Prevalência de tabagismo e morbimortalidade por câncer de pulmão nos estados brasileiros / Smoking prevalence and lung cancer morbimortality in Brazilian states / Prevalencia del tabaquismo y morbimortalidad por cáncer de pulmón en los estados brasileños

Introdução: O câncer de pulmão é uma doença grave, sendo a segunda maior causa de morte em todo o mundo, entretanto, em alguns países desenvolvidos, tornou-se já a primeira causa de morte. Cerca de 90% dos casos de neoplasia pulmonares são causados pela inalação da fumaça do cigarro. Objetivo: Correlacionar a prevalência de tabagismo e morbimortalidade por câncer de pulmão nos estados brasileiros, além de demonstrar a associação destes com sexo e faixa etária. Métodos: Estudo de caráter ecológico acerca da prevalência de tabagismo e morbimortalidade por câncer de pulmão nos estados brasileiros, nos períodos de 2013 e 2019, dividida por sexo e faixa etária. Foram utilizados bancos de coleta de dados como o Tabnet e Pesquisa Nacional de Saúde. Resultados: As maiores taxas de mortalidade e internações hospitalares foram do público masculino, em 2013, com taxa de 2,7 e 10, respectivamente, e em 2019 com 3,3 e 11,9, respectivamente. Ademais, a maior prevalência de tabagismo foi encontrada nos homens; entretanto seu índice tem caído, enquanto a quantidade de mulheres tabagistas tem aumentado. A Região Sul demonstrou maiores números de mortalidade em ambos os períodos estudados, com taxas de 4,9 e 5,8 por 100 mil habitantes, e morbidade hospitalar com 19,9 e 23,5 por 100 mil habitantes. Já a Região Norte se configurou com as menores prevalências: em 2013 apresentou taxa de óbito por câncer de pulmão de 1,0 e morbidade hospitalar de 3,5/100 mil habitantes, em 2019 apresentou taxa de mortalidade de 4,6 e internações de 1,6/100 mil habitantes. Os coeficientes de correlação de morbidade hospitalar e prevalência de tabagismo foram R2=0,0628, r=0,251 e p=0,042, enquanto os de mortalidade e prevalência de tabagismo foram R2=0,0337, r=0,183 e p=0,140. Conclusões: Na presente pesquisa, pode-se inferir que houve associação positiva na comparação entre taxa de morbidade hospitalar e prevalência de tabagismo; em contrapartida, não foi possível observar associação positiva na correlação da taxa de mortalidade por câncer de pulmão e prevalência de tabagismo.

Introduction: Lung cancer is a serious disease, being the second leading cause of death worldwide. Moreover, in some developed countries, it has already become the leading cause of death. About 90% of lung cancer cases are caused by cigarette smoking. Objective: To correlate the prevalence of smoking and lung cancer morbidity and mortality in Brazilian states, and to demonstrate their association with sex and age group as well. Methods: An ecological study on the prevalence of smoking and lung cancer morbidity and mortality in Brazilian states between 2013 and 2019, divided by sex and age group. The data collection databases Tabnet and National Health Survey were used. Results: The highest rates of mortality and hospital admissions were among men, in 2013 with a rate of 2.7 and 10, respectively, and in 2019 with 3.3 and 11.9, respectively. In addition, the highest prevalence of smoking was found in men, but this rate has fallen, while the number of women smokers has increased. The South region showed higher mortality rates in both periods studied, with rates of 4.9 and 5.8 per 100,000 inhabitants, and hospital morbidity with 19.9 and 23.5 per 100,000 inhabitants. The North region had the lowest prevalence, where in 2013, it had a death rate from lung cancer of 1.0 and hospital morbidity of 3.5/100 thousand inhabitants, and where in 2019, it had a mortality rate of 4.6 and hospitalizations of 1.6/100 thousand inhabitants. The correlation coefficients for hospital morbidity and smoking prevalence were R2=0.0628, r=0.251 and p=0.042, while for mortality and smoking prevalence, these were R2=0.0337, r=0.183 and p=0.140. Conclusions: In the present study, it can be inferred that there was a positive association between hospital morbidity rate and prevalence of smoking, while it was not possible to observe a correlation between lung cancer mortality rate and prevalence of smoking.

Introducción: El cáncer de pulmón es una enfermedad grave, siendo la segunda causa de muerte en todo el mundo, sin embargo, en algunos países desarrollados, ya se ha convertido en la primera causa de muerte. Alrededor del 90% de los casos de neoplasias pulmonares están causados por la inhalación del humo del cigarrillo. Objetivo: Correlacionar la prevalencia de tabaquismo y la morbimortalidad por cáncer de pulmón en los estados brasileños, además de demostrar la asociación de estos con el género y el grupo de edad. Métodos: estudio ecológico sobre la prevalencia de tabaquismo y morbimortalidad por cáncer de pulmón en los estados brasileños, dentro de los períodos 2013 y 2019, divididos por sexo y grupo de edad. Se utilizaron bancos de recogida de datos como Tabnet y la Encuesta Nacional de Salud. Resultados: las mayores tasas de mortalidad e ingresos hospitalarios se dieron en el público masculino, en 2013 con una tasa de 2,7 y 10, respectivamente, y en 2019 con 3,3 y 11,9, respectivamente. Además, la mayor prevalencia del tabaquismo se encontró en los hombres, sin embargo, su tasa ha disminuido, mientras que la cantidad de mujeres fumadoras ha aumentado. La región Sur presentó cifras más altas de mortalidad en ambos periodos estudiados, con tasas de 4,9 y 5,8 por 100.000 habitantes, y de morbilidad hospitalaria con 19,9 y 23,5 por 100.000 habitantes. Mientras que la región Norte se configuró con las prevalencias más bajas, en 2013 presentó una tasa de mortalidad por cáncer de pulmón de 1,0 y una morbilidad hospitalaria de 3,5/100.000 habitantes, en 2019 presentó una tasa de mortalidad de 4,6 y hospitalizaciones de 1,6/100.000 habitantes. Los coeficientes de correlación para la morbilidad hospitalaria y la prevalencia del tabaquismo fueron R2=0,0628, r=0,251 y p=0,042, mientras que para la mortalidad y la prevalencia del tabaquismo fueron R2=0,0337, r=0,183 y p=0,140. Conclusiones: En la presente investigación se puede inferir que existe una asociación positiva en la comparación entre la tasa de morbilidad hospitalaria y la prevalencia de tabagismo, en contrapartida, no fue posible observar una asociación positiva en la correlación de la tasa de mortalidad por cáncer de pulmón y la prevalencia de tabagismo.

Risk factors behind the increase of early-onset cancer in Italian adolescents and young adults: An investigation from the Italian AYA Working group.

The incidence of early-onset cancers in adolescents and young adults (AYA) has been increasing worldwide since the 1990s. In Italy, a significant increased rate of 1.6 % per year has been reported for early-onset cancers among females between 2008 and 2016. This is mainly attributable to melanoma, thyroid, breast and endometrial cancer. The aim of our work was to describe temporal trends of the main established lifestyle risk factors (tobacco use, alcohol consumption, obesity, physical inactivity, dietary westernization and reproductive factors) over the last 20 years in the Italian AYA population. Available data on behavioural risk factors, individual and household daily life have been obtained and elaborated from PASSI, ISTAT and Eurostat reports. Lowering age of smoking initiation, an increase in alcohol drinkers among young females, and an obesity and overweight epidemic, particularly among children and adolescents as a result of physical inactivity and dietary habits, may be contributing factors behind this cancer epidemic, especially among females. In-depth investigations are needed to understand the exact role of each contributing factor, the effects of exposure to nicotine-containing products and environmental factors such as endocrine disruptors that could play a role in this phenomenon.

Effect of the Heaviness of Smoking Index (HSI) and Duration of Smoking on Central Neural Processing Using Brainstem Auditory Evoked Responses (BAERs).

Purpose of study The goal of this research was to find the correlation of nicotine dependence and duration of smoking with the status of central neuronal processing in chronic smokers. Our primary objective was to record brainstem auditory evoked responses (BAERs) in chronic smokers and further find their correlation to the Heaviness of Smoking Index (HSI) scores and years of non-abstained smoking of the subjects. We postulated that smoking leads to myelination abnormalities which in turn causes decreased impulse conduction velocity. Methods After obtaining informed consent, we conducted BAER on 60 male smokers who were further classified into groups based on their HSI scores (low, moderate, and high nicotine dependency) and 20 age-matched, non-smoking males. The obtained data was examined using the two-way ANOVA test and the Kruskal-Wallis test. Pearson's coefficient of correlation and the median (as a measure of central tendency) were calculated. Results We observed a non-significant negative correlation between wave I BAER latency and the degree of nicotine dependence. Wave II showed minimal correlation, whereas a positive correlation was seen in waves III, IV, and V. Interpeak latencies (IPL) I-III and III-V showed a non-significant positive correlation with the HSI score, whereas IPL I-V showed a significant positive correlation with the same. When correlated with the duration of smoking (years), the latencies (msec) of BAER waves I-V showed a pattern of progressively decreasing negative correlation, out of which waves I, II, and III were significantly affected. The IPL (msec) of waves I-III was non-significantly, yet positively, correlated, while the IPL of waves I-V and III-V showed a significant positive correlation to the duration of smoking. Conclusions The degree of nicotine dependence and duration of tobacco smoking progressively affected the latencies of BAER waves at the pontomedullary level of the brainstem. This indicates slower central neuronal processing at this level and an increased central transmission time, the extent of which is directly dependent on the extent of tobacco smoking. This is attributed to the myelination defects caused by direct and indirect effects of the toxic metabolites of tobacco smoke, chronic hypoxia, hypercapnia, and respiratory acidosis.

Ten-year risk assessment for cardiovascular disease & associated factors among adult Indians (aged 40-69 yr): Insights from the National Noncommunicable Disease Monitoring Survey (NNMS).

Background & objectives Cardiovascular diseases (CVDs) are extremely prevalent in India, making early detection of people at high risk for CVDs and prevention crucial. This study aimed to estimate CVD risk distribution in older adults (40-69 yr) in India using WHO's non-laboratory risk chart and identify factors associated with elevated CVD risk (10%). Methods The current study used a nationally representative sample of 40-69 yr adults in India. The population's 10-yr CVD risk was defined as very low-to-low (10%), moderate (10-20%) and high to very high (>20%). We attempted univariable and multivariable logistic regressions to identify factors related to higher CVD risk (≥10%). Results Out of 4480 participants, 50 per cent were younger participants (40-49 years). The proportions of the population with very low to low, moderate and high to very high CVD risk were 84.9, 14.4 and 0.7 per cent, respectively. The estimated 10-year CVD risk was higher for people with unemployed [Adjusted Odds Ratio (AOR): 5.12; 95% Confidence Interval (CI): 3.63, 7.24], followed by raised blood glucose (AOR: 1.81; 95%CI: 1.39, 2.34). Interpretation & conclusions The non-laboratory-based chart proves valuable in low-resource settings, especially at the primary healthcare level, facilitating efficient CVD risk assessment and resource allocation. Further research is needed to explore the association of second-hand smoke with CVD risk in the Indian population.

Risk Factors for Adults with Chronic Obstructive Pulmonary Disease in the United States, Utilizing State-Based Surveillance.

Chronic Obstructive Pulmonary Disease (COPD) is a complex and heterogeneous condition. Exposure to tobacco smoke and air pollutants are key risk factors for COPD development; however, other risk factors include race/ethnicity, sex of adults, a history of asthma, occupational exposures, and chronic respiratory infections. Data for the current study were from the 2022 Behavioral Risk Factor Surveillance Survey. Chi-squares and multinomial logistic regression analyses, adjusted with the survey's sampling weight, were used to examine how critical health indicators impacted a COPD diagnosis. Participants (N = 311,175) were adults aged 45 years and older. Adjusted multinomial regression analyses showed adults who reported asthma, current and former smoking, poor physical health, depression, less physical activity, and fatigue were more likely to report COPD. Those with COPD were more likely to be male than female. Moreover, those with COPD reported higher rates of health insurance coverage, and yet had lower income and more financial difficulty affording a doctor for health services. In a follow up regression analysis, examining racial differences in COPD for participants, American Indian adults had a higher odds of reporting COPD than the "other" race groups. Because COPD remains a leading cause of death and disability in the U.S., and racial disparities persist in respiratory outcomes, continuing to identify risk factors for vulnerable groups could assist health program planners with development of successful health messaging.

Prevalence and disparities in receiving medical advice to quit tobacco use in the US adult population.

Introduction: Evidence suggests that advice from health care professionals (HCP) increases the likelihood of quit attempts and successful quitting of tobacco use. However, previous studies primarily focussed on cigarette smoking and did not include all forms of tobacco products. This study aimed to investigate the prevalence and disparities in receiving HCP's advice to quit tobacco use (combustible or noncombustible) in the US adult population. Methods: Using the 2022 National Health Information Survey (NHIS) data, we examined 4,424 adults who reported (i) any tobacco product use within the past 12 months and (ii) having seen an HCP within the past 12 months. The outcome variable included the receipt of advice to quit tobacco use from an HCP, and predictors included sociodemographic variables. Weighted prevalence estimates were calculated, and multivariable regression analyses were conducted. Results: Over 38% of tobacco users who visited an HCP were advised to quit. The odds of receiving such advice were lower among Hispanics (AOR: 0.625; 95% confidence interval (CI) [0.464-0.843];p = 0.002), males (AOR: 0.767; 95% CI [0.659-0.893], p = 0.001), those above the poverty level (AOR: 0.795; 95% CI [0.641-0.987];p = 0.037), foreign-born (AOR: 0.664; 95% CI [0.496-0.888]; p = 0.006), those with a bachelor's degree or higher educational level (AOR: 0.477; 95% CI [0.349-0.653]; p < 0.001) and those aged less than 45 years (AOR: 0.404; 95% CI: [0.344-0.473]; p < 0.001). Conclusion: The prevalence of receiving HCP's advice to quit tobacco use remains suboptimal and disparate among sociodemographic groups. Our findings call for strategic implementation of the USPHS's recommendation on treating tobacco use and taking further actions to equip HCPs with the training and resources needed to provide appropriate advice to quit tobacco.

Cognitive and Psychological Mediators of the Social Gradient in Tobacco Use Initiation Among Adolescents: Evidence from the ABCD Study.

Background: Tobacco use among adolescents is a significant public health concern, with early initiation leading to long-term health risks. Understanding the factors that contribute to the initiation of tobacco use is crucial for developing effective prevention strategies. This study investigates the roles of substance use harm knowledge and tobacco susceptibility in mediating the relationship between social gradients (race, ethnicity, and socioeconomic status) and tobacco use initiation among adolescents. Methods: Data from the Adolescent Brain Cognitive Development (ABCD) study, comprising a racially, ethnically, and economically diverse sample of tobacco-naive adolescents aged 9 to 16, were analyzed. Structural equation modeling (SEM) was used to test whether substance use harm knowledge and tobacco susceptibility mediate the effects of socioeconomic status (SES) on the initiation of tobacco use. Results: Findings indicated that both substance use harm knowledge and tobacco susceptibility partially mediate the relationship between SES and tobacco use initiation. Adolescents from lower SES backgrounds exhibited lower levels of harm knowledge and higher levels of tobacco susceptibility, which increased their likelihood of initiating tobacco use. Conclusion: This study highlights the complex interplay between social determinants and individual cognitive and psychological factors in influencing tobacco use initiation among adolescents. Public health interventions that enhance harm knowledge and reduce susceptibility to tobacco use are crucial for preventing initiation, particularly among racially, ethnically, and economically diverse adolescents. These efforts can help reduce health disparities and promote health equity.

Implementation of a Telehealth Smoking Cessation Program in Primarily Socioeconomically Disadvantaged Black Patients: Courage to Quit Rolling-Virtual (CTQ-RV).

BACKGROUND: Preliminary data indicate that smoking cessation offered in a rolling group format is feasible and effective. PURPOSE: The current study evaluated the implementation and outcomes of the remote Courage to Quit-Rolling Virtual (CTQ-RV) smoking group treatment compared to its precursor in-person format (Courage to Quit-Rolling, CTQ-R). METHODS: Virtual materials for CTQ-RV were adapted from in-person evidence-based programming, thus content in both groups was similar but delivered via videoconference or in-person. We used an interrupted time series design to examine feasibility by comparing attendance, monthly enrollment, and program completion between those who attended CTQ-R (July 2018-March 2020) versus CTQ-RV (April 2020-December 2022). RESULTS: There were 611 patients enrolled in tobacco cessation (N = 221 CTQ-R, N = 390 CTQ-RV). The average age was 59.4 years and most patients reported Black/African American race (81%) and female sex (69.5%). CTQ-RV proved feasible relative to CTQ-R, with higher rates of attendance (5.5 vs. 2.7 sessions, respectively), program completion (39.4% vs. 19%) and increased enrollment across each year (from 44.6 sessions per month in CTQ-R vs. 72.3 in CTQ-RV). CTQ-RV patients requested nicotine replacement therapy (NRT) at substantially higher rates (81.4%) than CTQ-R members (42.1%). Self-reported smoking abstinence at final session was higher in CTQ-RV compared with CTQ-R (33.3% vs. 15.7%). Within CTQ-RV, more than half (57%) of patients attended by video format, with outreach improving rates of video attendance each year. CONCLUSIONS: Results show that a transition to virtual rolling enrollment smoking group treatment is feasible and can augment treatment outcomes, such as engagement, NRT use, and self-reported cessation.

An open-enrollment (rolling) group treatment model for quitting smoking may help improve treatment outcomes and engagement in adults who smoke cigarettes. The aim of the current investigation was to compare two rolling group treatment models, one in-person and one entirely remote, after the program transitioned modalities due to the COVID-19 pandemic. Outcomes included feasibility, session attendance, nicotine replacement therapy (NRT use), and self-reported quitting. 611 patients were included in the study with an average age of 59.3 years and 81% were Black/African American. Compared with those who attended the in-person group, those in the remote-delivered, virtual group attended more sessions and were more likely to complete the program. Further, patients in the virtual group were more likely to request NRT and had higher rates of self-reported quitting. While more data is needed, specifically a randomized trial, to replicate and expand on these findings, these data suggest that transitioning an in-person rolling group smoking treatment to a fully remote delivery is not only feasible but also may augment engagement and smoking outcomes.

Examining Homeless-Experienced Adults' Smoking Cessation Treatment Use Pre- and Post-Entry into Permanent Supportive Housing.

Background: Homeless-experienced adults smoke at rates 5 times that of the general adult population, and often have limited access to cessation treatments while homeless. Permanent Supportive Housing (PSH) can be a catalyst for cessation treatment utilization, yet little is known about use of these treatments following PSH entry, or how to tailor and implement cessation care that meets homeless-experienced adults' vulnerabilities. Methods: Using Department of Veterans Affairs (VA) administrative data, we assessed smoking status (ie, current, former, non/never) among a cohort of homeless-experienced Veterans (HEVs) housed in Los Angeles-based PSH. We compared cessation treatment use rates (ie, nicotine replacement therapies, cessation medications, psychosocial counseling) pre- and post-housing using Chi-square tests. Predisposing (ie, demographics), enabling (eg, primary care, benefits), and need characteristics (ie, health, mental health, substance use diagnoses) were examined as correlates of cessation treatment utilization pre- and post-housing in univariable and multivariable logistic regression models. Results: Across HEVs (N = 2933), 48.6% were identified as currently-smoking, 17.7% as formerly-smoking, and 14.0% as non/never smoking. Among currently- and formerly-smoking HEVs (n = 1944), rates of cessation treatment use post-housing were significantly lower, compared to pre-housing, across all treatment types. Health, mental health, and substance use was more prevalent among currently- and formerly-smoking HEVs compared to non/never-smoking HEVs, and most diagnoses were positively associated with utilization univariably. However, in multivariable models, cessation clinic referrals and primary care engagement were the only significant (P < .001) predictors of pre-housing and post-housing cessation treatment utilization. Conclusion: Among HEVs, we found high smoking rates and low cessation treatment utilization pre- and post-PSH entry. Efforts to educate providers about this population's desire to quit smoking, support primary care engagement, and increase cessation clinic referrals may bolster their utilization. For homeless-experienced adults, optimizing cessation treatment accessibility by embedding cessation services within PSH and homeless service settings may reduce utilization impediments.

Technology-Based Interventions in Tobacco Use Treatment Among People Who Identify as African American/Black, Hispanic/Latina/o, and American Indian/Alaska Native: Scoping Review.

BACKGROUND: Although tobacco use has significantly declined in the general population, traditional tobacco use treatment uptake and success rates remain disproportionately low among people who identify as African American/Black, Hispanic/Latina/o, and American Indian/Alaska Native. Technology-based interventions (TBIs) for tobacco use are promising alternatives to traditional tobacco use treatments. OBJECTIVE: This scoping review aims to investigate the extent to which the use of digital TBIs in tobacco use treatment research promotes health equity among people who identify as African American/Black, Hispanic/Latina/o, and American Indian/Alaska Native. METHODS: This scoping review identifies US-based studies (between January 2000 and March 2021) that enlist TBIs for tobacco use treatment and include people who identify as African American/Black, Hispanic/Latina/o, and American Indian/Alaska Native at ≥50% of the sample when combined; features studies that are also race and ethnicity conscious; and highlights health equity-promoting insights from included studies. RESULTS: In 85% (22/26) of the studies, the largest proportion of the sample was African American/Black, most participants had low socioeconomic status, and recruitment was most commonly from medical settings. In total, 58% (15/26) of the studies were race and ethnicity conscious, and 67% (10/15) of these studies sought to partner with potential end users. An array of TBIs were represented; however, SMS text messaging was most prevalent. Most TBIs were combined with other evidence-based intervention components (eg, nicotine replacement therapy). Approximately one-third of the studies (8/26, 31%) required participants to have their own device or internet access. The majority were underpowered to detect substantial differences. CONCLUSIONS: The modest number of studies, particularly for persons who identify as Hispanic/Latina/o and American Indian/Alaska Native, demonstrates the limited application of TBIs for tobacco use and that additional research is needed to determine the extent to which TBIs for tobacco use promote health equity among these populations. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): RR2-10.2196/34508.

TRENDING CULTURAL DRIVERS OF SMOKELESS TOBACCO: FOR RECENT REFUGEE AND IMMIGRANTS AS KNOWLEDGE, ATTITUDES, AND BEHAVIOR DETERMINANTS: A SOUTH TEXAS ORAL HEALTH NETWORK COLLABORATIVE STUDY.

Objectives: Smokeless tobacco (SLT) use is a phenomenon that is detrimental to the health of adults worldwide and dramatically impacts the health of resettled populations. The prevalence of SLT has exponentially grown as a public health threat for the refugee and immigrant populations and is worthy of addressing. This research study examined the SLT cultural drivers of the Texas immigrant and refugee community, which led to their knowledge, perception, awareness, and cessation practices. Methods: A convenience sample of refugee and immigrant community members resettled in San Antonio was recruited from the local Health Clinic and Center. Ninety-four consented participants completed a 29-item survey that gathered participants' demographics, SLT history, beliefs, knowledge, perceptions of the risk, awareness, availability of SLT, and cessation practices influenced by their culture. Results: Of the 94 participants, 87.2% identified as Asian or natives of Afghanistan, Myanmar, and Pakistan. 70% reported SLT as a 'feel good' or recreational use, while 33% used it to relieve stress. Thirty-five percent stated they continuously use or have the desire to use SLT first thing in the morning. 86.2% perceived SLT products as unsafe for their health, 83% believed that it caused oral cancer and periodontal disease, and 76.6% were aware that SLT contains nicotine. 63.8% wished to stop using them, and 36.2% attempted to quit but were unsuccessful. 54% sought cessation assistance from a family member, 32% from a friend, and only 12% from a healthcare provider. Conclusion: SLT use is culturally prevalent within the immigrant and refugee populations. Participants' quit attempts likely failed due to a lack of professional cessation support that was taxing due to language, interpretation, and literacy barriers. Healthcare providers are well-positioned to offer cessation interventions and reduce SLT use to achieve community well-being pathways.

The Effect of Smoking on Outcomes of Reverse Total Shoulder Arthroplasty.

BACKGROUND: The effect of smoking status on clinical outcomes in reverse total shoulder arthroplasty (rTSA) has not been thoroughly characterized. We sought to compare pain and functional outcomes, complications, and revision-free survivorship between current smokers, former smokers, and non-smokers undergoing primary rTSA. METHODS: We retrospectively reviewed a prospectively-collected shoulder arthroplasty database from 2004-2020 to identify patients who underwent primary rTSA. Three cohorts were created based on smoking status: current smokers, former smokers, and non-smokers. Outcome scores (SPADI, SST, ASES, UCLA, Constant), range of motion (ROM) (external rotation [ER], forward elevation [FE], abduction, internal rotation [IR]) and shoulder strength (ER, FE) evaluated at 2-4-year follow-up were compared between cohorts. The incidence of complication and revision-free implant survivorship were evaluated. RESULTS: We included 676 primary rTSAs, including 38 current smokers (44±47 pack-years), 84 former smokers who quit on average 20±14 years (range: 0.5-57 years) prior to surgery (38±32 pack-years), and 544 non-smokers. At 2-4-year follow-up, current smokers had less favorable SPADI, SST, ASES scores, UCLA scores, and Constant scores compared to former smokers and non-smokers. On multivariable analysis, current smokers had less favorable SPADI, SST, ASES score, UCLA score, and Constant score compared to non-smokers. There were no significant differences between cohorts in complication rate and revision-free survivorship. CONCLUSION: Our data showed that current smokers may have poorer functional outcomes after rTSA compared to former smokers and non-smokers despite the incidence of complications and revision surgery not differing significantly between cohorts.

Adolescents' Experiences and Perceptions of E-Cigarettes and Nicotine Addiction.

BACKGROUND:  E-cigarettes are the most-used tobacco product among US adolescents and are associated with nicotine addiction. This qualitative investigation aimed to understand adolescents' experiences and perceptions with nicotine addiction, and related influences of addiction, to inform product regulation, health communication, and cessation resource development. METHODS:  Between May 2020 and December 2021, in-depth, semi-structured individual interviews were conducted with 47 California (United States) adolescents ages 13-17 who reported recent tobacco use (primarily e-cigarette use). The topic of addiction both arose organically and followed specific interviewer questions. Researchers used thematic analysis techniques to identify unifying themes related to addiction. RESULTS:  Adolescents described e-cigarette addiction in ways that reflected a loss of control over their routines and activities and as physical symptoms, including reward and withdrawal. While some viewed addiction risk as a reason not to vape, others perceived it possible to use e-cigarettes and avoid or manage addiction. Specific characteristics of e-cigarette devices, particularly disposable nicotine-salt products, including flavors, "cool" designs, concealable size and odor, low price, and ease-of-use, were seen as enhancing addiction risk. Quit attempts were difficult and usually unsupported by adults or formal cessation aids. CONCLUSIONS:  For many adolescents, addiction is a major component of their experience with e-cigarettes, often in ways that disrupt their routines and reduce their quality of life. Tobacco control or regulation could target e-cigarette product characteristics to decrease potential for addiction among adolescents. Needed are youth-targeted public communication about nicotine addiction and adolescent-tailored, evidence-based cessation support.

Comparison of School-Attending Adolescent Areca Nut Users with Tobacco-Only Users and Those Using Both Substances on Demographic Variables and Behavioral Determinants.

OBJECTIVE: Consumption of areca nut and tobacco, often initiated in adolescence, are important causes of oral cancers in India. Areca nut prevention, often subsumed into school tobacco prevention programs, assumes that users are similar. However, differences in gender or age of users could necessitate unique approaches. The study aimed to find if adolescent areca nut-only users are different from tobacco-only users and users of both areca and tobacco. METHODS: A cross-sectional survey with school-students attending grades 7, 8, 9 was used to compare differences in age, gender, knowledge, and attitudes among areca nut only users, tobacco-only, users of both, and non-users. RESULTS: Of 1909 respondents, 464 (24.3%) used only areca nut, 25 (1.3%) used only tobacco, 177 (9.3%) used both, and 1243 (65.1%) were never-users. Females, overwhelmingly, consumed only areca nut. Users of both substances, in greater proportions, were male, older in age, and more than half believed that tobacco-users had more friends. A third of tobacco-only and users of both substances found it hard to turn down a friend's request to use compared to a fifth of areca-only and non-users. CONCLUSIONS: Differences in gender, age, and behavioral determinants such as subjective norms and perceived behavioral control between the different types of users underlines the need for prevention and cessation programs and policies that are specific to and tailored to their unique profiles and needs.

Public Perception of the Tobacco 21 Amendment on Twitter in the United States: Observational Study.

BACKGROUND: Following the signing of the Tobacco 21 Amendment (T21) in December 2019 to raise the minimum legal age for the sale of tobacco products from 18 to 21 years in the United States, there is a need to monitor public responses and potential unintended consequences. Social media platforms, such as Twitter (subsequently rebranded as X), can provide rich data on public perceptions. OBJECTIVE: This study contributes to the literature using Twitter data to assess the knowledge and beliefs of T21. METHODS: Twitter data were collected from November 2019 to February 2021 using the Twitter streaming application programming interface with keywords related to vaping or e-cigarettes, such as "vape," "ecig," etc. The temporal trend of the T21 discussion on Twitter was examined using the mean number of daily T21-related tweets. Inductive methods were used to manually code the tweets into different sentiment groups (positive, neutral, and negative) based on the attitude expressed toward the policy by 3 coders with high interrater reliability. Topics discussed were examined within each sentiment group through theme analyses. RESULTS: Among the collected 3197 tweets, 2169 tweets were related to T21, of which 444 tweets (20.5%) showed a positive attitude, 736 (33.9%) showed a negative attitude, and 989 (45.6%) showed a neutral attitude. The temporal trend showed a clear peak in the number of tweets around January 2020, following the enactment of this legislation. For positive tweets, the most frequent topics were "avoidance of further regulation" (120/444, 27%), "Enforce T21" (110/444, 24.8%), and "health benefits" (81/444, 18.2%). For negative tweets, the most frequent topics were "general disagreement or frustration" (207/736, 28.1%) and "will still use tobacco" (188/736, 25.5%). Neutral tweets were primarily "public service announcements (PSA) or news posts" (782/989, 79.1%). CONCLUSIONS: Overall, we find that one-third of tweets displayed a negative attitude toward T21 during the study period. Many were frustrated with T21 and reported that underage consumers could still obtain products. Social media data provide a timely opportunity to monitor public perceptions and responses to regulatory actions. Continued monitoring can inform enforcement efforts and potential unintended consequences of T21.

Adapting and Evaluating a Brief Advice Tobacco Cessation Intervention in High-reach, Low-resource Settings in India: Protocol for a Cluster Randomized Controlled Trial.

BACKGROUND: About 1.35 million deaths annually are attributed to tobacco use in India. The main challenge, given the magnitude of tobacco use and limited resources, is delivering cessation support at scale, low cost, and through a coordinated cross-system effort; one such example being brief advice interventions. However, highly credentialed staff to identify and counsel tobacco users are scarce. Task-shifting is an important opportunity for scaling these interventions. OBJECTIVE: The LifeFirst SWASTH (Supporting Wellbeing among Adults by Stopping Tobacco Habit) program-adapted from the LifeFirst program (developed by the Narotam Sekhsaria Foundation, Mumbai, India)-is a tobacco cessation program focusing on lower-socioeconomic status patients in Mumbai receiving private health care. This parallel-arm, cluster randomized controlled trial investigates whether the LifeFirst SWASTH program increases tobacco cessation rates in low-resource, high-reach health care settings in Mumbai. METHODS: This study will target tuberculosis-specific nongovernmental organizations (NGOs), dental clinics, and NGOs implementing general health programs serving lower-socioeconomic status patients. Intervention arm patients will receive a pamphlet explaining tobacco's harmful effects. Practitioners will be trained to deliver brief cessation advice, and interested patients will be referred to a Narotam Sekhsaria Foundation counselor for free telephone counseling for 6 months. Control arm patients will receive the same pamphlet but not brief advice or counseling. Practitioners will have a customized mobile app to facilitate intervention delivery. Practitioners will also have access to a peer network through WhatsApp. The primary outcome is a 30-day point prevalence abstinence from tobacco. Secondary outcomes for patients and practitioners relate to intervention implementation. RESULTS: The study was funded in June 2020. Due to the COVID-19 pandemic, the study experienced some delays, and practitioner recruitment commenced in November 2023. As of July 2024, all practitioners have been recruited, and practitioner recruitment and training are complete. Furthermore, 36% (1687/4688) of patients have been recruited. CONCLUSIONS: It is hypothesized that those patients who participated in the LifeFirst SWASTH program will be more likely to have been abstinent from tobacco for 30 consecutive days by the end of 6 months or at least decreased their tobacco use. LifeFirst SWASTH, if found to be effective in terms of cessation outcomes and implementation, has the potential to be scaled to other settings in India and other low- and middle-income countries. The study will be conducted in low-resource settings and will reach many patients, which will increase the impact if scaled. It will use task-shifting and an app that can be tailored to different settings, also enabling scalability. Findings will build the literature for translating evidence-based interventions from high-income countries to low- and middle-income countries and from high- to low-resource settings. TRIAL REGISTRATION: ClinicalTrials.gov NCT05234983; https://clinicaltrials.gov/study/NCT05234983. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/57236.

Prevalence of Blunt and Hemp Wrap Use Among Young Adults in the United States, 2022.

INTRODUCTION: Blunt and hemp wraps, as a means of consuming cannabis, have emerged into the retail space where the prevalence has been increasing since 2017. There is limited epidemiological research on the prevalence of use of these products across the U.S. particularly among young adults who are at greater risk of tobacco and cannabis use. METHODS: This study draws from a U.S. national representative sample of young adults (n = 1178) captured in May 2022. Respondents participated in an online survey about their use of blunt and hemp wraps. Multinomial regression was used to examine differences in sociodemographic characteristics (gender, race/ethnicity, sexual orientation, educational attainment, and region) in relation to use of each wrap type. RESULTS: One quarter (22.7%) of young adults reported ever having used a blunt wrap, 3.2% in the past 30-days. One in seven (14.3%) had ever used a hemp wrap, 2.3% in the past 30-days. Non-Hispanic Black young adults were 1.55 and 2.91 times as likely to have ever used blunt or hemp wraps, respectively, compared to non-Hispanic Whites. Similarly, participants who identified as gay or lesbian or bisexual similarly had greater odds of having ever used blunt or hemp wraps. Hispanic young adults were 2.49 times as likely to have used hempwraps compared to non-Hispanic Whites. CONCLUSION: Blunt and hemp wrap use is prevalent among young adults, particularly among minoritized populations. Continued research and surveillance of use of these products is needed to fully evaluate the impact their use may have on the broader population.

Comparative analysis of cortical anatomy in male participants with internet gaming disorder or tobacco use disorder: Insights from normative modeling.

Background: Research on individual differences in brain structural features of internet gaming disorder (IGD) and established addictions such as tobacco use disorder (TUD) is currently limited. This study utilized normative modeling to analyze the cortical thickness (CT) development patterns of male patients with IGD and TUD, aiming to provide further insights into whether IGD qualifies as an addiction. Methods: Surface-based brain morphometry (SBM) was used to calculate CT from T1-weighted magnetic resonance imaging data of 804 male participants (665 healthy individuals, 68 IGD and 71 TUD). Gaussian process regression was employed to generate normative models of CT development. Deviation maps were produced to depict deviations of IGD and TUD participants from the typical developmental patterns. Results: Both addiction groups exhibited widespread cortical thinning, particularly in regions such as the bilateral temporal pole and medial orbitofrontal cortex. The TUD group demonstrated a higher degree of individualization and limited spatial overlap compared to the IGD group. Opposite trends in CT changes were observed between the two groups in the bilateral pericalcarine cortex and pars triangularis. Conclusions: These findings regarding the similarities and differences between IGD and TUD provide support for the idea that IGD shares common features with substance-related addictions and contribute to a deeper understanding of the neural mechanisms underlying IGD.

Factors Influencing the Use of Tobacco Among Youth in Low-Income, Lower-Middle-Income, and Upper-Middle-Income Countries: A Systematic Review.

BACKGROUND: The use of tobacco is a significant global public health issue. According to the World Health Organization, tobacco use is a considerable risk factor for many diseases and causes more than 8 million deaths per year, with a disproportionate impact on low- and middle-income countries. Therefore, this systematic review was conducted to identify the factors influencing tobacco use among youth in low-income, lower-middle-income, and upper-middle-income countries. Study Design: A system review. METHODS: The review followed the PRISMA guidelines, and the protocol was registered on PROSPERO (CRD42023430552). Several data sources were utilized, including PubMed, Scopus, ScienceDirect, MEDLINE, CINAHL, and ProQuest, and cross-sectional data from participants aged 15‒24 underwent investigation. Original full-text articles have been published between 2015 and 2023. Out of the 2892 studies, 20 were included in this review after two reviewers confirmed the eligibility criteria. RESULTS: The average age of the participants was (mean±standard deviation: 19.45±1.686). Most studies were conducted in lower-middle and upper-middle-income countries. Frequently reported influences were at the individual and social levels, including demographic, economic, and psychological parameters, attitude and knowledge, individual behavioral factors, parental education, family member tobacco use, stressful life events, and social networks. At the environmental level, factors included secondhand smoke exposure, community context, media channels, and access to tobacco. CONCLUSION: The findings demonstrated a significant association between youth tobacco use and individual-, social-, and environmental-level factors. Consequently, specific interventions targeting these factors should be deployed to mitigate youth tobacco use in various socioeconomic settings.

Do modifiable patient factors increase the risk of postoperative complications after total joint arthroplasty?

INTRODUCTION: Numerous studies demonstrate that modifiable lifestyle risk factors can influence patient outcomes including survivability, quality of life, and postoperative complications following orthopaedic surgery. The purpose of this study was to determine the impact of modifiable lifestyle risk factors on postoperative medical and surgical complications following a total joint arthroplasty (TJA) in a large national healthcare system. METHODS: A retrospective chart review of a large national health system database was performed to identify patients who underwent TJA between 2017 and 2021. TJA included total knee arthroplasty, total hip arthroplasty, and total shoulder arthroplasty. Modifiable lifestyle risk factors were defined as tobacco use, narcotic drug abuse, hypertension, and diabetes mellitus. Postoperative medical complications and postoperative surgical complications were collected. Logistic regression and odds ratio point estimate analysis were conducted to assess for associations between postoperative complications and modifiable lifestyle risk factors. RESULTS: Of the 16,940 patients identified, the mean age was 71 years, mean BMI was 29.7 kg/m2, and 62% were women. We found that 3.5% had used narcotics, 8.7% were past or current smokers, 24% had diabetes, and 61% had hypertension; in addition, 5.4% experienced postoperative medical complications and 6.4% experienced postoperative surgical complications. Patients who used narcotics were 90% more likely to have postoperative complications (p < 0.0001) and 105% more likely to experience prosthetic complications (p < 0.0001). Similarly, patients with tobacco use were 65% more likely to have postoperative complications (p < 0.0001) and 27% more likely to experience prosthetic complications. CONCLUSIONS: Our results demonstrate critical rates of increased postoperative medical and surgical complications after TJA for patients with narcotic abuse, tobacco use, or diabetes mellitus. Furthermore, adopting preoperative interventions and optimization programs informed by our findings on specific modifiable risk factors could aid orthopaedic surgeons in optimizing patient health. LEVEL OF EVIDENCE: III; Retrospective study.