Smoking Cessation Research Articles

Immunoglobulin free light chain-kappa, a novel biomarker of inflammation and cardiovascular risk, decreases after smoking cessation in association with NT-proBNP

Abstract Introduction Inflammation plays an important role in the development and progression of cardiovascular diseases. Unhealthy diet, infection, and smoking coupled with genetic factors induce inflammation in the heart and blood vessels by activating nuclear factor kappa B, which regulates the transcription of immunoglobulin free light chain (FLC)-κ in B-cells and the production of multiple inflammatory molecules. FLCs are novel biomarkers of inflammation, and their levels are associated with overall mortality in a general population and with cardiovascular outcomes. Purpose This study aimed to investigate the effect of smoking cessation (SC) on levels of FLCs as well as of the inflammation and heart failure markers. Methods Inclusion criterion was first-visit smokers with desire to quit smoking at our outpatient clinic. Smoking patients with nicotine dependence were treated with transdermal nicotine patches or orally administrated varenicline. Various clinical parameters, including inflammatory markers such as FLC levels, were measured on their first visit to our outpatient clinic for SC and after 3 months of successful and unsuccessful SC. Paired t-test or Wilcoxon signed-rank test was performed to evaluate changes in these parameters before and after SC. Results Out of 96 patients who participated in this study, 76 patients (55 males and 21 females) succeeded in SC over a period of 3 months. Body mass index (BMI) significantly increased from baseline to 3 months after initiating SC (from 23.8 to 24.2, p=0.004) in patients with successful SC. On the other hand, levels of various inflammatory markers; FLC-κ, FLC-κ/FLC-λ, and the neutrophil-to-lymphocyte ratio) significantly decreased from baseline to 3 months (from 27.5 to 24.7 mg/L, p = 0.042; from 1.2 to 1.2 mg/L, p = 0.010; and from 2.0 to 1.9, p = 0.024, respectively). In contrast, no significant changes occurred in these parameters among patients with unsuccessful SC. Percent changes of FLC-κ levels from baseline to 3 months were significantly correlated with those of CRP (r=0.217, p=0.034) and NT-proBNP (r=0.335, p<0.001) levels. Conclusion The FLC-κ level, a novel inflammatory and cardiovascular risk biomarker, decreased in smoking patients after their SC despite the increase in body weight, suggesting that the beneficial effect of SC overcomes potential risks by body weight increase. The results also suggest that a decrease in the FLC-κ level after SC is associated with a reduction of load on the heart as well as decrease in inflammation.

Positive effects from the introduction of fully subsidised nicotine replacement therapy in Ireland

Abstract Smoking remains a leading cause of preventable death in the Europe. Despite recent declines in prevalence, the adverse health and economic effects of smoking are felt disproportionately by disadvantaged groups. Nicotine replacement therapy (NRT) is well established as an effective smoking cessation aid; however, its financial cost may act as a barrier to uptake. In February 2023, eligibly for fully subsidised NRT was expanded to all users of smoking cessation services in Ireland. This study evaluated the impact of universal access to NRT on smoking cessation. This study utilised secondary analysis of routinely collected data from service users attending Irish smoking cessation services. Individuals were followed for twelve weeks. Changes in self-reported quit status and NRT use were analysed before (January 2021 - February 2023) and after (March 2023 - December 2023) the introduction of fully subsidised NRT. Logistic regression modelling identified factors associated with smoking cessation. The total number of participants was 19,717. There was higher uptake of NRT among service users who were eligible for free NRT (59% vs 40%, p < 0.001) and higher quit rates at four (41% vs 29%, p < 0.001) and twelve (29% vs 20%, p < 0.001) weeks. Logistic regression models demonstrated that NRT use was significantly associated with smoking cessation at four (aOR 1.88, 95%CI 1.47 - 2.41) and twelve (aOR 1.76, 95%CI 1.37 - 2.28) weeks. This study confirms the effectiveness of NRT in an Irish context and illustrates the benefits of universal access to this life saving medicine. Targeted interventions are required to intensify services offered to disadvantages groups if the ambitious objectives of Tobacco Endgame are to be achieved. These findings represent an urgent call to action for European policy makers to deliver equitable access to NRT across the continent. Such action can transform the public health landscape and help bring us closer to achieving a tobacco free Europe. Key messages • This study confirms the real-world effectiveness of NRT use as a smoking cessation aid. • The removal of financial barriers is associated with increased NRT use and successful smoking cessation.

Smoking cessation after acute myocardial infarction: a Swiss-wide cohort study

Abstract Background Smoking is a major cardiovascular risk factor and of great importance in terms of both primary and secondary prevention. The present study aims to identify patient characteristics associated with smoking cessation within 1 year after acute myocardial infarction (AMI) to inform physician-patient interactions, secondary prevention measures, and public health planning. Methods ST-elevation myocardial infarction (STEMI) and non-STEMI (NSTEMI) patients enrolled between 2012 and 2022 in the AMIS Plus registry who were active smokers at the time of the index event were included. At the 1-year follow-up, patients were questioned about their smoking behaviour via telephone interview and were further classified into those who had quit (stoppers) or continued (continuers) smoking. Patient characteristics were collected at the time of the index event and at follow-up and then compared using descriptive statistics. Results From a total of 4523 patients with AMI, 4242 (93.8%) provided information regarding their smoking status at a median follow-up of 395 days (interquartile range 370 to 469) after the index event. Of 1691 (39.9%) active smokers at the time of AMI, 861 (50.9%) reported quitting whereas 830 (49.1%) were still smoking at the 1-year follow-up. Stoppers were younger (57 vs. 58 years, p<0.001), more likely to be male (82.8% vs. 77.7%, p=0.008) and have presented with STEMI (77.0% vs. 71.0%, p=0.005), and less likely to have had a previous AMI (6.6% vs. 13.3%, p<0.001) than continuers. Smoking cessation was more common in patients with a more severe AMI characterised by a greater extent of myocardial injury (in-hospital median peak creatine kinase level 1291 IU/L vs. 1101 IU/L, p=0.012), at least one in-hospital complication (13.9% vs. 9.9%, p=0.01), and participation in a rehabilitation programme (83.7% vs. 68.8%, p<0.001). Stoppers more frequently implemented other favourable lifestyle changes, such as dietary changes (56.2% vs. 45.2%, p<0.001) and increased physical activity (54.6% vs. 37.7%, p<0.001) than continuers. Self-reported weight gain was more prevalent among those who quit smoking (44.0% vs. 19.7%, p<0.001). Conclusions In Switzerland, half of the patients with AMI who were active smokers at the time of AMI, reported to have stopped smoking 1 year after the index event. Smoking cessation was associated with participation in a rehabilitation programme and occurred more often in patients with larger AMI sizes, higher in-hospital complication rates and more frequent implementation of other favourable lifestyle changes after AMI. The significant weight gain after smoking cessation seems to represent a major issue that should specifically be addressed.

Sociodemographic inequalities in smoking cessation: a population survey from Flanders, Belgium

Abstract Background Flanders’ decline in daily tobacco use will not reach the aim of a 5% prevalence by 2040. A faster reduction necessitates, especially among low-educated and socially vulnerable groups, as in these groups the decline goes slower. Towards future smoking cessation interventions within these specific target groups, this study examined prevalence and sociodemographic inequalities in different indicators of smoking cessation in Flanders. Methods Data from the 2022 Prevention Barometer, a probability-based survey from Flanders, were used (N = 4011, 18+). Prevalence in ever smokers was calculated overall and by age, sex, educational attainment, making ends meet and employment status. Daily smokers reported their past-year quit smoking attempts, upcoming-year quit smoking intentions and intentions to use cessation aids. Former smokers reported successful cessation and use of cessation aids. Multivariate logistic regressions, including all demographic variables, aimed to uncover inequalities. Results Quit smoking attempts in daily smokers (26.5%) were lower for low education (vs. middle and high education). Quit smoking intentions in daily smokers (41.0%) were lower for low vs. middle and low vs. high education. Daily smokers had lower intentions to use cessation aids (48.5%) when having difficulties in making ends meet. Among ever smokers, being older, having high education (vs. middle and low education), having no difficulties in making ends meet and being retired (vs. working and not working) was associated with higher odds for successful quitting (73.2%). Among former smokers, people being retired (vs. working and not working) had higher odds of using cessation aids (15.3%). Conclusions Low educated daily smokers are less likely to quit smoking. Former smokers limitedly use cessation aids to quit smoking and the use varies regarding one’s sociodemographic profile. Encouraging quit attempts and equitable access to cessation aids are public health priorities. Key messages • Low-educated smokers in Flanders face barriers in quitting, highlighting the need for targeted cessation support. • Socioeconomic disparities impact cessation aid utilization, underlining the importance of equitable access to aid for all demographics.

Smoking cessation medicines and e-cigarettes in smokers with obesity

Abstract Purpose The interaction between obesity and smoking is complex. Aim of this study is to compare the abstinence rates of smoking cessation pharmacotherapies vs electronic cigarettes in obese smokers. Methods 57 obese smokers (aged 41±8 years, BMI: 33.8 ±2.4 Kg/m2) visiting our unit from January 2016 to November 2022 were randomized into three smoking cessation therapy groups: 1. NRT (nicotine patch), 2. NRT + bupropion (NRT+bupr) and 3. Electronic cigarette (EC). Results There were not significant differences in severity of nicotine dependence and cigarette consumption (pack-years) between the three treatment groups. Furthermore, the three groups had similar age and prevalence of traditional risk factors. At the end of treatment period (3 months), 5/19 (26 %) and 9/19 (47%) of subjects under therapy with NRT alone and NRT + bupropion combination respectively, were abstinent from smoking while 10/19 (53%) of individuals using EC did not smoke combustible cigarettes. Left plot shows the continuous abstinence rates at 6 months. Continuous abstinence rates were similar in the NRT and NRT+bupropion group at 6 months compared to 3 months (end of treatment), while 8/19 (42%) of individuals using EC did not smoke. Interestingly , at 6 months among users of EC 6 continued vaping nicotine alone, 7 continued to smoke tobacco cigarettes while vaping and 4 continued smoking cigarettes alone. Nevertheless only 2 out of 19 participants in that group stayed abstinent from both combustible cigarette smoking and vaping. Blood pressure remained unchanged in all groups while weight decreased in the group treated with the combination of bupropion and NRT compared to NRT alone and EC groups (right plot, P<0.01). Conclusions Our preliminary data indicate that continuous abstinence rates at 6 months were higher in obese smokers receiving NRT+bupropion combination therapy compared to those of individuals who used NRT alone. There is also a low abstinence rate of both cigarette smoking and vaping among individuals using EC as an aid for smoking cessation. The NRT+bupropion combination therapy was associated with a favorable effect on weight change in obese smokers.EC vs pharmacotherapy in obese smokers

Trajectories in smoking habits and outcomes in patients with stable coronary artery disease

Abstract Background Smoking is a well-identified risk factor for recurrent cardiovascular (CV) events in patients with stable coronary artery disease (CAD). However, smoking status is not binary, and there is a wide diversity of smoking habits trajectories within this population, with different consequences on residual CV risk. Purpose To better understand how smoking status evolves in patients with CAD, and how it is associated with subsequent CV events. Methods We analysed the CLARIFY registry, which included 32,378 patients with CAD. We defined groups according to smoking status at inclusion in the registry: never, former and active smokers. For former smokers, we assessed the timing of definitive smoking discontinuation and its relationship with subsequent CV events. For active smokers, we investigated the association between smoking reduction or discontinuation in active smokers with outcomes. Our primary endpoint was the occurrence of MACE defined by CV death or myocardial infarction (MI) during the 5-year follow-up period adjusted on known predictors for MACE in CAD patients. Results At inclusion, 13,366 (41.3%) patients had never smoked, 14,973 (46.2%) were former smokers, and 4,039 (12.5%) were current smokers, after an average of 6.5 (±6.3) years following CAD diagnosis. In former smokers that were smoking at the time of CAD diagnosis, 72.8% definitively discontinued smoking within the first year following diagnosis, while only 27.2% quit in subsequent years. Each additional year of active smoking after CAD diagnosis increased the risk of MACE (adjusted HR [aHR] 1.08, 95% CI 1.04-1.12 per year). However, regardless of the duration of smoking cessation, former smokers did not return to the cardiovascular risk levels observed in individuals who never smoked (figure). In active smokers at inclusion, smoking cessation was associated with improved CV outcomes, irrespective of the timing of cessation during follow-up (aHR 0.56, 95% CI 0.42-0.76, p < 0.001). Among active smokers, 25.7% reduced their quantity smoked within the first year of follow-up without quitting, but this did not significantly reduce the rate of CV death and MI (aHR 0.96, 95% CI 0.74-1.26, p = 0.78) compared to other active smokers. Conclusion In active smokers diagnosed with CAD, the vast majority of definite quitters cease smoking within the first year of CAD diagnosis. Each subsequent year of active smoking adversely affects CV outcomes. Smoking cessation at any time significantly reduces the risk of CV death or recurrent MI compared to persistent active smokers, although CV risk of former smokers does not decrease to the levels observed in never-smokers. Finally, smoking quantity reduction is not enough to reduce CV risk in this population. These findings underscore the critical importance of timely interventions for smokers diagnosed with CAD, and emphasize that when it comes to smoking cessation, sooner is better, but it is never too late.

Relationship of anxiety and depression with smoking cessation treatments: a follow-up study

ABSTRACT Background Smoking is known to be closely associated with a stress levels and anxiety. In this study, the effects of smoking cessation treatments were investigated on anxiety/depression. Methods Socio-demographic characteristics The Fagerström/Test/Nicotine/Dependence, the Hospital Anxiety and Depression (HAD) scale were applied at first time. The first group received “varenicline+counseling,” second group “bupropion+counseling,” and third group “counseling only.” The HAD scores were recorded in quit smokers. Anxiety and depression scores were compared between groups and between smokers and ex-smokers in the first and sixth month. Results Firstly, The HAD scores revealed that anxiety was present in 46.8%, depression in 11.2%, anxiety and/or depression in 48.9%. A significant decrease in both anxiety and depression scores was observed in quit smokers at 6 months (47.9% and 37.4%, respectively) (p < .001). At the sixth month, there was a significant decrease in anxiety scores in the varenicline and bupropion groups. In addition, a significant decrease in the depression score was observed in the varenicline group. In the bupropion group, the smoking cessation rate was higher in those with high anxiety and/or depression scores (66.7%). Conclusions Varenicline decreased anxiety/or depression scores in both smokers and quit smokers, whereas quit smoking rate increased in those with anxiety/depression in the bupropion.

Epidemiological profile of patients consulting for smoking cessation in Tunisia from 2020 to 2023

Abstract Background Tobacco addiction poses a significant global health challenge, contributing to various diseases and premature mortality. The main objective of our work was to describe the epidemiological profile of smokers seeking assistance at the smoking cessation departement of the ‘Abderrahmane Mami’ hospital. Methods We conducted a retrospective study involving smokers who attended the smoking cessation department between January 2020 and December 2023. Data were collected from the consultants’ records. The descriptive study was conducted using IBM SPSS 25 software. Results The number of consultants was 440 during the years of the study. The study population was predominantly male (75.2%). The average age of the consultants was 45.41 ± 13.9 years [14-89 years]. The education level of the patients was predominantly university-level (42.4%), followed by secondary education (33.6%). Cardiovascular history was the most common (22.42%). More than half of the consultants (n = 279; 63.4%) had tried to quit smoking at least once. More than half of the smokers followed (57.9%) were highly dependent on nicotine (Fagestrom score ≥ 7). The mean score of the hospital anxiety and depression scale was 8.03 ± 5.398 for anxiety and 5.44 ± 5.185 for depression. Conclusions Our study provides informations about the epidemiological profile of individuals seeking tobacco cessation support during the study period. The findings underscore the diverse demographic and clinical characteristics of this population. Understanding these profiles can provide information for the development of effective anti-tobacco programs. Key messages • Tailored interventions are essential to meet the diverse needs of people seeking smoking cessation, optimizing the impact on public health. • Understanding cessation seeker profiles crucial for effective strategies.

Favourable lifestyle changes 1 year after acute myocardial infarction

Abstract Background Acute myocardial infarction (AMI) is a life-threatening event that should be an excellent motivator to adopt a healthy lifestyle. We aimed to evaluate the proportion of patients with AMI who reported favourable lifestyle changes 1 year after AMI. Methods Harnessing a nationwide prospective cohort of patients with AMI in Switzerland, ST-elevation myocardial infarction (STEMI) and non-STEMI (NSTEMI) patients enrolled in the AMIS Plus registry between 2012 and 2022 were followed-up 1 year after the event by telephone interview. Favourable lifestyle changes, often addressed in hospitals or rehabilitation programmes were defined as smoking cessation, weight reduction (for overweight patients at index presentation), dietary changes, increased physical activity and stress reduction. Self-reported lifestyle changes were stratified according to AMI type, sex, and age. Results From 7906 AMI patients, 7234 (91.5%) with follow-up data were included. Of these, 5627 (77.8%) were male, 1607 (22.2%) female, 4664 (64.5%) had a STEMI, and 2570 (35.5%) a NSTEMI. At a median follow-up of 397 (interquartile range 371 to 465) days, 861 (50.9%) smokers at the time of the AMI had quit smoking, 1297 (35.0%) overweight patients had lost weight, 2567 (44.8%) patients had implemented nutritional changes, 2415 (41.2%) had increased their physical activity, and 1729 (30.5%) had reduced their stress levels. Patients with STEMI were more likely to stop smoking (53.0% vs. 45.1%, p=0.005), change their diet (46.4% vs. 41.6%, p&amp;lt;0.001), increase their physical activity (43.5% vs. 36.8%, p&amp;lt;0.001), or reduce stress (31.4% vs. 28.7%, p=0.04) compared to NSTEMI patients. Male sex was associated with smoking cessation [52.5% vs. 44.4%; p=0.008; age-adjusted odds ratio (OR), 0.78; 95% confidence interval (CI), 0.61-0.99; p=0.043], dietary change (47.8% vs. 33.7%; p&amp;lt;0.001; age-adjusted OR, 0.67; 95% CI, 0.58-0.77; p&amp;lt;0.001), and an increase in physical activity (43.5% vs. 32.9%; p&amp;lt;0.001; age-adjusted OR, 0.77; 95% CI, 0.67-0.88; p&amp;lt;0.001). However, after adjusting for age, stress reduction was comparable between males and females (30.9% vs. 28.9%; p&amp;lt;0.001; age-adjusted OR, 1.09; 95% CI, 0.94-1.26; p=0.25). Conclusions A substantial proportion of patients with AMI in Switzerland reported favourable lifestyle changes within 1 year after the index event. In general, STEMI as well as male patients were more likely to report multiple favourable lifestyle changes. Nevertheless, there is still room for improvement in terms of secondary prevention measures.

Impact of addressing modifiable risk factors on the 10-year risk of cardiovascular disease in individuals with familial hypercholesterolemia: a causal analysis utilising UK biobank

Abstract Background Familial hypercholesterolemia (FH) is a prevalent autosomal dominant disorder characterised by elevated low-density lipoprotein cholesterol (LDL-C) levels from birth. These elevated LDL-C levels significantly amplify the lifetime risk of cardiovascular disease (CVD). While the impact of early and effective initiation of lipid-lowering medication (LLM) on CVD risk is well documented in genetically confirmed FH, the additional impact of addressing modifiable lifestyle risk factors (MLRF) in that patient population remains largely unquantified. Methods This study quantified the potential effects of successfully managing 4 MLRF (smoking, obesity, alcohol consumption, and low physical activity) on the 10-year incidence of a first CVD diagnosis in adults with genetically confirmed FH treated with LLM within the UK Biobank. The synthesised causal estimates of these 4 MLF were obtained using two recent causal analysis frameworks, namely the doWhy causal calculus framework and the Causal Forest Double Machine Learning Method. Results In 660 FH individuals (mean age 56±8 years; 60.15% women), smoking cessation and reducing body mass index below 30 kg/m2 delivered the most substantial risk reductions (pooled estimates, adjusted for the 3 other MLRF: -6.5% and -3.2%, respectively; both p&amp;lt;0.001), followed by initiating moderate or high physical activity (-1.7%; p&amp;lt;0.001; Figure). Notably, cessation of alcohol consumption significantly increased CVD risk (+2.5%; p&amp;lt;0.001), aligning with existing literature. Conclusion In over 10 years, reductions in CVD risk ranging from 1.7% to 6.5% were achievable through smoking cessation, BMI reduction, and enhanced physical activity in FH individuals. Leveraging causal inference methodologies facilitates the discernment of which risk factors offer the most pronounced additional benefits beyond lipid-lowering interventions in this high-risk population.Forest Plot of Causal Effect Estimates

A mixed-methods evaluation of a virtual coach for smoking cessation and physical activity in adults

Abstract Background Mobile health (mHealth) interventions with virtual coaches (i.e. AI conversational agents) offer scalable and cost-effective solutions for health behavior change. We developed Perfect Fit, an mHealth intervention with a virtual coach providing personalized feedback to promote smoking cessation and physical activity simultaneously. Through innovative techniques (e.g. sensor technology) and iterative development involving end-users, we aim to overcome challenges faced by mHealth interventions, like insufficient personalization. This study examines Perfect Fit’s feasibility and acceptability. Methods A single-arm, mixed-method, real-world evaluation study was conducted with 100 adult smokers in the Netherlands. The intervention lasted approximately 16 weeks. Data were collected at baseline and post-intervention. Quantitative data included usage data and self-report questionnaires on feasibility, acceptability and participant characteristics (e.g. eHealth literacy). Qualitative data included semi-structured post-intervention interviews with a subsample of 12 participants. Descriptive analyses (quantitative) and the Framework Approach (qualitative) were used for data analysis, and quantitative and qualitative data were integrated during interpretation. Preliminary results Participants adapted the use of Perfect Fit to their preferences. Many participants were satisfied with the content but missed variations in conversations with the virtual coach. The coach offered anonymity, positively experienced by some (e.g. non-judgemental), but negatively by others (e.g. lower accountability). Many participants liked the combination of smoking cessation and physical activity enhancement. Conclusions Findings show the potential of interventions like Perfect Fit as a multiple health behavior change strategy in promoting public health and preventing chronic disease. Findings can inform intervention development and identify methods to foster feasibility and acceptability. Key messages • mHealth interventions with virtual coaches, like Perfect Fit, could promote public health. • Targeting multiple behaviors, like low physical activity and smoking, simultaneously seems beneficial.

Identity in the context of physical activity and smoking: A scoping review among adults aged 45+

Abstract Background Identity (i.e., self-perceptions of oneself) plays an important role in health behaviors such as physical activity (PA) and smoking. This review offers a comprehensive synthesis and comparison of how PA- and smoking-related identity is associated with PA and smoking behavior in adults aged 45+. It further synthesizes and compares identity terminology and measurement tools used to capture identity concerning smoking cessation and PA among adults aged 45+. Where applicable, the role of personal, PA-, and smoking-related characteristics were considered. Methods A thorough search across 11 databases, updated in May 2023, yielded 5801 unique publications. Ensuing careful screening procedures, 45 peer-reviewed empirical studies were systematically reviewed. Experts in the field contributed to validate and structure the narrative. Results The review reveals a complex, enduring connection between identity and behavior in both PA and smoking domains, encompassing processes like identity formation, maintenance, change, and loss. In essence, identities linked to PA and abstaining from smoking emerged as pivotal for promoting active lifestyles and successful smoking cessation. Many parallels but also distinctions emerged within this association, alongside variations in the terminology and measurement tools pertaining to identity. Factors such as gender, age, and behavioral history emerged as influential in shaping identities related to smoking and PA. Conclusions Despite variances, findings suggest that the relationship between identity and behavior, including associated processes, may not fundamentally differ between health-promoting and health-compromising behaviors. There is however need for more unified identity definitions and measurement tools. We propose avenues for future research, including exploring causality between identity and behavior to facilitate the development of identity-related smoking cessation and PA-promotion interventions. Key messages • Identities associated with physical activity and refraining from smoking are associated with a physically active lifestyle and successful smoking cessation. • Despite differences, the relationship between identity and behavior may not fundamentally vary between health-promoting and health-compromising behaviors.

A systematic review on the effect of identity-related interventions on physical activity and smoking

Abstract Background Identity (self-perceptions of ‘who I am’) is important for health behavior change. Hence, identity-related interventions, aiming to influence how people view themselves, show promise for health promotion. This systematic review describes the effect of identity-related interventions on physical activity (PA), a health-promoting behavior, and smoking, a health-compromising behavior, and PA- and smoking-related identities in adults. Methods A comprehensive search, updated in May 2023, identified 5801 publications across eleven databases. After screening, 19 quantitative and mixed-methods publications were selected, describing 20 different studies. Relevant data were systematically extracted and a quality assessment was conducted using the Mixed Methods Appraisal Tool. Results Identity-related interventions were more common for enhancing PA (n = 13) than for smoking cessation (n = 6). Only one study targeted PA- and smoking-related identities to change both behaviors simultaneously. Various identity-related interventions were used, e.g. possible (future) selves manipulations and avatar games. The target population was rarely involved in intervention development. The results are mixed; some studies showed (significant) positive effects of identity-related interventions on identities or behavior, and no significant negative effects were shown. Similar results were found for PA and smoking. The one study targeting both behaviors showed positive results. Conclusions Identity-related interventions hold promise in promoting PA and smoking cessation. Future research could investigate identity-related interventions targeting multiple health behaviors, e.g., PA-promotion and smoking cessation, leveraging the synergy between those identities and behaviors. Collaboratively developing these interventions with the target population (i.e., patient and public involvement) could optimize them for different populations, improving public health and reducing health disparities. Key messages • Identity-related interventions could improve public health. • Collaboratively developing identity-related interventions with the target population could optimize them for different populations.

Lifestyle factors before and after colorectal cancer treatment and their association with fatigue

Abstract Background As colorectal cancer (CRC) survivorship increases, so does the challenge of managing cancer-related fatigue, a prevalent condition that severely impacts survivors’ ability to work and overall quality of life. This study delves into the relationship between lifestyle behaviors, assessed using the HEALTHY lifestyle score, and its influence on fatigue among CRC patients. Methods Data was derived from MIRANDA, a multicenter cohort study that enrolls adult CRC patients during a 3-week in-patient rehab within a year after primary CRC treatment. Up to date, n = 438 participants provided information on lifestyle factors at the rehabilitation start (baseline) and then every three months for the first year. The predictors were the HEALTHY lifestyle score and its components (diet, alcohol consumption, physical activity, BMI, and smoking status) calculated at three time points: before surgery, after surgery, and 12 months following rehabilitation. The outcome was fatigue, assessed using the Functional Assessment of Chronic Illness Therapy - Fatigue (FACIT-F-FS) scale. Results Participants with a higher HEALTHY lifestyle score after CRC surgery had statistically significantly lower fatigue levels. The components that contributed most to this finding were smoking and physical activity. Participants who engaged in exercise post-surgery or did not smoke before their cancer diagnosis experienced lower fatigue levels during rehabilitation. Conclusions Lifestyle modifications, such as increasing physical activity and smoking cessation, are crucial in preventing or reducing fatigue among CRC patients. Tailored public health initiatives that advocate for these lifestyle adjustments and their incorporation into CRC rehabilitation protocols could significantly advance survivor care, ultimately leading to better health outcomes. Key messages • The HEALTHY score is associated with fatigue of CRC patients during rehabilitation, highlighting the crucial role of lifestyle changes after CRC treatment. • Smoking cessation and physical activity programs may be the most effective measures for decreasing the fatigue burden of these patients.

Smoking Discrimination Moderates the Relationship between Smoking Stigma and Cigarettes Per Day among Sexual and Gender Minority Individuals

Background: Sexual and gender minority (SGM) individuals report rates of tobacco use that range from 19% to 40% compared to roughly 20% of the general population. Higher rates of tobacco use, compounded by stress from discrimination, contribute to lower cessation rates and worse smoking-related outcomes for SGM individuals. Having multiple stigmatized identities, such as identifying as SGM and being a person who uses cigarettes, may further increase smoking, and decrease the likelihood of cessation. Smoking-related stigma is one relatively unexplored factor that may be related to smoking frequency. Objectives: The present study sought to examine how smoking stigma was related to smoking frequency, and how discrmination moderates the relationship between smoking stigma and cigarettes per day. Results: A sample of 399 self-identified SGM individuals (M age = 36.69) was collected via Qualtrics Panels. Participants were primarily White and bisexual. Participants completed a battery of questions, including measures regarding smoking frequency (operationalized in this article as cigarettes per day [CPD]), smoking felt-stigma, smoking self-stigma, and smoking discrimination. Moderation analyses revealed significant interactions of felt- and self-stigma with smoking-related discrimination. For individuals who perceived higher levels of both self- and felt-stigma, experiencing increased smoking discrimination was associated with increased smoking frequency. However, there was no significant interaction with discrimination for individuals who had lower levels of felt- and self-stigma. Results have implications for smoking reduction and cessation. Helping individuals who have higher levels of felt- and self-stigma manage stress related to being stigmatized may motivate individuals to reduce smoking. Ultimately, these findings can play a role in crafting smoking reduction and cessation programs targeted toward SGM communities, particularly individuals who experience high levels of smoking-related stigma.

Associations of smoking status with long-term cardiovascular events in different arterial territories: the EPIC Norfolk prospective population cohort

Abstract Background Smoking cessation is associated with a reduced risk of cardiovascular disease (CVD) events, mainly in ischemic heart disease (IHD) and stroke. However, the impact of smoking status (never, former or current smoking) on long-term CVD events across different arterial territories remains understudied. Knowledge of such associations is important, as it may assist in risk communication and smoking cessation motivation. We therefore investigated associations between smoking status and territory-specific CVD events in a large cohort with ≥20 years follow-up. Methods We included participants without baseline CVD from the European Prospective Investigation of Cancer (EPIC) Norfolk prospective population cohort. The strengths of associations between smoking, former smoking and never smoking with the first occurrence of a CVD event were evaluated using a competing risk-adjusted regression model. CVD events were defined as hospitalisation or death due to IHD, ischemic stroke, haemorrhagic stroke, peripheral arterial disease (PAD) or aortic aneurysm (AA). Patients were followed-up until the first event, non-CVD death (competing risk) or end of study (15-03-2018). The model was adjusted for sex, age, systolic blood pressure, low-density lipoprotein cholesterol (LDL-c), high-density lipoprotein cholesterol (HDL-c), diabetes, renal function and body mass index. We compared former and current smoking (at baseline) with never smoking. Results We included 23,581 participants (56% women) with a median baseline age of 58 years [interquartile range (IQR) 51-66]. During median follow up of 21.3 years (IQR 19.0-22.8), 26.4% experienced ≥1 CVD event. The first event of occurrence was IHD in 17.3%, ischemic stroke in 3.6%, haemorrhagic stroke in 1.4%, PAD in 3.1% and AA in 1.4%. Current (vs. never) smoking was associated with IHD [adjusted hazard rate (aHR) 1.53, 95% confidence interval (CI) 1.36-1.72], PAD (aHR 1.29, 95%CI 1.07-1.56) and AA (aHR 4.81, 95%CI 3.54-6.54). Current smoking was not significantly associated with ischemic stroke (aHR 1.20, 95% CI 0.95-1.52) and haemorrhagic stroke (aHR 1.18, 95% CI 0.81-1.70). In former (vs. never) smoking individuals, the association with AA remained statistically significant but less pronounced [aHR 1.69, 95%CI 1.29-2.23]. Conversely, former smoking was not associated with IHD (aHR 1.07, 95%CI 0.99-1.16) or PAD (aHR 1.09, 95%CI 0.95-1.26) (Figure 1). Conclusion After 20-years of follow-up, former smokers, compared to never-smokers, remain at considerably higher risk for CVD events, particularly for aortic aneurysm. This knowledge may assist in treatment decisions and risk communication.

Predictive value of Type D personality combined with unhealthy cardiovascular behaviors for the long-term adverse cardiovascular events in ACS patients

Abstract Background Acute coronary syndrome (ACS) has become a major public health problem worldwide due to its high morbidity and mortality. In addition to traditional risk factors, psychosocial factors play an important role in the development of ACS.Type D personality, as a combination of social inhibition and negative affect, has been defined as a psychological risk factor for coronary heart disease by the European Society of Cardiology.Meanwhile, ACS patients with Type D personality may have behaviors such as unhealthy dietary behaviors, less regular physical activity, and poorer self-management behaviors. Then, whether the combination of Type D personality and poor cardiovascular health behaviors can increase the risk of poor prognosis in patients with ACS requires further research. Purpose The aim of this study was to investigate the effect of Type D personality combined with poor cardiovascular health behaviors on long-term major adverse cardiovascular events(MACE) in patients with ACS. Methods A total of 18631 patients diagnosed with ACS between January 2017 and July 2023 were included in this study. Type D personality, cardiovascular health behaviors (smoking cessation, physical activity, average sleep duration at night, dietary assessment index, BMI, lipids, blood glucose, blood pressure) were assessed during the admission period, and were divided into poor, general, and ideal cardiovascular health with a cut-off score of 50 and 80.The binary logistic regression analysis was used to assese the effect of Type D personality combined with cardiovascular health score on the occurrence of MACE (stroke, reinfarction, revascularization, all-cause death). Results The median follow-up in this study was 37 months, and we found that a total of 3750 people had MACE during the follow-up period. The logistic regression result showed that compared with Type D personality (-) and cardiovascular health behaviors (poor) group, Type D personality (+) and cardiovascular health behaviors (poor) group (OR=1.451, 95%CI=1.055-1.995,P=0.022), Type D personality (+) and cardiovascular health behaviors (general) group (OR=1.425, 95%CI=1.092-1.858,P=0.009), Type D personality (-) cardiovascular health behavior (poor) group (OR=1.301, 95%CI=1.013-1.670, P=0.039) were independent risk factors for the occurrence of further adverse cardiovascular events. Conclusion Type D personality combined with unhealthy cardiovascular behavior individuals may be at high risk for MACE. Therefore, early assessment of Type D personality and cardiovascular health behaviors are needed, thereby reducing the incidence of MACE in ACS patients.

The association between periodontal disease and coronary artery disease: insights from imaging, observational and genome-wide data

Abstract Background Periodontal disease is the sixth most common disease worldwide. It has been suggested that it may be a contributory risk factor for coronary artery disease (CAD). From a public health perspective, prevention of periodontal disease is relatively straightforward and cost-effective: daily brushing, flossing and, where applicable, smoking cessation. Purpose This study utilises imaging, longitudinal and genomic data to characterise the association between periodontal disease and CAD. Methods 481,915 individuals from the UK Biobank were included in this study, 18.9% (n = 91,022) of whom had self-reported periodontal disease. For the imaging analysis, a maximum of 59,019 had paired cardiovascular magnetic resonance (CMR) data. Multivariable linear regression models were constructed to examine the association of periodontal disease on CMR outcomes with LV end-diastolic volume, LV mass, LV mass:volume ratio (MVR), LV ejection fraction, LV global longitudinal strain and native T1 values considered as prognostically important phenotypes. The relationship between periodontal disease and incident CAD was assessed using Cox proportional hazards regression models. To examine the relationship of genetically-determined periodontal disease on CAD, a de novo GWAS for periodontal disease was performed and a genome-wide polygenic risk score (PRS) was constructed. Results Periodontal disease was associated with a significantly higher LV MVR (effect size = 0.00233, 95% confidence interval [CI] = 0.0006, 0.004) and significantly lower LV native global T1 value (effect size = -0.86 ms, 95% CI = -1.63, -0.09). The presence of periodontal disease was independently associated with a significantly increased hazard of incident CAD (HR = 1.09, 95% CI = 1.07, 1.13) at a median follow-up time of 13.8 years (Figure 1). Each standard deviation increase in the periodontal disease PRS was associated with increased odds of CAD (OR = 1.03, 95% CI = 1.02, 1.05) (Figure 2). Conclusion Using an integrated approach across imaging, observational and genomic data, periodontal disease is independently associated with biomarkers of subclinical remodelling as well as incident CAD. These findings highlight the potential importance of periodontal disease in the broader context of cardiovascular disease prevention.

Understanding smoking cessation process in Tunisia from 2020 to 2023: description of quit attempts

Abstract Background Many smokers attempt multiple cessation methods before seeking specialist intervention. This study aims to describe these prior cessation attempts and identify relapse factors to enhance support for these individuals. Methods Data from 440 patients consulting the Department of Epidemiology Statistics at Abderrahman Mami Hospital from 2020 to 2023 were analyzed. It included information on previous quit attempts, methods used, longest duration of abstinence, number of attempts, reaction to cessation, and reasons for relapse. Statistical description was conducted using IBM SPSS 25. Results Among participants, More than half of the smokers had previously attempted to quit smoking 63,4%, with an average of 2 attempts ± 1,7 (0-10 attempts) per patient. The majority of patients (86.8%) quit smoking without using substitution methods. Among those who resorted to substitution, nicotine replacement therapy was the most frequently used method (n = 30; 6.8%). The longest duration of abstinence averaged 8 years. The main reaction to smoking cessation among patients was an improvement in their health (9,1%). The most common reasons for relapse were psychosocial problems (5.5%), followed by relapses during social events (4.3%), and withdrawal symptoms (3%). Conclusions This study emphasizes the importance of considering each patient’s journey during their smoking cessation process. Analyzing these factors will enable better management of the cessation program with the patient, as well as a deeper understanding of their feedback regarding our program, ensuring long-term cessation success. Key messages • Failed spontaneous quit attempts prior to NRT initiation are prevalent among smoking patients. • Understanding failed spontaneous cessation attempts can guide the development of more effective strategies.

Is the obesity paradox leading to a less stringent secondary prevention strategy in post-acute coronary syndrome patients?

Abstract Introduction Patients with acute coronary syndrome (ACS) are at very high risk of recurrent cardiovascular (CV) events. Despite being a major CV risk factor, obesity was associated with best survival in patients with ACS, the so-called "obesity paradox". It is uncertain if this finding is leading to a less stringent secondary prevention strategy in this group of patients, and whether it influences prognosis. Purpose To analyze the impact of obesity on outcomes after ACS and on other CV risk factor management. Methods Single-center, retrospective observational study that included all consecutive post-ACS patients enrolled in a phase 2 cardiac rehabilitation (CR) program in 2017, with a follow-up of 24 months. Patients were classified in 2 groups according to body mass index (BMI) at baseline: Group 1 (G1) were obese patients (BMI≥30 kg/m2), and Group 2 (G2) were non-obese patients (BMI&amp;lt;30kg/m2). Major adverse cardiovascular events (MACE) were defined as a composite of death, non-fatal ACS, non-fatal stroke, and unplanned revascularization. Results 198 patients were included (mean age of 60.3±10.7 years, 82% male) with a mean BMI of 27.7±4.2 kg/m2. Forty-seven patients (23.7%) had a BMI≥30 kg/m2. Patients in G1 were more likely to have hypertension (79% vs 55%; p=0.003) and diabetes (36% vs 20%; p=0.022). CR program was associated with smoking cessation, significant BMI (G1: -0.69 (95%CI: -0.40 to -0.10); G2: -0.39 (95%CI: -0.20 to -0.57) and LDL-Cholesterol (LDL-C) reduction (G1: -38 (95%CI: -25 to -50); G2: -29 (95%CI: -22 to -36), and functional capacity improvement (G1: +1.2 METs (95%CI: +0.9 to +1.5); G2: +1.1 METs (95%CI: +1.0 to +1.4) in both groups at 3 months, with similar magnitude of improvement. At 24 months, BMI had returned to baseline values in both groups, while the improvement in smoking status, LDL-C and functional capacity persisted. At 24 months, MACE occurrence was numerically increased in obese group (G1: 26.1% vs. G2: 17.2%, p=0.182), with a statistically significant higher incidence of non-fatal recurrent ACS in G1 (17% vs. 7.3%, p=0.048). Conclusions ACS patients with obesity have worse prognosis, despite the similar improvement in CV risk profile. Our data also suggests that, despite the short-term improvement in BMI, current treatment strategies are not effective at achieving a persistent weight control over 24-months.