco control denormalisation is not leading to stigma in these communities, some clinical consultations and interactions may have led to feelings of smoking-related shame among Yolŋu health workers who smoked. However, we found that caring, trusting relationships and having the right people communicating the right messages respectfully enabled raising the issue of smoking in clinical consultations without causing shame.

Electronic Cigarettes and Cardiovascular Risk: Caution Waiting for Evidence

Electronic cigarettes use is a growing trend in contemporary societies, with the propensity to compete with traditional tobacco smoking. Some preclinical studies demonstrated the toxic and detrimental effects of electronic cigarettes liquid components. Its impact on human health remains unknown and insufficiently studied. While some studies suggest that electronic cigarettes use might be associated with endothelial dysfunction, impaired platelet function and increased risk of adverse clinical events, other studies did not confirm these findings and epidemiological data mostly suggest that the use of electronic cigarettes appears to be safer than that of traditional tobacco cigarettes. This article provides an up-to-date overview of the current state of knowledge regarding electronic cigarettes and their impact on human health, with special emphasis on their effect on cardiovascular diseases.

Plain tobacco packaging, increased graphic health warnings and adolescents' perceptions and initiation of smoking: DePICT, a French nationwide study

BACKGROUND

Plain packaging (PP) of tobacco products and increased graphic warnings may contribute to lower attractiveness of smoking, particularly among youths. In France, this policy was introduced on 1 January 2017. We examined changes in smoking-related perceptions and behaviours among a nationwide sample of French adolescents before (2016) and 1 year post (2017) implementation.

METHODS

DePICT is a two-wave cross-sectional national telephone survey of adolescents aged 12-17 years per study wave (2016: n=2046 2017: n=1999). All participants reported smoking-related perceptions, as well as ever and current tobacco use. Smokers were also asked about their perceptions of tobacco brands. Data were weighted to be representative of youths in the French population: adjusted prevalence ratios (PRs, 95% CI) estimating changes between the two study waves were calculated using multivariate log-binomial regression models.

RESULTS

In 2017, as compared with 2016, French adolescents were more likely to report fear of the consequences of smoking (PR=1.06, 95% CI 1.02 to 1.09) and that smoking is dangerous (PR=1.08, 95% CI 1.05 to 1.11). They were also less likely to report that their friends (PR=0.61, 95% CI 0.54 to 0.70) and family (PR=0.51, 95% CI 0.44 to 0.60) accept smoking. Additionally, smoking initiation significantly decreased (PR=0.96, 95% CI 0.93 to 0.98) and a non-statistically significant drop in current tobacco use was observed (PR=0.93, 95% CI 0.78 to 1.11). Smokers' attachment to their tobacco brand also decreased (PR=0.47, 95% CI 0.30 to 0.73).

CONCLUSION

Our findings suggest that PP and increased graphic warnings could contribute to changes in smoking norms and rates among adolescents.

Association Between E-Cigarette Use and Acculturation Among Adult Immigrants in the United States

Despite a dramatic increase in e-cigarette popularity in recent years, the relationship between acculturation and e-cigarette use among immigrants largely remains unknown. We investigated the association between acculturation, measured by both self-reported English proficiency and length of stay in the United States, and immigrants’ use of e-cigarettes using data from the 2016-2017 National Health Interview Survey. Multivariate logistic regressions were used to examine the associations of acculturation factors with ever and current use of e-cigarettes. We found that high English proficiency increased the odds of ever using e-cigarettes among immigrants (adjusted odds ratios: “well,” 2.22; “very well,” 3.24; with the reference group being “not well”). The association was significant among only men. However, we did not find a significant association between length of stay in the United States and e-cigarette use after adjusting for English proficiency. Future research is warranted to investigate how peer use, family-level factors, country of origin, and marketing strategies jointly influence e-cigarette use among immigrants, especially men.

Prevalence and smokers' profile: comparisons between the psychiatric population and the general population

Objectives:

to identify the prevalence of smokers between the psychiatric population and the general population; to compare the personal, socio-demographic and clinical profile of smokers and non-smokers in the psychiatric population and the general population; to compare the reasons for smoking of these two population groups.

Method:

this is a cross-sectional descriptive-analytical epidemiological study with 378 patients from three services: Ambulatory Mental Health, Psychiatric Hospital, and Basic Health Unit. Interviews were conducted with three questionnaires. The Chi-square and Kruskal-Wallis tests were applied.

Results:

in the total of the 378 participants, 67% were women and 69% were over 40 years old. There was a higher prevalence of smokers among men, young people, illiterates, singles and with more than one government benefit. Smokers prevailed among schizophrenics, chronic patients, who used ≥ 3 psychotropic drugs and had a history of ≥ 4 psychiatric hospitalizations and/or suicide attempts. The main reason for smoking was the improvement of negative feelings.

Conclusion:

the prevalence of smokers is higher in the psychiatric population (especially among severely ill patients) and among men, young people, unmarried and with socioeconomic losses. The main reason for smoking is tension/relaxation relief. This study provides nurses and other professionals with knowledge capable of subsidizing the planning of smoking interventions in the Brazilian population.

Stability of alcohol and tobacco consumption biomarkers in a real rising main sewer

Since alcohol and tobacco consumption are among the leading causes of population health harm, it is very important to understand the consumption behaviour to develop effective harm reduction strategies. Wastewater-based epidemiology (WBE) is a potential tool for estimating their consumption, but there are several uncertainties that need to be determined, including the stability of biomarkers in the sewer. Utilizing a real rising main sewer, this study investigated the stability of alcohol and tobacco consumption biomarkers. Rhodamine and acesulfame were used as flow tracer and benchmarker to understand the transportation of wastewater in the sewer with a hydraulic retention time between 2.7 and 5.0 h. Ethyl sulphate (EtS) and ethyl glucuronide (EtG), two biomarkers of alcohol consumption, were found to have different in-sewer stability, with EtS much more stable than EtG. The degradation rate of EtS is approximately 8% per hour, while EtG has a half-life of 1.9 h. Formation of nicotine, cotinine and trans-3'-hydroxycotinine, three biomarkers for tobacco consumption, was observed during the experiment, probably due to deconjugation of their glucuronide chemicals. The deconjugation process has prevented the determination of actual stability of the three chemicals. However, it is suggested that cotinine is relatively stable, while nicotine and trans-3'-hydroxycotinine degrade to a certain degree in the sewer system. According to our findings, the in-sewer degradation is more important during the interpretation of alcohol consumption estimation than for tobacco consumption estimation.

Ups and downs of a peer-based smoking cessation intervention help tailored to hospital-employees with low socioeconomic status: The RESPEKT Study

INTRODUCTION

Smoking is one of the most important determinants of socioeconomic inequality in mortality. Few studies have tested which interventions are effective in smokers with low socioeconomic status (SES).

METHODS

All hospitals in the Capital Region of Denmark were included and randomized to intervention or control groups. The target-group was smokers with low SES. Intervention hospitals: smokers in the target-group assisted researchers to tailor a group-based smoking cessation intervention. Further they helped recruiting smoking colleagues and motivating them to stay abstinent. Control hospitals: ‘as usual’. Unforeseen organizational challenges led to a change of study design; the hospital-level assessment was reduced to two cross-sectional surveys.

RESULTS

Response rates in hospitals’ smoking status survey were very low. Smoking status was reported by 1876 out of 7003 employees at baseline and 2280 out of 7496 employees at 1-year follow-up. Two cross-sectional surveys showed no significant difference in self-reported smoking at 1-year follow-up between intervention and control hospitals (p=0.262). We recruited 100 smokers in the group-based smoking cessation intervention tailored to smokers with low SES (corresponding to approx. 10% of smokers in target-group); 32.4% of these were validated as continuously abstinent at 6 months follow-up.

CONCLUSIONS

Involving smokers with low SES as partners at an early stage of study design facilitated both recruitment and development of the intervention. Despite high validated long-term abstinence rates in smoking cessation groups in the intervention hospitals we found no apparent effect of the intervention at hospital-level after one year. However, larger involvement of the target-group seems feasible and is recommended.

Knowledge regarding factors that influence fertility in Thai reproductive-age population living in urban area: A cross-sectional study

Objective

To survey knowledge about the factors that influence fertility in a reproductive-age population living in an urban area.

Methods

A cross-sectional study was conducted using a questionnaire-based survey among both males and females aged 18–45 years living in the Bangkok metropolitan area.

Results

The mean age of the participants was 26.8±7.2 years (male, 41.9%; female, 58.1%). Of the participants, 53.1% had an undergraduate degree and 57.1% were single. Only one-fifth of the participants correctly identified the age when fecundity declines in male and female, the definition of infertility, and the period during the menstrual cycle with the highest chance of pregnancy. Approximately three-fourths of the participants correctly identified that cigarette smoking, alcohol consumption, and sexually transmitted infections affect fertility.

Conclusion

A considerable knowledge gap about the factors that influence fertility was identified in reproductive-age individuals in an urban area of Thailand. This issue should be urgently addressed by promoting fertility awareness through education, discussions about social perceptions regarding fertility, and reliable sources of knowledge.

Treating Smoking in Adults With Co-occurring Acute Psychiatric and Addictive Disorders

OBJECTIVES

Tobacco use is undertreated in individuals with psychiatric and substance use disorders (SUDs), with concerns that quitting smoking may compromise recovery. We evaluated outcomes of a tobacco intervention among psychiatric patients with co-occurring SUDs.

METHODS

Data from 2 randomized tobacco treatment trials conducted in inpatient psychiatry were combined; analyses focused on the subsample with co-occurring SUDs (n = 216). Usual care provided brief advice to quit and nicotine replacement therapy during the smoke-free hospitalization. The intervention, initiated during hospitalization and continued 6 months after hospitalization, was tailored to readiness to quit smoking, and added a computer-assisted intervention at baseline, and 3 and 6 months; brief counseling; and 10 weeks of nicotine replacement therapy after hospitalization. Outcomes were 7-day point prevalence abstinence from 3 to 12 months and past 30-day reports of alcohol and illicit drug use.

RESULTS

The sample consisted of 34% women, among which 36% were Caucasian, averaging 19 cigarettes/d prehospitalization; the groups were comparable at baseline. At 12 months, 22% of the intervention versus 11% of usual care participants were tobacco-abstinent (risk ratio 2.01, P = 0.03). Past 30-day abstinence from alcohol/drugs did not differ by group (22%); however, successful quitters were less likely than continued smokers to report past 30-day cannabis (18% vs 42%) and alcohol (22% vs 58%) use (P < 0.05), with no difference in other drug use.

CONCLUSIONS

Tobacco treatment in psychiatric patients with co-occurring SUDs was effective and did not adversely impact recovery. Quitting smoking was associated with abstinence from alcohol and cannabis at follow-up. The findings support addressing tobacco in conjunction with alcohol and other drugs in psychiatric treatment.