Non-tobacco Users Research Articles

Comparative evaluation of GSH, total protein and albumin levels in patients using smokeless tobacco with oral precancerous and cancerous lesions.

Smokeless tobacco (SLT) causes the excessive production of reactive oxygen species, leading to oxidative damage and carcinogenesis. The present study aimed to evaluate the levels of biomarkers, such as glutathione (GSH) in the blood, as well as serum albumin and total protein levels in SLT users with oral precancerous and cancerous lesions. A cross-sectional, prospective study was conducted on 240 patients aged 30-60 years, divided into four groups with 60 patients in each group as follows: Group 1, control group, non-tobacco users; group 2, 60 subjects with a history of SLT use and no oral lesions; group 3, SLT users with precancerous oral lesions; and group 4, SLT users with cancerous lesions. GSH levels in the blood, serum albumin levels and total protein levels were evaluated in all groups. ANOVA and Tukey's test post hoc were used to compare the levels of the biomarkers in all groups. Receiver operating characteristic curves were used to assess the reliability of the biomarkers, and regression analysis was used to determine the associations between the variables. The use of SLT was predominantly observed in males. The mean GSH and serum albumin levels were lowest in group 4 and highest in the control group (P<0.001). The total serum protein levels were higher in group 4 than in group 3. On the whole, as demonstrated herein, GSH and serum albumin were reliable biomarkers, whereas total protein was a weak biomarker. GSH and serum albumin levels may thus be efficiently used for the early diagnosis and prognosis of oral malignancies in SLT users.

A Systematic Review and Meta-analysis of Associations between E-cigarette Use among Nontobacco Users and Combustible Cigarette Smoking Intentions

Objectives: The potential association between e-cigarette use and cigarette smoking persists as an importantpublic health issue. Strictly adhering to AMSTAR 2 and PRISMA guidelines, our evidence synthesis examinedthe association between e-cigarette use among non-tobacco users and the intention to smoke cigarettes.Methods: We searched 3 databases from January 1, 2007 to April 26, 2023 and screened search resultsaccording to the PICOS review method. Results: We synthesized 20 demographically adjusted studieson smoking intention, including related outcome measures of willingness/openness/curiosity to smokecigarettes and susceptibility to smoke cigarettes. All studies suggested a significant association betweene-cigarette use and intention to smoke according to measures of experimental e-cigarette use (i.e., ever orcurrent use, and not established and/or regular use). Conclusions: Studies defining e-cigarette use accordingto measures of established and/or regular use, and that adequately controlled for specific confoundingvariables representing common liabilities between e-cigarette use and cigarette smoking are limited in theevidence base. Thus, currently there is limited evidence to support an association between e-cigarette useand the intention to smoke cigarettes. Future research should apply measures of regular and/or establishede-cigarette use that adequately account for confounding variables that consider common liabilities betweene-cigarette use and cigarette smoking. Doing so would enable the findings to support robust determinationsregarding any potential association between e-cigarette use and the intention to smoke cigarettes.

Poly-tobacco use and mental health in South Korean adolescents.

With the advent of new tobacco products, poly-tobacco use among adolescents is increasing. Smoking among adolescents negatively impacts both their physical and mental health. This study aimed to determine poly-tobacco use among adolescents in South Korea and to identify the mental health problems caused by single-, dual-, and poly-tobacco use. Data from 54948 adolescents in the 2020 Korea Youth Behavior Web-based Survey were included. Mental health variables of our primary outcome were loneliness, anxiety, and depression. Descriptive statistics, Rao-Scott χ2 test and complex sample multivariable logistic regression analysis were conducted to determine the association between the type of tobacco product use and mental health. Among the subjects, 95.2% were non-tobacco users, followed by single (3.0%), dual (1.1%), and poly users (0.7%). The subjects with poly-tobacco use had significantly higher rates of loneliness (33.2%, p<0.001), anxiety (22.3%, p<0.001), and depression (49.9%, p<0.001) than those who used fewer tobacco products. Subjects who used poly-tobacco products were 2.13 (95% CI: 1.61-2.83) times more likely to report loneliness, 1.52 (95% CI: 1.12-2.07) times more likely to report anxiety, and 2.18 (95% CI: 1.68-2.82) times more likely to report depression than non-tobacco users. Among adolescents, poly-tobacco use is associated with symptoms of loneliness, depression, and anxiety, which are internalized mental health problems. Poly-tobacco use warrants early assessment of high-risk groups, education on the need for tobacco-use cessation, and active intervention for the psychological difficulties that these high-risk groups experience.

Awareness and Knowledge of Tobacco Use and Its Relation to Oral Cancer Among Patients Visiting Stomatology Teaching Hospital.

Oral cancer (OC) is a major global health issue, with tobacco use being one of the most significant preventable risk factors. Despite its strong association with OC, public awareness about the harmful effects of tobacco remains limited. This study aims to evaluate the awareness and knowledge of tobacco use related to oral cancer among patients referred to the Stomatology Teaching Hospital. A cross-sectional survey was conducted at the Stomatology Teaching Hospital of Kabul University of Medical Sciences (KUMS) between January 1 and July 30, 2023. Using a convenience sampling method, the study included 435 patients aged 15 to 76 years. Logistic regression analysis was employed to determine factors associated with tobacco use, and the data were analyzed using SPSS version 26.0. Participants were divided into two groups: tobacco users and non-tobacco users. Most of them were young (18 to 30 years old) with a significant difference in oral cancer knowledge between the two groups (p < 0.001). Cigarettes were the most common tobacco type among users (62.1%), which was also statistically significant (p < 0.001). Tobacco users were 3.04 times more likely to have knowledge about oral cancer (OR: 3.04, p < 0.001, 95% CI: 1.93-4.80), indicating a significant association. The study reveals a general lack of awareness about oral cancer in our study population, particularly regarding specific risk factors. To improve awareness, it is essential for both public awareness campaigns and dentists to play a more active role in educating the public about oral cancer.

Impact of tobacco habits on poor oral health status among bone-factory workers in a low literacy city in India: A cross-sectional study.

Oral health is a vital indicator of well-being that is influenced by various habits and lifestyles of individuals. Oral diseases are the bottleneck in the effective control of non-communicable diseases (NCDs) due to chronic in nature and reciprocal relationship as sharing the common risk factors and habits such as sugar, tobacco, and alcohol consumption that increase the risk of developing various inevitable diseases. However, there is a lack of literature highlighting the relationship between risk factors for oral diseases and general health among individuals. This cross-sectional study was carried out among 500 study participants aged 20 to 64 years who gave written informed consent and were recruited by Multistage Stratified Cluster Sampling technique among workers in five bone factories, working for at least one year since January 2001 to March 2022 in Sambhal city, Uttar Pradesh. WHO-Basic Oral Health Survey-1997 was used to record the data regarding sociodemographic and oral health status variables. We used the modified WHO-STEPWISE pre-structured questionnaire to record tobacco consumption habits and oral health-seeking behavior. We scheduled a clinical intra-oral examination to record the Decayed Missing Filled Teeth (DMFT) index and the interview on the premises of five bone factories. Among the 500 bone-factory workers, the total number of males was 342 (68.40%) and 158 (31.60%) were females. The mean age (Standard Deviation) was 33.18 (10), and the mean DMFT score of factory workers was 2.84 (3.12). Production workers had the highest mean DMFT score of 4.60 (3.25). More than half of the factory workers (53.2%) were tobacco users. Tobacco users were 3.52 times more likely to have a severe DMFT index. Most common pre-cancerous lesions were oral submucous fibrosis and leukoplakia. Compared to non-tobacco users, mild tobacco users have 6.80 folds higher odds of oral lesions. Tobacco consumption is not only harmful for oral health but also leads to several non-communicable and systemic diseases. NCDs and dental caries are chronic and preventable conditions with a bidirectional relationship implicated by modifiable major risk factors such as tobacco consumption. Decreasing the consumption of tobacco use may improve oral health and reduce the risk of the development of NCDs. Also, regular dental visits should be scheduled to monitor the oral health status of factory workers. Additionally, tailored intervention for tobacco cessation should be implicated to maintain the general and oral health of industrial workers.

The Association Between Tobacco Use and Risk of COVID-19 Infection and Clinical Outcomes in Sweden: A Population-Based Study

Background: The association between tobacco use and COVID-19 is controversial. During the early course of the pandemic, limited testing prevented studying a wide spectrum of clinical manifestations.Objective: To examine the potential causal association between tobacco use and COVID-19 during the second wave (1 October 2020–30 June 2021) of the pandemic in Stockholm, Sweden.Methods: A population-based cohort study was conducted in the Stockholm region of Sweden, with information on tobacco use collected prior to the pandemic. Adjusted relative risks (RR) of COVID-19 and 95% confidence intervals (CI) were calculated, contrasting current smokers and snus users to non-users of tobacco.Results: Compared with non-users of tobacco, current smokers had a lower risk of COVID-19 (RR 0.78, 95% CI = 0.75–0.81) and of hospitalisation for the disease. Current snus users had a higher risk of COVID-19. Heavy smokers and snus users had longer hospital stays than non-users of tobacco.Conclusion: Tobacco use may have a different impact on the risk of being infected with SARS-CoV-2 and the risk of developing severe clinical manifestations. Further research is needed to determine the underlying mechanisms.

Association ofChronic Pain With Alcohol Consumption andTobacco Use inActive Duty Soldiers.

Chronic pain and lifestyle habits, namely alcohol consumption and tobacco use, impact soldier readiness. This study examines the relationship between chronic pain and these lifestyle habits in soldiers seen at the Interdisciplinary Pain Management Center (IPMC). This cross-sectional retrospective review utilized data from active duty soldiers receiving treatment at the IPMC. Soldiers (N = 203, 85% men) treated at the IPMC completed an intake questionnaire that included the Defense and Veterans Pain Rating Scale, the Alcohol Use Disorders Identification Test-Concise, and inquiries about tobacco use. Tobacco use was quantified as the amount and frequency of cigarettes smoked. Other tobacco products were converted to an equivalent number of cigarettes. Data were analyzed using descriptive statistics, Pearson's correlation, and independent samples t-test analyses. The mean duration of pain reported was 34.73 ± 38.66 months (median = 24.00). Soldiers engaging in hazardous drinking reported significantly higher interference with sleep (mean = 6.53 versus 5.40, P = .03) and greater negative effect on mood (mean = 6.33 versus 5.30, P = .04) compared to the no hazardous drinking group. Nonsignificant differences were found between tobacco users and non-tobacco users regarding pain intensity and pain effect on activity, sleep, mood, and stress (all P > .05). Among tobacco users, a significant negative correlation was found between a daily number of cigarettes used and sleep interference (r = -0.29, P = .024) as well as effect on mood (r = -0.33, P = .010). Years of tobacco use showed a significant negative correlation with the average pain intensity (r = -0.32, P = .025). The results suggest that addressing alcohol consumption is an essential part of chronic pain treatment. The finding of a negative association between years of nicotine use and pain intensity suggests that nicotine use may have served as a coping mechanism. Further research is needed.

A Global Health Survey of People Who Vape but Never Smoked: Protocol for the VERITAS (Vaping Effects: Real-World International Surveillance) Study.

There is only limited information about the health effects of regular vaping. Research on the health status of people who used to smoke faces the challenge that previous smoking may have caused unknown health effects. Only studies of people who vape but have never smoked combustible cigarettes can enable the detection of harms attributable to vaping. Large prospective studies of well-characterized electronic cigarette users with and without a history of combustible cigarette smoking are warranted to establish the long-term effects of regular vaping on respiratory health. We will conduct a global cross-sectional survey of individuals from 6 world regions. Respiratory symptoms will be assessed using a validated questionnaire-the Respiratory Symptom Experience Scale (RSES). Current vapers who are nonusers of other tobacco or nicotine products will be compared with matched controls who are nonusers of vapes and other tobacco or nicotine products. This will be a multicountry, cross-sectional internet-based survey of 750 adults aged ≥18 years who satisfy the criteria for inclusion in either a cohort of people who exclusively vape and who are nonusers of other tobacco or nicotine products ("vapers cohort"; target N=500) or a cohort of nonvapers who are also nonusers of other tobacco or nicotine products ("controls cohort"; target N=250). The primary end point of the study is the RSES score. RSES scores of people in the "vapers cohort" will be compared with those of people in the "controls cohort." Additionally, the study will collect data to characterize patterns of vaping product use among the vapers cohort. Data collection will include information about the age initiation of using vape products, reasons for starting and continuing the use of vape products, specific types of products used, flavors and nicotine strengths of recently used products, as well as the frequency and intensity of product use in the past 30 days. Participant recruitment started in April 2023, and enrollment was completed by November 2023 with 748 participants. Results will be reported in 2024. This will be the first study providing key insights into respiratory health effects associated with using electronic cigarettes in people who vape with no established use of combustible cigarettes or other tobacco or nicotine products. DERR1-10.2196/54236.

Tobacco consumption and its relation to time taken to death among COVID-19 patients died in an intensive care unit. A retrospective and descriptive study from Mizoram, India

Background: The relationship between tobacco consumption and coronavirus disease 2019 (COVID-19) deaths among patients admitted in an intensive care unit (ICU) has not been studied in North-east parts of India. Aims and Objectives: The aims and objectives of the present study were to study the prevalence of smoke form and smokeless form of tobacco usage among the patients who had died of COVID-19 and to study the relationship of tobacco usage and number of duration of stay in ICU and number of days taken to death from the time of testing positive. Materials and Methods: This was a retrospective descriptive study of 279 COVID-19-positive patients who got admitted in ICU in Zoram Medical College. Mizoram from February 2020 to February 2022 and subsequently died because of COVID-19 in ICU. The data regarding age, sex, date of testing positive, date of admission in ICU, and date of death were collected from the patient case sheet. The details regarding tobacco consumption were collected from the patients close relatives. Descriptive analysis was carried out by mean and standard deviation along with range for quantitative variables, frequency, and proportion for categorical variables. Data were analyzed using IBM software version 22. P&lt;0.05 was considered as significant. Results: The mean age of the study population was 63.8 years. Majority were males 178 (63.80%). 198 (70.97%) had comorbidities. One hundred and twenty-nine (46.24%) were tobacco users. Mean stay in ICU in days was 7.75 days. Majority were using smokeless form of tobacco 73 (56.59%). The mean duration of survival in days from time tested positive to the death was 39.52 days among tobacco users when compared with non-tobacco users (47.48 days) (P=0.265). Mean duration of survival was 53.07 days among smoke form versus 31.3 days among smokeless form users. (P=0.031). Conclusion: There is no conclusive finding to say that there is a significant difference in time taken to death between tobacco users and non-tobacco users.

Oral Nicotine Gum Discussions on Twitter: Content Analysis.

Oral nicotine gum such as LUCY, which comes in colorful packaging, mimicking traditional chewing gum, is becoming popular. Many brands of gum have not been approved by the FDA for smoking cessation. This study examined public discourse about, including sentiment toward, oral nicotine gum on Twitter. We used Twitter's Streaming Application Programming Interface to collect data from January 1, 2021, to December 21, 2021, using "nicotine gum" and/or "#nicotinegum" search terms (N = 19 171 unique tweets were collected). We used an inductive approach to become familiar with the data, generated a codebook, and conducted a content analysis on (n = 2152) tweets. Cessation (n = 716, 33.3%), personal experience (n = 370, 17.2%), and addiction to gum (n = 135, 6.3%) were the most prevalent themes. Cessation tweets primarily discussed cigarette smoking cessation (n = 418, 58.4% of cessation tweets) and successful cessation experiences (n = 155, 21.6%). Other identified themes pertained to using nicotine gum for cognitive enhancement or catching a "buzz" (n = 102, 4.7%), marketing (n = 98, 4.6%), using nicotine gum with other substances (n = 90, 4.2%), and adverse effects (n = 63, 2.9%). Sentiment analysis results revealed that 675 (44.2%) tweets were categorized as neutral, 605 (39.6%) tweets were classified as positive, and 248 tweets (16.2%) were negative. About one-third of tweets in our corpus mentioned nicotine gum in the context of smoking cessation. Most nicotine gum-related posts conveyed positive and neutral sentiments. Future studies should consider adding novel nicotine gum-specific search terms as well as exploring other social media platforms to gain more insights about these products. Our findings suggest that Twitter has the potential to track and facilitate conversations between those seeking cigarette cessation advice and those who have successfully quit tobacco by using nicotine gum. Monitoring of promotional content from nicotine gum companies is needed to ensure these products are not appealing to youth and nonusers of tobacco.

Perception of Threat and Efficacy in Contracting COVID-19 Infection among Tobacco Users - A Cross-sectional Analytical Study from Four Indian States.

To trigger quit intention and practice of preventive measures for COVID-19 among tobacco users; it is imperative for them to be well aware of the fact that they are at higher risk of COVID-19 infection and should be at higher efficacy to practice preventive measures for the disease as compared to nonusers of tobacco. This community-based cross-sectional analytical study was conducted from April 2020 to May 2020 among 1203 adult participants to compare the threat and efficacy perception among users and nonusers of tobacco. Perception of threat was assessed using three questions on perceived threat and one question on perceived susceptibility; whereas perception of efficacy was assessed using four questions each on self-efficacy and response efficacy through telephonic interview. There was no significant difference in the overall threat perception among users and nonusers of tobacco. However, state-wise analysis showed that tobacco users had higher perception of threat for SARS-CoV-2 infection in all the states except Telangana. The overall perception of efficacy among tobacco users was significantly higher as compared to nonusers of tobacco. The study calls for active collaboration between tobacco control enthusiasts and the Government to promote awareness of a higher risk of COVID-19 disease among tobacco users. In essence, the study's implications extend beyond COVID-19 and can guide targeted efforts to promote awareness, behavior change, and collaboration in the context of other infectious diseases among tobacco users.

Severity of COVID-19 Disease Among Unvaccinated Users and Non-users of Tobacco Products

BackgroundPrevious studies have identified several risk factors associated with the severity of COVID-19, the disease caused by the SARS-CoV-2 virus. However, studies on the effects of tobacco use on COVID-19 severity have shown contradictory results. This study was aimed at investigating the relationship between COVID-19 and tobacco use.MethodsA cross-sectional study was conducted among patients previously hospitalized because of COVID-19, none of whom had received any COVID-19 vaccinations. Subjective data, such as medical history of chronic diseases, hospital length of stay (LOS), intensive care unit (ICU) admission, requirement for mechanical ventilation, and tobacco use history, were gathered through telephone interviews through a pre-designed questionnaire.ResultsFifty-eight patients with COVID-19 used tobacco products, whereas 114 patients were non-users (tobacco use prevalence of 34%). The most common methods of tobacco use were smoking cigarettes (69%), smoking shisha (50%), using electronic cigarettes (10%), and chewing tobacco (3%). Although most patients developed COVID-19 symptoms, most of the reported symptoms were more frequent among the non-tobacco users. The associations of tobacco use with COVID-19 symptoms, mean LOS, ICU admission, and the need for mechanical ventilation were not significant (P > 0.05).ConclusionsAlthough no significant association was found between COVID-19 severity and tobacco use, continued comprehensive tobacco cessation strategies remain important to mitigate the overall health consequences associated with tobacco consumption.

Trend over time on knowledge of the health effects of cigarette smoking and smokeless tobacco use in Bangladesh: Findings from the International Tobacco Control Policy Evaluation Bangladesh Surveys.

Cigarette smoking and smokeless tobacco (ST) use are prevalent in Bangladesh. This longitudinal study examined how knowledge of the health effects of smoking and ST use in Bangladesh has changed overtime with the country's acceleration of tobacco control efforts. Data were analysed from the International Tobacco Control Survey, a nationally representative longitudinal study of users and non-users of tobacco (aged 15 and older) in Bangladesh, across four waves conducted in 2009 (n = 4378), 2010 (n = 4359), 2012 (n = 4223) and 2015 (n = 4242). Generalised estimating equations assessed the level of knowledge about harms of tobacco use across four waves. Multivariable logistic regressions assessed whether knowledge of health effects from cigarette smoking and ST use in 2015 differed by user group. In 2015 survey, most tobacco users were aware that cigarette smoking causes stroke (92%), lung cancer (97%), pulmonary tuberculosis (97%) and ST use causes mouth cancer (97%) and difficulty in opening mouth (80%). There were significant increases in the total knowledge score of smoking related health harm from 2010 to 2012 (mean difference = 0.640; 95% confidence interval [CI] 0.537, 0.742) and 2012 to 2015 (mean difference = 0.555; 95% CI 0.465, 0.645). Participants had greater odds of awareness for ST health effects from 2010 to 2015. The results suggest that increasing efforts of awareness policy interventions is having a positive effect on tobacco-related knowledge in Bangladesh. These policy initiatives should be continued to identify optimal methods to facilitate behaviour change and improve cessation of smoking and ST use.

Biomarkers of Toxic Exposure and Oxidative Stress Among U.S. Adult Users of Premium Cigar Versus Other Cigar Subtypes: 2013-2019.

Cigars are currently the second-highest-used combustible tobacco product among U.S. adults, but knowledge about health effects of premium cigars versus other cigar subtype use is limited. This study analyzed the biospecimen data (n = 31 875) from Waves 1-5 of the Population Assessment of Tobacco and Health Study, collected during 2013-2019. Multivariable generalized estimation equations, accounting for within-person clustering, were conducted to examine differences in urine biomarkers of exposure (BOE) from five classes of harmful and potentially harmful constituents along with a biomarker of oxidative stress (urine 8-isoprostane) among exclusive users of premium cigars versus other exclusive cigar subtypes (ie, non-premium large cigars, cigarillos, and filtered cigars), cigarettes, and non-tobacco users. In comparison to non-tobacco users, exclusive premium cigar users had higher geometric mean concentrations of the nicotine metabolite cotinine (5.8 vs. 0.5ng/mg, p < .0001), tobacco-specific nitrosamine (TSNA) (4-(methylnitrosamino)-1-(3-pyridyl)-1-butanol (NNAL): 7.8 vs. 1.3pg/mg, p < .0001), and volatile organic compound (VOC) (N-Acetyl-S-(2-cyanoethyl)-L-cysteine (CYMA, acrylonitrile): 4.7 vs. 1.6ng/mg, p < .0001). Exclusive premium cigar users were less likely to be daily users than other tobacco user groups and had comparable BOEs with exclusive non-premium large cigar users but generally lower BOEs than exclusive cigarillo, filtered cigar, and cigarette smokers. Daily exclusive premium cigar users had similar nicotine and TSNA exposure but lower exposure to polycyclic aromatic hydrocarbons and volatile organic compounds than exclusive cigarillo and filtered cigar users. Premium cigar use exhibits different exposure to toxicants from other cigar subtype users. Regulations of premium cigars need to formalize product definition and take the population's health effects into consideration. This population study provides important information on BOE and potential harm with premium cigar use and its potential health effects. At present, premium cigars appear to pose a relatively low overall population health risk due to low frequency of use. However, future regulation of other tobacco products might change the landscape of premium cigar use and alter the overall health impact.

Clinical symptoms of COVID-19 among tobacco users in Moradabad city, India: A retrospective observational study

Background: Tobacco is one of the leading risk factors for many respiratory infections and is linked to the clinical severity of the disease. COVID-19 primarily infects the lungs and causes severe pneumonia-like illness. Tobacco consumption may thus, increase the risk for developing COVID-19. However, this study was planned to assess the tobacco consumption among COVID-19 patients and determine the relationship between SARS CoV-2 and tobacco use among COVID-19 patients. Methods: Lists of laboratory-confirmed COVID-19 positive patients aged 18-70 years were obtained from District Government Hospital on November 2020 and were interviewed telephonically after taking informed consent. A total of 470 patients under home isolation for the past one month after getting diagnosed with SARS CoV-2 were recruited in this study. Data was entered in MS Excel 2019 (Microsoft Corp.) and analysis was done using SPSS 25 (IBM Inc.). Chi-square and Fisher’s exact test were used and significance level was set 0.05 with 95% confidence interval. Results: In the present study, the mean (standard deviation) age of participants was 37.8 (12.1) years. Among the COVID-19 patients, 21% of participants were tobacco users. Clinical symptoms such as fever, severe acute respiratory illness (SARI), acute respiratory illness (ARI), loss of taste/smell, and other symptoms such as body-ache, myalgia, nasal secretion and flue like symptoms were presented; of which most common symptoms were fever (26.8%) followed by SARI or ARI (11.5%) and significantly presented more among tobacco users (66.3%) than non-tobacco users (55.6%) (P=0.036). Nonetheless smokers, these symptoms also affected significantly SLT users (64.8%) (P=0.029) and dual tobacco users (100%) (P=0.010). Conclusion: Tobacco use may worsen COVID-19 disease symptoms among COVID-19 patients.

A systematic review of cancer risk among users of smokeless tobacco (Swedish snus) exclusively, compared with no use of tobacco.

The main objective of this systematic review was to assess cancer risk, and mortality after cancer diagnosis, for exclusive users of Swedish snus, compared with non-users of tobacco. We followed international standards for systematic reviews and graded our confidence in the risk estimates using the GRADE approach. Our search gave 2450 articles, of which 67 were assessed in full text against our inclusion criteria. Of these, 14 cohort-studies and one case-control study were included in the review. The studies investigated risk of cancer in the oral cavity or oropharynx (3 studies), esophagus (1 study), stomach (1 study), pancreas (2 studies), colorectum (2 studies), anus (1 study) and lung (1 study), as well as malignant lymphoma (1 study), leukemia and multiple myeloma (1 study), melanoma (1 study), any cancer (1 study) and mortality after cancer diagnosis (4 studies). Cancer risk could only be evaluated in men as there was a general lack of data for women. All included studies were evaluated to have a moderate risk of bias, mostly related to validity of exposure information. An increased risk of cancer of the esophagus, pancreas, stomach and rectum as well as an association between use of snus and increased mortality after a cancer diagnosis was reported. Our confidence in the various risk estimates varied from moderate through low to very low.

Purchase Intent and Product Appeal of Velo Nicotine Pouches Among Current Tobacco Users and Nonusers of Tobacco

Summary Background and objectives Oral nicotine pouches is a rapidly growing product category that potentially offers less risk than combustible tobacco products. Nicotine pouches may provide harm reduction for smokers because they contain no tobacco and have reduced harmful constituents compared to traditional tobacco product categories. Any potential public health benefit must weigh the likelihood that current tobacco users will switch to the lower-risk product against the likelihood that nonusers will start using tobacco products. To our knowledge, no existing studies provide population-level estimates of purchase intent or product appeal across tobacco user groups or how product characteristics might affect those variables. Methods This paper presents population-level estimates of purchase intent and product appeal for multiple Velo nicotine pouch products (including different flavors, nicotine strengths, format, and packaging) among five adult tobacco user groups (current established cigarette smokers, current established non-cigarette tobacco users, current tobacco experimenters, former tobacco users, and never ever tobacco users). Over 49,000 respondents were surveyed across twelve analytic samples. Results Results for the pooled sample as well as for each individual sample were remarkably consistent for every product. Ratings of purchase intent and appeal are higher for current tobacco users (current established cigarette smokers, current established non-cigarette tobacco users, and current tobacco experimenters) than for former and never ever tobacco users. Conclusions and scientific significance Variation in product characteristics had little or no effect on purchase intent or appeal ratings across tobacco user groups, suggesting that product characteristics do not materially affect public health.

Quantitative Association of Platelet-Rich Fibrin (PRF) and Hyperacute Serum (HAS) with Glycemic Control (HbA1c) in Chronic Periodontitis Patients: An Ex vivo Study.

To evaluate correlation of PRF and HAS with glycemic control (HbA1c) and other systemic parameters amongst the chronic periodontitis patients. Twenty-seven non-smoker, non-tobacco users, non-alcoholic moderate chronic periodontitis volunteers (Stage II, Grade A or B), aging between 40 and 50 years of both genders with type 2 diabetes mellitus (T2DM, HbA1c >6.5%) or without T2DM (HbA1c <6.5%), were recruited. After recording vitals and demographic parameters, 20 ml of intravenous fasting blood was collected, of which 11 ml blood was used for investigating complete blood count, lipid profile, glycated hemoglobin (HbA1c), C-reactive protein, and fasting insulin level. As per the standard protocol, PRF and HAS was prepared from the 9-ml blood sample of the patients. PRF obtained was quantified using Wensar's analytical balance with a readability of 0.0001 g. Prepared HAS from the fibrin clot was quantified using a micropipette and stored in 2 ml Eppendorf vials. Mean values of PRF and HAS obtained in the study were 2.0089 ± 0.844 g (ranged between 0.0 g and 3.968 g) and 1.540 ± 0.552 ml (ranged between 0.00 and 3.500 ml), respectively. The amount of PRF and HAS obtained were significantly higher in non-diabetic patients (mean 2.3093 g and 1.743 ml, respectively) as compared to diabetic patients (mean 1.5762 g and 1.266 ml, respectively). Results suggested a significant correlation between HbA1c level and quantification of PRF (P=0.007) and HAS (P=0.037), whereas no correlation was observed between HbA1c levels and hematologic, lipid, and demographic parameters. Within the limitation of the present study, it can be concluded that a significant correlation exists between the HbA1c level and quantification of PRF and HAS.

Assessing tobacco use in Swedish young adults from self-report and urinary cotinine: a validation study using the BAMSE birth cohort

ObjectivesStudies on health effects of tobacco often rely on self-reported exposure data, which is subjective and can lead to misclassification. The aim of this study was to describe the prevalence...

Inflammatory cytokines in alcohol use disorder patients are lower in smokers and users of smokeless tobacco.

Smoking and alcohol use often cooccur, and the use of nicotine-containing products is particularly common among persons with alcohol use disorder (AUD). Recent evidence shows that chronic alcohol use leads to inflammation through increased gut permeability and dysregulated cytokine levels. While cigarette smoking also has detrimental health effects, nicotine is indicated to exert immune dampening effects in some settings. Preclinical evidence demonstrates that nicotine may dampen alcohol induced inflammation, but inflammatory responses after use of nicotine has not yet been studied in persons with AUD. The current study compared the level of circulating cytokines in non-tobacco users, smokers, users of Swedish snus and dual tobacco users among abstinent AUD inpatients. We collected blood samples and information about somatic and mental health, and tobacco habits from 111 patients in residential treatment for AUD and 69 healthy controls. Levels of interferon (IFN)-γ, interleukin (IL)-10, tumor necrosis factor (TNF)-α, IL-17a, IL-1β, IL-6, IL-8, IL-1 receptor antagonist (ra), and monocyte chemoattractant protein (MCP)-1 were examined using a multiplex assay. Patients with AUD had higher levels of seven cytokines compared to healthy controls. Among the AUD patients, nicotine users had lower levels of IL-10, TNF-α, IL-17a, IL-1β, IL-8, and MCP-1 (all p<0.05). Our findings may indicate that nicotine has anti-inflammatory effects in patients with AUD. Still nicotine use cannot be recommended as a viable therapeutic option to reduce alcohol-induced inflammation because it may cause other adverse effects. Future studies of cytokine patterns in relation to mental or somatic health conditions are warranted to carefully investigate the effect of nicotine, by monitoring the use of any tobacco or nicotine product.