Changing patterns in E-cigarette use among Minnesota adults between 2014 and 2018.

Minnesota has observed declining combustible tobacco use and a large increase in e-cigarette use among youth and young adults. Less is known about adult e-cigarette users' frequency of use, smoking status, use of flavors, and demographic differences. The Minnesota Adult Tobacco Survey (MATS) is a cross-sectional, random digit-dial telephone survey representative of Minnesotans aged 18 and over. MATS measured e-cigarette use in 2014 (N = 9304) and 2018 (N = 6065). In 2018, 6.0% of adult Minnesotans used an e-cigarette in the past 30 days; this was unchanged from 2014 (5.9%). While past 30-day e-cigarette use declined for current smokers (2014: 27.3%; 2018: 16.1% p < 0.001), it increased for never smokers (2014: 1.2%; 2018: 4.4% p < 0.001) and 18-24-year-olds (2014: 12.8%; 2018: 21.9% p = 0.001). Daily e-cigarette use increased from 2014 to 2018 for current smokers (p = 0.001), 25-44-year-olds (p < 0.001), females (p = 0.001), and those with a high-school education (p = 0.006). Among e-cigarette users in 2018, use of flavored e-cigarettes was associated with smoking status (p = 0.041), age (p < 0.001), and using e-cigarettes to quit smoking (p = 0.011). E-cigarettes appeal primarily to younger adults. Of concern are increases in never smokers initiating e-cigarette use, increasing their exposure to nicotine, addiction, and the risk of future combustible tobacco use. Simultaneously, fewer smokers are using e-cigarettes but those who do are using them more frequently. Use of flavored e-cigarettes was common and correlated with interest in quitting combustible cigarettes. These findings can inform recent calls for additional tobacco control policy and programs aimed at reducing e-cigarette use.

Secondhand Smoke Exposure 7 Years After an Indoor Smoke-Free Law.

PURPOSE: To examine locations of secondhand smoke (SHS) exposure among nonsmokers, 7 years after a statewide smoke-free policy. DESIGN: Data collected via statewide, random digit dial telephone survey. Response rates were 64.7% for landline and 73.5% for cell phone. SETTING: Minnesota, 2014. PARTICIPANTS: Representative sample of 7887 nonsmoking adults. MEASURES: Self-reported locations of SHS exposure and opinions on smoke-free restrictions. ANALYSIS: Descriptive statistics and logistic regression. RESULTS: A total of 35.5% of nonsmokers reported SHS exposure in the past 7 days. The greatest proportion of exposure occurred in community settings (31.7%) followed by cars (6.9%) and in the home (3.2%). Young adults were more likely to be exposed in a home or car than older adults. Nonsmokers living with a smoker were 39.6 (20.6-75.8) times more likely to be exposed to SHS in their home and 5.3 (4.1-6.8) times more likely to be exposed in a car, compared to those who did not live with a smoker. CONCLUSION: SHS exposure continues after comprehensive smoke-free policies restricted it from public places. Disparities in exposure rates exist for those who live with a smoker, are young, and have low incomes. Findings suggest the need for additional policies that will have the greatest public health benefit.

Tobacco Use among Minnesota Adults, 2014.

OBJECTIVES: The changing landscape of tobacco including the introduction of new products such as smokeless tobaccos and electronic delivery devices has highlighted the need for continued surveillance of tobacco use. METHODS: Minnesota has conducted an in-depth surveillance of adult tobacco use since 1999. For the fifth in the series, conducted in 2014, 9304 telephone interviews were completed. RESULTS: The 2014 prevalence of cigarette smoking (14.4%) continues a downward trend that remains lower than the national smoking prevalence (17.3%). Among all Minnesota adults, use prevalence of other tobacco products was as follows: e-cigarettes 5.9%, all smokeless tobaccos 3.6%, cigars 3.0%, water pipe 1.4%, and regular pipe 0.7%. Among individuals who have never smoked cigarettes, smokeless tobacco was the most common product used (2.0%), nearly twice the prevalence of e-cigarette use (1.2%). Former smokers were equally likely to use smokeless tobacco (4.9%) or e-cigarettes (4.8%). Among smokers, 27.3% reported current use of e-cigarettes. CONCLUSION: In the past 15 years, cigarette smoking prevalence in Minnesota has dropped by an average of 0.51 percentage points annually, and prevalence could drop to less than 5% by 2034.

Intermediate CGG repeat length at the FMR1 locus is not associated with hormonal indicators of ovarian age.

OBJECTIVE: Premutation and intermediate CGG repeat length at the fragile X mental retardation 1 (FMR1) locus have been associated with premature ovarian failure. We tested whether intermediate length is associated with indicators of ovarian age in a sample of fertile women. Our primary measures of ovarian age were antimüllerian hormone (AMH) and follicle-stimulating hormone (FSH) levels. METHODS: The cross-sectional sample comprised 258 women with karyotyped spontaneous abortions (140 trisomic spontaneous abortions and 118 chromosomally normal spontaneous abortions or spontaneous abortions with anomalies other than trisomy) and 325 women with recent live births (LBs). We analyzed data from the total sample and data from LBs only. We defined CGG repeat length by the length (both continuous and categorical) on the longer allele. RESULTS: CGG repeat length was not significantly associated with either hormone measure. A repeat length of 35 to 54 CGG, versus the modal category of 30 CGG, was associated with an approximately 7% increase in median AMH level and a 3% increase in median FSH level. Results were unaltered when analyses were limited to LBs. Analyses of hormone levels using cutpoints to define older ovarian age showed no associations with repeat length. Among 10 women with repeat lengths of 35 to 54 CGG analyzed for AGG sequences, the uninterrupted CGG length was not significantly longer among women with hormonal indicators of "old" versus "young" ovarian age. CONCLUSIONS: Our data do not support an association between intermediate CGG repeat length and levels of AMH or FSH among fertile women.

Smoker identity among occasional smokers: findings from Minnesota.

OBJECTIVES: To investigate characteristics of occasional smokers who deny being smokers (ie, deniers). METHODS: Data were from 3 rounds of the Minnesota Adult Tobacco Survey (MATS 2003, 2007, and 2010), a statewide, cross-sectional, and random-digit-dial telephone survey. RESULTS: Nearly half of occasional smokers did not view themselves as smokers. Characteristics that were predictive of being a denier included less perceived harm from secondhand smoke, fewer days smoked, and fewer cigarettes smoked per day. CONCLUSIONS: Denial of being a smoker is primarily characterized by very light smoking. Future communication efforts should be tailored for this group.

Isanti County active living: measuring change in perception and behavior.

BACKGROUND: In 2003, Isanti County MN received an Active Living by Design grant from the Robert Wood Johnson Foundation to increase physical activity through environmental changes. PURPOSE: The goal of the Isanti County Active Living project was to provide leadership in promoting environments that offer choices for active living and increase the physical activity of community members. The project conducted two surveys to examine whether project activities had helped in shaping levels of physical activity and perceptions of the built environment. METHODS: The project conducted a mail survey with a random sample of Isanti County adult residents in February-March 2005 and repeated this survey in August-December 2008, using the same methodology for survey administration. RESULTS: There was a significant increase between 2005 and 2008 in the percentage of Isanti County adults who reported participating in moderate physical activity. In contrast, there was no change in the percentage of Minnesota adults as a whole who reported comparable amounts of moderate physical activity between 2005 and 2007. On measures of the physical environment, there was a significant increase between 2005 and 2008 in the percentage of residents who perceive that their neighborhood encourages physical activity. CONCLUSIONS: The Isanti County Active Living project likely contributed to the increase in moderate physical activity in Isanti County as well as to perceptions of a safe environment conducive to physical activity.

Concurrent use of cigarettes and smokeless tobacco in Minnesota.

Cigarette smokers are being encouraged to use smokeless tobacco (SLT) in locations where smoking is banned. We examined state-wide data from Minnesota to measure changes over time in the use of SLT and concurrent use of cigarettes and SLT. The Minnesota Adult Tobacco Survey was conducted four times between 1999 and 2010 and has provided state-wide estimates of cigarette smoking, SLT use and concurrent use of SLT by smokers. The prevalence of SLT was essentially unchanged through 2007, then increased significantly between 2007 and 2010 (3.1% versus 4.3%, P < 0.05). Similarly, the prevalence of cigarette smokers who reported using SLT was stable then increased between 2007 and 2010 (4.4% versus 9.6%, P < 0.05). The finding of higher SLT use by smokers could indicate that smokers in Minnesota are in an experimental phase of testing alternative products as they adjust to recent public policies restricting smoking in public places. The findings are suggestive that some Minnesota smokers are switching to concurrent use of cigarettes and SLT. Future surveillance reports will be necessary to confirm the results.

The prevalence of unrecognized tobacco use among young adults.

OBJECTIVE: To evaluate the prevalence of smoking among young adults and to describe their characteristics. METHODS: Data were examined from the Minnesota Adult Tobacco Survey, a telephone survey of 8821 residents with a sample of 1205 young adults. RESULTS: Prevalence was 39% using the adolescent definition and 32% using the adult definition. Nearly 1 in 5 young adult smokers may be considered a "previously unrecognized smoker" who would not have been identified as a cigarette user according to the standard adult definition. CONCLUSIONS: Future studies assessing prevalence should use both adolescent and adult measures.

Skewed X chromosome inactivation and trisomic spontaneous abortion: no association.

Several studies suggest that highly skewed X chromosome inactivation (HSXI) is associated with recurrent spontaneous abortion. We hypothesized that this association reflects an increased rate of trisomic conceptions due to anomalies on the X chromosome that lead both to HSXI and to a diminished oocyte pool. We compared the distribution of X chromosome inactivation (XCI) skewing percentages (range: 50%-100%) among women with spontaneous abortions in four karyotype groups-trisomy (n = 154), chromosomally normal male (n = 43), chromosomally normal female (n = 38), nontrisomic chromosomally abnormal (n = 61)-to the distribution for age-matched controls with chromosomally normal births (n = 388). In secondary analyses, we subdivided the nontrisomic chromosomally abnormal group, divided trisomies by chromosome, and classified women by reproductive history. Our data support neither an association of HSXI with all trisomies nor an association of HSXI with chromosomally normal male spontaneous abortions. We also find no association between HSXI and recurrent abortion (n = 45).

X-chromosome inactivation and ovarian age during the reproductive years.

OBJECTIVE: To explore whether skewed X-chromosome inactivation (XCI) is related to indicators of ovarian age. DESIGN: The XCI skewing percent and indicators of ovarian age were measured in women with recent pregnancy losses and women with recent livebirths. All analyses adjust for chronologic age and pregnancy outcome. SETTING: Hospital in eastern central New York. PATIENT(S): One hundred thirty-six women with informative XCI assays: 83 with index pregnancy losses and 53 with livebirths. INTERVENTION(S): None. MAIN OUTCOME MEASURE(S): The primary indicators of ovarian age were antral follicle count, levels of FSH and inhibin B. A secondary indicator was level of estradiol (E2). RESULT(S): The XCI skewing percent, defined either continuously or categorically (> or =90%), was unrelated to the indicators of ovarian age. The sample was large enough to rule out as unlikely a modest decline in antral follicle count or a modest increase in FSH in relation to skewed XCI. CONCLUSION(S): X-chromosome anomalies are associated with skewed XCI and with premature ovarian failure. Our data raise the possibility that X-chromosome anomalies may not be an important influence on ovarian aging in menstruating women.

Alcohol, caffeine and smoking in relation to age at menopause.

OBJECTIVES: Exposures which might influence age at natural menopause have been extensively studied but, with the exception of cigarette smoking, results have been inconsistent. We sought to determine: (i) whether alcohol and caffeine intake are associated with age at menopause; (ii) whether the association of cigarette smoking with age at menopause is confined to current smokers. METHODS: Analyses drew on longitudinal data from 494 women, aged 44-60 in 1993, of whom 159 experienced menopause before intake or during follow-up. We used parametric logistic survival analysis to estimate shifts in median age at menopause for women who drink alcohol or caffeine or who smoke cigarettes. RESULTS: The estimated median age at menopause was 2.2 (95% confidence interval (CI) 0.5, 3.9) years later for women who drank alcohol 5-7 days/week (13% of the sample) than for women who did not drink alcohol (54%). For women who drank at least 1 day/week, the estimated shift was 1.3 (95% CI 0.2, 2.3) years. Caffeine intake in approximate quartiles of mg/day-0-100, >100-200, >200-400, 400+-was not related to age at menopause. Current smokers of 14+cigarettes/day (6%) experienced menopause 2.8 (95% CI -4.8, -0.8) years earlier than women who never smoked (51%). Current smokers of 1-13 cigarettes/day (5%) and former smokers (38%) experienced menopause at about the same age as women who never smoked. CONCLUSIONS: The results are compatible with a pro-estrogenic effect of moderate alcohol intake and an anti-estrogenic effect of current cigarette smoking of 14+cigarettes/day.

Menopausal transition: predicting time to menopause for women 44 years or older from simple questions on menstrual variability.

OBJECTIVE: To assess whether menstrual variability predicts time to menopause. DESIGN: Analyses drew on 326 menstruating women, aged 44 to 56, who were followed until they reached menopause or the study ended. The women provided data on their menstrual characteristics at intake. We evaluated the utility of six definitions of menstrual variability for predicting time to ascertained menopause (final menstrual period + 12 months): (1) more than 90 days since the most recent menstrual period (n = 20); (2) 60 or more days of amenorrhea during the previous year (n = 71); (3) cycle lengths that varied by 19 or more days (n = 106); (4) cycle lengths too variable to report a usual length (n = 29); (5) cycles less regular than they had been at age 40 (n = 107); and (6) change in the duration or heaviness of menstrual flow compared with age 40 (n = 255). In addition, we evaluated hot flashes or night sweats during the previous week (n = 50) and age 50 or more years (n = 60) as predictors. RESULTS: Definitions 1 to 5 predicted time to menopause; definition 6 did not. Definition 1 had the highest positive predictive value for ascertained menopause within 2 years and within 4 years; definitions 2 and 4 had low to moderate positive predictive values for ascertained menopause within 2 years but good positive predictive values for ascertained menopause within 4 years. For ascertained menopause within 2 years, definition 2 showed the best balance of sensitivity (94%) and specificity (91%). CONCLUSION: Simple questions about menstrual variability elicit information that is informative about proximity to menopause.

Multiplex interphase FISH as a screen for common aneuploidies in spontaneous abortions.

BACKGROUND: A multiplex fluorescence in-situ hybridization (FISH) strategy using chromosome-specific probes for eight chromosomes as an initial screen for chromosome abnormalities in uncultured tissues from spontaneous abortions was evaluated. METHODS: Fifty-seven prefetal spontaneous abortions were studied by karyotyping cultured cells and using FISH on uncultured cells. Two probe sets were used, identifying chromosomes 13, 15, 16, 18, 21, 22, X and Y. RESULTS: Abnormalities were detected in 53% of cases by karyotyping, and 54% of cases by FISH. FISH detected an abnormality in four of five cases where cultures failed, and in two cases where maternal cells apparently overgrew the culture. FISH missed four trisomies not identifiable with the probe sets, and one trisomy because one probe set was unscorable. FISH using these probes identified 83% of all abnormalities detected by karyotyping. CONCLUSIONS: FISH can detect abnormalities in a significant proportion of cases where the culture fails to grow or is contaminated by maternal cell growth. Multiplex FISH as an initial screen, followed by culture and karyotyping in cases where no abnormality is detected, would identify a higher proportion of chromosome abnormalities in spontaneous abortion specimens than karyotype analysis alone.