A Clinical Trial Comparing Smoking Cessation Interventions at Two Levels of Intensity in Stroke Patients, Stratified by the Presence of Insular Cortex Lesions.

INTRODUCTION: Smoking is a stroke risk factor but the most efficient way to promote cessation is unknown. The smoking behavior in patients during the first 2 years post-stroke is studied comparing brief advice and intensive behavioral counseling interventions, taking into consideration biological, psychological, and social factors. METHODS: Randomized clinical trial of 196 stroke patients, stratified by the presence or not of an insular cortex lesion, with two levels of smoking cessation intervention. RESULTS: The study retention rate was 85.2%. Abstinence point prevalence at three months after stroke was 50% in the brief advice group and 51.7% in the intensive behavioral counseling group (p = .82) and at 24 months, 48.3% in the brief group and 47.5% in the intensive group (p = .92). Most relapses occurred in the first weeks. After 3 months the curves separated with fewer events in the intensive group and at 24 months the Hazard Ratio was 0.91 (95% CI = 0.61 to 1.37; p = .67). Twenty-four months after stroke, patients with an insular lesion were more likely to be abstinent (OR 3.60, 95% CI = 1.27 to 10.14), as were those who lived with a partner (OR 2.31, 95% CI = 1.17 to 4.55) and those who were less dependent (OR 0.84, 95% CI = 0.73 to 0.97). CONCLUSIONS: A high percentage of patients gave up smoking in both intervention groups with no significant differences between the two. The effect of the insular lesion on smoking cessation, which is early and continued after two years, is particularly notable. IMPLICATIONS: This two-year clinical trial compares for the first time the efficacy of two different intensities of smoking cessation intervention in stroke patients, taking into consideration the effect of the insula. Good results are obtained both in the short and medium-term in people with stroke, especially when this is accompanied by an insular cortex lesion, but there is no evidence that better results are obtained with longer, more time-intensive, and possibly more costly follow-ups obtain better results than are obtained with briefer interventions.

Polydrug use and its relationship with the familiar and social context amongst young college students.

The prevalence of polydrug use continues to grow among Spanish college students. The European Observatory for Drugs and Addictions establishes three different types of polydrug use: Pattern A (consumers of alcohol and tobacco), Pattern B (consumers of cannabis plus alcohol and/or tobacco) and Pattern C (consumers of cannabis plus alcohol plus tobacco plus at least one other kind of illegal drug). The objectives are: 1) to study the frequency of substance consumption among a sample of young Spanish undergradudates studying health and sports science according to their sex; 2) to describe the patterns of polydrug use; 3) to study the relationship between the polydrug use of the participants and polydrug use within their closest environment (parents, sisters or brothers, best friend and partner). The sample was composed of 480 Spanish undergraduates (43.7% females) aged 18 to 36. The level of drug consumption of students and their closest reference persons was evaluated by means of a self-report measure. A total of 46% of the participants reported consumption of two or more substances; among them 29.4% corresponded to Pattern A, 50.7% to Pattern B and 16.7% to Pattern C, while 3.2% corresponded to other multiple consumption patterns (alcohol + cocaine; alcohol + cocaine + tobacco; alcohol + inhalants; amphetamines + hallucinogens + Spice). An important correlation was observed concerning polydrug use between participants and their closest reference persons: the more the reference person is a multiple consumer, the more the participant tends to consume. Polydrug use within the closest environment emerges as one of the key elements to be taken into account in further prevention programs.

El policonsumo de drogas es cada vez más prevalente entre los jóvenes españoles. El Observatorio Europeo de las Drogas y las Toxicomanías establece tres tipologías de policonsumo: Patrón A (consumidores de alcohol y tabaco), Patrón B (consumidores de cannabis junto con alcohol y/o tabaco) y Patrón C (consumidores de cannabis junto con alcohol y tabaco y al menos otra droga ilegal). Los objetivos son: 1) estudiar la frecuencia de consumo de drogas en una muestra de jóvenes universitarios españoles del ámbito de la salud y el deporte según el sexo; 2) describir los patrones de policonsumo; 3) estudiar la relación entre el policonsumo de los participantes y el policonsumo de las personas de su entorno próximo (padres, hermanos, pareja y mejor amigo). La muestra consta de 480 universitarios (43.7% chicas) entre 18 y 36 años. Se administró un autoinforme para evaluar el policonsumo de los participantes y de sus referentes más próximos. Un 46% de los participantes eran consumidores de dos o más sustancias, de los cuales un 29.4% correspondían al Patrón A, un 50.7% al Patrón B, un 16.7% al Patrón C y un 3.2% a otros patrones de policonsumo (alcohol + cocaína; alcohol + cocaína + tabaco; alcohol + inhalantes; anfetaminas + alucinógenos + Spice). Se observa una elevada concordancia entre el policonsumo de los participantes y el de sus referentes próximos, de modo que si el referente es policonsumidor es más probable que el participante también lo sea. El policonsumo de drogas en el entorno próximo de los jóvenes deviene uno de los elementos clave a tener en cuenta en futuras campañas preventivas.

Sex-Related Differences in Post-Stroke Anxiety, Depression and Quality of Life in a Cohort of Smokers.

BACKGROUND: We aimed to study anxiety, depression and quality of life in smokers after stroke by sex. METHODS: A longitudinal prospective study with a 24-month follow-up of acute stroke patients who were previously active smokers. Anxiety and depression were evaluated with the Hospital Anxiety and Depression scale, and quality of life was evaluated with the EQ-5D questionnaire. RESULTS: One hundred and eighty patients participated (79.4% men); their mean age was 57.6 years. Anxiety was most prevalent at 3 months (18.9% in men and 40.5% in women) and depression at 12 months (17.9% in men and 27% in women). The worst perceived health occurred at 24 months (EQ-VAS 67.5 in men and 65.1 in women), which was associated with depression (p < 0.001) and Rankin Scale was worse in men (p < 0.001) and depression in women (p < 0.001). Continued tobacco use was associated with worse perceived health at 3 months in men (p = 0.034) and at 12 months in both sexes. Predictor variables of worse perceived health at 24 months remaining at 3 and 12 months were tobacco use in men and neurological damage in women. CONCLUSION: Differences by sex are observed in the prevalence of anxiety and depression and associated factors and in the predictive factors of perceived health.

Cigarette, e-cigarette and waterpipe cognitions and use among university students in Guangzhou, China.

INTRODUCTION: There is currently little research on polytobacco use in China. The present study examined cognitions that predicted the use of cigarettes, e-cigarettes and waterpipes in a Chinese sample of students. METHODS: A convenience sample of 281 university students, obtained using snowball sampling, completed an online survey during the 2019-2020 academic year in Guangzhou, China. RESULTS: Men more strongly agreed, than women, with the possible advantages of using alternative nicotine and tobacco products, including: young people who smoke have more friends, smoking makes young people look cool, smoking makes young people feel more comfortable, smoking helps relieve stress, and it would be easy to quit. Factors significantly associated with regular cigarette use were the cognitions: 'I would smoke if my best friend offered', 'Young people who use these products have more friends', and 'It would be easy to quit these products' (global good classifications= 80.1%). In the case of waterpipes, agreement with the cognition: 'The product helps people relieve stress' was significantly associated with its use (global good classifications=80.1%). In the case of e-cigarettes, agreement with the cognitions: 'I would smoke if my best friend offered' and 'It would be easy to quit using these products' were significantly associated with the use of e-cigarettes (global good classifications=74.7%). CONCLUSIONS: The results highlight the need to develop prevention programs that prepare young Chinese people to resist social pressure from friends to use tobacco products. There is also evidence of the need to facilitate and disseminate rigorous scientific information among young people about the possible negative health effects of alternative tobacco products. There were also gender differences in the use of these products and in the cognitions towards their use, so it is important to take the gender perspective into account in the analysis of the results and when writing future questionnaire items.

Smoking cessation 1 year poststroke and damage to the insular cortex.

BACKGROUND AND PURPOSE: Hospitalization as a result of stroke provides an opportunity to stop smoking that is often not taken up. The present study analyzes sociodemographic, psychological, and lesion-related variables to identify associated factors for smoking cessation during the first year after stroke. METHODS: We conducted a prospective longitudinal study with a 1-year follow-up of a cohort of 110 patients with acute stroke who were smokers at the time of diagnosis and were admitted consecutively between January 2005 and July 2007. RESULTS: On hospital release, 69.1% had given up smoking but at 1 year, only 40% had stopped smoking. Of the 110 patients, 27 (24.5%) had an acute stroke lesion in the insular cortex, of which 19 (70.3%) were nonsmokers at 1 year. Strongly associated factors in giving up smoking were the location of the lesion in the insular cortex (OR, 5.42; 95% CI, 1.95-15.01; P=0.001) and having the intention of giving up before the stroke, comparing precontemplating patients (without intention of giving up in the near future) with contemplating and prepared patients (intention of stopping in the near future; OR, 7.29; 95% CI, 1.89-28.07; P=0.004). CONCLUSIONS: Of patients with stroke who were smokers, only 4 of 10 patients had stopped smoking 1 year after admission. Our results show that the variables best predicting smoking cessation in patients with a stroke diagnosis 1 year after hospital discharge are insular damage and the prestroke intention to stop.

Family Climate and Intention to Use Cannabis as Predictors of Cannabis Use and Cannabis-Related Problems among Young University Students.

Determining the predictive variables associated with cannabis use and cannabis-related problems can ease the identification of young cannabis consumers who can benefit from prevention interventions. This study aimed: (1) to describe, among university students, the cannabis use and cannabis-use problems, intention to use cannabis and family climate based on the gender and the people the student lives with; (2) to explore whether the family climate and intention to use cannabis are predictors of cannabis use and cannabis-related problems. The sample was composed of 339 Spanish undergraduates (51.9% females) in a 17-to-25 age range (19.67 ± 1.53). The variables were assessed through a battery based on the ESPAD survey, cannabis abuse screening test, cannabis use intention questionnaire and family climate scale. More men than women had used cannabis in the precedent year and showed greater intention to use cannabis, whereas more women than men showed greater self-efficacy in not using cannabis. The family climate did not predict cannabis use and cannabis-related problems. However, subjective norms and self-efficacy were key predictors of cannabis use and cannabis-use problems, respectively. Different factors seemed to predict the use cannabis in the past year versus cannabis-related problems, and these differences may help inform the development and delivery of preventative efforts.

Facebook Intrusion as a Mediator Between Positive Capital and General Distress: A Cross-Cultural Study.

Background: Social networking sites (SNSs) play an important role in many aspects of life nowadays, and it seems to be crucial to explore their impact on human well-being and functioning. The main aim of the study was to examine the mediating role of Facebook intrusion between positive capital and general distress. Positive capital was considered as comprising self-esteem, ego-resiliency, and self-control, while general distress was seen as having three dimensions: depression, anxiety, and stress. Methods: The sample consisted of N = 4,495 participants (M = 22.96 years, SD = 5.46) from 14 countries: Australia, Cyprus, Greece, Hong Kong, Lithuania, New Zealand, Peru, Poland, Russia, Spain, Turkey, Ukraine, United Kingdom, and United States. We used the following methods: the Facebook Intrusion Questionnaire (FIQ), the Self-Esteem Scale (SES), the Brief Self-Control Scale (SCS), The Ego Resiliency Revised Scale and the Depression, Anxiety, and Stress Scale-21 (DASS-21). Results: We found that Facebook intrusion was a mediator between self-esteem and general distress and between self-control and general distress. Limitations: The present study was based on a cross-sectional study, and the measures used were self-report measures. The majority of the participants were recruited using convenience sampling. Conclusions: The present findings contribute to a better understanding on how the social media have impact on individual mental health. Implications for future studies are discussed.

Cigarette, E-Cigarette and Waterpipe Use among Young Adults: Differential Cognitions about These Three Forms of Smoking.

BACKGROUND: Polytobacco use is common among young adults. The purpose of the present study was to investigate a number of cognitions related to the use of three tobacco products (cigarettes, e-cigarettes and waterpipes) among young adults. METHODS: Participants (n = 799, 59.4% women) aged 18-25 years old (M = 21.8, SD = 1.7) completed an online tobacco cognitions questionnaire. RESULTS: For all three tobacco products, there was significantly more agreement with the cognition "I would smoke if my best friend offered" among tobacco users (used one or more tobacco products) than among non-users. For e-cigarettes and waterpipes, there was significantly more agreement with the cognition "It would be easy to quit these products" than was reported by non-users. Polytobacco users (three tobacco products) endorsed the cognitions scale (the six cognition items were combined to form a single cognitions scale for each tobacco product) significantly more than non-users for cigarettes and e-cigarettes. Furthermore, waterpipe users, polytobacco users, dual users and single users all endorsed the combined cognitions scales more strongly than non-users. CONCLUSIONS: Efforts to prevent polytobacco use should ensure that young adults have the necessary self-efficacy to resist peer pressure and provide them with clear information about the health risks associated with using alternative tobacco products.

Sex and Polytobacco Use among Spanish and Turkish University Students.

Polytobacco use has become increasingly popular among young adults, particularly males, and can be defined as the concurrent use of regular cigarettes and other tobacco products (e.g., e-cigarettes). The present study investigated the use of legal smoking products (cigarettes, waterpipe and electronic cigarettes) among young adults (n = 355) in Spain and Turkey. The survey measured demographics, lifetime and past month tobacco use, waterpipe and e-cigarette use, whether waterpipes and e-cigarettes contained nicotine and reasons for using these substances. The majority of the Turkish (men = 80% and women = 63.9%) and Spanish sample (men = 61.4% and women = 69.3%) were polytobacco users. The most common reason for using e-cigarettes was "to experiment, to see what is like" (Turkish sample: men 66.7% and women 57.1; Spanish sample: men 72.7% and women 93.8%). The most common reason to use regular cigarettes was "to relax and relieve tension" (Turkish sample: men 88.9% and women 77.6%; Spanish sample: men 78.1% and women 76%), while for waterpipe users, the most common reason was "to experiment, to see what it is like" (Turkish sample: men 93.3% and women 80%; Spanish sample: men 78.9% and women 93.8%). The implications for prevention and future research are discussed.

Predictors of intentions to use cigarettes and electronic-cigarettes among high school students.

PURPOSE: Tobacco is the second most commonly used drug by Spanish high school students and e-cigarette use has increased over the last three years among this population. Students who reported smoking tobacco and/or e-cigarette use often have friends and family that also consume these substances. The aims of the present study were to: determine the prevalence of tobacco and electronic cigarette consumption among young adolescents, the age of initiation and the intention to consume both of these substances in the future; study the relationships between their current tobacco and e-cigarette consumption status, intentions to consume these substances in the future and the consumption of these substances by family members living in their home and friend's consumption status; investigate the relationship between their current tobacco and e-cigarette consumption status, friends' consumption status and their intention to consume each substance in the future; analyse the relationship between current consumption status, intentions to consume in the future and perceived risk; identify the main predictors of intentions to use these substances in the future. METHODS: A cross-sectional survey was conducted in 2017. The sample consisted of 468 school students in the first cycle of secondary education in Catalonia, Spain. The participants who were aged between 11 and 15 years old, with 49.4% being female. RESULTS: A stepwise binary logistic regression showed that the best predictors of the intention to smoke tobacco in the future were: having tried tobacco, being a current consumer, having a family member smoking at home and having a low perceived risk of smoking. The best predictors of the intention to use electronic cigarettes in the future were: having tried tobacco, being a current consumer and having friends who smoke or use electronic cigarettes. CONCLUSION: Smoking prevention programs must consider the social network surrounding teenagers, particularly close friends and family. Intervention strategies for delaying the onset of tobacco or e-cigarette consumption are greatly needed.

Types of polydrug use among Spanish adolescents.

OBJECTIVE: This study examined the types of polydrug use among Spanish adolescents. METHOD: 1501 high school students (50.6% female) aged 12 to 17years old (mean age=14.03, SD=1.28), from public schools in the city of Girona (Catalonia, Spain), completed the survey. RESULTS: In the previous six months 20.9% of the Spanish adolescents used alcohol, 18.8% tobacco, 10.5% cannabis and 0.7% cocaine. Specifically, 28.6% of the sample (n=429; 29% males and 28.2% females) used at least one drug and 13.9% reported polydrug use (n=208; 12.6% males and 15.1% females). The present research also found that the most critical ages for starting polydrug use were 14 and 15years old. More than one quarter (27.9%) of the adolescent polydrug users were type A (tobacco and alcohol), 67.8% were type B (cannabis together with tobacco and/or alcohol) and 3.4% were type C (cannabis together with tobacco and/or alcohol, and cocaine). CONCLUSIONS: These results suggest that Spanish adolescents, particularly males, commence polydrug use at an earlier age than other European adolescents. Early preventative strategies and a multisubstance perspective are greatly needed in Spain to avoid the initiation of polydrug use or to prevent progress onto heavier drugs.