Tobacco Induced Diseases Research Articles

Pesticides and risk of pancreatic adenocarcinoma in France: a nationwide spatiotemporal ecological study between 2011 and 2021.

While pancreatic adenocarcinoma (PA) incidence is increasing, especially in France, the association between pesticides and PA remains unclear. The aims of this study were to assess the spatiotemporal distribution of the incidence of PA in France between 2011 and 2021 and to determine whether pesticide exposure was associated with higher risk of PA. We employed a disease-mapping and ecological regression approach with medicoadministrative data covering 99% of the French population. Exposure data were drawn from an open purchase database. A pesticide exposure intensity index (PEXI), defined as the logged and scaled median of the ratio quantity of substance over agricultural surface per spatial unit was used for total quantity (total PEXI) and 9 specific substances. The analyses were adjusted for tobacco-induced diseases, deprivation, community medicine accessibility, alcohol-related disease and morbid obesity. A Bayesian hierarchical spatiotemporal model was used to both model the incidence over time and space, and to estimate the risk of PA for pesticide use. We identified 134102 incident cases of PA between 2011 and 2021. The relative risk of PA was heterogeneous across space with greater risk around Paris, central France and the Mediterranean coast. We observed an association, albeit small, between the total PEXI and PA incidence over the study period (RR: 1.0130; CI95% [1.0057;1.0204]). Sulphur for spraying, mancozeb, and glyphosate showedevidence of an association of the same magnitude. These findings show that new cases of PA occur heterogeneously in space, raising questions about our understanding of PA environmental risk factors. The association with pesticide exposure should be confirmed and underlying mechanisms understood using individual-level studies.

The Impoverishing Effect of Tobacco Use in Indonesia.

Smoking households in Indonesia diverted a significant share of their budget to tobacco. Tobacco expenditure is deemed unproductive, as it crowds out resources from essential commodities and increases health care expenditure driven by tobacco-induced diseases. Therefore, despite having adequate resources, some smoking families in Indonesia may spend less on basic needs, which inadvertently puts their standard of living below the poverty line. Employing data from 2021 (March) Indonesia's Socioeconomic Survey (SUSENAS), this research aims to quantify the impoverishing effect of tobacco consumption in Indonesia, considering spending on tobacco and tobacco-attributable health care costs as unproductive expenditure. The de facto headcount poverty rate and poverty gap index are calculated by removing tobacco expenditures and tobacco-attributable health care expenditures from the household's total spending. Accounting for unproductive spending related to tobacco use, Indonesia's headcount poverty ratio in March 2021 would rise by 3.22 percentage points, equivalent to an additional 8.75 million people living below the poverty line. In addition, the poverty gap index would increase by 0.77 percentage points. The impoverishment effect of tobacco is larger among rural populations than their urban counterparts. Moreover, the impoverishment is mainly driven by direct tobacco spending rather than tobacco-attributable health care expenditure. Significant portions of Indonesia's population are exposed to secondary poverty due to tobacco use. A high level of cigarette spending among smoking households is the major source of the impoverishing effect of tobacco use. The study provides quantitative evidence of the true cost of smoking in Indonesia, where the de facto number of the poor population after accounting for tobacco-related spending is higher than what is published in the official statistics. The findings of this study support tobacco control policies in Indonesia, particularly to effectively reduce tobacco use and mitigate the impoverishing impact of tobacco use on low-income households.

Use of a Smartphone Self-assessment App for a Tobacco-Induced Disease (COPD, Cardiovascular Diseases, Cancer) Screening Strategy and to Encourage Smoking Cessation: Observational Study.

BackgroundPatient self-assessment via a mobile app detects actionable symptoms and has been shown to detect lung cancer relapses early, thereby lengthening survival.ObjectiveThe purpose of this study was to assess the incidence of chief symptoms associated with the main tobacco-induced pathologies in both current and ex-smokers through a self-assessment smartphone app and to evaluate the app’s capacity to encourage users to quit smoking or reduce consumption, as well as its impact on early lung cancer stages at the time of diagnosis.MethodsCurrent and ex-smokers were recruited through an advertising campaign in Sarthe county (France) proposing the free download of a smartphone app. App users were asked to answer 13 questions related to symptoms associated with tobacco-induced diseases (chronic obstructive pulmonary disease [COPD], cardiovascular diseases, cancer). In the event of any positive answer, a message was displayed recommending the user to consult a physician. In addition, they were asked about smoking cessation intention before and after answering these 13 questions. Finally, incidence of stage 1 or 2 lung cancers diagnosed during the launch period of our application was evaluated by comparing data from various sources to those from the same period during the previous year.ResultsOf the 5671 users who were eligible for evaluation, an alert was sent to the majority (4118/5671, 72.6%), with a higher incidence for current smokers (2833/3679, 77.0% vs 1298/1992, 65.2%; P<.001). The most frequent symptoms triggering the notifications were fatigue (2023/5671, 35.7%), cough (1658/5671, 29.2%), dyspnea (1502/5671, 26.5%), and persistent chest pain (1286/5671, 22.7%). Of the current smokers, 14.0% (515/3679) showed symptoms suggesting COPD, 15.5% (571/3679) showed symptoms suggesting stable angina, 12.4% (455/3679) probably had lower extremity artery disease, and 6.8% (249/3679) had possible cancer. Of the users, 36.5% (1343/3679) claimed that they thought about quitting smoking, and 48.7% (1795/3679) had thought about reducing their consumption. Surgery-eligible stage 1 and 2 lung cancer incidence was 24% (14/58) during the study period versus 9% (5/54) during the previous year in Sarthe county (P=.04), whereas it remained unchanged in the neighboring county of Maine-et-Loire.ConclusionsA majority of current and ex-smokers showed worrying symptoms, and the use of a self-assessment smartphone app may drive a majority of smokers toward the intention of smoking cessation or decreasing consumption. A randomized study should be performed to confirm this intention and to support the potential increase of symptomatic lung cancer detection at early, surgery-accessible stages.Trial RegistrationClinicalTrials.gov NCT04048954; https://www.clinicaltrials.gov/ct2/show/NCT04048954

Extraction and Determination of Nicotine in Tobacco from Selected Local Cigarettes Brands in Iraq

Tobacco smoke contains more than 3,800 different compounds, where all could harm the exposed humans to different degrees. Among them, nicotine (3-(1-methyl-2-pyrrolidinyl) pyridine) is considered the most toxic compound. In many countries, tobacco smoking is considered a severe health hazard and a significant factor in death and several common diseases. Because of that, knowing the toxicity of nicotine is important to help understand tobacco-induced human diseases and identify the potential risks associated with the therapeutic use of nicotine as an aid in smoking cessation. Thereby, estimating the nicotine amount is very crucial in tobacco production. As this work aims to extract and determine nicotine, which is the highest toxic component in tobacco plant leaves, several methods were carried out to extract the nicotine. All extracting methods were based on water extraction as a polar solvent and the other non-polar solvents. Water shows a limited extraction activity for nicotine from tobacco leaves. Since nicotine is a dibasic compound, an alkaline solution (40% NaOH) was used to extract nicotine from tobacco leaves for the selected samples. Further, solvent extraction by non-polar solvents was conducted to extract nicotine from the alkaline solution and prepare it for the spectrometric analysis. FT-IR and UV analysis show that the oily substance, which was extracted from tobacco leaves, is nicotine. Results were confirmed by microscopic examination for the extracted nicotine after the addition of mercuric chloride, where flowery shape crystals of nicotine liganded with mercuric chloride complex were formed.

Tobacco use and nicotine dependence among people living with HIV who drink heavily in South Africa: a cross-sectional baseline study

BackgroundPeople living with HIV (PLWH) who drink alcohol and use tobacco are particularly vulnerable to tobacco-induced diseases due to an already compromised immune system. This study investigated the prevalence and factors associated with tobacco use (cigarette and snuff) among PLWH who drink heavily.MethodsParticipants (n = 623) on antiretroviral therapy for HIV who reported heavy drinking using the Alcohol Use Disorders Identification Test (AUDIT) and AUDIT-C were recruited from six hospitals in Gauteng Province, South Africa. The Fagerström test was used to assess nicotine dependence. Chi Square tests and modified Poisson regression analyses were conducted to identify factors associated with tobacco use.ResultsAlmost half of the participants reported ever smoking (44.0%; CI: 40.1–47.9) and about a quarter reported ever using snuff (25.5%; CI: 22.2–29.1). Current smokers and current snuff users comprised 27.3% (CI: 23.9–30.9) and 19.1% (CI: 16.2–22.3) of all participants respectively. Among current smokers, 37.9% (CI: 30.8–45.3) were moderately/highly dependent on nicotine. Current ‘any tobacco product users’ (ATPU: use cigarettes or snuff) were 45.4% (CI: 41.5–49.3) while 1.0% (CI: 0.4–2.0) currently used cigarettes and snuff. Adjusted regression analyses showed that, compared to males, females were less at risk of being: ever smokers (Relative Risk Ratio [RRR] = 0.33; CI: 0.27–0.41), current smokers (RRR = 0.18; CI: 0.12–0.25), and ATPU (RRR = 0.75; CI: 0.63–0.89) but were more at risk of ever snuff use (RRR = 5.23; CI: 3.31–8.25), or current snuff use (RRR = 26.19; CI: 8.32–82.40) than males. Ever snuff users (RRR = 1.32; CI: 1.03–1.70), current snuff users (RRR = 1.40; CI: 1.03–1.89) and ATPU (RRR = 1.27; CI: 1.07–1.51) were more at risk of reporting significant depressive symptoms. We found no significant associations between smoking status and years on ART and viral load.ConclusionThere is a high prevalence of cigarette and snuff use among PLWH who drink heavily. Tobacco use cessation interventions tailored specifically for this population and according to their tobacco product of choice are urgently needed given their vulnerability to ill-health.

Factors associated with success of quitting smoking in Japanese Smoking Cessation Treatment Program: A systematic review and meta analysis focusing on gender, medicine and having present diseases

1. Gender differences and smoking cessation in the Japanese smoking cessation treatment program Meng Li, Reiko Okamoto Tobacco Induced Diseases CrossRef

TSLP and TSLP receptors variants are associated with smoking.

BackgroundTo search for new prevention markers for early detection of the diseases caused by tobacco, we aimed to investigate the polymorphisms in TSLP and TSLPRs associated with cigarette smoking in the Saudi population.Materials and methodsSamples were collected from 177 smokers and 126 healthy controls. Three TSLP SNPs [rs3806933, rs2289276, and rs10043985], three TSLPR SNPs [rs36133495, rs36177645, and rs36139698], and two IL7R SNPs rs1053496 and rs12516866 were analyzed by genotyping.ResultsTwo TSLP SNPs (rs10043985 and rs3806933) and one TSLPR SNP (rs36139698) showed significant correlations with smoking behavior, but not IL7R rs12516866 and rs1053496. rs10043985 showed a clear association with long‐term smoking regardless of daily cigarette consumption. rs2289276 was associated with short‐term smoking but not with daily cigarette consumption. rs3806933 was highly associated with different smoker subgroups. Rs36139698 was highly associated with long‐term smokers who consumed ≥20 cigarettes/day, and the “T” allele was associated only with individuals who smoked ≤20 cigarettes/day. Rs36139698 corresponds to a P195L substitution and produces a TSLPR mutant with a predicted ΔΔG increase of 2.15 kcal/mol and has a more stable structure than the wild‐type variant.ConclusionsInvestigating TSLP and TSLPR polymorphisms is crucial for elucidating the mechanisms underlying tobacco‐induced diseases.

“Everyone Needs a Breath of Fresh Air”

Europe continues to have among the highest worldwide prevalence of adult smoking (28%) and the highest among females (19%). Nurses' rates of smoking in the region are comparable or higher than the general female population. Nurses who smoke are less likely to intervene with patients who smoke; therefore, supporting nurses' efforts to quit is critical to promoting nurses' well-being and strengthening the profession's impact on prevention of tobacco-induced diseases. The aim of this study was to explore nurses' perceptions of hospital workplace factors that influence nurses' smoking and quitting behaviors in Central and Eastern Europe. Each country had a project director involved in the recruitment of participants and the translation of instruments. Using a moderator guide, focus groups (N = 9) about smoking and quitting were conducted in 5 countries (Czech Republic, Hungary, Romania, Slovakia, Slovenia) among 82 nurses who self-reported as current or former smokers. Recorded transcripts were translated and analyzed using content analysis methods. The majority of nurses were female (94%) and currently smoking (65%). Four major themes were identified that describe workplace factors influencing nurses' smoking behaviors and efforts to quit: (1) taking breaks, (2) effect of smoking on patient interactions, (3) perceived collegial support for quitting, and (4) impact of workplace policies. Workplace factors influence nurses smoking and quitting behaviors. Changes in healthcare systems and policies are needed to support nurses' quit efforts. Additional education is needed to ensure that nurses understand issues related to smoking and interactions with patients.

Observational study to check the compliance of implementation of 85% graphic health warnings on tobacco products in India from April 1, 2016

1. A pilot study to assess compliance and impact of health warnings on tobacco products in the Udupi district of Karnataka State, India Somya Mullapudi, John Britton, Muralidhar Kulkarni, Crawford Moodie, Veena Kamath, Asha Kamath Tobacco Induced Diseases CrossRef

Prevalence of e-cigarette in China: preliminary findings from two surveys

1. Perceptions and use of electronic cigarettes among young adults in China Xinsong Wang, Xiulan Zhang, Xiaoxin Xu, Ying Gao Tobacco Induced Diseases CrossRef

Smoking cessation therapy in Ethiopia: responsiveness and the predictors

1. The state of smokeless tobacco cessation in a context lacking cessation services: Evidence from Ethiopia Mamusha Hussen, Edao Etu Tobacco Induced Diseases CrossRef

Smoking rooms undermine FCTC agenda in Kazakstan

1. Air quality at venues of mixed smoking policies in Kazakhstan Jamilya Sadykova#, Ardak Baizhaxynova#, Byron Crape Tobacco Induced Diseases CrossRef

Mathiwos Wondu-YeEthiopia Cancer Society (MWECS) experiences in involvement of Ethiopian Tobacco Control Policy Advocacy

1. The state of smokeless tobacco cessation in a context lacking cessation services: Evidence from Ethiopia Mamusha Hussen, Edao Etu Tobacco Induced Diseases CrossRef

Predictors of intention to quit smokeless tobacco among adults in pastoral communities of Borena Zone, South Ethiopia

1. The state of smokeless tobacco cessation in a context lacking cessation services: Evidence from Ethiopia Mamusha Hussen, Edao Etu Tobacco Induced Diseases CrossRef

The "Canone Inverso": when tobacco was not so bad. A Look Back at the Primordial Debate on the tobacco effects in the Occupational Medicine.

Aim: The article provides an overview on the beginning and evolutions of medical observations on tobacco induced diseases between Eighteenth and Nineteenth century. Methods: By searching for historical medical literature,first studies on tobacco-induced diseases focused on production risks rather than on adverse effects that the use of tobacco has for the human health. Results: The approach induced first eighteenth-century authors to define this substance as a non-pathogenic and, consequently, not to consider tobacco factories dangerous for health workers. In those years, tobacco was employed in therapy as a stimulant treatment and it was considered harmless and even healthy and preventive of several acute diseases. Conclusions: Authors will show that studies on pathogenic effects of smoking will only start around late nineteenth century, when the idea of the healthiness of tobacco industry was already supported. (www.actabiomedica.it)

Using a Collaborative Approach to Tobacco Control Efforts in Marginalized Communities

ObjectiveTo examine community engagement as a means to strengthentobacco-related policies and programs use in marginalizedpopulations.IntroductionAlthough significant progress has been made in tobacco control inthe United States (US) over the past 50 years, more than 15% of thepopulation currently use tobacco products.1Tobacco use continuesto be the leading cause of preventable death, contributing to over480,000 deaths and about $300 billion in economic costs each year.To achieve theHealthy People 2020(HP2020) objective of 12%national adult smoking rate by 2020, it is important to focus ourtobacco control efforts on surveillance and addressing disparitiesin tobacco use prevalence and tobacco-induced diseases acrossdifferent subpopulations and geographic areas.2Utah reportedthe lowest prevalence rate (9.7% in 2014), while rates as high as28% were identified in central Appalachia. Modern epidemiologyis limited in its ability to explain patterns of tobacco use andtobacco-related interventions and policies in these highly prevalent,marginalized environments. Therefore, a combination of quantitativeand community-based participatory research (CBPR), as proposedin Public Health 3.0, will expand the scope and reach to addressall factors of tobacco use, including cross-sector collaboration andmulti-level actions.3This study aimed to comprehensively investigatecounties in the Northeast Tennessee region where tobacco useprevalence is disproportionately highest, and to identify regionaland culturally specific evidence-based practices for tobacco control.Additionally, the study examined how these practices can be scaledup to address similar high tobacco use and disadvantaged populationselsewhere in the US and worldwide.MethodsGrounded by the CBPR framework, a mixed-methods approachtriangulated multiple sources of data using a three-prong assemblageofProtection,Prevention, andCessation, to develop tobaccocontrol recommendations and goals as part of a Population HealthImprovement Plan for Tennessee. Information gained from healthcouncil discussions, focus groups, interviews, and stakeholdermeetings were combined with quantitative analyses of secondarydata from Tennessee Department of Health, school-based surveys,and qualitative analyses conducted for descriptive and inferentialstatistics. All discussions and interviews involving 222 individualsfrom 91 organizations were recorded and organized using NVivo10, thematically coded using grounded theory, and analyzed usingdescriptive statistics. The results utilized aggregated themes generatedfrom the data.ResultsTobacco use in the Northeast Tennessee region comprises cigarettesmoking and smokeless tobacco, with increasing uptake of electroniccigarettes across all age groups. Among others, culture of tobaccouse and cultivation was identified as the most salient factor fortobacco use. Reducing tobacco use requires a foundation built oninformatics, community engagement, and a model for sustainablefunding to support infrastructure and program interventions. Whilestate and national policies and programs have received less attentionin this region, several effective community-based policies andprograms to prevent tobacco use were identified, including incentiveprograms such as Baby and Me, voluntary smoke-free campuspolicies by businesses and colleges, 100% screening programs byhospitals, and nicotine-free employee population. Overall, a total of25 recommendations were identified, with 14 aimed at protection,four at prevention, and seven at cessation. These recommendationsculminated into five overarching goals:Protectthe population fromtobacco and secondhand smoke exposure through policy enforcementand implementation and counter-marketing;Preventinitiation oftobacco use with comprehensive youth-focused programs that increaseknowledge and awareness;Expandaccess to cessation resources andtreatment, especially in high risk populations;Fostercollaborationand partnership; andMonitordata for evaluation and validity.ConclusionsThis is one of the few comprehensive attempts to address the socialdynamics of tobacco use and identify population and geographicpolicies and programs in highly prevalent communities. Amongthe myriad issues identified, the expansion of surveillance data toinform tobacco policy and culturally-tailored tobacco policies andprograms are essential to reduce tobacco use in population subgroups.Combining CBPR with actionable data can spur innovations inlocal efforts, highlight social determinants of health, and contributeto evidence-based policy. While the results of this study primarilyprovide in-depth descriptions of central Appalachia’s tobacco-relatedrisks and their perceptions of and reactions to tobacco preventionintervention, the policies and programs identified through the processmay be more readily adopted and scaled-up to address the disparitiesin tobacco use and tobacco-induced diseases, particularly pertainingto low-income, disadvantaged, and hard-to-reach populations.

Epilogue to Special Issue on Tobacco and Other Substance Use Disorders: Links and Implications

ABSTRACTThis paper summarizes The American Journal of Drug and Alcohol Abuse special issue and offers suggestions for future steps. People who use alcohol or other addictive substances are much more likely to use tobacco. Yet, clinicians and scientists have long regarded these addiction categories as separate and unrelated. The resultant benign neglect of tobacco use has had disastrous consequences on patients. This special issue is an important step toward remedying that situation. It has reviewed what is known and what more needs to be discovered regarding the co-occurrence of tobacco use disorder (TUD) and other substance use disorders (SUDs). The timing of this special issue occurs at a moment when smoking rates among both adults and youth are at a modern low. But not all segments of the population have benefited from this improvement. In particular, those with a SUD smoke two to four times the rate of the general population and thus suffer disproportionately from the myriad tobacco-induced diseases. The multi-disciplinary contributors to this special issue have reviewed various aspects of the co-occurring disorders. What emerges is a complex portrait. In some categories, the facts are stark, such as the strong association between SUDs and tobacco use and the toll they both extract. In others, such as the emerging new electronic nicotine delivery devices, there are intriguing associations that warrant further investigation. What is clear is that the historic schism between smoking and other addictions needs to be breached in order to improve the health of the public. This special issue should be viewed as a call to action for breaching that schism.

Author's response to: "Harmful effects form one puff of shisha-pen vapor: methodological and interpretational problems in the risk assessment analysis".

We thank Dr. Farsalinos and Dr. Baeyens for their comments in their letter to the editor on our publication: “Potential harmful health effects of inhaling nicotine-free shisha-pen vapor: a chemical risk assessment of the main components propylene glycol and glycerol” [1]. Apparently some issues discussed in our publication were not sufficiently clear and we thank the editor of Tobacco Induced Diseases for the opportunity to respond to these comments and clarify the issues raised.

Acknowledgement of manuscript reviewers 2015

Contributing reviewersThe editors of Tobacco Induced Diseases would like to thank all our reviewers who have contributed to the journal in Volume 13 (2015).

EUREST PLUS - European Regulatory Science on Tobacco: Policy implementation to reduce lung diseases - Proposal (Horizon2020)

1. Associations of e-cigarette experimentation with support for tobacco control policies in the European Union, 2012-2014 Anthony Laverty, Filippos Filippidis, Esteve Fernandez, Constantine Vardavas Tobacco Induced Diseases CrossRef