Persistent Smoking Research Articles

The prognostic significance of smoking cessation after acute coronary syndromes: an observational, multicentre study from the Melbourne interventional group registry

ObjectiveWe aim to ascertain the prognostic significance of persistent smoking and smoking cessation after an acute coronary syndrome (ACS) in the era of percutaneous coronary intervention (PCI) and optimal secondary...

Alteration of adolescent aversive nicotine response and anxiety-like behavior in nicotine-exposed rats during late lactation period

Early nicotine exposure is an important cause of further habitual tobacco smoking. Although nicotine has not only rewarding but also aversive properties, the effects of early nicotine exposure on the distinct properties of nicotine are not well known. To reveal the effects of early adolescent nicotine exposure on further persistent tobacco smoking, we demonstrated developmental changes in nicotine-related appetitive and aversive behaviors of rats exposed to nicotine during the late lactation period. Sprague–Dawley rats were injected with saline or nicotine (2, 6 and 12mg/kg). We performed a two bottle free-choice test using escalating doses of nicotine (25, 50 and 100μg/ml), saccharin and quinine and the open field test in both adolescent and adult rats. The rats’ aversive response to nicotine was increased according to the increase in nicotine concentration. Adolescent rats showed higher nicotine preference and consumption behaviors than did adult rats at an aversive dose of nicotine. Nicotine-exposed rats increased adolescent nicotine consumption when the nicotine concentration was 12mg/kg. We observed significant increases in anxious behaviors in adolescent nicotine-injected rats compared to saline-injected rats, but there were no alterations in adult rats. In both adolescent and adult rats, saccharin and quinine intake were not significantly different between groups. Taken together, it suggests that repeated nicotine exposure in late lactation period affect changes in aversive nicotine responses and anxious behaviors during adolescence but there is no difference in adults.

Medical and sociodemographic factors predict persistent smoking after coronary events

BackgroundUnderstanding the determinants of persistent smoking after a coronary event constitutes the basis of modelling interventions of smoking cessation in secondary prevention programs. We aim to identify the potentially modifiable medical, sociodemographic and psychosocial factors, comprising the study factors, associated with unfavourable risk factor control after CHD events.MethodsA cross-sectional explorative study used logistic regression analysis to investigate the association between study factors and smoking status in 1083 patients hospitalized with myocardial infarction and/or coronary revascularization. Hospital record data, a self-report questionnaire, clinical examination and blood samples were applied.ResultsAt the index hospitalization, 390 patients were smoking and at follow-up after 2–36 months 167 (43%) of these had quit, while 230 reported persistent smoking. In adjusted analyses, unemployed or disability benefits (Odds ratio (OR) 4.1), low education (OR 3.5), longer smoking duration (OR 2.3) and not having ST-elevation myocardial infarction (STEMI) as index event (OR 2.3) were significantly associated with persistent smoking. Psychosocial factors at follow-up were not associated with persistent smoking. Smokers reported high motivation for cessation, with 68% wanting help to quit. Only 42% had been offered nicotine replacement therapy or other cessation aids. Smokers rated use of tobacco as the most important cause of their coronary disease (6.8 on a 1–10 Likert scale).ConclusionsLow socioeconomic status, prior duration of smoking, and not having STEMI as index event were associated with persisting smoking. Persistent smokers in this study seem to have an acceptable risk perception and were motivated to cease smoking, but needed assistance through cessation programs including prescription of pharmacological aids.Trial registrationRegistered at ClinicalTrials.gov: NCT02309255, registered retrospectively.

Smoking Trajectories during the Perinatal Period and Their Risk Factors: The Nationally Representative French ELFE (Etude Longitudinale Française Depuis l'Enfance) Birth Cohort Study

Background: In France, rates of perinatal smoking are among the highest worldwide; however, perinatal smoking trajectories and associated factors have still not been adequately researched. Methods: Among women participating in the French nationally representative etude longitudinale française depuis l'enfance birth cohort (n = 15,540), perinatal smoking trajectories were estimated using group-based modelling. Associated characteristics were studied using multinomial logistic regression. Results: Four trajectories were identified: non-smokers (59%), quitters (20%), persistent moderate (12%) and persistent heavy (9%) smokers. Older age, being native French, low socioeconomic position, persistent psychological difficulties and alcohol use in pregnancy, lack of social support, partner's smoking, mistimed pregnancy, and child formula feeding at birth were associated with persistent heavy smoking. Most of these factors were also associated, but to a lesser extent, with persistent moderate smoking, except for age and migrant status, which had opposite effects. Women who successfully lost weight prior to pregnancy had higher levels of quitting smoking. Conclusion: Women's long-term smoking trajectories vary in terms of initial tobacco consumption level but also in relation to socio-demographic, psychological, behavioral and partner characteristics. Health professionals in contact with pregnant smokers should address perceived risks and benefits of smoking, including partner's smoking and weight-gain concerns.

PP.21.05] PREVALENCE OF ASYMMETRICAL BLOOD PRESSURE AND ITS ASSOCIATION WITH CARDIOVASCULAR EVENTS IN UNCONTROLLED HYPERTENSIVE PATIENTS

Objective: Estimate the prevalence of asymmetrical blood pressure (BP) in uncontrolled hypertensive patients in daily community medical practice, and analyze its association with the occurrence of cardiovascular events. Design and method: Observational and descriptive cross sectional study conducted among 68 liberal and hospital cardiologists in the first term of 2016 in Tizi-ouzou and Bejaia areas (Algeria). The investigation focused on hypertensive patients treated with a combination of 2 or 3 antihypertensive drugs at a stable dose for at least 3 months. Uncontrolled hypertension was defined as BP superior or equal to 140 /90 mmHg under treatment. Asymmetrical BP was defined as a between-arm difference in systolic BP superior or equal to 15 mm Hg. Results: uncontrolled patients were included. The mean age of the population was 64 ± 11 years, with 56.4% of men. The proportions of diabetes, Dyslipidemia, persistent smoking, or history of major cardiovascular events were 34.5%, 41.7%, 16.2% and 23.6% respectively. Asymmetrical BP was present in 21.4% of the patients, and in a multiple regression analysis, was significantly associated with subclinical target organ damage [OR: 1.7 (1.3–1.9)], stroke [OR: 1.8 (1.2–2.3) and acute coronary syndrome [OR: 1.7 (1.4–2.5)]. Conclusions: asymmetrical BP is frequent in uncontrolled hypertensive patients and could help to identify patients at high cardiovascular risk.

PP.21.04] FREQUENCY OF ORTHOSTATIC HYPOTENSION AND ITS ASSOCIATION WITH BLOOD PRESSURE CONTROL IN HYPERTENSIVE OLDER PATIENTS

Objective: Estimate the prevalence of orthostatic hypotension in hypertensive older patients, and analyze the association between orthostatic hypotension and blood pressure control. Design and method: Study was observational, prospective and descriptive, including all hypertensive treated patients 75 years old or more, viewed for a routine follow-up in the hypertension unit of the teaching hospital of Tizi-ouzou city, during the year 2015. Orthostatic hypotension was defined as a decrease in systolic blood pressure superior or equal to 20 mm Hg, 1 minute after standing. The blood pressure was considered uncontrolled if systolic blood pressure at the office remained superior or equal to 150 mm Hg under treatment. Results: 896 patients were included, with a mean age of 82.2 ± 3.7 years, and 51.6% of women. The proportions of diabetes, dyslipidemia (or treatment with statins), persistent smoking and history of cardiovascular events were 31.4%, 39.8%, 11.3% and 28.7% respectively. The prevalence of orthostatic hypotension was 10.2%. The proportions of uncontrolled blood pressure were 22.8% and 13.4% in patients with and without orthostatic hypotension respectively (p < 0.001). In a multiple regression analysis, uncontrolled hypertension was significantly associated with the presence of orthostatic hypotension [OR: 2.08 (1.56–2.23)]. Conclusions: One out of ten hypertensive older patients had orthostatic hypotension in our population. Orthostatic hypotension is more frequent in patients with uncontrolled hypertension.

Integrated psychological care in Inflammatory Bowel Disease outpatients: Early data from a new initiative.

Introduction: Psychological issues are known to be prevalent in people with Inflammatory Bowel Disease (IBD), and are risk factors for poor outcomes such as hospitalisation, low medication adherence and persistent smoking. Despite this, psychological care is not routinely provided to IBD patients in outpatient settings. Short description of practice change implemented: At the Royal Adelaide Hospital, psychological screening and intervention have been integrated into the IBD service. Screening measures are administered at scheduled outpatient appointments, and individual psychological intervention is offered to patients where results indicate likely need. Aim and theory of change: This study aims to explore the possible benefits of incorporating psychological screening and therapy in an already established IBD service. By improving accessibility to psychological care and bypassing potential barriers, the aim is to improve patient outcomes (mental health, medication adherence, quality of life), and possibly healthcare utilisation. Targeted population and stakeholders: The target population is outpatients of the Inflammatory Bowel Disease Service at the Royal Adelaide Hospital, South Australia (which comprises approximately 1200 patients). Gastroenterologists and IBD nurses in the team are helping the psychologist with the integration of these changes. Timeline: The initial data collection phase is currently being conducted between September 2015 and September 2016. Twelve-month follow-up data will then be collected, concluding in September 2017. Highlights: This is a novel initiative in IBD healthcare, with early data uncovering a high need for psychological support. To date, 380 patients in the service have been approached, with 249 (66%) participating. 137 (55%) participants scored within the clinical range on mental health screening questionnaires. Fifty-eight participants (42% of those with clinical results) subsequently accepted psychological support. The screening process has so far been easy to implement, with positive feedback from both patients and staff. Comments on sustainability: The current initiative is a pilot study to explore the importance of psychological support in IBD patients and the usefulness of a more holistic approach to IBD healthcare. Study outcomes will inform both funding requirements and health practitioners regarding the need to address psychological factors in chronic disease management. Comments on transferability: Early data highlights the need to address psychological factors in IBD patients within the hospital setting. Similar services could be implemented in other hospitals in Australia and around the world, subject to funding. Conclusions :(key findings) Outcomes to date support the need for, and acceptability of, the integration of psychological care in the routine care environment. Discussions: Results are so far promising and support our hypotheses. Data collection will continue until September 2017 when analysis of longer-term outcomes will be possible. Lessons learned: While the initiative is still being piloted, initial evidence for the usefulness of integrating psychological support for IBD outpatients is solid.

Extending decomposition analysis to account for unobserved heterogeneity and persistence in health behavior: Income-related smoking inequality among Swedish women.

This article suggests an enrichment of the standard method for decomposition of the concentration index to account for unobserved heterogeneity and persistence in health behavior. As the underlying regression model in the decomposition, this approach uses a dynamic random-effect probit that both consider individual heterogeneity, using a Mundlak type of specification, and applies a simple solution to account for smoking persistence. I illustrate the suggested approach using a panel of Swedish women in Statistics Sweden's Survey of Living Conditions for one vital health-related behavior, smoking. The results highlight the importance of persistence and show that education and living in a single household are the main drivers of income-related smoking inequality.

Risk Stratification of Patients with Crohn's Disease: A Retrospective Analysis of Clinical Decision Making and Its Impact on Long-Term Outcome

Background and Aims: Complications such as need for bowel resections and hospitalization due to Crohn's disease (CD) occur when disease activity persists due to ineffective therapy. Certain “high-risk” features require an early introduction of anti-tumor necrosis factor-α therapy to prevent such complications. We aim to evaluate the prevalence of “high-risk” features among a cohort of patients with CD and examine the association between discordance of early therapy with baseline risk stratification and disease outcome. Patients and Methods: All adult patients with CD were retrospectively identified and their medical records were reviewed. Clinical, endoscopic, laboratory, and radiological data were collected. Patients were divided into “low” and “high” risk groups according to the presence or absence of penetrating disease, perianal involvement, foregut involvement, extensive disease seen on endoscopy or cross-sectional imaging, young age at the time of diagnosis (<40), persistent cigarette smoking and frequent early requirements for corticosteroid therapy. Initial treatment selection and treatment approach (“step-up” vs. “accelerated step-up” vs. “top-down”) within 6 months of diagnosis were recorded. Rates of CD-related bowel resections and hospitalization within 5 years of diagnosis were calculated. Logistic regression analysis was used to examine the association between “discordance” of early treatment selections and risk stratification categories with outcomes. Results: Eighty-five CD patients were included. The median age and duration of disease were 25 (interquartile range [IQR] 19-32) and 5 (IQR 4-6) years, respectively. Sixty five percent were females and 66% were native Saudis. Smoking was reported in 12% of patients and perianal disease in 18%. “High-risk” features were identified in 43 (51%) patients, of which only 6 (14%) were treated with “top-down” therapy and 7 (16%) with “accelerated step-up” care. The risk of requiring a bowel resection, and hospitalization was higher for “high-risk” patients compared to “low-risk” patients (risk ratio [RR] 13.67, 95% CI 1.88-99.41; p = 0.003, and RR 1.86, 95% CI 0.03-0.43; p = 0.0312, respectively). “Discordance” occurred in 34% of cases. Bowel resection was required in 15/85 (18%) patients and 32/85 (38%) required at least one hospitalization within 5 years of diagnosis. Logistic regression analysis identified a statistically significant association between “discordance” and need for bowel resections (OR 6.50, 95% CI 1.59-26.27, p = 0.009), and hospitalizations (OR 3.01, 95% CI 1.08-8.39, p = 0.035) within 5 years of diagnosis. Conclusions: “Discordance” between patient risk-profile and treatment selection early in the course of CD has a significant impact on disease outcome, specifically need for bowel resection and hospitalization, which are more likely to occur in the presence of “high-risk” features. Early identification of “high-risk” features could help prevent long-term complications.

Characteristics and Long-Term Prognosis of Patients ≤35 Years of Age with ST Segment Elevation Myocardial Infarction and “Normal or Near Normal” Coronary Arteries

There are scarce data regarding risk factors and prognosis of patients with premature ST segment elevation myocardial infarction (STEMI) and "normal or near normal" coronary arteries (N/NNCAs). We compared the characteristics and long-term prognosis of patients with premature STEMI and N/NNCAs with their counterparts with significant coronary artery disease (CAD). We recruited 330 patients who had STEMI ≤35 years of age and 167 age- and gender-matched controls. All patients underwent coronary angiography. Coronary arteries with no lesions or lesions causing <30% reduction in lumen diameter were defined as N/NNCAs, whereas narrowings causing ≥50% diameter reduction formed the significant CAD group. Lipid profile, homocysteine levels, and methylenetetrahydrofolate reductase (MTHFR) C677T polymorphism were determined. Sixty patients (18%) had N/NNCAs. Patients with N/NNCAs had lower low-density lipoprotein-cholesterol and higher high-density lipoprotein-cholesterol levels, higher homocysteine levels, and higher prevalence of MTHFR TT genotype (34.6 vs 18%, p = 0.008) compared with patients with significant CAD. After a median follow-up of 8 years, cardiovascular events occurred in 105 (36%) of 291 patients with available follow-up data. Significant CAD was associated with higher risk for recurrent cardiovascular events after adjustment for traditional risk factors (hazard ratio 2.095, 95% confidence interval 1.088 to 3.664, p = 0.022) and additional adjustment for the left ventricular ejection fraction, reperfusion therapy, and persistent smoking (hazard ratio 1.869, 95% confidence interval 1.007 to 3.468, p = 0.041). In conclusion, patients with premature STEMI and N/NNCAs have fewer lipid abnormalities, higher homocysteine levels and prevalence of MTHFR TT genotype, and better long-term prognosis compared with their counterparts with significant CAD.

Association between long-term smoking and leisure-time physical inactivity: a cohort study among Finnish twins with a 35-year follow-up.

To investigate longitudinal associations of smoking and a change in smoking status with leisure-time physical inactivity. In addition, to control whether familial confounding (genetics and shared environment) influences the associations. Data were based on the population-based Finnish Adult Twin Cohort of 5254 twin individuals born in 1945-1957 (41% men) and who participated in all four surveys over a 35-year follow-up (1975-2011). Logistic and conditional logistic regression models with multiple covariates were used for analyses. Compared to never-smokers, long-term daily smokers (1975-1990) had the highest likelihood for both long-term inactivity and to change into inactive by 2011. Recurrent smoking was associated with long-term inactivity. Instead, in comparison to persistent daily smokers, quitting smoking decreased the likelihood of becoming physically inactive at leisure time. The associations remained in the analyses which accounted for multiple covariates and/or familial confounding. Daily smoking increases the likelihood of remaining or becoming physically inactive over the decades. Our results emphasize not only the importance of preventing smoking initiation, but also to support early smoking cessation in promotion of lifelong physical activity.

Neighborhood social environment as risk factors to health behavior among African Americans: The Jackson Heart Study

BackgroundFew studies have focused on the impact of neighborhood social environment on changes in smoking and alcohol use over time among African Americans. MethodJackson Heart Study participants were recruited from the Jackson, MS metropolitan area from 2000 to 2004. Neighborhood social environment was characterized using census-based neighborhood socio-economic status (NSES) and survey-derived perceptions of neighborhood social cohesion, disorder, and violence. Multinomial logistic regression was used to estimate the associations of neighborhood social environment with prevalence of smoking and alcohol use and with changes in these behaviors over time adjusted for individual sociodemographic characteristics. ResultsParticipants (N=3166) resided in 108 census tracts. All neighborhood social environment variables were consistently associated with prevalence of current smoking at baseline (11%) and with persistence of smoking over a median of 8-years follow-up (8%). The odds of being a consistent smoker relative to never smoking was about 30% higher per 1SD higher neighborhood violence (aOR: 1.30, 95% CI: 1.16–1.46) and disorder (aOR: 1.26, 95% CI: 1.08 – 1.47) and at least 16% lower per 1SD higher in neighborhood social cohesion (aOR: 0.84, 95% CI: 0.74–0.95) and NSES (aOR: 0.79, 95% CI: 0.67–0.95). Heavy alcohol use at baseline (17%) and consistent heavy use over the study period (8%) were negatively associated with higher NSES (aOR: 0.85, 95% CI: 0.73–0.99 per 1SD increase in NSES). ConclusionFavorable neighborhood social environments may reduce unhealthy behaviors among African Americans.

Nicotine Acutely Enhances Reinforcement from Non-Drug Rewards in Humans.

Preclinical research documents that, aside from the primary and secondary reinforcing effects of nicotine intake itself, nicotine also acutely enhances the reinforcing efficacy of non-drug reinforcers (“rewards”). Study of these effects in humans has largely been overlooked, but very recent findings suggest they may have clinical implications for more fully understanding the persistence of tobacco dependence. This overview first outlines the topic and notes some recent human studies indirectly addressing nicotine effects on related responses (e.g., subjective ratings), explaining why those findings do not directly confirm enhancement of behavioral reinforcement per se due to nicotine. Then, the methodology used in the subsequently presented studies is described, demonstrating how those studies specifically did demonstrate enhancement of reinforced responding for non-drug rewards. The main section focuses on the limited controlled research to date directly assessing nicotine’s acute reinforcement-enhancing effects in humans, particularly as it relates to reinforced behavioral responding for non-drug rewards in non-human animal models. After detailing those few existing human studies, we address potential consequences of these effects for dependence and tobacco cessation efforts and then suggest directions for future research. This research indicates that nicotine per se increases responding in humans that is reinforced by some rewards (auditory stimuli via music, visual stimuli via video), but perhaps not by others (e.g., money). These reinforcement-enhancing effects in smokers are not due to dependence or withdrawal relief and can be restored by a small amount of nicotine (similar to a smoking lapse), including from e-cigarettes, a non-tobacco nicotine product. Future clinical research should examine factors determining which types of rewards are (or are not) enhanced by nicotine, consequences of the loss of these nicotine effects after quitting smoking, potential individual differences in these effects, and the possibility that nicotine via nicotine replacement therapy and non-nicotine quit medications may attenuate loss of these effects upon quitting. Further study with humans of nicotine’s reinforcement-enhancing effects may provide a more complete understanding of smoking persistence and added mechanisms of cessation medication efficacy.

Maternal weight gain between pregnancies and childhood body mass index - using sibling analysis to address confounding by shared lifestyle

ABSTRACTObjectiveMaternal obesity during pregnancy is a risk factor for increased childhood body mass index (BMI) and the mechanism may be causal or confounded by lifestyle common to mother and child. We studied BMI in siblings and their mothers to test the hypothesis that siblings born after maternal weight gain will have increased BMI compared to older siblings. ApproachThis was a whole population data linkage study using data from North East Scotland, UK. Databases containing details from pregnant mothers and their five-year-old children born between 1997 and 2005 were linked using the community health index number. Childhood BMI and the difference between siblings BMI were related to maternal weight gain between pregnancies. Covariates included maternal obesity, smoking, socioeconomic status and the child’s birth weight.ResultsMaternal weight gain between pregnancies was determined for 5,863 mothers in whom 718 had &gt;2 pregnancies. Childhood BMI z score was increased in association with maternal obesity (mean increase 0.47 [95% CI 0.39, 0.56]) and with ≥10% maternal weight gain between pregnancies (mean increase 0.14 [95% CI 0.06, 0.21]), independent of covariates. In contrast, increased BMI z score for younger siblings, compared to older siblings, was not associated with maternal obesity in the earlier pregnancy or maternal weight gain between pregnancies. BMI z score was higher in younger compared to older siblings in association with deprivation (mean difference between most and least affluent categories 0.29 [0.08, 0.37]), persistent or new onset maternal smoking (increased by mean of 0.10[0.00, 0.19] for always smokers and 0.20[0.03, 0.38] for those starting compared to never smoked) and increased birth weight (BMI z score increased by 0.11 for each increase in birth weight z score [0.07, 0.14]).ConclusionWhen within-family confounding is considered, poverty, persistent and new onset maternal smoking during pregnancy and increased birth weight, but not maternal obesity or weight gain, are independent predictors of increased BMI in young children.

Smoking Status and Incidence of Cancer After Myocardial Infarction: A Follow-Up Study of over 20 Years

ObjectivesWe evaluated long-term incidence of cancer after myocardial infarction among current, former, and never smokers, and assessed whether reducing cigarette consumption is associated with decreased cancer risk. MethodsConsecutive patients aged ≤65 years discharged from 8 hospitals in central Israel after first myocardial infarction in 1992-1993 were followed for cancer and death. Extensive data including smoking habits were obtained at the index hospitalization and 4 time points during follow-up. Survival methods were applied to assess the hazard ratios (HRs) for cancer associated with smoking categories. ResultsIncluded in the study were 1486 cancer-free participants (mean age, 54 years; 81% men), among whom 787 were current smokers at baseline (average daily cigarette consumption = 29). Smokers were younger than nonsmokers and more likely to be male and of lower socioeconomic status. Over a median follow-up of 21.4 years, 273 (18.4%) patients developed cancer. Baseline smoking was associated with a ∼40% excess adjusted risk of cancer; ∼25% after accounting for death as a competing event. Considering changes in smoking during follow-up, the excess risk was confined to persistent smokers (adjusted HR 1.75; 95% confidence interval [CI], 1.22-2.50), whereas post- (HR 1.14; 95% CI, 0.80-1.62) and pre-myocardial infarction quitters (HR 1.02; 95% CI, 0.71-1.47) were comparable with never smokers. Among persistent smokers, each reduction of 10 cigarettes relative to pre-myocardial infarction consumption was associated with a ∼10% reduced adjusted risk. ConclusionAmong young survivors of first myocardial infarction followed-up longitudinally, smoking cessation is associated with lower risk of cancer. Reducing consumption among smokers may also be beneficial.

Concurrent Trajectories of Female Drinking and Smoking Behaviors Throughout Transitions to Pregnancy and Early Parenthood.

The purpose of this longitudinal study was to investigate whether there are distinct etiological processes explaining dual usage of alcohol and conventional cigarettes by mothers from preconception through the early parenting years. Data on 8800 biological mothers were drawn from the Early Childhood Longitudinal Study-Birth Cohort (ECLS-B), representative of US births in 2001. A general growth mixture model (GGMM) was used to empirically identify developmental trajectories of maternal smoking and drinking over the 5-6-year study period. Six classes defined by alcohol consumption and cigarette smoking were identified. These included a nonsmoking, low probability of drinking class (41%), and two drinking classes displaying no smoking with either moderate (26%) or escalating high (8%) probability drinking. Additionally, two predominantly smoking classes were identified, one displaying temporary reduction in smoking during pregnancy and low probability of drinking (11%) and one following a trajectory of persistent heavy smoking with a declining probability of drinking (9%). The sixth class was described by temporary reduction in smoking during pregnancy with high probability of drinking (6%). Covariates differentially predicted class membership, e.g., having a high school degree but not further education predicted concurrent drinking and smoking, and breastfeeding for more than 6months is protective against concurrent use. Prior to conception, during prenatal care, and in post-natal clinical visits, whether for personal or pediatric care, screening women of reproductive age via characteristics that predict heterogeneity in smoking and drinking trajectories may help guide prevention and treatment options.

Abstract P074: Smoking Status and Incidence of Cancer After Myocardial Infarction: a 20-year Follow-up Study

Objectives: We compared cancer incidence after acute myocardial infarction (MI) of never smokers, pre-MI quitters, post-MI quitters and persistent smokers, and assessed whether cigarette reduction among continued smokers is associated with lower cancer risk. Methods: Consecutive patients aged ≤65 years discharged from 8 hospitals in central Israel after first MI in 1992-3 were followed for cancer through 2013. Extensive data, including self-reported smoking habits, were obtained at the index hospitalization and 4 times during follow-up. Cox proportional hazards and Fine &amp; Gray competing risks models were constructed to assess the hazard ratios (HRs) for cancer associated with baseline smoking categories. Smoking categories were also modeled as time-varying variables using extended Cox models. Results: Overall, 1,486 cancer-free participants at baseline were studies (mean±SD age, 54±8 years; 81% male). Smokers were younger than nonsmokers and more likely to be male and of lower socioeconomic status. Over a median follow-up of 21.4 years, 273 incident cancers were diagnosed. Baseline smoking was associated with ~40% increased risk of cancer; ~25% after accounting for death as a competing event. Taking changes in smoking during follow-up into account, the increased risk was largely confined to persistent smokers, whereas the risk in post-MI quitters was close to that of never smokers (Figure). Among patients who continued smoking after MI, each reduction of 10 cigarettes relative to pre-MI consumption was associated with an adjusted HR of 0.86 (95% CI: 0.74-1.00). Conclusions: Smoking cessation either before or after MI is associated with lower risk of cancer. Reducing consumption among persistent smokers appears also to be beneficial.

The effects of alcoholism and smoking on advanced cancer patients admitted to an acute supportive/palliative care unit.

The aim of this prospective study was to determine the characteristics and symptom burden of advanced cancer patients with alcoholism problems and smoking, who were referred to an acute palliative/supportive care unit (ASPCU) of a comprehensive cancer center. Patients' characteristics, indications for admission, kind of admission, awareness of prognosis, and anticancer treatments were recorded. The Edmonton Symptom Assessment Scale (ESAS) was used to assess physical and psychological symptoms, and the CAGE questionnaire for the diagnosis of alcoholism. Patients were also divided in three groups: persistent smokers (PS), former smokers (FS), and non-smokers (NS). The Memorial Delirium Assessment Scale (MDAS) was used to assess the cognitive status of patients. Analgesic drugs and their doses at admission and discharge were recorded, as well opioid escalation index during hospital stay. Three hundred fourteen consecutive cancer patients were surveyed. Forty-seven (14.9%), 143 (45.5%), and 124 (39.5%) subjects were PS-patients, FS-patients, and NS-patients, respectively. Sixteen patients were CAGE-positive. Females were more frequently NS, while males were more frequently FS (p=0.0005). Statistical differences were also observed in disease awareness among the categories of smoking (p=0.048). No statistical differences were found in ESAS items, except for drowsiness at T0 in NS-patients. Differences were found in OME and OEI, although the large variability of data did not determined a statistical difference. Higher values of nausea (at T0, p=0.0005), dyspnea (at T0 and TX, p=0.08 and 0.023, respectively), and well-being (at TX p=0.003) were reported in CAGE-positive patients. No correlation was found between CAGE-positive patients and smokers. Although smoking and alcoholism have obvious implications in advanced cancer patients, data remain controversial, as present data did provide limited data to confirm risk factors for advanced cancer patients. Clinical response was not strongly influenced by these risk factors.

Nicotine increases anterior insula activation to expected and unexpected outcomes among nonsmokers.

Tobacco has a higher rate of dependence than other drugs of abuse. However, the psychopharmacological effects of nicotine are incongruent with the tenacity of tobacco addiction since nicotine does not produce robust euphoria in humans or self-administration in rodents. A potential explanation is that nicotine amplifies the salience of other stimuli that have some incentive value, which could influence the initiation and persistence of smoking. However, the neural mechanisms of this process are unknown. One way that nicotine may amplify the salience of other stimuli is by enhancing reward prediction errors. We hypothesized that nicotine would enhance the neural response to unexpected (relative to expected) rewards compared to placebo. Twenty-three nonsmokers underwent two fMRI scans, following nicotine (1mg) or placebo administration, while performing an outcome expectation task. In the task, a pair of cues was associated with either a subsequent reward (the image of a $100 bill) or a nonreward (the image of a blurry rectangle). On 20% of trials, the cue was followed by an unexpected outcome. Although nicotine did not affect the magnitude of prediction errors relative to placebo, nicotine did increase BOLD activation in the anterior insula/inferior frontal gyrus and decrease activation in the caudate across all outcome types (including both rewards and nonrewards). The insula and caudate could play a role in the initial effects of nicotine in nonsmokers, and these changes in baseline may be the mechanism that underlies how nicotine amplifies the salience of nondrug stimuli.

Demographic, Healthcare, and Contextual Factors Associated with Smoking Status Among Sexual Minority Women.

The study purpose was to examine demographic, healthcare, and contextual correlates of smoking among sexual minority women (SMW). Data were from the Chicago Health and Life Experiences of Women study (2010-2012, N = 726). The rate of current smoking was 29.6%, with 29.5% and 40.9% former or nonsmokers, respectively. A history of ever smoking was associated with lower educational levels, having a partner who smokes, heavy drinking, illicit drug use, and a bisexual identity. Statistically significant correlates of former versus current smoker included higher education, having a nonsmoking partner, being from the newest recruited cohort, and less illicit drug use. A past-year quit attempt among current smokers was associated with higher levels of illicit drug use, longer time until first cigarette, and being from the original cohort. The study results highlight key correlates of smoking behaviors among SMW and make an important contribution to the literature on smoking disparities. Additional research is needed to inform smoking cessation prevention and control efforts to reduce known and persistent smoking disparities among SMW.