Lifetime Smokers Research Articles

Alcohol consumption among Iranian population based on the findings of STEPS survey 2021

Alcohol production and consumption have been prohibited in Iran for over four decades, leading to a typical underestimation of its consumption. This study aimed to assess the prevalence of alcohol consumption, its associated factors, and estimate per capita alcohol consumption among Iran’s adult population. In this population-based survey, 27,874 adults from across Iran were selected using systematic proportional-to-size cluster sampling. Alcohol consumption was evaluated through a modified Persian version of the STEPS questionnaires from previous studies, applied over different timespans. Per capita consumption was calculated using the quantity-frequency method, expressed in liters of pure alcohol. Adjusted odds ratios were reported for associates of alcohol consumption concerning metabolic risk factors, sociodemographic elements, and lifestyle variables. The prevalence of lifetime alcohol consumption was 6.9% (95% CI 6.5–7.2) in the adult population, with a notable sex difference (males: 13.7% [95% CI 13–14.4]; females: 1.4% [95% CI 1.1–1.6]). The 12 month prevalence was 3.8% (95% CI 3.6–4.1). For individuals aged 18 and older, the per capita alcohol consumption in Iran was 0.12 L. Factors such as being a lifetime smoker, younger, wealthier, and having 7–12 years of education were significantly linked to higher alcohol consumption. Significant associations were also observed between alcohol consumption and having a history of heart attacks (OR = 2.04, 95% CI 1.44–2.89), and physical injuries (OR = 1.88, 95% CI 1.34–2.64). The estimated lifetime and 12-month prevalence of alcohol use in our study were higher among some of the subpopulations. The findings also revealed a complex relationship between alcohol consumption, behavioral risk factors, and metabolic profiles. Consequently, immediate preventive measures tailored to each factor’s association with alcohol use are recommended.

Productivity costs of lifelong smoking-the Northern Finland Birth Cohort 1966 study.

Smoking is one of the leading causes of impaired health and mortality. Loss of paid and unpaid work and replacements due to morbidity and mortality result in productivity costs. Our aim was to investigate the productivity costs of lifelong smoking trajectories and cumulative exposure using advanced human capital method (HCM) and friction cost method (FCM). Within the Northern Finland Birth Cohort 1966 (NFBC1966), 10 650 persons were followed from antenatal period to age 55 years. The life course of smoking behaviour was assessed with trajectory modelling and cumulative exposure with pack-years. Productivity costs were estimated with advanced HCM and FCM models by using detailed, national register-based data on care, disability, mortality, education, taxation, occupation and labour market. A two-part regression model was used to predict productivity costs associated with lifelong smoking and cumulative exposure. Of the six distinct smoking trajectories, lifetime smokers had the highest productivity costs followed by late starters, late adult quitters, young adult quitters and youth smokers. Never-smokers had the lowest productivity costs. The higher the number of pack-years, the higher the productivity costs. Uniform patterns were found in both men and women and when estimated with HCM and FCM. The findings were independent of other health behaviours. Cumulative exposure to smoking is more crucial to productivity costs than starting or ending age of smoking. This suggests that the harmful effects of smoking depend on dose and duration of smoking and are irrespective of age when smoking occurred.

Adolescent nicotine exposure induces long-term, sex-specific disturbances in mood and anxiety-related behavioral, neuronal and molecular phenotypes in the mesocorticolimbic system.

The majority of lifetime smokers begin using nicotine during adolescence, a critical period of brain development wherein neural circuits critical for mood, affect and cognition are vulnerable to drug-related insults. Specifically, brain regions such as the medial prefrontal cortex (mPFC), the ventral tegmental area (VTA), nucleus accumbens (NAc) and hippocampus, are implicated in both nicotine dependence and pathological phenotypes linked to mood and anxiety disorders. Clinical studies report that females experience higher rates of mood/anxiety disorders and are more resistant to smoking cessation therapies, suggesting potential sex-specific responses to nicotine exposure and later-life neuropsychiatric risk. However, the potential neural and molecular mechanisms underlying such sex differences are not clear. In the present study, we compared the impacts of adolescent nicotine exposure in male vs. female rat cohorts. We performed a combination of behavioral, electrophysiological and targeted protein expression analyses along with matrix assisted laser deionization imaging (MALDI) immediately post-adolescent exposure and later in early adulthood. We report that adolescent nicotine exposure induced long-lasting anxiety/depressive-like behaviors, disrupted neuronal activity patterns in the mPFC-VTA network and molecular alterations in various neural regions linked to affect, anxiety and cognition. Remarkably, these phenotypes were only observed in males and/or were expressed in the opposite direction in females. These findings identify a series of novel, sex-selective biomarkers for adolescent nicotine-induced neuropsychiatric risk, persisting into adulthood.

Association of smoking cessation with dynapenia among older lifetime smokers in Korea.

Muscle strength is known to play an important role in the health of older adults. The health burden of cigarette smoking among older adults remains significant. We investigated the association between smoking cessation and dynapenia among older lifetime smokers in Korea. This study is a secondary dataset analysis of cross-sectional data from theKorea National Health and Nutrition Examination Survey (KNHANES) 2016- 2019. We included 1450 participants aged 65-79 years, excluding those who had never smoked. Dynapenia was defined as grip strength <28 kg for men and <18 kg for women based on the Asian Working Group for Sarcopenia 2019 criteria. Multivariable logistic regression analysis evaluated the association between smoking cessation and dynapenia. Compared with current smokers, the adjusted odds ratio (AOR) of dynapenia in former smokers was 0.66 (95% CI: 0.44-0.99). The AORs for smoking cessation periods of ≤10 years, 10-20 years, 20-30 years, and >30 years were 0.67 (95% CI: 0.39-1.16), 0.61 (95% CI: 0.36-1.03), 0.65 (95% CI: 0.37-1.14), and 0.52 (95% CI: 0.25-1.06), respectively. The AOR for dynapenia significantly decreased with the years since smoking cessation (p for trend=0.043). Our findings suggest that smoking cessation can reduce the likelihood of dynapenia among older lifetime smokers, with a decreasing likelihood trend associated with longer cessation periods.

Cardiovascular disease outcomes among established cigar users 40 years and older: Findings from the population assessment of tobacco and health (PATH) study, waves 1–5 (2013–2019)

This study examined associations between established cigar use and prevalence and incidence of cardiovascular diseases (CVD; congestive heart failure, stroke, or heart attack/needed bypass surgery) among U.S. adults, 40 years or older. Using Waves 1–5 (2013–2019) of the Population Assessment of Tobacco and Health (PATH) Study, incidence (Nindividuals (Nind) = 6,692; Nobservations (Nobs) = 23,738) and prevalence (Nind = 7,819; Nobs = 33,952) of CVD outcomes were examined using weighted generalized estimating equations (WGEEs) among adults who were exclusive current/former established cigar smokers (ever cigar smokers who have smoked fairly regularly), exclusive current/former established cigarette smokers (lifetime smokers of 100 or more cigarettes), dual current/former established cigarette and cigar smokers compared with never smokers of cigars or cigarettes, adjusting for covariates. The population-averaged incidence of CVD from one wave to next among exclusive current/former established cigar smokers during a six-year period based on WGEEs was low (overall average rate of 3.0 %; 95 % CI: 1.2, 7.0). Compared with never users, exclusive current/former established cigar smokers (OR = 1.67, 95 % CI: 1.11, 2.51) and exclusive current/former established cigarette smokers (OR = 2.12, 95 % CI: 1.45, 3.09) were more likely to have any CVD outcome in unadjusted analyses. When adjusted for covariates, only exclusive current/former established cigarette use was associated with CVD outcomes (AOR = 1.60, CI: 1.07, 2.40). Results suggest that exclusive established use of cigars or duration of exclusive cigar use was not associated with lifetime CVD prevalence compared with never cigar or cigarette smokers, which is important in understanding health outcomes in cigar users.

Abstract B069: Lung cancer risk in women and racial minorities and genetic variants of UGT genes

Abstract The major research focus of this project is the identification of genetic variants involved in disparities in carcinogen metabolism and risk for cancer. Specifically, this research focuses on the identification of genetic variants in carcinogen metabolism genes, that increase lung cancer risk, particularity when the risk differs between men and women or by racial groups. Although cigarette smoking causes the vast majority of lung cancers, most lifetime smokers do not develop this disease. Many studies suggest that women have greater susceptibility than men for lung cancer, and that risk varies by racial groups. Genetic variation in tobacco carcinogen-metabolizing enzymes could give details as to why only some smokers develop lung cancer and why women or certain racial groups may be at a greater risk. Genetic changes have been shown to vary significantly between individuals of different races, which could contribute to racial disparities in cancer risk. Uridine glucuronosyltransferase (UGT) genes detoxify many carcinogens found in tobacco, so variants in UGT genes could explain differences in lung cancer risk among smokers. Many genetic association studies of UGT genes and lung cancer risk have been performed to identify alleles (SNPs and Copy Number Variants) in UGT genes that increase risk for lung cancer, and to determine if some variants display a gender or racial-specific association with this cancer. cBioPortal provides gene-based visualizations and analyses, so that users can find altered genes and/or networks within a study of interest or across all cancer studies. cBioPortal is a web application platform that facilitates data exploration and analysis through the use of a variety of visualization and analytical tools using populations of cancer cases and controls. cBioPortal has been utilized in this study to visualize variations in UGT genes across many lung cancer data sets. A copy number variant that deletes the entire UGT2B17 gene (which metabolizes the lung cancer carcinogen, NNAL) is a particular focus in this study using data from cBioPortal, as well as common copy number alterations (amplifications) in UGT3A1 and UGT3A2. Citation Format: James W. Gallagher, Talayshia Vicks, Carla J. Gallagher. Lung cancer risk in women and racial minorities and genetic variants of UGT genes [abstract]. In: Proceedings of the 16th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2023 Sep 29-Oct 2;Orlando, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2023;32(12 Suppl):Abstract nr B069.

Predictors of cigarette smoking in pregnant women with substance use disorders

Background Cigarette smoking is common among pregnant women with substance use disorders (SUD) and may contribute to more adverse health consequences for the infant than alcohol and illicit drug use. However, most studies focused on stopping illicit drug use and paid little attention to cigarette smoking in pregnant women with SUD. Purpose To identify predictors of current smoking among pregnant women with SUD, given past-month psychological distress, alcohol use and illicit drug use, the receipt of past-year mental health and substance use treatment controlling for potential confounders. Methods Secondary analysis of cross-sectional data from the National Survey on Drug Use and Health (NSDUH) 2015–2019 was conducted. The NSDUH included 3,540 pregnant women aged 18–44 years; among them were 195 lifetime smokers with SUD. Multiple logistic regression modeling was used to examine the probability of prenatal smoking. Results Sixty-one percent of pregnant women with SUD reported current cigarette smoking. The likelihood of prenatal smoking increased with a higher level of past-month psychological distress (Adjusted Odds Ratio [AOR] 1.14; 95% Confidence Interval [CI]: 1.02–1.28), past-month illicit drug use (AOR: 5.68; 95% CI: 1.59–20.21), and past-year substance use treatment receipt (AOR: 5.73; 95% CI: 1.88–17.45). Conclusion The receipt of substance use treatment markedly increased the probability of smoking in pregnant women with SUD. Treatment and policy initiatives are required to address and integrate cigarette smoking within other substance use treatment modalities for pregnant women with SUD.

Abstract 6148: Immunogenomic landscape of tumor-infiltrating B and plasma cells in early-stage lung adenocarcinoma

Abstract Lung adenocarcinoma (LUAD) is the leading cause of cancer-related deaths in lifetime smokers. Relative to recent advances in immunotherapy of advanced-stage LUAD, there are very limited strategies for early immune-based treatment or interception of the malignancy in its primitive stages. This is largely due to a poor understanding of the roles and functional phenotypes of distinct immune cell subsets and how they evolve early in LUAD pathogenesis. For instance, while T cells have been a central focus of cancer immunopathology and immunotherapy, the roles of tumor-infiltrating B and plasma cells (TIBs) in the activity of the adaptive immune response along the pathogenic course of solid tumors such as LUAD are extremely poorly understood. To fill these voids, we conducted pan-cancer single-cell RNA sequencing (scRNA-seq) analysis of TIBs using public and in-house cohorts of &amp;gt;15 cancers and matched normal samples. We found that fractions of TIBs, including plasma cells (PCs), were evidently high in the tumor microenvironment (TME) of LUADs, particularly in smokers. We then performed multi-region paired scRNA-seq and single-cell B cell receptor sequencing (scBCR-seq) of tumors and three matched normal lung (NL) tissue samples with varying spatial proximity from each of the tumors of 16 early-stage LUAD patients. Fractions of TIBs including PCs and memory B cells were immensely increased in the TME of early-stage LUADs compared to uninvolved NL, and conversely, the abundance of naïve B cells was markedly decreased. TIB fractions were progressively increased along the pathologic continuum of NL, premalignant lesions (PMLs), up to invasive LUAD. Consistently, expression of the B cell chemotactic CXCL13 - CXCR5 axis in T cells and TIBs, respectively, was increased in both PMLs and LUADs relative to NL. Simultaneous scBCR-seq revealed markedly reduced clonality of BCR repertoires in LUAD compared to NL. Multi-region NL tissues showed progressively increasing BCR clonotype diversity and immunoglobin somatic hypermutation (SHM) with increasing proximity to tumors. BCR clonality was strikingly lower in smoker LUADs relative to non-smoker tumors as well as progressively attenuated with increasing pathologic stage. TIBs in the LUAD TME were mostly composed of terminally differentiated IgA+ or IgG+ PCs and memory B cells with an immunosuppressive phenotype. To understand how TIBs shape the LUAD TME, we also profiled interactions of TIBs with other TME cell components and identified TIB subsets showing strong co-occurrence patterns with immunosuppressive T cell subsets. By comprehensively defining transcriptional profiles, SHM and antibody repertories, as well as cellular interactions of TIBs at single-cell resolution, our results map out the geospatial landscape of TIBs in early-stage LUAD and provide a valuable resource to leverage targets for innovative immunomodulatory strategies. Citation Format: Dapeng Hao, Guangchun Han, Ansam Sinjab, Lorena Gomez Bolanos, Rossana Lazcano Segura, Enyu Dai, Luisa Maren Solis Soto, Edwin Parra, Jennifer Wargo, Stephen Swisher, Tina Cascone, Boris Sepesi, Junya Fujimoto, Steven Dubinett, Ignacio Wistuba, Christopher Stevenson, Avrum Spira, Humam Kadara, Linghua Wang. Immunogenomic landscape of tumor-infiltrating B and plasma cells in early-stage lung adenocarcinoma [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2022; 2022 Apr 8-13. Philadelphia (PA): AACR; Cancer Res 2022;82(12_Suppl):Abstract nr 6148.

The Role of Social Position Within Peer Groups in Distress-Motivated Smoking Among Adolescents

The relationship between smoking and adolescents' peer relationships is complex, with studies showing increased risk of smoking for adolescents of both very high and very low social position. A key question is whether the impact of social position on smoking depends on an adolescent's level of coping motives (i.e., their desire to use smoking to mitigate negative affect). We assessed how social position predicts nicotine dependence in a longitudinal sample (N = 3,717; 44.8% male; mean age = 13.41 years) of adolescent lifetime smokers measured between 6th and 12th grades. Using both social network analysis and multilevel modeling, we assessed this question at the between-person and within-person level, hypothesizing that within-person decreases in social position would lead to increased risk of nicotine dependence among those with high levels of coping motives. In contrast to our hypotheses, only interactions with the between-person measures of social position were found, with a slight negative relationship at low levels of coping motives. In addition, the main effect of coping motives was considerably stronger than that of social position at the between-person level, and social position had no significant within-person main effect on nicotine dependence risk. These results suggest that adolescents with higher overall levels of social position among their peers may have slightly decreased risk for nicotine dependence, but only when coping motives are low. Counter to expectations, higher levels of nicotine dependence risk were not linked to fluctuations in social position.

Prevalence and clinical implication of adverse childhood experiences and their association with substance use disorder among patients with schizophrenia

BackgroundAdverse childhood experiences (ACEs) and substance use disorder (SUD) are well-known risk factors for psychosis and dramatically affect schizophrenia. In this research, we aimed to measure the prevalence of adverse childhood experiences and substance use disorder in patients with schizophrenia and assess the effect of ACEs on the clinical presentation and overall functioning and the association between them and SUD in patients with schizophrenia. A cross-sectional study included a random sample of 165 schizophrenic patients who were examined by doing drug screen in urine, structured questionnaire to collect Socioeconomic characteristics, history of schizophrenia, structured clinical interview for Diagnostic and Statistical Manual of Mental Disorders-fifth edition, Positive and Negative Syndrome Scale (PANSS), Adverse Childhood Experiences International Questionnaire (ACE-IQ), World Health Organization Disability Assessment Schedule 2.0, compliance rating scale, addiction severity index fifth edition (ASI) for individuals with positive urine drug screen.ResultsOnly 14.4% of the studied patients had no adverse childhood experiences. The prevalence of positive substance abuse screening was 18.2%. There were statistically significant negative correlations between total ACE score and educational level, socioeconomic level, and the onset of schizophrenia. On the other hand, statistically significant positive correlations were found between the total ACE score and PANSS score and ASI score. The first most frequent ACE was significantly associated with female gender, lower education levels, low and middle socioeconomic classes, lifetime substance use, smokers, and positive drug screening. Emotional neglect and contact sexual abuse were significantly associated with positive drug screening. At the same time, Physical abuse was significantly associated with both lifetime substance use and positive drug screening.ConclusionThe current study’s findings indicate that childhood adverse experiences and substance abuse are prevalent problems in patients with schizophrenia. Given that there is an association between both issues, they may affect the symptomatology of the disorder, the prognosis, and the therapeutic plan. It is advised that a greater emphasis on and identification of childhood trauma and drug use disorder may be a necessary step in assessing patients with schizophrenia.

Associations of smoking and biohazard exposure with Alzheimer’s disease brain and plasma biomarkers in early old age

AbstractBackgroundCigarette smoking and environmental exposure to other biohazardous chemicals and substances are associated with increased risk of developing cancer, cardiovascular disease, and other diseases that contribute to shorter life expectancy. Their associations with Alzheimer’s Disease (AD)‐related brain indicators of structural integrity and plasma biomarkers are less often examined.MethodAt average age 68 (range 61‐73), 1118 male participants in the Vietnam Era Twin Study of Aging (VETSA) self‐reported on cigarette smoking habits which we used to calculate pack years. Participants also self‐reported on prolonged or severe exposure to herbicides/pesticides, metal dust, Agent Orange, or other biochemical hazards. Using MRI data collected at average age 68 from approximately 470 participants, we examined a published an AD‐Brain signature based on thickness in 7 AD‐related cortical regions and hippocampal volume. We created a novel an AD‐Mean Diffusivity (AD‐MD) signature based on those same regions (higher AD‐MD scores being worse). We also examined a predicted brain age difference score (PBAD), an indicator of global accelerated brain aging. Plasma abeta42, abeta42/40 ratio, and total tau (t‐tau) were assayed using the Quanterix Simoa system. Multivariable analyses controlled for age, ethnicity, education, and the random effect of family (i.e., twin pairs).ResultsSmoking pack years at age 68 were negatively associated with AD‐Brain Signature (p&lt;0.0001) and PBAD (p=0.0013). Pack years (p=0.0001) and Agent Orange (p=0.047) were positively associated with AD‐MD Signature. T‐tau was positively significantly associated with smoking (p=0.0039) and Agent Orange (p=0.004).ConclusionsHeavier lifetime smokers had brains more similar to brains of adults with AD, showed accelerated brain aging, and had higher levels of t‐tau in early old age. All of these are indicators of higher risk for AD. Exposure to Agent Orange, a toxic herbicide, was also related to poorer structural brain integrity and t‐tau. Smoking had the strongest relationship with overall brain health in late midlife compared with other types of environmental exposures, reinforcing its role in pathological aging and its importance as a public health priority. The results suggest that more attention should be paid to potentially toxic environmental exposures that may increase risk for AD and other health conditions.

Cigarette smoking cessation and mental health treatment receipt in a U.S national sample of pregnant women with mental illness.

To (1) compare the probability of cigarette smoking cessation for pregnant women with and without past-year mental illness by the trimester of pregnancy; and (2) examine the association between the receipt of past-year mental health treatment and prenatal cigarette smoking cessation among pregnant lifetime-smokers with mental illness. We conducted secondary analysis of data from the National Survey on Drug Use and Health (NSDUH) 2008-2014. The NSDUH included 2019 pregnant lifetime smokers aged 18-44years, 528 of whom had a mental illness. We used multiple logistic regression to model the probability of prenatal cigarette smoking cessation. Pregnant lifetime-smokers with mental illness had a lower rate of cigarette smoking cessation than women without mental illness (47.9% vs. 61.7%, p=0.001). Compared to pregnant women without mental illness, pregnant women with mental illness had a significantly lower odds of smoking cessation in the first trimester (Adjusted Odds Ratio [AOR]: 0.34, 95% Confidence Interval [CI]: 0.18-0.66), but not in the second (AOR: 0.87, 95% CI: 0.46-1.63) and third trimesters (AOR: 0.94, 95% CI: 0.51-1.72). The likelihood of quitting smoking did not differ significantly for pregnant lifetime-smokers with mental illness who received and did not receive mental health treatment (AOR: 1.69, 95% CI: 0.87-3.28). Pregnant lifetime-smokers with mental illness are less likely to quit smoking than those without mental illness; overall, pregnant women tended to quit smoking as they progressed in their pregnancy. The receipt of mental health treatment was not associated with quitting smoking. Mental health care providers need to screen for cigarette use among pregnant women and strengthen smoking cessation efforts. Pregnancy presents a unique opportunity for mental health care providers to screen for cigarette use in women with mental illness and support their smoking cessation efforts.

778Risk of 27 cancer types in relation to tobacco smoking: cohort study involving 229,028 Australians

Abstract Background Tobacco smoke is a known carcinogen and the magnitude of smoking-related cancer risk varies according to time and population. Local, contemporary evidence can drive appropriate tobacco control. We provide comprehensive cancer risk estimates related to smoking in the population-based, New South Wales (NSW) 45 and Up Study. Methods We estimated smoking-related hazard ratios (HR) for cancer using Cox proportional hazards regression using linked questionnaire (2006-2009) and incident cancer data (n ≥ 50 cases per cancer type), from the NSW Cancer Registry (to December 2013) (via CHeReL). Results Of 18,475 cancers among 229,028 participants aged ≥45 years, current smokers had significantly increased risks of cancers of the lung, larynx, head and neck, oesophagus, liver, bladder, pancreas, stomach, colorectum, and cancers with unknown primary site, compared to never-smokers; lung cancer risk was markedly elevated, including for current-smokers of 1-5 cigarettes/day (HR = 9.25, 95%CI=5.2-16.6), increasing to 38.39 (26.2-56.2) for current-smokers of &amp;gt; 30 cigarettes/day. Quitting substantively decreased cancer risk compared to continued smoking, with lung cancer risk decreasing with decreasing age at quitting (p(trend)&amp;lt;0.05), however risks remained elevated for those quitting aged &amp;gt;25 compared to never-smokers (1.73, 1.1-2.6 for age 26-30 years). An estimated 20% of current-smokers in Australia will get lung cancer during their lifetime versus 1.6% of never-smokers. Conclusions Smoking-attributable cancer risks in Australia are significant, comparable to contemporary risks from other developed nations. Key messages Smokers – including “light” smokers – are at high cancer risk, with ∼one-fifth of Australian lifetime smokers developing lung cancer. Quitting is beneficial. Continued investment in tobacco control is essential.

Ability to Purchase Tobacco Products and Smoking Behavior of Cigarettes, E-cigarettes, and Heated Tobacco Products in Korean Adolescents.

Objectives: This study investigated the smoking behavior and its association with the availability of tobacco products purchases among Korean adolescents. Methods: The data of the 2019 Korea Youth Risk Behavior Survey were used (N =57,303). This study assessed 3 tobacco products: cigarettes, e-cigarettes, and heated tobacco products. Smoking behavior including lifetime, current, daily, heavy smoking, and attempting to quit and its association with the availability of tobacco products for purchase was assessed. Results: Overall, 92.9% did not try to purchase tobacco products during the past 30 days, 2.2% found it impossible to purchase, 0.8% could buy with a lot of effort, 1.7% could buy with little effort, and 2.3% could buy easily without any effort. Lifetime smokers were 13.8% (12.7% for cigarettes, 7.4% for e-cigarettes, and 4.9% for heated tobacco products). Among lifetime smokers, the current smoking rates for cigarettes, e-cigarettes, and heated tobacco products were 48.5%, 22.9%, and 19.0%, and the rates were lower in adolescents who responded that it was impossible to buy tobacco products. Among current smokers, the daily smoking rates were lower in adolescents who were found it impossible to buy tobacco products. Conclusions: The ease of access to tobacco products was associated with higher use of cigarettes, e-cigarettes, and heated tobacco products and lower attempts to quit smoking in Korean adolescents.

Tobacco smoking in non-psychotic patients with suicidal ideation

IntroductionTobacco smoking (TS) is a major public health concern worldwide because of its association with a number of unfavorable health-related outcomes. According to recent studies TS negatively affects both physical and mental health. Suicidal ideation (SI) is more prevalent in people with mental disorders than in the general population. Factors associated with the transition from SI to suicide attempt (SA) should be detected to prevent suicide in this high-risk population.ObjectivesThe aim of the study is to evaluate the influence of tobacco smoking on risk of lifetime suicide plan (SP), SA and nonsuicidal self-injury (NSSI) in patients with nonpsychotic mental disorders (NPMD) and SI.MethodsFour hundred and 78 consecutive patients with NPMD and SI were included into the study. All patients were evaluated by a psychiatrist, underwent Self-Injurious Thoughts and Behavior Interview as well as semi-structured interview designed to gather information on demographic and biographical features. Mann-Whitney, Fishers exact test, chi-square test and stepwise logistic regression were used as statistical methods.ResultsThree hundred and 24 (67.8%) patients have smoked at least 100 cigarettes in their entire life. No differences were found between smokers and non-smokers in terms of age, gender, educational and occupational statuses as well as age at onset of self-injurious thoughts and behavior, and total number of SP, SA and NSSI (all: p&gt;0.05). The lifetime smokers were at higher risk of SA (OR=2.379; 95% CI 1.58-3.581: p&lt;0.001) and NSSI (OR=1.591; 95% CI 1.064-2.38: p=0.024).ConclusionsLifetime smoking in patients with NPMD and SI is associated with SA and NSSI.

Factors associated with electronic cigarettes use among adolescents in Jakarta, Indonesia

PurposeThis study aimed to examine factors associated with electronic cigarette use among adolescents aged 15–19 in Jakarta, Indonesia.Design/methodology/approachThe study was a school-based survey involving 1,318 students from 14 high schools in Jakarta. A multistage cluster sampling methodology was used. The authors used the chi-square test and multiple logistic regression to examine the association between electronic cigarette use and sociodemographic, social influences, health risk perceptions, availability, affordability and conventional cigarette smoking status.FindingsOverall, 6.3% of females and 29% of males reported ever having used electronic cigarettes. Electronic cigarette use was independently associated with sex, school locations, conventional cigarette smoking status, peer use, availability and perceptions that electronic cigarettes aid conventional cigarette smoking cessation. Compared with non-smokers, lifetime (AOR: 8.740, 95% CI: 5.126–14.901) and current conventional cigarette smokers (AOR: 18.380, 95% CI: 10.577–31.938) were more likely to use electronic cigarettes.Social implicationsThe use of electronic cigarettes among adolescents was considerably high in this study. Therefore, the tobacco control policy should be extended to regulate the marketing and use of all types of tobacco products and not just conventional cigarettes.Originality/valueThe study explored beyond individual lifestyle factors that contributed to electronic cigarette use in Indonesia such as affordability, school locations and availability of electronic cigarettes. These issues have not been specifically discussed in previous studies.

Lifelong smoking trajectories of Northern Finns are characterized by sociodemographic and lifestyle differences in a 46-year follow-up

Smoking remains among the leading causes of mortality worldwide. Obtaining a comprehensive understanding of a population’s smoking behaviour is essential for tobacco control. Here, we aim to characterize lifelong smoking patterns and explore underlying sociodemographic and lifestyle factors in a population-based birth cohort population followed up for 46 years. Our analysis is based on 5797 individuals from the Northern Finland Birth Cohort 1966 who self-reported their tobacco smoking behaviour at the ages of 14, 31 and 46. Data on sex, education, employment, body mass index, physical activity, alcohol consumption, and substance addiction were also collected at the follow-ups. We profile each individual’s annual smoking history from the age of 5 to 47, and conduct a latent class trajectory analysis on the data. We then characterize the identified smoking trajectory classes in terms of the background variables, and compare the heaviest smokers with other classes in order to reveal specific predictors of non-smoking and discontinued smoking. Six smoking trajectories are identified in our sample: never-smokers (class size 41.0%), youth smokers (12.6%), young adult quitters (10.8%), late adult quitters (10.5%), late starters (4.3%), and lifetime smokers (20.7%). Smoking is generally associated with male sex, lower socioeconomic status and unhealthier lifestyle. Multivariable between-class comparisons identify unemployment (odds ratio [OR] 1.28–1.45) and physical inactivity (OR 1.20–1.52) as significant predictors of lifetime smoking relative to any other class. Female sex increases the odds of never-smoking and youth smoking (OR 1.29–1.33), and male sex increases the odds of adult quitting (OR 1.30–1.41), relative to lifetime smoking. We expect future initiatives to benefit from our data by exploiting the identified predictors as direct targets of intervention, or as a means of identifying individuals who may benefit from such interventions.

Dimension- and context-specific expression of preschoolers' disruptive behaviors associated with prenatal tobacco exposure

ObjectivePrecise phenotypic characterization of prenatal tobacco exposure (PTE)–related disruptive behavior (DB) that integrates nuanced measures of both exposures and outcomes is optimal for elucidating underlying mechanisms. Using this approach, our goals were to identify dimensions of DB most sensitive to PTE prior to school entry and assess contextual variation in these dimensions. MethodsA community obstetric sample of N = 369 women (79.2% lifetime smokers; 70.2% pregnancy smokers) from two Midwestern cities were assessed for PTE using cotinine-calibrated interview-based reports at 16, 28, and 40 weeks of gestation. A subset of n = 244 who completed observational assessments with their 5-year-old children in a subsequent preschool follow-up study constitute the analytic sample. Using two developmentally-meaningful dimensions previously associated with emergent clinical risk for DB—irritability and noncompliance—we assessed children with 2 parent-report scales: the Multidimensional Assessment Profile of Disruptive Behavior (MAP-DB) and the Early Childhood Inventory (ECI). We also assessed children by direct observation across 3 interactional contexts with the Disruptive Behavior Diagnostic Observation Schedule (DB-DOS). We used generalized linear models to examine between-child variability across behavioral dimensions, and mixed effects models to examine directly observed within-child variability by interactional context. ResultsIncreasing PTE predicted increasing impairment in preschoolers' modulation of negative affect (irritability), but not negative behavior (noncompliance) across reported (MAP-DB) and observed (DB-DOS) dimensional measures. Moreover, children's PTE-related irritability was more pronounced when observed with parents than with the examiner. The ECI did not detect PTE-related irritability nor noncompliance. ConclusionsNuanced, dimension- and context-specific characterization of PTE-related DB described can optimize early identification of at-risk children.

Cigarette Smoking, Health-Related Behaviors, and Burnout Among Mental Health Professionals in China: A Nationwide Survey.

ObjectivesMental health professionals (MHPs) play an important role in treating patients with nicotine addiction. However, data on MHPs’ cigarette smoking habits are scarce. This survey aimed to collect such data and to examine the correlates of smoking among MHPs working in China.MethodsA cross-sectional survey was conducted in all 41 provincial, tertiary psychiatric hospitals, and MHPs from these hospitals were targeted. An anonymous questionnaire was designed to collect socio-demographic and occupational factors, and the Maslach Burnout Inventory-Human Service Survey was used to assess burnout. Data about smoking and other health behaviors were also collected.ResultsIn total, 13,614 MHPs were included in the analysis. The overall rate of current smoking was 8.6% (31.3% in males, and 1.1% in females). A substantial proportion (28.0%) of life-time smokers had abstained for more than 3 months. Those who were male (OR=37.73), older (OR=1.02), divorced or widowed (OR=1.72), working in West (OR=1.45), and Northeast China (OR=1.65), were nurses (OR=1.44), had a high income (OR=1.31), experienced burnout (OR=1.29), frequent insomnia (OR=1.39), and used alcohol (OR=2.76) were significantly more likely to be smokers, while those who had a higher level of education (OR=0.67, 0.47, and 0.43 for college, master, and doctorate degrees, respectively), and exercised regularly (OR=0.73) were significantly less likely to be smokers.ConclusionAlthough lower than that of the general population in China, smoking is still relatively high among MPHs. Efforts to lower smoking rates among MHPs in China should continue and should incorporate strategies that target burnout, sleep, alcohol use, exercise and other factors associated with smoking.

Association of cigarette smoking with neuromyelitis opticaimmunoglobulin G sero-positivity in neuromyelitis optica spectrum disorder

Background: Neuromyelitis optica spectrum disorder (NMOSD) is a neuroinflammatory demyelinating disease caused by the presence of a highly specific serum autoantibody marker, NMO-immunoglobulin G (NMO-IgG), that reacts against the water channel aquaporin-4 (AQP4). The present study examined the association between NMO-IgG sero-positivity and environmental factors such as cigarette smoking. Methods: A cross-sectional study was conducted in Sina Hospital, a tertiary referral center in Tehran, Iran. All the patients with a definite diagnosis of NMOSD were involved in this study. The enzyme-linked immunosorbent assay (ELISA) was used to examine the AQP4-IgG status. To assess the association between NMO-IgG sero-positivity and cigarette smoking, a researcher-made questionnaire covering patients' lifestyle information on smoking habits was designed and administered using the structured face-to-face interviews with the patients. Results: The positive and negative NMO-IgG results were found in 44 (46.8%) and 50 (53.2%) patients, respectively. The increased NMO-IgG sero-positivity odds were observed among the lifetime smokers [odds ratio (OR) = 3.24, 95% confidence interval (CI): 1.16-9.08], current smokers (OR = 6.08, 95% CI: 1.26-29.39), and passive smokers (OR = 2.22, 95% CI: 1.10-4.50). Conclusion: Lifetime and current smoking as well as passive smoking can be regarded as risk factors for NMO-IgG sero-positivity. Smoking with its immunological effects can lead to the production of autoantibodies such as NMO-IgG.