Smoking, life expectancy, and chronic disease in South Korea, Singapore, and the United States: A microsimulation model.

The substantial social and economic burden attributable to smoking is well-known, with heavy smokers at higher risk of chronic disease and premature mortality than light smokers and nonsmokers. In aging societies with high rates of male smoking such as in East Asia, smoking is a leading preventable risk factor for extending lives (including work-lives) and healthy aging. However, little is known about whether smoking interventions targeted at heavy smokers relative to light smokers lead to disproportionately larger improvements in life expectancy and prevalence of chronic diseases and how the effects vary across populations. Using a microsimulation model, we examined the health effects of smoking reduction by simulating an elimination of smoking among subgroups of smokers in South Korea, Singapore, and the United States. We found that life expectancy would increase by 0.2 to 1.5 years among light smokers and 2.5 to 3.7 years among heavy smokers. Whereas both interventions led to an increased life expectancy and decreased the prevalence of chronic diseases in all three countries, the life-extension benefits were greatest for those who would otherwise have been heavy smokers. Our findings illustrate how smoking interventions may have significant economic and social benefits, especially for life extension, that vary across countries.

Anger, Smoking Behavior, and the Mediator Effects of Gender: An Investigation of Heavy and Moderate Smokers.

BACKGROUND: The existing literature suggests the presence of a possible relationship between high anger levels and smoking behavior; however, there are no available data highlighting possible differences between moderate and heavy smokers and the putative effect of gender on smoking behavior. OBJECTIVES: The aims of the current study were to assess the relationship among anger, depression, and anxiety and smoking patterns taking into account the possible mediator role of gender. METHODS: 150 smokers and 50 nonsmokers volunteers were recruited from the staff of the University of Messina, Italy. The final sample consisted of 90 smokers, divided in 50 heavy smokers (HS: more than 40 cigarettes per day), 40 moderate smokers (MS: 10-30 cigarettes per day), and 42 nonsmokers (NS). All subjects were assessed by State-Trait Anger Expression Inventory-2, Self-Rating Depression Scale, and Self-Rating Anxiety Scale. RESULTS: On anger, depression, and anxiety measures the HS group scored higher than MS and NS groups. HS showed higher than expected levels of trait-anger, a greater tendency to control anger reactions and to access to anger-management techniques. A moderate consumption of cigarettes (10-30 cigarettes per day) was not associated with negative emotions, as MS only showed higher than expected levels of state-anger. Cigarettes consumption was related to gender-specific anger features. Conclusions/Importance: Our study highlighted the importance of anger in smoking behavior and its related gender differences. Recognizing the link among anger, gender differences and smoking behavior could improve the knowledge for future-focused interventions on smoking cessation.

[Smoking cessation among HIV smokers: Experience of a French hospital-based smoking cessation service]. / Sevrage tabagique chez les patients fumeurs VIH : expérience de la consultation de tabacologie de l'HEGP à Paris.

INTRODUCTION: There is a particular need among HIV-infected patients to stop smoking because of the risk of smoking-related complications and the high prevalence of cigarette smoking among them. Only a few studies have focused on this population in real-world settings. AIM OF THE STUDY: Investigate the effectiveness of a smoking cessation support for HIV-infected patients at the Georges Pompidou University hospital (HEGP) smoking cessation service during the 2011-2012 period. METHODS: A retrospective study of smoking cessation medical records was performed for 39 smokers who had visited for the first time the HEGP smoking cessation service during the 2011-2012 period and declared to be infected by the HIV on their smoking cessation self-questionnaire. The study has described smokers' characteristics and follow-up to measure the abstinence rate, validated by the patient declaration, the registration of the number of days without cigarettes between each visit and a measure of expired carbon monoxide ≤ 5ppm at each visit. We examined smokers lost to follow-up and they have been considered as smokers. Maintained abstinence rates at 3 month-follow-up and at 9 months/one year were registered. RESULTS: The 39 HIV-infected smokers registered in the study were mainly male (30/39), were heavy smokers with a consumption mean of nearly 23 cigarettes per day. One third presented high nicotine dependence with a Fagerström test ≥ 7. A depression history was reported among one third of them. Symptoms of anxiety and depression were declared by 20% and 33% respectively among them. Thirteen percent of them received opioid replacement therapies, 41% were cannabis users (one out of four were daily users) and 10 % declared alcohol abuse. 85% of patients received nicotine replacement therapy (patch and/or oral forms) and 15% varenicline®, along with behavioral support techniques. At 3 month-follow-up, smoking cessation was validated for 20.5% of patients and at 9 months/1 year, smoking cessation rate decreased at 13%. When considering smokers with ≥ 2 visits, the maintained abstinence rates were respectively 27.6 and 17.2%. DISCUSSION AND CONCLUSION: With a severe smoking profile, frequent co-addictions and anxiodepressive symptoms, our results suggest that behavioral techniques combined with nicotine replacement therapy or varenicline® among HIV-infected smokers can help severe smokers to quit. Our data underline the need to take into account the co-addictions and to maintain such patients in treatment to achieve smoking cessation in real-world settings.

Altered brain functional networks in heavy smokers.

Recent neuroimaging studies have demonstrated that cigarette smoking is associated with changed brain structure and function. However, little is known about alterations of the topological organization of brain functional networks in heavy smokers. Thirty-one heavy smokers and 33 non-smokers underwent a resting-state functional magnetic resonance imaging scan. The whole-brain functional networks were constructed by thresholding the correlation matrices of 90 brain regions and their topological properties were analyzed using graph network analysis. Non-parametric permutation tests were performed to investigate group differences in network topological measures and multiple regression analysis was conducted to determine the relationships between the network metrics and smoking-related variables. Both heavy smokers and non-smokers exhibited small-world architecture in their brain functional networks. Compared with non-smokers, however, heavy smokers showed altered topological measurements characterized by lower global efficiency, higher local efficiency and clustering coefficients and greater path length. Furthermore, heavy smokers demonstrated decreased nodal global efficiency mainly in brain regions within the default mode network, whereas increased nodal local efficiency predominated in the visual-related regions. In addition, heavy smokers exhibited an association between the altered network metrics and the duration of cigarette use or the severity of nicotine dependence. Our results suggest that heavy smokers may have less efficient network architecture in the brain, and chronic cigarette smoking is associated with disruptions in the topological organization of brain networks. Our findings may further the understanding of the effects of chronic cigarette smoking on the brain and the pathophysiological mechanisms underlying nicotine dependence.

The Association Between Systemic Arterial Hypertension and Chronic Obstructive Pulmonary Disease. Results from the U.S. National Health and Nutrition Examination Survey 1999-2018: A Cross-sectional Study.

Background: Systemic arterial hypertension (HTN) is one of the common comorbidities among patients with chronic obstructive pulmonary disease (COPD). This study aimed to investigate the association between HTN and COPD. Methods: A total of 46,804 eligible non-pregnant participants aged ≥ 20 years examined in the Mobile Examination Center of the National Health and Nutrition Examination Survey (NHANES) 1999-2018 were included in this cross-sectional study. Participants with invalid data on covariates, HTN, and COPD were excluded. The association between HTN and COPD was studied using logistic regression upon adjusting the potential covariates. Results: Among the participants, 46.1% (95% confidence interval [CI], 45.3-46.9) had HTN, and 6.8% (95% CI, 6.4-7.2) had self-reported COPD. COPD was associated with HTN (OR [odds ratio]=1.18, 95% CI [1.05-1.31], P<0.01) after adjusting for demographics, socioeconomic factors, smoking, diabetes, body mass index, and medication use, including inhaled corticosteroids and methylxanthines. The association between HTN and COPD was significant among adults younger than 60 years (P<0.01). Stratified by smoking status, there was a significant association between HTN and COPD in current heavy smokers (1.25, 95% CI [1.01-1.58]; P=0.04). Conclusions: In this nationwide survey, COPD was associated with HTN. The association was more robust among adults younger than 60 years and current heavy smokers. Future prospective studies are needed to examine the relationship between HTN and COPD.

Cigarette heavy smoking alters DNA methylation patterns and gene transcription levels in humans spermatozoa.

Tobacco smoking is considered the most common reason of death and infertility around the world. This study was designed to assess the impact of tobacco heavy smoking on sperm DNA methylation patterns and to determine whether the transcription level of ALDH3B2, PTGIR, PRICKLE2, and ALS2CR12 genes is different in heavy smokers compared to non-smokers. As a screening study, the 450 K array was used to assess the alteration in DNA methylation patterns between heavy smokers (n = 15) and non-smokers (n = 15). Then, four CpGs that have the highest difference in methylation level (cg16338278, cg08408433, cg05799088, and cg07227024) were selected for validation using deep bisulfite sequencing in an independent cohort of heavy smokers (n = 200) and non-smokers (n = 100). A significant variation was found between heavy smokers and non-smokers in the methylation level at all CpGs within the PRICKLE2 and ALS2CR12 gene amplicon (P < 0.001). Similarly, a significant variation was found in the methylation level at nine out of thirteen CpGs within the ALDH3B2 gene amplicon (P < 0.01). Additionally, eighteen CpGs out of the twenty-six within the PTGIR gene amplicon have a significant difference in the methylation level between heavy smokers and non-smokers (P < 0.01). The study showed a significant difference in sperm global DNA methylation, chromatin non-condensation, and DNA fragmentation (P < 0.001) between heavy smokers and non-smokers. A significant decline was shown in the transcription level of ALDH3B2, PTGIR, PRICKLE2, and ALS2CR12 genes (P < 0.001) in heavy smokers. In conclusion, heavy smoking influences DNA methylation at several CpGs, sperm global DNA methylation, and transcription level of the PRICKLE2, ALS2CR12, ALDH3B2, and PTGIR genes, which affects negatively the semen parameters of heavy smokers.

Evaluation of Simplified Diet Scores Related to C-Reactive Protein in Heavy Smokers Undergoing Lung Cancer Screening.

The aim of this study was to assess the relationship between adherence to a healthy diet, such as the Mediterranean diet (MedDiet), and C-reactive protein (CRP) in Italian heavy smokers undergoing an LDCT screening program (bioMILD trial), using scores calculated by simple questionnaires. Simple formats of food frequency questionnaires were administered to a sample of 2438 volunteers, and the adherence to a healthy diet was measured by the validated 14-point MEDAS and by two adaptations proposed by us: 17-item revised-MEDAS and 18-item revised-MEDAS. The OR of CRP ≥ 2 mg/L for 1-point increase in 14-point MEDAS score was 0.95 (95% CI 0.91-0.99), for 17-point score was 0.94 (95% CI 0.91-0.98), and for 18-point score was 0.92 (95% CI 0.88-0.97). These inverse associations remained statistically significant also after further adjustment for body mass index. These results showed the efficacy of simplified scores and their relationship with lower levels of CRP in a population of heavy smokers. This suggests that a targeted nutritional intervention might achieve a substantial reduction in CRP levels. The findings will be prospectively tested in a new randomized study on primary prevention during lung cancer screening.

Distal radius correction osteotomy with tricortical bone graft is a successful method in heavy smokers.

BACKGROUND: Corrective osteotomy is a technically challenging surgical option to improve wrist function in tilted distal radius malunions. However fracture healing in smokers is adversely affected. The aim of this study was to evaluate the clinical and radiological effect of cigarettes on bone union in heavy-smokers who underwent corrective osteotomy with a triangular bone graft harvested from the iliac crest. METHOD: Fifteen patients, who were treated using trapezoidal block grafts taken from the iliac crest, who were smokers of 20 or more cigarettes daily (heavy smokers) with no chronic disease, and who consented to participate in the study. Fifteen non-smoker patients of the same age group were determined as the control group. Radiological measurements were made to include radial inclination and ulnar variance in pre-operative and post-operative radiographs. Functional evaluation was performed using Q-DASH and MAYO hand-wrist scores. RESULTS: In both groups, the mean age of the patients was 49,1 ±â€¯3,92 years. Smokers group the bone union in the osteotomy line was observed after 16,63 (12-24 h) weeks, non-smokers grup 14.1 (12-24) weeks (p = 0.06). Range of motion is found similar clinic between in groups (p > 0.05). Q-DASH for group smokers was 17.54 ±â€¯1.85, nonsmokers 17.20 ±â€¯1.24 (p = 0,878); MAYO was 82.27 ±â€¯6.06 for 82.00 ±â€¯7.74 (p = 0.874). for group B. No statistically significant difference was noted between the groups. CONCLUSION: Our study showed that cigarette smoking did not have negative effect on union time in the metaphyseal region after correction osteotomy. The time of bone-union in heavy-smokers was 2.5 weeks more than that of non-smokers.

Region-Specific Changes of Insular Cortical Thickness in Heavy Smokers.

Insula plays an essential role in maintaining the addiction to cigarette smoking and smoking-related alterations on the insular volume and density have been reported in smokers. However, less is known about the effects of chronic cigarette smoking on the insular cortical thickness. In this study, we explored the region-specific changes of insular cortical thickness in heavy smokers and their relations with smoking-related variables. 37 heavy smokers (29 males, mean age 47.19 ± 7.22 years) and 37 non-smoking healthy controls (29 males, mean age 46.95 ± 8.45 years) participated in the study. Subregional insular cortical thickness was evaluated and compared between the two groups. Correlation analysis was performed to investigate relationships between the insular cortical thickness and clinical characteristics in heavy smokers. There was no statistical difference on the cortical thickness in the left insula (p = 0.536) between the two groups while heavy smokers had a slightly thinner cortical thickness in the right insula (p = 0.048). In addition, heavy smokers showed a greater cortical thinning in the anterior (p = 0.0084) and superior (p = 0.0054) segment of the circular sulcus of the right insula as well as the inferior (p = 0.012) segment of the circular sulcus of the left insula. Moreover, the cortical thickness of the superior segment of the circular sulcus of the left insula was correlated negatively with nicotine severity (r = -0.423; p = 0.009) and the longer cigarette exposure was associated with the cortical thinning in the long insular gyrus and central sulcus of the right insula (r = -0.475; p = 0.003). Our findings indicate that chronic cigarette use is associated with region-specific insular thinning, which has the potential to improve our understanding of the specific roles of insular subregions in nicotine addiction.

The effects of self-regulation strategies following moderate intensity exercise on ad libitum smoking.

INTRODUCTION: The purpose of the present study was to examine whether self-regulation strategies can further extend the effect of moderate intensity exercise on smoking delay. METHOD: Participants were 40 adult smokers who were randomly assigned into two groups: control and self-regulation. A repeated measures design was adopted including a neutral condition (20 min video) and an exercise condition (20 min moderate intensity exercise). RESULTS: The results showed that smoking delay increased significantly for both groups; however, the increase for the self-regulation group was significantly larger than that of the control group. CONCLUSIONS: The results support the anti-smoking effects of acute exercise; furthermore, they highlight the usefulness of self-regulation strategies, and in particular goal setting, in extending smoking delay. The present findings provide important evidence for the exercise and smoking literature and useful directions for the development of smoking cessation interventions.

Qualitative coronary artery calcium assessment on CT lung screening exam helps predict first cardiac events.

RESULTS: A total of 1,513 individuals underwent CTLS. Downstream data, pre-test cardiac risk factors and CAC scores were available for 88.3% (1,336/1,513). The average length of follow-up was 2.64 (SD ±0.72) years. There were a total of 43 events, occurring in 1.55% (6/386) of patients with mild CAC, 3.24% (11/339) of patients with moderate CAC, and 8.90% (26/292) of patients with marked CAC. There were no events among patients with no reported CAC (0/319). Using multivariable logistic modeling, the increased odds of an initial cardiac event was 2.56 (95% CI, 1.76-3.92, P<0.001) for mild CAC, 6.57 (95% CI, 3.10-15.4, P<0.001) for moderate CAC, and 16.8 (95% CI, 5.46-60.3, P<0.001) for marked CAC, as compared to individuals with no CAC. Time to event analysis showed distinct differences among the four CAC categories (P<0.001). CONCLUSIONS: Qualitative coronary artery calcification scoring of CTLS exams may provide a novel method to help select individuals at elevated risk for an initial cardiac event.

Self-regulation strategies may enhance the acute effect of exercise on smoking delay.

The present study examined the acute effect of a moderate intensity aerobic exercise session combined with self-regulation on smoking delay in physically inactive smokers. Participants were 11 adults (5 males and 6 females) that completed three experimental conditions: control, exercise, and exercise using self-regulation strategies (SR). Following the experimental treatment smoking for the two exercise conditions delayed significantly more than for the control condition; in addition exercise SR delayed smoking marginally more that the plain exercise condition. Findings supported previous research that acute exercise reduces cravings to smoke, and suggests that the use of self-regulation strategies may strengthen exercise for smoking cessation interventions.

Measuring Airway Remodeling in Patients With Different COPD Staging Using Endobronchial Optical Coherence Tomography.

BACKGROUND: Although FEV1 remains the gold standard for staging COPD, the association between airway remodeling and airflow limitation remains unclear. Endobronchial optical coherence tomography (EB-OCT) was performed to assess the association between disorders of large and medium to small airways and COPD staging. We also evaluated small airway architecture in heavy smokers with normal FEV1 (SNL) and healthy never-smokers. METHODS: We recruited 48 patients with COPD (stage I, n = 14; stage II, n = 15; stage, III-IV, n = 19), 21 SNL, and 17 healthy never-smokers. A smoking history inquiry, as well as spirometry, chest CT, bronchoscopy, and EB-OCT were performed. Mean luminal diameter (Dmean), inner luminal area (Ai), and airway wall area (Aw) of third- to ninth-generation bronchi were measured using EB-OCT. RESULTS: Patients with more advanced COPD demonstrated greater abnormality of airway architecture in both large and medium to small airways, followed by SNL and never-smokers. Abnormality of airway architecture and EB-OCT parameters in SNL were comparable to those in stage I COPD. FEV1% predicted correlated with Dmean and Ai of seventh- to ninth-generation bronchi in COPD; however, neither Dmean nor Ai of third- to sixth-generation bronchi correlated with FEV1% in stage I and stage II COPD and in SNL. CONCLUSIONS: FEV1-based COPD staging partially correlates with small airway disorders in stage II-IV COPD. Small airway abnormalities detected by EB-OCT correlate with FEV1-based staging in COPD and identify early pathologic changes in healthy heavy smokers.

Inpatient smoking cessation therapy: truth or dare?

BACKGROUND: This study aims to answer the question to which extent even very heavy nicotine-dependent smokers can benefit from a 3-week inpatient smoking cessation program. A particular focus lies on analyzing the positive effects, which go above and beyond normally anticipated health benefits. METHODS: This is a descriptive study observing 270 patients over a 1-year period consisting of recruitment, therapy, and two post-therapy follow-up visits at 6-month interval. Gender differences, changes in body weight, and factors relating to addiction and the nicotine withdrawal process are analyzed. In comparing successful participants-post-therapy nonsmokers-with less successful ones, our analysis identifies benefits and advantages an inpatient smoking cessation therapy can bring to even the heaviest smokers. RESULTS: At the 12-month post-therapy follow-up visit, 42.6% of participants were identified as nonsmokers. A total of 34.0% of participants took up smoking again. No data is available on the remaining participants. Nonsmokers experienced significant reduction in nicotine craving and withdrawal symptoms. In terms of body weight, increases were found in both, men and women, nonsmokers and smokers. CONCLUSION: Successful quitters fail to report of an unbearable strong desire to smoke. Such unfounded fear should be communicated. Weight gain remains an undesired side effect. Hence, it is crucial to diagnose individuals more prone to weight gain and offer coping strategies thus reducing the risk of developing obesity. Nevertheless, the outcome of the study should be an encouragement to also heavy smokers and empower them to undertake smoking cessation.

Re-examining the price sensitivity of demand for cigarettes with quantile regression.

Existing studies suggest that teenagers, young adults, and individuals of low socioeconomic status are more sensitive to changes in cigarette prices. However, little is known as to whether there are differences in price sensitivity between heavy and light smokers. To examine this gap, the present study uses quantile regression to estimate price sensitivity of demand for smokers with different levels of tobacco consumption. We conducted a national personal interview survey in Taiwan and the results showed price sensitivity is positively associated with the level of cigarette consumption. The data indicate that pricing strategies are more likely to notably reduce cigarette consumption for heavy smokers. Our findings suggest policymakers can meet target control for cigarette consumption by effectively adjusting market prices of cigarettes.