Age Smoking Research Articles

PMH52 FACTORS ASSOCIATED WITH REGULAR NICOTINE SALT POD SYSTEM USE AMONG SMOKERS ABSTAINING FROM COMBUSTIBLE CIGARETTES

Previous studies have found a positive association between regular use of Nicotine Salt Pod Systems (NSPS) and abstinence from combustible cigarette use among smokers. This study assessed factors associated with daily use of NSPS among smokers who abstained from cigarette smoking 6 months after initiating NSPS use and those who continued smoking. Adult current smokers (age≥21) who bought an NSPS starter kit and completed baseline and 180-day follow-up assessments (N=18,834) reported demographic characteristics, smoking history and motivations for NSPS purchase at baseline and past 30-day cigarette smoking and NSPS use at 180-day assessment. The sample was stratified by switching (past 30-day abstinence from smoking) status at 180 days; differences in baseline characteristics among daily/non-daily NSPS users in each subgroup were assessed. The sample was divided into independent training and validation sets, and logistic regression models examined associations between baseline characteristics and daily/non-daily NSPS use at 180-days. Among switchers, daily NSPS users (vs. non-daily users) were more likely to be daily smokers, have a smoking history of >10 years, and cite quitting smoking as reasons for purchase. Smoking for >20 years (aOR = 2.7, CI = 1.5-4.9), smoking for 10-20 years (aOR = 1.6, CI = 1.0-2.6), believing NSPS to be less harmful than cigarettes (aOR = 1.4. CI = 1.1-1.8) and daily smoking at baseline (aOR = 1.8, CI = 1.5-2.4) were associated with daily NSPS use at 180-days in the switching subgroup. Logistic models from training samples performed well in validation samples (accuracy scores ranging from 0.68 – 0.73). This study provides new longitudinal data on attributes associated with regular NSPS use among smokers who switch from combustible cigarettes. Identifying factors associated with NSPS use and switching behavior may inform likelihood of behavior change or support development of techniques to aid switching away from cigarettes.

The association between flavor capsule cigarette use and sociodemographic variables: Evidence from Chile.

PurposeThe objective of this article is to examine the factors associated with smoking of flavor capsule cigarettes in Chile, where the popularity of these products has increased dramatically, a trend increasingly observed across the world.MethodsA representative poll of 851 smokers in Metropolitan Santiago de Chile, which comprises 40% of the country's total population, was implemented in mid-2017. Smokers were given a questionnaire that collected socio-demographic information and information on smoking patterns. Four discrete-choice models were estimated on the decision to smoke flavor capsule cigarettes to better understand the statistical relationships between traits of smokers and the consumption of flavor capsule cigarettes.ResultsThe results of these models show that each year less in a smoker’s age increases the likelihood of preferring flavor capsule cigarettes by, on average, between 0.8 and 0.9 percentage points. If the smoker is a woman, the likelihood of preferring flavor capsule cigarettes increases between 13.4 and 13.5 percentage points. Results also reveal a positive relationship between the price paid and the consumption of flavor capsule cigarettes, indicating that these cigarettes tend to be more expensive. There is no statistical relationship between participation in the labor market and smoking these products.ConclusionsChile has the world’s highest prevalence of flavor capsule cigarette smoking, which is concentrated among young people (25 years and younger) and females. No relationship between socioeconomic status and use of these products is found, though there are indications that such relationship may exist, as they were at the time of study 14% more expensive, on average, than conventional non-flavored cigarettes. As in most countries, the tobacco industry appears to be deliberately promoting these products with the goal of halting or slowing the decline in cigarette consumption in Chile. Thus, to reduce cigarette consumption (especially among youth), restricting or forbidding cigarette flavorings of all types, including flavor capsules, would be an effective strategy.

Analysis of which factors are important in controlling the number of smokers in Indonesia

The number of smokers in Indonesia is increasing, making the quality of health of the Indonesian population decrease. In addition, the age of smokers in Indonesia is also getting early. This paper discusses the problem of smoking in Indonesia by dividing the population of non-smokers, smokers, and ex-smokers divided into a population of teenagers and adults. First we will construct a mathematical model for this problem, then we get differential equation system. Next, a sensitivity analysis is carried out to get information about which factors are most important in controlling smoking.

139 Is Smoking Associated With an Increased Risk of Diverticulitis?

INTRODUCTION: Diverticulitis is inflammation of a previously existing diverticulum. Complicated diverticulitis is characterized by the formation of phlegmon, abscess, obstruction or perforation. Recent meta-analysis proved a positive association between tobacco and diverticulosis, but there is a lack of robust data on the effect of tobacco smoking on diverticulitis. METHODS: We retrospectively analyzed patients hospitalized with diverticulitis (via ICD-9 codes) in 2016 using the Nationwide Inpatient Sample (NIS) Database. Our primary end point was to establish a relationship between patients diagnosed with diverticulitis and tobacco smokers. We also analyzed the relationship between smoking and the presence of complicated versus non-complicated diverticulitis. Finally we analyzed the relationship between the presence of diverticulitis with race and gender. Univariate and multivariate logistic regression models were developed using STATA software version 15. RESULTS: A total of 331,999 patients with diverticulitis were included in our study population. We found that patients with diverticulitis were 35% more likely to be tobacco smokers than non-smokers (OR: 1.359; CI: 1.329–1.389; P-value: 0.000). This relationship was stronger in patients with complicated diverticulitis where 49% were more likely to be tobacco smokers than non-smokers (OR: 1.495; CI: 1.451–1.540; P-value: 0.000). In addition patients with complicated diverticulitis presented at a younger age in tobacco smokers than in non-smokers (mean age: 59.23 vs 61.55; P-value: 0.0001). On multivariate analysis adjusting for possible confounding factors we found that smoking (OR: 1.30; CI: 1.27–1.33; P-value: 0.00), Caucasian race (OR: 1.731; CI: 1.596–1.878; P-value: 0.000), female gender (OR: 1.09; CI: 1.07–1.11; P-value: 0.00), and colon cancer (OR: 1.07; CI: 1.01–1.15; P-value: 0.02) were all associated with an increased likelihood of diverticulitis. In contrast, diverticulitis was 14% less likely to occur in black patients (OR: 0.865; CI: 0.793–0.944; P-value: 0.001). CONCLUSION: We conclude there is a positive association between tobacco smoking and diverticulitis. Smoking increases the risk of complicated diverticulitis and this tends to occur at a younger age compared to non-smokers. Incidence of diverticulitis is more common in whites and least common among blacks when compared to other races. Given these findings more robust measures should be implemented to help young adults quit smoking tobacco.

3056 A Case of NSAID-Induced Collagenous Colitis

INTRODUCTION: Collagenous colitis is a disorder of chronic watery diarrhea. It has 2 main histologic forms. It is characterized by normal appearance of the colon on colonoscopy but abnormal histology. It is more likely to occur in elderly women and smokers and has been associated with certain medications such as NSAIDs, PPIs, Antipsychotics. Our case report demonstrates the importance of medication reconciliation when working patients up for diarrhea, and supports the fact that medications, such as those mentioned above can cause recurrence of symptoms, even after treatment. CASE DESCRIPTION/METHODS: A 68 year old female patient with a PMH notable for hypertension, GERD, and asthma was diagnosed with diarrhea-predominant IBS in 2015 treated with Rifaximin in the past. In 2015, she began to have 4-6 episodes of brown watery diarrhea daily, from a normal baseline. She underwent colonoscopy at the time, which was normal. She was treated with a 10 day course of Rifaximin with resolution of symptoms. 3 years later, she began to have diarrhea and abdominal cramping for which she made dietary changes with no improvement. She completed another 10 day course of Rifaximin with persistent symptoms. She was admitted to LHMC for weakness and diarrhea because of her inability to tolerate oral intake. Colonoscopy on 11/28 demonstrated ulceration in the hepatic and splenic flexures concerning for ischemic injury versus inflammatory bowel disease. Biopsies were consistent with collagenous colitis although there was neutrophilic cystitis concerning for a superimposed drug induced of infectious process. She was started on Budesonide with improvement in her symptoms before she returned 2 weeks later with diarrhea. Medication reconciliation demonstrated patient had been placed on Omeprazole and NSAID. This was discontinued however her symptoms persisted and she underwent repeat colonoscopy. Biopsies were consistent with Collagenous colitis. DISCUSSION: Collagenous colitis is a chronic inflammatory disease of colon. Presents with insidious onset of chronic watery non bloody diarrhea. Pathogenesis remains unclear. It has been associated with multiple medication classes, including medications that this patient was on. She had been treated with Budesonide with resolution of her symptoms, however re-initiation of both PPI and NSAID may have caused recurrence of her symptoms. Our case highlights the importance of vigorous history, chart and medication review when investigating a patient with diarrhea of unknown etiology.

294 Emergency Department Patients Who Smoke Have Higher Admission Rates Than Non-Smokers

Smoking is a known risk factor for poor health outcomes. We hypothesized smoking would result in an increased admission rate from the emergency department (ED). Our goal was to determine the magnitude of the difference in admission rates from the ED for smokers versus nonsmokers. Design retrospective cohort. Setting: Suburban community teaching hospital with annual visits of 90,000. Population: Consecutive ED patients from 40 to 70 years of age for the period 6-1-18 to 4-9-19. While the adverse effects from cigarette use and the age at which adverse health outcomes first appear varies, we a priori chose to examine the age group > 40 years of age. We also excluded patients greater than 70 years because other comorbidities may play a larger role. Trauma patients were also excluded as their smoking status is unlikely to influence the admission decision. Protocol: We obtained the current smoking and admission status from the electronic medical record. We calculated the admission rates for smokers and non-smokers and the relative change along with the 95% confidence interval (CI). Of the 28,894 patients who met our exclusion criteria, 18% were smokers. The average age of smokers and nonsmokers was 56 years. Females comprised 50% of the total patients. The percent of smokers in females and males was 15% and 22% respectively. The admission rate for smokers and nonsmokers was 61% and 45% respectively a relative increase of 37% (95% CI: 34% to 41%, p < 0.0001). We found a marked increase in admission rates in smokers compared to nonsmokers. To our knowledge this is the first report of an association between smoking and admission rates of ED patients who smoke. Modifiable lifestyle choices such as smoking should be addressed when counseling ED patients who smoke.

IBS30.03 Risk Assessment to Establish Screening Programs: The Canadian Point of View

The Canadian Task Force on Preventive Health Care (CTFPHC) supports screening with low dose computed tomography (LDCT) of the chest to decrease lung cancer mortality.1 The Task Force recommends annual screening up to three consecutive years in high risk adults aged 55-74 years with at least a 30 pack-year smoking history, who currently smoke or quit less than 15 years ago. Pilot LDCT screening program or studies are being conducted in Canada to help determine how to best implement organized lung cancer screening for people at high risk at the population level. Based on emerging data that suggests both the CTFPHC and the US Preventive Services Task Force (USPSTF) age and pack-years selection criteria2 are suboptimal and that risk prediction tools such as the PLCOm2012 are more sensitive with better positive predictive power to identify ever smokers who will develop lung cancer with a lower number needed to screen to prevent one lung cancer death and are more cost-effective,3-8 pilot studies in Canada adopt the PLCOm2012 risk prediction tool to select high risk ever smokers for LDCT screening. A prospective study is being conducted in newly diagnosed lung cancer patients in the Greater Vancouver area. In 1,076 patients, 37% were never smokers reflecting the foreign-born ethnic distribution. Of the 683 ever smokers, 60% met the PLCOm2012 model 6-year risk ≥1.5% screening criteria while only 39.5% met the USPSTF screening criteria. The International Lung Screen Trial (ILST), a multi-center prospective trial in Canada (British Columbia, Alberta), Australia, Hong Kong, and the United Kingdom, offer screening to ever smokers age 55 to 80 years if they meet the USPSTF criteria or the PLCOm2012 model 6-year risk ≥1.5% criteria. Participants receive two annual screens and are followed for six years for lung cancer outcomes. Interim results in 4,863 participants with 101 lung cancers showed that PLCOm2012 identified 26.6% more lung cancers than USPSTF criteria (99% of all lung cancers versus 78% with USPSTF). However, PLCOm2012 screened 9.9% more people than USPSTF criteria. If 2% six-year lung cancer risk threshold were used for screening selection criteria as is currently used in the Cancer Care Ontario Pilot, PLCOm2012 would be 12.7% more sensitive identifying 88.1% of lung cancers while screening 11% fewer people compared to USPSTF criteria. A 1.7% six-year lung cancer risk threshold would be 24.1% more sensitive identifying 97% of all lung cancers while screening only 1% more people than USPSTF criteria. The 1.7% threshold may be a better screening selection criterion. The worldwide burden of lung cancer is significant and projected to rise during the coming years especially in East Asian countries, namely, China, Japan, South Korea and Taiwan because of the large population size, high stable incidence rates in male and significant upward trends in females many of whom are never smokers.9 With global migration and increasing number of new Canadians who are diagnosed with lung cancer are from Asian countries such as in Vancouver, better lung cancer risk assessment tools need to be developed that take into account ethnicity and other environmental exposures such as outdoor and household air pollution exposures.10 Risk prediction tools may be perceived by some to be more complex to use than age and pack-years. The web based PanCan risk prediction tool, a precursor to the validated PLCOm2012 model, was tested in both English and French in 8 centers across Canada from coast to coast.7 The tool was found to be simple to use and took approximately 5 minutes to administer over the telephone. Similar experience was found with the web based PLCOm2012 risk assessment tool for enrollment into the International Lung Screen Trial and the Cancer Care Ontario pilot screening program. Risk assessment can be readily done by a navigator or a physician for enrollment into lung cancer screening programs as part of the shared decision process. Supported by the Terry Fox Research Institute, BC Cancer Foundation, the VGH-UBC Hospital Foundation, the Alberta Cancer Foundation, and the Australian NHMRC.

The Put It Out Project (POP) Facebook Intervention for Young Sexual and Gender Minority Smokers: Outcomes of a Pilot, Randomized, Controlled Trial.

This trial investigated whether a Facebook smoking cessation intervention culturally tailored to young sexual and gender minority (SGM) smokers (versus non-tailored) would increase smoking abstinence. Participants were 165 SGM young adult US smokers (age 18-25) recruited from Facebook in April 2018 and randomized to an SGM-tailored (POP; N = 84) or non-tailored (TSP-SGM; N = 81) intervention. Interventions delivered weekly live counseling sessions and 90 daily Facebook posts to participants in Facebook groups. Primary analyses compared POP and TSP-SGM on biochemically verified smoking abstinence (yes/no; primary outcome), self-reported 7-day point prevalence abstinence (yes/no), reduction in cigarettes per week by 50+% from baseline (yes/no), making a quit attempt during treatment (yes/no), and stage of change (precontemplation/contemplation vs. preparation/action). Supplemental analyses compared POP to two historical control groups. POP participants were more likely than TSP-SGM participants to report smoking abstinence at 3 (23.8% vs. 12.3%; OR = 2.50; p = .03) and 6 months (34.5% vs. 12.3%; OR = 4.06; p < .001) and reduction in smoking at 3 months (52.4% vs. 39.5%; OR = 2.11; p = .03). Biochemically verified smoking abstinence did not significantly differ between POP and TSP-SGM at 3 (OR = 2.00; p = .33) or 6 months (OR = 3.12; p = .08), potentially due to challenges with remote biochemical verification. In supplemental analyses, POP participants were more likely to report abstinence at 3 (OR = 6.82, p = .01) and 6 (OR = 2.75, p = .03) months and reduced smoking at 3 months (OR = 2.72, p = .01) than participants who received a referral to Smokefree.gov. This pilot study provides preliminary support for the effectiveness of a Facebook smoking cessation intervention tailored to SGM young adults. SGM individuals have disproportionately high smoking prevalence. It is unclear whether smoking cessation interventions culturally tailored to the SGM community are more effective than non-tailored interventions. This pilot trial found preliminary evidence that an SGM-tailored Facebook smoking cessation intervention increased reported abstinence from smoking, compared to a non-tailored intervention. NCT03259360.

HUBUNGAN PENGETAHUAN DAN SIKAP DENGAN PERILAKU MEROKOK SANTRIWAN DI PONDOK PESANTREN AL-JIHAD SURABAYA

Smoking is one of the health risk behaviors that increasingly threatens young and even teenagers. Not only in public schools, but also the increasing number of Islamic boarding schools. Even in some Islamic boarding school activities, in addition to serving food, the boarding school also provides treats for cigarettes. This is a challenge that is still difficult to resolve, because the age of smokers is getting younger. This study aims to find out the relationship between knowledge and attitude with smoking behavior of students in Surabaya Al Jihad Islamic Boarding School. Method: This study was an analytic observational study with crossectional design. The population of this research is all students who live in Al Jihad Islamic Boarding School Surabaya. The study sample was 97 respondents who were selected by random sampling. Data collection is done by interviewing using a questionnaire. Data were analyzed using the chi square test. This study shows that there is no significant relationship between knowledge (p = 0.885) and santriwan smoking behavior. But there is a significant relationship between attitudes and santriwan smoking behavior (p = 0.025). Strengthening the knowledge and attitudes of santrians regarding smoking is important, because this can affect the smoking behavior of santri in Islamic boarding schools. It is expected that the leaders and managers of Islamic Boarding Schools are committed to implementing a non-smoking area by providing warning bans on smoking around Islamic boarding schools

“Hey, I Got to Smoke Some Weed”: Favorable Perceptions of Marijuana Use Among Non-College-Educated Young Adult Cigarette Smokers

Introduction: As marijuana legalization progresses in the U.S., this study investigated the perceptions of marijuana use among non-college-educated young adult smokers. Methods: Twelve focus groups were conducted to explore themes related to marijuana and marijuana use among a racially and ethnically diverse sample of 75 young adult smokers (ages 18–29 years) with <4-year college education and <$90,000 annual household income living in the Washington, D.C. metropolitan area. Thematic content analysis was employed to analyze the transcripts. Data collection and analysis took place in 2017 and 2018, respectively. Results: Many participants reported smoking cigarettes to boost and maintain the psychoactive effect (“high”) of smoking marijuana; some smoked marijuana to substitute frequent cigarette smoking. Participants generally stated that they believed marijuana smoking was healthier and less addictive than cigarette smoking; many preferred smoking marijuana over cigarettes. Participants also mentioned that cigarette smoking was stigmatized and not socially acceptable but marijuana smoking was “trendy” and “cool.” Some reported that they smoked marijuana to cut down on cigarettes, although most were unsuccessful. Racial and ethnic differences in marijuana use were also identified. Discussion: Non-college-educated young adult smokers expressed largely favorable views towards smoking marijuana. Such positive views may lead to prolonged and escalated use of cigarettes and marijuana, resulting in exacerbated adverse health consequence of smoking both products as well as worsened outcomes of cigarette smoking cessation. Evidence-based messages are greatly needed to communicate the harm and risks of marijuana use and marijuana and tobacco co-use among this group.

Trends in Attempts to Quit Smoking in England Since 2007: A Time Series Analysis of a Range of Population-Level Influences.

To quantify population-level associations between quit attempts and factors that have varied across 2007-2017 in England. Data from 51 867 past-year smokers participating in the Smoking Toolkit Study (a monthly cross-sectional survey of individuals aged 16+) were aggregated over an 11-year period. Time series analysis was undertaken using ARIMAX modeling. The input series were: (1) prevalence of smoking reduction using (a) e-cigarettes and (b) nicotine replacement therapy; (2) prevalence of roll-your-own tobacco use; (3) prevalence of (a) smoking and (b) non-daily smoking; (4) mass media expenditure; (5) average expenditure on smoking; (6) characteristics in the form of (a) prevalence of high motivation to quit, (b) average age, (c) proportion from lower social grades, and (d) average number of cigarettes smoked; and (7) implementation of tobacco control policies. There was a decline in the prevalence of quit attempts from 44.6% to 33.8% over the study period. The partial point-of-sale ban was associated with a temporary increase in quit attempt prevalence (Badjusted = 0.224%; 95% confidence interval [CI] 0.061 to 0.388). Quit attempts were positively associated with the prevalence of high motivation to quit (Badjusted = 0.165%;95% CI 0.048 to 0.282) and negatively associated with the mean age of smokers (Badjusted = -1.351%; 95% CI -2.168 to -0.534). All other associations were nonsignificant. Increases in the prevalence of high motivation to quit was associated with higher prevalence of attempts to quit smoking, while an increase in the mean age of smokers was associated with lower prevalence. The introduction of the partial point-of-sale ban appeared to have a temporary positive impact. This study provides insight into how monthly changes in a wide range of population-level factors are associated with changes in quit attempts over an extended time period in a country with a strong tobacco control climate. The findings suggest a need for intervention or policy to stimulate quit attempts in older smokers. Otherwise, increases in the mean age of a smokers appears likely to undermine wider efforts to promote quit attempts in a population.

Long-term exposure to fine particulate matter and natural-cause and cause-specific mortality in Japan.

A number of studies have linked long-term exposure to particulate matter with aerodynamic diameter <2.5 µm (PM2.5) with mortality, but most of these studies were conducted in Europe and North America. Studies in Asian countries had been conducted at relatively high exposures. We evaluated the association of long-term exposure to PM2.5 and natural-cause and cause-specific mortality in Japan, where PM2.5 levels are relatively low compared with levels in other Asian countries. A cohort of 75,531 participants underwent basic health checkups in Okayama City in 2006 or 2007. We followed the participants until the end of 2016. Average PM2.5 levels from 2006 to 2010 were obtained and assigned to the participants by geographical location. We used the Cox proportional hazard models to estimate hazard ratios for a 5-μg/m3 increase in PM2.5 levels for natural-cause or cause-specific mortality, adjusting for potential confounders. PM2.5 exposure was associated with increased risk of mortality; the hazard ratios were 1.29 (95% confidence interval = 1.18, 1.41) for mortality from natural causes, 1.16 (1.02, 1.32) for cardiorespiratory mortality, and 1.63 (1.13, 2.34) for lung cancer mortality. PM2.5 exposure was more strongly associated with cardiorespiratory mortality from hypertension, pneumonia and influenza, and chronic obstructive pulmonary disease than with ischemic heart disease or cerebrovascular disease. Elderly participants and smokers tended to have higher effect estimates. Long-term exposure to PM2.5 can increase the risk of natural-cause, cardiorespiratory, and lung cancer mortality in Japan.

Lumbar Spine MRI: Missed Opportunities for Abdominal Aortic Aneurysm Detection

The US Preventive Services Task Force (USPSTF) recommends 1-time sonographic screening for abdominal aortic aneurysms (AAAs) in male smokers ages 65-75 and other selected individuals in this age group based on risk factors. Patients in this age range are frequent utilizers of lumbar spine MRI, in which the abdominal aorta is typically fully imaged. The purpose of this study was to assess the potential detection rate of AAAs on lumbar spine MRI performed in the USPSTF screening age range with systematic aortic measurement and the frequency with which AAAs are currently reported in practice. All consecutive lumbar spine MRI exams performed without contrast at a single academic tertiary care center over a 1-year period (4/1/2016-3/31/2017) in patients ages 65-75 were retrospectively reviewed. Maximal anteroposterior, and transverse dimensions of the abdominal aorta were measured using axial T2-weighted images, supplemented with sagittal T2-weighted images if assessment was limited by field-of-view or artifact. The detection rate of AAA, defined as dilation of the aorta to a diameter of ≥3 cm, size of AAAs detected, and frequency with which AAAs were reported, were assessed. Differences in aortic diameters and aneurysm detection rates between genders were compared with the unpaired 2-sample t test. Three hundred and ninety-five lumbar spine MRIs were reviewed, 240 (60.8%) in women and 155 (39.2%) in men, with mean ± standard deviation (SD) age of 70.2 ± 3.2 years. AAAs were detected in 38/395 (9.6%) cases, most (33/38, 86.8%) of which were <4 cm. Of these, only 4 (10.5%) were reported by the interpreting radiologist; 3/4 (75%) corresponded to aneurysms ≥4 cm. Lumbar spine MRI performed in the USPSTF AAA screening age range, especially in men, facilitates frequent detection of AAA when the aorta is systematically measured. However, in typical lumbar spine assessment, AAAs are often underreported, particularly for smaller aneurysms.

No Acute Effect of Smoking on Peripapillary and Macular Vessel Density in Healthy Middle-aged Smokers.

To investigate the acute effect of smoking on peripapillary and superficial parafoveal vessel density (VD) in healthy smokers. One eye each of 7 healthy smokers (age 40 y and above) was imaged using the Angiovue/RTvue-XR optical coherence tomography after a period of at least 2 hours without smoking (baseline) and 5, 30, and 90 minutes after smoking a cigarette of the brand usually smoked by each participant. In each session, 3 high-quality peripapillary and macular VD scans were acquired. The corresponding measurement results were averaged for each session, respectively. The participants' age was 45.7±7.1 years; the length of smoking 19.9±10.3 years; and the number of cigarettes per day 15.1±4.0. The image quality scores were high for both peripapillary and macular VD images (medians: 9.0 and 8.7) and did not change during the study (P≥0.196). At baseline peripapillary capillary VD, all-vessels VD and parafoveal VD were 52.4%±2.0%, 58.8%±2.5%, and 49.8%±1.6%, respectively. None of these parameters changed during the study period after smoking (P≥0.276). The relative change from the mean baseline VD values at the 3 timepoints after smoking ranged between -0.45% and 0.42%, -0.37% and 0.47%, and -0.13% and 2.0%, respectively. Our results suggest that VD values in healthy middle-aged smokers are not influenced either by acute smoking a cigarette or by the time elapsed since the most recent cigarette. This indicates that in long-term investigations for glaucomatous VD progression no control for smoking is needed, at least in the healthy control groups.

Low Rates of Patient-Reported Physician-Patient Discussion about Lung Cancer Screening among Current Smokers: Data from Health Information National Trends Survey.

Many professional societies published guidelines recommending lung cancer screening with low-dose CT scan. We examined the temporal trends in patient-reported physician-patient discussions about lung cancer screening, and aimed to determine the association of discussions of lung cancer screening with the smokers' attempt to quit and intent to quit. Data from years 2012, 2014, and 2017 of the National Cancer Institute's Health Information National Trends Survey (HINTS) were combined to create a multiple-year analytic dataset. We calculated the association between samples' characteristics and the presence of discussion about lung cancer screening. Using logistic regression, we estimated the probability of smokers' attempt to quit and intent to quit. Among 9,443 subjects, the crude estimated rates of physician-patient discussion decreased from 6.7% in 2012, to 4.2% in 2014 and 4.3% in 2017. Across the age and smoking status groups, the current smokers ages 55 to 74 in 2012 (26.8%), and current smokers older than 74 years in 2014 (23.5%) and 2017 (22.1%) had the highest rates of discussion. The physician-patient discussion about lung cancer screening was not associated with patients' intent to quit or attempt to quit in a multivariable analysis.Conclusions: Efforts are needed to improve the physician-patient discussion about lung cancer screening among individuals across a spectrum of lung cancer risk. Developing communication strategies for promoting beneficial lung cancer screening among lung cancer screening-eligible smokers and strategies for improving the quality of discussion on lung cancer screening integrating smoking cessation are needed to reduce the burden of lung cancer.

Adverse effect of smoking on cross-sectional area of small pulmonary vessel and arterial stiffness in healthy smokers without COPD.

Because it induces systemic inflammation, smoking is a risk factor of atherosclerosis and pulmonary hypertension. The brachial-ankle pulse wave velocity (baPWV) and cross-sectional area (CSA) of small pulmonary vessels can be useful markers to assess early changes of arterial stiffness and pulmonary vascular alteration in smokers. This study aimed to explore association between the CSA of small pulmonary vessel and arterial stiffness in healthy male smokers. We enrolled 90 male non-smokers and 90 male smokers (age: 51.5±9.7 years and 52.1±7.9 years, respectively). All subjects underwent chest computed tomography (CT), pulmonary function test and baPWV measurement. We evaluated the total CSAs less than 5 mm2 using ImageJ software and divided by the total lung area (%CSA<5). We compared the association between baPWV and %CSA<5 in two groups as well as correlations among the amount of smoking, baPWV and %CSA<5. Multiple linear regression analysis using %CSA<5 as the dependent variable was also performed. The mean baPWV and mean %CSA<5 were significantly different between the smokers and non-smokers. The pack-years was significantly correlated with %CSA<5 (r=-0.631, P<0.001) and baPWV (r=0.534, P<0.001) in smokers. In multiple linear regression analysis, age, pack-years, FEV1 /FVC and baPWV were associated with %CSA<5, regardless of body mass index, blood pressure and heart rate. There is a dose-response relationship between cigarette smoking and the CSA of small pulmonary vessels and arterial stiffness, respectively. Arterial stiffness, age, pack-years and mild airflow impairment are independent predictors of small pulmonary vascular destruction in smokers.

การศึกษาเบื้องต้นของผลการบอกอายุปอด (เพื่อสร้างแรงจูงใจ) ต่อการเลิกบุหรี่ในผู้ป่วย COPD

Objective: The aim of this research is to study the initial results of telling the lung age for motivation to quit smoking in COPD patients. Methods: Twenty-five smokers who diagnosed COPD more than 1 year and aged over 40 years old in COPD clinic, Siriraj Hospital, Thailand were recruited. They were informed the lung age (age of their lungs were calculated by spirometer) and advised to quit smoking after that enrolled the smoking cessation program. The outcome of quit smoke was measured repeated every 3, 6 and 12 months. Results: The stages of quitting smoking motivation in participants were 72% contemplation, 20% preparation and 8% pre-contemplation. Awareness about the lung age was the most motivation reason for quitting smoking (52%). The quit smoking rate was 16% in 3 and 6 months, and 25% in 12 months (total 24 subjects and 1 lost followed up). The reason of the participant that has successfully quit were 50% knowing the lung age. We founded that the subjects who good compliant will success in quit smoking. Conclusion: Telling the lung age in COPD smokers with a smoking cessation program can useful motivation tool for quit smoking. However, this is a pilot study so the future should be educated in more than a COPD patient group. Keywords: Smoking cessation; COPD; lung age

Evaluation and management of Idiopathic Pulmonary Fibrosis.

Idiopathic Pulmonary Fibrosis (IPF) is a most common progressive interstitial lung disease (ILD) of unknown etiology, although majority of patients are elderly male smokers. The main pathogenesis is aberrant recovery of epithelial injury and collagen deposition. Fibrotic nonspecific interstitial pneumonia, connective tissue disease (CTD) especially rheumatoid arthritis (RA) associated ILD, and chronic hypersensitivity pneumonia(CHP) are important differential diagnosis. Main symptoms are non-productive cough and progressive exertional dyspnea. Crucial physical findings are scalene muscle hypertrophy, bibasilar fine crackles, and finger clubbing. The serum markers such as lactate dehydrogenase (LDH) and Krebs von den Lungen-6 (KL-6) are sensitive for ILD detection and activity. Both pulmonary function test (PFT) and the 6-minute walk test (6MWT) are useful tool for evaluation of disease progression of IPF. Serial changes of forced vital capacity (FVC) and 6MWT distance predict mortality in IPF effectively. Recently published international IPF guidelines highlight the importance of chest high resolution computed tomography (HRCT) findings such as honeycombing, traction bronchiectasis (TBE), and sub-pleural reticular opacity. IPF is chronic and progressive; therefore, tracking disease behavior is crucial. Unifying clinical, physiological, and imaging information over time is useful. With regard to its management, two anti-fibrotic drugs such as pirfenidone and nintedanib have been available. These drugs can slow the decline of FVC and prevent acute exacerbation (AE). In this review, I outline the clinical characteristics of IPF, physiological, imaging, pathological findings and review diagnosis process and management.

Sexual and gender minority young adults' smoking characteristics: Assessing differences by sexual orientation and gender identity

IntroductionSexual and gender minority (SGM) young adults have higher smoking prevalence than their non-SGM peers. Less is known about differences in smoking characteristics within the SGM community. MethodsParticipants were SGM young adult smokers age 18–25 (N = 165, M age = 21.8) enrolled in a clinical trial of the Put It Out Project, a Facebook smoking cessation intervention for SGM young adults. Analyses tested differences between 1) sexual orientation groups, and 2) gender identity groups, on the following smoking characteristics: cigarettes/day, daily smoker (yes/no), social smoker (yes/no), years of smoking, number of close friends who smoke (out of 5), age of initiation, age began smoking regularly, time to first cigarette (30 min or less/>30 min), lifetime quit attempts, past-year quit attempts, and stage of change for quitting smoking (precontemplation, contemplation, preparation). ResultsParticipants were 56% bi/pansexual, 18% gay, 18% lesbian, 8% other (e.g., asexual, queer). The gender identity of the sample was 52% cisgender, 18% transgender, 30% gender non-binary. Lesbian women began smoking at an older age (M = 18.0, SD = 2.0) than “other” sexual orientation participants (M = 15.7, SD = 2.2), p < .05. Transgender participants smoked the most cigarettes per day (M = 11.3, SD = 6.7), followed by cisgender (M = 8.1, SD = 5.6), then non-binary (M = 5.7, SD = 3.5) participants (p < .001; pairwise comparisons p's < 0.05). No other constructs differed by sexual orientation or gender. ConclusionsSmoking characteristics were mostly similar across subgroups of young adult SGM smokers; however, transgender individuals were heavier smokers.

Evaluation of Serum Levels of LP-PLA2 and CA-242 in Adult Male Cigarette Smokers in Nnewi Metropolis

Background: Cigarette smoking is a behavioural lifestyle in which a substance is burned and the resulting smoke breathed into the body system. Thus, cigarette smoking is a known public health challenge given the number of tobacco-related diseases like hypertension, lung cancer, cardiovascular diseases (CVD) etc. leading to increased mortality in developed and developing countries. Notwithstanding that the effects of smoking are well documented, individuals who practice cigarette smoking are still on the increase most especially in the developing countries. Study Design/Aim: This was a cross-sectional study designed to evaluate the serum levels of Cancer Antigen-242 (CA-242) and Lipoprotein-Associated Phospholipase A2 (Lp-PLA2) in adult male smokers in Nnewi Metropolis, as emerging inflammatory biomarkers. Materials and methods: A total of 135 subjects aged between 16-65 years were selected for this study. They were classified into 2 major groups (test and control); comprising of 85 cigarette smokers (55 and 30 as test subjects for the evaluation of CA-242 and Lp-PLA2) respectively and 50 non-cigarette smokers (35 and 15 as control subjects for CA-242 and Lp-PLA2 evaluations) respectively. A well-structured questionnaire was used for the collation of information from the participants. Results: the mean serum level of Lp-PLA2 was significantly elevated (P&lt;0.05) in cigarette smokers (67.52±27.29) compared with the non-smokers (63.63±20.81). While the serum level of CA-242 among smokers (1.77±0.70) was of no significant difference (P=0.711) when compared with the non-smokers (1.81±0.20). More so, the mean serum levels of Lp-PLA2 correlated positively with the duration of smoking (r=0.297) and age (r=0.085) in male cigarette smokers. However, there were negative relationships when CA-242 were correlated with duration of smoking (r = -0.156) and age of smokers (r=-0.155). Conclusion: The increased level of Lp-PLA2 along with its positive correlation with other traditional markers like age and smoking duration suggests that Lp-PLA2 is a suitable biomarker to predict cardiac related diseases among cigarette smokers. This is because, Lp-PLA2 is a more specific cardiac predictor compared to the non-specific conventional biomarkers. We therefore suggest that Lp-PLA2 as an independent advanced predictor of cardiovascular disease be further evaluated using follow-up studies with better sample size in CVDs related cases