Home Smoking Research Articles

Evaluating the effectiveness of Smoke-Free Home SafeCare, an integrated intervention, among families at risk for secondhand smoke exposure and child maltreatment in the United States: a study protocol for a hybrid type 1 trial

BackgroundSecondhand smoke exposure (SHS) and child maltreatment (CM) are preventable yet have negative lifelong impacts on health. When considered together, the risk for negative health outcomes may be compounded, especially for people living in low-resource settings. Evidence-based interventions exist for preventing CM and reducing SHS among families with low resources; however, no programs jointly target SHS exposure and maltreatment risk.MethodsThis study is a hybrid type 1 trial to examine the effectiveness of a systematically braided intervention to target CM risk and SHS in the home. Fifty SafeCare Providers will be randomized to deliver either standard SafeCare (i.e., the SafeCare model alone; active treatment control; n = 25) or Smoke-Free Home SafeCare (SFHSC; treatment condition; n = 25), the braided intervention that includes both SafeCare and the Smoke-Free Homes: Some Things are Better Outside intervention to N = 500 families. Aim 2 is to assess family-level outcomes. The primary outcome is a full home smoking ban, validated by air nicotine monitors; secondary outcomes include parenting and smoking outcomes. Aim 3 is to evaluate process and implementation outcomes, including cost–benefit. We will use multilevel models and ROC analyses to evaluate and validate the primary outcome. We will use tests of non-inferiority to evaluate secondary outcomes. Cost-effectiveness analyses will be used to assess cost–benefit of SFHSC.DiscussionThis study will be the first to document the outcomes of a multi-component intervention to address cumulative risk factors that impact cancer risk among children whose parents are at risk or involved in child-protective services. Integrating an evidence-based intervention that targets SHS exposure in the home with a broadly disseminated CM prevention intervention may be a sustainable way to help reduce the compounded effects of SHS in the home and CM.Trial registrationClinicaltrials.gov, NCT05000632. Registered on August 11, 2021.

Rural-urban differences in smoking quit ratios and cessation-related factors: Results from a nationally representative sample.

There are significant rural/urban disparities that exist in cancer and chronic disease morbidity and mortality, many of which are attributed to increased tobacco use prevalence in rural populations compared to urban. Understanding differences in rural and urban tobacco use patterns is key to developing targeted interventions. Using nationally representative data from Wave 5 of the Population Assessment of Tobacco Use and Health (PATH), we examined weighted frequencies and conducted multivariable logistic regression to examine the use of cessation supports in people who currently smoke with a quit attempt in the last 12months (recent attempters) by rural and urban status and geographic region. Our second objective was to examine lifetime quitting in rural versus urban people who smoke and by geographic region. Rural people who recently attempted to quit were less likely to use any FDA-approved cessation aids, less likely to use Nicoctine Replacement Therapy (NRT), and less likely to be exposed to a home smoking ban in the adjusted analysis. The adjusted odds of quitting were lower in the rural Northeast, Midwest, and South compared to the urban regions. Findings from this data can serve to inform the development of targeted interventions for rural communities.

Predictive Factors of Peripheral Arterial Disease in Home Care Patients

Objective: The aim of the present study was to investigate the predictive factors of peripheral arterial disease (PAD) in home care patients. Materials and Methods: This descriptive study was conducted in Istanbul with 285 homebound patients who applied for the first time to receive services from the Home Health Care Unit of a tertiary hospital between 01.07.2014 and 01.12.2014. The patients having known PAD diagnosis were excluded. Sociodemographic characteristics, home dependency duration, chronic diseases, medications used and smoking status were recorded. Then, deformities in the patients' toenails, peripheral hair loss, foot wounds were recorded, and the patients' functional status and skinfold thickness were evaluated peripheral arterial disease was evaluated by ankle–brachial index (ABI). An ABI below 0.9 was considered indicative of PAD. A chi-square test, Mann–Whitney U test and a logistic regression analysis were used in the statistical analysis. Results: The mean age of the participants was 75.84±1.17 years (34% M; 65% F). Peripheral artery disease was detected in 16.8% (n=48) of the patients. Current or former smoking (β: 4.09), peripheral hair loss (β: 3.42), deformity of toenails (β: 3.02), and increased skinfold thickness (β: 1.124) were identified as predictors of PAD. Conclusion: The findings of the present study suggest that home healthcare providers should inquire about the patient's smoking history, assess skinfold thickness, and examine the toes for hair loss and deformities, to predict PAD.

Second Hand Tobacco Smoke Exposure among Adults in an Urbanized Village in Delhi

Abstract Background: India contributes to the maximum of the world’s health burdens attributable to tobacco use. Exposure to secondhand smoke (SHS) is also associated with adverse health effects, causing 1.2 million deaths worldwide each year. In Delhi, 28.0% had SHS exposure at public places. About one-fifth experienced exposure to SHS at workplace. This study aimed to determine the prevalence of SHS exposure among adults in an urbanized village in Delhi. Materials and Method: It was a community-based cross-sectional house-to-house survey conducted between January 2020 and June 2021 in Aliganj, an urbanized village in Delhi. A total of 490 residents ≥15 years were included using simple random sampling. The interview was conducted by the primary author using the Global Adult Tobacco Survey (GATS). Each subject enrolled in the study was explicitly informed of the purpose of the study by the investigator and provided written informed consent before enrolment. Data were checked for errors, entered in Microsoft Excel, and analyzed in Statistical Package for the Social Sciences (SPSS). Results: Of the 490 participants, 14.7% were exposed to SHS in their house and 16.1% were exposed to SHS outside the house in the last 1 month. The majority (85.3%) believed secondhand smoking is harmful, 6.5% disagreed, and the rest were unaware. Conclusion: Though most participants knew that exposure to SHS can cause serious illness, further awareness sessions need to be conducted to improve knowledge and understanding and reduce exposure to secondhand tobacco smoke in homes. Strict adherence to no-smoking policies should be implemented as per law to reduce exposure to SHS in public areas.

Global study on tobacco use among youth 13-15 years old in the Russian Federation: dynamic surveillance 2004-2021

The surveys used representative samples formed on the basis of all public schools. In 2004, 2015 and 2021 regional sampling included two stages. In 2021 national sampling included three stages: the selection of municipalities, schools and classes. All students of the selected classes were asked. The surveys used the same questionnaire. The total number of respondents - 38 345, the overall response rate - more than 90%. In the Russian Federation, in 2004-2021 among students aged 13-15, the prevalence of tobacco consumption decreased from 27.3 to 11.0%, passive smoking in homes from 76.4 to 23.1%, in closed public places from 89.4 to 23.7%. The consumption of ENDS and HTPs increased up to 16.7 and 3.5% respectively. Similar trends in consumption of products, passive smoking were identified in all the cities. The adoption in 2013 of the Federal Law "On protecting the health of citizens from the effects of second hand tobacco smoke, the consequences of tobacco consumption or the consumption of nicotine-containing products" had a significant impact on tobacco use by adolescents and reduced the prevalence of tobacco consumption and passive smoking among them by 3 times.

IJCM_111A: Awareness of third- and fourth-hand smoking and its implications among medical students - A cross sectional study

Background: The term third hand smoke (THS) may have initially appeared in print in 2006, more widely known in 2009. In that work, the researchers stated that 65.2% of non-smokers and 43.3% of smokers believed THS could harm children and such opinions were associated with the imposition of home smoking bans. Fourth-hand smoke, up to two thirds of cigarette butts terminate in the environment. Objective: To estimate awareness and implication of third- and fourth-hand smoking among Medical students. Methodology: A cross sectional study was conducted among Medical students of a Medical College in South India in the month of April 2023. All Medical students whoever gave consent were included in the study. A pre-designed semi-structured questionnaire was administered in google forms to the study participants and informed consent was obtained from the participants. The Beliefs About Third Hand (BATHS) Scale was used to determine beliefs about THS. The data was initially entered to Microsoft Excel 2010 and analysed using statistical package of social science (SPSS trial version 20.0). Results: Among the 360 participants only 35.6% (128) of participants were aware of third hand smoking and 23.3% (84) of participants were aware about fourth hand smoking. Nearly 222(61.6%) participants had opinion of developing asthma, followed by acute respiratory tract infection and wheeze in children when exposed to third hand smoke. Majority 341(94.7%) and 344 (95.6%) participants out of 360 had opinion that smoking should be banned in home environment and public places respectively. Conclusion: The medical students had less awareness about third hand smoke and its effect on human health, hence measures have to be taken to make medical students aware about it. It can be recommended to incorporate third- and fourth-hand smoking as educational messages in the medical curriculum.

Changes in oral home care and smoking habits during COVID-19 pandemic: A cross-sectional study.

The coronavirus disease-19 (COVID-19) pandemic has caused disruption in the health behavior in many aspects of life. While hand hygiene was promoted as one of the precautionary measures to mitigate and contain COVID-19, oral health and smoking might have received less attention in the media campaigns. The aim of this study was to examine health behavioral changes in terms of oral home care habits, smoking, and perception of dental care during the COVID-19 pandemic. An online survey was designed to assess oral home care, smoking habits, and attitude towarddental services of participants aged 18 years and older. The data were collected between September and November 2021. The strength of association between changes in oral home care habits, smoking, and attitude toward invasive/long dental procedures and each variable was measured by χ2 analysis. Estimates of relative risk were also calculated for all variables. Predictors of avoiding dental procedures were estimated by a binary logistic regression. A total of 532 participants, based in the United Arab Emirates, took part in this online survey with a response rate of 88.7%. The age of the participants ranged between 18 and 67 with mean age of 34.9 ± 9.0 years. The majority of the participants have adopted changes in their routine oral home care habits, with 82.1% of them changing the toothbrush more frequently. Participants who changed their oral home care habits were more likely to have received sufficient information on the importance of maintaining oral health. Likewise, the changes in smoking habits were significantly associated with receiving information on the relationship between smoking and the severity of the COVID-19 (p < 0.001). The findings showed that positive behavior towardoral home care and smoking was noticed during the pandemic particularly when public receives sufficient and up-to-date information.

The Relationship of Residential Density and Smoking Habits with The Incidence of Acute Respiratory Infections (Ari) In Toddlers in The Working Area at The Sausu Public Health Clinic, Parigi Moutong District, Central Sulawesi Province

ISPA is a respiratory tract disease that can cause mild to fatal infections due to environmental factors. ISPA in toddlers is caused by several factors including environmental factors, namely type of house, ventilation, type of floor, lighting, residential density, humidity, type of fuel and smoking habits. The aim of this research is to find out whether there is a relationship between population density and smoking habits with the incidence of ISPA in toddlers in the Sausu Community Health Center Working Area, Parigi Moutong Regency, Central Sulawesi Province. Analytical with the aim of finding relationships between one variable and other variables. The population was 167 samples, 62 toddlers suffering from ISPA and not suffering from ISPA. There is no relationship between the density of house occupants and the incidence of ISPA with a P-Value ≥ 0.252 &gt; 0.05, so Ho is accepted and Ha is rejected. There is no relationship between home smoking habits and the incidence of ARI with a P-Value ≥ 1,000 &gt; 0.05, so Ho is accepted and Ha is rejected. Keep the home environment clean and do not smoke near children, inside the house. Because it will have an impact on the health of the toddler and the entire family.

Estimating the prevalence of and clarifying factors associated with multiple tobacco product use in Japan: a cross-sectional study in 2022.

BackgroundMultiple tobacco product (MTP) use is a public health concern due to their combined adverse health effects. MTP use may have increased since heated tobacco products (HTPs) became more prevalent in Japan. This study aimed to (1) estimate the recent prevalence of MTP use and clarify the associated factors compared to (2) non-smokers and (3) single-product users.MethodWe used data from an internet survey conducted in February 2022. The prevalence of MTP use in Japan was estimated using inverse probability-weighted scores from this survey and a nationwide survey by the Japanese government. Tobacco products include six types: cigarettes, HTPs, e-cigarettes, cigars, pipe/water pipes, and smokeless tobacco products. MTP use was defined using the outcome variable (no use, single-product use, and MTP use) based on these six types of use. Using multivariate logistic regression, we calculated the adjusted odds ratios and 95% confidence intervals (CI) to clarify factors associated with MTP use compared to non-smokers, adjusting demographic variables, psychological distress, self-rated health, and alcohol use. Using multivariate Poisson regression, we calculated the adjusted prevalence ratios (aPR) and 95%CI to clarify factors associated with MTP use among smokers, adjusting for these covariates and smoking-related factors like workplace and home smoking rules.ResultsWe analyzed 30,141 participants whose mean age was 47.8 years (standard deviation = 17.9), and 14,722 participants were male (48.8%). The estimated prevalence of MTP use was 6.8%. The most common combination of MTP use was cigarettes and HTPs. Compared to non-smokers, being younger, male, low education, poor psychological distress, poor self-rated health, and alcohol use were factors associated with MTP use. Among smokers, workplace smoking rules, such as a partial smoking ban and no smoking ban, were not associated with MTP use compared to the indoor smoking ban. However, participants with no home smoking ban were positively associated with MTP use compared to those with a ban on both cigarettes and HTPs at home (both cigarettes and HTPs allowed aPR=1.36, 95%CI 1.15 to 1.61, HTPs only allowed aPR=1.73, 95%CI 1.43 to 2.10).ConclusionMTP users may account for a high percentage of Japanese smokers.

Use of nicotine replacement therapy to reduce children’s exposure to second-hand smoke in the home: a qualitative pilot study involving local community pharmacies

BackgroundIn Scotland, and in several other countries, most second-hand smoke exposure now occurs in low-income households, where housing constraints and sole parenting often make it harder to create a smoke-free home. This pilot study provided people who smoke with a free 12-week supply of nicotine replacement therapy through local community pharmacies to reduce smoking indoors.MethodsTwenty-five parents/caregivers who smoked in the home and cared for children at least weekly were recruited via Facebook during the COVID-19 pandemic. Air quality (PM2.5) was monitored in participant homes for seven days before their first pharmacy visit and 12 weeks later. Qualitative interviews (N = 14) were conducted with 13 participants who completed the study and one who withdrew part-way through. The interviews explored views/experiences of using nicotine replacement therapy to help create a smoke-free home. Another participant took part in a shorter telephone discussion at their request, with detailed notes taken by the interviewer, because of their speech disorder.ResultsThree participants reported smoking outdoors only, one of whom subsequently quit smoking. Six participants reported reduced cigarette consumption by 50% in the home, four reported no (sustained) reduction and one reported increased smoking indoors. Self-reported outcomes were not always consistent with PM2.5 readings. Participants’ experiences of accessing nicotine replacement therapy through community pharmacies varied. Some suggested ongoing support to use nicotine replacement products could better assist behavioural change, and that access could be streamlined by posting products to the home. Several suggested that focusing on changing home smoking behaviours using nicotine replacement therapy might facilitate a future quit attempt.ConclusionAccess to free nicotine replacement therapy for temporary use indoors may support some people who smoke to reduce children’s exposure to second-hand smoke. Our findings confirm the need to modify the intervention before undertaking a definitive trial to assess the effectiveness of this approach. This work is now underway.

Contamination of surfaces in children's homes with nicotine and the potent carcinogenic tobacco-specific nitrosamine NNK.

Tobacco smoke exposure (TSE) through secondhand and thirdhand smoke is a modifiable risk factor that contributes to childhood morbidity. Limited research has assessed surface TSE pollution in children's environments as a potential source of thirdhand smoke exposure, and none have examined levels of the tobacco-specific nitrosamine 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanone (NNK) on surfaces. This study measured surface NNK and nicotine in children's homes and associations with sociodemographics and parent-reported TSE behaviors. We assessed correlations of surface NNK and nicotine with dust NNK, dust nicotine, and child cotinine. Home surface wipe NNK and nicotine data from 84 children who lived with smokers were analyzed. Tobit and simple linear regression analyses were conducted to assess associations of surface NNK and nicotine with child characteristics. Spearman's (ρ) correlations assessed the strength of associations between environmental markers and child cotinine. Nearly half (48.8%) of children's home surfaces had detectable NNK and 100% had detectable nicotine. The respective geometric means (GMs) of surface NNK and nicotine loadings were 14.0 ng/m2 and 16.4 µg/m2. Surface NNK positively correlated with surface nicotine (ρ = 0.54, p < 0.001) and dust NNK (ρ = 0.30, p = 0.020). Surface nicotine positively correlated with dust NNK (ρ = 0.42, p < 0.001) and dust nicotine (ρ = 0.24, p = 0.041). Children with household incomes ≤$15,000 had higher surface NNK levels (GM = 18.7 ng/m2, p = 0.017) compared to children with household incomes >$15,000 (GM = 7.1 ng/m2). Children with no home smoking bans had higher surface NNK (GM = 18.1 ng/m2, p = 0.020) and surface nicotine (GM = 17.7 µg/m2, p = 0.019) levels compared to children with smoking bans (GM = 7.5 ng/m2, 4.8 µg/m2, respectively). Although nicotine on surfaces is an established marker of thirdhand smoke pollution, other thirdhand smoke contaminants have not been measured on surfaces in the homes of children living with smokers. We provide evidence that the potent carcinogenic tobacco-specific nitrosamine NNK was detectable on surfaces in nearly half of children's homes, and nicotine was detectable on all surfaces. Surface NNK was positively correlated with surface nicotine and dust NNK. Detectable surface NNK levels were found in homes with indoor smoking bans, indicating the role of NNK as a persistent thirdhand smoke pollutant accumulating on surfaces as well as in dust.

SAT214 A Rare Case Of Biopsy-proven Non-uremic Calciphylaxis In A Patient With Secondary Hyperparathyroidism

Abstract Disclosure: U.A. Ogar: None. A.G. Olafimihan: None. I. Asemota: None. E. Krishnaraju: None. A. Okafor: None. Introduction: Calciphylaxis, also known as calcific uremic arteriolopathy, is a rare, lethal, metastatic calcification involving cutaneous microvasculature that presents as painful necrotic skin lesions. It typically occurs in patients with end-stage kidney disease (ESKD), renal transplant, or acute kidney injury requiring renal replacement therapy. Calciphylaxis occurring without these comorbidities is termed non-uremic calciphylaxis (NUC), which is rarer. NUC’s etiology is unclear but it has been associated with hyperparathyroidism, malignancies, alcohol liver disease, and connective tissue disorders. There are only a few reported cases of biopsy-proven NUC in patients with secondary hyperparathyroidism, as in our patient. Clinical Case: A 63-year-old female with a history of COPD on home oxygen therapy, smoking, and alcohol use disorder presented with a four-day history of severe, painful, purplish left thigh rash. She had no recent trauma or insect bite. Her physical exam showed a large (6x10 cm), tender, distal anterior left thigh bruise. Laboratory findings were significant for elevated creatine of 4.3 mg/dL from a normal baseline creatinine (0.6 mg/dL), normal serum corrected calcium (10.1 mg/dL) and elevated phosphate (4.7mg/dL). Three days following her admission, the skin lesion had progressed into multiple brown coalescing bullae with central ulceration, collarette, surrounding erythema, warmth, and induration. Due to concern for possible skin and soft tissue infection, empiric vancomycin therapy was started. However, the overall clinical picture was not convincing of an infection, necessitating consultation with the Dermatology team. A skin biopsy was recommended, and this was diagnostic of calciphylaxis. Further testing revealed hyperparathyroidism (202pg/ml), low 25 hydroxy Vitamin D (12ng/ml), and negative autoimmune and thrombophilia workup. Her treatment plan included wound care with debridement, analgesia, and interdisciplinary clinic follow-up. During outpatient follow-up, her wound was seen to be slowly healing with daily wound dressing, and her elevated serum creatinine had resolved. Conclusion: NUC has a high mortality rate (52%) and requires a high index of clinical suspicion to ensure prompt diagnosis and initiation of treatment. Differential diagnoses include atherosclerotic vascular disease, vasculitis, hypercoagulable disorders, and cellulitis as in our patient. Skin biopsy is diagnostic. Aggressive wound care and analgesia are pivotal to treatment, in addition to addressing underlying precipitating conditions. Other treatment options like sodium thiosulphate exist but with uncertain outcomes. Efforts geared at definitive therapeutic modalities are needed. Presentation: Saturday, June 17, 2023

Changes and stability of hand nicotine levels in children of smokers: Associations with urinary biomarkers, reported child tobacco smoke exposure, and home smoking bans

BackgroundExposure to thirdhand smoke (THS) residue takes place through inhalation, ingestion, and dermal transfer. Hand nicotine levels have been proposed to measure THS pollution in the environment of children, but little is known about its variability and stability over time and correlates of change. ObjectivesThe goal was to determine the stability of hand nicotine in comparison to urinary biomarkers and to explore factors that influence changes in hand nicotine. MethodsData were collected from 0 to 11-year-old children (Mean age = 5.9) who lived with ≥1 tobacco smokers (N = 129). At a 6-week interval, we collected repeated measures of hand nicotine, four urinary biomarkers (cotinine, trans-3′-hydroxycotinine, nicotelline N-oxides, and 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanol), and parent-reported child tobacco smoke exposure (TSE). Dependent sample t-tests, correlations, and multivariable regression analyses were conducted to examine the changes in child TSE. ResultsHand nicotine levels (r = 0.63, p < 0.001) showed similar correlations between repeated measures to urinary biomarkers (r = 0.58–0.71; p < 0.001). Different from urinary biomarkers, mean hand nicotine levels increased over time (t(113) = 3.37, p < 0.001) being significantly higher in children from homes without smoking bans at Time 2 (p = 0.016) compared to Time 1 (p = 0.003). Changes in hand nicotine correlated with changes in cotinine and trans-3′-hydroxycotinine (r = 0.30 and r = 0.19, respectively, p < 0.05). Children with home smoking bans at Time 1 and 2 showed significantly lower hand nicotine levels compared to children without home smoking bans. DiscussionFindings indicate that hand nicotine levels provide additional insights into children’s exposure to tobacco smoke pollutants than reported child TSE and urinary biomarkers. Changes in hand nicotine levels show that consistent home smoking bans in homes of children of smokers can lower THS exposure. Hand nicotine levels may be influenced by the environmental settings in which they are collected.

Satisfaction with medication in older adult patients with chronic respiratory diseases: a multicenter cross-sectional observational study.

To gain insight into medication satisfaction and factors associated with chronic respiratory disease, particularly chronic obstructive pulmonary disease (COPD) in older adults, focusing on public health issues and improving the health of the older adult population. This cross-sectional study was conducted from October 2022 to November 2022 in 24 hospitals in different regions of Hunan Province, China. Older adult patient treatment satisfaction was assessed using the Treatment Satisfaction Questionnaire for Medication version II. Multiple regression analysis was used to identify factors independently associated with patient treatment satisfaction. Only 15.9% of all patients scored above 80 in the effectiveness domain, while 11.6 and 16.5% scored above 80 in the convenience and global satisfaction domains, respectively, while 17.3% reported having side effects. Interstitial lung disease was associated with lower drug satisfaction than other disorders (p < 0.05). Multifactorial regression analysis showed that age, education background, profession, and smoking status were independently associated with satisfaction among patients with chronic respiratory diseases (p < 0.05). Education background, profession, CAT score, number of acute exacerbations, duration of home oxygenation and duration of home ventilator use were independently associated with satisfaction in patients with COPD (p < 0.05). Low satisfaction with chronic respiratory drug therapy was associated with age, education background, profession and smoking status. Satisfaction was lower for patients with interstitial lung disease. For COPD, CAT score, education background, profession, number of acute exacerbations, home oxygen and ventilator use influence satisfaction. Clinicians can identify appropriate patients and communicate effectively with them throughout treatment and follow-up, vigorously promote smoking cessation and home oxygen therapy, increase medication satisfaction, especially among older adults, and in turn improve public health and the quality of life of older adults.

Expression of Concern: A Health Threat to Bystanders Living in the Homes of Smokers: How Smoke Toxins Deposited on Surfaces Can Cause Insulin Resistance.

Expression of Concern: A Health Threat to Bystanders Living in the Homes of Smokers: How Smoke Toxins Deposited on Surfaces Can Cause Insulin Resistance.

Disparities in Smokefree and Vapefree Home Rules and Smokefree Policy Attitudes Based on Housing Type and Cigarette Smoking Status, United States, 2019.

This study examined variations in cigarette smoking status, home smoking and vaping rules, and attitudes toward smoking rules among U.S. adults. We analyzed data from the 2019 U.S. Census Bureau's Current Population Survey Supplements (n = 40,296 adults) and calculated weighted prevalence estimates of adult cigarette smoking based on housing type. In 2019, multi-unit housing (MUH) residents who currently smoked were predominantly residents of privately rented housing (66.9%), followed by privately owned (17.6%) and public housing (15.5%). MUH residents who currently smoked had the highest proportions of allowing smoking (26.7%) or vaping (29.1%) anywhere inside their homes and were least likely to support rules allowing smoking inside all MUH apartments or living areas. In the adjusted models, MUH residents with a current smoking status were 92% less likely to have a complete smoking ban. More than one in four MUH residents with a current smoking status allowed all smoking inside the home and supported allowing smoking inside all MUH apartment or living areas, reinforcing how MUH residents may be at higher risk of experiencing secondhand smoke or aerosol exposure, or incursions within their places of residence. Our results can inform the development, implementation, and sustainment of strategies to reduce exposures from tobacco and nicotine products in all living environments.

Formation of pyrolysis-affected PAHs, oxygenated PAHs and MCPDs in home smoked meat

Traditional American home smoking of meat is becoming more and more popular also in Europe due to the positive characteristics of home smoked meat such as flavor, taste and texture. However, the long and intensive smoke exposure leads to the formation of pyrolysis-affected contaminants. Here, the contents of eight oxygenated polycyclic aromatic hydrocarbons (OPAHs), six PAHs, and free 3- and 2-MCPD were investigated in home smoked meat. The meat was prepared under seven different conditions (four replicates, each) defined by smoking device (offset smoker or kettle grill), heating material (beech wood logs or charcoal), smoking material (logs or chips) and sample pretreatment (unsalted and salted). The highest median contents were observed for salted meat prepared on an offset smoker using logs (OPAH4: 31 μg/kg; PAH4: 68 μg/kg; 3-MCPD: 98 μg/kg; 2-MCPD: 7 μg/kg), exceeding the PAH4 EU maximum level for barbecued meat of 30 μg/kg. Salting of meat before smoking had a great effect on the 3- and 2-MCPD content, but not on the OPAHs and PAHs. 3- and 2-MCPD noticeably penetrated the smoked product in contrast to the PAHs and OPAHs. An approximate prediction of the OPAH4 content on the basis of the PAH4 content is possible.

The association between risk perceptions, anxiety, and self-reported changes in tobacco and nicotine product use due to COVID-19 in May-June 2020 in Israel

BackgroundEarly in the COVID-19 pandemic, reports about a possible protective effect of nicotine on COVID-19 conflicted with messaging by public health organizations about increased risks of COVID-19 due to smoking. The ambiguous information the public received, combined with COVID-19-induced anxiety, may have led to changes in tobacco or other nicotine product use. This study examined changes in use of combustible cigarettes (CCs), nargila (hookah/waterpipe), e-cigarettes, and IQOS and home-smoking behaviors. We also assessed COVID-19 related anxiety and perceptions regarding changes in risk of COVID-19 severity due to smoking.MethodsWe used cross-sectional data from a population telephone survey that was conducted in Israel in the early phase of the COVID-19 pandemic (May–June 2020) and included 420 adult (age 18+) individuals who reported having ever used CCs (n = 391), nargila (n = 193), and/or electronic cigarettes (e-cigarettes)/heated tobacco products (e.g., IQOS) (n = 52). Respondents were asked about the effect that COVID-19 had on their nicotine product use (quit/reduced use, no change, increased use). We assessed changes in product use, risk perceptions, and anxiety using adjusted multinomial logistic regression analyses.ResultsMost respondents did not change their frequency of product use (CCs: 81.0%, nargila: 88.2%, e-cigarettes/IQOS: 96.8%). A small percentage either decreased use (CCs: 7.2%, nargila: 3.2%, e-cigarettes/IQOS:2.4%) or increased use (CCs:11.8%, nargila:8.6%, e-cigarettes/IQOS:+ 0.9%). 55.6% of respondents used a product in the home prior to COVID-19; but during the first lockdown COVID-19 period, a greater percentage increased (12.6%) than decreased (4.0%) their home use. Higher levels of anxiety due to COVID-19 were associated with increased home smoking (aOR = 1.59, 95% CI:1.04–2.42, p = 0.02). Many respondents believed that increased severity of COVID-19 illness was associated with CCs (62.0%) and e-cigarettes/vaping (45.3%), with uncertainty about the association being lower for CCs (20.5%) than for vaping (41.3%).ConclusionsWhile many respondents believed that nicotine product use (particularly CCs and e-cigarettes) was associated with increased risk of COVID-19 disease severity, the majority of users did not change their tobacco/nicotine use. The confusion about the relationship between tobacco use and COVID-19 calls for clear evidence-based messaging from governments. The association between home smoking and increased COVID-19-related stress suggests the need for campaigns and resources to prevent smoking in the home, particularly during times of stress.

The Enhanced Recovery After Surgery pathway for posterior cervical surgery: a retrospective propensity-matched cohort study.

The Enhanced Recovery After Surgery (ERAS) protocol is a comprehensive, multifaceted approach aimed at improving postoperative outcomes. It incorporates a range of strategies to promote early and more effective recovery, including reducing pain, complications, and length of stay, without increasing readmission rate. To date, ERAS for spine surgery patients has been primarily limited to lumbar surgery and anterior cervical decompression and fusion (ACDF). ERAS has not been previously studied for posterior cervical surgery, which may present a greater opportunity for improvement in patient outcomes with ERAS than ACDF. This single-institution, multi-surgeon study assessed the impact of an ERAS protocol in patients undergoing posterior cervical decompression surgery. This study included a retrospective consecutive patient cohort with controls that were propensity matched for age, body mass index, sex, home opioid use, surgical levels, Nurick grade, and smoking status. In addition, consecutive patients who underwent posterior cervical decompression surgery for degenerative disease from December 2014 to December 2021 were included. ERAS was implemented in December 2018. Demographic, perioperative, clinical, and radiographic information was gathered. Regression models were created to evaluate length of stay, physiological function, pain levels, and opioid use. The primary focus was length of stay, with secondary outcomes including timing of ambulation, bowel movement, and voiding; daily pain scores; opioid consumption; discharge status; 30-day readmission rates; and reoperation rates. There were 366 patients included in the study, all of whom were included in multivariate models, and 254 (127 in each cohort) were included on the basis of matching. After propensity matching, patient characteristics, operative procedures, and operative duration were similar between groups. The ERAS cohort had a significantly improved length of stay (3.2 vs 4.7 days, p < 0.0001) and home discharge rate (80% vs 50%, p < 0.001) without an increase in readmission rate. The ERAS cohort had an earlier day of the first ambulation (p = 0.003), bowel movement (p = 0.014), and voiding (p = 0.001). ERAS demonstrated a significantly lower composite complication rate (1.1 vs 1.8, p < 0.0001). ERAS resulted in better maximum pain scores (p = 0.043) and trended toward improved mean pain scores (p = 0.072), although total opioid use was similar. Implementing a novel ERAS protocol significantly improved length of stay, return of physiological function, home discharge, complications, and maximum pain score after posterior cervical surgery.

Early childhood lower respiratory tract infection and premature adult death from respiratory disease in Great Britain: a national birth cohort study

Lower respiratory tract infections (LRTIs) in early childhood are known to influence lung development and lifelong lung health, but their link to premature adult death from respiratory disease is unclear. We aimed to estimate the association between early childhood LRTI and the risk and burden of premature adult mortality from respiratory disease. This longitudinal observational cohort study used data collected prospectively by the Medical Research Council National Survey of Health and Development in a nationally representative cohort recruited at birth in March, 1946, in England, Scotland, and Wales. We evaluated the association between LRTI during early childhood (age <2 years) and death from respiratory disease from age 26 through 73 years. Early childhood LRTI occurrence was reported by parents or guardians. Cause and date of death were obtained from the National Health Service Central Register. Hazard ratios (HRs) and population attributable risk associated with early childhood LRTI were estimated using competing risks Cox proportional hazards models, adjusted for childhood socioeconomic position, childhood home overcrowding, birthweight, sex, and smoking at age 20-25 years. We compared mortality within the cohort studied with national mortality patterns and estimated corresponding excess deaths occurring nationally during the study period. 5362 participants were enrolled in March, 1946, and 4032 (75%) continued participating in the study at age 20-25 years. 443 participants with incomplete data on early childhood (368 [9%] of 4032), smoking (57 [1%]), or mortality (18 [<1%]) were excluded. 3589 participants aged 26 years (1840 [51%] male and 1749 [49%] female) were included in the survival analyses from 1972 onwards. The maximum follow-up time was 47·9 years. Among 3589 participants, 913 (25%) who had an LRTI during early childhood were at greater risk of dying from respiratory disease by age 73 years than those with no LRTI during early childhood (HR 1·93, 95% CI 1·10-3·37; p=0·021), after adjustment for childhood socioeconomic position, childhood home overcrowding, birthweight, sex, and adult smoking. This finding corresponded to a population attributable risk of 20·4% (95% CI 3·8-29·8) and 179 188 (95% CI 33 806-261 519) excess deaths across England and Wales between 1972 and 2019. In this prospective, life-spanning, nationally representative cohort study, LRTI during early childhood was associated with almost a two times increased risk of premature adult death from respiratory disease, and accounted for one-fifth of these deaths. National Institute for Health and Care Research Imperial Biomedical Research Centre, Royal Brompton and Harefield National Health Service (NHS) Foundation Trust, Royal Brompton and Harefield Hospitals Charity and Imperial College Healthcare NHS Trust, UK Medical Research Council.