1
|
Boruah P, Daoud RMEH, Walsh DV, Kharytaniuk N, Fredericks S, Ryan J, Abdelatif A, Birido N, Walsh TN. Patient's Perception of the Role of Gym Activity in Abdominal Wall Herniation in Adults: A Prospective Study. SPORTS MEDICINE - OPEN 2024; 10:88. [PMID: 39134817 PMCID: PMC11319541 DOI: 10.1186/s40798-024-00749-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/16/2024] [Accepted: 07/02/2024] [Indexed: 08/15/2024]
Abstract
BACKGROUND Despite significant changes in healthcare, work practices, and leisure activity, the proposed precipitating factors for abdominal wall hernias have remained largely unchanged for almost two centuries. We aimed to investigate if there have been shifts in these factors over time by examining patients' perception of precipitating factors for abdominal wall hernia development. This study was conducted in the Royal College of Surgeons In Ireland Department of Surgery, Connolly Hospital, Blanchardstown, Dublin, where patients with abdominal wall hernias completed a questionnaire . RESULTS A total of 277 patients (mean age 55.7; 85.6% male) with abdominal wall hernia completed the questionnaire (66.1% inguinal; 10.8% umbilical; 6.9% paraumbilical; 10.5% epigastric; 3.2% incisional; 1.4% femoral, and 1.1% port-site). One hundred and twenty patients (43.3%) believed their hernia was due to lifting, 71 (25.6%) cited gym activity and 17 (6.1%) cited other sporting activities as the precipitating factor. Traditional factors - chronic cough and constipation - were cumulatively cited only by 11 patients (4.0%), while prostatic obstruction was not cited by any. CONCLUSION This study suggests that fitness pursuits may be an increasing contributor to the development of abdominal wall hernia. Greater attention should be paid to the proper use of gym equipment to minimise the risk of hernia development.
Collapse
Affiliation(s)
- Prabir Boruah
- Department of Surgery, Royal College of Surgeons in Ireland, Connolly Hospital, Dublin, Ireland
| | - Rabbani Mahmoud ElSayed Hassan Daoud
- Royal College of Surgeons in Ireland - Medical University Bahrain, Busaiteen, Bahrain.
- Department of Surgery, Royal College of Surgeons in Ireland - Medical University Bahrain, Busaiteen, Bahrain.
| | - Dylan Viani Walsh
- Department of Surgery, Royal College of Surgeons in Ireland, Connolly Hospital, Dublin, Ireland
| | - Natallia Kharytaniuk
- Royal College of Surgeons in Ireland - Medical University Bahrain, Busaiteen, Bahrain
- Academic Department of Surgery, Connolly Hospital, Blanchardstown, Dublin, Ireland
| | - Salim Fredericks
- Department of Biochemistry, Royal College of Surgeons in Ireland - Medical University Bahrain, Busaiteen, Bahrain
| | - James Ryan
- Department of Surgery, Royal College of Surgeons in Ireland, Connolly Hospital, Dublin, Ireland
| | - Asila Abdelatif
- Department of Surgery, Royal College of Surgeons in Ireland, Connolly Hospital, Dublin, Ireland
| | - Nuha Birido
- Department of Surgery, Royal College of Surgeons in Ireland - Medical University Bahrain, Busaiteen, Bahrain
| | - Thomas Noel Walsh
- Department of Surgery, Royal College of Surgeons in Ireland, Connolly Hospital, Dublin, Ireland
- Department of Surgery, Royal College of Surgeons in Ireland - Medical University Bahrain, Busaiteen, Bahrain
| |
Collapse
|
2
|
Nyman J, Salanterä S, Pasanen M, Parisod H. Effectiveness of a Digital Health Game Intervention on Early Adolescent Smoking Refusal Self-Efficacy. HEALTH EDUCATION & BEHAVIOR 2024; 51:562-572. [PMID: 38497462 PMCID: PMC11193316 DOI: 10.1177/10901981241237788] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/19/2024]
Abstract
Smoking poses a significant threat to adolescent health because of its immediate and long-term detrimental health effects. Smoking refusal self-efficacy predicts smoking behavior in adolescence. In adolescents' health education, digital interventions are potential tools to support smoking refusal self-efficacy. The aim of this two-arm cluster randomized controlled trial was to evaluate the effectiveness of a digital health game intervention compared with a no-intervention control group on smoking refusal self-efficacy in 10- to 13-year-old Finnish early adolescents. The early adolescents (n = 781) were randomized to the control group (n = 394) and the health game intervention group (n = 387). Smoking refusal self-efficacy, sources of smoking and snus refusal self-efficacy, and motivation to decline smoking and snus use in the future were measured at baseline, 2-week postintervention, and 3-month follow-up. Data were analyzed using linear mixed model and Wilcoxon rank-based test for clustered data. According to the results, the intervention group made improvements in sources of smoking and snus refusal self-efficacy between baseline and postintervention, and in sources of snus refusal self-efficacy between baseline and follow-up, compared with the control group. The intervention group showed improvements in smoking refusal self-efficacy among 12-year-olds between baseline and follow-up, and postintervention and follow-up compared with the control group. Similar improvements were also found among those with a smoking friend or a smoking parent between postintervention and follow-up. The results were promising for the use of digital health game interventions to promote early adolescent smoking refusal self-efficacy and preventing smoking experimentation. Further research can evaluate the long-term effects for adolescents.
Collapse
Affiliation(s)
| | - Sanna Salanterä
- University of Turku, Turku, Finland
- Turku University Hospital, Turku, Finland
| | | | - Heidi Parisod
- University of Turku, Turku, Finland
- Nursing Research Foundation sr, Helsinki, Finland
| |
Collapse
|
3
|
Lachi A, Viscardi C, Cereda G, Carreras G, Baccini M. A compartmental model for smoking dynamics in Italy: a pipeline for inference, validation, and forecasting under hypothetical scenarios. BMC Med Res Methodol 2024; 24:148. [PMID: 39003462 PMCID: PMC11245805 DOI: 10.1186/s12874-024-02271-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Accepted: 06/27/2024] [Indexed: 07/15/2024] Open
Abstract
We propose a compartmental model for investigating smoking dynamics in an Italian region (Tuscany). Calibrating the model on local data from 1993 to 2019, we estimate the probabilities of starting and quitting smoking and the probability of smoking relapse. Then, we forecast the evolution of smoking prevalence until 2043 and assess the impact on mortality in terms of attributable deaths. We introduce elements of novelty with respect to previous studies in this field, including a formal definition of the equations governing the model dynamics and a flexible modelling of smoking probabilities based on cubic regression splines. We estimate model parameters by defining a two-step procedure and quantify the sampling variability via a parametric bootstrap. We propose the implementation of cross-validation on a rolling basis and variance-based Global Sensitivity Analysis to check the robustness of the results and support our findings. Our results suggest a decrease in smoking prevalence among males and stability among females, over the next two decades. We estimate that, in 2023, 18% of deaths among males and 8% among females are due to smoking. We test the use of the model in assessing the impact on smoking prevalence and mortality of different tobacco control policies, including the tobacco-free generation ban recently introduced in New Zealand.
Collapse
Affiliation(s)
- Alessio Lachi
- Department of Statistics, Computer Science, Applications "Giuseppe Parenti" (DiSIA), University of Florence, Viale Giovanni Battista Morgagni 59/65, Florence, 50134, Italy.
- Epidemiology and Health Research Lab, Institute of Clinical Physiology of the Italian National Research Council (IFC-CNR), Via Giuseppe Moruzzi 1, Pisa, 56124, Italy.
| | - Cecilia Viscardi
- Department of Statistics, Computer Science, Applications "Giuseppe Parenti" (DiSIA), University of Florence, Viale Giovanni Battista Morgagni 59/65, Florence, 50134, Italy
- Florence Center for Data Science, University of Florence, Viale Giovanni Battista Morgagni 59, Florence, 50134, Italy
| | - Giulia Cereda
- Department of Statistics, Computer Science, Applications "Giuseppe Parenti" (DiSIA), University of Florence, Viale Giovanni Battista Morgagni 59/65, Florence, 50134, Italy
- Florence Center for Data Science, University of Florence, Viale Giovanni Battista Morgagni 59, Florence, 50134, Italy
| | - Giulia Carreras
- Oncologic Network, Prevention and Research Institute (ISPRO), Servizio Sanitario della Toscana, Via Cosimo il Vecchio 2, Florence, 50139, Italy
| | - Michela Baccini
- Department of Statistics, Computer Science, Applications "Giuseppe Parenti" (DiSIA), University of Florence, Viale Giovanni Battista Morgagni 59/65, Florence, 50134, Italy.
- Florence Center for Data Science, University of Florence, Viale Giovanni Battista Morgagni 59, Florence, 50134, Italy.
| |
Collapse
|
4
|
Lou K, Chi J, Wu J, Ma J, Liu S, Cui Y. Research progress on the microbiota in bladder cancer tumors. Front Cell Infect Microbiol 2024; 14:1374944. [PMID: 38650736 PMCID: PMC11033431 DOI: 10.3389/fcimb.2024.1374944] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2024] [Accepted: 03/26/2024] [Indexed: 04/25/2024] Open
Abstract
The microbiota, also referred to as the microbial community, is a crucial component of the human microenvironment. It is located predominantly in various organs, including the intestines, skin, oral cavity, respiratory tract, and reproductive tract. The microbiota maintains a symbiotic relationship with the human body, influencing physiological and pathological functions to a significant degree. There is increasing evidence linking the microbial flora to human cancers. In contrast to the traditional belief that the urethra and urine of normal individuals are sterile, recent advancements in high-throughput sequencing technology and bacterial cultivation methods have led to the discovery of specific microbial communities in the urethras of healthy individuals. Given the prevalence of bladder cancer (BCa) as a common malignancy of the urinary system, researchers have shifted their focus to exploring the connection between disease development and the unique microbial community within tumors. This shift has led to a deeper investigation into the role of microbiota in the onset, progression, metastasis, prognosis, and potential for early detection of BCa. This article reviews the existing research on the microbiota within BCa tumors and summarizes the findings regarding the roles of different microbes in various aspects of this disease.
Collapse
Affiliation(s)
- Keyuan Lou
- Department of Urology, The Affiliated Yantai Yuhuangding Hospital of Qingdao University, Yantai, China
| | - Junpeng Chi
- Department of Urology, The Affiliated Yantai Yuhuangding Hospital of Qingdao University, Yantai, China
| | - Jitao Wu
- Department of Urology, The Affiliated Yantai Yuhuangding Hospital of Qingdao University, Yantai, China
| | - Jian Ma
- Department of Urology, The Affiliated Yantai Yuhuangding Hospital of Qingdao University, Yantai, China
| | - Shu Liu
- Department of Medical Oncology, The Affiliated Yantai Yuhuangding Hospital of Qingdao University, Yantai, China
| | - Yuanshan Cui
- Department of Urology, The Affiliated Yantai Yuhuangding Hospital of Qingdao University, Yantai, China
| |
Collapse
|
5
|
Rajani NB, Goyal J, Filippidis FT. First experience with nicotine products and transition to regular tobacco use: a secondary data analysis in 28 European countries. BMJ Open 2024; 14:e080818. [PMID: 38548355 PMCID: PMC10982745 DOI: 10.1136/bmjopen-2023-080818] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Accepted: 03/11/2024] [Indexed: 04/02/2024] Open
Abstract
OBJECTIVE The majority of tobacco users have had their first contact with nicotine at a young age. The aim of this study was to explore the association between the first tobacco or nicotine product tried and the transition to regular product use in 28 European countries. METHODS A secondary analysis of participants aged 15-40 years (n=8884) from 28 countries was conducted (Eurobarometer wave 93.2; August-September 2020). Participants who reported having ever tried tobacco or nicotine products were asked which product they tried first. Self-reported history of tobacco use determined whether they were established users (≥1 time weekly) of a range of products at any point in their life. Multilevel logistic regression was used to measure the association between first product tried and becoming a regular user of tobacco or nicotine products. RESULTS There was large variation between countries in the proportion of participants aged ≤40 years that ever tried tobacco or nicotine; Estonia had the highest proportion of ever users (85.8%) and Poland had the lowest (38.9%). Among those who had ever tried tobacco or nicotine, boxed cigarettes were the most common first product (72.3%) and pipe was the least common (0.4%). Compared with those who first tried e-cigarettes, the odds of ever becoming a regular user of any tobacco or nicotine product were higher among those who first had hand-rolled cigarettes (adjusted OR, aOR 2.23; 95% CI 1.43 to 3.48) or boxed cigarettes (aOR 2.08; 95% CI1.43 to 3.02) and lower among those who first tried waterpipe (aOR 0.22; 95% CI 0.14 to 0.34). CONCLUSIONS Although this study cannot infer causality, the findings show that odds of becoming a regular tobacco user differs widely depending on the first product used. Better understanding of the associations between first product use and regular tobacco use could be informative to tobacco control policy-makers and help tailor prevention programmes.
Collapse
Affiliation(s)
- Nikita B Rajani
- Department of Primary care and Public Health, Imperial College London School of Public Health, London, UK
| | - Jyoti Goyal
- Department of Primary care and Public Health, Imperial College London School of Public Health, London, UK
| | - Filippos T Filippidis
- Department of Primary care and Public Health, Imperial College London School of Public Health, London, UK
| |
Collapse
|
6
|
Mignozzi S, Santucci C, Malvezzi M, Levi F, La Vecchia C, Negri E. Global trends in anal cancer incidence and mortality. Eur J Cancer Prev 2024; 33:77-86. [PMID: 38047709 PMCID: PMC10833181 DOI: 10.1097/cej.0000000000000842] [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: 08/28/2023] [Accepted: 09/01/2023] [Indexed: 12/05/2023]
Abstract
OBJECTIVE Anal cancer is a rare disease, affecting more frequently women than men, mainly related to human papillomavirus infection (HPV). Rising incidence and mortality have been reported over the past four decades in different countries. METHODS To provide an up-to-date overview of recent trends in mortality from anal cancer, we analysed death certification data provided by the WHO in selected countries worldwide over the period from 1994 to 2020. We also analysed incidence derived from Cancer Incidence in Five Continents from 1990 to 2012 for all histologies as well as for anal squamous cell carcinoma (SCC). RESULTS The highest age-standardised mortality rates around 2020 were registered in Central and Eastern Europe, such as Slovakia (0.9/100 000 men and 0.40/100 000 women), in the UK (0.24/100 000 men and 0.35/100 000 women), and Denmark (0.33/100 000 for both sexes), while the lowest ones were in the Philippines, Mexico, and Japan, with rates below 0.10/100 000 in both sexes. Upwards trends in mortality were reported in most countries for both sexes. Similarly, incidence patterns were upward or stable in most countries considered for both sexes. In 2008-2012, Germany showed the highest incidence rates (1.65/100 000 men and 2.16/100 000 women). CONCLUSION Attention towards vaccination against HPV, increased awareness of risk factors, mainly related to sexual behaviours and advancements in early diagnosis and management are required to control anal cancer incidence and mortality.
Collapse
Affiliation(s)
- Silvia Mignozzi
- Department of Clinical Sciences and Community Health, University of Milan, Milan
| | - Claudia Santucci
- Department of Clinical Sciences and Community Health, University of Milan, Milan
| | - Matteo Malvezzi
- Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Fabio Levi
- Department of Epidemiology and Health Services Research, Centre for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne, Switzerland
| | - Carlo La Vecchia
- Department of Clinical Sciences and Community Health, University of Milan, Milan
| | - Eva Negri
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| |
Collapse
|
7
|
Jia X, Sheng C, Han X, Li M, Wang K. Global burden of stomach cancer attributable to smoking from 1990 to 2019 and predictions to 2044. Public Health 2024; 226:182-189. [PMID: 38071951 DOI: 10.1016/j.puhe.2023.11.019] [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: 07/11/2023] [Revised: 10/15/2023] [Accepted: 11/08/2023] [Indexed: 12/25/2023]
Abstract
OBJECTIVES This study aimed to assess the global temporal trends of stomach cancer attributable to smoking from 1990 to 2019 and to predict the global burden by 2044. STUDY DESIGN This was a comprehensive analysis based on data provided by the Global Burden of Disease Study 2019. METHODS Based on the Global Burden of Disease Study 2019, mortality, disability-adjusted life years (DALYs), and corresponding age-standardised rates of stomach cancer attributable to smoking by sociodemographic index (SDI), region, country, sex, and age were used to assess temporal trends from 1990 to 2019 by calculating the average annual percentage change (AAPC). In addition, the global burden of stomach cancer attributable to smoking up to 2044 was predicted using age-period-cohort models. RESULTS Globally, in 2019, 17.96% of stomach cancer deaths (1.72 million) and 17.15% of stomach cancer DALYs (38.13 million) were attributable to smoking, representing an increase compared to 1990; however, smoking-attributable age-standardised rates of mortality (ASMRs) and DALYs (ASDRs) significantly declined to 2.12/100,000 and 45.82/100,000 in 2019, respectively. While stomach cancer ASMR and ASDR attributable to smoking decreased in all regions and in most countries, they increased by >10% in some countries. A positive correlation was found between SDI and age-standardised rates (rASMR = 0.28, P < 0.01; rASDR = 0.29, P < 0.01). By 2044, although global age-standardised rates for smoking-attributable stomach cancer are predicted to decline, deaths and DALYs are estimated to increase to 2.22 million and 42.14 million, respectively. CONCLUSIONS Stomach cancer deaths and DALYs attributable to smoking have increased over the past 30 years and will continue to increase. Consequently, targeted prevention efforts and tobacco-control strategies need to be further developed and improved.
Collapse
Affiliation(s)
- Xiaoxiao Jia
- College of Public Health, Zhengzhou University, Zhengzhou 450001, Henan Province, China
| | - Chong Sheng
- College of Public Health, Zhengzhou University, Zhengzhou 450001, Henan Province, China
| | - Xiaoxuan Han
- College of Public Health, Zhengzhou University, Zhengzhou 450001, Henan Province, China
| | - Mengyuan Li
- College of Public Health, Zhengzhou University, Zhengzhou 450001, Henan Province, China
| | - Kaijuan Wang
- College of Public Health, Zhengzhou University, Zhengzhou 450001, Henan Province, China; Key Laboratory of Tumor Epidemiology of Henan Province, State Key Laboratory of Esophageal Cancer Prevention & Treatment, Zhengzhou University, Zhengzhou 450001, Henan Province, China.
| |
Collapse
|
8
|
Joannès C, Kelly-Irving M, Couarraze S, Castagné R. The effect of smoking initiation in adolescence on the subsequent smoking trajectories of people who smoke, and the role of adverse childhood experiences: Results from the 1958 British cohort study. Public Health Nurs 2024; 41:127-138. [PMID: 37953700 DOI: 10.1111/phn.13261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Revised: 10/02/2023] [Accepted: 10/23/2023] [Indexed: 11/14/2023]
Abstract
OBJECTIVE To examine the association between smoking initiation in adolescence and subsequent different smoking trajectories of people who smoke, and to examine the combined effect of adverse childhood experiences (ACEs) and smoking initiation in adolescence on smoking trajectories of people who smoke. DESIGN AND SAMPLE Data are from 8757 individuals in Great Britain from the birth cohort National Child Development Study and who reported being smokers or former smokers by age 23. MEASUREMENTS Smoking initiation in adolescence was measured at 16 y and smoking trajectories were derived from smoking variables from ages 23 to 55. We modelled the relationship between smoking initiation in adolescence with or without ACEs and smoking trajectories. RESULTS Individuals who initiated smoking in adolescence were more likely to quit later than quitting in twenties (RRR quitting in thirties = 3.43 [2.40; 4.89] p < .001; RRR quitting in forties = 5.25 [3.38; 8.14] p < .001; RRR quitting in fifties = 4.48 [2.95; 6.79] p < .001), to relapse (RRR Relapse = 3.66 [2.82; 4.76] p < .001) and to be persistent smokers (RRR persistent = 5.25 [3.81; 7.25] p < .001) compared to those who had initiated smoking in young adulthood. These effects were particularly pronounced in case of ACEs. CONCLUSION Smoking prevention programs aimed at reducing smoking initiation should be promoted to adolescents to limit the burden of smoking, especially for people who have suffered adversity during childhood.
Collapse
Affiliation(s)
- Camille Joannès
- EQUITY Research Team, Center for Epidemiology & Research in POPulation Health (CERPOP), UMR 1295, University Toulouse III Paul Sabatier, Toulouse, France
| | - Michelle Kelly-Irving
- EQUITY Research Team, Center for Epidemiology & Research in POPulation Health (CERPOP), UMR 1295, University Toulouse III Paul Sabatier, Toulouse, France
| | - Sébastien Couarraze
- Department of Medicine, Maieutics and Paramedicine, Faculty of Health, Center for Epidemiology & Research in POPulation Health (CERPOP), UMR 1295, University Toulouse III Paul Sabatier, Toulouse, France
| | - Raphaële Castagné
- EQUITY Research Team, Center for Epidemiology & Research in POPulation Health (CERPOP), UMR 1295, University Toulouse III Paul Sabatier, Toulouse, France
| |
Collapse
|
9
|
Watson LK, Weldon I, Lin GO, Nanyangwe-Moyo T, Hoffman SJ, Poirier MJP. Beyond MPOWER: a systematic review of population-level factors that affect European tobacco smoking rates. Eur J Public Health 2023; 33:851-856. [PMID: 37496387 PMCID: PMC10567248 DOI: 10.1093/eurpub/ckad112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/28/2023] Open
Abstract
BACKGROUND Population-level factors within and beyond the scope of the World Health Organization's (WHO) MPOWER policy package have significant impacts on smoking rates. However, no synthesis of the existing evidence exists. This systematic review identifies population-level factors that influence cigarette smoking rates in European countries. METHODS We searched the ProQuest database collection for original, peer-reviewed quantitative evaluations that investigated the effects of population-level exposures on smoking rates in European countries. Of the 3122 studies screened, 62 were ultimately included in the review. A standardized data extraction form was used to identify key characteristics of each study including publication year, years evaluated, countries studied, population characteristics, study design, data sources, analytic methods, exposure studied, relevant covariates and effects on tobacco smoking outcomes. RESULTS One hundred and fifty-five population-level exposures were extracted from the 62 studies included in the review, 99 of which were related to WHO MPOWER measures. An additional 56 exposures fell into eight policy realms: economic crises, education policy, macro-economic factors, non-MPOWER tobacco regulations, population welfare, public policy, sales to minors and unemployment rates. About one-half of the MPOWER exposures affected smoking rates (55/99) and did so in an overwhelmingly positive way (55/55). Over three-quarters of the non-MPOWER exposures were associated with statistically significant changes in smoking outcomes (43/56), with about two-thirds of these exposures leading to a decrease in smoking (29/43). CONCLUSIONS Population-level factors that fall outside of the WHO's MPOWER measures are an understudied research area. The impacts of these factors on tobacco control should be considered by policymakers.
Collapse
Affiliation(s)
- Leah K Watson
- Global Strategy Lab, Dahdaleh Institute for Global Health Research, Faculty of Health and Osgoode Hall Law School, York University, Toronto, ON, Canada
| | - Isaac Weldon
- Global Strategy Lab, Dahdaleh Institute for Global Health Research, Faculty of Health and Osgoode Hall Law School, York University, Toronto, ON, Canada
- Department of Politics, York University, Toronto, ON, Canada
| | - Gigi O Lin
- Global Strategy Lab, Dahdaleh Institute for Global Health Research, Faculty of Health and Osgoode Hall Law School, York University, Toronto, ON, Canada
| | - Tina Nanyangwe-Moyo
- Global Strategy Lab, Dahdaleh Institute for Global Health Research, Faculty of Health and Osgoode Hall Law School, York University, Toronto, ON, Canada
| | - Steven J Hoffman
- Global Strategy Lab, Dahdaleh Institute for Global Health Research, Faculty of Health and Osgoode Hall Law School, York University, Toronto, ON, Canada
- School of Global Health, Faculty of Health, York University, Toronto, ON, Canada
- Department of Health Research Methods, Evidence, and Impact, McMaster Health Forum, McMaster University, Hamilton, ON, Canada
| | - Mathieu J P Poirier
- Global Strategy Lab, Dahdaleh Institute for Global Health Research, Faculty of Health and Osgoode Hall Law School, York University, Toronto, ON, Canada
- School of Global Health, Faculty of Health, York University, Toronto, ON, Canada
| |
Collapse
|
10
|
Kitaba NT, Knudsen GTM, Johannessen A, Rezwan FI, Malinovschi A, Oudin A, Benediktsdottir B, Martino D, González FJC, Gómez LP, Holm M, Jõgi NO, Dharmage SC, Skulstad SM, Watkins SH, Suderman M, Gómez-Real F, Schlünssen V, Svanes C, Holloway JW. Fathers' preconception smoking and offspring DNA methylation. Clin Epigenetics 2023; 15:131. [PMID: 37649101 PMCID: PMC10469907 DOI: 10.1186/s13148-023-01540-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Accepted: 07/24/2023] [Indexed: 09/01/2023] Open
Abstract
BACKGROUND Experimental studies suggest that exposures may impact respiratory health across generations via epigenetic changes transmitted specifically through male germ cells. Studies in humans are, however, limited. We aim to identify epigenetic marks in offspring associated with father's preconception smoking. METHODS We conducted epigenome-wide association studies (EWAS) in the RHINESSA cohort (7-50 years) on father's any preconception smoking (n = 875 offspring) and father's pubertal onset smoking < 15 years (n = 304), using Infinium MethylationEPIC Beadchip arrays, adjusting for offspring age, own smoking and maternal smoking. EWAS of maternal and offspring personal smoking were performed for comparison. Father's smoking-associated dmCpGs were checked in subpopulations of offspring who reported no personal smoking and no maternal smoking exposure. RESULTS Father's smoking commencing preconception was associated with methylation of blood DNA in offspring at two cytosine-phosphate-guanine sites (CpGs) (false discovery rate (FDR) < 0.05) in PRR5 and CENPP. Father's pubertal onset smoking was associated with 19 CpGs (FDR < 0.05) mapped to 14 genes (TLR9, DNTT, FAM53B, NCAPG2, PSTPIP2, MBIP, C2orf39, NTRK2, DNAJC14, CDO1, PRAP1, TPCN1, IRS1 and CSF1R). These differentially methylated sites were hypermethylated and associated with promoter regions capable of gene silencing. Some of these sites were associated with offspring outcomes in this cohort including ever-asthma (NTRK2), ever-wheezing (DNAJC14, TPCN1), weight (FAM53B, NTRK2) and BMI (FAM53B, NTRK2) (p < 0.05). Pathway analysis showed enrichment for gene ontology pathways including regulation of gene expression, inflammation and innate immune responses. Father's smoking-associated sites did not overlap with dmCpGs identified in EWAS of personal and maternal smoking (FDR < 0.05), and all sites remained significant (p < 0.05) in analyses of offspring with no personal smoking and no maternal smoking exposure. CONCLUSION Father's preconception smoking, particularly in puberty, is associated with offspring DNA methylation, providing evidence that epigenetic mechanisms may underlie epidemiological observations that pubertal paternal smoking increases risk of offspring asthma, low lung function and obesity.
Collapse
Affiliation(s)
- Negusse Tadesse Kitaba
- Human Development and Health, Faculty of Medicine, University of Southampton, Southampton, SO16 6YD, UK
| | - Gerd Toril Mørkve Knudsen
- Department of Clinical Sciences, University of Bergen, Bergen, Norway
- Department of Occupational Medicine, Haukeland University Hospital, Bergen, Norway
| | - Ane Johannessen
- Centre for International Health, Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Faisal I Rezwan
- Department of Computer Science, Aberystwyth University, Aberystwyth, UK
| | - Andrei Malinovschi
- Department of Medical Sciences: Clinical Physiology, Uppsala University, Uppsala, Sweden
| | - Anna Oudin
- Section of Sustainable Health, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Bryndis Benediktsdottir
- Department of Allergy, Respiratory Medicine and Sleep, Landspitali University Hospital, Reykjavik, Iceland
- Faculty of Medicine, University of Iceland, Reykjavik, Iceland
| | - David Martino
- Wal-Yan Respiratory Research Centre, Telethon Kids Institute, University of Western Australia, Perth, Australia
| | | | | | - Mathias Holm
- Occupational and Environmental Medicine, School of Public Health and Community Medicine, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden
| | - Nils Oskar Jõgi
- Department of Clinical Sciences, University of Bergen, Bergen, Norway
- Department of Occupational Medicine, Haukeland University Hospital, Bergen, Norway
| | - Shyamali C Dharmage
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia
| | - Svein Magne Skulstad
- Department of Occupational Medicine, Haukeland University Hospital, Bergen, Norway
| | - Sarah H Watkins
- University of Bristol, MRC Integrative Epidemiology Unit, Population Health Sciences, Bristol Medical School, Bristol, UK
| | - Matthew Suderman
- University of Bristol, MRC Integrative Epidemiology Unit, Population Health Sciences, Bristol Medical School, Bristol, UK
| | - Francisco Gómez-Real
- Department of Clinical Sciences, University of Bergen, Bergen, Norway
- Department of Gynaecology and Obstetrics, Haukeland University Hospital, Bergen, Norway
| | - Vivi Schlünssen
- Department of Public Health, Work, Environment and Health, Danish Ramazzini Centre, Aarhus University Denmark, Aarhus, Denmark
- National Research Center for the Working Environment, Copenhagen, Denmark
| | - Cecilie Svanes
- Department of Occupational Medicine, Haukeland University Hospital, Bergen, Norway
- Centre for International Health, Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - John W Holloway
- Human Development and Health, Faculty of Medicine, University of Southampton, Southampton, SO16 6YD, UK.
- NIHR Southampton Biomedical Research Center, University Hospitals Southampton, Southampton, UK.
| |
Collapse
|
11
|
Wu S, Jiang W, Li J, Wu Z, Xu C, Xie N. Global burden of esophageal cancer attributable to smoking: a systematic analysis for the Global Burden of Disease Study 2019. Front Oncol 2023; 13:1223164. [PMID: 37621692 PMCID: PMC10446760 DOI: 10.3389/fonc.2023.1223164] [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: 06/05/2023] [Accepted: 07/21/2023] [Indexed: 08/26/2023] Open
Abstract
Background Epidemiological trends of esophageal cancer attributable to smoking remain unclear. This study aimed to estimate the spatiotemporal trends of the esophageal cancer burden attributable to smoking to assist in global esophageal cancer prevention and smoking cessation. Methods Data on esophageal cancer attributable to smoking were obtained from the Global Burden of Disease Study 2019. The number and age-standardized rates of esophageal cancer mortality (ASMR) and disability-adjusted life years (ASDR) were analyzed by age, sex, and location. Joinpoint regression analysis was used to analyze the temporal trends of esophageal cancer burden attributable to smoking over 30 years. Results In 2019, the number of global esophageal cancer deaths and disability-adjusted life years (DALYs) attributable to smoking was approximately 203,000 and 475 million, respectively. The global esophageal cancer deaths and DALYs due to smoking were approximately 1.5-fold increased from 1990 to 2019, but the corresponding ASMR and ASDR had decreased. The heaviest burden occurred in East Asia, Mongolia, and the middle socio-demographic index (SDI) region. The male-to-female ratio was approximately 12.7 in the esophageal cancer deaths and DALYs and was approximately 14.3 in the ASMR and ASDR. The heaviest burden appeared in the 60-74 years age group. The estimated annual percentage change (EAPC) in ASMR was highly negatively associated with ASMR in 1990 (ρ = -0.41, p < 0.001) and SDI in 2019 (ρ = -0.29, p < 0.001). Conclusion Despite reductions in ASMR and ASDR, the esophageal cancer burden attributable to smoking remains heavy, especially in middle SDI regions. Active tobacco control can reduce esophageal cancer burden.
Collapse
|
12
|
Ghorab D, Abu-El-Rub EM, Gharaibeh MH, Yehya A, Khasawneh RR, Matalqah LM, Helaly AM. Neurological Effects of Combining Low Toxic Dose of Tramadol and Nicotine: An Animal Model Evidence of Endoplasmic Reticulum Stress. BIOMED RESEARCH INTERNATIONAL 2023; 2023:1953356. [PMID: 37593523 PMCID: PMC10432102 DOI: 10.1155/2023/1953356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Revised: 07/17/2023] [Accepted: 07/21/2023] [Indexed: 08/19/2023]
Abstract
Tramadol abuse is a common problem in the Middle East in conjunction with smoking. The current study applied immunohistochemistry, western blot, real-time PCR, and ELISA to test the combination toxicity. Low toxic doses of tramadol induced animal brain cortex inflammation and hippocampus injury. Adding nicotine reverted hippocampus pathological changes without triggering marked brain injury. The expression of CHOP protein with real-time PCR showed mild endoplasmic reticulum stress (ER) in rat's brain. Histological, immunohistochemical, and western blotting analysis of CHOP (CCAAT-enhancer-binding protein homologous protein) and BIP (immunoglobulin heavy chain-binding protein) chaperones demonstrated endoplasmic reticulum stress in the brains of animals. Furthermore, the levels of apoptosis and autophagy markers demonstrated a mild reaction. The blood level of serotonin was high in all study groups, with a marked increase in the combined one. The high serotonin levels in the blood can be critical and associated with a high risk of serious withdrawal and pathological consequences. Serotonin receptor blockers such as olanzapine may increase systemic serotonin levels and need further investigation to utterly pinpoint their roles in managing mood disorders. In conclusion, the combination of tramadol and nicotine is less harmful than expected. However, serious withdrawal effects can occur as a result of high systemic serotonin effects.
Collapse
Affiliation(s)
- Doaa Ghorab
- Basic Medical Sciences, Faculty of Medicine, Yarmouk University, Yarmouk, Irbid, Jordan
- Pathology Department, Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Ejlal M. Abu-El-Rub
- Basic Medical Sciences, Faculty of Medicine, Yarmouk University, Yarmouk, Irbid, Jordan
| | - Mohamed Hamdi Gharaibeh
- Department of Basic Veterinary Medical Sciences, Faculty of Veterinary, Jordan University of Science and Technology, Irbid, Jordan
| | - Alaa Yehya
- Clinical Pharmacy and Pharmacy Practice, Faculty of Pharmacy, Yarmouk University, Irbid, Jordan
| | - Ramada R. Khasawneh
- Basic Medical Sciences, Faculty of Medicine, Yarmouk University, Yarmouk, Irbid, Jordan
| | - Laila M. Matalqah
- Basic Medical Sciences, Faculty of Medicine, Yarmouk University, Yarmouk, Irbid, Jordan
| | - Ahmed Mohamed Helaly
- Forensic Medicine and Toxicology Department, Faculty of Medicine, Mansoura University, Mansoura, Egypt
- Clinical Sciences Department, Faculty of Medicine, Yarmouk University, Irbid, Jordan
| |
Collapse
|
13
|
Allalou A, Peng J, Robinson GA, Marruganti C, D’Aiuto F, Butler G, Jury EC, Ciurtin C. Impact of puberty, sex determinants and chronic inflammation on cardiovascular risk in young people. Front Cardiovasc Med 2023; 10:1191119. [PMID: 37441710 PMCID: PMC10333528 DOI: 10.3389/fcvm.2023.1191119] [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: 03/21/2023] [Accepted: 06/14/2023] [Indexed: 07/15/2023] Open
Abstract
Worrying trends of increased cardiovascular disease (CVD) risk in children, adolescents and young people in the Modern Era have channelled research and public health strategies to tackle this growing epidemic. However, there are still controversies related to the dynamic of the impact of sex, age and puberty on this risk and on cardiovascular health outcomes later in life. In this comprehensive review of current literature, we examine the relationship between puberty, sex determinants and various traditional CVD-risk factors, as well as subclinical atherosclerosis in young people in general population. In addition, we evaluate the role of chronic inflammation, sex hormone therapy and health-risk behaviours on augmenting traditional CVD-risk factors and health outcomes, ultimately aiming to determine whether tailored management strategies for this age group are justified.
Collapse
Affiliation(s)
- Amal Allalou
- University College London Medical School, University College London, London, United Kingdom
| | - Junjie Peng
- Centre for Adolescent Rheumatology Versus Arthritis, University College London, London, United Kingdom
- Centre for Rheumatology Research, Division of Medicine, University College London, London, United Kingdom
| | - George A. Robinson
- Centre for Adolescent Rheumatology Versus Arthritis, University College London, London, United Kingdom
- Centre for Rheumatology Research, Division of Medicine, University College London, London, United Kingdom
| | - Crystal Marruganti
- Eastman Dental Hospital, University College London Hospital, London, United Kingdom
| | - Francesco D’Aiuto
- Eastman Dental Hospital, University College London Hospital, London, United Kingdom
| | - Gary Butler
- Department of Paediatric Endocrinology, University College London Hospital, London, United Kingdom
- Institute of Child Health, University College London, London, United Kingdom
| | - Elizabeth C. Jury
- Centre for Rheumatology Research, Division of Medicine, University College London, London, United Kingdom
| | - Coziana Ciurtin
- Centre for Adolescent Rheumatology Versus Arthritis, University College London, London, United Kingdom
- Centre for Rheumatology Research, Division of Medicine, University College London, London, United Kingdom
| |
Collapse
|
14
|
Tsikrika S, Dai S, Dilektasli A, Katsaounou P, Dagli E. Challenges and perspectives of tobacco cessation in special groups of patients and populations. Breathe (Sheff) 2023; 19:220224. [PMID: 37645019 PMCID: PMC10461735 DOI: 10.1183/20734735.0224-2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Accepted: 06/27/2023] [Indexed: 08/31/2023] Open
Abstract
During the first 2 years of the coronavirus disease 2019 pandemic, health systems worldwide were put under extreme pressure, and healthcare professionals had to manage unprecedented health crises as well as provide healthcare services to an increased number of patients. Therefore, public health policies with respect to smoking and education of the general population regarding the harmful effects of active and second-hand smoking may not have received adequate attention during this period. More specifically, certain subpopulations suffering from chronic diseases may not have received adequate information about the effects of smoking on the course and outcome of their disease; high-level, evidence-based pharmaceutical therapies; and the potential for follow-up. However, adequate education and awareness regarding short- and long-term health benefits from smoking cessation for the general population as well as special subgroups remains of utmost importance. Healthcare professionals should understand that it is only through high-quality evidence and results from independent studies that they will be able to provide their expertise and scientific knowledge concerning newer tobacco products and their effects on human health.
Collapse
Affiliation(s)
| | - Siyu Dai
- Department of Paediatrics, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
| | - Asli Dilektasli
- Department of Pulmonary Medicine, Bursa Uludag University, Bursa, Turkey
| | - Paraskevi Katsaounou
- National and Kapodistrian University of Athens, 1st Department of Critical Care and Pulmonary Medicine, Evaggelismos Hospital, Athens, Greece
| | - Elif Dagli
- Marmara and Acibadem University, Istanbul, Turkey
| |
Collapse
|
15
|
Leta K, Lauwerier E, Willems S, Vermeersch S, Demeester B, Verloigne M. Smoking prevention within social work organizations: a qualitative study about youngsters' and youth workers' perceptions. Health Promot Int 2023; 38:7171694. [PMID: 37202340 DOI: 10.1093/heapro/daad047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/20/2023] Open
Abstract
Tobacco smoking uptake is still a major public health concern, especially among youngsters living in vulnerable situations. Finding optimal ways to engage youngsters in smoking prevention is important. Compared to traditional settings such as schools, social work settings providing sports-based and recreational activities (SR-settings) tend to reach and engage youngsters more. This study aimed to gain insight into the reasons for smoking uptake among youngsters living in vulnerable situations and the conditions through which SR-settings are potentially beneficial for smoking prevention initiatives. Data were collected in two SR-settings in Flanders, Belgium, by means of five focus group discussions and six individual interviews with youngsters (n = 38, mean age = 12.9 ± 2.61 years, 69.7% boys) and eight individual interviews with youth workers (n = 8, mean age = 27.5 ± 7.95 years, 87.5% men). A thematic analysis (TA) approach was applied to analyse the data. Besides individual factors, such as attitudes towards smoking, the desire to be part of a group and conformity to group norms seem to be important drivers of smoking uptake among youngsters in vulnerable situations. The presence of powerful role models in SR-settings with whom youngsters identify may counteract group norms by encouraging healthy behaviour. SR-settings seem suitable for questioning perceptions of vulnerable youngsters, unlike other settings where they may struggle to be heard. The conditional characteristics of SR-settings, such as authentic group processes, having meaningful roles, and being heard, make these contexts promising venues for smoking prevention efforts among vulnerable youngsters. Youth workers who have established trusting relationships with youngsters seem well-suited to communicate smoking prevention messages. A participatory approach, in which youngsters are involved in developing smoking prevention programs, is desirable.
Collapse
Affiliation(s)
- Kenji Leta
- Department of Public Health and Primary Care, Ghent University, Corneel Heymanslaan 10, 9000 Ghent, Belgium
| | - Emelien Lauwerier
- Department of Public Health and Primary Care, Ghent University, Corneel Heymanslaan 10, 9000 Ghent, Belgium
- Department of Experimental-Clinical and Health Psychology, Ghent University, Henri Dunantlaan 2, 9000 Ghent, Belgium
| | - Sara Willems
- Department of Public Health and Primary Care, Ghent University, Corneel Heymanslaan 10, 9000 Ghent, Belgium
| | - Sarah Vermeersch
- Department of Public Health and Primary Care, Ghent University, Corneel Heymanslaan 10, 9000 Ghent, Belgium
| | - Babette Demeester
- Department of Public Health and Primary Care, Ghent University, Corneel Heymanslaan 10, 9000 Ghent, Belgium
| | - Maïté Verloigne
- Department of Public Health and Primary Care, Ghent University, Corneel Heymanslaan 10, 9000 Ghent, Belgium
| |
Collapse
|
16
|
Mzhavanadze G, Yanin D. The Potential Impact of E-cigarettes on the Life-Years Lost from Conventional Smoking in the Russian Federation. JOURNAL OF CONSUMER POLICY 2023; 46:253-274. [PMID: 37274086 PMCID: PMC10159831 DOI: 10.1007/s10603-023-09540-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Accepted: 04/04/2023] [Indexed: 06/06/2023]
Abstract
This study analyses the potential impact of e-cigarettes on the death toll of cigarette smoking in the Russian Federation by working under a variety of assumptions pertaining to how much vaping might affect smoking cessation and initiation, and its adverse impacts on health in comparison to conventional smoking. Within this study, each combination of these assumptions generates a single vaping scenario (210 in total). A dynamic population simulation model, specifically for the Russian Federation, that is tailoured to tobacco control policy analysis, is built for estimation purposes. Considering the toll of smoking on cumulative life-years saved via the inclusion of vaping across a period of 80 years, the simulation analysis produces positive results in 88.1% of e-cigarette scenarios, ranging from - 3.3 million to 38.5 million life-years saved. In relative terms, the estimated life-years saved from vaping varies from - 1.6 to 18.6% of the predicted life-years lost from smoking. Most of the model scenarios involve a significant number of individuals who stopped smoking in favour of vaping. These results suggest that vaping has great potential to reduce the prevalence of smoking and the related death toll in the Russian Federation. Supplementary Information The online version contains supplementary material available at 10.1007/s10603-023-09540-z.
Collapse
Affiliation(s)
- G. Mzhavanadze
- Healthy Initiatives, Machavariani 63, 0159 Tbilisi, Georgia
- TSU: Ivane Javakhishvili Tbilisi State University, Tbilisi, Georgia
| | - D. Yanin
- Healthy Initiatives, Rustaveli 36, Kyiv, 01033 Ukraine
| |
Collapse
|
17
|
Long D, Mackenbach JP, Klokgieters S, Kalėdienė R, Deboosere P, Martikainen P, Heggebø K, Leinsalu M, Bopp M, Brønnum-Hansen H, Costa G, Eikemo T, Nusselder WJ. Widening educational inequalities in mortality in more recent birth cohorts: a study of 14 European countries. J Epidemiol Community Health 2023; 77:400-408. [PMID: 37094941 PMCID: PMC10176379 DOI: 10.1136/jech-2023-220342] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Accepted: 04/01/2023] [Indexed: 04/26/2023]
Abstract
BACKGROUND Studies of period changes in educational inequalities in mortality have shown important changes over time. It is unknown whether a birth cohort perspective paints the same picture. We compared changes in inequalities in mortality between a period and cohort perspective and explored mortality trends among low-educated and high-educated birth cohorts. DATA AND METHODS In 14 European countries, we collected and harmonised all-cause and cause-specific mortality data by education for adults aged 30-79 years in the period 1971-2015. Data reordered by birth cohort cover persons born between 1902 and 1976. Using direct standardisation, we calculated comparative mortality figures and resulting absolute and relative inequalities in mortality between low educated and high educated by birth cohort, sex and period. RESULTS Using a period perspective, absolute educational inequalities in mortality were generally stable or declining, and relative inequalities were mostly increasing. Using a cohort perspective, both absolute and relative inequalities increased in recent birth cohorts in several countries, especially among women. Mortality generally decreased across successive birth cohorts among the high educated, driven by mortality decreases from all causes, with the strongest reductions for cardiovascular disease mortality. Among the low educated, mortality stabilised or increased in cohorts born since the 1930s in particular for mortality from cardiovascular diseases, lung cancer, chronic obstructive pulmonary disease and alcohol-related causes. CONCLUSIONS Trends in mortality inequalities by birth cohort are less favourable than by calendar period. In many European countries, trends among more recently born generations are worrying. If current trends among younger birth cohorts persist, educational inequalities in mortality may further widen.
Collapse
Affiliation(s)
- Di Long
- Department of Public Health, Erasmus MC, Rotterdam, Netherlands
| | | | - Silvia Klokgieters
- Department of Sociology, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Ramunė Kalėdienė
- Department of Health Management, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Patrick Deboosere
- Department of Sociology, Vrije Universiteit Brussel, Brussel, Belgium
| | - Pekka Martikainen
- Population Research Unit, Faculty of Social Sciences, University of Helsinki, Helsinki, Finland
| | - Kristian Heggebø
- Department of Sociology and Political Science, Norwegian University of Science and Technology, Trondheim, Norway
- NOVA, Oslo Metropolitan University, Oslo, Norway
| | - Mall Leinsalu
- Stockholm Centre for Health and Social Change, Södertörn University, Huddinge, Sweden
- Department of Epidemiology and Biostatistics, National Institute for Health Development, Tallinn, Estonia
| | - Matthias Bopp
- Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
| | | | - Giuseppe Costa
- Department of Clinical Medicine and Biology, University of Turin, Torino, Italy
| | - Terje Eikemo
- Department of Sociology and Political Science, Norwegian University of Science and Technology, Trondheim, Norway
| | | |
Collapse
|
18
|
Affolter J, Rohland E, Philippe M, Tal K, Auer R, Jakob J. Use of tobacco, nicotine and cannabis products among students in Switzerland. Front Public Health 2023; 11:1076217. [PMID: 37124821 PMCID: PMC10137165 DOI: 10.3389/fpubh.2023.1076217] [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: 10/21/2022] [Accepted: 03/06/2023] [Indexed: 03/31/2023] Open
Abstract
Introduction Most people who smoke cigarettes begin in their teens and teens may also be attracted to new tobacco, nicotine, and cannabis products. We describe use prevalence among upper-secondary school students in Switzerland, including daily use, of tobacco, nicotine, and cannabis products. Methods We invited secondary school students (age 15 to 21) in two Swiss cantons to take an online survey between October 2021 and February 2022. The survey collected demographic information and asked how frequently they used tobacco products (cigarettes in commercial packages, self-rolled cigarettes, hookahs, pipes, cigars and cigarillos, tobacco heating systems, snus, snuff), non-tobacco nicotine products (nicotine pouches, e-cigarettes with and without nicotine), and cannabis products (smoking with and without tobacco, cannabis vaping). Answers were scored on a Likert scale (no use in past month, less than weekly, weekly but not daily, daily use, prefer not to say), then tabulated and reported as descriptive statistics. Results Of 32,614 students in the schools we contacted, 9,515 (29.2%) completed the survey; 49.5% identified as female and 48.4% as male; 9.5% were under 16, 47% were 16-17, 27.5% were 18-19, and 16% were over 19. Reported daily use was most frequent for tobacco cigarettes in commercial packages (14.2%), snus (4.1%) and cannabis smoking with tobacco (3.6%). Most participants (54.8%) reported they had used at least one product at least once within the last month. Conclusion Students who used a product were most likely to smoke cigarettes, but many regularly used new tobacco, nicotine and cannabis products, though use frequency varies.
Collapse
Affiliation(s)
- Jana Affolter
- Department of Health Promotion and Prevention, Swiss Lung Association Aargau, Aarau, Switzerland
| | - Eveline Rohland
- Department of Health Promotion and Prevention, Swiss Lung Association Aargau, Aarau, Switzerland
- Sozialdienst Limmattal, Suchtpräventionsstelle der Bezirke Affoltern und Dietikon, Schlieren, Switzerland
| | - Marc Philippe
- Department of Health Promotion and Prevention, Swiss Lung Association St. Gallen - Appenzell, St. Gallen, Switzerland
| | - Kali Tal
- Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland
| | - Reto Auer
- Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland
- Center for Primary Care and Public Health (Unisanté), Lausanne, Switzerland
| | - Julian Jakob
- Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland
- Department of Paediatrics, University Hospital Bern, Inselspital, Bern, Switzerland
| |
Collapse
|
19
|
Panunzi S, Marchetti P, Stafoggia M, Badaloni C, Caranci N, de Hoogh K, Giorgi Rossi P, Guarda L, Locatelli F, Ottone M, Silocchi C, Ricci P, Marcon A. Residential exposure to air pollution and adverse respiratory and allergic outcomes in children and adolescents living in a chipboard industrial area of Northern Italy. THE SCIENCE OF THE TOTAL ENVIRONMENT 2023; 864:161070. [PMID: 36565877 DOI: 10.1016/j.scitotenv.2022.161070] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Revised: 12/16/2022] [Accepted: 12/16/2022] [Indexed: 06/17/2023]
Abstract
BACKGROUND Chipboard production is a source of wood dust, formaldehyde, and combustion-related pollutants such as nitrogen dioxide (NO2) and particulate matter (PM). In this cohort study, we assessed whether exposures to NO2, formaldehyde, PM10, PM2.5, and black carbon were associated with adverse respiratory and allergic outcomes among all 7525 people aged 0-21 years residing in the Viadana district, an area in Northern Italy including the largest chipboard industrial park in the country. METHODS Data on hospitalizations, emergency room (ER) admissions, and specialist visits in pneumology, allergology, ophthalmology, and otorhinolaryngology were obtained from the Local Health Unit. Residential air pollution concentrations in 2013 (baseline) were derived using local (Viadana II), national (EPISAT), and continental (ELAPSE) exposure models. Associations were estimated using negative binomial regression models for counts of events occurred during 2013-2017, with follow-up time as an offset term and adjustment for sex, age, nationality, and a census-block socio-economic indicator. RESULTS Median annual exposures to NO2, PM10, and PM2.5 were below the European Union annual air quality standards (40, 40, and 25 μg/m3) but above the World Health Organization 2021 air quality guideline levels (10, 15, and 5 μg/m3). Exposures to NO2 and PM2.5 were significantly associated with higher rates of ER pneumology admissions (13 to 30 % higher rates per interquartile range exposure differences, all p < 0.01). Higher rates of allergology and ophthalmology visits were found for participants exposed to higher pollutants' concentrations. When considering the 4-km buffer around the industries, associations with respiratory hospitalizations became significant, and associations with ER pneumology admissions, allergology and ophthalmology visits became stronger. Formaldehyde was not associated with the outcomes considered. CONCLUSION Using administrative indicators of health effects a priori attributable to air pollution, we documented the adverse impact of long-term air pollution exposure in residential areas close to the largest chipboard industries in Italy. These findings, combined with evidence from previous studies, call for an action to improve air quality through preventive measures especially targeting emissions related to the industrial activities.
Collapse
Affiliation(s)
- Silvia Panunzi
- Unit of Epidemiology and Medical Statistics, Department of Diagnostics and Public Health, University of Verona, Italy
| | - Pierpaolo Marchetti
- Unit of Epidemiology and Medical Statistics, Department of Diagnostics and Public Health, University of Verona, Italy.
| | - Massimo Stafoggia
- Department of Epidemiology, Lazio Regional Health Service ASL Roma 1, Rome, Italy
| | - Chiara Badaloni
- Department of Epidemiology, Lazio Regional Health Service ASL Roma 1, Rome, Italy
| | - Nicola Caranci
- Regional Health and Social Care Agency, Emilia-Romagna Region, Bologna, Italy
| | - Kees de Hoogh
- Swiss Tropical and Public Health Institute, Allschwil, Switzerland; University of Basel, Basel, Switzerland
| | | | - Linda Guarda
- UOC Osservatorio Epidemiologico, Agenzia di Tutela della Salute della Val Padana, Mantova, Italy
| | - Francesca Locatelli
- Unit of Epidemiology and Medical Statistics, Department of Diagnostics and Public Health, University of Verona, Italy
| | - Marta Ottone
- Epidemiology Unit, AUSL - IRCCS Reggio Emilia, Reggio Emilia, Italy
| | - Caterina Silocchi
- UOS Salute e Ambiente, Agenzia di Tutela della Salute della Val Padana, Mantova, Italy
| | - Paolo Ricci
- UOC Osservatorio Epidemiologico, Agenzia di Tutela della Salute della Val Padana, Mantova, Italy
| | - Alessandro Marcon
- Unit of Epidemiology and Medical Statistics, Department of Diagnostics and Public Health, University of Verona, Italy
| |
Collapse
|
20
|
Svanes C, Holloway JW, Krauss-Etschmann S. Preconception origins of asthma, allergies and lung function: The influence of previous generations on the respiratory health of our children. J Intern Med 2023; 293:531-549. [PMID: 36861185 DOI: 10.1111/joim.13611] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/03/2023]
Abstract
Emerging research suggests that exposures occurring years before conception are important determinants of the health of future offspring and subsequent generations. Environmental exposures of both the father and mother, or exposure to disease processes such as obesity or infections, may influence germline cells and thereby cause a cascade of health outcomes in multiple subsequent generations. There is now increasing evidence that respiratory health is influenced by parental exposures that occur long before conception. The strongest evidence relates adolescent tobacco smoking and overweight in future fathers to increased asthma and lower lung function in their offspring, supported by evidence on parental preconception occupational exposures and air pollution. Although this literature is still sparse, the epidemiological analyses reveal strong effects that are consistent across studies with different designs and methodologies. The results are strengthened by mechanistic research from animal models and (scarce) human studies that have identified molecular mechanisms that can explain the epidemiological findings, suggesting transfer of epigenetic signals through germline cells, with susceptibility windows in utero (both male and female line) and prepuberty (male line). The concept that our lifestyles and behaviours may influence the health of our future children represents a new paradigm. This raises concerns for future health in decades to come with respect to harmful exposures but may also open for radical rethinking of preventive strategies that may improve health in multiple generations, reverse the imprint of our parents and forefathers, and underpin strategies that can break the vicious circle of propagation of health inequalities across generations.
Collapse
Affiliation(s)
- Cecilie Svanes
- Centre for International Health, Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway.,Department of Occupational Medicine, Haukeland University Hospital, Bergen, Norway
| | - John W Holloway
- Human Development and Health, Faculty of Medicine, University of Southampton, Southampton, UK
| | - Susanne Krauss-Etschmann
- Division of Early Life Origins of Chronic Lung Diseases, Research Center Borstel, Airway Research Center North (ARCN), German Center for Lung Research (DZL), Borstel, Germany.,Institute of Experimental Medicine, Christian-Albrechts-Universität zu Kiel, Kiel, Germany
| |
Collapse
|
21
|
Sharma R, Rakshit B. Global burden of cancers attributable to tobacco smoking, 1990-2019: an ecological study. EPMA J 2023; 14:167-182. [PMID: 36866162 PMCID: PMC9971393 DOI: 10.1007/s13167-022-00308-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Accepted: 11/19/2022] [Indexed: 12/23/2022]
Abstract
Aim and background Identifying risk factors for cancer initiation and progression is the cornerstone of the preventive approach to cancer management and control (EPMA J. 4(1):6, 2013). Tobacco smoking is a well-recognized risk factor for initiation and spread of several cancers. The predictive, preventive, and personalized medicine (PPPM) approach to cancer management and control focuses on smoking cessation as an essential cancer prevention strategy. Towards this end, this study examines the temporal patterns of cancer burden due to tobacco smoking in the last three decades at global, regional, and national levels. Data and methods The data pertaining to the burden of 16 cancers attributable to tobacco smoking at global, regional, and national levels were procured from the Global Burden of Disease 2019 Study. Two main indicators, deaths and disability-adjusted life years (DALYs), were used to describe the burden of cancers attributable to tobacco smoking. The socio-economic development of countries was measured using the socio-demographic index (SDI). Results Globally, deaths due to neoplasms caused by tobacco smoking increased from 1.5 million in 1990 to 2.5 million in 2019, whereas the age-standardized mortality rate (ASMR) decreased from 39.8/100,000 to 30.6/100,000 and the age-standardized DALY rate (ASDALR) decreased from 948.9/100,000 to 677.3/100,000 between 1990 and 2019. Males accounted for approximately 80% of global deaths and DALYs in 2019. Populous regions of Asia and a few regions of Europe account for the largest absolute burden, whereas countries in Europe and America have the highest age-standardized rates of cancers due to tobacco smoking. In 8 out of 21 regions, there were more than 100,000 deaths due to cancers attributable to tobacco smoking led by East Asia, followed by Western Europe in 2019. The regions of Sub-Saharan Africa (except southern region) had one of the lowest absolute counts of deaths, DALYs, and age-standardized rates. In 2019, tracheal, bronchus, and lung (TBL), esophageal, stomach, colorectal, and pancreatic cancer were the top 5 neoplasms attributable to tobacco smoking, with different burdens in regions as per their development status. The ASMR and ASDALR of neoplasms due to tobacco smoking were positively correlated with SDI, with pairwise correlation coefficient of 0.55 and 0.52, respectively. Conclusion As a preventive tool, tobacco smoking cessation has the biggest potential among all risk factors for preventing millions of cancer deaths every year. Cancer burden due to tobacco smoking is found to be higher in males and is positively associated with socio-economic development of countries. As tobacco smoking begins mostly at younger ages and the epidemic is unfolding in several parts of the world, more accelerated efforts are required towards tobacco cessation and preventing youth from entering this addiction. The PPPM approach to medicine suggests that not only personalized and precision medicine must be provided to cancer patients afflicted by tobacco smoking but personalized and targeted preventive solutions must be provided to prevent initiation and progression of smoking. Supplementary Information The online version contains supplementary material available at 10.1007/s13167-022-00308-y.
Collapse
Affiliation(s)
- Rajesh Sharma
- Humanities and Social Sciences, National Institute of Technology Kurukshetra, Kurukshetra, India
| | - Bijoy Rakshit
- Economics and Business Environment, Indian Institute of Management Jammu, Jammu and Kashmir, India
| |
Collapse
|
22
|
Glushkova N, Smailova D, Namazbayeva Z, Mukasheva G, Zhamakurova A, Kuanyshkalieva A, Karibayeva IK, Kauysheva A, Otyzbayeva N, Kulzhanov M, Semenova Y. Prevalence of Smoking Various Tobacco Types in the Kazakhstani Adult Population in 2021: A Cross-Sectional Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:1509. [PMID: 36674264 PMCID: PMC9865649 DOI: 10.3390/ijerph20021509] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Revised: 01/04/2023] [Accepted: 01/10/2023] [Indexed: 06/17/2023]
Abstract
Tobacco use was the second-leading risk factor for death, accounting for 15.4% of total deaths in 2019. In 2019, 20.4% (2.7 million) of the adult population in Kazakhstan, 36.5% of men, and 6.0% of women smoked tobacco. A cross-sectional study of a random sample (n = 1201) was conducted between October and December 2021 in accordance with the STEPwise approach. The tobacco-use questions were focused on current and previous smoking status, initiation and duration of smoking, amount of tobacco use, exposure to secondhand smoke, and information related to quitting smoking. From 20.8% of smokers, 93.8% of men and 80.2% of women use tobacco products daily, χ2 = 10.983, p-score < 0.001. The earliest initiation of smoking was 6 years old. The prevalence of smoking tobacco products in Kazakhstan is 20.8%, which means that every fifth adult smokes. In addition, the proportion of smokers among men was 38.5%, and among women, it was 10.1%. A total of 93.8% of men and 80.2% of women smoked daily. The role of healthcare professionals in smoking prevention is very low, and only 16.9% of respondents have been advised to quit smoking in the last 12 months. New interventions for tobacco smoking prevention are urgently needed in Kazakhstan.
Collapse
Affiliation(s)
- Natalya Glushkova
- Department of Epidemiology, Evidence Based Medicine and Biostatistics, Kazakhstan’s Medical University “Kazakhstan School of Public Health”, Almaty 050000, Kazakhstan
- Department of Epidemiology, Biostatistics and Evidence Based Medicine, Al-Farabi Kazakh National University, Almaty 050040, Kazakhstan
| | - Dariga Smailova
- Department of Epidemiology, Evidence Based Medicine and Biostatistics, Kazakhstan’s Medical University “Kazakhstan School of Public Health”, Almaty 050000, Kazakhstan
- Asfendiyarov Kazakh National Medical University, Almaty 050040, Kazakhstan
| | - Zhanar Namazbayeva
- Department of Epidemiology, Evidence Based Medicine and Biostatistics, Kazakhstan’s Medical University “Kazakhstan School of Public Health”, Almaty 050000, Kazakhstan
| | - Gulmira Mukasheva
- Department of Epidemiology, Evidence Based Medicine and Biostatistics, Kazakhstan’s Medical University “Kazakhstan School of Public Health”, Almaty 050000, Kazakhstan
| | - Ayaulym Zhamakurova
- Department of Epidemiology, Evidence Based Medicine and Biostatistics, Kazakhstan’s Medical University “Kazakhstan School of Public Health”, Almaty 050000, Kazakhstan
| | - Asylzhan Kuanyshkalieva
- Department of Epidemiology, Evidence Based Medicine and Biostatistics, Kazakhstan’s Medical University “Kazakhstan School of Public Health”, Almaty 050000, Kazakhstan
| | - Indira K. Karibayeva
- Department of Epidemiology, Evidence Based Medicine and Biostatistics, Kazakhstan’s Medical University “Kazakhstan School of Public Health”, Almaty 050000, Kazakhstan
| | - Almagul Kauysheva
- Department of Epidemiology, Evidence Based Medicine and Biostatistics, Kazakhstan’s Medical University “Kazakhstan School of Public Health”, Almaty 050000, Kazakhstan
| | - Nurzhamal Otyzbayeva
- Department of Epidemiology, Evidence Based Medicine and Biostatistics, Kazakhstan’s Medical University “Kazakhstan School of Public Health”, Almaty 050000, Kazakhstan
| | - Maksut Kulzhanov
- Department of Epidemiology, Evidence Based Medicine and Biostatistics, Kazakhstan’s Medical University “Kazakhstan School of Public Health”, Almaty 050000, Kazakhstan
- Asfendiyarov Kazakh National Medical University, Almaty 050040, Kazakhstan
| | - Yuliya Semenova
- Department of Medicine, School of Medicine, Nazarbayev University, Astana 010000, Kazakhstan
| |
Collapse
|
23
|
Ribera-Osca JA, Carrion-Valero F, Martin-Gorgojo V, Rando-Matos Y, Martin-Cantera C, Martin-Moreno JM. Characteristics of tobacco use among secondary school students: a cross-sectional study in a school in Valencia, Spain. Front Public Health 2023; 11:1069294. [PMID: 37206875 PMCID: PMC10189142 DOI: 10.3389/fpubh.2023.1069294] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Accepted: 04/05/2023] [Indexed: 05/21/2023] Open
Abstract
Introduction Cigarette smoking is a significant public health problem, and it is essential to work actively with young people to limit the incorporation of this addiction. This study aimed to identify characteristics associated with tobacco use in adolescents in a real setting. Methods Epidemiologic, cross-sectional study including secondary school students aged 12-17 years in the 1st, 2nd, and 3rd grades of "Joan Fuster High School" in the city of Sueca, Valencia (Spain). An anonymous, self-administered questionnaire was used to collect data on demographics, cigarette smoking history, alcohol consumption, nicotine dependence, and exposure to parental cigarette smoking. Results The final sample of individuals surveyed included 306 students (50.6% females) with a median age of 13 years. The prevalence of cigarette smoking was 11.8% (13.5% in females and 9.9% in males). The mean age of cigarette smoking onset was 12.7 ± 1.6 years. Ninety-three students (30.4%) were repeaters, and 114 (37.3%) reported alcohol consumption. Significant factors associated with tobacco use were being a repeater (odds ratio [OR] 4.19, 95% confidence interval [CI] 1.75-10.55, p = 0.002), alcohol consumption (OR 4.06, 95% CI 1.75-10.15, p = 0.002) and parental cigarette smoking (OR 3.76, 95% CI 1.52-10.74, p = 0.007). Discussion An operational profile of features associated with tobacco consumption was identified in the presence of parental cigarette smoking, alcohol consumption, and poor academic performance. Consideration of these factors could be useful in the operational design of cigarette smoking cessation interventions for young people in a context where there is a great need for better prevention and control of cigarette smoking.
Collapse
Affiliation(s)
| | - Francisco Carrion-Valero
- Pneumology Department, Hospital Clínico Universitario, Valencia, Spain
- Medicine Department, Universitat de València, Valencia, Spain
- Biomedical Research Institute INCLIVA, Hospital Clínico Universitario, Valencia, Spain
| | - Victor Martin-Gorgojo
- Biomedical Research Institute INCLIVA, Hospital Clínico Universitario, Valencia, Spain
- Orthopaedic Surgery and Traumatology Department, Hospital Clínico Universitario, Valencia, Spain
| | - Yolanda Rando-Matos
- Primary Health Center Florida Nord, Direcció d'Atenció Primària Costa de Ponent, Catalan Health Institute, L’Hospitalet de Llobregat, Barcelona, Spain
| | - Carlos Martin-Cantera
- Research Support Unit, Institut Universitari d’Investigació en Atenció Primària Jordi Gol (IDIAPJGol), Barcelona, Spain
| | - Jose M. Martin-Moreno
- Medicine Department, Universitat de València, Valencia, Spain
- Department of Preventive Medicine and Public Health, Universitat de València, Valencia, Spain
- *Correspondence: Jose M. Martin-Moreno,
| |
Collapse
|
24
|
Microbiome in Bladder Cancer: A Systematic Review. Diagnostics (Basel) 2022; 13:diagnostics13010084. [PMID: 36611376 PMCID: PMC9818914 DOI: 10.3390/diagnostics13010084] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 12/21/2022] [Accepted: 12/25/2022] [Indexed: 12/29/2022] Open
Abstract
Although many studies on bladder cancer and the microbiome have been conducted so far, useful strains at the species level have not yet been identified. In addition, in the case of urine studies, methodological heterogeneity is too great, and in tissue studies, the species level through shotgun analysis has not been revealed, and studies using stool samples have provided only limited information. In this review, we will review all the microbiome studies related to bladder cancer so far through a systematic review.
Collapse
|
25
|
Xing S, Zhao M, Magnussen CG, Xi B. Proportion and trend in the age of cigarette smoking initiation among adolescent smoking experiencers aged 13-15 years in 148 countries/territories. Front Public Health 2022; 10:1054842. [PMID: 36518585 PMCID: PMC9742527 DOI: 10.3389/fpubh.2022.1054842] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Accepted: 11/10/2022] [Indexed: 11/29/2022] Open
Abstract
Background Limited studies have assessed the recent proportion and trend in the age of cigarette smoking initiation among adolescent smoking experiencers globally. We aimed to assess the recent global proportion, associated factors and the long-term trend of the initiated age of cigarette smoking among adolescent smoking experiencers. Methods We used data from the most recent Global Youth Tobacco Survey on 99,728 adolescent smoking experiencers aged 13-15 years from 144 countries/territories (hereafter "countries") that had conducted at least one survey in 2010-20, to assess the recent proportion of the age of cigarette smoking initiation. Additionally, we used data from 148 countries that had conducted ≥2 surveys between 1999 and 2020, to assess the trend in the average age of cigarette smoking initiation. Results Among 99,728 adolescent smoking experiencers aged 13-15 years, the proportions of initiating cigarette smoking when aged ≤ 9 years, 10-11 years, 12-13 years, and 14-15 years were 22.8% (95%CI 21.3-24.4), 18.8% (17.3-20.2), 36.8% (34.5-39.2), and 21.6% (19.9-23.2), respectively. The average age of cigarette smoking initiation decreased by 0.44 years per 5 calendar-years averagely in 17 (11.5%) of 148 countries, was unchanged in 95 (64.2%) countries, and increased by 0.38 years per 5 calendar-years averagely in 36 (24.3%) countries. Higher income category (reference group: low-income countries; lower-middle-income: OR = 0.44, 95%CI = 0.28-0.70; upper-middle-income: OR = 0.56, 95%CI = 0.38-0.83; high-income: OR = 0.35, 95%CI = 0.22-0.53) and Framework Convention on Tobacco Control ratification (OR = 0.51, 95%CI = 0.42-0.63) were inversely associated with early cigarette smoking initiation. Conclusions A substantial proportion (~80%) of adolescent smoking experiencers aged 13-15 years initiated cigarette smoking before 13 years, and the average age of cigarette smoking initiation decreased or remained unchanged in nearly three quarters of the countries surveyed. These findings emphasize that national governments around the world need to strengthen intervention strategies and measures aimed at children and adolescents to prevent smoking up-take.
Collapse
Affiliation(s)
- Shuhui Xing
- Department of Epidemiology, School of Public Health, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Min Zhao
- Department of Nutrition and Food Hygiene, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Costan G. Magnussen
- Baker Heart and Diabetes Institute, Melbourne, VIC, Australia,Research Centre of Applied and Preventive Cardiovascular Medicine, University of Turku, Turku, Finland,Centre for Population Health Research, University of Turku and Turku University Hospital, Turku, Finland
| | - Bo Xi
- Department of Epidemiology, School of Public Health, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China,*Correspondence: Bo Xi
| |
Collapse
|
26
|
Galindo-Utrero A, San-Román-Montero JM, Gil-Prieto R, Gil-de-Miguel Á. Trends in hospitalization and in-hospital mortality rates among patients with lung cancer in Spain between 2010 and 2020. BMC Cancer 2022; 22:1199. [PMID: 36411427 PMCID: PMC9680125 DOI: 10.1186/s12885-022-10205-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Accepted: 10/20/2022] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Lung cancer is the third most frequent tumor and the main cause of death by tumor in Spain. Although the incidence and mortality are still significantly higher in men than in women, the disparity between the sexes is decreasing. The objective of this study was to analyze the evolution of lung cancer hospitalization and in-hospital mortality rates in Spain from 2010 to 2020. METHODS The reports of the Minimum Basic Data Set (MBDS) at hospital discharge were used to retrospectively analyze the data of all patients with a primary diagnosis of lung cancer, according to the International Classification of Diseases (ICD-9-CM and ICD-10-CM). RESULTS Between 2010 and 2020, there were 315,263 hospitalizations and 70,490 deaths from lung cancer in Spain, the majority (~ 80%) in men. Overall, the rates of hospitalization and in-hospital mortality from lung cancer showed a downward trend throughout the period, although the number of new diagnoses and the absolute number of deaths in women increased. Due to the aging of the population, the degree of comorbidity in patients with lung cancer, although it remains relatively low, is also on the rise. CONCLUSION Lung cancer represents a substantial clinical and economic burden for patients and for the National Health System, so it is necessary to promote primary prevention campaigns, as well as to develop more effective population screening measures to detect cancers early and increase the patient survival.
Collapse
Affiliation(s)
- Abraham Galindo-Utrero
- grid.28479.300000 0001 2206 5938Department of Medical Specialties and Public Health, Area of Preventive Medicine and Public Health, Rey Juan Carlos University, Avenida de Atenas S/N, 28922 Madrid, Spain
| | - Jesús María San-Román-Montero
- grid.28479.300000 0001 2206 5938Department of Medical Specialties and Public Health, Area of Medicine, Rey Juan Carlos University, Avenida de Atenas S/N, 28922 Madrid, Spain
| | - Ruth Gil-Prieto
- grid.28479.300000 0001 2206 5938Department of Medical Specialties and Public Health, Area of Preventive Medicine and Public Health, Rey Juan Carlos University, Avenida de Atenas S/N, 28922 Madrid, Spain
| | - Ángel Gil-de-Miguel
- grid.28479.300000 0001 2206 5938Department of Medical Specialties and Public Health, Area of Preventive Medicine and Public Health, Rey Juan Carlos University, Avenida de Atenas S/N, 28922 Madrid, Spain
| |
Collapse
|
27
|
Zammit N, Maatoug J, Ghammam R, Fredj SB, Dhouib W, Ayouni I, Maatouk A, Belgacem WB, Ouertani M, Ghannem H. Surveillance of tobacco use among young adolescents: trends and predictors across three years in Sousse, Tunisia. BMC Public Health 2022; 22:2022. [PMID: 36333690 PMCID: PMC9636701 DOI: 10.1186/s12889-022-14416-x] [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: 05/09/2022] [Accepted: 10/21/2022] [Indexed: 11/06/2022] Open
Abstract
Background In developed countries, there was an overall decrease in tobacco use over the last decades. In Tunisia, a national strategy to reduce tobacco use was set up since 2008. However, this strategy was rarely evaluated. The objective of the current study was to examine the trends in tobacco use among the middle schoolchildren of the governorate of Sousse (Tunisia) between 2014 and 2016 and to determine predictors of its experimentation. Methods Three cross-sectional studies were conducted in 2014, 2015 and 2016 school years among middle schoolchildren randomly selected from the governorate of Sousse-Tunisia. The required sample size for each study was 760 participants. Each year, the same procedure was used to recruit pupils from the same middle schools. The same pre-established and pre-tested questionnaire was self-administered anonymously to participants in their classrooms. Results Lifetime tobacco use rose from 11% in 2014 to 17.3% in 2016 (p = 0.001). Across the 3 years of survey, predictors of lifetime tobacco use were: The male sex (OR, 95% CI: 4.4 [3.2-6.1]), age above 13 (OR, 95% CI: 2.3 [1.7-3.1]), lifetime illicit substances use (OR, 95% CI: 3.9 [1.1- 13.8), lifetime inhalant products use (OR, 95% CI: 2.2 [1.2-4.3]), tobacco use among the father (OR, 95% CI: 2.2 [1.2-4.3]), tobacco use among siblings (OR, 95% CI: 1.7 [1.2-2.4]) and current anxiety symptoms (OR, 95% CI: 1.8 [1.4-2.4]). Conclusion Lifetime tobacco use is in expansion among the young adolescents of Sousse. The current national tobacco prevention program should be strengthened and expanded to cover other substances use issues with emphasis on secondhand smoking and mental health problems.
Collapse
|
28
|
Yacouba A, Tidjani Alou M, Lagier JC, Dubourg G, Raoult D. Urinary microbiota and bladder cancer: A systematic review and a focus on uropathogens. Semin Cancer Biol 2022; 86:875-884. [PMID: 34979272 DOI: 10.1016/j.semcancer.2021.12.010] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Revised: 12/14/2021] [Accepted: 12/25/2021] [Indexed: 01/27/2023]
Abstract
The higher incidence of bladder cancer in men has long been attributed to environmental factors, including smoking. The fact that the sex ratio of bladder cancer remains consistently weighted toward men despite the remarkable increase in the prevalence of smoking among women suggests that other risk factors influence the incidence rates of bladder cancer. These factors may include the urinary microbiota. In this study, we provide a review of recent literature regarding the association between bladder cancer and changes in the urinary microbiota, with a focus on the potential role of uropathogens in the microbiota and sex in bladder cancer. Four databases were systematically searched up to 31 March 2021 to identify human case-controlled studies that evaluated the relationship between urinary microbiota and bladder cancer. We combined bacterial taxa that were significantly higher or lower in the bladder cancer group in each study in the urine (voided and catheterized) and tissue samples. Findings from sixteen eligible studies were analyzed. The total sample size of the included studies was 708 participants, including 449 (63.4 %) bladder cancer patients and 259 (36.6 %) participants in the control group. When considering only the taxa that have been reported in at least two different studies, we observed that with regards to neoplastic tissues, no increased taxa were reported, while Lactobacillus (2/5 of the studies on tissue samples) was increased in nonneoplastic-tissue compared to neoplastic-tissues at the genus level. In catheterized urine, Veillonella (2/3 of the studies on catheterized urine) was increased in bladder cancer patients compared to the control groups at the genus level. In voided urine, Acinetobacter, Actinomyces, Aeromonas, Anaerococcus, Pseudomonas, and Tepidomonas were increased in the bladder cancer patients, while Lactobacillus, Roseomonas, Veillonella were increased in the control groups. Regarding gender, the genus Actinotignum was increased in female participants while Streptococcus was increased in male participants at the genus level. Regarding potential uropathogens in the urinary microbiota, Escherichia-Shigella provided conflicting results, with both showing higher and lower levels in the bladder cancer groups. However, the family Enterobacteriaceae was lower in the bladder cancer groups than in the control groups. In conclusion, there is no consensus on what taxa of the urinary microbiota are associated with bladder cancer according to the sample type. Findings on the potential role of uropathogens in the urinary microbiota in bladder cancer remain inconsistent. Due to the limited number of studies, further studies on urinary microbiota and bladder cancer are needed to address this issue. Given that all publications concerning the urinary microbiota and bladder cancer have been performed using 16S rRNA gene sequencing, we propose that polyphasic approaches, including culture-dependent techniques, may allow for a more comprehensive investigation of the urinary microbiota associated with bladder cancer.
Collapse
Affiliation(s)
- Abdourahamane Yacouba
- Aix Marseille Univ, IRD, Microbes, Evolution, Phylogeny and Infection (MEPHI), AP-HM, Marseille, France; IHU Méditerranée Infection, France; Université Abdou Moumouni, Niamey, Niger
| | - Maryam Tidjani Alou
- Aix Marseille Univ, IRD, Microbes, Evolution, Phylogeny and Infection (MEPHI), AP-HM, Marseille, France; IHU Méditerranée Infection, France
| | - Jean-Christophe Lagier
- Aix Marseille Univ, IRD, Microbes, Evolution, Phylogeny and Infection (MEPHI), AP-HM, Marseille, France
| | - Grégory Dubourg
- Aix Marseille Univ, IRD, Microbes, Evolution, Phylogeny and Infection (MEPHI), AP-HM, Marseille, France.
| | - Didier Raoult
- Aix Marseille Univ, IRD, Microbes, Evolution, Phylogeny and Infection (MEPHI), AP-HM, Marseille, France; IHU Méditerranée Infection, France.
| |
Collapse
|
29
|
Ugai T, Sasamoto N, Lee HY, Ando M, Song M, Tamimi RM, Kawachi I, Campbell PT, Giovannucci EL, Weiderpass E, Rebbeck TR, Ogino S. Is early-onset cancer an emerging global epidemic? Current evidence and future implications. Nat Rev Clin Oncol 2022; 19:656-673. [PMID: 36068272 PMCID: PMC9509459 DOI: 10.1038/s41571-022-00672-8] [Citation(s) in RCA: 138] [Impact Index Per Article: 69.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/22/2022] [Indexed: 02/07/2023]
Abstract
Over the past several decades, the incidence of early-onset cancers, often defined as cancers diagnosed in adults <50 years of age, in the breast, colorectum, endometrium, oesophagus, extrahepatic bile duct, gallbladder, head and neck, kidney, liver, bone marrow, pancreas, prostate, stomach and thyroid has increased in multiple countries. Increased use of screening programmes has contributed to this phenomenon to a certain extent, although a genuine increase in the incidence of early-onset forms of several cancer types also seems to have emerged. Evidence suggests an aetiological role of risk factor exposures in early life and young adulthood. Since the mid-20th century, substantial multigenerational changes in the exposome have occurred (including changes in diet, lifestyle, obesity, environment and the microbiome, all of which might interact with genomic and/or genetic susceptibilities). However, the effects of individual exposures remain largely unknown. To study early-life exposures and their implications for multiple cancer types will require prospective cohort studies with dedicated biobanking and data collection technologies. Raising awareness among both the public and health-care professionals will also be critical. In this Review, we describe changes in the incidence of early-onset cancers globally and suggest measures that are likely to reduce the burden of cancers and other chronic non-communicable diseases.
Collapse
Affiliation(s)
- Tomotaka Ugai
- Program in MPE Molecular Pathological Epidemiology, Department of Pathology, Brigham and Women's Hospital, and Harvard Medical School, Boston, MA, USA.
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA.
| | - Naoko Sasamoto
- Department of Obstetrics and Gynecology, Brigham and Women's Hospital, Boston, MA, USA
- Department of Obstetrics, Gynecology, and Reproductive Biology, Harvard Medical School, Boston, MA, USA
| | - Hwa-Young Lee
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Institute of Convergence Science, Convergence Science Academy, Yonsei University, Seoul, Republic of Korea
| | - Mariko Ando
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Mingyang Song
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Clinical and Translational Epidemiology Unit, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
- Division of Gastroenterology, Massachusetts General Hospital, Boston, MA, USA
| | - Rulla M Tamimi
- Department of Population Health Sciences, Weill Cornell Medicine, New York, NY, USA
| | - Ichiro Kawachi
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Peter T Campbell
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, New York, NY, USA
| | - Edward L Giovannucci
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | | | - Timothy R Rebbeck
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Division of Population Sciences, Dana-Farber Cancer Institute, Boston, MA, USA
- Zhu Family Center for Global Cancer Prevention, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Shuji Ogino
- Program in MPE Molecular Pathological Epidemiology, Department of Pathology, Brigham and Women's Hospital, and Harvard Medical School, Boston, MA, USA.
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA.
- Broad Institute of MIT and Harvard, Cambridge, MA, USA.
- Cancer Immunology and Cancer Epidemiology Programs, Dana-Farber Harvard Cancer Center, Boston, MA, USA.
| |
Collapse
|
30
|
Afghani E, Klein AP. Pancreatic Adenocarcinoma: Trends in Epidemiology, Risk Factors, and Outcomes. Hematol Oncol Clin North Am 2022; 36:879-895. [PMID: 36154788 PMCID: PMC10548451 DOI: 10.1016/j.hoc.2022.07.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Pancreatic cancer is one of the most lethal cancers in the world; it is a silent disease in which symptoms do not present until advanced stages, thereby reducing the 5-year survival rate to 10%. The global burden of pancreatic cancer has doubled over the past 25 years despite advancements in medicine. This review aims to discuss the global trends and disparities in pancreatic cancer, as well as the up-to-date literature on the known risk factors. A better understanding of these risk factors will reduce mortality by providing opportunities to screen these patients as well as counseling on lifestyle modifications.
Collapse
Affiliation(s)
- Elham Afghani
- Johns Hopkins School of Medicine, 1830 E Monument Street, Room 436, Baltimore, MD 21205, USA
| | - Alison P Klein
- Johns Hopkins School of Medicine, 1830 E Monument Street, Room 436, Baltimore, MD 21205, USA; Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins School of Medicine, Johns Hopkins Bloomberg School of Public Health, 1550 Orleans Street, Baltimore, MD 21231, USA.
| |
Collapse
|
31
|
Wen H, Xie C, Shi F, Liu Y, Liu X, Yu C. Trends in Deaths Attributable to Smoking in China, Japan, United Kingdom, and United States From 1990 to 2019. Int J Public Health 2022; 67:1605147. [PMID: 36188749 PMCID: PMC9519860 DOI: 10.3389/ijph.2022.1605147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2022] [Accepted: 08/31/2022] [Indexed: 11/29/2022] Open
Abstract
Objectives: This study aimed to estimate the long-term trends of deaths attributable smoking in China, Japan, the United Kingdom (UK) and the United States (US). Methods: Using 2000–2019 death data from Global Burden of Disease (GBD) 2019, we estimated age-period-cohort effects on smoking attributable mortality, and decomposed of differences in smoking-attributable deaths in 1990 and 2019 into demographic factors. Results: From 1990 to 2019, smoking-attributable deaths increased in China, which was due to population growth and demographic aging. From 1990 to 2019, both age-standardized smoking attributable mortality rates trended downward across countries. Among four countries, age rate ratios (RRs) for smoking-attributable mortality increased with age, while period and cohort RRs decreased with year. Conclusion: The age-standardized mortality rates, period effects and cohort effects of smoking attributable mortality in China, Japan, UK, and US have been declining in both sexes from 1990 to 2019, which suggests that smoke-free policies, help to quit tobacco use, improved health education, more accessible healthcare service, and increased taxes have been effective. Additionally, increased smoking attributable deaths in elderly should got more attention.
Collapse
Affiliation(s)
- Haoyu Wen
- Department of Epidemiology and Biostatistics, School of Public Health, Wuhan University, Wuhan, China
| | - Cong Xie
- Hubei Provincial Center for Diseases Control and Prevention, Wuhan, China
| | - Fang Shi
- Department of Epidemiology and Biostatistics, School of Public Health, Wuhan University, Wuhan, China
| | - Yan Liu
- Department of Epidemiology and Biostatistics, School of Public Health, Wuhan University, Wuhan, China
| | - Xiaoxue Liu
- Department of Epidemiology and Biostatistics, School of Public Health, Wuhan University, Wuhan, China
| | - Chuanhua Yu
- Department of Epidemiology and Biostatistics, School of Public Health, Wuhan University, Wuhan, China
- *Correspondence: Chuanhua Yu,
| |
Collapse
|
32
|
Marshall DC, Al Omari O, Goodall R, Shalhoub J, Adcock IM, Chung KF, Salciccioli JD. Trends in prevalence, mortality, and disability-adjusted life-years relating to chronic obstructive pulmonary disease in Europe: an observational study of the global burden of disease database, 2001-2019. BMC Pulm Med 2022; 22:289. [PMID: 35902833 PMCID: PMC9336030 DOI: 10.1186/s12890-022-02074-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Accepted: 07/08/2022] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION Chronic Obstructive Pulmonary Disease (COPD) is associated with significant mortality and well-defined aetiological factors. Previous reports indicate that mortality from COPD is falling worldwide. This study aims to assess the burden of COPD using prevalence, mortality, and disability-adjusted life years (DALYs) between 2001 and 2019 in 28 European countries (the European Union and the United Kingdom). METHODS We extracted COPD data from the Global Burden of Disease database based on the International Classification of Diseases versions 10 (J41, 42, 43, 44 and 47). Age-standardised prevalence rates (ASPRs), age-standardised mortality rates (ASMRs), and DALYs were analysed for European countries by sex for each year (2001-2019) and reported per 100,000 population. We used Joinpoint regression analysis to quantify changing trends in the burden of COPD. RESULTS In 2019, the median ASPR across Europe was 3230/100,000 for males and 2202/100,000 for females. Between 2001 and 2019, the median percentage change in ASPR was - 9.7% for males and 4.3% for females. 23/28 countries demonstrated a decrease in ASPRs in males, and 11/28 demonstrated a decrease in females. The median percentage change in ASMR between 2001 and 2019 was - 27.5% for males and - 10.4% for females. 25/28 and 19/28 countries demonstrated a decrease in ASMR in males and females, respectively. CONCLUSION In the EU between 2001 and 2019 COPD prevalence has overall increased in females but continues to decrease in males and in some countries, female prevalence now exceeds that of males. COPD mortality in the EU has decreased overall between 2001 and 2019; however, this decrease is not universal, particularly in females, and therefore remains a substantial source of amenable mortality.
Collapse
Affiliation(s)
- Dominic C Marshall
- National Heart and Lung Institute, Imperial College London, London, UK. .,Medical Data Research Collaborative, London, UK.
| | - Omar Al Omari
- Mount Auburn Hospital, Cambridge, MA, USA.,Harvard Medical School, Boston, MA, USA
| | - Richard Goodall
- Medical Data Research Collaborative, London, UK.,Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Joseph Shalhoub
- Medical Data Research Collaborative, London, UK.,Imperial College Healthcare NHS Trust, London, UK.,Department of Surgery and Cancer, Imperial College London, London, UK
| | - Ian M Adcock
- National Heart and Lung Institute, Imperial College London, London, UK
| | - Kian Fan Chung
- National Heart and Lung Institute, Imperial College London, London, UK.,Royal Brompton Hospital, London, SW3, UK
| | - Justin D Salciccioli
- Medical Data Research Collaborative, London, UK.,Harvard Medical School, Boston, MA, USA.,Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Boston, MA, USA
| |
Collapse
|
33
|
Rulkiewicz A, Pilchowska I, Lisik W, Pruszczyk P, Domienik-Karłowicz J. Prevalence of Cigarette Smoking among Professionally Active Adult Population in Poland and Its Strong Relationship with Cardiovascular Co-Morbidities-POL-O-CARIA 2021 Study. J Clin Med 2022; 11:jcm11144111. [PMID: 35887881 PMCID: PMC9324331 DOI: 10.3390/jcm11144111] [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: 05/08/2022] [Revised: 07/08/2022] [Accepted: 07/14/2022] [Indexed: 11/17/2022] Open
Abstract
Smoking is a leading cause of preventable mortality. It affects both the health and economic situation within societies. The aim of the study is to perform an epidemiological analysis of smoking among professionally active adults in Poland in the years 2016–2020 and its Strong Relationship with Cardiovascular Co-morbidities. The article retrospectively analyzed the records of 1,450,455 who underwent occupational medicine examinations between 2016 and 2020. Statistical analyses performed using IBM SPSS Statistics 25 software were performed. In general, irrespective of the year of measurement, 11.6% of women and 17.1% of men declared smoking. After sorting by year of measurement, we found that the percentage of female smokers was decreasing, while that of males remained relatively consistent. In the case of BMI, it was found that among tobacco smokers the percentage of people with normal body weight decreases with successive years of measurement, while the percentage of overweight and level I obesity increases. Moreover, we analyzed in detail the occurrence of particular comorbidities in the group of people who declared smoking. The most common diseases in this group were: arterial hypertension (39%), lipid disorders (26.7%), and hypertension and lipid disorders (16.5%). Active preventive measures are necessary to reduce the number of smokers and the negative impact of smoking on the occurrence of comorbid diseases.
Collapse
Affiliation(s)
| | - Iwona Pilchowska
- LUX MED, Postępu 21C, 02-676 Warsaw, Poland; (A.R.); (I.P.)
- Department of Psychology, SWPS University of Social Sciences and Humanities, 03-815 Warsaw, Poland
| | - Wojciech Lisik
- Department of General and Transplantation Surgery, Medical University of Warsaw, 02-014 Warsaw, Poland;
| | - Piotr Pruszczyk
- Department of Internal Medicine and Cardiology, Medical University of Warsaw, 02-005 Warsaw, Poland;
| | - Justyna Domienik-Karłowicz
- LUX MED, Postępu 21C, 02-676 Warsaw, Poland; (A.R.); (I.P.)
- Department of Internal Medicine and Cardiology, Medical University of Warsaw, 02-005 Warsaw, Poland;
- Correspondence: or ; Tel.: +48-22-502-11-44
| |
Collapse
|
34
|
Fu L, Tian T, Yao K, Chen XF, Luo G, Gao Y, Lin YF, Wang B, Sun Y, Zheng W, Li P, Zhan Y, Fairley CK, Grulich A, Zou H. Global Pattern and Trends in Penile Cancer Incidence: Population-Based Study. JMIR Public Health Surveill 2022; 8:e34874. [PMID: 35793140 PMCID: PMC9301560 DOI: 10.2196/34874] [Citation(s) in RCA: 40] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Revised: 03/01/2022] [Accepted: 05/26/2022] [Indexed: 12/16/2022] Open
Abstract
Background
Penile cancer is a relatively rare genital malignancy whose incidence and mortality are rising in many countries.
Objective
This study aims to assess the recent incidence and mortality patterns and incidence trends of penile cancer.
Methods
The age-standardized incidence and mortality rates (ASIR and ASMR, respectively) of penile cancer in 2020 were estimated from the Global Cancer Registries (GLOBOCAN) database. Incidence trends of penile cancer from 1973 to 2012 were assessed in 44 populations from 43 countries using the Cancer Incidence in Five Continents plus (CI5plus) and the Nordic Cancer Registries (NORDCAN) databases. Average annual percentage change was calculated to quantify trends in ASIR using joinpoint regression.
Results
Globally, the estimated ASIR and ASMR of penile cancer were 0.80 (per 100,000) and 0.29 (per 100,000) in 2020, equating to 36,068 new cases and 13,211 deaths in 2020, respectively. There was no significant correlation between the ASIR (P=.05) or ASMR (P=.90) and Human Development Index. In addition, 15 countries saw increasing ASIR for penile cancer, 13 of which were from Europe (United Kingdom, Lithuania, Norway, Estonia, Finland, Sweden, Cyprus, Netherlands, Italy, Croatia, Slovakia, Russia, and the Czech), and 2 from Asia (China and Israel).
Conclusions
Although the developing countries still bear the higher incidence and mortality of penile cancer, the incidence is on the rise in most European countries. To mitigate the disease burden resulting from penile cancer, measures to lower the risk for penile cancers, including improving penile hygiene and male human papillomavirus vaccination, may be warranted.
Collapse
Affiliation(s)
- Leiwen Fu
- School of Public Health (Shenzhen), Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Tian Tian
- School of Public Health (Shenzhen), Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Kai Yao
- Department of Urology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - Xiang-Feng Chen
- Center for Reproductive Medicine, Ren Ji Hospital, Shanghai Jiao Tong University, Shanghai, China
- Shanghai Key Laboratory for Assisted Reproduction and Reproductive Genetics, Shanghai, China
- Shanghai Human Sperm Bank, Shanghai, China
| | - Ganfeng Luo
- School of Public Health (Shenzhen), Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Yanxiao Gao
- School of Public Health (Shenzhen), Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Yi-Fan Lin
- School of Public Health (Shenzhen), Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Bingyi Wang
- School of Public Health (Shenzhen), Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Yinghui Sun
- School of Public Health (Shenzhen), Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Weiran Zheng
- School of Public Health (Shenzhen), Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Peiyang Li
- School of Public Health (Shenzhen), Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Yuewei Zhan
- School of Public Health (Shenzhen), Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Christopher K Fairley
- Central Clinical School, Monash University, Melbourne, Australia
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, Australia
| | - Andrew Grulich
- Kirby Institute, University of New South Wales, Sydney, Australia
| | - Huachun Zou
- School of Public Health (Shenzhen), Sun Yat-sen University, Guangzhou, Guangdong, China
- Kirby Institute, University of New South Wales, Sydney, Australia
| |
Collapse
|
35
|
Petkeviciene J, Kriaucioniene V, Raskiliene A. Academic Achievements, Satisfaction with Studies and Risky Behaviours among First-Year Students of Kaunas (Lithuania) Universities, 2000-2017. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19137616. [PMID: 35805274 PMCID: PMC9266131 DOI: 10.3390/ijerph19137616] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Revised: 06/19/2022] [Accepted: 06/20/2022] [Indexed: 11/16/2022]
Abstract
Risky behaviours are prevalent among university students and may affect academic achievements. This study aimed to evaluate the associations between academic achievements, satisfaction with studies and risky behaviours among first-year students of Kaunas (Lithuania) universities. Three cross-sectional surveys were conducted in 2000, 2010, and 2017. The self-administered questionnaires were filled in during lectures and assessed frequency and amount of alcohol consumption, drinking problems (CAGE test), smoking and drug use frequency, and academic achievements. The associations between risky behaviours and academic achievements were analysed using multivariable logistic regression analysis. Altogether 3325 students (1341 men and 1984 women) aged 20.0 (1.5) years participated in the survey. The proportion of students who consumed alcohol at least once a week and drank 11 or more standard alcoholic units (SAU) a week decreased. Every fifth student reported a drinking problem. Daily smoking prevalence declined, and drug use increased among male students. Multivariable logistic regression analysis revealed that frequent alcohol consumption and problem drinking were associated with low importance of good grades. Students who rated their academic performance below average and were dissatisfied with studies were more likely to consume ≥11 SAU a week. Daily smoking was more common among students who reported low importance of good grades and academic performance below average. A higher prevalence of drug use was found only in male students who declared low importance of good grades. Health promoting interventions at the individual and student community level are required to reduce the prevalence of substance use and improve the academic achievements of students.
Collapse
Affiliation(s)
- Janina Petkeviciene
- Health Research Institute, Faculty of Public Health, Lithuanian University of Health Sciences, LT47181 Kaunas, Lithuania; (V.K.); (A.R.)
- Department of Preventive Medicine, Faculty of Public Health, Lithuanian University of Health Sciences, LT47181 Kaunas, Lithuania
- Correspondence: ; Tel.: +370-620-61556
| | - Vilma Kriaucioniene
- Health Research Institute, Faculty of Public Health, Lithuanian University of Health Sciences, LT47181 Kaunas, Lithuania; (V.K.); (A.R.)
- Department of Preventive Medicine, Faculty of Public Health, Lithuanian University of Health Sciences, LT47181 Kaunas, Lithuania
| | - Asta Raskiliene
- Health Research Institute, Faculty of Public Health, Lithuanian University of Health Sciences, LT47181 Kaunas, Lithuania; (V.K.); (A.R.)
| |
Collapse
|
36
|
Arslan Işık N, Bilgin H. Determination The effects of black pepper and angelica oil on nicotine craving of students: a randomized controlled pilot trial. JOURNAL OF SUBSTANCE USE 2022. [DOI: 10.1080/14659891.2022.2082335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Nurten Arslan Işık
- Department of Nursing, Health Science Faculty, Erzincan Binali Yıldırım University, Erzincan, Türkiye
| | - Hülya Bilgin
- Department of Mental Health and Psychiatric Nursing, Istanbul University Cerrahpaşa, Istanbul, Turkey
| |
Collapse
|
37
|
Sharma R. A comparative examination of colorectal cancer burden in European Union, 1990-2019: Estimates from Global Burden of Disease 2019 Study. Int J Clin Oncol 2022; 27:1309-1320. [PMID: 35590123 DOI: 10.1007/s10147-022-02182-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Accepted: 04/25/2022] [Indexed: 12/13/2022]
Abstract
AIM This study examines the burden of colorectal cancer (CRC) in European Union (EU) countries in the last 3 decades. METHODS The data pertaining to CRC burden were procured from the Global Burden of Disease 2019 Study for 28 EU countries (including United Kingdom) for the period 1990-2019. The age-standardized rates of CRC were utilized to compare the country-wise burden and joinpoint regression models were applied to examine the trends. RESULTS In EU, CRC incident cases increased by 70.2% from 261,306 to 444,872 and deaths increased by 36.8% from 155,823 to 213,174 between 1990 and 2019. The age-standardized incidence rate (ASIR) increased by 11.9% from 37.8/100,000 to 42.3/100,000 between 1990 and 2019; in contrast, the age-standardized mortality rate (ASMR) decreased by 16.9% (1990: 22.4/100,000; 2019: 18.6/100,000) and age-standardized DALYs rate (ASDALR) decreased by 18.6% (1990: 472.9/100,000; 2019: 385.1/100,000) in the study period. In 2019, Hungary was the leading country in terms of ASMR (28.6/100,000) and ASDALR (630.3/100,000), and Lithuania (29.2/100,000) had the lowest ASIR, whereas Finland had the lowest ASMR (12.3/100,000) and ASDALR (253.6/100,000) in 2019. CONCLUSION CRC incidence is increasing in EU and mortality rates, although decreasing, are still unacceptably high. CRC control efforts must be focused around early detection using screening and prevention through reduction of modifiable risk factors. Increasing CRC incidence rates in young adults in recent years requires more research to pinpoint risk factors, and there must be more awareness of this recent development among general public and clinicians.
Collapse
Affiliation(s)
- Rajesh Sharma
- University School of Management and Entrepreneurship, Delhi Technological University, East Delhi Campus, Room No. 305, Vivek Vihar Phase II, Delhi, 110095, India.
| |
Collapse
|
38
|
Esposito F, Squillante J, Nolasco A, Montuori P, Macrì PG, Cirillo T. Acrylamide levels in smoke from conventional cigarettes and heated tobacco products and exposure assessment in habitual smokers. ENVIRONMENTAL RESEARCH 2022; 208:112659. [PMID: 34990604 DOI: 10.1016/j.envres.2021.112659] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Revised: 12/29/2021] [Accepted: 12/30/2021] [Indexed: 06/14/2023]
Abstract
Acrylamide (AA) is a neurotoxic, genotoxic, and carcinogenic compound developed during heating at high temperatures. Foods such as potatoes, biscuits, bread and coffee are the main foodstuffs containing AA. Cigarette smoke may be a significant additional source of exposure. However, AA content may vary among different types of cigarettes. The study aimed to evaluate the AA content in conventional cigarettes (CC) and heated tobacco products (HTP) and its resulting exposure through their use. AA levels from the two types of cigarettes were determined by GC-MS and the daily exposure to AA was also ascertained. The margin of exposure (MOE) was calculated for neurotoxic and carcinogenic risk based on benchmark dose lower confidence limit for a 10% response (BMDL10) of 0.43 and 0.17, 0.30, and 1.13 mg/kgbw/day. AA level in CC ranged from 235 to 897 ng/cigarette, whereas HTP reported AA levels in the range of 99-187 ng/cigarette. The data showed a low neurotoxic risk for either CC or HTP, whereas a carcinogenic risk emerged through the smoking of CC based on different Benchmark doses. The carcinogenic risk for CC based on the highest Benchmark dose that was considered showed unsafe levels, as little as 10 CC cigarettes/day, whereas it was almost always of low concern for HTP. Another approach based upon the incremental lifetime cancer risk (ILCR) analysis led to similar results, exceeding, in some cases, the safety value of 10-4, as far as CC are concerned. Overall, the results confirmed that CC are a significant source of AA, and its levels were five times higher than in HTP.
Collapse
Affiliation(s)
- Francesco Esposito
- Department of Public Health, University of Naples "Federico II", via Sergio Pansini, 5 - 80131 Naples, Italy.
| | - Jonathan Squillante
- Department of Agricultural Sciences, University of Naples "Federico II", via Università, 100 - 80055 Portici, Naples, Italy
| | - Agata Nolasco
- Department of Agricultural Sciences, University of Naples "Federico II", via Università, 100 - 80055 Portici, Naples, Italy
| | - Paolo Montuori
- Department of Public Health, University of Naples "Federico II", via Sergio Pansini, 5 - 80131 Naples, Italy
| | - Pasquale Giuseppe Macrì
- Area Dipartimentale Medicina Legale e Gestione Della Responsabilità Sanitaria Az. USL Toscana Sud Est, Siena, Arezzo, Grosseto, Italy
| | - Teresa Cirillo
- Department of Agricultural Sciences, University of Naples "Federico II", via Università, 100 - 80055 Portici, Naples, Italy
| |
Collapse
|
39
|
Opazo Breton M, Gillespie D, Pryce R, Bogdanovica I, Angus C, Hernandez Alava M, Brennan A, Britton J. Understanding long-term trends in smoking in England, 1972-2019: an age-period-cohort approach. Addiction 2022; 117:1392-1403. [PMID: 34590368 DOI: 10.1111/add.15696] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Accepted: 09/09/2021] [Indexed: 01/11/2023]
Abstract
BACKGROUND AND AIMS Smoking prevalence has been falling in England for more than 50 years, but remains a prevalent and major public health problem. This study used an age-period-cohort (APC) approach to measure lifecycle, historical and generational patterns of individual smoking behaviour. DESIGN APC analysis of repeated cross-sectional smoking prevalence data obtained from three nationally representative surveys. SETTING England (1972-2019). PARTICIPANTS Individuals aged 18-90 years. MEASUREMENTS We studied relative odds of current smoking in relation to age in single years from 18 to 90, 24 groups of 2-year survey periods (1972-73 to 2018-19) and 20 groups of 5-year birth cohorts (1907-11 to 1997-2001). Age and period rates were studied for two groups of birth cohorts: those aged 18-25 years and those aged over 25 years. FINDINGS Relative to age 18, the odds of current smoking increased with age until approximately age 25 [odds ratio (OR) = 1.48, 95% confidence interval (CI) = 1.41-1.56] and then decreased progressively to age 90 (OR = 0.06, 95% CI = 0.04-0.08). They also decreased almost linearly with period relative to 1972-73 (for 2018-19: OR = 0.30, 95% CI = 0.26-0.34) and with birth cohort relative to 1902-06, with the largest decreased observed for birth cohort 1992-96 (OR = 0.44, 95% CI = 0.35-0.46) and 1997-2001 (OR = 0.35, 95% CI = 0.74-0.88). Smoking declined in the 18-25 age group by an average of 7% over successive 2-year periods and by an average of 5% in those aged over 25. CONCLUSIONS Smoking in England appears to have declined over recent decades mainly as a result of reduced smoking uptake before age 25, and to a lesser extent to smoking cessation after age 25.
Collapse
Affiliation(s)
- Magdalena Opazo Breton
- School of Health and Related Research, University of Sheffield, Sheffield, United Kingdom
| | - Duncan Gillespie
- School of Health and Related Research, University of Sheffield, Sheffield, United Kingdom
| | - Robert Pryce
- School of Health and Related Research, University of Sheffield, Sheffield, United Kingdom
| | - Ilze Bogdanovica
- Division of Epidemiology and Public Health, University of Nottingham, Nottingham, United Kingdom
| | - Colin Angus
- School of Health and Related Research, University of Sheffield, Sheffield, United Kingdom
| | - Monica Hernandez Alava
- School of Health and Related Research, University of Sheffield, Sheffield, United Kingdom
| | - Alan Brennan
- School of Health and Related Research, University of Sheffield, Sheffield, United Kingdom
| | - John Britton
- Division of Epidemiology and Public Health, University of Nottingham, Nottingham, United Kingdom
| |
Collapse
|
40
|
Dalmartello M, La Vecchia C, Bertuccio P, Boffetta P, Levi F, Negri E, Malvezzi M. European cancer mortality predictions for the year 2022 with focus on ovarian cancer. Ann Oncol 2022; 33:330-339. [DOI: 10.1016/j.annonc.2021.12.007] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Revised: 12/09/2021] [Accepted: 12/15/2021] [Indexed: 12/21/2022] Open
|
41
|
Ambrosio MR, Aliberti L, Gagliardi I, Franceschetti P, Zatelli MC. Bone health in adolescence. Minerva Obstet Gynecol 2021; 73:662-677. [PMID: 34905874 DOI: 10.23736/s2724-606x.20.04713-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Adolescence is a fundamental period for the formation of the skeleton, because is the stage in which bones grow more in both size and strength, laying a solid foundation for the future health of the skeleton. Any condition interfering with optimal peak bone mass accrual can increase fracture risk later in life. Up to 80% of peak bone mass is genetically determined while the remaining 20% is modulated by environmental factors that, if deleterious, may result in low bone mineral density (BMD) and an increased risk of fracture. The preferred test to assess bone health is dual-energy x-ray absorptiometry (spine or total body less head) using Z scores instead of T scores, even though in short stature or growth delay, should be used the height Z-score. The correction of risk factors is the first treatment for low BMD in children and adolescents. It's necessary having a correct lifestyle for preserving bone health: a proper nutrition, an adequate physical weight-bearing activity and avoidance of alcohol intake and tobacco smoke. Bisphosphonates could be used in children who sustained osteoporotic fractures, impairing quality of life, when spontaneous recovery is low for the persistence of osteoporosis risk factors. This clinical review discusses factors affecting bone health during childhood and adolescence and deals with diagnosis and treatment of low bone mass or osteoporosis in this age group.
Collapse
Affiliation(s)
- Maria R Ambrosio
- Section of Endocrinology and Internal Medicine, Department of Medical Sciences, University of Ferrara, Ferrara, Italy -
| | - Ludovica Aliberti
- Section of Endocrinology and Internal Medicine, Department of Medical Sciences, University of Ferrara, Ferrara, Italy
| | - Irene Gagliardi
- Section of Endocrinology and Internal Medicine, Department of Medical Sciences, University of Ferrara, Ferrara, Italy
| | - Paola Franceschetti
- Operative Unit of Endocrinology and Metabolic Diseases, Department of Oncology and Specialty Medicine, Ferrara University Hospital, Ferrara, Italy
| | - Maria C Zatelli
- Section of Endocrinology and Internal Medicine, Department of Medical Sciences, University of Ferrara, Ferrara, Italy
| |
Collapse
|
42
|
López-Cervantes JP, Lønnebotn M, Jogi NO, Calciano L, Kuiper IN, Darby MG, Dharmage SC, Gómez-Real F, Hammer B, Bertelsen RJ, Johannessen A, Würtz AML, Mørkve Knudsen T, Koplin J, Pape K, Skulstad SM, Timm S, Tjalvin G, Krauss-Etschmann S, Accordini S, Schlünssen V, Kirkeleit J, Svanes C. The Exposome Approach in Allergies and Lung Diseases: Is It Time to Define a Preconception Exposome? INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:12684. [PMID: 34886409 PMCID: PMC8657011 DOI: 10.3390/ijerph182312684] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/30/2021] [Revised: 11/26/2021] [Accepted: 11/29/2021] [Indexed: 12/30/2022]
Abstract
Emerging research suggests environmental exposures before conception may adversely affect allergies and lung diseases in future generations. Most studies are limited as they have focused on single exposures, not considering that these diseases have a multifactorial origin in which environmental and lifestyle factors are likely to interact. Traditional exposure assessment methods fail to capture the interactions among environmental exposures and their impact on fundamental biological processes, as well as individual and temporal factors. A valid estimation of exposure preconception is difficult since the human reproductive cycle spans decades and the access to germ cells is limited. The exposome is defined as the cumulative measure of external exposures on an organism (external exposome), and the associated biological responses (endogenous exposome) throughout the lifespan, from conception and onwards. An exposome approach implies a targeted or agnostic analysis of the concurrent and temporal multiple exposures, and may, together with recent technological advances, improve the assessment of the environmental contributors to health and disease. This review describes the current knowledge on preconception environmental exposures as related to respiratory health outcomes in offspring. We discuss the usefulness and feasibility of using an exposome approach in this research, advocating for the preconception exposure window to become included in the exposome concept.
Collapse
Affiliation(s)
- Juan Pablo López-Cervantes
- Center for International Health, Department of Global Public Health and Primary Care, University of Bergen, 5020 Bergen, Norway; (M.L.); (A.J.); (G.T.); (J.K.); (C.S.)
- Department of Occupational Medicine, Haukeland University Hospital, 5021 Bergen, Norway; (N.O.J.); (T.M.K.); (S.M.S.)
| | - Marianne Lønnebotn
- Center for International Health, Department of Global Public Health and Primary Care, University of Bergen, 5020 Bergen, Norway; (M.L.); (A.J.); (G.T.); (J.K.); (C.S.)
- Department of Occupational Medicine, Haukeland University Hospital, 5021 Bergen, Norway; (N.O.J.); (T.M.K.); (S.M.S.)
| | - Nils Oskar Jogi
- Department of Occupational Medicine, Haukeland University Hospital, 5021 Bergen, Norway; (N.O.J.); (T.M.K.); (S.M.S.)
- Department of Clinical Science, University of Bergen, 5021 Bergen, Norway; (F.G.-R.); (R.J.B.)
| | - Lucia Calciano
- Unit of Epidemiology and Medical Statistics, Department of Diagnostics and Public Health, University of Verona, 37134 Verona, Italy; (L.C.); (S.A.)
| | | | - Matthew G. Darby
- Institute of Infectious Disease and Molecular Medicine and Division of Immunology, University of Cape Town, Cape Town 7925, South Africa;
| | - Shyamali C. Dharmage
- School of Population and Global Health, University of Melbourne, Melbourne, VIC 3010, Australia; (S.C.D.); (J.K.)
| | - Francisco Gómez-Real
- Department of Clinical Science, University of Bergen, 5021 Bergen, Norway; (F.G.-R.); (R.J.B.)
- Department of Obstetrics and Gynecology, Haukeland University Hospital, 5053 Bergen, Norway
| | - Barbara Hammer
- Department of Pulmonology, Medical University of Vienna, 1090 Vienna, Austria;
| | | | - Ane Johannessen
- Center for International Health, Department of Global Public Health and Primary Care, University of Bergen, 5020 Bergen, Norway; (M.L.); (A.J.); (G.T.); (J.K.); (C.S.)
| | - Anne Mette Lund Würtz
- Danish Ramazzini Centre, Department of Public Health—Work, Environment and Health, Aarhus University, 8000 Aarhus, Denmark; (A.M.L.W.); (K.P.); (V.S.)
| | - Toril Mørkve Knudsen
- Department of Occupational Medicine, Haukeland University Hospital, 5021 Bergen, Norway; (N.O.J.); (T.M.K.); (S.M.S.)
- Department of Clinical Science, University of Bergen, 5021 Bergen, Norway; (F.G.-R.); (R.J.B.)
| | - Jennifer Koplin
- School of Population and Global Health, University of Melbourne, Melbourne, VIC 3010, Australia; (S.C.D.); (J.K.)
- Murdoch Children’s Research Institute, Melbourne, VIC 3052, Australia
| | - Kathrine Pape
- Danish Ramazzini Centre, Department of Public Health—Work, Environment and Health, Aarhus University, 8000 Aarhus, Denmark; (A.M.L.W.); (K.P.); (V.S.)
| | - Svein Magne Skulstad
- Department of Occupational Medicine, Haukeland University Hospital, 5021 Bergen, Norway; (N.O.J.); (T.M.K.); (S.M.S.)
| | - Signe Timm
- Department of Regional Health Research, University of Southern Denmark, 5230 Odense, Denmark;
- Research Unit, Kolding Hospital, University Hospital of Southern Denmark, 6000 Kolding, Denmark
| | - Gro Tjalvin
- Center for International Health, Department of Global Public Health and Primary Care, University of Bergen, 5020 Bergen, Norway; (M.L.); (A.J.); (G.T.); (J.K.); (C.S.)
- Department of Occupational Medicine, Haukeland University Hospital, 5021 Bergen, Norway; (N.O.J.); (T.M.K.); (S.M.S.)
| | | | - Simone Accordini
- Unit of Epidemiology and Medical Statistics, Department of Diagnostics and Public Health, University of Verona, 37134 Verona, Italy; (L.C.); (S.A.)
| | - Vivi Schlünssen
- Danish Ramazzini Centre, Department of Public Health—Work, Environment and Health, Aarhus University, 8000 Aarhus, Denmark; (A.M.L.W.); (K.P.); (V.S.)
- National Research Centre for the Working Environment, 2100 Copenhagen, Denmark
| | - Jorunn Kirkeleit
- Center for International Health, Department of Global Public Health and Primary Care, University of Bergen, 5020 Bergen, Norway; (M.L.); (A.J.); (G.T.); (J.K.); (C.S.)
- Department of Occupational Medicine, Haukeland University Hospital, 5021 Bergen, Norway; (N.O.J.); (T.M.K.); (S.M.S.)
| | - Cecilie Svanes
- Center for International Health, Department of Global Public Health and Primary Care, University of Bergen, 5020 Bergen, Norway; (M.L.); (A.J.); (G.T.); (J.K.); (C.S.)
- Department of Occupational Medicine, Haukeland University Hospital, 5021 Bergen, Norway; (N.O.J.); (T.M.K.); (S.M.S.)
| |
Collapse
|
43
|
Hewer RMF, Hill S, Amos A. "You Do It Through the Grapevine": A Bourdieusian Analysis of Under-Age Access to Tobacco Among Adolescents From Seven European Cities. QUALITATIVE HEALTH RESEARCH 2021; 31:2692-2705. [PMID: 34636260 PMCID: PMC8649819 DOI: 10.1177/10497323211044465] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Despite efforts to reduce adolescent smoking via minimum age-of-sale legislation, many young people continue to access tobacco through a mix of social and commercial sources. Little is known about the roles of habitus, capital, and social topographies in shaping under-age access to tobacco. This article draws on Bourdieu's theory of practice and data generated from 56 focus groups with 14- to 19-year-olds across seven European cities to answer the question "via what sources and by what means do adolescents obtain tobacco?" We find that adolescents use a range of personal capitals (social, cultural, and economic) to access tobacco, with the specific constitution and deployment of these capitals varying according to the regularities of different fields. Since adolescents access tobacco via culturally embedded practices, attempts to curtail this access are more likely to be effective if they are multi-pronged, culturally informed, and attuned to the lived experiences of adolescent smokers.
Collapse
Affiliation(s)
| | - Sarah Hill
- The University of Edinburgh, Edinburgh, United Kingdom
| | - Amanda Amos
- The University of Edinburgh, Edinburgh, United Kingdom
| | | |
Collapse
|
44
|
Accordini S, Calciano L, Johannessen A, Benediktsdóttir B, Bertelsen RJ, Bråbäck L, Dharmage SC, Forsberg B, Gómez Real F, Holloway JW, Holm M, Janson C, Jõgi NO, Jõgi R, Malinovschi A, Marcon A, Martínez-Moratalla Rovira J, Sánchez-Ramos JL, Schlünssen V, Torén K, Jarvis D, Svanes C. Prenatal and prepubertal exposures to tobacco smoke in men may cause lower lung function in future offspring: a three-generation study using a causal modelling approach. Eur Respir J 2021; 58:2002791. [PMID: 33795316 PMCID: PMC8529197 DOI: 10.1183/13993003.02791-2020] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Accepted: 03/11/2021] [Indexed: 11/24/2022]
Abstract
Mechanistic research suggests that lifestyle and environmental factors impact respiratory health across generations by epigenetic changes transmitted through male germ cells. Evidence from studies on humans is very limited.We investigated multigeneration causal associations to estimate the causal effects of tobacco smoking on lung function within the paternal line. We analysed data from 383 adult offspring (age 18-47 years; 52.0% female) and their 274 fathers, who had participated in the European Community Respiratory Health Survey (ECRHS)/Respiratory Health in Northern Europe, Spain and Australia (RHINESSA) generation study and had provided valid measures of pre-bronchodilator lung function. Two counterfactual-based, multilevel mediation models were developed with: paternal grandmothers' smoking in pregnancy and fathers' smoking initiation in prepuberty as exposures; fathers' forced expiratory volume in 1 s (FEV1) and forced vital capacity (FVC), or FEV1/FVC z-scores as potential mediators (proxies of unobserved biological mechanisms that are true mediators); and offspring's FEV1 and FVC, or FEV1/FVC z-scores as outcomes. All effects were summarised as differences (Δ) in expected z-scores related to fathers' and grandmothers' smoking history.Fathers' smoking initiation in prepuberty had a negative direct effect on both offspring's FEV1 (Δz-score -0.36, 95% CI -0.63- -0.10) and FVC (-0.50, 95% CI -0.80- -0.20) compared with fathers' never smoking. Paternal grandmothers' smoking in pregnancy had a negative direct effect on fathers' FEV1/FVC (-0.57, 95% CI -1.09- -0.05) and a negative indirect effect on offspring's FEV1/FVC (-0.12, 95% CI -0.21- -0.03) compared with grandmothers' not smoking before fathers' birth nor during fathers' childhood.Fathers' smoking in prepuberty and paternal grandmothers' smoking in pregnancy may cause lower lung function in offspring. Our results support the concept that lifestyle-related exposures during these susceptibility periods influence the health of future generations.
Collapse
Affiliation(s)
- Simone Accordini
- Unit of Epidemiology and Medical Statistics, Dept of Diagnostics and Public Health, University of Verona, Verona, Italy
- Equal contribution as first authors
| | - Lucia Calciano
- Unit of Epidemiology and Medical Statistics, Dept of Diagnostics and Public Health, University of Verona, Verona, Italy
- Equal contribution as first authors
| | - Ane Johannessen
- Centre for International Health, Dept of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | | | - Randi Jacobsen Bertelsen
- Dept of Clinical Science, University of Bergen, Bergen, Norway
- Oral Health Centre of Expertise in Western Norway/Vestland, Bergen, Norway
| | - Lennart Bråbäck
- Section of Sustainable Health, Dept of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Shyamali C Dharmage
- Allergy and Lung Health Unit, School of Population and Global Health, University of Melbourne, Melbourne, Australia
| | - Bertil Forsberg
- Section of Sustainable Health, Dept of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Francisco Gómez Real
- Dept of Clinical Science, University of Bergen, Bergen, Norway
- Dept of Obstetrics and Gynecology, Haukeland University Hospital, Bergen, Norway
| | - John W Holloway
- Human Development and Health, Faculty of Medicine, University of Southampton, Southampton, UK
| | - Mathias Holm
- Occupational and Environmental Medicine, School of Public Health and Community Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Christer Janson
- Dept of Medical Sciences: Respiratory, Allergy and Sleep Research, Uppsala University, Uppsala, Sweden
| | - Nils O Jõgi
- Dept of Clinical Science, University of Bergen, Bergen, Norway
- Lung Clinic, Tartu University Hospital, Tartu, Estonia
| | - Rain Jõgi
- Lung Clinic, Tartu University Hospital, Tartu, Estonia
| | - Andrei Malinovschi
- Dept of Medical Sciences: Clinical Physiology, Uppsala University, Uppsala, Sweden
| | - Alessandro Marcon
- Unit of Epidemiology and Medical Statistics, Dept of Diagnostics and Public Health, University of Verona, Verona, Italy
| | - Jesús Martínez-Moratalla Rovira
- Servicio de Neumología, Complejo Hospitalario Universitario de Albacete (CHUA), Servicio de Salud de Castilla-La Mancha (SESCAM), Albacete, Spain
| | | | | | - Kjell Torén
- Occupational and Environmental Medicine, School of Public Health and Community Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Deborah Jarvis
- Faculty of Medicine, National Heart and Lung Institute, Imperial College London, London, UK
- MRC-PHE Centre for Environment and Health, Imperial College London, London, UK
- Equal contribution as last authors
| | - Cecilie Svanes
- Centre for International Health, Dept of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
- Equal contribution as last authors
| |
Collapse
|
45
|
Christopoulou R, Mavropoulos G, Voucharas G. The Greek smoking epidemic from a life-course perspective. J Public Health (Oxf) 2021; 44:e479-e486. [PMID: 34498081 PMCID: PMC9715303 DOI: 10.1093/pubmed/fdab342] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Revised: 05/28/2021] [Accepted: 08/17/2021] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Smoking rates in Greece are the highest recorded among OECD countries, but the historical and life-course evolution of smoking patterns is largely unknown. The present paper addresses this gap. METHODS We produce nationally representative life-course trajectories of smoking and related mortality of eight generations of Greek men and women. We estimate the smoking-mortality correlation conditional on several confounders and project the estimates forward. RESULTS We show that smoking prevalence among Greek men has plateaued at >60% for all but the youngest generation. For women, smoking prevalence is relatively lower, lags by several generations and follows a hump-shaped pattern. Smoking-attributable mortality is currently peaking for men (nearing 40% of total deaths) and is rising for women. We estimate that it takes ~20 years of smoking to maximize the smoking-mortality correlation (at 0.48 for men and 0.32 for women). Based on this estimation, we forecast that mortality rates will begin falling within the current decade. CONCLUSIONS The breadth of the Greek smoking epidemic has been high by international standards, reflecting the ineffective tobacco control efforts in the country. While smoking popularity fell during the Great Recession, policy vigilance is necessary to prevent a relapse once the economy recovers.
Collapse
Affiliation(s)
| | - Georgios Mavropoulos
- Department of Economic Sciences, University of Macedonia, 156 Egnatia Str, Thessaloniki 54636, Greece
| | - Georgios Voucharas
- Department of Economic Sciences, University of Macedonia, 156 Egnatia Str, Thessaloniki 54636, Greece
| |
Collapse
|
46
|
Schreuders M, Linnansaari A, Lindfors P, van den Putte B, Kunst AE. Why staff at European schools abstain from enforcing smoke-free policies on persistent violators. Health Promot Int 2021; 35:1106-1115. [PMID: 31652317 PMCID: PMC7585527 DOI: 10.1093/heapro/daz111] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Secondary schools in European countries increasingly implement comprehensive smoke-free school policies (SFSPs) that prohibit most or even all adolescents from smoking during school hours. Consistent enforcement of SFSPs is essential for realizing optimum effectiveness. A main challenge represents adolescents who persistently violate the rules. We studied how staff in European countries respond to these persistent violators and why they may turn a blind eye. We used interview transcripts from 69 staff members at 22 schools in 6 European countries to identify cases in which staff turned a blind eye. We then applied thematic analysis for identifying the considerations as to why they turn a blind eye. Turning a blind eye on persistent violators happened among school staff in all six countries. Three considerations were identified. First, staff believe their primary role and duty is to support all adolescents to develop into well-functioning adults, and sometimes it is best to accept smoking. Second, staff expect that applying stricter disciplinary measures will not stop persistent violators and is more likely to create more severe problems. Third, staff do not feel supported by relevant actors in society (e.g. parents) in influencing adolescent smoking. We conclude that staff’s considerations stress the need to support school staff in enforcing the increasingly comprehensive rules on the most persistent smokers.
Collapse
Affiliation(s)
- Michael Schreuders
- Department of Public Health, Amsterdam Public Health Institute, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Anu Linnansaari
- Faculty of Social Sciences, Unit of Health Sciences, Tampere University, Tampere, Finland
| | - Pirjo Lindfors
- Faculty of Social Sciences, Unit of Health Sciences, Tampere University, Tampere, Finland
| | - Bas van den Putte
- Department of Communication, Faculty of Social and Behavioural Sciences, University of Amsterdam, Amsterdam, The Netherlands
| | - Anton E Kunst
- Department of Public Health, Amsterdam Public Health Institute, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| |
Collapse
|
47
|
Genetic overlap and causal associations between smoking behaviours and mental health. Sci Rep 2021; 11:14871. [PMID: 34290290 PMCID: PMC8295327 DOI: 10.1038/s41598-021-93962-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Accepted: 06/10/2021] [Indexed: 12/17/2022] Open
Abstract
Cigarette smoking is a modifiable behaviour associated with mental health. We investigated the degree of genetic overlap between smoking behaviours and psychiatric traits and disorders, and whether genetic associations exist beyond genetic influences shared with confounding variables (cannabis and alcohol use, risk-taking and insomnia). Second, we investigated the presence of causal associations between smoking initiation and psychiatric traits and disorders. We found significant genetic correlations between smoking and psychiatric disorders and adult psychotic experiences. When genetic influences on known covariates were controlled for, genetic associations between most smoking behaviours and schizophrenia and depression endured (but not with bipolar disorder or most psychotic experiences). Mendelian randomization results supported a causal role of smoking initiation on psychiatric disorders and adolescent cognitive and negative psychotic experiences, although not consistently across all sensitivity analyses. In conclusion, smoking and psychiatric disorders share genetic influences that cannot be attributed to covariates such as risk-taking, insomnia or other substance use. As such, there may be some common genetic pathways underlying smoking and psychiatric disorders. In addition, smoking may play a causal role in vulnerability for mental illness.
Collapse
|
48
|
Pancreatic cancer epidemiology: understanding the role of lifestyle and inherited risk factors. Nat Rev Gastroenterol Hepatol 2021; 18:493-502. [PMID: 34002083 PMCID: PMC9265847 DOI: 10.1038/s41575-021-00457-x] [Citation(s) in RCA: 407] [Impact Index Per Article: 135.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/20/2021] [Indexed: 12/24/2022]
Abstract
Pancreatic cancer is a leading cause of cancer death worldwide and its global burden has more than doubled over the past 25 years. The highest incidence regions for pancreatic cancer include North America, Europe and Australia, and although much of this increase is due to ageing worldwide populations, there are key modifiable risk factors for pancreatic cancer such as cigarette smoking, obesity, diabetes and alcohol intake. The prevalence of these risk factors is increasing in many global regions, resulting in increasing age-adjusted incidence rates for pancreatic cancer, but the relative contribution from these risk factors varies globally due to variation in the underlying prevalence and prevention strategies. Inherited genetic factors, although not directly modifiable, are an important component of pancreatic cancer risk, and include pathogenic variants in hereditary cancer genes, genes associated with hereditary pancreatitis, as well as common variants identified in genome-wide association studies. Identification of the genetic changes that underlie pancreatic cancer not only provides insight into the aetiology of this cancer but also provides an opportunity to guide early detection strategies. The goal of this Review is to provide an up-to-date overview of the established modifiable and inherited risk factors for pancreatic cancer.
Collapse
|
49
|
The Undeserving Sick? An Evaluation of Patients' Responsibility for Their Health Condition. Camb Q Healthc Ethics 2021; 29:175-191. [PMID: 32159486 DOI: 10.1017/s0963180119000975] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
The recent increased prevalence of diseases related to unhealthy lifestyles raises difficulties for healthcare insurance systems traditionally based on the principles of risk-management, solidarity, and selective altruism: since these diseases are, to some extent, predictable and avoidable, patients seem to bear some responsibility for their condition and may not deserve full access to social medical services. Here, we investigate with objective criteria to what extent it is warranted to hold patients responsible for their illness and to sanction them accordingly. We ground our analysis on a series of minimal conditions for 'practical' and for 'moral' responsibility attribution. By applying these criteria consistently, we highlight that individual responsibility applies to risk-taking life choices rather than stigmatized sickness. We explain that responsibility is a matter of degree, that it varies across life-history, and can be affected by factors beyond the patients' grasp. We point out that scientific knowledge about the effect of these factors generates responsibilities for other parties such as public health agencies and private industry. The upshot of our analysis is that health policies targeting the 'liable' undeserving sick are mostly unwarranted, and tend to increase unequal treatment of already vulnerable groups: the unlucky sick.
Collapse
|
50
|
Mallol J, Urrutia-Pereira M, Mallol-Simmonds MJ, Calderón-Rodríguez L, Osses-Vergara F, Matamala-Bezmalinovic A. Prevalence and Determinants of Tobacco Smoking Among Low-Income Urban Adolescents. PEDIATRIC ALLERGY IMMUNOLOGY AND PULMONOLOGY 2021; 34:60-67. [PMID: 34107753 DOI: 10.1089/ped.2021.0018] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Background: Tobacco-smoking in children is one of the most crucial public health concerns, which could be highly prevalent in underprivileged populations. Methods: A cross sectional, random sampling survey was conducted to determine the prevalence of current tobacco-smoking and related risk factors among adolescents living in a low-income area of Santiago de Chile. Results: Of the 2,747 adolescents participating in the study, 24.0% [95% confidence interval (CI) 22.3-25.5] were current smokers, with no significant difference between girls and boys. Factors associated with current smoking were as follows: positive attitude to smoking cigarettes offered by peers [odds ratio (OR) 8.0; 95% CI 5.7-11.3, P < 0.001], having smoking best friends (OR 4.0; 95% CI 2.6-6.0, P < 0.001), and passive smoking in the house (OR 1.9; 95% CI 1.2-3.1, P = 0.008). A total of 16.8% (95% CI 11.4-18.2) of children had smoked an entire cigarette at the age of ≤12, and 62.3% (95% CI, 60.5-64.1) were passive smokers at home. Regarding nonsmoking children, 52.4% (95% CI 49.74-55.06) were exposed to tobacco smoke at home. Conclusion: The prevalence of current tobacco-smoking in adolescents is high and increasing compared to previous studies undertaken in the selected low-resourced area. Two-thirds of children who started smoking before the age of 12 years were current smokers at the time of the survey, highlighting the prevalence of the powerful addiction generated and the need for better preventive strategies against tobacco-smoking for children living in low-resource communities.
Collapse
Affiliation(s)
- Javier Mallol
- Department of Pediatric Respiratory Medicine, Hospital CRS El Pino, University of Santiago de Chile (USACH), Santiago, Chile
| | | | | | | | | | | |
Collapse
|