Use of electronic nicotine delivery systems by pregnant women II: Hair biomarkers for exposures to nicotine and tobacco-specific nitrosamines

INTRODUCTION

Public awareness of electronic nicotine delivery systems (ENDS) has increased over time, and the perception that ENDS offer a safer alternative to cigarettes may lead some pregnant women to use them to reduce cigarette smoking during pregnancy. No previous studies have used metabolite levels in hair to measure nicotine exposure for ENDS users during pregnancy. We aimed to measure and compare levels of nicotine, cotinine, and tobacco-specific nitrosamines (TSNAs) in hair samples from pregnant women who were current ENDS users, current smokers, and current non-smokers. We also aimed to estimate the association between ENDS use/smoking and smallness for gestational age (SGA).

METHODS

We used hair specimens from pregnant women who were dual users (ENDS and cigarettes), smokers, and non-smokers from a prospective cohort study to estimate exposure to nicotine, cotinine, and TSNAs. The exposure biomarkers and self-reports of smoking and ENDS use were used in log-binomial regression models to estimate risk ratios (RRs) for SGA among offspring.

RESULTS

Nicotine concentrations for pregnant dual users were not significantly different from those for smokers (11.0 and 10.6 ng/mg hair, respectively; p=0.58). Similarly, levels of cotinine, and TSNAs for pregnant dual users were not lower than those for smokers. The RR for SGA was similar for dual users and smokers relative to nonsmokers, (RR=3.5, 95% CI: 0.8-14.8) and (RR=3.3, 95% CI: 0.9-11.6), respectively. Using self-reports confirmed by hair nicotine, the RR values for dual ENDS users and smokers were 8.3 (95% CI: 1.0-69.1) and 7.3 (95% CI:1.0-59.0), respectively.

CONCLUSIONS

We did not observe lower levels of nicotine, cotinine, and TSNAs for current dual users compared to smokers during pregnancy. The risk of SGA for offspring of pregnant dual users was similar to that for offspring of pregnant smokers. Future studies are needed to further estimate the magnitude of the association between ENDS use and smallness for gestational age.

Use of Electronic Nicotine Delivery Systems (ENDS) by pregnant women I: Risk of small-for-gestational-age birth

INTRODUCTION

The 2016 US Surgeon General's Report suggests that the use of electronic nicotine delivery systems (ENDS) is a fetal risk factor. However, no previous study has estimated their effect on adverse pregnancy outcomes. We assessed the prevalence of current ENDS use in pregnant women and explored the effect on birth weight and smallness-for-gestational-age (SGA), correcting for misclassification from nondisclosure of smoking status.

METHODS

We conducted a cohort study with 248 pregnant women using questionnaire data and biomarkers (salivary cotinine, exhaled carbon monoxide, and hair nicotine). We evaluated the association between birth weight and the risk of SGA by applying multivariate linear and log-binomial regression to reproductive outcome data for 232 participants. Participants who did not disclose their smoking status were excluded from the referent group. Sensitivity analysis corrected for misclassification of smoking/ENDS use status.

RESULTS

The prevalence of current ENDS use among pregnant women was 6.8% (95% CI: 4.4-10.2%); most of these (75%) were concurrent smokers. Using self-reports, the estimated risk ratio of SGA for ENDS users was nearly two times the risk in the unexposed (RR=1.9, 95% CI: 0.6-5.5), and over three times that for ENDS-only users versus the unexposed (RR=3.1, 95% CI: 0.8-11.7). Excluding from the referent group smokers who did not disclose their smoking status, the risk of SGA for ENDS-only use was 5 times the risk in the unexposed (RR=5.1, 95% CI: 1.1- 22.2), and almost four times for all types of ENDS users (RR=3.8, 95% CI: 1.3-11.2). SGA risk ratios for ENDS users, corrected for misclassification due to self-report, were 6.5-8.5 times that of the unexposed.

CONCLUSIONS

Our data suggest that ENDS use is associated with an increased risk of SGA.

Seroprevalence of anti-Toxoplasma gondii IgG antibody and risk factors among abattoir workers in Uyo, Southern Nigeria

Context

The asymptomatic nature of toxoplasmosis with its severe consequences, especially in populations with high HIV infection rate, makes it a disease of public health importance. Being a zoonosis, Toxoplasma gondii infection may be high among people who work with animals. Thus, there is the need to determine the prevalence of the infection among abattoir workers in Uyo, where HIV prevalence rate is in double digits, which could lead to reactivation of toxoplasmosis in those with immunosuppression.

Aim

To determine the prevalence and associated risk factors of T. gondii infection in abattoir workers in Uyo.

Settings and Design

A descriptive cross-sectional study that was conducted among persons who work with livestock and birds, in Uyo and its environs.

Methodology

The study was conducted among 339 workers in abattoirs in Uyo and its environs. Data were collected using interviewer-administered questionnaire and detection of IgG antibodies to T. gondii using ELISA technique and HIV testing using the national algorithm. Data were analyzed using STATA statistical software version 20, and statistically significant level was set at P < 0.05.

Results

The seroprevalence of T. gondii IgG antibodies among the study participants was 55.8%. At a univariate level, many factors were associated with T. gondii seropositivity; they were age, sex, level of education, ethnicity, occupation in the abattoir, type of animal exposure, always washing hands before eating in the workplace, and taking of raw/unpasteurized milk. However, after multivariate analysis, participants exposed to poultry, butchers/raw meat sellers, and those who had worked for more than 5 years in abattoirs were at a greater risk of being T. gondii IgG seropositive; odds ratio (OR) 5.46 [confidence interval (CI) 1.88, 15.86]; OR 1.89 (CI 1.14, 3.14), and OR 1.25 (CI 1.25, 6.42), respectively.

Conclusion

T. gondii IgG seroprevalence is high among abattoir workers in Uyo, and there is a need for Akwa Ibom State government to establish enlightenment and prevention programs for these occupationally exposed and other populations at risk of infection.

Electronic Nicotine Delivery Systems and Smoking Cessation in Arkansas, 2014

OBJECTIVES

As of October 2015, evidence needed to make a recommendation about the use of electronic nicotine delivery systems (ENDS) for smoking cessation was limited. We used the 2014 Arkansas Behavioral Risk Factor Surveillance System with additional state-specific questions to determine the prevalence of ENDS use, the impact of ENDS use on smoking cessation, and beliefs about ENDS use in Arkansas. Our objectives were to determine if (1) ENDS use was associated with lower odds of quitting smoking, (2) ENDS users believed that ENDS use was not harmful to their health, and (3) ENDS users believed that switching to ENDS reduced their tobacco-related health risks.

METHODS

We conducted a cross-sectional study of 4465 respondents to the Arkansas Behavioral Risk Factor Surveillance System and used weighted analyses to account for the complex survey design. We used a subset of records formed by (1) formers smokers who quitted smoking in the last 5 years and (2) current smokers to assess the odds of quitting.

RESULTS

In 2014, 6.1% (95% confidence interval [CI], 5.0%-7.4%) of Arkansas adults were currently using ENDS. Of the 1083 participants who were current smokers or had quit smoking within the past 5 years, 515 (54.1%) had used ENDS. Of the 515 ENDS users, 404 (80.3%) had continued smoking. ENDS use was significantly associated with reduced odds of quitting smoking (weighted odds ratio = 0.53; 95% CI, 0.34-0.83). Although 2437 of 3808 participants (62.5%) believed that it was harmful for nonsmokers to start using ENDS and 1793 of 3658 participants (47.0%) believed that switching to ENDS did not reduce tobacco-related health risks, only 80 of 165 (41.3%) and 50 of 168 (33.9%) ENDS users shared these same respective beliefs.

CONCLUSIONS

Most smokers who indicated smoking in the past 5 years and who tried ENDS did not stop smoking. ENDS use was inversely associated with smoking cessation. Tobacco cessation programs should tell cigarette smokers that ENDS use may not help them quit smoking.

Long-Term Nonmalignant Disease Mortality in Subjects Exposed to Transmissible Agents Present in Animals Used for Food

OBJECTIVE

To study mortality from nonmalignant diseases in subjects with high exposure to transmissible agents present in animals used for food, and in their raw or inadequately cooked products.

METHODS

Mortality was compared in a cohort of meat handlers in slaughtering and processing plants with that of the U.S. general population.

RESULTS

Excess mortality was observed for conditions known to be associated with infections-these include, septicemia, chronic nephritis, diseases of the kidney and ureter, diseases of the pancreas, cirrhosis of the liver, acute and subacute endocarditis, acute rheumatic fever, functional diseases of the heart, aortic aneurysm, intracranial and intraspinous abscess, and meningitis. Excess mortality was also observed for ischemic heart disease and diabetes, conditions without an established infectious etiology, but which have been linked with infections.

CONCLUSIONS

If transmissible agents present in food animals and their raw products cause long-term diseases and mortality in humans, this study importantly points to the likely diseases, many of which are already known to be associated with infections. The excess mortality observed for ischemic heart disease and diabetes is consistent with existing evidence linking these conditions with infections, and gives rise to the novel hypothesis that microbial agents present in food animals and their products may be candidates for an infective role in the occurrence of these conditions, and therefore needs further investigation.

Overweight and obesity profiles in Niger Delta Region, Nigeria

INTRODUCTION

Overweight and obesity are global public health problems because of their effect on individuals, families and communities. The objective of this study was to describe the profile of overweight and obesity amongst adult out patients in Uyo in the Niger Delta region of Nigeria.

METHOD

This was a cross-sectional descriptive study done between October 2011 and March 2012. Using a systematic sampling technique, 584 subjects aged 18-65 years were recruited; data were collected with a structured questionnaire. Subjects were measured for height, weight, waist and hip circumferences. Body mass index (BMI) and waist-hip ratio (WHR) were calculated. Subjects with a BMI of 25.0 kg/m2 - 29.9 kg/m2 were regarded as being overweight whilst a BMI of > 30.0 kg/m2 was regarded as obese. Subjects with a WHR of > 0.90 for men or > 0.85 for women were regarded as having abnormal WHR.

RESULTS

Of the 584 subjects, 196 (36.6%) were men and 388 (66.4%) women. The mean age for men and women was 43.3 ± 17.8 years and 50.2 ± 13.6 years, respectively. The prevalence of overweight amongst men was 39.8% versus 31.7% for women; obesity in men was 28.0% versus 52.0% in women. Overweight and obesity were more prevalent in subjects aged 25-54 years and amongst married subjects. There was a significant relationship between obesity and television viewing (p = 0.003). Hypertension (p = 0.008) and osteoarthropathies (p = 0.043) were more prevalent amongst the obese than the non-obese subjects.

CONCLUSION

Overweight and obesity are now common in our environment. There is therefore a need for more public education about the health consequences of big body size.

High blood pressure in a semi-urban community in south-south Nigeria: a community-based study

BACKGROUND

Non communicable diseases (NCDs) are taking their toll in most low and middle income countries; incidentally, in the same populations that are struggling to deal with communicable diseases, hence presenting a picture of "double tragedy". Most of the researches conducted on NCDs are facility-based; often in urban locations.

OBJECTIVE

To determine the prevalence of high BP in a semi-urban community in Nigeria.

METHODS

It was a cross-sectional study, where all the adult residents of the community were enrolled. Data was collected using a multi-section questionnaire, including anthropometric measurements. Data entry and analysis was done using SPSS 17.0 for windows and STATA 10.

RESULTS

The results showed that 47.0% of the study population had a raised BP ≥140/90mmHg. At a univariate level, age, sex, higher income, more people in the household, daily cigarette smoking, daily alcohol intake and BMI, showed increased risk for high BP. However, sleeping for at least 8 hours a day showed protective influence against raised BP among the participants. In the adjusted model, only age, sex and BMI remained statistically significant with Odds Ratio (OR) of 1.04 (95%CI; 1.00, 1.08), 0.45 (95%CI; 0.22, 0.90) and 1.08(95%CI; 1.03, 1.13) respectively. The model had an area under curve of 71.9%.

CONCLUSION

It was concluded that there is a high prevalence of raised BP in this semi-urban community, thus the need for intervention and preventive services to curb the looming epidemic of hypertension in this community in particular, and Nigeria as a whole, cannot be overemphasized.

Awareness, use and main source of information on preventive health examinations: a survey of childbearing women in Uyo, Nigeria

The study determined awareness, use and the main source of information about preventive health examinations among 387 childbearing women attending three health facilities in Uyo, Nigeria. Respondents were consenting women aged 15-49 years who had a live birth in the two months preceding the survey. Respondents were interviewed using structured questionnaires during child welfare clinic visits at each facility. Awareness about pap smears and breast self examination was 14.2% and 35.3% respectively. Testing rates were highest for blood pressure checks, HIV and blood sugar and lowest for Pap smears and mammograms. Health workers were the main informants on preventive tests. Awareness and secondary education enhanced women's uptake of screening services across levels of health care. Secondary education as a minimum and intensified awareness creation about preventive health examinations through media, school based programs, durbars and public health campaigns are vital to the health and well being of women and children.