Smoking Women Research Articles

Score-2 in heavy smokers: are we underestimating the risk?

Abstract Background The shared diagnostic decision-making process in patients with atypical chest pain is challenging, especially when functional tests are negative. SCORE2 (1) can help in making decisions. In this score, the risk is assessed based on geographical origin, age, sex, current smoking, systolic blood pressure, cholesterol values. However, it does not take into account the quantity of cigarettes smoked but only the current binary value, yes or no. In our study we wanted to evaluate the impact of smoking on prognosis, considering the number of cigarettes smoked and in particular focusing on heavy smokers. Methods In the last 15 years we evaluated 3,588 outpatients aged >35 years (average 64±9, women 55%) for the presence of stable chest pain. We excluded 290 patients who had ECG changes compatible with recent ischemia, history of myocardial infarction or any other major cardiovascular event, evidence of heart failure, left ventricular dysfunction, or cardiomyopathies. In the other 3,298 cases we applied the traditional classification of typical, atypical angina and non-anginal pain. A functional test was performed in all patients. In 2,774 patients with atypical chest pain and negative functional test we evaluated the extent of cardiovascular risk based on SCORE2 and the number of cigarettes currently smoked. One year follow-up was carried out to evaluate vital status and any fatal and non-fatal cardiovascular events. Results Table 1 shows the events in patients classified according to the degree of cardiovascular risk of SCORE2 and in heavy smokers (≥ 20 cigarettes per day) aged <70 years as a cathegory in itself. In moderate smokers (<20 cigarettes/day) of any age, the risk was considered binary as in the conventional assessment. Tables 2 and 3 show the risk stratification in male and female patients. SCORE2 is unable to intercept the extremely high risk of heavy smokers aged <70 years. This happens both in males, considered at moderate risk in 76% of cases but with a rate of fatal events of 2.4% and as many non-fatal events, both in women with a risk considered moderate in 80% of cases but with a 12% rate of fatal events (as seen in Table 1). Conclusions SCORE2 does not consider the quantity of cigarettes smoked per day, so if we rely on it heavy smokers seem to have a moderate risk. On the contrary, based on our analysis, they all have an extremely high risk, regardless of other risk factors, and in any case higher than non-smoking or moderately smoking patients. Especially heavy smoking women aged <70 years with atypical chest pain and negative functional tests have an extreme risk of fatal cardiac events (12% at one year). Probably these patients (male and female), regardless of the outcome of functional tests, should be sent for an anatomical evaluation for the detection of high-risk stenosis, as well as firmly urged to improve lifestyles and treat risk factors .

Sex differences in the prevalence of metabolic syndrome and associated factors in the general population of Mongolia: A nationwide study.

The prevalence and factors associated with metabolic syndrome (MetS) between men and women in Mongolia were compared using secondary data from the STEPwise approach to non-communicable disease risk factor surveillance conducted in 2019. In total, 5,695 participants (2,577 males and 3,118 females) aged 18-69 years old were enrolled in the study. The prevalence of MetS was 37.4% in total and the prevalence was significantly higher in women (39.2%) than men (35.2%, P = 0.002). The most prevalent MetS components were abdominal obesity in women (74.2%) and high blood glucose levels in men (58.7%). All of the 2,128 participants who were categorized into MetS met the criteria of abdominal obesity. Factors associated with MetS included being 30-69 years old compared to 18-29 years old, low and moderate physical activity levels compared to high levels, history of hypertension and diabetes mellitus, and a high body mass index (overweight and obesity) compared to a normal body mass index in both sexes. Additional factors included Buryat ethnicity compared to Khalkh ethnicity, living in Ulaanbaatar, no education compared to primary education, higher monthly income, and currently drinking in men; and smoking and sufficient fruit and vegetable intake in women. Significant differences were observed between men and women in terms of the prevalence of MetS, components of MetS, and factors associated with MetS. To reduce MetS prevalence in Mongolia, sex-specific programs should be designed to promote health behavior, such as reducing alcohol consumption in men and smoking in women.

High Prevalence of Tobacco Consumption among Pregnant Women in a Southern European City (Seville): A Challenge for the Health System.

The prevalence of prenatal tobacco exposure remains high in many countries, particularly in southern Europe. The aims of this study were to estimate the prevalence of smoking among pregnant women in a southern Spanish city (Seville) and to identify the associated sociodemographic and obstetric characteristics. In a descriptive, cross-sectional study, a random sample of pregnant women who were scheduled to undergo a morphology scan at their public referral hospital in their 20th week of gestation were interviewed in person. At the start of pregnancy, 38.2% of the pregnant women were smokers. In the twentieth week, 19.1% continued to smoke, and the same percentage had quit. The prevalence of smoking in pregnant women was higher among those with a low level of education (60% among pregnant women with no studies and 30.4% in those with primary education) and among those who had had abortions (38.5%). Pregnant smokers with obesity were the least likely to have given up smoking during pregnancy. Women with a lower educational level should be a prime target for cross-sectoral interventions aimed at preventing prenatal tobacco exposure. Implementation of support measures for providing effective clinical advice in preconception and prenatal care regarding healthy lifestyles is particularly needed.

The effect of online motivational interviewing on pregnant women's smoking cessation behaviour: A randomized controlled trial.

This study aims to examine the effect of online individual motivational interviewing based on the transtheoretical model on pregnant women's smoking cessation behaviour. Sixty-two pregnant women who did not complete the 16th gestational week and who smoked were randomly assigned to intervention (n = 31) and control (n = 31) groups. While the intervention group was administered model-based motivational individual counselling interventions, the control group was administered no interventions. The results showed that 58.1% of the pregnant women in the intervention group and 22.6% of the pregnant women in the control group ceased smoking. Online motivational interviewing based on the transtheoretical model was found to be effective in pregnant women's smoking cessation.

Behavior change, health, and health disparities 2024: Smoking and other tobacco use among women and girls

This Special Issue (SI) of Preventive Medicine is the 11th in an annual series on behavior change, health, and health disparities. The theme of this 2024 issue is Smoking and Other Tobacco Use among Women and Girls. Cigarette smoking remains the single most preventable cause of death in the U.S., causing the premature death of more than 200,000 U.S. women annually, a mortality rate that far exceeds levels from conditions more commonly associated with premature death in women (e.g., breast cancer). Of course, cigarette smoking among women and girls is also a well-known cause of intergenerational adverse health effects. Women and girls are also using e-cigarettes and many other tobacco products that are flooding the U.S. tobacco marketplace. This SI includes eleven peer-reviewed articles that advance knowledge across a wide range of topics on disproportionate adverse effects, prevalence, and risk factors for cigarette smoking and other tobacco use in women and girls.

Trajectories of Breastfeeding-Related Thoughts and Attitudes Among Low-Income Smoke-Exposed Pregnant Women: A Latent Class Growth Analysis.

Psychosocial predictors of breastfeeding and changes in those factors during pregnancy, along with the relationship of those changes with both breastfeeding and smoke use and exposure, are not well explored. The aim of this study was to identify distinct trajectories of psychosocial determinants of breastfeeding and smoking in pregnant women. We used a longitudinal study design and data from a randomized controlled trial conducted among smoke-exposed pregnant women and their infants. Participants were recruited early in pregnancy and were surveyed at ≤ 16 and 32 weeks gestation, delivery, 3 and 6 months postpartum for breastfeeding intentions, initiation, continuation, and smoke use and exposure. Psychosocial variables associated with breastfeeding were measured at baseline and 32 weeks gestation using the Mitra index, a structured questionnaire that assesses barriers and facilitators of breastfeeding intentions. Latent class growth analysis was performed using Mitra scores to identify distinct subgroups of participants with different trajectories. Sociodemographic characteristics, breastfeeding, and tobacco smoke use and exposure were compared across classes. Three or four trajectories were identified for each of the six Mitra scores. Trajectories for all Mitra scores were associated with breastfeeding intention and initiation. Overall, Mitra, knowledge, self-efficacy, social support, and time barrier classes all differed by tobacco smoke use or exposure. Trajectories of breastfeeding knowledge, self-efficacy, social support, and time to breastfeed/social barriers are associated with tobacco smoke use and exposure during pregnancy. Encouragement to breastfeed and to cease and avoid tobacco smoke should start early in pregnancy, focusing on these determinants to improve health outcomes.

The Concentration of Follistatin and Activin A in Serum and Selected Biochemical Parameters in Women with Polycystic Ovary Syndrome: Stratification by Tobacco Smoke Exposure, Insulin Resistance, and Overweight/Obesity.

Background/Objectives: The aim of the study was to investigate the concentrations of follistatin and activin A in the serum of women with polycystic ovary syndrome (PCOS) and to assess their relationship with selected biochemical parameters, specifically stratifying the analysis based on tobacco smoke, insulin resistance, and abnormal weight. Methods: The research was carried out within a cohort of 88 women (60 women with and 28 without PCOS). Results: We observed significant differences (p < 0.05) in follistatin concentrations between women with PCOS stratified by homeostatic model assessment for insulin resistance (HOMA-IR) values. These differences were consistent across both smoking and non-smoking subgroups with PCOS. Similar results were observed when comparing normal-weight women with PCOS to those with overweight or obesity. Additionally, activin A concentrations were significantly increased by higher body mass index (BMI) and HOMA-IR values in non-smoking women with PCOS. Moreover, we identified a negative correlation (r = -0.30; p < 0.023) between cotinine levels and Anti-Müllerian hormone. Among smoking women with PCOS, we noted decreased concentrations of sex hormone-binding globulin and high-density lipoproteins, alongside increased fasting glucose, insulin, HOMA-IR, and free androgen index values. Conclusions: Our findings suggest that activin A and follistatin concentrations are more strongly influenced by disruptions in glucose metabolism and BMI than by tobacco smoke exposure. The observed changes were more pronounced in follistatin than in activin A level.

Tobacco retail availability and smoking-A systematic review and meta-analysis.

Health policy makers worldwide have adopted evidence-based legislation, largely directed at consumers, to reduce tobacco-related harm. It is suggested that limiting supply by decreasing retail availability can also reduce cigarette smoking. To inform policy makers this systematic literature review assesses whether reducing availability is associated with smoking behaviours. Systematic literature searches of five databases were carried out up to January 2023. Included studies had at least one exposure (tobacco retail density, proximity or mixed measures thereof) and outcomes of smoking behaviour. Meta-analysis of effect estimates were undertaken if there were at least three studies with similar population, exposure and outcome measures. Sixty-two studies were included, and positive associations were found between tobacco outlet density and cigarette smoking in pregnancy, youth, adults and cessation. Meta-analyses were undertaken for retail density and ever smoking (odds ratio [OR] 1.20; 95% confidence interval [CI] 1.04, 1.37; I2 = 87.3%), and current youth smoking (OR 1.23; 95% CI 1.08, 1.40; I2 = 0.0%), adult smoking (OR 1.11; 95% CI 1.01, 1.22; I2 = 74.8%); and mixed measures of retail availability near schools and current youth smoking (OR 1.03; 95% CI 1.01, 1.05; I2 = 0.0%). There is evidence higher tobacco retail density is consistently associated with cigarette smoking in pregnant women, young people and adults when ecological studies are included in meta-analysis. Meanwhile, evidence synthesis reveals restrictive tobacco retail laws based on proximity or mixed measures near home or very near school may not reduce smoking except in men who smoke heavily. Mechanisms to reduce retailer density should be thus considered part of tobacco control strategies.

1576P Smoking and lung cancer mortality in Italian men and women: 2003-2019

1576P Smoking and lung cancer mortality in Italian men and women: 2003-2019

Assessment of Respiratory Health Implications of Vaping: A Systematic Review of Toxicity Mechanisms and Adverse Effects of Electronic Nicotine Delivery Systems.

E-cigarettes are thought to aid in tobacco smoking cessation, but there are concerns about their overall effectiveness and safety for the general population, particularly adults. This review aims to investigate the mechanisms of toxicity and adverse effects of e-cigarettes on the respiratory system, comparing these effects with those of conventional smoking. A systematic review was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Searches were performed on PubMed, Embase, and the Cochrane Library using keywords, controlled vocabulary, and text words, with the following criteria: studies published in English from 2014 to 2024, open access, peer-reviewed, and full-text availability. Study selection, quality assessment, and data extraction were carried out by two independent reviewers. The Cochrane Risk of Bias 2.0 tool was used to evaluate the risk of bias in included randomized controlled trials, and the Grading of Recommendations Assessment, Development and Evaluation (GRADE) tool was employed to assess the strength of evidence and determine its generalizability. Electronic nicotine delivery systems (ENDS) have diverse mechanisms of toxicity, including inflammation, hypoxia, cardiovascular stress, and metabolic changes. Reported adverse effects include cough, throat irritation, nausea, and hemodynamic changes. However, ENDS are associated with fewer risks compared to conventional cigarette smoking. ENDS users experience fewer respiratory and cardiovascular issues and have lower levels of biomarkers such as NNAL and CO compared to traditional smokers. Additionally, ENDS are more effective than nicotine replacement therapy (nicotine patches) for smoking cessation, particularly in pregnant women. The side effects of ENDS and nicotine-free vaping are similar to those of conventional smoking in pregnant women, with the exception of a lower birth weight among newborns exposed to ENDS (p < 0.05). ENDS present a complex balance of benefits and risks regarding respiratory health. While there are adverse effects, ENDS are considered less detrimental than conventional smoking and a viable option for smoking cessation. Longitudinal studies are needed to evaluate their safety with long-term use (>16 weeks). Policymakers and health practitioners should use these findings to develop balanced public health policies that weigh the benefits of ENDS against potential health risks, enabling informed decision-making for users.

Reprint of: Clustering of behavioral economic biases in decision-making and risk for cigarette smoking and other substance use in women and men

BackgroundLow loss aversion (LA) and high delay discounting (DD) are behavioral-economic decision-making biases that independently predict cigarette smoking and other risky substance use. Here we examine (1) whether low-LA and high-DD co-occur, (2) does co-occurrence increase the odds of current smoking and other substance use compared to only low-LA, high-DD, or neither; and (3) potential gender differences in these associations. MethodData are from five studies with U.S. adults who currently smoked or never-smoked cigarettes recruited using online convenience sampling matching on gender and education. Participants completed identical sociodemographic, substance use (cigarette, other drugs, alcohol), and LA (hypothetical 50–50 gambles) and DD (monetary-choice questionnaire) measures. LA and DD scores were dichotomized as low and high using Receiver-Operating-Characteristic Curve logistic regression. ResultsLA and DD each independently predicted substance use and with few exceptions were not influenced by gender. Low-LA compared to high-LA predicted two-fold greater odds of co-occurring high-DD (AOR = 2.120, 95%CI:1.749–2.571, p < .0001). Similarly, high-DD compared to low DD predicted two-fold greater odds of low-LA (AOR = 2.118, 95%CI:1.747–2.568, p < .0001). Among those with co-occurring low-LA and high-DD, odds of substance use were 5–10 times greater than those exhibiting neither, and 2–3 times greater than those exhibiting only low-LA or high-DD. ConclusionsLow-LA and high-DD cluster in women and men such that exhibiting one of these decision-making biases doubles the odds of exhibiting the other. These results demonstrate reliable clustering of low-LA and high-DD and a striking increase in risk for substance use relative to having only one or neither decision-making bias.

Reprint of: Smoking and pulmonary health in women: A narrative review and behavioral health perspective

ObjectiveCigarette smoking prevalence has declined slower among women than men, and smoking-related pulmonary disease (PD) has risen among women. Given these trends, there is a critical need to understand and mitigate PD risk among women who smoke. The purpose of this narrative review and commentary is to highlight important evidence from the literature on smoking and PD among women. MethodsThis review focuses broadly on examining cigarette smoking and PD among women within six topic areas: (1) demographic characteristics and prevalence of smoking, (2) smoking behavior, (3) lung cancer, (4) obstructive PD, (5) diagnostic and treatment disparities, and (6) gaps in the literature and potential directions for future research and treatment. ResultsGrowing evidence indicates that compared to men, women are at increased risk for developing smoking-related PD and poorer PD outcomes. Gender disparities in smoking-related PD may be largely accounted for by genetic differences and sex hormones contributing to PD pathogenesis and presentation, smoking behavior, nicotine dependence, and pathogen/carcinogen clearance. Moreover, gender disparities in smoking-related PD may be exacerbated by important social determinants (e.g., women with less formal education and those from minoritized groups may be at especially high risk for poor PD outcomes due to higher rates of smoking). ConclusionRising rates of smoking-related PD among women risk widening diagnostic and treatment disparities. Ongoing research is needed to explore potentially complex relationships between sex, gender, and smoking-related PD processes and outcomes, and to improve smoking-cessation and PD treatment for women.

Association Between Smoking with a Molecular Profile of Breast Cancer

Background: Female breast cancer is one of the causes of the highest cancer mortality and morbidity in the world. It is already known that there is a strong association between smoking and breast cancer. However, the association between smoking and tumor severity is not very clear. The objective of this study was to assess the severity of the breast tumor, using the tumor's molecular classification as a tool according to its immunohistochemical profile in smoking and non-smoking women. Methods: This is a longitudinal study in which 208 women with a diagnosis of breast cancer were followed for 17 months, 80 of whom were smokers and all underwent anatomopathological diagnosis by core biopsy and subsequent immunohistochemistry, followed by treatment indicated according to the type and the clinical staging of the tumor. The severity of the tumor was assessed by its molecular classification according to its immunohistochemical profile. Results: Smoking was associated with higher mortality. The tumor with the most severe immunohistochemical profile was found in younger smokers. 19.7% of smokers had a triple negative tumor and 10% of non-smokers. The age of female smokers with triple negative was 48.2 years and of non-smoking women was 52.6 years (p = 0.005). In 17 months of follow-up, mortality among smokers was 39.5% and for nonsmokers, 20%. Survival was statistically significantly lower among the group of smokers (p=0.01). Conclusion: smoking is associated with greater breast cancer severity, risk for cancer severity was OR 5.5 times higher for the smoking group survival was statistically significantly lower among the group of smokers

Endothelium-mediated vasodilation: associations with cardiometabolic diseases and their risk factors in aging

Aim. To evaluate the association of flow-mediated vasodilation (FMD) with cardiometabolic diseases (CMDs) and their risk factors (RF) in old age.Material and methods. The study was conducted in the Russian population cohort of the HAPIEE project (Novosibirsk, 2015-2018). Endothelial function was assessed in a random subsample (788 men and women aged 55-84 years) using ultrasound measurements of the brachial artery FMD. Endothelial dysfunction (ED) was recorded with FMD &lt;10%. Cardiovascular diseases (CVD) and risk factors were assessed using standard epidemiological methods.Results. The incidence of hypertension (HTN) was 78,8% (the same in men and women), major CVDs — 21,7% and 17,1%, type 2 diabetes (T2D) — 18,7% and 19,1% in men and women, respectively. The mean FMD values were 2,7% (SD 7,32) and 3,2% (7,19), while the prevalence of ED was 88,2% and 85,8% in men and women, respectively, and did not differ significantly by sex. Men with ED had higher levels of blood triglycerides (125,1 (71,23) vs 102,7 (45,79) mg/dl; p=0,033), waist/hip circumference indices (0,94 (0,050) vs 0,92 (0,076); p=0,009) and body weight (27,7 (45,79) vs 26,5 (4,36) kg/m2; p=0,077). In women, a tendency towards an association of ED with smoking was revealed (p=0,067). There were no associations of ED with HTN, T2D and CVD in men and women.Conclusion. The PMD test demonstrated a high incidence of ED in a population sample of 55-84 years old. ED is associated with metabolic risk factors in men and smoking in women. No associations of PMD with CMDs were found, presumably due to the high incidence of ED and cumulative disease in the elderly. Modification of metabolic risk factors and smoking cessation are relevant at any age to prevent the progression of ED.

Clustering of behavioral economic biases in decision-making and risk for cigarette smoking and other substance use in women and men

BackgroundLow loss aversion (LA) and high delay discounting (DD) are behavioral-economic decision-making biases that independently predict cigarette smoking and other risky substance use. Here we examine (1) whether low-LA and high-DD co-occur, (2) does co-occurrence increase the odds of current smoking and other substance use compared to only low-LA, high-DD, or neither; and (3) potential gender differences in these associations. MethodData are from five studies with U.S. adults who currently smoked or never-smoked cigarettes recruited using online convenience sampling matching on gender and education. Participants completed identical sociodemographic, substance use (cigarette, other drugs, alcohol), and LA (hypothetical 50–50 gambles) and DD (monetary-choice questionnaire) measures. LA and DD scores were dichotomized as low and high using Receiver-Operating-Characteristic Curve logistic regression. ResultsLA and DD each independently predicted substance use and with few exceptions were not influenced by gender. Low-LA compared to high-LA predicted two-fold greater odds of co-occurring high-DD (AOR = 2.120, 95%CI:1.749–2.571, p < .0001). Similarly, high-DD compared to low DD predicted two-fold greater odds of low-LA (AOR = 2.118, 95%CI:1.747–2.568, p < .0001). Among those with co-occurring low-LA and high-DD, odds of substance use were 5–10 times greater than those exhibiting neither, and 2–3 times greater than those exhibiting only low-LA or high-DD. ConclusionsLow-LA and high-DD cluster in women and men such that exhibiting one of these decision-making biases doubles the odds of exhibiting the other. These results demonstrate reliable clustering of low-LA and high-DD and a striking increase in risk for substance use relative to having only one or neither decision-making bias.

Prevalence of tobacco smoking and related factors in people aged 15 years and above in Beijing, 2014-2021

Objective: To evaluate the effect of the implementation of Beijing Smoking Control Regulation in 2015 on the smoking prevalence in people aged ≥15 years in Beijing during 2014-2021, and explore factors associated with tobacco use behavior in local population. Methods Using a pooled cross-sectional design, data from Beijing Adult Tobacco Survey in 2014, 2016, 2019 and 2021 (4 surveys) were combined into one dataset. The 4 surveys used same multistage cluster sampling procedure. After complex survey weighting, multiple logistic regression models were constructed to analyze factors influencing smoking status. Results: A total of 8 484, 9 372, 8 534 and 10 551 respondents were included in the surveys in 2014, 2016, 2019 and 2021, respectively. The smoking prevalence rate was 23.4%, 22.3%, 20.3% and 19.9%, respectively, in Beijing residents aged ≥15 years, exhibiting a linear declining trend (P=0.010). Factors associated with current smoking in men were age 25-44 years (OR=2.22, 95%CI: 1.68-2.95) and 45-64 years, (OR=2.64, 95%CI: 2.06-3.39), educational level of high school (OR=0.69, 95%CI: 0.49-0.95) and undergraduate and above (OR=0.46, 95%CI: 0.33-0.63), and awareness of smoking causing stroke (OR=0.71, 95%CI: 0.61-0.81), and awareness of smoking causing lung cancer (OR=0.53, 95%CI: 0.42-0.66), the differences were significant (all P<0.05). After controlling interfering factors, the current smoking prevalence in men in 2019 (OR=0.73, 95%CI: 0.63-0.87, P<0.001) and 2021 (OR=0.72, 95%CI: 0.61-0.88, P<0.001) were significantly lower than that in 2014. Factors associated with current smoking in women were living alone (OR=1.80, 95%CI: 1.33-2.44), educational level of undergraduate and above (OR=0.43, 95%CI: 0.27-0.69), other occupations except doctor and teacher (OR=8.54, 95%CI: 2.80-26.02) or being retired/unemployed (OR=9.39, 95%CI: 3.19-27.65), and awareness of smoking causing cardiovascular events (OR=0.58, 95%CI: 0.39-0.84), and awareness of smoking causing lung cancer (OR=0.54, 95%CI: 0.35-0.83), the differences were significant (all P<0.05). No significant change in smoking status in women was found in 4 surveys. Conclusions: The smoking prevalence rate in men in Beijing has declined since the implementation of Beijing Smoking Control Regulation 5 years, indicating the effectiveness of legislative approach in tobacco control. Socio-demographic factors and the awareness level of tobacco harm could influence smoking status. Future tobacco control programs should target the people with lower education level, young men, women living alone, and those with occupations other than teachers/doctors or the unemployed/retired and include more comprehensive health education.

P-310 Impact of adenomyosis on the live birth rate during management by in vitro fertilization : a French study

Abstract Study question Evaluate the impact of adenomyosis on the likelihood of live birth after a fresh embryo transfer. Summary answer Adenomyosis reduces the live-birth rate. The location of adenomyosis and the type of protocol appears to have no impact on the live birth rates. What is known already The prevalence of adenomyosis varies between 7 and 27%, and affects 25% of infertile women. Its impact on fertility remains debated. According to some studies, it leads to a lower pregnancy rate, a doubling of the spontaneous miscarriage rate and a lower live birth rate as compared to non-adenomyosis women. However according to some authors adenomyosis does not reduce the live birth rate. Similarly, the impact of the location of adenomyosis remains debated. On the impact of the stimulation protocol, several studies have shown that the use of GnRH agonist improves the live birth rate in patients with adenomyosis. Study design, size, duration This is a retrospective, descriptive and observational study, managed at the fertility department of Dijon University Hospital between January 2015 and March 2020. Systematically, the women infertility cause was assessed. We compared the group of patients with adenomyosis (i.e. symptomatic adenomyosis completed with a 3D ultrasound within a maximum of 1 year prior to management) with controls (i.e. patients treated for another cause of infertility). Ultrasound was performed by the same two experienced operators. Participants/materials, setting, methods We included 340 patients aged 18-41 years. Data concerning live births and type of stimulation protocol were collected from the patient’s electronic medical and therapeutic records. MUSA classification was used to determine whether the adenomyosis was localized or diffuse. The primary endpoint of this study was the live-birth rate (LBR) after fresh embryo transfer. The implantation and miscarriage rates were also compared. Main results and the role of chance We included 92 patients in adenomyosis group, and 248 patients in control group. Baseline characteristics of patients including women age, BMI and smoking habits were comparable in both groups. Moreover, no difference was found on the mean number of mature oocytes and embryos between the two groups. LBR after fresh embryo transfer was significantly lower in the adenomyosis group than in the control (34.8 % versus 41.5%, respectively, p = 0,02). There was no significant difference in implantation rate (35.7% versus 37,4%, p = 0.76). Early miscarriage rate (&amp;lt;12 weeks of amenorrhea) was higher in the control group than the adenomyosis group (15.3 versus 7.5, p = 0.012). Concerning late miscarriage (&amp;gt;12 weeks of amenorrhea), we observed 3 medical termination of pregnancy (all for fetal malformation) and 1 miscarriage (10%) in the adenomyosis group and 1 miscarriage (0.81%) in the control group (p = 0.02). Subgroup analyses showed no decrease in LBR according to adenomyosis location (32.7% versus 37.2% in the diffuse and localized groups, respectively, p = 0.46). Limitations, reasons for caution Even though our cohort is a good reflection of the all-French population of Burgundy since all patients are treated at the fertility center of Dijon. Despite its retrospective nature and the small number of included adenomyosis-patients, the ultrasound scans were performed by two experienced operators that reduced inter-observer variability. Wider implications of the findings It would be useful to carry out a prospective study including more patients to better assess the impact of location on implantation. It would also be interesting to evaluate neonatal and obstetrical complications, especially the late miscarriage issue requiring further investigation. Trial registration number non-clinical trials

Smoking-attributable Mortality in Korea, 2020: A Meta-analysis of 4 Databases.

Estimating the number of deaths caused by smoking is crucial for developing and evaluating tobacco control and smoking cessation policies. This study aimed to determine smoking-attributable mortality (SAM) in Korea in 2020. Four large-scale cohorts from Korea were analyzed. A Cox proportional-hazards model was used to determine the hazard ratios (HRs) of smoking-related death. By conducting a meta-analysis of these HRs, the pooled HRs of smoking-related death for 41 diseases were estimated. Population-attributable fractions (PAFs) were calculated based on the smoking prevalence for 1995 in conjunction with the pooled HRs. Subsequently, SAM was derived using the PAF and the number of deaths recorded for each disease in 2020. The pooled HR for all-cause mortality attributable to smoking was 1.73 for current men smokers (95% confidence interval [CI], 1.53 to 1.95) and 1.63 for current women smokers (95% CI, 1.37 to 1.94). Smoking accounted for 33.2% of all-cause deaths in men and 4.6% in women. Additionally, it was a factor in 71.8% of men lung cancer deaths and 11.9% of women lung cancer deaths. In 2020, smoking was responsible for 53 930 men deaths and 6283 women deaths, totaling 60 213 deaths. Cigarette smoking was responsible for a significant number of deaths in Korea in 2020. Monitoring the impact and societal burden of smoking is essential for effective tobacco control and harm prevention policies.

Maternal smoking prevalence in Brazil in 2013 and 2019: not what we expected when they were expecting!

Monitoring tobacco use during pregnancy is critical for achieving the United Nations Sustainable Development Goals. We examined changes between 2013 and 2019 in the relative differences in smoking prevalence rates between pregnant and non-pregnant women aged 18-49 years. We used data from a nationally representative health survey conducted in Brazil in 2013 and 2019. A generalized linear model with binomial family and logarithmic link function was used to estimate, for each year of analysis, the crude and adjusted (by age-group, educational attainment, place of residence, and status of protection from passive smoking at home) relative differences. In 2013,the proportion point estimate of tobacco use among pregnant women was lower than that observed among non-pregnant women (4.7% vs. 9.6%). However, in 2019 proportion point estimates were virtually the same (8.5% vs. 8.4%). After adjustment for selected variables, in 2013, smoking prevalence among pregnant women was 42% (p-value≤0.05) lower than that observed among non-pregnant women. On the other hand, in 2019, maternal smoking prevalence was 13% (p-value>0.05) higher than that found among non-pregnant women. Ongoing tobacco industry interference and the marketing of tobacco products to vulnerable populations pose serious threats to public health and likely contributed to increasing maternal smoking prevalence. The fact that women smoke in such an important phase of their and their unborn children's lives reinforces the need to strengthen the implementation of concurrent tobacco control actions, including tobacco excise tax policy and pre-natal tobacco prevention and cessation interventions as part of health professionals' routine consultation. The decline in smoking prevalence among non-pregnant women between 2013 and 2019 was accompanied by an increase in maternal smoking prevalence. Monitoring tobacco use during pregnancy is critical for achieving the United Nations Sustainable Development Goals. Ongoing tobacco industry interference and the marketing of tobacco products to vulnerable populations in Brazil pose serious threats to public health. The fact that women smoke in such an important phase of their and their unborn children's lives reinforces the need to strengthen the implementation of concurrent tobacco control actions, including tobacco excise tax policy and primary healthcare professionals´ tobacco-related assistance during interaction with their patients.

Makna Merokok bagi Wanita: Studi Fenomenologi pada Mahasiswi Perokok

Smoking activity is not only dominated by men. Female smoker is an existing phenomena that can be found in our daily life. Most of them are female college student. Even though they are threatened by some health risks and negative stigmas from society, female smokers keep doing their habit. This phenomena becomes interesting to explore that we may have deeper understanding about the meaning of smoking from the female smoker perspective. This study uses qualitative method with phenomenology approach. Data gain by: in-depth interview, observation, and literature study. The result shows that female smoker perceives smoking activity as: breathing exercise that bring calm and clarity of mind, an emotional reducer that helps relieve anger or sadness, a self-protection camouflage as a tough woman. Nevertheless informant also thinks that smoking could be harmful because of the health risk and stereotype from others. Based on analysis using Cognitive Dissonance Theory, the three meanings are the informant's efforts to minimize the dissonance between one cognitive element that she already knows about the risks of smoking for women and the cognitive element of the informant as an active smoker.