Smoking-related Illnesses Research Articles

Impact of Medicaid expansion on smoking prevalence and quit attempts among those newly eligible, 2011-2019.

INTRODUCTIONLow-income populations have higher rates of smoking and are disproportionately affected by smoking-related illnesses. This study assessed the long-term impact of increased coverage for tobacco cessation through Medicaid expansion on past-year quit attempts and prevalence of cigarette smoking.METHODSUsing data from CDC’s annual Behavioral Risk Factor Surveillance System 2011–2019, we conducted difference-in-difference regression analyses to compare changes in smoking prevalence and past-year quit attempts in expansion states versus non-expansion states. Our sample included non-pregnant adults (18–64 years old) without dependent children with incomes at or below 100% of the Federal Poverty Level (FPL).RESULTSRegression analyses indicate that Medicaid expansion was associated with reduced smoking prevalence in the first two years post-expansion (β=-0.019, p=0.04), but that this effect was not maintained at longer follow-up periods (β=-0.006, p=0.49). Results of regression analyses also suggest that Medicaid expansion does not significantly impact quit attempts in the short-term (β=-0.013, p=0.52) or at longer term follow-up (β=-0.026, p=0.08).CONCLUSIONSExpanded coverage for tobacco cessation services through Medicaid alone may not be enough to increase quit-attempts or sustain a reduction in overall prevalence of smoking in newly eligible populations over time. Medicaid programs should consider additional strategies, such as public education campaigns and removal of barriers, to support cessation among enrollees.

The affective economy of vaping: a qualitative analysis of responses to an online questionnaire

ABSTRACT E-cigarettes are believed to be less harmful than combustible tobacco. However, e-cigarettes have created divisions in public health: within and between academia, policy and practice. As e-cigarettes proliferate, and public health debates intensify, the best interests of those most at risk of smoking related illness can be lost in the furore. This article draws on 183 open-ended responses to a 2019–2020 questionnaire posted to various online vaping discussion forums to argue that emotion needs to become part of this discussion – particularly the emotional perspectives of vapers. The findings indicated that for many vapers, e-cigarettes are not just another potential harm reduction or alternative nicotine product. For many of the respondents, vaping is a social practice, but also more than this: an affective economy. In this economy, emotions do things, specifically they indicate the boundaries of a vaping community. This community is based on shared experiences of e-cigarettes creating positive new lifeworlds and changes to everyday life. However, it is also based on fears that these new lifeworlds are under threat. The aim of this article is to encourage more acknowledgment of this affective economy in the interests of reducing division and increasing reflexivity.

“What We Do Not Know About Smoking and COVID-19 Can Hunt Us Down”

In the COVID-19 pandemic, smoking is often overlooked, and it is widely abused by underserved populations. Drug addictions such as tobacco could influence future outcomes as they impact obstructive pulmonary and cardiovascular diseases that might prove long-lived and worsens the impact of COVID-19. Future studies need to focus on smoking related illness by COVID-19 patients.

Use and perceptions of electronic nicotine delivery systems among patients attending lung cancer screening who smoke.

Given accumulating evidence that electronic nicotine delivery systems (ENDS) may be a harm-reduction alternative to combustible tobacco products, it is important to understand the real-world implications of these devices in the populations that may benefit from them the most. We surveyed the use, perceptions of, and interest in using ENDS among patients attending their initial low-dose CT scan (LDCT) for lung cancer screening (LCS) who reported current smoking, a cohort of older individuals at high-risk for lung cancer and other smoking-related illnesses due to their heavy smoking history (30 or more pack years). Participants (N=107) completed the survey in clinic immediately before their shared decision-making visit for lung cancer screening on the day of their LDCT. Approximately a quarter of participants reported ever use of ENDS in the past; nearly a third expressed a willingness to try switching to them in the future. Prior ENDS use was significantly associated with willingness to try switching to ENDS in the future. The most common reasons to consider switching included smoking cessation and harm reduction. Only about a third were aware that ENDS are not approved by the FDA for smoking cessation; knowledge significantly varied by demographic and clinical characteristics. These findings have important implications for ENDS public health campaigns and tobacco harm reduction strategies for older individuals who smoke.

Switching away from Cigarette Smoking with JUUL: Populations of Special Interest.

Objectives: In this study, we examined complete switching away from cigarettes across various medico-socio-demographic subpopulations of adult smokers who purchased a JUUL Starter Kit (JSK) electronic nicotine delivery system. Methods: We analyzed trajectories of smoking over 12 months in 17,986 adult smokers who purchased a JSK. Populations of special interest were characterized by race/ethnicity, income, diagnoses of potentially smoking-related illness (SRI), depression, and anxiety. Results: Across all 16 subgroups examined, a consistent pattern of trends was observed where complete switching increased, and dual-use decreased over time. Non-Hispanic Asian race/ethnicity, low income, diagnoses of potential SRI, depression, and anxiety were associated with significantly lower switching rates; however, complete switching rates at month 12 were near 50% for all groups, and surpassed the dual-use rates in all subgroups except for those with potential SRI. Conclusions: Substantial rates of complete switching were consistently achieved across all medico-socio-demographic subgroups 12 months following the purchase of the JSK. The potential benefits of switching with JUUL on smokers are likely to be experienced by a wide range of adult smokers.

Worldwide relative smoking prevalence among people living with and without HIV.

People living with HIV (PLH) suffer disproportionately from the chronic diseases exacerbated by smoking tobacco. We performed a systematic review and meta-analysis to establish the relative prevalence of smoking among PLH. We included observational studies reporting current smoking rates among PLH and comparators without HIV. We searched Medline, EMBASE, LILACS and SciELO from inception to 31 August 2019. We excluded studies that recruited participants with smoking related illness. We used a random effects model to estimate the odds ratio for current smoking in PLH and people without HIV. We used the Newcastle--Ottawa scale to assess methodological bias. We performed subgroup analysis based on sex and WHO region. We quantified heterogeneity with meta-regression and predictive distributions. PROSPERO registration:CRD42016052608. We identified 6116 studies and included 37. Of 111 258 PLH compared with 10 961 217 HIV-negative participants pooled odds of smoking were 1.64 [(95% confidence interval, 95% CI: 1.45-1.85) (95% prediction interval: 0.66-4.10, I2 = 98.1%)]. Odds for men and women living with HIV were 1.68 [(95% CI: 1.44-1.95) (95% prediction interval: 0.71-3.98, I2 = 91.1%)] and 2.16 [(95% CI: 1.77-2.63) (95% prediction interval: 0.92-5.07, I2 = 81.7%)] respectively. PLH are more likely to be smokers than people without HIV. This finding was true in subgroup analyses of men, women and in four of five WHO regions from which data were available. Meta-regression did not explain heterogeneity, which we attribute to the diversity of PLH populations worldwide. Smoking is a barrier to PLH achieving parity in life expectancy and an important covariate in studies of HIV-associated multimorbidity.

Provider Attitudes and Practices on Treating Tobacco Dependence in New York City After 10 years of Comprehensive Tobacco Control Efforts.

To design strategies for provider education and implementation of clinical guidelines, this study investigated how physicians (1) approach tobacco cessation, including barriers to screening and treatment, (2) prioritize tobacco cessation, and (3) perceive the role of public health. Semi-structured focus groups were conducted with 30 New York City physicians across specialties. Physicians reported that they: (1) understand risks of smoking, as well as basic counseling and medications for smoking cessation; (2) do not always follow clinical guidelines for treatment of smoking cessation; (3) prioritize treatment of patients based upon a number of criteria; and (4) see the role of public health and the city health department as separate from the clinical environment, despite population-level interventions to reduce smoking. Physicians understand the importance of treating tobacco dependence, but identified barriers to treatment, some of which are health system-related. Further, patients who do not yet present with smoking-related illness may receive less intense interventions.

Cigarette Smoking Behaviors and Beliefs in Persons Living With HIV in Nairobi, Kenya.

IntroductionPersons living with HIV (PLWH) use tobacco at higher rates than the general population in both high-income countries and low- and middle-income countries. Tobacco use rates are increasing in sub-Saharan Africa, the home to most of the world’s PLWH. As the reach of antiretroviral therapy (ART) expands and HIV-related morbidity and mortality wanes, tobacco use is emerging as a leading cause of disease and death in PLWH. A better understanding of tobacco use behaviors in various settings will be crucial to designing optimal tobacco control strategies.MethodsIn late 2019, we enrolled 50 PLWH cigarette smokers from 6 clinical sites in Nairobi, Kenya (4 HIV care clinics and 2 methadone maintenance programs) for one-on-one interviews focusing on their behaviors and beliefs related to tobacco use.ResultsFifty PLWH smokers completed the interviews. The mean age was 38.5 ± 9.7 years (range 20-57 years) and 68% were male. All were currently receiving ART. They smoked a mean of 14.9 ± 12.4 cigarettes per day, and 82% reported smoking every day. Only 6% reported dual use of smokeless tobacco products. Nicotine dependence was moderate or high in 74%. More than a third (36%) reported a prior history of tuberculosis. In our sample, use of other substances was common, especially alcohol, marijuana, and methadone. On the motivation to quit scale, 90% were at least in the contemplation stage, but only 2% had ever received behavioral cessation counseling, and only 8% had ever used pharmacotherapy (exclusively nicotine replacement therapy). Participants reported significant concern about developing smoking-related illness, exposing others to secondary smoke, and the financial burden associated with their tobacco use. Measures of intrinsic and extrinsic motivation to quit, smoker and abstainer self-concept, and social support yielded encouraging results regarding the possibility of successful quitting.ConclusionsTobacco use is an important health concern in PLWH in Kenya. A more thorough understanding of their tobacco use behaviors and beliefs will provide critical information for providers, public health officials, and policy makers as they redouble their efforts to confront this urgent health challenge.

Tobacco smoking and risk of all-cause mortality in Indonesia.

Tobacco is well known as a risk factor for early morbidity and mortality worldwide. However, the relative risk of mortality and the effects of smoking vary among the countries. Indonesia, as one of the world’s largest market for smoking tobacco, is significantly affected by tobacco-related illness. Previous research has shown that smoking causes several diseases, including stroke, neoplasm and coronary heart disease. There has to date been no research on the hazard risk of smoking for all-cause mortality in Indonesia. This study aimed to identify the association between smoking and all-cause mortality rates in Indonesia. Information from a total of 3,353 respondents aged 40 years and older was collected in this study. The data were taken from the Indonesian Family Life Survey (IFLS) Wave 4 (2007) to collect personal information and determine smoking status and from Wave 5 (2015) to collect information about deaths. Current smokers make up 40.3% of Indonesia’s population. Current smokers were more likely to have a higher risk of all-cause death (hazard ratio = 1.48, 95% confidence interval = 1.11 to 1.98) than non-current smokers. The number of smokers in Indonesia remains high and is expected to increase gradually every year. A firm government policy is needed to reduce the number of smokers in Indonesia which would automatically reduce the health problem of smoking-related illness in the future.

Smoking-Related Social Interactions as Experienced by Persons Who Smoked Long-term.

Smoking-related stigma is manifested in the everyday social interactions of persons who smoke and can result in low self-esteem, diminished self-efficacy, and resistance to smoking cessation. The purpose of this study was to describe smoking-related social interactions as experienced by persons with a history of long-term smoking. This study used a qualitative descriptive approach. This study is part of a larger study designed to identify factors that influence lung cancer screening participation. Data were drawn from 39 qualitative interviews with persons from the parent study. All descriptions about smoking-related social interactions found in the narratives were extracted, coded, categorized, and summarized with content analytic techniques. Seven different types of social interactions were identified: (a) being looked down on for smoking, (b) being humiliated for smoking in public, (c) being banished while smoking, (d) being blamed for one's health problems, (e) not "really" being blamed for smoking, (f) being told "just quit," and (g) being worried about hurting others. Clinical nurse specialists should promote antismoking campaigns that are not stigmatizing, discuss health risks of smoking in a respectful manner, provide evidence-based cessation resources, improve communication with persons who smoke, and address stigma in programs to improve screening for smoking-related illnesses.

Tobacco control’s effects on social inequalities in smoking: Moving towards a health equity approach

Abstract Population-level public health policies aim to improve health for the entire population. Yet, in doing so, they may unintentionally neglect vulnerable populations' specific needs, which may perpetuate social inequalities in health. As an example, tobacco control policies (e.g. media campaigns, smoke-free places, tax increases, and tobacco product regulation) have been found to significantly reduce overall smoking prevalence in many high-income countries. However, social inequalities in smoking have been increasing, with smoking prevalence being higher, notably for those of low socio-economic status (SES). Low SES individuals start smoking at younger ages, smoke more cigarettes per day, have lower cessation rates, and are exposed to more second-hand smoke than higher SES individuals. These social inequalities in smoking translate into social inequalities in health such that low SES groups carry a disproportionately heavier burden of smoking-related illnesses. Based on data from a critical discourse analysis of tobacco control policy in Quebec, Canada, as well as from a literature review of vulnerable populations' experiences with tobacco control policies, this presentation will: 1) illustrate ways in which tobacco control policies may be increasing social inequalities in smoking, including the absence of vulnerable populations who smoke from policy planning, smoking denormalization's unintended stigmatizing effects, and targeting behaviours rather than the 'causes of the cause' in policy; 2) provide ideas for future population-level policies based on a health equity approach, which includes integrating vulnerable population's voices in policy design, prioritizing vulnerable populations and health equity in policy, and shifting attention towards policies addressing social inequalities in access to social determinants (e.g. education, income, employment security, safe, clean, and affordable housing) to improve health rather than targeting behaviours, such as smoking.

Predictive Risk Factors for Continued Smoking after the Diagnosis of a Genitourinary Malignancy

To determine risk factors for continued smoking following a diagnosis of a genitourinary (GU) malignancy. Smoking is a well established risk factor in the development of cancers involving the GU tract. Unfortunately, a large percentage of patients continue to smoke or relapse after cancer diagnosis; by doing so, there is an increased risk of recurrence, poor survival rates, treatment complications, secondary primary cancers, and other chronic smoking related illnesses. Two hundred and five patients who presented to a Urologic Oncology clinic at a single tertiary treatment center were given smoking cessation counseling and pharmacotherapy, as well as a questionnaire which was used to identify smoking status, demographics, and behavioral/psychosocial characteristics. Patients were followed for a minimum of 1 year with a median length of follow up for 13 months. 91% of patients enrolled in the study continued smoking at survey completion. After accounting for age, ethnicity, education and cigarettes consumed/day, 5 variables were independently associated with an increased risk of continued smoking: smoking 20 or more cigarettes per day, less than 2 prior quit attempts, anxiety and/or depression, fear of cancer recurrence, and home secondhand smoke exposure. The role of the urologist is imperative for encouraging smoking cessation. While every patient should receive adequate counseling regarding smoking at the time of a GU malignancy diagnosis, identifying patients with the risk factors noted in this study and augmenting smoking cessation efforts may result in stronger efforts to quit and prevention of long-term complications.

Quitting behaviours and cessation methods used in eight European Countries in 2018: findings from the EUREST-PLUS ITC Europe Surveys.

We examined quit attempts, use of cessation assistance, quitting beliefs and intentions among smokers who participated in the 2018 International Tobacco Control (ITC) Europe Surveys in eight European Union Member States (England, Germany, Greece, Hungary, the Netherlands, Poland, Romania and Spain). Cross-sectional data from 11 543 smokers were collected from Wave 2 of the ITC Six European Country (6E) Survey (Germany, Greece, Hungary, Poland, Romania and Spain-2018), the ITC Netherlands Survey (the Netherlands-late 2017) and the Four Countries Smoking and Vaping (4CV1) Survey (England-2018). Logistic regression was used to examine associations between smokers' characteristics and recent quit attempts. Quit attempts in the past 12 months were more frequently reported by respondents in the Netherlands (33.0%) and England (29.3%) and least frequently in Hungary (11.5%), Greece (14.7%), Poland (16.7%) and Germany (16.7%). With the exception of England (35.9%), the majority (56-84%) of recent quit attempts was unaided. Making a quit attempt was associated with younger age, higher education and income, having a smoking-related illness and living in England. In all countries, the majority of continuing smokers did not intend to quit in the next 6 months, had moderate to high levels of nicotine dependence and perceived quitting to be difficult. Apart from England and the Netherlands, smokers made few quit attempts in the past year and had low intentions to quit in the near future. The use of cessation assistance was sub-optimal. There is a need to examine approaches to supporting quitting among the significant proportion of tobacco users in Europe and increase the use of cessation support as part of quit attempts.

Cessation outcomes in adult dual users of e-cigarettes and cigarettes: the Population Assessment of Tobacco and Health cohort study, USA, 2013-2016.

Objectives:We examined the transitions of adult dual e-cigarette/cigarette users in the United States (US) in relation to nicotine dependence (ND) symptoms, interest in quitting, and history of cardiovascular disease (CVD).Methods:We used the Population Assessment of Tobacco and Health study Waves 1 and 3 (2013–2016) in a longitudinal analysis of adults (≥18years). Dual past-month users of e-cigarettes/cigarettes were identified from Wave 1 and followed for tobacco use transitions two years later (Wave 3).Results:Among 1,870 adult dual users at Wave 1, 25.7% (95% CI 23.5–28.2) were dual users two years later, 12.1% (95% CI 10.6–13.7) reported no past-month tobacco use, 7.0% (95% CI 5.6–8.9) e-cigarette mono-use, and 55.2% (95% CI 52.4–58.0) cigarette mono-use. In the regression analysis, greater ND severity was associated with decreased risk of no past-month tobacco use (RRR 0.29; 95% CI 0.12–0.71). Interest in quitting and CVD factors were not associated with no past-month tobacco or e-cigarette mono-use.Conclusion:Dual users who are nicotine dependent are less likely to transition to cessation. To quit cigarette use, other cessation resources may be necessary to support the needs of cigarette smokers who use e-cigarettes, particularly those at risk of continuing cigarette smoking or those with smoking-related illness.

\u2018Very brief advice\u2019 (VBA) on smoking in family practice: a qualitative evaluation of the tobacco user\u2019s perspective

BackgroundVery Brief Advice on smoking (VBA) is an evidence-based intervention designed to increase quit attempts among patients who smoke. VBA has been widely disseminated in general practice settings in the United Kingdom, however its transferability to Southern European settings is not well established. This study sought to document the perspectives of Greek general practice patients in terms of the acceptability and satisfaction with receiving VBA from their general practitioner (GP) and its influence on patients’ motivation to make a quit attempt. We also examine patient identified barriers and facilitators to acting on VBA.MethodsSemi-structured interviews were conducted with 50 patients who reported current tobacco use recruited from five general practices in Crete, Greece. All patients received VBA from their GP and interviews were conducted immediately after the GP appointment. Thematic analysis was used to analyze data.ResultsThe majority of patients were satisfied with the VBA intervention. Approximately one quarter of patients reported they were motivated to make an attempt to quit smoking after receiving VBA from their GP. Patients identified a clear preference for VBA to be delivered in a supportive manner, which communicated genuine concern versus fear-based approaches. Patients with an existing smoking-related illness were more likely to report plans to act on their GP’s VBA. Patients not ready to quit smoking indicated they would be likely to seek the support of their GP for future quit attempts as a result of VBA. Many patients reported low self-efficacy with quitting and apprehension about available quit smoking supports.ConclusionsVBA was positively received by the majority of smokers interviewed. Participating patients confirmed the motivational role of advice when delivered in a supportive and caring manner. Personal health status, beliefs about quit smoking supports, and low self-efficacy appear to influence patient’s motivation to make an aided quit attempt.

Two-year efficacy of varenicline tartrate and counselling for inpatient smoking cessation (STOP study): A randomized controlled clinical trial.

Varenicline tartrate is superior for smoking cessation to other tobacco cessation therapies by 52 weeks, in the outpatient setting. We aimed to evaluate the long-term (104 week) efficacy following a standard course of inpatient-initiated varenicline tartrate plus Quitline-counselling compared to Quitline-counselling alone. Adult patients (n = 392, 20-75 years) admitted with a smoking-related illnesses to one of three hospitals, were randomised to receive either 12-weeks of varenicline tartrate (titrated from 0.5mg daily to 1mg twice-daily) plus Quitline-counselling, (n = 196) or Quitline-counselling alone, (n = 196), with continuous abstinence from smoking assessed at 104 weeks. A total of 1959 potential participants were screened for eligibility between August 2008 and December 2011. The proportion of participants who remained continuously abstinent (intention-to-treat) at 104 weeks were significantly greater in the varenicline tartrate plus counselling arm (29.2% n = 56) compared to counselling alone (18.8% n = 36; p = 0.02; odds ratio 1.78; 95%CI 1.10 to 2.86, p = 0.02). Twenty-two deaths occurred during the 104 week study (n = 10 for varenicline tartrate plus counselling and n = 12 for Quitline-counselling alone). All of these participants had known or developed underlying co-morbidities. This is the first study to examine the efficacy and safety of varenicline tartrate over 104 weeks within any setting. Varenicline tartrate plus Quitline-counselling was found to be an effective opportunistic treatment when initiated for inpatient smokers who had been admitted with tobacco-related disease.

Early-Life Adversities and Recalcitrant Smoking in Midlife: An Examination of Gender and Life-Course Pathways.

Little is known about life-course factors that explain why some individuals continue smoking despite having smoking-related diseases. We examined (a) the extent to which early-life adversities are associated with the risk of recalcitrant smoking, (b) psychosocial factors that mediate the association, and (c) gender differences in the associations. Data were from 4,932 respondents (53% women) who participated in the first and follow-up waves of the Midlife Development in the U.S. National Survey. Early-life adversities include low socioeconomic status (SES), abuse, and family instability. Potential mediators include education, financial strain, purpose in life, mood disorder, family problems/support, and marital status. We used sequential logistic regression models to estimate the effect of early-life adversities on the risk of each of the three stages on the path to recalcitrant smoking (ever-smoking, smoking-related illness, and recalcitrant smoking). For women, low SES (odds ratio [OR] = 1.29; 1.06-1.55) and family instability (OR = 1.73; 1.14-2.62) are associated with an elevated risk of recalcitrant smoking. Education significantly reduces the effect of childhood SES, yet the effect of family instability remains significant even after accounting for life-course mediators. For men, the effect of low SES on recalcitrant smoking is robust (OR = 1.48; 1.10-2.00) even after controlling for potential mediators. There are noteworthy life-course factors that independently affect recalcitrant smoking: for both genders, not living with a partner; for women, education; and for men, family problems. The findings can help shape intervention programs that address the underlying factors of recalcitrant smoking.

Phasic Dopamine Release Magnitude Tracks Individual Differences in Sensitization of Locomotor Response following a History of Nicotine Exposure

Smoking remains the primary cause of preventable death in the United States and smoking related illness costs more than $300 billion annually. Nicotine (the primary reinforcer in cigarettes) causes changes in behavior and neurochemistry that lead to increased probability of relapse. Given the role of mesolimbic dopamine projections in motivation, substance use disorder, and drug relapse, we examined the effect of repeated nicotine on rapid dopamine signals in the nucleus accumbens (NAc) of rats. Adult, male Sprague-Dawley rats were exposed to nicotine (0.2 or 0.4 mg/kg, subcutaneous) once daily for 7 days. On day 8, dopamine release and uptake dynamics, and their modulation by nicotinic receptor agonists and antagonists, were assessed using fast scan cyclic voltammetry in the NAc core. Nicotine exposure decreased electrically-stimulated dopamine release across a range of stimulation frequencies and decreased α6β2-containing nicotinic receptor control over dopamine release. Additionally, nicotine locomotor sensitization correlated with accumbal dopamine modulation by nicotine and mecamylamine. Taken together, our study suggests that repeated exposure to nicotine blunts dopamine release in the NAc core through changes in α6β2 modulation of dopamine release and individual differences in the sensitivity to this outcome may predict variation in behavioral models of vulnerability to substance use disorder.

Adolescent smoking behaviour determinants in the city of Yogyakarta, Indonesia

Background: The increasing number of smokers has an impact on increasing the number of deaths due to smoking-related illnesses. Teenagers are the easiest targets for cigarette marketing, including in the city of Yogyakarta, whose numbers continue to increase. The proper investigation needs to be carried out to determine the determinants that play a role in developing effective interventions to reduce the number of teenage smokers. The purpose of this study was to determine the determinants of smoking in adolescents in The City of Yogyakarta.Methods: This study was a cross-sectional study with senior high school/vocational students’ samples. The sampling technique uses multistage random cluster sampling with Chi-Square analysis.Results: Researchers collected 481 respondents. Variables significantly associated with smoking behavior of senior high school/vocational high school students in Yogyakarta City are knowledge, attitude, self-confidence, family’s role, and peer’s role, while the unrelated variables are teacher’s role and information sources. The RP value of these variables is more than 1, which shows the seven variables are risk factors for adolescent smoking behavior.Conclusions: There is a significant relationship between knowledge, attitudes, self-confidence, the role of family, the role of peers and the smoking behavior of adolescents in Yogyakarta, Indonesia. The role of the teacher and the source of information has no significant relationship with the smoking behavior of adolescents in Yogyakarta, Indonesia. The intervention program for reducing and preventing smoking must pay attention to these variables as a determining factor.

Using genomic profiling for understanding and improving response to smoking cessation treatment.

This review focuses on the implementation of genomic discoveries associated with smoking behaviors and smoking-related illnesses to improve prevention efforts and smoking cessation. Large-scale studies have discovered genomic variation that contributes to smoking heaviness and smoking cessation. Variation in the α5 nicotinic acetylcholine receptor subunit (CHRNA5) and the primary nicotine metabolizing gene (CYP2A6) strongly contribute to smoking behaviors, lung cancer, and chronic obstructive pulmonary disease. The analytic and clinical validity of these genes is clearly established, and evidence of clinical utility for risk stratification is growing. Equity will be a critical issue facing the translation of genomic findings into improved health because the majority of genomic studies have been conducted in European ancestry populations. Now is the time to increase the state of readiness for implementation of genomic profiling and we must address issues of increasing healthcare disparities that may arise with this new genomic technology.