Tongue cancer in non-smoking and non-alcoholic mother and daughter

Tongue cancer is more prevalent in male smokers and alcoholics. Although an increased incidence of tongue cancer has been noted in non-smoking and non-alcoholic women, reports of its occurrence in mother and daughter are extremely rare. Here, we report a case of a non-smoking and non-alcoholic mother and her daughter diagnosed and treated surgically for tongue squamous cell carcinoma (SCC). The daughter is still being monitored and the mother died from complications from COVID-19 after 6 years of treatment. This report shows that OSCC should be considered in the differential diagnosis of oral ulcerated lesions in non-smoking and non-alcoholic women, especially if there is a family history of first-degree oral cancer.

Comparison of smokers' mortality with non-smokers following out-of-hospital cardiac arrests: a systematic review and meta-analysis

OBJECTIVE

Although some studies have linked smoking to mortality after out-of-hospital cardiac arrests (OHCAs), data regarding smoking and mortality after OHCAs have not yet been discussed in a meta-analysis. Thus, this study conducted this systematic review to clarify the association.

METHODS

The study searched Medline-PubMed, Web of Science, Embase and Cochrane libraries between January 1972 and July 2022 for studies that evaluated the association between smoking and mortality after OHCAs. Studies that reportedly showed relative risk estimates with 95% confidence intervals (CIs) were included.

RESULTS

Incorporating a collective of five studies comprising 2477 participants, the analysis revealed a lower mortality risk among smokers in the aftermath of OHCAs compared with non-smokers (odds ratio: 0.77; 95% CI 0.61-0.96; P < 0.05). Egger's test showed no publication bias in the relationship between smoking and mortality after OHCAs.

CONCLUSIONS

After experiencing OHCAs, smokers had lower mortality than non-smokers. However, due to the lack of data, this 'smoker's paradox' still needs other covariate effects and further studies to be considered valid.

Evaluation of Oral Mucosal Lesions in Iranian Smokers and Non-smokers

BACKGROUND

Tobacco smoking statistics are alarming and the oral mucosa is the first human part of the body that is exposed to the toxic substances of smoking.

AIMS

Considering the high prevalence rate of tobacco-associated problems in the oral cavity and few studies on the Iranian population regarding the effects of smoking on the oral cavity, this study aimed to evaluate the relationship between smoking and oral lesions in the Iranian population.

MATERIALS AND METHODS

Observational study. In this observational study, the oral cavities of 200 participants (smokers = 100 and non-smokers = 100) were examined by a trained dental student under the supervision of an oral and maxillofacial medicine expert, and the presence of coated tongue, leukoedema, leukoplakia, smoker's palate, smoker's melanosis, erythroplakia, frictional hyperkeratosis, acute pseudomembranous candidiasis, and erythematous candidiasis were recorded. Xerostomia was evaluated based on participants' self-reporting through a questionnaire. All data were analyzed using T-test, Chi-square test, odd ratio, 95% confidence interval, Fisher's exact test, and Spearman's rank correlation coefficient.

RESULTS

The results of this study showed smoking is significantly associated with an increased risk of coated tongue (OR: 1.80, 95% CI: 1.32-3.54, P = 0.005), smoker's melanosis (OR: 6.176, 95% CI: 3.28-11.62, P = 0.00002), and frictional hyperkeratosis (OR: 1.33, 95% CI: 0.68-2.60, P = 0.005). However, no significant association was observed between smoking and leukoedema (OR: 1, 95% CI: 0.51-1.94, P = 1). None of the participants presented smoker's palate, erythroplakia, and candidiasis.

CONCLUSIONS

This study's results showed that smokers exhibited a greater chance of developing oral lesions compared to non-smokers.

Gender-Specific Pictorial Health Warnings: Moderation Effects of the Threat Level and Gender

This study examined the effects of gender-specific pictorial health warning labels contingent on their intended gender and threat levels (for females) in forming anti-smoking intentions. We conducted a within-subject design experiment with smokers and nonsmokers in Singapore (N = 100, 50% men). Each participant viewed 10 warning labels-four female-specific (high and low threat), four gender-neutral (high and low threat), and two male-specific (only low threat)-in a random order, evaluating each label on personal relevance, attention, cognitive elaboration, reactance, and intentions to purchase or avoid smoking. The findings showed that females reported greater relevance, attention, elaboration, and intentions to avoid smoking for low threat female-specific warning labels than male-specific or gender-neutral counterparts. Males reported less attention, elaboration, and relevance for low threat male-specific warning labels than female-specific or gender-neutral counterparts. Under high threat conditions, female-specific and gender-neutral warning labels were equally effective for both genders. No differences were observed by smoking status. Overall, gender-specific warning labels are potentially more effective than gender-neutral ones for deterring smoking in women contingent on low threat levels. By providing a deeper understanding of persuasive mechanisms and boundary conditions for the effects of gender specificity, findings can aid health policymakers in developing better gender-responsive interventions.

Exposure to Toxicants Associated With Use and Transitions Between Cigarettes, e-Cigarettes, and No Tobacco

IMPORTANCE

Transitions between e-cigarettes and cigarettes are common among tobacco users, but empirical evidence on the health outcomes of switching tobacco products is scarce.

OBJECTIVES

To examine changes in urinary biomarkers between baseline and 1-year follow-up among adult tobacco users switching between e-cigarettes and cigarettes.

DESIGN, SETTING, AND PARTICIPANTS

This cohort study used data from wave 1 (baseline, September 2013 to December 2014) and wave 2 (1-year follow-up, October 2014 to October 2015) of the Population Assessment of Tobacco and Health Study. A subset of the probability sample of US adults who voluntarily provided biospecimens at 2 waves was analyzed. Participants were divided into 3 mutually exclusive groups at baseline: exclusive cigarette smokers, exclusive e-cigarette users, and dual users. Data analysis was performed in 2021.

EXPOSURES

Harmful and potentially harmful constituents included nicotine metabolites, tobacco-specific nitrosamines (TSNAs; including 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanol [NNAL]), metals, polycyclic aromatic hydrocarbons (PAHs), and volatile organic compounds (VOCs).

MAIN OUTCOMES AND MEASURES

Within-participant changes in 55 urinary biomarkers of exposure (BOEs) to harmful and potentially harmful constituents were examined using multivariable regression models.

RESULTS

Among 3211 participants (55.6% women, 68.3% White, 13.2% Black, and 11.8% Hispanic) at baseline, 21.9% of exclusive cigarette users, 42.8% of exclusive e-cigarette users, and 62.1% of dual users changed product use at follow-up (all percentages are weighted). There was a significant reduction in urine concentrations of TSNAs, PAHs, and VOCs when users transitioned from exclusive cigarette to exclusive e-cigarette use, with a 92% decrease in NNAL, from a mean of 168.4 pg/mg creatinine (95% CI, 102.3-277.1 pg/mg creatinine) to 12.9 pg/mg creatinine (95% CI, 6.4-25.7 pg/mg creatinine; P < .001). A similar panel of BOEs decreased when dual users transitioned to exclusive e-cigarette use; NNAL levels decreased by 96%, from a mean of 143.4 pg/mg creatinine (95% CI, 86.7-237.0 pg/mg creatinine) to 6.3 pg/mg creatinine (95% CI, 3.5-11.4 pg/mg creatinine; P < .001). Nicotine metabolites, TSNAs, PAHs, and VOCs significantly increased when baseline exclusive e-cigarette users transitioned to exclusive cigarette use or dual use. Switching from exclusive cigarette use to dual use was not associated with significant decreases in BOEs.

CONCLUSIONS AND RELEVANCE

This national cohort study provides evidence on the potential harm reduction associated with transitioning from exclusive cigarette use or dual use to exclusive e-cigarette use. e-Cigarettes tend to supplement cigarettes through dual use instead of cessation at the population level. Continuous monitoring of BOE at the population level and assessment of BOE change by product transition are warranted, as well as defined adverse health outcomes.

Genomic and evolutionary classification of lung cancer in never smokers

Lung cancer in never smokers (LCINS) is a common cause of cancer mortality but its genomic landscape is poorly characterized. Here high-coverage whole-genome sequencing of 232 LCINS showed 3 subtypes defined by copy number aberrations. The dominant subtype (piano), which is rare in lung cancer in smokers, features somatic UBA1 mutations, germline AR variants and stem cell-like properties, including low mutational burden, high intratumor heterogeneity, long telomeres, frequent KRAS mutations and slow growth, as suggested by the occurrence of cancer drivers' progenitor cells many years before tumor diagnosis. The other subtypes are characterized by specific amplifications and EGFR mutations (mezzo-forte) and whole-genome doubling (forte). No strong tobacco smoking signatures were detected, even in cases with exposure to secondhand tobacco smoke. Genes within the receptor tyrosine kinase-Ras pathway had distinct impacts on survival; five genomic alterations independently doubled mortality. These findings create avenues for personalized treatment in LCINS.

Association between smoking history and optical coherence tomography angiography findings in diabetic patients without diabetic retinopathy

Purpose

To investigate any associations between cigarette smoking and retinal microvascular changes in diabetic patients without visible retinopathy.

Design

Retrospective, cross-sectional study.

Participants

1099 eyes from 1099 diabetic patients with no clinical evidence of diabetic retinopathy (DR) were included in this study.

Methods

Diabetic patients underwent optical coherence tomography angiography (OCTA) scanning at Zuckerberg San Francisco General Hospital and Trauma Center between April 2018 and September 2019. Patient demographic and clinical information was collected. Standard bivariate statistics and multivariate linear regression were performed.

Main outcome measures

OCTA parameters included metrics related to the foveal avascular zone (FAZ; area, perimeter, circularity), perfusion density (PD; full, center, inner), and vessel length density (VLD; full, center, inner).

Results

The study population included 750 non-smokers and 349 smokers. FAZ perimeter was the only OCTA parameter that was significantly different between the two groups on uncontrolled analysis (P = 0.033). Multivariate regression analyses revealed significant associations between lower VLD full (β = -0.31, P = 0.048), lower VLD inner (β = -0.35, P = 0.046) and a history of smoking. No significant associations between cigarette smoking and either FAZ or PD were detected.

Conclusions

Our results suggest that smoking is likely associated with deleterious changes in the retinal microvasculature of patients with a history of diabetes and no visible DR. Based on these findings, diabetic patients with a history of smoking may benefit from higher prioritization in terms of ophthalmic screening.

Blood pressure-lowering effect of repeated Waon therapy in non-smokers with hypertension

Waon therapy (WT) has been used as a thermal therapy in chronic heart failure patients. However, its effect in patients with hypertension is unclear. This study aimed to reveal the hypotensive effect of WT in patients with hypertension. WT was performed on 31 patients with hypertension (63.9 ± 11.9 years, male: 17) on standard hypertension treatment focusing on lifestyle modification and medication. Systolic and diastolic blood pressures were measured before and after WT using an upper arm automated sphygmomanometer. We investigated the effect of single and repeated (1 time/d, >5 times) WT sessions on blood pressure and further compared its effect between current smoking (n = 11, 55.4 ± 6.4 years, 8.5 ± 2.4 times) and non-smoking (n = 11, 66.9 ± 8.5 years, 12.2 ± 5.9 times) groups. A total of 370 sessions of WT were conducted. Systolic and diastolic blood pressures significantly decreased after a single WT session (systolic blood pressure: 118.5 ± 10.1 to 115.1 ± 9.0 mm Hg, P < .001; diastolic blood pressure: 70.5 ± 6.4 to 65.9 ± 5.3 mm Hg, P < .001). The blood pressure decrease following repeated WT was not significant when all participants were considered (systolic blood pressure: 122.3 ± 15.2 to 116.9 ± 19.6 mm Hg; diastolic blood pressure: 73.8 ± 16.7 to 68.2 ± 13.2 mm Hg); however, it was significant in the non-smoking group (systolic blood pressure: 124.2 ± 11.3 to 108.8 ± 13.4 mm Hg, P < .001; diastolic blood pressure: 73.6 ± 4.9 to 62.1 ± 7.6 mm Hg, P < .001). Repeated WT (at least 5 sessions) decreased blood pressure in patients with hypertension, especially in non-smokers. WT is a simple method to reduce blood pressure in non-smoking patients with hypertension.

Tobacco use in the Myeloproliferative neoplasms: symptom burden, patient opinions, and care

BACKGROUND

Patients with Philadelphia-negative Myeloproliferative Neoplasms (MPN) suffer from numerous symptoms and decreased quality of life. Smoking is associated with an increased symptom burden in several malignancies. The aim of this study was to analyze the association between smoking and MPN-related symptom burden and explore MPN patients' opinions on smoking.

METHODS

A total of 435 patients with MPN participated in a cross-sectional internet-based survey developed by the Mayo Clinic and the Myeloproliferative Neoplasm Quality of Life Group. Patients reported their demographics, disease characteristics, tobacco use, and opinions on tobacco use. In addition, MPN-related symptoms were reported via the validated 10-item version of the Myeloproliferative Neoplasms Symptom Assessment Form.

RESULTS

Current/former smokers reported worse fatigue (mean severity 5.6 vs. 5.0, p = 0.02) and inactivity (mean severity 4.0 vs. 3.4, p = 0.03) than never smokers. Moreover, current/former smokers more frequently experienced early satiety (68.5% vs. 58.3%, p = 0.03), inactivity (79.9% vs. 71.1%, p = 0.04), and concentration difficulties (82.1% vs. 73.1%, p = 0.04). Although not significant, a higher total symptom burden was observed for current/former smokers (mean 30.4 vs. 27.0, p = 0.07). Accordingly, overall quality of life was significantly better among never smokers than current/former smokers (mean 3.5 vs. 3.9, p = 0.03). Only 43.2% of the current/former smokers reported having discussed tobacco use with their physician, and 17.5% did not believe smoking increased the risk of thrombosis.

CONCLUSION

The current study suggests that smoking may be associated with increased prevalence and severity of MPN symptoms and underscores the need to enhance patient education and address tobacco use in the care of MPN patients.

Concentrations of Cotinine and 4-(Methylnitrosamino)-1-(3-Pyridyl)-1-Butanol (NNAL) in U.S. Non-Daily Cigarette Smokers

BACKGROUND

Accumulating evidence suggests that non-daily smokers have higher disease and mortality risks than never smokers. Yet, the accuracy of self-reported non-daily cigarette smoking is poorly understood.

METHODS

We examined the concordance between self-reported non-daily smoking and serum cotinine in 18,835 adult participants (20 years or older) of the 2007 to 2014 National Health and Nutrition Examination Surveys, in comparison with daily smokers and nonsmokers. We also analyzed concentrations of the urinary biomarker 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanol (NNAL) by smoking status.

RESULTS

In the study sample, 77.8% (14,660) reported currently not smoking (nonsmokers), 18.3% (3,446) smoked every day (daily smokers), and 3.9% (729) smoked on some days of the past month (non-daily smokers). Just 2.1% of nonsmokers had cotinine concentrations in the active smoking range (>10 ng/mL), compared with 70.4% of non-daily and 98.8% of daily smokers. Non-daily smokers reported smoking a median of 24 cigarettes per month [interquartile range (IQR) = 9-60] and had substantially higher concentrations of NNAL (median = 72.5; IQR = 14.8-211.0 pg/mL) than nonsmokers (median = 0.4; IQR = 0.4-2.1 pg/mL), although lower than daily smokers (median = 294.0; IQR = 148.0-542.0 pg/mL). Among non-daily smokers, concentrations of cotinine and NNAL were positively correlated with days and cigarettes smoked per month (P < 0.001).

CONCLUSIONS

We observed excellent concordance between self-reported non-daily cigarette smoking and concentrations of serum cotinine.

IMPACT

These results provide evidence for the validity of self-reported non-daily smoking and indicate that non-daily smokers are exposed to substantial concentrations of carcinogenic nitrosamines regardless of the low number of cigarettes they smoke per month.

Cigarette Smoke Underlies the Pathogenesis of Palmoplantar Pustulosis via an IL-17A-Induced Production of IL-36γ in Tonsillar Epithelial Cells

Palmoplantar pustulosis (PPP) is characterized by sterile pustules on the palms and soles. A strong association between PPP and tobacco smoking has been reported, and it has been speculated that the IL-17A pathway may play an important role in PPP. Recent studies have suggested that IL-36 plays a pivotal role in the pathogenesis of psoriasis and its subtypes. The relationships among IL-36, smoking, and PPP have not been examined. Here, we investigated the relationships among the smoking index, severity of the clinical condition of PPP, and in vitro dynamics of IL-36 in human tonsillar epithelial cells under the condition of exposure to a cigarette smoke extract. The results demonstrated that the Palmoplantar Pustulosis Area and Severity Index was strongly and positively correlated with the smoking index in female patients. Immunohistochemical examinations showed that IL-36γ was highly expressed in tonsillar epithelial cells from patients with PPP but not in those from patients with recurrent tonsillitis without PPP. The in vitro study revealed that IL-17A synergistically induced a release of IL-36γ under cigarette smoke extract exposure. These results suggest that local production of IL-36γ by epithelial cells induced by cigarette smoke exposure plays an important role in the pathogenesis of PPP.

[Retrospective study of lung carcinoid: experience in a third level Spanish hospital]

INTRODUCTION

Pulmonary carcinoids are relatively rare neuroendocrine neoplasms, accounting for only 1-2% of malignant thoracic tumours. We describe our experience in the management and follow-up of such an infrequent tumour, with special emphasis on possible problems that might arise.

PATIENTS AND METHODS

We present a descriptive retrospective study of all patients diagnosed with carcinoid tumour between January 2013 and January 2018. Demographic, histological and clinical data were collected and analyzed. Survival was recorded. SPSS version 21 was used for the statistical analysis.

RESULTS

42 patients with an average age of 66.26 years were included. The mean period of follow-up was 60 months and the average survival 59.12 months. The only statistically significant factor related to an improved survival time was tumour stage at diagnosis.

CONCLUSION

Carcinoid tumours are infrequent, which makes the objective collecting of data difficult. For this reason, we hope that the present study will contribute to a better understanding of their evolution.

Smoking, Genetic Predisposition, and Colorectal Cancer Risk

INTRODUCTION

Smoking and genetic predisposition are established risk factors for colorectal cancer (CRC). We aimed to assess and compare their individual and joint impact on CRC risk using the novel approach of genetic risk equivalent (GRE).

METHODS

Data were extracted from the Darmkrebs: Chancen der Verhütung durch Screening study, a large population-based case-control study in Germany. A polygenic risk score (PRS) based on 140 CRC-related single nucleotide polymorphisms was derived to quantify genetic risk. Multiple logistic regression was used to estimate the individual and joint impact of smoking and PRS on CRC risk, and to quantify the smoking effect in terms of GRE, the corresponding effect conveyed by a defined difference in PRS percentiles.

RESULTS

There were 5,086 patients with CRC and 4,120 controls included. Current smokers had a 48% higher risk of CRC than never smokers (adjusted odds ratio 1.48, 95% confidence interval 1.27-1.72). A PRS above the 90th percentile was significantly associated with a 3.6-, 4.3-, and 6.4-fold increased risk of CRC in never, former, and current smokers, respectively, when compared with a PRS below the 10th percentile in never smokers. The interaction between smoking and PRS on CRC risk did not reach statistical significance (P = 0.53). The effect of smoking was equivalent to the effect of having a 30 percentile higher level of PRS (GRE 30, 95% confidence interval 18-42).

DISCUSSION

Both smoking and the PRS carry essentially independent CRC risk information, and their joint consideration provides powerful risk stratification. Abstinence from smoking can compensate for a substantial proportion of genetically determined CRC risk.

HTRA1 Variants and the Interaction with Smoking Confer the Genetic Susceptibility to Ischemic Stroke

High temperature requirement protein A1 (HtrA1) was identified as the causative gene of autosomal recessive arteriopathy and associated with lacunar ischemic stroke (IS) in European. This study aimed at evaluating the association of HTRA1 with IS and four tagging single-nucleotide polymorphisms (SNPs) were genotyped in a cohort of 4,098 Chinese. The mRNA level of HTRA1 in 72 IS cases and 72 hypertension controls were measured and compared. In whole population, SNP rs2268350 (C>T) was significantly associated with IS incidence (P=0.034). Stratification analysis observed significant association of rs2268350 in male, smoking and drinking populations, rs2672587 (C>G) in smoking and nonsmoking populations and rs3793917 (C>G) in smoking, nonsmoking and nondrinking populations with stroke respectively (P<0.05). The additive interaction and multiplicative interaction between rs2268350 and smoking were both of significant (P<0.05) after adjustment for the covariates. There was a cumulated risk of IS among genotypes of rs3793917 (P=0.009) and rs2672587 (P=0.047) in smoking population. The mRNA level of HTRA1 in non-smokers with rs2268350 CC was significantly higher than smokers with rs2268350 CT/TT (P=0.046) in IS cases. Our findings support that HTRA1 confers the genetic susceptibility to IS and smoking might modify the genetic effect of HTRA1 on IS by suppressing HTRA1 mRNA expression.

Clinicopathological characteristics of young never smoker females with oral cavity squamous cell carcinoma: A STROBE compliant retrospective observational study

Although the incidence of oral cavity cancer (OCC) in young never smoker females is increasing worldwide, there has been little research on the etiologies and characteristics of these patients to date. In this study, we sought to evaluate the annual increase in OCC incidence in young never smoker females (YNSF) in our hospital as well as to investigate their clinicopathological characteristics and different disease courses compared with those of other OCC patients. We retrospectively reviewed the medical records of patients who were diagnosed and treated at our tertiary referral hospital from 2006 to 2016. The annual incidence of OCC and proportion of YNSF (never smoker females aged 45 years or younger at the time of diagnosis) among the enrolled OCC patients were evaluated. The characteristics and prognosis of the YNSF group were analyzed using their clinicopathological and survival data. Among the OCC patients primarily enrolled in this study, the proportion of YNSF did not show significant annual increase. There were 32 YNSF among 354 OCC patients (9%), who were ultimately included for the analyses of clinicopathological characteristics and survival. However, YNSF showed no significant differences compared with other OCC patients, even in subgroup analyses for overall survival. Our study did not demonstrate significant changes in the annual proportion of YNSF among OCC patients. In addition, differences in neither clinicopathological characteristics nor survival were noted between YNSF and other OCC patients.

Association between processes of diabetes care and health care utilization in patients with diabetes: Evidence from a nationally representative US sample

BACKGROUND

This study examined the association between quality of processes of diabetes care in terms of adherence to American Diabetes Association (ADA)-recommended guidelines and health care utilization in patients with diabetes.

METHODS

Adults with diabetes were identified from the pool of five panels of the Medical Expenditure Panel Survey, a nationally representative US sample, between 2012 and 2017. The Diabetes Care Survey was used to determine adherence to the ADA-recommended guidelines for processes of diabetes care if all of the following were performed annually: glycosylated hemoglobin check, foot examination, dilated eye examination, lipid panel, influenza immunization, blood pressure check, and dental examination. Health care utilization in terms of inpatient hospitalization, and emergency department (ED) and outpatient visits were estimated using two-part hurdle models.

RESULTS

An estimated 26.3 million adults with diabetes were derived from the pooled 5-panel data, of which 7.8% met the ADA-recommended guidelines for processes of diabetes care, and adherence rates of individual recommendations were generally below 50%. Overall, adults who adhered to the ADA-recommendations were older, non-Hispanic white, and married nonsmokers with private insurance and higher income. Mean inpatient hospital stays, ED, and outpatient visits between ADA-adherent vs nonadherent patients were 0.98 vs 1.62 (P < .001), 0.36 vs 0.39 (P = .074), and 17.9 vs 12.8 (P < .001), respectively.

CONCLUSIONS

Socioeconomic disadvantage and minority status were linked with nonadherence to the ADA-recommended processes of diabetes care. Adherence to the ADA recommendation was associated with significant reduction in inpatient hospitalization and a trend toward less ED visits. Our findings may apply to the United States and are likely to be different in other parts of the world.

Association between secondhand smoke exposure and diabetes mellitus in 131 724 Korean never smokers using self-reported questionnaires and cotinine levels: Gender differences

OBJECTIVE

The aim of this study is to compare the gender-different associations between secondhand smoke (SHS) exposure and diabetes in self-reported never smokers verified by cotinine.

METHODS

Self-reported never smokers verified by cotinine levels (<50 ng/mL) enrolled in the Kangbuk Samsung Health Study between April 2011 and December 2016 were included for this study. SHS exposure was defined as current exposure to passive smoke indoors at home or workplace. The gender-specific association between SHS exposure and diabetes was assessed using multivariable regression analyses.

RESULTS

Of the total 131 724 individuals (mean age 35 years, SD 7.1 years), 66.8% were female, and the prevalence of SHS exposure in the entire population was 22.9%. The prevalence of diabetes in the group exposed to SHS was higher than that in the group unexposed to SHS only in females (1.8% vs 1.2%, P < .001 for females; 2.2% vs 2.2%, P = .956 for males). A significant gender interaction existed for the relationships between SHS exposure and diabetes (P for interaction <.001). The multivariate regression model showed that SHS exposure was significantly associated with diabetes only in females (odds ratio [95% CI], 1.40 [1.20, 1.65] for females; 1.00 [0.85, 1.19] for males). In particular, females with SHS exposure ≥1 hour/day, ≥3 times/week, and ≥10 years showed an increased risk of diabetes by more than 50% compared to those without SHS exposure.

CONCLUSIONS

SHS exposure was significantly associated with diabetes in female never smokers with dose-dependent relationship. However, further longitudinal studies are needed to elucidate the gender difference in the incidence of diabetes associated with SHS exposure.

Association of Clinical and Demographic Factors With the Severity of Palmoplantar Pustulosis

Importance

Although palmoplantar pustulosis (PPP) can significantly impact quality of life, the factors underlying disease severity have not been studied.

Objective

To examine the factors associated with PPP severity.

Design, Setting, and Participants

An observational, cross-sectional study of 2 cohorts was conducted. A UK data set including 203 patients was obtained through the Anakinra in Pustular Psoriasis, Response in a Controlled Trial (2016-2019) and its sister research study Pustular Psoriasis, Elucidating Underlying Mechanisms (2016-2020). A Northern European cohort including 193 patients was independently ascertained by the European Rare and Severe Psoriasis Expert Network (2014-2017). Patients had been recruited in secondary or tertiary dermatology referral centers. All patients were of European descent. The PPP diagnosis was established by dermatologists, based on clinical examination and/or published consensus criteria. The present study was conducted from October 1, 2014, to March 15, 2020.

Main Outcomes and Measures

Demographic characteristics, comorbidities, smoking status, Palmoplantar Pustulosis Psoriasis Area Severity Index (PPPASI), measuring severity from 0 (no sign of disease) to 72 (very severe disease), or Physician Global Assessment (PGA), measuring severity as 0 (clear), 1 (almost clear), 2 (mild), 3 (moderate), and 4 (severe).

Results

Among the 203 UK patients (43 men [21%], 160 women [79%]; median age at onset, 48 [interquartile range (IQR), 38-59] years), the PPPASI was inversely correlated with age of onset (r = -0.18, P = .01). Similarly, in the 159 Northern European patients who were eligible for inclusion in this analysis (25 men [16%], 134 women [84%]; median age at onset, 45 [IQR, 34-53.3] years), the median age at onset was lower in individuals with a moderate to severe PGA score (41 years [IQR, 30.5-52 years]) compared with those with a clear to mild PGA score (46.5 years [IQR, 35-55 years]) (P = .04). In the UK sample, the median PPPASI score was higher in women (9.6 [IQR, 3.0-16.2]) vs men (4.0 [IQR, 1.0-11.7]) (P = .01). Likewise, moderate to severe PPP was more prevalent among Northern European women (57 of 134 [43%]) compared with men (5 of 25 [20%]) (P = .03). In the UK cohort, the median PPPASI score was increased in current smokers (10.7 [IQR, 4.2-17.5]) compared with former smokers (7 [IQR, 2.0-14.4]) and nonsmokers (2.2 [IQR, 1-6]) (P = .003). Comparable differences were observed in the Northern European data set, as the prevalence of moderate to severe PPP was higher in former and current smokers (51 of 130 [39%]) compared with nonsmokers (6 of 24 [25%]) (P = .14).

Conclusions and Relevance

The findings of this study suggest that PPP severity is associated with early-onset disease, female sex, and smoking status. Thus, smoking cessation intervention might be beneficial.

Periodontal Conditions and Whole Salivary IL-17A and -23 Levels among Young Adult Cannabis sativa (Marijuana)-Smokers, Heavy Cigarette-Smokers and Non-Smokers

In the United States, prevalence of marijuana-use has doubled in the past 2 decades. The aim was to compare the periodontal conditions and whole-salivary IL-17A and IL-23 levels among young adult marijuana-smokers, heavy cigarette-smokers and non-smokers. Self-reported marijuana-smokers, heavy-cigarette-smokers, non-smokers with periodontitis and periodontally-healthy non-smokers were included. Demographic data was recorded and full-mouth plaque index (PI), bleeding on probing (BoP), probing depth (PD) and clinical attachment loss (AL), marginal bone loss (MBL) and missing teeth were recorded. Levels of IL-17A and IL-23 levels were measured in the whole saliva. p < 0.01 was considered statistically significant. Fifteen-marijuana-smokers, 15 heavy-cigarette-smokers, 16 non-smokers-with-periodontitis and 15 periodontally-healthy-non-smokers) were included. The clinicoradiographic parameters were worse among marijuana-smokers (p < 0.01), cigarette-smokers (p < 0.01) and non-smokers-with-periodontitis (p < 0.01) than periodontally-healthy-non-smokers. Marijuana- and cigarette-smokers had Stage-IV/Grade C and non-smokers with periodontitis had Stage-III/Grade-C. Salivary IL-17A and IL-23 levels were higher in marijuana-smokers than cigarette-smokers (p < 0.01) and non-smokers-with-periodontitis (p < 0.01). Whole salivary IL-17A and IL-23 levels were higher among cigarette-smokers than non-smokers with periodontitis (p < 0.01) and periodontally-healthy-individuals (p < 0.01). Marijuana- and heavy cigarette-smokers have comparable clinicoradiographic periodontal statuses. This rejects hypothesis-1. However, whole salivary immunoinflammatory response may be moderately worse in marijuana-smokers compared with heavy cigarette-smokers and non-smoker with periodontitis thereby supporting hypothesis-2.

[Regional and demographic differences on passive smoking among non-smokers aged 30-79 years in 10 regions of China]

Objective: To describe the regional and demographic differences on passive non-smokers from 10 regions involved in the China Kadoorie Biobank (CKB) study. Methods: Detailed information regarding passive smoking behaviors related to 317 486 non-smokers who were 30-79 years old from the 10 study regions were gathered and analyzed. Results: Following the standardization of the 2010 China national population, the prevalence rate of passive smoking was 56.7%, and the prevalence rate of living with smokers was 66.5% among the Chinese adults. Both of the aforementioned rates were higher in rural than in urban areas. Meanwhile, the regional distribution of weekly passive smoking frequency and cumulative duration of passive smoking per week and cumulative duration of passive smoking per day were significantly different. The cumulative passive smoking duration per week increased along with the weekly frequency in people living in urban areas. Among women, the weekly passive smoking frequency was the highest, and the cumulative durations per week and per day appeared the lowest in Hunan, opposite to the situation in Henan. The prevalence of passive smoking among participants living with smokers was 2.27 times (95%CI: 2.24-2.29) of those who were not and the association appeared stronger in women (OR=2.61, 95%CI: 2.58-2.64) but not in men (OR=1.01, 95%CI: 0.95-1.06). Almost all the indicators seemed higher in women than those in men, except for the cumulative duration per day. Furthermore, these indicators appeared higher among those who were at younger age or with less education. The prevalence rates of passive smoking and living with smokers were lower but the cumulative duration per day was higher among those with lower household income. And the two rates were higher in married women and lower in married men, as compared to their counterparts. Conclusion: Regional and demographic differences in passive smoking were noticed among study population of CKB in the 10 regions.

Understanding resource utilization and mortality in COPD to support policy making: A microsimulation study

Chronic obstructive pulmonary disease (COPD) poses a significant but heterogeneous burden to individuals and healthcare systems. Policymakers develop targeted policies to minimize this burden but need personalized tools to evaluate novel interventions and target them to subpopulations most likely to benefit. We developed a platform to identify subgroups that are at increased risk of emergency department visits, hospitalizations and mortality and to provide stratified patient input in economic evaluations of COPD interventions. We relied on administrative and survey data from Ontario, Canada and applied a combination of microsimulation and multi-state modeling methods. We illustrated the functionality of the platform by quantifying outcomes across smoking status (current, former, never smokers) and by estimating the effect of smoking cessation on resource use and survival, by comparing outcomes of hypothetical cohorts of smokers who quit at diagnosis and smokers that continued to smoke post diagnosis. The cumulative incidence of all-cause mortality was 37.9% (95% CI: 34.9, 41.4) for never smokers, 34.7% (95% CI: 32.1, 36.9) for current smokers, and 46.4% (95% CI: 43.6, 49.0) for former smokers, at 14 years. Over 14 years, smokers who did not quit at diagnosis had 16.3% (95% CI: 9.6, 38.4%) more COPD-related emergency department visits than smokers who quit at diagnosis. In summary, we combined methods from clinical and economic modeling to create a novel tool that policymakers and health economists can use to inform future COPD policy decisions and quantify the effect of modifying COPD risk factors on resource utilization and morality.

Lung Cancer in Non-Smokers

Lung cancer is the leading cause of cancer death worldwide and the third most common cancer following breast and prostate.1 As expected, the primary factor leading to lung cancer is tobacco smoke, and as smoking rates have declined, we have also seen an overall decline in lung cancer rates.2 Despite the general reduction in lung cancer rates, the rate of lung cancer in non-smokers has been noted to be increasing.3-8.

Seminal plasma protein networks and enriched functions in varicocele: Effect of smoking

To verify a possible synergistic effect of smoking and varicocele on the seminal plasma proteome and biological functions, a cross-sectional study was performed in 25 smokers and 24 nonsmokers. Samples were used for conventional semen analysis, functional analysis (DNA fragmentation, acrosome integrity and mitochondrial activity) and proteomics by a shotgun approach. Functional enrichment of biological pathways was performed in differentially expressed proteins. Smokers presented lower ejaculate volume (p = .027), percentage of progressively motile spermatozoa (p = .002), total sperm count (p = .039), morphology (p = .001) and higher percentage of immotile spermatozoa (p = .03), round cell (p = .045) and neutrophil count (p = .009). Smokers also presented lower mitochondrial activity and acrosome integrity and higher DNA fragmentation. We identified and quantified 421 proteins in seminal plasma, of which one was exclusive, 21 were overexpressed and 70 were underexpressed in the seminal plasma of smokers. The proteins neprilysin, beta-defensin 106A and histone H4A were capable of predicting the smoker group. Enriched functions were related to immune function and sperm machinery in testis/epididymis. Based on our findings, we can conclude that cigarette smoking leads to the establishment of inflammatory protein pathways in the testis/epididymis in the presence of varicocele that seems to act in synergy with the toxic components of the cigarette.

Lung cancer mortality among never-smokers in the United States: estimating smoking-attributable mortality with nationally representative data

PURPOSE

Lung cancer mortality among never-smokers is an often overlooked yet important cause of adult mortality. Moreover, indirect approaches for estimating smoking-attributable mortality use never-smoker lung cancer death rates to approximate smoking burden. To date, though, most studies using indirect approaches import rates from the Cancer Prevention Study II (CPS-II), which is not representative of the U.S.

POPULATION

METHODS

We use the nationally representative 1985-2015 National Health Interview Survey-Linked Mortality Files (NHIS-LMF) to calculate lung cancer death rates among never-smokers aged 50 years or older. We then import rates from NHIS-LMF and CPS-II into the Preston-Glei-Wilmoth indirect method to determine whether smoking-attributable fractions differ.

RESULTS

Never-smokers account for 16% of U.S. lung cancer deaths among women and 11% among men. Lung cancer death rates among never-smokers are higher in NHIS-LMF than CPS-II for several age groups. Smoking-attributable fractions of mortality are slightly lower with NHIS-LMF rates (19% of male deaths and 16% of female deaths) than with CPS-II rates (21% of male deaths and 17% of female deaths).

CONCLUSIONS

Fractions based on nonrepresentative CPS-II data may modestly overestimate smoking-attributable mortality. Thus, indirect methods should use never-smoker lung cancer death rates from such nationally representative datasets as NHIS-LMF.

Comparison of Genotoxic Effect in Buccal Exfoliated Cells between Cigarette and Waterpipe Smokers

BACKGROUND/AIM

Cytogenetic biomarkers such as micronuclei (MN) are used for the evaluation of exposure to carcinogens and genotoxic effects in oral epithelial cells. Tobacco is one of the strongest carcinogens responsible for the development of cancer in oral mucosa. The aim of this study was to compare the genotoxic effect of waterpipe smoking with that of cigarette smoking.

METHODS

This case-control study was performed on 30 waterpipe smokers, 30 cigarette smokers, and 30 nonsmokers. Buccal exfoliated cells were prepared using cytobrushes and stained with the Papanicolaou technique. The cytologic slides were examined under a light microscope for counting the number of MN and the number of cells with MN per 1,000 epithelial cells.

RESULTS

The mean number ± standard deviation (SD) of MN in waterpipe smokers, cigarette smokers, and nonsmokers was 7.55 ± 5.530, 4.95 ± 5.633, and 2.00 ± 2.406, respectively. The mean number ± SD of cells with MN in waterpipe smokers, cigarette smokers, and nonsmokers was 6.20 ± 4.830, 3.50 ± 3.832, and 1.45 ± 1.701, respectively. Numbers of cells with MN differed significantly between waterpipe smokers and cigarette smokers (p = 0.04) and between waterpipe smokers and nonsmokers (p < 0.001). Numbers of MN differed significantly between waterpipe smokers and nonsmokers (p < 0.001). Numbers of MN did not differ significantly between waterpipe smokers and cigarette smokers (p = 0.10). Numbers of MN and of cells with MN did not differ significantly between cigarette smokers and nonsmokers (p = 0.06 and p = 0.052, respectively).

CONCLUSIONS

Waterpipe smoking is associated with a significantly higher frequency of MN, and it seems that waterpipe smoking has a greater genotoxic effect than cigarette smoking.

Association between vitiligo and smoking: A nationwide population-based study in Korea

No study has examined the associations between vitiligo and smoking. The purpose of this study was to investigate the incidence of vitiligo according to smoking status. We used clinical data from individuals aged over 20 years who received a health examination in the National Insurance Program between 2009 and 2012 (n = 23,503,807). We excluded individuals with pre-existing vitiligo who had ever been diagnosed with vitiligo before the index year (n = 35,710) or who were diagnosed with vitiligo within a year of the index year (n = 46,476). Newly diagnosed vitiligo was identified using claims data from baseline to date of diagnosis or December 31, 2016 (n = 22,811). The development of vitiligo was compared according to self-reported smoking status by a health examination survey. The hazard ratio of vitiligo in current smokers was 0.69 (95% confidence interval; 0.65-0.72) with a reference of never-smokers after adjustment for age, sex, regular exercise, drinking status, body mass index, diabetes mellitus, hypertension, dyslipidemia, history of stroke, and history of ischemic heart diseases. The decreased risk of vitiligo in current smokers persisted after subgroup analysis of sex and age groups. The results suggested there are suppressive effects of smoking on the development of vitiligo. Further studies are needed to evaluate the mechanism of smoking on the development of vitiligo.

Association between environmental tobacco smoke exposure and risk of type 2 diabetes mellitus in Chinese female never smokers: A population-based cohort study

BACKGROUND

Evidence for the association between environmental tobacco smoke (ETS) exposure and the risk of type 2 diabetes mellitus (T2DM) is limited. The aim of this study was to investigate this association in female never smokers.

METHODS

We analyzed 28 177 female participants of the China Kadoorie Biobank (CKB) in the Suzhou area, who were never smokers and had no diabetes. ETS exposure was defined as being exposed to other people's tobacco smoke either at home, workplace, or in public places at least 1 d/wk. Cox proportional hazard regression models were used to assess the association between ETS exposure and incident T2DM according to the frequency and duration of ETS exposure.

RESULTS

A total of 774 incident cases of T2DM were identified during a median 7.3-year follow-up. Compared with no ETS exposure, hazard ratios (95% CIs) for all ETS exposure, daily, and ≥14 h/wk ETS exposure were 1.17 (1.00-1.37), 1.23 (1.04-1.46), and 1.25 (1.03-1.53), respectively. Moreover, a positive dose-response relationship was observed between ETS exposure level and T2DM (all P <.05 for trend).

CONCLUSIONS

This prospective study suggests that ETS exposure increases the risk of T2DM incidence with dose-response relationship in female never smokers. Thus, reducing ETS exposure may help decrease the burden of T2DM in Chinese females.

Associations between smoking status and bodily pain in a cross-sectional survey of UK respondents

BACKGROUND

Research indicates that ex- and current smokers report increased levels of bodily pain compared with never smokers. This could be secondary to smoking-related disease or psychological characteristics of smokers, or it could be a neurological or vascular effect of a period of regular smoking.

AIMS

We compared self-reported levels of bodily pain in daily, never daily and former daily smokers stratified by age group and adjusting for a wider range of covariates than has been undertaken to-date, including health status, neuroticism, anxiety and depression.

METHOD

223,537 UK respondents aged 16+ years were surveyed between 2009 and 2013 in the British Broadcasting Corporation (BBC) Lab UK Study. Respondents provided information on bodily pain, smoking status and a range of sociodemographic, health, behavioural and psychological characteristics.

RESULTS

After adjusting for all covariates, in 16-34-year-olds, reported levels of bodily pain in former daily smokers (Badj = 0.72, 95% CI = 0.30, 1.15, p < .001) and daily smokers (Badj = 0.50, 95% CI = 0.18, 0.82, p < .01) were higher than in never daily smokers. Reported levels of bodily pain were also higher in former daily smokers than in never daily smokers in those aged 35-64 (Badj = 1.04, 95% CI = 0.69, 1.38, p < .001) and 65 + years (Badj = 1.65, 95% CI = 0.07, 3.24, p < .05).

CONCLUSIONS

After adjusting for key characteristics, former daily smokers reported higher levels of bodily pain compared with never daily smokers at all ages. This raises the possibility that a period of smoking may have lasting effects on pain experiences.

Secondhand smoke exposure at home and public places among smokers and non-smokers in India: findings from the Global Adult Tobacco Survey 2016-17

Secondhand smoke (SHS) accounts for 0.9 million deaths and 24 million disability adjusted life years (DALYs) annually. Nearly 30% of adults in India are exposed to SHS in India. To reduce SHS exposure, India enacted a smoke-free law in 2003 under which smoking in public places is banned. However, the compliance to this law has been variable in several assessments in the country. A better understanding of the nature and extent of SHS exposure can help inform better implementation of national smoke-free policies. The Global Adult Tobacco Survey (GATS) India 2016-17 collects information on the self-reported prevalence of SHS exposure in homes, workplaces, government buildings, restaurants, public transportation and health care facilities among adults (> 15 years of age).The present study utilized the GATS India 2016-17 dataset to provide estimates of SHS exposure among adults in India in homes, workplace and other public places, across gender and age groups and among the overall population and non-smokers. Weighted analysis was carried out. In the overall population, exposure to SHS in the home was 29.2%, more among young females. In workplaces, exposure to SHS was 29.2% overall, significantly higher among males (32.5%) compared to females (17.8%). In public buildings such as health care facilities and government offices, SHS exposure was less with 15.6% and 21.2% respectively. SHS exposure was high in restaurants with 39.3% overall, significantly higher among males (43.2%) compared to females (22.2%). Similar results were also seen among non-smokers. A large proportion of adults in India, both smokers and non-smokers are exposed to SHS in their homes, workplaces and other public places, especially restaurants, workplaces and public transportation. Females are more exposed to SHS at home, whereas males are more exposed in public places including workplaces. High SHS exposure among youths is also a concern. Stricter enforcement of legislation is required to ensure 100% smoke-free homes, public places and workplaces and reduce SHS exposure.

Relationship of Cigarette Smoking and Time of Quitting with Incident Dementia and Cognitive Decline

OBJECTIVES

Understanding how dementia risk is impacted by timing of smoking cessation has public health implications for prevention efforts. We investigated the relationship of cigarette smoking and cessation with dementia risk and cognitive decline in the Atherosclerosis Risk in Communities (ARIC) study.

DESIGN

Ongoing prospective cohort study.

SETTING

Begun in 1987-1989, ARIC was conducted in four US communities.

PARTICIPANTS

A total of 13 002 men and women (25% African American) aged 52 to 75 years.

MEASUREMENTS

All-cause dementia was defined using standardized algorithms incorporating longitudinal cognitive data, proxy report, and hospital and death certificate dementia codes. Cognitive decline was measured using a composite cognitive score created from three tests measured at two time points (1996-1998 and 2011-2013). Smoking and cessation status were defined by self-report using data from 1987-1989 (visit 1) and 1996-1998 (visit 4). Incident dementia risk and differences in cognitive change by smoking status were estimated with Cox proportional hazards and linear regression models, respectively. To address smoking-related attrition, cognitive scores were imputed for living participants with incomplete cognitive testing.

RESULTS

The proportion of never, former, and current smokers was 44%, 41%, and 14%; 79% of former smokers quit 9 years or more before baseline. A total of 1347 participants developed dementia. After adjustment, compared with never smoking, the hazard ratio for all-cause dementia for current smoking was 1.33 (95% confidence interval [CI] = 1.12-1.59) and for recent quitting (<9 y before baseline) was 1.24 (95% CI = 1.01-1.52). Quitting 9 years or more before baseline was not associated with dementia. We found no differences in rates of cognitive decline by smoking status.

CONCLUSION

Although quitting at any time suggested benefit, dementia risk depended on time since smoking cessation. Our study highlights the importance of early midlife cessation to decrease dementia risk. J Am Geriatr Soc 68:337-345, 2020.

Communicating the relative health risks of E-cigarettes: An online experimental study exploring the effects of a comparative health message versus the EU nicotine addiction warnings on smokers' and non-smokers' risk perceptions and behavioural intentions

INTRODUCTION

This study investigated the effects of the European Union Tobacco Products Directive [EU-TPD] Article 20 E-cigarette (EC) health warnings ("This product contains nicotine which is a highly addictive substance. [It is not recommended for non-smokers.]") and a comparative harm message ("Use of this product is much less harmful than smoking" [COMP]) on smokers' and non-smokers' perceptions and behavioural intentions.

METHODS

2495 UK residents (1283 smokers and 1212 non-smokers) self-reported perceived harm, addictiveness, EC effectiveness, social acceptability, and intentions to purchase and use EC, and in smokers, intentions to quit and intentions to use EC in future quit attempts. These were measured before and after exposure to EC images containing either the TPD, COMP, TPD + COMP or no message.

RESULTS

Non-smokers had higher harm, addictiveness and lower social acceptability perceptions. TPD presence increased, whilst COMP decreased, harm and addictiveness perceptions in both groups. For smokers only, harm perceptions were lower following exposure to COMP alone vs. no message. For non-smokers the TPD increased harm perceptions vs. no message. There were no effects on social acceptability, EC effectiveness or use intentions. In smokers only, purchase and quit intentions were higher following exposure to the COMP alone.

CONCLUSION

TPD messages may be effective smoking prevention tools, although the COMP message was more effective in reducing harm perceptions and increasing use intentions in smokers. That COMP did not increase use intentions in non-smokers suggest that such exposures may potentially act as an effective harm reduction tool without resulting in increased uptake among non-smokers.

Lung function decline in former smokers and low-intensity current smokers: a secondary data analysis of the NHLBI Pooled Cohorts Study

BACKGROUND

Former smokers now outnumber current smokers in many developed countries, and current smokers are smoking fewer cigarettes per day. Some data suggest that lung function decline normalises with smoking cessation; however, mechanistic studies suggest that lung function decline could continue. We hypothesised that former smokers and low-intensity current smokers have accelerated lung function decline compared with never-smokers, including among those without prevalent lung disease.

METHODS

We used data on six US population-based cohorts included in the NHLBI Pooled Cohort Study. We restricted the sample to participants with valid spirometry at two or more exams. Two cohorts recruited younger adults (≥17 years), two recruited middle-aged and older adults (≥45 years), and two recruited only elderly adults (≥65 years) with examinations done between 1983 and 2014. FEV1 decline in sustained former smokers and current smokers was compared to that of never-smokers by use of mixed models adjusted for sociodemographic and anthropometric factors. Differential FEV1 decline was also evaluated according to duration of smoking cessation and cumulative (number of pack-years) and current (number of cigarettes per day) cigarette consumption.

FINDINGS

25 352 participants (ages 17-93 years) completed 70 228 valid spirometry exams. Over a median follow-up of 7 years (IQR 3-20), FEV1 decline at the median age (57 years) was 31·01 mL per year (95% CI 30·66-31·37) in sustained never-smokers, 34·97 mL per year (34·36-35·57) in former smokers, and 39·92 mL per year (38·92-40·92) in current smokers. With adjustment, former smokers showed an accelerated FEV1 decline of 1·82 mL per year (95% CI 1·24-2·40) compared to never-smokers, which was approximately 20% of the effect estimate for current smokers (9·21 mL per year; 95% CI 8·35-10·08). Compared to never-smokers, accelerated FEV1 decline was observed in former smokers for decades after smoking cessation and in current smokers with low cumulative cigarette consumption (<10 pack-years). With respect to current cigarette consumption, the effect estimate for FEV1 decline in current smokers consuming less than five cigarettes per day (7·65 mL per year; 95% CI 6·21-9·09) was 68% of that in current smokers consuming 30 or more cigarettes per day (11·24 mL per year; 9·86-12·62), and around five times greater than in former smokers (1·57 mL per year; 1·00-2·14). Among participants without prevalent lung disease, associations were attenuated but were consistent with the main results.

INTERPRETATION

Former smokers and low-intensity current smokers have accelerated lung function decline compared with never-smokers. These results suggest that all levels of smoking exposure are likely to be associated with lasting and progressive lung damage.

FUNDING

National Institutes of Health, National Heart Lung and Blood Institute, and US Environmental Protection Agency.

Evaluation of Tobacco Smoke and Diet as Sources of Exposure to Two Heterocyclic Aromatic Amines for the U.S. Population: NHANES 2013-2014

BACKGROUND

Heterocyclic aromatic amines (HAA) are a group of hazardous substances produced during combustion of tobacco or high-temperature cooking of meats. 2-Amino-9H-pyrido[2,3-b]indole (AαC) is a major carcinogenic HAA in tobacco smoke.

METHODS

Urinary AαC, used as a marker of AαC exposure, was analyzed on spot urine samples from adult participants of the 2013-2014 cycle of the National Health and Nutrition Examination Survey (N = 1,792). AαC was measured using isotope-dilution liquid chromatography-tandem mass spectrometry. Exclusive combusted tobacco smokers were differentiated from nonusers of tobacco products through both self-report and serum cotinine data.

RESULTS

Among exclusive smokers, sample-weighted median urinary AαC was 40 times higher than nonusers. Sample-weighted regression models showed that urinary AαC increased significantly with serum cotinine among both exclusive tobacco users and nonusers with secondhand smoke exposure. Among nonusers, eating beef cooked at high temperature was associated with a significant increase in urinary AαC, whereas consuming vegetables was associated with decreased AαC. In addition, smoking one-half pack of cigarettes per day was associated with a significant increase of 23.6 pg AαC/mL calculated at geometric mean of AαC, controlling for potential confounders. In comparison, increase in AαC attributable to consuming the 99th percentile of beef cooked at high temperature was 0.99 pg AαC/mL.

CONCLUSIONS

Both exclusive smokers and nonusers of tobacco in the general U.S. population are exposed to AαC from tobacco smoke, with additional, lesser contributions from certain dietary components.

IMPACT

AαC is an important biomarker that is associated with tobacco smoke exposure.

Molecular footprints of muscle-invasive bladder cancer in smoking and nonsmoking patients

BACKGROUND

Bladder cancer is the fifth most common cancer in the United States and smoking is the largest known risk factor. Tobacco-derived carcinogens may induce the accumulation of somatic mutations in urothelial cells, and likely promote tumorigenesis. However, it is still unknown whether smoking-induced bladder carcinogenesis results in tumors with distinctive molecular features that can be therapeutically exploited.

METHODS

We investigated the genomic alterations of human bladder cancer and examined their association with patient smoking history. We performed bioinformatic analyses and looked at differences in gene expression, somatic mutations, and DNA mutational signatures comparing nonsmokers, reformed smokers, and current smokers.

RESULTS

We detected a limited set of gene expression and gene mutation differences between smokers and nonsmokers. We also identified a specific mutational signature that is enriched in tumors from smokers. This mutational signature was described before and has been linked to specific DNA repair defects in human bladder tumors, as well as to the direct effect of nitrosamine carcinogens in the BBN murine model of bladder cancer.

CONCLUSION

We showed associations between smoking status and selected mutational signatures, which could provide insights in the biology of bladder carcinogenesis and tumor progression.

Smoking susceptibility among non-smoking school-going adolescents in Malaysia: findings from a national school-based survey

OBJECTIVE

The identification of susceptible non-smoking adolescents is an essential step in reducing smoking initiation among adolescents. The aim of this study was to examine the prevalence and factors associated with smoking susceptibility among non-smoking school-going adolescents in Malaysia.

DESIGN

Cross-sectional study.

SETTING

Primary and secondary schools in Malaysia.

PARTICIPANTS

11 246 non-smoking school-going adolescents.

OUTCOME MEASURES

The prevalence and factors associated with smoking susceptibility among non-smoking school-going adolescents in Malaysia.

RESULTS

Approximately 14% of non-smokers were susceptible to smoking, and the prevalence of susceptibility was significantly higher among males, ever-smokers and e-cigarette users. The odds of susceptibility to smoking were higher among males, e-cigarette users, those aged 12 years and under and those who had ever smoked or tried cigarettes. Students from schools with educational programmes on the health effects of second-hand smoke (SHS) and who perceived smoking to be harmful were less likely to be susceptible to smoking.

CONCLUSION

Smoking susceptibility is prevalent among school-going adolescents. A comprehensive approach that enhances or reinforces health education programmes on the adverse health effects of smoking and SHS among school children, that considers multiple factors and that involves all stakeholders is urgently needed to reduce the prevalence of smoking susceptibility among vulnerable subgroups, as identified from the present findings.

The association between e-cigarette use and asthma among never combustible cigarette smokers: behavioral risk factor surveillance system (BRFSS) 2016 & 2017

BACKGROUND

E-cigarette use prevalence has grown rapidly in the US. Despite the popularity of these products, few acute exposure toxicity studies exist, and studies on long-term pulmonary health effects are limited. E-cigarette users who are never combustible cigarette smokers (sole users) constitute a unique group of young adults that may be at increased risk of bronchial hyperreactivity and development of asthma. Given the public health concern about the potential pulmonary health effects of sole e-cigarette use, we aimed to examine the association between e-cigarette use and asthma among never combustible cigarette smokers.

METHODS

We pooled 2016 and 2017 data of the Behavioral Risk Factor Surveillance System (BRFSS), a large, cross-sectional telephone survey of adults aged 18 years and older in the U.S. We included 402,822 participants without any history of combustible cigarette smoking (defined as lifetime smoking < 100 cigarettes) and with complete self-reported information on key variables. Current e-cigarette use, further classified as daily or occasional use, was the primary exposure. The main outcome, asthma, was defined as self-reported history of asthma. We assess the relationship of sole e-cigarette use with asthma using multivariable logistic regression adjusting for age, sex, race, income, level of education and body mass index.

RESULTS

Of 402,822 never combustible cigarette smokers, there were 3103 (0.8%) current e-cigarette users and 34,074 (8.5%) with asthma. The median age group of current e-cigarette users was 18-24 years. Current e-cigarette use was associated with 39% higher odds of self-reported asthma compared to never e-cigarette users (Odds Ratio [OR], 1.39; 95% confidence interval: 1.15, 1.68). There was a graded increased odds of having asthma with increase of e-cigarette use intensity. The odds ratio of self-reported asthma increased from 1.31 (95% confidence interval: 1.05, 1.62) in occasional users to 1.73 (95% confidence interval: 1.21, 2.48) in daily e-cigarette users, compared to never e-cigarette users.

CONCLUSION

Our findings from a large, nationally representative survey suggest increased odds of asthma among never combustible smoking e-cigarette users. This may have potential public health implications, providing a strong rationale to support future longitudinal studies of pulmonary health in young e-cigarette-using adults.

Trends in Illicit Drug Use Among Smokers and Nonsmokers in the United States, 2002-2014

OBJECTIVE

Cigarette smoking has declined in the United States. Still, identifying prevalent and modifiable barriers to quitting can help inform the next steps for tobacco control. Illicit drug use, which may be increasingly common in the United States, could be one such factor. We investigated the relationship between past-month illicit drug use and cigarette smoking status and estimated trends in the prevalence of past-month illicit drug use by cigarette smoking status from 2002 to 2014 in the United States.

METHODS

The 2002-2014 National Survey on Drug Use and Health was used to obtain nationally representative data on past-month illicit drug use.

RESULTS

From 2002 to 2014, past-month illicit drug use (for all drugs considered) was nearly 5 times more common among current smokers than among never smokers (adjusted odds ratio = 4.79) and nearly twice as prevalent in former smokers as in never smokers (adjusted odds ratio = 1.99). Illicit drug use increased linearly over time from 2002 to 2014 in the entire general population (ie, across and within current smokers, former smokers, and never smokers). This increasing trend in drug use was most rapid among former smokers (relative to current smokers and never smokers) and was largely, but not entirely, driven by increases in cannabis use.

CONCLUSIONS

Illicit drug use is most prevalent among current cigarette smokers. Yet, the rate of increase in illicit drug use prevalence was most rapid among former smokers. Because former smokers outnumber current smokers in the general population, it may be important to monitor former smokers into the future for potential negative drug-related outcomes.

Clinical, Angiographic Characteristics and In-Hospital Outcomes of Smoker and Nonsmoker Patients After Primary Percutaneous Coronary Intervention

BACKGROUND

Smoking is a well-established cardiac risk factor there is dearth of Local data regarding clinical and angiographic characteristics of smoker patients.

OBJECTIVES

This study was planned to assess the differences in the clinical characteristics, angiographic characteristics, and in-hospital outcomes of smokers and nonsmokers after primary percutaneous coronary intervention at a tertiary care hospital in Karachi, Pakistan.

METHODS

We included patients between 40 and 80 years of age diagnosed with ST-segment elevation myocardial infarction who underwent primary percutaneous coronary intervention from July 1, 2017, to March 31, 2018. Clinical and angiographic characteristics and in-hospital outcomes were obtained from the cases submitted to the National Cardiovascular Data Registry's CathPCI (Catheterization-Percutaneous Coronary Intervention) Registry from our site.

RESULTS

A total of 3,255 patients were included in this study. Smokers consist of 25.1% (817) of the total sample. A high majority of smokers were male, 98.8% (807), and smokers were relatively younger as compared to nonsmokers with a mean age of 52.89 ± 10.59 versus 55.98 ± 11.24 years; p < 0.001. Smokers had higher post-procedure TIMI (Thrombolysis In Myocardial Infarction) flow grade III: 97.8% (794) versus 95.53% (2,329); p = 0.037, and they had a relatively low mortality rate: 2.69% (22) versus 3.16% (77); p = 0.502.

CONCLUSIONS

Smokers were predominantly male and around 3 years younger than nonsmokers. Diabetes mellitus and hypertension were less common among smokers and single-vessel disease was the more common angiographic finding for smokers as compared to 3-vessel disease for nonsmokers. No statistically significant differences in in-hospital outcomes were observed. ST-segment elevation myocardial infarction in smokers despite younger age and the low atherosclerotic risk profile, in our region, emphasize the need for nicotine addiction management and smoking cessation campaigns at large and for pre-discharge counseling.

How did the tobacco ban increase inmates' body weight during incarceration in Canadian federal penitentiaries? A cohort study

OBJECTIVE

This study aimed to determine how inmates' body weight changed during incarceration in Canadian federal penitentiaries, based on their history of tobacco use. Since tobacco was banned from all Canadian federal penitentiaries in 2008, little is known about the unintended health consequences of this ban, especially on inmates' body weight.

DESIGN

Cohort study.

SETTING

Participants were male and female inmates incarcerated for at least 6 months in Canadian federal penitentiaries. We collected data from 10 institutions in two Canadian regions (Ontario and Atlantic).

PARTICIPANTS

We collected data from 754 inmates who volunteered to participate in the study.

INTERVENTION

This study examined weight change in relation to a history of tobacco use. In 2016-2017, anthropometric data were collected and compared with recorded anthropometric data at the beginning of incarceration (mean follow-up of 5.0±8.3 years). Self-reported data on tobacco and substance use were collected. Weight change was compared between inmates with and without a history of tobacco use.

OUTCOMES

The main outcome measures were body weight change (kg), body mass index (BMI) change (kg/m²), annual weight change (kg/year), and BMI and waist circumference (cm) at the time of the interview.

RESULTS

During incarceration, ex-smokers gained more than twice the amount of weight compared with non-smokers (7.5 kg weight gain for smokers vs 3.7 kg weight gain for non-smokers). Once adjusted for covariates in a regression analysis, for inmates who gained the most weight (75th and 90th percentiles), non-smokers had, respectively, 1.64 and 2.3 lower BMI points than ex-smokers.

CONCLUSIONS

During incarceration in Canadian federal penitentiaries, inmates with a history of tobacco use gained significantly more weight than non-smokers. This put them at increased risk of developing obesity-related health problems. This information is important for the prison setting when planning related programmes and regulation.

Exposure to Court-Ordered Tobacco Industry Antismoking Advertisements Among US Adults

IMPORTANCE

In 2006, US District Judge Gladys Kessler ordered tobacco companies to make corrective statements through paid advertisements informing the public of their deceptive practices. This landmark ruling and its subsequent execution represent the first time the tobacco industry sponsored a nationwide corrective advertising campaign against its own products.

OBJECTIVE

To assess the reach of the court-ordered antismoking advertisements within the US adult population, stratified by demographic characteristics and tobacco use.

DESIGN, SETTING, AND PARTICIPANTS

This nationally representative, population-based cross-sectional survey of US adults included respondents to the 2018 Health Information National Trends Survey 5, Cycle 2. Respondents were representatives of households selected by equal-probability sampling of the Marketing Systems Group database of addresses that included all nonvacant US residential addresses. Data collection was conducted from January to May 2018, and analysis took place from December 2018 to April 2019.

MAIN OUTCOMES AND MEASURES

Self-reported exposure to court-ordered antismoking advertisements.

RESULTS

The overall sample of 3484 respondents included 2054 women (weighted percentage, 50.8%), 1976 non-Hispanic white respondents (weighted percentage, 59.9%), 2952 respondents who lived in urban US areas (weighted percentage, 84.9%), and 450 current smokers (weighted percentage, 15.6%). Estimated exposure to court-ordered antismoking advertisements was 40.6% (95% CI, 37.5%-43.7%) among the full sample and 50.5% (95% CI, 41.4%-59.6%) among current smokers. Exposure was lowest among those aged 18 to 34 years (37.4%; 95% CI, 28.0%-46.8%), those with a high school education or less (34.5%; 95% CI, 29.3%-39.8%), and those with household annual income less than $35 000 (37.5%; 95% CI, 32.0%-42.9%). Among current smokers, Hispanic respondents had lower exposure rates (42.2%; 95% CI, 18.5%-65.9%) than non-Hispanic white respondents (51.7%; 95% CI, 40.4%-63.1%). As the advertising campaign's duration increased, exposure rates increased. Individuals with a high school education or less had lower odds of antismoking advertisement exposure than those with college or postgraduate degrees (adjusted odds ratio, 0.67; 95% CI, 0.48-0.94). Current smokers had higher odds of exposure than never smokers (adjusted odds ratio, 1.81; 95% CI, 1.17-2.80). Among those exposed to antismoking advertisements, 70.5% saw multiple antismoking messages.

CONCLUSIONS AND RELEVANCE

Approximately 1 of 2 smokers reported exposure to the federal court-ordered antismoking advertisements. However, exposure was relatively lower among several subgroups, including individuals aged 18 to 34 years, only one-third of whom reported exposure. Increasing the duration of antismoking advertisements as well as expanding their coverage to youth-oriented media may increase their potential public health impact.

Would placing pictorial health warnings on waterpipe devices reduce waterpipe tobacco smoking? A qualitative exploration of Egyptian waterpipe smokers' and non-smokers' responses

BACKGROUND

Although Egypt places four generic pictorial health warnings (PHWs) on the front and back half of waterpipe tobacco packs (WTPs), waterpipe tobacco smoking (WTS) rates have continued to rise. It has been suggested that PHWs would be more salient if placed on the waterpipe device itself. This qualitative study explored how participants perceived the effects placing PHWs on waterpipe devices would have on warning salience and uptake or quitting of WTS.

METHODS

We conducted 10 focus groups and 10 in-depth interviews with 90 adult waterpipe smokers and non-smokers, men and women, who lived in rural, semi-urban and urban regions of Egypt. We presented participants with four novel PHWs of different sizes positioned randomly at four locations on a waterpipe device (the glass body, metal holder, mouthpiece or hose), one at a time. At each session, participants viewed a PHW on all four locations. Novel warnings were shown on plain labels with a dark uniform background and featured pictures, text and the quitline number. Transcripts were analysed using thematic analysis.

RESULTS

Participants thought placing PHWs on waterpipe devices might increase salience, prevent WTS initiation or trigger quit attempts; they favoured placing PHWs on the glass body, mouthpiece or waterpipe hose. Both waterpipe smoker and non-smoker participants thought these potential effects would affect non-smokers or non-established smokers more than established waterpipe users.

CONCLUSIONS

Our exploratory study suggests that PHWs featured prominently on waterpipe devices could potentially deter experimentation with waterpipe tobacco products and promote cessation, especially among non-established users.

Lung cancer and residential radon in never-smokers: A pooling study in the Northwest of Spain

BACKGROUND

Using a pooled case-control study design, including only never-smokers, we have assessed the association of residential radon exposure with the subsequent occurrence of lung cancer. We also investigated whether residential radon poses a different risk specifically for adenocarcinoma.

METHODS

We pooled individual data from different case-control studies conducted in recent years in Northwestern Spain which investigated residential radon and lung cancer. All participants were never-smokers. Cases had a confirmed biopsy of primary lung cancer. Hospital controls were selected at pre-surgery units, presenting for non-complex surgical procedures. They were interviewed using a standardized instrument. Residential radon was measured using alpha track detectors at the Galician Radon Laboratory at the University of Santiago de Compostela.

RESULTS

A total of 1415 individuals, 523 cases and 892 controls were included. We observed an odds ratio of 1.73 (95%CI: 1.27-2.35) for individuals exposed to ≥ 200 Bq/m³ compared with those exposed to ≤100 Bq/m³. Lung cancer risk for adenocarcinoma was 1.52 (95%CI: 1.14-2.02) using the same categories for radon exposure.

CONCLUSIONS

Residential radon is a clear risk factor for lung cancer in never-smokers. Our data suggest that radon exposure is associated with all histological types of lung cancer and also with adenocarcinoma, which is currently the most frequent histological type for this disease.

Voluntary home and car smoke-free rules in Japan: a cross-sectional study in 2015

OBJECTIVES

Recently, the Tokyo Metropolitan Assembly passed an ordinance prohibiting smoking in private homes and cars if children are present. However, no previous study has investigated existing, voluntary home and car smoke-free rules in Japan. Therefore, we examined prevalence and determinants of comprehensive home and car smoke-free rules.

DESIGN

A cross-sectional study.

SETTING

Internet survey data with adjustments using inverse probability weighting for 'being a respondent in an internet survey'.

PARTICIPANTS

5600 respondents aged 15-69 years in 2015 were analysed to estimate weighted percentages and prevalence ratios (PRs) with 95% CIs of having comprehensive home and car smoke-free rules.

MAIN OUTCOME MEASURES

Respondents who answered 'smoking is never allowed' in their home and car were defined as having home and car smoke-free rules.

RESULTS

Overall, 47.0% (95% CI=45.8% to 48.3%) of respondents implemented comprehensive home and car smoke-free rules. People who agreed with 'smoking relieves stress' were less likely to have comprehensive smoke-free rules (PR=0.76, 0.71 to 0.82), especially among ever-users of electronic nicotine delivery systems (PR=0.49, 0.30 to 0.81). Higher education was significantly associated with higher PR for comprehensive smoke-free rules (PR=1.30, 1.19 to 1.41). Living with children was significantly associated with higher PR for smoke-free rules among current smokers than not living with children (PR=2.91, 1.99 to 4.27).

CONCLUSIONS

In Japan, about 50% of respondents had voluntary smoke-free rules in the home and car. Information on current voluntary smoke-free rules will be useful as baseline information on home and car smoke-free status before enforcement of the 2018 Tokyo home and car smoke-free legislation.

Cannabis use among a nationally representative cross-sectional sample of smokers and non-smokers in the Netherlands: results from the 2015 ITC Netherlands Gold Magic Survey

OBJECTIVES

Existing evidence shows that co-occurring use of tobacco and cannabis is widespread. Patterns of co-use of tobacco and cannabis may change as more jurisdictions legalise medicinal and/or recreational cannabis sales. This analysis examined predictors of current cannabis use and characterised methods of consumption among smokers and non-smokers in a context where cannabis use is legal.

SETTING

The 2015 International Tobacco Control Netherlands-Gold Magic Survey conducted between July and August 2015.

PARTICIPANTS

Participants (n=1599; 1003 current smokers, 283 former smokers and 390 non-smokers) were asked to report their current (past 30-day) use of cigarettes and cannabis. Cigarette smokers reported whether they primarily used factory made of roll-your-own cigarettes. Those who reported any cannabis use in the last 30 days were asked about forms of cannabis used. X2and logistic regression analyses were used to assess relationships among combustible tobacco and cannabis use.

RESULTS

Past 30-day cannabis use was somewhat higher among current tobacco (or cigarette) smokers (n=57/987=5.8%) than among former or never smokers (n=10/288=3.5% and n=6/316=1.9%, respectively). Joints were the most commonly used form of cannabis use for both current cigarette smokers (96.9%) and non-smokers (76.5%). Among those who smoked cannabis joints, 95% current smokers and 67% of non-smokers reported that they 'always' roll cannabis with tobacco.

CONCLUSIONS

In this Netherlands-based sample, most cannabis was reported to be consumed via smoking joints, most often mixed with tobacco. This behaviour may present unique health concerns for non-cigarette smoking cannabis users, since tobacco use could lead to nicotine dependence. Moreover, many non-cigarette smoking cannabis users appear to be misclassified as to their actual tobacco/nicotine exposure.

Circulating high sensitivity C reactive protein concentrations and risk of lung cancer: nested case-control study within Lung Cancer Cohort Consortium

OBJECTIVES

To conduct a comprehensive analysis of prospectively measured circulating high sensitivity C reactive protein (hsCRP) concentration and risk of lung cancer overall, by smoking status (never, former, and current smokers), and histological sub-type.

DESIGN

Nested case-control study.

SETTING

20 population based cohort studies in Asia, Europe, Australia, and the United States.

PARTICIPANTS

5299 patients with incident lung cancer, with individually incidence density matched controls.

EXPOSURE

Circulating hsCRP concentrations in prediagnostic serum or plasma samples.

MAIN OUTCOME MEASURE

Incident lung cancer diagnosis.

RESULTS

A positive association between circulating hsCRP concentration and the risk of lung cancer for current (odds ratio associated with a doubling in hsCRP concentration 1.09, 95% confidence interval 1.05 to 1.13) and former smokers (1.09, 1.04 to 1.14) was observed, but not for never smokers (P<0.01 for interaction). This association was strong and consistent across all histological subtypes, except for adenocarcinoma, which was not strongly associated with hsCRP concentration regardless of smoking status (odds ratio for adenocarcinoma overall 0.97, 95% confidence interval 0.94 to 1.01). The association between circulating hsCRP concentration and the risk of lung cancer was strongest in the first two years of follow-up for former and current smokers. Including hsCRP concentration in a risk model, in addition to smoking based variables, did not improve risk discrimination overall, but slightly improved discrimination for cancers diagnosed in the first two years of follow-up.

CONCLUSIONS

Former and current smokers with higher circulating hsCRP concentrations had a higher risk of lung cancer overall. Circulating hsCRP concentration was not associated with the risk of lung adenocarcinoma. Circulating hsCRP concentration could be a prediagnostic marker of lung cancer rather than a causal risk factor.

Exposure to Secondhand Smoke Among Nonsmokers - United States, 1988-2014

Exposure to secondhand smoke from burning tobacco products can cause sudden infant death syndrome, respiratory infections, ear infections, and asthma attacks in infants and children, and coronary heart disease, stroke, and lung cancer in adult nonsmokers (1). There is no risk-free level of secondhand smoke exposure (2). CDC analyzed questionnaire and laboratory data from the National Health and Nutrition Examination Survey (NHANES) to assess patterns of secondhand smoke exposure among U.S. nonsmokers. The prevalence of secondhand smoke exposure among U.S. nonsmokers declined substantially during 1988–2014, from 87.5% to 25.2%. However, no change in exposure occurred between 2011–2012 and 2013–2014, and an estimated one in four nonsmokers, or approximately 58 million persons, were still exposed to secondhand smoke during 2013–2014. Moreover, marked disparities persisted across population groups. Exposure prevalence was highest among nonsmokers aged 3–11 years (37.9%), non-Hispanic blacks (50.3%), and those who were living in poverty (47.9%), in rental housing (38.6%), or with someone who smoked inside the home (73.0%), or among persons who had less than a high school education (30.7%). Comprehensive smoke-free laws and policies for workplaces and public places and smoke-free rules for homes and vehicles can further reduce secondhand smoke exposure among all nonsmokers.

The effects of the European e-cigarette health warnings and comparative health messages on non-smokers' and smokers' risk perceptions and behavioural intentions

BACKGROUND

Article 20 of the EU Tobacco Products Directive [TPD] stipulates that e-cigarette packets and refill products must carry a nicotine addiction health warning. Although previous studies conducted in North America have found that perceived harm, addictiveness and intention to use declined following exposure to e-cigarette health warnings, possible effects of the TPD health warnings on smokers and non-smokers has not been studied. This study will investigate the effects of the EU TPD e-cigarette health warnings and a comparative harm message (COMP; developed specifically for this study) on smokers' and non-smokers' perceptions of harm, addictiveness and social acceptability of e-cigarettes. Additionally, the potential effects of the TPD warnings and the COMP on smokers' intentions to purchase and use e-cigarettes will be explored.

METHODS/DESIGN

A sample of 2400 UK residents will be recruited in this experimental, randomised design, with Smoking status (Smoker vs. Non-smoker), TPD presence (TPD1 vs. TPD2 vs. No-TPD) and COMP presence (Presence vs. Absence) as between subjects independent variables, and Time (pre-post exposure of images) as a within subjects factor. Dependent variables comprise self-reported perceived harm, addictiveness, social acceptability, e-cigarettes' effectiveness, intentions to purchase and use e-cigarettes. Cigarette dependence, previous e-cigarette exposure, and baseline intentions to quit will be measured as covariates.

DISCUSSION

Health warnings, such as those implemented by the TPD, may help to prevent non-smokers from e-cigarettes use, but it is possible that they may inadvertently deter smokers from initiating use and substituting their tobacco smoking for e-cigarettes use if their content is deemed too negative. It is hoped that this study will help identify the most effective message or combination of messages that encourage use among smokers without promoting use among non-smokers.

TRIAL REGISTRATION

ISRCTN registry ISRCTN76967031 ; date of registration: 23/10/18.

Pre-surgical register of tobacco consumption

INTRODUCTION AND OBJECTIVE

Smoking cessation before surgery decreases the risk of complications. The aim of this study was to analyse the smoking register, associated variables and a short talk given to smokers in pre-surgical visits.

MATERIAL AND METHOD

Cross-sectional study. The pre-surgical records of 680 patients were assessed. We selected patient sociodemographic variables, surgical intervention characteristics, smoking status and consumption pattern. Logistic regression was used to study the variables association with smoking.

RESULTS

A percentage of 97.2 of the pre-surgical records include information on tobacco consumption. Overall 20% of surgical patients are smokers. The probability of smoking is higher among men (adjusted odds ratio [aOR] 2.6, 95% confidence interval [CI] 1.7-4.0) and≤60 years (aOR 5.4, 95% CI 3.2-9.1). None of the records had information regarding a short talk given to patients to give up smoking.

CONCLUSION

Smoking consumption was prevalent, but the characterisation of a smoker's profile and short talk given to patient before surgery was practically nonexistent. Ensuring that patients who smokes receives a short talk to give up smoking before surgery is necessary.

Short- and long-term exposure to ambient air pollution and circulating biomarkers of inflammation in non-smokers: A hospital-based cohort study in South Korea

Despite increasing epidemiological evidence of an association between air pollution and adverse health outcomes, the detailed mechanisms underlying the adverse effects of air pollution on medical conditions remain unclear. We evaluated the effects of short- and long-term exposure to ambient air pollution on key inflammatory markers in non-smoking subjects. Serum fibrinogen, C-reactive protein, ferritin, and white blood cell counts were repeatedly measured 3 times in 6589 subjects at the Samsung Medical Center (Seoul, South Korea) between 2010 and 2016. Both short- (≤8-day averages) and long-term (annual averages) exposure measures of 6 air pollutants (particles < 2.5 μm, particles < 10 μm, nitrogen dioxide, sulfur dioxide, ozone, and carbon monoxide) were estimated for each subject based on available residential addresses. Linear mixed-effects models were used to relate interquartile range increases in pollutant concentrations to inflammatory marker levels. Short-term exposure to air pollution was associated with increased fibrinogen and ferritin levels. Long-term exposure to air pollution was associated with increased fibrinogen levels and white blood cell counts. The largest short- and long-term associations were observed for ferritin in response to nitrogen dioxide exposure (1.4%, 95% confidence interval [CI] 0.3-2.5) and fibrinogen exposed to particles < 2.5 μm (3.4%, 95% CI 3.0-3.8), respectively. Significantly higher associations were observed among subjects with elevated levels of inflammatory markers (upper 25th percentile), including C-reactive protein, and those with cardiac infarction, chronic obstructive pulmonary disease, cerebral infarction, or diabetes. We found clear associations between short- and long-term exposure to air pollution and inflammatory markers, especially among vulnerable subgroups. Our findings provide evidence in support of the hypothesis that air pollution increases systemic inflammation, particularly among susceptible subgroups.

Comparison at the first prenatal visit of the maternal dietary intakes of smokers with non-smokers in a large maternity hospital: a cross-sectional study

OBJECTIVES

Using detailed dietary and supplement questionnaires in early pregnancy, we compared the dietary intakes of micronutrients and macronutrients at the first prenatal visit of women who reported continuing to smoke during pregnancy with the intakes of women who were non-smokers.

DESIGN

Cross-sectional study conducted between June 2014 and March 2016.

SETTING

Stand-alone tertiary maternity hospital in an urban setting with approximately 8000 deliveries per year.

PARTICIPANTS

Women were recruited at their convenience after sonographic confirmation of an ongoing singleton pregnancy (n=502). Detailed dietary and supplement information was available for 398 women. Women <18 years and those who did not speak English fluently were excluded.

PRIMARY AND SECONDARY OUTCOME MEASURES

The differences in dietary micronutrients and macronutrients and maternal folate levels between women who continued to smoke in pregnancy compared with non-smokers.

RESULTS

Of the 502 women, the mean age was 30.5 (SD 5.6) years, 42.5% were nulliparas, 19.2% were obese and 398 (79.3%) completed the questionnaire satisfactorily. In the 50 (12.6%) current smokers, the micronutrients magnesium, iron, carotene and copper were lower (all p<0.005) whereas sodium and chloride were higher compared with the 348 (87.4%) non-smokers. Smokers reported lower intakes of dietary total folate (p=0.006) compared with non-smokers (i.e., dietary folate equivalents; intake from natural and fortified dietary sources) (p=0.005). Smokers also reported lower intakes of fibre than non-smokers (13.1 g (IQR 7.7) vs 16.3 g (IQR 8.5), p<0.001). The dietary intakes of former smokers compared favourably with non-smokers.

CONCLUSIONS

We found that women who continue to smoke during pregnancy have serious dietary inadequacies which could potentially aggravate fetal growth restriction associated with direct toxicity from cigarettes. This provides a further reason to promote smoking cessation interventions in pregnancy, and highlights the need for dietary and supplementation interventions in women who continue to smoke.