Flavored E-cigarette Use and Cigarette Smoking Reduction and Cessation—A Large National Study among Young Adult Smokers

Background: E-cigarette use prevalence has increased drastically among young adult cigarette smokers in recent years. Objectives: This study seeks to understand which e-cigarette flavors—sweet and fruity or tobacco and menthol/mint—are more likely to be associated with smoking reduction and cessation among young adults. Methods: Longitudinal data (waves 1 and 2) of the Population Assessment of Tobacco and Health (PATH) Study from young adult (aged 18–34) cigarette smokers (n = 4,645) at wave 1 and current e-cigarette users (n = 844) at wave 2 were used. Univariate and multivariate regressions were conducted to examine the associations between past-year smoking reduction and cessation and current e-cigarette flavor use at wave 2. Results: At wave 2, 25.9% of respondents either reduced or quit smoking, and 6.7%, 5.2%, and 6.3% of them reported currently using e-cigarettes with tobacco/menthol (TM) flavors, one non-tobacco/non-menthol (NTM) flavor, and multiple NTM flavors, respectively. E-cigarette users with one (AOR = 2.5, p < 0.001) and multiple NTM flavors (AOR = 3.0, p < 0.001) were more likely to have reduced or quit smoking over the past year compared to non-e-cigarette users. NTM flavor use was positively associated with e-cigarette use of a higher frequency and larger amount. Conclusions: The positive association between past-year smoking reduction and cessation and current NTM flavored e-cigarette use may be explained by young adults' escalated e-cigarette use with NTM flavors. Public health professionals should prevent and reduce multiple tobacco use through enhanced education about the harm of vaping NTM flavors and by advising young adult smokers to quit tobacco altogether using evidence-based methods.     

Exposure to medicines among patients admitted for hip fracture and the case-fatality rate at 1?year: a longitudinal study

Purpose

To describe the demographic and clinical characteristics and the pre-fracture exposure to medicines of patients admitted for a hip fracture, and to explore their association with fatal outcome 1?year after the fracture.

Methods

All patients ≥65?years old admitted for a hip fracture in a tertiary hospital in Barcelona between January 1 and December 31 2007 were included. Data on the patients’ clinical characteristics before and during hospital admission and on pre-fracture exposures to medicines were collected from the clinical records. One-year mortality was checked by approaching the patients and their families and was cross-checked with the national mortality statistics database. A Cox proportional hazards analysis was carried out.

Results

Four hundred and fifty-six patients [mean age (SD) 82.9 (7.2) years, 73.5?% female], were admitted with hip fracture during the study period. Almost 80?% of the patients (363, 79.6?%) had three or more associated conditions, and 41.7?% received pre-fracture treatment with five or more drugs. The case-fatality rate during hospital admission was 4.6?% (21 patients). One hundred and seven patients died within 1?year (23.5?%). Advanced age, male gender, two or more associated chronic conditions, cancer, severe cognitive impairment, and treatment with opiates before fracture were significantly associated with the risk of dying. An inverse association was recorded between mortality and pre-hospital exposure to medicines for osteoporosis.

Conclusions

One-quarter of patients admitted for hip fracture died within 1?year after the fracture. Exposure to opiates before hip fracture was associated with an increased 1-year death rate, whereas treatment with drugs for osteoporosis was associated with a decrease in death rate. These results should be confirmed in studies with detailed prospective collection of information on exposure to medicines.     

Trends in adolescent substance use: The Mokotów study 1988–2004

This study, conducted every 4 years since 1984, is aimed at monitoring alcohol, tobacco, tranquillizers and illegal drug-use trends among 15-year-olds from Warsaw. The self-report data are taken from a representative sample of students attending schools in three districts of Warsaw (sample size ranged from 1461 to 3918 in the different study waves). Between late 1980s and mid-1990s a significant increase in youth substance use, including alcohol, cigarettes and illegal drugs, has been documented. The most recent results (from 2000 to 2004) indicated stabilization in alcohol and illegal drug use and decrease in tobacco use. The trend in the use of tranquillizers/sleeping pills was relatively stable over the past 16 years. However, changes in adolescent substance use differ across gender. While boys as a group became more restrained in substance use, girls remained at the same level or continued to show increasing trends (e.g. in getting drunk). These differences reflect changes in young female risky behaviours.     

Alcohol use among abused and non-abused older persons aged 60–84 years: An European study

Aims: Describing alcohol use by abuse type (e.g. psychological) and considering other factors (e.g. depression).

Methods: The respondents were 4467 (2559 women, 57.3%) randomly selected elders (60–84 years) from seven European cities. The cross-sectional data were collected with scales covering various areas and examined with bivariate/multivariate methods.

Findings: Psychologically abused elders were more often alcohol users than non-users (21.7% vs. 16.3%) and the opposite regarding financially abused elders (4.8% vs. 3.5%). Psychologically abused elders also had more often three or more drinks containing alcohol in a drinking day (21.1% vs. 16.1%) and six or more drinks on one occasion (24.5% vs. 18.3%). Psychological abuse, demographics/socio-economics (e.g. education), smoking and leisure activities were positively associated alcohol use, and being from certain countries (e.g. Italy), age (e.g. 80–84 years), depression and financial abuse negatively.

Conclusions: Across countries, 64.2% of the elders were drinkers. Some variables (e.g. psychological abuse) were positively related to alcohol use and others (e.g. depression) negatively. Many of the elders were exposed to abuse. Our findings may be useful to prevent/manage drinking and abuse among elders. However, alcohol use was influenced by various factors that need to be further elucidated, particularly the relation between abuse and drinking.     

The effect of long-term danazol prophylaxis on liver function in hereditary angioedema—a longitudinal study

Background

Danazol is a drug most widely used for the prophylaxis of hereditary angioedema resulting from the deficiency of the C1-inhibitor. Potential hepatotoxic or liver tumor-inducing side effects of long-term danazol prophylaxis have been investigated during the follow-up of hereditary angioedema patients.

Methods

Characteristic parameters of liver function (including bilirubin, GOT, GPT, γGT, total protein, ALP, LDH), as well as findings of viral serology screens and abdominal ultrasonography—determined during years 0 and 5 of follow-up of patient groups taking/not taking danazol—have been reviewed and analyzed comparatively.

Results

From a population of 126 hereditary angioedema patients, 46 subjects taking danazol and another 46 not taking danazol fulfilled the inclusion criteria. Longitudinal follow-up did not reveal any clinically relevant difference between the liver function parameters determined in years 0 and 5 in the two groups. Abdominal ultrasound did not detect neoplastic or other potentially treatment-related alterations of the liver parenchyma. There were no discontinuations of treatment during the study.

Conclusions

Our results clearly suggest that, administered at the lowest effective dose, danazol does not induce liver injury in hereditary angioedema patients.     

Antimicrobial use and drug–drug interactions among nursing home residents in Singapore: a multicentre prevalence study

Background With the Ministry of Health’s projected increase in nursing home beds and optimization of antimicrobial use in health care settings, it is therefore timely to consider baseline prevalence and patterns of antimicrobial use at nursing homes in Singapore as well as to evaluate the prevalence of potential clinically significant drug–drug interactions involving antimicrobials. Objective The primary objective was to determine the prevalence and patterns of antimicrobial use at nursing homes in Singapore. The secondary objective was to evaluate the prevalence of potential clinically significant drug–drug interactions involving antimicrobials. Setting Four nursing homes in Singapore. Method A retrospective cross-sectional study was conducted among nursing home residents. The antimicrobial prevalence, defined daily doses, days of therapy, and potential drug–drug interactions were determined using data from archived resident medication prescribing and administration records. Main outcome measure Prevalence and patterns of antimicrobial use, drug–drug interactions involving antimicrobials. Results Among 707 residents (mean age: 80.7?±?8.8 years, female: 57.1%), 10% used antimicrobials during the study month, with a 1-day point prevalence of 3%. The utilization rates of antimicrobials were 28.9 defined daily doses/1000 resident-days and 24.8 days of therapy/1000 resident-days. Potential drug–drug interactions involving antimicrobials were identified among 32 of the 70 (46%) residents who were prescribed antimicrobials. Of these, 26 (81%) residents had 43 potential clinically significant drug–drug interactions. Conclusions The prevalence and utilization rates of antimicrobial use in Singapore nursing homes appear to be low. Yet, potential clinically significant drug–drug interactions are prevalent.     

Current Frequent Cigarette Smoking Among U.S. Middle and High School Students, 2000–2011

This study assessed trends in current frequent smoking among United States middle and high school students. Methods: Data were obtained from the National Youth Tobacco Survey (2000–2011). Current frequent smoking was defined as smoking cigarettes on ≥20 days during the past 30 days. Trends were assessed using linear coefficients in a binary logistic regression (p < 0.05). Results: Current frequent cigarette smoking among all students declined between 2000 (6.4%) and 2011 (3.6%) (p < 0.001 for linear trend). Significant declines were observed by age, sex, race/ethnicity, school and grade level. Conclusion: Sustained efforts are needed to further reduce youth use of all tobacco products.     

‘Vaping and fidget-spinners’: A qualitative,longitudinal study of e-cigarettes in adolescence

BackgroundWe see the contours of a cigarette-free adolescent cohort in Norway. Simultaneously, increasing use of vaping devices among adolescents internationally, and in the US in particular, has evoked fear of a new nicotine-addicted generation. This longitudinal study explores the vaping phenomenon in a context where nicotine e-liquid is still prohibited.MethodsData are from longitudinal, qualitative interviews with a sizable sample of 12-17 year olds (118 8^th graders from 6 schools/classes at baseline). Four follow-ups were conducted from 2015 to 2019 (a total of 50 semi-structured group and 175 individual interviews). The interviews were coded using HyperResearch software and thematically analysed in the light of actor network and interaction ritual theory.ResultsGradual and collective shifts in vaping practices and in the symbolic meaning of vaping were observed in three phases. First, in 8^th grade, few had tried to vape, even if several were curious about this novel invention, practice and the available flavours. Second, after 9^th grade, one in three reported personal use. They emphasised harmlessness, coolness, performance and accessibility online. However, by the end of middle school, a third phase became visible; vaping had lost status and was described as ‘childish’ and unpopular. Interviewees repeated the lack of relevance in high school, comparing e-cigarettes with the fidget-spinner and reserving vaping for kids and addicted adult smokers. The analysis displays a systematic pattern in which adolescents account for vaping as a time-limited trend.ConclusionE-cigarettes were devalued from novelty and transgression to childish and uninteresting within the same sample over a four-year period. In conclusion, e-cigarettes in the sample represented fashionable experimentation rather than steady user patterns.     

Time to change – an exploratory study of motivation among untreated and treated substance abusers

This exploratory study examines whether the attitudes towards change and treatment of untreated non-abstinent substance abusers differ from those of patients undergoing treatment in residential care. The sample (n?=?97) consists of untreated, voluntarily and compulsorily treated substance abusers who completed a questionnaire in 2003. Attitudes were measured with scales on e.g. problem recognition, desire for help, treatment readiness and aspects of time perspectives, e.g. past, present and future orientation. The attitudes of the three groups?–?untreated, voluntarily and compulsorily treated subjects?–?differed with respect to lifestyle change. Factor analysis of the measures revealed one component of primary interest, general willingness to change. Results show that willingness to change was correlated with other attitudinal characteristics in the three groups. The stability of substance abusers’ motivation is discussed with the focus on different social contexts’ influence on change-compliant attitudes and behaviour.     

The Variability of Drinking Patterns and Problems among Young Men,Age 16–31: A Longitudinal Study

This paper utilizes a longitudinal design to explore the relationship between problem drinking in adolescence and problem drinking in later life. Specifically, the issues investigated include the degree to which there is a continuity or lack of continuity of involvement in a particular pattern of drinking between adolescence and young adulthood, and an assessment of the usefulness of adolescent correlates of drinking for understanding adult patterns of drinking. The results indicate that there is little continuity in drinking behavior across time, and that while an explanatory model using as independent variables the impact of negative peers, family social class, family support, and high school success is successful in predicting alcohol involvement at age 18, this model is of little utility in predicting alcohol involvement at age 31.     

Aspirin Use among Saudi Adults: The Prevalence and Users’ Characteristics

IntroductionDespite the public routine use of aspirin as cardio-prophylaxis agent, its use is only recommended in particular situations, and not as usual primary prevention. Only few local studies investigate the use of aspirin in patients with certain diseases, but not within the public population. The purpose of this study was to evaluate the prevalence of aspirin use and identify the demographic and clinical characteristics among Saudi users.MethodologyA cross-sectional study targeting Saudi adults in Saudi Arabia was conducted over a period of four months in 2021 using online Google forms. The study collected data to assess the prevalence of use, use of aspirin according to prevention type, users’ characteristics and comorbidities. Additionally, a self-assessment of knowledge, perception, reasons and attitude towards aspirin use among Saudi adults was conducted. A chi-square test was used to determine the association between the variables. A P-value ≤ 0.05 was considered statistically significant.ResultsThe prevalence of aspirin use was 47%. Regarding the self-assessed aspirin knowledge, the majority of the respondents (n = 481; 62.4 %) found to have good knowledge. Less than half of the participants (n = 341; 44%) use aspirin as primary prevention agent while only 23 participants (2.9%) use aspirin as secondary prevention agent. There was a significant difference between gender and user type (p = 0.001). With regards to comorbidities, hypertension, hyperlipidemia, diabetes, and obesity were common among the primary users of aspirin. Significant associations were found (p = 0.001) between participant’s user type and the following characteristics such as smoking status, past medical history, presence of comorbidities.ConclusionAspirin use is commonly prevalent Saudi population with good level of knowledge of the therapy; however, its popular use as primary preventive agent for CVD may necessitate medical advice based on the level of cardiovascular risk.     

Positive Affect as a Predictor of Smoking Cessation and Relapse: Does It Offer Unique Predictive Value among Depressive Symptom Domains?

Background: Prior studies have suggested that, among the domains of depressive symptoms, low positive affect (PA) may have a distinct relationship with smoking cessation and relapse. However, the empirical basis for PA-focused interventions cessation is limited, with some mixed findings. Objectives: Using a large, diverse sample of treatment-seeking smokers, this study tested the hypothesis that PA adds unique predictive value beyond the effects of the other symptom domains in models of cessation and relapse. Methods: Adult smokers participating in a smoking cessation trial (n = 450) were included in this post hoc analysis. Cessation outcomes included smoking abstinence at end of treatment and at 6-month follow-up. Relapse was defined as recurrence of smoking at 6-month follow-up among the end-of-treatment abstainers. Depressive symptoms were assessed at baseline using the Center for Epidemiologic Studies-Depression (CES-D) scale. Results: With the exception of PA, all of the CES-D domains predicted reduced likelihood of smoking abstinence at end of treatment and cotinine-confirmed (but not self-reported) abstinence at 6 months, as did total CES-D score (all p-values < .05). None of the symptom domains predicted relapse. Conclusions/Importance: Our results provide further evidence that current depressive symptoms predict worse cessation outcomes, but they fail to support recent work suggesting that low PA has incremental predictive value for cessation or relapse beyond the other depressive symptom domains. To improve quit rates for smokers with depressive symptoms, evidence-based mood management interventions should be included in treatment planning.     

Cost effectiveness of rivaroxaban versus warfarin among nonvalvular atrial fibrillation patients in Saudi Arabia: A Single–Center retrospective cohort study

BackgroundRivaroxaban is a novel oral anticoagulant (NOAC) that is commonly used for stroke prevention among patients with atrial fibrillation (AF). However, its cost effectiveness in reducing the risk of hospitalization and mortality in comparison to warfarin among nonvalvular AF patients in Saudi Arabia is largely unknown.MethodsThis was a single-center retrospective chart review of adult patients (≥18 years) with nonvalvular AF who were treated with warfarin or rivaroxaban for at least 12 months. Patients with mitral valve stenosis were excluded from the study. Multiple logistic regression was conducted to examine the risk of hospitalization and mortality as a composite outcome, and all annual healthcare costs were captured. Inverse probability treatment weighting with bootstrapping was conducted to determine the mean costs and effectiveness rates.ResultsTwo-hundred and twenty-six patients (142 on rivaroxaban and 84 on warfarin) met the inclusion criteria and were included in the analysis. Most of the patients were females (65.91 %), had diabetes (50.57 %) and hypertension (73.76 %), and with a mean age of 68.95 ± 12.55 years. No significant difference in the odds of the composite outcome for rivaroxaban versus warfarin was found (OR = 0.785, 95 % CI = [0.427–1.446], p = 0.443). Rivaroxaban resulted in a mean annual cost saving of $13,260.79 with an 87.65 % confidence level that it would be more effective than warfarin with a mean difference in effectiveness rate of 0.168 % (95 % CI [-5.210–18.36]).ConclusionRivaroxaban was associated with lower direct medical costs and non-inferior effectiveness among nonvalvular AF patients in comparison to warfarin.     

The comparative study of Sprague–Dawley and Lewis rats in adjuvant-induced arthritis

The outbred Sprague–Dawley (SD) rats, similar to the inbred Lewis (LEW) rats, have been recently demonstrated to be highly susceptible to adjuvant-induced arthritis (AIA). We herein compared AIA in SD and LEW rats in terms of clinical, histological, radiological, and immuno-inflammatory features. The results showed that, following inoculation with a ground Mycobacterium tuberculosis (MT) suspension, SD and LEW rats manifested closely similar disease progression, with 100% incidence and similar severity. The development of arthritis was accompanied by significantly higher erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) levels than in control rats. Radiographic examination of the hind paws showed that both SD and LEW AIA rats manifested conspicuous soft tissue swelling, bone matrix resorption, periosteal new bone formation and bone erosion, while histopathological analysis of the synovial joints revealed marked cellular infiltration, angiogenesis, synovial hyperplasia, pannus formation, narrowing of joint space, and cartilage and bone destruction. Moreover, in relation to disease progression, serum tumor necrosis factor-α (TNF-α), interleukin-1β (IL-1β), and IL-6 levels were markedly overexpressed in both SD and LEW AIA versus control rats, and SD and LEW AIA rats exhibited divergent profiles for the expression of TNF-α and IL-1β. Taken together, these results demonstrated that the SD rat AIA model shares several arthritic features with the comparable model in LEW rats. Hence, given the more favorable characteristics of SD rats than LEW rats (i.e., lower cost, wider availability, and heterogenic background), this SD rat AIA model is more cost effective and advantageous for screening and testing novel anti-arthritic agents.