Adverse childhood experiences and adult disease: Examining mediating pathways in the Hispanic Community Health Study/Study of Latinos Sociocultural Ancillary Study.

OBJECTIVES: Adverse childhood experiences (ACEs) have been linked to adulthood chronic diseases, but there is little research examining the mechanisms underlying this association. We tested pathways from ACEs to adult disease mediated via risk factors of depression, smoking, and body mass index. METHOD: Prospective data from adults 18 to 74 years old from the Hispanic Community Health Study/Study of Latinos and Sociocultural Ancillary Study were used. Retrospectively reported ACEs and hypothesized mediators were measured at Visit 1 (2008-2011). Outcomes of disease prevalence were assessed at Visit 2, approximately 6 years later. The analytic sample includes 5,230 Hispanic/Latino participants with ACE data. Statistical mediation was examined using structural equation modeling on cardiometabolic and pulmonary disease prevalence and reported probit regression coefficients with 95% confidence intervals (CIs). RESULTS: We found a significant association between ACEs and the prevalence of asthma/chronic obstructive pulmonary disorder (standardized ß = .07, 95% CI [0.02, 0.12]). In the mediational model, the direct association was nonsignificant (ß = .02, 95% CI [-0.04, 0.07]) but was mediated by depressive symptoms (ß = .03, 95% CI [0.02, 0.04]). There were no associations between ACEs and the prevalence of diabetes and self-reported coronary heart disease or cerebrovascular disease. However, a small indirect effect was identified via depressive symptoms and coronary heart disease (ß = .02, 95% CI [0.01, 0.03]). CONCLUSION: In this diverse Hispanic/Latino sample, depressive symptoms were found to be a pathway linking ACEs to self-reported cardiopulmonary diseases, although the effects were of small magnitude. Future work should replicate pathways, confirm the magnitude of effects, and examine cultural moderators that may dampen expected associations. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Understanding ethnic inequities associated with tobacco use in Aotearoa New Zealand: a quantitative analysis.

Despite the inclusion of both individual interventions and population-based measures in the Aotearoa New Zealand (Aotearoa NZ) Tobacco Control Programme, the gap between Maori, Pacific peoples and European/Asian/Other (EAO) populations in tobacco use has not decreased significantly. Tobacco control interventions that focus on individual behaviour change have produced little impact towards reducing tobacco smoking inequities for Maori and Pacific peoples in Aotearoa NZ. Using data from the New Zealand Health Survey (NZHS), this research investigates the impact of the wider determinants of health and individual-level factors on inequities in tobacco use between Maori, Pacific peoples and EAO. A conceptual framework was developed to support the theoretical positioning of this research and to inform data categorization, framing, discourse, analyses and interpretation. We conducted hierarchical regression to examine the effect of factors from each domain on ethnic inequities in tobacco use. We found that socioeconomic factors accounted for a significant amount of the disparity in adults currently smoking between Maori and Pacific peoples and EAO. Our results suggest that socioeconomic factors may be a more effective target of intervention than individual behaviours for reducing tobacco-related inequities. Addressing the broader determinants of health through comprehensive cross-agency cooperation to reduce ethnic inequities in tobacco use in Aotearoa NZ is likely to be more effective than individual behaviour change approaches.

Evidence-based screening, clinical care and health education recommendations for Alaska Native peoples with prediabetes living in southcentral Alaska: findings from the Alaska EARTH follow-up study.

Pre-diabetes (pre-DM) is a strong predictor of diabetes (DM) over time. This study investigated how much of the recent increase in pre-DM identified among Alaska Native (AN) peoples living in urban southcentral Alaska may be due to changes in diagnostic methods. We used clinical and demographic data collected at baseline between 2004 and 2006 and at follow-up collected between 2015 and 2017 from the urban southcentral Alaska Education and Research Towards Health (EARTH) cohort. We used descriptive statistics and logistic regression to explore differences in demographic and clinical variables among the identified pre-DM groups. Of 388 participants in the follow-up study, 243 had A1c levels indicating pre-DM with only 20 demonstrating pre-DM also by fasting blood glucose (FBG). Current smoking was the sole predictor for pre-DM by A1c alone while abdominal obesity and elevated FBG-predicted pre-DM by A1c+FBG. No participants had an elevated FBG without an A1c elevation. A substantial portion of the rise in pre-DM found among urban southcentral AN peoples in the EARTH follow-up study was due to the addition of A1c testing. Pre-DM by A1c alone should be used to motivate behavioural changes that address modifiable risk factors, including smoking cessation, physical activity and weight management.

The social determinants of Aboriginal and Torres Strait Islander adults who do not smoke in regional Australia.

INTRODUCTION: Commercial tobacco use was systematically embedded as a valuable commodity through colonisation that continues to be exploited for profit by the Tobacco Industry. There have been significant declines in current smoking prevalence among Aboriginal and Torres Strait Islander peoples 18 years and over, from 55% in 1994 to 43% in 2018-2019. This paper seeks to better understand smoke-free behaviours, and to systematically quantify associations between a range of SDOH and non-smoking/never-smoking among Aboriginal and Torres Strait Islander adults (≥18) living in regional Australia. OBJECTIVE: To explore the social determinants of health (SDOH) related to non- and never-smoking among Aboriginal and Torres Strait Islander peoples in regional Australia. DESIGN: Cross-sectional analysis of the NATSIHS, weighted to the Aboriginal and Torres Strait Islander adult population living in regional Australia, was conducted. Participants were characterised as people who were current smokers, never-smokers and non-smokers (ex- and never-smokers). The social determinants of health exposures related to socioeconomic position, well-being and access to healthcare. SETTING: Regional Australia is distinct from urban and remote areas, based on the ASGS Remoteness Structure (ABS) 2018-2019. PARTICIPANTS: Aboriginal and Torres Strait Islander adults (≥18 years) who were selected, consented and asked questions about smoking in the National Aboriginal and Torres Strait Islander Health Survey (NATSIHS 2018/19). RESULTS: High income was associated with non-smoking (Prevalence Ratio [PR] = 2.07; 95% CI: 1.66-2.57) and never-smoking (PR = 2.02; 1.46-2.79), as was completing year 10 (non-smoking PR = 1.34; 1.12-1.61 and never-smoking PR = 1.56; 1.20-2.03). Better food security was associated with a higher prevalence of never-smoking (PR = 2.42; 1.48-3.98). Lower psychological distress scores were associated with non-smoking (PR = 1.30; 1.10-1.53) and never-smoking (PR = 1.56; 1.21-2.01). Never-smoking was more frequent in participants reporting no experiences of unfair treatment (PR = 1.59; 1.22-2.06). Having a usual healthcare provider was associated with non-smoking (PR = 1.38; 1.02-1.86). Positive exposure to the SDOH were associated with non- and never-smoking among Aboriginal and Torres Strait Islander adults in regional Australia. Structural and systemic changes to address the SDOH, including discrimination and racism, are expected to accelerate non-smoking behaviours and improve health outcomes for Aboriginal and Torres Strait Islander peoples.

Differences in Smoking Behavior by Nativity, Race/Ethnicity, and Education among Women Diagnosed with Breast Cancer.

BACKGROUND: We evaluated smoking differences across nativity and race/ethnicity among women diagnosed with breast cancer. METHODS: In our Northern Californian pooled population of 5,653 [670 Asian, 690 Hispanic, and 4,300 non-Hispanic White (White)] women diagnosed with breast cancer, we evaluated smoking differences across nativity, race/ethnicity, and acculturation and effect modification of nativity by race/ethnicity and education. RESULTS: Foreign-born women currently smoked less than US-born women [odds ratio (OR) = 0.46, 95% confidence limit (CL): 0.29-0.72]. Hispanic (OR = 0.50; 95% CL: 0.32-0.78) women currently smoked less than White women. Among those who ever smoked (n = 2,557), foreign-born women smoked 5.23 fewer pack-years (PY) than US-born women (95% CL: -2.75 to -7.70). Furthermore, Asian (-4.60, 95% CL: -0.81 to -8.39) and Hispanic (-6.79, 95% CL: -4.14 to -9.43) women smoked fewer PY than White women. Associations were generally suggestive of greater smoking with greater acculturation (immigration age, US years, survey language). Finally, associations for nativity differed by education but not race/ethnicity, with a higher likelihood of smoking in US-born women only among those with less than a bachelor's degree (OR = 2.84, 95% CL: 2.15-3.77; current smoking: P = 0.01, PY: P = 0.05). CONCLUSIONS: Asian and Hispanic (vs. White) and foreign-born (vs. US-born) breast cancer survivors reported fewer smoking behaviors. Smoking differences across nativity and education were driven by higher rates of smoking in US-born women with lower educational attainment. IMPACT: Smoking behavioral patterns were similar among breast cancer survivors and the general population, informing potential smoking interventions.

The impact of blunt use on smoking abstinence among Black adults: Secondary analysis from randomized controlled smoking cessation clinical trial.

INTRODUCTION: People who smoke cigarettes are more likely than people who do not to use cannabis, including blunts, a tobacco product containing nicotine and marijuana. Blunts represent a challenge for cessation trials because nicotine could make stopping cigarettes more difficult. Few studies have examined the impact of blunt use on individuals actively engaged in a cigarette quit attempt. METHODS: Blunt use was assessed at baseline, Weeks 4, 8, 12, 16, and 26 among Black adult people who smoke enrolled in a double-blind, placebo-controlled, randomized trial of varenicline (VAR, n = 300) versus placebo (PBO, n = 200) for smoking cessation. Participants were categorized as ever blunt (blunt use reported at any timepoint) versus non-blunt (no blunt use reported). The primary outcome was salivary cotinine-verified 7-day point prevalence smoking abstinence at Weeks 12 and 26. Logistic regression examined the effects of treatment and blunt use on abstinence. RESULTS: 75 participants (mean age 45.6 years (SD = 12.5, range: 22,80); 32 (42%) female) reported blunt use. Logistic regression analyses showed no treatment by blunt use interaction or significant main effect of blunt use on smoking abstinence at Weeks 12 or 26 (p > 0.05). After adjusting for treatment, those who used blunts had statistically similar odds of quitting at Week 12 (OR: 0.68, 95% CI: 0.31, 1.5) and Week 26 (OR: 0.84, 95% CI: 0.38, 1.87) as those who never used blunts during the study. DISCUSSION: Blunt use had no statistically significant impact on cessation among participants in a smoking cessation clinical trial. Future trials are needed in which the target of cessation is all combustible products.

Introdução ao estudo das políticas públicas: uma visão interdisciplinar e contextualizada

Em relação a políticas públicas, a sociedade contemporânea se comporta de duas maneiras distintas: pode ser mais esclarecida e participante, solicitando melhores resultados da gestão pública na solução de seus problemas, ou assiste estarrecida aos fatos que envolvem os desvios em torno da gestão pública. Entender como se articulam as variáveis, explícitas ou implícitas, na formulação, na execução e na avaliação das políticas públicas, é uma necessidade urgente. Este livro propõe olhar os acontecimentos recentes, da perspectiva do conhecimento de políticas públicas.

Representação social de adultos sobre tabagismo e suas implicações para a saúde: estudo realizado em comunidade rural - MG / The social representation of smoking among adults and its implications for health: study conducted in a rural community in the state of Minas Gerais

Objetivo: Apreender a representação social de adultos de uma comunidade rural sobre o tabagismo e suas implicações para a saúde e, por conseguinte, fornecer subsídios para planejamento das ações dos serviçosde saúde. Materiais e Métodos: Foram realizadas entrevistas semi-estruturadas com 15 adultos (fumantes, exfumantes e não-fumantes), entre 30 a 59 anos, moradores de uma região rural em Santa Bárbara-MG e usuários do serviço de saúde municipal, para uma análise utilizando a abordagem qualitativa dos dados. Resultados:Foi possível classificar e separar os discursos em três grandes temas: Iniciação do Tabagismo; Influência naQualidade de Vida e Cessação do Hábito. Os entrevistados consideraram importante que os profissionais desaúde tenham maior ação no apoio à cessação do tabagismo. Há concordância de que é necessário não apenasmanter as propagandas antitabaco nos maços e ampliar o número de áreas restritivas ao cigarro, bem comoa intensificação destas medidas. Conclusão: Deve-se aumentar as ações direcionadas aos jovens e à família,pois ambos interferem fundamentalmente na iniciação ao fumo. A criação de grupos de convivência podeauxiliar na cessação do hábito de fumar. Diminuir as formas de pressão social aos grupos em situação devulnerabilidade social pode ajudar na diminuição do número de fumantes.

A Preliminary investigation of periodontal disease and diabetes in Trinidad / Una investigación de la enfermedad periodontal y la diabetes en Trinidad

OBJECTIVES: To describe periodontal disease status in diabetic patients in Trinidad. METHOD: A cross-sectional study was conducted. Patients attending a tertiary referral centre for diabetes at an out-patient clinic were invited to undergo oral examinations. The basic periodontal examination (BPE) was used to assess periodontal disease status. RESULTS: Seventy-two patients participated in the study. Mean age was 55.7 years, 54.2% were female, with 66.7% and 22.2% being of Indo-Trinidadian and Afro-Trinidadian ethnicity respectively. There were 61.1% who had not attended for dental treatment within the last year and 56.9% only attended when in pain; 15.3% had a history of cigarette smoking and 31.9% currently wore a denture. Plaque was detectable with the use of a probe in 40.3% of the 67% that underwent a BPE assessment; 38.8% were found to have advanced periodontal disease. CONCLUSION: The prevalence of periodontal disease in this sample of diabetic patients suggests that regular dental examinations, oral health education, and collaborative patient care between medical and dental practitioners should form part ofthe routine management ofdiabetic patients in Trinidad.

OBJETIVOS: Describir el estado de la enfermedad periodontal en los pacientes diabéticos en Trinidad. MÉTODO: Se llevó a cabo un estudio transversal. Un número de pacientes que asistían a un centro terciario de remisión terciario para la diabetes en una clínica ambulatoria, fue invitado a recibir exámenes orales. Se usó el examen periodontal básico (EPB) para evaluar el estado de la enfermedad periodontal. RESULTADOS: Setenta y dos pacientes participaron en el estudio. La edad promedio fue 55.7 años, 54.2% fueron hembras; 66.7% y 22.2% fueron de etnicidad indotrinitense y afrotrinitense respectivamente. Hubo un 61.1% que no habían asistido para recibir tratamiento dental en el último año, y 56.9% que sólo asistieron cuando tuvieron dolor; el 15.3% tenía una historia de hábito de fumar cigarrillos, y el 31.9% usaba una prótesis dental. La placa era detectable usando una sonda dental en el 40.3% del 67% que recibió la evaluación del EPB, en tanto que se halló que el 38.8% tenía la enfermedad periodontal en estado avanzado. CONCLUSIÓN: La prevalencia de la enfermedad periodontal en esta muestra de pacientes diabéticos indica que los exámenes dentales regulares, la educación para la salud oral, y el cuidado colaborativo entre pacientes y trabajadores de la salud dental, deben formar parte del manejo de los pacientes diabéticos en Trinidad.

Tabaquismo entre estudiantes de medicina

Objetivo: Estimar la prevalencia de tabaquismo entre estudiantes de medicina de nuestra universidad y determinar su actitud hacia las acciones contra el tabaquismo. Métodos: Se aplicó un cuestionario de 12 preguntas a todos los estudiantes de los semestres primero a décimo de la Facultad de Medicina de la Pontificia Universidad Javeriana de Bogotá. Resultados: 618 de 625 estudiantes (99 por ciento) contestaron la encuesta. El 19 por ciento del total fueron fumadores, 14 por ciento de las mujeres y el 22 por ciento de los hombres (p<0.01). La prevalencia fue diferente en cada semestre con una tendencia a aumentar en los semestres más altos: 10 por ciento en primer semestre y 32 por ciento en décimo semestre (p<0.01). Entre los fumadores, las mayores razones para no fumar fueron no interés (43 por ciento) y salud (25 por ciento). Los estudiantes estuvieron expuestos al tabaco en cafeterías (96 por ciento), oficinas (69 por ciento), salones de clases (41 por ciento), ascensores (27 por ciento) y pabellones de hospitalización (9 por ciento). Sobre la posibilidad de implementar áreas restringidas para fumar, 94 por ciento estuvieron de acuerdo (79 por ciento fumadores, 98 por ciento, no fumadores) y 67 por ciento (39 por ciento fumadores, 74 por ciento no fumadores) en prohibirlo. El 68 por ciento de los fumadores participarían en un programa de cesación del tabaquismo. Conclusiones: La prevalencia de tabaquismo en esta población de estudiantes de medicina es levemente inferior a la nacional del 21.4 por ciento. Hay una prevalencia mayor en los semestres superiores (p<0.01), lo que podría estar influenciado por la ausencia de programas contra el tabaquismo en nuestra universidad. Es necesaria la implementación de programas de educación y áreas sin tabaco la universidad y en el hospital.

Fumar o no fumar: ¿Cual es el problema? / To smoke or not smoke: what is the problem?

El trabajo es una selección selectiva de la investigación conductual y farmacológica realizada sobre el hábito de fumar. Se examinan la mayoría de las implicaciones teóricas oriundas de la investigación anterior y reciente relacionadas con la iniciación, mantenimiento y terapia del hábito de fumar, incluyendo algunos estudios sobre suspensión y abandono del hábito