Tobacco-related Diseases Research Articles

Economic costs of tobacco-related diseases in Hong Kong in 2021

BackgroundHong Kong has one of the lowest smoking prevalence both within China and among high-income economies. As tobacco use consistently declined over the past decades, we examine whether there are...

A proof-of-concept trial of a smoking cessation and anxiety sensitivity reduction smartphone application for Black adults

ABSTRACT Black persons who smoke are recognized as a smoking health disparity group and face higher rates of tobacco-related disease and morbidity. These disparities result from, in part, exposure to minority-related stress, which results in lower rates of quit success. Anxiety sensitivity (AS), which refers to the fear of stress, is associated with lower rates of cessation and impedes quit success among Black adults who smoke. The current study evaluated the feasibility, utilization, acceptability, and initial efficacy of a smoking cessation and AS reduction smartphone application for Black adults with elevated AS who smoke (The Mobile Anxiety Sensitivity Program for Smoking [MASP]). Participants (N = 24; 62.50% female; M age = 47.83 years, SD = 9.32) participated in a 6-week trial of MASP. Retention was 83.33% at the 6-week follow-up and MASP utilization was high, with all features used by most participants. Participants reported that MASP was acceptable and 25% of participants reported 7-day point-prevalence abstinence, demonstrating strong utility and impact potential. Results also indicated a statistically significant reduction in AS from baseline to follow-up (p = .003, Cohen’s d=.76). Black persons who smoke with AS may benefit from an accessible, adaptive app with culturally tailored treatment that addressed AS in the context of smoking cessation.

Qualitative examination of US and Israeli adults' perceptions of IQOS advertising messages: modified exposure and risk statements, US FDA endorsement, and health warnings.

IQOS, a leading heated tobacco product, is advertised as less harmful than cigarettes and received US Food and Drug Administration (FDA) authorization for 'reduced exposure' advertising claims. Perceptions of advertising messages, including reduced exposure/risk claims, FDA endorsements, and health warning labels (HWLs), are understudied. Qualitative interviews (N=84) from US and Israeli adults (2022) examined perceptions of advertising messages, specifically: 1) scientific claims that switching completely from cigarettes to IQOS reduces 1a) chemical exposure and 1b) tobacco-related disease risk; 2) FDA endorsement of IQOS as a 2a) better choice for adult smokers and 2b) fundamentally different product (heat-not-burn); and 3) promoting IQOS as cigarette alternatives with a HWL pertaining to cigarettes. For half of participants, referencing scientific studies or the FDA enhanced credibility; some believed this implied unbiased, rigorous research. Half were skeptical due to lack of research-related details. Half interpreted message 1 (switching) to mean any substitution could be beneficial; half interpreted it as complete substitution was necessary. Most did not perceive differences between message 1a (reduced exposure) vs. 1b (reduced risk). Some believed message 2a (FDA endorsement, not targeting youth) demonstrated IQOS' social responsibility. Some interpreted message 2b (fundamentally different product) as risk reduction; others perceived no difference. The majority paraphrased messages using the terms 'safer', 'healthier', or 'less harmful'. For message 3 (safer alternative), some did not think the HWL applied to IQOS; some believed it promoted IQOS. Regulators and researchers must monitor harm reduction advertising messaging and take actions to prevent consumer misinterpretations. Philip Morris International's IQOS received US Food and Drug Administration (FDA) authorization for 'reduced exposure' advertising claims, which are often misinterpreted, and has exploited FDA authorization to promote IQOS globally. This qualitative study showed that most participants perceived no difference between reduced risk vs. exposure messages in IQOS ads, half believed that references to scientific studies or FDA enhanced credibility, some believed certain messages demonstrated IQOS' social responsibility, and some perceived warnings in IQOS ads to promote IQOS. Product ads using harm reduction messages must be monitored to inform efforts to prevent potentially harmful misinterpretations and mitigate negative population-level impacts.

Tobacco Treatment Disparities Among California Medicaid Members With and Without Chronic Disease Who Smoke

Introduction: People who are covered by Medicaid have a higher smoking prevalence than the general population and are at increased risk for tobacco-related disease, a major driver of Medicaid costs. California has the largest Medicaid program, called Medi-Cal, whose members also have higher tobacco use rates and tobacco-related disease. Quitting is beneficial at any age and health professional advice and assistance is a key indicator of smoking cessation. As Medi-Cal transforms to improve population health and health equity, this study aimed to understand both prevention and treatment of tobacco-related disease by comparing health professional advice and assistance among all Medi-Cal members with and without chronic disease who smoke. Materials and Methods: Using data from the California Health Interview Survey (2014, 2016-2018), we examined 3,517 Medi-Cal current smokers (age ≥18) who consulted a health professional and reported about having a chronic disease. The outcomes were receipt of health professional advice or assistance to quit smoking. Adjusted logistic regression models were conducted to examine the association between chronic disease and the outcomes, including adjusting for frequency of office visits. Results: Among 1,227,154 Medi-Cal members who smoke, over half (51.9%) of whom had at least one chronic disease, approximately half received cessation advice, and less than one-third received smoking cessation assistance. Smokers with chronic disease, compared to those without chronic disease, were more likely to receive health professional advice (63.9% vs. 33.7%, P < .001) and assistance (37.7% vs. 20.5%, P < .001). In adjusted models, smokers with chronic disease, compared to those without chronic disease, were almost twice as likely to receive advice (OR=1.97, 95% CI: 1.39, 2.78) and 1.5 times as likely to receive assistance (OR=1.50, 95% CI: 0.94, 2.38), but the latter was not statistically significant. Conclusions: Medi-Cal members who smoke have tobacco treatment disparities by whether they are with or without chronic disease, even after adjusting for the number of office visits. Medi-Cal population health strategies for tobacco cessation treatment will need to improve prevention, not just treatment, of tobacco-related disease to reduce the long-term burden on the health care system and associated costs.

Electronic Cigarette Use and Use of Evidence-Based Smoking Cessation Methods among American Indian Cigarette Smokers: A Cross-Sectional Analysis

Introduction: Tobacco use is the leading cause of death in the United States (US), and American Indian/Alaska Native (AI/AN) people have high rates of tobacco-related diseases. While US Food and Drug Administration approved products and evidence-based methods exist for smoking cessation, people who smoke might use electronic cigarettes (e-cigarettes) as cessation aids. Whether e-cigarette use is associated with the use of evidence-based methods is unknown, particularly among AI/AN individuals. Methods: Using survey data collected in 2016 from 289 adult AI people who smoke and who reported a previous cessation attempt, we conducted multivariate logistic regression analyses to assess associations between e-cigarette use and evidence-based cessation methods. Analyses were performed in 2023. Results: Individuals who currently or formerly used e-cigarettes compared to those who did not use e-cigarettes were significantly more likely to report using nicotine replacement therapy (NRT) during their last quit attempt (current vs never adjusted Odds Ratio (aOR)=4.6, 95% Confidence Interval (CI) (1.9-11.9); past vs never aOR=4.6, 95% CI (2.2-9.8); p<0.001). Current and former e-cigarette use were significantly associated with prescription use in the unadjusted analysis but lost significance in the adjusted analysis (current vs never aOR=3.1, 95% CI (1.0-10.5); past vs never aOR=2.7, 95% CI (1.1-7.9); p>0.05). Individuals with current or former use of e-cigarettes were significantly less likely than individuals who never used e-cigarettes to use the cold turkey method (unassisted cessation) (current vs never aOR=0.3, 95% CI (0.2-0.6); past vs never aOR=0.3, 95 %CI (0.1-0.7); p<0.01). Conclusions: These results suggest that persons who use e-cigarettes are more likely than individuals who do not use e-cigarettes to previously have tried NRT but less likely to use the cold turkey method. A larger study is needed to determine if individuals who use e-cigarettes are also more likely to have tried prescription medication for smoking cessation. Whether e-cigarette use impedes or encourages the use of evidence-based cessation methods is unknown. +

Associations Among Experiences With Racial Discrimination, Religion/Spirituality, and Cigarette Smoking Among African American Adults: The Jackson Heart Study.

African American adults exhibit disproportionately high rates of tobacco-related diseases and associated death. Experiences with racial discrimination contribute to health disparities among African Americans, but more research is needed to understand associations between perceived discrimination and tobacco use as well as potential protective factors. This study examined associations between perceived racial discrimination and cigarette smoking, as well as religion and spirituality as moderators of any associations. Cross-sectional data were drawn from the Jackson Heart Study, a study of cardiovascular disease risk factors among African American adults in Jackson, MS. Measures included perceived everyday discrimination and major life events discrimination that was attributed to race. Participants also reported religious attendance, prayer, spirituality, and whether they prayed in response to discriminatory experiences. Logistic regression models tested associations between perceived racial discrimination and cigarette smoking status, and interactions between religiosity/spirituality and discrimination in predicting smoking status. A total of 2,972 participants were included in the analysis (62.7% female, mean age 55.1 years). Thirteen percent reported currently smoking cigarettes. Everyday racial discrimination was associated with a higher likelihood of current smoking (p = .01). The association between lifetime racial discrimination and current smoking status was weaker for those who reported prayer as a reaction compared to those who did not report prayer as a reaction (adjusted odds ratio = 0.32, 95% confidence interval: 0.11 to 0.91) while adjusting for demographics and covariates. Stressful experiences with racial discrimination may create risks for health behaviors like smoking. However, prayer may act as a coping strategy to help buffer the effects of racial discrimination on smoking behavior.

The impact of the tobacco law on tobacco-related hospitalizations in Portugal - a natural experiment

Abstract Introduction Tobacco is responsible for approximately 8 million deaths annually worldwide, with 1.2 million resulting from passive exposure to smoke, as reported by the WHO. Comprehensive tobacco control policies have been enacted across Europe, yet their impacts are seldom assessed. This study evaluates the effects of the anti-tobacco legislation enacted in Portugal in 2007 on tobacco-related hospitalizations between 2002 and 2018. Methods Data from all in-patient admissions in public hospitals throughout the 2002-2018 period were utilized. A quasi-experimental interrupted time series design was employed, treating 2008 as an exogenous shock. The dependent variables include the municipality-based incidence of hospitalizations by year for tobacco-related diseases, namely, Acute Myocardial Infarction, stroke, lower respiratory tract infections, chronic obstructive pulmonary disease, and asthma. The analysis was adjusted for the percentage of women, the percentage of individuals aged over 65, and purchasing power in the municipality. Time trend graphs for each variable were generated, followed by an adjustment using the Poisson regression model to forecast their trends. A comparison was conducted between observed post-law implementation data and projected values from the regression model to ascertain the percentage difference between the two. Expected Results The 2007 tobacco law led to significant reductions in tobacco-related disease incidence, with the most notable effects immediately post-implementation. The impact varies across age groups, with younger individuals (30-49 years) showing a sharper decrease. The effect diminished over time, as indicated by negative coefficients in time:law interactions, such as -0.03. Conclusions The anti-tobacco laws implemented in Portugal have effectively decreased hospitalizations related to tobacco use, suggesting potential increases in life expectancy and reduction in health system burden. Key messages • Public health policies are crucial for the long-term improvement of people’s health. • Non-exposure to tobacco can bring health gains on several levels.

Variation in Relative Risk Perceptions and Tobacco Use by Race and Socioeconomic Status among Older Adults who Smoke: Evidence from the Population Assessment of Tobacco and Health (PATH) Study.

Older adults who smoke face significant risk of tobacco-related disease and hold misperceptions about health risks posed by nicotine product use. This study examined whether socioeconomic status and race are associated with variation in cigarette/e-cigarette relative risk perceptions, whether relative risk perceptions are associated with tobacco use behaviors, and whether socioeconomic status and race moderate associations between perceptions and use behaviors. Five waves of PATH Study yielded data from 1,879 adults >55 who smoked within the past 30 days during Wave 1. Adjusted longitudinal logistic models estimated associations between higher vs. lower SES ("low-SES": less than high school diploma/GED. and annual household income<$25,000) and race (White vs. Black/African American; AA) and e-cigarette/cigarette relative risk perceptions, behavioral intentions, and e-cigarette use. Lower-SES adults were more likely to report e-cigarettes were very/extremely harmful to health (AOR: 1.74, p<0.01) and less likely to report e-cigarettes were less harmful than cigarettes (AOR: 0.65, p<0.01). Black/AA adults were less likely to report that e-cigarettes were less harmful than cigarettes. Participants rating e-cigarettes as equally/more harmful than cigarettes exhibited lower odds of intending to quit smoking or switch to e-cigarettes. Finally, Black/AA adults who also perceived e-cigarettes equally/more harmful than cigarettes exhibited greater odds of trying to reduce rather than quit smoking (AOR: 1.58, p=0.02). Many older adults who smoke perceive e-cigarettes as equally or more harmful than cigarettes, particularly low-SES and Black/AA older adults. Differences in relative risk perceptions among high priority populations could negatively influence cessation attempts and switching behaviors. This study found that Black/AA and low-SES older adults who smoke cigarettes were more likely to perceive e-cigarettes as harmful or more harmful than cigarettes. The absence of accurate, evidence-based information regarding the relative health risks associated with the long-term use of various tobacco products may impede policy efforts to reduce disparities in smoking-related disease through increased cessation and/or harm reduction.

Unlocking the power of tobacco taxation to mitigate the social costs of smoking in Mexico: a microsimulation model.

Despite being the most cost-effective tobacco control policy, tobacco taxation is the least implemented component of the World Health Organization MPOWER package to reduce smoking worldwide. In Mexico, both smoking prevalence and taxation have remained stable for more than a decade. This study aims to provide evidence about the potential effects of taxation to reduce the burden of tobacco-related diseases and the main attributable social costs in Mexico, including informal (unpaid) care costs, which are frequently ignored. We employ a first-order Monte Carlo microsimulation model that follows hypothetical population cohorts considering the risks of an adverse health event and death. First, we estimate tobacco-attributable morbidity and mortality, direct medical costs and indirect costs, such as labour productivity losses and informal care costs. Then, we assess the potential effects of a 50% cigarette price increase through taxation and two alternative scenarios of 25% and 75%. The inputs come from several sources, including national surveys and vital statistics. Each year, 63 000 premature deaths and 427 000 disease events are attributable to tobacco in Mexico, while social costs amount to MX$194.6 billion (US$8.5)-MX$116.2 (US$5.1) direct medical costs and MX$78.5 (US$3.4) indirect costs-representing 0.8% of gross domestic product. Current tobacco tax revenue barely covers 23.3% of these costs. Increasing cigarette prices through taxation by 50% could reduce premature deaths by 49 000 over the next decade, while direct and indirect costs averted would amount to MX$87.9 billion (US$3.8) and MX$67.6 billion (US$2.9), respectively. The benefits would far outweigh any potential loss even in a pessimistic scenario of increased illicit trade. Tobacco use imposes high social costs on the Mexican population, but tobacco taxation is a win-win policy for both gaining population health and reducing tobacco societal costs.

Health, economic and social burden of tobacco in Latin America and the expected gains of fully implementing taxes, plain packaging, advertising bans and smoke-free environments control measures: a modelling study

ObjectiveTo investigate the tobacco-attributable burden on disease, medical costs, productivity losses and informal caregiving; and to estimate the health and economic gains that can be achieved if the main tobacco...

Thirdhand smoke exposure promotes gastric tumor development in mouse and human

The pollution of indoor environments and the consequent health risks associated with thirdhand smoke (THS) are increasingly recognized in recent years. However, the carcinogenic potential of THS and its underlying mechanisms have yet to be thoroughly explored. In this study, we examined the effects of short-term THS exposure on the development of gastric cancer (GC) in vitro and in vivo. In a mouse model of spontaneous GC, CC036, we observed a significant increase in gastric tumor incidence and a decrease in tumor-free survival upon THS exposure as compared to control. RNA sequencing of primary gastric epithelial cells derived from CC036 mice showed that THS exposure increased expression of genes related to the extracellular matrix and cytoskeletal protein structure. We then identified a THS exposure-induced 91-gene expression signature in CC036 and a homologous 84-gene signature in human GC patients that predicted the prognosis, with secreted phosphoprotein 1 (SPP1) and tribbles pseudokinase 3 (TRIB3) emerging as potential targets through which THS may promote gastric carcinogenesis. We also treated human GC cell lines in vitro with media containing various concentrations of THS, which, in some exposure dose range, significantly increased their proliferation, invasion, and migration. We showed that THS exposure could activate the epithelial-mesenchymal transition (EMT) pathway at the transcript and protein level. We conclude that short-term exposure to THS is associated with an increased risk of GC and that activation of the EMT program could be one potential mechanism. Increased understanding of the cancer risk associated with THS exposure will help identify new preventive and therapeutic strategies for tobacco-related disease as well as provide scientific evidence and rationale for policy decisions related to THS pollution control to protect vulnerable subpopulations such as children.

A Lost Opportunity in Tobacco Cessation Care: Impact of Underbilling in a Large Health System

IntroductionTobacco cessation remains a critical challenge in healthcare, with evidence-based interventions often under-utilized due to misaligned economic incentives and inadequate training. This study aims to quantify the economic impact of missed billing opportunities for tobacco cessation in a healthcare system, thereby assessing potential revenue loss and evaluating the effectiveness of systems-based approaches to enhancing tobacco cessation efforts. MethodsA retrospective cohort study utilized aggregated de-identified patient health data from an 8-hospital regional health system across Pennsylvania and Maryland, from 1/1/21 to 12/31/23. The analysis focused on primary care encounters eligible for tobacco cessation counseling (CPT codes 99406 or 99407), with potential revenue calculated based on the Medicare reimbursement rate. ResultsOver three years, and 507,656 office visits, only 1,557 (0.3%) of encounters with persons using tobacco were billed for cessation services. The estimated total potential revenue gained if each person who was identified as using tobacco was billed consistently for tobacco cessation counseling was $5,947,018.13, and $1,982,339.38 annually. ConclusionsThe study reveals a significant gap between the potential and actual billing for tobacco cessation services, highlighting not only the financial implications of missed opportunities but also a validation of a health system's public health impact. Underbilling contributes to considerable annual revenue loss and undermines primary prevention efforts against tobacco-related diseases. The findings illuminate the need for enhanced billing practices and systemic changes, including policy improvements that influence proper billing to promote public health benefits through improved tobacco cessation interventions.

Impact of a structured teaching on the ill effects of tobacco chewing among Indian adults.

Tobacco chewing remains a prevalent health issue globally, particularly in India, where it is deeply ingrained in cultural practices. This study evaluates the impact of a structured teaching program on knowledge regarding the ill effects of tobacco chewing among adults enrolled in arts and commerce colleges in Patan, India. A quasi-experimental design was employed, with 100 participants recruited from arts and commerce colleges. The structured teaching program included educational sessions covering the harmful effects of tobacco chewing and cessation strategies. Pre and post-test knowledge assessments were conducted using a self-structured questionnaire. The majority of participants were aged 15-17 years (75%), male (75%), and from urban areas (58.33%). Significant improvements in knowledge scores were observed following the intervention (pretest mean score = 11.5, posttest mean score = 44.38), with a significant difference between pre and post-test scores (t = 11.38, p < 0.001). Associations between pre-test knowledge scores and demographic variables such as gender, education, type of family, area of residence, father's education and occupation, monthly income, history of illness, and previous knowledge were identified (p < 0.05). Conclusion: The study underscores the significance of targeted health education programs in addressing tobacco-related health risks and promoting public health. By enhancing awareness and knowledge among adults, such interventions contribute to fostering behavior change and reducing the burden of tobacco-related diseases.

Tobacco smoking-attributable mortality in Kenya, 2012-2021.

Tobacco smoking poses a significant risk for various diseases, including cardiovascular diseases, chronic respiratory diseases, and cancers. In Kenya, tobacco-related deaths contribute substantially to non-communicable disease mortality. This study aims to quantify the mortality attributed to tobacco smoking in Kenya from 2012 to 2021. Employing a prevalence-based analysis model, the study utilized population attributable fraction (PAF) to estimate age-specific smoke attributable mortality (SAM) rates for individuals aged ≥35 years. Causes of death associated with tobacco use, including cancers, cardiovascular diseases, respiratory diseases, tuberculosis, and diabetes, were analyzed based on age, sex, and death records between 2012 and 2021. Over the study period, 60228 deaths were attributed to tobacco-related diseases, with an annual increase observed until 2016 and subsequent fluctuations. Respiratory diseases, diabetes mellitus, malignant cancers, tuberculosis, and cardiovascular diseases collectively accounted for 16.5% of deaths among individuals aged ≥35 years. Notable contributors were pneumonia and influenza (respiratory diseases), esophageal cancer (cancers), and cerebrovascular diseases (cardiovascular diseases). Of the observed deaths, 16.5% were attributed to smoking, with respiratory diseases (40.5%), malignant cancers (31.4%), tuberculosis (13%), cardiovascular diseases (8.9%), and diabetes mellitus (6.1%) contributing. Pneumonia and influenza, esophageal cancer, chronic airway obstruction, and tuberculosis were primary causes, comprising 70% of all SAM. Tobacco-related mortality is a significant public health concern in Kenya. Efforts should focus on preventing tobacco use and managing associated disease burdens. Smoking cessation initiatives and comprehensive tobacco control measures are imperative to mitigate the impact on population health.

Associations of demographic and tobacco use characteristics with young adults’ self-reported clinical encounters: Implications for cessation efforts

IntroductionAccelerating smoking cessation, particularly among young adults, is a national priority for decreasing tobacco-related disease. Healthcare providers play a critical role in delivering tobacco treatment interventions to this population. This study examined associations of demographic and tobacco use characteristics with young adults’ self-reported past-year clinical encounters to identify opportunities to facilitate cessation. MethodsWe conducted cross-sectional, secondary analyses on a sample of 831 young adults aged 18–34 participating in the first wave of the National Young Adult Health Survey (NYAHS 2018–2019). Demographic and tobacco use characteristics were participants’ sex, age, race, current cigarette use, and current other tobacco use. Clinical encounter outcomes were past-year self-report of (1) seeing a clinician, (2) being asked about tobacco use, and among those currently smoking, (3) being advised to quit smoking. ResultsAfter adjustment for covariates, women (vs. men) had 2.16 times greater odds of reporting seeing a clinician, while Non-White (vs. White) young adults and those currently (vs. never) smoking had 69% and 47% lower odds. Women and those currently smoking had 2.98 and 2.66 times greater odds, respectively, of being asked about tobacco use. Among those who currently smoked, being not confident (vs. confident) about quitting smoking was associated with 69% lower odds of being advised to quit; those who reported moderate (vs. low) nicotine dependence had 3.11 times higher odds of being advised to quit. ConclusionsSex, racial, and smoking status differences in young adults’ clinical encounter outcomes suggest multiple opportunities for future smoking prevention and cessation intervention efforts.

Randomized controlled trial of a text-based smokeless tobacco cessation intervention for rural and medically underserved communities.

Smokeless tobacco use remains prevalent in rural and medically underserved populations, leading to increased rates of tobacco-related cancers and chronic disease. While access to effective cessation programs is limited, text-based interventions may offer a delivery approach with broad reach. This two-armed randomized control trial (RCT) assessed the efficacy of #EnufSnuff.TXT, a text-based smokeless tobacco cessation intervention, in rural and medically underserved communities. We conducted a two-arm RCT assessing #EnufSnuff.TXT, a text-based scheduled reduction intervention paired with text-based cessation support messages compared with the modified Enough Snuff intervention comprised of a cessation education booklet and bi-weekly motivational text messages. We recruited participants via social media and surveyed participants at three and six months post-randomization. The primary outcome was self-reported seven-day point prevalence abstinence at six months. We recruited and randomized 532 participants. At three months post randomization, the quit rate was significantly higher in #EnufSnuff.TXT arm compared to the Enough Snuff arm for intent-to-treat (ITT) cases (29.2% vs 19.0%, OR=1.75, p=0.0066). The quit rate at six months post randomization remained higher in #EnufSNuff.TXT compared to Enough Snuff for ITT cases (23.1% vs 20.9%, OR=1.14, p=0.5384), although no longer significantly different. This is the first large-scale text-based cessation clinical trial for individuals in underserved areas who use smokeless tobacco. The #EnufSnuff.TXT intervention performed better in the short term, however both interventions yielded similar quit-rates at 6-months post randomization. Future research should focus on improving long-term abstinence in the #EnufSNuff.TXT intervention. Text-based cessation approaches have the potential to increase access to cessation interventions in rural and medically underserved areas and reduce tobacco-related chronic disease morbidity and mortality. Our study shows short-term efficacy from the first ever randomized controlled trial of a smokeless tobacco cessation intervention, #EnufSnuff.TXT, for rural and medically underserved residents in the United States. Our #EnufSnuff.TXT Intervention offers a scalable solution to reach and provide much needed access to cessation interventions in medically underserved, rural communities in the United States. This work provides the foundation for further inquiry on augmented text-based approaches to increase cessation in this at-risk group.

Harm Reduction in Tobaccoism : What Does the Scientific Evidence Say?

Smoking is considered a chronic disease caused by chemical dependence of nicotine. This is highly addicting, it in the brain system it influences our emotions, increases the feeling of pleasure/humor and reduces the anxiety. In a planet with about 8 billion people, around 1,36 billion are smokers. Cigarette smoking is the leading cause of preventable death in the world, around 8 million people die every year. A global public health problem, and those who smoke are vulnerable to 50 tobacco-related diseases, several kinds of cancer, lung diseases, cardiovascular disease, erectile dysfunction, female infertility and pregnancy complications. In 2020, according to data from the World Health Organization, 22,3% of the world population consumed tobacco, 36,7% of men and 7,8%of women. In Brazil, due to policies implemented to smoking control, we had a significant drop in the of period (1989 to 2019) from 34,8% of smokers to 12,6% and in 2021, the total percentage of smokers age 18 or over was 9.1%. All forms of tobacco consumption are harmful to health and there is no safe level. Cigarette smoke 4.720 different toxic substances such as nicotine, irritants, tar and carbon monoxide. In the last 15 years, new heated tobacco devices have arrived on the market with promises of less harm to health. In 78 countries this products are available, including Japan, The United States, Canada, Portugal, Australia, Italy and The United Kingdom. As they do not cause tobacco combustion, they created significantly lower levels of toxic substances, which is the strongest arguments made by defenders of those products. A systematic review of the literature in 2018 on heated tobacco products identified 31 studies randomly and blind over those devices, 11 independent and 20 funded by the products manufacturers, needing further long-term research. Another systematic review (relevant studies from 2015 to February 2021), both “in vitro” as alive has shown that the benefits of heated tobacco are controversial and more research is needed to the short-and-long term health effects. Another large concern is that availability of these smokeless products may encourage cigarette consumption, especially among young people and often with the combined use of traditional cigarettes and heated tobacco products.

A Novel mHealth App for Smokers Living With HIV Who Are Ambivalent About Quitting Smoking: Formative Research and Randomized Feasibility Study.

More people who smoke and are living with HIV now die from tobacco-related diseases than HIV itself. Most people are ambivalent about quitting smoking and want to quit someday but not yet. Scalable, effective interventions are needed to motivate and support smoking cessation among people ambivalent about quitting smoking (PAQS) who are living with HIV. This study aims to develop an app-based intervention for PAQS who are living with HIV and assess its feasibility, acceptability, and potential impact. Results of this study will inform plans for future research and development. In phase 1, PAQS living with HIV (n=8) participated in user-centered design interviews to inform the final intervention app design and recruitment plan for a subsequent randomized pilot study. In phase 2, PAQS living with HIV were randomized to either a standard care control app or a similar experimental app with additional content tailored for PAQS and those with HIV. Participants were followed for 3 months. Feasibility focused on recruitment, retention, and participants' willingness to install the app. The study was not powered for statistical significance. Indices of acceptability (satisfaction and use) and impact (smoking behavior change and treatment uptake) were assessed via automated data and self-report among those who installed and used the app (n=19). Recruitment for both study phases was a challenge, particularly via web-based and social media platforms. Enrollment success was greater among people living with HIV recruited from a health care provider and research registry. Once enrolled, retention for the phase 2 randomized study was good; 74% (14/19) of the participants completed the 3-month follow-up. Phase 1 findings suggested that PAQS living with HIV were receptive to using an app-based intervention to help them decide whether, when, and how to stop smoking, despite not being ready to quit smoking. Phase 2 findings further supported this conclusion based on feedback from people who agreed to use an app, but group differences were observed. Indices of acceptability favored the experimental arm, including a descriptively higher mean number of sessions and utilization badges. Similarly, indices of potential impact were descriptively higher in the experimental arm (proportion reducing smoking, making a quit attempt, or calling free tobacco quitline). No participants in either arm quit smoking at the 3-month follow-up. On the basis of this formative work, PAQS living with HIV may be receptive to using a mobile health-based app intervention to help them decide whether, when, or how to stop using tobacco. Indices of acceptability and impact indicate that additional research and development are warranted. ClinicalTrials.gov NCT05339659; https://clinicaltrials.gov/study/NCT05339659.

Cognitive Distortions as Barriers to Seeking Smoking Cessation Treatment: A Comparative Study.

Background/Objectives: Despite the availability of effective pharmacotherapy and evidence-based treatments, a substantial proportion of smokers do not seek treatment. This study aims to explore the cognitive distortions associated with not seeking evidence-based smoking cessation treatment and to identify cognitive barriers. Methods: The research conducted in Istanbul between October and December 2017 employs a cross-sectional design and includes two groups: a treatment-seeking group comprising 156 patients diagnosed with tobacco use disorder and a non-treatment seeking group of 78 patients with tobacco use disorder who had never sought professional help for smoking cessation. A comprehensive data collection process was used, including sociodemographic information, cognitive distortion assessment using the cognitive distortions scale, a smoking-related cognitive distortions interview and the Fagerström Test for Nicotine Dependence. Results: While no significant sociodemographic differences were observed between the treatment-seeking and non-treatment-seeking groups, the study found that higher nicotine dependence was associated with a higher likelihood of seeking treatment. The treatment-seeking group displayed significantly higher levels of "all-or-nothing thinking" cognitive distortions related to smoking and smoking cessation. Conversely, the non-treatment-seeking group exhibited elevated levels of cognitive distortions such as "labeling", "mental filtering", "should statements" and "minimizing the positive" regarding receiving smoking cessation treatment. Conclusions: Understanding the cognitive distortions associated with treatment-seeking behavior for tobacco use disorder is crucial for developing targeted public-based interventions, public service announcements for tobacco use prevention and encouraging individuals to seek evidence-based treatment. Addressing these cognitive distortions can also potentially enhance the effectiveness of smoking cessation programs and reduce the global burden of tobacco-related diseases and mortality.

A decomposition analysis of sociodemographic factors and non-cigarette tobacco use as contributors to the change in smoking rates in South Africa between 2017/18 and 2021.

Trends data up to 2018 suggest that tobacco smoking was increasing in South Africa (SA), but only limited information is available on the impact of the COVID-19 pandemic on the current pattern of use of tobacco and nicotine products (TNPs). To assess trends in sociodemographic patterns in the use of TNPs and the extent to which sociodemographic factors and non-cigarette tobacco use may explain possible changes in rates of TNP use between 2017/18 and 2021. Data from three waves (2017, 2018 and 2021) of the South African Social Attitudes Survey (total N=8 140) were analysed. The sociodemographic correlates of current daily and non-daily use of factory-manufactured cigarettes (FMCs), roll-your-own (RYO) cigarettes, waterpipe/hubbly, electronic cigarettes (ECigs), snuff (a smokeless tobacco) and any combination of FMCs, RYO cigarettes and waterpipe/hubbly ('current smoking') in 2017/18 (pre-pandemic) were compared with those for 2021 (during the pandemic). Chi-square analyses and generalised linear models were used to compare the prevalence of TNP use between the two periods. A Blinda-Oaxaca decomposition analysis was also used to explore the roles of various sociodemographic factors, including any differences in the use of TNPs, that may explain any observed differences in smoking rates between 2017/18 and 2021. Current smoking increased significantly from 22.4% (95% confidence interval (CI) 20.4 - 24.5) in 2017/18 to 27.6% (95% CI 24.3 - 31.1) in 2021 (p=0.009). Smoking of FMCs did not change significantly overall between these two periods (20.1% v. 22.1%; p=0.240), except for a significant increase among those who self-identified as black African and a decrease among those who self-identified as coloured and those currently employed. However, the use of waterpipe/hubbly, ECigs, RYO cigarettes and snuff increased significantly. Women, individuals aged <35 years and black Africans had the largest increase in waterpipe/hubbly and ECig use. A decomposition analysis showed that increased waterpipe/hubbly and RYO use explained 52% and 15%, respectively, of the increase in smoking rates, while lower employment during 2021 compared with 2017/18 explained 15% of the increase in smoking rates during 2021. The use of all TNPs continued to increase in SA, particularly among women and unemployed people. These findings have policy and practice implications for addressing socioeconomic disparities in tobacco-related diseases.