Continued Smoking Research Articles

Risk Factors of Patient-Reported Xerostomia Among Oropharyngeal Cancer Survivors Treated with Definitive Radiotherapy

<h3>Purpose/Objective(s)</h3> Xerostomia is a common sequela of radiation therapy (RT) and chemoradiotherapy (CRT). Head and neck cancer treatment can contribute to salivary glands injury with diminished salivary production and changes in consistency, volume, and pH of saliva. Previous studies examining xerostomia have investigated RT regimens, dosimetric predictors, and quality of life (QoL) associations but few have identified clinicodemographic risk factors for xerostomia and quantified their associations among oropharyngeal carcinoma (OPC) survivors. The objective of this study was to identify risk factors for xerostomia among long-term OPC survivors. <h3>Materials/Methods</h3> This was a cross-sectional study conducted at a comprehensive cancer center. Study participants included disease-free, adult OPC survivors who completed curative definitive radiotherapy treatment between January 2000 and December 2013, and responded to a survey administered from September 2015 to July 2016. This study included 881 OPC survivors with a median survival duration at time of survey of 7 years (range, 1-16 years) of which self-reported xerostomia scores were available for 853 participants. The primary outcome variable was patient-reported xerostomia measured using the MD Anderson Symptom Inventory Head and Neck Cancer Module. Clinicodemographic risk factors for moderate to severe xerostomia were identified using multivariable logistic regression. <h3>Results</h3> Of 853 OPC survivors who responded to the xerostomia question, 337 (39.5%) reported moderate to severe xerostomia. Multivariable logistic regression identified current smoking at time of survey (OR:2.57, 95% CI: 1.20-5.53, <b>P</b> = 0.016) as a risk factor for moderate to severe xerostomia and concurrent cetuximab chemotherapy (OR:0.63; 95% CI: 0.41-0.97, <b>P</b> = 0.038) as a protective factor. Additionally, female sex (OR:1.81, 95% CI: 1.21-2.71, <b>P</b> = 0.004) and less than high school education (OR:1.68, 95% CI: 1.15-2.45, <b>P</b> = 0.008) were risk factors for moderate to severe xerostomia and bilateral intensity modulated radiotherapy (IMRT) combined with proton therapy (OR:0.34, 95% CI: 1.16-0.73, <b>P</b> = 0.005) and ipsilateral IMRT (OR:0.18, 95% CI: 0.07-0.46, <b>P</b> < 0.001) were protective. <h3>Conclusion</h3> In this large xerostomia study, about 4 out of 10 OPC survivors reported moderate to severe xerostomia over long-term follow-up. Continued smoking after cancer diagnosis, sex, and education were identified as important risk factors of moderate to severe xerostomia and concurrent cetuximab therapy and more modern RT regimens had a protective association. Sustained smoking post-diagnosis is a modifiable risk factor which can be addressed with continued smoking cessation efforts. Lastly, these results can inform future research and targeted patient-centered interventions to monitor and manage RT-associated xerostomia and preserve QoL among OPC patients.

Foetal tobacco and cannabis exposure, body fat and cardio‐metabolic health in childhood

SummaryBackgroundFoetal tobacco and cannabis exposure may have persistent cardio‐metabolic consequences in the offspring.ObjectiveWe examined the associations of maternal and paternal tobacco and cannabis use during pregnancy with offspring body fat and cardio‐metabolic outcomes.MethodsIn a population‐based prospective cohort study among 4792 mothers, fathers, and children, we assessed parental substance use by questionnaires. Childhood outcomes included body mass index (BMI), body fat, blood pressure, and lipid, glucose and insulin concentrations at 10 years.ResultsChildren exposed to maternal tobacco use during pregnancy had a higher android/gynoid fat mass ratio (difference 0.22 SDS, 95% confidence interval [CI]: 0.13, 0.30), fat mass index (difference 0.20 SDS, 95% CI: 0.12, 0.28), triglyceride concentrations (difference 0.15 SDS, 95% CI: 0.04, 0.26), and a higher risk of overweight (odds ratio [OR] 1.35, 95% CI: 1.07, 1.71), compared to non‐exposed. Children exposed to maternal cannabis during pregnancy had a higher BMI (difference 0.26 SDS, 95% CI: 0.08, 0.44), android/gynoid fat mass ratio (difference 0.21 SDS, 95% CI: 0.04, 0.39), and fat‐free mass index (difference 0.24 SDS, 95% CI: 0.06, 0.41), compared to non‐exposed. The associations for paternal substance use with child cardio‐metabolic health outcomes were similar as those for maternal use.ConclusionsSimilar associations for maternal and paternal substance use during pregnancy suggest that these findings may be explained by shared family‐based social and lifestyle factors, rather than by direct foetal programming.

Not really a smoker? Prevalence and attitudes to social occasional smoking in Trinity College Dublin

Abstract Background Occasional smoking is defined as any smoking which occurs on a less than daily basis. Social smoking is a sub-group of occasional smoking which is smoking primarily carried out in social contexts. Data on occasional cigarette smoking and the subset of social smoking among third-level students are limited. This study assessed the prevalence of and attitudes to occasional/social smoking among undergraduates and postgraduates in an Irish university Aims (1) To determine the prevalence of occasional/social smoking among third-level students; (2) To evaluate students' attitudes to occasional/social smoking, including perceived benefits and harm; (3) To explore when students commenced occasional/social smoking, their reasons and their continued smoking habits; and (4) To determine any influence of other factors e.g. alcohol consumption on occasional/social smoking. Methods Anonymous online survey of undergraduates and postgraduates, via email and social media using Survey Monkey. Data were analysed in Microsoft Excel. Results 1,310/18,407 (7.1%) of students responded. 1,267/1,310 (96.7%) provided adequate data for analysis. 423/1267 (33.4%) self-reported as current smokers of whom 106/1267 (8.4%) classified themselves as daily and 317/1267 (25%) as occasional smokers. The occasional smokers comprised 266/1267 (21%) social smokers and 51/1267 (4%) non-social smokers. Occasional smokers tended to start smoking later and think less about quitting than daily smokers. 386/423 (97.2%) of all current smokers reported that alcohol increased their smoking habits. Conclusions Prevalence of self-reported occasional smoking among university students was higher than daily smoking. Most occasional smokers primarily smoked in social contexts. All current smokers reported that alcohol increased cigarette intake. Effective intervention campaigns tailored to determinants of occasional/social smoking are needed as part of induction to third level. Key messages Prevalence of self-reported occasional smoking among university students is higher than daily smoking. Most occasional smokers smoke primarily in a social environment. Campaigns tailored to determinants of occasional/social smoking are needed for university entrants as part of induction to third level.

Perceptions, behaviours and attitudes towards smoking held by the male partners of Chinese pregnant women: a qualitative study

BackgroundDirect associations of tobacco exposure during pregnancy with pregnancy complications and adverse birth outcomes have been proven. Previous studies suggest that expecting a child provides a valuable opportunity to promote behavioural changes, such as smoking cessation, among the male partners of pregnant women. Thorough understandings of Chinese expectant fathers’ smoking behaviour during the transition to fatherhood is a prerequisite to the development of appropriate interventions to facilitate smoking cessation. This study aimed to explore the perceptions, behaviours and attitudes related to smoking among male partners of pregnant women in China.MethodsA descriptive phenomenological approach was adopted. A purposive sample of expectant fathers aged 18 years or older who had a tobacco use history within the past year were recruited at obstetrics and gynaecology clinics and invited to participate in one-to-one, 20–30-min semi-structured interviews. The data analysis followed Colaizzi’s descriptive phenomenological method.ResultsTwenty-five expectant fathers were interviewed. Four themes were generated: 1) the benefits of smoking and respondents’ misperceptions of the impact of smoking and SHS and neglectful attitude of the impact of smoking, which were given as the major reasons for continuing to smoke; 2) factors contributing to smoking cessation, including concern for the potential health impact of continued smoking on the pregnant partner and baby, the role of being father, and the encouragement to quit from family members; and 3) perceived barriers to smoking cessation, including withdrawal symptoms or cigarette cravings, absence of smoking cessation support, and increasing stress.ConclusionThis study provides a comprehensive understanding of the perception, behaviours, and attitudes related to smoking among Chinese expectant fathers. The findings of this study can guide healthcare professionals and policymakers in combining the distribution of educational information about the hazards of SHS for maternal and neonatal health with smoking cessation assistance for expectant fathers through policy initiatives and other types of incentives and programmes targeted to enhance smoking cessation among this population.Trial registrationProspectively registered at clinicaltrial.org (NCT03401021) on 8 Jan 2018.

Risk factors for chronic cough in adults: A systematic review and meta-analysis.

Despite the challenges of diagnosing and managing adult patients with chronic cough, a systematic synthesis of evidence on aetiological risk factor is lacking. We systematically searched PubMed and EMBASE to synthesize the current evidence for longitudinal associations between a wide range of risk factors and chronic cough in the general adult population, following the meta-analysis of observational studies in epidemiology (MOOSE) guidelines. The Newcastle-Ottawa scale was used to assess the quality of the included studies. Fixed-effect meta-analysis was conducted where appropriate. Of 26 eligible articles, 16 domains of risk factors were assessed. There was consistent evidence that asthma (pooled adjusted OR [aOR]=3.01; 95% CI: 2.33-3.70; I2 = 0%; number of articles [N]=3) and low education levels/socioeconomic status (SES) (pooled aOR=1.46; 95% CI: 1.20-1.72; I2 = 0%; N= 3) were associated with an increased risk of chronic cough after adjusting for smoking and other confounders. While continuous smoking was associated with chronic cough (aOR=1.81; 95% CI: 1.36-2.26; I2 = 57%; N= 3), there was too little evidence to draw conclusions for occupational exposures, outdoor air pollution, early-life exposures, diet, snoring and other chronic conditions, including obesity, chronic obstructive pulmonary disease, gastro-oesophageal reflux disease and chronic pain. Asthma, persistent smoking and lower education/SES were associated with an increased risk of chronic cough. Longitudinal associations between other factors frequently mentioned empirically (i.e., occupational exposures, air pollution and chronic respiratory conditions) need further investigation, ideally with objective and standardized measurement.

Impact of smoking cessation on depression after acute coronary syndrome

Abstract Background Smoking and depression are two risk factors for acute coronary syndrome (ACS) that often go hand-in-hand, as smokers are more likely to be depressed and people that are depressed are more likely to be smokers. Smoking cessation in depressed patients with ACS may worsen depressive symptoms, which could increase the risk of recurrence of cardiac events and decrease adherence to other cardiac risk-reducing lifestyle changes. Purpose We aimed to investigate the evolution of depression according to smoking cessation one-year after ACS. Furthermore, we investigated if there was a higher incidence of one-year depression among ACS smokers who quit in comparison to continuous smokers. Method Data from 1,822 patients with ACS of the Swiss multicenter SPUM-ACS cohort study were analysed over a one-year follow-up period. Participants were classified in three groups based on smoking status one-year post-ACS – continuous smokers, smokers who quit within the year post-ACS, and non-smokers. Depression status at baseline and at one-year after the index ACS event was assessed with the Center for Epidemiologic Studies Depression scale (CES-D) and antidepressant drug use. A multivariate adjusted logistic regression model was used to calculate the risk ratio (RR) between groups. Results In comparison to depressed smokers who continued to smoke one year post-ACS, depressed smokers who quit smoking had an adjusted RR of 2.02 (95% CI 1.04–3.92) of improving their depression. Among 543 non-depressed ACS smokers, new depression at one-year was found in 57/266 (21.4%) smokers who quit, and 68/277 (24.6%) continuous smokers, with an adjusted RR of 0.89 (95% CI 0.58–1.36) of incidence of new depression. Conclusion Smokers with depression at the time of ACS who quit smoking improved more frequently their depression compared to those who continued smoking. Although not statistically significant, there was a smaller incidence of new depression among smokers who quit after ACS in comparison to continuous smokers. Funding Acknowledgement Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Swiss National Science Foundation

Late outcomes of percutaneous coronary interventions (PCI) and subsequent life-quality in patients younger 40 years of age

BackgroundLate results of PCI in patients aged ≤40 years are few presented without differentiation of groups with acute coronary syndrome (ACS) vs. Stable Angina, and age borderlines≤35 years vs. 36–40 years. Health-life quality following PCI in patients ≤40 years of age not studied.ObjectiveTo analyze predictors of outcomes, and subsequent life-style in patients aged ≤35 vs. 36–40 years underwent PCI according to ACS vs. Stable Angina.MaterialEnrolled 208 consecutive patients with coronary artery disease aged 24–40 years, of them 157 (75.5%) – aged 36–40 years, 51 (24.5%) – ≤35 years. 197 (94.7%) patients underwent revascularization of the myocardium, of them: 165 (79.3%) patients underwent PCI; 32 (15.4%) – CABG. 11 (5.3%) patients abandoned revascularization. Late results of PCI, and subsequent health-life quality studied in 126 (76,4%) of 165 patients on 10–108 months (mean 62,5±2,6).Results84 (50.9%) patients underwent PCI according to ACS; 81 (49.1%) – Stable Angina, without any complications. In-hospital, and 30-days mortality 0%.Actuarial survival on 9 years comprised 99,2%; cardiac mortality – 0,8%; events-free survival on 1–2–3 years comprised 90,5–84,1%-81,7%; on 5–9 years – 79,4%.Active lifestyle verified in 74,6% patients; sparing lifestyle – in 25,4%; return to work – in 86,5% patients. 88,1% examined preserved family; transitory sexual disorders revealed in 28,6% patients. Regular medication, and dietary regimen followed by 83,3% & 27,8% patients. Continue smoking & abuse energetic drinks 34,1% & 23,8% examined; overweight and obesity persisted in 23,8% & 19% examined patients. 23% patients fall in depression tied with re-MI/ angina; 18,3% – with quarantine (COVID-19); 6,3% examined suffered “panic attack” waiting recurrence of angina. Re-MI/angina revealed in 23% patients; 20,6% examined underwent re-PCI.ConclusionPredictors of poor outcomes were: 1) ACS; 2) age in time of PCI ≤35 years; 3) early MI, DM, LVEF ≤35–40%; 4) used stents diameter<28mm.; 5) continued smoking, and abuse of energetic drinks.Leading independent predictor – aggressively current atherosclerosis & DM in individuals ≤40 years of age leading to rapid dysfunction of stents; in patients with patency stents – lesion of native or “protected” coronary arteries.FUNDunding AcknowledgementType of funding sources: None.

Efficacy and safety of e-cigarette use for smoking cessation: a systematic review and meta-analysis of randomized controlled trials

Abstract Background Quitting smoking substantially reduces the risk of developing cardiovascular disease. Smokers are increasingly turning to electronic cigarettes (e-cigarettes) to help them quit smoking combustible cigarettes. However, the efficacy and safety of e-cigarettes for smoking cessation remain controversial. Purpose To examine the efficacy and safety of e-cigarette use for smoking cessation. Methods We conducted a systematic review and meta-analysis of randomized controlled trials (RCTs) comparing nicotine and non-nicotine e-cigarettes (alone, or in combination with behavioural and/or pharmacological interventions) to conventional smoking cessation therapies (pharmacological, behavioural, or both). We systematically searched MEDLINE, Embase, and the Cochrane Libraries. Inclusion was restricted to RCTs that reported biochemically validated abstinence at six months or greater. The primary comparison was nicotine e-cigarettes versus any (non-e-cigarette) conventional smoking cessation therapy. Count data were pooled using DerSimonian and Laird random-effects models with inverse variance weighting to obtain relative risks (RRs) and 95% confidence intervals (CIs). Results A total of six RCTs (n=3,401) were included, with maximum follow-up durations ranging from six to 12 months. Compared with conventional smoking cessation therapies, point estimates favoured nicotine e-cigarettes for the most rigorous criterion of abstinence, continuous abstinence, and point prevalence abstinence, although findings were inconclusive due to wide 95% CIs (Table 1). Similar trends were observed when comparing non-nicotine e-cigarettes to traditional smoking cessation therapies. Compared with non-nicotine e-cigarettes, nicotine e-cigarettes increased abstinence as defined by the most rigorous criterion. Although there was a signal suggesting a potential increased risk of respiratory adverse events with nicotine e-cigarettes versus traditional therapies, the 95% CI is wide. Conclusion E-cigarettes appear to be more efficacious than conventional nicotine pharmacotherapies and behavioural smoking cessation therapies. Although currently available safety data are inconclusive, e-cigarettes may be considered for smoking cessation given the established long-term health consequences of continued smoking. Funding Acknowledgement Type of funding sources: Public Institution(s). Main funding source(s): Mr. Levett is supported by an Ivan Racheff Scholarship, funded through the McGill University Faculty of Medicine and Health Sciences Research Bursary Program. Dr. Filion is supported by a Senior Research Scholar award from the Fonds de recherche du Québec – Santé and a William Dawson Scholar award from McGill University.

Combined Associations of Changes in Noncombustible Nicotine or Tobacco Product and Combustible Cigarette Use Habits With Subsequent Short-Term Cardiovascular Disease Risk Among South Korean Men: A Nationwide Cohort Study.

The associations of changes in noncombustible nicotine or tobacco product (NNTP) and combustible cigarette (CC) use habits with subsequent cardiovascular disease (CVD) risk are still unclear. The study population consisted of 5 159 538 adult men who underwent health screening examinations during both the first (2014-2015) and second (2018) health screening periods from the Korean National Health Insurance Service database. All participants were divided into continual CC-only smokers, CC and NNTP users, recent (<5 years) CC quitters without NNTP use, recent CC quitters with NNTP use, long-term (≥5 years) CC quitters without NNTP use, long-term CC quitters with NNTP use, and never smokers. Propensity score matching analysis was conducted to further compare CVD risk among CC quitters according to NNTP use. Starting from the second health screening date, participants were followed up until the date of CVD event, death, or December 31, 2019, whichever came earliest. Multivariable Cox proportional hazards regression was used to determine the adjusted hazard ratios (aHRs) and 95% CIs for CVD risk according to changes in NNTP and CC smoking habits. Compared with continual CC-only smokers, CC and NNTP users (aHR, 0.83 [95% CI, 0.79-0.88]) and initial CC smokers who quit CCs and switched to NNTP use only (recent CC quitters with NNTP use, aHR, 0.81 [95% CI, 0.78-0.84]) had lower risk for CVD. After propensity score matching, recent CC quitters with NNTP use (aHR, 1.31 [95% CI, 1.01-1.70]) had higher risk for CVD than recent CC quitters without NNTP use. Similarly, compared with long-term CC quitters without NNTP use, long-term CC quitters with NNTP use (aHR, 1.70 [95% CI, 1.07-2.72]) had higher CVD risk. Switching to NNTP use among initial CC smokers was associated with lower CVD risk than continued CC smoking. On CC cessation, NNTP use was associated with higher CVD risk than CC quitting without NNTPs. Compared with CC smokers who quit without NNTP use, CC quitters who use NNTPs may be at higher future CVD risk.

Smoking cessation after acute coronary syndrome: A systematic review and meta-analysis.

Smoking cessation is an effective secondary prevention measure after acute coronary syndrome (ACS). We conducted a systematic review with the aim to better understand which patients have a greater propensity to quit smoking and the risk factors for continued smoking after ACS. We searched MEDLINE and EMBASE for studies that evaluated smoking cessation after ACS. The pooled rate of smoking cessation across included studies was performed. Random effects meta-analysis for different variables and their association with smoking cessation was conducted. A total of 39 studies with 11228 patients were included in this review. The pooled rate of smoking cessation following ACS across 38 studies was 45.0%. Factors associated with greater likelihood of smoking cessation were attendance at cardiac rehabilitation (OR 1.90 95% CI 1.44-2.51), married/not alone (OR 1.68 95% CI 1.32-2.13), intention/attempt to quit smoking (OR 1.27 95% CI 1.11-1.46), diabetes mellitus (OR 1.24 95% CI 1.03-1.51) and hospitalised duration (OR 1.09 95% CI 1.02-1.15). Variables associated with a lower likelihood of smoking cessation were depression (OR 0.57 95% CI 0.43-0.75), chronic obstructive pulmonary disease/lung disease (OR 0.73 95% CI 0.57-0.93), previous admission with acute myocardial infarction/cardiac admission (OR 0.61 95% CI 0.47-0.80), cerebrovascular disease/transient ischaemic attack (OR 0.42 95% CI 0.30-0.58) and unemployment (OR 0.37 95% CI 0.17-0.80). The majority of smokers with an ACS continue to smoke after admission. Patients attending cardiac rehabilitation show increased odds of quitting while people who are depressed and those with chronic lung disease were less likely to quit smoking and should be targeted for intensive smoking cessation interventions.

Smoking, Vaping, While Breastfeeding in the Era of COVID-19

Breastfeeding MedicineAhead of Print EditorialFree AccessSmoking, Vaping, While Breastfeeding in the Era of COVID-19Arthur I. EidelmanArthur I. Eidelman—Arthur I. Eidelman, MD, FABM, Editor in Chief, Breastfeeding Medicine Search for more papers by this authorPublished Online:28 Sep 2021https://doi.org/10.1089/bfm.2021.29192.aieAboutSectionsPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack Citations Back To Publication ShareShare onFacebookTwitterLinked InRedditEmail This month's issue of Breastfeeding Medicine includes a most balanced summary by our regular esteemed contributor Phil Anderson regarding the dilemma of proscribing smoking cessation/reduction products to breastfeeding mothers. Estimates as to maternal postpartum smoking prevalence vary, but surveys of high-income countries report a rate of ∼10%.1 These levels do not include data from recent reports regarding the additional exposure to nicotine that results from the increased prevalence of >7% of e-cigarette use (vaping), particularly by teenagers and young adults.2 Unfortunately, specific data as to prevalence in nursing mothers are, to date, lacking.Smoking by breastfeeding mothers has been associated with reduced volume of breast milk, earlier weaning, and an increased risk for sudden infant death syndrome.3 Tobacco smoking itself has a negative effect on the macrocomposition of the milk as it decreases lipids, protein, and caloric content. In addition, smoking results in decreased antioxidant property of human milk. These negative effects have been attributed primarily to the pharmacologic effect of nicotine, but also to the effect of other toxic substances such as tar, lead, and cadmium. As such, use of e-cigarettes that results in less exposure of the mother to these toxic substances might well be preferable. Unfortunately data as to such a therapeutic trial are unavailable. However, one should note the recent disturbing report from McBride4 that noted an association of e-cigarette use during pregnancy and a decreased frequency of breastfeeding postpartum.In these days of the COVID-19 pandemic, the inevitable question is does smoking increase the risk of severe disease in those infected with the virus. Given the fact that smoking is an established risk factor for a myriad of pulmonary diseases, one would expect a clear-cut association with COVID-19 severity. Surprisingly, to date the population epidemiological surveys are inconclusive, with reports such as that of Karanasos5 who reported that smoking was associated with higher odds of severe disease, whereas another meta-analysis by Farsalinos,6 using a different methodology reported that in patients who were smokers, there was no increased risk for COVID-19 severe disease and or mortality.This seeming counter-intuitive finding may be supported by our understanding more fully the function of the nicotinic acetyl choline receptors who when stimulated (by nicotine) facilitate a pathway that modulates the activity of the immune system. Thus, it is postulated that exposure to nicotine (paradoxically) minimizes an uncontrolled immune response that is triggered by the COVID-19 virus, a response that may well be a major factor (mechanism) in inducing a severe morbidity/mortality outcome.These preliminary data surely do not legitimate the use of nicotine as a therapeutic modality in the treatment of COVID-19. In fact as Anderson details, the primary goal in the situation where a breastfeeding mother is also a smoker should be to maximize the continued and well-documented benefits of exclusive breastfeeding while minimizing the infant's exposure to the combined toxicity of smoking as much as possible. Thus, as he recommends the absolute goal should be to have the mother stop smoking and provide cautiously and judiciously an alternative less toxic source of nicotine such as patches and e-cigarettes for the mother to proceed with a weaning process. It is clear that no smoking cessation therapy appears to be ideal for nursing mothers as the various drugs have a theoretical potential toxicity for the breastfed infant or they have not been adequately studied for efficacy. But as Anderson so simply puts it, smoking cessation products are preferable to continued smoking during breastfeeding. Surely in these days of COVID-19.

Reference standards for facial measurements in early third trimester South African fetuses, and the effect of maternal and fetal characteristics

abstract Fetal alcohol spectrum disorder (FASD) is a major problem worldwide and dysmorphic facial features may be a prenatal biomarker for FASD. Deviations from normal facial development cannot be explored before establishing the normal variation in a specific population, since ethnic differences may exist. Objectives: Main objective: to establish reference standards for 23 facial measurements on 3D ultrasound volumes obtained between days 196 and 224 of gestation in healthy unexposed South African fetuses from an area with historically high alcohol consumption prevalence and a population group with no existing normative values. Secondary objective: to assess the confounding effect of maternal and fetal characteristics. Design: This study involves 97 women (including 43 smokers) who had been enrolled in the Safe Passage Study (SPS), a large prospective multinational cohort study assessing the effects of prenatal alcohol exposure. They had adequate 3 D ultrasound volumes of the fetal face acquired at 28+0–31+6 weeks in singleton pregnancies without comorbidities, congenital abnormalities or exposure to alcohol, marijuana, or methamphetamines from 4 weeks before conception. Participants, materials, setting, methods: The participants were recruited from two residential areas of low socioeconomic status in Cape Town. Meticulous information was collected on maternal and pregnancy characteristics, including alcohol use at different time points. Gestational age (GA) was based on ultrasound biometry before 24 weeks, and 3D ultrasound volumes were acquired trans-abdominally from a sagittal and axial plane of the fetal face. Volumes were independently assessed offline by two observers and the image with the best landmark definition was used for 23 facial measurements, representing features previously described in children with FASD. The relation to the exact GA was assessed by regression analysis, the expected mean value and standard error of the estimate (SEE) was determined to transform all raw measurements into z-scores, and the effect of possible confounders on z-scores was assessed by ANOVA. Results: Ten variables changed significantly with advancing GA (extraocular diameter, anteroposterior, medio-lateral and supero-inferior ocular diameter, ocular volume, interlens distance, prenasal thickness, nasal bone length, nose length and nose protrusion) and thirteen did not (interocular distance; interocular: extraocular diameter ratio, prenasal thickness: nasal bone length ratio, pronasal-subnasal distance, subnasal-mouth distance, philtrum length, upper vermillion thickness, nose-philtrum angle, maxillary angle, facial height, facial protrusion, frontomaxillary facial angle and maxilla-nasion-mandible angle). Reference values (expected mean and SEE) for the 23 measurements were established for each day. The z-scores of all facial measurements were not independently affected by maternal age, parity, gravidity, smoking or body mass index, but infant sex and birthweight z-score significantly influenced several z-scores (infant sex for extraocular, medio-lateral, and supero-inferior ocular diameter, ocular volume, prenasal thickness and nose protrusion; birthweight z-score for extraocular diameter, interocular and interlens distance, nose protrusion and maxillary angle). Limitations: GA was not always confirmed by first trimester ultrasound and some measurements could not be obtained in all cases due to suboptimal image quality. The cohort included few heavy smokers so an effect of heavy or continued smoking cannot be ruled out, and the effect of ethnicity was not assessed. Conclusions: These are the first local reference standards for fetal facial measurements and, to our knowledge, the first reference standards for the supero-inferior ocular diameter, face protrusion, upper vermillion thickness, maxillary angle, and nose-philtrum angle. They were broadly in keeping with published references, with small discrepancies explained by minor differences in technique. Even in this narrow GA window, the distribution of many variables changed over time and normal variation was significantly influenced by fetal sex and birthweight z-score. The possible confounding effect of these factors needs to be considered when assessing the impact of harmful exposures like alcohol on facial development.

Factors Influencing Smoking Decisions Among Older Korean American Men: A Qualitative Study.

Cigarette smoking is highly prevalent among Korean American men. Although the nationwide anti-smoking efforts and American individualism-oriented cultural system seem to help some Korean American men stop smoking, many of them still smoke. Thus, it is necessary to understand factors influencing decisions to continue smoking or stop smoking among older Korean American men. We recruited a convenience sample of 24 Korean American men (12 current smokers, 12 former smokers) who were aged 55-79 years to participate in this qualitative study. Five focus groups and nine individual interviews were conducted. Thematic content analysis was used to analyze the qualitative data. Participants were older (mean age = 69 years) and have lived in the United States an average of 26 years. Average duration of smoking was 41 years among current smokers and 31 years among former smokers. Key themes influencing continuous smoking include stress relief, fear of side effects, difficulty stopping, smoking peers, and misbeliefs about lung cancer and smoking, whereas key themes for decisions to stop smoking include present health issues, family/physician/media recommendation, and smoking-restricted environments. This study reinforces the importance of culturally and age-relevant smoking cessation programs targeting smokers and their families. Future quantitative studies in different geographic areas can validate the study findings.

Oncology Patient Smoking Cessation Treatment Preferences: Perceptions Across Former and Current Cigarette Smokers.

Although the benefits of smoking cessation following a cancer diagnosis have been well-established, up to 50% of cancer patients continue to smoke. Continued smoking through oncology treatment leads to increased risk of adverse events including reduced effectiveness of treatment, recurrence of additional malignancies, and reduced survival rates. Upon the cancer diagnosis, oncology healthcare providers become the primary trusted source of information and support, which represents a great opportunity to assist these patients to quit smoking. However, it remains unclear how oncology healthcare providers can best address smoking cessation from a patient-centered perspective. The present study surveyed oncology patients from Birmingham, AL, classified as either former (n = 174) or current smokers (n = 81) to identify their perceptions regarding the role of oncology healthcare providers in their smoking cessation efforts. Current smokers were more likely to be younger, received their cancer diagnosis within the past 3years, and have a cancer diagnosis with high smoking-related public awareness (i.e., head, neck, or lung) compared to former smokers. Additionally, 81% of current smokers reported experiencing smoking cessation discussions with their oncology healthcare providers with the most prominent recommendations being use of nicotine replacement therapies (46.9%) and medication (35.8%). These smoking cessation experiences align with patient preferences. However, despite the frequency of smoking cessation discussions, current smokers demonstrated an ambivalence in understanding the risks of continued smoking during their medical treatment. Overall, this study highlights the important role of oncology healthcare providers on implementing smoking cessation intervention for their patients who continue to smoke.

1388Risk factors for chronic cough in adults: A systematic review and meta-analysis

Abstract Background Despite the challenges of diagnosing and managing adult patients with chronic cough, a systematic synthesis of evidence on aetiological risk factor is lacking. Methods We systematically searched PUBMED and EMBASE to synthesize the current evidence for longitudinal associations between various risk factors and chronic cough in the general adult population, following the meta-analysis of observation studies in epidemiology (MOOSE) guidelines. The Newcastle-Ottawa scale was used to assess the quality of the included studies. Fixed-effect meta-analysis was conducted where appropriate. Results Of 26 eligible articles, 16 domains of risk factors were assessed. There was consistent evidence that asthma (pooled adjusted OR (aOR) = 3.01; 95%CI: 2.33-3.70; I2=0%, number of articles (N)=3) and low education levels/socioeconomic status (SES) (pooled aOR=1.46; 95%CI: 1.20-1.72; I2=0%; N = 3) were associated with an increased risk of chronic cough after adjusting for smoking and other confounders. While continuous smoking was associated chronic cough (aOR =1.81; 95%CI: 1.36,2.26; I2=57%; N = 3), there was too little evidence to draw conclusions for occupational exposures, outdoor air pollution, early-life exposures, diet, snoring and other chronic conditions. Conclusions Asthma, persistent smoking and lower education/SES were associated with increased risk of chronic cough. Longitudinal associations between other factors frequently mentioned empirically need further investigation. Key messages Our systematic review found asthma, smoking and lower education to be associated with adult chronic cough. More longitudinal studies are needed to understand other potential risk factors for adult chronic cough.

662Factors associated with smoking continuation and indoor smoking among pregnant women’s partners

Abstract Background Secondhand smoke by partners is a major source of exposure for non-smoking women. However, factors associated with smoking continuation and indoor smoking among pregnant women’s partners remain unknown. Methods We used data from 6348 partners of non-smoking pregnant women who participated in the Tohoku Medical Megabank Project Birth and Three-Generation Cohort Study in Japan from 2013 to 2017. Partners’ age, educational attainment, equivalent household income, and pregnant women’s smoking history (never, quitting before pregnancy awareness, quitting after pregnancy awareness) were used as explanatory variables. Multivariate logistic regression analyses were conducted to examine the associations between these variables and smoking continuation/indoor smoking of partners. Results Among 6348 partners, 2506 partners had been smokers at pregnancy awareness. Among them, the prevalence of smoking continuation after pregnancy awareness was 92.0%. Partners whose wives had quitted smoking after pregnancy awareness were less likely to continue smoking than partners whose wives had never smoked; the odds ratio was 0.57 (95% confidence interval, 0.41–0.80). Among partners who continued smoking, the prevalence of indoor smoking was 30.7%. Partners with ≤high school education were more likely to smoke indoors than partners with ≥university education; the odds ratio was 1.60 (95% confidence interval, 1.23–2.07). Conclusions Women’s smoking cessation after pregnancy awareness was associated with decreased risk of partners’ smoking continuation, and lower level of partners’ education was associated with increased risk of partners’ indoor smoking. Key messages Interventions for both women and their partners may be effective in reducing secondhand smoke exposure during pregnancy.

778Risk of 27 cancer types in relation to tobacco smoking: cohort study involving 229,028 Australians

Abstract Background Tobacco smoke is a known carcinogen and the magnitude of smoking-related cancer risk varies according to time and population. Local, contemporary evidence can drive appropriate tobacco control. We provide comprehensive cancer risk estimates related to smoking in the population-based, New South Wales (NSW) 45 and Up Study. Methods We estimated smoking-related hazard ratios (HR) for cancer using Cox proportional hazards regression using linked questionnaire (2006-2009) and incident cancer data (n ≥ 50 cases per cancer type), from the NSW Cancer Registry (to December 2013) (via CHeReL). Results Of 18,475 cancers among 229,028 participants aged ≥45 years, current smokers had significantly increased risks of cancers of the lung, larynx, head and neck, oesophagus, liver, bladder, pancreas, stomach, colorectum, and cancers with unknown primary site, compared to never-smokers; lung cancer risk was markedly elevated, including for current-smokers of 1-5 cigarettes/day (HR = 9.25, 95%CI=5.2-16.6), increasing to 38.39 (26.2-56.2) for current-smokers of &amp;gt; 30 cigarettes/day. Quitting substantively decreased cancer risk compared to continued smoking, with lung cancer risk decreasing with decreasing age at quitting (p(trend)&amp;lt;0.05), however risks remained elevated for those quitting aged &amp;gt;25 compared to never-smokers (1.73, 1.1-2.6 for age 26-30 years). An estimated 20% of current-smokers in Australia will get lung cancer during their lifetime versus 1.6% of never-smokers. Conclusions Smoking-attributable cancer risks in Australia are significant, comparable to contemporary risks from other developed nations. Key messages Smokers – including “light” smokers – are at high cancer risk, with ∼one-fifth of Australian lifetime smokers developing lung cancer. Quitting is beneficial. Continued investment in tobacco control is essential.

Efficacy of smoking cessation intervention delivered through mobile tele-counseling among smokers with tuberculosis in a Revised National Tuberculosis Control Program

BackgroundIndia has high burden of tuberculosis and smokers. Prevalence of tuberculosis is three times higher in smokers than non-smokers. Active smoking causes severe disease, delay in seeking treatment, lost to treatment follow up, delayed sputum conversion and drug resistance. WHO advocates mobile phone technology to improve health outcomes (mHealth). We used mobile tele-counseling as a smoking cessation intervention in smokers with tuberculosis (TB) receiving treatment under tuberculosis control program. AimTo determine smoking quit rate at six months of TB treatment among smokers receiving mobile tele-counseling versus brief advice and to estimate smoking quit rates and relapse rates during the tele-counseling period. MethodsOpen label randomized controlled trial. Newly detected pulmonary tuberculosis or pleural effusion patients received brief advice on smoking cessation as per The UNION's guiding framework. Subjects were then randomly allocated to intervention or control group. Intervention group was contacted telephonically at 2,3,4,5 and 6 months to assess smoking quit rates and provide continued smoking cessation advice. ResultsIntervention group had 80 and 82 in the control group, mean (SD) age was 40.6(12.6), 43.5(12.7) p = 0.53. Quit rate at six months was 54 (67.5%) in intervention group versus 34 (42%) in control group; RR 1.60 (95% CI 1.19, 2.16) p = 0.001. Trend in smoking quit rates in intervention group was 81.3%, 61.3%, 55%, 73.8% at 2,3,4 and 5 months respectively. Smoking relapse rate was 43.1%, 53.1%, 20.5%,15.3% at 3,4,5 and 6 months respectively. 27.5%, 43.8% were abstinent for last three, two months. ConclusionsMobile tele-counseling is an effective strategy for smoking cessation among TB patients.

Modern Perioperative Practices May Mitigate Effects of Continued Smoking Among Lung Cancer Patients

BackgroundAlthough smokers are at an increased risk for postoperative pulmonary complications after thoracic surgery, the relationship between cessation timing and postoperative pulmonary complications has not been explored in an era of enhanced recovery protocols and active tobacco cessation programs. Because a strong preference exists among thoracic surgeons to delay surgery to continued smokers, we sought to evaluate this relationship in a modern era. MethodsPatients undergoing lung resection for a diagnosis of non-small cell lung cancer from 2012 to 2017 were identified. Multivariable logistic regression was used to evaluate preoperative tobacco cessation timing to determine the impact on postoperative pulmonary complications. ResultsIn all, 1038 ever smokers were identified. Patients were current smokers in 30 (3%) instances, and among former smokers, the preoperative cessation interval was 0 to 14 days in 10% (104), more than 14 days to 1 month in 6% (62), more than 1 month to 1 year in 18% (189), more than 1 to 5 years in 10% (107), and more than 5 years in 53% (546). Pulmonary complications occurred in 269 patients (26%). Multivariable analysis revealed that no group of recent or long-term quitters had superior outcomes in terms of pulmonary complications when evaluating various periods of abstinence in comparison with continued smokers and active quitters. ConclusionsIn an era of enhanced recovery protocols, minimally invasive surgery, and active tobacco cessation programs that may help patients to cut back, our data do not support the practice of delaying or denying surgery to patients who have difficulty quitting completely. Perioperative cessation counseling should be aimed at long-term benefits, including reduction of disease recurrence and secondary malignancies.

The State of the Science on Cancer Diagnosis as a "Teachable Moment" for Smoking Cessation: A Scoping Review.

Theoretically, a cancer diagnosis has the potential to spur health behavior changes in physical activity, diet, substance use, medication adherence, and the like. The Teachable Moment heuristic is a parsimonious, transtheoretical framework for understanding the conditions under which behavior change might occur, with constructs that include affective, cognitive, and social factors. Application of the Teachable Moment to smoking cessation after cancer diagnosis might aid selection of predictors in observational studies and inform how to optimally design interventions to promote quit attempts and sustain abstinence, as many smoking cessation interventions for cancer survivors do not yield positive outcomes. This scoping review of 47 studies that span nearly 20 years of literature examines the measurement of the Teachable Moment constructs and what empirical support they have in explaining cancer survivors' smoking behavior. From this review, it appears the construct of affective response is more widely explored than risk perceptions, social role, and self-concept. Strong, negative affective responses (e.g., anxiety, general distress) may be a powerful contributor to continued smoking after a cancer diagnosis. Risk perceptions may also play a role in smoking behavior, such that never and former smokers espouse stronger perceptions of smoking-related risks than current smokers. Finally, due to a paucity of studies, the role of cancer survivors' self-concept (e.g., identity as a "cancer survivor") and changes in their social role (e.g., employee, athlete) are unclear contributors to their smoking behavior. In summary, the Teachable Moment holds promise in its application to smoking cessation after a cancer diagnosis, though more direct research is needed. This scoping review of the scientific literature is the first formal test of the extent to which cancer diagnosis has been explored as a "teachable moment" for smoking cessation, with results that provide insight into issues of measurement precision and breadth as well as empirical support of the "teachable moment" heuristic.