Socioeconomic differences in nicotine exposure and dependence in adult daily smokers

HINT1 Gene Polymorphisms, Smoking Behaviour, and Personality Traits: A Haplotype Case-Control Study

The factors influencing the development and maintenance of nicotine dependence are numerous and complex. Recent studies indicate that smokers exhibit distinct genetic predispositions to nicotine dependence. We aimed to analyse (1) the association between rs2551038 and cigarette smoking, (2) the association of between the rs3864236-rs2526303-rs2551038 haplotype and cigarette smoking, and (3) the personality traits measured by the NEO Five-Factor Inventory in cigarette users and never-smokers. No significant differences were present in the frequency of rs2551038 genotypes and alleles in the studied cigarette users compared to the control group. Cigarette users, compared to the control group, had higher scores on the NEO-FFI Extraversion scale (p = 0.0011), and lower scores were obtained by the cigarette users for the NEO-FFI Openness (p = 0.0060), Agreeability (p ≤ 0.000), and Conscientiousness (p ≤ 0.000) scales. There was a significant positive Pearson's linear correlation between the age and the Fagestrom test (r = 0.346; p < 0.0001) and the NEO-FFI Openness scale (r = 0.180; p < 0.0001) in the group of cigarette users. We observed significant linkage disequilibrium between rs2526303 and rs3864236 (D' = 0.3581; p < 2.2204 × 10-16) and between rs2526303 and rs2551038 (D' = 0.9993; p < 2.2204 × 10-16) in the tested sample. The sex-stratified haplotype analysis revealed that in the group of male never-smokers, the GTC haplotype was significantly more frequent than in the group of cigarette users (38% vs. 22%; p = 0.0039). The presented study reveals significant differences in personality trait scores between cases and controls. Moreover, the sex-stratified analysis showed significant differences in haplotype distribution. These results underscore the interplay between genetic predisposition, sex, and personality in nicotine-using individuals.

Beyond lung cancer: air pollution and bladder, breast and prostate cancer incidence

BACKGROUND

The carcinogenicity of air pollution and its impact on the risk of lung cancer is well known; however, there are still knowledge gaps and mixed results for other sites of cancer.

METHODS

The current study aimed to evaluate the associations between ambient air pollution [fine particulate matter (PM2.5) and nitrogen oxides (NOx)] and cancer incidence. Exposure assessment was based on historical addresses of >900 000 participants. Cancer incidence included primary cancer cases diagnosed from 2007 to 2015 (n = 30 979). Cox regression was used to evaluate the associations between ambient air pollution and cancer incidence [hazard ratio (HR), 95% CI].

RESULTS

In the single-pollutant models, an increase of one interquartile range (IQR) (2.11 µg/m3) of PM2.5 was associated with an increased risk of all cancer sites (HR = 1.51, 95% CI: 1.47-1.54), lung cancer (HR = 1.73, 95% CI: 1.60-1.87), bladder cancer (HR = 1.50, 95% CI: 1.37-1.65), breast cancer (HR = 1.50, 95% CI: 1.42-1.58) and prostate cancer (HR = 1.41, 95% CI: 1.31-1.52). In the single-pollutant and the co-pollutant models, the estimates for PM2.5 were stronger compared with NOx for all the investigated cancer sites.

CONCLUSIONS

Our findings confirm the carcinogenicity of ambient air pollution on lung cancer and provide additional evidence for bladder, breast and prostate cancers. Further studies are needed to confirm our observation regarding prostate cancer. However, the need for more research should not be a barrier to implementing policies to limit the population's exposure to air pollution.

Social Determinants of Health in Cardio-Oncology: Multi-Level Strategies to Overcome Disparities in Care: JACC: CardioOncology State-of-the-Art Review

Addressing the need for more equitable cardio-oncology care requires attention to existing disparities in cardio-oncologic disease prevention and outcomes. This is particularly important among those affected by adverse social determinants of health (SDOH). The intricate relationship of SDOH, cancer diagnosis, and outcomes from cardiotoxicities associated with oncologic therapies is influenced by sociopolitical, economic, and cultural factors. Furthermore, mechanisms in cell signaling and epigenetic effects on gene expression link adverse SDOH to cancer and the CVD-related complications of oncologic therapies. To mitigate these disparities, a multifaceted strategy is needed that includes attention to health care access, policy, and community engagement for improved disease screening and management. Interdisciplinary teams must also promote cultural humility and competency and leverage new health technology to foster collaboration in addressing the impact of adverse SDOH in cardio-oncologic outcomes.

Physician-brief advice for promoting smoking cessation among cancer patients on treatment in low and middle-income countries: a scoping review

INTRODUCTION

Physician-brief advice has been utilized in high-income countries to promote smoking cessation among cancer patients. Empirical evidence on its effectiveness among cancer patients in low and middle-income countries (LMICs) is lacking. The gap could be due to inadequate training, and competing healthcare priorities, leading to insufficient implementation of targeted smoking cessation interventions in oncology settings. We undertook this scoping review to determine if physician-brief advice is effective in promoting smoking cessation among cancer patients in LMICs.

METHODS

We conducted a literature search of all relevant articles across five databases: Cochrane Central Register of Controlled Trials, Cochrane Library (Tobacco Addiction Group trials), World Conference on Lung Cancer proceedings, PubMed, and Google Scholar up to November 2023, using pre-defined inclusion criteria and keywords. The study population was cancer survivors in LMICs, the intervention was smoking cessation advice by a physician in a clinic or oncology center during a consultation, and the outcome was the effect of smoking cessation programs in discontinuing smoking among cancer survivors in LMICs.

RESULTS

Overall, out of every 10 cancer patients in LMICs, about seven were smokers, and one-half had received physician-brief advice for smoking cessation. Physician-brief advice was more likely to be delivered to patients with smoking-related cancer (Cohen's d = 0.396). This means that there is a noticeable difference between patients with smoking-related cancer compared to those with cancer unrelated to smoking. Smoking cessation failure was due to the inability to cope with the symptoms of withdrawal, missed smoking cessation clinic visits, mental health disorders, limited time and resources, and minimal patient-physician contact.

CONCLUSION

There is very little literature on the frequency of use or the efficacy of physician-brief advice on smoking cessation in LMICs. The literature suggests that cancer patients in LMICs have low self-efficacy to quit smoking, and smoking cessation is rarely part of cancer care in LMICs. Physicians in LMICs should be trained to use motivational messages and good counseling techniques to improve smoking cessation among cancer patients. Policymakers should allocate the resources to implement physician-brief advice and design training programs for physicians focusing on physician-brief advice tailored to cancer patients.

Prevalence of adult smokers in Brazilian capitals according to socioeconomic deprivation

OBJECTIVE

To estimate the prevalence of adult smokers in the 26 capitals and the Federal District according to the Brazilian Deprivation Index (Índice Brasileiro de Privação - IBP).

METHODS

Dataset on smoking were obtained from the Surveillance of Risk and Protective Factors for Noncommunicable Diseases by Survey (Vigitel) system for the 26 capitals and the Federal District, in the period from 2010 to 2013. The IBP classifies the census sectors according to indicators such as: income less than ½ minimum wage, illiterate population and without sanitary sewage. In the North and Northeast regions, the census sectors were grouped into four categories (low, medium, high and very high deprivation) and in the South, Southeast and Midwest regions into three (low, medium and high deprivation). Prevalence estimates of adult smokers were obtained using the indirect estimation method in small areas. To calculate the prevalence ratios, Poisson models are used.

RESULTS

The positive association between prevalence and deprivation of census sector categories was found in 16 (59.3%) of the 27 cities. In nine (33.3%) cities, the sectors with the greatest deprivation had a higher prevalence of smokers when compared to those with the least deprivation, and in two (7.4%) there were no differences. In Aracaju, Belém, Fortaleza, João Pessoa, Macapá and Salvador, the prevalence of adult smokers was three times higher in the group of sectors with greater deprivation compared to those with less deprivation.

CONCLUSION

Sectors with greater social deprivation had a higher prevalence of smoking, compared with less deprivation, pointing to social inequalities.

Advice for smokers in smoking cessation clinic: a review

Background

Tobacco dependence has become a global public health concern. We chose to investigate the modifiable factors and motivations during the period of smoking cessation based on the mechanism of nicotine addiction.

Methods

We selected emotion, sleep, alcohol, caffeine beverages, mental activities after dinner, exercise and CYP2A6 genotype as influencing factors, and provided corresponding recommendations for smokers based on these factors. Based on these characteristics, we reviewed literature and summarized the relationship between these factors and nicotine dependence or smoking.

Results

Different emotion, sleep deficiency, caffeine intake, alcohol consumption, mental activities after dinner, physical exercises and CYP2A6 genotype have an effect on daily smoking and nicotine dependence.

Conclusion

These suggestions related literature-derived factors may increase the success rate of smoking cessation.

Socio-economic status moderates within-person associations of risk factors and smoking lapse in daily life

BACKGROUND AND AIMS

Individuals of lower socio-economic status (SES) display a higher prevalence of smoking and have more diffxiculty quitting than higher SES groups. The current study investigates whether the within-person associations of key risk (e.g. stress) and protective (self-efficacy) factors with smoking lapse varies by facets of SES.

DESIGN AND SETTING

Observational study using ecological momentary assessment to collect data for a 28-day period following a smoking quit attempt. Multi-level mixed models (i.e. generalized linear mixed models) examined cross-level interactions between lapse risk and protective factors and indicators of SES on smoking lapse.

PARTICIPANTS

A diverse sample of 330 adult US smokers who completed a larger study examining the effects of race/ethnicity and social/environmental influences on smoking cessation.

MEASUREMENTS

Risk factors included momentary urge, negative affect, stress; protective factors included positive affect, motivation, abstinence self-efficacy; SES measures: baseline measures of income and financial strain; the primary outcome was self-reported lapse.

FINDINGS

Participants provided 43 297 post-quit observations. Mixed models suggested that income and financial strain moderated the effect of some risk factors on smoking lapse. The within-person association of negative [odds ratio (OR) = 0.967, 95% CI= 0.945, 0.990, P < 0.01] and positive affect (OR = 1.023, 95% CI = 1.003, 1.044, P < 0.05) and abstinence self-efficacy (OR = 1.020, 95% CI = 1.003, 1.038, P < 0.05) on lapse varied with financial strain. The within-person association of negative affect (OR = 1.005, 95% CI = 1.002, 1.008, P < 0.01), motivation (OR = 0.995, 95% CI = 0.991, 0.999, P < 0.05) and abstinence self-efficacy (OR = 0.996, 95% CI = 0.993, 0.999, P < 0.01) on lapse varied by income. The positive association of negative affect with lapse was stronger among individuals with higher income and lower financial strain. The negative association between positive affect and abstinence self-efficacy with lapse was stronger among individuals with lower financial strain, and the negative association between motivation and abstinence self-efficacy with lapse was stronger among those with higher income. The data were insensitive to detect statistically significant moderating effects of income and financial strain on the association of urge or stress with lapse.

CONCLUSION

Some risk factors (e.g. momentary negative affect) exert a weaker influence on smoking lapse among lower compared to higher socio-economic status groups.

Lung Cancer Screening Penetration in an Urban Underserved County

PURPOSE

To compare residential geography, sex, socioeconomic status (SES), and race/ethnicity of patients screened at Montefiore's Lung Cancer Screening Program with those of patients diagnosed with lung cancer, assessing whether screening efforts are appropriately focused.

METHODS

This retrospective cohort study involved patients within a multisite urban medical center undergoing lung cancer screening or diagnosed with lung cancer from January 1, 2015 to December 31, 2019. Inclusion criteria were residence within the Bronx, NY and age between 55 and 80 years. Institutional review board approval was obtained. Data were analyzed using the Wilcoxon two-sample t test and χ².

RESULTS

The cohorts comprised 1568 (50.3%) women and 1551 (49.7%) men (mean age 65.6 ± 6.16). The Southeast Bronx had the most diagnosed lung cancers (29.96%) and screenings (31.22%). Sex did not significantly differ (p = 0.053). Cancer and screening cohorts were from impoverished neighborhoods with mean SES of - 3.11 ± 2.78 and - 3.44 ± 2.80 (p < 0.01). The lower tier SES neighborhoods demonstrated more patients in the screening cohort than cancer cohort (p = 0.01). Both cohorts included a majority of Hispanic patients, although race/ethnicity differed significantly (p = 0.01). Lower SES neighborhoods showed no significant difference in race/ethnicity between cancer and screening cohorts (p = 0.262).

CONCLUSION

Though statistically significant differences were found between cohorts, likely due to sample size, few clinically meaningful differences were found, implying our lung cancer screening program was effective in reaching the desired population. Demographics-based programs should be considered in global efforts to screen vulnerable populations.

The Influence of Socioeconomic Factors on the Body Characteristics, Proportion, and Health Behavior of Children Aged 6-12 Years

BACKGROUND

The research aimed to determine how socioeconomic factors influence the body structure and health behaviors of children in a suburban commune.

METHODS

Data from 376 children aged 6.78 to 11.82 years from Jabłonna, Poland, were analyzed. A questionnaire was used to gather information regarding the socioeconomic status and dietary habits of these children, and physical measurements such as height, weight, pelvic width, shoulder width, chest, waist, hip, and arm circumferences, and three skinfolds were taken. Hip index, pelvi-acromial index, Marty's index, BMI (body mass index), WHR (waist-hip ratio), and the sum of three skinfolds were calculated. One-way analysis of variance, Student's t-test, and X2 test with p < 0.05 were used.

RESULTS

The size of the family and the level of education and occupation of the fathers had a significant impact on the body proportions of the children. Children from larger centers with more educated parents were seen to have healthier eating habits and higher levels of physical activity, and their parents were less likely to smoke cigarettes.

CONCLUSIONS

It was concluded that the development environment of the parents, such as their level of education and profession, play a more important role than the size of birthplace.

E-Cigarette Users' Profiles and Their Association with Identified Impacts of COVID-19 on Vaping among Young Adults in Malaysia

Electronic cigarettes (ECs) users' profiles and behaviors during the COVID-19 pandemic remain unclear. This cross-sectional study aimed to explore Malaysian EC users' profiles and their associations with related behaviors during the pandemic. The EC users (N = 351) were recruited from an official national vape entity. Respondents were predominantly of Malay ethnicity (90.6%), aged 31 to 35 years (27.6%), males (97.7%), married (68.7%), from Malaysia's west region states (63.5%) and tertiary educated (69.2%). The majority (80.3%) were non-dual users, and most purchased their vaping products online (77.2%), liked that they can vape while working at home (83.8%) and vaped more because of boredom (55.3%), had low and moderate nicotine addiction levels (94.9%), had low motivation level to quit EC use (92.6%) and were more likely to perceive that vaping did not increase the chances of complications from COVID-19. Respondents with moderate to high addiction levels had twice the odds of checking on their current EC supplies, whilst respondents with low motivation to quit had higher odds of using their tank/pod until the last drop and distancing from others when vaping. EC users should be encouraged to quit EC use, especially during the COVID-19 pandemic.

Efficacy of mindfulness and goal setting interventions for increasing resilience and reducing smoking in lower socio-economic groups: randomised controlled trial protocol

BACKGROUND

Smoking and resulting health problems disproportionately impact low socioeconomic status (SES) individuals. Building resilience presents an approach to 'closing the gap'. Mindfulness-based interventions and setting realistic goals are preferred in low socioeconomic communities. We aim to test if these interventions, delivered online and consolidated with peer support offered via ex-smokers, are successful in promoting smoking cessation and resilience. Our conceptualisation of resilience encompasses the inner capacity/skills and external resources (e.g., social support) which smokers utilise to bounce back from adversity. We include a process evaluation of barriers/facilitators to interventions and cost-effectiveness analysis (from health system perspective).

METHODS

We plan a four-arm parallel 12-month RCT with a 6-month follow-up to test the efficacy of three group-based interventions each followed by peer support. Arm 1: mindfulness-integrated cognitive behavioural therapy; Arm 2: mindfulness training; Arm 3: setting realistic goals; Arm 4: active control group directed to quit services. All interventions will be administered online. Participants are adult smokers in Australia (N = 812) who have an average weekly household income less than $457AUD or receive welfare benefits. Group-based interventions will occur over 6 months, followed by 6 months of forum-based peer support.

PRIMARY OUTCOME

self-reported 14-day period prevalence of smoking abstinence at 6 months, with remote biochemical verification of saliva cotinine (< 30 ng/mL). Secondary outcomes include: internal resilience (Connor-Davidson Resilience Scale-25); external resilience (ENRICHD social support tool); quality adjusted life years (EQ-5D-5L); self-efficacy for smoking abstinence (Smoking-Abstinence Self-Efficacy Questionnaire); motivation to quit smoking (Biener and Abrams Contemplation Ladder); nicotine dependence (Fagerstrom Test for Nicotine Dependency); equanimity (Equanimity Scale-16); stress (Perceived Stress Scale-10); goal assessment/attainment (Problems and Goals Assessment Scale).

DISCUSSION

This study is the first to compare resilience interventions for low SES smokers which have been identified by them as acceptable. Our various repeated measures and process evaluation will facilitate exploration of mechanisms of impact. We intervene within the novel framework of the Psychosocial Model of Resilience, applying a promising paradigm to address a critical and inequitable public health problem. Trial registration Australian New Zealand Clinical Trials Registry ID: ACTRN12621000445875, registered 19 April 2021 ( https://anzctr.org.au/Trial/Registration/TrialReview.aspx?id=381007&isReview=true ). The Universal Trial Number is U1111-1261-8951.

Residence near industrial complex and cancer incidence: A registry-based cohort of 1,022,637 participants with a follow-up of 21 years, Israel

BACKGROUND

Industrial complex (IC) residence is associated with higher cancer incidence in adults and children. However, the effect on young adults and the residence duration are not well described. Since the beginning of the 20th century, the Haifa bay area (HBA) has a major IC area with petrochemical industry complex and many other industries. The objectives of the current study were to estimate the association between IC residence and cancer incidence and to evaluate the effect of the residence duration.

METHODS

This study is a registry-based cohort (N = 1,022,637) with a follow-up of 21 years. Cox regression models were used to evaluate the associations (hazards ratios (HR) and its 95% confidence intervals (CIs)) between HBA residence and incidence of all cancer sites (n = 62,049) and for site-specific cancer types including: lung cancer (n = 5398), bladder cancer (n = 3790), breast cancer (n = 11,310), prostate cancer (n = 6389) skin cancer (n = 4651), pancreatic cancer (n = 2144) and colorectal cancer (n = 8675). We evaluated the effect of the duration of exposure as categories of 7 years for those with 15 years of follow-up.

RESULTS

IC residence was associated with higher risk for all cancer sites (HR:1.09, 95% CI: 1.06-1.12), for site-specific cancer incidence including: lung cancer (HR:1.14, 95% CI: 1.04-1.23), bladder cancer (HR:1.11, 95% CI: 1.01-1.23), breast cancer (HR:1.04, 95% CI: 0.98-1.10), prostate cancer (HR:1.07, 95% CI: 0.99-1.16), skin cancer (HR:1.22, 95% CI: 1.12-1.33) and colorectal cancer (HR:1.10, 95%CI: 1.03-1.17). Similar risk was also observed among young adults (HR: 1.10, 95% CI: 1.00-1.20). In the analyses for the duration of exposure, IC residence was associated with higher risk for all cancer site for the longest residence duration (15-21 years: HR: 1.08, 95% CI: 1.04-1.13).

CONCLUSIONS

Harmful associations were found between IC residence and incidence of all cancer sites and site-specific cancers types. Our findings add to the limited evidence of associations between IC residence and cancer in young adults.

Nighttime Waking to Smoke, Stress, and Nicotine Addiction

INTRODUCTION

Up to one-half of cigarette smokers may wake up during the night and smoke. This behavior may result in greater likelihood of cessation failure, clinically relevant sleep difficulties, and a range of health issues. Whereas the scientific literature has often attributed this behavior to nicotine dependence, up to 85% of smokers who wake at night and smoke attribute this behavior to factors other than nicotine. This study examines the relations between nicotine dependence, psychological distress, perceived stress, and waking at night to smoke.

METHODS

A total of 351 adult smokers from the Pennsylvania Adult Smoking Study (PASS) completed self-report surveys and provided saliva for the evaluation of cotinine values. Survey instruments included measures of nicotine addiction, perceived stress, a broad measure of global psychological distress, and a range of demographic factors.

RESULTS

Logistic regression demonstrated that nicotine addiction, psychological distress, and perceived stress were all related to waking at night to smoke, but cotinine levels were not. Mediation models found that psychological distress had a direct relation to waking at night to smoke, even when considering nicotine addiction and other causes of sleep disturbances (e.g., apnea and chronic physical pain). Alternative moderation and mediation models were conducted but did not support other plausible associations between variables.

CONCLUSIONS

Waking at night to smoke is likely the result of both nicotine dependence and psychological distress. Given that cotinine levels were not associated with waking at night, the mechanisms of how nicotine dependence may affect waking at night need further investigation.

Prevalence of tobacco consumption and the associated factors among the adults in an urban slum: Findings from the WHO STEPwise survey

INTRODUCTION

Despite Pakistan's stringent tobacco control policy, its effective implementation has always been a challenge, leading to rising tobacco consumption. The aim of the study is to determine the prevalence of tobacco consumption and associated risk factors in the adult population of deprived urban areas.

METHODS

A community-based, cross-sectional survey was conducted from February to July 2019, comprising 607 adults residing in the urban squatter settlement of Lahore using a standardized questionnaire, the WHO STEPwise approach. The outcome was current use of tobacco and/or smokeless tobacco daily. Multivariable logistic regression was applied to determine factors associated with smoking and smokeless tobacco consumption.

RESULTS

Among 607 participants, about 64% were females, 49.3% were illiterate, 64.9% were currently unemployed, and 47.1% belonged to the low-income group. The prevalence of tobacco smoke was 10.5% (95% CI: 8.07-12.93), and smokeless tobacco consumption was 8.6% (95% CI: 6.38-10.82). Multivariable logistic regression found that smokeless tobacco was more likely among the aged 50-59 years (AOR=4.1; 95% CI: 1.1-13.8) and unemployed (AOR=3.6; 95% CI: 1.1-12.2). Whereas tobacco smoking was more likely among the aged 30-39 years (AOR=5.5; 95% CI: 1.8-16.7), Urdu ethnicity (AOR=2.9; 95% CI: 1.2-7.3), unemployed (AOR=6.6; 95% CI: 2.9-14.9), and never exposed to any media (AOR=3.2; 95% CI: 1.8-17.4). Participants exposed to health warnings were less likely to smoke (AOR=0.02; 95% CI: 0.01-0.05).

CONCLUSIONS

This study reports a high prevalence of tobacco consumption among adults and calls for effective policy implementation using a multi-pronged approach, including health professionals and media, to spread awareness about the harmful effects of tobacco and endorsement of health warnings on tobacco packaging.

"Residential greenness and site-specific cancer: A registry based cohort of 144,427 participants with a 21-years of follow-up, Tel-Aviv district, Israel"

BACKGROUND

Few longitudinal studies evaluated the beneficial associations between cumulative residential greenness and site-specific cancer. Our objective was to evaluate the associations between cumulative residential greenness exposure and site-specific cancer incidence (lung, bladder, breast, prostate, and skin cancer) within a registry-based cohort study.

METHODS

This study was based on 144,427 participants who lived in the Tel Aviv district during 1995-2015. The residential greenness exposure was estimated for every participant, as the weighted mean residential greenness exposure, based on the mean Normalized Difference Vegetation Index (NDVI) in the residential area and the duration of the residence in this area. Cox regression models were used to evaluate the unadjusted and adjusted associations between exposure to greenness and cancer incidence during 1998-2015 (Hazard Ratios (HRs) and 95% Confidence Intervals (CIs)). Covariates included in adjusted models were selected based on prior knowledge and directed acyclic graphs. We imputed missing data and further sensitivity analyses were conducted.

RESULTS

After adjustments, beneficial associations between exposure to greenness and cancer incidence were observed. An interquartile range (IQR) increase in NDVI was associated with a lower HRs for lung cancer (HR_adj. = 0.75 95% CI: 0.66-0.85), bladder cancer (HR_adj. = 0.71, 95% CI: 0.62-0.82), breast cancer (HR_adj. = 0.81, 95% CI: 0.74-0.88), prostate cancer (HR_adj. = 0.77, 95% CI: 0.70-0.86) and skin cancer (HR_adj. = 0.78, 95% CI: 0.69-0.88). Generally, the patterns of associations were consistent between complete-case models and imputed models, when estimated for participants aged 16 years or 40 years and older at baseline, when stratified by area level socioeconomic status, when evaluated for non-movers participants and after further adjustment to social determinants of health.

CONCLUSION

Residential greenness may reduce the risk for lung, bladder, breast, prostate, and skin cancers. If our observations will be replicated, it may present a useful avenue for public-health intervention to reduce cancer burden.

Study on the effects of combined tea drinking and mental activity after dinner on smokers in China

INTRODUCTION

Cigarette and tobacco use is a leading cause of chronic obstructive pulmonary disease, lung cancer, and other malignant tumors. In China, people prefer to engage in mental activities (gambling, overtime work, playing video games, or other mental activities) on the weekends or during spare time, especially in the evening before they prepare for bed. In China, smokers frequently consume tea while smoking. The relationship between smokers who consume tea, engage in mental activities after dinner, or both (drinking tea and engaging in cognitive activities after dinner together), and daily cigarette smoking or nicotine addiction must be clarified.

METHODS

A total of 438 smokers were included in the study. Age, gender, body mass index (BMI), smoking habits, Fagerström test for nicotine dependence scores, and behaviors, were recorded. The study excluded smokers with a Fagerström score <1 or with a mental disorder diagnosis. The smokers were divided into four groups based on their behaviors: those who did not drink tea, did not engage in mental activities after dinner, those who drank tea only, those who engaged in mental activities only, and those who engaged in both.

RESULTS

Only drinking tea or doing mental activities after dinner cannot increase cigarettes per day (22.20 ± 10.143 vs 23.49 ± 11.966, p=0.362; 22.20 ± 10.143 vs 22.66 ± 1.192, p=0.750) or FTND scores [6.0 (4.0; 7.0) vs 6.0 (4.0; 7.75), p=0.941; 6.0 (4.0; 7.0) vs 6.0 (4.25; 7.75), p=0.980]. People who drink tea and engage in mental activities after dinner smoke more (22.20 ± 10.143 vs 30.75 ± 17.264, p<0.0001) and have higher nicotine dependence levels [6.0 (4.0; 7.0) vs 7.0 (5.0; 8.0), p=0.015].

CONCLUSIONS

The consumption of tea or a mental activity after dinner is not associated with daily smoking or nicotine dependence. There is an association between the combined behaviors (tea drinking and mental activity after dinner) and the daily consumption of cigarettes, and the degree of nicotine dependence.

Tobacco use prevalence and its determinate factor in Ethiopia- finding of the 2016 Ethiopian GATS

BACKGROUND

Tobacco, one of the risk factors for non-communicable diseases, kills 8 million people each year. Like other sub-Saharan countries, Ethiopia faces the potential challenge of a tobacco epidemic. However, there is no organized data on the prevalence of tobacco use in the country. Therefore, this study aims to determine adult tobacco use in Ethiopia.

METHODS

The study was conducted using the WHO and CDC GATS survey methods. Complex survey analysis was used to obtain prevalence and population estimates with 95% confidence intervals. Bivariate regression analyses were employed to examine factors related to tobacco use.

RESULTS

The overall tobacco use percentage was 5.0% [95% CI (3.5, 6.9)], of which 65.8% [95% CI (53.4, 76.3)] only smoked tobacco products; 22.5% [95% CI (15.7, 31.2)] used smokeless tobacco only; and 11.8% [95% CI (6.5, 20.4)] used both smoked and smokeless tobacco products. In 2016, more men adults (8.1%) used tobacco than women did (1.8%). Eight out of eleven states have a higher smoking rate than the national average (3.7%). Gender, employment, age, religion, and marital status are closely linked to current tobacco use (p-value< 0.05). Men adults who are employed, married, and mostly from Muslim society are more likely to use tobacco.

CONCLUSION

The prevalence of tobacco use is still low in Ethiopia. However, the percentage of female smokers is increasing, and regional governments such as Afar and Gambella have a relatively high prevalence. This calls for the full implementation of tobacco control laws following the WHO MPOWER packages. A tailored tobacco control intervention targeting women, younger age groups, and regions with a high proportion of tobacco use are recommended.

Financial Worry and Psychological Distress Among Immigrants in the United States, 2013-2018

The coronavirus disease 2019 (COVID-19) pandemic has highlighted links among economic stability, health outcomes, and migration. The facets of financial worry and their associated psychological burden have been understudied among the immigrant population. The goal of this study was to determine the specific facets of financial worry and associated psychological burden in immigrants. This cross-sectional study, which used data from the 2013 to 2018 National Health Interview Survey (NHIS), examined patient-reported measures of worry regarding financial strain. The NHIS is a household survey of noninstitutionalized, nonmilitary adults in the United States. Multivariable ordinal logistic regressions were used to define adjusted odds ratios (AORs) for financial worry and psychological distress, adjusting for various sociodemographic variables. Among 131,669 US-born and 26,155 non-US-born participants who responded to all 6 questions on the 6-item Kessler Psychological Distress Scale (K6), the overall prevalence of participants reporting any serious psychological distress (K6 score ≥13) was 3.0% and 2.25%, respectively. Despite these overall prevalence data, there were specific areas of financial worries that were higher in non-US-born participants than in US-born participants. Compared with US-born participants, non-US-born participants had higher rates of financial worries regarding retirement [75.78% vs. 69.08%, AOR=1.37, 95% confidence interval (CI) 1.29-1.45, P<0.001], medical costs due to illness (worry about not being able to pay medical costs of a serious illness or accident) (74.94% vs. 65.27%, AOR=1.37, 95% CI: 1.29-1.45, P<0.001), standard of living (74.25% vs. 65.29%, AOR=1.42, 95% CI: 1.34-1.51, P<0.001), and medical cost of health care (worry about not having enough to pay medical costs for normal health care) (66.52% vs. 52.67%, AOR=1.51, 95% CI: 1.43-1.60, P<0.001), among other costs. Notably, serious psychological distress in non-US-born individuals was associated with increased financial worry relative to US-born individuals with a similar level of psychological distress. Further research is needed to evaluate the role physicians can play in mitigating psychological distress in patients with increased financial worry.

Smoking intensity and urinary nicotine metabolites by socioeconomic status in the Heinz Nixdorf Recall study

Background

Smoking intensity, which is generally based on self-reported average cigarettes per day (CPD), is a major behavioural risk factor and strongly related to socioeconomic status (SES). To assess the validity of the CPD measure, correlations with objective markers of tobacco smoke exposure – such as urinary nicotine metabolites – were examined. Yet, it remains unclear, whether this correlation is affected by SES, which may indicate imprecise or biased self-reports of smoking intensity.

Methods

We investigated the role of SES in the association between CPD and nicotine metabolites in current smokers among the participants of the population-based, prospective Heinz Nixdorf Recall Study. We determined urinary cotinine and additionally trans-3′-hydroxy-cotinine. SES was assessed by the International Socio-Economic Index of occupational status, and education. We calculated correlations (Pearson’s r) between logarithmised CPD and cotinine in subgroups of SES and analysed SES and further predictors of cotinine in multiple linear regression models separately by gender.

Results

Median reported smoking intensity was 20 CPD in male and 19 CPD in female smokers. Men showed higher cotinine concentrations (median 3652 μg/L, interquartile range (IQR) 2279–5422 μg/L) than women (3127 μg/L, IQR 1692–4920 μg/L). Logarithmised CPD correlated moderately with cotinine in both, men and women (Pearson’s r 0.4), but correlations were weaker in smokers with lower SES: Pearson’s r for low, intermediate, and high occupational SES was 0.35, 0.39, and 0.48 in men, and 0.28, 0.43, and 0.47 in women, respectively. Logarithmised CPD and urinary creatinine were main predictors of cotinine in multiple regression models, whereas SES showed a weak negative association in women. Results were similar for trans-3′-hydroxy-cotinine.

Conclusions

Decreasing precision of self-reported CPD was indicated for low SES in men and women. We found no strong evidence for biased self-reports of smoking intensity by SES.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-022-12609-y.

Association between health behaviors and depression: findings from the 2019 Brazilian National Health Survey

OBJECTIVE

To analyze the association of depression with various health behaviors and to verify if they differ according to gender or income.

METHODS

This is a cross-sectional study based on data of 65,803 Brazilian adults (18-59 years old) interviewed in the National Health Survey, conducted in 2019. Presence or absence of depression was evaluated using the Patient Health Questionnaire (PHQ)-9. The prevalence of smoking, alcohol consumption, physical activity, sedentary lifestyle and food indicators were estimated according to the presence of depression. Stratified analyses were made according to sex and income, and prevalence ratios were estimated using the Poisson Regression.

RESULTS

We found a significant association between depression and all indicators studied, except occasional alcohol consumption. Depression was associated with heavy episodic drinking and insufficient consumption of fruits and vegetables only in women. In men, the associations of depression with sedentary lifestyle and with being a former smoker were stronger than in women. The occasional consumption of alcohol was more prevalent only in men without depression. The analysis stratified by income showed that the association of depression with physical inactivity is stronger in the higher-income group, while with heavy episodic drinking is only significant in the lower-income stratum.

CONCLUSION

The results point to the need to consider mental health in programs aimed at reducing harmful health behaviors and the specificity of sociodemographic groups.

Influence of Maternal Active and Secondhand Smoking during Pregnancy on Childhood Obesity at 3 Years of Age: A Nested Case-Control Study from the Japan Environment and Children's Study (JECS)

Maternal smoking during pregnancy is a risk factor for childhood obesity; however, the combined effect of secondhand smoking during pregnancy on children in the early years is unclear. We examined the effects of maternal active and secondhand smoking during pregnancy on childhood obesity in a large population-based cohort. A nested case–control study originating from the Japan Environment and Children’s Study was performed. The maternal smoking status was collected via self-administered questionnaires during mid/late pregnancy. Obesity in children was determined based on BMI measured at 3 years of age. In total, 4875 cases and 19,491 controls were included in the analyses. Conditional logistic regression models with a significance level of 5% (two-tailed test) were used to test the association. The proportion of mothers who continued smoking and who were exposed to secondhand smoking daily during pregnancy were 3.9% and 13.0% in cases and 2.9% and 10.8% in controls, respectively. Continuous maternal smoking was associated with increased odds of obesity compared to those who never smoked or quit smoking before the pregnancy (adjusted odds ratio, 1.39; 95% confidence interval, 1.01–1.92). The odds increased further when combined with secondhand smoking. The promotion of non-smoking among family members, in public and workplace could benefit pregnant women and offspring.

Addressing tobacco use in the context of complex social needs: A new conceptual framework and approach to address smoking cessation in community health centers

Objective

This article presents a new conceptual framework “Connection to Health for Smokers” (CTHS), its application to address smoking cessation, and its acceptability in community health centers (CHCs).

Methods

CTHS, an online interactive patient educational tool comprehensively implements the “5 A's” (ask, advise, assess, assist, and arrange) within the context of patients' social and behavioral health needs. Semi-structured interviews were conducted with five health educators (nurses) who administered CTHS with 62 patients to evaluate the acceptability of the program. Thematic analyses were conducted with interview transcripts.

Results

CHC health educators viewed CTHS has enhanced patient-centered communication, was able to identify patients' needs beyond tobacco use, and individualize action planning to integrate social and behavioral health needs.

Conclusion

CTHS received enthusiasm from CHC health educators as a helpful tool to address tobacco use among their patients. Comprehensive on-site smoking cessation programs at CHCs that provide a structured evidence-based approach informed by an understanding of each patient's coexisting social and behavioral health needs may play an important role in reducing tobacco use disparities in the United States.

Innovation

CTHS offers a new promising framework to comprehensively integrate the 5A's within the context of social and behavioral determinants of health for smoking cessation.

•

Social and behavioral health challenges may interfere smoking cessation

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CTHS implements “5A's” while addressing coexisting social and behavioral needs

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Integrate patients' needs in tobacco treatment optimizes cessation outcomes

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Nurses viewed addressing complex needs helpful to motivate smokers to quit smoking

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Comprehensive patient-centered approach may reduce tobacco use disparities

Income disparity and utilization of cardiovascular preventive care services among U.S. adults

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Low income individuals are less likely to receive smoking cessation counseling.

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Low income individuals are less likely to have their blood pressure checked.

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Low income individuals are less likely to be receive exercise counseling.

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Low income individuals are less likely to receive dietary counseling.

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Low income individuals are less likely to have their cholesterol levels checked.

Objective

: Associations between income disparity and utilization of cardiovascular disease (CVD) preventive care services, such as receipt of lifestyle advice and screening for CVD risk factors in populations with and without CVD, are not well understood. The purpose of this study was to evaluate associations between income and utilization of CVD-preventive services among U.S. adults.

Methods

: We included adults ≥18 years with and without CVD from the 2006 to 2015 Medical Expenditure Panel Survey. We categorized participants as high-income (>400% of federal poverty level [FPL]), middle income (200–400% of FPL), low-income (125–200% of FPL) and very low (VL)-income (<125% of FPL). We used logistic regression to compare the likelihood of receiving CVD-preventive services by income strata, adjusting for sociodemographic factors and comorbidities.

Results

: The study included 185,081 participants (representing 194.6 million U.S. adults) without CVD, and 32,862 participants (representing 37 million U.S. adults) with CVD. VL-income adults without CVD were less likely than high-income adults to have blood pressure measured within past 2 years [odds ratio [OR] 0.41 (95% confidence interval [CI] 0.37–0.45)] or cholesterol levels checked within past 5 years [0.36 (0.33–0.38)] or receive counseling about diet modifications [0.77 (0.74–0.81)], exercise [0.81 (0.77–0.85)], or smoking cessation [0.71 (0.63–0.79)] within past year. VL-income adults with CVD were also less likely to have blood pressure [0.32 (0.22–0.46)] or cholesterol [0.33 (0.26–0.42)] checked and receive counseling about exercise [0.84 (0.76–0.93)] or smoking cessation [0.78 (0.61–0.99)]. Additional subgroup analyses restricted to participants who had seen a healthcare provider within the preceding 12 months, as well as secondary analyses stratified by sex, race and ethnicity, showed similar disparities between high-income and VL-income participants.

Conclusions

: VL-income adults were less likely to be screened for CVD risk factors or receive CVD-prevention counseling than high-income adults, regardless of CVD status. More work must be done to reduce disparities in access to and utilization of CVD-preventive services among adults in different income groups.

Trends in socioeconomic inequalities in smoking in Turkey from 2008 to 2016

Background

Smoking inequalities in Turkey were previously demonstrated in an early stage of the smoking epidemic model. This paper aimed to assess the trends for socioeconomic inequalities in smoking in Turkey over the years in the context of the smoking epidemic model using data from the Global Adult Tobacco Survey (GATS) Turkey 2008–2012-2016.

Methods

Cross-sectional data were analyzed to calculate the association of smoking with, wealth, education, occupation and place of residence using age-standardized prevalence rates, odds ratios, relative index of inequality (RII) and slope index of inequality (SII). The analysis was performed separately for age groups (younger: 20–39 years/older: 40 and above years) and sex.

Results

Younger women with higher wealth and older women with higher wealth and education smoked more. For both age groups, smoking was increased for working class and urban women. Relative wealth inequalities in smoking narrowed and then showed a reversal for younger women (RII₂₀₀₈ = 3.37; 95% CI:1.64–3.40; RII₂₀₁₂ = 2.19; 95% CI:1.48–3.24; RII₂₀₁₆ = 0.80; 95% CI:0.58–1.10, p-for trend < 0.0001). Relative educational inequalities in smoking for older women also showed a narrowing (RII₂₀₀₈ = 21.45; 95% CI:11.74–39.19; RII₂₀₁₂ = 15.25; 95% CI:9.10–25.55; and RII₂₀₁₆ = 5.48; 95% CI:3.86–7.78, p-for trend < 0.0001). For older women, a similar narrowing was observed for wealth (RII₂₀₀₈ = 3.94; 95% CI:2.38–6.53; RII₂₀₁₂ = 2.79; 95% CI:1.80–4.32; and RII₂₀₁₆ = 1.34; 95% CI:0.94–1.91, p-for trend = 0.0001). The only significant trend for absolute inequalities was for younger women by wealth. This trend showed a narrowing and then a reversal (SII₂₀₀₈ = 0.14; 95% CI:0.09–1.20; SII₂₀₁₂ = 0.12; 95% CI:0.06–0.18; and SII₂₀₁₆ = -0.05; 95% CI:-0.12–0.02, p-for trend = 0.0001). Unlike women, smoking in men showed inverse associations for wealth and education, although not statistically confirmed for all years. Smoking was increased in working classes and unemployed men in 2012 and 2016. Inequalities did not show a trend in relative and absolute terms for men.

Conclusions

For smoking inequalities in Turkey, a transition to the next stage was observed, although the previously defined Southern European pattern also existed. Low socioeconomic women deserve special attention as well as stressors at work and drivers of smoking at urban settings.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-021-12200-x.

The effect of nicotine dependence on the risk of developing post-traumatic stress disorder: Results from the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC)

BACKGROUND

It is evident that an association between smoking and post-traumatic stress disorder (PTSD) exists, but research is lacking in establishing the directionality of the relationship.

METHODS

We used longitudinal data from wave I (2001-2002) and II (2004-2005) of the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC). Individuals with nicotine dependence (ND) were matched to individuals without ND using propensity score matching to estimate the risk of developing PTSD after trauma. We also matched smokers (with or without ND) to lifetime non-smokers to estimate their risk of developing PTSD after trauma. Lastly, we conducted a mediation analysis on the effect of ND severity on PTSD symptoms.

RESULTS

Individuals with ND (n = 1,514) were more likely to develop PTSD (OR: 1.59; 95%CI: 1.09-2.32; p = 0.017) compared to individuals without ND (n = 6,047). Smokers (regardless of ND status) (n = 2,335) compared to non-smokers (n = 5,226) had no significant effect on risk of PTSD (p = 0.26). Withdrawal was found to be a mediator of the effect of ND severity on PTSD symptoms.

CONCLUSION

ND, but not smoking status, increases a smoker's risk of developing PTSD. This provides information that could aid in preventive strategies for individuals with ND who are exposed to trauma.

IMPLICATIONS

This study provides evidence in a national representative sample of adults in the U.S. that nicotine dependence may increase one's risk of developing PTSD after exposure to trauma. It also shows the directionality of the association between smoking and PTSD. Lastly, it demonstrates that withdrawal may be the link to the association between nicotine dependence and PTSD. We hope that with these findings, preventative strategies are put in place for smokers who are dependent and are exposed to trauma, such that they do not develop PTSD.

Menthol Smoking and Nicotine Dependence among Black/African American Women Smokers Living in Low-Resource, Rural Communities

Black/African American women from low-resource, rural communities bear a disproportionate burden of tobacco-related morbidity and mortality. This study examined associations between menthol smoking and socioeconomic deprivation with nicotine dependence and quitting behaviors among Black/African American women cigarette and/or little cigar/cigarillo smokers, aged 18–50 living in low-resource, rural communities. Baseline survey data from a randomized controlled behavioral/intervention trial (#NCT03476837) were analyzed (n = 146). Outcomes included time to first tobacco product (cigarette/little cigar/cigarillo) use within 5 min of waking, Fagerstrom Test for Nicotine Dependence (FTND) score, and ever attempting to quit cigarettes. Socioeconomic deprivation measures included education, income, and receiving supplemental nutritional assistance (SNAP) program benefits. In adjusted regression analyses, menthol smoking was associated with both greater FTND scores and time to first tobacco product use within 5 min of waking, but not ever attempting to quit cigarettes. Regardless of menthol status, only 25.0% of smokers reported that they would quit smoking if menthol cigarettes were banned. The proportion of smokers who smoked their first tobacco product within 5 min of waking increased slightly with greater socioeconomic deprivation. Additional research and targeted efforts are needed to reduce nicotine dependence among Black/African American women smokers living in rural, low-resource communities where access to cessation services is limited.

Factors associated with alcohol and tobacco consumption as a coping strategy to deal with the coronavirus disease (COVID-19) pandemic and lockdown in Spain

Aim

To provide a population-based characterization of sociodemographic and clinical risk and protective factors associated with consumption of alcohol, tobacco, or both as a coping strategy in a sample of the Spanish general population during the early phase of the COVID-19 pandemic.

Methods

Cross-sectional study based on an online snowball recruiting questionnaire. The survey consisted of an ad hoc questionnaire comprising clinical and sociodemographic information and the Spanish versions of the Depression, Anxiety, and Stress Scale (DASS-21) and the Impact of Event Scale (IES).

Results

The final sample included 21,207 individuals [mean age (SD) = 39.7 (14.0); females: 14,768 (69.6%)]. Up to 2867 (13.5%) of participants reported using alcohol, 2545 (12%) tobacco and 1384 (6.5%) both substances as a strategy to cope with the pandemic. Sex-related factors were associated with alcohol consumption as a coping strategy [female, OR = 0.600, p < 0.001]. However, education level, work status, and income played different roles depending on the substance used to cope. Having a current mental disorder was associated only with tobacco consumption as a coping strategy [OR = 1.391, p < 0.001]. Finally, sex differences were also identified.

Conclusions

Sociodemographic, clinical, and psychological factors were associated with consumption of alcohol, tobacco, or both as a coping method for the COVID-19 pandemic and lockdown. Our findings may help develop specific intervention programs reflecting sex differences, which could minimize negative long-term outcomes of substance use after this pandemic.

Associations between chronic cigarette smoking and taste function: Results from the 2013-2014 national health and nutrition examination survey

We identified associations between cigarette-smoking and taste function in the U.S. NHANES 2013-2014. Adults ≥ 40 years (n = 2849, nearly half former or current smokers) rated whole-mouth and tongue-tip bitter (1 mM quinine) and salt (1 M NaCl, 0.32 M NaCl) intensities and reported smoking history (pack years, PY), dependence (time to first cigarette, TTFC) and menthol/non-menthol use. Perceived intensity on the tongue-tip averaged just below moderate for quinine and moderate to strong for 1 M NaCl. Current chronic smokers (≥ 20 PY) reported lower bitter and salty intensities on the tongue-tip (β: -2.0, 95% CI: -3.7 to -0.4 and β: -3.6, 95% CI: -6.9 to -0.3, respectively) than never smokers. Similarly, compared to never smokers, dependent current smokers (TTFC ≤ 30 min) and dependent chronic smokers (≥ 20 PY, TTFC ≤ 30 min) rated less bitter (β: -2.0, 95% CI: -4.0 to 0.1 and β: -2.9, 95% CI: -4.5 to -1.3, respectively) and salty (β: -5.3, 95% CI: -9.3 to -1.4 and β: -4.7, 95% CI: -8.6 to -0.7, respectively) intensities on the tongue-tip. Depressed tongue-tip intensity in dependent smokers (with/without chronicity) versus never smokers was significant in younger (40-65 years), but not older (> 65 years) adults. Former smokers, non-chronic/less dependent smokers, and menthol smokers were more likely to report elevated whole-mouth quinine and 1 M NaCl intensities. Tongue-tip and whole-mouth taste intensity concordance varied between smokers and never smokers-current dependent smokers were more likely to rate tongue-tip quinine and NaCl lower than their respective whole-mouth tastants (OR: 1.8, 95% CI: 1.0 to 3.1 and OR: 1.8, 95% CI: 1.1 to 2.8, respectively). In summary, these U.S. nationally-representative data show that current smoking with chronicity and/or dependence associates with lower tongue-tip intensity for bitter and salty stimuli. Smokers with greater exposure to nicotine and/or dependence showed greater risk of taste alterations, with implications for diet- and smoking-related health outcomes.

Household Smoking Restrictions, Time to First Cigarette and Tobacco Dependence

OBJECTIVE

Environmental factors, such as household smoking restrictions (HSR), may impact a range of smoking-related outcomes. The current study examined the effects of various levels of HSR on smoking behaviors, including the number of cigarettes smoked per day and levels of nicotine dependence in a population of adult smokers. (1) Having specific HSR reduces the urges to smoke (path A); (2) having specific HSR reduces CPD (path B); (3) having specific HSR results in lower overall nicotine addiction (path C), and later, TTFC will be associated with (4) lower urges to smoke in the morning (path A'), (5) fewer CPD (path B'), and (6) lower levels of nicotine addiction (path C').

METHOD

Regression models using self-reported data from the Pennsylvania Adult Smoking Study (N = 353) were used. TTFC was measured minutes between waking and the first cigarette of the day. Household smoking restrictions were measured as follows: (1) full ban on smoking in the home, (2) partial ban, or (3) no ban.

RESULTS

Subjects with no household smoking restrictions had lower incomes and education than those with at least some household smoking restrictions; those with full bans smoked less and had an earlier TTFC than those with at least some household smoking restrictions. Smokers with a full ban had a later TTFC, mediated by fewer cigarettes per day and lower cravings. Among those with partial bans, there is no reduction in cigarettes per day and an increase in urges to smoke.

CONCLUSIONS

Partial household smoking restrictions are no better than no household smoking restrictions with regard to cigarettes per day and TTFC, and may cause an increase in urges to smoke in the morning.

Cigarette smoking behaviors and the importance of ethnicity and genetic ancestry

Cigarette smoking contributes to numerous diseases and is one of the leading causes of death in the United States. Smoking behaviors vary widely across race/ethnicity, but it is not clear why. Here, we examine the contribution of genetic ancestry to variation in two smoking-related traits in 43,485 individuals from four race/ethnicity groups (non-Hispanic white, Hispanic/Latino, East Asian, and African American) from a single U.S. healthcare plan. Smoking prevalence was the lowest among East Asians (22.7%) and the highest among non-Hispanic whites (38.5%). We observed significant associations between genetic ancestry and smoking-related traits. Within East Asians, we observed higher smoking prevalence with greater European (versus Asian) ancestry (P = 9.95 × 10^-12). Within Hispanic/Latinos, higher cigarettes per day (CPD) was associated with greater European ancestry (P = 3.34 × 10^-25). Within non-Hispanic whites, the lowest number of CPD was observed for individuals of southeastern European ancestry (P = 9.06 × 10^-5). These associations remained after considering known smoking-associated loci, education, socioeconomic factors, and marital status. Our findings support the role of genetic ancestry and socioeconomic factors in cigarette smoking behaviors in non-Hispanic whites, Hispanic/Latinos, and East Asians.

Mental activities after dinner increase cigarettes consumption

Tobacco smoking is the main risk factor for many diseases such as chronic obstructive pulmonary disease as well as lung cancer and cigarettes. Smokers usually keep continuing to smoke during their mental activities in the evening between dinner and sleep time on work days. So it is critical to elucidate the relationship between cigarettes daily consumption and mental activities after dinner. A survey designed by ourselves was finished among 369 patients who came to our clinic for smoking cessation. Age, gender, BMI, cigarettes consumption were recorded and analyzed. Statistically, Pearson correlation test and general linear model test were used. Compared to ≤ 40 years’ group, patients with mental activities after dinner consumed more cigarettes than those without mental activities (22.80 ± 10.86 vs. 30.88 ± 18.69, P value < 0.001). The Pearson correlation test showed no interact effects on age and BMI, and general linear model test showed that the cigarettes numbers between smokers with mental activities after dinner and smokers without mental activities after dinner are different (P value < 0.001). Mental activities from dinner finish to sleep time increase cigarettes consumption. It provides evidence that mental thinking activities after dinner is a risk factor of tobacco using.

Investigations on the new mechanism of action for acetaldehyde-induced clastogenic effects in human lung fibroblasts

Acetaldehyde (AA) has been classified as a probable human carcinogen by the International Agency for Research on Cancer (IARC, WHO) and by the US Environmental Protection Agency due to its ability to cause tumours following inhalation or alcohol consumption in animals. Humans are constantly exposed to AA through inhalation from the environment through cigarette smoke, vehicle fumes and industrial emissions as well as by persistent alcohol ingestion. Individuals with deficiencies in the enzymes that are involved in the metabolism of AA are more susceptible to its toxicity and constitute a vulnerable human population. Studies have shown that AA induces DNA damage and cytogenetic abnormalities. A study was undertaken to elucidate the clastogenic effects induced by AA and any preceding DNA damage that occurs in normal human lung fibroblasts as this will further validate the detrimental effects of inhalation exposure to AA. AA exposure induced DNA damage, involving DNA double strand breaks, which could possibly occur at the telomeric regions as well, resulting in a clastogenic effect and subsequent genomic instability, which contributed to the cell cycle arrest. The clastogenic effect induced by AA in human lung fibroblasts was evidenced by micronuclei induction and chromosomal aberrations, including those at the telomeric regions. Co-localisation between the DNA double strand breaks and telomeric regions was observed, suggesting possible induction of DNA double strand breaks due to AA exposure at the telomeric regions as a new mechanism beyond the clastogenic effect of AA. From the cell cycle profile following AA exposure, a G2/M phase arrest and a decrease in cell viability were also detected. Therefore, these effects due to AA exposure via inhalation may have implications in the development of carcinogenesis in humans.

Variation in characteristics of people with mental disorders across smoking status in the Canadian general population

INTRODUCTION

People with mental disorders are less successful in smoking cessation efforts. This study compared the characteristics of current smokers and former smokers with mental disorders.

METHODS

This was a cross-sectional study that used the Public Use Microdata File of the Canadian Community Health Survey 2012. Survey respondents with any mental health disorder in the last 12 months (n=2700), identified using the World Health Organization Composite International Diagnostic Interview instrument, were included in the analysis. Smoking status was classified based on self-report responses as current, former and never smoker. Logistic regression models were used to analyze the data.

RESULTS

The odds of quitting smoking were significantly lower among people who were single or never married (widowed/divorced/separated/single) compared to those who were married or had a common-law partner (adjusted odds ratio, AOR=0.6, 95% CI: 0.4–0.9). Similarly, significantly lower odds of quitting smoking were observed among people with less than post-secondary education compared to those with post-secondary education (AOR=0.4, 95% CI: 0.3– 0.6). Also, the odds of quitting were significantly lower among immigrants, young adults, and middle-aged adults.

CONCLUSIONS

People who are young or middle-aged, single or never married, less educated, and immigrants, are less likely to quit smoking. This pattern underscores the socioeconomic disparities in quitting smoking among people with mental disorders. Future research should investigate why these groups continue to smoke more often than their counterparts. This will help design the smoking cessation support that address the challenges experienced by vulnerable populations and reduce the disparities.

A methodology for small area prevalence estimation based on survey data

BACKGROUND

Brazil conducts many health surveys to provide estimates by national level, macro-regions, states, metropolitan regions and capitals. However, estimates for smaller areas are lacking due to their high cost. The Health Vulnerability Index (in Portuguese, Índice de Vulnerabilidade em Saúde, IVS) is a measure that combines socioeconomic and environmental variables in the same indicator and allows for the analysis of the characteristics of population groups residing in census tracts, grouping them into four health risk areas (low, medium, high and very high risk) in addition to showing inequalities in the epidemiological profile of different social groups. This index was developed by the Municipal Health Secretariat of Belo Horizonte to guide health planning.

OBJECTIVE

The aim of the study is to produce a methodology for obtaining reliable estimates for tobacco smoking in small areas for which the IVS was not designed.

METHODS

The Vigitel dataset from 2006 to 2013 was used to obtain estimates of the prevalence of smokers based on the IVS employing small area estimation methods that use data from a larger domain to obtain estimates in smaller areas. For indirect estimates, the covariates included were sanitation, housing, education, income, and social and health factors. Post-stratification weights were used according to the IVS based on the population of the 2010 census.

RESULTS

From 2006 to 2009, 16.2% (95% CI: 13.6-14.8%) of the adult population in Belo Horizonte were smokers, and 14.8% (95% CI: 14.0-15.6%) were smokers between 2010 and 2013. The very high-risk population maintained a high prevalence over the same period of 21.1% (95% CI: 17.1-25.0%) between 2006 and 2009 and 20.8% (95% CI: 17.0-24.6%) between 2010 and 2013, while in the low-risk group, the prevalence in the same period fell from 14.9% (95% CI: 13.7-16.2%) to 11.8% (95% CI, 10.6-13.1%).

CONCLUSIONS

The present study identified differences in the profile of smokers by the IVS in the city of Belo Horizonte. While the smoking prevalence declined in richer areas, it remained high in poor areas. This methodology can be used to produce reliable estimates for subgroups with greater vulnerability in small areas and thus subsidize the formulation, monitoring and evaluation of public health policies and programmes aimed at smoking.

Household Exposure to Secondhand Smoke among Chinese Children: Status, Determinants, and Co-Exposures

Smoking prevalence stays high among adults in China, which also makes children exposed to secondhand smoke (SHS) in their households. This study aimed to investigate the status of SHS exposure among Chinese children, identify the influencing factors, and determine "co-exposure" to tobacco and other smokes in households. A total of 41,439 children aged 6-17 years were recruited from 30 provinces in Mainland China through the first Chinese Environmental Exposure-Related Human Activity Model Survey for Children (CEERHAPS-C). Information regarding children's demographics, socioeconomic status, and exposures to SHS and solid fuel smoke (SFS) in households was collected using a comprehensive questionnaire. Factors that affected exposures to household smokes were identified using multivariable logistic regressions. The overall prevalence of household SHS exposure was 41.7%, and the average duration was 14.7 ± 14.6 min/day among the exposed participants. Prevalence of household SHS exposure increased among children in older age groups and with parents in lower education levels. Among SHS-exposed children, 34% had co-exposure to SFS, and they had a significantly higher risk of co-exposure than non-SHS exposed children (odds ratio = 1.12, 95% confidence interval: 1.061, 1.162). The prevalence of household SHS exposure remains high among school-age children, suggesting the need to develop and implement smoking-free home programs.

Survey of characteristics of exposure to mainstream cigarette smoke using discarded cigarette butts from Korean smokers

Evaluating the characteristics of exposure to mainstream cigarette smoke is an essential field in tobacco research because of the large risk burden among smokers. Detailed evaluation of the complex factors pertaining to the exposure of smokers to mainstream cigarette smoke was attempted by analysis of discarded cigarette butts. A total of 5475 samples of discarded cigarette butts was collected to investigate the exposure characteristics in relation to Korean smokers. The basic physico-chemical characteristics of cigarettes, including the filter length, filter type, menthol addition, and nicotine and tar content, were determined and the manufacturer and cigarette size were identified. The tobacco-burned percentage (TBP)) and tar staining were used as physical markers, and actual human exposure to cigarette smoke was determined using the part filter method. Multiple linear regression analyses and generalized ordinal logistic regression analysis were conducted to identify the relationship between the socio-demographic factors and the physico-chemical characteristics of the cigarettes themselves and the exposure characteristics. Significant associations were observed between the TBP and age group, occupational group, manufacturer, tar staining, ISO tar content, and filter length. Increased odds of smoking with a heavier tar stain among Korean smokers were associated with blue collar workers vs. other workers, manufacturer B vs. other manufacturers, recess filter vs. other filter types, ISO tar content, and TBP. Finally, significant associations between the log-transformed human-smoked tar and nicotine yields and occupational group, the TBP, tar staining, and physico-chemical properties of cigarettes were found and were used to propose models for predicting the actual exposure to tar and nicotine. The proposed models account for 60-61% and 47-49% of the variance of human exposure to tar and nicotine, respectively. This analysis of discarded cigarette butts revealed that various factors, including socio-demographic factors such as age group and occupational group, as well as the physico-chemical properties of cigarette products such as the filter type and length, cigarette size, ISO tar and nicotine content, and mentholation, affect the characteristics of exposure of Korean smokers to mainstream cigarette smoke.

Socioeconomic differences in the motivation to stop using e-cigarettes and attempts to do so

Introduction

In England, the use of electronic cigarettes as a smoking cessation aid has become more popular than any other aid. Previous research suggests that ex-smokers from lower social groups are more likely to use e-cigarettes compared to ex-smokers from more socially advantaged groups. The present study aimed to assess the association between baseline education, income and employment status and (1) baseline motivation to stop using e-cigarettes (2) attempts to stop using e-cigarettes during follow-up among current smokers, recent ex-smokers and long-term ex-smokers who use e-cigarettes.

Methods

UK online longitudinal survey of smokers, ex-smokers and e-cigarette users, May/June 2016 (baseline) and September 2017 (follow-up). In logistic regression models, motivation to stop using e-cigarettes at baseline (n = 994) and attempts to stop using e-cigarettes at follow-up (n = 416) among current smokers and ex-smokers were regressed onto baseline educational attainment, income, employment status while adjusting for baseline demographics, vaping status, smoking and e-cigarette dependence.

Results

(1) Respondents with higher education (OR = 1.36; 95% CI: 1.06-1.74) or higher income (OR = 1.52; 95% CI: 1.17-1.98) were more likely to be motivated to stop using e-cigarettes, but only in unadjusted analysis. (2) Again, in unadjusted analysis only, employment was associated with reduced odds of attempting to stop using e-cigarette (OR = 0.50; 95% CI: 0.32-0.79).

Conclusion

Higher socio-economic status may be associated with higher motivation to stop vaping but with lower likelihood of trying to do so.