Smoking-related Behaviors Research Articles

Medical Vulnerability of Young Adults to Severe COVID-19 Illness—Data From the National Health Interview Survey

PurposeCOVID-19 morbidity and mortality reports in the U.S. have not included findings specific to young adults. The Centers for Disease Control and Prevention provides a list of conditions and associated behaviors, including smoking, conferring vulnerability to severe COVID-19 illness regardless of age. This study examines young adults' medical vulnerability to severe COVID-19 illness, focusing on smoking-related behavior. MethodsA young adult subsample (aged 18–25 years) was developed from the National Health Interview Survey, a nationally representative data set, pooling years 2016–2018. The medical vulnerability measure (yes vs. no) was developed, guided by the Centers for Disease Control and Prevention medical indicators. The estimates of medical vulnerability were developed for the full sample, the nonsmoking sample, and the individual risk indicators. Logistic regressions were conducted to examine differences by sex, race/ethnicity, income, and insurance. ResultsMedical vulnerability was 32% for the full sample and half that (16%) for the nonsmoking sample. Patterns and significance of some subgroup differences differed between the full and the nonsmoking sample. Male vulnerability was (33%) higher than female (30%; 95% CI: .7–.9) in the full sample, but lower in nonsmokers: male (14%) versus female (19%; 95% CI: 1.2–1.7). The white subgroup had higher vulnerability than Hispanic and Asian subgroups in both samples—full sample: white (31%) versus Hispanic (24%; 95% CI: .6–.9) and Asian (18%; 95% CI: .4–.5); nonsmokers: white (17%) versus Hispanic (13%; 95% CI: .06–.9) and Asian (10%; 95% CI: .3–.8). ConclusionsNotably, lower young adult medical vulnerability within nonsmokers versus the full sample underscores the importance of smoking prevention and mitigation.

Harnessing Population Pedigree Data and Machine Learning Methods to Identify Patterns of Familial Bladder Cancer Risk.

Relatives of patients with bladder cancer have been shown to be at increased risk for kidney, lung, thyroid, and cervical cancer after correcting for smoking-related behaviors that may concentrate in some families. We demonstrate a novel approach to simultaneously assess risks for multiple cancers to identify distinct multicancer configurations (multiple different cancer types that cluster in relatives) surrounding patients with familial bladder cancer. This study takes advantage of a unique population-level data resource, the Utah Population Database (UPDB), containing vast genealogy and statewide cancer data. Familial risk is measured using standardized incidence risk (SIR) ratios that account for sex, age, birth cohort, and person-years of the pedigree members. We identify 1,023 families with a significantly higher bladder cancer rate than population controls (familial bladder cancer). Familial SIRs are then calculated across 25 cancer types, and a weighted Gower distance with K-medoids clustering is used to identify familial multicancer configurations (FMC). We found five FMCs, each exhibiting a different pattern of cancer aggregation. Of the 25 cancer types studied, kidney and prostate cancers were most commonly enriched in the familial bladder cancer clusters. Laryngeal, lung, stomach, acute lymphocytic leukemia, Hodgkin disease, soft-tissue carcinoma, esophageal, breast, lung, uterine, thyroid, and melanoma cancers were the other cancer types with increased incidence in familial bladder cancer families. This study identified five familial bladder cancer FMCs showing unique risk patterns for cancers of other organs, suggesting phenotypic heterogeneity familial bladder cancer. FMC configurations could permit better definitions of cancer phenotypes (subtypes or multicancer) for gene discovery and environmental risk factor studies.

Perceptions, Characteristics, and Behaviors of Cigarette and Electronic Cigarette Use among Pregnant Smokers.

Smoking during pregnancy is a primary risk factor for adverse perinatal outcomes. Although electronic cigarette (e-cigarette) use has increased, reasons for and behaviors of use are not fully understood. The purpose of this study, composed exclusively of pregnant current smokers, was to describe perceptions of health risks associated with e-cigarette use among pregnant women, describe the use patterns of pregnant dual users (defined as those who simultaneously use conventional/combustible cigarettes and e-cigarettes), and examine smoking-related behaviors between conventional-only (defined as those smoking combustible cigarettes but not e-cigarettes) and dual users. Cross-sectional data from a larger study of pregnant conventional-only and dual users were analyzed. A brief survey measured perceptions of prenatal e-cigarette use and smoking behaviors. Analysis included descriptive statistics, bivariate analysis, and logistic and linear regression analysis. Among 176 pregnant smokers (38% dual users), more than one-half of participants believed e-cigarettes were harmful to women (56%) and posed harm to the fetus (53%). Among dual users, 41% used their e-cigarette daily, on average eight times per day. Eleven percent of dual users smoked a pack of cigarettes per day, compared with 5% of conventional-only smokers, and dual users scored significantly higher (p=.026) on the Penn State Cigarette Dependence Index. The most common e-cigarette liquid flavor was fruit (64%), and the most frequently reported e-cigarette nicotine concentration was 1-6mg. Characterizing perceptions and behaviors of e-cigarette use during pregnancy is foundational for future research to explore the association between product use and maternal and infant outcomes.

Assessment of Physicians’ Knowledge, Attitudes, and Practices Regarding Smoking Cessation Management in the Gaza Strip

Background: Despite its negative effects, approximately 23% of Palestinians (≥ 18 years) smoke cigarettes. Studies have shown physicians to be an important channel for smoking cessation intervention. This investigation examines physicians’ smoking-related knowledge, attitudes, and behaviors in the Gaza strip (Palestinian Territories). Methods and Findings: A convenience sample of 154 physicians in medical and surgical units took part in this investigation (87.7% response rate). The data show that 37.8% of physicians in Gaza smoke, and most of them about 72% smoke in the hospital’s public spaces, thereby implicitly giving public approval for smoking. While 82.4% reported that they advise patients who smoke to stop, the majority (59%) also believe that their own smoking habits negatively influence the impact of that advice. Unfortunately, our survey showed that physicians’ knowledge levels towards smoking addiction and management were lower than expected (e.g. only 34% knew that nicotine dependence is a psychiatric disorder that necessitates treatment). The physicians in this study believed that the primary barriers to failure of their patients’ smoking cessation were the perceived lack of will (81.3%), and the strength of patients’ addiction (67.9%). Moreover, (61%) of physicians did not spend enough time to convince their patients to quit smoking. Conclusion: Smoking is common among Gaza-strip physicians, and unfortunately, most of them smoke in the hospital’s public spaces. Many obstacles face the smoking cessation program that some physicians linked it to patients, and others linked it to the health-care system. Furthermore, smokers in Gaza receive poor care regarding assessment, referral, and management of their smoking habit.

A Randomized Clinical Trial Examining the Effects of Instructions for Electronic Cigarette Use on Smoking-Related Behaviors and Biomarkers of Exposure.

Electronic cigarettes (e-cigarettes) have the potential to significantly reduce exposure to harmful constituents associated with cigarette smoking when smokers completely substitute cigarettes with e-cigarettes. This study examined patterns of e-cigarette and cigarette use, and extent of toxicant exposure, if smokers were instructed and incentivized to completely switch to e-cigarettes compared to instructions to use the product ad libitum. US adult daily smokers (n = 264; 49.2% female; Mage = 47.0), uninterested in quitting smoking immediately, were recruited from Minneapolis, MN, Columbus, OH, and Buffalo, NY. Participants were randomized to 8 weeks of instructions for (1) ad libitum use of e-cigarettes (AD-E), (2) complete substitution of cigarettes with e-cigarettes (CS-E), (3) complete substitution of cigarettes with nicotine gum or lozenge (CS-NRT), or (4) continue smoking of usual brand cigarettes (UB). Participants were incentivized for protocol compliance, including complete switching in the CS-E and CS-NRT groups. Outcome variables were cigarette smoking rate and tobacco-related biomarkers of exposure. Smokers in the CS-E and CS-NRT groups showed lower rates of smoking and lower exposure to carbon monoxide, tobacco carcinogens, and other toxicants than smokers in the AD-E group. In general, no significant differences were observed between CS-E versus CS-NRT or between AD-E versus UB for most biomarkers. Significantly higher 7-day point prevalence smoke-free rates were observed for CS-E versus CS-NRT. Smokers instructed and incentivized to completely switch to e-cigarettes resulted in lower smoking rates and greater reductions in exposures to harmful chemicals than smokers instructed to use the product ad libitum. Smokers instructed to completely substitute e-cigarettes for cigarettes displayed significantly lower levels of smoking and biomarkers of exposure to carcinogens and toxicants, compared to smokers instructed to use e-cigarettes ad libitum and similar levels as smokers instructed to completely substitute with nicotine replacement therapies. Furthermore, a higher rate of complete switching was achieved with e-cigarettes versus nicotine replacement therapies. Approaches to maximize complete substitution with e-cigarettes are an important area for future research.

Understandings of the component causes of harm from cigarette smoking in Australia.

To investigate relationships between smoking-related behaviours and knowledge of the disease risks of smoking and the causes of smoking harms, using a four-way division of 'component causes': nicotine, other substances found in unburned tobacco, combustion products of tobacco and additives. The data were collected using an on-line survey in Australia with 1047 participants in three groups; young non-smokers (18 to 25), young smokers (18 to 25) and older smokers (26 and above). Most participants agreed that cancer and heart disease are major risks of smoking but only a quarter accurately quantified the mortality risk of lifetime daily smoking. Very few (two of 1047) correctly estimated the relative contributions of all four component causes. Post-hoc analyses reinterpreting responses as expressions of relative concern about combustion products and nicotine showed that 29% of participants rated combustion products above nicotine. We delineated six relative concern segments, most of which had distinctive patterns of beliefs and actions. However, higher levels of concern about combustion products were only weakly positively associated with harm reducing beliefs and actions. Most smokers do not appear to understand the risks of smoking and their causes well enough to be able to think systematically about the courses of action open to them to reduce their health risk. To facilitate informed decision-making, tobacco control communicators may need to better balance the dual aims of creating fear/negative affect about smoking and imparting knowledge about the health harms and their mechanisms.

Adolescents’ smoking environment under weak tobacco control: A mixed methods study for Portugal

IntroductionBans on smoking in public places and on sales to minors have been widely implemented across the globe. However, many countries have either adopted non-comprehensive (i.e., partial) bans and/or weakly enforce those bans. Little is known, from the adolescents’ perspective, how this affects their smoking-related perceptions and behaviors. We studied the case of Portugal, where bans are partial and/or weakly enforced. We sought to understand how the bans affect adolescents’ access to cigarettes from commercial sources, the visibility of smoking in public places, and smoking locations. Material and methodsWe used a mixed methods design on data gathered in 2016. Quantitative, cross-sectional surveys were conducted in six schools (n = 2,444) in Coimbra, Portugal. In two of these schools, qualitative data were collected in eight single-sex focus group interviews (n = 42). ResultsNinety-five percent of the adolescents who tried to buy cigarettes were able to do so from commercial sources, through vending machines, or directly from the vendor. Bans on smoking on school premises and at enclosed public places did not prevent these adolescents from observing smoking outside school gates (84.0%), in cafes and restaurants (97%), or from smoking at cafes, bars, or nightclubs (72.9%). DiscussionPartial and/or weakly enforced policies seem to not prevent adolescents from having access to cigarettes, frequently seeing smoking, and finding ample opportunities to smoke in public places. Adopting and enforcing comprehensive policies are necessary efforts to prevent unfavorable responses and more effectively reduce adolescents’ smoking behavior.

Status quo on smoking and related change pattern of smoking related behavior in past 20 years in urban residents in Tianjin

Objective: To understand the status quo of smoking and change pattern of smoking related behaviors in the past 20 years in the urban adults in Tianjin. Methods: Data was from the study of Chinese Chronic Disease and Risk Factors (2015). Multi stage stratified random sampling method was used to conduct a questionnaire survey in 7 surveillance sites in Tianjin. Results: in the urban residents aged>20 years were compared with those in surveys in 1996 and 2010. Results In 2015, the smoking rate in men and women aged>20 years in Tianjin were 41.1% and 4.5% respectively. The average age of starting smoking was (19.2±4.7) years for men and (24.8±10.9) years for women, showing a younger age trend. Compared with the data from 1996 and 2010, the smoking rate in the urban residents was in decrease, but the rate of successful smoking cessation was in increase in 2015, the differences were significant. Conclusions: Since 1996, the rate of smoking in the urban residents of Tianjin has been in decline, however it is still at a high level, especially in women. The average age of starting smoking remains to be younger. It is necessary to strengthen the health education about harm of smoking in adolescents.

Prevalence and analysis of tobacco use disorder in patients diagnosed with lung cancer.

IntroductionTobacco use disorder (TUD), previously known as nicotine dependence, was associated with increased risk of lung cancer. However, little is known about the prevalence of TUD and symptom manifestation in smokers with lung cancer.ObjectivesThe aim of the present study was to investigate the prevalence of TUD using DSM-5 diagnostic criteria in patients diagnosed with lung cancer and analyze their tobacco use characteristics.MethodsA total of 200 histologically confirmed lung cancer patients who used tobacco within the prior 12-month period at the time of diagnosis were recruited for this study. Participants were assessed using interviewer-administered questionnaires to determine TUD symptoms and smoking-related behaviors, and self-administered Fagerstrom Test for Nicotine Dependence (FTND) was also administered.ResultsThe prevalence of DSM-5 TUD was 92.0% (n = 184). Of a total of 200 subjects, 23 (11.5%), 35 (17.5%), and 126 (63.0%) were classified into mild, moderate, and severe TUD categories, respectively. A total of 19 (81.3%) moderate TUD and 98 (77.8%) severe TUD patients had attempted smoking cessation. Of these subjects, 21 (21.4%) severe TUD and 12 (63.2%) moderate TUD patients tried more than three times. The number of satisfied criteria under DSM-5 TUD was positively correlated with FTND score, cumulative lifetime smoking amount, and daily smoking levels.ConclusionsSmokers diagnosed with lung cancer showed a high prevalence of DSM-5 TUD. Their heavy and consistent tobacco use suggests reduced motivation to abstain from smoking.

Plain tobacco packaging, increased graphic health warnings and adolescents’ perceptions and initiation of smoking: DePICT, a French nationwide study

BackgroundPlain packaging (PP) of tobacco products and increased graphic warnings may contribute to lower attractiveness of smoking, particularly among youths. In France, this policy was introduced on 1 January 2017....

Why flavored vape products may be attractive: Green apple tobacco flavor elicits reward-related behavior, upregulates nAChRs on VTA dopamine neurons, and alters midbrain dopamine and GABA neuron function

While nicotine is the primary addictive component in tobacco products, additional flavors have become a concern with the growing popularity of electronic nicotine delivery systems (ENDS). For this reason, we have begun to investigate popular tobacco and ENDS flavors. Here, we examined farnesol, a chemical flavorant used in green apple and fruit flavors in ENDS e-liquids, for its ability to produce reward-related behavior. Using male and female 3–6 month old C57BL/6 J mice and farnesol doses of 0.1, 1, and 10 mg/kg we identified a sex-dependent effect in a conditioned place preference assay: farnesol-alone produces reward-related behavior in only male mice. Despite this sex-dependent effect, 1.0 mg/kg farnesol enhances locomotor activity in both male and female mice. To understand farnesol's effect on reward-related behavior, we used whole-cell patch-clamp electrophysiology and confocal microscopy to investigate changes in putative dopamine and GABA neurons. For these approaches, we utilized genetically modified mice that contain fluorescent nicotinic acetylcholine receptors (nAChRs). Our electrophysiological assays with male mice revealed that farnesol treatment increases ventral tegmental area (VTA) dopamine neuron firing frequency and this may be due to a decrease in inhibitory tone from GABA neurons. Our microscopy assays revealed that farnesol treatment produces a significant upregulation of α6* nAChRs in male mice but not female mice. This was supported by an observed increase in α6* nAChR function in additional electrophysiology assays. These data provide evidence that popular tobacco flavorants may alter smoking-related behavior and promote the need to examine additional ENDS flavors.

Sex differences in amphetamine-induced dopamine release in the dorsolateral prefrontal cortex of tobacco smokers.

Sex differences exist in the neurochemical mechanisms underlying tobacco smoking and smoking-related behaviors. Men tend to smoke for the reinforcing effects of nicotine, whereas women tend to smoke for stress and mood regulation, and have a harder time maintaining long-term abstinence. The mesolimbic dopamine (DA) system drives the reinforcing effects of tobacco smoking, whereas the mesocortical DA system-including the dorsolateral prefrontal cortex (dlPFC)-is critical for stress-related cognitive functioning and inhibitory control. This study is the first to investigate dlPFC D2/3-type receptor (D2R) availability and amphetamine-induced cortical DA release in smokers and nonsmokers. Forty-nine subjects (24 tobacco smokers (12 females) and 25 sex- and age-matched nonsmokers) participated in two same-day [11C]FLB457 positron emission tomography (PET) scans before and 3-hours after amphetamine administration (0.4-0.5 mg/kg, PO). D2R availability (non-displaceable binding potential; BPND) was measured pre- and post-amphetamine. The percent fractional change in BPND (%ΔBPND) between pre- and post-amphetamine, an index of DA release, was compared between male and female smokers and nonsmokers. Smokers showed significantly lower dlPFC D2R availability (BPND = 0.77 ± 0.05) than nonsmokers (BPND = 0.92 ± 0.04), p = 0.016, driven by males. Female smokers showed significantly less amphetamine-induced DA release in dlPFC (%ΔBPND = 1.9 ± 3.0%) than male smokers (%ΔBPND = 14.0 ± 4.3%), p < 0.005, and female nonsmokers (%ΔBPND = 9.3 ± 3.3%), p < 0.005. This study shows that in the prefrontal cortex, smokers have lower D2R availability than nonsmokers and that female vs. male smokers have a blunted amphetamine-induced DA release. These findings demonstrate that tobacco smoking differentially affects the mesocortical DA system in men vs. women, suggesting a potential target for gender-specific treatments.

What Low-income Smokers Have Learned from Public Health Pedagogy: A Narrative Inquiry.

Objectives: Health advocates have been working to educate the public about the harms of smoking for more than 50 years. However, smoking rates have reduced more slowly among people with low incomes. The purpose of this study was to evaluate what low-income smokers have learned from a lifetime of exposure to public health education and how this knowledge may have translated into smoking-related behaviors. Methods: We used narrative inquiry and elicitation interview techniques. Interviews were recorded, transcribed verbatim, coded, and organized into themes using the constant comparative method. Results: All participants were aware of smoking-related harms to health but negative experiences with quitting, cessation medications, and healthcare professionals contributed to avoiding or rejecting educational messages. Participants' perceptions of hypocritical societal tobacco control policies also led some to believe that the harms of tobacco use were exaggerated, or were being used to control or manipulate them. This contributed to a distrust of the government, public health advocates, and healthcare providers. Conclusions: Low-income smokers were aware of the harms of smoking and that quitting would improve their health. Public health advocates should consider developing messages that attempt to foster trust in healthcare professionals and are consistent with low-income adult smokers' quitting experiences.

Smoking status and quit behaviors among health center patients with substance use disorders: A national study

BackgroundDespite a high prevalence of smoking among individuals with substance use disorders, tobacco dependence in this vulnerable population is undertreated. MethodsWe analyzed data from 5592 adult (≥18 years old) respondents to the 2014 Health Center Patient Survey, a nationally representative cross-sectional survey of individuals who receive care at U.S. Federally Qualified Health Centers. We evaluated self-reported smoking status, smoking-related quit behaviors (having quit, wanting or attempting to quit in the past year, and planning to quit in the next 6 months), and receipt of advice to quit smoking among participants with and without alcohol use disorder (AUD) and drug use disorder (DUD). ResultsCurrent smoking was common among individuals with AUD (64.3%) and DUD (55.0%). Few patients with AUD or DUD had quit smoking (16.7% and 24.0%, respectively). Smokers with AUD had higher odds of wanting to quit smoking in the past year (adjusted odds ratio = 2.88; 95% confidence interval = 1.19, 7.05), but were not more likely to have made a past-year quit attempt. DUD was not significantly associated with smoking-related quit behaviors. Smokers with AUD or DUD, as well as those who engaged in treatment for AUD or DUD, did not differ significantly from other smokers in receipt of advice to quit smoking. ConclusionsSmokers with AUD and DUD were unlikely to have quit smoking despite interest in quitting. Our findings suggest a need for individualized tobacco treatment approaches in patients with AUD and DUD and missed opportunities to provide tobacco cessation counseling during addiction treatment.

Correlates of smoker identity among intermittent and light daily young adult smokers: Findings from Wave 1 of the Population Assessment of Tobacco and Health (PATH) Study

Identifying as a ‘smoker’ has been associated with many cigarette smoking-related behaviors, including less frequent and intense cigarette use. Additional smoking behaviors (e.g., use of cannabis or cigars) also may contribute to self-identification as a ‘smoker’. This study compared correlates of identifying as a ‘smoker’ and measurement strategies for non-daily cigarette consumption among young-adult intermittent and light daily smokers. Using data from Wave 1 of the PATH Study, different measurements of past 30-day non-daily cigarette use were evaluated. Weighted logistic regression models were used to compare associations with self-identification as a smoker among 18–24 year-old intermittent and light daily smokers (n = 1531). Use of other smoked products (combustible tobacco, cannabis) and other documented correlates of smoker identity were evaluated. As frequency of monthly smoking increased, self-identification as a smoker increased (1–5 days = 24%, 6–19 days = 48%, 20–29 days = 78%, light daily smokers = 93%, daily smokers using >5 cigarettes per day = 99%). Self-reported smoking status 12 months ago significantly contributed to current identification as a smoker. Smoking cigars daily or using cannabis in the past 30 days were each positively associated with smoker identity. Different measurement approaches to non-daily cigarette use offer different advantages in terms of interpretability and granularity of information. Compared to daily smokers, non-daily smokers exhibit significant variability in identifying as a smoker, and systematic correlates of smoker identification are apparent. These findings may serve to enhance understanding of non-daily smokers and potential targets for intervention among this growing subpopulation of tobacco users.

“I'm not the anti-smoker now. I just don't smoke anymore”: social obstacles to quitting smoking among emerging adults

Background: Emerging adulthood presents unique challenges to smoking cessation that are not well understood. During this phase, smoking identities can develop that become obstacles for quitting, particularly in social situations where smoking is accepted and expected. Using a social identity approach, this study explores how social relationships and normative group behaviours can be barriers to transitioning from a smoker to non-smoker identity.Method: Six focus groups of five participants (N = 30) were conducted with participants aged 18-25 years (57% male). Participants’ smoking status was ascertained to construct six groups, two each of daily smokers, occasional (non-daily) smokers, and ex-smokers.Results: Salient in-group identities invoked out-group comparisons that could create barriers to change including feeling conflicted about becoming a “non-smoker”, and maintenance of pro-smoking group norms. Three subthemes were identified: 1) Managing the division between smoker and non-smoker groups; 2) The isolation associated with navigating others’ expectations about quitting when attempting to quit; and 3) Encountering normative in-group smoking-related behaviours when attempting to quit.Conclusions: The transition from smoker to non-smoker, when understood from a social identity approach, is not straightforward. Identifying as a smoker can invoke negative judgements from non-smokers while, conversely, attempting to quit may lead to perceived rejection among smokers. Further research is needed to explore whether perceptions of social risk can be reduced by increasing the salience of a transitional “quitter” identity that helps to reduce the perceived gap between “smoker” and “non-smoker”.

Tobacco Smoking, Eating Behaviors, and Body Weight: a Review

This narrative review provides an overview of the relationships among tobacco smoking, eating behaviors, and body weight. The aims are to (1) examine the concurrent and longitudinal associations between tobacco smoking and body weight, (2) describe potential mechanisms underlying the relationships between smoking and body weight, with a focus on mechanisms related to eating behaviors and appetite, and (3) discuss management of concomitant tobacco smoking and obesity. Adolescents who smoke tobacco tend to have body mass indexes (BMI) the same as or higher than nonsmokers. However, adult tobacco smokers tend to have lower BMIs and unhealthier diets relative to nonsmokers. Smoking cessation is associated with a mean body weight gain of 4.67 kg after 12 months of abstinence, though there is substantial variability. An emerging literature suggests that metabolic factors known to regulate food intake (e.g., ghrelin, leptin) may also play an important role in smoking-related behaviors. While the neural mechanisms underlying tobacco smoking-induced weight gain remain unclear, brain imaging studies indicate that smoking and eating cues overlap in several brain regions associated with learning, memory, motivation and reward. Behavioral and pharmacological treatments have shown short-term effects in limiting post-cessation weight gain; however, their longer-term efficacy is limited. Further studies are needed to identify the exact mechanisms underlying smoking, eating behaviors, and body weight. Moreover, effective treatment options are needed to prevent long-term weight gain during smoking abstinence.

Parental Dual Use of e-Cigarettes and Traditional Cigarettes

BackgroundE-cigarettes are growing in popularity. Dual use of e-cigarettes and cigarettes is an increasingly common practice, but little is known about patterns of dual use in parents. We sought to describe smoking-related behaviors among dual-users. MethodsParent exit surveys were conducted following their child's visit in 5 control pediatric practices in 5 states participating in the Clinical Effort Against Secondhand Smoke Exposure trial. We examined factors associated with dual use of e-cigarettes and cigarettes versus cigarette-only smokers, assessed by self-report. ResultsOf 1382 smokers or recent quitters screened after their child's visit between April and October 2017, 943 (68%) completed the survey. Of these, 727 parents reported current use of cigarettes; of those, 81 (11.1%) also reported e-cigarette use, meeting the definition of dual use. Compared with cigarette-only smokers, dual users were more likely to have a child younger than 1 year old, planned to quit in the next 6 months, and had tried to quit in the past (had a quit attempt in the past 3 months, called the quitline, or used medicine to quit in the past 2 years; P < .05 for each). ConclusionsParents who use both e-cigarettes and cigarettes may have greater rates of contemplating smoking cessation than parents who only smoke cigarettes. These parents may be using e-cigarettes for harm reduction or as a step toward cessation. Identification of these parents may provide an opportunity to deliver effective treatment, including nicotine-replacement therapies that do not expose infants and children to e-cigarette aerosol.

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

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

Socio-demographic Factors Associated with Smoking Habits Among University Students in Belgrade, Serbia.

BackgroundSmoking rates in Serbian adults are among the highest in Europe. The objective of this study is to assess the prevalence of smoking and smoking-related behaviours of Belgrade University students depending on their sociodemographic characteristics and faculty group.MethodsA cross-sectional study was carried out among 2,608 Belgrade University students (59.6% female) in 2015. A self-administered questionnaire was applied to the opportunity sample to collect the data describing students’ smoking habits and attitudes across all 30 faculties of the university.Results30.5% of students reported smoking: 26.4% of medical, and 31.1% of non-medical ones. Smoking rate among female students was 31.2% vs. 29.5% among males. Age (p=0.001), relationship (<0.001) and employment status (p=0.002) had statistically significant influence on smoking status, while the differences in smoking status between genders (p=0.141) and medical and non-medical group of students (p=0.066) were not statistically significant. The highest percentage of students started smoking during high school (66.2%). As the most common reason to start smoking, respondents cited peer influence (36.5%). 44.3% of students who smoked unsuccessfully tried to quit smoking.ConclusionTo combat high smoking prevalence among a younger population, the formal education of students about the adverse impacts of smoking should be integrated in all active anti-smoking programs. Medical students, as future healthcare professionals, can play an important role in smoking rates reduction among both younger and general populations, if properly trained and educated about smoking prevention and cessation techniques.