Regular Tobacco Research Articles

Sex differences in the frequency of gastrointestinal symptoms and olfactory or taste disorders in 1942 nonhospitalized patients with coronavirus disease 2019 (COVID-19).

The coronavirus disease 2019 (COVID 19) is a communicable disease caused by a novel coronavirus. This study aimed to assess self‑reported frequency of gastrointestinal symptoms and olfactory or taste disorders in nonhospitalized patients with COVID‑19 in Poland. This cross‑sectional survey was conducted between April 17 and 18, 2020, in 4516 nonhospitalized patients with COVID‑19 in Poland. The questionnaire included 8 questions related to the health status, symptoms of COVID‑19, comorbidities, and smoking status. Completed questionnaires were obtained from 1942 patients with COVID‑19 with a response rate of 43%. The median age of the respondents was 50 years; 60.2% were women. Among nonhospitalized patients with COVID‑19, 21.3% had hypertension, 4.5% had diabetes, and 3.1% had a chronic respiratory disease. Regular tobacco use was declared by 11.2% of patients with COVID‑19. At least one gastrointestinal symptom was reported by 53.6% of patients. Almost half of patients (47%) with COVID‑19 reported lack of appetite and 24.2% reported diarrhea. Among 1942 interviewed patients, 54.2% reported at least 1 olfactory or taste disorder and 42.5% reported both alterations. Self‑reported olfactory and taste disorders were 49.2% and 47.5%, respectively. Self‑reported frequency of gastrointestinal symptoms and olfactory or taste disorders during COVID‑19 was significantly higher (P <0.001) in women than men. This study demonstrated that olfactory and taste disorders are frequent symptoms in patients with mild‑to‑moderate COVID‑19. Moreover, our study indicated sex differences in the frequency of gastrointestinal symptoms and olfactory or taste disorders among nonhospitalized patients with COVID‑19.

4219 Discrepancies in flavor preferences among adult ever users of various tobacco products in the US – Findings from The Population Assessment of Tobacco and Health Study (2015-2016)

OBJECTIVES/GOALS: Flavorings differ between brands and tobacco products, potentially altering the sensory perceptions. This study aimed to examine discrepancies in flavor preference across various non-cigarette tobacco products among a national representative sample of US adult regular tobacco users. METHODS/STUDY POPULATION: Data from the Population Assessment of Tobacco and Health (PATH) Study Wave 3 (W3) were used. Weighted prevalence of flavor preference for various tobacco products, including electronic nicotine delivery systems (ENDS), traditional cigars, cigarillos/filtered cigars, hookah and snus/smokeless, was presented for 9,037 adult current and new former users of multiple flavored tobacco products. Within-subject flavor discrepancies were assessed using generalized estimating equations (GEE) models considering the complex sampling design of the PATH study. RESULTS/ANTICIPATED RESULTS: Most regular users of a flavored tobacco products reported using one flavor category per product. Fruit flavors, followed by tobacco, were the most common flavor categories among ENDS (32% and 25%, respectively) and hookah users (44% and 36%, respectively). Tobacco flavor was the most common among regular users of traditional cigars (80%), cigarillos/filtered cigars (55%), and smokeless tobacco (79%). Polytobacco users of ENDS and traditional cigars had the largest discrepancy, where about 68-76%% used different flavor categories when switching products. Conversely, polytobacco users of traditional cigars and cigarillos/filtered cigars had the lowest discrepancy (23-25%). DISCUSSION/SIGNIFICANCE OF IMPACT: Many consumers of multiple tobacco products had different flavor preferences when switching between products. In the event of a partial or full flavor ban for ENDS, these findings raise questions about consumer loyalty to a particular tobacco product or a particular flavor category. Conflict of Interest Description: MLG serves as a paid consultant for Johnson &amp; Johnson and has received research grant from Pfizer, manufacturers of smoking cessation medications. The other authors have no conflicts to declare. CONFLICT OF INTEREST DESCRIPTION: MLG serves as a paid consultant for Johnson &amp; Johnson and has received research grant from Pfizer, manufacturers of smoking cessation medications. The other authors have no conflicts to declare.

The Relationship Between Baseball Participation and Health: A Systematic Scoping Review.

To investigate the relationship between baseball participation and health (musculoskeletal, general, and psychological health) and to identify research gaps in the existing literature. Systematic scoping review. Medical databases and gray literature were systematically searched from inception to November 2018. All studies that investigated constructs related to the health of current or former baseball players were included. Data were extracted for thematic summaries. Ten thousand five hundred seventy-four titles/abstracts were screened, and 678 studies were included. Ninety percent of articles included only baseball players playing in the United States, 34% of articles investigated professional baseball players, and 11% studied college baseball players. Five hundred eighty-three (86%) studies investigated musculoskeletal health, 77 (11%) general health, and 18 (3%) psychological health. Injury incidence (injuries per 1000 athlete exposures) ranged from 0.7 to 3.6 in professional, 4.7 to 5.8 in college, and 0.8 to 4.0 in high school baseball. Among baseball players, 31% to 50% reported regular tobacco use. There was limited research investigating psychological health in current or former baseball players at all competition levels. Almost 90% of all articles investigated musculoskeletal health, with few articles studying general or psychological health. Baseball players have high tobacco, alcohol, and drug use compared to the general population, which may have negative health outcomes. Little is understood about the long-term musculoskeletal, general, and psychological health of baseball players. J Orthop Sports Phys Ther 2020;50(2):55-66. doi:10.2519/jospt.2020.9281.

The Good, the Bad and the Ugly: Die Beziehung zwischen sozialer Mediennutzung, subjektiver Gesundheit und Risikoverhalten im Kindes- und Jugendalter

The current generation of young people spends more time using social media than any other age group. So far, not much is known about the consequences of social media use in terms of health and well-being among teenagers in Germany. The aim of the study was to investigate the association between social media use, health and risk behavior using data from a large representative sample for Germany. Data were obtained from the German part of the WHO collaborative study "Health Behavior in School-aged Children (HBSC)" conducted in 2013/14. The analysis is based on 5.094 students aged 11, 13 and 15 years. Social media use was measured with an index based on 5 items. Outcomes were different measures of health and well-being as well as risk behavior. Analyses were conducted using cross tabulations and log-binomial regression models, separately for girls and boys. The results show that a frequent use of social media among girls was linked with poorer self-rated health (OR=1.58, 95%-CI=1.17-2.15) as well as repeated multiple psychosomatic complaints (OR=1.56, 95%-CI=1.22-1.98). For boys, multiple psychosomatic complaints (OR=1.36, 95%-CI=1.03-1.80) and low school satisfaction (OR=1.39, 95%-CI=1.06-1.83) were associated with high social media use. In terms of risk behavior, there was a clear and consistent link between frequent social media use and regular tobacco and alcohol consumption, drunkenness and bullying of classmates, irrespective of gender. The results remained stable after adjusting for age, school type and migration background. A clear association between social media use and various indicators of health and risk-behavior in childhood and adolescence in Germany could be identified. The results provide first indications of possible health-damaging effects of heavy social media use; these need to be confirmed using longitudinal data.

In What Measure Is Public Finance Sustainability Threatened by Illicit Tobacco Trade: The Case of Western Balkan Countries

The aim of this paper is to gain new knowledge about illicit tobacco trade in Western Balkan countries and its effects on public finance sustainability. It includes an estimation of the volume of illicit tobacco trade, identifying and quantifying the key factors that cause illegal tobacco trade, the effects of illegal tobacco trade on public finance sustainability, and the effects on the intensity of total tobacco trade. An empirical analysis was conducted using the data collected by field research on consumer preferences in tobacco products in Western Balkan countries (Bosnia and Herzegovina, Croatia, Kosovo, Macedonia, Montenegro, Serbia, and Slovenia). The reference research period is the year 2018. The results obtained show a high variability of volume of illicit tobacco trade in Western Balkan countries. While more than 20% of tobacco products in Montenegro and Bosnia and Herzegovina are bought on the gray market, a share of illicit tobacco trade lower than 5% is found in Slovenia and Macedonia. Underdeveloped institutional framework fighting against illicit trade and weak rule of law, coupled with the heavy taxation of tobacco products, are the key factors behind a higher intensity of illicit trade in comparison to more developed European Union (EU) economies. Illicit tobacco trade negatively affects the stability of public finance of Western Balkan economies and reduces the level of public service. It is especially important for the health system combating the negative consequences of smoking. Regular and illicit tobacco trade amongst Western Balkan countries is found to flow in opposite directions.

Effectiveness of a School-Based Tobacco Prevention Program for Middle School Students in Saudi Arabia: A Quasi-Experimental Controlled Trial.

Objective:To evaluate the effect of a school-based tobacco program in preventing initiation of tobacco use among adolescents in Saudi Arabia.Methods:We used a quasi-experimental controlled design. Four intervention and four control schools were selected from the regional education registry. A baseline questionnaire was administered to all grade 7 students before implementing the tobacco prevention program, Dentists Fighting Nicotine Dependence (DFND). The intervention group (n =379) received the DFND program whereas the control group (n = 255) received the regular tobacco program administered by the Department of Education. The program was delivered by trained health educators over 5 weeks. Pre- and post-test surveys (immediate and 2-year post-intervention) were collected. Study outcomes were current tobacco use, tobacco knowledge, attitude towards not using tobacco, and perceived behavioral control (PBC) of tobacco use. Covariates included sex, parent education, academic performance, absenteeism, student allowance, and religiosity. Data were analyzed using a two-level hierarchical mixed models.Results:In the immediate post-test, 597 participants (intervention, n = 366; control, n = 231) were surveyed. There was no difference in tobacco use between intervention and control schools, however, the intervention group had significantly higher mean scores for knowledge (β = 1.27, SE = 0.27, P < .01) and attitude toward not using tobacco (β = 5.17, SE = 2.48, P < .05) after adjusting for covariates. At 2-year post-intervention, 463 participants (intervention, n = 289; control, n = 173) were surveyed. There were no differences in tobacco use, knowledge, attitude or PBC between intervention and control groups.Conclusions:Our program did not impact tobacco use. In the short-term, the program significantly improved knowledge and attitude towards not using tobacco. These effects decayed 2 years post-intervention without additional programming. Increasing the effectiveness of DFND may be achieved by expanding curriculum content and practice time throughout the school years and by targeting high-risk adolescents within the program.

Pack-years of tobacco cigarette smoking as a predictor of spontaneous pain reporting and experimental pain reactivity.

The pack-years formula is a widely used estimate of lifetime tobacco smoking exposure, and greater pack-years have been associated with greater risk of chronic pain development and poorer pain-related outcomes among smokers with chronic pain. The pathophysiology underlying these associations is poorly understood. Regular tobacco smoking exposure may dysregulate homeostatic pain processes, producing an allostatic state of pain facilitation. Maladaptive pain mechanisms, such as central and peripheral sensitization, are chronic pain risk factors. Yet no published research has examined the relation between lifetime-smoking exposure and dysregulated pain processing. The current study used hierarchical linear regression analyses to test pack-years of tobacco smoking as a predictor of (a) pain reporting (current pain severity, pain frequency in the last 180 days) among a sample of 228 daily smokers without chronic pain, and (b) experimental capsaicin-induced pain reactivity (pain intensity, area of flare, mechanical pain sensitivity, and area of mechanical hyperalgesia) among 101 daily smokers without chronic pain. As hypothesized, results indicated that pack-years smoking was positively and significantly associated with current pain severity, past 180-day pain frequency, experimental pain intensity, mechanical pain sensitivity ratings, and area of mechanical hyperalgesia. Pack-years smoking was not significantly associated with neurogenic flare. These findings implicate central sensitization as a factor that may underlie the association between chronic tobacco smoking and increased risk for persistent pain. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Mis-anaesthetized society: expectancies and recreational use of ketamine in Taiwan

BackgroundThe popularity of ketamine for recreational use has been increasing in Asia, including Taiwan. Still, little known about the pattern of ketamine expectancies and whether such patterns are related to ketamine use. This study aimed to examine whether the positive and negative ketamine expectancies are differentially associated with ketamine-using behavior, and whether such relationship may differ by early-onset use of tobacco or alcohol.MethodsParticipants were recruited using respondent-driven sampling (RDS) among regular tobacco and alcohol users, aged 18 to 50, residing in Taipei from 2007 to 2010. Totally 1115 participants (with an age distribution skewed to the right, median = 26; interquartile range: 22–32) had information on substance use and completed a 12-item ketamine expectancies questionnaire (with 6 positive and 6 negative statements). Using two axes of High and Low expectancies, the four combinations of binary positive and binary negative ketamine expectancies were created. Each participant’s drug-using experience was categorized into illicit drug naïve, exclusive ketamine use, polydrug ketamine use, or other illicit drug use. Using the weights in the network output by RDS Analysis Tool, multivariable logistic regression analysis was then conducted.ResultsThe weighted prevalence was 2.4% for exclusive ketamine use, 9.0% for polydrug ketamine use, and 9.1% for the other illicit drug use. Ketamine users (11.4%) had greater positive expectancies and lower negative expectancies, particularly the combination of High Positive with Low Negative, as compared to the illicit drug-naïve or other illicit drug users. After adjustment for early-onset tobacco (or alcohol) use and sociodemographic characteristics, High Positive, Low Negative, and their combination of High Positive-Low Negative expectancies remained strongly associated with ketamine uses, without evidence of moderation from early-onset use of tobacco or alcohol.ConclusionsPositive and negative ketamine expectancies were associated in opposite directions with ketamine use, independent of early-onset use of tobacco or alcohol. Our results indicate ketamine expectancies as possible targets for future intervention and prevention of ketamine use, with a less confrontational feedback on decreasing an individual’s positive expectancies is essential in preventing young people from the initiation of ketamine use.

Changes in Alcohol Intake During Pregnancy in Spain, 1980 to 2014.

Even small amounts of alcohol consumed during pregnancy can have adverse effects on the embryo and the fetus. We estimated how alcohol intake among pregnant women in Spain changed between 1980 and 2014, and identified factors associated with alcohol use. Data came from the Spanish Collaborative Study of Congenital Malformations (ECEMC). The sample includes ECEMC's control mothers, 40,268 pregnant women from all regions of Spain. We classified alcohol consumption during pregnancy into 3 categories: no consumption; sporadic consumption of small amounts of alcohol; and regular consumption, or sporadic but in large quantities including drunkenness. Independent variables included sociodemographic factors, planned/unplanned pregnancy, maternal chronic diseases, gestational diabetes, and tobacco and illegal drug use during pregnancy. Trend analyses were performed using data from 1980 to 2014. The multinomial logistic regression models designed to identify associated factors differentiated between 2 periods: 1994 to 2004 and 2005 to 2014. Prevalence of alcohol consumption declined from 29.6% (95% CI: 27.1 to 32.2) in 1980 to 5.4% (95% CI: 3.7 to 7.6) in 2014, mostly due to the reduction in regular intake. This decline was especially acute between 1980 and 1994. Sporadic and regular consumption increased among women working outside the home, born outside Spain, those whose pregnancy was unplanned, and those reporting using tobacco or other drugs. Comparing 1994 to 2004 versus 2005 to 2014, a stronger association was observed between regular alcohol consumption and tobacco consumption in the latter period (interaction p=0.003). Alcohol consumption among expectant mothers has declined substantially in the last 35years. However, it is worth highlighting the significant and substantial associations between alcohol use and consumption of tobacco, which have become stronger in the most recent years.

FinnTwin12 Cohort: An Updated Review.

This review offers an update on research conducted with FinnTwin12 (FT12), the youngest of the three Finnish Twin Cohorts. FT12 was designed as a two-stage study. In the first stage, we conducted multiwave questionnaire research enrolling all eligible twins born in Finland during 1983–1987 along with their biological parents. In stage 2, we intensively studied a subset of these twins with in-school assessments at age 12 and semistructured poly-diagnostic interviews at age 14. At baseline, parents of intensively studied twins were administered the adult version of the interview. Laboratory studies with repeat interviews, neuropsychological tests, and collection of DNA were made of intensively studied twins during follow-up in early adulthood. The basic aim of the FT12 study design was to obtain information on individual, familial and school/neighborhood risks for substance use/abuse prior to the onset of regular tobacco and alcohol use and then track trajectories of use and abuse and their consequences into adulthood. But the longitudinal assessments were not narrowly limited to this basic aim, and with multiwave, multirater assessments from ages 11 to 12, the study has created a richly informative data set for analyses of gene–environment interactions of both candidate genes and genomewide measures with measured risk-relevant environments. Because 25 years have elapsed since the start of the study, we are planning a fifth-wave follow-up assessment.

SUPER WARFARIN POISONING AFTER MARIJUANA USE

SESSION TITLE: Wednesday Medical Student/Resident Case Report Posters SESSION TYPE: Med Student/Res Case Rep Postr PRESENTED ON: 10/23/2019 09:45 AM - 10:45 AM INTRODUCTION: Long acting vitamin K antagonists (super warfarins) produce coagulopathy in humans that can last for weeks to months. Exposure to these poisons can be very dangerous, but if recognized early can be effectively treated. CASE PRESENTATION: SW is a 32 year old female with no past medical history who presented to the emergency room due to nausea, vomiting, and abdominal discomfort. Symptoms started suddenly a week prior. Abdominal pain was constant, not associated with food, and was mainly in the upper quadrants with radiation to the flanks. The day of presentation she began to have bright red blood in her emesis as well as gross hematuria. She also noted sudden onset of bruising of her legs bilaterally. Patient was mildly tachycardic with heart rate in the 100s. Initial lab work showed a Hb 14.9 and an INR >29. She stated that she had no allergies, took no medications or herbal supplements, and had no family history of bleeding disorders. She denies any previous history of easy bruising or heavy menses. No previous psychiatric history of depression or suicidality. She denied regular tobacco use and states that she drank alcohol only on rare occasions. She admitted to very rare marijuana use, her last use being a week prior. She had smoked with a friend and this was their first time buying from the specific dealer. She stated the friend was not exhibiting any of the same symptoms. After admission to the ICU she initially received K-Centra which briefly corrected her coagulopathy to an INR 1.1. Over the next 24 hours, however, her INR gradually rose back up to 7.13. After consultation with toxicology the patient was placed on 10mg vitamin K every 8 hours which required escalation to 30mg every 8 hours before the INR remained corrected. An anticoagulant poisoning panel was sent and was positive for brodifacoum and difenacoum. A synthetic cannabinoid panel was run which was negative. She was sent home on this dose of vitamin K with close follow-up scheduled with her PCP. DISCUSSION: Case reports of accidental or intentional exposures to super warfarins have been seen as far back as 1984. They have more recently gained attention due to super warfarins being found mixed with synthetic marijuana. Compared to warfarin, the coagulopathy produced by these agents is more potent and prolonged. Elevated prothrombin time has been reported for weeks to months after ingestion. There is little data on the most optimal treatment algorithm, although case reports have shown large doses of vitamin K are effective for reversing the coagulopathy and maintaining normal INR. CONCLUSIONS: This case shows an occurrence of super warfarin poisoning in conjunction with non-synthetic marijuana use. In cases of significant and prolonged elevation of PT clinicians should keep a low index of suspicion for super warfarin poisoning. Reference #1: Chua JD, Friedenberg WR. Superwarfarin Poisoning. Arch Intern Med. 1998;158(17):1929–1932. https://doi.org/10.1001/archinte.158.17.1929 Reference #2: Long J, Peng X, Luo Y, et al. Treatment of a long-acting anticoagulant rodenticide poisoning cohort with vitamin K1 during the maintenance period. Medicine (Baltimore). 2016;95(51):e5461 DISCLOSURES: No relevant relationships by Jay Patel, source=Web Response No relevant relationships by Rahul Sangani, source=Web Response

Formaldehyde and acetaldehyde in the indoor air of waterpipe cafés: Measuring exposures and assessing health effects

The aims of this study were to investigate the exposure to formaldehyde (FA) and acetaldehyde (AA) concentrations in the indoor air of waterpipe (WP) cafés and to assess their health risk for smokers and employees. In this work, a number of 40 cafés were selected; the samples were taken from standing breathing zone of smokers and employees, and were analyzed using GC-MS. The results showed that the mean (±SD) concentrations of indoor air FA were 151.1 ± 67 and 60 ± 21.4 μg/m3 in cafés with fruit flavored tobacco and regular tobacco, respectively. This value for AA was 281.9 ± 141.1 and 108.4 ± 43.8 μg/m3 for cafés with fruit flavored tobacco and regular tobacco, respectively. The mean of inhalation lifetime cancer risk (LTCRs) for FA in smokers and employees were calculated 3.9 × 10−5 and 19.3 × 10−5, respectively. Also, the mean of estimated LTCRs for AA in smokers and employees were 1.3 × 10−5 and 6.3 × 10−5, respectively. The mean of Hazard quotients (HQ) for FA in Cafés with fruit flavored and regular tobacco in smokers and employees were calculated to be 0.4 and 3.4, and 0.1 and 1.3, respectively, indicating an unacceptable and high risk for employees. Also, the mean of HQ for AA in cafés with fruit flavored and regular tobacco for smokers and employees were calculated 0.8 and 7.1, and 0.3 and 2.7, respectively, indicating an unacceptably high risk for employees. Therefore, WP cafés can be a potential source for exposure to FA and AA that can cause health problems for exposed people, especially employees working in these places.

Factors associated with current tobacco use among adolescents and young students

ObjectivesTo determine the prevalence of current tobacco use and its association with sociodemographic factors and risk behaviors among adolescents and young students, according to gender. MethodsThe sample consisted of students from the state public school network aged between 12 and 24 years, who answered the Brazilian version of the Youth Risk Behavior Survey questionnaire. The data were analyzed in SPSS software (v. 20.0), using Poisson regression to evaluate the prevalence ratio (PR) of the independent variables in relation to the outcome. p<0.05 was established as the significance level. ResultsThe final analysis consisted of 1275 adolescents, of whom 716 (56.2%) were girls and 559 (43.8%) were boys. The prevalence of current tobacco use was 6.6% among girls and 9.7% among boys. In females, consuming alcohol in the last 30 days (3.91 [1.54–9.94]) and being 14 years old or younger (0.50 [0.26–0.96]) influenced current tobacco use. In the male gender, tobacco use in the last 30 days was influenced by current alcohol consumption (2.92 [1.21–7.08]) and involvement in physical fighting in the last 12 months (2.32 [1.32–4.09]). ConclusionAlthough the prevalence of current tobacco use was low in both genders, the assessed population still presents a risk, since male involvement in physical fighting and current consumption of alcohol in both genders increased the probability of this population becoming regular tobacco users.

Exposure and risk assessment of PAHs in indoor air of waterpipe cafés in Ardebil, Iran

The aim of this study was to determine the concentrations of polycyclic aromatic hydrocarbons (PAHs) bound to particulate matter (PM) in the indoor air of waterpipe cafés of Ardebil city, and to further assess the health risk due to exposure to PAHs. 50 out of 236 cafés were selected using systematic random sampling method and air samples were taken from standing breathing zone of smokers and employees, ∼150 cm above the ground level. The concentrations of PAHs were determined using GC-MS. The results showed that the mean indoor concentration of PAHs in the cafés was 5522.1 ± 594.8 ng/m3. It was 5915.2 ± 650.5, 2404 ± 271.4, and 7304.9 ± 846.0 ng/m3 for cafés with fruit flavored tobacco, regular tobacco, and the both, respectively. The means of the hazard quotient (HQ) for PAHs in different age groups, including 11 to <16, 16 to <21, 21 and older, and the cafés employees were 0.35, 0.75, 3.65, and 18, respectively. Also, the mean of estimated cancer risk for PAHs in the aforementioned age groups and employees were 0.65 (10−5), 1.31(10−5), 6.43 (10−5) and 31.3 (10−5), respectively. The results indicated the increased health risk levels related to the inhalation of tobacco smoke due to PAHs concentrations in the waterpipe cafés.

Widespread Belief That Organic and Additive-Free Tobacco Products are Less Harmful Than Regular Tobacco Products: Results From the 2017 US Health Information National Trends Survey.

US smokers of Natural American Spirit, a brand marketed as "organic" and "additive-free," are more likely than other cigarette smokers to believe that their brand might be less harmful than other brands. This article (1) describes the prevalence of belief that "organic" and "additive-free" tobacco is less harmful than regular tobacco products in the US population and (2) describes the sociodemographic characteristics of adults who believe tobacco products with these descriptors are less harmful. Data were drawn from the 2017 Health Information National Trends Survey (HINTS), a nationally representative survey of US adults. Logistic regression models were used to examine correlates of the belief that "organic" or "additive-free" tobacco products are less harmful than regular tobacco products. Overall, 26.7% of US adults and 45.3% of adult smokers believe that "organic" tobacco products are less harmful than regular tobacco products. Similarly, 35.2% of US adults and 47.1% of smokers believe that "additive-free" tobacco products are less harmful. When examining gender, age, education, race/ethnicity, sexual orientation, and smoking status, only age (adjusted odds ratio [aOR] ~0.98, 95% confidence interval [CI]: 0.97, 0.99 for both outcomes) and smoking status (current vs. never smokers, aOR ~1.78, 95% CI 1.03, 3.07 for both outcomes) were correlates of believing that "organic" or "additive-free" tobacco is less harmful than regular tobacco products. Belief that "organic" and "additive-free" tobacco products are less harmful than other products is widespread. Younger adults and current smokers are most likely to be misinformed by "organic" or "additive-free" tobacco product descriptors. Belief that "organic" and "additive-free" tobacco products are less harmful than other products is widespread among US adults and most prevalent among smokers. Removal of terms that incorrectly imply reduced harm may correct current and future consumers' misperceptions about the brand.

Abstract WP515: Depression is Associated With Persistent Smoking After Stroke and Myocardial Infarction

Introduction: Depression is associated with poor risk factor control after stroke and myocardial infarction (MI). We sought to estimate the prevalence of objectively-measured persistent smoking in stroke and MI survivors in a nationally representative sample, and we hypothesized that depression is associated with persistent smoking. Methods: We performed a cross-sectional analysis using data from 5 cycles of the National Health and Nutrition Examination Survey (2005-2014). Participants in each independent cycle were asked detailed questions about their medical history and underwent neuropsychiatric and laboratory assessment. We included participants 20 years and older who reported a prior stroke or MI and regular tobacco smoking at the time of the event. Individuals who reported both stroke and MI were categorized based on the more recent event. Depression, at the time of survey participation, was defined using a validated threshold ( &gt; 10) on the Patient Health Questionnaire-9 scale. Persistent smoking was defined using validated serum cotinine measures that minimize the effect of second-hand smoke exposure. Multivariable logistic regression methods for survey data were used to assess the association between depression and persistent smoking while adjusting for demographics and smoking-related conditions and behaviors. Results: We identified 1,215 participants with prior stroke or MI who also reported regular tobacco smoking at the time of the event. The mean age was 74.1 years (standard error [SE], 0.5), and the mean duration since the event was 9.7 years (SE, 0.4). Serum cotinine levels revealed evidence of persistent smoking in 429 (41.8%; SE, 1.9%) individuals. Depression was present at the time of survey participation in 30% of persistent smokers versus 13% of former smokers (P&lt;0.0001). In unadjusted analysis, depression was associated with persistent smoking (OR, 3.1; 95% CI, 1.9-4.8). In fully adjusted models, the association was attenuated (OR, 2.01; 95% CI, 0.99-4.09). Conclusions: In this nationally representative sample, 42% of smokers with stroke or MI had laboratory evidence of persistent smoking several years later. Improved smoking cessation efforts and interventions are needed, especially for those with depression.

Heated tobacco products: things we do and do not know

This Special Issue is focused on IQOS, electronic devices that offer yet another nicotine delivery alternative to smoking regular tobacco cigarettes. IQOS are designed to heat rather than burn tobacco,...

Use of Tobacco, Alcohol and Illegal Drugs Among Brandenburg Youth 2005-2017

Children and adolescents are seen as an important target group for reducing tobacco and alcohol consumption in the population. Data on substance use over a longer period of time for adolescents are a basis for addiction policy in the state of Brandenburg and show certain trends. Adolescents of the 10th grade in the state of Brandenburg were asked in 2005, 2009, 2013 and 2017 about consumption of alcohol, tobacco and other psychoactive substances and about possibly helpful contact persons. A total of 42,221 adolescents with an average age of 15.7 years (standard deviation 0.7 years) were contacted. Regular (at least weekly) tobacco consumption decreased between 2005 and 2017 from 41 to 17% for girls and from 37 to 18% for boys. The regular consumption of alcohol decreased in girls from 18 to 9% and in boys from 34 to 15%. Boys drink more alcohol than girls. Tobacco use is lowest in high schools and there are differences between regions in the consumption of both substances. The adolescents see their peers as the main contact persons for problems with addictive substances. Professional help is accessed less often. The Brandenburg study describes a positive development. If the reduction is sustained or even continued, alcohol and tobacco consumption in the population will decrease. The results suggest strengthening the peer approach for addiction prevention.

Autologous Chondrocyte Implantation and Tibial Tubercle Osteotomy for Patellofemoral Chondral Defects: Improved Pain Relief and Occupational Outcomes Among US Army Servicemembers

Background: The occupational and functional results of patellofemoral autologous chondrocyte implantation (ACI) are underreported. This investigation sought to establish clinical outcomes and rates for return to work in a predominantly high-demand military cohort undergoing this procedure. Purpose: To determine the return-to-work, pain relief, and perioperative complication rates in a high-demand athletic cohort undergoing patellofemoral ACI. Study Design: Case series; Level of evidence, 4. Methods: All military servicemembers from 2 military medical centers undergoing ACI for high-grade patellofemoral chondral defects between 2006 and 2014 were identified, and data were abstracted from their medical records and clinical databases. Demographic and surgical variables were obtained for patients with at least 2 years of postoperative follow-up, and perioperative complications, rates of return to work, and survivorship from revision were quantified. Results: Seventy-two patients (72%) had >2-year follow-up and had patellofemoral ACI for high-grade chondral defects, with 66 knees (91%) undergoing a concomitant offloading tibial tubercle osteotomy. Mean follow-up was 4.3 years (range, 2.0-9.9 years). The mean ± SD age was 34.4 ± 6.1 years; 86% were male; and 57% were involved in military occupational specialties of heavy or very heavy demand. Second-generation patellofemoral ACI with a type I/III collagen membrane was used for 85% of knees. Most defects were isolated to the patella (n = 40, 55%). The mean total defect surface area was 4.5 ± 2.9 cm2 (range, 2.7-13.5 cm2). Fifty-six servicemembers (78%) returned to their occupational specialties. Three patients (4.1%) were classified as having surgical failures, requiring subsequent knee arthroplasty (n = 2) or a revision chondral procedure (n = 1). Mean visual analog scores improved significantly from 6.5 ± 1.5 to 3.2 ± 2.1 (P < .0001). Multivariate analysis identified use of a periosteal patch as the only significant independent predictor for surgical (P = .013) and overall (P = .033) failures. Age <30 years (P = .019), female sex (P = .019), and regular tobacco use (P = .011) were independent predictors of overall failure. Conclusion: For patellofemoral chondral defects without a failed primary procedure, second-generation ACI successfully returned to work 78% of patients of moderate to very heavy occupational demand with significantly decreased patient-reported knee pain. Risk factors after ACI for patellofemoral articular lesions for overall failure were age <30 years, female sex, and tobacco use, while surgical and overall failures were associated with periosteal patch use.

Youth Tobacco Survey among the School Going Adolescents in a Block of Vadodara District, Gujarat.

Background: Tobacco use is the leading cause of Preventable death, Tobacco use during adolescence increases the risk of persistent addiction, leading to regular and sustained tobacco use in adulthood. Objective: To assess the prevalence and practice of tobacco use among the school going adolescents in a block of Vadodara district, Gujarat. Material &amp; Methods: Multiphase sampling was done to select the sample students (13 to 17 years) from private and government schools in a selected block of Vadodara. A cross-sectional study including 1045 students was carried out using a pre-designed and pre-tested proforma. Results: Out of 1045 students, 3% (n=32) tried cigarette smoking ever, one or two puffs and 1.8% (19 students) of students were current cigarette or beedi smokers. Around 27.9% students and 23% students admitted that at least one of their parents and friends smoked cigarettes, respectively. About 24% and 44% of the students were exposed to passive smoking at home and outside home, respectively. Conclusions: Present study provides the baseline information of prevalence of smoking and attitude of school going adolescents towards smoking in Gujarat. The result gives an alarm to work upon tobacco control among adolescents and make them aware about the hazards.