Current Tobacco Use Research Articles

Prevalence of Tobacco Use and the Attitude towards Quitting Tobacco Habit amongst Hamals in Navi Mumbai, India – A Cross-sectional Study

Abstract Introduction: As per the World Health Organisation, tobacco tends to be the growing global cause of death (4.9 million people a year) worldwide and also is associated with many fatal diseases. The objective of the study is to determine the prevalence of tobacco use amongst the study group and also to evaluate their attitude towards quitting tobacco habit. Materials and Methods: A self-designed structured questionnaire was used by the single-trained examiner for interviewing the participants. Three hundred and six (298 males and 8 females) hamal workers of Navi Mumbai were surveyed after ethical approval by the institution. Data were collected through face-to-face interviews. Data obtained were analysed using the SPSS software version 16 (SPSS < 0.005 considered Inc. Chicago, IL, USA). Descriptive statistics were calculated with P as significant. Results: Out of 306 hamals, 245 (80.01%) were using tobacco amongst which 210 (85.7%) consumed on a daily basis and 23 were past tobacco users that is only 7.5% were able to quit. Out of the 268 present and past tobacco users, 134 (50%) tried to quit of which 111 (85%) were unsuccessful and 23 (15%) were successful. 82.5% of current tobacco users expressed a desire to quit but needed help. Conclusion: A high prevalence of tobacco consumption was seen amongst the surveyed hamals and most of them need help to quit the habit. Employers, trade associations and worker representatives can work in partnership with their state and local health departments in implementing evidence-based policies and programmes to reduce the prevalence of tobacco use amongst these working population.

Feasibility of recruiting young adults with low socioeconomic status for formative evaluation of a smoking cessation mobile intervention.

Participant recruitment is critical to the success of smoking cessation trials. However, recruitment feasibility studies for inclusion and exclusion criteria commonly used in smoking cessation research remain scarce. We assessed the feasibility of recruiting potential research volunteers (PRVs) under two sets of inclusion criteria to inform eligibility requirements for a smoking cessation mobile intervention trial. We invited PRVs nationwide to participate in qualitative evaluation of a smoking cessation mobile application. To be eligible under Criteria I, participants were aged 18-29 years, neither four-year college graduates nor enrollees, exclusive cigarette smokers, willing to quit within 30 days, and not using cessation aids. Criteria II expanded eligibility to those using cigarettes and non-combustible tobacco products (e.g. e-cigarettes) and willing to quit within 6 months. We calculated recruitment yields and associated costs. Of 10533 PRVs screened for eligibility, 48 were enrolled. Only 54 (0.5%) participants qualified under Criteria I and 164 (1.6%) under Criteria II. Age ineligibility was the top reason for exclusion (66.7%), whereas lifetime smoking, quit timeframe, and other tobacco product use contributed to ineligibility rates ranging from 46.5% to 65.3%. Enrolled participants were equally split by sex and roughly reflected the racial/ethnic composition of the United States. American Indians, who have the highest smoking prevalence, were <5% of enrolled participants. Recruitment costs averaged $106 per PRV. Eligibility requirements used in cessation trials were restrictive for recruitment efforts. Relaxing inclusion criteria will reflect current tobacco use patterns and facilitate the timely completion of trials within budgetary thresholds.

The Impact of Smoking on Sacrocolpopexy Perioperative Outcomes: An Observational Study.

Tobacco smoke is a modifiable risk factor that surgeons discuss with patients prior to undergoing sacrocolpopexy or mesh revision surgery. The aim of the study was to investigate the effect of smoking on perioperative outcomes after sacrocolpopexy for pelvic organ prolapse and mesh revision repair. This was a retrospective cohort study of data obtained from the National Surgical Quality Improvement Project's database. Women who underwent surgery for pelvic organ prolapse via abdominal sacrocolpopexy (ASCP) or minimally invasive sacrocolpopexy (MISCP) or prolapse mesh revision surgery from 2011 to 2021 were identified and compared based on current tobacco use. Demographic, medical, and surgical history, as well as intraoperative and 30-day perioperative outcomes, were compared. Multivariate analysis was performed. Overall, 21,980 women underwent MISCP (8.60% smokers) and 3,775 underwent ASCP (8.74% smokers). Postoperative wound infections were more common after sacrocolpopexy in patients who smoked. Readmission after MISCP was more common in smokers. The composite perioperative morbidity score was different between smokers and nonsmokers for MISCP (P = 0.001) and ASCP (P = 0.002). Multivariate analyses of MISCP outcomes found an association between smoking and wound infection, readmission, and composite score. Multivariate analyses of ASCP outcomes found an association between smoking and wound infection. Overall 2,160 patients underwent mesh removal by any modality (16.57% smokers), and no difference in perioperative outcomes between smokers and nonsmokers for mesh removal was found. An association was found between tobacco smoking and wound infection as well as other postoperative complications. Tobacco use prior to a mesh excision procedure does not appear to increase perioperative outcomes.

Oral Cancer Incidence Among Adult Males With Current or Former Use of Cigarettes or Smokeless Tobacco: Population-Based Study.

Tobacco use has been identified as a risk factor for oral cancer worldwide. However, relative oral cancer incidence among adults who smoke cigarettes, use smokeless tobacco products (ST), have transitioned from cigarettes to ST, quit cigarettes and/or ST ("quitters"), or never used tobacco has not been well studied. We aim to present population-based oral cancer incidence rates for adults who smoke cigarettes, use ST, are former smokers who now use ST, or quit. We estimated cross-sectional incidence rates and incidence rate ratios (IRRs) using data from statewide cancer registries (Colorado, Florida, North Carolina, and Texas) and population counts derived from national surveys using combined data from 2014-2017. A random-effect meta-analysis approach was used to summarize estimates among these groups, based on multiple imputation-based IRR estimates by state and age group while considering potential heterogeneity. A total of 19,536 oral cancer cases were identified among adult males 35 years and older in the study geographies and period. The oral cancer incidence rate among adults who smoke was significantly higher than the ST group (2.6 times higher, 95% CI 2.0-3.3, P<.001), 3.6 (95% CI 3.2-4.1, P<.001) times higher than the never users, and 2.4 (95% CI 1.8-3.1, P<.001) times higher compared to former smokers who now use ST. The IRR among the ST group relative to never users was 1.4 (95% CI 1.1-1.9, P=.02). The IRR between former smokers who now use ST and those who quit was 1.4 (95% CI 1.0-2.1, P=.08). Findings from this population-based study with a large number of oral cancer cases support significantly high oral cancer incidence among adults who smoke and a lower risk of oral cancer incidence among never users, quitters, users of ST, and former smokers who now use ST compared to cigarettes. Future studies with detailed control of tobacco history and other relevant confounders are needed to confirm these findings.

Hunger and housing: Economic disparities in current and daily tobacco use among high school students in the United States in 2021

IntroductionEconomic disparities in tobacco use and dependence are well-documented among adults but not adolescents. This study aims to examine economic disparities in patterns of tobacco use among a nationally representative sample of high school students in Spring 2021. MethodsWe analyzed data from n = 6,750 US high school student via the 2021 Adolescent Behaviors and Experiences Survey (ABES). We estimated the association between experiencing homelessness and food insecurity (analyzed independently) and current (past 30-day) and daily (all 30 days) use of four tobacco products (e-cigarettes; cigarettes; cigars; smokeless). Models controlled for sex, race/ethnicity, age, and sexual identity. ResultsOverall, ∼1.8 % experienced homelessness and 23.7 % experienced food insecurity. Experiencing homeless was significantly associated with greater odds of current use for e-cigarette (aOR: 3.43), cigarettes (aOR: 5.58), cigars (aOR: 10.47), and smokeless tobacco (aOR: 4.41) as well as greater risk for daily use of e-cigarettes (aOR: 2.66), cigarettes (aOR: 10.94), and cigars (aOR: 5.23) but not smokeless tobacco (aOR: 2.48; 95 %CI: 0.51 – 12.16). Food insecurity was significantly associated with greater odds of current use of e-cigarettes (aOR: 2.00), cigarettes (aOR: 2.15), and cigars (aOR: 2.44) but not smokeless (aOR: 1.04; 95 % CI: 0.56 – 1.93). No association was observed between food insecurity and daily tobacco use. ConclusionSubstantial economic disparities in tobacco use were observed in a nationally representative sample of high school students. Interventions should consider prioritizing economic determinants of health during adolescence, including a focus on preventing youth tobacco use as well as addressing upstream determinants of homelessness and food insecurity.

Cardiometabolic risk factor clusters in older adults using latent class analysis on the Bushehr elderly health program

Metabolic syndrome (MetS), comprising obesity, insulin resistance, hypertension, and dyslipidemia, increases the risk of type II diabetes mellitus and cardiovascular disease. This study aimed to identify the prevalence and determinants of specific clusters of the MetS components and tobacco consumption among older adults in Iran. The current study was conducted in the second stage of the Bushehr Elderly Health (BEH) program in southern Iran—a population-based cohort including 2424 subjects aged ≥ 60 years. Latent class analysis (LCA) was used to identify MetS and tobacco consumption patterns. Multinomial logistic regression was conducted to investigate factors associated with each MetS class, including sociodemographic and behavioral variables. Out of 2424 individuals, the overall percentage of people with one or more components of MetS or current tobacco use was 57.8% and 20.8%, respectively. The mean (SD) age of all participants was 69.3(6.4) years. LCA ascertained the presence of four latent classes: class 1 (“low risk”; with a prevalence of 35.3%), class 2 (“MetS with medication-controlled diabetes”; 11.1%), class 3 (“high risk of MetS and associated medication use”; 27.1%), and class 4 (“central obesity and treated hypertension”; 26.4%). Compared to participants with a body mass index (BMI) < 30, participants with BMI ≥ 30 were more likely to belong to class 3 (OR 1.91, 95% CI 1.31–2.79) and class 4 (OR 1.49, 95% CI 1.06–2.08). Polypharmacy was associated with membership in class 2 (OR 2.07, 95% CI 1.12–3.81), class 3 (OR 9.77, 95% CI 6.12–15.59), and class 4 (OR 1.76, 95% CI 1.07–2.91). The elevated triglyceride-glucose index was associated with membership in class 2 (OR 12.33, 95% CI 7.75–19.61) and class 3 (OR 12.04, 95% CI 8.31–17.45). Individuals with poor self-related health were more likely to belong to class 3 (OR 1.43; 95% CI 1.08–1.93). Four classes were identified among older adults in Iran with distinct patterns of cardiometabolic risk factors. Segmenting elderly individuals into these cardiometabolic categories has the potential to enhance the monitoring and management of cardiometabolic risk factors. This strategy may help reduce the severe outcomes of metabolic syndrome in this susceptible population.

Comprehensive risk factor management through a dedicated secondary prevention clinic: experience from hamilton, Ontario

Abstract Introduction and Background Atherosclerotic cardiovascular diseases (ASCVD) remain a major source of morbidity and mortality. Modifiable ASCVD risk factors can be effectively treated, however, there is a lack of systematic implementation of secondary prevention therapies in ASCVD patients. We established a comprehensive secondary prevention program for patients with ASCVD to provide care for all modifiable risk factors in an integrated manner. Methods Patients with established coronary artery disease (CAD), cerebrovascular disease (CVD) and peripheral vascular disease (PVD) who had one or more uncontrolled risk factors, were referred to the center(s). Patients were assessed between November 2022 and October 2023. Uncontrolled risk factors were defined as dyslipidemia (LDL &amp;gt; 70 mg/dL [1.8 mmol/L]), hypertension (defined as BP &amp;gt;130/80 mmHg), diabetes (HbA1c &amp;gt;6.5%), chronic kidney disease (eGFR &amp;lt;60 ml/min/1.73m2) obesity (BMI &amp;gt;30 kg/m2) and current tobacco use. Data was collected at the initial visit and subsequent follow-up visits. Results A total of 274 patients were seen, with 85% were referred for CAD. Median age was 62 years,72% were men. The most common uncontrolled modifiable risk factor was hypertension (62% of patients), followed by dyslipidemia (60%) and obesity (50%). 39% of patients had diabetes, with 57% on a SGLT2i, 16% on a GLP-1 agonist and with 23% with HbA1c &amp;gt;8%. Blood pressure was above 140/90 mm Hg in 41% of patients, 20% were current smokers and 75% of patients had two or more uncontrolled risk factors. At the first visit, 56% of patients had a pharmacological intervention. The most common was for management of dyslipidemia, followed by diabetes and then hypertension. 17.8%(n=49) patients had a change in statin,13.8% (n= 38) patients were started on Ezetmibe, 9.1%(n=25) on Icosapent Ethyl, and 16.4% (n= 45) on a PCSK9i inhibitor (monoclonal antibody or Inclisiran). Among patients with diabetes, 5.1%(n=14) patients were started on a GLP-1 agonist and 2.5%(n=7) were started on a SGLT2i. 2.9%(n=8) patients were started on Varenicline and 2.9%(n=8) were started on NRT. Mean LDL (with LDL &amp;gt;1.8 at baseline) at visit 1 was at 3.03 ± 1.1 (n=157) mmol/dl, which reduced to 2.05 ± 0.9 (n=77) mmol/dl by 2nd visit and to 1.90 ± 1.3 (n=32) mmol/dl by visit 3. Average SBP (SBP &amp;gt;130 at baseline) at visit 1 was 143.3 ± 13.4 (n=114) mm Hg, this was subsequently reduced to 126.4 ± 14.0 (n=58) mm Hg at visit 2 and further reduced to 123.2 ± 14.7 (n=31) mm Hg by visit 3. Discussion and Impact: In our tertiary Cardiac Care center there are a significant number of patients with established ASCVD that remain on inadequate treatment for secondary prevention. Addressing these risk factors in a timely and integrated fashion in one clinic improves the implementation of guideline directed therapies for management of secondary risk factors in ASCVD and is expected to result in improved outcomes.

Demographic, Social, Behavioral, and Clinical Characteristics Associated with Long-Term Opioid Therapy and Any Opioid Prescription in High-Risk VA Patients.

Social risks (individual social and economic conditions) have been implicated as playing a major role in the opioid epidemic and may be more prevalent in the most medically vulnerable patients. However, the extent to which specific social risks and other patient factors are associated with opioid use among high-risk patients has not been comprehensively assessed. To identify patient-reported and electronic health record (EHR)-derived demographic, social, behavioral/psychological, and clinical characteristics associated with opioid use in Veterans Affairs (VA) patients at high risk for hospitalization or death. We used generalized estimating equations to calculate the probability of long-term opioid therapy (LTOT) and the probability of filling any opioid prescription (regardless of duration) over five intervals during a 4-year period (12/2016-12/2020). Prospective cohort of 4121 medically high-risk VA patients not receiving palliative or end-of-life care, and who responded to a survey mailed to a nationally representative sample of 10,000 high-risk VA patients. Patient-reported demographic, social risk, behavioral/psychological, and clinical measures, and linked EHR-derived data. The average age was 69.8years, 6.7% were female, and 17.5% were Non-Hispanic Black race/ethnicity. The majority had diagnosed chronic pain (76.1%). LTOT and any opioid prescription were positively associated with the following: younger age, non-Hispanic White race/ethnicity (compared to non-Hispanic Black race/ethnicity), male sex assigned at birth (LTOT only), not being currently employed, current tobacco use, no alcohol use, higher grit (any opioid prescription only), functional limitations, diagnosed chronic pain, lower comorbidity burden (LTOT only), obesity class I or class II/III (any opioid prescription only), undergoing surgery (any opioid prescription only), and diagnosed cancer (any opioid prescription only). Multifactor screening could help identify individuals at elevated risk for adverse opioid-related outcomes and augment current multifaceted initiatives, as several social risks and patient characteristics were predictors of LTOT and any opioid prescription.

The Intersection of Sexual Orientation, Substance Use, and Mental Health: Findings from Hints 5.

The data for this study were obtained from the Health Information National Trends Survey (HINTS 5, Cycle 4). Sample participants included 3583 adults (93.87% heterosexuals). We used multinomial regression to measure the relative risk ratios (RRRs) of being a former and current user versus never a user of tobacco and e-cigarettes and binomial regression to measure the odds ratios of depression between the LGBTQ and heterosexuals. Current smoking prevalence is higher among LGBTQ participants (17.3%) compared to heterosexuals (11.0%). The disparity is even greater for e-cigarette use, with 7.3% of LGBTQ participants being current users versus 2.8% of heterosexuals and 24.5% of LGBTQ participants being former users compared to 9.3% of heterosexuals. Compared to heterosexuals, the relative risk ratio of being a current tobacco user among the LGBTQ participants was about 1.75 times higher [RRR = 1.75, 95%CI = 1.16, 2.64], and that of e-cigarette use was about 2.8 times higher [RRR = 2.81, 95%CI = 1.57, 5.05]. Among current e-cigarette users, heterosexual participants had 1.9 percentage points [risk difference = 1.94, 95%CI = 1.20, 3.13] higher probability of depression, whereas among the LGBTQ participants, the risk was about 3.7 times higher [OR = 3.67, 95%CI = 1.06, 12.74]. Our findings conclude that the LGBTQ are more likely to use tobacco and e-cigarettes compared to heterosexuals and that the risk of depression from e-cigarette smoking is more pronounced among the LGBTQ participants.

Prevalence and Risk Factors of Oral Cancer Among Dental Students From Two Private Colleges in Pakistan: A Comparative Study.

Globally, oral cancer is still a major public health concern, with different lifestyle and socioeconomic variables influencing its occurrence. This study compared the prevalence and risk factors of oral cancer among students from private colleges in Pakistan, identifying patterns and variations in risk profiles within this group. This six-month cross-sectional research was carried out at Azra Naheed Dental College and Rahbar College of Dentistry, two private dental institutions in Lahore, Pakistan. Four hundred and thirty students between the ages of 18 and 30 who were split evenly between the two schools made up the sample. A well-structured questionnaire including lifestyle variables, oral cancer awareness, and demographic information was used to gather data. Dental practitioners with training conducted clinical oral exams to look for any indications of oral lesions. The demographic variables were summed up using descriptive statistics, and the relationships between risk factors and the prevalence of oral cancer were assessed using multivariate logistic regression analysis. A p-value of less than 0.05 was used to define statistical significance. Among the 430 students, 215 were from Azra Naheed Dental College and 215 were from Rahbar College of Dentistry; 12 students (5.58%) at Azra Naheed and 19 students (8.84%) at Rahbar College were found to have oral lesions. Regarding lifestyle factors, 69 students (32.22%) at Azra Naheed and 62 students (28.89%) at Rahbar College reported current tobacco use. Regular betel quid chewing was observed in 93 students (43.33%) at Azra Naheed compared to 77 students (35.56%) at Rahbar College. Dietary habits showed that 148 students (68.89%) at Azra Naheed and 138 students (64.44%) at Rahbar College consumed a diet high in processed foods. The multivariate logistic regression analysis identified significant risk factors for oral cancer, including current tobacco use (odds ratio (OR) = 2.15, p = 0.001), regular betel quid chewing (OR = 2.87, p < 0.001), and a diet high in processed foods (OR = 1.62, p = 0.021). The research identifies important risk factors for oral cancer among dentistry college students, pointing to the need for focused preventative and educational initiatives to address lifestyle-related concerns.

6914 Footing the Bill: Analysis of DFU-related amputation cost expenditure in a sample of HealthFirst Insured Patients

Abstract Disclosure: M. Hashmi: None. C. Schechter: None. A. Herrera Chancay: None. H. Tabassum: None. N. Shiraliyeva: None. J. Daily: None. A.K. Myers: None. Objective Diabetes complications, especially diabetic foot ulcers (DFU), are a leading cause of health care expenditures. This study examined the total cost of amputations and subsequent procedures in Health First insured (HF) patients initially treated at Montefiore Medical Center (MMC) for DFU. Using the database of HF, a large-scale Medicaid managed insurance organization, we captured healthcare utilization beyond the scope of one hospital system, obtaining a more comprehensive understanding of expenditures. We also explored the associations of demographic and lab values with expenditures. Methods The HF data extraction covered calendar years 2021 and 2022 plus YTD 2023. Amputations were identified by CPT codes 27880, 27590, 28810, and 28820. One hundred twenty patients were included in the sample as they had HF insurance and their initial admission for DFU was at one of three hospitals at MMC. Demographic and laboratory data were extracted from the EHR. Demographics, lab values within 3 months of the index admission, and total costs were summarized, and paid amounts per capita per year were calculated. Expenditures included amputation, labs, wound care, surgery, hyperbaric therapy, interpreter services, emergency department visits, home care visits, and outpatient follow-up (in-person and telehealth). We explored demographic, comorbidity, and lab values as predictors of expenditure levels using a bivariate analysis. Results The mean age was 60.6 ± 12 years with majority being male (n=79, 65.3%) and having Type 2 Diabetes (n=103, 96.3%). A significant portion identified their race as other (n=58, 53.7%) or ethnicity as Hispanic-Latino (n=60, 56.1%). Common comorbidities in this group were current or former tobacco use (n=64, 59.2%), chronic kidney disease (n=62, 57.9%), and hypertension (n=94, 86.2%). Glycemic control was suboptimal with an average Hemoglobin A1c of 9.1% (SD 3.1%) and average admission glucose of 232.2 mg/dL. C-reactive protein 17.1 (SD 34.1) and erythrocyte sedimentation rate 88.8 (SD 36.3) were both elevated for most patients. The DFU-related amputation cost was higher for Hispanic-Latino individuals, RR 1.97 (CI 1.04, 3.71) and for those with chronic kidney disease, RR 1.36 (1, 1.86). Female sex, serum glucose and BMI were moderately associated with increased relative cost. The study was limited by not having access to subsequent visits outside our health system and the retrospective nature of the study. Conclusions Our study highlights disparities among patients who underwent a DFU related amputation, with higher costs for Hispanic-Latino individuals, those with chronic kidney disease , and women, emphasizing the need for tailored interventions for these populations to ameliorate the high cost of DFU-related care. Presentation: 6/2/2024

Exploring cannabis information and perceptions of cannabis harms among patients with cancer.

361 Background: Cannabis use is rising among both the general and cancer populations. While the impact of cannabis on cancer care remains unclear, many patients who use cannabis report improvement in their cancer-related symptoms. However, little is known about the potential impact of cannabis on cancer development and treatment outcomes. Understanding patient beliefs about cannabis risks and their awareness of information about cannabis use may be important for future patient education. Here, we explored patient perceptions of harms and information-seeking habits on cannabis. Methods: Patients with cancer were recruited across outpatient ambulatory clinics at the Princess Margaret Cancer Centre (Toronto, Canada) through convenience sampling from July to August 2023. A one-time, paper-based, self-administered questionnaire was used to assess sociodemographic characteristics, perceptions of cannabis harms, and awareness of cannabis information. Multivariable regression analysis was used to identify factors associated with perceptions of cannabis use. Results: Among 243 participants, median age was 65 years, 45% reported lifetime cannabis use (12% were using cannabis at the time of survey), 50% were cigarette smokers, 62% were not employed full-time, and 77% spoke English as a primary language at home. Half (51%) of the participants reported being worried about the potential impacts of cannabis on their health. Current tobacco users (aOR=0.46 [0.19-1.07], p=0.07), primary English speakers at home (aOR=0.53 [0.28-1.01], p=0.06) and those not currently employed (aOR=0.57 [0.33-0.99], p=0.04) were less worried about the effect of cannabis on their health. Despite the perceived harms of cannabis, 84% of participants never sought cannabis-related information, while 40% wanted to know more about the influence of cannabis on cancer risk and treatment. Furthermore, Most (90%) participants reported never having discussed cannabis with their oncologists, but 93% felt it was important for healthcare providers to ask patients about cannabis use. Conclusions: Many patients with cancer are worried about the impact of cannabis on their health and want to know more about cannabis use in cancer care. Most patients report it is important for healthcare providers to have discussions about cannabis use. With the rising prevalence of cannabis use among patients with cancer, validated tools to assess cannabis use and cannabis-related educational resources specific to cancer risk and treatment outcomes should be explored to help address informational needs.

Patterns and Determinants of Exclusive Smokeless Tobacco (Snus) Use, Exclusive Smoking and Dual Use in General Population During 20 Years.

We investigate smokeless tobacco (snus) use and its correlates over 20 years in a country where selling snus is prohibited but a large import quota and illicit market exists. Repeated cross-sectional population-based surveys during 2000 to 2020 in Finland, including N = 57 111 adults aged 20 to 64 years. The outcome measures were current tobacco use (exclusive snus use, dual use, exclusive smoking, no tobacco use) and snus use (daily, occasional, no snus use). Study years, gender, age, education, marital status, self-rated health, body mass index, and binge drinking were used as explanatory variables. Exclusive snus use and dual use increased 3.6% units and 2.6% units from 2000 to 2005 and from 2018 to 2020, respectively. Overall decrease of tobacco use was led by decreasing exclusive smoking from 30.1% to 18.2%. The shared risk factors for snus use and dual use were male gender, age group 20 to 34 years, and binge drinking. The increases in snus and dual use over time were also most prevalent among these groups. Among men, occasional smoking increased the likelihood of daily (relative risk ratio [RRR] 2.38, 95% confidence interval [CI] 1.42, 3.99) and occasional (RRR 3.11, 95% CI 1.93, 5.03) snus use. Snus use has increased among the general adult population in Finland during 2000 to 2020 yet remains less common than smoking. Snus use and dual use share some common risk factors. Snus use should be considered in cessation services, with support for quitting developed and targeted predominantly for men, younger adults, and persons drinking to intoxication.

Leveraging electronic medical record (EMR) changes and virtual care towards improving tobacco screening and referral rates.

426 Background: Continued smoking after a cancer diagnosis is associated with poorer outcomes. Ontario Regional Cancer Centres are required to screen all new cancer patients for tobacco use and offer referrals for cessation support to patients using tobacco. At Princess Margaret Cancer Centre (Toronto, Canada), we leveraged an EMR change to Epic along with uptake in virtual care strategies from COVID-19, to improve both tobacco screening and referral rates for new patients. Methods: Following the EMR transition to Epic in June 2022, we piloted EMR and virtual care strategies from Jan 2023 to Mar 2024 to improve both tobacco screening and referral rates. Due to precautions during COVID-19, screening and referrals were completed using a hybrid pre-visit electronic tobacco use assessment questionnaire and in clinic paper-based referral system. Our interventions were co-developed by a team of hospital leadership, IT team members and clinicians. These included: 1) Collation of tobacco assessment data sources on Epic (Jan 2023); 2) Creation of an Epic referral inbox to track referrals (Aug 2023); 3) Assignment of electronic pre-visit tobacco assessments questionnaires to correct visit types (Sep 2023); 4) Creation of a half-day virtual nursing clinic to offer referrals for cessation support to patients initially declining support or those who were not offered using monthly reports from Epic (Nov 2023). Screening and referral rates were tracked monthly and quarterly during this period. Results: From Jan 2023 to March 2024, 15,063 new patients presented to our cancer centre. Baseline screening and referral rates before COVID-19 were 47% and 16%, respectively. Prior to this QI initiative, screening and referral rates were 18% and 1%, respectively. Post implementation, screening and referral rates improved to 42% and 25% (Table); rates of current tobacco use remained consistent from 12-16%. Collation of tobacco use assessments data on Epic had the greatest impact on improving screening rates from 18% to 39% (p&lt;0.001), while the virtual nursing clinic helped to improve referral rates from 3% to 25% (p&lt;0.001), with the greatest referral rate in Jan 2024 at 36%. Our virtual nursing clinic was feasible, where among patients contacted who initially declined or were not offered cessation support, 90% were contacted within 1-3 phone calls. Among patients contacted, 20% accepted a referral, while 41% of patients had already quit smoking by the time of contact. Conclusions: Both EMR and virtual care strategies helped to successfully improve both tobacco screening and referral rates for smoking cessation support; with the greatest impact from the collation of EMR data sources on tobacco use and development of a virtual nurse led clinic. Quarterly tobacco screening and referral rates. Jan-Mar 2023 Apr-Jun 2023 Jul-Sep 2023 Oct-Dec 2023 Jan-Mar 2024 Screening 33% 38% 39% 41% 42% Referrals 0% 1% 3% 20% 25%

Global burden of oral cancer in 2022 attributable to smokeless tobacco and areca nut consumption: a population attributable fraction analysis

Consuming products that contain smokeless tobacco or areca nut increases the risk of oral cancer. We aimed to estimate the burden of oral cancer attributable to smokeless tobacco or areca nut consumption globally and by type of smokeless tobacco or areca nut product in four major consuming countries. We calculated population attributable fractions (PAFs) using prevalence of current use of smokeless tobacco or areca nut products from national surveys and corresponding risks of oral cancer from the literature. We applied PAFs to national estimates of oral cancer incidence in 2022 from the Global Cancer Observatory's Cancer Today database to obtain cases attributable to smokeless tobacco or areca nut consumption. We modelled 95% uncertainty intervals (UIs) using Monte Carlo simulations. Globally, an estimated 120 200 (95% UI 115 300-124 300) cases of oral cancer diagnosed in 2022 were attributable to smokeless tobacco or areca nut consumption, accounting for 30·8% (95% UI 29·6-31·9) of all oral cancer cases (120 200 of 389 800). An estimated 77% of attributable cases were among male patients (92 600 cases, 95% UI 88 000-96 500) and 23% were among female patients (27 600 cases, 26 000-29 000). Regions with the highest PAFs were Melanesia, Micronesia, and Polynesia (78·6%, 95% UI 74·4-80·5), southcentral Asia (57·5%, 54·8-59·5), and southeastern Asia (19·8%, 19·0-20·6). Lower-middle-income countries represented 90·2% of the world total attributable cases (108 400 cases, 95% UI 103 400-112 200). Our findings suggest that one in three cases of oral cancer globally are attributable to smokeless tobacco or areca nut consumption, and could be prevented through smokeless tobacco and areca nut control. Global cancer control efforts must incorporate further measures to reduce smokeless tobacco and areca nut consumption in populations with the largest attributable burden. French National Cancer Institute.

Nicotine and cannabis routes of administration and dual use among U.S. young adults who identify as Hispanic, non-Hispanic Black, and non-Hispanic White

BackgroundUse of cannabis and nicotine is at record levels among young adults, and health consequences vary by route of administration. However, there is a paucity of research characterizing use of both substances, especially among individuals of racial/ethnic minoritized identities. MethodParticipants (N = 1,032; age 18–25 years) completed a cross-sectional survey administered through an online panel in 2021 in eight U.S. states where cannabis was legal for both recreational and medical use and eight states where cannabis was not legal for medical or recreational purposes. Sampling was stratified by race/ethnicity (Hispanic, non-Hispanic Black, non-Hispanic White) and gender (male, female). Survey weighting was based on state-level gender and race/ethnicity data in the 2021 U.S. Census Bureau. ResultsOver one third (37.9%) of respondents reported current use of both cannabis and tobacco, more than double the proportion using tobacco (12.1%) or cannabis (4.1%) only. Vaporization was the most common method for using nicotine (40.2%). Disposable nicotine vape products were used more than any other method (27.1%). Smoking was the most common route of administration for cannabis (35.7%). Simultaneous use of tobacco and cannabis was common (27.0%) overall and greater among those who identify as non-Hispanic Black than non-Hispanic White. There were few differences in product use by gender or state legality. DiscussionDual cannabis and tobacco use is prevalent among young adults. Given the dynamic regulatory landscape, continued monitoring of specific cannabis formulations and tobacco products is recommended. Trends in simultaneous use of cannabis and tobacco and associated adverse effects warrant continued assessment.

Long-term patient outcomes from a multidisciplinary cardiac rehabilitation programme with integrated nurse specialist support: A retrospective cohort study

BackgroundCardiac rehabilitation programmes, while demonstrating benefits, face challenges in universal adoption, particularly in New Zealand. This study evaluates the long-term impact of cardiac rehabilitation participation and attendance on survival and readmission rates in the Auckland Health District. ObjectiveTo examine the impact of patient participation in nurse-led lifestyle rehabilitation and physiotherapy exercise rehabilitation on key outcomes, including all-cause mortality, and all-cause, cardiac-specific, and kidney disease readmission rates. DesignRetrospective cohort study. SettingAuckland Health District, New Zealand. Participants3331 patients registered in the Auckland cardiac rehabilitation programme between 2016 and 2020. MethodsData analysis included examining associations between attendance at nurse-led lifestyle and physiotherapy-led exercise sessions and outcomes at 12, 24 months, and 2022 year-end, including all-cause mortality, all-cause readmission, and cardiac-specific readmission rates. Analysis methods included survival analysis, Cox proportional regression, and logistic binary regression, controlling for confounders using propensity score weights and baseline factors. Results1363 (40.9 %) patients attended at least one lifestyle rehabilitation session (average 5.0 ± 2.9 sessions), 1121 (33.7 %) patients attended at least one exercise rehabilitation session (average 6.8 ± 7.4 sessions), and 649 (19.5 %) patients attended at least one lifestyle and one exercise rehabilitation session. Increased likelihood of participation in rehabilitation was explained by ethnicity, while current and historical tobacco use, history of heart failure, receiving an angiogram, PCI, or other treatment such as medical management or implantable devices were associated with lower odds of participation. Participation in rehabilitation (average 7.9 ± 6.1 sessions) was associated with a higher mean survival estimate (7.6 years vs. 6.4 years, p < 0.001) while Cox proportional hazard regression, controlling for baseline factors and propensity score weights showed that a single session of rehabilitation attended had a 2.1 % decreased risk of mortality (hazard ratio = 0.98, 95 % CI: 0.96 to 0.99, p = 0.29). The cumulative hazard ratio for average attendance (7.9 ± 6.1 sessions) was 0.85 (95 % CI: 0.83 to 0.86, p < 0.001) indicating a 15 % decreased risk of mortality during follow-up. 20 % lower kidney disease readmission rates were observed among participants over the next 24 months (p < 0.05). However, no differences in all-cause or cardiac-specific readmission rates were observed. ConclusionsThe study supports the effectiveness of cardiac rehabilitation in improving long-term survival for Auckland Health District patients. The positive impact of nurse-led interventions and integrated support throughout the cardiac rehabilitation process highlights the need for translating this model to other health districts in New Zealand to optimise patient care and outcomes.

Study of Knowledge, Attitudes and Practices Related to Smoking Among Health Professionals in Public Hospitals in the Department of Dakar in 2021

Introduction: In Senegal, previous studies showed a prevalence of smoking among health professionals of between 11.6 and 12.8%. The general objective was to study smoking among health professionals in public hospitals in the department of Dakar. This was a cross-sectional study with a descriptive and analytical aim, the data collection phase of which took place from October 11 to November 23, 2021. The study population consisted of medical and paramedical staff. We collected 262 cases, i.e. a non-participation rate of 12.67%. Results: The average age of the health workers surveyed was 28.19 %. There were 148 men and women with a sex ratio of 1.30. Thus, 68.3% were single. During our study, the health workers at Abass NDAO Hospital were 110 (42%), 80 (30.5%) at the Principal Hospital in Dakar and 72 (27.5%) at HOGGY. The majority of the workers surveyed (69 cases, 26.3%) were DES or 7th year medical students. The least represented professional category was that of nursing assistants. Thus, 3.4% of the health workers surveyed were current tobacco users compared to 10.2% (26 health workers) who were former users. The average age at which these workers first used tobacco was 16.5 ± 2.5 years. Within the study population, 86% (225 workers) had never used tobacco. Smoked tobacco was the only form used by the subjects surveyed. The average consumption of smoked tobacco was 3.5 ± 0.51 times per day. However, the last attempt to quit was more than a year ago for the majority (5/7) of consumer health workers. The main reason for this attempt (failed) was awareness of the dangers of tobacco consumption (5/7). The main reason (05/07) that justified their tobacco consumption was stress management. All the workers surveyed were unanimous on the dangers of tobacco consumption on health. The consequences of tobacco most cited by the health workers surveyed were lung cancer (224 responses or 85.5% of respondents), COPD (205 or 78.24%) and strokes (165 or 62.98%). Male health workers were more likely to have good knowledge about smoking than female health workers. The agents thus surveyed had for 73.7% (i.e. 193 people) of them an insufficient or weak attitude towards smoking. Conclusion: At the end of our study and in light of the conclusions reached, we make the following suggestions to the health authorities: To organize communication-education sessions during World Tobacco Day.

Sociodemographic, mental, and physical health determinants of incident depressive symptoms among ageing men and women in rural South Africa: A longitudinal study from 2015 to 2022

We aimed to assess the associations between sociodemographic, mental, and physical health factors and incident depressive symptoms (IDS) among ageing men and women in rural South Africa over time. Data from the 7-year South African longitudinal Health and Ageing in Africa INDEPTH Community study (HAALSI: 2015–2022) were used in the analysis (study sample: n = 3 122, aged 40 and older). The proportion of IDS was in 28.2% in 2019 and 30.0% in 2022 among men, and 30.3% in 2019 and 2022 among women. Among men, the adjusted model indicated that older age, food insecurity, poor life satisfaction, physical pain, functional disability, diabetes, kidney disease, anaemia, and obesity were positively associated, and hypertension was negatively associated with IDS. Among women, food insecurity, poor life satisfaction, physical pain, and diabetes were positively associated, and current smokeless tobacco use was negatively associated with IDS. By sex, a high proportion of IDS were found, as was the prevalence of food insecurity, poor life satisfaction, physical pain, and diabetes associated with IDS. Among older men only, older age, functional disability, kidney disease, anaemia, and obesity, but not hypertension were associated with higher odds for IDS. Among older women, only current smokeless tobacco use was negatively associated with IDS. Interventions addressing the risk for depression should consider specific sex differences.

Flavored Tobacco User Characteristics in U.S. young Adults: Wave 5 of the Population Assessment of Tobacco and Health Study

Introduction: Flavorings are one of the major appealing factors of current tobacco products, especially for young adults. They constantly evolve, and new flavorings are introduced to the market every year, but little is known about user profiles of flavored tobacco products (FTPs). Methods: We analyzed young adult (ages 18–24) tobacco product users (N = 4,707) from Wave 5 of the Population Assessment of Tobacco and Health Study. We applied bivariate analyses to compare individuals who use FTP and non-FTPs by different flavor types (i.e., menthol/mint, fruit, candy/sweets, and tobacco). Parameter estimates were weighted by applying the sample and replicate weights for the complex study design to produce population-representative estimates. Results: Sixty percent of the current combustible tobacco users and 90% of electronic nicotine delivery systems (ENDS) users were FTP users. FTP users were more likely to be multiple product users than non-FTP users. Being non-Hispanic White, drinking alcohol in the past year, experiencing internalizing problems in the past month, and having tobacco dependence were associated with FTP use. Flavored ENDS users had different sociodemographic characteristics by flavor types but did not differ significantly in vaping-related behaviors (e.g., frequency). Also, preferred flavors differed among tobacco user groups (i.e., ENDS, hookah, and cigars). Conclusions: FTPs appear to be gaining popularity among young adults and tend to show co-use with multiple tobacco products and other substances. Future studies are warranted to monitor the risk factors of young adult FTP use, especially in the context of flavor ban on ENDS products.