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Park E, Kang HY, Lim MK, Kim B, Oh JK. Cancer Risk Following Smoking Cessation in Korea. JAMA Netw Open 2024; 7:e2354958. [PMID: 38319658 PMCID: PMC10848071 DOI: 10.1001/jamanetworkopen.2023.54958] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Accepted: 12/14/2023] [Indexed: 02/07/2024] Open
Abstract
Importance Tobacco smoking is associated with increased risk of various cancers, and smoking cessation has been associated with reduced cancer risks, but it is still unclear how many years of smoking cessation are required to significantly reduce the cancer risk. Therefore, investigating the association of smoking cessation with cancer is essential. Objective To investigate the time course of cancer risk according to the time elapsed since smoking cessation and the benefits of smoking cessation according to the age at quitting. Design, Setting, and Participants This population-based, retrospective cohort study included Korean participants aged 30 years and older who underwent 2 or more consecutive health examinations under the National Health Insurance Service since 2002 and were followed-up until 2019. Data analysis was performed from April to September 2023. Exposures Exposures included (1) time-updated smoking status based on biennial changes in smoking status, defined as complete quitters, transient quitters, relapsed quitters, continuous smokers, and never smokers; (2) duration of smoking cessation, defined as years since quitting; and (3) categorical variable for age at quitting. Main Outcomes and Measures The primary cancer was ascertained using the cancer registry data: all-site cancer (International Statistical Classification of Diseases and Related Health Problems, Tenth Revision [ICD-10] codes C00-43, C45-96, or D45-D47), lung cancer (ICD-10 code C34), liver cancer (ICD-10 code C22), stomach cancer (ICD-10 code C16), and colorectal cancer (ICD-10 codes C18-20). Hazard ratios (HRs) and 95% CIs were estimated using a Cox proportional hazards regression model with follow-up years as the timescale. Results Of the 2 974 820 participants, 1 727 340 (58.1%) were men (mean [SD] age, 43.1 [10.0] years), and 1 247 480 (41.9%) were women (mean [SD] age, 48.5 [9.9] years). Over a mean (SD) follow-up of 13.4 (0.1) years, 196 829 cancer cases were confirmed. Compared with continuous smokers, complete quitters had a lower risk of cancer, with HRs of 0.83 (95% CI, 0.80-0.86) for all cancer sites, 0.58 (95% CI, 0.53-0.62) for lung, 0.73 (95% CI, 0.64-0.82) for liver, 0.86 (95% CI, 0.79-0.93) for stomach, and 0.80 (95% CI, 0.72-0.89) for colorectum. The cancer risk exhibited a slightly higher value for 10 years after quitting compared with continued smoking and then it decreased over time, reaching 50% of the risk associated with continued smoking after 15 or more years. Lung cancer risk decreased 3 years earlier than that of other cancer types, with a larger relative reduction. Regardless of quitting age, a significant reduction in the cancer risk was observed. Quitting before the age of 50 years was associated with a greater reduction in lung cancer risk (HR, 0.43; 95% CI, 0.35-0.53) compared with quitting at age 50 years or later (HR, 0.61; 95% CI, 0.56-0.66). Conclusions and Relevance In this population-based retrospective cohort study, sustained smoking cessation was associated with significantly reduced risk of cancer after 10 years since quitting. Quitting at any age helped reduce the cancer risk, and especially for lung cancer, early cessation before middle age exhibited a substantial risk reduction.
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Affiliation(s)
- Eunjung Park
- Department of Cancer Control and Population Health, National Cancer Center Graduate School of Cancer Science and Policy, Goyang, Republic of Korea
- Division of Cancer Prevention, National Cancer Control Institute, National Cancer Center, Goyang, Republic of Korea
| | - Hee-Yeon Kang
- Department of Cancer Control and Population Health, National Cancer Center Graduate School of Cancer Science and Policy, Goyang, Republic of Korea
- Division of Cancer Prevention, National Cancer Control Institute, National Cancer Center, Goyang, Republic of Korea
| | - Min Kyung Lim
- Department of Social and Preventive Medicine, Inha University College of Medicine, Incheon, Republic of Korea
| | - Byungmi Kim
- Division of Cancer Prevention, National Cancer Control Institute, National Cancer Center, Goyang, Republic of Korea
| | - Jin-Kyoung Oh
- Department of Cancer Control and Population Health, National Cancer Center Graduate School of Cancer Science and Policy, Goyang, Republic of Korea
- Division of Cancer Prevention, National Cancer Control Institute, National Cancer Center, Goyang, Republic of Korea
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Smith P, Quinn-Scoggins H, Murray RL, McCutchan G, Nelson A, Moore G, Callister M, Tong H, Brain K. Barriers and facilitators to engaging in smoking cessation support among lung screening participants. Nicotine Tob Res 2023:ntad245. [PMID: 38071660 DOI: 10.1093/ntr/ntad245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Indexed: 03/01/2024]
Abstract
INTRODUCTION Embedded smoking cessation support within lung cancer screening is recommended in the UK; however, little is known about why individuals decline smoking cessation support in this setting. This study identified psychosocial factors that influence smoking cessation and quit motivation among those who declined support for quitting smoking alongside lung cancer screening. METHODS Qualitative interviews conducted between August 2019 - April 2021 with thirty adults with a smoking history, recruited from the Yorkshire Lung Screening Trial. Participants had declined smoking cessation support. Verbatim interview transcripts were thematically analysed. RESULTS Fifty percent of participants were male and the majority were from the most deprived groups. Participants reported low motivation and a variety of barriers to stopping smoking. Participants described modifiable behavioural factors that influenced their quit motivation including self-efficacy, perceived effectiveness of stop-smoking services including smoking cessation aids, risk-minimising beliefs, lack of social support, absence of positive influences on smoking and beliefs about smoking/smoking cessation. Broader contextual factors included social isolation and stigma, COVID-19 and comorbid mental and physical health conditions that deterred smoking cessation. CONCLUSIONS To encourage engagement in smoking cessation support during lung cancer screening, interventions should seek to encourage positive beliefs about the effectiveness of smoking cessation aids and increase confidence in quitting as part of supportive, person-centred care. Interventions should also acknowledge the wider social determinants of health among the lung screening-eligible population. IMPLICATIONS This study provides an in-depth understanding of the beliefs surrounding smoking and smoking cessation and further potential psychosocial factors that influence those attending lung cancer screening. Many of the barriers to smoking cessation found in the present study are similar to those outside of a lung screening setting however this work offers an understanding of potential facilitators that should be considered in future lung screening programmes.
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Affiliation(s)
- Pamela Smith
- Cardiff University, Division of Population Medicine, Heath Park, Cardiff, UK
| | | | - Rachael L Murray
- University of Nottingham, Division of Epidemiology and Public Health Clinical Sciences, Nottingham City Hospital
| | - Grace McCutchan
- Cardiff University, Division of Population Medicine, Heath Park, Cardiff, UK
| | - Annmarie Nelson
- Cardiff University, Marie Curie Research Centre, Cardiff, UK
| | - Graham Moore
- Cardiff University, School of Social Sciences, 1-3 Museum Place, Cardiff, UK
| | - Mat Callister
- Department of Respiratory Medicine, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Hoang Tong
- Cardiff University, Division of Population Medicine, Heath Park, Cardiff, UK
| | - Kate Brain
- Cardiff University, Division of Population Medicine, Heath Park, Cardiff, UK
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Magaldino A, Dang C, In E, Nguyen K, Nguyen OT, Motwani K, Feller DB. Patient-Level Characteristics Associated with Tobacco Users and Nonusers at a Student-Run Free Clinic. South Med J 2023; 116:906-912. [PMID: 37913811 PMCID: PMC10624112 DOI: 10.14423/smj.0000000000001614] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2023]
Abstract
OBJECTIVES Many tobacco users are motivated to quit but lack the resources to do so. To date, studies characterizing tobacco users at student-run free clinics have used small sample sizes, which may not be large enough to detect differences across key variables. As such, we assessed sociodemographic differences between tobacco users and nonusers at a student-run free clinic using a pooled cross-sectional design. METHODS We used patient-level data from the electronic health records for all of the patients who were seen during January 2012 to February 2020 inclusive. Our dependent variable was whether patients self-reported tobacco use. We assessed for differences across age, sex, race/ethnicity, and education level using a multivariable logistic regression model. RESULTS Across 4264 patients, 28.7% reported tobacco use. When controlling for other factors, greater odds of tobacco use were observed in this cohort for patients who were male (odds ratio [OR] 1.690, 95% confidence interval [CI] 1.468-1.944), those with educational attainment of 9th to 11th grade (OR 2.291, 95% CI 1.558-3.369), and those who were high school graduates/completed the General Education Development test (OR 1.849, 95% CI 1.295-2.638) compared with those with less than a high school education. Similarly, patients of older age had greater odds of tobacco use. CONCLUSIONS Our study found patient-level differences that may need to be integrated into improving the reach of intervention methods. Future research should look at a broader set of metrics (eg, geographic location, socioeconomic status) and ascertain reasons for sociodemographic differences observed.
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Affiliation(s)
- Alexandra Magaldino
- Department of Community Health & Family Medicine, University of Florida, Gainesville
| | - Corina Dang
- Department of Community Health & Family Medicine, University of Florida, Gainesville
| | - Emily In
- Department of Community Health & Family Medicine, University of Florida, Gainesville
| | - Ken Nguyen
- Department of Community Health & Family Medicine, University of Florida, Gainesville
| | - Oliver T. Nguyen
- Department of Health Outcomes and Behavior, H. Lee Moffitt Cancer Center & Research Institute, Tampa, Florida
| | - Kartik Motwani
- Department of Community Health & Family Medicine, University of Florida, Gainesville
| | - David B. Feller
- Department of Community Health & Family Medicine, University of Florida, Gainesville
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Nguyen NLT, Dang NDT, Vu QVAN, Dang AK, Ta TVAN. A Model for Gastric Cancer Risk Prediction Based on MUC1 Polymorphisms and Health-risk Behaviors in a Vietnamese Population. In Vivo 2023; 37:2347-2356. [PMID: 37652501 PMCID: PMC10500499 DOI: 10.21873/invivo.13339] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2023] [Revised: 07/02/2023] [Accepted: 07/05/2023] [Indexed: 09/02/2023]
Abstract
BACKGROUND/AIM Although the expression of mucin 1(MUC1) and prostate stem cell antigen (PSCA) genes is correlated with gastric cancer development and progression, the utility of these two genes as biomarkers of gastric cancer prognosis still needs to be confirmed in clinical practice. This study aimed to develop a model predictive of gastric cancer that integrates several significant single nucleotide polymorphisms (SNPs) of MUC1 and PSCA genes, and some health-risk behavior factors in a Vietnamese population. PATIENTS AND METHODS A total of 302 patients with primary gastric carcinoma and 304 healthy persons were included in a case-control study. The generalized linear model was used with the profile of age, sex, history of smoking and using alcohol, personal and family medical history of stomach diseases, and the SNPs of MUC1 and PSCA. The prognostic value of the model was assessed by the area under a receiver operating characteristic curve (AUC) and Akaike Information Criterion (AIC) values. RESULTS In male participants, the final model, consisting of age, sex, history of smoking and using alcohol, personal and family medical history of stomach diseases and SNP MUC1 rs4072037, provided acceptable discrimination, with an AUC of 0.6374 and the lowest AIC value (539.53). In female participants, the predictive model including age, sex, history of smoking and using alcohol, personal and family medical history of stomach diseases, SNPs MUC1 rs4072037 and rs2070803 had an AUC of 0.6937 and AIC of 266.80. The calibration plots of the male model approximately fitted the ideal calibration line. CONCLUSION The predictive model based on age, sex, medical history, and genetic and health-risk behavior factors has a high potential in determining gastric cancer. Further studies that elucidate other genetic variants should be carried out to define high-risk gastric cancer groups and propose appropriate personalized prevention.
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Affiliation(s)
| | - Ngoc Dung Thi Dang
- Hanoi Medical University Hospital, Hanoi Medical University, Hanoi, Vietnam;
| | - Quy VAN Vu
- Hanoi Medical University Hospital, Hanoi Medical University, Hanoi, Vietnam
| | - Anh Kim Dang
- School of Preventive Medicine and Public Health, Hanoi Medical University, Hanoi, Vietnam
| | - Thanh-VAN Ta
- Hanoi Medical University Hospital, Hanoi Medical University, Hanoi, Vietnam;
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Feng X. Integrative analysis of GWAS and transcriptomics data reveal key genes for non-small lung cancer. Med Oncol 2023; 40:270. [PMID: 37592093 DOI: 10.1007/s12032-023-02139-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Accepted: 07/25/2023] [Indexed: 08/19/2023]
Abstract
Lung cancer is one of the world's most common and deadly cancers. The two main types of lung cancer are non-small cell lung cancer (NSCLC) and small cell lung cancer (SCLC). More than 85% of lung cancers are NSCLC. Genetic factors play a significant role in the risk of NSCLC. Growing studies focus on studying risk factors at the molecular level. The aim of the study is to build a pipeline to integrate Genome-wide association analysis (GWAS) and transcriptomics data with machine learning to effectively identify genetic risk factors of NSCLC. GWAS datasets and GWAS summary data were downloaded from GWAS catalog, which include lung carcinoma genetic variants among the European population. Then, with the GWAS summary, data functional analysis of significant SNPs was performed using a webserver called FUMAGWAS. The transcriptomics data of NSCLC and non-NSCLC people were used to build a machine learning model to identify the key genes that help predict the NSCLC. The top up-regulation and down-regulation genes were identified by the BART cancer webserver, and the mechanistic roles of the genes were validated by literature review. By performing integrative analysis of GWAS and transcriptomics analysis using machine learning, we identified multiple SNPs and genes that related to NSCLC. The computational pipeline may facilitate the biomarker discovery for NSCLC and other diseases.
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Affiliation(s)
- Xiangxiong Feng
- University of California Davis, Shields Avenue, Davis, CA, 95616, USA.
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Nguyen TG, Kieu HD, Truong DTT, Ngo KX, Ikeda S, Le NT. Exclusive waterpipe smoking and the risk of nasopharynx cancer in Vietnamese men, a prospective cohort study. Sci Rep 2023; 13:13237. [PMID: 37580413 PMCID: PMC10425396 DOI: 10.1038/s41598-023-40253-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Accepted: 08/07/2023] [Indexed: 08/16/2023] Open
Abstract
Tobacco smoking is carcinogenic to humans. Besides cigarettes, the most common form of tobacco smoking, there was sparse evidence of waterpipe's carcinogenicity-induced nasopharyngeal cancer (NPC). This study investigated the association between waterpipe smoking and NPC mortality. Our study followed up with 20,144 eligible man participants from nine northern Vietnam communes between 2007 and 2019. Face-to-face interviews were conducted to gather data on exclusive waterpipe and cigarette smoking and dietary intake using structured semi-quantitative food frequency and lifestyle questionnaires. Nasopharyngeal cancer was determined by accessing the medical records at the state health facilities. We estimated the Cox proportional hazard ratio and 95% confidence intervals, HR (95% CI). The proportion of never smokers, exclusive waterpipe, exclusive cigarette, and dual waterpipe and cigarette smokers was 55.8%, 14.5%, 16.6%, and 13.1%, respectively. Exclusively waterpipe smokers increased the risk of NPC death compared to exclusively cigarette smokers, HR (95% CI): 4.51 (1.25, 16.31), p = 0.022. A dose-dependent positive relationship between NPC and exclusive waterpipe smoking was significantly seen for higher intensity HR (95% CI): 1.35 (1.07, 1.71), earlier age of smoking initiation HR (95% CI): 1.26 (1.06, 1.50), longer duration HR (95% CI): 1.31 (1.04, 1.66), and the cumulative number of a smoke lifetime HR (95% CI): 1.37 (1.08, 1.74). We observed a significant positive association between exclusive waterpipe smoking and NPC in men. The findings suggested that waterpipe smoking is likely more harmful than cigarettes in developing this cancer. A firm tobacco control against waterpipe smoking is highly recommended.
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Affiliation(s)
- Thinh Gia Nguyen
- School of Medicine, International University of Health and Welfare, Narita, Japan
| | - Hung Dinh Kieu
- Department of Surgery, Hanoi Medical University, Hanoi, Vietnam
| | - Dung Thuy Thi Truong
- University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Vietnam
- Graduate School of Public Health, International University of Health and Welfare, Narita, Japan
| | - Khoa Xuan Ngo
- Department of Anatomy, Hanoi Medical University, Hanoi, Vietnam
| | - Shunya Ikeda
- Graduate School of Public Health, International University of Health and Welfare, Narita, Japan
| | - Ngoan Tran Le
- Institute of Research and Development, Duy Tan University, Da Nang, Vietnam.
- Department of Occupational Health, Institute for Preventive Medicine and Public Health, Hanoi Medical University, Hanoi, Vietnam.
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Baghery F, Lau LDW, Mohamadi M, Vazirinejad R, Ahmadi Z, Javedani H, Eslami H, Nazari A. Risk of urinary tract cancers following arsenic exposure and tobacco smoking: a review. ENVIRONMENTAL GEOCHEMISTRY AND HEALTH 2023; 45:5579-5598. [PMID: 37248359 DOI: 10.1007/s10653-023-01627-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Accepted: 05/18/2023] [Indexed: 05/31/2023]
Abstract
Bladder cancer, prostate cancer, and kidney cancer, due to their high morbidity and mortality rates, result in significant economic and health care costs. Arsenic exposure affects the drinking water of millions of people worldwide. Long-term exposure to arsenic, even in low concentrations, increases the risk of developing various cancers. Smoking is also one of the leading causes of bladder, prostate and kidney cancers. Accordingly, this research reviews the relationship between arsenic exposure and smoking with three kinds of urinary tract cancers (bladder cancer, prostate cancer, and kidney cancer) due to their widespread concern for their negative impact on public health globally. In this review, we have gathered the most current information from scientific databases [PubMed, Scopus, Google Scholar, ISI web of science] regarding the relationship between arsenic exposure and tobacco smoking with the risk of bladder, prostate, and kidney cancer. In several studies, a significant relationship was determined between the incidence and mortality rate of the above-mentioned cancers in humans with arsenic exposure and tobacco smoking. The decrease or cessation of smoking and consumption of arsenic-free water significantly declined the incidence of bladder, prostate, and kidney cancers.
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Affiliation(s)
- Fatemeh Baghery
- Pistachio Safety Research Center, Rafsanjan University of Medical Sciences, Rafsanjan, Iran
| | | | - Maryam Mohamadi
- Occupational Safety and Health Research Center, NICICO, WorldSafety Organization and Rafsanjan University of Medical Sciences, Rafsanjan, Iran
| | - Reza Vazirinejad
- Social Determinants of Health Research Center, Rafsanjan University of Medical Sciences, Rafsanjan, Iran
| | - Zahra Ahmadi
- Pistachio Safety Research Center, Rafsanjan University of Medical Sciences, Rafsanjan, Iran
| | - Hossein Javedani
- Immunology of Infectious Diseases Research Center, Research Institute of Basic Medical Sciences, Rafsanjan University of Medical Sciences, Rafsanjan, Iran
| | - Hadi Eslami
- Occupational Safety and Health Research Center, NICICO, WorldSafety Organization and Rafsanjan University of Medical Sciences, Rafsanjan, Iran
| | - Alireza Nazari
- Social Determinants of Health Research Center, Rafsanjan University of Medical Sciences, Rafsanjan, Iran.
- Department of Surgery, School of Medicine, Rafsanjan University of Medical Sciences, Rafsanjan, Iran.
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Kjeld SG, Jørgensen MB, Aundal M, Bast LS. Price elasticity of demand for cigarettes among youths in high-income countries: a systematic review. Scand J Public Health 2023; 51:35-43. [PMID: 34609239 DOI: 10.1177/14034948211047778] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Aims: Smoking in youth remains a major public health issue. As increasing tobacco prices is considered one of the most effective prevention strategies, examining youth's responsiveness to price changes on cigarettes will provide crucial knowledge. This study aims systematically to review research examining the price elasticity of demand for cigarettes among youths (<30 years of age) in high-income countries. Methods: Searches were conducted in three databases (Web of Science, Pubmed and Scopus). Inclusion criteria were publications within the past 10 years (2011-2021) written in English and with a population of youths below 30 years of age, concerning price elasticity of demand for cigarettes and from high-income countries. Searches were screened by two independent reviewers and the quality of studies was assessed using a quality assessment tool. Results: Four outcomes related to price elasticity of demand for cigarettes were examined in six studies included in this review; that is, cigarette initiation, consumption, prevalence and cessation. Overall, findings indicate that increasing tobacco prices affect youth tobacco use. The effect was associated with gender and age; young women were more price sensitive concerning smoking initiation, whereas young men were more price sensitive concerning cigarette prevalence and consumption. Moreover, younger age was associated with higher price elasticity. Conclusions: Estimates for price elasticity varied across the included studies. This may be caused by differences in data sources, collection methods used and country of origin. Most included studies were of older date. Therefore, to make reliable predictions of the expected effects of increased tobacco prices, further examinations of up-to-date and locally embedded measures are required.
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Affiliation(s)
- Simone Gad Kjeld
- National Institute of Public Health, University of Southern Denmark, Denmark
| | | | - Maria Aundal
- National Institute of Public Health, University of Southern Denmark, Denmark
| | - Lotus Sofie Bast
- National Institute of Public Health, University of Southern Denmark, Denmark
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Satia I, Mayhew AJ, Sohel N, Kurmi O, Killian KJ, O’Byrne PM, Raina P. Impact of productive and dry chronic cough on mortality in the Canadian Longitudinal Study on Aging (CLSA). J Thorac Dis 2022; 14:5087-5096. [PMID: 36647475 PMCID: PMC9840029 DOI: 10.21037/jtd-22-1306] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Accepted: 12/13/2022] [Indexed: 12/24/2022]
Abstract
Background Chronic cough is a common troublesome condition and accounts for a high burden on quality of life. Previous data investigating the mortality associated with chronic cough has been derived in patients with chronic bronchitis. No data exists on chronic dry cough. Therefore, we investigated if chronic dry and productive cough is independently associated with increased mortality. Methods The Canadian Longitudinal Study on Ageing (CLSA) is a prospective, nationally generalizable, stratified random sample of adults aged 45-85 years at baseline recruited between 2011-2015 and followed up three years later. Chronic cough was identified based on a self-reported daily cough in the last 12 months. Deaths were confirmed by the Ministry of Health and/or completion of descendent questionnaire by a family member. Models were investigated for dry and productive chronic cough and was adjusted for age, sex, smoking, body mass index (BMI), and respiratory diseases. Results Of the 30,016 participants, 4,783 (15.9%) reported chronic cough at baseline; 2,724 (57%) had a dry cough, and 2,059 (43%) had productive chronic cough. There was a total of 561 deaths between baseline and follow-up-1 (3 years later). There was a 49% higher risk of death in participants with chronic productive cough {adjusted odds ratio (aOR) 1.49 [95% confidence intervals (CI): 1.08-2.07]}, but not dry chronic cough [aOR 0.85 (0.60-1.20)]. The effects of chronic productive cough on mortality were persistent in those with no airflow obstruction [chronic productive cough aOR 1.90 (1.09-3.31)]. Conclusions Chronic productive cough is associated with a higher risk of death, while chronic dry cough has no impact on mortality risk of death in middle-aged and older adults. This highlights the importance of careful evaluation of patients with chronic cough.
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Affiliation(s)
- Imran Satia
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada;,Firestone Institute for Respiratory Health, St Joseph’s Healthcare, Hamilton, Ontario, Canada;,Department of Health Research Methods, Evidence, and Impact, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada;,McMaster Institute for Research on Ageing, McMaster University, Hamilton, Ontario, Canada
| | - Alexandra J. Mayhew
- Department of Health Research Methods, Evidence, and Impact, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada;,McMaster Institute for Research on Ageing, McMaster University, Hamilton, Ontario, Canada;,Labarge Centre for Mobility in Aging, McMaster University, Hamilton, Ontario, Canada
| | - Nazmul Sohel
- Department of Health Research Methods, Evidence, and Impact, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada;,McMaster Institute for Research on Ageing, McMaster University, Hamilton, Ontario, Canada;,Labarge Centre for Mobility in Aging, McMaster University, Hamilton, Ontario, Canada
| | - Om Kurmi
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada;,Firestone Institute for Respiratory Health, St Joseph’s Healthcare, Hamilton, Ontario, Canada;,Department of Health Research Methods, Evidence, and Impact, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada;,Faculty of Health and Life Sciences, Coventry University, Coventry, UK
| | - Kieran J. Killian
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Paul M. O’Byrne
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada;,Firestone Institute for Respiratory Health, St Joseph’s Healthcare, Hamilton, Ontario, Canada
| | - Parminder Raina
- Department of Health Research Methods, Evidence, and Impact, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada;,McMaster Institute for Research on Ageing, McMaster University, Hamilton, Ontario, Canada
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Effah F, Taiwo B, Baines D, Bailey A, Marczylo T. Pulmonary effects of e-liquid flavors: a systematic review. JOURNAL OF TOXICOLOGY AND ENVIRONMENTAL HEALTH. PART B, CRITICAL REVIEWS 2022; 25:343-371. [PMID: 36154615 PMCID: PMC9590402 DOI: 10.1080/10937404.2022.2124563] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
Electronic cigarettes (ECs) are purported to be tobacco harm-reduction products whose degree of harm has been highly debated. EC use is considered less hazardous than smoking but is not expected to be harmless. Following the banning of e-liquid flavors in countries such as the US, Finland, Ukraine, and Hungary, there are growing concerns regarding the safety profile of e-liquid flavors used in ECs. While these are employed extensively in the food industry and are generally regarded as safe (GRAS) when ingested, GRAS status after inhalation is unclear. The aim of this review was to assess evidence from 38 reports on the adverse effects of flavored e-liquids on the respiratory system in both in vitro and in vivo studies published between 2006 and 2021. Data collected demonstrated greater detrimental effects in vitro with cinnamon (9 articles), strawberry (5 articles), and menthol (10 articles), flavors than other flavors. The most reported effects among these investigations were perturbations of pro-inflammatory biomarkers and enhanced cytotoxicity. There is sufficient evidence to support the toxicological impacts of diacetyl- and cinnamaldehyde-containing e-liquids following human inhalation; however, safety profiles on other flavors are elusive. The latter may result from inconsistencies between experimental approaches and uncertainties due to the contributions from other e-liquid constituents. Further, the relevance of the concentration ranges to human exposure levels is uncertain. Evidence indicates that an adequately controlled and consistent, systematic toxicological investigation of a broad spectrum of e-liquid flavors may be required at biologically relevant concentrations to better inform public health authorities on the risk assessment following exposure to EC flavor ingredients.
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Affiliation(s)
- Felix Effah
- Pharmacology Section, St George’s University of London, London, UK
- Radiation, Chemical and Environmental Hazards, UK Health Security Agency, Didcot, UK
| | - Benjamin Taiwo
- Physiology Section, St George’s University of London, London, UK
| | - Deborah Baines
- Infection and Immunity Institute, St George’s University of London, London, UK
| | - Alexis Bailey
- Pharmacology Section, St George’s University of London, London, UK
| | - Tim Marczylo
- Radiation, Chemical and Environmental Hazards, UK Health Security Agency, Didcot, UK
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Grant WB, Boucher BJ, Al Anouti F, Pilz S. Comparing the Evidence from Observational Studies and Randomized Controlled Trials for Nonskeletal Health Effects of Vitamin D. Nutrients 2022; 14:nu14183811. [PMID: 36145186 PMCID: PMC9501276 DOI: 10.3390/nu14183811] [Citation(s) in RCA: 28] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Revised: 09/13/2022] [Accepted: 09/14/2022] [Indexed: 12/12/2022] Open
Abstract
Although observational studies of health outcomes generally suggest beneficial effects with, or following, higher serum 25-hydroxyvitamin D [25(OH)D] concentrations, randomized controlled trials (RCTs) have generally not supported those findings. Here we review results from observational studies and RCTs regarding how vitamin D status affects several nonskeletal health outcomes, including Alzheimer’s disease and dementia, autoimmune diseases, cancers, cardiovascular disease, COVID-19, major depressive disorder, type 2 diabetes, arterial hypertension, all-cause mortality, respiratory tract infections, and pregnancy outcomes. We also consider relevant findings from ecological, Mendelian randomization, and mechanistic studies. Although clear discrepancies exist between findings of observational studies and RCTs on vitamin D and human health benefits these findings should be interpreted cautiously. Bias and confounding are seen in observational studies and vitamin D RCTs have several limitations, largely due to being designed like RCTs of therapeutic drugs, thereby neglecting vitamin D’s being a nutrient with a unique metabolism that requires specific consideration in trial design. Thus, RCTs of vitamin D can fail for several reasons: few participants’ having low baseline 25(OH)D concentrations, relatively small vitamin D doses, participants’ having other sources of vitamin D, and results being analyzed without consideration of achieved 25(OH)D concentrations. Vitamin D status and its relevance for health outcomes can usefully be examined using Hill’s criteria for causality in a biological system from results of observational and other types of studies before further RCTs are considered and those findings would be useful in developing medical and public health policy, as they were for nonsmoking policies. A promising approach for future RCT design is adjustable vitamin D supplementation based on interval serum 25(OH)D concentrations to achieve target 25(OH)D levels suggested by findings from observational studies.
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Affiliation(s)
- William B. Grant
- Sunlight, Nutrition and Health Research Center, San Francisco, CA 94164-1603, USA
- Correspondence:
| | - Barbara J. Boucher
- The London School of Medicine and Dentistry, The Blizard Institute, Barts, Queen Mary University of London, London E1 2AT, UK
| | - Fatme Al Anouti
- Department of Health Sciences, College of Natural and Health Sciences, Zayed University, Abu Dhabi 144534, United Arab Emirates
| | - Stefan Pilz
- Division of Endocrinology and Diabetology, Department of Internal Medicine, Medical University of Graz, 8036 Graz, Austria
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Whaley P, Piggott T, Morgan RL, Hoffmann S, Tsaioun K, Schwingshackl L, Ansari MT, Thayer KA, Schünemann HJ. Biological plausibility in environmental health systematic reviews: a GRADE concept paper. ENVIRONMENT INTERNATIONAL 2022; 162:107109. [PMID: 35305498 DOI: 10.1016/j.envint.2022.107109] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/20/2021] [Revised: 01/19/2022] [Accepted: 01/20/2022] [Indexed: 05/11/2023]
Abstract
BACKGROUND "Biological plausibility" is a concept frequently referred to in environmental and public health when researchers are evaluating how confident they are in the results and inferences of a study or evidence review. Biological plausibility is not, however, a domain of one of the most widely-used approaches for assessing the certainty of evidence (CoE) which underpins the findings of a systematic review, the Grading of Recommendations Assessment, Development and Evaluation (GRADE) CoE Framework. Whether the omission of biological plausibility is a potential limitation of the GRADE CoE Framework is a topic that is regularly discussed, especially in the context of environmental health systematic reviews. OBJECTIVES We analyse how the concept of "biological plausibility", as applied in the context of assessing certainty of the evidence that supports the findings of a systematic review, is accommodated under the processes of systematic review and the existing GRADE domains. RESULTS AND DISCUSSION We argue that "biological plausibility" is a concept which primarily comes into play when direct evidence about the effects of an exposure on a population of concern (usually humans) is absent, at high risk of bias, is inconsistent, or limited in other ways. In such circumstances, researchers look toward evidence from other study designs in order to draw conclusions. In this respect, we can consider experimental animal and in vitro evidence as "surrogates" for the target populations, exposures, comparators and outcomes of actual interest. Through discussion of 10 examples of experimental surrogates, we propose that the concept of biological plausibility consists of two principal aspects: a "generalisability aspect" and a "mechanistic aspect". The "generalisability aspect" concerns the validity of inferences from experimental models to human scenarios, and asks the same question as does the assessment of external validity or indirectness in systematic reviews. The "mechanistic aspect" concerns certainty in knowledge of biological mechanisms and would inform judgements of indirectness under GRADE, and thus the overall CoE. While both aspects are accommodated under the indirectness domain of the GRADE CoE Framework, further research is needed to determine how to use knowledge of biological mechanisms in the assessment of indirectness of the evidence in systematic reviews.
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Affiliation(s)
- Paul Whaley
- Lancaster Environment Centre, Lancaster University, UK; Evidence-based Toxicology Collaboration at Johns Hopkins Bloomberg School of Public Health (EBTC), USA
| | - Thomas Piggott
- Department of Health Research Methods, Evidence and Impact, McMaster University, 1280 Main St West, Hamilton, ON L8N 3Z5, Canada
| | - Rebecca L Morgan
- Department of Health Research Methods, Evidence and Impact, McMaster University, 1280 Main St West, Hamilton, ON L8N 3Z5, Canada
| | - Sebastian Hoffmann
- Evidence-based Toxicology Collaboration at Johns Hopkins Bloomberg School of Public Health (EBTC), USA
| | - Katya Tsaioun
- Evidence-based Toxicology Collaboration at Johns Hopkins Bloomberg School of Public Health (EBTC), USA
| | - Lukas Schwingshackl
- Institute for Evidence in Medicine, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Mohammed T Ansari
- School of Epidemiology and Public Health, University of Ottawa, Room 101, 600 Peter Morand Crescent, Ottawa, Ontario K1G 5Z3, Canada
| | - Kristina A Thayer
- U.S. Environmental Protection Agency (US EPA), Office of Research and Development, Center for Public Health and Environmental Assessment (CPHEA), Chemical Pollutant Assessment Division (CPAD), 1200 Pennsylvania Avenue, NW (8623R), Washington, DC 20460, USA
| | - Holger J Schünemann
- Department of Health Research Methods, Evidence and Impact, McMaster University, 1280 Main St West, Hamilton, ON L8N 3Z5, Canada; Michael G DeGroote Cochrane Canada and McMaster GRADE Centres, McMaster University, HSC-2C, 1280 Main St West, Hamilton, ON L8N 3Z5, Canada; Dipartimento di Scienze Biomediche, Humanitas University, Via Rita Levi Montalcini, 4, 20090 Pieve Emanuele, Milan, Italy
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Kulhánek A, Lukavska K, Gabrhelík R, Novák D, Burda V, Prokop J, Holter MTS, Brendryen H. Comparing Reminders Sent via SMS Text Messaging and Email for Improving Adherence to an Electronic Health Program: Randomized Controlled Trial. JMIR Mhealth Uhealth 2022; 10:e31040. [PMID: 35302945 PMCID: PMC8976257 DOI: 10.2196/31040] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Revised: 08/12/2021] [Accepted: 12/20/2021] [Indexed: 11/13/2022] Open
Abstract
Background
eHealth interventions can help people change behavior (eg, quit smoking). Reminders sent via SMS text messaging or email may improve the adherence to web-based programs and increase the probability of successful behavior change; however, it is unclear whether their efficiency is affected by the modality of the communication channel.
Objective
A 2-armed randomized control trial was conducted to compare the effect of providing reminders via SMS text messaging versus email on the adherence to an eHealth program for smoking cessation and on the probability to initiate a quit attempt.
Methods
Smokers were recruited via an internet-based advertisement. A total of 591 participants who diverted from intended use of the program (ie, failed to log on to a session) were automatically randomized to the experimental (SMS text messaging reminder, n=304) or the active comparator (email reminder, n=287) group.
Results
Unexpectedly, we found that the mode of reminder delivery did not significantly affect either the adherence, namely the number of completed program sessions, with the SMS text messaging reminder group showing a mean of 4.30 (SD 3.24) and the email reminder group showing a mean of 4.36 (SD 3.27) (t586=0.197, P=.84, and Cohen d=0.016), or the outcome, namely the quit smoking attempt rate (34.2% in the SMS text messaging group vs 31.7% in the email group; χ21=0.4, P=.52). Secondary analyses showed that age, gender, and education had significant effects on program adherence and education on the outcome. Moreover, we found a significant interaction effect between the mode of reminder delivery and gender on program adherence, suggesting that the effectiveness of SMS text message reminders might be different for females and males. However, this particular finding should be treated with care as it was based on post hoc subgroup analysis.
Conclusions
This study indicates that the modality of user reminders to log on increased neither the program adherence nor the probability of quitting smoking. This suggests that program developers may save costs using emails instead of SMS text messaging reminders.
Trial Registration
ClinicalTrials.gov NCT03276767; https://clinicaltrials.gov/ct2/show/ NCT03276767
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Affiliation(s)
- Adam Kulhánek
- Department of Addictology, General University Hospital in Prague, Prague, Czech Republic
- Department of Addictology, First Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Katerina Lukavska
- Department of Addictology, General University Hospital in Prague, Prague, Czech Republic
- Department of Addictology, First Faculty of Medicine, Charles University, Prague, Czech Republic
- Department of Psychology, Faculty of Education, Charles University, Prague, Czech Republic
| | - Roman Gabrhelík
- Department of Addictology, General University Hospital in Prague, Prague, Czech Republic
- Department of Addictology, First Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Daniel Novák
- Department of Cybernetics, Faculty of Electrical Engineering, Czech Technical University in Prague, Prague, Czech Republic
| | - Václav Burda
- Department of Addictology, First Faculty of Medicine, Charles University, Prague, Czech Republic
- Department of Cybernetics, Faculty of Electrical Engineering, Czech Technical University in Prague, Prague, Czech Republic
| | - Jindřich Prokop
- Department of Cybernetics, Faculty of Electrical Engineering, Czech Technical University in Prague, Prague, Czech Republic
| | - Marianne T S Holter
- The Norwegian Centre for Addiction Research (SERAF), Faculty of Medicine, University of Oslo, Oslo, Norway
- Department of Psychology, Faculty of Social Sciences, University of Oslo, Oslo, Norway
| | - Håvar Brendryen
- The Norwegian Centre for Addiction Research (SERAF), Faculty of Medicine, University of Oslo, Oslo, Norway
- Department of Psychology, Faculty of Social Sciences, University of Oslo, Oslo, Norway
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Abstract
BACKGROUND "Biological plausibility" is a concept frequently referred to in environmental and public health when researchers are evaluating how confident they are in the results and inferences of a study or evidence review. Biological plausibility is not, however, a domain of one of the most widely-used approaches for assessing the certainty of evidence (CoE) which underpins the findings of a systematic review, the Grading of Recommendations Assessment, Development and Evaluation (GRADE) CoE Framework. Whether the omission of biological plausibility is a potential limitation of the GRADE CoE Framework is a topic that is regularly discussed, especially in the context of environmental health systematic reviews. OBJECTIVES We analyse how the concept of "biological plausibility", as applied in the context of assessing certainty of the evidence that supports the findings of a systematic review, is accommodated under the processes of systematic review and the existing GRADE domains. RESULTS AND DISCUSSION We argue that "biological plausibility" is a concept which primarily comes into play when direct evidence about the effects of an exposure on a population of concern (usually humans) is absent, at high risk of bias, is inconsistent, or limited in other ways. In such circumstances, researchers look toward evidence from other study designs in order to draw conclusions. In this respect, we can consider experimental animal and in vitro evidence as "surrogates" for the target populations, exposures, comparators and outcomes of actual interest. Through discussion of 10 examples of experimental surrogates, we propose that the concept of biological plausibility consists of two principal aspects: a "generalisability aspect" and a "mechanistic aspect". The "generalisability aspect" concerns the validity of inferences from experimental models to human scenarios, and asks the same question as does the assessment of external validity or indirectness in systematic reviews. The "mechanistic aspect" concerns certainty in knowledge of biological mechanisms and would inform judgements of indirectness under GRADE, and thus the overall CoE. While both aspects are accommodated under the indirectness domain of the GRADE CoE Framework, further research is needed to determine how to use knowledge of biological mechanisms in the assessment of indirectness of the evidence in systematic reviews.
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15
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Saenz-de-Miera B, Wu DC, Essue BM, Maldonado N, Jha P, Reynales-Shigematsu LM. The distributional effects of tobacco tax increases across regions in Mexico: an extended cost-effectiveness analysis. Int J Equity Health 2022; 21:8. [PMID: 35057813 PMCID: PMC8772114 DOI: 10.1186/s12939-021-01603-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Accepted: 12/08/2021] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND Several studies have shown the beneficial effects of tobacco fiscal policy, but distributional effects have been less examined, especially at the subnational level. The objective of this study is to analyse the distributional effects of a one-peso tobacco tax increase (roughly equivalent to tripling the current excise tax) on health, poverty, and financial outcomes at the subnational level in Mexico. METHODS We employ an extended cost-effectiveness analysis that estimates life-years gained, smoking attributable deaths averted, treatment costs averted, number of persons avoiding poverty and catastrophic health expenditures, and additional tax revenues by income group across five regions. RESULTS With the one-peso tax increase (or 44% price increase), about 1.5 million smokers would quit smoking across the five regions, resulting in nearly 630 thousand premature deaths averted and 12.6 million life years gained. The bottom income quintile would gain three times more life years gains than the top quintile (ratio 3:1), and the largest gain for the most deprived would occur in the South (ratio 19:1), the region with the highest poverty incidence. Costs averted and additional tax revenues would reach 44.6 and 16.2 billion pesos, respectively. Moreover, 251 thousand individuals would avoid falling into poverty, including 53.2 in the lowest income quintile, and 563.9 thousand would avoid catastrophic health expenditures. Overall, the bottom income group would obtain 26% of the life years gained and 24% of the cost averted, while only paying 3% of the additional tax revenue. CONCLUSIONS The most significant gains from a substantial cigarette price increase would be for the poorest 20%, especially in the South, the most impoverished region of Mexico. Therefore, tobacco taxes are an opportunity for governments to advance in equity and towards the achievement of sustainable development goals on non-communicable diseases.
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Affiliation(s)
- Belen Saenz-de-Miera
- Department of Economics, Universidad Autonoma de Baja California Sur, Carretera al Sur Km 5.5, 23080, La Paz, Baja California Sur, Mexico.
| | - Daphne C Wu
- Centre for Global Health Research, Unity Health Toronto, University of Toronto, Toronto, Canada
| | - Beverly M Essue
- Centre for Global Health Research, Unity Health Toronto, University of Toronto, Toronto, Canada
| | | | - Prabhat Jha
- Centre for Global Health Research, Unity Health Toronto, University of Toronto, Toronto, Canada
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16
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Aryannejad A, Tabary M, Ebrahimi N, Mohammadi E, Fattahi N, Roshani S, Masinaei M, Naderimagham S, Azadnajafabad S, Jamshidi K, Fateh SM, Moghimi M, Kompani F, Rezaei N, Farzadfar F. Global, regional, and national survey on the burden and quality of care of pancreatic cancer: a systematic analysis for the Global Burden of Disease study 1990-2017. Pancreatology 2021; 21:1443-1450. [PMID: 34561167 DOI: 10.1016/j.pan.2021.09.002] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Revised: 08/24/2021] [Accepted: 09/03/2021] [Indexed: 12/11/2022]
Abstract
BACKGROUND Pancreatic cancer (PC) is among the most lethal cancers worldwide, and the quality of care provided to PC patients is a vital public health concern. We aimed to investigate the quality of care of PC globally and to report its current burden. METHODS The Quality of Care Index (QCI) was achieved by performing a Principal Component Analysis utilizing the results of the GBD study 2017. The QCI was defined as a range between 0 and 100, in which higher QCIs show higher quality of care. Possible gender- and age-related inequalities in terms of QCI were explored based on WHO world regions and the sociodemographic index (SDI). RESULTS In 2017, Japan had the highest QCI among all countries (QCI = 99/100), followed by Australia (QCI = 83/100) and the United States (QCI = 76/100). In Japan and Australia, males and females had almost the same QCIs in 2017, while in the United States, females had lower QCIs than males. In contrast to these high-QCI nations, African countries had the lowest QCIs in 2017. Besides, QCI increased by SDI, and high-SDI regions had the highest QCIs. Regarding patients' age, elderly cases had higher QCIs than younger patients globally and in high-SDI regions. CONCLUSION This study provides clinicians and health authorities with a wider vision around the quality of care of PC worldwide and highlights the existing disparities. This could help them investigate possible effective strategies to improve the quality of care in regions with lower QCIs and higher gender- and age-related inequities.
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Affiliation(s)
- Armin Aryannejad
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammadreza Tabary
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Narges Ebrahimi
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Esmaeil Mohammadi
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Nima Fattahi
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Shahin Roshani
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Masoud Masinaei
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Shohreh Naderimagham
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran; Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Sina Azadnajafabad
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Kosar Jamshidi
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Sahar Mohammadi Fateh
- Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran; Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Mana Moghimi
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran; Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Farzad Kompani
- Division of Hematology and Oncology, Children's Medical Center, Pediatrics Center of Excellence, Tehran University of Medical Sciences, Tehran, Iran
| | - Negar Rezaei
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran; Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran.
| | - Farshad Farzadfar
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran; Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
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Ni MY, Canudas-Romo V, Shi J, Flores FP, Chow MSC, Yao XI, Ho SY, Lam TH, Schooling CM, Lopez AD, Ezzati M, Leung GM. Understanding longevity in Hong Kong: a comparative study with long-living, high-income countries. Lancet Public Health 2021; 6:e919-e931. [PMID: 34774201 DOI: 10.1016/s2468-2667(21)00208-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Revised: 08/17/2021] [Accepted: 08/24/2021] [Indexed: 01/19/2023]
Abstract
BACKGROUND Since 2013, Hong Kong has sustained the world's highest life expectancy at birth-a key indicator of population health. The reasons behind this achievement remain poorly understood but are of great relevance to both rapidly developing and high-income regions. Here, we aim to compare factors behind Hong Kong's survival advantage over long-living, high-income countries. METHODS Life expectancy data from 1960-2020 were obtained for 18 high-income countries in the Organisation for Economic Co-operation and Development from the Human Mortality Database and for Hong Kong from Hong Kong's Census and Statistics Department. Causes of death data from 1950-2016 were obtained from WHO's Mortality Database. We used truncated cross-sectional average length of life (TCAL) to identify the contributions to survival differences based on 263 million deaths overall. As smoking is the leading cause of premature death, we also compared smoking-attributable mortality between Hong Kong and the high-income countries. FINDINGS From 1979-2016, Hong Kong accumulated a substantial survival advantage over high-income countries, with a difference of 1·86 years (95% CI 1·83-1·89) for males and 2·50 years (2·47-2·53) for females. As mortality from infectious diseases declined, the main contributors to Hong Kong's survival advantage were lower mortality from cardiovascular diseases for both males (TCAL difference 1·22 years, 95% CI 1·21-1·23) and females (1·19 years, 1·18-1·21), cancer for females (0·47 years, 0·45-0·48), and transport accidents for males (0·27 years, 0·27-0·28). Among high-income populations, Hong Kong recorded the lowest cardiovascular mortality and one of the lowest cancer mortalities in women. These findings were underpinned by the lowest absolute smoking-attributable mortality in high-income regions (39·7 per 100 000 in 2016, 95% CI 34·4-45·0). Reduced smoking-attributable mortality contributed to 50·5% (0·94 years, 0·93-0·95) of Hong Kong's survival advantage over males in high-income countries and 34·8% (0·87 years, 0·87-0·88) of it in females. INTERPRETATION Hong Kong's leading longevity is the result of fewer diseases of poverty while suppressing the diseases of affluence. A unique combination of economic prosperity and low levels of smoking with development contributed to this achievement. As such, it offers a framework that could be replicated through deliberate policies in developing and developed populations globally. FUNDING Early Career Scheme (RGC ECS Grant #27602415), Research Grants Council, University Grants Committee of Hong Kong.
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Affiliation(s)
- Michael Y Ni
- School of Public Health, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, China; The State Key Laboratory of Brain and Cognitive Sciences, The University of Hong Kong, Hong Kong Special Administrative Region, China; Healthy High Density Cities Lab, HKUrbanLab, The University of Hong Kong, Hong Kong Special Administrative Region, China.
| | - Vladimir Canudas-Romo
- School of Demography, College of Arts and Social Sciences, The Australian National University, Canberra, ACT, Australia
| | - Jian Shi
- School of Public Health, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Francis P Flores
- School of Public Health, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Mathew S C Chow
- School of Public Health, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Xiaoxin I Yao
- School of Public Health, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, China; Department of Orthopedics, The Eighth Affiliated Hospital, Sun Yat-sen University, Shenzhen, China
| | - Sai Yin Ho
- School of Public Health, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Tai Hing Lam
- School of Public Health, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, China
| | - C Mary Schooling
- School of Public Health, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, China; School of Public Health and Health Policy, City University of New York, New York, NY, USA
| | - Alan D Lopez
- Melbourne School of Population and Global Health, The University of Melbourne, VIC, Australia
| | - Majid Ezzati
- MRC Centre for Environment and Health, School of Public Health, Imperial College London, London, UK; Abdul Latif Jameel Institute for Disease and Emergency Analytics, Imperial College London, London, UK; Regional Institute for Population Studies, University of Ghana, Legon, Ghana
| | - Gabriel M Leung
- School of Public Health, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, China; Laboratory of Data Discovery for Health (D(2)4H), Hong Kong Science Park, Hong Kong Special Administrative Region, China
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Herath P, Wimalasekera S, Amarasekara T, Fernando M, Turale S. Adverse effects of cigarette smoking on exhaled breath carbon monoxide, blood carboxyhemoglobin, and hematological parameters amongst Sri Lankan adult tobacco smokers: A descriptive study. POPULATION MEDICINE 2021. [DOI: 10.18332/popmed/143076] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
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Karekla M, Savvides SN, Gloster A. An Avatar-Led Intervention Promotes Smoking Cessation in Young Adults: A Pilot Randomized Clinical Trial. Ann Behav Med 2021; 54:747-760. [PMID: 32383736 DOI: 10.1093/abm/kaaa013] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Smoking remains a global concern, especially for young adults. There is a dearth of smoking cessation programs for this population, who seldom seek help or are motivated to quit. PURPOSE This pilot study assessed the effectiveness of a digital avatar-led Acceptance and Commitment Therapy (ACT) smoking cessation program (Flexiquit) for young adult smokers at all levels of motivation to quit. METHODS Smokers with no particular interest in quitting smoking (65.45% reported being in pre-contemplation or contemplation stages of change) were recruited from three universities (105 smoking ≥ 1 cigarette per day during the past 30 days, 68 females). Those who completed questionnaires online (N = 84; M = 22.44 years, SD = 2.61, range 18-28 years old) were randomized to either a six-session avatar-led intervention (Flexiquit; N = 49) or a wait-list control (N = 35). Primary outcomes included cessation status (7-day point prevalence) and number of cigarettes smoked per day; secondary outcomes were nicotine dependence, intention-to-quit smoking and self-efficacy, assessed at pre- and post-intervention, and only for Flexiquit at 6-month follow-up. RESULTS In intention-to-treat analysis more participants (OR = 3.10, 95% CI = 0.92-10.41) in the treatment group (28.57%) versus the control group (11.43%) reported quitting smoking; however, the difference was not statistically significant (p = .067). There were statistically significant decreases in average number of cigarettes, nicotine dependence and increases in self-efficacy, and intention-to-quit smoking compared to controls. Treatment gains in the Flexiquit group were maintained through the 6-month follow-up. CONCLUSIONS An avatar-led digitized smoking cessation intervention based on ACT could increase the odds of quitting smoking. Findings suggest that a digitized program designed to engage young adults in smoking cessation may result in quitting smoking and has a high applicability potential especially among the hard-to-reach population of young adults. QUESTION Can an avatar-led digitized Acceptance and Commitment Therapy (ACT) smoking cessation intervention result in quitting smoking and increasing intention to quit among young smokers at various levels of motivation to quit, compared to a wait-list control group? FINDINGS In this pilot randomized clinical trial that included 84 smokers, 28.57% in the treatment condition versus 11.43% in the wait-list control group were abstinent at post (intention-to-treat [ITT] analysis). An avatar-led digitized ACT smoking cessation intervention results in high quitting smoking rates and has a high applicability potential especially among the hard-to-reach population of young adult smokers.
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Affiliation(s)
- Maria Karekla
- Department of Psychology, University of Cyprus, Nicosia, Cyprus
| | | | - Andrew Gloster
- Faculty of Clinical Psychology and Intervention Science, University of Basel, Basel, Switzerland
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Alhawmdeh M, Isreb M, Aziz A, Jacob BK, Anderson D, Najafzadeh M. Interferon-γ liposome: a new system to improve drug delivery in the treatment of lung cancer. ERJ Open Res 2021; 7:00555-2020. [PMID: 34435034 PMCID: PMC8381253 DOI: 10.1183/23120541.00555-2020] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Accepted: 03/23/2021] [Indexed: 11/11/2022] Open
Abstract
Lung cancer is one of the main causes of death worldwide. Published data show the use of interferons (IFNs) in treating lung tumours. IFNs also have potential for their antiproliferative, antiangiogenic, immunoregulatory and proapoptotic effects. IFN-γ functions as an anticancer agent against various forms of cancer. This study aimed to investigate the effect of IFN-γ liposome (nano) on peripheral lymphocytes from 20 individuals in each group: lung cancer patients compared to healthy individuals. The effectiveness of IFN-γ liposome against oxidative stress was also evaluated in this study. A concentration of 100 U·mL−1 of IFN-γ liposome was used to treat the lymphocytes in the Comet and micronucleus assays based on the preliminary test for the optimal dose. The lymphocytes from lung cancer patients presented with higher DNA damage levels than those of healthy individuals. In healthy individuals, IFN-γ liposome did not cause any DNA damage in the lymphocytes. Also, it caused a significant reduction in DNA damage in the lymphocytes from lung cancer patients in both the Comet and micronucleus assays. The 100 U·mL−1 of IFN-γ liposome significantly reduced the oxidative stress caused by H2O2 and appeared to be effective in both groups using the Comet and micronucleus assays. Results from both Comet and micronucleus assays were consistent. The data obtained indicated that IFN-γ in both forms (IFN-γ bulk and IFN-γ nanoliposome) may potentially be effective for the treatment of lung cancer and showed the ability of IFN-γ liposome to reduce DNA damage more than the bulk form. A research article on the effect of bulk and nanoliposome interferon-γ on lymphocytes from patients with lung cancer compared to healthy controls: assessing the ability of IFN-γ liposome to reduce DNA damage more than the bulk formhttps://bit.ly/3wvfSyY
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Affiliation(s)
- Maysa Alhawmdeh
- Division of Medical Sciences, Faculty of Life Sciences, University of Bradford, Bradford, UK
| | - Mohammad Isreb
- Faculty of Life Sciences, School of Pharmacy, University of Bradford, Bradford, UK
| | - Abid Aziz
- Bradford Royal Infirmary, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK
| | - Badie K Jacob
- Bradford Royal Infirmary, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK
| | - Diana Anderson
- Division of Medical Sciences, Faculty of Life Sciences, University of Bradford, Bradford, UK
| | - Mojgan Najafzadeh
- Division of Medical Sciences, Faculty of Life Sciences, University of Bradford, Bradford, UK
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Lin JH, Wen CP, Jiang CQ, Yuan JM, Chen CJ, Ho SY, Gao W, Zhang W, Wang R, Chien YC, Xu L, Wu X, Jin YL, Koh WP, Hsu WL, Zhu F, Wen C, Zhu T, Lee JH, Mai ZM, Lung ML, Lam TH. Smoking and nasopharyngeal cancer: individual data meta-analysis of six prospective studies on 334 935 men. Int J Epidemiol 2021; 50:975-986. [PMID: 33787881 PMCID: PMC8271191 DOI: 10.1093/ije/dyab060] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Accepted: 03/04/2021] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND The role of smoking in nasopharyngeal carcinoma (NPC) remains uncertain, especially in endemic regions. We conducted an individual participant data (IPD) meta-analysis of prospective cohort studies to investigate the associations between smoking exposure and risk of NPC. METHODS We obtained individual participant data of 334 935 male participants from six eligible population-based cohorts in NPC-endemic regions, including two each in Guangzhou and Taiwan, and one each in Hong Kong and Singapore. We used one- and two-stage approaches IPD meta-analysis and Cox proportional hazard models to calculate hazard ratios (HRs) and 95% confidence intervals (CIs) of NPC for smoking exposure adjusting for age and drinking status. RESULTS During 2 961 315 person-years of follow-up, 399 NPC evens were ascertained. Risks of NPC were higher in ever versus never smokers (HRone-stage = 1.32, 95% CI = 1.07-1.63, P = 0.0088; HRtwo-stage = 1.27, 1.01-1.60, 0.04). These positive associations appeared to be stronger in ever smokers who consumed 16+ cigarettes/day (HRone-stage = 1.67, 95% CI = 1.29-2.16, P = 0.0001), and in those who started smoking at age younger than 16 (2.16, 1.33-3.50, 0.0103), with dose-response relationships (P-values for trend = 0.0028 and 0.0103, respectively). Quitting (versus daily smoking) showed a small reduced risk (stopped for 5+ years: HRone-stage = 0.91, 95% CI = 0.60-1.39, P = 0.66; for former smokers: HRtwo-stage = 0.84, 0.61-1.14, 0.26). CONCLUSIONS This first IPD meta-analysis from six prospective cohorts in endemic regions has provided robust observational evidence that smoking increased NPC risk in men. NPC should be added to the 12-16 cancer sites known to be tobacco-related cancers. Strong tobacco control policies, preventing young individuals from smoking, would reduce NPC risk in endemic regions.
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Affiliation(s)
- Jia Huang Lin
- School of Public Health, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong
- Centre for Nasopharyngeal Carcinoma Research (CNPCR), Research Grants Council Area of Excellence Scheme, University of Hong Kong, Hong Kong
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University Health Science Centre, Beijing, China
| | - Chi Pang Wen
- Institute of Population Health Sciences, National Health Institutes, Zhunan, Taiwan
- Graduate Institute of Clinical Medical Science, China Medical University, Taichung, Taiwan
| | | | - Jian-Min Yuan
- Division of Cancer Control and Population Sciences, UPMC Hillman Cancer Centre, University of Pittsburgh, Pittsburgh, PA, USA
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
| | - Chien Jen Chen
- Genomics Research Centre, Academia Sinica, Taipei, Taiwan
- Graduate Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan
| | - Sai Yin Ho
- School of Public Health, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong
| | - Wayne Gao
- Master's Program in Global Health and Development, Taipei Medical University, Taipei, Taiwan
| | | | - Renwei Wang
- Division of Cancer Control and Population Sciences, UPMC Hillman Cancer Centre, University of Pittsburgh, Pittsburgh, PA, USA
| | - Yin-Chu Chien
- Genomics Research Centre, Academia Sinica, Taipei, Taiwan
| | - Lin Xu
- School of Public Health, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong
- School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Xifeng Wu
- Centre for Biostatistics Bioinformatics and Big Data, School of Public Health, National Institute for Data Science in Health and Medicine, Zhejiang University, Hangzhou, China
| | - Ya Li Jin
- Guangzhou No.12 Hospital, Guangzhou, China
| | - Woon-Puay Koh
- Health Services and Systems Research, Duke-NUS Medical School, Singapore
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore
| | - Wan-Lun Hsu
- Genomics Research Centre, Academia Sinica, Taipei, Taiwan
| | - Feng Zhu
- Guangzhou No.12 Hospital, Guangzhou, China
| | - Christopher Wen
- Department of Radiology, Long Beach Veterans Administration Hospital, University of California at Irvine, Irvine, CA, USA
| | - Tong Zhu
- Guangzhou No.12 Hospital, Guangzhou, China
| | - June Han Lee
- Institute of Population Health Sciences, National Health Institutes, Zhunan, Taiwan
| | - Zhi-Ming Mai
- School of Public Health, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong
- Centre for Nasopharyngeal Carcinoma Research (CNPCR), Research Grants Council Area of Excellence Scheme, University of Hong Kong, Hong Kong
- Radiation Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD, USA
- Corresponding author. School of Public Health, Li Ka Shing Faculty of Medicine, University of Hong Kong Patrick Manson Building (North Wing), 7 Sassoon Road, Pok Fu Lam, Hong Kong, China. E-mail:
| | - Maria Li Lung
- Centre for Nasopharyngeal Carcinoma Research (CNPCR), Research Grants Council Area of Excellence Scheme, University of Hong Kong, Hong Kong
- Department of Clinical Oncology and Centre for Cancer Research, University of Hong Kong, Hong Kong
| | - Tai-Hing Lam
- School of Public Health, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong
- Centre for Nasopharyngeal Carcinoma Research (CNPCR), Research Grants Council Area of Excellence Scheme, University of Hong Kong, Hong Kong
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22
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Sengupta D, Banerjee S, Mukhopadhyay P, Mitra R, Chaudhuri T, Sarkar A, Bhattacharjee G, Nath S, Roychoudhury S, Bhattacharjee S, Sengupta M. A comprehensive meta-analysis and a case-control study give insights into genetic susceptibility of lung cancer and subgroups. Sci Rep 2021; 11:14572. [PMID: 34272429 PMCID: PMC8285487 DOI: 10.1038/s41598-021-92275-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2020] [Accepted: 06/08/2021] [Indexed: 12/17/2022] Open
Abstract
Reports of genetic association of polymorphisms with lung cancer in the Indian subcontinent are often conflicting. To summarise and replicate published evidence for association with lung cancer and its subgroups. We performed a meta-analysis of candidate associations on lung cancer, its histological subtypes and smoking status in the Indian subcontinent following PRISMA guidelines. Multiple testing corrections were done by the Benjamini-Hochberg method through assessment of significance at a false discovery rate of 10%. We genotyped and investigated rs1048943/CYP1A1 in a case-control sample from eastern India, followed by its global meta-analysis using a similar protocol. Meta-analysis of 18 variants of 11 genes reported in 39 studies (7630 cases and 8169 controls) showed significant association of rs1048943/CYP1A1 [2.07(1.49-2.87)] and rs4646903/CYP1A1 [1.48(1.93-1.95)] with overall lung cancer risk at 10% FDR, while nominal association (p < 0.05) was observed for del1/GSTT1, del2/GSTM1, rs1695/GSTP1 and rs17037102/ DKK2. Subtype analysis showed a significant association of del1/GSTT1 with adenocarcinoma, rs4646903/CYP1A1 with squamous carcinoma, and rs1048943/CYP1A1 with both. Association of rs4646903/CYP1A1 in smokers and effect modification by meta-regression analysis was observed. Genotyping of rs1048943/CYP1A1 that presented significant heterogeneity (p < 0.1) revealed an association with adenocarcinoma among eastern Indian smokers, while a global meta-analysis in 10458 cases and 10871 controls showed association with lung cancer and its subgroups. This study identified the susceptibility loci for lung cancer and its covariate-subgroups.
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Affiliation(s)
- Debmalya Sengupta
- Department of Genetics, University of Calcutta, 35, Ballygunge Circular Road, Kolkata, 700019, India
| | - Souradeep Banerjee
- Department of Genetics, University of Calcutta, 35, Ballygunge Circular Road, Kolkata, 700019, India
| | - Pramiti Mukhopadhyay
- Greehey Children's Cancer Research Institute, UT Health San Antonio, 8403 Floyd Curl Dr., San Antonio, TX-78229, USA
| | - Ritabrata Mitra
- Department of CHEST, IPGME&R, 244 A.J.C. Bose Road, Kolkata, 700020, India
| | - Tamohan Chaudhuri
- Saroj Gupta Cancer Centre and Research Institute, Mahatma Gandhi Road, Thakurpukur, Kolkata, 700063, India
| | - Abhijit Sarkar
- Saroj Gupta Cancer Centre and Research Institute, Mahatma Gandhi Road, Thakurpukur, Kolkata, 700063, India
| | - Gautam Bhattacharjee
- Saroj Gupta Cancer Centre and Research Institute, Mahatma Gandhi Road, Thakurpukur, Kolkata, 700063, India
| | - Somsubhra Nath
- Saroj Gupta Cancer Centre and Research Institute, Mahatma Gandhi Road, Thakurpukur, Kolkata, 700063, India
| | - Susanta Roychoudhury
- CSIR-Indian Institute of Chemical Biology, 4, Raja S.C. Mullick Road, Kolkata, 700032, India
| | - Samsiddhi Bhattacharjee
- National Institute of Biomedical Genomics, Near Netaji Subhas Sanatorium Post Office, Kalyani, West Bengal, 741251, India.
| | - Mainak Sengupta
- Department of Genetics, University of Calcutta, 35, Ballygunge Circular Road, Kolkata, 700019, India.
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Rai B, Arokiasamy P. Identifying stages of smoke and smokeless tobacco cessation among adults in India: an application of transtheoretical model. JOURNAL OF SUBSTANCE USE 2021. [DOI: 10.1080/14659891.2020.1807634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- Balram Rai
- Department of Mathematical Demography & Statistics, International Institute for Population Sciences, Mumbai, India
| | - Perianayagam Arokiasamy
- Department of Development Studies, International Institute for Population Sciences, Mumbai, India
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24
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Smith P, Daniel R, Murray RL, Moore G, Nelson A, Brain K. Psychosocial determinants of quit motivation in older smokers from deprived backgrounds: a cross-sectional survey. BMJ Open 2021; 11:e044815. [PMID: 33952547 PMCID: PMC8103390 DOI: 10.1136/bmjopen-2020-044815] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Revised: 02/15/2021] [Accepted: 04/15/2021] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVES To identify psychosocial determinants of quit motivation in older deprived smokers. The evidence may be used to optimise smoking cessation interventions for the target population. DESIGN Cross-sectional survey using online recruitment methods including Facebook-targeted advertising. SETTING UK, 2019. PARTICIPANTS Current smokers aged 50 years or older and from a socioeconomically deprived background. MAIN OUTCOME MEASURES Measures included motivation to stop smoking, smoking history, perceived social support, self-efficacy for quitting, self-exempting beliefs and lung cancer risk perception. Multivariable regression was used to analyse factors associated with quit motivation. RESULTS Of a total 578 individuals who consented to take part, 278 (48.1%) did not meet the inclusion criteria. Of the 300 eligible participants, most were recruited using Facebook (94.0%), were aged 50-64 years (83.7%) and women (85.7%). Most participants were renting from a housing association (72.0%) and had low education (61.0%). Higher motivation to quit was statistically significantly associated with a higher intensity of previous quit attempts (p=0.03), higher quit confidence (p=0.01), higher smoking self-efficacy (p=0.01), a lower risk-minimising beliefs score (p=0.01) and using traditional nicotine replacement therapy (NRT) when trying to stop smoking or cut down (p<0.001). CONCLUSION Older smokers from deprived backgrounds face complex barriers to quitting smoking. Interventions are needed to increase self-efficacy for quitting, modify risk-minimising beliefs and target elements of previous quit attempts (ie, the use of NRT) that are associated with motivation to stop smoking.
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Affiliation(s)
- Pamela Smith
- Division of Population Medicine, Cardiff University, Cardiff, UK
| | - Rhian Daniel
- Division of Population Medicine, Cardiff University, Cardiff, UK
| | - Rachael L Murray
- UK Centre for Tobacco Control Studies, Division of Epidemiology & Public Health, University of Nottingham, Nottingham, UK
| | - Graham Moore
- School of Social Sciences, Cardiff University, Cardiff, UK
| | - Annmarie Nelson
- Marie Curie Palliative Care Research Centre, Cardiff University, Cardiff, UK
| | - Kate Brain
- Division of Population Medicine, Cardiff University, Cardiff, UK
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25
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Khalaf N, El-Serag HB, Abrams HR, Thrift AP. Burden of Pancreatic Cancer: From Epidemiology to Practice. Clin Gastroenterol Hepatol 2021; 19:876-884. [PMID: 32147593 PMCID: PMC8559554 DOI: 10.1016/j.cgh.2020.02.054] [Citation(s) in RCA: 144] [Impact Index Per Article: 48.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2019] [Revised: 02/05/2020] [Accepted: 02/28/2020] [Indexed: 12/24/2022]
Abstract
Pancreatic cancer is the seventh leading cause of cancer-related deaths worldwide with 432,242 related deaths in 2018. Unlike other cancers, the incidence of pancreatic cancer continues to increase, with little improvement in survival rates. We review the epidemiologic features of pancreatic cancer, covering surveillance and early detection in high-risk persons. We summarize data on worldwide incidence and mortality and analyze the 1975-2016 data from 9 registries of the National Cancer Institute's Surveillance, Epidemiology, and End Results study, on the overall burden of pancreatic cancer as well as age-, sex-, and race-specific incidence, survival rates and trends. It is important to increase our knowledge of the worldwide and regional epidemiologic features of and risk factors for pancreatic cancer, to identify new approaches for prevention, surveillance, and treatment.
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Affiliation(s)
- Natalia Khalaf
- Section of Gastroenterology and Hepatology, Department of Medicine, Baylor College of Medicine and Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas.
| | - Hashem B El-Serag
- Section of Gastroenterology and Hepatology, Department of Medicine, Baylor College of Medicine and Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas
| | - Hannah R Abrams
- Department of Internal Medicine, Baylor College of Medicine, Houston, Texas
| | - Aaron P Thrift
- Section of Epidemiology and Population Sciences, Department of Medicine, Baylor College of Medicine, Houston, Texas; Dan L Duncan Comprehensive Cancer Center, Baylor College of Medicine, Houston, Texas
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26
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Radiation Therapy Alone for Human Papillomavirus-Related Squamous Cell Carcinoma of the Oropharynx: A Single-Arm, Phase 2 Study. Int J Radiat Oncol Biol Phys 2020; 110:403-411. [PMID: 33373656 DOI: 10.1016/j.ijrobp.2020.12.025] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Revised: 12/01/2020] [Accepted: 12/10/2020] [Indexed: 12/13/2022]
Abstract
PURPOSE Human papillomavirus (HPV)-related squamous cell carcinoma of the oropharynx (OPSCC) is extremely radiosensitive. Radiation therapy plus high-dose cisplatin remains the standard of care but causes long-term toxicity. Treatment deintensification approaches that reduce toxicity while maintaining survival are desirable for HPV-related OPSCC. METHODS AND MATERIALS We conducted a single-arm, multicenter, phase 2 trial. Patients with newly diagnosed, biopsy-proven, American Joint Committee on Cancer (seventh edition) stage III or IV OPSCC positive for both p16 and HPV DNA were eligible. Patients with T4, N3, or T1N1 disease were excluded. Smoking history was not included in eligibility criteria. Patients received intensity modulated radiation therapy (IMRT) of 70 Gy in 35 fractions or 70.4 Gy in 32 fractions without chemotherapy. The primary endpoint was complete response or complete metabolic response 10 weeks after IMRT completion. RESULTS Between September 13, 2013, and November 15, 2016, 39 patients were enrolled according to a 2-stage Simon design. Twenty-three patients (59%) had smoked for more than10 pack-years. Thirty-six patients (92%) had tumors genotyped as HPV16. Thirty-seven patients (95%) received full-dose radiation therapy and 35 (90%) had complete response or complete metabolic response. Median follow-up was 51 months (interquartile range, 41-63 months). One patient (3%) had regional recurrence and 3 (8%) had distant metastasis. One patient died of disease. The 2-year progression-free survival rate was 94% (95% CI, 81%-99%), and the 2-year overall survival rate was 100%. Common grade 3 adverse events during IMRT included mucositis in 10 patients (26%) and dysphagia in 7 patients (18%). No patients were dependent on a feeding tube at 1 month after IMRT completion. No grade 3 or 4 late adverse events were observed. CONCLUSIONS IMRT alone is associated with excellent response as well as reduced toxicity and could be a treatment option for carefully selected patients with locally advanced "true" HPV-related OPSCC. Further studies are warranted.
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Holipah H, Sulistomo HW, Maharani A. Tobacco smoking and risk of all-cause mortality in Indonesia. PLoS One 2020; 15:e0242558. [PMID: 33259522 PMCID: PMC7707492 DOI: 10.1371/journal.pone.0242558] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2020] [Accepted: 11/04/2020] [Indexed: 11/18/2022] Open
Abstract
Tobacco is well known as a risk factor for early morbidity and mortality worldwide. However, the relative risk of mortality and the effects of smoking vary among the countries. Indonesia, as one of the world's largest market for smoking tobacco, is significantly affected by tobacco-related illness. Previous research has shown that smoking causes several diseases, including stroke, neoplasm and coronary heart disease. There has to date been no research on the hazard risk of smoking for all-cause mortality in Indonesia. This study aimed to identify the association between smoking and all-cause mortality rates in Indonesia. Information from a total of 3,353 respondents aged 40 years and older was collected in this study. The data were taken from the Indonesian Family Life Survey (IFLS) Wave 4 (2007) to collect personal information and determine smoking status and from Wave 5 (2015) to collect information about deaths. Current smokers make up 40.3% of Indonesia's population. Current smokers were more likely to have a higher risk of all-cause death (hazard ratio = 1.48, 95% confidence interval = 1.11 to 1.98) than non-current smokers. The number of smokers in Indonesia remains high and is expected to increase gradually every year. A firm government policy is needed to reduce the number of smokers in Indonesia which would automatically reduce the health problem of smoking-related illness in the future.
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Affiliation(s)
- Holipah Holipah
- Faculty of Medicine Universitas Brawijaya, Malang, Indonesia
- * E-mail:
| | | | - Asri Maharani
- Division of Nursing, Midwifery & Social Work, University of Manchester, Manchester, United Kingdom
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Gossin M, Gmel G, Studer J, Saubade M, Clair C. The Association between Type and Intensity of Sport and Tobacco or Nicotine Use-A Cross-Sectional Study among Young Swiss Men. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17228299. [PMID: 33182675 PMCID: PMC7696790 DOI: 10.3390/ijerph17228299] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Revised: 11/01/2020] [Accepted: 11/04/2020] [Indexed: 11/16/2022]
Abstract
The objective of this study was to assess the association between tobacco/nicotine use and type and intensity of sport. Data were drawn from the second follow-up of the Cohort Study on Substance Use Risk Factors. Young Swiss men completed a questionnaire about tobacco/nicotine use (cigarette, vaping, snus, snuff), type and intensity of sport and other demographic and medical variables. Among the 5414 included participants (mean age 25.5), 3434 (63.4%) reported regularly practicing a sport. They had a lower rate of cigarette smoking (32.3%) compared with participants not practicing a sport (44.6%) but a higher rate of snus use (15.0% vs. 10.0%). In adjusted models, individual-sport participants were less likely to use snus and snuff (OR = 0.63, 95% CI = 0.51–0.77 and OR = 0.73, 95% CI = 0.61–0.88), compared with team-sport participants. The association was inversed for vaping users (OR = 1.54, 95% CI = 1.03–2.30). Furthermore, participants who practiced high-intensity sports had a lower likelihood to smoke cigarettes (OR = 0.63, 95% CI = 0.52–0.78) compared with low-intensity sports. Our findings suggest that type and intensity of sport are associated with tobacco/nicotine use. Youth who practice an individual sport are less likely to use snus or snuff and more likely to vape compared with a team sport. This could help better target smoking prevention in young people
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Affiliation(s)
- Marine Gossin
- Department of Training, Research and Innovation, Center for Primary Care and Public Health (Unisanté), University of Lausanne, 1010 Lausanne, Switzerland;
- Correspondence:
| | - Gerhard Gmel
- Addiction Medicine, Department of Psychiatry, Lausanne University Hospital and University of Lausanne, 1011 Lausanne, Switzerland; (G.G.); (J.S.)
- Research Department, Addiction Switzerland, 1001 Lausanne, Switzerland
- Centre for Addiction and Mental Health, Institute for Mental Health Policy Research, Toronto, ON M5S 2S1, Canada
- Department of Health and Social Sciences, University of the West of England, Bristol BS16 1QY, UK
| | - Joseph Studer
- Addiction Medicine, Department of Psychiatry, Lausanne University Hospital and University of Lausanne, 1011 Lausanne, Switzerland; (G.G.); (J.S.)
| | - Mathieu Saubade
- Swiss Olympic Medical Center, Division of Physical and Rehabilitation Medicine, University Hospital of Lausanne, 1011 Lausanne, Switzerland;
- Department of Prevention and Public Health, Center for Primary Care and Public Health (Unisanté), University of Lausanne, 1010 Lausanne, Switzerland
| | - Carole Clair
- Department of Training, Research and Innovation, Center for Primary Care and Public Health (Unisanté), University of Lausanne, 1010 Lausanne, Switzerland;
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29
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Shah A, Chaiton M, Baliunas D, Schwartz R. Tailored Web-Based Smoking Interventions and Reduced Attrition: Systematic Review and Meta-Analysis. J Med Internet Res 2020; 22:e16255. [PMID: 33074158 PMCID: PMC7605982 DOI: 10.2196/16255] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2019] [Revised: 04/24/2020] [Accepted: 06/03/2020] [Indexed: 01/20/2023] Open
Abstract
Background The increasing number of internet users presents an opportunity to deliver health interventions to large populations. Despite their potential, many web-based interventions, including those for smoking cessation, face high rates of attrition. Further consideration of how intervention features impact attrition is needed. Objective The aim of this systematic review is to investigate whether tailored web-based smoking cessation interventions for smokers are associated with reduced rates of attrition compared with active or passive untailored web-based interventions. The outcomes of interest were dropout attrition at 1-, 3-, 6-, and 12-month follow-ups. Methods Literature searches were conducted in May 2018 and updated in May 2020 on MEDLINE (Medical Literature Analysis and Retrieval System Online), PsycINFO (Psychological Information), EMBASE (Excerpta Medica dataBASE), CINAHL (Cumulated Index to Nursing and Allied Health Literature), Scopus, and the Cochrane Tobacco Addiction Group Specialized Register with the following search terms: smoking cessation, tailored, or web- or internet-based. Included studies were published in English before or in May 2020 using a randomized controlled trial design. Studies were restricted to those with web-based delivery, a tailored intervention group, an untailored control group, and a reported outcome of smoking cessation. Studies were assessed for methodological quality using the Cochrane Risk of Bias tool. Two reviewers independently extracted the study characteristics and the number of participants lost to follow-up for each treatment group. Results A total of 13 studies were included in the systematic review, of which 11 (85%) were included in the meta-analysis. Tailoring had no statistically significant effect on dropout attrition at 1-month (risk ratio [RR]=1.02, 95% CI 0.95-1.09; P=.58; I2=78%), 3-month (RR=0.99, 95% CI 0.95-1.04; P=.80; I2=73%), 6-month (RR=1.00, 95% CI 0.95-1.05; P=.90; I2=43%), or 12-month (RR=0.97, 95% CI 0.92-1.02; P=.26; I2=28%) follow-ups. Subgroup analyses suggested that there was a statistically significant effect of tailoring between the active and passive subgroups at 1-month (P=.03), 3-month (P<.001), and 6-month (P=.02) follow-ups but not at 12-month follow-up (P=.25). Conclusions The results suggest that tailoring of web-based smoking cessation interventions may not be associated with reduced rates of dropout attrition at 1-, 3-, 6-, or 12-month follow-ups. Significant differences between studies that include untailored active and passive control groups suggest that the role of tailoring may be more prominent when studies include a passive control group. These findings may be because of variability in the presence of additional features, the definition of smokers used, and the duration of smoking abstinence measured. Future studies should incorporate active web-based controls, compare the impact of different tailoring strategies, and include populations outside of the Western countries.
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Affiliation(s)
- Amika Shah
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Michael Chaiton
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.,Ontario Tobacco Research Unit, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Dolly Baliunas
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.,Office of Education, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Robert Schwartz
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.,Ontario Tobacco Research Unit, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
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30
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Al-Rubaye AKQ, Johansson K, Alrubaiy L. The association of health behavioral risk factors with quality of life in northern Sweden-A cross-sectional survey. J Gen Fam Med 2020; 21:167-177. [PMID: 33014667 PMCID: PMC7521790 DOI: 10.1002/jgf2.333] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2020] [Revised: 04/21/2020] [Accepted: 04/27/2020] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND It is well known that behavioral risk factors such as obesity, smoking, physical activity, diet, and excessive alcohol are linked to general health in northern Sweden. This study aimed to explore the joint relationship between these risk factors and the quality of life (QoL). METHODS Data were collected from Sweden's national public health survey between February and May 2014 in the four northern counties in Sweden. QoL was assessed using the EuroQol (EQ-5D). Multivariable regression analysis was used to examine the relationship between five risk factors: BMI, physical activity, smoking status, fruit and vegetable intake, and alcohol consumption and QoL. RESULTS Data from 17 138 complete questionnaires showed that individuals who were not obese, did at least 30 minutes of physical activity daily, consumed at least 3 portions of vegetable or fruits, were not smoking daily, and who did not report being drunk at least once every week were found to have better QoL (P < .005). The mean EQ-5D score ranged from 0.85 to 0.79. Approximately, two thirds of the studied population reported being physically active for at least 30 minutes every day and two fifths of them had a normal BMI. Only around 7% of the sample reported that they were eating the recommended daily level of fruits and vegetables. CONCLUSIONS The results of the study suggest that QoL has a significant relationship with lifestyle behaviors. This finding would emphasize the role of interventions to improve population health.
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Affiliation(s)
| | - Klara Johansson
- Department of Epidemiology and Global Health Umeå University Umeå Sweden
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31
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Zhang S, Zhou C, Liu D, Piao Y, Zhang F, Hu J, Ma Z, Wei Z, Zhu W, Lv M. Is smoking a risk factor for bleeding in adult men with cerebral arteriovenous malformations? A single-center regression study from China. J Stroke Cerebrovasc Dis 2020; 29:105084. [PMID: 32807480 DOI: 10.1016/j.jstrokecerebrovasdis.2020.105084] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Revised: 04/21/2020] [Accepted: 06/21/2020] [Indexed: 01/22/2023] Open
Abstract
OBJECTIVE To assess whether smoking increases the risk of bleeding in patients with cerebral arteriovenous malformations (CAVM). MATERIAL AND METHODS According to our research plan, 385 CAVM patients admitted to Beijing Tiantan Hospital from December 2015 to January 2018 were included in this study, including 210 bleeding patients and 175 non-bleeding patients. We divided patients into three subgroups of current smokers, ex-smokers (those who quit smoking for one year or more) and non-smokers. The relationship between smoking and the risk of CAVM rupture was assessed by univariate and multivariate regression analysis. RESULTS Multivariate regression analysis showed that there was a statistically significant difference between current smoker and non-smoker (OR = 1.87, p = 0.019). Among the covariates of the multivariate regression analysis, the location, combined with blood flow-related intracranial aneurysms and size were related to the risk of CAVM bleeding. CONCLUSION Current smoking may increase the risk of CAVM bleeding; however, there was no significant correlation between ex-smoking and CAVM bleeding.
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Affiliation(s)
- Shuai Zhang
- Department of Neurosurgery, Beijing Jingmei Group General Hospital, Beijing 102300, PR China
| | - Chenguang Zhou
- Department of Neurology, The Fifth Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, Henan, PR China
| | - Dong Liu
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, China National Clinical Research Centre for Neurological Diseases, Beijing, 100070, China
| | - Yongjun Piao
- Department of Neurosurgery, Beijing Jingmei Group General Hospital, Beijing 102300, PR China
| | - Fuqiang Zhang
- Department of Neurosurgery, Beijing Jingmei Group General Hospital, Beijing 102300, PR China
| | - Jie Hu
- Department of Neurosurgery, Beijing Jingmei Group General Hospital, Beijing 102300, PR China
| | - Zongqian Ma
- Department of Neurosurgery, Beijing Jingmei Group General Hospital, Beijing 102300, PR China
| | - Zhanyang Wei
- Department of Neurosurgery, Beijing Jingmei Group General Hospital, Beijing 102300, PR China
| | - Weisheng Zhu
- Department of Neurosurgery, Beijing Jingmei Group General Hospital, Beijing 102300, PR China.
| | - Ming Lv
- Department of Interventional Neuroradiology, Beijing Neurosurgical Institute and Beijing Tian Tan Hospital, Capital Medical University, Beijing 100070, PR China.
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32
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Schubauer-Berigan MK, Berrington de Gonzalez A, Cardis E, Laurier D, Lubin JH, Hauptmann M, Richardson DB. Evaluation of Confounding and Selection Bias in Epidemiological Studies of Populations Exposed to Low-Dose, High-Energy Photon Radiation. J Natl Cancer Inst Monogr 2020; 2020:133-153. [PMID: 32657349 PMCID: PMC7355263 DOI: 10.1093/jncimonographs/lgaa008] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND Low-dose, penetrating photon radiation exposure is ubiquitous, yet our understanding of cancer risk at low doses and dose rates derives mainly from high-dose studies. Although a large number of low-dose cancer studies have been recently published, concern exists about the potential for confounding to distort findings. The aim of this study was to describe and assess the likely impact of confounding and selection bias within the context of a systematic review. METHODS We summarized confounding control methods for 26 studies published from 2006 to 2017 by exposure setting (environmental, medical, or occupational) and identified confounders of potential concern. We used information from these and related studies to assess evidence for confounding and selection bias. For factors in which direct or indirect evidence of confounding was lacking for certain studies, we used a theoretical adjustment to determine whether uncontrolled confounding was likely to have affected the results. RESULTS For medical studies of childhood cancers, confounding by indication (CBI) was the main concern. Lifestyle-related factors were of primary concern for environmental and medical studies of adult cancers and for occupational studies. For occupational studies, other workplace exposures and healthy worker survivor bias were additionally of interest. For most of these factors, however, review of the direct and indirect evidence suggested that confounding was minimal. One study showed evidence of selection bias, and three occupational studies did not adjust for lifestyle or healthy worker survivor bias correlates. Theoretical adjustment for three factors (smoking and asbestos in occupational studies and CBI in childhood cancer studies) demonstrated that these were unlikely to explain positive study findings due to the rarity of exposure (eg, CBI) or the relatively weak association with the outcome (eg, smoking or asbestos and all cancers). CONCLUSION Confounding and selection bias are unlikely to explain the findings from most low-dose radiation epidemiology studies.
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Affiliation(s)
- Mary K Schubauer-Berigan
- Evidence Synthesis and Classification Section, International Agency for Research on Cancer, Lyon, France
| | | | - Elisabeth Cardis
- Radiation Programme, Barcelona Institute for Global Health (ISGlobal), Barcelona, Spain
- Universitat Pompeu Fabra (UPF), Barcelona, Spain
- CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Dominique Laurier
- Institut de Radioprotection et de Sûreté Nucléaire (IRSN), Fontenay-aux-Roses, France
| | - Jay H Lubin
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD
| | - Michael Hauptmann
- Division of Epidemiology and Biostatistics, Netherlands Cancer Institute, Amsterdam, The Netherlands (MH); Brandenburg Medical School, Institute of Biostatistics and Registry Research, Neuruppin, Germany
| | - David B Richardson
- Department of Epidemiology, University of North Carolina, School of Public Health, Chapel Hill, NC, USA
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Carmona-Bayonas A, Jimenez-Fonseca P, Sánchez Arraez Á, Álvarez Manceñido F, Castañón E. Does active smoking worsen Covid-19? Eur J Intern Med 2020; 77:129-131. [PMID: 32507518 PMCID: PMC7254011 DOI: 10.1016/j.ejim.2020.05.038] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Accepted: 05/24/2020] [Indexed: 11/19/2022]
Abstract
Probably it does.
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Affiliation(s)
- Alberto Carmona-Bayonas
- Hematology & Medical Oncology Department, UMU, IMIB, Hospital Universitario Morales Meseguer, Murcia, Spain.
| | - Paula Jimenez-Fonseca
- Medical Oncology Department, Hospital Universitario Central de Asturias, Oviedo, Spain
| | - Álvaro Sánchez Arraez
- Interdisciplinary teragnosis and radiosomics (INTRA) network. Universidad de Navarra, Madrid, Spain
| | | | - Eduardo Castañón
- Medical Oncology Department, Clínica Universidad de Navarra, Madrid, Spain
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34
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Villanti AC, West JC, Klemperer EM, Graham AL, Mays D, Mermelstein RJ, Higgins ST. Smoking-Cessation Interventions for U.S. Young Adults: Updated Systematic Review. Am J Prev Med 2020; 59:123-136. [PMID: 32418800 PMCID: PMC7453837 DOI: 10.1016/j.amepre.2020.01.021] [Citation(s) in RCA: 44] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2019] [Revised: 01/19/2020] [Accepted: 01/20/2020] [Indexed: 01/15/2023]
Abstract
CONTEXT Recent data suggest that the onset of cigarette smoking is now more likely during young adulthood than adolescence. Additionally, the landscape of delivering smoking-cessation interventions has changed in the past decade, with the emergence of mobile phone and web-based approaches. The objective of this study is to update a 2010 systematic review of smoking-cessation interventions for U.S. young adults (aged 18-24 years). EVIDENCE ACQUISITION Electronic searches were conducted in CINAHL, the Cochrane Library, Embase, PsycINFO, PubMed, Scopus, and Sociological Abstracts to identify eligible interventions from August 31, 2009 through July 17, 2019. Two independent coders critically evaluated the methodology and findings of all retrieved articles. Data analysis was conducted in 2019. EVIDENCE SYNTHESIS A total of 17 RCTs and 1 nonrandomized study were added to the original 14 studies meeting the inclusion criteria for this review; these studies varied with respect to sample size, intervention, assessed outcomes, and smoking measures. Of the new studies, 3 increased cessation in the short term, 2 at 6 months, and 1 had short-term effects on cigarette reduction. Pooled analyses supported the use of interventions employing social cognitive theory, quitline counseling, and text message programs for short-term cessation in young adults. CONCLUSIONS Of 32 included studies, 9 demonstrated efficacy of smoking cessation or reduction in U.S. young adults. There were no eligible pharmacologic interventions included in this review. Findings support the promise of 3 approaches for young adult cessation not included in the prior review: text message interventions, sustained quit-and-win contests, and multiple behavior interventions.
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Affiliation(s)
- Andrea C Villanti
- Vermont Center on Behavior and Health, Department of Psychiatry, University of Vermont, Burlington, Vermont.
| | - Julia C West
- Vermont Center on Behavior and Health, Department of Psychiatry, University of Vermont, Burlington, Vermont
| | - Elias M Klemperer
- Vermont Center on Behavior and Health, Department of Psychiatry, University of Vermont, Burlington, Vermont
| | - Amanda L Graham
- Innovations, Truth Initiative, Washington, District of Columbia; Department of Oncology, Georgetown University Medical Center, Cancer Prevention & Control Program, Lombardi Comprehensive Cancer Center, Washington, District of Columbia
| | - Darren Mays
- Department of Oncology, Georgetown University Medical Center, Cancer Prevention & Control Program, Lombardi Comprehensive Cancer Center, Washington, District of Columbia
| | - Robin J Mermelstein
- Department of Psychology and Institute for Health Research and Policy, University of Illinois at Chicago, Chicago, Illinois
| | - Stephen T Higgins
- Vermont Center on Behavior and Health, Department of Psychiatry, University of Vermont, Burlington, Vermont
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Abstract
E‑cigarettes are increasingly used to replace tobacco cigarettes and to stop smoking, but mainly in the sense of dual use. There is lively debate about the assessment of the health risks of e‑cigarettes, but so far there are no comprehensive data for direct comparison with tobacco cigarettes. Other points of controversy include the potential for smoking cessation and the risk of moving from e‑cigarettes to tobacco cigarettes (gateway hypothesis). The present overview comes to the conclusion that, in accordance with the health policy already largely implemented in Great Britain, e‑cigarettes represent a greatly reduced health risk compared with tobacco cigarettes and are certainly suitable for giving up smoking.
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Sheng Xiong P, Juan Xiong M, Xi Liu Z, Liu Y. Prevalence of smoking among adolescents in China: an updated systematic review and meta-analysis. Public Health 2020; 182:26-31. [PMID: 32145409 DOI: 10.1016/j.puhe.2020.01.011] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Revised: 11/23/2019] [Accepted: 01/14/2020] [Indexed: 02/05/2023]
Abstract
OBJECTIVES Smoking is a major public health problem worldwide. Estimates for smoking prevalence among adolescents in different regions and in the whole of China are important for the development of public health policies. We conducted a systematic review and meta-analysis to estimate the prevalence of smoking among youth in China. STUDY DESIGN This is a meta-analysis study. METHODS English (PubMed, EMBASE) and Chinese (China National Knowledge Internet, WANFANG Data, and CBM) databases were independently searched by two investigators from inception to May 2019. Random effects meta-analysis was conducted to estimate the pooled prevalence of smoking. Subgroup analysis and meta-regression were performed to investigate sources of heterogeneity. This study is registered with PROSPERO, number CRD42019130803. RESULTS In total, 131 articles were included in the meta-analysis, with a total of 146 studies, involving 684,370 Chinese participants. The total prevalence of smoking among youth in mainland China was 8.17% (95% confidence interval: 6.97-9.45). Subgroup analysis showed that the geographic location and gender could significantly influence the prevalence of smoking. Meta-regression analyses revealed study year, sex ratio (male, %), and response rates did not contribute to the heterogeneity of the results (P-value >0.05). Sensitivity analysis showed that the results were statistically stable. CONCLUSION This meta-analysis indicates that smoking is common among adolescents in China, and the rate varies between different regions. More practical and effective policies targeting adolescents are urgently needed.
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Affiliation(s)
- P Sheng Xiong
- Zhanggong District Center for Disease Control and Prevention, GanZhou City, JiangXi Province, China.
| | - M Juan Xiong
- Shenzhen Cancer Hospital, Shenzhen, Guangdong Province, China
| | - Z Xi Liu
- Shantou University Medical College, Shantou, Guangdong Province, China
| | - Y Liu
- Shangrao Center for Disease Control and Prevention, Shangrao, JiangXi Province, China
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37
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Villanti AC, Niaura RS, Abrams DB, Mermelstein R. Preventing Smoking Progression in Young Adults: the Concept of Prevescalation. PREVENTION SCIENCE : THE OFFICIAL JOURNAL OF THE SOCIETY FOR PREVENTION RESEARCH 2020. [PMID: 29525899 DOI: 10.1007/s11121-018-0880-y] [Citation(s) in RCA: 77] [Impact Index Per Article: 19.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
As adolescents cross the threshold to young adulthood, they encounter more opportunities to engage in or accelerate previously discouraged or prohibited behaviors. Young adults, therefore, are more apt to initiate cigarette smoking and, more importantly, to accelerate their use if they tried and experimented as an adolescent. Preventing the escalation and entrenchment of smoking in the young adult years is critically important to reducing tobacco's long-term health toll. However, traditional interventions for youth have focused on preventing smoking initiation, and interventions for adults have focused on smoking cessation; both have failed to address the needs of young adults. We introduce the concept of "prevescalation" to capture the need and opportunity to prevent the escalation of risk behaviors that typically occur during young adulthood, with a focus on the example of cigarette smoking. Prevescalation negates the notion that prevention has failed if tobacco experimentation occurs during adolescence and focuses on understanding and interrupting transitions between experimentation with tobacco products and established tobacco use that largely occur during young adulthood. However, since risk behaviors often co-occur in young people, the core concept of prevescalation may apply to other behaviors that co-occur and become harder to change in later adulthood. We present a new framework for conceptualizing, developing, and evaluating interventions that better fit the unique behavioral, psychosocial, and socio-environmental characteristics of the young adult years. We discuss the need to target this transitional phase, what we know about behavioral pathways and predictors of cigarette smoking, potential intervention considerations, and research challenges.
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Affiliation(s)
- Andrea C Villanti
- Vermont Center on Behavior and Health, Department of Psychiatry, University of Vermont, Burlington, VT, USA. .,Schroeder Institute for Tobacco Research and Policy Studies at Truth Initiative, Washington, DC, USA. .,Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
| | - Raymond S Niaura
- Schroeder Institute for Tobacco Research and Policy Studies at Truth Initiative, Washington, DC, USA.,Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.,Department of Oncology, Georgetown University Medical Center/Cancer Prevention and Control Program, Lombardi Comprehensive Cancer Center, Washington, DC, USA
| | - David B Abrams
- Schroeder Institute for Tobacco Research and Policy Studies at Truth Initiative, Washington, DC, USA.,Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.,Department of Oncology, Georgetown University Medical Center/Cancer Prevention and Control Program, Lombardi Comprehensive Cancer Center, Washington, DC, USA
| | - Robin Mermelstein
- Department of Psychology and Institute for Health Research and Policy, University of Illinois at Chicago, Chicago, IL, USA
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Jha P. The hazards of smoking and the benefits of cessation: a critical summation of the epidemiological evidence in high-income countries. eLife 2020; 9:49979. [PMID: 32207405 PMCID: PMC7093109 DOI: 10.7554/elife.49979] [Citation(s) in RCA: 65] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2019] [Accepted: 02/14/2020] [Indexed: 12/15/2022] Open
Abstract
In high-income countries, the biggest cause of premature death, defined as death before 70 years, is smoking of manufactured cigarettes. Smoking-related disease was responsible for about 41 million deaths in the United States, United Kingdom and Canada, cumulatively, from 1960 to 2020. Every million cigarettes smoked leads to one death in the US and Canada, but slightly more than one death in the UK. The 21st century hazards reveal that smokers who start smoking early in adult life and do not quit lose a decade of life expectancy versus non-smokers. Cessation, particularly before age 40 years, yields large reductions in mortality risk. Up to two-thirds of deaths among smokers are avoidable at non-smoking death rates, and former smokers have about only a quarter of the excess risk of death compared to current smokers. The gap between scientific and popular understanding of smoking hazards is surprisingly large.
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Affiliation(s)
- Prabhat Jha
- Centre for Global Health Research, Dalla Lana School of Public Health and Unity Health, Toronto, University of Toronto, Ontario, Canada
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39
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Li W, Wang D, Zhang H, Zhang Y, Zheng W, Xue X, Shen W, Sitas F, Jiang G. The methodology for assessing smoking-attributed mortality based on All Causes of Death Surveillance in Tianjin, China, 2010-2015. Tob Induc Dis 2020; 18:21. [PMID: 32265615 PMCID: PMC7132577 DOI: 10.18332/tid/116970] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2019] [Revised: 01/14/2020] [Accepted: 01/22/2020] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION The All Causes of Death Surveillance (ACDS) system was used to measure smoking-attributed mortality by inserting questions on smoking on death certificates. Smoking status information of the deceased has been routinely collected in death certificates since 2010. We describe a death registry-based case-control study using smoking and cause-of-death data for the period 2010-15. METHODS From 2010, three questions about the smoking status of the deceased were inserted in a revised death certificate: 1) Smoking status (current smoker, quit smoking, never smoker); 2) Number of cigarettes per day smoked; and 3) Number of years of smoking. A data-accuracy survey of 1788 telephone interviews of the family of the deceased was also conducted. Smoking habits (current/ex-smoker vs non-smoker) were compared in study cases (persons who died of lung cancer and other diseases known to be caused by smoking) and the controls (never smokers). Multivariate logistic regression analysis was conducted to estimate relative risks, RR (odds ratios) for smoking-attributed mortality, for lung cancer and all causes of death related to smoking, adjusted for 5-year interval age groups, education, marital status, and year of death. RESULTS During the study period (2010-15), the annual crude death reporting rates ranged from 6.5‰ to 7.0‰. The reporting rates of smoking status, smoking history and the number of cigarettes smoked daily were 95.5%, 98.6% and 98.6%, respectively. Compared to never smokers, the RR of ever smoking in males was 1.38 (95% CI: 1.33-1.43) for all causes of smoking-related deaths and 3.07 (95% CI: 2.91-3.24) for lung cancer, while in females the values were 1.46 (95% CI: 1.39-1.54) for all causes of smoking-related deaths and 4.07 (95% CI: 3.81-4.35) for lung cancer. The results in Tianjin are in accord with published results from previous studies. CONCLUSIONS Levels and trends in smoking attributed mortality can be measured at low cost by using the stable, complete and effective ACDS system in Tianjin.
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Affiliation(s)
- Wei Li
- Department of Non-communicable Disease Control and Prevention, Tianjin Centers for Disease Control and Prevention, Tianjin, China
| | - Dezheng Wang
- Department of Non-communicable Disease Control and Prevention, Tianjin Centers for Disease Control and Prevention, Tianjin, China
| | - Hui Zhang
- Department of Non-communicable Disease Control and Prevention, Tianjin Centers for Disease Control and Prevention, Tianjin, China
| | - Ying Zhang
- Department of Non-communicable Disease Control and Prevention, Tianjin Centers for Disease Control and Prevention, Tianjin, China
| | - Wenlong Zheng
- Department of Non-communicable Disease Control and Prevention, Tianjin Centers for Disease Control and Prevention, Tianjin, China
| | - Xiaodan Xue
- Department of Non-communicable Disease Control and Prevention, Tianjin Centers for Disease Control and Prevention, Tianjin, China
| | - Wenda Shen
- Department of Non-communicable Disease Control and Prevention, Tianjin Centers for Disease Control and Prevention, Tianjin, China
| | - Freddy Sitas
- Centre for Primary Health Care and Equity, School of Public Health and Community Medicine, University of New South Wales Sydney, Sydney, Australia.,Menzies Centre for Health Policy, University of Sydney, Sydney, Australia.,School of Public Health, University of Sydney, Sydney, Australia
| | - Guohong Jiang
- Department of Non-communicable Disease Control and Prevention, Tianjin Centers for Disease Control and Prevention, Tianjin, China.,School of Public Health, Tianjin Medical University, Tianjin, China
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40
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Chen WC, Singh E, Muchengeti M, Bradshaw D, Mathew CG, Babb de Villiers C, Lewis CM, Waterboer T, Newton R, Sitas F. Johannesburg Cancer Study (JCS): contribution to knowledge and opportunities arising from 20 years of data collection in an African setting. Cancer Epidemiol 2020; 65:101701. [PMID: 32169796 DOI: 10.1016/j.canep.2020.101701] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Revised: 03/03/2020] [Accepted: 03/04/2020] [Indexed: 10/24/2022]
Abstract
The Johannesburg Cancer Study (JCS) aims were to examine whether cancer risk factors identified in Western countries applied to black patients in Johannesburg, South Africa and to understand the impact of HIV on cancer risk, with a view to identifying previously unrecognised HIV associated cancers. A total of 24 971 black patients with an incident histologically proven (>95%) cancer of any type were enrolled between 1995-2016. Response rates were >90%. Patients provided informed consent, lifestyle and demographic information using a structured questionnaire; 19 351 provided a serum sample and 18 972 a whole blood sample for genomic analyses. This is currently the largest cancer epidemiological biobank in Africa. JCS uses a cancer case-control method; controls being cancer types unrelated to exposures of interest. Published results show the importance of HIV in several cancers known to be infection associated e.g. Kaposi sarcoma (OR = 1683; CI = 595-5194) in those with high Kaposi-sarcoma-associated-herpesvirus titres; no effect of HIV on lung or liver cancer-in the latter showing a strong association with HBVDNA, sAg and c positivity (OR = 47; CI = 21-104). Comparable data to higher-income country studies include lung cancer ORs in relation to smoking (15+g tobacco/day) (ORMales = 37; CI = 21-67, ORFemales = 18.5; CI = 8-45) and associations between alcohol and oesophageal cancer in smokers (ORM&F = 4.4; CI = 3-6). Relationship between hormonal contraception declined to null 10 or more years after stopping for breast (OR = 1.1; CI = 0.9-1.4) and cervical cancer (OR = 1.0;CI = 0.8-1.2), and protective effects shown, five or more years after stopping for ovarian (OR = 0.6; CI = 0.4-1) and endometrial cancer (OR = 0.4; CI = 0.2-0.9). Preferential access is based on data requests promoting data pooling, equal collaborative opportunities and enhancement of research capacity in South Africa. The JCS is a practical and valid design in otherwise logistically difficult settings.
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Affiliation(s)
- Wenlong Carl Chen
- National Cancer Registry, National Health Laboratory Service, Johannesburg, South Africa; Sydney Brenner Institute for Molecular Bioscience, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Elvira Singh
- National Cancer Registry, National Health Laboratory Service, Johannesburg, South Africa; School of Public Health, University of the Witwatersrand, Johannesburg, South Africa.
| | - Mazvita Muchengeti
- National Cancer Registry, National Health Laboratory Service, Johannesburg, South Africa; School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
| | - Debbie Bradshaw
- Burden of Disease Research Unit, South African Medical Research Council, Cape Town, South Africa
| | - Christopher G Mathew
- Sydney Brenner Institute for Molecular Bioscience, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; Department of Medical and Molecular Genetics, Faculty of Life Sciences and Medicine, King's College London, SE1 9RT, United Kingdom
| | - Chantal Babb de Villiers
- Division of Human Genetics, School of Pathology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Cathryn M Lewis
- Department of Medical and Molecular Genetics, Faculty of Life Sciences and Medicine, King's College London, SE1 9RT, United Kingdom; Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology & Neuroscience, King's College London, SE5 8AF, United Kingdom
| | - Tim Waterboer
- Infections and Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Robert Newton
- MRC/UVRI and LSHTM Uganda Research Unit, Entebbe, Uganda; University of York, York, United Kingdom
| | - Freddy Sitas
- Burden of Disease Research Unit, South African Medical Research Council, Cape Town, South Africa; Centre for Primary Health Care and Equity, School of Public Health and Community Medicine, University of New South Wales Sydney, Australia; Menzies Centre of Health Policy, School of Public Health, University of Sydney, Australia
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41
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Lipfert FW, Wyzga RE. Longitudinal relationships between lung cancer mortality rates, smoking, and ambient air quality: a comprehensive review and analysis. Crit Rev Toxicol 2020; 49:790-818. [DOI: 10.1080/10408444.2019.1700210] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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42
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Wang R, Li B, Jiang Y, Guan Y, Wang G, Zhao G. Smoking cessation mutually facilitates alcohol drinking cessation among tobacco and alcohol co-users: A cross-sectional study in a rural area of Shanghai, China. Tob Induc Dis 2019; 17:85. [PMID: 31889947 PMCID: PMC6897049 DOI: 10.18332/tid/114076] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2019] [Revised: 10/30/2019] [Accepted: 11/07/2019] [Indexed: 02/02/2023] Open
Abstract
INTRODUCTION Tobacco smoking and alcohol drinking are strongly paired behaviours, affecting millions of people worldwide. Studies in western countries demonstrate that alcohol use among smokers makes it harder to quit smoking, and addressing alcohol use is particularly important for smoking cessation, but the evidence is limited in China. We conducted a cross-sectional study to understand the prevalence of smoking, drinking, as well as tobacco and alcohol co-use, and to explore how smoking cessation mutually facilitates drinking cessation among tobacco and alcohol co-users. METHODS During 2016 and 2017, we sampled 36698 participants aged >18 years in Songjiang district, Shanghai. A questionnaire was designed to collect data, and participants were classified into non-smokers and smokers (current and former smokers), as well as non-alcohol drinkers and alcohol drinkers (current and former alcohol drinkers). SAS software was applied to analyse the differences by weighted logistic regressions. RESULTS The prevalence of tobacco smoking, alcohol drinking, and tobacco and alcohol co-use was 23.53%, 13.52% and 9.85%, respectively. Smoking cessation prevalence was 15.93%, which was higher than drinking cessation prevalence (8.22%). Tobacco and alcohol co-users had a higher prevalence of smoking cessation (16.95%) than participants who were only smokers (15.20%) and had higher prevalence of alcohol drinking cessation (8.71%) than residents who were only drinkers (6.91%). Tobacco and alcohol co-users who stopped alcohol drinking were much more likely to stop smoking than those who still drank alcohol (OR=8.83; 95% CI: 6.91–11.28) or those who only smoked (OR=7.51; 95% CI: 5.93–9.52). CONCLUSIONS Drinking cessation prevalence was lower than that of smoking cessation, and drinking cessation could mutually facilitate smoking cessation among tobacco and alcohol co-users. Tobacco smoking cessation programs could incorporate alcohol drinking cessation measures to achieve higher public health benefits.
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Affiliation(s)
- Ruiping Wang
- Yueyang Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China.,Disease Control Division, Songjiang Center for Disease Control and Prevention, Shanghai, China.,School of Public Health, Fudan University, Shanghai, China
| | - Bin Li
- Yueyang Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Yonggen Jiang
- Disease Control Division, Songjiang Center for Disease Control and Prevention, Shanghai, China
| | - Ying Guan
- Disease Control Division, Songjiang Center for Disease Control and Prevention, Shanghai, China
| | - Guimin Wang
- Disease Control Division, Songjiang Center for Disease Control and Prevention, Shanghai, China
| | - Genming Zhao
- School of Public Health, Fudan University, Shanghai, China
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Yang QY, He YQ, Xue WQ, Zhou T, Liao Y, Zheng MQ, Jia YJ, Yuan LL, Jia WH. Association Between Serum Cotinine Level and Serological Markers of Epstein-Barr Virus in Healthy Subjects in South China Where Nasopharyngeal Carcinoma Is Endemic. Front Oncol 2019; 9:865. [PMID: 31572673 PMCID: PMC6753229 DOI: 10.3389/fonc.2019.00865] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2019] [Accepted: 08/21/2019] [Indexed: 11/23/2022] Open
Abstract
Introduction: Self-reported smoking has been associated with higher seropositivity for the IgA response to Epstein–Barr virus (EBV) viral capsid antigen (VCA-IgA) and transcription activator protein (Zta) in healthy men in southern China where nasopharyngeal carcinoma (NPC) is endemic. Results on the association of biochemically verified smoking status with EBV reactivation are scarce. We aimed to investigate the relations of serum cotinine level with serological markers of EBV in healthy women, in addition to men. Methods: We collected information on demographic, lifestyle, environmental factors, and EBV serological markers in a cross-sectional study on 2,275 healthy subjects who were recruited from physical examination centers in Guangdong Province, China. In the present analysis, 901 subjects' serum cotinine levels have been measured by enzyme-linked immunosorbent assay (ELISA). Odds ratios (seropositivity of four EBV serological markers vs. seronegativity) for categorical serum cotinine levels were calculated by unconditional logistic regression with a group-specific confidence interval (CI). Results: In women, compared with lower serum cotinine level (0–0.71 ng/ml), higher cotinine level (>0.71–1.20 ng/ml; >1.20–228.40 ng/ml) was associated but non-significantly with higher seropositivity for EBV VCA-IgA (age- and education-adjusted OR = 1.18, 95% CIs = 0.84–1.64, 1.06, 0.75–1.50). These associations remained but still non-significant after adjusting for 5-year age group, education, family history of cancer, consumption of tea, Chinese herbal tea, salted fish at childhood, and exposure to occupational dust, chemical, fume, and radiation (multivariable adjusted OR = 1.21, 95% CIs = 0.85–1.71, 1.09, 0.76–1.55). In men, compared with lower serum cotinine level (0–2.15 ng/ml), higher cotinine level (>2.15–103.6 ng/ml; >103.6–419.4 ng/ml) was significantly associated with higher seropositivity for EBV VCA-IgA and Zta-IgA (age- and education-adjusted OR = 2.16, 95% CIs = 1.37–3.41, 1.79, 1.11–2.90; 1.98, 1.17–3.34, 1.95, 1.14–3.34). The association remained significant after adjusting for potential confounders for Zta-IgA (OR = 2.32, 95% CI = 1.37–3.93 for >2.15–103.6, and 2.50, 1.43–4.38 for >103.6–419.4 ng/ml), but not for VCA-IgA (2.06, 1.29–3.27, and 1.61, 0.96–2.71). Conclusions: Higher serum cotinine level is associated with higher seropositivity for EBV serological markers in healthy men in southern China. Such positive association was also observed in women but became non-significant. If confirmed to be causal, this finding has important implications for tobacco control and prevention of EBV-related disease, particularly for NPC.
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Affiliation(s)
- Qian-Yi Yang
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Sun Yat-sen University Cancer Center, Guangzhou, China.,Department of Anesthesiology, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Yong-Qiao He
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Wen-Qiong Xue
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Ting Zhou
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Ying Liao
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Mei-Qi Zheng
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Yi-Jing Jia
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Lei-Lei Yuan
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Wei-Hua Jia
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Sun Yat-sen University Cancer Center, Guangzhou, China.,School of Public Health, Sun Yat-sen University, Guangzhou, China.,Cancer Center of Guangzhou Medical University, Guangzhou, China
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Lee Y, Lee KS, Kim H. Predictors of Abstinence from Smoking: A Retrospective Study of Male College Students Enrolled in a Smoking Cessation Service. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16183363. [PMID: 31547229 PMCID: PMC6765825 DOI: 10.3390/ijerph16183363] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Revised: 09/06/2019] [Accepted: 09/10/2019] [Indexed: 01/02/2023]
Abstract
There were high smoking rates among young male college students in Korea. We aimed to investigate the prevalence of and factors affecting abstinence from smoking following smoking cessation service attendance in this population. Data were collected between 1 August 2015 and 20 August 2018. Participants were administered more than nine face-to-face and telephone counseling sessions by trained tobacco cessation specialists for six months. Follow-up assessments were conducted at 4, 6, and 12 weeks, and 6 months after the quit date. A total of 3978 male college student smokers were enrolled; their mean age was 23.17 (±3.45) years. Almost one-third of the participants (64.9%) reported that they had attempted to quit during the past year. The number of cigarettes smoked per day, CO ppm, and Fagerström Test of Nicotine Dependence score at the baseline were negatively associated with abstinence, while motivational variables-importance, confidence, and readiness-were positively associated with abstinence. Our results suggest that provision of visiting smoking cessation services can be an active intervention platform for college student smokers who need professional assistance or support. Active and accessible support should be provided to such people. Visiting a smoking cessation service may result in increased long-term abstinence rates in such students.
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Affiliation(s)
- Yeji Lee
- Department of Public Health, Graduate School, The Catholic University of Korea, 222 Banpo-daero, Seocho-gu, Seoul 06591, Korea.
- Department of Preventive Medicine, College of Medicine, The Catholic University of Korea, 222 Banpo-daero, Seocho-gu, Seoul 06591, Korea.
- Seoul Tobacco Control Center, 222 Banpo-daero, Seocho-gu, Seoul 06591, Korea.
| | - Kang-Sook Lee
- Department of Public Health, Graduate School, The Catholic University of Korea, 222 Banpo-daero, Seocho-gu, Seoul 06591, Korea.
- Department of Preventive Medicine, College of Medicine, The Catholic University of Korea, 222 Banpo-daero, Seocho-gu, Seoul 06591, Korea.
- Seoul Tobacco Control Center, 222 Banpo-daero, Seocho-gu, Seoul 06591, Korea.
| | - Haena Kim
- Department of Public Health, Graduate School, The Catholic University of Korea, 222 Banpo-daero, Seocho-gu, Seoul 06591, Korea.
- Department of Preventive Medicine, College of Medicine, The Catholic University of Korea, 222 Banpo-daero, Seocho-gu, Seoul 06591, Korea.
- Seoul Tobacco Control Center, 222 Banpo-daero, Seocho-gu, Seoul 06591, Korea.
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Duncan MS, Freiberg MS, Greevy RA, Kundu S, Vasan RS, Tindle HA. Association of Smoking Cessation With Subsequent Risk of Cardiovascular Disease. JAMA 2019; 322:642-650. [PMID: 31429895 PMCID: PMC6704757 DOI: 10.1001/jama.2019.10298] [Citation(s) in RCA: 189] [Impact Index Per Article: 37.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
IMPORTANCE The time course of cardiovascular disease (CVD) risk after smoking cessation is unclear. Risk calculators consider former smokers to be at risk for only 5 years. OBJECTIVE To evaluate the association between years since quitting smoking and incident CVD. DESIGN, SETTING, AND PARTICIPANTS Retrospective analysis of prospectively collected data from Framingham Heart Study participants without baseline CVD (original cohort: attending their fourth examination in 1954-1958; offspring cohort: attending their first examination in 1971-1975) who were followed up through December 2015. EXPOSURES Time-updated self-reported smoking status, years since quitting, and cumulative pack-years. MAIN OUTCOMES AND MEASURES Incident CVD (myocardial infarction, stroke, heart failure, or cardiovascular death). Primary analyses included both cohorts (pooled) and were restricted to heavy ever smokers (≥20 pack-years). RESULTS The study population included 8770 individuals (original cohort: n = 3805; offspring cohort: n = 4965) with a mean age of 42.2 (SD, 11.8) years and 45% male. There were 5308 ever smokers with a median 17.2 (interquartile range, 7-30) baseline pack-years, including 2371 heavy ever smokers (406 [17%] former and 1965 [83%] current). Over 26.4 median follow-up years, 2435 first CVD events occurred (original cohort: n = 1612 [n = 665 among heavy smokers]; offspring cohort: n = 823 [n = 430 among heavy smokers]). In the pooled cohort, compared with current smoking, quitting within 5 years was associated with significantly lower rates of incident CVD (incidence rates per 1000 person-years: current smoking, 11.56 [95% CI, 10.30-12.98]; quitting within 5 years, 6.94 [95% CI, 5.61-8.59]; difference, -4.51 [95% CI, -5.90 to -2.77]) and lower risk of incident CVD (hazard ratio, 0.61; 95% CI, 0.49-0.76). Compared with never smoking, quitting smoking ceased to be significantly associated with greater CVD risk between 10 and 15 years after cessation in the pooled cohort (incidence rates per 1000 person-years: never smoking, 5.09 [95% CI, 4.52-5.74]; quitting within 10 to <15 years, 6.31 [95% CI, 4.93-8.09]; difference, 1.27 [95% CI, -0.10 to 3.05]; hazard ratio, 1.25 [95% CI, 0.98-1.60]). CONCLUSIONS AND RELEVANCE Among heavy smokers, smoking cessation was associated with significantly lower risk of CVD within 5 years relative to current smokers. However, relative to never smokers, former smokers' CVD risk remained significantly elevated beyond 5 years after smoking cessation.
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Affiliation(s)
- Meredith S. Duncan
- Division of Cardiovascular Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
- Division of Epidemiology, Vanderbilt University, Nashville, Tennessee
| | - Matthew S. Freiberg
- Division of Cardiovascular Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
- Geriatric Research Education and Clinical Centers (GRECC), Veterans Affairs Tennessee Valley Healthcare System, Nashville, Tennessee
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Robert A. Greevy
- Geriatric Research Education and Clinical Centers (GRECC), Veterans Affairs Tennessee Valley Healthcare System, Nashville, Tennessee
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Suman Kundu
- Division of Cardiovascular Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Ramachandran S. Vasan
- Sections of Preventive Medicine and Epidemiology and Cardiology, Department of Medicine, Boston University School of Medicine, Boston, Massachusetts
- Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts
- Boston University and NHLBI Framingham Heart Study, Framingham, Massachusetts
| | - Hilary A. Tindle
- Geriatric Research Education and Clinical Centers (GRECC), Veterans Affairs Tennessee Valley Healthcare System, Nashville, Tennessee
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
- Division of General Internal Medicine and Public Health, Vanderbilt University Medical Center, Nashville, Tennessee
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46
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Hunter A, Bobak A, Anderson C. A survey of smoking cessation training within UK pharmacy education. CURRENTS IN PHARMACY TEACHING & LEARNING 2019; 11:696-701. [PMID: 31227092 DOI: 10.1016/j.cptl.2019.03.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/27/2018] [Revised: 01/19/2019] [Accepted: 03/12/2019] [Indexed: 06/09/2023]
Abstract
INTRODUCTION Tobacco smoking is a significant public health problem, and remains the leading cause of preventable, premature death in the United Kingdom (UK). In order to reduce the burden of smoking in the UK, all healthcare professionals should be able to advise smokers how to quit and assist them to do so. The aim was to identify the extent of smoking cessation teaching and examination in UK pharmacy schools. METHODS A short survey of smoking cessation was sent to each Programme Director for all UK pharmacy schools (n = 29). RESULTS The survey achieved a response rate of 72%. All schools dedicated time teaching smoking cessation interventions, with 76% spending more than three hours, and 90% examining students on some aspect of smoking cessation. All schools taught about nicotine replacement therapy (NRT) and the role of behavioural support. At least 90% of schools taught about the role of the stop smoking services and opportunistic brief interventions, e.g., very brief advice (VBA). Only 14% covered practical delivery in clinical settings. CONCLUSIONS UK pharmacy schools are teaching and examining students on a wide range of smoking cessation interventions, including VBA. However, there was a lack of training reported on the management of mental health patients who smoke, and practical skills training. All schools should do more to ensure they are providing practical skills training to enable students to be adequately prepared for delivering smoking cessation support to all smokers, including vulnerable populations.
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Affiliation(s)
- Abby Hunter
- Division of Epidemiology and Public Health, University of Nottingham, C109, Clinical Sciences Building, Nottingham City Hospital, NG5 1PB, UK.
| | - Alex Bobak
- GPSI Smoking Cessation, Wandsworth Medical Centre, London SW18 4DD, UK
| | - Claire Anderson
- Division of Social Research in Medicines and Health, School of Pharmacy, University of Nottingham, Nottingham, UK
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Impact of smoking history on postoperative complications after lung cancer surgery - a study based on 286 cases. POLISH JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY 2019; 16:13-18. [PMID: 31043970 PMCID: PMC6491375 DOI: 10.5114/kitp.2019.83940] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/29/2019] [Accepted: 03/03/2019] [Indexed: 11/26/2022]
Abstract
Aim The aim of the study was to evaluate the impact of smoking cessation and its timing in the preoperative period on postoperative morbidity in patients undergoing surgery for non-small cell lung cancer (NSCLC). Material and methods Two hundred and eighty-six patients surgically treated for NSCLC were prospectively analyzed in terms of duration and intensity of smoking, time period from smoking cessation to surgery, and postoperative morbidity. The patients were divided into five groups: I – current smokers and past smokers who quit smoking less than 2 weeks before surgery (n = 67), II – past smokers who quit 2 weeks to 3 months (n = 106), III – past smokers who quit 3 months to 1 year (n = 30), IV – past smokers who quit more than 1 year (n = 71), V – never smokers (n = 12). Results In the analyzed group 95.8% were smokers or past smokers. Postoperative complications occurred in 40.2% of patients including pulmonary (21.3%) and cardiac morbidity (17.8%). The pulmonary and circulatory morbidity rates were the lowest in group V but the differences were not significant. Similarly, there were no significant differences between groups with and without pulmonary or circulatory complications regarding: number of daily smoked cigarettes, smoking duration and the moment of cessation. The analysis of segmental regression showed the smallest percentage of complications in patients who quit smoking between the 8th and the 10th week before the operation. Conclusions Among patients surgically treated for NSCLC, duration of smoking and number of smoked cigarettes has no significant influence on frequency and type of postoperative complications. The best moment to quit smoking is the period between the 8th and the 10th week preceding surgery.
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Perduca V, Alexandrov LB, Kelly-Irving M, Delpierre C, Omichessan H, Little MP, Vineis P, Severi G. Stem cell replication, somatic mutations and role of randomness in the development of cancer. Eur J Epidemiol 2019; 34:439-445. [PMID: 30623292 PMCID: PMC10654895 DOI: 10.1007/s10654-018-0477-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2018] [Accepted: 12/17/2018] [Indexed: 12/26/2022]
Abstract
An intense scientific debate has recently taken place relating to the "bad luck" hypothesis in cancer development, namely that intrinsic random, and therefore unavoidable, mutagenic events would have a predominant role in tumorigenesis. In this article we review the main contributions to this debate and explain the reasons why the claim that cancer is mostly explained by intrinsic random factors is unsupported by data and theoretical models. In support of this, we present an analysis showing that smoking-induced mutations are more predictive of cancer risk than the lifetime number of stem cell cellular divisions.
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Affiliation(s)
- Vittorio Perduca
- Laboratoire de Mathématiques Appliquées MAP5 (UMR CNRS 8145), Université Paris Descartes, 75006, Paris, France
- CESP (Inserm U1018), Facultés de Médicine Université Paris-Sud, UVSQ, Université Paris-Saclay, Gustave Roussy, 94805, Villejuif, France
| | - Ludmil B Alexandrov
- Department of Cellular and Molecular Medicine and Department of Bioengineering and Moores Cancer Center, University of California, San Diego, La Jolla, CA, 92093, USA
| | - Michelle Kelly-Irving
- UMR1027, INSERM, 31000, Toulouse, France
- UMR1027, Université Toulouse III Paul-Sabatier, 31000, Toulouse, France
| | - Cyrille Delpierre
- UMR1027, INSERM, 31000, Toulouse, France
- UMR1027, Université Toulouse III Paul-Sabatier, 31000, Toulouse, France
| | - Hanane Omichessan
- CESP (Inserm U1018), Facultés de Médicine Université Paris-Sud, UVSQ, Université Paris-Saclay, Gustave Roussy, 94805, Villejuif, France
| | - Mark P Little
- Radiation Epidemiology Branch, National Cancer Institute, Bethesda, MD, 20892-9778, USA
| | - Paolo Vineis
- MRC-PHE Centre for Environment and Health, Imperial College, Norfolk Place, W21PG, London, UK
| | - Gianluca Severi
- CESP (Inserm U1018), Facultés de Médicine Université Paris-Sud, UVSQ, Université Paris-Saclay, Gustave Roussy, 94805, Villejuif, France.
- Cancer Epidemiology Centre, Cancer Council Victoria, Melbourne, 3004, Australia.
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Chen X, Zhang L, Zhang Q, Zhao R. The effects of cigarette smoking on the associations between sitting time and all-cause mortality: a meta-analysis. Eur J Public Health 2019; 29:315-319. [PMID: 29982348 DOI: 10.1093/eurpub/cky121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Sedentary behavior is recognized as an independent risk factor for mortality, but it remains unclear whether cigarette smoking will aggravate the detrimental effects of prolonged sitting on mortality. This study examined the impact of cigarette smoking on the relationship between sitting time and all-cause mortality in adults. METHODS Electronic database searches were conducted in PubMed, Web of Science, and the EMBASE up to 1 June 2017. Prospective studies that reported sitting time, percent of current smokers, and all-cause mortality were included. Data were extracted independently by two authors. RESULTS Ten prospective studies met the inclusion criteria. These studies included 850990 adults who were followed up for 2-15.7 years, during which 64 781 died (7.6%). Generally, during follow-up sitting time showed a dose-response relationship with all-cause mortality, with each 1 h increment of sitting time per day accounting for hazard ratio (HR) of mortality 1.02 (95%CI, 1.02-1.03). The relationship remained significant when stratified by the quartiles of smoking populations (≤8.4%, 8.5%-12.6%, 12.7%-27.9%, and ≥28.0%), and the risk of sitting time-related mortality increased parallel to the increment of the percent of smoking populations, with HRs 1.02 (95%CI, 1.02-1.03), 1.03 (95%CI, 1.02-1.03), 1.04 (95%CI, 1.03-1.04) and 1.06 (95%CI, 1.06-1.06), respectively. The associations between the risk of prolonged sitting-related mortality and the percent of smoking populations were linear (P = 0.032). CONCLUSIONS Cigarette smoking significantly aggravated the detrimental effects of sitting time on all-cause mortality. Our findings provided further evidence on the harmful effects of smoking combing prolonged sitting on adult health.
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Affiliation(s)
- Xianguo Chen
- Department of Cardio-Thoracic Surgery, Jinhua Hospital, Zhejiang University School of Medicine, Jinhua, Zhejiang, China
| | - Liuji Zhang
- College of Physical Education, Yangzhou University, Yangzhou, Jiangsu, China.,Jiangdong Middle School, Yiwu, Zhejiang, China
| | - Qi Zhang
- College of Physical Education and Health Sciences, Zhejiang Normal University, Jinhua, Zhejiang, China
| | - Renqing Zhao
- College of Physical Education, Yangzhou University, Yangzhou, Jiangsu, China
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50
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O' Keeffe A, Hayes B, Prihodova L. "Do as we say, not as we do?" the lifestyle behaviours of hospital doctors working in Ireland: a national cross-sectional study. BMC Public Health 2019; 19:179. [PMID: 30744600 PMCID: PMC6371571 DOI: 10.1186/s12889-019-6451-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2018] [Accepted: 01/17/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND This study was conducted to assess the lifestyle behaviours of a national sample of hospital doctors working in Ireland. We also sought to compare the prevalence of these behaviours in doctors to the general Irish population. METHODS This was a national cross-sectional study of a randomised sample of hospital doctors working in Irish publicly funded hospitals and residential institutions. The final cohort consisted of 1749 doctors (response rate of 55%). All hospital specialties were represented except radiology. The following data were collected: sociodemographic data (age, sex), work grade (consultant, trainee) average hours worked over a two-week period, specialty and lifestyle behaviours (smoking, alcohol, physical activity). Lifestyle data for the general population was provided by the Healthy Ireland 2015 study. RESULTS Half of participants were men (50.5%). Just over half of the sample were consultants (54.3%), with 45.7% being trainees. 9.3% of doctors surveyed were smokers, 88.4% consumed alcohol and 24.5% were physically inactive. Trainees were more likely to smoke and be physically inactive when compared to consultants. Smoking rates amongst doctors were lower than the general population (9.3% -v- 23%). Doctors were more likely to consume alcohol than the general population (88.4% -v- 71.7%) but less likely to engage in binge drinking on a typical drinking occasion (12.8% -v- 39.5%). Doctors were more compliant than the general population with minimum exercise targets (75.5% -v- 70.5%), but less likely to engage in health enhancing physical activity (19.1% -v- 33%). CONCLUSIONS While the prevalence of health behaviours amongst hospital doctors in Ireland compares favourably to the general population, their alcohol consumption and engagement in health enhancing physical activity suggest room for improvement. Continued health promotion and education on the importance of personal health behaviours is essential.
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Affiliation(s)
- Anthony O' Keeffe
- Occupational Health Department, Beaumont Hospital, Dublin, Ireland. .,Research Department, Royal College of Physicians of Ireland, Dublin, Ireland.
| | - Blánaid Hayes
- Occupational Health Department, Beaumont Hospital, Dublin, Ireland.,Research Department, Royal College of Physicians of Ireland, Dublin, Ireland
| | - Lucia Prihodova
- Research Department, Royal College of Physicians of Ireland, Dublin, Ireland
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