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1.
Addiction ; 2022 May 02.
Artigo em Inglês | MEDLINE | ID: mdl-35491743

RESUMO

AIM: To measure whether the prevalence of use and real-world effectiveness of different smoking cessation aids has changed in England since the coronavirus disease 2019 (COVID-19) pandemic. DESIGN: Representative monthly cross-sectional surveys, January 2015-June 2021. SETTING: England. PARTICIPANTS: A total of 7300 adults (≥18 y) who had smoked within the previous 12 months and had made ≥1 quit attempt during that period. MEASUREMENTS: The independent variable was the timing of the COVID-19 pandemic (pre-pandemic [January 2015-February 2020] vs pandemic [April 2020-June 2021]). We analysed (i) the association between the pandemic period and self-reported use (vs non-use) during the most recent quit attempt of: prescription medication (nicotine replacement therapy [NRT]/varenicline/bupropion), NRT bought over-the-counter, e-cigarettes, traditional behavioural support and traditional remote support (telephone support/written self-help materials/websites) and (ii) the interaction between the pandemic period and use of these cessation aids on self-reported abstinence from quit date to survey. Covariates included age, sex, social grade, level of cigarette addiction and characteristics related to the quit attempt. FINDINGS: After adjustment for secular trends, there was a significant increase from the pre-pandemic to pandemic period in the prevalence of use of traditional remote support by past-year smokers in a quit attempt (OR = 2.18; 95% CI, 1.42-3.33); specifically telephone support (OR = 7.16; 95% CI, 2.19-23.45) and websites (OR = 2.39; 95% CI, 1.41-4.08). There was also an increase in the prevalence of use of prescription medication (OR = 1.47; 95% CI, 1.08-2.00); specifically varenicline (OR = 1.66; 95% CI, 1.09-2.52). There were no significant changes in prevalence of use of other cessation aids after adjustment for secular trends. People who reported using prescription medication (OR = 1.41; 95% CI, 1.09-1.84) and e-cigarettes (OR = 1.87; 95% CI, 1.62-2.16) had greater odds of reporting abstinence than people who did not. There were no significant interactions between the pandemic period and use of any cessation aid on abstinence, after adjustment for covariates and use of the other aids, although data were insensitive to distinguish no change from meaningful modest (OR = 1.34) effects (Bayes factors 0.72-1.98). CONCLUSIONS: In England, the COVID-19 pandemic was associated with an increase in use of remote support for smoking cessation and varenicline by smokers in a quit attempt up to June 2021. The data were inconclusive regarding an association between the pandemic and changes in the real-world effectiveness of popular smoking cessation aids.

2.
Nicotine Tob Res ; 2022 Apr 13.
Artigo em Inglês | MEDLINE | ID: mdl-35417551

RESUMO

INTRODUCTION: Tobacco-free nicotine pouches are products that are placed between the lip and gum, where they deliver nicotine to users. Little is known about nicotine pouch use in Great Britain since they entered the market in 2019. METHODS: Data came from a monthly representative survey of the adult (≥18y) population in Great Britain (England, Scotland, and Wales) between November 2020 and October 2021 (n=25,698). We estimated the weighted prevalence of pouch use, overall and stratified by demographics, smoking status, and other nicotine use. RESULTS: Nicotine pouch use was rare among adults, with a weighted prevalence of just 0.26% (95% compatibility interval [CI]=0.19-0.35). Prevalence doubled from November 2020 to October 2021 (0.14% to 0.32%; Prevalence ratio [PR]=2.22, 95%CI=1.33-3.70). Pouch use was four times more common among men than women (0.42% versus 0.09%; PR=4.55, 95%CI=2.27-9.09) but less common in older age groups (p<.001). Pouch use was more prevalent among current smokers (0.87%; PR=13.60, 95%CI=5.46-33.89), recent former smokers (0.97%; PR=15.21, 95%CI=4.03-57.42), and long-term (>1y) former smokers (0.24%; PR=3.71, 95%CI=1.36-10.15), compared with never smokers (0.06%). Prevalence was also elevated among e-cigarette (1.64% versus 0.15%; PR=10.59, 95%CI=5.74-19.52) and nicotine replacement therapy users (2.02% versus 0.21%; PR=9.75, 95%CI=4.64-20.49). CONCLUSIONS: One in 400 adults in Great Britain use nicotine pouches, but prevalence increased from 2020 to 2021. IMPLICATIONS: Tobacco-free nicotine pouches were introduced to the market in Great Britain in 2019. We found that, while pouch use is currently rare in Great Britain, these products have become more popular over time. Pouch use is largely concentrated among younger and middle-aged men who use other nicotine products and have a history of smoking. Continued monitoring of nicotine pouch use is needed.

3.
J Neurosci ; 42(14): 2905-2916, 2022 04 06.
Artigo em Inglês | MEDLINE | ID: mdl-35232758

RESUMO

Paternal environmental perturbations can influence the physiology and behavior of offspring. For example, our previous work showed reduced cocaine reinforcement in male, but not female, progeny of rat sires that self-administered cocaine. The information transfer from sire to progeny may occur through epigenetic marks in sperm, encompassing alterations in small noncoding RNAs, including microRNAs (miRNAs) and/or DNA methylation. Here, no reliable changes in miRNAs in the sperm of cocaine- relative to saline-experienced sires were identified. In contrast, 272 differentially methylated regions were observed in sperm between these groups. Two hypomethylated promoter regions in the sperm of cocaine-experienced rats were upstream of cyclin-dependent kinase inhibitor 1a (Cdkn1a). Cdkn1a mRNA also was selectively increased in the NAc of cocaine-sired male (but not female) offspring. Cocaine self-administration also enhanced Cdkn1a expression in the accumbens of cocaine-sired rats. These results suggest that changes in Cdkn1a may play a role in the reduced cocaine reinforcing efficacy observed in cocaine-sired male rats. Introducing a 90 d delay between sire self-administration and breeding reversed both cocaine resistance and the increase in accumbens Cdkn1a mRNA in male offspring, indicating that cocaine-induced epigenetic modifications are eliminated with sperm turnover. Collectively, our results indicate that cocaine self-administration produces hypomethylation of Cdkn1a in sperm and a selective increase in the expression of this gene in the NAc of male offspring, which is associated with blunted cocaine reinforcement.SIGNIFICANCE STATEMENT The relatively new field of transgenerational epigenetics explores the effects of environmental perturbations on offspring behavior and physiology. Our prior work in rats indicated that male, but not female, progeny of sires that self-administered cocaine displayed reduced cocaine reinforcement. The information transfer from sire to progeny may occur through heritable epigenetic marks in sperm, including DNA methylation. The present findings revealed two hypomethylated promoter regions upstream of the Cdkn1a gene in sire sperm. Remarkably, Cdkn1a expression was selectively decreased in offspring NAc, a brain region that regulates cocaine reinforcement.


Assuntos
Cocaína , Inibidor de Quinase Dependente de Ciclina p21 , Metilação de DNA , Epigênese Genética , Espermatozoides , Animais , Cocaína/farmacologia , Inibidor de Quinase Dependente de Ciclina p21/genética , Inibidor de Quinase Dependente de Ciclina p21/metabolismo , Inibidor de Quinase Dependente de Ciclina p21/farmacologia , Metilação de DNA/efeitos dos fármacos , Masculino , MicroRNAs/metabolismo , Núcleo Accumbens , RNA Mensageiro/metabolismo , Ratos , Ratos Sprague-Dawley , Espermatozoides/metabolismo
4.
Pain ; 163(2): 258-266, 2022 02 01.
Artigo em Inglês | MEDLINE | ID: mdl-35029597

RESUMO

ABSTRACT: Discrimination negatively influences health and well-being in the general population, but its impact on people with pain is unclear. This study assessed discrimination, health, and well-being in people with and without pain. Data were from 5871 participants from the English Longitudinal Study of Ageing. Experiences of discrimination were reported in 2010 to 2011. Pain, self-rated health, depressive symptoms, quality of life, life satisfaction, and loneliness were assessed in 2010 to 2011 and 2016 to 2017. A quarter (26%, n = 1524) of the sample reported pain at baseline. Participants with pain were more likely to report discrimination than those without pain (odds ratio [OR] = 1.28, 95% confidence interval [CI] 1.13-1.46). Cross-sectionally, those with pain who perceived discrimination had poorer self-rated health (OR = 1.28, 95% CI 1.02-1.61), greater depressive symptoms (OR = 1.90, 95% CI 1.48-2.45), were more likely to be lonely (ß = 0.21, 95% CI 0.15-0.26), and had lower quality of life (ß = -4.01, 95% CI -4.88 to -3.14), and life satisfaction (ß = -1.75, 95% CI -2.45 to -1.06) than those with pain who did not perceive discrimination. Prospectively, discrimination in those with pain was associated with greater depression (OR = 1.67, 95% CI 1.19-2.34) and loneliness (ß = 0.11, 95% CI 0.05-0.17), adjusting for baseline values. In those without pain in 2010 to 2011, discrimination predicted pain in 2016 to 2017, controlling for covariates (OR = 1.29, 95% CI 1.06-1.56). People with pain are more likely to report discrimination than those without pain, and this experience is associated with increased depression and loneliness. Discrimination was predictive of incident pain in pain-free adults. These findings highlight the need to tackle discrimination to improve well-being in those with pain and to potentially reduce the risk of pain onset.


Assuntos
Qualidade de Vida , Adulto , Depressão/epidemiologia , Humanos , Estudos Longitudinais , Dor/epidemiologia , Estudos Prospectivos
5.
Addiction ; 117(3): 772-783, 2022 03.
Artigo em Inglês | MEDLINE | ID: mdl-34431577

RESUMO

AIM: To estimate changes in smoking, drinking and quitting behaviour from before to during the first COVID-19 lockdown in England, and whether changes differed by age, sex or social grade. DESIGN: Representative cross-sectional surveys of adults, collected monthly between August 2018 and July 2020. SETTING: England. PARTICIPANTS: A total of 36 980 adults (≥ 18 years). MEASUREMENTS: Independent variables were survey month (pre-lockdown: August-February versus lockdown months: April-July) and year (pandemic: 2019/20 versus comparator: 2018/19). Smoking outcomes were smoking prevalence, cessation, quit attempts, quit success and use of evidence-based or remote cessation support. Drinking outcomes were high-risk drinking prevalence, alcohol reduction attempts and use of evidence-based or remote support. Moderators were age, sex and occupational social grade (ABC1 = more advantaged/C2DE = less advantaged). FINDINGS: Relative to changes during the same time period in 2018/19, lockdown was associated with significant increases in smoking prevalence [+24.7% in 2019/20 versus 0.0% in 2018/19, adjusted odds ratio (aOR) = 1.35, 95% confidence interval (CI) = 1.12-1.63] and quit attempts (+39.9 versus -22.2%, aOR = 2.48, 95% CI = 1.76-3.50) among 18-34-year-olds, but not older groups. Increases in cessation (+156.4 versus -12.5%, aOR = 3.08, 95% CI = 1.86-5.09) and the success rate of quit attempts (+99.2 versus +0.8%, aOR = 2.29, 95% CI = 1.31-3.98) were also observed, and did not differ significantly by age, sex or social grade. Lockdown was associated with a significant increase in high-risk drinking prevalence among all socio-demographic groups (+39.5 versus -7.8%, aOR = 1.80, 95% CI = 1.64-1.98), with particularly high increases among women (aOR = 2.17, 95% CI = 1.87-2.53) and social grades C2DE (aOR = 2.34, 95% CI = 2.00-2.74). Alcohol reduction attempts increased significantly among high-risk drinkers from social grades ABC1 (aOR = 2.31, 95% CI = 1.78-3.00) but not C2DE (aOR = 1.25, 95% CI = 0.83-1.88). There were few significant changes in use of support for smoking cessation or alcohol reduction, although samples were small. CONCLUSIONS: In England, the first COVID-19 lockdown was associated with increased smoking prevalence among younger adults and increased high-risk drinking prevalence among all adults. Smoking cessation activity also increased: more younger smokers made quit attempts during lockdown and more smokers quit successfully. Socio-economic disparities in drinking behaviour were evident: high-risk drinking increased by more among women and those from less advantaged social grades (C2DE), but the rate of reduction attempts increased only among the more advantaged social grades (ABC1).


Assuntos
COVID-19 , Adulto , Controle de Doenças Transmissíveis , Estudos Transversais , Inglaterra/epidemiologia , Feminino , Humanos , SARS-CoV-2 , Fumar/epidemiologia
6.
Acta Psychol (Amst) ; 222: 103458, 2022 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-34933210

RESUMO

Risk perceptions are important influences on health behaviours. We used descriptive statistics and multivariable logistic regression models to assess cross-sectionally risk perceptions for severe Covid-19 symptoms and their health behaviour correlates among 2206 UK adults from the HEBECO study. The great majority (89-99%) classified age 70+, having comorbidities, being a key worker, overweight, and from an ethnic minority as increasing the risk. People were less sure about alcohol drinking, vaping, and nicotine replacement therapy use (17.4-29.5% responding 'don't know'). Relative to those who did not, those who engaged in the following behaviours had higher odds of classifying these behaviours as (i) decreasing the risk: smoking cigarettes (adjusted odds ratios, aORs, 95% CI = 2.26, 1.39-3.37), and using e-cigarettes (aORs = 5.80, 3.25-10.34); (ii) having no impact: smoking cigarettes (1.98; 1.42-2.76), using e-cigarettes (aORs = 2.63, 1.96-3.50), drinking alcohol (aORs = 1.75, 1.31-2.33); and lower odds of classifying these as increasing the risk: smoking cigarettes (aORs: 0.43, 0.32-0.56), using e-cigarettes (aORs = 0.25, 0.18-0.35). Similarly, eating more fruit and vegetables was associated with classifying unhealthy diet as 'increasing risk' (aOR = 1.37, 1.12-1.69), and exercising more with classifying regular physical activity as 'decreasing risk' (aOR = 2.42, 1.75-3.34). Risk perceptions for severe Covid-19 among UK adults were lower for their own health behaviours, evidencing optimism bias. These risk perceptions may form barriers to changing people's own unhealthy behaviours, make them less responsive to interventions that refer to the risk of Covid-19 as a motivating factor, and exacerbate inequalities in health behaviours and outcomes.


Assuntos
COVID-19 , Sistemas Eletrônicos de Liberação de Nicotina , Abandono do Hábito de Fumar , Adulto , Idoso , Estudos Transversais , Comportamentos Relacionados com a Saúde , Humanos , Grupos Minoritários , Fatores de Risco , SARS-CoV-2 , Dispositivos para o Abandono do Uso de Tabaco
7.
J Spec Oper Med ; 21(4): 37-45, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34969125

RESUMO

BACKGROUND: Stress inoculation training (SIT) interventions have demonstrated promise within military contexts for human performance enhancement and psychological health applications. However, lack of manualized guidance on core content selection, delivery, and measurement processes has limited their use. PURPOSE: The purpose of this study was to develop and evaluate a comprehensive SIT intervention protocol to enhance the performance and health of military personnel engaged in special warfare and first-response activities. METHODS: Multidisciplinary teams of subject matter experts (n = 19) were consulted in protocol generation. The performance improvement/human performance technology (HPT) model was used in the selection, refinement, and measurement of core skills. The protocol was trialed and refined (44 cohorts, n = =300; 2013-2020) to generate the results. RESULTS: Four primary aims were achieved: (1) The generation of a flexible, evidence-based/evidence-driven psychological performance and health sustainment hybrid, SIT-NORCAL. (2) Manualized content and process guidance. (3) The creation of multimedia materials using evidence-based methodologies. (4) The design of initial measurement systems. Preliminary quality improvement analysis demonstrated positive results using standard-of-care and performance enhancement assessments. CONCLUSION: Hybridized human performance and psychological health sustainment protocols represent a paradigm shift in the delivery of psychological performance training with the potential to overcome barriers to success in traditional care. Further study is needed to determine the effectiveness and reach of SIT-NORCAL.


Assuntos
Transtornos Mentais , Militares , Humanos
8.
J Spec Oper Med ; 21(4): 46-53, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34969126

RESUMO

BACKGROUND: Despite being a well-supported strategy, Stress Inoculation Training (SIT) has not been fully incorporated in the advancement of human performance among most military personnel. The RAND Study recommendations for maximizing SIT's potential within high-risk/ high-intensity occupational groups were used in designing the Core Training protocol targeting psychological performance, SIT-NORCAL (Part 1). PURPOSE: The current project (Part 2) sought to further develop the protocol as a health and human performance hybrid through quality improvement analysis of the content, process, and measurement elements for use in the human performance context. METHODS: Evidence-based/evidence-driven methodologies were used in collaborative design tailored to the unique needs of special warfare enablers specializing in Explosive Ordnance Disposal (n = 17). The resultant three-phase training was conducted with a novice group (n = 10) using standardized measurements of collaboration, human performance, and adaptive capabilities on identified training targets. RESULTS: Process elements demonstrated high feasibility, resulting in high collaboration and trainee satisfaction. Significant improvements in psychological performance targets were observed pre- to post-training, and during an Adaptive Environmental Simulation designed by unit members. Two weeks post-training, unit members (n = 5) responded to an actual crash of an F-16 aircraft; measurements indicated maintenance of skill set from training to real-world events. CONCLUSION: Deployment of the elements in the SIT-NORCAL protocol demonstrated early feasibility and positive training impact on occupationally relevant skills that carried over into real-world events.


Assuntos
Substâncias Explosivas , Militares , Humanos , Projetos Piloto , Guerra
9.
Nicotine Tob Res ; 23(11): 1831-1838, 2021 10 07.
Artigo em Inglês | MEDLINE | ID: mdl-34089607

RESUMO

INTRODUCTION: This study aimed to examine how the proportion of dual users of cigarettes and e-cigarettes who use e-cigarettes in situations where smoking is not permitted has changed since e-cigarettes became popular in England, and to characterize those who do so. METHODS: Data were from 5081 adults in England who reported current smoking and current use of e-cigarettes ('dual users') participating in a nationally-representative monthly survey between April 2011 and February 2020. We modeled quarterly changes in prevalence of e-cigarette use in situations where smoking is not permitted and assessed multivariable associations with sociodemographic and smoking characteristics. RESULTS: Between 2011 and 2020, prevalence of e-cigarette use in situations where smoking is not permitted followed a positive cubic trend, with a decelerating increase from an estimated 52.5% of dual users in Q2-2011 to 72.7% in Q3-2014, followed by a small decline to 67.5% in 2018, and subsequent increase to 74.0% in 2020. Odds were higher among those who were from more disadvantaged social grades, reported stronger smoking urges, or had made a past-year quit attempt, and lower among those who were aged at least 65 years (vs. 16-24 years), from the south (vs. north) of England, reported currently cutting down on their cigarette consumption or currently using nicotine replacement therapy. CONCLUSIONS: In England, use of e-cigarettes in situations where smoking is not permitted is common among dual cigarette and e-cigarette users, has increased nonlinearly since 2011, and is particularly prevalent among those who are younger, disadvantaged, more addicted, have recently failed to quit, and are not attempting to cut down. IMPLICATIONS: The ability to use nicotine in smoke-free settings appears to be an important part of the appeal of e-cigarettes. It is possible that if e-cigarette use was prohibited in public places, smokers may be deterred from using e-cigarettes alongside combustible tobacco, which could undermine quitting. Our results suggest disadvantaged and more addicted smokers would be disproportionately affected, suggesting such restrictions may contribute to inequalities in smoking and associated health outcomes.


Assuntos
Sistemas Eletrônicos de Liberação de Nicotina , Abandono do Hábito de Fumar , Vaping , Adulto , Inglaterra/epidemiologia , Humanos , Fumantes , Dispositivos para o Abandono do Uso de Tabaco
10.
Sci Rep ; 11(1): 13203, 2021 06 24.
Artigo em Inglês | MEDLINE | ID: mdl-34168216

RESUMO

This study examined use trends of e-cigarette devices types, heated tobacco products (HTPs) and e-liquid nicotine concentrations in England from 2016 to 2020. Data were from a representative repeat cross-sectional survey of adults aged 16 or older. Bayesian logistic regression was used to estimate proportions and 95% credible intervals (CrIs). Of 75,355 participants, 5.3% (weighted = 5.5%) were currently using e-cigarettes or HTPs, with the majority (98.7%) using e-cigarettes. Among e-cigarette users, 53.7% (CrI 52.0-55.1%) used tank devices, 23.7% (22.4-25.1%) mods, 17.3% (16.1-18.4%) pods, and 5.4% (4.7-6.2%) disposables. Tanks were the most widely used device type throughout 2016-2020. Mods were second until 2020, when pods overtook them. Among all e-cigarette/HTP users, prevalence of HTP use remains rare (3.4% in 2016 versus 4.2% in 2020), whereas JUUL use has risen from 3.4% in 2018 to 11.8% in 2020. Across all years, nicotine concentrations of ≤ 6 mg/ml were most widely (41.0%; 39.4-42.4%) and ≥ 20 mg/ml least widely used (4.1%; 3.4-4.9%). Among e-cigarette/HTP users, ex-smokers were more likely than current smokers to use mod and tank e-cigarettes, but less likely to use pods, disposables, JUUL and HTPs. In conclusion, despite growing popularity of pods and HTPs worldwide, refillable tank e-cigarettes remain the most widely used device type in England.


Assuntos
Sistemas Eletrônicos de Liberação de Nicotina/estatística & dados numéricos , Produtos do Tabaco/estatística & dados numéricos , Adolescente , Adulto , Idoso , Teorema de Bayes , Estudos Transversais , Inglaterra , Feminino , Temperatura Alta , Humanos , Masculino , Pessoa de Meia-Idade , Nicotina/administração & dosagem , Fumantes/estatística & dados numéricos , Tabaco , Adulto Jovem
11.
Front Immunol ; 12: 657945, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33912186

RESUMO

Human cytomegalovirus (HCMV) infection is not cleared by the initial immune response but persists for the lifetime of the host, in part due to its ability to establish a latent infection in cells of the myeloid lineage. HCMV has been shown to manipulate the secretion of cellular proteins during both lytic and latent infection; with changes caused by latent infection mainly investigated in CD34+ progenitor cells. Whilst CD34+ cells are generally bone marrow resident, their derivative CD14+ monocytes migrate to the periphery where they briefly circulate until extravasation into tissue sites. We have analyzed the effect of HCMV latent infection on the secretome of CD14+ monocytes, identifying an upregulation of both CCL8 and CXCL10 chemokines in the CD14+ latency-associated secretome. Unlike CD34+ cells, the CD14+ latency-associated secretome did not induce migration of resting immune cell subsets but did induce migration of activated NK and T cells expressing CXCR3 in a CXCL10 dependent manner. As reported in CD34+ latent infection, the CD14+ latency-associated secretome also suppressed the anti-viral activity of stimulated CD4+ T cells. Surprisingly, however, co-culture of activated autologous CD4+ T cells with latently infected monocytes resulted in reactivation of HCMV at levels comparable to those observed using M-CSF and IL-1ß cytokines. We propose that these events represent a potential strategy to enable HCMV reactivation and local dissemination of the virus at peripheral tissue sites.


Assuntos
Infecções por Citomegalovirus/imunologia , Infecções por Citomegalovirus/virologia , Citomegalovirus/fisiologia , Ativação Viral , Latência Viral , Linfócitos B/imunologia , Linfócitos B/metabolismo , Biomarcadores , Quimiotaxia de Leucócito/imunologia , Citocinas/metabolismo , Infecções por Citomegalovirus/metabolismo , Humanos , Ativação Linfocitária/imunologia , Monócitos/imunologia , Monócitos/metabolismo , Monócitos/virologia , Linfócitos T/imunologia , Linfócitos T/metabolismo , Replicação Viral
12.
Addiction ; 116(10): 2816-2824, 2021 10.
Artigo em Inglês | MEDLINE | ID: mdl-33885203

RESUMO

BACKGROUND AND AIMS: Analysed using classical frequentist hypothesis testing with alpha set to 0.05, the Evaluating Adverse Events in a Global Smoking Cessation Study (EAGLES) did not find enough evidence to reject the hypothesis of no difference in neuropsychiatric adverse events (NPSAEs) attributable to varenicline, bupropion, or nicotine patch compared with placebo. This might be because the null hypothesis was true or because the data were insensitive. The present study aimed to test the hypothesis more directly using Bayes factors. DESIGN: EAGLES was a randomised, double-blind, triple-dummy, controlled trial. SETTING: Global (16 countries across five continents), between November 2011 and January 2015. PARTICIPANTS: Participants were smokers with (n = 4116) and without (n = 4028) psychiatric disorders. INTERVENTIONS: Varenicline (1 mg twice daily), bupropion (150 mg twice daily), nicotine patch (21 mg once daily with taper) and matched placebos. MEASUREMENTS: The outcomes included: (i) a composite measure of moderate/severe NPSAEs; and (ii) a composite measure of severe NPSAEs. The relative evidence for there being no difference in NPSAEs versus data insensitivity for the medications was calculated in the full and sub-samples using Bayes factors and corresponding robustness regions. FINDINGS: For all but two comparisons, Bayes factors were <1/3, indicating moderate to strong evidence for no difference in risk of NPSAEs between active medications and placebo (Bayes factor = 0.02-0.23). In the psychiatric cohort versus placebo, the data were suggestive, but not conclusive of no increase in NPSAEs with varenicline (Bayes factor = 0.52) and bupropion (Bayes factor = 0.71). Here, the robustness regions ruled out a ≥7% and ≥8% risk increase with varenicline and bupropion, respectively. CONCLUSIONS: Secondary analysis of the Evaluating Adverse Events in a Global Smoking Cessation Study trial using Bayes factors provides moderate to strong evidence that use of varenicline, bupropion or nicotine patches for smoking cessation does not increase the risk of neuropsychiatric adverse events relative to use of placebo in smokers without a history of psychiatric disorder. For smokers with a history of psychiatric disorder the evidence also points to no increased risk but with less confidence.


Assuntos
Bupropiona , Agonistas Nicotínicos , Teorema de Bayes , Benzazepinas , Bupropiona/efeitos adversos , Método Duplo-Cego , Humanos , Agonistas Nicotínicos/efeitos adversos , Quinoxalinas , Dispositivos para o Abandono do Uso de Tabaco/efeitos adversos , Vareniclina/efeitos adversos
13.
Addiction ; 116(9): 2476-2485, 2021 09.
Artigo em Inglês | MEDLINE | ID: mdl-33738884

RESUMO

BACKGROUND AND AIMS: The National Institute for Health and Care Excellence (NICE) has called for research into tobacco harm reduction across ethnicities, genders and socio-economic status. Although there is increasing research focused on the latter two, relatively few studies have considered ethnic variations. Therefore this study aimed to assess (i) the association between ethnicity and use of e-cigarettes and nicotine replacement therapy (NRT) for temporary abstinence and cutting down, and (ii) trends in prevalence of these over time. DESIGN: Repeated cross-sectional household survey. SETTING: England. PARTICIPANTS: Between April 2013 and September 2019, data were collected on 24 114 smokers, 16+ of age, taking part in the Smoking Toolkit Study (STS). MEASUREMENTS: Ethnicity coding included: White, mixed/multiple ethnic group, Asian, Black and Arab/other ethnic group. Smokers reported whether they were currently using e-cigarettes and/or NRT for cutting down or during periods of temporary abstinence. FINDINGS: Odds of e-cigarette use for cutting down and temporary abstinence were significantly lower among those of Asian ethnicity (OR = 0.79, 95% CI = 0.66-0.93) and Arab/other ethnicity (OR = 0.58, 95% CI = 0.40-0.83) compared with White ethnicity. Those of mixed/multiple ethnicity had higher odds for NRT us (OR = 1.42, 95% CI = 1.04-1.94) compared with those of White ethnicity. Trend analysis indicated that for White ethnicity, e-cigarette use by smokers for cutting down and temporary abstinence followed an 'inverse S' shaped cubic curve indicating an overall rise, whereas NRT use followed an 'S' shaped cubic curve, indicating an overall decline. For mixed/multiple ethnicity a similar trend was found for NRT use only, with other ethnicities showing no statistically significant trends (suggesting relative stability over time). CONCLUSIONS: In England, e-cigarette use by smokers for cutting down and temporary abstinence is less common among Asian and Arab/other ethnicity smokers compared with White smokers. Smokers of mixed/multiple ethnicity are the most likely to be using NRT compared with other ethnic groups for cutting down and temporary abstinence. E-cigarette use by smokers for cutting down and temporary abstinence has increased over time among White smokers, whereas prevalence in other ethnic groups has remained stable.


Assuntos
Sistemas Eletrônicos de Liberação de Nicotina , Abandono do Hábito de Fumar , Estudos Transversais , Inglaterra , Humanos , Autorrelato , Dispositivos para o Abandono do Uso de Tabaco
14.
Nicotine Tob Res ; 23(9): 1623-1628, 2021 08 18.
Artigo em Inglês | MEDLINE | ID: mdl-33751125

RESUMO

INTRODUCTION: We examined differences in negative attitudes toward vaccines in general, and intentions to vaccinate against Covid-19 specifically, by smoking status in a large sample of adults in the UK. METHOD: Data were from 29 148 adults participating in the Covid-19 Social Study in September-October 2020. Linear regression analyses examined associations between smoking status (current/former/never) and four types of general negative vaccine attitudes: mistrust of vaccine benefit, worries about unforeseen effects, concerns about commercial profiteering, and preference for natural immunity. Multinomial logistic regression examined associations between smoking status and uncertainty and unwillingness to be vaccinated for Covid-19. Covariates included sociodemographic characteristics and diagnosed health conditions. RESULTS: Relative to never and former smokers, current smokers reported significantly greater mistrust of vaccine benefit, were more worried about unforeseen future effects, had greater concerns about commercial profiteering, and had a stronger preference for natural immunity (Badjs 0.16-0.36, p < .001). Current smokers were more likely to be uncertain (27.6% vs. 22.7% of never smokers, RRadj 1.43 [95% confidence interval = 1.31-1.56]; vs. 19.3% of former smokers, RRadj 1.55 [1.41-1.73]) or unwilling (21.5% vs. 11.6% of never smokers, RRadj 2.12 [1.91-2.34]; vs. 14.7% of former smokers, RRadj 1.53 [1.37-1.71]) to receive a Covid-19 vaccine. CONCLUSIONS: Current smokers hold more negative attitudes toward vaccines in general, and are more likely to be undecided or unwilling to vaccinate against Covid-19, compared with never and former smokers. With a disproportionately high number of smokers belonging to socially clustered and disadvantaged socioeconomic groups, lower vaccine uptake in this group could also exacerbate health inequalities. IMPLICATIONS: These results suggest that without intervention, smokers will be less likely than nonsmokers to take up the offer of a Covid-19 vaccine when offered. Targeted policy action may be required to ensure that low uptake of Covid-19 vaccination programs does not compound health inequalities between smokers and nonsmokers.


Assuntos
COVID-19 , Vacinas , Adulto , Atitude , Vacinas contra COVID-19 , Humanos , Intenção , SARS-CoV-2 , Fumar , Reino Unido/epidemiologia , Vacinação
16.
Addiction ; 116(8): 2187-2197, 2021 08.
Artigo em Inglês | MEDLINE | ID: mdl-33565612

RESUMO

AIMS: To establish the number of smokers in England who would be targeted by increasing the age of sale of cigarettes from 18 to 21 years and to assess the smoking and socio-demographic profile of those smokers. DESIGN AND SETTING: Nationally representative cross-sectional survey of adults in England conducted between January 2009 and July 2019. PARTICIPANTS: A total of 219 720 adults. MEASUREMENTS: All participants reported their current smoking status and socio-demographic characteristics (i.e. age, gender, home ownership, social grade and ethnicity). Smokers reported motivation to quit, urges to smoke and the Heaviness of Smoking Index (HIS). Weighted prevalence statistics were calculated. Multinomial regression and logistic regression were used to assess differences in smoking characteristics among smokers and socio-demographic characteristics relative to non-smokers. FINDINGS: The prevalence of smoking between January 2009 and July 2019 was highest among those aged 21-30. In 2019, 15.6% [95% confidence interval (CI) = 12.8-18.8%] of 18-20-year-olds reported smoking, which is estimated to represent 364 000 individuals in England. Relative to smokers aged 18-20, older smokers (aged 21+) had a higher motivation to quit smoking [odds ratios (ORs) = 1.40-1.45 range] and higher nicotine dependency as measured by urges to smoke (ORs = 1.06-1.24 range) and HSI (ORs = 1.05-2.85 range). Compared with non-smokers aged 18-20, smokers in this age group had lower odds of being female (OR = 0.89) and higher odds of being of white ethnicity (OR = 2.78) and from social grades C1-E (lower social grades) compared with AB (higher social grades) (OR = 1.19-1.83 range). CONCLUSION: Increasing the age of sale of cigarettes to 21 years in England would currently target approximately 364 000 lower dependent smokers from more disadvantaged backgrounds aged 18-20, who have less motivation to quit.


Assuntos
Abandono do Hábito de Fumar , Produtos do Tabaco , Adulto , Estudos Transversais , Feminino , Humanos , Recém-Nascido , Fumantes , Fumar/epidemiologia
17.
Proc Natl Acad Sci U S A ; 118(9)2021 03 02.
Artigo em Inglês | MEDLINE | ID: mdl-33619107

RESUMO

Reactivation of human cytomegalovirus (HCMV) from latency is a major health consideration for recipients of stem-cell and solid organ transplantations. With over 200,000 transplants taking place globally per annum, virus reactivation can occur in more than 50% of cases leading to loss of grafts as well as serious morbidity and even mortality. Here, we present the most extensive screening to date of epigenetic inhibitors on HCMV latently infected cells and find that histone deacetylase inhibitors (HDACis) and bromodomain inhibitors are broadly effective at inducing virus immediate early gene expression. However, while HDACis, such as myeloid-selective CHR-4487, lead to production of infectious virions, inhibitors of bromodomain (BRD) and extraterminal proteins (I-BETs), including GSK726, restrict full reactivation. Mechanistically, we show that BET proteins (BRDs) are pivotally connected to regulation of HCMV latency and reactivation. Through BRD4 interaction, the transcriptional activator complex P-TEFb (CDK9/CycT1) is sequestered by repressive complexes during HCMV latency. Consequently, I-BETs allow release of P-TEFb and subsequent recruitment to promoters via the superelongation complex (SEC), inducing transcription of HCMV lytic genes encoding immunogenic antigens from otherwise latently infected cells. Surprisingly, this occurs without inducing many viral immunoevasins and, importantly, while also restricting viral DNA replication and full HCMV reactivation. Therefore, this pattern of HCMV transcriptional dysregulation allows effective cytotoxic immune targeting and killing of latently infected cells, thus reducing the latent virus genome load. This approach could be safely used to pre-emptively purge the virus latent reservoir prior to transplantation, thereby reducing HCMV reactivation-related morbidity and mortality.


Assuntos
Proteínas de Ciclo Celular/genética , Citomegalovirus/imunologia , DNA Viral/genética , Epigênese Genética , Histona Desacetilases/genética , Fator B de Elongação Transcricional Positiva/genética , Fatores de Transcrição/genética , Azepinas/farmacologia , Proteínas de Bactérias/genética , Proteínas de Bactérias/metabolismo , Benzodiazepinas/farmacologia , Proteínas de Ciclo Celular/antagonistas & inibidores , Proteínas de Ciclo Celular/imunologia , Ciclina T/genética , Ciclina T/imunologia , Quinase 9 Dependente de Ciclina/genética , Quinase 9 Dependente de Ciclina/imunologia , Citomegalovirus/efeitos dos fármacos , Citomegalovirus/genética , Infecções por Citomegalovirus/genética , Infecções por Citomegalovirus/imunologia , Infecções por Citomegalovirus/patologia , Replicação do DNA/efeitos dos fármacos , DNA Viral/antagonistas & inibidores , DNA Viral/imunologia , Genes Precoces , Genes Reporter , Inibidores de Histona Desacetilases/farmacologia , Histona Desacetilases/imunologia , Interações Hospedeiro-Patógeno , Humanos , Proteínas Luminescentes/genética , Proteínas Luminescentes/metabolismo , Modelos Biológicos , Fator B de Elongação Transcricional Positiva/imunologia , Cultura Primária de Células , Regiões Promotoras Genéticas , Linfócitos T Citotóxicos/efeitos dos fármacos , Linfócitos T Citotóxicos/imunologia , Linfócitos T Citotóxicos/virologia , Células THP-1 , Talidomida/análogos & derivados , Talidomida/farmacologia , Fatores de Transcrição/antagonistas & inibidores , Fatores de Transcrição/imunologia , Transcrição Genética , Ativação Viral/efeitos dos fármacos , Latência Viral/efeitos dos fármacos
18.
Drug Alcohol Depend ; 221: 108590, 2021 04 01.
Artigo em Inglês | MEDLINE | ID: mdl-33631546

RESUMO

AIMS: To explore i) associations between vaping and self-reported diagnosed/suspected Covid-19; ii) changes in vaping since Covid-19 and factors associated with these changes; iii) whether Covid-19 motivated current or recent ex-vapers to quit. METHODS: Cross-sectional online survey of 2791 UK adults recruited 30/04/2020-14/06/2020. Participants self-reported data on sociodemographic characteristics, diagnosed/suspected Covid-19, vaping status, changes in vaping and motivation to quit vaping since Covid-19. RESULTS: There were no differences in diagnosed/suspected Covid-19 between never, current and ex-vapers. Bayes factors indicated there was sufficient evidence to rule out small negative (protective) associations between vaping status and diagnosed/suspected Covid-19. Among current vapers (n = 397), 9.7 % (95 % CI 6.8-12.6 %) self-reported vaping less than usual since Covid-19, 42.0 % (37.2-46.9 %) self-reported vaping more, and 48.3 % (43.4-53.2 %) self-reported no change. In adjusted analyses, vaping less was associated with being female (aOR = 3.40, 95 % CI 1.73-6.71), not living with children (aOR = 4.93, 1.15-21.08) and concurrent smoking (aOR = 8.77, 3.04-25.64), while vaping more was associated with being younger (aOR = 5.26, 1.37-20.0), living alone (aOR = 2.08, 1.14-3.85), and diagnosed/suspected Covid-19 (aOR = 4.72, 2.60-8.62). Of current vapers, 32.2 % (95 % CI 27.5-36.8 %) were motivated to quit vaping since Covid-19, partly motivated by Covid-19, and 21.0 %, (10.5-31.4 %) of recent ex-vapers quit vaping due to Covid-19. CONCLUSIONS: Among UK adults, self-reported diagnosed/suspected Covid-19 was not associated with vaping status. Half of current vapers changed their vaping consumption since Covid-19, with the majority reporting an increase, and a minority was motivated to quit due to Covid-19. REGISTRATION: The analysis plan was pre-registered, and it is available at https://osf.io/6j8z3/.


Assuntos
COVID-19/psicologia , Motivação , Fumantes/psicologia , Abandono do Hábito de Fumar/psicologia , Vaping/psicologia , Adulto , Idoso , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Autorrelato , Fumantes/estatística & dados numéricos , Reino Unido/epidemiologia , Vaping/epidemiologia , Adulto Jovem
19.
Addiction ; 116(7): 1859-1870, 2021 07.
Artigo em Inglês | MEDLINE | ID: mdl-33405286

RESUMO

BACKGROUND AND AIM: There have been substantial recent changes in youth tobacco product use in the United States-including, notably, a rapid increase in use of e-cigarettes. It is not known whether, and if so how far, these changes are reflected in levels of nicotine dependence. This study used data from a large, nationally representative sample of US adolescents to (i) estimate the annual prevalence of nicotine dependence in relation to current use of tobacco products, (ii) describe trends in dependence over time and (iii) evaluate whether the increase in youth use of tobacco products has been paralleled by a similar increase in the population burden of nicotine dependence. DESIGN: Secondary analysis of National Youth Tobacco Surveys conducted annually, 2012-19. SETTING: United States. PARTICIPANTS: A total of 86 902 high school students. MEASUREMENTS: Prevalence of (i) strong cravings to use tobacco in the past 30 days and (ii) wanting to use nicotine products within 30 minutes of waking, in relation to type of product used (cigarettes, other combustible tobacco, smokeless tobacco, e-cigarettes). FINDINGS: Between 2012 and 2019 there was a marked decline in past 30-day cigarette smoking and a surge in use of e-cigarettes. Different products were associated with differing levels of nicotine dependence, with cigarettes characterized by highest dependence (strong craving 42.3%; wanting to use within 30 minutes 16.8% among exclusive users in 2019) and e-cigarettes in otherwise tobacco-naive students by low dependence (16.1 and 8.8% respectively in 2019). The overall 33.8% increase in population use of nicotine products between 2012 and 2019 (from 23.2 to 31.2%) was not accompanied by an equivalent increase in overall population burden of dependence {percentage reporting craving 10.9% [95% confidence interval (CI) = 9.8-12.2%] in 2012 and 9.5% (95% CI = 7.5-12.0%) in 2019; wanting to use within 30 minutes 4.7% (95% CI = 4.0-5.5%) in 2012, 5.4% (95% CI = 4.0-7.2%) in 2019}. CONCLUSIONS: Among US high school students, increases in the prevalence of nicotine product use from 2012 to 2019 do not appear to have been accompanied by a similar increase in the population burden of nicotine dependence. This may be at least partly attributable to a shift in the most common product of choice from cigarettes (on which users are most dependent) to e-cigarettes (on which users are least dependent).


Assuntos
Sistemas Eletrônicos de Liberação de Nicotina , Produtos do Tabaco , Tabagismo , Adolescente , Humanos , Nicotina , Instituições Acadêmicas , Fumar/epidemiologia , Estudantes , Uso de Tabaco , Tabagismo/epidemiologia , Estados Unidos/epidemiologia
20.
Tob Control ; 30(e2): e111-e121, 2021 12.
Artigo em Inglês | MEDLINE | ID: mdl-32826387

RESUMO

BACKGROUND: This study aimed to examine associations between smoking and COVID-19 relevant outcomes, taking into account the influence of inequalities and adjusting for potential confounding variables. METHODS: Cross-sectional data were used from an online study of adults in the UK (n=53 002). Main outcome measures were confirmed and suspected COVID-19, worry about catching or becoming seriously ill from COVID-19 and adherence to protective behaviours. Covariates included age, sex, ethnicity, education (post-16 qualifications: yes/no), key worker status and comorbid health conditions. RESULTS: Compared with never smokers (0.26% (95% CI 0.21% to 0.33%)), prevalence of confirmed COVID-19 was higher among current (0.56% (0.41% to 0.75%)) but not ex-smokers (0.19% (0.13% to 0.28%)). Associations were similar before (current: OR=2.14 (1.49-3.08); ex-smokers: OR=0.73 (0.47-1.14)) and after (current: OR=1.79 (1.22-2.62); ex-smokers: OR=0.85 (0.54-1.33)) adjustment. For current smokers, this was moderated by socio-economic position, with higher rates only seen in those without post-16 qualifications (OR=3.53 (2.04-6.10)). After including suspected cases, prevalence was higher among current smokers (11.2% (10.6% to 11.9%), OR=1.11 (1.03-1.20)) and ex-smokers (10.9% (10.4% to 11.5%), OR=1.07 (1.01-1.15)) than never smokers (10.2% (9.9% to 10.6%)), but remained higher only among ex-smokers after adjustment (OR=1.21 (1.13-1.29)). Current and ex-smokers had higher odds than never smokers of reporting significant stress about becoming seriously ill from COVID-19 (current: OR=1.34 (1.27-1.43); ex-smokers: OR=1.22 (1.16-1.28)). Adherence to recommendations to prevent spread of COVID-19 was high (96.3% (96.1% to 96.4%)), but lower among current than never smokers (OR=0.70 (0.62-0.78)). CONCLUSIONS: In a population sample, current smoking was independently associated with self-reported confirmed COVID-19 infection. There were socio-economic disparities, with the association only apparent among those without post-16 qualifications. Smokers reported lower adherence to guidelines despite being more worried than non-smokers about catching or becoming seriously ill from COVID-19.


Assuntos
COVID-19 , Adulto , Estudos Transversais , Humanos , SARS-CoV-2 , Fumar/epidemiologia , Reino Unido/epidemiologia
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