Gender Differences in Smoking Among an Urban Emergency Department Sample

Causal relationship between circulating immune cells and the risk of esophageal cancer: a Mendelian randomization study

BACKGROUND

Although relevant research has unveiled the intricate connections between immune cells and the occurrence and prognosis of esophageal cancer (EC), the specific impact of immune cell phenotypes on EC remains unclear.

METHODS

We employed bidirectional two-sample Mendelian Randomization (MR) analysis to explore the causal relationship between immune cell phenotypes and EC. The summary data for immune cell phenotypes and EC are both sourced from the GWAS (Genome-Wide Association Study) database. Sensitivity analysis was conducted on the results, utilizing a combination of MR-Egger and MR-Presso to assess horizontal pleiotropy, employing Cochran's Q test to evaluate heterogeneity.

RESULTS

We identified 24 immunophenotypes with potential causal relationships to EC. Our results are presented based on the panel results from flow cytometry detection, categorized into B-cell panel, TBNK panel, cDC panel, Maturation stages of T-cell panel, Monocyte panel, and Myeloid cell panel. In the reverse MR analysis, we found a potential negative correlation between EC and IgD + CD38dim B cell Absolute Count (OR = 0.94, 95% CI, 0.88-0.99, P = 0.023).

CONCLUSION

This study has unveiled the causal relationship between immune cell phenotypes and EC, providing new insights for the exploration of immunotherapy targets in subsequent EC research and for the assessment of EC prognosis.

Greater smoking intensity may be linked to early smoking initiation among Filipinos: Evidence from the 2021 Global Adult Tobacco Survey Philippines

INTRODUCTION

Understanding the relationship between age at smoking initiation and later smoking intensity is crucial for assessing future health consequences of smoking early and informing strategies to prevent and reduce tobacco use. This study explores the relationship between the two smoking-related behaviors among Filipino daily smokers.

METHODS

Secondary data analyses from the 2021 Global Adult Tobacco Survey Philippines were performed. This study covers those who were reported to be daily smokers. The outcome of interest was smoking intensity, measured as the number of manufactured cigarettes consumed per day, while the main predictor was age at smoking initiation. Data from 2260 participants were analyzed. Negative binomial regression was used to test for the relationship between age at smoking initiation and smoking intensity while controlling for sociodemographic variables and other smoking-related behaviors.

RESULTS

The average age at which daily smoking commenced was 20.93 (SD=6.35) years, while the average number of manufactured cigarettes consumed per day was 9.50 (SD=7.26). Age at smoking initiation was a significant predictor of smoking intensity, even after controlling for potential confounders. Each additional year in the age at which smoking was initiated was associated with a 1.55% decrease in smoking intensity in the adjusted model (β= -0.0155, p<0.0001). Other predictors of smoking intensity were current age (β=0.0072; 95% CI: 0.0050-0.0094, p<0.0001), sex (β= -0.1146; 95% CI: -0.2157 - -0.0136, p=0.0262), and smoking rules at home (β=0.1807; 95% CI: 0.1175-0.2439, p<0.0001).

CONCLUSIONS

Greater smoking intensity may be linked to early smoking initiation among Filipino adult daily smokers. The results may support interventions that target younger ages to curb heavy tobacco use at later ages.

Current tobacco use patterns associated with healthcare utilization among non-Hispanic Black and Hispanic men with chronic conditions

INTRODUCTION

Tobacco use disparities persist among U.S. adults who are male, racially/ethnically diverse, and have chronic conditions. This study assessed current tobacco use patterns associated with past year healthcare utilization among non-Hispanic Black and Hispanic men ≥40 years old with ≥1 chronic condition.

METHODS

Data were collected from a sample of 1,904 non-Hispanic Black and Hispanic men from across the U.S. using an internet-delivered survey. Participants were categorized into four tobacco use groups: nontobacco users, exclusive cigarette smokers, dualtobacco users (cigarettes + one other tobacco product), and polytobacco users (cigarettes + ≥2 other tobacco products). Logistic regression analyses were conducted to assess current tobacco use patterns with past year primary care visits, emergency department (ED) visits, and overnight hospital stays. Adjusted models included participants' age, race/ethnicity, education level, marital status, health insurance coverage, body mass index, and number of chronic conditions.

RESULTS

Relative to nontobacco users, exclusive cigarette smokers were at decreased odds of having a past year primary care visit (adjusted odds ratio [AOR] = 0.68, 95% confidence interval [CI] = 0.47-0.99). Exclusive cigarette smokers (AOR = 1.66, 95%CI = 1.25-2.19), dualtobacco users (AOR = 1.75, 95%CI = 1.23-2.50), and polytobacco users (AOR = 4.10, 95%CI = 2.46-6.84) were at increased odds of having a past year ED visit compared to nontobacco users. Additionally, polytobacco users were at increased odds of having a past year overnight hospital stay (AOR = 2.72, 95%CI = 1.73-4.29) compared to nontobacco users.

CONCLUSIONS

Findings suggest current tobacco use patterns are uniquely associated with past year healthcare utilization among non-Hispanic Black and Hispanic men, while taking into consideration important factors including complex disease profiles.

2021 SAEM Consensus Conference Proceedings: Research Priorities for Developing Emergency Department Screening Tools for Social Risks and Needs

Introduction: The Emergency Department (ED) acts as a safety net for our healthcare system. While studies have shown increased prevalence of social risks and needs among ED patients, there are many outstanding questions about the validity and use of social risks and needs screening tools in the ED setting. Methods: In this paper, we present research gaps and priorities pertaining to social risks and needs screening tools used in the ED, identified through a consensus approach informed by literature review and external expert feedback as part of the 2021 SAEM Consensus Conference -- From Bedside to Policy: Advancing Social Emergency Medicine and Population Health. Results: Four overarching research gaps were identified: (1) Defining the purpose and ethical implications of ED-based screening; (2) Identifying domains of social risks and needs; (3) Developing and validating screening tools; and (4) Defining the patient population and type of screening performed. Furthermore, the following research questions were determined to be of highest priority: (1) What screening tools should be used to identify social risks and needs? (2) Should individual EDs use a national standard screening tools or customized screening tools? (3) What are the most prevalent social risks and needs in the ED? and (4) Which social risks and needs are most amenable to intervention in the ED setting? Conclusion: Answering these research questions will facilitate the use of evidence-based social risks and needs screening tools that address knowledge gaps and improve the health of our communities by better understanding the underlying determinants contributing to their presentation and health outcomes.

Association of Cannabis Use and At-Risk Alcohol Use With Intimate Partner Violence in an Urban ED Sample

INTRODUCTION

Urban ED patients have elevated rates of substance use and intimate partner violence. The purpose of this study is to describe the risk profiles for intimate partner violence among urban ED patients who report at-risk alcohol use only, cannabis use only, or both types of substance use.

METHODS

Cross-sectional survey data were collected from study participants (N = 1037; 53% female; ages 18-50) following informed consent. We measured participants' past-year at-risk drinking (women/men who had 4+/5+ drinks in a day), cannabis use, psychosocial and demographic characteristics, and past-year physical intimate partner violence (assessed with the Revised Conflict Tactics Scale). We used bivariate analysis to assess whether rates of intimate partner violence perpetration and victimization differed by type of substance use behavior. Multivariate logistic regression models were estimated for each intimate partner violence outcome. All analyses were stratified by gender.

RESULTS

Rates of intimate partner violence differed significantly by type of substance use behavior and were highest among those who reported both at-risk drinking and cannabis use. Multivariate analysis showed that women who reported at-risk drinking only, cannabis use only, or both types of substance use had increased odds for intimate partner violence perpetration and victimization compared with women who reported neither type of substance use. Men's at-risk drinking and cannabis use were not associated with elevated odds of intimate partner violence perpetration or victimization.

DISCUSSION

Brief screening of patients' at-risk drinking and cannabis use behaviors may help identify those at greater risk for intimate partner violence and those in need of referral to treatment.

Adverse childhood experiences are associated with at-risk drinking, cannabis and illicit drug use in females but not males: an Emergency Department study

BACKGROUND

Adverse childhood experiences (ACEs) are associated with adult substance use in the general population. Given pervasive health disparities among underserved populations, understanding how ACEs are associated with substance use among urban Emergency Department (ED) patients could help inform design of effective screening, brief interventions, and referral to treatment.

OBJECTIVES

To estimate gender differences in prevalence of separate and cumulative ACEs among a sample of urban ED patients, and assess its association with at-risk drinking (4+/5+ drinks for females/males), cannabis, and illicit drug use. We hypothesized that the association between ACEs and each outcome would be stronger among females than males.

METHODS

Cross-sectional survey data were obtained from 1,037 married/partnered ED patients (53% female) at a public safety-net hospital. Gender-stratified logistic regression models were estimated for each substance use outcome.

RESULTS

One+ ACEs were reported by 53% of males and 60% of females. Females whose mother was a victim of domestic violence had greater odds of at-risk drinking compared to females who did not report this ACE (AOR = 1.72; 95% CI 1.03, 2.88). Females' cumulative ACEs were associated with cannabis use (OR = 2.26, 95% CI 1.06, 4.83) and illicit drug use (OR = 3.35; 95% CI 1.21, 9.30). Males' separate and cumulative ACEs were not associated with increased likelihood for any of the outcomes.

CONCLUSION

ACEs are associated with greater odds of substance use among female than male ED patients. The prevalence of ACE exposure in this urban ED sample underscores the importance of ED staff providing trauma-informed care.