High Smoking Rates Research Articles

The Impact of Cytokines on the Health-Related Quality of Life in Patients with Systemic Lupus Erythematosus.

Introduction: Systemic lupus erythematosus (SLE) reduces the health-related quality of life (HRQoL), even during periods of disease quiescence. We investigated whether subclinical inflammation as reflected by cytokine levels is linked with reduced HRQoL. Methods: A cross-sectional study of SLE patients (n = 52, mean age 47.3, 86.5% female) who completed a Short Form Health Survey-36 (SF-36) questionnaire. The clinical and demographic data, scores for the disease activity (SLEDAI-2K), organ damage (SDI), and laboratory data were collected simultaneously. The autoantibody and cytokine levels (IFN-γ, IL-1β, IL-4, IL-6, IL-10, IL-12, IL-17, BAFF, TNF-α, TGF-β1, MIP-1α, MIP-1β and MCP-1 (levels in pg/mL) were quantified by sandwich ELISA. The comparisons and associations were assessed non-parametrically, and a multiple regression determined the effect sizes (ES) of the variables on the SF-36 domain and summary scores. Results: The SF-36 summary and domain scores for SLE patients were significantly (20–40%) lower than in a comparable control group, with the exception of the Mental Health scores (p = 0.06). SLE patients had a normal body mass index (BMI) (median, 24.2 kg/m2), a high rate of smoking (69.2%), and usage of social security benefits (90.4%). TGF-β1 (ES 0.06), IL-12 (ES −0.11), IFN-γ (ES 0.07) and MCP-1 (ES 0.06) influenced the SF-36 domain scores; and MCP-1 (ES 0.04) influenced the Mental Health Summary Score (MCS). Obvious manifestations, including patient visual analogue scale (VAS) (ES −2.84 to −6.29), alopecia (ES −14.89), malar rash (ES −14.26), and analgesic requirement (ES −19.38), independently influenced the SF-36 items; however, the SF-36 scores were not reflected by the physician VAS or disease activity (SLEDAI-2K). Conclusions: Cytokines had a minimal impact on HRQoL in SLE patients, especially compared to visible skin manifestations, central nervous system (CNS) damage, and pain. Better tools are needed to capture HRQoL in measures of disease activity.

Associations between psychological distress and health-related behaviors among adults with chronic kidney disease

Chronic kidney disease (CKD) affects 15% of the US general population, and this rate is projected to increase. A healthy lifestyle is important for individuals with CKD to reduce risk for CKD progression and adverse heath events. Adults with CKD also have high rates of psychological distress, which may be associated with unhealthy behaviors. Using the 2013–2017 public use data files of the US National Health Interview Survey, we compared health behaviors (smoking, alcohol use, and physical activity [PA]) and psychological distress (assessed with the Kessler-6 scale) between adults with a CKD diagnosis in the preceding year and a matched sample of adults without a CKD diagnosis. We then examined the association between psychological distress and health behaviors among adults with CKD (n = 3923) using multinomial logistic regression models. Compared to those without CKD, those with CKD had lower rates of smoking, heavy alcohol use, and engagement in any type of PA 3+ times a week and higher rates of psychological distress. In addition to the health concerns posed by the high smoking rate (17%) and low physical activity rate (34%) among those with CKD, smoking and lack of PA were associated with greater risk of mild-moderate and/or serious psychological distress. Compared to no unhealthy behaviors, 2–3 unhealthy behaviors were associated with 4.72 (95% CI = 2.97–7.48) times greater risk of serious psychological distress. Adults with CKD and unhealthy behaviors need help with lifestyle modifications and assessment and treatment of psychological distress to reduce CKD progression and prevent other health complications.

Electronic Cigarette Use During a Randomized Trial of Interventions for Smoking Cessation Among Medicaid Beneficiaries with Mental Illness

Objective: People with mental illness have high rates of cigarette smoking, but many wish to quit. Electronic cigarette (e-cigarette) use has become increasingly common, especially among smokers who wish to quit, but research on whether this facilitates quitting has been mixed, and little research has examined e-cigarette use among smokers with mental illness. This secondary analysis examined the associations between spontaneous e-cigarette use during cessation treatment and 6-month outcomes within a cessation trial among Medicaid beneficiaries with mental illness. Main outcomes were previously reported. Methods: Adult Medicaid beneficiaries receiving mental health services were recruited between 2012 and 2015. Eligible daily smokers were randomized, using equipoise stratification, to one of six cessation treatment conditions (combinations of prescriber visit for pharmacotherapy, behavioral interventions, and abstinence incentives; e-cigarette use was not a recommended intervention). Presence of any self-reported e-cigarette use, all tobacco product use, quit attempts, and biologically verified abstinence were assessed at 3, 6, 9, and 12 months. The 456 participants who completed the 6-month assessment were included in logistic regressions, adjusting for subject characteristics and treatment condition, examining associations between self-reported, spontaneous e-cigarette use and 6-month outcomes. We evaluated three outcomes: biologically verified abstinence at 6 months, quit attempts over the treatment period, and heavy smoking (≥20 cigarettes per day) at 6 months. Results: Any use of e-cigarettes was reported by 192 participants (42.1%) during the treatment period. Use of pharmacotherapy was not different between those who used e-cigarettes and those who did not use e-cigarettes. A total of 13.5% of participants (n = 61) had achieved biologically verified abstinence at the 6-month assessment. E-cigarettes were not significantly associated with biologically verified abstinence, use of cessation pharmacotherapy, self-reported quit attempts, or heavy smoking at the 6-month assessment. Conclusions: Spontaneous e-cigarette use during cessation treatment was common among smokers with mental illness and was not associated with positive or negative treatment outcomes. The high rate of naturalistic e-cigarette use in this group suggests that e-cigarettes are an appealing strategy to obtain nicotine during cessation treatment that could be harnessed as a smoking cessation tool or for harm reduction.

Pilot study of a mobile smoking cessation intervention for low-income smokers with serious mental illness

AbstractIntroductionPeople with serious mental illness (SMI) have high rates of smoking and need better access to cessation treatment. Mobile behavioral interventions for cessation have been effective for the general population, but are not usable by many with SMI due to cognitive impairments or severe symptoms. We developed a tailored mobile cessation treatment intervention with features to reduce cognitive load.MethodWe enrolled 20 smokers with SMI and showed them how to use the program on a device of their choice. They were assessed at 8 weeks for intervention use, usability, satisfaction, smoking characteristics, and biologically verified abstinence.ResultsParticipants accessed an average of 23.6 intervention sessions (SD = 17.05; range 1–48; median = 17.5) for an average total of 231.64 minutes (SD = 227.13; range 4.89–955.21; median = 158.18). For 87% of the sessions, average satisfaction scores were 3 or greater on a scale of 1–4. Regarding smoking, 25% of participants had reduced their smoking and 10% had biologically verified abstinence from smoking at 8 weeks.ConclusionHome and community use of this mobile cessation intervention was feasible among smokers with SMI. Further research is needed to evaluate such scalable approaches to increase access to behavioral treatment for this group.

Lower smoking rates and increased perceived harm of cigarettes among French adults one year after comprehensive tobacco control measures

ContextFrance has high smoking rates, and recently intensified tobacco control policies spearheaded by the introduction of plain tobacco packaging (PP), and an increase in graphic health warnings (GHW). We examine smoking and e-cigarettes use rates, as well as smoking-related perceptions before (2016) and one year after (2017) comprehensive tobacco control measures. MethodsDePICT is a two waves cross-sectional national telephone survey of French adults aged 18–64 years (2016: 4456 – 2017: 4114). Data were weighted to be representative of the French adult population. Adjusted prevalence ratios (PR, 95% CI) estimating changes between the two study waves were calculated using multivariate Log-Binomial regression models. Main FindingsIn 2017, as compared with 2016, smoking rates (PR = 0.93 (0.88-0.99) and current e-cigarette use (PR = 0.76 (0.61-0.96)) decreased in France. Further, French adults were more likely to report fear of the consequences of smoking (PR = 1.10 (1.06–1.14)) and that smoking is dangerous (PR = 1.08 (1.06–1.11)). Smokers were also more likely to report that health messages on tobacco products are efficient (PR = 1.18 (1.05–1.32)). ConclusionsOur study provides early and encouraging results on potential effects of the comprehensive tobacco control strategies in France introduced in 2017, including PP and larger GHW. Our findings also suggest that e-cigarettes did not replace traditional smoking.

Sex Differences in Veterans Admitted to the Hospital for Chronic Obstructive Pulmonary Disease Exacerbation.

Rationale: As chronic obstructive pulmonary disease (COPD) prevalence in women has outpaced that in men, COPD-related hospitalization and mortality are now higher in women. Presentation, evaluation, and treatment of COPD differ between women and men. Despite higher smoking rates in Veterans, little work has characterized differences in Veterans with COPD by sex. Objectives: To determine risk factors for 30-day readmission among Veterans hospitalized for COPD exacerbations and how they differed by sex. Methods: We performed a retrospective observational analysis of Veterans receiving primary care in Veterans Health Affairs facilities. We included Veterans Administration-based hospitalizations for Veterans with a COPD exacerbation (identified by International Classification of Disease, Ninth Revision codes) who survived to discharge between fiscal years 2012 and 2015. Primary outcome was 30-day readmission. Predictors ascertained before hospitalization included smoking status (current, former, never), pulmonary function testing, pulmonary medication prescriptions, and medical and psychiatric comorbidities (identified by International Classification of Disease, ninth revision codes). We created combined and sex-stratified multivariate logistic regression models to identify associations with 30-day readmission. Results: Our sample included 48,888 Veterans (4% women). Compared with men, women Veterans were younger, more likely to be nonwhite, and differed in smoking status. Women were more likely to have asthma, drug use, and several psychiatric comorbidities. Before hospitalization, women were less likely to have pulmonary function testing (76% vs. 78%; P = 0.01) or be treated with antimuscarinic (43% vs. 48%) or combined long-acting bronchodilator/inhaled corticosteroid (61% vs. 64%) inhalers. Women were more likely to receive nicotine-replacement therapy (all P < 0.01). Women had shorter length of stay (median days, 2 vs. 3; P = 0.04) and lower 30-day readmission rate (20% vs. 22%; P = 0.01). In adjusted models including both sexes, age, antimuscarinic use, comorbidities, and diagnosis of drug or alcohol use were associated with readmission; there was no association with sex and readmission risk. In models stratified by sex, associations were similar between women and men. Conclusions: This study suggests differences between women and men hospitalized for COPD regarding presentation, evaluation, and management. Readmission is strongly influenced by comorbidities, suggesting individualized and comprehensive case management may reduce readmission risk for women and men with COPD.

Healthy Recovery: A Pilot Study of a Smoking and Other Health Behavior Change Intervention for People Attending Residential Alcohol and Other Substance Dependence Treatment

Objective: It is common for people attending alcohol and other substance dependence treatment to present with multiple unhealthy lifestyle behaviors such as high rates of smoking, physical inactivity, and poor diet. Healthy lifestyle interventions are increasing in importance in the general population, but have been underexamined within alcohol and other substance use populations. The purpose of the current study was to pilot “Healthy Recovery,” a group program that primarily aimed to help people attending alcohol or other substance dependence treatment to reduce or quit smoking. The program also encourages participants to increase physical activity and to eat more servings of fruit and vegetables. Methods: The current study was conducted as a non-randomized controlled pilot trial. All participants were attending residential substance dependence treatment provided by the Australian Salvation Army. In addition to treatment as usual, participants in the treatment condition completed Healthy Recovery (n = 50) and participants in the control group completed an online depression program (n = 27). The study examined the health outcomes of participants (i.e., smoking, physical activity, fruit and vegetable intake, and symptom distress) and the feasibility of running the group sessions within the residential facilities. Results: Within-treatment effects demonstrated medium to large positive effects for reductions in smoking and increases in physical activity, servings of fruit, and servings of vegetables for people completing Healthy Recovery. When compared to the control condition, there were medium effects in favor of the Healthy Recovery condition for reductions in smoking and increases in physical activity. There was a small effect for servings of fruit and no effect for servings of vegetables. Conclusions: Results from this study demonstrated that people attending residential substance dependence treatment are willing and capable of engaging in multiple health behavior change interventions.

A study of tobacco abuse as a risk factor for adrenal cortical carcinoma.

e16119 Background: Smoking has been suggested as a risk factor for adrenal cortical carcinoma (ACC), but, due to the rarity of this tumor, this hypothesis has only been inferred from single study using a mixed population of adrenal tumors that included pheochromocytoma and neuroblastoma as well as ACC. Methods: De-identified IRB exempted records were analyzed for age, gender, and smoking history in adult patients diagnosed with ACC in both the West Virginia University database containing 2,699,193 patients and, in the larger TriNetX database of 21,426,477 patients from 2008-2018. In addition, the statewide ratio of smoking to ACC prevalence was computed in all 50 states using data from SEER and the CDC. Results: Given the high rate of both tobacco use and ACC in the West Virginia Health System, we hypothesized that smoking contributed to increased prevalence of ACC in our state. We compared the rates of ACC and smoking in all 50 states using data from SEER. Among the 50 states, West Virginia had the highest smoking rate and the second highest rate of ACC. Utah had the lowest rate of smoking and the third lowest rate of ACC. The sample correlation between statewide smoking and ACC is .4177 indicating a significant association between the two (p = .0035). From 2008 to 2018, 20 patients with ICD10 code c74.0 (ACC) were abstracted from our EMR system. Examination of the individual charts determined 15 of the 20 patients had confirmed ACC diagnosis. This cohort was compared with matched age and gender matched controls. In the control group, there 13.3% were smokers while in the ACC group, 60% were smokers. The difference is significant (p = .0005) (OR) = 9.75 (95% CI; (2.54, 37.38). We next reviewed the larger TriNetX database and found that the prevalence of smoking in the ACC group to be 35.2% as compared to 9.0% in the TriNetX group(p-value &lt; .0001). Conclusions: Our retrospective review strongly supports smoking as a major risk factor ACC. To our knowledge, this is the first study to demonstrate a strong association of smoking in a cohort of biopsy proven ACCs.

Knowledge and factors related to smoking among university students at Hodeidah University, Yemen.

INTRODUCTIONTobacco smoking, especially among university students, remains a significant issue worldwide. This survey aims to investigate and evaluate the smoking behavior and smoking-related knowledge and their relationship in students of Hodeidah University, Yemen.METHODSA cross-sectional study was performed among students at Hodeidah University. Using a global youth tobacco survey and a global health professional survey, data were collected from three colleges (Commerce and Economics, Engineering, and Medicine) from April to June 2017, from 420 randomly chosen students.RESULTSThe smoking prevalence among university students was 33.1% (cigarettes 13.6%, waterpipe 9.3%, and 10.2% for dual cigarettes and waterpipe use), with a higher rate of smoking among males than females (36.3% vs 28.0%, p<0.001). The percentage of individuals participating in the three types of smoking among males and females, respectively, were 18.9% vs 5.0% for cigarettes, 1.9% vs 21.1% for waterpipe, and 15.4% vs 1.9% for dual cigarettes and waterpipe use, with a student mean age of 21.93 ± 2.55 years. The regression outcome revealed that year of study was highly associated with smoking (OR=0.87, 95% CI: 0.85–0.89, p<0.001). Age (OR=0.96, 95% CI: 0.94–0.99, p<0.05), residence (OR=1.05, 95% CI: 1.00–1.09, p<0.05) and family income (OR=1.03, 95% CI: 1.00–1.06, p<0.05) were also significant predictors of smoking.CONCLUSIONSAccording to this study, most of the male students were cigarette users, while female students were waterpipe users. The prevalence of waterpipe use among females, as opposed to males, is an issue of concern. Policy makers may need to initiate anti-smoking programmes in Yemeni universities.

Tobacco Control in Hospitals in Jordan: Policy Analysis

&lt;p&gt;&lt;em&gt;Despite the concerns about very high rates of smoking in Jordanian population and the growing efforts to combat the tobacco epidemic, smoking at hospitals in Jordan and the poor complying with smoking prevention policies are important aspects of the problem. The paper examined the scope &lt;/em&gt;&lt;em&gt;and the progress &lt;/em&gt;&lt;em&gt;of smoking problem in Jordanian hospitals, &lt;/em&gt;&lt;em&gt;recognized public health policies on tobacco control &lt;/em&gt;&lt;em&gt;in hospitals in Jordan, and explored the obstacles in applying tobacco control policies in hospitals. The paper also proposed some recommendations for effective public health policies that regulate tobacco smoking in hospitals and other health care facilities in Jordan.&lt;/em&gt;&lt;/p&gt;

Demographic, Behavioral, and Social Characteristics Associated With Smoking and Vaping Among Men Who Have Sex With Men in San Francisco.

Tobacco use is the leading lifestyle-related cause of death in the United States. We analyzed correlates of smoking and vaping tobacco in the National HIV Behavioral Surveillance (NHBS) among men who have sex with men (MSM) in San Francisco in 2014 (n = 410) using multivariable logistic regression models. We found that more than two in five MSM (41%) smoked or vaped. Smoking was greater for men of color (46% vs. 35%; p = .02); those with annual income below $50,000 (47% vs. 34%; p = .01); those without a college education (51% vs. 30%; p < .01); and the uninsured (55% vs. 38%; p = .04). In multivariable analyses, greater odds of smoking were observed among men living with HIV (adjusted odds ratio [aOR] = 1.7; 95% CI [1.00, 2.8]); men who reported cocaine use (aOR = 3.1; 95% CI [1.9, 5.0]), and men who reported greater number of alcohol drinks on a drinking day (aOR = 1.2; 95% CI [1.05, 1.29]). Lower odds of smoking were observed for men who completed college (aOR = 0.57; 95% CI [0.36, 0.88]). Greater odds of vaping were observed among men who reported meth use (aOR = 3.01; 95% CI [1.65, 5.50]). Lower odds of vaping were observed among men who completed college (aOR = 0.55; 95% CI [0.32, 0.98]). In conclusion, the prevalence of smoking and vaping among MSM is extremely high, particularly HIV-positive MSM. MSM who smoked and vaped were more likely to be racial and ethnic minorities, have lower socioeconomic status, and report more substance and alcohol use. These findings highlight the need to develop strategies effectively addressing the high rates of cigarette smoking and vaping among MSM, particularly among minority MSM and MSM living with HIV.

The burden of non-communicable diseases and their related risk factors in the country of Georgia, 2015

BackgroundNon-communicable diseases (NCDs), mainly cardiovascular diseases, are a substantial cause of mortality in the country of Georgia, accounting for approximately 93% of all deaths (standardized mortality rate 630.7 deaths per 100,000 persons per year) and an important threat to health security. We conducted a nationally representative survey examining the prevalence of NCDs and their risk factors as part of a 2015 Hepatitis C Virus (HCV) and Hepatitis B Virus (HBV) serosurvey.MethodsWe conducted a cross-sectional serosurvey among adults aged ≥18 years using a stratified, multi-stage cluster design (n = 7000). We asked participants standardized questions from the Global Adult Tobacco Survey and the WHO STEPwise approach to Surveillance (STEPS) Survey. We also measured blood pressure and Body Mass Index for each participant. Weighted frequencies were computed for NCD and risk factor prevalence and compared to 2010 STEPS results.ResultsGeorgians reported high rates of smoking, alcohol use, elevated blood pressure, obesity, diabetes and cardiovascular disease. An estimated 27.1% (95% confidence interval [CI]: 25.3, 28.8%) of adults (51.5% of men and 6.0% of women) reported daily use of tobacco products and 27.5% (95% CI: 25.7, 29.2%) of adults (52.1% of men and 7.0% of women) reported binge drinking within the last 30 days. Physical measurements revealed that 37.5% (95% CI: 35.8, 39.3%) of adults had elevated blood pressure and 33.4% (95% CI: 31.8, 35.0%) had obesity. 5.4% (95% CI: 4.6, 6.2%) of adults had self-reported diagnosed diabetes and 15.3% (95% CI: 14.1, 16.6%) had self-reported diagnosed cardiovascular disease. From 2010 to 2015, the prevalence of obesity increased by 8.3 percentage points (95% CI: 5.9, 10.7%; p < 0.01) and the prevalence of elevated blood pressure increased by 4.1 percentage points (95% CI: 1.4, 6.8%; p < 0.01).ConclusionsGeorgia has a high NCD burden, and results from the survey showed an increase in obesity and elevated blood pressure since 2010. The prevalence of other major NCDs have remained near levels reported in the 2010 STEPs survey. Comprehensive public health interventions are needed to control the heath security threats of major NCDs and their risk factors in the future.

A Qualitative Systematic Review of Cigarette Smoking Cessation Interventions for Persons Living with HIV.

Persons living with HIV (PLWH) have disproportionately high rates of both cigarette smoking and tobacco-induced negative health outcomes. The goal of this qualitative systematic review was to identify gaps in the existing literature and future directions for smoking cessation support for PLWH. Three online databases were searched from their inception through December 31, 2017, using designated search terms. Peer-reviewed English-language articles that documented an intervention designed to increase smoking cessation among PLWH were reviewed. Data were abstracted using a standardized form to document study and intervention characteristics and results. Thirty-two articles, describing 28 unique intervention studies, met inclusion criteria. Interventions consisted primarily of combinations of counseling, pharmacotherapy, and the use of information and communications technology; few interventions were implemented at the clinic level. Thirteen interventions resulted in significant improvements in cessation-related outcomes. Information and communications technology and clinic-level interventions had the greatest potential for increasing smoking cessation among PLWH. Efficacious interventions designed for PLWH in the US South, and for groups of PLWH facing additional health disparities (e.g., communities of color and sexual and gender minorities), are needed. There is also a need for more rigorous research designs to test the efficacy of interventions designed to increase cessation-related outcomes among PLWH.

Smoking among stigmatized populations in Serbia

ABSTRACTBackground: Despite progress in reducing smoking prevalence in many countries, stigmatized, marginalized and socially deprived populations with low socioeconomic status still have higher smoking rates compared to general population. The aim of this study is to explore smoking prevalence and correlates among six stigmatized population groups in Serbia.Methods: Smoking prevalence data were extracted from the database from the bio-behavioral cross-sectional surveys conducted in 2013 among populations most at risk for HIV and people living with HIV (PLHIV). Various sampling techniques were used: among sex workers (n=400, snow ball sampling); men having sex with men (MSM) (n=1000, respondent-driven sampling), Roma youth (n=700, respondent-driven sampling); institutionalized children without parental care (n=211, cluster sampling); prisoners (n=543, cluster sampling); PLHIV (n=445, convenient sampling).Results: Smoking prevalence in all stigmatized groups included in this study ranged from 51% (PLHIV) to 91% (Sex Workers). Statistically significant smoking prevalence was found among female prisoners and sex workers. In all population groups, except for sex workers, alcohol use was statistically significantly associated with smoking status.Conclusions: There is a need for targeted interventions for stigmatized population groups in order to reduce smoking-related health disparity between these groups and general population.

FEATURES OF THE ATTITUDE TOWARDS SMOKING IN CONNECTION WITH THE NATURE OF WORK AND MARITAL STATUS IN OPEN URBAN POPULATION: GENDER DIFFERENCES

Aim. To study the attitudes towards smoking in working-age men and women with different nature of work and marital status in Tyumen city.Material and Methods. The cross-sectional epidemiological study was carried out as part of the cardiac screening in open urban male and female population. The study included 850 men (response rate 85.0%) and 704 women (response rate of 70.4%) aged 25–64 years. A self-report questionnaire of the World Health Organization titled «Knowledge and Attitude to Health» with a fixed list of answer options was used to analyze attitudes to smoking. Social status was assessed according to the nature of work (four categories: «unemployed and pensioners», «manual labour», «specialists and technical/engineering employees», and «leaders»), and marital status (have or do not have a life partner). Statistical analysis of the results was conducted using SPSS (11.5) and Statistica 7.0 software packages and Microsoft Excel spreadsheet software. Values were considered statistically significant when p was &lt;0.05.Results. The prevalence of smoking among single men was higher than the corresponding value in men who had a life partner (63.4 vs. 46.6%, р&lt;0.001); the opposite trend was observed in women (13.1 vs. 17.0%, р&gt;0.05). In regard to the nature of work, the highest smoking rate was found among men who were engaged in manual labour (m/f: 60.8/19.8%). Men from the categories of «specialists and technical/engineering employees» and «leaders» (40.7 and 41%) as well as women from the «unemployed and pensioners» category smoked less often (11.6%), (р&lt;0.001). Gender differences in attitudes to smoking depended on marital status and the nature of work. Correlations between the nature of work and attempts to change something in smoking pattern were observed in men (R=0.35, p=0.05) and women (R=0.18, p=0.01).Conclusion. According to the study of open urban population, significant differences were detected between men and women in regard to their attitudes towards smoking. Gender-related differences in the associations of smoking with marital status and the nature of work were identified.

Developing Tobacco Control Interventions in Permanent Supportive Housing for Formerly Homeless Adults.

Smoke-free policies are effective population-based strategies to reduce tobacco use yet are uncommon in permanent supportive housing (PSH) for formerly homeless individuals who have high rates of smoking. In this study, we partnered with six supportive housing agencies in the San Francisco Bay Area to examine the implementation of smoke-free policies and cessation services. We administered a questionnaire and conducted in-depth, semistructured interviews with agency directors (n = 6), property management staff (n = 23), and services staff (n = 24) from 23 PSH sites on the barriers to implementing tobacco control interventions. All properties restricted smoking in indoor shared areas, but only two had policies restricting smoking in living areas. While there was staff consensus that smoke-free policies were important to reduce tobaccorelated harm, participants disagreed on whether smoke-free policies were aligned with PSH’s harm reduction framework. Residents’ comorbid mental illness and substance use and the lack of appropriate enforcement tools were barriers to implementation. Using these formative findings, we present a framework for a toolkit of strategies to increase implementation of smoke-free policies and cessation interventions in PSH. Successful implementation of indoor smoke-free policies in PSH will require concurrent cessation services to support smoking cessation efforts and address the mental health and substance use needs of residents.

Disparities in Lung Cancer Screening Availability: Lessons From Southwest Virginia

Little is known about health disparities in access to low-dose computed tomography (LDCT) screening. This study hypothesized that the current capacity for LDCT screening would be exceeded by the number of at-risk individuals in Virginia. Cancer incidence data and adult smoking rates for Virginia were obtained from public sources between 2006 and 2012. The American College of Radiology website was queried in 2015 to identify lung cancer screening facilities in Virginia, which were surveyed. Spatial exploratory data analysis was used to examine secondary data, and descriptive analysis was used to examine primary survey data. Rural counties have higher lung cancer death rates and smoking rates than metropolitan counties. Despite a tremendous burden for LDCT screening in rural counties, particularly in southwest Virginia, there were only two LDCT facilities. In total,37 accredited LDCT facilities were identified in Virginia. On average, facilities had been screening for 14.6 months and screened an average of 76 patients. At-risk smokers in Virginia, particularly those living in rural areas with high smoking rates, do not have adequate recommended LDCT coverage. More screening centers are needed to care for the high number of rural smokers at risk for lung cancer.

Tobacco control: prevention and cessation in Europe

Reasons for high smoking prevalence in Europe compared to Australia and North America are low prices of tobacco adjusted for purchasing power and poor smoke-free legislation and enforcement in Central and Eastern Europe. High rates of passive smoking in Czechia, Slovakia, Poland and Austria are associated with weak implementation of smoke-free public rooms, especially in the hospitality industry. In 2018 Austria cancelled the smoking ban in all bars and restaurants and continued to allow access to minors, while Hungary since 2012 showed remarkable success by limiting supply of cigarettes and by banning access of minors to tobacco shops. Even more advanced are Western European countries because of lower affordability of cigarettes, ban of smoking rooms and tobacco advertising, plain packaging and public information campaigns. Smoking cessation services across Europe make use of quitlines, provide internet counseling and apps for self-help. Cooperation with physicians should be improved and could help oncologists to combine cancer screening with smoking cessation. Cancer therapy is more successful after smoking cessation.

Abstract 78: Outcomes Following Augmentation Mammoplasty in Transgender and Cisgender Females

BACKGROUND: Gender dysphoria (GD) refers to an incongruence between one’s self expressed gender and their birth assigned sex that causes marked distress. In addition to psychological and medical therapy, many patients also seek gender affirmation surgery (GAS). For transgender females, breast augmentation (‘Top Surgery’) is typically the first, and in some cases, the only, GAS procedure that they will undergo. Recent legislative changes have significantly expanded access to GAS and the demand for these procedures has increased in parallel. The aim of this study was to compare postoperative outcomes of augmentation mammoplasty in transgender and cisgender females. METHODS: We queried the ACS-NSQIP database from 2006–2017 to establish two cohorts: 1) transgender females undergoing gender affirming top surgery and 2) cisgender females seeking cosmetic breast augmentation (without any other or concurrent procedures). Postoperative outcomes were compared between the two cohorts. Multivariable regression analysis was used to control for confounders. RESULTS: A total of 1,360 cases were identified, of which 280 (21%) were male-to-female (MtF) top surgeries and 1,080 (79%) were cosmetic breast augmentation (CBA) cases. The MtF cohort was significantly older (36.8 ± 12.9 years versus 34.8 ± 10.6, p=0.02), had a higher average BMI (26.7 ± 5.6 kg/m2 versus 22.3 ± 3.4 kg/m2, p<0.001), and had a different racial distribution (45.7% white versus 88.2% white, p<0.001) compared with the CBA cohort. MtF patients also had higher rates of smoking (27.1% versus 10.9%, p<0.001), diabetes (4.3% versus 0.9%, p<0.001), and hypertension (10.4% versus 3.1%, p<0.001). The rate of all-cause complications was 1.8% (n=5) in the MtF cohort and 1.6% (n=18) in the CBA cohort (p=0.890). Rates of readmission were also similar between the two groups (1.4% [n=4] in the MtF cohort versus 0.5% [n=5] in the CBA cohort). Multivariable regression analysis revealed no statistically significant predictors for all-cause complications. CONCLUSION: Transfeminine breast augmentation is a safe procedure that has a similar complication profile to its cisgender counterpart. As the social climate for transgender individuals in the United States continues to improve and access to care expands, the need for such procedures will continue to rise. The results of this study should reassure and encourage surgeons who are considering performing this procedure

Challenges and Opportunities for Lung Cancer Screening in Rural America

Rural populations have higher rates of smoking and both lung cancer incidence and mortality compared with their urban peers. As such, it is imperative that high-risk, rural populations have access to recommended low-dose CT (LDCT) screening, which can detect lung cancer at an earlier, more treatable stage. Data from the 2015 National Health Interview Survey, a nationally representative survey, were analyzed to assess nonmetropolitan-metropolitan and geographic differences in LDCT utilization among screening-eligible individuals. Screening uptake did not differ by nonmetropolitan vs. metropolitan status (3.72% and 3.83%, respectively). Regional uptake varied from 1.58% in the West to 10.11% in the Northeast. Additionally, nonmetropolitan populations represent a disproportionately high 23% of the screening-eligible population despite accounting for only 15% of the US population. There are two key challenges to high-quality LDCT screening experienced by rural populations: (1) geographic access to LDCT screening programs and (2) provider-patient communication. Despite the increased availability of LDCT screening centers since 2015, which is when most insurance plans began to cover the costs of screening, centers are geographically maldistributed relative to the rural-urban and regional need. Although decision aids can facilitate discussion between providers and patients regarding the risks and benefits of LDCT screening, research on the uptake and utility of these tools in rural areas is very limited. Analyses of population-based surveys and administrative and clinical data are needed to continue to surveil screening utilization, elucidate predictors of screening use, and inform shared decision-making tools and interventions for at-risk rural populations.