Cigarette Smoking Intensity Research Articles

Effect of Smoking on Red Blood Cell Parameters: A Cross-sectional Study in a Divisional City of Bangladesh

Background: Several metabolic and biochemical processes, hormone secretion, and the haematological system are all affected by smoking. Numerous studies have found that smoking is associated with higher levels of haemoglobin concentration (Hb%), total red blood cell count (RBC), and red cell distribution width (RDW). Objectives: To study the RBC parameters in healthy male smokers and non-smokers among adults. Methodology: This research was carried out in the Department of Physiology of Sylhet MAG Osmani Medical College, from July, 2021 to June, 2022. A total of 200 participants were included with healthy adult smokers and age-matched healthy adult non-smokers. History and physical examinations were used to evaluate each individual. We measured height and weight, and calculated body mass index of the subjects. Calculations were made on cigarette smoking intensity and duration. Blood was collected to determine RBC parameters, such as total RBC count, haemoglobin level, haematocrit, mean corpuscular volume (MCV), mean corpuscular haemoglobin (MCH), mean corpuscular haemoglobin concentration (MCHC) and red cell distribution width (RDW) by using Sysmex 500i automatic haematology analyzer (Japan). Results: Among the 200 participants, 100 were adult smokers and another 100 age-matched healthy adult non-smokers. The RBC indices were significantly elevated in smokers compared to non-smokers group: mean haemoglobin concentration (g/dl)+ standard deviation (SD) were 14.17 ± 2.13 versus 13.27 ± 1.39 respectively with p<0.001, mean haematocrit (HCT) (percent)+ SD were 41.60 ± 6.88 versus 39.13 ± 5.46 respectively with p=0.005, mean corpuscular volume (MCV) (fl) + SD 91.13 ± 8.86 versus 88.33 ± 5.58 respectively with p=0.033, mean corpuscular hemoglobin (MCH) (pg) + SD 31.16 ± 3.26 versus 30.05 ± 3.0 respectively with p=0.016 and mean red cell distribution width (RDW) (percent)+ SD 14.74 ± 1.63 versus 14.00 ± 1.57 respectively with p=0.001. However, RBC count (×106/μl) (4.60 ± 0.80 versus 4.46 ± 0.60; p=0.143) and mean corpuscular haemoglobin concentration (MCHC) (g/dl) (34.23 ± 2.11 versus 34.11 ± 2.32; p=0.707) did not differ significantly between smoker and non-smoker groups. There was no statistical difference between mild, moderate, and severe smokers, according to the study's variables. Conclusion: MCV, MCH, RDW, haematocrit, and haemoglobin concentration were all significantly higher in smokers. Journal of Monno Medical College December, 2023; 9 (2):41-46

Maternal cigarette smoking before or during pregnancy increases the risk of severe neonatal morbidity after delivery: a nationwide population-based retrospective cohort study

BackgroundThe association of maternal cigarette smoking during pregnancy with severe neonatal morbidity (SNM) is still inconclusive. We aimed to examine the associations of the timing and the intensity of maternal...

Abstract A093: Assessing cigarette smoking intensity among California adults and the need for tailored interventions to reduce health disparities

Abstract Background: Smoking causes about 20% of all cancers and about 30% of all cancer deaths in the U.S (ACS, 2024). Smoking increases the risk for cancers of the mouth, larynx, pharynx, esophagus, kidney, cervix, breast, liver, bladder, pancreas, stomach, colon, and acute myeloid leukemia and there is no safe form of tobacco smoke (CDC, 2023; ACS, 2024). This study aims to inform public health strategies that can mitigate smoking related disparities and improve health outcomes for marginalized populations. Methods: This study assessed the prevalence of cigarette smoking by demographic characteristics among California adults. We used secondary data from the 2019 California Health Interview Survey (CHIS) that was collected through a random-digit dial telephone survey. Adults ages 18+ were interviewed. We utilized secondary data comprised of 22,160 participants. We conducted interactions between gender and race/ethnicity, and one's smoking status. Multinomial logistic regression test was conducted to predict the probability of participants' level. This study was approved by the researchers Institutional Review Board. Results: Majority or participants were non-smokers (93.1%), mostly females (51.2%,). Many had a bachelor’s degree (23.9%) or some college, vocational training, or an associate degree (22.8%). Many participants (59.8%) were married/living with a partner, and (25.7%) were single. Most participants spoke English (55.4%) and the largest race/ethnic groups were White (40.2%) followed by Latinos (21.8%). Age distribution was as follows: 18–29 (22.9%), 30–39 (17.6%), and 40–49-year-olds (16.2%). For low-intensity smokers , in terms of race/ethnicity, Latino participants were less likely to be low-intensity smokers relative to non-smokers in comparison to White participants (RRR = .411, p = .043). For moderate-intensity smokers , education was statistically significant, with participants holding a graduate degree being significantly less likely to be moderate-intensity smokers relative to non-smokers in comparison to participants who had a HS degree (RRR = .068, p = .025). For high-intensity smokers , single participants were more likely to be high-intensity smokers compared to those married or living with a partner (RRR = 2.72, p = .011). In terms of age, only participants that were 30 to 39 years old were statistically significant, with this group more likely to be high-intensity smokers relative to non-smokers in comparison to participants who were 20 to 29 years of age (RRR = 3.40, p = .031). Conclusion: Findings suggest that one’s demographics characteristics does play a role in smoking consumption rates. Addressing disparities in smoking and cancer requires a multifaceted approach that includes policy changes, targeted interventions, and improved access to healthcare and smoking cessation resources. Hence, public health efforts should create evidence-based interventions and consider the social, economic, and cultural contexts of target populations to reduce disparities in smoking and cancer. Citation Format: Salome Kapella Mshigeni, Anhthu Nguyen, Julian C Sacdalan, Elizabeth Pinder-McSwain, Felipe Aperador Tarazona. Assessing cigarette smoking intensity among California adults and the need for tailored interventions to reduce health disparities [abstract]. In: Proceedings of the 17th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2024 Sep 21-24; Los Angeles, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2024;33(9 Suppl):Abstract nr A093.

Use of cigarettes and e-cigarettes, impulsivity and anxiety: Influences on suicidal ideation among youth and young adults in Texas.

Cigarette use and smoking intensity increase risk of suicidal ideation. Less is known about e-cigarette use. Here we examine direct influences of cigarette versus e-cigarette use on suicidal ideation among 16-to-23-year-olds in Texas. Since 2019 the Texas Adolescent Tobacco and Marketing Surveillance study collected data on suicidal ideation every six months covering the previous two-weeks. Youths answering that they had "thoughts that you would be better off dead, or of hurting yourself" on more than two of 14 days were categorized as having suicidal ideation. Generalized linear mixed-effects logistic regressions examined the influence of ever and past 30-day (P30D) use of cigarettes, e-cigarettes, impulsivity and anxiety on suicidal ideation, controlling for gender, race/ethnicity, SES, and grade in school. Interactions between ever and P30D use of both products and a) impulsivity and b) gender were examined. Of the 2,329 participants, 29.1% reported ever and 6.5% reported P30D cigarette use, 48.2% reported ever and 11.6% reported P30D e-cigarette use, and 18.5% reported suicidal ideation. Ever cigarette use among females (aOR=1.83; 95% CI: 1.36-2.46), P30D e-cigarette use (aOR=1.30; 95% CI: 1.00-1.68), and P30D cigarette use (aOR=1.47; 95% CI: 1.06-2.05) were independently associated with higher risk for suicidal ideation, after adjusting for covariates. Impulsivity and anxiety directly increased risk for suicidal ideation regardless of product type used. Hispanic youth had higher risk of suicidal ideation than white youth, while higher levels of SES were protective. Cigarette/e-cigarette use, as well as impulsivity and anxiety, directly increase the risk of suicidal ideation. Clinicians should ask young adults with a history of tobacco use, anxiety or impulsive behavior, about suicidal ideationNicotine prevention and cessation programs might be more effective if they simultaneously target substance use and mental healthCulturally appropriate support is needed for ethnic and racial minority youth and young adults in school, college and at workWhen evaluating and understanding risk, the role of multiple social identities (such as minority status, gender, and SES) is important.

Distinct patterns of cigarette smoking intensity and other substance use among women who experience housing instability

BackgroundRecent insights into substance use cessation suggest that outcomes short of long-term abstinence are clinically meaningful and may offer more realistic incremental goals, particularly for highly vulnerable individuals. With the goal of informing tobacco treatment programs, we examined distinct patterns of cigarette smoking and their association with the ongoing use of other substances in women who experience housing instability. MethodsWe recruited participants from a longitudinal study of women experiencing housing instability. Between June 2017 and January 2019, participants completed six monthly survey interviews regarding social conditions and the use of multiple substances. We examined associations between cigarette smoking intensity, including number of cigarettes smoked per day, heavy smoking, and an increase in number of cigarettes smoked from the previous 30-days, and other substance use in the past 7-days. ResultsOf the 243 participants, 69 % were current smokers and 58 % were daily smokers. Number of cigarettes smoked per day (Adjusted odds ratio [AOR] 1.02, 95 % CI 1.00–1.03), heavy cigarette smoking, compared to none or light smoking (AOR 2.02, 95 % CI 1.46–2.79), and an increase in number of cigarettes smoked from the previous 30-days (AOR 1.06, 95 % CI 1.01–1.12) were all significantly associated with methamphetamine use in the past 7-days. Associations with other substance use were not as strong. ConclusionsIn a sample of unstably housed women, where almost half used multiple substances, methamphetamine use was associated with higher cigarette smoking intensity. Our findings highlight a potential role for integrating tobacco and methamphetamine use treatment to reduce tobacco use among unstably housed women.

A Cross-Country Study of Cigarette Affordability and Single-Stick Purchases Using Survey Data From African Countries.

Reducing cigarette affordability is paramount for reducing cigarette consumption. Measuring affordability requires data on cigarette prices. Unlike the commonly used retail price of a 20-pack of the most-sold cigarette domestically, survey-derived cigarette prices reflect differences arising from the brand variety and the types of packaging in which cigarettes are purchased. This paper uses self-reported cigarette price data from the eight African countries that have implemented the Global Adult Tobacco Survey (GATS) to construct country-level Relative Income Prices. The relationship between cigarette affordability, cigarette smoking prevalence, and cigarette smoking intensity, is examined using logit models for smoking participation (N = 51122) and generalized linear models for conditional cigarette demand (N = 2443). GATS data are also used to produce nationally representative estimates of the prevalence of single-stick cigarette purchases in the sampled countries. The estimated affordability elasticity of cigarette smoking participation is -0.245 (95% CI = -0.411 to -0.078). The estimated affordability elasticity of smoking intensity is -0.155 (95% CI = -0.286 to -0.023). Single-stick cigarette sales dominate all-markets. The proportion of smokers who reported buying cigarettes in the form of single sticks during their most recent cigarette purchase exceeds 90% in Kenya, Tanzania, and Uganda. The results point to the need for governments in the countries sampled to increase excise taxes in a manner that renders cigarettes less affordable over time, and to enact and enforce legislation that prohibits the sale of single cigarettes. These findings highlight that measures to reduce both the demand and supply of cigarettes will be required to reduce their use in the region. This study is the first to examine the prevalence of single-stick cigarette purchases, and the association between cigarette affordability and smoking outcomes, in the African setting, using data from the GATS. Findings provide local evidence for the countries sampled, which represent over half of sub-Saharan Africa's adult population (aged 15 and older), on the importance of implementing excise tax increases that reduce cigarette affordability over time. They also highlight the need to enact and enforce legislation that prohibits the sale of single cigarettes.

A Longitudinal Analysis of Flavored Cigar Use and Cigar Smoking Cessation Among US Adults.

Flavorings in cigars increase their appeal, mask the harsh taste of tobacco, and may hinder successful cigar smoking cessation; however, limited evidence has examined whether flavors are associated with short- or long-term cigar smoking cessation. Using restricted data from the Population Assessment of Tobacco and Health Study Waves 1-5, we examined whether flavored cigar use was associated with 30-day-plus and 1-year-plus cigar smoking cessation among US adults. Multivariable discrete-time survival models were fit to a nationally representative sample of US adult (18+) respondents who had a current, established cigar use, smoked five or more days in the past 30 days, and did not exclusively smoke traditional premium cigars at baseline. Models adjusted for age, sex, race and ethnicity, income, cigar and cigarette smoking intensity, and blunt use. At baseline, 44.6% of respondents (n = 674) were 18-34 years old, 75.0% were male, 56.7% were non-Hispanic White, 78.9% had household incomes of <$50,000, and 56.2% smoked flavored cigars. In fully adjusted models, flavored cigar use was associated with a lower risk of 30-day-plus (HR = 0.76, 95% CI = 0.60, 0.97) but not 1-year-plus cigar smoking cessation (HR = 0.81, 95% = 0.62, 1.05). We found that flavored cigar use was associated with a lower risk of short-term but not long-term cigar smoking cessation. More work is needed to understand the dynamics of cigar smoking transitions, including initiation, cessation, and relapse, particularly in larger cohorts and among those who exclusively use cigars or dual-use cigars and cigarettes. As local and some state jurisdictions continue to adopt partial or complete bans of flavored cigar products and the United States Food and Drug Administration considers a national ban of all characterizing flavors in cigars, there is a need for more longitudinal work examining the associations between flavorings in cigars and short and long-term cigar-smoking behaviors, including but not limited to initiation, cessation, intensity of use, and relapse, particularly in diverse cohorts.

Characterization of trajectories of physical activity and cigarette smoking from early adolescence to adulthood

BackgroundCigarette smoking and physical inactivity are two critical risk factors for noncommunicable diseases and all-cause mortality. However, few studies have compared the long-term trajectories of both behaviors, as well as multilevel factors associated with trajectory patterns. Using the National Longitudinal Study of Adolescent to Adult Health (Add Health) Wave I through V survey data, this study characterized distinct subgroups of the population sharing similar behavioral patterns from adolescence to adulthood, as well as predictors of subgroup membership for physical activity (PA) and cigarette smoking behavior respectively.MethodsUsing the Add Health Wave I through V survey data, we identified the optimal number of latent classes and class-specific trajectories of PA and cigarette smoking from early adolescence to adulthood, fitting latent growth mixture models with standardized PA score and past 30-day cigarette smoking intensity as outcome measures and age as a continuous time variable. Associations of baseline sociodemographic factors, neighborhood characteristics, and sociopsychological factors with trajectory class membership were assessed using multinomial logistic regression.ResultsWe identified three distinct subgroups of non-linear PA trajectories in the study population: moderately active group (N = 1067, 5%), persistently inactive group (N = 14,257, 69%) and worsening activity group (N = 5410, 26%). Foror cigarette smoking, we identified three distinct non-linear trajectory subgroups: persistent non-smoker (N = 14,939, 72%), gradual quitter (N = 2357, 11%), and progressing smoker (N = 3393, 16%). Sex, race/ethnicity, neighborhood environment and perceived peer support during adolescence were significant predictors of both physical activity and cigarette smoking trajectory subgroup membership from early adolescence to adulthood.ConclusionsThere are three distinct subgroups of individuals sharing similar PA and cigarette smoking behavioral profile respectively from adolescence to adulthood in the Add Health study population. Behavioral interventions that focus on neighborhood environment (e.g. establish community-based activity center) and relationship to peers during adolescence (e.g. peer counseling) could be key to long-term PA promotion and cigarette smoking cessation.

Cluster Headache Genomewide Association Study and Meta-Analysis Identifies Eight Loci and Implicates Smoking as Causal Risk Factor.

The objective of this study was to aggregate data for the first genomewide association study meta-analysis of cluster headache, to identify genetic risk variants, and gain biological insights. A total of 4,777 cases (3,348 men and 1,429 women) with clinically diagnosed cluster headache were recruited from 10 European and 1 East Asian cohorts. We first performed an inverse-variance genomewide association meta-analysis of 4,043 cases and 21,729 controls of European ancestry. In a secondary trans-ancestry meta-analysis, we included 734 cases and 9,846 controls of East Asian ancestry. Candidate causal genes were prioritized by 5 complementary methods: expression quantitative trait loci, transcriptome-wide association, fine-mapping of causal gene sets, genetically driven DNA methylation, and effects on protein structure. Gene set and tissue enrichment analyses, genetic correlation, genetic risk score analysis, and Mendelian randomization were part of the downstream analyses. The estimated single nucleotide polymorphism (SNP)-based heritability of cluster headache was 14.5%. We identified 9 independent signals in 7 genomewide significant loci in the primary meta-analysis, and one additional locus in the trans-ethnic meta-analysis. Five of the loci were previously known. The 20 genes prioritized as potentially causal for cluster headache showed enrichment to artery and brain tissue. Cluster headache was genetically correlated with cigarette smoking, risk-taking behavior, attention deficit hyperactivity disorder (ADHD), depression, and musculoskeletal pain. Mendelian randomization analysis indicated a causal effect of cigarette smoking intensity on cluster headache. Three of the identified loci were shared with migraine. This first genomewide association study meta-analysis gives clues to the biological basis of cluster headache and indicates that smoking is a causal risk factor. ANN NEUROL 2023;94:713-726.

A Significant Increasing Risk Association between Cigarette Smoking and XPA and XPC Genes Polymorphisms.

Cigarette smoking (CS) is a major cause of various serious diseases due to tobacco chemicals. There is evidence suggesting that CS has been linked with the DNA damage repair system, as it can affect genomic stability, inducing genetic changes in the genes involved in the repair system, specifically the nucleotide excision repair (NER) pathway, affecting the function and/or regulation of these genes. Single nucleotide polymorphism (SNP), along with CS, can affect the work of the NER pathway and, therefore, could lead to different diseases. This study explored the association of four SNPs in both XPA and XPC genes with CS in the Saudi population. The Taq Man genotyping assay was used for 220 healthy non-smokers (control) and 201 healthy smokers to evaluate four SNPs in the XPA gene named rs10817938, rs1800975, rs3176751, and rs3176752 and four SNPs in the XPC gene called rs1870134, rs2228000, rs2228001, and rs2607775. In the XPA gene, SNP rs3176751 showed a high-risk association with CS-induced diseases with all clinical parameters, including CS duration, CS intensity, gender, and age of smokers. On the other hand, SNP rs1800975 showed a statistically significant low-risk association with all clinical parameters. In addition, rs10817938 showed a high-risk association only with long-term smokers and a low-risk association only with younger smokers. A low-risk association was found in SNP rs3176752 with older smokers. In the XPC gene, SNP rs2228001 showed a low-risk association only with female smokers. SNP rs2607775 revealed a statistically significant low-risk association with CS-induced diseases, concerning all parameters, except for male smokers. However, SNP rs2228000 and rs1870134 showed no association with CS. Overall, the study results demonstrated possible significant associations (effector/and protector) between CS and SNPs polymorphisms in DNA repair genes, such as XPA and XPC, except for rs2228000 and rs1870134 polymorphisms.

Prevalence and intensity of cigarette smoking in Iranian households: measurement of socioeconomic inequality

ABSTRACT Background Cigarette smoking is one of the most important behavioral risk factors for chronic diseases. This study aimed to investigate socioeconomic inequalities in cigarette smoking (CS) among Iranian households. Methods Concentration index (C) was calculated to measure socioeconomic inequality in smoking and number of smoked cigarettes per month among households using data from the income-expenditure survey of the statistical center of Iran (SCI) in 2017. To identify the contribution of socioeconomic and demographic variables to the measured socioeconomic inequality, the C index was decomposed using Wagstaff method. Results The results indicated that 19.89% (N = 7547) of the households were smoking cigarettes with an average number of 87.91 (SD = 235.22) per month. The C index was −0.009 for smoking households (95% CI = −0.023, 0.006) and 0.004 (95% CI = −0.011, 0.019) for the number of cigarettes smoked per month and were not statistically significant. Most of provinces had pro-rich inequality in prevalence and intensity of CS. The province of residence had the highest contribution to inequality in smoking (66.82%) followed by SES and age of the household head. Conclusions The study concluded that the prevalence and intensity of cigarette smoking were more concentrated among low-SES groups. The strategies to control CS should be modified based on the province of residence, and socioeconomic inequalities in CS among households.

Smoking Histories by State in the U.S.

Smoking rates across U.S. states have declined at different rates over time because some states have progressive tobacco control policies, whereas others have yet to adopt them. Therefore, each state has its own unique historical experience of smoking initiation, cessation, and prevalence. This study characterizes smoking histories for each U.S. state by birth cohort. Using 1965-2018 National Health Interview Survey and 1992-2019 Tobacco Use Supplement to the Current Population Survey data, statistical methods applied an age‒period‒cohort modeling framework to reconstruct population-level smoking histories for each state. Smoking initiation, cessation, and intensity by age, gender, and cohort were estimated for each state. These were used to construct state-specific trends in the prevalence of current, former, and never smoking as well as the mean smoking duration and pack years. Analysis was conducted from 2017 to 2022. California and Kentucky, respectively, are exemplar states of more and less aggressive tobacco control. Initiation probabilities were consistently lower in California than in Kentucky, and cessation probabilities were higher. Hence, the smoking prevalence derived from these parameters is higher in Kentucky. The intensity of cigarette smoking was higher in Kentucky than in California, yielding considerably higher estimated pack years when used with the other parameters. Summaries of smoking trends are given for all states. Smoking initiation, cessation, and intensity trends vary substantially across states, resulting in major differences in estimated smoking prevalence, duration, and pack years. Some states show improvements in smoking metrics over time with more recent birth cohorts, but others have shown very little.

A Study of the Association of Smoking with Cardiometabolic Risk

Aim of the study: To explore the effects of cigarette smoking on cardiometabolic risk in Saudis in Jeddah City. Methods: Following a descriptive case-control approach, the study included 160 healthy Saudi adults who were sampled consecutively (100 smokers [60 males and 40 females] and 60 non-smokers [36 males and 24 females]). Personal characteristics, smoking patterns, and cardiometabolic risk assessment were included in a questionnaire. Each participant’s cardiometabolic functions were assessed by drawing blood. Results: Among participant smokers, 80% smoked one pack daily, while 20% smoked more than one pack daily. Smokers had insignificantly higher levels of total cholesterol, LDL-cholesterol, and non-HDL, significantly higher vWF functional activity, and high-sensitivity cardiac troponin I (p&lt;0.001 for both), but significantly lower albumin and total bilirubin levels than non-smokers (p=0.026, and p&lt;0.001, respectively). The number of daily cigarettes consumed correlated positively and significantly with plasma levels of LDL-cholesterol (r=0.225, p=0.004), non-HDL cholesterol (r=0.220, p=0.005), vWF function activity (r=410, p&lt;0.001), high-sensitivity cardiac troponin I (r=0.686, p&lt;0.001), but negatively correlated with total bilirubin (r=-0.459, p&lt;0.001). Moreover, the cigarette smoking intensity correlated positively and significantly with the participant’s systolic blood pressure (r=0.303, p&lt;0.001) and diastolic blood pressure (r=0.300, p&lt;0.001), body mass index (r=0.448, p&lt;0.001), and waist-to-hip ratio (r=0.493, p&lt;0.001). Those who had smoked for more than 10 years had significantly higher plasma levels of triglycerides (p=0.031), total cholesterol (p=0.023), LDL cholesterol (p=0.011), non-HDL cholesterol (p=0.008), vWF functional activity (p&lt;0.001), systolic blood pressure (p=0.011), and diastolic blood pressure (p=0.023). Moreover, heavy smokers had a significantly higher BMI (p=0.001) and waist-to-hip ratio among male smokers (p=0.003). Conclusions: Cigarette smoking is associated with increased dyslipidemia, body mass index, and central obesity, in addition to higher vWF functional activity. Increased hs-cTnI levels in smokers indicate a higher risk of heart failure and cardiovascular death. Keywords: smoking, cardiometabolic risk, lipid profile, liver function, troponin.

Short- and Long-Term Cigarette and Tobacco Abstinence Among Daily and Nondaily Older Smokers.

There is mixed evidence regarding whether older (vs. younger) smokers are more or less likely to quit smoking. We examined how age is associated with cigarette and all tobacco product abstinence and the potential moderating effects of smoking frequency. Data from a 4-year cohort of the Population Assessment of Tobacco and Health (PATH) study were used, including 7512 smokers at Wave 1 who had smoking status data at Wave 4. Logistic regression models were used to examine the effects of age (18-24, 25-34, 35-44, 45-54, and ≥55 years) on Wave 4, 30-day and 12-month cigarette and all tobacco product abstinence, adjusting for covariates and the interaction between age and cigarette use frequency (nondaily, light daily, and heavy daily). Older smokers (≥55 years) were more likely to be heavy daily smokers than younger smokers 18-24 and 25-34 years, but were less likely to have a past-year cigarette quit attempt. Younger smokers 45-54 years were less likely to report 12-month cigarette abstinence than older smokers (odds ratio = 0.72 [0.54-0.95]). Younger smokers 18-24 and 45-54 years were less likely to report 12-month tobacco product abstinence than older smokers (odds ratio = 0.65 [0.45-0.93]; odds ratio = 0.73 [0.55-0.96], respectively). Thirty-day cigarette abstinence significantly decreased as age increased for nondaily smokers, significantly increased for heavier daily smokers, but remained similar across age for light daily smokers. Older smokers were more likely to report 12-month cigarette and tobacco abstinence than younger smokers 45-54 years old, and the effect of age on abstinence differed by smoking frequency/intensity. Smoking cessation interventions need to be age specific and consider smoking frequency. This study shows that although older smokers are more likely to be heavy smokers and less likely to have a quit attempt at baseline, they are more likely to have 12-month cigarette and tobacco abstinence than younger smokers. Furthermore, 30-day cigarette abstinence significantly decreases as age increases for nondaily smokers and significantly increases for heavy daily smokers, suggesting that the effect of cigarette smoking frequency and intensity changes with age. Smoking cessation interventions need to be age specific as well as consider the smoking frequency/intensity of each age group. Younger smokers may need more targeted cessation interventions to successfully quit.

Smoking cessation behaviors and reasons for use of electronic cigarettes and heated tobacco products among Romanian adults

We report cessation behaviors, reasons for use of electronic cigarettes (EC) and heated tobacco products (HTP) and association of their use with quit attempts and smoking intensity using Romania Global Adult Tobacco Survey 2018. Weighted estimates of EC and HTP by cigarette smoking (CS) status were assessed. Quit attempts, intention to quit, reasons for lack of intention to quit among current CS, and reasons for current use of EC and HTP were estimated. The association of ‘ever use’ of EC and HTP with cigarette smoking intensity and quit attempts was explored using binary logistic regression. Of the total 4571 surveyed, 1243 (27.3%) were current CS, 300 (24.4%) made quit attempts in the past 12 months. Only 38 (12.5%) and 26 (8.6%) had used EC and HTP as an aid to quit. Among current CS, 512 (41.2%) had no intention to quit. Reasons for this were, ‘enjoy smoking’ (86.1%), ‘reduce stress’ (65.9%), and ‘staying alert’ (46.3%). Awareness and use of EC and HTP were significantly higher among current CS. ‘Dual use’ of EC and HTP with CS was manifolds higher than stand-alone use. Reasons for current use of EC and HTP were ‘enjoyment’, and ‘use in places where smoking was prohibited’.

Long-Term Adverse Effects of Cigarette Smoking on the Incidence Risk of Metabolic Syndrome With a Dose-Response Relationship: Longitudinal Findings of the Korean Genome and Epidemiology Study Over 12 Years

ObjectiveTo investigate the association between the intensity and cumulative dose of cigarette smoking and incidence risk of metabolic syndrome (MetS) in a longitudinal prospective study over 12 years of follow-up. MethodsThis study included 3151 men aged 40 to 69 years from the Korean Genome and Epidemiology Study. MetS was defined as proposed by the Joint Interim Statement of the Circulation 2009 report. The hazard ratios (HRs) and 95% confidence intervals (95% CIs) for incidence risk of MetS were calculated from 2 separate perspectives: (1) number of cigarettes smoked per day (intensity) and (2) total number of cigarettes smoked over a person’s lifetime (cumulative dose) using multiple logistic regression analyses. ResultsIn comparison with never smokers, the HRs (95% CIs) were 0.97 (0.78-1.21) for former smokers and 1.50 (1.07-2.01) with 0 to 9 cigarettes per day, 1.66 (1.34-2.06) with 10 to 19 cigarettes per day, and 1.75 (1.34-2.29) with ≥20 cigarettes per day for current smokers after adjusting for confounding variables. Similar positive dose-response relationships were also observed when the cumulative dose of cigarette smoking was categorized into former and current smokers, with subcategories of <20 and >20 pack-years (PYs). The HRs (95% CIs) were 0.99 (0.77-1.23) for <20 PYs and 0.99 (0.77-1.28) for ≥20 PYs for former smokers and 1.63 (1.32-2.02) for <20 PYs and 1.67 (1.30-2.14) for ≥20 PYs for current smokers after adjusting for the same covariables. ConclusionCigarette smoking intensity and cumulative dose were both found to be positively associated with the incidence risk of MetS in men.

Maternal cigarette smoking before or during pregnancy increases the risk of birth congenital anomalies: a population-based retrospective cohort study of 12 million mother-infant pairs

BackgroundThe associations of maternal cigarette smoking with congenital anomalies in offspring have been inconsistent. This study aimed to clarify the associations of the timing and intensity of maternal cigarette smoking with 12 subtypes of birth congenital anomalies based on a nationwide large birth cohort in the USA.MethodsWe used nationwide birth certificate data from the US National Vital Statistics System during 2016–2019. Women reported the average daily number of cigarettes they consumed 3 months before pregnancy and in each subsequent trimester during pregnancy. Twelve subtypes of congenital anomalies were identified in medical records. Poisson regression analysis was used to estimate the risk ratios (RRs) with 95% confidence intervals (CIs) for 12 subtypes of congenital anomalies associated with the timing (i.e., before pregnancy, and during three different trimesters of pregnancy) and intensity (i.e., number of cigarettes consumed per day) of maternal cigarette smoking.ResultsAmong the 12,144,972 women included, 9.3% smoked before pregnancy and 7.0%, 6.0%, and 5.7% in the first, second, and third trimester, respectively. Maternal smoking before or during pregnancy significantly increased the risk of six subtypes of birth congenital anomalies (i.e., congenital diaphragmatic hernia, gastroschisis, limb reduction defect, cleft lip with or without cleft palate, cleft palate alone, and hypospadias), even as low as 1–5 cigarettes per day. The adjusted RRs (95% CIs) for overall birth congenital anomalies (defined as having any one of the congenital malformations above significantly associated with maternal cigarette smoking) among women who smoked 1–5, 6–10, and ≥ 11 cigarettes per day before pregnancy were 1.31 (1.22–1.41), 1.25 (1.17–1.33), and 1.35 (1.28–1.43), respectively. Corresponding values were 1.23 (1.14–1.33), 1.33 (1.24–1.42), 1.33 (1.23–1.43), respectively, for women who smoked cigarettes in the first trimester; 1.32 (1.21–1.44), 1.36 (1.26–1.47), and 1.38 (1.23–1.54), respectively, for women who smoked cigarettes in the second trimester; and 1.33 (1.22–1.44), 1.35 (1.24–1.47), and 1.35 (1.19–1.52), respectively, for women who smoked cigarettes in the third trimester. Compared with women who kept smoking before and throughout pregnancy, women who never smoked had significantly lower risk of congenital anomalies (RR 0.77, 95% CI 0.73–0.81), but women who smoked before pregnancy and quitted during each trimester of pregnancy had no reduced risk (all P > 0.05).ConclusionsMaternal smoking before or during pregnancy increased the risk of several birth congenital anomalies, even as low as 1–5 cigarettes per day. Maternal smokers who stopped smoking in the subsequent trimesters of pregnancy were still at an increased risk of birth congenital anomalies. Our findings highlighted that smoking cessation interventions should be implemented before pregnancy.

Epigenome Wide Associations of Smoking Behavior in the Health and Retirement Study

DNA methylation (DNAm) is an increasingly popular biomarker of health and aging outcomes. Smoking behaviors have a significant and well documented correlation with methylation signatures within the epigenome and are important confounding variables to account for in epigenome-wide association studies (EWAS). However, the common classification of individuals as ‘current’, ‘former’, and ‘never’ smokers may miss crucial DNAm patterns associated with other smoking behaviors such as duration, intensity, and frequency of cigarette smoking, resulting in an underestimation of the contribution of smoking behaviors to DNAm and potentially biasing EWAS results. We investigated associations between multiple smoking behavioral phenotypes (smoking pack years, smoking duration, smoking start age, and smoking end age) and single site DNAm using linear regressions adjusting for age, sex, race/ethnicity, education, and cell-type proportions in a subsample of individuals who participated in the HRS 2016 Venous Blood Study (N=1,775). DNAm was measured using the Infinium Methylation EPIC BeadChip. All 4 phenotypes had significant associations (FDR < 0.05) with many methylation sites (packyears=6859, smoking duration=6572, start age=11374, quit age=773). There was not much overlap in DNAm sites between the full set of models with only 6 overlapping between all 4. However, the phenotypes packyears and smoking duration showed large overlap (N=3782). Results suggest additional smoking phenotypes beyond current/former/never smoker classification should be included in EWAS analyses to appropriately account for the influence of smoking behaviors on DNAm.

Cigarette smoking and mammographic breast density among Polish women.

High mammographic breast density (MBD) is one of the strongest breast cancer risk factors. The results of some epidemiological studies suggest that one of the lifestyle factors likely altering breast density is cigarette smoking. The aim of this study was to assess the association between active smoking, considering in detail the duration and intensity of smoking, and MBD among Polish women. A cross-sectional study included 467 women aged 40-60 years who underwent screening mammography in Łódź, Poland. Volumetric mammographic density, fibroglandular tissue volume and non-fibroglandular tissue volume were determined based on the analysis of mammographic image (in the "for processing" format) using Volpara Imaging Software. Current and lifetime intensity of cigarette smoking was assessed based on the data from interviews. Linear and logistic regressions were fitted with estimated MBD parameters as the outcomes, and life-long smoking duration and intensity as the determinants, adjusted for major confounders. The former smokers had a significantly lower volumetric mammographic density compared to the non-smokers in the crude analysis (p = 0.022). However, the associations became insignificant after adjustments for important confounding factors. The analyses adjusted for important confounders revealed an inverse statistically significant association between the number of pack-years and volumetric mammographic density among the current smokers (p = 0.048). The observed result is consistent with the majority of previous studies that analyzed the associations between mammographic density and life-long smoking duration. Int J Occup Med Environ Health. 2021;34(6):805-15.

Target organ damage in relation to intensity of cigarette smoking, statin therapy and the endogenous testosterone in middle aged hypertensive men with erectile dysfunction

Abstract Background Target organ damage (TOD) amplifies cardiovascular risk in essential hypertension. Erectile dysfunction (ED) refers to microvascular disease and frequently accompanies the hypertensive middle aged male population. Endogenous testosterone (TT) and statins exhibit vasoprotective effects while cigarette smoking typically relates to an adverse cardiovascular outcome. Purpose To investigate TOD in relation to cigarette smoking, statin therapy and TT in essential hypertension middle aged males with ED. Methods 223 hypertensive ED males (mean age: 59 yo) with no history of diabetes mellitus or overt cardiovascular disease enrolled the study. There were all screened for the presence of microalbuminuria, defined as urinary albumin loss 30 – 300 mg in a 24 h urine volume collection. Among them 96 (43%) were current cigarette smokers. Intensity of smoking referred in terms of packs per year. The presence and severity of ED was assessed by the SHIM-5 score (range 0–25), higher values indicate better erectile ability. All underwent a non invasive evaluation of the carotid – femoral pulse wave velocity (PWV), estimation of central pressures and augmentation index (AIx) a parameter of wave reflection amplification (Sphygmocor device).Moreover left ventricular mass index (LVMI) was assessed by 2D echocardiography (Devereux formula) and intima-media thickness (cIMT) of the common carotid artery by vascular ultrasound imaging. cIMT is a marker of atheromatosis. Results Microalbuminuria detected in 89 (40%) patients was positively related to other parameters of TOD such as PWV, cIMT, LVMI (all p&amp;lt;0,005) and smoking habits (p=0,02) and negatively to the SHIM-5 score, TT and statin use (all p&amp;lt;0,01). A notably negative correlation to the intensity of smoking was the SHIM-5 score (p=0,013) and a positive the cIMT (p=0,001). Statins were positively related to TT (p=0,006).In linear regression analysis, relation of packs per year remained significant regarding microalbuminuria and the SHIM-5 after adjustment for age, body mass index, PWV, LVMI, central systolic, diastolic and pulse blood pressure. Similarly, relation of statins, TT and microalbuminuria remained significant after adjustment for age, LVMI, PWV, AIx and smoking status. Conclusion Intensive cigarette smoking accelerates silent kidney damage and sabotages erectile performance in hypertensive middle aged men with ED independently of the central hemodynamic load. Statins protect from microvascular kidney damage and the decline of testosterone probably by enhancing endothelial physiology. In such population group, simple and clinically oriented criteria may reveal early diagnosis of target organ damage and guide appropriate life-style modifications and further therapeutic judgments. Funding Acknowledgement Type of funding sources: None. Figure 1