Current Tobacco Research Articles

Initial impacts of the COVID-19 pandemic on tobacco use among college students in California

Objective: To evaluate the change in tobacco use by college students in California during the COVID-19 pandemic. Participants: Young adults (18–24 years) currently enrolled in a California college or university (N = 212). Methods: Students recruited through social media posts and by student tobacco advocate members completed an online survey of 59 questions in Spring 2021. Results: Almost 80% of current tobacco users reported a change in tobacco use during the pandemic. Most current tobacco users who changed their tobacco use reported an increase in use during the pandemic (43.2%) and 38.7% reported a decrease in use. Conclusion: As a result of COVID-19, many college students changed their tobacco use. As students return to campus and COVID-19 regulations are lifted, this may be an ideal time for prevention and cessation messages, which could include information on health risks associated with tobacco and e-cigarette use, and healthy methods for stress reduction.

Changes in Tobacco Dependence and Association With Onset and Progression of Use by Product Type From Waves 1 to 3 of the Population Assessment of Tobacco and Health (PATH) Study.

This study examined trajectories of tobacco dependence (TD) in relationship to changes in tobacco product use, and explored the effects of product-specific adding, switching, or discontinued use on dependence over time. Data were analyzed from the first three waves from the Population Assessment of Tobacco and Health (PATH) Study, a nationally representative, longitudinal study of adults and youth in the United States. Data included 9556 wave 1 (2013-2014) adult current established tobacco users aged 18 or older who completed all three interviews and had established use at ≥2 assessments. Mutually exclusive groups included: users of cigarettes only, e-cigarettes only, cigars only, hookah only, any smokeless only, cigarette + e-cigarette dual users, and other multiple product users. A validated 16-item scale assessed TD across product users. People who used e-cigarettes exclusively at wave 1 had small increases in TD through wave 3. Wave 1 multiple product users' TD decreased across waves. TD for all other wave 1 user groups remained about the same. For wave 1 cigarette only smokers, switching to another product was associated with lower levels of TD than smokers whose use stayed the same. Movement to no established use of any tobacco product was consistently associated with lower TD for all product users. Except for wave 1 e-cigarette only users (who experienced small increases in TD), TD among U.S. tobacco product users was stable over time, with daily users less likely to vary from baseline. The level of TD among most U.S. tobacco users was stable over the first three waves of the PATH Study and trends in levels of TD were predominantly unrelated to changes in patterns of continued product use. Stable levels of TD suggest a population at persistent risk of health impacts from tobacco. Wave 1 e-cigarette users experienced small increases in levels of TD over time, perhaps due to increases in quantity or frequency of their e-cigarette use or increasing efficiency of nicotine delivery over time.

Association of Neighborhood Socioeconomic Deprivation With Utilization and Costs of Anterior Cervical Discectomy and Fusion.

A retrospective analysis. The aim of our study was to analyze the association of Area Deprivation Index (ADI) with the utilization and costs of elective anterior cervical discectomy and fusion (ACDF) surgery. ADI, a comprehensive neighborhood-level measure of socioeconomic disadvantage, has been shown to be associated with worse perioperative outcomes in a variety of surgical settings. The Maryland Health Services Cost Review Commission Database was queried to identify patients who underwent primary elective ACDF between 2013 and 2020 in the state. Patients were stratified into tertiles by ADI, from least disadvantaged (ADI1) to most disadvantaged (ADI3). The primary endpoints were ACDF utilization rates per 100,000 adults and episode-of-care total costs. Univariable and multivariable regression analyses were performed. A total of 13,362 patients (4984 inpatient and 8378 outpatient) underwent primary ACDF during the study period. In our study, there were 2,401 (17.97%) patients residing in ADI1 neighborhoods (least deprived), 5974 (44.71%) in ADI2, and 4987 (37.32%) in ADI3 (most deprived). Factors associated with increased surgical utilization were increasing ADI, outpatient surgical setting, non-Hispanic ethnicity, current tobacco use, and diagnoses of obesity and gastroesophageal reflux disease. Factors associated with lower surgical utilization were: non-white race, rurality, Medicare/Medicaid insurance status, and diagnoses of cervical disk herniation or myelopathy. Factors associated with higher costs of care were increasing ADI, older age, Black/African American race, Medicare or Medicaid insurance, former tobacco use, and diagnoses of ischemic heart disease and cervical myelopathy. Factors associated with lower costs of care were outpatient surgical setting, female sex, and diagnoses of gastroesophageal reflux disease and cervical disk herniation. Neighborhood socioeconomic deprivation is associated with increased episode-of-care costs in patients undergoing ACDF surgery. Interestingly, we found greater utilization of ACDF surgery among patients with higher ADI. 3.

Purchase Intent and Product Appeal of Velo Nicotine Pouches Among Current Tobacco Users and Nonusers of Tobacco

Summary Background and objectives Oral nicotine pouches is a rapidly growing product category that potentially offers less risk than combustible tobacco products. Nicotine pouches may provide harm reduction for smokers because they contain no tobacco and have reduced harmful constituents compared to traditional tobacco product categories. Any potential public health benefit must weigh the likelihood that current tobacco users will switch to the lower-risk product against the likelihood that nonusers will start using tobacco products. To our knowledge, no existing studies provide population-level estimates of purchase intent or product appeal across tobacco user groups or how product characteristics might affect those variables. Methods This paper presents population-level estimates of purchase intent and product appeal for multiple Velo nicotine pouch products (including different flavors, nicotine strengths, format, and packaging) among five adult tobacco user groups (current established cigarette smokers, current established non-cigarette tobacco users, current tobacco experimenters, former tobacco users, and never ever tobacco users). Over 49,000 respondents were surveyed across twelve analytic samples. Results Results for the pooled sample as well as for each individual sample were remarkably consistent for every product. Ratings of purchase intent and appeal are higher for current tobacco users (current established cigarette smokers, current established non-cigarette tobacco users, and current tobacco experimenters) than for former and never ever tobacco users. Conclusions and scientific significance Variation in product characteristics had little or no effect on purchase intent or appeal ratings across tobacco user groups, suggesting that product characteristics do not materially affect public health.

Environmental Factors Influencing Tobacco Usage among High School Children in Lucknow City: A Cross-sectional Study

Background: Evidence proves that the majority of adult tobacco users begin using tobacco as children or teens. Teenagers are drawn to tobacco products for a variety of reasons. Public health planners are gravely concerned about the current rapid trade and tobacco use among teenagers in a developing nation like India. Objective: The present paper focuses on the prevalence of tobacco use among children in the eighth to tenth grades and the various environmental factors that contribute to tobacco use among children. Material and Methods: Following ethical clearance, six government schools in Lucknow were chosen for this cross-sectional study, and data was gathered using the Global Youth Tobacco Survey (GYTS) to examine the relationship between tobacco use in children and other independent influencing factors. Logistic regression analysis was used. Results: 21.7% of the children used tobacco in some or the other way. Supari with tobacco was the most popular tobacco product consumed by children (48.3%). Statistical analysis showed that family members consuming tobacco at home and adults sending their kid to get tobacco had a high connection with tobacco use among children. The direct relationship between children watching individuals consuming tobacco on television and their arousal of interest for the same was also seen. Similarly, the presence of tobacco vendors outside the school and easy availability of tobacco products to children significantly influenced the tobacco consumption habit. Conclusion: Tobacco users in families, adults sending children to buy tobacco, children’s arousal of interest on seeing people using tobacco on media, tobacco vendors outside the school, and the easy availability of tobacco products have all been proven to be environmental triggering factors for tobacco consumption amongst high school students.

Disparities in adherence to retesting guidelines in women with Trichomonas vaginalis infection

Trichomoniasis is the most prevalent nonviral sexually transmitted infection in the United States. Numerous studies have shown disproportionately higher prevalence rates in non-Hispanic Black women. Because of the high rates of reinfection, the Centers for Disease Control and Prevention recommends retesting women treated for trichomoniasis. Despite these national guidelines, there are few studies examining adherence to retesting recommendations for patients with trichomoniasis. Adherence to retesting guidelines has been shown in other infections to be an important determinant of racial disparities. This study aimed to describe Trichomonas vaginalis infection rates, evaluate adherence to retesting guidelines, and examine characteristics of women who were not retested according to the guidelines in an urban, diverse, hospital-based obstetrics and gynecology clinic population. We conducted a retrospective cohort study of patients from a single hospital-based obstetrics and gynecology clinic who were tested for Trichomonas vaginalis between January 1, 2015 and December 31, 2019. Descriptive statistics were used to examine guideline-concordant testing for reinfection among patients with trichomoniasis. Multivariable logistic regression was used to identify characteristics associated with testing positive and with appropriate retesting. Subgroup analyses were performed for patients who were pregnant and tested positive for Trichomonas vaginalis. Among the 8809 patients tested for Trichomonas vaginalis, 799 (9.1%) tested positive at least once during the study. Factors associated with trichomoniasis included identifying as non-Hispanic Black (adjusted odds ratio, 3.13; 95% confidence interval, 2.52-3.89), current or former tobacco smoking (adjusted odds ratio, 2.27; 95% confidence interval, 1.94-2.65), and single marital status (adjusted odds ratio, 1.96; 95% confidence interval, 1.51-2.56). Similar associated factors were found in the pregnant subgroup analysis. For women with trichomoniasis, guideline-concordant retesting rates were low across the entire population, with only 27% (214/799) of patients retested within the recommended time frame; 42% (82/194) of the pregnant subgroup underwent guideline-concordant retesting. Non-Hispanic Black women had significantly lower odds of undergoing guideline-recommended retesting than non-Hispanic White women (adjusted odds ratio, 0.54; 95% confidence interval, 0.31-0.92). Among patients tested according to guideline recommendations, we found a high rate of Trichomonas vaginalis positivity at retesting: 24% in the entire cohort (51/214) and 33% in the pregnant subgroup (27/82). Trichomonas vaginalis infection was identified at a high frequency in a diverse, urban hospital-based obstetrics and gynecology clinic population. Opportunities exist to improve on equitable and guideline-concordant retesting of patients with trichomoniasis.

Patterns and perceptions of nicotine use among U.S. adolescents and young adults receiving medication treatment for opioid use disorder

Nicotine use among U.S. youth is cause for concern, as previous studies have shown that nicotine use in adolescence increases the risk of developing substance use disorders later in life. This exploratory study aimed to understand patterns of nicotine use and perceptions of various nicotine products among adolescents and young adults (AYA) receiving medication treatment for opioid use disorder (MOUD). We administered an adapted version of the National Youth Tobacco Survey via REDCap to AYA (n = 32) receiving outpatient care in the Medication-Assisted Treatment of Addiction at Nationwide Children’s Hospital in Columbus, Ohio, U.S.A. Thirty (97%) participants had tried a combustible cigarette and 27 (90%) had tried an electronic cigarette. By age 13, nineteen (61%) participants had tried combustible cigarettes and eight (25%) had tried opioids. Twenty-two (71%) participants reported smoking combustible cigarettes every day for the past 30 days, and 15 (48%) reported smoking more than 10 cigarettes per day on average. Only ten (32%) participants reported e-cigarette use in the last 30 days. Participants universally agreed that tobacco products are dangerous, and twenty (67%) current tobacco users reported that they planned to quit in the next year. Nicotine use patterns among AYA receiving MOUD differ from that previously shown in the general population, primarily by high prevalence of nicotine use in early adolescence and high current combustible cigarette use. Interventions such as universal screening for nicotine use before age 13 and tailored smoking cessation programs for AYA with OUD may help optimize care for these individuals.

Tobacco consumption patterns among Iranian adults: a national and sub-national update from the STEPS survey 2021

Smoking is recognised as a critical public health priority due to its enormous health and economic consequences. Constant monitoring of the effectiveness of tobacco control programs calls for timely population-based data. This study reports the national and sub-national patterns in tobacco consumption among Iranian adults based on the results from the STEPwise approach to chronic disease risk factor surveillance (STEPS) survey 2021. This study was performed through an analysis of the results of the STEPS survey 2021 which had been conducted as a nationally representative cross-sectional study. Participants included Iranian adults aged ≥ 18 years in all provinces of Iran, who were selected via multistage cluster sampling method. Data were analyzed via survey analysis while considering population weights. The total number of participants was 27,874, including 15,395 (55.23%) women and 12,479 (44.77%) men. The all-ages prevalence of current tobacco smoking was 14.01% overall, 4.44% among women, and 25.88% among men. The all-ages prevalence of current cigarette smoking was 9.33% overall, 0.77% among women, and 19.95% among men. The all-ages prevalence of current hookah smoking was 4.5% overall, 3.64% among women, and 5.56% among men. The mean (SD) number of cigarettes smoked per day was 12.41 (10.27) overall, 7.65 (8.09) among women, and 12.64 (10.31) among men. The mean (SD) monthly times of hookah use was 0.42 (7.87) overall, 2.86 (23.46) among women, and 0.3 (6.2) among men. The national all-ages prevalence of second-hand smoking at home was 24.64% overall, 27.38% among women, and 20.26% among men. The national all-ages prevalence of second-hand smoking at work was 19.49% overall, 17.33% among women, and 22.94% among men. The tobacco consumption in Iran remains alarmingly high, indicating the current tobacco control policy implementation level is ineffective and insufficient. This calls for adopting, implementing, and enforcing comprehensive packages of evidence-based tobacco control policies.

1845-PUB: Key Lifestyle Behaviours among Diabetics, Prediabetics, and Nondiabetics in India

Purpose: To assess prevalence of key lifestyle behaviours including maintaining a body mass index (BMI) <25Kg/m2, engaging in physical activity for ≥150 min/week, consuming >5 servings of fruits & vegetables daily, & no tobacco use among diabetics, pre-diabetics, & nondiabetics. Methods: We conducted a large population-based survey among 12284 participants aged ≥30 years residing in rural and urban North and South India. Participants were selected using multistage cluster random sampling. Trained personnel collected data using a questionnaire, conducted anthropometry & collected bio-samples. Diabetes was defined as FPG ≥ 126 mg/dl or HbA1C ≥ 6.5% or self-reported physician diagnosis or being on treatment & prediabetes as FPG ≥ 100 mg/dl & <126 mg/dl or HbA1C ≥ 5.7% & <6.5%. Results: Age-standardized prevalence of diabetes was 17.4% (95% CI: 16.7-18.1) & prediabetes was 31.3% (30.7-31.9). Diabetics were more likely to be overweight/obese [BMI≥25Kg/m2: 60.7% (58.6-62.7)], & less physically active [physical activity (PA) <150 min/week: 30.6% (28.8-32.6), compared to pre-diabetics [BMI: 49.1% (47.5-50.7); PA: 22.3% (21.0-23.7)] & nondiabetics [BMI: 36.6% (35.4-37.8); PA: 22.2% (21.1-23.2)]. Mean (±SD) waist circumference (WC) was higher among diabetics [92.8 cm (±11.9)] compared to pre-diabetics [88.0 cm (±12.6)] & nondiabetics [83.7 cm (±12.5)] with more diabetics [65.4% (63.4-67.4)] having WC above World Health Organization’s recommended cut-off compared to pre-diabetics [54.2% (52.6-55.8) & nondiabetics [43.4% (42.4-44.6)]. Consumption of fruits & vegetables was low among all groups. Diabetics were less likely to be current tobacco users [21.7% (19.9-23.4)] compared to pre-diabetics [26.2% (24.8-27.7)] & nondiabetics [28.1% (27.0-29.2)]. Conclusions: Tailored clinic based, and population wide health promotion programs focussed on improving diet and physical activity are warranted to advance diabetes prevention and control in India. Disclosure S. Mohan: None. P. Jarhyan: None. D. Prabhakaran: None.

The Analysis of the Content of Tobacco Control Policymaking and Legislation in Iran and Providing Policy Solutions

Background. Tobacco use is the fifth risk factor for non-communicable diseases in Iran. This study aimed to analyze the policies and measures of tobacco control in Iran in the last four decades (1983-2021). Methods. The present study is a retrospective policy analysis that used a case study plan based on the Walt and Gilson triangle policy analysis framework to examine the content of tobacco control policies in Iran. Data were collected using tobacco use policies and legal documents and analyzed using documentary analysis. MAXQDA 11 software was used to categorize and analyze the findings. Results. The policies include setting prices and taxes on tobacco to reduce demand; protecting the public from second-hand smoke; controlling the composition of tobacco products; setting regulations on the disclosure of information about tobacco packaging and labeling; educating the public about the dangers of tobacco use; advertising, promotion, and financial support of tobacco; setting measures to encourage smoking cessation and reduce the demand and dependence on tobacco; banning illegal tobacco product trading; banning youngsters from tobacco trading; financially supporting the practical alternatives such as economic activities and research; setting monitoring and evaluation systems; and enhancing the exchange of information. Conclusion. Strengthening the government's tobacco control capacity and formulating a clear and coherent national tobacco control strategy and roadmap, including a mechanism for practical cross-sectoral cooperation between different actors, can reduce conflicts of interest between the actors involved and determine the country's current and future tobacco control policies.

Bridge connection between depression and anxiety symptoms and lifestyles in Chinese residents from a network perspective.

Lifestyle habits are vital components of the culture of mental health treatment settings. We examined the bridge connection between depressive and anxiety symptoms and lifestyles from a network perspective using a population-based study. Face-to-face interviews were conducted with a provincially representative sample of 13,768 inhabitants from the Guangdong Sleep and Psychosomatic Health Survey based on standardized evaluation techniques. We identified the central symptoms by expected influence. The interconnection between depression and anxiety symptoms, as well as the bridge connectivity linking depression-anxiety symptoms and lifestyle factors, were assessed using the bridge centrality index. Network stability and sensibility analyses were performed using a case-dropping bootstrap procedure. The core symptom that exhibited the highest expected influence was fatigue or little energy, followed by uncontrollable worry, trouble relaxing, and sad mood in the depression-anxiety symptoms network, while guilt was the most interconnected symptom and had the highest bridge strength. Surrounding nodes of each node explained an average variance of 57.63%. Additionally, suicidal thoughts were recognized as collective bridging symptoms connecting lifestyle variables in the network integrating depression-anxiety symptoms with lifestyle factors. Current tobacco and alcohol consumption were positively associated with suicidal thoughts and irritability. Habitual diet rhythm and physical exercise frequency were linked to suicidal thoughts, guilt, and poor appetite or overeating. Suicidal thoughts, irritability, and guilt indicated the greatest connectivity with lifestyle factors. All networks had high stability and accuracy. These highlighted core and bridge symptoms could serve as latent targets for the prevention and intervention of comorbid depression and anxiety. It might be crucial for clinical practitioners to design effective and targeted treatment and prevention strategies aiming at specific lifestyles and behaviors.

#4600 MPO AND PR3 DUAL POSITIVE ANCA AND ANA: A CASE REPORT

Abstract Background and Aims Anti-neutrophil cytoplasmic antibody (ANCA) vasculitis has been thought to be a relatively rare disease, although it has been increasing in incidence recently likely due to improved testing and recognition. One of two main antigens are targeted in this condition, either proteinase 3 (PR3) or myeloperoxidase (MPO). Uncommonly, both antigens can be targeted in specific situations such as during levisamole use, propylthiouracil use, hydralazine use or infections. Herein, we illustrate a case of a patient who presented with progressively worsening kidney function in the setting of recent COVID booster. Method A 79 year old female with a history of hypertension, hyperlipidemia, acid reflux and hypothyroidism was admitted to our facility from her outpatient nephrologist due to abnormal labs. This was the first time the patient had seen a nephrologist, although she was told that her serum creatinine (SCr) was elevated to ∼3 mg/dL three months earlier. At that time, she noted blood tinged urine as well as frothiness of urine that had since resolved. She also endorsed a raised erythematous rash that also resolved. She did mention that she had increasing fatigue over the past week prior to presentation along with weight loss over the past few months. She denied ear pain, sinus pain, epistaxis, hemoptysis or specific joint pain. She denied any kidney stones or NSAID use. She was a former smoker, having quit decades ago. She denied any current tobacco or illicit drug use, including cocaine as well as any herbal supplements or medications that were not otherwise prescribed to her by a medical provider. She did note recent COVID booster prior to being told of a SCr ∼3 mg/dL. She had a repeat kidney function test one month prior to presentation, at which time she was told her SCr was 5 mg/dL. In our Emergency Department, SCr was elevated to 8.45 mg/dL with a BUN of 68 mg/dL. Computed tomography of the abdomen and pelvis ruled out any hydronephrosis or kidney stones. Urinalysis was revealing for 509 RBCs, 39 WBCs, WBC casts as well as granular casts. Spot urine protein to creatinine ratio was found to be elevated at 6925 mg/g. Serologies were pertinent for a positive ANA as well as ANCA. Interestingly, both MPO and PR3 titres were elevated at 72 AU/mL and 391 AU/mL, respectively. Kidney biopsy was performed and revealed a pauci-immune glomerulonephritis with crescents along with mixed interstitial inflammatory infiltrate (Figure 1). The diagnosis of dual positive ANCA glomerulonephritis was made. Computed tomography of the chest revealed scattered ground glass opacities and subpleural nodules which was consistent with a vasculitis. She started treatment with Rituximab and steroids on Day 5 of hospitalization. Results Although evidence linking ANCA vasculitis to COVID infection and vaccine has been starting to develop, the association with dual positive ANCA is something that has been elusive. Having titres for both MPO and PR3 ANCA is uncommon and has traditionally been attributed to very few causes; as COVID infection and vaccination has been a fairly recent development, this has not historically been considered a cause to think of in such patients. In the case presentation above, our patient had no other identifiable risk factors for presenting with a dual positive ANCA vasculitis. She did endorse recent booster vaccination which was subsequently followed by elevated SCr and positive serologies. Conclusion Dual positive ANCA vasculitis is an uncommon finding and should trigger a high clinical suspicion for implicated drugs, infections as well as COVID vaccination.

ASSESSMENT OF MAJOR RISK FACTORS OF DIABETES MELLITUS AMONG DOCTORS IN URBAN AREA AT NORTH WEST RAJASTHAN

Objectives: To determine the prevalence of diabetes mellitus and its association with risk factors among the study population. Methods: This was a cross-sectional study including 297 doctors with the minimum qualification of MBBS/BDS, working in government health care facilities in urban Bikaner from December 2019 to May 2020 at the Department of Medicine, S.P. Medical College, Bikaner, Rajasthan. Results: The mean age of the study population was 42.58±9.21 years. We found that 10.78% were current smokers, 9.18% consumed ≥6 drinks/ occasion, 66% consumed <5 fruit servings/day, 75% consumed >5 g of salt/day, 49.84% were physically inactive, 46.47% were overweight and 6.73% were obese, 14.14% had a systolic BP ≥140 mmHg, and the prevalence of diabetes mellitus was 15.82%. Diabetes mellitus was associated with age group, gender, alcohol use, overweight and obesity, raised blood pressure, and raised total cholesterol (p<0.05). Conclusion: The prevalence of risk factors for lifestyle diseases was high among health professionals. In this study, a higher prevalence of diabetes mellitus was observed than the WHO estimated prevalence of DM for India. Modifiable associated risk factors were current tobacco use, current alcohol use, raised blood pressure, and raised total cholesterol.

Nicotine Pouch Awareness and Use Among Youth, National Youth Tobacco Survey, 2021.

This manuscript examines prevalence of awareness and use of nicotine pouches among U.S. middle and high school students by sociodemographic characteristics and other tobacco product use and characterizes nicotine pouch and other tobacco product use behaviors among current nicotine pouch users. Data are from the 2021 National Tobacco Youth Survey, a cross-sectional, school-based survey of middle and high school students (N = 20 413; overall response rate: 44.6%), which included questions on nicotine pouches in 2021 for the first time. Prevalence estimates, 95% confidence intervals, and estimated population counts were assessed for nicotine pouch awareness, ever use, and current (past 30 days) use, and for use behaviors related to nicotine pouches (frequency of use, flavor(s) used) and other tobacco products (ever, current, frequency of use) among current nicotine pouch users. Over one-third of students (35.5%) had ever heard of nicotine pouches. An estimated 1.9% (490 000) reported ever using them, while 0.8% (200 000) reported current use. Among current nicotine pouch users, 61.6% reported flavored nicotine pouch use, 64.2% reported current e-cigarette use, and 52.6% used multiple (≥2) tobacco products. Current use of nicotine pouches was common among current smokeless tobacco users (41.3%). Overall, in 2021, while relatively few students had ever tried nicotine pouches or currently used them, more than one-third had heard of them. Current nicotine pouch users tended to use other tobacco products, particularly e-cigarettes and smokeless tobacco. Given previous rapid increases in youth uptake of e-cigarettes, it is important to continue monitoring nicotine pouch use among young people. This study's findings provide an important baseline for future monitoring of nicotine pouch awareness and use among middle and high school students. Emerging tobacco products, particularly those that are flavored, widely available, discreet, and inexpensive have the potential to attract youth. Given the potential of these products to appeal to young people, ongoing monitoring of nicotine pouch use behaviors is important to inform public health and regulatory efforts.

Pyramid feature fusion through shifted window self-attention for tobacco leaf classification

Classification of tobacco leaves by stalk position and color is a necessary prerequisite for tobacco accurate pricing and subsequent fine blending. The similarity of color, contour, and texture features limits the classification accuracy of current tobacco recognition technology, which is focusing on either a local feature or global feature extraction. To improve the feature fusion ability, we propose a tobacco classification model FSWPNet based on pyramid feature fusion through shifted window self-attention. Firstly, owing to the large proportion of tobacco targets in the original image, it is difficult for the standard pooling module to make full use of the overall appearance feature information. The Serial Maximum Spatial Pyramid Pooling (SMSPP) module is designed to aggregate multi-scale leaf apex features by concatenating multiple maximum pooling layers consecutively. Subsequently, to fusion, both local and global tobacco features, the Shifted Window Transformer Bottleneck (STRB) module is integrated into the feature pyramid fusion architecture. In the window encoder, window self-attention focuses on the low-level semantic local features. While shifted window self-attention is capable of long-distance modeling. It can obtain macroscopic tobacco features such as color, contour, and texture through a cross-window connection. The tobacco classification needs to be combined with the comprehensive identification of multiple feature information. The Spatial and Channel Mixed Multi-Layer Perceptron (SCMix MLP) is used to blend intra-patch positional feature and inter-patch spatial feature information. Finally, aiming at the hard samples with similar features, FSWPNet adopted DIoU Non-Maximum Suppression (DIoU-NMS) strategy for calculating the minimum outer rectangular diagonal distance to eliminate redundant regression boxes with low scores. The FSWPNet model is deployed and tested on the tobacco grading equipment. The experimental results show that FSWPNet achieves the best performance in terms of average classification accuracy 75.8%, inference time 12 ms and model size 16.8 MB. The proposed FSWPNet model can effectively classify 10 categories of tobacco agricultural products, which provides an important theoretical basis and premise for acquisition and fine processing.

Impact of time period of diagnosis, race, and military exposures on the survival of US military veterans with multiple myeloma and/or plasmacytoma.

e20061 Background: The aging veteran population represents a unique demographic with potential exposures to carcinogens. Multiple myeloma has been linked to exposure to Agent Orange, burn pits, radiation, and water contamination. There have been remarkable advances in the management of multiple myeloma. We investigate whether the survival of veterans diagnosed with multiple myeloma and/or plasmacytoma has changed over time. Methods: Using ICD-O criteria we identified 14,026 veterans diagnosed with multiple myeloma and/or plasmacytoma between 1/1/2000 and 12/31/2020 in the national electronic Veterans Administration (VA) medical records. Variables including age and date of diagnosis, race, gender, branch of military service, tobacco use, military exposures, cause of death and survival were analyzed. Patients were subdivided into 4 time periods for analysis based on date of diagnosis: Group 1 (1/1/2000-12/31/2005), Group 2 (1/1/2006-12/31/2010), Group 3 (1/1/2011-12/31/2015), Group 4 (1/1/2016-12/31/2020). Results: Of the 14,026 cases, 98% of patients were male, 58% were white and 28% black; 57% were current or previous tobacco users, 26% were never users. The table summarizes military exposures and causes of death. Median overall survival (OS) for Group 1 was 0.9 years [95% CI, 0.8-1], Group 2 was 2 years [95% CI, 1.8-2.9], Group 3 was 2.8 years [95% CI, 2.6-2.9], and Group 4 was 3.5 years [95% CI, 3.3-3.6]. These differences in OS were statistically significant (p<0.0001). Deaths attributed to myeloma accounted for 67%, 65%, 63%, and 56% of patients in Group 1, 2, 3, and 4, respectively. On multivariable analysis of 6023 cases where selected variables were consistently available, tobacco use, exposure to Agent Orange or burn pits, older age and earlier time period of diagnosis were significantly associated with shorter survival. However, race did not significantly impact survival. Conclusions: In US military veterans diagnosed with multiple myeloma and/or plasmacytoma, survival has significantly improved over the past two decades. Survival was adversely impacted by tobacco use and military exposures, but not impacted by race. Advances in diagnosis, therapies and supportive care may have contributed to the observed improvement in survival over time. Future research should investigate if differences exist in the pathophysiology of malignancies developing in veterans with military exposures, and whether novel treatments can improve their outcomes. [Table: see text]

A multi-component educational intervention for oncologists to improve tobacco cessation treatment among patients with cancer who smoke.

e22500 Background: Oncologists are change agents to improve tobacco cessation among patients. As part of the National Cancer Institute Cancer Center Cessation Initiative, we established an electronic health record (EHR, Epic)-based "opt-out" approach to refer patients to tobacco treatment specialist without active involvement by oncologists. However, the role of oncologists in contributing to the “opt-out” approach to patients has not been explored. We tested the hypothesis that a multi-component educational program for oncologists would increase the proportion of patients who completed tobacco treatment appointments. Methods: As a quality improvement initiative, oncology providers at the Rochester Mayo Clinic Cancer Center were educated using a multimodal academic detailing approach with group and individual educational sessions. Its effectiveness was tested using a modified step-wedge implementation design. The primary outcomes were patient behaviors that could plausibly be changed by conversations with their provider: the rate at which cancer patients identified as current tobacco users scheduled an appointment in the Nicotine Dependence Center (NDC) (which required active patient involvement), and the rate at which patients scheduled for a NDC appointment completed their appointment. Comparisons were made before, during, and after the education period (from July through Dec 2019) and with a separate group of providers who did not complete education (results examined over a similar time period). Results: Education did not improve outcomes in providers who received education; indeed, the rate of appointment scheduling decreased, although this may reflect other concurrent changes in the referral process (Table). Outcomes were similar between providers who did and did not receive education. Conclusions: Tobacco cessation efforts should be routinely integrated into cancer care to improve outcomes. The “opt-out” program resulted in approximately 1 in 5 cancer patients being seen for tobacco use, but an academic detailing approach designed to equip oncology providers to encourage their patients to complete appointments was not effective. Other approaches are needed to increase the uptake of tobacco treatment in these patients. [Table: see text]

Evaluating disparities in pancreatic cancer outcomes in African Americans.

e18657 Background: Pancreatic Adenocarcinoma (PA) is a leading cause of cancer-related death across the world, with poorer outcomes observed in minority populations. The observed variation in outcomes has been attributed to delayed diagnosis, barriers to optimal treatment and health care related disparities. We sought to evaluate the impact of race on clinical presentation and outcomes in pancreatic cancer at a large academic teaching center. Methods: We performed a retrospective review of patients with pancreatic adenocarcinoma diagnosed between January 2016 to December 2021. The demographic characteristics (age, tobacco use, alcohol use, BMI); comorbidities (diabetes, acute/chronic pancreatitis); pathology, treatment (chemotherapy regimen, radiation, surgery) and progression free survival (PFS) based on race were analyzed. Results: The cohort (N = 983) consisted of 154 (16%) African Americans (AA) and 803 (82%) Non-Hispanic Whites (NHW). The median age at diagnosis was 65 years (60, 70) among AA and 71 years (64, 78) in NHW. Thirty-seven (26%) of AA and 104 (14%) of NHW were current smokers; 46 (33%) of AA and 323 (45%) of NHW consumed alcohol regularly. Among AA, 32 (22%) were obese (BMI > 30), compared to 194 (25%) in NHW. Other comorbidities included diabetes (35% in AA vs. 32% in NHW) and acute/chronic pancreatitis (11% among AA vs. 9% among NHW). The treatment modality consisted of chemotherapy (57% in AA vs. 61% in NHW), surgery (26% in AA vs. 27% in NHW) and radiation (10% in AA vs. 12% in NHW). The median time to treatment initiation was 24 (16, 41) months for AA and 34 (20, 56) months for NHW. On univariate analysis, AA race was associated with younger age at diagnosis (p 0.043), higher current tobacco use (p 0.001), lower alcohol use (p 0.012), lower rates of obesity (p 0.024) and higher rate of acute pancreatitis (p 0.037) in pancreatic cancer. On multivariate analysis, race was not associated with difference in progression free survival (12 months in AA vs. 14 months in NHW; p 0.96) when adjusted for age, sex, alcohol use, tobacco use, cancer stage and chemotherapy. Conclusions: Our study revealed that pancreatic cancer in AA was diagnosed at a younger age, associated with active smoking and pancreatitis. Although there was a shorter time to treatment initiation among AA, there was no significant difference in progression free survival compared to NHW when adjusted for other variables. Future studies incorporating novel biomarkers are needed to determine impact of racial health disparities on outcomes in pancreatic cancer.

Conjoint tobacco and alcohol use and depression among HIV-positive patients in Sedibeng, South Africa.

Psychosocial challenges among human immunodeficiency virus (HIV)-positive patients may promote substance use disorders. This study explored the relationship between conjoint tobacco and alcohol use and depression symptoms among HIV positive patients in Sedibeng District, South Africa. In a cross-sectional study of 404 participants, a questionnaire collected information on sociodemography, tobacco and alcohol use and depression symptoms. Outcome measures included the prevalence of conjoint tobacco and alcohol use and its association with positive screen for depression. The mean participant age was 43.2 years. Most completed secondary school (62.9%), were black (99.0%), female (65.8%), unemployed (53.6%) and on antiretroviral therapy (ART) for 1 year (97.8%). Current tobacco use was reported by 23.3% (n= 94) participants with most smoking cigarette (73.7%) and having low nicotine dependence (75.5%). Current alcohol use was reported by 43.6% (n= 176) participants, and 36.9% were categorised as harmful users. Only 7.7% (n= 31) participants screened positive for depression; the prevalence of conjoint tobacco and alcohol use was 19.6% (n= 79) and this was not associated with depression (p= 0.438). Harmful alcohol users were more than five times likely to report conjoint tobacco and alcohol use (p= 0.000), but women were less likely to report it (p= 0.000). Conjoint tobacco and alcohol use is common among patients with HIV infection. Although not associated with positive screen for depression, its relationship with harmful alcohol use reiterates the need for an integrated tobacco and alcohol use screening and treatment strategy in the HIV treatment programme in primary care.Contribution:To the authors best knowledge, this study is the first published study that explored the relationship between conjoint tobacco and alcohol use, and depression among HIV-positive patients in the South African primary care settings.

A hybrid agent-based model integrated with a multi-stage learning-based fuzzy cognitive map

PurposeThis article proposes a novel hybrid simulation model for understanding the complex tobacco use behavior.Design/methodology/approachThe model is developed by embedding the concept of the multistage learning-based fuzzy cognitive map (FCM) into the agent-based model (ABM) in order to benefit from advantageous of each methodology. The ABM is used to represent individual level behaviors while the FCM is used as a decision support mechanism for individuals. In this study, socio-demographic characteristics of individuals, tobacco control policies, and social network effect are taken into account to reflect the current tobacco use system of Turkey. The effects of plain package and COVID-19 on tobacco use behaviors of individuals are also searched under different scenarios.FindingsThe findings indicate that the proposed model provides promising results for representing the mental models of agents. Besides, the scenario analyses help to observe the possible reactions of people to new conditions according to characteristics.Originality/valueThe proposed method combined ABM and FCM with a multi-stage learning phases for modeling a complex and dynamic social problem as close as real life. It is expected to contribute for both ABM and tobacco use literature.