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Montes de Oca D, Paraje G, Cuadrado C. Impact of Total Indoor Smoking Ban on Cardiovascular Disease Hospitalizations and Mortality: The Case of Chile. Nicotine Tob Res 2024; 26:1166-1174. [PMID: 38457437 PMCID: PMC11339173 DOI: 10.1093/ntr/ntae045] [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: 04/01/2023] [Revised: 01/22/2024] [Accepted: 02/21/2024] [Indexed: 03/10/2024]
Abstract
INTRODUCTION The harmful effects of first and secondhand smoking are well-established. Smoke-free laws aim at protecting nonsmokers. This study aimed to assess the impact of the 2013 total ban on indoor smoking in Chile on hospitalizations and deaths of major cardiovascular events. AIMS AND METHODS The logarithm of the monthly hospitalization and death rates, standardized by age for every 100 000 inhabitants, were estimated for ischemic heart disease, acute myocardial infarction, strokes, and a composite outcome of ischemic heart diseases (which includes acute myocardial infarction) and strokes. In addition, interrupted time series with synthetic control groups were used to assess changes in levels and trends after the intervention. RESULTS The total ban on indoor smoking caused significant reductions in death rates for the three diseases studied for age groups above 20 years old. In addition, there were substantial decreases in the post-intervention hospitalization rates for ischemic heart disease: for the 20-44 age group, the decrease was 8.7% compared to the pre-intervention period (p < .01). In comparison, such a reduction was 4% (p < .01) for the ≥65 age group. For acute myocardial infarction, the decrease was 11.5% (p < .01) for the 20-44 age group, while for stroke, it was a 1.2% (p < .01) decrease for the total population. It is estimated that the smoking ban averted 15.6% of the deaths compared with the synthetic control groups. CONCLUSIONS The implementation of total smoke-free environments in Chile contributed to the reduction of mortality for main cardiovascular diseases. This study provides additional evidence of causality linking the policy to health outcomes. IMPLICATIONS The total indoor smoking ban significantly affected age-standardized hospitalization and deaths. The number of deaths averted by this policy is estimated at approximately 4758 and 5256 for IHD and stroke, respectively, during the 2013-2017 period (15.6% fewer deaths than predicted by the synthetic control groups). The study contributes to the body of evidence that supports total indoor smoking bans.
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Affiliation(s)
| | - Guillermo Paraje
- Business School, Universidad Adolfo Ibáñez, Peñalolén, Santiago de Chile, Chile
- Millennium Nucleus for the Evaluation and Analysis of Drug Policies (nDP), Peñalolén, Santiago de Chile, Chile
| | - Cristóbal Cuadrado
- Millennium Nucleus for the Evaluation and Analysis of Drug Policies (nDP), Peñalolén, Santiago de Chile, Chile
- School of Public Health, Universidad de Chile, Santiago de Chile, Chile
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Chanel O, Cucchi I. Better accounting for long-term health effects in economic assessments: an illustration for air pollution in the Canton of Geneva. Public Health 2024; 233:31-37. [PMID: 38848618 DOI: 10.1016/j.puhe.2024.04.039] [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: 02/28/2024] [Revised: 04/05/2024] [Accepted: 04/30/2024] [Indexed: 06/09/2024]
Abstract
OBJECTIVES We propose a general framework for estimating long-term health and economic effects that takes into account four time-related aspects. We apply it to a reduction in exposure to air pollution in the Canton of Geneva. STUDY DESIGN Methodological developments on the evaluation of long-term economic and health benefits, with an empirical illustration. METHODS We propose a unified framework-the comprehensive impact assessment (CIA)-to assess the long-term effects of morbidity and mortality in health and economic terms. This framework takes full account of four time-related issues: cessation lag, policy/technical implementation timeframe, discounting and time horizon. We compare its results with those obtained from standard quantitative health impact assessment (QHIA) in an empirical illustration involving air pollution reduction in the canton of Geneva. RESULTS We find that by neglecting time issues, the QHIA estimates greater health and economic benefits than the CIA. The overestimation is about 50% under reasonable assumptions and increases ceteris paribus with the magnitude of the cessation lag and the discount factor. It decreases both with the time horizon and with the implementation timeframe. CONCLUSION A proper evaluation of long-term health and economic effects is an important issue when they are to be used in cost-benefit analyses, particularly for mortality, which often represents the largest fraction. We recommend using the CIA to calculate more accurate values.
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Affiliation(s)
- O Chanel
- Aix-Marseille Univ, CNRS, AMSE, Marseille, France.
| | - I Cucchi
- Service de l'air, du bruit et des rayonnements non-ionisants, Département du Territoire, République et Canton de Genève, Genève, Switzerland
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Holt AG, Hussong A, Castro MG, Bossenbroek Fedoriw K, Schmidt AM, Prentice A, Ware OD. Smoking Policies of Outpatient and Residential Substance Use Disorder Treatment Facilities in the United States. Tob Use Insights 2024; 17:1179173X241254803. [PMID: 38752184 PMCID: PMC11095085 DOI: 10.1177/1179173x241254803] [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: 10/27/2023] [Accepted: 04/28/2024] [Indexed: 05/18/2024] Open
Abstract
Tobacco use is associated with morbidity and mortality. Many individuals who present to treatment facilities with substance use disorders (SUDs) other than tobacco use disorder also smoke cigarettes or have a concomitant tobacco use disorder. Despite high rates of smoking among those with an SUD, and numerous demonstrated benefits of comprehensive SUD treatment for tobacco use in addition to co-occurring SUDs, not all facilities address the treatment of comorbid tobacco use disorder. In addition, facilities vary widely in terms of tobacco use policies on campus. This study examined SUD facility smoking policies in a national sample of N = 16,623 SUD treatment providers in the United States in 2021. Most facilities with outpatient treatment (52.1%) and facilities with residential treatment (67.8%) had a smoking policy that permitted smoking in designated outdoor area(s). A multinomial logistic regression model found that among facilities with outpatient treatment (n = 13,778), those located in a state with laws requiring tobacco free grounds at SUD facilities, those with tobacco screening/education/counseling services, and those with nicotine pharmacotherapy were less likely to have an unrestrictive tobacco smoking policy. Among facilities with residential treatment (n = 3449), those with tobacco screening/education/counseling services were less likely to have an unrestrictive tobacco smoking policy. There is variability in smoking policies and tobacco use treatment options in SUD treatment facilities across the United States. Since tobacco use is associated with negative biomedical outcomes, more should be done to ensure that SUD treatment also focuses on reducing the harms of tobacco use.
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Affiliation(s)
- Alison G. Holt
- School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Andrea Hussong
- Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - M. Gabriela Castro
- School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | | | | | - Amy Prentice
- School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Orrin D. Ware
- School of Social Work, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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Baker AL, McCarter K, Turner A, Segan C, Castle D, Brophy L, Borland R, Kelly PJ, Bonevski B, Baird D, Filia S, Attia J, Szwec S, Palazzi K, White SL, Williams JM, Wrobel AL, Ireland A, Saxby K, Ghijben P, Petrie D, Sweeney R. 'Quitlink': Outcomes of a randomised controlled trial of peer researcher facilitated referral to a tailored quitline tobacco treatment for people receiving mental health services. Aust N Z J Psychiatry 2024; 58:260-276. [PMID: 37353970 PMCID: PMC10903138 DOI: 10.1177/00048674231181039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/25/2023]
Abstract
OBJECTIVE The aim of this study was to test the effectiveness of a tailored quitline tobacco treatment ('Quitlink') among people receiving support for mental health conditions. METHODS We employed a prospective, cluster-randomised, open, blinded endpoint design to compare a control condition to our 'Quitlink' intervention. Both conditions received a brief intervention delivered by a peer researcher. Control participants received no further intervention. Quitlink participants were referred to a tailored 8-week quitline intervention delivered by dedicated Quitline counsellors plus combination nicotine replacement therapy. The primary outcome was self-reported 6 months continuous abstinence from end of treatment (8 months from baseline). Secondary outcomes included additional smoking outcomes, mental health symptoms, substance use and quality of life. A within-trial economic evaluation was conducted. RESULTS In total, 110 participants were recruited over 26 months and 91 had confirmed outcomes at 8 months post baseline. There was a difference in self-reported prolonged abstinence at 8-month follow-up between Quitlink (16%, n = 6) and control (2%, n = 1) conditions, which was not statistically significant (OR = 8.33 [0.52, 132.09] p = 0.131 available case). There was a significant difference in favour of the Quitlink condition on 7-day point prevalence at 2 months (OR = 8.06 [1.27, 51.00] p = 0.027 available case). Quitlink costs AU$9231 per additional quit achieved. CONCLUSION The Quitlink intervention did not result in significantly higher rates of prolonged abstinence at 8 months post baseline. However, engagement rates and satisfaction with the 'Quitlink' intervention were high. While underpowered, the Quitlink intervention shows promise. A powered trial to determine its effectiveness for improving long-term cessation is warranted.
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Affiliation(s)
- Amanda L Baker
- School of Medicine and Public Health, College of Health, Medicine and Wellbeing, University of Newcastle, NSW, Australia
| | - Kristen McCarter
- School of Psychological Sciences, College of Engineering, Science and Environment, University of Newcastle, Callaghan, NSW, Australia
| | - Alyna Turner
- School of Medicine and Public Health, College of Health, Medicine and Wellbeing, University of Newcastle, NSW, Australia
- IMPACT Strategic Research Centre, School of Medicine, Barwon Health, Deakin University, Geelong, VIC, Australia
| | - Catherine Segan
- Cancer Council Victoria, Melbourne, VIC, Australia
- Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia
| | - David Castle
- Centre for Complex Interventions, Centre for Addiction and Mental Health, Department of Psychiatry, University of Toronto, ON, Canada
| | - Lisa Brophy
- Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia
- Social Work and Social Policy, School of Allied Health, Human Services and Sport, La Trobe University Melbourne, VIC, Australia
| | - Ron Borland
- Cancer Council Victoria, Melbourne, VIC, Australia
- Centre for Mental Health, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia
| | - Peter J Kelly
- Illawarra Health and Medical Research Institute and the School of Psychology, University of Wollongong, Wollongong, NSW, Australia
| | - Billie Bonevski
- Flinders Health and Medical Research Institute (FHMRI), College of Medicine & Public Health, Flinders University, Bedford Park, SA, Australia
| | - Donita Baird
- School of Medicine and Public Health, College of Health, Medicine and Wellbeing, University of Newcastle, NSW, Australia
| | - Sacha Filia
- Cancer Council Victoria, Melbourne, VIC, Australia
| | - John Attia
- School of Medicine and Public Health, College of Health, Medicine and Wellbeing, University of Newcastle, NSW, Australia
| | - Stuart Szwec
- Hunter Medical Research Institute, Newcastle, NSW, Australia
| | - Kerrin Palazzi
- Hunter Medical Research Institute, Newcastle, NSW, Australia
| | | | - Jill M Williams
- Division of Addiction Psychiatry, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | - Anna L Wrobel
- IMPACT – The Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Deakin University, Geelong, VIC, Australia
- Orygen, Parkville, VIC, Australia
| | - Andrew Ireland
- Centre for Health Economics, Monash Business School, Monash University, Melbourne, VIC, Australia
| | - Karinna Saxby
- Centre for Health Economics, Monash Business School, Monash University, Melbourne, VIC, Australia
| | - Peter Ghijben
- Centre for Health Economics, Monash Business School, Monash University, Melbourne, VIC, Australia
| | - Dennis Petrie
- Centre for Health Economics, Monash Business School, Monash University, Melbourne, VIC, Australia
| | - Rohan Sweeney
- Centre for Health Economics, Monash Business School, Monash University, Melbourne, VIC, Australia
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Chapman LS, Siddle HJ, Serban S, Mankia K, Rooney CM, Mustufvi Z, Pini S, Vinall-Collier K. 'What is my risk really?': a qualitative exploration of preventive interventions among individuals at risk of rheumatoid arthritis. Rheumatol Adv Pract 2024; 8:rkae023. [PMID: 38495430 PMCID: PMC10939459 DOI: 10.1093/rap/rkae023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Accepted: 02/05/2024] [Indexed: 03/19/2024] Open
Abstract
Objectives Intervention in the pre-arthritis phase of RA could prevent or delay the onset of disease. The primary aim of this study was to explore perspectives of being at risk and potential preventive interventions among individuals at risk of developing RA and to identify factors influencing their engagement with prevention. A secondary aim, established during the analytical process, was to understand and compare different approaches to health-related behaviours related to prevention of RA. Methods Anti-CCP-positive (CCP+) at-risk individuals with musculoskeletal symptoms but no synovitis participated in semi-structured interviews. Data were analysed using reflexive thematic analysis, followed by a secondary ideal-type analysis. Results Nineteen CCP+ at-risk individuals (10 women; age range 35-70 years) participated. Three overarching themes were identified: being CCP+ at risk; aiming to prevent RA; and influencers of engagement. Participants described distress related to symptoms and uncertainty about disease progression. Many participants had concerns about medication side effects. In contrast, most participants expressed willingness to make lifestyle changes with the aim of preventing RA. Engagement with preventive measures was influenced by symptom severity, personal risk level, co-morbidities, experiences of taking other medications/supplements, knowledge of RA, risk factors and medications, and perceived effort. Three types of participants were identified from the data: proactive preventers, change considerers and fearful avoiders. Overall orientation to health behaviours also impacted the attitude towards preventing RA. Conclusion Findings could inform recruitment and retention in RA prevention research and promote uptake of preventive interventions in clinical practice.
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Affiliation(s)
- Lara S Chapman
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK
| | - Heidi J Siddle
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK
| | - Stefan Serban
- School of Medicine, Dentistry and Nursing, University of Glasgow, Glasgow, UK
| | - Kulveer Mankia
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK
- NIHR Leeds Biomedical Research Centre, Leeds, UK
| | | | | | - Simon Pini
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
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Trigg J, Skelton E, Lum A, Guillaumier A, McCarter K, Handley T, Judd L, Lye A, Bonevski B. Smoking Cessation Interventions and Abstinence Outcomes for People Living in Rural, Regional, and Remote Areas of Three High-Income Countries: A Systematic Review. Nicotine Tob Res 2023; 25:1709-1718. [PMID: 37338988 PMCID: PMC10475608 DOI: 10.1093/ntr/ntad098] [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: 07/19/2022] [Revised: 04/10/2023] [Accepted: 06/16/2023] [Indexed: 06/22/2023]
Abstract
INTRODUCTION Tobacco smoking rates in high-income countries are greater in rural, regional, and remote (RRR) areas compared to cities. Yet, there is limited knowledge about interventions targeted to RRR smokers. This review describes the effectiveness of smoking cessation interventions for RRR smokers in supporting smoking abstinence. AIMS AND METHODS Seven academic databases were searched (inception-June 2022) for smoking cessation intervention studies to include if they reported on RRR residents of Australia, Canada, or the United States, and short- (<6 months) or long-term (≥6 months) smoking abstinence outcomes. Two researchers assessed study quality, and narratively summarized findings. RESULTS Included studies (n = 26) were primarily randomized control (12) or pre-post (7) designs, from the United States (16) or Australia (8). Five systems change interventions were included. Interventions included cessation education or brief advice, and few included nicotine monotherapies, cessation counseling, motivational interviewing, or cognitive behavioral therapy. Interventions had limited short-term effects on RRR smoking abstinence, decreasing markedly beyond 6 months. Short-term abstinence was best supported by contingency, incentive, and online cessation interventions, and long-term abstinence by pharmacotherapy. CONCLUSIONS Cessation interventions for RRR smokers should include pharmacotherapy and psychological cessation counseling to establish short-term abstinence, and identify effective means of maintaining abstinence beyond 6 months. Contingency designs are a suitable vehicle for psychological and pharmacotherapy support for RRR people who smoke, and intervention tailoring should be explicitly considered. IMPLICATIONS Smoking disproportionately harms RRR residents, who can encounter access barriers to smoking cessation support. High-quality intervention evidence and outcome standardization are still required to support long-term RRR smoking abstinence.
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Affiliation(s)
- Joshua Trigg
- Flinders Health and Medical Research Institute, College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia
| | - Eliza Skelton
- Faculty of Health and Medicine, School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, Australia
| | - Alistair Lum
- Faculty of Health and Medicine, School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, Australia
| | - Ashleigh Guillaumier
- Flinders Health and Medical Research Institute, College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia
| | - Kristen McCarter
- Faculty of Health and Medicine, School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, Australia
| | - Tonelle Handley
- Faculty of Health and Medicine, School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, Australia
| | - Lucy Judd
- Faculty of Health and Medicine, School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, Australia
| | - Alexie Lye
- Faculty of Health and Medicine, School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, Australia
| | - Billie Bonevski
- Flinders Health and Medical Research Institute, College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia
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Oh JK, Han M, Lim MK. Short-term effects of national smoking cessation service on smoking-related disease prevalence and healthcare costs: Experience from the National Health Insurance Service Smoking Cessation Intervention Program in Korea. Tob Induc Dis 2023; 21:107. [PMID: 37637229 PMCID: PMC10448735 DOI: 10.18332/tid/169654] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Revised: 07/02/2023] [Accepted: 07/15/2023] [Indexed: 08/29/2023] Open
Abstract
INTRODUCTION We measured the short-term clinical and economic impacts of the National Health Insurance Service (NHIS) smoking cessation program, which subsidizes the cost of pharmacotherapy and medical consultations, by comparing the changes in prevalence and healthcare costs of smoking-related diseases among cessation service users, non-users, and never smokers. METHODS Smokers who used the cessation service from 2015 to 2017 were included (n=779315). We used claims data from the NHIS, a mandatory, single-payer insurance covering the entire Korean population, to determine the number of patients with selected diseases, their healthcare utilization, and medical costs, and compared these amounts in the one year before and after enrollment. For further comparison, we also estimated disease prevalence and medical costs in matched controls by age, sex, income, and residential area, including never smokers and smokers who never used the cessation program. RESULTS Across all 15 selected diseases, the number of patients, days spent in the hospital, and medical costs for 1 year were consistently higher after service enrollment than before. This pattern was observed for both men and women. Notably, decreased prevalence and medical costs for pneumonia were observed among individuals aged <50 years. Healthcare utilization for any kind of disease for 1 year was 97.7%, 91.1%, and 88.8% among cessation service users, never smokers, and smokers who did not use the cessation service, respectively. The disease-specific prevalence was also highest and increased more in the cessation service users compared with the control groups. CONCLUSIONS Cessation service users were more likely to seek healthcare. Increased healthcare utilization in the first year after cessation service use may have resulted from smoking-related conditions that led individuals to attempt smoking cessation.
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Affiliation(s)
- Jin-Kyoung Oh
- Department of Cancer Control and Population Health, National Cancer Center Graduate School of Cancer Science and Policy, Goyang, Republic of Korea
| | - Minji Han
- Department of Health Science and Technology, Graduate School of Convergence Science and Technology, Seoul National University, Seoul, Republic of Korea
| | - Min Kyung Lim
- Department of Social and Preventive Medicine, College of Medicine, Inha University, Incheon, Republic of Korea
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Ye L, Ye Y, Gao H. Effectiveness of social video platforms in promoting smoking cessation among youth: A content-specific analysis of smoking cessation topic videos on the social platform Bilibili. Tob Induc Dis 2023; 21:105. [PMID: 37605770 PMCID: PMC10405226 DOI: 10.18332/tid/169662] [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: 03/17/2023] [Revised: 07/09/2023] [Accepted: 07/16/2023] [Indexed: 08/23/2023] Open
Abstract
INTRODUCTION Smoking cessation is a significant public health issue for young people. Social media provide the public with health knowledge through various types of videos. Bilibili is a trendy social video platform among the young population in China, and the number of smoking cessation videos on this platform is continuously increasing. Different content creators advocating smoking cessation through videos may influence young people's attitudes and behaviors towards tobacco and smoking. This study aims to measure the message sensation value (MSV) and the information appeals in smoking cessation videos on Bilibili, examining their impact on communication effectiveness. METHODS This study collected 337 videos from Bilibili and conducted a content analysis regarding the content creator's information, video presentation, MSV, and message appeals. The communication effectiveness of the videos was defined as a dependent variable and was divided into three dimensions: communication breadth, recognition, and participation. RESULTS The average MSV (rated on a scale of 0 to 11) for smoking cessation-themed videos was 4.49 (SD=2.23). Chi-squared analysis revealed significant differences among different types of videos in the use of threat appeal (p<0.001), humor appeal (p<0.001), and psychological benefit (p<0.05). Additionally, different types of creators showed differences in the use of threat appeal (p<0.05), humor appeal (p<0.001), and psychological benefit (p<0.05). ANOVA results indicated significant differences in the level of MSV among different smoking cessation videos (F=39.775, p<0.001). Linear regression analysis showed that MSV, threat appeal, humor appeal, and economic benefit positively impacted dissemination effects (p<0.001). CONCLUSIONS The results indicate that young people are likelier to watch smoking cessation videos with higher MSV and information appeal. These elements can enhance persuasion and the effectiveness of communication. Therefore, when video creators aim to promote smoking cessation among young people, they can consider factors such as MSV, threat appeal, humor appeal, and economic benefit to enhance communication effects.
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Affiliation(s)
- Liujiang Ye
- School of Journalism and Communication, Nanjing Normal University, Nanjing, China
| | - Yijie Ye
- School of Journalism and Communication, Nanjing Normal University, Nanjing, China
| | - Hao Gao
- School of Journalism and Communication, Nanjing Normal University, Nanjing, China
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Wang X, Romero-Gutierrez CW, Kothari J, Shafer A, Li Y, Christiani DC. Prediagnosis Smoking Cessation and Overall Survival Among Patients With Non-Small Cell Lung Cancer. JAMA Netw Open 2023; 6:e2311966. [PMID: 37145597 PMCID: PMC10163381 DOI: 10.1001/jamanetworkopen.2023.11966] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Accepted: 03/23/2023] [Indexed: 05/06/2023] Open
Abstract
Importance Lung cancer remains the leading cause of cancer-related death globally; non-small cell lung cancer (NSCLC) accounts for 85% of all lung cancer cases, and cigarette smoking is the factor most significantly associated with its risk. However, little is known about the association of years since prediagnosis smoking cessation and cumulative smoking with overall survival (OS) following a lung cancer diagnosis. Objective To characterize the association of years since smoking cessation before diagnosis and cumulative smoking pack-years with OS in patients with NSCLC in a lung cancer survivor cohort. Design, Setting, and Participants The cohort study involved patients with NSCLC who were recruited to the Boston Lung Cancer Survival Cohort at Massachusetts General Hospital (Boston, Massachusetts) between 1992 and 2022. Patients' smoking history and baseline clinicopathological characteristics were prospectively collected through questionnaires, and OS following lung cancer diagnosis was regularly updated. Exposures Duration of smoking cessation before a lung cancer diagnosis. Main Outcomes and Measures The primary outcome was the association of detailed smoking history with OS following a lung cancer diagnosis. Results Of 5594 patients with NSCLC (mean [SD] age, 65.6 [10.8] years; 2987 men [53.4%]), 795 (14.2%) were never smokers, 3308 (59.1%) were former smokers, and 1491 (26.7%) were current smokers. Cox regression analysis suggested that former smokers had 26% higher mortality (hazard ratio [HR], 1.26; 95% CI, 1.13-1.40; P < .001) and current smokers had 68% higher mortality (HR, 1.68; 95% CI, 1.50-1.89; P < .001) compared with never smokers. Log2-transformed years since smoking cessation before diagnosis were associated with significantly lower mortality among ever smokers (HR, 0.96; 95% CI, 0.93-0.99; P = .003). Subgroup analysis, stratified by clinical stage at diagnosis, revealed that former and current smokers had even shorter OS among patients with early-stage disease. Conclusions and Relevance In this cohort study of patients with NSCLC, quitting smoking early was associated with lower mortality following a lung cancer diagnosis, and the association of smoking history with OS may have varied depending on clinical stage at diagnosis, potentially owing to the differing treatment regimens and efficacy associated with smoking exposure following diagnosis. Detailed smoking history collection should be incorporated into future epidemiological and clinical studies to improve lung cancer prognosis and treatment selection.
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Affiliation(s)
- Xinan Wang
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts
| | | | - Jui Kothari
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts
| | - Andrea Shafer
- Pulmonary and Critical Care Division, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston
| | - Yi Li
- Department of Biostatistics, School of Public Health, University of Michigan, Ann Arbor
| | - David C. Christiani
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts
- Pulmonary and Critical Care Division, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston
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Simonetto C, Heier M, Peters A, Kaiser JC, Rospleszcz S. From Atherosclerosis to Myocardial Infarction: A Process-Oriented Model Investigating the Role of Risk Factors. Am J Epidemiol 2022; 191:1766-1775. [PMID: 35231928 PMCID: PMC9535448 DOI: 10.1093/aje/kwac038] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Revised: 01/14/2022] [Accepted: 02/24/2022] [Indexed: 01/29/2023] Open
Abstract
Mathematical models are able to reflect biological processes and to capture epidemiologic data. Thus, they may help elucidate roles of risk factors in disease progression. We propose to account for smoking, hypertension, and dyslipidemia in a previously published process-oriented model that describes the development of atherosclerotic lesions resulting in myocardial infarction (MI). The model is sex-specific and incorporates individual heterogeneity. It was applied to population-based individual risk factors and MI rates (Cooperative Health Research in the Region of Augsburg (KORA) study) together with subclinical atherosclerotic lesion data (Pathobiological Determinants of Atherosclerosis in Youth (PDAY) study). Different model variants were evaluated, testing the association of risk factors with different disease processes. Best fits were obtained for smoking affecting a late-stage disease process, suggesting a thrombogenic role. Hypertension was mainly related to complicated, vulnerable lesions. Dyslipidemia was consistent with increasing the number of initial lesions. By accounting for heterogeneity, individual hazard ratios differ from the population average. The mean individual hazard ratio for smoking was twice the population-based hazard ratio for men and even more for women. Atherosclerotic lesion progression and MI incidence data can be related in a mathematical model to illuminate how risk factors affect different phases of this pathological process.
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Affiliation(s)
- Cristoforo Simonetto
- Correspondence to Dr. Cristoforo Simonetto, Institute of Radiation Medicine, Helmholtz Zentrum München, German Research Center for Environmental Health (GmbH), Ingolstädter Landstraße 1, D-85764 Neuherberg, Germany (e-mail: )
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Dhawan P, Goel S, Aggarwal A, Ghosh A, Vijayvergiya R, Medhi B, Khurana D, Verma R. Comparative effectiveness of two behavioral change intervention packages for tobacco cessation initiated in the tertiary care setting of North India-protocol for a two-arm randomized controlled trial. Trials 2022; 23:753. [PMID: 36064444 PMCID: PMC9446864 DOI: 10.1186/s13063-022-06673-3] [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: 02/10/2022] [Accepted: 08/18/2022] [Indexed: 11/26/2022] Open
Abstract
Background To reduce the global burden of tobacco use, clinical guidelines support behavioral therapy and pharmacotherapy as preferred interventions for tobacco cessation. The evidence-based behavioral interventions has consistently shown to be impactful in community settings; however, its efficacy has not been established in hospital settings. The current study aims to investigate impact of trans-theoretical-based behavioral intervention package on tobacco users suffering from non-communicable diseases attending tertiary care settings of North India. Methods/design A two-arm randomized controlled trial (RCT) in a tertiary healthcare hospital will be performed. A total of 360 tobacco users attending NCD clinics in four departments, cardiology, neurology, pulmonary medicine, and ENT (otolaryngology), will be recruited over a period of 3 months. After ascertaining the eligibility criteria, they will be followed up to 6 months (1, 3, 6) for their tobacco use status, readiness to quit, nicotine dependence, stage of behavior change, and self-reported and biochemical validation (urine cotinine) for tobacco abstinence. Assignment of intervention including allocation concealment, sequence generation, and blinding will be done as per SPIRIT guidelines for RCT protocols. Discussion As no strong evidence exists about the effectiveness of tobacco cessation intervention in tertiary settings, the current study will build evidence about the similar interventions in such settings. Trial registration CTRI/2019/09/021406.
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Affiliation(s)
- Priyanka Dhawan
- Department of Community Medicine & School of Public Health, PGIMER, Chandigarh, India
| | - Sonu Goel
- Department of Community Medicine & School of Public Health, PGIMER, Chandigarh, India.
| | | | | | | | - Bikash Medhi
- Department of Pharmacology, PGIMER, Chandigarh, India
| | | | - Roshan Verma
- Department of Otolaryngology, PGIMER, Chandigarh, India
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12
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Ohlrogge AH, Frost L, Schnabel RB. Harmful Impact of Tobacco Smoking and Alcohol Consumption on the Atrial Myocardium. Cells 2022; 11:2576. [PMID: 36010652 PMCID: PMC9406618 DOI: 10.3390/cells11162576] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Revised: 08/05/2022] [Accepted: 08/11/2022] [Indexed: 11/23/2022] Open
Abstract
Tobacco smoking and alcohol consumption are widespread exposures that are legal and socially accepted in many societies. Both have been widely recognized as important risk factors for diseases in all vital organ systems including cardiovascular diseases, and with clinical manifestations that are associated with atrial dysfunction, so-called atrial cardiomyopathy, especially atrial fibrillation and stroke. The pathogenesis of atrial cardiomyopathy, atrial fibrillation, and stroke in context with smoking and alcohol consumption is complex and multifactorial, involving pathophysiological mechanisms, environmental, and societal aspects. This narrative review summarizes the current literature regarding alterations in the atrial myocardium that is associated with smoking and alcohol.
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Affiliation(s)
- Amelie H. Ohlrogge
- Department of Cardiology, University Heart and Vascular Centre Hamburg, 20246 Hamburg, Germany
- German Centre for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, 20246 Hamburg, Germany
| | - Lars Frost
- Diagnostic Centre, University Clinic for Development of Innovative Patient Pathways, Silkeborg Regional Hospital, 8600 Silkeborg, Denmark
- Department of Clinical Medicine, Aarhus University, 8200 Aarhus, Denmark
| | - Renate B. Schnabel
- Department of Cardiology, University Heart and Vascular Centre Hamburg, 20246 Hamburg, Germany
- German Centre for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, 20246 Hamburg, Germany
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13
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Giorgi-Pierfranceschi M, Monreal M, Di Micco P, Francisco I, Hernández-Blasco L, Madridano O, López-Sáez JB, Hernando E, Meireles J, Dentali F. Prognostic Impact of Active Cigarette Smoking on Mortality in Patients with Acute Venous Thromboembolic Events, Findings from Real World Data. Medicina (B Aires) 2022; 58:medicina58020295. [PMID: 35208618 PMCID: PMC8880138 DOI: 10.3390/medicina58020295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Revised: 02/09/2022] [Accepted: 02/10/2022] [Indexed: 11/16/2022] Open
Abstract
Background and Objectives: The influence of smoking habits on mortality, VTE recurrence, and major bleeding in patients receiving anticoagulant therapy for venous thromboembolism (VTE) has not been consistently evaluated. Materials and Methods: We used data from the RIETE (Registro Enfermedad TromboEmbólica) registry to compare mortality, VTE recurrence, and major bleeding risk in smoking versus non-smoking patients with acute VTE. Results: 50,881 patients (43,426 non-smoking and 7455 smoking patients) were included. After a median follow-up of 8.8 months, 7110 patients died (fatal PE 292 and fatal bleeding 281), 3243 presented VTE recurrence, and 1579 had major bleeding. At multivariate analysis, smoking behavior was associated with a higher hazard of death, (HR: 1.28; 95% CI: 1.19–1.40). The risk of VTE recurrence was marginally increased in smoking patients compared to non-smoking patients (1.14; 95% CI: 1.02–1.27). Major bleeding did not differ in smoking and non-smoking patients (1.15; 95% CI: 0.96–1.38). The presence of cancer did not appear to influence the association between smoking habits and death (HR: 1.34; 95% CI: 1.22–1.47 in cancer patients and HR: 1.23; 95% CI: 1.04, 1.45 in non-cancer patients, respectively) Conclusions: the risk of death after an acute episode of VTE appeared to be higher in smoking than in non-smoking patients and this risk is higher between patients presenting PE at the onset of symptoms.
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Affiliation(s)
| | - Manuel Monreal
- Department of Internal Medicine, Hospital Germans Trias i Pujol, Universidad Católica de Murcia, 08016 Barcelona, Spain;
| | - Pierpaolo Di Micco
- Department of Internal Medicine and Emergency Room, Ospedale Buon Consiglio Fatebenefratelli, 80122 Naples, Italy;
| | - Iria Francisco
- Department of Internal Medicine, Hospital Universitari de Girona Dr. Josep Trueta, 17007 Gerona, Spain;
| | - Luis Hernández-Blasco
- Department of Pneumonology, Hospital General Universitario de Alicante, ISABIAL, UMH, 03014 Alicante, Spain;
| | - Olga Madridano
- Department of Internal Medicine, Hospital Universitario Infanta Sofía, 28042 Madrid, Spain;
| | - Juan Bosco López-Sáez
- Department of Internal Medicine, Hospital Universitario de Puerto Real, 11006 Cádiz, Spain;
| | - Elena Hernando
- Department of Pneumonology, Hospital San Pedro, 26001 Logroño, Spain;
| | - Jose Meireles
- Department of Internal Medicine, Centro Hospitalar de Entre o Douro e Vouga, 4520-195 Santa María da Feira, Portugal;
| | - Francesco Dentali
- Department of Medicine and Surgery, Insubria University, 21100 Varese, Italy;
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Yang Y, Peng N, Chen G, Wan Q, Yan L, Wang G, Qin Y, Luo Z, Tang X, Huo Y, Hu R, Ye Z, Qin G, Gao Z, Su Q, Mu Y, Zhao J, Chen L, Zeng T, Yu X, Li Q, Shen F, Chen L, Zhang Y, Wang Y, Deng H, Liu C, Wu S, Yang T, Li M, Xu Y, Xu M, Zhao Z, Wang T, Lu J, Bi Y, Wang W, Ning G, Zhang Q, Shi L. Interaction between smoking and diabetes in relation to subsequent risk of cardiovascular events. Cardiovasc Diabetol 2022; 21:14. [PMID: 35073925 PMCID: PMC8787903 DOI: 10.1186/s12933-022-01447-2] [Citation(s) in RCA: 25] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Accepted: 01/08/2022] [Indexed: 12/23/2022] Open
Abstract
Background Whether smoking modifies the associations of diabetes and risk factor management with subsequent risk of cardiovascular disease (CVD), and whether the smoking related CVD risk differs among people with and without diabetes are unclear. This study aimed to examine the associations and interactions of smoking, diabetes, and risk factor management in relation to incident CVD. Methods This nationwide, population-based, prospective cohort study of 20 communities from various geographic regions recruited adults aged 40 years or older during 2011–2012. The follow-up survey was conducted between 2014 and 2016. This study included 126,181 participants who were free from CVD at baseline. Results Study participants included 19,397 current smokers (15.4%), 6,049 former smokers (4.8%), and 100,735 never smokers (79.8%). Mean (SD) age ranged from 55.8 (8.6) years to 60.7 (9.1) years. Compared with never smokers, heavy smokers exhibited a greater risk of CVD events among participants with diabetes (multivariable-adjusted hazard ratio [HR], 1.45; 95% CI, 1.17–1.78) than among participants without diabetes (HR, 1.20; 95% CI, 1.01–1.42; P for interaction = 0.006). Compared with participants without diabetes, participants with diabetes who were never smokers and had 5 or more controlled risk factors showed no significantly excess CVD risk (HR, 0.93; 95% CI, 0.71–1.22), but the cardiovascular benefits from risk factor management were counteracted among participants with diabetes who were current smokers (HR, 1.28; 95% CI, 0.77–2.14) or former smokers (HR, 1.22; 95% CI, 0.66–2.28). Conclusions Smoking and diabetes interacted with each other in relation to increased risk of CVD events, and the beneficial effect of risk factor management on CVD risk among participants with diabetes was attenuated by current or former smoking. Supplementary Information The online version contains supplementary material available at 10.1186/s12933-022-01447-2.
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Chen P, Zhang M, Zhang Y, Su X, Chen J, Xu B, Tao J, Wang Z, Ma A, Li H. Economic Burden of Myocardial Infarction Combined With Dyslipidemia. Front Public Health 2021; 9:648172. [PMID: 33681139 PMCID: PMC7933193 DOI: 10.3389/fpubh.2021.648172] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Accepted: 01/28/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Dyslipidemia is a common comorbidity and an important risk factor for myocardial infarction (MI). This study aimed to examine the economic burden of MI combined with dyslipidemia in China. Methods: Patients who were hospitalized due to MI combined with dyslipidemia in 2016 were enrolled. Costs were measured based on electronic medical records and questionnaires. The annual costs were analyzed by conducting descriptive statistics, univariable, and multivariable analyses. Results: Data of 900 patients were analyzed, and 144 patients were dead during the follow-up. The majority of patients were aged 51-70 years (n = 563, 62.55%) and males (n = 706, 78.44%). For all-cause costs, the median annual direct medical costs, direct non-medical costs, indirect costs, and total costs were RMB 13,168 (5,212-29,369), RMB 600 (0-1,750), RMB 676 (0-1,787), RMB 15,361 (6,440-33,943), respectively; while for cardiovascular-related costs, the corresponding costs were RMB 12,233 (3,795-23,746), RMB 515 (0-1,680), RMB 587 (0-1,655), and RMB 14,223 (4,914-28,975), respectively. Lifestyle and complications significantly affected both all-cause costs and cardiovascular-related costs. Conclusions: Increasing attention should be paid to encourage healthy lifestyle, and evidence-based medicine should focus on optimal precautions and treatments for complications, to reduce the economic burden among MI patients with a comorbid dyslipidemia.
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Affiliation(s)
- Pingyu Chen
- Department of Health Economics, China Pharmaceutical University, Nanjing, China
- Center for Pharmacoeconomics and Outcomes Research, China Pharmaceutical University, Nanjing, China
| | - Mengran Zhang
- Department of Health Economics, China Pharmaceutical University, Nanjing, China
| | - Yan Zhang
- Department of Cardiology, Peking University First Hospital, Beijing, China
| | - Xi Su
- Department of Cardiology, Wuhan Asia Heart Hospital, Wuhan, China
| | - Jiyan Chen
- Department of Cardiology, Guangdong Provincial People's Hospital, Guangzhou, China
| | - Biao Xu
- Department of Cardiology, Nanjing Gulou Hospital, Nanjing, China
| | - Jianhong Tao
- Department of Cardiology, Sichuan Provincial People's Hospital, Chengdu, China
| | - Zhen Wang
- Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Aixia Ma
- Department of Health Economics, China Pharmaceutical University, Nanjing, China
- Center for Pharmacoeconomics and Outcomes Research, China Pharmaceutical University, Nanjing, China
| | - Hongchao Li
- Department of Health Economics, China Pharmaceutical University, Nanjing, China
- Center for Pharmacoeconomics and Outcomes Research, China Pharmaceutical University, Nanjing, China
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Choi JW, Han E, Kim TH. Association of smoking cessation after new-onset type 2 diabetes with overall and cause-specific mortality among Korean men: a nationwide population-based cohort study. BMJ Open Diabetes Res Care 2020; 8:8/1/e001249. [PMID: 32624482 PMCID: PMC7337624 DOI: 10.1136/bmjdrc-2020-001249] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Revised: 05/08/2020] [Accepted: 06/02/2020] [Indexed: 12/11/2022] Open
Abstract
INTRODUCTION This study aimed to examine the association between smoking cessation after new-onset type 2 diabetes and overall and cause-specific mortality risks among Korean men. RESEARCH DESIGN AND METHODS The Korean National Health Insurance Service-National Health Screening Cohort database was searched, and 13 377 Korean men aged ≥40 years diagnosed with new-onset type 2 diabetes between 2004 and 2007 were included and followed up until 2013. We defined smoking status changes by comparing participants' answers in the last survey before diagnosis to those in the first survey after diagnosis. We estimated the adjusted HR (AHR) and 95% CI for mortality risk using multivariable Cox proportional hazards regression models. RESULTS We identified 1014 all-cause mortality events (cancer, n=406 and cardiovascular disease (CVD), n=184) during an average follow-up duration of 7.2 years. After adjustment for all confounding factors, the reduced risk of all-cause mortality was more significant among short-term quitters (AHR 0.78; 95% CI 0.64 to 0.95), long-term quitters (AHR 0.68; 95% CI 0.54 to 0.85), and never smokers (AHR 0.66; 95% CI 0.56 to 0.78) compared with current smokers (p for trend <0.001). The lower risk of mortality from cancer was significant among the short-term quitters (AHR 0.60; 95% CI 0.44 to 0.83), long-term quitters (AHR 0.67; 95% CI 0.46 to 0.90), and never smokers (AHR 0.50; 95% CI 0.39 to 0.65) compared with current smokers (p for trend <0.001). There was no significant association between changes in smoking status and death from CVD. Smoking cessation after diagnosis in non-obese individuals (AHR 0.73; 95% CI 0.58 to 0.92) and exercisers (AHR 0.54; 95% CI 0.38 to 0.76) was significantly associated with reduced mortality risk than current smoking. CONCLUSIONS Smoking cessation after new-onset type 2 diabetes was associated with reduced mortality risk.
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Affiliation(s)
- Jae Woo Choi
- College of Pharmacy, Yonsei University, Incheon, South Korea
| | - Euna Han
- College of Pharmacy, Yonsei University, Incheon, South Korea
| | - Tae Hyun Kim
- Graduate School of Public Health, Yonsei University, Seoul, South Korea
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Abstract
This article is a comprehensive document on the diagnosis and management of fibromuscular dysplasia (FMD) which was commissioned by the Working Group 'Hypertension and the Kidney' of the European Society of Hypertension (ESH) and the Society for Vascular Medicine (SVM). This document updates previous consensus documents/scientific statements on FMD published in 2014 with full harmonization of the position of European and US experts. In addition to practical consensus-based clinical recommendations, including a consensus protocol for catheter-based angiography and percutaneous angioplasty for renal FMD, the document also includes the first analysis of the European/International FMD Registry and provides updated data from the US Registry for FMD. Finally, it provides insights on ongoing research programs and proposes future research directions for understanding this multifaceted arterial disease.
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18
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Usman M, Khunti K, Davies MJ, Gillies CL. Cost-effectiveness of intensive interventions compared to standard care in individuals with type 2 diabetes: A systematic review and critical appraisal of decision-analytic models. Diabetes Res Clin Pract 2020; 161:108073. [PMID: 32061637 DOI: 10.1016/j.diabres.2020.108073] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2019] [Revised: 12/03/2019] [Accepted: 02/10/2020] [Indexed: 01/04/2023]
Abstract
AIMS The objective of this systematic review is to identify and assess the quality of published decision-analytic models evaluating the long-term cost-effectiveness of target-driven intensive interventions for single and multifactorial risk factor control compared to standard care in people with type 2 diabetes. METHODS We searched the electronic databases MEDLINE, the National Health Service Economic Evaluation Database, Web of Science and the Cochrane Library from inception to October 31, 2019. Articles were eligible for inclusion if the studies had used a decision-analytic model evaluating both the long-term costs and benefits associated with intensive interventions for risk factor control compared to standard care in people with type 2 diabetes. Data were extracted using a standardised form, while quality was assessed using the decision-analytic model-specific Philips-criteria. RESULTS Overall, nine articles (11 models) were identified, four models evaluated intensive glycaemic control, three evaluated intensive blood pressure control, two evaluated intensive lipid control, and two evaluated intensive multifactorial interventions. Six reported using discrete-time simulations modelling approach, whereas five reported using a Markov modelling framework. The majority, seven studies, reported that the intensive interventions were dominant or cost-effective, given the assumptions and analytical perspective taken. The methodological and reporting quality of the studies was generally weak, with only four studies fulfilling more than 50% of their applicable Philips-criteria. CONCLUSIONS This is the first systematic review of decision-analytic models of target-driven intensive interventions for single and multifactorial risk factor control in individuals with type 2 diabetes. Identified shortcomings are lack of transparency in data identification and evidence synthesis as well as for the selection of the modelling approaches. Future models should aim to include greater evaluation of the quality of the data sources used and the assessment of uncertainty in the model.
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Affiliation(s)
- Muhammad Usman
- Diabetes Research Centre, University of Leicester, Leicester, UK.
| | - Kamlesh Khunti
- Diabetes Research Centre, University of Leicester, Leicester, UK; NIHR Applied Research Collaborations - East Midlands (NIHR ARC - EM), Leicester, UK
| | - Melanie J Davies
- Diabetes Research Centre, University of Leicester, Leicester, UK; NIHR Leicester Biomedical Research Centre, UK
| | - Clare L Gillies
- Diabetes Research Centre, University of Leicester, Leicester, UK
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Deal JA, Power MC, Palta P, Alonso A, Schneider AL, Perryman K, Bandeen-Roche K, Sharrett AR. Relationship of Cigarette Smoking and Time of Quitting with Incident Dementia and Cognitive Decline. J Am Geriatr Soc 2020; 68:337-345. [PMID: 31675113 PMCID: PMC7002272 DOI: 10.1111/jgs.16228] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2019] [Revised: 08/30/2019] [Accepted: 09/16/2019] [Indexed: 12/22/2022]
Abstract
OBJECTIVES Understanding how dementia risk is impacted by timing of smoking cessation has public health implications for prevention efforts. We investigated the relationship of cigarette smoking and cessation with dementia risk and cognitive decline in the Atherosclerosis Risk in Communities (ARIC) study. DESIGN Ongoing prospective cohort study. SETTING Begun in 1987-1989, ARIC was conducted in four US communities. PARTICIPANTS A total of 13 002 men and women (25% African American) aged 52 to 75 years. MEASUREMENTS All-cause dementia was defined using standardized algorithms incorporating longitudinal cognitive data, proxy report, and hospital and death certificate dementia codes. Cognitive decline was measured using a composite cognitive score created from three tests measured at two time points (1996-1998 and 2011-2013). Smoking and cessation status were defined by self-report using data from 1987-1989 (visit 1) and 1996-1998 (visit 4). Incident dementia risk and differences in cognitive change by smoking status were estimated with Cox proportional hazards and linear regression models, respectively. To address smoking-related attrition, cognitive scores were imputed for living participants with incomplete cognitive testing. RESULTS The proportion of never, former, and current smokers was 44%, 41%, and 14%; 79% of former smokers quit 9 years or more before baseline. A total of 1347 participants developed dementia. After adjustment, compared with never smoking, the hazard ratio for all-cause dementia for current smoking was 1.33 (95% confidence interval [CI] = 1.12-1.59) and for recent quitting (<9 y before baseline) was 1.24 (95% CI = 1.01-1.52). Quitting 9 years or more before baseline was not associated with dementia. We found no differences in rates of cognitive decline by smoking status. CONCLUSION Although quitting at any time suggested benefit, dementia risk depended on time since smoking cessation. Our study highlights the importance of early midlife cessation to decrease dementia risk. J Am Geriatr Soc 68:337-345, 2020.
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Affiliation(s)
- Jennifer A. Deal
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Melinda C. Power
- Department of Epidemiology and Biostatistics, George Washington University Milken Institute School of Public Health, Washington, DC
| | - Priya Palta
- Division of General Medicine, Department of Medicine, Columbia University Medical Center, New York, NY
| | - Alvaro Alonso
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA
| | | | - Kelly Perryman
- Neurosurgery, Florida Cancer Specialists and Research Institute, Palm Beach Gardens, FL
| | - Karen Bandeen-Roche
- Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - A. Richey Sharrett
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
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Symonds P, Hutchinson E, Ibbetson A, Taylor J, Milner J, Chalabi Z, Davies M, Wilkinson P. MicroEnv: A microsimulation model for quantifying the impacts of environmental policies on population health and health inequalities. THE SCIENCE OF THE TOTAL ENVIRONMENT 2019; 697:134105. [PMID: 32380606 PMCID: PMC7212697 DOI: 10.1016/j.scitotenv.2019.134105] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/12/2019] [Revised: 07/30/2019] [Accepted: 08/24/2019] [Indexed: 05/07/2023]
Abstract
The Sustainable Development Goals (SDGs) recognise the critical need to improve population health and environmental sustainability. This paper describes the development of a microsimulation model, MicroEnv, aimed at quantifying the impact of environmental exposures on health as an aid to selecting policies likely to have greatest benefit. Its methods allow the integration of morbidity and mortality outcomes and the generation of results at high spatial resolution. We illustrate its application to the assessment of the impact of air pollution on health in London. Simulations are performed at Lower Layer Super Output Area (LSOA), the smallest geographic unit (population of around 1500 inhabitants) for which detailed socio-demographic data are routinely available in the UK. The health of each individual in these LSOAs is simulated year-by-year using a health-state-transition model, where transition probabilities from one state to another are based on published statistics modified by relative risks that reflect the effect of environmental exposures. This is done through linkage of the simulated population in each LSOA with 1 × 1 km annual average PM2.5 concentrations and area-based deprivation indices. Air pollution is a leading cause of mortality and morbidity globally, and improving air quality is critical to the SDGs for Health (Goal 3) and Cities (Goal 11). The evidence of MicroEnv is aimed at providing better understanding of the benefits for population health and health inequalities of policy actions that affect exposure such as air quality, and thus to help shape policy decisions. Future work will extend the model to integrate other environmental determinants of health.
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Affiliation(s)
- Phil Symonds
- Institute of Environmental Design and Engineering, UCL, London, UK.
| | | | | | - Jonathon Taylor
- Institute of Environmental Design and Engineering, UCL, London, UK.
| | - James Milner
- London School of Hygiene and Tropical Medicine, London, UK.
| | - Zaid Chalabi
- Institute of Environmental Design and Engineering, UCL, London, UK; London School of Hygiene and Tropical Medicine, London, UK.
| | - Michael Davies
- Institute of Environmental Design and Engineering, UCL, London, UK.
| | - Paul Wilkinson
- Institute of Environmental Design and Engineering, UCL, London, UK.
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Schmidt KMT, Hansen KM, Johnson AL, Gepner AD, Korcarz CE, Fiore MC, Baker TB, Piper ME, Stein JH. Longitudinal Effects of Cigarette Smoking and Smoking Cessation on Aortic Wave Reflections, Pulse Wave Velocity, and Carotid Artery Distensibility. J Am Heart Assoc 2019; 8:e013939. [PMID: 31795823 PMCID: PMC6951052 DOI: 10.1161/jaha.119.013939] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2019] [Accepted: 10/30/2019] [Indexed: 02/06/2023]
Abstract
Background We evaluated the effects of smoking and smoking cessation on aortic wave reflections (augmentation index), aortic pulse wave velocity, and carotid artery distensibility and stiffness (distensibility coefficient, Young's elastic modulus). Methods and Results Current smokers underwent carotid, radial, and femoral artery tonometry and carotid ultrasound at baseline and 3 years after a quit attempt. Baseline associations of smoking heaviness markers (exhaled carbon monoxide and cigarettes smoked/d) and effects of smoking cessation at year 3 on changes in arterial measures were assessed using multivariable linear regression models. The 1417 smokers (54% female) were mean (SD) 49.3 (11.6) years old and smoked 17.2 (8.3) cigarettes/d (exhaled carbon monoxide 14.7 [8.2] parts per million). Arterial measures were associated more strongly with age, blood pressure (BP), and waist circumference than with smoking heaviness markers. Augmentation index was associated independently with carbon monoxide (P=0.004). Pulse wave velocity, distensibility coefficient, and Young's elastic modulus had small, inconsistent associations with smoking heaviness markers. At year 3, augmentation index improved with smoking cessation (P=0.006) despite more weight gain (2.54 vs 0.36 kg, P<0.001) and insulin resistance (P=0.001) among abstainers, but distensibility coefficient decreased (P=0.004). Changes in arterial measures were related more strongly to changes in BP than smoking cessation. Conclusions Arterial wave reflection and stiffness measures were associated more strongly with age, BP, and waist circumference than smoking heaviness. Smoking cessation was associated with weight gain and increased insulin resistance. Changes in arterial measures were predicted by changes in BP, highlighting the need to address weight gain and BP changes during a quit attempt.
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Affiliation(s)
| | - Kristin M. Hansen
- School of Medicine and Public HealthUniversity of WisconsinMadisonWI
| | | | - Adam D. Gepner
- School of Medicine and Public HealthUniversity of WisconsinMadisonWI
| | | | - Michael C. Fiore
- School of Medicine and Public HealthUniversity of WisconsinMadisonWI
| | - Timothy B. Baker
- School of Medicine and Public HealthUniversity of WisconsinMadisonWI
| | - Megan E. Piper
- School of Medicine and Public HealthUniversity of WisconsinMadisonWI
| | - James H. Stein
- School of Medicine and Public HealthUniversity of WisconsinMadisonWI
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Caponnetto P, DiPiazza J, Cappello GC, Demma S, Maglia M, Polosa R. Multimodal Smoking Cessation in a Real-Life Setting: Combining Motivational Interviewing With Official Therapy and Reduced Risk Products. Tob Use Insights 2019; 12:1179173X19878435. [PMID: 31636483 PMCID: PMC6783661 DOI: 10.1177/1179173x19878435] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2019] [Accepted: 08/30/2019] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Tobacco use is a global pandemic, affecting an estimated 1.2 billion people and resulting in substantial health burdens and associated costs. OBJECTIVES The aim of this study was to estimate the efficacy of several treatments for smoking cessation in a real-life setting and to evaluate predictors of smoking abstinence. METHODS This research was designed with a sample of 593 cases recorded over the period between 2015 and 2016. Six treatment groups were included: (1) bupropion and motivational interviewing (MI); (2) bupropion, nicotine replacement therapy (NRT), and MI; (3) NRT and MI; (4) varenicline and MI; (5) personal vaporizer electronic cigarette and MI; and (6) electronic cigarette, cigarette like "cigalike," and MI. RESULTS Results support the efficacy of all treatment groups when used in a real-life setting. The predictors of smoking abstinence were sex, partner smoking status, previous quit attempts, daily consumption, self-efficacy, and level of nicotine dependence. CONCLUSIONS The use of different therapeutic strategies in clinical practice, including pharmacotherapy and nonstandard electronic nicotine delivery systems, such as an electronic cigarette, ensures a greater chance of cessation success and the possibility of tailoring interventions according to patients' resources.
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Affiliation(s)
- Pasquale Caponnetto
- Centro per la Prevenzione e Cura del
Tabagismo, Azienda Ospedaliero-Universitaria, “V. Emanuele-Policlinico,” Università
di Catania, Catania, Italy
- Center of Excellence for the
acceleration of HArm Reduction (COEHAR), Dipartimento di Medicina clinica e
sperimentale, University of Catania, Catania, Italy
- Institute for Social Marketing,
University of Stirling, Stirling, UK
| | - Jennifer DiPiazza
- Hunter-Bellevue School of Nursing,
Hunter College, The City University of New York, New York, NY, USA
| | - Giorgio Carlo Cappello
- Dipartimento di Filosofia e
Comunicazione, Alma Mater Studiorum Università di Bologna, Italy
| | - Shirin Demma
- Center of Excellence for the
acceleration of HArm Reduction (COEHAR), Dipartimento di Medicina clinica e
sperimentale, University of Catania, Catania, Italy
| | - Marilena Maglia
- Center of Excellence for the
acceleration of HArm Reduction (COEHAR), Dipartimento di Medicina clinica e
sperimentale, University of Catania, Catania, Italy
| | - Riccardo Polosa
- Centro per la Prevenzione e Cura del
Tabagismo, Azienda Ospedaliero-Universitaria, “V. Emanuele-Policlinico,” Università
di Catania, Catania, Italy
- Center of Excellence for the
acceleration of HArm Reduction (COEHAR), Dipartimento di Medicina clinica e
sperimentale, University of Catania, Catania, Italy
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Shapiro MD, Maron DJ, Morris PB, Kosiborod M, Sandesara PB, Virani SS, Khera A, Ballantyne CM, Baum SJ, Sperling LS, Bhatt DL, Fazio S. Preventive Cardiology as a Subspecialty of Cardiovascular Medicine. J Am Coll Cardiol 2019; 74:1926-1942. [DOI: 10.1016/j.jacc.2019.08.1016] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2019] [Accepted: 08/20/2019] [Indexed: 02/06/2023]
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Jee Y, Jung KJ, Lee S, Back JH, Jee SH, Cho SI. Smoking and atherosclerotic cardiovascular disease risk in young men: the Korean Life Course Health Study. BMJ Open 2019; 9:e024453. [PMID: 31196897 PMCID: PMC6575821 DOI: 10.1136/bmjopen-2018-024453] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2018] [Revised: 02/16/2019] [Accepted: 02/21/2019] [Indexed: 11/06/2022] Open
Abstract
OBJECTIVE To examine the effect of smoking on risk of atherosclerotic cardiovascular disease (ASCVD) in Korean young men and to examine whether serum total cholesterol levels could modify the effect of smoking on ASCVD. DESIGN A prospective cohort study within a national insurance system. SETTING Health screenings provided by national insurance in 1992 and 1994. PARTICIPANTS A total of 118 531 young men between 20 and 29 years of age and were followed up for an average of 23 years. OUTCOME MEASURE To assess the independent effects of smoking on the risk of ischaemic heart disease (IHD), stroke and ASCVD, Cox proportional hazards regression models were used, controlling for age, hypertension, diabetes, hypercholesterolaemia and alcohol drinking. RESULTS The total number of current smokers was 78 455 (66.2%), and 94 113 (79.7%) of the sample recorded a total cholesterol level <200 mg/dL measured at baseline. Between 1993 and 2015, 2786 cases of IHD (53/100 000 person year), 2368 cases of stroke (45.4/100 000 person year) and 6368 ASCVD (122.7/100 000 person year) occurred. The risk of IHD, stroke and total ASCVD events was found to increase for current smokers, with a HR with 95% CI of 1.5 (95% CI 1.3 to 1.6), 1.4 (95% CI 1.2 to 1.6) and 1.4 (95% CI 1.3 to 1.5), respectively. Furthermore, the risks above were also found throughout the range of serum levels of cholesterol. CONCLUSIONS Smoking among Korean young adult men was independently associated with increased risk of IHD, stroke and ASCVD. The concentration of cholesterol in Korean men did not modify the effect of smoking on ASCVD.
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Affiliation(s)
- Yongho Jee
- Department of Public Health Science, Graduate School of Public Health, Seoul National University, Seoul, The Republic of Korea
| | - Keum Ji Jung
- Institute for Health Promotion, Graduate School of Public Health, Yonsei University, Seoul, The Republic of Korea
| | - Sunmi Lee
- Health Insurance Policy Research Institute, National Health Insurance Service, Wonju, Gangwon-do, The Republic of Korea
| | - Joung Hwan Back
- Wonju Gangwon-do, The Republic of Korea Wonju Gangwon-do, The Republic of Korea Health Insurance Policy Research Institute, National Health Insurance Service, Wonju Gangwon-do, The Republic of Korea
| | - Sun Ha Jee
- Department of Epidemiology and Health Promotion, Graduate School of Public Health, Yonsei University, Seoul, The Republic of Korea
| | - Sung-Il Cho
- Department of Public Health Science, Graduate School of Public Health, Seoul National University, Seoul, The Republic of Korea
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Airaksinen J, Ervasti J, Pentti J, Oksanen T, Suominen S, Vahtera J, Virtanen M, Kivimäki M. The effect of smoking cessation on work disability risk: a longitudinal study analysing observational data as non-randomized nested pseudo-trials. Int J Epidemiol 2019; 48:415-422. [PMID: 30815682 PMCID: PMC6469311 DOI: 10.1093/ije/dyz020] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/14/2019] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Smoking increases disability risk, but the extent to which smoking cessation reduces the risk of work disability is unclear. We used non-randomized nested pseudo-trials to estimate the benefits of smoking cessation for preventing work disability. METHODS We analysed longitudinal data on smoking status and work disability [long-term sickness absence (≥90 days) or disability pension] from two independent prospective cohort studies-the Finnish Public Sector study (FPS) (n = 7393) and the Health and Social Support study (HeSSup) (n = 2701)-as 'nested pseudo-trials'. All the 10 094 participants were smokers at Time 1 and free of long-term work disability at Time 2. We compared the work disability risk after Time 2 of the participants who smoked at Time 1 and Time 2 with that of those who quit smoking between these times. RESULTS Of the participants in pseudo-trials, 2964 quit smoking between Times 1 and 2. During the mean follow-up of 4.8 to 8.6 years after Time 2, there were 2197 incident cases of work disability across the trials. Quitting smoking was associated with a reduced risk of any work disability [summary hazard ratio = 0.89, 95% confidence interval (CI) 0.81-0.98]. The hazard ratio for the association between quitting smoking and permanent disability pension (928 cases) was of similar magnitude, but less precisely estimated (0.91, 95% CI 0.81-1.02). Among the participants with high scores on the work disability risk score (top third), smoking cessation reduced the risk of disability pension by three percentage points. Among those with a low risk score (bottom third), smoking cessation reduced the risk by half a percentage point. CONCLUSIONS Our results suggest an approximately 10% hazard reduction of work disability as a result of quitting smoking.
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Affiliation(s)
- Jaakko Airaksinen
- Department of Psychology and Logopedics, Medicum, University of Helsinki, Helsinki, Finland
- Department of Occupational Health, Finnish Institute of Occupational Health, Helsinki, Finland
| | - Jenni Ervasti
- Department of Occupational Health, Finnish Institute of Occupational Health, Helsinki, Finland
| | - Jaana Pentti
- Clinicum, University of Helsinki, Helsinki, Finland
- Department of Public Health, University of Turku and Turku University Hospital, Turku, Finland
| | - Tuula Oksanen
- Department of Occupational Health, Finnish Institute of Occupational Health, Helsinki, Finland
| | - Sakari Suominen
- Department of Public Health, University of Turku and Turku University Hospital, Turku, Finland
| | - Jussi Vahtera
- Department of Public Health, University of Turku and Turku University Hospital, Turku, Finland
| | - Marianna Virtanen
- Department of Occupational Health, Finnish Institute of Occupational Health, Helsinki, Finland
- Institute of Public Health and Caring Sciences, University of Uppsala, Uppsala, Sweden
| | - Mika Kivimäki
- Department of Occupational Health, Finnish Institute of Occupational Health, Helsinki, Finland
- Clinicum, University of Helsinki, Helsinki, Finland
- Department of Epidemiology and Public Health, University College London, London, UK
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Hua Q, Fan L, Li J. 2019 Chinese guideline for the management of hypertension in the elderly. J Geriatr Cardiol 2019; 16:67-99. [PMID: 30923539 PMCID: PMC6431598 DOI: 10.11909/j.issn.1671-5411.2019.02.001] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Affiliation(s)
- Qi Hua
- Hypertension Branch of Chinese Geriatrics Society
- National Clinical Research Center of the Geriatric Diseases-Chinese Alliance of Geriatric Cardiovascular Disease
| | - Li Fan
- Hypertension Branch of Chinese Geriatrics Society
- National Clinical Research Center of the Geriatric Diseases-Chinese Alliance of Geriatric Cardiovascular Disease
| | - Jing Li
- Hypertension Branch of Chinese Geriatrics Society
- National Clinical Research Center of the Geriatric Diseases-Chinese Alliance of Geriatric Cardiovascular Disease
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Gornik HL, Persu A, Adlam D, Aparicio LS, Azizi M, Boulanger M, Bruno RM, de Leeuw P, Fendrikova-Mahlay N, Froehlich J, Ganesh SK, Gray BH, Jamison C, Januszewicz A, Jeunemaitre X, Kadian-Dodov D, Kim ESH, Kovacic JC, Mace P, Morganti A, Sharma A, Southerland AM, Touzé E, van der Niepen P, Wang J, Weinberg I, Wilson S, Olin JW, Plouin PF. First International Consensus on the diagnosis and management of fibromuscular dysplasia. Vasc Med 2019; 24:164-189. [DOI: 10.1177/1358863x18821816] [Citation(s) in RCA: 151] [Impact Index Per Article: 30.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
This article is a comprehensive document on the diagnosis and management of fibromuscular dysplasia (FMD), which was commissioned by the working group ‘Hypertension and the Kidney’ of the European Society of Hypertension (ESH) and the Society for Vascular Medicine (SVM). This document updates previous consensus documents/scientific statements on FMD published in 2014 with full harmonization of the position of European and US experts. In addition to practical consensus-based clinical recommendations, including a consensus protocol for catheter-based angiography and percutaneous angioplasty for renal FMD, the document also includes the first analysis of the European/International FMD Registry and provides updated data from the US Registry for FMD. Finally, it provides insights on ongoing research programs and proposes future research directions for understanding this multifaceted arterial disease.
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Affiliation(s)
- Heather L Gornik
- Division of Cardiovascular Medicine, University Hospitals Cleveland Medical Center and UH Harrington Heart and Vascular Institute, Cleveland, OH, USA
| | - Alexandre Persu
- Division of Cardiology, Department of Cardiovascular Diseases, Cliniques Universitaires Saint-Luc and Pole of Cardiovascular Research, Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain, Brussels, Belgium
| | - David Adlam
- Department of Cardiovascular Sciences, Glenfield Hospital, Leicester, UK
- NIHR Leicester Biomedical Research Centre, Glenfield Hospital, Leicester, UK
| | - Lucas S Aparicio
- Hypertension Section, Internal Medicine Department, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Michel Azizi
- Paris Descartes University, Paris, France
- Assistance-Publique Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Hypertension Unit, Paris, France
- Institut national de la santé et de la recherche médicale, Centre d’Investigation Clinique 1418, Paris, France
| | - Marion Boulanger
- Normandie Université, UNICAEN, Inserm U1237, CHU Caen Normandie, Caen, France
| | - Rosa Maria Bruno
- Department of Clinical and Experimental Medicine University of Pisa, Pisa, Italy
| | - Peter de Leeuw
- Department of Medicine, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Natalia Fendrikova-Mahlay
- Department of Cardiovascular Medicine, Cleveland Clinic Heart and Vascular Institute, Cleveland, OH, USA
| | - James Froehlich
- Department of Internal Medicine, Frankel Cardiovascular Center, University of Michigan, Ann Arbor, MI, USA
| | - Santhi K Ganesh
- Department of Internal Medicine, Frankel Cardiovascular Center, University of Michigan, Ann Arbor, MI, USA
| | - Bruce H Gray
- University of South Carolina School of Medicine/Greenville, Greenville, SC, USA
| | - Cathlin Jamison
- Association belge de patients atteints de Dysplasie Fibromusculaire/FMD Groep België (FMD-Be), Brussels, Belgium
| | | | - Xavier Jeunemaitre
- APHP, Department of Genetics and Centre for Rare Vascular Diseases, Hôpital Européen Georges Pompidou, Paris, France
- INSERM, U970 – PARCC, University Paris Descartes, Sorbonne Paris
Cité, Paris, France
| | - Daniella Kadian-Dodov
- Zena and Michael A Wiener Cardiovascular Institute and Marie-Josée and Henry R. Kravis Center for Cardiovascular Health; Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Esther SH Kim
- Division of Cardiovascular Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Jason C Kovacic
- Zena and Michael A Wiener Cardiovascular Institute and Marie-Josée and Henry R. Kravis Center for Cardiovascular Health; Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Pamela Mace
- Fibromuscular Dysplasia Society of America (FMDSA), North Olmsted, OH, USA
| | - Alberto Morganti
- Centro Fisiologia Clinica e Ipertensione, Policlinico Hospital, University of Milan, Milan, Italy
| | - Aditya Sharma
- Department of Medicine, Cardiovascular Medicine Division, University of Virginia, Charlottesville, VA, USA
| | | | - Emmanuel Touzé
- Normandie Université, UNICAEN, Inserm U1237, CHU Caen Normandie, Caen, France
| | - Patricia van der Niepen
- Department of Nephrology & Hypertension Vrije Universiteit Brussel (VUB), Universitair Ziekenhuis Brussel (UZ Brussel), Brussels, Belgium
| | - Jiguang Wang
- Shanghai Institute of Hypertension and Center for Epidemiological Studies and Clinical Trials, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Ido Weinberg
- Vascular Medicine Section and Vascular Center, Harvard Medical School, Massachusetts General Hospital, Boston, MA, USA
| | - Scott Wilson
- Monash University (Central Clinical School of Medicine), Melbourne, VIC, Australia
- Department of Renal Medicine, Alfred Health, Melbourne, VIC, Australia
| | - Jeffrey W Olin
- Zena and Michael A Wiener Cardiovascular Institute and Marie-Josée and Henry R. Kravis Center for Cardiovascular Health; Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Pierre-Francois Plouin
- Paris Descartes University, Paris, France
- Assistance-Publique Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Hypertension Unit, Paris, France
- Institut national de la santé et de la recherche médicale, Centre d’Investigation Clinique 1418, Paris, France
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Dinh PC, Schrader LA, Svensson CJ, Margolis KL, Silver B, Luo J. Smoking cessation, weight gain, and risk of stroke among postmenopausal women. Prev Med 2019; 118:184-190. [PMID: 30359645 DOI: 10.1016/j.ypmed.2018.10.018] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2018] [Revised: 10/13/2018] [Accepted: 10/19/2018] [Indexed: 01/09/2023]
Abstract
The relationship between smoking cessation, concurrent weight gain, and stroke events is not yet understood. Thus, we examined the association between smoking cessation and subsequent stroke risk and whether the association was modified by concurrent weight gain. In 2017, we analyzed data from 109,498 postmenopausal US women enrolled in the Women's Health Initiative from 1993 to 1998. Women with a history of cancer or cardiovascular disease events were excluded. The median length of follow-up time was 14.01 years. Variables of primary focus were smoking cessation, weight change, and clinically confirmed incident cases of hemorrhagic and ischemic stroke. Hazard ratios were estimated for stroke incidences (all, ischemic, and hemorrhagic) associated with smoking cessation using Cox regression. The exposure-outcome relationship of smoking cessation and risk of stroke was evaluated for effect modification by weight change. Recent quitters between baseline and year 3 had a significantly lower risk for all stroke and ischemic stroke, but not hemorrhagic stroke, when compared to the reference group of continuing smokers. In the multivariable-adjusted model for ischemic stroke, the hazard ratio for recent quitters was 0.66 (95% CI: 0.46, 0.95). In the model for hemorrhagic stroke, the hazard ratio for recent quitters was 0.76 (95% CI: 0.36, 1.61). The association between recent quitting and stroke risk was not significantly modified by weight change. Smoking cessation was associated with a significant reduction in stroke risk. The benefit of smoking cessation on the risk of stroke was not attenuated by concurrent weight gain.
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Affiliation(s)
- Paul C Dinh
- Indiana University School of Public Health, 1025 E. 7th Street, Bloomington, IN 47405, United States of America.
| | - Lauren A Schrader
- Indiana University School of Public Health, 1025 E. 7th Street, Bloomington, IN 47405, United States of America.
| | - Catherine J Svensson
- Indiana University School of Public Health, 1025 E. 7th Street, Bloomington, IN 47405, United States of America.
| | - Karen L Margolis
- HealthPartners Institute, Box 1524, Mailstop 21111R, Minneapolis, MN, United States of America.
| | - Brian Silver
- Department of Neurology, UMass Memorial Medical Center, 55 Lake Avenue North, Worcester, MA 01655, United States of America.
| | - Juhua Luo
- Indiana University School of Public Health, 1025 E. 7th Street, Bloomington, IN 47405, United States of America.
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Barua RS, Rigotti NA, Benowitz NL, Cummings KM, Jazayeri MA, Morris PB, Ratchford EV, Sarna L, Stecker EC, Wiggins BS. 2018 ACC Expert Consensus Decision Pathway on Tobacco Cessation Treatment: A Report of the American College of Cardiology Task Force on Clinical Expert Consensus Documents. J Am Coll Cardiol 2018; 72:3332-3365. [PMID: 30527452 DOI: 10.1016/j.jacc.2018.10.027] [Citation(s) in RCA: 188] [Impact Index Per Article: 31.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
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Economic Impact of Financial Incentives and Mailing Nicotine Patches to Help Medicaid Smokers Quit Smoking: A Cost-Benefit Analysis. Am J Prev Med 2018; 55:S148-S158. [PMID: 30454669 DOI: 10.1016/j.amepre.2018.08.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2018] [Revised: 05/05/2018] [Accepted: 08/02/2018] [Indexed: 01/12/2023]
Abstract
An RCT designed to increase Medicaid smokers' quitting success was conducted in California during 2012-2013. In the trial, alternative cessation treatment strategies were embedded in the state's ongoing quitline services. It found that modest financial incentives of up to $60 per participant and sending nicotine patches induced significantly higher cessation rates compared with usual care alone and usual care plus nicotine patches. Building upon that study, this study assessed potential population-level costs and benefits of integrating financial incentives and nicotine patches in a quitline setting for Medicaid smokers. A cost-benefit analysis was undertaken from the Medicaid program's perspective. The Cardiovascular Disease Policy Model was used to simulate future healthcare expenditures over a 10-year horizon for each treatment strategy for a study cohort of California Medicaid enrollees who were aged 35-64 years in 2014 (n=2,452,000). To simulate potential population-level benefits under each treatment strategy, each treatment was applied to all active smokers in the study cohort (n=478,300). Sensitivity analyses were conducted by varying key parameters, such as cessation costs, discount rate, relapse rates, and time horizon. Adding both financial incentives and nicotine patches to usual quitline care would result in $15 million net savings over 10 years, with a benefit-cost ratio of 1.30 compared with the usual care plus nicotine patches strategy. It would yield $44 million net savings, with a benefit-cost ratio of 1.90 compared with usual care alone. The strategy of providing financial incentives and mailing nicotine patches directly to Medicaid smokers who call the quitline is cost saving. SUPPLEMENT INFORMATION: This article is part of a supplement entitled Advancing Smoking Cessation in California's Medicaid Population, which is sponsored by the California Department of Public Health.
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Feodoroff M, Harjutsalo V, Forsblom C, Groop PH. Dose-dependent effect of smoking on risk of coronary heart disease, heart failure and stroke in individuals with type 1 diabetes. Diabetologia 2018; 61:2580-2589. [PMID: 30229273 DOI: 10.1007/s00125-018-4725-9] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2018] [Accepted: 08/02/2018] [Indexed: 11/26/2022]
Abstract
AIMS/HYPOTHESIS The aim of this study was to assess the potential dose-dependent effects of smoking on the risk of CHD, heart failure and stroke in individuals with type 1 diabetes. METHODS The study included 4506 individuals with type 1 diabetes who were participating in the Finnish Diabetic Nephropathy (FinnDiane) study. Intensity of smoking was estimated by packs per day and cumulative smoking by pack-years. Cox regression analyses were used to estimate the risk of incident CHD, heart failure or stroke during follow-up. RESULTS One pack per day significantly increased the risk of incident CHD in current smokers compared with never smokers (HR 1.45 [95% CI 1.15, 1.84]), after adjustment for age, sex, HbA1c, hypertension, duration of diabetes and BMI. The risk of CHD in former smokers was similar to the risk in never smokers. The risk of incident heart failure was 1.43 (95% CI 1.03, 1.97) in current smokers per one pack per day and 1.37 (95% CI 1.05, 1.77) in former smokers, while the risk of incident stroke was 1.70 (95% CI 1.26, 2.29) and 1.49 (95% CI 1.14, 1.93), respectively. After further adjustments for lipids, however, the difference in the risk of heart failure in current and former smokers was no longer significant. Cumulative smoking data were similar to smoking intensity data. CONCLUSIONS/INTERPRETATION There is a dose-dependent association between smoking and cardiovascular disease in individuals with type 1 diabetes. In men in particular, the risk of incident stroke remains high even after smoking cessation and is increased in current and former smokers independently of other risk factors.
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Affiliation(s)
- Maija Feodoroff
- Folkhälsan Institute of Genetics, Folkhälsan Research Center, Biomedicum Helsinki, University of Helsinki, Haartmaninkatu 8, P.O. Box 63, FIN-00014, Helsinki, Finland
- Abdominal Center Nephrology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
- Research Programs Unit, Diabetes and Obesity, University of Helsinki, Helsinki, Finland
| | - Valma Harjutsalo
- Folkhälsan Institute of Genetics, Folkhälsan Research Center, Biomedicum Helsinki, University of Helsinki, Haartmaninkatu 8, P.O. Box 63, FIN-00014, Helsinki, Finland
- Abdominal Center Nephrology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
- Research Programs Unit, Diabetes and Obesity, University of Helsinki, Helsinki, Finland
- National Institute for Health and Welfare, The Chronic Disease Prevention Unit, Helsinki, Finland
| | - Carol Forsblom
- Folkhälsan Institute of Genetics, Folkhälsan Research Center, Biomedicum Helsinki, University of Helsinki, Haartmaninkatu 8, P.O. Box 63, FIN-00014, Helsinki, Finland
- Abdominal Center Nephrology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
- Research Programs Unit, Diabetes and Obesity, University of Helsinki, Helsinki, Finland
| | - Per-Henrik Groop
- Folkhälsan Institute of Genetics, Folkhälsan Research Center, Biomedicum Helsinki, University of Helsinki, Haartmaninkatu 8, P.O. Box 63, FIN-00014, Helsinki, Finland.
- Abdominal Center Nephrology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
- Research Programs Unit, Diabetes and Obesity, University of Helsinki, Helsinki, Finland.
- Department of Diabetes, Central Clinical School, Monash University, Melbourne, VIC, Australia.
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Alzahrani T, Pena I, Temesgen N, Glantz SA. Association Between Electronic Cigarette Use and Myocardial Infarction. Am J Prev Med 2018; 55:455-461. [PMID: 30166079 PMCID: PMC6208321 DOI: 10.1016/j.amepre.2018.05.004] [Citation(s) in RCA: 211] [Impact Index Per Article: 35.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2017] [Revised: 03/21/2018] [Accepted: 05/04/2018] [Indexed: 12/29/2022]
Abstract
INTRODUCTION Electronic cigarettes (e-cigarettes) are promoted as a less risky alternative to conventional cigarettes and have grown in popularity. Experimental and clinical evidence suggests that they could increase the risk of myocardial infarction. METHODS The National Health Interview Surveys of 2014 (n=36,697) and 2016 (n=33,028) were used to examine the cross-sectional association between e-cigarette use (never, former, some days, daily) and cigarette smoking (same categories) and myocardial infarction in a single logistic regression model that also included demographics (age, gender, BMI) and health characteristics (hypertension, diabetes, and hypercholesterolemia) using logistic regression. Data were collected in 2014 and 2016 and analyzed in 2017 and 2018. RESULTS Daily e-cigarette use was independently associated with increased odds of having had a myocardial infarction (OR=1.79, 95% CI=1.20, 2.66, p=0.004) as was daily conventional cigarette smoking (OR=2.72, 95% CI=2.29, 3.24, p<0.001). Former and some day e-cigarette use were not significantly associated with having had a myocardial infarction (p=0.608 and p=0.392) whereas former (OR=1.70, p<0.001) and some day cigarette smoking (OR=2.36, p<0.001) were. Odds of a myocardial infarction were also increased with history of hypertension (OR=2.32, p<0.001); high cholesterol (OR=2.36, p<0.001); and diabetes (OR=1.77, p<0.001); and age (OR=1.65 per 10 years, p<0.001). Women (OR=0.47, p<0.001) had lower odds of myocardial infarction. CONCLUSIONS Daily e-cigarette use, adjusted for smoking conventional cigarettes as well as other risk factors, is associated with increased risk of myocardial infarction.
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Affiliation(s)
- Talal Alzahrani
- Department of Medicine, George Washington University, Washington, District of Columbia
| | - Ivan Pena
- Department of Medicine, George Washington University, Washington, District of Columbia
| | - Nardos Temesgen
- Department of Medicine, George Washington University, Washington, District of Columbia
| | - Stanton A Glantz
- Department of Medicine, Cardiovascular Research Institute, Philip R. Lee Institute for Health Policy Studies, Center for Tobacco Control Research and Education, University of California, San Francisco, San Francisco, California.
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Goulden R, Nguyen QD, Azoulay L. Risk of Bias in Study of Varenicline and Cardiovascular Outcomes. Am J Respir Crit Care Med 2018; 198:690-691. [DOI: 10.1164/rccm.201803-0423le] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
| | | | - Laurent Azoulay
- McGill UniversityMontreal, Quebec, Canadaand
- Jewish General Hospital MontrealMontreal, Quebec, Canada
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Mayne SL, Widome R, Carroll AJ, Schreiner PJ, Gordon-Larsen P, Jacobs DR, Kershaw KN. Longitudinal Associations of Smoke-Free Policies and Incident Cardiovascular Disease: CARDIA Study. Circulation 2018; 138:557-566. [PMID: 29735485 PMCID: PMC6202173 DOI: 10.1161/circulationaha.117.032302] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2017] [Accepted: 03/21/2018] [Indexed: 12/16/2022]
Abstract
BACKGROUND Smoke-free legislation has been associated with lower rates of cardiovascular disease hospital admissions in ecological studies. However, prior studies lacked detailed information on individual-level factors (eg, sociodemographic and clinical characteristics) that could potentially confound associations. Our objective was to estimate associations of smoke-free policies with incident cardiovascular disease in a longitudinal cohort after controlling for sociodemographics, cardiovascular disease risk factors, and policy covariates. METHODS Longitudinal data from 3783 black and white adults in the CARDIA study (Coronary Artery Risk Development in Young Adults; 1995-2015) were linked to state, county, and local 100% smoke-free policies in bars, restaurants, and nonhospitality workplaces by Census tract. Extended Cox regression estimated hazard ratios (HRs) of incident cardiovascular disease associated with time-dependent smoke-free policy exposures. Models were adjusted for sociodemographic characteristics, cardiovascular disease risk factors, state cigarette tax, participant-reported presence of a smoking ban at their workplace, field center, and metropolitan statistical area poverty. RESULTS During a median follow-up of 20 years (68 332 total person-years), 172 participants had an incident cardiovascular disease event (2.5 per 1000 person-years). Over the follow-up period, 80% of participants lived in areas with smoke-free policies in restaurants, 67% in bars, and 65% in nonhospitality workplaces. In fully adjusted models, participants living in an area with a restaurant, bar, or workplace smoke-free policy had a lower risk of incident cardiovascular disease compared with those in areas without smoke-free policies (HR, 0.75, 95% confidence interval, 0.49-1.15; HR, 0.76, 95% confidence interval, 0.47-1.24; HR, 0.54, 95% confidence interval, 0.34-0.86, respectively; HR, 0.58, 95% confidence interval, 0.33-1.00 for living in an area with all 3 types of policies compared with none). The estimated preventive fraction was 25% for restaurant policies, 24% for bar policies, and 46% for workplace policies. CONCLUSIONS Consistent with prior ecological studies, these individual-based data add to the evidence that 100% smoke-free policies are associated with lower risk of cardiovascular disease among middle-aged adults.
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Affiliation(s)
- Stephanie L Mayne
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (S.L.M., A.J.C., K.N.K.)
| | - Rachel Widome
- Division of Epidemiology and Community Health, University of Minnesota School of Public Health, Minneap-olis (R.W., P.J.S., D.R.J.)
| | - Allison J Carroll
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (S.L.M., A.J.C., K.N.K.)
| | - Pamela J Schreiner
- Division of Epidemiology and Community Health, University of Minnesota School of Public Health, Minneap-olis (R.W., P.J.S., D.R.J.)
| | - Penny Gordon-Larsen
- Department of Nutrition, University of North Carolina Gillings School of Public Health, Chapel Hill (P.G.-L.)
| | - David R Jacobs
- Division of Epidemiology and Community Health, University of Minnesota School of Public Health, Minneap-olis (R.W., P.J.S., D.R.J.)
| | - Kiarri N Kershaw
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (S.L.M., A.J.C., K.N.K.)
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Chen M, Li Z, Zhang Z, Du Y, Zhang Y, Xu M, Sun C. Intervention of integrative medicine treatment has impact on serum levels of ET-1, TNF-α, MLT in RA-CVD. Saudi J Biol Sci 2018; 25:959-964. [PMID: 30108447 PMCID: PMC6087809 DOI: 10.1016/j.sjbs.2018.03.005] [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: 10/12/2017] [Revised: 03/02/2018] [Accepted: 03/05/2018] [Indexed: 11/20/2022] Open
Abstract
Rheumatoid arthritis (RA) is a systemic autoimmune disease that can destroy peripheral joints. However, very little is known regarding specific biological marker for RA in Chinese patients. In this study, we determined the serum biomarkers and clinical features of RA-CVD. We also evaluated the short-term efficacy of routine RA treatment combined with integrative medicine treatment on RA-CVD. We found that anti-cyclic citrullinated peptide (CCP) and disease activity score in 28 joints (DAS28) are associated with risks of cardiovascular disease (CVD) in RA. And, melatonin (MLT) may play a negative regulatory role in cardiovascular damage in patients with RA. Furthermore, endothelin (ET-1) and inflammatory markers may be subclinical cardiovascular damages in RA. Moreover, of the 17 patients with RA-CVD, test results of ET-1, TNF-α and OSCAR after integrative medicine treatment were significantly decreased than before treatment. Collectively, our results provide a therapeutic potential of integrative medicine to the treatment of RA-CVD.
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Affiliation(s)
- Meng Chen
- Department of Rheumatology, Affiliated Hospital of Hebei University, Baoding 071000, PR China
| | - Zhenbin Li
- Department of Rheumatology and Immunology, Bethune International Peace Hospital of PLA, Shijiazhuang 050000, PR China
- Corresponding author.
| | - Zheng Zhang
- Department of Rheumatology, Affiliated Hospital of Hebei University, Baoding 071000, PR China
| | - Yong Du
- Department of Rheumatology, Affiliated Hospital of Hebei University, Baoding 071000, PR China
| | - Yingjie Zhang
- Department of Rheumatology, Affiliated Hospital of Hebei University, Baoding 071000, PR China
| | - Minghua Xu
- Department of Rheumatology, Affiliated Hospital of Hebei University, Baoding 071000, PR China
| | - Caixia Sun
- Department of Rheumatology, Affiliated Hospital of Hebei University, Baoding 071000, PR China
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Levy DE, Chang Y, Regan S, Tindle HA, Singer DE, Rigotti NA. Improvements in health-related quality of life among smokers who quit after hospitalization. Prev Med 2018; 110:38-46. [PMID: 29427673 PMCID: PMC6456898 DOI: 10.1016/j.ypmed.2018.02.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2017] [Revised: 02/02/2018] [Accepted: 02/05/2018] [Indexed: 11/17/2022]
Abstract
Few rigorous longitudinal assessments have examined health-related quality of life (HRQoL) changes after smoking cessation, especially among recently-hospitalized smokers. We compared the change in HRQoL between those who did or did not quit smoking 6 months after hospital discharge. Participants were 1357 smokers recruited for a cessation trial between 2012 and 2014 while hospitalized at two hospitals in Massachusetts and one in Pennsylvania. Cessation was defined as biochemically confirmed 7-day point prevalence abstinence at 6 months or as self-reported continuous abstinence at 1, 3, or 6 months post discharge. HRQoL measures included a single-item global health measure (SF1); the Patient Health Questionnaire for Depression and Anxiety (PHQ-4) screening tool for psychological distress; and the EQ-5D-5L health utilities measure. Multivariable models controlled for age, sex, race, education, insurance, study site, study arm, discharge diagnoses, and baseline HRQoL. Improvements in HRQoL were evident in the first month after discharge among those achieving abstinence compared to continuing smokers. At 6 months post-discharge, those with biochemically confirmed cessation were 30% more likely to report at least good health by the SF1 (aRR 95% CI 1.14-1.45), 19% less likely to screen positive for psychological distress (aRR, 95% CI 0.68-0.93), and had EQ-5D-5L health utility scores 0.05 points (95% CI 0.02-0.08) higher than continuing smokers. Results were similar when assessed as a function of self-reported cessation. Hospital-initiated smoking cessation is associated with rapid statistically and clinically significant improvements in a range of HRQoL measures, providing an additional tool clinicians and health systems could use to encourage smoking cessation.
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Affiliation(s)
- Douglas E Levy
- Tobacco Research and Treatment Center at the Massachusetts General Hospital, Boston, MA, United States; Mongan Institute Health Policy Center at the Massachusetts General Hospital, Boston, MA, United States; Department of Medicine, Harvard Medical School, Boston, MA, United States.
| | - Yuchiao Chang
- Department of Medicine, Harvard Medical School, Boston, MA, United States; Division of General Internal Medicine at the Massachusetts General Hospital, Boston, MA, United States
| | - Susan Regan
- Tobacco Research and Treatment Center at the Massachusetts General Hospital, Boston, MA, United States; Department of Medicine, Harvard Medical School, Boston, MA, United States; Division of General Internal Medicine at the Massachusetts General Hospital, Boston, MA, United States
| | - Hilary A Tindle
- Vanderbilt Center for Tobacco Addiction and Lifestyle, Division of General Internal Medicine, Department of Medicine, Vanderbilt University Medical School, Nashville, TN, United States
| | - Daniel E Singer
- Department of Medicine, Harvard Medical School, Boston, MA, United States; Division of General Internal Medicine at the Massachusetts General Hospital, Boston, MA, United States
| | - Nancy A Rigotti
- Tobacco Research and Treatment Center at the Massachusetts General Hospital, Boston, MA, United States; Mongan Institute Health Policy Center at the Massachusetts General Hospital, Boston, MA, United States; Department of Medicine, Harvard Medical School, Boston, MA, United States; Division of General Internal Medicine at the Massachusetts General Hospital, Boston, MA, United States
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Gershon AS, Campitelli MA, Hawken S, Victor C, Sproule BA, Kurdyak P, Selby P. Cardiovascular and Neuropsychiatric Events after Varenicline Use for Smoking Cessation. Am J Respir Crit Care Med 2018; 197:913-922. [DOI: 10.1164/rccm.201706-1204oc] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Andrea S. Gershon
- Department of Medicine and Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
- Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
- Department of Medicine
- Hospital for Sick Children, Toronto, Ontario, Canada
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada; and
| | | | - Steven Hawken
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
- Institute for Clinical Evaluative Sciences, Ottawa, Ontario, Canada
| | - Charles Victor
- Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
- Hospital for Sick Children, Toronto, Ontario, Canada
| | - Beth A. Sproule
- Leslie Dan Faculty of Pharmacy
- Department of Psychiatry
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada; and
| | - Paul Kurdyak
- Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
- Department of Psychiatry
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada; and
| | - Peter Selby
- Department of Psychiatry
- Department of Family and Community Medicine
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada; and
- Ontario Tobacco Research Unit, Toronto, Ontario, Canada
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Effects of aging on the effectiveness of smoking cessation medication. Oncotarget 2017; 7:30032-6. [PMID: 27166253 PMCID: PMC5058661 DOI: 10.18632/oncotarget.9090] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2015] [Accepted: 04/08/2016] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Considering the pharmacokinetic and pharmacodynamic aspects of different medications, it is plausible that the age of a smoker could affect the half-life of these drugs. The aim of this study was to compare the effectiveness of smoking cessation drugs (nicotine replacement therapy, bupropion, and varenicline) used either in isolation or in combination in adults under and over 60 years of age. METHODS Data were collected from 940 Brazilian patients participating in a smoking cessation program. Participants were prescribed smoking cessation medication to be used for at least 12 weeks and were followed for 52 weeks. RESULTS Cessation rates were significantly different among younger and older participants who were using nicotine replacement therapy (NRT) alone. Being over 60 years of age was significantly associated with increased cessation success among those who used NRT alone (OR 2.34, 95% CI: 1.36 to 4.04, p = 0.002). The effectiveness of varenicline and bupropion were not significantly different according to age groups. CONCLUSION Using age as a predictor for tailoring smoking cessation drugs might potentially lead to a more individualized prescription of smoking cessation therapy. These results should be tested in randomized controlled trials.
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Yang W, Zou Q, Tan E, Watkins L, Beronja K, Hogan PF, Elenberg K. Future Health and Economic Impact of Comprehensive Tobacco Control in DoD: A Microsimulation Approach. Mil Med 2017; 183:e104-e112. [DOI: 10.1093/milmed/usx015] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2017] [Accepted: 10/20/2017] [Indexed: 11/14/2022] Open
Affiliation(s)
- Wenya Yang
- The Lewin Group, 3130 Fairview Park Dr., Suite 500, Falls Church, VA 22042
| | - Quan Zou
- The Lewin Group, 3130 Fairview Park Dr., Suite 500, Falls Church, VA 22042
| | - Eleonora Tan
- The Lewin Group, 3130 Fairview Park Dr., Suite 500, Falls Church, VA 22042
| | - Lachlan Watkins
- The Lewin Group, 3130 Fairview Park Dr., Suite 500, Falls Church, VA 22042
| | - Kaleigh Beronja
- The Lewin Group, 3130 Fairview Park Dr., Suite 500, Falls Church, VA 22042
| | - Paul F Hogan
- The Lewin Group, 3130 Fairview Park Dr., Suite 500, Falls Church, VA 22042
| | - Kimberly Elenberg
- Department of Defense, U.S. Public Health Service, OUSD(P&R)/Force Resiliency; Pentagon, Room 2E593, Washington, DC 20301-3010
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40
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Sisler L, Omofoye O, Paci K, Hadar E, Goldstein AO, Ripley-Moffitt C. Using Lean Quality Improvement Tools to Increase Delivery of Evidence-Based Tobacco Use Treatment in Hospitalized Neurosurgical Patients. Jt Comm J Qual Patient Saf 2017; 43:633-641. [DOI: 10.1016/j.jcjq.2017.06.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2016] [Revised: 06/09/2017] [Accepted: 06/28/2017] [Indexed: 11/30/2022]
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van den Broek-Altenburg EM, Atherly AJ. The Effect of an Inpatient Smoking Cessation Treatment Program on Hospital Readmissions and Length of Stay. J Hosp Med 2017; 12:880-885. [PMID: 29091974 DOI: 10.12788/jhm.2801] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE The objective of this study is to estimate the impact of an inpatient tobacco cessation treatment program on 30-day readmission rates and length of stay (LOS). METHODS Participants were 28,994 patients admitted to the hospital between July 2012 and July 2014. Smokers were identified through the electronic medical records system and were offered cessation treatment. Program effects were estimated by using a difference-in-differences approach, comparing all smokers to all nonsmokers before versus after introduction of the program. Readmission rates were modeled by using probit regression; LOS was modeled by using truncated negative binomial regression. Models controlled for age, sex, race, payer, hospital department, severity of illness, and intensive care unit days. RESULTS The hospital-initiated smoking cessation intervention had no significant effect on 30-day readmission rates or LOS. Other control variables had the expected signs and were statistically significant. CONCLUSIONS The evaluation of an inpatient tobacco dependence treatment did not find significant short-term changes in healthcare utilization in the first 30 days after initial hospitalization.
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Affiliation(s)
| | - Adam J Atherly
- Department of Health Systems, Management and Policy, Colorado School of Public Health, Aurora, Colorado, USA
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Caponnetto P, DiPiazza J, Aiello MR, Polosa R. Training pharmacists in the stage-of-change model of smoking cessation and motivational interviewing: A randomized controlled trial. Health Psychol Open 2017; 4:2055102917736429. [PMID: 29379624 PMCID: PMC5779937 DOI: 10.1177/2055102917736429] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
This study evaluated the effect of training pharmacists in the stage-of-change model for smoking cessation and motivational interviewing on smoking cessation outcomes. A training based on the stage-of-change model for smoking cessation and motivational interviewing was introduced to pharmacists. Pharmacists were randomly assigned to the intervention or control group. The control group attended a 3-hour training session, whereas the intervention group also attended a further 6-hour training session. At week 24, 12.2 percent of the smokers quit smoking in the intervention group, whereas 1.6 percent of the smokers quit smoking in the control group. The findings of this study showed that training pharmacists, in the stage-of-change model for smoking cessation and motivational interviewing, improves smoking reduction and cessation rates.
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Asay GRB, Homa DM, Abramsohn EM, Xu X, O’Connor EL, Wang G. Reducing Smoking in the US Federal Workforce: 5-Year Health and Economic Impacts From Improved Cardiovascular Disease Outcomes. Public Health Rep 2017; 132:646-653. [PMID: 29072961 PMCID: PMC5692166 DOI: 10.1177/0033354917736300] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE We estimated the reduction in number of hospitalizations for acute myocardial infarction and stroke as well as the associated health care costs resulting from reducing the number of smokers in the US federal workforce during a 5-year period. METHODS We developed a 5-year spreadsheet-based cohort model with parameter values from past literature and analysis of national survey data. We obtained 2015 data on the federal workforce population from the US Office of Personnel Management and data on smoking prevalence among federal workers from the 2013-2015 National Health Interview Survey. We adjusted medical costs and productivity losses for inflation to 2015 US dollars, and we updated future productivity losses for growth. Because of uncertainty about the achievable reduction in smoking prevalence and input values (eg, relative risk for acute myocardial infarction and stroke, medical costs, and absenteeism), we performed a Monte Carlo simulation and sensitivity analysis. RESULTS We estimated smoking prevalence in the federal workforce to be 13%. A 5 percentage-point reduction in smoking prevalence could result in 1106 fewer hospitalizations for acute myocardial infarction (range, 925-1293), 799 fewer hospitalizations for stroke (range, 530-1091), and 493 fewer deaths (range, 494-598) during a 5-year period. Similarly, estimated costs averted would be $59 million (range, $49-$63 million) for medical costs, $332 million (range, $173-$490 million) for absenteeism, and $117 million (range, $93-$142 million) for productivity. CONCLUSION Reductions in the prevalence of smoking in the federal workforce could substantially reduce the number of hospitalizations for acute myocardial infarction and stroke, lower medical costs, and improve productivity.
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Affiliation(s)
- Garrett R. Beeler Asay
- Office of the Associate Director for Policy, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - David M. Homa
- Office on Smoking and Health, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Erin M. Abramsohn
- Office of the Associate Director for Policy, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Xin Xu
- Office on Smoking and Health, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Erin L. O’Connor
- Office on Smoking and Health, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Guijing Wang
- Division for Heart Disease and Stroke Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
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Cost-effectiveness of Antihypertensive Medication: Exploring Race and Sex Differences Using Data From the REasons for Geographic and Racial Differences in Stroke Study. Med Care 2017; 55:552-560. [PMID: 28333708 DOI: 10.1097/mlr.0000000000000719] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Antihypertensive medication decreases risk of cardiovascular disease (CVD) events in adults with hypertension. Although black adults have higher prevalence of hypertension and worse CVD outcomes compared with whites, limited attention has been given to the cost-effectiveness of antihypertensive medication for blacks. OBJECTIVE To compare the cost-effectiveness of antihypertensive medication treatment versus no-treatment in white and black adults. RESEARCH DESIGN We constructed a State Transition Model to assess the costs and quality-adjusted life-years (QALYs) associated with either antihypertensive medication treatment or no-treatment using data from the REasons for Geographic and Racial Differences in Stroke (REGARDS) study and published literature. CVD events and health states considered in the model included stroke, coronary heart disease, heart failure, chronic kidney disease, and end-stage renal disease. SUBJECTS White and black adults with hypertension in the United States, 45 years of age and above. MEASURES Yearly risk of CVD was determined using REGARDS data and published literature. Antihypertensive medication costs were determined using Medicare claims. Event and health state costs were estimated from published literature. All costs were adjusted to 2012 US dollars. Effectiveness was assessed using QALYs. RESULTS Antihypertensive medication treatment was cost-saving and increased QALYs compared with no-treatment for white men ($7387; 1.14 QALYs), white women ($7796; 0.89 QALYs), black men ($8400; 1.66 QALYs), and black women ($10,249; 1.79 QALYs). CONCLUSIONS Antihypertensive medication treatment is cost-saving and increases QALYs for all groups considered in the model, particularly among black adults.
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Peralbo-Molina A, Calderón-Santiago M, Jurado-Gámez B, Luque de Castro MD, Priego-Capote F. Exhaled breath condensate to discriminate individuals with different smoking habits by GC-TOF/MS. Sci Rep 2017; 7:1421. [PMID: 28469199 PMCID: PMC5431160 DOI: 10.1038/s41598-017-01564-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2016] [Accepted: 03/31/2017] [Indexed: 12/29/2022] Open
Abstract
Smoking is a crucial factor in respiratory diseases and lung inflammation, which are the reasons for high mortality worldwide. Despite the negative impact that tobacco consumption causes on health, few metabolomics studies have compared the composition of biofluids from smoker and non-smoker individuals. Exhaled breath condensate (EBC) is one of the biofluids less employed for clinical studies despite its non-invasive sampling and the foreseeable relationship between its composition and respiratory diseases. EBC was used in this research as clinical sample to compare three groups of individuals: current smokers (CS), former smokers (FS) and never smokers (NS). Special attention was paid to the cumulative consumption expressed as smoked pack-year. The levels of 12 metabolites found statistically significant among the three groups of individuals were discussed to find an explanation to their altered levels. Significant compounds included monoacylglycerol derivatives, terpenes and other compounds, the presence of which could be associated to the influence of smoking on the qualitative and quantitative composition of the microbiome.
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Affiliation(s)
- A Peralbo-Molina
- Department of Analytical Chemistry, Annex Marie Curie Building, Campus of Rabanales, University of Córdoba, E-14071, Córdoba, Spain.,Maimónides Institute of Biomedical Research (IMIBIC), Reina Sofía Hospital, University of Córdoba, E-14004, Córdoba, Spain
| | - M Calderón-Santiago
- Department of Analytical Chemistry, Annex Marie Curie Building, Campus of Rabanales, University of Córdoba, E-14071, Córdoba, Spain.,Maimónides Institute of Biomedical Research (IMIBIC), Reina Sofía Hospital, University of Córdoba, E-14004, Córdoba, Spain
| | - B Jurado-Gámez
- Maimónides Institute of Biomedical Research (IMIBIC), Reina Sofía Hospital, University of Córdoba, E-14004, Córdoba, Spain.,Department of Respiratory Medicine, Reina Sofia Hospital, E-14004, Córdoba, Spain
| | - M D Luque de Castro
- Department of Analytical Chemistry, Annex Marie Curie Building, Campus of Rabanales, University of Córdoba, E-14071, Córdoba, Spain. .,Maimónides Institute of Biomedical Research (IMIBIC), Reina Sofía Hospital, University of Córdoba, E-14004, Córdoba, Spain.
| | - F Priego-Capote
- Department of Analytical Chemistry, Annex Marie Curie Building, Campus of Rabanales, University of Córdoba, E-14071, Córdoba, Spain. .,Maimónides Institute of Biomedical Research (IMIBIC), Reina Sofía Hospital, University of Córdoba, E-14004, Córdoba, Spain.
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46
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Pinilla J, Abásolo I. The effect of policies regulating tobacco consumption on smoking initiation and cessation in Spain: is it equal across socioeconomic groups? Tob Induc Dis 2017; 15:8. [PMID: 28149259 PMCID: PMC5273787 DOI: 10.1186/s12971-016-0109-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2016] [Accepted: 12/27/2016] [Indexed: 01/30/2023] Open
Abstract
Background In Spain, the Law 28/2005, which came into effect on January 2006, was a turning point in smoking regulation and prevention, serving as a guarantee for the progress of future strategies in the direction marked by international organizations. It is expected that this regulatory policy should benefit relatively more to lower socioeconomic groups, thus contributing to a reduction in socioeconomic health inequalities. This research analyzes the effect of tobacco regulation in Spain, under Law 28/2005, on the initiation and cessation of tobacco consumption, and whether this effect has been unequal across distinct socioeconomic levels. Methods Micro-data from the National Health Survey in its 2006 and 2011 editions are used (study numbers: 4382 and 5389 respectively; inventory of statistical operations (ISO) code: 54009), with a sample size of approximately 24,000 households divided into 2,000 census areas. This allows individuals’ tobacco consumption records to be reconstructed over five years before the initiation of each survey, as well as identifying those individuals that started or stopped smoking. The methodology is based on “time to event analysis”. Cox’s proportional hazard models are adapted to show the effects of a set of explanatory variables on the conditional probability of change in tobacco consumption: initiation as a daily smoker by young people or the cessation of daily smoking by adults. Results Initiation rates among young people went from 25% (95% confidence interval (CI), 23–27) to 19% (95% CI, 17–21) following the implementation of the Law, and the change in cessation rates among smokers was even greater, with rates increasing from 12% (95% CI, 11–13) to 20% (95% CI, 19–21). However, this effect has not been equal by socioeconomic groups as shown by relative risks. Before the regulation policy, social class was not a statistically significant factor in the initiation of daily smoking (p > 0.05); however, following the implementation of the Law, young people belonging to social classes IV-V and VI had a relative risk of starting smoking 63% (p = 0.03) and 82% (p = 0.02) higher than young people of higher social classes I-II. On the other hand, lower social class also means a lower probability of smoking cessation; however, the relative risk of cessation for a smoker belonging to a household of social class VI (compared to classes I-II) went from 24% (p < 0.001) lower before the Law to 33% (p < 0.001) lower following the law’s implementation. Conclusion Law 28/2005 has been effective, as after its promulgation there has been a decrease in the rate of smoking initiation among young people and an increase in the rate of cessation among adult smokers. However, this effect has not been equal by socioeconomic groups, favoring relatively more to those individuals belonging to higher social classes.
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Affiliation(s)
- Jaime Pinilla
- Departamento de Métodos Cuantitativos en Economía y Gestión (Universidad de Las Palmas de Gran Canaria). Facultad de Economía, Empresa y Turismo. Campus Universitario de Tafira, 35017 Las Palmas de Gran Canaria, Spain
| | - Ignacio Abásolo
- Departamento de Economía Aplicada y Métodos Cuantitativos; Instituto Universitario de Desarrollo Regional (Universidad de La Laguna). Facultad de Economía, Empresa y Turismo. Universidad de La Laguna, Campus de Guajara, 38071 La Laguna, Tenerife Spain
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Abstract
Background: Priority setting in public health policy must be based on information on the effectiveness of alternative preventive and therapeutic interventions. The purpose of this study is to predict the effect on mortality from ischaemic heart disease (IHD) in Denmark of reduced exposure to the risk factors hypertension, hypercholesterolaemia, cigarette smoking, and physical inactivity. Methods: The simulation model, "Prevent'', was used. The input data for the model were population size, death rates, prevalence of cardiovascular risk factors, and relative risks. Scenarios of the impact of reduced exposure to risk factors on mortality from IHD were studied, including the health benefi ts of successful implementation of some of the targets in the Danish Government programme for public health and health promotion, 1999-2008. Results: The greatest reduction in mortality from IHD would be achieved by interventions against cigarette smoking. If the proportion of cigarette smokers could be reduced by one-third within 10 years, the number of deaths due to IHD among people under 65 would be 10% lower for men and 15% lower for women. If the proportion of heavy smokers or the proportion of people with hypertension were reduced by 25%, the rate of mortality from IHD would be 5% lower for men and 6-7% lower for women. Reducing the number of cases of severe hypercholesterolaemia by 25% would lower the IHD mortality rate before age 65 by 3% for men and 6% for women after 15 years, similar to the effect of easy exercise for at least 4 hours a week among physically inactive people.
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Affiliation(s)
- Henrik Brønnum-Hansen
- National Institute of Public Health, Copenhagen, Denmark, , National Institute of Public Health, 25 Svanemøllevej, DK-2100 Copenhagen, Denmark
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Haglund B, Eliasson M, Stenbeck M, Rosén M. Is moist snuff use associated with excess risk of IHD or stroke? A longitudinal follow-up of snuff users in Sweden. Scand J Public Health 2016; 35:618-22. [PMID: 17852996 DOI: 10.1080/14034940701436949] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Background: The potential risks of Swedish moist snuff (snus) are debated and studies have shown diverging results. Aims: The aim of this study is to investigate whether there is any excess risk of ischaemic heart disease (IHD) and stroke from snuff use. Methods: The Swedish Survey of Living Conditions from 1988—89 was record-linked to the Swedish Cause of Death Register and the Swedish Hospital Discharge Register to investigate excess mortality and hospitalization from IHD and stroke. A Poisson regression model was used and incidence rate ratios (IRRs) for snuff and smoking were calculated controlling for age, physical activity, self-reported health, number of longstanding illnesses, residential area, and socioeconomic position. Results: Among snuff users there were no excess risks of mortality or hospitalization from IHD (IRR 0.8; 0.5—1.2,) or stroke (IRR 1.1; 0.7—1.8), but, as expected, clear excess risks were found for smokers (IRR 1.7; 1.4—2.1 for IHD, and IRR 1.4; 1.0—1.9 for stroke). Conclusions: This study has not shown any excess risk among users of snuff for IHD or stroke. If there is a risk associated with snuff it is evidently much lower than those associated with smoking.
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Affiliation(s)
- Bengt Haglund
- Centre for Epidemiology, Swedish National Board of Health and Welfare, Stockholm, Sweden.
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49
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Seabury SA, Goldman DP, Gupta CN, Khan ZM, Chandra A, Philipson TJ, Lakdawalla DN. Quantifying Gains in the War on Cancer Due to Improved Treatment and Earlier Detection. Forum Health Econ Policy 2016; 19:141-156. [PMID: 31419891 DOI: 10.1515/fhep-2015-0028] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
INTRODUCTION There have been significant improvements in both treatment and screening efforts for many types of cancer over the past decade. However, the effect of these advancements on the survival of cancer patients is unknown, and many question the value of both new treatments and screening efforts. METHODS This study uses a retrospective analysis of SEER Registry data to quantify reductions in mortality rates for cancer patients diagnosed between 1997 and 2007. Using variation in trends in mortality rates by stage of diagnosis across cancer types, we use logistic regression to decompose separate survival gains into those attributable to advances in treatment versus advances in detection. We estimate the gains in survival due to gains in both treatment and detection overall and separately for 15 of the most common cancer types. RESULTS We estimate that 3-year cancer-related mortality of cancer patients fell 16.7% from 1997 to 2007. Overall, advances in treatment reduced mortality rates by approximately 12.2% while advances in early detection reduced mortality rates by 4.5%. The relative importance of treatment and detection varied across cancer types. Improvements in detection were most important for thyroid, prostate and kidney cancer. Improvements in treatment were most important for non-Hodgkins lymphoma, lung cancer and myeloma. CONCLUSION Both improved treatment options and better early detection have led to significant survival gains for cancer patients diagnosed from 1997 to 2007, generating considerable social value over this time period.
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Affiliation(s)
- Seth A Seabury
- University of Southern California - Department of Emergency Medicine and Leonard D. Schaeffer Center for Health Policy and Economics, 635 Downey Way Verna & Peter Dauterive Hall (VPD), 2nd Floor Los Angeles CA 90089-3333, USA
| | - Dana P Goldman
- University of Southern California - Leonard D. Schaeffer Center for Health Policy and Economics, Los Angeles, CA, USA
| | - Charu N Gupta
- The Wharton School of the University of Pennsylvania - Health Care Management Department, PA, USA
| | - Zeba M Khan
- Celgene Corporation, Summit, New Jersey, USA
| | - Amitabh Chandra
- Harvard University - John F. Kennedy School of Government, Boston, MA, USA
| | - Tomas J Philipson
- University of Chicago - Irving B. Harris Graduate School of Policy Studies, Chicago, IL, USA
| | - Darius N Lakdawalla
- University of Southern California - Leonard D. Schaeffer Center for Health Policy and Economics, Los Angeles, CA, USA
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50
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Lightwood J, Glantz SA. Smoking Behavior and Healthcare Expenditure in the United States, 1992-2009: Panel Data Estimates. PLoS Med 2016; 13:e1002020. [PMID: 27163933 PMCID: PMC4862673 DOI: 10.1371/journal.pmed.1002020] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2015] [Accepted: 03/31/2016] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Reductions in smoking in Arizona and California have been shown to be associated with reduced per capita healthcare expenditures in these states compared to control populations in the rest of the US. This paper extends that analysis to all states and estimates changes in healthcare expenditure attributable to changes in aggregate measures of smoking behavior in all states. METHODS AND FINDINGS State per capita healthcare expenditure is modeled as a function of current smoking prevalence, mean cigarette consumption per smoker, other demographic and economic factors, and cross-sectional time trends using a fixed effects panel data regression on annual time series data for each the 50 states and the District of Columbia for the years 1992 through 2009. We found that 1% relative reductions in current smoking prevalence and mean packs smoked per current smoker are associated with 0.118% (standard error [SE] 0.0259%, p < 0.001) and 0.108% (SE 0.0253%, p < 0.001) reductions in per capita healthcare expenditure (elasticities). The results of this study are subject to the limitations of analysis of aggregate observational data, particularly that a study of this nature that uses aggregate data and a relatively small sample size cannot, by itself, establish a causal connection between smoking behavior and healthcare costs. Historical regional variations in smoking behavior (including those due to the effects of state tobacco control programs, smoking restrictions, and differences in taxation) are associated with substantial differences in per capita healthcare expenditures across the United States. Those regions (and the states in them) that have lower smoking have substantially lower medical costs. Likewise, those that have higher smoking have higher medical costs. Sensitivity analysis confirmed that these results are robust. CONCLUSIONS Changes in healthcare expenditure appear quickly after changes in smoking behavior. A 10% relative drop in smoking in every state is predicted to be followed by an expected $63 billion reduction (in 2012 US dollars) in healthcare expenditure the next year. State and national policies that reduce smoking should be part of short term healthcare cost containment.
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Affiliation(s)
- James Lightwood
- School of Pharmacy, University of California, San Francisco, San Francisco, California, United States of America
- Center for Tobacco Control Research and Education, University of California, San Francisco, San Francisco, California, United States of America
| | - Stanton A. Glantz
- Center for Tobacco Control Research and Education, University of California, San Francisco, San Francisco, California, United States of America
- Division of Cardiology, Department of Medicine, University of California, San Francisco, San Francisco, California, United States of America
- Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, San Francisco, San Francisco, California, United States of America
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