Smoking Odds Ratio Research Articles

Risk factors for COVID-19 infection among the German older adult population

Abstract Background There are scarce analyses on COVID-19 infection risk factors for the older adult population. This study aims to examine COVID-19 infection risk factors in the older adult general population. Methods The data for this analysis came from the population-representative Study on Health of Older People in Germany (Gesundheit65+) conducted by the Robert Koch Institute from 10/2021 to 08/2022. We considered information on COVID-19 infection status (self-reported infection confirmed by PRC test at least once vs. never), socio-demographic factors, health risk factors, and different face-to-face interactions. The analysis was restricted to 2,976 individuals aged 65+ years with complete infection status information. We assessed weighted prevalences and used univariable and multivariable logistic regressions to evaluate infection risk factors. Results The overall prevalence of infection was 7.2% (95% confidence interval, 6.0-8.7). Infection prevalences were significantly higher (compared to their respective reference group) among participants living in assisted living facilities (24.7% vs. 6.7%), individuals who got help to perform basic activities of daily living (10.8% vs. 6.8%), COVID-19 unvaccinated individuals (25.2% vs. 6.9%), individuals who did not meet family or friends in the last month (12.7% vs. 6.7%), and participants who did not smoke (7.8% vs. 2.6%). No other variable was significantly related to COVID-19 infection. In multivariable analysis, variables independently associated with higher odds ratio (OR) of COVID-19 infection were: living in an assisted living facility OR 3.6 (1.8-7.2), not being vaccinated against COVID-19 OR 4.6 (1.5-14.1), and not smoking OR 1.6 (1.1-2.6). Conclusions The preliminary results of this study align with the prevalence of COVID-19 infection found in concomitant studies. A noteworthy element of our study is the vaccine’s protective effect. The pandemic had a particularly detrimental effect on residents of assisted living facilities Key messages • Improvement in quality of care and infection preventive measures in nursing homes is necessary. • Pandemic preparedness must consider the need for help in the daily life of the older population.

Sub-fertility and life style factors which affecting sub-fertility among women in Regional Director of Health Service area, Colombo

Sub-fertility and life style factors which affecting sub-fertility among women in Regional Director of Health Service area, Colombo

Relative Risk Regression for Clustered Data with Application to Oral Health Research

Introduction: Cluster-weighted generalized estimating equations (CWGEE) and doubly-weighted GEE (DWGEE) are used to produce unbiased estimates when informative cluster size (ICS) exists. However, their performance in estimating the relative risk (RR) from a Poisson regression is unknown. Methods: Using the dental data from the San Juan Overweight Adults Longitudinal Study (SOALS), we estimated the association between patient-level (sex, education level, smoking status, age) and tooth-level (bleeding upon probing) predictors and two types of outcomes with high and low prevalence each. We compared the odds ratio (OR) and RR estimates from logistic and Poisson CWGEE/DWGEE, respectively. Results: For patient-level covariates, the ORs estimated from logistic CWGEE/DWGEE and the RRs estimated from Poisson CWGEE/DWGEE were similar to the low-prevalence outcome (tooth loss). With the high-prevalence outcome (tooth loss or increase in attachment loss or pocket depth), the ORs were further from the null compared to the RRs. For example, within CWGEE, the OR of smoking was 1.301 (95% CI: 1.063-1.592), whereas the RR of smoking was 1.235 (95% CI: 1.052-1.450). For the tooth-level covariate (bleeding), there was a considerable difference between OR/RR on tooth loss estimated from CWGEE vs DWGEE. For example, the RR estimated from CWGEE was 1.692 (95% CI: 1.386-2.067), whereas the RR estimated from DWGEE was 1.354 (95% CI: 1.072-1.710). Discussion: CWGEE and DWGEE may produce different estimates for tooth-level (sub-cluster) covariates, especially when the prevalence of the outcome is low. In general, RRs estimated from Poisson CWGEE/DWGEE are closer to the null compared to ORs estimated from logistic CWGEE/DWGEE.

Risk of de novo aneurysm formation in patients previously diagnosed with a ruptured or unruptured aneurysm: 18-year follow-up

BackgroundData on de novo aneurysm formation after treatment for intracranial aneurysms remains scarce. We studied the incidence of de novo aneurysm formation in patients who had undergone aneurysm treatment more than 18 years prior to follow-up. As it is a disease affecting a younger patient population more specific guidelines are needed when planning a follow-up regime. MethodsThe rate of de novo aneurysm formation was assessed with Magnetic Resonance Angiography (MRA) follow-up >18 years after endovascular or microsurgical treatment for an intracranial aneurysm. Variables associated with de novo aneurysm formation were studied using logistic regression. Missing data were imputed using chained random forests. A data-driven model for the prediction of de novo aneurysm was created to calculate the relative variable importance of ten clinical features. ResultsDe novo aneurysms were identified in 11/81 (13.6 %) patients, of whom 1 was male, over a median follow-up of 20 years. Sex was the most important variable associated with de novo aneurysm formation. Regarding the development of de novo aneurysm, men displayed an odds ratio (OR) of 0.16 (0.01–0.97), compared with women. OR for mRS score 2 or more was 0.20 (95 % CI 0.01–1.34), and OR for smokers was 3.70 (0.54–31.18). Six out of 11 patients (54.5 %) needed treatment; 1 underwent endovascular treatment (EVT) and 5 underwent microsurgical treatment (MST). The overall annual de novo aneurysm formation rate was 0.92 %. ConclusionsThis study highlights the need for a longer follow-up imaging monitoring of patients that have previously undergone treatment for an intracranial aneurysm. These data are useful to take into consideration when planning a follow-up strategy.

Characteristic associated with alcohol drinking in early pregnancy: a cross sectional study

We aimed to identify characteristics associated with alcohol drinking before and during pregnancy to better target pregnancy guidance and public health campaigns. A cross sectional study including 1895 pregnant women interviewed at 16 weeks’ gestation. Information on characteristics and drinking habits before and during pregnancy was collected by in-person interview. Associations between characteristics and alcohol consumption were estimated by ordinal logistic regression models. Average alcohol intake before pregnancy was categorised; 0; > 0–3; > 3–6; > 6 drinks/week; and intake during pregnancy 0; < 1; 1–3; > 3 drinks/week; binge drinking 0; 1; 2; 3; ≥ 4 episodes. Characteristics for average alcohol intake before pregnancy were older age, odds ratio (OR) 3.99 (95% CI 2.77–5.74) when being 35 years or older. Schooling > 10 years, being primiparous and partner’s alcohol consumption were also significantly associated with average alcohol intake before pregnancy. Characteristics for average alcohol intake during pregnancy were age 25 to < 35 years, OR 0.78 (CI 95% 0.61–0.98) and being single OR 1.52 (CI 95% 1.01–2.29). Characteristics for binge drinking during pregnancy were smoking OR 1.34 (CI 95% 1.06–1.69) when binge drinking was defined as ≥ 3 drinks/occasion and OR 1.49 (CI 95% 1.18–1.91) when defined as ≥ 5 drinks/ occasion. Other characterises found with a significant association were schooling > 10 years, being single, being primiparous and partner’s alcohol consumption. We identified characteristics that may be considered when counselling pregnant women or women planning to conceive. Public persuasive campaigns can be used to reach the general public, especially women of childbearing age, before they start planning to conceive, but also their partners, since women with partners consuming alcohol, did show to be more likely to consume alcohol during pregnancy.

Cumulative smoking dose is associated with subclinical renal injury: a pathological study in individuals without chronic kidney disease.

Epidemiological studies have identified smoking as an independent risk factor for development of chronic kidney disease. However, the early renal pathological lesions have not been clearly elucidated. We investigated time-zero biopsy specimens from 547 living kidney donors and evaluated the relationships between smoking and renal histological changes, including arteriolar hyalinization, intimal thickening of small-medium arteries, global glomerulosclerosis, and interstitial fibrosis and tubular atrophy (IF/TA). A total of 199 subjects (36.4%) had smoking history; 92 (16.8%) and 107 (19.6%) subjects had <20 pack-years and ≥20 pack-years of smoking, respectively. Cumulative smoking dose was significantly associated with prevalence of arteriolar hyalinization: the multivariable-adjusted odds ratio (OR) per 20 pack-year increase was 1.50 (95% confidence interval 1.15-1.97). The ORs for smokers with <20 pack-years and ≥20 pack-years versus never-smokers were 1.76 (1.01-3.09) and 2.56 (1.48-4.44), respectively. Smoking was also associated with prevalence of >10% global glomerulosclerosis: the OR per 20 pack-year increase was 1.24 (0.96-1.59). The ORs for smokers with <20 pack-years and ≥20 pack-years versus never-smokers were 1.50 (0.98-2.78) and 2.11 (1.18-3.79), respectively. The ORs for these pathological changes increased significantly depending on cumulative smoking dose. Intimal thickening of small-medium arteries and IF/TA were not associated with smoking status. The prevalence of arteriolar hyalinization remained higher in patients with ≥10 years since smoking cessation than in never-smokers [OR 2.23 (1.03-4.83)]. Subclinical pathological injury caused by smoking is potentially associated with renal arteriolar hyalinization and glomerular ischaemia.

Smoking during pregnancy and gestational diabetes mellitus: a systematic review and meta-analysis

PurposeTo investigate whether maternal cigarette smoking during pregnancy is a risk factor for developing GDM.MethodsMEDLINE, Scopus, CENTRAL and Google Scholar databases were searched from inception to December 2022 to identify eligible original articles. A systematic review and meta-analysis (weighted data, random-effects model) were performed. The primary outcome was the development of GDM in pregnant women. The results were expressed as odds ratios (OR) with 95% confidence interval (CI) (inverse variance method). Subgroup analysis was planned according to the maternal smoking status and GDM diagnostic criteria. Statistical heterogeneity was checked with the Chi-squared (Chi2) test and the I2 index was used to quantify it. The studies were evaluated for publication bias.ResultsThirty-five studies, including 23,849,696 pregnant women, met the inclusion criteria. The pooled OR of smoking during pregnancy compared with non-smoking (never smokers and former smokers) was 1.06 (95% CI 0.95–1.19), p = 0.30; I2 = 90%; Chi2 = 344; df=34; p < 0.001. Subgroup analysis was performed according to the two-step Carpenter-Coustan diagnostic criteria, due to the high heterogeneity among the other applied methods. The pooled OR for the Carpenter-Coustan subgroup was 1.19 (95% CI 0.95–1.49), p = 0.12; I2 = 63%; Chi2 = 27; df=10; p < 0.002. Further subgroup analysis according to maternal smoking status was not performed due to missing data.ConclusionThere is no evidence to support an association between maternal cigarette smoking during pregnancy and the risk for GDM. Universally accepted diagnostic criteria for GDM must be adopted to reduce heterogeneity and clarify the association between smoking and GDM.

Prevalence of tobacco smoking in people at clinical high-risk for psychosis: Systematic review and meta-analysis.

Several hypotheses have been proposed to explain why individuals with psychosis consume more tobacco compared with the general population, but the reasons remain unclear. The phases predating the onset of psychosis could provide an interesting framework to clarify this association. The aim of this systematic review and meta-analysis is to provide an updated and comprehensive synthesis of the association between tobacco smoking and Clinical High Risk for Psychosis (CHRP) status. We performed a multistep systematic PRISMA/MOOSE-compliant electronic search for articles published from inception until October 1st, 2021. Web of Science was searched, complemented by a manual search of original articles reporting the outcome of tobacco consumption (defined as the number of individuals which were smoking tobacco at baseline) in a group of CHR-P patients versus healthy controls (HC). We employed quality assessment of the included studies with Newcastle Ottawa Scale (NOS). The effect size for the primary outcome was the odds ratio (OR) of smoking tobacco in CHR-P samples vs HC. We performed a random-effects model meta-analysis, assessment of heterogeneity with I2 index, sensitivity analyses excluding one study at a time for primary outcome, meta-regressions with four independent moderators (mean age, female ratio, sample size, NOS) and assessment of publication bias with funnel plot and Egger's test. We included 21 independent articles, totalling 2018 CHR-P individuals (mean age of 21.35±2.91years and average female ratio of 41±7%) and 1160 HC (mean age of 22.42±3.70years and average female ratio of 45±11%). The NOS score was 6.52±1.25 (range from 0 to 9). The OR of smoking status was 2.22 (95%CI 1.74-2.84, p<0.01). Heterogeneity (I2) was 24.09 (p=0.16). Sensitivity analyses, removing one study at a time, revealed the robustness of our main finding. Meta-regressions did not reveal any significant association between the moderators and the main outcome. Visual inspection of the funnel plot and Egger's test did not reveal evident publication bias. Our main finding of an increased OR of smokers in the CHR-P individuals compared to healthy controls corroborates the accumulation of unhealthy lifestyles in this vulnerable group. This does not demonstrate any causal association between tobacco smoking and incidence of psychosis, which should be investigated in future prospective cohorts. In conclusion, the window of opportunity represented by CHR-P status should involve more efficient physical health screening and better investigating the aetiological impact of smoking in the development of psychosis.

Nephrolithiasis-Associated Renal Cell Carcinoma in Patients Who Underwent Nephrectomy: A Single-Center Experience.

Kidney stones (nephrolithiasis) affect around 5% of the world's population. Some medical disorders, like obesity or diabetes, have increased the incidence and prevalence of nephrolithiasis. In addition, chronic inflammation and infection are frequently linked to kidney stone formation. Urothelial cell proliferation may change as a result of chronic inflammation, tumors will therefore develop as a result of this. The correlation between nephrolithiasis and renal cell cancer can also be explained by shared risk factors. At Adam Malik General Hospital, we strive to identify the risk factor for stone-induced renal cell cancer. This study was carried out at Adam Malik General Hospital by collecting medical record reports from patients who had nephrectomy for nephrolithiasis between July 2014 and August 2020. A variety of information was obtained, including identification, smoking status, body mass index (BMI), hypertension, diabetes mellitus, and nephrolithiasis history. The histopathological examination of cancer patients was used to determine adjusted odds ratios (ORs) both separately and in combination with other variables. Age, smoking status, BMI, hypertension, and diabetes mellitus all influenced the OR. The single variable was examined using Chi-square test, and the multivariate analysis was carried out using linear regression. A total of 84 patients who underwent nephrectomy due to nephrolithiasis were included in the study, with an average age of 48.77 ± 7.23 years old; 48 (60%) of those were aged < 55 years old. In this study, 52 male patients (63.4%) and 16 patients (20%) were found to have renal cell carcinoma. Univariate analysis showed that the OR of patients with familial history of cancer was 4.5 (95% confidence interval (CI) 2.17 - 19.8), and the OR for smokers was 1.54 (95% CI 1.42 - 1.68). Similar results were shown in patients with hypertension and urinary tract infections due to stones. Nephrolithiasis patients with hypertension were 2.56 (95% CI 1.075 - 6.106) times more likely to develop a malignancy, while patients who had an infection due to a urinary tract stone were 2.85 (95% CI 1.37 - 5.92) times more likely to develop renal cell carcinoma compared to its counterpart. Both have a P-value of less than 0.05. Contrarily, alcoholism and frequent nonsteroidal anti-inflammatory drugs (NSAIDs) user results were different. Both have a P-value of 0.264 and 0.07, respectively. Furthermore, diabetes mellitus type 2 and BMI over 25 are not statistically significant, with a P-value of 0.341 and 0.12, respectively. In multivariable-adjusted analyses, participants with a family history of cancer and recurrent urinary tract infection due to urinary tract stones had a statistically significant increase in overall renal cell carcinoma risk (hazard ratio (HR): 1.39, 95% CI 1.05 - 1.84 and HR: 1.12, 95% CI 1.05 - 1.34). Kidney stone and renal cell carcinoma are significantly correlated due to recurrent urinary tract infection and familial history of cancer, which increases renal cell carcinoma risk.

Quadratic stratification of left ventricular hypertrophy and association with mitral insufficiency grading: a retrospective study using cardiac magnetic resonance.

Chronic primary mitral regurgitation (MR) is caused by the defect in >1 component of the mitral valve, potentially leading to left ventricular hypertrophy (LVH). The relationship between LVH subtypes and the insufficiency grading of chronic MR remains unclear. Thus, we aimed to investigate this association and explore the impact of unhealthy habits on LVH development in patients with chronic primary MR through a cross-sectional study. Cardiac magnetic resonance (CMR) data was retrospectively collected from 3T magnetic resonance imaging (MRI) scanners in 71 patients with chronic primary MR (range, 20-84 years, 52% men). Considered patients (with mild-to-severe MR) were enrolled between March 2015 and September 2022 from the Cardiovascular Imaging Registry of Calgary (CIROC) database. Left ventricle (LV) function was assessed using cvi42 v5.11.5. Patients were categorized into 'mild-to-severe' MR using regurgitation fraction (RF), according to the current imaging guidelines. LVH subtypes were determined using mass-to-volume (M/V) calculations. IBM SPSS was used to run all the statistical analyses. This study employed normality checks by using the Shapiro-Wilk test; one-way analysis of variance (ANOVA) and Kruskal-Wallis tests with post-hoc pairwise comparisons; Chi-squared tests, Fisher's Exact test, crosstabulation analysis, and multinomial logistic regression to examine relationships between MR severity, LVH types, and impact of lifestyle factors, significance at P<0.05. Eccentric LVH was significantly associated with increased severity of MR, while concentric remodeling (CR) was linked to decreased MR severity (χ2=13.276, P=0.03, stratified by sex χ2=7.729, P=0.005). Sex differences emerged in the overall study population. Eccentric LVH was dominantly higher than CR in both males and females (females: 57.7% vs. 42.3%, P=0.05, males: 82.8% vs. 17.2%, P=0.26). No differences were observed between age groups ('Young-Middle' = under 60 years, and 'Middle-Old' = over 60 years). Still, there were notable differences in LVH prevalence within the 'Young-Middle' age group for mild-moderate (P=0.01) and moderate-severe MR (P=0.02). Eccentric LVH was associated with higher body mass index (BMI), smoking, and frequent alcohol consumption [odds ratio (OR) 1.02, 95% confidence interval (CI): 0.56-1.26; OR 1.65, 95% CI: 1.31-6.52; OR 1.15, 95% CI: 0.26-1.34], while CR was solely associated with increased BMI (smokers OR =1.84, 95% CI: 1.25-3.91 and alcohol consumers OR =1.32, 95% CI: 0.86-2.48). Nicotine and caffeine consumption did not appear to be a risk factor for LVH (nicotine: eccentric, OR =0.99, 95% CI: 0.65-1.86; CR, OR =0.97, 95% CI: 0.69-2.39 and caffeine: eccentric, OR =0.69, 95% CI: 0.48-1.61; CR, OR =0.97, 95% CI: 0.78-4.01). This study reveals sex-based associations between LVH subtypes and severity of chronic primary MR. Lifestyle factors such as cigarette smoking, alcohol consumption, and elevated BMI influence LVH risk, while nicotine and caffeine consumption exhibit minimal effects.

An Analysis of Risk Factor for ARI Incidence in Toddlers in the Working Area of the Liwuto Public Health Center Baubau City

ARI is a disease that ranks first out of the top 10 diseases at the Liwuto Health Center, Baubau City. In 2018 the incidence of ARI in toddlers was 97 (26.1%) cases, in 2019 there were 124 (28.9%) cases and in 2020 period January-November ARI cases in toddlers were 77 (22.9%) cases. This study aimed to determine the analysis of risk factors for ARI incidence in toddlers in the working area of ​​the Liwuto Health Center, Baubau City. The type of study was analytical research using a quantitative approach with a Case-Control Study method. The population was all toddlers aged 1-5 years who suffered from ARI in the 2020 for the January-November period, namely 77 cases. The sampling used simple random sampling to get a case sample of 44 people and 44 people control, while the total sample was 88 people. The method of analysis uses Odds Ratio (OR). The results showed that the risk factors for ARI incidence in toddlers with calculated OR values ​​obtained immunization status OR = 2.1 (LL =0.364; UL =12.106), the clean and healthy lifestyle behavior OR = 3.7 (LL =1.551; UL =9.068 , exposure to cigarette smoke OR = 5.2 (LL =2.096 ; UL =13.149). The conclusion of this study is that immunization status, the Clean and Healthy Lifestyle Behavior and exposure to cigarette smoke are risk factors for ARI incidence in toddlers. It is recommended to Public Health Center can take preventive steps that can reduce the occurrence of ARI.

Autoimmune Hemolytic Anemia and Increased Stroke Risk in the United States: A Population-Based Study

Introduction Autoimmune hemolytic anemia (AIHA) is a clinically heterogeneous collection of disorders characterized by the presence of autoantibodies against the patient's erythrocytes. AHIA has been associated with an increased risk of thromboembolic events, including stroke. A recent nationwide cohort study from Denmark and France showed an increased risk of ischemic stroke compared to the general population. However, no extensive studies have been done in the United States (US); hence, we conducted a study of stroke and AIHA in the US population. Methods This is a retrospective study from 1999 to 2022. We analyzed data from a nationwide commercial database (Explorys, IBM) that aggregates records from 26 healthcare systems spread over 50 states with almost 80 million patients. It is a cloud-based platform in which participating institutions provide de-identified data from electronic health records. Pooled data is then standardized and normalized. Explorys uses Systemized Nomenclature of Medicine - Clinical Terms (SNOMED CT) coding for medical diagnosis. We identified adult patients (over 18 years old) with the diagnosis of AIHA. Patients with stroke were identified with the following SNOMED-CT diagnosis "cerebrovascular accidents''. In addition, we obtained information on risk factors for stroke, including sex, age over 65 years, and comorbidities known to be a risk factor, including hypertension, atrial fibrillation, diabetes mellitus, hyperlipidemia, smoking, and obesity.Multivariable logistic regression adjusting for all covariates was created to test for stroke. Results were presented as odds ratio (OR) with a corresponding 95% confidence interval (CI). All tests were two-sided, and a p-value ≤ 0.01 was considered statistically significant. Results An adult population of 69,339,860 were included. AHIA was diagnosed in 12,800 patients (less than 1 per 100,000) and stroke was diagnosed in 238,860 (0.34%). AIHA population characteristics were; females 7,720 (60%), age over 65 years 7,510 (59%), stroke 260 (2%), hypertension 8,260 (65%), hyperlipidemia 6,580 (51%), diabetes mellitus 4,030 (31%), obesity 3,080 (24%), atrial fibrillation 2,650 (21%), and smoking 1,080 (14%). Baseline characteristics are shown in table 1. Statically significant OR of covariates tested is as follows; hypertension OR 9.35 (95% CI 9.22-9.49), AHIA OR 2.75 (95% CI 2.49 - 3.01), atrial fibrillation OR 2.59 (95% CI 2.57 - 2.62), diabetes mellitus 2.44 (95% CI 2.42, 2.47), hyperlipidemia OR 1.96 (95% CI 1.94, 1.98), smoking OR 1.5 (95% CI 1.94, 1.98), age over 65 years OR 1.19 (95% CI 1.18, 1.20), and male OR 0.85 (95% CI 0.84, 0.85). Multivariable logistic regression of factors associated with stroke is shown in table 2. Discussion and conclusion This is the largest population-based study analyzing the association between AIHA and stroke, and we included the most relevant confounding risk factors in our analysis. As expected, the strongest risk factor associated with stroke was hypertension. What was surprising was that AIHA followed it as the second strongest risk factor, which exceeded atrial fibrillation as a risk factor. Limitations of the retrospective design of the study are numerous. They include lack of patient-level data, the subtype of stroke, the subtype of AIHA, the severity of AIHA, temporality, medications used, and their implications on stroke risk, and inaccuracies in coding. A potential explanation for increased thrombosis includes depletion of nitric oxide as a consequence of intravascular hemolysis with resultant enhanced platelet adhesions, and another possible mechanism is the release of procoagulant microparticles during hemolysis. While there is an ongoing trial looking into long-term apixaban in the primary prevention of venous thromboembolism in AIHA (NCT05089227), no active study is looking into minimizing stroke risk. Prospective studies to affirm association, risk stratifies patients, and ultimately test the utility of prophylactic anticoagulation are most needed. Figure 1View largeDownload PPTFigure 1View largeDownload PPT Close modal

Intergenerational transmission of parental smoking: when are offspring most vulnerable?

BackgroundPrevious literature has showed that the likelihood of smoking is higher among offspring with smoking parents. The aim of this cohort study is to investigate during which smoking initiation stages and at what ages adolescents are more likely to be influenced by parental smoking.MethodsThis study used the EPITeen Cohort, which recruited 13-year-old adolescents born in 1990, enrolled at schools in Porto, Portugal. Participants (n = 996) were followed across four waves at 13, 17, 21 and 24 years old. We computed the odds ratio (OR) and 95% confidence intervals for the prevalence of the different smoking states (never smoking, experimenter, less than daily smoker, daily smoker and former smoker), and incidence transitions between these states (to smoking experimenter; to less than daily smoker, to daily smoker; to former smoker) as function of age, parental smoking status and their interaction.ResultsCompared with other participants, those with two smoking parents had an increased prevalence of experimentation at 13 years (OR for the interaction at 13 years compared with 24 years = 2.13 [1.50–3.01]) and daily smoking at all ages (OR for parental smoking =1.91 [1.52–2.40]). The latter increase is related to a significantly increased risk to transit from early smoking stages to daily smoking at all ages (OR for parental smoking = 1.83 [1.43–2.34]).ConclusionsParental smoking influences offspring’s daily smoking prevalence especially by increasing the risk to transit to daily smoking up to early adulthood. Prevention should focus on parents and parental influences especially among offspring who may transition to daily smokers.

Do School-Level Factors Affect the Health Behaviors of High School Students in Korea?

We conducted a multilevel analysis to identify the individual- and school-level factors that affect Korean high school students’ tooth brushing, soda intake, smoking, and high-intensity physical activity. We sampled 27,919 high school students from the 15th Korea Youth Risk Behavior Web-Based Survey. The individual-level variables included demographic, socioeconomic, and health-related factors. The school-level variables included school system and school type. Regarding the individual-level factors, economic level and academic performance had a significant effect on health behavior when the demographic variables were adjusted. In the final model, the school-level factors had a significant effect on health behavior. The odds ratio (OR) of brushing less than twice a day in vocational schools compared to general schools was 1.63 (p < 0.001), and the OR of soda intake more than three times a week in vocational schools was 1.33 (p < 0.001). In addition, the OR of smoking in vocational schools was 2.89 (p < 0.001), and the OR of high-intensity physical activity in vocational schools was 0.80 (p < 0.001). Therefore, both individual- and school-level factors affect Korean students’ health behaviors. A school-based comprehensive health promotion strategy should be developed that considers schools’ characteristics to equip all students with health awareness, regardless of socioeconomic status.

Association of Sources of Worry and Stress with Smoking in Japan: Findings from the Comprehensive Survey of Living Conditions 2010.

The purpose of this study is to examine which sources of worry and stress are associated with smoking behavior and if these associations are varied by gender. The anonymous data of 28,588 men and 30,813 women aged 20-79 years old in Japan were analyzed. We defined the subjects who chose "smoking everyday" as "smokers." We also assessed 20 sources of worry and stress. Multivariable odds ratios (ORs) and 95% confidence intervals (CIs) of smoking for each source of worry and stress were calculated using logistic regression analysis. We found significant association of financial stress with smoking behavior in both genders. The multivariable OR (95% CI) of smoking according to stress from financial stress was 1.22 (1.15-1.31) in men and 1.66 (1.53-1.80) in women. Moreover, the OR of smoking according to stress from human relationships and job affairs was significantly higher for women. We found that some sources of worry and stress were related to smoking behavior and these associations were found to be gender-specific.

Macronutrients Intake and Stomach Cancer Risk in Iran: A Hospital-based Case-Control Study.

Background: Stomach cancer (SC) is one of the most common cancers in the world. Dietary risk factors of SC are not fully understood. This study aimed to investigate the association between macronutrient intakes and the risk of SC. Study design: A hospital-based case-control study. Methods: The data were obtained from a hospital-based case-control study conducted at the Cancer Institute of Iran from 2010 to 2012. Patients were 40 years or older and were diagnosed with SC in less than one year with no history of any cancers. On the other hand, the controls were healthy subjects who were caregivers or visitors of the patients. Demographic characteristics were collected using a structured questionnaire through face to face interviews by trained interviewers. Dietary data were obtained using a validated Diet History Questionnaire. The age and gender-adjusted odds ratios (ORs), as well as the adjusted ORs of age, gender, energy, education, smoking, and body mass index, were reported for continuous and tertiles of intakes. Results: Totally, 207 SC patients and 217 controls participated in this study. In the full adjusted model, after comparing the highest tertiles to the lowest ones, the intake of sucrose (OR: 2.94; 95% CI: 1.66-5.19; P-trend<0.001), protein (OR: 2.04; 95% CI: 1.17-3.55; P-trend=0.011), cholesterol (OR: 2.22; 95% CI: 1.28-3.85; P-trend=0.005), and percent of calories from protein (OR: 3.09; 95% CI: 1.69-5.61; P-trend<1.001) showed a positive significant association with SC. Moreover, a significantly negative association was found between the percent of calories obtained from carbohydrates and SC (OR: 0. 57; 95% CI: 0.33-0.98; P-trend=0.015). Conclusion: The findings in this study showed that macronutrient intakes might be associated with the etiology of SC in Iran.

Smoking, diabetes mellitus, and obesity as risk factors of gastroesophageal reflux disease and extraesophageal symptoms of gastroesophageal reflux disease: A case-control study

Background: Gastroesophageal reflux disease (GERD) is a spectrum of disease usually producing symptoms of heartburn and acid regurgitation. Its prevalence in general population is about 12–17% worldwide. There are many suggested risk factors for GERD. Aim and Objective: This study was conducted to find out whether smoking, diabetes mellitus (DM), and obesity are risk factors of GERD and to find out the extraesophageal symptoms of GERD. Materials and Methods: This is a case–control study matched for age done in 46 GERD patients who were cases and 92 subjects with dyspepsia who were not having GERD as controls. The statistical analysis was done to find out proportions and odds ratio (OR) with 95% confidence interval (CI). Results: Most of the study subjects were in the age group of 40–49 years. About 59% were males. About 14% were smokers and 25% were diabetics. OR for smoking, DM, and obesity was 3.706, 5.571, and 3.618, respectively. About 28% of the GERD patients had easy tiredness. Conclusion: In this study, smoking and DM were found to be the risk factors of GERD based on OR with 95% CI. The most frequent extraesophageal symptom among GERD patients was found to be tiredness.

Obesity is positively related and tobacco smoking and alcohol consumption are negatively related to an increased risk of thyroid cancer

The purpose of this study was to evaluate the relationships of smoking, alcohol consumption, and obesity with thyroid cancer in Korean residents. The Korean National Health Insurance Service-Health Screening Cohort includes individuals ≥ 40 years who were assessed from 2002 to 2013. In total, 4977 thyroid cancer participants were matched with respect to age, sex, income, and region of residence with 19,908 controls at a ratio of 1:4. Crude and adjusted (for the Charlson comorbidity index, smoking status, frequency of alcohol consumption, and obesity) odds ratios (ORs) were analyzed using conditional logistic regression analyses. Additionally, 95% confidence intervals (CIs) were calculated. The adjusted OR of smoking for thyroid cancer was 0.62 (95% CI 0.54–0.72, P < 0.001), and that of alcohol consumption was 0.83 (95% CI 0.75–0.92, P < 0.001). The adjusted ORs of the BMI categories were 1.13 (95% CI 1.05–1.22, P = 0.002) for obese I, and 1.24 (95% CI 1.04–1.47, P = 0.014) for obese II. The ORs of smoking and alcohol consumption were lower, and those of overweight and obesity were higher in thyroid cancer patients than in individuals in the control group.

Telomere Length, Traditional Risk Factors, Factors Related to Human Immunodeficiency Virus (HIV) and Coronary Artery Disease Events in Swiss Persons Living With HIV.

Leukocyte telomere length (TL) shortens with age and is associated with coronary artery disease (CAD) events in the general population. Persons living with human immunodeficiency virus (HIV; PLWH) may have accelerated atherosclerosis and shorter TL than the general population. It is unknown whether TL is associated with CAD in PLWH. We measured TL by quantitative polymerase chain reaction (PCR) in white Swiss HIV Cohort Study participants. Cases had a first CAD event during 1 January 2000 to 31 December 2017. We matched 1-3 PLWH controls without CAD events on sex, age, and observation time. We obtained univariable and multivariable odds ratios (OR) for CAD from conditional logistic regression analyses. We included 333 cases (median age 54 years; 14% women; 83% with suppressed HIV RNA) and 745 controls. Median time (interquartile range) of TL measurement was 9.4 (5.9-13.8) years prior to CAD event. Compared to the 1st (shortest) TL quintile, participants in the 5th (longest) TL quintile had univariable and multivariable CAD event OR = 0.56 (95% confidence interval [CI], .35-.91) and OR = 0.54 (95% CI, .31-.96). Multivariable OR for current smoking was 1.93 (95% CI, 1.27-2.92), dyslipidemia OR = 1.92 (95% CI, 1.41-2.63), and for recent abacavir, cumulative lopinavir, indinavir, and darunavir exposure was OR = 1.82 (95% CI, 1.27-2.59), OR = 2.02 (95% CI, 1.34-3.04), OR = 3.42 (95% CI, 2.14-5.45), and OR = 1.66 (95% CI, 1.00-2.74), respectively. The TL-CAD association remained significant when adjusting only for Framingham risk score, when excluding TL outliers, and when adjusting for CMV-seropositivity, HCV-seropositivity, time spent with detectable HIV viremia, and injection drug use. In PLWH, TL measured >9 years before, is independently associated with CAD events after adjusting for multiple traditional and HIV-related factors.

Non-alcoholic steatohepatitis and the risk of myocardial infarction: A population-based national study.

BACKGROUNDNon-alcoholic fatty liver disease (NAFLD) is a systemic disease with bidirectional relationships with cardiovascular disease (CVD). Non-alcoholic steatohepatitis (NASH) is a more severe subtype of NAFLD. Patients with NASH exhibit more intra and extrahepatic inflammation, procoagulant imbalances and proatherogenic lipid profiles. Whether NASH increases the risk of ischemic heart disease is currently unclear.AIMTo investigate the relationship between acute myocardial infarction (MI) and NASH in a large cohort of subjects in the United States.METHODSWe reviewed data from a large commercial database (Explorys IBM) that aggregates electronic health records from 26 large nationwide healthcare systems. Using systemized nomenclature of clinical medical terms (SNOMED CT), we identified adult with the diagnosis of NASH from 1999-2019. We included patients with the diagnosis of acute MI from 2018-2019. Comorbidities known to be associated with NASH and MI such as obesity, diabetes mellitus, hyperlipidemia, smoking, male gender, and hypertension were collected. Univariable and multivariable analyses were performed to investigate whether NASH is independently associated with the risk of MI.RESULTSOut of 55099280 patients, 43170 were diagnosed with NASH (0.08%) and 107000 (0.194%) had a MI within 2018-2019. After adjusting for traditional risk factors, NASH conferred greater odds of MI odds ratio (OR) 1.5 [95% confidence interval (CI): 1.40-1.62]. Hyperlipidemia had the strongest association with MI OR 8.39 (95%CI: 8.21-8.58) followed by hypertension OR 3.11 (95%CI: 3.05-3.17) and smoking OR 2.83 (95%CI: 2.79-2.87). NASH had a similar association with MI as the following traditional risk factors like age above 65 years OR 1.47 (95%CI: 1.45-1.49), male gender OR 1.53 (95%CI: 1.51-1.55) diabetes mellitus OR 1.89 (95%CI: 1.86-1.91).CONCLUSIONMI appears to be a prevalent disease in NASH. Patients with NASH may need early identification and aggressive cardiovascular risk modification.