Apparent underreporting of cigarette consumption among Mexican American smokers

Smoking data quality of primary care practices in comparison with smoking data from the New Zealand Māori and Pacific abdominal aortic aneurysm screening programme: an observational study

BACKGROUND

Quality smoking data is crucial for assessing smoking-related health risk and eligibility for interventions related to that risk. Smoking information collected in primary care practices (PCPs) is a major data source; however, little is known about the PCP smoking data quality. This project compared PCP smoking data to that collected in the Māori and Pacific Abdominal Aortic Aneurysm (AAA) screening programme.

METHODS

A two stage review was conducted. In Stage 1, data quality was assessed by comparing the PCP smoking data recorded close to AAA screening episodes with the data collected from participants at the AAA screening session. Inter-rater reliability was analysed using Cohen's kappa scores. In Stage 2, an audit of longitudinal smoking status was conducted, of a subset of participants potentially misclassified in Stage 1. Data were compared in three groups: current smoker (smoke at least monthly), ex-smoker (stopped > 1 month ago) and never smoker (smoked < 100 cigarettes in lifetime).

RESULTS

Of the 1841 people who underwent AAA screening, 1716 (93%) had PCP smoking information. Stage 1 PCP smoking data showed 82% concordance with the AAA data (adjusted kappa 0.76). Fewer current or ex-smokers were recorded in PCP data. In the Stage 2 analysis of discordant and missing data (N = 313), 212 were enrolled in the 29 participating PCPs, and of these 13% were deceased and 41% had changed PCP. Of the 93 participants still enrolled in the participating PCPs, smoking status had been updated for 43%. Data on quantity, duration, or quit date of smoking were largely missing in PCP records. The AAA data of ex-smokers who were classified as never smokers in the Stage 2 PCP data (N = 27) showed a median smoking cessation duration of 32 years (range 0-50 years), with 85% (N = 23) having quit more than 15 years ago.

CONCLUSIONS

PCP smoking data quality compared with the AAA data is consistent with international findings. PCP data captured fewer current and ex-smokers, suggesting ongoing improvement is important. Intervention programmes based on smoking status should consider complementary mechanisms to ensure eligible individuals are not missed from programme invitation.

Differences in Smoking Behavior by Nativity, Race/Ethnicity, and Education among Women Diagnosed with Breast Cancer

BACKGROUND

We evaluated smoking differences across nativity and race/ethnicity among women diagnosed with breast cancer.

METHODS

In our Northern Californian pooled population of 5,653 [670 Asian, 690 Hispanic, and 4,300 non-Hispanic White (White)] women diagnosed with breast cancer, we evaluated smoking differences across nativity, race/ethnicity, and acculturation and effect modification of nativity by race/ethnicity and education.

RESULTS

Foreign-born women currently smoked less than US-born women [odds ratio (OR) = 0.46, 95% confidence limit (CL): 0.29-0.72]. Hispanic (OR = 0.50; 95% CL: 0.32-0.78) women currently smoked less than White women. Among those who ever smoked (n = 2,557), foreign-born women smoked 5.23 fewer pack-years (PY) than US-born women (95% CL: -2.75 to -7.70). Furthermore, Asian (-4.60, 95% CL: -0.81 to -8.39) and Hispanic (-6.79, 95% CL: -4.14 to -9.43) women smoked fewer PY than White women. Associations were generally suggestive of greater smoking with greater acculturation (immigration age, US years, survey language). Finally, associations for nativity differed by education but not race/ethnicity, with a higher likelihood of smoking in US-born women only among those with less than a bachelor's degree (OR = 2.84, 95% CL: 2.15-3.77; current smoking: P = 0.01, PY: P = 0.05).

CONCLUSIONS

Asian and Hispanic (vs. White) and foreign-born (vs. US-born) breast cancer survivors reported fewer smoking behaviors. Smoking differences across nativity and education were driven by higher rates of smoking in US-born women with lower educational attainment.

IMPACT

Smoking behavioral patterns were similar among breast cancer survivors and the general population, informing potential smoking interventions.

Tax revenue lost due to illicit cigarettes in South Africa: 2002-2022

OBJECTIVE

To estimate lost excise and value-added tax (VAT) revenue as a result of illicit cigarette trade from 2002 to 2022.

DESIGN

Using gap analysis, we estimated the number of illicit cigarettes by calculating the difference between the number of self-reported cigarettes (derived from nationally representative surveys) and the number of legal (tax-paid) cigarettes (derived from government sources) from 2002 to 2022. We then calculated the excise and VAT revenue that the government lost through illicit trade, taking into account that some people would have quit or reduced their consumption if cigarette prices had been higher (ie, tax paid).

SETTING

South Africa.

OUTCOME MEASURES

Illicit trade estimates and lost revenue estimates.

RESULTS

The illicit cigarette market comprised 5% of the market in 2009, peaked at 60% in 2021, and decreased to 58% in 2022. Accounting for the fact that some people would have reduced their consumption if cigarette prices had been higher (had the illicit marke not existed), the government lost R15 billion in excise revenue and R3 billion in VAT revenue in 2022. From 2002 to 2022, the government lost R119 billion (2022 prices) in excise and VAT revenue. The majority of the lost revenue occurred in the period 2010 to 2022, where R110 billion (2022 prices) in excise and VAT revenue was lost. A comprehensive sensitivity analysis indicates that the estimated lost revenue of R119 billion from 2002 to 2022 falls within the range of R65 billion to R130 billion (all 2022 prices).

CONCLUSIONS

The South African government has been losing a significant amount of revenue by not receiving excise and VAT from all cigarettes consumed in South Africa. This trend is likely to continue if the government does not secure the supply chain from the point of production to the point of sale.

Prevalence of electronic cigarette use and its determinants in us persons of Hispanic/Latino background: The Hispanic community health study / study of Latinos (HCHS/SOL)

Objective

To determine the prevalence and determinants of electronic nicotine delivery systems (ENDS) use among Hispanic/Latino adults from the Hispanic Community Health Study/Study of Latinos (HCHS/SOL).

Methods

Cross-sectional data collected between the years 2015-2017 were analyzed to assess ENDS use (ever (current: use ≤ past 30 days; former: use > past 30 days) and never) among 11,623 adults (mean age 47 years±0.3 years; 52% women). Weighted prevalence estimates were reported, and age-adjusted logistic regression models were used to examine associations between sociodemographic and clinical exposures with ENDS use.

Results

The prevalence of current and former ENDS use was 2.0% and 10.4%, respectively. Having ever used ENDS was associated with prevalent coronary artery disease. Current ENDS use was higher in males and associated with higher education, English language preference, and Puerto Rican background compared with nonsmokers and cigarette-only smokers (all p<0.05).

Conclusions

Hispanic/Latino individuals who are young adults, male, US-born, and have high acculturation were more likely to report current ENDS use. These findings could inform preventive and regulatory interventions targeted to Hispanics/Latinos.

Urinary cotinine and exposure to passive smoke in children and adolescents in Germany - Human biomonitoring results of the German Environmental Survey 2014-2017 (GerES V)

Passive smoking is a preventable and significant cause of many serious health problems, with children being particularly at risk. In the fifth German Environmental Survey (GerES V), conducted from 2014 to 2017, information reflecting the extent of passive smoke exposure in children and adolescents was collected by interview-based questionnaires and human biomonitoring (HBM) analyses of cotinine in urine from 2260 participants, aged 3-17 years. Based on these population-representative data, we describe current passive smoke exposure stratified by different subgroups and identify specific exposure determinants using multivariate logistic regression. The questionnaire data revealed that 42% of children and adolescents lived with at least one smoker in the household. Quantifiable concentrations of cotinine could be detected in 56% of the participants. The overall median concentration of cotinine was 0.2 μg/L, with children and adolescents of low socioeconomic status found to be a group particularly affected by passive smoke with higher cotinine concentrations (median = 1.2 μg/L). In the multiple analysis, the most significant predictor of cotinine levels derived from the questionnaire was passive smoking at home (odds ratio (OR) 13.07 [95CI: 4.65, 36.70]). However, parental smoking and passive smoking among friends and relatives could also be identified as independent factors influencing elevated cotinine levels. The comparison between the previous cycle GerES IV (2003-2006) on 3-14-year-olds and GerES V shows that tobacco smoke exposure of children decreased significantly. This decrease is likely an effect of extensive non-smoker protection laws being enforced 2007-2008 on federal and state level. This is reflected by a halving of urinary cotinine concentrations. Nevertheless, our results indicate that passive smoke is still a relevant source of harmful pollutants for many children and adolescents in Germany, and thus support the need for further efforts to reduce passive smoke exposure, especially in the private environment.

The temporary ban on tobacco sales in South Africa: lessons for endgame strategies

BACKGROUND

The endgame literature recommends that, for a tobacco sales ban to be successful, several demand-side preconditions (eg, low prevalence and effective cessation support) should be in place. The South African Government imposed a ban on the sale of all tobacco and vaping products between 27 March and 17 August 2020, as part of the COVID-19 lockdown.

OBJECTIVES

To assess how cigarette smokers responded to the sales ban, to evaluate how the ban impacted the cigarette market in South Africa and to use the South African experience to inform endgame planning.

METHODS

Regular preban cigarette smokers completed an online questionnaire from 4 to 19 June 2020 (n=23 631), in which they reported on their prelockdown cigarette smoking patterns, quitting behaviour (if relevant) and smoking behaviour during the ban.

RESULTS

About 9% of prelockdown smokers in the sample successfully quit smoking. 93% of continuing smokers purchased cigarettes despite the sales ban. The average price of cigarettes increased by 250% relative to prelockdown prices. Most respondents purchased cigarettes through informal channels.

CONCLUSIONS

The demand-side preconditions for an effective sales ban were not in place in South Africa, making a sales ban inappropriate. The South African experience suggests that supply-side factors are also important in ensuring the success of a sales ban. These are: (1) the illicit market must be under control before implementing a sales ban; and (2) an effective sales ban needs to be synchronised with a ban on the manufacture, transport and distribution of cigarettes.

Perceptions of electronic cigarettes among ethno-culturally diverse Latino adults in four US urban centers

OBJECTIVE

The aim of this study was to examine perceptions including knowledge, attitudes, and beliefs about e-cigarettes among ethno-culturally diverse Latino adults living in the US, a rapidly growing minority group for which we know little about their e-cigarette perceptions.

DESIGN

A total of 25 focus groups with Latinos (n = 180; ages 18-64 years) were conducted in 2014. E-cigarettes users and non-users were recruited via purposive sampling techniques. Participants completed brief questionnaires on sociodemographic factors and tobacco use. Focus group discussions were conducted in English and Spanish, audio-recorded, and transcribed. Data were analyzed using thematic analysis procedures.

RESULTS

Participants were of diverse Latino backgrounds. Over one-third (35%) reported current cigarette smoking and 8% reported current e-cigarette or hookah use. Nonsmokers reported experimenting with e-cigarettes and hookah during social occasions. Participants' perceptions towards e-cigarettes were generally formed in comparison to conventional cigarettes. Perceived benefits of using e-cigarettes included their utility as a smoking cessation aid, higher social acceptability, and lower harm compared to conventional cigarettes. Negative perceptions of e-cigarettes included lower overall satisfaction compared to conventional cigarettes and high content of toxins. Socio-cultural factors (e.g. gender roles, familismo, and simpatía) also influenced perceptions of e-cigarette of study participants.

CONCLUSIONS

Overall, Latino adults knew relatively little about the potential health risks associated with e-cigarette use. The limited knowledge about and misinformation of e-cigarettes among this rapidly growing minority group have important public health implications. Findings may inform culturally tailored health communication campaigns, which are much needed among underserved US Latino populations in light of low effectiveness of tobacco control and regulatory efforts.

Racial and Ethnic Minorities Have a Lower Prevalence of Airflow Obstruction than Non-Hispanic Whites

Racial and ethnic disparities in chronic obstructive pulmonary disease (COPD) are not well-studied. Our objective was to examine differences in limited COPD-related outcomes between three minority groups-African Americans (AAs), Hispanics, and American Indians (AIs) versus non-Hispanic Whites (NHWs), as the referent group, in separate cohorts. Separate cross-sectional evaluations were performed of three US-based cohorts of subjects at risk for COPD: COPDGene Study with 6,884 NHW and 3,416 AA smokers; Lovelace Smokers' Cohort with 1,598 NHW and 378 Hispanic smokers; and Mining Dust Exposure in the United States Cohort with 2,115 NHW, 2,682 Hispanic, and 2,467 AI miners. Prebronchodilator spirometry tests were performed at baseline visits using standard criteria. The primary outcome was the prevalence of airflow obstruction. Secondary outcomes were self-reported physician diagnosis of COPD, chronic bronchitis, and modified Medical Research Council dyspnea score. All minority groups had a lower prevalence of airflow obstruction than NHWs (adjusted ORs varied from 0.29 in AIs to 0.85 in AAs; p < 0.01 for all analyses). AAs had a lower prevalence of chronic bronchitis than NHWs. In our study, all minority groups had a lower prevalence of airflow obstruction but a greater level of self-reported dyspnea than NHWs, and covariates did not explain this association. A better understanding of racial and ethnic differences in smoking-related and occupational airflow obstruction may improve prevention and therapeutic strategies.

Comparative evaluation of serum cotinine levels in chronic periodontitis and chronic obstructive pulmonary disease

Context:

Periodontitis and chronic obstructive pulmonary disease (COPD) are chronic progressive inflammatory conditions. Smoking has been associated with both chronic periodontitis and COPD. Hence, the present study was designed to correlate serum levels of cotinine with the severity of periodontal disease with or without COPD.

Settings and Design:

A total of eighty patients, twenty healthy individuals, twenty patients with chronic generalized periodontitis without smoking and without COPD, twenty patients who are smokers with chronic periodontitis without COPD and twenty patients who are smokers with chronic periodontitis and COPD in the age range of 43–65 years were selected for the study.

Subjects and Methods:

Serum cotinine level assessment, smoking history, and periodontal examination were done in all the patients and the data obtained were statistically analyzed.

Results:

The mean serum cotinine level was highest in smokers with chronic periodontitis and COPD (93.642 ± 14.727) and it differed significantly between the four groups (P < 0.001). There is a significant positive correlation between the number of cigarettes and serum cotinine levels in both groups involving smoking. There was no significant correlation between serum cotinine level and clinical attachment loss in chronic periodontitis smokers with or without COPD.

Conclusions:

The result of this study indicates that increased smoking with COPD causes a higher chance of progression of periodontal destruction but it is not statistically significant. Furthermore, this study indicates that the assessment of serum cotinine levels is a reliable method to evaluate smoking exposure.

Concentrations of Cotinine and 4-(Methylnitrosamino)-1-(3-Pyridyl)-1-Butanol (NNAL) in U.S. Non-Daily Cigarette Smokers

BACKGROUND

Accumulating evidence suggests that non-daily smokers have higher disease and mortality risks than never smokers. Yet, the accuracy of self-reported non-daily cigarette smoking is poorly understood.

METHODS

We examined the concordance between self-reported non-daily smoking and serum cotinine in 18,835 adult participants (20 years or older) of the 2007 to 2014 National Health and Nutrition Examination Surveys, in comparison with daily smokers and nonsmokers. We also analyzed concentrations of the urinary biomarker 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanol (NNAL) by smoking status.

RESULTS

In the study sample, 77.8% (14,660) reported currently not smoking (nonsmokers), 18.3% (3,446) smoked every day (daily smokers), and 3.9% (729) smoked on some days of the past month (non-daily smokers). Just 2.1% of nonsmokers had cotinine concentrations in the active smoking range (>10 ng/mL), compared with 70.4% of non-daily and 98.8% of daily smokers. Non-daily smokers reported smoking a median of 24 cigarettes per month [interquartile range (IQR) = 9-60] and had substantially higher concentrations of NNAL (median = 72.5; IQR = 14.8-211.0 pg/mL) than nonsmokers (median = 0.4; IQR = 0.4-2.1 pg/mL), although lower than daily smokers (median = 294.0; IQR = 148.0-542.0 pg/mL). Among non-daily smokers, concentrations of cotinine and NNAL were positively correlated with days and cigarettes smoked per month (P < 0.001).

CONCLUSIONS

We observed excellent concordance between self-reported non-daily cigarette smoking and concentrations of serum cotinine.

IMPACT

These results provide evidence for the validity of self-reported non-daily smoking and indicate that non-daily smokers are exposed to substantial concentrations of carcinogenic nitrosamines regardless of the low number of cigarettes they smoke per month.

Associations between select blood VOCs and hematological measures in NHANES 2005-2010

Exposure to VOCs is linked to health effects ranging from asthma to cancer and to negative impacts on the hematopoietic system. We examined the association between select blood VOC concentrations and hematological measures in a representative sample of the U.S. population from NHANES cycles spanning the years 2005 to 2010. We used Cox regression to assess the association between complete blood count with five-part differential (CBC) parameters and seven select blood VOCs, while addressing low detection rates among VOCs. Tobacco smoke exposure was classified using serum cotinine levels. The not-smoke-exposed group had lower VOC levels for most analytes compared with the smoke-exposed. Correlations between benzene, toluene, ethylbenzene, and xylenes (BTEX) were moderate to strong. Statistical associations were found between benzene, toluene, ethylbenzene, xylene, and styrene (BTEXS) and hematocrit, hemoglobin, and white blood cell count among the smoke-exposed. Among the not-smoke-exposed, there was an association between BTEX and platelet count. We considered benzene most likely to be associated with higher levels of CBC concentrations. Our findings suggest VOC levels currently found in the general U.S. population are associated with changes in hematological measures, and smoking could be a contributor.

Measuring the illicit cigarette market in the absence of pack security features: a case study of South Africa

There are several ways to measure the illicit cigarette market. In South Africa, different methods were used to triangulate results. The aim of this paper is to assist researchers to decide which method is most suitable to their context, especially for countries that do not have security features on cigarette packs (eg, tax stamps). We analysed the methods and results from three published articles that used various approaches to measure cigarette illicit trade in South Africa: (1) gap analysis, (2) price threshold method using secondary data from a national survey, and (3) price threshold method using primary data collected in low socioeconomic areas. We provide methodological insights and background information. We discuss the advantages and disadvantages of each method. The method chosen by researchers will depend on data availability, the existence or absence of security features on cigarette packs and funding. Researchers investigating illicit trade should use more than one method to increase confidence in the obtained results.

Genome-wide analyses of behavioural traits are subject to bias by misreports and longitudinal changes

Genome-wide association studies (GWAS) have discovered numerous genetic variants associated with human behavioural traits. However, behavioural traits are subject to misreports and longitudinal changes (MLC) which can cause biases in GWAS and follow-up analyses. Here, we demonstrate that individuals with higher disease burden in the UK Biobank (n = 455,607) are more likely to misreport or reduce their alcohol consumption levels, and propose a correction procedure to mitigate the MLC-induced biases. The alcohol consumption GWAS signals removed by the MLC corrections are enriched in metabolic/cardiovascular traits. Almost all the previously reported negative estimates of genetic correlations between alcohol consumption and common diseases become positive/non-significant after the MLC corrections. We also observe MLC biases for smoking and physical activities in the UK Biobank. Our findings provide a plausible explanation of the controversy about the effects of alcohol consumption on health outcomes and a caution for future analyses of self-reported behavioural traits in biobank data.

Evaluation of Revised US Preventive Services Task Force Lung Cancer Screening Guideline Among Women and Racial/Ethnic Minority Populations

Importance

Lung cancer incidence and mortality disproportionately affect women and racial/ethnic minority populations, yet screening guidelines for the past several years were derived from clinical trials of predominantly White men. To reflect current evidence, the US Preventive Services Task Force (USPSTF) has revised the eligibility criteria, which may help to ameliorate sex- and race/ethnicity-related disparities in lung cancer screening.

Objective

To determine the changes associated with the revised USPSTF guideline for lung cancer screening eligibility among female, Black, and Hispanic populations using a large nationwide survey.

Design, Setting, and Participants

This cross-sectional study included respondents to the Centers for Disease Control and Prevention's Behavioral Risk Factor Surveillance System who were 50 to 80 years of age with a smoking history in 19 states that used the optional lung cancer screening module. The change in eligibility among female, male, Black, Hispanic, and White participants was examined. Eligibility by sex and race/ethnicity was compared with a reference population. Data were collected from January 1, 2017, to December 31, 2018, and analyzed from May 8 to June 11, 2020.

Exposures

Self-reported sex, race/ethnicity, age, and smoking history.

Main Outcomes and Measures

Lung cancer screening eligibility using the revised USPSTF criteria. The previous criteria included current or past smokers (within 15 years) who were 55 to 80 years of age and had a smoking history of more than 30 pack-years. In the revised criteria, age was modified to 50 to 80 years; smoking history, to 20 pack-years.

Results

Among 40 869 respondents aged 50 to 80 years with a smoking history, 21 265 (52.0%) were women, 3430 (8.4%) were Black, and 1226 (30.0%) were Hispanic (mean [SD] age, 65.6 [7.9] years). The revised criteria increased eligibility for the following populations: men (29.4% to 38.3% [8.9% difference]; P < .001), women (25.9% to 36.4% [10.5% difference]; P < .001), White individuals (31.1% to 40.9% [9.8% difference]; P < .001), Black individuals (16.3% to 28.8% [12.5% difference]; P < .001), and Hispanic individuals (10.5% to 18.7% [8.2% difference]; P < .001). The odds of eligibility were lower for women compared with men (adjusted odds ratio [AOR], 0.88; 95% CI, 0.79-0.99; P = .04) and for Black (AOR, 0.43; 95% CI, 0.33-0.56; P < .001) and Hispanic populations (AOR, 0.70; 95% CI, 0.62-0.80; P < .001) compared with the White population.

Conclusions and Relevance

The revised USPSTF guideline may likely increase lung cancer screening rates for female, Black, and Hispanic populations. However, despite these potential improvements, lung cancer screening inequities may persist without tailored eligibility criteria.

Toward Precision Medicine for Smoking Cessation: Developing a Neuroimaging-Based Classification Algorithm to Identify Smokers at Higher Risk for Relapse

INTRODUCTION

By improving our understanding of the neurobiological mechanisms underlying addiction, neuroimaging research is helping to identify new targets for personalized treatment interventions. When trying to quit, smokers with larger electrophysiological responses to cigarette-related, compared with pleasant, stimuli ("C > P") are more likely to relapse than smokers with the opposite brain reactivity profile ("P > C").

AIM AND METHOD

The goal was to (1) build a classification algorithm to identify smokers characterized by P > C or C > P neuroaffective profiles and (2) validate the algorithm's classification outcomes in an independent data set where we assessed both smokers' electrophysiological responses at baseline and smoking abstinence during a quit attempt. We built the classification algorithm applying discriminant function analysis on the event-related potentials evoked by emotional images in 180 smokers.

RESULTS

The predictive validity of the classifier showed promise in an independent data set that included new data from 177 smokers interested in quitting; the algorithm classified 111 smokers as P > C and 66 as C > P. The overall abstinence rate was low; 15 individuals (8.5% of the sample) achieved CO-verified 12-month abstinence. Although individuals classified as P > C were nearly 2.5 times more likely to be abstinent than smokers classified as C > P (12 vs. 3, or 11% vs. 4.5%), this result was nonsignificant, preliminary, and in need of confirmation in larger trials.

CONCLUSION

These results suggest that psychophysiological techniques have the potential to advance our knowledge of the neurobiological underpinnings of nicotine addiction and improve clinical applications. However, larger sample sizes are necessary to reliably assess the predictive ability of our algorithm.

IMPLICATIONS

We assessed the clinical relevance of a neuroimaging-based classification algorithm on an independent sample of smokers enrolled in a smoking cessation trial and found those with the tendency to attribute more relevance to rewards than cues were nearly 2.5 times more likely to be abstinent than smokers with the opposite brain reactivity profile (11% vs. 4.5%). Although this result was not statistically significant, it suggests our neuroimaging-based classification algorithm can potentially contribute to the development of new precision medicine interventions aimed at treating substance use disorders. Regardless, these findings are still preliminary and in need of confirmation in larger trials.

Estimating illicit cigarette consumption using a tax-gap approach, India

Objective

To estimate the magnitude of illicit cigarette consumption in India using a tax-gap approach.

Methods

In the tax-gap analysis, illicit cigarette consumption in India was defined as the difference between total and legal consumption. Data on total cigarette consumption came from two national Global Adult Tobacco Surveys carried out from 2009 to 2010 and from 2016 to 2017. Legal consumption was derived from Government of India data on domestic cigarette production and trade.

Findings

Estimated total cigarette consumption was 104.8 billion sticks in 2009 to 2010 and 94.2 billion sticks in 2016 to 2017, a decrease of 10.6 billion sticks, or of 10%, over the time period. Legal cigarette consumption fell from 99.4 to 88.5 billion sticks over the same period, a drop of 11%. Estimated illicit cigarette consumption was, therefore, 5.4 billion sticks in 2009 to 2010 and 5.6 billion sticks in 2016 to 2017, and accounted for 5.1% and 6.0% of the market in these periods, respectively. Consequently, only about 1 in 20 cigarettes consumed in India was illicit. Between 2016 and 2017, the estimated equivalent retail sales value of illicit cigarettes was 49 billion Indian rupees (753 million United States dollars, US$) and the estimated tax revenue foregone was 25 billion Indian rupees (US$ 390 million).

Conclusion

Illicit cigarette consumption is relatively modest in India by global standards. Nonetheless, India should strengthen its capacity to control the illicit tobacco market as part of a comprehensive tobacco control strategy, while also continuing to implement traditional demand reduction measures, such as tobacco taxation.

Combustible and electronic cigarette use among patients at a large academic dental school clinic: A preimplementation needs assessment survey

BACKGROUND

Tobacco product use is a significant public health concern, particularly with the increasing use of electronic nicotine delivery systems (electronic cigarettes [e-cigarettes]). Dental care providers are well positioned to screen and provide guidance regarding tobacco use, but these services are generally underused.

METHODS

In preparation for a quality improvement project, patients at a large academic dental school clinic were anonymously surveyed regarding past and current use of combustible cigarettes and e-cigarettes, attitudes about quitting, and health beliefs regarding these products.

RESULTS

Among 166 surveyed patients, past month use of combustible cigarettes, e-cigarettes, and both combustible cigarettes and e-cigarettes (dual use) was reported by 14.5%, 2.4%, and 5.4% of patients, respectively. Daily combustible cigarette, e-cigarette, and dual use was reported by 12.7%, 1.2%, and 1.8% of patients, respectively. Most current tobacco users expressed thoughts or plans about changing their tobacco use and concerns regarding continued use of these products on their oral health. More than one-half of the current tobacco users expressed interest in receiving additional support to help them quit.

CONCLUSIONS

Dental care providers see a sizable number of patients who use combustible cigarettes and e-cigarettes, many of whom are concerned about the potential harms of these products on their health and express interest in tobacco-use cessation support.

PRACTICAL IMPLICATIONS

It is critical that dental care professionals engage in efforts to assess combustible cigarette and e-cigarette use and provide guidance regarding these products to their patients.

The illicit cigarette market in six South African townships

Background

We estimate the size of the illicit cigarette market in low socioeconomic areas in South Africa before and after a tax increase. In 2018, the real excise tax increased by 3% and the value-added tax (VAT) rate increased from 14% to 15%. Thus, the real tax on cigarettes increased by 4%.

Methods

A total of 2427 smokers were interviewed over two rounds of data collection (1234 before the tax increase and 1193 after). Data were collected in six townships across four of South Africa’s nine provinces. Smokers were asked about their most recent cigarette purchase. Cigarettes purchased for R1 (US$0.08) or less per stick are presumed illicit, based on a threshold price, which includes production costs and taxes.

Results

In 2017 and 2018 respectively, 34.6% and 36.4% of smokers in the sample purchased illicit cigarettes. The increase in the proportion of illicit purchases was not statistically significant. Smokers with relatively low socioeconomic status, those who have low levels of education and those who are older or unemployed are most likely to purchase illicit cigarettes.

Conclusions

The illicit cigarette trade in South African townships is widespread. The government should implement an independent track and trace system to curb tax evasion. This would reduce the availability of illicit cigarettes, improve public health and increase excise tax collection.

A randomized controlled trial of a smoking cessation self-help intervention for Spanish-speaking Hispanic/Latinx smokers: Study design and baseline characteristics

Although the current smoking prevalence among Hispanics/Latinxs (10%) is lower than in non-Hispanic whites (15%), higher prevalence is observed among certain subgroups (e.g., Puerto Rican males, 19%). Hispanic/Latinx smokers face unique challenges such as lower awareness and acceptability of nicotine replacement aids, lower prevalence of using counseling or medication, and receiving less advice to quit by their health care providers. Despite these barriers to smoking cessation, few interventions specifically targeted to Hispanic/Latinx smokers have been developed and evaluated. This paper summarizes the design, methods, analysis plan, and sample baseline characteristics of an ongoing randomized controlled trial to assess the efficacy of a Spanish-language self-help smoking cessation intervention among Hispanics/Latinxs. Current smokers who prefer health education materials in Spanish were randomized to one of two conditions. The usual care group received a standard smoking cessation booklet developed by the National Cancer Institute. The intervention group received 10 booklets, 9 pamphlets and a booklet for family and friends mailed monthly over 18 months. All participants complete self-report surveys every 6 months over 2 years. Smoking abstinence is biochemically verified at 12- and 24-month follow-up. A total of 2387 smokers were screened, 2056 were eligible and 1417 were enrolled in the study. The primary outcome is self-reported 7-day point prevalence abstinence. If the intervention is deemed efficacious, it has potential to have a large public health impact with respect to reducing smoking rates and smoking related morbidity and mortality among a large underserved minority population.

Illicit cigarette trade in South Africa: 2002-2017

BACKGROUND

Increasing cigarette excise taxes is widely recognised as the most effective measure to reduce the demand for cigarettes. The presence of illicit trade undermines the effectiveness of tax increases as both a public health and a fiscal measure, because it introduces cheaper alternatives to legal, full-priced cigarettes.

OBJECTIVE

To assess trends in the size of the illicit cigarette market in South Africa from 2002 to 2017 using gap analysis.

METHODS

Tax-paid cigarette sales are compared with consumption estimates from two nationally representative surveys: the All Media and Products Survey and the National Income Dynamics Study. We explore the size of the illicit cigarette market and its changes over the period 2002-2017.

RESULTS

Since 2009, illicit trade has increased sharply. We estimate that illicit trade is between 30% and 35% of the total market in 2017. The acceleration in the growth of the illicit market since 2015 corresponds with a turbulent time at the South African Revenue Service, when many of the enforcement functions were greatly reduced.

CONCLUSIONS

The current levels of illicit trade are extremely high and need to be addressed urgently by implementing effective control mechanisms such as a track and trace system to monitor the production, taxation, and sale of cigarettes.

Reexamination of hemoglobin adjustments to define anemia: altitude and smoking

The correct interpretation of hemoglobin (Hb) to identify anemia requires adjusting for altitude and smoking. Current adjustments were derived using data collected before 1985, from low-income preschool-aged children (PSC) in the United States and indigenous men in Peru for altitude, and from White women of reproductive age (WRA) in the United States for smoking. Given the oldness and limited representativeness of these data, we reexamined associations between Hb and altitude and/or smoking using 13 population-based surveys and 1 cohort study each conducted after 2000. All WHO regions except South-East Asia were represented. The dataset included 68,193 observations among PSC (6-59 months) and nonpregnant WRA (15-49 years) with data on Hb and altitude (-28 to 4000 m), and 19,826 observations among WRA with data on Hb and smoking (status or daily cigarette quantity). Generalized linear models were used to assess the robustness of associations under varying conditions, including controlling for inflammation-corrected iron and vitamin A deficiency. Our study confirms that Hb should be adjusted for altitude and/or smoking; these adjustments are additive. However, recommendations for Hb adjustment likely need updating. Notably, current recommendations may underadjust Hb for light smokers and for those residing at lower altitudes and overadjust Hb for those residing at higher altitudes.

Smoking Among Hispanic/Latino Nationality Groups and Whites, Comparisons Between California and the United States

Introduction

Although California is home to the largest Hispanic/Latino population, few studies have compared smoking behavior trends of Hispanic/Latino nationality groups in California to the remaining United States, which may identify the impact of the states antitobacco efforts on these groups. This study compared smoking status, frequency, and intensity among Mexican Americans, Central/South Americans, and non-Hispanic Whites in California to the remaining United States in the 1990s and 2000s.

Methods

Data were analyzed using the 1992-2011 Current Population Survey Tobacco Use Supplement to report the estimated prevalence of smoking status, frequency, and intensity by decade, race/ethnicity, and state residence. Weighted logistic regression explored sociodemographic factors associated with never and heavy smoking (≥20 cigarettes per day).

Results

There were absolute overall increases from 6.8% to 9.6% in never smoking across all groups. Compared to the remaining United States, there was a greater decrease in heavy smoking among Mexican American current smokers in California (5.1%) and a greater increase in light and intermittent smokers among Central/South American current smokers in California (9.3%) between decades. Compared to those living in the remaining United States, smokers living in California had lower odds of heavy smoking (1990s: odds ratio [OR] = 0.64, 95% confidence interval [CI] = 0.62, 0.66; 2000s: 0.54, 95% CI = 0.52, 0.55).

Conclusions

California state residence significantly impacted smoking behaviors as indicated by significant differences in smoking intensity between California and the remaining United States among Hispanic/Latino nationality groups. Understanding smoking behaviors across Hispanic/Latino nationality groups in California and the United States can inform tobacco control and smoking prevention strategies for these groups.

Implications

The present study explored the differences in smoking behaviors between Whites, Mexican Americans, and Central South/Americans living in California versus the rest of the United States in the 1990s and the 2000s. The results contribute to our current knowledge as there have been minimal efforts to provide disaggregated cigarette consumption information among Hispanic/Latino nationality groups. Additionally, by comparing cigarette consumption between those in California and the remaining United States, our data may provide insight into the impact of California's antitobacco efforts in reaching Hispanic/Latino subpopulations relative to the remaining US states, many of which have had less tobacco control policy implementation.

Individual differences in the processing of smoking-cessation video messages: An imaging genetics study

Studies testing the benefits of enriching smoking-cessation video ads with attention-grabbing sensory features have yielded variable results. Dopamine transporter gene (DAT1) has been implicated in attention deficits. We hypothesized that DAT1 polymorphism is partially responsible for this variability. Using functional magnetic resonance imaging, we examined brain responses to videos high or low in attention-grabbing features, indexed by "message sensation value" (MSV), in 53 smokers genotyped for DAT1. Compared to other smokers, 10/10 homozygotes showed greater neural response to High- vs. Low-MSV smoking-cessation videos in two a priori regions of interest: the right temporoparietal junction and the right ventrolateral prefrontal cortex. These regions are known to underlie stimulus-driven attentional processing. Exploratory analysis showed that the right temporoparietal response positively predicted follow-up smoking behavior indexed by urine cotinine. Our findings suggest that responses to attention-grabbing features in smoking-cessation messages is affected by the DAT1 genotype.

Overview of Cotinine Cutoff Values for Smoking Status Classification

While cotinine is commonly used as a biomarker to validate self-reported smoking status, the selection of an optimal cotinine cutoff value for distinguishing true smokers from true nonsmokers shows a lack of standardization among studies. This review describes how the cutoff values have been derived, and explains the issues involved in the generalization of a cutoff value. In this study, we conducted an English-language literature search in PubMed using the keywords “cotinine” and “cutoff” or “self-reported” and “smoking status” and “validation” for the years 1985–2014. We obtained 104 articles, 32 of which provided (1) sensitivity and specificity of a cutoff value and (2) determination methods for the given cutoff value. We found that the saliva cotinine cutoff value range of 10–25 ng/mL, serum and urine cotinine cutoff of 10–20 ng/mL and 50–200 ng/mL, respectively, have been commonly used to validate self-reported smoking status using a 2 × 2 table or a receiver operating characteristics (ROC) curve. We also found that recent large population-based studies in the U.S. and UK reported lower cutoff values for cotinine in serum (3 ng/mL) and saliva (12 ng/mL), compared to the traditionally accepted ones (15 and 14 ng/mg, respectively).

Differences in Dietary Patterns of Nonsmoking Adults Married to Smokers vs. Nonsmokers

Purpose.

To compare dietary intakes of nonsmoking adults married to smokers or non-smokers.

Design.

Respondents to the U.S. Department of Agriculture's Continuing Survey of Food Intakes by Individuals (CSFII), 1994 to 1996 (response rate = 76.1% for 2 days of dietary intake). Nonsmoking adults aged 18 and older were grouped according to the smoking status of their spouse.

Setting.

In-home interviews in all 50 states and Washington, D.C.

Subjects.

The selected sample included 757 men and 754 women who were married to nonsmokers, and 197 men and 262 women who were married to smokers.

Measures.

Selected demographic variables, food group servings, food energy, and densities of selected nutrients were compared using χ2 and analysis of covariance.

Results.

Men and women married to smokers had greater (p ⩽ .025) energy-adjusted intakes of total and saturated fat but significantly lower (p ⩽ .05) energy-adjusted intakes of fiber and vitamin A. Men married to smokers consumed significantly more (p < .025) energy-adjusted cholesterol and ethanol but significantly less calcium (p = .026); women married to smokers consumed significantly less (p = .014) energy-adjusted folate. Men married to smokers consumed significantly more (p ⩽ .05) alcoholic beverages, coffee, and soft drinks; women married to smokers consumed significantly less water (p = .014) but more cheese and table sweeteners (p ⩽ .05).

Conclusions.

Nonsmoking men and women who were married to smokers had compromised dietary intakes. Nonsmoking men whose wives smoked, in particular, had unhealthy diets due to elevated intakes of fat and cholesterol and low intakes of vitamin A, calcium, and fiber. Health professionals should continue to provide tobacco cessation instruction and dietary guidance, but also be aware of at-risk patients' immediate family members who likely share an increased risk of disease because of poor diet quality and exposure to environmental tobacco smoke.

Cigarette and Smokeless Tobacco Use among Migrant and Nonmigrant Mexican American Youth

Increase in smoking/tobacco-related diseases among the Hispanic population calls for an examination of its use among this population. This study examined the relationship between gender, level of cultural identification, migrant status, and grade level and tobacco use and perception of its harn among Mexican American youth. Results showed males more likely to use cigarettes (occasional and daily) and smokeless tobacco than females when grade, cultural identification, and migrant status of parents are held constant. No gender effect was found for lifetime cigarette use. The odds of using cigarettes and smokeless tobacco increase substantially across grades. Effects were foundfor Mexican American/Spanish and AnglolWhite American cultural identification and daily cigarette use. Youths who belonged to nonmigrant families or who identified with a traditional Mexican American/Spanish culture were more likely to consider regular tobacco use as harmful. These and other findings are discussed from the perspective offuture research and prevention and intervention efforts.

Further evidence that periodontal bone loss increases with smoking and age

DESIGN

Cohort study. COHORT SELECTION: A birth cohort born at the Queen Mary Hospital, Dunedin, New Zealand between 1 April 1972 and 31 March 1973 that are being followed as part of the Dunedin Multidisciplinary Health and Development Study (DMHDS). EXPOSURE MEASUREMENT: Periodontal examinations were conducted at ages 26, 32 and 38, with only half-mouth examinations possible at age 26, but full-mouth examinations undertaken at 32 and 38. Third molars and implants were not included in the periodontal examinations. Tobacco smoking was determined at ages 15, 18, 21, 26, 32 and 38.

OUTCOME MEASURE

Attachment loss (AL).

DATA ANALYSIS

Generalised linear mixed modelling with a quasi-binomial approach was used to examine associations between chronic smoking and periodontal attachment loss.

RESULTS

Of the 1037 participants initially enrolled in the study, 913 were periodontally examined at age 26, and periodontal data were available for 863 (94.5%) individuals at ages 26, 32, and 38 using listwise deletion. At age 32 and 38 respectively, 918 and 905 (98.6%), and 913 and 869 (95.1%) participants were examined and included in the analysis. Approximately equal numbers of females and males were included. Attachment loss increased in smokers with age. At ages 26, 32 and 38, smokers had 3.5%, 12.8% and 23.2% (respectively) greater AL than non-smokers. Regular cannabis use was associated with greater AL after age 32, but not at age 26. Males had more AL than females. Participants with high plaque scores had consistently greater AL; those who were of persistently low SES (socio-economic status) had higher AL at age 32 and 38, but not at age 26. The amount of AL in anteriors was less than in premolars and molars. Gingival bleeding was associated with higher AL at ages 26, 32 and 38.

CONCLUSIONS

This research confirmed the strong association between chronic smoking and periodontal disease.

Evaluating the validity of self-reported smoking in Mexican adolescents

OBJECTIVES

We aimed to evaluate the validity of the self-reported smoking indicator used in the Global Youth Tobacco Survey (GYTS).

SETTING

43 middle and high-school classrooms from 26 schools were selected from Mexico City and Cuernavaca, Morelos.

PARTICIPANTS

A total of 1257 students provided both a questionnaire and a urine sample.

PRIMARY AND SECONDARY OUTCOME

Sensitivity and specificity of self-reported smoking compared to urinary cotinine. Validity indices were evaluated by subgroups of gender, social acceptability of smoking (ie, smoking parents or friends) and smoking frequency.

RESULTS

Sensitivity and specificity for current smoking were 93.2% and 81.7%, respectively. Validity indices remained stable across gender. Parental smoking status moderated the validity of self-report, which had lower sensitivity in adolescents with non-smoking parents (86.7%) than in adolescents with smoking parents (96.6%). Sensitivity and specificity increased with smoking frequency.

CONCLUSIONS

This first validation study of self-reported current smoking used in the GYTS among Mexican adolescents suggests that self-reported smoking in the past 30 days is a valid and stable indicator of current smoking behaviour. This measure appears suitable for public health research and surveillance.

Smoking among pregnant women in small towns in Poland

Objectives

The aim of the work was to assess among pregnant women from small towns and villages in Poland: the prevalence of smoking, credibility of smoking, and influence of socioeconomic factors on smoking status.

Methods

The data came from 4512 interviews with women in different trimesters of pregnancy. The interviews were collected in 2007 and 2008 year in towns up to 8000 citizens in 12 voivodeships.

Results

Prevalence of smoking in the beginning of pregnancy was confirmed by 34.6 % of women. During the pregnancy 14.7 % of women declared quitting smoking and 19.9 % continued smoking. Cigarette smoking was most frequent in those with a primary education, unemployed, very low incomes in household, and having both smoking parents. In multifactorial analysis, risk of smoking was highest (95 % CI 1.74–6.06) for women that were divorced or not living with a partner compared with married.

Conclusions

Rates of active smoking among a population of pregnant women living in small towns in Poland are very high. Since the correlates of smoking during pregnancy are a low education level and a low economic status of the pregnant woman, these socioeconomic groups should be first priority targets.

Validation of Non-Smoking Status by Spouse Following a Cessation Intervention

BACKGROUND

Following cessation interventions, self-reported smoking abstinence with biochemical verification is the "gold standard" for defining outcomes. Because obtaining biochemical verification is challenging in community studies, we compared self-reported cessation among smokers completing treatment to the smoking status reported by each participant's spouse or proxy.

METHOD

Participants were smokers who had reported quitting 12 months after a cessation intervention. Participants had either attended a smoking cessation clinic or they were patients seen by physicians who had recently participated in a cessation-training program. Proxies living with these participants were interviewed by telephone to ask about their partner's smoking status. We compared the participants' responses to those from their spouses.

RESULTS

At 12 months, 346 of 1423 baseline smokers had quit; 161/346 reported non-smokers were called and 140 proxies were interviewed. The participants averaged 51 years of age, 69% were women. At baseline, the mean number of cigarettes smoked per day was 20.1 (SD = 9.9) and the average number of quit attempts was 2.4 (SD = 1.2). Cessation methods used were medical advice (21%) and/or pharmacotherapy (79%). Of the 140 spouses interviewed, only 10 (7.1%) reported that their partners were currently smoking.

CONCLUSIONS

Proxy-reported data on smoking status could be used to validate self-report.

Disparities in the Population Distribution of African American and Non-Hispanic White Smokers Along the Quitting Continuum

PURPOSE

To examine disparities and changes over time in the population-level distribution of smokers along a cigarette quitting continuum among African American smokers compared with non-Hispanic Whites.

METHODS

Secondary data analyses of the 1999, 2002, 2005, and 2008 California Tobacco Surveys (CTS). The CTS are large, random-digit-dialed, population-based surveys designed to assess changes in tobacco use in California. The number of survey respondents ranged from n = 6,744 to n = 12,876 across CTS years. Current smoking behavior (daily or nondaily smoking), number of cigarettes smoked per day, intention to quit in the next 6 months, length of most recent quit attempt among current smokers, and total length of time quit among former smokers were assessed and used to recreate the quitting continuum model.

RESULTS

While current smoking rates were significantly higher among African Americans compared with non-Hispanic Whites across all years, cigarette consumption rates were lower among African Americans in all years. There were significant increases in the proportion of former smokers who had been quit for at least 12 months from 1999 (African Americans, 26.8% ± 5.5%; non-Hispanic Whites, 36.8% ± 1.6%) to 2008 (African Americans, 43.6% ± 4.1%; non-Hispanic Whites, 57.4% ± 2.9%). The proportion of African American former smokers in each CTS year was significantly lower than that of non-Hispanic Whites.

CONCLUSIONS

Despite positive progression along the quitting continuum for both African American and non-Hispanic White smokers, the overall distribution was less favorable for African Americans. The lower smoking consumption levels among African Americans, combined with the lower rates of successful smoking cessation, suggest that cigarette addiction and the quitting process may be different for African American smokers.

Did the tobacco industry inflate estimates of illicit cigarette consumption in Asia? An empirical analysis

Objective

Estimates of illicit cigarette consumption are limited and the data obtained from studies funded by the tobacco industry have a tendency to inflate them. This study aimed to validate an industry-funded estimate of 35.9% for Hong Kong using a framework taken from an industry-funded report, but with more transparent data sources.

Methods

Illicit cigarette consumption was estimated as the difference between total cigarette consumption and the sum of legal domestic sales and legal personal imports (duty-free consumption). Reliable data from government reports and scientifically valid routine sources were used to estimate the total cigarette consumption by Hong Kong smokers and legal domestic sales in Hong Kong. Consumption by visitors and legal duty-free consumption by Hong Kong passengers were estimated under three scenarios for the assumptions to examine the uncertainty around the estimate. A two-way sensitivity analysis was conducted using different levels of possible undeclared smoking and under-reporting of self-reported daily consumption.

Results

Illicit cigarette consumption was estimated to be about 8.2–15.4% of the total cigarette consumption in Hong Kong in 2012 with a midpoint estimate of 11.9%, as compared with the industry-funded estimate of 35.9% of cigarette consumption. The industry-funded estimate was inflated by 133–337% of the probable true value. Only with significant levels of under-reporting of daily cigarette consumption and undeclared smoking could we approximate the value reported in the industry-funded study.

Conclusions

The industry-funded estimate inflates the likely levels of illicit cigarette consumption.

Neighborhood social cohesion and smoking among legal and unauthorized Brazilian migrants in metropolitan Boston

Tobacco smoking is estimated to be the largest preventable cause of mortality in the USA, but little is known about the relationship between neighborhood social environment and current smoking behavior or how this may differ by population and geography. We investigate how neighborhood social cohesion and disorder are associated with smoking behavior among legal and unauthorized Brazilian migrant adults using data from the 2007 Harvard-UMASS Boston Metropolitan Immigrant Health and Legal Status Survey (BM-IHLSS), a probabilistic household survey of adult Brazilian migrants. We employ logistic regression to estimate associations between neighborhood social cohesion, neighborhood disorder, and current smoking. We find that neighborhood-level social cohesion is associated with lower likelihood of being a current smoker (O.R. = .836; p < .05), and neighborhood disorder, measured as crime experienced in the neighborhood, is not associated with current smoking. Neighborhood population density, age, being male, and residing with someone who smokes are each positively associated with current smoking (p < .10). The health of participants' parents at the age of 35, being married, and individual earnings are associated with a reduction in the probability of being a current smoker (p < .05). Migrant legal status and length of residence in the USA are not associated with current smoking. Our findings suggest that neighborhood social cohesion may be protective against smoking. Alternatively, neighborhood disorder does not appear to be related to current smoking among Brazilian migrants.

Status of cardiovascular disease and stroke in Hispanics/Latinos in the United States: a science advisory from the American Heart Association

BACKGROUND AND PURPOSE

This American Heart Association (AHA) scientific statement provides a comprehensive overview of current evidence on the burden cardiovascular disease (CVD) among Hispanics in the United States. Hispanics are the largest minority ethnic group in the United States, and their health is vital to the public health of the nation and to achieving the AHA's 2020 goals. This statement describes the CVD epidemiology and related personal beliefs and the social and health issues of US Hispanics, and it identifies potential prevention and treatment opportunities. The intended audience for this statement includes healthcare professionals, researchers, and policy makers.

METHODS

Writing group members were nominated by the AHA's Manuscript Oversight Committee and represent a broad range of expertise in relation to Hispanic individuals and CVD. The writers used a general framework outlined by the committee chair to produce a comprehensive literature review that summarizes existing evidence, indicate gaps in current knowledge, and formulate recommendations. Only English-language studies were reviewed, with PubMed/MEDLINE as our primary resource, as well as the Cochrane Library Reviews, Centers for Disease Control and Prevention, and the US Census data as secondary resources. Inductive methods and descriptive studies that focused on CVD outcomes incidence, prevalence, treatment response, and risks were included. Because of the wide scope of these topics, members of the writing committee were responsible for drafting individual sections selected by the chair of the writing committee, and the group chair assembled the complete statement. The conclusions of this statement are the views of the authors and do not necessarily represent the official view of the AHA. All members of the writing group had the opportunity to comment on the initial drafts and approved the final version of this document. The manuscript underwent extensive AHA internal peer review before consideration and approval by the AHA Science Advisory and Coordinating Committee.

RESULTS

This statement documents the status of knowledge regarding CVD among Hispanics and the sociocultural issues that impact all subgroups of Hispanics with regard to cardiovascular health. In this review, whenever possible, we identify the specific Hispanic subgroups examined to avoid generalizations. We identify specific areas for which current evidence was less robust, as well as inconsistencies and evidence gaps that inform the need for further rigorous and interdisciplinary approaches to increase our understanding of the US Hispanic population and its potential impact on the public health and cardiovascular health of the total US population. We provide recommendations specific to the 9 domains outlined by the chair to support the development of these culturally tailored and targeted approaches.

CONCLUSIONS

Healthcare professionals and researchers need to consider the impact of culture and ethnicity on health behavior and ultimately health outcomes. There is a need to tailor and develop culturally relevant strategies to engage Hispanics in cardiovascular health promotion and cultivate a larger workforce of healthcare providers, researchers, and allies with the focused goal of improving cardiovascular health and reducing CVD among the US Hispanic population.

Smoking among U.S. Hispanic/Latino adults: the Hispanic community health study/study of Latinos

BACKGROUND

Prior national surveys capture smoking behaviors of the aggregated U.S. Hispanic/Latino population, possibly obscuring subgroup variation.

PURPOSE

To describe cigarette use among Hispanic/Latino adults across subgroups of age, gender, national background, SES, birthplace, and degree of acculturation to the dominant U.S. culture.

METHODS

A cross-sectional survey of 16,322 participants in the Hispanic Community Health Study/Study of Latinos aged 18-74 years, recruited in Bronx NY, Chicago IL, Miami FL, and San Diego CA, was conducted during 2008-2011.

RESULTS

Prevalence of current smoking was highest among Puerto Ricans (men, 35.0%; women, 32.6%) and Cubans (men, 31.3%; women, 21.9%), with particularly high smoking intensity noted among Cubans as measured by pack-years and cigarettes/day. Dominicans had the lowest smoking prevalence (men, 11.0%; women, 11.7%). Individuals of other national backgrounds had a smoking prevalence that was intermediate between these groups, and typically higher among men than women. Non-daily smoking was common, particularly although not exclusively among young men of Mexican background. Persons of low SES were more likely to smoke, less likely to have quit smoking, and less frequently used over-the-counter quit aids compared to those with higher income and education levels. Smoking was more common among individuals who were born in the U.S. and had a higher level of acculturation to the dominant U.S. culture, particularly among women.

CONCLUSIONS

Smoking behaviors vary widely across Hispanic/Latino groups in the U.S., with a high prevalence of smoking among population subgroups with specific, readily identifiable characteristics.

National trends in smoking behaviors among Mexican, Puerto Rican, and Cuban men and women in the United States

OBJECTIVES

We examined trends in smoking behaviors across 2 periods among Mexicans, Puerto Ricans, and Cubans in the United States.

METHODS

We analyzed data from the 1992-2007 Tobacco Use Supplements to the Current Population Survey. We constructed 2 data sets (1990s vs 2000s) to compare smoking behaviors between the 2 periods.

RESULTS

Significant decreases in ever, current, and heavy smoking were accompanied by increases in light and intermittent smoking across periods for all Latino groups, although current smoking rates among Puerto Rican women did not decline. Adjusted logistic regression models revealed that in the 2000s, younger Mexicans and those interviewed in English were more likely to be light and intermittent smokers. Mexican and Cuban light and intermittent smokers were less likely to be advised by healthcare professionals to quit smoking. Mexicans and Puerto Ricans who were unemployed and Mexicans who worked outdoors were more likely to be heavy smokers.

CONCLUSIONS

Increases in light and intermittent smoking among Mexican, Puerto Rican, and Cuban Americans suggest that targeted efforts to further reduce smoking among Latinos may benefit by focusing on such smokers.

Reliability of adult self-reported smoking history: data from the tobacco use supplement to the current population survey 2002-2003 cohort

INTRODUCTION

This study examined the reliability of self-reported smoking history measures. The key measures of interest were time since completely quitting smoking among former smokers; age at which fairly regular smoking was initiated among former and current smokers; the number of cigarettes smoked per day and the number of years of daily smoking among former smokers; and never smoking. Another goal was to examine sociodemographic factors and interview method as potential predictors of the odds of strict agreement in responses.

METHODS

Data from the 2002-2003 Tobacco Use Supplement to the Current Population Survey were examined. Descriptive analysis was performed to detect discrepant data patterns, and intraclass and Pearson correlations and kappa coefficients were used to assess reporting consistency over the 12-month interval. Multiple logistic regression models with replicate weights were built and fitted to identify factors influencing the logit of agreement for each measure of interest.

RESULTS

All measures revealed at least moderate levels of overall agreement. However, upon closer examination, a few measures also showed some considerable differences in absolute value. The highest percentage of these differences was observed for former smokers' reports of the number of years smoking every day.

CONCLUSIONS

Overall, the data suggest that self-reported smoking history characteristics are reliable. The logit of agreement over a 12-month period is shown to depend on a few sociodemographic characteristics as well as their interactions with each other and with interview method.

New Mexican Hispanic smokers have lower odds of chronic obstructive pulmonary disease and less decline in lung function than non-Hispanic whites

RATIONALE

The epidemiology of cigarette smoking-related chronic obstructive pulmonary disease (COPD) is not well characterized in Hispanics in the United States. Understanding how ethnicity influences COPD is important for a number of reasons, from informing public health policies to dissecting the genetic and environmental effects that contribute to disease.

OBJECTIVES

The present study assessed differences in risk between Hispanics and non-Hispanic whites for longitudinal and cross-sectional COPD phenotypes. Genetic ancestry was used to verify findings based on self-reported ethnicity. Hispanics in New Mexico are primarily differentiated from non-Hispanic whites by their proportion of Native American ancestry.

METHODS

The study was performed in a New Mexican cohort of current and former smokers. Self-reported Hispanic and non-Hispanic white ethnicity was validated by defining genetic ancestry proportions at the individual level using 48 single-nucleotide polymorphism markers. Self-reported ethnicity and genetic ancestry were independently used to assess associations with cross-sectional and longitudinal measures of lung function. Multivariable models were adjusted for indicators of smoking behavior.

MEASUREMENTS AND MAIN RESULTS

Self-reported Hispanic ethnicity was significantly associated with lower odds of COPD (odds ratio, 0.49; 95% confidence interval, 0.35-0.71; P = 0.007), and this protection was validated by the observation that Hispanic smokers have reduced risk of rapid decline in lung function (odds ratio, 0.48; 95% confidence interval, 0.30-0.78; P = 0.003). Similar findings were noted when Native American genetic ancestry proportions were used as predictors instead of self-report of Hispanic ethnicity.

CONCLUSIONS

Hispanic ethnicity is inversely associated with cross-sectional and longitudinal spirometric COPD phenotypes even after adjustment for smoking. Native American genetic ancestry may account for this "Hispanic protection."

Differences in smoking behavior and attitudes among Puerto Rican, Dominican, and non-Latino white caregivers of children with asthma

PURPOSE

No studies have examined the differences in smoking attitudes and behavior between Dominicans (DRs) and Puerto Ricans (PRs). Identification of pretreatment differences is important for cultural adaptation of evidenced-based smoking cessation treatments.

DESIGN

Secondary analysis. SETTING/INTERVENTION: Three home visits for asthma education and smoking cessation.

SUBJECTS

Caregivers who smoke and have a child with asthma: DRs (n = 30), PRs (n = 67), and non-Latino whites (n = 128; NLWs).

MEASURES

Baseline assessment of psychosocial variables.

ANALYSES

Controlled for age, education, and acculturation.

RESULTS

Compared with DRs, PRs were more acculturated, more nicotine dependent, less motivated and confident to quit, and identified more pros of smoking (all p < .05). Compared with NLWs, PRs were less likely to be employed, smoked fewer cigarettes per day, and had lower education, greater depressed mood, greater pros and cons of smoking, less social support, and higher child asthma morbidity (all p < .05). Compared with NLWs, DRs were less nicotine dependent, more confident to quit, and less likely to live with a smoker; reported greater cons of smoking and greater stress; and were more likely to have a household smoking ban (DRs 60% vs. NLWs 33.6%). Only 3.3% of DRs were precontemplators vs. 16.4% (PRs) and 10.9% (NLWs).

CONCLUSIONS

PRs appear to have more factors associated with risk of smoking treatment failure; DRs appear to have more protective factors. Examination of the role of these smoking attitudes as potential moderators and mediators of smoking behavior are needed to guide the cultural adaptation of evidenced-based treatments.

A nationwide analysis of US racial/ethnic disparities in smoking behaviors, smoking cessation, and cessation-related factors

OBJECTIVES

We used nationally representative data to examine racial/ethnic disparities in smoking behaviors, smoking cessation, and factors associated with cessation among US adults.

METHODS

We analyzed data on adults aged 20 to 64 years from the 2003 Tobacco Use Supplement to the Current Population Survey, and we examined associations by fitting adjusted logistic regression models to the data.

RESULTS

Compared with non-Hispanic Whites, smaller proportions of African Americans, Asian Americans/Pacific Islanders, and Hispanics/Latinos had ever smoked. Significantly fewer African Americans reported long-term quitting. Racial/ethnic minorities were more likely to be light and intermittent smokers and less likely to smoke within 30 minutes of waking. Adjusted models revealed that racial/ethnic minorities were not less likely to receive advice from health professionals to quit smoking, but they were less likely to use nicotine replacement therapy.

CONCLUSIONS

Specific needs and ideal program focuses for cessation may vary across racial/ethnic groups, such that approaches tailored by race/ethnicity might be optimal. Traditional conceptualizations of cigarette addiction and the quitting process may need to be revised for racial/ethnic minority smokers.

Survival following non-small cell lung cancer among Asian/Pacific Islander, Latina, and Non-Hispanic white women who have never smoked

BACKGROUND

Lung cancer is the leading cause of cancer death among U.S. Asian/Pacific Islander (API) and Latina women despite low smoking prevalence. This study examined survival patterns following non-small cell lung cancer in a population-based sample of lung cancer cases from the San Francisco Bay Area Lung Cancer Study (SFBALCS).

METHODS

Women diagnosed with lung cancer from 1998 to 2003 and 2005 to 2008 and identified through the Greater Bay Area Cancer Registry were telephone-screened for eligibility for the SFBALCS. The screener data were linked to the cancer registry data to determine follow-up. This analysis included 187 non-Hispanic (NH) white, 23 U.S.-born Latina, 32 foreign-born Latina, 30 U.S.-born API, and 190 foreign-born API never-smokers diagnosed with lung cancer and followed through 2008.

RESULTS

All-cause survival was poorer among APIs [HR=1.7 (95% CI: 1.0-2.8) among U.S.-born APIs and HR=1.2 (95% CI: 0.9-1.5) among foreign-born APIs] and Latinas [HR=2.1 (95% CI: 1.2-3.6) among U.S.-born Latinas; HR=1.4 (95% CI: 0.9-2.3) among foreign-born Latinas] relative to NH whites. These survival differences were not explained by differences in selected sociodemographic or clinical factors.

CONCLUSIONS

Further research should focus on factors such as cultural behaviors, access to or attitudes toward health care, and genetic variations as possible explanations for these striking racial/ethnic differences.

IMPACT

Latina and API female never-smokers diagnosed with lung cancer were up to two times more likely to die than NH whites, highlighting the need for additional research to identify the underlying reasons for the disparities and heightened clinical awareness.

Menthol cigarettes and smoking cessation among racial/ethnic groups in the United States

AIM

To examine the association between smoking mentholated cigarettes and smoking cessation, separately for different racial/ethnic groups.

DESIGN

Secondary data analysis of the 2003 and 2006-07 Tobacco Use Supplements to the Current Population Survey.

SETTING

United States.

PARTICIPANTS

African American, Asian American/Pacific Islander, Hispanic/Latino, Native American, non-Hispanic white adults.

MEASUREMENTS

Examined relations between the use of mentholated cigarettes and measures of smoking cessation.

FINDINGS

Among African Americans (ORadj = 1.62, 95% CI: 1.35-1.95) and Hispanics/Latinos (ORadj = 1.21, 95% CI: 1.00-1.47), those who currently smoked mentholated cigarettes were more likely be seriously considering quitting in the next six months than were non-menthol smokers, after adjusting for sociodemographic factors. African Americans (ORadj = 1.87, 95% CI: 1.60-2.19) and Hispanics/Latinos (ORadj = 1.34, 95% CI: 1.11-1.62) who smoked mentholated cigarettes were also significantly more likely to have a positive estimation of successfully quitting in the next six months compared to non-menthol smokers. These associations were not found among Asian Americans/Pacific Islanders, Native Americans/Alaska Natives and Non-Hispanic Whites. Among former smokers, across racial/ethnic groups, those who smoked mentholated cigarettes (vs. non-menthols) were significantly less likely to have successfully quit for at least six months: African Americans (ORadj = 0.23, 95% CI: 0.17-0.31), Asian Americans/Pacific Islanders (ORadj = 0.22, 95% CI: 0.11-0.45), Hispanics/Latinos (ORadj = 0.48, 95% CI: 0.34-0.69) and Non-Hispanic Whites (ORadj = 0.28, 95% CI: 0.25-0.33).

CONCLUSION

Across race/ethnic groups, those who used to regularly smoke mentholated cigarettes were less likely to have experienced long-term quitting success. Cessation programs should consider the type of cigarette typically smoked by participants, particularly menthols.

Transcriptomic epidemiology of smoking: the effect of smoking on gene expression in lymphocytes

BACKGROUND

This investigation offers insights into system-wide pathological processes induced in response to cigarette smoke exposure by determining its influences at the gene expression level.

METHODS

We obtained genome-wide quantitative transcriptional profiles from 1,240 individuals from the San Antonio Family Heart Study, including 297 current smokers. Using lymphocyte samples, we identified 20,413 transcripts with significantly detectable expression levels, including both known and predicted genes. Correlation between smoking and gene expression levels was determined using a regression model that allows for residual genetic effects.

RESULTS

With a conservative false-discovery rate of 5% we identified 323 unique genes (342 transcripts) whose expression levels were significantly correlated with smoking behavior. These genes showed significant over-representation within a range of functional categories that correspond well with known smoking-related pathologies, including immune response, cell death, cancer, natural killer cell signaling and xenobiotic metabolism.

CONCLUSIONS

Our results indicate that not only individual genes but entire networks of gene interaction are influenced by cigarette smoking. This is the largest in vivo transcriptomic epidemiological study of smoking to date and reveals the significant and comprehensive influence of cigarette smoke, as an environmental variable, on the expression of genes. The central importance of this manuscript is to provide a summary of the relationships between gene expression and smoking in this exceptionally large cross-sectional data set.

Acculturation differentially predicts smoking cessation among Latino men and women

OBJECTIVES

The current study examined the influence of gender, acculturation indicators, and their interaction on smoking cessation among Latinos.

METHODS

Logistic regression analysis was used to examine the main effects of gender, acculturation indicators, and their interactions on self-reported 7-day abstinence at 12-week follow-up among 271 Latino smokers seeking cessation counseling.

RESULTS

Analyses revealed significant main effects for several acculturation indicators and significant interactions of gender with number of years lived in the United States, proportion of life lived in the United States, and preferred media language (all P values <0.05). Follow-up analyses indicated no significant relationships between abstinence and acculturation indicators among women. Among men, abstinence rates increased with years in the United States, proportion of life in the United States, and preferred media language of English.

CONCLUSIONS

Greater acculturation predicted higher abstinence rates, but this relationship was restricted to men. This study is among the first to examine the effects of gender and acculturation on smoking abstinence among Latinos. Findings highlight the need for research focused on mechanisms underlying these relationships.

Do smokers know what we're talking about? The construct validity of nicotine dependence questionnaire measures

Few studies have examined whether nicotine dependence self-report questionnaires can predict specific behaviors and symptoms at specific points in time. The present study used data from a randomized clinical trial (N = 608; M. E. Piper et al., 2007) to assess the construct validity of scales and items from 3 nicotine dependence measures: the Fagerström Test for Nicotine Dependence (T. F. Heatherton, L. T. Kozlowski, R. C. Frecker & K.-O. Fagerström, 1991), the Nicotine Dependence Syndrome Scale (S. Shiffman, A. J. Waters, & M. Hickcox, 2004), and the Wisconsin Inventory of Smoking Dependence Motives (M. E. Piper et al., 2004). Scales from these measures were used to predict participants' reports on real-time measures of withdrawal symptoms and smoking behavior and retrospective self-report questionnaires to assess convergent and discriminative validity. The nicotine dependence measures' scales and items generally predicted the real-time measures of similar constructs, but the percent of variance accounted for was low. The nicotine dependence measures did, however, show evidence of discriminative validity. Thus, this study provides modest support for the construct validity of these nicotine dependence scales.

Cigarette smoking among adult Latinos: the California Tobacco Baseline Survey

This article presents probability estimates of smoking prevalence for the Latino adult population in California and examines differences in smoking prevalence and nicotine dependence between different levels of education and acculturation and between different ethnic and gender groups. Prevalence estimates are based on the California Baseline Tobacco Survey (CTS). The CTS is a Random Digit Dial Survey including N=70,997 non-Latino Whites and 28,000 Latino adults. Overall smoking prevalence among Latinos was estimated at 24.4% for men and 12.0% for women. Multiple logistic regression analyses suggest higher smoking prevalence and higher nicotine dependence for men than for women, for individuals who have not finished high school, for non-Latinos when compared to Latinos, and for Latinos of high level of acculturation when compared to Latinos of low level of acculturation. These estimates can serve as baselines to evaluate progress toward year 2000 health objectives. Findings stress the importance of taking into account socio-economic level when comparing Latinos and other ethnic groups on health behaviors. Moreover, findings suggest that interventions helping Latinos quit smoking are most needed for men with twelve years or less of formal education and stress the importance of programs to prevent smoking uptake, specifically among Latinos of low level of acculturation.

Calibrating self-reported measures of maternal smoking in pregnancy via bioassays using a Monte Carlo approach

Maternal smoking during pregnancy is a major public health problem that has been associated with numerous short- and long-term adverse health outcomes in offspring. However, characterizing smoking exposure during pregnancy precisely has been rather difficult: self-reported measures of smoking often suffer from recall bias, deliberate misreporting, and selective non-disclosure, while single bioassay measures of nicotine metabolites only reflect recent smoking history and cannot capture the fluctuating and complex patterns of varying exposure of the fetus. Recently, Dukic et al. have proposed a statistical method for combining information from both sources in order to increase the precision of the exposure measurement and power to detect more subtle effects of smoking. In this paper, we extend the Dukic et al. method to incorporate individual variation of the metabolic parameters (such as clearance rates) into the calibration model of smoking exposure during pregnancy. We apply the new method to the Family Health and Development Project (FHDP), a small convenience sample of 96 predominantly working class white pregnant women oversampled for smoking. We find that, on average, misreporters smoke 7.5 cigarettes more than what they report to smoke, with about one third underreporting by 1.5, one third under-reporting by about 6.5, and one third underreporting by 8.5 cigarettes. Partly due to the limited demographic heterogeneity in the FHDP sample, the results are similar to those obtained by the deterministic calibration model, whose adjustments were slightly lower (by 0.5 cigarettes on average). The new results are also, as expected, less sensitive to assumed values of cotinine half-life.