Maternal trajectories of cigarette use as a function of maternal age and race

BackgroundPatterns of smoking vary as a function of age and race. The goals of this study were to identify trajectories of maternal cigarette use over a 17-year span, and to determine if maternal age at first birth and race were associated with smoking trajectories.MethodsPregnant women (N = 690) were recruited at an urban prenatal clinic. The women (13–42 years old; 62% African-American, 38% White) were interviewed about cigarette use during pregnancy and 6, 10, 14, and 16 years postpartum. Growth mixture modeling (GMM) was used to identify trajectories. Regressions were used to determine if maternal age at first birth and race predicted trajectory class membership.ResultsA GMM of maternal cigarette use delineated 5 groups: none/unlikely to use (33%), decreasing likelihood of use (6%), late desistance (5%), increasing likelihood of use (17%), and chronic use (39%). Women who became mothers at a younger age were more likely to be classified as late desisters or increasingly likely to smoke. White mothers were more likely to be chronic smokers. Different smoking trajectories and predictors of trajectories were identified for the African-American and White mothers. Covariates including prenatal substance use, hostility, education, and economic hardship also differentiated smoking trajectories.ConclusionsBoth prevention and treatment of smoking should be targeted to specific groups by age of first pregnancy and race. Pregnant smokers should be provided with more information and resources to help them avoid cigarettes during pregnancy and maintain abstinence after pregnancy.     

Examining characteristics associated with quitting smoking during pregnancy and relapse postpartum

IntroductionSmoking during pregnancy is a significant public health concern that can cause adverse health outcomes for both the mother and fetus. Studies have shown only 40% of women quit smoking during pregnancy, with more than half relapsing within 6 months, and up to 90% relapsing within one year. This study investigates differences in demographics and smoking-related symptomatology between pregnant smokers and pregnant quitters, as well as factors associated with postpartum relapse.MethodsData on pregnant smokers and pregnant quitters were obtained from two separate parent studies. Data on smoking demographics and smoking-related symptomatology were collected at screening visits.ResultsCompared to pregnant smokers, pregnant quitters had more favorable smoking characteristics (e.g., smoked fewer cigarettes per day, reported higher motivation for abstinence and less dependency). They also had more favorable relationship characteristics (e.g., were more likely to be married, less likely to have a significant other who smokes) and had less reproductive liability (e.g., fewer pregnancies, fewer children). In terms of symptomatology, pregnant quitters reported more positive affect, negative affect, physical symptoms and withdrawal but less craving. Predictors of postpartum relapse included increased maternal age, having a significant other who smokes and an increased likelihood of returning to smoking after pregnancy (self-reported prior to delivery).ConclusionsSeveral demographics and smoking-related symptomatology were significantly different between pregnant quitters and pregnant smokers. In addition, multiple factors predicting postpartum relapse were identified. This information can inform personalized interventions for high risk pregnant smokers and pregnant quitters at risk for postpartum relapse.     

A comparison of active and passive smoking during pregnancy: long-term effects

Previous research has determined that maternal smoking during pregnancy is associated with negative effects for the child at birth and throughout childhood. Much less is known about the consequences of exposure to secondary smoke during fetal development. The present study investigates and compares the long-term consequences of active and passive smoking during pregnancy. Ninety-one children between the ages of six and nine years were tested using a comprehensive neuropsychological test battery. After considering potential confounds, children of nonsmoking mothers generally were found to perform better than the two smoking groups on tests of speech and language skills, intelligence, visual/spatial abilities and on the mother's rating of behavior. The performance of children of passive smokers was found, in most areas, to be between that of the active smoking and nonsmoking groups. It was concluded that there is a continuum of long-term smoking effects and that, although active maternal smoking is associated with effects of greater breadth and magnitude than passive maternal smoking, children of passive smokers are also at risk for a pattern of negative developmental outcomes.     

People Who Use Drugs as Agents of Change: Peer-to-Peer Education as a Force for Positive Change

Background: Over 80% of people in methadone treatment smoke cigarettes, and existing smoking cessation interventions have been minimally effective. Objective: To develop an Information-Motivation-Behavioral Skills (IMB) Model of behavior change based smoking cessation intervention for methadone maintained smokers, we examined smoking cessation related IMB factors in this population. Methods: Current or former smokers in methadone treatment (n = 35) participated in focus groups. Ten methadone clinic counselors participated in an individual interview. A content analysis was conducted using deductive and inductive approaches. Results: Commonly known IMB factors related to smoking cessation were described. These factors included: the health effects of smoking and treatment options for quitting (information); pregnancy and cost of cigarettes (motivators); and coping with emotions, finding social support, and pharmacotherapy adherence (behavioral skills). IMB factors specific to methadone maintained smokers were also described. These factors included: the relationship between quitting smoking and drug relapse (information), the belief that smoking is the same as using drugs (motivator); and coping with methadone clinic culture and applying skills used to quit drugs to quitting smoking (behavioral skills). IMB strengths and deficits varied by individual. Conclusions: Methadone maintained smokers could benefit from research on an IMB Model based smoking cessation intervention that is individualized, addresses IMB factors common among all smokers, and also addresses IMB factors unique to this population.     

Person-Environment Interactions and Adolescent Substance Use: The Role of Sensation Seeking and Perceived Neighborhood Risk

ABSTRACT

Aims: This longitudinal study investigated person-environment interactions and adolescent substance use by examining whether, and if so how, early temperamental quality of sensation seeking interacted with current neighborhood characteristics to shape underage smoking, drinking, and marijuana use. Sample: Participants consisted of a community-representative sample of 352 adolescents. Methods: Early temperament was assessed when adolescents were between seven and 13 years of age, and current neighborhood characteristics (as perceived by participants and their mothers) and current adolescent substance use (self-reported smoking, drinking, and marijuana use in the past 30 days) were assessed approximately three years later. Results: The results from a zero-inflated negative binomial (ZINB) regression revealed a potent negative effect of the perceived neighborhood risk, such that riskier neighborhoods were associated with both a greater probability for any substance use among adolescents, and a greater frequency of substance use among those who were engaging in these behaviors. High sensation seeking was a risk factor only for frequency of substance use among adolescent extant users, but not for the likelihood of any use. In addition, a significant interaction between sensation seeking and neighborhood risk revealed that adolescent sensation seekers engaged in smoking, drinking, and marijuana use primarily under conditions of elevated neighborhood risk and increased opportunity for such behaviors. Conclusion: Underage substance use was affected by synergistic effects between personal and community risk factors.     

Smoking during pregnancy as a possible risk factor for pediatric neoplasms in the offspring: A population-based cohort study

ObjectiveThe aim of this study was to evaluate the association between maternal smoking during pregnancy and future risk of childhood neoplasm risk.Study designA population based cohort analysis comparing the risk for long-term childhood neoplasms in children born (1991–2014) to mothers that smoked during pregnancy vs. those that did not. Childhood neoplasms were pre-defined based on ICD-9 codes, as recorded in the hospital medical files. Children with congenital malformations and multiple gestations were excluded from the analysis. Kaplan-Meier survival curves were constructed to compare cumulative oncological morbidity over time. Cox proportional hazards model was used to control for confounders.Results241,273 infants met the inclusion criteria; out of those 2841 were born to mothers that smoked during pregnancy. Offspring to smoking mothers had higher incidence of benign (OR 1.6, 95%CI 1.02–2.58; p value = .038) but not malignant tumors. Total cumulative neoplasm incidence was significantly higher in smoking women (Log Rank = 0.001) but no significant difference in the incidence of malignant tumors was noted (Log Rank = 0.834). In a Cox regression model controlling for maternal confounders; a history of maternal smoking during pregnancy remained independently associated only with increased risk for benign tumors (adjusted HR 2.5, 95%CI 1.57–3.83, p = .001).ConclusionMaternal smoking during pregnancy is associated with increased long-term risk for benign but not malignant tumors. This is important when counseling mothers regarding potential future risks and recommended lifestyle modifications. Despite this large population study with long follow-up, childhood malignancies are rare, and clarifying the possible association may require further studies.     

The effects of maternal smoking on pregnancy outcome and placental histopathology lesions

ObjectiveTo study the effects of maternal smoking on pregnancy outcome and placental histopathology findings.Materials & methodsMaternal and labor characteristics and pathological reports were compared between term placentas of complicated and uncomplicated pregnancies of: heavy smokers (>10 cigarettes per day, H-smokers), moderate smokers (<10 cigarettes per day, M-smokers) and non-smokers (controls, N-smokers).ResultsBirth-weights were lower in the H-smokers and M-smokers as compared to the N-smokers (p < 0.001), with a higher rate of small for gestational age (SGA): 18.2%, 19.2% and 11.4%, respectively (p = 0.01). Deliveries among smokers were characterized by higher rates of abnormal fetal heart rate tracings during labor as compared to non-smokers (p = 0.01). Rates of placental maternal and fetal stromal-vascular supply lesions was similar between the groups.ConclusionsMaternal smoking is associated with higher rates of SGA. Tobacco’s potential influence is probably through the disruption of normal placental epigenetic patterns, not expressed in placental histopathology lesions.     

Postpartum smoking relapse

While it has been established that many women quit smoking during pregnancy, little is known about postpartum maintenance of smoking cessation and relapse. A sample of 567 women were surveyed at about 6 months postpartum in order to (a) describe the patterns of smoking relapse; (b) assess the perceived importance of smoking cessation in pregnancy and postpartum; and (c) identify potentially high risk situations for smoking relapse. Results indicate that about half (56%) of the women who quit smoking during pregnancy relapse to smoking by 30 days postpartum. Most of these relapses occur in the company of other smokers. Socializing and/or living with a smoker had a powerful negative impact on ability to maintain abstinence in postpartum. Smoking cessation programs for pregnant women should emphasize the importance of continued abstinence in postpartum.     

Alcohol and tobacco co‐use in nondaily smokers: An inevitable phenomenon?

Introduction and Aims. Alcohol use has consistently been associated with smoking among nondaily smokers. However, this may not be an inevitable relationship that extends across all drinking sessions and/or all nondaily smokers. Recently, distinct subgroups of nondaily smokers have been identified, with one subgroup maintaining a stable pattern of nondaily smoking (long‐term occasional smokers; LOS), and others transitioning to nondaily smoking either from a non‐smoking status (early occasional smokers; EOS) or from a daily smoking status (former daily smokers; FDS). However, little is known about the extent to which these subgroups differ in their alcohol–tobacco co‐administration patterns. Design and Methods. 183 nondaily smokers (74 LOS; 55 EOS; 54 FDS) completed face‐to‐face interviews during which they provided details about their lifetime and past‐week tobacco and alcohol administration patterns. Results. EOS were more likely to report having used alcohol at the time of their first‐ever cigarette relative to the other subgroups (P ≤ 0.001), but there were no differences in past‐week co‐administration patterns between the subgroups. Overall, less than one‐third of all smoking sessions occurred when drinking, but these accounted for more than half of all cigarettes consumed during the previous week. Moreover, while only 42% of drinking sessions involved tobacco co‐administration, when drinking and smoking did co‐occur, significantly greater amounts of alcohol were consumed relative to drinking sessions where no tobacco was used (P < 0.01). Discussion and Conclusions. Findings suggest that alcohol use is not invariably related to smoking in EOS, FDS or LOS, but when it is, across all subgroups co‐administration is associated with mutual dose escalation.[Campbell ML, Bozec LJ, McGrath D, Barrett SP. Alcohol and tobacco co‐use in nondaily smokers: An inevitable phenomenon? Drug Alcohol Rev 2012;31:447–450]     

Cigarette use and smoking beliefs among older Americans: findings from a nationally representative survey*

Background: Between 2005 and 2015, the prevalence of smoking among US adults has decreased for all age subgroups, except those aged 65 and older.

Aim: In order to identify potential correlates of smoking behaviors in older adults, this research examined associations between age, smoking beliefs, and quitline utilization.

Methods: Self-reported, nationally representative data from the Health Information National Trends Survey 2015 cycle (HINTS-FDA) were used (n?=?3738). Multivariable logistic regression analyses examined associations between sociodemographic characteristics and beliefs about smoking behaviors. All analyses were conducted with jackknife estimation using sampling weights.

Results: Among all survey respondents, 10.5% of those aged 65+ were current smokers (smoked 100 lifetime cigarettes and currently smoked every day or some days). These older adults, compared to those aged 18–29 years, had significantly higher odds of agreeing that smoking behavior is something one can do little to change (AOR?=?1.89, 95% CI =1.08, 3.28) and agreeing that nicotine is the substance that causes cancer (AOR?=?3.93, 95% CI?=?2.17, 7.12). Post hoc analyses compared midlife adults (ages 50–64) with older adults (ages 65+), and indicated older adults had lower odds of having used a quitline/smoking cessation website (AOR?=?0.36, 95% CI?=?0.14, 0.94, p?=?0.04) compared to their midlife peers.

Discussion: US adults aged 65 and older hold erroneous beliefs about cigarette smoking behaviors and are less likely to utilize quitline supports. This may be contributing to the stagnant smoking rates among older adults. Smoking cessation efforts targeting older adult Americans are critical in order to stem tobacco use among all Americans.     

Psychosocial Factors Related to the Intergenerational Transmission of Externalizing Behaviors in Early Midlife

Background: To study the intergenerational transmission of externalizing behaviors. Methods: Participants came from a community-based random sample of residents in two upstate New York counties (N = 548). Data were collected from mothers at mean age 40 and from their children from adolescence (mean age = 14, SD = 2.8) to early midlife (mean age = 43, SD = 2.8) at seven time points. Structural equation modeling (SEM) was used to study the psychosocial factors as related to externalizing behaviors in early midlife. Results: First, maternal externalizing behaviors were indirectly associated with the offspring's externalizing behaviors through the offspring's substance use in adolescence, the offspring's partner's smoking patterns, and the offspring's marital conflict. Second, maternal cigarette smoking was indirectly associated with the offspring's externalizing behaviors through the offspring's substance use in adolescence, the offspring's partner's cigarette smoking, and the offspring's marital conflict. Third, maternal marital conflict had an indirect effect on the offspring's externalizing behaviors, mediated by offspring marital conflict. Conclusions: The finding that externalizing behaviors can be transmitted from parent to child informs the need for family-based interventions that are appropriate to adolescents.     

Interaction of maternal smoking and other in-pregnancy exposures: analytic considerations

The teratogenicity of cigarette smoke has been widely researched over the past two decades, in large part due to the work of Fried et al. The current study was designed to investigate some methodological issues surrounding the investigation of the effects of maternal smoking along with other potentially teratogenic agents in pregnancy. Specifically, maternal smoking was investigated both as a covariate and with regards to its main and interactive effects on child IQ in a prospectively ascertained sample of children whose mothers reported pregnancy exposures to four classes of agents: varicella virus infection (VC), selective serotonin reuptake inhibitors (SSRIs), antiepileptic drugs (AEDs) and benzodiazepines (BZDs). Children were also included whose mothers were not exposed to one of these four agents during pregnancy. The goal of this study was not to examine the behavioral teratogenic potential of these agents or of maternal smoking. Rather, our goal was to illustrate some methodological issues in addressing the combined effects of these agents in behavioral teratology. In the analyses of all four exposures, when smoking was considered as a covariate, it was either a significant or marginally significant covariate and the exposure of interest was not significantly related to a change in IQ score. However, when maternal smoking was considered as a factor in the analyses, four different patterns emerged illustrating the potential importance of properly addressing maternal smoking in the analysis of other potential behavioral teratogens.     

Maternal smoking during pregnancy and long-term neurological morbidity of the offspring

ObjectiveTo evaluate the long-term pediatric neurological morbidity of children born to mothers who reported smoking during pregnancy as compared with children born to non-smoking mothers.Study designA population-based cohort analysis was performed comparing all deliveries of mothers who reported smoking during pregnancy and non-smoking mothers between 1991 and 2014 at a single tertiary medical center. Hospitalizations of the offspring up to the age of 18 years involving neurological morbidities were evaluated according to a predefined set of ICD-9 codes, including autism, development and movement disorders, cerebral palsy and more. A Kaplan-Meier survival curve was used to compare cumulative hospitalization rate in exposed and unexposed offspring and a Cox proportional hazards model was used to control for confounders.ResultsDuring the study period, 242,342 deliveries met the inclusion criteria. Of them, 2861 (1.2%) were children of smoking mothers. Neurological-related hospitalizations were significantly higher in children born to smoking mothers, as compared with the non-smoking group (5.3% vs. 3.1%, p < 0.01). Specifically, these children had higher rates of movement, eating and developmental disorders as well as attention deficit hyperactive disorder. The Kaplan-Meier survival curve demonstrated a significant higher cumulative incidence of neurological-related hospitalizations in the smoking group (log rank p < 0.01). Using a Cox proportional hazards model, controlling for potential confounders, maternal tobacco use was found to be independently associated with long-term neurological morbidity of the offspring (adjusted HR = 1.58, CI 1.33–1.89, p value < 0.01).ConclusionMaternal smoking during pregnancy is an independent risk factor for long-term neurological morbidity of the offspring.     

Flavored Tobacco Use Among U.S. Adults by Age Group: 2013–2014

Objective: This study sought to assess patterns of flavored tobacco product (FTP) use and their associations with (1) susceptibility to smoke cigarettes among young adults aged 18–29 who have never smoked; (2) quit attempts in the past 12?months among current cigarette users by age group (18–29, 30–49, and 50+). Methods: We used the 2013–2014 National Adult Tobacco Survey (n?=?75,233) to estimate the prevalence of single-, dual-, and poly-use of FTP (menthol cigarettes, e-cigarettes, cigars, regular pipes/hookahs, and smokeless). Logistic regression models were performed to examine the associations between FTP use and smoking behaviors. Results: Among current tobacco users, young adults aged 18–29 (72.7%) had a higher prevalence of FTP use than other age groups (30–49: 51.7% and 50+: 37.9%). For FTP use within each age group, dual- and poly-FTP use was most popular among young adults aged 18–29 and menthol cigarette use was most popular among older adults aged 50+. Compared with not using any tobacco products, FTP use was associated with higher odds of susceptibility to cigarette smoking among young adult never smokers (single FTP use: aOR =5.5, CI: 4.2–7.3; dual/poly FTP use: aOR =10.7, CI: 6.2–18.4). FTP use was not associated with quit attempts among current cigarettes users aged under 50, while dual/poly-FTP use was associated with higher odds of quit attempts among current cigarette users aged 50?+?(aOR =1.7, CI: 1.2–2.4). Conclusions: This study shows the heterogeneity of FTP use among adults by age group and demonstrates its associations with susceptibility to cigarette smoking among young adult never smokers.     

Anger,Smoking Behavior,and the Mediator Effects of Gender: An Investigation of Heavy and Moderate Smokers

Background: The existing literature suggests the presence of a possible relationship between high anger levels and smoking behavior; however, there are no available data highlighting possible differences between moderate and heavy smokers and the putative effect of gender on smoking behavior. Objectives: The aims of the current study were to assess the relationship among anger, depression, and anxiety and smoking patterns taking into account the possible mediator role of gender. Methods: 150 smokers and 50 nonsmokers volunteers were recruited from the staff of the University of Messina, Italy. The final sample consisted of 90 smokers, divided in 50 heavy smokers (HS: more than 40 cigarettes per day), 40 moderate smokers (MS: 10–30 cigarettes per day), and 42 nonsmokers (NS). All subjects were assessed by State-Trait Anger Expression Inventory-2, Self-Rating Depression Scale, and Self-Rating Anxiety Scale. Results: On anger, depression, and anxiety measures the HS group scored higher than MS and NS groups. HS showed higher than expected levels of trait-anger, a greater tendency to control anger reactions and to access to anger-management techniques. A moderate consumption of cigarettes (10–30 cigarettes per day) was not associated with negative emotions, as MS only showed higher than expected levels of state-anger. Cigarettes consumption was related to gender-specific anger features. Conclusions/Importance: Our study highlighted the importance of anger in smoking behavior and its related gender differences. Recognizing the link among anger, gender differences and smoking behavior could improve the knowledge for future-focused interventions on smoking cessation.     

Does a childhood history of externalizing problems predict smoking during pregnancy?

While the demographic characteristics of women who smoke during pregnancy are well established, less is known about psychiatric characteristics that may differentiate among persistent smokers, spontaneous quitters, and nonsmokers. The purpose of the present study was to test the hypothesis that a history of externalizing problems is related to persistent smoking during pregnancy. Participants included 93 pregnant women (mean age=28 years; 89% non-Hispanic White; 46% persistent smokers; and 16% spontaneous quitters). Externalizing problems, as evidenced by conduct disorder (CD) and attention deficit hyperactivity disorder (ADHD), were assessed using diagnostic interviews. History of CD and ADHD varied by smoking status, with persistent smokers most likely to have a history of both disorders and exhibiting the highest levels of symptomatology. In multivariate analyses, a history of CD, but not ADHD symptoms, distinguished women who persisted in smoking during pregnancy from spontaneous quitters. Results suggest that a childhood history of conduct problems is a risk factor for maternal smoking during pregnancy and that psychiatric history is important to consider in developing more targeted cessation interventions.     

瘢痕子宫孕妇阴道试产对母儿结局的影响

目的 探讨瘢痕子宫孕妇不同分娩方式的选择以及对母儿结局的影响。方法 选择2017年1月至2018年12月在合肥市第一人民医院产科住院且符合剖宫产后阴道试产纳入标准的产妇160例,依据医生评估结果及产妇意愿选择分娩方式,按实际分娩结果分为剖宫产后阴道分娩（简称阴道分娩）组68例,再次剖宫产（简称剖宫产）组80例,12例因阴道试产失败急诊行子宫下段剖宫产术（简称阴道试产失败组）。同时选择同期住院分娩的40例单胎顺产初产妇作为对照组。比较各组产妇的临床特征以及分娩信息,分析影响瘢痕子宫产妇阴道试产成功的相关因素。结果 在瘢痕子宫患者中,阴道分娩成功率为85%。阴道分娩组与阴道试产失败组相比,孕妇体质量、体质量指数、距上次剖宫产时间、新生儿体质量、产时出血量、产后24 h出血量差异均有统计学意义（P<0.05）,而孕妇年龄、孕次、产次、瘢痕厚度、新生儿Apgar评分差异无统计学意义（P>0.05）。阴道分娩组孕妇体质量、体质量指数、孕周、距上次剖宫产时间、新生儿体质量、产后24 h出血量、住院时间均小于剖宫产组,差异有统计学意义（P<0.05）,孕妇年龄、孕次、产次、瘢痕厚度、新生儿Apgar评分差异均无统计学意义（P>0.05）。阴道分娩组与对照组相比,分娩时出血量、产后24 h出血量、新生儿Apgar评分、产后住院时间差异均无统计学意义（P>0.05）。结论 瘢痕子宫孕妇在严格的操作规程以及孕期控制体质量指数、胎儿体质量可鼓励阴道试产。     

Ecological and individual predictors of maternal smoking behaviour. Looking beyond individual socioeconomic predictors at the community setting

The aim of this study is to examine the prevalence of smoking during pregnancy by the individual mother's sociodemographic characteristics and ecological factors at the community level (suburbs). This analysis combined 1996 Australia Census and data on 3424 women attending Well-Baby-Clinics (WBC) between January 1996 and February 1998 within a region in South Western Sydney (SWS), Australia. The prevalence of maternal smoking was 31%. Maternal factors such as marital status, country of birth, education, occupation, socioeconomic status (SES), and types of antenatal care (ANC) were independent risk factors for maternal smoking. Small area analysis revealed suburbs within SWS with high rates of maternal smoking (47-57%). Community level characteristics such as low income, low educational level, young mothers, and unemployment can explain 85.7% of the variation in maternal smoking in SWS. Smoking during pregnancy is recognised as a serious risk factor to the unborn child. The present study draws attention to local community level factors, other than individual SES, which may be important when developing strategies for maternal smoking prevention programs.     

Two-Year Therapeutic Effectiveness of Varenicline for Smoking Cessation in a Real World Setting

Background: Varenicline is an effective smoking cessation therapy in clinical trials. However, its effectiveness might vary in a real world setting and its long term effectiveness (2-year) has not been reported yet. Objective: The objective was ascertaining the effectiveness of varenicline in the treatment of tobacco consumption in Primary Care settings. Methods: Observational, multicenter, retrospective study using medical records of smokers followed for 24 months. Sociodemographic characteristics, comorbidity, type of treatment (varenicline with or without group therapy), and smoking characteristics (Fageström and Richmond tests, starting age, number of cigarettes, cessation attempts, and initial CO-oximeter measurements) were evaluated. Results: 773 smokers treated with varenicline (72.4%) or varenicline combined with group therapy (27.6%) were included. Mean age was 43.6 years [51.7% male (n = 400)]. Continuous abstinence rate at 24 months was 44.4%, with no significant gender or age differences. Median cessation time was 398 days (95%CI: 376–421). A clear association was detected between the probability of remaining abstinent at 24 months and participation in group therapy (OR: 1.877, 95%CI: 1.362–2.589), as well as treatment adherence (compliance >80%) (OR: 6.556, 95%CI: 5.870–7.242), but not with co-financing of treatment (observed in 77% of patients). For every day that varenicline was taken, abstinence increased by an average of 6.6 days. Conclusions: This retrospective cohort study suggests that 2-year effectiveness of varenicline might be substantial in a real world setting. The abstinence rate was higher for those who also receive group therapy.     

Effect of smoking on retina nerve fiber layer and ganglion cell-inner plexiform layer complex

Purpose: The aim of this study is to show the effects of smoking on retina layers, especially retina nerve fiber layer (RNFL) and ganglion cell-inner plexiform layer complex (GCIPL).

Materials and methods: Participants smoking for more than 10 years at least 1 pack of cigarettes a day and a control group, both including participants between ages of 20 and 50 years with no other systemic or ocular diseases were studied. After normality tests, an independent sample t test was used to analyze the differences in age, sex, spherical equivalent (SE), intraocular pressure (IOP), axial length (AL), GCIPL and RNFL values between the groups.

Results: There were 44 participants in each group. There were 32 (62.5%) men and 12(37.5%) women in smokers and 36 (77.88%) men and 8 (22.22%) women in control group. Mean ages were 39.85?±?8.41 and 38.66?±?10.47 years, mean spherical equivalent (SE) values were ?0.15?±?0.4 and 0?±?0.29 dioptries in smokers and control groups, respectively. The IOP, AXL, GCIPL and RNFL values were 17.58?±?3.41?mmHg, 23.69?±?0.56?mm, 84.3?±?5.83?μm and 92.3?±?3.51?μm in the smokers group and 18.5?±?2.91?mmHg, 23.45?±?0.72?mm, 86.11?±?8.02?μm and 97.66?±?8.23?μm in the control group. The inferior, superior, nasal and temporal values of RNFL quadrants were 123.18?±?26.14, 117.05?±?5.51, 64.95?±?8.67 and 63.5?±?6.88?μm in the smokers group and 130.81?±?11.8, 123.55?±?11.03, 72.44?±?9.84 and 58.44?±?7.48?μm in the control group. There were no significant difference of age, sex, SE, IOP, AXL and GCIPL values between the smokers and control groups (p?>?0.05). The mean RNFL was significantly thinner in the smokers group compared to controls (p?=?0.03, independent t test). Inferior and superior quadrants of RNFL decreased in smokers group (p?=?0.01 and p?=?0.03, respectively) but temporal and nasal quadrants did not seem to be changed (p?=?0.96 and p?=?0.07, respectively).

Discussion: Smoking may affect RNFL thickness but not GCIPL.