High Smoking Rates Research Articles

Theoretically framing views of people who smoke in understanding what might work to support smoking cessation in coastal communities: adapting the TIDieR checklist to qualitative analysis for complex intervention development

IntroductionPeople living in coastal communities have some of the worst health outcomes in the UK, driven in part by high smoking rates. Deprived coastal communities include socially disadvantaged groups that struggle to access traditional stop smoking services. The study aimed to seek the views of people who smoke living in coastal communities, to assess the optimal smoking cessation intervention for this population. In addition, the Template for Intervention Description Replication (TIDieR) checklist was adapted as an analytical framework for qualitative data to inform intervention design.MethodsCurrent or recent ex-smokers (n = 25) were recruited to participate in qualitative interviews from a range of community locations in a deprived English seaside town. A thematic analysis of the interview data was undertaken adapting the TIDieR framework. This analysis was triangulated with relevant literature and notes from stakeholder meetings and observations to map onto the TIDieR checklist to describe the optimal intervention.ResultsBarriers to quitting smoking in the target population included low motivation to quit, high anxiety/boredom, normalisation of smoking and widespread illicit tobacco use. There was broad support for combining behavioural support, e-cigarettes and financial incentives, with a strong preference for the intervention to be delivered opportunistically and locally within (non-healthcare) community settings, in a non-pressurising manner, ideally by a community worker specially trained to give stop smoking support.ConclusionsAn intensive community-based smoking cessation intervention was acceptable to the target population. Adapting the TIDieR checklist as a deductive qualitative analytical framework offered a systematic approach to intervention development. Combined with other intervention development activities, this ensured that the intervention design process was transparent and the proposed intervention was well defined. It is recommended that prior to intervention development researchers speak to members of the target population who may give valuable insight into the optimal intervention.

Cancer Care in Resource-Limited Countries: Jordan as an Example.

Jordan, a lower- to middle-income country, is relatively small, but with rapidly growing population and a challenged economy. Cancer is a growing health care problem and currently ranked second, after cardiovascular diseases, as a cause of death. Jordan's national cancer registry continues to suffer from problems mostly related to long lag time in reporting, absence of outcome data, and accurate staging. The number of new patients with cancer diagnosed in Jordan is increasing at an expected, none disturbing rate, fueled by population growth, improving life expectancy, changing population structure that hosts more older population, high rate of obesity, smoking, and lack of adequate exercise. However, age-standardized rate for cancer incidence is significantly lower than Western societies, yet, mortality rate is higher. Despite efforts, cancer is still diagnosed at more advanced stages and at younger age. The Jordan breast cancer program represents a great example of opportunistic screening that led to significant downstaging of breast cancer. Efforts to evaluate the feasibility of screening programs for colorectal and lung cancers are underway. Tremendous efforts resulted in the execution of the largest clinical cancer genetics program in the region that helps identify patients and at-risk relatives for hereditary cancers. Low-resourced countries, including Jordan, will not be able to keep up with the rapidly increasing cost of cancer care. A better access to clinical trials and moving cancer care to ambulatory settings should offset some of this cost. A cancer control program that addresses all issues of cancer care from screening and early detection, through active cost-effective treatment that assures wider access to palliative care, hospice, and survivorship programs under an expanded universal health coverage, is an urgent national health priority.

Implementing a Metabolism-informed approach for smoking cessation in an Alaska Tribal health system: study protocol for a single-arm implementation pilot trial

BackgroundIndividualized treatment for commercial tobacco smoking cessation, such as through the utilization of the nicotine metabolite ratio (NMR), offers potential clinical benefit. NMR is a metabolism-informed biomarker that can be used to guide medication selection. NMR testing is particularly promising for tobacco cessation efforts in populations with high rates of smoking, such as some Alaska Native and American Indian (AN/AI) communities. To date, no prior study has evaluated the implementation of NMR-guided tobacco cessation with AN/AI populations.MethodsThe present “QUIT” protocol is a two-phase study that will occur at Southcentral Foundation (SCF), an Alaska Native-owned health system, serving 70,000 AN/AI people, based in Anchorage, Alaska. In Phase one, qualitative interviews with customer-owners (patients), providers and administrators (n = 36) and a 10-participant beta-test will be used to refine a strategy to implement NMR testing in the health system. Phase two will involve a single-arm pilot trial (n = 50) and qualitative interviews throughout data collection (n = 48) to evaluate the implementation strategy and explore the real-world acceptability and feasibility of NMR testing to guide tobacco cessation with AN/AI populations.DiscussionThis study utilizes a community-based participatory approach to refine and implement a nicotine metabolism-informed smoking cessation program in a Tribal healthcare setting. The process and findings from this study will reflect the importance of customer-owner choice and honor the lived experience involved in quitting commercial tobacco. Pilot study data will inform the effect and sample sizes required for a future pragmatic trial of NMR-guided smoking cessation.Trial registrationThis study will be registered with clinicaltrials.gov after the beta test is complete and the final IRB protocol is approved.

Cardiovascular risk factors among Roma and non-Roma populations in underprivileged settlements.

The 'Taking the screening tests close to the people' program offers cardiovascular screening to the inhabitants of underprivileged settlements. This study aimed to evaluate the cardiovascular risk factors of underprivileged populations, including individuals who described themselves as belonging to the Roma population. During the program, we collected information about demographic features, lifestyle and current illnesses. A general health assessment (body weight, height, blood pressure and fasting blood glucose) and cardiovascular examination were performed. We analysed data on both Roma and non-Roma groups and used Pearson's chi-squared test and multiple logistic regression models to analyse the factors that contribute to the onset of comorbidities, with a special focus on ethnicity. Data from 6211 participants were processed. Based on self-reports, the non-Roma population consisted of 5352 respondents (1364 men (25.5%) and 3988 women (74.5%)), and the Roma population comprised 859 respondents (200 men (23.3%) and 659 women (76.7%)). A total of 91.2% (4849) of the non-Roma population and 92.5% (788) of the Roma population exercised less than 3h per week (p < 0.001). Of the non-Roma population, 71.7% (3512) had a body mass index above 25kg/m2, while the corresponding figure was 72.4% (609) in the Roma population (p = 0.709). The median body mass index was 28.0 (24.6-31.9) in the non-Roma population and 28.8 (24.5-33.0) in the Roma population (p < 0.001). The prevalence of active smokers was 28.7% (1531) in the non-Roma population and 60.3% (516) in the Roma population (p < 0.001). The prevalence of hypertension was 54.9% (2824) in the non-Roma population and 49.8% (412) in the Roma population (p < 0.001). The prevalence of diabetes was 11.5% (95) in the Roma population and 12.2% (619) in the non-Roma population (p < 0.001). We found a high prevalence of overweight and obesity, a lack of physical activity and an remarkably high smoking rate in the studied underprivileged population. Both type 2 diabetes and hypertension were more common among people living in underprivileged settlements than in the general Hungarian population. People living in underprivileged settlements need more attention in primary care.

Is It Time to Ban Flavored Cigarettes in Asia-Pacific Countries? A Scoping Review.

Flavored cigarettes encourage youth smoking and deter quitting. No country in Asia-Pacific, a region with some of the world's highest smoking rates, has regulated tobacco flavors. We examined market data, academic literature, and gray literature to describe what is known on flavored cigarettes in the Asia-Pacific region. Of the 12 countries for which market data were available, ten had substantial flavored cigarette market shares ranging from 10% to 97%. With no regulations and growing markets for flavor capsule variants, the tobacco industry's ongoing promotion of flavored cigarettes, which targets primarily youth and women, is expected to drive further increases in smoking prevalence. There are significant research and monitoring gaps on the industry's marketing tactics and use of flavored cigarettes in the region. Given the large market shares, Asia-Pacific countries stand to benefit substantially from a tobacco flavors ban.

Unveiling the hidden pathologies: preoperative endoscopic findings in patients with obesity undergoing bariatric surgery

BackgroundObesity is closely associated with upper gastrointestinal disorders. The recommendations for routine preoperative esophagogastroduodenoscopy (EGD) before bariatric surgery remains a topic of debate. This study aimed to describe the pathological endoscopic findings in individuals qualified for bariatric surgery.MethodsRetrospective analysis was conducted on preoperative gastroscopy reports of patients who underwent bariatric surgery at our hospital between October 2022 and October 2023.ResultsA total of 405 patients were included in the study. The two most prevalent endoscopic findings during EGD in this patient cohort were chronic superficial gastritis (326/405, 80.5%) and reflux esophagitis (82/405, 20.2%). Some patients exhibited two or more abnormalities. Patients with reflux esophagitis were older, had a higher proportion of men, higher BMI, higher rates of smoking and drinking compared to those without it (P = 0.033, P < 0.001, P = 0.003, P = 0.001, and P = 0.003, respectively). Morbid obesity (P = 0.037), smoking habits (P = 0.012), and H. pylori infection (P = 0.023) were significant risk factors for reflux esophagitis in male patients, while age (P = 0.007) was the sole risk factor in female patients. No statistically significant differences were observed in surgical procedures between LA-A and B groups (P = 0.382), but statistically significant differences were noted between the nondiabetic and diabetic groups (P < 0.001).ConclusionsPreoperative EGD can unveil a broad spectrum of pathologies in patients with obesity, suggesting the need for routine examination before bariatric surgery. The findings of this study can guide bariatric surgeons in developing tailored treatments and procedures, thus significantly enhancing prognosis. Gastroscopy should be performed routinely in Chinese patients planning to undergo bariatric surgery.

Comparative Analysis of Right vs. Left Radial Access in Percutaneous Coronary Intervention: Impact on Silent Cerebral Ischemia.

Background and Objectives: Silent cerebral ischemia (SCI) is defined as a condition that can be detected by biochemical markers or cranial imaging methods but does not produce clinical symptom. This study aims both to compare the frequency of SCI in PCIs performed with right transradial access and left transradial access and to evaluate the influencing factors. Materials and Methods: A prospective, single-center study included 197 patients undergoing PCI via transradial access between November 2020 and July 2022. The patients were categorized into right radial and left radial groups. Neuron-specific enolase (NSE) values were measured and recorded before and 18 h after the procedure. A post-procedure NSE level higher than 20 ng/dL was defined as SCI. Results: SCI occurred in 60 of the 197 patients. NSE elevation was observed in 37.4% (n = 37) of the right radial group and in 23.5% (n = 23) of the left radial group (p = 0.032). Patients with SCI had higher rates of smoking (p = 0.043), presence of subclavian tortuosity (p = 0.027), and HbA1c (p = 0.031). In the multivariate logistic regression analysis, the level of EF (ejection fraction) (OR: 0.958 95% CI 0.920-0.998, p = 0.039), right radial preference (OR: 2.104 95% CI 1.102-3.995 p = 0.023), and smoking (OR: 2.088 95% CI 1.105-3.944, p = 0.023) were observed as independent variables of NSE elevation. Conclusions: Our findings suggest that PCI via right radial access poses a greater risk of SCI compared to left radial access. Anatomical considerations and technical challenges associated with right radial procedures and factors such as smoking and low ejection fraction contribute to this elevated risk.

Much lower prevalence and mortality of chronic obstructive pulmonary disease in Japan than in the US despite higher smoking rates: A meta analysis/systematic review.

A recent systematic review showed Japan's mortality from chronic obstructive pulmonary disease (COPD) is the lowest among 204 countries, despite notably higher smoking rates in men in Japan than in the US. This study aims to compare (1) trends in smoking rates, (2) trends in COPD mortality, and (3) the spirometry-based COPD prevalence in the general adult population between Japan and the US. Age- and sex-specific smoking rates from the 1980s through 2010s and COPD mortality from 1999 through 2019 were obtained from national surveys and official statistics (International Classification of Diseases-10th codes J40-44), respectively. A systematic review and meta-analysis was performed to estimate COPD prevalence in Japan, while the National Health and Nutrition Examination Survey 2007-2012 was used for the US. A fixed ratio of 0.7 of forced expiratory volume in the first second of forced vital capacity was used to define COPD. Over the past four decades, men in Japan consistently had 20-30% higher smoking rates than their US counterparts. From 1999-2019, age-adjusted COPD mortality in men in Japan was only a third of the US, whereas that in women was less than a tenth in 2019. Synthesizing data from 11 studies, involving 89,955 participants, Japan's COPD prevalence was more than 10% lower than in the US in almost all age groups for both sexes. This study showed markedly lower rates of COPD in Japan than in the US. Investigating factors contributing to the paradoxical observations could lead to advancing COPD risk reduction strategies.

Clinicopathological significance of mutation profile detected by next generation sequencing in different metastatic organs of non-small cell lung cancers

BackgroundThe primary tumor and it’s metastases show heterogeneity in molecular studies for targeted therapies in Non-Small Cell Lung Cancer(NSCLC), the leading cause of cancer-related deaths worldwide. The study aimed to identify somatic mutations in biopsies from NSCLC patients’ metastatic organs using Next-Generation Sequencing(NGS) and examine their association with clinicopathological parameters. Materials and methodsThe study included 128 NSCLC patients and, NGS was performed on tumor biopsies from different metastatic organs at Molecular Pathology laboratory of the Department of Medical Pathology in Aydın Adnan Menderes University Faculty of Medicine. The age, gender, histopathological diagnoses, metastatic organs, smoking and mutation status were all recorded, along with the analysis results of 72 genes and 4149 primers in the panel of the NGS system. Results53.9 % of the cases had a history of smoking and patients with brain metastases had a higher smoking rate(p=0.000). The most common occurrence(39.8 %) was lymph node metastasis, followed by brain(19.5 %). There was a strong correlation between mutation presence and metastasis in the liver(p=0.012), bone(p=0.002), and pleura(p=0.008). Smokers had a higher frequency of KRAS(p=0.000) and TP53(p=0.001) mutations. Brain metastases showed a statistically significant NF1 mutation(p=0.001), while the liver exhibited a significant BRAF mutation(p=0.000). NF1-TP53, PTEN-TP53 and NF1-PTEN were the most common concomitant mutations and, the brain was the most common metastatic organ in which they occurred. ConclusionOur results suggest prizing assessing detected mutations, in the prediction, follow-up and management of metastases, especially in patients with lung adenocarcinoma. The assessment also needs to consider the tumor's mutation status in metastatic organs. New therapeutic agents targeting NF1 mutations will be available in the future to treat NSCLC, especially in metastases.

CORRELATION OF MORBIDITY WITH SMOKING STATUS AND POSBINDU PTM TO PREPARE AGING SOCIETY HEALTH MANIFESTATION IN INDONESIA

Aging increases vulnerability to diseases, necessitating comprehensive strategies promoting healthy lifestyles. Posbindu PTM (Integrated Guidance Post for NCDs) is Indonesia's community-based program which was aimed to mitigate the impact of NCDs through monitoring risk factors and empowering individuals for early intervention and lifestyle’s changes. This study examined the correlations between smoking status, and implementation of Posbindu PTM among Indonesia's elderly population with morbidity rates. Data from 34 provinces were analyzed using Spearman's correlation test (α=5%) to examine relationships between morbidity rates (dependent variable) from the 2022 Elderly Population Statistics data, smoking status (active smokers, ex-smokers, non-smokers), and the percentage of Posbindu PTM implementation (independent variables) from the data of the 2021 Indonesia Health Profile. Active smokers (p=0.007, r=0.455) and ex-smokers (p=0.003, r=0.497) showed positive correlations with morbidity, while non-smokers (p=0.002, r=-0.506) exhibited a negative correlation. Posbindu PTM implementation (66,4% average in 2021) was not significantly correlated with morbidity (p=0.367). High smoking rates among Indonesia's elderly affect morbidity levels. Posbindu PTM, as an early detection and health promotion program, has not been well-implemented nationwide. Efforts and government commitment to prioritize health promotion and prevention at the grassroots level are essential for achieving a prosperous and effective aging society.

Building the African American/Black Community's Capacity to Elucidate Factors for High Smoking Rates in Jackson, MS: Results from Implementing a Community-Led Needs Assessment.

Although smoking has decreased dramatically over the last 50years, reductions are uneven by race and income, specifically in the Southern United States. There is a need for intentional collaboration with communities located where large tobacco disparities exist to make lasting change. Using community-based participatory research principles, we provided intensive capacity building to a community advisory group (CAG) of 14 Jackson, MS, residents to conduct a community-led needs assessment. The aim of the community-led needs assessment was to investigate firsthand why the community smokes and the impacts of smoking-giving the CAG voice and choice to work towards reducing tobacco-related harms and inequities. From October 2020 to September 2021, CAG members conducted thirteen interviews and nine focus groups, reaching 54 residents. We analyzed the data using a thematic and in vivo approach. Participants reported smoking is used to cope with systemic socio-economic issues (e.g., racism, poverty). Smoking is normalized in the community through continued use, ease of purchase, visibility of tobacco retailers, and lack of conversations or questioning surrounding smoking. Participants felt that peer and family use, addiction, and inaccessible smoking resources were the most influential factors driving smoking behaviors. This community engagement approach empowered residents to design and implement a comprehensive needs assessment resulting in rich data-a needed approach for a community experiencing enduring health inequities. Communities need to be engaged and invested in from the beginning as equal partners to learn, investigate, and develop community-relevant and innovative solutions to address tobacco social norms.

Global burden of bladder cancer attributable to smoking in 204 countries and territories, 1990–2019

Bladder cancer (BCa) poses a significant medical burden worldwide. However, the epidemiological pattern of the global smoking-induced BCa burden is unclear. Our analysis of the 2019 Global Burden of Disease (GBD) database showed a significant increase in the number of BCa cases worldwide from 1990 to 2019, with a clear upward trend in both age-standardized prevalence and incidence. In contrast, age-standardized rates of mortality (ASMR) and disability-adjusted life-years (ASDR) showed a downward trend, despite an increase in the absolute number of death and disability-adjusted life years. The burden of BCa caused by smoking is greater in males, middle-aged and older adults, and people in countries with high-middle socio-demographic indices (SDI). The study highlights the continuing global health challenge posed by smoking-related BCa. Targeted health policies and interventions are critical, especially in areas with high smoking rates and low socioeconomic status.

Predictors of hemorrhagic transformation in patients of first ever acute ischemic stroke receiving recombinant tissue plasminogen activator (rTPA)

Abstract Background Hemorrhagic transformation (HT) represents a serious complication of acute ischemic stroke (AIS). Aim To detect predictive factors linked to HT among patients having a first-ever AIS who received recombinant tissue plasminogen activator (rTPA), for better preselection of patients eligible for thrombolytic therapy. Patients and methods This research took place at the Neuropsychiatry Department and Centre of Psychiatry, Neurology, and Neurosurgery, Tanta University Hospitals over 12 months. The total number of patients included was 460, with 115 who received rTPA and 345 who did not receive rTPA. All participants underwent a comprehensive medical history, clinical and neurological assessments, radiological evaluation (ASPECT score), cardiac investigation, and were followed-up for two weeks to detect any HT. Results Patients with HT represented 21.7% of all rTPA patients, with symptomatic intracranial hemorrhage representing 6.9%, while non-rTPA patients with HT represented 13.9% and symptomatic intracranial hemorrhage represented 4.3%. HT patients in the rTPA group had significantly higher rates of smoking, respiratory rate, and lower platelet count, low density lipoprotein and cholesterol levels, while HT patients in the non-rTPA group exhibited significantly higher blood pressure, random blood sugar, as well as lower ASPECT scores. Conclusion There was an association between HT and five predictors (higher smoking rate, higher respiratory rate, lower platelet count, and lower low density lipoprotein and cholesterol levels) in first ever acute ischemic stroke patients receiving rTPA. In patients who did not receive rTPA, HT was associated with lower ASPECT scores, higher blood pressure, and random blood sugar.

Evaluation of glycemic control, comorbidities, complications and mortality twenty-five-year follow-up at a diabetes outpatient clinic in Brazil

Objective: The objective of this study is to evaluate glycemic control, comorbidities, diabetes-related complications, and mortality among people with DM followed-up at an outpatient clinic based at a Diabetes Association in Brazil. Methods: Sociodemographic, medical and mortality data were obtained from 1,173 patients with type 1 (T1DM) and type 2 diabetes (T2DM) who were evaluated once between 1996-2011 and whose vital status was checked in 2022. Data were analyzed using statistical tests to find out different characteristics between patients with DM1 and DM2. Results: 204 patients had T1DM (17.3%), 969 T2DM (82.6%) and 404 (34.4%) died during the study period (2.8% T1DM and 31.6% T2DM). Among T1DM, 82.3% had inadequate glycemic control, 61.2% had no associated comorbidity and presented varied causes of death. Regarding T2DM, 64.18% had inadequate glycemic control, had more comorbidities, higher rates of smoking and died more frequently due to cardiovascular diseases. Conclusion: Based on glycemic control, current care model provided needs to be rethought to provide more frequent clinical follow-up and structured education. Training health professionals, general practitioners and specialists is urgently needed as well as further long-term prospective studies in this topic.

Response to adalimumab in Caucasian and Asian patients with hidradenitis suppurativa: A retrospective cohort study of an Australian cohort stratified by patient-reported ethnicity.

Caucasian and Asian patients with hidradenitis suppurativa demonstrate significant differences with regard to age, gender and body mass index. Demographic characteristics are known to influence the efficacy and drug survival of hidradenitis suppurativa therapeutics including biologic therapies. What remains unknown is the impact of ethnicity upon the efficacy of therapeutics once demographic and disease characteristics have been taken into account. This is an important question given the expansion of biologic therapies for HS into the global patient community. We assessed 170 patients from a single HS specialist centre in Australia stratified by patient-identified ethnicity including those identifying as either Caucasian or Asian. Asian patients demonstrated lower BMI, higher rates of smoking and greater odds of Hurley stage 3 disease with tunnels than Caucasian patients in line with the reported literature. There was no significant difference between percentage of individuals achieving HiSCR50 or IHS4-55 at Week 16. Significant differences were seen in median time to secondary loss of response, and Kaplan-Meier curve analysis showed a significant difference between curves when stratified by patient-reported ethnicity. Cox regression analysis demonstrated after accounting for age, gender, BMI, smoking and Hurley stage, the significance of ethnicity in influencing time to secondary loss of response disappears. Caucasian or Asian ethnicity does not influence response to adalimumab treatment on patients with hidradenitis suppurativa.

Acute nicotine vapor normalizes sensorimotor gating and reduces locomotor activity deficits in HIV-1 transgenic rats.

Despite improved life expectancy of people with HIV (PWH), HIV-associated neurocognitive impairment (NCI) persists, alongside deficits in sensorimotor gating and neuroinflammation. PWH exhibit high smoking rates, possibly due to neuroprotective, anti-inflammatory, and cognitive-enhancing effects of nicotine, suggesting potential self-medication. Here, we tested the effects of acute nicotine vapor exposure on translatable measures of sensorimotor gating and exploratory behavior in the HIV-1 transgenic (HIV-1Tg) rat model of HIV. Male and female HIV-1Tg and F344 control rats (n=57) were exposed to acute nicotine or vehicle vapor. Sensorimotor gating was assessed using prepulse inhibition (PPI) of the acoustic startle response, and exploratory behavior was evaluated using the behavioral pattern monitor (BPM). Vehicle-treated HIV-1Tg rats exhibited PPI deficits at low prepulse intensities compared to F344 controls, as seen previously. No PPI deficits were observed in nicotine-treated HIV1-Tg rats, however. HIV-1Tg rats were hypoactive in the BPM relative to controls, whilst nicotine vapor increased activity and exploratory behavior across genotypes. Cotinine analyses confirmed comparable levels of the primary metabolite of nicotine across genotypes. Previous findings of PPI deficits in HIV-1Tg rats were replicated and, importantly, attenuated by acute nicotine vapor. Evidence for similar cotinine levels suggest a nicotine-specific effect in HIV-1Tg rats. HIV-1Tg rats had reduced exploratory behavior compared to controls, attenuated by acute nicotine vapor. Therefore, acute nicotine may be beneficial for remediating sensorimotor and locomotor activity deficits in PWH. Future studies should determine the long-term effects of nicotine vapor on similar HIV/NCI-relevant behaviors.

Influence of smoking on changes in indicators of bronchitis, asthma and lung cancer - comparison on the example of Poland, Malta and other European Union countries

Introduction. Smoking is associated with respiratory diseases. Despite declining smoking rates, asthma and chronic bronchitis cases rose between 2014 and 2019. Quitting smoking is vital for managing asthma and reducing the risks of bronchitis and lung cancer. Aim. A correlational study of smoking prevalence and its association with asthma, bronchitis and lung cancer in people from Malta, Poland and the EU in 2008/2014/2019. Materials and methods. Integration and comparison of statistical data from EUROSTAT – (EHIS) 2008/2014/2019, ISAAC; ESPAD, 2014/2015, ECIS 2020. Results. Smoking habits exhibit notable gender disparities, with 24% of Polish men and 23% of Maltese men being regular smokers, compared to women (Poland – 15%, Malta – 16%). While male smoking rates have declined, especially in Poland, female rates persist. In 2019, asthma affected 5.6% of the EU adult population, with Poland at 4.1% and Malta at 6%. Chronic bronchitis is more prevalent in Poland (3%) than Malta (1%). In 2020, lung cancer rates among men varied slightly between Poland and Malta (120.0; 100.3 per 100.000). However, the incidence among women is twice as high in Poland (53.1; 23.9 per 100.000). Conclusions. Malta’s elevated asthma rate, despite comparable smoking rates, hints at additional risk factors like traffic. Poland’s increased bronchitis rate likely stems from higher historical smoking. The doubled lung cancer incidence in Polish women suggests a passive smoking connection. The burden of bronchitis intensifies due to high smoking rates in men over 50. Addressing smoking rates can potentially address respiratory disease rates, but other risk factors should also be identified and managed. Keywords: tobacco smoking, asthma, bronchitis, lung cancer.

The impact of gender differences on the clinical characteristics of critically ill patients with venous thromboembolism: A retrospective, observational study.

The aim of this study is to describe the general information, disease and treatment of venous thromboembolism (VTE) in critically ill patients, to explore the characteristics of severe patients with deep venous VTE and provide clinical reference data for the prevention and treatment of VTE in critically ill patients. This study carried out a retrospective study on the medical records of patients who were treated in the intensive care unit of Affiliated Hospital of Jining Medical College from 2020 to 2022. The general data, general conditions, drug use, past history, VTE prevention measures, post-VTE conditions, and Padua risk score of 297 patients with VTE during the period of hospitalization in intensive care unit (ICU) were classified and statistically analyzed. A total of 297 including 171 male and 126 male patient medical records were included in the analysis, we compared multiple clinical indicators between male and female patients. Compared to women, male patients have a higher acute physiology and chronic health evaluation II score(APACHE-II score) (P = .027), a higher state of consciousness (P = .003), a higher rate of smoking and drinking history (P < .001), a lower rate of heart failure (P = .003) and chronic depression (P = .013), and a higher rate of recommended operations for male patients after VTE (P = .031). The prothrombin time (PT) (P = .041) and activated partial thromboplastin time (APTT) (P = .040) of male patients were significantly higher than those of female patients, while triglyceride (P = .009) and total cholesterol (TC) (P = .001) were significantly lower than those of female patients. The difference in D-dimer (P = .739) was not significant. This study shows that male and female patients with VTE in the ICU have significant differences in general characteristics, general clinical conditions, history of past illness, thrombosis character, and examination items, this may be the reason for the different rates of VTE between male and female patients in the ICU.

Associations Between Pro/Anti-Tobacco Media and Messaging Exposure and Knowledge and Support of Smoke-Free Policy Among Adults in Armenia and Georgia.

Despite high smoking rates, Armenia and Georgia recently adopted smoke-free policies (2022 and 2018). We examined associations between exposure to pro-tobacco media (news opposing smoke-free policies; cigarette, e-cigarette, heated tobacco product [HTP] advertisements) and anti-tobacco media (media, community-based action) and (1) knowledge that the policies applied to alternative tobacco products (ATPs), and (2) support for the policies applying to ATPs and various settings. We analyzed 2022 survey data. Data were from 28 communities in Armenia and Georgia. The sample comprised 1468 adults (31.6% past-month smokers). We conducted multivariable regressions, controlling for country and sociodemographics. Participants were knowledgeable that the policy applied to ATPs (79.2%) and supportive of them applying to ATPs and various settings (means = 3.43 and 3.00; 1-4 = strongly support). Greater exposure to anti-tobacco media/community-based action correlated with more likely knowing that the policies applied to ATPs and greater support of the policies applying to various settings; HTP advertisement exposure correlated with less support of the policies applying to various settings. Less exposure to news opposing smoke-free policies and greater exposure to media supporting such policies correlated with greater support of the policies applying to ATPs. Media and community-based action may promote smoke-free policy knowledge and support. HTP advertisements may uniquely undermine smoke-free policies.

Disparities in trends in bladder cancer mortality between urban and rural patients: A 2000-2020 analysis.

4583 Background: Patients in rural areas in the US often have worse healthcare outcomes due to socioeconomic deprivation, higher rates of smoking, and limited access to medical care. Despite a general decline in bladder cancer mortality over the past two decades, comprehensive studies comparing these trends between urban and rural mortality are scarce. Methods: Utilizing the CDC WONDER database, we extracted mortality data for bladder cancer from 2000 to 2020. Age-adjusted mortality rates per 100,000 persons were standardized to the Year 2000 US standard population. Data segmentation by urbanity utilized the 2013 National Center for Health Statistics Urban-Rural Classification Scheme. The National Cancer Institute's Joinpoint Regression Program was employed to calculate average annual percent changes (AAPCs) and annual percent changes (APCs). Results: In our analysis, we identified a total of 306,750 bladder cancer death cases from 2000 to 2020. Significant improvements in bladder cancer mortality were observed in urban areas, with large central metros experiencing the most pronounced decrease (AAPC -1.0%, p&lt;0.001). This decline was moderate between 2000 and 2016 (APC -0.3, p&lt; 0.001) but accelerated between 2016 and 2020 (APC -3.8%, p&lt;0.001). Large fringe and medium metros also saw comparatively smaller but significant declines (AAPC -0.6%, P&lt;0.05) and also accelerated between 2016-2020. In contrast, small metro and rural areas (micropolitan and noncore) showed no significant improvement, with mortality rates remaining stable between 2000 and 2020 (AAPC 0.2%, P=0.099). Conclusions: This analysis, the largest to date comparing urban and rural mortality trends in bladder cancer, highlights significant disparities in outcomes between large urban and rural areas. The marked improvement in urban areas, especially noted around the time novel agents such as immunotherapy were introduced, underscores the potential impact of advanced treatments. However, the stable mortality rates in rural areas suggest that access to advanced care, environmental influences, socioeconomic status, and slower adaptation of new guidelines in rural settings may play critical roles. These findings underline the urgent need for strategies to close the urban-rural gap. [Table: see text]