Concurrent Smoking Research Articles

Concurrent Daily Alcohol and Tobacco Use among Sexual Minority and Heterosexual Women

Background: Studies show that sexual minority women (SMW) report more hazardous alcohol use patterns and higher rates of tobacco use than exclusively heterosexual women. Despite the public health implications of drinking and smoking, especially when they co-occur, little is known about SMW’s daily use patterns or the factors that may facilitate concurrent use. Objectives: The present study seeks to identify patterns of daily concurrent alcohol and tobacco use among SMW and heterosexual women, including socio-environmental drinking contexts of concurrent use. Methods: Data come from a community sample of lesbian, bisexual, and heterosexual women (N = 246) who completed up to 84 consecutive days of web-based reports about substance use. Results: Participants reported 4,012 drinking days (24%), 2,019 smoking days (12%), and 769 concurrent drinking and smoking days (5%). No differences were found between SMW and heterosexual women in the proportion of drinking days; however, SMW consumed more drinks on drinking days. SMW also reported a greater proportion of smoking days, more cigarettes smoked on smoking days, and a greater proportion of concurrent drinking and smoking days. Reciprocal daily relationships between alcohol and tobacco use were identified, and these relationships were strongest for bisexual women. Socio-environmental factors—including certain locations, situations, and companions—increased the likelihood of concurrent use for all women; however, few sexual identity differences were found in concurrent use contexts. Importance: Results expand our understanding about daily concurrent alcohol and tobacco use risk among SMW, and potentially inform treatment research to better address the unique experiences of this vulnerable group.

Relationship between Occurrence and Progression of Lung Cancer and Nocturnal Intermittent Hypoxia, Apnea and Daytime Sleepiness.

The possible relationship between lung cancer and nocturnal intermittent hypoxia, apnea and daytime sleepiness, especially the possible relationship between the occurrence and progression of lung cancer and obstructive sleep apnea syndrome (OSAS) was explored. Forty-five cases of primary lung cancer suitable for surgical resection at the Third Affiliated Hospital of Kunming Medical University between January 2017 and December 2017 were recruited (lung cancer group), and there were 45 patients in the control group who had no significant differences in age, sex and other general data from lung cancer group. The analyzed covariates included general situation, snore score, the Epworth Sleeping Scale (ESS), Pittsburgh Sleep Quality Index (PSQI), apnea and hypopneas index (AHI), oxygen desaturation index 4 (ODI4), lowest arterial oxygen saturation [LSpO2 (%)], oxygen below 90% of the time [T90% (min)], the percentage of the total recorded time spend below 90% oxygen saturation (TS90%), to explore the possible relationship between lung cancer and above indicators. The participants were followed up for one year. The results showed that: (1) There was significant difference in body mass index (BMI), ESS, AHI, T90% (min), TS90%, ODI4, snore score and LSpO2 (%) between lung cancer group and control group (P<0.05). There was no statistically significant difference in age, gender, PSQI score, incidence of concurrent hypertension, diabetes and coronary heart disease (CHD), and smoking history between the two groups (P>0.05); (2) Patients in the lung cancer group were divided into OSAS subgroup and non-OSAS subgroup according to the international standard for the diagnosis of OSAS. There was significant difference in BMI, age, staging, incidence of concurrent hypertension and concurrent CHD, snore score, ESS score, T90% (min), TS90%, ODI4 and LSpO2 (%) between OSAS subgroup and non-OSAS subgroup (P<0.05). There was no statistically significant difference in gender, PSQI score, incidence of concurrent diabetes, smoking history and lung cancer type between the two groups (P>0.05); (3) AHI was strongly negatively correlated with the LSpO2 (%) and positively with ESS, staging, snoring score, T90% (min), TS90%, ODI4 and BMI (P<0.05); (4) There were 3 deaths, 5 cases of recurrence, and 4 cases of metastasis in OSAS subgroup; and there was 1 death, 4 cases of recurrence and 2 cases of metastasis in non-OSAS subgroup during the follow-up period of one year, respectively. There was no significant difference in mortality, recurrence rate and metastasis rate between the two subgroups, and the total rate of deterioration in OSAS subgroup was significantly increased compared to the non-OSAS subgroup (P<0.05). It was concluded that the patients with lung cancer are prone to nocturnal hypoxemia, apnea, snoring and daytime sleepiness compared to control group. The incidence of OSAS in patients with lung cancer was higher, and the difference in the hypoxemia-related indicators was statistically significant. The mortality, recurrence rate, and metastasis rate increases in lung cancer patients with OSAS during the one-year follow-up period, suggesting that OSAS may be a contributing factor to the occurrence and progression of lung cancer.

Electronic Vapor Product Usage and Substance Use Risk Behaviors Among U.S. High School Students.

Objectives: The initiation of substance use at a young age increases one's likelihood of developing substance use disorders (SUDs). Understanding trends in youth substance-related risk behaviors is important in identification and prevention of SUDs. The objective of this study was to assess, in a nationally representative sample of U.S. high school students, how current electronic vapor product (EVP), cigarette, and dual-product usage as well as EVP usage frequency are related to other substance use behaviors. Methods: Respondents (N = 12,667) of the 2017 National Youth Risk Behavior Survey were categorized by previous 30-day EVP and cigarette usage into one of four groups: nonuse, cigarette only, EVP only, or dual use. Separately, respondents were categorized by 30-day EVP usage frequency: 0, 1-9, 10-29, or 30 days. Thirteen substance use behaviors were selected as dependent variables. Adjusted prevalence ratios (aPRs) were calculated using multivariable modified Poisson regression to determine associations between outcome behaviors and both current EVP/cigarette usage and EVP usage frequency. Linear contrasts were conducted to compare aPRs across categories. Results: Cigarette, EVP, and dual users were more likely to engage in 12 of 13 substance use behaviors compared to nonusers (p < 0.001). Dual-users were more likely than EVP-only users to engage in 12 of 13 behaviors. Past 30-day EVP users at any frequency were also more likely to engage in nearly all risk behaviors examined. Occasional EVP users were similarly likely as frequent and daily users to engage in 11 of 13 behaviors. Conclusions: Adolescent EVP use, with or without concurrent cigarette smoking, is associated with a higher likelihood of engagement in several substance use behaviors. Prevalence of risk behaviors is generally greater for dual users than EVP-only users, but prevalence proportions do not significantly differ among occasional, frequent, or daily EVP users for most behaviors.

Alternative Tobacco Products Use among Late Adolescents in Kelantan, Malaysia.

BackgroundThe rising prevalence of alternative tobacco and nicotine products (ATNPs) use among adolescents is a global concern that has been attributed to the reemergence of preexisting alternative tobacco products and emergence of new ones in the market. This study examined ATNP use among late adolescents. The association between ATNP use and reasons for using them was explored.MethodsThis cross-sectional study conducted in 2016 involving 388 late adolescents from six government colleges in Kelantan, Malaysia, aged 18 to 19 years. They were requested to answer self-directed questionnaires with items on sociodemographic information and types of ATNP used. Other variables obtained include the environmental influence and reasons for using the products. Regression analyses between the dependent and independent variables were conducted using IBM SPSS ver. 20.0 (IBM Corp., Armonk, NY, USA).ResultsThe prevalence of ATNP use among late adolescents was 14.4%. The male sex, cigarette smoking status, and peer use were significantly associated with ATNP use. Several reasons for use were not significantly associated with ATNP use: perception of ATNP being less harmful and less addictive compared with cigarettes, curiosity, less expensive than cigarettes, to aid smoking cessation, and pleasurable flavors and taste.ConclusionThe prevalence of ATNP use among late adolescents studying in government colleges in Kelantan is significant. There is higher perception on ATNP being less harmful and addictive than the conventional cigarette among the users compared with non-users. Significant associations are seen for the male sex, peer use, and concurrent cigarette smoking.

The impact of sarcopenia on tolerance of radiation and outcome in patients with head and neck cancer receiving chemoradiation

Background and purposeSarcopenia is a predictor of poor prognosis in cancer patients. One potential mechanism for worse outcomes in sarcopenic patients is worse tolerance to treatment; this has not been investigated with regard to radiation treatment. We reviewed our institutional experience of head and neck cancer patients receiving concurrent chemoradiation and assessed outcomes with respect to sarcopenia. Materials and methodsPatients treated between 2012 and 2016 were reviewed. Sarcopenia was assessed from radiation planning computed tomography (CT) scans using muscles at the C3 vertebral body using previously published methods. Survival was calculated using the Kaplan–Meier method. Association between patient factors and outcome was calculated in univariate and multivariate analyses. ResultsTwo hundred and forty-six patients were included. Fifty-eight percent met criteria for sarcopenia. Thirty-seven percent experienced chemotherapy delays of >1 week and 14% had radiation treatment breaks >1 week. On multivariate analysis, concurrent smoking (HR 3.85, p < 0.01) and sarcopenia (HR 2.15, p = 0.01) were associated with chemotherapy toxicity and age >65 years (HR 2.94, p < 0.01) and sarcopenia (HR 2.99, p = 0.04) were associated with prolonged radiation breaks. Sarcopenia was associated with worse overall survival (HR 1.83, p = 0.03) and progression-free survival (HR 1.65, p = 0.03) in the overall cohort. When analyzed separately, sarcopenia was not associated with outcomes in p16-positive oropharynx cancers. ConclusionSarcopenic patients receiving concurrent chemoradiation are more likely to require radiation treatment breaks and suffer chemotherapy toxicity than their non-sarcopenic counterparts. This may contribute to worse survival outcomes in head and neck cancer, with the exception of p16-positive oropharyngeal cancer.

Youth perspectives on concurrent smoking and vaping: Implications for tobacco control

Most people who smoke cigarettes begin young. Consequently, public health efforts directed at youth are a priority. The increasing popularity of electronic nicotine delivery systems (ENDS) among youth in the United States has raised concerns in the public health community about the potential of ENDS to renormalize cigarette smoking and perpetuate nicotine addiction, creating dual users who both vape and smoke. Despite limited and inconclusive evidence about dual use for young people, restrictive approaches towards ENDS have shaped tobacco control agendas in the United States. Based on analysis of 26 interviews with young dual users in California, we explored the meanings young people ascribe to their dual using practices and how those meanings relate to the broader tobacco control environment which structures their lives. Results suggest that dual users of ENDS and cigarettes overwhelmingly perceive a utilitarian meaning of dual use and view vaping as a tool for reducing smoking-related harm in the near term and facilitating quitting smoking in the long term. Also, participants’ narratives related to Tobacco 21 laws, which prohibit sales of both ENDS and cigarettes to individuals under 21 years of age, revealed concerns about restrictive policies that limit access to less harmful tobacco products. Results of this study raise important questions about whether we are working towards further reductions in the prevalence of smoking and tobacco-related diseases.

Prevalence and characteristics associated with concurrent smoking and alcohol misuse within Australian general practice patients.

Objectives This study sought to determine, among a large sample of Australian general practice patients: (1) the prevalence of smoking among different levels of alcohol misuse; and (2) whether the associations between demographic characteristics and alcohol use differ according to smoking status. Methods A cross-sectional survey was administered from 2010 to 2011 to 3559 patients from 12 Australian urban general practices. Patients reported their demographic details, smoking status and their alcohol intake. Results The overall prevalence of reported concurrent smoking and alcohol misuse was 7.8%. Smokers were 3.81-fold more likely to have a higher level of alcohol consumption than non-smokers (95% confidence interval 3.13-4.63; P<0.0001). There was evidence that smoking was an effect modifier of the relationship between alcohol misuse and chronic illness. Conclusions There was an increasing prevalence of smoking with increasing level of alcohol consumption. In addition, those with chronic conditions who smoked had greater odds of higher levels of alcohol consumption. Preventative interventions for these substances are needed to reduce the burden associated with concurrent smoking and alcohol misuse. What is known about the topic? Tobacco and alcohol are the most commonly used substances and contribute to over 10million deaths annually. The risk of disease is high when using either of these substances, however, concurrent use is associated with a greatly compounded risk. Australian data is limited regarding the prevalence of concurrent tobacco and alcohol misuse, however, international studies suggest variation in prevalence rates between different clinical settings. What does this paper add? This study examined the prevalence of concurrent smoking and alcohol misuse among different levels of alcohol misuse severity within an Australian general practice setting. Additionally it explored whether the associations between demographic characteristics and alcohol use differ according to smoking status. What are the implications for practitioners? This study has important implications for disease prevention and the delivery of preventive health services by general practitioners. Considering one in 100 clinical treatments provided in general practice relate to preventative smoking or alcohol counselling, it is critical that efforts are made to ascertain risk factors such as smoking and alcohol misuse to increase treatment rates. General practitioners should consider screening for smoking and alcohol misuse opportunistically during routine clinical encounters, as well as screening for smoking or alcohol misuse if one or the other is present.

Alcohol consumption and hospitalization burden in an adult Italian population: prospective results from the Moli-sani study.

Epidemiological evidence on the impact of different alcohol drinking patterns on health-care systems or hospitalizations is sparse. We investigated how the different average volumes of alcohol consumed relate to all-cause and cause-specific hospitalizations. Prospective cohort study (baseline 2005-10) linked to a registry of hospital discharge records to identify hospitalizations at follow-up (December 2013). Molise region, Italy. A total of 20 682 individuals (48% men, age≥35years) who participated in the Moli-sani Study and were free from cardiovascular disease or cancer at baseline. The alcohol volume consumed in the year before enrolment was classified as: life-time abstainers, former drinkers, occasional drinkers and current drinkers who drank 1-12 (referent), 12.1-24, 24.1-48 and>48 g/day of alcohol. Cause-specific hospitalizations were assigned by Italian Diagnosis Related Groups classification or by ICD-9 code of main admission diagnoses. Incidence rate ratios (IRR) of hospitalization were estimated by Poisson regression, taking into account the total number of admissions that occurred during the follow-up per person. During a median follow-up of 6.3years, 12 996 multiple hospital admissions occurred. In multivariable analyses, life-time abstainers and former drinkers had higher rates of all-cause [IRR=1.11, 95% confidence interval (CI)=1.05-1.17 and IRR=1.19, 95% CI=1.02-1.31, respectively] and vascular (IRR=1.14, 95% CI=1.02-1.27 and IRR=1.48, 95% CI=1.24-1.76, respectively) hospitalizations compared with light alcohol consumers. Alcohol consumption >48 g/day was associated with a higher rate of hospitalization for both alcohol-related diseases (IRR=1.74, 95% CI=1.32-2.29) and cancer (IRR=1.36, 95% CI=1.12-1.65). The magnitude of the association between heavier alcohol intake and hospitalization tended to be greater in smokers than non-smokers. No associations were observed with hospitalization for trauma or neurodegenerative diseases. Moderate alcohol consumption appears to have a modest but complex impact on global hospitalization burden. Heavier drinkers have a higher rate of hospitalization for all causes, including alcohol-related diseases and cancer, a risk that appears to be further magnified by concurrent smoking.

A bidirectional path analysis model of smoking cessation self-efficacy and concurrent smoking status: impact on abstinence outcomes.

Self-efficacy is routinely associated with abstinence in the addictions literature, and is a major component relapse-prevention models. The magnitude of this relationship has been brought into question following equivocal results in studies controlling for concurrent smoking status. The aim of our study was to clarify the relationship between cessation self-efficacy, smoking status, and cessation outcomes in a cohort of treatment-seeking smokers. Smokers participating in the FLEX trial, a randomized trial investigating the efficacy of three pharmacologic treatments for smoking cessation, completed questionnaires assessing cessation self-efficacy at baseline and at weeks 1, 3, 5 and 10 post-target quit date; smoking status was verified using expired carbon monoxide. Structural models were fit in order to ascertain the relationship between cessation self-efficacy and concurrent smoking at each time-point, and to assess the association between cessation self-efficacy, smoking and seven-day point prevalence smoking status at week 10. A total of 737 treatment-seeking smokers participated. In our path model, self-efficacy and smoking status at all time points were associated with week 10 abstinence (except week 3 self-efficacy), after controlling these values' previous time-points. All direct pathways between cessation self-efficacy and smoking were also significant, supporting a bidirectional relationship. Our results support a bidirectional and reciprocal relationship between cessation self-efficacy and concurrent smoking behavior; participants with higher confidence were more likely to be smoke-free, and concurrent smoking status predicted levels of confidence over the ensuing weeks. Both measures were associated with week 10 abstinence. Our results indicate that while correlated, both cessation self-efficacy and current smoking behavior during a cessation attempt are important independent markers of ultimate cessation success.

Protective effect of breastfeeding on recurrent cough in adulthood

RationaleBreastfeeding protects from respiratory infections in early life but its relationship to recurrent cough and other respiratory outcomes in adult life is not well established.MethodsInfant feeding practices were assessed prospectively...

MActive-Smoke: A Prospective Observational Study Using Mobile Health Tools to Assess the Association of Physical Activity With Smoking Urges.

BackgroundEvidence that physical activity can curb smoking urges is limited in scope to acute effects and largely reliant on retrospective self-reported measures. Mobile health technologies offer novel mechanisms for capturing real-time data of behaviors in the natural environment.ObjectiveThis study aimed to explore this in a real-world longitudinal setting by leveraging mobile health tools to assess the association between objectively measured physical activity and concurrent smoking urges in a 12-week prospective observational study.MethodsWe enrolled 60 active smokers (≥3 cigarettes per day) and recorded baseline demographics, physical activity, and smoking behaviors using a Web-based questionnaire. Step counts were measured continuously using the Fitbit Charge HR. Participants reported instantaneous smoking urges via text message using a Likert scale ranging from 1 to 9. On study completion, participants reported follow-up smoking behaviors in an online exit survey.ResultsA total of 53 participants (aged 40 [SD 12] years, 57% [30/53] women, 49% [26/53] nonwhite) recorded at least 6 weeks of data and were thus included in the analysis. We recorded 15,365 urge messages throughout the study, with a mean of 290 (SD 62) messages per participant. Mean urge over the course of the study was positively associated with daily cigarette consumption at follow-up (Pearson r=.33; P=.02). No association existed between daily steps and mean daily urge (beta=−6.95×10−3 per 1000 steps; P=.30). Regression models of acute effects, however, did reveal modest inverse associations between steps within 30-, 60-, and 120-min time windows of a reported urge (beta=−.0191 per 100 steps, P<.001). Moreover, 6 individuals (approximately 10% of the study population) exhibited a stronger and consistent inverse association between steps and urge at both the day level (mean individualized beta=−.153 per 1000 steps) and 30-min level (mean individualized beta=−1.66 per 1000 steps).ConclusionsAlthough there was no association between objectively measured daily physical activity and concurrently self-reported smoking urges, there was a modest inverse relationship between recent step counts (30-120 min) and urge. Approximately 10% of the individuals appeared to have a stronger and consistent inverse association between physical activity and urge, a provocative finding warranting further study.

Carboplatin-Based Chemoradiation Improves Outcomes Compared to Cetuximab Bioradiation in Cisplatin Ineligible Locally Advanced p16 Negative Head and Neck cancer

Many patients cannot tolerate standard of care cisplatin (CP) concurrent with radiation therapy (RT) for the definitive treatment of locally advanced (LA) head and neck cancer (HNSCC). In such cases, cetuximab (CTX) bioradiation (bioRT) is an increasingly popular substitute therapy. Yet, mounting evidence suggests that the addition of cytotoxic chemotherapy to RT is needed to optimize clinical outcomes in HNSCC, especially in p16(-) disease. In this regard, concurrent carboplatin-based (CB) chemoradiation (CRT) is another alternative to CP-CRT; however, there are no large trials comparing the efficacy of CTX-bioRT or CB-CRT to CP-CRT in this population. We hypothesized that CB-CRT would result in superior clinical outcomes compared to CTX-bioRT in p16(-) LA-HNSCC. We identified cases of treatment-naïve p16(-) LA-HNSCC (stage III-IVB) of the oropharynx (31%), larynx (55%), and hypopharynx (13%) who received definitive (≥70 Gy) CTX-bioRT (n = 35), CB-CRT (n = 43), or CP-CRT (n = 67) at our institution from 2009 to 2015. Variables with P < .05 on log-rank/Kaplan-Meier analysis were included as covariates in Cox proportional hazards modeling to adjust for potential confounders; variables included: concurrent systemic agent, sex, age, smoking history, T stage, N stage, performance status, and primary tumor site. We identified 145 cases: 107 men (73.7%), median age 60 years (range, 41-87), ≥T3 (63.4%), and ≥N2b (56.6%). There were no statistical differences in sex, age, smoking history, T stage, N stage, performance status, or frequency of primary site among the groups. The most common reasons for CP ineligibility were hearing loss (41.0%), medical comorbidities (35.9%), and renal disease (9%). Median follow up was 3 years. Locoregional control (LRC), distant metastasis-free survival (DMFS), recurrence-free survival (RFS), and overall survival (OS) at 3 years were not statistically different between those treated with CB or CP-CRT. When compared to CTX-bioRT, CB-CRT improved 3-year LRC (81.5 vs 40.0%; P = .001), RFS (76.9 vs 38.3%; P = .009), and OS (60.0 vs 55.2%; P = .05), with a trend toward improved distant metastasis free survival (89.5% vs 65.8%; P = .06). On MVA CB-CRT remained associated with improved LRC (HR 0.25, 95% CI 0.10-0.67; P = .006), RFS (HR 0.30, 95% CI 0.12-0.76; P = 0.01), and OS (HR 0.44, 95% CI 0.20-0.96; P = .04) compared to CTX-bioRT. On subset analysis of non-oropharynx primary tumors, concurrent platinum agents (CP or CB) were associated with improved 3-year larynx preservation compared to CTX-bioRT (83.6 vs 47.1%; P = .02). When patients cannot receive CP, CB-CRT is an effective alternative in p16(-) LA-HNSCC. Furthermore, CB-CRT markedly improved LRC, RFS, and OS compared to CTX-bioRT and should be a preferred substitute for CP in this population. Prospective validation of these results is needed.

The dynamic shuttling of SIRT1 between cytoplasm and nuclei in bronchial epithelial cells by single and repeated cigarette smoke exposure.

SIRT1 (silent information regulator 2 homolog 1) is a crucial cellular survival protein especially in oxidative stress environments, and has been thought to locate within the nuclei, but also known to shuttle between cytoplasm and nuclei in some cell types. Here, we show for the first time the dynamics of SIRT1 in the presence of single or concurrent cigarette smoke extract (CSE) exposure in human bronchial epithelial cells (HBEC). In BEAS-2B HBEC or primary HBEC, SIRT1 was localized predominantly in cytoplasm, and the CSE (3%) induced nuclear translocation of SIRT1 from cytoplasm in the presence of L-buthionine sulfoximine (an irreversible inhibitor of γ-glutamylcystein synthetase), mainly through the activation of phosphatidylinositol 3-kinase (PI3K) α subunit. This SIRT1 nuclear shuttling was associated with FOXO3a nuclear translocation and the strong induction of several anti-oxidant genes including superoxide dismutase (SOD) 2 and 3; therefore seemed to be an adaptive response. When BEAS-2B cells were pretreated with repeated exposure to a lower concentration of CSE (0.3%), the CSE-induced SIRT1 shuttling and resultant SOD2/3 mRNA induction were significantly impaired. Thus, this result offers a useful cell model to mimic the impaired anti-oxidant capacity in cigarette smoking-associated lung disease such as chronic obstructive pulmonary disease.

Poor sleep in concurrent users of alcohol, khat, and tobacco smoking in community-dwelling Ethiopian adults.

BACKGROUND:Polysubstance dependence, stress, and sleep disturbances are inter-related by shared physiological pathways. No study has investigated the relationship between sleep and concurrent use of alcohol and khat.OBJECTIVES:The aim of the study was to assess the effect of the concurrent use of alcohol and khat as well as concurrent alcohol, khat, and tobacco smoking on sleep patterns.METHODS:A sample of community-dwelling adults (n = 339, age = 25.5 ± 5.7 years, body mass index = 22.0 ± 2.2 kg/m2) from Mizan-Aman, Ethiopia, participated in a cross-sectional study. Semi-structured tool for sociodemographics, substance use habit, and the Pittsburgh Sleep Quality Index (PSQI) were used. The difference in sleep patterns among substance use groups, i.e., nonusers, alcohol use only, concurrent alcohol and khat use, and concurrent alcohol, khat and tobacco smoking was assessed.RESULTS:The poorest sleep quality was found among concurrent users of alcohol, khat, and tobacco smoking (PSQI global score = 8.2 ± 2.4), followed by concurrent users of alcohol and khat (PSQI global score = 7.3 ± 2.9) (F (3.335) = 23.64, P < 0.001). There were significant differences in the PSQI component score of sleep quality χ2(3) =159.09, P < 0.001, the PSQI component score of sleep latency χ2(3) = 128.09, P < 0.001, and the PSQI component score of sleep disturbances χ2(3) = 37.69, P < 0.001 between substance use groups.CONCLUSION:Concurrent use of alcohol, khat as well as alcohol, khat, and tobacco smoking was associated with poor sleep. Sleep disturbances in this group need management to avoid the prospective development of psychosocial disturbances in polysubstance users.

Characterizing a Hidden Group of At-Risk Drinkers: Epidemiological Profiles of Alcohol-Use Disorder Diagnostic Orphans

ABSTRACTBackground: Drinkers who report some symptoms of alcohol-use disorder (AUD) but fail to meet full criteria are “diagnostic orphans.” To improve risk-reduction efforts, we sought to develop better epidemiologic profiles of this underrecognized subgroup. Methods: This study estimated the population prevalence and described AUD symptoms of diagnostic orphans using the 2012–2013 National Epidemiological Survey of Alcohol and Related Conditions-III. Multivariate logistic regression was used to model odds of being a diagnostic orphan or meeting mild, moderate, and severe AUD criteria versus no AUD symptoms. Models were adjusted for the complex survey design using sampling weights and survey procedures (e.g., proc surveylogistic). Results: Among drinkers, 14% of men and 11% of women were classified as diagnostic orphans. The most common symptoms were drinking more or for longer periods than intended, wanting or trying unsuccessfully to quit or cut back, and drinking in ways that increased risk of injury. We noted broad similarities between diagnostic orphans and mild/moderate AUD groups. There were no differences in odds of diagnostic orphans status by race/ethnicity; however, female gender was associated with lower odds of diagnostic orphan status and all levels of AUD. Individual history of AUD, family history of problem drinking, concurrent smoking, and concurrent marijuana use were associated with greater odds of problem drinking, with stronger associations as AUD severity increased. Conclusions: Diagnostic orphans remain a sizeable and overlooked population of problem drinkers. Clarifying the array of symptoms and cooccurring disorders can improve screening and facilitate alcohol risk-reduction intervention efforts.

Childhood maltreatment and adulthood poor sleep quality: a longitudinal study.

Available evidence from cross-sectional studies suggests that childhood maltreatment may be associated with a range of sleep disorders. However, these studies have not controlled for potential individual-, familial- and environmental-level confounders. To determine the association between childhood maltreatment and lower sleep quality after adjusting for potential confounders. Data for the present study were obtained from a pre-birth cohort study of 3778 young adults (52.6% female) of the Mater Hospital-University of Queensland Study of Pregnancy follow up at a mean age of 20.6 years. The Mater Hospital-University of Queensland Study of Pregnancy is a prospective Australian pre-birth cohort study of mothers consecutively recruited during their first obstetric clinic visit at Brisbane's Mater Hospital in 1981-1983. Participants completed the Pittsburgh Sleep Quality Index at the 21-year follow up. We linked this dataset to agency-recorded substantiated cases of childhood maltreatment. A series of separate logistic regression models was used to test whether childhood maltreatment predicted lower sleep quality after adjustment for selected confounders. Substantiated physical abuse significantly predicted lower sleep quality in males. Single and multiple forms of childhood maltreatment, including age of maltreatment and number of substantiations, did not predict lower sleep quality in either gender in both crude and adjusted models. Not being married, living in a residential problem area, cigarette smoking and internalising were significantly associated with lower sleep quality in a fully adjusted model for the male-female combined sample. Childhood maltreatment does not appear to predict young adult poor sleep quality, with the exception of physical abuse for males. While childhood maltreatment has been found to predict a range of mental health problems, childhood maltreatment does not appear to predict sleep problems occurring in young adults. Poor sleep quality was accounted for by concurrent social disadvantage, cigarette smoking and internalising.

The Role of Nicotine Dependence in E-Cigarettes' Potential for Smoking Reduction.

E-cigarettes (Electronic Nicotine Delivery Systems, or ENDS) are an increasingly popular tobacco product among youth. Some evidence suggests that e-cigarettes may be effective for harm reduction and smoking cessation, although these claims remain controversial. Little is known about how nicotine dependence may contribute to e-cigarettes' effectiveness in reducing or quitting conventional smoking. A cohort of young adults were surveyed over 4 years (approximately ages 19-23). Varying-coefficient models (VCMs) were used to examine the relationship between e-cigarette use and conventional smoking frequency, and how this relationship varies across users with different nicotine dependence levels. Lifetime, but not recent, e-cigarette use was associated with less frequent concurrent smoking of conventional cigarettes among those with high levels of nicotine dependence. However, nondependent e-cigarette users smoked conventional cigarettes slightly more frequently than those who had never used e-cigarettes. Nearly half of ever e-cigarette users reported using them to quit smoking at the last measurement wave. For those who used e-cigarettes in a cessation attempt, the frequency of e-cigarette use was not associated with reductions in future conventional smoking frequency. These findings offer possible support that e-cigarettes may act as a smoking reduction method among highly nicotine-dependent young adult cigarette smokers. However, the opposite was found in non-dependent smokers, suggesting that e-cigarette use should be discouraged among novice tobacco users. Additionally, although a substantial proportion of young adults used e-cigarettes to help them quit smoking, these self-initiated quit attempts with e-cigarettes were not associated with future smoking reduction or cessation. This study offers potential support for e-cigarettes as a smoking reduction tool among highly nicotine-dependent young adult conventional smokers, although the extent and nature of this remains unclear. The use of e-cigarettes as a quit aid was not associated with reductions in conventional smoking, consistent with most other quit aids in this sample except for nicotine replacement therapy, which was only effective for the most dependent smokers. Notably, these findings highlight the necessity of accounting for smokers' nicotine dependence levels when examining tobacco use patterns.

Elevated Behavioral Economic Demand for Alcohol in a Community Sample of Heavy Drinking Smokers.

Cigarette smokers are more likely to consume alcohol at higher levels and experience poorer response to treatment for alcohol problems than are nonsmokers. One previous study in university students suggests that a potential reason for the high overlap between alcohol and tobacco use is that concurrent smoking is associated with overvaluation of alcohol, as reflected in elevated behavioral economic demand. The present study sought to extend these initial findings in a community sample with heavier levels of alcohol and tobacco use. Participants were 111 non-treatment-seeking heavy drinkers(defined as 18+/14+ drinks per week for men/women) from a larger study on alcohol pharmacotherapy mechanisms. Forty-nine participants (44%) reported regular smoking (≥5 cigarettes/day). Participants completed a hypothetical alcohol purchase task assessing alcohol consumption at escalating levels of price. Covariates included demographics, drinking quantity, alcohol use disorder severity, depression, and delay discounting. In covariate-adjusted models, smokers reported significantly higher maximum alcohol expenditures (Omax) and breakpoint price (first price suppressing consumption to zero) compared with nonsmokers. Elevated alcohol demand correlated with drinking quantity and severity in the entire sample, but not with smoking frequency or nicotine dependence among smokers only. This study offers further evidence of increased reinforcing value of alcohol among smokers in a sample of heavy drinkers from the community. Clinical implications and potential mechanisms underlying this relationship are discussed.

E-cigarette Use, Cigarette Smoking, Dual Use, and Problem Behaviors Among U.S. Adolescents: Results From a National Survey

PurposeThere is a need to obtain greater clarity regarding adolescents' e-cigarette use and the associations of use with a wider range of risk behaviors. This study examines the associations among past-month e-cigarette use only, traditional cigarette smoking only, dual use (i.e., concurrent e-cigarette use and cigarette smoking), school-related (i.e., truancy and poor academic performance) risk behaviors, and substance-related (i.e., alcohol use, binge drinking, marijuana use, illicit drug use, and nonmedical prescription drug use) risk behaviors. MethodsData were collected via self-administered questionnaires from a nationally representative sample of 8,696 high school seniors. ResultsAn estimated 9.9% of U.S. high school seniors reported past-month e-cigarette use only, 6.0% reported past-month cigarette smoking only, and 7.3% reported past-month dual use. School- and substance-related risk behaviors had strong associations with past-month e-cigarette use. Adolescents who only used e-cigarettes had significantly greater odds of all school- and substance-related risk behaviors relative to nonusers. Dual users had significantly greater odds of frequent/daily e-cigarette use as well as all school- and substance-related risk behaviors relative to those who only used e-cigarettes. Finally, adolescents who engaged in frequent/daily e-cigarette use had significantly greater odds of binge drinking, marijuana use, other illicit drug use and nonmedical prescription drug use, relative to experimental e-cigarette users. ConclusionsE-cigarette use is common among U.S. adolescents, and there are robust associations between e-cigarette use and school- and substance-related risk behaviors. There is evidence that e-cigarette use clusters with risk behaviors and appears to represent a problem behavior, especially dual use of e-cigarettes and traditional cigarettes.

Concurrent Trajectories of Female Drinking and Smoking Behaviors Throughout Transitions to Pregnancy and Early Parenthood.

The purpose of this longitudinal study was to investigate whether there are distinct etiological processes explaining dual usage of alcohol and conventional cigarettes by mothers from preconception through the early parenting years. Data on 8800 biological mothers were drawn from the Early Childhood Longitudinal Study-Birth Cohort (ECLS-B), representative of US births in 2001. A general growth mixture model (GGMM) was used to empirically identify developmental trajectories of maternal smoking and drinking over the 5-6-year study period. Six classes defined by alcohol consumption and cigarette smoking were identified. These included a nonsmoking, low probability of drinking class (41%), and two drinking classes displaying no smoking with either moderate (26%) or escalating high (8%) probability drinking. Additionally, two predominantly smoking classes were identified, one displaying temporary reduction in smoking during pregnancy and low probability of drinking (11%) and one following a trajectory of persistent heavy smoking with a declining probability of drinking (9%). The sixth class was described by temporary reduction in smoking during pregnancy with high probability of drinking (6%). Covariates differentially predicted class membership, e.g., having a high school degree but not further education predicted concurrent drinking and smoking, and breastfeeding for more than 6months is protective against concurrent use. Prior to conception, during prenatal care, and in post-natal clinical visits, whether for personal or pediatric care, screening women of reproductive age via characteristics that predict heterogeneity in smoking and drinking trajectories may help guide prevention and treatment options.