Self-reported Current Smokers Research Articles

The Association Between Cotinine-Verified Smoking Status and Risk of Gallstones: A Cohort Study.

Previous epidemiological data on the association between cigarette smoking and risk of gallstone development remain controversial, and most relevant studies have relied on self-reported questionnaires. We aimed to elucidate this association using both an objective biomarker of tobacco exposure (urinary cotinine) and a self-reported questionnaire. We analyzed 221,721 asymptomatic adults who underwent abdominal ultrasonography and urinary cotinine measurement between January 2011 and December 2016. Cotinine-verified current smokers were defined as participants with urinary cotinine levels ≥50 ng/mL. The mean age of the study population was 35.9 years, and the proportion of men was 55.8%. The proportions of self-reported and cotinine-verified current smokers were 21.3% and 21.2%, respectively. After adjusting for confounding factors, self-reported current smoking was associated with an increased risk of gallstone development [adjusted odds ratio (aOR) 1.14; 95% confidence interval (95%CI), 1.04-1.25]. Moreover, among the current smokers, the risk of gallstone development increased with an increase in the amount of cigarette smoking (<20 and ≥20 pack-years vs. never smoked; aOR=1.11 and 1.25; 95%CI: 1.01-1.22 and 1.07-1.45, respectively). Cotinine-verified current smoking was also associated with an increased risk of gallstone development (aOR=1.16; 95%CI: 1.07-1.25). Among the self-reported never or former smokers, the cotinine-verified current smokers (aOR=1.20; 95%CI: 1.01-1.44) showed a significantly higher risk of gallstones than cotinine-verified never smokers. Cotinine-verified and self-reported current smoking were independent risk factors for gallstones, suggesting a distinct role of tobacco smoking in gallstone development.

Urine cotinine versus self-reported smoking and the risk of chronic kidney disease.

Evidence on the role of smoking in the development of chronic kidney disease (CKD) has mostly relied on self-reported smoking status. We aimed to compare the associations of smoking status as assessed by self-reports and urine cotinine with CKD risk. Using the PREVEND prospective study, smoking status was assessed at baseline using self-reports and urine cotinine in 4333 participants (mean age, 52 years) without a history of CKD at baseline. Participants were classified as never, former, light current and heavy current smokers according to self-reports and comparable cut-offs for urine cotinine. Hazard ratios (HRs) with 95% CIs were estimated for CKD. The percentages of self-reported and cotinine-assessed current smokers were 27.5% and 24.0%, respectively. During a median follow-up of 7.0 years, 593 cases of CKD were recorded. In analyses adjusted for established risk factors, the HRs (95% CI) of CKD for self-reported former, light current, and heavy current smokers compared with never smokers were 1.17 (0.95-1.44), 1.48 (1.10-2.00), and 1.48 (1.14-1.93), respectively. On further adjustment for urinary albumin excretion (UAE), the HRs (95% CI) were 1.07 (0.87-1.32), 1.26 (0.93-1.70), and 1.20 (0.93-1.57), respectively. For urine cotinine-assessed smoking status, the corresponding HRs (95% CI) were 0.81 (0.52-1.25), 1.17 (0.92-1.49), and 1.32 (1.02-1.71), respectively, in analyses adjusted for established risk factors plus UAE. Self-reported current smoking is associated with increased CKD risk, but dependent on UAE. The association between urine cotinine-assessed current smoking and increased CKD risk is independent of UAE. Urine cotinine-assessed smoking status may be a more reliable risk indicator for CKD incidence than self-reported smoking status.

Validation of Urinary Thiocyanate as a Robust Biomarker of Active Tobacco Smoking in the Prospective Urban and Rural Epidemiological Study.

Tobacco smoking is a leading preventable cause of premature death globally. Urinary thiocyanate is a biomarker of cyanide exposure from tobacco smoke; however, few studies have evaluated its utility in diverse populations of smokers. We examined the associations between urinary thiocyanate and self-reported never and current smokers among 1000 participants from 14 countries in the Prospective Urban and Rural Epidemiological study. We analyzed urinary thiocyanate in light and heavy smokers as compared to never-smokers from high- (HICs), middle- (MICs), and low-income countries (LICs) using a validated capillary electrophoresis method in conjunction with standardized questionnaires. The median urinary thiocyanate concentration was 31 μM, which ranged from 8.6 μM to 52 μM for never-smokers (n = 335) and current smokers (n = 660), respectively. Urinary thiocyanate was correlated with daily cigarette consumption (r = 0.621) and total nicotine equivalents (r = 0.514). Thiocyanate also displayed a better dose-response than urinary cotinine. A moderate association of urinary thiocyanate was found in biochemically verified never-smokers (r ~0.38) because of intake of vegetables, fruits, and dairy. Receiver-operating characteristic curves established cutoff values for urinary thiocyanate to differentiate current from never-smokers with an optimal threshold of 23.9 μM (Area Under the Curve or AUC = 0.861), which lowered progressively from HICs, MICs, and LICs. Elevated thiocyanate was evident in current smokers from high-income countries likely reflecting differences in smoking topography and greater toxicant burden. Background urinary thiocyanate in never-smokers was associated with goitrogenic food intake that obscured detection of secondhand smoke exposure. Urinary thiocyanate is a sensitive biomarker of active tobacco smoking relative to cotinine that can be measured by an inexpensive capillary electrophoresis assay. Regional cutoff values are demonstrated to improve discrimination of smoking status in developing countries because of differences in smoking habits and cigarette products consumed, as well as intake of goitrogenic foods. Urinary thiocyanate may allow for more reliable estimates of the hazards of tobacco smoking between countries with varying socioeconomic development as compared to self-reports.

Agreement between nicotine metabolites in blood and self-reported smoking status: The Netherlands Epidemiology of Obesity study

IntroductionSelf-report and nicotine detection are methods to measure smoking exposure and can both lead to misclassification. It is important to highlight discrepancies between these two methods in the context of epidemiological research. ObjectiveThe aim of this cross-sectional study is to assess the agreements between self-reported smoking status and nicotine metabolite detection. MethodsData of 599 participants from the Netherlands Epidemiology of Obesity study were used to compare serum metabolite levels of five nicotine metabolites (cotinine, hydroxy-cotinine, cotinine N-Oxide, norcotinine, 3-hydroxy-cotinine-glucuronide) between self-reported never smokers (n = 245), former smokers (n = 283) and current smokers (n = 71). We assessed whether metabolites were absent or present and used logistic regression to discriminate between current and never smokers based on nicotine metabolite information. A classification tree was derived to classify individuals into current smokers and non/former smokers based on metabolite information. ResultsIn 94% of the self-reported current smokers, at least one metabolite was present, versus in 19% of the former smokers and in 10% of the never smokers. In none of the never smokers, cotinine-n-oxide, 3-hydroxy-cotinine-n-glucorinide or norcotinine was present, while at least one of these metabolites was detected in 68% of the self-reported current smokers. The classification tree classified 95% of the participants in accordance to their self-reported smoking status. All self-reported smokers who were classified as non-smokers according to the metabolite profile, had reported to be occasional smokers. ConclusionThe agreement between self-reported smoking status and metabolite information was high. This indicates that self-reported smoking status is generally reliable.

Does genetic variation in a bitter taste receptor gene alter early smoking behaviours in adolescents and young adults?

Variation in the TAS2R38 taste receptor gene alters the ability to taste bitter compounds. We tested whether TAS2R38 variation influences early smoking behaviours in adolescence, a critical period of acquisition when taste may influence the natural course of tobacco use. Observational study (Nicotine Dependence in Teens [NDIT]). Cox proportional hazards models were conducted using data from European ancestry adolescent participants who initiated smoking during follow-up (n = 219, i.e. incident smokers). In young adulthood, cross-sectional analyses were restricted to European ancestry self-reported current smokers at age 24 (n = 148). Montréal, Canada. In adolescents, the rates of attaining early smoking milestones were estimated for tasters {PAV diplotypes (i.e. PAV/PAV or PAV/AVI)} versus non-tasters {AVI diplotype (i.e. AVI/AVI)}. In young adults, associations between tasting status and a nicotine intake biomarker (cotinine + 3'hydroxycotinine) and past-week cigarette consumption were assessed. Among incident smokers, similar rates to first whole cigarette were found between the diplotype groups (hazard ratio [HR], 1.05; 95% confidence interval (CI), 0.75-1.48; P = 0.765). However, smokers with the PAV (vs AVI) diplotypes attained monthly smoking more rapidly (HR, 1.55; 95% CI, 1.04-2.32; P = 0.033) and had faster conversion to three different measures of tobacco dependence (International Classification of Diseases: HR,2.29; 95% CI, 0.99-5.28; P = 0.052; modified Fagerström Tolerance Questionnaire: HR, 3.02, 95% CI, 1.04-8.79; P = 0.043; Hooked on Nicotine Checklist: HR,1.87; 95% CI, 0.98-3.60; P = 0.059). At age 24, those with PAV (vs AVI) diplotypes had higher mean cotinine + 3'hydroxycotinine (197 vs 143 ng/mL; P = 0.053). Adolescents with a genetic variation increasing their ability to taste bitter compounds appear to escalate more quickly to monthly smoking and tobacco dependence during adolescence and have higher nicotine intake in young adulthood versus those without that genetic variation.

Expired Air Carbon Monoxide Testing Is Effective for Preoperative Screening of Cigarette Use in Orthopaedic Patients: A Prospective Pilot Study of 70 Veterans

Introduction: Screening for cigarette use is standard in the orthopedic pre-operative clinic, however traditional biochemical testing methods, including serum and urine cotinine assays, do not differentiate active smoking from nicotine replacement therapy (NRT). In this prospective pilot study, we hypothesize that exhaled carbon monoxide (eCO) testing will be non-inferior to the gold standard serum cotinine (SC) test in screening for pre-operative cigarette use, will differentiate active smoking from NRT, and will allow for substantial cost savings in a clinic setting. Methods: Adult orthopaedic veterans indicated for elective surgery at our institution were offered inclusion. Self-reported smoking status (SRS), eCO and SC levels were obtained preoperatively. An eCO level of &gt;6 parts per million and a SC level &gt;3 ng/ml were considered positive for recent cigarette use. Agreement between SRS, eCO levels and SC levels, and eCO level test-retest reliability were evaluated. Results: Of the 55 patients enrolled into the study, 4 were self-reported Current Smokers and 51 were self-reported Ex-Smokers or Non-Smokers. Combining SRS with eCO levels as a screening tool for recent cigarette use yielded a sensitivity of 100%, a specificity of 98%, a positive predictive value of 95% and a negative predictive value of 100%. eCO testing differentiated NRT from cigarette use in all non-smoking patients. Test-retest reliability for eCO levels showed perfect agreement for 16 patients that had two or more eCO levels pre-operatively. Conclusion: Exhaled CO testing is as effective as SC testing but can differentiate active smoking from NRT, while maintaining a high level of accuracy and reliability when combined with SRS as a screening tool.

Comparative evaluation of cognitive behavioral therapy and regular health education in reducing nicotine dependence among cigarette smokers: A randomized controlled trial

Introduction: It is important to introspect if the methods used in tobacco cessation counseling are effective in achieving abstinence and reducing nicotine dependence among tobacco users. The objective of this study was to evaluate the effectiveness of cognitive behavioral therapy (CBT) at tobacco cessation clinics in a teaching dental institution in reducing nicotine dependence among dental patients with the habit of cigarette smoking in comparison to regular health education to quit tobacco. Materials and Methods: This prospective, randomized controlled trial was conducted in a teaching dental institution in the state of Andhra Pradesh. 160 self-reported current cigarette smokers with no tobacco chewing habits participated in the study. 80 each were assigned to the intervention group and control group where CBT for cessation of cigarette smoking and regular health education to quit smoking were provided, respectively. Data relating to frequency of cigarette smoking and nicotine dependence scores using Fagerstrom nicotine dependence scale were collected at baseline. Both the groups were followed up for 4 months in two-monthly intervals. IBM SPSS version 20 software was used for data analysis. Results: While there was no significant difference in the mean nicotine dependence score between the study groups at baseline, a statistically significant difference was observed between the groups at follow up visits. Repeated measures analysis of variance revealed significant reduction in nicotine dependence scores with time in the intervention group (P = 0.004), whereas the differences in the control group between different study time points were not significant (P = 0.39). It was also observed that the frequency of cigarette smoking reduced significantly between the baseline and follow-up visits in the intervention group (Cochran's Q-test; P = 0.028). Conclusion: The findings of this study provide an insight into the fact that CBT as tobacco cessation counseling technique is effective in reducing nicotine dependence among subjects seeking oral health care.

Abstract 14735: Volatile Organic Compounds Are Associated With Lower Ankle-Brachial Indexes in African Americans of the Jackson Heart Study

Introduction: Cigarette smoking is associated with peripheral artery disease (PAD) in African Americans (AA), but the association between cigarette constituents and PAD remain inadequately studied. We evaluated the effect of volatile organic compounds (VOC) acrolein and crotonaldehyde on ankle-brachial index (ABI) as well as related biomarkers in AA participants of the Jackson Heart Study. Methods: Urinary VOC concentrations were measured in a subset of participants at baseline including 345 self-reported current smokers and 718 never smokers. Multivariable linear regression assessed the association between ABI and VOC concentrations after adjustment for acute (cotinine) and chronic (pack-years) smoking measures in models 1 and 2, respectively. The degree of association was assessed after adjusting for possible mediation (Baron &amp; Kenny procedure) by C-reactive protein (CRP), fibrinogen, and homocysteine (HCY) concentrations. VOC concentrations were natural log transformed for normal distribution and all models adjusted for relevant covariates. Results: The mean age of included participants was 52 years and 49% women. Individuals who smoked were more likely to be men, less educated, have prevalent cardiovascular disease, and lower mean ABI. In model 1, ABI was inversely associated with urinary acrolein and crotonaldehyde concentrations. Model 2 retained the inverse ABI association for both VOC. Crotonaldehyde was directly associated with CRP and HCY in models 1 and 2. In model 1, acrolein was associated with HCY (Table). Biomarker mediation of the VOC-ABI relationship was insignificant. Conclusions: Acrolein and crotonaldehyde concentrations are associated with lower ABI and higher measures of inflammation and thrombosis in a community-based sample of AA. These findings suggest reduction in VOC exposure may reduce the risk of PAD in AA who smoke cigarettes.

Machine learning to identify and understand key factors for provider-patient discussions about smoking.

We sought to identify key determinants of the likelihood of provider-patient discussions about smoking and to understand the effects of these determinants. We used data on 3666 self-reported current smokers who talked to a health professional within a year of the time the survey was conducted using the 2017 National Health Interview Survey. We included wide-ranging information on 43 potential covariates across four domains, demographic and socio-economic status, behavior, health status and healthcare utilization. We exploited a principled nonparametric permutation based approach using Bayesian machine learning to identify and rank important determinants of discussions about smoking between health providers and patients. In the order of importance, frequency of doctor office visits, intensity of cigarette use, length of smoking history, chronic obstructive pulmonary disease, emphysema, marital status were major determinants of disparities in provider-patient discussions about smoking. There was a distinct interaction between intensity of cigarette use and length of smoking history. Our analysis may provide some insights into strategies for promoting discussions on smoking and facilitating smoking cessation. Health care resource usage, smoking intensity and duration and smoking-related conditions were key drivers. The "usual suspects", age, gender, race and ethnicity were less important, and gender, in particular, had little effect.

Association between Cigarette Smoking and New-Onset Diabetes Mellitus in 78,212 Koreans Using Self-Reported Questionnaire and Urine Cotinine.

BackgroundNo study has assessed association between cigarette smoking and new-onset diabetes mellitus (NODM) incidence using two different smoking classification systems: self-reported questionnaire and urine cotinine. The objective of this longitudinal study was to evaluate NODM risk using the above two systems in Korean adults.MethodsAmong individuals enrolled in Kangbuk Samsung Health Study and Cohort Study who visited between 2011 and 2012 at baseline and 2014 at follow-up, 78,212 participants without baseline diabetes mellitus were followed up for a median of 27 months. Assessment of NODM incidence was made at the end of follow-up period. Cotinine-verified current smoking was having urinary cotinine ≥50 ng/mL.ResultsPercentages of self-reported and cotinine-verified current smokers were 25.9% and 23.5%, respectively. Overall incidence of NODM was 1.5%. According to multivariate regression analyses, baseline self-reported current smoking (relative risk [RR], 1.33; 95% confidence interval [CI], 1.07 to 1.65) and cotinine-verified current smoking (RR, 1.27; 95% CI, 1.08 to 1.49) increased NODM risk compared to baseline self-reported never smoking and cotinine-verified current non-smoking. Higher daily amount and longer duration of smoking were also associated with increased NODM risk (P for trends <0.05). In particular, self-reported current smokers who smoked ≥20 cigarettes/day (RR, 1.62; 95% CI, 1.25 to 2.15) and ≥10 years (RR, 1.34; 95% CI, 1.08 to 1.67) had the highest RRs for NODM. These results remained significant in males, although there was no gender interaction.ConclusionThis longitudinal study showed that baseline self-reported and cotinine-verified current smoking were associated with increased risks of NODM, especially in males.

Association Between Cotinine-verified Smoking Status and Risk of Colorectal Neoplasia.

We evaluated the association of urinary cotinine-verified smoking status with the risk of colorectal neoplasia (CRN). Many studies have reported the association between the risk of CRN and smoking status, based on self-reported questionnaires. Although self-reported smoking status may be inaccurate, to our knowledge, no study has yet assessed the association between objective biomarkers of tobacco exposure and the risk of CRN. A cross-sectional study was conducted on 96,806 asymptomatic examinees who underwent colonoscopy and urinary cotinine measurements as part of a health check-up. Cotinine-verified current smokers were participants having a urinary cotinine level ≥50 ng/mL. The mean participant age was 38.4 years, and the proportion of cotinine-verified current smokers was 23.0%. Cotinine-verified current smoking was an independent risk factor for CRN [adjusted odds ratio (AOR), 1.49; 95% confidence interval (CI), 1.42-1.56] and advanced CRN (ACRN) (AOR, 1.79; 95% CI, 1.57-2.05). Moreover, the risk of CRN and ACRN increased with increasing cotinine levels. Among self-reported never smokers, cotinine-verified current smokers had a higher risk of CRN (AOR, 1.77; 95% CI, 1.57-2.00) and ACRN (AOR, 1.94; 95% CI, 1.37-2.74) than cotinine-verified never smokers did, whereas among self-reported current smokers, cotinine-verified never smokers had a lower risk of CRN (AOR, 0.78; 95% CI, 0.70-0.87) and ACRN (AOR, 0.71; 95% CI, 0.52-0.98) than cotinine-verified current smokers did. Cotinine-captured smoking status and metabolic variation exhibit associations with CRN more accurately and objectively than self-reporting does, providing clearer evidence for the role of tobacco in the development of CRN.

Association between cigarette smoking and diabetes mellitus using two different smoking stratifications in 145 040 Korean individuals: Self-reported questionnaire and urine cotinine concentrations.

Although previous studies have assessed the relationship between smoking and diabetes using self-reported questionnaires, interpretations may be limited by an underestimation of the actual smoking population. This study evaluated the relationship between smoking and diabetes using both self-reported questionnaires and urine cotinine concentrations. The present cross-sectional study enrolled 145 040 Koreans in Kangbuk Samsung Health and Cohort Studies between 2011 and 2013. Urinary cotinine was measured after a 10-hour smoking-free period. Cotinine-verified current smoking was defined as a urinary cotinine concentrations ≥50 ng/mL. Overall diabetes prevalence in self-reported (4.5% vs 1.6%) and cotinine-verified (4.4% vs 2.1%) current smokers was higher than in self-reported and cotinine-verified never smokers. Multivariate regression analysis showed that cotinine-verified current smoking (odds ratio [OR] 1.25; 95% confidence interval [CI] 1.13-1.38), self-reported former smoking (OR 1.16; 95% CI 1.01-1.33) and current smoking (OR 1.33; 95% CI 1.17-1.50) were associated with increased diabetes compared with cotinine-verified and self-reported never smoking. Unobserved smoking (OR 1.79; 95% CI 1.20, 2.66) also increased the odds for diabetes. There were no significant sex interactions in the analyses. This study shows that self-reported former and current smoking, cotinine-verified current smoking, and unobserved smoking (i.e. self-reported never smoking with urine cotinine >50 ng/mL) are all associated with increased diabetes prevalence. These findings suggest that cotinine could provide additional information when assessing cardiometabolic risks, such as diabetes.

The association between self-reported versus nicotine metabolite-confirmed smoking status and coronary artery calcification.

There are no data comparing the relationship between coronary artery calcification and self-reported and cotinine-verified smoking. This study was carried out to evaluate the relationship between coronary artery calcium (CAC) and urinary cotinine or self-reported smoking status in Korean adults. Study participants included 22 797 individuals (19 181 men; mean age±SD 39.2±7.1 years) who were enrolled in the Kangbuk Samsung Health Study and Kangbuk Samsung Cohort Study between 2011 and 2013, and who had urinary cotinine and CAC measurements. Cotinine-verified current smokers were defined as having a urinary cotinine level of above 50 ng/ml. The prevalence of never smokers, former smokers, and current smokers according to the self-reported questionnaires was 44.6, 24.2, and 31.2%, respectively, and that of cotinine-verified current smokers was 30.2%. The prevalence of the presence of CAC in self-reported current smokers was higher than that in self-reported never/former smokers (13.7 vs. 10.2%, P<0.001), and that in cotinine-verified current smokers was higher than that in cotinine-verified never smokers (14.0 vs. 10.2%, P<0.001). A multivariate logistic regression model adjusted for the variables with univariate relationships showed that self-reported former smokers and current smokers had significantly increased odds ratio (OR) for the presence of CAC compared with self-reported never smokers [OR (95% confidence interval): 1.20 (1.03-1.40) in former smokers and 1.29 (1.11-1.50) in current smokers]. Cotinine-verified current smokers also showed a significant association with the presence of CAC [1.23 (1.12-1.35)]. Furthermore, log-transformed cotinine levels increased the OR for the presence of CAC [1.03 (1.01-1.05)]. This study is the first large cohort study to show that both self-reported and cotinine-verified smoking is associated independently with the presence of CAC in Korean adults.

Association between cotinine-verified smoking status and risk of nonalcoholic fatty liver disease.

The relationship between cigarette smoking and nonalcoholic fatty liver disease (NAFLD) has been controversial. Most relevant studies have relied on self-reported questionnaires. We aimed to elucidate the association between smoking status and NAFLD using an objective biomarker of tobacco exposure (urinary cotinine) and self-reported questionnaire. A cross-sectional study was conducted on 160862 asymptomatic examinees who underwent abdominal ultrasonography and urinary cotinine measurements between April 2011 and December 2015. Cotinine-verified current smokers were defined as participants with urinary cotinine levels ≥50ng/mL. The mean age of the study population was 36.1years, and the proportion of men was 51.7%. The proportions of self-reported and cotinine-verified current smokers were 17.6% and 17.7% respectively. After adjusting for confounding factors, self-reported current smoking was associated with an increased risk of NAFLD (adjusted odds ratio [AOR], 1.10; 95% confidence interval [CI], 1.06-1.14). Moreover, among the current smokers, the risk of NAFLD increased with an increase in the amount of cigarette smoking (<10 and ≥10 pack-years vs never smokers; AOR, 1.04 and 1.11; 95% CI, 1.01-1.08 and 1.05-1.16 respectively). Cotinine-verified current smoking was also associated with an increased risk of NAFLD (AOR, 1.10; 95% CI, 1.06-1.14). Cotinine-verified current smoking and self-reported current smoking were independent risk factors for NAFLD. Further longitudinal studies are needed to more clearly elucidate the impact of smoking on the development of NAFLD.

The relationship between smoking intensity and subclinical cardiovascular injury: The Multi-Ethnic Study of Atherosclerosis (MESA)

Background and aimsModern tobacco regulatory science requires an understanding of which biomarkers of cardiovascular injury are most sensitive to cigarette smoking exposure. MethodsWe studied self-reported current smokers from the Multi-Ethnic Study of Atherosclerosis. Smoking intensity was defined by number of cigarettes/day and urinary cotinine levels. Subclinical cardiovascular injury was assessed using markers of inflammation [high-sensitivity C-reactive protein (hsCRP), interleukin 6 & 2 (IL-2 & IL-6), tumor necrosis factor alpha (TNF-α)], thrombosis (fibrinogen, D-dimer, homocysteine), myocardial injury (troponin T; TnT), endothelial damage (albumin: creatinine ratio), and vascular function [aortic & carotid distensibility, flow-mediated dilation (FMD)]. Biomarkers were modeled as absolute and percent change using multivariable-adjusted linear regression models adjusted for cardiovascular risk factors and smoking duration. ResultsAmong 843 current smokers, mean age was 58 (9) years, 53% were men, 39% were African American, mean number of cigarettes per day was 13 (10), and median smoking duration was 39 (15) years. Cigarette count was significantly associated with higher hsCRP, IL-6 and fibrinogen (β coefficients: 0.013, 0.011, 0.60 respectively), while ln-transformed cotinine was associated with the same biomarkers (β coefficients: 0.12, 0.04, 5.3 respectively) and inversely associated with aortic distensibility (β coefficient: −0.13). There was a limited association between smoking intensity and homocysteine, D-dimer, and albumin:creatinine ratio in partially adjusted models only, while there was no association with IL-2, TNF-α, carotid distensibility, FMD, or TnT in any model. In percent change analyses, relationships were strongest with hsCRP. ConclusionsSmoking intensity was associated with early biomarkers of CVD, particularly, markers of systemic inflammation. Of these, hsCRP may be the most sensitive.

Lipid Distribution Differentials among Smokers, Non-Smokers and within Various Types of Smokers

Data from National Health and Nutrition Examination Survey for those aged >=20 years fasting for at least 8 hours for the years 1999-2012 were used to evaluate adjusted and unadjusted differences in the levels of lowdensity- lipoprotein-cholesterol (LDL), high-densitylipoprotein- cholesterol (HDL), total cholesterol (TC), and triglyceride (TG) among self-reported current smokers and nonsmokers as well as smokers smoking cigarettes, pipes, cigars etc. Adjustments were made for the effects of gender; race/ethnicity; dietary intake of alcohol, caffeine, fatty acids, saturated and total fat; fasting time; body mass index; and frequency and intensity of smoking during the last five days. Adjusted levels of LDL, TC, and TG did not vary among smokers and nonsmokers but contrary to what could be expected, smokers were observed to have high HDL levels than nonsmokers (52.2 vs. 50.1 mg/dL, p=0.02). However, in the unadjusted analysis, smokers were found to have lower levels of HDL (48.2 vs. 52.1 mg/dL, p<0.01) and higher levels of TG (123.2 vs. 113.5 mg/dL, p<0.01) than nonsmokers but the differences for LDL (112.9 vs. 112.5 mg/dL, p=0.68) and TC (193.4 vs. 194.3 mg/dL, p=0.39) remained statistically insignificant. Adjusted levels of HDL, TC, and LDL levels did not differ among exclusive cigarette and cigar users and exclusive tobacco chewers and snuffers. Exclusive cigarette and cigar users had higher adjusted levels of TG than exclusive tobacco snuffers (125.7 and 133.8 vs. 101.5 mg/dL, p<0.01).

An organisational change intervention for increasing the delivery of smoking cessation support in addiction treatment centres: study protocol for a randomized controlled trial

BackgroundThe provision of smoking cessation support in Australian drug and alcohol treatment services is sub-optimal. This study examines the cost-effectiveness of an organisational change intervention to reduce smoking amongst clients attending drug and alcohol treatment services.Methods/designA cluster-randomised controlled trial will be conducted with drug and alcohol treatment centres as the unit of randomisation. Biochemically verified (carbon monoxide by breath analysis) client 7-day-point prevalence of smoking cessation at 6 weeks will be the primary outcome measure. The study will be conducted in 33 drug and alcohol treatment services in four mainland states and territories of Australia: New South Wales, Australian Capital Territory, Queensland, and South Australia. Eligible services are those with ongoing client contact and that include pharmacotherapy services, withdrawal management services, residential rehabilitation, counselling services, and case management services. Eligible clients are those aged over 16 years who are attending their first of a number of expected visits, are self-reported current smokers, proficient in the English language, and do not have severe untreated mental illness as identified by the service staff. Control services will continue to provide usual care to the clients. Intervention group services will receive an organisational change intervention, including assistance in developing smoke-free policies, nomination of champions, staff training and educational client and service resources, and free nicotine replacement therapy in order to integrate smoking cessation support as part of usual client care.DiscussionIf effective, the organisational change intervention has clear potential for implementation as part of the standard care in drug and alcohol treatment centres.Trial registrationAustralian and New Zealand Clinical Trials Registry, ACTRN12615000204549. Registered on 3 March 2015.Electronic supplementary materialThe online version of this article (doi:10.1186/s13063-016-1401-6) contains supplementary material, which is available to authorized users.

Cancer Screening Adherence of Asian Women According to Biochemically-verified Smoking Status: Korea National Health and Nutrition Examination Survey.

Men and women who smoke tend to show less compliance to screening guidelines than non- smokers. However, a recent study in Korea showed that self-reported female smokers constituted less than half of cotinine-verified smokers. Therefore, the aim of this study was to identify hidden smokers using cotinine- verified method and examine cancer screening behavior according to biochemically verified smoking status. Among 5,584 women aged 30 years and older who participated in the Fourth and Fifth Korea National Health and Nutrition Examination Survey (KNHANES), 372 (6.66%) hidden smokers were identified based on interview responses and verified by urinary cotinine levels. We compared cancer-screening behavior (cervical, breast, stomach, and colon cancer) of female hidden smokers to that of non-smokers and self- reported smokers by cross-sectional analysis. Hidden female smokers had significantly lower adherence to breast cancer screening compared to non-smokers (aOR (adjusted odds ratio) [95% CI] = 0.71 [0.51-0.98]). Adherence to stomach cancer (aOR [95% CI] = 0.75 [0.54-1.03]) and cervical cancer (aOR [95% CI] = 0.85 [0.66-1.10]) screening was also lower among hidden female smokers compared to non-smokers. Self-reported (current) smokers showed lowest adherence to cervical cancer (aOR: 0.64, 95% CI0.47-0.87), breast cancer (0.47 [0.32-0.68]), stomach cancer (0.66[0.46-0.95]), and colon cancer (0.62 [0.38-1.01]) screening compared to non-smokers, followed by female hidden smokers, then non-smokers. These lower adherence rates of current smokers were attenuated after we incorporated hidden smokers into the current smoker group. Cancer screening adherence of female hidden smokers was lower than cotinine-verified non-smokers but higher than current smokers. Considering the risk of smoking-related cancer among women, identifying hidden smokers is important to encourage appropriate cancer screening.

Gender differences in risk factors of benign vocal fold disease in Korea: the fifth Korea National Health and Nutritional Examination Survey

The aim of this study was to confirm the prevalence rate of benign vocal fold disease (BVFD) based on gender in the Korean adult population and investigate potential risk factors of BVFD. Subjects were 8,677 non-institutionalized civilian adults over the age of 19 (3,788 males and 4,899 females) who completed the laryngeal examination of the fifth Korea National Health and Nutrition Examination Survey. Poisson regression analyses were conducted to examine the potential risk factors of BVFD. The prevalence rates of BVFD were similar in men (2.7%) and women (2.6%). When adjusted for covariates, men with self-reported voice problems had a 6.7 times greater risk (RR 6.72, 95% CI 4.17–10.84) of BVFD (P < 0.01). In addition, women with self-reported voice problems (RR 4.71, 95% CI 3.01–7.37) and current smokers (RR 1.97, 95% CI 1.01–3.81) were more likely to have BVFD (P < 0.01). There are gender differences in the risk factors of BVFD. In order to prevent BVFD, the enactment of guidelines reflecting gender differences is required.

Physician-prescribed Asthma Treatment Regimen does not differ Between Smoking and Non-smoking Patients With Asthma in Seoul and Gyunggi province of Korea.

PurposeSmoking has detrimental effects on asthma symptom control and response to treatment and is prevalent among asthma patients in South Korea. The aim of this study is to determine the prevalence of smoking among asthma patients in South Korea and to compare the medication regimens of asthma patients who do and do not smoke.MethodsA cross-sectional survey was conducted from August 2010 to January 2011. Participating physicians (N=25) recorded demographic and clinical data on all asthma patients presenting during the study period (N=2,032), and then recruited a subset of patients (N=500) for the survey such that half were self-reported current smokers. Recruited patients were between the ages of 18 and 60.ResultsAmong presenting asthma patients, 17.3% were current smokers, 19.2% were former smokers, and 63.5% had never smoked. Within the analyzable study population (N=471), 212 patients reported smoking currently, 79 smoking formerly, and 180 never smoking. Among current and former smokers, 79.7% and 81.0%, respectively, were men, while women represented 80.5% of patients who had never smoked. Agreement was strong between physician-determined smoking status and patient-reported smoking status (κ=0.82; P<0.001). However, asthma medication regimens examined according to GINA treatment steps did not differ by smoking status. In addition, mean quality of life scores and level of asthma control did not differ by smoking status.ConclusionsIn South Korea, physicians are well aware of the smoking status of their patients. However, smoking status did not affect the prescribed medication regimens of this population of asthma patients.