Rates Of Tobacco Use Research Articles

The role of sexual identity in tobacco information–seeking behaviours and perceptions

Objective: To explore differences in tobacco information–seeking behaviours and perceptions between sexual minority and heterosexual (or ‘straight’) adults and to determine if these differences are mediated by tobacco use. Design: Cross-sectional national survey. Setting: Nationally representative probability-based surveys of adults 18 years of age or older in the US civilian non-institutionalised population. Methods: Data from respondents identifying as gay, lesbian, bisexual (LGB; n = 156) or straight ( n = 4,964) in the US National Cancer Institute’s Health Information National Trends Survey Food and Drug Administration cycles 1 and 2 (HINTS-FDA 2015, 2017) were analysed. We compared the responses of sexual minority and straight respondents aged 18 years and older concerning tobacco information-seeking behaviours and perceptions. Results: Sexual minority respondents were more likely than their straight counterparts to seek out tobacco health information, to look for information about e-cigarettes and to use the Internet for health information searches. Some of these differences were mediated by tobacco use. Sexual minority respondents were similar to their straight counterparts regarding perceptions of trust and confidence in tobacco health information, as well as perceptions of the hazards of tobacco use. Conclusion: Because sexual minority adults have higher rates of tobacco use and higher rates of tobacco information seeking than others, tobacco health information campaigns should consider carefully tailoring the messages directed towards sexual minority populations.

Tibia fractures and NSAIDs. Does it make a difference? A multicenter retrospective study

PurposeThe purpose of this study was to compare healing time for diaphyseal tibia fractures (OTA/AO 42 A, B, C) treated with intramedullary nailing (IMN) in one geographic cohort using nonsteroidal anti-inflammatory drugs (NSAIDs) for post-operative pain control to that of another geographic cohort using opioid medications. The groups represent differing cultural approaches to post-operative pain control. We hypothesized there would be no difference in healing time. MethodsTibia fractures presenting at two level I trauma centers located in different countries between January 1, 2010 and December 31, 2017 were retrospectively screened for enrollment. Fractures classified as OTA/AO 42 A, B, or C that were treated with IMN and had radiographic follow up to union were included. At hospital discharge, one cohort (n = 190) was prescribed NSAIDs and the other (n = 182) was prescribed opioids for pain control. Each analgesic method represented the standard of care for that location. Fracture union was defined as cortical bridging in at least 3 out of 4 cortices on AP and lateral radiographs. The primary outcome was healing time on radiographic evaluation. ResultsThere was no statistically significant difference in healing time between the opioid and NSAID groups: 185 vs 180.5 days respectively (p = 0.64). Both groups had similar mean age. Student t-tests were run to compare rates of tobacco use, diabetes mellitus (DM), open fractures, and polytrauma between the two groups. The opioid cohort had statistically significant higher rates of tobacco use, DM, and polytrauma. The NSAID cohort, however, had a larger number of open fractures. ConclusionThe difference in healing time between the NSAID and opioid groups was not statistically significant. The deleterious effect of NSAID use on fracture healing has been debated for decades. Numerous animal studies have supported this theory; however, high quality clinical studies in humans have not provided convincing evidence to substantiate this negative effect. Our study suggests that NSAIDs may be used safely and effectively in the acute phase of fracture healing without significantly increasing the risk of delayed union or nonunion. Prospective randomized studies are necessary to rule out the negative effect of NSAIDS on bone healing.

Opioid misuse and perceived smoking-pain relationships among HIV+ individuals with pain: Exploring negative affect responses to pain

Persons living with HIV/AIDS (PLWHA) report high rates of clinically significant pain that is associated with several negative outcomes, including higher CD4 T-cell count, poor medication adherence, and substance use and misuse. Importantly, PLWHA also report elevated rates of both opioid and tobacco use, and these elevated rates have often been associated with increased pain experience. Although research suggests that negative affective responses to pain may be uniquely associated with substance misuse among individuals in the general population, little work has examined these relations among PLWHA. The current study examined negative emotions in response to pain as a predictor of current opioid misuse, future opioid misuse, and perceived smoking-pain relationships among 66 (Mage = 51.26, SD = 8.00, 60.6% male) HIV+ adults with co-occurring pain. Results indicated that negative emotions in response to pain uniquely predicted each of the substance use outcomes, with clinically significant effect sizes that may be characterized as medium in magnitude. Overall, these findings suggest that negative affective responses to pain may play a role in prescription opioid misuse and smoking among PLWHA. These findings may inform the development of tailored interventions for PLWHA smokers who are prescribed opioid pain medications.

Maternal and neonatal characteristics of a Canadian urban cohort receiving treatment for opioid use disorder during pregnancy.

The epidemic of prescription and non-prescription opioid misuse is of particular importance in pregnancy. The Society of Obstetricians and Gynaecologists of Canada currently recommends opioid replacement therapy with methadone or buprenorphine for opioid-dependent women during pregnancy. This vulnerable segment of the population has been shown to be at increased risk of blood-borne infectious diseases, nutritional insecurity and stress. The objective of this study was to describe an urban cohort of pregnant women on opioid replacement therapy and to evaluate potential effects on the fetus. A retrospective chart review of all women on opioid replacement therapy and their infants who delivered at The Ottawa Hospital General and Civic campuses between January 1, 2013 and March 24, 2017 was conducted. Data were collected on maternal characteristics, pregnancy outcomes, neonatal outcomes and corresponding placental pathology. Maternal comorbidities identified included high rates of infection, tobacco use and illicit substance use, as well as increased rates of placental abruption compared with national averages. Compared with national baseline averages, the mean neonatal birth weight was low, and the incidence of small for gestational age infants and congenital anomalies was high. The incidence of NAS was comparable with estimates from other studies of similar cohorts. Findings support existing literature that calls for a comprehensive interdisciplinary risk reduction approach including dietary, social, domestic, psychological and other supports to care for opioid-dependent women in pregnancy.

Patterns and Profiles of Adolescent Tobacco Users: Results From the Virginia Youth Survey

BackgroundCigarette smoking has decreased to a record low among youth across the United States, including in Virginia. Rates of alternative tobacco use, however, are rising and polytobacco use is common. A better understanding of the shifting use patterns and associated risk factors is important for informing tobacco prevention, cessation, and policy efforts.MethodsWeighted data from the 2013 Virginia Youth Survey were used. The sample was limited to 1168 youth who reported past 30-day tobacco use of ≥1 product (cigarettes, smokeless tobacco [smokeless], or cigars/little cigars/cigarillos [cigars]). Latent class analysis categorized individuals based on current tobacco use frequency/intensity. Multivariable multinomial logistic regressions compared classes on demographics, other tobacco-related factors, other substance use, and health/psychosocial factors.ResultsThe five-class model indicated the best fit with classes characterized as “Chippers” (28.0%; high probability of low-frequency/intensity cigarette use), “Moderate Poly-Users” (23.6%; low- to high-frequency/moderate intensity cigarette use; moderate probability smokeless/cigar use), “Cigar Users” (20.9%; no–low-probability cigarette/smokeless use; high-probability cigar use), “Smokeless Users” (17.3%; no–low-probability cigarette/cigar use; moderate–high-probability smokeless use), and “Heavy Poly-Users” (10.4%; daily/high-intensity cigarette use, moderate–high-probability smokeless/cigar use). Classes differed significantly by demographics and inconsistently by other tobacco-related factors. Heavy Poly-Users were more likely to engage in other substance use behaviors, report suicidal ideation, and report being bullied because of gender.ConclusionsClasses identified indicate that a large proportion of youth engage in polytobacco use and certain subgroups may be at greater risk for negative health consequences due to elevated psychosocial and behavioral risk factors.ImplicationsThese findings suggest distinct patterns of current tobacco use, including a high proportion of youth engaging in polytobacco use. Heavy polytobacco use co-occurs with other health risk behaviors and may be attributed to psychosocial risk factors. Results underscore the need for detailed monitoring of shifting youth tobacco use patterns as well as targeted prevention, cessation, and policy efforts.

Disparities in Cardiovascular Risk Factors in Northern Plains American Indians Undergoing Coronary Artery Bypass Grafting.

Objectives: Heart disease is the leading cause of death in American Indians (AIs). For AI patients with severe coronary artery disease requiring coronary artery bypass graft (CABG) surgery, little data exist. The purpose of this study was to evaluate short-term outcomes of Northern Plains AI undergoing CABG and identify variations in patient presentation.Methods: All patients undergoing isolated CABG between June 2012 and June 2017 were studied. Seventy-four AI and 1236 non-American Indian (non-AI) patients were identified. Risk factors, preoperative characteristics, cardiac status, procedural information, and outcomes were collected. Univariate analysis comparing short-term clinical outcomes between AI and non-AI populations was performed. Multivariable logistic regression models were constructed and outcome differences assessed. Unadjusted Kaplan–Meier survival estimates were produced using 5-year survival data.Results: AI patients presented with increased risk factors, including higher rates of diabetes mellitus (AI 63.5% vs. non-AI 38.7% p=< 0.001) and smoking/tobacco use (AI 60.8% vs. non-AI 20.0% p=> 0.001). Seventy-nine percent of AI patients resided on or near federal reservations and presented from rural locations. Internal mammary artery (IMA) graft use in both groups was high (AI 95.9% vs. non-AI 94.9% p=0.904), and multiarterial grafting with left internal mammary artery and radial artery use was common in both groups (AI 67.6% vs. non-AI 69.6% p=0.814). No significant differences in unadjusted 30-day mortality or short-term outcomes were detected. Adjusted Kaplan–Meier survival curves were similar between race groups up through 5 years after CABG (p-value=0.38).Conclusion: AIs presented with significantly more risk factors for cardiovascular disease compared with the general population, with especially high rates of insulin-dependent diabetes and active tobacco use. Despite this, outcomes were similar between groups. In propensity-matched groups, AIs were at decreased risk for prolonged length of stay and combined morbidity/mortality. In contrast to previous reports, AI racial identity did not adversely affect survival up to 5 years after CABG.

Exposure to community and collective violence during childhood and tobacco use patterns among young adults in Tunisia.

Accumulating evidence demonstrates that experiencing intrafamilial adversities (abuse, neglect and household dysfunction) during childhood is linked to addictive behaviours. However, the impact of social adversities (peer, community and collective violence) as well as gender, on tobacco initiation and dependence has received much less attention. The aim of this study was to examine the relationships between social childhood adversities and tobacco use patterns by gender among young adults in Tunisia. We performed a cross-sectional study from May to December, 2014 on 1,200 respondents using the validated Arabic version of the World Health Organization Adverse Childhood Experiences-International questionnaire (WHO ACE-IQ). Data on smoking characteristics among current smokers were also collected. Data analysis was performed using logistic and linear regression models. The rate of current tobacco use was significantly higher for males (43.9%) than for females (9.3%). Female and male respondents differed significantly on almost every examined adversity. Males were more likely to have experienced all types of social violence than females. The odds of tobacco use were significantly higher regardless the mental health status and the occurrence of intrafamilial early life adversity for both genders. Smokers exposed to social violence during childhood had a strong association between nicotine dependence and the overall burden of adversity. That is, 74 and 58% of nicotine dependence was explained by the number of childhood social adversities in females and males respectively. The findings underscore the role of community and collective violence in addictive behaviours among young adults. Multisectorial and population-based strategies are needed to minimise the occurrence of social early life adversity and related tobacco patterns.

A Model of Enhanced Primary Care for Patients with Severe Mental Illness.

Life expectancy and other outcomes for patients with serious mental illness (SMI) are unacceptably poor, largely due to a high prevalence of poorly controlled chronic diseases, high rates of tobacco use, and low rates of preventive care services. Since many of these illnesses are effectively treated in primary care settings, integrating primary care with behavioral health care is necessary to narrow health disparities for patients with SMI.

Associations between History of Hospitalization for Violence Victimization and Substance-Use Patterns among Adolescents: A 2017 Korean National Representative Survey.

Violence victimization can adversely affect adolescents’ long-term health. Existing research has mainly focused on the link between victimization and substance use; however, the evidence obtained to date has been inconsistent. This study, using a Korean national representative sample, examined the association between violence victimization and substance-use patterns (including tobacco, alcohol, and drug use) in terms of sex and number of violence victimization experiences. We analyzed secondary data from the 2017 Korean Youth Risk Behavior Web-based Survey. Chi-squared test analyses and logistic regression analysis were used to examine substance use in terms of violence victimization; additionally, p-values for trends were calculated to reveal the dose-response relationship per number of violence victimization experiences. We consequently found that participants’ rates of tobacco, alcohol, and drug use were higher among those who experienced violence victimization than among those who did not. For each substance-use-related variable, the greater the violence victimization experience, the higher the odds of substance use (p for trend < 0.001). Early intervention may help prevent the development of substance use, especially among adolescents who have experienced violence victimization. Prevention efforts regarding substance abuse and violence prevention should be included in school curricula to effectively prevent adverse health consequences among adolescents.

Mental and Physical Health Disparities in Patients With Carpal Tunnel Syndrome Living With High Levels of Social Deprivation

Social, mental, and physical health have a complex interrelationship with each influencing individuals' overall health experience. Social circumstances have been shown to influence symptom intensity and magnitude of disability for a variety of medical conditions. We tested the null hypothesis that social deprivation would not impact Patient-Reported Outcomes Measurement Information System (PROMIS) scores or objective health factors in patients presenting for treatment of carpal tunnel syndrome (CTS). This cross-sectional study analyzed data from 367 patients who presented for evaluation of CTS to 1 of 6 hand surgeons at a tertiary academic center between August 1, 2016, and June 30, 2017. Patients completed PROMIS Physical Function-v1.2, Pain Interference-v1.1, Depression-v1.0, and Anxiety-v1.0 Computer Adaptive Tests. The Area Deprivation Index was used to quantify social deprivation. Medical record review determined duration of symptoms, tobacco and opioid use, and the Charlson Comorbidity Index (CCI) for each patient. Sample demographics, PROMIS scores, and objective health measures were compared in groups defined by national quartiles of social deprivation. Patients with CTS living in the most deprived quartile had worse mean scores across all 4 PROMIS domains compared with those living in the least deprived quartile. A higher proportion of individuals from the most deprived quartile had a heightened level of anxiety than those in the least deprived quartile (37.3% vs 12.6%). The mean CCI was higher in the most deprived quartile, as was the proportion of individuals using tobacco. There were no differences in opioid use or symptom duration between patients from each deprivation quartile. Social deprivation is associated with worse patient-reported health measures in patients with CTS. Compared with those from the least deprived areas, patients from the most deprived areas also have a greater comorbidity burden and higher rates of tobacco use at presentation to a hand surgeon. Prognostic II.

A Conceptual Framework for Understanding Multiple Tobacco Product Use and the Impact of Regulatory Action.

Over 35% of the adult tobacco-using population regularly use more than one tobacco product. Although rates of tobacco use in the United States have declined over the last decade, rates of multiple tobacco product (MTP) have either remained stable (among adults) or increased (among youth). In this paper, we review the literature and propose a framework for understanding both MTP use and how regulatory actions on any single tobacco product (STP) may influence the use of other tobacco products. Within the framework, Product, Person, and Context/Situational factors (and their interactions) influence product cross-substitution and thus patterns of use of MTPs. In addition, we propose that Context/Situation effects specifically increase the complexity of MTP-use patterns resulting in "dynamic complementarity" in addition to substitution-like relationships between tobacco products. Experimentation with, and use of, various tobacco products results in reinforcement histories that affect which products are used, in what contexts, and by whom, which in turn has downstream impacts on toxicant exposure and health. We conclude our analysis with an examination of how regulation of STPs can have impacts on the use of other STP and MTP use and provide research questions for further examining MTP use. Though rates of tobacco use have declined in the United States, over 35% of the adult tobacco-using population regularly uses more than one tobacco product. This paper provides a framework for understanding MTP use and how regulatory actions on any STP may influence the use of other tobacco products. We conclude our analysis by providing research questions for further examining MTP use.

Prevalence of Smoking among Men in Ethiopia and Kenya: A Cross-Sectional Study.

While tobacco use remains the largest single cause of premature death in the industrialized countries, low-and-middle income countries are also experiencing a rising burden of the tobacco epidemic and are making various programmatic efforts to tackle the issue. Evidence-based policy making is critical to the long-term success of tobacco intervention programs and is reliant on regular monitoring of the trends and prevalence rates of tobacco use though population-based surveys, which are sparse for countries in eastern Africa. Therefore, in the present study we aimed to (1) estimate the trends in the prevalence of self-reported smoking status; and (2) explore the sociodemographic factors associated with smoking among adult men in Ethiopia and Kenya. Methods: Subjects were 26,919 adult men aged between 15 and 59 years from Ethiopia and Kenya. Nationally representative cross-sectional data on self-reported smoking and relevant sociodemographic indicators were collected from the Demographic and Health Surveys (DHS) conducted in these two countries. Data analysis was performed by descriptive, bivariate, and multivariable methods. Results: In Ethiopia, the prevalence rate of smoking increased from 8.5% in 2005 to 11.7% in 2011. While in Kenya, the rate declined albeit slowly from 22.9% in 2003 to 18.8% in 2008–2009 and 17% in 2014. The prevalence was significantly different in urban and rural areas. In majority of the surveys, prevalence of smoking was highest in the age group of 25–34 years. The prevalence of smoking varied widely across several socioeconomic characteristics. Conclusions: The findings indicate a high rate of smoking among men especially in urban areas, and call for policy actions to address the socioeconomic factors as a part of the policy to strengthen tobacco-control efforts.

Prevalence of tobacco use and perceptions of student health professionals about cessation training: results from Global Health Professions Students Survey

IntroductionHealth professionals play an important role in providing advice to their patients about tobacco prevention and cessation. Health professionals who use tobacco may be deterred from providing cessation advice and...

Tobacco-Free Policies and Tobacco Cessation Systems at Health Centers Serving Lesbian, Gay, Bisexual, and Transgender Clients.

LGBT populations have high rates of tobacco use. Health centers serving LGBT clients are an important source of care. The researchers aimed to assess the implementation of recommended systems-level tobacco cessation interventions at these health centers. Using systematic searching, directories, and expert review, we identified health centers serving LGBT clients that provide primary care. We conducted phone-based, semi-structured interviews with administrators (n = 11) between September 2016 and March 2017 regarding implementation of the Clinical Practice Guideline, Treating Tobacco Use and Dependence: 2008 Update (the Guideline). Two authors confirmed saturation and two authors conducted thematic coding. Eight themes were identified, including clear evidence of systems-level procedures for asking about, advising on, and assessing tobacco use. Interviewees viewed tobacco use as important given existing disparities. However, there was room for improvement in the following areas: (1) Education for staff on tobacco cessation was ad hoc and not formalized; (2) materials and resources for tobacco cessation available in the center varied widely and changed when a staff champion arrived or left; (3) no point person was assigned to coordinate tobacco cessation efforts; and, (4) assessment of tobacco use as a vital sign is not consistent-some centers met meaningful use quality metrics (e.g., once or more in the past 24 months) instead of the Guideline recommendation (every visit). Addressing tobacco use competes with addressing other health risk behaviors. Administrators at health centers serving LGBT clients viewed tobacco use as an important issue. However, there was room for improvement in implementation of systems recommended in the Guideline. Targeted outreach is warranted to improve standardization of implementation and promote cessation of tobacco use.

Proactive Tobacco Treatment for Smokers Using Veterans Administration Mental Health Clinics

Veterans with a mental health diagnosis have high rates of tobacco use but encounter low rates of treatment from providers. This study tested whether a proactive tobacco treatment approach increases treatment engagement and abstinence rates in Department of Veterans Affairs mental health patients. RCT. The study was performed from 2013 to 2017 and analyses were conducted in 2017. Investigators used the electronic medical record at four Veterans Administration facilities to identify patients documented as current smokers and who had a mental health clinic visit in the past 12 months. Patients were mailed an introductory letter and baseline survey. Survey respondents were enrolled and randomized to intervention (n=969) or control (n=969). Control participants received a list of usual Veterans Administration smoking services. Intervention participants received a motivational outreach call, multisession telephone counseling, and assistance with obtaining nicotine replacement therapy. Participants completed surveys at baseline, 6 months, and 12 months after randomization. The primary outcome was self-reported 7-day abstinence from cigarettes at 12-month follow-up. Secondary outcomes included use of cessation treatment, self-reported 7-day abstinence at 6-month follow-up, and 6-month prolonged abstinence at 12-month follow-up. At 12 months, intervention participants were more likely to report using telephone counseling (19% vs 3%, OR=7.34, 95% CI=4.59, 11.74), nicotine replacement therapy (47% vs 35%, OR=1.63, 95% CI=1.31, 2.03), or both counseling and nicotine replacement therapy (16% vs 2%, OR=11.93, 95% CI=6.34, 22.47). Intervention participants were more likely to report 7-day abstinence (19% vs 14%, OR=1.50, 95% CI=1.12, 2.01) and prolonged 6-month abstinence (16% vs 9%, OR=1.87, 95% CI=1.34, 2.61). After adjusting for non-ignorable missingness at follow-up, the intervention effects on 7-day and prolonged abstinence remained significant (p<0.05). Proactive outreach was more effective than usual Veterans Administration care at increasing treatment engagement and long-term abstinence in mental health patients. This study is registered at www.clinicaltrials.gov NCT01737281.

Low rates of alcohol and tobacco use, strong cultural ties for Native American college students in the Southwest

IntroductionCollege attendance is associated with an increased risk for substance use yet we know little about substance use among Native American college students and its regional variation. This study examined alcohol, tobacco, and drug use and their relation to gender, institution, age, and cultural involvement among Native American college students in the Southwest. MethodsNative American community college and university students in a large Southwest city (N = 347) completed an online survey about past-month and lifetime substance use and involvement in cultural activities. ResultsCultural involvement was related to less past-month substance use. In the past month, 43% drank alcohol, 27% binge drank, 20% used drugs, and 13% were current smokers. Males, community college students, and older individuals were more likely to have a positive CAGE-AID and have used drugs more than 100 times. Younger individuals were more likely to use marijuana in the past month. ConclusionsThese findings highlight cultural strengths and comparatively low rates of tobacco and alcohol use among Native American college students in the Southwest.

A cross-sectional study on the status of tobacco use among junior middle school students in Shaanxi province

Objective: To understand the rate on tobacco use and associated factors in junior middle school students in Shaanxi province. Methods: We used a multi-stage stratified random sampling method to select students from 30 junior middle schools in 10 areas of Shaanxi province in 2013. All the participants completed a self-administered questionnaire. Results: A total of 4 633 questionnaires were dispatched and 4 298 were qualified for further analysis. The current smoking rate of junior middle school students in Shaanxi was 6.5%, with rate in male (11.1%) higher than that of female students (1.7%). The current smoking rate of students in grade three (9.3%) was higher than those of students in grade one (3.5%) or in grade two (7.0%). The smoking rate of students with pocket money more than 31 Yuan per week was (10.0%) higher than those of students with pocket money less than 10 Yuan (4.6%) or 10-30 Yuan (6.3%) per week. Results from the logistic regression analysis showed that factors as: male, school located in the city, older age, with more pocket money, having smokers in the family and exposure to second hand smoking were high risk factors for current smoking. Conclusion: Rate on current smoking was high in junior middle schools students in Shaanxi, suggesting that comprehensive intervention programs be developed to reduce the rate of tobacco use in junior middle school students.

Conscientiousness and occupational prestige as independent predictors of the change of tobacco use in adulthood

This study investigated the association between childhood intelligence, personality traits, parental social class, maternal smoking, educational qualifications and occupation prestige, and smoking status assessed at different ages. The study was based on a British birth cohort with nine follow-ups. At age 54 years, cohort members provided information on current tobacco use (Yes/No) and the frequency of daily cigarettes smoking. Response of the same questions was also collected four years earlier, at age 50 years. Results showed that among the 5316 participants with complete data, there was a significant (p < 0.001) decrease in the rates of current tobacco use from age 50 to age 54 years (17.9% and 15.0%). Logistic regression analyses showed that, whilst educational qualifications, occupational prestige, and three of the Big-Five personality traits (Extraversion, Conscientiousness, and Openness) were all significant predictors of current smoking status at age 54 years. After controlling for the initial smoking status, measured four years earlier, only trait Conscientiousness and occupational prestige were significant and independent predictors of the outcome variable. Low intelligence predicted smoking status >39 years later, mediated by educational qualifications. Implications and limitations are noted.

Racial and Ethnic Disparities in Hospital Mortality among Ischemic Stroke Patients in Hawaii

We evaluated disparities in in-hospital mortality rates among whites, Native Hawaiians and other Pacific Islanders (NHOPI), Filipinos, and other Asian groups in Hawaii who were hospitalized for acute ischemic stroke. Using a statewide hospital claims database, we performed a retrospective study including sequential acute ischemic stroke patients between 2010 and 2015. We compared in-hospital mortality rates among whites, NHOPI, Filipinos, other Asian groups excluding Filipinos, and other races (Blacks, Hispanics, Native Americans, mixed race). A total of 13,030 patient discharges were included in this study. The mean (±SD) age in years at the time of stroke was 63.5 ± 14.3 for NHOPI, 69.6 ± 14.4 for Filipinos, 67.8 ± 14.2 for other race, 71.4 ± 13.8 for whites, and 76.1 ± 13.5 for other Asians (P < .001). NHOPI patients had higher rates of diabetes (48.8%), obesity (18.4%), and tobacco use (31.3%) compared with patients in other racial-ethnic categories. Filipino patients had the highest rate of hemorrhagic transformation (9.7%). Age-adjusted stroke mortality rates were highest among Filipinos (15.9%; 95% confidence interval [CI] = 14.3%-17.6%), followed by other Asian groups (15.1%; 95% CI = 14.0%-16.2%), NHOPI (14.8%; 95% CI = 12.8%-16.8%), other race (14.4%; 95% CI = 11.3%-17.4%), and lowest among whites (12.8%; 11.5%-14.2%). After adjusting for other confounding variables, Filipinos had higher mortality (odds ratio = 1.22, 95% CI = 1.03-1.45), whereas other Asian groups, NHOPI, and other race patients had mortality rates that were similar to whites. In Hawaii, Filipino ethnicity is an independent risk factor for higher in-hospital stroke mortality compared with whites.

Clinical and molecular characteristics of younger versus older patients with colorectal cancer.

630 Background: Although overall incidence of colorectal cancer is declining, the incidence for young patients (age &lt; 50) with colon cancer is increasing. Reasons for this rise are unclear. Understanding clinical and molecular differences between younger and older cohorts can help guide both patient education strategies and future research into the mechanisms of this phenomenon. Methods: A retrospective analysis of patients diagnosed with colon cancer between 2008 and 2015 who underwent molecular tumor profiling via next-gen sequencing of 26 commonly mutated genes at the University of Colorado. Data collected by chart review includes demographic, pathologic, treatment course, and outcomes. Age group cutoffs for data analysis were set at &lt; 50, 50-65, and &gt; 65 based on screening guidelines and average age of diagnosis Results: We evaluated a total of 242 patients, stage I (n = 1), stage II (n = 65), stage III (n = 68), stage IV (n = 105). Mean age was 59.5 (range 27 to 89). A higher percentage of younger patients were non-smokers (77% of youngest cohort vs 46% of oldest cohort, p &lt; 0.001) and had a non-significant trend towards male gender (youngest cohort 63.8% male, oldest cohort 43.4% male, p = 0.065). Younger patients had similar body mass index (BMI) compared to older patients (BMI 27 vs 25.7, p = 0.35). Younger patients had higher rates of rectal cancer (42% vs 21%, p = 0.01) and lower rates of proximal/right sided colon cancer (20% vs 46.5%, p = 0.014). Younger patients also had lower rates of MSI-H tumors (8% vs 14%, p = 0.01). Finally, younger patients had significantly lower rates of APC (43.1% vs 69.3%, p = 0.009) and BRAF (3.5% vs 19.7%, p = 0.004) mutations. Conclusions: Younger patients ( &lt; 50 years old) with colorectal cancer had lower rates of tobacco use and no difference in obesity rates compared to older patients. In addition, although APC and BRAF mutations were lower in younger patients, there were no mutations that were more prevalent in the young cohort. Therefore, further research into lifestyle factors (specific diet/exercise patterns) or alternative molecular mechanisms are needed.