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Coleman SR, Higgins ST, Smyth JM, Rodriguez BL, Loganathan M, Gaalema DE. Extending contingency management for smoking cessation to patients with or at risk for cardiovascular disease: A preliminary trial of a home-based intervention. Exp Clin Psychopharmacol 2024; 32:270-276. [PMID: 37602999 PMCID: PMC10879453 DOI: 10.1037/pha0000677] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/22/2023]
Abstract
Cigarette smoking puts individuals with or at risk for developing cardiovascular disease (CVD) in jeopardy of experiencing a major cardiovascular event. Contingency management (CM) for smoking cessation is an intervention wherein financial incentives are provided contingent on biochemically verified smoking abstinence. Conventional CM programs typically require frequent clinic visits for abstinence monitoring, a potential obstacle for patients with medical comorbidities who may face barriers to access. This preliminary study examined the feasibility and comparative efficacy of (a) usual care (UC; advice to quit smoking, self-help materials, quitline referral) versus (b) UC plus home-based CM for smoking cessation (UC + HBCM). HBCM entailed earning monetary-based vouchers contingent on self-reported 24-hr smoking abstinence biochemically verified by a breath carbon monoxide (CO) sample ≤ 6 ppm. Participants were 20 outpatients with a CVD diagnosis or qualifying CVD risk factor randomly assigned 1:1 to the two conditions. Intervention participants received 14 in-home abstinence visits over 6 weeks. Voucher monetary value started at $10 and escalated by $2.50 for each subsequent negative sample (maximum earnings: $367.50). Positive samples earned no vouchers and reset voucher value to $10, but two negative samples following a positive allowed participants to continue earning vouchers at the prereset value. Primary outcome was point-prevalence smoking abstinence at Week 6 assessment. More participants assigned to UC + HBCM than UC were smoking abstinent at that Week 6 assessment (90% vs. 30%), χ²(1, N = 20) = 7.5, p < .01. These results provide initial evidence that HBCM can effectively promote smoking abstinence in CVD outpatients. (PsycInfo Database Record (c) 2024 APA, all rights reserved).
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Affiliation(s)
- Sulamunn R.M. Coleman
- Vermont Center on Behavior and Health, University of Vermont
- Departments of Psychiatry, University of Vermont
- Psychological Science, University of Vermont
| | - Stephen T. Higgins
- Vermont Center on Behavior and Health, University of Vermont
- Departments of Psychiatry, University of Vermont
- Psychological Science, University of Vermont
| | - Joshua M. Smyth
- The Pennsylvania State University, Department of Biobehavioral Health, University of Vermont
| | | | | | - Diann E. Gaalema
- Vermont Center on Behavior and Health, University of Vermont
- Departments of Psychiatry, University of Vermont
- Psychological Science, University of Vermont
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Vargees C, Stroup AM, Niznik T, Dunn D, Wyatt R, Hoetger C, Taleb ZB, Cohn AM, Cobb CO, Fetterman JL. Patterns of use, perceptions, and cardiopulmonary health risks of cigar products: a systematic review. BMC Public Health 2023; 23:2357. [PMID: 38017396 PMCID: PMC10685631 DOI: 10.1186/s12889-023-17216-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Accepted: 11/13/2023] [Indexed: 11/30/2023] Open
Abstract
OBJECTIVE A systematic review was conducted to evaluate the use patterns, health perceptions, and cardiopulmonary health effects of cigars. DATA SOURCES PubMed and Google Scholar were searched for peer-reviewed articles published between June 2014 and February 2021. Search keywords included cigars, cigarillos, little cigars, and cardiopulmonary health outcomes. STUDY SELECTION Of 782 papers identified, we excluded non-English articles, review articles, commentaries, and those without empirical data on cigars. Three coders independently reviewed all articles and compared codes to resolve discrepancies. 93 articles met the inclusion criteria and were included. DATA SYNTHESIS Cigars have evolved from premium cigars to encompass little cigars and cigarillos (LCCs). LCCs are available in an array of flavors and at a price advantage, and as a result, are used by different groups compared to premium cigars. LCCs are more frequently used by youth, young adults, and those who identify as Black/African American. LCCs are often used in combination with other tobacco products, alcohol, and cannabis. Despite limited regulation, cigars generate smoke of a similar composition as cigarettes. Among the studies identified, evidence suggests that cigar use is associated with cardiovascular and pulmonary toxicity. Higher all-cause and cancer-related mortalities are associated with cigar use, particularly with more frequent and deeper inhalation, compared to non-tobacco users. CONCLUSIONS LCCs are used more frequently by at-risk groups compared to premium cigars. Recent studies evaluating cigar cardiopulmonary health effects are limited but suggest cigars have similar health risks as conferred by cigarette smoking. With the use of LCCs and targeted marketing on the rise among high-risk groups, there is a critical need for continued research in this area.
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Affiliation(s)
- Comreen Vargees
- Evans Department of Medicine and Whitaker Cardiovascular Institute, Boston University School of Medicine, 600 Albany Street, Boston, MA, USA
| | | | - Taylor Niznik
- TSET Health Promotion Research Center, Stephenson Cancer Center, University of Oklahoma Health Sciences Center, Oklahoma City, USA
| | - Delaney Dunn
- TSET Health Promotion Research Center, Stephenson Cancer Center, University of Oklahoma Health Sciences Center, Oklahoma City, USA
| | - Riley Wyatt
- TSET Health Promotion Research Center, Stephenson Cancer Center, University of Oklahoma Health Sciences Center, Oklahoma City, USA
| | - Cosima Hoetger
- Department of Psychology, Virginia Commonwealth University, 806 W Franklin St, Richmond, VA, 23284, USA
- Center for the Study of Tobacco Products, Virginia Commonwealth University, 100 W Franklin St, Richmond, VA, 23220, USA
- Institute for Integrative Health Care and Health Promotion (IGVF), Witten/Herdecke University, Alfred-Herrhausen-Straße 50, Witten, 58455, Germany
| | - Ziyad Ben Taleb
- Department of Kinesiology, College of Nursing and Health Innovation, University of Texas at Arlington, Arlington, TX, USA
| | - Amy M Cohn
- TSET Health Promotion Research Center, Stephenson Cancer Center, University of Oklahoma Health Sciences Center, Oklahoma City, USA
- Department of Pediatrics, College of Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, USA
| | - Caroline O Cobb
- Department of Psychology, Virginia Commonwealth University, 806 W Franklin St, Richmond, VA, 23284, USA
- Center for the Study of Tobacco Products, Virginia Commonwealth University, 100 W Franklin St, Richmond, VA, 23220, USA
| | - Jessica L Fetterman
- Evans Department of Medicine and Whitaker Cardiovascular Institute, Boston University School of Medicine, 600 Albany Street, Boston, MA, USA.
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Gaalema DE, Khadanga S, Pack QR. Clinical challenges facing patient participation in cardiac rehabilitation: cigarette smoking. Expert Rev Cardiovasc Ther 2023; 21:733-745. [PMID: 37938825 DOI: 10.1080/14779072.2023.2282026] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Accepted: 11/07/2023] [Indexed: 11/10/2023]
Abstract
INTRODUCTION Cardiac rehabilitation (CR) is highly effective at reducing morbidity and mortality. However, CR is underutilized, and adherence remains challenging. In no group is CR attendance more challenging than among patients who smoke. Despite being more likely to be referred to CR, they are less likely to enroll, and much more likely to drop out. CR programs generally do not optimally engage and treat those who smoke, but this population is critical to engage given the high-risk nature of continued smoking in those with cardiovascular disease. AREAS COVERED This review covers four areas relating to CR in those who smoke. First, we review the evidence of the association between smoking and lack of participation in CR. Second, we examine how smoking has historically been identified in this population and propose objective screening measures for all patients. Third, we discuss the optimal treatment of smoking within CR. Fourth, we review select populations within those who smoke (those with lower-socioeconomic status, females) that require additional research and attention. EXPERT OPINION Smoking poses a challenge on multiple fronts, being a significant predictor of future morbidity and mortality, as well as being strongly associated with not completing the secondary prevention program (CR) that could benefit those who smoke the most.
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Affiliation(s)
- Diann E Gaalema
- Department of Psychiatry, University of Vermont, Burlington, VT, United States of America
| | - Sherrie Khadanga
- Cardiac Rehabilitation and Prevention, University of Vermont Medical Center, South Burlington, VT, United States of America
| | - Quinn R Pack
- Department of Healthcare Delivery and Population Sciences, University of Massachusetts Chan Medical School - Baystate, Springfield, MA, United States of America
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Mamudu HM, Adzrago D, Dada O, Odame EA, Ahuja M, Awasthi M, Weierbach FM, Williams F, Stewart DW, Paul TK. Examining Disparities in Current E-Cigarette Use among U.S. Adults before and after the WHO Declaration of the COVID-19 Pandemic in March 2020. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:5649. [PMID: 37174168 PMCID: PMC10177985 DOI: 10.3390/ijerph20095649] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Revised: 03/14/2023] [Accepted: 04/18/2023] [Indexed: 05/15/2023]
Abstract
This paper aims to estimate the prevalence of e-cigarette use before and after the COVID-19 pandemic declaration and to delineate disparities in use across subpopulations. Data were derived from the 2020 Health Information National Trends Survey (N = 3865) to conduct weighted multivariable logistic regression and marginal analyses. The overall prevalence of current e-cigarette use increased from 4.79% to 8.63% after the COVID-19 pandemic declaration. Furthermore, non-Hispanic Black people and Hispanic people had lower odds of current e-cigarette use than non-Hispanic White people, but no significant differences were observed between groups before the pandemic. Compared to heterosexual participants, sexual minority (SM) participants had higher odds of current e-cigarette use after the declaration, with insignificant differences before. People who had cardiovascular disease conditions, relative to those without, had higher odds of current e-cigarette use after the declaration, but no group differences were found before the declaration. The marginal analyses showed that before and after the pandemic declaration, SM individuals had a significantly higher probability of using e-cigarettes compared to heterosexual individuals. These findings suggest the importance of adopting a subpopulation approach to understand and develop initiatives to address substance use, such as e-cigarettes, during pandemics and other public health emergencies.
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Affiliation(s)
- Hadii M. Mamudu
- College of Public Health, East Tennessee State University, Johnson City, TN 37614, USA; (M.A.); (M.A.)
- Center for Cardiovascular Risk Research, College of Public Health, East Tennessee State University, Johnson City, TN 37614, USA; (F.M.W.); (D.W.S.); (T.K.P.)
| | - David Adzrago
- Center for Health Promotion and Prevention Research and School of Public Health, The University of Texas Health Science Center at Houston, Houston, TX 77030, USA;
| | - Oluwabunmi Dada
- Department of Occupational Safety and Health, Murray State University, 157 Industry and Technology Center, Murray, KY 42071, USA;
| | - Emmanuel A. Odame
- Department of Environmental Health Sciences, Ryals Public Health Building (RPHB), University of Alabama at Birmingham, 1665 University Boulevard, Birmingham, AL 35233, USA;
| | - Manik Ahuja
- College of Public Health, East Tennessee State University, Johnson City, TN 37614, USA; (M.A.); (M.A.)
- Center for Cardiovascular Risk Research, College of Public Health, East Tennessee State University, Johnson City, TN 37614, USA; (F.M.W.); (D.W.S.); (T.K.P.)
| | - Manul Awasthi
- College of Public Health, East Tennessee State University, Johnson City, TN 37614, USA; (M.A.); (M.A.)
- Center for Cardiovascular Risk Research, College of Public Health, East Tennessee State University, Johnson City, TN 37614, USA; (F.M.W.); (D.W.S.); (T.K.P.)
| | - Florence M. Weierbach
- Center for Cardiovascular Risk Research, College of Public Health, East Tennessee State University, Johnson City, TN 37614, USA; (F.M.W.); (D.W.S.); (T.K.P.)
- College of Nursing, East Tennessee State University, Johnson City, TN 37614, USA
| | - Faustine Williams
- Division of Intramural Research, National Institute on Minority Health and Health Disparities, National Institutes of Health, Bethesda, MD 20892, USA;
| | - David W. Stewart
- Center for Cardiovascular Risk Research, College of Public Health, East Tennessee State University, Johnson City, TN 37614, USA; (F.M.W.); (D.W.S.); (T.K.P.)
- Bill Gatton College of Pharmacy, East Tennessee State University, Johnson City, TN 37614, USA
| | - Timir K. Paul
- Center for Cardiovascular Risk Research, College of Public Health, East Tennessee State University, Johnson City, TN 37614, USA; (F.M.W.); (D.W.S.); (T.K.P.)
- Division of Medicine, University of Tennessee at Nashville/Ascension Saint Thomas Hospital, Nashville, TN 37205, USA
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Gaalema DE, Yant B, Khadanga S, Savage PD, Rengo JL, Ades PA. Carbon monoxide monitoring to objectively measure smoking status in cardiac rehabilitation. Health Psychol 2022; 41:733-739. [PMID: 35389691 PMCID: PMC9481659 DOI: 10.1037/hea0001178] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Participation in cardiac rehabilitation (CR) is associated with reduced morbidity and mortality. However, most programs rely on self-report measures when assessing the critical risk factor of smoking. This study examined smoking status using self-report versus objective measurement using expired carbon monoxide (CO) and compared patient characteristics by CO level. METHOD Patients were screened for smoking status when entering CR by self-report and by objectively measured CO. Measures of aerobic fitness, educational attainment, depressive symptoms, and self-reported physical function were also collected. The discrepancy between smoking status based on self-report and objective measurement was examined and patient characteristics by CO measurement were compared. RESULTS Of the 853 patients screened, 62 self-reported current smoking and 112 had a CO of ≥ 4 ppm. Using a cut-off of ≥ 4 ppm encompassed almost all self-reported smokers (specificity: 98.5%) and identified 61 patients (not reporting current smoking) needing further screening. Further questioning yielded an additional 21 patients with combusted use (tobacco/cannabis), six nonsmoking patients with environmental CO exposure, and 34 where the reason for elevated CO was unknown. CO ≥ 4 ppm patients were younger (62.2 vs. 67.7, p < .01), had higher depression scores (5.6 vs. 3.7, Patient Health Questionairre-9, p < .01), had lower educational attainment (59.0% ≤ high school vs. 31.3%, p < .01), had lower levels of fitness (after controlling for clinical characteristics, p < .01), and completed fewer CR sessions (18 vs. 22, p < .01). CONCLUSIONS A substantial number of patients who are actively smoking may be misclassified by relying on patient report alone. CO monitoring provides a simple and objective method of systematically screening patients. (PsycInfo Database Record (c) 2022 APA, all rights reserved).
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Affiliation(s)
| | - Blair Yant
- Department of Psychiatry, University of Vermont
| | | | | | - Jason L. Rengo
- Division of Cardiology, University of Vermont Medical Center
| | - Philip A. Ades
- Division of Cardiology, University of Vermont Medical Center
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Loretan CG, Cornelius ME, Jamal A, Cheng YJ, Homa DM. Cigarette Smoking Among US Adults With Selected Chronic Diseases Associated With Smoking, 2010-2019. Prev Chronic Dis 2022; 19:E62. [PMID: 36173703 PMCID: PMC9541675 DOI: 10.5888/pcd19.220086] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION People who smoke cigarettes are at greater risk of developing chronic diseases and related complications. Our study provides recent estimates and trends in cigarette smoking among people with respiratory and cardiovascular diseases, cancers, and diabetes. METHODS Using data from the 2019 National Health Interview Survey, we calculated the prevalence of current and former cigarette smoking among adults aged 18 to 44 years, 45 to 64 years, and 65 years or older with chronic diseases. Those diseases were cancers associated with smoking, chronic obstructive pulmonary disease, diabetes, coronary heart disease, and/or stroke (N = 3,741). Using data from the 2010-2019 National Health Interview Surveys, we assessed trends in current cigarette smoking by chronic disease by using the National Cancer Institute's Joinpoint Regression Program. RESULTS In 2019, current cigarette smoking prevalence among adults with chronic diseases associated with smoking ranged from 6.0% among adults aged 65 or older with diabetes to 51.9% among adults aged 18 to 44 years with 2 or more chronic diseases. During 2010 through 2019, a significant decrease occurred in current cigarette smoking among adults aged 45 to 64 years with diabetes. CONCLUSION Overall, smoking prevalence remains high and relatively unchanged among people with chronic diseases associated with smoking, even as the overall prevalence of cigarette smoking in the US continues to decrease. The lack of progress in smoking cessation among adults with chronic diseases associated with smoking suggests that access, promotion, and integration of cessation treatment across the continuum of health care (ie, oncology, pulmonology, and cardiology settings) may be important in the success of smoking cessation in this population.
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Affiliation(s)
- Caitlin G Loretan
- Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, 4770 Buford Hwy, MS S107-7, Atlanta, GA 30341.
| | - Monica E Cornelius
- Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Ahmed Jamal
- Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Yiling J Cheng
- Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - David M Homa
- Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
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Gaalema DE, Savage PD, O'Neill S, Bolívar HA, Denkmann D, Priest JS, Khadanga S, Ades PA. The Association of Patient Educational Attainment With Cardiac Rehabilitation Adherence and Health Outcomes. J Cardiopulm Rehabil Prev 2022; 42:227-234. [PMID: 34840247 PMCID: PMC9127001 DOI: 10.1097/hcr.0000000000000646] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE Participating in cardiac rehabilitation (CR) after a cardiac event provides many clinical benefits. Patients of lower socioeconomic status (SES) are less likely to attend CR. It is unclear whether they attain similar clinical benefits as patients with higher SES. This study examines how educational attainment (one measure of SES) predicts both adherence to and improvements during CR. METHODS This was a prospective observational study of 1407 patients enrolled between January 2016 and December 2019 in a CR program located in Burlington, VT. Years of education, smoking status (self-reported and objectively measured), depression symptom level (Patient Health Questionnaire), self-reported physical function (Medical Outcomes Survey), level of fitness (peak metabolic equivalent, peak oxygen uptake, and handgrip strength), and body composition (body mass index and waist circumference) were obtained at entry to, and for a subset (n = 917), at exit from CR. Associations of educational attainment with baseline characteristics were examined using Kruskal-Wallis or Pearson's χ 2 tests as appropriate. Associations of educational attainment with improvements during CR were examined using analysis of covariance or logistic regression as appropriate. RESULTS Educational attainment was significantly associated with most patient characteristics examined at intake and was a significant predictor of the number of CR sessions completed. Lower educational attainment was associated with less improvement in cardiorespiratory fitness, even when controlling for other variables. CONCLUSIONS Patients with lower SES attend fewer sessions of CR than their higher SES counterparts and may not attain the same level of benefit from attending. Programs need to increase attendance within this population and consider program modifications that further support behavioral changes during CR.
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Affiliation(s)
- Diann E Gaalema
- Larner College of Medicine at the University of Vermont, Burlington (Drs Gaalema, O'Neill, and Bolívar and Ms Denkmann); Department of Medicine, Division of Cardiology, University of Vermont Medical Center, Burlington (Mr Savage and Drs Khadanga and Ades); and Department of Biostatistics, University of Vermont, Burlington (Dr Priest)
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Chagué F, Boulin M, Eicher JC, Bichat F, Saint-Jalmes M, Cransac A, Soudry A, Danchin N, Laurent G, Cottin Y, Zeller M. Smoking in Patients With Chronic Cardiovascular Disease During COVID-19 Lockdown. Front Cardiovasc Med 2022; 9:845439. [PMID: 35557527 PMCID: PMC9086588 DOI: 10.3389/fcvm.2022.845439] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Accepted: 03/14/2022] [Indexed: 01/04/2023] Open
Abstract
Objectives This cross-sectional study aims to investigate health-related behaviors including tobacco consumption among patients with cardiovascular diseases (CVD), during the first COVID-19-related lockdown. Methods After 5 weeks of COVID-19 lockdown, 220 patients with chronic coronary syndromes (CCS) and 124 with congestive heart failure (CHF) answered a phone questionnaire. Results Among these 344 patients, 43 (12.5%) were current smokers, and none had quit during the lockdown. When compared with non-smokers, smokers were 15 years younger, more often diabetic, more likely to live in an urban than a rural lockdown location, and more often in the CCS cohort (p = 0.011). Smokers described greater psychological impairment, but their rates of decrease in physical activity and of increase in screen time were similar to non-smokers. More than one-third (13/43) increased their tobacco consumption, which was mainly related to stress or boredom, but not driven by media messages on a protective effect of nicotine. Conclusions During the first COVID-19 lockdown, we found a decrease in favorable lifestyle behaviors among patients with CVD. Strikingly, one-third of smokers with CCS or CHF increased their tobacco consumption. Given the major impact of persistent smoking in patients with CVD, this highlights the need for targeted prevention strategies, in particular during such periods.
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Affiliation(s)
- Frédéric Chagué
- Service de Cardiologie, Centre Hospitalier Universitaire, Dijon, France.,Réseau Français d'Excellence de Recherche sur le tabac, la nicotine et les produits connexes, Paris, France
| | - Mathieu Boulin
- Département de Pharmacie, Centre Hospitalier Universitaire, Dijon, France
| | | | - Florence Bichat
- Service de Cardiologie, Centre Hospitalier Universitaire, Dijon, France
| | | | - Amélie Cransac
- Département de Pharmacie, Centre Hospitalier Universitaire, Dijon, France
| | - Agnès Soudry
- Département de Recherche Clinique, Centre Hospitalier Universitaire, Dijon, France
| | - Nicolas Danchin
- Service de Cardiologie, Hôpital Européen Georges Pompidou, Paris, France
| | - Gabriel Laurent
- Service de Cardiologie, Centre Hospitalier Universitaire, Dijon, France
| | - Yves Cottin
- Service de Cardiologie, Centre Hospitalier Universitaire, Dijon, France
| | - Marianne Zeller
- Réseau Français d'Excellence de Recherche sur le tabac, la nicotine et les produits connexes, Paris, France.,PEC2, EA 7460, Université Bourgogne Franche-Comté, Dijon, France
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Objective measure of smoking status highlights disparities by sex. AMERICAN HEART JOURNAL PLUS: CARDIOLOGY RESEARCH AND PRACTICE 2022; 17. [PMID: 35937642 PMCID: PMC9351394 DOI: 10.1016/j.ahjo.2022.100171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Current smoking is the strongest predictor of future morbidity and mortality in those with cardiovascular disease, yet clinically, smoking status is usually ascertained through self-report. We objectively measured smoking status, using exhaled carbon monoxide (CO), for 1122 consecutive patients entering cardiac rehabilitation. Within those with elevated CO levels (≥4 ppm), females had CO levels almost twice that of males (20.4 vs. 11.6), suggesting higher amounts of smoking.
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10
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Glantz SA. The Perils of Drawing Strong Conclusions Based on Underpowered Analyses. Am J Prev Med 2022; 62:e137-e139. [PMID: 35000691 DOI: 10.1016/j.amepre.2021.09.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Accepted: 09/28/2021] [Indexed: 11/26/2022]
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Critcher CR, Siegel M. Re-examining the Association Between E-Cigarette Use and Myocardial Infarction: A Cautionary Tale. Am J Prev Med 2021; 61:474-482. [PMID: 34304940 DOI: 10.1016/j.amepre.2021.05.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2020] [Revised: 05/07/2021] [Accepted: 05/16/2021] [Indexed: 11/15/2022]
Abstract
INTRODUCTION Cross-sectional analyses have suggested that e-cigarette use, independent of combustible cigarette use, elevates the risk of myocardial infarction. Previous researchers confused their own models' assumptions that these risks were independent with the idea that their analyses validated the presence of independent risks. This study avoids this pitfall. METHODS Cross-sectional analyses of the 2014-2019 National Health Interview Surveys (N=175,546) were conducted in 2020. RESULTS Logistic regressions found that e-cigarette use was associated with having had a myocardial infarction, but this association significantly varied on the basis of one's smoking history. With a host of demographic and clinical variables controlled, e-cigarette use was associated with lifetime myocardial infarction occurrence only among current smokers. A counterfactual analysis first removed all (current or former) e-cigarette‒using respondents who had suffered a myocardial infarction without a history of smoking. The independent-effects model used in previous research misleadingly indicated that daily vaping increases never smokers' odds of having had a myocardial infarction by 1.55 (95% CI=1.11, 2.15), even though no such myocardial infarction sufferers remained in the analyzed data. The association between myocardial infarction and vaping daily has shown a significant annual decline (AOR=0.81, 95% CI=0.67, 0.98). CONCLUSIONS There is no reliable evidence that e-cigarette use is associated with ever having had a myocardial infarction among never smokers. Contrary to concerns that the harms associated with e-cigarettes are only now emerging after more years of possible product use, the only evidence of time-dependent variation in the association between e-cigarette use and myocardial infarction ran counter to this possibility. The scientific community must insist that researchers engage in accurate public communication of peer-reviewed findings.
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Affiliation(s)
- Clayton R Critcher
- Haas School of Business, University of California, Berkeley, Berkeley, California.
| | - Michael Siegel
- Department of Community Health Sciences, School of Public Health, Boston University, Boston, Massachusetts
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Bricknell RA, Ducaud C, Figueroa A, Schwarzman LS, Rodriguez P, Castro G, Zevallos JC, Barengo NC. An association between electronic nicotine delivery systems use and a history of stroke using the 2016 behavioral risk factor surveillance system. Medicine (Baltimore) 2021; 100:e27180. [PMID: 34516517 PMCID: PMC8428735 DOI: 10.1097/md.0000000000027180] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Revised: 07/29/2021] [Accepted: 08/20/2021] [Indexed: 01/05/2023] Open
Abstract
ABSTRACT Electronic nicotine delivery systems (ENDS) are growing in use and many of the health implications with these devices remain unknown. This study aims to assess, using a survey representative of the USA general population, if an association exists between a history of ENDS use and a history of stroke.This cross-sectional study was a secondary data analysis using the 2016 behavioral risk factor surveillance system survey. The main exposure variable of the study was a self-reported history of ENDS use. The main outcome was a self-reported history of stroke. Covariates included sex, race, traditional cigarette use, smokeless tobacco use, chronic kidney disease, diabetes, myocardial infarction, and coronary artery disease. Unadjusted and adjusted logistic regression analyses were done. Adjusted odds ratios (AOR) and their corresponding 95% confidence intervals (CI) were calculated.Of the 486,303 total behavioral risk factor surveillance system survey participants, 465,594 met the inclusion criteria for this study of ENDS use and stroke. This study shows that current ENDS use was positively associated with a history of stroke. AOR of some daily ENDS use with stroke was 1.28 (95% CI: 1.02-1.61) and AOR of current daily ENDS use with stroke was 1.62 (95% CI: 1.18-2.31). The majority (55.9%) of current daily ENDS users reported former traditional cigarette smoking. Female sex, non-white ethnicity, elderly age, chronic kidney disease, coronary artery disease, diabetes, and traditional cigarette use characteristics were all also associated with increased odds of reporting a stroke.This study found a statistically significant and positive association between ENDS use and a history of stroke. Further research is warranted to investigate the reproducibility and temporality of this association. Nevertheless, this study contributes to the growing body of knowledge about the potential cardiovascular concerns related to ENDS use and the need for large cohort studies.
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Affiliation(s)
| | | | | | | | - Pura Rodriguez
- Department of Translational Medicine, Herbert Wertheim College of Medicine, Florida International University, Miami, FL
| | - Grettel Castro
- Department of Translational Medicine, Herbert Wertheim College of Medicine, Florida International University, Miami, FL
| | | | - Noël C. Barengo
- Department of Translational Medicine, Herbert Wertheim College of Medicine, Florida International University, Miami, FL
- Faculty of Medicine, Riga Stradins University, Riga, Latvia
- Department of Public Health, Faculty of Medicine, University of Helsinki, Helsinki, Finland
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13
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Khadanga S, Gaalema DE, Savage P, Ades PA. Underutilization of Cardiac Rehabilitation in Women: BARRIERS AND SOLUTIONS. J Cardiopulm Rehabil Prev 2021; 41:207-213. [PMID: 34158454 PMCID: PMC8243714 DOI: 10.1097/hcr.0000000000000629] [Citation(s) in RCA: 36] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
PURPOSE Despite the known benefits of cardiac rehabilitation (CR), it remains underutilized particularly among women. The aim of this review was to provide an overview regarding women in CR, addressing barriers that may affect enrollment and attendance as well as to discuss the training response and methods to optimize exercise-related benefits of CR. REVIEW METHODS The review examines original studies and meta-analyses regarding women in CR. SUMMARY Women are less likely to engage in CR compared with men, and this may be attributed to lack of referral or psychosocial barriers on the part of the patient. Furthermore, despite having lower levels of fitness, women do not improve their fitness as much as men in CR. This review summarizes the current literature and provides recommendations for providers regarding participation and adherence as well as optimal methods for exercise training for women in CR.
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Affiliation(s)
- Sherrie Khadanga
- Department of Medicine, Division of Cardiology, University of Vermont, Burlington, VT
- Departments of Psychiatry and Psychology, University of Vermont, Burlington, VT
| | - Diann E. Gaalema
- Departments of Psychiatry and Psychology, University of Vermont, Burlington, VT
- Vermont Center on Behavior and Health, University of Vermont, Burlington, VT
| | - Patrick Savage
- Department of Medicine, Division of Cardiology, University of Vermont, Burlington, VT
| | - Philip A. Ades
- Department of Medicine, Division of Cardiology, University of Vermont, Burlington, VT
- Vermont Center on Behavior and Health, University of Vermont, Burlington, VT
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14
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Reynolds LM, Zamora C, Lee UJ, Stokes AC, Benjamin EJ, Bhatnagar A, Payne TJ, Rodriguez CJ. Tobacco Use Prevalence and Transitions From 2013 to 2018 Among Adults With a History of Cardiovascular Disease. J Am Heart Assoc 2021; 10:e021118. [PMID: 34102851 PMCID: PMC8477862 DOI: 10.1161/jaha.121.021118] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Accepted: 04/26/2021] [Indexed: 11/24/2022]
Abstract
Background Although tobacco product use and transitions have been characterized in the general population, few studies have focused on individuals with established cardiovascular disease (CVD) in a population-based sample. Methods and Results We examined tobacco use prevalence and longitudinal patterns of tobacco product transitions in adults (≥18 years) of the nationally representative PATH (Population Assessment of Tobacco and Health) study, from 2013 to 2014 (Wave 1) through 2016 to 2018 (Wave 4). Prevalent CVD was classified through self-report of having had a heart attack, heart failure, stroke, or other heart condition. Factors associated with tobacco product use and transitions were investigated using survey logistic regression. We examined 2615 participants with self-reported CVD at Wave 1. Overall, 28.9% reported current tobacco use, equating to ≈6.2 million adults in the United States with prevalent CVD and current tobacco use. Among adults with CVD who are current tobacco users, the most commonly used product was cigarettes (82.8%), followed by any type of cigar (23.7%), and e-cigarette use (23.3%). E-cigarette use without concurrent cigarette use among participants with prevalent CVD was uncommon (1.1%). Factors associated with tobacco use were younger age, male sex, had lower education level, and lack of knowledge about the association between smoking and CVD. Men with prevalent CVD were less likely to use e-cigarettes compared with women (odds ratio [OR], 0.7; 95% CI, 0.5-0.9). Among cigarette users with CVD, transition rates between Waves 1 and 4 demonstrated <5% decrease in cigarette, with a 0.5% increase in e-cigarette use. Only ≈10% were in formal tobacco cessation programs. Conclusions Despite known harmful cardiovascular effects, over one fourth of adults with prevalent CVD use tobacco products and few quit smoking over the 4 waves of the PATH data set.
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Affiliation(s)
- Lindsay M. Reynolds
- Department of Epidemiology & PreventionWake Forest School of MedicineWinston‐SalemNC
| | - Cristian Zamora
- Department of Internal MedicineJacobi Medical CenterAlbert Einstein College of MedicineBronxNY
| | - Un Jung Lee
- Department of Medicine, Epidemiology and Population HealthAlbert Einstein College of MedicineBronxNY
| | - Andrew C. Stokes
- Department of Global Health and Center for Global Health and DevelopmentBoston University School of Public HealthBostonMA
| | - Emelia J. Benjamin
- Department of EpidemiologyBoston University School of Public HealthBostonMA
- Department of MedicineBoston University School of MedicineBostonMA
| | - Aruni Bhatnagar
- Department of MedicineChristina Lee Brown Envirome InstituteUniversity of LouisvilleKY
| | - Thomas J. Payne
- Department of Otolaryngology and Communicative SciencesUniversity of Mississippi Medical CenterJacksonMS
| | - Carlos J. Rodriguez
- Department of Medicine, Epidemiology and Population HealthAlbert Einstein College of MedicineBronxNY
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15
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Hisam A, Haq ZU, Khan Z, Doherty P, Pell J. Mobile Health Augmented Cardiac Rehabilitation (MCard) in Post-Acute Coronary Syndrome Patients: A randomised controlled trial protocol. Pak J Med Sci 2021; 37:890-896. [PMID: 34104184 PMCID: PMC8155414 DOI: 10.12669/pjms.37.3.3664] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Objectives To determine the effectiveness of mobile health augmented cardiac rehabilitation (MCard) on health-related quality of life (HRQoL), clinical and behavioural outcomes in post-ACS. Methods A single-centre, single-blinded, two-arm randomised controlled trial is planned at Armed Forces Institute of Cardiology (AFIC), Pakistan. The duration was two years, that is from January 2019 till December 2020. A total of 160 participants were recruited and randomly allocated to the control group or the intervention group. Intervention is a mobile health augmented cardiac rehabilitation (MCard), a medically supervised cardiac rehabilitation program for 23-24 weeks. The phase one includes individual counselling during the hospital stay and in phase two includes communication of standardised messages related to healthy lifestyle modification through a specifically designed software. Results This clinical trial results will give insight into the impact of MCard in improving the health outcomes (HRQoL, clinical and behavioural) of participants. If proven to be effective, this technology can be scaled up and implemented in other cardiac centres in the country. It utilises fewer human resources and can be delivered at a lower cost. Conclusion The study protocol will be giving evidence either MCard can contribute to improving the HRQoL, clinical and behavioural outcomes of post-ACS patients following hospital discharge. Considering the COVID-9 situation, this is the perfect time to implement and evaluate the effectiveness of MCard on health outcomes among post-ACS patients.
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Affiliation(s)
- Aliya Hisam
- Dr. Aliya Hisam, MBBS, MPH, FCPS, PhD Scholar. Department of Community Medicine Army Medical College, NUMS, Rawalpindi, Pakistan
| | - Zia Ul Haq
- Prof Zia Ul Haq, MBBS, MPH, PhD, Department of Public Health & Social Sciences, Khyber Medical University, Peshawar, Pakistan
| | - Zohaib Khan
- Dr. Zohaib Khan, MBBS, PhD, Department of Public Health & Social Sciences, Khyber Medical University, Peshawar, Pakistan
| | - Patrick Doherty
- Dr. Patrick Doherty, PhD. Department of Health Sciences, University of York, United Kingdom
| | - Jill Pell
- Prof. Jill Pell, MBChB, MD, FFPH. Institutes of Health & Wellbeing, University of Glasgow, United Kingdom
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16
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Bolívar HA, Elliott RJ, Middleton W, Yoon JH, Okoli CTC, Haliwa I, Miller CC, Ades PA, Gaalema DE. Social Smoking Environment and Associations With Cardiac Rehabilitation Attendance. J Cardiopulm Rehabil Prev 2021; 41:46-51. [PMID: 32925296 PMCID: PMC7755730 DOI: 10.1097/hcr.0000000000000518] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
PURPOSE Continued cigarette smoking after a major cardiac event predicts worse health outcomes and leads to reduced participation in cardiac rehabilitation (CR). Understanding which characteristics of current smokers are associated with CR attendance and smoking cessation will help improve care for these high-risk patients. We examined whether smoking among social connections was associated with CR participation and continued smoking in cardiac patients. METHODS Participants included 149 patients hospitalized with an acute cardiac event who self-reported smoking prior to the hospitalization and were eligible for outpatient CR. Participants completed a survey on their smoking habits prior to hospitalization and 3 mo later. Participants were dichotomized into two groups by the proportion of friends or family currently smoking ("None-Few" vs "Some-Most"). Sociodemographic, health, secondhand smoke exposure, and smoking measures were compared using t tests and χ2 tests (P < .05). ORs were calculated to compare self-reported rates of CR attendance and smoking cessation at 3-mo follow-up. RESULTS Compared with the "None-Few" group, participants in the "Some-Most" group experienced more secondhand smoke exposure (P < .01) and were less likely to attend CR at follow-up (OR = 0.40; 95% CI, 0.17-0.93). Participants in the "Some-Most" group tended to be less likely to quit smoking, but this difference was not statistically significant. CONCLUSION Social environments with more smokers predicted worse outpatient CR attendance. Clinicians should consider smoking within the social network of the patient as an important potential barrier to pro-health behavior change.
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Affiliation(s)
- Hypatia A Bolívar
- Vermont Center on Behavior and Health (Drs Bolívar, Ades, and Gaalema, Ms Elliott, and Mr Middleton) and Departments of Psychiatry (Drs Bolívar and Gaalema and Ms Elliott) and Psychology (Mr Middleton and Dr Gaalema), University of Vermont, Burlington; Departments of Psychiatry and Behavioural Sciences (Dr Yoon and Ms Haliwa) and Cardiothoracic and Vascular Surgery (Dr Miller), University of Texas Health Science at Houston; College of Nursing, University of Kentucky, Lexington (Dr Okoli); and Division of Cardiology, University of Vermont College of Medicine, Burlington (Dr Ades)
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17
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Gaalema DE, Bolívar HA, Khadanga S, Priest JS, Higgins ST, Ades PA. Current smoking as a marker of a high-risk behavioral profile after myocardial infarction. Prev Med 2020; 140:106245. [PMID: 32910931 PMCID: PMC7680426 DOI: 10.1016/j.ypmed.2020.106245] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Revised: 08/25/2020] [Accepted: 08/28/2020] [Indexed: 11/28/2022]
Abstract
Continued smoking following myocardial infarction (MI) is strongly associated with increased morbidity and mortality. Patients who continue to smoke may also engage in other behaviors that exacerbate risk. This study sought to characterize the risk profile of a national sample of individuals with previous MI who currently smoke. Data were taken from the 2017 Behavioral Risk Factor Surveillance Survey (United States), with 4.2% of the sample reporting a past MI (N = 26,004). Participants were classified by smoking status (current/former/never) and compared on medical comorbidities and the clustering of modifiable behaviors relevant for secondary prevention (smoking, poor nutrition, problematic alcohol use, physical inactivity, medication adherence). Current smokers were more likely to report other comorbidities including stroke, chronic obstructive pulmonary disease, physical limitations, and poor mental health. Smokers were also less likely to report taking blood pressure and cholesterol medications, and less likely to attend cardiac rehabilitation (examined in a subset of the sample, N = 2181). Current smoking remained an independent predictor of other health-related behaviors even when controlling for age, sex, race, educational attainment, and other comorbidities. In the modifiable risk-factor behavior cluster analysis, the most common pattern among current smokers was having two risk factors, smoking plus one additional risk factor, whereas the most common pattern was zero risk factors among never or former-smokers. Physical inactivity was the most common additional risk factor across smoking statuses. Current smoking is associated with multiple comorbidities and should be considered a marker for a high-risk behavioral profile among patients with a history of MI.
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Affiliation(s)
- Diann E Gaalema
- Vermont Center on Behavior and Health, United States; University of Vermont, Burlington, VT, United States.
| | - Hypatia A Bolívar
- Vermont Center on Behavior and Health, United States; University of Vermont, Burlington, VT, United States
| | - Sherrie Khadanga
- Vermont Center on Behavior and Health, United States; University of Vermont, Burlington, VT, United States; University of Vermont Medical Center, Burlington, VT, United States
| | - Jeffrey S Priest
- Vermont Center on Behavior and Health, United States; University of Vermont, Burlington, VT, United States
| | - Stephen T Higgins
- Vermont Center on Behavior and Health, United States; University of Vermont, Burlington, VT, United States
| | - Philip A Ades
- Vermont Center on Behavior and Health, United States; University of Vermont, Burlington, VT, United States; University of Vermont Medical Center, Burlington, VT, United States
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18
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Gathright EC, Wu WC, Scott-Sheldon LAJ. Electronic cigarette use among heart failure patients: Findings from the Population Assessment of Tobacco and Health study (Wave 1: 2013-2014). Heart Lung 2020; 49:229-232. [PMID: 31812280 PMCID: PMC7266714 DOI: 10.1016/j.hrtlng.2019.11.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2019] [Revised: 11/18/2019] [Accepted: 11/20/2019] [Indexed: 11/29/2022]
Abstract
BACKGROUND Smoking cessation is recommended for adults with heart failure (HF). The prevalence of e-cigarette use among adults with HF is unknown. OBJECTIVE To determine prevalence of and reasons for e-cigarette use among adults with HF. METHODS Data from the Population Assessment of Tobacco and Health Study (Wave 1) were examined. RESULTS Of 484 respondents with HF, 1% (weighted) reported current e-cigarette use, and 5% (weighted) reported dual cigarette/e-cigarette use. Adults with HF had higher odds of dual use (OR = 1.76, 95% CI: 1.22-2.54) compared to those without HF, controlling for age, sex, race, and income. Dual users with HF reported using e-cigarettes because they may be less harmful to nearby people and to themselves than cigarettes. CONCLUSIONS E-cigarette use should be assessed and monitored to understand the safety and potential efficacy of e-cigarettes as a harm reduction approach for HF patients.
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Affiliation(s)
- Emily C Gathright
- Centers for Behavioral and Preventive Medicine, The Miriam Hospital, CORO Building, Suite 309, 164 Summit Avenue, Providence, RI 02906, United States; Department of Psychiatry and Human Behavior, Alpert School of Medicine, Brown University, Providence, RI, United States.
| | - Wen-Chih Wu
- Center forCardiac Fitness, The Miriam Hospital, Providence, RI, United States; Department of Medicine, Alpert School of Medicine, Brown University, Providence, RI, United States; Veterans Affairs Hospital, Providence, RI, United States
| | - Lori A J Scott-Sheldon
- Centers for Behavioral and Preventive Medicine, The Miriam Hospital, CORO Building, Suite 309, 164 Summit Avenue, Providence, RI 02906, United States; Department of Psychiatry and Human Behavior, Alpert School of Medicine, Brown University, Providence, RI, United States; Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI, United States
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19
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Higgins ST, Kurti AN, Palmer M, Tidey JW, Cepeda-Benito A, Cooper MR, Krebs NM, Baezconde-Garbanati L, Hart JL, Stanton CA. A review of tobacco regulatory science research on vulnerable populations. Prev Med 2019; 128:105709. [PMID: 31054904 PMCID: PMC6824984 DOI: 10.1016/j.ypmed.2019.04.024] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Revised: 04/22/2019] [Accepted: 04/28/2019] [Indexed: 12/15/2022]
Abstract
In 2013 the U.S. Food and Drug Administration and National Institutes of Health established fourteen Tobacco Centers of Regulatory Science (TCORS) to advance scientific knowledge relevant to conducting evidence-based tobacco regulation. This report reviews TCORS-funded research with adult vulnerable populations. The literature search included a list of all TCORS-funded publications compiled by the TCORS coordinating center; all TCORS were requested to share publications not in the coordinating-center's list. Only TCORS-funded reports describing an empirical study with an adult vulnerable population published in a peer-reviewed journal between September 2013 and June 2018 were included. 71 reports met inclusion criteria; 39% (28/71) examined tobacco use among those with mental health and medical comorbidities, 34% (24/71) socioeconomic disadvantage, 31% (22/71) women of reproductive age, 30% (21/71) racial/ethnic minorities, 18% (13/71) rural residents, and 3% (2/71) each among active military/veterans and sexual/gender minorities. Regarding scientific domains, 63% (45/71) investigated behavior, 37% (26/71) addiction, 24% (17/71) health effects, 20% (14/71) impact analyses, 18% (13/71) toxicity, 8% (6/71) marketing influences, and 7% (5/71) communications. Totals exceed 100% because some reports addressed multiple populations/domains. TCORS funding has generated a substantial, multidisciplinary body of new scientific knowledge on tobacco use in adult vulnerable populations. However, considerable variability was noted in the amount of research conducted across the various vulnerable populations and scientific domains. Most notably, relatively few studies focused on active military/veterans or sexual/gender minorities, and the scientific domains of marketing influences and communications were conspicuously underrepresented. These are important knowledge gaps to address going forward.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Joy L Hart
- University of Louisville, United States of America
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20
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Bhatta DN, Glantz SA. Electronic Cigarette Use and Myocardial Infarction Among Adults in the US Population Assessment of Tobacco and Health. J Am Heart Assoc 2019; 8:e012317. [PMID: 31165662 PMCID: PMC6645634 DOI: 10.1161/jaha.119.012317] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2018] [Accepted: 04/30/2019] [Indexed: 12/21/2022]
Abstract
Background E-cigarettes are popular for smoking cessation and as an alternative to combustible cigarettes. We assess the association between e-cigarette use and having had a myocardial infarction ( MI ) and whether reverse causality can explain the observed cross-sectional association between e-cigarette use and MI . Methods and Results Cross-sectional analysis of the Population Assessment of Tobacco and Health Wave 1 for association between e-cigarette use and having had and MI . Longitudinal analysis of Population Assessment of Tobacco and Health Waves 1 and 2 for reverse causality analysis. Logistic regression was performed to determine the associations between e-cigarette initiation and MI , adjusting for cigarette smoking, demographic and clinical variables. Every-day (adjusted odds ratio, 2.25, 95% CI : 1.23-4.11) and some-day (1.99, 95% CI : 1.11-3.58) e-cigarette use were independently associated with increased odds of having had an MI with a significant dose-response ( P<0.0005). Odds ratio for daily dual use of both products was 6.64 compared with a never cigarette smoker who never used e-cigarettes. Having had a myocardial infarction at Wave 1 did not predict e-cigarette use at Wave 2 ( P>0.62), suggesting that reverse causality cannot explain the cross-sectional association between e-cigarette use and MI observed at Wave 1. Conclusions Some-day and every-day e-cigarette use are associated with increased risk of having had a myocardial infarction, adjusted for combustible cigarette smoking. Effect of e-cigarettes are similar as conventional cigarette and dual use of e-cigarettes and conventional cigarettes at the same time is risker than using either product alone.
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Affiliation(s)
- Dharma N. Bhatta
- Center for Tobacco Control Research and EducationUniversity of California, San FranciscoSan FranciscoCA
- Helen Diller Family Comprehensive Cancer CenterUniversity of California, San FranciscoSan FranciscoCA
| | - Stanton A. Glantz
- Center for Tobacco Control Research and EducationUniversity of California, San FranciscoSan FranciscoCA
- Helen Diller Family Comprehensive Cancer CenterUniversity of California, San FranciscoSan FranciscoCA
- Department of Medicine (Cardiology)Cardiovascular Research Institute, and Philip R Lee Institute for Health Policy StudiesUniversity of California, San FranciscoSan FranciscoCA
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21
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Alzahrani T, Pena I, Temesgen N, Glantz SA. E-cigarettes: Stick to the Evidence. Am J Prev Med 2019; 56:160-161. [PMID: 30573144 PMCID: PMC9635843 DOI: 10.1016/j.amepre.2018.09.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2018] [Revised: 09/03/2018] [Accepted: 09/04/2018] [Indexed: 01/03/2023]
Affiliation(s)
- Talal Alzahrani
- Department of Medicine, George Washington University, Washington, District of Columbia; Department of Medicine, Cardiovascular Research Institute, Philip R. Lee Institute for Health Policy Studies, Center for Tobacco Control Research and Education, University of California, San Francisco San Francisco, California
| | - Ivan Pena
- Department of Medicine, George Washington University, Washington, District of Columbia; Department of Medicine, Cardiovascular Research Institute, Philip R. Lee Institute for Health Policy Studies, Center for Tobacco Control Research and Education, University of California, San Francisco San Francisco, California
| | - Nardos Temesgen
- Department of Medicine, George Washington University, Washington, District of Columbia; Department of Medicine, Cardiovascular Research Institute, Philip R. Lee Institute for Health Policy Studies, Center for Tobacco Control Research and Education, University of California, San Francisco San Francisco, California
| | - Stanton A Glantz
- Department of Medicine, George Washington University, Washington, District of Columbia; Department of Medicine, Cardiovascular Research Institute, Philip R. Lee Institute for Health Policy Studies, Center for Tobacco Control Research and Education, University of California, San Francisco San Francisco, California
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Abstract
This Special Issue of Preventive Medicine (PM) is the 5th in a series on behavior change, health, and health disparities. Unhealthy behavior patterns (i.e., lifestyle choices) including cigarette smoking and other substance abuse, physical inactivity, unhealthy food choices, and non-adherence with recommended medical regimens, undermine U.S. population health by increasing risk for chronic disease and premature death. This Special Issue brings together scholarly contributions from the emerging area of tobacco regulatory science to examine current topics of critical importance to reducing the burden of cigarette smoking on U.S. population health. More specifically, three related topics are examined including (a) the potential for reducing smoking by adopting a national policy that would cap the nicotine content of cigarettes at minimally-addictive levels; (b) increasing scientific understanding of cigarette smoking and other tobacco use among populations that are especially vulnerable to initiating smoking, tobacco addiction, and its adverse health consequences; and (c) the potential of a harm-reduction strategy for reducing the burden of smoking by advocating that those who are unwilling or unable to quit nicotine use substitute electronic cigarettes or other non-combusted sources of nicotine for cigarettes in order to avoid exposure to the other toxins in tobacco smoke that are most responsible for smoking morbidity and mortality. While tremendous progress has been made in reducing overall U.S. smoking prevalence and its adverse health impacts, more needs to be done. This Special Issue offers some ideas that have the potential to make a substantive contribution towards that goal.
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Affiliation(s)
- Stephen T Higgins
- Vermont Center on Behavior and Health, Departments of Psychiatry and Psychological Science, University of Vermont.
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23
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Streck JM, Bergeria CL, Parker MA, Davis DR, DeSarno M, Sigmon SC, Hughes JR, Gaalema DE, Heil SH, Tidey JW, Stitzer ML, Rothman M, Higgins ST. Response to reduced nicotine content cigarettes among smokers with chronic health conditions. Prev Med Rep 2018; 12:321-329. [PMID: 30416951 PMCID: PMC6224320 DOI: 10.1016/j.pmedr.2018.10.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2018] [Revised: 09/30/2018] [Accepted: 10/13/2018] [Indexed: 12/15/2022] Open
Abstract
Individuals with chronic health conditions persist in smoking despite the presence of smoking-related illness. The aim of this study was to examine whether chronic health conditions moderate response to reduced nicotine content cigarettes (0.4, 2.4, 5.2, 15.8 mg/g of tobacco). This is a secondary analysis of a controlled clinical laboratory study that examined the acute effects of cigarettes varying in nicotine content among individuals especially vulnerable to smoking and tobacco dependence. Participants in the present study were categorized as having 0, 1–2, or ≥3 smoking-related chronic health conditions (i.e., chronic condition severity, CCS). Repeated-measures analysis of variance was used to examine whether CCS moderated response to cigarettes across measures of addiction potential (i.e., concurrent choice testing between nicotine dose pairs, Cigarette Purchase Task (CPT) performance, positive subjective effects), tobacco withdrawal, cigarette craving, and smoking topography. No main effects of CCS or interactions of CCS and nicotine dose were observed for concurrent choice testing, positive subjective effects, tobacco withdrawal, or smoking topography. Main effects of CCS were noted on the CPT with greater CCS being associated with less persistent demand. There was an interaction of CCS and nicotine dose on Factor 1 of the Questionnaire on Smoking Urges with the effects of dose significant only among those with 1–2 chronic conditions. Overall, we see minimal evidence that chronic condition severity affects response to reduced nicotine content cigarettes. A policy that reduces the nicotine content of cigarettes to minimally addictive levels may benefit smokers already experiencing smoking-related chronic conditions.
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Affiliation(s)
- Joanna M Streck
- Vermont Center on Tobacco Regulatory Science, Departments of Psychiatry and Psychological Science, University of Vermont, Burlington, VT, United States of America
| | - Cecilia L Bergeria
- Vermont Center on Tobacco Regulatory Science, Departments of Psychiatry and Psychological Science, University of Vermont, Burlington, VT, United States of America
| | - Maria A Parker
- Vermont Center on Tobacco Regulatory Science, Departments of Psychiatry and Psychological Science, University of Vermont, Burlington, VT, United States of America
| | - Danielle R Davis
- Vermont Center on Tobacco Regulatory Science, Departments of Psychiatry and Psychological Science, University of Vermont, Burlington, VT, United States of America
| | - Michael DeSarno
- Vermont Center on Tobacco Regulatory Science, Departments of Psychiatry and Psychological Science, University of Vermont, Burlington, VT, United States of America
| | - Stacey C Sigmon
- Vermont Center on Tobacco Regulatory Science, Departments of Psychiatry and Psychological Science, University of Vermont, Burlington, VT, United States of America
| | - John R Hughes
- Vermont Center on Tobacco Regulatory Science, Departments of Psychiatry and Psychological Science, University of Vermont, Burlington, VT, United States of America
| | - Diann E Gaalema
- Vermont Center on Tobacco Regulatory Science, Departments of Psychiatry and Psychological Science, University of Vermont, Burlington, VT, United States of America
| | - Sarah H Heil
- Vermont Center on Tobacco Regulatory Science, Departments of Psychiatry and Psychological Science, University of Vermont, Burlington, VT, United States of America
| | - Jennifer W Tidey
- Center for Alcohol and Addiction Studies, Brown University, Providence, RI, United States of America
| | - Maxine L Stitzer
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, United States of America
| | - Matthew Rothman
- Vermont Center on Tobacco Regulatory Science, Departments of Psychiatry and Psychological Science, University of Vermont, Burlington, VT, United States of America
| | - Stephen T Higgins
- Vermont Center on Tobacco Regulatory Science, Departments of Psychiatry and Psychological Science, University of Vermont, Burlington, VT, United States of America
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24
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Pipe AL, Reid RD. Smoking Cessation and Cardiac Rehabilitation: A Priority! Can J Cardiol 2018; 34:S247-S251. [DOI: 10.1016/j.cjca.2018.07.416] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2018] [Revised: 07/13/2018] [Accepted: 07/13/2018] [Indexed: 12/11/2022] Open
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