The clinical implications of a smoking ban on submarines in the U.S. Navy

By the end of calendar year 2010, a total smoking ban on submarines is expected to be implemented throughout the submarine force because of the negative health effects of environmental tobacco smoke and the recently demonstrated exposure of nonsmoking submariners to measurable levels of nicotine during submarine deployments. Historically, smoking has been highly prevalent in the military, but new data on the negative health effects of tobacco have led the military to change its policies, restricting its use in certain environments. A number of research studies have examined the effect of smoking on the military, cessation and prevention interventions, effect of environmental tobacco smoke onboard the submarine, and treatment modalities aimed at smokers attempting to quit. With the potential for considerable physical and psychological effects, a mass tobacco cessation program is being implemented to support the prohibition onboard the submarine. Recommendations for a successful implementation program are included.     

Smoking and tobacco use by U.S. military personnel

Findings regarding smoking behavior for the 1985 survey of military personnel were compared to findings from earlier surveys. A decline in the percentage of cigarette smokers was evident for all ranks and ages. Reported use of smokeless tobacco and cigar/pipe smoking indicated that one-fifth of the cigarette smokers also use smokeless tobacco and that two-fifths of the cigarette users smoke a pipe or cigar. Among non-smokers of cigarettes, about one-tenth of the respondents used smokeless tobacco and/or smoked a pipe or cigars. Using self-evaluation of health status, non-smokers reported "excellent" health significantly more than smokers.     

Screening Mammography Visits as Opportunities to Engage Smokers With Tobacco Cessation Services and Lung Cancer Screening

ObjectiveTobacco use is the leading cause of preventable mortality in the United States. Screening mammography (SM) visits present opportunities for radiology practices to reduce tobacco-related morbidity and mortality. Our study evaluates implementation of a program that provides tobacco cessation service referrals and screens for lung cancer screening (LCS) eligibility among smokers presenting for SM at a community health center.MethodsIn 2018, two sets of questions were added to our SM patient intake questionnaire to assess (1) smoking history and (2) interest in referral to the health center-based tobacco cessation program for mailed information, telephone-based consultation, and in-person counseling. Primary outcomes were proportion of current smokers who requested a referral and of all smokers who were LCS-eligible. Bivariate logistic regression analyses compared sociodemographic characteristics of smokers who requested versus declined a referral.ResultsOf the 89.3% (1,907 of 2,136) who responded, 10.5% (201 of 1,907) were current and 29.1% (555 of 1,907) were former smokers. Of current smokers, 26.4% (53 of 201) requested referrals: mailed information by 23.9% (48 of 201), in-person counseling by 9% (18 of 201), and telephone-based consultation by 7.5% (15 of 201). No sociodemographic predictors for referral requests were identified. Of all smokers, 9.3% (70 of 756) were eligible for LCS, of which 31.4% (22 of 70) were up to date.ConclusionOne in ten women who underwent SM at our community health center were current smokers, of which one-quarter requested tobacco cessation referrals. Among LCS-eligible smokers, one-third were up to date. SM presents opportunities for radiology practices to advance population health goals such as tobacco cessation and LCS.     

Military tobacco policies: the good, the bad, and the ugly

The United States military has the legacy of a pro-tobacco culture and still has prevalence rates of tobacco use that are higher than their civilian counterparts. One tactic for decreasing use and the subsequent health problems is through effective tobacco control policies. We collected available tobacco control policies from all four branches of the military and, through qualitative analysis, identified policies that were unique either as providing more or less detail and restriction than peer group policies. Best and worst practice policies in the areas of enforcement, smoking cessation, smokeless tobacco use, environmental tobacco smoke, framing tobacco as non-normative, designated tobacco use areas, and monitoring of tobacco use are presented. Because policy making can be an effective tool for improving the health of military members, understanding what policy components are comparatively positive or negative is an important tool for health advocates both in the military and civilian settings.     

Improving Lung Cancer Screening Access for Individuals With Serious Mental Illness

Lung cancer continues to be the leading cause of cancer mortality in the United States across all races and ethnicities, but it does not affect everyone equally. Individuals with serious mental illness (SMI), including schizophrenia and bipolar disorder, experience two to four times greater lung cancer mortality in part due to high rates of smoking, delays in cancer diagnosis, and inequities in cancer treatment. Additionally, adults with SMI experience patient, clinician, and health care system–level barriers to accessing cancer screening, such as cognitive deficits that impact understanding of cancer risk, higher rates of poverty and social isolation, patient-provider communication challenges, decreased access to tobacco cessation, and the fragmentation of primary care and mental health care. Despite the proven benefits and mandated coverage by public and private payers, lung cancer screening participation rates remain low among eligible patients, below 4% a year. Given disparities in other cancer screening modalities, these rates are likely to be even lower among individuals with SMI. This article provides a brief overview of current challenges in lung cancer screening and describes a pilot collaboration between radiology and psychiatry that has potential to improve access to lung cancer screening for individuals with serious mental illness.     

CT-Screening für Lungenkrebs

Lung cancer is by far the most frequent type of cancer worldwide and in particular the most frequent cause of cancer deaths. The most important risk factor is smoking and abstinence is therefore the most effective primary prevention for lung cancer. As even ex-smokers live under elevated lung cancer risk for years and additionally not all smokers are willing to stop smoking or attempts to stop fail, early detection by low-dose multislice computed tomography (MSCT) is a realistic option for secondary prevention. First results from the USA appear supportive for this view but important issues still remain unresolved, such as overdiagnosis, screening interval and how to control the rate of false positive findings. European trials in parallel to the USA National lung screening trial (NLST), including a German trial will also address these issues and will thus be continued. Before the final analysis in several years time routine lung cancer screening with MSCT cannot be recommended and MSCT lung screening can only be performed within the framework of studies.     

The Patient Perspective on Lung Cancer Screening and Health Disparities

Lung cancer screening is just starting to be implemented across the United States. Challenges to screening include access to care, awareness of the option for screening, stigma and implicit bias that are due to stigmatization of smoking, stigma of race, nihilism with lung cancer diagnosis viewed as a “death sentence,” shared decision making, and underestimation of lung cancer risk. African Americans (AA) have the highest lung cancer mortality rate in the United States despite similar smoking rates as whites. AAs are diagnosed at a later stage, and there is a greater likelihood they will refuse treatment options when diagnosed. Additionally, fewer AAs were found to meet lung cancer screening eligibility criteria compared with whites because of lower tobacco exposure and younger age at time of diagnosis. Outreach and access for lung cancer screening in the AA community and other subpopulations at risk are critical to avoid further increasing disparities in lung cancer morbidity and mortality as lung cancer screening is implemented across the United States. The path forward requires implementing outreach programs and providing lung cancer screening in underserved communities at high risk for lung cancer; consideration of using National Comprehensive Cancer Network guidelines for screening selection criteria, including risk model screening selection; and developing interventions to address stigma, clinician implicit bias, and nihilism.     

Smoking status and smoke-related gingival melanin pigmentation in army recruitments

This study aimed to define the smoking status and smoke-related gingival melanin pigmentation in army recruitments and was conducted with army recruitments in Sivas. Nine hundred eight subjects were examined. The oral and dental health of those subjects was checked and recorded. The smoking status of the subjects was self-reported and recorded on questionnaires by researchers. The chi2 test and Kruskal-Wallis test were used for statistical analysis. More than one-half of the subjects (54.3%) were primary school graduates and the mean age was 20.2 +/- 0.95 years. The response rate regarding smoking was 100%. Of the respondents, 596 (65.7%) were current smokers, 12 (1.3%) were former smokers, and 300 (33.0%) were never smokers. The gingival melanin pigmentation rate was 27.5% in current smokers and 8.6% in those who never smoked (p = 0.000). Smoking five to nine cigarettes a day appeared to be sufficient to cause gingival melanin pigmentation. The proportion of smokers who had melanin pigmentation did not change after 10 cigarettes a day. A rehabilitation project on smoking prevention and smoking cessation for army recruitments is urgently needed.     

Seven steps of gradual cessation of smoking--an example from India

BACKGROUND/AIM: [corrected] One sixth of smokers in the world live in India. The National Family Health Survey showed that individuals with no education were 2.69 times more likely to smoke and chew tobacco than those with postgraduate education. Whether the physicians' interaction with public can cause the smoking cessation or habit by detailing the harmful effects as well as benefits of cessation without any withdrawal effects? Our aim was, therefore, to help people to stop smoking step by step. METHODS: The study was conducted at the University Student Health Care Centre, Banaras Hindu University, Varanasi, India, from June 2004 to February 2005. A total of 1,200 students smokers (graduate, post graduate or research scholars) participated. They were from 17 to 32 years old (mean age, 26 years). All were male sex. Each and every student was explained in details risks and hazards, and benefits of cessation, focusing this latter on immediate and substantial benefits at any sex and age; their every question and quarries were explained. All were told that either they should stop smoking immediately or minimized step by step. The seven steps were explained to them. RESULTS: The smoking duration was one year and more in all the participants ranging from one to 15 years; the average period of smoking was five years and six months; the number of smoked cigarettes per day was 12 on average (5-20). In 450/1200 (37.50%) students, either of any family members were smoking while 200 (16.66%) students have been inspired from their friends. The majority of 780/1200 (65%) gave-up smoking at any step as advised. The followup could not be done in 80/1200 (6.6%) students who did not report at any of the stages. Finally, 340/1200 (28.0%) students either reduced the number or failed to give-up smoking. CONCLUSION: The results of the study are very encouraging. Such interaction type of doctors with smokers will not only help to the concerned person but also to the society.     

Crazy vaping and crazy-paving,a case of E-Cigarette/Vaping-Associated Lung Injury (EVALI) with chest CT showing crazy-paving pattern

E-cigarettes are devices that generate an aerosol by heating a fluid containing multiple chemicals, such as nicotine, additives, and flavorings. They were developed to aid in smoking cessation and were promoted as socially acceptable, healthier, cheaper than conventional cigarettes. Multiple lung disorders related to e-cigarette use are reported, and they range from mild cases of pneumonitis to life-threatening lung disorders that may require intubation and mechanical ventilation. Most of the complications are due to the generation of various unknown and potentially harmful chemicals within the aerosol generated in the e-cigarette. These disorders are known collectively as e-cigarette/Vaping-associated lung injury (EVALI). E-cigarettes are marketed as safer alternatives to traditional cigarettes, with the highest rates of use are noted in young smokers. Given the significant prevalence of e-cigarettes use and their pulmonary complications, EVALI should be considered a potential etiology in the broad differential diagnosis of patients with pulmonary disease and a history of vaping. Herein, we present a case of cryptogenic organizing pneumonia with a chest C.T. showing a crazy-paving pattern in a patient with a history of vaping.     

Deposition of cigar smoke particles in the lung: evaluation with ventilation scan using (99m)Tc-labeled sulfur colloid particles.

This study examined the degree to which cigar smokers inhale when they smoke cigars. A second objective was to assess the level of association between self-reported inhalation and observable cigar particle deposition in the lung. We hypothesized that cigar smokers with a history of cigarette smoking would show a greater amount of smoke deposition than would cigar smokers with no history of cigarette smoking. We conjectured that self-reported cigar smoke inhalation would be a reliable predictor of observable smoke particle deposition in the lung. METHODS: Twenty-four male cigar smokers were recruited to participate in the study. Twelve of the participants were current or past regular cigarette smokers, and the remaining 12 participants had no history of cigarette smoking. The volunteers completed an anonymous questionnaire commenting on the frequency of their current cigarette and cigar use as well as the degree to which they inhale when they smoke cigars. Volunteers smoked a cigar through a holder that permitted cigar smoke to mix with a radioaerosol of (99m)Tc-labeled sulfur colloid particles. The total radioactivity administered to each volunteer was 100 MBq. Lung ventilation scanning was subsequently performed. RESULTS: Total lung counts showed that volunteers inhaled the cigar smoke to varying degrees, although 100% of nonsmokers and 58% of smokers in the study reported that they never or rarely inhaled when they smoked cigars. With respect to total lung counts, smokers as a group inhaled less than their nonsmoking counterparts; however, this difference reflected a trend in the data and did not reach statistical significance. CONCLUSION: Contrary to the widely held belief that cigar smokers do not inhale when they smoke cigars, we concluded that cigar smoke is inhaled regardless of self-reported inhalation and smoking history.     

Lung cancer screening: Computed tomography or chest radiographs?

Worldwide, lung cancer is the leading cause of mortality due to malignancy. The vast majority of cases of lung cancer are smoking related and the most effective way of reducing lung cancer incidence and mortality is by smoking cessation. In the Western world, smoking cessation policies have met with limited success. The other major means of reducing lung cancer deaths is to diagnose cases at an earlier more treatable stage employing screening programmes using chest radiographs or low dose computed tomography. In many countries smoking is still on the increase, and the sheer scale of the problem limits the affordability of such screening programmes. This short review article will evaluate the current evidence and potential areas of research which may benefit policy making across the world.     

Smoking-related attitudes, characteristics, and opinions in a group of young men with asthma.

The objective of this study was to examine the attitudes, characteristics, and opinions about smoking of a group of young asthmatic men. POPULATION AND METHODS: An anonymous, personal questionnaire was administered to 611 young male volunteers who had been diagnosed with asthma (according to the National Heart, Lung, and Blood Institute/World Health Organization Global Initiative for Asthma, 1995) in the respiratory disease and allergy clinics of the Burgos Military Hospital (Spain). This questionnaire contained items related to personal information, asthma characteristics, opinions about smoking, and information related to smoking habits. RESULTS: Six hundred patients with asthma completed the questionnaire. All were men, mean age 20.16 +/- 3.03 years; 189 (31.5%) were smokers and 16 (2.5%) were ex-smokers. Mean age at onset of regular smoking was 16.46 +/- 2 years. Sixty-five percent (65.07%) smoked fewer than 10 cigarettes per day. Most of the smoking asthmatics had mild asthma (58.9%). Eighty-eight percent (88.3%) had moderate dependence. Many of the smoking asthmatics were contemplating stopping smoking (54%), and 59% had tried before to stop. Concern about health was the main reason given for stopping smoking. Asthmatics who smoked had a higher percentage of smokers among family members, friends, and colleagues than nonsmoking asthmatics. Attitudes toward smoking were more permissive among smoking asthmatics. Only 36.64% of the total had received information about tobacco previously. In the sample group, 7% claimed that they did not smoke but their carbon monoxide concentration in exhaled air was 10 ppm or higher. CONCLUSIONS: There were no differences in the onset of the smoking habit between asthmatic and nonasthmatic young people. A large percentage of the smoking asthmatics were considering smoking cessation, motivated mainly by their asthma condition. The group as a whole had little previous information about tobacco.     

吸烟与新兵基础训练损伤关系的调查分析

目的　研究吸烟对新兵基础训练的影响。方法　采用问卷调查方式 ,询问参训的新兵吸烟的数量和时间。结果　吸烟人群与不吸烟人群训练伤的发生有非常显著性差异 ,吸烟人群明显高于不吸烟人群。每天吸烟≥ 5支 ,吸烟时间≥1年 ,容易发生训练伤。吸烟人群训练伤主要发生在训练的后期。结论　长期大量吸烟对军训损伤是一个危险因素。     

Implementation and Uptake of Rural Lung Cancer Screening

ObjectiveGiven the higher rates of tobacco use along with increased mortality specific to lung cancer in rural settings, low-dose CT (LDCT)-based lung cancer screening could be particularly beneficial to such populations. However, limited radiology facilities and increased geographical distance, combined with lower income and education along with reduced patient engagement, present heightened barriers to screening initiation and adherence.MethodsIn collaboration with community leaders and stakeholders, we developed and implemented a community-based lung cancer screening program, including telephone-based navigation and tobacco cessation counseling support, serving 18 North Texas counties. Funding was available to support clinical services costs where needed. We collected data on LDCT referrals, orders, and completion.ResultsTo raise awareness for lung cancer screening, we leveraged our established collaborative network of more than 700 community partners. In the first year of operation, 107 medical providers referred 570 patients for lung cancer screening, of whom 488 (86%) were eligible for LDCT. The most common reasons for ineligibility were age (43%) and insufficient tobacco history (20%). Of 381 ordered LDCTs, 334 (88%) were completed. Among screened patients, 61% were current smokers and 36% had insurance coverage for the procedure. The program cost per patient was $430.DiscussionImplementation, uptake, and completion of LDCT-based lung cancer screening is feasible in rural settings. Community outreach, health promotion, and algorithm-based navigation may support such efforts. Given low lung cancer screening rates nationally and heightened lung cancer risk in rural populations, similar programs in other regions may be particularly impactful.     

Cme credit quiz

In brief: Despite major medical advances, life expectancy has increased relatively little over the past 35 years. Most of today's serious illnesses are related to such chronic conditions as heart disease, cancer, and arteriosclerosis, rather than to acute infectious diseases. These chronic diseases affect the national economy as well as the health of individuals. Many authorities believe that 50% to 80% of the deaths related to these conditions could be prevented or postponed through proper nutrition, weight control, exercise, smoking cessation, and stress management. Accordingly, physicians should take a more active role in disease prevention efforts. A procedure for physicians to use in health assessment and risk management for M individual patients is outlined.     

无锡市社区卫生服务中心人员学历对控烟认知的影响

目的了解无锡市社区卫生服务中心工作人员有关控烟知识的基本情况，为项目的进一步开展提供科学依据。方法整群抽样，采用《无烟医疗卫生机构基线调查（社区卫生）》调查问卷，对无锡市城区所有的23个社区卫生服务中心工作人员进行问卷调查。结果1319名调查对象的教育程度按初等、中等、高等分别为13人（0．94％）、467人（35．41％）、839人（63．64％），吸烟率为10．46％，吸烟者均为男性。结果显示吸烟率、日均吸烟量随教育程度升高而减少；吸烟、不吸烟者对吸烟危害性的认识均处于较高水平，不同学历组间无差异；对二手烟危害的基本认识、希望控烟及控烟政策严厉性等方面则随着学历的升高而升高；对二手烟可致“成人心脏病”的认识不同学历组均处于相对较低的水平，各组间无差异。结论社区卫生服务中心工作人员主要由高、中等学历人员组成，吸烟率、日均吸烟量和综合性医院相似，对控烟均有较好的认识．但二手烟对机体损害的知识有待于加强。     

The cigarette manufacturers' efforts to promote tobacco to the U.S. military

This article describes findings from review of tobacco industry documents regarding promotion of tobacco to the military, and efforts to influence Department of Defense policies regarding the use and sale of tobacco products. The documents reveal that the industry has targeted the military for decades for reasons including: (1) the volume of worldwide military personnel; (2) the opportunity to attract young men who fit a specific socioeconomic and cultural profile; (3) potential carryover of profits to civilian markets; and (4) the unusual price structure of commissaries and exchanges. The industry used distinctive promotion methods such as in-store merchandising, sponsorships, and even brand development to target the military, both in the United States and abroad during times of conflict. Legislative activity to protect tobacco promotion to this vulnerable population was carried out in response to smoking policy changes proposed by the Department of Defense. The tobacco industry has contributed to the high prevalence of smoking in the military and among veterans.     

A submarine shipboard smoking cessation program

The discouragement of tobacco abuse in the military requires effective smoking cessation assistance for all active duty and dependent personnel. Specifically tailoring this assistance to the unique features of the various military communities will help to make it more effective. The program presented herein was designed for use in the submarine fleet. It combines basic proven workplace smoking cessation techniques with lessons learned from experience in submarines. It is believed that other military populations can benefit from similar efforts. This paper is an abridged version of the author's Submarine Medical Officer qualification thesis.