Genetic insights into smoking behaviours in 10,558 men of African ancestry from continental Africa and the UK

Smoking is a leading risk factor for many of the top ten causes of death worldwide. Of the 1 billion smokers globally, 80% live in low- and middle-income countries, where the number of deaths due to tobacco use is expected to double in the next decade according to the World Health Organization. Genetic studies have helped to identify biological pathways for smoking behaviours, but have mostly focussed on individuals of European ancestry or living in either North America or Europe.Here we present a genome-wide association study of two smoking behaviour traits in 10,558 men of African ancestry living in five African countries and the UK. Eight independent variants were associated with either smoking initiation or cessation at p-value < 5 × 10−6. Of these, four were monomorphic or rare in European populations. Gene prioritization strategy highlighted five genes, including SEMA6D, previously described as associated with several smoking behaviour traits. These results confirm the importance of genetic epidemiological studies in underrepresented populations.

Exploring stakeholder views on intervening in hospital around childhood secondhand smoke exposure (Precedent): a protocol for a qualitative study

IntroductionSecondhand smoke exposure (SHSe) in childhood is linked with increased morbidity and mortality. Hospital or secondary care contact may present a ‘teachable moment’ to provide parents with support to change their home smoking behaviours to reduce children’s SHSe. There is a lack of robust qualitative evidence around parents and healthcare professionals (HCPs) views on using this teachable moment to successfully initiate behavioural change. We aim to identify and understand what is important to stakeholders with a view to informing the development of a support package to help parents change their home smoking behaviours.Methods and analysisThis qualitative study will be theoretically underpinned by the Capability, Opportunity and Motivation Behaviour (COM-B) model of behavioural change. It will involve semistructured interviews and/or discussion groups with up to 20 parents who smoke and up to 25 HCPs. Stakeholders will be recruited from a single National Health Service children’s hospital in England. Interviews and/or discussion groups will be audio recorded, transcribed and anonymised. The transcripts and any field notes will be analysed using the framework method. Initially, we will apply COM-B to the data deductively and will then code inductively within each domain.Ethics and disseminationThe protocol for this study received a favourable outcome from the East Midlands Leicester Central Research Ethics Committee (19/EM/0171). Results will be written up as part of a PhD thesis, submitted for publication in peer-reviewed journals and presentation at conferences.Trial registration numberISRCTN40084089.

Genetic overlap and causal associations between smoking behaviours and mental health

Cigarette smoking is a modifiable behaviour associated with mental health. We investigated the degree of genetic overlap between smoking behaviours and psychiatric traits and disorders, and whether genetic associations exist beyond genetic influences shared with confounding variables (cannabis and alcohol use, risk-taking and insomnia). Second, we investigated the presence of causal associations between smoking initiation and psychiatric traits and disorders. We found significant genetic correlations between smoking and psychiatric disorders and adult psychotic experiences. When genetic influences on known covariates were controlled for, genetic associations between most smoking behaviours and schizophrenia and depression endured (but not with bipolar disorder or most psychotic experiences). Mendelian randomization results supported a causal role of smoking initiation on psychiatric disorders and adolescent cognitive and negative psychotic experiences, although not consistently across all sensitivity analyses. In conclusion, smoking and psychiatric disorders share genetic influences that cannot be attributed to covariates such as risk-taking, insomnia or other substance use. As such, there may be some common genetic pathways underlying smoking and psychiatric disorders. In addition, smoking may play a causal role in vulnerability for mental illness.

Changes in adult smoking behaviours in ten global adult tobacco survey (GATS) countries during 2008–2018 - a test of ‘hardening’ hypothesis’

Background Hardcore smoking behaviours and test of hardening are seldom reported from low-and-middle-income countries (LMICs). We report country-wise changes in smoking behaviors between two sequential surveys and explored ecologically the relationship between MPOWER scores and smoking behaviors including hardcore smoking. Methods We analysed sequential Global Adult Tobacco Survey (GATS) data done at least at five years interval in 10 countries namely India, Bangladesh, China, Mexico, Philippines, Russia, Turkey, Ukraine, Uruguay, and Vietnam. We estimated weighted prevalence rates of smoking behaviors namely current smoking (both daily and non-daily), prevalence of hardcore smoking (HCS) among current smokers (HCSs%) and entire surveyed population (HCSp%), quit ratios (QR), and the number of cigarettes smoked per day (CPD). We calculated absolute and relative (%) change in rates between two surveys in each country. Using aggregate data, we correlated relative change in current smoking prevalence with relative change in HCSs% and HCSp% as well as explored the relationship of MPOWER score with relative change in smoking behaviors using Spearman’ rank correlation test. Results Overall daily smoking has declined in all ten countries lead by a 23% decline in Russia. In India, Bangladesh, and Philippines HCSs% decreased as the smoking rate decreased while HCSs% increased in Turkey (66%), Vietnam (33%) and Ukraine (15%). In most countries, CPD ranged from 15 to 20 sticks except in Mexico (7.8), and India (10.4) where CPD declined by 18 and 22% respectively. MPOWER scores were moderately correlated with HCSs% in both sexes (r = 0.644, p = 0.044) and HCSp% (r = 0.632, p = 0.05) and among women only HCSs% (r = 0.804, p = 0.005) was significantly correlated with MPOWER score. Conclusion With declining smoking prevalence, HCS had also decreased and quit rates improved. Ecologically, a positive linear relationship between changes in smoking and HCS is a possible evidence against ‘hardening’. Continued monitoring of the changes in quitting and hardcore smoking behaviours is required to plan cessation services.

Validating a previously untested Intentions and Beliefs around Smoking sub-scale for inclusion in the published Attitudes and Beliefs about Cardiovascular Disease (ABCD) Risk Questionnaire using a cross-sectional sample

Objectives: To provide evidence of validity, reliability and generalisability of results obtained using the Attitudes and Beliefs about Cardiovascular Disease (ABCD) Risk Questionnaire with a sample of the English population surveyed within the SPICES Horizon 2020 project (Nottingham study site), and to specifically evaluate the psychometric and factor properties of an as-yet untested 5 item sub-scale relating to smoking behaviours. Design and setting: Community based cross-sectional study in Nottingham, UK. Participants: 466 English adults fitting inclusion criteria (aged 18+, without known history of CVD, not pregnant, able to provide informed consent) were included in the study. Methods: We re-validated the published ABCD questionnaire on a sample of the general population in Nottingham to confirm the psychometric properties. Furthermore, we introduced 5 items related to smoking which were dropped in the original study due to inadequate valid samples. Primary and secondary outcome measures: Psychometric and factor performance of untested 5 item smoking behaviours sub-scale Psychometric and factorial properties in combination with the remaining 18 items across 3 sub-scales Results: Analyses of the data largely confirmed the validity, reliability, and factor structure of the original ABCD Risk Questionnaire. Sufficient participants in our study provided data against an additional five smoking related items to confirm their validity as a sub-scale and to advocate for their inclusion in future applications of the scale. EFA and CFA calculations support some minor changes to the remaining sub-scales which may further improve psychometric performance and therefore generalisability of the instrument. Conclusions: An amended version of the ABCD Risk Questionnaire would provide public health researchers and practitioners with a brief, easy to use, reliable and valid survey tool. The amended tool may now assist public health practitioners and researchers to quickly survey patient or public intentions and beliefs around three key areas of individually modifiable risk (Physical Activity, Diet, and Smoking).

Behaviour of smokers and their influencers in the UK during COVID-19 pandemic

Purpose The COVID-19 pandemic has resulted in unprecedented circumstances and changes in behaviour. This research sought to better understand the impact of the COVID-19 pandemic, and lockdown, on smoking behaviour in the UK from the perspectives of consumers (current and former smokers) and some of their smoking-related behaviour-influencers. Design/methodology/approach This research project encompassed two surveys, one for current and former smokers (Consumers) and one for those individuals in professions with the potential to influence smoking behaviours (Influencers). Both surveys were conducted online and were infield for approximately two weeks during UKs first COVID-19 lockdown. Because of the unprecedented times the society was experiencing, several questions relating directly to COVID-19 were added to the survey and this paper is based only on findings only from those questions and not the whole project. The results were analysed descriptively. Findings A total of 954 consumers and 1027 influencers participated in the surveys. Increased smoking was reported by 67% of the consumers mainly due to stress and boredom arising out of COVID-19 lockdown. Consumers under 45 years of age, those in professional and managerial occupations, and among dual users reported increased smoking in lockdown. The COVID-19 situation changed the plans to quit smoking in 36% of consumers, with only 6% deciding to quit. Only 40% of healthcare professionals (HCPs) documented patient smoking status in over half their interactions. Originality/ value This research among current and former smokers and their influencers highlights important changes in behaviour during the COVID-19 times and underscores urgent measures to be taken by HCPs and policymakers for staying on course of achieving smokefree goals despite challenges posed by COVID-19.

Evaluation of the relationship between antenatal and postnatal tobacco smoke exposure and childhood cancers.

e22011 Background: The incidence of childhood cancers increased by 1 % per year over the last three decades. Life style changes and increased variety of environmental exposures are accused of this trend. One of these environmental factors is cigarette smoking and parental smoking is the main source of tobacco smoke exposure of children. There are strong reasons for considering parental smoking behaviour as a risk factor for childhood cancers. Many tobacco related compounds are detected in fetal tissues, breast milk and tissues of children of smoking parents. However, it is hard to make causal relationship between parental smoking and childhood cancers. One of the reasons is the difficulty to detect tobacco smoke exposure. Questionnaires, commonly used method to detect tobacco smoke exposure, are prone to biases. Cotinine is the main metabolite of nicotine which is the abundant organic compound in tobacco and a good biomarker to detect tobacco smoke exposure. Methods: 104 newly diagnosed, 0-18 years aged pediatric cancer patients from two pediatric oncology centers ( Ankara University Children’s Hospital and Ankara City Hospital) and 99 healthy children aged 0-18 applied to the Ankara University Children’s Hospital participated our study. Parental smoking behaviours (preconceptional, during pregnancy and current smoking) and environmental tobacco smoke exposures (ETS) of children were compared between two groups. ETS exposures of cancer patients and healthy children were evaluated by hair cotinine ELISA analysis and questionnaire. For hair cotinine analysis, 30 mg of hair samples were taken from occipital part of scalp by a stainless scissors. Samples were processed according to manufacturer's instructions. Parents of two groups were surveyed about their smoking behaviours and ETS exposures of their children. Results: We found no differences between two groups by means of maternal preconceptional smoking, smoking during pregnancy and current smoking behaviours. Paternal preconceptional smoking and smoking during pregnancy rates were significantly low in cancer patients (p < 0,05) according to questionnaire. Environmental tobacco smoke exposures were found statistically low in cancer patients according to questionnaire (p < 0,05). However, quantitative exposure assessment by hair cotinine analysis revealed that cancer patients are exposed to tobacco smoke more than healthy children (p < 0,001). Conclusions: Our findings support that smoking could be a risk factor for childhood cancers. This study also revealed that questionnaires could cause biases. We thought, social desirability bias of father of cancer patients could be a reason of their low smoking rates according to questionnaire. We suggest that cotinine analysis along with validated questionnaires can be used to prevent biases in studies of tobacco smoke in the etiology of childhood cancers.

Changes in adult smoking behaviours in ten Global Adult Tobacco Survey (GATS) countries during 2008-2018 - a test of ‘hardening’ hypothesis

Background Hardcore smoking behaviours and test of hardening are seldom reported from low-and-middle-income countries (LMICs). We report country-wise changes in smoking behaviors between two sequential surveys and explored ecologically the relationship between MPOWER scores and smoking behaviors including hardcore smoking. Methods We analysed sequential Global Adult Tobacco Survey (GATS) data done at least at five years interval in 10 countries namely India, Bangladesh, China, Mexico, Philippines, Russia, Turkey, Ukraine, Uruguay, and Vietnam. We estimated weighted prevalence rates of smoking behaviors namely current smoking (both daily and non-daily), prevalence of hardcore smoking (HCS) among current smokers (HCSs%) and entire surveyed population (HCSp%), quit ratios (QR), and the number of cigarettes smoked per day (CPD). We calculated absolute and relative (%) change of rates between two surveys in each country. Using aggregate data, we correlated relative change in current smoking prevalence with relative change in HCSs% and HCSp% as well explored the relationship of MPOWER score with relative change in smoking behaviors using Spearman’ rank correlation test. Results Overall daily smoking has declined in all ten countries lead by a 23% decline in Russia. In India, Bangladesh, and Philippines HCSs% decreased as the smoking rate decreased while HCSs% increase in Turkey (66%), Vietnam (33%) and Ukraine (15%). In most countries, CPD ranged from 15 - 20 sticks except in Mexico (7.8), and India (10.4) where CPD declined by 18% and 22% respectively. MPOWER scores were moderately and significantly correlated with HCSs% in both sexes (r=0.578, p=0.023) and HCSp% (r= 0.489, p=0.057) and among women both HCSs% (r=0.667, p=0.009) and HCSp% (r=0.533, p=0.037) were significantly correlated with MPOWER scores. Conclusion With declining smoking prevalence, HCS had also decreased and quit rates improved. Ecologically, a positive linear relationship between changes in smoking and HCS is a possible evidence against ‘hardening’. Continued monitoring of the changes in quitting and hardcore smoking behaviours is required to plan cessation services.

Roma Socioeconomic Status Has a Higher Impact on Smoking Behaviour than Genetic Susceptibility

It is a matter of speculation whether the high prevalence of smoking among Hungarian Roma (HR) is related to genetic, gene-environmental interactions or cultural factors. Our aim is to compare the genetic susceptibility and possible effects of determinants associated with smoking behaviours in the Hungarian general (HG) and Roma populations. A complex health survey including three pillars (questionnaire, physical and laboratory examinations) was carried out (NHG = 412 and NHR = 402). Risk allele frequencies of ten single-nucleotide polymorphisms (SNPs) were compared, and their combined effect was estimated by computing unweighted and weighted genetic risk scores (GRS, wGRS). The effects of genetic and environmental factors were investigated in regression analyses after confounders were introduced. Socio-economic status (SES) was calculated based on the Kuppuswamy scale 2019. Risk allele frequencies of only four SNPs were found to be different between populations (p < 0.01). Median values of GRS did not differ, while the wGRS median was slightly higher among Roma individuals (5.2 vs. 4.9; p = 0.02). Roma individuals were more likely to be heavy smokers (ORmales = 2.05, 95% CI [1.47–2.86]; ORfemales = 1.89, 95% CI [1.58–2.25]. Smokers have lower SES compared to never smokers (SES βHR = −0.039, p = 0.023; βHG = −0.010, p = 0.049). An inverse relationship was found between SES and smoking behaviours (p < 0.0001) and was found to be a better predictor of smoking behaviours than genetic susceptibility. Our study findings suggest that the high prevalence of smoking behaviours and nicotine-dependence were not revealed to have a genetic susceptibility among HR individuals; therefore, the highest efforts should be focused on targeting SES-related factors in the Roma population. Strengths of the study: This is the first study carried out to investigate and detect the most relevant factors and the possible genetic background of the extremely high prevalence of smoking based in the Roma population. Limitations of the study: No standard instrument has been used to assess the intensity of addiction to nicotine. Because of some participants’ unwillingness to define themselves as Roma, the overall HR population was not represented by the sample of this study.