Women and smoking: risks, impacts, and challenges

Difficulties in the Prognostic Study of Oral Leukoplakia: Standardisation Proposal of Follow-Up Parameters

Oral leukoplakia is the most prevalent potentially malignant disorder of the oral cavity. To evaluate its potential for malignancy, appropriate documentation of the biological parameters is crucial, allowing the patients' progression to be assessed. We hypothesized a lack of standardization in the parameters employed for the prognostic study of oral leukoplakia; our aims were to determine the different parameters used for follow-up according to definition, importance, and frequency of use, and to provide a standardization proposal of follow-up research. We made a scoping review to identify papers with the keywords “leukoplakia,” “oral,” and “follow-up” published until June 2019 in English, Spanish and Portuguese literature through an online search in PUBMED, SCIELO, and SCOPUS databases. In total, 514 articles were initially identified, and fifty-nine publications were selected, of which 37 were retrospective. The reports included a total of 18,660 patients between 13 and 98 years old, with a mean age of 57.6 years. Tobacco and alcohol habits were positive for 77 and 37% of the patients, respectively. Our results showed that reported leukoplakias were predominantly located on buccal mucosa (40.4%), were homogeneous (60.8%), multiple (59.9%), smaller than 2 cm (74.4%) and histopathologically non-dysplastic (71%). The mean follow-up time was 55 months, with a 13% malignant transformation rate. The categorization and definition of multiple variables were notably diverse. Age, sex, habits (tobacco and alcohol), site, size, distribution, morphology, degree of dysplasia, and evolution were the chosen parameters for our proposal. The current study reflected the lack of consensus found in the literature regarding parameters for diagnosis or follow-up, impacting negatively on clinical and research results. standardization comprises an efficient way to facilitate the prognosis assessment of oral leukoplakia, being beneficial for clinical practice, and enabling better quality information to apply in research.

Effectiveness of Aerobic Exercise on Smoking Cessation in Adults: A Systematic Review and Meta-Analysis

BACKGROUND

The specific benefits of aerobic exercises in smoking cessation are unclear, as they have different characteristics, intensities, and durations. The purpose of this systematic review with meta-analysis was to evaluate the effects of aerobic exercise, with or without co-interventions, compared with a control group of cognitive behavior treatment on smoking cessation.

METHODS

This review was prospectively registered on PROSPERO, and the searches were performed from 2016 to 2018. Randomized controlled trials evaluating the effects of aerobic exercise, with or without nicotine therapy replacement, compared with usual care were included. The primary outcome was smoking cessation defined as the prevalence of those who quit or continuous abstinence. Meta-analysis was calculated using random effects model in the comprehensive meta-analysis software.

RESULTS

The authors identified 18 trials reporting data for a total of 2815 participants. There was moderate-quality evidence that aerobic exercise was better than usual care in promoting smoking cessation at short term (11 trials, risk ratio 0.79; 95% confidence interval, 0.66-0.94). However, there were no differences between aerobic exercises and usual care at medium- or long-term follow-ups.

CONCLUSIONS

According to review, aerobic exercise may be effective in promoting smoking cessation at short-term, but not at medium- and long-term follow-ups.

Smoking cessation in Brazil: a survival analysis based on consumers' profile

Cigarette consumption is a worldwide epidemic and its reduction is one of the major public health concerns. In Brazil, although there is a wide literature on smoking cessation it is restricted to experimental studies. Based on data from the 2013 National Health Survey (PNS), this study uses the survival methodology and use population data and consumer's profile to investigate which characteristics will affect smoking cessation hazard. The results showed that the people who are less likely to quit smoking are older, single men, with low income and fewer education years. They also do not practice physical exercise. The findings of cigarette cessation hazard to Brazilian population are similar of experimental studies with smokers and ex-smokers in country. Therefore, in order to decrease public health spending, Brazilian health policies regarding tobacco cessation could focus on those groups who will likely smoke for a long time.

Smoking and pulmonary tuberculosis treatment failure: a case-control study

OBJECTIVE

To determine the association between smoking and pulmonary tuberculosis treatment failure.

METHODS

This was a case-control study conducted at the Brazilian Institute for Tuberculosis Research in the city of Salvador, Brazil, between 2007 and 2015. We evaluated 284 patients treated for pulmonary tuberculosis, comparing 50 cases of treatment failure with 234 control cases in which the final outcome was cure.

RESULTS

Treatment failure was attributed to smoking and age rather than to gender, income, level of education, alcohol consumption, or marital status. Therefore, even after adjustment for age, the risk of treatment failure was 2.1 times (95% CI: 1.1-4.1) higher among the patients with a history of smoking. In addition, being over 50 years of age was found to increase the likelihood of treatment failure by 2.8 times (95% CI: 1.4-6.0).

CONCLUSIONS

Smoking and aging are both associated with pulmonary tuberculosis treatment failure. Therefore, as part of a tuberculosis control program, health personnel should be prepared to offer strategies to promote smoking cessation and should be more careful with older patients.

Fatores associados ao tabagismo entre adolescentes do sexo feminino

RESUMO O objetivo foi conhecer os fatores associados ao tabagismo entre adolescentes do sexo feminino. Pesquisa descritiva, qualitativa, em duas escolas de Belo Horizonte, Minas Gerais, Brasil. Participaram do estudo 75 adolescentes do sexo feminino. A análise de conteúdo foi utilizada com o suporte do software de apoio à análise qualitativa. O uso de tabaco foi associado ao controle do peso corporal, socialização no ambiente escolar, redução da ansiedade e estresse e pouca percepção de risco para a saúde. Ações de prevenção ao uso de tabaco no ambiente escolar devem ser planejadas considerando gênero, faixa etária, linguagem e modos de vida.

Avaliação dos resultados obtidos nos grupos de controle do tabagismo realizados numa unidade de saúde de Curitiba-PR

Introdução: O tabagismo é fator de risco para diversas doenças, sendo responsável por seis óbitos a cada segundo. No Brasil, sua prevalência é de 14,7%. A terapia cognitivo comportamental é alicerce principal para esta abordagem. Objetivo: Avaliar os resultados obtidos nos grupos do programa nacional de controle do tabagismo (PNCT) desenvolvidos numa unidade municipal de saúde (UMS) de Curitiba – Paraná (PR), com ênfase na avaliação da taxa de cessação da dependência nicotínica e análise do perfil clínico epidemiológico dos pacientes. Métodos: Trata-se de um estudo descritivo, observacional e retrospectivo. Foram analisados dados da população participantes dos grupos do PNCT através das fichas da avaliação inicial e das planilhas de consolidação de informações do Ministério da Saúde. Resultados: Foram realizados 8 grupos, totalizando 160 tabagistas. 68% eram do sexo feminino, 38% eram casados e 32,5% tinham ensino fundamental incompleto. A média de idade foi de 47,2 anos e de início do tabagismo, de 15 anos. A porcentagem de cessação do uso do tabaco variou de 12,5 até 72,7 ao final do primeiro mês. A taxa de desistência do tratamento chegou a 62,5% nos grupos. Conclusão: Os Grupos do Programa de Controle ao Tabagismo apresentam resultados a curto prazo, porém alto índice de abandono do tratamento. Houve baixa adesão à manutenção da abstinêcia no decorrer do tempo. Maiores esforços devem ser destinados visando uma abstinência duradoura.

Sex differences in nicotine intravenous self-administration: A meta-analytic review

OBJECTIVE

This report reflects a meta-analysis that systematically reviewed the literature on intravenous self-administration (IVSA) of nicotine in female and male rats. The goal was to determine if sex differences in nicotine IVSA exist, estimate the magnitude of the effect, and identify potential moderators of the relationship between sex differences and nicotine consumption.

METHODS

Extensive search procedures identified 20 studies that met the inclusion criteria of employing both female and male rats in nicotine IVSA procedures. The meta-analysis was conducted on effect size values that were calculated from mean total intake or nicotine deliveries using the Hedges' unbiased g^u statistic.

RESULTS

A random effects analysis revealed that overall females self-administered more nicotine than males (weighted g^u=0.18, 95% CI [0.003, 0.34]). Subsequent moderator variable analyses revealed that certain procedural conditions influenced the magnitude of sex differences in nicotine IVSA. Specifically, higher reinforcement requirements (>FR1) and extended-access sessions (23h) were associated with greater nicotine IVSA in females versus males. Females also displayed higher nicotine intake than males when the experiment included a light cue that signaled nicotine delivery. Sex differences were not influenced by the diurnal phase of testing, dose of nicotine, or prior operant training.

CONCLUSION

Overall, the results revealed that female rats display higher levels of nicotine IVSA than males, suggesting that the strong reinforcing effects of nicotine promote tobacco use in women.

Survival in a cohort of patients with lung cancer: the role of age and gender in prognosis

OBJECTIVE

To determine the demographic and clinical characteristics of patients with non-small cell lung cancer (NSCLC), as well as their disease course, by age group and gender.

METHODS

This was a retrospective cohort study of patients diagnosed with NSCLC from 2000 to 2012 and followed until July 2015 in a tertiary referral hospital in the city of São Paulo, Brazil. Based on the 25th and 75th percentiles of the age distribution, patients were stratified into three age groups: < 55 years; ≥ 55 and < 72 years; and ≥ 72 years. Survival time was evaluated during the follow-up period of the study. Functions of overall and gender-specific survival stratified by age groups (event: all-cause mortality) were calculated using the Kaplan-Meier method. Differences among survival curves were assessed via the log-rank test.

RESULTS

We included 790 patients with the following age distribution: < 55 years, 165 patients; ≥ 55 and < 72 years, 423; and ≥ 72 years, 202. In the entire sample, there were 493 men (62.4%). Adenocarcinoma was the most common histological pattern in the < 72-year age groups; 575 patients (73%) presented with advanced disease (stages IIIB-IV). The median 5-year survival was 12 months (95% CI: 4-46 months), with no significant differences among the age groups studied.

CONCLUSIONS

NSCLC remains more common in men, although we found an increase in the proportion of the disease in women in the < 55-year age group. Adenocarcinoma predominated in women. In men, squamous cell carcinoma predominated in the ≥ 72-year age group. Most patients presented with advanced-stage disease at diagnosis. There were no statistical differences in survival between genders or among age groups.

Smoking among female sex workers: prevalence and associated variables

Objective:

To assess the prevalence of smoking and associated variables in female sex workers (FSWs)

Methods:

This was a quantitative cross-sectional study involving FSWs in the city of Botucatu, Brazil, who completed a sociodemographic questionnaire, including data regarding smoking status, motivational stage of change, and degree of nicotine dependence, as well as the Perceived Stress Scale and the Hospital Anxiety and Depression Scale

Results:

We included 83 FSWs. The mean age was 26.8 years. Among the participants, 58 (69.8%) had at least a high school education, only 26 (31.3%) resided in the city of Botucatu, 59 (71.1%) were smokers, 5 (6.0%) were former smokers, 74 (89.2%) regularly consumed alcohol, and 43 (51.8%) used illicit drugs. The majority of the women were classified as having an intermediate stress level, and 51 (61.4%) were classified as having possible or probable anxiety, whereas depression was found to be improbable in 57 (68.7%). The level of nicotine dependence was high among the smokers, the majority of whom showed no intention to quit smoking. Smoking was associated with illicit drug use (p = 0.0271) and with alcohol consumption (p = 0.0001), although not with the levels of stress, anxiety, or depression; nor was the age at smoking initiation associated with the length of time as an FSW (p = 0.4651)

Conclusions:

The prevalence of smoking among the FSWs evaluated here was much higher than the 8.3% reported for the overall female population of Brazil. Our findings show that FSWs are exposed to various risk factors inherent to their profession. Therefore, harm reduction is an important strategy to be adopted.

Parental smoking and cessation during pregnancy and the risk of childhood asthma

Background

To evaluate the association between maternal and paternal smoking during pregnancy, and asthma among offspring.

Methods

We conducted a hospital-based birth retrospective observational birth cohort study in a University-based Obstetrics and Gynecology Department, Kuopio University Hospital, Finland. 39 306 women, delivering between 1989 and 2006, were linked to the national register for asthma reimbursement for their offspring (2641 asthmatics). Pregnancy factors were recorded during pregnancy.

Results

The risk of asthma was significantly elevated if both parents smoked (aOR 3.7; 95 % Cl 3.2-4.4) and it remained high in only paternal smoking families (aOR 2.9; 95 % Cl 2.5-3.3) as well as only maternal smoking families (aOR 1.7; 95 % Cl 1.2-2.2). Paternal cessation of smoking during pregnancy seemed to reduce the risk of asthma regardless of maternal smoking (aOR 0.3-0.4).

Conclusions

Parental smoking, and especially paternal smoking, was significantly associated with the risk of asthma in offspring and paternal cessation of smoking during pregnancy was associated with a decreased risk of childhood asthma regardless of maternal smoking. The results indicate that both parents should be encouraged to quit smoking during pregnancy, since it is a relatively easy and cheap way to reduce the risk of asthma in offspring.

Trial registration

The study is registered in Kuopio University Hospital register (TUTKI): ID5302448

Smoking prevalence, reduction, and cessation during pregnancy and associated factors: a cross-sectional study in public maternities, Rio de Janeiro, Brazil

Background

Smoking epidemic in Brazilian women has later onset, smaller magnitude, and slower decreasing trend, compared to men. Among pregnant women, smoking has an additional deleterious effect. The purpose of this study was to analyze smoking prevalence during pregnancy and associated factors, and to describe the frequency of smoking reduction and cessation in public maternities of Rio de Janeiro State, southeastern Brazil, in 2011.

Methods

A cross-sectional study was conducted in two maternities located at public hospitals in two cities of the Rio de Janeiro state, Niterói (maternity A) and of Rio de Janeiro (maternity B). Data were gathered by interviews 12 hours after the delivery, and analyses of prenatal cards and medical records. Smoking prevalence according to maternal characteristics, adequacy of prenatal care, and proportions of smoking reduction and cessation during pregnancy were calculated. Factors associated to smoking during pregnancy were estimated by logistic regression analysis.

Results

Smoking prevalence at maternity A (24.8%, 95% CI: 21.1-29.0) and maternity B (17.9%, 95% CI: 15.8-20.1) were high. Prevalence rates were greater in women aged 20-34 years, mainly without partner, multiparous and brown or black skin color. Low education (OR = 2.14, 95% CI 1.21, 3.79) and multiparity (OR = 3.48, 95% CI 1.78, 6.81), at maternity A; adolescence (OR = 0.44, 95% CI 0.26, 0.75), black skin color (OR = 1.71, 95% CI 1.06, 2.74), low education (OR = 1.61, 95% CI 1.08, 2.40), and multiparity (OR = 1.58, 95% CI 1.03, 2.44), at maternity B, were associated with smoking in multivariable analysis. Adequacy of prenatal care and smoking prevalence showed an inverse association. More than half of the smokers kept the smoking habits during pregnancy. Reduction occurred mainly between the 1^st and 2^nd trimesters of pregnancy.

Conclusion

Smoking prevalence during pregnancy was higher for multiparous and less educated women. Population and individual strategies for smoking prevention and control must include actions specific for women, especially during the reproductive period.

Sex differences and menstrual cycle phase-dependent modulation of craving for cigarette: an FMRI pilot study

While overall more men than women smoke cigarettes, women and girls take less time to become dependent after initial use and have more difficulties quitting the habit. One of the factors contributing to these differences may be that women crave cigarettes more than men and that their desire to smoke is influenced by hormonal fluctuations across the menstrual cycle. Therefore, the purpose of the present study was twofold: (a) to examine potential sex/gender differences in functional neuroanatomy of craving and to (b) delineate neural correlates of cigarette cravings in women across their menstrual cycle. Fifteen tobacco-smoking men and 19 women underwent a functional MRI during presentation of neutral and smoking-related images, known to elicit craving. Women were tested twice: once during early follicular phase and once during midluteal phase of their menstrual cycle. The analysis did not reveal any significant sex differences in the cerebral activations associated with craving. Nevertheless, the pattern of activations in women varied across their menstrual cycle with significant activations in parts of the frontal, temporal, and parietal lobe, during follicular phase, and only limited activations in the right hippocampus during the luteal phase.

Behavioral, Biochemical, and Molecular Indices of Stress are Enhanced in Female Versus Male Rats Experiencing Nicotine Withdrawal

Stress is a major factor that promotes tobacco use and relapse during withdrawal. Although women are more vulnerable to tobacco use than men, the manner in which stress contributes to tobacco use in women versus men is unclear. Thus, the goal of this study was to compare behavioral and biological indices of stress in male and female rats during nicotine withdrawal. Since the effects of nicotine withdrawal are age-dependent, this study also included adolescent rats. An initial study was conducted to provide comparable nicotine doses across age and sex during nicotine exposure and withdrawal. Rats received sham surgery or an osmotic pump that delivered nicotine. After 14 days of nicotine, the pumps were removed and controls received a sham surgery. Twenty-four hours later, anxiety-like behavior and plasma corticosterone were assessed. The nucleus accumbens (NAcc), amygdala, and hypothalamus were examined for changes in corticotropin-releasing factor (CRF) gene expression. In order to differentiate the effects of nicotine withdrawal from exposure to nicotine, a cohort of rats did not have their pumps removed. The major finding is that during nicotine withdrawal, adult females display higher levels of anxiety-like behavior, plasma corticosterone, and CRF mRNA expression in the NAcc relative to adult males. However, during nicotine exposure, adult males exhibited higher levels of corticosterone and CRF mRNA in the amygdala relative to females. Adolescents displayed less nicotine withdrawal than adults. Moreover, adolescent males displayed an increase in anxiety-like behavior and an up-regulation of CRF mRNA in the amygdala during nicotine exposure and withdrawal. These findings are likely related to stress produced by the high doses of nicotine that were administered to adolescents to produce equivalent levels of cotinine as adults. In conclusion, these findings suggest that intense stress produced by nicotine withdrawal may contribute to tobacco use in women.

Pregnancy, maternal tobacco smoking, and early age leukemia in Brazil

BACKGROUND

Cigarette smoking has been associated with acute myeloid leukemia (AML) but hypothesis on the association between maternal smoking during pregnancy and childhood leukemia remains unclear.

OBJECTIVES

To investigate the association between maternal exposure to tobacco smoking during pregnancy and early age (<2 year) leukemia (EAL).

METHODS

A hospital-based multicenter case-control study aiming to explore EAL risk factors was carried out in Brazil during 1999-2007. Data were collected by direct interview with the biological mothers using a standardized questionnaire. The present study included 675 children (193 acute lymphoid leukemia - ALL, 59 AML and 423 controls), being the latter age frequency matched and paired by area of residence with the cases. Unconditional logistic regression was performed, and odds ratios (OR) on the association between tobacco smoking (3 months before pregnancy, during pregnancy, and 3 months after delivery) and EAL were ascertained after adjustment for selected variables (maternal age at birth and education, birth weight, infant skin color, and oral contraceptives use during pregnancy).

RESULTS

Smoking was reported by 17.5% of case mothers and 20.6% of controls. Among women who reported to have smoked 20 or more cigarettes during the index pregnancy, an adjusted OR = 5.28 (95% CI 1.40-19.95) for ALL was observed. Heavy smoking during breastfeeding yielded an adjusted risk estimate for ALL, OR = 7.78 (95% CI 1.33-45.5). No dose-response effect was observed according to smoking exposure during pregnancy and EAL. An association between secondhand smoking during pregnancy or breastfeeding was not observed.

CONCLUSION

An association between maternal smoking and EAL in the offspring was restricted to women who have reported an intense exposure to tobacco smoke during pregnancy and breastfeeding.

Airway disease: similarities and differences between asthma, COPD and bronchiectasis

Airway diseases are highly prevalent worldwide; however, the prevalence of these diseases is underestimated. Although these diseases present several common characteristics, they have different clinical outcomes. The differentiation between asthma, chronic obstructive pulmonary disease and bronchiectasis in the early stage of disease is extremely important for the adoption of appropriate therapeutic measures. However, because of the high prevalence of these diseases and the common pathophysiological pathways, some patients with different diseases may present with similar symptoms. The objective of this review is to highlight the similarities and differences between these diseases in terms of the risk factors, pathophysiology, symptoms, diagnosis and treatment.