Cessation Programs Research Articles

The Effect of Intervention Preference Matching on Outcomes and Engagement in a Post-cessation Weight Management Trial.

This study examined the effect of intervention treatment preference in a post-smoking cessation weight management trial. Participants were randomized to a weight management intervention (Stability, Loss, or Bibliotherapy); all participants received a standard smoking cessation program. Adults aged 18+ were recruited from Memphis, TN, and nationally. Individuals were eligible if they had a BMI of 22kg/m2 or greater. Participants were asked about their preferred weight intervention at screening. Weight change and self-reported point-prevalence abstinence were assessed (Month 12). Participants rated perceived effectiveness, difficulty (screening, Month 2), and intervention satisfaction (Month 12). We examined the effect of intervention preference match on 12-month weight change, smoking cessation, perceived effectiveness, difficulty, and satisfaction. Participants (n = 305) were majority female (68%); white (52%); and had overweight/obesity (87%). At screening, most participants perceived the Loss intervention as most effective; at Month 2, Stability was perceived as most effective. The Stability intervention was perceived as easiest at screening and Month 2. Those who were matched to their treatment preference had greater 12-month weight loss, but similar rates of smoking cessation. Participants who were matched to their preference were more successful in preventing post-cessation weight gain, compared to those who were not matched. Future research should systematically test intervention preference effects with the aim of precision health.

Perspectives of Malaysian community pharmacists on challenges and barriers to smoking cessation programme: a qualitative study.

Smoking remains a significant public health concern, necessitating effective smoking cessation interventions. This study explores the barriers community pharmacists face in delivering smoking cessation services in Malaysia and potential solutions to improve their contribution to public health. This qualitative study employed purposive and snowball sampling to recruit community pharmacists in Malaysia. Semi-structured interviews were conducted, exploring pharmacists' perspectives on barriers, counselling approaches, follow-up strategies, and opinions on smoking cessation services. Thematic analysis was employed to identify key themes and sub-themes. Three main themes emerged from the data analysis: barriers, counselling and enhancing follow-up, and pharmacists' opinions on professional fees. Under the theme of barriers, sub-themes included underutilization by the public, poor follow-up by customers, time constraints, lack of educational materials and support, and customer perception. The counselling and enhancing follow-up theme encompassed shared decision-making, motivational intervention, follow-up via phone calls or messaging apps, and providing rebate vouchers. Pharmacists' opinions on professional fees revealed mixed perspectives, with some advocating for fees to recognize the professional service provided, while others expressed concerns about access barriers. Community pharmacists face challenges in delivering smoking cessation services, such as underutilization, poor follow-up, time constraints, and affordability. However, strategies like shared decision-making and proactive communication can enhance effectiveness. Addressing professional fees and collaborative efforts are essential to optimising these services.

Addressing Tobacco Use Disorder in Individuals With Mental Health Disorders: The Critical Role of Nurses.

Individuals with mental health disorders tend to smoke more frequently and intensely than the general population; however, smoking cessation efforts are still often neglected in mental health care. This position paper advocates for creating a more prominent role for mental health nurses in assisting individuals with severe psychiatric disorders to quit smoking. Given their extensive patient contact and holistic care approach, mental health nurses are uniquely positioned to lead smoking cessation initiatives. Consequently, there is an urgent need for increased awareness, mandatory professional training and policy support to empower nurses in this critical role. Strengthening the involvement of mental health nurses in smoking cessation programs could lead to reduced premature mortality and improved overall health for individuals with severe mental illnesses.

Health and Wellness Coaching Can Improve Tobacco Quit Rates and Weight Management Efforts in an Employee Population.

This study aims to investigate gender differences in tobacco quit rates and weight gain among employees undergoing a cessation program with a health and wellness coach. This project was a retrospective observational study of an employee population. All data were collected during health coaching sessions by nationally certified health coaches. 211 men and women (116 males, 95 females, age 51.3 ± 9.9 years) enrolled in a Tobacco cessation health coaching program (TCHC) between January 2020 and December 2021. Data were compared between genders for quit rate, weight, body mass index (BMI), and nicotine replacement therapy (NRT) usage across 12-month follow-ups. Descriptive statistics, repeated measures ANOVA, and independent samples t-test. Significantly more men than women successfully quit by the goal date set with their coach (P < 0.05). There was a significant reduction in tobacco use across 12 months, leading to the participant's quit date (P < 0.001). Women (Weight lost ± SD= 1.49 lbs. ±16.06 lbs.) lost significantly more weight than men (0.7 lbs. ± 8.5 lbs.; P < 0.001). NRT users lost significantly more weight than non-users (P = .007). Health and wellness coaching was effective for participants to successfully stop tobacco use while in this program by their quit date. The coaching program also elicited weight loss while achieving smoking cessation for both men and women.

Participation in Tobacco Cessation Programs Among Medicaid Managed Care Enrollees in Florida.

Background/Objectives: Tobacco use remains a significant public health issue, particularly among individuals with low incomes, including Medicaid recipients who often face multiple barriers to quitting. This study aimed to identify barriers, from the perspective of Medicaid managed care organizations (MCOs), influencing Medicaid recipient participation in tobacco cessation programs. Methods: Focus group interviews were conducted with Florida Medicaid MCOs to elicit processes for case identification, outreach, referral, program participation, and incentives. Answers were synthesized into themes. Results: Medicaid recipients were primarily identified through nicotine dependency claim codes or Health Risk Assessments (HRAs). Individuals were referred to state and local community tobacco cessation programs through text messaging and outreach by MCO case managers. The MCOs identified the following as barriers: primary care physicians (PCPs) with limited knowledge about cessation programs and pharmacologic treatments for nicotine dependence, low availability of health coaches, long wait times for entry into cessation programs, weak coordination between MCOs and cessation programs, and insufficient incentives for individuals for program participation. Suggested strategies to overcome barriers were continuing medical education (CME) for PCPs about tobacco cessation programs and prescription therapies, increasing the training of health coaches, more investment in quitlines, increasing data sharing between MCOs and cessation programs, and increasing incentives for individuals. Conclusions: These findings highlight the importance of engaging MCOs in discussions about policy and program improvements, as their insights can drive meaningful changes in how tobacco cessation and other preventive health programs are structured and implemented. Targeted interventions are needed to enhance tobacco cessation program participation among Medicaid recipients.

Social Epidemiology of Dual Use of Electronic and Combustible Cigarettes Among U.S. Adults: Insights from the Population Assessment of Tobacco and Health (PATH) Study.

The dual use of e-cigarettes and combustible cigarettes poses significant public health concerns due to the compounded risks associated with the use of both products. Understanding the predictors of dual use can inform targeted interventions and tobacco control strategies aimed at reducing nicotine dependence and health risks among adults. This study aims to identify the sociodemographic predictors of dual use of e-cigarettes and combustible cigarettes among U.S. adults using baseline data from the Population Assessment of Tobacco and Health (PATH) Study. We analyzed baseline data from the PATH Study, focusing on adult participants who reported the use of both e-cigarettes and combustible cigarettes. Logistic regression models were used to identify the associations between dual use and key sociodemographic variables, including age, gender, race/ethnicity, and education level. The analysis revealed that dual use of e-cigarettes and combustible cigarettes was predominantly observed among young, female, non-Latino, White, and highly educated adults. Younger adults were more likely to engage in dual use compared to older age groups. Females showed higher rates of dual use compared to males. Non-Latino White individuals were more likely to be dual users than individuals from other racial/ethnic backgrounds. Additionally, higher educational attainment was associated with increased dual use, contrary to traditional smoking patterns. The findings highlight specific demographic groups that are at higher risk of dual use of e-cigarettes and combustible cigarettes, particularly younger, highly educated, non-Latino White females. These insights suggest the need for tailored public health interventions that address the unique needs and behaviors of these populations. Future research should explore the underlying motivations and contextual factors contributing to dual use to enhance the effectiveness of tobacco control policies and cessation programs.

Sex-specific associations of cigarettes and e-cigarettes use with self-reported premature atherosclerotic cardiovascular disease among adults aged 18–54 in the United States

BackgroundPremature atherosclerotic cardiovascular disease (ASCVD) is increasing in young adults (<55 years old). While research suggests females who smoke cigarettes have a higher risk of ASCVD than males, studies on the impact of exclusive e-cigarette and dual use on premature ASCVD are limited. This study investigated the association between tobacco use and self-reported premature ASCVD and explored potential sex differences. MethodsUsing pooled data from 480,317 adults (ages 18–54; ∼50 % female) from the 2020–2022 Behavioral Risk Factor Surveillance System from the United States, logistic regression models assessed associations between cigarette and e-cigarette use patterns and self-reported premature ASCVD. Tobacco use categories were defined as: non-use, former use (cigarettes, e-cigarettes), and current use (cigarettes, e-cigarettes) and dual use. Self-reported premature ASCVD was defined as self-reported angina or coronary heart disease, heart attack, or stroke. Weighted analyses were conducted for the overall sample and stratified by sex. ResultsAfter controlling for potential confounders, former exclusive cigarette (adjusted OR: 1.47 [95 % CI 1.29, 1.67]), current exclusive cigarette (1.68 [1.47–1.94]) and current dual (2.03 [1.69–2.44]) use were associated with higher odds of self-reported premature ASCVD. There was no significant association for e-cigarette use. Sex-specific analyses revealed similar patterns but the magnitude of these associations varied between males and females. ConclusionBoth sexes showed higher odds of self-reported premature ASCVD for dual and exclusive cigarette use. Although the cross-sectional design precludes causal inferences, the findings suggest comprehensive tobacco cessation programs tailored to diverse use patterns are needed to reduce the burden of premature ASCVD.

E-Cigarette Addiction in Adolescents-How Do We Get Them to Stop?

E-cigarette use in adolescents is increasing and the addictive potential of these devices is well recognised. Most health authorities have no E-cigarette cessation programmes. We reviewed randomised control trials evaluating prevention strategies for adolescent E-cigarette use and identified any successful components. Search terms were created in accordance with the main objective (vaping/E-cigarette use prevention/cessation/adolescents). Search was conducted via Ovid MedLine for English-language randomised control trials published from 2020 to 2023 containing keywords relating to adolescent E-cigarette use. Seven U.S. studies were included in the review. We established common themes of qualitative outcomes and identification of successful components of prevention programmes. Interventions showed significant improvement in general knowledge and perceived risk of E-cigarettes, and lower risk of using other tobacco products. Other consequences showed lower susceptibility to vaping uptake and higher abstinence rates although future studies are required to see if these were sustained long-term. Focus groups aid development of cessation and prevention campaigns. Messages should be digital and relatable. Messages should contain health "harm" warnings. Furthermore, support services should be well-signposted for adolescents. Social media is a low-cost and important tool to halt teenage E-cigarette addiction.

300,000 quitters and counting; A systematic approach to tobacco cessation

ObjectiveTo describe Kaiser Permanente Northern California's (KPNC) systematic implementation of universal tobacco screening, evidence-based interventions, and performance measures to achieve long-term smoking cessation success. MethodsWe outline seven key components of KPNC's tobacco screening and intervention program that contributed to a significant decline in smoking prevalence. We also report changes in the prevalence of current smokers within KPNC from 2014 to 2023 using linear regression analyses. ResultsKey factors driving the success of the tobacco cessation program included risk-based screening algorithms, alert prompts for at-risk patients, system-wide medical champions, performance tracking, virtual coaching, widespread messaging, and comprehensive medication management. Implementing this multifaceted approach across all facilities was associated with a significant reduction in smoking prevalence, from 8.6% in 2014 to 5.8% in 2023 (p < 0.0001). ConclusionOur comprehensive, system-wide approach resulted in substantial public health gains and highlights the potential of similar preventive strategies as healthcare systems transition toward value-based care.

Abstract 4122507: Fetal Socioeconomic and Environmental Exposures Influence Fetal Brain Growth and Risk of Neonatal Brain Injury in Congenital Heart Disease

Introduction: Fetuses with CHD have smaller total brain volume (TBV) and are at risk for acquired brain white matter injury (WMI), both of which are linked to neurodevelopmental impairments. Social determinants of health (SDOH) and other fetal environmental factors have been linked to fetal brain health in other populations. Our aim was to test our hypothesis that these exposures influence fetal brain growth and postnatal WMI risk in severe CHD. Methods: Our prospective longitudinal cohort study enrolled fetuses with severe CHD to undergo fetal brain MRI and postnatal pre-operative brain MRI. Participants completed home environment surveys on individual SDOH and exposures. Community SDOH metrics were determined using Child Opportunity Index (COI) based on home address. An ‘at risk’ fetus composite was created if there was exposure to: personal/household smoking, welfare/food stamps, or poverty. TBV was calculated at both time points. Presence/degree of WMI was determined on postnatal MRI. Repeated measures analysis and logistic regression were performed to determine association between individual and community SDOH metrics with rate of TBV growth and risk of WMI. Results: 55 participants enrolled (54 fetal scans: mean GA 33.9 wks, 95%CI: 33.7,34.1; 47 neonatal scans: mean GA 39.3 wks 95%CI: 38.9,39.6). Fetal sex, smoking exposure, and several individual SDOH were associated with TBV growth. Adjusting for fetal sex and GA at scan, rate of TBV growth was slower with smoking exposure (coeff: -5.2, 95%CI: -10.3, -0.2, p= 0.04) and trended towards significance for those with welfare/food stamps or poverty. ‘At risk’ fetuses had slower rate of TBV growth than those without risk (coeff: -2.5, 95%CI: -5.0, -0.07, p= 0.04) (Figure 1). There were lower odds of pre-operative WMI with high COI compared to low after adjusting for GA at scan (OR= 0.16, 95%CI: 0.03, 0.9, p= 0.04). Conclusion: Smoking exposure and individual-level SDOH influence brain growth, while community COI is associated with risk of postnatal pre-op WMI in CHD. Our findings identify targets for intervention to optimize brain growth and outcomes in the CHD population, including smoking cessation programs, and nutritional and needs assessment during pregnancy.

Post-discharge tobacco abstinence in a Mumbai hospital after implementation of tobacco cessation counseling: A pragmatic evaluation of the LifeFirst program.

Hospitalization provides a key opportunity to address tobacco use. Few studies have examined cessation treatment in hospitals in low- and middle-income countries (LMIC). We aimed to measure tobacco abstinence among individuals discharged from a Mumbai hospital after the implementation of cessation counseling compared to abstinence among those discharged pre-implementation. Pre-post intervention study in the Prince Aly Khan Hospital, Mumbai pre- (11/2015-10/2016) and post-implementation (02/2018-02/2020) of LifeFirst counseling. LifeFirst is multi-session (up to six sessions) counseling extending from hospitalization up to six months post-discharge. Primary analyses compare self-reported 6-month continuous abstinence among hospitalized individuals post-implementation (intervention) with pre-implementation (comparator) using an intent-to-treat approach that includes all participants offered LifeFirst post-implementation in the intervention group. Secondary analyses compare those who received ≥ 1 LifeFirst session with the pre-implementation group. We enrolled n = 437 individuals pre-implementation (8.7% dual use, 57.7% smokeless tobacco, 33.6% smoking) and n = 561 post-implementation (8.6% dual use, 64.3% smokeless tobacco, 27.1% smoking). Post-implementation, 490 patients (87.3%) accepted ≥ 1 counseling session. Continuous abstinence 6-months post-discharge was higher post-implementation (post: 41.6% vs. pre: 20.0%; adjusted odds ratio [aOR]: 2.86, 95% confidence interval [CI] 1.94-4.21). Those who received LifeFirst had higher odds of continuous abstinence compared to pre-implementation (aOR: 2.95, 95% CI 1.98-4.40). Post-discharge abstinence was more common after implementation of a multi-session tobacco counseling program for hospitalized patients compared to abstinence among patients hospitalized before implementation. These findings represent observational evidence of a promising association between post-discharge abstinence and a hospital-based tobacco cessation program implemented within routine practice in an LMIC setting.

Smokeless tobacco use and its associated factors among secondary school students of Rangeli Municipality of Morang district, Nepal.

The tobacco epidemic is one of the biggest public health threats and the world's leading cause of preventable death which is responsible for killing 8 million people every year. Adolescents are the vulnerable age group and are at greater risk of any tobacco use including smokeless tobacco (SLT) and nicotine addiction. Tobacco use at a young age increases the risk of various non-communicable diseases (NCDs) such as respiratory illness, asthma, chronic obstructive respiratory disease (COPD), reduced pulmonary function, and cancers. This study aimed to determine the prevalence of smokeless tobacco and its associated factors among secondary school students of grades 11 and 12 in Rangeli Municipality, Nepal. A cross-sectional study was conducted among 355 students from the selected secondary schools. A self-administered questionnaire was used to collect the data. Data was cleaned and then exported to IBM SPSS Statistics 20 for analysis. Participants' characteristics were described using frequencies, percentages, mean, and standard deviation. Multivariate logistic regression was conducted to determine the association between individual characteristics and prevalence of smokeless tobacco. All the tests were performed at a 95% Confidence Interval (CI) and a p-value less than 0.05. The mean (±SD) age of the participants was 18.0±1.3 years. Most participants were female (61.1%). The majority of the participants were from grade 11 (58.3%), government schools (60%), and nuclear families (64.8%). This study found that 38.4% and 61.6% of the participants were SLT ever users and never users respectively. Among the ever users, 29.5% were current users and most tried (47.7%) at the age of 10-14 years. Most participants revealed that homes and public places were common sites for SLT use. Paan Masala and Gutkha were the most commonly preferrable SLTs. This study found that age (AOR = 1.5, CI: 1.2-2.2), sex (AOR = 2.6, CI:1.6-4.4), and school type (AOR = 1.8, CI:1.1-3.0) were significantly associated with the prevalence of SLT. This study found that the prevalence of current SLT users is higher than the national survey. This study concludes that males, young adolescents, and students from private schools are at greater risk of SLT use and are unaware of the consequences on their health. Concerned stakeholders must expand awareness and promote educational programs on the harmful use of tobacco targeting secondary school students. The government organizations, educational institutions, and private organizations jointly work to strengthen the implementation of tobacco cessation programs and tobacco control strategies.

Global, regional, and national burden of ischemic stroke attributable to active smoking, 1990-2021.

Ischemic stroke is a major global health issue, with active smoking identified as a key modifiable risk factor. This study examines the burden of ischemic stroke due to active smoking from 1990 to 2021, across different sociodemographic contexts. Data from the Global Burden of Disease (GBD) 2021 database were used to extract information on mortality and disability-adjusted life years (DALYs) attributable to active smoking-related ischemic stroke. Countries and regions were categorized by the sociodemographic index (SDI) into five levels. Statistical analyses were conducted using R Studio, including the calculation of estimated annual percentage change (EAPC) and joinpoint regression models. In 2021, there were 342674 deaths globally due to ischemic stroke caused by active smoking, with an age-standardized mortality rate (ASMR) of 4.06 and a population-attributable fraction (PAF) of 9.54%. The number of deaths increased by 35.59% from 1990 to 2021, with males aged ≥70 years experiencing the largest increase. The global age-standardized DALY rate in 2021 was 98.29, with an overall increase in DALYs by 33.55% from 1990. Regional analysis revealed significant disparities, with the middle SDI region reporting the highest number of deaths and DALYs, while the high SDI region reported the lowest. Geographically, East Asia had the highest burden in 2021. Nationally, China had the highest number of deaths and DALYs due to smoking-related ischemic stroke. This study highlights the significant global burden of ischemic stroke attributable to active smoking and the critical need for targeted smoking cessation programs and stroke prevention strategies. Despite overall declines in ASMR and age-standardized DALY rates, the burden varies significantly across different regions and sociodemographic groups. Effective public health interventions, particularly in low- to middle-SDI regions, are essential to mitigate the impact of smoking-related ischemic stroke and improve global health outcomes.

Nested multilevel modelling study of smoking and smokeless tobacco consumption among middle aged and elderly Indian adults: distribution, determinants and socioeconomic disparities

IntroductionThe Global Adult Tobacco Survey (GATS) shows a drop in tobacco use worldwide. Despite the drop, there still continues to be a significant number of tobacco users in India. Research on tobacco use among young persons is commonly prioritised in India, while studies on tobacco use among middle-aged (45–59 years) and elderly (≥ 60 years) adults are noticeably lacking. We have conducted this study with objective to estimate the distribution, determinants and socioeconomic inequalities of smoking (SM) and smokeless tobacco (SLT) consumption across Indian states and union territories.MethodsThis study was based on 66,606 participants aged ≥ 45 years using Longitudinal Aging Study in India (LASI)-1 (2017–2018) data. Distribution of tobacco consumption (any form, smoking (SM), smokeless (SLT) and both) was documented as per Indian states and union territories with spatial distribution by Indian map. Demographic, socioeconomic, health related and behavioural determinants were established using nested multilevel regression modelling. Socioeconomic disparities were documented using concentration curve. P-value < 0.05 was considered as statistically significant.ResultsOverall, 36.78% participants documented using any form of tobacco; with higher consumption of SLT (19.88%) than smoking/SM (13.92%). Only 2.98% consumed both. Mizoram had highest consumption of tobacco in any form (78.21%) and smoking (35.18%). Elderly participants had higher odds of consuming tobacco (any 1.23 (1.18–1.28), SM 1.99 (1.14–1.27), SLT 1.08 (1.03–1.14) and both 1.27 (1.14–1.40 times) than middle aged participants. Females, OBC (other backward castes), urban residence had lower odds in all the categories, while being widow/ separated/ divorced, belonging to Muslim community, having clerical and skilled occupation, poor self-rated health, comorbidity and multimorbidity had higher odds. With decrease in the wealth index, educational status and frequency of physical activity the odds of tobacco consumption increased. The odds of higher tobacco consumption were documented from northeast region (2.56 (2.37–2.76) higher than north). Alcohol consumption had the highest odds (4.94 (4.69–5.21)). Participants exposed to media had lower odds (11% lower) of consuming tobacco. The socioeconomic inequalities in tobacco consumption were significantly distributed more among the poorest (any -0.064 (-0.072 to -0.056) and SLT -0.069 (-0.072 to -0.056)).ConclusionPrioritising tobacco prevention and increasing availability and accessibility of cessation programmes that are suited with unique requirements and circumstances, even for elderly population, are essential focusing on the higher determinants across poorest section in the country.

Novel Risk Factors for Postoperative Hematoma Requiring Reoperation Following Anterior Cervical Discectomy and Fusion.

Retrospective cohort study. To investigate the correlation between comorbid chronic obstructive pulmonary disease (COPD), asthma, tobacco use, and the incidence of postoperative hematoma requiring reoperation after anterior cervical discectomy and fusion (ACDF). Prior studies have identified general risk factors such as multilevel fusion and coagulopathy. However, specific coughing-related factors like COPD, asthma, and tobacco use have not been extensively investigated. Patients who underwent single or multilevel ACDF between 2011 and 2021 were identified using Current Procedural Terminology (CPT) codes in the PearlDiver database. The primary outcome was the occurrence of postoperative hematoma requiring reoperation within 30 days. χ2 tests and t tests compared groups, and multivariable logistic regression identified predictors for postoperative hematoma. Among 399,900 patients with ACDF, 901 (0.2%) developed postoperative hematoma requiring reoperation within 30 days. Patients with postoperative hematoma were older (58 vs. 55, P<0.001) and predominantly male (62.5% vs. 44.9%, P<0.001). After adjustment, tobacco use and comorbid COPD were associated with postoperative hematoma (odds ratio [OR], 1.27; 95% confidence interval [CI], 1.10-1.47; P<0.001 and OR, 1.41; 95% CI, 1.21-1.64; P<0.001, respectively). Comorbid asthma was not a significant risk factor. Additional risk factors included comorbid hypertension (OR, 1.46; 95% CI, 1.18-1.82; P<0.001), coagulopathy (OR, 1.50; 95% CI, 1.24-1.81; P<0.001), anemia (OR, 1.38; 95% CI, 1.17-1.62; P<0.05), and history of deep vein thrombosis (OR, 1.93; 95% CI, 1.44-2.54; P<0.001). Tobacco use and COPD were identified as novel risk factors for postoperative hematoma formation requiring reoperation after ACDF. Recognizing these modifiable factors, providers may consider postponing nonemergent ACDFs until patients undergo smoking cessation programs or receive optimal COPD management.

Long-term trends and future projections of larynx cancer burden in China: a comprehensive analysis from 1990 to 2030 using GBD data

Larynx cancer poses a significant public health challenge in China, with rising incidence and mortality rates over the past decades. Understanding the long-term trends and underlying factors is crucial for effective intervention and policy formulation. Data were utilized from the global burden of disease (GBD) Study 2021 to analyze the incidence, prevalence, mortality, disability-adjusted life years (DALYs), years lived with disability (YLDs), and years of life lost (YLLs) due to larynx cancer in China from 1990 to 2021. Joinpoint regression analysis identified key changes in trends, while age-period-cohort (APC) analysis and decomposition analysis quantified the contributions of aging, epidemiological changes, and population growth to these trends. Our study found a significant increase in the incidence and prevalence of larynx cancer in China, particularly among males. The age-standardized incidence rate (ASIR) and age-standardized mortality rate (ASMR) for males were substantially higher than those for females. Decomposition analysis revealed that aging was the primary driver of increasing incidence and mortality rates, while epidemiological changes had a mitigating effect. Joinpoint analysis identified periods of rapid urbanization and economic growth as key turning points for increased incidence. Bayesian APC models projected a continued upward trend in incidence rates up to 2030. The rising burden of larynx cancer in China underscores the need for targeted public health interventions, including smoking cessation programs, environmental pollution control, and early detection strategies. Addressing gender disparities and implementing effective prevention measures are crucial to mitigating the impact of larynx cancer in China.

PREVALENCE OF DENTAL CARIES AMONG SMOKERS OF A TERTIARY CARE HOSPITAL OF LAHORE

Dental caries is a common chronic oral health condition globally, with an increased prevalence among smokers. Smoking contributes to caries risk by affecting saliva production, oral microbiota, and oral hygiene practices. In Pakistan, where smoking is prevalent. Objective: This study aims to assess the prevalence of dental caries among smokers attending a tertiary care hospital in Lahore. Methods: A cross-sectional study was conducted at Jinnah Hospital, Lahore, from January to July 2024. The sample included 100 adult smokers aged 18 years and above. Data on demographics, smoking frequency, oral hygiene practices, and dental caries were collected using structured interviews and clinical examinations. Caries severity was assessed using the Decayed, Missing, and Filled Teeth (DMFT) index. Statistical analyses, including chi-square tests, were conducted to explore associations between smoking habits and caries prevalence. Results: The majority of participants were aged 26-35 (30%), with 35% smoking 6-10 cigarettes daily. Oral hygiene practices were suboptimal, with only 25% brushing twice daily, and 15% reporting no regular hygiene routine. The prevalence of dental caries was strongly correlated with smoking frequency and duration. Participants smoking more than 21 cigarettes daily had an 80% caries prevalence, while those with a smoking history of over 16 years had a mean DMFT score of 7.6. These results align with previous studies linking smoking with higher caries risk and severity. Conclusion: The study highlights a high prevalence of dental caries among smokers, with significant associations between smoking frequency, duration, and caries severity. These findings underscore the need for preventive dental health interventions, including smoking cessation programs and targeted oral hygiene education, to mitigate the burden of dental caries in this high-risk population.

Which reference groups matter for Taiwanese high school adolescent smoking? A card sorting study

BackgroundAdolescence represents a pivotal period for the initiation of smoking behaviours. While family, peer and social groups serve as significant reference groups influencing adolescents’ decision-making process, there remains a paucity of research that examines how diversified reference groups influence their smoking decisions.ObjectiveThe objective is to compare normative and informative influences given by different reference groups on adolescents’ smoking decision-making.DesignThis study applied reference group theory and used the card sorting technique. Adolescents were presented with 16 cards portraying various reference groups and 27 cards portraying different types of reference group influences. They were asked to construct sentences as smoking-elicited and smoking-inhibited cues and ranked these influences based on their relevance to their smoking decision-making.ParticipantsThe participants were recruited from four cities in the North, Central, South and East regions of Taiwan. The study sample consisted of 297 Taiwanese 11th graders drawn from high schools, vocational high schools and night schools.Primary outcome measuresThe most influential reference group among smokers, former smokers and never smokers.ResultsOur results of multivariable logistic regression show that for current smokers, having a smoking best friend (aOR=7.58,p&lt;0.01), having a smoking colleague (aOR=3.83,p&lt;0.01) and participating in ceremonial dance performances (aOR=4.62,p&lt;0.01) are more likely to smoke. Peers play an important role in providing smoking-elicited cues for current smokers. Families provided the most smoking-inhibited cues for former and never smokers. Normative influences such as encouraging adolescent smoking provided more cues for adolescents than informative influences such as releasing stress by smoking.ConclusionsAdolescent smoking behaviour was influenced by peer norms, while former and non-smoking behaviours are associated with family norms. Therefore, tobacco prevention efforts should focus more on family-level interventions to discourage smoking initiation. Smoking cessation programmes for current smokers should address the reduction of peer pressure to smoke. Moreover, schools and community partners should collaborate to develop effective smoking cessation strategies, particularly for high-risk groups such as adolescents who involved in ceremonial dance performance.

The hidden crisis: Health impacts of tobacco and nicotine products on Indian women

ABSTRACT Tobacco use among women in India is becoming a critical public health issue. Once viewed predominantly as a male habit, tobacco consumption among Indian women has seen a rising trend. This shift is driven by factors such as evolving societal norms, aggressive marketing by the tobacco industry, and increasing urbanization. Women are now using a variety of tobacco products, including smokeless tobacco and electronic nicotine delivery systems (ENDS). The health effects are particularly alarming, with elevated risks for cancers, cardiovascular diseases, respiratory conditions, and reproductive health problems. Despite these concerns, public health initiatives and policies often fail to address the specific needs of women. editorial examines the social and cultural drivers of tobacco use among Indian women, outlines the severe health risks, and calls for immediate action through gender-sensitive tobacco control policies. It provides recommendations, including robust regulation, community involvement, and specialized cessation programs to reduce the growing tobacco use among women.

EPROs in the routine care of a major oncology center: Results and experiences

To what extent and under what conditions electronically captured patient-reported outcomes (ePROs) can be used in routine medical care and contribute to improved patient care is a widely discussed question. In the field of oncology, few studies in Germany have focused this topic that go beyond the scope of time-limited studies. First, we present the centrally coordinated collection of ePROs in the routine care of a comprehensive cancer center of the German Cancer Aid in its development, and then describe its qualitative dimension. Subsequently, the intervention is discussed using the Consolidated Framework of Implementation Research. Since the implementation started in 2019, over 2,000 patients from the interdisciplinary outpatient clinic of the oncology center have been surveyed. The number of respondents varied between 19 and 65 per month. Over the five years of the reporting period, numerous adjustments have been made regarding content and usage purposes as well as technical and personnel structures. The consistent purpose of use was screening for supportive needs, initially related to psycho-oncology, later expanded to include sports therapy, smoking cessation programs, social and nutritional counseling. The instruments used varied accordingly; health-related quality of life and psychological stress were consistently surveyed. Successful use of ePROs in oncological routine care requires personnel and technical resources as well as a high degree of adaptability. In our case, the complexity of a centrally coordinated ePRO collection within an interdisciplinary cancer center is of particular importance. Path dependencies arising from initial decisions, such as the survey software, need to be considered during implementation. Reservations about the intervention and the importance of opinion leaders for successful deployment have been observed. External conditions such as the certification system of oncology centers in Germany proved to be another relevant factor. Overall, the analysis examines a segment of the ongoing digitization process of the hospital system directed towards needs-based, individualized patient care.