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BACKGROUND: In the United States, limited English proficiency may reduce the quality of care and worsen outcomes after stroke. The aim was to compare stroke process measures and clinical outcomes between English preferring and non-English preferring stroke patients. METHODS/MATERIALS: This single-center retrospective cohort study evaluated patients from one United States hospital with acute ischemic stroke between July 2013 and June 2022. The primary outcomes were defect-free care, a composite of 7 stroke process measures, and independent ambulation at hospital discharge. Multivariate logistic regression models quantified the association between language preference and outcomes. Secondary outcomes included individual components of defect-free care, discharge modified Rankin scale, and discharge disposition. RESULTS: There were 4,030 patients with acute ischemic stroke identified, of which 2,965 were matched with language data from the electronic medical record. There were 373 non-English preferring patients, among which 76.9% preferred Spanish and 23.1% were non-English, non-Spanish preferring. In the multivariable model, there was no significant association between non-English preference and defect-free care (OR=0.64, 95% CI=0.26-1.59) or independent ambulation at discharge (OR=0.89, 95% CI=0.67-1.17). When compared to Spanish preferring patients, non-English, non-Spanish preferring patients had more severe strokes (P<0.001) but there was no difference in defect-free care or independent ambulation after adjustment. CONCLUSION: Our results suggest that process and clinical outcomes are similar regardless of language preference; although, our data are limited by small numbers of non-English, non-Spanish preferring patients. Additional research is needed among this population.
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AVC Isquêmico , Proficiência Limitada em Inglês , Alta do Paciente , Recuperação de Função Fisiológica , Humanos , Masculino , Feminino , Idoso , Estudos Retrospectivos , Pessoa de Meia-Idade , Resultado do Tratamento , AVC Isquêmico/diagnóstico , AVC Isquêmico/terapia , Avaliação da Deficiência , Idoso de 80 Anos ou mais , Estado Funcional , Avaliação de Processos e Resultados em Cuidados de Saúde , Idioma , Disparidades em Assistência à Saúde , Reabilitação do Acidente Vascular Cerebral , Indicadores de Qualidade em Assistência à Saúde , Fatores de TempoRESUMO
OBJECTIVE: We analyzed the pooled case-control data from the International Head and Neck Cancer Epidemiology (INHANCE) consortium to compare cigarette smoking and alcohol consumption risk factors for head and neck cancer between less developed and more developed countries. SUBJECTS AND METHODS: The location of each study was categorized as either a less developed or more developed country. We compared the risk of overall head and neck cancer and cancer of specific anatomic subsites associated with cigarette smoking and alcohol consumption. Additionally, age and sex distribution between categories was compared. RESULTS: The odds ratios for head and neck cancer sites associated with smoking duration differed between less developed and more developed countries. Smoking greater than 20 years conferred a higher risk for oral cavity and laryngeal cancer in more developed countries, whereas the risk was greater for oropharynx and hypopharynx cancer in less developed countries. Alcohol consumed for more than 20 years conferred a higher risk for oropharynx, hypopharynx, and larynx cancer in less developed countries. The proportion of cases that were young (<45 years) or female differed by country type for some HNC subsites. CONCLUSION: These findings suggest the degree of industrialization and economic development affects the relationship between smoking and alcohol with head and neck cancer.
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Neoplasias de Cabeça e Pescoço , Neoplasias Laríngeas , Humanos , Feminino , Países em Desenvolvimento , Estudos de Casos e Controles , Fatores de Risco , Neoplasias de Cabeça e Pescoço/epidemiologia , Consumo de Bebidas Alcoólicas/epidemiologia , Consumo de Bebidas Alcoólicas/efeitos adversos , Neoplasias Laríngeas/epidemiologia , EtanolRESUMO
OBJECTIVE: To study the association between knowledge of diseases caused by smoking, perceptions of harm of cigarettes and intention to quit among cigarettes and e-cigarettes users. Methods: Using US Population Assessment of Tobacco and Health (PATH) Wave 1 data (2013-2014), we investigated the mean knowledge of diseases due to smoking and perceptions of harm of cigarettes scores among cigarette smokers (n = 8,263), e-cigarette users (n = 829), and dual users (n = 745) and examined the association between knowledge, perceptions of harm and intention to quit. Results: E-cigarette users had the highest scores in both knowledge and perceptions of harm items. We found a stronger association between knowledge and intention to quit among females (aOR: 1.25; 95% CI: 1.18, 1.34) compared to males (aOR: 1.11; 95% CI: 1.05, 1.18). We observed a strong association between perceptions of harm and intention to quit among cigarette smokers (p < 0.0001) and dual users (p = 0.0001), but not e-cigarette users. Conclusions: Our study indicates it is urgent for federal and state governments to develop comprehensive guidelines for targeted health messaging regarding the harms of cigarettes, noncombustible tobacco products, and dual use, and the benefits of cessation. Further, findings suggest that effective health education should include tobacco product-specific risks and the comprehensive negative health impacts of tobacco given the strong positive association of perceptions of harm and intention to quit.Supplemental data for this article is available online at https://doi.org/10.1080/10826084.2021.1879145.
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Sistemas Eletrônicos de Liberação de Nicotina , Abandono do Hábito de Fumar , Produtos do Tabaco , Feminino , Humanos , Intenção , Masculino , Percepção , Fumantes , NicotianaAssuntos
Líquidos Corporais , Produtos do Tabaco , Adulto , Humanos , Fumantes , Fumar/efeitos adversos , BiomarcadoresRESUMO
INTRODUCTION: Previous research indicates that cigarette smokers with a time to first cigarette (TTFC) of less than 30 minutes after waking up had significantly higher levels of carcinogen biomarkers compared to those with a TTFC of more than 30 minutes. The mediation (potential mediator: cigarettes smoked per day) between TTFC and carcinogen biomarkers, remains unclear and has yet to be established. METHODS: Multivariable linear regression models were used to estimate adjusted geometric means (GMs) and ratios of GMs for urine biomarkers of VOCs by smokers' TTFC status (≤30 vs >30 min). Further, data from the NHANES 2015-2016 special sample were analyzed to assess the mediation between TTFC (exposure) and carcinogen biomarkers, including urine metabolites of polycyclic aromatic hydrocarbons (PAHs), volatile organic compounds (VOCs), and cadmium. RESULTS: Cigarette smokers with a short TTFC (≤30 min) presented significantly higher concentrations in 8 out of 17 urine metabolites of VOCs examined compared to smokers with TTFC >30 min. The association between exposure and carcinogen biomarkers was not mediated by CPD. CONCLUSIONS: Cigarette smokers with a short TTFC (≤30 min) had significantly higher levels in VOCs, PAHs, and cadmium, but the association was not mediated by cigarettes smoked per day.
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Obesity, indicated by Body Mass Index (BMI), is a risk factor for type 2 diabetes. However, its association with glycated hemoglobin (HbA1c), a crucial indicator of blood-sugar control, may vary across different populations and disease statuses. Data from the National Health and Nutrition Examination Survey (NHANES) 2017-2018 were analyzed. Participants aged 18-79 years with complete information on BMI, diabetes status, and HbA1c were included (n = 4003). Linear regression models were used to assess the association between BMI and HbA1c, adjusting for demographic confounders, smoking status, alcohol consumption, and healthcare access. Among participants without diabetes, BMI was positively associated with HbA1c levels (coefficient: 0.015, 95% CI: 0.01, 0.02; p-value < 0.05), after adjusting for potential confounders. However, this association was not significant among those with diabetes (coefficient: -0.005, 95% CI: -0.05, 0.04; p-value > 0.1). Our findings suggest a differential relationship between BMI and HbA1c in individuals with and without diabetes. While BMI remains a significant predictor of HbA1c in non-diabetic individuals, its significance diminishes in those with diabetes.
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Índice de Massa Corporal , Diabetes Mellitus Tipo 2 , Hemoglobinas Glicadas , Adolescente , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Adulto Jovem , Diabetes Mellitus Tipo 2/epidemiologia , Diabetes Mellitus Tipo 2/sangue , Hemoglobinas Glicadas/análise , Inquéritos Nutricionais , Obesidade/epidemiologia , Obesidade/sangue , Fatores de Risco , Estados Unidos/epidemiologiaRESUMO
Diet behavior and nutrition are critical for maintaining health and improving quality of life. Cigarette smoking remains the leading cause of preventable death in the United States. Poor dietary choices, such as excessively frequenting restaurants, consuming ready-to-eat foods from grocery stores, and ingesting ultra-processed foods (like frozen meals and pizzas), can adversely impact health. Despite this, research comparing dietary behaviors between smokers and non-smokers is limited. Using data from the National Health and Nutritional Examination Survey 2017-2018, we analyzed diet behavior based on smoking status. Our findings reveal that smokers had a significant increase (90%) in the frequency of consuming frozen meals/pizzas in the past 30 days compared to non-smokers (coefficient: 1.9; 95% CI: 1.4, 2.6; p-value < 0.001). Additionally, over 70% of participants, regardless of their smoking status, were unaware of MyPlate, a nutritional guide created by the United States Department of Agriculture (USDA) to encourage Americans to make healthier food choices. There is an urgent need to increase public awareness of MyPlate and promote a better understanding of healthy dietary behaviors.
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Comportamento Alimentar , não Fumantes , Inquéritos Nutricionais , Fumantes , Humanos , Masculino , Feminino , Adulto , Estados Unidos/epidemiologia , Pessoa de Meia-Idade , Fumantes/estatística & dados numéricos , não Fumantes/estatística & dados numéricos , Adulto Jovem , Dieta/estatística & dados numéricos , Idoso , Fumar/epidemiologia , Adolescente , Dieta Saudável/estatística & dados numéricos , Política Nutricional , Padrões DietéticosRESUMO
INTRODUCTION: The objective of this study was to investigate the differences in urine concentrations of heavy metals (uranium, cadmium, and lead) between exclusive menthol and non-menthol cigarette smokers across three racial/ethnic groups using data from the National Health and Nutrition Examination Survey (NHANES) 2015-2016 Special Sample. METHODS: Data from NHANES 2015-2016 Special Sample were analyzed to assess the association between menthol smoking and heavy metal biomarkers in urine across three racial/ethnic groups (N=351), including Non-Hispanic White (NHW), Non-Hispanic Black (NHB), and Hispanic/Other (HISPO). Multivariable linear regression models were used to estimate adjusted geometric means (GMs) and ratio of GMs (menthol/non-menthol smokers) (RGMs) for urine biomarkers of heavy metals between menthol and non-menthol smokers by race/ethnicity. RESULTS: Among the 351 eligible participants, 34.4% (n=121) were NHW, 33.6% (n=118) were NHB, and 32.0% (n=112) were HISPO exclusive cigarette smokers. The analysis revealed significantly higher concentrations of urine uranium in NHB menthol smokers compared to NHB non-menthol smokers (RGMs=1.3; 95% CI: 1.0-1.6; p=0.04). NHW menthol smokers appeared to have higher levels of urine uranium than non-menthol smokers, but the difference was not statistically significant (9.0 vs 6.3; RGMs=1.4; 95% CI: 1.0-2.2; p=0.08). There were no significant differences in urine metals (cadmium and lead) by menthol status among NHW, NHB, or HISPO cigarette smokers (p>0.05). CONCLUSIONS: The research findings regarding the higher levels of urine uranium among Non-Hispanic Black (NHB) menthol cigarette smokers raise questions about the claims suggesting that additives in cigarettes do not contribute to increased toxicity.
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OBJECTIVE: The aim of this study was to assess and compare knowledge of the health consequences of heavy alcohol consumption among individuals with different substance use statuses. METHODS: We used a cross-sectional study design to analyze the Health Information National Trends Survey (HINTS) 5, Cycle 3 (2019). Participants were classified into four categories based on their substance use status: (a) nonsmoker and nondrinkers; (b) nonsmokers but drinkers; (c) smokers but nondrinkers; and (d) smokers and drinkers. Weighted logistic regression models were utilized to evaluate the association between knowledge of heavy alcohol consumption and health conditions by participants' substance use status. RESULTS: More than 79% of participants were aware that drinking too much alcohol causes liver disease. However, less than 40% of them realized that heavy alcohol consumption also contributes to cancer. The odds of correctly identifying heavy alcohol consumption as a risk factor for diabetes were 3.00 times (95% confidence interval (CI): 1.29,7.00) higher among smokers but nondrinkers than smokers and alcohol drinkers. Education level was significantly associated with participants' awareness of risk factor (p < 0.01). DISCUSSION: There is an urgent need for targeted educational campaigns and interventions to increase understanding of the impact of heavy alcohol consumption on cancer risk.
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Cigarette smokers face greater challenges in accessing healthcare compared with non-smokers. In the US, approximately 2.2 million individuals are chronically infected with hepatitis B virus (HBV). I used data from the National Health and Nutrition Examination Survey (NHANES) 2017-2018 to investigate the association between smoking status (current, former, and never smoker) and different health outcomes, including healthcare accessibility, HBV vaccination, general health condition, and health insurance. Multivariable logistic regressions were used to analyze healthcare disparity by smoking status. I found that current smokers had 40% higher odds (AOR = 1.4, 95% CI: 1.1, 1.8) of lacking routine healthcare access compared with non-smokers. Regardless of smoking status, I observed a high rate of HBV non-vaccination among all participants. Specifically, 64% of current smokers, 67% of former smokers, and 57% of non-smokers had not received a single dose of HBV immunization. My study sheds light on the persisting gaps in healthcare access, particularly for smokers, and the urgent need to promote awareness and vaccination against hepatitis B.
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BACKGROUND: The US FDA announced its commitment to prohibiting menthol as a characterizing flavor in tobacco. The relationship between cigarette menthol and exposure to toxic substances in mainstream tobacco smoke is not well characterized. METHODS: Data from the National Health and Nutrition Examination Survey (NHANES) 2015 to 2016 special sample were used to study markers of 26 harmful and potentially harmful constituents (HPHC) in tobacco smoke. These include urine metabolites of polycyclic aromatic hydrocarbons (PAH), volatile organic compounds (VOC), and heavy metals in exclusive menthol (n = 162) and nonmenthol (n = 189) cigarette smokers. Urine metabolites of 7 PAHs, 15 VOCs, and 4 heavy metal biomarkers were compared by menthol status. Multivariable analyses were conducted on creatinine-adjusted concentrations. RESULTS: There were no significant differences in cotinine levels or in 22 of 26 HPHCs. Among the urine metabolites of PAHs, the levels of 1-hydroxyphenanthrene were about 16% lower in menthol smokers. Among the urine metabolites of VOCs, menthol cigarette smokers presented significantly lower concentrations of acrylamide, N,N-dimethylformamide, and acrylonitrile. Menthol and nonmenthol smokers presented similar levels of heavy metals. Menthol did not affect the levels of cotinine and the nicotine metabolite ratio in urine. CONCLUSIONS: Menthol and nonmenthol cigarettes deliver similar levels of most HPHCs. IMPACT: Findings on toxicity are similar for menthol and nonmenthol cigarettes.
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Hidrocarbonetos Policíclicos Aromáticos , Produtos do Tabaco , Poluição por Fumaça de Tabaco , Biomarcadores/urina , Carcinógenos/análise , Cotinina/análise , Humanos , Mentol/análise , Inquéritos Nutricionais , Hidrocarbonetos Policíclicos Aromáticos/urina , Fumantes , Fumar/efeitos adversos , Fumar/urina , Nicotiana/efeitos adversos , Produtos do Tabaco/efeitos adversos , Produtos do Tabaco/análise , Poluição por Fumaça de Tabaco/análiseRESUMO
BACKGROUND: Menthol upregulates nicotinic acetylcholine receptors and is associated with tobacco dependence. The effects of menthol when smoking cigarettes with varying low nicotine content up to 98 % (e.g., non-addicting) less than commercial cigarettes is not well understood. The U.S. Food and Drug Administration is considering two tobacco product standards in cigarettes including banning menthol and reducing nicotine content. These new standards have the potential to significantly reduce smoking initiation and maintenance by limiting the mechanistic effects of nicotine and menthol on the brain. METHODS: We conducted two parallel randomized clinical trials of gradually reduced nicotine in cigarettes from 11.6 mg down to 0.2 mg nicotine/cigarette (very low nicotine content; VLNC) vs. usual nicotine content (11.6 mg; UNC) over an 18-week period in people who smoke cigarettes with low socioeconomic status (SES) and mental health conditions. RESULTS: Compared to UNC, VLNC was associated with significant reductions in cotinine, cigarettes per day, expired carbon monoxide levels, nicotine dependence and symptomology. These associations did not differ between menthol and non-menthol cigarettes, except people who smoke menthol cigarettes had less of a cotinine reduction in the SES trial. The pooled odds ratio of being adherent with using only VLNC study cigarettes in the gradual nicotine reduction arm for people who smoke non-menthol vs. menthol cigarettes was 2.6 (95 % CI:1.0, 6.4; p-value: 0.04). CONCLUSIONS: When nicotine is lowered to non-addicting levels, the results indicate an independent effect of menthol on the need to sustain nicotine intake in addicted people who smoke cigarettes.
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Receptores Nicotínicos , Abandono do Hábito de Fumar , Tabagismo , Monóxido de Carbono , Cotinina , Humanos , Mentol , Nicotina , Ensaios Clínicos Controlados Aleatórios como Assunto , Abandono do Hábito de Fumar/métodosRESUMO
PURPOSE: Determine whether dual tobacco users have different levels of knowledge about nicotine addiction, perceived harm beliefs of low nicotine cigarettes (LNCs) and beliefs about electronic cigarettes (e-cigarettes). DESIGN: Quantitative, Cross-sectional. SETTING: Health Information National Trends Survey 5 (Cycle 3, 2019). PARTICIPANTS: Nationally representative adult non-smokers (n=3113), exclusive cigarette smokers (n=302), and dual (cigarette and e-cigarette) users (n=77). MEASURES: The survey included single item measures on whether nicotine causes addiction and whether nicotine causes cancer. A five-point Likert scale assessed comparative harm of e-cigarettes and LNCs relative to conventional combustible cigarettes (1=much more harmful, 3=equally harmful 5 = much less harmful, or don't know). ANALYSIS: We used weighted multiple linear regression model to estimate means and 95% confidence intervals (CI) of e-cigarettes and LNCs beliefs by current tobacco user status. RESULTS: Over 97% of dual users, 83% of non-smokers and 86% of exclusive cigarette smokers correctly identified that nicotine is addictive. The majority of subjects incorrectly identified nicotine as a cause of cancer, with dual users having the lowest proportion of incorrect responses (60%). Dual users rated e-cigarette harmfulness as less harmful than combustibles (mean=2.20; 95% CI=1.73, 2.66) while exclusive cigarette smokers and non-smokers rated them as similarly harmful. LNCs were considered equally harmful and addictive as conventional cigarettes. CONCLUSION: Dual users had a higher knowledge base of tobacco-related health effects. The effectiveness of policies or medical recommendations to encourage smokers to switch from cigarettes to LNCs or e-cigarettes will need to consider accurate and inaccurate misperceptions about the harm and addictiveness of nicotine. Improved public health messages about different tobacco products are needed.
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In 2018, the United States Food and Drug Administration (FDA) issued an advanced notice of proposed rulemaking to reduce nicotine in tobacco products to produce a minimally addictive or nonaddictive effect, but there was a research gap in the subjective responses of reduced-nicotine-content cigarettes. We compared the responses of the modified cigarette evaluation questionnaire (mCEQ) and cigarette-liking scale (CLS) between the gradually reduced nicotine content (RNC) group and the usual nicotine content (UNC) group. Linear mixed-effects models for repeated measures were used to analyze and compare the change over time for the mCEQ and CLS across the two treatment groups (RNC and UNC). We found that the change over time for the mCEQ and CLS was significant between the RNC and the UNC treatment groups at the beginning of visit 6 with 1.4 mg nicotine/cigarette. At visits 8 and 9, the RNC group reported significantly lower satisfaction scores compared to UNC. Subscale analysis showed that smoking satisfaction decreased in RNC while other measures, such as cigarette enjoyment, did not change. Understanding the impact of nicotine reduction on cigarette subjective responses through evaluation and liking scales would provide valuable information to the FDA on nicotine reduction policies for cigarettes.