Concurrent Smoking Research Articles

Tobacco exposure and alcohol drinking prevalence and associations with hypertension in rural southwest China: A cross-sectional study.

This study examined the prevalence of tobacco exposure and drinking and ascertained the relationships between tobacco exposure, alcohol drinking, concurrent smoking and drinking, and hypertension in rural southwestern China. Data were collected from a cross-sectional health interview and examination survey, which included 7572 adults aged ≥35 years, in rural China. Participant demographic characteristics, smoking habits, exposure to secondhand smoke (SHS), and alcohol drinking habits were obtained using a standard questionnaire. Blood pressure (BP), height, weight, and waist circumference were measured for each participant. The overall prevalence of smoking, SHS exposure, drinking, concurrent smoking and drinking, concurrent exposure to SHS and drinking, and hypertension was 37.7%, 27.4%, 16.2%, 12.6%, 1.6%, and 41.3%, respectively. Males had a significantly higher prevalence of smoking (74.1% vs 2.2%, p<0.01), drinking (31.1% vs 1.7%, p<0.01), and concurrent smoking and drinking than females (25.3% vs 0.3%, p<0.01). However, females had a higher prevalence of SHS exposure than males (30.2% vs 20.6%, p<0.01). Ethnic minorities had a higher prevalence of SHS exposure, drinking, and concurrent smoking and drinking, than Han participants (p<0.01). Participants with a higher education level had a higher prevalence of smoking, drinking, and concurrent smoking and drinking than their counterparts (p<0.01). In contrast, participants with a lower education level had a higher prevalence of SHS exposure than their counterparts (p<0.01). Multivariate logistic regression analysis found that smokers (AOR=1.31; 95% CI: 1.13-1.51), individuals exposed to SHS (AOR=1.24; 95% CI: 1.11-1.43), drinkers (AOR=1.31; 95%: CI: 1.15-1.50), and concurrent smokers and drinkers (AOR=1.45; 95% CI: 1.25-1.67) all had a higher probability of having hypertension (p<0.01). Additionally, concurrent smoking and drinking had the strongest association with the prevalence of hypertension (AOR=1.45; 95% CI: 1.25-1.67; p<0.01). Socioeconomic factors play an important role in influencing the prevalence of smoking, exposure to SHS, and drinking in rural southwest China. Interventions to prevent and reduce hypertension should, in particular, focus on smokers, individuals exposed to SHS, drinkers, and, in particular, concurrent smokers and drinkers.

Smokeless tobacco and periodontitis: A systematic review with meta-analysis.

The present systematic review with meta-analysis aimed to investigate the global association between smokeless tobacco (SLT) use and periodontitis, considering significant effect size variation based on the income levels of countries. We searched seven databases to identify studies that assessed the prevalence of periodontitis in adult SLT users compared to non-users. The quality of studies was evaluated using the 10-item risk-of-bias tool, and publication bias was addressed through the trim-and-fill method. Sensitivity analysis utilized the leave-one-out approach. Meta-analysis and meta-regression, stratified by country income, SLT type, and smoking status, employed robust variance estimation. From an initial pool of 484 studies, 29 studies met the selection criteria and were subjected to qualitative synthesis. Subsequently, data from 19 studies were included in the meta-analysis. SLT users exhibited a nearly threefold greater likelihood of periodontitis compared to non-users (OR = 2.99; 95% CI: 2.10, 4.27; p < .01). The pooled estimate did not vary significantly based on the type of SLT used or concurrent smoking. However, the odds of periodontitis varied according to the economic level of the country; the pooled estimate was higher in high-income countries (OR = 1.69; 95% CI: 1.20, 2.37; p < .01) and even higher in lower-middle-income and lower-income countries (OR = 3.91; 95% CI: 2.66, 5.77; p < .01). Smokeless tobacco users have a higher likelihood of developing periodontitis. This study underscores global disparities in the SLT-periodontitis relationship, highlighting the need for targeted interventions, particularly in economically challenged areas where SLT use is largely unregulated.

Projected effectiveness of lung cancer screening and concurrent smoking cessation support in the Netherlands

The NELSON trial demonstrated a 24% intention-to-screen reduction in lung cancer mortality from regular screening with low-dose computed tomography. Implementation efforts in Europe are ongoing, but still await country-specific and NELSON-adapted estimates of the benefits and harms of screening. We use the MISCAN-Lung microsimulation model, calibrated to individual-level outcomes from the NELSON trial, to estimate the effectiveness under 100% compliance of biennial lung cancer screening with concomitant smoking cessation support for Dutch cohorts 1942-1961. The model simulates smoking behaviour, lung cancer incidence and the effects of screening and smoking cessation on lung- and other-cause mortality. We find biennial screening with eligibility criteria equal to those of the 4-IN-THE-LUNG-RUN implementation trial to reduce lung cancer mortality by 16.9% among the eligible population, equivalent to 1076 LC deaths prevented per year in the next two decades. Eligible individuals constitute 21.5% of the cohorts studied, and stand to face 61% of the projected lung cancer mortality burden in the absence of screening. 10.3 life-years are gained per prevented LC death, for 14.9 screens per life year gained. Concomitant smoking cessation interventions may increase the expected gains in life years from screening by up to 20%. Policy makers should imminently consider the implementation of lung cancer screening in Europe, paired with effective smoking cessation interventions. Smoking cessation interventions on their own are not estimated to yield a gain in remaining life expectancy of the magnitude offered by even a single CT screen. European UnionHorizon 2020 grant 848294: 4-IN-THE-LUNG-RUN.

The Impact of Marijuana Use on Postoperative Outcomes in Abdominal-based Free Flap Breast Reconstruction.

There is an increasing prevalence of marijuana use in the general population yet clinical studies on marijuana's effect on surgical outcomes remain limited. Marijuana's effect on wound healing, venous thromboembolism (VTE) due to endothelial inflammation, and bleeding due to inhibited platelet function have been cited based on animal models but have not been evaluated clinically in patients undergoing microsurgical reconstruction. Retrospective chart review was performed on all patients who underwent abdominal-based free flap breast reconstruction in a single institute from August 2018 to December 2022. Patient self-reported marijuana use, demographics, total narcotic use during hospitalization converted to oral morphine milligram equivalent (MME), and 90-day complications were collected and compared. A total of 162 patients were included and 13 patients (8.5%) had reported marijuana use on presurgical history. Marijuana users are more likely to be younger and report concurrent nicotine smoking. Marijuana users were also at a significantly elevated risk of developing symptomatic VTE (15 vs. 1%; odds ratio (OR) 13.4 [95% confidence interval (CI) 1.71-104.2]; p = 0.01) and marijuana use remained a significant risk factor with multivariate analysis. On postoperative 90-day complications, there was no increased risk of flap loss, reoperation, postoperative transfusion, or hematoma associated with marijuana use, and no significantly increased risk for overall donor or recipient site complications. Marijuana users required significantly more narcotics for pain control during hospitalization (100 ± 77 vs. 49 ± 45 MME; p = 0.0003), although they had similar lengths of stay, achievement of mobilization on post operative day (POD)1, and maximal pain scores. Marijuana use increases the risks of postoperative VTE and increased postoperative narcotic requirements in patients who underwent abdominal-based free flap breast reconstruction. Future prospective cohort study is required to further understand marijuana-associated risks in microsurgical procedures.

Familial effects account for association between chronic pain and past month smoking.

Smoking is associated with chronic pain, but it is not established whether smoking causes pain or if the link is due to familial effects. One proposed mechanism is that smoking strengthens maladaptive cortico-striatal connectivity, which contributes to pain chronification. We leveraged a twin design to assess direct effects of smoking on pain controlling for familial confounds, and whether cortico-striatal connectivity mediates this association. In a population-based sample of 692 twins (age = 28.83 years), we assessed past-month smoking frequency (n = 132 used in the past month), presence and severity of a current pain episode (n = 179 yes), and resting-state functional connectivity of the nucleus accumbens and medial prefrontal cortex (NAc-mPFC). Smoking was significantly associated with pain, but the association was not significantly mediated by NAc-mPFC connectivity. In a co-twin control model, smoking predicted which families had more pain but could not distinguish pain between family members. Pain risk was 43% due to additive genetic (A) and 57% due to non-shared environmental (E) influences. Past-month smoking frequency was 71% genetic and 29% non-shared environmental. Smoking and pain significantly correlated phenotypically (r = 0.21, p = 0.001) and genetically (rg = 0.51, p < 0.001), but not environmentally (re = -0.18, p = 0.339). Pain and smoking are associated; however, the association appears to reflect shared familial risk factors, such as genetic risk, rather than being causal in nature. The connectivity strength of the reward pathway was not related to concurrent pain and smoking in this sample. Smoking does not appear to directly cause chronic pain; rather, there may be shared biopsychosocial risk factors, including genetic influences, that explain their association. These findings can be integrated into future research to identify shared biological pathways of both chronic pain and smoking behaviours as a way to conceptualize pain chronification.

Abstract A001: Racial differences in cigarettes and marijuana use among acute pancreatitis patients

Abstract Background/Objectives: Smoking increases the risk of pancreatitis and pancreatic cancer, while the effects of marijuana on pancreatic disorders are unknown. Black and White patients with chronic pancreatitis differ in the prevalence of behavioral risk factors, contributing to subsequent racial differences in pancreatic cancer risk, but the behavior pattern has been unexplored in patients with acute pancreatitis (AP). Our objectives were to: 1) estimate the prevalence of current and lifetime cigarettes and marijuana use among AP patients who identify as Black, White, and other races, and examine racial differences in their usage patterns, and 2) describe the type and frequency of marijuana or other cannabis products used among the different racial groups. Methods: We utilized data from an on-going case-crossover study of patients diagnosed with alcohol-associated AP who are recruited from five medical sites in the United States. Hospitalized patients who meet the Revised Atlanta Classification of AP and have an AUDIT-C score of 3 or higher are enrolled in the study. Chi-squared tests were used to assess for racial differences in co-substance use and the type of substance used; while Fisher’s exact test was used to examine racial differences in the frequency of marijuana and other cannabis products used. To account for multiple testing, post-hoc pairwise comparisons were conducted using Holm procedure. Other races included American Indian/Alaska Native, Asian, Brazilian, Mexican, Indian, and people who did not know or could not provide their race. Results: In this analysis, a total of 143 participants were included, among whom 71 identified as White, 46 as Black, and 20 as belonging to other racial backgrounds. Males comprised 69% of patients and the median age was 39 years. Current cigarette smoking and use of marijuana was reported by 51% and 48% patients, respectively. Concurrent cigarette smoking and marijuana use at enrollment was reported in 19%, while 51.8% reported ever use of both substances. Joints/cigars/blunts (JCB) was the most common form of cannabis product used followed by edibles. Majority of the marijuana users used it regularly: daily (36.2%) or 1-6 days a week (38%). While current co-use was not statistically different between races (24% in White, 17% in Black, and 10% in Other), we found that White (62%) and Black (54%) patients were more likely to report ever use of both cigarette and marijuana than other races (20%) (p= 0.013). The differences were also noted for the use of JCB: 38% in White, 52% in Black, and 10% in other races (p=0.006). Conclusions: We identified racial differences in the usage of cigarettes and marijuana, the use of JCB, and the number of marijuana or other cannabis products. Our findings underscore the importance of considering race when addressing multiple substance use in AP patients. Citation Format: Esther A. Adeniran, Dhiraj Yadav, Sungjin Kim, Georgios I. Papachristou, James L. Buxbaum, Joseph R. Pisegna, Stephen J. Pandol, Christie Y. Jeon. Racial differences in cigarettes and marijuana use among acute pancreatitis patients [abstract]. In: Proceedings of the 16th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2023 Sep 29-Oct 2;Orlando, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2023;32(12 Suppl):Abstract nr A001.

MA02.09 Effectiveness of Screening with Concurrent Smoking Cessation for the Netherlands

MA02.09 Effectiveness of Screening with Concurrent Smoking Cessation for the Netherlands

Systematic review and meta-analysis investigating nicotine, cotinine and carbon monoxide exposures in people who both smoke and use nicotine replacement therapy.

To determine effects of concurrent smoking and nicotine replacement therapy (NRT) use on reported heaviness of smoking, nicotine (cotinine) body fluid and exhaled air carbon monoxide (CO) concentrations. Systematic review and meta-analysis of RCTs, which test interventions permitting concurrent NRT use and smoking and comparing, within participants, outcomes when smoking with those when smoking and using NRT concurrently. Measurements included reported number of cigarettes smoked per day (CPD), body fluid cotinine and expired air CO concentrations. Twenty-nine studies were included in the review. Meta-analysis of nine showed that, compared with when solely smoking, fewer cigarettes were smoked daily when NRT was used (mean difference during concurrent smoking and NRT use, -2.06 CPD [95% CI = -3.06 to -1.07, P < 0.0001]). Meta-analysis of seven studies revealed a non-significant reduction in exhaled CO during concurrent smoking and NRT use (mean difference, -0.58 ppm [95% CI = -2.18 to 1.03, P = 0.48]), but in the three studies that tested NRT used in the lead-up to quitting (i.e. as preloading), a similar reduction in exhaled CO was statistically significant (mean difference, -2.54 ppm CO [95% CI = -4.14 to -0.95, P = 0.002]). Eleven studies reported cotinine concentrations, but meta-analysis was not possible because of data reporting heterogeneity; of these, seven reported lower cotinine concentrations with concurrent NRT use and smoking, four reported no differences, and none reported higher concentrations. People who smoke and also use nicotine replacement therapy report smoking less heavily than people who solely smoke. When nicotine replacement therapy is used in the lead-up to quitting (preloading), this reported smoking reduction has been biochemically confirmed. There is no evidence that concurrent smoking and nicotine replacement therapy use result in greater nicotine exposure than solely smoking.

Systematic review and meta-analysis investigating nicotine, cotinine, and carbon monoxide exposures in people who both smoke and use nicotine replacement therapy.

Smoking is a major international public health problem. To determine effects of concurrent smoking and nicotine replacement therapy (NRT) use on reported heaviness of smoking, nicotine (cotinine) body fluid, and exhaled air carbon monoxide (CO) concentrations. Systematic review and meta-analysis of randomised controlled trials (RCTs) that test interventions permitting concurrent NRT use and smoking, and comparing, within participants, outcomes when smoking with those when smoking and using NRT concurrently. In total, 29 studies were included in the review. Meta-analysis of nine showed that, compared to when solely smoking, fewer cigarettes were smoked daily when NRT was used (mean difference during concurrent smoking and NRT use, -2.06 CPD [95% confidence interval {CI} = -3.06 to -1.07, P<0.0001]). Meta-analysis of seven studies revealed a non-significant reduction in exhaled CO during concurrent smoking and NRT use (mean difference, -0.58 ppm [95% CI = -2.18 to 1.03, P = 0.48]), but in the three studies that tested NRT 'preloading', a similar reduction in exhaled CO was statistically significant (mean difference, -2.54 ppm CO [95% CI = -4.14 to -0.95, P = 0.002]). Overall, 11 studies reported cotinine concentrations, but meta-analysis was not possible due to data reporting heterogeneity; of these, seven reported lower cotinine concentrations with concurrent NRT and smoking, four reported no differences, and none reported higher concentrations. People who smoke but who also use NRT reported smoking less heavily than when solely smoking, and when NRT was used as 'preloading' this reported smoking reduction was biochemically confirmed. There was no evidence concurrent smoking and NRT use resulted in greater nicotine exposure than smoking.

Renal Vein Thrombosis Occurring in Association with Oral Contraceptives: A Case Report

Peripheral venous thromboembolism is a well-known complication of hormonal contraception, but reports on its association with visceral vein thrombosis is limited. We report the case of left renal vein thrombosis (RVT) associated with oral contraceptives (OCs) and concurrent smoking. The clinical presentation of this patient was acute left flank pain. Computed tomography revealed left RVT. The OC was discontinued, and we initiated anticoagulation with heparin and switched to edoxaban. Computed tomography 6 months later showed complete resolution of the thrombosis. This report alerts us regarding the importance of OCs as a risk factor for RVT.

Factors Associated with Concurrent Tobacco Smoking and Heavy Drinking within a Women Firefighters’ Sample

Studies showed that tobacco use and excessive alcohol consumption frequently occur, and both are significant causes of preventable morbidity and mortality. Data were collected as part of a national online study of the health of women in the fire service. Multinomial logistic regression was employed to determine factors associated with smoking and drinking characteristics. A total of 2330 women firefighters completed questions regarding tobacco and alcohol use; 3.2% (n = 75) were concurrent users, 0.9% (n = 22) were smokers only, 49.4% (n = 1150) were heavy drinkers only, and 46.5% (n = 1083) were low-risk users. Compared with those who neither smoked nor binge drank, concurrent users were more likely to be younger and live alone or not married. The findings also suggested that smokers, heavy drinkers, or those who were both were more likely to report symptoms of depression and PTSD and a history of physician diagnosis of anxiety disorder compared to low-risk users. Smoking rates are relatively low among women firefighters; however, mental health risks are prevalent, particularly for those who both smoked and drank heavily. Results can be potentially used to inform prevention and treatment research to better address the unique condition of this occupational group.

Blood RNA and protein biomarkers are associated with vaping and dual use, and prospective health outcomes

Background: Electronic nicotine delivery systems (ENDS) are driving an epidemic of vaping. Identifying biomarkers of vaping and dual use (concurrent vaping and smoking) will facilitate studies of the health effects of vaping. To identify putative biomarkers of vaping and dual use, we performed association analysis in an observational cohort of 3,892 COPDGene study participants with blood transcriptomics and/or plasma proteomics data and self-reported current vaping and smoking behavior. Methods: Biomarkers of vaping and dual use were identified through differential expression analysis and related to prospective health events over six years of follow-up. To assess the predictive accuracy of multi-biomarker panels, we constructed predictive models for vaping and smoking categories and prospective health outcomes. Results: We identified three transcriptomic and three proteomic associations with vaping, and 90 transcriptomic and 100 proteomic associations to dual use. Many of these vaping or dual use biomarkers were significantly associated with prospective health outcomes, such as FEV1 decline (three transcripts and 62 proteins), overall mortality (18 transcripts and 73 proteins), respiratory mortality (two transcripts and 23 proteins), respiratory exacerbations (13 proteins) and incident cardiovascular disease (24 proteins). Multimarker models showed good performance discriminating between vaping and smoking behavior and produced informative, modestly powerful predictions of future FEV1 decline, mortality, and respiratory exacerbations. Conclusions: In summary, vaping and dual use are associated with RNA and protein blood-based biomarkers that are also associated with adverse health outcomes.

Preoperative Malnutrition and Metabolic Markers May Predict Periprosthetic Fractures in Total Hip Arthroplasty

BackgroundPeriprosthetic fractures are a devastating complication of total hip arthroplasty (THA) and are associated with significantly higher mortality rates in the postoperative period. Given the strain that periprosthetic fractures place on the patient as well as the healthcare system, identifying and optimizing medical comorbidities is essential in reducing complications and improving outcomes. MethodsAll THA with primary indications of osteoarthritis from 2007 to 2020 were queried from the National Surgical Quality Improvement Program database. Demographic data, preoperative laboratory values, medical comorbidities, hospital course, and acute complications were collected and compared between patients with and without readmission for a periprosthetic fracture. A multivariate logistic regression analysis was performed to determine associated independent risk factors for periprosthetic fractures after index THA. ResultsThe analysis included 275,107 patients, of which 2539 patients were readmitted for periprosthetic fractures. Patients with postoperative fractures were more likely to be older (>65 years), females, BMI >40, and increased medical comorbidities. Preoperative hypoalbuminemia, hyponatremia, and abnormal estimated glomerular filtration rates were independent risk factors for sustaining a periprosthetic fracture and readmission within 30 days. Modifiable patient-related factors of concurrent smoking and chronic steroid use at the time of index THA were also independent risk factors for periprosthetic fractures. Inpatient metrics of longer length of stay, operative time, and discharge to rehab predicted postarthroplasty fracture risk. Readmitted fracture patients subsequently had increased risks of developing a surgical site infection, urinary tract infection, and requiring blood transfusions. ConclusionsPatients with hypoalbuminemia, hyponatremia, and abnormal estimated glomerular filtration rate are at increased risk for sustaining periprosthetic fractures after THA. Preoperative optimization with close monitoring of metabolic markers and modifiable risk factors may help not only prevent acute periprosthetic fractures but also associated infection and bleeding risk with fracture readmission.

Concurrent Hookah (Waterpipe) and Substance Use among Sexual Minority Adults in the United States: Findings from the Population Assessment of Tobacco and Health Study

Despite higher rates of hookah (i.e., waterpipe) tobacco smoking among sexual minority (SM) adults, little is known on concurrent substance use, including alcohol or other drugs, among SM hookah smokers as compared to their heterosexual counterparts. Utilizing data from the Population Assessment of Tobacco and Health Study (2013–2015), weighted analyses compared concurrent substance use among current SM adult hookah smokers versus heterosexuals. Findings revealed that SM hookah smokers had a higher prevalence of concurrent alcohol, marijuana and other drug use, including stimulants and sedatives, than heterosexuals (p &lt; 0.05). As compared to heterosexuals, SM women and young adult (18–24 years old) smokers had higher odds of marijuana use (Women: Wave 1 odds ratio (OR), 2.16, [95% CI = 1.30–3.60]; Wave 2 OR, 2.67 [95% CI = 1.36–5.25]); young adults: Wave 1 OR, 1.55, [95% CI = 0.99–2.43]; Wave 2 OR, 2.19, [95% CI = 1.22–3.94]). In this population-based, representative sample of U.S. adults, concurrent hookah smoking and substance use differed between SM and heterosexuals. Sexual minority women and young adult hookah tobacco smokers were at increased risk for concurrent marijuana use, increasing the risk for health-related consequences in this group vulnerable to tobacco and substance use.

Usual care in a multicentre randomised controlled trial of financial incentives for smoking cessation in pregnancy: qualitative findings from a mixed-methods process evaluation

ObjectivesFinancial incentives are recommended by the UK’s National Institute for Health and Care Excellence to aid smoking cessation in pregnancy. However, little is known about how implementation contexts might impact...

Dual Use of Combustible Cigarettes and E-cigarettes: a Narrative Review of Current Evidence.

E-cigarette use (vaping) among adults has increased, and various patterns of concurrent smoking and vaping (i.e., "dual use") have emerged. Understanding dual use is important for mitigating tobacco-related harm. This narrative review summarizes recent research on dual use, including prevalence and types of dual use, sociodemographic and psychiatric characteristics, nicotine dependence, reasons for dual use, harm perceptions, toxicant exposure, trajectories of dual use, and emerging treatments for dual use. Nearly half of e-cigarette users concurrently use cigarettes, and many smoke more frequently than they use e-cigarettes. This is concerning because dual users are exposed to both cigarette and potential e-cigarette toxicants and the data are mixed regarding the ability of e-cigarettes to promote smoking cessation. Further work is needed to identify ways to increase complete smoking abstinence and optimize harm reduction among dual users, including strategies to encourage e-cigarette cessation after stopping smoking.

EP04.02-003 Improving Supportive Care for Patients with Thoracic Cancer

Improving lung cancer care among Veterans is a priority within the Veterans Affairs due to higher rates of lung cancer incidence, morbidity, and mortality among Veterans compared to non-veterans. Unaddressed symptom burden is common among Veterans with lung cancer due to many factors. These factors include complex comorbidities and psychosocial challenges, including concurrent smoking related illness such as cardiac disease and diabetes and limited social support networks. Additionally, complications from social determinants of health can obstruct successful discussions of symptom-burden between Veterans and their clinical care teams and can limit compliance with recommended symptom management strategies.

The implementation of a smoking cessation and alcohol abstinence intervention for people experiencing homelessness

BackgroundIn the United States, eighty percent of the adult homeless population smokes cigarettes compared to 15 percent of the general population. In 2017 Power to Quit 2 (PTQ2), a randomized clinical trial, was implemented in two urban homeless shelters in the Upper Midwest to address concurrent smoking cessation and alcohol treatment among people experiencing homelessness. A subset of this study population were interviewed to assess their experiences of study intervention. The objective of this study was to use participants’ experiences with the intervention to inform future implementation efforts of combined smoking cessation and alcohol abstinence interventions, guided by the Consolidated Framework for Implementation Research (CFIR).MethodsQualitative semi-structured interviews were conducted with 40 PTQ2 participants between 2016–2017 and analyzed in 2019. Interviews were audio-recorded, transcribed, and analyzed using a socially constructivist approach to grounded theory.ResultsParticipants described the PTQ2 intervention in positive terms. Participants valued the opportunity to obtain both counseling and nicotine-replacement therapy products (intervention characteristics) and described forming a bond with the PTQ2 staff and reliance on them for emotional support and encouragement (characteristics of individuals). However, the culture of alcohol use and cigarette smoking around the shelter environment presented a serious challenge (outer setting). The study setting and the multiple competing needs of participants were reported as the most challenging barriers to implementation (implementation process).ConclusionThere are unique challenges in addressing smoking cessation with people experiencing homelessness. For those in shelters there can be the difficulty of pro-smoking norms in and around the shelter itself. Considering pairing cessation with policy level interventions targeting smoke-free spaces, or pairing cessation with housing support efforts may be worthwhile.. Participants described a discord in their personal goals of reduction compared with the study goals of complete abstinence, which may pose a challenge to the ways in which success is defined for people experiencing homelessness.Trial registrationClinicaltrials.gov, NCT01932996, registered 08/30/2013.

Malondialdehyde Acetaldehyde-Adduction Changes Surfactant Protein D Structure and Function.

Alcohol consumption with concurrent cigarette smoking produces malondialdehyde acetaldehyde (MAA)-adducted lung proteins. Lung surfactant protein D (SPD) supports innate immunity via bacterial aggregation and lysis, as well as by enhancing macrophage-binding and phagocytosis. MAA-adducted SPD (SPD-MAA) has negative effects on lung cilia beating, macrophage function, and epithelial cell injury repair. Because changes in SPD multimer structure are known to impact SPD function, we hypothesized that MAA-adduction changes both SPD structure and function. Purified human SPD and SPD-MAA (1 mg/mL) were resolved by gel filtration using Sephadex G-200 and protein concentration of each fraction determined by Bradford assay. Fractions were immobilized onto nitrocellulose by slot blot and assayed by Western blot using antibodies to SPD and to MAA. Binding of SPD and SPD-MAA was determined fluorometrically using GFP-labeled Streptococcus pneumoniae (GFP-SP). Anti-bacterial aggregation of GFP-SP and macrophage bacterial phagocytosis were assayed by microscopy and permeability determined by bacterial phosphatase release. Viral injury was measured as LDH release in RSV-treated airway epithelial cells. Three sizes of SPD were resolved by gel chromatography as monomeric, trimeric, and multimeric forms. SPD multimer was the most prevalent, while the majority of SPD-MAA eluted as trimer and monomer. SPD dose-dependently bound to GFP-SP, but SPD-MAA binding to bacteria was significantly reduced. SPD enhanced, but MAA adduction of SPD prevented, both aggregation and macrophage phagocytosis of GFP-SP. Likewise, SPD increased bacterial permeability while SPD-MAA did not. In the presence of RSV, BEAS-2B cell viability was enhanced by SPD, but not protected by SPD-MAA. Our results demonstrate that MAA adduction changes the quaternary structure of SPD from multimer to trimer and monomer leading to a decrease in the native anti-microbial function of SPD. These findings suggest one mechanism for increased pneumonia observed in alcohol use disorders.

The 2019 Raikoke volcanic eruption – Part 2: Particle-phase dispersion and concurrent wildfire smoke emissions

Abstract. Between 27 June and 14 July 2019 aerosol layers were observed by the United Kingdom (UK) Raman lidar network in the upper troposphere and lower stratosphere. The arrival of these aerosol layers in late June caused some concern within the London Volcanic Ash Advisory Centre (VAAC) as according to dispersion simulations the volcanic plume from the 21 June 2019 eruption of Raikoke was not expected over the UK until early July. Using dispersion simulations from the Met Office Numerical Atmospheric-dispersion Modelling Environment (NAME), and supporting evidence from satellite and in situ aircraft observations, we show that the early arrival of the stratospheric layers was not due to aerosols from the explosive eruption of the Raikoke volcano but due to biomass burning smoke aerosols associated with intense forest fires in Alberta, Canada, that occurred 4 d prior to the Raikoke eruption. We use the observations and model simulations to describe the dispersion of both the volcanic and forest fire aerosol clouds and estimate that the initial Raikoke ash aerosol cloud contained around 15 Tg of volcanic ash and that the forest fires produced around 0.2 Tg of biomass burning aerosol. The operational monitoring of volcanic aerosol clouds is a vital capability in terms of aviation safety and the synergy of NAME dispersion simulations, and lidar data with depolarising capabilities allowed scientists at the Met Office to interpret the various aerosol layers over the UK and attribute the material to their sources. The use of NAME allowed the identification of the observed stratospheric layers that reached the UK on 27 June as biomass burning aerosol, characterised by a particle linear depolarisation ratio of 9 %, whereas with the lidar alone the latter could have been identified as the early arrival of a volcanic ash–sulfate mixed aerosol cloud. In the case under study, given the low concentration estimates, the exact identification of the aerosol layers would have made little substantive difference to the decision-making process within the London VAAC. However, our work shows how the use of dispersion modelling together with multiple observation sources enabled us to create a more complete description of atmospheric aerosol loading.