Self-reported Current Smoking Research Articles

Cigarette smoking and prostate cancer aggressiveness among African and European American men.

Smoking is a modifiable lifestyle factor that has not been established as a prostate cancer risk factor, nor emphasized in prostate cancer prevention. Studies have shown that African American (AA) smokers have a poorer cancer prognosis than European Americans (EAs), while having a lower prevalence of heavy smoking. We examined the relationship between cigarette smoking and prostate cancer aggressiveness and assessed racial differences in smoking habits on the probability of high-aggressive prostate cancer. Using data from the North Carolina-Louisiana Prostate Cancer Project (n = 1,279), prostate cancer aggressiveness was defined as high or low based on Gleason scores, serum prostate-specific antigen levels, and tumor stage. Cigarette smoking was categorized as current, former, or never smokers. Multivariable logistic regression was used to estimate adjusted odds ratios (OR) and 95% confidence intervals (CI). Self-reported current (OR = 1.99; 95% CI 1.30-3.06) smoking was associated with high-aggressive prostate cancer relative to never smokers. When stratified by self-reported race, the odds of having high-aggressive cancer increased among AA current (OR = 3.58; 95% CI 2.04-6.28) and former smokers (OR = 2.21; 95% CI 1.38-3.53) compared to AA never smokers, but the odds were diminished among the EA stratum (Pself-reported race x smoking status = 0.003). Cigarette smoking is associated with prostate cancer aggressiveness, a relationship modulated by self-reported race. Future research is needed to investigate types of cigarettes smoked and metabolic differences that may be contributing to the racial disparities observed.

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.

Association of Race-Ethnicity Intersection with Disparities in Cigarette Smoking in US Adults.

Detailed estimates of disparities in cigarette smoking across single- and multi-race groups and their intersections with ethnicity are lacking. This study estimates the prevalence of self-reported current smoking among intersecting adult race-ethnicity groups in the United States. The analysis uses 2018-2019 data from the Tobacco Use Supplement - Current Population Supplement (TUS-CPS; n=137,471). Self-reported Hispanic origin and race were recoded into 19 mutually-exclusive race by ethnicity intersecting groups. Weighted race-ethnicity group smoking prevalence were compared to the overall population prevalence and one another. Compared to the US population current smoking prevalence (11.4% [95% CI=11.2%-11.6%]), smoking was particularly higher in non-Hispanic American Indian/Alaska Native (AI/AN) groups (20.7% [95% CI=17.8%-24.0%]) and non-Hispanic multiracial AI/AN/White (24.4% [95% CI = 20.3%-29.1%]) and AI/AN/Black (22.4% [95% CI = 14.4%-33.2%]) groups. Non-Hispanic single-race Asian (5.0% [95% CI = 4.4%-5.6%]) and Hispanic single-race White (7.2% [95% CI = 6.7%-7.7%]) smoking prevalence undercut the overall US population prevalence. In pairwise comparisons, smoking prevalence was higher in various non-Hispanic single- and multi-race AI/AN groups than non-AI/AN groups and was lower in various Hispanic groups than non-Hispanic groups. Smoking prevalence disparities are not monolithic across complex diversity of race and ethnicity in the US. Accurate identification of priority populations in need of targeted tobacco control efforts may benefit by acknowledging multinomial heterogeneity across intersecting racial and ethnic identities. Understanding racial and ethnic disparities in cigarette smoking can inform national strategies for reducing health inequities. This study examines cigarette smoking disparities among 19 adult intersecting race-ethnicity groups in the United States using the 2018-2019 TUS-CPS data. Results show higher smoking rates in some non-Hispanic American Indian/Alaska Native and Black groups, while lower rates are seen in Asian and Hispanic individuals. These findings emphasize the need for disaggregated data to tackle smoking disparities and guide targeted prevention efforts.

Association between tobacco control policies and smoking behaviour in Europe

Abstract Background Smoking is an important public health problem. The European Health Interview Survey (EHIS) provides regular data on prevalence and determinants of smoking for the populations of European countries, while the Tobacco Control Scale (TCS) quantifies the implementation of tobacco control measures. The aim is to examine the associations between tobacco control policies at country level and individual-level smoking prevalence. Methods Using multi-level regression modelling, individual data from EHIS 2019/2020 and country-level data from TCS 2019 were analysed. The outcome measure was self-reported current smoking (daily or occasional) at the individual level. Predictor variables were at the individual level: gender, age and education attainment level, and at country level: scores of TCS policy components ‘Price', ‘Public place bans', ‘Advertising bans', ‘Health warnings', ‘Treatment’ and ‘Illicit trade'. Microdata from the 3rd wave of EHIS for 28 European countries were used with a total of n = 66.934 individuals aged &amp;gt;15 years. A weighting factor was applied to consider each country proportionally according to its sample size in EHIS. Results There are large cross-national differences in current smoking prevalence ranged from 12.6% (95% confidence interval (CI) 11.9-13.3) in Sweden to 36.2% (95% CI 35.0-37.4) in Bulgaria. In the final multi-level model besides individual variables (female gender, age 60 years and over, medium or high education level), following variables at country level were significantly associated with lower prevalence of current smoking: ‘Price’ (Odds Ratio (OR)=0.96 (p &amp;lt; 0.05) and ‘Treatment’ OR = 0.88; (p &amp;lt; 0.01). For ‘Public place bans', ‘Advertising bans', ‘Health warnings’ and and ‘Illicit trade’ association were in same direction but without significance. Conclusions Tobacco control policies help to reduce the prevalence of smoking in population, although the different measures have differing impact. Key messages • Our study confirms the link between the implementation of tobacco control policies and smoking prevalence using recent data. • Policy components have different effects on smoking prevalence at population level.

Blood RNA and protein biomarkers are associated with vaping and dual use, and prospective health outcomes

Background: Electronic nicotine delivery systems (ENDS) are driving an epidemic of vaping. Identifying biomarkers of vaping and dual use (concurrent vaping and smoking) will facilitate studies of the health effects of vaping. To identify putative biomarkers of vaping and dual use, we performed association analysis in an observational cohort of 3,892 COPDGene study participants with blood transcriptomics and/or plasma proteomics data and self-reported current vaping and smoking behavior. Methods: Biomarkers of vaping and dual use were identified through differential expression analysis and related to prospective health events over six years of follow-up. To assess the predictive accuracy of multi-biomarker panels, we constructed predictive models for vaping and smoking categories and prospective health outcomes. Results: We identified three transcriptomic and three proteomic associations with vaping, and 90 transcriptomic and 100 proteomic associations to dual use. Many of these vaping or dual use biomarkers were significantly associated with prospective health outcomes, such as FEV1 decline (three transcripts and 62 proteins), overall mortality (18 transcripts and 73 proteins), respiratory mortality (two transcripts and 23 proteins), respiratory exacerbations (13 proteins) and incident cardiovascular disease (24 proteins). Multimarker models showed good performance discriminating between vaping and smoking behavior and produced informative, modestly powerful predictions of future FEV1 decline, mortality, and respiratory exacerbations. Conclusions: In summary, vaping and dual use are associated with RNA and protein blood-based biomarkers that are also associated with adverse health outcomes.

Carbon monoxide monitoring to objectively measure smoking status in cardiac rehabilitation.

Participation in cardiac rehabilitation (CR) is associated with reduced morbidity and mortality. However, most programs rely on self-report measures when assessing the critical risk factor of smoking. This study examined smoking status using self-report versus objective measurement using expired carbon monoxide (CO) and compared patient characteristics by CO level. Patients were screened for smoking status when entering CR by self-report and by objectively measured CO. Measures of aerobic fitness, educational attainment, depressive symptoms, and self-reported physical function were also collected. The discrepancy between smoking status based on self-report and objective measurement was examined and patient characteristics by CO measurement were compared. Of the 853 patients screened, 62 self-reported current smoking and 112 had a CO of ≥ 4 ppm. Using a cut-off of ≥ 4 ppm encompassed almost all self-reported smokers (specificity: 98.5%) and identified 61 patients (not reporting current smoking) needing further screening. Further questioning yielded an additional 21 patients with combusted use (tobacco/cannabis), six nonsmoking patients with environmental CO exposure, and 34 where the reason for elevated CO was unknown. CO ≥ 4 ppm patients were younger (62.2 vs. 67.7, p < .01), had higher depression scores (5.6 vs. 3.7, Patient Health Questionairre-9, p < .01), had lower educational attainment (59.0% ≤ high school vs. 31.3%, p < .01), had lower levels of fitness (after controlling for clinical characteristics, p < .01), and completed fewer CR sessions (18 vs. 22, p < .01). A substantial number of patients who are actively smoking may be misclassified by relying on patient report alone. CO monitoring provides a simple and objective method of systematically screening patients. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

The UK Coronavirus Job Retention Scheme and smoking, alcohol consumption and vaping during the COVID-19 pandemic: evidence from eight longitudinal population surveys

BackgroundEmployment disruptions can impact smoking and alcohol consumption. During the COVID-19 pandemic, many countries implemented furlough schemes to prevent job loss. We examine how furlough was associated with smoking, vaping and alcohol consumption in the UK.MethodsData from 27,841 participants in eight UK adult longitudinal surveys were analysed. Participants self-reported employment status and current smoking, current vaping and alcohol consumption (>4 days/week or 5+ drinks per typical occasion) both before and during the early stages of the pandemic (April–July 2020). Risk ratios were estimated within each study using modified Poisson regression, adjusting for a range of potential confounders, including pre-pandemic behaviour. Findings were synthesised using random effects meta-analysis.ResultsCompared to stable employment and after adjustment for pre-pandemic characteristics, furlough was not associated with smoking (ARR = 1.05; 95% CI: 0.95–1.16; I2: 10%), vaping (ARR = 0.89; 95% CI: 0.74–1.08; I2: 0%) or drinking (ARR = 1.03; 95% CI: 0.94–1.13; I2: 48%). There were similar findings for no longer being employed, and stable unemployment, though this varied by sex: stable unemployment was associated with smoking for women (ARR = 1.35; 95% CI: 1.00–1.82; I2: 47%) but not men (0.84; 95% CI: 0.67–1.05; I2: 0%). No longer being employed was associated with vaping among women (ARR = 2.74; 95% CI: 1.59–4.72; I2: 0%) but not men (ARR = 1.25; 95% CI: 0.83–1.87; I2: 0%).ConclusionsWe found no clear evidence of furlough or unemployment having adverse impacts on smoking, vaping or drinking behaviours during the early stages of the COVID-19 pandemic in the UK. Differences in risk compared to those who remained employed were largely explained by pre-pandemic characteristics.

Characteristics and Predictors of Controlled Hypertension at A Tertiary Health Facility in Nigeria

Aim: Our cross-sectional study set out to identify characteristics and predictors of hypertension control among adults on drug treatment. The aim was to provide current, actionable evidence of the factors that promote hypertension control and hence, improve health outcomes through reduction of cardiovascular morbidity and mortality. Methods: We conducted a descriptive, cross-sectional, and hospital-based study of 90 eligible, previously diagnosed and currently treated adults (18 years or older) with hypertension at the Medical Outpatients’ Clinic of Igbinedion University Teaching Hospital, Benin City, Nigeria. Controlled hypertension was defined as systolic blood pressure &lt;140 mm Hg and diastolic blood pressure &lt;90 mm Hg, on treatment with antihypertensive medication. The distribution of characteristics of adults with controlled hypertension was summarized with descriptive analysis and the predictor of hypertension control investigated by fitting binary logistic regression model. Results: Mean age of the adult study population was 58.34 years (SD 12.54, 95% CI 55.78 to 60.91). The majority were female (57.8%), married (76.7%), self-employed (64.4%), urban dwellers (73.3%) and all (100%) had at least primary school education. Almost two-thirds (65.6%) had never taken or had stopped taking alcohol, and none self-reported current smoking status. Some 62.2% had excess adiposity, 17.8% had diabetes and 40% had evidence of hypertensive target organ damage. Only 10% (95% CI 4.7%-18.1%) of patients had health insurance coverage. Mean systolic blood pressure was 138 mmHg (SD 21.71; 95% CI 133-142) while mean diastolic blood pressure was 86 mmHg (SD, 13.96; 95% CI, 83-89 mmHg). Slightly over half of the study population (n = 47; 52.2%, 95% CI 41.4%-62.9%) had controlled hypertension. The most frequently prescribed antihypertensive medication was calcium channel blocker (84.4%) either singly or in combination with other drug classes. Majority of the patients (n = 61, 67.8%) were on free-drug or fixed-dose combinations. Fifty-two patients (57.8%; 95% CI 46.9%-68.1%) had good adherence to prescribed antihypertensive medication. Apart from health insurance coverage and good adherence to medications, no other patients’ characteristics were significantly associated statistically, with controlled hypertension. The only independent predictor of controlled hypertension was good adherence to antihypertensive medication. Conclusion: This study adds to the body of literature on hypertension control by shedding light on the attributes of adults with controlled hypertension. However, hypertension control to target among our study population was suboptimal. The salient evidence of gaps in hypertension control provided by this study should be regarded as an opportunity to review and adopt more effective patient-centered and health system-related hypertension control strategies. Wider health insurance coverage and interventions to boost patients’ adherence to components of hypertension management are strategies that could make a significant impact on health outcomes, if adequately and sustainably implemented.

Abstract WP17: Impact Of Cigarette Smoking And Its Interaction With Hypertension And Diabetes On Cognitive Function

Introduction: We evaluated the association of a cigarette-smoking biomarker with cognitive function, and tested whether smoking acts synergistically with hypertension and diabetes to influence cognition. Methods: We performed a cross-sectional analysis of nationally representative data from the US National Health and Nutrition Examination Survey. From 2011-2014, participants ≥60 years old were given 4 standardized cognitive tests by trained examiners: immediate word recall, delayed word recall, Animal Fluency Test (AFT), and Digit Symbol Substitution Test (DSST) - a multidomain cognitive test. Participants also had 3 consecutive standardized blood pressure measurements and hemoglobin A1c and serum cotinine tests, the latter an accurate biomarker of cigarette smoking/exposure. We used linear regression to evaluate the association of cotinine with cognitive performance. Where an association was found, interaction term testing evaluated effect modification by systolic blood pressure and hemoglobin A1c as continuous measures, and hypertension and diabetes as categorical variables. Models were adjusted for demographics, socioeconomic factors, education, cardiovascular risk factors/disease, alcohol use, and depression. Results: The mean age of 3,244 participants was 69 years and 54% were women. Self-reported current smoking was present in 23%, 77% had hypertension, and 24% had diabetes. In adjusted linear regression models, higher serum cotinine levels were associated with worse performance on the DSST (β, -0.02; 95% CI, -0.03, -0.01; P=0.001), and non-significantly on the AFT (β, -0.003; 95% CI, -0.006, 0.0003; P=0.07), but not immediate or delayed recall. For the DSST, effect modification by systolic blood pressure (P=0.14) and hemoglobin A1c (P=0.39) was not observed. There was also no evidence of effect modification when testing interactions for hypertension and diabetes. Conclusions: Higher levels of a smoking biomarker were associated with worse performance on a multidomain cognitive test at the population level, regardless of hypertension or diabetes. These data demonstrate the detrimental impact of smoking on cognition and underscore the broad importance of promoting smoking cessation to preserve cognitive health.

Self-Reported Modifiable Risk Factors of Cardiovascular Disease among Older Adults in Malaysia: A Cross-Sectional Study of Prevalence and Clustering.

The co-occurrence of multiple modifiable risk factors increases the risk of cardiovascular disease (CVD) morbidity or mortality. This study examines the prevalence and clustering of self-reported modifiable CVD risk factors among older adults in Malaysia. A total of 7117 adults aged ≥50 years participated in the National Health and Morbidity Survey (NHMS) 2018: Elderly Health, a community-based cross-sectional survey. Data were collected using a standardized structured questionnaire. Multivariable logistic regression was used to determine the factors associated with the clustering of self-reported modifiable CVD risk factors. The prevalence of self-reported diabetes, hypertension, hypercholesterolemia, overweight/obesity, and current smoking was 23.3%, 42.2%, 35.6%, 58.4%, and 17.5%, respectively. Overall, the prevalence of clustering of ≥1, ≥2, and ≥3 modifiable CVD risk factors was 83.3%, 75.4%, and 62.6%, respectively. Multivariable logistic regression analysis showed that men, 60–69 age group, urban dwellers, having no formal education, unemployed/retirees/homemakers, and being physically inactive were independently associated with self-reported modifiable CVD risk factors clustering. There are also ethnic differences in self-reported modifiable CVD risk factors clustering. Our findings underscore the necessity of targeted interventions and integrated strategies for early detection and treatment of modifiable CVD risk factors among older adults, considering age, sex, ethnicity, and socioeconomic status.

Patterns of Tobacco Smoking and Nicotine Vaping among University Students in the United Arab Emirates: A Cross-Sectional Study.

Various forms of tobacco smoking and nicotine vaping tools are available on the market. This study quantified the prevalence of and identified factors associated with patterns of smoking and nicotine vaping among university students in the United Arab Emirates (UAE). A cross-sectional sample of students enrolled in three public universities was surveyed. Self-reported current smoking and nicotine vaping were recorded. Of 1123 students, 81.7% completed the online survey (mean age, 20.7 ± 3.4 (SD) years; 70.7% females). The prevalence of current smoking was 15.1% while the prevalence of current nicotine vaping was nearly 4.0%. Among current smokers, 54.7% reported conventional smoking only, 15.1% reported nicotine vaping only, and 28.8% were poly-users. Conventional midwakh (47.5%), followed by conventional shisha/waterpipe (36.7%), conventional cigarettes (36.7%), electronic shisha/waterpipe (25.2%), and electronic cigarettes (24.5%), were most commonly reported by students. Students aged 20–25 years (adjusted odds ratios (aOR): 2.08, 95% confidence interval (CI): 1.18–3.67) or >25 years (aOR: 4.24, 95% CI: 1.41–12.80) had higher odds of being current smokers compared to those aged 17–19 years. The male gender was also independently associated with higher odds of being a current smoker (aOR: 5.45, 95% CI: 3.31–8.97) as well as higher odds of smoking cigarettes, shisha, and midwakh, or nicotine vaping compared to being female. Of nicotine vaping users, 36.1% reported using nicotine vaping because they enjoyed the flavor and vaporizing experience and 34.4% used it to help them to quit smoking. A relatively high prevalence of self-reported smoking was reported among university students in the UAE. The findings also suggest that nicotine vaping use is relatively widespread, but still less common than traditional smoking. Vigilant and tailored university-based smoking control and preventive measures are warranted.

Tobacco Smoking Cessation and Quitline Use Among Adults Aged ≥15 Years in 31 Countries: Findings From the Global Adult Tobacco Survey

Introduction:About 80% of the 1.1 billion people who smoke tobacco worldwide reside in low- and middle-income countries. Evidence-based approaches to promote cessation include brief advice from health professionals and referrals through quitlines. This study assesses cessation behaviors and the use of cessation services in the past 12 months among current tobacco smokers in 31 countries who attempted to quit.Methods:Data came from the Global Adult Tobacco Survey, a household-based survey of non-institutionalized adults aged ≥15 years. Surveys were conducted in 31 countries during 2008–2018; sample sizes ranged from 4,250 (Malaysia) to 74,037 (India), and response rates ranged from 64.4% (Ukraine) to 98.5% (Qatar). In 2019, data from the 31 countries were assessed in June 2019, and indicators included self-reported current (daily or less than daily) tobacco smoking, past-year quit attempts, and cessation methods used in the past 12 months.Results:Current tobacco smoking prevalence ranged from 3.7% (Ethiopia) to 38.2% (Greece). Overall, an estimated 176.8 million adults from the 31 countries made a quit attempt in the past 12 months, with country-level prevalence ranging from 16.4% (Greece) to 54.7% (Botswana). Most individuals who made a quit attempt did so without assistance (median=74.4%). Other methods were less prevalent, including quitlines (median=0.2%) and counseling (median=7.2%).Conclusions:In the assessed countries, the majority of those who currently smoked tobacco and made a quit attempt did so without assistance; very few reported using quitlines, partly because of the lack of quitlines in some countries. In resource-limited settings, quitlines can play a greater role in helping people quit smoking as part of a comprehensive approach.

Adding vaping restrictions to smoke-free air laws: associations with conventional and electronic cigarette use.

In the United States, some states and localities have added vaping restrictions to established smoke-free indoor air laws in order to reduce electronic cigarette use. Yet, if smokers use e-cigarettes to quit, such restrictions could have the unintended effect of attenuating the original smoke-free air policy's effects on smoking. This study estimated changes in current smoking, past-year smoking cessation, and recent vaping following the introduction of smoke- and vape-free air laws. Observational study of nationally representative data from the 2014-2018 National Health Interview Survey. United States. 87 334 participants, 18-54years of age. Multivariable linear regressions estimated the association between increased exposure to smoke- and vape-free worksite and restaurant laws and self-reported current smoking and recent vaping among emerging adults (ages 18-25), as well as past-12-month smoking cessation among prime age adults (ages 26-54). All regressions adjusted for respondent sociodemographic and other tobacco control policies, along with state and year fixed effects. Smoke-free worksite laws were associated with significant reductions in the likelihood of current smoking ( =-0.050, 95% CI: -0.098, -0.002, P=0.038) and recent vaping ( =-0.040, 95% CI: -0.072, -0.007, P=0.013), as well as increases in the likelihood of smoking cessation ( =0.026, 95% CI: 0.000, 0.052, P=0.046). Adding vaping restrictions to smoke-free worksite laws did not yield further reductions in recent vaping ( =0.008, 95% CI: -0.021, 0.036, P=0.568) and counteracted over half of the estimated association with current smoking relative to smoke-free policies alone ( =0.030, 95% CI: -0.028, 0.088, P=0.301). From 2014 to 2018, increased adoption of smoke-free worksite laws in the United States was associated with reductions in both current smoking and recent vaping, as well as increases in smoking cessation. Adding vaping restrictions to smoke-free worksite laws, however, was not associated with a reduction in recent vaping among emerging adults and may have attenuated the smoke-free policy's impact on current smoking in this age group.

Smoking, urinary cotinine levels and incidence of visual impairment

The longitudinal relationship between smoking status and risk of developing visual impairment (VI) remains unclear. We examined the relationship of smoking status and urinary cotinine level, an objective measure of smoking, with incidence of VI. This cohort study included 279,069 individuals free of VI who were followed for up to 8.8 years (median 4.8 years). VI was defined as when bilateral visual acuity was worse than 0.5 (cutoffs of 0.3 Logarithm of the Minimum Angle of Resolution). During 1,324,429.8 person-years of follow-up, 7852 participants developed new-onset bilateral VI. Self-reported current smoking status was associated with increased risk of developing VI in both men and women, with a stronger association in women (P for interaction = 0.01). Multivariable adjusted hazard ratios (95% confidence intervals) for incident VI comparing current smokers to never-smokers were 1.14 (1.04–1.25) in men and 1.52 (1.28–1.80) in women. Urinary cotinine levels of ≥ 100 ng/ml were significantly associated with increased risk of incident VI, and these associations remained when introducing changes in urinary cotinine and other confounders during follow-up as time-varying covariates. Cigarette smoking assessed based on self-report and urinary cotinine level was associated with increased incidence of VI. Our findings identify smoking as an independent risk factor for VI.

Estimating Undercoverage Bias of Internet Users.

IntroductionIn the last decade, response rates to the Behavioral Risk Factor Surveillance System (BRFSS) surveys have been declining. Attention has turned to the possibility of using web surveys to complement or replace BRFSS, but web surveys can introduce coverage bias as a result of excluding noninternet users. The objective of this study was to describe undercoverage bias of internet use.MethodsWe used data from 402,578 respondents who completed BRFSS questions in 2017 on internet use, self-reported health, current smoking, and binge drinking. We examined undercoverage bias of internet use by partitioning it into a product of 2 components: proportion of noninternet use and difference in the prevalences of interest (self-reported health, current smoking, and binge drinking) between internet users and noninternet users.ResultsOverall, the weighted proportion of noninternet use overall was 15.0%; the proportion increased with an increase in age and a decrease in education and, by race/ethnicity, was lowest among non-Hispanic white respondents. The overall relative bias was −19.2% for self-reported health, −4.0% for current cigarette smoking, and 8.4% for binge drinking. For all 3 variables of interest, we found large biases and relative biases in some demographic subgroups.ConclusionUndercoverage bias of internet use existed in the 3 studied variables. Both proportion of noninternet users and difference in prevalences of studied variables between internet users and noninternet users contributed to the bias to different degrees. These findings have implications on helping health-related behavioral risk factor surveys transition to more cost-effective survey modes than telephone only.

The effects of hidden female smokers on the association between smoking and chronic obstructive pulmonary disease in Korean adults

ObjectiveSmoking is an important causative factor of chronic obstructive pulmonary disease (COPD), and females are considered more susceptible to the effects of smoking than males. However, in previous Korean studies, the effects of sex differences on the association between smoking and COPD have been controversial. In this study, the effects of sex differences on the association between smoking and COPD and the effects of female hidden smokers on that association in Korean adults were investigated. MethodsData were acquired from the Korea National Health and Nutrition Examination Surveys (KNHANES). ResultsThe multivariate logistic regression analysis showed that self-reported smoking status for ex-smoker and current smoker correlated with COPD (odds ratio, OR: 1.67 and OR: 2.41, respectively). Self-reported smoking status for ex-smoker and current smoker correlated with COPD in men (OR: 1.61, OR: 2.43, respectively). Female self-reported current smoking status correlated with COPD (OR: 2.52), but female ex-smoker status was not significantly correlated with COPD. The ratios of cotinine-verified to self-reported smoking rates were 1.95 for women and 1.07 for men. ConclusionThe results of this study were that sex differences might affect the association between COPD and smoking and that female hidden smoking might affect the association between smoking and COPD in Korean adults.

Serum cotinine verification of self-reported smoking status among adults eligible for lung cancer screening in the 1999-2018 National Health and Nutrition Examination Survey

BackgroundSelf-reported smoking behavior is widely used in identifying the eligibility for lung cancer screening (LCS). In clinical trials, self-reported smoking status was shown to be a reliable measure, while its effectiveness outside of trial settings remains to be clarified. We aimed to verify self-reported smoking status with serum cotinine levels among LCS-eligible adults from the National Health and Nutrition Examination Survey (NHANES). MethodsFrom the combined 1999-2018 NHANES data, we selected adults (aged ≥18 years) with complete data on serum cotinine and smoking behavior, and determined their LCS eligibility according to the United States Preventive Services Task Force recommendation. Using established race/ethnicity specific cotinine cutpoints as the gold standard, we verified self-reported current smoking status with five measures: sensitivity (Se), specificity (Sp), positive predictive value (PPV), negative predictive value (NPV), and reliability Kappa. We also compared these performance measures in subgroups stratified by sex, race/ethnicity, education, family income to poverty ratio, health insurance, and secondhand smoking exposure (SHS) at home. All analyses took into account the complex survey design. ResultsApproximately 9.3% (n = 2335, equivalent to 8.82 million weighted population) of all adults who currently smoke or formerly smoked were eligible for LCS. The prevalence of current smoking was 52.6% and 60.8% based on self-report and cotinine, respectively. The Se and Sp were 86.4% (95%CI: 83.9%-88.9%) and 99.7% (95%CI: 99.4%-100%), respectively; PPV and NPV were 99.8% (95%CI: 99.6%-100%) and 82.6% (95%CI: 79.4%-85.7%), respectively; and Kappa was 0.83 (95%CI: 0.80-0.86). The reliability Kappa was higher among females than males (0.87 (95%CI: 0.82-0.93)) vs 0.80 (95%CI: 0.77-0.84), the lowest among non-Hispanic white (0.82 (95%CI: 0.78-0.86)), and higher among those with SHS (0.72 (95%CI: 0.63-0.80) vs (0.68 (95%CI: 0.61-0.76)). ConclusionSelf-reported smoking status is reasonably reliable among adults with high risk for developing lung cancer in the general population.

Abstract P470: Heterogeneity In Prevalence Of Cardiovascular Disease Risk Factors Among Hispanic Ethnic Groups: Evidence From The 2010-2018 National Health Interview Survey

Introduction: Persons of Hispanic origin are a growing share of the U.S. population but include diverse ethnic groups with unique cultures, lifestyles, exposures, and countries of origin. Hispanics are disproportionately affected by cardiovascular disease (CVD) risk factors in comparison to non-Hispanics. However, few studies have examined the heterogeneity in their burden of CVD risk. Hypothesis: We hypothesized that there would be significant heterogeneity in the prevalence of CVD risk factors among ethnic subgroups of Hispanic adults. Methods: We used a cross-sectional design to examine the prevalence of CVD risk factors, defined per national guidelines, among Hispanic adults in the 2010-2018 National Health Interview Surveys. Generalized linear models using Poisson distribution were fitted to obtain adjusted predicted probabilities and risk of self-reported hypertension, overweight/obesity, diabetes, high cholesterol, physical inactivity, and current smoking by Hispanic ethnic subgroup. Results: We included 185,511 participants with mean(±sd) age 31(0.2) years and 50% male. Most were Mexican (65.1%) whereas, few were Dominican (3.0%). Prevalence of hypertension (28.4%), diabetes (12.9%), high cholesterol (25.0%), and current smoking (6.1%) was highest among Puerto Ricans. Prevalence of overweight/obesity was highest among Mexicans (74.5%) and physical inactivity was highest among Dominicans (62.3%). Compared to Mexicans, Central Americans were less likely to smoke and have hypertension, overweight/obesity, and diabetes (ps&lt;0.05). ( Table ) Conclusion: We observed striking heterogeneity in the prevalence of CVD risk factors across Hispanic ethnic subgroups, especially for diabetes, physical inactivity, and smoking. These results suggest that aggregating data on Hispanics may mask differences in CVD risk and hinder efforts to reduce health disparities in this population. Our findings provide actionable information on CVD risk factors for specific Hispanic ethnic subgroups.

Association of Self-Reported and Cotinine-Verified Smoking Status with Atrial Arrhythmia.

BackgroundThe relationship between self-reported and urinary cotinine-verified smoking status and atrial arrhythmia (AA) is unclear. The aim of this study was to evaluate the association of self-reported and urine cotinine-verified smoking status with AA.MethodA total of 201,788 participants (106,375 men, mean age 37 years) who had both a urinary cotinine measurement and electrocardiogram were included. Cotinine-verified current smoking was defined as a urinary cotinine level above 50 ng/mL. Individuals were divided into three groups based on self-reported smoking and two groups based on cotinine-verified smoking status.ResultsAmong overall subjects, 505 had documented AA (0.3%) and 135 had atrial fibrillation (AF) (0.1%). Self-reported current smoking was associated with an increased risk of AA (odds ratio [OR], 1.42; 95% confidence interval [CI], 1.06–1.91; P = 0.019) and AF (OR, 2.20; 95% CI, 1.24–3.90; P = 0.007), whereas self-reported former smoking had no significant association with AA (OR, 1.30; 95% CI, 0.97–1.73; P = 0.078) and AF (OR, 1.74; 95% CI, 1.00–3.04; P = 0.051). Cotinine-verified current smoking showed no significant association with AA (OR, 1.24; 95% CI, 0.98–1.58; P = 0.080) and AF (OR, 1.20; 95% CI, 0.79–1.83; P = 0.391).ConclusionSelf-reported current smoking was associated with AA and AF, while self-reported former smoking and cotinine-verified current smoking showed no significant association with AA and AF.