Determinants of Incident Atherosclerotic Cardiovascular Disease Events Among Those With Absent Coronary Artery Calcium: Multi-Ethnic Study of Atherosclerosis

Background : The 2018 American Heart Association/ American College of Cardiology Multisociety (AHA/ACC/MS) cholesterol guideline states that statin therapy may be withheld or delayed among intermediate risk individuals in the absence of coronary artery calcium (CAC=0). We evaluated whether traditional cardiovascular risk factors are associated with incident atherosclerotic cardiovascular disease (ASCVD) events among individuals with CAC=0 over long−term follow−up. Methods : We included participants with CAC=0 at baseline from the Multi-Ethnic Study of Atherosclerosis (MESA), a prospective cohort study of individuals free of clinical ASCVD at baseline. We used multivariable-adjusted Cox proportional hazards models to study the association between cardiovascular risk factors [cigarette smoking, diabetes mellitus, hypertension, preventive medication use (aspirin and statin), family history of premature ASCVD, chronic kidney disease, waist circumference, lipid and inflammatory markers] and adjudicated incident ASCVD outcomes. Results : We studied 3,416 individuals (mean (SD) age 58 (9) years; 63% were female, 33% White, 31% Black, 12% Chinese-American, and 24% Hispanic. Over a median follow-up of 16 years, there were 189 ASCVD events (composite of CHD and stroke) of which 91 were CHD, 88 were stroke, and 10 were both CHD and stroke events. The unadjusted event rates of ASCVD were ≤5 per 1000−person−years among individuals with CAC=0 for most risk factors with the exception of current cigarette smoking (7.3), diabetes mellitus (8.9), hypertension (5.4), and chronic kidney disease (6.8). After multivariable-adjustment, risk factors that were significantly associated with ASCVD: hazard ratio (HR) 95% confidence interval (CI) included current cigarette smoking: 2.12 (1.32,3.42), diabetes mellitus: 1.68 (1.01,2.80), and hypertension: 1.57 (1.06,2.33). Conclusions : Current cigarette smoking, diabetes mellitus, and hypertension are independently associated with incident ASCVD over 16-year follow-up among those with CAC=0. Family history of premature ASCVD may be associated with ASCVD risk among women only.

Incidence and Risk Factors Associated with Latent Tuberculosis Infection and Pulmonary Tuberculosis among People Deprived of Liberty in Colombian Prisons

People deprived of liberty (PDL) are at high risk of acquiring Mycobacterium tuberculosis infection (latent tuberculosis infection [LTBI]) and progressing to active tuberculosis (TB). We sought to determine the incidence rates and factors associated with LTBI and active TB in Colombian prisons. Using information of four cohort studies, we included 240 PDL with two-step tuberculin skin test (TST) negative and followed them to evaluate TST conversion, as well as, 2,134 PDL that were investigated to rule out active TB (1,305 among people with lower respiratory symptoms of any duration, and 829 among people without respiratory symptoms and screened for LTBI). Latent tuberculosis infection incidence rate was 2,402.88 cases per 100,000 person-months (95% CI 1,364.62–4,231.10) in PDL with short incarceration at baseline, and 419.66 cases per 100,000 person-months (95% CI 225.80–779.95) in individuals with long incarceration at baseline (who were enrolled for the follow after at least 1 year of incarceration). The TB incidence rate among PDL with lower respiratory symptoms was 146.53 cases/100,000 person-months, and among PDL without respiratory symptoms screened for LTBI the incidence rate was 19.49 cases/100,000 person-months. History of Bacillus Calmette-Guerin vaccination decreased the risk of acquiring LTBI among PDL who were recently incarcerated. Female sex, smoked drugs, and current cigarette smoking were associated with an increased risk of developing active TB. This study shows that PDL have high risk for LTBI and active TB. It is important to perform LTBI testing at admission to prison, as well as regular follow-up to control TB in prisons.

Initiation or cessation: what keeps the prevalence of smoking higher in Quebec than in the rest of Canada?

Introduction We compared smoking initiation and cessation in Quebec versus the rest of Canada as possible underpinnings of the continued higher cigarette smoking prevalence in Quebec. Methods Data were drawn from the Canadian Community Health Survey (CCHS). We compared average and sex-stratified prevalence estimates of (1) current cigarette smoking in persons aged 15 years and older; (2) past-year initiation of cigarette smoking in those aged 12 to 17 and 18 to 24 years; and (3) past-year cessation in adults aged 25 years and older in Quebec versus the other nine Canadian provinces in each two-year CCHS cycle from 2007/08 to 2017/18. Results The prevalence of current smoking decreased from 25% to 18% among adults aged 15 years and older in Quebec from 2007/08 to 2017/18, and from 22% to 16% in the rest of Canada. Initiation among those aged 12 to 17 years decreased from 9% to 5% in Quebec, and from 7% to 3% in the rest of Canada. Neither initiation among people aged 18 to 24 (at 6% and 7%, respectively) nor cessation among adults aged 25 and older (approximately 8%) changed over time in Quebec or in the rest of Canada. In each two-year CCHS cycle, past-year initiation among those 12 to 17 years of age was consistently higher in Quebec than in the rest of Canada, but there were no substantial or sustained differences in initiation among people aged 18 to 24 or in past-year cessation. Findings were similar when stratified by sex. Conclusion Higher levels of smoking initiation among youth aged 12 to 17 years could be a proximal underpinning of the continuing higher prevalence of smoking in Quebec versus the rest of Canada.

Tobacco use among School-going Adolescents in Comoros: A Secondary Analysis of the 2015 Comoros Global Youth Tobacco Survey.

BackgroundTobacco use among adolescents has long term adverse health consequences, especially during adulthood. Currently, little is known about tobacco use behaviour among adolescents in Comoros. Our study aims to estimate the prevalence and identify key factors associated with tobacco use among adolescents in Comoros using the 2015 Comoros Global Youth Tobacco Survey data.MethodsNational cross-sectional survey data of 2,810 eligible school-going adolescents aged between 11-17 years were analysed. Complex sample logistic regression analyses to determine the correlates of current cigarette smoking and current use of non-cigarette tobacco products.ResultsThe overall prevalence of current cigarette smoking was 14.3% [males (18.5%), females (9.9%)]. The prevalence of current use of non-cigarette tobacco products was 5.8% [males (6.7%), females (4.9%)]. Being male (AOR=2.23;95%CI:1.38-3.59), exposure secondhand smoke within (AOR=3.869;95%CI:2.835-5.280)) and outside their home (AOR= 1.514; 95%CI: 1.100-2.084) and exposure to tobacco industry promotion (AOR=2.986; 95%CI:2.246-3.969) were predictors of current tobacco use among adolescents. Similarly, Exposure to tobacco industry promotion (AOR=.2.669;95%CI:1.610-4.425) were associated with non-cigarette tobacco use. Adolescents exposed to anti-smoking education in schools were less likely to use non-cigarette tobacco (AOR=0.523;95% CI:0.311-0.881) than those not exposed to anti-smoking education in schools.ConclusionOne in seven school-going adolescents smoke cigarettes, and approximately one in 20 school-going adolescents use non-cigarette tobacco products in Comoros. Exposure to secondhand smoke within and outside the home and exposure to tobacco industry promotion were associated with tobacco use in school-going adolescents in Comoros. Our findings suggest the need for adolescent-friendly gender-sensitive tobacco interventions, including strengthening existing tobacco control laws to prevent and reduce tobacco use among school-going adolescents in Comoros.

The Persistent Association Between Exposure to Intimate Partner Physical Violence and Current Cigarette Smoking Among Women in Papua New Guinea: A Modified Poisson Regression Analysis

Background: Intimate partner physical violence (IPPV) is a preventable public health threat associated with health deteriorating lifestyles such as cigarette smoking. However, limited research has focused on the association between IPPV and cigarette smoking among women in unions in low-and middle-income countries like Papua New Guinea (PNG). The aim of this study was to examine the association between IPPV and current cigarette smoking using a nationally representative sample. Methods: We utilized 2016-2018 PNG Demographic and Health Survey data of 9,943 women aged 15-49 years who were in intimate unions. We estimated the direct risk of smoking cigarette using modified Poisson regression models with a robust variance relative risk and 95% confidence intervals (CI) of cigarette smoking. Results: Among the total participants, the prevalence of IPPV was 52.4% and smoking cigarette in the last 24 hours was 25.1%. The modified Poisson regression results indicated a robust and persistent association between IPPV and cigarette smoking among women in unions both in the absence and presence of covariates. The risk of smoking cigarette was significantly elevated among those who reported a history of IPPV relative to their counterparts with no physical violence history (IRR: 1.35, 95%CI: 1.20-1.52) in the absence of covariates. After controlling for demographic, social and economic variables, the association between IPPV and cigarette smoking persisted (IRR: 1.24, 95%CI: 1.08-1.41). Conclusions: The present study provides strong evidence to indicate a robust and persistent association between IPPV and current cigarette smoking among women in unions. Interventions aimed at addressing IPPV among women in unions in PNG to reduce the increased risk of cigarette smoking are needed.

Complete Home Smoking Ban Survey Analysis: An Opportunity to Improve Health Equity Among Sexual Minority Adults in California, USA

Introduction: Increasing the proportion of adults living in smoke-free homes is a US Healthy People 2020 objective. Complete home smoking bans are associated with higher odds of smoking cessation attempts and cessation duration. Sexual minority adults have disproportionality higher rates of smoking. This study investigates correlates of having a complete home smoking ban among sexual minority adults in California. Methods: Secondary data analyses of the California Behavioral Risk Factor Surveillance System (CA BRFSS), 2014-2016. The CA BRFSS telephone survey of adults was conducted in English and Spanish and used random digit dial for landline and cell numbers. Weighted descriptive, bivariate, and multivariable logistic regression analyses were stratified by sexual orientation and biological sex.Results: Sexual minority adults in California had a lower prevalence of complete home smoking bans (Female 76.2%; Male 75.7%), higher prevalence of current cigarette smoking (Female 23.3%; Male 17.4%) and of e-cigarette use (Female 5.8%; Male 6.4%) than their straight counterparts. Sexual minorities that currently smoke “everyday” (Female AOR 0.26, 95% CI 0.11-0.63; Male AOR 0.24, 95% CI 0.01-0.56) or “somedays” (Female AOR 0.28, 95% CI 0.090.90) had lower adjusted odds of having a complete home smoking compared to those who “never smoked”. Conclusions: Currently smoking everyday was the strongest predictor of not having a complete home smoking ban among sexual minority adults. Focused efforts to increase prevalence of complete home smoking bans should address smoking status to improve health equity among sexual minority adults.

Questioning the sex-specific differences in the association of smoking on the survival rate of hospitalized COVID-19 patients

Introduction In the absence of a universally accepted association between smoking and COVID-19 health outcomes, we investigated this relationship in a representative cohort from one of the world’s highest tobacco consuming regions. This is the first report from the Middle East and North Africa that tackles specifically the association of smoking and COVID-19 mortality while demonstrating a novel sex-discrepancy in the survival rates among patients. Methods Clinical data for 743 hospitalized COVID-19 patients was retrospectively collected from the leading centre for COVID-19 testing and treatment in Lebanon. Logistic regression, Kaplan-Meier survival curves and Cox proportional hazards model adjusted for age and stratified by sex were used to assess the association between the current cigarette smoking status of patients and COVID-19 outcomes. Results In addition to the high smoking prevalence among our hospitalized COVID-19 patients (42.3%), enrolled smokers tended to have higher reported ICU admissions (28.3% vs 16.6%, p<0.001), longer length of stay in the hospital (12.0 ± 7.8 vs 10.8 days, p<0.001) and higher death incidences as compared to non-smokers (60.5% vs 39.5%, p<0.001). Smokers had an elevated odds ratio for death (OR = 2.3, p<0.001) and for ICU admission (OR = 2.0, p<0.001) which remained significant in a multivariate regression model. Once adjusted for age and stratified by sex, our data revealed that current smoking status reduces survival rate in male patients ([HR] = 1.9 [95% (CI), 1.029–3.616]; p = 0.041) but it does not affect survival outcomes among hospitalized female patients([HR] = 0.79 [95% CI = 0.374–1.689]; p = 0.551). Conclusion A high smoking prevalence was detected in our hospitalized COVID-19 cohort combined with worse prognosis and higher mortality rate in smoking patients. Our study was the first to highlight potential sex-specific consequences for smoking on COVID-19 outcomes that might further explain the higher vulnerability to death from this disease among men.

The Long-term Effectiveness of a Community-based Lifestyle Intervention on Tobacco-related Habits in Adolescent Boys and Girls: Tehran Lipid and Glucose Study

Background: To assess the long-term effectiveness of a community-based intervention on cigarette, passive, and hookah smoking in adolescent boys and girls. Methods: 1159 adolescents who participated in the Tehran Lipid and Glucose Study (TLGS) between 2001 and 2004 were followed for 12 years (every-three-year follow-ups). Participants in the intervention area received lifestyle interventions in the settings of family, schools, and community. After excluding those with missing baseline parental data (n=66), complete parental data of 1093 adolescents was used for cluster analysis, and families were classified as low- and high-risk. Afterward, 296 individuals who did not complete intervention/follow-ups were excluded. The GEE analysis was performed on 797 adolescents (369 boys) to assess the intervention effect on tobacco-related habits; 605 and 192 resided in the control and intervention area, respectively.Results: Mean age of adolescents was 15.21±1.95 years at baseline. Adolescents living in high-risk families were more at risk of cigarette, passive, and hookah smoking. The intervention decreased the odds of cigarette and passive smoking by 38% and 57%, respectively. The intervention was not successful in reducing the risk of hookah smoking in adolescents. After sex-specific analysis, the intervention reduced the risk of current cigarette smoking by 40% only in boys and passive smoking in both sexes.Conclusions: Targeting lifestyle behaviors in adolescents and their families in a community setting reduces cigarette smoking in school-aged boys and protects both sexes from secondhand smoke; findings that could be valuable for designing future health promotion interventions focusing on adolescents smoking.Trial registration: This study is registered at Iran Registry for Clinical Trials (IRCT), a WHO primary registry (http://irct.ir). The registry date is 29/10/2008; (IRCTID: IRCT138705301058N1).

Self-reported history of intensity of smoking is associated with risk factors for suicide among high school students

Objective To examine the relationship between current cigarette smoking patterns and three established risk factors for suicide using nationally representative data of high school students in the United States. Methods We analyzed cross-sectional data from the national Youth Risk Behavior Surveillance Survey (YRBSS)–United States, 2017. Multivariable, logistic regressions examined the association between 3 cigarette smoking behaviors [i.e., past 30-day cigarette (n = 13,731), frequent (n = 1,093) and heavy (n = 880) smoking] and 3 risk factors for suicidal outcomes [feeling sad or hopeless, suicidal ideation, suicide plan] assessed over the previous year. Results Among high school cigarette smokers, smoking 11 or more cigarettes per day (i.e., heavy smoking) was associated with 3.43 (95% CI: 1.69, 6.94) greater odds of reporting feeling sad or hopeless, 2.97 (95% CI: 1.60, 5.51) greater odds of reporting suicidal ideations, and 2.11 (95% CI: 1.34, 3.32) greater odds of reporting having ever planned a suicide attempt, controlling for covariates. Conclusions Our study shows that it is not simply cigarette smoking, but heavy cigarette smoking that is a risk factor for suicidal outcomes among adolescents. Public health implications A comprehensive plan is needed to accommodate heavy adolescent smokers who are at increased suicidal risk.