Rates Of Tobacco Use Research Articles

Prevalence and Predictors of Current and Former Tobacco Use among Older Adults in Indonesia

Purpose:The study aims to describe sociodemographic and health variable indices related to current and former tobacco use among older adults who participated in the Indonesia Family Life Survey (IFLS-5) in 2014-15. Materials and Methods:A national population-based cross-sectional study was conducted with a probability sample of 8,001 aged 50 years or older Indonesians. Results:The overall prevalence of current tobacco use was 33.3% (62.2% in men and 6.5% in women) and former tobacco use was 9.8% (17.4% among men and 2.8% in women), of which 64.4% quit tobacco use when 50 years and older. In multinomial regression analysis, sociodemographic factors (being male, lower education, lower economic status, living in Java and rural residence) and health variables (cancer or malignant tumour, depression symptoms, functional disability and inadequate fruit and vegetable consumption) were associated with current tobacco use. In addition, being overweight or obese, having had a stroke, and other lung conditions were inversely associated with current tobacco use. Further, in adjusted analysis, sociodemographic factors (being 70 years and older, being male, living in Sumatra) and having chronic conditions (dyslipidemia, heart problems, asthma, stomach or digestive diseases and functional disability) were associated with former tobacco use. Conclusions:A high rate of current tobacco use and low rate of former tobacco use was found, particularly among men. The identified risk factors may help to better target this vulnerable population with tobacco cessation programmes.

Brief Report: Rate of Nicotine Metabolism and Tobacco Use Among Persons With HIV: Implications for Treatment and Research.

The nicotine metabolite ratio (NMR) is a biomarker that represents individual variation in the speed that nicotine is metabolized. The rate of nicotine metabolism alters smoking behavior (eg, amount) and has been validated for personalizing tobacco dependence medication selection to increase treatment efficacy and reduce treatment side effects in the general population of smokers. Although smoking rates are extremely high among those with HIV, the NMR has not been evaluated in this underserved population. We used baseline data from a smoking cessation clinical trial for smokers with HIV (N = 131) to examine associations between NMR and demographic, smoking, disease-related, and psychological characteristics. Pearson r and analysis of variance were used to identify univariate correlates of NMR, which were then entered into a multiple linear regression model. In univariate analyses, a higher NMR (faster nicotine metabolism) was associated with being white, and more cigarettes per day, nicotine dependence, exhaled carbon monoxide, and symptoms of depression and anxiety, and using efavirenz. In a multiple regression model, a higher NMR was associated with more cigarettes per day, higher anxiety symptoms, and efavirenz use. As in other populations, faster nicotine metabolism was associated with the use of more cigarettes and higher anxiety symptoms. Notably, efavirenz use was associated with faster metabolism, which might make it harder to quit smoking for people with HIV treated with that medication. These findings could help guide further study and the clinical use of the NMR to personalize nicotine dependence treatment in this underserved population.

Regional differences in ischemic stroke in India (north vs. south).

India is a large country with geographically diverse populations and varying risk factors. Identification of regional differences can improve healthcare policy decisions. To study regional differences in stroke between North and South India. We analyzed data from the Indo-US Collaborative Stroke Project, a National Institute of Health-funded multicentre prospective study conducted in five academic centers in India with a US-based coordinating center. Risk factors, severity, mechanisms, management, complications, and outcomes among ischemic stroke patients were compared between North and South Indian centers. Of the 2066 patients enrolled from North (n = 1060) and South India (n = 1006), North Indian patients were significantly older with fewer men and had lower rates of diabetes (32.8% vs. 38.7%, p < 0.01), dyslipidemia (3.5% vs. 25.7%, p < 0.01), tobacco use (27% vs. 38%, p < 0.001), and alcohol use (30.1% vs. 38.6%, p < 0.01). North Indian patients had higher median National Institute of Health stroke scale scores (10 vs. 9, p < 0.01), more frequent large-artery atherosclerosis mechanism (34% vs. 25.6%, p < 0.001), intravenous thrombolysis (14.0% vs. 6.1%, p < 0.001), and lower rates of pneumonia (10.5% vs. 15.1%, p = 0.02). The three-month outcome (modified Rankin Scale score 0-2, 45.8% vs. 50.3%, p = 0.08) did not differ; however, North Indian patients had higher 90-day mortality (23.5% vs. 13.5%, p < 0.0001). The substantial regional differences in stroke risk factors and mechanisms may be partly explained by factors such as differing dietary habits and lifestyle, which can be addressed at a national level. Differences in acute and inpatient stroke care suggest a need for better adoption of national stroke management guidelines.

On-Site Evaluation of Smoking, Alcohol consumption and Physical Inactivity Among Commercial Taxi Drivers in Buffalo City Metropolitan Municipality, South Africa

BACKGROUND: Commercial drivers have been identified as eliciting behaviours that promote non- communicable diseases and road traffic accidents. The aim of the study is to determine the prevalence and pattern of alcohol use, smoking and physical inactivity among commercial taxi drivers in Buffalo City Metropolitan Municipality, South Africa.&#x0D; &#x0D; METHODS: A cross-sectional study was conducted among 403 commercial drivers using the face-to-face interviews method. The WHO STEPwise questionnaire was used to obtain the demographic data, self-reported rate of alcohol consumption, tobacco use and physical inactivity.&#x0D; &#x0D; RESULTS: The participants&amp;rsquo; mean age was 43.3 &amp;plusmn; 12.5 years. About 30% of the participants were daily smokers, 37% consumed alcohol regularly and only 18% were physically active, whilst 82% were physically inactive.&#x0D; &#x0D; CONCLUSION: The prevalence of alcohol use, smoking and physical inactivity is high among commercial drivers in East London. Workplace health education on the health effects of these lifestyles&amp;rsquo; risky behaviours on individuals and the general public should be given to the drivers.

209. Perception of Gender And Mental Health In Transgender And Cisgender Adolescents And Young Adults

Emerging data suggest that transgender individuals have higher rates of anxiety, depression, tobacco use, and other risk behaviors compared to their cisgender counterparts. Prior research has suggested that stigma associated with transgender identities is a contributing factor. Experiences of adverse experiences based on misgendering and lack of gender affirmation by others might also contribute. The purpose of this study is to examine whether mismatch between gender expression self-perception and perceptions of others is associated with mental health outcomes for cisgender and transgender adolescents. This study combined data from a cross-sectional chart review of 15 randomly selected transgender and 30 age-matched cisgender (1 male, 1 female) adolescent patients receiving care at an Adolescent Medicine Clinic at the University of Utah from 2015 through 2018 who also filled out an in-clinic survey. The survey included information about sex at birth, current gender identity, their own and others’ perceptions of their gender expression. Patients aged 10 to 19 years were included in the study. Survey results were combined with electronic medical record (EMR) mental health profile (presence of symptoms of depression, anxiety, suicidal ideation, and self-harm). We performed t-tests and calculated 95% confidence intervals around means. Statistical significance was set at p-value ≤ .05. Of the 42 patients included in this study (3 were missing survey data), 12 (28.6%) were transgender, 30 (71.4%) were cisgender. We found higher rates (p=0.03, 1-tailed test) of anxiety in transgender patients compared to cisgender adolescents. We found no difference with respect to depression, suicidality, self-harm behavior, or substance use. Patients in this study reported relatively low rates of mismatch between their gender expression assessment and how others see them. We found no differences in rates of gender-perception mismatch between cisgender (mean=0.23, 95% CI: 0.07-0.39) and transgender youth (mean=0.42, 95%CI: 0.09-0.74). We also found no association between mental health outcomes or substance use and gender perception mismatch. Among patients seeking care in the same clinic, we found only limited evidence that transgender patients have significantly worse mental health outcomes compared to cisgender patients. We also found that the transgender patient population in this study does not report higher rates of mismatch between gender self-perception and perception by others. Transgender patients who receive gender-affirming care early in life might be less at risk for negative mental health outcomes compared to the overall trans* population. Our results also suggest that young patients report that others’ perception of their gender is consistent with their self-perceptions of gender. Additional research needs to examine the potential protective effects of this congruency.

Tobacco use among non-elderly adults with and without criminal justice involvement in the past year: United States, 2008\u20132016

BackgroundTobacco use remains the leading cause of preventable disease and death in the United States and is concentrated among disadvantaged populations, including individuals with a history of criminal justice involvement. However, tobacco use among individuals with a history of criminal justice involvement has been understudied in the United States, and data are needed to inform policy and practice.MethodsWe used data from the 2008–2016 National Survey on Drug Use and Health (unweighted N = 330,130) to examine trends in tobacco use, categories of tobacco use, characteristics of cigarette use, and health care utilization and tobacco use screening among individuals (aged 18–64) with and without a history of criminal justice involvement in the past year. We used multiple logistic and Poisson regression models with predictive margins to provide adjusted prevalence estimates.ResultsThe weighted sample in each year was, on average, representative of 8,693,171 individuals with a history of criminal justice involvement in the past year and 182,817,228 individuals with no history of criminal justice involvement in the past year. Tobacco use was significantly more common among individuals with a history of criminal justice involvement compared with individuals with no criminal justice involvement, and disparities increased over time (Difference in adjusted relative differences: − 10.2% [95% CI − 17.7 to − 2.7]). In 2016, tobacco use prevalence was more than two times higher among individuals with a history of criminal justice involvement (62.9% [95% CI 59.9–66.0] vs. 27.6% [95% CI 26.9–28.3]). Individuals with a history of criminal justice involvement who smoked reported a significantly earlier age of cigarette initiation, more cigarettes used per day, and higher levels of nicotine dependence and chronic obstructive pulmonary disease. Individuals with a history of criminal justice involvement were less likely to report an outpatient medical visit in the past year and, among those reporting an outpatient medical visit, were less likely to be asked about tobacco use, but paradoxically, more likely to report being advised to quit.ConclusionsNovel programs and tobacco control policies are needed to address persistently high rates of tobacco use and reduce cardiovascular morbidity and mortality among individuals with a history of criminal justice involvement.

The Frequency of Thromboembolism and Factors Associated with Thromboembolism in Patients Suffering from Polycythemia Vera

This study aimed to identify at what frequency of thromboembolic complications and the other risk factors that create a predisposition to thromboembolic complications occur in patients suffering from polycythemia vera (PV). In accordance with the 2001-2008 criteria put forth by World Health Organization, we reviewed the medical records of 207 patients who were diagnosed with PV between 2009 and 2017 at Ankara Numune Training and Research Hospital. We retrospectively looked at their demographical and clinical data, alongside their history of previous thrombotic events, what treatment they had received, and lab data at the time of diagnosis. We found that the mean hemoglobin and hematocrit levels, as well as their median white blood cell count and JAK2V617F positivity rate of those who had suffered thrombotic events were higher who had not. In addition, we also discovered that the mean age (60 vs. 55.3; p=0.012) and rate of tobacco use (62.9% vs. 23.7%; p<0.001) were both determined among the thrombotic groups versus the normal group. According to multivariate regression model of potential risk factors associated with thrombotic events, we had determined that smoking (OR=7.21; p<0.001), hypertension (OR=5.44; p=0.008), itching (OR=6.7; p=0.001), and JAK2V617F positivity (OR=2.61; p=0.043) were all independent risk factors that indicated the presence of an arterial event. We also arrived at the fact that smoking (OR=7.07; p=0.001) and itching (OR=12.9; p=0.001) were also independent risk factors predicting the presence of a venous event. Our findings conclusively reveal which risk factors are associated with thromboembolic events among PV patients. In light of that, we recommend that preventive measures be against these risk factors in order to decrease the frequency of thromboembolic complications that PV patients experience.

Tobacco use among school going children.

Despite increasing awareness of harmful effects of tobacco, its use in various forms continues to be significant health risk factors among children. To assess the prevalence, pattern, and age of initiation of tobacco consumption, various factors influencing the habit of tobacco consumption, correlation between the educational status of children and their habit of tobacco consumption, and evaluation of any tobacco-induced oral lesion among 8-14 years of school going children in Central Delhi zone. Total sample of 500 students aged 8-14 years from two schools in Central Delhi were studied using a structured, close ended, prevalidated questionnaire after taking prior permission and inform consent from the school authority. In the end, intraoral examination was done and health educational session was conducted to make students aware of health hazards of tobacco products. Prevalence of tobacco consumption among students was 16.4%. Out of total 82 tobacco users, 89% were male, whereas 11% were female. Smokeless tobacco consumption was predominant with Gutka being most preferred. Mean age of initiation of smoking form of tobacco was 9.57 ± 1.13 year, whereas for smokeless form, it was 9.25 ± 1.16 years. Friends (78.04%) were most common influencing factors, followed by family member (12.2%) and media (9.7%). The rate of tobacco use was high, considering very young age group of this study. Consumption of tobacco among children is an emerging health problem in Central Delhi zone. Mandatory health education sessions against tobacco should be held regularly for students, teachers, and parents.

Smoking and Smoking Cessation Among Criminal Justice-Involved Older Adults.

Background:In jails and prisons worldwide, older adults are among the fastest growing demographic groups. Criminal justice–involved populations smoke tobacco at high rates. Older adults are also disproportionate smokers and have more difficulty quitting smoking than other age groups. Yet, little is known about tobacco use or knowledge and attitudes toward smoking cessation among the growing population of incarcerated older adults.Methods:A descriptive, cross-sectional survey study of 102 adults aged 55 years or older recently incarcerated in an urban jail using items from the Global Adult Tobacco Survey (GATS).Results:More than 70% of participants reported being current smokers despite strong knowledge (95%) of the connection between smoking and serious illness. More than half of current smokers reported a past failed quit attempt (62%) and/or said they would like to quit (60%).Conclusions:High rates of tobacco use in this population suggest that correctional institutions represent a critical site for the delivery of appropriate smoking cessation interventions to older adults, including integrated treatment approaches for those with co-occurring behavioral health diagnoses.

Tobacco Use Among Transgender and Gender Non-conforming Adults in the United States.

Background:Findings from previous population-based studies are in conflict regarding the relative use of tobacco products among transgender populations compared with their cisgender counterparts. The purpose of this study was to estimate the prevalence of current tobacco use among transgender persons in the United States and evaluate differences in relative use between transgender and cisgender respondents.Methods:This was a secondary analysis of data from the Population Assessment of Tobacco and Health (PATH) Study Wave 2 (October 2014 and October 2015). Differences in current use of cigarettes, e-cigarettes, and cigars were examined between self-identified transgender (n = 154) and cisgender (n = 27 788) respondents.Results:In multivariable analyses, transgender identity was not associated with any of the 3 tobacco behaviors or the summary measure of tobacco use (ie, any current use of cigarettes, e-cigarettes, or cigars). In each of the models, female binary sex (compared with male), older age, Hispanic ethnicity (compared with non-Hispanic white), higher household income, and higher educational attainment were independently associated with lower odds of current use of cigarettes, e-cigarettes, or cigars, whereas sexual minority identity (ie, gay/lesbian or bisexual) was independently associated with higher odds of use.Conclusions:The prevalence of the use of cigarettes, e-cigarettes, and cigar use was statistically equivalent between transgender and cisgender populations in this national study of adults in the United States, which differs from previous research showing higher rates of tobacco use among transgender individuals. Differences in tobacco use that were identified were fully explained by sociodemographic characteristics (eg, income and education) between the transgender and cisgender populations.

Tobacco and smoking cessation

Background: Tobacco products have been used by human for a long history. The prevalence of tobacco use varies in different countries. Tobacco use is different from tobacco use disorder. Tobacco use disorder is a problematic pattern of tobacco use leading to significant distress or impairment. Cigarette smoking is a chronic relapsing substance use disorder caused by addiction to nicotine. Tobacco smoke contains over 7,000 different chemical compounds, of which 93 of them are harmful substances. Methods: In this review, the authors intended to address the issues of harmful effects of cigarette smoking and how to cease smoking. Results: Abundant studies showed that tobacco use is the main risk factor of morbidity and mortality in the world. People who use tobacco products should be advised to quit smoking and offered appropriate treatment. It is better for health-care providers to make the smoking cessation treatment as a standard component of medical care. Data from evidence-based literature showed that smoking cessation therapy can significantly raise smoking cessation rates and should be routinely in persons who are willing to quit tobacco smoking. Smoking cessation treatment includes psychosocial interventions and pharmacological treatment, which may be used in combination. Nonpharmacological management may be individual or group sessions, and it may include motivational interviewing, cognitive behavioral therapy, and others. Delivery formats of stop-smoking interventions are varied. Pharmacological therapy includes nicotine replacement treatment and smoking aids such as bupropion and varenicline. Morbidity and mortality rates are decreased with tobacco cessation at any point in time, although cessation before the age of 40 years has the most significant effect. Conclusion: The Tobacco Hazards Prevention Act took effect since 1997 in Taiwan. Rates of Taiwanese tobacco use have been steadily declining. Brilliant achievements in the field of tobacco control in Taiwan draw international attention.

Tobacco and Alcohol Consumption Rates among Chinese Women of Reproductive Age in 2004⁻2011: Rate and Sociodemographic Influencing Factors.

Background: Smoking and alcohol consumption have become major public health problems among Chinese women. In this study we explore the behavioral trends in smoking and alcohol consumption of Chinese women. We also explored the changes in the sociodemographic factors that affect the smoking and alcohol consumption behaviors of Chinese women at different reproductive stages. Methods: We used the Chinese Health and Nutrition Survey data for 2004 to 2011 to investigate the trends and influential factors of tobacco and alcohol consumption among Chinese women. Data for tobacco and alcohol consumption (consumption of beer or any other alcoholic beverage and smoking of cigarettes) were extracted using questionnaires. We applied the χ2 test to examine the trends of alcohol and tobacco consumption among Chinese women over the period of 2004 to 2011. We conducted two penalized logistic regressions with age as the continuous and classification variable (18–23, 24–29, 30–44, and 45–49 years), and independent variables included residence, age, and marital status. Results: Drinking rates among Chinese women significantly changed over the period of 2004 to 2011 (p = 0.018). Age was related to tobacco consumption rates for 2009 and 2011 (p < 0.05). Marital status was associated with tobacco consumption rates for 2004, 2009, and 2011 (p < 0.05). Tobacco and alcohol consumption rates from 2004 to 2011 were positively correlated (p < 0.05). Over the period of 2004 to 2011, alcohol consumption rates were higher among women living in urban areas than those among women living in rural areas (p < 0.05). High educational attainment was related to alcohol consumption. Educational attainment levels of secondary or primary schooling and university or above were related to alcohol consumption rates for 2004 to 2011 (p < 0.05). Employed women were more likely to consume alcohol than unemployed women in 2004, 2006, and 2011 (p < 0.05). Data from 2004 to 2011 showed that tobacco and alcohol use were correlated (p < 0.05) and that women aged 45–49 years old were more likely to consume tobacco than other women (p < 0.05); Conclusions: The drinking behavior of Chinese women changed considerably over the period of 2004 to 2011. Our results provide further insight on the smoking and drinking behaviors of Chinese women at different reproductive stages and the factors that influence such behaviors. Therefore, our findings on trends and factors that influence rates of tobacco and alcohol use allow for a better understanding of the smoking and drinking behaviors of Chinese women.

Study protocol testing toolkit versus usual care for implementation of screening, brief intervention, referral to treatment in hospitals: a phased cluster randomized approach

BackgroundAlarming rates of unhealthy alcohol, non-prescription drug, and tobacco use highlight the preventable health risks of substance abuse and the urgent need to activate clinicians to recognize and treat risky use. Screening, brief intervention, and referral to treatment (SBIRT) is an efficacious and effective processes to identify, reduce and prevent risky use of substances. This paper describes a study protocol testing implementation of a toolkit to enhance use of SBIRT in acute care settings to recognize and address patient risky alcohol, drug, and tobacco use.MethodsThis study uses a phased cluster randomized mixed method design to test nurse-led implementation of an SBIRT toolkit on one medical-surgical unit at 14 acute care hospitals (critical access, community and academic health centers). Medical surgical units will be randomly assigned to implement the SBIRT toolkit (engagement and communication, assessment, planning, training, and evaluation tools) or a wait-list usual care control group that begins implementation 6 months later. Primary endpoints are documentation of SBIRT delivery in randomly selected electronic medical records at baseline, 6 months and 12 months after group 1 implementation (61 records per unit per time period, N = 2562). Two surveys will be administered to unit nurses: smoking cessation activities will be assessed at baseline and SBIRT use will be assessed on randomly-selected days after implementation. In addition, site coordinators will complete a baseline capacity assessment, an implementation fidelity survey post-implementation, and a structured interview at the end of the study. Multilevel mixed-effects effects logistic and linear models will be used to analyze use of SBIRT and cost outcomes.DiscussionThis study will guide subsequent SBIRT implementation, dissemination, and spread across rural, community and urban healthcare systems throughout the state and beyond. The long-term objective is to activate clinicians to recognize, intervene and refer people with risky substance use to improve health and decrease substance use disorders.Trial registration ClinicalTrials.gov NCT03560076

604. Impact of Substance and Alcohol Abuse on Smoking-Related Behaviors When Using a Smoking Cessation Decisional Algorithm Among People Living with HIV (PLWH)

BackgroundCompared with the general population, PLWH have higher rates of tobacco use. We performed a prospective single-arm pilot study of the real-world feasibility of integrating an ambulatory smoking cessation decisional algorithm in our HIV clinic. We hypothesized that patients with drug and alcohol abuse would have a smaller change in smoking related behaviors.MethodsParticipants were PLWH attending our clinic and smoking at least 5 cigarettes/day regardless of their motivation to quit (N = 60). Each participant had an initial visit and two phone visits (+1 and +3 months). Participants completed surveys via computer during the first visit and by phone in the follow-ups. Additional clinical data were collected via chart review.ResultsParticipants had a mean age of 48, were mostly African-American (72%) and male (67%) with well-controlled HIV (mean CD4 622, undetectable viral load in 70%). The mean AUDIT score to assess for alcohol abuse did not change over the. three time points (7.1;7.2;7.6, median 4;5;5). A score of 8 or higher indicates harmful alcohol consumption and 23% of patients met the criteria. Lifetime self-reported treatment for substance abuse was high (35%). DAST score for assessing substance abuse was used and mean scores decreased slightly over time (2.3;1.2;0.93, median 2;0;0). A score of 6 or higher indicates a substance use disorder and 15% met that criterion at baseline, 3% at 3 months. Chart review had similar results with 18% having a diagnosis of substance abuse and 20% with alcohol abuse. Overall participants (n = 60) showed a decrease in tobacco use, with an average of 14 cigarettes/day at baseline and 7 cigarettes/day at 3 months (P = 0.001). Patients with a diagnosis of substance abuse had a baseline average of 12 cigarettes/day and 6 cigarettes/day at 3 months (reduction 6). For those with an alcohol abuse diagnosis, baseline was 16 cigarettes/day and at 3 months, 10 cigarettes/day (reduction 6). The change over time was not significantly different between the groups.ConclusionPeople living with HIV who smoke are a complex group of patients who commonly have concurrent or historical substance and alcohol abuse. A substance and alcohol abuse diagnosis did not impact the decrease in tobacco use seen with implementation of a decisional algorithm.Disclosures All authors: No reported disclosures.

Financial IncEntives for Smoking TreAtment: protocol of the FIESTA trial and FIESTA Oral Microbiome Substudy

BackgroundSmoking is the leading preventable cause of death in the United States, but evidence-based smoking cessation therapy is underutilized. Financial incentive strategies represent an innovative approach for increasing the use of counseling and pharmacotherapy. If effective, they could supplement or supplant resource-intensive policy options, particularly in populations for whom smoking has substantial societal costs. FIESTA (Financial IncEntives for Smoking TreAtment) will randomize hospitalized smokers to receive usual smoking cessation care alone or usual smoking care augmented with financial incentives. We aim to compare the impact of these two strategies on 1) smoking abstinence, 2) use of counseling and nicotine replacement therapy, and 3) quality of life of participants. We also will evaluate the short-term and long-term return on the investment of incentives. The FIESTA Oral Microbiome Substudy will compare the oral microbiome of smokers and nonsmokers to longitudinally assess whether smoking cessation changes oral microbiome composition.MethodsWe will enroll 182 inpatient participants from the Manhattan campus of the Veterans Affairs New York Harbor Healthcare System. All participants receive enhanced usual care, including screening for tobacco use, counseling while hospitalized, access to nicotine replacement therapy, and referral to a state Quitline. Patients in the financial incentive arm receive enhanced usual care and up to $550 for participating in the New York Smoker’s Quitline, using nicotine replacement therapy (NRT), and achieving biochemically confirmed smoking cessation at 2 months and 6 months. In the microbiome substudy, we enroll nonsmoking control participants matched to each recruited smoker’s hospital ward, sex, age, diabetes status, and antibiotic use. After discharge, participants are asked to complete periodic phone interviews at 2 weeks, 2 months, 6 months, and 12 months and provide expired carbon monoxide and saliva samples at 2 months, 6 months, and 12 months for cotinine testing and oral microbiome analysis.DiscussionThe incentive interventions of FIESTA may benefit hospitalized smokers, an objective made all the more critical because smoking rates among hospitalized patients are higher than those in the general population. Moreover, the focus of FIESTA on evidence-based therapy and bioconfirmed smoking cessation can help guide policy efforts to reduce smoking-related healthcare costs in populations with high rates of tobacco use and costly illnesses.Trial registrationClinicalTrials.gov, NCT02506829. Registered on 1 July 2014.

Predicting smokeless tobacco initiation and re-initiation in the United States Air Force

IntroductionActive Duty United States Air Force (USAF) members have substantially higher rates of smokeless tobacco (ST) use than the general population. MethodsWe longitudinally assessed demographics, tobacco use, intrapersonal factors, and interpersonal factors to determine associations with the initiation or re-initiation of ST in the year following a period of forced abstinence among 2188 newly recruited Airmen. Logistic regression analyses were conducted to examine associations between baseline predictors and ST use at one-year follow-up. ResultsIn the final multivariate models compared to never users, the strongest predictors of ST use initiation after BMT were male gender (adjusted OR 8.93, 95% CI 3.82, 20.88), pre-BMT cigarette and cigar use (adjusted OR 1.60, 95% CI 1.00, 2.57; adjusted OR 2.50, 95% CI 1.66, 3.81 respectively). Compared to former ST users, the strongest predictors of re-initiation were male gender (adjusted OR 10.68, 95% CI 2.25, 50.62) and intentions to use ST (adjusted OR 2.10, 95% CI 1.42, 3.12). Compared to initiators of ST, the strongest predictors of re-initiation were intentions to use ST and peer use (adjusted OR 3.26, 95% CI 1.94, 5.49; OR 2.55, 95% CI 1.92, 3.41 respectively). ConclusionsOur results suggest that initiators may be exploring and viewing ST as a less harmful alternative to cigarette smoking and ST users reporting intentions to use ST in the future often return to use. The development of interventions able to disrupt the link between intentions to use tobacco and future tobacco use in the USAF is vital.

Prevalence and Correlates of Electronic Cigarette Use Among a Clinical Sample of Polysubstance Users in Kentucky: Long Live the Cigarette?

Background: E-cigarette use has increased in the US, yet, in some regions rates of cigarette use remain high. Purpose: To describe the prevalence and features of lifetime and past-year e-cigarette use among a clinical sample of polysubstance users in Kentucky, and to determine significant associations of past-year e-cigarette use. Results: Of the final sample (N = 497), 83.5% reported having ever used e-cigarettes and 97.2% reported having ever used cigarettes. These rates surpass those found among Kentucky’s general population. Compared to those who did not report e-cigarette use, e-cigarette users were more likely to be younger ( = 33.4 vs. 43.6, p<.001) and White (88.2.1% vs. 62.5%, p = .001). E-cigarette users showed higher rates for lifetime incarceration (91.1% vs. 72.8%, p = .001) and past-year arrest (75.0% vs. 47.5%, p = .001). This group also presented with more severe substance use history and lower mean age for illicit drug use initiation ( = 13.8 vs. 16.4, p = .001). Approximately 65% of the sample reported past-year e-cigarette use and 96.6% reported past-year cigarette use. Logistic regression indicated that being younger (AOR = .973, p = .030), White (AOR = 1.92, .046), having a past-year arrest (AOR = 1.73, p = .047) and having used cigarettes (AOR = 8.93, p = .001) or kratom (AOR = 3.04, p = .025) within the past year were significantly associated with past-year e-cigarette use. Conclusions: E-cigarette use was related to more severe drug-using patterns. Rates of dual tobacco use among this sample are high, particularly among younger individuals. In ecological contexts where cigarette use remains normative, it is likely that dual use will persist for nicotine-dependent, polysubstance-using individuals.

Chronic Disease Burden of the Homeless: A Descriptive Study of Student-Run Free Clinics in Tampa, Florida.

Variation between homeless populations due to socioeconomic and environmental factors necessitates tailoring medical, health policy, and public health interventions to the unique needs of the homeless population served. Despite the relatively large size of the homeless population in Florida, there is a paucity of research that characterizes the homeless population who frequent homeless clinics within the state. This project describes the demographics, disease prevalence, and other risk factors among homeless individuals in Tampa, Florida. We conducted a retrospective chart review on adult homeless patients seen in 2015 and 2016 at two free clinic sites operated by Tampa Bay Street Medicine, a medical student-run organization from the University of South Florida in Tampa, Florida. Rates of diseases and substance use were recorded and Charlson Comorbidity Index (CCI) was calculated to assess mortality risk. Of the 183 homeless patients in this study, 34.4% reported hypertension, 13.7% reported diabetes, 27.1% reported a respiratory disease, 5.6% reported hyperlipidemia, and 32.8% reported a psychiatric disorder. Tobacco use was reported by 65.6% of patients, 32.2% reported alcohol use, and 17.5% reported illicit drug use. CCI was positively associated with age. Females reported higher rates of anemia, anxiety, chronic obstructive pulmonary disease, and psychiatric disorders. Hypertension, diabetes, certain respiratory diseases, and mental health disorders were more prevalent in the homeless population than in the general population in Tampa, Florida. Homeless women appeared to have higher morbidity than homeless men. Rates of tobacco and illicit drug use were significantly higher whereas alcohol use was lower in the study population than the general population. This study underscores the critical need for mental health initiatives, substance abuse treatment programs, and women's health programs that are accessible to the homeless in Tampa.

Outpatient Surgical Management for Acquired Buried Penis

To demonstrate the safety and feasibility of outpatient surgical management for patients with acquired buried penis (ABP). We conducted an Institutional Review Board approved review of patients who underwent surgical repair of ABP at a single institution from September 2014 to August 2017. Patient characteristics, operative details, and 30- and 90-day complications were assessed. Sixteen patients underwent surgical repair of ABP at the University of Kentucky during the study period. Mean age was 54 years (range 44-62). Median body mass index (BMI) was 47.7 (range 25.5-53.3). Patients largely underwent penile liberation, escutcheonectomy, and split thickness skin grafting. Concurrent scrotoplasty and urethroplasty were performed in select cases. The majority of patients 10/16 (62.5%) were discharged on the same day of surgery, while the remaining 6/16 (37.5%) were outpatient extended stay-and were discharged on postoperative day 1. The 30- and 90-day complications were 19% and 25% respectively, all were Clavien II. Split thickness skin graft take was 100%, and technical success was achieved in all patients. Patients with complications had higher BMIs, higher rates of diabetes, and higher rates of tobacco use, though only BMI reached statistical significance (P = .0150, P = .5846, and P = .0632) respectively. Multi component repair of adult ABP can be safely done on an outpatient basis without need for routine inpatient admission and complex algorithms. The most common complication is surgical site infection, which arose in the first 30 days postoperatively. Higher BMI was a significant risk factor for complications.

The Relationship Between Tobacco Use and Legal Document Gender-Marker Change, Hormone Use, and Gender-Affirming Surgery in a United States Sample of Trans-Feminine and Trans-Masculine Individuals: Implications for Cardiovascular Health.

Transgender individuals smoke tobacco at disproportionately higher rates than the general U.S. population, and concurrent use of gender-affirming hormones (estrogen or testosterone) and tobacco confers greater cardiovascular (CV) risk. This study examines the relationship between tobacco use and legal document gender-marker change, and medical/surgical interventions for gender transition. Data came from an Internet-based survey of U.S. trans-feminine (n = 631) and trans-masculine (n = 473) individuals. We used multivariable logistic regression to investigate the relationship between past 3-month tobacco use and legal document gender-marker change, hormone use, and gender-affirming surgery controlling for demographic covariates and enacted and felt stigma. Compared to trans-feminine participants, trans-masculine individuals reported significantly higher rates of lifetime (74.4% vs. 63.5%) and past 3-month tobacco use (47.8% vs. 36.1%), and began smoking at an earlier age (14.5 vs. 15.5 years). Trans-feminine smokers reported significantly more frequent and heavier use. Adjusting for demographic covariates and enacted and felt stigma, legal document gender-marker change was associated with lower tobacco-use odds among trans-feminine individuals, whereas gender-affirming surgery predicted lower smoking odds among trans-masculine individuals. There were no significant differences in tobacco use by hormone use status. In this study, trans-masculine individuals were more likely to smoke and trans-feminine individuals reported heavier use. It is concerning that individuals receiving hormones did not report lower smoking rates, given the elevated CV risk of this combination. This is a missed opportunity to intervene on a major public health issue and highlights the need for smoking cessation interventions in this population.