An Examination of Objective and Self-Report Measures of Ad Libitum Electronic Cigarette Use: Identifying Patterns of Puffing Behavior and Evaluating Self-Report Items.

INTRODUCTION: There has been little research objectively examining use-patterns among individuals who use electronic cigarettes (e-cigarettes). The primary aim of this study was to identify patterns of e-cigarette use and categorize distinct use-groups by analyzing patterns of puff topography variables over time. The secondary aim was to identify the extent to which self-report questions about use accurately assess e-cigarette use-behavior. AIMS AND METHODS: Fifty-seven adult e-cigarette-only users completed a 4-hour ad libitum puffing session. Self-reports of use were collected both before and after this session. RESULTS: Three distinct use-groups emerged from exploratory and confirmatory cluster analyses. The first was labeled the "Graze" use-group (29.8% of participants), in which the majority of puffs were unclustered (ie, puffs were greater than 60 seconds apart) with a small minority in short clusters (2-5 puffs). The second was labeled the "Clumped" use group (12.3%), in which the majority of puffs were within clusters (short, medium [6-10 puffs], and/or long [>10 puffs]) and a small minority of puffs were unclustered. The third was labeled the "Hybrid" use-group (57.9%), in which most puffs were either within short clusters or were unclustered. Significant differences emerged between observed and self-reported use-behaviors with a general tendency for participants to overreport use. Furthermore, commonly utilized assessments demonstrated limited accuracy in capturing use behaviors observed in this sample. CONCLUSIONS: This research addressed several limitations previously identified in the e-cigarette literature and collected novel data that provided substantial information about e-cigarette puff topography and its relationship with self-report measures and use-type categorization. IMPLICATIONS: This is the first study to identify and distinguish three empirically based e-cigarette use-groups. These use-groups, as well as the specific topography data discussed, can provide a foundation for future research assessing the impact of use across different use types. Furthermore, as participants tended to overreport use and assessments did not capture use accurately, this study can serve as a foundation for future work developing more appropriate assessments for use in research studies as well as clinical practice.

Wearable Egocentric Camera as a Monitoring Tool of Free-Living Cigarette Smoking: A Feasibility Study.

INTRODUCTION: Wearable sensors may be used for the assessment of behavioral manifestations of cigarette smoking under natural conditions. This paper introduces a new camera-based sensor system to monitor smoking behavior. The goals of this study were (1) identification of the best position of sensor placement on the body and (2) feasibility evaluation of the sensor as a free-living smoking-monitoring tool. METHODS: A sensor system was developed with a 5MP camera that captured images every second for continuously up to 26 hours. Five on-body locations were tested for the selection of sensor placement. A feasibility study was then performed on 10 smokers to monitor full-day smoking under free-living conditions. Captured images were manually annotated to obtain behavioral metrics of smoking including smoking frequency, smoking environment, and puffs per cigarette. The smoking environment and puff counts captured by the camera were compared with self-reported smoking. RESULTS: A camera located on the eyeglass temple produced the maximum number of images of smoking and the minimal number of blurry or overexposed images (53.9%, 4.19%, and 0.93% of total captured, respectively). During free-living conditions, 286,245 images were captured with a mean (±standard deviation) duration of sensor wear of 647(±74) minutes/participant. Image annotation identified consumption of 5(±2.3) cigarettes/participant, 3.1(±1.1) cigarettes/participant indoors, 1.9(±0.9) cigarettes/participant outdoors, and 9.02(±2.5) puffs/cigarette. Statistical tests found significant differences between manual annotations and self-reported smoking environment or puff counts. CONCLUSIONS: A wearable camera-based sensor may facilitate objective monitoring of cigarette smoking, categorization of smoking environments, and identification of behavioral metrics of smoking in free-living conditions. IMPLICATIONS: The proposed camera-based sensor system can be employed to examine cigarette smoking under free-living conditions. Smokers may accept this unobtrusive sensor for extended wear, as the sensor would not restrict the natural pattern of smoking or daily activities, nor would it require any active participation from a person except wearing it. Critical metrics of smoking behavior, such as the smoking environment and puff counts obtained from this sensor, may generate important information for smoking interventions.

Cigarette Smoking Detection with An Inertial Sensor and A Smart Lighter.

In recent years, a number of wearable approaches have been introduced for objective monitoring of cigarette smoking based on monitoring of hand gestures, breathing or cigarette lighting events. However, non-reactive, objective and accurate measurement of everyday cigarette consumption in the wild remains a challenge. This study utilizes a wearable sensor system (Personal Automatic Cigarette Tracker 2.0, PACT2.0) and proposes a method that integrates information from an instrumented lighter and a 6-axis Inertial Measurement Unit (IMU) on the wrist for accurate detection of smoking events. The PACT2.0 was utilized in a study of 35 moderate to heavy smokers in both controlled (1.5⁻2 h) and unconstrained free-living conditions (~24 h). The collected dataset contained approximately 871 h of IMU data, 463 lighting events, and 443 cigarettes. The proposed method identified smoking events from the cigarette lighter data and estimated puff counts by detecting hand-to-mouth gestures (HMG) in the IMU data by a Support Vector Machine (SVM) classifier. The leave-one-subject-out (LOSO) cross-validation on the data from the controlled portion of the study achieved high accuracy and F1-score of smoking event detection and estimation of puff counts (97%/98% and 93%/86%, respectively). The results of validation in free-living demonstrate 84.9% agreement with self-reported cigarettes. These results suggest that an IMU and instrumented lighter may potentially be used in studies of smoking behavior under natural conditions.

Understanding temporal changes and seasonal variations in glycemic trends using wearable data.

Seasonal variations in glycemic trends remain largely unstudied despite the growing prevalence of diabetes. To address this gap, our objective is to investigate temporal changes in glycemic trends by analyzing intensively sampled blood glucose data from 137 patients (ages 2 to 76, primarily type 1 diabetes) over the course of 9 months to 4.5 years. From over 91,000 days of continuous glucose monitor data, we found that glycemic control decreases significantly around the holidays, with the largest decline observed on New Year's Day among the patients with already poor glycemic control (i.e., <55% time in the target range). We also observed seasonal variations in glycemic trends, with patients having worse glycemic control in the months of November to February (i.e., mid-fall and winter, in the United States), and better control in the months of April to August (i.e., mid-spring and summer). These insights are critical to inform targeted interventions that can improve diabetes outcomes.

DeepPuff: Utilizing Deep Learning for Smoking Behavior Identification in Free-living Environment.

A comprehensive assessment of cigarette smoking behavior and its effect on health requires a detailed examination of smoke exposure. We propose a CNN-LSTM-based deep learning architecture named DeepPuff to quantify Respiratory Smoke Exposure Metrics (RSEM). Smoke inhalations were detected from the breathing and hand gesture sensors of the Personal Automatic Cigarette Tracker v2 (PACT 2.0). The DeepPuff model for smoke inhalation detection was developed using data collected from 190 cigarette smoking events from 38 medium to heavy smokers and optimized for precision (avoidance of false positives). An independent dataset of 459 smoking events from 45 participants (90 smoking events in the lab and 369 smoking events in free-living conditions) was used for testing the model. The proposed model achieved a precision of 82.39% on the training and 93.80% on the testing dataset (95.88% in the lab and 93.78% in free-living). RSEM metrics were then computed from the breathing signal of each detected smoke inhalation. Results from the RSEM algorithm were compared with respiratory metrics obtained from video annotation. Smoke exposure metrics of puff duration, inhale-exhale duration, and inhalation duration were not statistically different from the ground truth generated through video annotation. The results suggest that DeepPuff may be used as a reliable means to measure respiratory smoke exposure metrics collected under free-living conditions.

Investigating Temporal Patterns of Glycemic Control around Holidays.

Maintaining good glycemic control is a central part of diabetes care. However, it can be a tedious task because many factors in daily living can affect glycemic control. To support management, a growing number of people living with diabetes are now being prescribed continuous glucose monitors (CGMs) for real-time tracking of their blood glucose levels. However, routine use of CGMs is also an invaluable source of patient-generated data for individual and population-level studies. Prior research has shown that festive periods such as holidays can be a notable contributor to overeating and weight gain. Thus, in this work, we sought to investigate patterns of glycemic control around the holidays, particularly Thanksgiving, Christmas, and New Year, by using 3-months of CGM data from 14 patients with Type 1 Diabetes. We leveraged clinically validated metrics for quantifying glycemic control from CGM data and well-established statistical tests to compare diabetes management on holiday weeks versus non-holiday weeks. Based on our analysis, we found that 86% of subjects (12 out of 14) had worse glycemic control (i.e., more ad-verse glycemic events) during holiday weeks compared to non-holiday weeks. This general trend was prevalent amongst most subjects, however, we also observed unique individual patterns of glycemic control. Our findings provide a basis for further research on temporal patterns in diabetes management and data-driven interventions to support patients and caregivers with maintaining good glycemic control all year round.

Analyzing Impact of Mouthpiece-based Puff Topography Devices on Smoking Behavior using Wearable Sensors.

Detailed assessment of smoking topography (puffing and post-puffing metrics) can lead to a better understanding of factors that influence tobacco use. Research suggests that portable mouthpiece-based devices used for puff topography measurement may alter natural smoking behavior. This paper evaluated the impact of a portable puff topography device (CReSS Pocket) on puffing & post-puffing topography using a wearable system, the Personal Automatic Cigarette Tracker v2 (PACT 2.0) as a reference measurement. Data from 45 smokers who smoked one cigarette in the lab and an unrestricted number of cigarettes under free-living conditions over 4 consecutive days were used for analysis. PACT 2.0 was worn on all four days. A puff topography instrument (CReSS pocket) was used for cigarette smoking on two random days during the four days of study in the laboratory and free-living conditions. Smoke inhalations were automatically detected using PACT2.0 signals. Respiratory smoke exposure metrics (i.e., puff count, duration of cigarette, puff duration, inhale-exhale duration, inhale-exhale volume, volume over time, smoke hold duration, inter-puff interval) were computed for each puff/smoke inhalation. Analysis comparing respiratory smoke exposure metrics during CReSS days and days without CReSS revealed a significant difference in puff duration, inhale-exhale duration and volume, smoke hold duration, inter-puff interval, and volume over time. However, the number of cigarettes per day and number of puffs per cigarette were statistically the same irrespective of the use of the CReSS device. The results suggested that the use of mouthpiece-based puff topography devices may influence measures of smoking topography with corresponding changes in smoking behavior and smoke exposure.

Electromyogram in Cigarette Smoking Activity Recognition.

In this study, information from surface electromyogram (sEMG) signals was used to recognize cigarette smoking. The sEMG signals collected from lower arm were used in two different ways: (1) as an individual predictor of smoking activity and (2) as an additional sensor/modality along with the inertial measurement unit (IMU) to augment recognition performance. A convolutional and a recurrent neural network were utilized to recognize smoking-related hand gestures. The model was developed and evaluated with leave-one-subject-out (LOSO) cross-validation on a dataset from 16 subjects who performed ten activities of daily living including smoking. The results show that smoking detection using only sEMG signal achieved an F1-score of 75% in person-independent cross-validation. The combination of sEMG and IMU improved reached the F1-score of 84%, while IMU alone sensor modality was 81%. The study showed that using only sEMG signals would not provide superior cigarette smoking detection performance relative to IMU signals. However, sEMG improved smoking detection results when combined with IMU signals without using an additional device.

A CNN-LSTM neural network for recognition of puffing in smoking episodes using wearable sensors.

A detailed assessment of smoking behavior under free-living conditions is a key challenge for health behavior research. A number of methods using wearable sensors and puff topography devices have been developed for smoking and individual puff detection. In this paper, we propose a novel algorithm for automatic detection of puffs in smoking episodes by using a combination of Respiratory Inductance Plethysmography and Inertial Measurement Unit sensors. The detection of puffs was performed by using a deep network containing convolutional and recurrent neural networks. Convolutional neural networks (CNN) were utilized to automate feature learning from raw sensor streams. Long Short Term Memory (LSTM) network layers were utilized to obtain the temporal dynamics of sensor signals and classify sequence of time segmented sensor streams. An evaluation was performed by using a large, challenging dataset containing 467 smoking events from 40 participants under free-living conditions. The proposed approach achieved an F1-score of 78% in leave-one-subject-out cross-validation. The results suggest that CNN-LSTM based neural network architecture sufficiently detect puffing episodes in free-living condition. The proposed model be used as a detection tool for smoking cessation programs and scientific research.

Computation of Cigarette Smoke Exposure Metrics From Breathing.

Traditional metrics of smoke exposure in cigarette smokers are derived either from self-report, biomarkers, or puff topography. Methods involving biomarkers measure concentrations of nicotine, nicotine metabolites, or carbon monoxide. Puff-topography methods employ portable instruments to measure puff count, puff volume, puff duration, and inter-puff interval. In this article, we propose smoke exposure metrics calculated from the breathing signal and describe a novel algorithm for the computation of these metrics. The Personal Automatic Cigarette Tracker v2 (PACT-2) sensors, puff topography devices (CReSS), and video observation were used in a study of 38 moderate to heavy smokers in a controlled environment. Parameters of smoke inhalation including the start and end of each puff, inhale and exhale cycle, and smoke holding were computed from the breathing signal. From these, the traditional metrics of puff duration, inhale-exhale cycle duration, smoke holding duration, inter-puff interval, and novel Respiratory Smoke Exposure Metrics (RSEMs) such as inhale-exhale cycle volume, and inhale-exhale volume over time were calculated. The proposed RSEM algorithm to extract smoke exposure metrics named generated interclass correlations (ICCs) of 0.85 and 0.87 and Pearson's correlations of 0.97 and 0.77 with video observation and CReSS, respectively, for puff duration. Similarly, for the inhale-exhale duration, an ICC of 0.84 and Pearson's correlation of 0.81 was obtained with video observation. The RSEMs provided measures previously unavailable in research that are proportional to the depth and duration of smoke inhalation. The results suggest that the breathing signal may be used to compute smoke exposure metrics.

A Comparison of SVM and CNN-LSTM Based Approach for Detecting Smoke Inhalations from Respiratory signal.

Wearable sensors have successfully been used in recent studies to monitor cigarette smoking events and analyze people's smoking behavior. Respiratory inductive plethysmography (RIP) has been employed to track breathing and to identify characteristic breathing pattern specific to smoking. Pattern recognition algorithms such as Support Vector Machine (SVM), Hidden Markov Model, Decision tree, or ensemble approaches have been used to identify smoke inhalations. However, no deep learning approaches, which have been proved effective to many time series datasets, have ever been tested yet. Hence, a Convolutional Neural Network (CNN) and Long Term Short Memory (LSTM) based approach is presented in this paper to detect smoke inhalations in the breathing signal. To illustrate the effectiveness of this deep learning approach, a traditional machine learning (SVM) based approach was used for comparison. On the validation dataset of 120 smoking sessions performed in a laboratory setting by 30 moderate-to-heavy smokers, the CNN-LSTM approach achieved an F1-score of 72% in leave-one-subject-out (LOSO) cross-validation method whereas the classical SVM approach scored 63%. These results suggest that deep learning-based approaches might provide a better analytical method for detection of smoke inhalations than more conventional machine learning approaches.

Objective Detection of Cigarette Smoking from Physiological Sensor Signals.

Cigarette smoking has severe health impacts on those who smoke and the people around them. Several wearable sensing modalities have recently been investigated to collect objective data on daily smoking, including detection of smoking episodes from breathing patterns, hand to mouth behavior, and characteristic hand gestures or cigarette lighting events. In order to provide new insight into ongoing research on the objective collection of smoking-related events, this paper proposes a novel method to identify smoking events from the associated changes in heart rate parameters specific to smoking. The proposed method also accounts for the breathing rate and body motion of the person who is smoking to better distinguish these changes from intense physical activities. In this research, a human study was first performed on 20 daily cigarette smokers to record heart rate, breathing rate, and body acceleration collected from a wearable chest sensor consisting of an ECG and bioimpedance measurement sensor and a 3D inertial sensor. Each participant spent ~2 hours in a laboratory environment (mimicking daily activities that included smoking 4 cigarettes) and ~24 hours under unconstrained free-living conditions. A support vector machine-based classifier was developed to automatically detect smoking episodes from the captured sensor signals using fifteen features selected by a forward-feature selection method. In a leave one subject out cross-validation, the proposed approach detected smoking events (187 out of total 232) with the sensitivity and F-score accuracy of 0.87 and 0.79, respectively, in the laboratory setting (known activities) and 0.77 and 0.61, respectively, under free-living conditions. These results validate the proof-of-concept that, although further research is necessary for performance improvement, characteristic changes in heart rate parameters could be a useful indicator of cigarette smoking even under free-living conditions.

Smoking detection based on regularity analysis of hand to mouth gestures.

A number of studies have been introduced for the detection of smoking via a variety of features extracted from the wrist IMU data. However, none of the previous studies investigated gesture regularity as a way to detect smoking events. This study describes a novel method to detect smoking events by monitoring the regularity of hand gestures. Here, the regularity of hand gestures was estimated from a one axis accelerometer worn on the wrist of the dominant hand. To quantify the regularity score, this paper applied a novel approach of unbiased autocorrelation to process the temporal sequence of hand gestures. The comparison of regularity score of smoking events with other activities substantiated that hand-to-mouth gestures are highly regular during smoking events and have the potential to detect smoking from among a plethora of daily activities. This hypothesis was validated on a dataset of 140 cigarette smoking events generated by 35 regular smokers in a controlled setting. The regularity of gestures detected smoking events with an F1-score of 0.81. However, the accuracy dropped to 0.49 in the free-living study of same 35 smokers smoking 295 cigarettes. Nevertheless, regularity of gestures may be useful as a supportive tool for other detection methods. To validate that proposition, this paper further incorporated the regularity of gestures in an instrumented lighter based smoking detection algorithm and achieved an improvement in F1-score from 0.89 (lighter only) to 0.91 (lighter and regularity of hand gestures).

Can Thrifty Gene(s) or Predictive Fetal Programming for Thriftiness Lead to Obesity?

Obesity and related disorders are thought to have their roots in metabolic "thriftiness" that evolved to combat periodic starvation. The association of low birth weight with obesity in later life caused a shift in the concept from thrifty gene to thrifty phenotype or anticipatory fetal programming. The assumption of thriftiness is implicit in obesity research. We examine here, with the help of a mathematical model, the conditions for evolution of thrifty genes or fetal programming for thriftiness. The model suggests that a thrifty gene cannot exist in a stable polymorphic state in a population. The conditions for evolution of thrifty fetal programming are restricted if the correlation between intrauterine and lifetime conditions is poor. Such a correlation is not observed in natural courses of famine. If there is fetal programming for thriftiness, it could have evolved in anticipation of social factors affecting nutrition that can result in a positive correlation.

Metabolic syndrome: aggression control mechanisms gone out of control.

An upcoming hypothesis about the evolutionary origins of metabolic syndrome is that of a 'soldier' to 'diplomat' transition in behaviour and the accompanying metabolic adaptations. Theoretical as well as empirical studies have shown that similar to the soldier and diplomat dichotomy, physically aggressive and non-aggressive strategists coexist in animal societies with negative frequency dependent selection. Although dominant individuals have a higher reproductive success obtained through means such as greater access to females, subordinate individuals have alternative means such as sneak-mating for gaining a substantial reproductive success. The alternative behavioural strategies are associated with different neurophysiologic and metabolic states. Subordinate individuals typically have low testosterone, high plasma cholesterol and glucocorticoids and elevated serotonin signalling whereas dominant ones are characterized by high testosterone, low brain serotonin and lower plasma cholesterol. Food and sex are the main natural causes of aggression. However, since aggression increases the risk of injury, aggression control is equally crucial. Therefore chronic satiety in the form of fat should induce aggression control. It is not surprising that the satiety hormone serotonin has a major role in aggression control. Further chronically elevated serotonin signalling in the hypothalamus induces peripheral insulin resistance. Meta-analysis shows that most of the anti-aggression signal molecules are pro-obesity and pro-insulin-resistance. Physical aggression is known to increase secretion of epidermal growth factor (EGF) in anticipation of injuries and EGF is important in pancreatic beta cell regeneration too. In anticipation of injuries aggression related hormones also facilitate angiogenesis and angiogenesis dysfunction is the root cause of a number of co-morbidities of insulin resistance syndrome. Reduced injury proneness typical of 'diplomat' life style would also reorient the immune system resulting into delayed wound healing on the one hand and increased systemic inflammation on the other. Diabetes is negatively associated with physically aggressive behaviour. We hypothesize that suppression of physical aggression is the major behavioural cue for the development of metabolic syndrome. Preliminary trials of behavioural intervention indicate that games and exercises involving physical aggression reduce systemic inflammation and improve glycemic control.

The co-optimization of floral display and nectar reward.

In most insect-pollinated flowers, pollinators cannot detect the presence of nectar without entering the flower. Therefore, flowers may cheat by not producing nectar and may still get pollinated. Earlier studies supported this 'cheater flower' hypothesis and suggested that the cost saving by cheater flowers could be the most predominant selective force in the evolution of nectarless flowers. Previous models as well as empirical studies have addressed the problem of optimizing the proportion of nectarless and nectarful flowers. However, there has been no attempt to optimize the investment in nectar production along with that in floral display. One of the key questions that arises is whether the floral display will evolve to be an honest indicator of nectar reward. We use a mathematical model to cooptimize the investments in nectar and floral display in order to achieve maximum reproductive success. The model assumes that pollinators rely on a relative rather than an absolute judgement of reward. A conspicuous floral display attracts naive pollinators on the one hand and enhances pollinator learning on the other. We show that under these assumptions, plant-pollinator co-evolution leads to honest signalling, i.e. a positive correlation between display and reward.

Obesity as a perceived social signal.

Fat accumulation has been classically considered as a means of energy storage. Obese people are theorized as metabolically 'thrifty', saving energy during times of food abundance. However, recent research has highlighted many neuro-behavioral and social aspects of obesity, with a suggestion that obesity, abdominal obesity in particular, may have evolved as a social signal. We tested here whether body proportions, and abdominal obesity in particular, are perceived as signals revealing personality traits. Faceless drawings of three male body forms namely lean, muscular and feminine, each with and without abdominal obesity were shown in a randomized order to a group of 222 respondents. A list of 30 different adjectives or short descriptions of personality traits was given to each respondent and they were asked to allocate the most appropriate figure to each of them independently. The traits included those directly related to physique, those related to nature, attitude and moral character and also those related to social status. For 29 out of the 30 adjectives people consistently attributed specific body forms. Based on common choices, the 30 traits could be clustered into distinct 'personalities' which were strongly associated with particular body forms. A centrally obese figure was perceived as "lethargic, greedy, political, money-minded, selfish and rich". The results show that body proportions are perceived to reflect personality traits and this raises the possibility that in addition to energy storage, social selection may have played some role in shaping the biology of obesity.