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BackgroundResearch is inconclusive on the effectiveness of electronic nicotine delivery systems (ENDS) as cigarette cessation aids compared with nicotine replacement therapy (NRT) or non-NRT medication. This study compared the cigarette cessation rates for ENDS, NRT and non-NRT medication.MethodPopulation Assessment of Tobacco and Health Study wave 3 cigarette-only users who used ENDS, NRT or non-NRT medication (varenicline and bupropion) to quit smoking between wave 3 and 4 were included. ‘Cessation’ was defined as being a former cigarette smoker in wave 4. χ2, logistic regression, and a sensitivity analysis with Bayes factor assessed the association between quitting smoking and method used.ResultsAmong 6794 cigarette-only users, 532 used ENDS (n=75), NRT (n=289), non-NRT medication (n=68), or a combination of NRT and non-NRT medication (n=100) to quit smoking between wave 3 and 4. The percentages of quitting smoking among those who used ENDS, NRT, non-NRT medication, and a combination of NRT and non-NRT medication were 16.2% (n=14), 16.1% (n=47), 17.7% (n=13), and 14.8% (n=12), respectively (p=0.97). None of the cigarette-only users who used ENDS to quit smoking became ENDS-only users in wave 4; 37.6% became dual users of ENDS and cigarettes.ConclusionNo differences were found when cessation rates of ENDS, NRT or non-NRT medication were compared. Given uncertainty about the long-term health effect of ENDS and the likelihood of becoming dual users, people who smoke and need assistance quitting should be encouraged to use current Food and Drug Administration-approved cessation methods until more effective methods are developed.

Case Presentation A 48-year-old man presented with 6 months of progressive shortness of breath, intermittent exertional left-sided chest pain, and bilateral lower extremity edema. During the 2 days before admission, he experienced new onset confusion, fatigue, and malaise that prompted evaluation. He denied fever, chills, cough, or sputum production. He used anabolic steroids for 20 years as part of his bodybuilding hobby. Recently, he also began injecting mineral oil into his pectoral, bicep, and shoulder muscles for an improved muscular appearance. Additionally, he had a history of provoked DVT after traumatic fracture, schizophrenia, hypertension, and epilepsy. He was a former cigarette smoker with 2.5 pack-year history, having quit 10 years earlier. The patient’s occupation was construction, installing aluminum gutters. He specifically denied exposures to sand-blasting, coal, beryllium, hard metals, silicone, and fine particles. He had no recent travel, sick contacts, or animal exposures.

Introduction Increasing the reach of evidence-based cessation services is a longstanding public health priority, especially for subgroups who may be most at risk. Little research has examined whether quitlines are reaching menthol cigarette smokers who may have increased difficulty quitting compared with nonmenthol cigarette smokers. This study aims to understand whether quitline services are reaching menthol cigarette smokers. Methods The study sample included adult smokers enrolled in Minnesota's quitline program, QUITPLAN Services, between May 2017 and April 2018 (N=10,999). Cigarette smokers were asked about the usual cigarette type (menthol versus nonmenthol). Reach ratios were calculated by dividing the percentage of program enrollees who are menthol smokers by the percentage of Minnesota smokers who are menthol smokers. Differences in demographic, tobacco use, and utilization characteristics between menthol and nonmenthol smokers were assessed using chi-square and t-tests. Analyses were conducted in March 2019. Results Among QUITPLAN Services enrollees, 30.7% of smokers reported using menthol cigarettes. The reach ratio was 1.12 (95% CI=0.99, 1.25). Menthol smokers were more likely to be younger, be female, be Black/African American, be Hispanic, and live in an urban area than nonmenthol smokers. Although menthol smokers were more likely than nonmenthol smokers to enroll in text messaging, no other significant differences in service utilization were found. Conclusions The findings suggest that menthol smokers are proportionately represented among quitline enrollees. State quitlines should assess menthol smoking status at intake and allocate resources to reach and better serve menthol smokers.

Case Presentation A 41-year-old man presented to our institution with shortness of breath for 1 day, and nausea, vomiting, and diarrhea for 10 days. He has a medical history of gastroesophageal reflux disease, migraines, and anxiety. He is a 10 pack-year former cigarette smoker and an active vaper. He quit smoking cigarettes in 2013 but reports vaping flavored nicotine from 2013 to 2018. Since 2018, he has been vaping tetrahydrocannabinol products of different flavors and brands. A few weeks prior to admission, the subject had changed the brand of his vaping product to "Cookies High Flyers" with a "Biscotti" flavor. The new product contains 1,000 mg (883 mg tetrahydrocannabinol and 117 mg cannabidiol) in a 0.04 oz cartridge. He vapes five times a day, taking two to three puffs every time. He had recently traveled to Texas and had a sick contact with his 18-month-old daughter. She recently recovered from a diarrheal illness of presumed viral origin. Prior to admission, the subject tested negative for influenza and completed outpatient antibiotic treatment, with no improvement.

BackgroundCigarette smoking is associated with worse cognition and decreased cortical volume and thickness in healthy cohorts. Chronic cigarette smoking is prevalent in schizophrenia spectrum disorders (SSD), but the effects of smoking status on the brain and cognition in SSD are not clear. This study aimed to understand whether cognitive performance and brain morphology differed between smoking and non-smoking individuals with SSD compared to healthy controls.MethodsData were obtained from the Australian Schizophrenia Research Bank. Cognitive functioning was measured in 299 controls and 455 SSD patients. Cortical volume, thickness and surface area data were analysed from T1-weighted structural scans obtained in a subset of the sample (n = 82 controls, n = 201 SSD). Associations between smoking status (cigarette smoker/non-smoker), cognition and brain morphology were tested using analyses of covariance, including diagnosis as a moderator.ResultsNo smoking by diagnosis interactions were evident, and no significant differences were revealed between smokers and non-smokers across any of the variables measured, with the exception of a significantly thinner left posterior cingulate in smokers compared to non-smokers. Several main effects of smoking in the cognitive, volume and thickness analyses were initially significant but did not survive false discovery rate (FDR) correction.ConclusionsDespite the general absence of significant FDR-corrected findings, trend-level effects suggest the possibility that subtle smoking-related effects exist but were not uncovered due to low statistical power. An investigation of this topic is encouraged to confirm and expand on our findings.

Riau province, second largest cigarette smoker, 24.2% per day, the second largest average number of cigarettes smoked in Riau in 2013 was in Kampar Regency Sebayak (17.8%), (Riskesdas, 2013). Based on the initial survey, observation and interviews with SD 004 Domo students, on 15 male students, 9 of whom had smoked. The aim of this study was to determine factors related to smoking behavior in students of SDN Kampar Kiri District, Kampar Regency. This research is a quantitative analysis with a transversal conception. The male student population was 100 respondents, consisting of 3 elementary schools in Kampar Kiri district, Kampar Regency, namely SDN 004 Domo Village, SD 002 Kuntu and SD 011 Kuntu. Questionnaire measurement tool. The sampling technique in this study is to use the total sampling technique with criteria. Data analysis Univariate and bivariate analysis with the chi-square test. The results of the study show a relationship between knowledge (P-value = 0.017

Background Population models have been developed to evaluate the impact of new tobacco products on the overall population. Reliable input parameters such as longitudinal tobacco use transitions are needed to quantify the net population health impact including the number of premature deaths prevented, additional life years, and changes in cigarette smoking prevalence. Methods This secondary analysis assessed transition patterns from PATH wave 1 (2013–14) to wave 2 (2014–15) among adult exclusive cigarette smokers, exclusive e-cigarette users, and dual users. Transition probabilities were calculated by taking into account factors including cigarette smoking and e-cigarette use histories and experimental or established use behaviors. Multinomial logistic regression models were constructed to further evaluate factors associated with transition patterns. Results Differential transition probabilities emerged among study subgroups when taking into account cigarette smoking and e-cigarette use histories and experimental or established use behaviors. For example, overall 45% of exclusive e-cigarette users in wave 1 continued using e-cigarettes exclusively in wave 2. However, we observed approximately 11 to 14% of wave 1 exclusive experimental e-cigarette users continued to use e-cigarette exclusively in wave 2, compared to about 62% of exclusive established e-cigarette users. The history of cigarette smoking and e-cigarette use is another important factor associated with transition patterns. Among experimental e-cigarette users, 7.5% of individuals without a history of cigarette smoking transitioned to exclusive cigarette smoking, compared to 30% of individuals with a history of cigarette smoking. Additionally, 1.3% of exclusive cigarette smokers in wave 1 transitioned to exclusive e-cigarette use, with the highest transition probability (3.7%) observed in the established cigarette smoker with a history of e-cigarette use subgroup. Conclusions Product use histories and current use behaviors are important factors influencing transitions between product use states. Given that experimental users’ transition behaviors may be more variable and more influenced by tobacco use history, long-term predictions made by population models could be improved by the use of transition probabilities from established users. As transition patterns might be changing over time, long-term transition patterns can be examined through analysis of future waves of PATH data.

BackgroundChildren's overall tobacco smoke exposure (TSE) consists of both inhalation of secondhand smoke (SHS) and ingestion, dermal uptake, and inhalation of thirdhand smoke (THS) residue from dust and surfaces in their environments.ObjectivesOur objective was to compare the different roles of urinary cotinine as a biomarker of recent overall TSE and hand nicotine as a marker of children's contact with nicotine pollution in their environments. We explored the differential associations of these markers with sociodemographics, parental smoking, child TSE, and clinical diagnoses.MethodsData were collected from 276 pediatric emergency department patients (Median age=4.0 years) who lived with a cigarette smoker. Children's hand nicotine and urinary cotinine levels were determined using LC-MS/MS. Parents reported tobacco use and child TSE. Medical records were reviewed to assess discharge diagnoses.ResultsAll children had detectable hand nicotine (GeoM=89.7ng/wipe; 95% CI=[78.9; 102.0]) and detectable urinary cotinine (GeoM=10.4ng/ml; 95%CI=[8.5; 12.6]). Although hand nicotine and urinary cotinine were highly correlated (r=0.62, p&nbsp

Background: The impacts of smoking on the intestinal microbiome piece and arranged assortment have been appeared in different arranged controlled and observational clinical trials in individuals. Synbiotics are utilized not fair for the progressed survival of beneficial microorganisms included to food, however in expansion for the prompting of the duplication of specific nearby bacterial strains display within the gastrointestinal tract. Aims and Objective: This research proposes the impact of synbiotic supplement on gut-brain axis in Thai smokers in the realm of gut-related biochemical parameters and cognition. Materials and Methods: We directed a single gathering, pre-and post-test study; 20 patients lived in Mahasarakham, Fagerstrom Test for Nicotine Dependence at 4 or above, and no history of cerebrovascular diseases, brain and abdominal surgery, and not taking hormones or medications impacted brainwaves or utilizing antibiotics inside about fourteen days prior. Subjects were allocated to synbiotic supplement containing 3 kinds of prebiotics and 7 types of probiotics prior to sleep every day for about two months. Results:Results were estimated in gut-related biochemical parameters change and alternation in cognition. The present outcomes have indicated essentially decline in the scores of Fagerstrom Test for Nicotine Dependence and also the scores of craving for smoke after intervention. In additions, lipopolysaccharide (LPS) in plasma significantly decreased after the intervention. Conclusion: Further researches are obligatory to lead in finding a propensity to improve in gut-related biochemical parameter and cognition after admission of synbiotic supplement.

Background Uric acid (UA) contributes to beneficial extracellular antioxidant defense activities in the airways. However, pro-oxidant powers of UA can be a potential risk factor for gouty arthritis in chronic obstructive airway disease (COPD). Objectives To investigate the proper causation (antioxidant/pro-oxidant) and correlation between UA indices and COPD and whether the associations were modified by smoking. Is serum uric acid (SUA) concentration a reliable biomarker to predict COPD severity? Patients and methods A prospective cohort study enrolled 45 male patients, who were divided into COPD smoker group I, cigarette smoker group II, and apparently healthy participants, serving as a control group III. SUA concentration and creatinine (Cr) level, arterial blood gases, radiographic imaging, and postbronchodilator spirometric measurements were performed. Results SUA was significantly elevated in COPD smoker and cigarette smoker groups than control one. SUA/Cr ratios were significantly increased in COPD smoker than in other groups. Overall, 8/20 (40%) patients were diagnosed with gouty arthritis in COPD smoker group, 1/15 (6.7%) in non-COPD cigarette smoker group, and none in control group. There were statistical significant differences among three groups (P=0.010). There were significantly higher number of patients with severe to very severe COPD (6/8) than patients with mild to moderate COPD (2/8) (P=0.028). There were significant positive correlations between SUA and smoking index (P=0.033), COPD grading (P=0.011), and partial arterial carbon dioxide tension (P=0.028) and also negative correlations with forced expiratory volume in the first second (FEV1)/forced vital capacity (FVC) (P=0.029), partial arterial oxygen tension (P=0.001), and O2 saturation (P=0.001) in COPD smoker group I. In cigarette smoker group II, there were statistically significant positive correlations between SUA level and FVC% (P=0.033), FEV1 (P=0.017), and FEV1/FVC (P=0.010). Receiver operating characteristic curves for the evaluation of performance of serum uric acid/serum creatinine ratio in the diagnosis of severity of chronic obstructive airway disease. Conclusion SUA had pivotal antioxidant and pro-oxidant inflammatory effects (gouty arthritis) in COPD. Cigarette smoking is an independent risk factor that influences SUA in COPD. SUA and SUA/Cr ratio increase with rising severity of COPD. UA/Cr ratio is the proper biomarker in the assessment of COPD grading, with higher sensitivity and specificity.

Aims Compared to the general U.S. population, military veterans and those living in rural areas disproportionately smoke cigarettes at higher rates, leading to increased health consequences. In the current study, prevalence and severity of cigarette smoking in Iraq and Afghanistan era veterans was assessed across rural and urban areas and comorbid mental health disorders. Method Iraq/Afghanistan era veterans who participated in the Post-Deployment Mental Health study from 2005 to 2017 (N = 3229) were cross-sectionally assessed for the probability of being a current cigarette smoker based on locality status and psychiatric comorbidity. Multivariate logistic and linear regressions, adjusted for demographic characteristics, were used to model the odds of being a current smoker and the severity of nicotine dependence, respectively. Results Veterans residing in rural regions, veterans with psychiatric comorbidities, and the interaction of locality and psychiatric disorders were significantly associated with smoking rates. Those veterans living in extremely rural areas and, independently, those living with psychiatric comorbidities were also more severely dependent on nicotine compared to urban veterans and veterans without psychiatric conditions. Conclusions Rural veterans and veterans with psychiatric comorbidities are at increased risk of smoking and are more severely dependent on nicotine than urban veterans. These findings underscore the need to reduce barriers for treatment both for smoking cessation and mental healthcare for veterans residing in the most rural areas.

Since the advent of heated tobacco products in June 2017 in South Korea, the sale of heated tobacco products accounted for 10.5% of total tobacco sales in 2019. However, the decreasing trend in total tobacco sales is gradually weakening and the number of visitors using stop smoking services has also dropped. This study examines the association between the use of new tobacco products and related products and cessation behaviors. A cross-sectional study using a self-administered questionnaire was conducted from March 2019 to July 2019 for 2831 adult tobacco users. The difference in rates of quit attempts using the type of tobacco products and related products in the past year were noted (55.6% (any cigarette smoker), 46.7% (any e-cigarette user), and 39.6% (any heated tobacco product user)). About a 30% increase in quit attempts was observed for the triple users of either conventional cigarette or heated tobacco product than exclusive users. Exclusive heated tobacco product and e-cigarette users were approximately 40% and 20% less likely to quit the product they used than exclusive cigarette smokers, respectively. These findings can explain recent occurrences in South Korea, such as the reduction of visitors at smoking cessation clinics and the attenuation of the decline in tobacco sales.

Background: High parent education is protective against youth health risk behaviors such as tobacco use. According to the Minorities' Diminished Returns theory, however, higher parent education seems to exert less protection for the ethnic minority relative to the majority groups. Objectives: To explore ethnic differences in the effects of parent education on the transition to cigarette smoking in a national sample of American never-smoker adolescents. Methods: This longitudinal study used data of waves 1 and 4 of the Population Assessment of Tobacco and Health (PATH 2013-2018). This analysis included 5,021 American youth who were never smokers at baseline (2013) and were followed for 4 years. Transition to cigarette smoking was the dependent variable. Parent education was the independent variable. Youth age, youth gender, and family structure were the covariates. Ethnicity was the moderating variable. Results: From the 5,021 American youth who were never smokers at baseline (2013), 89.4% continued as never smokers, and 10.6% became ever-smokers. Overall, 4.0% were current smokers at wave 4. Overall, a higher parent education was associated with lower odds of transitioning to ever and current cigarette smoker at the end of the 4th year. Parent education, however, showed significant interaction with Latino ethnicity on both outcomes suggesting smaller protective effects of high parent education against transitioning to tobacco use for Latino than for non-Latino youth. Conclusions: In the U.S., ethnicity alters the magnitude of the protective effect of parent education against youth transition to tobacco use. While high parent education is protective against transitioning to become a cigarette smoking overall, non-Latinos (a socially privileged group) gain more and Latino youth (a socially marginalized group) gain least from such a resource. In addition to addressing the SES gap, policymakers should identify and address mechanisms by which ethnic minority youth remain at risk of tobacco use, even when they are from highly educated families.

Objectives: Cigarette and Shisha smoking is becoming a common practice in young generation worldwide. Since, this is a growing threat to public health, our study aims to investigate the cognitive function responses of cigarette and Shisha inhalation in adolescents. Methods: This retrospective cross sectional study comprised three groups, cigarette smoker, Shisha smoker, and nonsmoker control group (each n=25). All the participants were apparently healthy male volunteers aged 21-24 years. Cognitive functions were assessed by employing “Cambridge Neuropsychological Test Automated Battery”. The cognitive functions outcome variables were response time tasks (attention switching task (AST) and the percentage of correct answers pattern recognition memory (PRM) task. Results: Cigarette and Shisha smokers exhibited a considerable decline in cognitive performance parameters, AST mean correct latency (p=0.001), AST mean correct latency (congruent) (p=0.001), AST mean correct latency (incongruent) (p=0.001) and AST mean correct latency (switching) (p=0.001) compared to matched control group. Conclusions: Cigarette and Shisha smokers exhibited significant impairment in their cognitive functions. The present study findings convince that cigarette and Shisha smokers should quit smoking. doi: https://doi.org/10.12669/pjms.36.5.2251 How to cite this:Bashir S, Murtaza G, Meo SA, Al-Masri A. Effect of Cigarette and Shisha smoking on cognitive functions impairment: A cross sectional study. Pak J Med Sci. 2020;36(5):1042-1047. doi: https://doi.org/10.12669/pjms.36.5.2251 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

BACKGROUND: Electronic cigarette (E-cigarette) is an electronic nicotine delivery device that has been advocated as a safe alternative for cigarette smokers. Since the introduction of E-cigarette internationally and in the Kingdom of Saudi Arabia (KSA), it gained popularity, particularly among the youth and young adults. Moreover, many nonsmoker (nicotine-naïve) youth started to use E-cigarette as a new social habit. Recent researches have casted shadows on the E-cigarette safety profile. OBJECTIVE: The aim of this study is to assess the prevalence of E-cigarette use among students of health science colleges in Jeddah-KSA. It also assesses E-cigarette effectiveness as a smoking cessation method and its possible addictiveness. METHODS: The study is an epidemiological, cross-sectional study, which was conducted between November 2017 and December 2017 in three different universities in Jeddah. A self-administered online questionnaire related to E-cigarette and the conventional cigarette was used. RESULTS: A total of 1007 completed an electronic survey which was distributed to 3000 health sciences colleges' students. Of the participants 14.1% were cigarette smoker, 46% of them smoke regularly. Students who smoke half a pack per day and above were 22% of the smokers. More college students use the E-cigarette (27.7%). Moreover, one-fifth of the E-cigarettes users were using it on the regular daily basis. The study found that 42.7% of E-cigarettes users have used it as a tool to quit smoking. Interestingly, more than half (56.7%) of the students who used it to stop smoking has succeeded. However, only 46% of E-cigarettes users who tried to quit vaping have succeeded. Young aged, students believed that smoking is more addictive than vaping or recommended E-cigarette for smoking cessation found to have a higher chance of quitting smoking in the univariate regression analysis. While, in the multivariate analysis, students who believed that conventional smoking is more addictive than E-cigarettes; students started vaping to quit smoking, or used E-cigarettes with fruit flavor found to have significantly higher chance of quitting. CONCLUSION: The E-cigarettes vaping is more prevalent than conventional cigarette smoking among health sciences students in Jeddah-KSA. E-cigarettes are used as a tool to help smoking cessation in less than half of the user. E-cigarettes help some smokers to quit smoking. However, it seems as addictive to the users as conventional cigarette smoking.

2019 has been a landmark year in the world of electronic nicotine delivery systems (ENDS), specifically e-cigarette and vaping. Numerous state health departments across the United States have voiced their concerns in the growing number of lung injury cases from e-cigarettes and vaping. Over the past few decades, many agencies have brought into light the harmful effects of smoking cigarettes, and despite popular belief, a growing movement has started to recognize the harmful effects of ENDS. The Centers for Disease Control and Prevention have released recommendations and provided health practitioners a methodology to identify and diagnose e-cigarette, or vaping, product use-associated lung injury (EVALI). EVALI is a diagnosis of exclusion and comprises a variety of respiratory illnesses, with intubation rates nearing 32%. The most critical risk factor remains product use in the preceding 90 days, although a timeline on the development of symptoms or notable structural changes remains unknown. We present a case of acute lung injury in a traditional cigarette smoker that evolved within hours of switching to e-cigarettes.

Case Presentation An 80-year-old man presented with a 5-day history of hemoptysis, mild shortness of breath on exertion, fatigue, and malaise. He denied chest pain or fever. He had a history of hypertension, congestive heart failure, and left nephrectomy for renal cancer 10 years earlier; he was a former cigarette smoker with a 50 pack-year history, having quit 5 years prior to presentation. The patient did not report any recent travel history or occupational or animal exposures, and he did not have gastroesophageal reflux. Medications included diltiazem hydrochloride, irbesartan, hydrochlorothiazide, and ranitidine.

Background: Cigarette smoking is associated with various forms of acute cardiac events such as myocardial infarction and ventricular fibrillation etc.Objective: To observe immediate impact of cigarette smoking on power spectral measures of heart rate variability (HRV) in current apparently healthy male regular cigarette smokers.Methods: This study was carried out on 120 apparently healthy male current regular cigarette smoker aged 20-55 years. To watch the intense impacts, data were recorded 5 and 30 min after completing a full stick of cigarette. Power spectral measures of HRV were recorded by a RMS digital polyrite D. Statistical analysis was done by paired sample t test.Results: LF power, LF nu & LF/HF ratio were significantly increased and HF power & HF nu were significantly decreased from their corresponding baseline value just 5 minutes after smoking and returned close to their baseline value after 30 minutes of smoking.Conclusion: The result of the study concludes that acceleration of sympathetic activity with simultaneous withdrawn of cardiovascular vagal adjustment happens quickly in the wake of smoking a cigarette.J Bangladesh Soc Physiol. 2018, June; 13(1): 8-12

Using cigarettes and alternative tobacco products (ATPs) is associated with negative oral health outcomes, and dental health professionals are poised to help patients quit. The aim of this study was to determine dental, dental hygiene, and advanced dental students' use, knowledge, and beliefs about cigarettes and ATPs, including perceptions about their education in tobacco dependence treatment and counseling experience. All 1,783 students enrolled in the dental, dental hygiene, and postdoctoral dental programs at the New York University College of Dentistry were invited to participate in the survey in 2016. A total of 708 students at least partially completed the survey, for a response rate of 39.7%. In the results, 146 of the students (20.1%) reported ever using cigarettes, while 253 (35.7%) reported ever using any ATP. Regarding tobacco use intervention, the students reported they had not received enough training on ATPs, were neutral about cigarettes, and were somewhat confident and not so confident counseling a cigarette smoker or ATP user, respectively. By their fourth year, 77.8% of the dental students reported they had counseled someone to stop smoking cigarettes, but only 40.7% had counseled someone to stop using ATPs. Overall, all groups of students reported feeling more confident and had received more education on interventions for cigarettes than for ATPs (p

The aim of the present study was to compare the Sleep Quality, Problem-Solving Strategies and Psychological Hardiness in smokers and nonsmokers students. The study was a causal comparative research. Statistical population included all university of Mohaghagh Ardabili mail students in 2017 (1395s.c.). 30people were selected through cluster sampling and 30 no smokers participants were matched with them. Data were collected with the Pittsburgh Sleep Quality Questionnaire, Problem-Solving Strategies Cassidy & Long and Psychological Hardiness kiamarsi & et al. Data were analyzed through multivariate analysis of variance (MANOVA). Analysis of data showed sleep quality variables in smokers than non-smokers was significantly higher (01/0 p). Variable elements of style in general and problem solving, creativity, confidence, style trends in problem solving and non-smokers was significantly higher in smokers. Also in the components of helplessness in solving the problem, control of problem solving and avoiding light smokers was significantly higher than non-smokers (01/0 p). In addition tenacity variables in smokers than non-smokers was significantly lower (01/0> p). So you can understand the importance of respect in this sphere and help to improve the quality of life of the community.

This paper estimated the association between the U.S. Food and Drug Administration's 2009 ban on flavored cigarettes (which did not apply to menthol cigarettes or tobacco products besides cigarettes) and adolescents' tobacco use.Regression modeling was used to evaluate tobacco use before and after the ban. The analyses controlled for a quadratic time trend, demographic variables, prices of cigarettes and other tobacco products, and teenage unemployment rate. Data from the 1999-2013 National Youth Tobacco Surveys were collected and analyzed in 2016. The sample included 197,834 middle and high schoolers. Outcomes were past 30-day cigarette use; cigarettes smoked in the past 30 days among smokers; rate of menthol cigarette use among smokers; and past 30-day use of cigars, smokeless tobacco, pipes, any tobacco products besides cigarettes, and any tobacco products including cigarettes.Banning flavored cigarettes was associated with reductions in the probability of being a cigarette smoker (17%, p0.001) and cigarettes smoked by smokers (58%, p=0.005). However, the ban was positively associated with the use by smokers of menthol cigarettes (45%, p0.001), cigars (34%, p0.001), and pipes (55%, p0.001), implying substitution toward the remaining legal flavored tobacco products. Despite increases in some forms of tobacco, overall there was a 6% (p0.001) reduction in the probability of using any tobacco.The results suggest the 2009 flavored cigarette ban did achieve its objective of reducing adolescent tobacco use, but effects were likely diminished by the continued availability of menthol cigarettes and other flavored tobacco products.

Case Presentation A 44-year-old woman was referred for evaluation of dyspnea on exertion and multiple nodular opacities on a chest CT scan. She had a medical history of autoimmune encephalitis, diabetes mellitus, hypertension, migraines, and allergic rhinitis. Ten years earlier, the patient was admitted to an outside institution with symptoms of shortness of breath. She was found to have multiple pulmonary nodules and was diagnosed empirically with and treated for sarcoidosis. She was told that her pulmonary nodules had improved on follow up. However, she continued to have symptoms of dyspnea. Due to progressive symptoms of shortness of breath, she was referred to pulmonology. She reported a weight gain of 80 pounds over the last year. She denied fever, chills, hemoptysis, night sweats, joint swelling, or skin rash. She is a former cigarette smoker with a 15 pack-year smoking history, quit smoking in 2005. She denied alcohol or drug use. She resided in Arkansas and Texas over the past decade. She previously worked as a teacher and is currently unemployed. She had no other relevant exposures. She denied a family history of autoimmune diseases or malignancies.

Introduction. Globally, alcohol is one of the most prevalent forms of substance use that is particularly high among young age groups. Despite the adverse health and social challenges associated with alcohol use, it is one of the most common risky behaviours among university students. Objective. This study aimed to assess the prevalence of alcohol use and associated factors among Dilla University students in Southern Ethiopia. Methods. An institution-based cross-sectional study was conducted at Dilla University among undergraduate regular students from January to February 2018. A systematic random sampling technique was used to get a total sample of 803 students each year from the department of the university. The collected data were coded, entered into Epi Info version 7.1, and analyzed with SPSS version 20. Results. A total of 803 participants were successfully interviewed with a response rate of 91.7%. Alcohol use prevalence was 41.8% (n = 336) among participants. Being in fourth year (AOR = 2.66, 95% CI: 1.64, 4.31), having friends who use the substance (AOR = 1.53, 95% CI: 1.09, 2.1), being a khat user (AOR = 1.48, 95% CI: 1.05, 2.09), and being a cigarette smoker (AOR = 1.76, 95% CI: 1.09, 2.84) were found to be significantly associated with alcohol use. Conclusion. The current study revealed that fourth-year students, having friends who use the substance, being khat user, and being cigarette smoker had higher odds of alcohol use among the students. So the findings suggest that effective campus-based counselling and peer education should be implemented for early prevention, detection, and alleviation of alcohol use among students in the university.

The main objective of this study was to determine the prevalence of Irritable Bowel Syndrome (IBS) and its associated factors among University students in Saudi Arabia, as little is known about this issue in our country. This cross-sectional study was conducted between 13 March and 21 May of the Academic Year 2017-2018 at Jazan University, Saudi Arabia, involving a random sample of 890 students, selected using the stratified multistage method. IBS prevalence was determined using the Rome IV diagnostic Criteria. The overall prevalence of IBS was 8.8%. According to the results of the multivariate logistic regression, the most important independent predictors of IBS were being a student in a medical college (OR = 10.42; 95%CI: 3.45-31.51) and a scientific college (OR = 5.16; 95%CI: 1.64-16.22), cigarettes smoking (OR = 2.74; 95%CI: 1.24-6.07), emotional stress (OR = 2.53; 95%CI: 1.28-5.00), and food intolerance (OR = 2.15; 95%CI: 1.11-4.16). The present study revealed a prevalence rate of 8.8%. The main predictors of IBS were being a medical student, a scientific college student, cigarette smoker, and having emotional stress and food intolerance. No significant association was found between IBS and anxiety and depression.

Background The study assessed awareness and use of heated tobacco products (HTPs) and factors that influenced these issues among cigarette smokers from six European countries in 2016 (Wave 1) and 2018 (Wave 2). Methods A survey was conducted among a nationally representative sample of cigarette smokers aged 18 years or older from Germany, Greece, Hungary, Poland, Romania and Spain in 2016 (N = 6011) and 2018 (N = 6027; 53% of smokers from the previous wave were retained, regardless of smoking status and dropouts were replaced by a replenishment sample of smokers). Data were collected through face-to-face interviews. Estimates were produced using weighted data. The study presents the cross-sectional results. Results Awareness of HTPs increased from 8% to 17% between the two waves. At Wave 1, 1.1% of the smokers declared having used HTPs at least once during their lifetime; and at Wave 2, this increased to 1.9% (around 1% or less in four countries, except for Greece and Romania where it was around 4%). Factors associated with HTPs use among those who had ever heard about these products at Wave 1 were country of residence, being a daily cigarette smoker and ever use of electronic cigarettes. At Wave 2, ever use of HTPs was significantly higher among those who had tried to quit smoking combustible cigarettes in the last 12 months, had tried electronic cigarettes during lifetime and perceived HTPs as less dangerous than combustible cigarettes; the country of residence was also associated with HTPs use. Conclusion This study offers insights into the behaviours and perceptions of European adult smokers regarding HTPs, an important emerging issue in the field of tobacco control.

ObjectiveThe objective of the paper was to investigate the spatial distribution and correlates of tobacco smoking in various regions of Zambia.MethodsThis paper adopts a cross-sectional study design. The study used data from the 2013/2014 Zambia Demographic Health Survey which is a nationwide health survey conducted in all the 10 provinces. A random sample of men and women from 15 920 households was successfully selected and interviewed. All women aged 15–49 and men aged 15–59 who were either permanent residents of the households or visitors present in the households on the night before the survey were eligible to be interviewed.ResultsThe results show that 8.2% and 11% of Zambians in urban and rural areas smoke, respectively. In urban areas, the risk of being a cigarette smoker was 2.31 (CI: 1.69 to 3.16) and 2.03 (CI: 1.36 to 3.02) times higher for the divorced and separated. However, the risk of being a cigarette smoker was lower for those with some formal education. In rural areas, the risk of being a cigarette smoker was lower for the married (relative risk ratios (RRR): 0.69, CI: 0.55 to 0.86) and those with a formal education. Nevertheless, in rural areas, the risk of being a pipe and other smoker was higher for those who were self-employed (RRR: 8.46, CI: 2.95 to 24.20) and with an occupation (RRR: 2.37, CI: 1.39 to 4.02) but was lower among women.ConclusionTobacco smoking varies between and within regions as well as provinces. Therefore, interventions to curbsmoking should target specific demographic, socioeconomic and cultural factors and how they are spatially distributed.

CONTEXT Adults with unmet health care needs (UHCN) due to cost have fewer opportunities to receive behavioral counseling in clinical settings, which may be associated with a higher likelihood of having health-risk behaviors. OBJECTIVE This study assessed associations between UHCN and health-risk factors. DESIGN/SETTING We used 2016 Behavioral Risk Factor Surveillance System data to calculate age-adjusted weighted prevalence of 5 health-risk factors by UHCN and insurance status and to assess the association of UHCN with these factors using multivariable logistic regression. PARTICIPANTS US adults aged 18 to 64 years who participated in the survey (N = 301 035). MAIN OUTCOME MEASURES Five health-risk factors: obesity, current cigarette smoking, excessive alcohol use, sleeping less than 7 hours per 24-hour period, and no leisure-time physical activity within the past month. RESULTS In 2016, among adults aged 18 to 64 years, 11.2% of those with insurance and 40.1% of those without insurance (both age-adjusted) had UHCN. In both study populations, compared with adults with no UHCN, adults reporting UHCN were more likely to be a current cigarette smoker, report excessive alcohol use, and sleep less than 7 hours per 24-hour period. The prevalence of 3 or more health-risk factors was higher among adults with UHCN than among adults without UHCN (adults with insurance: adjusted prevalence ratio = 1.40; 95% confidence interval = 1.33-1.48; adults without insurance: adjusted prevalence ratio = 1.39; 95% confidence interval = 1.27-1.53). CONCLUSIONS Unmet health care needs was associated with more health-risk factors regardless of insurance status. Addressing cost barriers to behavioral counseling may be one approach to consider when seeking to reduce health-risk behaviors among high-risk populations.

Background Sleep problems are common in the general population. Cigarette smoking is common in the general population of China. Examinations of the prevalence of poor sleep quality among Chinese smokers and nonsmokers are still lacking. This study was designed to examine sleep quality and sleep disturbances among cigarette smokers and nonsmokers in the general population in central China. Methods In this population-based sampling project, we used a multi-stage sampling method to recruit survey participants from September 2012 to October 2012 in rural and urban areas of Hunan province, China. A total of 27,300 subjects were sampled from the general population and 26,282 completed the self-report of cigarette smoking characteristics. Cigarette smoker was defined as having smoked ≥100 cigarette in a lifetime and smoked during the last 28 days. Cigarette smoking characteristics were obtained from smokers, including cigarettes per day, years of smoking, quit attempts, and smoking cravings. The Pittsburgh Sleep Quality Index (PSQI) was applied to assess quality of sleep and sleep disturbances (PSQI score > 5). Results Significantly more smokers than nonsmokers demonstrated poor sleep quality and sleep disturbances. Among smokers, linear regression analyses showed that poor sleep was inversely associated with cigarettes per day, and positively associated with years of smoking, quit attempts, and smoking craving. Logistic regression analysis showed that quit attempts and smoking cravings were associated with higher odds of sleep disturbances. Conclusions Sleep disturbances were more prevalent among cigarette smokers than nonsmokers. Smokers also varied in sleep problems on the basis of the characteristics of their smoking. Smokers should be informed about the link between cigarette smoking and poor sleep quality, and should be advised that one of several important health benefits from smoking cessation could be the improvement of sleep quality. Sleep therapy should be recommended as an adjunctive treatment for smoking cessation.

Background: Tobacco smoke exposure impairs the lung´s innate immune response, leading to an increased risk of chronic infections. SPLUNC1 is a secreted, multifunctional innate defense protein that has antimicrobial activity against Gram negative organisms. We hypothesize that tobacco smoke-induced SPLUNC1 dysfunction contributes to the observed defect in innate immunity in tobacco smokers and that this dysfunction can be used as a potential biomarker of harm. Methods: We collected sputum from never-smokers and otherwise healthy smokers. We performed Western blotting to determine SPLUNC1 levels and determined antimicrobial activity against nontypeable Haemophilus influenzae. An in vitro exposure model was utilized to measure the effect of tobacco exposure on human bronchial epithelial culture (HBEC) antimicrobial activity against H. influenzae. The direct effects of cigarette and little cigar smoke exposure on SPLUNC1 function was determined using 24 h growth measurements and LPS binding assays. Results: H. influenzae growth in cigarette smoker´s sputum was significantly greater compared to never-smokers sputum over 24 h. HBEC supernatants and lysates contained significantly higher numbers of H. influenzae following chronic cigarette and little cigar smoke exposure compared to air-exposed controls. Furthermore, SPLUNC1´s antimicrobial activity and LPS-binding capability against both H. influenzae and P. aeruginosa was attenuated following cigarette and little cigar exposure. Conclusions: These data suggest that cigarette and little cigar exposure impairs SPLUNC1´s antimicrobial ability and that this inhibition may serve as a novel biomarker of harm that can be used to assess the toxicity of commercial tobacco products. Fil: Moore, Patrick J.. University of North Carolina; Estados Unidos Fil: Sesma, Juliana. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Rosario; Argentina. Universidad Nacional de Rosario. Facultad de Ciencias Médicas; Argentina Fil: Alexis, Neil E.. University of North Carolina; Estados Unidos Fil: Tarran, Robert. University of North Carolina; Estados Unidos

Smoking is one of the leading causes of death worldwide. Smokers have higher risk for coronary heart disease, atherosclerosis, acute myocardial infarction, hypertension, clotting disorders, inflammation, respiratory diseases, cancers, etc. A cigarette smoker is exposed to a number of harmful substances. In this study we hypothesized that smoking causes inflammatory reactions and induces hyperthrombic state in the body which may be reflected in erythrocyte sedimentation rate (ESR), total leucocyte count (TLC), differential leucocyte count (DLC) and platelet count values. The purpose of the study was to study the effects of cigarette smoking on erythrocyte sedimentation rate, total leucocyte count and platelet count in adult male smokers and to compare the results with non-smokers and to establish a relationship between the duration and quantity of smoking with the change in ESR, TLC, DLC and platelet count. A cross sectional study was conducted in the department of Pathology on 86 healthy male subjects (smokers=43 and non-smokers=43). ESR was estimated using Westergrens method. TLC, DLC and platelet counts were estimated using HORIBA Pentra ES60 autoanalyzer. TLC and basophil counts were significantly higher in smokers than in non-smokers (p