The continuing HIV epidemic among men who have sex with men

OBJECTIVES: This study characterized the AIDS epidemic among urban men who have sex with men (MSM). METHODS: A probability sample of MSM was obtained in 1997 (n = 2881; 18 years and older) from New York, Los Angeles, Chicago, and San Francisco, and HIV status was determined through self-report and biological measures. RESULTS: HIV prevalence was 17% (95% confidence interval = 15%, 19%) overall, with extremely high levels in African Americans (29%), MSM who used injection drugs (40%), "ultraheavy" noninjection drug users (32%), and less educated men (< high school, 37%). City-level HIV differences were non-significant once these other factors were controlled for. In comparing the present findings with historical data based on public records and modeling, HIV prevalence appears to have declined as a result of high mortality (69%) and stable, but high, incidence rates (1%-2%). CONCLUSIONS: Although the findings suggest that HIV prevalence has declined significantly from the mid-1980s, current levels among urban MSM in the United States approximate those of sub-Saharan countries (e.g., 14%-25%) and are extremely high in many population subsegments. Despite years of progress, the AIDS epidemic continues unabated among subsegments of the MSM community.     

Tobacco smoking and risk of hip fracture in men and women

BACKGROUND: Previous findings suggest that tobacco smoking increases the risk of hip fracture in women. A similar adverse effect of smoking is suspected to be present in men, but bone mineral density studies have raised the concern that men may be more sensitive to the deleterious effect of smoking on bone than women. In this study we prospectively determined the influence of current, previous, and cumulative smoking history on risk of hip fracture in men and women and addressed the issue of possible gender difference in the susceptibility to tobacco smoking. METHODS: Pooled data from three population studies conducted in Copenhagen with detailed information on smoking habit. A total of 13,393 women and 17,379 men, initially examined between 1964 and 1992, were followed until 1997 for first admission due to hip fracture. The relative risks (RR) of hip fracture associated with smoking were estimated by means of multiplicative Poisson regression models. RESULTS: During follow-up, 722 hip fractures were identified in women, and 447 in men. After adjustment for potential confounders, including body mass index, female current smokers had an RR of hip fracture of 1.36 (95% CI: 1.12-1.65) and male smokers 1.59 (95% CI: 1.04-2.43) relative to never smokers. In both sexes, the RR of hip fracture gradually increased by current and accumulated tobacco consumption. The RR were consistently higher in men than in women, but the test for interaction between sex and tobacco smoking was insignificant. After 5 years, male ex-smokers had an adjusted RR of 0.73 (95% CI: 0.55-0.98) relative to current smokers, while no significant decrease in risk was observed in female ex-smokers (RR = 0.91; 95% CI: 0.72-1.17)). Approximately 19% of all hip fractures in the present study population were attributable to tobacco smoking. CONCLUSION: Tobacco smoking is an independent risk factor for hip fracture in men and women, and there appears to be no gender differences in smoking related risk. Smoking cessation reduces the risk of hip fracture in men after 5 years, while the deleterious effect of smoking seems to be more long-lasting in female ex-smokers.     

Randomised control trial of a smoking cessation intervention directed at men whose partners are pregnant

BACKGROUND: Although smoking cessation programs significantly reduce smoking rates in the general population, some sectors are poorly motivated by them, especially healthy men from lower socioeconomic classes. METHODS: By using a significant life event (approaching birth of a child) we exploited a time of increased receptiveness to smoking cessation influences. A multicomponent intervention was conducted and evaluated using a stratified, randomised control trial, with an intention to treat analysis. RESULTS: Five hundred and sixty-one men were enrolled and 505 (90%) followed to the end of their partners' pregnancy. At 6-month follow-up 16.5% of 291 smokers of the intervention group and 9.3% of 270 in the control group reported they had stopped smoking (P=0.011, OR=0.52, 95% CI 0.31 - 0.86). The strongest predictors of smoking cessation were being in a skilled occupation, having a higher number of quit attempts in the previous year and having the first cigarette of the day relatively later. CONCLUSIONS: The number of smoking men who had to be treated to achieve one stopping smoking (NNT) during their partner's pregnancy was 13 to 14. Innovative antismoking population health measures for the partners of antenatal patients are effective and perhaps should be more widely adopted.     

Mental health and suicidal ideation among Chinese women who have sex with men who have sex with men (MSM)

ABSTRACT

In China, men who have sex with men (MSM) are the fastest growing population at risk for HIV. They face social stigma due to both MSM behavior and HIV. In addition, concern has been raised about the mental health of wives of MSM. In this cross-sectional study, the authors examine the mental health status of a sample of 135 of these women. Participants completed an Internet-administered questionnaire in Xi’an from April to June, 2012. Most were unaware at the time of marriage that their husbands were MSM. Physical abuse was frequently reported; depressive symptom and mental health (Symptom Checklist, SCL–90) scores were significantly higher than those of the general Chinese adult female population. A majority (59.8%) of women reported suicidal thoughts after discovering their husbands’ MSM behavior; about 10% had attempted suicide. Multiple logistic regression revealed that women’s experience with anal sex was associated with 7.8 times (95% CI: 1.3–65.9) greater odds of suicidal ideation. Also, women who demonstrated mental symptoms on the SCL–90 had 2.3 times (95% CI: 1.04–5.2) the odds of suicidal ideation. These results suggest that wives of MSM have a significant need for mental health care, suicide prevention, HIV education, and social support.     

Prevalence and sociodemographic determinants of tobacco use among adults in Pakistan: findings of a nationwide survey conducted in 2012

Background

Smoking is one of the leading causes of preventable mortality. The World Health Organization recommends that countries should monitor tobacco use regularly. In Pakistan, the last national study on smoking in the general population was conducted in 2002 to 2003.

Methods

We conducted a cross-sectional survey of a nationally representative sample of men and women living in rural and urban areas of four main provinces of Pakistan from March through April 2012. Face-to-face in-house interviews were undertaken using a pre-tested structured questionnaire that asked about smoking and other forms of tobacco use. Multistage stratified random area probability sampling was used. To determine the national prevalence of tobacco use, the sample was weighted to correspond to rural–urban population proportions in each of the four provinces as in the 1998 census conducted by Pakistan’s Population Census Organization. Associations between sociodemographic variables and tobacco use were investigated using multivariable robust regression.

Results

Out of 2,644 respondents (1,354 men and 1,290 women), 354 men and 4 women reported being current cigarette smokers. The weighted prevalence of current cigarette smoking was 15.2% (95% confidence interval [CI]; 11.2, 19.3) overall, 26.6% (95% CI: 19.1, 34.1) among males, and 0.4% (95% CI: -0.2, 1.0) among females. Among females, 1.8% (95% CI: 0.4, 3.1) used any smoked tobacco and 4.6% (95% CI: 1.8, 7.4) used any smokeless tobacco daily or on some days of the week. Among males, odds of current cigarette smoking decreased with increasing level of education (OR?=?0.75; 95% CI: 0.68, 0.84) and increased with having a father who used tobacco (OR?=?2.11; 95% CI: 1.39, 3.22) after adjusting for other sociodemographic characteristics. Lower household income was associated with current cigarette smoking among rural males only (odds ratio [OR]?=?0.67; 95% CI: 0.48, 0.92 per category increase in monthly household income).

Conclusion

A large proportion of males smoked cigarettes. Cigarette use was negligible among females, but they used other forms of tobacco. Low education was a determinant of cigarette smoking among males irrespective of socioeconomic status and area of residence. Tobacco control campaigns should target uneducated and rural poor men and monitor all forms of tobacco used by the population.

     

The impact of immigration status on tobacco use among Chinese-American adults in Texas

Objectives This study analyzed the impact of immigration status on current tobacco use among adult Chinese-Americans living in Texas. Methods A survey was administered in Chinese and English in 2004 to assess tobacco use among Chinese-American adults using a stratified probability sample from two large metropolitan areas in Texas. Data were adjusted for unequal probability of selection and weighted to provide state-wide estimates for Chinese-Americans in Texas. Results The study sample was comprised of 1,054 Chinese-American adults. The overall current smoking rate was 11.1% with men’s rates much higher (16.1%) than women’s (6.7%). Lower household income and education increased smoking among males but more educated females had a tendency to smoke more. Although overall smoking rate among Chinese-Americans was significantly lower than the general Texas population (20.6%), smoking rate among recent immigrant men (<5 years in the U.S.) was alarmingly higher (28.0%). U.S.-born Chinese-American men’s smoking rate (25.0%) is similar to that of their U.S.-born counterparts (23.7%). U.S.-born Chinese-American men initiated smoking 4 years earlier (13.8 years) than their immigrant counterparts. Conclusions Although Chinese-Americans in Texas had overall lower smoking rates than the general population, the high smoking rates among recently immigrated men emphasize the need for cessation activities targeting this group.     

A study on methods of estimating the population size of men who have sex with men in Southwest China

Objective: To ascertain practical methods of estimating the population size of men who have sex with men (MSM) by field application. Methods: Nine public places were selected, where men who have sex with men (MSM) frequented. Capture--recapture method and multiplier method were used to count the number of men who have sex with men (MSM) in the assigned places in 10 days. Results: The population size estimated using multiplier method counted 877. Three estimates produced by capture--recapture method were 1408 (95% CI: 1116--1908), 1207 (95% CI: 932--1712) and 949 (95% CI: 757--1272), respectively. Conclusions: Multiplier method was easy and smooth in practice and produced highly reliable results, which yet was expensive. The application of capture--recapture method cost less in both time and funds, and the three results produced could verify each other, which was fit for the estimation.     

台州市男性 HIV阳性者和 HIV阴性者吸烟率及其影响因素的比较

  目的  比较台州市男性人类免疫缺陷病毒（human immunodeficiency virus,HIV）阳性者和HIV阴性者吸烟率并分析其影响因素,为台州市HIV阳性者有针对的制定和实施控烟措施提供依据。  方法  基于"HIV与衰老相关疾病前瞻性队列研究"的基线数据,收集人口学、吸烟相关特征等信息。最终纳入分析3 785名男性研究对象,应用SAS 9.4软件进行统计分析。  结果  男性HIV阳性者当前吸烟率为33.9%（95% CI:31.4%~36.5%）,低于HIV阴性者（46.3%,95% CI:44.3%~48.3%）;男性HIV阳性者以前吸烟率为14.1%（95% CI:12.3%~16.1%）略高于HIV阴性者（12.5%,95% CI:11.2%~13.9%）,差异有统计学意义（χ2=56.81,P < 0.001）。男性HIV阳性者中,知晓感染后戒烟率为23.7%。使用多因素二分类Logistic回归模型分析显示,相较HIV阴性者,HIV阳性者当前吸烟的影响因素除职业、体重指数（body mass index,BMI）、日常锻炼以外,还包含年龄（40~岁,OR=1.87,95% CI:1.28~2.74,P=0.001;≥ 50岁,OR=2.30,95% CI:1.56~3.39,P < 0.001）、同性传播途径（OR=0.45,95% CI:0.35~0.59,P < 0.001）。  结论  台州市男性HIV阳性者目前吸烟状况仍然较普遍,且知晓HIV感染后曾尝试戒烟率较低。可通过加强男性HIV阳性者戒烟意识并结合影响当前吸烟的因素采取有针对性的措施控烟。     

High Prevalence of Smoking Among Urban-Dwelling Canadian Men Who Have Sex with Men

A small but consistent literature from the United States suggests increased risk for smoking among lesbians and men who have sex with men (MSM). Few studies have investigated smoking among MSM in other countries where different social norms and restrictions on smoking in public apply. We measured smoking behaviours in a convenience sample of urban-dwelling young Canadian MSM (median age 28 years). We compared the prevalence of smoking among MSM with that among other men in British Columbia (BC) using National Population Health Survey data to compute an age-adjusted standardized prevalence ratio (SPR). Independent predictors of smoking among MSM were identified using adjusted odds ratios (OR) with 95% confidence intervals (CI). Smoking during the previous year was reported by twice as many MSM (54.5% of 354) as other men in BC (25.9%) (SPR = 1.94, 95% CI 1.48–2.59), with largest differentials observed among men under 25 years of age. In multivariable analyses, smoking among MSM was significantly associated with younger age (OR 0.94, CI 0.88–1.00 per year), greater number of depressive symptoms (OR 1.12, CI 1.06–1.19 per symptom) and Canadian Aboriginal ethnicity (OR 2.64, CI 1.05–6.60). In summary, MSM in our study were twice as likely to smoke as other men in BC; the greatest differences were observed among the youngest men. The design of effective prevention and cessation programs for MSM will require identification of the age-dependent determinants of smoking initiation, persistence, and attempts to quit. Lampinen, Bonner, Rusch, and Hogg are with the Division of Epidemiology and Population Health, BC Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada; Lampinen, Rusch, and Hogg are with the Department of Health Care and Epidemiology, University of British Columbia, Vancouver, BC, Canada.     

Importance of light smoking and inhalation habits on risk of myocardial infarction and all cause mortality. A 22 year follow up of 12 149 men and women in The Copenhagen City Heart Study

STUDY OBJECTIVE: To determine risk of myocardial infarction (MI) and all cause mortality associated with light smoking and inhalation habits in men and women. DESIGN: Prospective cohort study with follow up of MI and all cause mortality through record linkage. SETTING: The Copenhagen City Heart Study, a cardiovascular study based on a sample of the general population established in 1976. PARTICIPANTS: 6505 women and 5644 men followed up until 1998 for first MI and for death from all causes. Main results: During follow up 476 women and 872 men suffered a MI whereas 2305 women and 2883 men died. After adjusting for major cardiovascular risk factors there was a dose-response relation between smoking with and without inhaling and both MI and all cause mortality. Among inhaling smokers significantly increased risks were found in women at a consumption of only 3-5 grams of tobacco per day with relative risks (RR) of MI and all cause mortality of 2.14 (95% CI 1.11 to 4.13) and 1.86 (95% CI 1.37 to 2.51), respectively. In men increased risks were seen when smoking 6-9 grams per day with RR of MI and all cause mortality of 2.10 (95% CI 1.40 to 3.14) and 1.76 (95% CI 1.39 to 2.23), respectively. Risks were also increased in non-inhaling smokers, although in men only significantly so for all cause mortality. After adjusting for inhalation and quantity smoked, cigarette smokers had a higher risk of all cause mortality (RR 1.16 (95% CI 1.07 to 1.26)) but not of MI (RR 1.11 (95% CI 0.95 to 1.30)). The RR associated with smoking were significantly higher in women than in men for both MI and all cause mortality. CONCLUSIONS: Smoking as little as 3-5 grams of tobacco per day or not inhaling the smoke was shown to carry a significantly increased risk of developing MI and of all cause mortality with higher RR found in women than in men. The study emphasises the importance of recognising that even very limited tobacco consumption has detrimental health effects.     

400例MSM行为特征及HIV、HAV、HCV、HEV、梅毒感染状况的横断面调查

目的 了解云南省玉溪市MSM人群的行为特征及HIV、HAV、HCV、HEV、梅毒感染状况,为开展有针对性的健康教育和行为干预提供依据。方法 2018年4 - 7月在玉溪市采用横断面调查,滚雪球抽样方法,共纳入400例MSM,开展行为学问卷调查,采集血液样本进行HIV、HAV、HCV、HEV和梅毒抗体检测。 结果 400例MSM中98.25%对艾滋病基本知识知晓。318例最近6个月与男性发生过肛交性行为,88.68%都坚持每次使用安全套,最近1次肛交时96.86%使用了安全套。84例最近6个月与异性发生性行为,94.05%都坚持每次使用安全套,最近1次与异性发生性行为时98.81%使用了安全套。HIV、HAV、HCV、HEV、梅毒感染率分别为3.00%（95%CI:1.33～4.67）、1.25%（95%CI:0.16～2.34）、0.25%（95%CI:0.00～0.74）、1.00%（95%CI:0.03～1.98）、4.75%（95%CI:2.67～6.83）。结论 MSM人群不仅是HIV、HCV、梅毒的高危人群,HAV、HEV也高发,需针对该人群推广接种HAV、HEV疫苗。     

General health and tobacco habits among middle-aged Swedes

BACKGROUND: Convincing scientific evidence exists that smoking has devastating effects on health. The use of smokeless tobacco (snuff) as a tobacco habit has been reported to be considerably less harmful, and has been suggested as an aid to smoking cessation, among other things. METHODS: Cross-sectional data on general health and tobacco habits were obtained through a self-administered mail questionnaire in 2002 representing 50-year-old (n = 6236) and 60-year-old (n = 6232) Swedes in two counties. Participation rates were 70.2 and 75.7% in the both age cohorts, respectively. Of all participants 46.2% were male and 53.8% female. A general health index encompassing five items (score 0-5) was designed, with the best general health attributed to those scoring 5. RESULTS: Male daily smokers accounted for 15.6% of the 50-year-olds and 18.7% of the 60-years-olds compared with 21.1 and 16.6%, respectively, for females. Corresponding figures for daily snuffing were 21.1 and 11.9% for men and 1.7 and 0.4% for women. When adjusting for age, sex, place of living, social network, education, and marital status, and related to subjects who never used tobacco, 'best general health' score 5, significant differences were found for ex-smokers (OR 0.82; 95% CI 0.74-0.90; P < 0.001) and ex-snuffers (OR 0.74; 95% CI 0.61-0.90; P < 0.01). CONCLUSION: Those who have stopped smoking or snuffing seem to be in a vulnerable condition with respect to general health and in need of extra support and health-promoting activities.     

Smoking cessation and mortality from cardiovascular disease among Japanese men and women: the JACC Study

To examine the effect of smoking cessation on cardiovascular disease mortality in Asians, the authors conducted a 10-year prospective cohort study of 94,683 Japanese (41,782 men and 52,901 women) aged 40-79 years who were part of the Japan Collaborative Cohort Study for Evaluation of Cancer Risk (JACC Study). During 941,043 person-years of follow-up between 1989-1990 and 1999, 698 deaths from stroke, 348 from coronary heart disease, and 1,555 from total cardiovascular disease occurred in men and 550, 199, and 1,155, respectively, in women. For men, the multivariate relative risks for current smokers compared with never smokers were 1.39 (95% confidence interval (CI): 1.13, 1.70) for stroke, 2.51 (95% CI: 1.79, 3.51) for coronary heart disease, and 1.60 (95% CI: 1.39, 1.84) for total cardiovascular disease. The respective relative risks for women were 1.65 (95% CI: 1.21, 2.25), 3.35 (95% CI: 2.23, 5.02), and 2.06 (95% CI: 1.69, 2.51), with larger excess risks for persons aged 40-64 years than for older persons. The risk decline after smoking cessation occurred for coronary heart disease and total cardiovascular disease within 2 years and for total stroke after 2-4 years. For each endpoint and in both age subgroups of 40-64 and 65-79 years, most of the benefit of cessation occurred after 10-14 years following cessation. Findings imply the importance of smoking cessation at any age to prevent cardiovascular disease in Japanese.     

The impact of body weight on smoking cessation in German adults

OBJECTIVE: To assess the relevance of pre-existing body weight for successful smoking cessation among women and men. METHODS: We carried out a retrospective cohort analysis among 4270 ever smoking participants of a general health screening examination in Germany recruited from July 2000 to June 2002 aged 50 to 74, who provided lifetime histories of both body weight and smoking. RESULTS: In the extended Cox model, the relative cessation rate (RCR) increased significantly with increasing body mass index (BMI) among both genders (test for trend: P < 0.01 for women and P < 0.0001 for men). In women, this effect was mainly due to a lower cessation rate in low-weight (BMI <20) smokers (adjusted RCR = 0.76, 95% confidence interval (CI) 0.62-0.95), whereas in men, the effect was mainly due to a higher cessation rate among overweight and obese smokers (adjusted RCR = 1.26, 95% CI 1.11-1.35, and 1.38, 95% CI 1.17-1.63, respectively) compared to normal-weight smokers. CONCLUSIONS: While in men, overweight and obesity are associated with increased smoking cessation, possibly related to increased health concerns, in women, low weight is associated with decreased smoking cessation, possibly related to increased fear of weight gain.     

广州市男男性行为者 HIV感染状况及影响因素

  目的  了解广州市男男性行为者（men who have sex with men,MSM）的人类免疫缺陷病毒（human immunodeficiency virus,HIV）感染现况,并分析影响因素。  方法  2014-2017年连续四年对广州市MSM进行面对面问卷调查,采集静脉血检测HIV抗体和采用SPSS 19.0软件分析资料。  结果  本次研究共调查2 419例MSM,HIV确证阳性200例,感染率为8.27%。多因素Logistic逐步回归分析结果显示,以广州市和月经济收入>0.5万元为参照,非广州市（OR=1.712,95% CI:1.176~2.492,P=0.005）和月经济收入≤ 0.5万元（OR=1.998,95% CI:1.409~2.833,P < 0.001）与MSM感染HIV存在关联。MSM被诊断为梅毒（OR=2.461,95% CI:1.375~4.405,P=0.002）和没检测梅毒（OR=2.333,95% CI:1.635~3.331,P < 0.001）、肛交角色为被动（OR=2.015,95% CI:1.244~3.267,P=0.004）和主动被动均有（OR=2.115,95% CI:1.374~3.251,P=0.001）、肛交时非每次使用安全套（OR=1.955,95% CI:1.374~2.781,P < 0.001）、肛交对象非固定（OR=2.150,95% CI:1.463~3.160,P < 0.001）是MSM感染HIV的主要危险因素。  结论  广州市MSM人群HIV感染率和高危性行为发生率高,亟需在MSM人群中扩大HIV检测范围和倡导安全性行为。     

Prevalence estimates of health risk behaviors of immigrant latino men who have sex with men

Purpose: Little is known about the health status of rural immigrant Latino men who have sex with men (MSM). These MSM comprise a subpopulation that tends to remain “hidden” from both researchers and practitioners. This study was designed to estimate the prevalence of tobacco, alcohol, and drug use, and sexual risk behaviors of Latino MSM living in rural North Carolina. Methods: A community‐based participatory research (CBPR) partnership used respondent‐driven sampling (RDS) to identify, recruit, and enroll Latino MSM to participate in an interviewer‐administered behavioral assessment. RDS‐weighted prevalence of risk behaviors was estimated using the RDS Analysis Tool. Data collection occurred in 2008. Results: A total of 190 Latino MSM was reached; the average age was 25.5 years and nearly 80% reported being from Mexico. Prevalence estimates of smoking everyday and past 30‐day heavy episodic drinking were 6.5% and 35.0%, respectively. Prevalence estimates of past 12‐month marijuana and cocaine use were 56.0% and 27.1%, respectively. Past 3‐month prevalence estimates of sex with at least one woman, multiple male partners, and inconsistent condom use were 21.2%, 88.9%, and 54.1%, respectively. Conclusions: Respondents had low rates of tobacco use and club drug use, and high rates of sexual risk behaviors. Although this study represents an initial step in documenting the health risk behaviors of immigrant Latino MSM who are part of a new trend in Latino immigration to the southeastern United States, a need exists for further research, including longitudinal studies to understand the trajectory of risk behavior among immigrant Latino MSM.     

Recent decline in the incidence of human immunodeficiency virus infection among California men who have sex with men

Monitoring the incidence of human immunodeficiency virus (HIV) infection among men who have sex with men (MSM) is imperative for developing targeted prevention programs and evaluating their effectiveness. The authors used California counseling and testing data to estimate the temporal trend in HIV incidence among MSM in California. HIV incidence rates were retrospectively calculated among MSM who had received at least 1 HIV test at a public California counseling and testing site between 1997 and 2007 and had a prior HIV-negative test from any HIV testing source. All study subjects were weighted on the basis of the interval between the last HIV-negative test and the current HIV test to account for the right-truncation bias introduced by more frequent testers. The authors observed that the HIV incidence rate among MSM in California increased from 2.0/100 person-years (95% confidence interval (CI): 1.8, 2.2) in 1997 to 2.4/100 person-years (95% CI: 2.2, 2.6) in 2003 and then decreased to 1.9/100 person-years (95% CI: 1.7, 2.0) in 2006. Trend analyses showed that both the increase (P < 0.001) and the decrease (P < 0.01) were statistically significant. The study showed that HIV incidence among MSM in California had decreased since 2003.     

Use of antiretroviral therapies among HIV-infected men who have sex with men: a household-based sample of 4 major American cities

OBJECTIVES: This study sought to determine the prevalence and determinants of use of recommended antiretroviral regimens among urban seropositive men who have sex with men (MSM). METHODS: A probability telephone sample of MSM was taken within regions of Chicago, Los Angeles, New York, and San Francisco. Analysis focused on use of antiretroviral therapies. RESULTS: Although the majority of seropositive MSM with CD4 counts below 500 per microliter were using recommended antiretroviral regimens, 26% of seropositive MSM were not receiving such care. Men who were younger, who reported a sexual orientation other than homosexual, who had a more recent interview date, who were at middle levels of affiliation with the gay community, and who reported higher levels of perceived exclusivity on the part of the gay community were less likely to be using recommended antiretroviral regimens. CONCLUSIONS: Although current efforts to make antiretroviral therapies available to HIV-seropositive MSM are reasonably effective, additional efforts are needed for MSM characterized by relative youth and lower social support.     

Impact of tobacco smoking on subsequent cancer risk among middle-aged Japanese men and women: data from a large-scale population-based cohort study in Japan--the JPHC study

BACKGROUND: The present study aimed to obtain a relevant epidemiological index of the impact of tobacco smoking on the subsequent risk of cancer in Japan. METHODS: We conducted a cohort analysis on the possible association between tobacco smoking habits and total cancer risk among a middle-aged Japanese population, using a large-scale population-based cohort of 92,792 subjects (44,521 men and 48,271 women) with 10-year follow-up. RESULTS: During 1990-2001, 4,922 cases of cancer (2,969 men and 1,953 women) were newly diagnosed. From the baseline questionnaire, 52.2% of men were current smokers and they presented a significantly increased hazard ratio (HR) of subsequent cancer occurrence compared with never-smokers [HR 1.64, 95% confidence interval (95% CI) 1.48-1.82]. Only 5.6% of women were current smokers and their HR also represented a significant increase (HR 1.46, 95% CI 1.21-1.75). The corresponding population attributable fraction (PAF) (%) of total cancer incidence in men was 22.4% (95% CI 15.7%-28.5%) and 7.0% (95% CI 3.7%-10.3%) in relation to current and past exposures to tobacco smoke. In women, the PAF was only 2.2% and 0.6% due to the low prevalence of current and former smokers. CONCLUSIONS: Our results suggest that 29% of male cancer and 3% of female cancer would be preventable in Japanese middle-aged population by avoidance of tobacco smoking.     

江苏省18～69岁男性自报慢性病与戒烟行为关系

  目的  探讨江苏省成年男性自报慢性病患病与戒烟行为的关系。  方法  分别于2007、2010、2013年采用多阶段分层整群抽样的方法,在江苏省14个成人慢性病及其危险因素监测点中抽取居民进行调查,以18~69岁男性为研究对象,分析慢性病患病与吸烟、戒烟行为的关系。  结果  18~69岁男性共8 313名,自报心脑血管疾病、恶性肿瘤、哮喘和慢性阻塞性肺部疾病（chronic obstructive pulmonary disease,COPD）患病率分别为1.5%、1.1%、1.5%和2.8%。戒烟者4种慢性病自报患病率均高于现在吸烟和不吸烟者（均有P < 0.05）。多因素分析显示,患心脑血管疾病、恶性肿瘤、哮喘和COPD者戒烟率分别是未患者的3.356倍（95% CI:1.966~5.728）、3.864倍（95% CI:2.277~6.555）、2.103倍（95% CI:1.321~3.345）和2.586倍（95% CI:1.872~3.573）。  结论  患有慢性病者戒烟率高于未患病者,提示患病后会促进吸烟者的戒烟行为。