Regular Tobacco Use Research Articles

A 5-Factor Framework for Assessing Tobacco Use Disorder.

Cigarette use is the leading cause of preventable death in the United States. Despite the well documented dangers of smoking, nearly 20% of adults report regular use of tobacco. A majority desire to discontinue but the long-term cessation success rate remains near 4%. One challenge to reducing the prevalence of tobacco use is an incomplete understanding of the individual correlates that reinforce continued use. Evidence from research on nicotine and tobacco suggests that Tobacco Use Disorder is a complex, and multifactorial condition. Personality traits, comorbidities, habits and lifestyle, genetics, socioeconomic status, and mental and physical health all contribute to the risk for dependence and to the likelihood of quitting. This perspective review provides an overview of some common factors that contribute to liability risk for Tobacco Use Disorder and a framework for assessing individual tobacco users. The framework includes 5 areas that research suggests contribute to continued tobacco use: nicotine addiction, psychological influences, behavioral dependencies, neurobiological factors, and social reinforcement. Nicotine addiction includes drug-seeking behavior and the role of withdrawal avoidance. Psychological and emotional states contribute to a perceived reliance on tobacco. Behavioral dependence is reinforced by associative and non-associative learning mechanisms. Neurobiological factors include genetic variables, variations in neurotransmitters and receptors, pharmacogenetics, and interaction between psychiatric illnesses and nicotine use and dependence. Finally, social reinforcement of smoking behavior is explained by a network phenomenon and consistent visual cues to smoke. A comprehensive assessment of individual tobacco users will help better determine appropriate treatment options to achieve improved efficacy and outcomes.

Alcohol, tobacco and cannabis use in adolescence - Cross-sectional results of the 2017/18 HBSC study.

Tobacco, alcohol and cannabis are psychoactive substances that is often tried for the first time during adolescence and further continued in later life. Regular tobacco and cannabis use as well as alcohol abuse are associated with serious health consequences. According to the importance of health reporting, this article describes current prevalence of adolescent substance use and the associations between psychoactive substance use and specific social determinants. Representative data for Germany from the 2017/18 Health Behaviour in School-Aged Children (HBSC) study among schoolchildren aged 11, 13 and 15 years are used. The article analyses both, the lifetime and 30-day prevalence of tobacco, alcohol and cannabis use (in the latter case, data were only available for 15-year-olds) among adolescents as well as their experiences of alcohol-related misuse (binge drinking). Tobacco and alcohol are used comparatively rarely by 11- and 13-year-olds. However, the prevalence increases significantly among 15-year-olds. In addition, cannabis use is also quite common among this age group. Schoolchildren who do not attend grammar schools are at greater risk of smoking and those with high family affluence are at a greater risk of alcohol use, this applies particularly to girls. Finally, adolescents with a migration background are less at risk of regular alcohol use or binge drinking, but face an increased risk of cannabis use (girls with one-sided migration background). The results indicate that prevention measures should start early, as the prevalence of substance use is significantly higher among older schoolchildren. Depending on the substance, different risk groups can be identified that require particular consideration when drawing up preventive measures.

Sexual and reproductive health correlates of polysubstance use among female adolescents who sell sex in the southwest of China

BackgroundSubstance use and adverse sexual and reproductive health (SRH) outcomes continue to be significant threats to female adolescents’ health and wellbeing, particularly to these marginalized subpopulations. Our research aimed to tackle knowledge gaps regarding the prevalence of concurrent substance use including alcohol, tobacco, illicit drug among Chinese adolescent female sex workers (AFSWs), while to assess the correlates between substance use and SRH risks; the needs for comprehensive SRH services were also examined in this study.MethodsA cross-sectional study enrolled 310 AFSWs aged 15–19 years by using cluster sampling method in Kunming, China. Descriptive analysis was employed to characterize the participants who were regular-alcohol users, regular-tobacco users, illicit drug users and polysubstance users. Multivariable logistic regression analysis was performed to detect the SRH correlates of regular-alcohol use, regular-tobacco use, illicit drugs and polysubstance use respectively.ResultsThere is a high prevalence of regular-alcohol drinking (83%, 257/310) among AFSWs, with 44% (136/310) smoking cigarettes regularly and 9% using illicit drug (27/310) in the past year. In multivariate analysis, AFSWs who had middle and high school education, had higher monthly income, experienced of sexual and gender based violence (SGBV) and prior abortion, and regular-tobacco smoking were associated with increased odds of regular-alcohol drinking; engaging in unprotected sex while drunk, having STIs symptoms and using illicit drugs were significantly associated with regular-tobacco smoking; while AFSWs who had an illicit drug using- intimate partner, experienced forced sexual initiation, accessed unsafe medical providers for STIs treatment were associate with increased odds of illicit drug use. Moreover, 35% (105/298) AFSWs sought unsafe medical care for STIs treatment, or no treatment at all, among them, majority were using polysubstance (87%; 91/105).ConclusionsOur findings reveal combined threats of substance use to AFSWs’ SRH and wellbeing in China, this study emphasises that the coordinated efforts are needed to integrate SRH promotion and harm reduction service across sectors, and not only fragmented measures. An effective response should include an agreed framework, indicators and targets supported by political will, solid leadership and policy reform to deal with AFSWs’ overlapping vulnerabilities in a systematic way.

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.

Prevalence and predictors of hazardous alcohol use among tuberculosis patients: The need for a policy on joint tuberculosis-alcohol collaborative activities in India.

Collaborative activities to address tobacco addiction among tuberculosis (TB) patients are in place in India. The research was carried out to estimate the prevalence and to determine the predictors of hazardous alcohol use among pulmonary TB patients, assessing the need for joint TB-alcohol collaborative activities. It was a cross-sectional study carried out among 200 drug-sensitive pulmonary TB patients of Bhavnagar city of Gujarat using the "Alcohol Use Disorder Identification Test" (AUDIT), with patients scoring ≥8 on AUDIT said to be having hazardous alcohol use. The prevalence of hazardous alcohol use among drug-sensitive pulmonary tuberculosis patients was found to be 20% (95% CI=15%-26%). On applying multiple logistic regression, regular use of smokeless tobacco (adjusted Odds Ratio aOR=5, 95% CI=1.8-14.9, p=0.002), history of alcohol use by father (aOR=4, 95% CI=1.7-10.2, p=0.002), residing at a place where spurious liquor was being brewed (aOR=4.8, 95% CI=1.4-16.4, p=0.012), and belonging to scheduled caste/scheduled tribe (SC/ST) (aOR=2.7, 95% CI=1.1-6.8, p=0.034) were the significant predictors for hazardous alcohol use. It is concluded from the study that one-fifth of drug-sensitive pulmonary tuberculosis patients in Bhavnagar have hazardous alcohol use. The study calls for joint TB-alcohol collaborative activities in India.

New Understanding of the Health Hazards of Electronic Cigarettes and Vaping.

1. Harold J. Farber, MD, MSPH* 1. *Baylor College of Medicine and Texas Children’s Hospital, Houston, TX This In Brief was accepted for publication in November 2019. Considering that medical information on the effects of vaping continues to develop, please see the Centers for Disease Control and Prevention (CDC) website on vaping for up-to-date information: https://www.cdc.gov/tobacco/basic_information/e-cigarettes/severe-lung-disease.html. Joseph A. Zenel, MD Editor-in-Chief ​ ​ Electronic cigarettes are addicting a new generation. Although initially promoted as safer than cigarettes and “no tobacco smoke, only vapor,” we are now finding substantial health hazards from these products. Designed to appeal to and promoted to youth, their popularity has surged among middle and high school students, increasing from 1.5% in 2011 to 27.5% in 2019. As a rising tide lifts all boats, after a long period of decline, in 2018 combustible tobacco use among high school students increased. Electronic cigarette use among adolescents and young adults is associated with greater rates of progression to combustible tobacco smoking and progression from intermittent to regular use of combustible tobacco. Electronic cigarettes are referred to by many terms, including e-cigarettes, vape pens, vapes, vaporizers, e-hookah, mechanical mods, Juul, and others. Electronic cigarettes use a heating element or atomizer to create an aerosol from a solution of nicotine, flavoring chemicals, propylene glycol, and glycerin. Other substances may be added. Heating of the solution …

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.

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

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.

Health education for reducing tobacco consumption in Shanghai based on the health versus financial framing effect: A randomized field study.

INTRODUCTIONIn China, the regular use of tobacco by much of the population has brought great losses in both health and economy. This study used the framing-effect theory to explore people’s preferences regarding message-framing for education about financial and health-related gains associated with smoking cessation in different areas of Shanghai, China. In particular, it attempts first to identify any influencing factors and offers some suggestions to improve the efficiency of education efforts regarding tobacco control.METHODSA message-framing field study was conducted in three districts in Shanghai that represent low-income, middle-income and high-income areas between June and August 2015, respectively. This study examines leaflets with a different message-framing (Health-Financial Framework) to ascertain the preferences of participants at the different locations. A total of 4650 participants were recruited and asked to complete a questionnaire. The z-test, chi-squared test and logistic regression analysis were used for statistical analysis.RESULTSIn low-income areas, participants were more inclined towards financial rather than health message-framing, especially in financial and health oriented locations. In the middle-income areas, participants preferred health message-framing, especially at hospital locations. In the high-income areas, health message-framing was preferred in health and neutral locations in comparison with financial locations. The type of area, location and household monthly income have an impact on participants’ preference for message-framing.CONCLUSIONSThree suggestions are proposed for tobacco control health education in China: 1) Combine health education information design with the framing-effect theory to improve the effectiveness of information content, 2) Considering the impact of different types of area and location, different tobacco control health education strategies should be adopted to improve the efficiency of publicity, and 3) Targeted and personalized tobacco control health education strategies should be implemented among different audiences.

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.

Quality of life and associated factors in patients with chronic Chagas disease.

To evaluate the quality of life (QoL) of patients with Chagas disease (CD) and the association between QoL domains and several clinical, socioeconomic and lifestyle characteristics of this population. Cross-sectional observational study conducted from March 2014 to March 2017 including a total of 361 outpatients followed at Evandro Chagas National Institute of Infectious Disease, Brazil. QoL was assessed using the Portuguese shorter version of the original WHO Quality of Life questionnaire (WHOQOL-BREF). Information about clinical CD presentation, presence of comorbidities, functional class, previous benznidazole treatment, socioeconomic profile and lifestyle was also obtained. Environment and physical domains presented the worst QoL scores, while the social relationship domain presented the highest score. Multivariate regression analysis demonstrated that variables independently associated with QoL were functional class, sex, clinical presentation of CD, sleep duration, schooling, physical activity level, smoking, income per capita and residents by domicile. The low socioeconomic status and the physical limitations imposed by the disease presented an important impact on the QoL reduction among CD patients, especially on environment and physical domains. Strategies to improve QoL among CD patients should be tailored and consider many different variables to maximise improvements not only of patients' physical but also of their mental health.

Early-onset tobacco use and suicide-related behavior – A prospective study from adolescence to young adulthood

BackgroundDevelopmental relationships between tobacco use and suicide-related behaviors (SRB) remain unclear. Our objective was to investigate the longitudinal associations of tobacco use in adolescence and SRB in adulthood. MethodsUsing a prospective design, we examined whether tobacco use in adolescence is associated with SRB (intentional self-injury, suicide ideation) in young adulthood in a population-based sample of 1330 twins (626 males, 704 females). The baseline and follow-up data were collected by professionally administered semi-structured poly-diagnostic interviews at ages 14 and 22, respectively. ResultsAfter adjusting for multiple potential confounders, those who reported early-onset of regular tobacco use had a significantly increased risk for intentional self-injury, such as cutting or burning, at age 22 (adjusted odds ratio [AOR] 4.57, 95% CI 1.93–10.8) in comparison to those who had not at all initiated tobacco use. Also, daily cigarette smoking at baseline was associated with future intentional self-injury (AOR 4.45, 95% CI 2.04–9.70). Early-onset tobacco use was associated with suicidal ideation in females (AOR 3.69, 95% CI 1.56–8.72) but not in males. Considering any SRB, baseline daily smokers (AOR 2.13, 95% CI 1.12–4.07) and females with early onset of regular tobacco use (AOR 3.97, 95% CI 1.73–9.13) had an increased likelihood. Within-family analyses among twin pairs discordant for exposure and outcome controlling for familial confounds showed similar, albeit statistically non-significant, associations. ConclusionEarly-onset tobacco use in adolescence is longitudinally associated with SRB (intentional self-injury and/or suicide ideation) in young adulthood, particularly among females. Further investigation may reveal whether this association has implications for prevention of SRB in adolescence and young adulthood.

Suicide, santé mentale et usages de substances psychoactives chez les adolescents français en 2014

BackgroundThe aim of this study was to describe potential associations between suicidal behaviors and psychoactive substance uses among adolescents. MethodsA cross-sectional, national survey representative of adolescents aged 17, living in continental France, was conducted in 2014. A total of 22,023 adolescents answered an anonymous, self-administered questionnaire about their health and their use of psychoactive substances. Suicidal risk was assessed by means of a 4-level indicator [1. No depression, as stipulated by the Adolescent Depression Rating Scale (ADRS); 2. Depression, no suicidal ideation, no suicidal attempts; 3. Depression with suicidal ideation; 4. Depression with suicidal attempts]. Multivariate logistic regressions were conducted to identify the factors significantly related to frequent substance uses. ResultsThree percent of adolescents (1.8% of boys vs. 3.7% of girls) were labeled as suffering from severe depression, 10% stated they had suicidal thoughts during the last year and 3% attempted to commit suicide at least once in their lifetime. The results support the view of a gradient between suicidal risk severity and regular use of tobacco and cannabis. The association with regular alcohol use appears somewhat weaker. ConclusionSuicidal behaviors and regular substance uses are significantly related but also mediated by adolescents’ mental health.

Smokeless tobacco use among United States Air Force trainees

ABSTRACTBackground: The prevalence of smokeless tobacco use in the United States Air Force (USAF) exceeds civilian use rates. The prevalence and correlates of smokeless tobacco use were assessed and evaluated in a sample of USAF trainees. Methods: We conducted a cross-sectional survey of USAF technical training school personnel at Joint Base San Antonio-Lackland and Fort Sam Houston (N = 14,810). Survey completion rate was 78%. Logistic regression was used to analyze the associations between demographic variables, tobacco use, and social factors for both regular and infrequent smokeless tobacco (e.g., chewing tobacco, snuff) users. Results: Overall, 16% of Airmen had ever used smokeless tobacco and 10% regularly used smokeless tobacco. In multivariate analyses, men had greater odds than women of regular smokeless tobacco use (adjusted odds ratio [OR] = 15.2; 95% confidence interval [CI]: 10.8–21.5) and infrequent smokeless tobacco use (adjusted OR = 4.2; 95% CI: 3.1–5.7). Smokeless tobacco use was associated with participation in high school sports (adjusted OR = 1.9; 95% CI: 1.6–2.3 for regular users; adjusted OR = 1.4; 95% CI: 1.1–1.7 for infrequent users), smoking cigarettes (adjusted OR = 4.3; 95% CI: 3.6–5.1 for regular users; adjusted OR = 4.0; 95% CI: 3.2–5.0 for infrequent users), or living with someone who used smokeless tobacco (adjusted OR = 2.2; 95% CI: 1.9–2.6 for regular users; adjusted OR = 1.4; 95% CI: 1.1–1.7 for infrequent users). Black or African Americans were less likely than whites to be regular (adjusted OR = 0.3; 95% CI: 0.1–0.4) or infrequent (adjusted OR = 0.3; 95% CI: 0.2–0.4) users of smokeless tobacco. Conclusions: Smokeless tobacco use among incoming Air Force recruits is common and negatively impacts the Air Force's goal to be tobacco-free. Understanding sociodemographic characteristics perpetuating smokeless tobacco use in the Air Force population can inform the development of health promotion interventions.

High Urinary Polycyclic Aromatic Hydrocarbon Concentrations in Bomet County, Kenya, a Region With a High Incidence of Esophageal Squamous Cell Carcinoma

Abstract 43 Background: Polycyclic aromatic hydrocarbons (PAHs) are a group of more than 100 compounds that are formed during incomplete combustion of organic materials, many of which have been classified as known carcinogens. Exposure to PAHs has been suggested as an important risk factor for developing esophageal squamous cell carcinoma (ESCC) in several high-incidence areas, such as China and Iran, but corresponding PAH assessments have not been conducted in East Africa, another ESCC hot spot. To assess the internal uptake of PAH as a result of external exposures, body fluids and tissues can be monitored for PAHs or their metabolites. The primary aim of this study was to quantify the concentration of seven PAH urine metabolites in a cross-section of participants from Bomet, Kenya, an endemic area for ESCC. An additional aim was to assess demographic and lifestyle factors that may be associated with PAH metabolites. Methods: A community-based sample of 294 asymptomatic adults were recruited. Participants collected spot urine specimens and completed a questionnaire. Urine specimens were analyzed at the National Center for Environmental Health at the Centers for Disease Control—the same lab has performed similar analyses on urine samples from the US National Health and Nutrition Examination Survey (NHANES). The seven PAH analytes were hydroxylated metabolites of naphthalene, fluorene, phenanthrene, and pyrene. Median creatinine-adjusted PAH metabolite concentrations (nanogram per gram of creatinine) were compared by all relevant questionnaire items. Results: All seven measured PAH metabolites in the study population were markedly elevated compared with the US population. For example, the median value for 1-hydroxypyrene in Bomet was 1,190 ng/g in males versus 106 ng/g in NHANES, and 2,840 ng/g in females versus 133 ng/g in NHANES. Age (&lt; 50 years), sex (female), and performing indoor cooking were significantly ( P &lt; .01) associated with higher PAH concentrations for all measured metabolites. Regular tobacco use was not reported by many participants (19%) and was not associated with PAH concentrations. Conclusion: PAH metabolite concentrations in Bomet were high compared with the US population. Elevated PAH concentrations were associated with age, sex, and indoor cooking. Additional studies are needed to define the association between high PAH exposure and the risk of developing ESCC as well as to determine the sources of PAH exposure in this high-risk population. Funding: The African Organization for Research and Training in Cancer’s Beginning Investigator Grant for Catalytic Research (BIG Cat) Program, in collaboration with the US National Institutes of Health’s National Cancer Institute, Office of International Affairs. AUTHORS' DISCLOSURES OF POTENTIAL CONFLICTS OF INTEREST No COIs from the authors.

Flavored Tobacco Product Use in Youth and Adults: Findings From the First Wave of the PATH Study (2013–2014)

The 2009 Family Smoking Prevention and Tobacco Control Act banned characterizing flavors other than menthol in cigarettes but did not restrict their use in other forms of tobacco (e.g., smokeless, cigars, hookah, e-cigarettes). A cross-sectional analysis of Wave 1 data from 45,971 U.S. adults and youth, aged ≥12 years in the Population Assessment of Tobacco and Health (PATH) Study collected in 2013-2014, was conducted in 2016. This study examined (1) the prevalence and reasons for use of flavored tobacco products; (2) the proportion of ever tobacco users reporting that their first product was flavored; and (3) correlates of current flavored tobacco product use. Current flavored (including menthol) tobacco product use was highest in youth (80%, aged 12-17 years); and young adult tobacco users (73%, aged 18-24 years); and lowest in older adult tobacco users aged ≥65 years (29%). Flavor was a primary reason for using a given tobacco product, particularly among youth. Eighty-one percent of youth and 86% of young adult ever tobacco users reported that their first product was flavored versus 54% of adults aged ≥25 years. In multivariable models, reporting that one's first tobacco product was flavored was associated with a 13% higher prevalence of current tobacco use among youth ever tobacco users and a 32% higher prevalence of current tobacco use among adult ever users. These results add to the evidence base that flavored tobacco products may attract young users and serve as starter products to regular tobacco use.

Waterpipe tobacco smoking prevalence and illegal underage use in waterpipe-serving premises: a cross-sectional analysis among schoolchildren in Stoke-on-Trent

ObjectivesWaterpipe tobacco smoking has received little epidemiological and policy attention in the UK despite reports of increasing prevalence alongside an anecdotally non-compliant industry. This study aimed to determine how waterpipe tobacco smoking is changing among young people in the UK, both in terms of prevalence and sociodemographic correlates of use, and to quantify the extent of illegal underage use in waterpipe-serving premises in the UK. Study designRepeat cross-sectional. MethodsA secondary analysis of two cross-sectional surveys (total N = 3376), conducted in 2013 and 2015 among secondary school students aged 11–16 years in Stoke-on-Trent, measured lifetime (both surveys) and regular (at least monthly; 2015 survey only) waterpipe tobacco prevalence and location of usual use. Logistic regression models measured the association between independent variables (age, sex, ethnicity, presence of free school meals, cigarette smoking status) with lifetime and regular waterpipe tobacco use, and with illegal underage use; the latter defined as usually smoking waterpipe tobacco in a waterpipe-serving premise. ResultsLifetime waterpipe tobacco prevalence remained similar in 2013 (13.7%, 95% confidence interval [CI] 12.0–15.4%) and 2015 (14.6%, 95% CI 12.8–16.4%), whereas regular use was measured at 2.9% (95% CI 2.1–3.8%) in 2015. Older, non-white, males who concurrently used cigarettes had higher odds of lifetime waterpipe tobacco use. Illegal underage use was reported among 27.1% of all regular users, correlates of which included increasing age and South Asian ethnicity. The presence of free school meals was not associated with lifetime or regular waterpipe tobacco prevalence, nor illegal underage use. ConclusionsIncreased monitoring of waterpipe tobacco prevalence and patterns, including the underage policy compliance of waterpipe-serving premises, is needed to help inform policy decisions to control waterpipe tobacco use.

Determinants of tobacco use by students.

ABSTRACTOBJECTIVE Estimate the prevalence and determinants of tobacco use by students.METHODS This cross-sectional study, carried out between 2013 and 2014, evaluates 701 public school students between 10 and 79 years of age living in a city in the countryside of the State of Goias, Midwest of Brazil. A structured questionnaire collected the data and the predictor variables were demographic data, family nucleus, religion, physical activity practice, family functionality and parental smoking. Two multivariable models were implemented, the first for occasional tobacco use and the second for regular use, acquiring the measure of prevalence ratio (PR) and their respective 95%CI. Variables with p < 0.10 were included in Poisson regression models with robust variance to obtain the adjusted PR (adPR) and 95%CI. The Wald Chi-Squared test examined the differences between proportions, and values with p < 0.05 were statistically significant.RESULTS The prevalence of occasional and regular tobacco use were 33.4% (95%CI 29.8–36.9) and 6.7% (95%CI 5.0–8.8), respectively. The factors associated with occasional tobacco consumption were age of 15 to 17 years (adPR = 1.98) and above 18 years (adPR = 3.87), male gender (adPR = 1.23), moderate family dysfunction (adPR = 1.30), high family dysfunction (adPR = 1.97) and parental smoking (adPR = 1.60). In regards to regular consumption of tobacco, age above 18 years (adPR = 4.63), lack of religion (adPR = 2.08), high family dysfunction (adPR = 2.35) and parental smoking (adPR = 2.89) remained associated.CONCLUSIONS Students exhibit a high prevalence of occasional and regular tobacco use. This consumption relates to sociodemographic variables and family dysfunction.