Differences in tobacco use prevalence, behaviors, and cessation services by race/ethnicity: A survey of persons in addiction treatment

Impacto - A single-arm open-label pilot trial of a digital-based integrated smoking cessation program for Spanish-speaking Hispanic individuals who smoke: Development, feasibility, engagement, and clinical outcomes

INTRODUCTION

Hispanic/Latinx (hereafter Hispanic) individuals who smoke have challenges in quitting and a disproportionate risk of smoking-related health problems when compared to the general population. The smoking inequalities among the Hispanic population are influenced by limited treatment access and chronic stress exposure (e.g., racial/ethnic discrimination). The present study sought to culturally adapt and initially test a novel, Spanish-language mobile intervention entitled Impacto. Impacto helps address aversive psychosomatic stress (e.g., bodily symptoms, negative affect states) that can maintain smoking by targeting individual differences in anxiety sensitivity during the cessation process.

METHODS

The current study utilized a single-arm open-label pilot trial of an integrated, anxiety sensitivity and smoking cessation Spanish language mobile health application for the Android platform, Impacto. Participants were 30 adults who engaged in daily combustible cigarette use (females n = 15, Mage = 40.2 years, SD = 11.1). The study evaluated effects of Impacto on 7-day point-prevalence smoking abstinence, cigarettes smoked per day, and anxiety sensitivity and examined feasibility, acceptability, and engagement.

RESULTS

Results indicated that Impacto had a positive impact on smoking abstinence with over half of the sample (65.4 %) reporting smoking abstinence 4-weeks post-quit. Moreover, rates of cigarettes smoked per day and anxiety sensitivity levels significantly decreased from baseline through 4-weeks post-quit. High rates of feasibility, acceptability, and engagement were also observed.

CONCLUSIONS

Impacto represents a promising new smoking cessation intervention for Hispanic individuals with elevated psychosomatic symptoms who smoke.

Negative emotional reactivity to racial/ethnic stress among Black adults who smoke

Black/African American (hereafter, Black) adults who smoke are at risk for tobacco-related health disparities in the United States (US). Although racial-based stressors (e.g., discrimination) are associated with smoking among this group, past work has not characterized individual differences in negative emotional reactivity to racial/ethnic stress in terms of smoking. The present investigation sought to address this limitation and evaluate the incremental validity of negative emotional reactivity to racial/ethnic stress on smoking processes after accounting for clinically important covariates. Participants included 517 Black individuals from the US who endorsed daily cigarette smoking (≥5 cigarettes per day, Mage = 45.1 years of age, 51.5% female). Results indicated that negative emotional reactivity to racial/ethnic minority stress was associated with an increased risk of severity of problems when quitting (ΔR2 = .01), perceived barriers for smoking cessation (ΔR2 = .03), and addictive (ΔR2 = .03) as well as negative mood reduction smoking motives (ΔR2 = .04); with effects evident after adjusting for frequency of racial/ethnic discrimination and other factors (e.g., drug use problems). Overall, the present findings provide novel empirical evidence that negative emotional reactivity to racial/ethnic minority stress among Black adults in the US is associated with several smoking processes implicated in the maintenance and relapse of smoking.

The Intersection of Sexual Orientation, Substance Use, and Mental Health: Findings from Hints 5

Objectives: In this study, we aimed to investigate (1) the association of tobacco and e-cigarette use with sexual orientation (LGBTQ and heterosexual individuals) and (2) the difference in the association of tobacco and e-cigarette use with self-reported depression by sexual orientation.

METHODS

The data for this study were obtained from the Health Information National Trends Survey (HINTS 5, Cycle 4). Sample participants included 3583 adults (93.87% heterosexuals). We used multinomial regression to measure the relative risk ratios (RRRs) of being a former and current user versus never a user of tobacco and e-cigarettes and binomial regression to measure the odds ratios of depression between the LGBTQ and heterosexuals.

RESULTS

Current smoking prevalence is higher among LGBTQ participants (17.3%) compared to heterosexuals (11.0%). The disparity is even greater for e-cigarette use, with 7.3% of LGBTQ participants being current users versus 2.8% of heterosexuals and 24.5% of LGBTQ participants being former users compared to 9.3% of heterosexuals. Compared to heterosexuals, the relative risk ratio of being a current tobacco user among the LGBTQ participants was about 1.75 times higher [RRR = 1.75, 95%CI = 1.16, 2.64], and that of e-cigarette use was about 2.8 times higher [RRR = 2.81, 95%CI = 1.57, 5.05]. Among current e-cigarette users, heterosexual participants had 1.9 percentage points [risk difference = 1.94, 95%CI = 1.20, 3.13] higher probability of depression, whereas among the LGBTQ participants, the risk was about 3.7 times higher [OR = 3.67, 95%CI = 1.06, 12.74].

CONCLUSIONS

Our findings conclude that the LGBTQ are more likely to use tobacco and e-cigarettes compared to heterosexuals and that the risk of depression from e-cigarette smoking is more pronounced among the LGBTQ participants.

Adverse Childhood Experiences and Tobacco Use among Latinx Parents in the USA

The current study aimed to understand the effects of adverse childhood experiences (ACEs) and cultural factors on Latinx parents' tobacco use. Tobacco use is the leading cause of death among Latinx individuals in the USA, and parental use has long-term secondary harm for children. Thus, it is important to examine cultural protective factors that could prevent Latinx parents and children from the negative health effects of tobacco use. Data came from 2813 18- to 50-year-old Latinx respondents who participated in the Wave 3 of the National Epidemiological Survey on Alcohol and Related Conditions. They reported having children living in their household and had complete data for the variables of interest. In this sample (mean age = 33.5 years, 53.7% female), 16.4% (95%CI = 14.7%, 18.4%) and 7.4% (95%CI = 6.4%, 8.6%) were current and former smokers, respectively. The multivariate multinomial logistic regression analysis showed that experiencing more ACEs categories was associated with increased likelihood of current and former tobacco use compared to never use. Past year discrimination experiences and being US born (2nd and 3rd-generation parents) also increased the likelihood of current use. Differences in risk of current and former tobacco use were found based on respondents' country of origin, with protection against tobacco use found for most countries compared to being from Puerto Rico. Stronger ethnic-racial identity was not protective against tobacco use. Findings show the importance of considering ACEs and cultural factors when designing and implementing tobacco cessation programs for Latinx parents and increasing awareness of the impact of parents' tobacco use on their children.

Examining Racial/Ethnic and Income Disparities on Tobacco Product Use Among US Adults Within Wave 5 of the PATH Study

OBJECTIVE

The aim of this study was to examine the interactions between race/ethnicity and income across different types of tobacco products.

METHODS

The prevalence of past 30-day use of cigarettes, traditional cigars, cigarillos, filtered little cigars, and electronic nicotine delivery systems (ENDS) among adults was examined by race/ethnicity and income levels based on wave 5 (2018-2019) data of the Population Assessment of Tobacco and Health study.

RESULTS

Multivariate analysis across race/ethnicity and income showed that, although non-Hispanic Blacks (NHBs) were significantly more than likely to smoke cigarettes than non-Hispanic Whites (NHWs) at low- and high-income levels, such disparity only applied to low-income Hispanics compared with low-income NHWs. NHBs were significantly more likely to smoke traditional cigars, cigarillos, and filtered little cigars than NHWs at low and high incomes. No differences were found between Hispanics and NHWs with regard to traditional cigars and cigarillos. However, low-income Hispanics were significantly less likely to smoke filtered little cigars than NHWs, whereas high-income Hispanics were more likely to do so than NHWs. With regard to ENDS, significant differences were only found at the low-income bracket with NHBs and Hispanics being less likely to smoke these products than NHWs.

CONCLUSIONS

Our findings highlight significant interactions between race/ethnicity and income in the use of tobacco products, suggesting that income should be taken into account when designing interventions targeting different racial/ethnic groups.

Stagnant daily smoking prevalence between 2008 and 2019 among Black and Hispanic adults with serious psychological distress

BACKGROUND

Racial/ethnic minority status and mental illness independently drive inequity in cigarette smoking and related morbidity. Racial/ethnic minority groups suffer a disproportionate burden of tobacco-related diseases. People with serious mental illness (SMI) smoke at up to 7 times the rate of the general population. There is a need to quantify smoking prevalence and trends among people at the intersection of both groups.

METHODS

This study analyzes 2008-2019 data from the National Survey on Drug Use and Health. Linear time trends of daily smoking prevalence were assessed among people with serious psychological distress (SPD; marker for SMI) and people without SPD reporting White, Black, Hispanic, and Other race/ethnicity using logistic regression, with survey year as the predictor. Models with year-by-smoking status interaction terms and F-tests assessed differential time trends.

RESULTS

The prevalence of daily smoking among people without SPD decreased over time among people reporting White (aOR=0.96, p<0.001), Black (aOR=0.96, p<0.001), Hispanic (aOR=0.95, p<0.001), and Other (aOR=0.97, p=0.002) race/ethnicity. Among people with SPD, the smoking prevalence decreased among people with White race/ethnicity (aOR=0.95, p<0.001), with no significant changes among people of Black, Hispanic, and Other race/ethnicity.

CONCLUSIONS

Smoking among people with SPD who report Black and Hispanic race/ethnicity has not changed significantly in the past 11 years, despite decreasing among non-SPD and White groups. People who are Black/Hispanic and people with SPD struggle to quit smoking, which is amplified intersectionally. Tailored interventions may be a better mechanism to reduce barriers to smoking cessation in this population.

Cardiopulmonary Consequences of Vaping in Adolescents: A Scientific Statement From the American Heart Association

Although the US Food and Drug Administration has not approved e-cigarettes as a cessation aid, industry has at times positioned their products in that way for adults trying to quit traditional cigarettes; however, their novelty and customizability have driven them into the hands of unintended users, particularly adolescents. Most new users of e-cigarette products have never smoked traditional cigarettes; therefore, understanding the respiratory and cardiovascular consequences of e-cigarette use has become of increasing interest to the research community. Most studies have been performed on adult e-cigarette users, but the majority of these study participants are either former traditional smokers or smokers who have used e-cigarettes to switch from traditional smoking. Therefore, the respiratory and cardiovascular consequences in this population are not attributable to e-cigarette use alone. Preclinical studies have been used to study the effects of naive e-cigarette use on various organ systems; however, almost all of these studies have used adult animals, which makes translation of health effects to adolescents problematic. Given that inhalation of any foreign substance can have effects on the respiratory and cardiovascular systems, a more holistic understanding of the pathways involved in toxicity could help to guide researchers to novel therapeutic treatment strategies. The goals of this scientific statement are to provide salient background information on the cardiopulmonary consequences of e-cigarette use (vaping) in adolescents, to guide therapeutic and preventive strategies and future research directions, and to inform public policymakers on the risks, both short and long term, of vaping.

Correlates of Tobacco and Nicotine Use Among Transgender and Gender Diverse People: A Systematic Review Guided by the Minority Stress Model

INTRODUCTION

ransgender and gender diverse (TGD) people have a higher prevalence of tobacco and nicotine use compared to their cisgender peers.

AIMS AND METHODS

Using the minority stress model as a guide, we conducted a systematic review of correlates of tobacco and nicotine use among TGD people. We reviewed the literature from Pubmed, PsycINFO, and CINAHL between April 1, 1995 and April 20, 2021. Article inclusion criteria were the following: written in English, reported empirical data, sampled exclusively or reported separate outcomes for transgender/gender diverse people, and reported correlates of tobacco or nicotine use, broadly defined. The first and second authors reviewed the articles retrieved from the search and from gray literature (relevant listserv solicitations) for inclusion. They then reviewed references of any included articles for additional candidate articles.Results: This resulted in 35 articles for review, which were synthesized in a qualitative fashion. The overall quality of the articles was fair, with the articles ranging from poor to fair quality and using primarily cross-sectional design and survey methods.

CONCLUSIONS

Overall, the literature demonstrated external minority stressors were mostly researched (and supported) correlates of tobacco and nicotine use among TGD people. There is a critical need for higher quality research, such as longitudinal or experimental designs, to improve our understanding and prevention of tobacco and nicotine use in this population.

IMPLICATIONS

This systematic review used the minority stress model as a guide to understand correlates of tobacco and nicotine use among transgender and gender diverse people. Literature of fair quality demonstrated that external minority stressors were the most researched and supported correlates of tobacco and nicotine use within the framework of the minority stress model. This review demonstrated a critical need for higher quality research, such as longitudinal or experimental designs, to improve our understanding and prevention of tobacco and nicotine use in this population. Preliminary findings from the limited literature highlight factors that may be relevant to target with this population, including general/environmental stressors and external minority stressors such as discrimination.

Exploring the Role of Traumatic Event Exposure in Tobacco Dependence Treatment Outcomes Among African Americans

African Americans are more likely to die from tobacco-related diseases and less likely to quit smoking than their white counterparts. Evidence of greater prevalence of posttraumatic stress disorder (PTSD) among African Americans underscores the importance of studying the effects of traumatic event exposure on tobacco dependence treatment outcomes in this group. In this secondary analysis of data from a previously completed randomized control trial, we examined the effects of traumatic event exposure (e.g., serious accident) on tobacco dependence treatment outcomes, as well its moderating effects on the effectiveness of an adapted smoking cessation treatment, in a sample (n = 169) of African American smokers in New York City. Traumatic event exposure did not have a significant impact on tobacco treatment outcomes and did not moderate the relationship between treatment type and outcomes in this sample. While results may be driven by unique sample characteristics, they may also indicate that an average level of traumatic event exposure does not significantly impact tobacco treatment outcomes among African Americans. Future research should examine the effects of higher levels of traumatic event exposure on treatment outcomes, as well as investigating the factors underlying trauma-exposed individuals' difficulties with reducing/quitting smoking in a larger, more diverse African American sample.

Racial/Ethnic Differences in Tobacco Use and Cessation Services among Individuals in Substance Use Treatment

Few studies explore racial/ethnic disparities in tobacco use and access to cessation services among people with substance use disorders (SUD). We collected data from Hispanics (n = 255), non-Hispanic Whites (n = 195), and non-Hispanic Blacks (n = 126) across 24 Californian residential SUD treatment programs. Data were analyzed via regression models adjusting for demographics, cigarettes per day, past quit attempts, intent to quit in the next 30 days, and physical health status. Non-Hispanic Whites smoked at a higher rate (68.7%) than both Hispanics (54.9%) and non-Hispanic Blacks (55.6%) and smoked more cigarettes per day (M = 11.2, SD = 6.5). Hispanics were more likely than non-Hispanic Whites to receive a referral to a cessation specialist (adjusted odds ratio; AOR = 2.34, 95% CI = 1.15, 4.78) and tobacco-cessation counseling (AOR = 2.68, 95% CI = 1.28, 5.62). Non-Hispanic Blacks were also more likely than non-Hispanic Whites to receive cessation counseling (AOR = 3.61, 95% CI = 1.01, 12.87) and NRT/pharmacotherapy (AOR = 2.65, 95% CI = 1.57, 4.47). Despite their decreased smoking prevalence and severity, REMs were accessing smoking cessation services while in treatment, suggesting that SUD treatment could serve as a place to address tobacco-related racial inequities.

Anhedonia in tobacco withdrawal among African-American smokers

Anhedonia-diminished interest and pleasure in response to rewards-may be a symptom of tobacco withdrawal that is understudied in priority populations. This experiment investigated the magnitude and correlates of various dimensions of anhedonia during tobacco withdrawal among African-American (AA) smokers-a population subject to health disparities. AA smokers (N = 607; ≥ 10 cigarettes/day, 37.8% female, M[SD] age = 50.0[10.6] years) completed self-report measures assessing expected pleasure from (i.e., consummatory anhedonia) and desire to engage in (i.e., anticipatory anhedonia) various types of hypothetically experienced rewards at counterbalanced 16-hr tobacco deprived and nondeprived lab visits. Other tobacco withdrawal symptom measures (e.g., craving, negative affect, hunger) were also assessed. Tobacco deprivation most robustly increased scores on a composite measure of consummatory anhedonia directed toward various reward domains (i.e., hobbies, sensory experiences, social activities; d = .32, p < .001). Deprivation modestly increased consummatory and anticipatory anhedonia directed toward sexual rewards (ds = .09-.12, ps < .02), did not significantly change anhedonia toward food rewards, and decreased anhedonia directed toward psychoactive drug rewards (i.e., increased desire for and pleasure from drugs; ds = -.21 to -.19, ps < .001). Deprivation-induced changes in anhedonia were modestly correlated with other withdrawal symptoms (average |r|s = .04-.23) and were amplified among participants with higher nicotine dependence and lower positive affect-related traits (|β|s = .10-.12, ps < .01). Some dimensions of anhedonia may be genuine expressions of acute tobacco withdrawal in AA smokers. Applying multi-dimensional anhedonia conceptualizations might advance basic knowledge and treatment of tobacco use disorder, improve smoking cessation outcomes, and address tobacco-related health disparities facing AA smokers. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Factors associated with dual and polytobacco use among people in residential substance use disorder treatment

BACKGROUND AND OBJECTIVES

Little is known about whether people in substance use disorder (SUD) treatment are at risk for multiple-tobacco use. We examined the factors associated with dual- and polytobacco use among clients in SUD treatment.

METHODS

A cross-sectional survey was conducted in 2019 among 562 clients (M_age  = 39, 74% male) in 20 residential SUD treatment programs in California, USA. The outcomes included single-, dual- (use of two products), and polytobacco use (use of three of more products). Independent variables were nicotine dependence, quitting-related factors, blunt/spliff use, and health-related factors. A multinomial model examined associations between the independent variables and the outcome, controlling for demographics, and time in treatment.

RESULTS

Overall, 32.6%, 18.9%, and 14.0% of the sample were single-, dual-, and polytobacco users, respectively. Factors associated with increased odds of polytobacco use included greater nicotine dependence (adjusted odds ratio [AOR] = 1.60; 95% CI = 1.19, 2.16), ever using e-cigarettes for quitting (AOR = 4.56; 95% CI = 2.23, 9.34), and past 30-day use of blunt/spliff (AOR = 2.96; 95% CI = 1.48, 5.89). Factors associated with increased odds of dual use were ever using e-cigarettes for quitting (AOR = 3.19; 95% CI = 1.79, 5.66) and reporting more mentally unhealthy days (AOR = 1.05; 95% CI = 1.02, 1.07).

CONCLUSION AND SCIENTIFIC SIGNIFICANCE

This study extends the literature on tobacco use among people in SUD treatment by revealing the high prevalence of dual- and polytobacco use and the unique characteristics of users. The findings have implications for interventions reducing all types of tobacco use in this understudied population.

Factors influencing smoking behaviour of online ride-hailing drivers in China: a cross-sectional analysis

BACKGROUND

Online ride-hailing is a fast-developing new travel mode. However, tobacco control policies on its drivers remain underdeveloped. This study aims to reveal the status and determine the influencing factors of ride-hailing drivers' smoking behaviour to provide a basis for the formulation of tobacco control policies.

METHODS

We derived our cross-sectional data from an online survey of full-time ride-hailing drivers in China. We used a survey questionnaire to collect variables, including sociodemographic and work-related characteristics, health status, health behaviour, health literacy and smoking status. Finally, we analysed the influencing factors of current smoking by conducting chi-square test and multivariate logistic regression.

RESULTS

A total of 8990 ride-hailing drivers have participated in the survey, in which 5024 were current smokers, accounting to 55.9%. Nearly one-third of smokers smoked in their cars (32.2%). The logistic regression analysis results were as follows: male drivers (OR = 0.519, 95% CI [0.416, 0.647]), central regions (OR = 1.172, 95% CI [1.049, 1.309]) and eastern regions (OR = 1.330, 95% CI [1.194, 1.480]), working at both daytime and night (OR = 1.287, 95% CI [1.164, 1.424]) and non-fixed time (OR = 0.847, 95% CI [0.718, 0.999]), ages of 35-54 years (OR = 0.585, 95% CI [0.408, 0.829]), current drinker (OR = 1.663, 95% CI [1.526, 1.813]), irregular eating habits (OR = 1.370, 95% CI [1.233, 1.523]), the number of days in a week of engaging in at least 10 min of moderate or vigorous exercise ≥3 (OR = 0.752, 95% CI [0.646, 0.875]), taking the initiative to acquire health knowledge occasionally (OR = 0.882, 95% CI [0.783, 0.992]) or frequently (OR = 0.675, 95% CI [0.591, 0.770]) and underweight (OR = 1.249, 95% CI [1.001, 1.559]) and overweight (OR = 0.846, 95% CI [0.775, 0.924]) have association with the prevalence of current smoking amongst online ride-hailing drivers.

CONCLUSION

The smoking rate of ride-hailing drivers was high. Sociodemographic and work-related characteristics and health-related factors affected their smoking behaviour. Psychological and behavioural interventions can promote smoking control management and encourage drivers to quit or limit smoking. Online car-hailing companies can also establish a complaint mechanism combined with personal credit.

Persistent tobacco smoke residue in multiunit housing: Legacy of permissive indoor smoking policies and challenges in the implementation of smoking bans

Secondhand smoke (SHS) is a common indoor pollutant in multiunit housing (MUH). It is also the precursor of thirdhand smoke (THS), the toxic mixture of tobacco smoke residue that accumulates in indoor environments where tobacco has been used. This study examined the levels, distribution, and factors associated with THS pollution in low-income MUH. Interviews were conducted 2016-2018 in a cross-sectional study of N = 220 MUH homes in San Diego, California. Two surface wipe samples were collected per home and analyzed for nicotine, a THS marker, using liquid chromatography-triple quadrupole mass spectrometry. Nicotine was detected in all homes of nonsmokers with indoor smoking bans (Geo Mean = 1.67 µg/m²; 95% CI = [1.23;2.30]) and smokers regardless of an indoor ban (Geo Mean = 4.80 µg/m²; 95% CI = [1.89;12.19]). Approximately 10% of nonsmokers' homes with smoking bans showed nicotine levels higher than the average level in homes of smokers without smoking bans from previous studies (≥30 µg/m²). Housing for seniors, smoking bans on balconies, indoor tobacco use, difficult to reach surfaces, and self-reported African-American race/ethnicity were independently associated with higher THS levels. Individual cases demonstrated that high levels of surface nicotine may persist in nonsmoker homes for years after tobacco use even in the presence of indoor smoking bans. To achieve MUH free of tobacco smoke pollutants, attention must be given to identifying and remediating highly polluted units and to implementing smoking policies that prevent new accumulation of THS. As THS is a form of toxic tobacco product waste, responsibility for preventing and mitigating harmful impacts should include manufacturers, suppliers, and retailers.

A systematic scoping review of research on Black participants in the National Drug Abuse Treatment Clinical Trials Network

Black individuals experience a disproportionate burden of substance-related disabilities and premature death relative to other racial/ethnic groups, highlighting the need for additional research. The National Drug Abuse Treatment Clinical Trials Network (CTN), a research platform for multisite behavioral, pharmacological, and integrated trials designed to evaluate the effectiveness of substance use treatments in community settings with diversified patient populations, provides a wealth of research knowledge on substance use. Although CTN trials have enrolled over 5,000 Black individuals since its inception in 2000, there has been no synthesis of the findings, discussion of the implications, or suggestions for future research for Black individuals. Members of the Minority Interest Group of the CTN conducted a scoping review of published research on Black participants in CTN trials. Studies were included if the sample was more than 75% Black and/or specific findings pertaining to Black participants were reported. The review yielded 50 articles, with studies that mostly focused on baseline characteristics, followed by substance use treatment outcomes, HIV/risky sex behaviors, retention, comorbid conditions and measurement issues. This review highlighted the importance of several issues that are critical to understanding and treating substance misuse among Black people, such as the characteristics of Black people entering treatment, measurement equivalence, and engaging/retaining adolescents and young adults in treatment. There is still a continued need to identify the most effective treatments for Black individuals who use substances. The CTN offers several untapped opportunities to further advance research on Black individuals who use substances (e.g., secondary analyses of publicly available data). (PsycINFO Database Record (c) 2020 APA, all rights reserved).

The synergistic effect of tobacco and alcohol consumption on oral squamous cell carcinoma: a systematic review and meta-analysis

OBJECTIVES

This systematic review (SR) aimed to summarise and critically appraise available evidence about the association between the synergistic consumption of alcohol and tobacco and the occurrence of oral squamous cell carcinoma (OSCC).

MATERIALS AND METHODS

Observational studies investigating the association between the synergistic consumption of alcohol and tobacco and OSCC occurrence were included. Studies were selected in a two-phase process and searches were conducted on five main electronic databases, complemented by three grey literature databases.

RESULTS

From 3260 records identified, 33 articles were included for qualitative analysis, of which 15 were included in the meta-analyses. Overall, the synergistic consumption was positively associated with the occurrence of OSCC (odds ratio [OR] = 5.37; 95% confidence interval [95%CI] = 3.54-8.14). Increased odds for OSCC occurrence were observed regarding the synergistic consumption of alcohol and smoked tobacco (OR = 4.74; 95%CI = 3.51-6.40), alcohol and smokeless tobacco (OR = 7.78; 95%CI = 2.86-21.14), and alcohol, smoked tobacco, and smokeless tobacco (OR = 16.17; 95%CI = 7.97-32.79).

CONCLUSIONS

According to the results of this SR, the synergistic consumption of alcohol and tobacco (both smoked and smokeless) significantly increased the odds for the occurrence of OSCC.

CLINICAL RELEVANCE

The knowledge provided by this SR may be useful for a better understanding of differences in the effect of synergistic consumption of alcohol and tobacco products in OSCC development. These data might aid healthcare authorities to develop measures for tobacco and alcohol control considering the needs of their population.