Classifying a smoker scale in adult daily and nondaily smokers

Sociobehavioral, Biological, and Health Characteristics of Riverside People in the Xingu Region, Pará, Brazil

This study aimed to evaluate the sociodemographic, behavioral, and biological profile and its relationship with the emergence of chronic non-communicable diseases in riverside populations in the Xingu region, Pará, Brazil. Characteristics related to health indicators and which risk factors are considered most important were analyzed. This is a cross-sectional, exploratory, and descriptive study. The sample consisted of riverside people of over 18 years of both sexes. The sample size (n = 86) was calculated with a confidence level of 95% and a sample error of 5%. The K-means clustering algorithm was adopted through an unsupervised method to divide the groups, and the values were expressed as a median. For continuous and categorical data, the Mann-Whitney and chi-square tests were used, respectively, and the significance level was set at p < 5%. The multi-layer perceptron algorithm was applied to classify the degree of importance of each variable. Based on this information, the sample was divided into two groups: the group with low or no education, with bad habits and worse health conditions, and the group with opposite characteristics. The risk factors considered for cardiovascular diseases and diabetes in the groups were low education (p < 0.001), sedentary lifestyle (p < 0.01), smoking, alcoholism, body mass index (p < 0.05), and waist-hip ratio, with values above the expected being observed in both groups. The factors considered important so as to be considered to have good health condition or not were the educational and social conditions of these communities, and one part of the riverside population was considered healthier than the other.

Inflammation and atherogenic markers in patients with type 2 diabetes mellitus

Type two diabetes mellitus (T2DM) is characterized by a chronic inflammation status. Altered markers such as lipid concentrations are usually found in this disease. Elevated inflammation markers have been described such as cytokines (interleukin 6, tumour necrosis factor-alpha, and IL-8). However, there is a lack of information about the behaviour of the neutrophil-lymphocyte ratio (NLR), platelet-lymphocyte ratio (PLR), lymphocyte-monocyte ratio (LMR), lipid coefficients, and atherogenic index in T2DM.

OBJECTIVE

To describe the atherogenic and inflammation parameters in a group of patients with T2DM.

MATERIALS AND METHODS

42 patients with T2DM were included, all patients were surveyed on clinic history (disease history, comorbidity, smoking, and other relevant variables), measurements of haematological, biochemical, and anthropometric parameters were taken and atherogenic coefficients and inflammation ratios were calculated.

RESULTS

Inflammation markers such as interleukin 6 and 8, necrosis tumour factor, and NLR were elevated. Of the patients, 88% were classified as high risk according to the atherogenic index. Former smokers had lower levels of IL-8 and higher NLR than non-smokers.

CONCLUSION

The atherogenic and inflammation markers such as atherogenic index, IL-8, and NLR make it possible to identify a subgroup of patients that are at risk of severe complications and mortality.

The COVID-19 Pandemic and Smoking Cessation-A Real-Time Data Analysis from the Polish National Quitline

Since the outbreak of the COVID-19 pandemic, tobacco research has delivered new evidence on the harmfulness of smoking in the context of SARS-CoV-2 infection and the course of the COVID-19 disease. More and more research proves that smoking is an important risk factor contributing to increased risk of mortality among COVID-19 patients. The aim of this study was to assess whether and how the COVID-19 pandemic impacted decisions about quitting smoking. A total of 4072 records of anonymized data were obtained from the Polish National Quitline. Between 15 April 2020 and 31 May 2021, the callers were asked about the COVID-19 pandemic and its influence on their decisions on smoking continuation or cessation. Our results indicate that smokers are very receptive to communication concerning COVID-19 and smoking risk. This phenomenon can possibly be connected to the immediate potential health consequences of smoking and COVID-19 virus infection. Results may indicate that putting emphasis on arguments combined with short-term health consequences of smoking may result in better outcomes in smoking cessation. There is a need for further and constant education on tobacco-related health harm. Our results showed that an irregular and mass communication on health consequences may result in high effectiveness in smoking cessation.

"It's all About the Colors:" How do Mexico City Youth Perceive Cigarette Pack Design

Objectives: Cigarette packs are relevant to branding strategies, designed to appeal to specific groups. There is little research on how pack features increase product appeal among key constituents such as youth in low- and middle-income countries.

Methods: We conducted 10 focus group discussions (FGDs) with adolescents and 5 FGDs with young adult smokers in Mexico City, separated by age, gender, smoking, and socioeconomic status. Participants separated 23 cigarette packs into “appealing” and “unappealing” groups, and were asked to explain their decisions, describing the features that supported their views. FGDs were video-recorded, transcribed in Spanish, translated into English, and subjected to thematic analysis.

Results: Pack groupings did not differ greatly across FGDs; bold, contrasting colors and elements communicating flavor and promotion increased cigarette pack appeal and desire to try. Participants perceived packs with these features to be used by and designed for youth, like themselves.

Conclusion: Our findings reinforce the importance of packaging design in attracting new consumers and maintaining current ones. Mexico should consider stronger tobacco advertising policies that include packaging color and depiction of flavor to reduce product appeal.

Differences in Distress Intolerance Among Daily and Intermittent Smokers

INTRODUCTION

Distress intolerance is an important risk factor for smokers. Smokers have greater problems tolerating distress than nonsmokers, and distress intolerance is theoretically an important predictor of early lapse. However, much of the distress intolerance research has been conducted on daily smokers. Understanding distress intolerance in nondaily or intermittent smokers may help elucidate whether distress intolerance is a function of current smoking habits.

AIMS AND METHODS

Daily (n = 36) and intermittent (n = 28) smokers completed behavioral distress intolerance tasks (breath holding, mirror tracing persistence, and image persistence) along with self-report measures of both general and smoking-specific distress intolerance. They also completed 1 week of ecological momentary assessment where positive and negative affect were assessed along with momentary distress intolerance, at both random times (7×/day) and immediately prior to smoking a cigarette.

RESULTS

Results found no differences between intermittent and daily smokers on behavioral distress intolerance tasks or general self-reported distress intolerance. Daily smokers reported greater self-reported smoking-specific distress intolerance compared to intermittent smokers. In addition, across both smoker groups, momentary distress intolerance was higher at smoking compared to random sessions, and low positive affect predicted greater momentary distress intolerance specifically for intermittent smokers prior to smoking.

CONCLUSIONS

The lack of differences between daily and intermittent smokers on general distress intolerance measures suggests that distress intolerance abilities and self-perceptions are not a function of higher levels of current smoking. However, the contextual variation in momentary distress intolerance is worth further exploration in both daily and intermittent smokers.

IMPLICATIONS

The overall lack of differences between intermittent and daily smokers on distress intolerance tasks and self-report measures suggests that daily smoking is not associated with lower abilities to manage or tolerate distress at the individual difference level. However, understanding fluctuations in distress intolerance across time and context is crucial, as smokers' perceptions of their abilities to manage distress shift based on affect and smoking contexts. Stabilizing or increasing self-efficacy in tolerating distress during daily life is likely an important avenue for future research.

Accounting for the Consequences of Tobacco Dependence on Cravings, Self-efficacy, and Motivation to Quit: Consideration of Identity Concerns

Tobacco dependence has been found to increase smoking cravings, and reduce both self-efficacy and motivation to quit. The present research proposes to test the hypothesis that such negative consequences are related to identity concerns and should thus appear more strongly in dependent smokers with a high (vs. low) smoker identity. In two correlational studies, daily smokers (Study 1: N = 237; Study 2: N = 154) were assessed for tobacco dependence, smoker identity, self-efficacy, craving to smoke (Study 1), and motivation to quit (Study 2). Among smokers who declared to be strongly dependent, those scoring high in smoker identity reported more smoking cravings (β = .28, p = .008, 95% CI [0.084, 0.563], $ {\upeta}_p^{{}^2} $ = .03) and less motivation to quit than those scoring low (β = -.58, p = .003, 95% CI [-1.379, -0.282], $ {\upeta}_p^{{}^2} $ = .06). Smoker identity was unrelated to these variables among non-dependent smokers (ps > .40). The relationship between tobacco dependence and self-efficacy was not affected by smoker identity (ps > .45). Through these studies, we provided evidence that the implications of tobacco dependence on smoking maintenance and difficulties in quitting may be, in part, explained by identity mechanisms.

Genetic variants in CYP2A6 and UGT1A9 genes associated with urinary nicotine metabolites in young Mexican smokers

Nicotine is the major pharmacologically active substance in tobacco. Several studies have examined genotypes related to nicotine metabolism, but few studies have been performed in the Mexican population. The objective was to identify associations between gene variants in metabolizing enzymes and the urinary levels of nicotine metabolites among Mexican smokers. The levels of nicotine and its metabolites were determined in the urine of 88 young smokers from Mexico, and 167 variants in 24 genes associated with nicotine metabolism were genotyped by next-generation sequencing (NGS). Trans-3′-hydroxy-cotinine (3HC) and 4-hydroxy-4-(3-pyridyl)-butanoic acid were the most abundant metabolites (35 and 17%, respectively). CYP2A6*12 was associated with 3HC (p = 0.014). The rs145014075 was associated with creatinine-adjusted levels of nicotine (p = 0.035), while the rs12471326 (UGT1A9) was associated to cotinine-N-glucuronide (p = 0.030). CYP2A6 and UGT1A9 variants are associated to nicotine metabolism. 4HPBA metabolite was an abundant urinary metabolite in young Mexican smokers.

Effects of physical activity and smoking on cardio-ankle vascular index, respiratory muscle strength, and exercise performance in early normal weight adulthood: a cross-sectional study

Few studies have shown the impact of unhealthy habits on arterial stiffness, respiratory muscle strength and exercise performance in early normal weight adulthood. This study sought to determine the effects of physical activity and smoking on its parameters in normal weight male participants. Forty-eight participants were divided into four groups: physically inactive nonsmokers and smokers and physically active nonsmokers and smokers (n=12 in each group). All of the participants were measured for body composition, arterial stiffness, respiratory muscle strength and exercise performance. Two-way analysis of variance design was used to test the main and interaction effects of physical activity by group (smokers vs. nonsmokers). P-value of less than 0.05 was considered as a statistically significant difference. As a result, cardio-ankle vascular index and respiratory muscle strength were diminished in smokers and physically inactive participants, while body and visceral fat mass were increased in both those groups. Fat-free mass was lower in only physically inactive participants. This study also found the interaction effects on body fat and arterial stiffness. In conclusion, participants with healthy normal weight, but smoked and performed inappropriate physical activity, exhibited body composition imbalance, decreased respiratory muscle strength, exercise performance, and increased arterial stiffness. Therefore, smoking cessation and exercise in younger adults are appropriate ways of improving body composition, respiratory muscle strength, aerobic capacity and arterial stiffness instead of trying to control their weight by smoking.

Smoker identity and resistance to antismoking campaigns: The role of group entitativity

Past works have shown that identification with smokers predicts increased resistance to antismoking campaigns. In this research, we hypothesized that group entitativity, because it affects the extent to which people feel committed to act for their group, can mitigate this link. We conducted two studies with convenient samples of smokers that both included a measure of identification and measured (Study 1) or manipulated (Study 2) entitativity. Then, participants read an antismoking message and, finally, reported their attitude toward smoking (Studies 1 and 2), as well as their urge to smoke and intention to quit (Study 2). Consistently, both studies revealed more resistance among high (vs. low) identifiers, but only when they perceived smokers as a highly entitative group. These findings emphasized the importance of group processes and social identity factors for accounting for responses to antismoking information.

Ecological momentary assessment of smoking behaviors in native and converted intermittent smokers

BACKGROUND AND OBJECTIVES

About 22% of adult smokers in the U.S. are intermittent cigarette smokers (ITS). ITS can be further classified as native ITS who never smoked daily and converted ITS who formerly smoked daily but reduced to intermittent smoking. Ecological momentary assessment (EMA) was conducted to determine the behaviors and experiences that are associated with the decision to smoke.

METHODS

The study included 24 native ITS and 36 converted ITS (N = 60) from the Pennsylvania Adult Smoking Study. A baseline questionnaire, daily log, and an EMA smoking log that assessed emotions, activities, and smoking urges was filled out with each cigarette for 1 week to capture 574 smoking sessions.

RESULTS

Both groups had very low levels of cigarette dependence. Both groups were more tempted to smoke in positive or negative situations than situations associated with habituation. EMA showed that the most common emotional state during smoking sessions was positive (47%), followed by negative (32%), neutral (16%), and mixed (5%) emotions. Smokers were more likely to smoke during activities of leisure (48%) than during performative duties (29%), social (16%) or interactive occasions (7%). Converted ITS were more likely to smoke alone compared to native ITS (p < .001).

DISCUSSION AND CONCLUSIONS

ITS report minimal levels of dependence when captured on traditional scales of nicotine dependence, yet experience loss of autonomy and difficulty quitting. The majority of the ITS reported positive emotions and leisure activities while smoking, and smoked during the evening.

SCIENTIFIC SIGNIFICANCE

The current paper identifies environmental and behavioral factors that are associated with smoking among ITS in real time. (Am J Addict 2018;27:131-138).

The Role of the Subjective Importance of Smoking (SIMS) in Cessation and Abstinence

Introduction

Each year about two thirds of U.S. smokers make a quit attempt. Yet, less than 5% remain abstinent three months post-quit date. One factor that may affect abstinence is negative feelings about the self-associated with being a smoker (disequilibrium), particularly if smoking is important to the sense of self and one is trying to quit.

Aims

We evaluated a multivariate structural equation model proposing that smoking's subjective importance to a smoker would influence carbon monoxide verified smoking abstinence at 24 weeks (post-quit date). Further, we assessed whether the relation would be moderated by the smoker's experience of disequilibrium.

Methods

Participants were 440 regular smokers taking part in a clinical trial assessing the effectiveness of different durations of nicotine replacement therapy use. Participants completed the subjective importance of smoking survey at baseline and were assessed for carbon monoxide verified seven-day point prevalence abstinence at 24 weeks.

Results

Using exploratory structural equation modelling, the subjective importance of smoking was associated with point prevalence abstinence at 24 weeks, but only for smokers with high disequilibrium.

Conclusions

The results of this study suggest that experiencing negative feelings about being a smoker could motivate smokers to remain abstinent, despite the importance of smoking to the smoker's sense of self.

Among whom is cigarette smoking declining in the United States? The impact of cannabis use status, 2002-2015

OBJECTIVES

To 1) estimate changes in the prevalence of daily and non-daily cigarette smoking among current (past 30-day) daily, non-daily, and non-cannabis users in the United States (U.S.) population; 2) examine time trends in current (past 30-day) cigarette smoking in daily, non-daily, and non-cannabis users ages 12+ from 2002 to 2015.

METHODS

Data collected annually from the 2002 to 2015 National Survey on Drug Use and Health (NSDUH) were employed. Linear time trends of daily and non-daily cigarette smoking were assessed using logistic regression with year as the predictor.

RESULTS

In 2015, the prevalence of current (past 30-day) cigarette smoking was highest among daily (54.57%), followed by non-daily (40.17%) and non-cannabis users (15.06%). The prevalence of non-daily cigarette smoking increased among daily cannabis users from 2002 to 2015, whereas non-daily cigarette smoking declined among non-daily cannabis users and non-cannabis users from 2002 to 2015. Daily cigarette smoking declined among both cannabis users and non-users; the most rapid decline was observed among daily cannabis users, followed by non-daily and then by non-cannabis users. However, the relative magnitude of the change in prevalence of daily cigarette smoking was similar across the three cannabis groups.

CONCLUSIONS

Despite ongoing declines in cigarette smoking in the U.S., non-daily cigarette smoking is increasing among current cannabis users, a growing proportion of the U.S.

POPULATION

Daily and non-daily cigarette smoking continue to decline among those who do not use cannabis. Efforts to further tobacco control should consider novel co-use-oriented intervention strategies and outreach for the increasing population of cannabis users.

A randomized clinical trial of counseling and nicotine replacement therapy for treatment of African American non-daily smokers: Design, accrual, and baseline characteristics

BACKGROUND

Non-daily smokers (NDS) who smoke on some but not all days are a growing subset of United States (US) tobacco users. Racial/ethnic minorities are more likely to be NDS. African American NDS have strikingly high levels of nicotine and carcinogen exposure, making treatment of this high risk group a priority.

METHODS

The current study is one of three ongoing federally-funded clinical trials of NDS and, to our knowledge the only RCT focused on racial/ethnic minority NDS. The design has been guided by input from Patient and Stakeholder Advisory Panels who helped develop the research questions, design the intervention, and select the outcomes. The objective is to compare the effectiveness of smoking cessation counseling alone (C) or smoking cessation counseling plus participant's choice of nicotine replacement therapy (NRT; C + NRT) for African American NDS. Two-hundred seventy-eight African American NDS will be randomized in a 2:1 fashion to C + NRT or C. All participants receive five sessions of smoking cessation counseling; those randomized to C + NRT receive their choice of nicotine gum, patch, and/or lozenge. Treatment in both groups lasts for 12 weeks. We hypothesize that C + NRT will be more effective than C on the primary outcome of biochemically-confirmed abstinence from smoking at week 12. Secondary aims will compare C + NRT and C on patient- and provider-desired outcomes including abstinence from smoking at week 26, change in biochemically-verified nicotine and carcinogen exposure, days abstinent, and treatment process measures (e.g., NRT use and side effects). Predictors of abstinence will also be explored.

DISCUSSION

Findings will illuminate effective treatment options for African American NDS and contribute to development of evidence-based guidelines for treating the 8.9 million US adult NDS for whom no guidelines currently exist.

TRIAL REGISTRATION NUMBER

ClinicalTrials.gov: NCT02244918.

Where there is smoke…there is sleep apnea: exploring the relationship between smoking and sleep apnea

Smoking and OSA are widely prevalent and are associated with significant morbidity and mortality. It has been hypothesized that each of these conditions adversely affects the other, leading to increased comorbidity while altering the efficacy of existing therapies. However, while the association between smoking and OSA is plausible, the evidence is less than conclusive. Cigarette smoking may increase the severity of OSA through alterations in sleep architecture, upper airway neuromuscular function, arousal mechanisms, and upper airway inflammation. Conversely, some evidence links untreated OSA with smoking addiction. Smoking cessation should improve OSA, but the evidence to support this is also limited. This article reviews the current evidence linking both conditions and the efficacy of various treatments. Limitations of the current evidence and areas in need of future investigation are also addressed.

Expected Problem Drinker Possible Self: Predictor of Alcohol Problems and Tobacco Use in Adolescents

BACKGROUND

Alcohol and tobacco use commonly co-occur in adolescents. According to the cross-substance facilitation of information processing hypothesis, cognitive structures related to one substance increase use of another related substance through enhanced cognitive processing. In this study, the authors test this hypothesis by determining whether a problem drinker "possible self" in 8th grade predicts alcohol and tobacco use in 9th grade.

METHODS

A secondary data analysis of a 12-month longitudinal dataset was conducted. The outcome variables were alcohol consumption, alcohol problems, and tobacco use in 9th grade. The main predictor of interest was presence of an expected problem drinker possible self in 8th grade. Zero-inflated gamma regression, zero-inflated negative binomial regression, and logistic regression were used.

RESULTS

Among 137 adolescents, controlling for known family, parent, and peer determinants, and corresponding 8th grade behavior, having an expected problem drinker possible self in 8th grade predicted alcohol problems, but not level of alcohol consumption in 9th grade. Moreover, the expected problem drinker possible self in 8th grade predicted tobacco use in 9th grade, controlling for known determinants and concurrent alcohol problems.

CONCLUSIONS

Findings provide support for the cross-substance facilitation hypothesis, suggesting that interventions designed to modify the expected problem drinker possible self may reduce not only adolescent alcohol use but also tobacco use. Further studies are needed to determine whether smoking content is embedded in a drinking cognition or 2 separate but related drinking and smoking cognitions account for the association between alcohol and tobacco use.

Reasons for smoking among tri-ethnic daily and nondaily smokers

INTRODUCTION

Nondaily smokers experience adverse effects from tobacco use, yet they have been understudied compared to daily smokers. Understanding how reasons for smoking (RS) differ by smoking level, gender, and race/ethnicity could inform tailored interventions.

METHODS

A cross-sectional survey was administered through an online panel survey service to 2,376 current smokers who were at least 25 years of age. The sample was stratified to obtain equal numbers of 3 racial/ethnic groups (African American [AA], Latino, and White) across smoking level (native nondaily, converted nondaily, daily light, and daily moderate/heavy).

RESULTS

A 7-factor structure of a 20-item Modified Reasons for Smoking Scale (MRSS) was confirmed (each subscale alpha > 0.80). Each factor of the MRSS varied by smoking level, with nondaily smokers endorsing all RS less frequently than daily smokers (p < .0001). The 4 smoker subgroups incrementally differed from one another (p < .05) with several exceptions between converted nondaily and daily light smokers. Males reported stronger RS on 5 out of 7 reasons (p < .05). Females had higher scores on tension reduction/relaxation (p < .0001). Latinos reported stronger RS than Whites and AAs on all reasons (p < .05) except for tension reduction/relaxation (p > .05). AAs and Whites were comparable on all RS (p > .05).

CONCLUSIONS

The present study highlights considerable variability across smoking level, gender, and race/ethnicity in strength of RS. Addressing subgroup differences in RS may contribute to more sensitive and effective prevention and treatment efforts.