Current Tobacco Research Articles

Genetically predicted basal metabolic rate and venous thromboembolism risk: a Mendelian randomization study.

Basal metabolic rate (BMR) is the minimum amount of energy needed by the body to carry out essential physiological functions. The goal of this study was to evaluate whether BMR causally influences venous thromboembolism (VTE) and its subtypes in European individuals. A two-sample Mendelian randomization (MR) was performed. Within a genome-wide association study (GWAS) involving 454,874 people, genetic variants were chosen as instrumental variables based on their significant associations (p < 5 × 10-8) with BMR and their limited linkage disequilibrium (r2 < 0.001). The FinnGen project served as sources for summary statistics of VTE, encompassing different subtypes. Using the multiplicative random-effect inverse variance weighted method, our investigation revealed that one standard deviation higher BMR was associated with VTE (odds ratio [OR] = 1.684, 95% confidence interval [CI]: 1.465-1.936, p = 2.339 × 10-13), PE (OR = 1.824, 95% CI: 1.512-2.200, p = 3.399 × 10-10), and DVT of lower extremities (OR = 1.887, 95% CI: 1.562-2.280, p = 4.778 × 10-11). The consistency of these associations was observed in sensitivity analyses using various MR techniques like Mendelian randomization pleiotropy residual sum and outlier, MR-Egger, weighted median, and contamination mixture method. In addition, multivariable MR revealed direct effects of BMR on VTE and its subtypes when taking body mass index and current tobacco smoking into account. Higher BMR may increase the risk of VTE and its subtypes including PE and DVT of lower extremities.

Tobacco Packaging Design in China, Thailand, and New Zealand: A Comparative Study

Packaging design has received much interest from the academic and industrial worlds. Numerous studies have shown that packaging significantly impacts purchase intent, product satisfaction, and repeat purchases. However, to some extent, tobacco packaging is not used to fulfil its consumer target’s demands or increase the repeat purchase rate. By contrast, it has the official duty to discourage tobacco use, as it is a highly regulated business. Nevertheless, tobacco manufacturers do their best to find the last opportunity to advertise on tobacco boxes because the packet is their final or only marketing or advertising tool in many countries. Thus, tobacco packaging design could be the most challenging advertising practice in many nations because two contradicting advertising contents (persuasion and dissuasion) emerge in one medium simultaneously. In this paper, I comparatively content-analysed 65 popular cigarette brands from China, Thailand, and New Zealand to find out how tobacco companies use cigarette packaging to communicate with their customers. The results suggested that Chinese tobacco packaging is highly market-oriented and emphasises the use of traditional Chinese cultural elements. Conversely, tobacco packaging in Thailand and New Zealand focuses on health communication. But warning labels in the two countries are platitudes. The results also indicate that although policy factors have had a positive impact on tobacco packaging in terms of its discouraging function and contributing to tobacco control over the past decades, there is a need for policies to be tailored to the socio-cultural context. Efforts should focus on improving tobacco packaging from the perspective of smokers’ psychology. This adjustment is deemed necessary due to the declining effectiveness of current tobacco packaging control policies in reducing smoking rates in recent years.

Noncigarette Tobacco Product Use Among Smoking-Susceptible and Nonsusceptible Adolescent Never Smokers, 2009–2021

PurposeExamine trends in noncigarette tobacco use among smoking susceptible and nonsusceptible adolescents from 2009–2021. MethodsData came from cross-sectional samples of the National Youth Tobacco Survey (N = 183,198). Using Pierce's smoking susceptibility scale, participants were classified as either susceptible or nonsusceptible to cigarette smoking. Their use of noncigarette tobacco products was classified into four mutually exclusive categories: nonuse, noncigarette combustibles use, noncombustibles use, and noncigarette combustibles and noncombustibles dual use. We produced covariate-adjusted predicted marginal proportions of noncigarette tobacco use for 12 National Youth Tobacco Survey years, which were entered into Joinpoint trend analysis software to determine (a) trends in noncigarette tobacco use from 2009–2021 using the average annual percent changes (AAPCs) and (b) changes in each time segment using the average percent change. Models were fitted by smoking susceptibility, sex, and race/ethnicity. ResultsNonuse was lower among susceptible (vs. nonsusceptible) adolescents whereas noncigarette tobacco use was higher. Trends show significant declines in nonuse (nonsusceptible: AAPC = −0.3%) and noncigarette combustibles use (susceptible: AAPC = −12%) between 2009–2021, increases in noncombustibles use (susceptible: AAPC = 18%, nonsusceptible: AAPC = 19%) between 2009 and 2019, and steadiness in dual use. Parallel trends were observed when stratified by sex and race/ethnicity with notable increases in noncombustibles use among females and Latinos. DiscussionNoncigarette tobacco use differed by smoking susceptibility. Observed trends, especially when stratified by sex and race/ethnicity, raise concerns about tobacco use disparities among females and Latinos. Smoking susceptibility can help identify at-risk adolescents for current or future tobacco use.

Associations between body mass index and smoking behaviour: A cross-sectional study of the German adult population

BackgroundBoth smoking and high body weight are risk factors for disease, hence, the association between smoking and body weight is an important health issue. Furthermore, concern about weight gain after quitting smoking is for many smokers a barrier to smoking cessation. The present study aims to explore the association between body mass index (BMI) and current tobacco smoking status in the population of Germany, and smoking and quitting behaviour amongst smokers (and recent ex-smokers =<12 months since quitting). MethodsCross-sectional analysis of two waves of data collected from March through June 2021 through a representative face-to-face household survey in Germany (N = 3 997 respondents aged ≥18). The associations between smoking and quitting behaviours and BMI were analysed through four regression models adjusted for socio-demographic, socio-economic, and smoking characteristics of respondents. ResultsLong-term ex-smokers (>= 12 months since quitting smoking) were more likely to have a higher BMI compared to never smokers (β = 0.64, 95% confidence interval (CI) = 0.10–1.19). There was no statistically significant association between current smoking status or recent ex-smoking status and BMI (β = -0.29,95 %CI = -0.75–0.17 and β = -0.53, 95 %CI = -2.45–1.40). Among current smokers, no statistically significant association was found between BMI and the motivation to stop smoking (OR = 1.01, 95 %CI = 0.99–1.03). Neither number of cigarettes smoked a day nor outcome of most recent quit attempt were related to BMI (β = 0.01, 95 %CI = -0.04–0.05 and OR = 0.41, 95 %CI = 0.05–3.05). ConclusionIn the German population long-term ex-smoking but not current and recent ex-smoking was associated with increased BMI. Future research should further explore the association between smoking behaviour and abdominal obesity, preferably using a more accurate measure for abdominal obesity than BMI.

Implementation of a nonopioid multimodal analgesia protocol significantly reduces opioids prescribed after total shoulder arthroplasty: a retrospective study

BackgroundThe purpose of this study was to evaluate the impact of a nonopioid multimodal pain protocol on the amount of opioids prescribed, pain level, and complications in patients undergoing total shoulder arthroplasty (TSA) compared to a standard opioid regimen. MethodsWe retrospectively reviewed 2 consecutive cohorts who underwent either primary anatomic or reverse TSA by a single surgeon. The opioid cohort included patients from 2016 to 2020 who received an intraoperative periarticular injection (Ropivacaine, Epinephrine, and Ketorolac cocktail) and were prescribed Oxycodone/Acetaminophen 5/325 mg on discharge. The nonopioid cohort included patients from 2020 to 2022, consisting of preoperative oral analgesics (Celecoxib, Pregabalin, and Tramadol); intraoperative intravenous Dexamethasone and Acetaminophen and periarticular injection; and postoperative oral Dexamethasone and oral analgesics (Pregabalin, Tizanidine, Magnesium, Ibuprofen, and Acetaminophen). The nonopioid cohort had the option to ask for an opioid prescription postoperatively if needed. Patient-reported outcomes collected included visual analog scale scores for pain and Patient-Reported Outcome Measurement Information System up to 1 year after surgery. Opioid consumption using Morphine Milligram Equivalents were compared up to 3 months postoperatively. ResultsThere were 232 patients in the opioid and 112 in the nonopioid cohorts, respectively. The nonopioid protocol had lower mean visual analog scale scores at preoperative (6.4 vs. 7.4, P < .05), 10-day (3.5 vs. 4.2, P < .05), and 6-week postoperative time points (2.1 vs. 2.8, P < .05), but no differences between the groups were noted 3 months postoperatively. No differences in Patient-Reported Outcome Measurement Information System–upper extremity, pain interference, or depression were found preoperatively and up to 1 year after surgery. Opioid consumption was lower in the nonopioid cohort at all time periods (P < .01). Patients in the nonopioid cohort had significantly lower Morphine Milligram Equivalents at discharge, 10-day, 6-week, and 90-day time periods (P < .01) when compared to the opioid cohort. When analyzing risk factors for continued opioid prescriptions for the whole cohort, preoperative opioid use within 90 days before surgery (relative risk 4.69 [95% confidence interval 3.18-6.91; P < .01) and current tobacco use (relative risk 2.61 [95% confidence interval 1.50-4.54]; P = .01) were associated with continued refills >30 days. Complications in the perioperative period and 90-day hospital readmissions were not significantly different between the groups. ConclusionA nonopioid postoperative regimen for patients undergoing TSA significantly reduces opioid prescriptions with similar patient-reported outcomes, subjective pain scores, and without increased complication rates compared to an opioid-only regimen.

Strengths and Limitations of Web-Based Cessation Support for Individuals Who Smoke, Dual Use, or Vape: Qualitative Interview Study.

Tobacco use has shifted in recent years, especially with the introduction of e-cigarettes. Despite the current variable and intersecting tobacco product use among tobacco users, most want to quit, which necessitates cessation programs to adapt to these variable trends (vs focusing on combustible cigarettes alone). The use of web-based modalities for cessation support has become quite popular in recent years and has been compounded by the COVID-19 pandemic. Therefore, understanding the current strengths and limitations of existing programs to meet the needs of current various tobacco users is critical for ensuring the saliency of such programs moving forward. The purpose of this study was to understand the strengths and limitations of web-based cessation support offered through QuitNow to better understand the needs of a variety of end users who smoke, dual use, or vape. Semistructured interviews were conducted with 36 nicotine product users in British Columbia. Using conventional content analysis methods, we inductively derived descriptive categories and themes related to the strengths and limitations of QuitNow for those who smoke, dual use, or vape. We analyzed the data with the support of NVivo (version 12; QSR International) and Excel (Microsoft Corporation). Participants described several strengths and limitations of QuitNow and provided suggestions for improvement, which fell under 2 broad categories: look and feel and content and features. Shared strengths included the breadth of information and the credible nature of the website. Individuals who smoke were particularly keen about the site having a nonjudgmental feeling. Moreover, compared with individuals who smoke, individuals who dual use and individuals who vape were particularly keen about access to professional quit support (eg, quit coach). Shared limitations included the presence of too much text and the need to create an account. Individuals who dual use and individuals who vape thought that the content was geared toward older adults and indicated that there was a lack of information about vaping and personalized content. Regarding suggestions for improvement, participants stated that the site needed more interaction, intuitive organization, improved interface esthetics, a complementary smartphone app, forum discussion tags, more information for different tobacco user profiles, and user testimonials. Individuals who vape were particularly interested in website user reviews. In addition, individuals who vape were more interested in an intrinsic approach to quitting (eg, mindfulness) compared with extrinsic approaches (eg, material incentives), the latter of which was endorsed by more individuals who dual use and individuals who smoke. The findings of this study provide directions for enhancing the saliency of web-based cessation programs for a variety of tobacco use behaviors that hallmark current tobacco use.

Rural-urban health differences among aging adults in India

BackgroundThe aim of this study was to determine the rural-urban health differences among aging adults in India. MethodsThe national cross-sectional data of 67,489 individuals (≥45 years) in 2017–2018 from 35 states and union territories of India (excluding Sikkim) in 2017–2018 were analysed. Various sociodemographic data, well-being indicators, lifestyle factors and physical conditions were assessed by face-to-face interviews and physical measurement. Univariable and multivariable logistic regression was utilized to assess the predictors between residence status (rural dweller, urban migrant, and urban dweller) and various health indicator outcomes. ResultsMajority (70.4 %) of the participants lived in rural areas, 10.3 % were urban migrants and 19.3 % urban dwellers. In the multivariable logistic regression analysis, urban migrants and urban dwellers had a higher self-rated health status, cognitive functioning, physical inactivity, overweight or obesity and abdominal obesity than rural dwellers, while urban migrants and/or urban dwellers had lower functional disability, insomnia symptoms, current smokeless tobacco use, current smoking, heavy episodic drinking and underweight than rural dwellers. Furthermore, urban migrants and/or urban dwellers had higher odds of diabetes, hypertension, heart disease, cancer, high cholesterol than rural dwellers, while urban migrants and/or urban dwellers had lower odds of persistent headaches, major injury, recurrent fall, physical pain, periodontal disease, vision impairment, and gastrointestinal problems than rural dwellers. ConclusionAmong 30 health indicators assessed, 16 had an urban migrant and/or urban dweller advantage, 8 had urban migrant and/or urban dweller penalty, and 6 did not differ between rural-urban groups. Public health promotion and health care should address differing health care needs of rural and urban middle-aged and older adults.

A dedicated risk prediction model of 1-year mortality following endovascular aortic aneurysm repair involving the renal-mesenteric arteries

ObjectiveTreatment goals of prophylactic endovascular aortic repair of complex aneurysms involving the renal-mesenteric arteries (complex endovascular aortic repair [cEVAR]) include achieving both technical success and long-term survival benefit. Mortality within the first year after cEVAR likely indicates treatment failure owing to associated costs and procedural complexity. Notably, no validated clinical decision aid tools exist that reliably predict mortality after cEVAR. The purpose of this study was to derive and validate a preoperative prediction model of 1-year mortality after elective cEVAR. MethodsAll elective cEVARs including fenestrated, branched, and/or chimney procedures for aortic disease extent confined proximally to Ishimaru landing zones 6 to 9 in the Society for Vascular Surgery Vascular Quality Initiative were identified (January 2012 to August 2023). Patients (n = 4053) were randomly divided into training (n = 3039) and validation (n = 1014) datasets. A logistic regression model for 1-year mortality was created and internally validated by bootstrapping the AUC and calibration intercept and slope, and by using the model to predict 1-year mortality in the validation dataset. Independent predictors were assigned an integer score, based on model beta-coefficients, to generate a simplified scoring system to categorize patient risk. ResultsThe overall crude 1-year mortality rate after elective cEVAR was 11.3% (n = 456/4053). Independent preoperative predictors of 1-year mortality included chronic obstructive pulmonary disease, chronic renal insufficiency (creatinine >1.8 mg/dL or dialysis dependence), hemoglobin <12 g/dL, decreasing body mass index, congestive heart failure, increasing age, American Society of Anesthesiologists class ≥IV, current tobacco use, history of peripheral vascular intervention, and increasing extent of aortic disease. The 1-year mortality rate varied from 4% among the 23% of patients classified as low risk to 23% for the 24% classified as high risk. Performance of the model in validation was comparable with performance in the training data. The internally validated scoring system classified patients roughly into quartiles of risk (low, low/medium, medium/high and high), with 52% of patients categorized as medium/high to high risk, which had corresponding 1-year mortality rates of 11% and 23%, respectively. Aneurysm diameter was below Society for Vascular Surgery recommended treatment thresholds (<5.0 cm in females, <5.5 cm in males) in 17% of patients (n = 679/3961), 41% of whom were categorized as medium/high or high risk. This subgroup had significantly increased in-hospital complication rates (18% vs 12%; P = .02) and 1-year mortality (13% vs 5%; P < .0001) compared with patients in the low- or low/medium-risk groups with guideline-compliant aneurysm diameters (≥5.0 cm in females, ≥5.5 cm in males). ConclusionsThis validated preoperative prediction model for 1-year mortality after cEVAR incorporates physiological, functional, and anatomical variables. This novel and simplified scoring system can effectively discriminate mortality risk and, when applied prospectively, may facilitate improved preoperative decision-making, complex aneurysm care delivery, and resource allocation.

Current Smoking Status Is Not a Risk Factor for Perioperative Outcomes in Patients with Aneurysmal Subarachnoid Hemorrhage Who Underwent Craniotomy Repair

BackgroundAneurysmal subarachnoid hemorrhage is a rupture leading to blood accumulating in the subarachnoid region. Smoking status often is a risk factor for postoperative complications for vascular procedures. This study aims to retrospectively examine the effect of being a current tobacco smoker on postoperative outcomes in nontraumatic subarachnoid hemorrhage patients. MethodsPatients with aneurysmal subarachnoid hemorrhage who underwent craniotomy were identified in the ACS-NSQIP database. The 30-day perioperative outcomes of current smokers were compared to that of control, which was patients who have not smoked tobacco in the past year. Postoperative outcomes included death, cardiac complications, stroke, operation time greater than four hours, bleeding, and other events. Additionally, this studied examined the same surgical outcomes in patients over age 65. ResultsWe found no significant difference between these two groups across all adverse outcomes analyzed. In age>65, we again found no significant different between these two groups across all adverse outcomes analyzed. ConclusionsThis study shows that although current tobacco smoker status is commonly a risk factor for vascular diseases and postoperative complications, it is not a risk factor for the postoperative variables we analyzed during craniotomy for aneurysmal subarachnoid hemorrhage. Additional research should be conducted to determine if different procedures to treat aneurysmal subarachnoid hemorrhage may have different outcomes among smokers.

Motivations for continued tobacco smoking and reasons for quitting among youths in Wakiso district, Uganda: a qualitative study

BackgroundEfforts have been invested towards cessation of tobacco use among youths aged 18–35 years, however, motivators for continued tobacco smoking and reasons for quitting are limited in Ugandan settings. Therefore, this study aimed to explore motivations for continued tobacco smoking and reasons for quitting in Wakiso district Uganda.MethodsThis study used explanatory sequential method. Data from a Population-based survey collected from October 2019 to September 2020 was used to select participants for this qualitative study. Twenty-three in-depths interviews were conducted from July to October 2021 among youths (18-35years old) who reported continued tobacco use and those who quit. Data were analyzed using a team-based thematic content approach with the help of NVivo.ResultsData was collected from a total of twenty three participants, fourteen were tobacco quitters and nine were current tobacco smokers. Recurrent habit, desire to complement the use of other drugs, peer pressure, using smoking as a replacement for alcohol consumption, low tobacco prices, smoking as a tradition were reported as motivators for continued tobacco smoking. However, reported reasons for quitting smoking by youths included; packaging health warnings, school based prevention programs, fear of associated health risks due to tobacco use, embarrassment from family members.ConclusionTargeted, and tailored tobacco prevention counselling through family support programs, intensified health education on the risks of smoking, and implementing stronger health warnings on tobacco packaging can be employed to reduce or stop tobacco use among urban youth.

Prevalence of lifestyle cardiovascular risk factors and estimated framingham 10-year risk scores of adults with psychotic disorders compared to controls at a referral hospital in Eldoret, Kenya

IntroductionLifestyle factors such as smoking, alcohol use, suboptimal diet, and inadequate physical activity have been associated with increased risk of cardiovascular diseases. There are limited data on these risk factors among patients with psychosis in low- and middle-income countries.ObjectivesThis study aimed to establish the prevalence of lifestyle cardiovascular risk factors, and the 10-year cardiovascular risk scores and associated factors in patients with psychosis compared to controls at Moi Teaching and Referral Hospital in Eldoret, Kenya.MethodsA sample of 297 patients with schizophrenia, schizoaffective disorder, or bipolar mood disorder; and 300 controls matched for age and sex were included in this analysis. A study specific researcher-administered questionnaire was used to collect data on demographics, antipsychotic medication use, smoking, alcohol intake, diet, and physical activity. Weight, height, abdominal circumference, and blood pressure were also collected to calculate the Framingham 10-year Cardiovascular Risk Score (FRS), while blood was drawn for measurement of glucose level and lipid profile. Pearson’s chi-squared tests and t-tests were employed to assess differences in cardiovascular risk profiles between patients and controls, and a linear regression model was used to determine predictors of 10-year cardiovascular risk in patients.ResultsCompared to controls, patients with psychosis were more likely to have smoked in their lifetimes (9.9% vs. 3.3%, p = 0.006) or to be current smokers (13.8% vs. 7%, p = 0.001). Over 97% of patients with psychosis consumed fewer than five servings of fruits and vegetables per week; 78% engaged in fewer than three days of vigorous exercise per week; and 48% sat for more than three hours daily. The estimated 10-year risk of CVD was relatively low in this study: the FRS in patients was 3.16, compared to 2.93 in controls. The estimated 10-year cardiovascular risk in patients was significantly associated with female sex (p = 0.007), older patients (p < 0.001), current tobacco smoking (p < 0.001), and metabolic syndrome (p < 0.001).ConclusionIn the setting of Eldoret, there is suboptimal physical exercise and intake of healthy diet among patients with psychosis and controls. While the estimated risk score among patients is relatively low in our study, these data may be useful for informing future studies geared towards informing interventions to promote healthy lifestyles in this population.

Recovery From Idiopathic Sudden Sensorineural Hearing Loss: Association With Cardiovascular Disease Risk.

The purpose of this study is to investigate the association between cardiovascular disease (CVD) risk factors and idiopathic sudden sensorineural hearing loss (ISSNHL) disease severity and recovery. A retrospective medical chart review was performed on 90 patients (n = 48 men; Mage = 59.8 years, SD = 15.8) evaluated for ISSNHL. Major CVD risk factors (current tobacco smoking, diabetes, total cholesterol ≥ 240 mg/dl or treatment, and hypertension [systolic blood pressure [BP]/diastolic BP ≥ 140/ ≥ 90 mmHg or treatment]) determined two CVD risk groups: lower (no major risk factors) and higher (one or more risk factors). Two pure-tone averages (PTAs) were computed: PTA0.5,1,2 and PTA3,4,6,8. Complete recovery of ISSNHL was defined as PTAinitial - PTAfollow-up ≥ 10 dB. Logistic regression estimated the odds of ISSNHL recovery by CVD risk status adjusting for age, sex, body mass index, noise exposure, and treatment. Most patients (67.8%) had one or more CVD risk factors. Severity of initial low- and high-frequency hearing loss was similar between CVD risk groups. Recovery was 53.2% for PTA0.5,1,2 and 32.9% for PTA3,4,6,8. With multivariable adjustment, current/former smoking was associated with lower odds of PTA0.5,1,2 recovery (OR = 0.27; 95% CI [0.08, 0.92]). Neither higher CVD risk status nor individual CVD risk factors had a significant association with recovery. For every one-unit increase in Framingham Risk Score, odds of PTA3,4,6,8 recovery were 0.95 times lower (95% CI [0.90, 1.00]) after accounting for age, sex, body mass index, noise exposure, and treatment/time-to-treatment grouping (p = .056). The prognosis of low-frequency ISSNHL recovery is worse among current/former smokers than nonsmokers. Other CVD risk factors and aggregate risk are not significantly related to recovery.

Prepectoral versus subpectoral two-stage implant-based breast reconstruction: U.S. medical center experience and narrative review.

With the incorporation of autologous fat grafting, acellular dermal matrix (ADM) products, and nipple-sparing mastectomy, prepectoral device placement has become more popular in selected patients when compared to partial submuscular (dual plane) or complete submuscular device placement. In this article, we aimed to present a review of the current state-of-the-art for implant-based breast reconstruction (IBBR) using expanders. Additionally, we present a case series of our experience with IBBR evaluating perioperative outcomes, complications, and patient-reported outcomes (PRO). For our series, we retrospectively evaluated adult female patients undergoing 2-stage immediate IBBR after total mastectomy between 2011 and 2021. We performed a systematic search across PubMed MEDLINE for articles evaluating outcomes of prepectoral versus subpectoral two-stage IBBR with expanders published from database inception through February 28th, 2023. Both prepectoral and subpectoral are safe alternatives for two-stage IBBR. Due to current advancements in the field of breast reconstruction, prepectoral IBBR has gained popularity and has a comparable rate of complications compared to a subpectoral approach in selected patients according to high-quality articles. In patients with several comorbidities, current tobacco use, history of preoperative radiation, and limited perfusion of the mastectomy flaps, subpectoral device placement should be given special consideration as a layer of vascularized tissue can decrease the risk of major complications or unplanned procedures. As prepectoral device placement does not require dissection of the pectoral muscles, faster recovery, better implant position, decreased pain, and a shorter time to complete expansion is expected. The plane of reconstruction does not seem to significantly affect the time for expander-to-implant exchange or PRO for quality-of-life (QOL) according to most studies. Prepectoral and subpectoral IBBR demonstrated a comparable rate of complications in selected patients. Nonetheless, perioperative outcomes seem to be improved using a prepectoral approach in terms of reduced pain, reduced time to conclude outpatient expansions, and less animation deformity.

Community-based Screening of Oral Cancer in Selected Districts of Nepal: A Cross-Sectional Study.

Oral cancer screening plays a vital role in the prevention and control of oral cancer. This study aimed to determine the prevalence of oral potentially malignant disorders (OPMDs) in the Nepalese community. A cross-sectional study was conducted in six purposively selected districts in Nepal from May to December 2019. It utilized a camp-based approach, where a standardized questionnaire was administered through face-to-face interviews. Screening of oral cancer was performed by direct visualization and palpation. The study included adults aged 18 years and above, while those already diagnosed with oral cancer were excluded. Logistic regression was used to find out the association between OPMDs and the related variables. A total of 1930 participants with a mean age of 44.3 years (SD=15.1) underwent oral cancer screening. Among them, 32% were current tobacco users, 2% were ex-users, and 11% were alcohol consumers. OPMDs, including suspected cancer, were identified in 139 (7.2%, 95% CI=6.1-8.4) participants. The most common lesion detected was leukoplakia (4.2%), followed by submucous fibrosis (1.5%), erythroplakia (0.9%), and palatal changes due to reverse smoking (0.1%). Additionally, 10 participants were suspected of having oral cancer. Older age group (AOR=7.00; 95% CI=2.76-17.77), male gender (AOR=2.52; 95% CI=1.58-4.02), tobacco chewers (AOR = 14.30; 95% CI=8.82-23.19), and smokers (AOR=4.67; 95% CI=2.88-7.57)) were identified as predictors of OPMDs. This study revealed a high prevalence of OPMDs in Nepal, highlighting the need for oral cancer screening. The findings emphasize the importance of developing strategies to reduce tobacco use and implementing tobacco cessation intervention programs in Nepal to alleviate the burden of oral cancer.

Associations of history of intimate partner violence with mental ill-health and lifestyle factors in middle-aged and older men and women in South Africa

ObjectivesThe aim of this study was to assess the association between history of intimate partner violence (IPV) exposure and mental and lifestyle factors among middle-aged and older men and women in rural South Africa. MethodsThe analysis utilized data from wave 3 of the longitudinal Health and Ageing in Africa: A Longitudinal Study of an INDEPTH Community in South Africa (HAALSI) (n = 3,707, median age 66 years, range 46–118 years). History of IPV was assessed with five questions on physical, sexual, psychological, and economic IPV. Logistic regression was used to assess the association between history of IPV exposure and mental and lifestyle factors. ResultsAmong men 7.8% and among women 10.9% reported a history of IPV. In terms of mental health outcomes, in the final adjusted model, among men, exposure to 1 and/or 2–4 types of IPV were associated with depressive symptoms, insomnia symptoms, PTSD, and loneliness, while among women, exposure to 1 and/or 2–4 types of IPV was associated with insomnia symptoms and PTSD. In terms of lifestyle outcomes, in the final adjusted model, among men, 2–4 types of IPV were associated current tobacco use, current heavy alcohol use, inadequate fruit intake, and food insecurity, and among women, 1 and/or 2–4 types of IPV were associated with soft drink intake, and food insecurity. ConclusionWe found that lifetime exposure to IPV was associated with several mental and lifestyle factors in middle-aged and older men and women. Enhanced screening and treatment of IPV may reduce poor mental and health risk behavior among this aging male and female population in South Africa.

Critical analysis of tobacco taxation policies in Pakistan after two decades of FCTC: Policy gaps and lessons for low- and middle-income countries.

Tobacco taxation remains a poorly used intervention to control tobacco use in many low- and middle-income countries (LMICs) including Pakistan even after two decades of FCTC adoption. This study identifies gaps and implementation challenges in the current Tobacco Taxation and Pricing Policies (TTPP) in Pakistan, and highlights key policy implications and lessons for LMICs to strengthen tobacco control measures. We used qualitative document analysis to examine the policy documents to assess the TTPP against the WHO Framework Convention on Tobacco Control (FCTC) guidelines for the implementation of Article 6 of the FCTC. In addition, we used secondary data on tobacco tax and prices to assess the impact of TTPP on tobacco affordability in the country. Although Pakistan taxes raw tobacco, cigarettes and other tobacco products (cigarillos, cigars, cheroots), the existing TTPP falls below the WHO FCTC requirements of: uniform tax level, simple tax structure and 70% share of excise tax in the price of a product's pack; among others. There are also multiple issues in tobacco tax administration such as lack of monitoring. This is leading to the availability of highly affordable tobacco products in the country. Pakistan does not have a clear strategy on using tobacco taxation and prices as a public health tool in the country. Existing TTPP face dual issues of flawed structure and poor administration translating into highly affordable tobacco products and low revenues in the country. There is a need to introduce multisectoral tobacco control policies in countries like Pakistan in the context of the tobacco sector political economy.

Attitudes and behaviours regarding e-cigarettes in people aged 15–30 years in the UK: a cross-sectional study

BackgroundThe use of e-cigarettes has been rising in the UK, with 7·7% of people aged over 16 years currently vaping daily or occasionally. Young people aged 16–24 years have the highest proportion of vapers at 11·1%. Therefore, this study investigated behaviours, attitudes, and beliefs about e-cigarettes among people aged 15–30 year in the UK. MethodsFor this cross-sectional study, we administered an online survey to a representative sample of people aged 15–30 years in the UK (based on a web panel) between Oct 1, and Nov 30, 2021. Questions related to respondent demographics; use of vaping or smoking products; motivations, attitudes, and behaviours related to vaping; and exposure to e-cigarette advertising. Ever use was described as use even “just once or twice”. We used multivariable logistic regression to identify factors associated with ever e-cigarette use. Findings1009 participants responded to the survey (mean age 23 years, 520 [51·5%] women, 470 [46.6%] men) and were included in the study. 222 (22·3%) participants vaped at least monthly, with one in ten doing it daily. Current smokers were the most likely to use e-cigarettes (453, 44·9%), followed by previous smokers (288, 28·5%) and never smokers (23, 2·3%). Of the 222 participants vaping at least monthly, 199 (89·6%) had used e-cigarettes containing nicotine. The most common reasons for vaping were having friends who used e-cigarettes (103, 46·4%) and quitting or reducing smoking (89, 40·1%). Most participants agreed that e-cigarettes are addictive (698, 75·1%), help people quitting smoking (597, 64·2%), and are bad for health (584, 62·8%). Warning labels on e-cigarettes were seen by 611 (65·7%) participants, and 489 (52·6%) had been exposed to e-cigarette advertising, especially online. Previous or current tobacco smokers were nine and 22 times more likely to use e-cigarettes than never smokers, respectively (odds ratio [OR] 8·5, 95% CI 5·2–14·0 for previous smokers and 22·3, 12·2–40·7 for current smokers). Perceiving e-cigarettes as harmful was associated with a 40% lower likelihood of vaping (OR 0·6, 0·49–0·83). InterpretationVaping seems relatively common among people aged 15–30 years in the UK, mainly among previous and current smokers. Caution should be taken as these findings might not be generalisable to the young UK population, and cross-sectional associations might not be causal. However, perceiving e-cigarettes as harmful might reduce their use, and many users seem unaware of their potential harms, which emphasises the need for further regulation on labelling, marketing, and sales. FundingNational Health and Medical Council.

Associations of social media use with smoking and e-cigarettes: a national longitudinal study

BackgroundSocial media use is high among children and young people and might influence health behaviours. We examined social media use and use of tobacco and e-cigarettes in the UK. MethodsWe used data from participants aged 10–25 years from the UK Household Longitudinal Study (January 2015–January 2022). Participants were asked: “On a normal weekday, that is Monday to Friday, how many hours do you spend chatting or interacting with friends through a social website or app like that?”. Specific social media platforms were not specified. Responses were none, less than 1 h, 1–3 h, 4–6 h, 7 h or more. Outcomes were current tobacco smoking and e-cigarette use. Generalised Estimating Equation (GEE) logistic regression models investigated associations of social media use with tobacco and e-cigarette use, and fixed effects analyses investigated changes in social media use with uptake of both products. Models included possible confounders such as age, sex, household income, ethnicity (White vs non-White) and use of tobacco or e-cigarettes by others within the home. All participants gave written informed consent. FindingsThe analytic sample included 10 808 participants with 27 962 observations (mean age 15·7 years [SD 3·8], 5080 [47%] male, 5728 [53%] female, and 7868 [73%] White). Current tobacco smoking was reported at one or more timepoints by 929 (8·6%) participants, and current e-cigarette use by 270 (2·5%) participants. In adjusted GEE models, all levels of social media use were associated with greater odds of current smoking than no use. This association was particularly apparent at higher levels of use adjusted odds ratio [aOR] 3·11, 95% CI 2·41–4·03 for ≥7 h use vs no use), with similar associations for e-cigarettes (aOR 3·04, 2·11–4·40 for ≥7 h use vs no use). Fixed effects analyses also found increased use of social media to be associated with increased uptake of both products (eg, changing to using social media for ≥7 h/day was associated with >2 times the odds of taking up tobacco smoking [aOR 2·33, 1·28–4·24]). InterpretationThese analyses suggest an association between social media use and e-cigarette and tobacco use. Potential pathways include promotion of these products on social media. Further research with details on specific platforms would be useful as well as with longer follow-up time. FundingCancer Research UK.

An Atlas Characterizing the Shared Genetic Architecture of Inflammatory Bowel Disease with Clinical and Behavioral Traits.

Inflammatory bowel disease (IBD) development is a complex, multifactorial process that involves extrinsic and intrinsic factors such as host genetics, the immune system, the gut microbiome, and environmental risks. To help understand the genetic contribution of clinical, behavioral, psychiatric, and diet-related traits, we aim to provide a deep and comprehensive characterization of the shared genetic architecture between IBD and hundreds of potentially related traits. Utilizing publicly available summary statistics from a previously published IBD genome-wide association study and hundreds of traits from the United Kingdom BioBank (UKBB), we performed linkage disequilibrium score regression (LDSR) analysis to estimate cross-trait genetic correlations between Crohn's disease (CD), ulcerative colitis (UC), and IBD summary statistics with the UKBB traits of interest. Nominally significant (P < .05) genetic correlations were observed for 181 traits in overall IBD, 239 traits in CD, and 94 traits in UC. We replicate the known association between smoking behavior and CD/UC, namely that current tobacco smoking has a positive genetic correlation with CD (rg = 0.12, P = 4.2 × 10-4), while "ever smoking" has a negative genetic correlation with UC (rg = -0.07, P = .042). Globally, all 3 strata (IBD, CD, and UC) demonstrated increased genetic correlations for psychiatric-related traits related to anxiety and depression. The present analysis reveals the shared genetic architecture between multiple traits and IBD, CD, and UC. Understanding the relevance of joint occurrences of IBD with psychiatric diseases may moderate management of these diseases for individuals jointly affected by them.

State-Specific Prevalence of Adult Tobacco Product Use and Cigarette Smoking Cessation Behaviors, United States, 2018-2019.

Increasing quitting among people who smoke cigarettes is the quickest approach to reducing tobacco-related disease and death. We analyzed data from the 2018-2019 Tobacco Use Supplement to the Current Population Survey for 137,471 adult self-respondents from all 50 US states and the District of Columbia to estimate state-specific prevalence of current tobacco product use, interest in quitting smoking, past-year quit attempts, recent successful cessation (past-year quit lasting ≥6 months), receipt of advice to quit smoking from a medical doctor, and use of cessation medications and/or counseling to quit. Prevalence of current any-tobacco use (use every day or some days) ranged from 10.2% in California to 29.0% in West Virginia. The percentage of adults who currently smoked cigarettes and were interested in quitting ranged from 68.2% in Alabama to 87.5% in Connecticut; made a past-year quit attempt ranged from 44.1% in Tennessee to 62.8% in Rhode Island; reported recent successful cessation ranged from 4.6% in West Virginia and Wisconsin to 10.8% in South Dakota; received advice to quit from a medical doctor ranged from 63.3% in Colorado to 86.9% in Rhode Island; and used medications and/or counseling to quit ranged from 25.5% in Nevada to 50.1% in Massachusetts. Several states with the highest cigarette smoking prevalence reported the lowest prevalence of interest in quitting, quit attempts, receipt of advice to quit, and use of counseling and/or medication, and the highest prevalence of e-cigarette, smokeless tobacco, and cigar use. Adults who smoke struggle with smoking cessation and could benefit from additional intervention.