Pain, smoking, and moderating effect of gender in a large, representative sample of Danish adults.

Comorbidity between smoking and chronic pain is well-documented, but gender differences in the pain-smoking relationship are not well understood. Although men experience greater acute analgesic benefit from smoking, pain may be more highly related to nicotine dependence and barriers to quitting among women. Utilizing a large, representative sample of adults in Denmark (N = 18,019), the current study examined gender as a moderator of the relationship between pain and smoking. Being a current smoker was related to greater likelihood of experiencing pain in univariate analysis (Chi-Square = 67.07, p < .01). In the multivariate logistic regression analysis, being male (log odds = .28, p < .01), having pain (log odds = .37, p < .01), and having lower education level (log odds = -.37, p < .01) increased the likelihood of being a current smoker. The negative Gender X Pain interaction was also significant (log odds = -.17, p = .02), indicating that among males, the effect (in log odds) of Pain on Smoking was lower, when compared to females. The stronger relationship between pain and smoking observed among women may indicate that women are more likely to use smoking means of coping with pain than men. It is also possible that over the long-term, smoking exacerbates painful conditions to a higher degree among women than men. Future research should seek to clarify differences in smoking negative reinforcement expectancies, nicotine dependence, and barriers to quitting between male and female smokers with pain.

Prevalence of Meeting Physical Activity, Screen-Time, and Sleep Guidelines Among Children and Adolescents With and Without Visual Impairments in the United States.

The purpose of this study was to compare the degree to which children and adolescents with and without visual impairments (VIs) met national physical activity, screen-time, and sleep guidelines. This observational, cross-sectional analysis of the 2016 National Survey of Children's Health focused on children (age 6-12 yr) and adolescents (age 13-17 yr) with and without VIs. The sample included 241 (weighted n = 472,127) and 17,610 (weighted n = 28,249,833) children, and 255 (weighted n = 505,401) and 17,417 (weighted n = 20,071,557) adolescents with and without VIs, respectively. Chi-square statistics were computed to examine the degree to which participants with and without VIs met health-behavior guidelines. Children (p = .02) with VIs were less likely to meet screen-time guidelines, but adolescents with VIs were not (p = .87). VI status was not associated with the likelihood of meeting physical activity or sleep guidelines (p < .05). Low numbers of children and adolescents with and without VIs meeting health-behavior guidelines warrant targeted interventions aimed at enhancing engagement.

Meeting the 24-hr movement guidelines: An update on US youth with autism spectrum disorder from the 2016 National Survey of Children's Health.

The purpose of this study was to examine how adherence to the physical activity (PA), screen-time (ST), and sleep duration guidelines differ between youth with autism spectrum disorder (ASD) and youth with typical development (TD). A secondary objective was to assess how PA, ST, and sleep duration varied among youth with ASD by age and ASD severity. Utilizing the 2016 National Survey of Children's Health data, parental reports of time spent by youth in PA, ST, and sleep were used to determine adherence to the 24-hr movement guidelines for 1008 youth with ASD and 34 489 youth with TD. Multivariate logistic regression analyses determined that children with ASD were less likely to meet the guidelines for PA, ST, and sleep duration, and adolescents with ASD were less likely to meet the guidelines for PA and ST than participants with TD. Furthermore, logistic regression analyses determined adolescents with severe ASD to be less likely to meet the sleep guideline compared to adolescents with mild ASD. Overall, youth with ASD were significantly less likely to adhere to all three guidelines. The findings highlight the breadth of health behaviors that require intervention to counteract the poorer health status among youth with ASD. Autism Res 2019, 12: 941-951. © 2019 International Society for Autism Research, Wiley Periodicals, Inc. LAY SUMMARY: New health recommendations suggest children and adolescents should have at least 1 hr of physical activity, no more than 2 hr of screen-time (e.g., television), and 9-11 hr of sleep (or 8-10 hr for children aged 14 or older) every day. This article looked at how children and adolescents with autism meet these new guidelines. The two main results were that: (a) children with autism were less likely to meet all three guidelines compared to children without autism, and (b) adolescents with autism were less likely to meet the guidelines for physical activity and screen-time.

Physical activity, body mass index, and health status among youth with severe visual impairments aged 13-17 years in the United States.

BACKGROUND: Limited population-based data is available in the United States (US) examining physical activity engagement, weight status, and health status among youth with visual impairments. OBJECTIVE: To compare parent-reported physical activity participation, weight status, and health status among a nationally representative sample of US children with and without severe visual impairments. METHODS: This observational, cross-sectional analysis utilized data from the 2011-2012 National Survey of Children's Health (NSCH). The NSCH data is composed of a cross-sectional probability sample of noninstitutionalized youth aged 0-17 years in the US. This study focused on 28,390 adolescents (aged 13-17 years); 106 with SVIs and 28,284 without severe visual impairments. Parent reported physical activity participation, height and weight, and overall health status were utilized in this study to understand nationally representative trends. RESULTS: Adolescents with severe visual impairments participated in fewer days of moderate-to-vigorous physical activity per week (Mean = 2.40, SE = 0.65) than those without impairments (Mean = 3.93, SE = 0.03), t = 2.35, p = .02. Prevalence of obesity/overweight did not differ between youth with and without severe visual impairments, OR = 1.032 (CI = 0.45, 2.37), p = .94. Youth with severe visual impairments were more likely to have poor health (9.3%), compared to youth without impairments (3.4%), OR = 2.89 (CI = 1.13, 7.41), p = .03. CONCLUSIONS: Participants with severe visual impairments engaged in less physical activity and had poorer health status than participants without impairments. Future interventions, tailored to this populations' unique needs, are needed to increase physical activity and improve health status.

Prevalence of overweight and obesity among US youth with autism spectrum disorder.

The purpose of this study was to examine current overweight and obesity prevalence rates among US youth (aged 10-17 years) with and without autism spectrum disorder, based on the 2016 National Survey of Children's Health. Analyses of weight status, derived from parent-reported height and weight measures, were conducted for a weighted sample of 875,963 youth with autism spectrum disorder and 31,913,657 typically developing youth. Controlling for age, race/ethnicity, income, and sex, youth with autism spectrum disorder had significantly higher odds of overweight (odds ratio = 1.48, p = 0.04) and obesity (odds ratio = 1.49, p = 0.02) compared to typically developing youth. Among youth with autism spectrum disorder, 19.4% were overweight and 23.05% were obese. Among typically developing youth, 14.9% were overweight and 15.91% were obese. Higher odds of obesity were reported for youth with severe autism spectrum disorder (odds ratio = 3.35, p < 0.01), compared to those with mild autism spectrum disorder.

The role of pain in quitting among human immunodeficiency virus (HIV)-positive smokers enrolled in a smoking cessation trial.

BACKGROUND: Smoking rates among people living with human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS; PLWHA) are at least twice as high as rates in the general population. Consistent with the reciprocal model of pain and smoking, PLWHA with pain who smoke may use smoking as a means of coping with pain, thus presenting a potential barrier to quitting. The aim of this study is to better understand how pain relates to smoking cessation among 474 HIV-positive adults enrolled in a cell phone-delivered smoking cessation trial. METHODS: Participants were randomly assigned to usual care (cessation advice and self-help materials) or 11 sessions of cell phone-delivered smoking cessation treatment. Pain, as assessed by the Medical Outcomes Study-HIV Health Survey (MOS-HIV), and point prevalence abstinence were collected at the 3-month treatment end and at 6- and 12-month follow-ups. Self-reported abstinence was biochemically verified by expired carbon monoxide (CO) level of <7 ppm. RESULTS: Using multilevel modeling for binary outcome data, the authors examined the relationship between pain and abstinence, from treatment end through the 12-month follow-up. Consistent with the authors' hypothesis, less pain was associated with greater likelihood of 24-hour (ß = .01, t(651) = 2.53, P = .01) and 7-day (ß = .01, t(651) = 2.35, P = .02) point prevalence abstinence, controlling for age, gender, baseline pain, nicotine dependence, and treatment group. No pain × treatment group interaction was observed. CONCLUSIONS: These results can help us to better identify PLWHA at greater risk for relapse in smoking cessation treatment. Future research may examine the effectiveness of more comprehensive smoking cessation treatment that incorporates aspects of pain management for PLWHA who smoke and have high pain and symptom burden.

The Association of Smoking with English and Spanish Language Use as a Proxy of Acculturation Among Mexican-Americans.

To better characterize the relation of acculturation, based on language use, to smoking status among Mexican-Americans, a large study sample from an ongoing cohort of Mexican-American households in Texas was stratified into current smokers and non-smokers. Four language-use groups were created based on Low/High use of Spanish and English, representing different degrees of acculturation. Participants who reported high English but low Spanish use had the highest smoking prevalence (20.1 %), followed by High English/High Spanish (13.6 %), Low English/High Spanish (8.7 %), and Low English/Low Spanish (6.4 %). Current smokers were more likely to be male, have lower than high school education, currently consume alcohol or had consumed alcohol but quit, and report low Spanish/high English use. Consistent with recent models of acculturation, individuals can differ both in their maintenance of the native language and adoption of a new language and both dimensions are important in predicting tobacco use.

The Association of Pain With Smoking and Quit Attempts in an Electronic Diary Study of Cancer Patients Trying to Quit.

INTRODUCTION: The purpose of this electronic daily diary study was to examine the relation of pain to smoking and quit attempts among 34 cancer patients with pain enrolled in a smoking cessation program. METHODS: Electronic daily diary assessments of pain and smoking were collected at the end of each day for a 2-week period during smoking cessation treatment. Pain experienced throughout the day was measured on a scale from 1 to 5, from "no pain" to "pain as bad as you can imagine." Smoking was defined as the number of cigarettes smoked per day. RESULTS: Linear multilevel modeling was used in examining associations between pain and smoking. A within-person pain and smoking association was found, such that greater daily pain was linked to greater daily smoking within individuals, controlling for baseline symptoms, nicotine dependence, smoking urge, age, and gender. No between-person pain and smoking association was observed. Additionally, cancer patients with higher average pain across the 2-week assessment period were less likely to make a quit attempt (defined as a day on which participants smoked no cigarettes) during the study period. CONCLUSIONS: The findings of this study add to a nascent literature on pain and smoking by providing initial evidence that pain may be a barrier to quitting among cancer patients who smoke and have pain. Future research examining the effectiveness of integrated pain and smoking cessation treatment in this population may be warranted.

The association of presurgery psychological symptoms with postsurgery pain among cancer patients receiving implantable devices for pain management.

PURPOSE: Psychological symptoms are a common part of the cancer pain experience, yet little is known about how these factors relate to implantable device outcomes in patients with cancer pain. The purpose of this study was to examine how psychological symptoms relate to implantable device outcomes in cancer pain management. METHODS: We retrospectively examined the medical records of 79 cancer patients, collecting information on psychological symptoms and pain, as assessed on the Edmonton Symptom Assessment System. Data were collected prior to and at three points following the implantation of either a spinal cord stimulator or an intrathecal pump. RESULTS: Pain was correlated with both anxiety, r = 0.39 (n = 74, p < 0.01), and depression, r = 0.38, (n = 75, p < 0.01), at the presurgery baseline. Results of linear mixed model (LMM) analysis indicated that neither baseline anxiety nor baseline depression main effects were significantly associated with pain at postimplant assessments, when adjusting for baseline pain, demographics, and clinical factors. However, the group-by-time interaction was significant for anxiety (beta = 0.223, p value = 0.037). The trajectory of pain scores over time differed by baseline anxiety scores, with pain scores increasing over time at a higher rate for those with a high baseline anxiety score, compared to those with low baseline anxiety scores. CONCLUSION: Presurgery psychological symptoms should be considered, along with other medical, psychosocial, and individual characteristics in multidisciplinary treatment planning. Multidisciplinary care which includes aspects of mood management or supportive psychotherapy would likely be beneficial to cancer patients presenting with high psychological symptoms.

The biopsychosocial model in cancer pain.

PURPOSE OF REVIEW: The purpose of this review is to provide the reader with an up-to-date overview on the biopsychosocial model in cancer pain. RECENT FINDINGS: This review contains articles published from 2012 to 2014, which advance our understanding of biopsychosocial factors related to the cancer pain experience and psychosocial treatment for cancer pain. Greater depression, anxiety, and distress, and lower quality of life are related to greater pain intensity in cancer patients. Recent publications have expanded on this research by examining how psychosocial factors relate to the development of chronic pain conditions after cancer treatment. Recent publications have also advanced our understanding of psychosocial interventions for cancer pain and symptom management. In the last few years, several reviews have emerged, which have found modest effect sizes for psychosocial interventions in cancer pain management. SUMMARY: The biopsychosocial model is a helpful way to comprehensively approach the conceptualization and treatment of pain in cancer patients at all stages of the disease process. We currently have an established base of research on the importance of biopsychosocial model in cancer pain. Our ability to treat patients with cancer pain effectively will improve as we gain a better understanding of which treatments work for which patients.

Perception of tobacco use prevention and cessation among faculty members in Latin American and Caribbean dental schools.

Rates of tobacco use are increasing in the regions of Latin America and the Caribbean (LAC). Unfortunately, tobacco cessation education is not a standard component of the dental curriculum in LAC dental schools. The objective of this study was to identify the perceptions of LAC dental faculty members regarding the tobacco use prevention and cessation (TUPAC) competencies that should be addressed in the dental curricula. Dental deans and faculty completed a web-based questionnaire in Spanish, Portuguese, French, or English. The questionnaire contained 32 competencies grouped into the five A's (Ask, Advise, Assess, Assist, and Arrange) of tobacco cessation and six supplementary questions for identifying barriers to providing TUPAC education to dental students. Respondents indicated the degree to which they believed each competency should be incorporated into the dental curricula using a five-point Likert scale ("1" = strongly disagree to "5" = strongly agree). Responses were obtained from 390 faculty members (66 % South America, 18 % Mexico/Central America, 16 % the Caribbean). Of the respondents, 2, 12, and 83 % reported that smoking was allowed in clinical environments, other indoor environments, and outdoor environments of their dental schools, respectively. Mean importance ratings for each of the competencies were as follows: Ask (4.71), Advise (4.54), Assess (4.41), Assist (4.07), and Arrange (4.01). Overall, LAC dental educators agree that TUPAC training should be incorporated into the dental curricula. Assist and Arrange competencies were rated lower, relative to other competencies. Tobacco use among dental educators and high rates of on-campus smoking could potentially pose barriers to promoting cessation interventions in the LAC dental schools.

Individual and combined effects of multiple high-risk triggers on postcessation smoking urge and lapse.

INTRODUCTION: Negative affect, alcohol consumption, and presence of others smoking have consistently been implicated as risk factors for smoking lapse and relapse. What is not known, however, is how these factors work together to affect smoking outcomes. This paper uses ecological momentary assessment (EMA) collected during the first 7 days of a smoking cessation attempt to test the individual and combined effects of high-risk triggers on smoking urge and lapse. METHODS: Participants were 300 female smokers who enrolled in a study that tested an individually tailored smoking cessation treatment. Participants completed EMA, which recorded negative affect, alcohol consumption, presence of others smoking, smoking urge, and smoking lapse, for 7 days starting on their quit date. RESULTS: Alcohol consumption, presence of others smoking, and negative affect were, independently and in combination, associated with increase in smoking urge and lapse. The results also found that the relationship between presence of others smoking and lapse and the relationship between negative affect and lapse were moderated by smoking urge. CONCLUSIONS: The current study found significant individual effects of alcohol consumption, presence of other smoking, and negative affect on smoking urge and lapse. Combing the triggers increased smoking urge and the risk for lapse to varying degrees, and the presence of all 3 triggers resulted in the highest urge and lapse risk.