Association of cannabis use disorder with atrial fibrillation in young men without concomitant tobacco use:Insights from nationwide propensity matched analysis

BACKGROUND Recent data are inconclusive regarding the risk of arrhythmias among young cannabis users.Furthermore,many young adults use both cannabis and tobacco,which could add a residual confounding effect on outcomes.So,we studied young men who have cannabis use disorder(CUD)excluding tobacco use disorder(TUD)to understand their independent association with atrial fibrillation(AF)and related outcomes.AIM To study the association of CUD with AF and related outcomes.METHODS We used weighted discharge records from National Inpatient Sample(2019)to assess the baseline characteristics and mortality rates for AF-related hospitalizations in young(18-44 years)men in 1:1 propensity-matched CUD+vs CUD-cohorts without TUD.RESULTS Propensity matched CUD+and CUD-cohorts consisted of 108495 young men in each arm.Our analysis showed an increased incidence of AF in black population with CUD.In addition,the CUD+cohort had lower rates of hyperlipidemia(6.4%vs 6.9%),hypertension(5.3%vs 6.3%),obesity(9.1%vs 10.9%),alcohol abuse(15.5%vs 16.9%),but had higher rates of anxiety(24.3%vs 18.4%)and chronic obstructive pulmonary disease(COPD)(9.8%vs 9.4%)compared to CUD-cohort.After adjustment with covariates including other substance abuse,a non-significant association was found between CUD+cohort and AF related hospitalizations(odd ratio:1.27,95%confidence interval:0.91-1.78,P=0.15).CONCLUSION Among hospitalized young men,the CUD+cohort had a higher prevalence of anxiety and COPD,and slightly higher proportion of black patients.Although there were higher odds of AF hospitalizations in CUD+cohort without TUD,the association was statistically non-significant.The subgroup analysis showed higher rates of AF in black patients.Large-scale prospective studies are required to evaluate long-term effects of CUD on AF risk and prognosis without TUD and concomitant substance abuse.

Smokeless Tobacco Use among Women in Kasama District-Zambia

Background: Smokeless tobacco is defined as a product that contains tobacco, is not smoked or burned at the time of use, and commonly consumed orally or nasally. These products can be placed in the mouth, cheek or the lip and are sucked or chewed. The Zambian government, in the 2019 country report, gave an estimated figure of 4.5% of females aged 15 years and above in 2017 used smokeless tobacco and by 31st December, 2018, there was an increase of smokeless tobacco users to 6.8% women of the same age group. This study aimed to explore the extent of smokeless tobacco use among women in Kasama district-Zambia. Methodology: An analytical cross-sectional quantitative study design was used to collect data using the modified structured interview schedule, adopted from Medicine for Global Health. Simple random sampling method using rotary technique was used to select 430 respondents after meeting the inclusion criteria. Informed consent to participate in the study was obtained. Data was analysed using version 26.0 of the Statistical Package for Social Sciences. Appropriate parametric or non-parametric statistical tests (Chi-squared or Fisher’s exact test) were adopted in testing for associations between variables. Univariable and multivariable binary logistic regression analysis were employed in identifying smokeless tobacco use among women using an investigator-led stepwise approach, guided by various fit statistics and the likelihood ratio test. All statistical analyses adopted a 5% significance level at 95% confidence interval. Results: The results showed that most of the respondents were aged between 18 and 25 years (45.6%), (53.7%) lived in urban settlements and the majority (80%) were unemployed. The majority of respondents (83.5%) had a friend/relative who used smokeless tobacco and over half (53.5%) thought smokeless tobacco was beneficial to them. The commonly mentioned benefits of smokeless tobacco included body warmth (13.6%) and vaginal tightening (7.9%). The results revealed that most of the respondents attained a secondary level of education (38.4%). According to the study, smokeless tobacco use among women of Kasama-Zambia was significantly associated with the following;age (p Conclusion: Based on these findings, the study recommends that efforts should be channeled towards the dissemination of information on the impacts of smokeless tobacco use in order to overcome cultural beliefs attached to smokeless tobacco use.

Factors Associated with Tobacco Use among Community Dwelling Older Adults in Jos South, Nigeria

Background: Tobacco use poses an enormous threat to public health worldwide. Its use is associated with an epidemic of cancer, heart disease, stroke, chronic lung disease and other non-communicable diseases especially with increases in age leading to increase morbidity and mortality. The aim of the study was to determine prevalence and associated factors with tobacco use among elderly members of a community in Jos South LGA, Plateau State, Nigeria. Methods: Data was collected from 17th to 31st August, 2018. The study employed a cross sectional design. Out of 422 elderly members (≥60 years) of the community identified, only 400 were interviewed with a composite questionnaire that includes the following: socio-demography, Alcohol Smoking and Substance Involvement Screening Test (ASSIST), Mini International Neuropsychiatric Interview (MINI) as well as the 12-item General Health Questionnaire (GHQ-12). Results: Results show the lifetime prevalence of tobacco use to be 17.5% and current prevalence to be 15.8%. Tobacco use disorders were not significantly associated with gender (X2 = 0.10, p<0.75), or living status (p = 0.22). Participants who used tobacco were more likely to report cardiovascular (X2 = 0.03, p = 0.96), respiratory (X2 = 0.21, p = 0.65), digestive (X2 = 3.86, p = 0.05), difficulty ambulating (X2 = 0.34, 0.56), probable psychiatric co-morbidity (X2 = 0.12, p = 0.72) and chronic pain conditions (X2 = 0.74, p = 0.39), and had more hospital visits (X2 = 1.18, p = 0.40), and admissions (X2 = 0.03, p = 0.96) but the relationships did not attain statistical significance. Conclusion: We conclude that tobacco use is highly prevalent among older adults living in the community. There is need to step up efforts on programs of intervention especially smoking cessation programs and as a result reduce the burden of tobacco related diseases and disorders.

The status of tobacco use and knowledge,and attitudes relating to smoking among female students in a Bengbu medical school

Objective： To learn the status of tobacco use, and the knowledge, attitudes, and behaviors among female students in Bengbu Medical College. Methods： In a cross-sectional survey, questionnaires were completed by 634 female students in the medical college in 2007, including the prevalence of current smoking, their knowledge of the effects of tobacco use on health, and attitudes towards the smoking behaviors of young women. Results： Only 6.9% of female medical students were former smokers, and 4.9% of them were current smokers. There was no significant difference in the current smoking rate among the students from each department surveyed. Female students from urban areas were more likely to be current or attempted smokers than those from rural areas. The proportion of the students who were aware of the health risks of smoking was less than 45%. The students from the Department of Nursing had more knowledge regarding the harmful health effects of smoking than those from the other departments. There was no significant difference in attitudes towards the smoking behaviors of young women among the students from each department. Compared with female students from rural areas, the female students from urban areas were significantly more likely to think that a young woman who smoked was cool, mature and charming. Conclusion： The smoking prevalence of the female students in Bengbu Medical College is high. They are not aware of the smoking related risks and have erroneous beliefs and perceptions about female smoking behaviors.

Snuffing out Tobacco Use

AMONG the many things in the world at which China ranks number one, smoking is perhaps the most undignified. The number of Chinese smokers totals 300 million, roughly equivalent to the entire U.S. population, and one third of the global smoking population. The prevalence of smoking as a habit leaves at least 740 million non-smokers regularly exposed to secondhand smoke and 1.4 million Chinese die from smoking-related diseases every year on the mainland.

Effect of Nitrogen Fertilization on Growth and Photosynthetic Nitrogen use Efficiency in Tobacco （Nicotiana tabacum L.）

Soil pot experiments were conducted in a greenhouse to examine the effects of different nitrogen （N） supply （low, 0.15 g N/kg; middle, 0.3 g N/kg; and high, 0.6 g N/kg dry soil） on the growth, photosynthetic characteristics and photosynthetic nitrogen use efficiency （PNUE） of tobacco seedlings （Nicotiana tabacum L. Yunyan 87）. The results showed middle and high N significantly enhanced seedling growth including plant stem and leaf dry weight comparing with low N. High N supply could lead to a dramatic increase in the photosynthetic capacity of tobacco seedlings under low N conditions. There were significant differences in leaf N content between nitrogen treatments. About a 76% increase in leafN content in plants fed by high N resulted in about 43% increase in Rubisco content and 27% in net photosynthetic rate. The non-corresponding increases in photosynthetic rate in tobacco seedlings fed by high N relative to low N resulted from Rubisco activity and/or carboxylation efficiency （CE）. These results indicated that tobacco seedlings under high N application can maintain high net photosynthetic rate （Pn） but lower PNUE, will finally result in a decline in N use efficiency.

Smoking cessation prior to elective total joint arthroplasty results in sustained abstinence postoperatively

BACKGROUND Tobacco use is a well-documented modifiable risk factor for perioperative complications.AIM To determine the tobacco abstinence rates of patients who made cessation efforts prior to a total joint arthroplasty(TJA)procedure.METHODS A retrospective evaluation was performed on 88 self-reported tobacco users who underwent TJA between 2014-2022 and had tobacco cessation dates within 3 mo of surgery.Eligible patients were contacted via phone survey to understand their tobacco use pattern,and patient reported outcomes.A total of 37 TJA patients participated.RESULTS Our cohort was on average 61-years-old,60%(n=22)women,with an average body mass index of 30 kg/m^(2).The average follow-up time was 2.9±1.9 years.A total of 73.0%(n=27)of patients endorsed complete abstinence from tobacco use prior to surgery.Various cessation methods were used perioperatively including prescription therapy(13.5%),over the counter nicotine replacement(18.9%),cessation programs(5.4%).At final follow up,43.2%(n=16)of prior tobacco smokers reported complete abstinence.Patients who were able to maintain cessation postoperatively had improved Patient-Reported Outcomes Measurement Information System(PROMIS)-10 mental health scores(49 vs 58;P=0.01),and hip dysfunction and osteoarthritis outcome score for joint replacement(HOOS.JR)scores(63 vs 82;P=0.02).No patients in this cohort had a prosthetic joint infection or required revision surgery.CONCLUSION We report a tobacco cessation rate of 43.2%in patients undergoing elective TJA nearly 3 years postoperatively.Patients undergoing TJA who were able to remain abstinent had improved PROMIS-10 mental health scores and HOOS.JR scores.The perioperative period provides clinicians a unique opportunity to assist active tobacco smokers with cessation efforts and improve postoperative outcomes.

Incidence of Haematoma Formation in Relation to Smoking in Abdominoplasty Cases

Objective: This study aims at assessing the relation between smoking and the incidence of haematoma formation in abdominoplasty surgery cases. Patients and Methods: This is a 4 years retrospective study involving the patients who underwent abdominoplasty surgery between the period of May 2015 and April 2019 in Zayed Military Hospital, Abu Dhabi, United Arab of Emirates. The incidence of haematoma formation was assessed in relation to tobacco use in these patients. Results: 164 patients met the inclusion criteria of the study. 35 patients were smokers (21.3%) and 129 patients were non-smokers (78.7%). The mean age was 38.4 (21 - 59 years). The mean BMI was 27 kg/m2 (21.4 - 34.7 kg/m2) and the mean hospital stay was 6.5 days (4 - 19). 23 patients in the study developed haematoma (14%). 11 of them had surgical evacuation of the haematoma (6.7%) while the rest were aspirated in the out-patient clinic. Out of the 23 patients who developed haematoma, 17 patients were smokers and 6 were non-smokers. The incidence of haematoma among smokers was 48.6% (17 out of 35 cases) while its incidence among nonsmokers was 4.7% (6 out of 129 cases) showing a clear relationship between smoking and hematoma formation (p Conclusion: Our study shows a direct relationship between smoking and haematoma formation in abdominoplasty cases. Cessation of smoking during the perioperative period is required before embarking on such a procedure.

Effect of smoking on semen quality of infertile men in Shandong, China

Aim: To study the effect of smoking on the semen quality in infertile men in Shandong Province, China. Methods:Adult non-drinker males attending the infertility clinic, including 110 non-smokers and 191 smokers, were recruited forthe study. Sixty-one fertile, non-smoker and non-drinker males, who had one or more children, served as the controls.The smokers were divided into subgroups according to the amount and duration of smoking. Semen parameters (semenvolume and sperm density, viability, motility, and morphology) were examined and seminal plasma contents of Zn,Cu and superoxide dismutase (SOD) determined. Results: The semen volume and acidity, and the sperm density,viability and forward progression, as well as the seminal plasma contents of Zn, Cu and SOD were much lower in themedium, heavy and long-term smokers than in the non-smokers ( P < 0.01). The sperm density, viability and forwardprogression, and the seminal plasma Zn, Cu and SOD levels were negatively correlated with the amount and duration ofcigarette smoking (P < 0.01). Conclusion: Medium, heavy and long-term smoking adversely affected the semenquality in a population of men visiting the infertility clinic in Shandong, China.

Exploring Barriers to Implementation of Smoking Policies: A Qualitative Study on Health Professionals from Three County-Level Hospitals

Objective This study was to identify factors limiting the implementation of smoking policies in county-level hospitals. Methods We conducted qualitative interviews （17 focus groups discussions and 6 one-to-one in depth interviews） involving 103 health professionals from three target county-level hospitals. A combination of purposive and convenience sampling was used to recruit subjects and gain a broad range of perspectives on issues emerging from ongoing data-analysis until data saturation occurred. The transcripts were analyzed for themes and key points. Results The main themes that emerged suggested that both smokers and non-smokers viewed smoking very negatively. However, it was clear that, underlying this acceptance of the health risks of smoking, there was a wide range of beliefs. Most of the health professionals pointed out that, as smoking was legal, addictive, and influenced by social norms, currently it was almost unrealistic to expect all smokers to give up smoking or not to smoke in the hospitals. Furthermore, they were concerned about the potentially detrimental effects of providing counseling advice to all smokers on the interpersonal relationship among colleagues or between doctors and patients. In addition, low level of employee participation influenced the sustainable implementation of smoking policies. Conclusions Simply being aware of the health risks about smoking did not necessarily result in successful implementation of the smoking policies. Application of comprehensive intervention strategies such as implementing smoking policies in public places at the county level, creating supportive environments, promoting community participation, and conducting health education, may be more effective.

Addictive behaviors in liver transplant recipients: The real problem?

Liver transplantation(LT) is the gold standard treatment for end-stage liver disease. Whatever the primary indication of LT, substance abuse after surgery may decrease survival rates and quality of life. Prevalence of severe alcohol relapse is between 11 and 26%,and reduces life expectancy regardless of the primary indication of LT. Many patients on waiting lists for LT are smokers and this is a major risk factor for both malignant tumors and cardiovascular events post-surgery. The aim of this review is to describe psychoactive substance consumption after LT, and to assess the impact on liver transplant recipients. This review describes data about alcohol and illicit drug use by transplant recipients and suggests guidelines for behavior management after surgery. The presence of an addiction specialist in a LT team seems to be very important.

Social Determinants of Change in Smoking Status over a 26-Year Follow up Period among Middle-Aged and Older Americans

Educational attainment and income are among major socioeconomic status (SES) indicators that are inversely associated with cigarette smoking. Marginalization-related Diminished Returns (MDRs), however, are weaker protective effects of SES indicators for racial and ethnic minority groups compared to non-Hispanic White people. The aim is to test whether racial and ethnic differences exist in the effects of educational attainment and income on cigarette smoking of middle-aged and older American adults. This is a 26-year longitudinal study using data from the Health and Retirement Study (HRS), a nationally representative study of middle-aged and older adults in the US. A total number of 11,316 middle-aged and older adults (age ≥ 50) were followed for up to 26 years. The independent variables were educational attainment and income. The dependent variables were always smoking and being quitters over the follow-up time. Age, gender, self-rated health, and chronic medical conditions were the covariates. Race/ethnicity was the moderator. Logistic regressions were used to analyze the data. Most participants were never smokers (n = 7950), followed by quitters (n = 1765), always smokers (n = 1272), and initiators (n = 329). Overall, high educational attainment (OR = 0.92, 95% CI = 0.90 - 0.95) and income (OR = 0.99, 95% CI = 0.99 - 0.99) reduced the odds of being always smoker. High educational attainment (OR = 1.05, 95% CI = 1.02 - 1.08) was associated with higher odds of being a quitter. Ethnicity, however, showed significant interactions with education on both outcomes suggesting that the effects of educational attainment on reducing the odds of always being a smoker (OR = 1.24, 95% CI = 1.14 - 1.35) and increasing the odds of quitting (OR = 0.84, 95% CI = 0.75 - 0.93) were smaller for Hispanics than non-Hispanics. In the United States, middle-aged and older Hispanic adults remain at high risk of smoking cigarettes despite high educational attainment. That is, high educational attainment may better help non-Hispanic than Hispanic middle-aged and older adults to avoid cigarette smoking. As a result, we may observe a more than expected burden of tobacco use in middle class Hispanic middle-aged and older adults. Policymakers should not reduce racial and ethnic tobacco inequalities to SES gap, as ethnic tobacco disparities may persist in high SES levels as well.

Effect of acupuncture treatment on smoking cessation in smokers from Hong Kong

OBJECTIVE: To analyze the characteristics of smokers treated with acupuncture for smoking cessation in Hong Kong.METHODS: A total of 2051 subjects were recruited in a clinical pilot research project "acupuncture for smoking cessation", which was conducted jointly by Institute of Acupuncture and Moxibustion, China Academy of Chinese Medical Sciences and Hong Kong Pok Oi Hospital from January of 2011 to December of 2013. The characteristics of study subjects, including baseline information, smoking background, intention to quit and influencing factors were analyzed.RESULTS: The majority of subjects treated with acupuncture for smoking cessation in Hong Kong was male(66.7%), but the proportion of female smokers in this study(33.3%) was higher than that of female smokers in Hong Kong population(13.8%, P <0.05). Subjects were at the mean age of 43.83 years old, of which the percentage of females aged 31-40 years was the highest(38.8%, P < 0.05). The mean duration of smoking was 25.49 years. The number of cigarettes smoked per day was 17.57 cigarettes.Fagerstrom Test for Nicotine Dependence(FTND)was 5.29 points. Most of the subjects had attempted quitting smoking(81.42%). The confidence index(7.44 points) and the readiness to quit smoking(8.13 points) were high. Subjects quitting smoking were mostly due to health cause(81.91%). The majority of subjects were at the level of middle school(61.63%). The higher the educational level was, the lower the tobacco dependence was and the higher the confidence in successfully quitting smoking was. 50.27% of subjects chose acupuncture for smoking cessation mainly through friends, television and network publicity. Subjects who had received acupuncture had the highest confidence index, while those who wanted to try a new method had the lower confidence index.CONCLUSION: Acupuncture for smoking cessation was more popular in female smokers, especially those aged 31-40 years. The effectiveness of acupuncture-smoking cessation was most significant in the smokers over 60.