High Tobacco Research Articles

Six-month contingency management effects on smoking cessation in individuals with substance use disorders

IntroductionPersons with substance use disorders (SUD) smoke at strikingly high rates and tobacco use cessation rates are notably low in this population. Contingency Management (CM) is effective to promote substance abstinence, including tobacco, in a large range of populations. CM is scarcely implemented in clinical settings mainly due to barriers at the therapist and organizational levels.ObjectivesThe study sought to examine the additive effectiveness of CM on Cognitive-Behavioral Therapy (CBT) over long-term smoking abstinence in persons undergoing SUD treatment.MethodsA total of 54 smokers (75.9% males, Mage=46.19, SD=9.21) were randomly assigned to CBT (n=30) or to CBT+CM (n=24). Interventions consisted of eight weeks of group-based therapy. Participants were instructed to gradually reduce their nicotine intake by 20% weekly. The CM arm was voucher-based, and the primary outcome was biochemically verified tobacco abstinence (CO≤4ppm, and urine cotinine≤80ng/ml).ResultsA total of 42/54 (77.78%) participants completed the treatment (73.33% in CBT and 83.33% in CBT+CM; p=.380). At the end of treatment, participants in CBT+CM showed higher 24-hour smoking abstinence (50% vs. 20%, p=.032); however, both treatment conditions show equal abstinence rates in the remaining follow-ups (CBT1month= 13.33% vs. CBT+CM1month= 25%; CBT2months= 10% vs. CBT+CM2months= 16.66%; CBT3months= 10% vs. CBT+CM3months= 16.66%; CBT6months= 10% vs. CBT+CM6months= 8.33%; all p-values ≥ .244).ConclusionsCM facilitates early abstinence outcomes in smokers with SUD more than CBT only does. However, no additive effects of CM were observed at long-term, suggesting the convenience to intensify CM schedules or using technology platforms for incentives delivery.DisclosureNo significant relationships.

Changes in student behaviors and policy opinion regarding E-cigarettes at a Kentucky University from 2014 to 2018.

The behaviors and opinions regarding e-cigarette use and campus policies prohibiting vaping vary greatly among college students nationally. Kentucky is one of the four U.S. states with the highest tobacco use prevalence, and characterizing e-cigarette use, trends and policy opinions among Kentucky undergraduates may inform interventions. To characterize population-level differences in e-cigarette-related behaviors and policy opinions among undergraduates from 2014 to 2018, results from two cross-sectional surveys (2014 and 2018) from a public regional university in south-central Kentucky were analyzed. Students from randomly selected undergraduate general studies courses completed a 5-minute in-class survey. Data were obtained from 514 and 519 respondents in 2014 and 2018, respectively. Mean age did not differ (19.9 and 20.1 years; p = 0.41) nor did class rank (p = 0.30) by survey year. Chi-square analysis indicated previous 30-day e-cigarette use was higher in 2018 than 2014 (28% vs. 18%; p < 0.001), and current cigarette use was lower in 2018 than 2014 (13% vs. 25%; p < 0.001). When current smoking and recent e-cigarette use were combined as a use variable, there was no significant difference between 2018 (29%) and 2014 (30%). Fraternity/sorority affiliation, being under 22 years old, male gender, out-of-state residency, and having a smoking parent were associated with recent e-cigarette use in multivariable logit models. Support for the on-campus vaping prohibition was lower among 2018 respondents (68% approval) compared to 2014 respondents (74% approval), respectively (p = 0.022). Overall, these findings may inform policy, population-specific health communications, and future research.

Exposure to Cadmium, Lead, and Tobacco Smoke and the 10-Year Cumulative Incidence of Olfactory Impairment

Olfactory impairment is common in older adults. Identification of modifiable risk factors for olfactory impairment at midlife has the potential to reduce the burden of olfactory impairment at older ages. To determine the 10-year cumulative incidence of olfactory impairment and evaluate potentially modifiable risk factors for impairment including exposure to cadmium, lead, and tobacco smoke. Data from the Beaver Dam Offspring Study, a longitudinal cohort study of sensory health and aging in a general population, were available from examinations at baseline (2005-2008), 5 years (2010-2013), and 10 (2015-2017) years. A total of 2312 participants without olfactory impairment at baseline and with olfaction data available at the 5- and/or 10-year examination were included. The present study was conducted from April 28, 2020, to January 8, 2021. Olfactory impairment was measured by the San Diego Odor Identification Test. Cox discrete-time proportional hazards analyses were used to model associations between baseline covariates, including blood cadmium and lead levels and tobacco smoke exposure, and the 10-year cumulative incidence of olfactory impairment. Of the 2312 participants, 1269 (54.9%) were women; mean age was 49 years (range, 22-84 years) at baseline. The 10-year cumulative incidence of olfactory impairment was 4.6% (95% CI, 3.7%-5.6%) and increased with age. Because of high collinearity, cadmium and tobacco smoke exposure were modeled separately. In a multivariable adjusted model, higher blood cadmium level (hazard ratio [HR], 1.70; 95% CI, 1.05-2.74) was associated with the 10-year cumulative incidence of olfactory impairment. Substituting tobacco smoke exposure for cadmium in the model, high exposure to tobacco smoke as a current smoker (HR, 2.94; 95% CI, 1.63-5.29, smoker vs no exposure) or from environmental tobacco smoke (HR, 2.65; 95% CI, 1.24-5.63, high vs no exposure) was also associated with an increased risk for developing olfactory impairment. Blood lead levels were not associated with olfactory impairment. Results of this longitudinal cohort study suggest that modifiable environmental exposures may contribute to olfactory impairment that occurs with aging. Identification of modifiable risk factors for olfactory impairment may lead to prevention strategies that have the potential to reduce the burden of olfactory impairment at older ages.

Burden of increased blood glucose due to modifiable risk factors among men in India

Background and aimsWorldwide, many diabetes cases are occurring mainly due to lifestyle risk factors. Hence, to quantify and compare the attributable burden of key modifiable risk factors associated with increased Blood Glucose (BG) among Indian states and districts. MethodsThe study used the National Family Health Survey (2015–16) data to estimate Population Attributable Risk (PAR) for increased BG (>140 mg/dl) among men aged 15–54 years in 640 districts of 36 States/Union Territories (UTs), India. We have considered three key modifiable factors such as high Body Mass Index (BMI), use of tobacco and alcohol. Population Attributable Risk techniques were employed to address the attributable burden of increased blood glucose due to modifiable risk factors. ResultsSubstantial variations were found in the burden of increased BG due to high BMI, alcohol and tobacco use in India. The overall burden of increased BG due to high BMI, tobacco and alcohol in India was 28.5%, 2.1% and 6.4%, respectively. Regional variations in BG were found in high BMI, tobacco and alcohol consumption groups. The high burden of increased BG related to the above key modifiable risk factors mostly seen in North-Eastern’ districts due to alcohol, Southern and Northern’ districts was due to high BMI. However, the higher burden due to tobacco was reported in Central, Eastern and North-Eastern’ districts. ConclusionThree modifiable risk factors are contributing significantly to increased BG among men. Since there are regional differences in their contributions, state/district, specific targeted interventions may be necessary to control increased BG among men in India.

Disparities in absolute cardiovascular risk, metabolic syndrome, hypertension, and other risk factors by income within racial/ethnic groups among middle-aged and older US people.

This cross-sectional study determined income disparities in age-adjusted prevalence and trends of 10-year high absolute cardiovascular disease (CVD) risk, metabolic syndrome, hypertension, diabetes, obesity, chronic kidney disease (CKD), leisure-time physical activity (LTPA), and current tobacco smoking within racial/ethnic groups in the US. National Health and Nutrition Examination Survey 2001-2016 data of 40-79-year-old people were analyzed. Survey periods were grouped as 2001-2006, 2007-2012, and 2013-2016. Race/ethnicity was grouped as non-Hispanic whites, non-Hispanic blacks, and other races/ethnicities. Three equal-sized strata (low-, middle-, and high income) were made from the family income-to-poverty ratio. Of the 25,777 participants (mean age: 55.6 years, 48% males), a majority of the studied prevalence was higher in most survey years among non-Hispanic blacks compared to non-Hispanic whites. Most studied prevalence was also higher among low-income people than middle-/high-income people. Within racial/ethnic groups, the prevalence also differed by income for high CVD risk, metabolic syndrome, hypertension, diabetes, obesity, CKD, LTPA, and tobacco smoking (P < 0.05) in most survey periods. After stratifying by race/ethnicity, the prevalence of many conditions remained disproportionately higher among low- and middle-income people, compared to those with high income during most survey periods in all racial/ethnic groups. These results reveal income in addition to race/ethnicity to be an important correlate of cardiovascular health and underscore the need to consider each when controlling for risk factors.

ES12.01 Patient Perspective on Lung Cancer Screening and Health Disparities

Lung cancer is the leading cause of cancer deaths in much of the world. Over 80% of lung cancer deaths are caused by tobacco. Systematic reviews show smoking rates are higher in low socio-economic status individuals.(1) This is true even in low and middle income countries(2). In the United States Native Americans and Alaska Natives have the highest tobacco use; 32.3% of Native Americans/Alaska Natives use any tobacco product as compared to 21.9% of Whites. In Canada, the Intuit have the highest smoking rates; 74% of Intuits in Canada smoke as compared to 23% of non-Aboriginal individuals in Ontario.(3) Smoking rates in Australian Indigenous populations are about double those of Non-indigenous populations.(4) Indigenous/Native populations and Blacks are at higher risk of lung cancer than non-indigenous populations and Whites. They are diagnosed at a younger age and have higher lung cancer incidence and mortality rates. In the US, Black men have 15% higher lung cancer incidence rates and 19% higher mortality rates than whites. Overall US indigenous/native populations have 8.8% higher lung cancer incidence rates than non-Hispanic whites with local incidence rates up to 80% higher in Alaska Native, Southern and Northern Plain populations.(5) Similarly, in Australia indigenous populations have higher lung cancer incidence and mortality rates and a younger age at diagnosis. (4) In the Ontario province in Canada lung cancer incidence rates are 19% higher for indigenous men and 48% higher for indigenous women as compared to non-Indigenous men and women respectively. Mortality in indigenous men is 13% higher and 43% higher in women than non-indigenous men and women respectively.(6) Age and smoking history don’t capture everyone at equivalent risk. Blacks are less likely to meet current CT lung screening criteria in the US than whites. Aldrich et al. assessed eligibility for CT lung screening using 2013 USPSTF screening guidelines in the Southern Community Cohort.(7) In their sample of 48,364 individuals, 17% of Blacks were eligible for screening as compared to 31% of whites. In the subset diagnosed with lung cancer (n= 1269): 32% of Blacks would have been eligible for screening as compared to 56% of whites. The American Lung Association 2020 State of Lung Cancer Report shows US CT lung screening rates are still low. The national average is 5.7% with large state to state variation. Massachusetts has the highest screening rate at 18.5% and Utah the lowest at 1%. Significant challenges remain for patients, especially those in disadvantage populations. These include lack of access to care, lack of awareness of the option for screening, difficult to understand eligibility criteria, distrust of the medical community, stigma and implicit bias due to the close association with smoking, nihilism and low perceived risk of getting lung cancer. Disadvantaged populations experience double stigma; the stigma of their lung cancer and the stigma of their disadvantage. It’s imperative to address eligibility, awareness, and access to CT lung screening for Blacks, indigenous/native populations and other disadvantaged populations to avoid increasing the current mortality and morbidity disparity for these populations. Encouragingly, in the US, the USPSTF updated draft CT lung screening recommendations lower the age of eligibility from 55 to 50 and the smoking history from 30 to 20 pack years. This will help address the disparity in screening eligibility between Blacks and whites of equivalent risk. A better approach to screen those at highest equivalent risk is to use a lung cancer risk prediction model as part of eligibility criteria. Recommended interventions include: Implementation of outreach programs to raise awareness and to provide CT lung screening in underserved communities. A good example of this is the Crosbie et al. UK mobile van lung health check study (8) Develop relationships with national and local minority organizations and partner with native/indigenous community leaders Form multidisciplinary state/provincial/local CT lung screening coalitions and learning collaboratives. Share lessons learned. Include lung cancer risk prediction model risk score in eligibility criteria. Example approaches include the Cancer Care Ontario program in Canada and the International Lung Screening Trial. Education to address stigma and clinician implicit bias and nihilism. Position lung cancer screening as health choice, similar to mammography and colonoscopy, co-develop culturally tailored education materials, public health campaigns raising awareness about stigma and implicit bias including information on glamorization of smoking in the early days when many eligible for CT lung screening started smoking.

Tobacco Use Among Reproductive Age Women in Ethiopia: Evidence from the National Health Survey.

PurposeTo assess the prevalence and determinants of current tobacco use among reproductive-age women in Ethiopia.MethodsA cross-sectional study was conducted by utilizing secondary data taken from the Ethiopian Demographic Health Survey of 2016. Descriptive statistics and logistic regressions were used to analyze the data. The odds ratio with a 95% confidence interval was considered to interpret associations and a significant association was stated at a p-value < 0.05.ResultsThe overall magnitude of current tobacco use was 1.4% (n= 217). Majority of them 59.91% (n= 130) smoke cigarettes and followed by smoking gaya 43.32% (n= 94). Higher prevalence was found among participants from Gambella 44.24% (n= 96), Benishangul.59% (n= 36) and afar regions 13.36% (n= 29). Age group of 25–34 years [AOR = 2.78; 95% CI: 1.69, 4.57)], age group of ≥ 35 years [AOR = 4.24; 95% CI: 2.54, 7.07)], followers of protestant religion [AOR = 2.36; 95% CI: 4.17, 9.42], Islamic religion [AOR = 3.92; 95% CI: 2.16, 7.11], and traditional religion [AOR = 16.23; 95% CI: 8.33, 31.61], being in poorest wealth index [AOR = 15.78; 95% CI: 7.38, 33.70], poorer wealth index [AOR = 5.85; 95% CI: 2.64, 12.97], middle wealth index [AOR = 3.61; 95% CI: 1.57, 8.29], and richer wealth index [AOR = 2.48; 95% CI: 1.10, 5.85], who were never in union [AOR = 0.31; 95% CI: 0.14, 0.67], ever drinking alcohol [AOR = 5.44; 95% CI: 3.71, 7.95] and ever chewing khat [AOR = 7.59; 95% CI: 4.99, 11.55] were factors associated with current tobacco use.ConclusionWomen used tobacco in different forms, and its distribution varies across Ethiopian regional states. The concerned body needs to give attention to the identified associated factors and regions with higher tobacco use.

Associations of lifestyle risk factors with overweight or obesity among adolescents: a multicountry analysis

About 35% of the global burden of disease has roots in adolescence. Health in adolescence is an important determinant of health in adulthood. This study aimed to generate risk scores for lifestyle behaviors among adolescents and to estimate the country-specific prevalence of these risk scores. The study also examined the relations of lifestyle risk scores with overweight or obesity among adolescents. We used the most recent data available from 20 nationally representative Global School-based Student Health Surveys. Our analytical sample size was 51,597. The outcome of interest was overweight or obesity. We developed 4 lifestyle risk scores (dietary habits, physical activity, sedentary behavior, and tobacco use), which were used as the exposure variables in this study. Multilevel logistic regression models were used to estimate adjusted ORs with 95% CIs. In total, 18.2% of the participants were overweight or obese. Across countries, the percentage of adolescents with unhealthy dietary habits ranged from 76.7% (the Cook Islands) to 94.2% (Timor-Leste), physical inactivity ranged from 47.5% (Bangladesh) to 90.1% (the Philippines), and sedentary behavior ranged from 34.5% (Nepal) to 88.2% (Kuwait). Girls engaged in less physical activity than did boys. Increased odds of overweight or obesity were found among participants with high risk scores for physical inactivity (OR: 1.19; 95% CI: 1.11, 1.27) and for unhealthy sedentary behavior (OR: 1.25; 95% CI: 1.16, 1.35) compared with participants with low risk scores. Girls with high tobacco risk scores had higher odds (OR: 1.30; 95% CI: 1.02, 1.65) of overweight or obesity than did girls with low risk scores for tobacco use, whereas there were no significant differences in risk in boys. Unhealthy lifestyle behaviors were quite prevalent among adolescents, and higher lifestyle risk scores increased the risk of overweight or obesity.

An efficient LC-MS method for isomer separation and detection of sugars, phosphorylated sugars, and organic acids.

Assessing central carbon metabolism in plants can be challenging due to the dynamic range in pool sizes, with low levels of important phosphorylated sugars relative to more abundant sugars and organic acids. Here, we report a sensitive liquid chromatography-mass spectrometry method for analysing central metabolites on a hybrid column, where both anion-exchange and hydrophilic interaction chromatography (HILIC) ligands are embedded in the stationary phase. The liquid chromatography method was developed for enhanced selectivity of 27 central metabolites in a single run with sensitivity at femtomole levels observed for most phosphorylated sugars. The method resolved phosphorylated hexose, pentose, and triose isomers that are otherwise challenging. Compared with a standard HILIC approach, these metabolites had improved peak areas using our approach due to ion enhancement or low ion suppression in the biological sample matrix. The approach was applied to investigate metabolism in high lipid-producing tobacco leaves that exhibited increased levels of acetyl-CoA, a precursor for oil biosynthesis. The application of the method to isotopologue detection and quantification was considered through evaluating 13C-labeled seeds from Camelina sativa. The method provides a means to analyse intermediates more comprehensively in central metabolism of plant tissues.

Analysis of factors affecting alcohol and tobacco concurrent use by bivariate probit model in Turkey.

Alcohol and tobacco use are risky factors that are associated with one another. High alcohol and tobacco use are significant public health problems with social and economic costs and one of the leading causes of preventable death and disease. The aim of this study was to determine the sociodemographic and economic factors on alcohol and tobacco concurrent use. In this study, a bivariate probit model was employed to determine the factors affecting alcohol and tobacco concurrent use among individuals aged 15 and above who were living in Turkey. The data used in this study was obtained from the Turkey Health Survey conducted in 2010, 2012, 2014, and 2016 by the Turkish Statistical Institute. The data were gathered from a total of 77,327 individuals. Empirical findings suggest that factors affecting alcohol and tobacco use were simultaneous. Also, the results revealed that several key variables such as age, gender, educational status, marital status, household monthly income level, and survey year were significant determinants of alcohol and tobacco concurrent use. Psychosocial support is significant for only tobacco use. In the last decade, a number of restrictions aimed to combat alcohol and tobacco use have been associated with reducing the usage habits of individuals. This is the first study that simultaneously compared both alcohol use and tobacco use using a Turkish sample.

Risk factors for chronic liver disease in population of Central India: a case-control study from rural India

BackgroundChronic liver disease (CLD) is one of the leading causes of morbidity and mortality in today’s world. Common risk factors for CLD are alcohol, chronic hepatitis B, chronic hepatitis C, non-alcoholic steatohepatitis (NASH), malnutrition, toxins, and some tropical infections. This case-control study was carried out to determine the risk factors of domestic CLD in a resource-constrained setting in central rural India. A hospital-based matched case-control study was carried out among eligible CLD cases from November 2015 to October 2017. A total of 200 cases and 200 age- and gender-matched community controls were selected using consecutive sampling from tertiary care hospitals from central rural India. Information on socio-demographic, etiological was collected through using a pretested structured questionnaire after obtaining informed written consent. Univariate and multivariate analyses were carried out to find the risk factors associated with CLD.ResultsThe median age of study participant was 58.5 years among the cases. There were 75% male and remaining 25% were female in each case and control group. On multivariate analysis, we found less education, poor socioeconomic status, diabetes mellitus, increased body mass index (BMI), alcohol consumption, and tobacco chewing were significant risk factors for CLD in comparison to controls. However, amount of alcohol, smoking, and occupation were not found to be statistically significant association with CLD.ConclusionsThe findings showed that in patients with CLD when compared to controls, high alcohol intake, diabetes mellitus, tobacco chewing, central obesity, low education, and low-income group are significant risk factors in our rural population. An initiative needs to be taken to reduce alcohol, and tobacco chewing habits at various levels through awareness campaigns, strict control, and legislation to limit further abuse. Control of blood glucose and reduction of obesity may be important in preventing CLD in our rural community.

Adapting Evidence-Based Tobacco Addiction Treatment for Inuit Living in Ontario: A Qualitative Study of Collaboration and Co-creation to Move From Pan-Indigenous to Inuit-Specific Programming

&#x0D; &#x0D; &#x0D; Settler introduction of tobacco to Inuit Nunangat (homeland of Inuit in Canada) has led to high tobacco use prevalence among Inuit. Inuit are moving from traditional territories to the province of Ontario to access resources, including health services. Indigenous-specific tobacco cessation approaches in Ontario lack cultural relevance among Inuit, as they often reflect First Nations and Métis worldviews. To improve effectiveness of tobacco cessation services for Inuit living in Ontario, materials reflective of Inuit culture and worldviews were developed through a community-based participatory approach. The Centre for Addiction and Mental Health collaborated with Tungasuvvingat Inuit and members of an Engagement Circle who work with Inuit or identify as Inuk (n = 25) to initiate a knowledge translation project aimed at co-creating a toolkit of Inuit-specific cessation resources. Development was guided by Two-Eyed Seeing, whereby Inuit and Western worldviews come together to support a strengths-based approach. The toolkit was evaluated through a pilot session and focus group with Inuit living in Ottawa who use tobacco (n = 13) and an online survey administered with a group of helpers who work with Inuit (n = 11). Analysis of qualitative data from the focus group and online survey highlighted five themes: choice, cultural relevance and safety, capacity-building, access, and impact. Focus group participants reported they learned quitting was possible and identified new strategies to quit through the session. Our findings emphasize the importance of engagement and co-creation with Indigenous Peoples to ensure cultural relevance and appropriateness of healthcare interventions.&#x0D; &#x0D; &#x0D;

Optimization of cutting parameters of microwave expanded stem in slim cigarette

In order to explore the cutting optimization parameters of the processing technology of the expanded stem of slim cigarette, according to the quality characteristics of the microwave expanded stem, the samples with different combinations of cutting parameters were optimized. The results showed that under the combination of cutting parameters with a slicing thickness of 0.5mm and cutting width of 0.2mm, the high whole cut tobacco ratio, moderate small particle content, and minimum tobacco loss from cigarette end could be obtained. At the same time, the samples also had a lower hazard index and better sensory quality. This study provides a reference for technical research on the processing technology of the expanded stem of slim cigarettes.

Progress in Controlling Illicit Tobacco Trade in Singapore

Despite increasing industry-funded reports of illicit tobacco trade in Singapore, Singapore’s revenue from tobacco tax has been increasing in the past decade. This is partly because Singapore has one of the highest tobacco tax rates in ASEAN – second only to Thailand’s 70%, estimated at 60% (before the 7% goods and services tax) of cigarette retail price since it has increased tobacco taxes by 10% in 2018. The tobacco industry has been known to inflate illegal tobacco trade statistics to oppose tobacco tax increases (Gallagher et al., 2019). Moreover, the tobacco industry, through industry-funded think-tanks as front groups, has also utilized arguments based on trade, particularly the impact of taxation on illicit tobacco trade, to oppose tobacco tax increases (SEATCA, 2014; Ross, 2015). Singapore’s progress in reducing smoking prevalence in its population with a comprehensive approach to tobacco control has been showcased as one of the world’s best practices in tobacco control. With tobacco control measures dating back to the 1970s, Singapore’s progress shows the value of comprehensive, long-term goals for public health through a progressive roll-out of complementary tobacco control measures, including tobacco taxation. The tobacco-related burden of disease in Singapore has decreased significantly from 1990 to 2017, for both males and females, compared to the global tobacco burden (See Figure 1). Singapore presents a good case study of a city-state that has imposed high tobacco taxes with strict law enforcement tackling illicit tobacco trade that led to increased tobacco tax revenues, and that benefits both public health objectives and the government’s economic objectives. This study aims to describe the policy measures that have been implemented by Singapore to address the evasion of its tobacco tax system through illicit tobacco trade.

How Kerala transgenders are faring amidst the COVID-19 pandemic.

Dear Editor, We read the article by Asadi[1] with great interest where the authors have described how an empowered transgender community gains the ability to handle adversities. The transgenders are a vulnerable group in this pandemic. The 2011 census and 2015 Kerala transgender survey estimates 3,902[2] and 25,000[3] self revealed transgenders, respectively, in Kerala. With a high literacy rate of 94%,[2] the transgenders in Kerala depict a strong community with empowered members who actively voice their rights and needs. An article by Madhavan[4] and other literature[5] reveal transgenders have high prevalence and risk factors for non-communicable, communicable diseases, HIV, high tobacco consumption and other conditions, which makes them prone to COVID-19 adversities. Older transgenders are at a higher risk due to weaker immunity, possible presence of comorbidities, emotional and financial issues. The pandemic scenario would leave many on hormone replacement therapy and with scheduled gender reassignment surgeries unable to continue with it. Lack of familial support, stress about COVID and non-COVID conditions including post-surgical care are major issues. Majority mostly rely on daily wage/unsteady jobs including begging and paid sex. The pandemic has impinged drastically on their outdoor work and income generation. Their stay in overcrowded circumstances makes social distancing difficult posing high transmission threat. Inability to pay rents during such periods of non-earning makes secure shelter difficult. However, Kerala became the first state to provide relief in the form of temporary housing and food facilities to transgenders who had registered with the government during the lockdown. This falls in line with the State Policy for Transgenders in Kerala, 2015[3] which noted inclusiveness of transgenders in the socio-economic and political spectrum as pivotal; and The Transgender Persons (Protection of Rights) Act, 2019 which has a component of access to welfare measures including healthcare. The Transgender cell,[3] a first in the country, functioning under the Social Justice Department caters to this population’s needs including operating a 24 × 7 distress counselling helpline. Many live together in large households and such clusters might need more provisions than an average household. Those who choose temporary shelters like lodges find cooking facilities inaccessible even after receiving raw materials. Steps to provide cooked food are taken in transgender care homes. Special arrangements for vaccinating transgenders and providing kits containing sanitizers and masks are under process to ensure coverage in the second wave. Kerala’s Kudumbashree system (Women Self Help Group) has empowered transgender ‘neighbourhood groups’ in eight districts that enthusiastically worked towards public service during COVID-19. Augmentation of such groups across the state and country can prove highly effective. The government welcomed 0.015% transgenders who enrolled in as COVID-19 volunteers in the pandemic control activities of the state.[6] Transgender identity options are being included in all Kerala government application forms to aid in identification and improve service coverage to the invisible pocket-sects of this populace. Health workers may be motivated further to give equitable care by promoting provision for essential primary medical and advanced care through telemedicine services, addressing mental health issues to provide psychosocial support amidst the pandemic scare and infection. Financial support and sponsorship SHSRC-K Conflicts of interest There are no conflicts of interest.

Raising the legal age for purchase and use of tobacco to 21 years: A step towards tobacco endgame in India

BackgroundGlobally, policies to counter targeting of young people by the tobacco industry have proven to be effective and a key determinant of reducing the magnitude of tobacco epidemic. This paper presents a case for increasing the minimum legal age to access tobacco to 21 years in India. MethodWe analysed the two rounds of nationally representative Global Adult Tobacco Survey (GATS) data: GATS-1 (2009–10) and GATS-2 (2016–17). We segregated data for two categories of tobacco consumption (smokers and smokeless tobacco users) at the age of initiation (<18, 18–21 and >21 years) and analysed for their consumption patterns found during the time of the survey (current daily, current less than daily, former and ever users) from GATS-2 (2016–17). Further, we compared the projections from the sub-national level analysis for youth initiating tobacco use before 21 years and change in the prevalence of overall underage tobacco users between the two survey rounds. ResultNearly 77% of smokers and 75% smokeless tobacco users in India initiate tobacco use before or until the age of 21 years. Many large, most populous and high tobacco prevalence states had higher than national mean (14.1%) of youth initiating into tobacco use before 21 years. Overall, as compared to GATS-1, there is a perceptible increase in the prevalence of underage tobacco use in most states. ConclusionGlobal best practices and the significant number of young tobacco users in India call for increasing the age of access to tobacco from the current 18 years to 21 years. This will help in reducing the overall adult tobacco use prevalence in the longer run in India.

1155. Clinical and Epidemiological Characteristics of Patients with Paracoccidioidomycosis in Asuncion Paraguay

BackgroundParacoccidioidomycosis (PCM) is an endemic systemic fungal disease caused by Paracoccidioides brasiliensis. It is obtained exclusively in Latin American countries, and presents with a greater prevalence in South America. It is acquired through inhalation and spreads by lympho-hematogenous dissemination. Once the fungus has established itself in the body, it can affect any organ or tissue, but most commonly the skin, mucous membranes and lungs. It is a neglected disease, without mandatory notification, its impact is unknown.MethodsDescriptive, observational, retro-prospective study with analytical components, The patients were adults (>18 years), diagnosed with paracoccidioidomycosis who were hospitalized at the Instituto De Medicina Tropical Asunción-Paraguay during 2010-2019.ResultsThere were 33 patients included in this study. Most patients were male (90%) and 10% were female, the mean age of 48. The main reason for consult was: oral lesion(s) (21%), difficulty swallowing (15%), and skin lesions (15%). The geographic regions with the highest prevalence rates (Fig1) were: Central, Cordillera and Caaguazú. The major risk factors for acquiring Paracoccidioidomycosis were farming (51%), smokers (66%) and alcoholism (42%). Only one patient was co-infected with HIV. The diagnosis was made either by culture or by biopsy results (Fig 2). All the patients were started on treatment with amphotericin B deoxycholate, with an average dose of 1,020 mg for induction and continued maintenance treatment with imidazoles. The mortality rate was 9.09%. The outpatient clinic follow up was low at 15% and 12 patients (80%) were treated successfully.Figure 1: Paraguay Coutnry Map showing the most affected areas with Paracoccidioidomycosis. Figure 2: Culture result. ConclusionThis study suggests that paracoccidioidomycosis mainly affects men, farmers, associated with high tobacco consumption in Paraguay. Common clinical manifestations were oral lesion, skin lesions, and difficulty swallowing. There are no current IDSA guidelines for treatment thus we use the national Paraguayan treatment guidelines. This study highlights the need to further study PCM and establish global guidelines.Disclosures All Authors: No reported disclosures

Clinical and Genome-Wide Analysis of Multiple Severe Cisplatin-Induced Neurotoxicities in Adult-Onset Cancer Survivors.

Cisplatin is a first-line chemotherapeutic for many cancers, but causes neurotoxicity including hearing loss, tinnitus, and peripheral sensory neuropathy. However, no study has comprehensively characterized risk factors for developing multiple (>1) severe neurotoxicities. The relationship between multiple severe neurotoxicities and age, cumulative cisplatin dose, medical history, and lifestyle/behavioral factors was evaluated in 300 cisplatin-treated testicular cancer survivors using logistic regression. Case-control genome-wide association study (GWAS; cases, n = 104 and controls, n = 196) was also performed. Age at clinical examination (P = 6.4 × 10-16) and cumulative cisplatin dose (P = 5.4 × 10-4) were positively associated with multiple severe neurotoxicity risk, as were high serum platinum levels (P = 0.02), tobacco use (ever smoker, P = 0.001 and current smoker, P = 0.002), and hypertension (P = 0.01) after adjustment for age and cumulative cisplatin dose. Individuals with multiple severe neurotoxicities were more likely to experience dizziness/vertigo (P = 0.01), Raynaud phenomenon (P = 3.7 × 10-9), and symptoms consistent with peripheral motor neuropathy (P = 4.3 × 10-14) after age and dose adjustment. These patients also reported poorer overall health (P = 2.7 × 10-5) and a greater use of psychotropic medications (P = 0.06). GWAS identified no genome-wide significant SNPs. Gene-based association analysis identified RGS17 (P = 3.9 × 10-5) and FAM20C (P = 5.5 × 10-5) as near genome-wide significant. Decreased FAM20C expression was associated with increased cisplatin sensitivity in tumor cell lines. Certain survivors are more susceptible to cisplatin-induced neurotoxicity, markedly increasing likelihood of developing numerous neuro-otological symptoms that affect quality of life. Genome-wide analysis identified genetic variation in FAM20C as a potentially important risk factor.

Tobacco dependence management in a smoke-free inpatient drug and alcohol unit.

Various smoke-free policies and practices (carbon monoxide monitoring, nicotine replacement therapy, pharmacotherapy, behavioural interventions) have been introduced to manage tobacco dependence in inpatient drug and alcohol facilities. Since the introduction of a smoke-free policy to our inpatient drug and alcohol facility, there has been no objective evaluation of its practices or patients' views. We administered a questionnaire to 42 inpatients identified as smokers. A retrospective record review was performed on those patients for demographic data, substance use, psychiatric conditions and tobacco dependence assessment and management. Descriptive analyses and tests of association were conducted. Open-ended questions were subjected to content analysis. Tobacco dependence assessment was mostly completed with daily cigarette consumption documented for 41 (98%), time to first cigarette for 39 (93%) and CO monitoring performed for 42 (100%) patients. Patients' views of the various management strategies were positive, although many were underutilised. Those with high tobacco dependence were more likely to approve of nicotine replacement therapy patches than those with low tobacco dependence (p = 0.009). The results demonstrate that while the various interventions provided were reported to be helpful, many were underutilised. Future research could consider why certain strategies were not utilised and help improve uptake.

Self-Reported and Genetically Predicted Coffee and Tobacco Consumption in Dementia

Background: Studies of self-reported coffee and tobacco consumption on risk of dementia have shown results conflicting with causal genetic studies. We tested the hypotheses that coffee and tobacco consumption causally influence risk of Alzheimer’s disease and non-Alzheimer’s dementia using a Mendelian randomization study design. Methods: We included 114,551 individuals from the general population. First, we tested whether high self-reported coffee and tobacco consumption were associated with risk of dementia. Second, we examined whether two genetic variants near CYP1A1/2 (rs2472297) and AHR (rs4410790) genes were associated with coffee consumption and whether one variant near CHRNA3 was associated with tobacco consumption in our population. Third, we examined whether genetically predicted high coffee and tobacco consumption due to variation in the genetic variants were associated with risk of dementia. Findings: Self-reported coffee and tobacco consumption were not associated with Alzheimer’s disease; however, moderate coffee consumption was associated with low risk and high tobacco consumption was associated with high risk of non-Alzheimer’s dementia. Genetically predicted tobacco and coffee consumption were not associated with risk of Alzheimer’s disease and non-Alzheimer’s dementia: hazard ratios (95% confidence interval) for Alzheimer’s disease and non-Alzheimer’s dementia were 1·16 (0 · 93-1·44) and 1·23 (0·95-1·58) for +1 coffee cup/day and 1·06 (0.97-1·16) and 0·98 (0·88-1·10) for +1 pack-year, respectively. Interpretation: Neither coffee nor tobacco consumption appears to be related convincingly to risk of Alzheimer’s disease or non-Alzheimer’s dementia. Funding: Herlev and Gentofte Hospital, Copenhagen University Hospital. Declaration of Interests: None exist. Ethics Approval Statement: The study was approved by institutional review boards and by Danish ethical committees, and was conducted according to the declaration of Helsinki. Written informed consent was obtained from all individuals included in the study.