662Factors associated with smoking continuation and indoor smoking among pregnant women’s partners

Background Secondhand smoke by partners is a major source of exposure for non-smoking women. However, factors associated with smoking continuation and indoor smoking among pregnant women’s partners remain unknown. Methods We used data from 6348 partners of non-smoking pregnant women who participated in the Tohoku Medical Megabank Project Birth and Three-Generation Cohort Study in Japan from 2013 to 2017. Partners’ age, educational attainment, equivalent household income, and pregnant women’s smoking history (never, quitting before pregnancy awareness, quitting after pregnancy awareness) were used as explanatory variables. Multivariate logistic regression analyses were conducted to examine the associations between these variables and smoking continuation/indoor smoking of partners. Results Among 6348 partners, 2506 partners had been smokers at pregnancy awareness. Among them, the prevalence of smoking continuation after pregnancy awareness was 92.0%. Partners whose wives had quitted smoking after pregnancy awareness were less likely to continue smoking than partners whose wives had never smoked; the odds ratio was 0.57 (95% confidence interval, 0.41–0.80). Among partners who continued smoking, the prevalence of indoor smoking was 30.7%. Partners with ≤high school education were more likely to smoke indoors than partners with ≥university education; the odds ratio was 1.60 (95% confidence interval, 1.23–2.07). Conclusions Women’s smoking cessation after pregnancy awareness was associated with decreased risk of partners’ smoking continuation, and lower level of partners’ education was associated with increased risk of partners’ indoor smoking. Key messages Interventions for both women and their partners may be effective in reducing secondhand smoke exposure during pregnancy.

Smoking and Vaping During the COVID-19 Pandemic: A Qualitative Study Among Healthcare Workers in a Low and Middle-Income Country

Objective: To investigate social, economic, and environmental contributors to quit or continue smoking and vaping during the COVID-19 pandemic. Methods: A qualitative study design was adopted to identify smokers’ beliefs in a LMIC, using a small community sample. Results: 276 participants were primarily surveyed. Motivation to continue smoking included temporary pleasurable effects, working remotely, stress or anxiety, whereas a motivator to quit smoking was the overlap with COVID-19 symptomatology. There was a rise in social awareness regarding the potential harm of smoking and vaping during the pandemic yet those participants who were younger felt they were immune from its morbid complications. Conclusions: With paradoxical associations of COVID-19 with cigarette and vape usage, it is important to pay attention to biases in data in favor of educating its users of the increased risk of severe disease.

Evidence-Based Information Which Could Influence Arterial Hypertension Treatment Approach after Publication of SPRINT Trial Results

The article discusses results of secondary analysis of the data obtained in the SPRINT study and published in recent years. Unresolved issues in the tactics of managing patients with arterial hypertension are discussed. One of such issues is choosing an optimum level of blood pressure (BP) for a subgroup of patients with certain characteristics, including elderly and senile patients, patients with chronic kidney disease, and patients with arterial hypertension who continue smoking. The article discusses calculation of a threshold of risk for complications of cardiovascular diseases, at which a maximum advantage of intensified regimens of antihypertensive therapy could be achieved. In addition, the article addresses approaches to selection of antihypertensive drugs in the current conditions. The authors discussed the role of candesartan in the treatment of arterial hypertension, a sartan most studied in a broad range of patients. The issue of a rapid increase in BP without a damage to target organs is addressed; evidence for the role of captopril in such clinical situation is provided.

The needs of pregnant women and their significant others regarding professional smoking cessation support

Introduction Despite the health risks of smoking, some women continue smoking during pregnancy. Professional smoking cessation support (SCS) has shown to be effective in increasing the proportion of women who quit smoking during pregnancy. However, few women actually make use of professional SCS. The aim of this study is to investigate the needs of women and their partners for professional SCS. Methods Semi-structured interviews were held with pregnant women and recent mothers who smoked or quit smoking during pregnancy, and their partners, living in the North of the Netherlands. Recruitment was done via Facebook, LinkedIn, food banks, baby stores and healthcare professionals. The interviews were recorded, transcribed and thematically analyzed. Results 28 interviews were conducted, 23 with pregnant women and recent mothers, and five with partners of the women. The following themes were identified: 1) Understanding women's needs, 2) Responsibility without criticism, and 3) Women and their social network. These themes reflect that women need support from an involved and understanding healthcare professional, who holds women responsible for smoking cessation but refrains from criticism. Women also prefer involvement of their social network in the professional support. Conclusions For tailored support, the guideline for professional SCS may need some adaptations, and women and their partners should be involved in the development of future guidelines. Women prefer healthcare professionals to address smoking cessation in a neutral way and to respect their autonomy in the decision to stop smoking.

Impact of flavors and humectants on waterpipe tobacco smoking topography, subjective effects, toxicant exposure and intentions for continued use

IntroductionThe present study examined how the lack of characterising flavours and low levels of humectants may affect users’ waterpipe tobacco (WT) smoking topography, subjective effects, toxicant exposure and intentions for continued use.Methods89 WT smokers completed four ad libitum smoking sessions (characterising flavor/high humectant (+F+H); characterising flavor/low humectant (+F-H); no characterising flavor/high humectant (-F+H); no characterising flavor/low humectant (-F-H)) in a randomised cross-over design. WT was commercially available; same brand but nicotine levels were not held constant. A subsample (n=50) completed a standardised, 10-puff session preceding ad libitum smoking. Participants completed questionnaires, exhaled carbon monoxide (eCO) testing and provided blood samples for plasma nicotine. Smoking topography was measured throughout the session. Post hoc analyses showed that -F+H and -F-H did not differ significantly in humectant levels. Therefore, these groups were collapsed in analyses (-F-H).ResultsWT smokers reported significantly greater satisfaction, liking, enjoyment and greater intentions for continued use when smoking +F+H compared with other WT products, with -F-H receiving the lowest ratings. Significant differences in topography were observed during standardised and ad libitum sessions, with the -F-H preparation leading to greater total inhaled volume and eCO boost, but lower nicotine boost compared with +F+H (all p<0.05).DiscussionThe findings demonstrate the importance of flavours and humectants on improving WT smoking experience and increasing the likelihood that users will want to initiate and continue smoking. Moreover, it demonstrates that flavours and humectants influence smoking behaviour and toxicant exposure in some unexpected ways that are important for regulatory efforts.

Nicotine: From plants to people

Nicotine is naturally present in many crops, including but not limited to tobacco, eggplant, and tomatoes. Only in the tobacco plant is nicotine present in high enough quantities (~2% of dry weight) to have pharmacological effects. People have recognized the stimulating effects of the smoke created by burning dried tobacco leaves for thousands of years, and cigarette smoking remains the most common form of nicotine uptake from tobacco. Decades of epidemiologic data show that smoking causes a number of serious diseases (including cardiovascular diseases, lung cancer, and chronic obstructive pulmonary disease [COPD]). Undoubtedly, the best way to avoid the harm from smoking is to never start. For current smokers, quitting smoking altogether is the most effective way to reduce the risk of harm and smoking-related disease. Along with other aspects such as taste and ritual, nicotine is one of the reasons people smoke. Nicotine, while addictive and not risk-free, is not the primary cause of smoking-related diseases. Indeed, experts agree that smoking-related diseases are caused primarily by chronic exposure to the harmful constituents that are produced when tobacco is burning. Nevertheless, many people still mistakenly believe that nicotine is a major cause of tobacco-related diseases. While nicotine-containing products should not be used by certain groups of people - such as minors, people with or at risk of heart disease, diabetes, epilepsy, or seizure, pregnant or breast-feeding women or women who think they may be pregnant - delivery of nicotine by less harmful means can support public health goals by encouraging smokers who would otherwise continue smoking to switch to less harmful products. It is, therefore, pivotal to address the biggest misconceptions about nicotine to empower smokers to make informed decisions. In this article, we discuss basic facts about nicotine, its effects on the human body, as well as the risks related to nicotine consumption.

Modifiable risk factors for poor health outcomes in multiple sclerosis: The urgent need for research to maximise smoking cessation success

Tobacco smoking is a well-established risk factor for multiple sclerosis (MS) onset, progression and poor health outcomes in people with MS. Despite smoking being a modifiable risk factor, no research has been undertaken to understand how, or who is best placed, to assess or understand smoking behaviour in people with MS, or how healthcare professionals can best assist people with MS to quit. People with MS may have unique motivators to continue smoking, or unique barriers to smoking cessation, that are not addressed by existing cessation tools. Research is urgently needed in this area if the aim is to maximise health outcomes for all people with MS.

Trends in and Correlates of Use of Roll-Your-Own Cigarettes: A Population Study in England 2008–2017

Introduction Understanding the use of cheaper roll-your-own (RYO) cigarettes may have implications for tobacco tax policy. We examined trends in RYO cigarette use in England between 2008 and 2017, and characterized users’ sociodemographic and smoking profiles. Methods We used data from 211 469 respondents to a survey representative of the adult (≥16 years) population. In current smokers across the entire study period (n = 43 389), we assessed multivariable associations between cigarette type (RYO or factory-made [FM]) and sociodemographic and smoking characteristics. Among current smokers in 2008 and 2017 (n = 7685), we tested interactions between year and cigarette type to assess the stability of each characteristic. Results Between 2008 and 2017, FM cigarette use declined from 15.3% to 9.2% whereas RYO use increased from 6.7% to 8.1%. Greater odds of RYO use were observed among younger, male smokers from lower social grades, who were more addicted and used electronic cigarettes (ORrange = 1.28–1.86, p &lt; .001). Lower odds of RYO use were observed among nondaily smokers, those with high motivation to stop, and higher spending on smoking (ORrange = 0.46–0.89, p ≤ .001). The RYO smoker profile was relatively stable between 2008 and 2017. However, compared with FM use, RYO use increased in younger (p &lt; .001) and female (p = .019) smokers, and there was a relatively smaller decline in the proportion cutting down or trying to quit (p = .004). Conclusion In England, RYO use increased when overall smoking prevalence and FM use decreased. The profile of RYO smokers remained relatively stable, with users typically younger, male, more addicted, deprived, spending less on smoking, and less inclined to quit than FM smokers. Implications This population-based study provides novel insight into recent trends in RYO use in England, providing an up-to-date understanding of the profile of RYO smokers. Without the consistent application of tax across the range of combustible products, smokers who are more dependent are able to capitalize on the lower cost of RYO in order to continue smoking, undermining the potential benefit of taxation on cessation.

Obesity and Cardiovascular Risk After Quitting Smoking: The Latest Evidence

Smoking cessation is one of the most effective ways to reduce cardiovascular risk. However, weight gain and abdominal obesity generally occur after quitting smoking, as a result of nicotine withdrawal. Obesity increases various inflammatory markers, and weight gain after smoking cessation temporarily increases the risk of diabetes and reduces the benefit gained by smoking abstinence. The benefits of smoking cessation may be minimised by obesity in those who have stopped smoking. Pharmacological treatment with medications such as nicotine patches and varenicline is useful to suppress weight gain during smoking cessation. Supporting patients to continue smoking cessation and to gradually decrease their weight will be crucial.

RISK FACTORS FOR RENAL CELL CARCINOMA

Smoking, overweight, obesity, hypertension, occupational exposures to pesticides, specifically to trichloroethylene are considered causal risk factors for sporadic i.e. non-hereditary renal cell cancer (RCC). Some of these factors not only increase the risk of RCC but also affect the survival of patients. For example, in patients with RCC who continue smoking, the risk of dying from other causes is twice as high as in patient who quit smoking. The risk of second cancer is 5 times higher in patients who continue smoking 20 or more cigarettes per day than in non-smokers. The low penetrance polymorphism is an important factor in etiology of sporadic RCC, which contrary to high penetrance mutations is a common event. However, the risk associated with this type of inheritance is quite low. The majority of sporadic RCC have polygenic etiology. They develop as a result of combined effect of large number of low penetrance genetic susceptibility genes (genetic polymorphism). Environmental factors play a decisive role in causation of sporadic RCC. The interplay of exposures to environmental risk factors and genetic susceptibility of exposed individuals is believed to influence the risk of developing sporadic RCC. The studies in molecular epidemiology based on candidate gene approach have shown that polymorphisms of certain genes, for example glutathione-S-transferase family genes, are associated with RCC. The genome wide association studies identified about twenty loci with single nucleotide polymorphism (SNPs) affecting the risk of RCC. However the risk loci so far identified for RCC account for only about 10 % of the familial risk of RCC. The power of largest studies which include many thousands of observations allow to detect 80 % of the major common loci (with minor allele frequency – MAF>0.2) conferring risk ≥1.2. However, for detecting alleles with smaller effects and/or MAF<0.1, more studies with larger sample size are needed. By implication, variants with such profiles probably represent a much larger class of susceptibility loci for RCC and hence a large number of variants remain to be discovered. Future investigation of the genes targeted by the risk SNPs is likely to yield increased insight into biology of RCC and will lead to new approaches for prevention, early detection and treatment.