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1.
BMC Public Health ; 21(1): 959, 2021 05 20.
Artículo en Inglés | MEDLINE | ID: mdl-34016066

RESUMEN

BACKGROUND: While rates of e-cigarette use ('vaping') continue to potentiate concern, there is limited data on common symptoms of e-cigarette dependence among young adults who vape. This study sought to critically explore how young adults experience, manifest, and conceptualize vaping dependence symptoms in their everyday lives. METHODS: Between June 2018 and 2019, in-depth qualitative interviews were conducted with 62 young adults who use e-cigarettes (aged 18-25) and live in Southern California. We explored participants' product preferences, daily e-cigarette use patterns, vaping history, withdrawal experiences, and quit attempts or periods of cessation. We used a thematic analysis approach to interpret the transcripts. RESULTS: Young adults discussed nine dimensions of vaping dependence that were organized into two categories: 1) general nicotine dependence symptoms, and 2) unique dependence symptoms related to vaping. Nicotine dependence symptoms included cravings and urgency to use, increased use to achieve desired effects, and unsuccessful quit attempts and withdrawal. Symptoms unique to vaping dependence included greater nicotine consumption due to accessibility and lack of restrictions, habitual vaping, inability to track vaping frequency, immediate gratification and comfort, social acceptability and norms, and awareness of vaping dependency. CONCLUSIONS: In addition to nicotine dependence symptoms that have been characterized for other tobacco products, young adult e-cigarette users described unique symptoms of vaping dependence that necessitate the need for more refined measures. All dimensions of vaping dependence should be considered in discussions of policies as well as treatment and education efforts intended to protect young people from e-cigarette dependence.


Asunto(s)
Sistemas Electrónicos de Liberación de Nicotina , Cese del Hábito de Fumar , Tabaquismo , Vapeo , Adolescente , Adulto , Humanos , Nicotina , Tabaquismo/diagnóstico , Tabaquismo/epidemiología , Vapeo/efectos adversos , Adulto Joven
2.
Asian J Psychiatr ; 57: 102562, 2021 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-33571916

RESUMEN

BACKGROUND: To date, no study has evaluated the association of alcohol dependence with the outcome of the COVID-19 infection. AIM: The current study aimed to evaluate the association of substance dependence (alcohol and tobacco) with the outcome (i.e., time to have two consecutive negative test reports) of the COVID-19 infection. RESULTS: The mean age of the study participants (n = 95) was 37.2 yrs (SD-13.2). More than half of the participants were males. About one-fourth (N = 25; 26.3 %) were consuming various substances in a dependent pattern. Alcohol dependence was present in 21 participants (22.1 %), and Tobacco dependence was present in 10.5 % of participants. Even after using gender, age, and physical illness as covariates, patients with any kind of substance dependence had a significantly lower chance of having a negative report on RT-PCR on 14th day, 18th 23rd day. CONCLUSION: Persons with substance dependence takes a longer time to test negative on RT-PCR, once diagnosed with COVID-19 infection. Mental health professionals involved in the care of patients with COVID-19 should accordingly prepare these patients for a possible longer hospital stay to reduce the distress associated with prolongation of hospital stay.


Asunto(s)
Alcoholismo/epidemiología , /diagnóstico , Tabaquismo/epidemiología , Adulto , Femenino , Humanos , Masculino , Persona de Mediana Edad , Factores de Tiempo , Adulto Joven
3.
JAMA Netw Open ; 4(2): e2036512, 2021 02 01.
Artículo en Inglés | MEDLINE | ID: mdl-33538824

RESUMEN

Importance: Substance use disorders are a major source of morbidity and mortality in the United States. National data comparing the prevalence of substance use disorder diagnoses (SUDDs) among transgender and cisgender individuals are lacking in the United States. Objectives: To investigate the prevalence of SUDDs among transgender and cisgender adults and to identify within-group and between-group differences by age, gender, and geographic location. Design, Setting, and Participants: This cross-sectional study used the OptumLabs Data Warehouse to analyze deidentified claims from approximately 74 million adults aged 18 years or older enrolled in commercial or Medicare Advantage insurance plans in 2017. A total of 15 637 transgender adults were identified based on a previously developed algorithm using a combination of International Classification of Diseases, Tenth Revision (ICD-10) transgender-related diagnosis and procedure codes and sex-discordant hormone prescriptions. A cohort of 46 911 cisgender adults was matched to the transgender cohort in a 3:1 ratio based on age and geographic location. Main Outcomes and Measures: SUDDs, based on ICD-10 codes, were assessed overall and compared between transgender and cisgender cohorts and by geographic region (ie, Northeast, Midwest, South, and West); age groups (eg, 18-25, 26-30, 31-35 years), and gender (ie, transfeminine [TF; assigned male sex at birth, identify along feminine gender spectrum], transmasculine [TM; assigned female sex at birth, identify along masculine gender spectrum], male, and female). Results: In this study of 15 637 transgender adults (4955 [31.7%] TM) and 46 911 cisgender adults (23 247 [50.4%] men), most (8627 transgender adults [55.2%]; 51 762 cisgender adults [55.2%]) were aged between 18 and 40 years, and 6482 transgender adults (41.5%) and 19 446 cisgender adults (41.5%) lived in the South. Comparing transgender to cisgender groups, significant differences were found in the prevalence of a nicotine (2594 [16.6%] vs 2551 [5.4%]; P < .001), alcohol (401 [2.6%] vs 438 [0.9%]; P < .001), and drug (678 [4.3%] vs 549 [1.2%]; P < .001) SUDDs. Among transgender adults, cannabis was the most prevalent drug SUDD (321 [2.1%]), followed by opioid SUDD (205 [1.3%]) and cocaine SUDD (81 [0.5%]), whereas among cisgender adults, cannabis and opioid SUDDs were equally prevalent (cannabis, 186 [0.4%]; opioid, 207 [0.4%]), followed by cocaine SUDD (59 [0.1%]). Conclusions and Relevance: In this study, the prevalence of SUDDs was significantly elevated among transgender adults relative to their cisgender peers. These findings underscore the need for culturally tailored clinical interventions to treat substance use disorder in transgender populations.


Asunto(s)
Alcoholismo/epidemiología , Trastornos Relacionados con Cocaína/epidemiología , Abuso de Marihuana/epidemiología , Trastornos Relacionados con Opioides/epidemiología , Tabaquismo/epidemiología , Personas Transgénero/estadística & datos numéricos , Adolescente , Adulto , Estudios de Casos y Controles , Comorbilidad , Femenino , Humanos , Masculino , Persona de Mediana Edad , Prevalencia , Trastornos Relacionados con Sustancias/epidemiología , Estados Unidos/epidemiología , Adulto Joven
4.
Am Heart J ; 234: 111-121, 2021 04.
Artículo en Inglés | MEDLINE | ID: mdl-33453161

RESUMEN

BACKGROUND: Among patients with severe aortic stenosis (AS), there are limited data on aortic valve replacement (AVR), reasons for nonreceipt and mortality by race. METHODS: Utilizing the Duke Echocardiography Laboratory Database, we analyzed data from 110,711 patients who underwent echocardiography at Duke University Medical Center between 1999 and 2013. We identified 1,111 patients with severe AS who met ≥1 of 3 criteria for AVR: ejection fraction ≤50%, diagnosis of heart failure, or need for coronary artery bypass surgery. Logistic regression models were used to assess the association between race, AVR and 1-year mortality. χ2 testing was used to assess potential racial differences in reasons for AVR nonreceipt. RESULTS: Among the 1,111 patients (143 AA and 968 CA) eligible for AVR, AA were more often women, had more diabetes, renal insufficiency, aortic regurgitation and left ventricular hypertrophy. CA were more often smokers, had more ischemic heart disease, hyperlipidemia and higher median income levels. There were no racial differences in surgical risk utilizing logistic euroSCORES. Relative to CA, AA had lower rates of AVR (adjusted odds ratio 0.46, 95% CI 0.3-0.71, P < .001) yet similar 1-year mortality (aHR 0.81, 95% CI 0.57-1.17, P = .262). There were no significant differences in reasons for AVR nonreceipt. CONCLUSIONS: We identified 143 African Americans (AA) and 968 Caucasian Americans(CA) with severe AS who met prespecified criteria for AVR.. AA relative to CA were more often women, had more diabetes, renal insufficiency, and left ventricular hypertrophy, however had less tobacco use, ischemic heart disease, hyperlipidemia and lower median income levels. Among patients with severe AS, AA relative to CA had lower rates of AVR (adjusted odds ratio 0.46, 95% CI 0.3-0.71, P < .001) without significant differences in reasons for AVR nonreceipt and similar 1-year mortality.


Asunto(s)
Afroamericanos/estadística & datos numéricos , Estenosis de la Válvula Aórtica/cirugía , Grupo de Ascendencia Continental Europea/estadística & datos numéricos , Implantación de Prótesis de Válvulas Cardíacas/estadística & datos numéricos , Anciano , Anciano de 80 o más Años , Estenosis de la Válvula Aórtica/diagnóstico por imagen , Estenosis de la Válvula Aórtica/etnología , Estenosis de la Válvula Aórtica/mortalidad , Distribución de Chi-Cuadrado , Puente de Arteria Coronaria/estadística & datos numéricos , Diabetes Mellitus/epidemiología , Ecocardiografía , Femenino , Implantación de Prótesis de Válvulas Cardíacas/mortalidad , Humanos , Hiperlipidemias/epidemiología , Hipertrofia Ventricular Izquierda/epidemiología , Renta , Modelos Logísticos , Masculino , Isquemia Miocárdica/epidemiología , Insuficiencia Renal/epidemiología , Factores Sexuales , Volumen Sistólico , Tabaquismo/epidemiología , Estados Unidos/epidemiología , Estados Unidos/etnología
5.
Soc Psychiatry Psychiatr Epidemiol ; 56(6): 981-992, 2021 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-33386872

RESUMEN

PURPOSE: To characterize the association of social class discrimination with the timing of first cigarette use and progression to DSM-IV nicotine dependence (ND) in Black and White youth, examining variation by race, parent vs. youth experiences of discrimination, socioeconomic status (SES), and stage of smoking. METHODS: Data were drawn from 1461 youth (55.2% Black, 44.8% White; 50.2% female) and mothers in a high-risk family study of alcohol use disorder and related conditions. Cox proportional hazard regression analyses were conducted, using youth's and mother's social class discrimination to predict first cigarette use and progression to ND, stratifying by race. Interactions between discrimination and SES indicators (parental education and household income) were tested. Adjusted models included psychiatric covariates. RESULTS: In the adjusted first cigarette use models, neither youth's nor mother's social class discrimination was a significant predictor among Black youth, but mother's discrimination was associated with increased risk [HR = 1.53 (1.18-1.99)] among White youth. In the adjusted ND models, mother's discrimination was associated with reduced ND risk for Black youth in middle-income families [HR = 0.29 (CI 0.13-0.63)], but neither youth's nor mother's discrimination predicted transition to ND among White youth. CONCLUSIONS: The observed race and smoking stage-specific effects suggest that social class discrimination is more impactful on early stages of smoking for White youth and later stages for Black youth. The robustness of links with mother's discrimination experiences further suggests the importance of considering family-level effects and the need to explore possible mechanisms, such as socialization processes.


Asunto(s)
Productos de Tabaco , Tabaquismo , Adolescente , Afroamericanos , Grupo de Ascendencia Continental Europea , Femenino , Humanos , Masculino , Clase Social , Tabaquismo/epidemiología
6.
Addict Behav ; 115: 106787, 2021 04.
Artículo en Inglés | MEDLINE | ID: mdl-33383566

RESUMEN

BACKGROUND: Adult smokers with symptoms of any mental illness (AMI) are highly dependent on nicotine and may face additional difficulty quitting smoking. While there is evidence that adult smokers with AMI have high dependence, there is insufficient evidence regarding the unique role that AMI may play in moderating the relationship between dependence and cessation outcomes over time. METHODS: 7290 current established adult smokers at Wave 1 (2013-2014) of the PATH Study also participated in data collection in Waves 2-4 (2014-2018). Linear probability models with individual-level random effects were fit to the data, modeling associations between AMI, nicotine dependence, and the 1) likelihood of achieving cessation during the study period, 2) making a cessation attempt within the previous 12 months, and 3) log of past 30-day total consumption of cigarettes. RESULTS: Adults who experienced both AMI symptoms and high dependence were 4.7 percentage points (PP) less likely to achieve cessation at any point during the study period (p < 0.01) and smoked more cigarettes per month (ß = 0.214, p < 0.05) than adults with AMI who were not highly dependent, despite being as likely to attempt to quit. Adults with AMI who were not highly dependent were 4.6 PP more likely to report a quit attempt and 1.6 PP more likely to achieve cessation than those with neither AMI nor high dependence. CONCLUSIONS: Adults with AMI are particularly affected by the burden of tobacco use, in part because of the likely interaction between nicotine dependence and AMI. Tobacco control efforts that focus on this interplay may provide an opportunity to better target interventions for this vulnerable population.


Asunto(s)
Cese del Hábito de Fumar , Tabaquismo , Adulto , Humanos , Salud Mental , Fumar/epidemiología , Tabaco , Tabaquismo/epidemiología
7.
Rev. cuba. med. mil ; 49(4): e554, tab
Artículo en Español | LILACS, CUMED | ID: biblio-1156503

RESUMEN

Introducción: El tabaquismo se considera una epidemia de carácter universal y es una gravosa carga para el individuo, la familia y la sociedad. La cavidad bucal se afecta en toda su extensión y esto trae como resultado, efectos negativos sobre los tejidos que la conforman. Objetivo: Determinar las modificaciones en el nivel de conocimientos sobre tabaquismo y su relación con la cavidad bucal, con la aplicación de una intervención educativa. Métodos: Se realizó un estudio longitudinal en 55 voluntarios fumadores, de ambos sexos, adultos, del Hospital Militar Central Dr. Carlos J. Finlay, en el período comprendido de diciembre de 2017 a enero de 2018. Se les aplicó un cuestionario para determinar el nivel de conocimientos sobre tabaquismo y la cavidad bucal, antes y después de una intervención educativa. Se compararon los resultados de ambas aplicaciones. Resultados: El nivel de conocimientos fue suficiente en el 23,63 por ciento de los sujetos; después de aplicada la intervención aumentó al 83,63 por ciento. En relación con la enfermedad periodontal, predominaron los conceptos erróneos antes de la intervención (83,63 por ciento insuficiente) y después, respondió acertadamente el 65,45 por ciento. Conclusiones: La intervención aplicada fue efectiva para aumentar el nivel de conocimiento sobre el tabaquismo, relacionado con el cáncer oral y la enfermedad periodontal(AU)


Introduction: smoking is considered an epidemic of a universal nature and is a burden for the individual, the family and society. The oral cavity is affected to its full extent and this results in negative effects on its tissues. Objective: to determine the changes in the level of knowledge about smoking and its relationship with the oral cavity, with the application of an educational intervention. Methods: a longitudinal study was carried out in 55 smoking volunteers, of both sexes, adults, from the Hospital Militar Central Dr. Carlos J. Finlay, in the period from December 2017 to January 2018. A questionnaire was applied to determine the level of knowledge about smoking and the oral cavity, before and after an educational intervention. The results of both applications were compared. Results: the level of knowledge was sufficient in 23.63 percent of the subjects; after the intervention was applied, it increased to 83.63 percent. In relation to periodontal disease, misconceptions prevailed before the intervention (83.63 percent insufficient) and afterwards, 65.45 percent responded correctly. Conclusions: the intervention applied, was effective increasing the level of knowledge about smoking and oral cavity(AU)


Asunto(s)
Humanos , Masculino , Femenino , Tabaquismo/epidemiología , Neoplasias de la Boca/epidemiología , Cese del Uso de Tabaco , Boca , Estudios Longitudinales
8.
Rev. cuba. med. mil ; 49(4): e715,
Artículo en Español | LILACS, CUMED | ID: biblio-1156530

RESUMEN

Al leer detenidamente el artículo Nivel de conocimiento sobre el tabaquismo y su relación con la cavidad bucal,1 pareció de gran importancia resaltar este tema, debido a la elevada tasa de fumadores en Cuba, y cada vez son más los jóvenes que se suman a esta práctica, ya sea por motivos recreativos o de otra índole. Al revisar exhaustivamente las cifras ofrecidas en el trabajo1 se hace relevante que el 83,63 % de la muestra no conociera la influencia negativa del hábito de fumar en los tejidos periodontales. Las enfermedades periodontales, no solo se encuentran entre las más frecuentes, sino que existen evidencias cada vez mayores, sobre su impacto sistémico, con importantes repercusiones orgánicas. Se estima que las enfermedades periodontales tienen algún grado de asociación con otras 54 enfermedades, algunas tan importantes como la diabetes, complicaciones del embarazo o algunas enfermedades cardiovasculares. La propia Sociedad Europea de Cardiología sitúa a la periodontitis como sexto factor de riesgo cardiovascular.2,3,4 Otra de las cifras a resaltar en la investigación,1 es el conocimiento sobre la relación con el cáncer bucal. Aunque se muestra una cifra relativamente alta, un porciento nada despreciable de personas aún no conocen esta relación. Los tumores de cavidad bucal, son la principal causa de mortalidad por cáncer de cabeza y cuello (localizaciones C00-C14) con un total de 826 fallecidos en 2018 (Cuba) con una razón de 4,7 hombres por cada mujer.5) Como antes se mencionaba, el hábito de fumar se ha extendido a una gran parte de la población y con ello ha disminuido la edad media de fumadores, se instaura un balance entre sexos, debido al aumento de mujeres fumadoras. Esta situación ha llevado a que cada vez sea más frecuente la presencia de estos tumores en menores de 60 años y con ello la edad media de fallecimiento disminuya. Solo queda expresar la satisfacción de leer el artículo1 e incentivar a más investigadores a abordar este tema como un problema de salud en la sociedad cubana. Además, se recomienda realizar estudios similares, pero con poblaciones mayores para lograr datos más consistentes, e impulsar estudios en adolescentes y jóvenes(AU)


Asunto(s)
Humanos , Femenino , Adolescente , Tabaquismo/epidemiología , Boca/lesiones , Enfermedades de la Boca/epidemiología , Cuba
9.
Nutrients ; 12(12)2020 Dec 15.
Artículo en Inglés | MEDLINE | ID: mdl-33334010

RESUMEN

As food addiction is being more commonly recognized within the scientific community, parallels can be drawn between it and other addictive substance use disorders, including tobacco use disorder. Given that both unhealthy diets and smoking are leading risk factors for disability and death, a greater understanding of how food addiction and tobacco use disorder overlap with one another is necessary. This narrative review aimed to highlight literature that investigated prevalence, biology, psychology, and treatment options of food addiction and tobacco use disorder. Published studies up to August 2020 and written in English were included. Using a biopsychosocial lens, each disorder was assessed together and separately, as there is emerging evidence that the two disorders can develop concurrently or sequentially within individuals. Commonalities include but are not limited to the dopaminergic neurocircuitry, gut microbiota, childhood adversity, and attachment insecurity. In addition, the authors conducted a feasibility study with the purpose of examining the association between food addiction symptoms and tobacco use disorder among individuals seeking tobacco use disorder treatment. To inform future treatment approaches, more research is necessary to identify and understand the overlap between the two disorders.


Asunto(s)
Adicción a la Comida/epidemiología , Adicción a la Comida/psicología , Tabaquismo/epidemiología , Tabaquismo/psicología , Adulto , Adultos Sobrevivientes de Eventos Adversos Infantiles/psicología , Terapia Conductista , Encéfalo/fisiopatología , Comorbilidad , Terapia por Estimulación Eléctrica , Femenino , Adicción a la Comida/terapia , Microbioma Gastrointestinal/fisiología , Humanos , Masculino , Apego a Objetos , Prevalencia , Factores de Riesgo , Cese del Uso de Tabaco , Tabaquismo/terapia
10.
Nicotine Tob Res ; 22(Suppl 1): S76-S84, 2020 12 15.
Artículo en Inglés | MEDLINE | ID: mdl-33320256

RESUMEN

INTRODUCTION: This study assessed the association of exclusive and concurrent use of cigarettes, electronic nicotine delivery systems (ENDS), and cigars with ever and past 12-month wheezing symptoms among a nationally representative sample of US adult current tobacco users. METHODS: Cross-sectional data from the Population Assessment of Tobacco and Health (PATH) Study Wave 3 (W3) were used. The weighted prevalence of self-reported ever and past 12-month wheezing symptoms for noncurrent users compared with users of cigarettes, ENDS, cigars, and any combination of these products (polytobacco use of these tobacco products) were presented for 28 082 adults. The cross-sectional association of tobacco use with self-reported wheezing symptoms was assessed using weighted multivariable and ordinal logistic regression with consideration of complex sampling design. RESULTS: Significantly higher odds of ever had wheezing or whistling in the chest at any time in the past were observed among current cigarette (adjusted odds ratio: 2.62, 95% confidence intervals [CI]: 2.35, 2.91), ENDS (1.49, 95% CI: 1.14, 1.95), and polytobacco users (2.67, 95% CI: 2.26, 3.16) compared with noncurrent users. No associations were seen for cigar use. Polytobacco use was associated with a higher odds of ever wheezing when compared with exclusive ENDS (1.61, 95% CI: 1.19, 2.17) and exclusive cigar use (2.87, 95% CI: 1.93, 4.26), but not exclusive use of cigarettes. CONCLUSIONS: Ever wheezing is associated with the use of cigarettes, ENDS, and polytobacco use of cigarettes, ENDS, and/or cigars, but not cigar use. The association of polytobacco use and wheezing appears to be driven by cigarette use. IMPLICATIONS: Cross-sectional associations with ever and past 12-month wheezing symptoms were found to be the strongest among cigarette users, exclusively or in combination. Future longitudinal research is needed to better understand how cigarette use interacts with other tobacco and nicotine products and contributes to respiratory symptoms.


Asunto(s)
Sistemas Electrónicos de Liberación de Nicotina/estadística & datos numéricos , Ruidos Respiratorios/fisiopatología , Productos de Tabaco/efectos adversos , Tabaquismo/epidemiología , Uso de Tabaco/efectos adversos , Adolescente , Adulto , Estudios Transversales , Femenino , Humanos , Estudios Longitudinales , Masculino , Prevalencia , Ruidos Respiratorios/efectos de los fármacos , Tabaquismo/etiología , Estados Unidos/epidemiología , Adulto Joven
11.
Rev. int. androl. (Internet) ; 18(4): 151-158, oct.-dic. 2020. tab, graf
Artículo en Inglés | IBECS | ID: ibc-200828

RESUMEN

INTRODUCTION AND OBJECTIVES: To examine the association between lifestyle factors (body mass index, smoking, alcohol consumption, coffee intake, physical activity, sauna and cell phone usage, wearing tight-fitting underwear), and conventional semen parameters. MATERIALS AND METHODS: 1311 participants who attended the Andrology Clinic were included in the study. All participants were separated into two groups as men with normozoospermia and dysspermia. All participants answered a questionnaire which contains questions about the modifiable lifestyle factors. The total risk scores were calculated after all the positive lifestyle factors had been counted. RESULTS: Men with normozoospermia and dysspermia consisted of 852 (65.0%) and 459 (35.0%) participants respectively. A negative relationship between the wearing of tight underwear and having normal semen parameters was detected between the two groups (p = 0.004). While going to a sauna regularly was negatively related to semen concentration, wearing tight underwear was also related to both lower motility, normal morphology as well as semen concentration (p < 0.05). While the total score of all participants was 5.22±1.34 point, there were no statistical differences between the two groups (p = 0.332). It was found that having 3 more or fewer points was not related to any type of semen parameters and results of a spermiogram. CONCLUSION: The clinicians should give advice to infertile male patients about changing their risky lifestyle, for infertility, to a healthy lifestyle for fertility. Better designed studies, with larger sample sizes using conventional semen analysis with sperm DNA analysis methods, should be planned to identify the possible effects of lifestyle factors on semen quality


INTRODUCCIÓN Y OBJETIVOS: Examinar la asociación entre los factores asociados al estilo de vida (índice de masa corporal, tabaquismo, consumo de alcohol, ingesta de café, actividad física, sauna, uso del teléfono móvil y llevar ropa interior ajustada), y los parámetros seminales convencionales. MATERIALES Y MÉTODOS: Se incluyó en el estudio a 1.311 participantes que acudieron a la Clínica de Andrología. Se separó a los participantes en 2 grupos: varones con normozoospermia o dispermia. Todos los participantes respondieron a un cuestionario que contenía preguntas relativas a los factores modificables asociados al estilo de vida. Se calcularon las puntuaciones de riesgo total tras el recuento de todos los factores positivos del estilo de vida. RESULTADOS: De entre los participantes, el número de varones con normozoospermia ascendió a 852 (65%) y a 459 (35%) los varones con dispermia. Se detectó una relación negativa entre llevar ropa interior ajustada y tener parámetros normales de semen entre los 2 grupos (p = 0,004). Mientras el acudir regularmente a una sauna guardó una relación negativa con la concentración de semen, el llevar ropa interior ajustada se relacionó también con menor movilidad, morfología normal y concentración del semen (p < 0,05). A pesar de que la puntuación total de todos los participantes fue de 5,22±1,34 puntos, no se encontraron diferencias estadísticas entre los 2 grupos (p = 0,332). También se encontró que tener 3 puntos menos, o más, no guardaba relación con ningún tipo de parámetro seminal y los resultados del espermiograma. CONCLUSIÓN: Los clínicos deberían asesorar a los varones infértiles acerca de modificar su estilo de vida de riesgo de infertilidad, llevando una vida sana de cara a la fertilidad. Deberán planificarse y diseñarse estudios con mayores tamaños de muestra, utilizando análisis convencionales de semen con métodos analíticos de ADN espermático, para identificar los posibles efectos en la calidad del semen de los factores asociados al estilo de vida en DNA


Asunto(s)
Humanos , Masculino , Adulto Joven , Adulto , Estilo de Vida , Análisis de Semen/métodos , Espermatozoides/clasificación , Recuento de Espermatozoides/métodos , Infertilidad Masculina/diagnóstico , Oligospermia/etiología , Factores de Riesgo , Teratozoospermia/diagnóstico , Estudios de Casos y Controles , Tabaquismo/epidemiología , Consumo de Bebidas Alcohólicas/epidemiología
12.
Pediatr. aten. prim ; 22(88): 411-422, oct.-dic. 2020. tab, graf
Artículo en Español | IBECS | ID: ibc-FGT-6183

RESUMEN

El consumo de tabaco puede llegar a ser un problema durante la adolescencia. La experimentación con el tabaco puede llevar a un consumo de larga duración y dependencia. Los adolescentes fumadores tienen el mismo riesgo a largo plazo que los fumadores adultos de desarrollar cáncer, enfermedades cardiovasculares o enfermedad pulmonar obstructiva crónica. Además, el tabaco supone un riesgo importante para el bebé durante el embarazo y la lactancia. Tras realizar una revisión amplia de la literatura científica, el grupo PrevInfad concluye que no existen pruebas de buena calidad a favor ni en contra para recomendar la intervención individual frente al consumo de tabaco en adolescentes. No obstante, dadas las importantes implicaciones que tiene para la salud el desarrollo precoz de dependencia del tabaco y la mayor dificultad de abandono de este cuando se inicia a edades tempranas, parece mayor el beneficio que el riesgo de realizar consejo o intervención breve, teniendo en cuenta tanto las preferencias y valores de los adolescentes y sus familias como los recursos disponibles


Tobacco consumption may become a problem in adolescence. Experiencing tobacco may drive to a long-lasting consumption and dependence. Adolescents smokers have the same risk in the long term than adult smokers as far as cancer, cardiovascular disease or chronic obstructive pulmonary disease is concerned. Moreover, tobacco implies relevant risks during pregnancy and breastfeeding. After a comprehensive literature review, the group PrevInfad concludes that there is no good quality evidence in favor nor against the recommendation of individual intervention on tobacco consumption in adolescents. Nevertheless, given the relevant implications in health of the early tobacco dependence, and the greater difficulty of its cessation when started at an early age, the benefit of the brief counseling or intervention seems greater than its risk, taking into account the values and preferences of the adolescents and their families as well as the available resources


Asunto(s)
Humanos , Adolescente , Prevención del Hábito de Fumar/métodos , Tabaquismo/complicaciones , Tabaquismo/epidemiología , Conducta del Adolescente , Europa (Continente)
13.
MMWR Morb Mortal Wkly Rep ; 69(46): 1736-1742, 2020 Nov 20.
Artículo en Inglés | MEDLINE | ID: mdl-33211681

RESUMEN

Cigarette smoking remains the leading cause of preventable disease and death in the United States (1). The prevalence of current cigarette smoking among U.S. adults has declined over the past several decades, with a prevalence of 13.7% in 2018 (2). However, a variety of combustible, noncombustible, and electronic tobacco products are available in the United States (1,3). To assess recent national estimates of tobacco product use among U.S. adults aged ≥18 years, CDC analyzed data from the 2019 National Health Interview Survey (NHIS). In 2019, an estimated 50.6 million U.S. adults (20.8%) reported currently using any tobacco product, including cigarettes (14.0%), e-cigarettes (4.5%), cigars (3.6%), smokeless tobacco (2.4%), and pipes* (1.0%).† Most current tobacco product users (80.5%) reported using combustible products (cigarettes, cigars, or pipes), and 18.6% reported using two or more tobacco products.§ The prevalence of any current tobacco product use was higher among males; adults aged ≤65 years; non-Hispanic American Indian/Alaska Native (AI/AN) adults; those whose highest level of educational attainment was a General Educational Development (GED) certificate; those with an annual household income <$35,000; lesbian, gay, or bisexual (LGB) adults; uninsured adults and those with Medicaid; those with a disability; or those with mild, moderate, or severe generalized anxiety disorder. E-cigarette use was highest among adults aged 18-24 years (9.3%), with over half (56.0%) of these young adults reporting that they had never smoked cigarettes. Implementing comprehensive, evidence-based, population level interventions (e.g., tobacco price increases, comprehensive smoke-free policies, high-impact antitobacco media campaigns, and barrier-free cessation coverage), in coordination with regulation of the manufacturing, marketing, and sale of all tobacco products, can reduce tobacco-related disease and death in the United States (1,4). As part of a comprehensive approach, targeted interventions are also warranted to reach subpopulations with the highest prevalence of use, which might vary by tobacco product type.


Asunto(s)
Productos de Tabaco/estadística & datos numéricos , Tabaquismo/epidemiología , Adolescente , Adulto , Anciano , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estados Unidos/epidemiología , Adulto Joven
14.
Rev. clín. med. fam ; 13(3): 180-189, oct. 2020. tab, graf
Artículo en Español | IBECS | ID: ibc-ET1-7132

RESUMEN

OBJETIVOS: Describir la prevalencia de síndrome metabólico, de cada uno de sus componentes y de otros modificadores del riesgo cardiovascular (RCV) en hipertensos ≤ 65 años, así como analizar su relación con el grado de control de la presión arterial (PA). MATERIAL Y MÉTODOS: Estudio descriptivo observacional transversal realizado en 267 adultos de ≤ 65 años, diagnosticados de hipertensión arterial (criterios Guías Europeas hipertensión y riesgo cardiovascular), atendidos en consultas de medicina de familia de cuatro Zonas Básicas de Salud. La variable principal fue la presencia de síndrome metabólico (ATPIII/AHA-2004). Se recogieron variables sociodemográficas, problemas de salud, consumo de fármacos, cumplimiento terapéutico, actividad física (IPAQ-breve y BPAAT), consumo de tabaco, determinaciones analíticas, riesgo cardiovascular, cifras de presión arterial y su grado de control. RESULTADOS: Edad media 56,7 años (DE: 6,6). La prevalencia de síndrome metabólico fue del 40,4% (IC95%: 34,4%-46,5%). Un 76,8% mostró obesidad abdominal, 36,7% hipertrigliceridemia, 25,8% c-HDL disminuido y 26,2% hiperglucemia. El 55,8% presentaba dislipemia, 54,3% obesidad, 24,7% diabetes y 21,3% fumaba. Un 40,2% (IC95%: 33,9%-45,8%) no mostró adecuado control de PA. Mediante regresión logística, fueron variables asociadas a inadecuado control de presión arterial: menor puntuación cuestionario-BPAAT (OR:1,19; p = 0,027), menor número de problemas de salud (OR:1,20; p = 0,009), incumplimiento terapéutico (OR:1,93; p = 0,043) y síndrome metabólico (OR:2,85; p < 0,001). CONCLUSIONES: Más de un tercio de hipertensos adultos presentan síndrome metabólico y tres cuartos obesidad abdominal. El síndrome metabólico no sólo es un factor modificador de RCV, sino que también se debe considerar en el control de la PA en adultos hipertensos junto con el cumplimiento terapéutico, la comorbilidad y la actividad física


OBJECTIVES: To describe the prevalence of metabolic syndrome, of each of its components, and of other cardiovascular risk (CVR) modifiers in hypertensive patients ≤ 65 years of age, as well as to analyze its relationship with the degree of control of blood pressure (BP). MATERIAL AND METHODS: Descriptive cross-sectional observational study carried out in 267 adults aged ≤ 65 years, diagnosed with arterial hypertension (European Guidelines criteria for hypertension and cardiovascular risk), seen in family medicine consultations in four Basic Health Zones. The main variable was the presence of metabolic syndrome (ATPIII / AHA-2004). Sociodemographic variables, health problems, drug consumption, therapeutic compliance, physical activity (IPAQ-brief and BPAAT), tobacco consumption, analytical determinations, cardiovascular risk, blood pressure readings and their degree of control were collected. RESULTS: Average age 56.7 years (SD: 6.6). The prevalence of metabolic syndrome was 40.4% (95% CI: 34.4%-46.5%). 76.8% showed abdominal obesity, 36.7% hypertriglyceridemia, 25.8% decreased HDL-c, and 26.2% hyperglycemia. 55.8% had dyslipidemia, 54.3% obesity, 24.7% diabetes, and 21.3% smoked. 40.2% (95% CI: 33.9%-45.8%) did not show adequate BP control. Using logistic regression, variables associated with inadequate blood pressure control were: lower BPAAT-questionnaire score (OR: 1.19; p = 0.027), fewer health problems (OR: 1.20; p = 0.009), therapy non-compliance (OR: 1.93; p = 0.043) and metabolic syndrome (OR: 2.85; p < 0.001). CONCLUSIONS: More than one third of hypertensive adults have metabolic syndrome and three quarters have abdominal obesity. Metabolic syndrome is not only a modifying factor of CVR, but it should also be considered in the control of BP in hypertensive adults along with therapeutic compliance, comorbidity and physical activity


Asunto(s)
Humanos , Masculino , Femenino , Adulto , Persona de Mediana Edad , Enfermedades Cardiovasculares/epidemiología , Hipertensión/complicaciones , Síndrome Metabólico/epidemiología , Obesidad Abdominal/epidemiología , Atención Primaria de Salud/estadística & datos numéricos , Hipertrigliceridemia/epidemiología , Estudios Transversales , Diabetes Mellitus/epidemiología , Tabaquismo/epidemiología , Indicadores de Morbimortalidad , Dislipidemias/epidemiología
15.
Gac. sanit. (Barc., Ed. impr.) ; 34(5): 442-448, sept.-oct. 2020. tab
Artículo en Español | IBECS | ID: ibc-198866

RESUMEN

OBJETIVO: Investigar la influencia del sexo en la mortalidad según la presencia o ausencia de diabetes mellitus tipo 2 (DM2) y otros factores de riesgo cardiovascular en la cohorte del Estudio Asturias. MÉTODO: El Estudio Asturias (iniciado en 1998) es un estudio de cohortes observacional, prospectivo, de una muestra representativa de la población asturiana de entre 30 y 75 años. Se dividió la población en grupos según la presencia o ausencia de DM2 y el sexo para valorar el control de los factores de riesgo cardiovascular. Además, conociendo el estatus vital de la cohorte 18 años después del inicio del estudio, se analizaron las diferencias en causas de mortalidad según las categorías anteriores. RESULTADOS: En 1998 iniciaron el estudio 1034 personas, de las cuales 561 eran mujeres (54,25%) y 473 eran hombres (45,75%). Padecían diabetes 131 (12,66%; 75 varones y 56 mujeres). Las mujeres con DM2 presentaron una hazard ratio (HR) para mortalidad total de 1,64 (intervalo de confianza del 95% [IC95%]: 0,97-2,77), y los hombres de 1,63 (IC95%: 1,07-2,50); para mortalidad cardiovascular, la HR fue de 3,06 (IC95%: 1,44-6,47) en las mujeres y de 1,49 (IC95%: 0,64-3,46) en los hombres. La tasa de mortalidad para las personas con DM2 en ambos sexos fue más alta que para las personas sin DM2. CONCLUSIONES: Las mujeres con DM2 tienen un riesgo de fallecer por causas cardiovasculares tres veces mayor que las mujeres sin DM2. Deberían implementarse estrategias de tratamiento en las mujeres con esta condición


OBJECTIVE: To investigate the influence of gender on mortality according to the presence or absence of type 2 diabetes mellitus (DM2) and other cardiovascular risk factors in the Asturias Study cohort. METHOD: The Asturias Study (started in 1998) is an observational, prospective cohort study of a representative sample of a population of Asturias aged 30-75 years. The population was divided into groups according to the presence or absence of DM2 and according to gender to assess control of cardiovascular risk factors. In addition, aware of the vital status of the cohort 18 years after the beginning of the study, we analyzed differences in causes of mortality according to the previous categories. RESULTS: In 1998, 1034 people started the study, 561 women (54.25%) and 473 men (45.75%). Of these, 131 (12.66%) had diabetes (75 men and 56 women). The women with T2D presented a hazard ratio (HR) for total mortality of 1.64 (95% confidence interval [95%CI]: .97-2.77), which was 1.63 (95%CI: 1.07-2.50) for the men and, for cardiovascular mortality, 3.06 (95%CI: 1.44-6.47) for the females, versus 1.49 (95%CI: 0.64-3.46) for the males. The mortality rate for people with T2D of both sexes was higher than for people without T2D. CONCLUSIONS: Women with T2D have a risk more than three times higher than women without diabetes of dying from cardiovascular causes. We should implement treatment strategies in women with this condition


Asunto(s)
Humanos , Masculino , Femenino , Adulto , Persona de Mediana Edad , Anciano , Diabetes Mellitus Tipo 2/mortalidad , Enfermedades Cardiovasculares/epidemiología , Hiperglucemia/prevención & control , Distribución por Sexo , Factores de Riesgo , Indicadores de Morbimortalidad , Estudios Prospectivos , Estudios de Casos y Controles , Encuestas Epidemiológicas/estadística & datos numéricos , Tabaquismo/epidemiología , Conducta Sedentaria
16.
S Afr Med J ; 110(8): 796-801, 2020 Jul 29.
Artículo en Inglés | MEDLINE | ID: mdl-32880309

RESUMEN

BACKGROUND: Smoking cessation is a complex process influenced by factors such as smokers' nicotine dependence levels, socioeconomic status (SES) and other lifestyle behaviours. Little is known about these relationships in South Africa (SA). OBJECTIVES: To explore the relationship between nicotine dependence, SES, lifestyle behaviours and lifetime quit attempts among adult smokers in SA. METHODS: This study used data from 2 651 participants aged ≥16 years in the 2011 South African Social Attitudes Survey. Information on SES (measured by asset ownership), binge drinking, physical activity, fruit and vegetable intake, intention to quit smoking and lifetime quit attempts was extracted. Nicotine dependence was measured using the Heaviness of Smoking Index (HSI). All data were weighted to account for the complex survey design and to yield nationally representative estimates. Data analysis included binary logistic regression with high nicotine dependence (HND) defined as HSI ≥4 and lifetime quit attempts as separate outcomes. RESULTS: The prevalence of smoking was 20.1% (31.6% for males and 9.5% for females), and was highest in the mixed-ancestry group (37.0%). Overall, 14.5% of smokers had HND, with a higher proportion in the high-SES group. The odds of HND increased with every 10  years of smoking history (odds ratio (OR) 2.05; 95% confidence interval (CI) 1.40 - 3.00) but decreased among participants who reported frequent physical activity (OR 0.4; 95% CI 0.18 - 0.86) and those who planned to quit (OR 0.37; 95% CI 0.19 - 0.75). Quit attempts were more likely among participants who reported frequent fruit and vegetable intake (OR 1.8; 95% CI 1.07 - 2.98) and less likely among those reporting binge drinking (OR 0.31; 95% CI 0.16 - 0.59) or assessed as having HND (OR 0.32; 95% CI 0.17 - 0.58). CONCLUSIONS: Most adult smokers in SA have low nicotine dependence. However, the association of HND with high SES in this study suggests that although cessation treatment based on an integrated lifestyle behavioural intervention package may suffice for most smokers, a more intense cessation treatment package is needed for smokers of higher SES.


Asunto(s)
Cese del Hábito de Fumar/estadística & datos numéricos , Tabaquismo/epidemiología , Adulto , Consumo Excesivo de Bebidas Alcohólicas/epidemiología , Grupos de Población Continentales/estadística & datos numéricos , Dieta , Ejercicio Físico , Femenino , Frutas , Humanos , Estilo de Vida , Masculino , Distribución por Sexo , Clase Social , Sudáfrica/epidemiología , Encuestas y Cuestionarios , Verduras
17.
PLoS One ; 15(9): e0237938, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32877429

RESUMEN

BACKGROUND: More smokers report using e-cigarettes to help them quit than FDA-approved pharmacotherapy. OBJECTIVE: To assess the association of e-cigarettes with future abstinence from cigarette and tobacco use. DESIGN: Cohort study of US sample, with annual follow-up. PARTICIPANTS: US adult (ages 18+) daily cigarette smokers identified at Wave 1 (W1; 2013-14) of the PATH Study, who reported a quit attempt before W2 and completed W3 (n = 2443). EXPOSURES: Use of e-cigarettes, pharmacotherapy (including nicotine replacement therapy), or no product for last quit attempt (LQA), and current daily e-cigarette use at W2. ANALYSIS: Propensity score matching (PSM) of groups using different methods to quit. OUTCOME MEASURES: 12+ months abstinence at W3 from cigarettes and from all tobacco (including e-cigarettes). 30+ days abstinence at W3 was a secondary outcome. RESULTS: Among daily smokers with an LQA, 23.5% used e-cigarettes, 19.3% used pharmacotherapy only (including NRT) and 57.2% used no product. Cigarette abstinence for 12+ months at W3 was ~10% in each group. Half of the cigarette abstainers in the e-cigarette group were using e-cigarettes at W3. Different methods to help quitting had statistically comparable 12+ month cigarette abstinence at W3 (e-cigarettes vs no product: Risk Difference (RD) = 0.01, 95% CI: -0.04 to 0.06; e-cigarettes vs pharmacotherapy: RD = 0.02, 95% CI:-0.04 to 0.09). Likewise, daily e-cigarette users at W2 did not show a cessation benefit over comparable no-e-cigarette users and this finding was robust to sensitivity analyses. Abstinence for 30+ days at W3 was also similar across products. LIMITATIONS: The frequency of e-cigarette use during the LQA was not assessed, nor was it possible to assess continuous abstinence from the LQA. CONCLUSION: Among US daily smokers who quit cigarettes in 2014-15, use of e-cigarettes in that attempt compared to approved cessation aids or no products showed similar abstinence rates 1-2 years later.


Asunto(s)
Fumar Cigarrillos/efectos adversos , Quimioterapia/estadística & datos numéricos , Sistemas Electrónicos de Liberación de Nicotina/estadística & datos numéricos , Cese del Hábito de Fumar/métodos , Tabaquismo/terapia , Vapeo/efectos adversos , Adolescente , Adulto , Terapia Conductista , Fumar Cigarrillos/psicología , Femenino , Humanos , Incidencia , Estudios Longitudinales , Masculino , Cese del Hábito de Fumar/psicología , Factores de Tiempo , Dispositivos para Dejar de Fumar Tabaco/efectos adversos , Tabaquismo/epidemiología , Tabaquismo/etiología , Estados Unidos/epidemiología , Adulto Joven
19.
Pediatr. aten. prim ; 22(87): 251-261, jul.-sept. 2020. tab, graf
Artículo en Español | IBECS | ID: ibc-200815

RESUMEN

INTRODUCCIÓN: la alta prevalencia de patología bucodental en adolescentes, junto con la relación directa o indirecta entre patología y hábitos, hacen necesaria la prevención y promoción oral a nivel escolar, sanitario y familiar. Nuestro objetivo principal fue mediante un cuestionario sobre hábitos de estilo de vida en adolescentes, conocer la prevalencia de estos y su relación con la salud bucodental. MATERIAL Y MÉTODOS: estudio observacional de corte transversal en 39 escolares, preadolescentes y adolescentes de 12 a 17 años. Se realizó un cuestionario de 42 preguntas que fue entregado a los participantes. Los resultados obtenidos se analizaron mediante tablas de contingencia y con un valor de significación p <0,05. RESULTADOS: la prevalencia de escolares con correcta frecuencia de cepillado es del 54% y solo el 48,7% visita al odontólogo una vez al año. Existe relación significativa entre la nacionalidad y las visitas al dentista (p = 0,02) o entre la frecuencia de cepillado con el desayuno (p = 0,005), consumo de bollería industrial o bocadillos (p = 0,02), o refrescos (p = 0,011), utilización de ordenador, televisión y videoconsola (p = 0,049); y el sedentarismo (p = 0,00). CONCLUSIÓN: se obtuvieron resultados estadísticamente significativos al relacionar hábitos de estilo de vida y salud oral. En la adolescencia es fundamental la creación de estrategias de prevención y promoción en salud dental, para instaurar rutinas correctas que no afecten a la salud general del adolescente


INTRODUCTION: the high prevalence of oral disease in adolescents, together with the direct or indirect association between disease and lifestyle habits, call for the implementation of oral health prevention and promotion strategies at the school, household and public health levels. Our main objective was to design a questionnaire on lifestyle habits in adolescents to determine their prevalence and assess their association with oral health. MATERIALS AND METHODS: we conducted a cross-sectional observational study in 39 preadolescent and adolescent students aged 12 to 17 years. We developed a 42-item questionnaire and administered it to participating students. We analysed the obtained responses using contingency tables, defining statistical significance as a p-value of <0.05. RESULTS: we found that the frequency of brushing was correct in 54% of participating students, while only 48.7% visit the dentist every year. We found a significant association between nationality and visits to the dentist (p = 0.02) and between the frequency of brushing with: eating breakfast (p = 0.005), consumption of industrial baked goods or snacks (p = 0.02) and consumption of sugary drinks (p = 0.011), the use of computer, television and gaming consoles (p = 0.049), and a sedentary lifestyle (p = 0.00). CONCLUSION: we found statistically significant associations between lifestyle habits and oral health. The development and implementation of oral health prevention and promotion strategies targeting the adolescent population is essential in order to establish adequate habits that will not have a detrimental effect on the general health of the adolescent


Asunto(s)
Humanos , Masculino , Femenino , Niño , Adolescente , Salud Bucal/estadística & datos numéricos , Estilo de Vida Saludable/clasificación , Tabaquismo/epidemiología , Conducta del Adolescente/clasificación , Estudios Transversales , Promoción de la Salud/organización & administración , Higiene Bucal/clasificación , Encuestas de Salud Bucal/estadística & datos numéricos
20.
PLoS One ; 15(8): e0237723, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32857771

RESUMEN

PURPOSE: This study investigated nicotine dependence as an independent risk factor for upper aerodigestive tract (UADT) cancers, including lung and head and neck cancers (HNC). The study aimed to isolate the direct effect of nicotine dependence, independent of tobacco smoking. METHODS: A case-control study with a total of 4957 participants was conducted in Ontario, Canada, of which 2964 categorized as either current or former smokers were used in the analysis. Nicotine dependence of ever-smokers (2360 UADT cases and 604 controls) was measured using the Fagerström Test for Nicotine Dependence. Using mediation analyses and adjusted logistic regression models, we decomposed the direct effect of nicotine dependence and the mediated effect of smoking duration to quantify the risks of lung and HNC. The role of human papillomavirus (HPV) and cancer subtypes were assessed. RESULTS: Most individual nicotine dependence behaviours showed positive associations with lung cancer with approximately 1.8 to 3.5-fold risk increase, and to lesser extent with 1.4 to 2.3-fold risk for HNC. Nicotine dependence is partially accountable for increased risks of lung cancer (OR = 1.20, 95%CI = 1.13-1.28) and HNC (1.12, 95%CI = 1.04-1.19). Nicotine dependence had a greater effect on the risk of HPV-negative oropharyngeal cancer (OR = 3.06, 95%CI = 1.65-5.66) in comparison to HPV-positive oropharyngeal cancer (OR = 1.05, 95%CI = 0.67-1.65). The direct effects of nicotine dependence remained significant after accounting for cumulative tobacco exposures. CONCLUSION: Nicotine dependence increases the risks of lung and HNC cancers after accounting for tobacco smoking, suggesting potential toxic effects of nicotine. These results are informative for the safety consideration of nicotine exposures.


Asunto(s)
Neoplasias de Cabeza y Cuello/epidemiología , Neoplasias Pulmonares/epidemiología , Nicotina/efectos adversos , Tabaquismo/epidemiología , Anciano , Estudios de Casos y Controles , Femenino , Neoplasias de Cabeza y Cuello/etiología , Humanos , Neoplasias Pulmonares/etiología , Masculino , Persona de Mediana Edad , Ontario/epidemiología , Medición de Riesgo , Factores de Riesgo , Factores de Tiempo , Tabaquismo/complicaciones
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