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The survey assessed changes in tobacco, alcohol and other substance use during the COVID-19 pandemic.
Objectives
The survey was carried out in Moscow and Nizhegorodskaya Oblast in December, 2020 - February, 2021 and included 650 medical organizations’ employees and 344 individuals with harmful alcohol or other substances use.
Methods
The instrument included ASSIST, Kessler-10 and IES-R tests modified for self-reporting about different pandemic periods.
Results
Among medical workers 36.8% smoked last 12 months; during the COVID-19 pandemic 13% maintained usual cigarette smoking level, 2.4% increased smoking during incidence rises. 71.2% drank alcohol last 12 months; during incidence rises 20.4% drank as usual, 15.0% drank less frequently; 2.4% increased frequency of drinking, 1.8% volumes on drinking days, 1.3% frequency of heavy episodic drinking. In harmful substance use group 61.9% smoked last 12 months; during COVID-19 incidence rises 40% kept their usual level of smoking; 13.4% increased their smoking during the first and 8.7% during the second ‘wave’ of the pandemic. 90.1% drank alcohol last 12 months; during incidence rises 49% kept drinking as usual, 20% reduced drinking and 17.3% increased drinking frequency, 21.0% volumes on drinking days, 16.4% heavy episodic drinking frequency. Wastewater-based epidemiology analysis performed in Moscow Oblast location demonstrated significant increase during COVID-19 pandemic, compared to same period 2 years earlier: inhaled nicotine use by average of 40%, ethanol consumption by average of 49%.
Conclusions
Changes in cigarette smoking and alcohol use during the COVID-19 pandemic had significant variation. Increases were more likely to occur during the pandemic ‘waves’ among individual from harmful users’ group.
Whether smoking should be regarded as a risk factor for mental disorders remains unresolved. Prescribed psychotropic drugs can be used as indications for mental disorders. We investigated how smoking was prospectively related to prescription of antipsychotics, mood stabilizers, antidepressants, and anxiolytics.
Methods
Information about smoking, including the Fagerström Test for Nicotine Dependence, and relevant confounders, were obtained from the population-based Young in Norway Study (N = 2602), with four data collection waves between 1992 and 2006. These survey data were linked with information on prescriptions for psychotropic drugs from the comprehensive, nationwide Norwegian Prescription Database from 2007 to 2015.
Results
Daily smoking with high dependence in 2006 at age 28.5 (s.d. = 2.0) was associated with filling prescriptions of antipsychotics (OR, 6.57, 95% CI 2.19–19.70, p = 0.001), mood stabilizers (OR, 7.11, 95% CI 2.51–20.15, p < 0.001) and antidepressants (OR, 1.91, 95% CI 1.13–3.23, p = 0.016) 1–9 years later. Associations remained significant after adjustment for a variety of potential confounders measured before the assessment of smoking, including sociodemographic background, conduct problems, cannabis use, mental distress, and previous prescriptions for psychotropic medications. The association between smoking and prescription of anxiolytics was weaker and more unstable.
Conclusions
In this study of young adults, daily smoking with high dependence was associated with later prescriptions of antipsychotics, mood stabilizers and antidepressants, indicating smoking as a risk factor for mental disorders treated with these drugs.
The detrimental systemic effects of cigarette smoking are well established. Though less pronounced in the field of otology, they are proposed to contribute to the global burden of unaddressed hearing loss. Recently, in efforts to stop smoking, individuals have used electronic cigarettes of which the long-term safety data are largely unknown. This study aimed to conduct a systematic review of cigarette smoking and electronic cigarette effects in the field of otology.
Method
Relevant articles were identified by a National Institute for Health and Care Excellence healthcare database literature search and by scanning the references of relevant articles and reviews.
Results
A total of 473 articles were identified, with 43 articles included in the review after trials were excluded.
Conclusion
Cigarette smoking is associated with recurrent otitis media, otitis media with effusion and sensorineural hearing loss in children exposed to second-hand smoke. In adults, it is associated with active and aggressive chronic suppurative otitis media, worse tympanoplasty success rates, increased post-operative complications and sensorineural hearing loss that is more pronounced in the long term and at high frequencies. The effects of e-cigarettes in otology are largely unknown.
The link between schizophrenia and cigarette smoking has been well established through observational studies. However, the cause–effect relationship remains unclear.
Aims
We conducted Mendelian randomisation analyses to assess any causal relationship between genetic variants related to four smoking-related traits and the risk of schizophrenia.
Method
We performed a two-sample Mendelian randomisation using summary statistics from genome-wide association studies (GWAS) of smoking-related traits and schizophrenia (7711 cases, 18 327 controls) in East Asian populations. Single nucleotide polymorphisms (SNPs) correlated with smoking behaviours (smoking initiation, smoking cessation, age at smoking initiation and quantity of smoking) were investigated in relation to schizophrenia using the inverse-variance weighted (IVW) method. Further sensitivity analyses, including Mendelian randomisation-Egger (MR-Egger), weighted median estimates and leave-one-out analysis, were used to test the consistency of the results.
Results
The associated SNPs for the four smoking behaviours were not significantly associated with schizophrenia status. Pleiotropy did not inappropriately affect the results.
Conclusions
Cigarette smoking is a complex behaviour in people with schizophrenia. Understanding factors underlying the observed association remains important; however, our findings do not support a causal role of smoking in influencing risk of schizophrenia.
Cigarette smoking is a great health problem and prevalent among subjects with schizophrenia. Our aim was to investigate the prevalence and associations of cigarette smoking in patients with long-term schizophrenia.
Methods
Seven hundred and sixty schizophrenia patients were interviewed and their cigarette smoking was recorded.
Results
Smoking was more prevalent men than in women patients. In logistic regression analysis, male gender, duration of illness (DUI) from 10 to 19 years, being divorced or separated, lower education and high daily doses of neuroleptics (DDN) associated significantly with regular smoking. Heavy smoking associated, in men, with hospital treatment.
Conclusions
In schizophrenia patients, smoking is associated with long DUI, high DDN and institutional care. Interventions for cessation and/or reduction of cigarette smoking should be a part of the treatment for patients with schizophrenia.
Cigarette smoking is more prevalent among individuals with psychiatric disorders than the general population. Obsessive-compulsive disorder (OCD) may be an intriguing exception, although no recent study has investigated this hypothesis in OCD patients. Moreover, it is unknown whether reduced smoking rates are present in unaffected first-degree relatives of OCD patients.
Methods:
We assessed smoking prevalence in adults with OCD and unaffected parents of youth with OCD (PYOCD). To this end, 113 adults with OCD completed online questionnaires assessing symptom severity and smoking status. Smoking status was obtained from an independent sample of 210 PYOCD assessed for psychiatric diagnoses.
Results:
Smoking prevalence rates in adults with OCD (13.3%; n = 15) and PYOCD (9.5%; n = 20) samples were significantly lower than those found in representative samples of the general population (19–24%, all P < .001) and Axis I disorders (36–64%; all P < .001). There were no smokers in the adult OCD subset without clinically significant depressive symptoms (n = 54).
Conclusion:
Low prevalence of smoking in OCD may be familial and unique among psychiatric disorders, and might represent a possible state-independent OCD marker. Hypotheses concerning the uncharacteristically low prevalence rates are discussed with relation to OCD phenomenology and pathophysiology.
Combined smoking and heavy drinking is a significant health burden. Varenicline, an efficacious tobacco pharmacotherapy that also shows promise for drinking, has yielded mixed results among heavy-drinking smokers. This pilot study investigated integrated tobacco and alcohol counselling plus varenicline for this vulnerable group.
Design
Twelve-week parallel, randomized controlled pilot trial of two behavioural interventions in combination with open-label varenicline. Participants were randomized using computer-generated tables, stratified by sex.
Setting
Outpatient academic medical centre research clinic.
Participants
Volunteers who reported smoking and heavy drinking and sought tobacco or alcohol treatment (N = 26).
Intervention
(1) Integrated tobacco + alcohol counselling (INT; n = 13) or (2) counselling focused on their presenting concern (i.e., tobacco or alcohol) (SINGLE; n = 13), plus varenicline (2 mg) for 12 weeks.
Main outcomes
Feasibility/acceptability, smoking quit rates and heavy drinking.
Results
INT feasibility/acceptability was high among men but not women. More participants quit smoking in INT than SINGLE. This outcome was only in men, not significant, but had a medium effect size. Both conditions yielded significant drinking reductions.
Conclusion
Integrated tobacco and alcohol behavioural counselling plus varenicline may be feasible and promote smoking cessation among men who smoke and drink heavily, but a larger sample is needed to replicate this finding.
Introduction: Tobacco smoking is a priority public health concern, and a leading cause of death and disability globally. While the smoking prevalence in Canada is approximately 13-18%, the proportion of smokers among emergency department (ED) patients has been found to be significantly higher. This disparity primes the emergency department as a critical environment to provide smoking cessation counselling and support. Methods: A verbal questionnaire was administered to adult patients (18+) presenting to Royal University, Saskatoon City, and St. Paul's Hospital ED's. Patients were excluded if they were underage, too ill, or physically/mentally unable to complete the questionnaire independently. Patients’ smoking habits were also correlated with Fagerstrom tobacco dependence scores, chief complaints, Canadian Triage Acuity Scale (CTAS) scores, and willingness to partake in ED specific cessation counselling. Data were analyzed using IBM SPSS software to determine smoking prevalence and compared to Statistics Canada data using chi-square tests. Results: In total, 1190 eligible patients were approached, and 1078 completed the questionnaire. Adult Saskatoon ED patients demonstrated a cigarette smoking prevalence of 19.6%, which is significantly higher than the general adult Saskatchewan public at 15.1% (p < 0.0001). Comparing smoking and non-smoking cohorts, there are no significant differences in CTAS scores (p = 0.60). Of the proposed cessation interventions, ED cessation counselling was most popular among patients (62.4%), followed by receiving a pamphlet (56.2%), and being contacted by a smokers’ quit line (49.5%). Out of the smoking cohort, 51.4% indicated they want to quit smoking, and would be willing to partake in ED-specific cessation counselling, if available. Additionally, 88.1% of current smokers started smoking when they were less than 19 years old. Conclusion: The higher smoking prevalence demonstrated in ED patients highlights the need for a targeted intervention program that is feasible for the fast-paced environment. Quit attempts have been demonstrated to be more efficacious with repeated interventions, which could be achieved by training ED staff to conduct brief motivational interviews and faxing referrals to a smokers' quit line for follow-up. Furthermore, pediatric ED's could be a valuable location for cigarette smoking screening, as the majority began smoking in their adolescence.
The aim of this research was to examine effects of cigarette smoking on depression and anxiety among children and adolescents (youth) with early onset schizophrenia and/or psychosis. Data were obtained from the national evaluation of the Comprehensive Community Mental Health Services for Children and Their Families Program (CMHS Program). Cubic mixed models were used to analyze the longitudinal data with seven waves (over 3 years). Results showed that 29% youth (N = 117, mean age at intake = 13.9) smoked cigarettes in any prior 6-month period. Cigarette users had high levels of initial and sustained depression and anxiety throughout the seven waves. Predicted depression and anxiety scores of cigarette users and non-users showed that cigarette users had higher but more stable states of anxiety and depression. Results suggested that youth with EOS might use cigarettes for mood regulation. Implications of results for psychologists and counsellors in schools are discussed.
Obsessive compulsive disorder (OCD) showed a lower prevalence of cigarette smoking compared to other psychiatric disorders in previous and recent reports. We assessed the prevalence and clinical correlates of the phenomenon in an international sample of 504 OCD patients recruited through the International College of Obsessive Compulsive Spectrum Disorders (ICOCS) network.
Cigarette smoking showed a cross-sectional prevalence of 24.4% in the sample, with significant differences across countries. Females were more represented among smoking patients (16% vs 7%; p<.001). Patients with comorbid Tourette’s syndrome (p<.05) and tic disorder (p<.05) were also more represented among smoking subjects. Former smokers reported a higher number of suicide attempts (p<.05).
We found a lower cross-sectional prevalence of smoking among OCD patients compared to findings from previous studies in patients with other psychiatric disorders but higher compared to previous and more recent OCD studies. Geographic differences were found and smoking was more common in females and comorbid Tourette’s syndrome/tic disorder.
Background: Few studies examining the genetic architecture of cigarette smoking have focused on adolescents or examined developmental changes in additive genetic, shared environment, and unique environmental influences on liability to initiate cigarette smoking and quantity of cigarettes smoked. The aim of this study was to add to the literature on liability to initiate and use cigarettes during adolescence using a nationally representative sample. Method: Data for this study came from adolescent and young adult twin pairs (aged 14–33 years) from the National Longitudinal Study of Adolescent to Adult Health. We ran a series of developmental causal–contingent–common pathway models to examine whether additive genetic, shared, and unique environmental influences on liability to the initiation of cigarette use are shared with those on smoking quantity, and whether their contributions change across development. Results: We found evidence for a developmental shift in genetic and shared environmental contributions to cigarette use. Early in adolescence, genetic and environmental influences work independently on liability to cigarette smoking initiation and quantity of cigarettes smoked, but liability to these behaviors becomes correlated as individuals age into young adulthood. Conclusions: These findings provide insight into the causal processes underlying the liability to smoke cigarettes. With age, there is greater overlap in the genetic and environmental factors that influence the initiation of cigarette smoking and quantity of cigarettes smoked.
Genetic and environmental factors contribute to the risk of depression and several studies have noted an association between tobacco smoke and depression. Cadmium is a neurotoxicant and the main source of non-occupational exposure is tobacco smoke.
Method.
We conducted a cross-sectional analysis of data from 2892 young adult (aged 20–39 years) participants of the National Health and Nutrition Examination Survey (NHANES) 2007–2010. Multivariate logistic regressions, adjusted for age, sex, race/ethnicity, education, poverty income ratio (PIR), obesity, alcohol intake, blood lead (BPb) and smoking status, were used to analyze the association between blood cadmium (BCd) and depressive symptoms, as determined by the score on the nine-item Patient Health Questionnaire (PHQ-9).
Results.
Individuals in the highest BCd quartile had higher odds of having depressive symptoms [odds ratio (OR) 2.79, 95% confidence interval (CI) 1.84–4.25] than those in the lowest BCd quartile. Smoking status, but not BPb, was statistically significantly associated with depressive symptoms. Stratification by smoking status found that BCd was significantly associated with depressive symptoms in both non-smokers (OR 2.91, 95% CI 1.12–7.58) and current smokers (OR 2.69, 95% CI 1.13–6.42).
Conclusions.
This is the first study to report an association between BCd levels and depressive symptoms using a nationally representative sample. The association of cadmium with depressive symptoms was independent of smoking status. If this association is further confirmed, the continued efforts at reducing cadmium exposures, mainly through tobacco smoking cessation programs, may decrease the incidence of depression.
Objective: A case–control study was performed in Belgrade in order to investigate the association between Parkinson's disease (PD) and smoking, coffee and alcohol consumption.
Methods: During the period 2001–2005, 110 new PD cases and 220 hospital controls were interviewed. Cases and controls were matched by sex, age and place of residence (urban/rural). For the analysis of data conditional univariate and multivariate logistic regression methods were used.
Results: With PD were associated, independently from each other, current smoking [odds ratio (OR) = 0.44; 95% confidence interval (CI) = 0.23–0.82], alcohol consumption (OR = 4.78; 95% CI = 2.67–8.55) and coffee consumption (OR = 2.54; 95% CI = 1.36–4.75). In ever smokers the risk for PD significantly decreased with the increasing number of cigarettes smoked and with increasing duration of smoking. The risk for PD significantly increased with the increasing quantity of alcohol consumption. PD risk was significantly higher in subjects whose average daily consumption of coffee was 1 and 2–3 cups, and it was lower (but not significantly) in those whose daily coffee consumption was 4+ cups. Cases and controls did not differ in duration of alcohol and coffee consumption. The results of multivariate analyses did not substantially change after adjustment on family history positive on PD.
Conclusion: The findings of this study support the hypotheses of inverse association of smoking with PD, but an inverse association with coffee was not confirmed. PD was found to be positively associated with coffee and alcohol consumption.
Both peer groups and genetics have been associated with adolescent smoking behavior. Recently, Loehlin (Loehlin, J. C. (2010). Is there an active gene–environment correlation in adolescent drinking behavior? Behavior Genetics, 40, 447–451) reported that twin differences in alcohol use were associated with differences in the number of common friends. Twins with more common friends were more similar in drinking, but only for dizygotic pairs. Using the same sample as Loehlin's (the National Merit twins), we replicated all of these findings for a composite cigarette smoking measure and for smoking initiation, but not persistence. The pattern of results is most consistent with homophily, or the tendency to associate with individuals that are like oneself. If peer influence occurs in the presence of homophily, then active genotype–environment correlation will be induced.
We examined whether externalizing problem behaviors (hyperactivity–impulsivity, aggressiveness, and inattention) predict illicit drug use independently, or whether their associations with drug use are mediated through cigarette smoking. We used a prospective longitudinal design within the FinnTwin12-17 study among Finnish adolescents with baseline at age 12 and follow-up surveys at ages 14 and 17. Path models were conducted with Mplus and included 1992 boys and 2123 girls. The outcome was self-reported ever use of cannabis or other illicit drugs at age 17. The predictors were: externalizing behaviors (hyperactivity–impulsivity, aggressiveness, and inattention) assessed by teachers and parents (age 12) and self-reported cigarette smoking (age 14). The findings differed across behavior studied. The association of hyperactivity–impulsivity with drug use was mostly mediated through earlier cigarette smoking. Concerning aggressiveness and inattention, the results were different among girls than boys. Among girls no significant mediation occurred, whereas among boys more consistent evidence on mediation was seen. Consistently in all models, the direct association of early cigarette smoking on drug use was strong and highly significant. We conclude that the associations of externalizing problem behaviors with illicit drug use are partially mediated through cigarette smoking. Although interventions targeting externalizing problem behaviors may protect adolescents from early onset smoking and subsequently experimenting with drugs, interventions to prevent cigarette smoking initiation are also important in reducing risk of later drug use.
Introduction: Cessation efforts and maintained abstinence in smokers have been associated with social support from others (i.e., ‘support persons’). Characteristics of support persons appear to affect the amount and quality of support provided to adults who smoke. In the present investigation, the relationship between support person characteristics and perceived quality and quantity of smoking-specific support provided was examined. Method: College students (N = 244) were asked to identify an adult who smokes about whom they were concerned. Participants reported demographic and smoking-related information about themselves and their identified smoker and perceptions of positive and negative smoking-specific social support provided. Results: Results indicated significant differences in smoking status (p < .05), such that current and ex-smokers reported providing more negative support than never smokers. Additionally, participants romantically involved with their smokers reported providing more positive (p < .05) support than those in other relationships. Discussion: Findings suggest the importance of relationship in the perception of support provided during the cessation process and highlight the need for future research in this area.
Puumala hantavirus (PUUV) is apparently transmitted to humans by inhalation of aerosolized secretions of carrier rodents (bank voles). The means of transmission and the associated risk factors are poorly defined. An epidemiological study during the peak of an epidemic season in Finland was conducted based on 282 acute clinical PUUV infections and 204 controls without PUUV infection or immunity. The main risk factors adjusted by age, sex and living environment were cigarette smoking [odds ratio (OR) 3·6, 95% confidence interval (CI) 2·1–5·9, P<0·0001] and buildings with holes allowing rodents to enter (OR 3·3, 95% CI 2·0–5·6); these results were similar in two subsets. Further, use of rodent traps (OR3·5, 95% CI 2·2–5·7) and handling firewood (OR 2·7, 95% CI 1·6–4·4) were associated with a risk. The risk attributed to smoking also remained high using simulated population controls with average smoking habits. The results suggest that hantavirus transmission occurs by inhalation mainly indoors and is dependent on the condition of the respiratory tract.
Both cigarette smoking and high fat meals induce oxidative stress, which is associated with the pathogenesis of numerous diseases. We compared blood antioxidant status, oxidative stress biomarkers and TAG in twenty smokers and twenty non-smokers, matched for age and physical activity, in response to a high fat test meal standardized to body mass. Blood samples were collected before feeding (resting and fasted) and at 1, 2, 4 and 6 h post feeding and analysed for antioxidant capacity (trolox equivalent antioxidant capacity; TEAC), xanthine oxidase activity (XO), hydrogen peroxide (H2O2), malondialdehyde (MDA) and TAG. Smoking status (P < 0·001) and time (P ≤ 0·01) effects were noted for all variables, with smokers demonstrating higher values compared with non-smokers for all variables except for TEAC, for which values were lower for smokers. XO, H2O2, MDA and TAG increased following feeding with a peak response at the 4 h post feeding time point, with the opposite response occurring for TEAC. Although no interaction effects were noted (P>0·05), contrasts revealed greater values in smokers compared with non-smokers for XO, H2O2, MDA and TAG, and lower values for TEAC at times from 1–6 h post feeding (P ≤ 0·05). Our findings indicate that young cigarette smokers experience an exaggerated oxidative stress response to feeding, as well as hypertriacylglycerolaemia, as compared with non-smokers. These data provide insight into another possible mechanism associating cigarette smoking with ill health and disease.
Smoking initiation and persistence are clearly associated with factors commonly thought to be environmental in origin, including socio-economic status. However, twin models that incorporate gene–environment correlation and gene×environment interaction have not been applied to elucidate the genetic or environmental role that socio-economic status plays in smoking initiation and nicotine dependence.
Method
Twin structural equation modelling was used to examine gene–environment correlation and gene×environment interaction of one index of socio-economic status, educational attainment, with smoking initiation and nicotine dependence among 5119 monozygotic and 4295 dizygotic male–male Vietnam-era twins from the Vietnam Era Twin Registry, a national registry of twin pairs who served in the military during the Vietnam era.
Results
Educational attainment correlated significantly with smoking initiation (r=−0.27, p<0.001). Additive genetic (p=0.011), shared environment (p=0.002) and unique environment (p=0.027) components contributed to the correlation between educational attainment and smoking initiation. Educational attainment also significantly moderated the variance in smoking initiation (p<0.001), suggestive of gene×environment interaction, although the interaction with the additive genetic, shared environmental and unique environmental components could not be resolved due to multicollinearity. In contrast, educational attainment neither correlated with nor moderated nicotine dependence, once smokers had initiated.
Conclusions
Our study suggests that educational attainment is associated with smoking initiation, in part due to gene–environment correlation and gene×environment interaction. However, once smoking initiation is taken into account, there are no effects – be they gene–environment correlation or gene×environmental interaction – of educational attainment on nicotine dependence.
This study examined the associations between cigarette smoking and suicidal ideation and suicide attempts, both before and after control for potentially confounding using fixed effects regression models.
Method
Data were gathered during the Christchurch Health and Development Study, a 25-year longitudinal study of a birth cohort of New Zealand children (635 males, 630 females). The analysis was based on a sample of 1041 participants with available data on cigarette smoking and suicidal behaviour from ages 16 to 25 years. The main outcome measures were suicidal ideation and suicide attempts, ages 16–18, 18–21, and 21–25.
Results
There were significant bivariate associations between the frequency of cigarette smoking and both suicidal ideation and suicide attempts. Cohort members who smoked 20 or more cigarettes per day had odds of suicidal ideation that were 3.39 times (95% CI 2.06–5.59) those of non-smokers, and odds of suicide attempt that were 4.39 (95% CI 2.18–8.85) times those of non-smokers. Control for non-observed fixed confounding factors reduced the association between cigarette smoking and suicidal ideation and suicide attempts to statistical non-significance. After adjustment, those smoking more than 20 cigarettes per day had odds of suicidal ideation that were 1.00 times (95% CI 0.46–2.18) those of non-smokers, and odds of suicide attempt that were 1.84 (95% CI 0.81–4.18) times those of non-smokers.
Conclusions
The findings suggest that the associations between frequency of cigarette smoking and suicidal behaviour may largely be explained by the non-observed background factors and life circumstances that are associated with both cigarette smoking and suicidal behaviour.