E-Cigarettes and Cardiopulmonary Health.

E-cigarettes have surged in popularity over the last few years, particularly among youth and young adults. These battery-powered devices aerosolize e-liquids, comprised of propylene glycol and vegetable glycerin, typically with nicotine, flavors, and stabilizers/humectants. Although the use of combustible cigarettes is associated with several adverse health effects including multiple pulmonary and cardiovascular diseases, the effects of e-cigarettes on both short- and long-term health have only begun to be investigated. Given the recent increase in the popularity of e-cigarettes, there is an urgent need for studies to address their potential adverse health effects, particularly as many researchers have suggested that e-cigarettes may pose less of a health risk than traditional combustible cigarettes and should be used as nicotine replacements. This report is prepared for clinicians, researchers, and other health care providers to provide the current state of knowledge on how e-cigarette use might affect cardiopulmonary health, along with research gaps to be addressed in future studies.

Cardiovascular disease: Psychological, social, and behavioral influences: Introduction to the special issue.

Although deaths due to cardiovascular diseases have declined significantly since the 1970s, they remain the most common cause of morbidity and mortality in the United States. A large number of cardiovascular risk factors, such as smoking, obesity, and sedentary lifestyle, are modifiable. Psychologists and other behavioral scientists and practitioners are engaged in not only understanding the mechanistic links between behaviors and cardiovascular health but also developing effective interventions for improving health. The purpose of this special issue is to highlight some of the more innovative psychological research in cardiovascular health promotion, disease prevention, and management. Articles included in this issue focus on 2 primary areas. First, cutting-edge research on the current state of knowledge of modifiable health behaviors and their impact on cardiovascular health include articles on e-cigarette use as a putative risk factor, psychological factors involved in adherence to medications, the role of sleep in cardiovascular health, and innovative approaches to enhancing the treatment and recovery of patients with cardiovascular diseases. Second, outstanding research identifying the mechanisms by which psychological factors such as stress, depression, and anxiety impact cardiovascular disease include an overview of the current state of science examining psychological comorbidities that can accompany cardiovascular disease and influence outcomes, discussion of the neurocognitive processes that connect stress appraisal with biological functioning and diseases processes, and the role of genetics on behavioral interventions and clinical decision-making in the context of behavioral weight loss treatments. Our goal with these innovative articles is to stimulate additional advances in cardiovascular behavioral medicine. (PsycINFO Database Record (c) 2018 APA, all rights reserved).

E-cigarette use as a potential cardiovascular disease risk behavior.

Electronic cigarette (e-cigarette) use is rapidly increasing among youth and adults despite limited information regarding the long-term risks or benefits. The potential impact of e-cigarette use on public health is complex. E-cigarettes are sometimes considered as smoking cessation aids and, to the extent that they are successful in this regard, could have a net population benefit for adult smokers. However, limited knowledge exists about the long-term health effects of e-cigarette use, and research has suggested these novel tobacco products may lead to initiation and continued use among vulnerable populations, including youth. The current review aimed to summarize trends and available scientific information about e-cigarette use, focusing on the potential cardiovascular health risks and benefits, characteristics associated with e-cigarette use, and critical areas for future investigation to inform the research and clinical work of psychologists. Psychologists have a leadership role in mitigating health risks from smoking behavior, and there is a need for rigorous research assessing the impact of e-cigarette use on population health. In addition, psychologists are uniquely qualified to understand the underlying processes regarding decision-making and behaviors around e-cigarette use. Collectively, the research of psychologists in this area can have a substantial impact on patient education, policies, and the development of prevention and intervention programs to promote public health. (PsycINFO Database Record (c) 2018 APA, all rights reserved).

Referring Hospitalized Smokers to Outpatient Quit Services: A Randomized Trial.

INTRODUCTION: Linking outpatient cessation services to bedside counseling for hospitalized smokers can improve long-run quit rates. Adding an assisted referral (AR) offer to a tobacco treatment specialist consult service fits the team approach to care in U.S. hospitals. DESIGN: A two-arm patient-randomized trial tested the effectiveness of adding an AR offer to outpatient smoking-cessation services and interactive voice recognition (AR+IVR) follow-up to a usual care (UC) tobacco-cessation consult for hospitalized smokers. SETTING/PARTICIPANTS: Over 24 months (November 2011-November 2013), 898 hospitalized adult smokers interested in quitting smoking were recruited from three large hospitals in the Portland, Oregon, area: an integrated group model HMO (n=622), a community hospital (n=195), and an academic health center (n=81). INTERVENTION: Tobacco treatment specialists identified smokers and provided an intensive bedside tobacco use assessment and cessation consultation (UC). AR+IVR recipients also received proactive ARs to available outpatient counseling programs and medications, and linked patients to a tailored IVR telephone follow-up system. MAIN OUTCOME MEASURES: The primary outcome was self-reported 30-day abstinence at 6-month follow-up. Secondary outcomes included self-reported and continuous abstinence and biochemically confirmed 7-day abstinence at 6 months. Follow-up was completed in September 2014; data were analyzed in 2015. RESULTS: A total of 597 and 301 hospitalized smokers were randomized to AR+IVR and UC, respectively. AR+IVR and UC recipients received 19.3 and 17.0 minutes of bedside counseling (p=0.372), respectively. Most (58%) AR+IVR patients accepted referrals for counseling, 43% accepted medications, and 28% accepted both. Self-reported 30-day abstinence for AR+IVR (17.9%) and UC (17.3%) were not statistically significant (p=0.569). Differences in 7-day, continuous, and biochemically confirmed abstinence by treatment group also were insignificant, overall and adjusting for site. CONCLUSIONS: Adding an AR to outpatient counseling and medications did not increase cigarette abstinence at 6 months compared to UC alone.

Reducing cardiovascular risk through treatment of obstructive sleep apnea: 2 methodological approaches.

Obstructive sleep apnea (OSA) significantly impacts cardiovascular health, demonstrated by observational investigations showing an independently increased risk of ischemic heart disease, diabetes, hypertension, congestive heart failure, acute coronary syndrome, stroke, cardiovascular mortality, and all-cause mortality. Positive airway pressure (PAP), a medical therapy for sleep apnea, reverses airway obstruction and may help reduce cardiovascular risk. Prior to planning large phase III randomized controlled trials to test the impact of PAP on cardiovascular outcomes, several gaps in knowledge need to be addressed. This article describes 2 independent studies that worked collaboratively to fill these gaps. The populations, design features, and relative benefits/challenges of the 2 studies (SleepTight and BestAIR) are described. Both studies were encouraged to have multidisciplinary teams with expertise in behavioral interventions to improve PAP compliance. Both studies provide key information that will be useful to the research community in future large-scale, event-driven, randomized trials to evaluate the efficacy and/or effectiveness of strategies to identify and treat significant OSA for decreasing risk of major adverse cardiovascular events in high-risk patients.

Major Depressive Disorder and Bipolar Disorder Predispose Youth to Accelerated Atherosclerosis and Early Cardiovascular Disease: A Scientific Statement From the American Heart Association.

In the 2011 "Expert Panel on Integrated Guidelines for Cardiovascular Health and Risk Reduction in Children and Adolescents," several medical conditions among youth were identified that predispose to accelerated atherosclerosis and early cardiovascular disease (CVD), and risk stratification and management strategies for youth with these conditions were elaborated. Major depressive disorder (MDD) and bipolar disorder (BD) among youth satisfy the criteria set for, and therefore merit inclusion among, Expert Panel tier II moderate-risk conditions. The combined prevalence of MDD and BD among adolescents in the United States is ≈10%, at least 10 times greater than the prevalence of the existing moderate-risk conditions combined. The high prevalence of MDD and BD underscores the importance of positioning these diseases alongside other pediatric diseases previously identified as moderate risk for CVD. The overall objective of this statement is to increase awareness and recognition of MDD and BD among youth as moderate-risk conditions for early CVD. To achieve this objective, the primary specific aims of this statement are to (1) summarize evidence that MDD and BD are tier II moderate-risk conditions associated with accelerated atherosclerosis and early CVD and (2) position MDD and BD as tier II moderate-risk conditions that require the application of risk stratification and management strategies in accordance with Expert Panel recommendations. In this scientific statement, there is an integration of the various factors that putatively underlie the association of MDD and BD with CVD, including pathophysiological mechanisms, traditional CVD risk factors, behavioral and environmental factors, and psychiatric medications.