Factors Associated with Single-Use and Co-Use of Tobacco and Alcohol: A Multinomial Modeling Approach

Long-term exposure to PM2.5 and mortality: a national health insurance cohort study

BACKGROUND

Previous studies with large data have been widely reported that exposure to fine particulate matter (PM2.5) is associated with all-cause mortality; however, most of these studies adopted ecological time-series designs or have included limited study areas or individuals residing in well-monitored urban areas. However, nationwide cohort studies including cause-specific mortalities with different age groups were sparse. Therefore, this study examined the association between PM2.5 and cause-specific mortality in South Korea using the nationwide cohort.

METHODS

A longitudinal cohort with 187 917 National Health Insurance Service-National Sample Cohort participants aged 50-79 years in enrolment between 2002 and 2019 was used. Annual average PM2.5 was collected from a machine learning-based ensemble model (a test R2 = 0.87) as an exposure. We performed a time-varying Cox regression model to examine the association between long-term PM2.5 exposure and mortality. To reduce the potential estimation bias, we adopted generalized propensity score weighting method.

RESULTS

The association with long-term PM2.5 (2-year moving average) was prominent in mortalities related to diabetes mellitus [hazard ratio (HR): 1.03 (95% CI: 1.01, 1.06)], circulatory diseases [HR: 1.02 (95% CI: 1.00, 1.03)] and cancer [HR: 1.01 (95% CI: 1.00, 1.02)]. Meanwhile, circulatory-related mortalities were associated with a longer PM2.5 exposure period (1 or 2-year lags), whereas respiratory-related mortalities were associated with current-year PM2.5 exposure. In addition, the association with PM2.5 was more evident in people aged 50-64 years than in people aged 65-79 years, especially in heart failure-related deaths.

CONCLUSIONS

This study identified the hypothesis that long-term exposure to PM2.5 is associated with mortality, and the association might be different by causes of death. Our result highlights a novel vulnerable population: the middle-aged population with risk factors related to heart failure.

Tobacco use and heavy episodic drinking among persons aged 18-69 years in Bolivia in 2019

OBJECTIVES

The aim of this study was to estimate the prevalence and sociodemographic factors associated with tobacco use and heavy episodic drinking (TUHED), current tobacco use only (TU), and current heavy episodic drinking only (HED) among people 18-69 years in Bolivia in 2019.

STUDY DESIGN

Cross-sectional study.

METHODS

The analysis used cross-sectional data from Bolivia's STEPS 2019 survey; 4472 individuals answered questions about substance use and socio-demographic information.

RESULTS

The sample included 50.2% women and 49.8% men, 52.1% had secondary or higher education, 48.6% were Mestizo and 28.0% Quechua. The prevalence of TUHD was 6.0% (10.5% for men, 1.6% for women), TU 12.2% (20.0% for men, 4.4% for women), and HED 11.2% (13.4% for men and 9.1% for women). Male sex increased the risk of TU, HED and TUHED and belonging to the Amara ethnic group decreased the risk of TU and TUHED. Higher education was increased the odds of HED and among women of TUHED. Urban residence increased the risk of TUHED and among women of HED. For women, unemployment was associated with TU and marriage or cohabitation was inversely associated with TU, and for men, belonging to another ethnic group (such as Castellano or Tacana) increased the risk of TU and TUHED.

CONCLUSION

More than 10% of the general adult population in Bolivia participated in TU and HED, and among men in TUHED. Various factors associated with the different categories of substance use were identified.

Epidemiologic relationship between alcohol flushing and smoking in the Korean population: the Korea National Health and Nutrition Examination Survey

Although facial flushing after drinking alcohol (alcohol flushing response) is common in Asian populations, the epidemiological features in a large sample have been investigated in only a few studies. This study assessed the epidemiologic characteristics and associated factors for alcohol flushing in a Korean population. This study was based on data collected during the 2019 Korea National Health and Nutrition Examination Survey (KNHANES). A total of 5572 Korean adults was included in the general population group, and the alcohol flushing group consisted of 2257 participants. Smoking and physical activity were evaluated as possible associated factors for alcohol flushing. The overall prevalence of alcohol flushing was estimated at 40.56% of the general population (43.74% in males and 37.4% in females), and the prevalence was highest at 60-69 years of age and lowest in individuals older than 80 years. Occasional, frequent, and persistent alcohol flushing was reported by 11.9%, 3.7% and 15.0% of current flushers, among whom persistent flushers consumed the least amount of alcohol. Subjects who currently smoke had a higher propensity of alcohol flushing (adjusted OR 1.525, 95% CI 1.2-1.938), and subjects with smoking history of 20-29 pack-years (PYs) showed the highest association (adjusted OR 1.725, 95% CI 1.266-2.349) with alcohol flushing after adjustment for confounders. In contrast, significant association was not found between physical activity and alcohol flushing. The results demonstrated that current smoking status is shown to be significantly associated with alcohol flushing, and that current smokers with a history of smoking ≥ 20 PYs had a higher likelihood of alcohol flushing than non-smokers or ex-smokers.

Tobacco and alcohol co-use: Lifestyle and sociodemographic factors, and personality aspects as potential predictors in the "Seguimiento Universidad de Navarra" cohort

Tobacco and alcohol co-use are two major lifestyle modifiable risk factors. Understanding the determinants of both behaviors helps to develop interventions to prevent these exposures. However, previous studies have focused on predictors of individual tobacco or alcohol use. This study aims to explore the potential predictors of tobacco and alcohol co-use among Spanish university graduates from the "Seguimiento Universidad de Navarra" (SUN) cohort study. A total of 7175 participants who were co-users of tobacco and alcohol were selected for this cross-sectional analysis. Their mean age was 39.1 years (12.04 SD) and 57.3% were women. Univariate regression models were used to select the potential predictors of tobacco and alcohol co-use, and the areas under the ROC curves (AUC) were calculated. Multivariable logistic regression models were used to create a predictive model. Baseline potential predictors included sociodemographic factors, lifestyle habits, and perceived personality aspects. In the multivariable model, the main significant potential predictors of tobacco and alcohol co-use were driving under the influence of alcohol (odds ratio [OR] = 1.65 [1.43-1.90]), drinking 1-2 cups of coffee daily (OR = 1.50 [1.24-1.84]), drinking three or more cups of coffee daily (OR = 1.61 [1.35-1.91]), and doing more physical activity than recommended (OR = 1.18 [1.02-1.34]) when compared with the reference group. Conversely, those who were married (OR = 0.87 [0.75-0.99], ate at home 7 days a week (OR = 0.69 [0.60-0.80]), or had a high perceived level of competitiveness (OR = 0.83 [0.72-0.95]) had a lower risk of co-use (AUC 0.61 [confidence interval 95% 0.59-0.63]), compared to the reference group. These results could be used by healthcare professionals, especially nurses, to effectively assess patients at higher risk of tobacco and alcohol co-use. [Correction added on 16 February 2024, after first online publication: The abstract section has been revised to provide more clarity in this version.].

Prévalence et facteurs associés à la co-consommation d'alcool et de tabac dans la commune de Natitingou, Bénin

INTRODUCTION

La consommation d'alcool et la consommation de tabac entraînent chacune des risques importants pour la santé. L'objectif de cette étude était d'étudier la prévalence de la co-consommation d'alcool et de tabac ainsi que les facteurs associés dans la commune de Natitingou en 2016.

MÉTHODES

Il s'agissait d'une étude transversale à caractère analytique. L'enquête s'est déroulée en octobre 2016 et a porté sur un échantillon de 270 sujets. Elle a été menée selon une technique de sondage aléatoire à plusieurs degrés. Les données collectées ont été analysées avec le logiciel R.

RÉSULTATS

Sur les 270 sujets interrogés, 72,2 % étaient des hommes. L'âge moyen était de 30,7 ± 9,2 ans. La prévalence de la co-consommation était de 33,7 % [IC95% : 28,1 %-39,7 %]). Les facteurs associés à la co-consommation d'alcool et de tabac étaient : le sexe masculin (ORa = 2,1 ; p = 0,023), la dipsomanie (ORa = 1,4 ; p = 0,032), le fait d'avoir des amis buveurs ou fumeurs (ORa = 2,8 ; p = 0,004), le fait de suivre les publicités des médias sur les boissons alcoolisées (ORa = 1,9 ; p = 0,029) et le faible coût /accessibilité des deux substances (ORa = 2,1 ; p = 0,011).

CONCLUSION

Cette étude a montré qu'il est important de dépasser la prévention centrée sur la personne qui consiste à sensibiliser et à prendre en charge pour adopter des mesures de prévention structurelle (notamment législatives).

Trends in concurrent tobacco use and heavy drinking among individuals 15 years and older in Mongolia

The study aimed to evaluate trends in the prevalence and correlates of current tobacco use only (= CT), current heavy drinking only (= CHD), and current tobacco use and current heavy drinking (= CTHD) in people 15 years and older from 2009 to 2019 in Mongolia. Cross-sectional data were analyzed from 5,438 individuals (15-64 years) of the Mongolia STEPS 2009 survey, 6,013 (15-69 years) of the Mongolia STEPS 2013 survey, and 6,654 persons (15-69 years) of the Mongolia STEPS 2019 survey and responded to questions about substance use, other health risk behaviours and physical measurements. Trend analysis shows that the prevalence of CT increased from 14.4% in 2009 to 15.3% in 2019, and the prevalence of CHD significantly decreased from 13.3% in 2009 to 10.3% in 2019, and the prevalence of CTHD significantly decreased from 14.2% in 2009 to 9.4% in 2019. Middle and older age, male sex (13 times higher for CT, 3.4 times higher for CHD, and 28 times higher for CTHD) and high physical activity significantly increased the odds of CT, CHD and CTHD. Higher education decreased the odds of CT but increased the odds of CHD. Urban residence was positively associated with CT, and among women with CTHD. Underweight decreased the odds of CT, CHD, and CTHD, and obesity decreased the odds of CT and CTHD and increased the odds of CHD. Hypertension was positively associated with CHD and CTHD, while sedentary behaviour was positively associated with CT and CTHD. Being Khalkh by ethnicity increased the odds of CT and inadequate fruit and vegetable intake increased the odds of CHD. More than one in six persons 15 years and older engaged in CT and more than one in ten engaged in CHD and CTHD. Several sociodemographic factors, such as male sex and middle and/or older age, and health variables, such as obesity and hypertension for CHD, were identified associated with CT, CHD, and CTHD that can help in guiding public interventions.

Residential Characteristics as Factors Related to Healthy Behavior Practices-Decision Tree Model Analysis Using a Community Health Survey from Korea

In this study, we sought to identify relevant factors in healthy behavior practices, including not only individual-level variables but also regional and physical environments. Data from the Korea Community Health Survey (KCHS) of Gyeongsangnam-do in 2018 were used, with data from 16,519 of the 17,947 individuals (excluding 1428 individuals who had missing values) who participated in the survey. Healthy behavior practices were defined as meeting the criteria for all three modifiable healthy behaviors (non-smoking, moderate alcohol consumption, regular walking). A decision tree analysis was performed. In men, healthy behavior practices were lower in the unemployed population, in those aged 40−50 years, living in rural residential areas, and with stress. For women who lived in areas with small populations (<100,000 population), healthy behavior practices were below-average. Men and women who had below-average healthy behavior practices reported poor access to places for exercise and fair or poor self-rated health statuses. It is necessary to implement a health behavior practice intervention that considers not only individual characteristics but also access to local exercise facilities and residential area characteristics (urban, rural). Since age is an important variable in healthy behaviors for both men and women, customized programs that consider age should be provided.

Smoking Behavior Changes during COVID-19 among Korean Adults

OBJECTIVES

In this study, we investigated the changes in smoking behavior during the COVID-19 outbreak in Korea in 2020. We also examined the influence of general characteristics and mental health problems due to COVID-19 on changes in smoking behavior.

METHODS

We collected data from August to October 2020 from adults aged 19 years and older from the Korea Community Health Survey (N=229,269).

RESULTS

Among current smokers (N=39,534), 11.0% reported an increase in smoking, and 12.8% reported a decrease in smoking. Overall, 33.3% reported perceived stress and 3.7% reported depression. Participants reported COVID-related anxiety about infecting family (83.0%), economic damage (76.3%), blame or harm from others (66.5%), infection (60.6%), and death (31.3%). Lower education level, living alone, and poor subjective health status were associated with increased smoking. Being a woman and being of older age were associated with decreased smoking. Stress, depression, and anxiety about economic damage due to COVID-19 were more likely to result in increased smoking. Anxiety related to death due to COVID-19 was more likely to result in decreased smoking.

CONCLUSION

These findings provide insight into the changes in smoking behavior caused by COVID-19.