Gender empowerment and female-to-male smoking prevalence ratios

The impact of specific health warning messages on Chinese young people's perception of smoking risks and quitting intentions

INTRODUCTION

Although a substantial body of research has analyzed the effectiveness of cigarette package warning labels in tobacco control, the very general health warnings messages (HWMs) on cigarette packaging in China have shown limited effectiveness in deterring youth from smoking. Therefore, this study investigates the impact of specific and more detailed warning text messages on Chinese young people's risk perception of smoking and their intention to quit.

METHODS

We employed a randomized survey experiment to examine the impact of specific text-based warning labels on Chinese young people's risk perception of smoking and intention to quit. The total effective sample size was 1064 participants. The subjects were divided into three groups: the first group served as the control group, which was shown the existing cigarette package warning labels; the second group was shown cigarette package warning labels related to cardiovascular, digestive, and respiratory diseases; and the third group was shown cigarette package warning labels related to sexual dysfunction.

RESULTS

The respiratory disease-related warnings significantly increased young people's awareness of smoking-related respiratory risks (p<0.01). The impact of warning labels for the three common diseases on enhancing young people's overall risk perception of smoking (p<0.05) and their intention to quit exhibited only weak statistical significance (p<0.05). In contrast, warning labels related to sexual dysfunction significantly increased young people's risk perception of smoking (p<0.001) and their intention to quit (p<0.001), with a much higher level of statistical significance compared to those related to the other three common diseases.

CONCLUSIONS

Detailed descriptions of the risks associated with all four diseases were positively correlated with awareness of smoking-related harm and the intention to quit. However, warnings related to sexual dysfunction had a greater level of statistical significance compared to those related to the other three common diseases. This stronger significance may be attributed to young people's heightened concern about sexual dysfunction.

Smoking increases risk of complication after musculoskeletal surgery: analysis of single immune parameter to predict complication risk

Smoking is the most significant and modifiable risk factor for a range of conditions, including cancer, cardiovascular and respiratory diseases. Furthermore, it significantly reduces bone mass and increases the risk of fragility fractures due to its detrimental effects on bone metabolism and regeneration. Moreover, smoking is a known cause of chronic systemic inflammation, leading to an imbalance of cytokines. Comprehending the pathological mechanisms that underlie cytokine production and its impact on post-surgical healing is essential to prevent post-surgical complications. The present study recruited a total of 1144 patients, including 897 patients, among them non-smokers (N = 413), current smokers (N = 201) and ex-smokers (N = 283). Human proteome profiler arrays were used to screen for smoking-dependent differences in the serum cytokine and protein profiles, after matching samples for age, gender, body mass index (BMI), alcohol use, and diabetes risk. Cytokines and immune checkpoint proteins such as CD28, B7-1, MIG, TGFβ2 and IL-1α/β were quantified by ELISA. Our study demonstrates a comprehensive understanding of the relationship between smoking, the development of complications, the systemic immune inflammation index (SII) and cytokine/protein levels. We found that a comparison of non-smokers, former smokers, and active smokers in our study cohort did not exhibit significantly altered cytokine and protein serum levels although other studies reported differences between smokers and non-smokers. We were unable to identify single blood circulating markers that could predict complications in smokers after trauma. However, we found the ratio of women to men to be inverted between non-smokers and active smokers resulting in a ratio of 0.62 in smokers. Furthermore, we demonstrate a higher complication rate, longer hospitalizations and elevated SII values among smokers, indicating an involvement of the immune system. See also the graphical abstract(Fig. 1).

Prevalence of cigarette use and addiction among Chinese females by age and province: Findings from nationwide China Health Literacy Survey during 2018-19

BACKGROUND

The prevalence of cigarette smoking among women is significantly different from that of men, however, cigarette use by women is little known. The study aims to describe cigarette use prevalence and patterns among Chinese females by age and province.

METHODS

This study was based on the 2018 China Health Literacy Survey (2018 CHLS), a nationally representative cross-sectional study, and our analysis included 43,319 female participants aged 20-69 with valid data. The prevalence of cigarette use was estimated overall by sociodemographic factors and weighted based on the census population data. The logistic regression model was conducted to estimate adjusted odds ratios (aORs) and 95% confidence intervals (CIs) for the risk factors associated with cigarette use and dependency.

RESULTS

In China, the estimated female current cigarette use prevalence was 1.85%, with over half of the population suffering from tobacco dependence (7.34 million). Jilin Province has the highest cigarette prevalence among women (10.59%), while Fujian Province has the lowest (0.27%). Participants over 60 years old (aOR=1.61, 95%CI=1.20-2.14), single (aOR=1.54, 95%CI=1.07-2.21), with primary education (aOR=1.93, 95%CI=1.47-2.52) were more likely to smoke. The age of smoking initiation among women intergenerational advanced, and compared to the cigarette users without tobacco dependence, those who have tobacco dependence start smoking earlier in all age groups (25.69 years vs. 19.36 years, p<0.001).

CONCLUSIONS

The cigarette use prevalence among Chinese women was 1.85%, and there are significant differences among provinces. We noted a trend of women initiating smoking at increasingly younger ages, particularly among those with tobacco dependence.

Gender-specific genetic and epigenetic signatures in cardiovascular disease

Cardiac sex differences represent a pertinent focus in pursuit of the long-awaited goal of personalized medicine. Despite evident disparities in the onset and progression of cardiac pathology between sexes, historical oversight has led to the neglect of gender-specific considerations in the treatment of patients. This oversight is attributed to a predominant focus on male samples and a lack of sex-based segregation in patient studies. Recognizing these sex differences is not only relevant to the treatment of cisgender individuals; it also holds paramount importance in addressing the healthcare needs of transgender patients, a demographic that is increasingly prominent in contemporary society. In response to these challenges, various agencies, including the National Institutes of Health, have actively directed their efforts toward advancing our comprehension of this phenomenon. Epigenetics has proven to play a crucial role in understanding sex differences in both healthy and disease states within the heart. This review presents a comprehensive overview of the physiological distinctions between males and females during the development of various cardiac pathologies, specifically focusing on unraveling the genetic and epigenetic mechanisms at play. Current findings related to distinct sex-chromosome compositions, the emergence of gender-biased genetic variations, and variations in hormonal profiles between sexes are highlighted. Additionally, the roles of DNA methylation, histone marks, and chromatin structure in mediating pathological sex differences are explored. To inspire further investigation into this crucial subject, we have conducted global analyses of various epigenetic features, leveraging data previously generated by the ENCODE project.

Prevalence and factors associated with second hand smoke exposure among a sample of pregnant women in Cairo, Egypt

PURPOSE

This study estimated the prevalence of and factors associated with secondhand smoke (SHS) exposure, and assessed attitudes and knowledge about SHS among pregnant women in Cairo, Egypt.

METHODS

Pregnant women in the third trimester were recruited to participate in a survey assessing tobacco smoking and SHS exposure during their current pregnancy. Participants were recruited from three antenatal clinics in Cairo, Egypt, from June 2015 to May 2016. We examined differences in sociodemographic characteristics and SHS exposure, attitudes, and knowledge by smoking/SHS status. We used multivariable ordinary least squares regression to examine the association between husbands' smoking and pregnant women's mean daily hours of SHS exposure, adjusting for women's smoking status, age group, education, and urban (vs. suburban/rural) residence.

RESULTS

Of two hundred pregnant women aged 16-37 years, about two-thirds (69%) had a husband who smoked tobacco. During their current pregnancy, most women reported being non-smokers (71%), and 38% of non-smokers reported being SHS-exposed. Non-smokers exposed to SHS tended to live in more rural areas and have husbands who smoked in the home. In adjusted analyses, having a husband who smoked was significantly associated with a greater mean number of hours of SHS exposure per day exposed, and this difference was driven by husbands who smoked in the home (p < 0.001). Women in the SHS-exposed group were less likely than other groups to agree that SHS exposure was harmful to their own or their future child's health; however, all groups agreed that SHS was harmful to newborn health.

CONCLUSION

Among our sample of pregnant women in Cairo, Egypt, there was a high rate of SHS exposure as well as misconceptions about the safety of SHS exposure to a developing fetus. Our findings suggest a need for targeted education and gender-sensitive messaging about SHS exposure, along with improved enforcement of existing tobacco control policies.

How do self-exempt beliefs affect intentions to quit smoking? An exploration of the mediating role of threat appraisal and coping appraisal

Introduction

Numerous smokers are cognizant of the detrimental effects associated with this habit yet exhibit a persistent reluctance to cease their tobacco consumption. Self-exempt beliefs serve as an obstacle to the cessation of this addictive behavior. This research explored the impact of self-exempt beliefs on the readiness to quit smoking based on the Protection Motivation Theory (PMT) model and the mediating roles of threat appraisal and coping appraisal.

Methods

Self-exempt beliefs, PMT constructs, and the intention to quit smoking constituted the theoretical model. The questionnaires were collected from 488 Chinese adult male smokers based on snowball sampling. Exploratory Factor Analysis (EFA) was used to examine the underlying factor structure of the pre-designed self-exempt beliefs scale. The reliability, validity, path coefficients, and explanatory power of the model were calculated using Partial Least Squares Structural Equation Modeling (PLS-SEM).

Results and discussion

The results showed that : (1) three common factors (skeptic beliefs, bulletproof beliefs, and "worth it" beliefs) with a total of 11 items were retained after EFA; (2) skeptic beliefs and "worth it" beliefs had a significantly negative effect on both threat appraisal and coping appraisal, while bulletproof beliefs did not; (3) bulletproof beliefs had a significantly positive direct impact on intention to quit, "worth it" beliefs had a significantly negative direct impact on intention, while skeptic beliefs had no significantly direct impact on intention; (4) threat appraisal and coping appraisal positively and significantly predicted cessation intention; and (5) threat appraisal and coping appraisal, as two main cognitive processes, acted as full mediations between skeptic beliefs and the intention to quit, as complementary partial mediations between "worth it" beliefs and the intention, and as non-mediation between bulletproof beliefs and the intention. Our findings suggest that efforts to undermine or "prevent" these self-exempt beliefs, particularly "worth it" and skeptic beliefs, may be an effective tactic for health communication interventions for quitting smoking.

Risk Factors and Cellular Differences in Heart Failure: The Key Role of Sex Hormones

Patients with heart failure are conventionally stratified into phenotypic groups based on their ejection fraction. The aim of this stratification is to improve disease management with a more targeted therapeutic approach. A further subdivision based on patient gender is justified. It is recognized that women are underrepresented in randomized controlled clinical trials, resulting in limited clinical and molecular differentiation between males and females. However, many observational studies show that the onset, development, and clinical course of the disease may substantially differ between the two sexes. According to the emerging concept of precision medicine, investigators should further explore the mechanisms responsible for the onset of heart failure due to sex differences. Indeed, the synergistic or opposing effects of sex hormones on the cardiovascular system and underlying heart failure mechanisms have not yet been clarified. Sex hormones, risk factors impact, and cardiovascular adaptations may be relevant for a better understanding of the intrinsic pathophysiological mechanisms in the two sexes. Despite the differences, treatment for HF is similar across the whole population, regardless of sex and gender. In our review, we describe the main differences in terms of cardiovascular dysfunction, risk factors, and cellular signaling modifications related to the hormonal pattern.

A roadmap for sex- and gender-disaggregated health research

Sex and gender are fundamental aspects of health and wellbeing. Yet many research studies fail to consider sex or gender differences, and even when they do this is often limited to merely cataloguing such differences in the makeup of study populations. The evidence on sex and gender differences is thus incomplete in most areas of medicine. This article presents a roadmap for the systematic conduct of sex- and gender-disaggregated health research. We distinguish three phases: the exploration of sex and gender differences in disease risk, presentation, diagnosis, treatment, and outcomes; explaining any found differences by revealing the underlying mechanisms; and translation of the implications of such differences to policy and practice. For each phase, we provide critical methodological considerations and practical examples are provided, taken primarily from the field of cardiovascular disease. We also discuss key overarching themes and terminology that are at the essence of any study evaluating the relevance of sex and gender in health. Here, we limit ourselves to binary sex and gender in order to produce a coherent, succinct narrative. Further disaggregation by sex and gender separately and which recognises intersex, non-binary, and gender-diverse identities, as well as other aspects of intersectionality, can build on this basic minimum level of disaggregation. We envision that uptake of this roadmap, together with wider policy and educational activities, will aid researchers to systematically explore and explain relevant sex and gender differences in health and will aid educators, clinicians, and policymakers to translate the outcomes of research in the most effective and meaningful way, for the benefit of all.

A Functional Genomics Review of Non-Small-Cell Lung Cancer in Never Smokers

There is currently a dearth of information regarding lung cancer in never smokers (LCINS). Additionally, there is a difference in somatic mutations, tumour mutational burden, and chromosomal aberrations between smokers and never smokers (NS), insinuating a different disease entity in LCINS. A better understanding of actionable driver alterations prevalent in LCINS and the genomic landscape will contribute to identifying new molecular targets of relevance for NS that will drastically improve outcomes. Differences in treatment outcomes between NS and smokers, as well as sexes, with NSCLC suggest unique tumour characteristics. Epidermal growth factor receptor (EGFR) tyrosine kinase mutations and echinoderm microtubule-associated protein-like 4 anaplastic lymphoma kinase (EML4-ALK) gene rearrangements are more common in NS and have been associated with chemotherapy resistance. Moreover, NS are less likely to benefit from immune mediators including PD-L1. Unravelling the genomic and epigenomic underpinnings of LCINS will aid in the development of not only novel targeted therapies but also more refined approaches. This review encompasses driver genes and pathways involved in the pathogenesis of LCINS and a deeper exploration of the genomic landscape and tumour microenvironment. We highlight the dire need to define the genetic and environmental aspects entailing the development of lung cancer in NS.

Gender and socioeconomic disparities in global burden of chronic kidney disease due to glomerulonephritis: A global analysis

AIM

To investigate the gender and socioeconomic disparities in the global burden of chronic kidney disease (CKD) due to glomerulonephritis from 1990 to 2019.

METHODS

Data were extracted from the global burden of diseases (GBD) 2019 study, including incidence, prevalence and disability-adjusted life-years (DALYs). Estimated annual percentage changes (EAPCs) were calculated to quantify the temporal trends in age-standardized rate (ASR) of CKD due to glomerulonephritis. Paired t-test, paired Wilcoxon signed-rank test and Spearman correlation were performed to analyse the association and gender disparity in CKD due to glomerulonephritis.

RESULTS

Globally, incident cases of CKD due to glomerulonephritis increased 81% from 9 557 397 in 1990 to 17 308 071 in 2019. The age-standardized incidence rate increased by 1.47 compared with 1990 and DALYs increased by 1.35 compared with 1990 (per 100 000). The number of patients with CKD due to glomerulonephritis in low-middle SDI (3829917) and middle SDI (6268817) regions accounts for more than 55% of the total cases. CKD due to glomerulonephritis caused a higher burden including the incidence rate (p < .0001) and DALY rate (p < .0001) in men compared to women. The age-standardized DALY rate was negatively correlated with SDI (ρ = -0.64, p < .001). In the analysis of risk factors for DALYs, male individuals had a larger burden of hypertension, high BMI and high sodium diet in the DALY rates than female subjects.

CONCLUSION

The burden of CKD due to glomerulonephritis was more skewed towards developing and less developed economies and differed by gender, so certain nations should implement far more focused and targeted policies.

Evolution of the Cross-Sectional Area of the Osseous Lumbar Spinal Canal across Decades: A CT Study with Reference Ranges in a Swiss Population

Spinal canal dimensions may vary according to ethnicity as reported values differ among studies in European and Chinese populations. Here, we studied the change in the cross-sectional area (CSA) of the osseous lumbar spinal canal measured in subjects from three ethnic groups born 70 years apart and established reference values for our local population. This retrospective study included a total of 1050 subjects born between 1930 and 1999 stratified by birth decade. All subjects underwent lumbar spine computed tomography (CT) as a standardized imaging procedure following trauma. Three independent observers measured the CSA of the osseous lumbar spinal canal at the L2 and L4 pedicle levels. Lumbar spine CSA was smaller at both L2 and L4 in subjects born in later generations (p < 0.001; p = 0.001). This difference reached significance for patients born three to five decades apart. This was also true within two of the three ethnic subgroups. Patient height was very weakly correlated with the CSA at both L2 and L4 (r = 0.109, p = 0.005; r = 0.116, p = 0.002). The interobserver reliability of the measurements was good. This study confirms the decrease of osseous lumbar spinal canal dimensions across decades in our local population.

Smoking and diabetes: sex and gender aspects and their impact on vascular diseases

Smoking and diabetes mellitus (DM) have been identified as two major cardiovascular risk factors for many years. In the field of cardiovascular diseases, considering sex differences, or gender differences, or both has become an essential element in moving toward equitable and quality healthcare. We reviewed the impact of sex or gender on the link between smoking and DM. The risk of type 2 DM (T2DM) due to smoking has been established in both sexes at the same level. As is the case in the general population, the prevalence of smoking in those with DM is higher in men than in women, although the decrease in smoking observed in recent years is more pronounced in men than in women. Regarding chronic DM complications, smoking is an independent risk factor for all-cause mortality, as well as macrovascular and microvascular complications, in both sexes. Nevertheless, in T2DM, the burden of smoking appears to be greater in women than in men for coronary heart disease morbidity, women having a 50% higher risk of fatal coronary event. Women are more dependent to nicotine, cumulate psychosocial barriers to quitting smoking, and are more likely to gain weight, which might make it more difficult for them to quit smoking. Smoking cessation advice and treatments should take into account gender differences to improve the success and long-term maintenance of abstinence in people with and without DM. This might include interventions that address emotions and stress in women or designed to reach specific populations of men.

Influence of cigarettes on myocardial injury in healthy population after exposure to high altitude over 5000 m

BACKGROUND

Myocardial injury (MI) is a severe complication once subjected to hypoxic condition at high altitude. Little evidence exists about the association of cigarettes and MI at high altitude, especially over 5000 m. In the present study, we intend to explore the influence of cigarettes on MI in healthy population after travelling to this extreme environment.

METHODS

Physical examination was performed in population at Pamirs plateau during November and December 2020. All participants were divided into cigarette group or control group. MI was diagnosed based on lactate dehydrogenase (LDH), creatine kinase (CK), creatine kinase isoenzymes (CK-MB) and aspartate amino transferase (AST).

RESULTS

311 people were included, 58 of whom developed MI, accounting for 18.6 %. Participants in cigarette group were all male, and younger than those in control group. There was longer exposure time in cigarette group. Compared with control group, red blood cell counting, hemoglobin (HGB) and hematocrit in cigarette group were significantly increased, while heart rate was significantly decreased. Cigarettes were found to significantly upregulate the level of CK-MB and LDH. After adjustment with age, sex, body mass index, altitude and exposure time as covariables, 108 male participants remained in each group, showing that none of clinical indexes had significant difference between the two groups. Logistic regression analysis revealed that female sex and oxygen saturation (SO₂) were independent risk factors for MI in non-smokers while HGB was independent risk factor in smokers. By using Spearman correlation analysis, four myocardial enzymes were not relevant with the level of SO₂ in non-smokers. For smokers, HGB was found to be in significant positive correlation with LDH.

CONCLUSION

Our study suggested that exposure to high altitude over 5000 m could abrogate the impact of cigarettes on MI in healthy population. The independent factors affecting the occurrence of MI were distinctive depending on current smoking status.

A 10-Year Cardiovascular Risk in Adults with Different Levels of Spiritual Health: Tehran Lipid and Glucose Study

Background

Previous studies have shown that spiritual experience may reduce cardiovascular disease (CVDs). However, little is known about the relationship between spiritual health and the gender-specific risk of CVDs in communities with different cultures.

Methods

A total of 3249 individuals (53.7% female, 75.0% middle-aged) participated in the Tehran Lipid and Glucose Study (TLGS) from 2015 to 2017 were included. Based on the ACC/AHA pooled cohort equation, CVD risk over ten years was examined. Spiritual health was measured using a developed tool for measuring spiritual health in Muslim populations (SHIMA-48). Linear regression models were used to assess the association between spiritual health and ACC/AHA risk scores. The natural logarithm scale was calculated to consider the normal distribution hypothesis of the regression model.

Results

The current results suggest a slight but significant increase in the mean of spiritual health in women compared to men in both cognitive/emotional and behavioral dimensions (P < 0.001). In both sexes, a higher prevalence of smoking was observed in participants with lower levels of spiritual health (P < 0.004). In men, compared to those with a low level of spiritual health (the first tertile), the logarithm of the ACC-AHA risk score was reduced by 0.11 (P = 0.004) and 0.18 (P < 0.001) for those in the second and third tertiles of spiritual health, respectively. This result may be attributed to higher cigarette smoking among the latter group. Similar results were not observed in women.

Conclusions

Current results indicate a gender-specific association between spiritual health and cardiovascular disease risk. Our findings imply that promoting spiritual health can be considered an effective strategy in future preventive interventions, primarily by controlling the desire to smoke in men.

Are Women's Empowerment and Income Inequality Associated with Excess Weight in Latin American Cities?

While income gradients and gender inequalities in excess weight have been noted elsewhere, data from Latin American cities is lacking. We analyzed gender-specific associations between city-level women's empowerment and income inequality with individual-level overweight/obesity, assessing how these associations vary by individual education or living conditions within cities in Latin America. Data came from national surveys and censuses, and was compiled by the SALURBAL project (Urban Health in Latin America). The sample included 79,422 individuals (58.0% women), living in 538 sub-cities, 187 cities, and 8 countries. We used gender-stratified Poisson multilevel models to estimate the Prevalence Rate Ratios (PRR) for overweight/obesity (body mass index ≥ 25 kg/m2) per a unit change in city-level women's empowerment (proxied by a score that measures gender inequalities in employment and education) and income inequality (proxied by income-based Gini coefficient). We also tested whether individual education or sub-city living conditions modified such associations. Higher city labor women's empowerment (in women) and higher city Gini coefficient (in men) were associated with a lower prevalence of overweight/obesity (PRR = 0.97 (95%CI 0.94, 0.99) and PRR = 0.94 (95%CI 0.90, 0.97), respectively). The associations varied by individual education and sub-city living conditions. For labor women's empowerment, we observed weakened associations towards the null effect in women with lower education and in residents of sub-cities with worse living conditions (men and women). For the Gini coefficient, the association was stronger among men with primary education, and a negative association was observed in women with primary education. Our findings highlight the need for promoting equity-based policies and interventions to tackle the high prevalence of excess weight in Latin American cities.

Gender differences in social environmental changes associated with smoking: a cross-sectional study from Chinese internal migrants

OBJECTIVES

To identify clues for women's tobacco control, this study analyses the gender differences in social environmental changes associated with smoking and the interaction between the environment and individuals' social integration.

DESIGN, SETTING AND PARTICIPANTS

A cross-sectional design and secondary analysis were used among Chinese internal migrants. Data were from the 2012 Migrant Dynamics Monitoring Survey in China with participants aged 15-59 years old (75 416 women and 83 140 men) who resided in cities for more than 1 month.

PRIMARY AND SECONDARY OUTCOME MEASURES

Social environmental changes were measured by differences in smoking prevalence and women's empowerment between the migrant-receiving province (MRP) and migrant-sending province (MSP). Social participation and duration of stay (DOS) were adopted as indicators of social integration. Stratified analysis and binary logistic regression models were used to determine the dependent variable (smoking status) and environmental changes after controlling for age, education, income and happiness.

RESULTS

Differences in the smoking prevalence environment (lower in MRP, OR 0.70, 95% CI 0.60 to 0.83; higher rate in MRP, OR 1.79, 95% CI 1.35 to 2.37) and women's empowerment (lower rate in MRP, OR 0.80, 95% CI 0.68 to 0.97; higher rate in MRP, OR 1.15, 95% CI 1.00 to 1.33) between MRP and MSP were positively correlated with women's smoking. In men, however, migrating to an area with lower smoking prevalence could not reduce smoking risk, whereas moving to an area with higher women's empowerment could. A long DOS was an independent risk factor for smoking in women (ranged from 1.20 to 2.00 in various environmental changes scenarios) but a protective factor for men. An interaction between environmental changes and social integration could not be verified.

CONCLUSIONS

Tobacco control strategies should consider gender differences, especially women who are experiencing social environmental changes.

Pattern and Predictors of Tobacco Use Among Undergraduates in Three Tertiary Institutions in North-Western Nigeria

BACKGROUND

Tobacco use is associated with medical, social and economic problems. There is paucity of data on tobacco use among undergraduates in northern Nigeria. This study assessed pattern and predictors of tobacco use among undergraduates in Zaria, North-western Nigeria.

METHOD

It was a cross-sectional study of undergraduates in three tertiary institutions. Multi-stage sampling technique was used to select 1,080 undergraduates. Data was collected using a questionnaire adapted from Global Adult Tobacco Survey and Global Youth Tobacco Survey. Bi-variate analysis was used to identify independent variables showing statistically significant association with current tobacco use. These were entered into step-wise logistic regression.

RESULTS

Their median age was 24 years (range:15-47). Prevalence of current tobacco use was 27.0%. About 58.7% smoked tobacco daily and 40.0% used smokeless tobacco daily. Commonest places where tobacco was used were off campus accommodation (30.2%), social center (30.2%) and bar or club (28.1%). Predictors of tobacco use were being a male [2.64(1.82-3.84)], married [2.33(1.49-3.70)], experiencing tobacco promotional activity [1.56(1.12-2.17)], willing to use promotional objects [2.06(1.35-3.14)], using of promotional objects [2.74(1.90-3.96)], and exposure to secondhand smoke [14.10(4.16-47.81)]. Predictors of non-use of tobacco were spending two years or less awaiting university admission [0.65 (0.46-0.91)], parents currently together [0.48(0.33-0.69)], and supporting ban on tobacco [0.34 (0.23-0.48)].

CONCLUSION

Prevalence of tobacco use and expenditure on tobacco were high. University authorities should commence programs to identify tobacco users and encourage cessation. The findings also highlight the need to establish effective tobacco surveillance system that includes students of tertiary institutions.

Cigarette smoke-induced trophoblast cell ferroptosis in rat placenta and the effects of L-arginine intervention

Cigarette smoke (CS) disrupts placental development, and impairs fetal health and maternal fertility, thus resulting in low birth weight, premature delivery, and spontaneous abortion; however, the underlying mechanisms remain unclear. This study investigated the mechanism through which CS impairs placental trophoblast cell viability and function. An in vivo study in pregnant rats exposed to CS indicated that CS- exposure decreased antioxidant factors expression and blocked NRF2 activation in the placenta. Anti-ferroptosis regulators expression was downregulated, and pro-ferroptosis regulators expression was upregulated in placentas from CS-exposed rats. Further analysis revealed that cigarette smoke extract (CSE) led to peroxins downregulation and decreased the number of peroxisomes. An in vitro study in HTR-8/SVneo(HTR-8) cells showed that CSE led to free iron and ROS accumulation, and subsequently induced lipid peroxidation and cell death. Ferroptosis inhibitors and the antioxidant L-arginine (ARG) partially inhibited CSE-induced cell death. ARG partially alleviated the toxic effects of CSE by promoting antioxidant factors expression in placenta and suppressing HTR-8 cell ferroptosis. Knockdown of PEX14, a peroxisome biogenesis marker, led to the downregulation of multiple PEXs, thus increasing intracellular H₂O₂ levels and inducing HTR-8 cell ferroptosis. These findings demonstrated that ferroptosis is responsible for CSE-induced trophoblast cell death and suggest that peroxisome dysfunction is involved in CSE-induced ferroptosis. Therefore, CSE-induced ferroptosis may serve as a potential therapeutic target for preventing adverse pregnancy outcomes.

Patterns of tobacco use in low and middle income countries by tobacco product and sociodemographic characteristics: nationally representative survey data from 82 countries

OBJECTIVES

To determine the prevalence and frequency of using any tobacco product and each of a detailed set of tobacco products, how tobacco use and frequency of use vary across countries, world regions, and World Bank country income groups, and the socioeconomic and demographic gradients of tobacco use and frequency of use within countries.

DESIGN

Secondary analysis of nationally representative, cross-sectional, household survey data from 82 low and middle income countries collected between 1 January 2015 and 31 December 2020.

SETTING

Population based survey data.

PARTICIPANTS

1 231 068 individuals aged 15 years and older.

MAIN OUTCOME MEASURES

Self-reported current smoking, current daily smoking, current smokeless tobacco use, current daily smokeless tobacco use, pack years, and current use and use frequencies of each tobacco product. Products were any type of cigarette, manufactured cigarette, hand rolled cigarette, water pipe, cigar, oral snuff, nasal snuff, chewing tobacco, and betel nut (with and without tobacco).

RESULTS

The smoking prevalence in the study sample was 16.5% (95% confidence interval 16.1% to 16.9%) and ranged from 1.1% (0.9% to 1.3%) in Ghana to 50.6% (45.2% to 56.1%) in Kiribati. The user prevalence of smokeless tobacco was 7.7% (7.5% to 8.0%) and prevalence was highest in Papua New Guinea (daily user prevalence of 65.4% (63.3% to 67.5%)). Although variation was wide between countries and by tobacco product, for many low and middle income countries, the highest prevalence and cigarette smoking frequency was reported in men, those with lower education, less household wealth, living in rural areas, and higher age.

CONCLUSIONS

Both smoked and smokeless tobacco use and frequency of use vary widely across tobacco products in low and middle income countries. This study can inform the design and targeting of efforts to reduce tobacco use in low and middle income countries and serve as a benchmark for monitoring progress towards national and international goals.

Molecular Biology and Therapeutic Perspectives for K-Ras Mutant Non-Small Cell Lung Cancers

In non-small cell lung cancer (NSCLC) the most common alterations are identified in the Kirsten rat sarcoma viral oncogene homolog (KRAS) gene, accounting for approximately 30% of cases in Caucasian patients. The majority of mutations are located in exon 2, with the c.34G > T (p.G12C) change being the most prevalent. The clinical relevance of KRAS mutations in NSCLC was not recognized until a few years ago. What is now emerging is a dual key role played by KRAS mutations in the management of NSCLC patients. First, recent data report that KRAS-mutant lung AC patients generally have poorer overall survival (OS). Second, a KRAS inhibitor specifically targeting the c.34G > T (p.G12C) variant, Sotorasib, has been approved by the U.S. Food and Drug Administration (FDA) and by the European Medicines Agency. Another KRAS inhibitor targeting c.34G > T (p.G12C), Adagrasib, is currently being reviewed by the FDA for accelerated approval. From the description of the biology of KRAS-mutant NSCLC, the present review will focus on the clinical aspects of KRAS mutations in NSCLC, in particular on the emerging efficacy data of Sotorasib and other KRAS inhibitors, including mechanisms of resistance. Finally, the interaction between KRAS mutations and immune checkpoint inhibitors will be discussed.

Estimates of incidence, prevalence, mortality, and disability-adjusted life years of lung cancer in Iran, 1990-2019: A systematic analysis from the global burden of disease study 2019

BACKGROUND

Lung cancer is one of the leading cancers, with a high burden worldwide. As a developing country, Iran is facing with population growth, widespread tobacco use, demographic and epidemiologic changes, and environmental exposures, which lead to cancers becoming a severe concern of public health in Iran. We aimed to examine the burden of lung cancer and its risk factors in Iran.

METHODS

We utilized the Global Burden of Disease 2019 data and analyzed the total burden of the lung cancer and seven related risk factors by sex, age at national and sub-national levels from 1990 to 2019.

RESULTS

The lung cancer age-standardized death rate increased from 11.8 (95% Uncertainty Interval: 9.7-14.4) to 12.9 (11.9-13.9) per 100,000 between 1990 and 2019. This increase was among women from 5 (4.2-7.1) to 8 (7.2-8.8) per 100,000; in contrast, there was a decline among men from 18.5 (14.8-22.6) to 17.8 (16.2-19.4) per 100,000. The burden of lung cancer is concentrated in the advanced age groups. Smoking with 53.5% of total attributable deaths (51.0%-55.9%) was the leading risk factor. At the provincial level, there was a wide range between the lowest and highest, from 8.3 (7.0-10.0) to 19.1 (16.4-22.0) per 100,000 population in the incidence rate and from 8.7 (7.3-10.3) to 20.6 (17.7-24.0) per 100,000 population in mortality rate, respectively in Tehran and West Azerbaijan provinces in 2019.

CONCLUSION

The increasing trend of lung cancer burden among the entire Iranian population, the inter-provincial disparities, and the significant rise in burden of this cancer in women necessitate the urgent implementation and development of policies to prevent and manage lung cancer burden and strategies to reduce exposure to risk factors.

[Benefits of the cigarette tax in Mexico, by sex and income quintileBenefícios do imposto sobre cigarros no México: análise por sexo e quintil de renda]

Objective

Estimate economic and health benefits, by sex and income quintile, of tax-based cigarette price increases in Mexico.

Methods

An extended cost-effectiveness analysis (ECEA) model was used to estimate distributional benefits for women and men in the scenario of a 44% increase in the price of cigarettes (from 56.4 Mexican pesos [MX$] to MX$81.2 per pack), as a result of tripling the current specific excise tax (from MX$0.49/cigarette to MX$1.49/cigarette). The model was calibrated with official national information sources.

Results

With a tax increase of one peso per cigarette, about 1.5 million smokers would quit (351 300 women and 1.1 million men). This would prevent approximately 630 000 smoking-attributable premature deaths. Reducing the burden of disease would save the health sector close to MX$42.8 billion and prevent more than 250 000 people (including 50 200 women smokers) from falling into poverty. It would also result in an additional MX$16.2 billion in revenue per year, of which the lowest income quintile would contribute less than 3% (1% for low-income women).

Conclusions

The tobacco epidemic has clearly differentiated patterns between women and men, reflecting a gender component. While the tobacco tax in Mexico would have great benefits with respect to the current state of the epidemic, this could also contribute to the broader goal of social justice by reducing gender inequities.

What Helps and What Hinders the Creation of a Smoke-free Home: A Qualitative Study of Fathers in Scotland

INTRODUCTION

Few studies have explored fathers' views and experiences of creating a smoke-free home, with interventions largely targeting mothers. This study aimed to identify barriers and facilitators to fathers creating a smoke-free home, to inform future intervention development.

METHODS

Eighteen fathers who were smokers and lived in Scotland were recruited from Dads' community groups, Early Years Centres and through social media advertising. Semi-structured interviews explored their views and experiences of creating a smoke-free home. A theory-informed thematic analysis using the COM-B model highlighted ways in which capability, opportunity, and motivations shaped fathers' home smoking behaviors.

RESULTS

Several fathers understood the health risks of second-hand smoke exposure through public health messaging associated with recent smoke-free legislation prohibiting smoking in cars carrying children. Limited understanding of effective exposure reduction strategies and personal mental health challenges reduced some fathers' ability to create a smoke-free home. Fathers were keen to maintain their smoke-free home rules, and their motivations for this largely centered on their perceived role as protector of their children, and their desire to be a good role model.

CONCLUSIONS

Fathers' abilities to create a smoke-free home are shaped by a range of capabilities, opportunities, and motivations, some of which relate to their role as a father. Establishing a fuller understanding of the contextual and gender-specific factors that shape fathers' views on smoking in the home will facilitate the development of interventions and initiatives that fathers can identify and engage with, for the broader benefit of families and to improve gender equity and health.

IMPLICATIONS

Our findings can inform future development of father-centered and household-level smoke-free home interventions. They identify fathers' views and experiences and help reframe smoking in the home as a gendered family-wide issue, which is important in building consensus on how best to support parents to create a smoke-free home. Our findings highlight the need for additional research to develop understanding of the ways in which gender-related aspects of family structures, heterosexual relationships, and child living arrangements influence home smoking rules and how to tailor interventions accordingly.

Sex-disaggregated data matters: tracking the impact of COVID-19 on the health of women and men

Sex and gender matter to health outcomes, but despite repeated commitments to sex-disaggregate data in health policies and programmes, a persistent and substantial absence of such data remains especially in lower-income countries. This represents a missed opportunity for monitoring and identifying gender-responsive, evidence-informed solutions to address a key driver of the pandemic. In this paper we review the availability of national sex-disaggregated surveillance data on COVID-19 and examine trends on the testing-to-outcome pathway. We further analyse the availability of data according to the economic status of the country and investigate the determinants of sex differences, including the national gender inequality status (according to a global index) in each country. Results are drawn from 18 months of global data collection from over 200 countries. We find differences in COVID-19 prevention behaviours and illness outcomes by sex, with lower uptake of vaccination and testing plus an elevated risk of severe disease and death among men. Supporting and maintaining the collection, collation, interpretation and presentation of sex-disaggregated data requires commitment and resources at subnational, national and global levels, but provides an opportunity for identifying and taking gender-responsive action on health inequities. As a first step the global health community should recognise, value and support the importance of sex-disaggregated data for identifying and tackling an inequitable pandemic.

A Comparative Analysis of Smoking Rates by Sex and Socioeconomic Status Among Ultra-Orthodox City Residents and Non-Ultra-Orthodox City Residents in Israel

The aim of this cross-sectional study is to examine the differences in smoking rates between ultra-Orthodox Jews and non-ultra-Orthodox Jews and to understand the role of sex and socioeconomic status (SES) in predicting smoking among the two populations. The study population included all Maccabi Healthcare Services members aged 50 or older (N = 30,170) who lived in two cities in the center of Israel: Bnei Brak-a city with a high concentration of ultra-Orthodox, and Ramat Gan-a non-ultra-Orthodox city. After adjusting for age, sex, and SES, the prevalence of smoking in the ultra-Orthodox city was significantly lower than that in the non-ultra-Orthodox city. A significant interaction was found between sex and degree of religiosity in predicting smoking. The smoking differences between men and women in the ultra-Orthodox city were high compared with those in the non-ultra-Orthodox city. Similarly, a significant interaction was found between SES and degree of religiosity in predicting smoking. These results in the effects of sex and SES in predicting smoking between ultra-Orthodox Jews and non-ultra-Orthodox Jews require further research to better understand these differences and plan intervention programs tailored to different populations accordingly.

Is the male disadvantage real? Cross-national variations in sex gaps in COVID-19 incidence and mortality

ABSTRACTAlthough the excess male mortality from COVID-19 is well-known, the variations in sex gaps in incidence and mortality across countries and the sources of such variations are not well understood. This study explored the patterns and the sources of variation in the sex gap in COVID-19 incidence and mortality rates across 100 countries where sex-disaggregated cases and deaths were available as of September 2020. Our results show that there is generally a male disadvantage in both incidence and mortality; however, COVID-19 incidence exhibited a lower male disadvantage (1.2 times higher risk for males) than COVID-19 mortality (1.5 times higher risk for males). The extent of male disadvantages in COVID-19 outcomes across countries varied by societal gender inequalities and behavioural factors. Greater gender equality, both socially and behaviourally, was associated with more equal COVID-19 incidence and mortality between men and women. The findings imply that male disadvantages in COVID-19 outcomes, particularly incidence, are socially determined, whereas further investigation is needed to understand behavioural and biological elements yielding a male disadvantage in mortality.

Influence of excessive daily sleeping and sleep quality on BDNF and NGF serum levels in adolescents

INTRODUCTION

The brain-derived neurotrophic factor (BDNF) and neural growth factor (NGF) are widely expressed in the brain and play an important role in neuroplasticity, neurogenesis, and increased neuronal connections. Previous studies have shown that reduced serum levels of these proteins are associated with disorders in human sleep.

OBJECTIVE

Current study evaluates the prevalence in adolescents of excessive daytime sleepiness (EDS) and sleep quality, and analyzes the influence of these factors on BDNF and NGF serum levels.

METHODS

A cross-section population-based study was conducted with data from a Brazilian birth cohort, with a sample of five hundred and thirteen 18-19-year-old adolescents. Sleep quality was assessed by the Pittsburgh Sleep Quality Index and EDS by Epworth Sleepiness Scale. Neurotrophins serum levels were measured by Luminex™ technology kits. Analysis consisted of marginal structural models which compared people who were exposed and not exposed to sleep quality and EDS.

RESULTS

Poor sleep quality and EDS were detected in 62.57% and 36.35% of the sample. Adolescents with poor sleep quality and EDS had -0.39 (p-value = 0.049) and -0.51 pg/ml in NGF (p-value = 0.009). Individuals with self-reported sleep disorder had lower serum levels of NGF (Coef. -0.41, p-value = 0.045).

CONCLUSION

High prevalence of EDS and low sleep quality in a population of adolescents were evidenced. Poor sleep quality and EDS were associated with lower NGF levels, whilst adolescents with self-reported sleep disorder had lower serum levels of NGF.

Socioeconomic status and tobacco consumption: Analyzing inequalities in China, Ghana, India, Mexico, the Russian Federation and South Africa

INTRODUCTION

Globally, there has been a rapid rise in non-communicable diseases driven by changing lifestyle choices and health behaviors. Different lifestyle choices threaten to exacerbate existing health inequalities, yet evidence monitoring the extent of this impact in emerging economies is lacking. The article sets out to measure the level of wealth-related inequality and its drivers in one of these lifestyle choices, tobacco consumption, among populations aged ≥50 years in six Low- and Middle-Income Countries.

METHODS

The study provides empirical evidence of the inequality in tobacco consumption across wealth groups in China, Ghana, India, Mexico, the Russian Federation and South Africa using the Erreygers’ corrected concentration indices. These inequalities are then decomposed to gain a deeper understanding of the factors and broader social forces driving inequality. The WHO SAGE data set, collected between 2008 and 2010, is used for the analysis.

RESULTS

Current tobacco consumption is concentrated among the poor in China, Ghana, India, and South Africa, and among the wealthy in the Russian Federation and Mexico. The inequalities widen when we focus solely on the male population. Although the results differ by country, the major drivers of inequality include wealth, locality, and gender.

CONCLUSIONS

The focus on tobacco consumption in this age group is key to curbing rising healthcare costs and ensuring longevity. Policies aimed at reducing wealth-related inequalities should especially target high tobacco consumption rates among males, while simultaneously pre-empting and curbing rising rates among women.

Evaluation of pharmacy-led weight management service to minimise the risk of cardiovascular disease

AIMS

The primary aim of the programme was a minimum of a 5% weight reduction of the initial weight, while the secondary outcomes were a reduction in participants' body mass index (BMI), waist circumference (WC), blood pressure (BP), AUDIT-C score and an increase in the Mediterranean diet (MD) score and an improvement in physical activity levels.

METHODS

This 'before and after' study was a 10-week weight management (WM) programme and it was developed and delivered in community pharmacies in Patras chosen for convenience, thus consisting the first service of its type in Greece. The sample size was calculated (n = 96) based on the mean BMI for a Greek male and female individual, and the standard deviation (SD) of weight at baseline of 14 kg.

RESULTS

Nearly every participant enrolled in the 20 participating pharmacies, 97.4% (n = 114/117), achieved the programme's aim, losing at least 5% of their initial weight. The mean percentage of total weight loss of the 117 participants at the 10th week was 8.97% (SD 2.65), and the t-test showed statistically significant results (P-value < 0.001; 95% CI [8.48, 9.45]). A significant reduction in the waist-to-height ratio (WHtR) was observed in both male (P-value = 0.004) and female (P-value < 0.001) participants. The participants' BP and AUDIT-C score and physical activity levels significantly improved (P-value < 0.001), as well as their MD score.

CONCLUSION

This study provides the first evidence that Greek pharmacists have the potential to play an important role within primary healthcare and that after training they are able to provide public health services for both the public's benefit and their clinical role enhancement.

The Impact of Smoking on Clinical Outcomes after Percutaneous Coronary Intervention in Women Compared to Men

Background

For decades, cardiovascular diseases (CVD) have been known as men's disease. However, recent research studies showed that they have become more common in women. Smoking is a strong risk factor for CVD especially that of coronary artery disease (CAD). Several studies reported that women are more susceptible to drastic sequels of smoking than men. There is limited data regarding the impact of smoking on post-revascularization clinical events stratified by gender. This study aimed to investigate if gender significantly changes the incidence of adverse clinical outcomes after percutaneous coronary intervention (PCI) among those with history of smoking.

Methods

Participants were selected from two hospitals from 2003 to 2019. Among patients who had PCI (index PCI), those with stable CAD who underwent elective PCI were included. Exclusion criteria were defined as primary PCI and those with multiple prior revascularizations. Participants were followed up seeking for major adverse cardiac events (MACE) including revascularization (PCI or coronary artery bypass grafting), myocardial infarction, and coronary death in three time intervals according to the time of index PCI (short term: up to 24 hours, mid-term: 24 hours to less than 6 months, and long term: more than 6 months).

Results

Of the 1799 patients, 61% were men and 47.08% had history of smoking (75% of the smokers were men). At the time of index PCI, smokers were significantly younger than nonsmokers. Also, MACE were significantly higher in smokers than nonsmokers, which was particularly pronounced at the long-term interval. In the nonsmokers group, there was no difference in MACE occurrence between men and women. However, of the smokers, women showed significantly higher MACE rate compared with men peers.

Conclusion

Smoking makes women more prone to MACE in comparison to men among patients with stable CAD after PCI with drug-eluting stent.

Substance Use among Street-Connected Children and Adolescents in Ghana and South Africa: A Cross-Country Comparison Study

Using two cross-sectional surveys with a purposive sample of 376 homeless children and adolescents in both Ghana and South Africa, this study was conducted to examine the prevalence, sociodemographic and psychosocial correlates of substance use among street children and adolescents. An interviewer-administered questionnaire was used to obtain information on substance use, sociodemographic and psychosocial variables. Both bivariate and multivariate analyses showed that street-connected adolescents in Ghana reported higher prevalence of lifetime alcohol use and past-month alcohol use than those in South Africa. The protective effect of male gender was not observed in South Africa but significantly more pronounced in Ghana for all substances except past-month marijuana use. Sexual assault, indirect sexual victimization, physical beating, robbery, assault with a weapon and survival sex increased the odds of lifetime alcohol use and past-month alcohol use in Ghana. However, in South Africa, only robbery and assault with a weapon increased the odds of lifetime alcohol use while robbery and sexual assault increased the odds of past-month alcohol use. These results have implications for the development of harm reduction interventions, taking into consideration both the psychosocial and cultural context of substance use.

Global burden of active smoking among people living with HIV on antiretroviral therapy: a systematic review and meta-analysis

BACKGROUND

Although the high burden of both active smoking and human immunodeficiency virus (HIV) is clearly known, the relationship between them is still not well characterized. Therefore, we estimated the global prevalence of active smoking in people living with HIV (PLHIV) on antiretroviral therapy (ART) and investigated the association between exposure to active smoking and risk for suboptimal adherence to ART. Main text: We searched PubMed, Embase, and Web of Science to identify articles published until September 19, 2019. Eligible studies reported the prevalence of active smoking in PLHIV on ART or investigated the association between active smoking and ART adherence; or enough data to compute these estimates. We used a random-effects model to pool data and quantified heterogeneity (I2). The global prevalence of active smoking was 36.1% (95% CI: 33.7-37.2; 329 prevalence data; 462 104 participants) with substantial heterogeneity. The prevalence increased with level of country income; from 10.1% (95% CI: 6.8-14.1) in low-income to 45.2% (95% CI: 42.7-47.7) in high-income countries; P < 0.0001. With regards to the Joint United Nations Programme on HIV/AIDS (UNAIDS) regions, the prevalence was higher in West and Central Europe and North America 45.4% (42.7-48.1) and lowest in the two UNAIDS regions of sub-Saharan Africa: Eastern and Southern Africa 10.7% (95% CI: 7.8-14.0) and West and Central Africa 4.4% (2.9-6.3); P < 0.0001. Globally, we estimated that there were 4 110 669 PLHIV on ART who were active smokers, among which the highest number was from Eastern and Southern Africa (35.9%) followed by Asia and the Pacific (25.9%). Active smoking was significantly associated with suboptimal ART adherence: pooled odds ratio 1.57 (95% CI: 1.37-1.80; I2 = 56.8%; 19 studies; 48 450 participants); even after considering adjusted estimates: 1.67 (95% CI: 1.39-2.01; I2 = 53.0%; 14 studies).

CONCLUSIONS

This study suggests a high prevalence of active smoking in PLHIV on ART and an association between active smoking and ART suboptimal adherence. As such, healthcare providers and policy makers should focus on adopting and implementing tobacco harm reduction strategies in HIV care, especially in sub-Saharan Africa known as epicenter of HIV pandemic with highest number of active tobacco smoking among PLHIV on ART.

National, regional, and global prevalence of cigarette smoking among women/females in the general population: a systematic review and meta-analysis

Background

This systematic and meta-analysis review aimed to provide an updated estimate of the prevalence of ever and current cigarette smoking in women, in geographic areas worldwide, and demonstrate a trend of the prevalence of smoking over time by using a cumulative meta-analysis.

Methods

Following PRISMA guidelines, we conducted a systematic review and meta-analysis of studies published on the prevalence of ever and current cigarette smoking in women. We searched PubMed, Web of Science (ISI), Scopus, and Ovid from January 2010 to April 2020. The reference lists of the studies included in this review were also screened. Data were reviewed and extracted independently by two authors. A random effects model was used to estimate the pooled prevalence of ever and current cigarette smoking in women. Sources of heterogeneity among the studies were determined using subgroup analysis and meta-regression.

Results

The pooled prevalence of ever and current cigarette smoking in women was 28% and 17%, respectively. The pooled prevalence of ever cigarette smoking in adolescent girls/students of the school, adult women, pregnant women, and women with the disease was 23%, 27%, 32%, and 38%, respectively. The pooled prevalence of ever cigarette smoking in the continents of Oceania, Asia, Europe, America, and Africa was 36%, 14%, 38%, 31%, and 32%, respectively.

Conclusions

The prevalence of cigarette smoking among women is very high, which is significant in all subgroups of adolescents, adults, and pregnant women. Therefore, it is necessary to design and implement appropriate educational programs for them, especially in schools, to reduce the side effects and prevalence of smoking among women.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12199-020-00924-y.

Gender Patterns in Immigrants' Health Profiles in France: Tobacco, Alcohol, Obesity and Self-Reported Health

Background: to date, little attention has been given to gender differences in the health of migrants relative to native-born. In this study, we examine the health profile of the largest immigrant groups in metropolitan France, considering several health indicators and with a special interest in the gendered patterns. Methods: The data originate from the 2017 Health Barometer survey representative of metropolitan France. A subsample of 19,857 individuals aged 18-70 years was analysed using modified Poisson regression, and risk ratio estimates (RR) were provided for the different migrant groups regarding alcohol use, current smoking, obesity and less-than-good self-reported health, adjusting for age and educational level. Results: None of the groups of male migrants differs from the native-born in terms of self-reported health, and they have healthier behaviours for alcohol (men from sub-Saharan Africa: 0.42 (0.29-0.61)) and from the Maghreb: 0.30 (0.1-0.54)) and smoking (men from sub-Saharan Africa: 0.64 (0.4-0.84)), with less frequent obesity (men from the Maghreb: 0.61 (0.3-0.95)). The latter, however, more frequently report current smoking (1.21 (1.0-1.46)). For women, less-than-good health is more frequently reported by the groups from sub-Saharan Africa (1.42 (1.1-1.75)) and from the Maghreb (1.55 (1.3-1.84)). Healthier behaviours were found for alcohol (women from overseas départements: 0.38 (0.1-0.85)) and from the Maghreb: (0.18 (0.0-0.57)) and current smoking (women from southern Europe: 0.68 (0.4-0.97), from sub-Saharan Africa: 0.23 (0.1-0.38) and from the Maghreb: 0.42 (0.2-0.61)). Conversely, some were more frequently obese (women from overseas départements: 1.79 (1.2-2.56) and from sub-Saharan Africa: 1.67 (1.2-2.23)). In the latter two groups from Africa, there is a larger relative male excess for tobacco than in the native-born (male-to-female ratios of respectively 2.87 (1.6-5.09) and 3.1 (2.0-4.65) vs 1.13 (1.0-1.20)) and there is a female excess for obesity (0.51 (0.2-0.89) and 0.41 (0.2-0.67)) in contrast with the native-born (1.07 (0.9-1.16)). The female disadvantage in terms of less-than-good self-reported health is more pronounced among migrants from the Maghreb than among the natives (0.56(0.4-0.46) vs. 0.86 (0.8-0.91)). Conclusion: Considering a set of four health indicators, we provide evidence for distinctive gender patterns among immigrants in France. Male immigrants have a healthy behavioural profile in comparison with the natives and no health disadvantage. Female immigrants have a more mixed profile, with a health disadvantage for the non-Western groups from Africa. The contribution to this discordance of socioeconomic factors and gender relations needs to be investigated.

The impact of information about tobacco-related reproductive vs. general health risks on South Indian women's tobacco use decisions

Smokeless tobacco use among Indian women is increasing despite prevention efforts. Evolutionary theories suggest that reproductive-aged women should be more concerned about immediate threats to reproduction than threats to survival occurring late in life. This study therefore compared an anti-tobacco intervention that emphasized near-term reproductive harms to one involving general harms occurring later in life. Scheduled Tribal women (N = 92) from Karnataka, India participated in this study. At baseline, women reported tobacco use and knowledge of harms, provided a saliva sample to assess use, and randomly viewed either a general harms presentation (GHP) or reproductive harms presentation (RHP). At followup, women reported their use, knowledge of harms and intentions to quit, and provided another saliva sample. At baseline, participants were aware of general harms but not reproductive harms. Both interventions increased knowledge of harms. Women in the RHP condition did not list more harms than women in the GHP condition, however, and the RHP was not more effective in reducing tobacco use than the GHP. In the RHP condition fetal health was particularly salient. In the GHP condition, oral health was highly salient, aligning with the local disease ecology and research on tobacco use and attractiveness.

COVID-19 case-fatality rate and demographic and socioeconomic influencers: worldwide spatial regression analysis based on country-level data

OBJECTIVE

To investigate the influence of demographic and socioeconomic factors on the COVID-19 case-fatality rate (CFR) globally.

DESIGN

Publicly available register-based ecological study.

SETTING

Two hundred and nine countries/territories in the world.

PARTICIPANTS

Aggregated data including 10 445 656 confirmed COVID-19 cases.

PRIMARY AND SECONDARY OUTCOME MEASURES

COVID-19 CFR and crude cause-specific death rate were calculated using country-level data from the Our World in Data website.

RESULTS

The average of country/territory-specific COVID-19 CFR is about 2%-3% worldwide and higher than previously reported at 0.7%-1.3%. A doubling in size of a population is associated with a 0.48% (95% CI 0.25% to 0.70%) increase in COVID-19 CFR, and a doubling in the proportion of female smokers is associated with a 0.55% (95% CI 0.09% to 1.02%) increase in COVID-19 CFR. The open testing policies are associated with a 2.23% (95% CI 0.21% to 4.25%) decrease in CFR. The strictness of anti-COVID-19 measures was not statistically significantly associated with CFR overall, but the higher Stringency Index was associated with higher CFR in higher-income countries with active testing policies (regression coefficient beta=0.14, 95% CI 0.01 to 0.27). Inverse associations were found between cardiovascular disease death rate and diabetes prevalence and CFR.

CONCLUSION

The association between population size and COVID-19 CFR may imply the healthcare strain and lower treatment efficiency in countries with large populations. The observed association between smoking in women and COVID-19 CFR might be due to the finding that the proportion of female smokers reflected broadly the income level of a country. When testing is warranted and healthcare resources are sufficient, strict quarantine and/or lockdown measures might result in excess deaths in underprivileged populations. Spatial dependence and temporal trends in the data should be taken into account in global joint strategy and/or policy making against the COVID-19 pandemic.

A gender framework for understanding health lifestyles

PURPOSE

A health lifestyles approach holds promise for understanding change in women's and men's health behaviors and reducing gendered health disparities. The emerging theoretical and empirical literature on health lifestyles (individuals' bundled health behaviors that are shaped by group-based identities and norms) helps elucidate complex disparities in health behaviors, but research is needed on how gender shapes the development of health lifestyles. This study proposed and assessed a dynamic multilevel framework for understanding health lifestyles that draws on insights from contemporary gender and life course scholarship.

DATA

Using the transition from adolescence into adulthood as an empirical case, we analyzed US data from the National Longitudinal Study of Adolescent to Adult Health (Add Health; N = 6605), which followed adolescents through young adulthood, collecting information on their health behaviors and social contexts.

FINDINGS

Latent class analyses showed that health lifestyles differed significantly by gender. Results supported the dynamic multilevel framework, finding more variation in health lifestyle behaviors within genders than between, high levels of change across ages, intersections of gender with age, and socioeconomic status as a structural pathway for gender's influence.

CONCLUSION

Taken together, these findings suggest that conceptualizing gender as a dynamic multilevel system intersecting with other social statuses is fruitful for understanding how health lifestyles form and change. These findings can inform more effective policies to change health behaviors.

'As Long as It Comes off as a Cigarette Ad, Not a Civil Rights Message': Gender, Inequality and the Commercial Determinants of Health

Scholarship on the commercial determinants of health (CDoH) has sought to understand the multiple ways corporate policies, practices and products affect population health. At the same time, gender is recognised as a key determinant of health and an important axis of health inequalities. To date, there has been limited attention paid to the ways in which the CDoH engage with and impact on gender inequalities and health. This review seeks to address this gap by examining evidence on the practices and strategies of two industries-tobacco and alcohol-and their interaction with gender, with a particular focus on women. We first describe the practices by which these industries engage with women in their marketing and corporate social responsibility activities, reinforcing problematic gender norms and stereotypes that harm women and girls. We then examine how tobacco and alcohol companies contribute to gender inequalities through a range of strategies intended to protect their market freedoms and privileged position in society. By reinforcing gender inequalities at multiple levels, CDoH undermine the health of women and girls and exacerbate global health inequalities.

Migration-related changes in smoking among non-Western immigrants in France

Background

Migrants make up a growing share of European populations, and very little is known about the impact of migration on their smoking patterns. We develop a longitudinal analysis of smoking prevalence among native-born and immigrants in France based on retrospective data collected in the 2010 national Baromètre santé health survey.

Methods

Analyses concerned 19 578 individuals aged 18–70 years and born in metropolitan France, in the Maghreb or in sub-Saharan Africa. Person-years with and without smoking were reconstructed using migration and smoking histories and analyzed with discrete-time regression models.

Results

Prior to migration, immigrants from both the Maghreb and sub-Saharan Africa had lower smoking prevalence than the native-born of similar birth cohort, age and education. After migration, the prevalence increased over time among Maghrebin men up to levels beyond those of the native-born (odds ratio: 1.54 [1.09–2.17] for 10 years of residence or more), while it remained much lower throughout among men from sub-Saharan Africa (odds ratio: 0.36 [0.19–0.68] for 10 years of residence or more). Starting at extremely low levels, the prevalence in both groups of women rose considerably after migration. Women from sub-Saharan Africa nearly caught up to the native-born (odds ratio: 0.70 [0.37–1.32] for 10 years of residence or more), but this was not the case for those from the Maghreb (odds ratio: 0.52 [0.33–0.81] for 10 years of residence or more).

Conclusion

The findings uncover the low pre-migration prevalence and the diversity of post-migration trajectories. Tobacco control programs targeting recently arrived migrants would contribute to prevent unhealthy assimilation.

Host, Gender, and Early-Life Factors as Risks for Chronic Obstructive Pulmonary Disease

Although smoking results in lung pathology in many, still not all smokers develop chronic obstructive pulmonary disease (COPD). Roughly a quarter of patients with COPD have never smoked. An understanding of both host and environmental factors beyond smoking that contribute to disease development remain critical to understanding disease prevention and ultimately effectively intervene. In this article, we summarize host factors, including genetics and gender, as well as early-life events that contribute to the development of COPD.

Gender, women, and the future of tobacco control

Purpose

This paper aims to provide a gendered analysis of the WHO Framework Convention on Tobacco Control (FCTC) benchmarked upon the global commitments to women’s health and well-being in the UN Convention on the Elimination of All Forms of Discrimination against Women (CEDAW) and the Beijing Declaration and Platform for Action. It reviews evidence of the global consequences of neglecting women’s tobacco use and health, as well as analyzes persistent issues related to sex and gender that compromise the efficacy of tobacco control and science. Actionable recommendations are made to the Conference of the Parties to the FCTC and other key stakeholders.

Design/methodology/approach

This paper draws upon empirical studies, literature reviews and global health data at the varying intersections of gender, sex, tobacco and global health.

Findings

The global tobacco control framework and its implementation by state governments have been largely gender blind to date with dire health and economic consequences, including inequitable positive outcomes for men compared to women, and an increase in women’s smoking with associated morbidity and mortality. Gender equitable progress in combatting the tobacco epidemic will not be possible without resolving the gender bias, stigmatization, sexism and lack of intersectionality that plague tobacco control policy, research and interventions for cessation and harm reduction.

Originality/value

This paper provides an updated global overview of current trends in women’s tobacco use and comprehensively details the persistent structural barriers in tobacco control and science that limit their capacity to effectively analyze and address tobacco use and its impact on women.

Conscientiousness and Smoking: Do Cultural Context and Gender Matter?

Prior studies have found that conscientiousness has a protective effect against smoking, but evidence for this relationship mostly comes from Western contexts. In societies where smoking is pervasive and less stigmatized, the protective effect of conscientiousness on smoking may be less evident. Moreover, whether smoking is viewed as normal or deviant also may vary by gender norms attached to smoking. Using surveys of Midlife Development in the United States (MIDUS) and Japan (MIDJA), we examined patterns in the association between conscientiousness and smoking status (never, former, current) for men and women. We found that in the United States, where the social unacceptability of smoking has dramatically increased, there is an inverse association between conscientiousness and smoking status for both genders. In Japan, where the stigma attached to smoking operates for women but not men, the association between conscientiousness and smoking status varies by gender. For Japanese men, levels of conscientiousness do not differ across smoking statuses. For Japanese women, those who formerly smoked show lower levels of conscientiousness than those who never smoked and those who currently smoke. We interpret these findings in light of differing cultural and historical backgrounds of smoking for men and women.

Sex-based differences in myocardial infarction-induced kidney damage following cigarette smoking exposure: more renal protection in premenopausal female mice

The impact of cigarette smoking (CS) on kidney homeostasis in the presence of myocardial infarction (MI) in both males and females remains poorly elucidated. C57BL6/J mice were exposed to 2 weeks of CS prior to MI induction followed by 1 week of CS exposure in order to investigate the impact of CS on kidney damage in the presence of MI. Cardiac hemodynamic analysis revealed a significant decrease in ejection fraction (EF) in CS-exposed MI male mice when compared with the relative female subjects, whereas cardiac output (CO) comparably decreased in CS-exposed MI mice of both sexes. Kidney structural alterations, including glomerular retraction, proximal convoluted tubule (PCT) cross-sectional area, and total renal fibrosis were more pronounced in CS-exposed MI male mice when compared with the relative female group. Although renal reactive oxygen species (ROS) generation and glomerular DNA fragmentation significantly increased to the same extent in CS-exposed MI mice of both sexes, alpha-smooth muscle actin (α-SMA) and connective tissue growth factor (CTGF) significantly increased in CS-exposed MI male mice, only. Metabolically, nicotinamide phosphoribosyltransferase (NAMPT) and nicotinamide riboside-1 (NMRK-1) substantially increased in CS-exposed MI female mice only, whereas sirtuin (SIRT)-1 and SIRT-3 substantially decreased in CS-exposed MI male mice compared with their relative female group. Additionally, renal NAD levels significantly decreased only in CS-exposed MI male mice. In conclusion, MI female mice exhibited pronounced renal protection following CS when compared with the relative male groups.

Demographics and medical disorders associated with smoking: a population-based study

Background

Few studies have investigated factors associated with smoking behaviors. In this population-based study, we investigated demographics and medical comorbid diseases to establish a prediction model for smoking behaviors by using the National Health Interview Survey (NHIS) and National Health Insurance Research Database (NHIRD).

Methods

We enrolled individuals aged ≥40 years who had participated in the NHIS in 2001, 2005, and 2009. We identified the smoking behaviors of the study participants in the NHIS. Smoking behaviors were divided into ever smokers (current smokers and ex-smokers) and nonsmokers (never smokers).We defined medical comorbid disorders of the study participants by using medical claim data from the NHIRD. We used multivariable logistic regression models to calculate the adjusted odds ratio and 95% confidence interval for variables associated with smoking. The significant variables in the multivariable model were included in the receiver operating characteristic curves (ROC) to predict the sensitivity and specificity of the model.

Results

In total, 26,375 participants (12,779 men and 13,596 women) were included in the analysis. The prevalence of smoking was 39.29%. The mean ages of the 16,012 nonsmokers were higher than those of the 10,363 smokers (57.86 ± 12.92 years vs. 53.59 ± 10.82 years). Men outnumbered women among smokers (68.18% vs. 31.82%). Male sex, young age and middle age, being insured categories, residence in suburban areas, and chronic obstructive pulmonary disease (COPD) were independent factors associated with smoking. The area under the ROC curve of these significant factors to predict smoking behaviors was 71.63%.

Conclusion

Sex, age, insured categories, residence in suburban areas, and COPD were associated with smoking in people.

Knowledge, attitudes, harm perception, and practice related to waterpipe smoking in Lebanon

Waterpipe smoking (WPS) is one of the most emerging popular trends in Lebanon, with a prevalence of 36.9%, the highest among all Middle Eastern countries. Thus, the primary objective of the study was to examine the factors associated with knowledge, attitudes, and practice (KAP) related to WPS among a representative sample of waterpipe smokers. The secondary objective was to examine the effect of KAP on cumulative waterpipe dose and dependence. This cross-sectional study was carried out between May and December 2018 and enrolled a representative sample of 1550 waterpipe smokers from all Lebanese districts. The questionnaire used was specifically designed for this study. High knowledge score (Beta = 0.02, p = 0.002) were significantly associated with higher waterpipe harm perception score. In addition, high knowledge score (Beta = 0.32, p = 0.007) were significantly associated with higher attitude score toward smoking ban. Higher waterpipe harm perception score (Beta = - 1.30, p < 0.001), higher attitude (Beta = - 0.21, p < 0.001), and higher knowledge score (Beta = - 0.11, p < 0.001) were significantly associated with lower waterpipe dependence. In addition, higher waterpipe dependence (Beta = 2.02, p < 0.001) was significantly associated with higher cumulative waterpipe smoking, while higher waterpipe harm perception score (Beta = - 1.96, p = 0.009) and higher knowledge score (Beta = 0.27, p < 0.001) were significantly associated with lower cumulative waterpipe smoking. Our main finding was that better knowledge and perception of the harmful effects of waterpipe were related to a better attitude toward smoking bans and a lower waterpipe smoking. Therefore, health care providers and policymakers should join efforts to make awareness campaigns across Lebanon and develop adequate interventions to curb the use of waterpipe among the population.

Sex-based differences in inflammatory bowel diseases: a review

Sex-based differences in inflammatory bowel disease (IBD) pathogenesis, disease course, and response to therapy have been increasingly recognized, however, not fully understood. Experimental and translational models have been leveraged to investigate hypothesized mechanisms for these observed differences, including the potential modifying role of sex hormones and sex-dependent (epi)genetic and gut microbiome changes. The primary objective of this review is to comprehensively describe sex-based differences in IBD including epidemiology, pathogenesis, phenotypic differences, therapeutic response, and outcomes.

Female reproductive factors and the risk of lung cancer in postmenopausal women: a nationwide cohort study

Background

Reproductive factors and hormone use in postmenopausal women have been hypothesised to affect the risk of developing lung cancer, but the epidemiological evidence is inconsistent.

Methods

Using the Korean National Health Insurance System database, we identified 4,775,398 postmenopausal women older than 40 years who had undergone both cardiovascular health- and cancer screening between 1 January 2009 and 31 December 2014. Information about reproductive factors was obtained from a self-administered questionnaire. The risk of lung cancer was estimated using Cox proportional hazard regression models.

Results

During a median follow-up of 4.4 years, 16,556 women (15,223 non-smokers) were diagnosed with lung cancer. The risk of lung cancer was not significantly influenced by early menarche age (adjusted hazard ratio [aHR] 1.03 for menarche ≥18 vs. ≤14; 95% confidence interval [CI], 0.98–1.09) or late age at menopause (aHR 1.02 for menopause ≥55 vs. <40; 95% CI, 0.91–1.14). Furthermore, the number of children, duration of breastfeeding and use of hormone replacement therapy were not associated with the risk of lung cancer.

Conclusions

No statistically significant association was found between reproductive factors and the risk of lung cancer in postmenopausal Korean women.

Epidemiology of lung cancer in northeast of Iran: A 25-year study of 939 patients

Background: Lung cancer (LC) is a global public health priority. In this study, the epidemiology and current trends of primary LCs were investigated in northeast of Iran.

Methods: Demographic and pathologic records of primary LCs during 1985-2012 in Mashhad (capital of northeast of Iran) were reviewed. Data were obtained from archives of the largest referral oncologic hospital and the only private outpatient radiation-oncologic clinic in the region. To investigate trends, study duration was classified into 3 periods: 1985-1995, 1995-2005, and 2005-2012. Patients were placed in one of these 3 groups, based on the date of their pathologic diagnosis. Data were analyzed by SPSS 16 software. T test, chi-squared, and ANOVA tests were used for data analysis, and statistical significant level was set at < 0.05.

Results: Among 939 cases with pathologic diagnosis of primary LC, male-to-female ratio was 2.36. Mean±SD age at diagnosis was 61.47±12.01 years in males and 58.45±12.75 in females (p=0.001). Squamous cell carcinoma (SCC) was the most frequent pathologic subtype. Mean age at diagnosis and rate of smokers were unchanged during the study (p= 0.978 and 0.153, respectively). Relative frequency of leading pathologic subtypes changed in 3 intervals (p<0.001): it was increasing in adenocarcinoma and large cell carcinoma and decreasing in SCC and small cell lung cancer (SCLC). There were statistically significant differences in the mean age at diagnosis (p<0.001), rate of smokers (p<0.001), and male-to-female ratio (p=0.011) between leading pathologic subtypes.

Conclusion: Similar to universal picture, rate of adenocarcinoma in northeast of Iran was rising during recent decades, especially among younger patients, women, and nonsmokers. These trends are indicative of changes in exposures and smoking habits and reveal the need for regional studies in these contexts.